Public Health Service Amendments of 1987
PL 100-177 (S.1158), enacted 12/01/1987

101 STAT. 986 
PUBLIC LAW 100-177—DEC. 1, 1987 
Public Law 100-177 
100th Congress 
An Act 
Dec. 1, 1987 
[S. 1158] 
Public Health 
Service 
Amendments of 
1987. 
42 u s e 201 note. 
To amend the Public Health Service Act to establish a National Health Service Corps 
Loan Repayment Program and to otherwise revise and extend the program for the 
National Health Service Corps. 
Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled, 
SECTION 1. SHORT TITLE; TABLE OF CONTENTS. 
(a) SHORT TITLE.—This Act may be cited as the "Public Health 
Service Amendments of 1987". 
(b) TABLE OF CONTENTS.—The table of contents is as follows: 
Sec. 1. Short title; table of contents. 
Sec. 2. References to the Public Health Service Act. 
TITLE I-HEALTH RESEARCH, TECHNOLOGY, STATISTICS, AND 
PREVENTIVE HEALTH PROGRAMS 
Sec. 101. Establishment of certain rural programs of National Center for Health 
Services Research and Health Care Technology Assessment. 
Sec. 102. Duties and composition of National Advisory Council on Health Care Tech-
nology Assessment. 
Sec. 103. Prohibition against altering certain administrative relationships. 
Sec. 104. National Center for Health Statistics. 
Sec. 105. National Committee on Vital and Health Statistics. 
, i, 
Sec. 106. Health care reports and profiles. 
Sec. 107. Requirement of peer review groups for evaluations of grant proposals. 
Sec. 108. Authorization of appropriations. 
Sec. 109. Requirement with respect to amount of non-Federal contributions in grant 
program for Council on Health Care Technology. 
Sec. 110. Project grants for preventive health projects for immunizations. 
Sec. 111. Project grants for preventive health projects for tuberculosis; additional 
grants. 
TITLE II—NATIONAL HEALTH SERVICE CORPS LOAN REPAYMENT 
PROGRAM 
Sec. 201. Establishment of loan repayment program. 
Sec. 202. Technical and conforming amendments. 
Sec. 203. Report and authorization of appropriations for scholarship and loan repay-
ment programs; State programs. 
Sec. 204. Special repayment provisions. 
Sec. 205. Regulations. 
TITLE III—NATIONAL HEALTH SERVICE CORPS 
Sec. 301. Requirement of consideration of needs of Indian Health Service, certain 
Indian tribes, and the homeless. 
Sec. 302. Designation of health manpower shortage areas. 
Sec. 303. Placement of physicians. 
Sec. 304. Assignment of family physicians. 
Sec. 305. Authorizations of appropriations for general operations of National Health 
Service Corps. 
Sec. 306. Obligated service. 
Sec. 307. Private practice. 
Sec. 308. Discharge of obligations in bankruptcy. 
Sec. 309. Special loans for Corps members to enter private practice. 
PUBLIC LAW 100-177—DEC. 1, 1987 
101 STAT. 987 
TITLE IV-MISCELLANEOUS 
Sec. 401. Geriatric medicine training projects. 
Sec. 402. Professional review activities. 
SEC. 
2
. 
REFERENCES 
TO 
THE 
PUBLIC 
HEALTH 
SERVICE 
ACT. 
Except as otherwise specifically provided, whenever in this Act an 
amendment or repeal is expressed in terms of an amendment to, or 
a repeal of, a section or other provision, the reference shall be 
considered to be made to a section or other provision of the Public 
Health Service Act (42 U.S.C. 201 et seq.). 
TITLE I—HEALTH RESEARCH, TECHNOL-
OGY, STATISTICS, AND PREVENTIVE 
HEALTH PROGRAMS 
SEC. 101. ESTABLISHMENT OF CERTAIN RURAL PROGRAMS OF NATIONAL 
CENTER FOR HEALTH SERVICES RESEARCH AND HEALTH 
CARE TECHNOLOGY ASSESSMENT. 
Section 305 (42 U.S.C. 242c) is amended— 
(1) by redesignating subsections (c) through (i) as subsections 
(d) through (j), respectively; and 
(2) by inserting after subsection (b) the following new 
subsection: 
"(c) In carrying out section 304(a), the Secretary, acting through 
the Center, shall undertake and support research, evaluation, and 
demonstration projects (that may include and shall be appropriately 
coordinated with experiments and demonstration activities au-
thorized by the Social Security Act (42 U.S.C. 301 et seq.) and the 
Social Security Amendments of 1967 (Public Law 90-248; 81 Stat. 
821)) respecting the delivery of health care services in rural areas 
(including frontier areas), which may include projects with respect 
to— 
"(1) the future of the rural hospital; 
"(2) long-term health care for the rural elderly; 
"(3) hospital care for the rural poor and uninsured; and 
"(4) alternative health care delivery systems and managed 
health care in rural areas.". 
SEC. 102. DUTIES AND COMPOSITION OF NATIONAL ADVISORY COUNCIL 
ON HEALTH CARE TECHNOLOGY ASSESSMENT. 
Section 305(h) (as redesignated in section 101(1) of this Act) is 
amended— 
(1) in the last sentence of paragraph (1), by striking out "shall 
assist the Director in developing" and inserting in lieu thereof 
"shall make recommendations to the Director with respect to 
the development of; and 
(2) by striking out paragraph (3) and inserting in lieu thereof 
the following new paragraph: 
"(3)(A) The Secretary shall appoint to the Council— 
"(i) six individuals distinguished in the fields of medicine, 
engineering, and science (including social science); 
"(ii) four individuals distinguished in the fields of law, ethics, 
economics, and management; and 
"(iii) two individuals representing the interests of consumers 
of health care services. 
Health care 
facilities. 
Aged persons. 
Disadvantaged 
persons. 
101 STAT. 988 
PUBLIC LAW 100-177—DEC. 1, 1987 
"(B) The Secretary shall ensure that members of the Council, as a 
group, are representative of professions and entities concerned with, 
or affected by, health care technology.". 
42 u s e 242c 
SEC. 103. PROHIBITION AGAINST ALTERING CERTAIN ADMINISTRATIVE 
note. 
RELATIONSHIPS. 
With respect to carrying out section 305 of the Public Health 
Service Act (42 U.S.C. 242c), the Secretary may not alter the 
administrative relationship between the Assistant Secretary for 
Health and the Director of the National Center for Health Services 
Research and Health Care Technology Assessment, as in effect 
during fiscal year 1986. 
SEC. 104. NATIONAL CENTER FOR HEALTH STATISTICS. 
J 
Section 306(a) (42 U.S.C. 242k(a)) is amended by striking out "and 
supervised" and all that follows through the period and inserting in 
lieu thereof a period. 
SEC. 105. NATIONAL COMMITTEE ON VITAL AND HEALTH STATISTICS. 
(a) IN GENERAL.—Section 306(k) (42 U.S.C. 242k(k)) is amended— 
(1) in paragraph (1), by striking out "fifteen" and inserting in 
lieu thereof "16"; 
(2) in the second sentence of paragraph (2)(A), by striking out 
w 
"three" and inserting in lieu thereof "4"; and 
(3) in paragraph (2), by striking out subparagraph (B) and 
inserting in lieu thereof the following: 
"(B)(i) In the case of membership terms on the Committee under 
this subsection (as in effect prior to January 1, 1988) that expire in 
calendar year 1988, the appointments to three such terms in such 
calendar year shall be for a period of 4 years and the appointments 
to two such terms in such calendar year shall be for a period of 3 
years, as designated by the Secretary. 
"(ii) In the case of membership terms on the Committee under this 
subsection (as in effect prior to January 1, 1988) that expire in 
calendar year 1989, one such term shall be extended for an addi-
tional consecutive 1-year period, as designated by the Secretary. 
• J 
"(iii) In the case of membership terms on the Committee under 
this subsection (as in effect prior to January 1, 1988) that expire in 
calendar year 1990, two of such terms shall each be extended for an 
additional 
consecutive 
1-year period, as designated 
by 
the 
Secretary.". 
42 use 242k 
(b) EFFECTIVE DATE.—The amendments made by this section shall 
note. 
become effective on January 1,1988. 
SEC. 106. HEALTH CARE REPORTS AND PROFILES. 
(a) REPORTS.—Section 308 (42 U.S.C. 242m(a)) is amended— 
(1) by striking out paragraphs (1) and (2) and inserting in lieu 
thereof the following new paragraphs: 
"(1) Not later than March 15 of each year, the Secretary shall 
submit to the President and Congress the following reports: 
"(A) A report on— 
_ , 
"(i) the administration of sections 304 through 307 and 
,pnf/i 
section 309 during the preceding fiscal year; and 
"(ii) the current state and progress of health services 
dT:rtS!».- 
research, health statistics, and health care technology. 
PUBLIC LAW 100-177—DEC. 1, 1987 
101 STAT. 989 
"(B) A report on health care costs and financing. Such report 
shall include a description and analysis of the statistics col-
lected under section 30603)(1)(G). 
"(C) A report on health resources. Such report shall include a 
description and analysis, by geographical area, of the statistics 
collected under section 306(b)(1)(E). 
"(D) A report on the utilization of health resources. Such 
report shall include a description and analysis, by age, sex, 
income, and geographic area, of the statistics collected under 
section 306(b)(1)(F). 
"(E) A report on the health of the Nation's people. Such 
report shall include a description and analysis, by age, sex, 
income, and geographic area, of the statistics collected under 
section 306(b)(1)(A). 
"(2) The reports required by subparagraphs (B) through (E) of 
paragraph (2) shall be prepared through the National Center for 
Health Services Research and Health Care Technology Assessment 
and the National Center for Health Statistics."; and 
(2) in paragraph (3), by striking out "or (2)". 
(b) NATIONAL DISEASE PREVENTION DATA PROFILES.—The first sen-
tence of section 404(a) of the Health Services and Centers Amend-
ments of 1978 (42 U.S.C. 242p(a)) is amended by striking out "on 
December 1, 1980, and on December 1 of every third year there-
after" and inserting in lieu thereof "on March 15, 1990, and on 
March 15 of every third year thereafter". 
(c) EFFECTIVE DATE.—The amendments made by subsections (a) 42 USC 242m 
and (b) shall apply to reports and profiles required to be submitted note. 
after November 1,1987. 
SEC. 107. REQUIREMENT OF PEER REVIEW GROUPS FOR EVALUATIONS 
OF GRANT PROPOSALS. 
Section 308(b) (42 U.S.C. 242m(b)) is amended— 
(1) in paragraph (1), by inserting before the period at the end 
thereof the following: "and unless a peer review group referred 
to in paragraph (2) has recommended the application for ap-
proval"; and 
(2) by striking out paragraph (2) and inserting in lieu thereof 
the following new paragraph: 
"(2)(A) Each application submitted for a grant or contract under 
section 304 or 305, in an amount exceeding $50,000 of direct costs 
and for a health services research, evaluation, or demonstration 
project, shall be submitted to a peer review group for an evaluation 
of the technical and scientific merits of the proposals made in each 
such application. The Secretary, acting through the Director of the 
National Center for Health Services Research and Health Care 
Technology Assessment (or, as appropriate, through the Director of 
the National Center for Health Statistics), shall establish such peer 
review groups as may be necessary to provide for such an evaluation 
of each such application. 
"(B) A peer review group to which an application is submitted 
Reports. 
pursuant to subparagraph (A) shall report its finding and rec-
ommendations respecting the application to the Secretary, acting 
through the Director involved, in such form and manner as the 
Secretary shall by regulation prescribe. The Secretary may not 
approve an application described in such subparagraph unless a 
peer review group has recommended the application for approval. 
101 STAT. 990 
PUBLIC LAW 100-177—DEC. 1, 1987 
"(C) The Secretary, acting through the Directors, shall make 
appointments to the peer review groups required in subparagraph 
(A) from among persons who are not officers or employees of the 
United States and who possess appropriate technical and scientific 
qualifications.". 
SEC. 108. AUTHORIZATION OF APPROPRIATIONS. 
Subsection (i) of section 308 (42 U.S.C. 242m(i)) is amended to read 
as follows: 
"(i)(l)(A) For health service research, evaluation, and demonstra-
tion activities undertaken or supported under section 304 or 305, 
there are authorized to be appropriated $30,000,000 for fiscal year 
1988 and such sums as may be necessary for each of the fiscal years 
1989 and 1990. At least 20 percent of the amount appropriated under 
the preceding sentence for any fiscal year or $6,000,000, whichever is 
less, shall be available only for health services research, evaluation 
and demonstration activities directly undertaken through the Na-
tional Center for Health Services Research and Health Care Tech-
nology Assessment, and at least 10 percent of such amount or 
$1,500,000 whichever is less, shall be available only for the user 
liaison program and the technical assistance program referred to in 
section 305(d)(2) and for dissemination activities directly undertaken 
through such Center. 
"(B) For health care technology assessment activities undertaken 
under subsections (b)(5), (g), and (h) of section 305, the Secretary 
shall obligate from funds appropriated under this paragraph not less 
than $4,500,000 for each of the fiscal years 1988 through 1990. 
"(C) For grants under section 309, the Secretary shall make 
available from funds appropriated under this paragraph not more 
than $750,000 for each of the fiscal years 1988 through 1990. Of such 
amounts made available, the Secretary shall, with respect to non-
Federal contributions made available by grantees pursuant to sec-
tion 309(a)(2)(B), obligate during each such fiscal year such amounts 
as may be necessary to pay the Federal share appropriate under 
such section as a result of such contributions. 
"(D) Of the amounts appropriated under this paragraph for any 
fiscal year, not more than $1,500,000 may be used for grants and 
contracts for all the costs of planning, establishing, and operating 
centers under section 305(e). 
"(2) For health statistical and epidemiological activities under-
taken or supported under section 304 or 306, there are authorized to 
be appropriated $55,000,000 for fiscal year 1988 and such sums as 
may be necessary for each of the fiscal years 1989 and 1990.". 
SEC. 109. REQUIREMENT WITH RESPECT TO AMOUNT OF NON-FEDERAL 
CONTRIBUTIONS IN GRANT PROGRAM FOR COUNCIL ON 
HEALTH CARE TECHNOLOGY. 
Section 309(a)(2)(B) (42 U.S.C. 242n(a)(2)(B)) is amended by insert-
ing before the period at the end thereof the following: ", except that 
for fiscal years 1988 and 1989, the Secretary may only require 
"
" ' 
expenditures from non-Federal sources in an amount not less than 
the amount of the grant applied for". 
SEC. no. PROJECT GRANTS FOR PREVENTIVE HEALTH PROJECTS FOR 
IMMUNIZATIONS. 
(a) IN GENERAL.—Paragraph (1) of section 317(j) (42 U.S.C. 
247b(jXl)) is amended to read as follows: 
PUBLIC LAW 100-177—DEC. 1, 1987 
101 STAT. 991 
"(IXA) Except for grants for immunization programs the 
authorization of appropriations for which are established in 
subparagraph (B), for grants under subsections (a) and (k)(l) for 
preventive health service programs to immunize without charge 
individuals against vaccine-preventable diseases, there are au-
thorized to be appropriated $94,000,000 for fiscal year 1988, and such 
sums as may be necessary for each of the fiscal years 1989 and 1990. 
Not more than 10 percent of the total amount appropriated under 
the preceding sentence for any fiscal year shall be available for 
grants under subsection (kXl) for such fiscal year. 
"(B) For grants under subsection (a) for preventive health service 
programs for the provision without charge of immunizations with 
vaccines approved for use, and recommended for routine use, after 
the date of the enactment of Public Health Service Amendments of 
1987, there are authorized to be appropriated such sums as may be 
necessary for each of the fiscal years 1988,1989, and 1990. 
"(C) On the implementation of subtitle 2 of title XXI, there are 
authorized to be appropriated for grants under subsection (a) for 
which appropriations are authorized in subparagraph (A) such sums 
as may be necessary for fiscal years 1988 through 1990 to make such 
grants.". 
(b) SUPPLY OF VACCINES.— 
(1) IN GENERAL.—The Secretary of Health and Human Serv-
ices, acting through the Director of the Centers for Disease 
Control, shall acquire and maintain a supply of vaccines suffi-
cient to provide vaccinations throughout a 6-month period. 
(2) AUTHORIZATION OF APPROPRIATIONS.—There are authorized 
to be appropriated to carry out paragraph (1) $5,000,000 for 
fiscal year 1988, and such sums as may be necessary for each of 
the fiscal years 1989 and 1990. 
SEC. 111. PROJECT GRANTS FOR PREVENTIVE HEALTH PROJECTS FOR 
TUBERCULOSIS; ADDITIONAL GRANTS. 
(a) PROJECT GRANTS.—Paragraph (2) of section 317(j) (42 U.S.C. 
247b(j)(2)) is amended to read as follows: 
"(2) For grants under subsection (a) for preventive health service 
programs for tuberculosis, and for grants under subsection (kX2), 
there are authorized to be appropriated $24,000,000 for fiscal year 
1988, $31,000,000 for fiscal year 1989, and $36,000,000 for fiscal year 
1990. Not more than 10 percent of the total amount appropriated 
under the preceding sentence for any fiscal year shall be available 
for grants under subsection (kX2) for such fiscal year.". 
(b) ADDITIONAL GRANTS.—Section 317 is amended by adding at the 
end thereof the following new subsection: 
"(kXD The Secretary may make grants to States, political subdivi-
sions of States, and other public and nonprofit private entities for— 
"(A) research into the prevention and control of diseases that 
may be prevented through vaccination; 
' (B) demonstration projects for the prevention and control of 
such diseases; 
"(C) public information and education programs for the 
prevention and control of such diseases; and 
"(D) education, training, and clinical skills improvement 
activities in the prevention and control of such d^ases for 
health professionals (including allied health personnel). 
"(2) The Secretary may make grants to States, political subdivi-
sions of States, and other public £uid nonprofit private entities for— 
42 use 300aa-2 
note. 
State and local 
governments. 
Health care 
professionals. 
Education. 
101 STAT. 992 
PUBLIC LAW 100-177—DEC. 1, 1987 
"(A) research into the prevention and control of tuberculosis, 
especially research concerning strains of tuberculosis resistant 
to drugs and research concerning cases of tuberculosis that 
affect certain populations; 
"(B) demonstration projects for the prevention and control of 
tuberculosis; 
"(C) public information and education programs for preven-
tion and control of tuberculosis; and 
"(D) education, training, and clinical skills improvement 
activities in the prevention and control of tuberculosis for 
health professionals, including allied health personnel. 
"(3) The Secretary may make grants to States, political subdivi-
sions of States, and other public and nonprofit private entities for— 
"(A) research into the prevention and control of diseases and 
conditions; 
"(B) demonstration projects for the prevention and control of 
such diseases and conditions; 
"(C) public information and education programs for the 
prevention and control of such diseases and conditions; and 
"(D) education, training, and clinical skills improvement 
activities in the prevention and control of such diseases and 
conditions for health professionals (including allied health 
^"'- ' 
'^.••; 
personnel). 
"(4) No grant may be made under this subsection unless an 
application therefor is submitted to the Secretary in such form, at 
such time, and containing such information as the Secretary may by 
regulation prescribe. 
"(5) Subsections (d), (e), and (f) of section 317 shall apply to grants 
under this subsection in the same manner as such subsections apply 
to grants under subsection (a) of section 317.". 
Health care 
TITLE II—NATIONAL HEALTH SERVICE 
professionals 
CORPS LOAN REPAYMENT PROGRAM 
SEC. 201. ESTABLISHMENT 
OF 
LOAN 
REPAYMENT 
PROGRAM. 
Subpart II of part D of title III (42 U.S.C. 254d et seq.) is 
amended— 
(1) by redesignating section 338G (42 U.S.C. 254r) as section 
3381* 
(2) by redesignating sections 338B through 338F (42 U.S.C. 
* •
•
* 254m through 254q) £is sections 338C through 338G, respectively; 
and 
' 
(3) by inserting after section 338A the following new section: 
42 u s e 254Z-1. 
"SEC. 338B. NATIONAL HEALTH SERVICE CORPS LOAN REPAYMENT 
PROGRAM. 
"(a) ESTABLISHMENT.—The Secretary shall establish a program to 
be known as the National Health Service Corps Loan Repayment 
Program (hereinafter in this subpart referred to as the 'Loan Repay-
ment Program') in order to assure— 
"(1) an adequate supply of trained physicians, dentists, and 
nurses for the Corps; and 
"(2) if needed by the Corps, an adequate supply of podiatrists, 
'h'& optometrists, pharmacists, clinical psychologists, graduates of 
' schools of veterinary medicine, graduates of schools of public 
PUBLIC LAW 100-177—DEC. 1, 1987 
101 STAT. 993 
health, graduates of programs in health administration, grad-
uates of programs for the training of physician assistants, ex-
panded function dental auxiliaries, and nurse practitioners (as 
defined in section 822), and other health professionals. 
"(b) ELIGIBIUTY.—To be eligible to participate in the Loan Repay-
ment Program, an individual must— 
"(1)(A) be enrolled— 
"(i) as a full-time student— 
"(I) in an accredited (as determined by the Secretary) 
educational institution in a State; and 
"'' •' ' 
"(II) in the final year of a course of study or program, 
offered by such institution and approved by the Sec-
'/-'"'-' 
retary, leading to a degree in medicine, osteopathy, 
dentistry, or other health profession; or 
"(ii) in an approved graduate training program in medi-
*' 
cine, osteopathy, dentistry, or other health profession; or 
"(B) have— 
"(i) a degree in medicine, osteopathy, dentistry, or other 
•- 
health profession; 
"(ii) completed an approved graduate training program in 
^ 
medicine, osteopathy, dentistry, or other health profession 
in a State, except that the Secretary may waive the comple-
tion requirement of this clause for good cause; and 
"(iii) a license to practice medicine, osteopathy, dentistry, 
or other health profession in a State; 
'*' 
"(2) be eligible for, or hold, an appointment as a commissioned 
officer in the Regular or Reserve Corps of the Service or be 
: 
eligible for selection for civilian service in the Corps; 
"(3) submit an application to participate in the Loan Repay-
ment Program; and 
"(4) sign and submit to the Secretary, at the time of the 
submission of such application, a written contract (described in 
subsection (f)) to accept repayment of educational loans and to 
serve (in accordance with this subpart) for the applicable period 
' 
of obligated service in a health manpower shortage area. 
"(c) APPLICATION, CONTRACT, AND INFORMATION REQUIREMENTS.— 
"(1) SUMMARY AND INFORMATION.—In disseminating applica-
tion forms and contract forms to individuals desiring to partici-
pate in the Loan Repayment Program, the Secretary shall 
include with such forms— 
"(A) a fair summary of the rights and liabilities of an 
individual whose application is approved (and whose con-
tract is accepted) by the Secretary, including in the sum-
mary a clear explanation of the damages to which the 
United States is entitled under section 338E in the case of 
the individual's breach of the contract; and 
"(B) information respecting meeting a service obligation 
through private practice under an agreement under section 
338D and such other information as may be necessary for 
the individual to understand the individual's prospective 
participation in the Loan Repayment Program and service 
in the Corps. 
"(2) UNDERSTANDABIUTY.—The application form, contract 
form, and all other information furnished by the Secretary 
under this subpart shall be written in a manner calculated to be 
understood by the average individual applying to participate in 
the Loan Repayment Program. 
101 STAT. 994 
PUBLIC LAW 100-177—DEC. 1, 1987 
• 
"(3) AVAILABILITY.—The Secretary shall make such applica-
tion forms, contract forms, and other information available to 
individuals desiring to participate in the Loan Repayment Pro-
gram on a date sufficiently early to ensure that such individuals 
have adequate time to carefully review and evaluate such forms 
and information. 
"(d) PRIORITY.—In determining which applications under the Loan 
Repa3nnent Program to approve (£ind which contracts to accept), the 
Secretary shall give priority to applications made by— 
"(1) individuals whose training is in a health profession or 
specialty determined by the Secretary to be needed by the 
Corps; and 
"(2) individuals who are committed to service in medically 
underserved areas. 
"(e) APPROVAL REQUIRED FOR PARTICIPATION.— 
"(1) IN GENERAL.—An individual becomes a participant in the 
Loan Repajrment Program only on the Secretary's approval of 
the individual's application submitted under subsection (bX3) 
and the Secretary's acceptance of the contract submitted by the 
individual under subsection (bX4). 
"(2) WRITTEN NOTICE.—The Secretary shall provide written 
notice to an individual promptly on— 
"(A) the Secretary's approving, under paragraph (1), of 
the individual's participation in the Loan Repa5nnent Pro-
gram; or 
"(B) the Secretary's disapproving an individual's partici-
pation in such Program. 
"(f) CONTENTS OP CONTRACTS.—The written contract (referred to 
in this subpart) between the Secretary and an individual shall 
contain— 
"(1) an agreement that— 
"(A) subject to paragraph (3), the Secretary agrees— 
"(i) to pay on behalf of the individual loans in accord-
ance with subsection (g); and 
"(ii) to accept (subject to the availability of appro-
priated funds for carrying out sections 331 through 335 
and section 337) the individual into the Corps (or for 
equivalent service as otherwise provided in this sub-
f 
part); and 
"(B) subject to paragraph (3), the individual agrees— 
"(i) to accept loan pajrments on behalf of the 
individual; 
"(ii) in the case of an individual described in subsec-
tion (bXlXA), to maintain enrollment in a course of 
study or training described in such subsection until the 
individual completes the course of study or training; 
"(iii) in the case of an individual described in subsec-
tion (bXlXA), while enrolled in such course of study or 
training, to maintain an acceptable level of academic 
standing (as determined under regulations of the Sec-
retary by the educational institution offering such 
course of study or training); and 
"(iv) to serve for a time period (hereinsifter in this 
subpart referred to as the 'period of obligated service') 
equal to 2 years or such longer period as the individual 
may agree to, in a health manpower shortage area 
(designated under section 332) to which such individual 
PUBLIC LAW 100-177—DEC. 1, 1987 
101 STAT. 995 
is assigned by the Secretary as a member of the Corps 
or released under section 338D; 
"(2) a provision permitting the Secretary to extend for such 
longer additional periods, as the individual may agree to, the 
period of obligated service agreed to by the individual under 
paragraph (l)(B)(iv); 
"(3) a provision that any financial obligation of the United 
States arising out of a contract entered into under this subpart 
and any obligation of the individual that is conditioned thereon, 
is contingent on funds being appropriated for loan repayments 
under this subpart and to carry out the purposes of sections 331 
through 335 and sections 337 and 338; 
"(4) a statement of the damages to which the United States is 
entitled, under section 338E for the individual's breach of the 
contract; and 
"(5) such other statements of the rights and liabilities of the 
Secretary and of the individual, not inconsistent with this 
subpart. 
"(g) PAYMENTS.— 
"(I) IN GENERAL.—A loan repayment provided for an individ-
ual under a written contract under the Loan Repayment Pro-
gram shall consist of payment, in accordance with paragraph 
(2), on behalf of the individual of the principal, interest, and 
related expenses on government and commercial loans received 
by the individual for— 
"(A) tuition expenses; 
"(B) all other reasonable educational expenses, including 
fees, books, and laboratory expenses, incurred by the 
individual; or 
"(C) reasonable living expenses as determined by the 
Secretary. 
"(2) PAYMENTS FOR YEARS SERVED.— 
"(A) IN GENERAL.—Except as provided in subparagraph 
(B) and paragraph (3), for each year of obligated service that 
an individual contracts to serve under subsection (f) the 
Secretary may pay up to $20,000 on behalf of the individual 
for loans described in paragraph (1). 
"(B) INDIAN SERVICE.—For each year of obligated service 
that an individual contracts under subsection (f) to serve in 
the Indian Health Service, or to serve in a health program 
or facility operated by a tribe or tribal organization under 
the Indian Self-Determination Act (25 U.S.C. 450f et seq.), 
the Secretary may pay up to $25,000 on behalf of the 
individual for loans described in paragraph (1). 
"(C) REPAYMENT SCHEDULE.—Any arrangement made by 
the Secretary for the making of loan repayments in accord-
ance with this subsection shall provide that any repay-
ments for a year of obligated service shall be made no later 
than the end of the fiscal year in which the individual 
completes such year of service. 
"(3), TAX LIABILITY.—In addition to payments made under 
para^aph (2), in any case in which payments on behalf of an 
individual under the Loan Repayment Program result in an 
increase in Federal, State, or local income tax liability for such 
individual, the Secretary may, on the request of such individual, 
make payments to such individual in a reasonable amount, as 
91-194 O - 90 - 33 : QL.3 Part 1 
101 STAT. 996 
PUBLIC LAW 100-177—DEC. 1, 1987 
' 
determined by the Secretary, to reimburse such individual for 
all or part of the increased tax liability of the individual. 
"(4) PAYMENT SCHEDULE.—The Secretary may enter into an 
» 
agreement with the holder of any loan for which payments are 
' 
made under the Loan Repayment Program to establish a sched-
ule for the making of such payments. 
"(h) EMPLOYMENT CEILING.—Notwithstanding any other provision 
of law, individuals who have entered into written contracts with the 
Secretary under this section, while undergoing academic or other 
training, shall not be counted against any employment ceiling 
affecting the Department. 
"(i) REPORTS.—The Secretary shall, not later than March 1 of each 
year, submit to the Congress a report specifying— 
"(1) the number, and type of health profession training, of 
individuals receiving loan payments under the Loan Repayment 
y 
Program; 
"(2) the educational institution at which such individuals are 
receiving their training; 
"(3) the number of applications filed under this section in the 
school year beginning in such year and in prior school years; 
•i 
and 
"(4) the amount of loan payments made in the year reported 
on. . 
SEC. 202. TECHNICAL AND CONFORMING AMENDMENTS. 
(a) SECTION 303.—Section 303(d)(4) (42 U.S.C. 242a(d)(4)) is 
amended— 
^ 
(1) by striking out "752 or 753" each place it appears and 
inserting in lieu thereof "338C or 338D"; and 
,v 
(2) in subparagraph (A), by striking out "subpart IV of part C 
of title VII and inserting in lieu thereof "subpart II of part D". 
(b) SECTION 331.—Section 331 (42 U.S.C. 254d) is amended— 
(1) in subsection Qoi), by striking out "and the Scholarship 
Program" and inserting in lieu thereof ", the Scholarship Pro-
, 
gram, and the Loan Repayment Program"; 
7 
(2) in subsection (c), by striking out "338C" and inserting in 
^ 
lieu thereof "338D"; 
(3) in subsection (d)(2), by inserting after "Program" the 
! 
following: "or the Loan Repayment Program"; 
'^ 
(4) in subsection (f), by striking out "Scholarship Program" 
1
^ 
and inserting in lieu thereof "Scholarship Program or the Loan 
Repayment Program"; and 
"^ 
(5) in subsection (h)— 
"' 
(A) by redesignating paragraphs (2) and (3) as paragraphs 
(3) and (4), respectively; and 
(B) by inserting after paragraph (1) the following new 
paragraph: 
"(2) The term 'Loan Repayment Program' means the National 
? 
Health Service Corps Loan Repayment Program established 
^ 
under section 338B.". 
(c) SECTION 334.—Section 334(aX3XB) (42 U.S.C. 254g(aX3)(B)) is 
amended— 
(1) by inserting "or the Loan Repa3mient Program" after 
f 
"Scholarship Program"; and 
J 
(2) by striking out "service under the Program;" and inserting 
in lieu thereof "service under the Scholarship Program or the 
^ 
Loan Repayment Program;". 
PUBLIC LAW 100-177—DEC. 1, 1987 
101 STAT. 997 
(d) SECTION 336.—Section 336(a) (42 U.S.C. 254h-l(a)) is amended 
by striking out "scholarship program" and inserting in lieu thereof 
"Scholarship Program or Loan Repayment Program". 
(e) SECTION 338E.—Section 338E (as redesignated by section 201(2) 42 use 254o. 
of this Act) is amended— 
(1) in subsection (a)— 
(A) by inserting "(1)" after the subsection designation; 
(B) by redesignating paragraphs (1) through (4) as sub-
paragraphs (A) through (D), respectively; and 
(C) by adding at the end thereof the following new 
paragraph: 
"(2) An individual who has entered into a written contract with Contracts. 
the Secretary under section 338B and who— 
"(A) in the case of an individual who is enrolled in the final 
year of a course of study, fails to maintain an acceptable level of 
academic standing in the educational institution in which such 
^ 
individual is enrolled (such level determined by the educational 
'^ 
institution under regulations of the Secretary) or voluntarily 
terminates such enrollment or is dismissed from such edu-
cational institution before completion of such course of study; or 
"(B) in the case of an individual who is enrolled in a graduate 
training program, fails to complete such training program and 
does not receive a waiver from the Secretary under section 
338B(b)(l)(B)(ii), 
in lieu of any service obligation arising under such contract shall be 
liable to the United States for the amount that has been paid on 
behalf of the individual under the contract."; 
(2) in subsection (b)(1)— 
(A) by inserting "(A)" after the paragraph designation; 
(B) by striking out "338E(d)" and inserting in lieu thereof 
"338F(d)"; 
,«,,,r 
(C) by striking out "3380" each place it appears and 
^i-i,, , 
inserting in lieu thereof "338D"; 
(D) by striking out "338B" each place it appears and 
inserting in lieu thereof "338C"; 
(E) by inserting "under section 338A" after "service 
obligation"; 
(F) by striking the last sentence; and 
(G) by adding at the end the following new subparagraph: 
-"(B)(i) Any amount of damages that the United States is entitled 
to recover under this subsection or under subsection (c) shall, within 
the 1-year period beginning on the date of the breach of the written 
contract (or such longer period beginning on such date as specified 
by the Secretary), be paid to the United States. 
"(ii) If damages described in clause (i) are delinquent for 3 months, 
the Secretary shall, for the purpose of recovering such damages— 
"(I) utilize collection agencies contracted with by the Adminis-
trator of the General Services Administration; or 
"(II) enter into contracts for the recovery of such damages 
with collection agencies selected by the Secretary. 
"^ "(iii) Each contract for recovering damages pursuant to this Reports. 
subsection shall provide that the contractor will, not less than once 
each 6 months, submit to the Secretary a status report on the 
success of the contractor in collecting such damages. Section 3718 of 
title 31, United States Code, shall apply to any such contract to the 
extent not inconsistent with this subsection. 
101 STAT. 998 
PUBLIC LAW 100-177—DEC. 1, 1987 
"(iv) To the extent not otherwise prohibited by law, the Secretary 
shall disclose to all appropriate credit reporting agencies informa-
tion relating to damages of more than $100 that are entitled to be 
recovered by the United States under this subsection and that are 
delinquent by more than 60 days or such longer period as is deter-
mined by the Secretary."; 
(3) by redesignating subsection (c) as subsection (d); 
(4) by inserting after subsection O
t
>
) the following new 
subsection: 
"(c)(1) If (for any reason not specified in subsection (a) or section 
338F(d)) an individual breaches the written contract of the individ-
^^-.. .,, 
ual under section 338B by failing either to begin such individual's 
service obligation in accordance with section 338C or 338D or to 
complete such service obligation, the United States shall be entitled 
to recover from the individual an amount equal to the sum of— 
"(A) in the case of a contract for a 2-year period of obligated 
service— 
"(i) the total of the amounts paid by the United States 
under section 338B(gX2) on behalf of the individual for any 
,^." 
period of obligated service; and 
"(ii) an amount equal to the unserved obligation penalty; 
"(B) in the case of a contract for a period of obligated service 
Z* of greater than 2 years, and the breach occurs before the end of 
'" the first 2 years of such period— 
"(i) the total of the amounts paid by the United States 
under section 338B(gX2) on behalf of the individual for any 
1(. u. period of obligated service; and 
"(ii) an amount equsil to the unserved obligation penalty; 
and 
:m 
«(Q) ijj tjjg QQgQ Qf Q^ contract for a period of obligated service 
' 
of greater than 2 years, and the breach occurs after the first 2 
years of such period— 
rsc 
"(i) the total of the amounts paid by the United States 
under section 338B(gX2) on behalf of the individual for any 
;:;;t " 
period of obligated service not served; and 
"(ii) if the individual breaching the contract failed to give 
>'j;v 
the Secretary notice, that the individual intends to take 
action which constitutes a breach of the contract, at least 1 
year (or such shorter period of time as the Secretary deter-
mines is adequate for finding a replacement) prior to the 
breach, $10,000. 
"(2) For purposes of paragraph (1), the term 'unserved obligation 
penalty' means the amount equal to the product of the number of 
months of obligated service that were not completed by an individ-
ual, multiplied by $1,000, except that in any case in which the 
individual fails to serve 1 year, the unserved obligation penalty shall 
be equal to the full period of obligated service multiplied by $1,000. 
"(3) The Secretary may waive, in whole or in part, the rights of 
the United States to recover amounts under this section in any case 
of extreme hardship or other good cause shown, as determined by 
the Secretary. 
f t. 
"(4) Damages that the United States is entitled to recover shall be 
paid in accordance with subsection (bXlXB)."; 
(5) in subsection (d) (aa redesignated by clause (3) of this 
subsection), by inserting "or the Loan Repajmient Program (or a 
•^4 contract thereunder)" after "thereunder) each place it appears; 
and 
PUBLIC LAW 100-177—DEC. 1, 1987 
101 STAT. 999 
(6) in the section heading, by inserting "OR LOAN REPAYMENT 
CONTRACT" after "CONTRACT" . 
(f) PART D OF TITLE IIL—Part D of title III is amended— 
(1) by redesignating subparts III and IV as subparts IV and V, 
respectively; and 
(2) by inserting before section 338A the following: 
"Subpart III—Scholarship Program and Loan 
Repayment Program". 
SEC. 203. REPORT AND AUTHORIZATION OF APPROPRIATIONS FOR 
SCHOLARSHIP AND LOAN REPAYMENT PROGRAMS; STATE 
PROGRAMS. 
Part D of title III (42 U.S.C. 247d et seq.) is amended by striking 
out section 338G (as redesignated by section 201(2) of this Act) and 
inserting in lieu thereof the following new sections: 
"SEC. 338G. REPORT AND AUTHORIZATION OF APPROPRIATIONS. 
42 USC 254q. 
"(a) REPORT.—The Secretary shall report on January 20 of each 
year to the Committee on Labor and Human Resources of the 
Senate, the Committee on Energy and Commerce of the House of 
Representatives, and the Committees on Appropriations of the 
Senate and the House of Representatives on— 
"(1) the number of providers of health care who will be needed 
for the Corps during the 3 fiscal years beginning after the date 
the report is filed; and 
"(2) the number— 
"(A) of scholarships the Secretary proposes to provide 
under the Scholarship Program during such 3 fiscal years; 
"(B) of individuals for whom the Secretary proposes to 
*
* 
make loan repayments under the Loan Repayment Pro-
•
^ 
gram during such 3 fiscal years; and 
"(C) of individuals who have no obligation under section 
338C and who the Secretary proposes to have as members of 
the Corps during such 3 fiscal years, 
in order to provide such number of health care providers. 
"(b) AUTHORIZATION OF APPROPRIATIONS.—There are authorized to 
be appropriated such sums as may be necessary for scholarships and 
loan repayments under this subpart. 
"SEC. 338H. STATE PROGRAMS. 
42 USC 254q-l. 
"(a) GRANTS.—The Secretary may make grants to States to sup-
port the establishment by States of State programs similar to the 
Loan Repayment Program established under section 338B. Any 
State program supported with a grant under this section shall— 
'(1) provide for the repayment of government and commercial 
loans for the tuition, educational expenses, and living expenses 
described in section 338B(gXl); and 
"(2) be conducted in conformance with the description of such 
program contained in the application required under subsec-
tion (b). 
"(b) APPUCATIONS.—No grant may be made under this section for 
a State program unless an application therefor is submitted to the 
Secretary, in such form, at such time, and containing such informa-
tion as the Secretary may prescribe. Each such application shall 
contain such standards for the designation of medically underserved 
101 STAT. 1000 
PUBLIC LAW 100-177—DEC. 1, 1987 
areas under the State program and the determination of obligated 
service under the State program as may be acceptable to the Sec-
retary. 
"(c) FEDERAL SHARE.—The Federal share of the costs of any State 
program supported under this section shall not exceed 75 percent. 
"(d) AUTHORIZATION OF APPROPRIATIONS.—To carry out this sec-
tion, there are authorized to be appropriated $1,000,000 for fiscal 
year 1988 and such sums £is may be necessary for each of the fiscal 
years 1989 and 1990.". 
Contracts. 
SEC. 204. SPECIAL REPAYMENT PROVISIONS. 
4 2 U S C 2 5 4 0 
..^:^ 
r 
.. 
, , . . . , > 
. . . 
j ^ ^ 
note. 
(a) ELIGIBLE INDIVIDUALS.— 
* 
-
(1) IN GENERAL.—An individual who— 
(A)(i) breached a written contract entered into under 
section 338A of the Public Health Service Act (42 U.S.C. 
2541) by failing either to begin such individual's service 
obligation in accordance with section 3380 of such Act {as 
redesignated by section 201(2) of this Act) or to complete 
>
! 
:; ii.' 
such service obligation; or 
J ,, . ' 
(ii) otherwise breached such a contract; and 
(B) as of November 1, 1987, is liable to the United States 
under section 338E(b) of such Act (as redesignated by sec-
tion 201(2) of this Act), 
shall be relieved of liability to the United States under such 
section if the individual provides notice to the Secretary in 
accordance with paragraph (2) and provides service in accord-
ance with a written contract with the Secretary that obligates 
the individual to provide service in accordance with subsection 
, 
OJ) or (c). The Secretary may exclude an individual from relief 
,, from liability under this section for reasons related to the 
individual's professional competence or conduct. 
,, 
(2) NOTICE BY SECRETARY.—Not later than 90 days after the 
date of the enactment of this Act, the Secretary of Health and 
^ 
Human Services shall notify in writing individuals who are 
described in subsection (a) of the opportunity provided by such 
subsection to be relieved of liability to the United States under 
section 338E0t)) of the Public Health Service Act (as redesig-
nated by section 201(2) of this Act). Notice sent to the last 
known address of such individual shall constitute sufficient 
notice for the purposes of this section. The Secretary may 
require that an individual responding to such notice make an 
.' e. 
- ; * 
election between service under subsection Ot)) or subsection (c) 
q and provide that such election shall be binding. 
^ 
(3) NOTICE BY INDIVIDUAL.—Not later than 180 days after the 
date of the enactment of this Act, an individual who receives a 
notice from the Secretary may notify the Secretary that the 
individual intends to enter into a written contract with the 
., Secretary to provide service in accordance with subsection Ot)) or 
(c). The Secretary may extend the 180-day period for an individ-
P^ ual for good cause shown. 
y^ 
(4) STATUTE OF UMITATIONS.—If an individual provides notice 
under paragraph (3), the statute of limitations established by 
• section 2415 of title 28, United States Code, shall be tolled from 
the time the Secretary receives such notice until such time as it 
is determined by the Secretary that such individual will not be 
relieved of liability to the United States under the Public 
Health Service Act as provided under this section. 
PUBLIC LAW 100-177—DEC. 1, 1987 
101 STAT. 1001 
'i 
(5) PLACEMENTS.—Any individual who enters into a contract 
under this subsection shall be afforded an opportunity to locate 
and negotiate a placement in accordance with this section, 
except that the Secretary shall not be required to identify a 
placement for any individual in a medical specialty for which 
the National Health Service Corps has no need. 
(6) PARTIAL SERVICE.—The Secretary shall promulgate regula- Regulations. 
tions that provide for the reduction of the liability under section 
338F of the Public Health Service Act (as redesignated by 
section 201(2) of this Act) of an individual who breaches a 
contract entered into under this section to reflect any partial 
service or partial payment of liability of the individual under 
this section. 
(b) SERVICE AT HEALTH MANPOWER SHORTAGE AREA PLACEMENT 
OPPORTUNITY LIST SITES.— 
(1) IN GENERAL.—An individual notified under subsection 
(a)(2) may enter into a written contract with the Secretary to 
3 
serve, in accordance with subpart II of part D of title III of the 
;. 
Public Health Service Act (42 U.S.C. 254d et seq.), for the period 
of such individual's service obligation remaining under section 
338C of the Public Health Service Act (as redesignated by 
section 201(2) of this Act) at a site that— 
(A)(i) is on the Health Manpower Shortage Area Place-
ment Opportunity List created by the Secretary of Health 
4- 
and Human Services for obligated service under section 
338C of the Public Health Service Act (as so redesignated) 
to begin in fiscal year 1988 and to which no individual who 
is not described in subsection (a)(1) has been assigned by a 
date determined by the Secretary; or 
a 
(ii) is on the Health Manpower Shortage Area Placement 
ji> 
Opportunity List created by the Secretary of Health and 
Human Services for obligated service under section 338C of 
br 
the Public Health Service Act (as so redesignated) to begin 
in fiscal year 1989; and 
%
' 
(B) has agreed to permit the individual to serve at such 
site. 
(2) NUMBER OF SITES.—The Secretary shall to the extent prac-
ticable, include a total number of sites on the list referred to in 
paragraph (1) sufficient to provide placement to all obligors 
under the Scholarship Program scheduled to begin service in 
- 
fiscal year 1988 or 1989 and all individuals responding to the 
notice provided under subsection (a) and electing service under 
paragraph (1). 
(c) SERVICE AT SUPPLEMENTAL HEALTH MANPOWER SHORTAGE AREA 
PLACEMENT OPPORTUNITY LIST SITES.—An individual notified under 
subsection (a)(2) may enter into a written contract with the 
Secretary— 
( D t o -
(A) serve in accordance with subpart II of part D of title 
III of the Public Health Service Act (42 U.S.C. 254d et seq.) 
i. / : • 
for the period of such individual's service obligation 
remaining under section 338C of the Public Health Service 
> 
Act (as redesignated by section 201(2) of this Act) at a site 
that is on a supplemental Health Manpower Shortage Area 
s 
Placement Opportunity List created by the Secretary of 
Health and Human Services for obligated service under 
%.:c y 
section 338C of the Public Health Service Act (as so redesig-
101 STAT. 1002 
PUBLIC LAW 100-177—DEC. 1, 1987 
nated) and that has agreed to permit the individual to serve 
at such site; and 
(B) pay, in accordance with guidelines established by the 
Secretary of Health and Human Services, to the United 
States the sum of the amounts paid under subpart II of part 
D of title III of such Act to or on behalf of the individual 
K ' fiii» .« 
reduced by any amount paid, before entering into the con-
tract, by such individual to the Secretary with respect to 
the individual's indebtedness under such part D; or 
(2) to serve in accordance with such subpart II at a site 
described in paragraph (1) for 150 percent of such individual's 
remaining service obligation under section 338C of such Act (as 
so redesignated). 
(d) CREATION OF SUPPLEMENTAL HEALTH MANPOWER SHORTAGE 
AREA PLACEMENT OPPORTUNITY LIST SITES.—In creating the supple-
mental Health Manpower Shortage Area Placement Opportunity 
List for purposes of subsection (c), the Secretary— 
(1) shall include any site to which a National Health Service 
Corps member was previously assigned but which in fiscal year 
1988 or 1989 will not have such member or a member of the 
National Health Service Corps to replace such member unless 
the Secretary of Health and Human Services determines that 
--J such site may reasonably be expected to recruit a health care 
professional from other tnan the Corps; 
(2) shall include any migrant health center receiving funds 
under section 329 of the Public Health Service Act (42 U.S.C. 
247d) or community health center receiving funds under section 
.. 
330 of such Act (42 U.S.C. 254c) unless the Secretary of Health 
and Human Services determines that such center has been able 
to recruit health care professionals from other than the Corps to 
serve at the center and may reasonably be expected to recruit 
such health care professionals in the future; 
(3) may include any other site selected by the Secretary; and 
(4) shall designate the type of health care professional or 
-s- medical specialist who is eligible to serve at the sites included 
on the list. 
A site may be included on the supplemental list only if, at the time 
the list is created, the Secretary determines that the site meets the 
criteria prescribed by section 332 of such Act (42 U.S.C. 254e). 
(e) ADDITIONAL ELIGIBLE INDIVIDUALS.— 
(1) IN GENERAL.—The Secretary of Health and Human Serv-
i<*j ices may authorize an individual who is not described in subsec-
tion (a) and who is to begin to serve the individual's service 
obligation under section 338C of the Public Health Service Act 
i;, (as redesignated by section 201(2) of this Act) in fiscal year 1988 
• or 1989 to serve such obligation in accordance with subsection 
(c) if the Secretary determines that— 
(A) service by the individual in accordance with subsec-
A 
tion (c) would be in the best interests of the National 
Health Service Corps; and 
(B) allowing such service would alleviate a substantial 
hardship for such individual. 
(2) SCHOLARSHIP TRAINING PROGRAM.—Individuals who have 
breached a written contract entered into under section 225 of 
the Public Health Service Act (42 U.S.C. 234) (as such section 
existed before the amendment made by section 408(b) of the 
^ Health Professions Educational Assistance Act of 1976 (Public 
PUBLIC LAW 100-177—DEC. 1, 1987 
101 STAT. 1003 
Law 94-484; 90 Stat. 2281)) by failing to complete their service 
. obligations and who are, as of November 1, 1987, liable to the 
United States under section 225(f)(1) of the Public Health Serv-
ice Act (as such section so existed) may be relieved of their 
liability to the United States under the terms and conditions set 
forth in this section. 
SEC. 205. REGULATIONS. 
Not later than 180 days after the effective date of the amend-
ments made by this title, the Secretary of Health and Human 
Services shall issue regulations for the loan repayment programs 
established by the amendments. 
TITLE III—NATIONAL HEALTH SERVICE 
CORPS 
42 use 254/-1 
note. 
Health care 
professionals. 
SEC. 301. REQUIREMENT OF CONSIDERATION OF NEEDS OF INDIAN 
HEALTH SERVICE, CERTAIN INDIAN TRIBES, AND THE HOME-
LESS. 
Section 331 (42 U.S.C. 254d) is amended— 
(1) by redesignating subsection (h) as subsection (i); and 
(2) by inserting after subsection (g) the following new 
subsection: 
"(h) In assigning members of the Corps to health manpower 
shortage areas, to the extent practicable, the Secretary shall— 
"(1) give priority to meeting the needs of the Indian Health 
Service and the needs of health programs or facilities operated 
by tribes or tribal organizations under the Indian Self-Deter-
,;: mination Act (25 U.S.C. 450f et seq.); and 
"(2) provide special consideration to the homeless populations 
who do not have access to primary health care services.". 
SEC. 302. DESIGNATION OF HEALTH MANPOWER SHORTAGE AREAS. 
Section 332 (42 U.S.C. 254e) is amended— 
(1) in subsection (a)(1), by adding at the end thereof the 
lfi_ following new sentences: "The Secretary shall not remove an 
area from the areas determined to be health manpower short-
age areas under subparagraph (A) of the preceding sentence 
le until the Secretary has afforded interested persons and groups 
in such area an opportunity to provide data and information in 
support of the designation as a health manpower shortage area 
or a population group described in subparagraph (B) of such 
sentence or a facility described in subparagraph (C) of such 
sentence, and has made a determination on the basis of the data 
and information submitted by such persons and groups and 
other data and information available to the Secretary."; and 
(2) in subsection (b)(2)— 
(A) by striking out "and" after "services," in subpara-
graph (B); 
(B) by striking out the period at the end of subparagraph 
(C) and inserting in lieu thereof ", and"; and 
(C) by adding at the end the following new subparagraph: 
"(D) ability to pay for health services.". 
91-194 O - 90 - 34 : QL.3 Part 1 
101 STAT. 1004 
PUBLIC LAW 100-177—DEC. 1, 1987 
Urban areas. 
42 use 254m. 
Fellowships and 
scholarships. 
Education. 
Contracts. 
SEC. 303. PLACEMENT OF PHYSICIANS. 
Ol 
Section 333 (42 U.S.C. 254f) is amended by adding at the end the 
following new subsection: 
"(]) In determining the priority for the placement of members of 
the Corps under this section in medically underserved areas, the 
Secretary shall consider— 
"(1) whether the areas are served by at least one health 
professional and the effectiveness of non-Federal programs in 
4- recruiting health professionals for the areas; 
"(2) the geographic isolation of the areas; and 
"(3) the economic need of the populations of the areas and the 
association of the areas with a high infant mortality rate.". 
SEC. 304. ASSIGNMENT OF FAMILY PHYSICIANS. 
Section 333 (42 U.S.C. 254f) (as amended by section 304 of this 
Act) is amended by adding at the end thereof the following new 
subsection: 
"(k) In the assignment by the National Health Service Corps 
under this section of physicians specializing in family medicine, the 
Secretary shall— 
"(1) take account of the needs of urban areas; and 
"(2) place special attention on urban areas in which there are 
serious incidences of infant mortality, adolescent pregnancy, 
drug and alcohol abuse, sexually transmitted diseases, and 
other acute urban health care needs.". 
SEC. 305. AUTHORIZATIONS OF APPROPRIATIONS FOR GENERAL OPER-
ATIONS OF NATIONAL HEALTH SERVICE CORPS. 
Subsection (a) of section 338 (42 U.S.C. 254k) is amended to read as 
follows: 
"(a) To carry out this subpart, there are authorized to be appro-
priated $65,000,000 for fiscal year 1988, $65,000,000 for fiscal year 
1989, and $65,000,000 for fiscal year 1990.". 
SEC. 306. OBLIGATED SERVICE. 
Section 338C (as redesignated by section 201(2) of this Act) is 
amended— 
(1) in subsection (a)— 
Tf. 
(A) by striking out "338C" and inserting in lieu thereof 
5 
"338D"; and 
(B) by inserting "or 338B" after "338A"; 
m. 
(2) in subsection (bXD, by inserting "or 338B(f)(lXBXiv)" after 
fl 
"338A(f)(lXBXiv)"; 
(3) in subsection Ot)), by striking out paragraph (5) and insert-
ing in lieu thereof the following new paragraph: 
"(5XA) In the case of the Scholarship Program, with respect to an 
individual receiving a degree from a school of medicine, osteopathy, 
dentistry, veterinary medicine, optometry, podiatry, or pharmacy, 
the date referred to in paragraphs (1) through (4) shall be the date 
on which the individual completes the training required for such 
degree, except that— 
"(i) at the request of such an individual with whom the 
Secretary has entered into a contract under section 338A prior 
to October 1, 1985, the Secretary sheill defer such date until the 
end of the period of time (not to exceed the number of years 
'^ 
specified in subparagraph (B) or such greater period as the 
Secretary, consistent with the needs of the Corps, may au-
PUBLIC LAW 100-177—DEC. 1, 1987 
101 STAT. 1005 
thorize) required for the individual to complete an internship, 
residency, or other advanced clinical training; and 
"(ii) at the request of such an individual with whom the 
Secretary has entered into a contract under section 338A on or 
after October 1, 1985, the Secretary may defer such date in 
accordance with clause (i). 
"(B)(i) In the case of the Scholarship Program, with respect to an 
individual receiving a degree from a school of medicine, osteopathy, 
or dentistry, the number of years referred to in subparagraph (A)(i) 
shall be 3 years. 
"(ii) In the case of the Scholarship Program, with respect to an 
individual receiving a degree from a school of veterinary medicine, 
optometry, podiatry, or pharmacy, the number of years referred to 
in subparagraph (A)(i) shall be 1 year. 
P ,
, 
"(C) No period of internship, residency, or other advanced clinical 
training shall be counted toward satisfying a period of obligated 
service under this subpart. 
"(D) In the case of the Scholarship Program, with respect to an 
;., . 
individual receiving a degree from an institution other than a school 
' 
* J 
referred to in subparagraph (A), the date referred to in paragraphs 
(1) through (4) shall be the date on which the individual completes 
the academic training of the individual leading to such degree. 
"(E) In the case of the Loan Repayment Program, if an individual 
is required to provide obligated service under such Program, the 
date referred to in paragraphs (1) through (4)— 
"(i) shall be the date determined under subparagraph (A), (B), 
or (D) in the case of an individual who is enrolled in the final 
year of a course of study; 
"(ii) shall, in the case of an individual who is enrolled in an 
approved graduate training program in medicine, osteopathy, 
dentistry, or other health profession, be the date the individual 
completes such training program; and 
"(iii) shall, in the case of an individual who has a degree in 
medicine, osteopathy, dentistry, or other health profession and 
who has completed graduate training, be the date the individual 
enters into an agreement with the Secretary under section 
338B.";and 
(4) in subsection (c)(2), by striking out "338C" and inserting in 
lieu thereof "338D". 
SEC. 307. PRIVATE PRACTICE. 
Section 338D (as redesignated by section 201(2) of this Act) is 42 use 254n. 
amended— 
(1) in subsection (a), by striking out "338B(a)" and inserting in 
lieu thereof "338C(a)"; 
(2) in subsection (a)(1)— 
^j,, 
(A) by inserting after "individual" the following: "who Fellowships and 
received a scholarship under the Scholarship Program or a scholarships. 
^ 
loan repayment under the Loan Repayment Program and"; 
and 
(B) by inserting before the semicolon the following: "or in 
the case of an individual for whom a loan payment was 
made under the Loan Repayment Program and who is 
performing obligated service as a member of the Corps in a 
health manpower shortage area on the date of the applica-
l„ . 
tion of the individual for such a release, in the health 
manpower shortage area selected by the Secretary"; 
Ml 
101 STAT. 1006 
PUBLIC LAW 100-177—DEC. 1, 1987 
' 
(3) in subsection (a)(2), by inserting "selected by the Sec-
retary" before the period; 
(4) in subsection (b), by inserting at the end thereof the 
following new sentence: "The Secretary shall take such action 
as may be appropriate to ensure that the conditions of the 
written agreement prescribed by this subsection are adhered 
to."; 
(5) in subsection (c), by inserting "or 338B" after "338A"; and 
(6) in subsection (e)— 
(A) by striking out paragraph (1); and 
(B) by striking "(2)'^before "Upon". 
SEC. 308. DISCHARGE OF OBLIGATIONS IN BANKRUPTCY. 
42 use 254o. 
(a) IN GENERAL.—Section 338E(d)(3) (as redesignated by sections 
201(2) and 202(e)(3) of this Act) is amended by inserting before the 
period a comma and "and only if the bankruptcy court finds that 
nondischarge of the obligation would be unconscionable". 
42 use 254o 
(b) EXISTING PROCEEDINGS.—The amendment made by subsection 
note. 
(a) applies to any bankruptcy proceeding in which discharge of an 
obligation under section 338E(d)(3) of the Public Health Service Act 
(as redesignated by sections 201(2) and 202(e)(3) of this Act) has not 
been granted before the date that is 31 days after the date of 
enactment of this Act. 
SEC. 309. SPECIAL LOANS FOR CORPS MEMBERS TO ENTER PRIVATE 
PRACTICE. 
42 use 254p 
Section 338F (as redesignated by section 201(2) of this Act) is 
amended— 
(1) by striking out subsections (a) and 0>) and inserting in lieu 
thereof the following new subsections: 
"(a) The Secretary may, out of appropriations authorized under 
section 338, make one loan to a Corps member who has agreed in 
writing— 
"(1) to engage in the private full-time clinical practice of the 
profession of the member in a health manpower shortage area 
(designated under section 332) for a period of not less than 2 
years which— 
"(A) in the case of a Corps member who is required to 
complete a period of obligated service under this subpart, 
begins not later than 1 year after the date on which such 
. ^ 
individual completes such period of obligated service; and 
' 
• 
"(B) in the case of an individual who is not required to 
complete a period of obligated service under this subpart, 
begins at such time as the Secretary considers appropriate; 
"(2) to conduct such practice in accordance with section 
338Da))(l); and 
* ; 
"(3) to such additional conditions as the Secretary may re-
quire to carry out this section. 
Such a loan shall be used to assist such individual in meeting the 
costs of beginning the practice of such individual's profession in 
accordance with such agreement, including the costs of acquiring 
equipment and renovating facilities for use in providing health 
services, and of hiring nurses and other personnel to assist in 
providing health services. Such loan may not be used for the pur-
chase or construction of any building. 
"0))(1) The amount of a loan under subsection (a) to an individual 
shall not exceed $25,000. 
PUBLIC LAW 100-177—DEC. 1, 1987 
101 STAT. 1007 
"(2) The interest rate for any such loan shall not exceed an annual 
rate of 5 percent."; 
(2) in the first sentence of subsection (c), by striking "grant 
or"; and 
(3) in subsection (dXD— 
(A) by striking "this section," and inserting "this section 
(as in effect prior to October 1,1984),"; and 
(B) by striking "338D(b)" and inserting "338E(b)". 
TITLE IV—MISCELLANEOUS 
SEC. 401. GERIATRIC MEDICINE TRAINING PROJECTS. 
Section 788(e) (42 U.S.C. 295g-8(e)) is amended— 
(1) in parsigraph (1), by inserting after "support" the follow-
ing: "(including traineeships and fellowships) ; 
(2) in paragraph (2)(C), by striking out "medicine;" and insert-
ing in lieu thereof "medicine, or in a department of geriatrics in 
existence as of the date of enactment of the Public Health 
Service Amendments of 1987;"; and 
(3) in paragraph (3)(AXi), by inserting "geriatrics," after 
"gynecology,". 
SEC. 402. PROFESSIONAL REVIEW ACTIVITIES. 
(a) IN GENERAL.—Section 427 of Health Care Quality Improve-
ment Act of 1986 (42 U.S.C. 11137) is amended— 
(1) in subsection (bXl)— 
(A) bv striking out "with respect to medical malpractice 
actions ' and inserting in lieu thereof "as necessary to carry 
out subsections (b) and (c) of section 425 (as specified in 
regulations by the Secretary)"; and 
(B) by adding at the end thereof the following new sen-
tences: "Information reported under this part that is in a 
form that does not permit the identification of any particu-
lar health care entity, physician, other health care practi-
tioner, or patient shall not be considered confidential. The 
Secretary (or the agency designated under section 424(b)), 
on application by any person, shall prepare such informa-
tion in such form and shall disclose such information in 
such form."; and 
(2) in subsection (c)— 
(A) by inserting "(including the agency designated under 
section 424(b))" after "person or entity"; and 
(B) by inserting "(including information provided under 
subsection (a)" after "part". 
(b) FEES.—Section 427(b) of such Act is amended by adding at the 
end thereof the following new paragraph: 
"(4) FEES.—The Secretary may establish or approve reason-
able fees for the disclosure of information under this section or 
section 426. The amount of such a fee may not exceed the costs 
of processing the requests for disclosure and of providing such 
information. Such fees shall be available to the Secretary (or, in 
the Secretary's discretion, to the agency designated under sec-
tion 424(b)) to cover such costs.". 
(c) EFFECTIVE DATES.— 
42 use 1
1
1
3
7 
(1) IN GENERAL.—The amendments made by subsection (a) "°t® 
shall become effective on November 14,1986. 
101 STAT. 1008 
PUBLIC LAW 100-177—DEC. 1, 1987 
(2) FEES.—The amendment made by subsection (b) shall 
become effective on the date of enactment of this Act. 
Approved December 1, 1987. 
•.n'-s'^^\ 
'., r: ^
. 
1/. iL-'h-. • . 
LEGISLATIVE HISTORY—S. 1158 (H.R. 1327): 
HOUSE REPORTS: No. 100-252 accompanying H.R. 1327 (Comm. on Energy and 
Commerce). 
SENATE REPORTS: No. 100-108 (Comm. on Labor and Human Resources). 
CONGRESSIONAL RECORD, Vol. 133 (1987): 
July 23, considered and passed Senate. 
Sept. 9, H.R. 1327 considered and passed House; proceedings vacated and 
S. 1158, amended, passed in lieu. 
Oct. 27, Senate concurred in House amendments with an amendment. 
Nov. 3, House concurred in Senate amendment.