486
Title II, Subtitle B
year of such session shall be deemed to be a sepa-
rate regular session of the State legislature.
Subpart D—Consumer Education Grants
SEC. 2361. GRANTS FOR CONSUMER EDUCATION.
(a) GRANT PROGRAM AUTHORIZED.—The Secretary
is authorized to make grants—
(1) to States,
(2) to regional alliances (at the option of States
within which such Alliances are located), and
(3) to national organizations representing insur-
ance consumers, long-term care providers, and insur-
ers,
for the development and implementation of long-term care
information, counseling, and other programs.
(b) APPLICATIONS.—
(1) IN GENERAL.—Each State or organization
seeking a grant under this section shall submit to
the Secretary an application, in such format and
containing such information as the Secretary may
require.
(2) GOALS.—Programs under this section shall
be directed at the goals of increasing consumers’ un-
derstanding and awareness of options available to
them with respect to long-term care insurance (and
487
Title II, Subtitle B
alternatives, such as public long-term care pro-
grams), including—
(A) the risk of needing long-term care;
(B) the costs associated with long-term
care services;
(C) the lack of long-term care coverage
under the Medicare program, Medicare supple-
mental (Medigap) policies, and standard private
health insurance;
(D) the limitations on (and conditions of
eligibility for) long-term care coverage under
State programs;
(E) the availability, and variations in cov-
erage and cost, of private long-term care insur-
ance;
(F) features common to many private long-
term care insurance policies; and
(G) pitfalls to avoid when purchasing a
long-term care insurance policy.
(3) ACTIVITIES.—An application for a grant
under this section shall indicate the activities the
State or organization would carry out under such
grant, which activities may include—
(A) coordination of the activities of State
agencies and private entities as necessary to
488
Title II, Subtitle B
carry out the State’s program under this sec-
tion;
(B) collection, analysis, publication, and
dissemination of information,
(C) conducting or sponsoring of consumer
education, outreach, and information programs,
(D) providing (directly or through referral)
counseling and consultation services to con-
sumers to assist them in choosing long-term
care insurance coverage appropriate to their cir-
cumstances, and
(E) other appropriate activities.
(4) PRIORITY FOR INNOVATION.—In awarding
grants under this section, the Secretary shall give
priority to applications proposing to use innovative
approaches to providing information, counseling, and
other assistance to individuals who might benefit
from, or are considering the purchase of, long-term
care insurance.
(c) PERIOD OF GRANTS.—Grants under this section
shall be for not longer than 3 years.
(d) EVALUATIONS AND REPORTS.—
(1) BY GRANTEES TO THE SECRETARY.—Each
recipient of a grant under this section shall annually
489
Title II, Subtitle B
evaluate the effectiveness of its program under such
grant, and report its conclusions to the Secretary.
(2) BY THE SECRETARY TO THE CONGRESS.—
The Secretary shall annually evaluate, and report to
the Congress on, the effectiveness of programs under
this section, on the basis of reports received under
paragraph (1) and such independent evaluation as
the Secretary finds necessary.
(e) AUTHORIZATION
OF APPROPRIATIONS.—There
are authorized to be appropriated, for grants under this
section—
(1) $10,000,000 for each of fiscal years 1995
through 1997 for grants to States, and
(2) $1,000,000 for each of fiscal years 1995
through 1997,
for grants to eligible organizations.
PART 4—TAX TREATMENT OF LONG-TERM CARE
INSURANCE AND SERVICES
SEC. 2401. REFERENCE TO TAX PROVISIONS.
For amendments to the Internal Revenue Code of
1986 relating to the treatment of long-term care insurance
and services, see subtitle G of title VII.
490
Title II, Subtitle B
PART 5—TAX INCENTIVES FOR INDIVIDUALS
WITH DISABILITIES WHO WORK
SEC. 2501. REFERENCE TO TAX PROVISION.
For amendment to the Internal Revenue Code of
1986 providing for a tax credit for cost of personal assist-
ance services required by employed individuals, see section
7901.
PART 6—DEMONSTRATION AND EVALUATION
SEC. 2601. DEMONSTRATION ON ACUTE AND LONG-TERM
CARE INTEGRATION.
(a) PROGRAM
AUTHORIZED.—The Secretary of
Health and Human Services shall conduct a demonstra-
tion program to test the effectiveness of various ap-
proaches to financing and providing integrated acute and
long-term care services described in subsection (b) for the
chronically ill and disabled who meet eligibility criteria
under subsection (c).
(b) SERVICES AND BENEFITS.—
(1) IN GENERAL.—Except as provided in para-
graph (2), the following services and benefits shall
be provided under each demonstration approved
under this section:
(A) 
COMPREHENSIVE
BENEFIT
PACK-
AGE.—All benefits included in the comprehen-
sive benefit package under title I of this Act.
491
Title II, Subtitle B
(B) TRANSITIONAL
BENEFITS.—Special-
ized benefits relating to the transition from
acute to long-term care, including—
(i) assessment and consultation,
(ii) inpatient transitional care,
(iii) medical rehabilitation,
(iv) home health care and home care,
(v) caregiver support, and
(vi) self-help technology.
(C) LONG-TERM CARE BENEFITS.—Long-
term care benefits, including—
(i) adult day care,
(ii) personal assistance services,
(iii) homemaker services and chore
services;
(iv) home-delivered meals;
(v) respite services;
(vi) nursing facility services in special-
ized care units;
(vii) services in other residential set-
tings including community supported living
arrangements and assisted living facilities;
and
(viii) assistive devices and environ-
mental modifications.
492
Title II, Subtitle B
(D) HABILITATION SERVICES.—Specialized
habilitation services for participants with devel-
opmental disabilities.
(2) VARIATIONS IN MINIMUM BENEFITS.—
(A) IN GENERAL.—Subject to the require-
ment of subparagraph (B), demonstrations may
omit specified services listed under subpara-
graphs (C) and (D) of paragraph (1), or pro-
vide additional services, as found appropriate by
the Secretary in the case of a particular dem-
onstration, taking into consideration factors
such as—
(i) the needs of a specialized group of
eligible beneficiaries;
(ii) the availability of the omitted ben-
efits under other programs in the service
area; and
(iii) the geographic availability of
service providers.
(B) BREADTH REQUIREMENT.—In approv-
ing variant demonstrations pursuant to sub-
paragraph (A), the Secretary shall ensure that
demonstrations under this section, taken as a
group, adequately test financing and delivery
494
Title II, Subtitle B
quire, including the information specified in this
subsection.
(2) SERVICE DELIVERY.—The application shall
state the services to be provided under the dem-
onstration (either directly by the applicant or under
other arrangements approved by the Secretary),
which shall include services specified pursuant to
subsection (b) and—
(A) enrollment services;
(B) client assessment and care planning;
(C) simplified access to needed services;
(D) integrated management of acute and
chronic care, including measures to ensure con-
tinuity of care across settings and services;
(E) quality assurance, grievance, and ap-
peals mechanisms; and
(F) such other services as the Secretary
may require.
(3) CONSUMER
PROTECTION
AND
PARTICIPA-
TION.—The applicant shall provide evidence of con-
sumer participation—
(A) in the planning of the demonstration
(including a showing of support from commu-
nity agencies or consumer interest groups); and
495
Title II, Subtitle B
(B) in the conduct of the demonstration,
including descriptions of methods and proce-
dures to be used—
(i) to make available to individuals en-
rolled in the demonstration information on
self-help, health promotion and disability
prevention practices, and enrollees’ con-
tributions to the costs of care;
(ii) to ensure participation by such en-
rollees (or their designated representatives,
where appropriate) in care planning and in
decisions concerning treatment;
(iii) to handle and resolve client griev-
ances and appeals;
(iv) to take enrollee views into account
in quality assurance and provider con-
tracting procedures; and
(v) to evaluate enrollee satisfaction
with the program.
(4) APPLICANT
QUALIFICATIONS.—Applicants
for grants under this section shall meet eligibility
criteria established by the Secretary, including re-
quirements relating to—
(A) adequate financial controls to monitor
administrative and service costs,
496
Title II, Subtitle B
(B) demonstrated commitment of the
Board of Directors or comparable governing
body to the goals of demonstration,
(C) information systems adequate to pay
service providers, to collect required utilization
and cost data, and to provide data adequate to
permit evaluation of program performance, and
(D) compliance with applicable State laws.
(e) PAYMENTS TO PARTICIPANTS.—An entity con-
ducting a demonstration under this section shall be enti-
tled to receive, with respect to each enrollee, for the period
during which it is providing to such enrollee services under
a demonstration under this section, such amounts as the
Secretary shall provide, which amounts—
(1) may include risk-based payments and non-
risk based payments by governmental programs, by
third parties, or by project enrollees, or any com-
bination of such payments, and
(2) may vary by project and by enrollee.
(f) NUMBER AND DURATION OF DEMONSTRATION
PROJECTS.—
(1) REQUEST
FOR
APPLICATIONS.—The Sec-
retary shall publish a request for applications under
this section not later than one year after enactment
of this Act.
497
Title II, Subtitle B
(2) NUMBER AND DURATION.—The Secretary
shall authorize not more than 25 demonstrations
under this section, each of which shall run for 7
years from the date of the award.
(g) EVALUATION
AND REPORTS.—The Secretary
shall evaluate the demonstration projects under this sec-
tion, and shall submit to the Congress—
(1) an interim report, by three years after en-
actment, describing the status of the demonstration
and characteristics of the approved projects; and
(2) a final report, by one year after completion
of such demonstration projects, evaluating their ef-
fectiveness (including cost-effectiveness), and dis-
cussing the advisability of including some or all of
the integrated models tested in the demonstration as
a benefit under the comprehensive benefit package
under title I of this Act, or under the programs
under title XVIII of the Social Security Act.
(h) AUTHORIZATION OF APPROPRIATIONS.—
(1) FOR SECRETARIAL RESPONSIBILITIES.—
(A) IN GENERAL.—There are authorized to
be appropriated $7,000,000 for fiscal year
1996, and $4,500,000 for each of the 6 suc-
ceeding fiscal years, for payment of costs of the
Secretary in carrying out this section (including
498
Title II, Subtitle B
costs for technical assistance to potential serv-
ice providers, and research and evaluation),
which amounts shall remain available until ex-
pended.
(B) SET-ASIDE
FOR
FEASIBILITY
STUD-
IES.—Of the total amount authorized to be ap-
propriated under subparagraph (A), not less
than $1,000,000 shall be available for studies
of the feasibility of systems to provide inte-
grated care for nonaged populations (including
physically disabled children and adults, the
chronically mentally ill, and individuals with
disabilities, and combinations of these groups).
(2) FOR COVERED BENEFITS.—There are au-
thorized to be appropriated $50,000,000 for the first
fiscal year for which grants are awarded under this
section, and for each of the four succeeding fiscal
years, for payment of costs of benefits for which no
public or private program or entity is legally obli-
gated to pay.
SEC. 2602. PERFORMANCE REVIEW OF THE LONG-TERM
CARE PROGRAMS.
(a) IN GENERAL.—The Secretary of Health and
Human Services shall prepare and submit to the
Congress—
499
Title II, Subtitle B
(1) an interim report, not later than the end of
the seventh full calendar year beginning after the
date of the enactment of this Act, and
(2) a final report, not later than two years after
the date of the interim report,
evaluating the effectiveness of the programs established
and amendments made by this subtitle (and including at
a minimum the elements specified in subsection (b)).
(b) ELEMENTS OF ASSESSMENT.—The evaluations to
be made, and included in the reports required pursuant
to subsection (a), include at least the following:
(1) STATE SERVICE DELIVERY PROGRAMS.—An
evaluation of States’ effectiveness in meeting the
needs for home and community-based services (in-
cluding personal assistance services) of individuals
with disabilities (including individuals who do, and
who do not, meet the eligibility criteria for the serv-
ice program under part 1, individuals of different
ages, type and degree of disability, and income lev-
els, members of minority groups, and individuals re-
siding in rural areas).
(2) SERVICE ACCESS.—An evaluation of the de-
gree of (and obstacles to) access of individuals with
disabilities to needed home and community-based
services and to inpatient services.
500
Title III
(3) QUALITY.—An evaluation of the quality of
long-term care services available.
(4) PRIVATE INSURANCE.—An evaluation of the
performance of the private sector in offering afford-
able long-term care insurance that provides adequate
protection against the costs of long-term care, and
of the effectiveness of Federal standards and State
enforcement, pursuant to part 3, in adequately pro-
tecting long-term care insurance consumers.
(5) COST ISSUES.—An evaluation of the effec-
tiveness of amendments made by this subtitle in con-
taining the costs of long-term care, and in limiting
the share of such costs borne by individuals with
lower incomes.
(6) SERVICE
COORDINATION
AND
INTEGRA-
TION.—An evaluation of the effectiveness of the pro-
grams established or amended under this subtitle in
achieving coordination and integration of long-term
care services, and of such services with acute care
services and social services, and in ensuring provi-
sion of services in the least restrictive setting pos-
sible.
TITLE III—PUBLIC HEALTH
INITIATIVES
TABLE OF CONTENTS OF TITLE
501
Title III
Page
Subtitle A—Workforce Priorities Under Federal Payments
PART 1—INSTITUTIONAL COSTS OF GRADUATE MEDICAL EDUCATION;
WORKFORCE PRIORITIES
SUBPART A—NATIONAL COUNCIL REGARDING WORKFORCE PRIORITIES
Sec. 3001. National Council on Graduate Medical Education ................
504
SUBPART B—AUTHORIZED POSITIONS IN SPECIALTY TRAINING
Sec. 3011. Cooperation regarding approved physician training pro-
grams ............................................................................
506
Sec. 3012. Annual authorization of number of specialty positions; re-
quirements regarding primary health care ...................
509
Sec. 3013. Allocations among specialities and programs ........................
513
SUBPART C—INSTITUTIONAL COSTS OF GRADUATE MEDICAL EDUCATION
Sec. 3031. Federal formula payments to approved physician training
programs .......................................................................
515
Sec. 3032. Application for payments ......................................................
516
Sec. 3033. Availability of funds for payments; annual amount of pay-
ments .............................................................................
517
Sec. 3034. Additional funding provisions ................................................
522
SUBPART D—GENERAL PROVISIONS
Sec. 3041. Definitions .............................................................................
526
SUBPART E—TRANSITIONAL PROVISIONS
Sec. 3051. Transitional payments to institutions ...................................
527
PART 2—INSTITUTIONAL COSTS OF GRADUATE NURSING EDUCATION;
WORKFORCE PRIORITIES
Sec. 3061. National council; authorized graduate nurse training posi-
tions; institutional costs ................................................
533
Sec. 3062. Applicability of part 1 provisions ..........................................
535
Sec. 3063. Funding .................................................................................
536
PART 3—RELATED PROGRAMS
Sec. 3071. Programs of the Secretary of Health and Human Services
536
Sec. 3072. Programs of the Secretary of Labor .....................................
540
Sec. 3073. National Institute for Health Care Workforce Development
543
Sec. 3074. Requirement for certain programs regarding redeployment
of health care workers ...................................................
546
Subtitle B—Academic Health Centers
PART 1—FORMULA PAYMENTS
Sec. 3101. Federal formula payments to academic health centers .........
548
Sec. 3102. Request for payments ............................................................
551
Sec. 3103. Availability of funds for payments; annual amount of pay-
ments .............................................................................
552
502
Title III
Sec. 3104. Additional funding provisions ................................................
554
PART 2—ACCESS OF PATIENTS TO ACADEMIC HEALTH CENTERS
Sec. 3131. Contracts for ensuring access to centers ...............................
558
Sec. 3132. Discretionary grants regarding access to centers .................
559
Subtitle C—Health Research Initiatives
PART 1—PROGRAMS FOR CERTAIN AGENCIES
Sec. 3201. Biomedical and behavioral research on health promotion
and disease prevention ..................................................
560
Sec. 3202. Health services research ........................................................
561
PART 2—FUNDING FOR PROGRAMS
Sec. 3211. Authorizations of appropriations ...........................................
563
Subtitle D—Core Functions of Public Health Programs;
National Initiatives Regarding Preventive Health
PART 1—FUNDING
Sec. 3301. Authorizations of appropriations ...........................................
564
PART 2—CORE FUNCTIONS OF PUBLIC HEALTH PROGRAMS
Sec. 3311. Purposes ................................................................................
565
Sec. 3312. Grants to States for core health functions ............................
565
Sec. 3313. Submission of information ....................................................
570
Sec. 3314. Reports ..................................................................................
571
Sec. 3315. Application for grant .............................................................
571
Sec. 3316. General provisions .................................................................
572
Sec. 3317. Allocations for certain activities ............................................
572
Sec. 3318. Definitions .............................................................................
573
PART 3—NATIONAL INITIATIVES REGARDING HEALTH PROMOTION AND
DISEASE PREVENTION
Sec. 3331. Grants for national prevention initiatives .............................
573
Sec. 3332. Priorities ................................................................................
575
Sec. 3333. Submission of information ....................................................
576
Sec. 3334. Application for grant .............................................................
577
Subtitle E—Health Services for Medically Underserved
Populations
PART 1—COMMUNITY AND MIGRANT HEALTH CENTERS
Sec. 3401. Authorizations of appropriations ...........................................
578
Sec. 3402. Use of funds ..........................................................................
579
PART 2—INITIATIVES FOR ACCESS TO HEALTH CARE
SUBPART A—PURPOSES; FUNDING
Sec. 3411. Purposes ................................................................................
579
Sec. 3412. Authorizations of appropriations ...........................................
580
503
Title III
SUBPART B—DEVELOPMENT OF QUALIFIED COMMUNITY HEALTH PLANS AND
PRACTICE NETWORKS
Sec. 3421. Grants and contracts for development of plans and net-
works .............................................................................
581
Sec. 3422. Preferences in making awards of assistance .........................
586
Sec. 3423. Certain uses of awards ..........................................................
587
Sec. 3424. Accessibility of services ..........................................................
589
Sec. 3425. Additional agreements ...........................................................
592
Sec. 3426. Submission of certain information ........................................
594
Sec. 3427. Reports; audits ......................................................................
595
Sec. 3428. Application for assistance ......................................................
595
Sec. 3429. General provisions .................................................................
596
SUBPART C—CAPITAL COST OF DEVELOPMENT OF QUALIFIED COMMUNITY
HEALTH PLANS AND PRACTICE NETWORKS
Sec. 3441. Loans and loan guarantees regarding plans and networks
596
Sec. 3442. Certain requirements .............................................................
598
Sec. 3443. Defaults; right of recovery ....................................................
600
Sec. 3444. Provisions regarding construction or expansion of facilities
603
Sec. 3445. Application for assistance ......................................................
604
Sec. 3446. Administration of programs ..................................................
605
SUBPART D—ENABLING SERVICES
Sec. 3461. Grants and contracts for enabling services ...........................
605
Sec. 3462. Authorizations of appropriations ...........................................
608
PART 3—NATIONAL HEALTH SERVICE CORPS
Sec. 3471. Authorizations of appropriations ...........................................
608
Sec. 3472. Allocation for participation of nurses in scholarship and
loan repayment programs .............................................
609
PART 4—PAYMENTS TO HOSPITALS SERVING VULNERABLE POPULATIONS
Sec. 3481. Payments to hospitals ...........................................................
610
Sec. 3482. Identification of eligible hospitals ..........................................
612
Sec. 3483. Amount of payments .............................................................
3483
Sec. 3484. Base year ...............................................................................
615
Subtitle F—Mental Health; Substance Abuse
PART 1—FINANCIAL ASSISTANCE
Sec. 3501. Authorizations of appropriations ...........................................
615
Sec. 3502. Supplemental formula grants for States regarding activities
under part B of title XIX of Public Health Service Act
616
Sec. 3503. Capital costs of development of certain centers and clinics
621
PART 2—AUTHORITIES REGARDING PARTICIPATING STATES
SUBPART A—REPORT
Sec. 3511. Report on integration of mental health systems ...................
622
SUBPART B—PILOT PROGRAM
Sec. 3521. Pilot program ........................................................................
626
504
Title III
Subtitle G—Comprehensive School Health Education; School-
Related Health Services
PART 1—GENERAL PROVISIONS
Sec. 3601. Purposes ................................................................................
627
Sec. 3602. Definitions .............................................................................
629
PART 2—SCHOOL HEALTH EDUCATION; GENERAL PROVISIONS
Sec. 3611. Authorizations of appropriations ...........................................
631
Sec. 3612. Waivers of statutory and regulatory requirements ...............
632
PART 3—SCHOOL HEALTH EDUCATION; GRANTS TO STATE EDUCATION
AGENCIES
SUBPART A—PLANNING GRANTS FOR STATE EDUCATION AGENCIES
Sec. 3621. Application for grant .............................................................
636
Sec. 3622. Approval of Secretary ............................................................
638
Sec. 3623. Amount of grant ....................................................................
638
Sec. 3624. Authorized activities ..............................................................
639
SUBPART B—IMPLEMENTATION GRANTS FOR STATE EDUCATION AGENCIES
Sec. 3631. Application for grant .............................................................
640
Sec. 3632. Selection of grantees .............................................................
642
Sec. 3633. Amount of grant ....................................................................
642
Sec. 3634. Authorized activities; limitation on administrative costs ......
643
Sec. 3635. Subgrants to local educational agencies ................................
644
SUBPART C—STATE AND LOCAL REPORTS
Sec. 3641. State and local reports ..........................................................
646
PART 4—SCHOOL HEALTH EDUCATION; GRANTS TO CERTAIN LOCAL
EDUCATIONAL AGENCIES
SUBPART A—ELIGIBILITY
Sec. 3651. Substantial need of area served by agency ...........................
647
SUBPART B—PLANNING GRANTS FOR LOCAL EDUCATION AGENCIES
Sec. 3661. Application for grant .............................................................
647
Sec. 3662. Selection of grantees .............................................................
649
Sec. 3663. Amount of grant ....................................................................
649
Sec. 3664. Authorized activities ..............................................................
650
SUBPART C—IMPLEMENTATION GRANTS FOR LOCAL EDUCATIONAL AGENCIES
Sec. 3671. Application for grant .............................................................
651
Sec. 3672. Selection of grantees .............................................................
653
Sec. 3673. Amount of grant ....................................................................
654
Sec. 3674. Authorized activities ..............................................................
655
Sec. 3675. Reports ..................................................................................
655
PART 5—SCHOOL-RELATED HEALTH SERVICES
505
Title III, Subtitle A
SUBPART A—DEVELOPMENT AND OPERATION OF PROJECTS
Sec. 3681. Authorizations of appropriations ...........................................
656
Sec. 3682. Eligibility for development and operation grants ..................
656
Sec. 3683. Preferences ............................................................................
658
Sec. 3684. Grants for development of projects .......................................
659
Sec. 3685. Grants for operation of projects ............................................
662
Sec. 3686. Federal administrative costs .................................................
666
SUBPART B—CAPITAL COSTS OF DEVELOPING PROJECTS
Sec. 3691. Loans and loan guarantees regarding projects .....................
666
Sec. 3692. Funding .................................................................................
667
Subtitle H—Public Health Service Initiative
Sec. 3701. Public health service initiative ...............................................
667
Subtitle I—Coordination With COBRA Continuation Coverage
Sec. 3801. Public Health Service Act; coordination with COBRA con-
tinuation coverage .........................................................
668
Subtitle A—Workforce Priorities
Under Federal Payments
PART 1—INSTITUTIONAL COSTS OF GRADUATE
MEDICAL EDUCATION; WORKFORCE PRIORITIES
Subpart A—National Council
Regarding Workforce Priorities
SEC. 3001. NATIONAL COUNCIL ON GRADUATE MEDICAL
EDUCATION.
(a) IN GENERAL.—There is established within the
Department of Health and Human Services a council to
be known as the National Council on Graduate Medical
Education.
(b) DUTIES.—The Secretary shall carry out subpart
B acting through the National Council.
(c) COMPOSITION.—
506
Title III, Subtitle A
(1) IN GENERAL.—The membership of the Na-
tional Council shall include individuals who are ap-
pointed to the Council from among individuals who
are not officers or employees of the United States.
Such individuals shall be appointed by the Secretary,
and shall include individuals from each of the fol-
lowing categories:
(A) Consumers of health care services.
(B) Physicians who are faculty members of
medical schools.
(C) Physicians in private practice who are
not physicians described in subparagraph (B).
(D) Officers or employees of regional and
corporate health alliances.
(E) Officers or employees of health care
plans that participate in such alliances.
(F) Such other individuals as the Secretary
determines to be appropriate.
(2) EX
OFFICIO
MEMBERS; OTHER
FEDERAL
OFFICERS OR EMPLOYEES.—The membership of the
National Council shall include individuals designated
by the Secretary to serve as members of the Council
from among Federal officers or employees who are
appointed by the President, or by the Secretary or
507
Title III, Subtitle A
other Federal officers who are appointed by the
President with the advice and consent of the Senate.
(d) CHAIR.—The Secretary shall, from among mem-
bers of the National Council appointed under subsection
(c)(1), designate an individual to serve as the Chair of
the Council.
(e) DEFINITIONS.—For purposes of this subtitle:
(1) The term ‘‘medical school’’ means a school
of medicine (as defined in section 799 of the Public
Health Service Act) or a school of osteopathic medi-
cine (as defined in such section).
(2) The term ‘‘National Council’’ means the
council established in subsection (a).
Subpart B—Authorized Positions
in Specialty Training
SEC. 3011. COOPERATION REGARDING APPROVED PHYSI-
CIAN TRAINING PROGRAMS.
(a) IN GENERAL.—With respect to an approved phy-
sician training program in a medical specialty, a funding
agreement for payments under section 3031 for a calendar
year is that the program will ensure that the number of
individuals enrolled in the program in the subsequent aca-
demic year is in accordance with this subpart.
(b) DEFINITIONS.—
508
Title III, Subtitle A
(1) APPROVED PROGRAM.—For purposes of this
subtitle:
(A) The term ‘‘approved physician training
program’’, with respect to the medical speciality
involved, means a residency or other post-
graduate program that trains physicians and
meets the following conditions:
(i) Participation in the program may
be counted toward certification in the med-
ical specialty.
(ii) The program is accredited by the
Accreditation Council on Graduate Medical
Education, or approved by the Council on
Postgraduate Training of the American
Osteopathic Association.
(B) The term ‘‘approved physician training
program’’ includes any postgraduate program
described in subparagraph (A) that provides
health services in an ambulatory setting, with-
out regard to whether the program provides in-
patient hospital services.
(C) The term ‘‘approved physician training
program’’ includes any postgraduate program
described in subparagraph (A), whether oper-
ated by academic health centers, teaching hos-
509
Title III, Subtitle A
pitals, multispecialty group practices, ambula-
tory care providers, prepaid health plans, or
other entities.
(2) ELIGIBLE
PROGRAM; 
SUBPART
DEFINI-
TION.—For purposes of this subpart, the term ‘‘eli-
gible program’’, with respect to an academic year,
means an approved physician training program that
receives payments under subpart C for the calendar
year in which the academic year begins.
(3) OTHER DEFINITIONS.—For purposes of this
subtitle:
(A)(i) The term ‘‘academic year’’ means
the 1-year period beginning on July 1. The aca-
demic year beginning July 1, 1993, is academic
year 1993–94.
(ii) With respect to the funding agreement
described in subsection (a), the term ‘‘subse-
quent academic year’’ means the academic year
beginning July 1 of the calendar year for which
payments are to be made under the agreement.
(B) The term ‘‘funding agreement’’, with
respect to payments under section 3031 to an
eligible program, means that the Secretary may
make the payments only if the program makes
the agreement involved.
510
Title III, Subtitle A
(C) The term ‘‘medical specialty’’ includes
all medical, surgical, and other physician spe-
cialties and subspecialties.
SEC. 3012. ANNUAL AUTHORIZATION OF NUMBER OF SPE-
CIALTY POSITIONS; REQUIREMENTS REGARD-
ING PRIMARY HEALTH CARE.
(a) ANNUAL AUTHORIZATION OF NUMBER OF POSI-
TIONS.—In the case of each medical specialty, the Na-
tional Council shall, pursuant to section 3011, designate
for each academic year the number of individuals nation-
wide who are authorized to be enrolled in eligible pro-
grams. The preceding sentence is subject to subsection
(c)(2).
(b) PRIMARY HEALTH CARE.—
(1) IN GENERAL.—Subject to paragraph (2), in
carrying out subsection (a) for an academic year, the
National Council shall ensure that, of the class of
training participants entering eligible programs for
academic year 1998–99 or any subsequent academic
year, the percentage of such class that completes eli-
gible programs in primary health care is not less
than 55 percent (without regard to the academic
year in which the members of the class complete the
programs).
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Title III, Subtitle A
(2) RULE
OF
CONSTRUCTION.—The require-
ment of paragraph (1) regarding a percentage ap-
plies in the aggregate to training participants enter-
ing eligible programs for the academic year involved,
and not individually to any eligible program.
(c) DESIGNATIONS REGARDING 3-YEAR PERIODS.—
(1) DESIGNATION PERIODS.—For each medical
specialty, the National Council shall make the an-
nual designations under subsection (a) for periods of
3 academic years.
(2) INITIAL PERIOD.—The first designation pe-
riod established by the National Council after the
date of the enactment of this Act shall be the aca-
demic years 1998–99 through 2000–01.
(d) CERTAIN CONSIDERATIONS IN DESIGNATING AN-
NUAL NUMBERS.—
(1) IN GENERAL.—Factors considered by the
National Council in designating the annual number
of specialty positions for an academic year for a
medical specialty shall include the extent to which
there is a need for additional practitioners in the
speciality, as indicated by the following:
(A) The incidence and prevalence (in the
general population and in various other popu-
lations) of the diseases, disorders, or other
512
Title III, Subtitle A
health conditions with which the specialty is
concerned.
(B) The number of physicians who will be
practicing in the specialty in the academic year.
(C) The number of physicians who will be
practicing in the specialty at the end of the 5-
year period beginning on the first day of the
academic year.
(2) RECOMMENDATIONS OF PRIVATE ORGANIZA-
TIONS.—In designating the annual number of spe-
cialty positions for an academic year for a medical
specialty, the National Council shall consider the
recommendations of organizations representing phy-
sicians in the specialty and the recommendations of
organizations representing consumers of the services
of such physicians.
(3) TOTAL
OF
RESPECTIVE
ANNUAL
NUM-
BERS.—
(A) Subject to subparagraph (B), for aca-
demic year 1998-99 and subsequent academic
years, the National Council shall ensure that
the total of the respective annual numbers des-
ignated under subsection (a) for an academic
year is a total that—
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Title III, Subtitle A
(i) bears a relationship to the number
of individuals who graduated from medical
schools in the United States in the pre-
ceding academic year; and
(ii) is consistent with the purposes of
this subpart.
(B) For each of the academic years 1998-
99 through 2002-03, the total determined
under subparagraph (A) shall be reduced by a
percentage determined by the National Council.
(e) DEFINITIONS.—For purposes of this subtitle:
(1) The term ‘‘annual number of specialty posi-
tions’’, with respect to a medical specialty, means
the number designated by the National Council
under subsection (a) for eligible programs for the
academic year involved.
(2) The term ‘‘designation period’’ means a 3-
year period under subsection (c)(1) for which des-
ignations under subsection (a) are made by the Na-
tional Council.
(3) The term ‘‘primary health care’’ means the
following medical specialties: Family medicine, gen-
eral internal medicine, general pediatrics, and ob-
stetrics and gynecology.
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Title III, Subtitle A
(4) The term ‘‘specialty position’’ means a posi-
tion as a training participant.
(5) The term ‘‘training participant’’ means an
individual who is enrolled in an approved physician
training program.
SEC. 3013. ALLOCATIONS AMONG SPECIALITIES AND PRO-
GRAMS.
(a) IN GENERAL.—For each academic year, the Na-
tional Council shall for each medical specialty make alloca-
tions among eligible programs of the annual number of
specialty positions that the Council has designated for
such year. The preceding sentence is subject to subsection
(b)(3).
(b) ALLOCATIONS REGARDING 3-YEAR PERIOD.—
(1) IN GENERAL.—For each medical specialty,
the National Council shall make the annual alloca-
tions under subsection (a) for periods of 3 academic
years.
(2) ADVANCE NOTICE TO PROGRAMS.—With re-
spect to the first academic year of an allocation pe-
riod established by the National Council, the Na-
tional Council shall, not later than July 1 of the pre-
ceding academic year, notify each eligible program of
the allocations made for the program for each of the
academic years of the period.
515
Title III, Subtitle A
(3) INITIAL PERIOD.—The first allocation pe-
riod established by the National Council after the
date of the enactment of this Act shall be the aca-
demic years 1998–99 through 2000–01.
(c) CERTAIN CONSIDERATIONS.—
(1) GEOGRAPHIC
AREAS; QUALITY
OF
PRO-
GRAMS.—In making allocations under subsection (a)
for eligible programs of the various geographic
areas, the National Council shall include among the
factors considered the historical distribution among
the areas of approved physician training programs,
and the quality of such programs.
(2) 
UNDERREPRESENTATION
OF
MINORITY
GROUPS.—In making an allocation under subsection
(a) for an eligible program, the National Council
shall include among the factors considered the fol-
lowing:
(A) The extent to which the population of
training participants in the program includes
training participants who are members of racial
or ethnic minority groups.
(B) With respect to a racial or ethnic
group represented among the training partici-
pants, the extent to which the group is under-
516
Title III, Subtitle A
represented in the field of medicine generally
and in the various medical specialities.
(3) RECOMMENDATIONS OF PRIVATE ORGANIZA-
TIONS.—In making allocations under subsection (a)
for eligible programs, the National Council shall con-
sider the recommendations of organizations rep-
resenting physicians in the medical specialties and
the recommendations of organizations representing
consumers of the services of such physicians.
(d) DEFINITIONS.—For purposes of this subtitle, the
term ‘‘allocation period’’ means a 3-year period under sub-
section (b)(1) for which allocations under subsection (a)
are made by the National Council.
Subpart C—Institutional Costs of
Graduate Medical Education
SEC. 3031. FEDERAL FORMULA PAYMENTS TO APPROVED
PHYSICIAN TRAINING PROGRAMS.
(a) IN GENERAL.—In the case of an approved physi-
cian training program that in accordance with section
3032 submits to the Secretary an application for calendar
year 1996 or any subsequent calendar year, the Secretary
shall make payments for such year to the program for the
purpose specified in subsection (b). The Secretary shall
make the payments in an amount determined in accord-
517
Title III, Subtitle A
ance with section 3033, and may administer the payments
as a contract, grant, or cooperative agreement.
(b) PAYMENTS FOR OPERATION OF APPROVED PHY-
SICIAN TRAINING PROGRAMS.—The purpose of payments
under subsection (a) is to assist an eligible program with
the costs of operation. A funding agreement for such pay-
ments is that the approved physician training program in-
volved will expend the payments only for such purpose.
(c) ELIGIBLE PROGRAM; SUBPART DEFINITION.—
For purposes of this subpart, the term ‘‘eligible program’’,
with respect to the calendar year involved, means an ap-
proved physician training program that submits to the
Secretary an application for such year in accordance with
section 3032.
SEC. 3032. APPLICATION FOR PAYMENTS.
(a) IN GENERAL.—For purposes of section 3031(a),
an application for payments under such section for a cal-
endar year is in accordance with this section if—
(1) the approved physician training program in-
volved submits the application not later than the
date specified by the Secretary;
(2) the application demonstrates that the condi-
tion described in subsection (b) is met with respect
to the program;
518
Title III, Subtitle A
(3) the application contains each funding agree-
ment described in this part and the application pro-
vides such assurances of compliance with the agree-
ments as the Secretary may require; and
(4) the application is in such form, is made in
such manner, and contains such agreements, assur-
ances, and information as the Secretary determines
to be necessary to carry out this part.
(b) CERTAIN CONDITIONS.—An approved physician
training program meets the condition described in this
subsection for receiving payments under section 3031 for
a calendar year if the institution within which the program
operates agrees that such payments will be made by the
Secretary directly to the program (and such agreement is
included in the application under subsection (a)), and the
Secretary shall ensure that such institution is permitted
to participate as a provider in a regional or corporate alli-
ance health plan during such year only if each of the ap-
proved physician training programs of the institution
meets the requirements for receiving payments under such
section for such year.
SEC. 3033. AVAILABILITY OF FUNDS FOR PAYMENTS; AN-
NUAL AMOUNT OF PAYMENTS.
(a) ANNUAL HEALTH PROFESSIONS WORKFORCE
ACCOUNT.—
519
Title III, Subtitle A
(1) IN
GENERAL.—Subject to paragraph (2)
and section 3034, the amount available for a cal-
endar year for making payments under sections
3031 and 3051 (constituting an account to be
known as the annual health professions workforce
account) is the following, as applicable to the cal-
endar year:
(A) In the case of calendar year 1996,
$3,200,000,000.
(B) In the case of calendar year 1997,
$3,550,000,000.
(C) In the case of calendar year 1998,
$4,800,000,000.
(D) In the case of each of the calendar
years 1999 and 2000, $5,800,000,000.
(E) In the case of each subsequent cal-
endar year, the amount specified in subpara-
graph (D) increased by the product of such
amount and the general health care inflation
factor for such year (as defined in subsection
(d)).
(2) TRANSITIONAL PROVISION.—
(A) With respect to making payments
under sections 3031 and 3051 for calendar year
1996 or 1997, the Secretary shall first make
520
Title III, Subtitle A
payments under section 3031 to eligible pro-
grams described in subparagraph (B) in the
amount determined for the programs under
subsection (b) for such year, and then, from
such amounts as remain available in the annual
health professions workforce account for such
year, shall make payments under section 3031
to other eligible programs and shall make pay-
ments under section 3051.
(B) An eligible program described in this
subparagraph is such a program that is oper-
ated in a State that is a participating State
under title I.
(b) AMOUNT OF PAYMENTS FOR INDIVIDUAL ELIGI-
BLE PROGRAMS.—
(1) IN GENERAL.—Subject to the annual health
professions workforce account available for a cal-
endar year, the amount of payments required in sec-
tion 3031 to be made to an eligible program for the
calendar year is an amount equal to the product
of—
(A) the number of full-time equivalent
training participants in the program; and
(B) the national average of the costs of
such programs in training such a participant,
521
Title III, Subtitle A
as determined by consideration of the following
factors (and as adjusted under paragraph (2)):
(i) The national average salary of
training participants.
(ii) The national average costs of such
programs in providing for faculty super-
vision of training participants and for re-
lated activities.
(2) ADDITIONAL
PROVISIONS
REGARDING
NA-
TIONAL AVERAGE COST.—
(A) The Secretary shall in accordance with
paragraph (1)(B) determine, for academic year
1992–93, an amount equal to the national aver-
age described in such paragraph with respect to
training a participant in an approved physician
training program in the medical specialty in-
volved. The national average applicable under
such paragraph for a calendar year for such
programs is, subject to subparagraph (B), the
amount determined under the preceding sen-
tence increased by the amount necessary to off-
set the effects of inflation occurring since aca-
demic year 1992–93, as determined through use
of the consumer price index.
522
Title III, Subtitle A
(B) The national average determined
under subparagraph (A) and applicable to a cal-
endar year shall, in the case of the eligible pro-
gram involved, be adjusted by a factor to reflect
regional differences in the applicable wage and
wage-related costs.
(c) LIMITATION.—If, subject to subsection (a)(2), the
annual health professions workforce account available for
a calendar year is insufficient for providing each eligible
program with the amount of payments determined under
subsection (b) for the program for such year, the Sec-
retary shall make such pro rata reductions in the amounts
so determined as may be necessary to ensure that the total
of payments made under section 3031 for such year equals
the total of such account.
(d) DEFINITIONS.—For purposes of this subtitle:
(1) The term ‘‘annual health professions work-
force account’’ means the account established pursu-
ant to subsection (a)(1).
(2) The term ‘‘consumer price index’’ has the
meaning given such term in section 1902.
(3) The term ‘‘general health care inflation fac-
tor’’, with respect to a year, has the meaning given
such term in section 6001(a)(3) for such year.
523
Title III, Subtitle A
SEC. 3034. ADDITIONAL FUNDING PROVISIONS.
(a) SOURCES OF FUNDS FOR ANNUAL HEALTH PRO-
FESSIONS WORKFORCE ACCOUNT.—The amount specified
in section 3033(a)(1) for the annual health professions
workforce account for a calendar year shall be derived
from the sources specified in subsection (b).
(b) 
CONTRIBUTIONS
FROM
MEDICARE
TRUST
FUNDS, REGIONAL ALLIANCES, AND CORPORATE ALLI-
ANCES.—For purposes of subsection (a), the sources spec-
ified in this subsection for a calendar year are the fol-
lowing:
(1) Transfers made by the Secretary under sec-
tion 4051.
(2) Payments made by regional alliances under
section 1353 and—
(A) in the case of each of the calendar
years 1996 and 1997, transferred in an amount
equal to 50 percent of such payments made for
the calendar year involved; and
(B) in the case of calendar year 1998 and
each subsequent calendar year, transferred in
an amount equal to the aggregate regional alli-
ance portion determined under subsection
(c)(2)(A).
(3) The transfer made under subsection (d)(1).
530
Title III, Subtitle A
positions at the institution for academic year
1993–94 as a result of allocations under sub-
part B.
(2) RELEVANT
YEARS.—The Secretary may
make payments under subsection (a) to an institu-
tion only for the first four calendar years after cal-
endar 1997 for which the institution meets the con-
ditions described in paragraph (1).
(3) ELIGIBLE INSTITUTION.—For purposes of
this section, the term ‘‘eligible institution’’ means an
institution that submits to the Secretary an applica-
tion in accordance with subsection (d).
(c) PURPOSE OF PAYMENTS.—The purpose of pay-
ments under subsection (a) is to assist an eligible institu-
tion with the costs of operation. A funding agreement for
such payments is that the institution involved will expend
the payments only for such purpose.
(d) APPLICATION FOR PAYMENTS.—For purposes of
subsection (a), an application for payments under such
subsection is in accordance with this subsection if the in-
stitution involved submits the application not later than
the date specified by the Secretary; the application dem-
onstrates that the institution meets the conditions de-
scribed in subsection (b)(1) and that the institution has
cooperated with the approved physician training programs