personal health services, as indicated by the factors speci-
fied in paragraph (1) of this subsection.’’.
(4) DEFINITION.—Section 330(b) of the Public
Health Service Act, as amended by paragraph (3) of
this subsection, is amended by adding at the end the
following paragraph:
‘‘(9) The term ‘racial or ethnic minority group’ has
the meaning given such term in section 1707(g).’’.
(b) HEALTH PROFESSIONAL SHORTAGE AREAS.—
(1) FACTORS
IN
DESIGNATING
SHORTAGE
AREAS.—
(A) Section 332(b) of the Public Health
Service Act (42 U.S.C. 254e(b)) is amended—
(i) by redesignating paragraph (3) as
paragraph (6); and
(ii) by striking paragraphs (1) and (2)
and inserting the following:
‘‘(1) Factors indicating the health status of the
population, including the following (which the Sec-
retary shall consider to be of equal importance): The
rate of infant mortality and morbidity; and the ex-
tent to which there is a substantial rate of morbidity
resulting from complications in infectious, commu-
nicable, or chronic diseases that have progressed to
a critical condition (as indicated by data provided
pursuant to discharging patients from hospitals and
pursuant to admissions to the emergency facilities of
hospitals).
‘‘(2) The ability to pay for health services, in-
cluding the rate of poverty and including the per-
centage of the population constituted by individuals
and families that do not have health insurance.
‘‘(3) The percentage of the population con-
stituted by members of racial or ethnic minority
groups.
‘‘(4) With respect to community-based physi-
cians who provide primary health services and who
are accepting additional patients whose means of
payment is through the program established in title
XVIII or XIX, the following: The ratio of the num-
ber of such physicians to the number of individuals
in the population.
‘‘(5) The extent to which the individuals lack
access to primary health services, taking into consid-
eration barriers resulting from a lack of proficiency
in speaking the English language or from other cul-
tural factors; the distance to sites providing primary
health services and the lack of transportation to
such sites; and any other barriers encountered by
the population.’’.
(B) Section 332(a)(3) of the Public Health
Service Act (42 U.S.C. 254e(a)(3)) is amended
to read as follows:
‘‘(3) With respect to the consideration by the Sec-
retary under paragraph (1) of the population of an area,
the population served by a facility, or a population group,
the terms ‘population’ and ‘population group’ include His-
panics, African Americans, Native Americans, Asian
Americans; Pacific Islanders, and subgroups of such racial
or ethnic minority groups; individuals who lack proficiency
in speaking the English language; tribes and tribal organi-
zations; seasonal or migrant agricultural workers; home-
less individuals; elderly individuals; and individuals with
a disability.’’.
(2) PRIORITIES IN ASSIGNMENT OF CORPS PER-
SONNEL.—Section 333A(b) of the Public Health
Service Act (42 U.S.C. 254f–1(b)) is amended by
striking paragraphs (1) and (2) and inserting the
following:
‘‘(1) Factors indicating the health status of the
population, including the following (which the Sec-
retary shall consider to be of equal importance): The
rate of infant mortality and morbidity; and the ex-
tent to which there is a substantial rate of morbidity
resulting from complications in infectious, commu-
nicable, or chronic diseases that have progressed to
a critical condition (as indicated by data provided
pursuant to discharging patients from hospitals and
pursuant to admissions to the emergency facilities of
hospitals).
‘‘(2) The ability to pay for health services, in-
cluding the rate of poverty and including the per-
centage of the population constituted by individuals
and families that do not have health insurance.
‘‘(3) The percentage of the population con-
stituted by members of racial or ethnic minority
groups.
‘‘(4) With respect to community-based physi-
cians who provide primary health services and who
are accepting additional patients whose means of
payment is through the program established in title
XVIII or XIX, the following: The ratio of the num-
ber of such physicians to the number of individuals
in the population.
‘‘(5) The extent to which the individuals lack
access to primary health services, taking into consid-
eration barriers resulting from a lack of proficiency
in speaking the English language or from other cul-
tural factors; the distance to sites providing primary
health services and the lack of transportation to
such sites; and any other barriers encountered by
the population.’’.
(4) DEFINITION.—Section 331(a)(3) of the
Public Health Service Act (42 U.S.C. 254d(a)(3)) is
amended by adding at the end the following sub-
paragraph:
‘‘(E) The term ‘racial or ethnic minority group’
has the meaning given such term in section
1707(g).’’.
SEC. 6. LACK OF ENGLISH PROFICIENCY AS BARRIER TO
OBTAINING HEALTH CARE.
(a) CONTINUATION OF CERTAIN INITIATIVES FOR
REMOVAL OF BARRIERS.—
(1) 
MIGRANT
HEALTH
CENTERS.—Section
329(h) of the Public Health Service Act (42 U.S.C.
254b(h)) is amended by adding at the end the fol-
lowing paragraph:
‘‘(4)(A) For the purpose of carrying out subpara-
graph (B), there are authorized to be appropriated
$3,000,000 for each of the fiscal years 1994 through
1996.
‘‘(B) The Secretary may make grants to migrant
health centers for programs to reduce the extent to which
a lack of proficiency in speaking the English language (or
other cultural factors) constitute a significant barrier to
obtaining health services.’’.
(2) COMMUNITY
HEALTH
CENTERS.—Section
330(g) of the Public Health Service Act (42 U.S.C.
254c(g)) is amended by adding at the end the fol-
lowing paragraph:
‘‘(4)(A) For the purpose of carrying out subpara-
graph (B), there are authorized to be appropriated
$3,000,000 for each of the fiscal years 1994 through
1996.
‘‘(B) The Secretary may make grants to community
health centers for programs to reduce the extent to which
a lack of proficiency in speaking the English language (or
other cultural factors) constitute a significant barrier to
obtaining health services.’’.
(b) ISSUANCE OF REGULATIONS.—
(1) PROPOSED RULE.—Not later than the expi-
ration of the 90-day period beginning on the date of
the enactment of this Act, the Secretary of Health
and Human Services (in this section referred to as
the ‘‘Secretary’’) shall issue a proposed rule to es-
tablish regulations for policies to reduce the extent
to which a lack of proficiency in speaking the Eng-
lish language constitutes a significant barrier to in-
dividuals in establishing the eligibility of the individ-
uals for participation in health programs under the
Public Health Service Act or title XIX of the Social
Security Act, or in receiving services under such pro-
grams.
(2) FINAL RULE.—
(A) IN GENERAL.—Not later than the ex-
piration of the 1-year period beginning the date
of the enactment of this Act, the Secretary shall
issue a final rule to establish the regulations de-
scribed in paragraph (1).
(B) FAILURE
TO
ISSUE
BY
DATE
CER-
TAIN.—If the Secretary fails to issue a final
rule under subparagraph (A) before the expira-
tion of the period specified in such subpara-
graph, the proposed rule issued under para-
graph (1) is upon such expiration deemed to be
the final rule under subparagraph (A) (and
shall remain in effect until the Secretary issues
a final rule under such subparagraph).
SEC. 7. CENTERS OF EXCELLENCE IN HEALTH PROFES-
SIONS EDUCATION.
(a) USE OF FUNDS.—Section 739(b) of the Public
Health Service Act (42 U.S.C. 293c(b)), as added by sec-
tion 102 of Public Law 102–408 (106 Stat. 1994), is
amended to read as follows:
‘‘(b) USE OF FUNDS.—
‘‘(1) REQUIRED USES.—The Secretary may not
make a grant under subsection (a) unless the health
professions school involved agrees to expend the
grant for each of the following purposes:
‘‘(A) To colloborate with public and non-
profit private entities to carry out community-
based programs to recruit minority students of
secondary schools and institutions of higher
education and to prepare the students academi-
cally for attendance at the health professions
school.
‘‘(B) To improve the capacity of such
school to train, recruit, and retain minority fac-
ulty.
‘‘(C) With respect to minority health is-
sues, to carry out activities to improve the in-
formation resources and curricula of the school
and clinical education at the school.
‘‘(D) To facilitate faculty and student re-
search on health issues particularly affecting
minority groups.
‘‘(2) RELATIONSHIP WITH OTHER ENTITIES.—
In expending a grant under subsection (a), a health
professions school may permit public and nonprofit
private entities to participate in the programs and
activities that the school carries out under such sub-
section. The preceding sentence applies without re-
gard to whether such entities have been designated
under subsection (d) as centers of excellence.’’.
(b) DEFINITION.—Section 739(h) of the Public
Health Service Act (42 U.S.C. 293c(h)) is amended by
adding at the end the following paragraph:
‘‘(4) The term ‘minority’’, with respect to an in-
dividual, means an individual who is a member of a
racial or ethnic minority group, as defined in section
1707(g).’’.
(c) FUNDING.—Section 739(i) of the Public Health
Service Act (42 U.S.C. 293c(i)), as added by section 102
of Public Law 102–408 (106 Stat. 1994), is amended—
(1) in paragraph (1), by inserting before the pe-
riod the following: ‘‘, and $27,000,000 for each of
the fiscal years 1994 through 1996’’; and
(2) in paragraph (2)—
(A) in subparagraph (B), by striking ‘‘60
percent’’ and inserting ‘‘80 percent’’; and
(B) in subparagraph (C), by striking ‘‘40
percent’’ and inserting ‘‘20 percent’’.
SEC. 8. FUNDING FOR ACTIVITIES OF AGENCY FOR HEALTH
CARE POLICY AND RESEARCH.
Section 926(a) of the Public Health Service Act (42
U.S.C. 299c-5(a)) is amended by adding at the end the
following sentences: ‘‘Of the amounts appropriated under
the preceding sentence for a fiscal year, the Administrator
shall reserve not less than 8 percent for carrying out sec-
tion 902(b)(2). The activities carried out by the Secretary
with the amounts so reserved shall include activities re-
garding Hispanic individuals (as defined in section
1707(g)).’’.
SEC. 9. FUNDING FOR CERTAIN ACTIVITIES OF NATIONAL
CENTER FOR HEALTH STATISTICS.
Section 306(o) of the Public Health Service Act (42
U.S.C. 242k(o)) is amended—
(1) in paragraph (1)—
(A) by striking ‘‘subsections (a) through
(m)’’ and inserting ‘‘this section’’; and
(B) by striking ‘‘1993.’’ and inserting
‘‘1993, $65,000,000 for fiscal year 1994, and
such sums as may be necessary for each of the
fiscal years 1995 and 1996.’’; and
(2) by amending paragraph (2) to read as fol-
lows:
‘‘(2) Of the amounts appropriated under paragraph
(1) for a fiscal year, the Secretary shall obligate not less
than an aggregate $10,000,000 for carrying out sub-
sections (h), (m), and (n), except that not more than
$100,000 may be expended in the aggregate for the ad-
ministration of activities under subsection (n) and for ac-
tivities described in paragraph (2) of such subsection.’’.
SEC. 10. DEMONSTRATION PROJECTS REGARDING DIABE-
TES-RELATED EYE DISORDERS.
(a) IN GENERAL.—The Secretary may make grants
to public and nonprofit private entities for the purpose of
carrying out demonstration projects that, for Hispanics,
African Americans, and any other populations that are at
significant risk of contracting diabetes mellitus—
(1) provide screenings for eye disorders for
which diabetes mellitus is a significant causal factor;
(2) provide appropriate referrals for services for
individuals who are screened pursuant to paragraph
(1) and ensure, to the extent practicable, the provi-
sion of appropriate follow-up services;
(3) develop and disseminate public information
and education programs for the detection and con-
trol of such eye disorders; and
(4) improve the education, training, and skills
of health professionals (including allied health pro-
fessionals) in the detection and control of such eye
disorders.
(b) PRIORITY
REGARDING
DIABETIC
RETINOP-
ATHY.—The Secretary may make a grant under sub-
section (a) only if the applicant involved agrees to give
priority to carrying out paragraphs (1) through (4) of
such subsection with respect to the eye disorder known
as diabetic retinopathy.
(c) APPLICATION FOR GRANT.—The Secretary may
make a grant under subsection (a) only if an application
for the grant is submitted to the Secretary and the appli-
cation is in such form, is made in such manner, and con-
tains such agreements, assurances, and information as the
Secretary determines to be necessary to carry out this sec-
tion.
(d) DEFINITIONS.—For purposes of this section, the
term ‘‘Secretary’’ means the Secretary of Health and
Human Services.
(e) AUTHORIZATION OF APPROPRIATIONS.—For the
purpose of carrying out this section, there are authorized
to be appropriated $100,000 for fiscal year 1994, and
such sums as may be necessary for each of the fiscal years
1995 and 1996.
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