vidual’s service obligation required under such con-
tract or to complete such service obligation, the 
United States shall be entitled to recover from the in-
dividual an amount determined in accordance with 
the formula specified in subsection (l) of section 110 
in the manner provided for in such subsection. 
‘‘(3) CANCELLATION
UPON
DEATH
OF
RECIPI-
ENT.—Upon the death of an individual who receives 
an Indian Health Scholarship, any outstanding obli-
gation of that individual for service or payment that 
relates to that scholarship shall be canceled. 
‘‘(4) WAIVERS AND SUSPENSIONS.— 
‘‘(A) IN
GENERAL.—The Secretary shall 
provide for the partial or total waiver or suspen-
sion of any obligation of service or payment of 
a recipient of an Indian Health Scholarship if 
the Secretary determines that— 
‘‘(i) it is not possible for the recipient 
to meet that obligation or make that pay-
ment; 
‘‘(ii) requiring that recipient to meet 
that obligation or make that payment would 
result in extreme hardship to the recipient; 
or 
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‘‘(iii) the enforcement of the require-
ment to meet the obligation or make the 
payment would be unconscionable. 
‘‘(B) FACTORS
FOR
CONSIDERATION.—Be-
fore waiving or suspending an obligation of serv-
ice or payment under subparagraph (A), the Sec-
retary shall consult with the affected Area Office, 
Indian Tribes, Tribal Organizations, or Urban 
Indian Organizations, and may take into con-
sideration whether the obligation may be satis-
fied in a teaching capacity at a tribal college or 
university nursing program under subsection 
(b)(1)(D). 
‘‘(5) 
EXTREME
HARDSHIP.—Notwithstanding 
any other provision of law, in any case of extreme 
hardship or for other good cause shown, the Secretary 
may waive, in whole or in part, the right of the 
United States to recover funds made available under 
this section. 
‘‘(6) BANKRUPTCY.—Notwithstanding any other 
provision of law, with respect to a recipient of an In-
dian Health Scholarship, no obligation for payment 
may be released by a discharge in bankruptcy under 
title 11, United States Code, unless that discharge is 
granted after the expiration of the 5-year period be-
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ginning on the initial date on which that payment is 
due, and only if the bankruptcy court finds that the 
nondischarge of the obligation would be unconscion-
able. 
‘‘SEC. 105. AMERICAN INDIANS INTO PSYCHOLOGY PRO-
GRAM. 
‘‘(a) GRANTS AUTHORIZED.—The Secretary, acting 
through the Service, shall make grants of not more than 
$300,000 to each of 9 colleges and universities for the pur-
pose of developing and maintaining Indian psychology ca-
reer recruitment programs as a means of encouraging Indi-
ans to enter the behavioral health field. These programs 
shall be located at various locations throughout the country 
to maximize their availability to Indian students and new 
programs shall be established in different locations from 
time to time. 
‘‘(b) QUENTIN N. BURDICK PROGRAM GRANT.—The 
Secretary shall provide a grant authorized under subsection 
(a) to develop and maintain a program at the University 
of North Dakota to be known as the ‘Quentin N. Burdick 
American Indians Into Psychology Program’. Such pro-
gram shall, to the maximum extent feasible, coordinate with 
the Quentin N. Burdick Indian Health Programs author-
ized under section 117(b), the Quentin N. Burdick Amer-
ican Indians Into Nursing Program authorized under sec-
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tion 115(e), and existing university research and commu-
nications networks. 
‘‘(c) REGULATIONS.—The Secretary shall issue regula-
tions pursuant to this Act for the competitive awarding of 
grants provided under this section. 
‘‘(d) CONDITIONS OF GRANT.—Applicants under this 
section shall agree to provide a program which, at a min-
imum— 
‘‘(1) provides outreach and recruitment for 
health professions to Indian communities including 
elementary, secondary, and accredited and accessible 
community colleges that will be served by the pro-
gram; 
‘‘(2) incorporates a program advisory board 
comprised of representatives from the tribes and com-
munities that will be served by the program; 
‘‘(3) provides summer enrichment programs to 
expose Indian students to the various fields of psy-
chology through research, clinical, and experimental 
activities; 
‘‘(4) provides stipends to undergraduate and 
graduate students to pursue a career in psychology; 
‘‘(5) develops affiliation agreements with tribal 
colleges and universities, the Service, university affili-
ated programs, and other appropriate accredited and 
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accessible entities to enhance the education of Indian 
students; 
‘‘(6) to the maximum extent feasible, uses exist-
ing university tutoring, counseling, and student sup-
port services; and 
‘‘(7) to the maximum extent feasible, employs 
qualified Indians in the program. 
‘‘(e) ACTIVE DUTY SERVICE REQUIREMENT.—The ac-
tive duty service obligation prescribed under section 338C 
of the Public Health Service Act (42 U.S.C. 254m) shall 
be met by each graduate who receives a stipend described 
in subsection (d)(4) that is funded under this section. Such 
obligation shall be met by service— 
‘‘(1) in an Indian Health Program; 
‘‘(2) in a program assisted under title V of this 
Act; or 
‘‘(3) in the private practice of psychology if, as 
determined by the Secretary, in accordance with 
guidelines promulgated by the Secretary, such prac-
tice is situated in a physician or other health profes-
sional shortage area and addresses the health care 
needs of a substantial number of Indians. 
‘‘(f) AUTHORIZATION OF APPROPRIATIONS.—There is 
authorized to be appropriated to carry out this section 
$2,700,000 for each of fiscal years 2008 through 2017. 
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‘‘SEC. 106. SCHOLARSHIP PROGRAMS FOR INDIAN TRIBES. 
‘‘(a) IN GENERAL.— 
‘‘(1) GRANTS AUTHORIZED.—The Secretary, act-
ing through the Service, shall make grants to Tribal 
Health Programs for the purpose of providing schol-
arships for Indians to serve as health professionals in 
Indian communities. 
‘‘(2) AMOUNT.—Amounts available under para-
graph (1) for any fiscal year shall not exceed 5 per-
cent of the amounts available for each fiscal year for 
Indian Health Scholarships under section 104. 
‘‘(3) APPLICATION.—An application for a grant 
under paragraph (1) shall be in such form and con-
tain such agreements, assurances, and information as 
consistent with this section. 
‘‘(b) REQUIREMENTS.— 
‘‘(1) IN GENERAL.—A Tribal Health Program 
receiving a grant under subsection (a) shall provide 
scholarships to Indians in accordance with the re-
quirements of this section. 
‘‘(2) COSTS.—With respect to costs of providing 
any scholarship pursuant to subsection (a)— 
‘‘(A) 80 percent of the costs of the scholar-
ship shall be paid from the funds made available 
pursuant to subsection (a)(1) provided to the 
Tribal Health Program; and 
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‘‘(B) 20 percent of such costs may be paid 
from any other source of funds. 
‘‘(c) COURSE OF STUDY.—A Tribal Health Program 
shall provide scholarships under this section only to Indians 
enrolled or accepted for enrollment in a course of study (ap-
proved by the Secretary) in 1 of the health professions con-
templated by this Act. 
‘‘(d) CONTRACT.— 
‘‘(1) IN
GENERAL.—In providing scholarships 
under subsection (b), the Secretary and the Tribal 
Health Program shall enter into a written contract 
with each recipient of such scholarship. 
‘‘(2) REQUIREMENTS.—Such contract shall— 
‘‘(A) obligate such recipient to provide serv-
ice in an Indian Health Program or Urban In-
dian Organization, in the same Service Area 
where the Tribal Health Program providing the 
scholarship is located, for— 
‘‘(i) a number of years for which the 
scholarship is provided (or the part-time 
equivalent thereof, as determined by the Sec-
retary), or for a period of 2 years, which-
ever period is greater; or 
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‘‘(ii) such greater period of time as the 
recipient and the Tribal Health Program 
may agree; 
‘‘(B) provide that the amount of the scholar-
ship— 
‘‘(i) may only be expended for— 
‘‘(I) tuition expenses, other rea-
sonable educational expenses, and rea-
sonable living expenses incurred in at-
tendance at the educational institution; 
and 
‘‘(II) payment to the recipient of 
a monthly stipend of not more than the 
amount 
authorized 
by 
section 
338(g)(1)(B) of the Public Health 
Service Act (42 U.S.C. 254m(g)(1)(B)), 
with such amount to be reduced pro 
rata (as determined by the Secretary) 
based on the number of hours such stu-
dent is enrolled, and not to exceed, for 
any year of attendance for which the 
scholarship is provided, the total 
amount required for the year for the 
purposes authorized in this clause; and 
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‘‘(ii) may not exceed, for any year of 
attendance for which the scholarship is pro-
vided, the total amount required for the 
year for the purposes authorized in clause 
(i); 
‘‘(C) require the recipient of such scholar-
ship to maintain an acceptable level of academic 
standing as determined by the educational insti-
tution in accordance with regulations issued 
pursuant to this Act; and 
‘‘(D) require the recipient of such scholar-
ship to meet the educational and licensure re-
quirements appropriate to each health profession. 
‘‘(3) SERVICE IN OTHER SERVICE AREAS.—The 
contract may allow the recipient to serve in another 
Service Area, provided the Tribal Health Program 
and Secretary approve and services are not dimin-
ished to Indians in the Service Area where the Tribal 
Health Program providing the scholarship is located. 
‘‘(e) BREACH OF CONTRACT.— 
‘‘(1) SPECIFIC BREACHES.—An individual who 
has entered into a written contract with the Secretary 
and a Tribal Health Program under subsection (d) 
shall be liable to the United States for the Federal 
share of the amount which has been paid to him or 
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her, or on his or her behalf, under the contract if that 
individual— 
‘‘(A) fails to maintain an acceptable level of 
academic standing in the educational institution 
in which he or she is enrolled (such level as de-
termined by the educational institution under 
regulations of the Secretary); 
‘‘(B) is dismissed from such educational in-
stitution for disciplinary reasons; 
‘‘(C) voluntarily terminates the training in 
such an educational institution for which he or 
she is provided a scholarship under such contract 
before the completion of such training; or 
‘‘(D) fails to accept payment, or instructs 
the educational institution in which he or she is 
enrolled not to accept payment, in whole or in 
part, of a scholarship under such contract, in 
lieu of any service obligation arising under such 
contract. 
‘‘(2) OTHER BREACHES.—If for any reason not 
specified in paragraph (1), an individual breaches a 
written contract by failing to either begin such indi-
vidual’s service obligation required under such con-
tract or to complete such service obligation, the 
United States shall be entitled to recover from the in-
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dividual an amount determined in accordance with 
the formula specified in subsection (l) of section 110 
in the manner provided for in such subsection. 
‘‘(3) CANCELLATION
UPON
DEATH
OF
RECIPI-
ENT.—Upon the death of an individual who receives 
an Indian Health Scholarship, any outstanding obli-
gation of that individual for service or payment that 
relates to that scholarship shall be canceled. 
‘‘(4) INFORMATION.—The Secretary may carry 
out this subsection on the basis of information re-
ceived from Tribal Health Programs involved or on 
the basis of information collected through such other 
means as the Secretary deems appropriate. 
‘‘(f) RELATION TO SOCIAL SECURITY ACT.—The re-
cipient of a scholarship under this section shall agree, in 
providing health care pursuant to the requirements here-
in— 
‘‘(1) not to discriminate against an individual 
seeking care on the basis of the ability of the indi-
vidual to pay for such care or on the basis that pay-
ment for such care will be made pursuant to a pro-
gram established in title XVIII of the Social Security 
Act or pursuant to the programs established in title 
XIX or title XXI of such Act; and 
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‘‘(2) 
to 
accept 
assignment 
under 
section 
1842(b)(3)(B)(ii) of the Social Security Act for all 
services for which payment may be made under part 
B of title XVIII of such Act, and to enter into an ap-
propriate agreement with the State agency that ad-
ministers the State plan for medical assistance under 
title XIX, or the State child health plan under title 
XXI, of such Act to provide service to individuals en-
titled to medical assistance or child health assistance, 
respectively, under the plan. 
‘‘(g) CONTINUANCE OF FUNDING.—The Secretary shall 
make payments under this section to a Tribal Health Pro-
gram for any fiscal year subsequent to the first fiscal year 
of such payments unless the Secretary determines that, for 
the immediately preceding fiscal year, the Tribal Health 
Program has not complied with the requirements of this sec-
tion. 
‘‘SEC. 107. INDIAN HEALTH SERVICE EXTERN PROGRAMS. 
‘‘(a) EMPLOYMENT PREFERENCE.—Any individual 
who receives a scholarship pursuant to section 104 or 106 
shall be given preference for employment in the Service, or 
may be employed by a Tribal Health Program or an Urban 
Indian Organization, or other agencies of the Department 
as available, during any nonacademic period of the year. 
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‘‘(b) NOT COUNTED TOWARD ACTIVE DUTY SERVICE 
OBLIGATION.—Periods of employment pursuant to this sub-
section shall not be counted in determining fulfillment of 
the service obligation incurred as a condition of the scholar-
ship. 
‘‘(c) TIMING; LENGTH OF EMPLOYMENT.—Any indi-
vidual enrolled in a program, including a high school pro-
gram, authorized under section 102(a) may be employed by 
the Service or by a Tribal Health Program or an Urban 
Indian Organization during any nonacademic period of the 
year. Any such employment shall not exceed 120 days dur-
ing any calendar year. 
‘‘(d) NONAPPLICABILITY OF COMPETITIVE PERSONNEL 
SYSTEM.—Any employment pursuant to this section shall 
be made without regard to any competitive personnel sys-
tem or agency personnel limitation and to a position which 
will enable the individual so employed to receive practical 
experience in the health profession in which he or she is 
engaged in study. Any individual so employed shall receive 
payment for his or her services comparable to the salary 
he or she would receive if he or she were employed in the 
competitive system. Any individual so employed shall not 
be counted against any employment ceiling affecting the 
Service or the Department. 
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‘‘SEC. 108. CONTINUING EDUCATION ALLOWANCES. 
‘‘In order to encourage scholarship and stipend recipi-
ents under sections 104, 105, 106, and 115 and health pro-
fessionals, including community health representatives and 
emergency medical technicians, to join or continue in an 
Indian Health Program and to provide their services in the 
rural and remote areas where a significant portion of Indi-
ans reside, the Secretary, acting through the Service, may— 
‘‘(1) provide programs or allowances to transi-
tion into an Indian Health Program, including li-
censing, board or certification examination assist-
ance, and technical assistance in fulfilling service ob-
ligations under sections 104, 105, 106, and 115; and 
‘‘(2) provide programs or allowances to health 
professionals employed in an Indian Health Program 
to enable them for a period of time each year pre-
scribed by regulation of the Secretary to take leave of 
their duty stations for professional consultation, man-
agement, leadership, and refresher training courses. 
‘‘SEC. 109. COMMUNITY HEALTH REPRESENTATIVE PRO-
GRAM. 
‘‘(a) IN GENERAL.—Under the authority of the Act of 
November 2, 1921 (25 U.S.C. 13) (commonly known as the 
‘Snyder Act’), the Secretary, acting through the Service, 
shall maintain a Community Health Representative Pro-
gram under which Indian Health Programs— 
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‘‘(1) provide for the training of Indians as com-
munity health representatives; and 
‘‘(2) use such community health representatives 
in the provision of health care, health promotion, and 
disease prevention services to Indian communities. 
‘‘(b) DUTIES.—The Community Health Representative 
Program of the Service, shall— 
‘‘(1) provide a high standard of training for 
community health representatives to ensure that the 
community health representatives provide quality 
health care, health promotion, and disease prevention 
services to the Indian communities served by the Pro-
gram; 
‘‘(2) in order to provide such training, develop 
and maintain a curriculum that— 
‘‘(A) combines education in the theory of 
health care with supervised practical experience 
in the provision of health care; and 
‘‘(B) provides instruction and practical ex-
perience in health promotion and disease preven-
tion activities, with appropriate consideration 
given to lifestyle factors that have an impact on 
Indian health status, such as alcoholism, family 
dysfunction, and poverty; 
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‘‘(3) maintain a system which identifies the 
needs of community health representatives for con-
tinuing education in health care, health promotion, 
and disease prevention and develop programs that 
meet the needs for continuing education; 
‘‘(4) maintain a system that provides close su-
pervision of Community Health Representatives; 
‘‘(5) maintain a system under which the work of 
Community Health Representatives is reviewed and 
evaluated; and 
‘‘(6) promote traditional health care practices of 
the Indian Tribes served consistent with the Service 
standards for the provision of health care, health pro-
motion, and disease prevention. 
‘‘SEC. 110. INDIAN HEALTH SERVICE LOAN REPAYMENT 
PROGRAM. 
‘‘(a) ESTABLISHMENT.—The Secretary, acting through 
the Service, shall establish and administer a program to 
be known as the Service Loan Repayment Program (herein-
after referred to as the ‘Loan Repayment Program’) in 
order to ensure an adequate supply of trained health profes-
sionals necessary to maintain accreditation of, and provide 
health care services to Indians through, Indian Health Pro-
grams and Urban Indian Organizations. 
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‘‘(b) ELIGIBLE INDIVIDUALS.—To be eligible to par-
ticipate in the Loan Repayment Program, an individual 
must— 
‘‘(1)(A) be enrolled— 
‘‘(i) in a course of study or program in an 
accredited educational institution (as determined 
by the Secretary under section 338B(b)(1)(c)(i) 
of the Public Health Service Act (42 U.S.C. 
254l–1(b)(1)(c)(i))) and be scheduled to complete 
such course of study in the same year such indi-
vidual applies to participate in such program; 
or 
‘‘(ii) in an approved graduate training pro-
gram in a health profession; or 
‘‘(B) have— 
‘‘(i) a degree in a health profession; and 
‘‘(ii) a license to practice a health profes-
sion; 
‘‘(2)(A) be eligible for, or hold, an appointment 
as a commissioned officer in the Regular or Reserve 
Corps of the Public Health Service; 
‘‘(B) be eligible for selection for civilian service 
in the Regular or Reserve Corps of the Public Health 
Service; 
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‘‘(C) meet the professional standards for civil 
service employment in the Service; or 
‘‘(D) be employed in an Indian Health Program 
or Urban Indian Organization without a service obli-
gation; and 
‘‘(3) submit to the Secretary an application for 
a contract described in subsection (e). 
‘‘(c) APPLICATION.— 
‘‘(1) INFORMATION
TO
BE
INCLUDED
WITH 
FORMS.—In disseminating application forms and 
contract forms to individuals desiring to participate 
in the Loan Repayment Program, the Secretary shall 
include with such forms a fair summary of the rights 
and liabilities of an individual whose application is 
approved (and whose contract is accepted) by the Sec-
retary, including in the summary a clear explanation 
of the damages to which the United States is entitled 
under subsection (l) in the case of the individual’s 
breach of contract. The Secretary shall provide such 
individuals with sufficient information regarding the 
advantages and disadvantages of service as a commis-
sioned officer in the Regular or Reserve Corps of the 
Public Health Service or a civilian employee of the 
Service to enable the individual to make a decision on 
an informed basis. 
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‘‘(2) CLEAR LANGUAGE.—The application form, 
contract form, and all other information furnished by 
the Secretary under this section shall be written in a 
manner calculated to be understood by the average in-
dividual applying to participate in the Loan Repay-
ment Program. 
‘‘(3) TIMELY AVAILABILITY OF FORMS.—The Sec-
retary shall make such application forms, contract 
forms, and other information available to individuals 
desiring to participate in the Loan Repayment Pro-
gram on a date sufficiently early to ensure that such 
individuals have adequate time to carefully review 
and evaluate such forms and information. 
‘‘(d) PRIORITIES.— 
‘‘(1) LIST.—Consistent with subsection (k), the 
Secretary shall annually— 
‘‘(A) identify the positions in each Indian 
Health Program or Urban Indian Organization 
for which there is a need or a vacancy; and 
‘‘(B) rank those positions in order of pri-
ority. 
‘‘(2) APPROVALS.—Notwithstanding the priority 
determined under paragraph (1), the Secretary, in de-
termining which applications under the Loan Repay-
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ment Program to approve (and which contracts to ac-
cept), shall— 
‘‘(A) give first priority to applications 
made by individual Indians; and 
‘‘(B) after making determinations on all 
applications submitted by individual Indians as 
required under subparagraph (A), give priority 
to— 
‘‘(i) individuals recruited through the 
efforts of an Indian Health Program or 
Urban Indian Organization; and 
‘‘(ii) other individuals based on the 
priority rankings under paragraph (1). 
‘‘(e) RECIPIENT CONTRACTS.— 
‘‘(1) CONTRACT REQUIRED.—An individual be-
comes a participant in the Loan Repayment Program 
only upon the Secretary and the individual entering 
into a written contract described in paragraph (2). 
‘‘(2) CONTENTS OF CONTRACT.—The written con-
tract referred to in this section between the Secretary 
and an individual shall contain— 
‘‘(A) an agreement under which— 
‘‘(i) subject to subparagraph (C), the 
Secretary agrees— 
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‘‘(I) to pay loans on behalf of the 
individual in accordance with the pro-
visions of this section; and 
‘‘(II) to accept (subject to the 
availability of appropriated funds for 
carrying out this section) the indi-
vidual into the Service or place the in-
dividual with a Tribal Health Pro-
gram or Urban Indian Organization 
as provided in clause (ii)(III); and 
‘‘(ii) subject to subparagraph (C), the 
individual agrees— 
‘‘(I) to accept loan payments on 
behalf of the individual; 
‘‘(II) in the case of an individual 
described in subsection (b)(1)— 
‘‘(aa) to maintain enrollment 
in a course of study or training 
described in subsection (b)(1)(A) 
until the individual completes the 
course of study or training; and 
‘‘(bb) while enrolled in such 
course of study or training, to 
maintain an acceptable level of 
academic standing (as determined 
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under regulations of the Secretary 
by the educational institution of-
fering such course of study or 
training); and 
‘‘(III) to serve for a time period 
(hereinafter in this section referred to 
as the ‘period of obligated service’) 
equal to 2 years or such longer period 
as the individual may agree to serve in 
the full-time clinical practice of such 
individual’s profession in an Indian 
Health Program or Urban Indian Or-
ganization to which the individual 
may be assigned by the Secretary; 
‘‘(B) a provision permitting the Secretary 
to extend for such longer additional periods, as 
the individual may agree to, the period of obli-
gated service agreed to by the individual under 
subparagraph (A)(ii)(III); 
‘‘(C) a provision that any financial obliga-
tion of the United States arising out of a con-
tract entered into under this section and any ob-
ligation of the individual which is conditioned 
thereon is contingent upon funds being appro-
priated for loan repayments under this section; 
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‘‘(D) a statement of the damages to which 
the United States is entitled under subsection (l) 
for the individual’s breach of the contract; and 
‘‘(E) such other statements of the rights and 
liabilities of the Secretary and of the individual, 
not inconsistent with this section. 
‘‘(f) DEADLINE FOR DECISION ON APPLICATION.—The 
Secretary shall provide written notice to an individual 
within 21 days on— 
‘‘(1) the Secretary’s approving, under subsection 
(e)(1), of the individual’s participation in the Loan 
Repayment Program, including extensions resulting 
in an aggregate period of obligated service in excess 
of 4 years; or 
‘‘(2) the Secretary’s disapproving an individ-
ual’s participation in such Program. 
‘‘(g) PAYMENTS.— 
‘‘(1) IN GENERAL.—A loan repayment provided 
for an individual under a written contract under the 
Loan Repayment Program shall consist of payment, 
in accordance with paragraph (2), on behalf of the in-
dividual of the principal, interest, and related ex-
penses on government and commercial loans received 
by the individual regarding the undergraduate or 
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graduate education of the individual (or both), which 
loans were made for— 
‘‘(A) tuition expenses; 
‘‘(B) all other reasonable educational ex-
penses, including fees, books, and laboratory ex-
penses, incurred by the individual; and 
‘‘(C) reasonable living expenses as deter-
mined by the Secretary. 
‘‘(2) AMOUNT.—For each year of obligated serv-
ice that an individual contracts to serve under sub-
section (e), the Secretary may pay up to $35,000 or 
an amount equal to the amount specified in section 
338B(g)(2)(A) of the Public Health Service Act, 
whichever is more, on behalf of the individual for 
loans described in paragraph (1). In making a deter-
mination of the amount to pay for a year of such 
service by an individual, the Secretary shall consider 
the extent to which each such determination— 
‘‘(A) affects the ability of the Secretary to 
maximize the number of contracts that can be 
provided under the Loan Repayment Program 
from the amounts appropriated for such con-
tracts; 
‘‘(B) provides an incentive to serve in In-
dian Health Programs and Urban Indian Orga-
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nizations with the greatest shortages of health 
professionals; and 
‘‘(C) provides an incentive with respect to 
the health professional involved remaining in an 
Indian Health Program or Urban Indian Orga-
nization with such a health professional short-
age, and continuing to provide primary health 
services, after the completion of the period of ob-
ligated service under the Loan Repayment Pro-
gram. 
‘‘(3) TIMING.—Any arrangement made by the 
Secretary for the making of loan repayments in ac-
cordance with this subsection shall provide that any 
repayments for a year of obligated service shall be 
made no later than the end of the fiscal year in which 
the individual completes such year of service. 
‘‘(4) REIMBURSEMENTS
FOR
TAX
LIABILITY.— 
For the purpose of providing reimbursements for tax 
liability resulting from a payment under paragraph 
(2) on behalf of an individual, the Secretary— 
‘‘(A) in addition to such payments, may 
make payments to the individual in an amount 
equal to not less than 20 percent and not more 
than 39 percent of the total amount of loan re-
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payments made for the taxable year involved; 
and 
‘‘(B) may make such additional payments 
as the Secretary determines to be appropriate 
with respect to such purpose. 
‘‘(5) PAYMENT SCHEDULE.—The Secretary may 
enter into an agreement with the holder of any loan 
for which payments are made under the Loan Repay-
ment Program to establish a schedule for the making 
of such payments. 
‘‘(h) EMPLOYMENT CEILING.—Notwithstanding any 
other provision of law, individuals who have entered into 
written contracts with the Secretary under this section shall 
not be counted against any employment ceiling affecting the 
Department while those individuals are undergoing aca-
demic training. 
‘‘(i) RECRUITMENT.—The Secretary shall conduct re-
cruiting programs for the Loan Repayment Program and 
other manpower programs of the Service at educational in-
stitutions training health professionals or specialists identi-
fied in subsection (a). 
‘‘(j) APPLICABILITY OF LAW.—Section 214 of the Pub-
lic Health Service Act (42 U.S.C. 215) shall not apply to 
individuals during their period of obligated service under 
the Loan Repayment Program. 
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‘‘(k) ASSIGNMENT OF INDIVIDUALS.—The Secretary, 
in assigning individuals to serve in Indian Health Pro-
grams or Urban Indian Organizations pursuant to con-
tracts entered into under this section, shall— 
‘‘(1) ensure that the staffing needs of Tribal 
Health Programs and Urban Indian Organizations 
receive consideration on an equal basis with programs 
that are administered directly by the Service; and 
‘‘(2) give priority to assigning individuals to In-
dian Health Programs and Urban Indian Organiza-
tions that have a need for health professionals to pro-
vide health care services as a result of individuals 
having breached contracts entered into under this sec-
tion. 
‘‘(l) BREACH OF CONTRACT.— 
‘‘(1) SPECIFIC BREACHES.—An individual who 
has entered into a written contract with the Secretary 
under this section and has not received a waiver 
under subsection (m) shall be liable, in lieu of any 
service obligation arising under such contract, to the 
United States for the amount which has been paid on 
such individual’s behalf under the contract if that in-
dividual— 
‘‘(A) is enrolled in the final year of a course 
of study and— 
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‘‘(i) fails to maintain an acceptable 
level of academic standing in the edu-
cational institution in which he or she is 
enrolled (such level determined by the edu-
cational institution under regulations of the 
Secretary); 
‘‘(ii) voluntarily terminates such en-
rollment; or 
‘‘(iii) is dismissed from such edu-
cational institution before completion of 
such course of study; or 
‘‘(B) is enrolled in a graduate training pro-
gram and fails to complete such training pro-
gram. 
‘‘(2) OTHER BREACHES; FORMULA FOR AMOUNT 
OWED.—If, for any reason not specified in paragraph 
(1), an individual breaches his or her written con-
tract under this section by failing either to begin, or 
complete, such individual’s period of obligated service 
in accordance with subsection (e)(2), the United 
States shall be entitled to recover from such indi-
vidual an amount to be determined in accordance 
with the following formula: A=3Z(t¥s/t) in which— 
‘‘(A) ‘A’ is the amount the United States is 
entitled to recover; 
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‘‘(B) ‘Z’ is the sum of the amounts paid 
under this section to, or on behalf of, the indi-
vidual and the interest on such amounts which 
would be payable if, at the time the amounts 
were paid, they were loans bearing interest at 
the maximum legal prevailing rate, as deter-
mined by the Secretary of the Treasury; 
‘‘(C) ‘t’ is the total number of months in the 
individual’s period of obligated service in accord-
ance with subsection (f); and 
‘‘(D) ‘s’ is the number of months of such pe-
riod served by such individual in accordance 
with this section. 
‘‘(3) DEDUCTIONS
IN
MEDICARE
PAYMENTS.— 
Amounts not paid within such period shall be subject 
to collection through deductions in Medicare pay-
ments pursuant to section 1892 of the Social Security 
Act. 
‘‘(4) TIME
PERIOD
FOR
REPAYMENT.—Any 
amount of damages which the United States is enti-
tled to recover under this subsection shall be paid to 
the United States within the 1-year period beginning 
on the date of the breach or such longer period begin-
ning on such date as shall be specified by the Sec-
retary. 
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‘‘(5) RECOVERY OF DELINQUENCY.— 
‘‘(A) IN GENERAL.—If damages described in 
paragraph (4) are delinquent for 3 months, the 
Secretary shall, for the purpose of recovering 
such damages— 
‘‘(i) use collection agencies contracted 
with by the Administrator of General Serv-
ices; or 
‘‘(ii) enter into contracts for the recov-
ery of such damages with collection agencies 
selected by the Secretary. 
‘‘(B) REPORT.—Each contract for recov-
ering damages pursuant to this subsection shall 
provide that the contractor will, not less than 
once each 6 months, submit to the Secretary a 
status report on the success of the contractor in 
collecting such damages. Section 3718 of title 31, 
United States Code, shall apply to any such con-
tract to the extent not inconsistent with this sub-
section. 
‘‘(m) WAIVER OR SUSPENSION OF OBLIGATION.— 
‘‘(1) IN GENERAL.—The Secretary shall by regu-
lation provide for the partial or total waiver or sus-
pension of any obligation of service or payment by an 
individual under the Loan Repayment Program 
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whenever compliance by the individual is impossible 
or would involve extreme hardship to the individual 
and if enforcement of such obligation with respect to 
any individual would be unconscionable. 
‘‘(2) CANCELED UPON DEATH.—Any obligation 
of an individual under the Loan Repayment Program 
for service or payment of damages shall be canceled 
upon the death of the individual. 
‘‘(3) HARDSHIP
WAIVER.—The Secretary may 
waive, in whole or in part, the rights of the United 
States to recover amounts under this section in any 
case of extreme hardship or other good cause shown, 
as determined by the Secretary. 
‘‘(4) BANKRUPTCY.—Any obligation of an indi-
vidual under the Loan Repayment Program for pay-
ment of damages may be released by a discharge in 
bankruptcy under title 11 of the United States Code 
only if such discharge is granted after the expiration 
of the 5-year period beginning on the first date that 
payment of such damages is required, and only if the 
bankruptcy court finds that nondischarge of the obli-
gation would be unconscionable. 
‘‘(n) REPORT.—The Secretary shall submit to the 
President, for inclusion in the report required to be sub-
mitted to Congress under section 801, a report concerning 
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the previous fiscal year which sets forth by Service Area 
the following: 
‘‘(1) A list of the health professional positions 
maintained by Indian Health Programs and Urban 
Indian Organizations for which recruitment or reten-
tion is difficult. 
‘‘(2) The number of Loan Repayment Program 
applications filed with respect to each type of health 
profession. 
‘‘(3) The number of contracts described in sub-
section (e) that are entered into with respect to each 
health profession. 
‘‘(4) The amount of loan payments made under 
this section, in total and by health profession. 
‘‘(5) The number of scholarships that are pro-
vided under sections 104 and 106 with respect to each 
health profession. 
‘‘(6) The amount of scholarship grants provided 
under section 104 and 106, in total and by health 
profession. 
‘‘(7) The number of providers of health care that 
will be needed by Indian Health Programs and 
Urban Indian Organizations, by location and profes-
sion, during the 3 fiscal years beginning after the 
date the report is filed. 
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