‘‘SEC. 108. CONTINUING EDUCATION ALLOWANCES. 
‘‘In order to encourage health professionals, including 
community health representatives and emergency medical 
technicians, to join or continue in an Indian Health Pro-
gram or an Urban Indian Organization and to provide 
their services in the rural and remote areas where a sig-
nificant portion of Indians reside, the Secretary, acting 
through the Service, may provide allowances to health pro-
fessionals employed in an Indian Health Program or an 
Urban Indian Organization to enable them for a period 
of time each year prescribed by regulation of the Secretary 
to take leave of their duty stations for professional con-
sultation 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 Representa-
tive Program under which Indian Health Programs— 
‘‘(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 commu-
nities. 
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‘‘(b) DUTIES.—The Community Health Representa-
tive 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 preven-
tion services to the Indian communities served by 
the Program; 
‘‘(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 pre-
vention activities, with appropriate consider-
ation given to lifestyle factors that have an im-
pact on Indian health status, such as alco-
holism, family dysfunction, and poverty; 
‘‘(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; 
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CCOLEMAN on PROD1PC71 with BILLS
‘‘(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 Serv-
ice standards for the provision of health care, health 
promotion, and disease prevention. 
‘‘SEC. 110. INDIAN HEALTH SERVICE LOAN REPAYMENT 
PROGRAM. 
‘‘(a) 
ESTABLISHMENT.—The 
Secretary, 
acting 
through the Service, shall establish and administer a pro-
gram to be known as the Service Loan Repayment Pro-
gram (hereinafter referred to as the ‘Loan Repayment 
Program’) in order to ensure an adequate supply of 
trained health professionals necessary to maintain accredi-
tation of, and provide health care services to Indians 
through, Indian Health Programs and Urban Indian Or-
ganizations. 
‘‘(b) ELIGIBLE INDIVIDUALS.—To be eligible to par-
ticipate in the Loan Repayment Program, an individual 
must— 
‘‘(1)(A) be enrolled— 
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CCOLEMAN on PROD1PC71 with BILLS
‘‘(i) in a course of study or program in an 
accredited educational institution (as deter-
mined 
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 individual applies to partici-
pate 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; 
‘‘(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 
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CCOLEMAN on PROD1PC71 with BILLS
‘‘(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 applica-
tion is approved (and whose contract is accepted) by 
the Secretary, including in the summary a clear ex-
planation of the damages to which the United States 
is entitled under subsection (l) in the case of the in-
dividual’s breach of contract. The Secretary shall 
provide such individuals with sufficient information 
regarding the advantages and disadvantages of serv-
ice as a commissioned officer in the Regular or Re-
serve Corps of the Public Health Service or a civil-
ian employee of the Service to enable the individual 
to make a decision on an informed basis. 
‘‘(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 aver-
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CCOLEMAN on PROD1PC71 with BILLS
age individual applying to participate in the Loan 
Repayment Program. 
‘‘(3) TIMELY
AVAILABILITY
OF
FORMS.—The 
Secretary shall make such application forms, con-
tract forms, and other information available to indi-
viduals desiring to participate in the Loan Repay-
ment Program 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 pri-
ority determined under paragraph (1), the Secretary, 
in determining which applications under the Loan 
Repayment Program to approve (and which con-
tracts to accept), shall— 
‘‘(A) give first priority to applications 
made by individual Indians; and 
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CCOLEMAN on PROD1PC71 with BILLS
‘‘(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 Pro-
gram only upon the Secretary and the individual en-
tering into a written contract described in paragraph 
(2). 
‘‘(2) CONTENTS
OF
CONTRACT.—The written 
contract referred to in this section between the Sec-
retary and an individual shall contain— 
‘‘(A) an agreement under which— 
‘‘(i) subject to subparagraph (C), the 
Secretary agrees— 
‘‘(I) to pay loans on behalf of the 
individual in accordance with the pro-
visions of this section; and 
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CCOLEMAN on PROD1PC71 with BILLS
‘‘(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 deter-
mined under regulations of the 
Secretary by the educational in-
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