quirements of subsection (e)(3) by the end of
the period of support under that subsection.’’.
(4) Section 330(e)(3) of the Public Health
Service Act (42 U.S.C. 254c(e)(3)) is amended in
the matter after and below subparagraph (K) by
adding at the end the following sentence: ‘‘The Sec-
retary may not approve an application under sub-
section (d)(l)(B) unless the Secretary determines
that the entity will meet all of the requirements of
this paragraph by the end of the period of support
under that subsection.’’
(5) Section 330(e)(6) of the Public Health
Service Act (42 U.S.C. 254c(e)(6)) is amended—
(A) by striking ‘‘(c) or (d)’’ and inserting
‘‘(c), (d), or (l)’’; and
(B) by inserting ‘‘, network, or plan’’ after
‘‘community health center’’.
(6) Section 330(f)(1) of the Public Health Serv-
ice Act (42 U.S.C. 254c(f)(1)) is amended by strik-
ing ‘‘(e)(2)’’ and inserting ‘‘(e)(3)’’.
(7) Section 330(i) of the Public Health Service
Act (42 U.S.C. 254c(i)) is amended in each of para-
graphs (1) and (2) by striking ‘‘under subsection
(d)’’ and inserting ‘‘under this section’’.
SEC. 3. ESTABLISHING A PROGRAM OF LOANS AND LOAN
GUARANTEES.
(a) LOANS AND LOAN GUARANTEES.—Subpart I of
part D of title III of the Public Health Service Act (42
U.S.C. 254b et seq.) is amended by adding at the end the
following new section:
‘‘FEDERAL LOAN AND LOAN GUARANTEE PROGRAM
‘‘SEC. 330A. (a) LOANS AND LOAN GUARANTEES.—
‘‘(1) From the fund established pursuant to
subsection (b), the Secretary may make loans and
guarantee the payment of principal and interest to
Federal and non-Federal lenders for loans to any
public or nonprofit private entity that receives a
grant under sections 329, 330, or 340 for projects
for—
‘‘(A) the acquisition, modernization, expan-
sion or construction of facilities, or the conver-
sion of unneeded hospital facilities to facilities
that will assure or enhance the provision and
accessibility of primary health care and ena-
bling services to medically underserved popu-
lations;
‘‘(B) the purchase of major equipment, in-
cluding equipment necessary for the support of
external and internal information systems;
‘‘(C) the establishment of reserves required
for furnishing services on a prepaid basis; and
‘‘(D) such other capital costs as the Sec-
retary may determine are necessary to enable
the grant recipient to achieve the objectives of
sections 329, 330 or 340, as applicable.
‘‘(2)(A) In making loans and loan guarantees
authorized under this section, the Secretary shall
give preference to applications of community health
centers that have received grants under section
330(d)(1)(A) and community health service net-
works or plans that have received grants under sec-
tion 330(l).
‘‘(B) Priority shall be given to applications for
projects for the renovation and modernization of
medical facilities necessary to prevent or eliminate
safety hazards, avoid noncompliance with licensure
or accreditation standards, or projects to replace ob-
solete facilities.
‘‘(C) The Secretary may make loans or loan
guarantees for the construction of new buildings
only if the Secretary determines that appropriate fa-
cilities are not available through acquiring, mod-
ernizing, expanding or converting existing buildings,
or that construction of new buildings will cost less.
‘‘(3) The Secretary may pay, to the holder of
a loan under paragraph (1), for and on behalf of the
project for which the loan was made, amounts suffi-
cient to reduce, up to seventy five percent the net
effective interest rate otherwise payable on such
loan, if the Secretary finds that without such assist-
ance the project could not be undertaken.
‘‘(4) The principal amount of a loan directly
made or guaranteed under this section may, when
added to any other assistance under sections 329,
330, or 340, cover up to one hundred percent of
such costs.
‘‘(5) The cumulative total of the principal of
the loans outstanding at any time with respect to
which guarantees have been issued, or which have
been directly made, may not exceed limitations as
may be specified in appropriation Acts.
‘‘(6)(A) The Secretary may not approve a loan
guarantee for a project under this section unless he
determines that the terms, conditions, security (if
any), and schedule and amount of repayments with
respect to the loan are sufficient to protect the fi-
nancial interests of the United States and are other-
wise reasonable.
‘‘(B) Guarantees of loans under this section
shall be subject to such further terms and conditions
as the Secretary determines to be necessary to as-
sure that the purposes of this section will be
achieved.
‘‘(7)(A) The Secretary may approve a loan
under this section only if—
‘‘(i) the Secretary is reasonably satisfied
that the applicant for the project for which the
loan would be made will be able to make pay-
ments of principal and interest thereon when
due, and—
‘‘(ii) the applicant provides the Secretary
with reasonable assurances that there will be
available to it such additional funds as may be
necessary to complete the project or undertak-
ing with respect to which such loan is re-
quested.
‘‘(B) Any loan made under this section shall (i)
have such security, (ii) have such maturity date, (iii)
be repayable in such installments, (iv) bear interest
at a rate comparable to the rate of interest prevail-
ing on the date the loan is made, with respect to
loans guaranteed under this section, minus any in-
terest subsidy made in accordance with paragraph
(3), and (v) be subject to such other terms and con-
ditions (including provisions for recovery in case of
default), as the Secretary determines to be necessary
to carry out the purposes of this section and sections
329, 330 and 340, as applicable, while adequately
protecting the financial interests of the United
States.
‘‘(C) The Secretary may, for good cause but
with due regard to the financial interests of the
United States, waive any right of recovery which he
has by reasons of the failure of a borrower to make
payments of principal of and interest on a loan made
under this subsection, except that if such loan is
sold and guaranteed, any such waiver shall have no
effect upon the Secretary’s guarantee of timely pay-
ment of principal and interest.
‘‘(b) LOAN AND LOAN GUARANTEE FUND.—
‘‘(1) There is established in the Treasury a loan
and loan guarantee fund (hereinafter in this sub-
section referred to as the ‘fund’) which shall be
available as may be specified from time to time in
appropriations Acts to enable the Secretary to make
loans, loan guarantees, payment of interest subsidies
and such other actions as authorized under sub-
section (a). There shall also be deposited in the fund
‘‘(2) The Secretary may take such action, con-
sistent with State law respecting foreclosure proce-
dures, as the Secretary deems appropriate to protect
the interest of the United States in the event of a
default on a loan made or guaranteed under sub-
section (a), including selling real property pledged as
security for such a loan or loan guarantee and for
a reasonable period of time taking possession of,
holding, and using real property pledged as security
for such a loan or loan guarantee.
‘‘(d) APPLICATIONS.—No loan or loan guarantee may
be made under this section unless an application is sub-
mitted to and approved by the Secretary. The application
shall be in the form and manner and contain such infor-
mation as the Secretary may prescribe, and if the project
is for construction, conversion, expansion or moderniza-
tion of a facility, the application shall at a minimum meet
the requirements of Section 330(e)(l) of this Act.
‘‘(e) RIGHT OF RECOVERY.—
‘‘(1) If any facility with respect to which a loan
or loan guarantee was made under this section, or
with respect to which a grant was made under sec-
tions 329, 330, or 340, for construction, acquisition,
expansion or modernization, shall at any time within
twenty years after completion—
‘‘(A) be sold or transferred to any entity
which is not eligible for assistance under sec-
tions 329, 330 or 340 or which is not approved
by the Secretary as a transferee, or
‘‘(B) cease to be a public or nonprofit en-
tity that is eligible for assistance under sections
329, 330 or 340,
the United States shall be entitled to recover from
the recipient of the grant, loan or loan guarantee,
the purchaser or transferee, the amount of the
grant, loan or loan guarantee plus interest. This
right of recovery shall not constitute a lien on any
facility with respect to which funds have been paid
under this section.
‘‘(2) Notwithstanding paragraph (1), the Sec-
retary shall subordinate or waive the right of recov-
ery and any other Federal interest that may be de-
rived by virtue of a loan or loan guarantee under
this section, or a grant under sections 329, 330, or
340, to support the construction, acquisition, mod-
ernization, expansion, conversion of a facility or
other capital project authorized under this section,
where the facility is being used as security for a new
loan which will support improvements to the facility,
construction of new primary health care facilities or
improvements of health services described in section
330(a) to medically underserved populations, or
where the facility is being sold in order to finance
the acquisition or construction of another facility
which will be used for the purposes authorized by
sections 329, 330 or 340, provided that the Sec-
retary shall obtain an equivalent right of recovery or
interest in the new facility.’’.
SEC. 4. AMENDMENTS TO THE MIGRANT HEALTH CENTERS
AND HEALTH CARE FOR THE HOMELESS PRO-
GRAM AUTHORITIES.
(a) ENABLING AND OUTREACH SERVICES.—(1) Sec-
tion 329(a)(1) of the Public Health Service Act (42 U.S.C.
254b(a)(1)) is amended—
(A) in the matter preceding subparagraph (A),
by striking ‘‘provides—’’ and inserting the following:
‘‘provides, at appropriate locations, which may in-
clude schools and other sites—’’;
(B) in subparagraph (H), by inserting before
‘‘patient case management services’’ the following:
‘‘the services of outreach workers and others to de-
termine, or assist in determining, the eligibility of
individuals to receive services and benefits under
Federal, State and local health programs, and to as-
sist such individuals in enrolling in such programs,
and other’’;
(C) in subparagraph (G), by striking ‘‘and’’ at
the end;
(D) in subparagraph (H), by adding ‘‘and’’
after the comma at the end; and
(E) by inserting after subparagraph (H) the
following new subparagraph:
‘‘(I) enabling services, defined as services that
are not otherwise described in this subsection, that
promote access to necessary health and other human
and social services, and that increase the capacity of
individuals to utilize the items and services that are
included as covered benefits under Federal, State, or
local health programs,’’.
(2) Section 340(i) of the Public Health Service Act
(42 U.S.C. 256(i)) is amended—
(A) in paragraph (1)—
(i) in subparagraph (B), by adding ‘‘and’’
after the semicolon at the end;
(ii) in subparagraph (C), by striking ‘‘; or’’
and inserting a period; and
(iii) by striking subparagraph (D); and
(B) in paragraph (2), by amending the para-
graph to read as follows:
‘‘(2) Any grant may include the acquisition, expan-
sion, or modernization of existing buildings, and the con-
struction of new buildings (if the Secretary determines
that appropriate facilities are not available through the ac-
quisition, expansion or modernization of existing build-
ings, or that construction of a new building will cost
less).’’
(3) Section 340(r)(1) of the Public Health Service
Act (42 U.S.C. 256(r)(1)) is amended by inserting before
‘‘and substance abuse services’’ the following: ‘‘, supple-
mental health services, enabling services,’’.
(4) Section 340(r)(6) of the Public Health Service
Act (42 U.S.C. 256(r)(6)) is amended to read as follows:
‘‘(6) The terms ‘primary health services’, ‘sup-
plemental health services’ and ‘enabling services’,
have the meanings given such terms in section
330.’’.
(b) AUTHORIZATION OF APPROPRIATIONS.—(1) Sec-
tion 329(h)(1)(A) of the Public Health Service Act (42
U.S.C. 254b(h)(1)(A)) is amended by striking ‘‘there are
authorized’’ and all that follows and inserting the follow-
ing: 
‘‘there 
are 
authorized 
to 
be 
appropriated
$100,000,000 for fiscal year 1995, $110,000,000 for fis-
cal year 1996, $120,000,000 for fiscal year 1997,
$130,000,000 for fiscal year 1998, $140,000,000 for fis-
cal year 1999, $150,000,000 for fiscal year 2000, and
such sums equal to or greater than $150,000,000 as may
be necessary for each of the five fiscal years thereafter.
The preceding sentence constitutes budget authority in ad-
vance of appropriations acts and represents the obligation
of the Federal government to provide funding for pay-
ments in the amounts, and for the fiscal years specified
under this section. Such levels shall not be subject to offset
or reprogramming for any reason.’’.
(2) Section 340(q)(1) of the Public Health Service
Act is amended by striking ‘‘There are authorized’’ and
all that follows and inserting the following: ‘‘There are au-
thorized to be appropriated to carry out this section
$100,000,000 for fiscal year 1995, $110,000,000 for fis-
cal year 1996, $120,000,000 for fiscal year 1997,
$130,000,000 for fiscal year 1998, $140,000,000 for fis-
cal year 1999, $150,000,000 for fiscal year 2000, and
such sums equal to or greater than $150,000,000 as may
be necessary for each of the five fiscal years thereafter.
The preceding sentence constitutes budget authority in ad-
vance of appropriations acts and represents the obligation
of the Federal government to provide funding for pay-
ments in the amounts, and for the fiscal years specified
under this section. Such levels shall not be subject to offset
or reprogramming for any reason.’’.