‘‘(b) LOAN GUARANTEES.—The Secretary may not
approve a loan guarantee under section 2773 unless the
Secretary determines that the terms, conditions, security
(if any), schedule and amount of repayments with respect
to the loan are sufficient to protect the financial interests
of the United States and are otherwise reasonable. Such
loan guarantees shall be subject to such further terms and
conditions as the Secretary determines, in consultation
with the Secretary of the Treasury, and subject to the
Federal Credit Reform Act of 1990, to be necessary to
ensure that the purposes of this section will be achieved.
‘‘(c) USE OF EXISTING RESOURCES.—The Secretary
may provide a loan or loan guarantee under section 2773
only if the applicant involved agrees that, in developing
the qualified community health group involved, the appli-
cant will utilize existing resources to the maximum extent
practicable.
‘‘SEC. 2775. DEFAULTS; RIGHT OF RECOVERY.
‘‘(a) DEFAULTS.—
‘‘(1) IN
GENERAL.—The Secretary may take
such action as may be necessary to prevent a default
on loans or loan guarantees under section 2773, in-
cluding the waiver of regulatory conditions, deferral
of loan payments, renegotiation of loans, and the ex-
penditure of funds for technical and consultative as-
sistance, for the temporary payment of the interest
and principal on such a loan, and for other pur-
poses.
‘‘(2) FORECLOSURE.—The Secretary may take
such action, consistent with State law respecting
foreclosure procedures, as the Secretary deems ap-
propriate to protect the interest of the United States
in the event of a default on a loan made pursuant
to section 2773, including selling real property
pledged as security for such a loan or loan guarantee
and for a reasonable period of time taking posses-
sion of, holding, and using real property pledged as
security for such a loan or loan guarantee.
‘‘(3) WAIVERS.—The Secretary may, for good
cause, but with due regard to the financial interests
of the United States, waive any right of recovery
which the Secretary has by reasons of the failure of
a borrower to make payments of principal of and in-
terest on a loan made pursuant to section 2773, ex-
cept that if such loan is sold and guaranteed, any
such waiver shall have no effect upon the Secretary’s
guarantee of timely payment of principal and
interest.
‘‘(b) TWENTY-YEAR OBLIGATION; RIGHT OF RECOV-
ERY.—
‘‘(1) IN GENERAL.—With respect to a facility
for which a loan is to be made pursuant to section
2773, the Secretary may provide the loan or loan
guarantee only if the applicant involved agrees that
the applicant will be liable to the United States for
the amount of the loan or loan guarantee, together
with an amount representing interest, if at any time
during the 20-period beginning on the date of com-
pletion of the activities involved, the facility—
‘‘(A) ceases to be a facility utilized by a
qualified community health group, or by an-
other public or nonprofit private entity that
provides health services in one or more health
professional shortage areas or that provides
such services to a significant number of individ-
uals who are members of a medically under-
served population; or
‘‘(B) is sold or transferred to any entity
other than an entity that is—
‘‘(i) a qualified community health
group or other entity described in subpara-
graph (A); and
‘‘(ii) approved by the Secretary as a
purchaser or transferee regarding the facil-
ity.
‘‘(2) SUBORDINATION; 
WAIVERS.—The Sec-
retary may subordinate or waive the right of recov-
ery under paragraph (1), and any other Federal in-
terest that may be derived by virtue of a loan or
loan guarantee under subsection (a), if the Secretary
determines that subordination or waiver will further
the objectives of this part.
‘‘SEC. 2776. PROVISIONS REGARDING CONSTRUCTION OR
EXPANSION OF FACILITIES.
‘‘(a) SUBMISSION OF INFORMATION.—In the case of
a project for construction, conversion, expansion or mod-
ernization of a facility, the Secretary may provide loans
or loan guarantees under section 2773 only if the appli-
cant submits to the Secretary the following:
‘‘(1) A description of the site.
‘‘(2) Plans and specifications which meet re-
quirements prescribed by the Secretary.
‘‘(3) Information reasonably demonstrating that
title to such site is vested in one or more of the enti-
ties filing the application (unless the agreement de-
scribed in subsection (b)(1) is made).
‘‘(4) A specification of the type of assistance
being requested under section 2773.
‘‘(b) AGREEMENTS.—In the case of a project for con-
struction, conversion, expansion or modernization of a fa-
cility, the Secretary may provide loans or loan guarantees
under section 2773 only if the applicant makes the follow-
ing agreements:
‘‘(1) Title to such site will be vested in one or
more of the entities filing the application (unless the
assurance described in subsection (a)(3) has been
submitted under such subsection).
‘‘(2) Adequate financial support will be avail-
able for completion of the project and for its mainte-
nance and operation when completed.
‘‘(3) All laborers and mechanics employed by
contractors or subcontractors in the performance of
work on a project will be paid wages at rates not
less than those prevailing on similar construction in
the locality as determined by the Secretary of Labor
in accordance with the Act of March 3, 1931 (40
U.S.C. 276a et seq; commonly known as the Davis-
Bacon Act), and the Secretary of Labor shall have
with respect to such labor standards the authority
and functions set forth in Reorganization Plan
Numbered 14 of 1950 (15 FR 3176; 5 U.S.C. Ap-
pendix) and section 276c of title 40.
‘‘(4) The facility will be made available to all
persons seeking service regardless of their ability to
pay.
‘‘SEC. 2777. APPLICATION FOR ASSISTANCE.
‘‘The Secretary may provide loans or loan guarantees
under section 2773 only if an application for such assist-
ance is submitted to the Secretary, the application con-
tains each agreement described in this subpart, the appli-
cation contains the information required in section
2781(a), and the application is in such form, is made in
such manner, and contains such agreements, assurances,
and information as the Secretary determines to be nec-
essary to carry out this subpart.
‘‘SEC. 2778. ADMINISTRATION OF PROGRAMS.
This subpart, and any other program of the Secretary
that provides loans or loan guarantees, shall be carried
out by a centralized loan unit established within the De-
partment of Health and Human Services.
‘‘PART 3—ENABLING SERVICES
‘‘SEC. 2779. AUTHORIZATIONS OF APPROPRIATIONS FROM
FUND.
‘‘(a) ENABLING SERVICES.—For the purpose of car-
rying out this part, there are authorized to be appro-
priated from the Fund $200,000,000 for each of the fiscal
year 1996 through 1999, and $100,000,000 for fiscal year
2000.
‘‘(b) RELATION TO OTHER FUNDS.—The authoriza-
tions of appropriations established in subsection (a) are
in addition to any other authorizations of appropriations
that are available for the purpose described in such sub-
section.
‘‘SEC. 2780. GRANTS AND CONTRACTS FOR ENABLING SERV-
ICES.
‘‘(a) IN GENERAL.—
‘‘(1) GRANTS AND CONTRACTS.—The Secretary
may make grants to and enter into contracts with
entities described in paragraph (2) to assist such en-
tities in providing the services described in sub-
section (b) for the purpose of increasing the extent
to which individuals appropriately utilize health serv-
ices that are available to the individuals, including
health services for which the individuals are eligible
under Federal and State programs.
‘‘(2) RELEVANT
ENTITIES.—For purposes of
paragraph (1), the entities described in this para-
graph are qualified community health groups (as de-
fined in section 2763(a)), and other public or non-
profit private entities, that—
‘‘(A) provide health services in one or more
health professional shortage areas or that pro-
vide such services to a significant number of in-
dividuals who are members of a medically un-
derserved population; and
‘‘(B) are experienced in providing services
to increase the extent to which individuals ap-
propriately utilize health services that are avail-
able to the individuals.
‘‘(b) ENABLING SERVICES.—The services referred to
in subsection (a)(1) are transportation, community and
patient outreach, patient education, translation services,
and such other services as the Secretary determines to be
appropriate in carrying out the purpose described in such
subsection.
‘‘(c) CERTAIN REQUIREMENTS REGARDING PROJECT
AREA.—The Secretary may make an award of a grant or
contract under subsection (a) only if the applicant in-
volved—
‘‘(1) submits to the Secretary—
‘‘(A) information demonstrating that the
medically underserved populations in the com-
munity to be served under the award have a
need for enabling services; and
‘‘(B) a proposed budget for providing such
services; and
‘‘(2) the applicant for the award agrees that the
residents of the community will be significantly in-
volved in the project carried out with the award.
‘‘(d) IMPOSITION
OF FEES.—The Secretary may
make an award of a grant or contract under subsection
(a) only if the applicant involved agrees that, in the project
carried out under such subsection, enabling services will
be provided without charge to the recipients of the serv-
ices.
‘‘(e) USE OF EXISTING RESOURCES.—The Secretary
may make an award of a grant or contract under sub-
section (a) only if the applicant involved agrees that, in
carrying out the project under such subsection, the appli-
cant will utilize existing resources to the maximum extent
practicable.
‘‘(f) APPLICATION FOR AWARDS OF ASSISTANCE.—
The Secretary may make an award of a grant or contract
under subsection (a) only if an application for the award
is submitted to the Secretary, the application contains
each agreement described in this subpart, the application
contains the information required in subsection (d)(1),
and the application is in such form, is made in such man-
ner, and contains such agreements, assurances, and infor-
mation as the Secretary determines to be necessary to
carry out this subpart.
‘‘(g) DEFINITION.—For purposes of this section, the
term ‘enabling services’ means services described in sub-
section (b) that are provided for the purpose described in
subsection (a)(1).
‘‘PART 4—NATIONAL HEALTH SERVICE CORPS
‘‘SEC. 2781. AUTHORIZATIONS OF APPROPRIATIONS FROM
FUND.
‘‘(a) ADDITIONAL FUNDING; GENERAL CORPS PRO-
GRAM; ALLOCATIONS REGARDING NURSES.—For the pur-
pose of carrying out subpart II of part D of title III, and
for the purpose of carrying out subsection (c), there are
authorized to be appropriated from the Fund $50,000,000
for fiscal year 1995, $100,000,000 for fiscal year 1996,
and $200,000,000 for each of the fiscal years 1997
through 2000.
‘‘(b) RELATION TO OTHER FUNDS.—The authoriza-
tions of appropriations established in subsection (a) are
in addition to any other authorizations of appropriations
that are available for the purpose described in such sub-
section.
‘‘(c) ALLOCATION FOR PARTICIPATION OF NURSES
IN SCHOLARSHIP AND LOAN REPAYMENT PROGRAMS.—
Of the amounts appropriated under subsection (a), the
Secretary shall reserve such amounts as may be necessary
to ensure that, of the aggregate number of individuals who
are participants in the Scholarship Program under section
338A, or in the Loan Repayment Program under section
338B, the total number who are being educated as nurses
or are serving as nurses, respectively, is increased to 30
percent.
‘‘(d) AVAILABILITY OF FUNDS.—An appropriation
under this section for any fiscal year may be made at any
time before that fiscal year and may be included in an
Act making an appropriation under an authorization
under subsection (a) for another fiscal year; but no funds
may be made available from any appropriation under this
section for obligation under sections 331 through 335, sec-
tion 336A, and section 337 before the fiscal year involved.
‘‘PART 5—SATELLITE CLINICS REGARDING
PRIMARY HEALTH CARE
‘‘SEC. 2783. AUTHORIZATION OF APPROPRIATIONS FORM
FUND.
For the purpose of carrying out this part, there is
authorized to be appropriated from the Fund $50,000,000
for each of the fiscal years 1995 through 2000.
‘‘SEC. 2783A. GRANTS TO STATES FOR DEVELOPMENT AND
OPERATION OF SATELLITE CLINICS.
‘‘(a) IN
GENERAL.—With respect to outpatient
health centers that are providers of comprehensive health
services, the Secretary may make grants to States for the
purpose of assisting such centers in developing or operat-
ing facilities that—
‘‘(1) provide clinical preventive services, treat-
ment of minor illnesses and injuries, family planning
services, and referrals for health services, mental
health services, and health-related social services;
and
‘‘(2) are located at a distance from the center
sufficient to increase the extent to which individuals
in the geographic area involved have access to the
services specified in paragraph (1).
‘‘(b) CERTAIN REQUIREMENTS.—The Secretary may
make a grant under subsection (a) only if the State agrees
that the health facility for which the grant is made, once
in operation, will meet the following conditions:
‘‘(1) The clinical preventive services provided by
the facility will include routine preventive services,
including family planning services, for pregnant and
postpartum women and for children, including
health screenings and immunizations.
‘‘(2) The principal providers of health services
at the facility, and the principal managers of the fa-
cility, will be nurse practitioners or nurse clinicians,
subject to applicable law.
‘‘(3) The outpatient health center operating the
facility will serve as a referral center for physician
100
services and will provide for the ongoing monitoring
of the activities of the facility.
‘‘(c) MATCHING FUNDS.—The Secretary may make
a grant under subsection (a) only if the State involved
agrees to make non-Federal contributions toward the costs
of developing and operating the health facilities involved.
‘‘(d) 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
part.
‘‘(e) LIMITATION ON AMOUNT OF ASSISTANCE PER
FACILITY.—With respect to a health facility for which one
or more grants under subsection (a) are made, the Sec-
retary may not provide more than an aggregate $250,000
for the development and operation of the facility.
‘‘PART 6—COMMUNITY HEALTH ADVISORS
‘‘SEC. 2784. AUTHORIZATION OF APPROPRIATIONS FROM
FUND.
For the purpose of carrying out this part, there is
authorized 
to 
be 
appropriated 
from 
the 
Fund
$100,000,000 for fiscal year 1995, $125,000,000 for fis-
cal year 1996, $150,000,000 for fiscal year 1997,
101
$175,000,000 for fiscal year 1998, $175,000,000 for fis-
cal year 1999, and $175,000,000 for fiscal year 2000.
‘‘SEC. 2785. FORMULA GRANTS REGARDING COMMUNITY
HEALTH ADVISOR PROGRAMS.
‘‘(a) FORMULA GRANTS.—
‘‘(1) IN GENERAL.—In the case of each State
(or entity designated by a State under subsection
(b)) that submits to the Secretary an application in
accordance with section 2788 for a fiscal year, the
Secretary of Health and Human Services, acting
through the Director of the Centers for Disease
Control and Prevention and in coordination with the
heads of the agencies specified in paragraph (2),
shall make an award of financial assistance to the
State or entity for the development and operation of
community health advisor programs under section
2786(b). The award shall consist of the allotment
determined under section 2789 with respect to the
State, subject to section 2794.
‘‘(2) COORDINATION WITH OTHER AGENCIES.—
The agencies referred to in paragraph (1) regarding
coordination are the Health Resources and Services
Administration, the National Institutes of Health,
and the Substance Abuse and Mental Health Serv-
ices Administration.
102
‘‘(b) DESIGNATED ENTITIES.—With respect to the
State involved, an entity other than the State may receive
an award under subsection (a) only if the entity—
‘‘(1) is a public or nonprofit private academic
organization (or other public or nonprofit private en-
tity); and
‘‘(2) has been designated by the State to carry
out the purpose described in such subsection in the
State and to receive amounts under such subsection
in lieu of the State.
‘‘(c) ROLE
OF
STATE
AGENCY
FOR
PUBLIC
HEALTH.—A funding agreement for an award under sub-
section (a) is that—
‘‘(1) if the applicant is a State, the award will
be administered by the State agency with the prin-
cipal responsibility for carrying out public health
programs; and
‘‘(2) if the applicant is an entity designated
under subsection (b), the award will be administered
in consultation with such State agency.
‘‘(d) STATEWIDE RESPONSIBILITIES; LIMITATION ON
EXPENDITURES.—
‘‘(1) STATEWIDE RESPONSIBILITIES.—A fund-
ing agreement for an award under subsection (a) is
that the applicant involved will—
103
‘‘(A) operate a clearinghouse to maintain
and disseminate information on community
health advisor programs (and similar programs)
in the State, including information on develop-
ing and operating such programs, on training
individuals to participate in the programs, and
on evaluation of the programs;
‘‘(B) collaborate with schools of public
health to provide to community health advisor
programs in the State technical assistance in
training and supervising community health ad-
visors under section 2787(g)(1); and
‘‘(C) coordinate the activities carried out in
the State under the award, including coordina-
tion between the various community health ad-
visor programs and coordination between such
programs and related activities of the State and
of other public or private entities.
‘‘(2) LIMITATION.—A funding agreement for an
award under subsection (a) is that the applicant in-
volved will not expend more than 15 percent of the
award in the aggregate for carrying out paragraph
(1) and for the expenses of administering the award
with respect to the State involved, including the
process of receiving payments from the Secretary
104
under the award, allocating the payments among the
entities that are to develop and operate the commu-
nity health advisor programs involved, and monitor-
ing compliance with the funding agreements made
under this subtitle by the applicant.
‘‘SEC. 
2786. 
REQUIREMENTS 
REGARDING 
COMMUNITY
HEALTH ADVISOR PROGRAMS.
‘‘(a) PURPOSE OF AWARD; HEALTHY PEOPLE 2000
OBJECTIVES.—
‘‘(1) IN GENERAL.—Subject to paragraph (2), a
funding agreement for an award under section 2785
for an applicant is that the purpose of the award is,
through community health advisor programs under
subsection (b), to assist the State involved in attain-
ing the Healthy People 2000 Objectives.
‘‘(2) AUTHORITY
REGARDING
SELECTION
OF
PRIORITY OBJECTIVES.—With respect to compliance
with the agreement made under paragraph (1), an
applicant receiving an award under section 2785
may, from among the various Healthy People 2000
Objectives, select one or more Objectives to be given
priority in the operation of a community health advi-
sor program of the applicant, subject to the appli-
cant selecting such priorities in consultation with the
105
entity that is to carry out the program and the local
health department involved.
‘‘(b) REQUIREMENTS FOR PROGRAMS.—
‘‘(1) IN GENERAL.—A funding agreement for
an award under section 2785 for an applicant is
that, in expending the award, the purpose described
in subsection (a)(1) will be carried out in accordance
with the following:
‘‘(A) For each community for which the
purpose is to be carried out, the applicant will
establish a program in accordance with this
subsection.
‘‘(B) The program will be carried out in a
community only if the applicant has, under sec-
tion 2787(a), identified the community as hav-
ing a significant need for the program.
‘‘(C) The program will be operated by a
public or nonprofit private entity with experi-
ence in providing health or health-related social
services to individuals who are underserved with
respect to such services.
‘‘(D) The services of the program, as spec-
ified in paragraph (2), will be provided prin-
cipally by community health advisors (as de-
fined in subsection (d)).
107
‘‘(E) For the purpose of increasing the ca-
pacity of individuals to utilize health services
and health-related social services under Federal,
State, and local programs, the following condi-
tions will be met:
‘‘(i) The program will assist individ-
uals in establishing eligibility under the
programs and in receiving the services or
other benefits of the programs.
‘‘(ii) The program will provide such
other services as the Secretary determines
to be appropriate, which services may in-
clude (but are not limited to) transpor-
tation and translation services.
‘‘(F) The program will provide outreach
services to inform the community of the avail-
ability of the services of the program.
‘‘(c) PRIORITY FOR MEDICALLY UNDERSERVED COM-
MUNITIES.—A funding agreement for an award under sec-
tion 2785 is that the applicant involved will give priority
to developing and operating community health advisor
programs for medically underserved communities.
‘‘(d) DEFINITION OF COMMUNITY HEALTH ADVI-
SOR.—For purposes of this part, the term ‘community
health advisor’ means an individual—
108
‘‘(1) who has demonstrated the capacity to
carry out one or more of the authorized program
services;
‘‘(2) who, for not less than 1 year, has been a
resident of the community in which the community
health advisor program involved is to be operated;
and
‘‘(3) is a member of a socioeconomic group to
be served by the program.
‘‘SEC. 2787. ADDITIONAL AGREEMENTS.
‘‘(a) IDENTIFICATION OF COMMUNITY NEEDS.—A
funding agreement for an award under section 2785 is
that the applicant involved will—
‘‘(1) identify the needs of the community in-
volved for the authorized program services, including
the identifying of the resources of the community
that are available for carrying out the program;
‘‘(2) in identifying such needs, consult with
members of the community, with individuals and
programs that provide health services in the commu-
nity, and with individuals and programs that provide
health-related social services in the community; and
‘‘(3) consider such needs in carrying out a com-
munity health advisor program for the community.
‘‘(b) MATCHING FUNDS.—
109
‘‘(1) IN GENERAL.—With respect to the cost of
carrying out a community health advisor program, a
funding agreement for an award under section 2785
is that the applicant involved will make available (di-
rectly or through donations from public or private
entities) non-Federal contributions toward such cost
in an amount that is not less than 25 percent of
such cost.
‘‘(2) DETERMINATION
OF
AMOUNT
CONTRIB-
UTED.—
‘‘(A) Non-Federal contributions required in
paragraph (1) may be in cash or in kind, fairly
evaluated, including plant, equipment, or serv-
ices. Amounts provided by the Federal Govern-
ment, or services assisted or subsidized to any
significant extent by the Federal Government,
may not be included in determining the amount
of such non-Federal contributions.
‘‘(B) With respect to the State in which
the community health advisor program involved
is to be carried out, amounts provided by the
State in compliance with subsection (c) shall be
included in determining the amount of non-Fed-
eral contributions under paragraph (1).
110
‘‘(c) MAINTENANCE OF EFFORT.—With respect to
the purposes for which an award under section 2785 is
authorized in this subtitle to be expended, the Secretary
may make such an award only if the State involved agrees
to maintain expenditures of non-Federal amounts for such
purposes at a level that is not less than the level of such
expenditures maintained by the State for the fiscal year
preceding the first fiscal year for which such an award
is made with respect to the State.
‘‘(d) CULTURAL CONTEXT OF SERVICES.—A funding
agreement for an award under section 2785 for an appli-
cant is that the services of the community health advisor
program involved will be provided in the language and cul-
tural context most appropriate for the individuals served
by the program, and that for such purpose the community
health advisors of the program will include an appropriate
number of advisors who are fluent in both English and
not less than one of the other relevant languages.
‘‘(e) NUMBER
OF PROGRAMS PER AWARD; PRO-
GRAMS
FOR URBAN
AND RURAL AREAS.—A funding
agreement for an award under section 2785 for an appli-
cant is that the number of community health advisor pro-
grams operated in the State with the award will be deter-
mined by the Secretary, except that (subject to section
2786(b)(1)(B)) such a program will be carried out in not
111
less than one urban area of the State, and in not less than
one rural area of the State.
‘‘(f) ONGOING SUPERVISION OF ADVISORS.—A fund-
ing agreement for an award under section 2785 is that
the applicant involved will ensure that each community
health advisor program operated with the award provides
for the ongoing supervision of the community health advi-
sors of the program, and that the individuals serving as
supervisors in the program will include 1 or more public
health nurses with field experience and managerial experi-
ence.
‘‘(g) CERTAIN EXPENDITURES.—
‘‘(1) TRAINING; 
CONTINUING
EDUCATION.—
Funding agreements for an award under section
2785 include the following:
‘‘(A) The applicant involved will ensure
that, for each community health advisor pro-
gram operated with the award, a program is
carried out to train community health advisors
to provide the authorized program services, in-
cluding practical experiences in providing serv-
ices for health promotion and disease preven-
tion.
112
‘‘(B) The program of training will provide
for the continuing education of the community
health advisors.
‘‘(C) Not more than 15 percent of the
award will be expended for the program of
training.
‘‘(2) COMPENSATION.—With respect to compli-
ance with the agreements made under this subtitle,
the purposes for which an award under section 2785
may be expended include providing compensation for
the services of community health advisors.
‘‘(h) REPORTS TO SECRETARY; ASSESSMENT OF EF-
FECTIVENESS.—Funding agreements for an award under
section 2785 for an applicant include the following:
‘‘(1) The applicant will ensure that, for each
fiscal year for which a community health advisor
program receives amounts from the award, the pro-
gram will prepare a report describing the activities
of the program for such year, including—
‘‘(A) a specification of the number of indi-
viduals served by the program;
‘‘(B) a specification of the entities with
which the program has collaborated in carrying
out the purpose described in section 2786(a)(1);
and
113
‘‘(C) an assessment of the extent of the ef-
fectiveness of the program in carrying out such
purpose.
‘‘(2) Such reports will include such additional
information regarding the applicant and the pro-
grams as the Secretary may require.
‘‘(3) The applicant will prepare the reports as
a single document and will submit the document to
the Secretary not later than February 1 of the fiscal
year following the fiscal year for which the reports
were prepared.
‘‘SEC. 2788. APPLICATION FOR ASSISTANCE; STATE PLAN.
For purposes of section 2785, an application is in ac-
cordance with this section if—
‘‘(1) the application is submitted not later than
the date specified by the Secretary;
‘‘(2) the application contains each funding
agreement described in this subtitle;
‘‘(3) the application contains a State plan de-
scribing the purposes for which the award is to be
expended in the State, including a description of the
manner in which the applicant will comply with each
such funding agreement; and
‘‘(4) the application is in such form, is made in
such manner, and contains such agreements, assur-
114
ances, and information as the Secretary determines
to be necessary to carry out this subtitle.
‘‘SEC. 2789. DETERMINATION OF AMOUNT OF ALLOTMENT.
‘‘(a) IN GENERAL.—For purposes of section 2785,
the allotment under this section with respect to a State
for a fiscal year is the sum of the respective amounts de-
termined for the State under subsection (b) and sub-
section (c).
‘‘(b) AMOUNT RELATING TO POPULATION.—For pur-
poses of subsection (a), the amount determined under this
subsection is the product of—
‘‘(1) an amount equal to 50 percent of the
amount appropriated under section 2784 for the fis-
cal year and available for awards under section
2785; and
‘‘(2) the percentage constituted by the ratio
of—
‘‘(A) the number of individuals residing in
the State involved; to
‘‘(B) the sum of the respective amounts
determined for each State under subparagraph
(A).
‘‘(c) AMOUNT RELATING TO POVERTY LEVEL.—For
purposes of subsection (a), the amount determined under
this subsection is the product of—
115
‘‘(1) the amount determined under subsection
(b)(1); and
‘‘(2) the percentage constituted by the ratio
of—
‘‘(A) the number of individuals residing in
the State whose income is at or below an
amount equal to 200 percent of the official pov-
erty line; to
‘‘(B) the sum of the respective amounts
determined for each State under subparagraph
(A).
‘‘SEC. 2790. QUALITY ASSURANCE; COST-EFFECTIVENESS.
‘‘The Secretary shall establish guidelines for assuring
the quality of community health advisor programs (includ-
ing quality in the training of community health advisors)
and for assuring the cost-effectiveness of the programs.
A funding agreement for an award under section 2785 is
that the applicant involved will carry out such programs
in accordance with the guidelines.
‘‘SEC. 2791. EVALUATIONS; TECHNICAL ASSISTANCE.
‘‘(a) EVALUATIONS.—The Secretary shall conduct
evaluations of community health advisor programs and
disseminate information developed as result of the evalua-
tions to the States. In conducting such evaluations, the
Secretary shall determine whether the programs are in
116
compliance with the guidelines established under section
2790.
‘‘(b) TECHNICAL ASSISTANCE.—The Secretary may
provide technical assistance to recipients of awards under
section 2785 with respect to the planning, development,
and operation of community health advisor programs.
‘‘(c) GRANTS AND CONTRACTS.—The Secretary may
carry out this section directly or through grants, coopera-
tive agreements, or contracts.
‘‘(d) LIMITATION
ON
EXPENDITURES.—Of the
amounts appropriated under section 2784 for a fiscal year,
the Secretary may reserve not more than 10 percent for
carrying out this section.
‘‘SEC. 2792. RULE OF CONSTRUCTION REGARDING PRO-
GRAMS OF INDIAN HEALTH SERVICE.
This subtitle may not be construed as requiring the
Secretary to modify or terminate the program carried out
by the Director of the Indian Health Service and des-
ignated by such Director as the Community Health Rep-
resentative Program. The Secretary shall ensure that sup-
port for such Program is not supplanted by awards under
section 2785. In communities in which both such Program
and a community health advisor program are being carried
out, the Secretary shall ensure that the community health
advisor program works in cooperation with, and as a
119
‘‘PART 7—MENTAL HEALTH; SUBSTANCE ABUSE
‘‘SEC. 2795. AUTHORIZATIONS OF APPROPRIATIONS FROM
FUND.
‘‘(a) IN GENERAL.—For the purpose of carrying out
this part, there are authorized to be appropriated from
the 
Fund 
$100,000,000 
for 
fiscal 
year 
1995,
$150,000,000 for fiscal year 1996, $200,000,000 for fis-
cal year 1997, and $250,000,000 for each of the fiscal
years 1998 through 2000.
‘‘(b) ALLOCATION
AMONG
PROGRAMS.—Of the
amounts made available under subsection (a) for a fiscal
year—
‘‘(1) the Secretary may reserve for carrying out
section 2797 such amounts as the Secretary deter-
mines to be appropriate; and
‘‘(2) the Secretary shall, of the remaining
amounts, reserve 50 percent for carrying out sub-
section (a) of section 2796 and 50 percent for carry-
ing out subsection (b) of such section.
‘‘(c) RELATION TO OTHER FUNDS.—The authoriza-
tions of appropriations established in subsection (a) are
in addition to any other authorizations of appropriations
that are available for the purpose described in such sub-
section.
120
‘‘SEC. 
2796. 
SUPPLEMENTAL 
FORMULA 
GRANTS 
FOR
STATES 
REGARDING 
ACTIVITIES 
UNDER
PART B OF TITLE XIX.
‘‘(a) MENTAL HEALTH.—
‘‘(1) IN GENERAL.—In the case of any State
that submits to the Secretary an application in ac-
cordance with subsection (e) for a fiscal year with
respect to mental health, the Secretary shall make a
grant to the State for the purposes authorized in
subsection (c) with respect to mental health. The
grant shall consist of the allotment determined
under paragraph (2) for the State for such year.
‘‘(2) DETERMINATION
OF
ALLOTMENT.—For
purposes of paragraph (1), the allotment under this
paragraph for a State for a fiscal year shall be de-
termined as follows: With respect to the amount re-
served under section 2795(b)(2) for carrying out
this subsection, section 1918 shall be applied to such
amount to the same extent and in the same manner
as section 1918 is applied to the amount determined
under section 1918(a)(2).
‘‘(b) SUBSTANCE ABUSE.—
‘‘(1) IN GENERAL.—In the case of any State
that submits to the Secretary an application in ac-
cordance with subsection (e) for a fiscal year with
respect to substance abuse, the Secretary shall make
121
a grant to the State for the purposes authorized in
subsection (c) with respect to substance abuse. The
grant shall consist of the allotment determined
under paragraph (2) for the State for such year.
‘‘(2) DETERMINATION
OF
ALLOTMENT.—For
purposes of paragraph (1), the allotment under this
paragraph for a State for a fiscal year shall be de-
termined as follows: With respect to the amount re-
served under section 2795(b)(2) for carrying out
this subsection, section 1933 shall be applied to such
amount to the same extent and in the same manner
as section 1933 is applied to the amount determined
pursuant to sections 1933(a)(1)(B)(i).
‘‘(c) USE OF GRANTS.—
‘‘(1) IN GENERAL.—With respect to the expend-
iture of a grant to a State under subsection (a) or
(b), the Secretary, subject to paragraph (3)—
‘‘(A) shall designate as authorized expendi-
tures such of the activities described in para-
graph (2) with respect to mental health and
substance abuse, respectively, as the Secretary
determines to be appropriate; and
‘‘(B) may make the grant only if the State
agrees to expend the grant in accordance with
the activities so designated.
122
‘‘(2) DESCRIPTION OF ACTIVITIES.—The activi-
ties referred to in paragraph (1) are (as applicable
to the grant involved) the following:
‘‘(A) For the purpose of increasing the ac-
cess of individuals to services relating to mental
health and substance abuse, the following serv-
ices: Transportation, community and patient
outreach, patient education, translation serv-
ices, and such other services as the Secretary
determines to be appropriate regarding such
purpose.
‘‘(B) Improving the capacity of State and
local service systems to coordinate and monitor
mental health and substance abuse services, in-
cluding improvement of management informa-
tion systems, and establishment of linkages be-
tween public and private providers of mental
health and substance abuse services and pri-
mary care providers and health plans.
‘‘(C) Providing incentives to integrate pub-
lic and private systems for the treatment of
mental health and substance abuse disorders.
‘‘(D) Any activity for which a grant under
section 1911 or section 1921 is authorized to be
expended.
123
‘‘(3) REPORTS ON INTEGRATION OF SERVICES
INTO HEALTH CARE DELIVERY SYSTEM.—
‘‘(A) The Secretary may make a grant
under subsection (a) or (b) for a fiscal year
only if the State involved agrees to report to the
Secretary for the fiscal year, in accordance with
criteria under subparagraph (B), information
on—
‘‘(i) any activities carried out by the
State toward integrating the provision of
mental health and substance abuse services
in the State into the general health care
delivery system in the State;
‘‘(ii) the extent to which the activities
have been effective;
‘‘(iii) the difficulties encountered in
carrying out such activities; and
‘‘(iv) the recommendations of the
State regarding such activities.
‘‘(B) The Secretary shall establish criteria
for the uniform collecting and reporting of data
under subparagraph (A).
‘‘(C) The Secretary shall disseminate to
the States the information by the Secretary
under subparagraph (A), as appropriate.
124
‘‘(D) A State may expend a grant under
subsection (a) or (b) for the costs of complying
with subparagraph (A).
‘‘(d) MAINTENANCE OF EFFORT.—
‘‘(1) IN GENERAL.—With respect to the activi-
ties for which a grant under subsection (a) or (b) is
to be made, the Secretary may make the grant only
if the State involved agrees to maintain expenditures
of non-Federal amounts for such activities at a level
that is not less than the level of such expenditures
maintained by the State for the fiscal year preceding
the first fiscal year for which the State receives such
a grant.
‘‘(2) WAIVER.—The Secretary may waive all or
part of the requirement established for a State
under paragraph (1) if—
‘‘(A) the State agrees that the amounts
that otherwise would have been subject to such
requirement will be expended for the purpose of
developing community-based systems of care to
promote the eventual integration of the public
and private systems for treatment of mental
health, or substance abuse, as applicable to the
grant;
125
‘‘(B) the State submits to the Secretary a
request for the waiver and a description of the
manner in which the State will carry out such
purpose; and
‘‘(C) the Secretary approves the waiver.
‘‘(e) APPLICATION
FOR GRANT.—For purposes of
subsection (a)(1) and (b)(1), an application for a grant
under this section regarding mental health or substance
abuse, respectively, is in accordance with this subsection
if the State involved submits the application not later than
the date specified by the Secretary, the application con-
tains each applicable agreement described in this section,
and the application otherwise is in such form, is made in
such manner, and contains such agreements, assurances,
and information as the Secretary determines to be nec-
essary to carry out the purpose involved.
‘‘SEC. 2797. CAPITAL COSTS OF DEVELOPMENT OF CERTAIN
CENTERS AND CLINICS.
‘‘(a) IN GENERAL.—The Secretary may make loans
to, and guarantee the payment of principal and interest
to Federal and non-Federal lenders on behalf of, public
and private entities for the capital costs to be incurred
by the entities in the development of non-acute, residential
treatment centers and community-based ambulatory
clinics.
126
‘‘(b) PRIORITIES REGARDING USE OF FUNDS.—In
providing loans or loan guarantees under subsection (a),
the Secretary shall give priority to authorizing the use of
amounts for projects in health professional shortage areas
or in geographic area in which there resides a significant
number of individuals who are members of a medically un-
derserved population.
‘‘(c) APPLICABILITY OF CERTAIN PROVISIONS.—The
Secretary may provide loans or loan guarantees under
subsection (a) only if the applicant involved agrees that,
except to the extent inconsistent with the purpose de-
scribed in subsection (a), subpart C of part 2 applies to
such assistance to the same extent and in the same man-
ner as such subpart applies to loans and loan guarantees
under section 2773.
‘‘Subtitle G—General Provisions
‘‘SEC. 2798. REQUIREMENT REGARDING ACCREDITATION
OF 
SCHOOLS, 
DEPARTMENTS, 
AND 
PRO-
GRAMS.
‘‘Except as indicated otherwise in this title:
‘‘(1) A reference in this title to a school of pub-
lic health, a school of nursing, or any other entity
providing education or training in a health profes-
sion (whether a school, department, program, or
127
other entity) is a reference to the entity as defined
under section 799 or 853.
‘‘(2) If an entity is not defined in either of such
sections, the reference in this title to the entity has
the meaning provided by the Secretary, except that
the Secretary shall require for purposes of this title
that the entity be accredited for the provision of the
education or training involved.
‘‘SEC. 2799. DEFINITIONS.
‘‘(a) IN GENERAL.—For purposes of this title:
‘‘(1) The term ‘Healthy People 2000 Objectives’
means the objectives established by the Secretary to-
ward the goals of increasing the span of healthy life,
reducing health disparities among various popu-
lations, and providing access to preventive services,
which objectives apply to the health status of the
population of the United States for the year 2000.
‘‘(2) The term ‘medically underserved commu-
nity’ means—
(A) a community that has a substantial
number of individuals who are members of a
medically underserved population, as defined in
section 330; or
128
(B) a community a significant portion of
which is a health professional shortage area
designated under section 332.
Subtitle B—Comprehensive School
Health Education
PART 1—GENERAL PROVISIONS
SEC. 111. TABLE OF CONTENTS FOR SUBTITLE.
The table of contents for this subtitle is as follows:
Subtitle B—Comprehensive School Health Education
Part 1—General Provisions
Sec. 111. Table of contents for subtitle.
Sec. 112. Authorizations of appropriations from Fund.
Sec. 113. Definitions.
Part 2—Purposes
Sec. 121. Purposes.
Part 3—Grants to State Education Agencies
SUBPART A—PLANNING GRANTS FOR STATE EDUCATION AGENCIES
Sec. 131. Application for grant.
Sec. 132. Approval of Secretary.
Sec. 133. Amount of grant.
Sec. 134. Authorized activities.
SUBPART B—IMPLEMENTATION GRANTS FOR STATE EDUCATION AGENCIES
Sec. 141. Application for grant.
Sec. 142. Selection of grantees.
Sec. 143. Amount of grant.
Sec. 144. Authorized activities; limitation on administrative costs.
Sec. 145. Subgrants to local educational agencies.
SUBPART C—STATE AND LOCAL REPORTS
Sec. 151. State and local reports.
Part 4—Grants to Certain Local Educational Agencies
SUBPART A—ELIGIBILITY
Sec. 161. Substantial need of area served by agency.
SUBPART B—PLANNING GRANTS FOR LOCAL EDUCATION AGENCIES
Sec. 171. Application for grant.
129
Sec. 172. Selection of grantees.
Sec. 173. Amount of grant.
Sec. 174. Authorized activities.
SUBPART C—IMPLEMENTATION GRANTS FOR LOCAL EDUCATIONAL AGENCIES
Sec. 181. Application for grant.
Sec. 182. Selection of grantees.
Sec. 183. Amount of grant.
Sec. 184. Authorized activities.
Sec. 185. Reports.
SEC. 112. AUTHORIZATIONS OF APPROPRIATIONS FROM
FUND.
(a) FUNDING FOR SCHOOL HEALTH EDUCATION.—
For the purpose of carrying out this subtitle, there are
authorized 
to 
be 
appropriated 
from 
the 
Fund
$100,000,000 for fiscal year 1995, $125,000,000 for fis-
cal year 1996, $150,000,000 for fiscal year 1997,
$175,000,000 for fiscal year 1998, $200,000,000 for fis-
cal year 1999, and $200,000,000 for fiscal year 2000.
(b) ALLOCATIONS.—Of the amounts appropriated
under subsection (a) for a fiscal year—
(1) the Secretary may reserve not more than
$13,000,000 for carrying out part 4;
(2) the Secretary may reserve not more than
$5,000,000 to support national leadership activities,
such as research and demonstration, evaluation, and
training and technical assistance in comprehensive
school health education; and