524
Title III, Subtitle A
(c) CONTRIBUTIONS FROM REGIONAL
AND COR-
PORATE ALLIANCES.—
(1) DETERMINATION OF AGGREGATE REGIONAL
AND CORPORATE ALLIANCE AMOUNT.—For purposes
regarding the provision of funds for the annual
health professions workforce account for a calendar
year (other than calendar year 1996 or 1997), the
Secretary shall determine an aggregate regional and
corporate alliance amount, which amount is to be
paid by such alliances pursuant to paragraphs
(2)(B) and (3) of subsection (b), respectively, and
which amount shall be equal to the difference
between—
(A) the amount specified in section
3033(a)(1) for the annual health professions
workforce account for such year; and
(B) the amount transferred under section
4051 for the year.
(2) ALLOCATION OF AMOUNT AMONG REGIONAL
AND CORPORATE ALLIANCES.—With respect to the
aggregate regional and corporate alliance amount
determined under paragraph (1) for a calendar year
(other than calendar year 1996 or 1997)—
(A) the aggregate regional alliance portion
of such amount is the product of such amount
525
Title III, Subtitle A
and the percentage constituted by the ratio of
the total plan payments of regional alliances to
the combined total plan payments of regional
alliances and corporate alliances; and
(B) the aggregate corporate alliance por-
tion of such amount is the product of such
amount and the percentage constituted by the
ratio of the total plan payments of corporate al-
liances to such combined total plan payments.
(d) COMPLIANCE REGARDING CORPORATE ALLI-
ANCES.—
(1) IN GENERAL.—Effective January 15 of cal-
endar year 1996 and each subsequent calendar year,
there is hereby transferred to the Secretary, out of
any 
money 
in 
the 
Treasury 
not 
otherwise
appropriated—
(A) in the case of each of the calendar
years 1996 and 1997, an amount equal to the
difference between—
(i) the amount specified in section
3033(a)(1) for the annual health profes-
sions workforce account for the calendar
year involved; and
(ii) the sum of the amount transferred
under section 4051 for such year and the
526
Title III, Subtitle A
amount 
transferred 
under 
subsection
(b)(2)(A) for such year; and
(B) in the case of calendar year 1998 and
each subsequent calendar year, an amount
equal to the aggregate corporate alliance por-
tion determined under subsection (c)(2)(B) for
the calendar year involved.
(2) MANNER OF COMPLIANCE.—The payment
by corporate alliances of the tax imposed under sec-
tion 3461 of the Internal Revenue Code of 1986 (as
added by section 7121 of this Act), together with the
transfer made in paragraph (1)(B) for the calendar
year involved, is deemed to be the payment required
pursuant to subsection (c)(1) for corporate alliances
for such year.
(3) GRADUATE NURSE EDUCATION.—Effective
January 15 of calendar year 1996 and each subse-
quent calendar year, there is hereby transferred to
the Secretary, out of any money in the Treasury not
otherwise appropriated, 50 percent of the amount
specified in section 3063(b) with respect to the an-
nual graduate nurse training account.
(e) DEFINITIONS.—For purposes of this subtitle, the
term ‘‘plan payments’’ with respect to a regional or cor-
527
Title III, Subtitle A
porate alliance, means the amount paid to health plans
by the alliance.
Subpart D—General Provisions
SEC. 3041. DEFINITIONS.
For purposes of this subtitle:
(1) The term ‘‘academic year’’ has the meaning
given such term in section 3011(b).
(2) The term ‘‘allocation period’’ has the mean-
ing given such term in section 3013(d).
(3) The term ‘‘annual health professions work-
force account’’ has the meaning given such term in
section 3033(d).
(4) The term ‘‘annual number of specialty posi-
tions’’ has the meaning given such term in section
3012(e).
(5) The term ‘‘approved physician training pro-
gram’’ has the meaning given such term in section
3011(b).
(6) The term ‘‘consumer price index’’ has the
meaning given such term in section 3033(d).
(7) The term ‘‘designation period’’ has the
meaning given such term in section 3012(e).
(8) The term ‘‘eligible program’’ has the mean-
ing given such term in section 3011(b), in the case
528
Title III, Subtitle A
of subpart B; and has the meaning given such term
in section 3031(c), in the case of subpart C.
(9) The term ‘‘funding agreement’’ has the
meaning given such term in section 3011(b).
(10) The term ‘‘general health care inflation
factor’’ has the meaning given such term in section
3033(d).
(11) The term ‘‘medical school’’ has the mean-
ing given such term in section 3001(e).
(12) The term ‘‘medical specialty’’ has the
meaning given such term in section 3011(b).
(13) The term ‘‘National Council’’ has the
meaning given such term in section 3001(e).
(14) The term ‘‘plan payments’’ has the mean-
ing given such term in section 3034(e).
(15) The term ‘‘primary health care’’ has the
meaning given such term in section 3012(e).
(16) The term ‘‘specialty position’’ has the
meaning given such term in section 3012(e).
(17) The term ‘‘training participant’’ has the
meaning given such term in section 3012(e).
Subpart E—Transitional Provisions
SEC. 3051. TRANSITIONAL PAYMENTS TO INSTITUTIONS.
(a) PAYMENTS REGARDING EFFECTS OF SUBPART B
ALLOCATIONS.—For each of the four calendar years speci-
532
Title III, Subtitle A
(B) the national average salary of training
participants.
(3) APPLICABLE PERCENTAGE.—For purposes
of paragraph (1), the applicable percentage for a cal-
endar year is the following, as applicable to such
year:
(A) For the first calendar year after cal-
endar 1997 for which the eligible institution in-
volved meets the conditions described in sub-
section (b)(1), 100 percent.
(B) For the second such year, 75 percent.
(C) For the third such year, 50 percent.
(D) For the fourth such year, 25 percent.
(4) DETERMINATION OF SPECIALTY POSITIONS
LOST.—
(A) For purposes of this subsection, the
aggregate number of specialty positions lost,
with respect to a calendar year, is the difference
between—
(i) the aggregate number of specialty
positions described in subparagraph (B)
that are estimated for the eligible institu-
tion involved for the academic year begin-
ning in such calendar year; and
533
Title III, Subtitle A
(ii) the aggregate number of such spe-
cialty positions at the institution for aca-
demic year 1993-94.
(B) For purposes of subparagraph (A), the
specialty positions described in this subpara-
graph are specialty positions in the medical spe-
cialities with respect to which payments under
section 3031 are made to the approved physi-
cian training programs of the eligible institution
involved.
(5) ADDITIONAL
PROVISION
REGARDING
NA-
TIONAL AVERAGE SALARY.—
(A) The Secretary shall determine, for aca-
demic year 1992-93, an amount equal to the
national average described in paragraph (2)(B).
The national average applicable under such
paragraph for a calendar year is, subject to
subparagraph (B), the amount determined
under the preceding sentence increased by an
amount necessary to offset the effects of infla-
tion occurring since academic year 1992-93, as
determined through use of the consumer price
index.
(B) The national average determined
under subparagraph (A) and applicable to a cal-
534
Title III, Subtitle A
endar year shall, in the case of the eligible insti-
tution involved, be adjusted by a factor to re-
flect regional differences in the applicable wage
and wage-related costs.
PART 2—INSTITUTIONAL COSTS
OF GRADUATE NURSING EDU-
CATION; WORKFORCE PRIOR-
ITIES
SEC. 3061. NATIONAL COUNCIL; AUTHORIZED GRADUATE
NURSE 
TRAINING 
POSITIONS; 
INSTITU-
TIONAL COSTS.
(a) PROGRAM REGARDING GRADUATE NURSE TRAIN-
ING PROGRAMS.—The Secretary shall, in accordance with
this part, carry out a program with respect to graduate
nurse training programs that is equivalent to the program
carried out under part 1 with respect to approved physi-
cian training programs.
(b) DEFINITIONS.—For purposes of this part:
(1) The term ‘‘graduate nurse training pro-
grams’’ means programs for advanced nurse edu-
cation, programs for education as nurse practi-
tioners, programs for education as nurse midwives,
programs for education as nurse anesthetists, and
such other programs for training in clinical nurse
535
Title III, Subtitle A
specialties as are determined by the Secretary to re-
quire advanced education.
(2) The term ‘‘graduate nurse training posi-
tion’’ means a position as an individual who is en-
rolled in a graduate nurse training program.
(3) The term ‘‘programs for advanced nurse
education’’ means programs meeting the conditions
to be programs for which awards of grants and con-
tracts may be made under section 821 of the Public
Health Service Act.
(4) The term ‘‘programs for education as nurse
practitioners’’ means programs meeting the condi-
tions to be programs for which awards of grants and
contracts may be made under section 822 of the
Public Health Service Act for education as a nurse
practitioners.
(5) The term ‘‘programs for education as nurse
midwives’’ means programs meeting the conditions
to be programs for which awards of grants and con-
tracts may be made under section 822 of the Public
Health Service Act for education as nurse midwives.
(6) The term ‘‘programs for education as nurse
anesthetists’’ means programs meeting the condi-
tions to be programs for which awards of grants
536
Title III, Subtitle A
may be made under section 831 of the Public Health
Service Act for education as nurse anesthetists.
SEC. 3062. APPLICABILITY OF PART 1 PROVISIONS.
(a) IN GENERAL.—The provisions of part 1 apply to
the program carried out under section 3061 to the same
extent and in the same manner as such provisions apply
to the program carried out under part 1, subject to the
subsequent provisions of this section. Section 3051 does
not apply for purposes of the preceding sentence.
(b) NATIONAL COUNCIL.—With respect to section
3001 as applied to this part, the council shall be known
as the National Council on Graduate Nurse Education (in
this part referred to as the ‘‘National Council’’). The pro-
visions of section 851 of the Public Health Service Act
regarding the composition of the council under such sec-
tion apply to the composition of the National Council to
the same extent and in the same manner as such provi-
sions apply to the council under such section 851.
(c) ALLOCATION OF GRADUATE NURSE TRAINING
POSITIONS; FORMULA
PAYMENTS
FOR
OPERATING
COSTS.—With respect to subparts B and C of part 1 as
applied to this part—
(1) the funding agreement described in section
3011 is to be made by graduate nurse training pro-
grams;
537
Title III, Subtitle A
(2) designations under section 3012 and alloca-
tions under section 3013 apply to graduate nurse
training positions; and
(3) payments under section 3031 are to be
made to graduate nurse training programs, subject
to the requirements for such payments.
SEC. 3063. FUNDING.
(a) IN GENERAL.—With respect to sections 3033 and
3034 as applied to this part, the provisions of this section
apply.
(b) ANNUAL
GRADUATE
NURSE
TRAINING
AC-
COUNT.—Subject to subsection (c), the amount available
for each calendar year for making payments pursuant to
section 3062(c)(3) to graduate nurse training programs
(constituting an account to be known as the annual grad-
uate nurse training account) is $200,000,000.
(c) SOURCES
OF
FUNDS
FOR
ACCOUNT.—The
amount specified in subsection (b) for the annual graduate
nurse training account for a calendar year shall be derived
from the following sources:
(1) The transfer under section 3034(d)(3).
(2) The transfer under section 3104(d)(3).
538
Title III, Subtitle A
PART 3—RELATED PROGRAMS
SEC. 3071. PROGRAMS OF THE SECRETARY OF HEALTH AND
HUMAN SERVICES.
(a) IN GENERAL.—
(1) FUNDING.—For purposes of carrying out
the programs described in this section, there is au-
thorized to be appropriated $400,000,000 for fiscal
year 1994 and each subsequent fiscal year (in addi-
tion to amounts that may otherwise be authorized to
be appropriated for carrying out the programs).
(2) ADMINISTRATION.—The programs described
in this section and carried out with amounts made
available under subsection (a) shall be carried out by
the Secretary of Health and Human Services.
(b) PRIMARY CARE PHYSICIAN AND PHYSICIAN AS-
SISTANT TRAINING.—For purposes of subsection (a), the
programs described in this section include programs to
support projects to train additional numbers of primary
care physicians and physician assistants, including
projects to enhance community-based generalist training
for medical students, residents, and practicing physicians;
to retrain mid-career physicians previously certified in a
nonprimary care medical specialty; to expand the supply
of physicians with special training to serve in rural and
inner-city medically underserved areas; to support expan-
539
Title III, Subtitle A
sion of service-linked educational networks that train a
range of primary care providers in community settings;
to provide for training in managed care, cost-effective
practice management, and continuous quality improve-
ment; and to develop additional information on primary
care workforce issues as required to meet future needs in
health care.
(c) TRAINING OF UNDERREPRESENTED MINORITIES
AND DISADVANTAGED PERSONS.—For purposes of sub-
section (a), the programs described in this section include
a program to support projects to increase the number of
underrepresented minority and disadvantaged persons in
medicine, osteopathy, dentistry, nursing, public health,
and other health professions, including projects to provide
continuing financial assistance for such persons entering
health professions training programs; to increase support
for recruitment and retention of such persons in the health
professions; to maintain efforts to foster interest in health
careers among such persons at the preprofessional level;
and to increase the number of minority health professions
faculty.
(d) NURSE TRAINING.—For purposes of subsection
(a), the programs described in this section include a pro-
gram to support projects to support midlevel provider
training and address priority nursing workforce needs, in-
540
Title III, Subtitle A
cluding projects to train additional nurse practitioners and
nurse midwives; to support baccalaureate-level nurse
training programs providing preparation for careers in
teaching, community health service, and specialized clin-
ical care; to train additional nurse clinicians and nurse
anesthetists; to support interdisciplinary school-based
community nursing programs; and to promote research on
nursing workforce issues.
(e) INAPPROPRIATE PRACTICE BARRIERS; FULL UTI-
LIZATION OF SKILLS.—For purposes of subsection (a), the
programs described in this section include a program—
(1) to develop and encourage the adoption of
model professional practice statutes for advanced
practice nurses and physician assistants, and to oth-
erwise support efforts to remove inappropriate bar-
riers to practice by such nurses and such physician
assistants; and
(2) to promote the full utilization of the profes-
sional education and clinical skills of advanced prac-
tice nurses and physician assistants.
(f) OTHER PROGRAMS.—For purposes of subsection
(a), the programs described in this section include a pro-
gram to train health professionals and administrators in
managed care, cost-effective practice management, contin-
541
Title III, Subtitle A
uous quality improvement practices, and provision of cul-
turally sensitive care.
(g) RELATIONSHIP TO EXISTING PROGRAMS.—This
section may be carried out through programs established
in title VII or VIII of the Public Health Service Act, as
appropriate and as consistent with the purposes of such
programs.
SEC. 3072. PROGRAMS OF THE SECRETARY OF LABOR.
(a) IN GENERAL.—
(1) FUNDING.—For purposes of carrying out
the programs described in this section, and for car-
rying out section 3073, there is authorized to be ap-
propriated $200,000,000 for fiscal year 1994 and
each subsequent fiscal year (in addition to amounts
that may otherwise be authorized to be appropriated
for carrying out the programs).
(2) ADMINISTRATION.—The programs described
in this section and carried out with amounts made
available under subsection (a) shall be carried out by
the Secretary of Labor (in this section referred to as
the ‘‘Secretary’’).
(b) RETRAINING PROGRAMS; ADVANCED CAREER
POSITIONS; WORKFORCE ADJUSTMENT PROGRAMS.—
542
Title III, Subtitle A
(1) IN GENERAL.—For purposes of subsection
(a), the programs described in this section are the
following:
(A) A program for skills upgrading and oc-
cupational 
retraining 
(including 
retraining
health care workers for more advanced positions
as technicians, nurses, and physician assist-
ants), and for quality and workforce improve-
ment.
(B) A demonstration program to assist
workers in health care institutions in obtaining
advanced career positions.
(C) A program to develop and operate
health-worker job banks in local employment
services agencies, subject to the following:
(i) Such job banks shall be available
to all health care providers in the commu-
nity involved.
(ii) Such job banks shall begin oper-
ation not later than 90 days after the date
of the enactment of this Act.
(D) A program to provide for joint labor-
management decision-making in the health care
sector on workplace matters related to the re-
543
Title III, Subtitle A
structuring of the health care delivery system
provided for in this Act.
(E) A program to facilitate the comprehen-
sive workforce adjustment initiative.
(2) USE OF FUNDS.—Amounts made available
under subsection (a) for carrying out this section
may be expended for program support, faculty devel-
opment, trainee support, workforce analysis, and dis-
semination of information, as necessary to produce
required performance outcomes.
(c) CERTAIN REQUIREMENTS FOR PROGRAMS.—In
carrying out the programs described in subsection (b), the
Secretary shall, with respect to the organizations and em-
ployment positions involved, provide for the following:
(1) Explicit, clearly defined skill requirements
developed for all the positions and projections of the
number of openings for each position.
(2) Opportunities for internal career movement.
(3) Opportunities to work while training or
completing an educational program.
(4) Evaluation and dissemination.
(5) Training opportunities in several forms, as
appropriate.
(d) ADMINISTRATIVE REQUIREMENTS.—In carrying
out the programs described in subsection (b), the Sec-
544
Title III, Subtitle A
retary shall, with respect to the organizations and employ-
ment positions involved, provide for the following:
(1) Joint labor-management implementation
and administration.
(2) Discussion with employees as to training
needs for career advancement.
(3) Commitment to a policy of internal hirings
and promotion.
(4) Provision of support services.
(5) Consultations with employers and with or-
ganized labor.
SEC. 3073. NATIONAL INSTITUTE FOR HEALTH CARE WORK-
FORCE DEVELOPMENT.
(a) ESTABLISHMENT OF INSTITUTE.—The Secretary
of Health and Human Services and the Secretary of Labor
shall jointly establish an office to be known as the Na-
tional Institute for Health Care Workforce Development.
(b) DIRECTOR.—The Institute shall be headed by a
director, who shall be appointed jointly by the Secretaries.
(c) DUTIES.—
(1) IN GENERAL.—The Director of the Institute
shall make recommendations to the Secretaries
regarding—
(A) the supply of health care workers
needed for proper staffing of the health care de-
545
Title III, Subtitle A
livery system serving the regional and corporate
alliance health plans established under title I;
(B) the impact of this Act, and of related
changes regarding health care, on health care
workers and the needs of such workers with re-
spect to such matters, including needs regard-
ing education, training, and other matters relat-
ing to career development; and
(C) the development and implementation of
high-performance, high-quality health care de-
livery systems, including employee participation
committee systems and employee team systems,
that will contribute to the development of bet-
ter, more effective health care by increasing the
role, the responsibilities and the area of inde-
pendent decision-making authority of health
care workers.
(2) ADMINISTRATION OF PROGRAMS REGARD-
ING
RETRAINING, ADVANCED
CAREER
POSITIONS,
JOB
BANKS, 
AND
HIGH-PERFORMANCE
WORK-
PLACES.—The Secretary of Labor is authorized to—
(A) carry out section 3073 acting through
the Director of the Institute; and
546
Title III, Subtitle A
(B) implement the recommendations of the
Director regarding employee participation com-
mittees and other high-performance systems.
(d) ADVISORY BOARD.—
(1) IN GENERAL.—The Secretaries shall estab-
lish an advisory board to assist in the develop of rec-
ommendations under subsection (c).
(2) COMPOSITION.—The Advisory Board shall
be composed of—
(A) the Secretary of Labor;
(B) the Secretary of Health and Human
Services;
(C) representatives of health care workers
in organized labor;
(D) representatives of health care institu-
tions;
(E) representatives of health care edu-
cation organizations;
(F) representatives of consumer organiza-
tions; and
(G) such other individuals as the Secre-
taries determine to be appropriate.
(e) STAFF, QUARTERS, AND OTHER ASSISTANCE.—
The Secretaries shall provide the Institute and the Advi-
sory Board with such staff, quarters, and other adminis-
547
Title III, Subtitle A
trative assistance as may be necessary for the Institute
and the Advisory Board to carry out this section.
(f) DEFINITIONS.—For purposes of this section:
(1) The term ‘‘Advisory Board’’ means the ad-
visory board established under subsection (d).
(2) The term ‘‘employee participation commit-
tees’’ means committees of workers independently
drawn from a facility’s workforce, or selected by
unions where collective bargaining agreements are in
effect, and which operate without employer inter-
ference and consult with management on issues of
costs and efficiency, workplace reorganizations, pro-
ductivity, and quality of care.
(3) The term ‘‘Institute’’ means the Institute
established under subsection (a).
(4) The term ‘‘Secretaries’’ means the Sec-
retary of Health and Human Services and the Sec-
retary of Labor.
(g) SUNSET.—Effective upon the end of calendar
year 2000, this section is repealed.
SEC. 3074. REQUIREMENT FOR CERTAIN PROGRAMS RE-
GARDING REDEPLOYMENT OF HEALTH CARE
WORKERS.
(a) STATE PROGRAMS FOR HOME AND COMMUNITY-
BASED
SERVICES
FOR
INDIVIDUALS
WITH
DISABIL-
548
Title III, Subtitle A
ITIES.—With respect to the plan required in section
2102(a) (for State programs for home and community-
based services for individuals with disabilities under part
1 of subtitle B of title II), the plan shall, in addition to
requirements under such part, provide for the following:
(1) Before initiating the process of imple-
menting the State program under such plan, nego-
tiations will be commenced with labor unions rep-
resenting the employees of the affected hospitals or
other facilities.
(2) Negotiations under paragraph (1) will ad-
dress the following:
(A) The impact of the implementation of
the program upon the workforce.
(B) Methods to redeploy workers to posi-
tions in the proposed system, in the case of
workers affected by the program.
(3) The plan will provide evidence that there
has been compliance with paragraphs (1) and (2),
including a description of the results of the negotia-
tions.
(b) PLAN FOR INTEGRATION OF MENTAL HEALTH
SYSTEMS.—With respect to the plan required in section
3511(a) (relating to the integration of the mental health
and substance abuse services of a State and its political
549
Title III, Subtitle A
subdivisions with the mental health and substance abuse
services included in the comprehensive benefit package
under title I), the plan shall, in addition to requirements
under such section, provide for the following:
(1) Before initiating the process of imple-
menting the integration of such services, negotia-
tions will be commenced with labor unions rep-
resenting the employees of the affected hospitals or
other facilities.
(2) Negotiations under paragraph (1) will ad-
dress the following:
(A) The impact of the proposed changes
upon the workforce.
(B) Methods to redeploy workers to posi-
tions in the proposed system, in the case of
workers affected by the proposed changes.
(3) The plan will provide evidence that there
has been compliance with paragraphs (1) and (2),
including a description of the results of the negotia-
tions.