National Health Service Corps Revitalization Amendments of 1990
PL 101-597 (H.R.4487), enacted 11/16/1990

PUBLIC LAW 101-597—NOV. 16, 1990 
104 STAT. 3013 
Public Law 101-597 
101st Congress 
An Act 
To amend the Public Health Service Act to revise and extend the program for the 
National Health Service Clorps, and to establish certain programs of grants to the 
States for improving health services in the States. 
Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled, 
SECTION 1. SHORT TITLE. 
This Act may be cited as the "National Health Service Corps 
Revitalization Amendments of 1990". 
TITLE I—REVISIONS IN GENERAL PRO-
GRAM FOR NATIONAL HEALTH SERV-
ICE CORPS 
Nov. 16, 1990 
[H.R. 4487] 
National Health 
Service Corps 
Revitalization 
Amendments 
of 1990. 
42 u s e 201 
note. 
SEC. 101. NATIONAL HEALTH SERVICE CORPS. 
(a) PROVISION OF PRIMARY HEALTH SERVICES.—Section 331(a) of the 
Public Health Service Act (42 U.S.C. 254d(a)) is amended— 
(1) in the matter preceding subparagraph (A) of paragraph 
( D -
(A) by inserting "(1)" after the subsection designation; 
and 
(B) by striking "There is" and all that follows and insert-
ing the following: "For the purpose of eliminating health 
manpower shortages in health manpower shortage areas, 
there is established, within the Service, the National 
Health Service Corps, which shall consist of—"; 
(2) by striking "States," at the end of paragraph (1)(C) and all 
that follows and inserting "States."; and 
(3) by adding at the end the following new paragraphs: 
"(2) The Corps shall be utilized by the Secretary to provide 
primary health services in health manpower shortage areas. 
"(3) For purposes of this subpart and subpart III: 
"(A) The term 'Corps' means the National Health Service 
Corps. 
"(B) The term 'Corps member' means each of the officers, 
employees, and individuals of which the Corps consists pursuant 
to paragraph (1). 
"(C) The term 'health manpower shortage area' has the mean-
ing given such term in section 332(a). 
"(D) The term 'primary health services' means health services 
regarding family medicine, internal medicine, pediatrics, obstet-
rics and gynecology, dentistry, or mental health, that are pro-
vided by physicians or other health professionals.". 
104 STAT. 3014 
PUBLIC LAW 101-597—NOV. 16, 1990 
(b) RECRUITMENT AND RETENTION OF CORP MEMBERS, INCLUDING 
VOLUNTEERS.—Section 331(b) of the Public Health Service Act (42 
U.S.C. 254d(b)) is amended— 
(1) by inserting "(1)" after the subsection designation; 
(2) in paragraph (1) {as so designated)^ by adding at the end 
the following new sentence: "Such recruiting programs shall 
include efforts to recruit individuals who will serve in the Corps 
other than pursuant to obligated service under the Scholarship 
or Loan Repayment Program."; and 
(3) by adding at the end the following new paragraph: 
"(2) In the case of physicians, dentists, certified nurse midwives, 
certified nurse practitioners, £ind physician assistants who have an 
interest and a commitment to providing primary health care, the 
Secretary may establish fellowship programs to enable such health 
professionals to gain exposure to and expertise in the delivery of 
primary health services in health manpower shortage areas. To the 
maximum extent practicable, the Secretary shall ensure that any 
such programs are established in conjunction with accredited resi-
dency programs, and other training programs, regarding such 
health professions.". 
(c) 
REMOVAL OF LIMITATION REGARDING SUPPLEMENTAL PAY 
DURING INITIAL YEARS OF SERVICE.—Section 331(dXlXA) of the 
Public Health Service Act (42 U.S.C. 254d) is amended by striking 
striking "(not to exceed $1,000)". 
(d) ADEQUATE STAFF FOR CORPS PROGRAM.—Section 331 of 
the 
Public Health Service Act (42 (U.S.C. 254d) is amended by striking 
subsection (h) and inserting the following new subsection: 
"(h) The Secretary shall ensure that adequate staff is provided to 
the Service with respect to effectively administering the program for 
the Corps.". 
(e) TECHNICAL AMENDMENT REGARDING DEFINITIONS.—Section 
331(i) of the Public Health Service Act (42 U.S.C. 254d(i)) is amended 
in the matter preceding paragraph (1) by inserting "and subpart HI" 
before the colon. 
SEC. 102. DESIGNATION OF HEALTH MANPOWER SHORTAGE AREAS. 
(a) PuBUCATiON OF DESIGNATIONS AND REVISIONS.—Section 332(d) 
of the Public Health Service Act (42 U.S.C. 254e(d)) is amended by 
inserting "(1)" after the subsection designation and by adding at the 
end the following new paragraph: 
Federal 
"(2) For purposes of paragraph (1), a complete descriptive list shall 
S^lS^Hnn 
^ published in the Federal Register not later than July 1 of 1991 
and each subsequent year.". 
(b) DEFINITION OF MEDICAL FACILITY.—Section 332(aX2) of 
the 
Public Health Service Act (42 U.S.C. 254e(aX2)) is amended— 
(1) in subparagraph (A), by inserting before "and community 
health center" the following: "facility operated by a city or 
county health department,"; 
^ 
(2) in subparagraph (B), by inserting before the semicolon the 
following: ", and a health program or facility operated by a tribe 
or tribal organization under the Indian Self-Determination 
Act"; and 
(3) in subparagraph (C)— 
(A) by striking "sections 321" and inserting "section 321", 
by striking "or before "326", and by striking "or section 
320" and inserting "320"; and 
publication. 
PUBLIC LAW 101-597—NOV. 16, 1990 
104 STAT. 3015 
(B) by inserting before the semicolon at the end the 
following: ", or 340 (relating to the provision of health 
services to homeless individuals)", 
(c) REMOVAL OF SUPERFLUOUS REFERENCES.—Section 332 of 
the 
Public Health Service Act (42 U.S.C. 254e) is amended— 
(1) in subsection (b), in the first sentence of the matter 
preceding paragraph (1), by striking ", promulgated not later 
than May 1,1977,"; 
(2) in subsection (c), by striking paragraph (1) and redesignat-
ing paragraphs (2) and (3) as paragraphs (1) and (2), respectively; 
(3) in subsection (dXD (as designated by subsection (a) of this 
section), by striking ", not later than November 1, 1977,"; and 
(4) in subsection (f), by inserting "and" after the semicolon at 
the end of paragraph (1), and by striking paragraph (2) and 
redesignating paragraph (3) as paragraph (2). 
SEC. 103. ASSIGNMENT OF CORPS PERSONNEL. 
(a) REQUIREMENT OF APPROPRIATE AND EFFICIENT USE OF CURRENT 
PERSONNEL AS CONDITION OF RECEIVING FURTHER PERSONNEL.—Sec-
tion 333(a)(l)(D)(ii)(II) of the Public Health Service Act (42 U.S.C. 
254f(a)(l)(D)(iiXII)) is amended— 
(1) by striking "will be" and inserting "has been"; and 
(2) by inserting "any" before "Corps . 
(b) TECHNICAL AND CONFORMING AMENDMENTS REGARDING ADDI-
TIONAL PROVISIONS ON PRIORITY AND ON EFFECTIVE SERVICE OF 
PERSONNEL.—Section 333 of the Public Health Service Act (42 U.S.C. 
254f) is amended— 
(1) by striking subsections (b), (c), (f), (h), (j)> and (k); and 
(2) by redesignating subsections (d), (e), (g), and (i) as subsec-
tions (b), (c), (d), and (e), respectively, 
SEC. 104. PRIORITIES IN ASSIGNMENT OF CORPS PERSONNEL. 
Subpart II of part D of title III of the Public Health Service Act (42 
U.S.C. 254d et seq.) is amended by inserting after section 333 the 
following new section: 
"SEC. 333A. PRIORITIES IN ASSIGNMENT OF CORPS PERSONNEL. 
42 USC 554f-l. 
"(a) IN GENERAL.—In approving applications made under section 
333 for the assignment of Corps members, the Secretary shall— 
"(1) give priority to any such application that— 
*(A) is made regarding the provision of primary health 
services to a health manpower shortage area with the 
greatest such shortage, as determined in accordance with 
subsection (b); and 
"(B) is made by an entity that— 
"(i) serves a health manpower shortage area de-
scribed in subparagraph (A); 
"(ii) coordinates the delivery of primary health serv-
ices with related health and social services; 
"(iii) has a documented record of sound fiscal 
management; and 
"(iv) will experience a negative impact on its capacity 
to provide primary health services if a Corps member is 
not assigned to the entity; 
"(2) with respect to the geographic area in which the health 
manpower shortage area is located, take into consideration the 
willingness of individuals in the geographic area, and of the 
104 STAT. 3016 
PUBLIC LAW 101-597—NOV. 16, 1990 
appropriate governmental agencies or health entities in the 
area, to assist and cooperate with the Corps in providing effec-
tive primary health services; and 
"(3) take into consideration comments of medical, osteopathic, 
dental, or other health professional societies whose members 
deliver services to the health manpower shortage area, or if no 
such societies exist, comments of physicians, dentists, or other 
health professionals delivering services to the area. 
"(b) 
EXCLUSIVE FACTORS FOR DETERMINING GREATEST SHORT-
AGES.—In making a determination under subsection (aXlXA) of the 
health manpower shortage areas with the greatest such shortages, 
the Secretary may consider only the following factors: 
"(1) The ratio of available health manpower to the number of 
individuals in the area or population group involved, or served 
by the medical facility or other public facility involved. 
"(2) Indicators of need as follows: 
"(A) The rate of low birthweight births. 
"(B) The Tate of infant mortality. 
"(C) The rate of poverty. 
"(D) Access to primary health services, taking into ac-
count the distance to such services. 
"(c) ESTABLISHMENT OF CRITERIA FOR DETERMINING PRIORITIES.— 
"(1) IN GENERAL.—The Secretary shall establish criteria speci-
fying the manner in which the Secretary makes a determina-
tion under subsection (a)(1)(A) of the health manpower shortage 
areas with the greatest such shortages. Such criteria shall 
specify the manner in which the factors described in subsection 
(b) are implemented regarding such a determination. 
Federal 
"(2) PuBUCATiON OF CRITERIA.—The Criteria required in para-
puSication. 
graph (1) shall be published in the Federal Register not later 
than July 1, 1991, Any revisions made in the criteria by the 
Secretary shall be effective upon publication in the Federal 
Register. 
"(d) NOTIFICATIONS REGARDING PRIORITIES.— 
"(1) PREPARATION OF UST FOR APPUCABLE PERIOD.—For the 
purpose of canying out paragraph (2), the Secretary shall pre-
pare a list of health manpower shortage areas that are receiving 
priority under subsection (aXD in the assignment of Corps 
members for the period applicable under subsection (f). Such 
list— 
"(A) shall include a specification, for each such health 
manpower shortage area, of the entities for which the 
Secretary has provided an authorization to receive assign-
ments of Corps members in the event that Corps members 
are available for the assignments; and 
"(B) shall, of the entities for which an authorization 
described in subparagraph (A) has been provided, specify— 
"(i) the entities provided such an authorization for 
the assignment of Corps members who are participat-
ing in the Scholarship Program; 
"(ii) the entities provided such an authorization for 
the assignment of Corps members who are participat-
ing in the Loan Repajrment Program; and 
"(iii) the entities provided such an authorization for 
the assignment of Corps members who have become 
Corps members other than pursuant to contractual 
PUBLIC LAW 101-597—NOV. 16, 1990 
104 STAT. 3017 
obligations under the Scholarship or Loan Repayment 
Programs. 
The Secretary may set forth such specifications by medical 
specialty. 
'(2) NOTIFICATION OF AFFECTED PARTIES.— 
"(A) Not later than 30 days after the preparation of each 
list under paragraph (1), the Secretary shall notify entities 
specified for purposes of subparagraph (A) of such para-
>49;aph of) the fapt j;hat the entit^^ ha'^e beea-pi-ovided an 
,-,, 
authorization to receive assignments of Corps members in 
' 
the event that Corps members are available for the 
assignments. 
"(B) In the case of individuals with respect to whom a 
period of obligated service under the Scholarship Program 
will begin during the period under subsection (f) for which a 
list under paragraph (1) is prepared, the Secretary shall, 
not later than 30 days after the preparation of each such 
list, provide to such individuals the names of each of the 
entities specified for purposes of paragraph (lXB)(i) that is 
appropriate to the medical specialty of the individuals. 
"(3) REVISIONS IN UST.—If the Secretary makes a revision in a 
list under paragraph (1) during the period under subsection (f) 
to which the list is applicable, and the revision alters the status 
of an entity with respect to the list, the Secretary shall notify 
the entity of the effect on the entity of the revision. Such 
notification shall be provided not later than 30 days after the 
date on which the revision is made. 
"(e) LIMITATION ON NUMBER OF ENTITIES OFFERED AS ASSIGNMENT 
CHOICES IN SCHOLARSHIP PROGRAM.— 
"(1) DETERMINATION OF AVAILABLE CORPS MEMBERS.—The Sec-
retary shall determine the number of participants in the 
Scholarship Program who are available for assignments under 
section 333 for the period applicable under subsection (f). 
"(2) AVAILABILITY OF 500 OR FEWER MEMBERS.—If the number 
of participants for purposes of paragraph (1) is less than 500, the 
Secretary shall limit the number of entities specified under 
subsection (dXlXBXi) to the lesser of— 
"(A) 500 such entities; and 
"(B) a number of such entities constituting 300 percent of 
the number of such participants available for assignment 
under section 333. 
"(3) 
AVAILABIUTY OF MORE THAN 500 
MEMBERS.—If 
the 
number of participants for purposes of paragraph (1) is equal to 
or greater than 500, the Secretary shall determine the number 
of entities to be specified under subsection (dXlXBXi), subject to 
ensuring that assignments of such participants are made to 500 
entities that serve health manpower shortage areas that have 
chronic difficulty in recruiting and retaining health profes-
sionals to provide primary health services. 
"(4) ADJUSTMENT IN BASE NUMBER.—The number 500, as used 
for purposes of paragraphs (2) and (3), may by regulation be 
adjusted by the Secretary to a greater or a lesser number. 
"(f) APPLICABLE PERIOD REGARDING PRIORITIES.— 
"(1) IN GENERAL.—With respect to determinations under 
subsection (aXD of the applications that are to be given priority 
regarding the assignment of Corps members, the Secretary shall 
104 STAT. 3018 
PUBLIC LAW 101-597—NOV. 16, 1990 
make such a determination not less than once each fiscal year. 
The first determination shall be made not later than July 1 of 
the year preceding the year in which the period of obligated 
service begins. If the Secretary revises the determination before 
July 1 of the following year, the revised determination shall be 
applicable with respect to assignments of Corps members made 
during the period beginning on the date of the issuance of the 
revised determination and ending on July 1 of such year. 
"(2) DATE CERTAIN FOR PREPARATION OF NOTIFICATION UST.—A 
list under subsection (d)(1) shall be prepared for each of the 
periods decribed in paragraph (1). Each such list shall be pre-
pared not later than the date on which a determination of 
priorities under such paragraph is required to be made for the 
period involved.". 
SEC. 105. COST SHARING. 
Section 334(f)(2) of the Public Health Service Act (42 U.S.C. 
254g(f)(2)) is amended by adding at the end the following new 
subparagraph: 
"(C)(i) A determination under subparagraph (B) regarding the 
revenues and costs of an entity in an annual period shall be made by 
the Secretary utilizing criteria specific to the entity and shall be 
made without regard to whether the entity is making progress 
toward collecting sufficient revenues to provide an adequate level of 
primary health services without the assignment of Corps members. 
"(ii) In making a determination referred to in clause (i)— 
"(I) the Secretary may consider whether the proposed budget 
submitted under subparagraph (A) provides a reasonable esti-
mate regarding the revenues and costs of the entity; and 
"(II) may not consider the reasonableness of the amount of 
revenues collected, or the amount of costs incurred by the 
entity, except to the extent necessary to ensure that the entity 
is operating in good faith and is operating efficiently with 
respect to fiscal matters within the control of the entity. 
"(iii) A determination of whether an entity is eligible for a waiver 
under paragraph (3) shall be made by the Secretary without regard 
to the revenues and costs determined by the Secretary under 
subparagraph (B). 
"(iv) A determination of whether an entity is a small health 
center shall be made by the Secretary without regard to the reve-
nues and costs determined by the Secretary under subparagraph 
(B).". 
SEC. 106. ADMITTING PRIVILEGES OF HEALTH CARE PROFESSIONALS. 
Section 335(e)(1)(A) of the Public Health Service Act (42 U.S.C. 
254h(eXlXA)) is amended by striking "authorized physician" and all 
that follows through "admitting" and inserting 'authorized Corps 
member admitting . 
SEC. 107. PROVISIONS REGARDING EFFECTIVE PROVISION OF SERVICES. 
Section 336 of the Public Health Service Act (42 U.S.C. 254h-l) is 
amended to read as follows: 
"SEC. 336. FACILITATION OF EFFECTIVE PROVISION OF CORPS SERVICES. 
"(a) CONSIDERATION OF INDIVIDUAL CHARACTERISTICS OF MEMBERS 
IN MAKING ASSIGNMENTS.—In making an assignment of a Corps 
member to an entity that has had an application approved under 
PUBLIC LAW 101-597—NOV. 16, 1990 
104 STAT. 3019 
section 333, the Secretary shall, subject to making the assignment in 
accordance with section 333A, seek to assign to the entity a Corps 
member who has (and whose spouse, if any, has) characteristics that 
increase the probability that the member will remain in the health 
manpower shortage area involved after the completion of the period 
of service in the Corps. 
"0)) COUNSEUNG ON SERVICE IN CORPS.— 
"(1) IN GENERAL.—The Secretary shall, subject to paragraph 
(3), offer appropriate counseling on service in the Corps to 
individuals during the period of membership in the Corps, 
particularly during the initial period of each assignment. 
"(2) CAREER ADVISOR REGARDING OBLIGATED SERVICE.— 
"(A) In the case of individuals who have entered into 
contracts for obligated service under the Scholarship or 
Loan Repayment Program, counseling under paragraph (1) 
shall include appropriate counseling on matters particular 
to such obligated service. The Secretary shall ensure that 
career advisors for providing such counseling are available 
to such individuals throughout the period of participation 
in the Scholarship or Loan Repayment Program. 
"(B) With respect to the Scholarship Program, counseling 
under paragraph (1) shall include counseling individuals 
during the period in which the individuals are pursuing an 
educational degree in the health profession involved, 
including counseling to prepare the individual for service in 
the Corps. 
"(3) EXTENT OF COUNSEUNG SERVICES.—With respect to 
individuals who have entered into contracts for obligated serv-
ice under the Scholarship or Loan Repayment Program, this 
subsection shall be carried out regarding such individuals 
throughout the period of obligated service (and, additionally, 
throughout the period specified in paragraph (2)(B), in the case 
of the Scholarship Program). With respect to Corps members 
generally, this subsection shall be carried out to the extent 
practicable. 
"(c) GRANTS REGARDING PREPARATION OF STUDENTS FOR PRAC-
TICE.—With respect to individuals who have entered into contracts 
for obligated service under the Scholarship or Loan Repayment 
Program, the Secretary may make grants to, and enter into con-
tracts with, public and nonprofit private entities (including health 
professions schools) for the conduct of programs designed to prepare 
such individuals for the effective provision of primary health serv-
ices in the health manpower shortage areas to which the individuals 
are assigned. 
"(d) ASSISTANCE IN ESTABLISHING LOCAL PROFESSIONAL RELATION-
SHIPS.—The Secretary shall assist Corps members in establishing 
appropriate professional relationships between the Corps member 
involved and the health professions community of the geographic 
area with respect to which the member is assigned, including such 
relationships with hospitals, with health professions schools, with 
area health education centers under section 781, with health edu-
cation and training centers under such section, and with border 
health education and training centers under such section. Such 
assistance shall include assistance in obtaining faculty appoint-
ments at health professions schools. 
"(e) TEMPORARY REUEF FROM CORPS DUTIES.— 
104 STAT. 3020 
PUBLIC LAW 101-597—NOV. 16, 1990 
"(1) IN GENERAL.—The Secretary shall, subject to paragraph 
(4), provide assistance to Corps members in establishing 
arrangements through which Corps members may, as appro-
priate, be provided temporary relief from duties in the Corps in 
order to pursue continuing education in the health professions, 
to participate in exchange programs with teaching centers, to 
attend professional conferences, or to pursue other interests, 
including vacations. 
"(2) ASSUMPTION OF DUTIES OF MEMBER.— 
"(A) Temporary relief under paragraph (1) may be pro-
vided only if the duties of the Corps member involved are 
assumed by another health professional. With respect to 
such temporary relief, the duties may be assumed by Corps 
members or by health professionals who are not Corps 
members, if the Secretary approves the professionals for 
such purpose. Any health professional so approved by the 
Secretary shall, during the period of providing such tem-
porary relief, be deemed to be a Corps member for purposes 
of section 224 (including for purposes of the remedy de-
scribed in such section), section 333(f), and section 335(e). 
"(B) In carrying out paragraph (1), the Secretary shall 
provide for the formation and continued existence of a 
group of health professionals to provide temporary relief 
under such paragraph. 
"(3) RECRUITMENT FROM GENERAL HEALTH PROFESSIONS COMMU-
NITY.—In carr5dng out paragraph (1), the Secretary shall— 
"(A) encourage health professionals who are not Corps 
members to enter into arrangements under which the 
health professionals temporarily assume the duties of Corps 
members for purposes of paragraph (1); and 
"(B) with respect to the entities to which Corps members 
have been assigned under section 333, encourage the enti-
ties to facilitate the development of arrangements described 
in subparagraph (A). 
"(4) LIMITATION.—In carrying out paragraph (1), the Secretary 
may not, except as provided in paragraph (5), obligate any 
amounts (other than for incidental expenses) for the purpose 
of— 
"(A) compensating a health professional who is not a 
Corps member for assuming the duties of a Corps member; 
or 
"(B) pa3dng the costs of a vacation, or other interests that 
a Corps member may pursue during the period of tem-
porary relief under such paragraph. 
"(5) SOLE PROVIDERS OF HEALTH SERVICES.—In the case of any 
Corps member who is the sole provider of health services in the 
geographic area involved, the Secretary may, from amounts 
appropriated under section 338, obligate on behalf of the 
member such sums as the Secretary determines to be necessary 
for purposes of providing temporary relief under paragraph (1). 
"(f) DETERMINATIONS REGARDING EFFECTIVE SERVICE.—In carrying 
out subsection (a) and sections 338A(d) and 338B(d), the Secretary 
shall carry out activities to determine— 
"(1) the characteristics of physicians, dentists, and other 
health professionals who are more likely to remain in practice 
in health manpower shortage areas after the completion of the 
period of service in the Corps; 
PUBLIC LAW 101-597—NOV. 16, 1990 
104 STAT. 3021 
"(2) the characteristics of health manpower shortage areas, 
and of entities seeking assignments of Corps members, that are 
more likely to retain Corps members after the members have 
completed the period of service in the Corps; and 
"(3) the appropriate conditions for the assignment and utiliza-
tion in health manpower shortage areas of certified nurse 
practitioners, 
certified 
nurse 
midwives, 
and physician 
assistants.". 
SEC. 108. AUTHORIZATION OF APPROPRIATIONS. 
Section 338(a) of the Public Health Service Act (42 U.S.C. 254k(a)) 
is amended— 
(1) by inserting "(1)" after the subsection designation; 
(2) in paragraph (1) (as so designated), by striking "To carry" 
and all that follows and inserting the following: "For the pur-
pose of canying out this subpart, there are authorized to be 
appropriated such sums as may be necessary for each of the 
fiscal years 1991 through 2000."; and 
(3) by inserting at the end the following new paragraph: 
"(2) In the case of individuals who serve in the C!orps other than 
pursuant to obligated service under the Scholarship or Loan Repay-
ment Program, the Secretary each fiscal year shall, to the extent 
practicable, make assignments under section 333 of such individuals 
who are certified nurse midvnves, certified nurse practitioners, or 
physician assistants.". 
TITLE II—SCHOLARSHIP AND LOAN RE-
PAYMENT PROGRAMS OF NATIONAL 
HEALTH SERVICE CORPS 
SEC. 201. SCHOLARSHIP PROGRAM. 
(a) PROVISION OF PRIMARY HEALTH SERVICES.— 
(1) IN GENERAL.—Section 338A(^) of the Public Health Service 
Act (42 U.S.C. 2541 (a)) is amended by striking "Corps Scholar-
ship" and all that follows and inserting the following: "Corps 
Scholarship Program to assure, with respect to the provision of 
primary health services pursuant to section 331(aX2)— 
"(1) an adequate supply of physicians, dentists, certified nurse 
midwives, certified nurse practitioners, and physician assist-
ants; and 
"(2) if needed by the Corps, an adequate supply of other 
health professionals.". 
(2) SCHOLARSHIP CONTRACT.—Section 338A(fKlXBXiv) of the 
Public Health Service Act (42 U.S.C. 2541(fKlXBXiv)) is amended 
in the matter after and below subclause (II) by inserting "as a 
provider of primary health services" before "in a health man-
power shortage area". 
(b) RECRUrTMENT AND RETENTION.— 
(1) IN GENERAL.—Section 338A(c) of the Public Health Service 
Act (42 U.S.C. 254/(c)) is amended— 
(A) by inserting "(1)" after the subsection designation; 
(B) by striking "(1) a fair summary" and inserting "(A) a 
fair summary"; 
(C) by striking "(2) information respecting" and inserting 
"(B) information respecting"; 
39-194 O - 91 - 28 : QL 3 Part 4 
104 STAT. 3022 
PUBLIC LAW 101-597—NOV. 16, 1990 
(D) by striking "The application form, contract form," 
and inserting the following: 
"(2) The application form, contract form,"; and 
(E) by adding at the end the following new paragraph: 
"(3XA) The Secretary shall distribute to health professions schools 
materials providing information on the Scholarship Program and 
shall encourage the schools to disseminate the materials to the 
students of the schools. 
"(BXi) In the case of any health professional whose period of 
obligated service under the Scholarship Progreim is nearing comple-
tion, the Secretary shall encourage the individual to remain in a 
health manpower shortage area and to continue providing primary 
health services. 
"(ii) During the period in which a health professional is planning 
and making the transition to private practice from obligated service 
under the Scholarship Program, the Secretary may provide assist-
ance to the professional regarding such transition if the professional 
is remaining in a health manpower shortage area and is continuing 
to provide primary health services. 
"(C) In the case of entities to which participants in the Scholar-
ship Program are assigned under section 333, the Secretary shall 
encourage the entities to provide options with respect to assisting 
the participants in remaining in the health manpower shortage 
areas involved, and in continuing to provide primary health serv-
ices, after the period of obligated service under the Scholarship 
Program is completed. The options with respect to which the Sec-
retary provides such encouragement may include options regarding 
the sharing of a single emplojrment position in the health profes-
sions by 2 or more health professionals, and options regarding the 
recruitment of couples where both of the individuals are health 
professionals.". 
(2) PuBuciTY.—Section 338A(c) of the Public Health Service 
Act, as amended by paragraph (1) of this subsection, is amended 
in paragraph (1)(B) by inserting before the period the follow-
ing: ", including a statement of all factors considered in approv-
ing applications for participation in the Program and in making 
assignments for participants in the Program". 
Government 
(c) PRIORITY IN AWARDING SCHOLARSHIPS.—Section 338A(d) of the 
contracts. 
Public Health Service Act (42 U.S.C. 254/(d)) is amended to read as 
follows: 
"(dXD Subject to section 333A, in providing contracts under the 
Scholarship Program— 
"(A) the Secretary shall consider the extent of the dem-
onstrated interest of the applicants for the contracts in provid-
ing primary health services; and 
"(B) may 
consider 
such 
other 
factors 
regarding 
the 
applicants as the Secretary determines to be relevant to select-
ing qualified individuals to participate in such Program. 
"(2) In providing contracts under the Scholarship Program, the 
Secretary shall give priority— 
"(A) first, to any application for such a contract submitted by 
an individual who has previously received a scholarship under 
this section or under section 758; 
"(B) second, to any application for such a contract submitted 
by an individual who has characteristics that increase the 
probability that the individual will continue to serve in a health 
PUBLIC LAW 101-597—NOV. 16, 1990 
104 STAT. 3023 
manpower shortage area after the period of obligated service 
pursuant to subsection (f) is completed; and 
"(C) third, subject to subparagraph (B), to any application for 
such a contract submitted by an individual who is from a 
disadvEuitaged background.", 
(d) REPORTS TO CONGRESS.—Section 338A(i) of the Public Health 
Service Act (42 U.S.C. 2541(i)) is amended— 
(1) by amending the matter preceding paragraph (1) to read as 
follows: 
"(i) Not later than March 1 of each year, the Secretary shsdl 
submit to the Congress a report providing, with respect to the 
preceding fiscal year—"; and 
(2XA) in paragraph (3), by striking "and" after the semicolon 
at the end; 
(B) by striking paragraph (4); and 
(C) by adding at the end the following new paragraphs: 
"(4) the amount Of scholarship pajmients made for each of 
tuition, stipends, and other expenses, in the aggregate and at 
each educational institution for the school year beginning in 
such year and for prior school years; 
"(5XA) the number, and type of health professions training, of 
individuals who have breached the contract under subsection (f) 
through any of the actions specified in subsection (a) or (b) of 
section 338E; and 
"(B) with respect to such individuals— 
"(i) the educational institutions with respect to which 
pajmaents have been made or were to be made under the 
contract; 
"(ii) the amounts for which the individuals are liable to 
the United States under section 338E; 
"(iii) the extent of payment by the individuals of such 
amounts; and 
"(iv) if known, the basis for the decision of the individuals 
to breach the contract under subsection (f); and 
"(6) the effectiveness of the Secretary in recruiting health 
professionals to participate in the Scholarship Program, and in 
encouraging and assisting such professionals with respect to 
providing primary health services to health manpower shortage 
areas after the completion of the period of obligated service 
under such Program. . 
SEC. 
2
0
2
. 
LOAN 
REPAYMENT 
PROGRAM. 
(a) PROVISION OF PRIMARY HEALTH SERVICES.— 
(1) IN GENERAL.—Section 338B(a) of the Public Health Service 
Act (42 U.S.C. 2541-l(a)) is amended by striking "Corps Loan" 
and all that follows and inserting the following: "Corps Loan 
Repayment Program to assure, with respect to the provision of 
primary health services pursuant to section 331(aX2)— 
"(1) an adequate supply of physicians, dentists, certified nurse 
midwives, certified nurse practitioners, and physician assist-
ants; and 
"(2) if needed by the Corps, an adequate supply of other 
health professionals (including mental health professionals).". 
(2) LOAN REPAYMENT CONTRACT.—Section 338B(fKlXB)(iv) of 
the Public Health Service Act (42 U.S.C. 2541(fXlXBXiv)) is 42USC254/-1. 
amended by inserting "as a provider of primary health services" 
before "in a health manpower shortage area". 
104 STAT. 3024 
PUBLIC LAW 101-597—NOV. 16, 1990 
OD) EUGIBILTTY.— 
(1) IN GENERAL.— 
(A) Section 338B(bXl) of the Public Health Service Act (42 
U.S.C. 2541-l(bXl)) is amended to read £is follows: 
"(IXA) must have a degree in medicine, osteopathic medicine, 
dentistry, or other health profession, or be certified as a nurse 
midwife, nurse practioner, or physician assistant; 
"(B) be enrolled in an approved graduate training program in 
medicine, osteopathic medicine, dentistry, or other health 
profession; or 
"(C) be enrolled as a full-time student— 
"(i) in an accredited (as determined by the Secretary) 
educational institution in a State; and 
"(ii) in the final year of a course of a study or program, 
offered by such institution and approved by the Secretary, 
leading to a degree in medicine, osteopathic medicine, den-
tistry, or other health profession;". 
(B) Section 338B(fKlXB) of the Public Health Service Act 
(42 U.S.C. 2541-l(fKlXB)) is amended in clauses (ii) and (iii) 
by striking "(bXl)(A)" each place such term appears and 
inserting "(bXlXC)". 
(2) TIME FOR SUBMISSION OF CONTRACT.— 
(A) Section 338B(b) of the Public Health Service Act (42 
U.S.C. 2541-l(b)) is amended— 
(i) by adding "and" after the semicolon at the end of 
paragraph (2); and 
(ii) by striking paragraphs (3) and (4), and by insert-
ing after paragraph (2) the following: 
"(3) submit to the Secretary an application for a contract 
described in subsection (f) (relating to the payment by the 
Secretary of the educational loans of the individual in consider-
ation of the individual serving for a period of obligated 
service).". 
(B) Section 338B(e) of the Public Health Service Act (42 
U.S.C. 2541-l(e)) is amended by striking "only" and all that 
follows and inserting the following: "only upon the Sec-
retary and the individual entering into a written contract 
described in subsection (f).". 
(c) INCENTIVES FOR RECRUITMENT AND RETENTION.—Section 338B(c) 
of the Public Health Service Act (42 U.S.C. 2541-l(c)) is amended by 
adding at the end the following new paragraph: 
"(4) RECRUITMENT AND RETENTION.— 
"(A) The Secretary shall distribute to health professions 
schools materials providing information on the Loan Repay-
ment Program and shall encourage the schools to dissemi-
nate the materials to the students of the schools. 
"(BXi) In the case of any health professional whose period 
of obligated service under the Loan Repajrment Program is 
nearing completion, the Secretary shall encourage the 
individual to remain in a health manpower shortage area 
and to continue providing primary health services. 
"(ii) During the period in which a health professional is 
planning and making the transition to private practice 
from obligated service under the Loan Repayment Pro-
gram, the Secretary may provide assistance to the profes-
sional regarding such transition if the professional is 
PUBLIC LAW 101-597—NOV. 16, 1990 
104 STAT. 3025 
remaining in a health manpower shortage area and is 
continuing to provide primary health services. 
"(C) In the case of entities to which participants in the 
Loan Repayment Program are assigned under section 333, 
the Secretary shall encourage the entities to provide op-
tions with respect to assisting the participants in remaining 
in the health manpower shortage areas involved, and in 
continuing to provide primary health services, after the 
period of obligated service under the Loan Repayment Pro-
gram is completed. The options with respect to which the 
Secretary provides such encouragement may include op-
tions regarding the sharing of a single employment position 
in the health professions by 2 or more health professionals, 
and options regarding the recruitment of couples where 
both of the individuals are health professionals.". 
(d) PRIORITY IN MAKING AWARDS.—Section 338B(d) of the Public 
Health Service Act (42 U.S.C. 2541-l(d)) is amended to read as 
follows: 
"(d)(1) Subject to section 333A, in providing contracts under the 
Loan Repayment Program— 
"(A) the Secretary shall consider the extent of the dem-
onstrated interest of the applicants for the contracts in provid-
ing primary health services; and 
"(B) may consider such other factors regarding the applicants 
as the Secretary determines to be relevant to selecting qualified 
individuals to participate in such Program. 
"(2) In providing contracts under the Loan Repayment Program, 
the Secretary shall give priority— 
"(A) to any application for such a contract submitted by an 
individual whose training is in a health profession or specialty 
determined by the Secretary to be needed by the Corps; 
"(B) to any application for such a contract submitted by an 
individual who has (and whose spouse, if any, has) characteris-
tics that increase the probability that the individual will con-
tinue to serve in a health manpower shortage area after the 
period of obligated service pursuant to subsection (f) is com-
pleted; and 
' 
"(C) subject to subparagraph (B), to any application for such a 
contract submitted by an individual who is from a disadvan-
taged background.". 
(e) CONTENTS OF CONTRACT.—Section 338B(f)(2) of the Public 
Health Service Act (42 U.S.C. 2541-l(fK2)) is amended by inserting 
before the semicolon the following: ", including extensions resulting 
in an aggregate period of obligated service in excess of 4 years". 
(f) PAYMENTS.— 
(1) CLARIFICATION REGARDING UNDERGRADUATE LOANS.—Sec-
tion 338B(g)(l) of the Public Health Service Act (42 U.S.C. 
2541-l(gXl)) is amended in the matter preceding subparagraph 
(A) by striking "loans received by the individual for—' and 
inserting the following: "loans received by the individual 
regarding the undergraduate or graduate education of the 
individual (or both), which loans were made for—". 
(2) ANNUAL AMOUNT OF REPAYMENTS.—Section 338B(g)(2) of 
the Public Health Service Act (42 U.S.C. 2541-l(g)(2)) is 
amended— 
(A) in subparagraph (A)— 
104 STAT. 3026 
PUBLIC LAW 101-597—NOV. 16, 1990 
(i) by striking "Except" and all that follows through 
"for each" and inserting "For each"; 
(ii) by striking "$20,000" and inserting "$35,000"; and 
and 
(iii) by adding at the end the following new sentence: 
"In making a determination of the amount to pay for a 
year of such service by an individual, the Secretary 
shall 
consider 
the 
extent 
to which 
each 
such 
determination— 
"(i) affects the ability of the Secretary to maximize 
the number of contracts that can be provided under the 
Loan Repa5mient Program from the amounts appro-
priated for such contracts; 
"(ii) provides an incentive to serve in health man-
power shortage areas with the greatest such shortages; 
and 
"(iii) provides an incentive with respect to the health 
professional involved remaining in a health manpower 
shortage area, and continuing to provide primary 
health services, after the completion of the period of 
obligated service under the Loan Repayment Pro-
gram,"; and 
(B) by striking subparagraph (B) and redesignating 
subparagraph (C) as subparagraph (B). 
(g) TAX LiABiuTY.— 
(1) IN GENERAL.—Section 338B(gX3) of the Public Health Serv-
ice Act (42 U.S.C. 2541-l(gX3)) is amended to read as follows: 
"(3) TAX UABIUTY.—For the purpose of providing reimburse-
ments for tax liability resulting from payments under para-
graph (2) on behalf of an individual— 
"(A) the Secretary shall, in addition to such payments, 
make payments to the individual in an amount equal to 39 
percent of the total amount of loan repayments made for 
the taxable year involved; and 
"(B) may make such additional payments as the Sec-
retary determines to be appropriate with respect to such 
purpose,". 
42 use 254Z-1, 
(2) AppucABiLiTY OF AMENDMENT,—The amendment made by 
paragraph (1) shall apply only with respect to contracts under 
section 338B of the Public Health Service Act (relating to 
service in the National Health Service Corps) that are entered 
into on or after the effective date of this Act. 
(h) REPORTS TO CONGRESS,—Section 338B(i) of the Public Health 
Service Act (42 U,S.C, 2541-l(i)) is amended to read as follows: 
"(i) REPORTS.—Not later than March 1 of each year, the Secretary 
shall submit to the Congress a report providing, with respect to the 
preceding fiscal year— 
"(1) the total amount of loan payments made under the Loan 
Repayment Program; 
(2) the number of applications filed under this section; 
"(3) the number, and type of health profession training, of 
individuals receiving loan repa3anents under such Program; 
"(4) the educational institution at which such individuals 
received their training; 
"(5) the total amount of the indebtedness of such individuals 
for educational loans as of the date on which the individuals 
become participants in such Program; 
PUBLIC LAW 101-597—NOV. 16, 1990 
104 STAT. 3027 
"(6) the number of years of obligated service specified for such 
individuals in the initial contracts under subsection (f), and, in 
the case of individuals whose period of such service has been 
completed, the total number of years for which the individuals 
served in the Corps (including any extensions made for purposes 
of paragraph (2) of such subsection); 
"(7XA) the number, and type of health professions training, of 
such individuals who have breached the contract under subsec-
tion if) through any of the actions specified in subsection (a) or 
(b) of section 338E; and 
"(B) with respect to such individuals— 
"(i) the educational institutions with respect to which 
payments have been made or were to be made under the 
contract; 
"(ii) the amounts for which the individuals are liable to 
the United States under section 338E; 
"(iii) the extent of payment by the individuals of such 
amounts; and 
"(iv) if known, the basis for the decision of the individuals 
to breach the contract under subsection (f); and 
"(8) the effectiveness of the Secretary in recruiting health 
professionals to participate in the Loan Repayment Program, 
and in encouraging and £issisting such professionals with re-
spect to providing primary health services to health manpower 
shortage areas after the completion of the period of obligated 
service under such Program.". 
SEC. 203. APPLICABILITY OF BANKRUPTCY PROVISION TO REMAINING 
CONTRACTS UNDER FORMER PROGRAM. 
(a) ESTABUSHMENT OF RULE SPECIFIC T
O FORMER PROGRAM.—Sec-
tion 338E(dX3) of the Public Health Service Act (42 U.S.C. 
254o(d)(3), is amended— 
(1) by inserting "(A)" after the paragraph designation; and 
(2) by adding at the end the following new subparagrraph: 
"(B)(i) Subparagraph (A) shall apply to any financial obligation of 
an individual under the provision of law specified in clause (ii) to the 
same extent and in the same manner as such subparagraph applies 
to any obligation of an individual under the Scholarship or Loan 
Repayment Program (or contract thereunder) for payment of dam-
ages. 
"(ii) The provision of law referred to in clause (i) is subsection (f) of 
section 225 of this Act, as in effect prior to the repeal of such section 
by section 408(bXl) of Public Law 94-484.". 
(b) APPUCABIUTY OF RULE.—With respect to any financial obliga- 42 use 254o 
tion of an individual under subsection (f) of section 225 of the Public "°*®-
Health Service Act, as in effect prior to the repeal of such section by 
section 408(bXl) of Public Law 94-484, the amendment made by 
subsection (a) of this section applies to any backruptcy proceeding in 
which discharge of such an obligation has not been granted before 
the date that is 31 days after the date of the enactment of this Act. 
SEC. 204. ESTABLISHMENT OF CORPS MEMBER REPLACEMENT FUND. 
Subpart III of part D of title III of the Public Health Service Act 
(42 U.S.C. 2541 et seq.) is amended by redesignating sections 338F 
through 338H as sections 338G through sections 3381, respectively, 
42 USC 254p, 
and by inserting after section 338E the following new section: 
254q, 254q-i. 
104 STAT. 3028 
PUBLIC LAW 101-597—NOV. 16, 1990 
42 use 2540-1. 
"SEC. 338F. FUND REGARDING USE OF AMOUNTS RECOVERED FOR CON-
TRACT BREACH TO REPLACE SERVICES LOST AS RESULT OF 
BREACH. 
"(a) EsTABUSHMENT OF FuND.—There is established in the Treas-
ury of the United States a fund to be known as the National Health 
Service Corps Member Replacement Fund (hereafter in this section 
referred to as the 'Fund'). The Fund shall consist of such amounts as 
may be appropriated under subsection (b) to the Fund. Amounts 
appropriated for the Fund shall remain available until expended. 
"(b) AUTHORIZATION OF APPROPRIATIONS TO FUND.—For each fiscal 
year, there is authorized to be appropriated to the Fund an amount 
equal to the sum of— 
"(1) the amount collected during the preceding fiscal year by 
the Federal Government pursuant to the liability of individuals 
under section 338E for the breach of contracts entered into 
under section 338A or 338B; 
"(2) the amount by which grants under section 3381 have, for 
such preceding fiscal year, been reduced under subsection 
(gX2XB) of such section; and 
"(3) the aggregate of the amount of interest accruing during 
the preceding fiscal year on obligations held in the Fund pursu-
ant to subsection (d) and the amount of proceeds from the sale 
or redemption of such obligations during such fiscal year. 
"(c) USE OF FUND.— 
"(1) PAYMENTS TO CERTAIN HEALTH PACIUTIES.—Amounts in 
the Fund and available pursuant to appropriations Act may, 
subject to paragraph (2), be expended by the Secretary to make 
payments to any entity— 
"(A) to which a Corps member has been assigned under 
section 333; and 
"(B) that has a need for a health professional to provide 
primary health services as a result of the Corps member 
having breached the contract entered into under section 
338A or 338B by the individual. 
"(2) PURPOSE OF PAYMENTS.—An entity receiving pajnnents 
pursuant to paragraph (1) may expend the pajnnents to recruit 
and employ a health professional to provide primary health 
services to patients of the entity, or to enter into a contract with 
such a professional to provide the services to the patients. 
"(d) INVESTMENT.— 
"(1) IN GENERAL.—The Secretary of the Treasury shall invest 
such amounts of the Fund as such Secretary determines are not 
required to meet current withdrawals from the Fund. Such 
investments may be made only in interest-bearing obligations of 
the United States. For such purpose, such obligations may be 
acquired on original issue at the issue price, or by purchase of 
outstanding obligations at the market price. 
"(2) SALE OF OBUGATIONS.—Any obligation acquired by the 
Fund may be sold by the Secretary of the Treasury at the 
market price.". 
SEC. 205. REPORT AND AUTHORIZATION OF APPROPRIATIONS. 
(a) REPORT.— 
(1) DATE FOR REPORT.—Section 338H(a) of the Public Health 
Service Act, as redesignated by section 204 of this Act, is 
amended in the matter preceding paragraph (1) by striking 
"January 20" and inserting "March 1 . 
PUBLIC LAW 101-597—NOV. 16, 1990 
104 STAT. 3029 
(2) INCREASE IN PERIOD FOR WHICH NEEDS PROJECTED.—Section 
338H(a) of the Public Health Service Act, as redesignated by 
section 204 of this Act, is amended in paragraphs (1) and (2) by 
striking "3 fiscal years" each place such term appears and 
inserting "5 fiscal years", 
(b) FUNDING.—Section 338H(b) of the Public Health Service Act, 
as redesignated by section 203 of this Act, is amended to read as 
follows: 
"(b) FUNDING.— 
"(1) AUTHORIZATION OF APPROPRIATIONS.—For the purpose of 
carrying out this subpart, there are authorized to be appro-
priated $63,900,000 for fiscal year 1991, and such sums as may 
be necessary for each of the fiscal years 1992 through 2000. 
"(2) RESERVATION OF AMOUNTS.— 
"(A) 
SCHOLARSHIPS FOR 
NEW 
PARTICIPANTS.—Of 
the 
amounts appropriated under paragraph (1) for a fiscal year, 
the Secretary shall obligate not less than 30 percent for the 
purpose of providing contracts for scholarships under this 
subpart to individuals who have not previously received 
such scholarships. 
"(B) 
SCHOLARSHIPS FOR FIRST-YEAR STUDY IN CERTAIN 
FIELDS.—With respect to certification as a nurse practi-
tioner, nurse midwife, or physician assistant, the Secretary 
shall, of the amounts appropriated under paragraph (1) for 
a fiscal year, obligate not less than 10 percent for the 
purpose of providing contracts for scholarships under this 
subpart to individuals who are entering the first year of 
study in a course of study or program described in subsec-
tion 338A(b)(l)(B) that leads to such a 
certification. 
Amounts obligated under this subparagraph shall be in 
addition to amounts obligated under subparagraph (A).". 
TITLE III—GRANTS TO STATES FOR IM-
PROVEMENTS 
REGARDING 
HEALTH 
SERVICES 
SEC. 301. ESTABLISHMENT OF PROGRAM FOR STATE LOAN REPAYMENTS 
REGARDING SERVICE IN HEALTH MANPOWER SHORTAGE 
AREAS. 
Section 3381 of the Public Health Service Act, as redesignated by 
section 204 of this Act, is amended to read as follows: 
"SEC. 3381. GRANTS TO STATES FOR LOAN REPAYMENT PROGRAMS. 
"(a) IN GENERAL.— 
"(1) AUTHORITY FOR GRANTS.—The Secretary, acting through 
the Administrator of the Health Resources and Services 
Administration, may make grants to States for the purpose of 
assisting the States in operating programs described in para-
graph (2) in order to provide for the increased availability of 
primary health services in health manpower shortage areas. 
"(2) LOAN REPAYMENT PROGRAMS.—The programs referred to 
in paragraph (1) are, subject to subsection (c), programs of 
entering into contracts under which the State involved agrees to 
pay all or part of the principal, interest, and related expenses of 
the educational lo£ms of health professionals in consideration of 
104 STAT. 3030 
PUBLIC LAW 101-597—NOV. 16, 1990 
the professionals agreeing to provide primary health services in 
health manpower shortage areas. 
"(3) DIRECT ADMINISTRATION BY STATE AGENCY.—The Secretary 
may not make a grant under pareigraph (1) unless the State 
involved agrees that the program operated with the grant will 
be administered directly by a State agency. 
"(b) REQUIREMENT OF MATCHING FUNDS.— 
"(1) IN GENERAL.—The Secretary may not make a grant under 
subsection (a) unless the State agrees that, with respect to the 
costs of making pajmients on behalf of individuals under con-
tracts made pursuant to paragraph (2) of such subsection, the 
State will make available (directly or through donations from 
public or private entities) non-Federal contributions in cash 
toward such costs in an amount equal to not less than $1 for 
each $1 of Federal funds provided in the grant. 
"(2) DETERMINATION OF AMOUNT OF NON-FEDERAL CONTRIBU-
TION.—In determining the amount of non-Federal contributions 
in cash that a State has provided pursuant to paragraph (1), the 
Secretary may not include £my amounts provided to the State 
by the Federal Government. 
"(c) COORDINATION WITH FEDERAL PROGRAM.— 
"(1) ASSIGNMENTS FOR HEALTH MANPOWER SHORTAGE AREAS 
UNDER FEDERAL PROGRAM.—The Secretary may not make a 
grant under subsection (a) unless the State involved agrees that, 
in carrying out the program operated with the grant, the State 
will assign health professionals participating in the program 
only to public and nonprofit private entities located in and 
providing health services in health manpower shortEige areas. 
"(2) REMEDIES FOR BREACH OF CONTRACTS.—The Secretary may 
not make a grant under subsection (a) unless the State involved 
agrees that the contracts provided by the State pursuant to 
paragraph (2) of such subsection will provide remedies for any 
breach of the contracts by the health professionals involved. 
"(3) LIMITATION REGARDING CONTRACT INDUCEMENTS.— 
"(A) Except as provided in subparagraph (B), the Sec-
retary may not make a grant under subsection (a) unless 
the State involved agrees that the contracts provided by the 
State pursuant to paragraph (2) of such subsection will not 
be provided on terms that are more favorable to health 
professionals than the most favorable terms that the Sec-
retary is authorized to provide for contracts under the Loan 
Repayment Program under section 338B, including terms 
regarding— 
"(i) the annual amount of payments provided on 
behalf of the professionals regarding educational loans; 
and 
"(ii) the availability of remedies for any breach of the 
contracts by the health professionals involved. 
"(B) With respect to the limitation established in 
subparagraph (A) regarding the annual amount of pay-
ments that may be provided to a health professional under 
a contract provided by a State pursuant to subsection (aX2), 
such limitation shall not apply with respect to a contract 
if— 
"(i) the excess of such annual payments above the 
maximum amount authorized in section 338B(g)(2)(A) 
for annual payments regarding contracts is paid solely 
PUBLIC LAW 101-597—NOV. 16, 1990 
' 
104 STAT. 3031 
from non-Federal contributions under subsection (b); 
and 
"(ii) the contract provides that the health profes-
sional involved will satisfy the requirement of obligated 
service under the contract solely through the provision 
of primary health services in a health manpower 
shortage area that is receiving priority for purposes of 
section 333A(aXl) and that is authorized to receive 
assignments under section 333 of individuals who are 
participating in the Scholarship Program under section 
338A. 
"(d) RESTRICTIONS ON USE OF FUNDS.—The Secretary may 
not 
make a grant under subsection (a) unless the State involved agrees 
that the grant will not be expended— 
"(1) to conduct activities for which Federal funds are 
expended— 
"(A) within the State to provide technical or other non-
financial assistance under subsection (f) of section 330; 
"(B) under a memorandum of agreement entered into 
with the State under subsection (h) of such section; or 
"(C) under a grant under section 338J; or 
"(2) for any purpose other than making pa3m:ients on behalf of 
health professionals under contracts entered into pursuant to 
subsection (aX2). 
"(e) REPORTS.—The Secretary may not make a grant under subsec-
tion (a) unless the State involved agrees— 
"(1) to submit to the Secretary reports providing the same 
tjrpes of information regarding the program operated pursuant 
to such subsection as reports submitted pursuant to subsection 
(i) of section 338B provide regarding the Loan Repa3mient Pro-
gram under such section; and 
"(2) to submit such a report not later than January 10 of each 
fiscal year immediately following any fiscal year for which the 
State has received such a grant. 
"(f) REQUIREMENT OF APPUCATION.—The Secretary may not make 
a grant under subsection (a) unless an application for the grant is 
submitted to the Secretary and the application is in such form, is 
made in such manner, and contains such agreements, assurances, 
and information as the Secretary determines to be necessary to 
carry out such subsection. 
"(g) NONCOMPLIANCE.— 
"(1) IN GENERAL.—The Secretary may not make payments 
under subsection (a) to a State for smy fiscal year subsequent to 
the first fiscal year of such pajmients unless the Secretary 
determines that, for the immediately preceding fiscal year, the 
State has complied with each of the agreements made by the 
State under this section. 
"(2) REDUCTION IN GRANT RELATIVE TO NUMBER OF BREACHED 
CONTRACTS.— 
"(A) Before making a grant under subsection (a) to a 
State for a fiscal year, the Secretary shall determine the 
number of contracts provided by the State under paragraph 
(2) of such subsection with respect to which there has been 
an initial breach by the health professionals involved 
during the fiscal year preceding the fiscal year for which 
the State is applying to receive the grant. 
104 STAT. 3032 
PUBLIC LAW 101-597—NOV. 16,1990 
"(B) Subject to paragraph (3), in the case of a State with 1 
or more initial breaches for purposes of subparagraph (A), 
the Secretary shall reduce the amount of a grant under 
subsection (a) to the State for the fiscal year involved by an 
amount equal to the sum of the expenditures of Federal 
funds made regarding the contracts involved and an 
amount representing interest on the amount of such 
expenditures, determined with respect to each contract on 
the basis of the maximum legal rate prevailing for loans 
made during the time amounts were paid under the con-
tract, as determined by the Treasurer of the United States. 
"(3) WAIVER REGARDING REDUCTION IN GRANT.—The Secretary 
may waive the requirement established in paragraph (2XB) with 
respect to the initial breach of a contract if the Secretary 
determines that such breach by the health professional involved 
was attributable solely to the professional having a serious 
illness. 
"(h) DEFINITIONS.—For purposes of this section, the term 'State' 
means each of the several States, 
"(i) AUTHORIZATION OF APPROPRIATIONS.— 
"(1) IN GENERAL.—For the purpose of making grants under 
subsection (a), there is authorized to be appropriated $10,000,000 
for each of the fiscal years 1991 through 1995. 
"(2) AVAILABIUTY.—Amounts appropriated under parsigraph 
(1) shall remain available until expended.". 
SEC. 302. ESTABLISHMENT OF PROGRAM OF GRANTS TO STATES. 
Subpart III of part D of title III of the Public Health Service Act, 
as amended by section 204 of this Act, is amended by redesignating 
42 use 254s. 
section 338J as section 338K, and by inserting after section 3381 the 
following new section: 
42 use 254r. 
"SEC. 338J. GRANTS TO STATES FOR OPERATION OF OFFICES OF RURAL 
HEALTH. 
"(a) IN GENERAL.—The Secretary, acting through the Director of 
the Office of Rural Health Policy (established in section 711 of the 
Social Security Act), may make grants to States for the purpose of 
improving health care in rural areas through the operation of State 
offices of rural health. 
"(b) REQUIREMENT OF MATCHING FUNDS.— 
"(1) IN GENERAL.—The Secretary may not make a grant under 
subsection (a) unless the State involved agrees, with respect to 
the costs to be incurred by the State in carrying out the purpose 
described in such subsection, to provide non-Federal contribu-
tions in cash toward such costs in an amount equal to— 
"(A) for the first fiscal year of pasonents under the grant, 
not less than $1 for each $3 of Federal funds provided in the 
grant; 
"(B) for any second fiscal year of such pa3mients, not less 
than $1 for each $1 ®
f Federal funds provided in the grant; 
and 
"(C) for any third fiscal year of such pasnnents, not less 
than $3 for each $1 of Federal funds provided in the grant. 
"(2) DETERMINATION OF AMOUNT OF NON-FEDERAL CONTRIBU-
TION.— 
"(A) Subject to subparagraph (B), non-Federal contributions 
required in paragraph (1) may be in cash or in kind, fairly 
PUBLIC LAW 101-597—NOV. 16, 1990 
104 STAT. 3033 
evaluated, 
including 
plant, 
equipment, 
or 
services. 
Amounts provided by the Federal Government, or services 
assisted or subsidized to any significant extent by the Fed-
eral Government, may not be included in determining the 
amount of such non-Federal contributions. 
"(B) The Secretary may not make a grant under subsec-
tion (a) unless the State involved agrees that— 
"(i) for the first fiscal year of pajrments under the 
grant, 100 percent or less of the non-Federal contribu-
tions required in paragraph (1) will be provided in the 
form of in-kind contributions; 
"(ii) for any second fiscal year of such payments, not 
more than 50 percent of such non-Federal contributions 
will be provided in the form of in-kind contributions; 
and 
"(iii) for any third fiscal year of such payments, such 
non-Federal contributions will be provided solely in the 
form of cash. 
"(c) CERTAIN REQUIRED ACTIVITIES.—The Secretary may not make 
a grant under subsection (a) unless the State involved agrees that 
activities carried out by an office operated pursuant to such subsec-
tion will include— 
"(1) establishing and maintaining within the State a clearing-
house for collecting and disseminating information on— 
"(A) rural health care issues; 
"(B) research findings relating to rural health care; and 
"(C) innovative approaches to the delivery of health care 
in rural areas; 
"(2) coordinating the activities carried out in the State that 
relate to rural health care, including providing coordination for 
the purpose of avoiding redundancy in such activities; and 
"(3) identifjdng Federal and State programs regarding rural 
health, and providing technical assistance to public and non-
profit private entities regarding participation in such programs. 
"(d) REQUIREMENT REGARDING ANNUAL BUDGET FOR OFFICE.—The 
Secretary may not make a grant under subsection (a) unless the 
State involved agrees that, for any fiscal year for which the State 
receives such a grant, the office operated pursuant to subsection (a) 
will be provided with an annual budget of not less than $50,0()0. 
"(e) CERTAIN USES OF FUNDS.— 
"(1) RESTRICTIONS.—The Secretary may not make a grant 
under subsection (a) unless the State involved agrees that— 
"(A) if research with respect to rural health is conducted 
pursuant to the grant, not more than 10 percent of the 
grant will be expended for such research; and 
"(B) the grant will not be expended— 
"(i) to provide health care (including providing cash 
pavments regarding such care); 
'(ii) to conduct activities for which Federal funds are 
expended— 
"(I) within the State to provide technical and 
other nonfinancial assistance under subsection (f) 
of section 330; 
"(II) under a memorandum of agreement entered 
into with the State under subsection (h) of such 
section; or 
"(III) under a grant under section 3381; 
104 STAT. 3034 
PUBLIC LAW 101-597—NOV. 16, 1990 
"(iii) to purchase medical equipment, to purchase 
ambulances, aircraft, or other vehicles, or to purchase 
major communications equipment; 
"(iv) to purchase or improve real property; or 
"(v) to carry out any activity regarding a certificate 
of need. 
"(2) AUTHORITIES.—Activities for which a State may expend a 
grant under subsection (a) include— 
"(A) pajdng the costs of establishing an office of rural 
health for purposes of subsection (a); 
"(B) subject to paragraph (IXBXiiXIII), pa3dng the costs of 
any activity carried out with respect to recruiting and 
retaining health professionals to serve in rural areas of the 
State; and 
"(C) providing grants and contracts to public and non-
profit private entities to carry out activities authorized in 
this section. 
"(f) REPORTS.—The Secretary may not make a grant under subsec-
tion (a) unless the State involved agrees— 
"(1) to submit to the Secretary reports containing such 
information as the Secretary may require regarding activities 
carried out under this section by the State; and 
"(2) to submit such a report not later than January 10 of each 
fiscal year immediately following any fiscal year for which the 
State has received such a grant. 
"(g) REQUIREMENT OF APPUCATION.—The Secretary may not make 
a grant under subsection (a) unless an application for the grant is 
submitted to the Secretary and the application is in such form, is 
made in such manner, and contains such agreements, assurances, 
and information as the Secretary determines to be necessary to 
carry out such subsection. 
"(h) NoNCOMPUANCE.—The Secretary may not make payments 
under subsection (a) to a State for any fiscal year subsequent to the 
first fiscal year of such pa3mients unless the Secretary determines 
that, for the immediately preceding fiscal year, the State has com-
plied with each of the agreements made by the State under this 
section. 
"(i) DEFINITIONS.—For purposes of this section, the term 'State' 
means each of the several States, 
"(j) AUTHORIZATION OF APPROPRIATIONS.— 
"(1) IN GENERAL.—For the purpose of making grants under 
subsection (a), there are authorized to be 
appropriated 
$8,000,000 for fiscal year 1991, $4,000,000 for fiscal year 1992, 
and $3,000,000 for fiscal year 1993. 
"(2) AvAiLABiUTY.—Amounts appropriated under paragraph 
(1) shall remain available until expended. 
"(k) TERMINATION OF PROGRAM.—No grant may be made under 
this section after the aggregate amounts appropriated under subsec-
tion (jXD are equal to $10,000,000.". 
PUBLIC LAW 101-597—NOV. 16, 1990 
104 STAT. 3035 
TITLE 
IV—HEALTH 
PROFESSIONAL 
SHORTAGE 
AREAS 
SEC. 401. MODIFICATION 
REGARDING 
TERM 
"HEALTH 
MANPOWER 
SHORTAGE AREA". 
(b) PuBuc HEALTH SERVICE ACT.— 
(1) The Public Health Service Act, £is amended by the preced-
ing provisions of this Act, is amended in each of the provisions 
specified in paragraph (2)— 
(A) by striking "health manpower shortage area" each 
place such term appears and inserting "health professional 
shortage area"; and 
(B) in the case of each variation of the term "health 
manpower shortage area" that results from the capitaliza-
tion of any of the letters of such term, from the use of the 
plural, from the use of the possessive, or from the use of 
different forms of typeface, or from any combination 
thereof, by striking each such variation each place the 
variation appears and inserting the analogous variation of 
the term "health professional shortage area". 
(2) The provisions of the Public Health Service Act referred to 
in paragraph (1) are sections 303(dX2)(B), 331, 332, 333, 333A, 42 USC 242a, 
334, 335, 336(a), 336A, 338A, 338B, 338C, 338D, 338G(aXl), 3381, 254d-2^i, 
735, 741(fKlXC), 759(a), 781(a)(2)(B)(iii), and 822. 
ilq-i 294h, ' 
(b) UNIFORMED SERVICES HEALTH PROFESSIONS REVITALIZATION 294n, 294aa, 
ACT OF 1972.—Section 2123(e) of title 10, United States Code, is 295q-i, 296m. 
amended by striking out "an area of health manpower shortage" 
and inserting in lieu thereof "a health professional shortage area". 
(c) SOCIAL SECURITY ACT.—The Social Security Act is amended— 
(1) in section 1156(b)(5), by striking "health manpower short-
age area (HMSA)" and inserting "health professional shortage 
area"; and 
(2) in sections 1833(m), 1842(bX4XF), and 1861 (42 U.S.C. 
13951(m), 1395u(bX4XF), and 1395x), by striking "health man-
power shortEige area" each place such term appears and insert-
ing "health professional shortage area". 
(d) COMPREHENSIVE HEALTH MANPOWER TRAINING ACT OF 1971.— 
Section 202 of the Comprehensive Health Manpower Training Act of 
1971 (42 U.S.C. 3505d) is amended— 
(1) by striking out the section heading and inserting in lieu 
thereof the following: 
"NATIONAL HEALTH PROFESSIONAL SHORTAGE CLEARINGHOUSE"; 
and 
(2) in subsection (a), by striking out "Manpower" and insert-
ing in lieu thereof "Professional". 
(e) HEAD START ACT.—Section 645(aX2XB) of the Head Start Act 
(42 U.S.C. 9840(aX2XB)) is amended by striking "health manpower 
shortage area" and inserting "health professional shortage area". 
104 STAT. 3036 
PUBLIC LAW 101-597—NOV. 16, 1990 
TITLE V—GENERAL PROVISIONS 
42 u s e 242a 
SEC. 501. EFFECTIVE DATE. 
This Act and the amendments made by this Act shall take effect 
October 1, 1990, or upon the date of the enactment of this Act, 
whichever occurs later. 
Approved November 16, 1990. 
LEGISLATIVE HISTORY—H.R. 4487 (S. 2617): 
HOUSE REPORTS: No. 101-642 (Comm. on Energy and Commerce) and No. 101-945 
(Comm. of Conference). 
SENATE REPORTS: No. 101-370 accompanying S. 2617 (Comm. on Labor and Human 
Resources). 
CONGRESSIONAL RECORD, Vol. 136 (1990): 
July 30, considered and passed House. 
Aug. 4, considered and passed Senate, amended, in lieu of S. 2617. 
Oct. 26, House and Senate agreed to conference report. 
o