Disadvantaged Minority Health Improvement Act of 1990
PL 101-527 (H.R.5702), enacted 11/06/1990

PUBLIC LAW 101-527—NOV. 6, 1990 
104 STAT. 2311 
Public Law 101-527 
101st Congress 
An Act 
To amend the Public Health Service Act to improve the health of individuals who are 
^
^ 
„ -.gnn 
members of minority groups and who are from disadvantaged backgrounds, and for — 
_ ' 
— 
other purposes. 
LH.R. 5702] 
Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled, 
Disadvantaged 
Minority Health 
SECTION 1. SHORT TITLE AND FINDINGS. 
Improvement 
(a) SHORT TITLE.—This Act may be cited as the "Disadvantaged 42^use 201 note. 
Minority Health Improvement Act of 1990". 
OJ) FINDINGS.—The Congress finds that— 
42U8C300u-6 
(1) racial and ethnic minorities are disproportionately rep- '^°*®-
resented among individuals from disadvantaged backgrounds; 
(2) the health status of individuals from disadvantaged back-
grounds, including racial and ethnic minorities, in the United 
States is significantly lower than the health status of the gen-
eral population of the United States; 
(3) minorities suffer disproportionately high rates of cancer, 
stroke, heart diseases, diabetes, substance abuse, acquired 
immune deficiency sjnidrome, and other diseases and disorders; 
(4) the incidence of infant mortality among minorities is 
almost double that for the general population; 
(5) Blacks, Hispanics, and Native Americans constitute 
approximately 12 percent, 7.9 percent, and 0.01 percent, respec-
tively, of the population of the United States; 
(6) Blacks, Hispanics, and Native Americans in the United 
States constitute approximately 3 percent, 4 percent, and less 
than 0.01 percent, respectively, of physicians, 2.7 percent, 1.7 
percent, and less than 0.01 percent, respectively, of dentists, and 
4.5 percent, 1.6 percent, and less than 0.01 percent, respectively, 
of nurses; 
(7) the number of individuals who are from disadvantaged 
backgrounds in health professions should be increased for the 
purpose of improving the access of other such individuals to 
health services; 
(8) minority health professionals have historically tended to 
practice in low-income areas and to serve minorities; 
(9) minority health professionals have historically tended to 
engage in the general practice of medicine and specialties 
providing primary care; 
(10) reports published in leading medical journals indicate 
that access to health care among minorities can be substantially 
improved by increasing the number of minority health profes-
sionals; 
(11) increasing the number of minorities serving on the fac-
ulties of health professions schools can be an important factor 
in attracting minorities to pursue a career in the health 
professions; 
49-139 O - 90 (527) 
104 STAT. 2312 
PUBLIC LAW 101-527—NOV. 6, 1990 
(12) diversity in the faculty and student body of health profes-
sions schools enhances the quality of education for all students 
attending the schools; 
(13) the Report of the Secretary's Task Force on Black and 
Minority Health (prepared for the Secretary of Health and 
Human Services and issued in 1985) described the health status 
problems of minorities, and made recommendations concerning 
measures that should be implemented by the Secretary with 
respect to improving the health status of minorities through 
programs for providing health information and education; and 
(14) the Office of Minority Health, created in 1985 by the 
Secretary of Health and Human Services, should be authorized 
pursuant to statute and should receive increased funding to 
support efforts to improve the health of individuals from dis-
advantaged backgrounds, including minorities, including the 
implementation of the recommendations made by the Sec-
retary's Task Force on Black and Minority Health. 
SEC. 2. ESTABLISHMENT OF OFFICE OF MINORITY HEALTH. 
Title XVII of the Public Health Service Act (42 U.S.C. 300u et seq.) 
is amended by adding at the end the following new section: 
"ESTABLISHMENT OF OFFICE OF MINORITY HEALTH 
42 use 300U-6. 
"SEC. 1707. (a) IN GENERAL.—There is established an Office of 
Minority Health within the Office of the Assistant Secretary for 
Health. There shall be in the Department of Health and Human 
Services a Deputy Assistant Secretary for Minority Health, who 
shall be the head of the Office of Minority Health. The Secretary, 
acting through such Deputy Assistant Secretary, shall carry out this 
section. 
"(b) DUTIES.—The Secretary shall, with respect to the health 
concerns of individuals from disadv£mtaged backgrounds, including 
racial and ethnic minorities— 
"(1) establish short-range and long-range goals and objectives 
and coordinate all other activities within the Department of 
Health and Human Services that relate to disease prevention, 
health promotion, service delivery, and research concerning 
such individuals; 
Government 
"(2) enter into interagency agreements with other agencies of 
contracts. 
the Service to increase the participation of such individuals in 
health service and promotion programs; 
Public 
"(3) establish a national minority health resource center to 
information. 
facilitate the exchange of information regarding matters relat-
ing to health information and health promotion, preventive 
health services, and education in the appropriate use of health 
care, to facilitate access to such information, to assist in the 
analysis of issues and problems relating to such matters, and to 
provide technical assistance with respect to the exchange of 
such information (including facilitating the development of 
materials for such technical assistance); 
"(4) support research, demonstrations and evaluations to test 
new and innovative models, to increase knowledge and under-
standing of health risk factors, and to develop mechanisms that 
support better information dissemination, education, preven-
tion, and service delivery to individuals from disadvantaged 
bac^rounds, including racial and ethnic minorities; 
PUBLIC LAW 101-527—NOV. 6, 1990 
104 STAT. 2313 
Education. 
Public 
information. 
"(5) coordinate efforts to promote minority health progreims Volunteers. 
and policies in the voluntary and corporate sectors; 
"(6) develop health information and health promotion mate-
rials and teaching programs, including— 
"(A) models for the training of health professionads; 
"(B) model curriculums to be used in primary and second-
ary schools and institutions of higher learning; 
"(C) materials and programs for the continuing education 
of health professionals; 
"(D) materials for public service use by the print and 
broadcast media; and 
"(E) materials and programs to assist health care profes-
sionals in providing health education to their patients; and 
"(7) assist providers of primary health care and preventive 
health services in obtaining, with respect to the provision of 
such care and services, the assistance of bilingual health profes-
sionals £ind other bUingual individuals (including such assist-
ance in the provision of services regarding maternal and child 
health, nutrition, mental health, and substance abuse). 
"(c) CERTAIN REQUIREMENTS REGARDING DUTIES.— 
"(1) EQUITABLE ALLOCATION OF SERVICES.—In carrying out 
subsection (b), the Secretary shall ensure that services provided 
under such subsection are equitably allocated among all groups 
served under this section by the Secretary. 
"(2) 
APPROPRIATE CONTEXT OF SERVICES.—In canying 
out 
subsection (b), the Secretary shall ensure that information and 
services provided under such subsection are provided in the 
langUEige and cultured context that is most appropriate for the 
individuals for whom the information and services are intended. 
"(3) 
BlUNGUAL 
ASSISTANCE 
REGARDING HEALTH CARE.—In 
carrying out subsection (bX7), the Secretary shall give special 
consideration to the unique linguistic needs of health care 
providers serving Asians, and American Samoans and other 
Pacific Islanders, including such needs regarding particular 
subpopulations of such groups. 
"(d) GRANTS AND CONTRACTS REGARDING DUTIES.— 
"(1) AUTHORITY.—In carrjdng out subsection (b), the Secretary 
may msike grants to, and enter into cooperative agreements £ind 
contracts with, public and nonprofit private entities. 
"(2) EVALUATION AND DISSEMINATION.— 
"(A) The Secretary shall, directly or through contracts 
with public and private entities, provide for evaluations of 
projects carried out with financial Eissistance provided 
under paragraph (1) and for the dissemination of informa-
tion developed as result of such projects. 
"(B) Not later than January 20 of fiscal year 1993 and of 
each second year thereafter, the Secretary shall prepare a 
report summarizing evaluations carried out under subpara-
graph (A) during the preceding 2 fiscal years. The report 
shall be included in the report required in subsection (e) for 
the fisc£d year involved. 
"(e) REPORTS.—Not later than January 31 of fiscal year 1993 and 
of each second year thereafter, the Secretary shall submit to the 
CJongress a report describing the activities carried out under this 
section during the preceding 2 fiscal years. 
"(f) FUNDING.— 
39-194 O - 91 - 31 : QL 3 Part 3 
104 STAT. 2314 
PUBLIC LAW 101-527—NOV. 6, 1990 
Grant programs. 
42 u s e 256a. 
Government 
contracts. 
"(1) AUTHORIZATION OF APPROPRIATIONS.—For the purpose of 
carrying out this section, there is authorized to be appropriated 
$25,000,000 for each of the fiscal year 1991 through 1993. 
"(2) ALLOCATION OF FUNDS BY SECRETARY.—Of the amounts 
appropriated under paragraph (1) in excess of $15,000,000, the 
Secretary shall mgike available not less than $3,000,000 to carry 
out subsection (bX7).". 
SEC. 3. HEALTH SERVICES FOR RESIDENTS OF PUBLIC HOUSING. 
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 subpart: 
"Subpart VI—Health Services for Residents of Public Housing 
"HEALTH SERVICES FOR RESIDENTS OF PUBUC HOUSING 
"SEC. 340A. (a) ESTABUSHMENT.— 
"(1) The Secretary, acting through the Administrator of the 
Health Resources and Services Administration, shall make 
grants for the purpose of enabling grantees, directly or through 
contracts, to provide to residents of public housing, subject to 
subsections (e) and (f)— 
"(A) primary health services, including health screenings; 
and 
"(B) health counseling and education services. 
"(2) The Secretary may not make a grant under paragraph (1) 
unless the applicant for the grant agrees to expend the grant to 
carry out each of subparagraphs (A) and (B) of such paragraph. 
"(3) In carrying out the program established in paragraph (1), 
the Administrator shall consult with the Director of the Centers 
for Disease Control. 
"(b) MINIMUM QUALIFICATIONS OF GRANTEES.— 
"(1) Subject to paragraph (2), the Secretary may not make a 
grant under subsection (a) to an applicant unless— 
"(A) the applicant is a public or nonprofit private entity; 
"(B) the applicant has the capacity to effectively admin-
ister a grant under subsection (a); and 
"(C) in the case of any service under this section that is 
available pursuant to the State plan approved under title 
XIX of the Social Security Act for the State in which the 
service will be provided— 
"(i) the applicant for the grant will provide the serv-
ice directly, and the applicant has entered into a 
participation agreement under the State plan and is 
qualified to receive pa3mients under such plan; or 
"(ii) the applicant for the grant will enter into an 
agreement with a public or nonprofit private organiza-
tion under which the organization will provide the 
service, and the organization has entered into such a 
participation agreement and is quEilified to receive such 
pa5rments. 
"(2)(A) In the case of an organization making an agreement 
pursuant to paragraph (IXCXii) regarding the provision of serv-
ices under subsection (a), the requirement established in such 
paragraph regarding a participation agreement shall be waived 
by the Secretary if the organization does not, in providing 
services, impose a charge or accept reimbursement available 
PUBLIC LAW 101-527—NOV. 6, 1990 
104 STAT. 2315 
from any third-party payor, including reimbursement under 
any insurance policy or under any Federal or State health 
benefits program. 
"(B) A determination by the Secretary of whether an 
organization referred to in subparagraph (A) meets the criteria 
for a waiver under such subparagraph shall be made without 
regard to whether the organization accepts voluntary donations 
regarding the provision of services to the public. 
"(c) PREFERENCES IN MAKING GRANTS.—The Secretary shall, in 
making grants under subsection (a), give preference to qualified 
applicants that— 
"(1) are resident management corporations under section 20 
of the United States Housing Act of 1937; or 
"(2) are receiving funds under section 330 or 340. 
"(d) REQUIREMENT OF MATCHING FUNDS FROM PUBLIC GRANTEES.— 
"(1) In the case of a public entity applying for a grant under 
subsection (a), the Secretary may not maJce such a grant unless 
the public entity agrees that, with respect to the costs to be 
incurred by such entity in carrying out the purpose described in 
such subsection, the entity will make available non-Federal 
contributions in cash toward such costs in an amount equal to 
not less than $1 for each $1 of Federal funds provided in the 
grant. 
"(2) In determining the amount of non-Federal contributions 
in cash that a public entity heis provided pursuant to paragraph 
(1), the Secretary may not include any amounts provided to the 
public entity by the Federal Grovernment. 
"(e) REQUIREMENTS REGARDING SERVICES.—The Secretary may not 
make a grant under subsection (a) to an applicant unless the 
applicant agrees that the applicant will, directly or through 
' 
contract— 
"(1) provide services under this section on the premises of 
public housing projects or at other locations immediately acces-
sible to residents of public housing; 
i 
"(2) refer such residents, as appropriate, to qualified facilities 
and practitioners for necessary follow-up services; 
"(3) provide outreach services to inform such residents of the 
availability of such services; and 
"(4) aid such residents in establishing eligibility for assist-
ance, and in obtaining services, under Federal, State, and locEil 
programs providing health services, mental health services, or 
social services. 
"(f) OPTIONAL PROVISION OF CERTAIN SERVICES.— 
. 
"(1) A grantee under subsection (a) may expend the grant— 
"(A) to train residents of public housing to provide health 
screenings and to provide educational services; and 
; 
"(B) to provide health services to individuals who are not 
| 
residents of public housing. 
j 
"(2) The Secretary may not make a grant under subsection (a) 
I 
unless the applicant for the grgmt agrees that if, pursuant to 
! 
parEigraph (IXB), the applicant provides health services to 
individuals who are not residents of public housing, the health 
services will be provided to such individuals under the same 
terms and conditions as such services are provided to residents 
of public housing (including all terms and conditions in effect 
pursuant to this section). 
104 STAT. 2316 
PUBLIC LAW 101-527—NOV. 6, 1990 
"(g) CONSULTATION WITH RESIDENTS.—The Secretary may not 
make a grant under subsection (a) unless, with respect to the 
residents of the public housing involved, the applicant for the 
grant— 
"(1) has consulted with the residents in the preparation of the 
application for the grant; and 
"(2) agrees to provide for ongoing consultation with the resi-
dents regarding the planning and administration of the pro-
gram carried out with the grant. 
"(h) RESTRICTIONS ON USE OF GRANT FUNDS.— 
"(1) The Secretary may not, except as provided in paragraph 
(2), make a grant under subsection (a) to an applicant unless the 
applicant agrees that amounts received pursuant to such 
subsection will not, directly or through contract, be expended— 
"(A) for any purpose other than the purposes authorized 
in this section; 
"(B) to provide inpatient services; 
"(C) to make cash payments to intended recipients of 
services under this section; or 
"(D) to purchase or improve real property (other than 
minor remodeling of existing improvements to real prop-
erty) or to purchase major medical equipment or motor 
vehicles. 
"(2) If the Secretary finds that the purpose described in 
subsection (a) cannot otherwise be carried out, the Secretary 
may, with respect to an otherwise qualified applicant, waive the 
restriction established in paragraph (1)(D). 
"(i) LIMITATION ON CHARGES FOR SERVICES.—The Secretary may 
not make a grant under subsection (a) to an applicant unless the 
applicant agrees that, whether the services are provided directly or 
through contract— 
"(1) services under the grant will be provided without regard 
to ability to pay for the services; and 
"(2) if a charge is imposed for the delivery of the services, such 
charge— 
"(A) will be made according to a schedule of charges that 
is made available to the public; 
"(B) will not be imposed on any resident of public housing 
with an income less than the official poverty level; and 
"(C) will be adjusted to reflect the income and resources 
of the resident of public housing involved. 
"(j) REQUIREMENTS REGARDING ADMINISTRATION.—The Secretary 
may not make a grant under subsection (a) to an applicant unless 
the applicant— 
"(1) agrees to establish such procedures for fiscal control and 
fund accounting as may be necessary to ensure proper disburse-
ment and accounting with respect to the grant; 
"(2) agrees to establish an ongoing program of quality assur-
ance with respect to the services provided under the grant; 
"(3) agrees to ensure the confidentiality of records maintained 
on residents of public housing that are receiving such services; 
"(4) with respect to providing services to any population of 
such residents a substantial portion of which has a limited 
ability to speak the English language— 
"(A) has developed and has the ability to carry out a 
reasonable plan to provide services under the grant 
through individuals who are able to communicate with the 
PUBLIC LAW 101-527—NOV. 6, 1990 
104 STAT. 2317 
population involved in the language and cultural context 
that is most appropriate; and 
"(B) has designated at least one individual, fluent in both 
English and the appropriate language, to assist in carr3dng 
out the plan; and 
"(5) agrees to submit to the Secretary an annual report that 
describes the utilization and costs of services provided under the 
grant and that provides such other information as the Secretary 
determines to be appropriate, 
"(k) LIMITATION ON ADMINISTRATIVE EXPENSES OF GRANTEE.—The 
Secretary may not make a grant under subsection (a) to an applicant 
unless the applicant agrees that the applicant will not expend more 
than 10 percent of amounts received pursuant to such subsection for 
the purpose of administering the grant. 
"(1) REQUIREMENT OF APPUCATION.—The Secretary may not pro-
vide financial assistance under subsection (a) unless— 
"(1) an application for the assistance is submitted to the 
Secretary; 
"(2) with respect to carrying out the purpose for which the 
assistance is to be provided, the application provides assurances 
of compliance satisfactory to the Secretary; and 
"(3) 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 necessary to 
carry out this section, 
"(m) TECHNICAL ASSISTANCE.— 
"(1) The Secretary may provide technical assistance to ap-
plicants and grantees under subsection (a) regarding the plan-
ning, development, and operation of programs to carry out the 
purpose described in such subsection. The Secretary may pro-
vide such technical assistance directly, through contracts, or 
through grants. 
"(2) Any technical sissistance provided by the Secretary under 
paragraph (1) shall be provided without charge to applicants 
and grantees under subsection (a). 
"(3) Of the amounts appropriated pursuant to subsection (pXD 
for a fiscal year, the Secretary may expend not more than 
$2,000,000 for the purpose of carrjdng out paragraph (1). 
"(n) ANNUAL REPORTS BY SECRETARY.—Not later than January 10 
of each year, the Secretary shall submit to the Congress a report 
describing the utilization and costs of services provided under this 
section during the immediately preceding fiscal year. 
"(o) DEFINITIONS.—For purposes of this section: 
"(1) The term 'official poverty level' means the nonfarm 
income official poverty line defined by the Office of Manage-
ment and Budget and revised annually in accordance with 
section 673(2) of the Omnibus Budget Reconciliation Act of 1981. 
"(2) The term 'organization' includes individuals, corpora-
tions, partnerships, companies, and £issociations. 
"(3) The term 'primary health services' has the meaning 
given such term in section 330(bXl). 
"(4) The term 'public housing' has the meaning given such 
term in section 3(bXl) of the United States Housing Act of 1937. 
"(p) FUNDING.— 
"(1) For the purpose of carrjdng out this section, there are 
authorized to be appropriated $35,000,000 for fiscal year 1991, 
104 STAT. 2318 
PUBLIC LAW 101-527—NOV. 6, 1990 
and such sums as may be necessary for each of the fiscal years 
1992 and 1993. 
"(2) Amounts received by a grantee pursuant to subsection (a) 
remaining unobligated at the end of the fiscal year in which the 
amounts were received shall remain available to the grantee 
during the succeeding fiscal year for the purpose described in 
such subsection.". 
SEC. 4. REVISIONS IN PROGRAM FOR CENTERS OF EXCELLENCE IN 
HEALTH PROFESSIONS EDUCATION. 
(a) IN GENERAL.—Section 782 of the Public Health Service Act (42 
U.S.C. 295g-2) is amended to read as follows: 
"PROGRAMS OF EXCELLENCE I N HEALTH PROFESSIONS EDUCATION FOR 
MINORITIES 
Grant programs. 
"SEC. 782. (a) IN GENERAL.—The Secretary shall make grants to 
health profession schools described in subsection (c) for the purpose 
of assisting the schools in supporting programs of excellence in 
health professions education for minority individuals. 
"(b) REQUIRED USE OF FUNDS.—The Secretary may not make a 
grant under subsection (a) unless the health professions school 
involved agrees to expend the grant— 
"(1) to establish, strengthen, or expand programs to enhance 
the academic performance of minority students attending the 
school; 
"(2) to establish, strengthen, or expand programs to increase 
the number and quality of minority applicants to the school; 
"(3) to improve the capacity of such school to train, recruit, 
and retain minority faculty; 
"(4) with respect to minority health issues, to carry out 
activities to improve the information resources and curricula of 
the school and clinical education at the school; and 
"(5) to facilitate faculty and student research on health issues 
particularly affecting minority groups. 
"(c) CENTERS OF EXCELLENCE.— 
"(1) IN GENERAL.— 
"(A) The health professions schools referred to in subsec-
tion (a) are such schools that meet each of the conditions 
specified in subparagraph (B), and that— 
"(i) meet each of the conditions specified in para-
graph (2XA); 
"(ii) meet each of the conditions specified in para-
graph (3); 
"(iii) meet each of the conditions specified in para-
graph (4); or 
"(iv) meet each of the conditions specified in para-
graph (5). 
"(B) The conditions specified in this subparagraph are 
that a health professions school— 
"(i) has a significant number of minority individuals 
enrolled in the school, including individuals accepted 
for enrollment in the school; 
"(ii) has been effective in assisting minority students 
of the school to complete the program of education and 
receive the degree involved; 
PUBLIC LAW 101-527—NOV. 6, 1990 
104 STAT. 2319 
"(iii) has been effective in recruiting minority 
individuals to attend the school, including providing 
scholarships and other financial assistance to such 
individuals and encouraging minority students of 
secondary educational institutions to attend the health 
professions school; and 
"(iv) has made significant recruitment efforts to in-
crease the number of minority individuals serving in 
faculty or administrative positions at the school. 
"(C) In the case of any criteria established by the Sec-
retary for purposes of determining whether schools meet 
the conditions described in subparagraph (B), this section 
may not, with respect to racial and ethnic minorities, be 
construed to authorize, require, or prohibit the use of such 
criteria in any program other than the program established 
in this section. 
"(2) CENTERS OF EXCELLENCE AT CERTAIN HISTORICALLY BLACK 
COLLEGES AND UNIVERSITIES.— 
"(A) The conditions specified in this subparagraph are 
that a health professions school— 
"(i) is a school described in section 701(4); and 
"(ii) received a contract under section 788B for fiscal 
year 1987, as such section was in effect for such fiscal 
year. 
"(B) In addition to the purposes described in subsection 
(b), a grant under subsection (a) to a health professions 
school meeting the conditions described in subparagraph 
(A) may be expended— 
(i) to develop a plan to achieve institutional 
improvements, including financial independence, to 
enable the school to support programs of excellence in 
health professions education for minority individuals; 
and 
"(ii) to provide improved access to the library and 
informational resources of the school. 
"(3) HISPANIC CENTERS OF EXCELLENCE.—The conditions speci-
fied in this subparagraph are that— 
"(A) with respect to Hispanic individuals, each of clauses 
(i) through (iv) of paragraph (IXB) apply to the health 
professions school involved; and 
"(B) the health professions school agree, as a condition of 
receiving a grant under subsection (a), that the school will, 
in carrying out the duties described in subsection (b), give 
priority to carrying out the duties with respect to Hispanic 
individuals. 
"(4) NATIVE AMERICAN CENTERS OF EXCELLENCE.—The condi-
tions specified in this parsigraph are that— 
(A) with respect to Native Americans, each of clauses (i) 
through (iv) of paragraph (IXB) apply to the health profes-
sions school involved; 
"(B) the health professions school agree, as a condition of 
receiving a grant under subsection (a), that the school will, 
in carrying out the duties described in subsection (b), give 
priority to carrjdng out the duties with respect to Native 
Americans; and 
"(C) the health professions school agree, as a condition of 
receiving a grant under subsection (a), that— 
104 STAT. 2320 
PUBLIC LAW 101-527—NOV. 6, 1990 
"(i) the school will establish an arrangement with 1 
or more public or nonprofit private institutions of 
higher education whose enrollment of students has 
traditionally included a significant number of Native 
Americans, the purpose of which arrangement will be 
to cany out a program— 
(I) to identify Native American students of the 
institution who are interested in a career in the 
health profession or professions involved; and 
"(ID to facilitate the educational preparation of 
such students to enter the health professions 
school; and 
"(ii) the health professions school will make efforts to 
recruit Native American students, including students 
who have participated in the undergraduate program 
carried out under arremgements established by the 
school pursuant to subparagraph (A), and will assist 
Native American students regarding the completion 
of the educational requirements for a degree from the 
health professions school. 
"(5) OTHER CENTERS OF EXCELLENCE.—The conditions specified 
in this paragraph are that a health professions school has an 
enrollment of underrepresented minorities above the national 
average for such enrollments of health professions schools. 
"(d) DESIGNATION AS CENTER OF EXCELLENCE.— 
"(1) IN GENERAL.—Any health professions school receiving a 
grant under subsection (a) and meeting the conditions described 
in paragraph (2) or (5) of subsection (c) shall, for purposes of this 
section, be designated by the Secretary as a Center of Excel-
lence in Minority Health Professions Education. 
"(2) HISPANIC CENTERS OF EXCELLENCE.—Any health profes-
sions school receiving a grant under subsection (a) and 
meeting the conditions described in subsection (cX3) shall, for 
purposes of this section, be designated by the Secretary as a 
Hispanic Center of Excellence in Health Professions Education. 
"(3) NATIVE AMERICAN CENTERS OF EXCELLENCE.—Any health 
professions school receiving a grant under subsection (a) and 
meeting the conditions described in subsection (cX4) shall, for 
purposes of this section, be designated by the Secretary as a 
Native American Center of Excellence in Health Professions 
Education. 
"(e) DURATION OF GRANT.—The period during which pa5rments are 
made under a grant under subsection (a) may not exceed 3 years. 
Such pajrments shall be subject to annual approval by the Secretary 
and to the availability of appropriations for the fiscal year involved 
to make the pajnnents. 
"(f) MAINTENANCE OF EFFORT.— 
"(1) NON-FEDERAL FUNDS OF PUBUC SCHOOLS.—With respect to 
activities for which a grant under subsection (a) is authorized to 
be expended, the Secretary may not, in the case of a public 
health professions school, make such a grant to the school for 
any ^ c a l year unless the school agrees to maintain expendi-
tures of non-Federal amounts for such activities at a level equal 
to not less than the level of such expenditures maintained by 
the school for the fiscal year preceding the first fiscal year for 
which the school applies after fiscal year 1990 to receive such a 
grant. 
PUBLIC LAW 101-527—NOV. 6, 1990 
104 STAT. 2321 
"(2) NON-FEDERAL FUNDS OF PRIVATE SCHOOLS.— 
"(A) With respect to any non-Federal amounts received 
by a nonprofit private health professions school and avail-
able for carrying out activities for which a grant under 
subsection (a) is authorized to be expended, the Secretary 
may not make such a grant to the school for any fiscal year 
unless, subject to subparagraph (B), the school agrees to 
maintain expenditures of such non-Federal amounts for 
such activities at a level equal to not less than the level of 
such expenditures maintained by the school for the fiscal 
year preceding the first fiscal year for which the school 
applies after fiscal year 1990 to receive such a grant. 
"(B) The Secretary may require a nonprofit private 
health professions school to comply with an agreement 
made under subparagraph (A) by the school only to the 
extent of the level of non-Federal amounts available to the 
school for the activities to which the agreement applies. 
"(3) USE OF FEDERAL FUNDS.—With respect to any Federal 
amounts received by a health professions school and available 
for carrjdng out activities for which a grant under subsection (a) 
is authorized to be expended, the Secretary may not make such 
a grant to the school for any fiscal year unless the school agrees 
that the school will, before expending the grant, expend the 
Federal amounts obtained from sources other than the grant. 
'(g) DEFINITIONS.—For purposes of this section: 
"(1)(A) The term 'health professions school' means, except as 
provided in subparagraph (B), a school of medicine, a school of 
dentistry, or a school of pharmacy. 
"(B) The definition established in subparagraph (A) shall not 
apply to the use of the term 'health professions school' for 
purposes of subsection (c)(2). 
"(2) The term 'program of excellence' means any program 
carried out by a health professions school with a grant made 
under subsection (a), if the program is for purposes for which 
the school involved is authorized in subsection (b) or (c) to 
expend the grant, 
(3) The term 'Native Americans' means American Indians, 
Alaskan Natives, Aleuts, and Native Hawaiians. 
'(h) FUNDING.— 
"(1) AUTHORIZATION OF APPROPRIATIONS.—For the purpose of 
making grants under subsection (a), there are authorized to be 
appropriated such sums as may be necessary for each of the 
fiscal years 1991 through 1993. 
"(2) ALLOCATIONS BY SECRETARY.— 
"(A) Of the amounts appropriated under paragraph (1) for 
a fiscal year, the Secretary shall make available the first 
$12,000,000 for grants under subsection (a) to health profes-
sions schools meeting the conditions specified in paragraph 
(2XA) of subsection (c) (in addition to the conditions speci-
fied in paragraph (1)(B) of such subsection); and 
"(B) Of the amounts appropriated under paragraph (1) for 
a fiscal year in excess of $12,000,000, the Secretary shall 
make available the first $2,500,000 for grants under subsec-
tion (a) to health professions schools meeting the conditions 
specified in paragraph (3) or (4) of subsection (c) (in addition 
to the conditions specified in paragraph (IXB) of such 
subsection). 
104 STAT. 2322 
PUBLIC LAW 101-527—NOV. 6, 1990 
"(3) ADDITIONAL PRIORITIES.—In making grants under subsec-
tion (a) for a fiscal year from such amounts as are available for 
the grants after compliance with paragraph (2), the Secretary 
shall give priority to making grants to health professions 
schools meeting the conditions specified in any of paragraphs 
(3) through (5) of subsection (c) (in addition to the conditions 
specified in paragraph (1)(B) of such subsection).". 
SEC. 5. FEDERAL CAPITAL CONTRIBUTIONS TO CERTAIN STUDENT LOAN 
FUNDS FOR PURPOSES REGARDING DISADVANTAGED INDIVID. 
UALS. 
(a) IN GENERAL.—Section 740 of the Public Health Service Act (42 
U.S.C. 294m) is amended— 
(1) by redesignating subsection (c) as subsection (d); and 
(2) by inserting after subsection (b) the following new subsec-
tion: 
"(c)(1) With respect to amounts appropriated under subsection 
(c)(1) of section 742, each agreement entered into under this section 
with a school shall provide (in addition to the provisions required in 
subsection (b)) that— 
"(A) any Federal capital contribution made to the student 
loan fund of the school from such amounts, together with the 
school contribution appropriate under subsection (b)(2)(B) to the 
amount of the Federal capital contribution, will be utilized only 
for the purpose of— 
' (i) making loans to individuals who are individuals from 
disadvantaged backgrounds; and 
"(ii) the costs of the collection of the lo£ins and interest on 
the loans; and 
"(B) collections of principal and interest on loans made pursu-
ant to subparagraph (A), and any other earnings of the student 
loan fund attributable to amounts that are in the fund pursuant 
to such subparagraph, will be utilized only for the purpose 
described in such paragraph. 
"(2) The Secretary may not make a Federal capital contribution 
for purposes of pareigraph (1) for a fiscEil year unless the health 
professions school involved— 
"(A) is carrying out a program for recruiting and retaining 
students from disadvantaged backgrounds, including racial and 
ethnic minorities; and 
"(B) is canying out a program for recruiting and retaining 
minority faculty. 
"(3) The Secretary may not make a Federal capit£il contribution 
for purposes of parsigraph (1) for a fiscal year unless the health 
professions school involved agrees— 
"(A) to ensure that adequate instruction regarding minority 
heedth issues is provided for in the curricula of the school; 
"(B) with respect to health clinics providing services to a 
significant number of individuals who are from disadvantaged 
backgrounds, including members of minority groups, to enter 
into arrangements with 1 or more such clinics for the purpose of 
providing students of the school with experience in providing 
clinical services to such individuals; 
"(C) with respect to public or nonprofit private secondary 
educational institutions and undergraduate institutions of 
higher education, to enter into arrangements with 1 or more 
such institutions for the purpose of carrying out programs 
PUBLIC LAW 101-527—NOV. 6, 1990 
104 STAT. 2323 
regarding the educational preparation of disadvantaged stu-
dents, including minority students, to enter the health profes-
sions and regarding the recruitment of such individuals into the 
health professions; 
"(D) to establish a mentor program for assisting disadvan-
taged students, including minority students, regarding the 
completion of the educational requirements for degrees from 
the school; 
"(E) to be canying out each of the activities specified in any of 
subparagraphs (A) through (D) by not later than 1 year after the 
date on which the first Federal capital contribution is made to 
the school for purposes of paragraph (1); and 
"(F) to continue carrying out such activities, and the activities 
specified in subparagraphs (A) and (B) of paragraph (2), through-
out the period during which the student loan fund established 
pursuant to subsection (b) is in operation. 
"(4) With respect to amounts appropriated under subsection (a) of 
section 742, Federal capital contributions made pursuant to an 
agreement under subsection (b) of this subsection to the student loan 
fund of a school from such amounts, together with the school 
contributions appropriate under subsection (bX2XB) to the amount of 
the Federal capital contributions, may be utilized for the purpose of 
making loans to individuals from disadvantaged backgrounds.'. 
(b) DEFINITION WITH RESPECT TO INDIVIDUALS FROM DISADVAN-
TAGED BACKGROUNDS.—Section 740 of the Public Health Service Act, 
as amended by subsection (a) of this section, is amended by adding at 
the end the following new subsection: 
"(e) For purposes of this section, the term 'disadvantaged', with 
respect to an individual, shall be defined by the Secretary.'. 
(c) AUTHORIZATION OF APPROPRIATIONS.—Section 742 of the Public 
Health Service Act (42 U.S.C. 294o) is amended by adding at the end 
the following new subsection: 
"(cXl) With respect to making Federal capital contributions to 
student loan funds for purposes of section 740(c), there is authorized 
to be appropriated for such contributions $15,000,000 for each of the 
fiscal years 1991 through 1993. 
"(2) In making Federal capitel contributions to student loan funds 
for purposes of section 740(c), the Secretory shall give special consid-
eration to health professions schools that have enrollments of 
underrepresented minorities above the national average for health 
professions schools.". 
SEC. 6. ASSISTANCE PROGRAMS FOR HEALTH PROFESSIONS STUDENTS 
FROM DISADVANTAGED BACKGROUNDS. 
Part C of title VII of the Public Health Service Act (42 U.S.C. 294 
et seq.) is amended by adding at the end thereof the following new 
subpart: 
"Subpart VI—Assistance for Students From Disadvantaged 
Backgrounds 
"SEC. 760. GRANTS FOR SCHOLARSHIPS AND OTHER PURPOSES. 
42 USC 294bb. 
"(a) ESTABLISHMENT OF PROGRAM.— 
"(1) IN GENERAL.—The Secretory may make grants to health 
professions schools for the purpose of assisting such schools, 
subject to subsection (e), in providing scholarships to individuals 
who— 
104 STAT. 2324 
PUBLIC LAW 101-527—NOV. 6, 1990 
"(A) are individuals from disadvantaged backgrounds; 
and 
"(B) are enrolled (or accepted for enrollment) as full-time 
students in such schools. 
"(2) HEALTH PROFESSIONS SCHOOLS.—For purposes of this sec-
tion, the term 'health professions schools' means schools of 
medicine, nursing (as schools of nursing are defined in section 
853), osteopathic medicine, dentistry, pharmacy, podiatric medi-
cine, optometry, veterinary medicine, public health, or allied 
health, or schools offering graduate programs in clinical 
psychology. 
"(b) MINIMUM QUAUFICATIONS OF GRANTEES.—The Secretary may 
not make a grant under subsection (a) unless the health professions 
school— 
"(1) is carrying out a program for recruiting and retaining 
students from disadvantaged backgrounds, including racial emd 
ethnic minorities; and 
"(2) is carrying out a program for recruiting and retaining 
minority faculty. 
"(c) PREFERENCES IN PROVIDING SCHOLARSHIPS.—The Secretary 
may not make a grant under subsection (a) unless the health 
professions school involved agrees that, in providing scholarships 
pursuant to the grant, the school will give preference to students— 
"(1) who are from disadvantaged backgrounds; or 
"(2) for whom the costs of attending the school would con-
stitute a severe financigd hardship. 
"(d) USE OF SCHOLARSHIP.—A scholarship provided pursuant to 
subsection (a) for attendance at a health professions school— 
"(1) may be expended only for tuition expenses, other reason-
able educational expenses, and reasonable living expenses 
incurred in such attendance; and 
"(2) may not, for any year of such attendance for which the 
scholarship is provided, provide an amount exceeding the total 
amount required for the year for the expenses specified in 
paragraph (1). 
"(e) PROVISIONS REGARDING PURPOSES OTHER THAN SCHOLAR-
SHIPS.— 
"(1) AUTHORITY REGARDING ASSISTANCE FOR UNDERGRADU-
ATES.—With respect to undergraduates who have demonstrated 
a commitment to pursuing a career in the health professions, a 
health professions school may expend not more than 25 percent 
of a grant under subsection (a) for the purpose of providing 
financial assistance to such undergraduates in order to facili-
tate the completion of the educational requirements for such 
careers. 
"(2) REQUIRED ACTIVITIES OF SCHOOL.—The Secretary may not 
make a grant under subsection (a) unless the health professions 
school involved agrees— 
"(A) to ensure that adequate instruction regarding minor-
ity health issues is provided for in the curricula of the 
school; 
"(B) with respect to health clinics providing services to a 
significant number of individuals who are from disadvan-
taged backgrounds, including members of minority groups, 
to enter into arrangements with 1 or more such clinics for 
the purpose of providing students of the school with experi-
ence in providing clinical services to such individuals; 
PUBLIC LAW 101-527—NOV. 6, 1990 
104 STAT. 2325 
"(C) with respect to public or nonprofit secondary edu-
cational institutions and undergraduate institutions of 
higher education, to enter into arrangements with 1 or 
more such institutions for the purpose of carrying out 
programs regarding the educational preparation of dis-
advantaged students, including minority students, to enter 
the health professions and regarding the recruitment of 
such students into the health professions; 
"(D) to establish a mentor program for assisting disadvan-
taged students, including minority students, regarding the 
completion of the educational requirements for degrees 
from the school; 
"(E) to be carrjdng out the activities specified in subpara-
graphs (A) through (D) by not later than 1 year after the 
date on which a grant under subsection (a) is first made to 
the school; and 
"(F) to continue carrjdng out such activities, and the 
activities specified in paragraphs (1) and (2) of subsection 
(b), throughout the period during which the school is receiv-
ing a grant under subsection (a). 
"(3) RESTRICTIONS ON USE OF GRANT.—The Secretary may 
not 
make a grant under subsection (a) for a fiscal year unless the 
health professions school involved agrees that the grant will not 
be expended to carry out the activities specified in paragraph (1) 
or (2) of subsection (b), or in any of subparagraphs (A) through 
(D) of paragraph (2) of this subsection. 
"(f) REQUIREMENT OF APPUCATION.—The Secretary may not make 
a grant under subsection (a) unless an application for the grant is 
submitted to the Secretary 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 necessary to 
carry out this section. 
"(g) FUNDING.— 
"(1) AUTHORIZATION OF APPROPRIATIONS.—To carry out subsec-
tion (a), there are authorized to be appropriated $17,000,000 for 
fiscal year 1991, and such sums as may be necessary for each of 
the fiscal years 1992 and 1993. 
"(2) AixocATiONS B
Y SECRETARY.—In making grsmts under 
subsection (a), the Secretary— 
"(A) shall make available 30 percent for grants under 
subsection (a) to health professions schools agreeing to 
expend the grants only for scholarships under such subsec-
tion for nurses; and 
"(B) shall give special consideration to health professions 
schools that have enrollments of underrepresented minori-
ties above the national average for health professions 
schools. 
"SEC. 761. LOAN REPAYMENT PROGRAM REGARDING SERVICE ON FAC- 
42 USC 294cc. 
ULTIES OF CERTAIN HEALTH PROFESSIONS SCHOOLS. 
"(a) ESTABUSHMENT OF PROGRAM.—The Secretary shall establish a 
Government 
program of entering into contracts with individuals described in contracts. 
subsection (b) under which the individuals agree to serve as mem-
bers of the faculties of schools described in subsection (c) in consider-
ation of the Federal Government agreeing to pay, for each year of 
such service, not more than $20,000 of the principal and interest of 
the educational loans of such individuals. 
39-194 O - 91 - 33 : QL 3 Part 3 
104 STAT. 2326 
PUBLIC LAW 101-527—NOV. 6, 1990 
"(b) EuGiBLE INDIVIDUALS.—The individuals referred to in subsec-
tion (a) are individuals from disadvantaged backgrounds who— 
"(1) have a degree in medicine, osteopathic medicine, den-
tistry, or another health profession; 
"(2) are enrolled in an approved graduate training program in 
medicine, osteopathic medicine, dentistry, or other health 
profession; or 
"(3) are enrolled as a full-time student— 
"(A) in an accredited (as determined by the Secretary) 
school described in subsection (c); and 
"(B) in the final year of a course of a study or program, 
offered by such institution and approved by the Secretary, 
leading to a degree from such a school. 
"(c) EuGiBLE HEALTH PROFESSIONS SCHOOL.—The schools described 
in this subsection are schools of medicine, nursing (as schools of 
nursing are defined in section 853), osteopathic medicine, dentistry, 
pharmacy, podiatric medicine, optometry, veterinary medicine, or 
public health, or schools offering graduate programs in clinical 
psychology. 
"(d) ADDITIONAL LIMITATION ON AMOUNT OF REPAYMENTS.—Pay-
ments made by the Secretary under subsection (a) regarding the 
educational loans of an individual may not, for any year for which 
the payments are made, exceed an amount equal to 50 percent of the 
principal and interest due on such loans for such year. 
"(e) REQUIREMENTS REGARDING FACULTY POSITIONS.—The Sec-
retary may not enter into a contract under subsection (a) unless— 
"(1) the individual involved has entered into a contract with a 
school described in subsection (c) to serve as a member of the 
faculty of the school for not less than 2 years; and 
"(2) the contract referred to in paragraph (1) provides that— 
"(A) the school will, for each year for which the individ-
ual will serve as a member of the faculty under the contract 
with the school, make payments of the principal and in-
terest due on the educational loans of the individual for 
such year in an amount equal to the amount of such 
payments made by the Secretary for the year; and 
(B) the pajrments made by the school pursuant to 
subparagraph (A) on behalf of the individual will be in 
addition to the pay that the individual would otherwise 
receive for serving as a member of such faculty. 
"(f) WAIVER REGARDING SCHOOL CONTRIBUTIONS.—The Secretary 
may waive the requirement established in subsection (eX2) if the 
Secretary determines that the requirement will impose an undue 
financial hardship on the school involved. If the Secretary grants 
such a waiver, subsection (d) shall not apply with respect to the 
individual involved. 
"(g) APPUCABILITY OF CERTAIN PROVISIONS.—The provisions of 
sections 338B, 338C, and 338E shall apply to the program established 
in subsection (a) to the same extent and in the same manner as such 
provisions apply to the National Health Service Corps Loan Repay-
ment Program established in subpart III of part D of title III, 
including the applicability of provisions regarding reimbursements 
for increased tax liability and regarding bankruptcy. 
"(h) AUTHORIZATION OF APPROPRIATIONS.—To carry out this sec-
tion, there are authorized to be appropriated $4,000,000 for each of 
the fiscal years 1991 through 1993.". 
PUBLIC LAW 101-527—NOV. 6, 1990 
104 STAT. 2327 
SEC. 7. REVISION AND EXTENSION OF PROGRAM FOR NATIONAL CENTER 
FOR HEALTH STATISTICS. 
(a) ANNUAL COLLECTION OF DATA,— 
(1) DATA FROM RECORDS OF BIRTHS, DEATHS, ET CETERA, AMONG 
CERTAIN POPULATIONS.—Section 306(h) of the Public Health 
Service Act (42 U.S.C. 242k(h)) is amended by inserting after the 
second sentence the following new sentence: "The Secretary 
shall encourage States and registration areas to obtain detailed 
data on ethnic and racial populations, including subpopulations 
of Hispanics, Asian Americans, and Pacific Islanders with 
significant representation in the State or registration area.". 
(2) DATA FROM SAMPLE REGARDING HEALTH, ILLNESS, AND 
DISABILITY STATUS.—Section 306(h) of the Public Health Serv-
ice Act (42 U.S.C. 242k(h)), as amended by paragraph (1), is 
amended— 
(A) by inserting "(1)" after the subsection designation; 
and 
(B) by adding at the end the following new paragraph: 
"(2) There shall be an annual collection of data from a statistically 
valid sample concerning the general health, illness, and disability 
status of the civilian noninstitutionalized population. Specific topics 
to be addressed under this paragraph, on an annual or periodic 
basis, shall include the incidence of illness and accidental injuries, 
prevalence of chronic diseases and impairments, disability, physi-
cian visits, hospitalizations, and the relationship between demo-
graphic and socioeconomic characteristics and health characteris-
tics.". 
(b) (COLLECTION OF DATA SPECIFIC TO PARTICULAR POPULATIONS.— 
(1) IN GENERAL.—Section 306 of the Public Health Service Act 
(42 U.S.C. 242k) is amended— 
(A) by redesignating subsection (m) as subsection (o); and 
(B) by inserting after subsection (1) the following new 
subsections: 
"(m) In canying out this section, the Secretary, acting through 
the (Denter, shall collect and analyze adequate health data that is 
specific to particular ethnic and racial populations, including data 
collected under national health surveys. Activities carried out under 
this subsection shall be in addition to any activities carried out 
under subsection (n). 
"(nXl) The Secretary, acting through the CJenter, may make 
grants to public and nonprofit private entities for— 
"(A) the conduct of special surveys or studies on the health of 
ethnic and racial populations or subpopulations; 
"(B) analysis of data on ethnic and racial populations and 
| 
subpopulations; and 
"(C) research on improving methods for developing statistics 
on ethnic and racial populations and subpopulations. 
"(2) The Secretary, acting through the Center, may provide tech-
nical assistance, standards, and methodologies to grantees supported 
by this subsection in order to maximize the data quality and com-
parability with other studies. 
"(3) Provisions of section 308(d) do not apply to surveys or studies 
conducted by grantees under this subsection unless the Secretary, in 
accordance with regulations the Secretary may issue, determines 
that such provisions are necessary for the conduct of the survey or 
104 STAT. 2328 
PUBLIC LAW 101-527—NOV. 6, 1990 
study and receives adequate assurance that the grantee will enforce 
such provisions.". 
(2) APPLICATION AND PEER REVIEW.—Section 308(bX2) of the 
Public Health Service Act (42 U.S.C. 242m(bX2)) is amended— 
(A) in subparagraph (A), in the first sentence, bv insert-
ing after "demonstration project," the following: ' or for a 
grant under section 306(n),"; and 
(B) in subparagraph (C), by inserting before the period at 
the end the following: ", except that peer review groups 
regarding grants under section 306(n) may include appro-
priately qualified such officers and employees". 
(c) AUTHORIZATION OF APPROPRIATIONS.—Section 306(o), as redesig-
nated by subsection (b) of this section, is amended to read as follows: 
"(oXl) For health statistical and epidemiological activities under-
taken or supported under subsections (a) through (m), there are 
authorized to be appropriated such sums as may be necessary for 
each of the fiscal years 1991 through 1993. 
"(2) For activities authorized in subsection (n), there are 
authorized to be appropriated $5,000,000 for fiscal year 1991, 
$7,500,000 for fiscal year 1992, and $10,000,000 for fiscal year 1993. 
Of such amounts, the Secretary shall use not more than 10 percent 
for administration and for activities described in subsection (nX2).". 
(d) REPEAL OF CERTAIN RESTRICTION ON FUNDING.—Section 
308(bX3) of the Public Health Service Act (42 U.S.C. 242m(3)) is 
repealed. 
SEG. 8. DEMONSTRATION GRANTS TO STATES FOR COMMUNITY SCHOL-
ARSHIP PROGRAMS. 
Subpart III of part D of title III of the Public Health Service Act 
(42 U.S.C 241 et seq.) is amended by inserting before subpart IV of 
such part the following new section: 
42 u s e 254u. 
"SEC. 338L. DEMONSTRATION GRANTS TO STATES FOR COMMUNITY 
SCHOLARSHIP PROGRAMS. 
"(a) IN GENERAL.—The Secretary, acting through the Adminis-
trator of the Health Resources and Services Administration, may 
make grants to States for the purpose of canying out demonstration 
programs to increase the availability of primary health care in 
urban and rural health manpower shortage areas through assisting 
community organizations of such areas in educating individuals to 
serve as health professionals in such areas. 
"0>) CERTAIN REQUIREMENTS FOR STATES.— 
"(1) MINIMUM QUALIFICATIONS.—The Secretary may not make 
a grant under subsection (a) unless the State involved will, 
under any provision of this Act other than subsection (a), 
receive 1 or more grants, cooperative agreements, or contracts 
for the fiscal year for which the State is appl5dng pursuant to 
subsection (h) to receive a grant under subsection (a). 
"(2) ADMINISTRATION OF PROGRAM.—The Secretary may not 
make a grant under subsection (a) unless the State involved 
agrees that the program carried out by the State with the grant 
will be administered directly by a single State agency. 
"(c) GRANTS BY STATES TO COMMUNITY ORGANIZATIONS FOR PROVI-
SION OF SCHOLARSHIP CONTRACTS.—The Secretary may not make a 
grant under subsection (a) unless the State involved agrees, subject 
to subsections (d) and (e), to carry out the purpose described in 
subsection (a) only through operating a program in which the State 
PUBLIC LAW 101-527—NOV. 6, 1990 
104 STAT. 2329 
makes grants to community organizations located in health man-
power shortage areas in order to assist the organizations with the 
costs of entering into contracts under which— 
"(1) the community organizations agree to provide scholar-
ships to individuals for attendance at hesdth professions schools; 
and 
"(2) the individuals agree to provide, in the health manpower 
shortage areas in which the community organizations are 
located, primary health care for— 
"(A) a number of years equal to the number of years for 
which the scholarships are provided, or for a period of 2 
years, whichever period is greater; or 
"(B) such greater period of time as the individuals and 
the community organizations may agree. 
"(d) REQUIREMENT OF STATE AND LOCAL MATCHING FUNDS.— 
"(1) IN GENERAL.—With respect to the costs of providing any 
scholarship pursuant to subsection (c), the Secretary may not 
make a grant under subsection (a) unless the State involved 
agrees that— 
"(A) 40 percent of the costs of the scholarship will be paid 
from the grant made under subsection (a) to the State; and 
"(B) 60 percent of such costs will be paid from non-
Federal contributions made in cash by both the State and 
the community organization through which the scholarship 
is provided, subject to— 
"(i) the State making available through such con-
tributions not less than 15 percent, nor more than 25 
percent, of such costs; and 
"(ii) the community organization making available 
through such contributions not less than 35 percent, 
nor more than 45 percent, of such costs. 
"(2) DETERMINATION OF AMOUNT OF NON-FEDERAL CONTRIBU-
TIONS.—The Secretary may not make a grant under subsection 
(a) unless the State involved agrees that, in determining the 
amount of non-Federal contributions that have been provided in 
cash for purposes of paragraph (1), the State will not include 
any amounts provided by the Federal Government to the State 
or community organization involved, or to any other entity. 
"(3) USE OF DONATIONS.—Non-Federal contributions required 
in paragraph (1) may be provided directly by the State and 
community organization involved, and may be provided through 
donations from public and private entities. 
"(e) SPECIFICATIONS REGARDING SCHOLARSHIP CONTRACT.—The Sec-
retary may not make a grant under subsection (a) unless the State 
involved agrees that the State will make a grant to a community 
organization for a contract described in subsection (c) only if— 
"(1) the individual who is to receive the scholarship under the 
contract is a resident of the health manpower shortage area in 
which the community organization is located; 
"(2) the individual is enrolled or accepted for enrollment as a 
full-time student in a health professions school that is approved 
by the Secretary for purposes of this section; 
"(3) the individual agrees to maintain an acceptable level of 
academic standing at the school (as determined by the school in 
accordance with regulations issued by the Secretary for pur-
poses of section 338A(fKlXBXiii)); 
104 STAT. 2330 
PUBLIC LAW 101-527—NOV. 6, 1990 
"(4) the individual and the community organization agree 
that the scholarship provided pursuant to the contract— 
"(A) will be expended only for— 
*Xi) tuition expenses, other reasonable educational 
expenses, and reasonable living expenses incurred in 
attendance at the school; and 
"(ii) payment to the individual of a monthly stipend 
of not more than the amount authorized for purposes of 
section 338A(gXlXB); and 
"(B) will not, for any year of such attendance for which 
the scholarship is provided, be in an amount exceeding the 
total amount required for the year for the purposes 
authorized in subparagraph (A); 
"(5) the individual agrees to meet the educational and licen-
sure requirements necessary to be a physician, certified nurse 
practitioner, certified nurse midwife, or physician assistant; and 
"(6) the individual agrees that, in providing primary health 
care pursuant to the scholarship, the individusd— 
"(A) will not, in the case of an individual seeking such 
care, discriminate against the individual on the basis of the 
ability of the individual to pay for such care or on the basis 
that pajnnent for such care will be made pursuant to the 
program established in title XVIII of the Social Security 
Act or pursuant to the program established in title XIX of 
such Act; and 
"(B) will accept assignment under section 1842(bX3XBXii) 
of the Social Security Act for all services for which pajnment 
may be made under part B of title XVIII of such Act, and 
will enter into an appropriate agreement with the State 
agency that administers the State plan for medical assist-
ance under title XIX of such Act to provide service to 
individuals entitled to medical assistance under the plan. 
"(f) REPORTS TO SECRETARY.—The Secretary may not make a grant 
under subsection (a) unless the State involved agrees— 
"(1) for each fiscal year for which such a grant is received by 
the Stete, to submit to the Secretary a report— 
"(A) identifying the community organizations providing 
scholarships pursuant to subsection (c) and the health man-
power shortage areas in which the organizations are 
located; 
"(B) providing the names of individuals receiving the 
scholarships, the health professions in which the individ-
uals will engage pursuant to the scholarships, the number 
of years of service the individuals are obligated to provide 
pursuant to the scholarships, and the extent of compliance 
with the contracts under subsection (c) on the part of the 
individuals and the community organizations; and 
"(C) providing such information as the Secretary may 
determine to be necessary for carrying out this section; and 
"(2) to submit each such report not later than January 10 of 
the fiscal year immediately following the fiscal year for which 
the report is prepared. 
"(g) ESTIMATES REGARDING ALLOCATIONS BETWEEN URBAN AND 
RURAL AREAS.—The Secretary may not make a grant under subsec-
tion (a) unless the State involved submits to the Secretary, as part of 
the application required in subsection (h), an estimate of the amount 
of the grant that will be expended r ^ a r d i i ^ the provision of 
PUBLIC LAW 101-527—NOV. 6, 1990 
104 STAT. 2331 
primary health care in urb£in health manpower shortage areas of 
the State, and an estimate of the amount of the grant that will be 
expended regarding the provision of such care in rural health 
manpower shortage areas of the State. 
"(h) REQUIREMENT OF APPUCATION.—The Secretary may not make 
a grant under subsection (a) unless an application for the grant is 
submitted to the Secretary 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 necessary to 
carry out this section. 
"(i) NONCOMPUANCE.— 
"(1) IN GENERAL.—The Secretary may not make pajonents 
under subsection (a) to a State for any fiscal year subsequent to 
the first fiscal year of such pa3anents unless the Secretary 
determines that, for the immediately preceding fiscal year, the 
State has complied with each of the agreements made by the 
/ 
State under this section. 
/ 
"(2) REDUCTION IN GRANT RELATIVE TO NUMBER OF BREACHED 
CONTRACTS.— 
"(A) Before making a grant under subsection (a) to a 
State for a fiscal year, the Secretary shall determine the 
number of contracts provided under subsection (c) with 
respect to which there has been an initial breach by the 
community organizations or individuals involved during 
the fiscal year preceding the fiscal year for which the State 
is appl5dng to receive the grant. 
"(B) In the case of a State with 1 or more initial breaches 
for purposes of subparagraph (A), the Secretary shall 
reduce the amount of a grant under subsection (a) to the 
State for the fiscal year involved by an amount equal to the 
sum of— 
"(i) an amount equal to the expenditures of Federal 
funds made regarding the contracts involved; and 
"(ii) an amount representing interest on the amount 
of such expenditures, determined with respect to each 
contract on the basis of the maximum legal rate 
prevailing for loans made during the time amounts 
were paid under the contract, as determined by the 
Treasurer of the United States. 
"(C) If a State is not receiving a grant under subsection 
(a) for a fiscal year for which a reduction under subpara-
graph (B) would have been made in the event that the State 
had received such a grant, the Secretary shall reduce the 
amount of payments due to the State under other grants, 
cooperative agreements, or contracts under this Act by the 
amount specified in such subparagraph. 
"(D) With respect to contracts provided under subsection 
(c), the Secretary may carry out this paragraph on the basis 
of information submitted by the States involved, or on the 
basis of information collected through such other means as 
the Secretary determines to be appropriate. 
"(j) REPORTS TO CONGRESS.— 
"(1) IN GENERAL.—Each fiscal year the Secretary shall submit 
to the Committee on Energy and Commerce of the House of 
Representatives, and to the Committee on Labor and Human 
Resources of the Senate, a report summarizing information 
104 STAT. 2332 
PUBLIC LAW 101-527—NOV. 6, 1990 
District of 
Columbia. 
Reports. 
received by the Secretary under subsection (f) for the preceding 
fiscal year. 
"(2) DATE FOR SUBMISSION.—With respect to a fiscal year, the 
report required in paragraph (1) shall be submitted for purposes 
of such paragraph by not later than the date on which the 
report required in section 338A(i) is required to be submitted for 
purposes of such section, 
"(k) DEFINITIONS.—For purposes of this section: 
"(1) COMMUNITY ORGANIZATION.—The term 
'community 
organization' means a public or nonprofit private entity. 
(2) PRIMARY HEALTH CARE.—The term 'primary health care' 
means health services regarding family medicine, internal 
medicine, pediatrics, or obstetrics and gynecology, that are 
provided by physicians, certified nurse practitioners, certified 
nurse midwives, or physician assistants. 
"(3) STATE.—'The term 'State' means each of the several States 
and the District of Columbia. 
"G) FUNDING.— 
"(1) AUTHORIZATION OF APPROPRIATIONS.—For the purpose of 
making grants under subsection (a), there are authorized to be 
appropriated $5,000,000 for fiscal year 1991, $10,000,000 for 
fiscal year 1992, and such sums as may be necessary for fiscal 
year 1993. 
"(2) AVAILABILITY.—Amounts appropriated under paragraph 
(1) shall remain available untU expended. 
"(3) ALLOCATIONS FOR RURAL AREAS.— 
"(A) In canying out subsection (a), the Secretary shall, to 
the extent practicable, ensure that not less than 50 percent 
of the amounts appropriated under paragraph (1) are, in the 
aggregate, expended for making grants pursuant to subsec-
tion (c) to community organizations that are located in 
rural health manpower shortage areas. 
"(B) Subparagraph (A) may not be construed to prohibit 
the Secretary from making grants under subsection (a) to 
States in which no rural health manpower shortage areas 
are located. 
"(C) With respect to any fiscal year for which the Sec-
retary is unable to comply with subparagraph (A), the 
Secretary shall, not later than April 1 of the sulxsequent 
fiscal year, submit to the Committee on Energy and Com-
merce of the House of Representatives, and to the Commit-
tee on Labor and Human Resources of the Senate, a report 
stating the fact of such noncompliance and an explanation 
of the reasons underlying such noncompliance.". 
SEC. 9. COMMUNITY AND MIGRANT HEALTH CENTERS. 
(a) COMMUNITY HEALTH CENTERS.— 
(1) PARALLEL STATUS WITH MIGRANT HEALTH CENTERS REGARD-
ING CERTAIN SERVICES.—Section 330 of the Public Health Service 
Act (42 U.S.C. 254c) is amended— 
(A) in subsection (aX5), by amending such section to read 
as follows: 
"(5) information on the availability and proper use of health 
services and services which promote and facilitate optimal use 
of health services, including, if a substantial number of the 
individuals in the population served by a center are of limited 
English-speaking ability, the services of appropriate personnel 
PUBLIC LAW 101-527—NOV. 6, 1990 
104 STAT. 2333 
fluent in the language spoken by a predominant number of such 
individuals, and , and 
(B) in subsection (bX2)— 
(i) in subparagraph (L), by adding "and" after the 
semicolon at the end; and 
(ii) by striking subparsigraph (M) and redesignating 
subparagraph (N) as subparagraph (M). 
(2) AUTHORIZATION OF APPROPRIATIONS.—Section 330(g) of the 
Public Health Service Act (42 U.S.C. 254cO?)) is amended— 
(1) in paragraph (IXA)— 
(A) by striking "1989 and" and inserting "1989,"; and 
(B) by inserting before the period the following: ", and 
such sums as may be necessary for each of the fiscsd years 
1992 through 1994"; and 
(2) in paragraph (2XA)— 
(A) by striking "and" after "1990,"; and 
(B) by inserting before the period the following: ", and 
such sums as may be necessary for each of the fiscal years 
1992 through 1994". 
(b) AUTHORIZATION OF APPROPRIATIONS FOR MIGRANT HEALTH CEN-
TERS.—Section 329(h) of the Public Health Service Act (42 U.S.C. 
254b(h)) is amended— 
(1) in paragraph (IXA)— 
(A) by striking "1989 and" and inserting "1989,"; and 
(B) by inserting before the period the following: ", and 
such sums as may be necessary for each of the fiscal years 
1992 through 1994"; and 
(2) in paragraph (2XA)— 
(A) by striking "and" after "1990,"; and 
(B) by inserting before the period the following: ", and 
such sums as may be necessary for each of the fiscal years 
1992 through 1994". 
SEC. 10. GRANTS FOR HEALTH SERVICES FOR PACIFIC ISLANDERS. 
42 USC 254c-l. 
(a) GRANTS.—The Secretary of Health and Human Services (here-
after in this section referred to as the "Secretary") shall provide 
grants to, or enter into contracts with, public or private nonprofit 
agencies that have demonstrated experience in serving the health 
needs of Pacific Islanders living in the Territory of American 
Samoa, the Commonwealth of Northern Mariana Islands, the Terri-
tory of Guam, the Republic of the Marshall Islands, the Republic of 
Palau, and the Federated States of Micronesia. 
(b) USE OF GRANTS OR CONTRACTS.—Grants or contracts made or 
entered into under subsection (a) shall be used, among other items— 
(1) to continue, as a priority, the medical officer training 
\ 
program in Pohnpei, Federated States of Micronesia; 
(2) to improve the quality and availability of health and 
mental health services and systems, with an emphasis therein 
on preventive health services and health promotion programs 
and projects, including improved health data systems; 
(3) to improve the quality and availability of health man-
power, including programs and projects to train new and up-
grade the skills of existing health professionals by— 
(A) establishing dental officer, dental assistant, nurse 
practitioner, or nurse clinical specialist training programs; 
(B) providing technical training of new auxiliary health 
workers; 
104 STAT. 2334 
PUBLIC LAW 101-527—NOV. 6, 1990 
(C) upgrading the training of currently employed health 
personnel in special areas of need; 
(D) developing long-term plans for meeting health profes-
sion needs; 
(E) developing or improving programs for 
faculty 
enhancement or post-doctoral training; and 
(F) providing innovative health professions training ini-
tiatives (including scholarships) targeted toward ensuring 
that residents of the Pacific Basin attend and graduate 
from recognized health professional programs; 
(4) to improve the quality of health services, including labora-
tory, x-ray, and pharmacy, provided in ambulatory and 
inpatient settings through quality assurance, standard setting, 
and other culturally appropriate means; 
(5) to improve facility and equipment repair and maintenance 
systems; 
(6) to improve alcohol, drug abuse, and mental health preven-
tion and treatment services and systems; 
(7) to improve local and regional health planning systems; and 
(8) to improve basic local public health systems, with particu-
lar attention to primary care £ind services to those most in need. 
No funds under subsection (b) shall be used for capital construction. 
(c) ADVISORY COUNCIL.—The Secretary of Health and Human 
Services shall establish a "Pacific Health Advisory Council" which 
shall consist of 12 members and shall include— 
(1) the Directors of the Health Departments for the entities 
identified in subsection (a); and 
Hawaii. 
(2) 6 members, including a representative of the Rehabilita-
tion Hospital of the Pacific, representing organizations in the 
State of Hawaii actively involved in the provision of health 
services or technical assistance to the entities identified in 
subsection (a). The Secretary shall solicit the advice of the 
Governor of the State of Hawaii in appointing the 5 Council 
members in addition to the representative of the Rehabilitation 
Hospital of the Pacific from the State of Hawaii. 
The Secretary shall be responsible for providing sufficient staff 
support to the Council. 
(d) ADVISORY COUNCIL FUNCTIONS.—The Council shall meet at 
least annually to— 
(1) recommend priority areas of need for funding by the 
Public Health Service under this section; and 
(2) review progress in addressing priority areas and make 
recommendations to the Secretary for needed program modi-
fications. 
(e) REPORT.—The Secretary, in consultation with the Council, shall 
annually prepare and submit to the appropriate committees of 
Congress a report describing the expenditure of the 
funds 
authorized to be appropriated under this section and any rec-
ommendations that the Secretary may have. 
(f) AUTHORIZATION OF APPROPRIATION.—There is authorized to be 
appropriated to carry out this section $10,000,000 for each of the 
fiscal years 1991 through 1993. 
SEC. 11. MISCELLANEOUS PROVISIONS. 
Section 639 of Public Law 100-607 (42 U.S.C. 292h note) is 
repealed. 
PUBLIC LAW 101-527—NOV. 6, 1990 
104 STAT. 2335 
SEC. 12. EFFECTIVE DATE. 
42 USC 242k 
note. 
This Act and the amendments made by this Act shall take effect 
October 1, 1990, or upon the date of the enactment of this Act, 
whichever occurs later. 
Approved November 6, 1990. 
LEGISLATIVE HISTORY—H.R. 5702: 
HOUSE REPORTS: No. 101-804 (Comm. on Education and Labor). 
CONGRESSIONAL RECORD, Vol. 136 (1990): 
Oct. 10, considered and passed House. 
Oct. 16, considered and passed Senate. 
WEEKLY COMPILATION OF PRESIDENTIAL DOCUMENTS, Vol. 26 (1990): 
Nov. 6, Presidential statement.