Health Professions Education Partnerships Act of 1998
PL 105-392 (S.1754), enacted 11/13/1998

112 STAT. 3524 
PUBLIC LAW 105-392—NOV. 13, 1998 
Public Law 105-392 
105th Congress 
Nov. 13, 1998 
[S. 1754] 
Health 
Professions 
Education 
Partnerships Act 
of 1998. 
42 u s e 201 note. 
An Act 
To amend the Public Health Service Act to consoUdate and reauthorize health 
professions and minority and disadvantaged health education programs, and for 
other purposes. 
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 "Health Profes-
sions Education Peirtnerships Act of 1998". 
(b) TABLE OF CONTENTS.—The table of contents of this Act 
is as follows: 
Sec. 1. Short title; table of contents. 
T I T L E I — H E A L T H P R O F E S S I O N S E D U C A T I O N A N D F I N A N C I A L ASSISTANCE 
PROGRAMS 
Subtitle A—^Health Professions Education Programs 
Sec. 101. Under-represented minority health professions grant program. 
Sec. 102. Training m primary care medicine and dentistry. 
Sec. 103. Interdisciplinary, community-based linkages. 
Sec. 104. Health professions workforce information and analysis. 
Sec. 105. Public health workforce development. 
Sec. 106. General provisions. 
Sec. 107. Preference in certain programs. 
Sec. 108. Definitions. 
Sec. 109. Technical amendment on National Health Service Corps. 
Sec. 110. Savings provision. 
Subtitle B—^Nursing Workforce Development 
Sec. 121. Short title. 
Sec. 122. Purpose. 
Sec. 123. Amendments to Public Health Service Act. 
Sec. 124. Savings provision. 
Subtitle C—^Financial Assistance 
CHAPTER 
1—SCHOOL-BASED 
REVOLVING 
LOAN 
FUNDS 
Sec. 131. Primaiy care loan program. 
Sec. 132. Loans for disadvantaged students. 
Sec. 133. Student loans regardmg schools of nursing. 
Sec. 134. General provisions. 
CHAPTER 2—INSURED HEALTH EDUCATION ASSISTANCE LOANS TO 
GRADUATE STUDENTS 
Sec. 141. Health Education Assistance Loan Program. 
Sec. 142. HEAL lender and holder performance standards. 
Sec. 143. Insurance Program. 
Sec. 144. HEAL bankruptcy. 
Sec. 145. HEAL refinancing. 
TITLE n—OFFICE OF MINORITY HEALTH 
Sec. 201. Revision and extension of programs of Office of Minority Health. 
PUBLIC LAW 105-392—NOV. 13, 1998 
112 STAT. 3525 
TITLE III—SELECTED INITIATIVES 
Sec. 301. State offices of rural health. 
Sec. 302. Demonstration projects regarding Alzheimer's Disease. 
Sec. 303. Project grants lor immunization services. 
TITLE IV—MISCELLANEOUS PROVISIONS 
Sec. 401. Technical corrections regarding Public Law 103-183. 
Sec. 402. Miscellaneous amendments regarding PHS commissioned officers. 
Sec. 403. Clinical traineeships. 
Sec. 404. Project grants for screenings, referrals, and education regarding lead poi-
soning. 
Sec. 405. Project grants for preventive health services regarding tuberculosis. 
Sec. 406. CDC loan repayment program. 
Sec. 407. Community programs on domestic violence. 
Sec. 408. State loan repayment program. 
Sec. 409. Authority of the director of NIH. 
Sec. 410. Raise in maximum level of loan repayments. 
Sec. 411. Construction of regional centers for research on primates. 
Sec. 412. Peer review. 
Sec. 413. Funding for trauma care. 
Sec. 414. Health information and health promotion. 
Sec. 415. Emergency medical services for children. 
Sec. 416. Administration of certain requirements. 
Sec. 417. Aids drugassistance program. 
Sec. 418. National Foundation for Biomedical Research. 
Sec. 419. Fetal Alcohol Syndrome prevention and services. 
TITLE I—HEALTH PROFESSIONS EDU-
CATION AND FINANCIAL ASSISTANCE 
PROGRAMS 
Subtitle A—Health Professions Education 
Programs 
SEC. 
101. UNDER-REPRESENTED MINORITY HEALTH PROFESSIONS 
GRANT PROGRAM. 
(a) IN GENERAL.—Part B of title VII of the Public Health 
Service Act (42 U.S.C. 293 et seq.) is amended to read as follows: 
"PART B—HEALTH PROFESSIONS TRAINING 
FOR DIVERSITY 
"SEC. 
736. 
CENTERS 
OF 
EXCELLENCE. 
42 
USC 293. 
"(a) IN GENERAL.—^The Secretary shall make grants to, and 
enter into contracts with, designated health professions schools 
described in subsection (c), and other public and nonprofit health 
or educational entities, for the purpose of assisting the schools 
in supporting programs of excellence in health professions education 
for under-represented minority individuals. 
"(b) REQUIRED USE OF FUNDS.—^The Secretary may not make 
a grant under subsection (a) unless the designated health profes-
sions school involved agrees, subject to subsection (c)(1)(C), to 
expend the grant— 
"(1) to develop a large competitive applicant pool through 
linkages with institutions of higher education, local school dis-
tricts, and other community-based entities and establish an 
education pipeline for health professions careers; 
"(2) to establish, strengthen, or expand programs to 
enhance the academic performance of under-represented minor-
ity students attending the school; 
112 STAT. 3526 
PUBLIC LAW 105-392—NOV. 13, 1998 
"(3) to improve the capacity of such school to train, recruit, 
and retain under-represented minority faculty including the 
payment of such stipends and fellowships as the Secretary 
may determine appropriate; 
"(4) to carry out activities to improve the information 
resources, clinical education, curricula and cultural competence 
of the graduates of the school, as it relates to minority health 
issues; 
"(5) to facilitate faculty and student research on health 
issues particularly affecting under-represented minority groups, 
including research on issues relating to the delivery of health 
care; 
"(6) to carry out a program to train students of the school 
in providing health services to a significant number of under-
represented minority individuals through training provided to 
such students at community-based health facilities that— 
"(A) provide such health services; and 
"(B) are located at a site remote from the main site 
of the teaching facilities of the school; and 
"(7) to provide stipends as the Secretary determines appro-
priate, in amounts as the Secretary determines appropriate. 
"(c) CENTERS OF EXCELLENCE.— 
"(1) DESIGNATED SCHOOLS.^ 
"(A) IN GENERAL.—^The designated health professions 
schools referred to in subsection (a) are such schools that 
meet each of the conditions specified in subparagraphs 
(B) and (C), and that— 
"(i) meet each of the conditions specified in para-
graph (2)(A); 
"(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) GENERAL CONDITIONS.—The conditions specified 
in this subparagraph are that a designated health profes-
sions school— 
"(i) has a significant number of under-represented 
minority individuals enrolled in the school, including 
individuals accepted for enrollment in the school; 
"(ii) has been effective in assisting under-rep-
resented minority students of the school to complete 
the program of education and receive the degree 
involved; 
"(iii) has been effective in recruiting under-rep-
resented minority individuals to enroll in and graduate 
from the school, including providing scholarships and 
other financial assistance to such individuals and 
encouraging under-represented minority students from 
all levels of the educational pipeline to pursue health 
professions careers; and 
"(iv) has made significant recruitment efforts to 
increase the number of under-represented minority 
individuals serving in faculty or administrative posi-
tions at the school. 
PUBLIC LAW 105-392—NOV. 13, 1998 
112 STAT. 3527 
"(C) CONSORTIUM.—The condition specified in this 
subparagraph is that, in accordance with subsection (e)(1), 
the designated health profession school involved has with 
other health profession schools (designated or otherwise) 
formed a consortium to carry out the purposes described 
in subsection (b) at the schools of the consortium. 
"(D) APPLICATION OF CRITERIA TO OTHER PROGRAMS.— 
In the case of any criteria established by the Secretary 
for purposes of determining whether schools meet the condi-
tions 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) CONDITIONS.—The conditions specified in this 
subparagraph are that a designated health professions 
school— 
"(i) is a school described in section 799B(1); and 
"(ii) received a contract under section 788B for 
fiscal year 1987, as such section was in effect for such 
fiscal year. 
"(B) USE OF GRANT.—In addition to the purposes 
described in subsection (b), a grant under subsection (a) 
to a designated health professions school meeting the condi-
tions 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 under-represented 
minority individuals; and 
"(ii) to provide improved access to the library and 
informational resources of the school. 
"(C) EXCEPTION.—The requirements 
of paragraph 
(1)(C) shall not apply to a historically black college or 
university that receives funding under paragraphs (2) or 
(5). 
"(3) HISPANIC CENTERS OF EXCELLENCE.—^The conditions 
specified in this paragraph are that— 
"(A) with respect to Hispanic individuals, each of 
clauses (i) through (iv) of paragraph (1)(B) applies to the 
designated health professions school involved; 
"(B) the school agrees, 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 individ-
uals; and 
"(C) the school agrees, as a condition of receiving a 
grant under subsection (a), that— 
"(i) the school will establish an arrangement with 
1 or more public or nonprofit community based His-
panic serving organizations, or public or nonprofit pri-
vate institutions of higher education, including schools 
59-194 O - 98 - 25 : QL 3 Part 5 
112 STAT. 3528 
PUBLIC LAW 105-392—NOV. 13, 1998 
of nursing, whose enrollment of students has tradition-
ally included a significant number of Hispanic individ-
uals, the purposes of which will be to carry out a 
program— 
"(I) to identify Hispanic students who are 
interested in a career in the health profession 
involved; and 
"(11) to facilitate the educational preparation 
of such students to enter the health professions 
school; and 
"(ii) the school will make efforts to recruit Hispanic 
students, including students who have participated in 
the undergraduate or other matriculation program car-
ried out under arrangements established by the school 
pursuant to clause (i)(II) and will assist Hispanic stu-
dents regarding the completion of the educational 
requirements for a degree from the school. 
"(4) NATIVE AMERICAN CENTERS OF EXCELLENCE.—Subject 
to subsection (e), the conditions specified in this paragraph 
are that— 
"(A) with respect to Native Americans, each of clauses 
(i) through (iv) of paragraph (1)(B) applies to the designated 
health professions school involved; 
"(B) the school agrees, 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 Native Americans; 
and 
"(C) the school agrees, as a condition of receiving a 
grant under subsection (a), that— 
"(i) the school will establish an arrangement with 
1 or more public or nonprofit private institutions of 
higher education, including schools of nursing, whose 
enrollment of students has traditionally included a 
significant number of Native Americans, the purpose 
of which arrangement will be to carry out a program— 
"(I) to identify Native American students, from 
the institutions of higher education referred to 
in clause (i), who are interested in health profes-
sions careers; and 
"(H) to facilitate the educational preparation 
of such students to enter the designated health 
professions school; and 
"(ii) the designated health professions school will 
make efforts to recruit Native American students, 
including students who have participated in the under-
graduate program carried out under arrangements 
established by the school pursuant to clause (i) and 
will assist Native American students regarding the 
completion of the educational requirements for a degree 
from the designated health professions school. 
"(5) OTHER CENTERS OF EXCELLENCE.—^The conditions speci-
fied in this paragraph are— 
"(A) with respect to other centers of excellence, the 
conditions described in clauses (i) through (iv) of paragraph 
(l)(B);and 
PUBLIC LAW 105-392—NOV. 13, 1998 
112 STAT. 3529 
"(B) that the health professions school involved has 
an enrollment of under-represented minorities above the 
national average for such enrollments of health professions 
schools. 
"(d) DESIGNATION AS CENTER OF EXCELLENCE.— 
"(1) IN GENERAL.—^Any designated health professions school 
receiving a grant under subsection (a) and meeting the condi-
tions described in paragraph (2) or (5) of subsection (c) shall, 
for purposes of this section, be designated by the Secretary 
as a Center of Excellence in Under-Represented Minority 
Health Professions Education. 
"(2) HISPANIC CENTERS OF EXCELLENCE.—Any designated 
health professions school receiving a grant under subsection 
(a) and meeting the conditions described in subsection (c)(3) 
shall, for purposes of this section, be designated by the Sec-
retary as a Hispanic Center of Excellence in Health Professions 
Education. 
"(3) NATIVE AMERICAN CENTERS OF EXCELLENCE.—-Any des-
ignated health professions school receiving a grant under sub-
section (a) and meeting the conditions described in subsection 
(c)(4) shall, for purposes of this section, be designated by the 
Secretary as a Native American Center of Excellence in Health 
Professions Education. Any consortium receiving such a grant 
pursuant to subsection (e) shall, for purposes of this section, 
be so designated. 
"(e) 
AUTHORITY REGARDING NATIVE AMERICAN CENTERS OF 
EXCELLENCE.—^With respect to meeting the conditions specified in 
subsection (c)(4), the Secretary may make a grant under subsection 
(a) to a designated health professions school that does not meet 
such conditions if— 
"(1) the school has formed a consortium in accordance 
with subsection (d)(1); and 
"(2) the schools of the consortium collectively meet such 
conditions, without regard to whether the schools individually 
meet such conditions. 
"(f) DURATION OF GRANT.—^The period during which payments 
are made under a grant under subsection (a) may not exceed 
5 years. Such payments shall be subject to annual approval by 
the Secretary and to the availability of appropriations for the fiscal 
year involved to make the pa3niients. 
"(g) DEFINITIONS.—In this section: 
"(1) DESIGNATED HEALTH PROFESSIONS SCHOOL.— 
"(A) IN GENERAL.—The term 'health professions school' 
means, except as provided in subparagraph (B), a school 
of medicine, a school of osteopathic medicine, a school 
of dentistry, a school of pharmacy, or a graduate program 
in behavioral or mental health. 
"(B) 
EXCEPTION.—^The 
definition 
established 
in 
subparagraph (A) shall not apply to the use of the term 
'designated health professions school' for purposes of sub-
section (c)(2). 
"(2) PROGRAM OF EXCELLENCE.—^The term 'program of excel-
lence' means any program carried out by a designated 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. 
112 STAT. 3530 
PUBLIC LAW 105-392—NOV. 13, 1998 
"(3) NATIVE AMERICANS.—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 $26,000,000 for fiscal year 1998, and such 
sums as may be necessary for each of the fiscal years 1999 
through 2002. 
"(2) ALLOCATIONS.—Based on the amount appropriated 
under paragraph (1) for a fiscal year, one of the following 
subparagraphs shall apply: 
"(A) IN GENERAL.—If the amounts appropriated under 
paragraph (1) for a fiscal year are $24,000,000 or less— 
"(i) the Secretary shall make available $12,000,000 
for grants under subsection (a) to health professions 
schools that meet the conditions described in sub-
section (c)(2)(A); and 
"(ii) and available after grants are made with funds 
under clause (i), the Secretary shall make available— 
"(I) 60 percent of such amount for grants under 
subsection (a) to health professions schools that 
meet the conditions described in paragraph (3) 
or (4) of subsection (c) (including meeting the 
conditions under subsection (e)); and 
"(II) 40 percent of such amount for grants 
under subsection (a) to health professions schools 
that meet the conditions described in subsection 
(c)(5). 
"(B) FUNDING IN EXCESS OF $24,000,000.—If amounts 
^ 
appropriated under paragraph (1) for a fiscal year exceed 
$24,000,000 but are less than $30,000,000— 
"(i) 80 percent of such excess amounts shall be 
made available for grants under subsection (a) to 
health professions schools that meet the requirements 
described in paragraph (3) or (4) of subsection (c) 
(including meeting conditions pursuant to subsection 
(e)); and 
"(ii) 20 percent of such excess amount shall be 
made available for grants under subsection (a) to 
health professions schools that meet the conditions 
described in subsection (c)(5). 
"(C) FUNDING IN EXCESS OF $30,000,000.—If amounts 
appropriated under paragraph (1) for a fiscal year are 
$30,000,000 or more, the Secretary shall make available— 
"(i) not less than $12,000,000 for grants under 
subsection (a) to health professions schools that meet 
the conditions described in subsection (c)(2)(A); 
"(ii) not less than $12,000,000 for grants under 
subsection (a) to health professions schools that meet 
the conditions described in paragraph (3) or (4) of 
subsection (c) (including meeting conditions pursuant 
to subsection (e)); 
"(iii) not less than $6,000,000 for grants under 
subsection (a) to health professions schools that meet 
the conditions described in subsection (c)(5); and 
PUBLIC LAW 105-392—NOV. 13, 1998 
112 STAT. 3531 
"(iv) after grants are made with funds under 
clauses (i) through (iii), any remaining funds for grants 
under subsection (a) to health professions schools that 
meet the conditions described in paragraph (2)(A), (3), 
(4), or (5) of subsection (c). 
"(3) No LIMITATION.—Nothing in this subsection shall be 
construed as limiting the centers of excellence referred to in 
this section to the designated amount, or to preclude such 
entities from competing for other grants under this section. 
"(4) MAINTENANCE OF EFFORT.— 
"(A) IN GENERAL.—^With respect to activities for which 
a grant made under this part are authorized to be 
expended, the Secretary may not make such a grant to 
a center of excellence for any fiscal year unless the center 
agrees to maintain expenditures of non-Federal amounts 
for such activities at a level that is not less than the 
level of such expenditures maintained by the center for 
the fiscal year preceding the fiscal year for which the 
school receives such a grant. 
"(B) USE OF FEDERAL FUNDS.—^With respect to any 
Federal amounts received by a center of excellence and 
available for carrying out activities for which a grant under 
this part is authorized to be expended, the Secretary may 
not make such a grant to the center for any fiscal year 
unless the center agrees that the center will, before expend-
ing the grant, expend the Federal amounts obtained from 
sources other than the grant. 
"SEC. 737. SCHOLARSHIPS FOR DISADVANTAGED STUDENTS. 
42 USC 293a. 
"(a) IN GENERAL.—^The Secretary may make a grant to an 
eligible entity (as defined in subsection (d)(1)) under this section 
for the awarding of scholarships by schools to any full-time student 
who is an eligible individual as defined in subsection (d). Such 
scholarships may be expended only for tuition expenses, other 
reasonable educational expenses, and reasonable living expenses 
incurred in the attendance of such school. 
"(b) PREFERENCE IN PROVIDING SCHOLARSHIPS.—^The Secretary 
may not make a grant to an entity under subsection (a) unless 
the health professions and nursing schools involved agree that, 
in providing scholarships pursuant to the grant, the schools will 
give preference to students for whom the costs of attending the 
schools would constitute a severe financial hardship and, notwith-
standing other provisions of this section, to former recipients of 
scholarships under sections 736 and 740(d)(2)(B) (as such sections 
existed on the day before the date of enactment of this section). 
"(c) AMOUNT OF AWARD.—In awarding grants to eligible entities 
that are health professions and nursing schools, the Secretary shall 
give priority to eligible entities based on the proportion of graduat-
ing students going into primary care, the proportion of underrep-
resented minority students, and the proportion of graduates working 
in medically underserved communities. 
"(d) DEFINITIONS.—In this section: 
"(1) ELIGIBLE ENTITIES.—The term 'eligible entities' means 
an entity that— 
"(A) is a school of medicine, osteopathic medicine, den-
tistry, nursing (as defined in section 801), pharmacy, 
pediatric medicine, optometry, veterinary medicine, public 
112 STAT. 3532 
PUBLIC LAW 105-392—NOV. 13, 1998 
health, chiropractic, or alHed health, a school offering a 
graduate program in behavioral and mental health practice, 
or an entity providing programs for the training of physi-
cian assistants; and 
"(B) is carrying out a program for recruiting and retain-
ing students from disadvantaged backgrounds, including 
students who are members of racial and ethnic minority 
groups. 
"(2) ELIGIBLE INDIVIDUAL.—^The term 'eligible individual' 
means an individual who— 
"(A) is from a disadvantaged background; 
"(B) has a financial need for a scholarship; and 
"(C) is enrolled (or accepted for enrollment) at an 
eligible health professions or nursing school as a full-time 
student in a program leading to a degree in a health 
profession or nursing. 
42 use 293b. 
"SEC. 738. LOAN REPAYMENTS AND FELLOWSHIPS REGARDING FAC-
ULTY POSITIONS. 
"(a) LOAN REPAYMENTS.— 
Contracts. 
"(1) ESTABLISHMENT OF PROGRAM.—^The Secretary shall 
establish a program of entering into contracts with individuals 
described in paragraph (2) under which the individuals agree 
to serve as members of the faculties of schools described in 
paragraph (3) in consideration 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. 
"(2) ELIGIBLE INDIVIDUALS.—^The individuals referred to in 
paragraph (1) are individuals from disadvantaged backgrounds 
who— 
"(A) have a degree in medicine, osteopathic medicine, 
dentistry, nursing, or another health profession; 
"(B) are enrolled in an approved graduate training 
program in medicine, osteopathic medicine, dentistry, nurs-
ing, or other health profession; or 
"(C) are enrolled as full-time students— 
"(i) in an accredited (as determined by the Sec-
retary) school described in paragraph (3); and 
"(ii) 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. 
"(3) ELIGIBLE HEALTH PROFESSIONS SCHOOLS.—The schools 
described in this paragraph are schools of medicine, nursing 
(as schools of nursing are defined in section 801), osteopathic 
medicine, dentistry, pharmacy, allied health, podiatric medi-
cine, optometry, veterinary medicine, or public health, or 
schools offering graduate programs in behavioral and mental 
health. 
"(4) REQUIREMENTS REGARDING FACULTY POSITIONS.—The 
Secretary may not enter into a contract under paragraph (1) 
unless— 
"(A) the individual involved has entered into a contract 
with a school described in paragraph (3) to serve as a 
member of the faculty of the school for not less than 2 
years; and 
PUBLIC LAW 105-392—NOV. 13, 1998 
112 STAT. 3533 
"(B) the contract referred to in subparagraph (A) pro-
vides that— 
"(i) the school will, for each year for which the 
individual will serve as a member of the faculty under 
the contract with the school, make payments of the 
principal and interest 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; 
"(ii) the payments made by the school pursuant 
to clause (i) 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; and 
"(iii) the school, in making a determination of the 
amount of compensation to be provided by the school 
to the individual for serving as a member of the faculty, 
will make the determination without regard to the 
amount of payments made (or to be made) to the 
individual by the Federal Government under para-
graph (1). 
"(5) APPLICABILITY OF CERTAIN PROVISIONS.—^The provisions 
of sections 338C, 338G, and 3381 shall apply to the program 
established in paragraph (1) to the same extent and in the 
same manner as such provisions apply to the National Health 
Service Corps Loan Repayment 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. 
"(6) WAIVER REGARDING SCHOOL CONTRIBUTIONS.—^The Sec-
retary may waive the requirement established in paragraph 
(4)(B) if the Secretary determines that the requirement will 
impose an undue financial hardship on the school involved. 
"(b) FELLOWSHIPS.— 
"(1) IN GENERAL.—^The Secretary may make grants to and 
enter into contracts with eligible entities to assist such entities 
in increasing the number of underrepresented minority individ-
uals who are members of the faculty of such schools. 
"(2) APPLICATIONS.—^To be eligible to receive a grant or 
contract under this subsection, an entity shall provide an assur-
ance, in the application submitted by the entity, that— 
"(A) amounts received under such a grant or contract 
will be used to award a fellowship to an individual only 
if the individual meets the requirements of paragraphs 
(3) and (4); and 
"(B) each fellowship awarded pursuant to the grant 
or contract will include— 
"(i) a stipend in an amount not exceeding 50 per-
cent of the regular salary of a similar faculty member 
for not to exceed 3 years of training; and 
"(ii) an allowance for other expenses, such as travel 
to professional meetings and costs related to specialized 
training. 
"(3) ELIGIBILITY.—^To be eligible to receive a grant or con-
tract under paragraph (1), an applicant shall demonstrate to 
the Secretary that such applicant has or will have the ability 
to— 
112 STAT. 3534 
PUBLIC LAW 105-392—NOV. 13, 1998 
"(A) identify, recruit and select underrepresented 
minority individuals who have the potential for teaching, 
administration, or conducting research at a health profes-
sions institution; 
"(B) provide such individuals with the skills necessary 
to enable them to secure a tenured faculty position at 
such institution, which may include training with respect 
to pedagogical skills, program administration, the design 
and conduct of research, grants writing, and the prepara-
tion of articles suitable for publication in peer reviewed 
journals; 
"(C) provide services designed to assist such individuals 
in their preparation for an academic career, including the 
provision of counselors; and 
"(D) provide health services to rural or medically 
underserved populations. 
"(4) REQUIREMENTS.—^To be eligible to receive a grant or 
contract under paragraph (1) an applicant shall— 
"(A) provide an assurance that such applicant will 
make available (directly through cash donations) $1 for 
every $1 of Federal funds received under this section for 
the fellowship; 
"(B) provide an assurance that institutional support 
will be provided for the individual for the second and 
third years at a level that is equal to the total amount 
of institutional funds provided in the year in which the 
grant or contract was awarded; 
"(C) provide an assurance that the individual that will 
receive the fellowship will be a member of the faculty 
of the applicant school; and 
"(D) provide an assurance that the individual that 
will receive the fellowship will have, at a minimum, appro-
priate advanced preparation (such as a master's or doctoral 
degree) and special skills necessary to enable such individ-
ual to teach and practice. 
"(5) DEFINITION.—For purposes of this subsection, the term 
'underrepresented minority individuals' means individuals who 
are members of racial or ethnic minority groups that are under-
represented in the health professions including nursing. 
42 use 293c. 
"SEC. 739. EDUCATIONAL ASSISTANCE IN THE HEALTH PROFESSIONS 
REGARDING INDIVIDUALS FROM DISADVANTAGED BACK-
GROUNDS. 
"(a) IN GENERAL.— 
"(1) AUTHORITY FOR GRANTS.—For the purpose of assisting 
individuals from disadvantaged backgrounds, as determined 
in accordance with criteria prescribed by the Secretary, to 
undertake education to enter a health profession, the Secretary 
may make grants to and enter into contracts with schools 
of medicine, osteopathic medicine, public health, dentistry, vet-
erinary medicine, optometry, pharmacy, allied health, chiro-
practic, and podiatric medicine, public and nonprofit private 
schools that offer graduate programs in behavioral and mental 
health, programs for the training of physician assistants, and 
other public or private nonprofit health or educational entities 
to assist in meeting the costs described in paragraph (2). 
PUBLIC LAW 105-392—NOV. 13, 1998 
112 STAT. 3535 
"(2) AUTHORIZED EXPENDITURES.—A grant or contract under 
paragraph (1) may be used by the entity to meet the cost 
of— 
"(A) identifying, recruiting, and selecting individuals 
from disadvantaged backgrounds, as so determined, for 
education and training in a health profession; 
"(B) facilitating the entry of such individuals into such 
a school; 
"(C) providing counseling, mentoring, or other services 
designed to assist such individuals to complete successfully 
their education at such a school; 
"(D) providing, for a period prior to the entry of such 
individuals into the regular course of education of such 
a school, preliminary education and health research train-
ing designed to assist them to complete successfully such 
regular course of education at such a school, or referring 
such individuals to institutions providing such preliminary 
education; 
"(E) publicizing existing sources of financial aid avail-
able to students in the education program of such a school 
or who are undertaking training necessary to qualify them 
to enroll in such a program; 
"(F) paying such scholarships as the Secretary may 
determine for such individuals for any period of health 
professions education at a health professions school; 
"(G) paying such stipends as the Secretary may 
approve for such individuals for any period of education 
in student-enhancement programs (other than regular 
courses), except that such a stipend may not be provided 
to an individual for more than 12 months, and such a 
stipend shall be in an amount determined appropriate by 
the Secretary (notwithstanding any other provision of law 
regarding the amount of stipends); 
"(H) carrying out programs under which such individ-
uals gain experience regarding a career in a field of primary 
health care through working at facilities of public or private 
nonprofit community-based providers of primary health 
services; and 
"(I) conducting activities to develop a larger and more 
competitive applicant pool through partnerships with 
institutions of higher education, school districts, and other 
community-based entities. 
"(3) DEFINITION.—In this section, the term 'regular course 
of education of such a school' as used in subparagraph (D) 
includes a graduate program in behavioral or mental health. 
"(b) REQUIREMENTS FOR AWARDS.—In making awards to eligible 
entities under subsection (a)(1), the Secretary shall give preference 
to approved applications for programs that involve a comprehensive 
approach by several public or nonprofit private health or educational 
entities to establish, enhance and expand educational programs 
that will result in the development of a competitive applicant pool 
of individuals from disadvantaged backgrounds who desire to pursue 
health professions careers. In considering awards for such a com-
prehensive partnership approach, the following shall apply with 
respect to the entity involved: 
"(1) The entity shall have a demonstrated commitment 
to such approach through formal agreements that have common 
N 
112 STAT. 3536 
PUBLIC LAW 105-392—NOV. 13, 1998 
42 use 293d. 
Deadline. 
objectives with institutions of higher education, school districts, 
and other community-based entities. 
"(2) Such formal agreements shedl reflect the coordination 
of educational activities £uid support services, increased link-
ages, and the consolidation of resources within a specific 
geographic area. 
"(3) The design of the educational activities involved shsdl 
provide for the establishment of a competitive hoEdth profes-
sions applicant pool of individueds from disadvantaged back-
grounds by enhancing the total preparation (academic and 
social) of such individuals to pursue a health professions career. 
"(4) The programs or activities under the award shall focus 
on developing a culturally competent heeJth care workforce 
that will serve the unserved suid underserved populations 
within the geographic area. 
"(c) EQUITABLE ALLOCATION OF FINANCIAL ASSISTANCE.—The 
Secretary, to the extent practicable, shsdl ensure that services and 
activities under subsection (a) are adequately allocated among the 
various racial and ethnic populations who are from disadvantaged 
backgrounds. 
"(d) MATCHING REQUIREMENTS.—The Secretary may require 
that an entity that applies for a grant or contract under subsection 
(a), provide non-Federal matching funds, as appropriate, to ensure 
the institutional commitment of the entity to the projects funded 
under the grant or contract. As determined by the Secretary, such 
non-Feder^ matching funds may be provided directly or through 
donations fi-om public or private entities and may be in cash or 
in-kind, fairly evaluated, including plsuit, equipment, or services. 
"SEC. 740. AUTHORIZATION OF APPROPRIATION. 
"(a) SCHOLARSHIPS.—^There are authorized to be appropriated 
to carry out section 737, $37,000,000 for fiscal year 1998, and 
such sums as may be necessary for each of the fiscal years 1999 
through 2002. Of the amount appropriated in any fiscsd year, the 
Secretary shall ensure that not less than 16 percent shall be distrib-
uted to schools of nursing. 
"(b) LOAN REPAYMENTS AND FELLOWSHIPS.—For the purpose 
of canning out section 738, there is authorized to be appropriated 
$1,100,000 for fiscal ye£ir 1998, and such sums as may be necessary 
for each of the fiscal years 1999 through 2002. 
"(c) 
EDUCATIONAL 
ASSISTANCE 
IN 
HEALTH 
PROFESSIONS 
REGARDING INDIVIDUALS FOR DISADVANTAGED BACKGROUNDS.—For 
the purpose of grants £ind contracts under section 739(aXl), there 
is authorized to be appropriated $29,400,000 for fiscal year 1998, 
and such sums as may be necessary for each of the fiscal years 
1999 through 2002. The Secretary may use not to exceed 20 percent 
of the amount appropriated for a fiscal year luider this subsection 
to provide scholarships under section 739(a)(2)(F). 
"(d) REPORT.—Not later than 6 months after the date of enact-
ment of this part, the Secretary shall prepare and submit to the 
appropriate committees of Congress a report concerning the efforts 
of the Secretsiry to address the need for a representative mix 
of individuals fi*om historically minority health professions schools, 
or from institutions or other entities that historically or by 
geographic location have a demonstrated record of training or 
educating underrepresented minorities, within various health 
professions disciplines, on peer review councils.". 
PUBLIC LAW 105-392—NOV. 13, 1998 
112 STAT. 3537 
(b) REPEAL.— 
(1) IN GENERAL.—Section 795 of the Public Health Service 
Act (42 U.S.C. 295n) is repealed. 
(2) NONTERMINATION OF AUTHORITY.—The amendments 42USC295n 
made by this section shall not be construed to terminate agree- note, 
ments that, on the day before the date of enactment of this 
Act, are in effect pursuant to section 795 of the Public Health 
Service Act (42 U.S.C. 795) as such section existed on such 
date. Such agreements shall continue in effect in accordance 
with the terms of the agreements. With respect to compliance 
with such agreements, any period of practice as a provider 
of primary health services shall be counted towards the satisfac-
tion of the requirement of practice pursuant to such section 
795. 
(c) CONFORMING AMENDMENTS.—Section 481A(c)(3)(D)(i) of the 
Public Health Service Act (42 U.S.C. 287a-2(c)(3)(D)(i)) is amended 
by striking "section 739" and inserting "part B of title VII". 
SEC. 102. TRAINING IN PRIMARY CARE MEDICINE AND DENTISTRY. 
Part C of title VII of the Public Health Service Act (42 U.S.C. 
293 et seq.) is amended— 
(1) in the part heading by striking "PRIMARY HEALTH 
CARE" and inserting "FAMILY MEDICINE, GENERAL 
INTERNAL MEDICINE, GENERAL PEDIATRICS, PHYSI-
CIAN ASSISTANTS, GENERAL DENTISTRY, AND PEDI-
ATRIC DENTISTRY"; 
(2) by repealing section 746 (42 U.S.C. 293j); 
(3) in section 747 (42 U.S.C. 293k)— 
(A) by striking the section heading and inserting the 
following: 
"SEC. 747. FAMILY MEDICINE, GENERAL INTERNAL MEDICINE, GEN-
ERAL PEDIATRICS, GENERAL DENTISTRY, PEDIATRIC 
DENTISTRY, AND PHYSICIAN ASSISTANTS."; 
(B) in subsection (a)— 
(i) in paragraph (1)— 
(I) by inserting ", internal medicine, or pediat-
rics" after "family medicine"; and 
(II) by inserting before the semicolon the fol-
lowing: "that emphasizes training for the practice 
of family medicine, general internal medicine, or 
general pediatrics (as defined by the Secretary)"; 
(ii) in paragraph (2), by inserting ", general 
internal medicine, or general pediatrics" before the 
semicolon; 
(iii) in paragraphs (3) and (4), by inserting "(includ-
ing geriatrics), general internal medicine or general 
pediatrics" after "family medicine"; 
(iv) in paragraph (3), by striking "and" at the 
end thereof; 
(v) in paragraph (4), by striking the period and 
inserting a semicolon; and 
(vii) by adding at the end thereof the following 
new paragraphs: 
"(5) to meet the costs of projects to plan, develop, and 
operate or maintain programs for the training of physician 
assistants (as defined in section 799B), and for the training 
112 STAT. 3538 
PUBLIC LAW 105-392—NOV. 13, 1998 
of individuals who will teach in programs to provide such 
training; and 
"(6) to meet the costs of planning, developing, or operating 
programs, and to provide financial assistance to residents in 
such programs, of general dentistry or pediatric dentistry. 
For purposes of paragraph (6), entities eligible for such grants 
or contracts shall include entities that have programs in dental 
schools, approved residency programs in the general or pediatric 
practice of dentistry, approved advanced education programs in 
the general or pediatric practice of dentistry, or approved residency 
programs in pediatric dentistry."; 
(C) in subsection (b)-— 
(i) in paragraphs (1) and (2)(A), by inserting 
", general internal medicine, or general pediatrics" 
after "family medicine"; 
(ii) in paragraph (2)— 
(I) in subparagraph (A), by striking "or" at 
the end; and 
(II) in subparagraph (B), by striking the period 
and inserting "; or"; and 
(iii) by adding at the end the following: 
"(3) PRIORITY IN MAKING AWARDS.—In making awards of 
grants and contracts under paragraph (1), the Secretary shall 
give priority to any qualified applicant for such an award 
that proposes a collaborative project between departments of 
primary care."; 
(D) by redesignating subsections (c) and (d) as sub-
sections (d) and (e), respectively; 
(E) by inserting after subsection (b), the following new 
subsection: 
"(c) PRIORITY.— 
"(1) IN GENERAL.—^With respect to programs for the training 
of interns or residents, the Secretary shall give priority in 
awarding grants under this section to qualified applicants that 
have a record of training the greatest percentage of providers, 
or that have demonstrated significant improvements in the 
percentage of providers, which enter and remain in primary 
care practice or general or pediatric dentistry. 
"(2) DISADVANTAGED INDIVIDUALS.—With respect to pro-
grams for the training of interns, residents, or physician assist-
ants, the Secretary shall give priority in awarding grants under 
this section to qualified applicants that have a record of training 
individuals who are from disadvantaged backgrounds (including 
racial and ethnic minorities underrepresented among primary 
care practice or general or pediatric dentistry). 
"(3) SPECIAL CONSIDERATION.—In awarding grants under 
this section the Secretary shall give special consideration to 
projects which prepare practitioners to care for underserved 
populations and other high risk groups such as the elderly, 
individuals with HIV-AIDS, substance abusers, homeless, and 
victims of domestic violence."; and 
(F) in subsection (e) (as so redesignated by subpara-
graph (D))— 
(i) in paragraph (1), by striking "$54,000,000" and 
all that follows and inserting "$78,300,000 for fiscal 
year 1998, and such sums as may be necessary for 
each of the fiscal years 1999 through 2002."; and 
PUBLIC LAW 105-392—NOV. 13, 1998 
112 STAT. 3539 
(ii) by striking paragraph (2) and inserting the 
following: 
"(2) ALLOCATION.— 
"(A) IN GENERAL.—Of the amounts appropriated under 
paragraph (1) for a fiscal year, the Secretary shall make 
available— 
"(i) not less than $49,300,000 for awards of grants 
and contracts under subsection (a) to programs of fam-
ily medicine, of which not less than $8,600,000 shall 
be made available for awards of grants and contracts 
under subsection (b) for family medicine academic 
administrative units; 
"(ii) not less than $17,700,000 for awards of grants 
and contracts under subsection (a) to programs of gen-
' 
eral internal medicine and general pediatrics; 
"(iii) not less than $6,800,000 for awards of grants 
and contracts under subsection (a) to programs relating 
to physician assistants; and 
"(iv) not less than $4,500,000 for awards of grants 
and contracts under subsection (a) to programs of gen-
eral or pediatric dentistry. 
"(B) RATABLE REDUCTION.—If amounts appropriated 
under paragraph (1) for any fiscal year are less than the 
amount required to comply with subparagraph (A), the 
Secretary shall ratably reduce the amount to be made 
available under each of clauses (i) through (iv) of such 
subparagraph accordingly."; and 
(4) by repealing sections 748 through 752 (42 U.S.C. 2931 
through 293p) and inserting the following: 
"SEC. 748. ADVISORY COMMITTEE ON TRAINING IN PRIMARY CARE 42USC293/. 
MEDICINE AND DENTISTRY. 
"(a) ESTABLISHMENT.—^The Secretary shall establish an advisory 
committee to be known as the Advisory Committee on Training 
in Primary Care Medicine and Dentistry (in this section referred 
to as the 'Advisory Committee'). 
"(b) COMPOSITION.— 
"(1) IN GENERAL.—^The Secretary shall determine the appro-
priate number of individuals to serve on the Advisory Commit-
tee. Such individuals shall not be officers or employees of the 
Federal Government. 
"(2) APPOINTMENT.—^Not later than 90 days after the date Deadline. 
of enactment of this Act, the Secretary shall appoint the mem-
bers of the Advisory Committee from among individuals who 
are health professionals. In making such appointments, the 
Secretary shall ensure a fair balance between the health profes-
sions, that at least 75 percent of the members of the Advisory 
Committee are health professionals, a broad geographic rep-
resentation of members and a balance between urban and 
rural members. Members shall be appointed based on their 
competence, interest, and knowledge of the mission of the 
profession involved. 
"(3) MINORITY REPRESENTATION.—In appointing the mem-
bers of the Advisory Committee under paragraph (2), the Sec-
retary shall ensure the adequate representation of women and 
minorities. 
"(c) TERMS.— 
112 STAT. 3540 
PUBLIC LAW 105-392—NOV. 13, 1998 
Deadline. 
"(1) IN GENERAL.—^A member of the Advisory Committee 
shall be appointed for a term of 3 years, except that of the 
members first appointed— 
"(A) V
a of such members shall serve for a term of 
1 year; 
"(B) Vs of such members shall serve for a term of 
2 years; and 
"(C) Vs of such members shall serve for a term of 
3 years. 
"(2) VACANCIES.— 
"(A) IN GENERAL.—^A vacancy on the Advisory Commit-
tee shall be filled in the manner in which the original 
appointment was made and shall be subject to any condi-
tions which applied with respect to the original appoint-
ment. 
"(B) FILLING UNEXPIRED TERM.—^An individual chosen 
to fill a vacancy shall be appointed for the unexpired term 
of the member replaced. 
"(d) DUTIES.—^The Advisory Committee shall— 
"(1) provide advice and recommendations to the Secretary 
concerning policy and program development and other matters 
of significance concerning the activities under section 747; and 
"(2) not later than 3 years after the date of enactment 
of this section, and annually thereafter, prepare and submit 
to the Secretary, and the Committee on Labor and Human 
Resources of the Senate, and the Committee on Commerce 
of the House of Representatives, a report describing the activi-
ties of the Committee, including findings and recommendations 
made by the Committee concerning the activities under section 
747. 
"(e) MEETINGS AND DOCUMENTS.— 
"(1) MEETINGS.—^The Advisory Committee shall meet not 
less than 2 times each year. Such meetings shall be held 
jointly with other related entities established under this title 
where appropriate. 
"(2) DOCUMENTS.—Not later than 14 days prior to the 
convening of a meeting under paragraph (1), the Advisory 
Committee shall prepare and make available an agenda of 
the matters to be considered by the Advisory Committee at 
such meeting. At any such meeting, the Advisory Council shall 
distribute materials with respect to the issues to be addressed 
at the meeting. Not later than 30 days after the adjourning 
of such a meeting, the Advisory Committee shall prepare and 
make available a summary of the meeting and any actions 
taken by the Committee based upon the meeting. 
"(f) COMPENSATION AND EXPENSES.— 
"(1) 
COMPENSATION.—Each member 
of the 
Advisory 
Committee shall be compensated at a rate equal to the daily 
equivalent of the annual rate of basic pay prescribed for level 
IV of the Executive Schedule under section 5315 of title 5, 
United States Code, for each day (including travel time) during 
which such member is engaged in the performance of the duties 
of the Committee. 
"(2) EXPENSES.—The members of the Advisory Committee 
shall be allowed travel expenses, including per diem in lieu 
of subsistence, at rates authorized for employees of agencies 
under subchapter I of chapter 57 of title 5, United States 
PUBLIC LAW 105-392—NOV. 13, 1998 
112 STAT. 3541 
Code, while away from their homes or regular places of business 
in the performance of services for the Committee. 
"(g) FACA.—^The Federal Advisory Committee Act shall apply 
to the Advisory Committee under this section only to the extent 
that the provisions of such Act do not conflict with the requirements 
of this section.". 
SEC. 103. INTERDISCIPLINARY, COMMUNITY-BASED LINKAGES. 
Part D of title VII of the Public Health Service Act (42 U.S.C. 
294 et seq.) is amended to read as follows: 
"PART D—INTERDISCIPLINARY, COMMUNITY-
BASED LINKAGES 
"SEC. 750. GENERAL PROVISIONS. 
42 USC 294. 
"(a) COLLABORATION.—^To be eligible to receive assistance under 
this part, an academic institution shall use such assistance in 
collaboration with 2 or more disciplines. 
"(b) ACTIVITIES.—^An entity shall use assistance under this part 
to carry out innovative demonstration projects for 
strategic 
workforce supplementation activities as needed to meet national 
goals for interdisciplinary, community-based linkages. Such assist-
ance may be used consistent with this part— 
"(1) to develop and support training programs; 
"(2) for faculty development; 
"(3) for model demonstration programs; 
"(4) for the provision of stipends for fellowship trainees; 
"(5) to provide technical assistance; and 
"(6) for other activities that will produce outcomes consist-
ent with the purposes of this part. 
"SEC. 751. AREA HEALTH EDUCATION CENTERS. 
42 USC 294a. 
"(a) AUTHORITY FOR PROVISION OF FINANCIAL ASSISTANCE.— 
"(1) ASSISTANCE FOR PLANNING, DEVELOPMENT, AND OPER-
ATION OF PROGRAMS.— 
"(A) IN GENERAL.—^The Secretary shall award grants Grants, 
to and enter into contracts with schools of medicine and C
o
"
*
^
'
"
^
*
^
*
^
. 
osteopathic medicine, and incorporated consortia made up 
of such schools, or the parent institutions of such schools, 
for projects for the planning, development and operation 
of area health education center programs that— 
"(i) improve the recruitment, distribution, supply, 
quality and efficiency of personnel providing health 
services in underserved rural and urban areas and 
personnel providing health services to populations hav-
ing demonstrated serious unmet health care needs; 
"(ii) increase the number of primary care physi-
cians and other primary care providers who provide 
services in underserved areas through the offering of 
an educational continuum of health career recruitment 
through clinical education concerning underserved 
areas in a comprehensive health workforce strategy; 
"(iii) carry out recruitment and health career 
awareness programs to recruit individuals from under-
served 
areas 
and 
under-represented 
populations, 
including minority and other elementary or secondary 
students, into the health professions; 
112 STAT. 3542 
PUBLIC LAW 105-392—NOV. 13, 1998 
"(iv) prepare individuals to more effectively provide 
health services to underserved areas or underserved 
populations through field placements, preceptorships, 
the conduct of or support of community-based primary 
care residency programs, and agreements with commu-
nity-based organizations such as community health 
centers, migrant health centers, Indian health centers, 
public health departments and others; 
"(v) conduct health professions education and 
training activities for students of health professions 
schools and medical residents; 
"(vi) conduct at least 10 percent of medical student 
required clinical education at sites remote to the pri-
mary teaching facility of the contracting institution; 
and 
"(vii) provide information dissemination and edu-
cational support to reduce professional 
isolation, 
increase retention, enhance the practice environment, 
and improve health care through the timely dissemina-
tion of research findings using relevant resources. 
"(B) OTHER ELIGIBLE ENTITIES.—With respect to a State 
in which no area health education center program is in 
operation, the Secretary may award a grant or contract 
under subparagraph (A) to a school of nursing. 
"(C) PROJECT TERMS.— 
"(i) IN GENERAL.—Except as provided in clause 
(ii), the period during which payments may be made 
under an award under subparagraph (A) may not 
exceed— 
"(I) in the case of a project, 12 years or 
"(II) in the case of a center within a project, 
6 years. 
"(ii) EXCEPTION.—^The periods described in clause 
(i) shall not apply to projects that have completed 
the initial period of Federal funding under this section 
and that desire to compete for model awards under 
paragraph (2)(A). 
"(2) ASSISTANCE FOR OPERATION OF MODEL PROGRAMS.— 
"(A) IN GENERAL.—In the case of any entity described 
in paragraph (1)(A) that— 
"(i) has previously received funds under this sec-
tion; 
"(ii) is operating an area health education center 
program; and 
"(iii) is no longer receiving financial assistance 
under paragraph (1); 
the Secretary may provide financial assistance to such 
entity to pay the costs of operating and carrying out the 
requirements of the program as described in paragraph 
(1). 
"(B) MATCHING REQUIREMENT.—^With respect to the 
costs of operating a model program under subparagraph 
(A), an entity, to be eligible for financial assistance under 
subparagraph (A), shall make available (directly or through 
contributions from State, county or municipal governments, 
or the private sector) recurring non-Federal contributions 
PUBLIC LAW 105-392—NOV. 13, 1998 
112 STAT. 3543 
in cash toward such costs in an amount that is equal 
to not less than 50 percent of such costs. 
"(C) LIMITATION.—The aggregate amount of awards 
provided under subparagraph (A) to entities in a State 
for a fiscal year may not exceed the lesser of— 
"(i) $2,000,000; or 
"(ii) an amount equal to the product of $250,000 
and the aggregate number of area health education 
centers operated in the State by such entities. 
"(b) REQUIREMENTS FOR CENTERS.— 
"(1) GENERAL REQUIREMENT.—Each area health education 
center that receives funds under this section shall encourage 
the regionalization of health professions schools through the 
establishment of partnerships with community-based organiza-
tions. 
"(2) SERVICE AREA.—Each area health education center that 
receives funds under this section shall specifically designate 
a geographic area or medically underserved population to be 
served by the center. Such area or population shall be in 
a location removed from the main location of the teaching 
facilities of the schools participating in the program with such 
center. 
"(3) OTHER REQUIREMENTS.—Each area health education 
center that receives funds under this section shall— 
"(A) assess the health personnel needs of the area 
to be served by the center and assist in the planning 
and development of training programs to meet such needs; 
"(B) arrange and support rotations for students and 
residents in family medicine, general internal medicine 
or general pediatrics, with at least one center in each 
program being affiliated with or conducting a rotating 
osteopathic internship or medical residency training pro-
gram in family medicine (including geriatrics), general 
internal medicine (including geriatrics), or general pediat-
rics in which no fewer than 4 individuals are enrolled 
in first-year positions; 
"(C) conduct and participate in interdisciplinary train-
ing that involves physicians and other health personnel 
including, where practicable, public health professionals, 
physician assistants, nurse practitioners, nurse midwives, 
and behavioral and mental health providers; and 
"(D) have an advisory board, at least 75 percent of 
the members of which shall be individuals, including both 
health service providers and consumers, from the area 
served by the center. 
"(c) CERTAIN PROVISIONS REGARDING FUNDING.— 
"(1) ALLOCATION TO CENTER.—^Not less than 75 percent 
of the total amount of Federal funds provided to an entity 
under this section shall be allocated by an area health education 
center program to the area health education center. Such entity 
shall enter into an agreement with each center for purposes 
of specifying the allocation of such 75 percent of funds. 
"(2) OPERATING COSTS.—^With respect to the operating costs 
of the area health education center program of an entity receiv-
ing funds under this section, the entity shall make available 
112 STAT. 3544 
PUBLIC LAW 105-392—NOV. 13, 1998 
(directly or through contributions from State, county or munici-
pal governments, or the private sector) non-Federal contribu-
tions in cash toward such costs in an amount that is equal 
to not less than 50 percent of such costs, except that the 
Secretary may grant a waiver for up to 75 percent of the 
amount of the required non-Federal match in the first 3 years 
in which an entity receives funds under this section. 
42 use 294b. 
"SEC. 752. HEALTH EDUCATION AND TRAINING CENTERS. 
"(a) IN GENERAL.—^To be eligible for funds under this section, 
a health education training center shall be an entity otherwise 
eligible for funds under section 751 that— 
"(1) addresses the persistent and severe unmet health care 
needs in States along the border between the United States 
and Mexico and in the State of Florida, and in other urban 
and rural areas with populations with serious unmet health 
care needs; 
"(2) establishes an advisory board comprised of health serv-
ice providers, educators and consumers from the service area; 
"(3) conducts training and education programs for health 
professions students in these areas; 
"(4) conducts training in health education services, includ-
ing training to prepare community health workers; and 
"(5) supports health professionals (including nursing) 
practicing in the area through educational and other services. 
"(b) ALLOCATION OF FUNDS.—The Secretary shall make avail-
able 50 percent of the amounts appropriated for each fiscal year 
under section 752 for the establishment or operation of health 
education training centers through projects in States along the 
border between the United States and Mexico and in the State 
of Florida. 
42 use 294c. 
"SEC. 753. EDUCATION AND TRAINING RELATING TO GERIATRICS. 
"(a) GERIATRIC EDUCATION CENTERS.— 
"(1) IN GENERAL.—^The Secretary shall award grants or 
contracts under this section to entities described in paragraphs 
(1), (3), or (4) of section 799B, and section 853(2), for the 
establishment or operation of geriatric education centers. 
"(2) REQUIREMENTS.—^A geriatric education center is a pro-
gram that— 
"(A) improves the training of health professionals in 
geriatrics, including geriatric residencies, traineeships, or 
fellowships; 
"(B) develops and disseminates curricula relating to 
the treatment of the health problems of elderly individuals; 
"(C) supports the training and retraining of faculty 
to provide instruction in geriatrics; 
"(D) supports continuing education of health profes-
sionals who provide geriatric care; and 
"(E) provides students with clinical training in geri-
atrics in nursing homes, chronic and acute disease hos-
pitals, ambulatory care centers, and senior centers. 
"(b) GERIATRIC TRAINING REGARDING PHYSICIANS AND DEN-
TISTS.— 
"(1) IN GENERAL.—The Secretary may make grants to, and 
enter into contracts with, schools of medicine, schools of osteo-
pathic medicine, teaching hospitals, and graduate medical edu-
cation programs, for the purpose of providing support (including 
PUBLIC LAW 105-392—NOV. 13, 1998 
112 STAT. 3545 
residencies, traineeships, and fellowships) for geriatric training 
projects to train physicians, dentists and behavioral and mental 
health professionals who plan to teach geriatric medicine, geri-
atric behavioral or mental health, or geriatric dentistry. 
"(2) REQUIREMENTS.—Each project for which a grant or 
contract is made under this subsection shall— 
"(A) be staffed by full-time teaching physicians who 
have experience or training in geriatric medicine or geri-
atric behavioral or mental health; 
"(B) be staffed, or enter into an agreement with an 
institution staffed by full-time or part-time teaching den-
tists who have experience or training in geriatric dentistry; 
"(C) be staffed, or enter into an agreement with an 
institution staffed by full-time or part-time teaching behav-
ioral mental health professionals who have experience or 
training in geriatric behavioral or mental health; 
"(D) be based in a graduate medical education program 
in internal medicine or family medicine or in a department 
of geriatrics or behavioral or mental health; 
"(E) provide training in geriatrics and exposure to the 
physical and mental disabilities of elderly individuals 
through a variety of service rotations, such as geriatric 
consultation services, acute care services, dental services, 
geriatric behavioral or mental health units, day and home 
care programs, rehabilitation services, extended care facili-
ties, geriatric ambulatory care and comprehensive evalua-
tion units, and community care programs for elderly men-
tally retarded individuals; and 
"(F) provide training in geriatrics through one or both 
of the training options described in subparagraphs (A) and 
(B) of paragraph (3). 
"(3) TRAINING OPTIONS.—^The training options referred to 
in subparagraph (F) of paragraph (2) shall be as follows: 
"(A) A 1-year retraining program in geriatrics for— 
"(i) physicians who are faculty members in depart-
ments of internal medicine, family medicine, gyne-
cology, geriatrics, and behavioral or mental health at 
schools of medicine and osteopathic medicine; 
"(ii) dentists who are faculty members at schools 
of dentistry or at hospital departments of dentistry; 
and 
"(iii) behavioral or mental health professionals who 
are faculty members in departments of behavioral or 
mental health; and 
"(B) A 2-year internal medicine or family medicine 
fellowship program providing emphasis in geriatrics, which 
shall be designed to provide training in clinical geriatrics 
and geriatrics research for— 
"(i) physicians who have completed graduate medi-
cal education programs in internal medicine, family 
medicine, behavioral or mental health, neurology, gyne-
cology, or rehabilitation medicine; 
"(ii) dentists who have demonstrated a commit-
ment to an academic career and who have completed 
postdoctoral dental training, including postdoctoral 
dental education programs or who have relevant 
advanced training or experience; and 
112 STAT. 3546 
PUBLIC LAW 105-392—NOV. 13, 1998 
"(iii) behavioral or mental health professionals who 
have completed graduate medical education programs 
in behavioral or mental health. 
"(4) DEFINITIONS.—For purposes of this subsection: 
"(A) The term 'graduate medical education program' 
means a program sponsored by a school of medicine, a 
school of osteopathic medicine, a hospital, or a public or 
private institution that— 
"(i) offers postgraduate medical training in the 
specialties and subspecialties of medicine; and 
"(ii) has been accredited by the Accreditation Coun-
cil for Graduate Medical Education or the American 
Osteopathic Association through its Committee on 
Postdoctoral Training. 
"(B) The term 'post-doctoral dental education program' 
means a program sponsored by a school of dentistry, a 
hospital, or a public or private institution that— 
"(i) offers post-doctoral training in the specialties 
of dentistry, advanced education in general dentistry, 
or a dental general practice residency; and 
"(ii) has been accredited by the Commission on 
Dental Accreditation. 
"(c) GERIATRIC FACULTY FELLOWSHIPS.— 
"(1) ESTABLISHMENT OF PROGRAM.—^The Secretary shall 
establish a program to provide Geriatric Academic Career 
Awards to eligible individuals to promote the career develop-
ment of such individuals as academic geriatricians. 
"(2) ELIGIBLE INDIVIDUALS.—^To be eligible to receive an 
Award under paragraph (1), an individual shall— 
"(A) be board certified or board eligible in internal 
medicine, family practice, or psychiatry; 
"(B) have completed an approved fellowship program 
in geriatrics; and 
"(C) have a junior faculty appointment at an accredited 
(as determined by the Secretary) school of medicine or 
osteopathic medicine. 
"(3) LIMITATIONS.—No Award under paragraph (1) may 
be made to an eligible individual unless the individual— 
"(A) has submitted to the Secretary an application, 
at such time, in such manner, and containing such informa-
tion as the Secretary may require, and the Secretary has 
approved such application; and 
"(B) provides, in such form and manner as the Sec-
retary may require, assurances that the individual will 
meet the service requirement described in subsection (e). 
"(4) AMOUNT AND TERM.— 
"(A) AMOUNT.—^The amount of an Award under this 
section shall equal $50,000 for fiscal year 1998, adjusted 
for subsequent fiscal years to reflect the increase in the 
Consumer Price Index. 
"(B) TERM.—^The term of any Award made under this 
subsection shall not exceed 5 years. 
"(5) SERVICE REQUIREMENT.—^An individual who receives 
an Award under this subsection shall provide training in clinical 
geriatrics, including the training of interdisciplinary teams of 
health care professionals. The provision of such training shall 
PUBLIC LAW 105-392—NOV. 13, 1998 
112 STAT. 3547 
constitute at least 75 percent of the obligations of such individ-
ual under the Award. 
"SEC. 754. QUENTIN N. BURDICK PROGRAM FOR RURAL INTER- 
42 USC 294d. 
DISCIPLINARY TRAINING. 
"(a) GRANTS.—^The Secretary may make grants or contracts 
under this section to help entities fund authorized activities under 
an application approved under subsection (c). 
"(b) USE OF AMOUNTS.— 
"(1) IN GENERAL.—^Amounts provided under subsection (a) 
shall be used by the recipients to fund interdisciplinary training 
projects designed to— 
"(A) use new and innovative methods to train health 
care practitioners to provide services in rural areas; 
"(B) demonstrate and evaluate innovative interdiscipli-
nary methods and models designed to provide access to 
cost-effective comprehensive health care; 
"(C) deliver health care services to individuals residing 
in rural areas; 
"(D) enhance the amount of relevant research con-
ducted concerning health care issues in rural areas; and 
"(E) increase the recruitment and retention of health 
care practitioners from rural areas and make rural practice 
a more attractive career choice for health care practitioners. 
"(2) METHODS.—^A recipient of funds under subsection (a) 
may use various methods in carrying out the projects described 
in paragraph (1), including— 
"(A) the distribution of stipends to students of eligible 
applicants; 
"(B) the establishment of a post-doctoral fellowship 
program; 
"(C) the training of faculty in the economic and 
logistical problems confronting rural health care delivery 
systems; or 
"(D) the purchase or rental of transportation and tele-
communication equipment where the need for such equip-
ment due to unique characteristics of the rural area is 
demonstrated by the recipient. 
"(3) ADMINISTRATION.— 
"(A) IN GENERAL.—^An applicant shall not use more 
than 10 percent of the funds made available to such 
applicant under subsection (a) for administrative expenses. 
"(B) TRAINING.—Not more than 10 percent of the 
individuals receiving training with funds made available 
to an applicant under subsection (a) shall be trained as 
doctors of medicine or doctors of osteopathy. 
"(C) LIMITATION.—^An institution that receives a grant 
under this section shall use amounts received under such 
grant to supplement, not supplant, amounts made available 
by such institution for activities of the type described in 
subsection (b)(1) in the fiscal year preceding the year for 
which the grant is received. 
"(c) APPLICATIONS.—^Applications submitted 
for 
assistance 
under this section shall— 
"(1) be jointly submitted by at least two eligible applicants 
with the express purpose of assisting individuals in academic 
112 STAT. 3548 
PUBLIC LAW 105-392—NOV. 13, 1998 
institutions in establishing long-term collaborative relationships 
with health care providers in rural areas; and 
"(2) designate a rural health care agency or agencies for 
clinical treatment or training, including hospitals, community 
health centers, migrant health centers, rural health clinics, 
community behavioral and mental health centers, long-term 
care facilities. Native Hawaiian health centers, or facilities 
operated by the Indian Health Service or an Indian tribe or 
tribal organization or Indian organization under a contract 
with the Indian Health Service under the Indian Self-Deter-
mination Act. 
"(d) DEFINITIONS.—For the purposes of this section, the term 
'rural' means geographic areas that are located outside of standard 
metropolitan statistical areas. 
42 use 294e. 
"SEC. 755. ALLIED HEALTH AND OTHER DISCIPLINES. 
"(a) IN GENERAL.—^The Secretary may make grants or contracts 
under this section to help entities fund activities of the type 
described in subsection (b). 
"(b) ACTIVITIES.—^Activities of the type described in this sub-
section include the following: 
"(1) Assisting entities in meeting the costs associated with 
expanding or establishing programs that will increase the num-
ber of individuals trained in allied health professions. Programs 
and activities funded under this paragraph may include— 
"(A) those that expand enrollments in allied health 
professions with the greatest shortages or whose services 
are most needed by the elderly; 
"(B) those that provide rapid transition training pro-
grams in allied health fields to individuals who have bacca-
laureate degrees in health-related sciences; 
"(C) those that establish community-based allied health 
training programs that link academic centers to rural clini-
cal settings; 
"(D) those that provide career advancement training 
for practicing allied health professionals; 
"(E) those that expand or establish clinical training 
sites for allied health professionals in medically under-
served or rural communities in order to increase the num-
ber of individuals trained; 
"(F) those that develop curriculum that will emphasize 
knowledge and practice in the areas of prevention and 
health promotion, geriatrics, long-term care, home health 
and hospice care, and ethics; 
"(G) those that expand or establish interdisciplinary 
training programs that promote the effectiveness of allied 
health practitioners in geriatric assessment and the 
rehabilitation of the elderly; 
"(H) those that expand or establish demonstration cen-
ters to emphasize innovative models to link allied health 
clinical practice, education, and research; 
"(I) those that provide financial assistance (in the form 
of traineeships) to students who are participants in any 
such program; and 
"(i) who plan to pursue a career in an allied health 
field that has a demonstrated personnel shortage; and 
PUBLIC LAW 105-392—NOV. 13, 1998 
112 STAT. 3549 
"(ii) who agree upon completion of the training 
program to practice in a medically underserved commu-
nity; 
that shall be utilized to assist in the payment of all or 
part of the costs associated with tuition, fees and such 
other stipends as the Secretary may consider necessary; 
and 
"(J) those to meet the costs of projects to plan, develop, 
and operate or maintain graduate programs in behavioral 
and mental health practice. 
"(2) Planning and implementing projects in preventive and 
primary care training for podiatric physicians in approved or 
provisionally approved residency programs that shall provide 
financial assistance in the form of traineeships to residents 
who participate in such projects and who plan to specialize 
in primary care. 
"(3) Carrying out demonstration projects in which chiro-
practors and physicians collaborate to identify and provide effec-
tive treatment for spinal and lower-back conditions. 
"SEC. 756. ADVISORY COMMITTEE ON INTERDISCIPLINARY, COMMU- 42 USC 294f. 
NITY-BASED LINKAGES. 
"(a) ESTABLISHMENT.—^The Secretary shall establish an advisory 
committee to be known as the Advisory Committee on Interdiscipli-
nary, Community-Based Linkages (in this section referred to as 
the 'Advisory Committee'). 
"(b) COMPOSITION.— 
"(1) IN GENERAL.—^The Secretary shall determine the appro-
priate number of individuals to serve on the Advisory Commit-
tee. Such individuals shall not be officers or employees of the 
Federal Government. 
"(2) APPOINTMENT.—Not later than 90 days after the date Deadline. 
of enactment of this Act, the Secretary shall appoint the mem-
bers of the Advisory Committee from among individuals who 
are health professionals from schools of the types described 
in sections 751(a)(1)(A), 751(a)(1)(B), 753(b), 754(3)(A), and 
755(b). In making such appointments, the Secretary shall 
ensure a fair balance between the health professions, that 
at least 75 percent of the members of the Advisory Committee 
are health professionals, a broad geographic representation of 
members and a balance between urban and rural members. 
Members shall be appointed based on their competence, 
interest, and knowledge of the mission of the profession 
involved. 
"(3) MINORITY REPRESENTATION.—In appointing the mem-
bers of the Advisory Committee under paragraph (2), the Sec-
retary shall ensure the adequate representation of women and 
minorities. 
"(c) TERMS.— 
"(1) IN GENERAL.—^A member of the Advisory Committee 
shall be appointed for a term of 3 years, except that of the 
members first appointed— 
"(A) Vs of the members shall serve for a term of 1 
year; 
"(B) V
a of the members shall serve for a term of 2 
years; and 
112 STAT. 3550 
PUBLIC LAW 105-392—NOV. 13, 1998 
Deadlines. 
Deadline. 
"(C) M
? of the members shall serve for a term of 3 
years. 
"(2) VACANCIES.— 
"(A) IN GENERAL.—^A vacancy on the Advisory Commit-
tee shall be filled in the manner in which the original 
appointment was made and shall be subject to any condi-
tions which applied with respect to the original appoint-
ment. 
"(B) FILLING UNEXPIRED TERM.—^An individual chosen 
to fill a vacancy shall be appointed for the unexpired term 
of the member replaced. 
"(d) DUTIES.—^The Advisory Committee shall— 
"(1) provide advice and recommendations to the Secretary 
concerning policy and program development and other matters 
of significance concerning the activities under this part; and 
"(2) not later than 3 years after the date of enactment 
of this section, and annually thereafter, prepare and submit 
to the Secretary, and the Committee on Labor and Human 
Resources of the Senate, and the Committee on Commerce 
of the House of Representatives, a report describing the activi-
ties of the Committee, including findings and recommendations 
made by the Committee concerning the activities under this 
part. 
"(e) MEETINGS AND DOCUMENTS.— 
"(1) MEETINGS.—^The Advisory Committee shall meet not 
less than 3 times each year. Such meetings shall be held 
jointly with other related entities established under this title 
where appropriate. 
"(2) DOCUMENTS.—Not later than 14 days prior to the 
convening of a meeting under paragraph (1), the Advisory 
Committee shall prepare and make available an agenda of 
the matters to be considered by the Advisory Committee at 
such meeting. At any such meeting, the Advisory Council shall 
distribute materials with respect to the issues to be addressed 
at the meeting. Not later than 30 days after the adjourning 
of such a meeting, the Advisory Committee shall prepare and 
make available a summary of the meeting and any actions 
taken by the Committee based upon the meeting. 
"(f) COMPENSATION AND EXPENSES.— 
"(1) 
COMPENSATION.—Each 
member 
of the 
Advisory 
Committee shall be compensated at a rate equal to the daily 
equivalent of the annual rate of basic pay prescribed for level 
IV of the Executive Schedule under section 5315 of title 5, 
United States Code, for each day (including travel time) during 
which such member is engaged in the performance of the duties 
of the Committee. 
"(2) EXPENSES.—The members of the Advisory Committee 
shall be allowed travel expenses, including per diem in lieu 
of subsistence, at rates authorized for employees of agencies 
under subchapter I of chapter 57 of title 5, United States 
Code, while away from their homes or regular places of business 
in the performance of services for the Committee. 
"(g) FACA.—^The Federal Advisory Committee Act shall apply 
to the Advisory Committee under this section only to the extent 
that the provisions of such Act do not conflict with the requirements 
of this section. 
PUBLIC LAW 105-392—NOV. 13, 1998 
112 STAT. 3551 
"SEC. 757. AUTHORIZATION OF APPROPRIATIONS. 
42 USC 294g. 
"(a) IN GENERAL.—^There are authorized to be appropriated 
to carry out this part, $55,600,000 for fiscal year 1998, and such 
sums as may be necessary for each of the fiscal years 1999 through 
2002. 
"(b) ALLOCATION.— 
"(1) IN GENERAL.—Of the amounts appropriated under sub-
section (a) for a fiscal year, the Secretary shall make available— 
"(A) not less than $28,587,000 for awards of grants 
and contracts under section 751; 
"(B) not less than $3,765,000 for awards of grants 
and contracts under section 752, of which not less than 
50 percent of such amount shall be made available for 
centers described in subsection (a)(1) of such section; and 
"(C) not less than $22,631,000 for awards of grants 
and contracts under sections 753, 754, and 755. 
"(2) RATABLE REDUCTION.—If amounts appropriated under 
subsection (a) for any fiscal year are less than the amount 
required to comply with paragraph (1), the Secretary shall 
ratably reduce the amount to be made available under each 
of subparagraphs (A) through (C) of such paragraph accord-
ingly. 
"(3) INCREASE IN AMOUNTS.—If amounts appropriated for 
a fiscal year under subsection (a) exceed the amount authorized 
under such subsection for such fiscal year, the Secretary may 
increase the amount to be made available for programs and 
activities under this part without regard to the amounts speci-
fied in each of subparagraphs (A) through (C) of paragraph 
(2). 
"(c) OBLIGATION OF CERTAIN AMOUNTS.— 
"(1) AREA HEALTH EDUCATION CENTER PROGRAMS.—Of the 
amounts made available under subsection (b)(1)(A) for each 
fiscal year, the Secretary may obligate for awards under section 
751(a)(2)— 
"(A) not less than 23 percent of such amounts in fiscal 
year 1998; 
"(B) not less than 30 percent of such amounts in fiscal 
year 1999; 
"(C) not less than 35 percent of such amounts in fiscal 
year 2000; 
"(D) not less than 40 percent of such amounts in fiscal 
year 2001; and 
"(E) not less than 45 percent of such amounts in fiscal 
year 2002. 
"(2) SENSE OF CONGRESS.—It is the sense of the Congress 
that— 
"(A) every State have an area health education center 
program in effect under this section; and 
"(B) the ratio of Federal funding for the model program 
under section 751(a)(2) should increase over time and that 
Federal funding for other awards under this section shall 
decrease so that the national program will become entirely 
comprised of programs that are funded at least 50 percent 
by State and local partners.". 
112 STAT. 3552 
PUBLIC LAW 105-392—NOV. 13, 1998 
SEC. 104. HEALTH PROFESSIONS WORKFORCE INFORMATION AND 
ANALYSIS. 
(a) IN GENERAL.—Part E of title VII of the Public Health 
Service Act (42 U.S.C. 294n et seq.) is amended to read as follows: 
"PART E—HEALTH PROFESSIONS AND PUBLIC 
HEALTH WORKFORCE 
"Subpart 1—Health Professions Workforce 
Information and Analysis 
42USC294n. 
"SEC. 761. HEALTH PROFESSIONS WORKFORCE INFORMATION AND 
ANALYSIS. 
"(a) PURPOSE.—It is the purpose of this section to— 
"(1) provide for the development of information describing 
the health professions workforce and the analysis of workforce 
related issues; and 
"(2) provide necessary information for decision-making 
regarding future directions in health professions and nursing 
programs in response to societal and professional needs. 
"(b) GRANTS OR CONTRACTS.—^The Secretary may award grants 
or contracts to State or local governments, health professions 
schools, schools of nursing, academic health centers, community-
based health facilities, and other appropriate public or private 
nonprofit entities to provide for— 
"(1) targeted information collection and analysis activities 
related to the purposes described in subsection (a); 
"(2) research on high priority workforce questions; 
"(3) the development of a non-Federal analytic and research 
infrastructure related to the purposes described in subsection 
(a); and 
"(4) the conduct of program evaluation and assessment. 
"(c) AUTHORIZATION OF APPROPRIATIONS.— 
"(1) IN GENERAL.—^There are authorized to be appropriated 
to carry out this section, $750,000 for fiscal year 1998, and 
such sums as may be necessary for each of the fiscal years 
1999 through 2002. 
"(2) RESERVATION.—Of the amounts appropriated under 
subsection (a) for a fiscal year, the Secretary shall reserve 
not less than $600,000 for conducting health professions 
research and for carrying out data collection and analysis in 
accordance with section 792. 
"(3) AVAILABILITY OF ADDITIONAL FUNDS.—Amounts other-
wise appropriated for programs or activities under this title 
may be used for activities under subsection (b) with respect 
to the programs or activities from which such amounts were 
made available.". 
(b) COUNCIL ON GRADUATE MEDICAL EDUCATION.—Section 301 
of the Health Professions Education Extension Amendments of 1992 
42 use 295k 
(Public Law 102-408) is amended— 
note. 
(1) in subsection (j), by striking "1995" and inserting "2002"; 
(2) in subsection (k), by striking "1995" and inserting 
"2002"; 
(3) by adding at the end thereof the following new sub-
section: 
PUBLIC LAW 105-392—NOV. 13, 1998 
112 STAT. 3553 
"(1) FUNDING.—Amounts otherwise appropriated under this title 
may be utiHzed by the Secretary to support the activities of the 
Council."; 
(4) by transferring such section to part E of title VII of 
42 USC 295k 
the Public Health Service Act (as amended by subsection (a)); note. 
(5) by redesignating such section as section 762; and 
(6) by inserting such section after section 761. 
42 USC 294o. 
SEC. 105. PUBLIC HEALTH WORKFORCE DEVELOPMENT. 
Part E of title VII of the Public Health Service Act (as amended 
by section 104) is further amended by adding at the end the follow-
ing: 
"Subpart 2—Public Health Workforce 
"SEC. 765. GENERAL PROVISIONS. 
42 USC 295. 
"(a) IN GENERAL.—^The Secretary may award grants or contracts 
to eligible entities to increase the number of individuals in the 
public health workforce, to enhance the quality of such workforce, 
and to enhance the ability of the workforce to meet national. State, 
and local health care needs. 
"(b) ELIGIBILITY.—^To be eligible to receive a grant or contract 
under subsection (a) an entity shall— 
"(l)be— 
"(A) a health professions school, including an accredited 
school or program of public health, health administration, 
preventive medicine, or dental public health or a school 
providing health management programs; 
"(B) an academic health center; 
"(C) a State or local government; or 
"(D) any other appropriate public or private nonprofit 
entity; and 
"(2) prepare and submit to the Secretary an application 
at such time, in such manner, and containing such information 
as the Secretary may require. 
"(c) PREFERENCE.—In awarding grants or contracts under this 
section the Secretary may grant a preference to entities— 
"(1) serving individuals who are from disadvantaged back-
grounds (including underrepresented racial and ethnic minori-
ties); and 
"(2) graduating large proportions of individuals who serve 
in underserved communities. 
"(d) ACTIVITIES.—^Amounts provided under a grant or contract 
awarded under this section may be used for— 
"(1) the costs of planning, developing, or operating dem-
onstration training programs; 
"(2) faculty development; 
"(3) trainee support; 
"(4) technical assistance; 
"(5) to meet the costs of projects— 
"(A) to plan and develop new residency training pro-
grams and to maintain or improve existing residency train-
ing programs in preventive medicine and dental public 
health, that have available full-time faculty members with 
training and experience in the fields of preventive medicine 
and dental public health; and 
112 STAT. 3554 
PUBLIC LAW 105-392—NOV. 13, 1998 
"(B) to provide financial assistance to residency train-
ees enrolled in such programs; 
"(6) the retraining of existing public health workers as 
well as for increasing the supply of new practitioners to address 
priority public health, preventive medicine, public health den-
tistry, and health administration needs; 
"(7) preparing public health professionals for employment 
at the State and community levels; or 
"(8) other activities that may produce outcomes that are 
consistent with the purposes of this section. 
"(e) TRAINEESHIPS.— 
"(1) IN GENERAL.—^With respect to amounts used under 
this section for the training of health professionals, such train-
ing programs shall be designed to— 
"(A) make public health education more accessible to 
the public and private health workforce; 
"(B) increase the relevance of public health academic 
preparation to public health practice in the future; 
"(C) provide education or training for students from 
traditional on-campus programs in practice-based sites; or 
"(D) develop educational methods and distance-based 
approaches or technology that address adult learning 
requirements and increase knowledge and skills related 
to community-based cultural diversity in public health edu-
cation. 
"(2) 
SEVERE SHORTAGE DISCIPLINES.—Amounts provided 
under grants or contracts under this section may be used for 
the operation of programs designed to award traineeships to 
students in accredited schools of public health who enter edu-
cational programs in fields where there is a severe shortage 
of public health professionals, including epidemiology, biostatis-
tics, environmental health, toxicology, public health nursing, 
nutrition, preventive medicine, maternal and child health, and 
behavioral and mental health professions. 
42 use 295a. 
"SEC. 766. PUBUC HEALTH TRAINING CENTERS. 
"(a) IN GENERAL.—^The Secretary may make grants or contracts 
for the operation of public health training centers. 
"(b) ELIGIBLE ENTITIES.— 
"(1) IN GENERAL.—^A public health training center shall 
be an accredited school of public health, or another public 
or nonprofit private institution accredited for the provision 
of graduate or specialized training in public health, that plans, 
develops, operates, and evaluates projects that are in further-
ance of the goals established by the Secretary for the year 
2000 in the areas of preventive medicine, health promotion 
and disease prevention, or improving access to and quality 
of health services in medically underserved communities. 
"(2) PREFERENCE.—In awarding grants or contracts under 
this section the Secretary shall give preference to accredited 
schools of public health. 
"(c) CERTAIN REQUIREMENTS.—^With respect to a public health 
training center, an award may not be made under subsection (a) 
unless the program agrees that it— 
"(1) will establish or strengthen field placements for stu-
dents in public or nonprofit private health agencies or organiza-
tions; 
PUBLIC LAW 105-392—NOV. 13, 1998 
112 STAT. 3555 
"(2) will involve faculty members and students in collabo-
rative projects to enhance public health services to medically 
underserved communities; 
"(3) will specifically designate a geographic area or medi-
cally underserved population to be served by the center that 
shall be in a location removed from the main location of the 
teaching facility of the school that is participating in the pro-
gram with such center; and 
"(4) will assess the health personnel needs of the area 
to be served by the center and assist in the planning and 
development of training programs to meet such needs. 
"SEC. 767. PUBUC HEALTH TRAINEESHIPS. 
42 USC 295b. 
"(a) IN GENERAL.—^The Secretary may make grants to accred-
ited schools of public health, and to other public or nonprofit private 
institutions accredited for the provision of graduate or specialized 
training in public health, for the purpose of assisting such schools 
and institutions in providing traineeships to individuals described 
in subsection (b)(3). 
"(b) CERTAIN 
REQUIREMENTS.— 
"(1) AMOUNT.—^The amount of any grant under this section 
shall be determined by the Secretary. 
"(2) USE OF GRANT.—^Traineeships awarded under grants 
made under subsection (a) shall provide for tuition and fees 
and such stipends and allowances (including travel and subsist-
ence expenses and dependency allowances) for the trainees 
as the Secretary may deem necessary. 
"(3) ELIGIBLE INDIVIDUALS.—^The individuals referred to in 
subsection (a) are individuals who are pursuing a course of 
study in a health professions field in which there is a severe 
shortage of health professionals (which fields include the fields 
of epidemiology, environmental health, biostatistics, toxicology, 
nutrition, and maternal and child health). 
"SEC. 768. PREVENTIVE MEDICINE; DENTAL PUBLIC HEALTH. 
42 USC 295c. 
"(a) IN GENERAL.—^The Secretary may make grants to and 
enter into contracts with schools of medicine, osteopathic medicine, 
public health, and dentistry to meet the costs of projects— 
"(1) to plan and develop new residency training programs 
and to maintain or improve existing residency training pro-
grams in preventive medicine and dental public health; and 
"(2) to provide financial assistance to residency trainees 
enrolled in such programs. 
"(b) ADMINISTRATION.— 
"(1) AMOUNT.—^The amount of any grant under subsection 
(a) shall be determined by the Secretary. 
"(2) ELIGIBILITY.—^To be eligible for a grant under sub-
section (a), the applicant must demonstrate to the Secretary 
that it has or will have available full-time faculty members 
with training and experience in the fields of preventive medi-
cine or dental public health and support from other faculty 
members trained in public health and other relevant specialties 
and disciplines. 
"(3) OTHER FUNDS.—Schools of medicine, osteopathic medi-
cine, dentistry, and public health may use funds committed 
by State, local, or county public health officers as matching 
amounts for Federal grant funds for residency training pro-
grams in preventive medicine. 
112 STAT. 3556 
PUBLIC LAW 105-392—NOV. 13, 1998 
42USC295d. 
"SEC. 769. HEALTH ADMINISTRATION TRAINEESHIPS AND SPECIAL 
PROJECTS. 
"(a) IN GENERAL.—^The Secretary may make grants to State 
or local governments (that have in effect preventive medical and 
dental public health residency programs) or public or nonprofit 
private educational entities (including graduate schools of social 
work and business schools that have health management programs) 
that offer a program described in subsection (b)— 
"(1) to provide traineeships for students enrolled in such 
a program; and 
"(2) to assist accredited programs health administration 
in the development or improvement of programs to prepare 
students for employment with public or nonprofit private enti-
ties. 
"(b) RELEVANT PROGRAMS.—The program referred to in sub-
section (a) is an accredited program in health administration, hos-
pital administration, or health policy analysis and planning, which 
program is accredited by a body or bodies approved for such purpose 
by the Secretary of Education and which meets such other quality 
standards as the Secretary of Health and Human Services by regu-
lation may prescribe. 
"(c) PREFERENCE IN MAKING GRANTS.—In making grants under 
subsection (a), the Secretary shall give preference to qualified 
applicants that meet the following conditions: 
"(1) Not less than 25 percent of the graduates of the 
applicant are engaged in full-time practice settings in medically 
underserved communities. 
"(2) The applicant recruits and admits students from medi-
cally underserved communities. 
"(3) For the purpose of training students, the applicant 
has established relationships with public and nonprofit provid-
ers of health care in the community involved. 
"(4) In training students, the applicant emphasizes employ-
ment with public or nonprofit private entities. 
"(d) CERTAIN PROVISIONS REGARDING TRAINEESHIPS.— 
"(1) USE OF GRANT.—^Traineeships awarded under grants 
made under subsection (a) shall provide for tuition and fees 
and such stipends and allowances (including travel and subsist-
ence expenses and dependency allowances) for the trainees 
as the Secretary may deem necessary. 
"(2) PREFERENCE FOR CERTAIN STUDENTS.—Each entity 
applying for a grant under subsection (a) for traineeships shall 
assure to the satisfaction of the Secretary that the entity will 
give priority to awarding the traineeships to students who 
demonstrate a commitment to employment with public or non-
profit private entities in the fields with respect to which the 
traineeships are awarded. 
42 u s e 295e. 
"SEC. 770. AUTHORIZATION OF APPROPRIATIONS. 
"(a) IN GENERAL.—For the purpose of carrying out this subpart, 
there is authorized to be appropriated $9,100,000 for fiscal year 
1998, and such sums as may be necessary for each of the fiscal 
years 1999 through 2002. 
"(b) LIMITATION REGARDING CERTAIN PROGRAM.—In obligating 
amounts appropriated under subsection (a), the Secretary may not 
obligate more than 30 percent for carrying out section 767.". 
PUBLIC LAW 105-392—NOV. 13, 1998 
112 STAT. 3557 
SEC. 106. GENERAL PROVISIONS. 
(a) IN GENERAL.— 
(1) Part F of title VII of the Public Health Service Act 
(42 U.S.C. 295 et seq.) is repealed. 
(2) Part G of title VII of the Public Health Service Act 
(42 U.S.C. 295j et seq.) is amended— 
(A) by redesignating such part as part F; 
(B) in section 791 (42 U.S.C. 295j)— 
(i) by striking subsection (b); and 
(ii) redesignating subsection (c) as subsection (b); 
(C) by repealing section 793 (42 U.S.C. 2951); 
(D) by repeahng section 798; 
42 USC 295o. 
(E) by redesignating section 799 as section 799B; and 
42 USC 295p. 
(F) by inserting after section 794, the following new 
sections: 
"SEC. 796. APPUCATION. 
42 USC 295n-l. 
"(a) IN GENERAL.—^To be eligible to receive a grant or contract 
under this title, an eligible entity shall prepare and submit to 
the Secretary an application that meets the requirements of this 
section, at such time, in such manner, and containing such informa-
tion as the Secretary may require. 
"(b) PLAN.—^An application submitted under this section shall 
contain the plan of the applicant for carrying out a project with 
amounts received under this title. Such plan shall be consistent 
with relevant Federal, State, or regional health professions program 
plans. 
"(c) 
PERFORMANCE 
OUTCOME 
STANDARDS.—^An 
application 
submitted under this section shall contain a specification by the 
applicant entity of performance outcome standards that the project 
to be funded under the grant or contract will be measured against. 
Such standards shall address relevant health workforce needs that 
the project will meet. The recipient of a grant or contract under 
this section shall meet the standards set forth in the grant or 
contract application. 
"(d) LINKAGES.—An application submitted under this section 
shall contain a description of the linkages with relevant educational 
and health care entities, including training programs for other 
health professionals as appropriate, that the project to be funded 
under the grant or contract will establish. To the extent practicable, 
grantees under this section shall establish linkages with health 
care providers who provide care for underserved communities and 
populations. 
"SEC. 797. USE OF FUNDS. 
42USC295n-2. 
"(a) IN GENERAL.—^Amounts provided under a grant or contract 
awarded under this title may be used for training program develop-
ment and support, faculty development, model demonstrations, 
trainee support including tuition, books, program fees and reason-
able living expenses during the period of training, technical assist-
ance, workforce analysis, dissemination of information, and explor-
ing new policy directions, as appropriate to meet recognized health 
workforce objectives, in accordance with this title. 
"(b) MAINTENANCE OF EFFORT.—^With respect to activities for 
which a grant awarded under this title is to be expended, the 
entity shall agree to maintain expenditures of non-Federal amounts 
for such activities at a level that is not less than the level of 
112 STAT. 3558 
PUBLIC LAW 105-392—NOV. 13, 1998 
such expenditures maintained by the entity for the fiscal year 
preceding the fiscal year for which the entity receives such a grant. 
42 use 295o. 
"SEC. 798. MATCHING REQUIREMENT. 
"The Secretary may require that an entity that applies for 
a grant or contract under this title provide non-Federal matching 
funds, as appropriate, to ensure the institutional commitment of 
the entity to the projects funded under the grant. As determined 
by the Secretary, such non-Federal matching funds may be provided 
directly or through donations from public or private entities and 
may be in cash or in-kind, fairly evaluated, including plant, equip-
ment, or services. 
42 use 2950-1. 
"SEC. 799. GENERALLY APPLICABLE PROVISIONS. 
"(a) AWARDING OF GRANTS AND CONTRACTS.—^The Secretary 
shall ensure that grants and contracts under this title are awarded 
on a competitive basis, as appropriate, to carry out innovative 
demonstration 
projects 
or 
provide 
for 
strategic 
workforce 
supplementation activities as needed to meet health workforce goals 
and in accordance with this title. Contracts may be entered into 
under this title with public or private entities as may be necessary. 
"(b) ELIGIBLE ENTITIES.—Unless specifically required otherwise 
in this title, the Secretary shall accept applications for grants 
or contracts under this title from health professions schools, aca-
demic health centers, State or local governments, or other appro-
priate public or private nonprofit entities for funding and participa-
tion in health professions and nursing training activities. The Sec-
retary may accept applications from for-profit private entities if 
determined appropriate by the Secretary. 
"(c) INFORMATION REQUIREMENTS.— 
"(1) IN GENERAL.—Recipients of grants and contracts under 
this title shall meet information requirements as specified by 
the Secretary. 
"(2) DATA COLLECTION.—^The Secretary shall establish 
procedures to ensure that, with respect to any data collection 
required under this title, such data is collected in a manner 
that takes into account age, sex, race, and ethnicity. 
"(3) USE OF FUNDS.—^The Secretary shall establish proce-
dures to permit the use of amounts appropriated under this 
title to be used for data collection purposes. 
"(4) EVALUATIONS.—^The Secretary shall establish proce-
dures to ensure the annual evaluation of programs and projects 
operated By recipients of grants or contracts under this title. 
Such procedures shall ensure that continued funding for such 
programs and projects will be conditioned upon a demonstration 
that satisfactory progress has been made by the program or 
project in meeting the objectives of the program or project. 
"(d) TRAINING PROGRAMS.—Training programs conducted with 
amounts received under this title shall meet applicable accreditation 
and quality standards. 
"(e) DURATION OF ASSISTANCE.— 
"(1) IN GENERAL.—Subject to paragraph (2), in the case 
of an award to an entity of a grant, cooperative agreement, 
or contract under this title, the period during which payments 
are made to the entity under the award may not exceed 5 
years. The provision of payments under the award shall be 
subject to annual approval by the Secretary of the payments 
and subject to the availability of appropriations for the fiscal 
PUBLIC LAW 105-392—NOV. 13, 1998 
112 STAT. 3559 
year involved to make the payments. This paragraph may 
not be construed as Hmiting the number of awards under the 
program involved that may be made to the entity. 
"(2) LIMITATION.—In the case of an award to an entity 
of a grant, cooperative agreement, or contract under this title, 
paragraph (1) shall apply only to the extent not inconsistent 
with any other provision of this title that relates to the period 
during which payments may be made under the award. 
"(f) PEER REVIEW REGARDING CERTAIN PROGRAMS.— 
"(1) IN GENERAL.—Each application for a grant under this 
title, except any scholarship or loan program, including those 
under sections 701, 721, or 723, shall be submitted to a peer 
review group for an evaluation of the merits of the proposals 
made in the application. The Secretary may not approve such 
an application unless a peer review group has recommended 
the application for approval. 
"(2) COMPOSITION.—Each peer review group under this sub-
section shall be composed principally of individuals who are 
not officers or employees of the Federal Government. In provid-
ing for the establishment of peer review groups and procedures, 
the Secretary shall ensure sex, racial, ethnic, and geographic 
balance among the membership of such groups. 
"(3) ADMINISTRATION.—^This subsection shall be carried out 
by the Secretary acting through the Administrator of the Health 
Resources and Services Administration. 
"(g) PREFERENCE OR PRIORITY CONSIDERATIONS.—In considering 
a preference or priority for funding which is based on outcome 
measures for an eligible entity under this title, the Secretary may 
also consider the future ability of the eligible entity to meet the 
outcome preference or priority through improvements in the eligible 
entity's program design. 
"(h) ANALYTIC ACTIVITIES.—The Secretary shall ensure that— 
"(1) cross-cutting workforce anal5^ical activities are carried 
out as part of the workforce information and analysis activities 
under section 761; and 
"(2) discipline-specific workforce information and analytical 
activities are carried out as part of— 
"(A) the community-based linkage program under part 
D; and 
"(B) the health workforce development program under 
subpart 2 of part E. 
"(i) OSTEOPATHIC SCHOOLS.—^For purposes of this title, any 
reference to— 
"(1) medical schools shall include osteopathic medical 
schools; and 
"(2) medical students shall include osteopathic medical stu-
dents. 
"SEC. 799A. TECHNICAL ASSISTANCE. 
42 USC 295o-2. 
"Funds appropriated under this title may be used by the Sec-
retary to provide technical assistance in relation to any of the 
authorities under this title.". 
(b) PROFESSIONAL COUNSELORS AS MENTAL HEALTH PROFES-
SIONALS.—Section 792(a) of the Public Health Service Act (42 U.S.C. 
295k(a)) is amended by inserting "professional counselors," after 
"clinical psychologists,". 
- 26 : QL 3 PaH 5 
112 STAT. 3560 
PUBLIC LAW 105-392—NOV. 13, 1998 
SEC. 107. PREFERENCE IN CERTAIN PROGRAMS. 
(a) IN GENERAL.—Section 791 of the Public Health Service 
Act (42 U.S.C. 295j), as amended by section 105(a)(2)(B), is further 
amended by adding at the end thereof the following subsection: 
"(c) EXCEPTIONS FOR NEW PROGRAMS.— 
"(1) IN GENERAL.—^To permit new programs to compete 
equitably for funding under this section, those new programs 
that meet at least 4 of the criteria described in paragraph 
(3) shall qualify for a funding preference under this section. 
"(2) DEFINITION.—^As used in this subsection, the term 'new 
program' means any program that has graduated less than 
three classes. Upon graduating at least three classes, a program 
shall have the capability to provide the information necessary 
to qualify the program for the general funding preferences 
described in subsection (a). 
"(3) CRITERIA.—^The criteria referred to in paragraph (1) 
are the following: 
"(A) The mission statement of the program identifies 
a specific purpose of the program as being the preparation 
of health professionals to serve underserved populations. 
"(B) The curriculum of the program includes content 
which will help to prepare practitioners to serve under-
served populations. 
"(C) Substantial clinical training experience is required 
under the program in medically underserved communities. 
"(D) A minimum of 20 percent of the clinical faculty 
of the program spend at least 50 percent of their time 
providing or supervising care in medically underserved 
communities. 
"(E) The entire program or a substantial portion of 
the program is physically located in a medically under-
served community. 
"(F) Student assistance, which is linked to service in 
medically underserved communities following graduation, 
is available to the students in the program. 
"(G) The program provides a placement mechanism 
for deploying graduates to medically underserved commu-
nities.". 
(b) CONFORMING AMENDMENTS.—Section 791(a) of the Public 
Health Service Act (42 U.S.C. 295j(a)) is amended— 
(1) in paragraph (1), by striking "sections 747" and all 
that follows through "767" and inserting "sections 747 and 
750"; and 
(2) in paragraph (2), by striking "under section 798(a)". 
SEC. 108. DEFINITIONS. 
(a) GRADUATE PROGRAM IN BEHAVIORAL AND MENTAL HEALTH 
PRACTICE.—Section 799B(1)(D) of the Public Health Service Act 
(42 U.S.C. 295p(l)(D)) (as so redesignated by section 106(a)(2)(E)) 
is amended— 
(1) by inserting "behavioral health and" before "mental"; 
and 
(2) by inserting "behavioral health and mental health prac-
tice," before "clinical". 
(b) PROFESSIONAL COUNSELING AS A BEHAVIORAL AND MENTAL 
HEALTH PRACTICE.—Section 799B of the Public Health Service Act 
PUBLIC LAW 105-392—NOV. 13, 1998 
112 STAT. 3561 
(42 U.S.C. 295p) (as so redesignated by section 106(a)(2)(E)) is 
amended— 
(1) in paragraph (1)— 
(A) in subparagraph (C)— 
(i) by inserting "and 'graduate program in profes-
sional counsehng'" after "graduate program in mar-
riage and family therapy'"; and 
(ii) by inserting before the period the following: 
"and a concentration leading to a graduate degree in 
counseling"; 
(B) in subparagraph (D), by inserting "professional 
counseling," after "social work,"; and 
(C) in subparagraph (E), by inserting "professional 
counseling," after "social work,"; and 
(2) in paragraph (5)(C), by inserting before the period the 
following: "or a degree in counseling or an equivalent degree". 
(c) MEDICALLY UNDERSERVED COMMUNITY.—Section 799B(6) of 
the Public Health Service Act (42 U.S.C. 295p(6)) (as so redesignated 
by section 105(a)(2)(E)) is amended— 
(1) in subparagraph (B), by striking "or" at the end thereof; 
(2) in subparagraph (C), by striking the period and insert-
ing "; or"; and 
(3) by adding at the end the following: 
"(D) is designated by a State Governor (in consultation 
with the medical community) as a shortage area or medi-
cally underserved community.". 
(d) PROGRAMS FOR THE TRAINING OF PHYSICIAN ASSISTANTS.— 
Paragraph (3) of section 799B of the Public Health Service Act 
(42 U.S.C. 295p) (as so redesignated by section 105(a)(2)(E)) is 
amended to read as follows: 
"(3) The term 'program for the training of physician assist-
ants' means an educational program that— 
"(A) has as its objective the education of individuals 
who will, upon completion of their studies in the program, 
be qualified to provide primary care under the supervision 
of a physician; 
"(B) extends for at least one academic year and consists 
of— 
"(i) supervised clinical practice; and 
"(ii) at least four months (in the aggregate) of 
classroom instruction, directed toward preparing stu-
dents to deliver health care; 
"(C) has an enrollment of not less than eight students; 
and 
"(D) trains students in primary care, disease preven-
tion, health promotion, geriatric medicine, and home health 
care.". 
(e) PSYCHOLOGIST.—Section 799B of the Public Health Service 
Act (42 U.S.C. 295p) (as so redesignated by section 105(a)(2)(E)) 
is amended by adding at the end the following: 
"(11) The term 'psychologist' means an individual who— 
"(A) holds a doctoral degree in psychology; and 
"(B) is licensed or certified on the basis of the doctoral 
degree in psychology, by the State in which the individual 
practices, at the independent practice level of psychology 
to furnish diagnostic, assessment, preventive, and thera-
peutic services directly to individuals.". 
112 STAT. 3562 
PUBLIC LAW 105-392—NOV. 13, 1998 
SEC. 109. TECHMCAL AMENDMENT ON NATIONAL HEALTH SERVICE 
CORPS. 
Section 338B(b)(l)(B) of the Public Health Service Act (42 
U.S.C. 2541-1(b)(1)(B)) is amended by striking "or other health 
profession" and inserting "behavioral and mental health, or other 
health profession". 
42 u s e 293 note. 
SEC. 110. SAVINGS PROVISION. 
Nursing 
Education and 
Practice 
Improvement Act 
of 1998. 
42 u s e 201 note. 
In the case of any authority for making awards of grants 
or contracts that is terminated by the amendments made by this 
subtitle, the Secretary of Health and Human Services may, notwith-
standing the termination of the authority, continue in effect any 
grant or contract made under the authority that is in effect on 
the day before the date of the enactment of this Act, subject to 
the duration of any such grant or contract not exceeding the period 
determined by the Secretary in first approving such financial assist-
ance, or in approving the most recent request made (before the 
date of such enactment) for continuation of such assistance, as 
the case may be. 
Subtitle B—^Nursing Workforce 
Development 
SEC. 121. SHORT TITLE. 
This subtitle may be cited as the "Nursing Education and 
Practice Improvement Act of 1998". 
42 u s e 296 note. 
SEC. 122. PURPOSE. 
It is the purpose of this subtitle to restructure the nurse edu-
cation authorities of title VIII of the Public Health Service Act 
to permit a comprehensive, flexible, and effective approach to Fed-
eral support for nursing workforce development. 
SEC. 123. AMENDMENTS TO PUBLIC HEALTH SERVICE ACT. 
Title VIII of the Public Health Service Act (42 U.S.C. 296k 
et seq.) is amended— 
(1) by striking the title heading and all that follows except 
for subpart II of part B and sections 846 and 855; and inserting 
the following: 
42 u s e 297c. 
**TITLE VIII—NURSING WORKFORCE 
DEVELOPMENT"; 
(2) in subpart II of part B, by striking the subpart heading 
and inserting the following: 
"PART E—STUDENT LOANS"; 
(3) by striking section 837; 
(4) by inserting after the title heading the following new 
parts: 
PUBLIC LAW 105-392—NOV. 13, 1998 
112 STAT. 3563 
"PART A—GENERAL PROVISIONS 
"SEC. 801. DEFINITIONS. 
42 USC 296. 
"As used in this title: 
"(1) ELIGIBLE ENTITIES.—The term 'ehgible entities' means 
schools of nursing, nursing centers, academic health centers, 
State or local governments, and other public or private nonprofit 
entities determined appropriate by the Secretary that submit 
to the Secretary an application in accordance with section 802. 
"(2) SCHOOL OF NURSING.—^The term 'school of nursing" 
means a collegiate, associate degree, or diploma school of nurs-
ing in a State. 
"(3) COLLEGIATE SCHOOL OF NURSING.—^The term 'collegiate 
school of nursing* means a department, division, or other 
administrative unit in a college or university which provides 
primarily or exclusively a program of education in professional 
nursing and related subjects leading to the degree of bachelor 
of arts, bachelor of science, bachelor of nursing, or to an equiva-
lent degree, or to a graduate degree in nursing, or to an 
equivalent degree, and including advanced training related to 
such program of education provided by such school, but only 
if such program, or such unit, college or university is accredited. 
"(4) ASSOCIATE DEGREE SCHOOL OF NURSING.—^The term 
'associate degree school of nursing' means a department, divi-
sion, or other administrative unit in a junior college, community 
college, college, or university which provides primarily or exclu-
sively a two-year program of education in professional nursing 
and allied subjects leading to an associate degree in nursing 
or to an equivalent degree, but only if such program, or such 
unit, college, or university is accredited. 
"(5) DIPLOMA SCHOOL OF NURSING.—^The term 'diploma 
school of nursing' means a school affiliated with a hospital 
or university, or an independent school, which provides pri-
marily or exclusively a program of education in professional 
nursing and allied subjects leading to a diploma or to equivalent 
indicia that such program has been satisfactorily completed, 
but only if such program, or such affiliated school or such 
hospital or university or such independent school is accredited. 
"(6) ACCREDITED.— 
"(A) IN GENERAL.—Except as provided in subparagraph 
(B), the term 'accredited' when applied to any program 
of nurse education means a program accredited by a recog-
nized body or bodies, or by a State agency, approved for 
such purpose by the Secretary of Education and when 
applied to a hospital, school, college, or university (or a 
unit thereof) means a hospital, school, college, or university 
(or a unit thereof) which is accredited by a recognized 
body or bodies, or by a State agency, approved for such 
purpose by the Secretary of Education. For the purpose 
of this paragraph, the Secretary of Education shall publish 
a list of recognized accrediting bodies, and of State agencies, 
which the Secretary of Education determines to be reliable 
authority as to the quality of education offered. 
"(B) NEW PROGRAMS.—^A new program of nursing that, 
by reason of an insufficient period of operation, is not, 
at the time of the submission of an application for a grant 
or contract under this title, eligible for accreditation by 
112 STAT. 3564 
PUBLIC LAW 105-392—NOV. 13, 1998 
such a recognized body or bodies or State agency, shall 
be deemed accredited for purposes of this title if the Sec-
retary of Education finds, after consultation with the appro-
priate accreditation body or bodies, that there is reasonable 
assurance that the program will meet the accreditation 
standards of such body or bodies prior to the beginning 
of the academic year following the normal graduation date 
of students of the first entering class in such a program. 
"(7) NONPROFIT.—^The term 'nonprofit' as applied to any 
school, agency, organization, or institution means one which 
is a corporation or association, or is owned and operated by 
one or more corporations or associations, no part of the net 
earnings of which inures, or may lawfully inure, to the benefit 
of any private shareholder or individual. 
"(8) STATE.—^The term 'State' means a State, the Common-
wealth of Puerto Rico, the District of Columbia, the Common-
wealth of the Northern Mariana Islands, Guam, American 
Samoa, the Virgin Islands, or the Trust Territory of the Pacific 
Islands. 
42 use 296a. 
"SEC. 802. APPLICATION. 
"(a) IN GENERAL.—^To be eligible to receive a grant or contract 
under this title, an eligible entity shall prepare and submit to 
the Secretary an application that meets the requirements of this 
section, at such time, in such manner, and containing such informa-
tion as the Secretary may require. 
"(b) PLAN.—An application submitted under this section shall 
contain the plan of the applicant for carrying out a project with 
amounts received under this title. Such plan shall be consistent 
with relevant Federal, State, or regional program plans. 
"(c) PERFORMANCE 
OUTCOME STANDARDS.—An application 
submitted under this section shall contain a specification by the 
applicant entity of performance outcome standards that the project 
to be funded under the grant or contract will be measured against. 
Such standards shall address relevant national nursing needs that 
the project will meet. The recipient of a grant or contract under 
this section shall meet the standards set forth in the grant or 
contract application. 
"(d) LINKAGES.—An application submitted under this section 
shall contain a description of the linkages with relevant educational 
and health care entities, including training programs for other 
health professionals as appropriate, that the project to be funded 
under the grant or contract will establish. 
42 use 296b. 
"SEC. 803. USE OF FUNDS. 
"(a) IN GENERAL.—^Amounts provided under a grant or contract 
awarded under this title may be used for training program develop-
ment and support, faculty development, model demonstrations, 
trainee support including tuition, books, program fees and reason-
able living expenses during the period of training, technical assist-
ance, workforce analysis, and dissemination of information, as 
appropriate to meet recognized nursing objectives, in accordance 
with this title. 
"(b) MAINTENANCE OF EFFORT.—^With respect to activities for 
which a grant awarded under this title is to be expended, the 
entity shall agree to maintain expenditures of non-Federal amounts 
for such activities at a level that is not less than the level of 
PUBLIC LAW 105-392—NOV. 13, 1998 
112 STAT. 3565 
such expenditures maintained by the entity for the fiscal year 
preceding the fiscal year for which the entity receives such a grant. 
"SEC. 804. MATCHING REQUIREMENT. 
42 USC 296c. 
"The Secretary may require that an entity that applies for 
a grant or contract under tlds title provide non-Federal matching 
funds, as appropriate, to ensure the institutional commitment of 
the entity to the projects funded under the grant. Such non-Federal 
matching funds may be provided directly or through donations 
from public or private entities and may be in cash or in-kind, 
fairly evaluated, including plant, equipment, or services. 
"SEC. 805. PREFERENCE. 
42 USC 296d. 
"In awarding grants or contracts under this title, the Secretary 
shall give preference to applicants with projects that will substan-
tially benefit rural or underserved populations, or help meet public 
health nursing needs in State or local health departments. 
"SEC. 806. GENERALLY APPUCABLE PROVISIONS. 
42USC296e. 
"(a) AWARDING OF GRANTS AND CONTRACTS.—^The Secretary 
shall ensure that grants and contracts under this title are awarded 
on a competitive basis, as appropriate, to carry out innovative 
demonstration 
projects 
or 
provide 
for 
strategic 
workforce 
supplementation activities as needed to meet national nursing serv-
ice goals and in accordance with this title. Contracts may be entered 
into under this title with public or private entities as determined 
necessary by the Secretary. 
"(b) INFORMATION REQUIREMENTS.— 
"(1) IN GENERAL.—^Recipients of grants and contracts under 
this title shall meet information requirements as specified by 
the Secretary. 
"(2) EVALUATIONS.—^The Secretary shall estabUsh proce-
dures to ensure the annual evaluation of programs and projects 
operated by recipients of grants under this title. Such proce-
dures shall ensure that continued funding for such programs 
and projects will be conditioned upon a demonstration that 
satisfactory progress has been made by the program or project 
in meeting the objectives of the program or project. 
"(c) TRAINING PROGRAMS.—^Training programs conducted with 
amounts received under this title shall meet applicable accreditation 
and quality standards. 
"(d) DURATION OF ASSISTANCE.— 
"(1) IN GENERAL.—Subject to paragraph (2), in the case 
of an award to an entity of a grant, cooperative agreement, 
or contract under this title, the period during which pajrments 
are made to the entity under the award may not exceed 5 
years. The provision of payments under the award shall be 
subject to annual approval by the Secretary of the payments 
and subject to the availability of appropriations for the fiscal 
year involved to make the payments. This paragraph may 
not be construed as limiting the number of awards under the 
program involved that may be made to the entity. 
"(2) LIMITATION.—In the case of an award to an entity 
of a grant, cooperative agreement, or contract under this title, 
paragraph (1) shall apply only to the extent not inconsistent 
with any other provision of this title that relates to the period 
during which payments may be made under the award. 
"(e) PEER REVIEW REGARDING CERTAIN PROGRAMS.— 
112 STAT. 3566 
PUBLIC LAW 105-392—NOV. 13, 1998 
"(1) IN GENERAL.—Each application for a grant under this 
title, except advanced nurse traineeship grants under section 
811(a)(2), shall be submitted to a peer review group for an 
evaluation of the merits of the proposals made in the applica-
tion. The Secretary may not approve such an application unless 
a peer review group has recommended the application for 
approval. 
"(2) COMPOSITION.—Each peer review group under this sub-
section shall be composed principally of individuals who are 
not officers or employees of the Federal Government. In provid-
ing for the establishment of peer review groups and procedures, 
the Secretary shall, except as otherwise provided, ensure sex, 
racial, ethnic, and geographic representation among the mem-
bership of such groups. 
"(3) ADMINISTRATION.—This subsection shall be carried out 
by the Secretary acting through the Administrator of the Health 
Resources and Services Administration. 
"(f) ANALYTIC ACTIVITIES.—The Secretary shall ensure that— 
"(1) cross-cutting workforce anal3^ical activities are carried 
out as part of the workforce information and analysis activities 
under this title; and 
"(2) discipline-specific workforce information is developed 
and analytical activities are carried out as part of— 
"(A) the advanced education nursing activities under 
part B; 
"(B) the workforce diversity activities under part C; 
and 
"(C) basic nursing education and practice activities 
under part D. 
"(g) STATE AND REGIONAL PRIORITIES.—^Activities under grants 
or contracts under this title shall, to the extent practicable, be 
consistent with related Federal, State, or regional nursing profes-
sions program plans and priorities. 
"(h) FILING OF APPLICATIONS.— 
"(1) IN GENERAL.—Applications for grants or contracts 
under this title may be submitted by health professions schools, 
schools of nursing, academic health centers. State or local 
governments, or other appropriate public or private nonprofit 
entities as determined appropriate by the Secretary in accord-
ance with this title. 
"(2) FOR-PROFIT ENTITIES.—Notwithstanding paragraph (1), 
a for-profit entity may be eligible for a grant or contract under 
this title as determined appropriate by the Secretary. 
42 use 296f. 
"SEC. 807. TECHNICAL ASSISTANCE. 
"Funds appropriated under this title may be used by the Sec-
retary to provide technical assistance in relation to any of the 
authorities under this title. 
"PART B—NURSE PRACTITIONERS, NURSE 
MIDWIVES, 
NURSE 
ANESTHETISTS, 
AND 
OTHER ADVANCED EDUCATION NURSES 
42 use 296j. 
"SEC. 811. ADVANCED EDUCATION NURSING GRANTS. 
"(a) IN GENERAL.—The Secretary may award grants to and 
enter into contracts with eligible entities to meet the costs of— 
PUBLIC LAW 105-392—NOV. 13, 1998 
112 STAT. 3567 
"(1) projects that support the enhancement of advanced 
nursing education and practice; and 
"(2) traineeships for individuals in advanced nursing edu-
cation programs. 
"(b) DEFINITION OF ADVANCED EDUCATION NURSES.—For pur-
poses of this section, the term 'advanced education nurses' means 
individuals trained in advanced degree programs including individ-
uals in combined R.N./Master's degree programs, post-nursing mas-
ter's certificate programs, or, in the case of nurse midwives, in 
certificate programs in existence on the date that is one day prior 
to the date of enactment of this section, to serve as nurse practition-
ers, clinical nurse specialists, nurse midwives, nurse anesthetists, 
nurse educators, nurse administrators, or public health nurses, 
or in other nurse specialties determined by the Secretary to require 
advanced education. 
"(c) AUTHORIZED NURSE PRACTITIONER AND NURSE MIDWIFERY 
PROGRAMS.—Nurse practitioner and nurse midwifery programs 
eligible for support under this section are educational programs 
for registered nurses (irrespective of the type of school of nursing 
in which the nurses received their training) that— 
"(1) meet guidelines prescribed by the Secretary; and 
"(2) have as their objective the education of nurses who 
will upon completion of their studies in such programs, be 
qualified to effectively provide primary health care, including 
primary health care in homes and in ambulatory care facilities, 
long-term care facilities, acute care, and other health care set-
tings. 
"(d) 
AUTHORIZED 
NURSE 
ANESTHESIA 
PROGRAMS.—Nurse 
anesthesia programs eligible for support under this section are 
education programs that— 
"(1) provide registered nurses with full-time anesthetist 
education; and 
"(2) are accredited by the Council on Accreditation of Nurse 
Anesthesia Educational Programs. 
"(e) OTHER AUTHORIZED EDUCATIONAL PROGRAMS.—^The Sec-
retary shall prescribe guidelines as appropriate for other advanced 
nurse education programs eligible for support under this section. 
"(f) TRAINEESHIPS.— 
"(1) IN GENERAL.—^The Secretary may not award a grant 
to an applicant under subsection (a) unless the applicant 
involved agrees that traineeships provided with the grant will 
only pay all or part of the costs of— 
"(A) the tuition, books, and fees of the program of 
advanced nurse education with respect to which the 
traineeship is provided; and 
"(B) the reasonable living expenses of the individual 
during the period for which the traineeship is provided. 
"(2) DOCTORAL PROGRAMS.—The Secretary may not obligate 
more than 10 percent of the traineeships under subsection 
(a) for individuals in doctorate degree programs. 
"(3) SPECIAL CONSIDERATION.—In making awards of grants 
and contracts under subsection (a)(2), the Secretary shall give 
special consideration to an eligible entity that agrees to expend 
the award to train advanced education nurses who will practice 
in health professional shortage areas designated under section 
332. 
112 STAT. 3568 
PUBLIC LAW 105-392—NOV. 13, 1998 
"PART C—INCREASING NURSING WORKFORCE 
DIVERSITY 
42 use 296m. 
"SEC. 821. WORKFORCE DIVERSITY GRANTS. 
"(a) IN GENERAL.—The Secretary may award grants to and 
enter into contracts with eUgible entities to meet the costs of special 
projects to increase nursing education opportunities for individuals 
who are from disadvantaged backgrounds (including racial and 
ethnic minorities underrepresented among registered nurses) by 
providing student scholarships or stipends, pre-entry preparation, 
and retention activities. 
"(b) GUIDANCE.—In carrying out subsection (a), the Secretary 
shall take into consideration the recommendations of the First, 
Second and Third Invitational Congresses for Minority Nurse Lead-
ers on 'Caring for the Emerging Majority,' in 1992, 1993 and 1997, 
and consult with nursing associations including the American 
Nurses Association, the National League for Nursing, the American 
Association of Colleges of Nursing, the National Black Nurses 
Association, the National Association of Hispanic Nurses, the 
Association of Asian American and Pacific Islander Nurses, the 
Native American Indian and Alaskan Nurses Association, and the 
National Council of State Boards of Nursing. 
"(c) 
REQUIRED INFORMATION AND CONDITIONS FOR AWARD 
RECIPIENTS.— 
"(1) IN GENERAL.—^Recipients of awards under this section 
may be required, where requested, to report to the Secretary 
concerning the annual admission, retention, and graduation 
rates for individuals from disadvantaged backgrounds and eth-
nic and racial minorities in the school or schools involved 
in the projects. 
"(2) FALLING RATES.—If any of the rates reported under 
paragraph (1) fall below the average of the two previous years, 
the grant or contract recipient shall provide the Secretary with 
plans for immediately improving such rates. 
"(3) INELIGIBILITY.—A recipient described in paragraph (2) 
shall be ineligible for continued funding under this section 
if the plan of the recipient fails to improve the rates within 
the 1-year period beginning on the date such plan is imple-
mented. 
"PART D—STRENGTHENING CAPACITY FOR 
BASIC NURSE EDUCATION AND PRACTICE 
42 use 296p. 
"SEC. 831. BASIC NURSE EDUCATION AND PRACTICE GRANTS. 
"(a) IN GENERAL.—^The Secretary may award grants to and 
enter into contracts with eligible entities for projects to strengthen 
capacity for basic nurse education and practice. 
"(b) PRIORITY AREAS.—^In awarding grants or contracts under 
this section the Secretary shall give priority to entities that will 
use amounts provided under such a grant or contract to enhance 
the educational mix and utilization of the basic nursing workforce 
by strengthening programs that provide basic nurse education, such 
as through— 
"(1) establishing or expanding nursing practice arrange-
ments in noninstitutional settings to demonstrate methods to 
PUBLIC LAW 105-392—NOV. 13, 1998 
112 STAT. 3569 
improve access to primary health care in medically underserved 
communities; 
"(2) providing care for underserved populations and other 
high-risk groups such as the elderly, individuals with HIV-
AIDS, substance abusers, the homeless, and victims of domestic 
violence; 
"(3) providing managed care, quality improvement, and 
other skills needed to practice in existing and emerging orga-
nized health care systems; 
"(4) developing cultural competencies among nurses; 
"(5) expanding the enrollment in baccalaureate nursing 
programs; 
"(6) promoting career mobility for nursing personnel in 
a variety of training settings and cross training or specialty 
training among diverse population groups; 
"(7) providing education in informatics, including distance 
learning methodologies; or 
"(8) other priority areas as determined by the Secretary."; 
(5) by adding at the end the following: 
"PART F—FUNDING 
"SEC. 841. FUNDING. 
42USC297q. 
"(a) AUTHORIZATION OF APPROPRIATIONS.—For the purpose of 
carrying out parts B, C, and D (subject to section 845(g)), there 
are authorized to be appropriated $65,000,000 for fiscal year 1998, 
and such sums as may be necessary for each of the fiscal years 
1999 through 2002. 
"(b) ALLOCATIONS FOR FISCAL YEARS 1998 THROUGH 2002.— 
"(1) NURSE PRACTITIONERS; NURSE MIDWIVES.— 
"(A) FISCAL YEAR 1998.—Of the amount appropriated 
under subsection (a) for fiscal year 1998, the Secretary 
shall reserve not less than $17,564,000 for making awards 
of grants and contracts under section 822 as such section 
was in effect for fiscal year 1998. 
"(B) FISCAL YEARS 1999 THROUGH 2002.—Of the amount 
appropriated under subsection (a) for fiscal year 1999 or 
any of the fiscal years 2000 through 2002, the Secretary, 
subject to subsection (d), shall reserve for the fiscal year 
involved, for making awards of grants and contracts under 
part B with respect to nurse practitioners and nurse mid-
wives, not less than the percentage constituted by the 
ratio of the amount appropriated under section 822 as 
such section was in effect for fiscal year 1998 to the total 
of the amounts appropriated under this title for such fiscal 
year. For purposes of the preceding sentence, the Secretary, 
in determining the amount that has been reserved for 
the fiscal year involved, shall include any amounts appro-
priated under subsection (a) for the fiscal year that are 
obligated by the Secretary to continue in effect grants 
or contracts under section 822 as such section was in 
effect for fiscal year 1998. 
"(2) NURSE ANESTHETISTS.— 
"(A) FISCAL YEAR 1998.—Of the amount appropriated 
under subsection (a) for fiscal year 1998, the Secretary 
shall reserve not less than $2,761,000 for making awards 
112 STAT. 3570 
PUBLIC LAW 105-392—NOV. 13, 1998 
of grants and contracts under section 831 as such section 
was in effect for fiscal year 1998. 
"(B) FISCAL YEARS 1999 THROUGH 2002.—Of the amount 
appropriated under subsection (a) for fiscal year 1999 or 
any of the fiscal years 2000 through 2002, the Secretary, 
subject to subsection (d), shall reserve for the fiscal year 
involved, for making awards of grants and contracts under 
part B with respect to nurse anesthetists, not less than 
the percentage constituted by the ratio of the amount 
appropriated under section 831 as such section was in 
effect for fiscal year 1998 to the total of the amounts 
appropriated under this title for such fiscal year. For pur-
poses of the preceding sentence, the Secretary, in determin-
ing the amount that has been reserved for the fiscal year 
involved, shall include any amounts appropriated under 
subsection (a) for the fiscal year that are obligated by 
the Secretary to continue in effect grants or contracts under 
section 831 as such section was in effect for fiscal year 
1998. 
"(c) ALLOCATIONS AFTER FISCAL YEAR 2002.— 
"(1) IN GENERAL.—For fiscal year 2003 and subsequent 
fiscal years, amounts appropriated under subsection (a) for 
the fiscal year involved shall be allocated by the Secretary 
among parts B, C, and D (and programs within such parts) 
according to a methodology that is developed in accordance 
with paragraph (2). The Secretary shall enter into a contract 
with a public or private entity for the purpose of developing 
the methodology. The contract shall require that the develop-
ment of the methodology be completed not later than February 
1, 2002. 
"(2) USE OF CERTAIN FACTORS.—^The contract under para-
graph (1) shall provide that the methodology under such para-
graph will be developed in accordance with the following: 
"(A) The methodology will take into account the need 
for and the distribution of health services among medically 
underserved populations, as determined according to the 
factors that apply under section 330(b)(3). 
"(B) The methodology will take into account the need 
for and the distribution of health services in health profes-
sional shortage areas, as determined according to the fac-
tors that apply under section 332(b). 
"(C) The methodology will take into account the need 
for and the distribution of mental health services among 
medically underserved populations and in health profes-
sional shortage areas. 
"(D) The methodology will be developed in consultation 
with individuals in the field of nursing, including registered 
nurses, nurse practitioners, nurse miciwives, nurse anes-
thetists, clinical nurse specialists, nursing educators and 
educational institutions, nurse executives, pediatric nurse 
associates and practitioners, and women's health, obstetric, 
and neonatal nurses. 
"(E) The methodology will take into account the follow-
ing factors with respect to the States: 
"(i) A provider population ratio equivalent to a 
managed care formula of 1/1,500 for primary care serv-
ices. 
PUBLIC LAW 105-392—NOV. 13, 1998 
112 STAT. 3571 
"(ii) The use of whole rather than fractional counts 
in determining the number of health care providers. 
"(iii) The counting of only employed health care 
providers in determining the number of health care 
providers. 
"(iv) The number of families whose income is less 
than 200 percent of the official poverty line (as estab-
lished by the Director of the Office of Management 
and Budget and revised by the Secretary in accordance 
with section 673(2) of the Omnibus Budget Reconcili-
ation Act of 1981). 
"(v) The rate of infant mortality and the rate of 
low-birthweight births. 
"(vi) The percentage of the general population con-
stituted by individuals who are members of racial or 
ethnic minority groups, stated both by minority group 
and in the aggregate. 
"(vii) The percentage of the general population con-
stituted by individuals who are of Hispanic ethnicity, 
"(viii) The number of individuals residing in health 
professional shortage areas, and the number of individ-
uals who are members of medically underserved popu-
lations. 
"(ix) The percentage of the general population con-
stituted by elderly individuals. 
"(x) The extent to which the populations served 
have a choice of providers. 
"(xi) The impact of care on hospitalizations and 
emergency room use. 
"(xii) The number of individuals who lack pro-
ficiency in speaking the English language. 
"(xiii) Such additional factors as the Secretary 
determines to be appropriate. 
"(3) REPORT TO CONGRESS.—^Not later than 30 days after Deadline. 
the completion of the development of the methodology required 
in paragraph (1), the Secretary shall submit to the Committee 
on Commerce of the House of Representatives, and to the 
Committee on Labor and Human Resources of the Senate, 
a report describing the methodology and explaining the effects 
of the methodology on the allocation among parts B, C, and 
D (and programs within such parts) of amounts appropriated 
under subsection (a) for the first fiscal year for which the 
methodology will be in effect. Such explanation shall include 
a comparison of the allocation for such fiscal year with the 
allocation made under this section for the preceding fiscal year. 
"(d) USE OF METHODOLOGY BEFORE FISCAL YEAR 2003.—With DeadUne. 
respect to the fiscal years 1999 through 2002, if the report required 
in subsection (c)(3) is submitted in accordance with such subsection 
not later than 90 days before the beginning of such a fiscal year, 
the Secretary may for such year implement the methodology 
described in the report (rather than implementing the methodology 
in fiscal year 2003), in which case subsection (b) ceases to be 
in effect. The authority under the preceding sentence is subject 
to the condition that the fiscal year for which the methodology 
is implemented be the same fiscal year identified in such report 
as the fiscal year for which the methodology will first be in effect. 
112 STAT. 3572 
PUBLIC LAW 105-392—NOV. 13, 1998 
"(e) AUTHORITY FOR USE OF ADDITIONAL FACTORS IN METHODOL-
OGY.— 
"(1) IN GENERAL.—^The Secretary shall make the determina-
tions specified in paragraph (2). For any fiscal year beginning 
after the first fiscal year for which the methodology under 
subsection (c)(1) is in effect, the Secretary may alter the meth-
odology by including the information from such determinations 
as factors in the methodology. 
"(2) 
RELEVANT 
DETERMINATIONS.—^The 
determinations 
referred to in paragraph (1) are as follows: 
"(A) The need for and the distribution of health services 
among populations for which it is difficult to determine 
the number of individuals who are in the population, such 
as homeless individuals; migratory and seasonal agricul-
tural workers and their families; individuals infected with 
the human immunodeficiency virus, and individuals who 
abuse drugs. 
"(B) In the case of a population for which the deter-
minations under subparagraph (A) are made, the extent 
to which the population includes individuals who are mem-
bers of racial or ethnic minority groups and a specification 
of the skills needed to provide health services to such 
individuals in the language and the educational and cul-
tural context that is most appropriate to the individuals. 
"(C) Data, obtained from the Director of the Centers 
for Disease Control and Prevention, on rates of morbidity 
and mortality among various populations (including data 
on the rates of maternal and infant mortality and data 
on the rates of low-birthweight births of living infants). 
"(D) Data from the Health Plan Employer Data and 
Information Set, as appropriate. 
"PART G—NATIONAL ADVISORY COUNCIL ON 
NURSE EDUCATION AND PRACTICE 
42 use 297t. 
"SEC. 845. NATIONAL ADVISORY COUNCIL ON NURSE EDUCATION AND 
PRACTICE. 
"(a) ESTABLISHMENT.—^The Secretary shall establish an advisory 
council to be known as the National Advisory Council on Nurse 
Education and Practice (in this section referred to as the 'Advisory 
Council'). 
"(b) COMPOSITION.— 
"(1) IN GENERAL.—^The Advisory Council shall be composed 
of— 
"(A) not less than 21, nor more than 23 individuals, 
who are not officers or employees of the Federal Grovern-
ment, appointed by the Secretary without regard to the 
Federal civil service laws, of which— 
"(i) 2 shall be selected from full-time students 
enrolled in schools of nursing; 
"(ii) 2 shall be selected from the general public; 
"(iii) 2 shall be selected from practicing profes-
sional nurses; and 
"(iv) 9 shall be selected from among the leading 
authorities in the various fields of nursing, higher, 
secondary education, and associate degree schools of 
PUBLIC LAW 105-392—NOV. 13, 1998 
112 STAT. 3573 
nursing, and from representatives of advanced edu-
cation nursing groups (such as nurse practitioners, 
nurse midwives, and nurse anesthetists), hospitals, and 
other institutions and organizations which provide 
nursing services; and 
"(B) the Secretary (or the delegate of the Secretary 
(who shall be an ex officio member and shall serve as 
the Chairperson)). 
"(2) APPOINTMENT.—Not later than 90 days after the date Deadline, 
of enactment of this Act, the Secretary shall appoint the mem-
bers of the Advisory Council and each such member shall 
serve a 4 year term. In making such appointments, the Sec-
retary shall ensure a fair balance between the nursing profes-
sions, a broad geographic representation of members and a 
balance between urban and rural members. Members shall 
be appointed based on their competence, interest, and knowl-
edge of the mission of the profession involved. A majority of 
the members shall be nurses. 
"(3) MINORITY REPRESENTATION.—In appointing the mem-
bers of the Advisory Council under paragraph (1), the Secretary 
shall ensure the adequate representation of minorities. 
"(c) VACANCIES.— 
"(1) IN GENERAL.—^A vacsmcy on the Advisory Council shall 
be filled in the manner in which the original appointment 
was made and shall be subject to any conditions which applied 
with respect to the original appointment. 
"(2) FILLING UNEXPIRED TERM.—An individual chosen to 
fill a vacancy shall be appointed for the unexpired term of 
the member replaced. 
"(d) DUTIES.—-The Advisory Council shall— 
"(1) provide advice and recommendations to the Secretary 
and Congress concerning policy matters arising in the adminis-
tration of this title, including the range of issues relating to 
the nurse workforce, education, and practice improvement; 
"(2) provide advice to the Secretary and Congress in the 
preparation of general regulations and with respect to policy 
matters arising in the administration of this title, including 
the range of issues relating to nurse supply, education gind 
practice improvement; and 
"(3) not later than 3 years after the date of enactment Deadline, 
of this section, and annually thereafter, prepare and submit Reports, 
to the Secretary, the Committee on Labor and 
Human 
Resources of the Senate, and the Committee on Commerce 
of the House of Representatives, a report describing the activi-
ties of the Council, including findings and recommendations 
made by the Council concerning the activities under this title. 
"(e) MEETINGS AND DOCUMENTS.— 
"(1) MEETINGS.—^The Advisory Council shall meet not less 
than 2 times each year. Such meetings shall be held jointly 
with other related entities established under this title where 
appropriate. 
"(2) DOCUMENTS.—Not later than 14 days prior to the Deadlines, 
convening of a meeting under paragraph (1), the Advisory Coun-
cil shall prepare and make available an agenda of the matters 
to be considered by the Advisory Council at such meeting. 
At any such meeting, the Advisory Council shall distribute 
materials with respect to the issues to be addressed at the 
112 STAT. 3574 
PUBLIC LAW 105-392—NOV. 13, 1998 
meeting. Not later than 30 days after the adjourning of such 
a meeting, the Advisory Council shall prepare and make avail-
able a summary of the meeting and any actions taken by 
the Council based upon the meeting. 
"(f) COMPENSATION AND EXPENSES.— 
"(1) COMPENSATION.—Each member of the Advisory Council 
shall be compensated at a rate equal to the daily equivalent 
of the annual rate of basic pay prescribed for level IV of the 
Executive Schedule under section 5315 of title 5, United States 
Code, for each day (including travel time) during which such 
member is engaged in the performance of the duties of the 
Council. All members of the Council who are officers or employ-
ees of the United States shall serve without compensation 
in addition to that received for their services as officers or 
employees of the United States. 
"(2) EXPENSES.—^The members of the Advisory Council shall 
be allowed travel expenses, including per diem in lieu of subsist-
ence, at rates authorized for employees of agencies under sub-
chapter I of chapter 57 of title 5, United States Code, while 
away from their homes or regular places of business in the 
performance of services for the Council. 
"(g) FUNDING.—^Amounts appropriated under this title may be 
utilized by the Secretary to support the nurse education and practice 
activities of the Council. 
"(h) FACA.—^The Federal Advisory Committee Act shall apply 
to the Advisory Committee under this section only to the extent 
that the provisions of such Act do not conflict with the requirements 
of this section."; and 
(6) by redesignating section 855 as section 810, and 
42 use 298b-2, 
transferring such section so as to appear after section 809 
296g. 
(as added by the amendment made by paragraph (5)). 
42 u s e 296 note. 
SEC. 124. SAVINGS PROVISION. 
In the case of any authority for making awards of grants 
or contracts that is terminated by the amendment made by section 
123, the Secretary of Health and Human Services may, notwith-
standing the termination of the authority, continue in effect any 
grant or contract made under the authority that is in effect on 
the day before the date of the enactment of this Act, subject to 
the duration of any such grant or contract not exceeding the period 
determined by the Secretary in first approving such financial assist-
ance, or in approving the most recent request made (before the 
date of such enactment) for continuation of such assistance, as 
the case may be. 
Subtitle C—Financial Assistance 
CHAPTER 
1—SCHOOL-BASED 
REVOLVING 
LOAN 
FUNDS 
SEC. 131. PRIMARY CARE LOAN PROGRAM. 
(a) REQUIREMENT FOR SCHOOLS.—Section 723(b)( 1) of the Public 
Health Service Act (42 U.S.C. 292s(b)(l)), as amended by section 
2014(c)(2)(A)(ii) of Public Law 103-43 (107 Stat. 216), is amended 
by striking "3 years before" and inserting "4 years before". 
PUBLIC LAW 105-392—NOV. 13, 1998 
112 STAT. 3575 
(b) NONCOMPLIANCE.—Section 723(a)(3) of the Public Health 
Service Act (42 U.S.C. 292s(a)(3)) is amended to read as follows: 
"(3) 
NONCOMPLIANCE 
BY STUDENT.—Each 
agreement 
entered into with a student pursuant to paragraph (1) shall 
provide that, if the student fails to comply with such agreement, 
the loan involved will begin to accrue interest at a rate of 
18 percent per year beginning on the date of such noncompli-
ance.". 
(c) REPORT REQUIREMENT.—Section 723 of the Public Health 
Service Act (42 U.S.C. 292s) is amended— 
(1) by striking subsection (c); and 
(2) by redesignating subsection (d) as subsection (c). 
SEC. 132. LOANS FOR DISADVANTAGED STUDENTS. 
(a) AUTHORIZATION OF APPROPRIATIONS.—Section 724(f)(1) of 
the Public Health Service Act (42 U.S.C. 292t(0(l)) is amended 
by striking "$15,000,000 for fiscal year 1993" and inserting 
"$8,000,000 for each of the fiscal years 1998 through 2002". 
(b) REPEAL.—Effective October 1, 2002, paragraph (1) of section 
724(f) of the Public Health Service Act (42 U.S.C. 292t(f)(l)) is 
repealed. 
SEC. 133. STUDENT LOANS REGARDING SCHOOLS OF NURSING. 
(a) IN GENERAL.—Section 836(b) of the Public Health Service 
Act (42 U.S.C. 297b(b)) is amended— 
(1) in paragraph (1), by striking the period at the end 
and inserting a semicolon; 
(2) in paragraph (2)— 
(A) in subparagraph (A), by striking "and" at the end; 
and 
(B) by inserting before the semicolon at the end the 
following: ", and (C) such additional periods under the 
terms of paragraph (8) of this subsection"; 
(3) in paragraph (7), by striking the period at the end 
and inserting "; and"; and 
(4) by adding at the end the following paragraph: 
"(8) pursuant to uniform criteria established by the Sec-
retary, the repayment period established under paragraph (2) 
for any student borrower who during the repayment period 
failed to make consecutive pa5nm.ents and who, during the last 
12 months of the repayment period, has made at least 12 
consecutive pajmients may be extended for a period not to 
exceed 10 years.". 
(b) MINIMUM MONTHLY PAYMENTS.—Section 836(g) of the Public 
Health Service Act (42 U.S.C. 297b(g)) is amended by striking 
"$15" and inserting "$40". 
(c) ELIMINATION OF STATUTE OF LIMITATION FOR LOAN COLLEC-
TIONS.— 
(1) IN GENERAL.—Section 836 of the Public Health Service 
Act (42 U.S.C. 297b) is amended by adding at the end the 
following new subsection: 
"(1) ELIMINATION OF STATUTE OF LIMITATION FOR LOAN COLLEC-
TIONS.— 
"(1) PURPOSE.—It is the purpose of this subsection to ensure 
that obligations to repay loans under this section are enforced 
without regard to any Federal or State statutory, regulatory, 
or administrative limitation on the period within which debts 
may be enforced. 
112 STAT. 3576 
PUBLIC LAW 105-392—NOV. 13, 1998 
"(2) PROHIBITION.—Notwithstanding any other provision of 
Federal or State law, no limitation shall terminate the period 
within which suit may be filed, a judgment may be enforced, 
or an offset, garnishment, or other action may be initiated 
or taken by a school of nursing that has an agreement with 
the Secretary pursuant to section 835 that is seeking the repay-
ment of the amount due from a borrower on a loan made 
under this subpart after the default of the borrower on such 
loan.". 
42 use 297b 
(2) EFFECTIVE DATE.—^The amendment made by paragraph 
note. 
(1) shall be effective with respect to actions pending on or 
after the date of enactment of this Act. 
(d) BREACH OF AGREEMENTS.—Section 846 of the Public Health 
Service Act (42 U.S.C. 297n) is amended by adding at the end 
thereof the following new subsection: 
"(h) BREACH OF AGREEMENT.— 
"(1) IN GENERAL.—In the case of any program under this 
section under which an individual makes an agreement to 
provide health services for a period of time in accordance with 
such program in consideration of receiving an award of Federal 
funds regarding education as a nurse (including an award 
for the repayment of loans), the following applies if the agree-
ment provides that this subsection is applicable: 
"(A) In the case of a program under this section that 
makes an award of Federal funds for attending an accred-
ited program of nursing (in this section referred to as 
a 'nursing program'), the individual is liable to the Federal 
Government for the amount of such award (including 
amounts provided for expenses related to such attendance), 
and for interest on such amount at the maximum legal 
prevailing rate, if the individual— 
"(i) fails to maintain an acceptable level of aca-
demic standing in the nursing program (as indicated 
by the program in accordance with requirements estab-
lished by the Secretary); 
"(ii) is dismissed from the nursing program for 
disciplinary reasons; or 
"(iii) voluntarily terminates the nursing program. 
"(B) The individual is liable to the Federal Government 
for the amount of such award (including amounts provided 
for expenses related to such attendance), and for interest 
on such amount at the maximum legal prevailing rate, 
if the individual fails to provide health services in accord-
ance with the program under this section for the period 
of time applicable under the program. 
"(2) WAIVER OR SUSPENSION OF LIABILITY.—In the case 
of an individual or health facility making an agreement for 
purposes of paragraph (1), the Secretary shall provide for the 
waiver or suspension of liability under such subsection if 
compliance by the individual or the health facility, as the 
case may be, with the agreements involved is impossible, or 
would involve extreme hardship to the individual or facility, 
and if enforcement of the agreements with respect to the 
individual or facility would be unconscionable. 
"(3) DATE CERTAIN FOR RECOVERY.—Subject to paragraph 
(2), any amount that the Federal Government is entitled to 
recover under paragraph (1) shall be paid to the United States 
PUBLIC LAW 105-392—NOV. 13, 1998 
112 STAT. 3577 
not later than the expiration of the 3-year period beginning 
on the date the United States becomes so entitled. 
"(4) AVAILABILITY.—^Amounts recovered under paragraph 
(1) with respect to a program under this section shall be avail-
able for the purposes of such program, and shall remain avail-
able for such purposes until expended.". 
(e) TECHNICAL AMENDMENTS.—Section 839 of the Public Health 
Service Act (42 U.S.C. 297e) is amended— 
(1) in subsection (a)— 
(A) by striking the matter preceding paragraph (1) 
and inserting the following: 
"(a) If a school terminates a loan fund established under an 
agreement pursuant to section 835(b), or if the Secretary for good 
cause terminates the agreement with the school, there shall be 
a capital distribution as follows:"; and 
(B) in paragraph (1), by striking "at the close of 
September 30, 1999," and inserting "on the date of termi-
nation of the fund"; and 
(2) in subsection (b), to read as follows: 
"(b) If a capital distribution is made under subsection (a), 
the school involved shall, after such capital distribution, pay to 
the Secretary, not less often than quarterly, the same proportionate 
share of amounts received by the school in payment of principal 
or interest on loans made from the loan fund established under 
section 835(b) as determined by the Secretary under subsection 
(a).". 
SEC. 134. GENERAL PROVISIONS. 
(a) MAXIMUM STUDENT LOAN PROVISIONS AND MINIMUM PAY-
MENTS.— 
(1) IN GENERAL.—Section 722(aXirof the Public Health 
Service Act (42 U.S.C. 292r(a)(l)), as amended by section 
2014(b)(1) of Public Law 103-43, is amended by striking "the 
sum of and all that follows through the end thereof and insert-
ing "the cost of attendance (including tuition, other reasonable 
educational expenses, and reasonable living costs) for that year 
at the educational institution attended by the student (as deter-
mined by such educational institution).". 
(2) THIRD AND FOURTH YEARS.—Section 722(a)(2) of the 
Public Health Service Act (42 U.S.C. 292r(a)(2)), as amended 
by section 2014(b)(1) of Public Law 103-43, is amended by 
striking "the amount $2,500" and all that follows through 
"including such $2,500)" and inserting "the amount of the loan 
may, in the case of the third or fourth year of a student 
at a school of medicine or osteopathic medicine, be increased 
to the extent necessary". 
(3) REPAYMENT PERIOD.—Section 722(c) of the Public Health 
Service Act (42 U.S.C. 292r(c)), as amended by section 
2014(b)( 1) of Public Law 103-43, is amended— 
(A) in the subsection heading by striking "TEN-YEAR" 
and inserting "REPAYMENT"; 
(B) by striking "ten-year period which begins" and 
inserting "period of not less than 10 years nor more than 
25 years, at the discretion of the institution, which begins"; 
and 
(C) by striking "such ten-year period" and inserting 
"such period". 
112 STAT. 3578 
PUBLIC LAW 105-392—NOV. 13, 1998 
(4) MINIMUM PAYMENTS.—Section 722(j) of the Public 
Health Service Act (42 U.S.C. 292r(j)), as amended by section 
2014(b)(1) of Public Law 103-43, is amended by striking "$15" 
and inserting "$40". 
(b) ELIMINATION OF STATUTE OF LIMITATION FOR LOAN COLLEC-
TIONS.— 
(1) IN GENERAL.—Section 722 of the Public Health Service 
Act (42 U.S.C. 292r), as amended by section 2014(b)(1) of Public 
Law 103-43, is amended by adding at the end the following 
new subsection: 
"(m) ELIMINATION OF STATUTE OF LIMITATION FOR LOAN 
COLLECTIONS.— 
"(1) PURPOSE.—It is the purpose of this subsection to ensure 
that obligations to repay loans under this section are enforced 
without regard to any Federal or State statutory, regulatory, 
or administrative limitation on the period within which debts 
may be enforced. 
"(2) PROHIBITION.—^Notwithstanding any other provision of 
Federal or State law, no limitation shall terminate the period 
within which suit may be filed, a judgment may be enforced, 
or an offset, garnishment, or other action may be initiated 
or taken by a school that has an agreement with the Secretary 
pursuant to section 721 that is seeking the repayment of the 
amount due from a borrower on a loan made under this subpart 
after the default of the borrower on such loan.". 
42 use 292r 
(2) EFFECTIVE DATE.—^The amendment made by paragraph 
note. 
(1) shall be effective with respect to actions pending on or 
after the date of enactment of this Act. 
(c) DATE CERTAIN FOR CONTRIBUTIONS.—Paragraph (2) of sec-
tion 735(e) of the Public Health Service Act (42 U.S.C. 292y(e)(2)) 
is amended to read as follows: 
"(2) 
DATE 
CERTAIN 
FOR 
CONTRIBUTIONS.—Amounts 
described in paragraph (1) that are returned to the Secretary 
shall be obligated before the end of the succeeding fiscal year.". 
CHAPTER 2—INSURED HEALTH EDUCATION 
ASSISTANCE LOANS TO GRADUATE STUDENTS 
SEC. 141. HEALTH EDUCATION ASSISTANCE LOAN PROGRAM. 
(a) HEALTH EDUCATION ASSISTANCE LOAN DEFERMENT FOR 
BORROWERS PROVIDING HEALTH SERVICES TO INDIANS.— 
(1) IN GENERAL.—Section 705(a)(2)(C) of the Public Health 
Service Act (42 U.S.C. 292d(a)(2)(C)) is amended by striking 
"and (x)" and inserting "(x) not in excess of three years, during 
which the borrower is providing health care services to Indians 
through an Indian health program (as defined in section 
108(a)(2)(A) of the Indian Health Care Improvement Act (25 
U.S.C. 1616a(a)(2)(A)); and (xi)". 
(2) CONFORMING AMENDMENTS.—Section 705(a)(2)(C) of the 
Public Health Service Act (42 U.S.C. 292d(a)(2)(C)) is further 
amended— 
(A) in clause (xi) (as so redesignated) by striking "(ix)" 
and inserting "(x)"; and 
(B) in the matter following such clause (xi), by striking 
"(x)" and inserting "(xi)". 
42 use 292d 
(3) EFFECTIVE DATE.—^The amendments made by this sub-
i^o*^- 
section shall apply with respect to services provided on or 
PUBLIC LAW 105-392—NOV. 13, 1998 
112 STAT. 3579 
after the first day of the third month that begins after the 
date of the enactment of this Act. 
(b) REPORT REQUIREMENT.—Section 709(b) of the PubUc Health 
Service Act (42 U.S.C. 292h(b)) is amended— 
(1) in paragraph (4)(B), by adding "and" after the semicolon; 
(2) in paragraph (5), by striking "; and" and inserting 
a period; and 
(3) by striking paragraph (6). 
(c) PROGRAM ELIGIBILITY.— 
(1) LIMITATIONS ON LOANS.—Section 703(a) of the Public 
Health Service Act (42 U.S.C. 292b(a)) is amended by striking 
"or clinical psychology" and inserting "or behavioral and mental 
health practice, including clinical psychology". 
(2) DEFINITION OF ELIGIBLE INSTITUTION.—Section 719(1) 
of the Public Health Service Act (42 U.S.C. 292o(l)) is amended 
by striking "or clinical psychology" and inserting "or behavioral 
and mental health practice, including clinical psychology". 
SEC. 142. HEAL LENDER AND HOLDER PERFORMANCE STANDARDS. 
(a) GENERAL AMENDMENTS.—Section 707(a) of the Public Health 
Service Act (42 U.S.C. 292f) is amended— 
(1) by striking the last sentence; 
(2) by striking "determined." and inserting "determined, 
except that, if the insurance beneficiary including any servicer 
of the loan is not designated for 'exceptional performance', 
as set forth in paragraph (2), the Secretary shall pay to the 
beneficiary a sum equal to 98 percent of the amount of the 
loss sustained by the insured upon that loan."; 
(3) by striking "Upon" and inserting: 
"(1) IN GENERAL.—^Upon"; and 
(4) by adding at the end the following new paragraph: 
"(2) EXCEPTIONAL PERFORMANCE.— 
"(A) AUTHORITY.—^Where the Secretary determines that 
an eligible lender, holder, or servicer has a compliance 
performance rating that equals or exceeds 97 percent, the 
Secretary shall designate that eligible lender, holder, or 
servicer, as the case may be, for exceptional performance. 
"(B) COMPLIANCE PERFORMANCE RATING.—^For purposes 
of subparagraph (A), a compliance performance rating is 
determined with respect to compliance with due diligence 
in the disbursement, servicing, and collection of loans under 
this subpart for each year for which the determination 
is made. Such rating shall be equal to the percentage 
of all due diligence requirements applicable to each loan, 
on average, as established by the Secretary, with respect 
to loans serviced during the period by the eligible lender, 
holder, or servicer. 
"(C) ANNUAL AUDITS FOR LENDERS, HOLDERS, AND 
SERVICERS.—Each eligible lender, holder, or servicer desir-
ing a designation under subparagraph (A) shall have an 
annual financial and compliance audit conducted with 
respect to the loan portfolio of such eligible lender, holder, 
or servicer, by a qualified independent organization from 
a list of qualified organizations identified by the Secretary 
and in accordance with standards established by the Sec-
retary. The standards shall measure the lender's, holder's, 
or servicer's compliance with due diligence standards and 
112 STAT. 3580 
PUBLIC LAW 105-392—NOV. 13, 1998 
shall include a defined statistical sampling technique 
designed to measure the performance rating of the eligible 
lender, holder, or servicer for the purpose of this section. 
Each eligible lender, holder, or servicer shall submit the 
audit required by this section to the Secretary. 
"(D) 
SECRETARY'S DETERMINATIONS.—^The Secretary 
shall make the determination under subparagraph (A) 
based upon the audits submitted under this paragraph 
and any information in the possession of the Secretary 
or submitted by any other agency or office of the Federal 
Government. 
"(E) QUARTERLY COMPLIANCE AUDIT.—^To maintain its 
status as an exceptional performer, the lender, holder, or 
servicer shall undergo a quarterly compliance audit at the 
end of each quarter (other than the quarter in which status 
as an exceptional performer is established through a finan-
cial and compliance audit, as described in subparagraph 
(O), and submit the results of such audit to the Secretary. 
The compliance audit shall review compliance with due 
diligence requirements for the period beginning on the 
day after the ending date of the previous audit, in accord-
ance with standards determined by the Secretary. 
"(F) REVOCATION AUTHORITY.—^The Secretary shall 
revoke the designation of a lender, holder, or servicer under 
subparagraph (A) if any quarterly audit required under 
subparagraph (E) is not received by the Secretary by the 
date established by the Secretary or if the audit indicates 
the lender, holder, or servicer has failed to meet the stand-
ards for designation as an exceptional performer under 
subparagraph (A). A lender, holder, or servicer receiving 
a compliance audit not meeting the standard for designa-
tion as an exceptional performer may reapply for designa-
tion under subparagraph (A) at any time. 
"(G) DOCUMENTATION.—^Nothing in this section shall 
restrict or limit the authority of the Secretary to require 
the submission of claims documentation evidencing servic-
ing performed on loans, except that the Secretary may 
not require exceptional performers to submit greater docu-
mentation than that required for lenders, holders, and 
servicers not designated under subparagraph (A). 
"(H) COST OF AUDITS.—Each eligible lender, holder, 
or servicer shall pay for all the costs associated with the 
audits required under this section. 
"(I) ADDITIONAL 
REVOCATION AUTHORITY.—^Notwith-
standing any other provision of this section, a designation 
under subparagraph (A) may be revoked at any time by 
the Secretary if the Secretary determines that the eligible 
lender, holder, or servicer has failed to maintain an overall 
level of compliance consistent with the audit submitted 
by the eligible lender, holder, or servicer under this para-
graph or if the Secretary asserts that the lender, holder, 
or servicer may have engaged in fraud in securing designa-
tion under subparagraph (A) or is failing to service loans 
in accordance with program requirements. 
"(J) NONCOMPLIANCE.—A lender, holder, or servicer 
designated under subparagraph (A) that fails to service 
PUBLIC LAW 105-392—NOV. 13, 1998 
112 STAT. 3581 
loans or otherwise comply with applicable program regula-
tions shall be considered in violation of the Federal False 
Claims Act.". 
(b) DEFINITION.—Section 707(e) of the Public Health Service 
Act (42 U.S.C. 292f(e)) is amended by adding at the end the follow-
ing new paragraph: 
"(4) The term 'servicer' means any agency acting on behalf 
of the insurance beneficiary.". 
(c) EFFECTIVE DATE.—The amendments made by subsections 42USC292f 
(a) and (b) shall apply with respect to loans submitted to the note. 
Secretary for payment on or after the first day of the sixth month 
that begins after the date of enactment of this Act. 
SEC. 143. INSURANCE PROGRAM. 
Section 710(a)(2)(B) of the Public Health Service Act (42 U.S.C. 
292i(a)(2)(B)) is amended by striking "any of the fiscal years 1993 
through 1996" and inserting "fiscal year 1993 and subsequent fiscal 
years". 
SEC. 144. HEAL BANKRUPTCY. 
(a) IN GENERAL.—Section 707(g) of the Public Health Service 
Act (42 U.S.C. 292f(g)) is amended in the first sentence by striking 
"A debt which is a loan insured" and inserting "Notwithstanding 
any other provision of Federal or State law, a debt that is a 
loan insured". 
(b) APPLICATION.—^The amendment made by subsection (a) shall 
42 use 292f 
apply to any loan insured under the authority of subpart I of J^ote. 
part A of title VII of the Public Health Service Act (42 U.S.C. 
292 et seq.) that is listed or scheduled by the debtor in a case 
under title XI, United States Code, filed— 
(1) on or after the date of enactment of this Act; or 
(2) prior to such date of enactment in which a discharge 
has not been granted. 
SEC. 145. HEAL REFINANCING. 
Section 706 of the Public Health Service Act (42 U.S.C. 292e) 
is amended— 
(1) in subsection (d)— 
(A) in the subsection heading, by striking "CONSOLIDA-
TION" and inserting "REFINANCING OR CONSOLIDATION"; and 
(B) in the first sentence, by striking "indebtedness" 
and inserting "indebtedness or the refinancing of a single 
loan"; and 
(2) in subsection (e)— 
(A) in the subsection heading, by striking "DEBTS" 
and inserting "DEBTS AND REFINANCING"; 
(B) in the first sentence, by striking "all of the borrow-
er's debts into a single instrument" and inserting "all of 
the borrower's loans insured under this subpart into a 
single instrument (or, if the borrower obtained only 1 loan 
insured under this subpart, refinancing the loan 1 time)"; 
and 
(C) in the second sentence, by striking "consolidation" 
and inserting "consolidation or refinancing". 
112 STAT. 3582 
PUBLIC LAW 105-392—NOV. 13, 1998 
TITLE II—OFFICE OF MINORITY 
HEALTH 
SEC. 201. REVISION AND EXTENSION OF PROGRAMS OF OFFICE OF 
MINORITY HEALTH. 
(a) DUTIES AND REQUIREMENTS.—Section 1707 
of the Public 
Health Service Act (42 U.S.C. 300u-6) is amended by striking 
subsection (b) and all that follows and inserting the following: 
"(b) DUTIES.—^With respect to improving the health of racial 
and ethnic minority groups, the Secretary, acting through the Dep-
uty Assistant Secretary for Minority Health (in this section referred 
to as the 'Deputy Assistant Secretary'), shall carry out the following: 
"(1) Establish short-range and long-range goals and objec-
tives and coordinate all other activities within the Public Health 
Service that relate to disease prevention, health promotion, 
service delivery, and research concerning such individuals. The 
heads of each of the agencies of the Service shall consult with 
the Deputy Assistant Secretary to ensure the coordination of 
such activities. 
"(2) Enter into interagency agreements with other agencies 
of the Public Health Service. 
"(3) Support research, demonstrations and evaluations to 
test new and innovative models. 
"(4) Increase knowledge and understanding of health risk 
factors. 
"(5) Develop mechanisms that support better information 
dissemination, education, prevention, and service delivery to 
individuals from disadvantaged backgrounds, including individ-
uals who are members of racial or ethnic minority groups. 
"(6) Ensure that the National Center for Health Statistics 
collects data on the health status of each minority group. 
"(7) With respect to individuals who lack proficiency in 
speaking the English language, enter into contracts with public 
and nonprofit private providers of primary health services for 
the purpose of increasing the access of the individuals to such 
services by developing and carrying out programs to provide 
bilingual or interpretive services. 
"(8) Support a national minority health resource center 
to carry out the following: 
"(A) Facilitate the exchange of information regarding 
matters relating to health information and health pro-
motion, preventive health services, and education in the 
appropriate use of health care. 
"(B) Facilitate access to such information. 
"(C) Assist in the analysis of issues and problems relat-
ing to such matters. 
"(D) Provide technical assistance with respect to the 
exchange of such information (including facilitating the 
development of materials for such technical assistance). 
"(9) Carry out progt-ams to improve access to health care 
services for individuals with limited proficiency in speaking 
the English language. Activities under the preceding sentence 
^hall include developing and evaluating model projects. 
"(c) ADVISORY COMMITTEE.— 
PUBLIC LAW 105-392—NOV. 13, 1998 
112 STAT. 3583 
"(1) IN GENERAL.—^The Secretary shall establish an advisory 
committee to be known as the Advisory Committee on Minority 
Health (in this subsection referred to as the 'Committee'). 
"(2) DUTIES.—^The Committee shall provide advice to the 
Deputy Assistant Secretary carrying out this section, including 
advice on the development of goals and specific program activi-
ties under paragraphs (1) through (9) of subsection (b) for 
each racial and ethnic minority group. 
"(3) CHAIR.—^The chairperson of the Committee shall be 
selected by the Secretary from among the members of the 
voting members of the Committee. The term of office of the 
chairperson shall be 2 years. 
"(4) COMPOSITION.— 
"(A) The Committee shall be composed of 12 voting 
members appointed in accordance with subparagraph (B), 
and nonvoting, ex officio members designated in subpara-
graph (C). 
"(B) The voting members of the Committee shall be 
appointed by the Secretary from among individuals who 
are not officers or employees of the Federal Government 
and who have expertise regarding issues of minority health. 
The racial and ethnic minority groups shall be equally 
represented among such members. 
"(C) The nonvoting, ex officio members of the Commit-
tee shall be such officials of the Department of Health 
and Human Services as the Secretary determines to be 
appropriate. 
"(5) TERMS.—^Each member of the Committee shall serve 
for a term of 4 years, except that the Secretary shall initially 
appoint a portion of the members to terms of 1 year, 2 years, 
and 3 years. 
"(6) VACANCIES.—If a vacancy occurs on the Committee, 
a new member shall be appointed by the Secretary within 
90 days from the date that the vacancy occurs, and serve 
for the remainder of the term for which the predecessor of 
such member was appointed. The vacancy shall not affect the 
power of the remaining members to execute the duties of the 
Committee. 
"(7) COMPENSATION.—^Members of the Committee who are 
officers or employees of the United States shall serve without 
compensation. Members of the Committee who are not officers 
or employees of the United States shall receive compensation, 
for each day (including travel time) they are engaged in the 
performance of the functions of the Committee. Such compensa-
tion may not be in an amount in excess of the daily equivalent 
of the annual maximum rate of basic pay payable under the 
General Schedule (under title 5, United States Code) for posi-
tions above GS-15. 
"(d) CERTAIN REQUIREMENTS REGARDING DUTIES.— 
"(1) RECOMMENDATIONS REGARDING LANGUAGE AS IMPEDI-
MENT TO HEALTH CARE.—^The Deputy Assistant Secretary for 
Minority Health shall consult with the Director of the Office 
of International and Refugee Health, the Director of the Office 
of Civil Rights, and the Directors of other appropriate depart-
mental entities regarding recommendations for carrying out 
activities under subsection (b)(9). 
112 STAT. 3584 
PUBLIC LAW 105-392—NOV. 13, 1998 
"(2) EQUITABLE ALLOCATION REGARDING ACTIVITIES.—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. 
"(3) CULTURAL COMPETENCY OF SERVICES.—The Secretary 
shall ensure that information and services provided pursuant 
to subsection (b) are provided in the language, educational, 
and cultural context that is most appropriate for the individuals 
for whom the information and services are intended. 
"(e) GRANTS AND CONTRACTS REGARDING DUTIES.— 
"(1) IN GENERAL.—In carrying out subsection (b), the Sec-
retary acting through the Deputy Assistant Secretary may 
make awards of grants, cooperative agreements, and contracts 
to public and nonprofit private entities. 
"(2) PROCESS FOR MAKING AWARDS.—^The Deputy Assistant 
Secretary shall ensure that awards under paragraph (1) are 
made, to the extent practical, only on a competitive basis, 
and that a grant is awarded for a proposal only if the proposal 
has been recommended for such an award through a process 
of peer review. 
"(3) EVALUATION AND DISSEMINATION.—^The Deputy Assist-
ant Secretary, directly or through contracts with public and 
private entities, shall provide for evaluations of projects carried 
out with awards made under paragraph (1) during the preced-
ing 2 fiscal years. The report shall be included in the report 
required under subsection (f) for the fiscal year involved. 
"(f) REPORTS.— 
"(1) IN GENERAL.—^Not later than February 1 of fiscal year 
1999 and of each second year thereafter, 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 describing the 
activities carried out under this section during the preceding 
2 fiscal years and evaluating the extent to which such activities 
have been effective in improving the health of racial and ethnic 
minority groups. Each such report shall include the biennial 
reports submitted under sections 201(e)(3) and 201(f)(2) for 
such years by the heads of the Public Health Service agencies. 
"(2) AGENCY REPORTS.—^Not later than February 1, 1999, 
and biennially thereafter, the heads of the Public Health Service 
agencies shall submit to the Deputy Assistant Secretary a 
report summarizing the minority health activities of each of 
the respective agencies. 
"(g) DEFINITION.—For purposes of this section: 
"(1) The term 'racial and ethnic minority group' means 
American Indians (including Alaska Natives, Eskimos, and 
Aleuts); Asian Americans and Pacific Islanders; Blacks; and 
Hispanics. 
"(2) The term 'Hispanic' means individuals whose origin 
is Mexican, Puerto Rican, Cuban, Central or South American, 
or any other Spanish-speaking country. 
"(h) FUNDING.— 
"(1) AUTHORIZATION OF APPROPRIATIONS.—^For the purpose 
of carrying out this section, there are authorized to be appro-
priated $30,000,000 for fiscal year 1998, and such sums as 
may be necessary for each of the fiscal years 1999 through 
2002.". 
PUBLIC LAW 105-392—NOV. 13, 1998 
112 STAT. 3585 
(b) AUTHORIZATION FOR NATIONAL CENTER FOR HEALTH STATIS-
TICS.—Section 306 of the Public Health Service Act (42 U.S.C. 
242k) is amended— 
(1) in subsection (m), by adding at the end the following: 
"(4)(A) Subject to subparagraph (B), the Secretary, acting 
through the Center, shall collect data on Hispanics and major 
Hispanic subpopulation groups and American Indians, and for 
developing special area population studies on major Asian American 
and Pacific Islander populations. 
"(B) The provisions of subparagraph (A) shall be effective with 
respect to a fiscal year only to the extent that funds are appro-
priated pursuant to paragraph (3) of subsection (n), and only if 
the amounts appropriated for such fiscal year pursuant to each 
of paragraphs (1) and (2) of subsection (n) equal or exceed the 
amounts so appropriated for fiscal year 1997."; 
(2) in subsection (n)(l), by striking "through 1998" and 
inserting "through 2003"; and 
(3) in subsection (n)— 
(A) in the first sentence of paragraph (2)— 
(i) by striking "authorized in subsection (m)" and 
inserting "authorized in paragraphs (1) through (3) 
of subsection (m)"; and 
(ii) by striking "$5,000,000" and all that follows 
through the period and inserting "such sums as may 
be necessary for each of the fiscal years 1999 through 
2003."; and 
(B) by adding at the end the following: 
"(3) For activities authorized in subsection (m)(4), there are 
authorized to be appropriated $1,000,000 for fiscal year 1998, and 
such sums as may be necessary for each of the fiscal years 1999 
through 2002.". 
(c) MISCELLANEOUS AMENDMENTS.—Section 1707 of the Public 
Health Service Act (42 U.S.C. 300u-6) is amended— 
(1) in the heading for the section by striking "ESTABLISH-
MENT OF"; and 
(2) in subsection (a), by striking "Office of the Assistant 
Secretary for Health" and inserting "Office of Public Health 
and Science". 
TITLE III—SELECTED INITIATIVES 
SEC. 301. STATE OFFICES OF RURAL HEALTH. 
Section 338J of the Public Health Service Act (42 U.S.C. 254r) 
is amended— 
(1) in subsection (b)(1), in the matter preceding subpara-
graph (A), by striking "in cash"; and 
(2) in subsection (j)(l)— 
(A) by striking "and" after "1992,"; and 
(B) by inserting before the period the following: 
", and such sums as may be necessary for each of the 
fiscal years 1998 through 2002"; and 
(3) in subsection (k), by striking "$10,000,000" and inserting 
"$36,000,000". 
112 STAT. 3586 
PUBLIC LAW 105-392—NOV. 13, 1998 
SEC. 302. DEMONSTRATION PROJECTS REGARDING ALZHEIMER'S DIS-
EASE. 
(a) IN GENERAL.—Section 398(a) of the Public Health Service 
Act (42 U.S.C. 280c-3(a)) is amended— 
(1) in the matter preceding paragraph (1), by striking "not 
less than 5, and not more than 15,"; 
(2) in paragraph (2)— 
(A) by inserting after "disorders" the following: "who 
are living in single family homes or in congregate settings"; 
and 
(B) by striking "and" at the end; 
(3) by redesignating paragraph (3) as paragraph (4); and 
(4) by inserting after paragraph (2) the following: 
"(3) to improve the access of such individuals to home-
based or community-based long-term care services (subject to 
the services being provided by entities that were providing 
such services in the State involved as of October 1, 1995), 
particularly such individuals who are members of racial or 
ethnic minority groups, who have limited proficiency in speak-
ing the English language, or who live in rural areas; and". 
(b) DURATION.—Section 398A of the Public Health Service Act 
(42 U.S.C. 280C-4) is amended— 
(1) in the heading for the section, by striking "LIMITA-
TION" and all that follows and inserting "REQUIREMENT 
OF MATCHING FUNDS"; 
(2) by striking subsection (a); 
(3) by redesignating subsections (b) and (c) as subsections 
(a) and (b), respectively; and 
(4) in subsection (a) (as so redesignated), in each of para-
graphs (1)(C) and (2)(C), by striking "third year" and inserting 
"third or subsequent year". 
(c) AUTHORIZATION OF APPROPRIATIONS.—Section 398B(e) of the 
Public Health Service Act (42 U.S.C. 280c-5(e)) is amended— 
(1) by striking "and such sums" and inserting "such sums"; 
and 
(2) 
by 
inserting 
before 
the 
period 
the 
following: 
", $8,000,000 for fiscal year 1998, and such sums as may 
be necessary for each of the fiscal years 1999 through 2002". 
SEC. 303. PROJECT GRANTS FOR IMMUNIZATION SERVICES. 
Section 317(j) of the Public Health Service Act (42 U.S.C. 
247b(j)) is amended— 
(1) in paragraph (1), by striking "individuals against vac-
cine-preventable diseases" and all that follows through the 
first period and inserting the following: "children, adolescents, 
and adults against vaccine-preventable diseases, there are 
authorized to be appropriated such sums as may be necessary 
for each of the fiscal years 1998 through 2002."; and 
(2) in paragraph (2), by striking "1990" and inserting 
"1997". 
PUBLIC LAW 105-392—NOV. 13, 1998 
112 STAT. 3587 
TITLE IV—MISCELLANEOUS 
PROVISIONS 
SEC. 401. TECHNICAL CORRECTIONS REGARDING PUBLIC LAW 103-
183. 
(a) AMENDATORY INSTRUCTIONS.—Public Law 103-183 is 
amended— 
(1) in section 601— 
(A) in subsection (b), in the matter preceding paragraph 
(1), by striking "Section 1201 of the PubUc Health Service 
Act (42 U.S.C. 300d)" and inserting "Title XII of the Public 
Health Service Act (42 U.S.C. 300d et seq.)"; and 
(B) in subsection (f)(1), by striking "in section 1204(c)" 
and inserting "in section 1203(c) (as redesignated by sub-
section (b)(2) of this section)"; 
(2) in section 602, by striking "for the purpose" and insert-
ing "For the purpose"; and 
(3) in section 705(b), by striking "317D((1)(1)" and inserting 
"317D(1)(1)". 
(b) PUBLIC HEALTH SERVICE ACT.—^The Public Health Service 
Act, as amended by Public Law 103-183 and by subsection (a) 
of this section, is amended— 
(1) in section 317E(g)(2), by striking "making grants under 
subsection (b)" and inserting "carrying out subsection (b)"; 
(2) in section 318, in subsection (e) as in effect on the 
day before the date of the enactment of Public Law 103-
183, by redesignating the subsection as subsection (f); 
(3) in subpart 6 of part C of title IV— 
(A) by transferring the first section 447 (added by 
section 302 of Public Law 103-183) from the current place-
ment of the section; 
(B) by redesignating the section as section 447A; and 
(C) by inserting the section after section 447; 
(4) in section 1213(a)(8), by striking "provides for for" and 
inserting "provides for"; 
(5) in section 1501, by redesignating the second subsection 
(c) (added by section 101(JD of Public Law 103-183) as subsection 
(d); and 
(6) in section 1505(3), by striking "nonprofit". 
(c) MISCELLANEOUS CORRECTION.—Section 401(c)(3) of Public 
Law 103-183 is amended in the matter preceding subparagraph 
(A) by striking "(d)(5)" and inserting "(e)(5)". 
(d) CONFORMING AMENDMENT.—Section 308(b) of the Public 
Health Service Act (42 U.S.C. 242m(b)) is amended— 
(1) in paragraph (2)(A), by striking "306(n)" and inserting 
"306(m)"; and 
(2) in paragraph (2)(C), by striking "306(n)" and inserting 
"306(m)". 
(e) EFFECTIVE DATE.—^This section is deemed to have taken 
effect immediately after the enactment of Public Law 103-183. 
SEC. 402. MISCELLANEOUS AMENDMENTS REGARDING PHS COMMIS-
SIONED OFFICERS. 
42 u s e 300d-l— 
300d-3. 
42 u s e 300d-3. 
42 u s e 300d-32. 
42 u s e 247b-5. 
42 u s e 247b-6. 
42 u s e 247c. 
42 u s e 285f-2. 
42 u s e 300d-13. 
42 u s e 300k. 
42 u s e 300n-l. 
42 u s e 247c." 
42 u s e 242m 
note. 
(a) ANTI-DISCRIMINATION LAWS.-
lic Health Service Act (42 U.S.C. 
new subsection at the end thereof: 
-Amend section 212 of the Pub-
213) by adding the following 
112 STAT. 3588 
PUBLIC LAW 105-392—NOV. 13, 1998 
"(f) Active service of commissioned officers of the Service shall 
be deemed to be active military service in the Armed Forces of 
the United States for purposes of all laws related to discrimination 
on the basis of race, color, sex, ethnicity, age, religion, and disabil-
ity.". 
(b) TRAINING IN LEAVE WITHOUT PAY STATUS.—Section 218 
of the Public Health Service Act (42 U.S.C. 218a) is amended 
by adding at the end the following: 
"(c) A commissioned officer may be placed in leave without 
pay status while attending an educational institution or training 
program whenever the Secretary determines that such status is 
in the best interest of the Service. For purposes of computation 
of basic pay, promotion, retirement, compensation for injury or 
death, and the benefits provided by sections 212 and 224, an officer 
in such status pursuant to the preceding sentence shall be consid-
ered as performing service in the Service and shall have an active 
service obligation as set forth in subsection (b) of this section.". 
(c) UTILIZATION OF ALCOHOL AND DRUG ABUSE RECORDS THAT 
APPLY TO THE ARMED FORCES.—Section 543(e) of the Public Health 
Service Act (42 U.S.C. 290dd-2(e)) is amended by striking "Armed 
Forces" each place that such term appears and inserting "Uniformed 
Services". 
SEC. 403. CUNICAL TRAINEESHIPS. 
Section 303(d)(1) of the Public Health Service Act (42 U.S.C. 
242a(d)(l)) is amended by inserting "counseling," after "family ther-
apy,". 
SEC. 404. PROJECT GRANTS FOR SCREENINGS, REFERRALS, AND EDU-
CATION REGARDING LEAD POISONING. 
Section 317A(1)(1) of the Public Health Service Act (42 U.S.C. 
247b-l(l)(l)) is amended by striking "1998" and inserting "2002". 
SEC. 4
0
5
. 
PROJECT GRANTS FOR 
PREVENTIVE HEALTH SERVICES 
REGARDING 
TUBERCULOSIS. 
Section 317E(g) of the Public Health Service Act (42 U.S.C. 
247b-6(g)(l)) is amended— 
(1) in paragraph (1)— 
(A) in subparagraph (A), by striking "1998" and insert-
ing "2002"; and 
(B) in subparagraph (B), by striking "$50,000,000" and 
inserting "25 percent"; and 
(2) in paragraph (2), by striking "1998" and inserting 
"2002". 
SEC. 406. CDC LOAN REPAYMENT PROGRAM. 
Section 317F of the Public Health Service Act (42 U.S.C. 247b-
7) is amended— 
(1) in subsection (a)(1), by striking "$20,000" and inserting 
"$35,000"; 
(2) in subsection (c), by striking "1998" and inserting 
"2002"; and 
(3) by adding at the end the following: 
"(d) AVAILABILITY OF APPROPRIATIONS.—^Amounts appropriated 
for a fiscal year for contracts under subsection (a) shall remain 
available until the expiration of the second fiscal year beginning 
after the fiscal year for which the amounts were appropriated.". 
PUBLIC LAW 105-392—NOV. 13, 1998 
112 STAT. 3589 
SEC. 407. COMMUNITY PROGRAMS ON DOMESTIC VIOLENCE. 
(a) IN GENERAL.—Section 318(h)(2) of the Family Violence 
Prevention and Services Act (42 U.S.C. 10418(h)(2)) is amended 
by striking "fiscal year 1997" and inserting "for each of the fiscal 
years 1997 through 2002". 
(b) STUDY.—^The Secretary of Health and Human Services shall 
42 USC 10401 
request that the Institute of Medicine conduct a study concerning "ote. 
the training needs of health professionals with respect to the detec-
tion and referral of victims of family or acquaintance violence. 
Not later than 2 years after the date of enactment of this Act, 
the Institute of Medicine shall prepare and submit to Congress 
a report concerning the study conducted under this subsection. 
SEC. 408. STATE LOAN REPAYMENT PROGRAM. 
Section 338I(i)(l) of the Public Health Service Act (42 U.S.C. 
254q-l(i)(l)) is amended by inserting before the period ", and such 
sums as may be necessary for each of the fiscal years 1998 through 
2002". 
SEC. 409. AUTHORITY OF THE DIRECTOR OF NIH. 
Section 402(b) of the Public Health Service Act (42 U.S.C. 
282(b)) is amended— 
(1) in paragraph (11), by striking "and" at the end thereof; 
(2) in paragraph (12), by striking the period and inserting 
a semicolon; and 
(3) by adding after paragraph (12), the following new para-
graphs: 
"(13) may conduct and support research training— 
"(A) for which fellowship support is not provided under 
section 487; and 
"(B) which does not consist of residency training of 
physicians or other health professionals; and 
"(14) may appoint physicians, dentists, and other health 
care professionals, subject to the provisions of title 5, United 
States Code, relating to appointments and classifications in 
the competitive service, and may compensate such professionals 
subject to the provisions of chapter 74 of title 38, United States 
Code.". 
SEC. 410. RAISE IN MAXIMUM LEVEL OF LOAN REPAYMENTS. 
(a) REPAYMENT PROGRAMS WiTH RESPECT TO AIDS.—Section 
487A of the Public Health Service Act (42 U.S.C. 288-1) is 
amended— 
(1) in subsection (a), by striking "$20,000" and inserting 
"$35,000"; and 
(2) in subsection (c), by striking "1996" and inserting 
"2001". 
(b) REPAYMENT PROGRAMS WITH RESPECT TO CONTRACEPTION 
AND INFERTILITY.—Section 487B(a) of the Public Health Service 
Act (42 U.S.C. 288-2(a)) is amended by striking "$20,000" and 
inserting "$35,000". 
(c) REPAYMENT PROGRAMS WITH RESPECT TO RESEARCH GEN-
ERALLY.—Section 487C(a)(l) of the Public Health Service Act (42 
U.S.C. 288-3(a)(l)) is amended by striking "$20,000" and inserting 
"$35,000". 
(d) 
REPAYMENT 
PROGRAMS 
WITH 
RESPECT 
TO 
CLINICAL 
RESEARCHERS 
FROM 
DISADVANTAGED 
BACKGROUNDS.—Section 
112 STAT. 3590 
PUBLIC LAW 105-392—NOV. 13, 1998 
487E(a) of the Public Health Service Act (42 U.S.C. 288-5(a)) is 
amended— 
(1) in paragraph (1), by striking "$20,000" and inserting 
"$35,000"; and 
(2) in paragraph (3), by striking "338C" and inserting 
"338B, 338C". 
SEC. 
411. 
CONSTRUCTION 
OF 
REGIONAL 
CENTERS 
FOR 
RESEARCH 
ON 
PRIMATES. 
Section 481B(a) of the Public Health Service Act (42 U.S.C. 
287a-3(a)) is amended— 
(1) by striking "shall" and inserting "may"; and 
(2) by 
striking 
"$5,000,000" and 
inserting 
"up to 
$2,500,000". 
SEC. 412. PEER REVIEW. 
Section 504(d)(2) of the Public Health Service Act (42 U.S.C. 
290aa-3(d)(2)) is amended by striking "cooperative agreement, or 
contract" each place that such term appears and inserting "or 
cooperative agreement". 
SEC. 
413. 
FUNDING 
FOR 
TRAUMA 
CARE. 
Section 1232(a) of the Public Health Service Act (42 U.S.C. 
300d-32) is amended by striking "and 1996" and inserting "through 
2002". 
SEC. 
414. 
HEALTH 
INFORMATION 
AND 
HEALTH 
PROMOTION. 
Section 1701(b) of the Pubhc Health Service Act (42 U.S.C. 
300u(b)) is amended by striking "through 1996" and inserting 
"through 2002". 
SEC. 415. EMERGENCY MEDICAL SERVICES FOR CHILDREN. 
Section 1910 of the Public Health Service Act (42 U.S.C. 300w-
9) is amended— 
(1) in subsection (a)— 
(A) by striking "two-year period" and inserting "3-year 
period (with an optional 4th year based on performance)"; 
and 
(B) by striking "one grant" and inserting "3 grants"; 
and 
(2) in subsection (d), by striking "1997" and inserting 
"2005". 
SEC. 416. ADMINISTRATION OF CERTAIN REQUIREMENTS. 
(a) IN GENERAL.—Section 2004 of Public Law 103-43 (107 
42 use 238f 
Stat. 209) is amended by striking subsection (a). 
note. 
(b) CONFORMING AMENDMENTS.—Section 2004 of Public Law 
103-43, as amended by subsection (a) of this section, is amended— 
(1) by striking "(b) SENSE" and all that follows through 
"In the case" and inserting the following: 
"(a) SENSE OF CONGRESS REGARDING PURCHASE OF AMERICAN-
MADE EQUIPMENT AND PRODUCTS.—In the case"; 
(2) by striking "(2) NOTICE TO RECIPIENTS OF ASSISTANCE" 
and inserting the following: 
"(b) NOTICE TO RECIPIENTS OF ASSISTANCE"; and 
(3) in subsection (b), as redesignated by paragraph (2) 
of this subsection, by striking "paragraph (1)" and inserting 
"subsection (a)". 
PUBLIC LAW 105-392—NOV. 13, 1998 
112 STAT. 3591 
(c) EFFECTIVE DATE.—^This section is deemed to have taken 
effect immediately after the enactment of Public Law 103-43. 
SEC. 417. AIDS DRUG ASSISTANCE PROGRAM. 
Section 2618(b)(3) of the Public Health Service Act (42 U.S.C. 
300ff-28(b)(3)) is amended— 
(1) in subparagraph (A), by striking "and the Common-
wealth of Puerto Rico" and inserting ", the Commonwealth 
of Puerto Rico, the Virgin Islands, and Guam"; and 
(2) in subparagraph (B), by striking "the Virgin Islands, 
Guam". 
SEC. 418. NATIONAL FOUNDATION FOR BIOMEDICAL RESEARCH. 
Part I of title IV of the Public Health Service Act (42 U.S.C. 
290b et seq.) is amended— 
(1) by striking the part heading and inserting the following: 
"PART I—FOUNDATION FOR THE NATIONAL 
INSTITUTES OF HEALTH"; 
and 
(2) in section 499— 
(A) in subsection (a), by striking "National Foundation 
for Biomedical Research" and inserting "Foundation for 
the National Institutes of Health"; 
(B) in subsection (k)( 10)— 
(i) by striking "not"; and 
(ii) by adding at the end the following: "Any funds 
transferred under this paragraph shall be subject to 
all Federal limitations relating to federally-funded 
research."; and 
(C) in subsection (m)(l), by striking "$200,000" and 
all that follows through "1995" and inserting "$500,000 
for each fiscal year". 
SEC. 419. FETAL ALCOHOL SYNDROME PREVENTION AND SERVICES. 
(a) SHORT TITLE.—^This section may be cited as the "Fetal 
Alcohol Syndrome and Fetal Alcohol Effect Prevention and Services 
Act". 
(b) FINDINGS.—Congress finds that— 
(1) Fetal Alcohol Syndrome is the leading preventable cause 
of mental retardation, and it is 100 percent preventable; 
(2) estimates on the number of children each year vary, 
but according to some researchers, up to 12,000 infants are 
born in the United States with Fetal Alcohol Syndrome, suffer-
ing irreversible physical and mental damage; 
(3) thousands more infants are born each year with Fetal 
Alcohol Effect, also known as Alcohol Related Neurobehavioral 
Disorder (ARND), a related and equally tragic syndrome; 
(4) children of women who use alcohol while pregnant 
have a significantly higher infant mortality rate (13.3 per 1,000) 
than children of those women who do not use alcohol (8.6 
per 1,000); 
(5) Fetal Alcohol Syndrome and Fetal Alcohol Effect are 
national problems which can impact any child, family, or 
community, but their threat to American Indians and Alaska 
Natives is especially alarming; 
42 u s e 238f 
note. 
42 u s e 290b. 
Fetal Alcohol 
Syndrome and 
Fetal Alcohol 
EfTect Prevention 
and Services Act. 
42 u s e 201 note. 
42 u s e 280f 
note. 
59-194 O - 98 - 27 : QL 3 Part 5 
112 STAT. 3592 
PUBLIC LAW 105-392—NOV. 13, 1998 
(6) in some American Indian communities, where alcohol 
dependency rates reach 50 percent and above, the chances 
of a newborn suffering Fetal Alcohol Syndrome or Fetal Alcohol 
Effect are up to 30 times greater than national averages; 
(7) in addition to the immeasurable toll on children and 
their families, Fetal Alcohol Syndrome and Fetal Alcohol Effect 
pose extraordinary financial costs to the Nation, including the 
costs of health care, education, foster care, job training, and 
general support services for affected individuals; 
(8) the total cost to the economy of Fetal Alcohol Syndrome 
was approximately $2,500,000,000 in 1995, and over a lifetime, 
health care costs for one Fetal Alcohol Syndrome child are 
estimated to be at least $1,400,000; 
(9) researchers have determined that the possibility of giv-
ing birth to a baby with Fetal Alcohol Syndrome or Fetal 
Alcohol Effect increases in proportion to the amount and fre-
quency of alcohol consumed by a pregnant woman, and that 
stopping alcohol consumption at any point in the pregnancy 
reduces the emotional, physical, and mental consequences of 
alcohol exposure to the baby; and 
(10) though approximately 1 out of every 5 pregnant women 
drink alcohol during their pregnancy, we know of no safe dose 
of alcohol during pregnancy, or of any safe time to drink during 
pregnancy, thus, it is in the best interest of the Nation for 
the Federal Government to take an active role in encouraging 
all women to abstain from alcohol consumption during preg-
nancy. 
(c) PURPOSE.—It is the purpose of this section to establish, 
within the Department of Health and Human Services, a com-
prehensive program to help prevent Fetal Alcohol Syndrome and 
Fetal Alcohol Effect nationwide and to provide effective intervention 
programs and services for children, adolescents and adults already 
affected by these conditions. Such program shall— 
(1) coordinate, support, and conduct national. State, and 
community-based public awareness, prevention, and education 
programs on Fetal Alcohol Syndrome and Fetal Alcohol Effect; 
(2) coordinate, support, and conduct prevention and inter-
vention studies as well as epidemiologic research concerning 
Fetal Alcohol Syndrome and Fetal Alcohol Effect; 
(3) coordinate, support and conduct research and dem-
onstration projects to develop effective developmental and 
behavioral interventions and programs that foster effective 
advocacy, educational and vocational training, appropriate 
therapies, counseling, medical and mental health, and other 
supportive services, as well as models that integrate or coordi-
nate such services, aimed at the unique challenges facing 
individuals with Fetal Alcohol Syndrome or Fetal Alcohol Effect 
and their families; and 
(4) foster coordination among all Federal, State and local 
agencies, and promote partnerships between research institu-
tions and communities that conduct or support Fetal Alcohol 
Syndrome and Fetal Alcohol Effect research, programs, surveil-
lance, prevention, and interventions and otherwise meet the 
general needs of populations already affected or at risk of 
being impacted by Fetal Alcohol Syndrome and Fetal Alcohol 
Effect. 
PUBLIC LAW 105-392—NOV. 13, 1998 
112 STAT. 3593 
(d) ESTABLISHMENT OF PROGRAM.—Title III of the Public Health 
Service Act (42 U.S.C. 241 et seq.) is amended by adding at the 
end the following: 
"PART O—FETAL ALCOHOL SYNDROME 
PREVENTION AND SERVICES PROGRAM 
"SEC. 399G. ESTABLISHMENT OF FETAL ALCOHOL SYNDROME PREVEN- 
42 USC 280f. 
TION AND SERVICES PROGRAM. 
"(a) 
FETAL ALCOHOL SYNDROME PREVENTION, INTERVENTION 
AND SERVICES DELIVERY PROGRAM.—^The Secretary shall establish 
a comprehensive Fetal Alcohol Syndrome and Fetal Alcohol Effect 
prevention, intervention and services delivery program that shall 
include— 
"(1) an education and public awareness program to support, 
conduct, and evaluate the effectiveness of— 
"(A) educational programs targeting medical schools, 
social and other supportive services, educators and coun-
selors and other service providers in all phases of childhood 
development, and other relevant service providers, concern-
ing the prevention, identification, and provision of services 
for children, adolescents and adults with Fetal Alcohol 
Syndrome and Fetal Alcohol Effect; 
"(B) strategies to educate school-age children, including 
pregnant and high risk youth, concerning Fetal Alcohol 
Syndrome and Fetal Alcohol Effect; 
"(C) public and community 
awareness 
programs 
concerning Fetal Alcohol Syndrome and Fetal Alcohol 
Effect; and 
"(D) strategies to coordinate information and services 
across affected community agencies, including agencies 
providing social services such as foster care, adoption, and 
social work, medical and mental health services, and agen-
cies involved in education, vocational training and civil 
and criminal justice; 
"(2) a prevention and diagnosis program to support clinical 
studies, demonstrations and other research as appropriate to— 
"(A) develop appropriate medical diagnostic methods 
for identifying Fetal Alcohol Syndrome and Fetal Alcohol 
Effect; and 
"(B) develop effective prevention services and interven-
tions for pregnant, alcohol-dependent women; and 
"(3) an applied research program concerning intervention 
and prevention to support and conduct service demonstration 
projects, clinical studies and other research models providing 
advocacy, educational and vocational training, counseling, medi-
cal and mental health, and other supportive services, as well 
as models that integrate and coordinate such services, that 
are aimed at the unique challenges facing individuals with 
Fetal Alcohol Syndrome or Fetal Alcohol Effect and their fami-
lies. 
"(b) GRANTS AND TECHNICAL ASSISTANCE.—^The Secretary may 
award grants, cooperative agreements and contracts and provide 
technical assistance to eligible entities described in section 399H 
to carry out subsection (a). 
"(c) DISSEMINATION OF CRITERIA.—In carrying out this section, 
the Secretary shall develop a procedure for disseminating the Fetal 
112 STAT. 3594 
PUBLIC LAW 105-392—NOV. 13, 1998 
Alcohol Syndrome and Fetal Alcohol Effect diagnostic criteria devel-
oped pursuant to section 705 of the ADAMHA Reorganization Act 
(42 U.S.C. 485n note) to health care providers, educators, social 
workers, child welfare workers, and other individuals. 
"(d) NATIONAL TASK FORCE.— 
"(1) IN GENERAL.—^The Secretary shall establish a task 
force to be known as the National Task Force on Fetal Alcohol 
Syndrome and Fetal Alcohol Effect (referred to in this sub-
section as the 'Task Force') to foster coordination among all 
governmental agencies, academic bodies and community groups 
that conduct or support Fetal Alcohol Syndrome and Fetal 
Alcohol Effect research, programs, and surveillance, and other-
wise meet the general needs of populations actually or poten-
tially impacted by Fetal Alcohol Syndrome and Fetal Alcohol 
Effect. 
"(2) MEMBERSHIP.—^The Task Force established pursuant 
to paragraph (1) shall— 
"(A) be chaired by an individual to be appointed by 
the Secretary and staffed by the Administration; and 
"(B) include the Chairperson of the Interagency Coordi-
nating Committee on Fetal Alcohol Syndrome of the 
Department of Health and Human Services, individuals 
with Fetal Alcohol Syndrome and Fetal Alcohol Effect, and 
representatives from advocacy and research organizations 
such as the Research Society on Alcoholism, the FAS Fam-
ily Resource Institute, the National Organization of Fetal 
Alcohol Syndrome, the Arc, the academic community, and 
Federal, State and local government agencies and offices. 
"(3) FUNCTIONS.—The Task Force shall— 
"(A) advise Federal, State and local programs and 
research concerning Fetal Alcohol Syndrome and Fetal 
Alcohol Effect, including programs and research concerning 
education and public awareness for relevant service provid-
ers, school-age children, women at-risk, and the general 
public, medical diagnosis, interventions for women at-risk 
of giving birth to children with Fetal Alcohol Syndrome 
and Fetal Alcohol Effect, and beneficial services for individ-
uals with Fetal Alcohol Syndrome and Fetal Alcohol Effect 
and their families; 
"(B) coordinate its efforts with the Interagency Coordi-
nating Committee on Fetal Alcohol Syndrome of the 
Department of Health and Human Services; and 
"(C) report on a biennial basis to the Secretary and 
relevant committees of Congress on the current and 
planned activities of the participating agencies. 
"(4) TIME FOR APPOINTMENT.—^The members of the Task 
Force shall be appointed by the Secretary not later than 6 
months after the date of enactment of this part. 
42 use 280f-l. 
"SEC. 399H. ELIGIBILITY. 
"To be eligible to receive a grant, or enter into a cooperative 
agreement or contract under this part, an entity shall— 
"(1) be a State, Indian tribal government, local government, 
scientific or academic institution, or nonprofit organization; 
and 
"(2) prepare and submit to the Secretary an application 
at such time, in such manner, and containing such information 
PUBLIC LAW 105-392—NOV. 13, 1998 
112 STAT. 3595 
as the Secretary may prescribe, including a description of the 
activities that the entity intends to carry out using amounts 
received under this part. 
"SEC. 3991. AUTHORIZATION OF APPROPRIATIONS. 
42 USC 280f-2. 
"(a) IN GENERAL.—^There are authorized to be appropriated 
to carry out this part, $27,000,000 for each of the fiscal years 
1999 through 2003. 
"(b) TASK FORCE.—From amounts appropriated for a fiscal year 
under subsection (a), the Secretary may use not to exceed $2,000,000 
of such amounts for the operations of the National Task Force 
under section 399G(d). 
"SEC. 399J. SUNSET PROVISION. 
42 USC 280f-3. 
'This part shall not apply on the date that is 7 years after 
the date on which all members of the National Task Force have 
been appointed under section 399G(d)(l).". 
Approved November 13, 1998. 
LEGISLATIVE HISTORY—S. 1754: 
SENATE REPORTS: No. 105-220 (Comm. on Labor and Human Resources). 
CONGRESSIONAL RECORD, Vol. 144 (1998): 
July 31, considered and passed Senate. 
Oct. 13, considered and passed House, amended. 
Oct. 14, Senate concurred in House amendment.