Health Omnibus Extension of 1988
PL 100-607 (S.2889), enacted 11/04/1988

102 STAT. 3048 
PUBLIC LAW 100-607—NOV. 4, 1988 
Public Law 100-607 
100th Congress 
An Act 
Nov. 4, 1988 
[S. 2889] 
Health Omnibus 
Programs 
Extension of 
1988 
42 u s e 201 note. 
National 
Institute on 
Deafness and 
Other 
Communication 
Disorders and 
Health 
Research 
Extension Act 
of 1988. 
42 u s e 201 
note. 
To amend the Public Health Service Act to establish certain health programs, 
to revise and extend certain health 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 TITLES. 
(a) SHORT TITLE.—^This Act may be cited as the "Health Omnibus 
Programs Extension of 1988". 
0») TABLE OF TITLES.— 
Title I—^National Institute on Deafness and Other Communication Disorders and 
Health Research Extension Act of 1988 
Title n—^Programs with Respect to Acquired Immune Deficiency Syndrome 
Title ni—^PrevNitive Health, Health Services, and Health Promotion 
Title IV—Organ Transplant Amendments of 1988 
Title V—Food and Drug Administration 
Title VI—Health Professions Reauthorization Act of 1988 
Title Vn—Nursing Shortage Reduction and Education Extension Act of 1988 
Title Vm—^Revision and Extension of Programs of Health Care for the Homeless 
Title IX—Testing of Convicted Felons 
TITLE I—NATIONAL INSTITUTE ON DEAF-
NESS AND OTHER 
COMMUNICATION 
DISORDERS AND HEALTH RESEARCH 
EXTENSION ACT OF 1988 
SEC 100. SHORT TITLE; REFERENCES. 
(a) SHORT TITLE.—^This title may be cited as the "National In-
stitute on Deafness and Other Communication Disorders and Health 
Research Extension Act of 1988". 
(b) REFERENCES TO PUBUC HEALTH SERVICE ACT.—Except as other-
wise specifioedly provided, any reference made in this title to an 
amendment or repeal of a section or other provision shall be consid-
ered to be made to a section or other provision of the Public Health 
Service Act (42 U.S.C. 201 et seq.). 
Subtitle A—^National Institute on Deafness and 
Other Communication Disorders 
SEC 101. ESTABLISHMENT AND TRANSFER OF FUNCTIONS. 
Title IV (42 U.S.C. 281 et seq.) is amended— 
42 use 281. 
(1) in section 401(bXl)— 
(A) by striking "and Communicative" in subparagraph 
(J); and 
(B) by adding at the end the following new subparagraph: 
PUBLIC LAW 100-607—NOV. 4, 1988 
102 STAT. 3049 
''(M) The National Institute on Deafness and Other Commu-
nication Disorders.'^ 
(2) in the heading for subpart 10 of part C, by striking "and 
Communicative"; 
(3) in section 457— 
(A) by striking "and Communicative"; and 
(B) by striking "disorder, stroke/' and all that follows and 
inserting "and disorder and stroke."; and 
(4) in Part C, by adding at the end the following new subpart: 
"Subpart 13—^National Institute on Deafiiess and Other 
Communication Disorders 
42 u s e 285j. 
PURPOSE OF THE INSTITUTE 
"SEC. 464. The general purpose of the National Institute on Deaf- Research and 
ness and Other Communication Disorders (hereafter referred to in development. 
this subpart as the 'Institute') is the conduct and support of research ^^ ^ ^ 2
^
^
™
-
and training, the dissemination of health information, and other 
programs with respect to disorders of hearing and other communica-
tion processes, including diseases afiTecting hearing, balance, voice, 
speech, language, taste, and smell. 
"NATIONAL DEAFNESS AND OTHER COMMUNICATION DISORDERS 
PROGRAM 
"SEC. 464A. (a) The Director of the Institute, with the advice of the 42 use 285m-i. 
Institute's advisory council, shall establish a National Deafness and 
Other Communication Disorders Pn^^:am (hereafter in this section 
referred to as the 'Program'). The Director or the Institute shall, 
with respect to the Program, prepare and transmit to the Director of 
NIH a plan to initiate, eiq>and, intensify and coordinate activities of 
the Institute respecting diisorders of hearing (including tinnitus) and 
other communication processes, including diseases affecting hear-
ing, balance, voice, speech, language, taste, and smell. The plan 
shidl include such comments and recommendations as the Director 
of the Institute determines appropriate. The Director of the In-
stitute shall periodically review and revise the plan and shall 
transmit any revisions of the plan to the Director of NIH. 
"(b) Activities under the Program shall include— 
"(1) investigation into the etiology, pathology, detection, treat-
ment^ and prevention of all forms of disorders of hearing and 
other communication processes, primarily through the support 
of basic research in such areas as anatomy, audiol(^y, bio-
chemistiy, bioengineering, epidemiology, genetics, immunol<%y, 
microbiology, molecular biol(^y, the neurosciences, otolaryngol-
ogy, psychology, pharmacology, physiology, speech and lan-
guage pathology, and any other scientific disciplines that can 
contribute importemt knowledge to the understanding and 
elimination of disorders of hearing and other communication 
processes; 
"(2) research into the evaluation of techniques (including 
surgical, medical, and behavioral approaches) and devices 
(including hearing aids, implanted aucutory and nonauditory 
prosthetic devices and other communication aids) used in diag-
nosis, treatment, rehabiUtation, and prevention of disorders of 
hearing and other communication processes; 
102 STAT. 3050 
PUBLIC LAW 100-607—NOV. 4, 1988 
Research and 
"(3) research into prevention, and early detection and di£ig-
deveiopment. 
nosis, of hearing loss and speech and langu£^e disturb£uices 
(including stuttering) and research into preventing the effects of 
such disorders on learning and learning disabilities with exten-
sion of programs for appropriate referral and rehabilitation; 
"(4) research into the detection, treatment, and prevention of 
disorders of hearing and other communication processes in the 
growing elderly population with extension of rehabilitative pro-
grams to ensure continued effective communication skills in 
such population; 
"(5) research to expand knowledge of the effects of environ-
mental agents that influence hearing or other communication 
processes; and 
"(6) developing and facilitating intramural programs on clini-
cal and fundamental aspects of disorders of hearing and all 
other communication processes. 
"DATA SYSTEM AND INFORMATION CLEARINGHOUSE 
42 use 285m-2. 
"SEC. 464B. (a) The Director of the Institute shall establish a 
National Deafness and Other Communication Disorders Data 
System for the collection, storage, analysis, retrieval, and dissemina-
tion of data derived from patient populations with disorders of 
hearing or other communication processes, including where pos-
sible, data involving general populations for the purpose of identify-
ing individuals at risk of developing such disorders. 
db) The Director of the Institute shall establish a National Deaf-
ness and Other Ck)mmunication Disorders Information Clearing-
house to facilitate and enhance, through the effective dissemination 
of information, knowledge and understanding of disorders of hear-
ing and other communication processes by health professionals, 
patients, industry, and the public. 
"MULTIPURPOSE DEAFNESS AND OTHER COMMUNICATION DISORDERS 
CENTER 
42 use 285m-3. 
"SEC. 464C. (a) The Director of the Institute shall, after consulta-
tion with the advisory council for the Institute, provide for the 
development, modernization, and operation (including care required 
for research) of new and existing centers for studies of disorders of 
hearing and other communication processes. For purposes of this 
section, the term 'modernization' means the alteration, remodeling, 
improvement, expansion, and repair of existing buildings and the 
provision of equipment for such buildings to the extent necessary to 
make them suitable for use as centers described in the preceding 
sentence. 
"(b) Each center assisted under this section shall— 
"(1) use the facilities of a single institution or a consortium of 
cooperating institutions; and 
"(2) meet such qualifications as may be prescribed by the 
Secretaiy. 
"(c) Each center assisted under this section shall, at least, 
conduct— 
"(1) basic and clinical research into the cause, diagnosis, early 
detection, prevention, control and treatment of disorders of 
hearing and other communication processes and complications 
resulting from such disorders, including research into rehabili-
PUBLIC LAW 100-607—NOV. 4, 1988 
102 STAT. 3051 
tative aids, implantable biomaterials, auditory speech proc-
essors, speech production devices, and other otolaryngologic 
procedures; 
"(2) training programs for physicians, scientists, and other 
health and allied health professionsds; 
"(3) information and continuing education programs for 
physicians and other health and allied health professionals who 
will provide care for patients with disorders of hearing or other 
communication processes; and 
"(4) programs for the dissemination to the general public of 
information— 
"(A) on the importance of early detection of disorders of 
hearing and other communication processes, of seeking 
prompt treatment, rehabilitation, and of following an 
appropriate regimen; and 
"(B) on the importance of avoiding exposure to noise and 
other environmental toxic agents that may affect disorders 
of hearing or other communication processes. 
"(d) A center may use funds provided under subsection (a) to 
provide stipends for health professionals enrolled in training pro-
grams described in subsection (cX2). 
"(e) Each center assisted under this section may conduct 
programs— 
"(1) to establish the effectiveness of new and improved meth-
ods of detection, referral, and diagnosis of individuals at risk of 
developing disorders of hearing or other communication proc-
esses; and 
"(2) to disseminate the results of research, screening, and 
other activities, and develop means of standardizing patient 
data and recordkeeping. 
"(f) The Director of the Institute shall, to the extent practicable, 
provide for an equitable geographical distribution of centers assisted 
under this section. The Director shall give appropriate consideration 
to the need for centers especially suited to meeting the needs of the 
elderly, and of children (particularly with respect to their education 
and training), affected by disorders of hearing or other communica-
tion processes. 
"(g) Support of a center under this section may be for a period not 
to exceed seven years. Such period may be extended by the Director 
of the Institute for one or more additional periods of not more than 
five years if the operations of such center have been reviewed by an 
appropriate technical and scientific peer review group established 
by the Director, with the advice of the Institute's advisory council, if 
such group has recommended to the Director that such period 
should be extended.". 
Health care 
professionals. 
Education. 
Aged persons. 
Children and 
youth. 
Subtitle B—Biotechnology Information 
SEC. 105. ESTABLISHMENT OF NATIONAL CENTER FOR BIOTECHNOLOGY 
INFORMATION. 
Part D of title IV (42 U.S.C. 286 et seq.) is amended by adding at 
the end the following new subpart: 
102 STAT. 3052 
PUBLIC LAW 100-607—NOV. 4, 1988 
Research and 
development. 
42 use 286c. 
Appropriation 
authorization. 
"Subpart 3—National Center for Biotechnology Information 
"PURPOSE, ESTABUSHMENT, FUNCTIONS, AND FUNDING OF THE 
NATIONAL CENTER FOR BIOTECHNOLOGY INFORMATION 
"SEC. 478. (a) In order to focus and expand the collection, storage, 
retrieval, and dissemination of the results of biotechnology research 
by information systems, and to support and enhance the develop-
ment of new information technologies to aid in the understanding of 
the molecular processes that control health and disease, there is 
established the National Center for Biotechnology Information 
(hereinafter in this section referred to as the 'Center') in the 
National Library of Medicine. 
"(b) The Secretary, through the Center and subject to section 
465(d), shall— 
"(1) design, develop, implement, and manage automated sys-
tems for the collection, storage, retrieval, analysis, and dissemi-
nation of knowledge concerning human molecular biology, bio-
chemistry, and genetics; 
"(2) perform research into advanced methods of computer-
based information processing capable of representing and 
analyzing the vast number of biologically important molecules 
and compounds; 
"(3) enable persons engaged in biotechnology research and 
medical care to use systems developed under paragraph (1) and 
methods described in paragraph (2); and 
"(4) coordinate, as much as is practicable, efforts to gather 
biotechnology information on an international basis. 
"(c) For the purpose of performing the duties specified in subsec-
tion (b), there are authorized to be appropriated $8,000,000 for fiscal 
year 1989 and such sums as may be necessary for fiscal year 1990. 
Funds appropriated under this subsection shall remain available 
until expended.". 
Subtitle C—National Institutes of Health 
SEC. 111. APPOINTMENT AND AUTHORITY OF THE DIRECTOR. 
Section 402(bX6) (42 U.S.C. 282(bX6)) is amended by inserting "and 
scientific program advisory committees" after "scientific peer 
review groups". 
SEC. 112. REPORT OF DIRECTOR OF NIH. 
Section 403 (42 U.S.C. 283) is amended— 
(1) in paragraph (3), by striking out "and"; 
(2) by redesignating paragraph (4) as paragraph (5); and 
(3) by inserting after paragraph (3), the following new 
paragraph: 
"(4) a description of the health related behavioral research 
that has been supported by the National Institutes of Health in 
the preceding 2-year period, and a description of any plans for 
future activity in such area; and". 
PUBLIC LAW 100-607—NOV. 4, 1988 
102 STAT. 3053 
Subtitle D—(general Provisions Respecting 
National Research Institutes 
SEC 116. APPOINTMENT AND AUTHORITY OF THE DIRECTORS. 
Section 405 (42 U.S.C. 284) is amended— 
(1) in subsection (b), in the matter preceding subparagraph (A) 
of paragraph (1), by striking ''the human diseases" and insert-
ing ''human diseases"; and 
(2) in subsection (c)— 
(A) by amending paragraph (3) to read as follows: 
"(3) may, in consultation with the advisory council for the 
Institute and the approval of the Director of NIH, establish 
technical and scient^c peer review groups in addition to those 
established under section 402(bX6); and"; 
(B) by striking "and" at the end of paragraph (2); and 
(C) by adding at the end the following new paragraph: 
"(4) may publish, or arrange for the publication of, informa-
tion with respect to the purpose of the Institute without r^ard 
to section 501 of titie 44, United States Code.". 
SEC 117. ADVISORY COUNCILS. 
(a) VOTING STATUS.—Section 406(bXl) (42 U.S.C. 284a(bXl)) is 
amended by adding at the end the following: "The ex officio mem-
bers shall be nonvoting members.". 
(b) APPOINTMENT OF MEMBERS.—Section 406(bX3XA) (42 U.S.C. 
284a(bX3XA)) is amended by inserting after "(including" the follow-
ing: "not less than two individuals who are l^uiers in the fields of. 
(c) TERMINATION OP MEMBERSHIPS.—Section 406(hX2XAXv) (42 
U.S.C. 284a(hX2XAXv)) is amended— 
(1) by inserting "shall be nonvoting members and" after "the 
Board ; and 
(2) by striking out "and the Assistant Secretary of Defense for 
Health Affairs and inserting in lieu thereof "the Assistant 
Secretary of Defense for Healtii Affairs, and the Director of the 
Office of Eneigy Research of the Department of Energy". 
SEC 118. AUTHORIZATION OF APPROPRIATIONS. 
(a) IN GENERAL.—Paragraphs (1) and (2) of section 408(a) (42 U.S.C. 
284c(a)) are amended to lead as follows: 
"(IXA) For tiie National Cancer Institute (other than its 
programs under section 412), there are authorized to be appro-
priated $1,500,000,000 for Gacal year 1989 and such sums as may 
be necessary for fiscal year 1990. 
"(B) For tiie programs under section 412, there are authorized 
to be appropriated $100,000,000 for fiscal year 1989 and sudi 
sums as may be necessary for 
fiscal 
year 1990. 
"(2XA) For the National Heart, Lung, and Blood Institute 
(other than its program under section 419), there are au^orized 
to be appropriated $1,100,000,000 for fiscal year 1989 and such 
sums as may be necessary for fiscal year 1990. Of the amounts 
appropriated for the National Heart, Lung, and Blood Institute 
(omer than its program under section 419) for a fiscal year, the 
Secretary shall make available not less than 15 percent for 
programs respecting diseases of the lung and not less than 15 
102 STAT. 3054 
PUBLIC LAW 100-607—NOV. 4, 1988 
percent for programs respecting blood diseases and blood 
resources. 
"(B) For the program of the National Heart, Lung, and Blood 
Institute under section 419 there is authorized to be appro-
priated $101,000,000 for Hscal year 1989 and such sums as may 
be necessary for fiscal year 1990.". 
(b) APPUCABILTTY OP CERTAIN PROVISIONS TO NURSES AND ALLIED 
HEALTH PROFESSIONALS.—Section 408(b) (42 U.S.C. 284c(b)) is 
amended by adding at the end the following new paragraph: 
"(5) For fiscal year 1989 and subsequent fiscal years, amounts 
made available to the National Institutes of Health shall be avail-
able for pa3maent of nurses and allied health professionals in accord-
ance with pajnnent authorities, scheduling options, benefits, and 
other authorities provided under chapter 73 of title 38, United 
States Code, for nurses of the Veterans' Administration.". 
Subtitle E—National Cancer Institute 
SEC. 121. PURPOSE. 
Section 410 (42 U.S.C. 285) is amended by inserting ", rehabilita-
tion from cancer," after "treatment of cancer". 
SEC. 122. SPECIAL AUTHORITIES OF THE DIRECTOR 
Section 413 (42 U.S.C. 285a-20i))) is amended— 
(1) in subsection (a)— 
(AXi) in the first sentence, by striking "information and 
education center" and inserting "information and edu-
cation program"; and 
(ii) in the second sentence, by inserting after "between 
the Institute" the following: "and the public and between 
the Institute Euid"; and 
(B) by inserting "(1)" after the subsection designation and 
adding at the end the following new paragraph: 
"(2) In carrying out paragraph (1), the Director of the Institute 
shall— 
Public 
"(A) provide public and patient information and education 
information. 
programs, providing information that will help individuals take 
personal steps to reduce their risk of cancer, to make them 
aware of early detection techniques and to motivate appropriate 
utilization of those techniques, to help individuals deal with 
cancer if it strikes, and to provide information to improve long-
term survival; 
"(B) continue and expand programs to provide physicians and 
the public with state-of-the-art information on the treatment of 
particular forms of cancers, and to identify those clinical trials 
that might benefit patients while advancing knowledge of 
cancer treatment; 
"(C) assess the incorporation of state-of-the-art cancer treat-
ments into clinical practice and the extent to which cancer 
patients receive such treatments and include the results of such 
assessments in the biennial reports required under section 407; 
"(D) maintain and operate the International Cancer Research 
Data Bank, which shall collect, catalog, store, and disseminate 
insofar as feasible the results of cancer research and treatment 
underteiken in any country for the use of any person involved in 
cancer research and treatment in any country; and 
PUBLIC LAW 100-607—NOV. 4, 1988 
102 STAT. 3055 
"(E) to the extent practicable, in disseminating the results of 
such cancer research and treatment, utilize information sys-
tems available to the public"; and 
(2) in subsection (b)— 
(A) in paragraph (5), by striking "with the approval of 
and inserting "after consultation with"; and 
(BXi) by adding "and" at the end of paragraph (8); and 
(ii) by striking paragraph (9) and redesignating paragraph 
(10) as paragraph (9). 
SEC. 123. NATIONAL CANCER RESEARCH AND DEMONSTRATION CENTERS. 
Section 414(aXl) (42 U.S.C. 285a-3(aXl)) is amended by inserting 
"control," after "prevention,". 
Subtitle F—National Heart, Lung, and Blood 
Institute 
SEC. 126. INFORMATION AND EDUCATION. 
The second sentence of section 420 (42 U.S.C. 285b-2) is amended 
to read as follows: "In canying out this section, the Director of the 
Institute shall place special emphasis upon the utilization of collabo-
rative efforts with both the public and private sectors to— 
"(1) increase the awareness and knowledge of health care 
professionals and the public regarding the prevention of heart 
and blood vessel, lung, and blood diseases and the utilization of 
blood resources; and 
"(2) develop and disseminate to health professionals, patients Health care 
and patient families, and the public information designed to professionals. 
encourage adults and children to adopt healthful practices 
concerning the prevention of such diseases.". 
SEC. 127. RESOURCES PROGRAM. 
Section 421 (42 U.S.C. 285b-3) is amended— 
(1) in subsection (aXl)(D), by inserting "and rehabilitation 
from" after "treatment of; and 
(2) in subsection (b), by striking out ", after approved of in 
paragraph (1) and inserting "after consultation with"; 
SEC. 128. NATIONAL RESEARCH AND DEMONSTRATION CENTERS. 
Section 422(aXl) (42 U.S.C. 285b-4(aXl)) is amended— 
(1) in subparagraph (A), by inserting "and rehabilitation" 
after "treatment"; and 
(2) in subparagraph (B), by inserting "and rehabilitation" 
after "treatment". 
SEC. 129. INTERAGENCY TECHNICAL COMMITTEE. 
Subpart 2 of part C of title IV (42 U.S.C. 285b et seq.) is amended 
by striking section 423 and redesignating section 424 as section 423. 42 use 288b-5, 
285b-6. 
102 STAT. 3056 
PUBLIC LAW 100-607—NOV. 4, 1988 
Subtitle G—National Institute of Diabetes and 
Digestive and Kidney Diseases 
SEC. 131. ADVISORY BOARDS. 
Section 430 (42 U.S.C. 285c-4) is amended by striking subsection 
(k) and redesignating subsection (1) as subsection (k). 
Subtitle H—National Institute of Arthritis and 
Musculoskeletal and Skin Diseases 
SEC. 136. NATIONAL ARTHRITIS AND MUSCULOSKELETAL DISEASES PRO-
GRAMS. 
Section 436 (42 U.S.C. 285d-l) is amended— 
(1) in the section heading, by inserting "AND SKIN" after 
"MUSCULOSKELETAL"; 
(2) in the first sentence of subsection (a), by inserting "and 
skin" after "musculoskeletal" each place it appears; 
(3) in subsection (b)— 
(A) in the matter preceding paragraph (1), by inserting 
"and skin" after "musculoskeletal" each place it appears; 
(B) in paragraph (1), by inserting "and skin' 
after 
"musculoskeletal each place it appears; and 
(C) in paragraph (2), by inserting "and skin" after 
"musculoskeletal ; and 
(4) in subsection (c), by inserting "and skin" 
after 
"musculoskeletal". 
SEC. 137. MULTIPURPOSE DISEASE CENTERS. 
Section 441(bX2XA) (42 U.S.C. 285d-6(bX2XA)) is amended by 
inserting "and rehabilitation from" after "treatment of*. 
Subtitle I—National Institute on Aging . 
SEC. 141. CENTERS OF GERIATRIC RESEARCH AND TRAINING. 
Subpart 5 of part C of title IV (42 U.S.C. 285e et seq.) is amended 
by ad<ting at the end the following new section: 
"CENTERS OF GERIATRIC RESEARCH AND TRAINING 
Contracts. 
"SEC. 445A. (a) The Director of the Institute shall enter into 
Grants. 
cooperative agreements with, and make grants to, public and pri-
42 use 285e-3. 
y^^^ nonprofit entities for the development or expansion of centers 
of excellence in geriatric research and training of researchers. 
"(b) Each center developed or expanded under this section shaU— 
"(1) utilize the facilities of a single institution, or be formed 
from a consortium of cooperating institutions, meeting such 
research and training qualifications as may be prescribed by the 
Director; and 
"(2) conduct— 
"(A) research into the aging processes and into the diag-
nosis and treatment of diseases, disorders, and complica-
tions related to aging; and 
PUBLIC LAW 100-607—NOV. 4, 1988 
102 STAT. 3057 
"(B) programs to develop individuals capable of conduct-
ing research concerning aging and concerning such dis-
eases, disorders, and complications. 
'*(c) In making cooperative agreements and grants under this 
section for the development or expansion of centers, the Director of 
the Institute shall ensure that, to the extent practicable, any such 
centers are distributed equitably among the principal geographic 
r^ons of tiie United States.". 
SEC 142. TRANSFER OF CERTAIN PROVISIONS WITH RESPECT TO 
ALZHEIMER'S DISEASE AND RELATED DEMENTIAS. 
(a) IN GENERAL.—Sections 931, 941, 942, 951, and 952 of the 
Alzheimer's Disease and Related Dementias Services Research Act 
of 1986 (42 U.S.C. 11201 et seq.) are— 
(1) transferred to subpart 5 of part C of title IV (42 U.S.C. 285e 
et seq.); 
(2) redesignated as sections 445B through 445F, respectively; 
and 
(3) in the appropriate sequence, inserted after section 445A 
(42U.S.C.285e-2). 
(b) AvAiLABiUTT O
F A
P
P
R
O
P
R
I
A
T
I
O
N
S
.
—
^
W
i
t
h respect to amounts 
made available in appropriation Acts for the purpose of carrying out 
the programs transferred by subsection (a) to the Public Health 
Service Act, such subsection may not be construed to affect the 
availability of such funds for such purpose. 
(c) TECHNICAL AND CONFORMING AMENDMENTS TO ALZHEIMER'S 
D
r
a
B
A
S
E A
N
D RELATED DEMENTIAS SERVICES RESEARCH ACT OF 1986.— 
(1) The Alzheimer's Disease and Related Dementias Services 
Research Act of 1986 (42 U.S.C. 11201 et seq.) is amended— 
(A) by striking sections 932 and 953; 
(B) by striking the part designation and the heading for 
partD; 
(C!) by striking the part designation and the heading for 
partF; 
(D) by redesignating parts E and G as parts D and E, 
respectively; and 
(E) in section 912(bXl)t in the first sentence, by striking 
"Mut E" and inserting "part D". 
(2) Part D of of the Al^eimer's Disease and Related Demen-
tists Services Research Act of 1986 (as redesignated by para-
graph (1)(D) of this subsection) is amended— 
(A) by striking section 943; 
(B) by redesignating sections 944 through 949C as sections 
931 through 939, respectively; 
(Q by striking the subpart designation and the heading 
for subpart 1; and 
(D) by redesignating subparts 2 through 4 as subparts 1 
through 3, re«)ectively. 
(d) TECHNICAL AND CONFORMING AMENDMENTS TO PUBUC HEALTH 
SKRVICB ACT.—Subpart 5 of part C of title IV (42 U.S.C. 285e et seq.), 
as amended by subsection (a), is further amended— 
(1) in section 445B— 
(A) in subsection (a), in the first sentence, bv striking "the 
National Institute on Aging" and inserting the Institute"; 
(B) in subsection (b)— 
(i) b^ striking "the National Institute on Aging" and 
insertuig "the mstitute"; and 
42 u s e 11231, 
11241, 11242, 
11281, 11282. 
42 use 
285e-4—285e-8. 
42 u s e 285e-4 
note. 
42 u s e 11232, 
11283. 
42 u s e 11212. 
42 use 11243. 
42 use 11251 et 
seq., 11261 et 
seq., 11271 et seq. 
42 use 285e-4. 
102 STAT. 3058 
PUBLIC LAW 100-607—NOV. 4, 1988 
42 use 285e-5. 
42 use 285e-6. 
42 use 285e-7. 
42 use 285e-8. 
Grants, 
eontracts. 
(ii) by striking "of the Public Health Service Act"; 
(C) in subsection (c), bv striking "the National Institute 
on Aging" and inserting the Institute"; and 
(D) in subsection (d), by striking "the National Institute 
on Aging" and inserting the Institute"; 
(2) in section 445C— 
(A) in subsection (a), by striking "the National Institute 
on . ^ n g " and inserting the Institute"; 
(B) in subsection (b)— 
(i) in paragraph (1), in the first sentence— 
(I) by striking "this Act" and inserting "the Alz-
heimer's Disease and Related Dementias Services 
Research Act of 1986"; and 
(II) by striking "the National Institute on Aging" 
and inserting "the Institute"; 
(ii) in paragraph (1), in subparagraph (B), by striking 
"of the Public Health Service Act ; and 
(iii) in paragraph (2), by striking "the National In-
stitute on Aging and inserting *The Institute"; and 
(C) in subsection (c), by striking *The National Institute 
on Aging" and inserting the Institute"; 
(3) in section 445D— 
(A) by striking "the National Institute on Aging" and 
inserting "the Institute"; and 
(B) by striking "this subpart" and inserting "section 445C 
and this section ; 
(4) in section 445E— 
(A) in subsection (a), by striking "the National Institute 
on A^ng" and inserting the Institute"; and 
(B) in subsection (c)— 
(i) by striking "the National Institute on Aging" and 
insertmg "the Institute"; and 
(ii) by striking "part E" and inserting "part D"; and 
(5) in section 445F— 
(A) in subsection (a), by striking "the National Institute 
on Aging" and inserting the Institute"; and 
(B) in subsection (d), in the first sentence, by striking "the 
National Institute on Aging" and inserting the Institute". 
Subtitle J—National Library of Medicine 
SEC. 146. AUTHORIZATION OF APPROPRIATIONS. 
(a) IN GENERAL.—The first sentence of section 469 (42 U.S.C. 286b) 
is amended to read as follows: "For the purpose of grants and 
contracts under sections 472 through 476, there are authorized to be 
appropriated $14,000,000 for fiscal year 1989 and such sums as may 
be necessary for fiscal year 1990.". 
(b) GRANT AMOUNT.—Section 474(bX2) (42 U.S.C. 286b-5(bX2)) is 
amended by striking out "$500,000" and inserting in lieu thereof 
"$750,000". 
Subtitle K—Awards and Training 
SEC. 151. NATIONAL RESEARCH SERVICE AWARDS. 
Section 487(d) (42 U.S.C. 288(d)) is amended— 
PUBLIC LAW 100-607—NOV. 4, 1988 
102 STAT. 3059 
(1) in the matter preceding paragraph (1), by amending the Grants. 
first sentence to read as follows: "For the purpose of making Appropnation 
pa3maients under National Research Service Awards and under ^"'^"""^ ^°^-
f
rants for such Awards, there are authorized to be appropriated 
300,000,000 for fiscal year 1989 and such sums as may be 
necessary for fiscal year 1990."; and 
(2) in paragraph (3), by inserting after "made available" the 
first place it appears the following: "to the Secretary, acting 
through the Administrator of the Health Resources and Serv-
ices Administration,". 
Subtitle L—Fetal Research Moratorium 
SEC. 156. EXTENSION OF MORATORIUM. 
Section 498(c) (42 U.S.C. 289g(c)) is amended— 
(1) in paragraph (2), by striking "thirtynsix month period 
beginning on the date of enactment of this section" and insert-
ing "24-month period beginning on the date of the enactment of 
the National Institute on Deafness and Other Communication 
Disorders and Health Research Extension Act of 1988"; and 
(2) in paragraph (3), by striking "1988" and inserting "1990". 
SEC. 157. BOARD AND STUDY. 
(a) AUTHORIZATION OF APPROPRIATIONS.—Section 381(e) (42 U.S.C. 
275(e)) is amended by striking "and" after "1987," and inserting 
before the period the following: ", $2,000,000 for fiscal year 1989, and 
$2,500,000 for fiscal year 1990*^. 
(b) STUDY.—Section 498(cXl) (42 U.S.C. 289g(cXl)) is amended bv 
striking "thirty months after the date of enactment of this section 
and inserting "24 months after the date of the enactment of the 
National Institute on Deafness and Other Communication Disorders 
and Health Research Extension Act of 1988". 
Subtitle M—Miscellaneous 
SEC. 161. STUDY OF THYROID MORBIDITY FOR HANFORD, WASHINGTON. 
42 USC 241 note. 
(a) IN GENERAL.—In carrying out the purposes of section 301 of the 
Public Health Service Act (42 U.S.C. 241), the Secretary of Health 
and Human Services, acting through the Director of the Centers for 
Disease Control (hereafter referred to in this section as the "Direc-
tor"), shall conduct a study of thyroid morbidity of the population 
(including Indian tribes and tribal organizations) in the vicinity of 
Hanford, in the State of Washington, during the years 1944 through 
1957. 
(b) PEER REVIEW.—As soon as is practicable after the date of the 
enactment of this Act, the Director shall establish a peer review 
committee that shall, along with the Centers for Disease Control, 
ma^e any determinations as to the conduct of the study required 
under this section. 
(c) CONTRACTS.— 
(1) IN GENERAL.—Except as provided in paragraph (2), the 
Director may contract out any portion of the study required 
under this section if the Director considers such appropriate, 
except that such contractor shall not have any direct or indirect 
102 STAT. 3060 
PUBLIC LAW 100-607—NOV. 4, 1988 
Contracts. 
Oregon. 
Washington. 
interest in the outcome of such study including, contracts with 
the Department of Eneigy. 
(2) RELAHONSHIFS.—Contractors that currently are parties to 
contracts with the Department of Energy (or who have pre-
viously been parties to such) shall be given consideration pursu-
ant to iiaragraph (1), except that the Director shsdl make a 
determination in each such circumstance that the relationship 
of the contractor with the Department of Energy does not 
represent a conflict of interest or the appearance of such a 
conflict r^arding the conduct of the study required under this 
section, 
(d) REPORT.—^Not later than 42 months after the date of enactment 
of this section, the Director shall transmit a report including such 
study to the Congress, the chief executive officers of the States of 
Oregon and Washington, and the governing officials of the Indi£m 
tribes in the vicinity of Hanford, Washington. 
42 use 241 note. SEC 162. NATIONAL COMMISSION ON SLEEP DISORDERS RESEARCH. 
(a) ESTABLISHMENT.—Not later than 90 days after the date of 
enactment of this Act, the Secretary of Health and Human Services 
(hereafter in this section referred to as the "Secretaiy"), after 
consultation with the Director of the National Institutes of Health, 
shall establish a National (Ilommission on Sleep Disorders Research 
(hereafter in this section referred to as the ''Commission")-
(b) CoaiPOSiTiON.— 
(1) APPOINTED IKIEMBERS.—^The Commission shall be composed 
of 10 members to be appointed as follows: 
(A) Six members shall be appointed by the Secretary from 
among scientists, physicians, and other health professionals 
who are not in the employment of the Federal Grovemment, 
and who have primary expertise in sleep disorders research 
or medicine. 
(B) Two members shall be appointed by the Secretary 
from the general public, of whom one of which shall have 
personal or close family experience with sleep disorders. 
(C) Two members shall be appointed by the Secretary 
from among the personnel of the National Institutes of 
Health, and such members interest shall be in the field of 
sleep disorders research. 
(2) E!x O
F
F
I
C
I
O M
E
M
B
E
R
S
.
—
^
T
h
e Director of the National In-
stitutes of Health, the Director of the National Institute of 
Neurological and Communicative Disorders and Stroke, the 
Directors of the National Heart, Lung and Blood Institute, the 
National Institute on Mental Health, the National Institute on 
Aging, the National Institute on (3hild Health and Human 
Development, the Director of the Center for Disease Control, the 
(Hhief Medical Director of the Veterans' Administration, and the 
Secretary of Defense shall be ex officio members of the Commis-
sion, or meir designees. 
(c) CHAIRPERSON.—^^e members of the Commission shall select a 
Chairperson from among the appointed members of the Commis-
sion. 
(d) MEETINGS.—^Not later than 60 days after the establishment of 
the Commission, the Commission shall meet as directed by the 
Secretary, and thereafter shall meet at the call of the (Chairperson 
of the Conunission, but in no event shall the Commission meet less 
often than three times during the life of the Commission. The 
PUBLIC LAW 100-607—NOV. 4, 1988 
102 STAT. 3061 
Commission may hold such hearings, take such testimony, and sit 
and act at such time and places as the Commission considers 
appropriate. 
(e) PERSONNEL.— 
(1) EXECUTIVE SECRETARY.— 
(A) APPOINTMENT.—The Commission may appoint and fix 
the compensation of an executive secretary to effectively 
carry out the functions of the Commission. 
(B) COMPENSATION.—The executive secretary shall be ap-
pointed subject to title 5, United States Code, governing 
appointments in the competitive service, £md shall receive 
compensation in accordance with chapter 51 and sub-
chapter III of chapter 53 of such title relating to classifica-
tion and General Schedule pay rates. 
(2) ADDITIONAL PERSONNEL.—The Secretary shall, to the 
extent practicable, provide the Commission with such additional 
professional and clerical staff, such information, and the serv-
ices of such consultants as the Commission determines to be 
necessary to carry out its functions effectively. 
(f) COMPENSATION.— 
(1) OFFICERS OR EMPLOYEES OF THE FEDERAL GOVERNMENT.— 
Members of the Commission who are officers or employees of 
the Federal Grovernment shall serve as members of the Commis-
sion without compensation in addition to that received in their 
regular public employment. 
(2) NON-FEDERAL GOVERNMENT MEMBERS.—Members of the 
Commission who are not officers or employees of the Federal 
Government shall receive compensation at a rate not to exceed 
the daily equivalent of the annual rate in effect for Grade GS-
18 of the General Schedule for each day (including traveltime) 
that such members are engaged in the performance of their 
duties as members of the Commission. 
(3) EXPENSES.—All members of the Commission, while serving 
away from their homes or regular places of business in the 
performance of services for the Commission, shall be allowed 
travel expenses, including per diem in lieu of subsistence, in the 
same manner as such expenses are authorized by section 5703 of 
title 5, United States Code, for persons in Government Service 
employed intermittently. 
(g) DUTIES.— 
(1) STUDY.—The Commission shall— 
(A) conduct a comprehensive study of the present state of 
knowledge of the incidence, prevalence, morbidity, and 
mortality resulting from sleep disorders, and of the social 
and economic impact of such disorders; 
(B) evaluate the public and private facilities and re-
sources (including trained personnel and research activi-
ties) available for the diagnosis, prevention, and treatment 
of, and research into, such disorders; and 
(C) identify programs (including biological, physiological, 
behavioral, environmental, and social programs) by which 
improvement in the management and research into sleep 
disorders can be accomplished. 
(2) DEVELOPMENT OF PLAN.—Based on the study conducted 
under paragraph (1), the Commission shall develop a long-range 
plan for the use and organization of national resources to 
effectively deal with sleep disorders research and medicine. 
102 STAT. 3062 
PUBLIC LAW 100-607—NOV. 4, 1988 
42 u s e 242a, 
241. 
42 u s e 254c. 
AIDS 
Amendments of 
1988. 
(3) COOPERATION.—Each Federal entity administering pro-
grams and activities related to sleep disorders shall, on request, 
assist the Commission in canying out its duties under this 
subsection, 
(h) DEVELOPMENT OF ESTIMATES.—The Commission shall rec-
ommend, for each of the Institutes of the National Institutes of 
Health whose activities are to be affected by the long-range plan, 
estimates of the expenditures needed to carry out each Institute's 
part of the overall program. Such estimates shall be prepared for 
the fiscal year beginning immediately after completion of the plan 
under subsection (gX2) and for each of the next 2 fiscal years, 
(i) REPORT.—Not later than 18 months after the initial meeting of 
the Commission (as prescribed by subsection (d)), the Commission 
shall prepare and submit to the appropriate Committees of Con-
gress, a final report describing-
C
D the long-range plan developed under subsection (g); 
(2) the expenditure estimates required under subsection (h); 
and 
(3) any recommendations of the Commission for legislation. 
0) TERMINATION.—The Commission shall cease to exist on the 30th 
day following the date of the submission of the final report under 
subsection (i). 
SEC. 
1
6
3
. 
MISCELLANEOUS 
AMENDMENTS. 
The Public Health Service Act (42 U.S.C. 201 et seq.) is amended— 
(IXA) with respect to section 303(a), by transferring the 
matter after and below paragraph (2) of such section to section 
301; 
(B) by designating such matter as subsection (d); and 
(C) by adding subsection (d) (as so designated) at the end of 
section 301; 
(2) in section 301(d) (as so designated)— 
(A) in the first sentence, by striking "research on mental 
health, including" and inserting the 
rollowing: 
"biomedical, 
behavioral, clinical, or other research (including research 
on mental health, including"; and 
(B) by striking "drugs," and inserting "drugs)"; and 
(3) in section 330, by redesignating the second subsection (j) 
(as added by section 4 of Public Law 100-386) as subsection (k). 
TITLE II—PROGRAMS WITH RESPECT TO 
ACQUIRED IMMUNE DEFICIENCY SYN-
DROME 
42 u s e 201 note. 
SEC. 200. SHORT TITLE. 
This title may be cited as the "AIDS Amendments of 1988". 
Subtitle A—Research Programs 
42 u s e 300cc— 
300CC-2, 
300aaa— 
300aaa-2. 
SEC. 201. ESTABLISHMENT OF CERTAIN PROGRAMS. 
The Public Health Service Act (42 U.S.C. 201 et seq.) is amended— 
(1) by redesignating title XXIII as title XXV; 
(2) by redesignating sections 2301 through 2303 as sections 
2501 through 2503, respectively; 
PUBLIC LAW 100-607—NOV. 4, 1988 
102 STAT. 3063 
(3) by redesignating sections 2306 through 2316 as sections 
2504 through 2514, respectively; and 
(4) by inserting after title XXII the following new title: 
'TITLE XXIII—RESEARCH WITH RESPECT TO ACQUIRED 
IMMUNE DEFICIENCY SYNDROME 
"PART A—ADMINISTRATION OF RESEARCH PROGRAMS 
42 use 
300CC-15, 
300aaa-3— 
300aaa-13. 
"SEC. 2301. REQUIREMENT OF ANNUAL COMPREHENSIVE REPORT ON 42 USC 300cc. 
ALL EXPENDITURES BY SECRETARY WITH RESPECT TO 
ACQUIRED IMMUNE DEFICIENCY SYNDROME. 
"(a) IN GENERAL.—Not later than December 1 of each fisceil year, 
the Secretary shall prepare and submit to the Congress a report on 
the expenditures by the Secretary of amounts appropriated for the 
preceding fiscal year with respect to acquired immune deficiency 
sjmdrome. 
"Ot)) INCLUSION OF CERTAIN INFORMATION.—The report required in 
subsection (a) shall, with respect to acquired immune deficiency 
sjnidrome, include— 
"(1) for each program, project, or activity with respect to such 
sjmdrome, a specification of the amount obligated by each office 
and agency of the Department of Health and Human Services; 
"(2) a summary description of each such program, project, or 
activity; 
"(3) a list of such programs, projects, or activities that are Minorities. 
directed towards members of minority groups; 
"(4) a description of the extent to which programs, projects, 
and activities described in paragraph (3) have been coordinated 
between the Director of the Office of Minority Health and the 
Director of the Centers for Disease Control; 
"(5) a summary of the progress made by each such program, 
project, or activity with respect to the prevention and control of 
acquired immune deficiency s3mdrome; 
(6) a summary of the evaluations conducted under this title; 
and 
"(7) any report required in this Act to be submitted to the 
Secretary for inclusion in the report required in subsection (a). 
"SEC. 2302. REQUIREMENT OF EXPEDITING AWARDS OF GRANTS AND 42 USC 300cc-l. 
CONTRACTS FOR RESEARCH. 
"(a) IN GENERAL.—The Secretary shall expedite the award of 
grants, contracts, and cooperative agreements for research projects 
relating to acquired immune deficiency syndrome (including such 
research projects initiated independently of any solicitation by the 
Secretary for proposals for such research projects). 
"Qa) TIME LIMITATIONS WITH RESPECT TO CERTAIN APPUCATIONS.— 
"(1) With respect to programs of grants, contracts, and 
cooperative agreements described in subsection (a), any applica-
tion submitted in response to a solicitation by the Secretary for 
proposals pursuant to such a program— 
"(A) may not be approved if the application is submitted 
after the expiration of the 3-month period beginning on the 
date on which the solicitation is issued; and 
"(B) shall be awarded, or otherwise finally acted upon, 
not later than the expiration of the 6-month period begin-
102 STAT. 3064 
PUBLIC LAW 100-607—NOV. 4, 1988 
ning on the expiration of the period described in subpara-
graph (A). 
"(2) If the Secretary makes a determination that it is not 
practicable to administer a program referred to in paragraph 
(1) in accordance with the time limitations described in such 
paragraph, the Secretary may adjust the time limitations 
accordingly. 
"(c) 
REQUIREMENTS WITH RESPECT TO ADJUSTMENTS IN TIME 
LIMITATIONS.—With respect to any program for which a determina-
tion described in subsection (bX2) is made, the Secretary shall— 
"(1) if the determination is made before the Secretary issues a 
solicitation for proposals pursuant to the program, ensure that 
the solicitation describes the time limitations as adjusted by the 
determination; and 
"(2) if the determination is made after the Secretary issues 
such a solicitation for proposals, issue a statement describing 
the time limitations as adjusted by the determination and 
individually notify, with respect to the determination, each 
applicant whose application is submitted before the expiration 
of the 3-month period beginning on the date on which the 
solicitation was issued. 
"(d) 
ANNUAL REPORTS TO CONGRESS.—Except as provided 
in 
subsection (e), the Secretary shall annually prepare, for inclusion in 
the comprehensive report required in section 2301, a report— 
"(A) summarizing programs for which the Secretary has made 
a determination described in subsection (bX2), including a 
description of the time limitations as adjusted by the determina-
tion and including a summary of the solicitation issued by the 
Secretary for proposals pursuant to the program; and 
"(B) summarizing applications that— 
"(i) were submitted pursuant to a program of grants, 
contracts, or cooperative agreements referred to in para-
graph (1) of subsection (b) for which a determination 
described in paragraph (2) of such subsection has not been 
made; and 
"(ii) were not processed in accordance with the time 
limitations described in such paragraph (1). 
"(e) QUARTERLY REPORTS FOR FISCAL YEAR 1989.—For fiscal year 
1989, the report required in subsection (d) shall, not less than 
quarterly, be prepared and submitted to the Committee on Energy 
and Commerce of the House of Representatives and the Committee 
on Labor and Human Resources of the Senate. 
42 u s e 300CC-2. 
"SEC. 2303. REQUIREMENTS WITH RESPECT TO PROCESSING OF REQUESTS 
FOR PERSONNEL AND ADMINISTRATIVE SUPPORT. 
"(a) IN GENERAL.—The Director of the Office of Personnel 
Management or the Administrator of General Services, as the case 
may be, shall respond to any priority request made by the Admin-
istrator of the Alcohol, Drug Abuse, and Mental Health Admin-
istration, the Director of the Centers for Disease Control, the 
Commissioner of Food and Drugs, or the Director of the National 
Institutes of Health, not later than 21 days after the date on which 
such request is made. If the Director of the Office of Personnel 
Management or the Administrator of Gteneral Services, as the case 
may 1^, does not disapprove a priority request during the 21-day 
period, the request shall be deemed to be approved. 
PUBLIC LAW 100-607—NOV. 4, 1988 
102 STAT. 3065 
"(b) 
NOTICE TO SECRETARY AND TO ASSISTANT SECRETARY FOR 
HEALTH.—The Administrator of the Alcohol, Drug Abuse, and 
Mental Health Administration, the Director of the Centers for 
Disease Control, the Commissioner of Food and Drugs, and the 
Director of the National Institutes of Health, shall, respectively, 
transmit to the Secretary and the Assistant Secretary for Health a 
copy of each priority request made under this section by the agency 
head involved. The copy shall be transmitted on the date on which 
the priority request involved is made. 
"(c) DEFINITION OF PRIORFTY REQUEST.—For purposes of this sec-
tion, the term 'priority request' means any request that— 
"(1) is designated as a priority request by the Administrator of 
the Alcohol, Drug Abuse, and Mental Health Administration, 
the Director of the Centers for Disease Control, the Commis-
sioner of Food and Drugs, or the Director of the Nationsd 
Institutes of Health; and 
"(2XA) is made to the Director of the Office of Personnel 
Management for the allocation of personnel to carry out activi-
ties with respect to acquired immune deficiency syndrome; or 
"(B) is made to the Administrator of General Services for 
administrative support or space in carrjdng out such activities. 
"SEC. 2304. ESTABLISHMENT OF CLINICAL RESEARCH REVIEW COM- 42 USC 300cc-3. 
MITTEE. 
"(a) IN GENERAL.—After consultation with the Commissioner of 
Food and Drugs, the Secretary, acting through the Director of the 
National Institute of Allergy and Infectious Diseases, shall establish 
within such Institute an advisory committee to be known as the 
AIDS Clinical Research Review Committee (hereafter in this section 
referred to as the 'Committee'). 
"(b) COMPOSITION.—The Committee shall be composed of physi-
cians whose clinical practice includes a significant number of 
patients with acquired immune deficiency syndrome. 
"(c) DUTIES.—The Committee shall— 
"(1) advise the Director of such Institute on appropriate 
research activities to be undertaken with respect to clinical 
, treatment of such syndrome, including advice with respect to— 
"(A) research on drugs for preventing or minimizing the 
development of s3anptoms or conditions arising from infec-
tion with the etiologic sigent for such s)mdrome; and 
"(B) research on the effectiveness of treating such symp-
toms or conditions with drugs that— 
"(i) are not approved by the Commissioner of Food 
and Drugs for the purpose of treating such sjrmptoms 
or conditions; and 
"(ii) are being utilized for such purpose by individ-
uals infected with such etiologic agent; 
"(2XA) review ongoing publicly and privately supported re-
search on clinical treatment for acquired immune deficiency 
Sjoidrome, including research on drugs described in paragraph 
(l);and 
"(B) periodically issue, and make available to health care Reports. 
professionals, reports describing and evaluating such research. 
"(3) conduct studies and convene meetings for the purpose of 
determining the recommendations among physicians in clinical 
practice on clinical treatment of acquired immune deficiency 
102 STAT. 3066 
PUBLIC LAW 100-607—NOV. 4, 1988 
syndrome, including treatment with the drugs described in 
paragraph (1^ and 
"(4) conduct a study for the purpose of developing, with 
respect to individuals infected with the etiologic agent for ac-
quued immune deficiency syndrome, a consensus among health 
care professionals on clinical treatments for preventing or mini-
mizing the development of i^mptoms or conditions arising from 
infection with such etiologic agent. 
**PABT B—RESEARCH AUTHORITY 
42 use 
"SEC 2311. CLINICAL EVALUATION UNITS AT NATIONAL INSTITUTES OF 
300CC-11. 
HEALTH. 
"(a) I N GENERAL.—The Secretary, acting through the Director of 
the National Cancer Institute and the Director of the National 
Institute of Allergy and Infectious Diseases, shall for each such 
Institute establish a clinical evaluation unit at the Clinical Center 
at the National Institutes of Health. Each of the clinical evaluation 
units— 
"(1) shall conduct clinical evaluations of experimental treat-
ments for acquired immune deficiency syndrome developed 
within the preclinical drug development program; and 
"(2) may conduct clini<^ evaluations of experimental treat-
ments for such syndrome that are developed by any other 
national research institute of the National Institutes of Health 
or by any other entity. 
"(b) PERSONNEL AND AoMiNisTRATiyE SUPPORT.— 
"(1) For the purposes described in subsection (a), the Sec-
retary, acting tlux>ugh the Director of the National Institutes of 
Health, shall provide each of the clinical evaluation units re-
quired in such subsection— 
"(AKi) with not less than 50 beds; or 
"(ii) with an outpatient clinical capacity equal to not less 
than twice the outpatient clinical capacity, with respect to 
acquired immune deficiency syndrome, possessed by the 
Clinical Center of the National Institutes of Health on 
June 1,1988; and 
"(B) with such personnel, such administrative support, 
and such other support services as may be necessary. 
"(2) Facilities, personnel, administrative support, and other 
support services provided pursuant to paragraph (1) shall be in 
addition to the number or level of facilities, personnel, adminis-
trative support, and other support services that otherwise would 
be available at the Clinical Center at the National Institutes of 
Health for the provision of clinical care for individuals with 
diseases or disorders. 
"(c) AUTHORIZATION OF APPROPRIATIONS.—For the purpose of 
carrying out this section, there are authorized to be appropriated 
such sums as may be necessary. 
42 use 
"SEC 2312. USE OF INVESTIGATIONAL N
E
W DRUGS W
I
T
H RESPECT T
O 
300CC-12. 
ACQUIRED IMMUNE DEFICIENCY SYNDROME. 
"(a) ENCOURAGEMENT OF APPUCATIONS WITH RESPECT TO CUNICAL 
TRIALS,— 
Federal 
"(1) If, in the determination of the Secretary, there is prelimi-
^®^^f: 
nary evidence that a new drug has effectiveness in humans with 
pu ica ion. 
respect to the prevention or treatment of acquired immune 
PUBLIC LAW 100-607—NOV. 4, 1988 
102 STAT. 3067 
deficiency syndrome, the Secretary shall, through statements 
published in the Federal Roister— 
"(A) announce the fact of such determination; and 
"(B) with respect to the new drug involved, encourage an 
application for an exemption for investigational use of the 
new drug under r^ulations issued under section 505(i) of 
the Federal Food, Drug, and Cosmetic Act. 
"(2XA) The AIDS Clinical Research Review Committee estab-
lished pursuant to section 2304 shall msdce recommendations to 
the Secretary with respect to new drugs appropriate for deter-
minations described in paragraph (1). 
"(B) The Secretary shall, as soon as is practicable, determine 
the merits of recommendations received by the Secretary pursu-
ant to subparagraph (A). 
"(b) ENCOURAGEMENT OP APPUCATIONS WITH RESPECT TO TREAT-
MENT USE IN CIRCUMSTANCES OTHER THAN CLINICAL TRIALS.— 
"(1) In the case of a new drug with respect to which the 
Secretary has made a determination described in subsection (a) 
and with respect to which an exemption is in effect for purposes 
of section 505(i) of the Federal Food, Drug, and Cosmetic Act, 
the Secretary shall— 
"(A) as appropriate, encourage the sponsor of the inves-
tigation of the new drug to submit to the Secretary, in 
accordance with regulations issued under such section, an 
application to use the drug in the treatment of individ-
uals— 
"(i) who are infected with the etiologic agent for 
acquired immune deficiency syndrome; and 
(ii) who are not participating in the clinical trials 
conducted pursuant to such exemption; and 
"(B) if such an application is approved, encourage, as 
appropriate, licensed medical practitioners to obtain, in 
accordance with such regulations, the new drug from such 
sponsor for the purpose of treating such individuals. 
"(2) If the sponsor of the investigation of a new drug described 
in paragraph (1) does not submit to the Secretary an application 
described in such paragraph (relating to treatment use), the 
Secretary shall, through statements published in the Federal 
Register, encourage, as appropriate, licensed medical practition-
ers to submit to the Secretory such applications in accordance 
with regulations described in such paragraph. 
"(c) TECHNICAL ASSISTANCE WITH RESPECT TO TREATMENT USE.—In 
the case of a new drug with respect to which the Secretory has made 
a determination described in subsection (a), the Secretory may, 
directly or through grants or contracts, provide technical assistance 
with respect to the process of— 
"(1) submitting to the Secretary applications for exemptions 
described in paragraph (IXB) of such subsection; 
"(2) submitting to the Secretary applications described in 
subsection (b); and 
"(3) with respect to sponsors of investigations of new drugs, 
facilitoting the transfer of new drugs from such sponsors to 
licensed medical practitioners. 
"(d) DEFINITION.—For purposes of this section, the term "new 
drug" has the meaning given such term in section 201 of the Federal 
Food, Drug, and Cosmetic Act. 
Federal 
Register, 
publication. 
Grants. 
Contracts. 
19-194 a-91—Part -
i : Q L 3 
102 STAT. 3068 
PUBLIC LAW 100-607—NOV. 4, 1988 
42 use 
300CC-13. 
Grants. 
Contracts. 
Health care 
professionals. 
Minorities. 
Women. 
Children and 
youth. 
"SEC. 2313. COMMUNITY-BASED 
EVALUATIONS 
OF 
EXPERIMENTAL 
THERAPIES. 
"(a) IN GENERAL.—After consultation with the Commissioner of 
Food and Drugs, the Director of the National Institutes of Health, 
acting through the National Institute of Allergy and Infectious 
Diseases, may make grants to public entities and nonprofit private 
entities concerned with acquired immune deficiency syndrome, and 
may enter into contracts with public and private such entities, for 
the purpose of planning and conducting, in the community involved, 
clinical trials of experimental treatments for infection with the 
etiologic agent for such syndrome that are approved by the Commis-
sioner of Food and Drugs for investigational use under regulations 
issued under section 505 of the Federal Food, Drug, and Cosmetic 
Act. 
"(b) REQUIREMENT OF CERTAIN PROJECTS.— 
"(1) Financial assistance under subsection (a) shall include 
such assistance to community-bgised organizations and commu-
nity health centers for the purpose of— 
"(A) retaining appropriate medical supervision; 
"(B) assisting with administration, data collection and 
record management; and 
"(C) conducting training of community physicians, nurse 
practitioners, physicians' assistants and other 
health 
professionals for the purpose of conducting clinical trials. 
"(2XA) Financial assistance under subsection (a) shall include 
such assistance for demonstration projects designed to imple-
ment and conduct community-based clinical trials in order to 
provide access to the entire scope of communities affected by 
infections with the etiologic agent for acquired immune defi-
ciency S3nidrome, including minorities, hemophiliacs 
and 
transfusion-exposed individuals, women, children, users of 
intravenous drugs, and individuals who are asymptomatic with 
respect to such infection. 
"(B) The Director of the National Institutes of Health may not 
provide financial assistance under this paragraph unless the 
application for such assistance is approved— 
"(i) by the Commissioner of Food and Drugs; . 
"(ii) by a duly constituted Institutional Review Board that 
meets the requirements of part 56 of title 21, Code of 
Federed Regulations; and 
"(iii) by the Director of the National Institute of Allergy 
and Infectious Diseases. 
"(c) PARTICIPATION OF PRIVATE INDUSTRY AND SCHOOI^ OF MEDI-
CINE.—Programs carried out with financial assistance provided 
under subsection (a) shall be designed to encourage private industry 
and schools of medicine to participate in, £md to support, the clinical 
trials conducted pursuant to the programs. 
"(d) REQUIREMENT OF APPUCATION.—The Secretary may not pro-
vide financial assistance under subsection (a) unless— 
"(1) an application for the assistance is submitted to the 
Secretary; 
"(2) with respect to carrjring out the purpose for which the 
assistance is to be made, the ^plication provides assurances of 
compliance satisfactory to the Secretary; and 
"(3) the application otherwise is in such form, is made in such 
manner, and contains such agreements, assurances, and 
PUBLIC LAW 100-607—NOV. 4, 1988 
102 STAT. 3069 
information as the Secretaiy determines to be necessary to 
cany out this section. 
"(e) AUTHORIZATION OF APPROPRIATIONS.— 
"(1) For the purpose of carrying out subsection (JbXl), there are 
authorized to be appropriated such sums as may be necessary 
for each of the 
fiscal 
years 1989 through 1991. 
"(2) For the purpose of carrying out subsection (bX2), there are 
authorized to be appropriated such sums as may be necessary 
for each of the 
fiscal 
years 1989 through 1991. 
'^EC 2314. EVALUATION OF CERTAIN TREATMENTS. 
42 USC 
„. . _ 
_. 
300CC-14. 
(a) ESTABTJSHMKNT OF PROGRAM.— 
"(1) After consultation with the Clinical Research Review 
Conmiittee established pursuant to section 2304, the Secretary 
shall establish a program for the evaluation of drugs that— 
''(A) are not approved by the Commissioner of Food and 
Drugs for the purpose of treatments with respect to ac-
quired immune deficiency syndrome; and 
"(B) are being utilized for such purpose by individuals 
infected with the etiologic agent for such syndrome. 
"(2) The program established under paragraph (1) shall in-
clude evaluations of the efTectiveness and the risks of the 
treatment involved, including the risks of forgoing treatments 
with respect to acquired immune deficiency syndrome that are 
approved by the Commissioner of Food and Drugs. 
"(b) AUTHORITT WITH RBSPBCT TO GRANTS AND CONTRACTTS.— 
"(1) For the purpose of conducting evaluations required in 
subsection (a), the Secretary may make grants to, and enter into 
cooperative agreements and contracts with, public and non-
profit private entities. 
"(2) Nonprofit private entities under paragraph (1) may 
include nonprofit private organizations that— 
"(A) are established for the purpose of evaluating treat-
ments with respect to acquired immune deficiency ^n-
drome; and 
"(B) consist primarily of individuals infected with the 
etiologic agent for such i^yndrome. 
"(c) SCIENTIFIC AND ETHICAL GUIDELINES.— 
"(1) The Secretary shall establish appropriate scientific and 
ethical guidelines for the conduct of evaluations carried out 
pursuant to this section. The Secretary may not provide finan-
cial assistance under subsection (bXl) unless the applicant for 
such assistance agrees to comply with such guidelines. 
"(2) The Secretaiy may establish the guidelines described in 
paragraph (1) only after consulting with— 
"(A) physicians whose clinical practice includes a signifi-
cant number of individuals witii acquired immune defi-
deacy syndrome; 
"(B) individuals who are infected with the etiologic agent 
for such syndioiae; and 
"(Q other individuals with appropriate expertise or 
experience. 
*Xd) AUTHORIZATION OF APPROPRIATIONS.—^For the purpose of 
canying out this section, there are authorized to be appropriated 
sudi sums as may be necessary. 
102 STAT. 3070 
PUBLIC LAW 100-607—NOV. 4, 1988 
42 use 
"SEC. 2315. SUPPORT OF INTERNATIONAL EFFORTS. 
"(a) GRANTS AND CONTRACTS FOR RESEARCH.— 
"(1) Under section 307, the Secretary, acting through the 
Director of the National Institutes of Hesdth— 
"(A) sh£ill, for the purpose described in paragraph (2), 
make grants to, enter into cooperative agreements and 
contracts with, and provide technical assistance to, inter-
national organizations concerned with public health; and 
"(B) may, for such purpose, provide technical assistance 
to foreign governments. 
"(2) The purpose refe^ -ed to in paragraph (1) is promoting and 
expediting international research concerning the development 
and evaluation of vaccines and treatments for acquired immune 
deficiency syndrome. 
"(b) GRANTS AND CONTRACTS FOR ADDITIONAL PURPOSES.—After 
consultation with the Administrator of the Agency for International 
Development, the Secretary, acting through the Director of the 
Centers for Disease Control, shall under section 307 make grants to, 
enter into contracts with, and provide technical assistance to, 
international organizations concerned with public health and may 
provide technical assistance to foreign governments, in order to 
support— 
"(1) projects for training individuals with respect to develop-
ing skills and technical expertise for use in the prevention, 
diagnosis, and treatment of acquired immune deficiency S3ni-
drome; and 
"(2) epidemiological research relating to acquired immune 
deficiency S5Tidrome. 
"(c) 
SPECIAL PROGRAMME OF WORLD HEALTH ORGANIZATION.— 
Support provided by the Secretary pursuant to this section shall be 
in furtherance of the global strategy of the World Health Organiza-
tion Special Programme on Acquired Immunodeficiency Syndrome. 
"(d) PREFERENCES.—In providing grants, cooperative agreements, 
contracts, and technical assistance under subsections (a) and (b), the 
Secretary shall— 
"(1) give preference to activities under such subsections 
conducted by, or in cooperation with, the World Health 
Organization; and 
(2) with respect to activities carried out under such subsec-
tions in the Western Hemisphere, give preference to activities 
conducted by, or in cooperation with, the Pan American Health 
Organization or the World Health Organization. 
"(e) REQUIREMENT OF APPLICATION.—The Secretary may not make 
a grant or enter into a cooperative agreement or contract under this 
section unless— 
"(1) an application for such assistance is submitted to the 
Secretary; 
"(2) with respect to canying out the purpose for which such 
assistance is to be provided, the application provides assurances 
of compliance satisfactory to the Secretary; and 
"(3) the application otherwise is in such form, is made in such 
manner, and contains such agreements, assurances, and 
information as the Secretary determines to be necessary to 
carry out this section. 
"(f) 
AUTHORIZATION OF APPROPRIATIONS.—For the 
purpose 
of 
carrying out this section, there are authorized to be appropriated 
PUBLIC LAW 100-607—NOV. 4, 1988 
102 STAT. 3071 
$40,000,000 for fiscal year 1989 and such sums as may be necessary 
for each of the fiscal years 1990 and 1991. 
'^EC 2316. RESEARCH CENTERS. 
^'(a) IN GENERAL.— 
"(1) The Secretary, acting through the Director of the 
National Institute of Allergy and Infectious Diseases, may make 
grants to, and enter into contracts with, public and nonprofit 
private entities to assist such entities in planning, establishing, 
or strengthening, and providing basic operating support for, 
centers for basic and clinical research into, and training in, 
advanced diagnostic, prevention, and treatment methods for 
acquired immune deficiency ^ndrome. 
(2) A grant or contract under paragraph (1) shall be provided 
in accordance with policies established by the Secretary, acting 
through the Director of the National Institutes of Health, and 
after consultation with the advisoiy council for the National 
Institute of Allergy and Infectious Diseases. 
"(3) The Secretary shall ensure that, as appropriate, clinical 
research pn^rams carried out under paragraph (1) include as 
research 
subjects 
women, 
children, 
hemophiliacs, and 
minorities. 
"(b) USE OF FINANCIAL ASSISTANCE.— 
"(1) Financial assistance under subsection (a) may be 
expended for— 
"(A) the renovation or leasing of space; 
"(B) staffing and other basic operating costs, including 
such patient care costs as are required for clinical research; 
"(Q clinical training with respect to acquired immune 
deficiency syndrome (including such training for allied 
~ 
health professionals); and 
"(D) demonstration purposes, including projects in the 
long-term monitoring and outpatient treatment of individ-
uals infected with the etiologic agent for such syndrome. 
"(2) Financial assistance under subsection (a) may not be 
expended to provide research training for which National 
Research Service Awards may be provided under section 487. 
"(c) DURATION OF SUPPORT.—Support of a center under subsection 
(a) may be for not more than five years. Such period may be 
extended by the Director for additional periods of not more than five 
years each if the operations of such center have been reviewed by an 
appropriate technical and scientific peer review group established 
by the Director and if such group has recommended to the Director 
that such period should be extended. 
"(d) AUTHORIZATION OF APPROPRIATIONS.—For the purpose of 
carrying out this section, there are authorized to be appropriated 
such sums as may be necessary. 
"SEC 2317. INFORMATION SERVICES. 
"(a) ESTABLISHMENT OF PROGRAM.—^The Secretary shall establish, 
inaint.ain, and operate a program with respect to information on 
research, treatment, and prevention activities relating to infection 
with the etiologic agent for acquired immune deficiency syndrome. 
The program £u^all, with respect to the agencies of the Department 
of H ^ t h and Human Services, be integrated and coordinated. 
"(b) TOLL-FRSE TELEPHONE COMMUNICATIONS FOR HEALTH CARE 
EINTITIES.— 
42 use 
300CC-16. 
Grants. 
Contracts. 
42 use 
300CC-17. 
102 STAT. 3072 
PUBLIC LAW 100-607—NOV. 4, 1988 
"(1) After consultation with the Director of the Office of AIDS 
Research, the Administrator of the Health Resources and Serv-
ices Administration, and the Director of the Centers for Disease 
Control, the Secretary shall provide for toll-free telephone 
communications to provide medical and technical information 
with respect to acquired immune deficiency syndrome to health 
care professionals, allied health care providers, and to profes-
sionals providing emergency health services. 
"(2) Loformation provided pursuant to paragraph (1) shall 
include— 
"(A) information on prevention of exposure to, and the 
transmission of, the etiologic agent for acquired immune 
deficiency sjmdrome; and 
''(B) information contained in the data banks established 
in subsections (c) and (d). 
"(c) DATA BANK ON RESEARCH iNFORBfATioN.— 
"(1) After consultation with the Director of the Office of AIDS 
Research, the Director of the Centers for Disease Control, and 
the National Library of Medicine, the Secretary shall establish 
a data bank of information on the results of research with 
respect to acquired immune deficiency syndrome conducted in 
the United States and other countries. 
"(2) In canning out paragraph (1), the Secretary shall collect, 
catalog, store, and disseminate the information described in 
such paragraph. To the extent practicable, the Secretary shall 
make such information available to researchers, physicians, and 
other appropriate individuals, of countries other than the 
United States. 
"(d) DATA BANK ON CLINICAL TRIALS AND TREATBCENTS.— 
"(1) Afl»r consultation with the (Commissioner of Food and 
Drugs, the Clinical Research Review Committee, and the Direc-
tor of the Office of AIDS Research, the Secretary shall, in 
carrying out subsection (a), establish a data bank of information 
on clinical trials and treatments with respect to infection with 
the etiologic agent for acquired immune deficiency syndrome 
(hereafter in tins section referred to as the 'Data Bcuok'). 
"(2) In carrying out paragraph (1), the Secretary shall collect, 
catalog, store, and disseminate the information described in 
such paragraph. The Secretary shall disseminate such informa-
tion through information systems available to individuals 
infected witii the etiologic agent for acquired immune deficiency 
syndrome, to other members of the public, to health care provid-
ers, and to researchers. 
"(e) REQUIREMENTS WITH RESPECT TO DATA BANK.—The Data 
Bank shall include the following: 
"(1) A registry of clinical trials of experimental treatments for 
acquired immune deficiency i^ndrome and related illnesses 
conducted under regulations promulgated pursuant to section 
505 of tiie Federal Food, Drug and Cosmetic Act that provides a 
description of the purpose of each experimental drug protocol 
either with the consent of the protocol sponsor, or when a trial 
to t«3t efficacy b^ins. Information provided shall include eligi-
biti^ criteria and the location of trial sites, and must be 
foiTK^utled to the Data Bank by the sponsor of the trial not later 
than 21 days after the approval by the Food and Drug 
Administration. 
PUBLIC LAW 100-607—NOV. 4, 1988 
102 STAT. 3073 
"(2) Information pertaining to experimental treatments for 
acquired immune deficiency sjmdrome that may be available 
under a treatment investigational new drug application that 
has been submitted to the Food and Drug Administration pursu-
ant to part 312 of title 21, Code of Federal Regulations. The 
Data Bank shall also include information pertaining to the 
results of clinical trials of such treatments, with the consent of 
the sponsor, of such experimental treatments, including 
information concerning potential toxicities or adverse effects 
associated with the use or administration of such experimental 
treatment. 
"SEC. 2318. DEVELOPMENT OF MODEL PROTOCOLS FOR CLINICAL CARE 
OF INFECTED INDIVIDUALS. 
"(a) IN GENERAL.— 
"(1) The Secretary may make grants to public and nonprofit 
private entities for the establishment of projects to develop 
model protocols for the clinical care of individuals infected with 
the etiologic agent for acquired immune deficiency s)mdrome. 
"(2) The Secretary may not make a grant under paragraph (1) 
unless— 
"(A) the applicant for the grant is a provider of com-
prehensive primary care; or 
"(B) the applicant for the grant agrees, with respect to 
the project carried out pursuant to paragraph (1), to enter 
into a cooperative arrangement with an entity that is a 
provider of comprehensive primary care. 
"(b) REQUIREMENT OF PROVISION OF CERTAIN SERVICES.—The Sec-
retary may not make a grant under subsection (a) unless the 
applicant for the grant agrees that, with respect to patients partici-
pating in the project carried out with the grant, services provided 
pursuant to the grant will include— 
"(1) monitoring, in clinical laboratories, of the condition of 
such patients; 
"(2) clinical intervention for infection with the etiologic agent 
for acquired immune deficiency syndrome, including measures 
for the prevention of conditions arising from the infection; 
"(3) information and counseling on the availability of treat-
ments for such infection approved by the Commissioner of Food 
and Drugs, on the availability of treatments for such infection 
not yet approved by the Commissioner, and on the reports 
issued by the Clinical Research Review Committee under sec-
tion 2304(cX2)(B); 
"(4) support groups; and 
"(5) information on, and referrals to, entities providing appro-
priate social support services. 
"(c) LIMITATION ON IMPOSITION OF CHARGES FOR SERVICES.—The 
Secretary may not make a grant under subsection (a) unless the 
applicant for the grant agrees that, if the applicant will routinely 
impose a charge for providing services pursuant to the grsuit, the 
applicant will not impose the charge on any individual seeking such 
services who is unable to pay the charge. 
"(d) EVALUATION AND REPORTS.— 
"(1) The Secretary may not make a grant under subsection (a) 
unless the applicant for the grant agrees, with respect to the 
project carried out pursuant to subsection (a), to submit to the 
Secretary— 
42 use 
300CC-18. 
Grants. 
102 STAT. 3074 
PUBLIC LAW 100-607—NOV. 4, 1988 
"(A) information sufficient to assist in the replication of 
the model protocol developed pursuEint to the project; and 
"(B) such reports as the Secretary may require. 
"(2) The Secretary shall provide for evaluations of projects 
carried out pursuant to subsection (a) and shall annually submit 
to the Congress a report describing such projects. The report 
shall include the findings made as a result of such evaluations 
and may include any recommendations of the Secretary for 
appropriate administrative and l^slative initiatives with 
respect to the program established in this section. 
"(e) AUTHORIZATION OF APPROPRIATIONS.—For the purpose of 
carrying out this section, there are authorized to be appropriated 
such sums as may be necessary for each of the fiscal years 1989 
through 1991. 
42 u s e 
"SEC. 2319. NATIONAL BLOOD RESOURCE EDUCATION PROGRAM. 
Research and 
"After consultation with the Director of the National Heart, 
development. 
Lung, and Blood Institute and the Commissioner of Food and Drugs, 
the Secretary shall establish a program of research and education 
regarding blood donations and transfusions to maintain and 
improve the safety of the blood supply. Education programs shall be 
directed at health professionals, patients, and the community to— 
"(1) in the case of the public and patients undergoing 
treatment— 
"(A) increase awareness that the process of donating 
blood is safe; 
;[ . 
"(B) promote the concept that blood donors are contribu-
' 
tors to a national need to maintain an adequate and safe 
blood supply; 
"(C) encourage blood donors to donate more than once a 
year; and 
"(D) encourage repeat blood donors to recruit new donors; 
"(2) in the case of health professionals— 
"(A) improve knowledge, attitudes, and skills of health 
professionals in the appropriate use of blood and blood 
;. 
components; 
" * 
"(B) increase the awareness and understanding of health 
professionals regarding the risks versus benefits of blood 
transfusion; and 
"(C) encourage health professionals to consider alter-
natives to the administration of blood or blood components 
for their patients; and 
"(3) in the case of the community, increase coordination, 
communication, and collaboration among community, profes-
sional, industry, and government organizations regarding blood 
donation and transfusion issues. 
42 u s e 
"SEC. 2320. ADDITIONAL AUTHORITY WITH RESPECT TO RESEARCH. 
Contracts 
"^^^ D A T A COLLECTION WiTH RESPECT TO NATIONAL PREVALENCE.— 
Grants. 
"(D The Secretary, acting through the Director of the Centers 
for Disease Control, may, through representative sampling and 
other appropriate methodologies, provide for the continuous 
collection of data on the incidence in the United Stetes of cases 
of acquired immune deficiency sjmdrome and of cases of infec-
tion with the etiologic agent for such syndrome. The Secretary 
may carry out the program of data collection directly or 
PUBLIC LAW 100-607—NOV. 4, 1988 
102 STAT. 3075 
through cooperative agreements and contracts with public and 
nonprofit private entities. 
"(2) The Secretary shall encourage each State to enter into a 
cooperative agreement or contract under paragraph (1) with the 
Secretary in order to facilitate the prompt collection of the most 
recent accurate data on the incidence of cases described in such 
paragraph. 
"(3) The Secretary shall ensure that data collected under 
paragraph (1) includes data on the demographic characteristics 
of the population of individuals with cases described in para-
graph (1), including data on specific subpopulations at risk of 
infection with the etiologic agent for acquired immune defi-
ciency syndrome. 
"(4) In carrying out this subsection, the Secretary shall, for 
the purpose of assuring the utility of data collected under this 
section, request entities with expertise in the methodologies of 
data collection to provide, as soon as is practicable, eissistance to 
the Secretary and to the States with respect to the development 
and utilization of uniform methodologies of data collection. 
"(5) The Secretary shall provide for the dissemination of data 
collected pursuant to this section. In carr3dng out this para-
graph, the Secretary may publish such data as frequently as the 
Secretary determines to be appropriate with respect to the 
protection of the public health. The Secretary shall publish such 
data not less than once each year. 
"(b) EPIDEMIOLOGICAL AND DEMOGRAPHIC DATA.— 
"(1) The Secretary, acting through the Director of the Centers 
for Disease Control, shall develop an epidemiological data base 
and shall provide for long-term studies for the purposes of— 
"(A) 
collecting 
information 
on 
the 
demographic 
characteristics of the population of individuals infected 
with the etiologic agent for acquired immune deficiency 
syndrome; and 
"(B) developing models demonstrating the long-term 
domestic and international patterns of the transmission of 
such etiologic agent. 
"(2) The Secretary may carry out paragraph (1) directly or 
through grants to, or cooperative agreeements or contracts 
with, public and nonprofit private entities, including Federal 
agencies. 
"(c) LONG-TERM RESEARCH.—The Secretary may make grants to 
public and nonprofit private entities for the purpose of assisting 
grantees in conducting long-term research into treatments for ac-
quired immune deficiency sjmdrome developed from knowledge of 
the genetic nature of the etiologic agent for such syndrome. 
"(d) SOCIAL SCIENCES RESEARCH.—The Secretary, acting through 
the Director of the National Institute of Mental Health, may make 
grants to public and nonprofit private entities for the purpose of 
assisting grantees in conducting scientific research into the psycho-
logical and social sciences as such sciences relate to acquired 
immune deficiency syndrome. 
"(e) AUTHORIZATION OF APPROPRIATIONS.— 
"(1) For the purpose of carrjring out this section, there are 
authorized to be appropriated such sums as may be necessary 
for each of the fiscal years 1989 through 1991. 
"(2) Amounts appropriated pursuant to paragraph (1) to carry 
out subsection (c) shall remain available until expended. 
102 STAT. 3076 
PUBLIC LAW 100-607—NOV. 4, 1988 
'TART C—RESEARCH TRAINING 
42 use 
300CC-31. 
He£ilth care 
professionals. 
"SEC 2341. FELLOWSHIPS AND TRAINING. 
"(a) IN GENERAL.—The Secretary, acting through the Director of 
the Centers for Disease Control, shall establish fellowship and train-
ing programs to be conducted by the Centers for Disease Control to 
train individuals to develop skills in epidemiology, surveillance, 
testing, counseling, education, information, and laboratory analysis 
relatii^ to acquired immune deficiency syndrome. Such prc^ams 
shall be designed to enable health professionals and health person-
nel trained under such programs to work, after receiving such 
training, in national and international efforts toward the pre-
vention, diagnosis, and treatment of acquired immune deficiency 
syndrome. 
"(b) PROGRAMS CONDUCTED BY NATIONAL INSTITUTE OF MENTAL 
HEALTH.—^The Secretary, acting through the Director of the Na-
tional Institute of Mental Health, shall conduct or support fellow-
ship and training programs for individuals pursuing graduate or 
postgiBduate study in order to train such individuals to conduct 
scientific research into the psychological and social sciences as such 
sciences relate to acquired immune deficiency syndrome. 
"(c) RELATIONSHIP TO LIMITATION ON NUMBER OP EMPLOYEES.— 
Any individual receiving a fellowship or receiving training under 
subsection (a) or (b) shall not be included in any determination of the 
number of full-time equivalent employees of the Department of 
Health and Human Services for the purpose of any limitation on the 
number of such employees established by law prior to, on, or after 
the date of the enactment of the AIDS Federal Policy Act of 1988. 
"(d) AUTHORIZATION OP APPROPRIATIONS.—For the purpose of 
carrying out this section, there are authorized to be appropriated 
such sums as may be necessazy for each of the fiscal years 1989 
through 1991. 
'*PAirr D—SPECIAL AUTHORITIES OP THE DIRECTOR OP THE NATIONAL 
INSTITUTES OP HEALTH 
42 use 
300CC-41. 
"SEC 2351. ESTABLISHMENT OF AUTHORITIES. 
"(a) IN GENERAL.—^In carrying out research with respect to ac-
quired immune deficiency syndrome, the Secretary, acting through 
tiie Director of the National Institutes of Health— 
"(IKA) shall establish an office to be known as the Office of 
AIDS Research, which Office shall be headed by a Director 
appointed by the Director of the National Institutes of Health; 
and 
"(B) shall provide administrative support and support services 
to the Director of such Office; 
"(2) shall coordinate activities relating to acquired immune 
deficiency syndrome conducted by the national research in-
stitutes and the agencies of the National Institutes of Health; 
"(3) shall develop and expand clinical trials of treatments and 
therapies for infection with the etiologic agent for acquired 
immune deficiency syndrome, including such clinical trials for 
women, infants, children, hemophiliacs, and minorities; 
"(4) may establish or support the large-scale development and 
preclinical screening, production, or distribution of specialized 
biological materials and other therapeutic substances for 
PUBLIC LAW 100-607—NOV. 4, 1988 
102 STAT. 3077 
research relating to acquired immune deficiency syndrome and 
set standards of safety and care for persons using such 
materials; 
"(5) may, in consultation with the advisory council for the 
appropriate national research institute of the National In-
stitutes of Health, support— 
"(A) research relating to acquired immune deficiency 
s5mdrome conducted outeide the United States by qualified 
foreign professionals if such research can reasonably be 
expected to benefit the people of the United States; 
(B) collaborative research involving American and for-
eign participants; and 
"(C) the training of American scientists abroad and for-
eign scientists in the United States; 
"(6) may encourage and coordinate research relating to 
acquired immune deficiency sjnidrome conducted by any 
industrial concern that evidences a particular capability for the 
conduct of such research; 
"(7XA) may, in consultation with such advisory council, ac-
quire, improve, repair, operate, and maintain laboratories, 
other research facilities, equipment, and such other real or 
personal property as the Director of the National Institutes of 
Health determines necessary; 
"(B) may, in consultation with such advisory council, make 
grants for the construction or renovation of facilities; and 
"(C) may, in consultation with such advisory council, acquire, 
without regard to the Act of March 3, 1877 (40 U.S.C. 34) by 
lease or otherwise through the Administrator of (Jeneral Serv-
ices, buildings or parts of buildings in the District of C!olumbia 
or communities located adjacent to the District of Columbia for 
the use of the National Institutes of Health for a period not to 
exceed ten years; and 
"(8) subject to section 405(bX2) and without regard to section 
3324 of title 31, United States Code, and section 3709 of the 
Revised Statute (41 U.S.C. 5), may enter into such contracts 
and cooperative agreements with any public agency, or with 
any person, firm, association, corporation, or educational 
institution, as may be necessary to expedite and coordinate 
research relating to acquired immune deficiency s3mdrome. 
"(b) REPORT TO SECRETARY.—The Director of the National 
Institutes of Health, acting through the Director of the Office of 
AIDS Research, shall each fiscal year prepare and submit to the 
Secretary, for inclusion in the comprehensive report required in 
section 2301(a), a report— 
"(1) describing and evaluating the progress made in such 
fiscal year in research, treatment, and training with respect to 
acquired immune deficiency syndrome conducted or supported 
by the Institutes; 
"(2) summarizing and analyzing expenditures made in such 
fiscal year for activities with respect to acquired immune 
deficiency syndrome conducted or supported by the National 
Institutes of Health; and 
"(3) containing such recommendations as the Director consid-
ers appropriate. 
"(c) PROJECTS FOR COOPERATION AMONG PUBUC AND PRIVATE 
HEALTH ENTmES.—In carrying out subsection (a), the Director of the 
National Institutes of Health shall establish projects to promote 
Real property. 
Grants. 
District of 
Columbia. 
Public buildings 
and grounds. 
Contracts. 
State and local 
governments. 
Research £uid 
development. 
102 STAT. 3078 
PUBLIC LAW 100-607—NOV. 4, 1988 
cooperation £imong Federal agencies, State, local, and regional 
public health agencies, and private entities, in research concerning 
the diagnosis, prevention, and treatment of acquired immune defi-
ciency s3aidrome. 
"PART E—GENERAL PROVISIONS 
42 use 
300CC-51. 
42 use 300cc 
note. 
"SEC. 2361. DEFINITION. 
"For purposes of this title, the term 'infection with the etiologic 
agent for acquired immune deficiency syndrome' includes any condi-
tion arising from infection with such etiologic agent.". 
SEC. 202. AUTHORIZATION OF ADDITIONAL PERSONNEL. 
(a) IN GENERAL.—Notwithstanding any other provision of law, the 
Secretary of Health and Human Services, shall, in accordance with 
the civil service and classification laws, appoint and fix the com-
pensation of not less than 780 employees for the Public Health 
Service in addition to the number of employees assigned to such 
Service as of December 31,1987. 
(b) REPORT.—Not later than 90 days after the date of the enact-
ment of this Act, the Secretary of Health and Human Services shall 
report to the CJongress on the allocation among the agencies of the 
Public Health Service of the 780 additional employees required in 
subsection (a). 
(c) LIMITATION OF AVAILABILITY OF APPROPRIATIONS.—The require-
ment established in subsection (a) shall be carried out only to the 
extent of amounts made available in appropriations Acts for such 
purpose. 
(d) EXPIRATION OF REQUIREMENT.—Effective October 1, 1990, this 
section is repealed. 
SEC. 203. REQUIREMENT OF CERTAIN RESEARCH STUDIES. 
(a) MORTALITY RATES.—After consultation with the Director of the 
National Center for Health Services Research and Health Care 
Technology Assessment, the Secretary of Health and Human Serv-
ices, acting through the Director of the Centers for Disease Control, 
shall conduct a study for the purpose of determining the mortality 
rates with respect to acquired immune deficiency sjmdrome among 
individuals of various groups at risk of such s5mdrome, among 
various geographic areas, and among individuals with varjdng 
financial resources for the payment of health care services. 
(b) USE OF CONSORTIA FOR RESEARCH AND DEVELOPMENT.—The 
Secretary of Health and Human Services shall request the National 
Academy of Sciences and other similar appropriate nonprofit 
institutions to report to the Secretary findings made by such institu-
tions with respect to— 
(1) the manner in which research on, and the development of, 
vaccines and drugs for the prevention and treatment of 
acquired immune deficiency sjnidrome and related conditions 
can be enhanced by the establishment of consortia— 
(A) designed to combine and share resources needed for 
such research and development; and 
(B) consisting of businesses involved in such research and 
development, of nonprofit research institutions, or of com-
binations of such businesses and such institutions; and 
(2) the appropriate participation, if any, of the Federal 
Grovernment in such consortia. 
PUBLIC LAW 100-607—NOV. 4, 1988 
102 STAT. 3079 
(c) REPORTS TO Ck)NGB£SS.—The Secretary of Health and Human 
Services shall submit to the Congress a report describing the find-
ings made as a result of each of me studies required or requested in 
this section. The report for the study required in subsection (a) shall 
be submitted not later than 18 months after the date of the enact-
ment of this Act. The report for the study requested in subsection (b) 
shall be submitted not later than 1 year after such date. 
SEC. 204. CONFORMING AMENDMENTS. 
The Public Health Service Act (42 U.S.C. 201 et seq.) is amended— 
(1) in section 305(i), by striking "2313" each place it appears 
and inserting "2511"; 
(2) in section 465(f), by striking "2301" and inserting "2501"; 
and 
(3) in section 497, by striking "2301" and inserting "2501". 
Subtitle B—^Health Services 
SEC 211. STATE FORMULA GRANTS, SUBACUTE CARE, AND COUNSELING 
AND TESTING. 
The Public Health Service Act (42 U.S.C. 201 et seq.), as amended 
by section 201, is further amended by inserting after title XXin the 
following new title: 
"TITLE XXIV—HEALTH SERVICES WITH RESPECT TO 
ACQUIRED IMMUNE DEFICIENCY SYNDROME 
' T A B T A—FORMULA GRANTS TO STATES FOR HOME AND (]k>MMUNiT7-
BASED HEALTH SERVICES 
"SEC 2401. ESTABLISHMENT OF PROGRAM. 
42 USC 300dd. 
"(a) ALLOTMENTS FOR STATES.—^For the purpose described in 
subsection (b), the Secretary shall for each of the fiscal years 1989 
and 1990 make an allotment for each State in an amount deter-
mined in accordance with section 2408. The Secretary shall make 
payments each such fiscal year to each State from the allotment for 
the State if the Secretary am>roves for the fiscal year involved an 
application submitted by the State pursuant to section 2407. 
(b) PURPOSE OF GRANTS.^The Secretary may not make payments 
under subsection (a) for a fiscal year unless the State involved 
agrees to expend the payments oidy for the purpose of providing 
services in accordance with section 2402. 
"(c) ELIGIBLE INDIVIDUAL DEFINED.—^For purposes of this part: 
"(1) The term 'eligible individual' means an individual in-
fected with the etiologic agent for acquired immune deficiency 
i^mdrome who either is medically dependent or chronically 
dependent. 
(2) The term 'medically dependent' means, with respect to an 
individual, that the individual has been certified by a physician 
as— 
"(A) requiring the routine use of appropriate medical 
services (which may include home intravenous drug ther-
apy) to prevent or compensate for the individual's serious 
deterioration, arising from infection with the etiol^c 
agent for acquired immune deficiency syndrome, of physical 
health or cognitive function, and 
102 STAT. 3080 
PUBLIC LAW 100-607—NOV. 4, 1988 
"(B) being able to avoid long-term or repeated care as an 
inpatient or resident in a hospital, nursing facility, or other 
institution if home and community-based health services 
are provided to the individual. 
"(3) The term 'chronically dependent' means, with respect to 
an individual, that the individual has been certified by a physi-
cian as— 
"(A) being unable to perform, because of physical or 
cognitive impairment (without substantial assistance from 
another individual) arising from infection with the etiologic 
agent for acquired immune deficiency s3nidrome, at least 2 
of the following activities of daily living: bathing, dressing, 
toileting, transferring, and eating, or 
"(B) having a similar level of disability due to cognitive 
impairment (as defined by the Secretary). 
"(d) HOME AND CJOMMUNITY-BASED HEALTH SERVICES DEFINED.— 
For purposes of this part, the term 'home and community-based 
health services'— 
"(1) means, with respect to an el^ble individual, skilled 
health services furnished to the individual in the individual's 
home pursuant to a written plan of care established by a health 
care professional for the provision of such services and items 
and services described in paragraph (2); 
"(2)mcludes— 
"(A) durable medical equipment, 
"(B) homemaker/home health aide services and personal 
care services furnished in the individual's home, 
"(C) day treatment or other partial hospitalization 
services, 
"CD) home intravenous drug therapy (including prescrip-
tion drugs administered intravenously as part of such ther-
apv), and 
(E) routine diagnostic tests administered in the individ-
ual's home, 
furnished pursuant to such plan of care; but 
"(3) does not include, except as specifically provided in para-
graph (2)— 
"(A) diagnostic tests, 
"(B) inpatient hospital services, 
"(C) nursing facility services, and 
"(D) prescription drugs. 
42 u s e 300dd-l. 
"SEC. 2402. PROVISIONS WITH RESPECT TO CARRYING OUT PURPOSE OF 
GRANTS. 
"(a) REQUIRED USES OF FUNDS.—The Secretary may not make 
payments under section 2401(a) unless the State involved agrees 
that the State will—^' 
"(1) provide for home and community-based health services 
for eligible individuals pursuant to written plans of care estab-
lished by health care professionals for providing such services to 
such individuals; 
"(2) provide for the identification, location, and provision of 
outreach to eligible individuals; 
"(3) provide for coordinating the provision of services under 
this part with the provision of similar or related services by 
public and private entities; and 
PUBLIC LAW 100-607—NOV. 4, 1988 
102 STAT. 3081 
"(4) give priority to the provision of outreach and home and 
community-based services to eligible individuals with low 
incomes. 
"(b) AUTHORITY FOR GRANTS AND CONTRACTS.—A State may make 
pa5nnent for services under subsection (a) through grants to public 
and nonprofit private entities and through contracts with public and 
private entities. In providing such financial assistance, a State shall 
give priority to public and nonprofit private entities that have 
demonstrated experience in delivering home and community-based 
health services to individuals with the etiologic agent for acquired 
immune deficiency S3nidrome. 
"SEC. 2403. REQUIREMENT OF SUBMISSION OF DESCRIPTION OF IN- 42 USC 300dd-2. 
TENDED USES OF GRANT. 
"The Secretary may not make pa)nnents under section 2401(a) to a 
State for a fiscal year unless— 
"(1) the State submits to the Secretary a description of the 
purposes for which the State intends to expend such pajnnents 
for the fiscal year; 
"(2) such description provides information relating to the 
services and activities to be provided, including a description of 
the manner in which such services and activities will be coordi-
nated with any similar services and activities of public and 
private entities; and 
"(3) such description includes information relating to (A) the 
process for determining which eligible individuals are medically 
dependent or chronically dependent and (B) the process for 
establishing written plans of care for the provision of home and 
community-based health services under this part. 
"SEC. 2404. RESTRICTIONS ON USE OF GRANT. 
42 USC 300dd-3. 
"(a) IN GENERAL.—The Secretary may not make pajrments under 
section 2401(a) for a fiscal year to a State unless the State agrees 
that the pajmients will not be expended— 
'•(1) to provide for items or services described in section 
2401(dX3); 
"(2) to make cash pa3mients to intended recipients of services; 
"(3) to purchase or improve real property (other than minor Real property. 
remodeling of existing improvements to real property) or to 
purchase major medical equipment; or 
"(4) to satisfy any requirement for the expenditure of non-
Federal funds as a condition for the receipt of Federal funds. 
"0)) LIMITATION ON ADMINISTRATIVE EXPENSES.—The Secretary 
may not make pajmients under section 2401(a) for a fiscal year 
unless the State involved agrees that the State will not expend more 
than 5 percent of the pajmients made to the State under such 
section for administrative expenses with respect to canying out the 
purpose of this part. 
"(c) LIMITATION ON TOTAL PAYMENTS.— 
"(1) Before March 1, 1989, for fiscal vear 1989 and before 
September 1 of 1989 for fiscal year 1990, the Secretary shall 
determine and publish the national average monthly payments, 
for extended care services under part A of title XVlIl of the 
Social Security Act, for each resident of a skilled nursing facil-
ity the Secretary estimates will be paid in the fiscal year. 
"(2) The Secretary may not make payments under section 
2401(a) for a fiscal year to a State to the extent that the average 
102 STAT. 3082 
PUBLIC LAW 100-607—NOV. 4, 1988 
monthly payments for eligible individuals provided home and 
community-based health services under this part in the State 
exceeds 65 percent of the national average monthly pajmtients 
determined and published for the fiscal year under paragraph 
(1). 
42 use 300dd-4. 
"SEC. 2405. REQUIREMENT OF REPORTS AND AUDITS BY STATES. 
"(a) REPORTS.— 
"(1) The Secretary may not make pajmients under section 
2401(a) for a fiscal year unless the State involved agrees to 
prepare and submit to the Secretary, by not later than January 
1 following the fiscal year, an annual report in such form and 
containing such information as the Secretary determines (after 
consultation with the States and the Comptroller (Jeneral of the 
United States) to be necessary for— 
' 
"(A) securing a record and a description of the purposes 
for which pajrments received by the State pursuant to 
section 2401(a) were expended and of the recipients of such 
pavments; 
(B) determining whether the pa5rments were expended 
in accordance with the purpose of this part; and 
"(C) determining the percentage of pajmients received 
pursuant to section 2401(a) that were expended by the State 
for administrative expenses during the fiscal year involved. 
"(2) Each report by a State under paragraph (1) for a fiscal 
year also shall include— 
"(A) information on the number and t5rpe of eligible 
individuals provided home and community-based health 
services by the State under this part for the fiscal year; 
"(B) information on the types of home and community-
based health services so provided; 
"(C) information on the average monthly costs of such 
services and a comparison of such costs with costs of provid-
ing services in hospitals, nursing facilities, and similar 
institutions; and 
"(D) such other information as the Secretary may require 
to provide for an evaluation of the program under this part 
and its cost-effectiveness. 
"(b) AUDITS.— 
"(1) The Secretary may not make pa3mients under section 
2401(a) for a fiscal year unless the State involved agrees to 
esteblish such fiscal control and fund accounting procedures as 
may be necessary to ensure the proper disbursal of, and 
accounting for, amounts received by the State under such 
section. 
"(2) The Secretary may not make payments under section 
2401(a) for a fiscal year unless the State involved agrees 
that— 
"(A) the State will provide for— 
"(i) a financial and compliance audit of such pay-
ments; or 
"(ii) a single financial and compliance audit of each 
entity administering such payments; 
"(B) the audit will be performed biennially and will cover 
expenditures in each fiscal year; and 
"(C) the audit will be conducted in accordance with stand-
ards established by the Comptroller General of the United 
PUBLIC LAW 100-607—NOV. 4, 1988 
102 STAT. 3083 
States for the audit of governmental organizations, pro-
grams, activities, and functions. 
"(3) The Secretary may not make payments under section 
2401(a) for a fiscal year unless the State involved agrees that, 
not later than 30 days after the completion of an audit under 
paragraph (2), the State will provide a copy of the audit report 
to the State l^islature. 
"(4) For purposes of paragraph (2), the term 'financial and 
compliance audit' means an audit to determine whether the 
financial statements of an audited entity present fairly the 
financial position, and the results of financial operations, of the 
entity in accordance with generally accepted accounting prin-
ciples, and whether the entity has complied with laws and 
r^ulations that may have a material effect upon the financial 
statements. 
"(c) AVAILABILITY TO PUBLIC.—The Secretary may not make pay-
ments under section 2401(a) unless the State involved agrees to 
make copies of the reports and audits described in this section 
available for public inspection. 
"(d) EhrALUATiONS B
Y C
o
&
f
P
T
R
O
L
L
E
R GENERAL.—^Tho Comptroller 
General of the United States shall, from time to time, evaluate the 
expenditures by the States of payments under section 2401(a) in 
order to assure that expenditures are consistent with the provisions 
of this part. 
"SEC 2406. ADDITIONAL REQUIRED AGREEMENTS. 
42 USC 300dd-5. 
"(a) IN GENERAL.—The Secretary may not make payments under 
section 2401(a) for a fiscal year unless the State involved agrees 
that— 
"(1) the l^islature of the State will conduct public hearings 
on the proposed use and distribution of the payments to be 
received from the allotments for each such fiscal year; 
"(2XA) the State will, to the maximum extent practicable, 
ensure that services provided to an individual pursuant to the 
program involved will be provided without r^ard to the ability 
of the individual to pay for such services and without r^ard to 
the current or past health condition of the individual; 
"(B) if any charges are imposed for the provision of home and 
community-based health services for which assistance is pro-
vided under this part, such charges (i) will be pursuant to a 
public schedule of charges, (ii) will not be imposed on any 
eligible individual with an income that does not exceed 100 
percent of the official poverty line, and (iii) for an eligible 
individual with an income that exceeds 100 percent of the 
official poverty line, will be acyusted to reflect the income of the 
individual; 
"(3) the State will provide for periodic independent peer 
review to assess the quality and appropriateness of home and 
" 
community-based health services provided by entities that re-
ceive funds from the State pursuant to section 2401(a); 
"(4) the State will permit and cooperate with Federal inves-
tigations undertaken under section 2409(e); 
"(5) the State will maintain Stote expenditures for home and 
community-based health services for individuals infected with 
the etiologic agent for acquired immune deficiency syndrome at 
a level equal to not less than the average level of such expendi-
tures maintained by the State for the 2-year period preceding 
102 STAT. 3084 
PUBLIC LAW 100-607—NOV. 4, 1988 
the fiscal year for which the State is appljring to receive pay-
ments; and 
"(6) the State will not make payments from allotments made 
under section 2401(a) for any item or service to the extent that 
payment has been made, or can reasonably be expected to be 
made, with respect to that item or service (i) under any State 
compensation program, under an insurance poUcy, under any 
Federal or State health benefits pn^^iam, or (ii) by an entity 
that provides health services on a prepaid basis. 
42 use 300dd-6. 
"SEC. 2407. REQUIREMENT OF SUBMISSION OF APPLICATION CONTAIN-
ING CERTAIN AGREEMENTS AND ASSURANCES. 
"The Secretary may not make payments under section 2401(a) to a 
State for a fiscal year unless— 
"(1) the State submits to the Secretary an application for the 
payments containing agreements in accordance with sections 
2401 through 2406; 
"(2) the agreements are made through certification from the 
chief executive officer of the State; 
- 
"(3) with respect to such agreements, the application provides 
assurances of compliance satisfactory to the Secretary; 
"(4) the application contains the description of intended ex-
penditures required in section 2403; and 
"(5) the application otherwise is in such form, is made in such 
manner, and contains such agreements, assurances, and infor-
mation as the Secretary determines to be necessary to carry out 
this part. 
42 use 300dd-7. "SEC. 2408. DETERMINATION OF AMOUNT OF ALLOTMENTS FOR STATES. 
"(a) MINIMUM ALLOTMENT.—Subject to the extent of amounts 
made available in appropriations Acts, the amount of an allotment 
under section 2401(a) for— 
District of 
"(1) each of the several States, the District of Columbia, and 
Pue" 
to 
Rico 
*
*
*
® Commonwealth of Puerto Rico, for a fiscal year shall be the 
greater of— 
"(A) $100,000, and 
"(B) an amount determined under subsection (b); and 
"(2) each territory of the United States (as defined in section 
2413(5)) shaU be $25,000. 
**(b) DBTraaflNATioN UNDER FORMULA.— 
"(1) The amount referred to in subsection (aXl)(B) for a State 
is the product of— 
"(A) an amount equal to the amount appropriated pursu-
ant to section 2414(a) for the fiscal year involved; and 
"(B) the ratio of the distribution factor for the Stete to 
the sum of the distribution factors for all the States. 
"(2) In paragraph (1)(B), the term 'distribution factor' means, 
for a Stete, the product of— 
"(A) the number in the Stete of additional cases of ac-
quired immune deficiency syndrome, as indicated by the 
number of such cases reported to and confirmed by the 
Secretary for the most recent fiscal year for which such 
date are available, and 
"(B) the ratio (based on the most recent available date) of 
(i) the average per capite income of individuals in the 
United Stetes to (ii) the average per capite income of 
individuals in the Stete; 
PUBLIC LAW 100-607—NOV. 4, 1988 
102 STAT. 3085 
except that the distribution factors for all the States and terri-
tories shsdl be proportionally reduced to the extent necessary to 
assure that the total of the allotments under subsection (a) for 
all the States and territories for each fiscal year does not exceed 
the amount appropriated pursuant to section 2414(a) for the 
fiscal year. 
"(c) INDIAN TRIBES.— 
"(1) Upon the request of the governing body of an Indian tribe 
or tribal organization within a State to the Secretary, the 
Secretary shall— 
"(A) reserve from the amount that otherwise would be 
allotted for the fiscal year to the State under subsection (a) 
an amount determined in accordance with paragraph (2); 
and 
"(B) grant the amount reserved under subparagraph (A) 
to the Indian tribe or tribal organization serving eligible 
individuals who are members of the Indian tribe or tribal 
organization. 
"(2) The amount reserved under paragraph (IXA) shall be an 
amount equal to the product of— 
"(A) the amount that otherwise would be allotted to the 
State under subsection (a) for the fiscal year; and 
"(B) the Secretary's estimate of the proportion of the 
number of addition^ cases described in subsection (bX2XA) 
that are attributable to members of the Indian tribe or 
tribal organization. 
"(3) The Secretary may not make a grant under paragraph 
(1)(B) to an Indian tribe or tribal organization unless the Indian 
tribe or tribal organization submits to the Secretary an applica-
tion meeting the requirements of such an application under 
section 2407. 
"(d) DISPOSITION OP CERTAIN FUNDS APPROPRIATED FOR ALLOT-
MENTS.— 
"(1) Amounts described in paragraph (2) shall, in accordance 
with paragraph (3), be edlotted by the Secretary to States receiv-
ing pajrments under section 2401(a) for the fiscal year (other 
than any State referred to in paragraph (2)(B)). 
"(2) The amounts referred to in paragraph (1) are any 
amounts that are not paid to States or territories under section 
2401(a) as a result of^ 
"(A) the failure of any State or territory to submit an 
application under section 2407 within a reasonable time 
period established by the Secretary; or 
"(B) any State or territory informing the Secretary that 
the State or territory does not intend to expend the full 
amount of the allotment made to the State or territory. 
"(3) The amount of an allotment under paragraph (1) for a 
State for a fiscal year shall be an amount equal to the product 
of— 
"(A) an amount equal to the amount described in para-
graph (2) for the fiscal year involved; and 
"(B) the ratio determined under subsection (bXl)(B) for 
the State. 
"SEC. 2409. FAILURE TO COMPLY WITH AGREEMENTS. 
42 USC 300dd-8. 
"(a) REPAYMENT OP PAYMENTS.— 
102 STAT. 3086 
PUBLIC LAW 100-607—NOV. 4, 1988 
"(1) The Secretary may, subject to subsection (c), require a 
State to repay any payments received by the State under section 
2401(a) that the Secretary determines were not expended by the 
State in accordance with the agreements required to be con-
tained in the appUcation submitted by the State pursuant to 
section 2407. 
"(2) If a State fails to make a repasnnent required in para-
graph (1), the Secretary may offset the amount of the repay-
ment against the amount of any payment due to be paid to the 
State under section 2401(a). 
"(b) WITHHOLDING.— 
"(1) The Secretary may, subject to subsection (c), withhold 
pa3mients due under section 2401(a) if the Secretary determines 
that the State involved is not expending amounts received 
under such section in accordance with the agreements required 
to be contained in the application submitted by the State pursu-
ant to section 2407. 
"(2) The Secretary shall cease withholding payments from a 
State under paragraph (1) if the Secretary determines that 
there are reasonable assurances that the State will expend 
amounts received under section 2401(a) in accordance with the 
agreements referred to in such paragraph. 
"(c) OPPORTUNITY FOR HEARING.—Before requiring repa5anent of 
pajmaents under subsection (aXl), or withholding pajmients under 
subsection (bXD, the Secretary shall provide to the State an oppor-
tunity for a hearing conducted within the State. 
"(d) TECHNICAL VIOLATIONS.—The Secretary may not require 
repayment under subsection (aXD, or withhold payments under 
subsection (bXl), for a techniced violation, as determined by the 
Secretary, of any agreement required to be contained in the applica-
tion submitted by the State pursuant to section 2407. 
"(e) INVESTIGATIONS.— 
"(1) The Secretary shall conduct in the several States in each 
fiscal year investigations of the expenditure of payments re-
ceived by the States under section 2401(a) in order to evaluate 
compliance with the agreements required to be contained in the 
applications submitted to the Secretary pursuant to section 
2407. 
Records. 
"(2) Each State, and each entity receiving funds from pay-
ments made to a State under section 2401(a), shall make appro-
priate books, documents, papers, and records available to the 
Secretary and the Comptroller General of the United States, or 
any of their duly authorized representatives, for examination, 
copjdng, or mechanical reproduction on or off the premises of 
the appropriate entity upon a reasonable request therefor. 
"(3XA) In conducting any investigation in a State, the Sec-
retary and the Comptroller General of the United States may 
not make a request for any information not readily available to 
the State, or to an entity receiving funds from payments made 
to the State under section 2401(a), or make an unreasonable 
request for information to be compiled, collected, or transmitted 
in any form not readily available. 
"(B) Subparagraph (A) shall not apply to the collection, com-
pilation, or transmittal of data in the course of a judicial 
proceeding. 
PUBLIC LAW 100-607—NOV. 4, 1988 
102 STAT. 3087 
"SEC 2410. PROHmmON AGAINST CERTAIN FALSE STATEMENTS. 
42 USC 300dd-9. 
"(a) IN GENERAL.—^A person may not knowingly make or cause to 
be made any false statement or representation of a material fact in 
connection with the furnishing of items or services for which 
amounts may be paid by a State from payments received by the 
State under section 2401(a). 
"(b) CRIMINAL PENALTY FOR VIOLATION OF PROHIBITION.—^Any 
person who violates a prohibition established in subsection (a) may 
for each violation be fined in accordance with title 18, United States 
Code, or imprisoned for not more than 5 years, or both. 
"SEC 2411. TECHNICAL ASSISTANCE AND PROVISION BY SECRETARY OF 42 USC 
SUPPLIES AND SERVICES IN LIEU OF GRANT FUNDS. 
SOOdd-lO. 
"(a) TECHNICAL ASSISTANCE.—^Upon the request of a State receiv-
ing payments under section 2401(a), the Secretary may, vrithout 
cl^u*ge to the State, provide to the State (or to any public or private 
entity designated by the State) technical assistance with respect to 
the planning, development, and operation of this part. The Sec-
reta^ may provide such technical assistance directly, through con-
tract, or through grants. 
"(b) PROVISION BY SECRETARY OF SUPPLIES AND SERVICES IN LIEU OF 
GRANT FUNDS.— 
"(1) Upon the request of a State receivii^ payments under 
section 2401(a), the Secretary may, subject to paragraph (2), 
provide supplies, equipment, and services for the purpose of 
aiding the State in carrying out this part and, for such purpose, 
may detail to the State any officer or employee of the Depart-
ment of Health and Human Services. 
"(2) With respect to a request described in paragraph (1), the 
Secretary shall reduce the amount of payments under section 
2401(a) to the State by an amount equal to tiie costs of detailing 
personnel and the fair market value of any supplies, equipment, 
or services provided by the Secretary. The Secretary shall, for 
the payment of expenses incurred in complying with such 
request, expend the amounts withheld. 
"SEC 2412. REPORT BY SECRETARY. 
"Not later than March 1, 1990, the Secretary shall report to the 
Congress on the activities of the States under this part. Such report 
shall include a recommendation as to whether or not the program 
under this part should be extended beyond fiscal year 1990 and may 
include any recommendations of the Secretary for appropriate 
administrative and l^islative initiatives. 
"SEC 2413. DEFINITIONS. 
"For purposes of this part: 
(1) The terms ^Indian tribe' and 'tribal organization' have 
the same meaning given such terms in sections 4(b) and 4(c) of 
the Indian Self-Determination and Education Assistance Act. 
"(2) The term 'infected with the etiologic agent for acquired 
immune deficienqr syndrome' includes any condition arising 
from infection with such etiologic agent. 
"(3XA) An individual is considered to have low income if the 
individual's income does not exceed 200 percent of the official 
poverty line. 
"(B) The term 'official poverty line' refers, with respect to an 
individual, to the official poverty line defined by the Office of 
42 use 
300dd-ll. 
42 USC 
300dd-12. 
102 STAT. 3088 
PUBLIC LAW 100-607—NOV. 4, 1988 
42 use 
300dd-13. 
42 use 
300dd-14. 
Management and Budget, and revised annually in accordance 
with section 673(2) of the Omnibus Budget Reconciliation Act of 
1981, applicable to a family of the size involved. 
"(4XA) The term 'State' meems, except as provided in subpara-
graph (B), each of the several States, the District of Columbia, 
the Commonwealth of Puerto Rico, and each territory of the 
United States. 
"(B) For purposes of section 2408(d), the term 'State' means 
each of the several States, the District of Columbia, and the 
Commonwealth of Puerto Rico. 
"(5) The term 'territory of the United States' means each of 
the following: the Virgin Islands, Guam, American Samoa, and 
the Commonwealth of the Northern Mariana Islands. 
"SEC. 2414. FUNDING. 
"(a) AUTHORIZATION OF APPROPRIATIONS.—For the purpose of 
making grants under section 2401, there are authorized to be appro-
priated $100,000,000 for each of the fLScal years 1989 and 1990. 
"Ot)) AVAILABILITY TO STATES.—Any amounts paid to a State or 
territory under section 2401(a) shall remain available to the State or 
territory until the expiration of the 1-year period beginning on the 
date on which the State or territory receives such amounts. 
"SEC. 2415. SUNSET. 
"Effective with respect to appropriations made for any period 
after fiscal year 1990, part A of title XXIV of the Public Health 
Service Act is repealed. 
"PARTB—SUBACUTE CARE 
42 use 
300dd-21. 
"SEC. 2421. DEMONSTRATION PROJECTS. 
"(a) As used in this section: 
"(1) The term 
'patients 
infected 
with 
the 
human 
immunodeficiency virus' means persons who have a disease, or 
are recovering from a disease, attributable to the infection of 
such person with the human immunodeficiency virus, and as a 
result of the effects of such disease, are in need of subacute-care 
services. 
"(2) The term 'subacute care' means medical and health care 
services that are required for persons recovering from acute 
care episodes that are less intensive than the level of care 
provided in acute-care hospitals, and includes skilled nursing 
care, hospice care, and other t3T)es of health services provided in 
other long-term-care facilities. 
"(b) The Secretary shall conduct three demonstration projects to 
determine the effectiveness and cost of providing the subacute-care 
services described in subsection (b) to patients infected with the 
human immunodeficiency virus, and the impact of such services on 
the health status of such patients. 
"(cXl) The services provided under each demonstration project 
shall be designed to meet the specific needs of patients infected with 
the human immunodeficiency virus, and shall include— 
"(A) the care and treatment of such patients by providing— 
"(i) subacute care; 
"(ii) emergency medical care and specialized diagnostic 
and therapeutic services as needed and where appropriate, 
PUBLIC LAW 100-607—NOV. 4, 1988 
102 STAT. 3089 
either directly or through affiliation with a hospital that 
has experience in treating AIDS patients; and 
"(iii) case management services to ensure, through exist-
ing services and programs whenever possible, appropriate 
discharge planning for patients; and 
"(B) technical assistance, to other facilities in the region 
' 
served by such facility, that is directed toward education and 
training of physicians, nurses, and other health-care profes-
sionals in the subacute care and treatment of patients infected 
with the human immunodeficiency virus. 
"(2) Services provided under each demonstration project may also 
include— 
"(A) hospice services; 
"(B) outpatient care; and 
"(C) outreach activities in the surrounding community to 
hospitals and other health-care facilities that serve patients 
infected with the human immunodeficiency virus. 
"(d) The demonstration projects shall be conducted— 
"(1) during a 4-year period beginning not later than 9 months 
after the date of enactment of this section; and 
"(2) at sites that— 
"(A) are geographically diverse and located in areas that 
are appropriate for the provision of the required and au-
thorized services; and 
"(B) have the highest incidence of AIDS cases and the 
greatest need for subacute-care services. 
"(e) The Secretary shall evaluate the operations of the demonstra-
tion projects and shall submit to the Committee on Energy and 
Commerce of the House of Representatives and the Committee on 
Labor and Human Resources of the Senate— 
"(1) not later than 18 months after the beginning of the first 
project, a preliminary report that contains— 
"(A) a description of the sites at which the projects are 
being conducted and of the services being provided in each 
project; and 
"(B) a preliminary evaluation of the experience of the 
projects in the first 12 months of operation; and 
"(2) not later than 6 months after the completion of the last 
project, a final report that contains— 
"(A) an assessment of the costs of subacute care for 
patients infected with the human immunodeficiency virus, 
including a breakdown of all other sources of funding for 
the care provided to cover subacute care; and 
"(B) 
recommendations 
for 
appropriate 
legislative 
changes. 
"(f) Each demonstration project shall provide for other research to 
be carried out at the site of such demonstration project including— 
"(1) clinical research on the acquired immunodeficiency syn-
drome, concentrating on research on the neurological mani-
festations 
resulting 
from 
infection 
with 
the 
human 
immunodeficiency virus; and 
"(2) the study of the psychological and mental health issues 
related to the acquired immunodeficiency syndrome. 
"(gXD To carry out this section, there are authorized to be appro-
priated $10,000,000 for fiscal year 1988 and such sums as are nec-
essary for each of the fiscal years 1989 through 1991. 
Reports. 
Research and 
development. 
Appropriation 
authorization. 
102 STAT. 3090 
PUBLIC LAW 100-607—NOV. 4, 1988 
Contracts. 
Veterans. 
42 use 
300dd-31. 
42 use 
300dd-32. 
*H!& Amoiuits s^ypropriated pursuant to paragraph (1) shall remain 
available until September 10,1992. 
"(h) The Secretary shall enter into an agreement with the 
Admmistratar of the Veterans' Administration to ensure that 
appropriate provision will be made for the furnishing, through 
demonstration projects, of services to eligible veterans, under con-
tract with the Veterans' Administration pursuant to section 6 ^ of 
title 38, United States Code. 
'TABT C—OTHES HEALTH SERVICES 
"Subpart I—Counseling and Testing 
"SECL 2431. GRANTS FOR ANONYMOUS TESTING. 
"Hie Secretary may make grants to the States for the purpose of 
providing opportunities for individuals— 
"(1) to undergo counseling and testing with respect to the 
etiologic agent for acquired immune deficiency syn<home with-
out being required to provide any information relating to the 
identity of the individuals; and 
"(2) to undeigo such counseling and testing through the use of 
a pseudonym. 
-SEC 2432. REQUIREMENT OF PROVISION OF CERTAIN COUNSELING 
SERVICES. 
"(a) COUNSELING BEFORE TESTING.—^The Secretary may not make 
a grant under section 2431 to a State unless the Stete agrees that, 
before testing an individual pursuant to such section, the State will 
provide to the individual appropriate counseling with respect to 
acquired immune deficiency syndrome (based on the most recent 
scientific date relating to such syndrome), including— 
"(1) measures for the prevention of exposure to, and the 
transmission of, the etiologic agent for such syndrome; 
"(2) the accuracy and reliabUity of the results of such testing; 
"(3) the significance of the results of such testing, including 
the potential for developing acquired immune deficiency sjrn-
drome; and 
"(4) encouraging individuals, as appropriate, to undezgo test-
ing for such etiologic agent and providing information on the 
benefits of such testing. 
"(b) COUNSELING OF INDIVIDUALS WITH NEGATIVE TEST RESULTS.— 
Hie Secretary may not make a grant under section 2431 to a Stete 
unless the Stete agrees that, if the results of testing conducted 
pursuant to such section indicate that an individual is not infected 
with the etiologic agent for acquired immune deficiency syndrome, 
the Stete will review for the individual the information provided 
pursuant to subsection (a) with respect to such syndrome, 
including— 
"(1) the information described in i>aragraphs (1) through (3) of 
such subsection; and 
"(2) the appropriateness of further coum^ling, testing, and 
education of the individual with respect to acquired immune 
deficiency syndrome. 
"(c) COUNSELING OF INDIVIDUALS Wrre POSFTIVE TEST RESULTS.— 
The Secretary may not make a grant under section 2431 to a Stete 
unless the Stete agrees that, ^ the results of testing conducted 
pursuant to such section indicate that the individual is infected with 
. 
PUBLIC LAW 100-607—NOV. 4, 1988 
102 STAT. 3091 
the etiologic agent for acquired immune deficiency syndrome, the 
State will provide to the individual appropriate counseling with 
respect to such sjrndrome, including— 
"(1) reviewing the information described in paragraphs (1) 
through (3) of subsection (a); 
"(2) reviewing the appropriateness of further counseling, test-
ing, and education of the individual with respect to acquired 
immune deficiency s5mdrome; 
"(3) the importance of not exposing others to the etiologic 
agent for acquired immune deficiency sjoidrome; 
"(4) the availability in the geographic area of any appropriate 
services with respect to health care, including mental hecdth 
care and social and support services; 
"(5) the benefits of locating and counseling any individual by 
whom the infected individual may have been exposed to the 
etiologic agent for acquired immune deficiency sjmdrome and 
any individual whom the infected individual may have exposed 
to such etiologic agent; and 
"(6) the availability, if any, of the services of public health 
authorities with respect to locating and counseling any individ-
ual described in paragraph (4). 
"(d) RULE OF CONSTRUCTION WITH RESPECT TO CJOUNSEUNG WITH-
OUT TESTING.—Agreements entered into pursuant to subsections (a) 
through (c) may not be construed to prohibit any grantee under 
section 2431 from expending the grant for the purpose of providing 
counseling services described in such subsections to an individual 
who will not undergo testing described in such section as a result of 
the grantee or the individual determining that such testing of the 
individual is not appropriate. 
"(e) USE OF FUNDS.— 
"(1) The purpose of this part is to provide for counseling and 
testing services to prevent and reduce exposure to, and trans-
mission of, the etiologic agent for acquired immune deficiency 
83mdrome. 
"(2) All individuals receiving counseling pursuant to this part 
are to be counseled about the harmful effects of promiscuous 
sexual activity and intravenous substance abuse, and the bene-
fits of abstaining from such activities. 
"(3) None of the fund appropriated to carry out this part may 
be used to provide counseling that is designed to promote or 
encourage, directly, homosexual or heterosexual sexual activity 
or intravenous drug abuse. 
"(4) Paragraph (3) may not be construed to prohibit a coun-
selor who hsis already performed the counseling of an individual 
required by paragraph (2), to provide accurate information 
about means to reduce an individual's risk of exposure to, or the 
transmission of, the etiologic agent for acquired immune defi-
ciency syndrome, provided that any informational materials 
used are not obscene. 
"SEC. 2433. FUNDING. 
42 USC 
"For the purpose of grants under section 2431, there are au-
thorized to be appropriated $100,000,000 for each of the fiscal years 
1989 and 1990. 
102 STAT. 3092 
PUBLIC LAW 100-607—NOV. 4, 1988 
"Subpart II—Counseling and Mental Health Services 
42 use 
"SEC. 2441. DEMONSTRATION PROJECTS FOR INDIVIDUALS W
I
T
H POSI-
300dd-41. 
Tjyg j£g,j, RESULTS. 
Grants. 
"(a) IN GENERAL.—The Secretary may make grants to public and 
nonprofit private entities for demonstration projects for the develop-
ment, establishment, or expansion of programs to provide counsel-
ing and mental health treatment— 
"(1) for individuals who experience serious psychological reac-
tions as a result of being informed that the results of testing for 
the etiologic agent for acquired immune deficiency S5mdrome 
indicate that the individuals are infected with such etiologic 
agent; and 
"(2) for the families of such individuals, and for others, who 
experience serious psychological reactions as a result of being 
informed of the results of such testing of such individuals. 
"(b) PREFERENCES IN MAKING GRANTS.—In making grants under 
subsection (a), the Secretary shall give preference to applicants that 
are based at, or have relationships with, entities providing com-
prehensive health services to individuals who are infected with the 
etiologic agent for acquired immune deficiency s3mdrome. 
"(c) REQUIREMENT OF PROVISION OF INFORMATION ON PREVEN-
TION.—The Secretary may not make a grant under subsection (a) 
unless the applicant for the grant agrees that counseling provided 
pursuant to such subsection will include counseling relating to 
measures for the prevention of exposure to, and the transmission of, 
the etiologic agent for acquired immune deficiency syndrome. 
"(d) AUTHORITY FOR TRAINING.—A grantee under subsection (a) 
may expend the grant to train individuals to provide the services 
described in such subsection. 
"(e) REQUIREMENT OF IDENTIFICATION OF NEEDS AND OBJECTIVES.— 
The Secretary may not make a grant under subsection (a) unless the 
applicant for the grant submits to the Secretary— 
"(1) information demonstrating that the applicant has, with 
respect to mental health treatment related to the etiologic 
agent for acquired immune deficiency syndrome, identified the 
need for such treatment in the area in which the program will 
be developed, established, or expanded; and 
"(2) a description of— 
"(A) the objectives established by the applicant for the 
conduct of the program; and 
"(B) the method the applicant will use to evaluate the 
activities conducted under the program and to determine 
the extent to which such objectives have been met. 
"(f) REQUIREMENT OF APPLICATION.—The Secretary may not make 
a grant under subsection (a) unless— 
"(1) an application for the grant is submitted to the Secretary; 
"(2) with respect to carrying out the purpose for which the 
grant is to be made, the application provides assurances of 
compliance satisfactory to the Secretary; 
"(3) the application contains the information required to be 
submitted imder subsection (e); and 
"(4) the application otherwise is in such form, is made in such 
manner, and contains such agreements, assurances, and 
information as the Secretary determines to be necessary to 
carry out this section. 
PUBLIC LAW 100-607—NOV. 4, 1988 
102 STAT. 3093 
"(g) REQUIREMENT OF MINIMUM NUMBER OF GRANTS FOR FISCAL 
YEAR 1989.-^ubject to the extent of amounts made available in 
appropriations Acts, the Secretary shall, for fiscal year 1989, make 
not less than 6 grants under subsection (a). 
"(h) TECHNICAL ASSISTANCE AND ADMINISTRATIVE SUPPORT.—The 
Secretary, acting through the Director of the National Institute of 
Mental Health, may provide technical assistance and administrative 
support to grantees under subsection (a). 
(i) DEFINITION.—For purposes of this section, the term 'mental 
health treatment' means individual, family or group services de-
signed to alleviate distress, improve functional ability, or assist in 
changing dysfunctional behavior patterns. 
"^) AUTHORIZATION OF APPROPRIATIONS.—For the purpose of carry-
ing out this section, there are authorized to be appropriated such 
sums as may be necessary for each of the fiscal years 1989 through 
1991.". 
Subtitle C—Prevention 
SEC. 221. FORMULA GRANTS TO STATES. 
The Public Health Service Act (42 U.S.C. 201 et seq.), as amended 
by section 211, is further amended by inserting after title XXIV the 
following new title: 
"TITLE XV—PREVENTION OF ACQUIRED IMMUNE 
DEFICIENCY SYNDROME 
"SEC. 2500. USE OF FUNDS. 
"(a) IN GENERAL.—^The purpose of this part is to provide for the 
establishment of education and information programs to prevent 
and reduce exposure to, and the transmission of, the etiologic agent 
for acquired immune deficiency syndrome. 
"01)) CONTENTS OF PROGRAMS.—All programs of education and 
information receiving funds under this title shall include informa-
tion about the harmful effects of promiscuous sexual activity and 
intravenous substance abuse, and the benefits of abstaining from 
such activities. 
"(c) LIMITATION.—None of the funds appropriated to carry out this 
title may be used to provide education or information designed to 
promote or encourage, directly, homosexual or heterosexual sexual 
activity or intravenous substance abuse. 
"(d) CONSTRUCTION.—Subsection (c) may not be construed to re-
strict the ability of an education program that includes the informa-
tion required in subsection (b) to provide accurate information about 
various means to reduce an individual's risk of exposure to, or the 
transmission of, the etiologic agent for acquired immune deficiency 
syndrome, provided that any informational materials used are not 
obscene. 
"PART A—FORMULA GRANTS TO STATES 
42 use 300ee. 
"SEC. 2501. ESTABLISHMENT OF PROGRAM. 
"(a) ALLOTMENTS FOR STATES.—For the purpose described in 
subsection (b), the Secretary shall for each of the fiscal years 1989 
through 1991 make an allotment for each State in an amount 
determined in accordance with section 2507. The Secretary shall 
42 use 
300ee-ll. 
102 STAT. 3094 
PUBLIC LAW 100-607—NOV. 4, 1988 
Public 
information. 
42 use 
300ee-12. 
Public 
information. 
Public 
information. 
Research and 
development. 
Health care 
professionals. 
Education. 
Grants. 
Education. 
make payments each such fiscal year to each State from the allot-
ment for the State if the Secretary approves for the fiscal year 
involved an application submitted by the State pursuant to section 
2503. 
"(b) PusFOSB OF GRANTS.—^The Secretary may not make payments 
under subsection (a) for a fiscal year unless the State involved 
agrees to expend the payments only for the purpose of carrying out, 
in accordance with section 2502, public information activities with 
respect to acquired immune deficiency syndrome. 
"SEC 2502. PROVISIONS WITH RESPECT TO CARRYING OUT PURPOSE OF 
GRANTS. 
"A State may expend pajnnents received under section 2501(a)— 
"(1) to develop, establish, and conduct public information 
activities relating to the prevention and diagnosis of acquired 
immune deficiency syndrome for those populations or commu-
nities in the State in which there are a significant number of 
individuals at risk of infection with the etiologic agent for such 
s3mdrome; 
"(2) to develop, establish, and conduct such public information 
activities for the general public relating to the prevention and 
diagnosis of such syndrome; 
"(3) to develop, establish, and conduct activities to reduce 
risks relating to such syndroine, including research into the 
prevention of such syndrome; 
"(4) to conduct demonstration projects for the prevention of 
such syndrome; 
^'(5) to provide technical assistance to public entities, to non-
profit private entities concerned with such syndrome, to schools, 
and to employers, for the purpose of developing information 
programs relating to such syndrome; 
"(6) with respect to education and training programs for the 
prevention of such syndrome, to conduct such prc^ams for 
health professionals (including allied health professionals), 
public safety workers (including emergency response employ-
ees), teachers, school administrators, and other appropriate edu-
cation personnel; 
"(7) to conduct appropriate programs for educating school-
aged children with respect to such syndrome, after consulting 
with local school boards; 
"(8) to make available to physicians and dentists in the State 
information with respect to acquired immune deficiency syn-
drome, including measures for the prevention of exposure to, 
and the transmission of, the etiologic agent for such syndrome 
(which information is updated not less than annually with 
the most recently available scientific date relating to such 
syndrome); 
"(9) to carry out the initial implementation of recommenda-
tions contained in the guidelines and the model curriculum 
developed under section 2525; and 
"(10) to make grants to public entities, and to nonprofit 
private entities concerned with acquired immune deficiency 
ssjmdrome, for the purpose of the development, establishment, 
and expansion of prt^rams for education directed toward 
individuals at increased risk of infection with the etiol<^c agent 
for such syndrome and activities to reduce the risks of exposure 
to such etiologic agent, with preference to programs directed 
PUBLIC LAW 100-607—NOV. 4, 1988 
102 STAT. 3095 
toward populations in which there is significant evidence of 
such infection. 
"SEC. 2503. REQUIREMENT OF SUBMISSION OF APPUCATION CONTAIN- 42 USC 
ING CERTAIN AGREEMENTS AND ASSURANCES. 
300ee-13. 
"(a) IN GENERAL.—The Secretary may not make payments under 
section 2501(a) for a fiscal year unless— 
"(1) the State involved submits to the Secretary a description 
of the purposes for which the State intends to expend the 
payments for the fiscal year; 
"(2) the description identifies the populations, areas, and 
localities in the State with a need for the services for which 
amounts may be provided by the State under this part; 
"(3) the description provides information relating to the pro-
grams and activities to be supported and services to be provided, 
including a description of the manner in which such pn^rams 
and activities wUl be coordinated with any similar programs 
and activities of public and private entities; and 
"(4) the State submits to the Secretary an appUcation for the 
payments containing agreements in accordance with this part; 
(5) the agreements are made through certification from the 
chief executive officer of the State; 
"(6) with respect to such agreements, the application provides 
assurances of compliance satisfactory to ihe Secretary; and 
*\1) the appUcation otherwise is in such form, is made in such 
manner, and contains such agreements, assurances, and 
information as the Secretary determines to be necessary to 
carry out this part. 
"Ot)) OPPORTUNITY FOR PUBUC C
k
>
M
M
E
N
T
.
—
^
T
h
e Secretary may not 
make payments under section 2501(a) for a fiscal year unless the 
State involved agrees that, in developing and carrying out the 
description required in subsection (a), the State will provide pubUc 
notice with respect to the description (including any revisions) and 
will facilitete comments from interested persons. 
"SEC. 2504. RESTRICTIONS ON USE OF GRANT. 
"(a) IN GENERAL.—^The Secretary may not make payments under 
section 2501(a) for a fiscal year unless the State involved agrees that 
the payments will not be expended— 
**(X) 
to 
provide inpatient services; 
"(2) to make cash payments to intended recipients of services; 
"(3) to purchase or improve real property (other than minor 
remodeling of existing improvements to real property) or to 
purchase major medicsd equipment; or 
"(4) to satisfy any requirement for the expenditure of non-
Federal funds as a condition for the receipt of Federal funds. 
"(b) LIMITATION ON ADMINISTRATIVE EJXPENSES.—^The Secretary 
may not make payments under section 2501(a) for a fiscal year 
unless the State involved agrees that the State will not expend more 
than 5 percent of the payments for administrative expenses with 
respect to canying out &e purpose described in section 2501(b). 
"SEC 2505. REQUIREMENT OF REPORTS AND AUDITS BY STATES. 
"(a) REPORTS.—^The Secretary may not make payments under 
section 2501(a) for a fiscal year unless the Stete involved agrees to 
prepare and submit to the Secretary an annual report in such form 
42 use 
300ee-14. 
Real property. 
42 USC 
300ee-15. 
102 STAT. 3096 
PUBLIC LAW 100-607—NOV. 4, 1988 
and containing such information as the Secretary determines to be 
necessary for— 
Records. 
"(1) securing a record and a description of the purposes for 
which pa3anents received by the State pursuant to such section 
were expended and of the recipients of such payments; 
"(2) determining whether the payments were expended in 
accordance with the needs within the State required to be 
identified pursuant to section 2503(aX2); 
"(3) determining whether the pa5rments were expended in 
accordance with the purpose described in section 2501(b); and 
"(4) determining the percentage of pajnnents received pursu-
ant to such section that were expended by the State for adminis-
trative expenses during the preceding fiscsd year. 
"0)) AUDITS.— 
"(1) The Secretary may not pajmaents under section 2501(a) 
for a fiscal year unless the State involved agrees to establish 
such fiscal control and fund accounting procedures £is may be 
necessary to ensure the proper disbursal of, and accounting for, 
amounts received by the State under such section. 
"(2) The Secretary may not pa3maents under section 2501(a) 
for a fiscal year unless the State involved agrees that— 
"(A) the State will provide for— 
"(i) a financial and compliance audit of such pay-
ments; or 
"(ii) a single financial and compliance audit of each 
entity administering such pa3anents; 
"(B) the audit will be performed biennially and will cover 
expenditures in each fiscal year; and 
"(C) the audit will be conducted in accordance with stand-
ards established by the C!omptroller General of the United 
States for the audit of governmental organizations, pro-
grams, activities, and functions. 
"(3) The Secretary may not make payments under section 
2501(a) for a fiscal year unless the State involved agrees that, 
not later than 30 days after the completion of an audit under 
paragraph (2), the State will provide a copy of the audit report 
to the State legislature. 
"(4) For purposes of paragraph (2), the term 'financial and 
compliance audit' means an audit to determine whether the 
finsmcial statements of an audited entity present fairly the 
financial position, and the results of financial operations, of the 
entity in accordance with generally accepted accounting prin-
ciples, and whether the entity has complied with laws and 
regulations that may have a material effect upon the financial 
statements. 
Reports. 
"(c) AVAILABILITY TO PuBLic.—The Secretary may not make pay-
ments under section 2501(a) for a fiscal year unless the State 
involved agrees to make copies of the reports and audits described in 
this section available for public inspection. 
"(d) EVALUATIONS BY COMPTROLLER GENERAL.—The Comptroller 
General of the United States shall, from time to time, evaluate the 
expenditures by States of payments received under section 2501(a) in 
order to ensure that expenditures are consistent with the provisions 
of this part. 
PUBLIC LAW 100-607—NOV. 4, 1988 
102 STAT. 3097 
"SEC. 2506. ADDITIONAL REQUIRED AGREEMENTS. 
"The Secretary may not, except as provided in subsection (b), 
make payments under section 2501(a) for a fiscal year unless the 
State involved agrees that— 
"(1) all programs conducted or supported by the State with 
such payments will establish objectives for the program and will 
determine the extent to which the objectives are met; 
"(2) information provided under this part will be scientificsilly 
accurate and factually correct; 
"(3) in carrying out section 2501(b), the State will give priority 
to programs described in section 2502(10) for individuals 
described in such section; 
"(4) with respect to a State in which there is a substantial 
number of individuals who are intravenous substance abusers, 
the State will place priority on activities under this part 
directed at such substance abusers; 
"(5) with respect to a State in which there is a significant 
incidence of reported cases of acquired immune deficiency sjm-
drome, the State will— 
"(A) for the purpose described in subsection (b) of section 
2501, expend not less than 50 percent of pa5mients received 
under subsection (a) of such section for a fiscal year— 
"(i) to make grants to public entities, to migrant 
health centers (as defined in section 329(a)), to commu-
nity health centers (as defined in section 330(a)), and to 
nonprofit private entities concerned with acquired 
immune deficiency syndrome; or 
"(ii) to enter into contracts with public and private 
entities; and 
"(B) of the amounts reserved for a fiscal year by the State 
for expenditures required in subparagraph (A), expend not 
less than 50 percent to carry out section 2502(10) through 
grants to nonprofit private entities, including minority 
entities, concerned with acquired immune deficiency 
syndrome located in and representative of communities and 
subpopulations reflecting the local incidence of such 
syndrome; 
(For purposes of this section, the term 'significant percentage' 
means at least a percentage of 1 percent of the number of reported 
cases of such syndrome in the United States); 
"(6) with respect to programs carried out pursuant to section 
2502(10), the State will ensure that any applicant for a grant 
under such section agrees— 
"(A) that any educational or informational materials 
developed with a grant pursuant to such section will con-
tain material, and be presented in a manner, that is specifi-
cally directed toward the group for which such materials 
are intended; 
"(B) to provide a description of the manner in which the 
applicant has planned the program in consultation with, 
and of the manner in which such applicant will consult 
during the conduct of the program with— 
"(i) appropriate local officials and community groups 
for the area to be served by the program; 
42 use 
300ee-16. 
Grants. 
Contracts. 
Education. 
102 STAT. 3098 
PUBLIC LAW 100-607—NOV. 4, 1988 
"(ii) oiganizations comprised of, and representing, 
the specific population to which the education or 
prevention effort is to be directed; and 
"(iii) individuals having expertise in health education 
and in the needs of the population to be served; 
*\0 to provide information demonstrating that the 
applicant has continuing relationships, or wOl establish 
continuing relationships, with a portion of the population 
in the service area that is at risk of infection with the 
etiologic agent for acquired immune deficienQr syndrome 
and with public and private entities in such area that 
provide health or other support services to individuals with 
such infection; 
"(D) to provide a description of— 
"(i) the objectives established by the applicant for the 
conduct of the program; and 
"(ii) the methods the applicant will use to evaluate 
the activities conducted under the program to deter-
mine if such objectives are met; and 
"(E) such other information as the Secretary may pre-
scribe; 
"(7) with respect to programs carried out pursuant to section 
2502(10), the State will give preference to any applicant for a 
grant pursuant to such section that is located in, has a histoiy 
of service in, and will serve under the program, any geographic 
area in which— 
"(A) there is a significant incidence of acquired immune 
deficiency syndrome; 
"(B) 
tiiere 
has been a significant increase in the incidence 
of sudi syndrome; or 
"(O there is a significant risk of becoming infected with 
the etiologic agent 
for 
such syndrome; 
"(8) the State will establish reasonable criteria to evaluate the 
effective performance of entities that receive funds from to 
payments made to the State under section 2501(a) and will 
estoblish procedures for procedural and substantive independ-
ent State review of the failure by the State to provide fimds for 
any such entity; and 
(9) the State will permit and cooperate with Federal inves-
tigations undertaken in accordance with section 2509(e); 
"(10) the State will maintain State expenditures for services 
provided pursuant to section 2501 at a level equal to not less 
than the average level of such expenditures maintained by the 
State for the 2-year period preceding the fiscal year for which 
the State is applying to receive payments. 
42 use 
"SBC 2597. DETERMINATION OF AMOUNT OF ALLOTMENTS FOR STATES. 
^~ 
"(a) MINIMUM ALLOTMENT.—^The allotment for a State under sec-
tion 2501(a) 
for 
a 
fiscal 
year shall be the greater of— 
"(1) the amount described in subsection (b); or 
"(2) 
tibe 
amount determined in accordance with subsection (c). 
"(b) DETEHMINATION OF MINIMUM ALLOTMENT.— 
"(1) If the total amount appropriated under section 2516(a) for 
a fiscal year exceeds $100,000,000, the amount referred to in 
subsection (aXD is $300,000 for the 
fiscal 
year. 
"(2) If the total amount appropriated under section 2514(a) for 
a fiscal year equals or exceeds $50,000,000, but is less than 
PUBLIC LAW 100-607—NOV. 4, 1988 
102 STAT. 3099 
$100,000,000, the amount referred to in subsection (aXD is 
$200,000 for the fiscal year. 
"(3) If the total amount appropriated under section 2514(a) for 
a fiscal year is less than $50,000,000, the amount referred to in 
subsection (aXD is $100,000 for the fiscal year. 
"(c) DETERMINATION UNDER FORMULA.— 
"(1) The amount referred to in subsection (aX2) is the sum o
f
— 
"(A) the amount determined under paragraph (2); and 
"(B) the amount determined under paragraph (3). 
"(2) The amount referred to in paragraph (IXA) is the product 
o
f
— 
"(A) an amoimt equal to 50 percent of the amounts 
appropriated pursuant to section 2514(a); and 
(B) a percentage equal to the quotient of^ 
"(i) the population of the State involved; divided by 
"(ii) the population of the United States. 
"(3) The amount referred to in paragraph (IXB) is the product 
o
f
— 
"(A) an amount equal to 50 percent of the amounts 
apjpropriated pursuemt to section 2514(a); and 
(B) a percentage equal to the quotient o
f
— 
"(i) the number of additional cases of acquired 
immune deficiency s5ntidrome reported to and con-
firmed by the Secretary for the State involved for the 
most recent fiscal year for which such data is available; 
divided by 
"(ii) the number of additional cases of such sjnidrome 
reported to and confirmed by the Secretary for the 
United States for such fiscal year. 
"(d) DISPOSITION OF CERTAIN FUNDS APPROPRIATED FOR ALLOT-
MENTS.— 
"(1) Amounts described in paragraph (2) shall be allotted by 
the Secretary to States receiving payments under section 
2501(a) for the fiscal year (other than any State referred to in 
paragraph (2XC)). Such amounts shall be allotted according to a 
formula established by the Secretary. The formula shall be 
equivalent to the formula described in this section under which 
the allotment for the State for the fiscal year involved was 
determined. 
"(2) The amounts referred to in paragraph (1) are any 
amounts that are not paid to States under section 2501(a) as a 
result o
f
— 
"(A) the failure of any State to submit an application 
under section 2507; 
"(B) the failure, in the determination of the Secretary, of 
any State to prepare within a reasonable period of time 
such application in compliance with such section; or 
"(C) any State informing the Secretary that the State 
does not intend to expend the full amount of the allotment 
made to the State. 
"SEC. 2508. FAILURE TO COMPLY WITH AGREEMENTS. 
42 USC 
"(a) REPAYMENT OF PAYMENTS.— 
"(1) The Secretary may, subject to subsection (c), require a 
State to repay any pa3rments received by the State under section 
2501(a) that fiie Secretary determines were not expended by the 
State in accordance with the agreements required to be con-
19-194 O—91—Part 4 
5 : QL 3 
102 STAT. 3100 
PUBLIC LAW 100-607—NOV. 4, 1988 
tained in the application submitted by the State pursuant to 
section 2507. 
"(2) If a State fails to make a repayment required in para-
graph (1), the Secretary may ofTset the amount of the repay-
ment against the amount of any payment due to be paid to the 
State under section 2501(a). 
"
O
t
>
) WITHHOLDING.— 
"(1) The Secretary may, subject to subsection (c), withhold 
payments due under section 2501(a) if the Secretary determines 
that the State involved is not expending amounts received 
under such section in accordance with the agreements required 
to be contained in the application submitted by the State pursu-
ant to section 2507. 
"(2) The Secretary shall cease withholding payments from a 
State under paragraph (1) if the Secretary determines that 
there are reasonsdble assurances that the State will expend 
amounts received under section 2501(a) in accordance with the 
agreements referred to in such paragraph. 
"(3) The Secretary may not withhold funds under paragraph 
(1) 
firom 
a State for a minor failure to comply with the agree-
ments referred to in such paragraph. 
"(c) OPPOHTUNITY FOE HEABING.—Before requiring repayment of 
payments under subsection (aXl), or withholding pajrments under 
subsection (bXl), the Secretary shall provide to the State an oppor-
tunity for a hearing conducted within the State. 
"(d) PROBOT R E ^ N S E TO SERIOUS ALLEGATIONS.—The Secretary 
shall promptly respond to any complaint of a substantial or serious 
nature that a State has failed to expend amounts received under 
section 2501(a) in accordance with the agreements required to be 
contained in the application submitted by the State pursuant to 
section 2507. 
"(e) INVESTIGATIONS.— 
"(1) The Secretary shall conduct in several States in each 
fiscal year investigations of the expenditure of pa3rments 
received by the States under section 2501(a) in order to evaluate 
compliance with the agreements required to be contained in the 
applications submitted to the Secretary pursuant to section 
2507. 
"(2) The CJomptroUer (Jeneral of the United States may con-
duct investigations of the expenditure of funds received under 
section 2501(a) by a State in order to ensure compliance with 
the agreements referred to in paragraph (1). 
Records. 
"(3) Each State, and each entity receiving funds from pay-
ments made to a State under section 2501(a), shall make appro-
priate books, documents, papers, and records available to the 
Secretary and the Comptroller (Jeneral of the United States, or 
any of their duly authorized representatives, for examination, 
copying, or mechanical reproduction on or off the premises of 
the appropriate entity upon a reasonable request therefor. 
"(4XA) In conducting any investigacion in a State, the Sec-
retary and the CJomptroUer General of the United States may 
not make a request for any information not readily available to 
the State, or to an entity receiving funds from pa3mients made 
to the State imder section 2501(a), or make an unreasonable 
r e q u ^ for information to be compiled, collected, or transmitted 
in any form not readily available. 
PUBLIC LAW 100-607—NOV. 4, 1988 
102 STAT. 3101 
"(B) Subparagraph (A) shall not apply to the collection, com-
pilation, or transmittal of data in the course of a judicial 
proceeding. 
"SEC. 2509. PROHIBITION AGAINST CERTAIN FALSE STATEMENTS. 
"(a) IN GENERAL.— 
"(1) A person may not knowingly make or cause to be made 
any false statement or representation of a material fact in 
connection with the furnishing of items or services for which 
amounts may be paid by a State from pajrments received by the 
State under section 2501(a). 
"(2) A person with knowledge of the occurrence of any event 
affecting the right of the person to receive any amounts from 
payments made to the State under section 2501(a) may not 
conceal or fail to disclose any such event with the intent of 
fraudulently securing such amounts. 
"(b) CRIMINAL PENALTY FOR VIOLATION OF PROHIBITION.—Any 
person who violates a prohibition established in subsection (a) may 
for each violation be fined in accordance with title 18, United States 
Code, or imprisoned for not more than 5 years, or both. 
"SEC. 2510. TECHNICAL ASSISTANCE AND PROVISION BY SECRETARY OF 
SUPPLIES AND SERVICES IN LIEU OF GRANT FUNDS. 
"(a) TECHNICAL ASSISTANCE.—The Secretary may provide training 
and technical assistance to States with respect to the planning, 
development, and operation of any program or service carried out 
pursuant to this part. The Secretary may provide such technical 
assistance directly or through grants or contracts. 
"(b) PROVISION BY SECRETARY OF SUPPUES AND SERVICES IN LIEU OF 
GRANT FUNDS.— 
"(1) Upon the request of a State receiving payments under 
this part, the Secretary may, subject to paragraph (2), provide 
supplies, equipment, and services for the purpose of aiding the 
State in caniying out such part and, for such purpose, may 
detail to the State any officer or employee of the Department of 
Health and Human Services. 
"(2) With respect to a request described in paragraph (1), the 
Secretary shall reduce the amount of pajrmente under the 
program involved to the State by an amount equal to the costs 
of detailing personnel and the fair market value of any supplies, 
equipment, or services provided by the Secretary. The Secretary 
shall, for the pajnnent of expenses incurred in compl5dng with 
such request, expend the amounts withheld. 
"SEC. 2511. EVALUATIONS. 
"The Secretary shall, directly or through grants or contracts, 
evaluate the services provided and activities carried out with pay-
ments to States under this part. 
"SEC. 2512. REPORT BY SECRETARY. 
"The Secretary shall annually prepare a report on the activities of 
the States carried out pursuant to this part. Such report may 
include any recommendations of the Secretary for appropriate 
administrative and legislative initiatives. The report shall be 
submitted to the Congress through inclusion in the comprehensive 
report required in section 2301. 
42 use 
300ee-19. 
42 use 
300ee-20. 
Contracts. 
42 use 
300ee-21. 
Grants. 
Contracts. 
42 use 
300ee-22. 
102 STAT. 3102 
PUBLIC LAW 100-607—NOV. 4, 1988 
42 use 
300ee-23. 
42 use 
300ee-24. 
"SEC. 2513. DEFINITION. 
"For purposes of this part, the term 'infection with the etiologic 
agent for acquired immune deficiency sjrndrome' includes any condi-
tion arising from such etiologic agent. 
"SEC. 2514. FUNDING. 
"(a) AUTHORIZATION OF APPROPRIATIONS.—For the purpose of 
making allotments under section 2501(a), there are authorized to be 
appropriated $165,000,000 for fiscal year 1989 and such sums as may 
be necessary for each of the fiscal years 1990 and 1991. 
"0)) AVAILABILITY TO STATES.—Any amounts paid to a State under 
section 2501(a) shall remain available to the State until the expira-
tion of the 1-year period beginning on the date on which the State 
receives such amounts. 
42 use 
300ee-31. 
"PART B—NATIONAL INFORMATION PROGRAMS 
"SEC. 2521. AVAILABILITY OF INFORMATION TO GENERAL PUBLIC. 
"(a) COMPREHENSIVE INFORMATION PLAN.—The Secretary, acting 
through the Director of the Centers for Disease Control, shall 
annually prepare a comprehensive plan, including a budget, for a 
National Acquired Immune Deficiency Syndrome Information Pro-
gram. The plan shall contain provisions to implement the provisions 
of this title. The Director shall submit such plan to the Secretary. 
The authority established in this subsection may not be construed to 
be the exclusive authority for the Director to carry out information 
activities with respect to acquired immune deficiency syndrome. 
"(b) CLEARINGHOUSE.— 
"(1) The Secretary, acting through the Director of the Centers 
for Disease Control, may establish a clearinghouse to make 
information concerning acquired immune deficiency syndrome 
available to Federal agencies. States, public and private entities, 
and the general public. 
"(2) The clearinghouse may conduct or support programs— 
"(A) to develop and obtain educational materials, model 
curricula, and methods directed toward reducing the trans-
mission of the etiologic agent for acquired immune defi-
ciency syndrome; 
"(B) to provide instruction and support for individuals 
who provide instruction in methods and techniques of edu-
cation relating to the prevention of acquired immune defi-
ciency S3nidrome and instruction in the use of the materials 
and curricula described in subparagraph (A); and 
"(C) to conduct, or to provide for the conduct of, the 
materials, curricula, and methods described in paragraph 
(1) and the efficacy of such materials, curricula, and meth-
ods in preventing infection with the the etiologic agent for 
acquired immune deficiency s3aidrome. 
"(c) TOLL-FREE TELEPHONE COMMUNICATIONS.—The Secretary 
shall provide for the establishment and maintenance of toll-free 
telephone communications to provide information to, and respond to 
queries from, the public concerning acquired immune deficiency 
syndrome. Such communications shall be available on a 24-hour 
basis. 
PUBLIC LAW 100-607—NOV. 4, 1988 
102 STAT. 3103 
"SEC. 2522. PUBLIC INFORMATION CAMPAIGNS. 
42 USC 
"(a) IN GENERAL.—The Secretary, acting through the Director of Grants. 
the Centers for Disease Control, may make grants to public entities, Contracts. 
and to nonprofit private entities concerned with acquired immune 
deficiency s5mdrome, and shall enter into contracts with public and 
private entities, for the development and delivery of public service 
announcements and paid advertising messages that warn individ-
uals about activities which place them at risk of infection with the 
etiologic agent for such syndrome. 
"(b) REQUIREMENT OF APPUCATION.—The Secretary may not pro-
vide financial assistance under subsection (a) unless— 
"(1) an application for such assistance is submitted to the 
Secretary; 
"(2) with respect to carrying out the purpose for which the 
assistance is to be provided, the application provides assurances 
of compliance satisfactory to the Secretary; and 
"(3) the application otherwise is in such form, is made in such 
manner, and contains such agreements, assurances, and 
information as the Secretary determines to be necessary to 
carry out this section. 
"SEC. 2523. PROVISION OF INFORMATION TO UNDERSERVED POPU-
LATIONS. 
"(a) IN GENERAL.—The Secretary may make grants to public Grants. 
entities, to migrant health centers (as defined in section 329(a)), to 
community health centers (as defined in section 330(a)), and to 
nonprofit private entities concerned with acquired immune defi-
ciency syndrome, for the purpose of assisting grantees in providing 
services to populations of individuals that are underserved with 
respect to programs providing information on the prevention of 
exposure to, and the transmission of, the etiologic agent for acquired 
immune deficiency S3nidrome. 
"(b) PREFERENCES IN MAKING GRANTS.—In making grants under 
subsection (a), the Secretary shall give preference to any applic£uit 
for such a grant that has the ability to disseminate rapidly the 
information described in subsection (a) (including any national 
organization with such ability). 
42 use 
300ee-33. 
"SEC. 2524. AUTHORIZATION OF APPROPRIATIONS. 
"(a) IN GENERAL.—For the purpose of carrying out sections 2521 
through 2523, there are authorized to be appropriated $105,000,000 
for fiscal year 1989 and such sums as may be necessary for each of 
the fiscal years 1990 and 1991. 
"0)) ALLOCATIONS.— 
"(1) Of the amounts appropriated pursuant to subsection (a), 
the Secretary shall make available $45,000,000 to carry out 
fc 
section 2522 and $30,000,000 to carry out this part through 
financial assistance to minority entities for the provision of 
services to minority populations. 
"(2) After consultation with the Director of the Office of 
Minority Health and with the Indian Health Service, the Sec-
retary, acting through the Director of the Centers for Disease 
Control, shall, not later than 90 days after the date of the 
enactment of this section, publish guidelines to provide proce-
dures for applications for funding pursuant to pareigraph (1) and 
for public comment.". 
42 use 
300ee-34. 
102 STAT. 3104 
PUBLIC LAW 100-607—NOV. 4, 1988 
National 
Commission on 
Acquired 
Immune 
Deficiency 
Syndrome Act. 
42 u s e 300CC 
note. 
Subtitle D—National Commission on Acquired 
Immune Deficiency Syndrome 
SEC. 241. SHORT TITLE. 
This subtitle may be cited as the "National Commission on 
Acquired Immune Deficiency Syndrome Act". 
SEC. 242. ESTABLISHMENT. 
There is established a commission to be known as the "National 
Commission on Acquired Immune Deficiency S3mdrome" (herein-
after in this Act referred to as the "Commission"). 
SEC. 243. DUTIES OF COMMISSION. 
(a) GENERAL PURPOSE OF THE COMMISSION.—^The Commission shall 
carry out activities for the purpose of promoting the development of 
a national consensus on policy concerning acquired immune defi-
ciency syndrome (hereinafter in this subtitle referred to as "AIDS") 
and of studying and making recommendations for a consistent 
national policy concerning AIDS. 
(b) SUCCESSION.—The Commission shall succeed the Presidential 
O>nmiission on the Human Immunodeficiency Virus Epidemic, 
established by Executive Order 12601, dated June 24,1987. 
(c) FUNCTIONS.—The Ck>mmission shall perform the following 
functions: 
(1) Monitor the implementation of the recommendations of 
the Presidential Commission on the Human Immunodeficiency 
Virus Epidemic, modifying those recommendations as the 
(Commission considers appropriate. 
(2) Evaluate the adequacy of, and make recommendations 
r^arding, the financing of health care and research needs 
relating to AUXS, including the allocation of resources to var-
ious Federal agencies and State and local governments and the 
roles for and activities of private and public financing. 
(3) Elvaluate the adequacy of, and make recommendations 
r^arding, the dissemination of information that is essential to 
the prevention of the spread of AIDS, and that recognizes the 
special needs of minorities and the important role of tibe family, 
educational institutions, religion, and community organizations 
in education and prevention efforts. 
(4) Address any necessary behavioral changes needed to 
combat AIDS, taking into consideration the multiple moral, 
ethical, and l^al concerns involved, and make recommenda-
tions r^arding testing and counseling concerning AIDS, 
particularly witii respect to maintaining confidentiality. 
(5) Evaluate the adequacy of, and make recommendations 
r^arding. Federal and State laws on civil rights relating to 
AIDS. 
(6) Evaluate the adequacy of, and make recommendations, 
r^arding the capability of the Federal (jlovemment to make 
and imidement policy concerning AIDS (and, to the extent 
feasible to do so, other diseases, known and unknown, in the 
future), including research and treatment, the availability of 
clinical trials, education and the financing thereof, and includ-
ing specifically— 
PUBLIC LAW 100-607—NOV. 4, 1988 
102 STAT. 3105 
(A) the streamlining of rules, regulations, and adminis-
trative procedures relating to the approval by the Food and 
Drug Administration of new drugs and medical devices, 
including procedures for the release of experimental drugs; 
and 
(B) the advancement of administrative consideration by 
the Health Care Financing Administration relating to re-
imbursement for new drugs and medical devices approved 
by the Food and Drug Administration. 
(7) Evaluate the adequacy of, and make recommendations 
regarding, international coordination and cooperation concern-
ing data collection, treatment modalities, and research concern-
ing AIDS. 
SEC. 244. MEMBERSHIP. 
(a) NUMBER AND APPOINTMENT.— 
(1) APPOINTMENT.—The Commission shall be composed of 15 
members as follows: 
(A) Five members shall be appointed by the President— President of U.S. 
(i) three of whom shall be— 
(I) the Secretary of Health and Human Services; 
(II) the Administrator of Veterans' Affairs; and 
(III) the Secretary of Defense; 
who shall be nonvoting members, except that, in the 
case of a tie vote by the Commission, the Secretary of 
Health and Human Services shall be a voting member; 
f' 
and 
(ii) two of whom shall be selected from the general 
public on the basis of such individuals being speciEilly 
qualified to serve on the Commission by reason of their 
education, training, or experience. 
(B) Five members shall be appointed by the Speaker of 
the House of Representatives on the joint recommendation 
of the Majority and Minority Leaders of the House of 
Representatives. 
(C) Five members shall be appointed by the President pro 
tempore of the Senate on the joint recommendation of the 
Majority and Minority Leaders of the Senate. 
(2) 
CONGRESSIONAL 
COMMITTEE 
RECOMMENDATIONS.—In 
making appointments under subparagraphs (B) and (C) of para-
graph (1), the Majority and Minority Leaders of the House of 
Representatives and the Senate shsill duly consider the rec-
ommendations of the Chairmen and Ranlang Minority Mem-
bers of committees with jurisdiction over laws contained in 
chapter 17 of title 38, United States Code (relating to veterans' 
health care), title XIX of the Social Security Act (42 U.S.C. 1901 
et seq.) (relating to Medicaid), and the Public Health Service Act 
(42 U.S.C. 201 et seq.) (relating to the Public Health Service). 
(3) 
REQUIREMENTS OF APPOINTMENTS.—The Majority 
and 
Minority Leaders of the Senate and the House of Representa-
tives shall— 
(A) select individuals who are specially qualified to serve 
on the Commission by reason of their education, training, 
or experience; and 
(B) engage in consultations for the purpose of ensuring 
that the expertise of the 10 members appointed by the 
Speaker of the House of Representatives and the President 
102 STAT. 3106 
PUBLIC LAW 100-607—NOV. 4, 1988 
pro tempore of the Senate shall provide as much of a 
balance as possible and, to the greatest extent possible, 
cover the fields of medicine, science, law, ethics, health-care 
economics, and health-care and social services. 
(4) TERM OF MEMBERS.—Members of the Commission (other 
than members appointed under paragraph (IXAXi)) shall serve 
for the life of the Commission. 
(5) VACANCY.—A vacancy on the Commission shall be filled in 
the manner in which the original appointment was made. 
(b) CHAIRMAN.—Not later than 15 days after the members of the 
Commission are appointed, such members shall select a Chairman 
from among the members of the Commission. 
(c) QUORUM.—Seven members of the Commission shall constitute 
a quorum, but a lesser number may be authorized by the Commis-
sion to conduct hearings. 
(d) MEETINGS.—The Commission shall hold its first meeting on a 
date specified by the Chairman, but such date shall not be earlier 
than September 1,1988, and not be later than 60 days after the date 
of the enactment of this Act, or September 30, 1988, whichever is 
later. After the initial meeting, the Commission shall meet at the 
call of the Chairman or a majority of its members, but shall meet at 
least three times each year during the life of the Commission. 
(e) PAY.—Members of the Commission who are officers or em-
ployees or elected officials of a government entity shall receive no 
additional compensation by reason of their service on the 
Commission. 
(f) PER DIEM.—While away from their homes or regular places of 
business in the performance of duties for the Commission, members 
of the Commission shall be allowed travel expenses, including per 
diem in lieu of subsistence, at rates authorized for employees of 
agencies under sections 5702 and 5703 of title 5, United Stat^ Code. 
(g) DEADUNE FOR APPOINTMENT.—Not earlier than July 11, 1988, 
and not later than 45 days after the date of the enactment of this 
Act, or August 1, 1988, whichever is later, the members of the 
Commission shall be appointed. 
SEC. 245. REPORTS. 
(a) INTERIM REPORTS.— 
(1) IN GENERAL.—Not later than 1 year after the date on 
which the Commission is fully constituted under section 244(a), 
the Commission shall prepare and submit to the President and 
to the appropriate committees of Congress a comprehensive 
report on the activities of the Commission to that date. 
(2) CONTENTS.—The report submitted under paragraph (1) 
shaJI include such findings, and such recommendations for 
legislation and administrative action, as the Commission consid-
ers appropriate based on its activities to that date. 
(3) OTHER REPORTS.—^The Commission shall transmit such 
other reports as it considers appropriate. 
(b) F^NAL REPORT.— 
(1) IN GENERAL.—Not later than 2 years after the date on 
which the Commission is fully constituted under section 244(a), 
the Commission shall prepare and submit a final report to the 
President and to the appropriate committees of Congress. 
(2) CONTENTS.—The final report submitted under paragraph 
(1) shall contain a detailed statement of the activities of the 
Commission and of the findings and conclusions of the Commis-
PUBLIC LAW 100-607—NOV. 4, 1988 
102 STAT. 3107 
sion, including such recommendations for l^islation and 
adimnistrative action as the Commission considers appropriate. 
SEC 246. EXECUTIVE DIRECTOR AND STAFF. 
(a) EXECUTIVE DIRECTOR.— 
(1) APPOINTMENT.—^The Commission shall have an Executive 
Director who shall be appointed by the Chairman, with the 
approval of the Commission, not later than 30 days after the 
Chairman is selected. 
(2) COMPENSATION.—^The Executive Director shall be com-
pensated at a rate not to exceed the maximum rate of basic pay 
payable under GS-18 of the General Schedule as contained in 
title 5, United States Code. 
(b) STAFF.—^With the approval of the Commission, the Executive 
Director may appoint and fix the compensation of such additional 
personnel as the Executive Director considers necessary to carry out 
the duties of the Commission. 
(c) APPUCABUJTY OF CIVIL SERVICE LAWS.—The Executive Director 
and the additional personnel of the Commission appointed under 
subsection (b) may be appointed without r^ard to the provisions of 
title 5, United States Code, governing appointments in the competi-
tive service, and may be paid without regard to the provisions of 
chapter 51 and subchapter III of chapter 53 of such title relating to 
claeeification and General Schedule pay rates. 
(d) CONSULTANTS.—Subject to such rules as may be prescribed by 
the Commission, the Executive Director may procure temporary or 
intermittent services under section 3109(b) of title 5, United States 
Code, at rates for individuads not to exceed $200 per day. 
(e) DETAILED PERSONNEL AND SUPPORT SERVICES.—Upon the re-
quest of the Commission for the detail of personnel, or for adminis-
toative and support services, to assist the Commission in carrying 
out its duties under this Act, the Secretary of Health and Human 
Services and the Administrator of Veterans' Affairs, either jointly 
or separately, may on a reimbursable basis (1) detail to the Commis-
sion personnel of the Department of Health and Human Services or 
the Veterans' Administration, respectively, or (2) provide to the 
Commission administrative and support services. The Secretary and 
the Administrator shall consult for the purpose of determining and 
impl^nenting an appropriate method for jointly or separately 
detailing such personnel and providing such services. 
SEa 247. POWERS OF COMMISSION. 
(a) HEARINGS.—^For the purpose of carrying out this Act, the 
Commission may conduct such hearings, sit and act at such times 
and places, take such testimony, and receive such evidence, as the 
Commission considers appropriate. The Commission may administer 
oaths or affirmations to witnesses appearing before the Commission. 
(b) DELEGATION.—Any member or employee of the Commission 
may, if authorized by the Commission, take any action that the 
Gonmiission is authorized to take under this Act. 
(c) ACCESS TO INFORMATION.—^The Commission may secure directly 
firom any executive department or £^ncy such information as may 
be necessary to enable the Commission to carry out this Act, except 
to the extent that the department or agency is expressly prohibited 
lr7 law firom furnishing such information. On the request of the 
dnairman of the Commission, the head of such dep£utment or 
agency shall furnish nonprohibited information to the Commission. 
102 STAT. 3108 
PUBLIC LAW 100-607—NOV. 4, 1988 
(d) MAILS.—The Commission may use the United States mails in 
the same manner and under the same conditions as other depart-
ments and agencies of the United States. 
SEC. 248. AUTHORIZATION OF APPROPRIATIONS. 
There is authorized to be appropriated for fiscal year 1989 
$2,000,000, and such sums as may be necessary in any subsequent 
fiscal year, to carry out the purposes of this Act. Amounts appro-
priated pursuant to such authorization shall remain available until 
expended. 
SEC. 249. TERMINATION. 
The Commission shall cease to exist 30 days after the date on 
which its final report is submitted under section 24503). The Presi-
dent may extend the life of the Commission for a period of not to 
exceed 2 years. 
Subtitle E—General Provisions 
42 use 300ee-l 
note. 
42 use 300ee-l. 
42 use 300ee-2. 
SEC. 251. REQUIREMENT OF STUDY WITH RESPECT TO MINORITY 
HEALTH AND ACQUIRED IMMUNE DEFICIENCY SYNDROME. 
(a) IN GENERAL.—The Secretary of Health and Human Services, 
acting through the Director of the Office of Minority Health, shall 
conduct a study for the purpose of determining— 
(1) the level of knowledge within minority communities 
concerning acquired immune deficiency syndrome, the risks of 
the transmission of the etiologic agent for such syndrome, and 
the means of reducing such risk; and 
(2) the effectiveness of Federal, State, and local prevention 
programs with respect to acquired immune deficiency syndrome 
in minority communities. 
O
b
) REPORT.—The Secretary shall, not later than 12 months after 
the date of enactment of this Act, complete the study required in 
subsection (a) and submit to the Congress a report describing the 
findings made as a result of the study. 
SEC. 252. ESTABLISHMENT OF OFFICE WITH RESPECT TO MINORITY 
HEALTH AND ACQUIRED IMMUNE DEFICIENCY SYNDROME. 
The Secretary of Health and Human Services, acting through the 
Director of the Centers for Disease Control, shall establish an office 
for the purpose of ensuring that, in carryinjg out the duties of the 
Secreta^ with respect to prevention of acquired immune deficiency 
syndrome, the Secretary develops and implements prevention pro-
grams targeted at minority populations and provides appropriate 
technic£Q assistance in the implementation of such programs. 
SEC. 253. INFORMATION FOR HEALTH AND PUBLIC SAFETY WORKERS. 
(a) DEVELOPMENT AND DISSEMINATION OF GUIDEUNES.—Not later 
than 90 days after the date of the enactment of this title, the 
Secretary of Health and Human Services (hereafter in this section 
referred to as the "Secretary"), acting through the Director of the 
Centers for Disease Control, shall develop, issue, and disseminate 
emergency guidelines to all health workers, public safety workers 
(including emergency response employees) in the United States 
concerning— 
PUBLIC LAW 100-607—NOV. 4, 1988 
102 STAT. 3109 
(1) methods to reduce the risk in the workplace of becoming 
infected with the etiologic agent for acquired immune deficiency 
sjmdrome; and 
(2) circumstances under which exposure to such etiologic 
agent may occur. 
(b) USE IN OCCUPATIONAL STANDARDS.—The Secretary shall trans-
mit the guidelines issued under subsection (a) to the Secretary of 
Labor for use by the Secretary of Labor in the development of 
standards to be issued under the Occupational Safety and Health 
Act of 1970. 
(c) DEVELOPMENT AND DISSEMINATION OF MODEL CURRICULUM FOR 
EMERGENCY RESPONSE EMPLOYEES.— 
(1) Not later than 90 days after the date of the enactment of 
this title, the Secretary, acting through the Director of the 
Centers for Disease Control, shall develop a model curriculum 
for emergency response employees with respect to the preven-
tion of exposure to the etiologic agent for acquired immune 
deficiency syndrome during the process of responding to emer-
gencies. 
(2) In carrjdng out paragraph (1), the Secretary shall consider 
the guidelines issued by the Secretary under subsection (a). 
(3) The model curriculum developed under paragraph (1) 
shall, to the extent practicable, include— 
(A) information with respect to the manner in which the 
etiologic agent for acquired immune deficiency sjmdrome is 
transmitted; and 
(B) information that can assist emergency response 
employees in distinguishing between conditions in which 
such employees are at risk with respect to such etiologic 
£^ent and conditions in which such employees are not at 
risk with respect such etiologic agent. 
(4) The Secretary shall establish a task force to assist the 
Secretary in developing the model curriculum required in para-
graph (1). The Secretary shall appoint to the task force rep-
resentatives of the Centers for Disease Control, representatives 
of State governments, and representatives of emergency 
response employees. 
(5) The Secretary shall— 
(A) transmit to State public health officers copies of the 
guidelines and the model curriculum developed under para-
graph (1) with the request that such officers disseminate 
such copies as appropriate throughout the State; and 
(B) make such copies available to the public. 
SEC. 254. CONTINUING EDUCATION FOR HEALTH CARE PROVIDERS. 
(a) IN GENERAL.—The Secretary of Health and Human Services 
(hereafter in this section referred to as the "Secretary") may make 
grants to nonprofit organizations composed of, or representing, 
health care providers to assist in the pa5rment of the costs of projects 
to train such providers concerning— 
(1) appropriate infection control procedures to reduce the 
transmission of the etiologic agent for acquired immune defi-
ciency syndrome; and 
(2) the provision of care and treatment to individuals with 
such syndrome or related illnesses. 
O
t
>
) LIMITATION.—The Secretary may make a grant under subsec-
tion (a) to an entity only if the entity will provide services under the 
Public 
information. 
42 u s e 300ee-3. 
'Grants. 
Grants. 
102 STAT. 3110 
PUBLIC LAW 100-607—NOV. 4, 1988 
42 use 300ee-4. 
Drugs and drug 
42 use 300ee-5. 
42 use 275 note. 
grant in a geographic area, or to a population of individuals, not 
served by a program substantially similar to the program described 
in subsection (a). 
(c) REQUIREMENT OF MATCHING FUNDS.— 
(1) The Secretary may not make a grant under subsection (a) 
unless the applicant for the grant agrees, with respect to the 
costs to be incurred by the applicant in canying out the purpose 
described in such subsection, to make available, directly or 
through donations from public or private entities, non-Federal 
contributions (in cash or in kind under paragraph (2)) toward 
such costs in an amount equal to not less than $2 for each $1 of 
Federal funds provided in such pajnnents. 
(2) Non-Federal contributions required in paragraph (1) may 
be in cash or in kind, fairly evaluated, including plant, equip-
ment, or services. Amounts provided by the Federal Govern-
ment, or services assisted or subsidized to any significant extent 
by the Federal Government, may not be included in determin-
ing the amount of such non-Federal contributions. 
(d) REQUIREMENT OP APPUCATION.—The Secretary may not make 
a grant under subsection (a) unless— 
(1) an application for the grant is submitted to the Secretary; 
(2) with respect to carr3ring out the purpose for which the 
grant is to be made, the application provides assurances of 
compliance satisfactory to the Secretary; and 
(3) the application otherwise is in such form, is made in such 
manner, and contains such agreements, assurances, and 
information as the Secretary determines to be necessary to 
carry out this section. 
(e) AUTHORIZATION OF APPROPRIATIONS.—For the purpose of carry-
ing out this section, there are authorized to be appropriated such 
sums as may be necessary for each of the fiscal years 1989 through 
1991. 
SEC. 255. TECHNICAL ASSISTANCE. 
The Secretary of Health and Human Services shall provide tech-
nical assistance to public and nonprofit private entities carr3dng out 
programs, projects, and activities relating to acquired immune defi-
ciency sjmdrome. 
SEC. 256. MISCELLANEOUS PROVISIONS. 
(a) PuBuc HEALTH EMERGENCY FUND.—Section 319 of the Public 
Health Service Act (42 U.S.C. 247d) is amended— 
(1) in subsection (a), by inserting "the Administrator of 
Health Resources and Services," before "or the Director"; and 
(2) in subsection (bXD, by striking "$30,000,000" the second 
place it appears and inserting in lieu thereof "$45,000,000". 
(b) CERTAIN USE OF FUNDS.—None of the funds provided under 
this Act or an amendment made by this Act shall be used to provide 
individuals with hj^odermic needles or syringes so that such 
individuals may use illegal drugs, unless the Surgeon General of the 
United States determines that a demonstration needle exchange 
program would be effective in reducing drug abuse and the risk that 
the public will become infected with the etiologic agent for acquired 
immune deficiency syndrome. 
(c) REPORT ON CERTAIN ETHICAL ISSUES.—The Congressional Bio-
medical Ethics Board shall report to Congress within eighteen 
months from the effective date of this Act on the ethical issues 
PUBLIC LAW 100-607—NOV. 4, 1988 
102 STAT. 3111 
connected with the administration of nutrition and hydration to 
dying patients. This report shall include a review of State laws, 
regulations and court decisions on this topic. The report shall £dso 
discuss the arguments concerning the appropriate roles of the pa-
tient, the patient's fsunily, the care provider, the State and the 
appropriate Federal role, 
(d) STUDY OF STATE LAWS.— 
(1) The Secretary of Health and Human Services shall con-
duct a study for the purpose of determining— 
(A) the laws and policies of the States relating to con-
fidentiality and disclosure of information with respect to 
records of the counseling and testing of individuals regard-
ing the etiologic agent for acquired immune deficiency 
syndrome; and 
(B) the laws and policies of the States relating to discrimi-
nation against individuals infected with such etioli^c 
agent or r^^arded as being so infected. 
(2) Not later than 6 months after the date of the enactment of Reports. 
this Act, the Secretary of Health and Human Services shall 
complete the study required in subsection (a) and submit to the 
Congress a report describing the 
findings 
made as a result of the 
study. 
TITLE 
III—PREVENTIVE 
HEALTH, 
HEALTH 
SERVICES, 
AND 
HEALTH 
PRO-
MOTION 
Subtitle A—^Preventive Health and Health 
Services 
SEC 301. BLOCK GRANTS. 
(a) AUTHORIZATION OF APPROPRIATIONS.—Section 1901(a) of the 
Public Health Service Act (42 U.S.C. 300w(a)) is amended by striking 
"and" after "1986," and by inserting before the period the following: 
", $110,000,000 for fiscal year 1989, and such sums as may be 
necessary for each of the fiscal years 1990 and 1991". 
(b) USE OF ALLOTMENTS.—Section 1904(aXl) of the Public Health 
Service Act (42 U.S.C. 300w-3(aXl)) is amended— 
(1) in subparagraph (B), by inserting before the period the 
following: "and elevated serum cholesterol"; 
(2) in subparagraph (C), by inserting before the period the 
following: ", including pn^ams designed to reduce the in-
cidence of chronic diseases"; 
(3) in subparagraph (D), by inserting before the period the 
following: ", including immunization services"; 
(4) in subparagraph (F), in the second sentence, by striking 
"systems (other" and all that follows and inserting the follow-
ing: "systems, except that such amounts may be used for the 
payment of not more than 50 percent of the costs of purchasing 
communications equipment for the systems."; and 
(5) by inserting after subparagraph (G) the following new 
subparagraph: 
102 STAT. 3112 
PUBLIC LAW 100-607—NOV. 4, 1988 
"(H) Establishing and maintaining preventive health service 
programs for screening for, the detection, diagnosis, prevention, 
and referral for treatment of, and follow-up on compliance with 
treatment prescribed for, uterine cancer and breast cancer.". 
(c) APPUCATION AND DESCRIPTION OF AcnvmES.—Section 1905(d) 
of the Public Health Service Act (42 U.S.C. 300w-4(d)) is amended by 
adding at the end the following new sentence: "The description shall 
include a statement of the pidalic health objectives expected to be 
achieved by the State throui^ the use of the pajmients the State will 
receive imder section 1903.". 
(d) REPOBTS AND AUDITS.— 
(1) Section 1906(a) of the Public Health Service Act (42 U.S.C. 
300w-5(a)) is amended by adding at the end the following new 
paragraph: 
"(3) Each annual report required in paragraph (1) shall include— 
"(A) information and data on the number of individuals who 
received services provided through the use of payments under 
section 1903, the types of such services provided, the tjrpes of 
health care providers that delivered such services, and the cost 
of each type of such service; 
"(B) such other information and data as the Secretary may 
require; and 
"(O an evaluation of the extent to which such services have 
been effective toward meeting the public health objectives 
described in the statement submitted to the Secretary pursuant 
to section 1905(d).". 
(2) Section 190601X6) of the Public Health Service Act (42 
U.S.C. 300w-5(bX6)) is amended by striking "1983," and insert-
mg "1990,". 
SEC. 302. GRANTS FOR EMERGENCY MEDICAL SERVICES FOR CHILDREN. 
(a) DURATION OF GRANT.—Section 1910(a) of the Public Health 
Service Act (42 U.S.C. 300w-9(a)) is amended in the second sentence 
by striking "shall be for" and all that follows and inserting the 
following: "shall be for not more than a two-year period, subject to 
annual evaluation by the Secretary.". 
(b) AUTHORIZATION OF APPROPRIATIONS.—^Section 1910(d) of the 
PubUc Health Service Act (42 U5.C. 300w-9(d)) is amended by 
inserting before the period the following: ", $3,0()0,000 for fiscal year 
1989, $4,000,000 for fiscal year 1990, and $5,000,000 for fiscal year 
1991". 
SEC 303. REPEAL OF PROGRAM OF STATE PLANNING GRANTS. 
Part A of title XIX of the Public Health Service Act (42 U.S.C. 
42 use SOOw-io. 300w et seq.) is amended by striking section 1910A. 
Subtitle B—^Programs With Respect to Sexual-
ly Transmitted Diseases, Health Information, 
and Health Promotion 
SEC 311. GRANTS FOR PREVENTION OF SEXUALLY 
TRANSMITTED 
DISEASES. 
Section 318 of the PubUc Health Service Act (42 U.S.C. 247c) is 
amended— 
PUBLIC LAW 100-607—NOV. 4, 1988 
102 STAT. 3113 
(1) in the title, by striking "and acquired immune deficiency 
sjoidrome"; 
(2) by striking subsections (d) and (f); 
(3) by redesignating subsection (e) as subsection (d) and 
subsection (g) as subsection (e); and 
- 
(4) in subsection (dXl) (as so redesignated)— 
(A) in the first sentence— 
(i) by striking "(b), (c), and (d)" and inserting "(b) and 
(c)"; 
(ii) bv striking "and" after "1986,"; 
(iii) by striking the period and inserting a comma; 
and 
(iv) by adding at the end the following: "$78,000,000 
for fiscal year 1989, and such sums as mav be necessary 
for each of the fiscal years 1990 and 1991. ; 
(B) in the third sentence, by striking "Ob), (c), or (d)" and 
inserting "(b) or (c)"; and 
(C) by striking the last sentence. 
SEC. 
3
1
2
. 
HEALTH 
INFORMATION 
AND 
HEALTH 
PROMOTION. 
(a) AUTHORIZATION OF APPROPRIATIONS.—Title XVII of the Public 
Health Service Act (42 U.S.C. 300u et seq.) is amended— 
(1) in section 1701(b)— 
42 usc 300u. 
(A) by striking "this title," and inserting "sections 1701 
through 1705,"; and 
(B) by striking "and" after "1986," and inserting before 
the period the following: ", and $10,000,000 for each of the 
fiscal years 1989 through 1991"; and 
(2) in section 1706(e), by striking "and" after "1986," and 42USC300u-5. 
inserting before the period the following: ", $6,000,000 for fiscal 
year 1989, $8,000,000 for fiscal year 1990, and $10,000,000 for 
fiscal year 1991". 
O
t
>
) MODEL PROGRAMS FOR EMPLOYEE HEALTH PROMOTION AND 
DISEASE PREVENTION "
~
~
" 
(1) Section 1701(a) of the Public Health Service Act (42 U.S.C. 
300u(a)) is amended— 
(A) by redesignating paragraphs (7) through (10) as para-
graphs (8) through (11), respectively; and 
(B) by inserting after paragraph (6) the following new 
paragraph: 
"(7XA) develop model programs through which employers in 
Small business. 
the public sector, and employers that are small businesses (as 
defined in section 3 of the Small Business Act), can provide for 
their employees a program to promote healthy behaviors and to 
discourage participation in unhealthy behaviors; 
"(B) provide technical assistance to public and private 
employers in implementing such programs (including private 
employers that are not small businesses and that will imple-
ment programs other than the programs developed by the 
Secretary pursuant to subparsigraph (A)); and 
"(C) in providing such technical assistance, give preference to 
SIIldJ.1 l)llsi]1.6SS6S* 
(2) Not later than 18 months after the date of the enactment 
42 USC 300u 
of this Act, the Secretary of Health and Human Services shall 
^°^-
complete the development of the model programs required in 
section 1701(aX7XA) of the Public Health Service Act (as added 
by paragraph (1)(B) of this subsection). 
102 STAT. 3114 
PUBLIC LAW 100-607—NOV. 4, 1988 
(c) TBCHNICAL AND CONFORMING AMENDMENTS.—Section 1701(a) of 
the Public Health Service Act (42 U.S.C. 300u) is amended— 
(1) in paragraph (9) (as redesignated by subsection (bXlXA) of 
this section), by striking "paragraph (7)" and inserting "para-
graph (8)"; and 
(2) in the matter after and below paragraph (11)(D) (as so 
redesignated)— 
(A) by striking the first sentence; and 
(B) by striking "paragraph (1())" and inserting "para-
graph (11)". 
tepiant 
TITLE IV—ORGAN TRANSPLANT 
AS^onm*" 
AMENDMENTS OF 1988 
SEC 401. SHORT TITLE AND REFERENCE. 
42 use 201 note. 
(a) SHOBT TTTLE.—^This title may be cited as the "Organ Trans-
plant Amendments Act of 1988". 
(b) REFERENCE.—Whenever in this title an amendment or repeal is 
expressed in terms of an amendment to, or repeal of, a section or 
other provision, the reference shall be considered to be made to a 
section or other provision of the Public Health Service Act. 
SEC 402. ASSISTANCE FOR ORGAN PROCUREMENT ORGANIZATIONS. 
(a) ADDITIONAL GRANT AUTHORITY.—Section 371(a) (42 U.S.C. 
273(a)) is amended— 
(1) in paragraph (2), by inserting "consolidation," after "oper-
ation,"; 
(2) by redesignating paragraph (3) as paragraph (4) and insert-
ing after paragraph (2) the following new paragraph: 
"(3) The Secretary may make grants for special projects designed 
to increase the nunlser of organ donors."; and 
(3) in paragraph (4) (as redesignated in paragraph (2) of this 
subsection)— 
(A) by striking "and" at the end of subparagraph (A); 
(B) by striking the period at the end and inserting ", 
and"; and 
(Q by adding at the end the following new subparagraph: 
"(C) with respect to carrying out paragraph (3), give special 
consideration to proposals from existing organ procurement 
oiganizations.". 
(b) LIMITATIONS ON ADDITIONAL GRANT AUTHORITY.—Section 
374(bX3) (42 UJS.C. 274b(bK3)) is amended in the first sentence bv 
stri^ng "section 371" and all that follows through "organizations' 
and inserting "paragraphs (2) and (3) of section 371(a)". 
(c) DESCsupnoN O
F ORGAN PROCUREMENT ORGANIZATION.— 
(1) Section 371(b) (42 U.S.C. 273(b)) is amended— 
(A) in paragraph (1)(E)— 
(i) by striking "size which" and inserting "size such 
that"; and 
(ii) by striking "will include" and all that follows 
through "year" and inserting the following: "the 
organization can reasonably expect to procure organs 
from not less than 50 donors each year"; 
(B) in paragraph (2XC), by striking "372(bX2XD)," and 
inserting the following: "372(bX2)(E), including arranging 
PUBLIC LAW 100-607—NOV. 4, 1988 
102 STAT. 3115 
H 
for testing with respect to preventing the acquisition of 
organs that are infected with the etiologic agent for 
acquired immune deficiency syndrome,"; 
(C) in paragraph (2XE)— 
(i) by inserting "equitably" after "organs"; and 
(ii) by striking "centers and"; and 
(D) in paragraph (2)— 
(i) by striking "and" at the end of subparagraph (I); 
(ii) by striking the period at the end and inserting 
", and"; and 
(iii) by adding at the end the following new subpara-
graph: 
"(K) assist hospitals in establishing and implementing proto-
cols for making routine inquiries about organ donations by 
potential donors.". 
(2) Section 371(bXlXGXiXni) is amended by inserting before 
the comma the following: "or an individual with a doctorate 
degree in a biological science with knowledge, experience, or 
skill in the field of histocompatibility". 
(3) The amendment made by paragraph (IXA) shall not apply 42 USC 273 note, 
to an orgsm procurement organization designated under section 
1138(b) of the Social Security Act until 2 years after the initisil 
designation of the organization under such section, 
(d) AUTHORIZATIONS OF APPROPRIATIONS.—Section 371(c) (42 U.S.C. 
273(c)) is amended to read as follows: 
"(c) For grants under subsection (a), there is authorized to be 
appropriated $5,000,000 for each of the fiscal years 1988 through 
1990.". 
SEC. 403. ORGAN PROCUREMENT AND TRANSPLANTATION NETWORK. 
(a) DUTIES.—Section 372(bX2) (42 U.S.C. 27403X2)) is amended— 
(IXA) by redesignating subparagraphs (B) through (H) as 
subparagraphs (C) through (I), respectively; and 
(B) by adding after subparagraph (A) the following new 
subparagraph: 
"(B) establish membership criteria and medical criteria for 
allocating organs and provide to members of the public an 
opportunity to comment with respect to such criteria,"; 
(2) in subpareigraph (D) (as redesignated in paragraph (IXA) of 
this subsection), by striking "orgsins which" and all that follows 
and inserting "organs,"; 
(3) in subparagraph (E) (as redesignated in paragraph (IXA) of 
this subsection), strike "organs," and insert the following: 
"organs, including standards for preventing the acquisition of 
organs that are infected with the etiologic agent for acquired 
immune deficiency sjmdrome,"; 
(4) in subpargigraph (F) (as redesignated in paragraph (IXA) of 
this subsection), by striking "basis," and inserting the following: 
"basis (and, to the extent practicable, £unong regions or on a 
national basis),"; and 
(5XA) by striking "and" at the end of subparagraph (H) (as 
redesignated in pareigraph (IXA) of this subsection); 
(B) by striking the period at the end and inserting ", and"; 
and 
(C) by adding at the end the following new subparagraph: 
102 STAT. 3116 
PUBLIC LAW 100-607—NOV. 4, 1988 
Grants. 
Contracts. 
Appropriation 
authorization. 
Reports. 
"(J) carry out studies and demonstration projects for the 
purpose of improving procedures for organ procurement and 
allocation.". 
(b) CONSIDERATION OP CRITICAL COMMENTS.—Section 372 (42 U.S.C. 
274) is smfiended by adding at the end the following new subsection: 
**(c) The Secretary shall establish procedures for— 
"(1) receiving from interested persons critical comments relat-
ing to the manner in which the Organ Procurement and 
Transplantation Network is carrying out the duties of the 
Network under subsection (b); and 
"(2) the consideration by the Secretary of such critical com-
ments.". 
SEC. 404. REQUIREMENT 
OF ESTABLISHMENT 
OF BONE 
MARROW 
REGISTRY. 
(a) IN GENERAL.—Section 373 (42 U.S.C. 274a) is amended— 
(1) by inserting "(a)" after the section designation; arid 
(2) by adding at the end the following new subsection: 
"(bXD Not later than October 1, 1988, the Secretary shall, by 
grant or contract, establish a registry of voluntary bone marrow 
donors. 
"(2) For the purpose of carrjdng out paragraph (1), there are 
authorized to be appropriated $1,500,000 for fiscal year 1989 and 
$1,600,000 for fiscal year 1990.". 
(b) CONFORMING AMENDMENT.—Section 373 (42 U.S.C. 274a) is 
amended in the title by inserting "AND BONE MARROW REGISTRY" 
after "REGISTRY". 
SEC. 405. ADMINISTRATION. 
Section 375 (42 U.S.C. 274c) is amended— 
(1) in the matter preceding paragraph (1), by striking "1985, 
1986, 1987, and 1988," and inserting "1985 through 1990,"; and 
(2) in paragraph (4), by striking "one year" and all that 
follows through "annual report" and inserting the following: 
"not later than April 1 of each of the years 1989 and 1990, 
submit to the Congress a report". 
SEC. 406. REPORT. 
Section 376 (42 U.S.C. 274d) is amended by striking "shall 
annually" and inserting the following: "shall, not later than 
October 1 of each year,". 
SEC. 407. FETAL ORGAN TRANSPLANTS. 
Section 301(cXl) of the National Organ Transplant Act (42 U.S.C. 
274e(c)(l)) is amended to read as follows: 
"(1) The term 'human organ' means the human (including 
fetal) kidney, liver, heart, lung, pancreas, bone marrow, cornea, 
eye, bone, and skin or any subpart thereof and any other human 
organ (or any subpart thereof, including that derived from a 
fetus) specified by the Secretary of Health and Human Services 
by regulation.". 
SEC. 408. ESTABLISHMENT OF BLOCK GRANT PROGRAM. 
(a) IN GENERAL.—Title XIX of the Public Health Service Act (42 
U.S.C. 300w et seq.) is amended by adding at the end thereof the 
following new part: 
PUBLIC LAW 100-607—NOV. 4, 1988 
102 STAT. 3117 
"PART D—IMMUNOSUPPRESSIVE DRUG THERAPY BLOCK GRANT 
"SEC. 1931. DEFINITIONS. 
42 USC 300y-21. 
"For purposes of this part: 
(1) EUGIBLE PATIENT.—The term 'eUgible patient' means an 
organ transplant patient who is not eligible to receive 
reimbursement for the cost of immunosuppressive drug therapy 
under title XVIII of the Social Security Act (42 U.S.C. 1395 et 
seq.), under the State's medicaid plan under title XIX of such 
Act (42 U.S.C. 1396 et seq.), or under private insurance. 
"(2) IMMUNOSUPPRESSIVE DRUG THERAPY.—The term 'immuno-
suppressive drug therapy' means drugs and biologicals that are 
to be used for the purpose of preventing the rejection of trans-
planted organs and tissues and that can be administered by the 
transplant patient. 
"(3) TRANSPLANT CENTER.—The term 'transplant center' 
means a transplant center that is a member of the Organ 
Procurement and Transplantation Network established under 
section 372. 
"SEC. 1932. AUTHORIZATION OF APPROPRIATIONS. 
42 USC 300y-22. 
"For the purpose of making allotments to States to carry out this 
part, there are authorized to be appropriated $5,000,000 for each of 
the fiscal years 1988 through 1990. 
"SEC. 1933. ALLOTMENTS. 
42 USC 300y-28. 
"(a) AMOUNT.— 
"(1) IN GENERAL.—From amounts appropriated under section State and local 
1932 for each of the fiscal years 1988 through 1990, the Sec- governments. 
retary shall allot to each State an amount that bears the same 
ratio to the total amount appropriated under such section for 
such fiscal year as the total number of eligible patients in the 
State bears to the total number of eligible patients in the 
United States. 
"(2) MINIMUM ALLOTMENT.—Notwithstanding paragraph (1), 
the allotment of any State in any fiscal year under this subsec-
tion shall not be less than $50,000. If, under paragraph (1), the 
allotment of any State in any fiscal year will be less than 
$50,000, the Secretary shall increase the sdlotment of such State 
to $50,000 and shall proportionately reduce the allotments of all 
other States whose allotment exceeds $50,000 in a manner that 
will insure that the allotment of each State in such fiscal year is 
at least $50,000. 
"0)) UNALLOTTED FUNDS.— 
"(1) IN GENERAL.—Subject to paragraph (2), to the extent that 
all the funds appropriated under section 1932 for a fiscal year 
and available for allotment in such fiscal year are not otherwise 
allotted to States because— 
"(A) one or more States have not submitted an applica-
tion or description of activities in accordance with section 
1936 for such fiscal year; 
"(B) one or more States have notified the Secretary that 
they do not intend to use the full amount of their allotment; 
or 
"(C) some State allotments are offset or repaid under 
section 1906(bX3) (as such section applies to this part pursu-
ant to section 1936(d)); 
102 STAT. 3118 
PUBLIC LAW 100-607—NOV. 4, 1988 
such excess shall be allotted among each of the remaining 
States in proportion to the amount otherwise allotted to such 
States for such fiscal year without r^ard to this subsection. 
"(2) ORGAN TRANSPLANT CENTERS.— 
"(A) APPUCATION.—^If a State does not submit an applica-
tion for an allotment or description of activities in accord-
ance with section 1936 for a fiscal year or notifies the 
Secretary that the State does not intend to use the full 
amount of the allotment of the State, an organ transplant 
center in the State may submit an application in accord-
ance with section 1936 for the amount of the allotment not 
allocated to the State. 
"(B) ALLOTBCBNT.—Subject to subparagraph (C), if an 
applicant center complies with the requirements imposed 
on the State by this part, the Secretary shall provide to the 
center the amount of the allotment not allocated to the 
State. 
"(C) MULTIPLE APPLICANTS.—^If two or more applicant 
centers in a State meet the requirements of subparagraph 
(B), the Secretary shall divide among the eligible applicant 
centers in an equitable manner the amount of the allot-
ment not allocated to the State. 
"(D) DISTRIBUTION TO OTHER STATES.—If one or more cen-
ters in a State receive an allotment under this paragraph 
for a fiscal year, the allotment shall not be made avsnlable 
to remaining States under paragraph (1). 
42 use 300y-24. 
"SEC. 1934. PAYMENTS UNDER ALLOTMENTS TO STATES. 
"(a) IN GENERAL.—^For each fiscal year, the Secretary shall make 
payments, as provided by section 65()3(a) of title 31, United States 
Code, to each State from its allotments under section 1933 from 
amounts appropriated for that fiscal year. 
"(b) CARRYOVER FUNDS.—Any amount paid to a State for a fiscal 
year and remaining unobligated at the end of such year shall 
remain available for the next fiscal year to such State for the 
purposes for which it was made. 
42 use 300y-25. 
"SEC. 1935. USE OF ALLOTMENTS. 
"(a) IN GENERAL.— 
"(1) USE.—Except as provided in subsections (b) and (c), 
amounts paid to a State under section 1934 from its allotment 
under section 1933 for any fiscal year shall be used by the State 
to provide immunosuppressive drug therapy for eligible 
patients. 
"(2) METHODS.—A State may use amounts paid to the State 
under section 1934 from its allotment under section 1933 to 
provide immimosuppressive drug therapy for eligible patients— 
"(A) by purchasing the drugs and biolc^cals for such 
therapy and distributing such drugs and biologicals to 
transplant centers or eligible patients; 
"(B) by certifying that an individual is an eligible patient 
for purposes of this part and by reimbursing a transplant 
center for the costs of immunosuppressive drug therapy 
provided by such center to such individual; 
"(C) by any other method prescribed by the Secretary by 
r^ulation (other than the method described in subsection 
(bXD). 
PUBLIC LAW 100-607—NOV. 4, 1988 
102 STAT. 3119 
"(3) CoPAYMENTS.—A State may require an eligible patient to 
whom immunosuppressive drug therapy is provided with 
amounts paid to the State under this part to make copayments 
for part of the costs of such therapy, without regard to section 
1916 of the Social Security Act (42 U.S.C. 1396o). 
"(b) LIMITATIONS.—A State may not use amounts paid to it under 
section 1934 to— 
"(1) make direct payments to organ transplant patients; or 
"(2) satisfy any requirement for the expenditure of non-
Federal funds as a condition for the receipt of Federal funds. 
"(c) ADMINISTRATIVE COSTS.—Not more than 10 percent of the 
total amount paid to any State under section 1934 from its allotment 
under section 1933 for any fiscal year may be used for administering 
the funds made available under section 1934. The State will pay 
from non-Federal sources the remaining costs of administering such 
funds. 
"SEC. 1936. APPLICATION AND DESCRIPTION OF ACTIVITIES; REQUIRE- 42 USC 300y-26. 
MENTS. 
"(a) APPLICATION REQUIRED.—In order to receive an allotment for State and local 
a fiscal year under section 1933, each State shall submit an applica- governments. 
tion to the Secretary. Each such application shall be in such form 
and submitted by such date as the Secretary shall require. Each 
such application shall contain assurances that the State will meet 
the requirements of subsection (b). 
"(b) REQUIREMENTS.—As part of the annual application required 
by subsection (a), the chief executive officer of each State shall— 
"(1) certify that the State agrees to use the funds allotted to 
the State under section 1933 in accordance with the require-
ments of this part; 
"(2) agrees to cooperate with Federal investigations under-
taken in accordance with section 1907 (£is such section applies to 
this part pursuant to subsection (d) of this section); and 
"(3) certify that the State agrees that Federal funds made 
available under section 1934 for any period will be so used as to 
supplement and increase the level of State, local, and other non-
Federal funds that would in the absence of such Federal funds 
be made available for the activities for which funds are provided 
under such section and will in no event supplant such State, 
local, and other non-Federal funds. 
"(c) DESCRIPTION OF ACTIVITIES.— 
"(1) IN GENERAL.—The chief executive officer of a State shall, 
as part of the application required by subsection (a), also pre-
pare and furnish the Secretary (in accordance with such form as 
the Secretary shall provide) with a description of the intended 
use of the payments the State will receive under section 1934 for 
the fiscal year for which the application is submitted, including 
information on the programs and activities to be supported. 
"(2) PUBLIC COMMENT.—The description shall be made public 
within the State in such manner as to facilitate comment from 
any person (including any Federal or other public agency) 
during development of the description and after its transmittal. 
"(3) REVISIONS.—The description shall be revised (consistent 
with this section) throughout the year as may be necessary to 
reflect substantial changes in the programs and activities as-
sisted by the State under this part. Any revision shall be subject 
to paragraph (2). 
102 STAT. 3120 
PUBLIC LAW 100-607—NOV. 4, 1988 
"(d) ADMINISTRATION.—Unless inconsistent with this part, section 
1903(b), section 1906(a), paragraphs (1) through (5) of section 1906(b), 
and sections 1907,1908, and 1909 shall apply to this part in the same 
manner as such provisions apply to part A of this title. 
"(e) ADDITIONAL INFORMATION.—Each annual report submitted by 
a State to the Secretary under section 1906(a) (as such section 
applies to this part pursuant to subsection (d) of this section) with 
respect to its activities under this part shall contain— 
"(1) a specification of the number of eligible patients in the 
State receiving immunosuppressive drug therapy with amounts 
paid to the State under this part; 
"(2) a description of the amount of any copa3rment required by 
the State under section 1935(aX3); and 
"(3) a certification that amounts paid to the State under this 
part are being used in accordance with this part. 
42 use 300y-27. 
"SEC. 1937. TERMINATION DATE. 
"The amendments made under part D of this Act shall terminate 
effective January 1,1991.". 
42 u s e 300y-21 
(b) REPORT.— 
"°^- 
(1) IN GENERAL.—Not later than 24 months after the date of 
enactment of this Act, the Secretary of Health and Human 
Services shall prepare and transmit to the Congress a report 
concerning the impact of part D of title XIX of the Public 
Health Service Act (as added by section 407 of this title). 
(2) CONTENTS.—The report shall contain— 
(A) a description of the effect of the program established 
under such part on organ transplants in the United States; 
(B) an analysis of the effects of such program on the costs 
of organ transplants and renal dialysis; 
(C) an analysis of the extent to which amounts paid to 
States under such part are used for purposes other than the 
purposes specified by such part, including an analysis of the 
extent to which drugs and biologicals purchased with such 
amounts are provided to individuals who are not eligible 
patients under such part; and 
(D) such recommendations as the Secretary considers 
appropriate, including recommendations as to whether 
financial assistance under such program should be contin-
ued during fiscal years after fiscal year 1990. 
l^^^Z 
TITLE V-FOOD AND DRUG 
Act of 1988 
ADMINISTRATION 
21 u s e 301 note. 
SEC. 501. SHORT TITLE. 
This title may be cited as the "Food and Drug Administration Act 
of 1988". 
21 use 393 note. 
SEC. 502. FINDINGS. 
Congress finds that— 
(1) the public health has been effectively protected by the 
presence of the Food and Drug Administration during the last 
eighty years; 
(2) the presence and importance of the Food and Drug 
Administration must be guaranteed; and 
PUBLIC LAW 100-607—NOV. 4, 1988 
102 STAT. 3121 
(3) the independence and integrity of the Food and Drug 
Administration need to be enhemced in order to ensure the 
continuing protection of the public health. 
SEC. 503. ESTABLISHMENT OF ADMINISTRATION BY LAW. 
(a) EsTABUSHMENT.—Chapter IX of the Federal Food, Drug, and 
Cosmetic Act (21 U.S.C. 391 et seq.) is amended by adding at the end 
thereof the following new section: 
"SEC. 903. FOOD AND DRUG ADMINISTRATION. 
21 USC 393. 
"(a) IN GENERAL.—There is established in the Department of 
Health and Human Services the Food and Drug Administration 
(hereinafter in this section referreu to as the "Administration"). 
"(b) COMMISSIONER.— 
"(1) APPOINTMENT.—There shall be in the Administration a 
President of U.S. 
Commissioner of Food and Drugs (hereinafter in this section 
referred to as the "Commissioner") who shall be appointed by 
the President by and with the advice and consent of the Senate. 
"(2) GENERAL POWERS.—The Secretary, through the Commis-
sioner, shall be responsible for— 
"(A) providing overall direction to the Food and Drug 
Administration and establishing and implementing general 
policies respecting the management and operation of pro-
grams and activities of the Food and Drug Administration; 
"(B) coordinating and overseeing the operation of all 
administrative entities within the Administration; 
"(C) research relating to foods, drugs, cosmetics, and 
devices in carrying out this Act; 
"(D) conducting educational and public information pro-
grams relating to the responsibilities of the Food and Drug 
Administration; and 
"(E) performing such other functions as the Secretary 
may prescribe. 
"(c) TECHNICAL AND SCIENTIFIC REVIEW GROUPS.—The Secretary 
through the Commissioner of Food and Drugs may, without regard 
to the provisions of title 5, United States Code, governing appoint-
ments in the competitive service and without regard to the provi-
sions of chapter 51 and subchapter III of chapter 53 of such title 
relating to classification and General Schedule pay rates, establish 
such technical and scientific review groups as are needed to carry 
out the functions of the Administration, including functions under 
the Federal Food, Drug, and Cosmetic Act, and appoint £uid pay the 
members of such groups, except that officers and employees of the 
United States shall not receive additional compensation for service 
as members of such groups.". 
(b) CONFORMING AMENDMENTS.—Title 5, United States Code, is 
amended— 
(1) in section 5316, by striking out the item relating to the 
Commissioner of Food and Drugs, Department of Health and 
Human Services; and 
(2) in section 5315, by adding at the end thereof the following 
new item: 
"Commissioner of Food and Drugs, Department of Health and 
Human Services". 
(c) EFFECTIVE DATE.— 
21 use 393 note. 
Research and 
development. 
102 STAT. 3122 
PUBLIC LAW 100-607—NOV. 4, 1988 
(1) Except as provided in paragraph (2), the amendments 
made by this title shall take effect on the date of enactment of 
this Act. 
(2) Section 903(bXl) of the Federal Food, Drug, and Cosmetic 
Act (as added by subsection (a) of this section) shall apply to the 
appointments of Commissioners of Food and Drugs made after 
the date of enactment of this Act. 
Health 
Professions 
Reauthorization 
Act of 1988. 
TITLE VI—HEALTH PROFESSIONS 
REAUTHORIZATION ACT OF 1988 
SEC. 601. SHORT TITLE; REFERENCE. 
42 use 201 note. 
(a) SHORT TTTLE.—^This Act mav be cited as the "Health Profes-
sions Reauthorization Act of 1988 . 
(b) REFERENCE.—^Ebccept as otherwise expressly provided, when-
ever in this Act an amendment or repeal is expressed in terms of an 
amendment to, or repeal of, a section or other provision, the ref-
erence shall be considered to be made to a section or other provision 
of the Public Health Service Act. 
SEC. 602. FEDERAL PROGRAM OF INSURED LOANS TO GRADUATE STU-
DENTS IN HEALTH PROFESSIONS SCHOOLS. 
(a) ESTABLISHMENT OF ADDITIONAL CREDIT AUTHORITT.—Section 
728(a) (42 U.S.C. 294a(a)) is amended in the first sentence by striking 
"and" after "1987;" and by inserting before the period the following: 
"; $325,000,000 for fiscal year 1989; $375,000,000 for fiscal year 1990; 
and $400,000,000 for fiscal year 1991". 
(b) EXTENSION OF PERIOD FOR INSURANCE OF NEW LOANS.—Section 
728(a) (42 U.S.C. 294a(a)) is amended— 
(1) by inserting before the period at the end of the second 
sentence the following: ", and if in any fiscal year no ceiling has 
been established, any difference carried over shall constitute 
the ceiling for making new loans and paying installments for 
such fiscal year."; and 
(2) in the third sentence by striking "1991," and inserting 
"1994,". 
(c) PROHiBrnoN AGAINST APPORTIONMENTS OF CREDIT AUTHOR-
ITY.—Section 728(a) (42 U.S.C. 294a(a)) is amended by adding at the 
end the following new sentence: "The total principal amount of 
Federal loan insurance available under this subsection shall be 
granted by the Secretary without r^ard to any apportionment for 
the purpose of chapter 15 of title 31, United States Code, and 
without r^ard to any similar limitation.". 
(d) PRIORITY IN PROVISION OF INSURANCE.—Section 728(b) (42 
U.S.C. 294a(b)) is amended by inserting "(1)" after the subsection 
designation and by adding at the end the following new paragraph: 
"(2) In providing certificates of insurance under section 732 
through comprehensive contracts, the Secretary shall give priority 
to eligible lenders that agree— 
"(A) to make loans to students at interest rates below the 
rates prevailing, during the period involved, for loans covered 
by Federal loan insurance pursuant to this subpart; or 
"(B) to make such loans under terms that are otherwise 
favorable to the student relative to the terms under which 
PUBLIC LAW 100-607—NOV. 4, 1988 
, 
102 STAT. 3123 
eligible lenders are generally making such loans during such 
period.". 
(e) 
FREQUENCY 
OF 
CJOMPOUNDING 
OF 
INTEREST.—Section 
731(aX2XD)) (42 U.S.C. 294d(aX2XD)) is amended by inserting "not 
more frequently than" after "compounded". 
(f) DETERMINATION OF FINANCIAL NEED OF STUDENTS.—Section 731 
(42 U.S.C. 294d) is amended by adding at the end the following new 
subsection: 
"(e) With respect to any determination of the financial need of a 
student for a loan covered by Federal loan insurance under this 
subpart, this subpart may not be construed to limit the authority of 
any school to make such allowances for students with special cir-
cumstances as the school determines appropriate.". 
(g) AUTHORITY FOR ASSIGNMENT OF IX)ANS WITH RESPECT TO 
SECONDARY MARKET.—Section 732(d) (42 U.S.C. 294e(d)) is amended 
by striking "eligible lender, or" and inserting the following: "eligible 
lender (including a public entity in the business of purchasing 
student loans), or'. 
(h) CLARIFICATION WITH RESPECT TO REFERENCE TO HOLDERS OF 
FEDERALLY INSURED LOANS.—Section 733(d) (42 U.S.C. 294f(d)) is 
amended in the first sentence by inserting "eligible lender or" 
before "holder"; 
(i) AMOUNT OF Loss PURSUANT TO DEFAULT.—Section 733(eX2) (42 
U.S.C. 294f(eX2)) is amended by inserting before the semicolon the 
following: ", less the amount of any judgment collected pursuant to 
default proceedings commenced by the eligible lender or holder 
involved . 
(j) CLARIFICATION WITH RESPECT TO EFFECT OF BANKRUPTCY.— 
Section 733(g) (42 U.S.C. 294f(g)) is amended by inserting "any 
chapter o f before "title 11,". 
(k) PROVISIONS WITH RESPECT TO ACTIONS FOR DEFAULT.— 
(1) Section 733(a) (42 U.S.C. 294f(a)) is amended by striking 
"(including, if appropriate, commencement of a suit)" and 
inserting the following: "(including, subject to subsection (h), 
commencement and prosecution of an action)". 
(2) Section 733 (42 U.S.C. 294f) is amended— 
(A) in subsection (b), by adding at the end thereof the 
following new sentence: "The Secretary may sell without 
recourse to eligible lenders (or other entities that the Sec-
retary determines are capable of dealing in such loans) 
notes or other evidence of loans received through assign-
ment under the first sentence."; and 
(B) by adding at the end the following new subsections: 
"(hXD With respect to the default by a borrower on any loan 
covered by Federal loan insurance under this subpart, the Secretary 
shall, unaer subsection (a), require an eligible lender or holder to 
commence and prosecute an action for such default unless— 
"(A) in the determination of the Secretary— 
"(i) the eligible lender or holder has made reasonable 
efforts to serve process on the borrower involved and has 
been unsuccessful with respect to such efforts, or 
"(ii) prosecution of such an action would be fruitless 
because of the financial or other circumstances of the 
borrower; 
"(B) for such loans made before the date of the enactment of 
the Health Professions Reauthorization Act of 1988, the loan 
involved was made in an amount of less than $5,000; or 
102 STAT. 3124 
PUBLIC LAW 100-607—NOV. 4, 1988 
"(Q for such loans made after such date, the loan involved 
was made in an amount of less than $2,500. 
"(2) With respect to an eligible institution that has commenced an 
action pursuant to subsection (a), the Secretary shall make the 
payment required in such subsection, or deny the claim for such 
pajfment, not later than 60 days after the date on which the eligible 
institution notifies the Secretaxy that judgment has been entered 
with respect to the action. 
"(i) The Secretaxy may establish reasonable limits for default 
rates for borrowers in each of the health professions identified in 
section 737(1). If the eligible institutions within any of the health 
professions, taken as a group, exceed such limits, the Secretary may 
suspend, terminate, or otherwise restrict the eligibility of such 
group of sdiools for borrowing under this section.". 
(1) STATE DESIGNATIONS OF EUGIBLE LENDERS.—Section 737(2) (42 
U.S.C. 294j(2)) is amended— 
(1) by striking "or" after "State," the second place such term 
appear^ and 
(2) by inserting before the period the following: ", or a non-
profit private entity designated by the State, regulated by the 
State, and approved by the Secretary". 
(m) REKSUANCE AND REFINANCING AGREEMENTS AUTHORIZED.— 
Subpart I of part C of title Vn (42 U.S.C. 294 et seq.) is amended by 
adding at the end thereof the following new section: 
42 use 294/-1. 
"SEC 739A. REISSUANCE AND REFINANCING OF CERTAIN LOANS, 
"(a) IN GENEEAIK—^Any borrower who received a loan insured 
under this subpart bearing an interest rate that is fixed at a rate in 
excess of 12 percent per year may enter into an agreement with the 
eligible lender that made such loan for the reissuance of such loan 
in order to permit the borrower to obtain for such loan the interest 
rate in efiect for loans insurable under this subpart on the date the 
borrower submits an application to such lender for such reissuance. 
"(b) PROCEDURES.— 
"(1) DISCHARGE BY OBTAINING LOAN.—Any borrower who re-
ceived a loan under this subpart bearing an interest rate that is 
fixed at a rate in excess of 12 percent per year may obtain a 
loan firom an eligible lender (other than the original lender) for 
the purpose of dischazging the loan from such original eligible 
lender. A loan made for such purpose— 
"(A) shall bear interest at the interest rate in effect for 
loans insurable under this subpart on the date the borrower 
submits an application for a loan under this subsection; and 
"(B) shall be applied to dischsuge the borrower from any 
remaining obligation to the original eligible lender with 
respect to the original loan. 
"(2) CERTIFICATION.—E^ach new eligible lender may accept 
certification fix>m the original eligible lender to the borrower's 
original loan in lieu of presentation of the original promissozy 
note. 
"(c) TIME OF PAYMENT.—Any loan reissued under subsection (a) or 
refinanced under subsection 0>) shall be payable during the repay-
ment period applicable to the loan made under this subpart prior to 
the date of enactment of this section, and such reissuance or re-
financing shall not result in the extension of the duration of the 
loan. 
PUBLIC LAW 100-607—NOV. 4, 1988 
102 STAT. 3125 
"(d) ADMINISTRATIVE COSTS.—An eligible lender reissuing a loan 
under subsection (a) or refinancing a loan under subsection 0^) may 
charge a borrower an amount not in excess of $100 to cover the 
administrative costs of such reissuance or refinancing. 
"(e) INSURANCE.—^The reissuance of a loan imder subsection (a) or 
the refinancing of a loan under subsection (b) shall not affect any 
insurance appUcable to such loan, and no additional insurance 
premium may be charged with respect to such loan. 
"(f) NOTIFICATION.—Each holder of a loan made under this subpart 
shall, not later than January 1, 1989, in the case of loans made 
before the date of enactment of this section, notify the borrower of 
such loan— 
"(1) of the reissuance or refinancing options for which the 
borrower is eligible under this section; 
"(2) of those options which will be made available by the 
holder; and 
"(3) that, vfith respect to any option that the holder will not 
make available, the holder will, to the extent practicable, refer 
the borrower to an eligible lender offering such option. 
"(g) REGULATIONS.—The Secretary shall promulgate regulations to 
implement this section. 
"(h) DEFINITION.—For purposes of this section, the term 'eligible 
lender' includes the Student Loan Marketing Association.". 
SEC. 603. FEDERAL CAPITAL CONTRIBUTIONS INTO STUDENT LOAN 
FUNDS. 
(a) STANDARDS WITH RESPECT TO LOAN COLLECTION.—Section 
740(cXl) (42 U.S.C. 294m(cXl)) is amended by adding at the end the 
following new sentence: "This subsection may not be construed to 
require such schools to reimburse the student loan fiind under this 
subpart for loans that became uncollectible prior to August 1985 or 
to penalize such schools with respect to such loans.". 
(b) REDUCTION IN INTEREST RATE.—Section 741(e) (42 U.S.C. 
294n(e)) is amended by striking "9" and inserting "5". 
(c) GRACE PERIOD FOR ALL FULL-TIME STUDENTS.—Section 741(cXl) 
(42 U.S.C. 294n(cXl)) is amended by striking "and" at the end of 
subparagraph (B) and by adding at the end the following new 
subparagraph: 
"(D) during which the borrower is pursuing a full-time 
course of study at such a school; and". 
(d) STRIKING OF DATE CERTAIN WITH RESPECT TO DISTRIBUTION OF 
ASSETS OF LOAN FUNDS.—Section 743 (42 U.S.C. 294p) is amended— 
(1) in subsection (a), by amending the matter preceding para-
graph (1) to read as follows: "If a school terminates a loan fund 
established under an agreement pursuant to section 740(b), or if 
the Secretary for good cause terminates the agreement with the 
school, there shall be a capital distribution as follows:"; and 
(2) by amending subsection (b) to read as follows: 
"(b) If a capital distribution is made under subsection (a), the 
school involved shall, after the 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 pursuant 
to section 740(b) as was determined by the Secretary under 
subsection (a).". 
102 STAT. 3126 
PUBLIC LAW 100-607—NOV. 4, 1988 
SEC. 
6
0
4
. 
LOAN 
REPAYMENT 
PROGRAM 
FOR 
ALLIED 
HEALTH 
PERSONNEL. 
Part C of title VH (42 U.S.C. 294 et seq.) is amended by inserting 
after subpart II the following new subpart: 
"Subpart HI—Loan Repayment Program for Allied Health 
Personnel 
42 use 294r. 
"SEC. 75L ESTABLISHMENT OF PROGRAM. 
"(a) IN GENERAL.—The Secretary shall establish a program of 
entering into agreements with allied health personnel and with 
allied health professions students under which such individuals 
agree, in consideration of the agreement described in subsection (b) 
(relating to loan repayment), to serve as an allied health profes-
sional for a period of not less than two years in an Indian Health 
Service health center, in a Native Hawaiian health center, in a 
rural health clinic, in a rural health facility that is a sole commu-
nity provider, in any other rural hospital, in a rural home health 
agency, in a rural or urban hospital that serves a substantial 
number of patients pursuant to title XIX of the Social Security Act, 
in a private nursing facility 60 percent of whose patients are pa-
tients pursuant to title XIX of such Act, in a public nursing facility, 
in a migrant health center, in a community health center, or in a 
health facility determined by the Secretary to have a critical short-
age of nurses. 
"(b) PAYMENTS BY FEDERAL GOVERNMENT.—^The agreement re-
ferred to in subsection (a) is an agreement, made by the Federal 
Government in consideration of the agreement described in para-
graph (1) with respect to service as an allied health professional, 
under which the Federal (government agrees to pay— 
"(1) for the first year of such service, 30 percent of the balance 
of the principal and interest of the educational loans of the 
individual; 
"(2) for the second year of such service, 30 percent of such 
balance; and 
"(3) for the third year of such service, 25 percent of such 
balance. 
"(c) ADMINISTRATION.—^With respect to the National Health Serv-
ice Corps Loan Repayment Program established in subpart III of 
part D of title IQ, the provisions of such subpart shall, except as 
inconsistent with this section, apply to the program established in 
this section in the same manner and to the same extent as such 
provisions apply to the National Health Service (Dorps Loan Repay-
ment Program established in such subpart. 
"(d) AUTHORIZATION OF APPROPRIATIONS.—For the purpose of 
carrying out this section, there are authorized to be appropriated 
$2,000,000 for each of the fiscal years 1989 through 1991.'\ 
SEC. 605. SCHOLARSHIPS FOR FIRST-YEAR STUDENTS OF EXCEPTIONAL 
FINANCIAL NEED. 
(a) SCHOLARSHIPS FOR STUDENTS OF EXCEPTIONAL 
FINANCIAL 
NEED.—Section 758 (42 U.S.C. 294z) is amended— 
(1) in subsection (a), by striking out "and who are in their first 
year of study at such school"; and 
(2) in subsection (b)— 
(A) in paragraph (1), by striking out "in their first year of 
study at such school"; 
PUBLIC LAW 100-607—NOV. 4, 1988 
102 STAT. 3127 
(B) in paragraph (2)— 
(i) by striking out "shall consist" and inserting in lieu 
thereof "may consist of all or part''; and 
(ii) by inserting "not in excess" before "of $400" in 
subparagraph (B); 
(C) in paragraph (5), bv inserting "maximum allowable" 
before "monthly stipend'; and 
(D) by striking out paragraph (6). 
0)) AUTHORIZATION OF APPROPRIATIONS.—Section 758(d) (42 U.S.C. 
294z(d)) is amended by striking "and" after "1987," and inserting 
before the period the following: ", $7,300,000 for fiscal year 1989, 
$30,000,000 for fiscal year 1990, and $30,000,000 for fiscal year 1991". 
SEC. 606. CAPITATION GRANTS FOR SCHOOLS OF PUBLIC HEALTH. 
(a) AUTHORIZATION OF APPROPRIATIONS.—Section 770(e) (42 U.S.C. 
295f) is amended by striking "and" after "1987," and by inserting 
before the period the following: ", $4,700,000 for fiscal year 1989, and 
$3,000,000 for fiscal year 1990". 
(b) SUNSET PROVISION.—Part E of title VII (42 U.S.C. 295f et seq.) 
is amended by adding at the end the following new section: 
"SEC. 773. SUNSET PROVISION. 
"Effective October 1,1990, this part is repealed.". 
SEC. 607. AUTHORIZATION OF APPROPRIATIONS FOR PROJECT GRANTS 
FOR 
ESTABLISHMENT 
OF 
DEPARTMENTS 
OF 
FAMILY 
MEDICINE. 
Section 780(d) (42 U.S.C. 295g(d)) is amended— 
(1) by striking "There' and inserting "For the purpose of 
carrying out this section, there"; 
(2) by striking "and" after "1987," and inserting after "1988" 
the following: '\ and $7,000,000 for each of the fiscal years 1989 
through 1991"; and 
(3) by striking "for payments under grants under subsection 
(a)". 
SEC. 608. AREA HEALTH EDUCATION CENTERS. 
(a) MINIMUM NUMBER OF INDIVIDUALS IN CERTAIN INTERNSHIPS.— 
Section 781(d)(2XC) (42 U.S.C. 295g-l(d)(2)(C)) is amended by striking 
"six" and inserting "four". 
O
t
)
) AUTHORIZATION OF APPROPRIATIONS FOR GENERAL PROGRAM OF 
AREA HEALTH EDUCATION CENTERS.—(1) Section 781(a) (42 U.S.C. 
295g-l(a)) is amended by adding at the end of paragraph (2) the 
following new subparagraph: 
"(C) In the case of the requirement that an area health education Contracts. 
center be neither a school of medicine or osteopathy, the parent 
institution of such a school, nor a branch campus or other subunit of 
a school of medicine or osteopathy or its parent institution, or a 
consortium of such entities, to be eligible to enter into a contract 
under this section, the Secretary shall waive such requirement with 
respect to an area health education center having, at the time of 
initial application to enter into such contract under this section or a 
previous authorizing law, an operating program supported by both 
appropriations of a State legislature and local resources.". 
(2) Section 781(dX2)(F) is amended by striking out "and nurse 
practitioners" and inserting in lieu thereof ", nurse practitioners, 
and nurse midwives". 
102 STAT. 3128 
PUBLIC LAW 100-607—NOV. 4, 1988 
Contracts. 
Mexico. 
Minorities. 
Urban areas. 
Rural areas. 
Mexico. 
(3) Section 781(h) (as redesignated by subsection (cXD of this 
section) is amended in the first sentence— 
(A) by striking "There are authorized" and all that follows 
through "this section" and inserting the following: "For the 
purpose of canying out this section other than subsection (f), 
there are authorized to be appropriated"; and 
(B) by striking "and" after "1987," and inserting before the 
period the following: ", $18,700,000 for the fiscal year 1989, and 
$20,000,000 for each of the fiscal years 1990 and 1991". 
(c) HEALTH EDUCATION AND TRAINING CENTERS.—Section 781 (42 
U.S.C. 295g-l) is amended— 
(1) by redesignating subsections (f) and (g) as subsections (g) 
and (h), respectively; and 
(2) by adding after subsection (e) the following new subsection: 
"(fXD The Secretary shall enter into contracts with schools of 
medicine and osteopathy for the purpose of planning, developing, 
establishing, maintaining, and operating health education and 
training centers— 
(A) to improve the supply, distribution, quality, and effi-
ciency of personnel providii^ (in the United States) health 
services along the border between the United States and 
Mexico; 
"(B) to improve the supply, distribution, quality, and effi-
ciency of personnel provichng, in other urban and rural areas 
(including frontier areas) of the United States, health services to 
any population group, including Hispanic individuals, that has 
demonstrated serious unmet health care needs; and 
"(C) to encourage health promotion and disease prevention 
through public education in the areas described. 
"(2) The ScKa^taiy may not enter into a contract under paragraph 
(1) unless the appUcant for such assistance agrees, in canying out 
the purpose described in such paragraph, to enter into arrange-
ments with one or more pubUc or nonprofit private entities in the 
State that have expertise in providing health education to the 
public. 
"(3) The Secretary shall, after consultation with health education 
and training centers, designate the geographic area in which each 
such center will carry out the purpose described in paragraph (1). 
The service area of such a center shall be located entirely within the 
State in which the center is located. Each border health education 
and training center shall be located in a county (or other political 
subdivision) of the State in close proximity to the border between 
the United States and Mexico. 
"(4) The Secretary may not enter into a contract under paragraph 
(1) unless the appUcant for such assistance agrees— 
"(A) to establish an advisory group comprised of health serv-
ice providers, educators and consumers from the service area 
and of facul^ fh>m participating schools; 
"(B) after consultation with such advisory group, to develop a 
plan for carrying out the purpose described in paragraph (1) in 
the service area; 
"(C) to enter into contracts, as needed, with other institutions 
or entities to carry out such plan; and 
"(D) to be responsible for the evaluation of the program. 
"(5) The Secretary may not make a grant or enter into a contract 
under paragraph (1) unless the applicant for such assistance 
agrees— 
PUBLIC LAW 100-607—NOV. 4, 1988 
102 STAT. 3129 
"(A) to evaluate the specific service needs for health care 
personnel in the service area; 
"(B) to assist in the planning, development, and conduct of 
training pn^^ams to meet the needs identified pursuant to 
subparagraph (A); 
"(C) to conduct or support not less than one training and 
education program for physicians and one program for nurses 
for at least a portion of the clinical training of such students; 
"(D) to conduct or support training in health education serv-
ices, including training to prepare community health workers to 
implement health education programs in communities, health 
departments, health clinics, and public schools that are located 
in the service area; 
"(E) to conduct or support continuing medical education pro-
grams for physicians and other health professionals (including 
allied health personnel) practicing in the service area; 
"(F) to support health career educational opportunities de-
signed to provide students residing in the service area with 
counseliujg, education, and training in the health professions; 
"(G) with respect to border health education and training Mexico. 
centers, to assist in coordinating its activities and programs 
carried out pursuant to paragraph (IXA) with any similar pro-
grams and activities carried out in Mexico along the border 
between the United States and Mexico; and 
"(H) to make available technical assistance in the service area 
in the aspects of health care organization, financing and deUv-
ery. 
"(6) In carrying out this subsection, the Secretary shall ensure 
that— 
"(A) not less than 75 percent of the total funds provided to a 
school or schools of medicine or osteopathy will be expended in 
the development and operation of the health education and 
training center in the service area of such program; 
"(B) to the maximum extent feasible, the school of medicine 
or osteopathy will obtain from nongovernmental sources the 
amount of the total operating funds for such program which are 
not provided by the Secretary; 
"(C) no grant or contract shall provide funds solely for the 
planning or development of a health education and training 
center p n ^ a m for a period in excess of two years; 
"(D) not more than 10 percent of the annual budget of each 
program may be utilized for the renovation and equipping of 
clinical teaching sites; and 
"(E) no grant or contract shall provide funds to be used 
outside the United States except as the Secretary may prescribe 
for travel and communications purposes related to the conduct 
of a border health education and training center. 
"(7) For purposes of this subsection: 
"(A) The term Twrder health education and training center' 
means an entity that is a recipient of a contract under para-
graph (1) and that is carrying out (or will carry out) the purpose 
described in subparagraph (A) of such paragraph. 
"(B) The term 'health education and training center' means 
an entity that is a recipient of a contract under paragraph (1). 
"(C) TTie term 'service area' means, with respect to a health 
education and training center, the geographic area designated 
for the center under paragraph (3). 
102 STAT. 3130 
PUBLIC LAW 100-607—NOV. 4, 1988 
"(8)(A) Of the amounts appropriated pursuant to subsection (hX2) 
for a fiscal year, the Secretary shall make available 50 percent for 
allocations each fiscal year for applications approved by the Sec-
retary for border health education and training centers. The amount 
of the allocation for each such center shall be determined in accord-
ance with subparagraph (B). 
"(B) The amount of an allocation under subparagraph (A) for a 
fiscal year shall be determined in accordance with a formula pre-
scribed by the Secretary, which formula shall be based— 
"(i) with respect to the service area of the border health 
education and training center involved, on the low-income popu-
lation, including Hispanic individuals, along the border between 
the United States and Mexico and the growth rate of such 
population; 
"(ii) on the need of such population for additional personnel to 
provide health care services along such border; and 
"(iii) on the most current information concerning mortality 
and morbidity and other indicators of health status for such 
population.". 
(d) AUTHORIZATION OF APPROPRIATIONS FOR HEALTH EDUCATION 
AND TRAINING CENTERS.—Section 781(h) (as redesignated by subsec-
42 use 295g-i. 
tion (c)(1) of this section) is amended by inserting "(1)" after the 
subsection designation and by adding at the end the following new 
paragraph: 
"(2) For the purpose of carrying out subsection (f), there are 
authorized to be appropriated $4,000,000 for fiscal year 1989, 
$8,000,000 for fiscal year 1990, and $12,000,000 for fiscal year 1991.". 
SEC. 609. AUTHORIZATION OF APPROPRIATIONS FOR GRANTS FOR TRAIN-
ING, TRAINEESHIPS, AND FELLOWSHIPS IN GENERAL IN-
TERNAL MEDICINE AND GENERAL PEDIATRICS. 
(a) COORDINATION CRITERIA.—Section 784(b) (42 U.S.C. 295g-4(b)) is 
amended by inserting before the period the following: ", and 
coordination of curriculum development and resident teaching 
activities with departments of family medicine where there is a 
department within the same school". 
(b) AUTHORIZATIONS.—Section 784(c) (42 U.S.C. 295g-4(c)) is 
amended— 
(1) by striking "There" and all that follows through "section" 
and inserting "For the purpose of carrying out this section, 
there are authorized to be appropriated"; and 
(2) by striking "and" after "1987," and by inserting before the 
period the following: ", $23,000,000 for fiscal year 1989, 
$23,000,000 for fiscal year 1990, and $25,000,000 for fiscal year 
1991". 
SEC. 610. FAMILY MEDICINE AND GENERAL PRACTICE OF DENTISTRY. 
(a) GENERAL PRACTICE OF DENTISTRY.—Part F of title VII (42 
U.S.C. 295g et seq.) is amended— 
42 use 295g-6. 
(1) in section 786— 
(A) in the title, by striking "AND GENERAL PRACTICE OF 
DENTISTRY"; and 
(B) by striking subsection (b) and redesignating subsec-
tions (c) and (d) as subsections (b) and (c), respectively; and 
(2) by inserting after section 784 the following new section: 
PUBLIC LAW 100-607—NOV. 4, 1988 
102 STAT. 3131 
'^EC. 785. RESIDENCY PROGRAMS IN GENERAL PRACTICE OF DENTISTRY. 42 USC 295g-5. 
"(a) IN GENERAL.—^The Secretary may make grants to, and enter Grants. 
into contracts with, any public or nonprofit private school of den- Contracts. 
tistry or accredited postgraduate dental training institution— 
"(1) to plan, develop, and operate an approved residency 
program in the general practice of dentistry or an approved 
advanced educational program in the general practice of den-
tistry; and 
"(2) to provide financial assistance (in the form of traineeships 
and fellowships) to participants in such a program who are in 
need of financial assistance and who plan to specialize in the 
practice of general dentistry. 
"(b) AUTHORIZATION OF APPROPRIATIONS.—^For the purpose of 
carrying out this section, there are authorized to be appropriated 
$4,000,000 for fiscal year 1989, $6,000,000 for fiscal year 1990, and 
$8,000,000 for fiscal year 1991.". 
(b) AUTHORIZATION OF APPROPRIATIONS FOR FAMILY MEDICINE.— 
Section 786(c) (as redesignated by subsection (aXXXB) of this section) 42 USC 295g-6. 
is amended to read as follows: 
"(c) For the purpose of carryii^ out this section, there are au-
thorized to be appropriated $37,900,000 for fiscal year 1989, 
$40,000,000 for fiscal year 1990, and $40,000,000 for fiscal year 
1991.". 
SEC. 611. EDUCATIONAL ASSISTANCE TO INDIVIDUALS F
R
O
M
. DISADVAN-
TAGED BACKGROUNDS. 
(a) A
U
T
H
O
R
T
T
Y F
O
R STIPENDS F
O
R ADDITIONAL C
A
T
E
G
O
R
I
E
S O
F STU-
DENTS.—Section 787(aX2) (42 U.S.C. 295g-7(aX2)) is amended— 
(1) by striking "and" at the end of subparagraph (E); 
(2) by striking the period at the end of subparagraph (F) and 
inserting "; and"; and 
(3) by inserting after subparagraph (F) the following new 
paragraph: 
"(G) paying such stipends as the Secretary may approve for 
such individuals for any period of education at any school 
described in subsection (aXD, except schools of medicine, osteop-
athy, or dentistry.". 
(b) INCREASED ENROLLBIENTS.—Section 787 (42 U.S.C. 295g-7) is 
amended by redesignating subsections (b) and (c) as subsections (c) 
and (d), respectively, and by adding after subsection (a) the follow-
ing: 
(bXD Schools of medicine, osteopathy, public health, dentistry, 
veterinary medicine, optometry, pharmacy, allied health, chiroprac-
tic, podiatry, and pubUc and nonprofit schools that offer graduate 
prc^rams in clinic^ psychology that receive a grant under subsec-
tion (a) shall, during a period of 3 years commencing on the date of 
the award of the grant, increase their first year enrollments of 
individuals firom disadvantaged backgrounds by at least 20 percent 
over enrollments in the base year 1937. 
"(2) The Secretary shall give priority for funding, in years suttse-
quent to the expiration of the 3-year period described in paragraph 
(1)-
"(A) to schools that attain such increase in their first year 
enrollment by the end of such 3-year period, and 
"(B) to schools that attain a 20 percent increase over such 
base year enrollment. 
Schools and 
colleges. 
19-194 O—91—Part -
:QL3 
102 STAT. 3132 
PUBLIC LAW 100-607—NOV. 4, 1988 
"(3) The requirement for at least a 20 percent increase in such 
enroUment shall apply only to those schools referred to in para-
graph (1) that have a total enrollment of such individuals from 
disadvantaged backgrounds that is less than 200 percent of the 
national average total enrollment of such individuals in all schools 
of each health professions discipline. 
"(4) Determination of both fu-st year and total enrollment of such 
individuals shall be made by the Secretary in accordance with 
section 708.". 
(c) AUTHORIZATION OF APPROPRIATIONS.—Section 787(c) (42 U.S.C. 
29%-7(c)) (as so redesignated) is amended in the first sentence by 
striMng "and" after "1987," and by inserting before the period the 
following: ", $31,200,000 for fiscal year 1989, $34,000,000 for fiscal 
year 1990, and $36,000,000 for fiscal year 1991". 
(d) SET-ASIDES.—Section 787(c) (42 U.S.C. 295g-7(c)) (as so redesig-
nated) is amended in the second sentence by striking "Not less" and 
all that follows through "fiscal year" and inserting the following: 
"Of the amounts appropriated under this section for any fiscal year, 
10 percent shall be obligated for community-based programs and 70 
1[)6rC6Il^ 
(e) STIPENDS.—Section 787(c) (42 U.S.C. 295g-7(c)) (as so redesig-
nated) is amended by adding at the end the following: "Such sti-
pends shall be administered and awarded in the same manner and 
subject to the same r^ulations as scholarships under section 758.". 
42 use 295g-7 
(f) REPORT.—Not later than September 30, 1991, the Secretary 
^°^- 
shall prepare and submit, to the 0)mmittee on Energy and Com-
merce of the House of Representatives and the Committee on Labor 
and Human Resources of the Senate, a report that develops a 
tracking system to evaluate— 
(1) the success of the programs established under section 787 
of the Public Health Service Act in enhancing the professional 
education of individuals from disadvantaged backgrounds; and 
(2) the gains experienced by institutions in the retention of 
students from disadvantaged backgrounds.". 
SEC. 612. RETENTION PROGRAM FOR HEALTH PROFESSIONS SCHOOLS 
WITH INDIVIDUALS FROM DISADVANTAGED BACKGROUNDS. 
Part F of title VII is amended by inserting after section 787 (42 
U.S.C. 295g-7) the following new section: 
42 u s e 295g-7a. 
"SEC. 787A. RETENTION PROGRAM FOR HEALTH PROFESSIONS SCHOOLS 
WITH 
INDIVIDUALS 
FROM 
DISADVANTAGED 
BACK-
GROUNDS. 
Grants. 
"(a) ESTABLISHMENT.—The Secretary shall establish a supple-
mental grant program to award grants to schools of medicine, 
osteopathy, dentistry, veterinary medicine, optometry, podiatry, 
pharmacy, or public health that demonstrate sufficient graduation 
of students from disadvantaged backgrounds. 
"Qo) PAYMENT FORMULA.— 
"(1) IN GENERAL.—Payments to an eligible institution under 
this section shall be calculated in accordance with this subsec-
tion. 
"(2) EUGIBLE INSTITUTIONS.—An institution shall be eligible 
for fimds under this section for a fiscal year in an amount 
determined under paragraph (5), if the disadvantaged graduate 
figure for the institution (as determined under paragraph (3)) 
PUBLIC LAW 100-607—NOV. 4, 1988 
102 STAT. 3133 
exceeds the nondisadvantaged graduate figure for the institu-
tion (as determined under paragraph (4)). 
"(3) DISADVANTAGED GRADUATE FIGURE.—For each fiscal year, 
the Secretary shedl determine the disadvantaged graduate 
figure for the institution by dividing— 
"(A) the number of students from disadvantaged back-
grounds who graduated from the institution as part of such 
class; by 
"(B) the number of students from disadvantaged back-
grounds who matriculated into the institution as part of a 
class. 
"(4) NONDISADVANTAGED GRADUATE FIGURE.—For each fiscal 
year, the Secretary shall determine the nondisadvantaged grad-
uate figure for the institution by multiplying— 
(A) the quotient determined by dividing— 
"(i) the number of students from nondisadvantaged 
backgrounds who graduated from the institution as 
part of such class; by 
"(ii) the number of students from nondisadvantaged 
backgrounds who matriculated into the institution as 
part of a CIEISS; by 
"(B) .9. 
"(5) AMOUNT OF GRANT.—An institution determined to be 
eligible to receive a grant under this subsection shall be entitled 
to an amount determined by multipl)dng— 
"(A) the quotient determined by dividing— 
"(i) the total amount of funds made available to carry 
out this section during such preceding fiscal year; by 
"(ii) the number of students from disadvantaged 
backgrounds who graduated from eligible institutions 
during the preceding fiscal year; by 
"(B) the number of students from disadvantaged back-
grounds who graduated from the eligible institution during 
such preceding fiscal year. 
"(c) USE OF FUNDS.—Payment received by the institution under 
subsection (b) shall be used to provide— 
"(1) financial aid services for individuals from disadvantaged 
backgrounds who choose to attend such institution; 
"(2) retention services or for other retention purposes for 
individuals for disadvemtaged backgrounds. 
"(d) AUTHORIZATION OF APPROPRIATIONS.—There are authorized to 
be appropriated to carry out this section, $2,000,000 in each of the 
fiscal years 1990 and 1991.". 
SEC. 613. TWO-YEAR 
SCHOOLS 
OF 
MEDICINE, INTERDISCIPLINARY 
TRAINING, AND CURRICULUM DEVELOPMENT. 
(a) SPECIAL PROJECTS.—Section 788 (42 U.S.C. 295g-8(e)) is 
amended to read as follows: 
"SEC. 788. SPECIAL PROJECTS. 
"(a) TWO-YEAR SCHOOLS.— 
"(1) IN GENERAL.—The Secretary may make grants to main- Grants, 
tain and improve schools that provide the first or last 2 years of 
education leading to the degree of doctor of medicine or osteop-
athy. Grants provided under this paragraph to schools that 
were in existence on September 30, 1985, may be used for 
construction and the purchase of equipment. 
102 STAT. 3134 
PUBLIC LAW 100-607—NOV. 4, 1988 
"(2) EuGiBiLTTY.—To be eligible to apply for a grant under 
paragraph (1), the applicant must be a public or nonprofit school 
providing the first or last 2 years of education leading to the 
degree of doctor of medicine or osteopathy and be accredited by 
or be operated jointly with a school that is accredited by a 
recognized body or bodies approved for such purpose by the 
Secretary of Education. 
Schools and 
"(b) FACULTY AND CURRICULUM DEVELOPMENT AND CUNICAL 
colleges. 
TRAINING SITES.— 
"(1) GRANTS AND CONTRACTS.— 
"(A) IN GENERAT,.—The Secretary may make grants to 
and enter into contracts with any health professions 
institution or any other public or private nonprofit entity 
for the development and implementation of model projects 
in areas such as faculty and curriculum development, and 
development of new clinical training sites. 
"(B) AixocATiON OF FUNDS.—Priority shall be given to 
schools of medicine, osteopathy, dentistry, veterinary medi-
cine, optometry, pharmacy, podiatry, public health, chiro-
practic, allied health, and to graduate programs at public 
and nonprofit private schools in health administration and 
clinical psychology in the allocation of funds under this 
subsection. Funds shall be allocated to each profession for 
award within that profession on the basis of competitive 
applications. 
Investigator-initiated 
projects 
should be 
encouraged. Funding priorities may be determined by the 
Secretary on consultation with the health professions 
schools and the National Advisory Council on the Health 
Professions Education. 
"(C) F
*
E
E
R REVIEW.—Any application for a grant to institu-
tions described in subparagraph (A) shall be subject to 
appropriate peer review by peer review groups composed 
principally of non-Federal experts. The Secretary may not 
approve an application unless a peer review group has 
recommended it for approval. 
"(2) HEALTH PROFESSIONS INSTITUTIONS AND ALLIED HEALTH 
INSTITUTIONS.— 
"(A) SET-ASIDE.—At least 75 percent of the amounts avail-
able for grants and contracts under this subsection from 
amounts appropriated under subsection (e) shall be obli-
gated for grants to and contracts with health professions 
institutions and allied health institutions. 
"(B) PEER REVIEW.—Any application for a grant to 
institutions described in subparagraph (A) shall be subject 
to appropriate peer review by peer review groups composed 
principally of non-Federal experts. 
"(C) PREREQUISITES.—The Secretary may not approve or 
disapprove an application for a grant to an institution 
described in subpeiragraph (A) unless the appropriate peer 
review group required under subpare^aph (B) has rec-
ommended such approval and the Secretary has consulted 
with the National Advisory Council on Health Professions 
Education with respect to such application. 
"(c) TRAINING IN PREVENTIVE MEDICINE.— 
CoT^ ts 
"^"'^^ ' ^ GENERAL.—The Secretary may make grants to and 
^^^ ' 
enter into contracts with schools of medicine, osteopathy, and 
public health to meet the costs of projects— 
PUBLIC LAW 100-607—NOV. 4, 1988 
102 STAT. 3135 
"(A) to plan and develop new residency training pro-
grams and to maintain or improve existing residency train-
ing programs in preventive medicine; and 
"(B) to provide financial assistance to residency trainees 
enrolled in such programs. 
"(2) ADMINISTRATION.— 
"(A) AMOUNT.—The gmiount of any grant under para-
graph (1) shEill be determined by the Secretary. 
"(B) APPUCATION.—No grant may be made under para-
graph (1) unless an application therefor is submitted to and 
approved by the Secretary. Such an application shall be in 
such form, submitted in such manner, and contain such 
information, as the Secretary shall by regulation prescribe. 
"(C) EuGiBiLiTY.—To be eligible for a grant under para-
graph (1), 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 
medicine and support from other faculty members trained 
in public health and other relevant specialties and dis-
ciplines. 
"(D) OTHER FUNDS.—Schools of medicine, osteopathy, and 
public health may use funds committed by State, local, or 
county public health officers as matching amounts for Fed-
eral grant funds for residency training programs in preven-
tive medicine. 
"(d) PROGRAMS FOR PHYSICIAN ASSISTANTS.— 
"(1) IN GENERAL.—The Secretary may msike grants to and 
enter into contracts with public or nonprofit private schools of 
medicine and osteopathy and other public or nonprofit private 
entities to meet the costs of projects to plan, develop, and 
operate or maintain programs for the training of physician 
assistants (as defined in section 701(8)). 
"(2) APPUCATIONS.—No grant or contract may be made under 
paragraph (1) unless the application therefor contains or is 
supported by assurances satisfactory to the Secretary that the 
school or entity receiving the grant or contract has appropriate 
mechanisms for placing graduates of the training program with 
respect to which the application is submitted in positions for 
which they have been trained. 
"(e) CERTAIN PROJECTS WITH RESPECT TO HOSPITALS AND SCHOOLS 
OF PoDiATRic MEDICINE.—The Secretary may make grants to, and 
enter into contracts with, public and nonprofit private hospitals and 
schools of pediatric medicine for the purpose of planning and im-
plementing projects in primary care training for podiatric physi-
cians in approved or provisionally approved residency programs 
which shall provide financial assistance in the form of traineeships 
to residents who participate in such projects and who plan to 
specialize in primary care. 
"(f) AUTHORIZATIONS.—(IXA) For the purpose of carrying out 
subsections (a), (b), and (e), there are authorized to be appropriated 
$2,400,000 for fiscal year 1989, $4,000,000 for fiscal year 1990, and 
$4,000,000 for fiscal year 1991. 
"(B) Of the amounts appropriated pursuant to subparagraph (A) 
for each of the fiscal years 1989 through 1991, the Secretary shall 
make available 20 percent of such amounts to carry out subsection 
(a) and 25 percent of such amounts to carry out subsection (e). 
Regulations. 
Grants. 
Contracts. 
102 STAT. 3136 
PUBLIC LAW 100-607—NOV. 4, 1988 
"(2XA) For the purpose of carrying out subsection (c), there are 
authorized to be appropriated $1,500,000 for fiscal year 1989, 
$2,500,000 for fiscal year 1990, and $4,000,000 for fiscal year 1991. 
"(B) For the purpose of carrying out subsection (d), there are 
authorized to be appropriated $4,500,000 for fiscal year 1989, 
$5,200,000 for fiscal year 1990, and $5,400,000 for fiscal year 1991.". 
SEC. 614. GRANTS FOR MINORITY EDUCATION. 
(a) REORGANIZATION.—Section 778A (42 U.S.C. 295g-8a) is trans-
42 use 295g-8a, ferred to immediately after section 781 (42 U.S.C. 295g-l) and 
295g-2. 
redesignated as section 782. 
O
t
)
) PERIOD OF GRANTS.—Subsection (b) of section 782 (as trans-
42 use 295g-2. 
ferred and redesignated by subsection (a)) is amended by inserting 
after "(b)", the following new sentence: "The Secretary may award 
grants ifor periods not to exceed 3 years.". 
(c) EuGiBiuTY.—Subsection (c) of section 782 (as transferred and 
redesignated by subsection (a)) is amended to read as follows: 
"(c) Only health professions schools shall be eligible for a grant 
under this section, and to be eligible such schools must— 
(1) be a school described in section 701(4); and 
(2) have received a contract under section 788A for fiscal year 
1987.". 
SEC. 615. GERIATRIC PROGRAMS. 
(a) GERIATRIC EDUCATION CENTERS AND GERIATRIC TRAINING.— 
Part F of title VII is amended by inserting after section 788B (42 
U.S.C. 295g-8b) the following new section: 
42 u s e 295g-9. 
"SEC. 789. GERIATRIC EDUCATION CENTERS AND GERIATRIC TRAINING. 
"(a) GERIATRIC EDUCATION CENTERS.— 
Grants. 
"(1) IN GENERAL.—The Secretary may make grants to and 
Contracts. 
enter into contracts with accredited health professions schools, 
including schools of allied health, referred to in section 701(4) or 
701(10) and programs referred to in section 701(8) to assist in 
meeting the costs of such schools or programs of providing 
projects to— 
"(A) improve the training of health professionals in 
geriatrics; 
"(B) develop and disseminate curricula relating to the 
treatment of the health problems of elderly individuals; 
"(C) expand and strengthen instruction in methods of 
such treatment; 
"(D) support the training and retraining of faculty to 
provide such instruction; 
"(E) support continuing education of health professionals 
and allied health professionals who provide such treatment; 
and 
"(F) establish new affiliations with nursing homes, 
chronic and acute disease hospitals, ambulatory care cen-
ters, and senior centers in order to provide students with 
clinical training in geriatric medicine. 
"(2) APPROVAL OF APPUCATIONS.— 
"(A) PEER REVIEW.—Any application for a grant or con-
tract under this subsection shall be subject to appropriate 
peer review by peer review groups composed principally of 
non-FederEd experts. 
PUBLIC LAW 100-607—NOV. 4, 1988 
102 STAT. 3137 
"(B) PREREQUISITES.—The Secretary may not approve or 
disapprove an application for a grant or contract under this 
subsection unless the Secretary has received recommenda-
tions with respect to such application from the appropriate 
peer review group required under subparagraph (A) and 
has consulted with the National Advisory Council on 
Health Professions Education with respect to such appl-
ication. 
"(b) GERIATRIC TRAINING.— 
"(1) IN GENERAL.—The Secretary may make grants to, and Grants. 
enter into contracts with, schools of medicine, schools of osteop- Contracts. 
athy, teaching hospitals, and graduate medical education pro-
grams, for the purpose of providing support (including 
residencies, traineeships, and fellowships) for geriatric training 
projects to train physicians and dentists who plan to teach 
geriatric medicine or geriatric dentistry. 
"(2) REQUIREMENTS.—Each project for which a grant or con-
tract is made under this subsection shall— 
"(A) be staffed by full-time teaching physicians who have 
experience or training in geriatric medicine; 
(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 beised in a graduate medical education program in 
internal medicine or family medicine, or in a department of 
geriatrics in existence as of December 1,1987; 
"(D) provide participants in the project with exposure to a 
population of elderly individuals; 
(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 psychiatry units, day and home care programs, 
rehabilitation services, extended care facilities, geriatric 
ambulatory care and comprehensive evaluation units, and 
community care programs for elderly mentally 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 £is 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 psychiatry at schools of medicine 
and osteopathy; and 
"(ii) dentists who are faculty members at schools of 
dentistry or at hospital departments of dentistry. 
"(B) A 1-year or 2-year internal medicine or family medi-
cine fellowship program providing emphasis in geriatrics, 
which shall be desired to provide training in clinical 
geriatrics and geriatrics research for— 
"(i) physicians who have completed graduate medical 
education programs in internal medicine, family medi-
cine, psychiatry, neurology, gynecology, or rehabilita-
tion medicine; and 
102 STAT. 3138 
PUBLIC LAW 100-607—NOV. 4, 1988 
"(ii) dentists who have completed post-doctoral dental 
education programs. 
"(4) DEFINITIONS.—For purposes of this subsection: 
"(A) GRADUATE MEDICAL EDUCATION PROGRAM.—The term 
'graduate medical education program' means a program 
sponsored by a school of medicine, a school of osteopathy, 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 Council 
for Graduate Medical Education or the American 
Osteopathic Association through its Committee on 
Postdoctoral Training. 
"(B) POST-DOCTORAL DENTAL EDUCATION PROGRAM.—The 
term 'post-doctoral dental education program' means a pro-
gram 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) AUTHORIZATION OF APPROPRIATIONS.— 
"(1) GERIATRIC EDUCATION CENTERS.—For grants and contracts 
under subsection (a), there are authorized to be appropriated 
$7,000,000 for fiscal year 1989, $10,000,000 for fiscal year 1990, 
and $13,000,000 for fiscal year 1991. 
"(2) GERIATRIC TRAINING.—For grants and contracts under 
subsection (b), there are authorized to be appropriated 
$7,000,000 for fiscal year 1989, $10,000,000 for fiscal year 1990, 
and $13,000,000 for fiscal year 1991.". 
(b) CONFORMING AMENDMENTS.—Section 783 (42 U.S.C. 295g-3) is 
repealed. 
SEC. 616. GENERAL PROVISIONS. 
(a) MINIMUM AMOUNT OF GRANT FOR CERTAIN GRANTEES.—Section 
790 (42 U.S.C. 295g-10) is amended— 
(1) in paragraph (3), by striking "The amount" and inserting 
the following: "Except as provided in paragraph (4), the 
amount"; and 
(2) by adding at the end the following new paragraph: 
"(4) With respect to grants under any of sections 780, 784, 785, 
and 786 for fiscal year 1989 and subsequent fiscal years, if an 
entity has been a grantee under the section involved for two 
consecutive fiscal years and the Secretary approves an applica-
tion under such section from the entity for any subsequent 
consecutive fiscal year, the amount of the grant for such fiscal 
year may not be less than an amount equal to 20 percent of the 
average of the amounts received under such section by the 
entity for the consecutively preceding fiscal years.". 
(b) REQUIREMENT OF PEER REVIEW FOR CERTAIN PROGRAMS.—Sec-
tion 790 (42 U.S.C. 295g-10), as amended by subsection (a) of this 
section, is further amended by adding at the end the following new 
paragraph: 
"(5XA) Each application for a grant under any of sections 784 
through 786 shall be submitted to a peer review group for an 
evaluation of the merits of the p r o p e l s made in the evalua-
PUBLIC LAW 100-607—NOV. 4, 1988 
102 STAT. 3139 
tion. Each application for a grant under section 780 may be 
submitted to such peer review group for such an evaluation. 
"(B) The Secretary shall establish such peer review groups as 
may be necessary to carry out subparagraph (A). The Secretary 
shall make appointments to the peer review groups from among 
appropriately qualified persons who are not officers or employ-
ees of the United States. 
"(C) With respect to applications referred to in subparagraph 
(A), a peer review group established pursuant to such subpara-
graph shall report its findings and recommendations to the 
Secretary. The Secretary may not approve such an application 
unless a peer review group has recommended the application 
for approval. 
"(D) This paragraph shall be carried out by the Secretary, 
acting through the Administrator of the Health Resources and 
Services Administration.", 
(c) CERTAIN PROVISIONS WITH RESPECT TO HISPANIC INDIVIDUALS 
AND OTHER MEBIBERS OF MINORITY GROUPS.— 
(1) Section 708a)X2) (42 U.S.C. 292h(bX2)) is amended by 
adding at the end the following new sentence: "Such studies 
shall include studies determining by specialty and ge(^raphic 
location the number of health professionals (including allied 
health professionals and health care administration personnel) 
who are members of minority groups, including Hispanics, and 
studies providing by specialty and gec^raphic location evalua-
tions and projections of the supply of, and requirements for, 
health professionals (including allied health professionals and 
health care administration personnel) to serve minority groups, 
including Hispanics.". 
(2XA) The Secretary of Health and Human Services shall 42 USC 292h 
conduct a study for the purpose of determining— 
^°^^-
(iXD the extent to which health care is being provided to 
Hispanic individuals in medically underserved areas by 
health care professionals who are unable to communicate 
with such individuals in the most appropriate language and 
cultural context; and 
(11) whether the extent of the provision of health care to 
Hispanic individuals by such health care professionals is 
detrimental to the health of such individuals; and 
(ii)(D the extent to which Hispanic individuals in medi-
cally underserved areas rely on allied health personnel as 
the primary source of health care; 
(II) whether the extent of such reliance is detrimental to 
the health of such individuals; and 
(III) if the extent of such reliance is detrimental to such 
individuals, whether area health education center pro-
grams (as defined in section 781(g), as redesignated by 
section 6G8(cXl) of this Act) can be utilized with respect to 
providing appropriate health care to such individuals. 
(B) The S^retary of Health and Human Services shall, not Reports. 
later than 1 year after the date of the enactment of this Act, 
complete the study required in subparagraph (A) and submit to 
the Coi^ress a report describing the findings made as a result of 
the study. 
102 STAT. 3140 
PUBLIC LAW 100-607—NOV. 4, 1988 
SEC. 617. SPECIAL PROJECTS. 
Part F of title VH (42 U.S.C. 295f-2 et seq.) is amended by adding 
at the end the following new section: 
42 use 295g-ll. "SEC. 790A. SPECIAL PROJECTS. 
Contracts. 
"(a) GRANTS.—^The Secretary may make grants to, and enter into 
contracts with, schools of public health for the costs of planning, 
developing, demonstrating, operating, and evaluating projects— 
"(1) for preventive medicine; 
"(2) for health promotion and disease prevention; 
"(3) for increasing the enrollment in such schools of individ-
uals from disadvantaged backgrounds (as determined in accord-
ance with criteria established by the Secretary under section 
787(a)); and 
"(4) to improve access and quality in health care. 
"(b) PROHmmoNS.—^The Secretary may not make a grant under 
subsection (a) unless— 
"(1) an appUcation for the grant is submitted to the Secretary; 
"(2) with respect to carrying out the purpose for which the 
grant is to be made, the application provides assurances of 
compliance satisfactory to the Secretary; and 
"(3) the application otherwise is in such form, is made in such 
manner, and contains such agreements, assurances, and 
information as the Secretary determines to be necessary to 
carry out this section. 
"(c) LnynTATiONS.—^The Secretary may make a grant under this 
subsection only— 
"(1) pursuant to the issuance of sohcitations for such grants; 
and 
"(2) if the application for such a grant has been recommended 
for approval by an appropriate peer review group. 
"(d) AUTHORIZATION OP APPROPRIATIONS.—For the purpose of 
carrying out subsection (a), there are authorized to be appropriated 
$1,500,000 for fiscal year 1989, $3,500,000 for fiscal year 1990, and 
$5,000,000 for fiscal year 1991.". 
SEC 618. GRANTS FOR GRADUATE PROGRAMS IN HEALTH ADMINISTRA-
TION. 
(a) MINIMUM NUMBER OF STUDENTS.—Section 791(cX2XAXi) (42 
U.S.C. 295h(cX2XAXi)) is amended— 
(1) by strDdng "25" and insertmg "15"; and 
(2) by striking "except that" and all that follows through "in 
such school year". 
(b) AUTHORIZATION OP APPROPRIATIONS.—Section 791(d) (42 U.S.C. 
295h(d)) is amended by striking "and" after "1987," and by inserting 
before the period the following: ", $1,420,000 for fiscal year 1989, 
$1,420,000 for fiscal year 1990, and $1,700,000 for fiscal year 1991". 
SEC. 619. AUTHORIZATION OF APPROPRIATIONS FOR TRAINEESHIPS FOR 
STUDENTS IN OTHER GRADUATE PROGRAMS. 
Section 791A(c) (42 U.S.C. 295h-la(c)) is amended by striking 
"and" before "$500,000" and by inserting before the period the 
following: "; and $500,000 for each of the fiscal years 1989 through 
1991". 
PUBLIC LAW 100-607—NOV. 4, 1988 
102 STAT. 3141 
SEC. 620. PROVISIONS WITH RESPECT TO GRADUATE PROGRAMS IN 
CLINICAL PSYCHOLOGY. 
(a) DEFINITION OF GRADUATE PROGRAM IN CUNICAL PSTCHOLOGT.— 
(1) Section 701(4) (42 U.S.C. 292a(4)) is amended by inserting at 
the end the following new sentence: "The term 'graduate pro-
gram in clinical psychology* means an accredited graduate pro-
gram in a public or nonprofit private institution in a State 
which provides training leading to a doctoral d^ree in clinical 
psychology or an equivalent d^ree.". 
(2) Section 701 (42 U.S.C. 292a) is amended by striking para-
graph (14). 
(Jb) NATIONAL ADVISORY COUNCIL ON HEALTH PROFESSIONS EDU-
CATION.—Section 702(a) (42 U.S.C. 292b(a)) is amended— 
(1) in the first sentence, by striking "twenty members ap-
pointed" and inserting "twenty-one members appointed"; and 
(2) in paragraph (1)— 
(A) in the matter preceding subparagraph (A), by striking 
"twelve" and inserting "thirteen"; and 
(B) in subparagraph (A), by inserting before the semicolon 
the 
following: 
"and graduate 
programs in clinical 
psychology". 
(c) DISCRIMINATION ON BASIS OF SEX.—Section 704 (42 U.S.C. 292d) 
is amended— 
(1) in the first sentence, by inserting after "allied health 
personnel" the following: ", or graduate program in clinical 
psychol<^y,"; and 
(2) in the second sentence, by striking "school or training 
center" and inserting "school, training center, or graduate 
progtHm". 
SEC. 621. AUTHORIZATION OF APPROPRIATIONS FOR PUBLIC HEALTH 
TRAINEESHIPS. 
Section 792(c) (42 U.S.C. 295h-lb(c)) is amended by striking "and" 
after "1987;" and by insertii^ before the period the following: "; 
$4,100,000 for fiscal year 1989; $4,200,000 for fiscal year 1990; and 
$4,300,000 for fiscal year 1991". 
SEC. 622. TRAINING OF HEALTH PROFESSIONALS WITH RESPECT TO 
ACQUIRED IMMUNE DEFICIENCY SYNDROME. 
Section 788B is amended to read as follows: 
"SEC. 788B. TRAINING WITH RESPECT TO ACQUIRED IMMUNE DEFICIENCY 
42 USC 295g-8b. 
SYNDROME. 
"(a) GRANTS.—^The Secretary may make grants and enter into Contracts. 
contracts to assist schools and academic health science centers in Health care 
meeting the costs of projects— 
proession s. 
"(1) to train the faculty of schools and graduate departments 
of medicine, nursing, osteopathy, dentistry, public health, 
psycholi^y, and allied health to teach health professions stu-
dents to provide for the health care needs of individuals with 
acquired immune deficiency syndrome; 
"(2) with respect to improving clinical skills in the diagnosis, 
treatment, and prevention of such syndrome, to educate and 
train the health professionals and clinical stafT of schools of 
medicine, osteopatliy, and dentistry; and 
102 STAT. 3142 
PUBLIC LAW 100-607—NOV. 4, 1988 
"(3) t» develop and disseminate curricula relating to the care 
and treatment of individuals with acquired immune deficiency 
syndrome. 
Minorities. 
"(b) PREFERENCE.—In making grants under subsection (a), the 
Secretary shall give preference to projects which will— 
"(1) train, or result in the training of, health professionals 
who will provide treatment for minority individuals with ac-
quired immune deficiency syndrome and other individuals who 
are at high risk of contracting such syndrome; and 
"(2) train, or result in the training of, minority health profes-
sionals and minority allied health professionals to provide 
treatment for individuals with acquired inmiune deficiency 
syndrome. 
"(c) APPUCATION.—No grant or contract may be made under 
subsection (a) unless an application is submitted to the Secretary in 
such form, at such time, and containing such information, as the 
Secretary may prescribe. 
"(d) PEER REVIEW.— 
"(1) IN GENERAL.—An application for a grant or contract 
under subsection (a) shall be subject to appropriate peer review 
by peer review groups comjposed principally of non-Federal 
experts. 
"(2) LIMITATION.—The Secretary may not approve an applica-
tion for a grant or contract under subsection (a) unless the 
appropriate peer review group required under paragraph (1) has 
recommended such approval and the Secretary has consulted 
with the National Advisory Council on Health Professions Edu-
cation with respect to such application. 
"(e) AUTHORIZATION OP APPROPRIATIONS.—There are authorized to 
be appropriated for grants under subsection (a), such sums as may 
be necessary for each of the fiscal years 1989 through 1991. 
"(f) DENTAL SCHOOLS.— 
Grants. 
"(1) IN GENERAL.—The Secretary may make grants to assist 
dental schools and p n ^ a m s described in section 788(eX4XB) 
with respect to oral health care to AIDS patients. 
"(2) APPLICATION.—Each dental school or program described 
in section 788(eX4XB) may annually submit an application docu-
menting the unreimbursed costs of oral health care provided to 
AIDS patients by that school or hospital during the prior year. 
"(3) DISTRIBUTION.—The Secretary shall distribute the avail-
able funds among all eligible applicants, taking into account the 
number of AIDS patients served and the unreimbursed oral 
health care costs incurred by each institution as compared with 
the total number of patients served and costs incurred by all 
eligible applicants. 
"(4) The Secretary shall not make a grant under this subsec-
tion if doing so would result in any reduction in State funding 
allocation for such purposes. 
"(5) AUTHORIZATION OF APPROPRIATIONS.—For the purpose of 
carrying out this subsection, there is authorized to be appro-
priated such sums as may be necessary in fiscal year 1990 and 
fiscal year 1991.". 
SEC. 623. DEFINITIONS. 
(a) SCHOOL OF ALLIED HEALTH.—Section 701(10) (42 U.S.C. 292a(10)) 
is amended— 
PUBLIC LAW 100-607—NOV. 4, 1988 
102 STAT. 3143 
(1) in the matter preceding subparagraph (A), by striking 
"university—" and inserting "university or hospital-based edu-
cational entity—"; and 
(2) in subparagraph (BX by inserting before the semicolon the 
following: "(except that this subparagraph shall not apply to 
any hospital-based educational entity) . 
(b) AujED HEALTH PROFESSIONALS.—Section 701(13X0 (42 U.S.C. 
292a(13XC^) is amended— 
(1) by strikii^ out "an individual" and inserting in lieu 
thereof "a health professional"; 
(2) by striking out "or" before "a doctoral degree in clinical 
psychologjr"; and 
(3) by inserting before the period the following: ", or a degree 
in social work or an equivalent d^ree". 
SEC. 624. ALLIED HEALTH PROJECT GRANTS AND CONTRACTS. 
Section 796 (42 U.S.C. 295h-5) is amended— 
(1) by striking out subsection (a) and inserting in lieu thereof 
the following new subsection: 
"(a) The Secretary shall make grants to and enter into contracts 
with eligible entities to assist them in meeting the costs of planning, 
developing, establishing, operating, and evaluating projects relating 
to: 
*'(1) Improving and strengthening the effectiveness of allied 
health administration, program directors, facility, and clinical 
faculty. 
"(2) Improving and expanding prt^ram enrollments in those 
professions in greatest demand and whose services are most 
needed by the elderly. 
"(3) Interdisciplinary training prc^ams that promote the 
effectiveness of alUed health practitioners in geriatric assess-
ment and the rehabilitation of the elderly. 
"(4) Demonstration centers to emphasize innovative models to 
link allied health clinical practice, education, and research. 
"(5) Adding and strengthening curriculum units in allied 
healtii programs to include knowledge and practice concerning 
prevention and health promotion, geriatrics, long-term care, 
home health and hospice care, and ethics. 
"(6) The recruitment of individuals into allied health profes-
sions, including projects for— 
"(A) the identification and recruitment of highly quali- Schools and 
fied individuals, including the provision of educational and 
work experiences for recruits at the secondary and colle-
giate levels; 
"(B) the identification and recruitment of minority and 
disadvantaged students, including the provision of remedial 
and tutorial services prior and subsequent to admission, the 
provision of work-study programs for secondary students, 
and recruitment activities directed toward primary school 
students; and 
"(C) the coordination and improvement of recruitment 
efforts among official and voluntary agencies and institu-
tions, including official departments of education, at the 
city, county, and State, or regional level."; 
(2) by striking out subsection (c) and inserting in lieu thereof 
the following new subsection: 
Research and 
development. 
Minorities. 
Disadvantaged 
persons. 
102 STAT. 3144 
PUBLIC LAW 100-607—NOV. 4, 1988 
Schools and 
colleges. 
Appropriation 
authorization. 
Contracts. 
Grants. 
Contracts. 
"(c) For purpofies of subsection (a), the term 'eligible entities' 
means entities which are— 
"(1) schools, universities, or other educational entities which 
provide for allied health personnel education and training and 
which meet such standards as the Secretary may by regulation 
prescribe; or 
"(2) other public or nonprofit private entities capable, as 
determined by the Secretary, of carrying out projects described 
in subsection (a)."; and 
(3) by striking out subsection (d) and inserting in lieu thereof 
the following new subsection: 
"(d) For the purpose of making payments under grants and con-
tracts under subsection (a), there are authorized to be appropriated 
$2,000,000 for each of the fiscal years 1990 and 1991.". 
SEC. 625. TRAINEESmPS FOR ADVANCED TRAINING OF ALUED HEALTH 
PERSONNEL. 
Section 797 (42 U.S.C. 295h-6) is amended to read as follows: 
'^EC 797. TRAINEESHIPS FOR ADVANCED TRAINING OF ALLIED HEALTH 
PERSONNEL. 
"(a) GRANTS.—^The Secretary may make grants to and enter into 
contracts with training centers for allied health professions to meet 
the costs of projects designed to— 
"(1) plan, develop, establish, expand, and operate doctoral 
prt^rams for the advanced speciality training of allied health 
professionals who plan to teach and conduct research in an 
allied health training program; and 
"(2) provide financied assistance in the form of traineeships or 
fellowships to doctoral students who are participants in any 
such program and who plan to teach and conduct research in an 
allied health discipline or to post doctond students who are 
continuing specialized study and research in an allied health 
discipline. 
"(b) LIMITATION.—^The Secretary shall limit grants and contracts 
made or entered into under subsection (a) to those allied health 
fields or specialities as the Secretary shall, from time to time, 
determine to have— 
"(1) the most significant national or r^onal shortages of 
practitioners; 
"(2) insufficient numbers of qualified faculty in entry level or 
advanced educational programs; and 
"(3) a significant role in the care and rehabilitation of 
patients ana clients who are elderly or disabled. 
"(c) AUTHORIZATION OF APPROPRIATIONS.—For the purposes of 
making payments under grants under subsection (a), there are 
authorized to be appropriated $2,000,000 for each of the fiscal years 
1990 and 1991. 
"(d) AvAiLABiUTT OF FuNDS.—Funds appropriated under this sec-
tion for any fiscal year shall remain available until expended or 
through fiscal year 1991.". 
SEC 626. ALLIED HEALTH PROFESSIONS DATA. 
Section 708 (42 U.S.C. 292h) is amended by adding at the end the 
following: 
"(hXD In carrying out subsection (a), the Secretary may make 
grants, or enter into contracts and cooperative agreements with, and 
PUBLIC LAW 100-607—NOV. 4, 1988 
102 STAT. 3145 
provide technical assistance to, any nonprofit entity in order to 
establish a uniform sdlied health professions data reporting system 
to collect, compile, and analyze data on the allied health professions 
personnel. 
"(2) In the first report under subsection (d) made 2 years after the 
date of enactment of this Act and in each biennial report thereafter, 
the Secretary include a description and analysis of data collected 
pursuant to paragraph (1).". 
SEC. 627. COUNCIL ON GRADUATE MEDICAL EDUCATION. 
Section 799 (42 U.S.C. 295i) is amended by adding at the end the 
following: 
"(k) There is authorized to be appropriated $1,000,000 for each of Appropriation 
the fiscal years 1989, 1990, and 1991 to carry out this section.", authorization. 
SEC. 628. REFERENCES WITH RESPECT TO PODIATRIC MEDICINE. 
Title VII (42 U.S.C. 292a et seq.) is amended— 
(1) in section 701— 
42 use 292a. 
(A) in paragraph (4), by striking " 'school of podiatry'" and 
inserting '"school of podiatric medicine'" and by striking 
"'doctor of podiatry' 
and inserting "doctor of podiatric 
medicine"; and 
(B) in paragraph 13(C), by striking "podiatry" and insert-
ing "podiatric medicine"; 
(2) in section 702(aXlXA), by striking "podiatry," and insert- 42 use 292b. 
ing "podiatric medicine,"; 
(3) in section 704, in the first sentence, by striking "podiatry," 42 use 292d. 
and inserting "podiatric medicine,"; 
(4) in section 721— 
42 use 293a. 
(A) in subsection (cX3), in subparagraphs (A) and (B), by 
striking "podiatry," each place it appears and inserting 
"podiatric medicine,"; 
(B) in subsection (dXlXA), by striking "podiatry," and 
inserting "podiatric medicine,"; and 
(C) in subsection (f)— 
(i) in paragraph (1), in the first sentence, by striking 
"podiatry," and inserting "podiatric medicine,"; and 
(ii) in paragraph (3XA), by striking "podiatry," and 
inserting "podiatric medicine,"; 
(5) in section 729(a), in the first and second sentences, by 42 use 294b. 
striking "podiatry," each place it appears and inserting 
"podiatric medicine,"; 
(6) in section 737(1), by striking "podiatry," and inserting 42USC294J. 
"podiatric medicine,"; 
(7) in section 740— 
42 use 294m. 
(A) in subsection (a), by striking "podiatry," and inserting 
"podiatric medicine,"; 
(B) in subsection 0)X4), by striking "podiatry" and insert-
ing "podiatric medicine"; and 
(C) in subsection (c)— 
(i) in paragraph (1), by striking "podiatry," and 
inserting "podiatric medicine,"; and 
(ii) in paragraph (3XC), by striking "podiatry," and 
inserting "podiatric medicine,"; 
(8) in section 741— 
42 use 294n. 
(A) in subsection (bXD, by striking "podiatry" and insert-
ing "podiatric medicine"; 
102 STAT. 3146 
PUBLIC LAW 100-607—NOV. 4, 1988 
(B) in subsection (fXlXA), by striking "podiatry" and 
inserting "podiatric medicine"; and 
(C) in subsection (1X4), by striking "podiatry," and insert-
ing "podiatric medicine,"; 
42USC294Z. 
(9) in section 758(a), by striking "podiatry," and inserting 
^ 'Docii9.t)]*ic insdiciufi 
42 use 295g-7. 
(10) in section 787(aXl), by striking "podiatry," and inserting 
"podiatric medicine,"; and 
42 use 295g-8. 
(H) in section 788— 
(A) in subsection (cXD, in the first sentence, by striking 
"podiatry," and inserting "podiatric medicine,"; and 
(B) in subsection (f), by striking "podiatry" and inserting 
"podiatric medicine". 
Schools and 
SEC. 629. REFERENCES WITH RESPECT TO OSTEOPATHIC MEDICINE. 
COHGSCS 
(a) TECHNICAL AMENDMENTS TO TITLE III.—Title III (42 U.S.C. 241 
et seq.) is amended— 
(1) in section 327A(bXl), by inserting "schools of osteopathic 
medicine," after "schools of medicine," and by inserting "profes-
sions" after "health"; 
(2) by striking "osteopathy" each place such term appears and 
inserting "osteopathic medicine"; and 
(3) by striking "osteopaths" each place such term appears. 
(b) TECHNICAL AMENDMENTS TO TITLE VII.—Title VII (42 U.S.C. 
292a et seq.) is amended— 
(1) by striking "school of osteopathy" and "schools of osteop-
athy" each place such terms appear and inserting "school of 
osteopathic medicine" and "schools of osteopathic medicine", 
respectively; 
(2) by striking "school of medicine, osteopathy" and "schools 
of medicine, osteopathy" each place such terms appear and 
inserting "school of medicine, osteopathic medicine" and 
"schools of medicine, osteopathic medicine", respectively; and 
(3) by striking "medical or osteopathic" each place it precedes 
"school", "student", or "clinical education" and by inserting 
"medical (M.D. and D.O.)". 
SEC. 630. STUDY BY GENERAL ACCOUNTING OFFICE OF STATE PRAC-
TICES IN ENDORSEMENT LICENSING OF FOREIGN PHYSI-
CIANS. 
(a) IN GENERAL.—The Comptroller (Jeneral of the United States 
shall conduct a study for the purpose of determining the practices 
and policies of the States in licensing by endorsement physicians 
who are graduates of schools of medicine located in countries other 
than the United States. In carrying out the study, the Comptroller 
Genered shall— 
(1) with respect to such licensing of such physicians— 
(A) make a comparison with the practices and policies of 
the States in licensing by endorsement physicians who are 
graduates of American schools of medicine; and 
(B) determine the merits of any additional requirements 
imposed on physicians who are graduates of medical schools 
of other countries, including a determination of the relative 
proficiency of such physicians and a determination of the 
relevancy of any requirement of producing additional 
information or records; 
PUBLIC LAW 100-607—NOV. 4, 1988 
102 STAT. 3147 
(2) determine whether the graduates of schools of medicine 
located in other countries are being discriminated against with 
respect to licensing by endorsement in the United States; and 
(3) if such discrimination is occurring, determine the geo-
graphic areas in which the discrimination is occurring and the 
circumstances under which the discrimination is occurring. 
(b) CONSULTATION WITH APPROPRIATELY QUAUFIED INDIVIDUALS.— 
In carrying out the study required in subsection (a), the Comptroller 
GrenersJ of the United States shall consult with individuals with 
appropriate expertise. 
(c) TIME FOR COMPLETION.—Not later than 9 months after the date Reports. 
of the enactment of this Act, the Comptroller General of the United 
States shall complete the study required in subsection (a) and 
submit to the Committee on Energy and Commerce of the House of 
Representatives, and to the Committee on Labor and Human Re-
sources of the Senate, a report describing the landings made as a 
result of the study. 
SEC. 631. IDENTIFICATION AND NOTIFICATION OF POTENTIAL GRANTEES 
42 USC 295g-8 
UNDER CERTAIN PROGRAMS. 
note 
The Secretary of Health and Human Services shall identify enti-
ties that would be appropriate applicants for grants under section 
788(a) of the Public Health Service Act (42 U.S.C. 295g-8(a)) and shall 
notify such entities of such fact. 
SEC. 632. RESEARCH WITH RESPECT TO HEALTH RESOURCES AND SERV- 
42 USC 241 note. 
ICES ADMINISTRATION. 
With respect to any program of research pursuant to the Public 
Health Service Act, any such program carried out in fiscal year 1987 
by an agency other than the Health Resources and Services 
Administration (or appropriate to be carried out by such an agency) 
may not, for each of the fiscal years 1989 through 1991, be carried 
out by such Administration. 
SEC. 633. REQUIREMENTS WITH RESPECT TO APPLICATION AND AWARD 
42 USC 
PROCESS FOR CERTAIN PROGRAMS. 
295g-10a. 
(a) SEMIANNUAL GRANT SOUCITATIONS.—With respect to grants 
under any of sections 780, 784, 785, and 786 for fiscal year 1990 or 
subsequent fiscal years, the Secretary of Health and Human Serv-
ices shall, not less than twice each fiscal year, issue solicitations for 
applications for such grants if amounts appropriated for such 
grants, and remaining unobligated at the end of the first solicitation 
period, are sufficient with respect to issuing a second solicitation. 
(b) PREUMINARY REVIEW FOR TECHNICAL SUFFICIENCY.—In review-
ing applications for grants referred to in subsection (a), the Sec-
retary shall— 
(1) make a preliminary review of each such application in 
order to determine whether the application involved is suffi-
cient with respect to the minimum technical requirements 
established by the Secretary for applications under the program 
involved; and 
(2) if the Secretary determines pursuant to the preliminary 
review that any such application is not sufHcient with respect to 
such requirements— 
(A) prepare a statement explaining the insufficiencies of 
the application; and 
102 STAT. 3148 
PUBLIC LAW 100-607—NOV. 4, 1988 
(B) return the application, together with such statement, 
by a date that permits the applicant involved a sufficient 
period of time in which to prepare a timely second applica-
tion for submission pursuant to the solicitation with respect 
to which the first application is being returned. 
SEC. 634. ESTABLISHMENT OF LOAN REPAYMENT PROGRAM FOR RE-
SEARCH AT NATIONAL INSTITUTES OF HEALTH WITH RE-
SPECT TO ACQUIRED IMMUNE DEFICIENCY SYNDROME. 
(a) IN GENERAL.—Part F of title IV is amended by inserting after 
section 487 the following new section: 
42 u s e 288-1. 
"SEC. 487A. LOAN REPAYMENT PROGRAM FOR RESEARCH WITH RESPECT 
TO ACQUIRED IMMUNE DEFICIENCY SYNDROME. 
"(a) IMPLEMENTATION OF PROGRAM.— 
"(1) IN GENERAL.—Not later than one year after the date of 
the enactment of the Health Professions Reauthorization Act of 
1988, the Secretary shall, subject to paragraph (2), establish and 
implement a program of entering into agreements with appro-
priately qualified health professionals under which such health 
professionals agree to conduct, as employees of the National 
Institutes of Health, research with respect to acquired immune 
deficiency syndrome in consideration of the Federal Govern-
ment agreeing to repay, for each year of such service, not more 
than $20,000 of the principal and interest of the educational 
loans of such health professionals. 
"(2) LIMITATION.—The Secretary may not enter in an agree-
ment with a health professional pursuant to paragraph (1) 
unless such professional— 
"(A) has a substantial amount of educational loans rel-
ative to income; and 
"(B) was not employed at the National Institutes of 
Health during the 1-year period preceding the date of the 
enactment of the Health Professions Reauthorization Act of 
1988. 
"(b) APPUCATION.—With respect to the National Health Service 
Corps Loan Repa3nnent Program established in subpart III of part D 
of title III, the provisions of such subpart shall, except as inconsist-
ent with subsection (a) of this section, apply to the program estab-
lished in such subsection (a) in the same manner and to the same 
extent as such provisions apply to the National Health Service 
Corps Loan Repajonent Program established in such subpart. 
"(c) AUTHORIZATION OF APPROPRIATIONS.— 
"(1) IN GENERAL.—For the purpose of canying out subsection 
(a), there are authorized to be appropriated such sums as may 
be necessary for each of the fiscal years 1989 through 1991. 
"(2) AVAILABILITY.—Amounts appropriated pursuant to para-
graph (1) for a fiscal year shall remain available until the 
expiration of the second fiscal year beginning after the fiscal 
year for which the amounts were appropriated.'. 
SEC. 635. NATIONAL RESEARCH SERVICE AWARDS WITH RESPECT TO 
TITLE VII PROGRAMS. 
Section 487(dX3) (42 U.S.C. 288) is amended by inserting after 
"made available", the first time such appears, the following: to the 
Secretary, acting through the Administrator of the Health Re-
sources and Services Administration,". 
PUBLIC LAW 100-607—NOV. 4, 1988 
102 STAT. 3149 
SEC. 636. CLARIFICATION WITH RESPECT TO APPLICABILITY OF CERTAIN 
FEDERAL REGULATIONS TO SECONDARY MARKETS FOR STU-
DENT LOANS. 
Section 728(c) (42 U.S.C. 294a(c)) is amended by adding at the end 
the following new paragraph: 
"(3) With respect to Federal regulations for lenders, this subpart 
may not be construed to preclude the applicability of such reg-
ulations to the Student Loan Marketing Association or to any other 
entity in the business of purchasing student loans, including such 
regulations with respect to applications, contracts, and due 
diligence.". 
SEC. 637. HEALTH CARE FOR RURAL AREAS. 
(a) HEALTH CARE FOR RURAL AREAS.—Title VII of the Public 
Health Service Act is amended by adding at the end thereof the 
following: 
"PART I—HEALTH CARE FOR RURAL AREAS 
"SEC. 799A. HEALTH CARE FOR RURAL AREAS. 
42 USC 295j. 
"(a) GRANTS.—The Secretary may make grants to, or enter into Contracts, 
contracts with, any eligible applicant to help such applicant fund 
authorized activities under an application approved under subsec-
tion (d). 
"(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 conducted 
concerning health care issues in rural areas; and 
"(E) increase the recruitment and retention of health 
care practitioners in 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.— 
102 STAT. 3150 
PUBLIC LAW 100-607—NOV. 4, 1988 
"(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 individ-
uals receiving training with funds made available to an 
applicant under subsection (a) shall be trained as doctors of 
medicine or doctors of osteopathy. 
Schools and 
"(c) EuGiBLE APPLICANTS.—Applicants eligible to obtain funds 
colleges. 
under subsection (a) shall include local health departments, non-
profit organizations and public or nonprofit colleges, universities, or 
schools of, or programs that specialize in, nursing, psychology, social 
work, optometry, public he^th, dentistry, osteopathy, physicians 
assistants, pharmacy, podiatry, medicine, chiropractic, and allied 
health professions if such applicants submit applications approved 
by the Secretary under subsection (d). Applicants eligible to obtain 
funds under subsection (a) shall not include for-profit entities, either 
directly or through a subcontract or subgrant. 
"(d) APPUCATIONS.— 
"(1) SUBMISSION.—In order to receive a grant under subsec-
tion (a) an entity shall submit an application to the Secretary. 
"(2) FORMS.—An application submitted under this subsection 
shall be in such form, be submitted by such date, and contain 
such information as the Secretary shall require. 
"(3) REQUIREMENTS.—Applications submitted 
under 
this 
subsection shall— 
"(A) be jointly submitted by at least two eligible ap-
plicants with the express purpose of assisting individuals in 
academic institutions in establishing long-term collabo-
rative relationships with health care providers in rural 
areas; 
"(B) designate a rural health care agency or agencies for 
clinical treatment or training, including hospitals, commu-
nity health centers, migrant health centers, rural health 
clinics, community mental health centers, long-term care 
facilities, facilities operated by the Indian Health Service or 
an Indian tribe or tribal organization or Indian organiza-
tion under a contract with the Indian Health Service under 
the Indian Self-Determination Acts, or Native Hawaiian 
health centers; and 
"(C) provide any additional information required by the 
Secretary. 
"(e) STUDY.— 
C!ontracts. 
"(1) IN GENERAL.—The Secretary shall enter into a contract to 
conduct a study of manpower training needs in rural areas, with 
attention focused on the supply of health professionals and 
whether such supply is adequate to meet the demands for 
health care services in rural communities. 
"(2) CONTENTS.— 
"(A) STATISTICS.—The study conducted under paragraph 
(1) shall include statistics and projections on— 
"(i) the supply of health care practitioners in rural 
areas; and 
"(ii) suggested methods of improving access to health 
care services in rural areas. 
The study shall pay particular attention to the needs of the 
elderly in rural areas as well as the individuals in the rural 
areas who are not eligible for Medicare. 
PUBLIC LAW 100-607—NOV. 4, 1988 
102 STAT. 3151 
"(B) EVALUATION.—The study conducted under para-
graph (1) shall evaluate existing models for health care 
training and service delivery and propose innovative alter-
native models to enhance the quality and availability of 
health care services in rural areas and to increase the 
retention of health professionals in rural areas. 
"(3) HEALTH CARE TRAINING AND SERVICE DEUVERY MODELS.— 
The Secretary shall evaluate the effectiveness of the health care 
training and service delivery models developed with funds made 
available under this section and compare such models with 
programs designed to increase the availability of health care 
providers in rural areas, including the National Health Service 
Corps program authorized by subpart II of part D of the Public 
Health Service Act (42 U.S.C. 254d et seq.) and the area health 
education center program authorized under section 781 of such 
Act(42U.S.C.295g-l). 
"(4) SUBMISSION TO CONGRESS.—Not later than 18 months Reports, 
after the date of the signing of the contract for the health care 
study under paragraph (1), the Secretary shall submit to the 
appropriate committees of the Congress a report that describes 
the results of the study conducted under paragraph (1). 
"(f) PEER REVIEW.— 
"(1) IN GENERAL.—Each application for a grant or contract 
under this section shall be submitted to a peer review group for 
an evaluation of the merits of the proposals made in the applica-
tion. 
"(2) ESTABUSHMENT.—The Secretary shall establish such peer 
review groups as may be necessary to carry out paragraph (1). 
The Secretary shall make appointments to the peer review 
groups from among appropriately qualified persons who are not 
officers or employees of the United States. 
"(3) REPORT OF FINDINGS.—With respect to applications re-
ferred to in paragraph (1), a peer review group established 
pursuant to such subparagraph shall report its findings and 
recommendations to the Secretary. The Secretary may not ap-
prove such an application unless a peer review group has 
recommended the application for approval. 
"(4) ADMINISTRATION.—This paragraph shall be carried out by 
the Secretary, acting through the Director of the Indian Health 
Service. 
"(g) DEFINITION.—For the purposes of this section, the term 'rural 
area includes a frontier area, which is an area in which the 
population density is less than 7 individuals per square mile, 
(h) AUTHORIZATION OF APPROPRIATIONS.— 
"(1) IN GENERAL.—There is authorized to be appropriated to 
carry out this section, other than subsection (e), $5,000,000 for 
each of the fiscal years 1989,1990, and 1991. 
"(2) SUBSECTION (e).—There is authorized to be appropriated 
$1,000,000 for each of the fiscal years 1989, 1990, and 1991 to 
carry out subsection (e).". 
(b) REPEAL.—Section 714 of the Indian Hesdth Care Amendments 
of 1988 is repealed upon the date of the enactment of this Act. 42 use 295j. 
SEC. 638. ADVANCEMENT OF HEALTH CARE SERVICES. 
(a) IN GENERAL.—Of the amounts appropriated in each of the 
fiscal years 1989 through 1991 to carry out title Vll of the Public 
Health Service Act, the Secretary of Health and Human Services 
102 STAT. 3152 
PUBLIC LAW 100-607—NOV. 4, 1988 
shall, for each such fiscal year, make available $500,000 for the 
purpose of advancing the health care services furnished by qualified 
hospitals. For purposes of this subsection, the term "qualified hos-
pital" means a hospital located in a rural county that— 
(1) is adjacent to three counties, one of which is a central 
county of a Metropolitan Statistical Area, and all of which are 
classified as urban; 
(2) has a workforce of which at least 12.2 percent of such 
workers commute from the rural county to the central counties 
of the two immediately adjacent Metropolitan Statistical Areas 
(out-commuting), and the total in-commuting rate from the two 
immediately adjacent Metropolitan Statistical Areas to the 
rural county is at least 6.1 percent, so that when added to the 
out-commuting rate from the rural county the total in/out-
commuting rate is at least 18 percent; 
(3) is also impacted by a third Metropolitan Statistical Area 
with an out-commuting rate from the rural county to that 
Metropolitan Statistical Area that is at least .15 percent and the 
in-commuting rate from the Metropolitan Statistical Area to 
such rural county is at least .15 percent; 
(4) has more than 73,500 residents but less than 74,000 resi-
dents according to the 1980 census; and 
(5) that has a health-related labor pool that is competitively 
impacted by, in addition to the normal competitive pressures of 
an urban labor market, the location in one of the adjacent 
Metropolitan Statistical Areas of at least three large health-
related facilities, each with more than 375 beds, including a 
State-owned medical school/hospital complex with more than 
4,000 employees, and a large Veterans' Administration hospital 
with more than 400 beds. 
(b) PRO RATA DETERMINATION.—In making available amounts for 
a fiscal year for purposes of subsection (a), the Secretary of Health 
and Human Services may not reduce the amounts available for each 
program authorized under title VII of the Public Health Service Act 
by more than the amount equal to the product o
f
— 
(1) the amounts appropriated, £ifter the date of the enactment 
of this Act, for carr3dng out the program involved for the fiscal 
year; and 
(2) a percentage equal to the quotient of— 
(A) $500,000; divided by 
(B) the amounts appropriated, after the date of the enact-
ment of this Act, for carrying out such title VII. 
42 use 292h 
SEC. 639. ASSESSMENTS OF HEALTH MANPOWER SHORTAGES. 
qtate 
d 1 1 
^^^ REQUEST FOR INFORMATION.—Not later than 18 months after 
govermnente.^ 
the date of enactment of this Act, the Secretary of Health and 
Territories, U.S. 
Human Services shall contact the chief executive officer of each 
State, the Mayor of the District of Columbia, and the chief executive 
officer of the Virgin Islands, the Commonwealth of Puerto Rico, 
Guam, American Samoa, the Commonwealth of the Northern Mari-
ana Islands, and the Trust Territory of the Pacific Islands, and 
request that each such individual submit to the Secretary an assess-
ment of the greatest health manpower shortages by discipline of 
health care providers and by allopathic and osteopathic speciality, of 
such individuals State, District, Commonwealth, or Territory. 
(b) REPORT.—The Secretary of Health and Human Services shall 
compile and analyze the information obtained under subsection (a) 
PUBLIC LAW 100-607—NOV. 4, 1988 
102 STAT. 3153 
and prepare and submit, to the appropriate Committees of Congress, 
as part of the October 1,1991, report required under section 708(dXl) 
of the Public Health Service Act (42 U.S.C. 292h(dXl)), a report 
comtaining such information and analysis. 
TITLE VII—NURSING SHORTAGE REDUC-
TION AND EDUCATION EXTENSION ACT 
OF 1988 
SEC. 700. SHORT TITLE. 
(a) SHORT TITLE.—This title may be cited as the "Nursing Shortage 
Reduction and Education Extension Act of 1988". 
(b) REFERENCE.—Except as otherwise expressly provided, when-
ever in this title an amendment or repeal is expressed in terms of an 
£imendment to, or repeal of, a section or other provision, the ref-
erence shall be considered to be made to a section or other provision 
of the Public Health Service Act. 
Subtitle A—Special Projects 
Nursing 
Shortage 
Reduction and 
Education 
Extension Act 
of 1988. 
42 use 201. 
SEC. 701. SPECIAL PROJECT GRANTS AND CONTRACTS. 
(a) TRANSFER OF PROGRAM FOR INDIVIDUALS FROM DISADVANTAGED 
BACKGROUNDS.—Part A of title VIII (42 U.S.C. 296k et seq.) is 
amended— 
(1) by inserting after the heading for such part the following 
new heading: 
"Subpart I—Special Projects in General", 
(2) by striking section 820(aXl), and 
(3) by adding at the end the following new subpart: 
"Subpart II—Nursing Education Opportunities for Individuals 
From Disadvantaged Backgrounds 
"SPECIAL PROJECTS 
"SEC. 827. (a) The Secretary may make grants to -public and 
nonprofit private schools of nursing and other public or nonprofit 
private entities, and enter into contracts with any public or private 
entity, to meet the costs of sp|ecial projects to increase nursing 
education opportunities for individuals from disadvantaged back-
grounds, as determined in accordance with criteria prescribed by the 
Secretary— 
"(1) by identifying, recruiting, and selecting such individuals, 
"(2) by facilitating the entry of such individuals into schools of 
nursing, 
"(3) by providing counseling or other services designed to 
assist such individuals to complete successfully their nursing 
education, 
"(4) by providing, for a period prior to the entry of sucn 
individuals into the regular course of education at a school of 
nursing, preliminary education designed to sissist them to com-
plete successfully such regular course of education, 
42 use 296k. 
Schools and 
colleges. 
42 use 296r. 
102 STAT. 3154 
PUBLIC LAW 100-607—NOV. 4, 1988 
"(5) by pa)ring such stipends (including allowances for travel 
and dependents) as the Secretary may determine for such 
individuals for any period of nursing education, 
"(6) by publicizing, especially to licensed vocational or prac-
tical nurses, existing sources of financial aid available to per-
sons enrolled in schools of nursing or who are undertaking 
training necessary to qualify them to enroll in such schools, and 
"(7) by providing training, information, or advice to the fac-
ulty of such schools with respect to encouraging such individ-
uals to complete the programs of nursing education in which 
the individuals are enrolled. 
"(b) No grant or contract may be made under this section unless 
an application therefor has been submitted to and approved by the 
Secretary. The Secretary may not approve or disapprove such an 
application except after consultation with the National Advisory 
Reports. 
Council on Nurse Education. Such an application shall provide for 
Records. 
g^^jj fig^al control and accounting procedures and reports, and 
access to the records of the applicant, as the Secretary may require 
to assure proper disbursement of and accounting for Federal funds 
paid to the applicant under this section. 
"(c) For payments under grants and contracts under subsection 
(a), there are authorized to be appropriated $3,000,000 for fiscal year 
1989, $4,000,000 for fiscal year 1990, and $5,000,000 for fiscal year 
1991.". 
(b) STRIKING OF CERTAIN PROGRAMS.—Section 820(a) (42 U.S.C. 
296k(a)) is amended— 
(1) by striking paragraphs (3), (7), and (9), and 
(2) by redesignating paragraphs (2), (4), (5), (6), and (8) as 
paragraphs (1) through (5), respectively. 
(c) GERIATRIC TRAINING.—Section 820(aX2) (as redesignated by 
subsection (bX2) of this section) is amended to read as follows— 
"(2) demonstrate, through geriatric health education centers 
and other entities, improved geriatric training in preventive 
care, acute care, and long-term care (including home health 
care and institutional care);". 
(d) UPGRADING SKILLS.—Section 820(a) (42 U.S.C. 296k(a)) is 
amended— 
(1) by amending paragraph (3) (as redesignated by subsection 
0))(2) of this section) to read as follows: 
Rural areas. 
"(3XA) increase the supply of adequately trained nursing 
personnel (including bilingual nursing personnel) to meet the 
health needs of rural areas; and 
"(B) provide nursing education courses to rural areas through 
telecommunications via satellite;", and 
(2) by amending paragraph (4) (as so redesignated) to read as 
follows: 
"(4) provide training and education— 
(A) to upgrade the skills of licensed vocational or prac-
tical nurses, nursing assistants, and other paraprofessional 
nursing personnel with priority given to rapid transition 
programs toward achievement of professional nursing 
d^rees; and 
(B) to develop curricula for the achievement of bacca-
laureate degrees in nursing by registered nurses and bv 
individuals with baccalaureate degrees in other 
fields;'. 
(e) COORDINATION PROJECTS WITH RESPECT TO LOAN REPAYMENTS 
FOR SERVICE IN HEALTH FACILITIES.-Section 820(a) (42 U.S.C. 
PUBLIC LAW 100-607—NOV. 4, 1988 
102 STAT. 3155 
296k(a)) is amended by adding after paragraph (5) (as redesignated 
by subsection (bK2) of this section) the followii^ new paragraph: 
"(6XA) collect the names and addresses of health facilities 
willing to enter into agreements with nursing students and 
nursing personnel under which such individuals agree to serve 
as nurses in the health facilities in consideration of the health 
facilities agreeing to repay the principal and interest of tiie 
educational loans of such individuals; 
"(B) collect data on the specific terms of such agreements 
offered by health facilities; 
"(C) collect the names and addresses of nursing students 
identified pursuant to section 827(a), of other nursing students, 
and of nursing personnel, willing to enter into such agreements; 
and 
"(D) coordinate and facilitate communications between health 
facilities and such individuals with respect to such agree-
ments.". 
(f) GERIATRIC HEALTH EDUCATION CENTERS.—Section 820 (42 U.S.C. 
296k) is amended— 
(1) by redesignating subsections (b) through (d) as subsections 
(e) through (g), respectively, and 
(2) by adding after subsection (a) the following new subsection: 
"(bXl) The Secretary may make grants to, and enter into contracts 
with, accredited schools of nursing to assist in meeting the costs of 
such schools in providing projects— 
"(A) to improve the training of nurses in geriatrics; 
"(B) to develop and disseminate curricula relating to the 
treatment of the health problems of elderly individuals; 
"(C) to expand and strengthen instruction in methods of such 
treatment; 
"(D) to support the training and retraining of faculty to 
provide such instruction; 
"(E) to support continuing education of nurses who provide 
such treatment; and 
"(F) to establish new affiliations vdth nursing homes, chronic 
and acute disease hospitals, ambulatory care centers, and senior 
centers in order to provide students with clinical training in 
geriatric health care. 
"(2XA) Any application for a grant or contract under this subsec-
tion shall be subject to appropriate peer review by peer review 
groups composed principally of non-Federal experts. 
"(B) The Secretary may not approve or disapprove an application 
for a grant or contract under this subsection unless the Secretary 
has received recommendations with respect to such application from 
the appropriate peer review group required under paragraph (1) and 
has considted with the Advisory Council on Nurses Education with 
respect to such application. 
(C) For the purpose of carrying out this subsection, the Secretary 
may obligate each fiscal year not more than $2,000,000 of the 
amounts made available for such purpose pursuant to subsection 
(gX2).". 
(g) INNOVATIVE HOSPITAL NURSING PRACTICE MODELS.—Section 820 
(42 U.S.C. 296k), as amended by subsection (D of this section, is 
further amended by inserting after subsection (b) the following new 
subsection: 
"(cXD The Secretary may make grants to public and nonprofit 
private entities for the purpose of demonstrating innovative hospital 
102 STAT. 3156 
PUBLIC LAW 100-607—NOV. 4, 1988 
nursing practice models designed to reduce vacancies in professional 
nursing positions and to make such positions a more attractive 
career choice. 
"(2) The Secretary may not make a grant under paragraph (1) 
unless the applicant for the grant agrees that hospital nursing 
practice models demonstrated pursuant to such subsection will in-
clude initiatives— 
"(A) to restructure the role of the professional nurse, through 
changes in the composition of hospital staffs and through 
innovative approaches for interaction between hospital adminis-
tration and nursing personnel, in order to ensure that the 
particular expertise of such nurses is efficiently utilized and 
that such nurses are engaged in direct patient care during a 
larger proportion of their work time; 
"(B) to test innovative wage structures for professional nurses 
in order to— 
"(i) reduce vacancies in work shifts during impopular 
work hours; and 
"(ii) provide financial recognition based upon experience 
and education; and 
"(C) to evaluate the effectiveness of providing benefits for 
professional nurses, such as pensions, sabbaticals, and payment 
of educational expenses, as a means of developing increased 
loyalty of such nurses to health care institutions and reducing 
turnover in nursing positions.", 
(h) LONG-TERM CARE NURSING PRACTICE DEMONSTRATIONS.—Sec-
tion 820 (42 U.S.C. 296k), as amended by subsection (g) of this 
section, is further amended by inserting after subsection (c) the 
following new subsection: 
"(dXl) The Secretary may make grants to public and nonprofit 
private entities accredited for the training of nurses for the purpose 
of— 
"(A) demonstrating innovative nursing practice models for— 
"(i) the provision of case-managed health care services 
(including adult day care) and health care services in the 
home; or 
"(ii) the provision of health care services in long-term 
care facilities; or 
"(B) developing projects to increase the exposure of nursing 
students to clinical practice in nursing home, home health, and 
gerontologic settings through collaboration between such 
accredited entities and entities that provide health care in such 
settings. 
"(2) The Secretary may not make a grant under paragraph (1) 
unless the applicant for the grant agrees that models demonstrated 
pursuant to such paragraph will be designed— 
"(A) to increase the recruitment and retention of nurses to 
provide nursing care for individuals needing long-term care; 
and 
"(B) to improve nursing care in home health care settings and 
nursing homes.", 
(i) AUTHORIZATION OF APPROPRIATIONS.—Section 820(g) (as redesig-
nated by subsection (bX2) of this section) is amended to read as 
follows: 
"(gXD For payments under grants and contracts under this sec-
tion, there are authorized to be appropriated $13,000,000 for fiscal 
PUBLIC LAW 100-607—NOV. 4, 1988 
102 STAT. 3157 
year 1989, $16,000,000 for fiscal year 1990, and $20,000,000 for fiscal 
year 1991. 
"(2) Of the amounts appropriated pursuant to paragraph (1), the 
Secretary shall obligate not less than 20 percent to carry out 
subsection (aX2) and subsection 0
1
>
) (subject to subsection (bX2XC)), 
not less than 20 percent to carry out paragraph (3) of subsection (a), 
and not less than 10 percent to carry out paragraph (4) of such 
subsection. Of the amounts appropriated pursuant to paragraph (1) 
for fiscal year 1989, the Secretary shall obligate not less than 20 
percent to carry out section 827.". 
SEC 702. ADVANCED NURSE EDUCATION. 
Section 821(b) (42 U.S.C. 29610))) is amended to read as follows: 
"Q)) For payments under grants and contracts under this section, Appropriation 
there are authorized to be appropriated $13,000,000 for fiscal year authorization. 
1989, $13,000,000 for fiscal year 1990, and $20,000,000 for fiscal year 
1991.". 
SEC 703. NURSE PRACTITIONER AND NURSE MIDWIFE PROGRAMS. 
(a) REQUIRED NUMBER OF STUDENTS IN TRAINING PROGRAMS.— 
Section 822(aX2XBKii) (42 U.S.C. 296m(aX2XBXii)) is amended by 
striking ''not less than eight students" and inserting "not less than 
six fiill-time equivalent students". 
db) C
O
B
O
O
T
M
E
N
T UNDER TRAINEESHIP P
R
O
G
R
A
M T
O SERVE IN CER-
TAIN AREAS OR FAcnjnES.—Section 822a)X3) (42 U.S.C. 296m(bX3)) is 
amended bv striking ''332)" and all that follows and inserting the 
following: 332), in an Indian Health Service health center, in a 
Native Hawaiian health center, in a public health care facility, in a 
migrant health center (as defined in section 329(aXl)), in a rural 
hesdth clinic (as defined in section 1861(aaX2) of the Social Securitv 
Act), or in a community health center (as defined in section 330(a)) . 
(c) ASSURANCES OF OQMPLIANCE WITH GUIDELINES.—Section 822(c) 
(42 U.S.C. 296m(c)) is amended— 
(1) by inserting "under subsection (a) or (b)" after "operate a 
program"; and 
(2) by striking "midwives unless this application" and insert-
ing "midwives miless the application". 
(d) AUTHORIZATION OF APPROPRIATIONS.—Section 822(d) (42 U.S.C. 
296m(d)) is amended to read as follows: 
"(d) For payments under grants and contracts under subsections 
(a) and 0>), there are authorized to be appropriated $12,000,0(K) for 
fiscal year 1989, $17,000,000 for fiscal year 1990, and $21,000,000 for 
fiscal year 1991.". 
SEC 704. ENHANCEMENT OF QUALITY CARE. 
(a) IN GENERAL.—Of the amounts appropriated for each of the 
fiscal years 1989 through 1991 to carry out titles Vn and VIII of the 
Public Health Service Act, the Secretary of Health and Human 
Services shall, for each of such fiscal years, make available $650,000 
for the purpose of enhancing the ability of a qualified hospital to 
provide high-quality inpatient services. For purposes of this subsec-
tion, the term "qualified hospital" means a hospital that, as of the 
date of the enactment of this Act, is the only general short-term 
acute care hospital located in a rural county that is adjacent to 7 
counties, of which 1 such a^acent county is a county described in 
paragraph (8)(B) of section 1886(d) of the Act referred to in section 
3710>X1XC) of the Public Health Service Act and, of the remaining 6 
102 STAT. 3158 
PUBLIC LAW 100-607—NOV. 4, 1988 
such adjacent counties, 5 such counties are (or are treated as) urban 
counties for purposes of such section 1886(d) and 1 such county is not 
(or is not treated as) an urban county for purposes of such section, 
(b) PRO RATA DETERMINATION.—In making available amounts for 
a fiscal year for purposes of subsection (a), the Secretary of Health 
and Human Services may not reduce the gmiounts available for each 
program of titles VII and VIII of the Public Health Service Act by 
more than an amount equal to the product of— 
(1) the amounts appropriated, after the date of the enactment 
of this Act, for carrjdng out the program involved for the fiscal 
year; and 
(2) a percentage equal to the quotient of— 
(A) $650,000; divided by 
(B) the amounts appropriated, after the date of the enact-
ment of this Act, for carrjdng out such titles VII and VIII. 
SEC. 705. IMPROVING HEALTH CARE SERVICES. 
(a) IN GENERAL.—Of the amounts appropriated for each of the 
fiscal years 1989 through 1991 to carry out titles VII and VIII of the 
Public Health Service Act, the Secretary of Health and Human 
Services shall, for each of such fiscal years, make available $210,000 
for the purpose of improving the health care services furnished by a 
qualified hospital. For purposes of this subsection, the term "quali-
fied hospital means a hospital located in a rural county— 
(1) that is adjacent to 6 counties, of which 3 adjacent counties 
are urban (2 of the urban counties being located in another 
State), and of which 2 of the adjacent rural counties are without 
hospital facilities, 
(2) that is located within 7 miles of another urb£in county in a 
separate Metropolitan Statistical Area from the Metropolitan 
Statistical Area in which the urban counties adjacent to the 
rural counties are located, 
(3) that has more than 17,500 residents but less than 17,550 
residents according to the 1980 census, 
(4) that has a workforce of which more than 39.5 percent of 
those reporting workplace commute to the adjacent urban coun-
ties to the 1980 census, and 
(5) that has a health-related labor pool which is competitively 
impacted by, in addition to the normal competitive pressures of 
an urban labor market, the location in 1 of the adjacent urban 
counties (in another State) of several large health-related facili-
ties, including that State's sole State-owned medical school/ 
hospital complex with more than 5,500 employees, a large Vet-
erans' Administration hospital with more than 1,000 beds, and a 
United States Army hospital with more than 350 beds. 
Ot)) PRO RATA DETERMINATION.—In making available amounts for 
a fiscal year for purposes of subsection (a), the Secretary of Health 
and Human Services may not reduce the amounts available for each 
program of titles VII and VIII of the Public Health Service Act by 
more than an amount equal to the product of— 
(1) the amounts appropriated, after the date of the enactment 
of this Act, for carrying out the program involved for the fiscal 
year; and 
(2) a percentage equal to the quotient of— 
(A) $210,000; divided by 
(B) the amounts appropriated, after the date of the enact-
ment of this Act, for canying out such titles VII and VIII. 
PUBLIC LAW 100-607—NOV. 4, 1988 
102 STAT. 3159 
SEC 706. INCENTIVE SPECIAL PAY FOR PUBLIC HEALTH SERVICE Uniformed 
NURSES. 
services. 
Subsection (a.) of section 208 (42 U.S.C. 210(a)) is amended by 
adding at the end the following new paragraph: 
"(3) Commissioned nurse of^cers in the Regular and Reserve 
Corps shall, while in active duty, be paid incentive special pay in the 
same amounts as, and under the same terms and conditions which 
apply to, the incentive special pay now or hereafter paid to commis-
sioned nurse ofKcers of the Armed Forces under chapter 5 of title 37, 
United States Code.". 
SEC. 707. 
EXTENSION 
OF 
PERIOD 
FOR 
INSURANCE 
OF 
NEW 
LOANS. 
Section 728(a) (42 U.S.C. 294a(a)) is amended— 
(1) by inserting before the period at the end of the second 
sentence the following: ", and if in any fiscal year no ceiling has 
been established, any difference carried over shall constitute 
the ceiling for making new loans (including loans to new 
borrowers) and paying installments for such fiscal year."; and 
(2) in the third sentence by striking "1991," and inserting 
"1994,". 
Subtitle B—Assistance to Nursing Students 
SEC 71L TRAINEESHIPS FOR ADVANCED EDUCATION OF PROFESSIONAL 
NURSES. 
(a) TRAINEESHIFS FOR CERTAIN PART-TIME STUDENTS IN ADVANCED 
NURSING PROGRASiS.—Section 830 (42 U.S.C. 297) is amended by 
redesignating subsection (c) as subsection (d) and inserting after 
subsection (b) the following new subsection: 
"(cXD The Secretary may make grants to public and nonprofit 
private schools of nursing to cover the costs of traineeships for 
students— 
"(A) who are enrolled at least half-time in programs offering a 
masters d^n^'ee in nursing; and 
"(B) who agree to complete the requirements for degrees from 
such pn^ams not later than the end of the academic year 
during which the student is to receive the traineeship. 
"(2) In making grants under paragraph (1), the Secretary shall 
give special consideration to appUcations for traineeship programs 
that educate nursing students to serve in and prepare for practice as 
nurse practitioners, clinical specialists, or nurse midwives.". 
(b) 
AUTHORIZATION OP APPROPRIATIONS FOR TRAINEESHIP PRO-
GRAMS.—Section 830 (42 U.S.C. 297) is amended by amending subsec-
tion (d) (as redesignated by subsection (a) of this section) to read as 
follows: 
"(dXlXA) For the purposes of subsections (a) and (c), there are 
authorized to be appropriated $13,000,000 for fiscal year 1989, 
$15,000,000 for fiscal year 1990, and $16,000,000 for fiscal year 1991. 
"(B) Of the amounts made available pursuant to subparagraph 
(A), the Secretary shall make available not less than 25 percent to 
carry out subsection (c). 
"(2) For the purposes of subsection (b), there is authorized to be 
appropriated $1,100,000 for each of the fiscal years 1989 through 
1991.". 
Grants. 
Schools and 
colleges. 
102 STAT. 3160 
PUBLIC LAW 100-607—NOV. 4, 1988 
SEC. 712. NURSE ANESTHETISTS. 
(a) TRAINEESHIPS AND OTHER PROGRAMS.— 
(1) Section 831(aXl) (42 U.S.C. 297-l(aXl)) is amended to read 
as follows: 
Grants. 
"(1) The Secretary may make grants to public or private nonprofit 
institutions to cover the costs of traineeships for licensed registered 
nurses to become nurse anesthetists and to cover the costs of 
projects to develop and operate programs for the education of nurse 
Regulations. 
anesthetists. In order to be eligible for such a grant, the program of 
an institution must be accredited by an entity or entities designated 
by the Secretary of Education and must meet such requirements as 
the Secretary shaU by r^ulation prescribe.". 
(2) Section 831(aX2) (42 U.S.C. 297-l(aX2)) is amended by 
amending ^ e second sentence to read as follows: "Payments for 
traineeships shall be limited to such amounts as the Secretary 
determines to be necessary to cover the costs of tuition and fees 
and a stipend and allowances (including travel and subsistence 
expenses) for trainees.". 
(b) AUTHORIZATION OP APPROPRIATIONS,—^The first sentence of sec-
tion 831(c) (42 UJS.C. 297-l(c)) is amended to read as foUows: "For 
the purpose of making grants under this section, there is authorized 
to be appropriated $1,800,000 for each of the fiscal years 1989 
through 1991.". 
SEC 713. LOAN PROVISIONS. 
(a) 
RULE 
OP 
CONSTRUCTION 
WITH 
RESPECT 
TO 
CERTAIN 
UNOOLLBCTABLE LOANS.—Section 835(cXl) (42 U.S.C. 297a(cXl)) is 
amended by adding at the end the following new sentence: "With 
respect to the student loan fiind established pursuant to such agree-
ments, this subsection may not be construed to require such schools 
to reimburse such loan fund for loans that became uncollectable 
prior to 1983.". 
(b) INCREASES WITH RESPECT TO ANNUAL AND AGGREGATE LOAN 
TOTALS.—Section 836(a) (42 U.S.C. 297b(a)) is amended— 
(1) in the first sentence, by inserting before the period the 
following: ", except that for the final two academic years of the 
program involved, such total may not exceed $4,000"; and 
(2) in the second sentence, by striking "$10,0()0" and inserting 
"$13,000". 
(c) PREPERENCE CATEGORY OP EXCEPTIONAL FINANCIAL NEED.— 
Section 836(a) (42 U.S.C. 297b(a)) is amended in the third sentence by 
striking "practical nurses and" and inserting "practical nurses, to 
persons with exceptional financial need, and". 
(d) 
REDUCTION OP EUGIBILITY STANDARD OP NEED.—Section 
836a)XlXC) (42 U.S.C. 297ba)XlXC)) is amended to read as follows: 
"(Q with respect to any student enrolling in the school after June 
30,1986, is of financial need (as defined in regulations issued by the 
Secretary).". 
(e) DEPERRAL PERIOD POR HALP-TIME PROFESSIONAL TRAINING.— 
Section 836(bX2XB) (42 U.S.C. 297b(bX2XB)) is amended— 
(1) bv striking "(up to five years)" and inserting "(up to ten 
yearsy, and 
(2) by inserting after "fiill-time" the following: "or half-time". 
(f) REDUCTION IN INTEREST RATE.—Section 836(bX5) (42 U.S.C. 
297b(bX5)) is amended by striking "6 per centum" and inserting "5 
percent". 
PUBLIC LAW 100-607—NOV. 4, 1988 
102 STAT. 3161 
(g) STRIKING OF LOW-INCOME PROVISIONS WITH RESPECT TO LOAN 
REPAYMENT.—Section 836(j) (42 U.S.C. 297bO')) is amended by adding 
"and" at the end of parsigraph (2), by striking paragraph (3), and by 
redesignating paragraph (4) as paragraph (3). 
(h) USE OF CERTAIN UNEXPENDED FUNDS FOR ALLOTMENTS.— 
(1) Section 838(aX3) (42 U.S.C. 297d(aX3)) is amended— 
(A) by inserting "(A)" after the paragraph designation; 
and 
(B) by adding at the end the following new subparagraph: 
"(B) With respect to funds available pursuant to subparagraph 
(A), any such funds returned to the Secretary and not allotted by the 
Secretary, during the period of availability specified in such 
subparagraph, shall be available to carry out section 843 and, for 
such purpose, shall remain available until expended.". 
(2) Except as provided in Public Law 100-436, the amendment Effective date. 
made by paragraph (1) shall take effect as if such amendment 42 use 297d 
had been effective on September 30, 1988, and as if section 843 ^°^-
of the Public Health Service Act, as added by section 715 of this 
title, had been effective on such date. 
(i) EXTENSION OF DATE CERTAIN FOR CAPITAL DISTRIBUTION.—Sec-
tion 839 (42 U.S.C. 297e) is amended— 
(1) in subsection (a)— 
(A) in the matter preceding paragraph (1), by striking 
"1991" and inserting "1994"; and 
(B) in paragraph (1), by striking "1991" and inserting 
"1994"; and 
(2) in subsection (b), by striking "1991" each place it appears 
and inserting "1994". 
SEC. 714. LOAN REPAYMENTS FOR SERVICE IN CERTAIN HEALTH FACILI-
TIES. 
(a) AGREEMENTS FOR LOAN REPAYMENTS.—Section 836(h)(1)(C) (42 
U.S.C. 297b(hXlXC)) is amended to read as follows: 
"(C) who enters into an agreement with the Secretary to serve 
as nurse for a period of not less than two years in an Indian 
Health Service health center, in a Native Hawaiian health 
center, in a public hospital, in a migrant health center, in a 
community health center, in a nursing facility, in a rural health 
clinic, or in a health facility determined by the Secretary to 
have a critical shortage of nurses;". 
Ob) PRIORITIES WITH RESPECT TO AGREEMENTS.—Section 836(h) (42 
U.S.C. 297b(h)) is amended by adding at the end the following new 
paragraph: 
"(5) In entering into agreements under paragraph (1), the Sec-
retary shall give priority— 
"(A) to applicants with the greatest financial need; and 
"(B) to applicants that, with respect to health facilities de-
scribed in such paragraph, agree to serve in such health facili-
ties located in geographic areas with a shortage of and need for 
nurses, as determined by the Secretary.", 
(c) DEFINITIONS.—Section 836(h) (42 U.S.C. 297b(h)), as amended by 
subsection (b) of this section, is further amended by adding at the 
end the following new paragraph: 
"(6) For purposes of this subsection: 
"(A) The term 'community health center' has the meaning 
given such term in section 330(a). 
102 STAT. 3162 
PUBLIC LAW 100-607—NOV. 4, 1988 
42 use 2970-1. 
Grants. 
42 use 297j. 
"(B) The term 'migrant health center' has the meaning given 
such term in section 329(aXl)-
"(C) The term 'nursing facility' has the meaning given such 
term in section 1919(a) of the Social Security Act (as such 
section is in effect during fiscal year 1991 and subsequent Hscal 
years), except that for fiscal years 1989 and 1990, such term 
means an intermediate care facility and a skilled nursing facil-
ity, as such terms are defined in subsections (c) and (i), respec-
tively, of section 1905 of the Social Security Act. 
"(D) The term 'rural health clinic' has the meaning given 
such term in section 1861(aaX2) of the Social Security Act.". 
(d) AUTHORIZATION OP APPROPRIATIONS FOR LOAN REPAYMENTS.— 
Subpart II of part B of title VIII (42 U.S.C. 297a et seq.) is amended 
by inserting after section 837 the following new section: 
"AUTHORIZATION OF APPROPRIATIONS FOR LOAN REPAYMENTS FOR 
SERVICE IN CERTAIN HEALTH FACILITIES 
"SEC. 837A. For the purpose of pa5rments under agreements en-
tered into under section 836(h), there is authorized to be appro-
priated $5,000,000 for each of the fiscal years 1989 through 1991.". 
SEC. 715. NURSING SCHOLARSHIPS. 
Part B of title VIII (42 U.S.C. 297 et seq.) is amended by adding at 
the end the following new subpart: 
"Subpart III—Scholarships 
"UNDERGRADUATE EDUCATION OF PROFESSIONAL NURSES 
"SEC. 843. (a) The Secretary may make grants to public and 
nonprofit private schools accredited for the training of professional 
nurses for the purpose of providing scholarships to individuals who 
are enrolled (or accepted for enrollment) as nursing students of such 
schools and who are in financial need with respect to attending such 
schools. 
"(b) The Secretary may not make a grant under subsection (a) 
unless the applicant for the grant agrees that, in providing scholar-
ships pursugmt to the grant, the applicant will give preference to 
individuals from disadvantaged backgrounds (as determined in 
accordance with criteria prescribed by the Secretary under section 
844(a)). 
"(c) The Secretary may not make a grant under subsection (a) 
unless the applicant for the grant agrees that, in providing scholar-
ships pursuant to the grant, the applicant will provide a scholarship 
to an individual only if the individual agrees that, upon graduating 
from the program of nursing education offered by the applicant, the 
individual will serve as nurse for a period of not less than two years 
in an Indian Health Service health center, in a Native Hawaiian 
health center, in a public hospital, in a migrant health center, in a 
community health center, in a nursing facility, in a rural health 
clinic, or in a health facility determined by the Secretary to have a 
critical shortage of nurses. 
"(d) The Secretary may not make a grant under subsection (a) 
unless the applicant for the grant agrees that a scholarship provided 
pursuant to such subsection for attendance at a school described in 
such subsection may not, for any year of such attendance for which 
the scholarship is made, provide an amount exceeding an amount 
PUBLIC LAW 100-607—NOV. 4, 1988 
102 STAT. 3163 
equal to the amount of the tuition and any fees for the year 
involved. 
"(e) For purposes of this section: 
*\D The term 'community health center' has the meaning 
given such term in section 3^a). 
"(2) The term 'migrant health center' has the meaning given 
such term in section 329(aXl). 
"(3) The term 'nursing facility* has the meaning given such 
term in section 1919(a) of the Social Security Act (as such 
section is in effect during fiscal year 1991 and subsequent fiscal 
years), except that for fiscal years 1989 and 1990, such term 
means an intermediate care faciUty and a skilled nursing facil-
ity, as such terms are defined in subsections (c) and (i), respec-
trvelv, of section 1905 of the Social Security Act 
"(4) The term 'rural health clinic' has the meaning given such 
term in section 1861(aaX2) of the Social Security Act 
"(f) For the purpose of making grants under this section, there are 
authorized to be appropriated $15,000,000 for fiscal year 1989 and 
$30,000,000 for each of the fiscal years 1990 and 199L". 
SEC 716. ESTABUSHMENT OF DEMONSTRATION PROGRAM FOR STUDENT 
LOANS WITH RESPECT TO SERVICE IN CERTAIN HEALTH CARE 
FAOLrriES IN UNDERSERVED AREAS. 
Fart B of title Vm (42 U.S.C. 297 et seq.), as amended by section 
715 of this title, is further amended by adding at the end the 
following new subpart 
"Subpart IV—^Demonstration Program For Student Loans With Re-
spect to Service in Oertain Health Care Facilities in Underserved 
Appropriation 
authorization. 
"SEC 847. ESTABLISHMENT OF PROGRAM. 
"(a) IN GENERAL.—^The Secretary may, subject to subsections (c) 
and (d), make loans to individuals to assist the individuals in 
attending schools of nursing if the individuals enter into contracts 
with hemth facilities to engage, in consideration of the agreements 
made pursuant to subsection (d) (relating to loan repayments), in 
fiill-time employment as nurses fbr a period of time equal to not 
more than the period of time during which the individuals receive 
loan assistance under this section. 
"(b) p
R
E
F
E
B
E
N
C
E
S IN M
A
K
I
N
G LoANS.—^In making loans under 
subsection (a), the Secretaiy shall give preference to disadvantaged 
and minority individuals underrepresented in the nursing profes-
sion, as determined in aooordanoe with criteria established by the 
Secretaiy. 
"(c) OEBTAIN REQUIBEBISNTS WITH RESPECT TO STUDENTS.—The 
Secretary may not make a loan under sidbsection (a) unless— 
"(1) the applicant for the loan is enrolled (or accepted fbr 
enrollment) as a full-time student in a pubUc or nonprofit school 
accredited 
for 
the training of professional nurses; 
"(2) the applicant agrees to expend the loan only for the 
myment of the costs of tuition, reasonable living expenses, 
books, 
fees, 
and necessary transportation; and 
**&) the applicant agrees that, if the applicant is dismissed 
firom the school for academic reasons, voluntarily terminates 
academic training as a nurse, or violates the contract entered 
into pursuant to subsection (a)> the applicant will be liable to 
42 u s e 297. 
Contracts. 
Disadvantaged 
persons. 
Minorities. 
19-194 O—91—Part 4 
7 : QL 3 
102 STAT. 3164 
PUBLIC LAW 100-607—NOV. 4, 1988 
the United States in an amount equal to 100 percent of the 
principal and interest due on the login. 
"(d) CERTAIN REQUIREMENTS WITH RESPECT TO HEALTH CARE 
FACILITIES.—The Secretary may not make a loan under subsection 
(a) unless, with respect to contracts referred to in such subsection— 
"(1) the applicant for the loan has entered into such a con-
tract with a health care facility that is a nonprofit hospital or a 
long-term care facility certified under title XVIII or XIX of the 
Social Security Act; 
"(2) such health care facility is located in a geographic area 
that is underserved with respect to the services of nurses, as 
designated pursuant to subsection (e); 
"(3) the contract provides that the health care facility will 
repay 100 percent of the principal and interest of the loan made 
to the applicant under subsection (a); 
"(4) the contract provides that, in serving as a nurse at the 
health care facility, the pajrments made by the facility on behalf 
of the applicant in repayment of the loan will be in addition to 
the pay that the applicant would otherwise receive for such 
service; and 
"(5) the contract provides that, in the event the health care 
facility violates the contract, the facility will be liable to the 
United States in an amount equal to 100 percent of the prin-
cipal and interest due on such loan. 
Regulations. 
"(e) DESIGNATION OF UNDERSERVED GEOGRAPHIC AREAS.—For pur-
poses of subsection (dX2), the Secretary shall through regulation 
establish criteria for the designation of such areas. The Secretary 
may, as appropriate, designate geographic areas using criteria in 
section 330(bX4). 
"(f) MAXIMUM AMOUNT OF LOAN.—The Secretary may not provide 
a loan under subsection (a) in an amount exceeding 100 percent of 
the costs described in subsection (cX2). 
"(g) INTEREST.—Loans awarded under this section shall bear in-
terest on the unpaid balance of the loan at a rate of 5 percent per 
annum. Such interest shall accrue from the date the individual 
involved is no longer enrolled in the nursing program. 
Regulations. 
"(h) WAIVER O
R SUSPENSION OF STUDENT OBUGATIONS.—The Sec-
retary shall by regulation provide for the waiver or suspension of 
any obligation of any individual receiving a loan under subsection 
(a) whenever compliance by the individual is impossible or would 
involve extreme hardship to the individual. 
"(i) REQUIREMENT OF APPUCATION.—The Secretary may not make 
a loan under subsection (a) unless— 
"(1) an application for the loan is submitted to the Secretary; 
"(2) with respect to canying out the purpose for which the 
loan is to be made, the application provides assurances of 
compliance satisfactory to the Secretary; and 
"(3) the application otherwise is in such form, is made in such 
manner, and contains such agreements, assurances, and 
information as the Secretary determines to be necessary to 
carry out this section, 
"(j) SET-ASIDE WITH RESPECT TO RURAL AREAS.—Of the amounts 
appropriated for a fiscal year pursuant to subsection (1), the Sec-
retory shall make available not less than 35 percent for loans under 
subsection (a) to individuals who will, pursuant to such loan, serve 
as nurses in rural areas designated under subsection (e) as geo-
PUBLIC LAW 100-607—NOV. 4, 1988 
102 STAT. 3165 
graphic areas that are underserved with respect to the services of 
nurses. 
"(k) AUTHORIZATION OF APPROPRIATIONS.—For the 
purpose 
of 
making loans under subsection (a), there is authorized to be appro-
priated $5,000,000 for the fiscal years 1989 through 1991. 
"(1) SUNSET.—The authority to make loans under subsection (a) 
terminates September 30,1991.". 
Subtitle C—General Provisions of Title VIII 
SEC. 721. NATIONAL ADVISORY COUNCIL ON NURSE TRAINING. 
(a) IN GENERAL.—Section 851 (42 U.S.C. 298) is amended— 
(1) in the section heading, by striking "NATIONAL ADVISORY 
COUNCIL ON NURSE TRAINING*' and inserting in lieu thereof 
"ADVISORY COUNCIL ON NURSES EDUCATION"; and 
(2) in subsection (a)— 
(A) in the first sentence— 
(i) by striking "National Advisory Council on Nurse 
Training" and inserting in lieu thereof "Advisory 
Ck)uncil on Nurses Education"; and 
(ii) by striking "nineteen" and inserting "twenty-
one"; and 
(B) in the second sentence, by striking "general public" 
and inserting the following: "general public, one of the 
appointed members shall be selected from practicing profes-
sional nurses, one of the appointed members shall be 
selected from among representatives of associate degree 
schools of nursing,". 
flj) CONFORMING AMENDMENTS.— 
(1) Section 820 (42 U.S.C. 296k) is amended— 
(A) in subsection (e) (as redesignated by section 7010t))(2)). 
by striking "National Advisory Council on Nurse Training 
and inserting "Advisory Council on Nurses Education"; and 
(B) in sut^ection (f) (as so redesignated), in the second 
sentence, by striking "National Advisory Council on Nurse 
Training" and inserting "Advisory Council on Nurses Edu-
cation". 
(2) Section 856(1) (42 U.S.C. 298b-3(l)) is amended by striking 
"National Advisory Council on Nurse Training" and inserting 
"Advisory Council on Nurses Education". 
SEC. 722. EVALUATIONS AND REPORTS. 
Part C of title VHI (42 U.S.C. 298 et seq.) is amended by adding at 
the end the following new section: 
"EVALUATIONS 
"SEC. 859. (a) The Secretary shall, directly or through contracts 
42 use 298b-6. 
with public and private entities, provide for evaluations of projects 
Contracts. 
carried out pursuant to this title and for the dissemination of 
information developed as result of such projects. Such evaluations 
shall include an evaluation of the effectiveness of such projects in 
increasing the recruitment and retention of nurses. 
"OiXD The Secretary shall, not later than January 10, 1989, 
submit to the Committee on Energy and (Commerce of the House of 
Representatives, and to the Committee on Labor and Human 
102 STAT. 3166 
PUBLIC LAW 100-607—NOV. 4, 1988 
Besouroes of the Senate, a report describing the manner in which 
the Secreta^ intends to cany out subsection (a). 
*W The Secretaiy shall, not later than January 10, 1991, and 
biannnally thereafter, submit to the Committee on Energy and 
Gnnineroe Oi the House of Representatives, and to the Committee 
on Labor and Human Resources of the Senate, a report summarizing 
evaluations carried out pursuant to subsection (a) during the preced-
ing two 
fiscal 
years. 
^c) Of the amounts appropriated each fiscal jrear to carry out this 
titl^ the Secretaiy shall make available one percent to carry out 
this section.". 
Subtitie D—^Waiyer of Liability for Certain 
Sale of Facility Under Program of Construc-
tion and Modernization of Medical Facilities 
SECL 731. ESTABLISHMENT OF WAIVER AUTHORITT. 
(s^ IN GENERAL..—^If, pursuant to subsection (b) of section 732, the 
Secretaiy of Health and Human Services makes a certification of 
oompUa^Te with the conditions described in subsection (a) of such 
section, section 609 of the PubUc Health Service Act (42 U.S.a 291i) 
shall not, with respect to the transferor and transferee described in 
subsection (b), apply to the sale on November 26, 1986, of the 
medical £adli<y— 
Utah. 
(1) located in Blanding, in the State of Utah; 
(2) known, prior to such date, as San Juan County Nursing 
Hom^ and 
(3) with respect to which funds were received during the years 
1967 through 1970 pursuant to title VI of the PubUc Health 
Service Act (42 US.C. 291 et seq.). 
(b) DESCRIPTION OF PASTIES TO SALE.—^In the sale described in 
subsection (a), the transferor is San Juan County, a poUtical subdivi-
sion of the State of Utah, and the transferee is Auburn Manor 
Holding Corporation, a corporation under the laws of the State of 
Oedifomia. 
SEC 732. CONDITIONS OF WAIVER 
(a) IN GENERAL.—^The conditions referred to in section 731(a) are 
that^ not later than the expiration of the 12-month period b^^inning 
on the date of the enactment of this Act— 
(IXA) San Juan County establish an irrevocable trust with a 
res of $321,057 for the sole purpose of satisfying, with respect to 
the m^cal facility described in section 731(a), the obligation of 
San Juan County under r^ulations issued under clause (2) of 
section 603(e) of the PubUc Health Service Act (42 U.S.C. 
291c(e)); 
(B) except to the extent inconsistent with this title, San Juan 
establish such trust in accordance with r^ulations issued under 
section 609(dXlXA) of such Act for trusts established pursuant 
to such section; and 
(O San Juan County agree— 
(D except to the extent inconsistent with this title, to 
administer such trust in accordance with r^ulations issued 
under such section 609(dXlXA) of such Act; and 
PUBLIC LAW 100-607—NOV. 4, 1988 
102 STAT. 3167 
(ii) with respect to the obligation described in subpara-
graph {Ah-
(D to carry out such obligation at tiie medical facility 
known as San Juan County Hospital and locate in 
Montioello, in the State of Utah; 
GD to ensure that uncompensated services provided 
at any location other than such medical facility will not 
be reimbursed from the trust established pursuant to 
subparagraph (A); and 
^ 
(no not to seek contribution from Auburn Corpora-
tion toward the satisfaction of such obligation; and 
(2) Auburn Corporation agree— 
(A) to satisfy, with respect to the medical facility de-
scribed in section 731(a), the obligation of San Juan County 
under regulations issued under clause (1) of section 603(e) of 
the Public Health Service Act; 
^ 
(B) to satisfy such obligation at the medical facility de-
scribed in section 731(a); and 
(Q not to seek contribution from San Juan County 
toward the satisfaction of such obligation, 
(b) DETEHMINATION AND CERTIFICATTON OP SATISFACTION OF CONDI-
TIONS.—^The Secretary shall make a determination of whether the 
conditions described in subsection (a) are satisfied by San Juan 
County and Auburn Corporation within the period described in such 
subsection. If the Secretary makes a determination that the condi-
tions have been satisfied, the Secretary shall certify to the Congress 
the fact of such determination. 
SEC 733. MONITORING OF COMPLIANCE WITH AGREEMENTS AND 
EFFECT OF FAILURE TO COMPLY. 
(a) MoNTTORiNG.—^Tho Secretary shall determine the extent to 
which San Juan County and Auburn Corporation are canying out 
their respective duties under the agreements made pursuant to the 
conditions described in section 732(a). 
(b) FAILURE TO COMPLY.— 
(1) If the conditions described in section 732(a) are not satis-
fied by San Juan County and Auburn Corporation within the 
period described in such section, the Secretary shall ensure that 
proceedings under section 609 of the Public Health Service Act 
(42 U.S.C. 291i) with respect to the sale described in section 
731(a) are commenced or continued against San Juan County or 
Auburn Corporation, or both, as determined by the Secretary. 
(2) If San Juan County or Auburn Corporation fails to carry 
out its duties under the agreements made pursuant to the 
1 conditions described in section 732(a), the Secretary shall ensure 
that proceedings described in paragraph (1) are commenced or 
continued against San Juan County or Auburn Corporation, 
respectively. 
SEC 734. DEFINITIONS. 
For purposes of tius subtitle: 
(1) The term ''Auburn Corporation'* means Auburn Manor 
Holding Corporation, a corporation under the laws of the State 
of California. 
(2) The term "San Juan C>ounty*' means San Juan 0>tmty, a 
politicai subdivision of the State of Utah. 
102 STAT. 3168 
PUBLIC LAW 100-607—NOV. 4, 1988 
(3) The term "Secretary" means the Secretary of Health and 
Human Services. 
TITLE VIII—REVISION AND EXTENSION 
OF PROGRAMS OF HEALTH CARE FOR 
THE HOMELESS 
Subtitle A—Categorical Grants for Primary 
Health Services and Substance Abuse Services 
SEC. 801. INCREASE IN REQUIRED AMOUNT OF MATCHING FUNDS AND 
MODIFICATION IN ELIGIBILITY FOR WAIVER WITH RESPECT 
TO MATCHING FUNDS. 
(a) INCREASE IN REQUIRED AMOUNT.—Section 340(eXlXA) of the 
PubUc Health Service Act (42 U.S.C. 256(eXlXA)) is amended— 
(1) in clause (i), by striking "under the grant; and" and 
inserting the following: "for the first flscal year of payments 
under the grant and 66 2/3 percent of the costs of providing 
such services for any subsequent fiscal year of payments under 
the grant; and"; and 
(2) in clause (ii), by striking "Federal funds" and all that 
follows and inserting the following: "Federal funds provided for 
the first fiscal year of payments under the grant and not less 
than $1 (in cash or in kind under such subparagraph) for each 
$2 of Federal funds provided for any subsequent fiscal year of 
payments under the grant.". 
42 use 256 note. 
(b) EFFECTIVE DATE F
O
R INCREASE.—The amendments made by 
subsection (a) shall take effect October 1,1989. 
(c) MODIFICATION IN ELIGIBILITY FOR WAIVER.—Section 340(eX2) of 
the Public Health Service Act (42 U.S.C. 256(eX2)) is amended to 
read as follows: 
"(2) The Secretary may waive the requirement established in 
paragraph (IXA) if the applicant involved is a nonprofit private 
entity and the Secretary determines that it is not feasible for the 
applicant to comply with such requirement.". 
SEC 802. ESTABUSHMENT OF AUTHORITY FOR TEMPORARY CONTINUED 
PROVISION OF SERVICES TO CERTAIN FORMER HOMELESS 
INDIVIDUALS. 
(a) IN GENERAL.—Section 340 of the Public Health Service Act (42 
U.S.C. 256) is amended— 
(1) by redesignating subsections (h) through (q) as subsections 
(i) through (r), respectively; and 
(2) by ad<Ung after subsection (g) the following new subsection: 
"(h) TEMPORARY CONTINUED PROVISION OF SERVICES TO CERTAIN 
F
o
R
A
C
E
R HOMELESS INDIVIDUALS.—If any grantee under subsection 
(a) has provided services described in subsection (f) or (g) to a 
homeless individual, any such grantee may, notwithstanding that 
the individual is no longer homeless as a result of becoming a 
resident in permanent housing, expend the grant to continue to 
provide such services to the individual for not more than 12 
months.". 
(b) CONFORMING AMENDMENTS.— 
PUBLIC LAW 100-607—NOV. 4, 1988 
102 STAT. 3169 
(1) Section 340(dXl) of the Public Health Service Act (42 
U.S.C. 256(dXl)) is amended— 
(A) in subparagraph (C), by striking "(h)" and inserting 
"(i)"; 
(B) in subparagraph (D), by striking "(i)" and inserting 
"0")"; 
(C) in subparagraph (E), by striking "(j)" and inserting 
"(k)";and 
(D) in subparagraph (F), by striking "(k)" and inserting 
"(1)". 
(2) Section 332(aX3) of the Public Health Service Act (42 
U.S.C. 254e(aX3)) is amended by striking "340(qX2)" and insert-
ing "340(r)". 
(3) Section 536(1) of the Public Health Service Act (42 U.S.C. 
290cc-36(l)) is amended by striking "340(qX2)" and inserting 
"340(r)". 
SEC. 803. CLARIFICATION WITH RESPECT TO CERTAIN PROVISIONS. 
(a) DEFINITION OF HOMELESS INDIVIDUAL.—Section 340(rX2) of the 
Public Health Service Act (as redesignated in section 802(aXl) of this 
title) is amended by striking "living accommodations." and inserting 42 use 256. 
"living accommodations and an individual who is a resident in 
transitional housing.". 
(b) PROVISION OF TECHNICAL ASSISTANCE.—Section 340(oX2) of the 
Public Health Service Act (as redesignated in section 802(aXl) of this 
title) is amended by striking "(pXD, and inserting "(qXD for a fiscal 
year,". 
SEC. 804. AUTHORIZATION OF APPROPRIATIONS. 
Section 340(qXl) of the Public Health Service Act (as redesignated 
in section 802(aXl) of this title) is amended by striking "There are 42 use 256. 
authorized" and all that follows and inserting the following: "There 
are authorized to be appropriated to carry out this section 
$61,200,000 for fiscal year 1989, $63,600,000 for fiscal year 1990, and 
$66,200,000 for fiscal year 1991.". 
Subtitle B—Block Grant for Community 
Mental Health Services 
SEC. 811. 
AUTHORIZATION OF APPROPRIATIONS AND CONTINGENT 
CONVERSIONS 
TO 
CATEGORICAL PROGRAM. 
(a) IN GENERAL.—Section 535 of the Public Health Service Act (42 
U.S.C. 290CC-35) is amended to read as follows: 
"FUNDING 
"SEC. 535. (a) AUTHORIZATION OF APPROPRIATIONS.—For the pur-
pose of carrying out this part, there are authorized to be appro-
priated $35,000,000 for each of the fiscal years 1989 and 1990 and 
such sums as may be necessary for fiscal year 1991. 
"
O
k
)
) EFFECT OF INSUFFICIENT APPROPRIATIONS FOR MINIMUM ALLOT-
MENTS.— 
"(1) If the amounts made available pursuant to subsection (a) 
are insufficient for providing each State with an allotment 
under section 521(a) of not less than $150,000, the Secretary 
shall, from such amounts as are made available pursuant to 
102 STAT. 3170 
PUBLIC LAW 100-607—NOV. 4, 1988 
sucfa subBectioD, make grants to the States for providing to 
homelcflB individuals the mental health services desctibed in 
aectian524. 
'XZ^ Faragrs^ (1) may not be construed to require the Sec-
retary to naake a grant under such paragraph to each State.". 
(b) FAILDSB or STATB Wma RBSPBCT TO EXPENDING ALLOTMENT.— 
Section S29 of the PubUc Health Service Act (42 UJS.C. 290cc-29) is 
amended to read as follows: 
Grants. 
42 u s e 290CC-2. 
42 u s e 290dd. 
42 u s e 290ee. 
<XXNVEBSH>N TO STATS CATEGORICAL PROGRAM IN EVENT OF FAILURE 
<»• STATB WITH RESPECT TO EXPENDING ALLOTMENT 
"SEC 529. (a) IN GENERAL.—Subject to subsection (c), the Sec-
letanr shall, £rom amounts described in subsection 0>), make grants 
to pimlic and nxmpvxifit private entities for the purpose of providing 
to homdesB individuals the mental health services described in 
8ectioa524. 
'Xb) DracsipnoN OF FUNDS.—^The amounts referred to in subsec-
tion (a) are any amounts made available in appropriations Acts for 
aUotmoitB under section 521(a) that are not allotted under such 
section to a State as a result of— 
*X0 the 
fisdlure 
of the State to submit an application under 
section ^2i 
*X2) the 
fisdlure, 
in the determination of the Secretary, of any 
State to prepare within a reasonable period of time such 
i^lication in compliance with such section; or 
^3) the State informing the Secretary that the State does not 
interid to expend the full amount of the allotment made to the 
Stateu 
'Xc) REQUIREMENT OF PROVISION OF SERVICES IN CERTAIN STATES.— 
Willi respect to grants under subsection (a), amounts made available 
pursuant to subsection 0
1
>
) as a result of the State involved shall be 
available <mly ftn" grants to provide services in such State.". 
SBC 812. EUGIBIUTT OF TERRITORIES. 
(a) DEHNIIION OF STATE.—Section 536(3) of the Public Health 
Service Act (42 U.S.C. 290cc^6(3)) is amended by striking ''Colum-
bia," and all that 
follows 
and inserting the following: ''Columbia, the 
Commonwealth of Puerto Rico, Cuam, the Virgin Mands, American 
Samoa, and the Northern Mariana Islands.". 
(b) B
f
t
D
O
M
U
M ALLOTMENT.—Section 528(aXl) of the Public Health 
Service Act (42 U.S.C. 290cc-28(aKl)) is amended to read as follows: 
*Xl) pnSfiOO for each of the several States, the District of 
Columbia, and the Commonwealth of Puerto Rico and $50,000 
for eadi of Gruam, the Viigin Islands, American Samoa, and the 
Northern Mariana Islands; and". 
SBC 813. TECHNICAL AND CONFORMING ABIENDMENTS. 
Titie V of the Public Health Service Act (42 U.S.C. 290aa et seq.) is 
amended— 
(1) in section 521(a), by amending the first sentence to read as 
follows: "Hie Secretiuy shall for each of the fuscal years 1989 
throoc^ 1991 make an allotment for each State in an amount 
determined in accordance with section 528."; 
(2) in section 541(aX4), by striking "522" and inserting "543"; 
(3) in section 545(d), by striking "526" and inserting "547"; 
and 
PUBLIC LAW 100-607—NOV. 4, 1988 
102 STAT. 3171 
(4) in section 546(aX4), by striking "521" and inserting "542". 
42 use 290ee-i. 
Subtitle C—Authorization of Appropriations 
for Community Demonstration Projects 
SEC. 821. MENTAL HEALTH SERVICES FOR HOMELESS INDIVIDUALS 
WITH CHRONIC MENTAL ILLNESS. 
The first sentence of section 612(a) of the Stewart B. McKinney 
Homeless Assistance Act (42 U.S.C. 290aa-3 note) is amended to 
read as follows: "For payments pursuant to section 504(f) of the 
Public Health Service Act, there are authorized to be appropriated 
$11,000,000 for fiscal year 1989, $11,500,000 for fiscal year 1990, and 
such sums as may be necessary for fiscal year 1991, in addition to 
any other amounts authorized to be appropriated for such pajonents 
for each of such fiscal years.". 
SEC. 822. ALCOHOL AND DRUG ABUSE TREATMENT OF HOMELESS 
INDIVIDUALS. 
Section 513(b) of the Public Health Service Act (42 U.S.C. 290bb-
2(b)) is amended to read £is follows: 
"(b) There are authorized to be appropriated to carry out section 
512(c) $14,000,000 for fiscal year 1989, $17,000,000 for fiscal year 
1990, and such sums as may be necessary for fiscal year 1991.". 
Subtitle D—General Provisions 
SEC. 831. EFFECTIVE DATES. 
The amendments made by subsection (a) of section 801 shall take 
effect in accordance with subsection (b) of such section. The amend-
ments otherwise made by this title shall take effect October 1,1988, 
or upon the date of the enactment of this Act, whichever occurs 
later. 
42 use 256 note. 
TITLE IX—TESTING OF CONVICTED 
FELONS 
Prison Testing 
Act of 1988. 
AIDS. 
SEC. 901. SHORT TITLE. 
This title may be cited as the "Prison Testing Act of 1988". 
SEC. 902. TESTING OF STATE PRISONERS. 
(a) IN GENERAL.—To be eligible to receive funds under this section, 
the chief law enforcement officer of each State shall establish a 
State program to provide for the confidential testing of any individ-
u£d convicted under State law, of an intravenous drug or sex offense 
on or after the date of enactment of this title. 
(b) CONFIDENTIALITY.— 
(1) IN GENERAL.—Except as otherwise provided, no person 
receiving identifying information regarding an individual tested 
pursuant to this section shall disclose or redisclose such 
information to any person. 
(2) WAIVER.—The confidentiality of the testing required under 
subsection (a) shall be waived only so that— 
42 u s e 300ee-6 
note. 
42 u s e 300ee-6. 
State and local 
governments. 
Drugs and drug 
abuse. 
102 STAT. 3172 
PUBLIC LAW 100-607—NOV. 4, 1988 
(A) correctional personnel, as considered necessary under 
laws of the State or policies established by the State depart-
ment of health, may have access to the information; and 
-^^ 
(B) victims of rape may be informed of the result of the 
test, if the person convicted of the rape tests positive for 
e:qK)Sure to the human immunodeficiency virus. 
(c) MEDICAL TREATBISNT OF DRUG AND SEX OFFENDERS.—The chief 
law enforcement officer of each State receiving funds under this 
section shall provide education and counseling through existing 
prison medical facilities to any individual tested for exposure to the 
human immunodefidencgr virus established under subsection (a). 
(d) FUNDING.— 
(1) IN GENERAL.—^The program established under subsection 
(a) shall be conducted in part using funds made available under 
this section. 
(2) REQUIREMENT.—A State shall not receive funds under this 
section unless an application for such has been submitted to, 
and approved by, the Attorney GeneraL 
(3) CONTENTS.—^An application submitted under paragraph (1) 
shall— 
(A) be in such form and be submitted in such manner as 
the Attorney General may by r^^uiation require; and 
(B) contain— 
(i) assurances by the chief executive officer of the 
State will provide, through existing medical facilities in 
State penal institutions, education and pre- and post-
test counseling to any individual tested for exposure to 
the human immunodeficiency virus under this section; 
(ii) a 50 percent cost share under subsection (a) by the 
State; and 
(iii) such other information as the Attorney General 
may by r^^ation specify. 
(e) DEFINITIONS.—As used in this section, the term "intravenous 
drug or sex offense" means— 
(1) an ofiTense that is punishable, under a State law relating to 
intravenous use of a controlled substance (other than a law 
relating to simple possession of a controlled substance), by 
imprisonment for a term exceeding one year, 
(2) a State offense of the same type described under chapter 99 
of title 18, United States Code, relating to rape; or 
(3) a State criminal offense involving prostitution. 
(f) REGULATIONS.—^The Attorney General shall promulgate regula-
tions to carry out this section, including r^ulations that determine 
the amount of funds that each State is entitled to receive under this 
section. 
(g) AUTHORIZATION OF APPROPRIATIONS.—To carry out this section, 
there are authorized to be appropriated such sums as may be 
necessary for each of the fiscal years 1988 through 1990. 
42 u s e 300ee-6 
SEC M3. STUDY BY ATTORNEY GENERAL. 
Not later than I year after the date of enactment of this title, the 
Attorney General of the United States shall complete a study and 
submit a report to the appropriate Committees of Congress concern-
ing the appropriateness or inappropriateness of mandated prison 
sentences for any individual convicted of an intravenous drug or sex 
PUBLIC LAW 100-607—NOV. 4, 1988 
102 STAT. 3173 
ofTense who thereafter knowingly places others at risk of becoming 
infected with the human immunodeficiency virus. 
SEC. 904. EFFECTIVE DATE. 
42 USC 300ee-6 
This title shall become effective 180 days after the date of enact-
ment of this Act. 
Approved November 4, 1988. 
LEGISLATIVE HISTORY—S. 2889: 
CONGRESSIONAL RECORD, Vol. 134 (1988): 
Oct. 13, considered and passed Senate and House.