Health Professions Education Extension Amendments of 1992
PL 102-408 (H.R.3508), enacted 10/13/1992

106 STAT. 1992 
PUBLIC LAW 102-408—OCT. 13, 1992 
Public Law 102-408 
102d Congress 
An Act 
Oct. 13, 1992 
[H.R. 3508] 
Health 
Professions 
Education 
Extension 
Amendments 
of 1992. 
42 u s e 201 note. 
To amend the Public Health Service Act to revise and extend certain programs 
relating to the education of individuals as health professionals, and for other 
purposes. 
Be it enacted by the Senate and House of Representatives of 
the United States of 
America in Congress assembled, 
SECTION 1. SHORT TITLE; TABLE OF CONTENTS. 
(a) SHORT TITLE.—This Act may be cited as the "Health Profes-
sions Education Extension Amendments of 1992". 
(b) TABLE OF CONTENTS.—The table of contents for this Act 
is as follows: 
Sec. 1. Short title; table of contents. 
TITLE I—HEALTH PROFESSIONS EDUCATION 
Sec. 101. Table of contents regarding revised title VII of Public Health Service Act. 
Sec. 102. Revisionoftitle VII of Public Health Service Act. 
Sec. 103. Effective date. 
TITLE II—NURSE EDUCATION 
Sec. 201. Short title. 
Sec. 202. Special project grants and contracts. 
Sec. 203. Advanced nurse education. 
Sec. 204. Nurse practitioner and nurse midwife programs. 
Sec. 205. Special projects regarding disadvantaged individuals. 
Sec. 206. Traineeships for advanced education of professional nurses. 
Sec. 207. Nurse anesthetists. 
Sec. 208. Student loans. 
Sec. 209. Certain generally applicable provisions. 
Sec. 210. Demonstration program regarding service in certain health care facilities. 
Sec. 211. Transfer of loan repajrment program. 
Sec. 212. Advisory council on nurses education; review committee. 
Sec. 213. Evaluations. 
TITLE III—MISCELLANEOUS PROVISIONS 
Sec. 301. Advisory Council on Graduate Medical Education. 
Sec. 302. Commission on allied health. 
Sec. 303. Study regarding clinical laboratory technologists for medically under-
served and rural communities. 
., 
> 
Sec. 304. Residency training programs in emergency medicine. 
Sec. 305. Certain clinical traineeships. 
Sec. 306. Special consolidated loan program. 
Sec. 307. National Advisory Coimcil on Medical Licensure. 
Sec. 308. Required assurances regarding bloodbome diseases. 
Sec. 309. Study on effectiveness of health professions programs. 
Sec. 310. Delayed applicability of certain provisions. 
Sec. 311. Certain application procedures. 
Sec. 312. Certain projects. 
TITLE I—HEALTH PROFESSIONS 
EDUCATION 
SEC. 101. TABLE OF CONTENTS REGARDING REVISED TITLE VH OF 
PUBUC HEALTH SERVICE ACT. 
A table describing the contents of title VII of the Public Health 
Service Act, as amended by section 102 of this Act, is as follows: 
PUBLIC LAW 102-408—OCT. 13, 1992 
106 STAT. 1993 
TITLE VII—HEALTH PROFESSIONS EDUCATION 
PART A—STUDENT LOANS 
Subpart I—Insured Health Education Assistance Loans to Graduate Students 
Sec. 701. Statement of purpose. 
Sec. 702. Scope and duration of loan insurance program. 
Sec. 703. Limitations on individual insured loans and on loan insurance. 
Sec. 704. Sources of funds. 
Sec. 705. Eligibility of borrowers and terms of insured loans. 
Sec. 706. Certificate of loan insurance; effective date of insurance. 
Sec. 707. Default of borrower. 
Sec. 708. Risk-based premiums. 
Sec. 709. Office for Health Education Assistance Loan Default Reduction. 
Sec. 710. Insurance account. 
Sec. 711. Powers and responsibilities of Secretary. 
Sec. 712. Participation by Federal credit unions in Federal, State, and private stu-
dent loan insurance programs. 
Sec. 713. Determination of eligible students. 
Sec. 714. Repayment by Secretary of loans of deceased or disabled borrowers. 
Sec. 715. Additional requirements for institutions and lenders. 
Sec. 719. Definitions. 
Sec. 720. Authorization of appropriations. 
Subpart II—Federally-Supported Student Loan Funds 
Sec. 721. Agreements for operation of school loan funds. 
Sec. 722. Loan provisions. 
Sec. 723. Medical schools and primary health care. 
Sec. 724. Individuals from disadvantaged backgrounds. 
Sec. 725. Administrative provisions. 
Sec. 726. Provision by schools of information to students. 
Sec. 727. Procedures for appeal of termination of agreements. 
Sec. 728. Distribution of assets from loan funds. 
Sec. 735. Authorization of appropriations; certain other funding issues. 
PART B—STUDENTS FROM DISADVANTAGED BACKGROUNDS 
Sec. 736. Scholarships for students of exceptional financial need. 
Sec. 737. Scholarships generally; certain other purposes. 
Sec. 738. Loan repayments and fellowships regarding faculty positions. 
Sec. 739. Centers of excellence. 
Sec. 740. Educational assistance regarding undergraduates. 
PART C—^TRAINING IN PRIMARY HEALTH CARE 
Sec. 746. Area health education center programs. 
Sec. 747. Family medicine. 
Sec. 748. General internal medicine and general pediatrics. 
Sec. 749. Greneral practice of dentistry. 
Sec. 750. Physician assistants. 
Sec. 751. Pediatric medicine. 
Sec. 752. General provisions for certain programs. 
PART D—TRAINING IN CERTAIN HEALTH PROFESSIONS 
Subpart I—Public Health and Preventive Medicine 
Sec. 761. Public health traineeships. 
Sec. 762. Public health special projects. 
Sec. 763. Preventive medicine; dental public health. 
Sec. 765. Authorization of appropriations. 
Subpart II—^Allied Health Professions 
Sec. 766. Traineeships. 
Sec. 767. Project grants and contracts. 
Subpart III—Health Administration 
Sec. 771. Traineeships and special projects. 
PART E—SPECIAL TRAINING PROJECTS 
Sec. 776. Acquired immune deficiency syndrome. 
Sec. 777. Geriatrics. 
Sec. 778. Rural areas. 
106 STAT. 1994 
PUBLIC LAW 102-408—OCT. 13, 1992 
PART F—MISCELLANEOUS PROGRAMS 
Sec. 781. Research on certain health professions issues. 
Sec. 782. Chiropractic demonstration projects. 
PARTG—GENERAL PROVISIONS 
Sec. 791. Preferences and required information in certain programs. 
Sec. 792. Health professions data. 
Sec. 793. Statistics; annual report. 
Sec. 794. Prohibition against discrimination on basis of sex. 
Sec. 795. Obligated service regarding certain programs. 
Sec. 798. Certain general provisions. 
Sec. 799. Definitions. 
SEC. 102. REVISION OF TITLE VII OF PUBUC HEALTH SERVICE ACT. 
Title VII of the Public Health Service Act (42 U.S.C. 292a 
et seq.) is amended to read as follows: 
"TITLE VII—HEALTH PROFESSIONS 
EDUCATION 
"PART A—STUDENT LOANS 
''Subpart I—^Insured Health Education Assistance 
Loans to Graduate Students 
42 use 292. 
"SEC. 701. STATEMENT OF PURPOSE. 
'The purpose of this subpart is to enable the Secretary to 
provide a Federal program of student loan insurance for students 
in (and certain former students of) eligible institutions (as defined 
in section 719). 
42 use 292a. 
"SEC. 702. SCOPE AND DURATION OF LOAN INSURANCE PROGRAM. 
"(a) IN GENERAL.—^The total principal amount of new loans 
made and installments paid pursuant to lines of credit (as defined 
in section 719) to borrowers covered by Federal loan insurance 
imder this subpart shall not exceed $350,000,000 for fiscal year 
1993, $375,000,000 for fiscal year 1994, and $425,000,000 for fiscal 
year 1995. If the total amoimt of new loans made and installments 
paid pursuant to lines of credit in any fiscal year is less than 
the ceiling established for such year, the difference between the 
loans made and installments paid and the ceiling shall be carried 
over to the next fiscal year and added to the ceiling applicable 
to that fiscal year, and if in any fiscal year no ceiling has been 
established, any difiTerence carried over shall constitute the ceiling 
for making new loans (including loans to new borrowers) and paying 
installments for such fiscal year. Thereafter, Federal loan insurance 
pursuant to this subpart may be granted only for loans made 
(or for loan installments paid pursuant to lines of credit) to enable 
students, who have obtained prior loans insured under this subpart, 
to continue or complete their educational program or to obtain 
a loan under section 705(a)(lXB) to pay interest on such prior 
loans; but no insurance may be granted for any loan made or 
installment paid after September 30, 1998. The total principal 
amount of Federal loan insurance available under this subsection 
shall be granted by the Secretary without regard to any apportion-
ment for the purpose of chapter 15 of title 31, United States 
Code, and without regard to any similar limitation. 
PUBLIC LAW 102-408—OCT. 13, 1992 
106 STAT. 1995 
"(b) CERTAIN LIMITATIONS AND PRIORITIES.— 
"(1) LIMITATIONS REGARDING LENDERS, STATES, OR AREAS.— 
The Secretary may, if necessary to assure an equitable distribu-
tion of the benefits of this subpart, assign, within the maximum 
amounts specified in subsection (a). Federal loan insurance 
quotas applicable to eligible lenders, or to States or areas, 
and may nrom time to time reassign unused portions of these 
quotas. 
"(2) PRIORITY FOR CERTAIN LENDERS.—In providing certifi-
cates of insurance under section 706 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 
eligible lenders are generally making such loans during 
such period. 
"(c) AUTHORITY OF STUDENT LOAN MARKETING ASSOCIATION.— 
"(1) IN GENERAL.—Subject to paragraph (2), the Student 
Loan Marketing Association, established under part B of title 
IV of the Higher Education Act of 1965, is authorized to make 
advances on the security of, purchase, service, sell, consolidate, 
or otherwise deal in loans which are insured by the Secretary 
under this subpart, except that if any loan made imder this 
subpart is included in a consolidated loan pursuant to the 
authority of the Association under part B of title IV of the 
Higher Education Act of 1965, the interest rate on such consoli-
dated loan shall be set at the weighted average interest rate 
of all such loans offered for consolidation and the resultant 
per centum shall be rounded downward to the nearest one-
eighth of 1 per centum, except that the interest rate shall 
be no less than the applicable interest rate of the guaranteed 
student loan program established under part B of title IV 
of the Higher Education Act of 1965. In the case of such 
a consolidated loan, the borrower shall be responsible for any 
interest which accrues prior to the beginning of the repayment 
period of the loan, or which accrues during a period in which 
principal need not be paid (whether or not such principal is 
in fact paid) by reason of any provision of the Higher Education 
Act of 1965. 
"(2) APPLICABILITY OF CERTAIN FEDERAL REGULATIONS.— 
With respect to Federal regulations for lenders, this subpart 
may not be construed to preclude the applicability of such 
regulations 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, con-
tracts, and due diligence. 
•«EC. 703. LIMITATIONS ON INDIVIDUAL INSURED LOANS AND ON 
42 USC 292B. 
LOAN INSURANCE. 
"(a) IN GENERAL.—^The total of the loans made to a student 
in any academic year or its equivalent (as determined by the Sec-
retary) which may be covered by Federal loan insurance under 
this subpart may not exceed $20,000 in the case of a student 
106 STAT. 1996 
PUBLIC LAW 102-408—OCT. 13, 1992 
enrolled in a school of medicine, osteopathic medicine, dentistry, 
veterinary medicine, optometry, or podiatric medicine, and $12,500 
in the case of a student enrolled in a school of pharmacy, public 
health, allied health, or chiropractic, or a graduate program in 
health administration or clinical psychology. Trie aggregate insured 
unpaid principal amount for all such insured loans made to any 
borrower shall not at any time exceed $80,000 in the case of 
a borrower who is or was a student enrolled in a school of medicine, 
osteopathic medicine, dentistry, veterinary medicine, optometry, or 
podiatric medicine, and $50,000 in the case of a borrower who 
is or was a student enrolled in a school of pharmacy, public health, 
allied health, or chiropractic, or a graduate program in health 
administration or clinical psychology. The annual insurable limit 
per student shall not be exceeded mr a line of credit under which 
actual payments by the lender to the borrower will not be made 
in any year in excess of the annual limit. 
"(b) EXTENT OF INSURANCE LIABILITY.—^The insurance liability 
on any loan insured by the Secretary under this subpart shall 
be 100 percent of the unpaid balance of the principal amount 
of the loan plus interest. The full faith and credit of the United 
States is pledged to the pa3nnent of all amounts which may be 
required to be paid under the provisions of section 707 or 714. 
42 use 292c. 
«SEC. 704. SOURCES OF FUNDS. 
"Loans made bv eligible lenders in accordance with this subpart 
shall be insurable oy the Secretary whether made from funds mlly 
owned by the lender or from funds held by the lender in a trust 
or similar capacity and available for such loans. 
42 use 292d. 
'^EC. 705. EUGIBILITY OF BORROWERS AND TERMS OF INSURED 
LOANS. 
"(a) IN GENERAL.—^A loan by an eligible lender shall be insur-
able by the Secretary under the provisions of this subpart only 
if— 
"(1) made to— 
"(A) a student who— 
"(iXD has been accepted for enrollment at an 
eligible institution, or (II) in the case of a student 
attending an eligible institution, is in good standing 
at that institution, as determined by the institution; 
"(ii) is or will be a full-time student at the eligible 
institution; 
"(iii) has agreed that all funds received under such 
loan shall be used solely for tuition, other reasonable 
educational expenses, including fees, books, and labora-
tory expenses, and reasonable living expenses, incurred 
by such students; 
"(iv) if required under section 3 of the Military 
Selective Service Act to present himself for and submit 
to registration under such section, has presented him-
self and submitted to registration under such section; 
and 
"(v) in the case of a pharmacy student, has satisfac-
torily completed three years of training; or 
"(B) an individual who— 
"(i) has previously had a loan insured under this 
subpart when the individual was a full-time student 
at an eligible institution; 
PUBLIC LAW 102-408—OCT. 13, 1992 
106 STAT. 1997 
**(ii) is in a period during which, pursuant to para-
graph (2), the principal amoimt of such previous loan 
need not be paia; 
"(iii) has agreed that all funds received under the 
proposed loan shall be used solely for repajnnent of 
interest due on previous loans made under this sub-
part; and 
"(iv) if required under section 3 of the Military 
Selective Service Act to present himself for and submit 
to registration under such section, has presented him-
self and submitted to registration imder such section; 
"(2) evidenced by a note or other written agreement which— 
"(A) is made without security and without endorse-
ment, except that if the borrower is a minor and such 
note or other written agreement executed by him would 
not, imder the applicable law, create a binding obligation, 
an endorsement may be required; 
"(B) provides for repayment of the principal amount 
of the loan in installments over a period of not less than 
10 years (unless sooner repaid) nor more than 25 years 
beginning not earlier than 9 months nor later than 12 
months sSler the date of— 
"(i) the date on which— 
"(I) the borrower ceases to be a participant 
in an accredited internship or residency program 
of not more than four years in duration; 
"(II) the borrower completes the fourth year 
of an accredited internship or residency program 
of more than four years in duration; or 
"(III) the borrower, if not a participant in a 
program described in subclause (I) or (II), ceases 
to carry, at an eligible institution, the normal full-
time academic workload as determined by the 
institution; or 
"(ii) the date on which a borrower who is a grad-
uate of an eli^ble institution ceases to be a participant 
in a fellowship training program not in excess of two 
years or a participant in a full-time educational activity 
not in excess of two years, which— 
"(I) is directly related to the health profession 
for which the borrower prepared at an eligible 
institution, as determined by the Secretary; and 
"(II) may be engaged in by the borrower during 
such a two-year period which begins within twelve 
months after the completion of the borrower's 
participation in a program described in subclause 
(I) or (II) of clause (i) or prior to the completion 
of the borrower's participation in such program, 
except as provided in subparagraph (C), except that the 
period of the loan may not exceed 33 years from the date 
of execution of the note or written agreement evidencing 
it, and except that the note or other written instrument 
may contain such provisions relating to repayment in the 
event of default in the payment of interest or in the pay-
ment of the costs of insurance premiums, or other demult 
by the borrower, as may be authorized by regulations of 
the Secretary in effect at the time the loan is made; 
106 STAT. 1998 
PUBLIC LAW 102-408—OCT. 13, 1992 
Regulations. 
"(C) provides that periodic installments of principal 
and interest need not be paid, but interest shall accrue, 
during any period (i) during which the borrower is pursuing 
a full-time course of study at an eligible institution (or 
at an institution defined by section 481(a) of the Higher 
Education Act of 1965); (ii) not in excess of four years 
during which the borrower is a participant in an accredited 
internship or residency program (including any period in 
such a program described in subclause (I) or subclause 
(II) of subparagraph (B)(i)); (iii) not in excess of three 
years, during which the borrower is a member of the Armed 
Forces of the United States; (iv) not in excess of three 
years during which the borrower is in service as a volunteer 
under the Peace Corps Act; (v) not in excess of three 
years during which the borrower is a member of the 
National Health Service Corps; (vi) not in excess of three 
years during which the borrower is in service as a full-
time volunteer under title I of the Domestic Volunteer 
Service Act of 1973; (vii) not in excess of 3 years, for 
a borrower who has completed an accredited internship 
or residency training program in osteopathic general prac-
tice, family medicine, general internal medicine, preventive 
medicine, or general pediatrics and who is practicing pri-
mary care; (viii) not in excess of 1 year, for borrowers 
who are graduates of schools of chiropractic; (ix) any period 
not in excess of two years which is described in subpara-
graph (B)(ii); and (x) in addition to all other deferments 
for which the borrower is eligible under clauses (i) through 
(ix), any period during which the borrower is a member 
of the Armed Forces on active duty during the Persian 
Gulf conflict, and any period described in clauses (i) 
through (x) shall not be included in determining the 25-
year period described in subparagraph (B); 
"(D) provides for interest on the unpaid principal bal-
ance of the loan at a yearly rate, not exceeding the 
applicable maximum rate prescribed and defined by the 
Secretary (within the limits set forth in subsection (b)) 
on a national, regional, or other appropriate basis, which 
interest shall be compounded not more frequently than 
annually and payable in installments over the period of 
the loan except as provided in subparagraph (C), except 
that the note or other written agreement may provide 
that pa3rment of any interest may be deferred until not 
later than the date upon which repayment of the first 
installment of principal falls due or the date repajmnent 
of principal is required to resume (whichever is applicable) 
and may further provide that, on such date, the amoimt 
of the interest which has so accrued may be added to 
the principal for the purposes of calculating a repa}mient 
schedule; 
"(E) offers, in accordance with criteria prescribed by 
regulation by the Secretary, a schedule for repa3anent of 
principal and interest under which pa3anent of a portion 
of the principal and interest otherwise payable at the begin-
ning of the repa)anent period (as defined in such regula-
tions) is deferred until a later time in the period; 
PUBLIC LAW 102-408—OCT. 13, 1992 
106 STAT. 1999 
"(F) entitles the borrower to accelerate without penalty 
repayment of the whole or any part of the loan; 
"(G) provides that the check for the proceeds of the 
loan shall be made payable jointly to the borrower and 
the eligible institution in which the borrower is enrolled; 
"(H) notwithstanding the provisions of the Fair Debt 
Collection Practices Act, authorizes an institution or post-
graduate training program attended by the borrower to 
assist in the collection of any loan that becomes delinquent, 
including providing information concerning the borrower 
to the Secretary and to past and present lenders and hold-
ers of the borrower's loans; and 
"(I) contains such other terms and conditions consistent 
with the provisions of this subpart and with the regulations 
issued by the Secretary pursuant to this subpart, as may 
be agreed upon by the parties to such loan, including, 
if agreed upon, a provision requiring the borrower to pay 
to the lender, in addition to principal and interest, amounts 
equal to the insurance premiums payable by the lender 
to the Secretary with respect to such loan; and 
"(3) subject to the consent of the student and subject to 
applicable law, the eligible lender has obtained from the student 
appropriate demographic information regarding the student, 
including racial or ethnic background. 
"(b) LIMITATION ON RATE OF INTEREST.—^The rate of interest 
prescribed and defined by the Secretary for the purpose of sub-
section (a)(2)(D) may not exceed the average of the bond equivalent 
rates of the 91-day Treasury bills auctioned for the previous quarter 
plus 3 percentage points, rounded to the next higher one-eighth 
of 1 percent. 
"(c) MINIMUM ANNUAL PAYMENT BY BORROWER.—^The total of 
the payments by a borrower during any year or any repayment 
period with respect to the aggregate amount of all loans to that 
borrower which are insured under this subpart shall not be less 
than the annual interest on the outstanding principal, except as 
provided in subsection (aX2XC), unless the borrower, in the written 
agreement described in subsection (aX2), agrees to make payments 
during any year or any repayment period in a lesser amount. 
"(d) APPLICABILITY OF CERTAIN LAWS ON RATE OR AMOUNT 
OF INTEREST.—^No provision of any law of the United States (other 
than subsections (a)(2XD) and (b)) or of any State that limits 
the rate or amount of interest payable on loans shall apply to 
a loan insured under this subpart. 
"(e) DETERMINATION REGARDING FORBEARANCE.—Any period of 
time granted to a borrower under this subpart in the form of 
forbearance on the loan shall not be included in the 25-year total 
loan repa3m(ient period under subsection (aX2XC). 
"(f) LOAN REPAYMENT SCHEDULE.—Lenders and holders imder 
this subpart shall offer borrowers graduated loan repajonent sched-
ules that, during the first 5 years of loan repajnnent, are based 
on the borrower's debt-to-income ratio. 
"(g) RULE OF CONSTRUCTION REGARDING DETERMINATION OF 
NEED OF STUDENTS.—^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 
106 STAT. 2000 
PUBLIC LAW 102-408—OCT. 13, 1992 
students with special circumstances as the school determines appro-
priate. 
"(h) DEFINITIONS.—^For purposes of this section: 
**(1) The term 'active duty* has the meaning given such 
term in section 101(18) of title 37, United States Code, except 
that such term does not include active duty for training. 
"(2) The term 'Persian Gulf conflict' means the period be^n-
ning on August 2, 1990, and ending on the date thereafter 
prescribed by Presidential proclamation or by law. 
42 use 292e. 
«SEC. 706. CERTIFICATE OF LOAN INSURANCE; EFFECTIVE DATE OF 
INSURANCE. 
"(a) IN GENERAL.— 
"(1) AUTHORITY FOR ISSUANCE OF CERTIFICATE.—If, upon 
application by an eligible lender, made upon such form, contain-
ing such information, and supported by such evidence as the 
Secretary may require, and otherwise m conformity with this 
section, the Secretary finds that the applicant has made a 
loan to an eligible borrower which is insurable under the provi-
sions of this subpart, he may issue to the applicant a certificate 
of insurance covering the loan and setting forth the amount 
and terms of the insurance. 
"(2) EFFECTIVE DATE OF INSURANCE.—Insurance evidenced 
by a certificate of insurance pursuant to subsection (aXD shall 
become effective upon the date of issuance of the certificate, 
except that the Secretary is authorized, in accordance with 
regulations, to issue commitments with respect to proposed 
loans, or with respect to lines (or proposed lines) of credit, 
submitted by eligible lenders, and in that event, upon compli-
ance with subsection (a)(1) by the lender, the certificate of 
insurance may be issued effective as of the date when any 
loan, or any payment by the lender pursuant to a line of 
credit, to be covered by such insurance is made to a student 
described in section 705(aXl). Such insurance shall cease to 
be effective upon 60 days' default by the lender in the payment 
of any installment of the premiums payable pursuant to section 
708. 
— 
"(3) CERTAIN AGREEMENTS FOR LENDERS.—An application 
submitted pursuant to subsection (aXD shall contain— 
"(A) an agreement by the applicant to pay, in accord-
ance with regulations, the premiums fixed by the Secretary 
pursuant to section 708; and 
Reports. 
«(B) an agreement by the applicant that if the loan 
is covered by insurance the applicant will submit such 
supplementary reports and statements during the effective 
period of the loan agreement, upon such forms, at such 
times, and containing such information as the Secretary 
may prescribe by or pursuant to regulation. 
"(b) AUTHORITY REGARDING COMPREHENSIVE INSURANCE COV-
ERAGE.— 
"(1) IN GENERAL.—In lieu of requiring a separate insurance 
application and issuing a separate certificate of insurance for 
each loan made by an eligible lender as provided in subsection 
(a), the Secretary may, in accordance with regulations consist-
ent with section 702, issue to any eligible lender applying 
therefor a certificate of comprehensive insurance coverage 
which shall, without further action by the Secretary, insure 
PUBLIC LAW 102-408—OCT. 13, 1992 
106 STAT. 2001 
all insurable loans made by that lender, on or after the date 
of the certificate and before a specified cutoff date, within 
the limits of an aggregate maximimi amount stated in the 
certificate. Such regulations may provide for conditioning such 
insurance, with respect to any loan, upon compliance by the 
lender with such requirements (to be stated or incorporated 
by reference in the certificate) as in the Secretary's judgment 
will best achieve the purpose of this subsection while protecting 
the financial interest of the United States and promoting the 
objectives of this subpart, including (but not limited to) provi-
sions as to the reporting of such loans and information relevant 
thereto to the Secretary and as to the payment of initial and 
other premiums and the effect of default therein, and including 
provision for confirmation by the Secretary from time to time 
(through endorsement of the certificate) of the coverage of spe-
cific new loans by such certificate, which confirmation shall 
be incontestable by the Secretary in the absence of fraud or 
misrepresentation of fact or patent error. 
"(2) LINES OF CREDIT BEYOND CUTOFF DATE.—If the holder 
of a certificate of comprehensive insurance coverage issued 
under this subsection grants to a borrower a line of credit 
extending beyond the cutoff date specified in that certificate, 
loans or payments thereon made by the holder after that date 
pursuant to the line of credit shall not be deemed to be included 
in the coverage of that certificate except as may be specifically 
provided therein; but, subject to the limitations of section 702, 
the Secretary may, in accordance with regulations, make 
commitments to insure such future loans or payments, and 
such commitments may be honored either as provided in sub-
section (a) or by inclusion of such insurance in comprehensive 
coverage under this subsection for the period or periods in 
which such future loans or payments are made. 
"(c) ASSIGNMENT OF INSURANCE RIGHTS.—The rights of an 
eligible lender arising under insurance evidenced by a certificate 
of insurance issued to it under this section may be assigned by 
such lender, subject to regulation by the Secretary, only to— 
"(1) another eligible lender (including a public entity in 
the business of purchasing student loans); or 
"(2) the Student Loan Marketing Association. 
"(d) EFFECT OF CONSOLIDATION OF OBLIGATIONS.—The consoli-
dation of the obligations of two or more federally insured loans 
obtained by a borrower in any fiscal year into a single obligation 
evidenced by a single instrument of indebtedness shall not affect 
the insurance by the United Stetes. If the loans thus consolidated 
are covered by separate certificates of insurance issued under sub-
section (a), the Secretary may upon surrender of the original certifi-
cates issue a new certificate of insurance in accordance with that 
subsection upon the consolidated obligation. If the loans thus 
consolidated are covered by a single comprehensive certificate issued 
under subsection (b), the Secretary may amend that certificate 
accordingly. 
"(e) RULE OF CONSTRUCTION REGARDING CONSOLIDATION OF 
DEBTS.—^Nothing in this section shall be construed to preclude 
the lender and the borrower, by mutual agreement, from consolidat-
ing all of the borrower's debts into a single instrument under 
the terms applicable to an insured loan made at the same time 
as the consolidation. The lender or loan holder should provide 
106 STAT. 2002 
PUBLIC LAW 102-408—OCT. 13, 1992 
full information to the borrower concerning the advantages and 
disadvantages of loan consolidation. Nothing in this section shall 
be construed to preclude the consolidation of the borrower's loans 
insured under this subpart under section 428C of the Higher Edu-
cation Act of 1965. Any loans insured pursuant to this subpart 
that are consolidated under section 4280 of such Act shall not 
be eligible for special allowance pajnnents under section 438 of 
such Act. 
42USC292f. 
"SEC. 707. DEFAULT OF BORROWER. 
"(a) CoNDinoNS FOR PAYMENT TO BENEFICIARY.—Upon default 
by the borrower on any loan covered by Federal loan insurance 
pursuant to this subpart, and after a substantial collection effort 
(including, subject to subsection (h), commencement and prosecution 
of an action) as determined under regulations of the Secretary, 
the insurance beneficiary shall promptly notify the Secretary and 
the Secretary shall, if requested (at that time or after further 
collection efforts) by the beneficiary, or may on his own motion, 
if the insurance is still in effect, pay to the beneficiary the amount 
of the loss sustained by the insured upon that loan as soon as 
that amount has been determined. Not later than one year after 
the date of the enactment of the Health Professions Education 
Extension Amendments of 1992, the Secretary shall establish 
performance standards for lenders and holders of loans imder this 
subpart, including fees to be imposed for failing to meet such 
standards. 
"(b) SUBROGATION.—^Upon pa3rment by the Secretary of the 
amount of the loss pursuant to subsection (a), the United States 
shall be subrogated for all of the rights of the holder of the obligation 
upon the insured loan and shall be entitled to an assignment 
of the note or other evidence of the insured loan by the insurance 
beneficiary. If the net recovery made by the Secretary on a loan 
after deduction of the cost of that recovery (including reasonable 
administrative costs) exceeds the amount of the loss, the excess 
shall be paid over to the insured. The Secretary may sell without 
recourse to eligible lenders (or other entities that the Secretary 
determines are capable of dealing in such loans) notes or other 
evidence of loans received through assignment imder the first sen-
tence. 
"(c) FORBEARANCE.—^Nothing in this section or in this subpart 
shall be construed to preclude any forbearance for the benefit of 
the borrower which may be agreed upon by the parties to the 
insured loan and approved by the Secretary or to preclude forbear-
ance by the Secretary in the enforcement of the insured obligation 
after payment on that insurance. 
"(d) REASONABLE CARE AND DILIGENCE REGARDING LOANS.— 
Nothing in this section or in this subpart shall be construed to 
excuse the eligible lender or holder of a federally insured loan 
from exercising reasonable care and diligence in the making of 
loans under the provisions of this subpart and from exercising 
a substantial effort in the collection of loans imder the provisions 
of this subpart. If the Secretary, after reasonable notice and oppor-
tunity for nearing to an eligible lender, finds that the lender nas 
failed to exercise such care and diligence, to exercise such substan-
tial efforts, to make the reports and statements required under 
section 706(aX3), or to pay the required Federal loan insurance 
premiimis, he shall disqualify that lender from obtaining further 
PUBLIC LAW 102-408—OCT. 13, 1992 
106 STAT. 2003 
Federal insurance on loans granted pursuant to this subpart until 
he is satisfied that its failure hsis ceased and finds that there 
is reasonable assurance that the lender will in the fiiture exercise 
necessary care and diligence, exercise substantial effort, or comply 
with such requirements, as the case may be. 
"(e) DEFINITIONS.—^For purposes of this section: 
**(1) The term 'insurance beneficiary* means the insured 
or its authorized assignee in accordance with section 706(c). 
"(2) The term 'amoimt of the loss' means, with respect 
to a loan, unpaid balance of the principal amoiint and interest 
on such loan, less the amount of any judgment collected pursu-
ant to default proceedings commenced by the eligible lender 
or holder involved. 
"(3) The term 'default' includes only such defaults as have 
existed for 120 days. 
"(f) REDUCTIONS IN FEDERAL REIMBURSEMENTS OR PAYMENTS 
FOR DEFAULTING BORROWERS.—The Secretary shall, after notice 
and opportunity for a hearing, cause to be reduced Federal 
reimbursements or payments for health services under any Federal 
law to borrowers who are practicing their professions and have 
defaulted on their loans insured under this subpart in amounts 
up to the remaining balance of such loans. Procedures for reduction 
of payments under the medicare program are provided under section 
1892 of the Social Security Act. Notwithstan^ng such section 1892, 
any funds recovered under this subsection shall be deposited in 
the insurance fund established under section 710. 
"(g) CONDITIONS FOR DISCHARGE OF DEBT IN BANKRUPTCY.— 
A debt which is a loan insured under the authority of this subpart 
may be released by a discharge in bankruptcy under any chapter 
of title 11, United States Code, only if such discharge is granted— 
"(1) after the expiration of the five-year period beginning 
on the first date, as specified in subparagraphs (B) and (C) 
of section 705(aX2), when repa3rment of such loan is required; 
"(2) upon a finding by the Bankruptcy Court that the 
nondischarge of such debt would be unconscionable; and 
"(3) upon the condition that the Secretary shall not have 
waived the Secretary's rights to apply subsection (f) to the 
borrower and the discharged debt. 
"(h) REQUIREMENT REGARDING ACTIONS FOR DEFAULT.— 
"(1) IN GENERAL.—^With respect to the default by a borrower 
on any loan covered by Federal loan insurance imder this 
subpart, the Secretaiy shall, under 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 reason-
able 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 fruit-
less because of the financial or other circumstances 
of the borrower; 
"(B) for such loans made before the date of the enact-
ment of the Health Professions Reauthorization Act of 1988, 
the loan involved was made in an amount of less than 
$5,000; or 
106 STAT. 2004 
PUBLIC LAW 102-408—OCT. 13, 1992 
"(C) for such loans made after such date, the loan 
involved was made in an amount of less than $2,500. 
"(2) RELATIONSHIP TO CLAIM FOR PAYMENT.—With respect 
to an eligible lender or holder that has commenced an action 
pursuant to subsection (a), the Secretary shall make the pay-
ment required in such subsection, or deny the claim for such 
pajonent, not later than 60 days after the date on which the 
Secretary determines that the lender or holder has made 
reasonable efforts to secure a judgment and collect on the 
judgment entered into pursuant to this subsection. 
"(3) STATE COURT JUDGMENTS.—With respect to any State 
court judgment that is obtained by a lender or holder against 
a borrower for default on a loan insured under this subpart 
and that is subrogated to the United States under subsection 
(b), any United States attorney may register such judgment 
with the Federal courts for enforcement. 
"(i) INAPPLICABILITY OF FEDERAL AND STATE STATUTE OF 
LIMITATIONS ON ACTIONS FOR LOAN COLLECTION.—Notwithstanding 
any other provision of Federal or State law, there shall be no 
limitation on the period within which suit may be filed, a judgment 
may be enforced, or an offset, garnishment, or other action may 
be initiated or taken by the Secretary, the Attorney Greneral, or 
other administrative head of another Federal agency, as the case 
may be, for the repayment of the amount due from a borrower 
on a loan made under this subpart that has been assigned to 
the Secretary under subsection (b). 
42USC292g. 
"SEC. 708. RISK-BASED PREMIUMS. 
"(a) AUTHORITY.—^With respect to a loan made under this sub-
part on or after January 1, 1993, the Secretary, in accordance 
with subsection (b), shall assess a risk-based premium on an eligible 
borrower and, if required under this section, an eligible institution 
that is based on the default rate of the eligible institution involved 
(as defined in section 719). 
"(b) ASSESSMENT OF PREMIUM.—Except as provided in sub-
section (d)(2), the risk-based premium to be assessed under sub-
section (a) shall be as follows: 
"(1) LOW-RISK RATE.—^With respect to an eligible borrower 
seeking to obtain a loan for attendance at an eligible institution 
that has a default rate of not to exceed five percent, such 
borrower shall be assessed a risk-based premium in an amount 
equal to 6 percent of the principal amount of the loan. 
"(2) MEDIUM-RISK RATE.— 
"(A) IN GENERAL.—^With respect to an eligible borrower 
seeking to obtain a loan for attendance at an eligible 
institution that has a default rate of in excess of five 
percent but not to exceed 10 percent— 
"(i) such borrower shall be assessed a risk-based 
premium in an amount equal to 8 percent of the prin-
cipal amount of the loan; and 
"(ii) such institution shall be assessed a risk-based 
premium in an amount equal to 5 percent of the prin-
cipal amount of the loan. 
"(B) DEFAULT MANAGEMENT PLAN.—An institution of 
the type described in subparagraph (A) shall prepare and 
submit to the Secretary for approval, an annual default 
management plan, that shall specify the detailed short-
PUBLIC LAW 102-408—OCT. 13, 1992 
106 STAT. 2005 
term and long-term procedures that such institution will 
have in place to minimize defaults on loans to borrowers 
under this subpart. Under such plan the institution shall, 
among other measures, provide an exit interview to all 
borrowers that includes information concerning repayment 
schedules, loan deferments, forbearance, and the con-
sequences of default. 
"(3) HIGH-RISK RATE.— 
"(A) IN GENERAL.—^With respect to an eligible borrower 
seeking to obtain a loan for attendance at an eligible 
institution that has a default rate of in excess of 10 percent 
but not to exceed 20 percent— 
"(i) such borrower shall be assessed a risk-based 
premium in an amount equal to 8 percent of the prin-
cipal amount of the loan; and 
"(ii) such institution shall be assessed a risk-based 
premium in an amount equal to 10 percent of the 
principal amount of the loan. 
^'(B) DEFAULT MANAGEMENT PLAN.—An institution of 
the type described in subparagraph (A) shall prepare and 
submit to the Secretary for approval a plan that meets 
the requirements of paragraph (2)(B). 
"(4) INELIGIBILITY.—An individual shall not be eligible to 
obtain a loan under this subpart for attendance at an institution 
that has a default rate in excess of 20 percent. 
"(c) REDUCTION OF RISK-BASED PREMIUM.—Lenders shall reduce 
by 50 percent the risk-based premium to eligible borrowers if a 
credit worthy parent or other responsible party co-signs the loan 
note. 
"(d) ADMINISTRATIVE WAIVERS.— 
"(1) HEARING.—^The Secretary shall afford an institution 
not less than one hearing, and may consider mitigating cir-
cumstances, prior to malung such institution ineligible for 
participation in the program under this subpart. 
"(2) EXCEPTIONS.—In carrying out this section with respect 
to an institution, the Secretary may grant an institution a 
waiver of requirements of paragraphs (2) through (4) of sub-
section (b) if the Secretary determines that the default rate 
for such institution is not an accurate indicator because the 
volume of the loans under this subpart made by such institution 
has been insufficient. 
"(3) TRANSITION FOR CERTAIN INSTITUTIONS.—During 
the 
3-year period beginning on the effective date of the Health 
Professions Education Extension Amendments of 1992— 
"(A) subsection (bX4) shall not apply with respect to 
any eligible institution that is a Historically Black College 
or University; and 
"(B) any such institution that has a default rate in 
excess of 20 percent, and any eligible borrower seeking 
a loan for attendance at the institution, shall be subject 
to subsection (bX3) to the same extent and in the same 
manner as eligible institutions and borrowers described 
in such subsection. 
"(e) PAYOFF TO REDUCE RISK CATEGORY.—An institution may 
pay off the outstanding principal and interest owed by the borrowers 
of such institution who have defaulted on loans made under this 
subpart in order to reduce the risk category of the institution. 
106 STAT. 2006 
PUBLIC LAW 102-408—OCT. 13, 1992 
42 use 292h. 
"SEC. 709. OFFICE FOR HEALTH EDUCATION ASSISTANCE LOAN 
DEFAULT REDUCTION. 
"(a) ESTABLISHMENT.—The Secretary shall establish, within the 
Division of Student Assistance of the Bureau of Health Professions, 
an office to be known as the Office for Health Education Assistance 
Loan Default Reduction (in this section referred to as the 'Office'). 
"(b) PURPOSE AND FUNCTIONS.—It shall be the purpose of the 
Office to achieve a reduction in the number and amounts of defaults 
on loans guaranteed under this subpart. In canying out such pur-
pose the Office shall— 
"(1) conduct analytical and evaluative studies concerning 
loans and loan defaults; 
"(2) carry out activities designed to reduce loan defaults; 
"(3) respond to special circumstances that may exist in 
the financial lending environment that may lead to loan 
defaults; 
"(4) coordinate with other Federal entities that are involved 
with student loan programs, including— 
"(A) with respect to the Department of Education, in 
the development of a single student loan application form, 
a single student loan deferment form, a single disability 
form, and a central student loan database; and 
"(B) with respect to the Department of Justice, in 
the recovery of payments from health professionals who 
have defaulted on loans guaranteed under this subpart; 
"(5) provide technical assistance to borrowers, lenders, hold-
ers, 
and institutions concerning deferments and collection 
activities; and 
Reports. 
"(6) prepare 
and 
submit 
a 
report 
not 
later 
than 
March 31, 1993, and annually, thereafter, to the Committee 
on Labor and Human Resources of the Senate and the Commit-
tee on Energy and Commerce of the House of Representatives 
concerning— 
"(A) the default rates for each— 
"(i) institution described in section 719(1) that is 
participating in the loan programs under this subpart; 
"(ii) lender participating in the loan program under 
this subpart; and 
"(iii) loan holder under this subpart; 
"(B) the total amounts recovered pursuant to section 
707(b) during the preceding fiscal year; and 
"(C) a plan for improving the extent of such recoveries 
during the current fiscal year. 
"(c) ADDITIONAL DUTIES.—In conjunction with the report 
submitted under subsection (b), the Office shall— 
Federal 
«(1) compile, and publish in the Federal Register, a list 
^u^fcation 
®
^ *^® borrowers who are in default imder this subpart; and 
pu 1 a ion. 
„^2) ggjuj the report and notices of default with respect 
to these borrowers to relevant Federal agencies and to schools, 
school associations, professional and specialty associations. 
State licensing boards, hospitals with which such borrowers 
may be associated, and any other relevant organizations. 
"(d) ALLOCATION OF FUNDS FOR OFFICE.—Inthecaseofamoimts 
reserved under section 710(a)(2)(B) for obligation under this sub-
section, the Secretary may obligate the amounts for the purpose 
of administering the Office, including 7 full-time equivalent employ-
ment positions for such Office. With respect to such purpose. 
PUBLIC LAW 102-408—OCT. 13, 1992 
106 STAT. 2007 
amounts made available under the preceding sentence are in addi-
tion to amounts made available to tne Health Resources and Serv-
ices Administration for program management for the fiscal year 
involved. With respect to such emplovment positions, the positions 
are in addition to the number of mil-time equivalent employment 
positions that otherwise is authorized for the Department of Health 
and Human Services for the fiscal year involved. 
"SEC. 710. INSURANCE ACCOUNT. 
42 USC 292i. 
"(a) IN GENERAL.— 
"(1) ESTABLISHMENT.—There is hereby established a stu-
dent loan insurance account (in this section referred to as 
the 'Accoimt') which shall be available without fiscal year 
limitation to the Secretary for making payments in connection 
with the collection and default of loans insured imder this 
subpart by the Secretary. 
"(2) FUNDING.— 
"(A) Except as provided in subparagraph (B), all 
amoimts received by the Secretary as premium charges 
for insurance and as receipts, earnings, or proceeds derived 
firom any claim or other assets acquired by the Secretary 
in connection with his operations under this subpart, and 
any other moneys, property, or assets derived by the Sec-
retary from the operations of the Secretary in connection 
with this section, snail be deposited in the Accoimt. 
"(B) With respect to amoimts described in subpara-
graph (A) that are received by the Secretary for any of 
the fiscal years 1993 through 1996, the Secretary may, 
before depositing such amounts in the Accoimt, reserve 
firom the amoimts each such fiscal year not more than 
$1,000,000 for obligation under section 709(d). 
"(3) EXPENDITURES.—^All pa3anents in connection with the 
default of loans insured by the Secretary under this subpart 
shall be paid from the Account. 
"(b) CONTINGENT AUTHORITY FOR ISSUANCE OF NOTES OR OTHER 
OBLIGATIONS.—If at any time the moneys in the Account are insuffi-
cient to make payments in connection with the collection or default 
of any loan insured by the Secretary under this subpart, the Sec-
retary of the Treasury may lend the Account such amounts as 
may be necessary to make the pajrments involved, subject to the 
Federal Credit Reform Act of 1990. 
"SEC. 711. POWERS AND RESPONSmiLITIES OF SECRETARY. 
42 USC 292j. 
"(a) IN GENERAL.—In the performance of, and with respect Regulations. 
to, the functions, powers, and duties vested in the Secretary by 
this subpart, the Secretary is authorized as follows: 
"(1) To prescribe such regulations as may be necessary 
to carry out the purposes of this subpart. 
"(2) To sue and be sued in any (tistrict court of the United 
States. Such district courts shall have jurisdiction of civil 
actions arising under this subpart without regard to the amount 
in controversy, and any action instituted under this subsection 
by or against the Secretary shall survive notwithstanding any 
change in the person occupjring the office of Secretary or any 
vacancy in that office. No attachment, injunction, garnishment, 
or other similar process, mesne or final, shall be issued against 
the Secretary or property under the control of the Secretary. 
Nothing herein shall be constructed to except litigation arising 
106 STAT. 2008 
PUBLIC LAW 102-408—OCT. 13, 1992 
42 use 292k. 
42 use 292/. 
42 use 292m. 
out of activities under this subpart from the appUcation of 
sections 517 and 547 of title 28 of the United States Code. 
"(3) To include in any contract for Federal loan insurance 
such terms, conditions, and covenants relating to repa}anent 
of principal and payments of interest, relating to his obligations 
and rights and to those of eligible lenders, and borrowers in 
case of default, and relating to such other matters as the 
Secretary determines to be necessary to assure that the pur-
poses of this subpart will be achieved. Any term, condition, 
and covenant made pursuant to this paragraph or any other 
provisions of this subpart may be modified by the Secretary 
if the Secretary determines that modification is necessary to 
protect the financial interest of the United States. 
"(4) Subject to the specific limitations in the subpart, to 
consent to the modification of any note or other instrument 
evidencing a loan which has been insured by him under this 
subpart (including modifications with respect to the rate of 
interest, time of pajrment of any installment of principal and 
interest or any portion thereof, or any other provision). 
"(5) To enforce, pay, compromise, waive, or release any 
right, title, claim, lien, or demand, however acquired, including 
any equity or any right or redemption. 
"(b) ANNUAL BUDGET; ACCOUNTS.—The Secretary shall, with 
respect to the financial operations arising by reason of this 
subpart— 
"(1) prepare annually and submit a budget program as 
provided for wholly owned Government corporations by the 
Government Corporation Control Act; and 
"(2) maintain with respect to insurance imder this subpart 
an integral set of accoimts. 
"SEC. 712. PARTICIPATION BY FEDERAL CREDIT UNIONS IN FEDERAL, 
STATE, AND PRIVATE STUDENT LOAN INSURANCE PRO-
GRAMS. 
**Notwithstending any other provision of law, Federal credit 
unions shall, pursuant to regulations of the Administrator of the 
National Credit Union Administration, have power to make insured 
loans to eligible students in accordance with the provisions of this 
subpart relating to Federal insured loans. 
"SEC. 713. DETERMINATION OF EUGIBLE STUDENTS. 
"For purposes of determining eligible students imder this part, 
in the case of a public school in a Stete that offers an accelerated, 
integrated program of study combining undergraduate premedical 
education and medical education leading to advanced entry, b^ 
contractual agreement, into an accredited four-year school of medi-
cine which provides the remaining training leading to a degree 
of doctor of medicine, whenever in this part a provision refers 
to a student at a school of medicine, such reference shall include 
only a student enrolled in any of the last four years of such acceler-
ated, integrated program of study. 
"SEC. 714. REPAYMENT BY SECRETARY OF LOANS OF DECEASED OR 
DISABLED BORROWERS. 
"If a borrower who has received a loan dies or becomes perma-
nently and totelly disabled (as determined in accordance with 
regulations of the Secretory), the Secretory shall discharge the 
PUBLIC LAW 102-408—OCT. 13, 1992 
106 STAT. 2009 
borrower's liability on the loan by repaying the amount owed on 
the loan from the account established under section 710. 
"SEC. 715. ADDITIONAL REQUIREMENTS FOR INSTITUTIONS AND 42 USC 292n. 
LENDERS. 
"(a) IN GENERAL.—^Notwithstanding any other provision of this 
Regulations, 
subpart, the Secretary is authorized to prescribe such regulations 
as may be necessary to provide for— 
"(1) a fiscal audit of an eligible institution with regard 
to any funds obtained from a borrower who has received a 
loan insured under this subpart; 
"(2) the establishment of reasonable standards of financial 
responsibility and appropriate institutional capability for the 
administration by an eligible institution of a program of student 
financial aid with respect to funds obtained from a student 
who has received a loan insured under this subpart; 
"(3) the limitation, suspension, or termination of the eligi-
bility under this subpart of any otherwise eligible institution, 
whenever the Secretary has determined, after notice and afford-
ing an opportunity for hearing, that such institution has vio-
lated or failed to carry out any regulation prescribed under 
this subpart; 
"(4) the collection of information from the borrower, lender, 
or eligible institution to assure compliance with the provisions 
of section 705; 
"(5) the assessing of tuition or fees to borrowers in amounts 
that are the same or less than the amount of tuition and 
fees assessed to nonborrowers; 
"(6) the submission, by the institution or the lender to 
the Office of Health Education Assistance Loan Default Reduc-
tion, of information concerning each loan made under this 
subpart, including the date when each such loan was originated, 
the date when each such loan is sold, the identity of the 
loan holder and information concerning a change in the borrow-
er's status; 
"(7) the withholding of services, including academic tran-
scripts, financial aid transcripts, and alumni services, by an 
institution from a borrower upon the default of such borrower 
of a loan under this subpart, except in case of a borrower 
who has filed for bankruptey; and 
"(8) the offering, by the lender to the borrower, of a variety 
of repayment options, including fixed-rate, graduated repay-
ment with negative amortization permitted, and income depend-
ent payments for a limited period followed by level monthly 
pa3niients. 
"(b) 
RECORDING BY INSTITUTION OF INFORMATION ON STU-
DENTS.—The Secretary shall require an eligible institution to record, 
and make available to the lender and to the Secretary upon request, 
the name, address, postgraduate destination, and other reasonable 
identifying information for each student of such institution who 
has a loan insured under this subpart. 
"(c) WORKSHOP FOR STUDENT BORROWERS.—Each participating 
eligible institution must have, at the beginning of each academic 
year, a workshop concerning the provisions of this subpart that 
all student borrowers shall be required to attend. 
"SEC. 719. DEFINITIONS. 
42 USC 292o. 
"For purposes of this subpart: 
106 STAT. 2010 
PUBLIC LAW 102-408—OCT. 13, 1992 
"(1) The term 'eligible institution' means, with respect to 
a fiscied year, a school of medicine, osteopathic medicine, den-
tistry, veterinary medicine, optometry, podiatric medicine, phar-
macy, public health, allied health, or chiropractic, or a graduate 
program in health administration or clinical psycholo^. 
"(2) The term 'eUgible lender* means an eligible institution 
that became a lender under this subpart prior to September 
15, 1992, an agency or instnunentality of a State, a nnancial 
or credit institution (including an insurance company) which 
is subject to examination and supervision by an agency of 
the United States or of any State, a pension fund approved 
by the Secretary for this purpose, or a nonprofit private entity 
designated by the State, regulated by the State, and approved 
by the Secretary. 
"(3) The term line of credit' means an arrangement or 
agreement between the lender and the borrower whereby a 
loan is paid out by the lender to the borrower in annual 
installments, or whereby the lender agrees to make, in addition 
to the initial loan, additional loans in subsequent years. 
"(4) The term 'school of allied health means a program 
in a school of allied health (as defined in section 799) which 
leads to a masters' degree or a doctoral degree. 
"(SXA) The term 'default rate*, in the case of an eligible 
entity, means the percentage constituted by the ratio of— 
"(i) the principal amount of loans insured under this 
^ 
subpart— 
"(1) that are made with respect to the entity and 
that enter repayment status after April 7, 1987; and 
"(11) for which amoimts have been paid under sec-
tion 707(a) to insurance beneficiaries, exclusive of any 
loan for which amounts have been so paid as a result 
of the death or total and permanent disability of the 
borrower; exclusive of any loan for which the borrower 
begins payments to the Secretary on the loan pursuant 
to section 707(b) and mcdntains payments for 12 
consecutive months in accordance with the agreement 
involved (with the loan subsequently being included 
or excluded, as the case may be, as amounts paid 
under section 707(a) according to whether further 
defaidts occur and whether with respect to the default 
involved compliance with such requirement regarding 
12 consecutive months occurs); and exclusive of any 
loan on which payments may not be recovered by rea-
son of the obligation under the loan being discharged 
in bankruptcy under title 11, United States Code; to 
"(ii) the total principal amount of loans insured under 
this subpart that are made with respect to the entity 
and that enter repayment status after April 7,1987. 
"(B) For purposes of subparagraph (A), a loan insured 
under this subpart shall be considered to have entered repay-
ment status if the applicable period described in subparagraph 
(B) of section 705(aX2) regarding the loan has expired (without 
regard to whether any period described in subparagraph (C) 
of such section is applicable regarding the loan). 
"(C) For purposes of subparagraph (A), the term 'eligible 
entity' means an eligible institution, an eligible lender, or a 
holder, as the case may be. 
PUBLIC LAW 102-408—OCT. 13, 1992 
106 STAT. 2011 
"(D) For purposes of subparagraph (A), a loan is made 
with respect to an eligible entity if— 
"(i) in the case of an eligible institution, the loan was 
made to students of the institution; 
"(ii) in the case of an eligible lender, the loan was made 
by the lender; and 
''(iii) in the case of a holder, the loan was purchased by 
the holder. 
"SEC. 720. AUTHORIZATION OF APPROPRIATIONS. 
42 USC 292p. 
"(a) IN GENERAL.—For fiscal year 1993 and subsequent fiscal 
years, there are authorized to be appropriated such simis as may 
be necessary for the adequacy of the student loan insurance account 
under this subpart and for the purpose of administering this sub-
part. 
"(b) AVAILABILITY OF SUMS.—Sums appropriated imder sub-
section (a) shall remain available until expended. 
^Subpart II—Federally-Supported Student Loan 
Funds 
"SEC. 721. AGREEMENTS FOR OPERATION OF SCHOOL LOAN FUNDS. 
42 USC 292q. 
"(a) FUND AGREEMENTS.—^The Secretary is authorized to enter 
into an agreement for the establishment and operation of a student 
loan fund in accordance with this subpart with any public or other 
nonprofit school of medicine, osteopathic medicine, dentistry, phar-
macy, podiatric medicine, optometry, or veterinary medicine. 
"(b) REQUIREMENTS.—Each agreement entered into under this 
section shall— 
"(1) provide for establishment of a student loan fimd by 
the school; 
"(2) provide for deposit in the fund of— 
"(A) the Federal capital contributions to the fund; 
"(B) an amount equal to not less than one-ninth of 
such Federal capital contributions, contributed by such 
institution; 
"(C) collections of principal and interest on loans made 
from the fund; 
"(D) collections pursuant to section 722(j); and 
"(E) any other earnings of the fund; 
"(3) provide that the fund shall be used only for loans 
to students of the school in accordance with the agreement 
and for costs of collection of such loans and interest thereon; 
"(4) provide that loans may be made from such fimds 
only to students pursuing a full-time course of study at the 
school leading to a degree of doctor of medicine, doctor of 
dentistry or an equivalent degree, doctor of osteopathy, bachelor 
of science in pharmacy or an equivalent degree, doctor of phar-
macy or an equivalent degree, doctor of podiatric medicine 
or an equivalent degree, doctor of optometry or an equivalent 
degree, or doctor of veterinary medicine or an equivalent degree; 
"(5) provide that the school shall advise, in writing, each 
applicant for a loan from the student loan fund of the provisions 
of section 722 under which outstanding loans from the student 
loan fund may be paid (in whole or in part) by the Secretary; 
and 
106 STAT. 2012 
PUBLIC LAW 102-408—OCT. 13, 1992 
"(6) contain such other provisions as are necessary to pro-
tect the financial interests of the United States. 
"(c) FAILURE OF SCHOOL TO COLLECT LOANS.— 
"(1) IN GENERAL.—^Any standard established by the Sec-
retary by regulation for the collection by schools of medicine, 
osteopathic medicine, dentistry, pharmacy, pediatric medicine, 
optometry, or veterinary medicine of loans made pursuant to 
loan agreements under this subpart shall provide that the 
^ 
failure of any such school to collect such loans shall be meas-
ured in accordance with this subsection. This subsection may 
not be construed to require such schools to reimburse the 
student loan fund under this subpart for loans that became 
uncollectible prior to August 1985 or to penalize such schools 
with respect to such loans. 
"(2) EXTENT OF FAILURE.—The measurement of a school's 
failure to collect loans made under this subpart shall be the 
ratio (stated as a percentage) that the defaulted principal 
amount outstanding of such school bears to the matured loans 
of such school. 
"(3) DEFINITIONS.—For purposes of this subsection: 
"(A) The term 'default' means the failure of a borrower 
of a loan made under this subpart to— 
"(i) make an installment pajrment when due; or 
"(ii) comply with any other term of the promissory 
note for such loan, 
except that a loan made under this subpart shall not be 
considered to be in default if the loan is discharged in 
bankruptcy or if the school reasonably concludes from writ-
ten contracts with the borrower that the borrower intends 
to repay the loan. 
"(B) The term 'defaulted principal amount outstanding' 
means the total amount borrowed from the loan fund of 
a school that has reached the repayment stage (minus 
any principal amount repaid or canceled) on loans— 
"(i) repayable monthly and in default for at least 
120 days; and 
"(ii) repayable less frequently than monthly and 
in default for at least 180 days; 
"(C) The term 'grace period' means the period of one 
year beginning on the date on which the borrower ceases 
to pursue a full-time course of study at a school of medicine, 
osteopathic medicine, dentistry, pharmacy, pediatric medi-
cine, optometry, or veterinary medicine; and 
"(D) The term 'matured loans' means the total principal 
amount of all loans made by a school under this subpart 
minus the total principal amount of loans made by such 
school to students who are— 
"(i) enrolled in a full-time course of study at such 
school; or 
"(ii) in their grace period. 
42USC292r. 
"SEC. 722. LOAN PROVISIONS. 
"(a) LIMITATION ON AMOUNT.—Loans from a student loan fund 
(established under an agreement with a school under section 721) 
may not exceed for any student for each school year (or its equiva-
lent) the sum of— 
"(1) the cost of tuition for such year at such school, and 
PUBLIC LAW 102-408—OCT. 13, 1992 
106 STAT. 2013 
"(2) $2,500. 
"(b) TERMS AND CONDITIONS.—Subject to section 723, any such 
loans shall be made on such terms and conditions as the school 
may determine, but may be made only to a student— 
"(1) who is in need of the amount thereof to pursue a 
full-time course of study at the school leading to a degree 
of doctor of medicine, doctor of dentistry or an equivalent 
degree, doctor of osteopathy, bachelor of science in pnarmacy 
or an equivalent degree, doctor of pharmacy or an equivalent 
degree, doctor of podiatric medicine or an equivalent degree, 
doctor of optometry or an equivalent degree, or doctor of veteri-
nary medicine or an equivalent degree; 
"(2) who, if pursuing a full-time course of study at the 
school leading to a degree of doctor of medicine or doctor of 
osteopathy, is of exceptional financial need (as defined by regu-
lations of the Secretary); and 
"(3) who, if required under section 3 of the Military Selec-
tive Service Act to present himself for and submit to registration 
under such section, has presented himself and submitted to 
registration under such section. 
"(c) REPAYMENT; EXCLUSIONS FROM TEN-YEAR PERIOD.—Such 
loans shall be repayable in equal or graduated periodic installments 
(with the right of the borrower to accelerate repayment) over the 
ten-year period which begins one year after the student ceases 
to pursue a full-time course of study at a school of medicine, 
osteopathic medicine, dentistry, pharmacy, podiatry, optometry, or 
veterinary medicine, excluding from such ten-year period— 
"(1) all periods— 
"(A) not in excess of three years of active duty i)er-
formed by the borrower as a member of a uniformed service; 
"(B) not in excess of three years during which the 
borrower serves as a volunteer under the Peace Corps 
Act; 
"(C) during which the borrower participates in 
advanced professional training, including internships and 
residencies; and 
"(D) during which the borrower is pursuing a full-
time course of study at such a school; and 
"(2) a period— 
"(A) not in excess of two years during which a borrower 
who is a full-time student in such a school leaves the 
school, with the intent to return to such school as a full-
time student, in order to engage in a full-time educational 
activity which is directly related to the health profession 
for which the borrower is preparing, as determined by 
the Secretary; or 
"(B) not in excess of two years during which a borrower 
who is a graduate of such a school is a participant in 
a fellowship training program or a full-time educational 
activity which— 
"(i) is directly related to the health profession for 
which such borrower prepared at such school, as deter-
mined by the Secretary; and 
"(ii) may be engaged in by the borrower during 
such a two-year period which begins within twelve 
months after the completion of the borrower's partici-
pation in advanced professional training described in 
106 STAT. 2014 
PUBLIC LAW 102-408—OCT. 13, 1992 
E
aragraph (1)(C) or prior to the completion of such 
orrower's participation in such training. 
"(d) CANCELLATION OF LIABILITY.—The liabiUty to repay the 
unpaid balance of such a loan and accrued interest thereon shall 
be canceled upon the death of the borrower, or if the Secretary 
determines that he has become permanently, and totally disablea. 
"(e) RATE OF INTEREST.—Such loans shall bear interest, on 
the unpaid balance of the loan, computed only for periods for 
which the loan is repayable, at the rate of 5 percent per year. 
"(f) SECURITY OR ENDORSEMENT.—Loans shall be made under 
this subpart without security or endorsement, except that if the 
borrower is a minor and the note or other evidence of obligation 
executed by him would not, under the applicable law, create a 
binding obligation, either security or endorsement may be required. 
"(g) TRANSFERRING AND ASSIGNING LOANS.—NO note or other 
evidence of a loan made under this subpart may be transferred 
or assigned by the school making the loan except that, if the 
borrowers transfer to another school participating in the program 
imder this subpart, such note or other evidence of a loan may 
be transferred to such other school. 
"(h) CHARGE WITH RESPECT TO INSURANCE FOR CERTAIN CAN-
CELLATIONS.—Subject to regulations of the Secretary, a school may 
assess a charge with respect to loans made this subpart to cover 
the costs of insuring against cancellation of liability under sub-
section (d). 
"(i) CHARGE WITH RESPECT TO LATE PAYMENTS.—Subject to 
regulations of the Secretary, and in accordance with this section, 
a school shall assess a charge with respect to a loan made under 
this subpart for failure of the borrower to pay all or any part 
of an installment when it is due and, in the case of a borrower 
who is entitled to deferment of the loan under subsection (c), for 
any failure to file timely and satisfactory evidence of such entitle-
ment. No such charge may be made if the payment of such install-
ment or the filing of such evidence is made within 60 days after 
the date on which such installment or filing is due. The amount 
of any such charge may not exceed an amount equal to 6 percent 
of the amount of such installment. The school may elect to add 
the amount of any such charge to the principal amount of the 
loan as of the first day after the day on which such installment 
or evidence was due, or to make the amount of the charge payable 
to the school not later than the due date of the next installment 
after receipt by the borrower of notice of the assessment of the 
charge. 
*
X
j
) AUTHORITY OF SCHOOLS REGARDING RATE OF PAYMENT.— 
A school may provide, in accordance with regulations of the Sec-
retary, that during the repayment period of a loan from a loan 
fund established pursuant to an agreement under this subpart 
payments of principal and interest by the borrower with respect 
to all the outstanding loans made to him from loan funds so estab-
lished shall be at a rate equal to not less than $15 per month. 
"(k) AUTHORITY REGARDING REPAYMENTS BY SECRETARY.—^Upon 
application by a person who received, and is under an obligation 
to repay, any loan made to such person as a health professions 
student to enable him to study medicine, osteopathy, dentistry, 
veterinary medicine, optometry, pharmacy, or podiatry, the Sec-
retary may imdertake to repay (without liability to the applicant) 
all or £uiy part of such loan, and any interest or portion thereof 
PUBLIC LAW 102-408—OCT. 13, 1992 
106 STAT. 2015 
outstanding thereon, upon his determination, pursuant to regula-
tions establishing criteria therefor, that the applicant— 
"(1) failed to complete such studies leading to his first 
professional degree; 
"(2) is in exceptionally needy circumstances; 
"(3) is from a low-income or disadvantaged family as those 
terms may be defined by such regulations; and 
"(4) has not resumed, or cannot reasonably be expected 
to resume, the study of medicine, osteopathy, dentistry, veteri-
nary medicine, optometry, pharmacy, or podiatric medicine, 
within two years following the date upon which he terminated 
such studies. 
"(1) COLLECTION EFFORTS BY SECRETARY.—The Secretary is 
authorized to attempt to collect any loan which was made under 
this subpart, which is in default, and which was referred to the 
Secretary by a school with which the Secretary has an agreement 
under tnis subpart, on behalf of that school imder such terms 
and conditions as the Secretary may prescribe (including reimburse-
ment from the school's student loan fund for expenses the Secretary 
may reasonably incur in attempting collection), but only if the 
school has complied with such requirements as the Secretary may 
specify by regulation with respect to the collection of loans under 
this subpart. A loan so referred shall be treated as a debt subject 
to section 5514 of title 5, United States Code. Amounts collected 
shall be deposited in the school's student loan fund. Whenever 
the Secretary desires the institution of a civil action regarding 
any such loan, the Secretary shall refer the matter to the Attorney 
General for appropriate action. 
<^EC. 723. MEDICAL SCHOOLS AND PRIMARY HEALTH CARE. 
42 USC 292s. 
"(a) REQUIREMENTS FOR STUDENTS.— 
"(1) IN GENERAL.—Subject to the provisions of this sub-
section, in the case of student loan funds established under 
section 721 by schools of medicine or osteopathic medicine, 
each agreement entered into under such section with such 
a school shall provide (in addition to the provisions required 
in subsection (b) of such section) that the school will make 
a loan from such fund to a student only if the student agrees— 
"(A) to enter and complete a residency training pro-
gram in primary health care not later than 4 years after 
the date on which the student graduates from such school; 
and 
"(B) to practice in such care through the date on which 
the loan is repaid in full. 
"(2) INAPPLICABILITY TO CERTAIN STUDENTS.— 
"(A) The requirement established in paragraph (1) 
regarding the student loan fund of a school does not apply 
to a student if— 
"(i) the first loan to the student from such fimd 
is made before July 1,1993; or 
**(ii) the loan is made from— 
"(I) a Federal capital contribution under sec-
tion 721 that is made from amounts appropriated 
under section 724(f) (in this section referred to 
as an 'exempt Federal capital contribution'); or 
"(11) a school contribution made under section 
721 pursuant to such a Federal capital contribu-
106 STAT. 2016 
PUBLIC LAW 102-408—OCT. 13, 1992 
tion (in this section referred to as an 'exempt school 
contribution'). 
"(B) A Federal capital contribution under section 721 
may not be construed as being an exempt Federal capital 
contribution if the contribution was made from amounts 
appropriated before October 1, 1990. A school contribution 
under section 721 ma^ not be construed as being an exempt 
school contribution if the contribution was made pursuant 
to a Federal capital contribution under such section that 
was made from amoimts appropriated before such date. 
"(3) 
NONCOMPLIANCE 
BY 
STUDENT.—Each 
agreement 
entered into with a student pursuant to paragraph (1) shall 
provide that, if the student fails to comply with the agreement— 
"(A) the balance due on the loan involved will be imme-
diately recomputed from the date of issuance at an interest 
rate of 12 percent per year, compounded annually; and 
"(B) the recomputed balance will be paid not later 
than the expiration of the 3-year period beginning on 
the date on which the student fails to comply with the 
agreement. 
"(b) REQUIREMENTS FOR SCHOOLS.— 
"(1) IN GENERAL.—Subject to the provisions of this sub-
section, in the case of student loan funds established under 
section 721 by schools of medicine or osteopathic medicine, 
each agreement entered into under such section with such 
a school shall provide (in addition to the provisions required 
in subsection (b) of such section) that, for the 1-year period 
ending on June 30, 1994, and for the 1-year period ending 
on June 30 of each subsequent fiscal year, the school will 
meet not less than 1 of the conditions described in paragraph 
(2) with respect to graduates of the school whose date of gradua-
tion from the school occurred approximately 4 years before 
the end of the 1-year period involved. 
"(2) DESCRIPTION OF CONDITIONS.—^With respect to grad-
uates described in paragraph (1) (in this paragraph referred 
to as 'designated graduates'), the conditions referred to in such 
paragraph for a school for a 1-year period are as follows: 
"(A) Not less than 50 percent of designated graduates 
of the school meet the criterion of either being in a resi-
dency training program in primary health care, or being 
engaged in a practice in such care (having completed such 
a program). 
"(B) Not less than 15 percent of the designated grad-
uates of the school meet such criterion, and such percentage 
is not less than 5 percentage points above the percentage 
of such graduates meeting such criterion for the preceding 
1-yearperiod. 
"(C) In the case of schools of medicine or osteopathic 
medicine with student loans funds under section 721, the 
school involved is at or above the 75th percentile of such 
schools whose designated graduates meet such criterion. 
"(3) DETERMINATIONS BY SECRETARY.—^Not later than 90 
days after the close of each 1-year period described in paragraph 
(1), the Secretary shall make a determination of whether the 
school involved has for such period complied with such para-
^ a p h and shall in writing inform the school of the determina-
tion. Such determination shall be made only after consideration 
PUBLIC LAW 102-408—OCT. 13, 1992 
106 STAT. 2017 
of the report submitted to the Secretary by the school under 
paragraph (6). 
"(4) NONCOMPLIANCE BY SCHOOL.— 
"(AXi) Subject to subparagraph (C), each agreement 
under section 721 with a school of medicine or osteopathic 
medicine shall provide that, if the school fails to comply 
with paragraph (1) for a 1-year period under such para-
graph, the school— 
"(I) will pay to the Secretary the amount 
applicable under subparagraph (B) for the period; 
and 
"(II) will pay such amount not later than 90 
days £iiter the school is informed under paragraph 
(3) of the determination of the Secretary regarding 
such period. 
"(ii) Any amount that a school is required to pay under 
clause (i) may be paid from the student loan fund of the 
school under section 721. 
"(B) For purposes of subparagraph (A), the amount 
applicable for a school, subject to subparagraph (C), is— 
"(i) for the 1-year period ending June 30, 1994, 
an amount equal to 10 percent of the income received 
during such period by the student loan fund of the 
school under section 721; 
"(ii) for the 1-year period ending June 30, 1995, 
an amount equal to 20 percent of the income received 
during such period by the student loan fund; and 
"(iii) for any subsequent 1-year period under para-
graph (1), an amount equal to 30 percent of the income 
received during such period by the student loan fund. 
"(C) In determining the amount of income that a stu-
dent loan fund has received for purposes of subparagraph 
(B), the Secretary shall exclude any income derived from 
exempt contributions. Payments made to the Secretary 
under subparagraph (A) may not be made with such con-
tributions or with income derived from such contributions. 
"(5) EXPENDITURE OF PAYMENTS.— 
"(A) Amounts paid to the Secretary under paragraph 
(4) shall be expended to make Federal capital contributions 
to student loan funds under section 721 of schools that 
are in compliance with paragraph (1). 
"(B) A Federal capital contribution under section 721 
may not be construed as being an exempt Federal capital 
contribution if the contribution is made from payments 
under subparagraph (A). A school contribution under such 
section may not be construed as being an exempt school 
contribution if the contribution is made pursuant to a Fed-
eral capital contribution from such pajmients. 
"(6) REPORTS BY SCHOOLS.—^Each agreement imder section 
721 with a school of medicine or osteopathic medicine shall 
provide that the school will submit to the Secretary a report 
for each 1-year period under paragraph (1) that provides such 
information as the Secretary determines to be necessary for 
carrying out this subsection. Each such report shall include 
statistics concerning the current training or practice status 
of all graduates of such school whose date of graduation from 
106 STAT. 2018 
PUBLIC LAW 102-408—OCT. 13, 1992 
the school occurred approximately 4 years before the end of 
the 1-year period involved. 
"(c) REPORTS BY SECRETARY.—^The Secretary shall each fiscal 
year submit to the Committee on Energy and Commerce of the 
House of Representatives, and the Committee on Labor and Human 
Resources of the Senate, a report regarding the administration 
of this section, including the extent of compliance with the require-
ments of this section, during the preceding nscal year. 
"(d) DEFINITIONS.—^For purposes of tins section: 
"(1) The term 'exempt contributions' means exempt Federal 
capital contributions and exempt school contributions. 
"(2) The term 'exempt Federal capital contribution' means 
a Federal capital contribution described in subclause (I) of 
subsection (a)(2XAXii). 
"(3) The term 'exempt school contribution' means a school 
contribution 
described 
in 
subclause 
(II) of subsection 
(aX2XAXii). 
"(4) The term 'income', with respect to a student fund 
under section 721, means pajrments of principal and interest 
on £my loan made from the fimd, and any other earnings 
of the fund. 
"(5) The term 'primary health care' means family medicine, 
general internal medicine, general pediatrics, preventive medi-
cine, or osteopathic general practice. 
42 use 292t. 
'nSEC. 724. INDIVIDUALS FROM DISADVANTAGED BACKGROUNDS. 
"(a) FUND AGREEMENTS REGARDING CERTAIN AMOUNTS.—With 
respect to amoimts appropriated under subsection (f), each agree-
ment entered into under section 721 with a school shall provide 
(in addition to the provisions required in subsection (b) of such 
section) that— 
"(1) any Federal capital contribution made to the student 
loan fund of the school from such amounts, together with the 
school contribution appropriate under subsection (bX2XB) of 
such section to the amount of the Federal capital contribution, 
will be utilized only for the purpose o
f
— 
"(A) making loans to individuals from disadvantaged 
backgrounds; and 
^B) the costs of the collection of the loans eind interest 
on the loans; and 
"(2) collections of principal and interest on loans made 
pursuant to paragraph (1), and any other earnings of the stu-
dent loan fund attributable to amoimts that are in the fund 
pursuant to such paragraph, will be utilized only for the pur-
pose described in such paragraph. 
*'(b) MINIMUM QUALIFICATIONS FOR SCHOOLS.—The Secretary 
may not make a Federal capital contribution for purposes of sub-
section (a) for a fiscal year imless the health professions school 
involved— 
"(1) is carrying out a program for recruiting and retaining 
students from disadvantaged backgrounds, including racial and 
ethnic minorities; and 
"(2) is carrying out a program for recruiting and retaining 
minority faculty. 
"(c) CERTAIN AGREEMENTS REGARDING EDUCATION OF STU-
DENTS; DATE CERTAIN FOR COMPLIANCE.—The Secretary may not 
make a Federal capital contribution for purposes of subsection 
PUBLIC LAW 102-408—OCT. 13, 1992 
106 STAT. 2019 
(a) for a fiscal year unless the health professions school involved 
agrees— 
"(1) to ensure that adequate instruction regarding minority 
health issues is provided for in the curricula of the school; 
"(2) with respect to health clinics providing services to 
a significant number of individuals who are from disadvantaged 
backgrounds, including members of minority groups, to enter 
into arrangements with 1 or more such clinics for the purpose 
of providing students of the school with experience in providing 
clinical services to such individuals; 
"(3) with respect to public or nonprofit private secondary 
educational institutions and undergraduate institutions of 
higher education, to enter into arrangements with 1 or more 
such institutions for the purpose of carrying out programs 
regarding the educational preparation of disadvantaged stu-
dents, including minority students, to enter the health profes-
sions and regarding the recruitment of such individuals into 
the health professions; 
"(4) to establish a mentor program for assisting disadvan-
taged students, including minority students, regarding the 
completion of the educational requirements for degrees from 
the school; 
"(5) to be carrying out each of the activities specified in 
any of paragraphs (1) through (4) by not later than 1 year 
after the date on which the first Federal capital contribution 
is made to the school for purposes of subsection (a); and 
"(6) to continue canying out such activities, and the activi-
ties specified in paragraphs (1) and (2) of subsection (b), 
throughout the period during which the student loan fimd 
estabfished pursuant to section 721(b) is in operation. 
"(d) AVAILABILITY OF OTHER AMOUNTS.—With respect to Federal 
capital contributions to student loan funds under agreements under 
section 721(b), any such contributions made before October 1, 1990, 
together with the school contributions appropriate under paragraph 
(2XB) of such section to the amount of the Federal capital contribu-
tions, may be utilized for the purpose of making loans to individuals 
fi*om disadvantaged backgrounds, subject to section 723(a)(2)(B). 
"(e) DEFINITION.—For purposes of this section, the term 'dis-
advantaged', with respect to an individual, shall be defined by 
the Secretary. 
"(f) AUTHORIZATION OF APPROPRIATIONS.— 
"(1) IN GENERAL.—^With respect to making Federal capital 
contributions to student loan funds for purposes of subsection 
(a), there is authorized to be appropriated for such contributions 
$15,000,000 for fiscal year 1993. 
"(2) SPECIAL CONSIDERATION FOR CERTAIN SCHOOLS.—In 
making Federal capital contributions to student loan funds 
for purposes of subsection (a), the Secretary shall give special 
consideration to health professions schools that have enroll-
ments of underrepresented minorities above the national aver-
age for health professions schools. 
<^EC. 725. ADMINISTRATIVE PROVISIONS. 
42 USC 292u. 
"The Secretary may agree to modifications of agreements or 
loans made under this subpart, and may compromise, waive, or 
release any right, title, claim, or demand of the United States 
arising or acquired under this subpart. 
59-194 O—93 
8:QL3(Pt. 3) 
106 STAT. 2020 
PUBLIC LAW 102-408—OCT. 13, 1992 
42 use 292v. 
"SEC. 726. PROVISION BY SCHOOLS OF INFORMATION TO STUDENTS. 
"(a) IN GENERAL.—^With respect to loans made by a school 
xinder this subpart after June 30, 1986, each school, in order to 
carry out the provisions of sections 721 and 722, shall, at any 
time such school makes such a loan to a student under this subpart, 
provide thorough and adequate loan information on loans made 
under this subpart to the student. The loan information required 
to be provided to the student by this subsection shall include— 
"(1) the yearly and cumulative maximum amounts that 
may be borrowed by the student; 
"(2) the terms under which repayment of the loan will 
begin; 
"(3) the maximum number of years in which the loan 
must be repaid; 
"(4) the interest rate that will be paid by the borrower 
and the minimum amount of the required monthly pajonent; 
"(5) the amount of any other fees charged to the borrower 
by the lender; 
"(6) any options the borrower may have for deferral, can-
cellation, prepa3anent, consolidation, or other refinancing of 
the loan; 
"(7) a definition of default on the loan and a specification 
of the consequences which will result to the borrower if the 
borrower defaults, including a description of any arrangements 
which may be made with credit bureau organizations; 
"(8) to the extent practicable, the effect of accepting the 
loan on the eligibility of the borrower for other forms of student 
assistance; and 
"(9) a description of the actions that may be taken by 
the Federal Government to collect the loan, including a descrip-
tion of the type of information concerning the borrower that 
the Federal Government may disclose to (A) officers, employees, 
or agents of the Department of Health and Human Services, 
(B) officers, employees, or agents of schools with which the 
Secretary has an agreement under this subpart, or (C) any 
other person involved in the collection of a loan under this 
subpart. 
"(b) STATEMENT REGARDING LOAN.—Each school shall, imme-
diately prior to the graduation from such school of a student who 
receives a loan under this subpart after June 30, 1986, provide 
such student with a statement specifying— 
"(1) each amount borrowed by the student under this 
subpart; 
"(2) the total amount borrowed by the student under this 
subpart; and 
"(3) a schedule for the repajnnent of the amoimts borrowed 
under this subpart, including the number, amount, and fre-
quency of payments to be made. 
42 use 292w. 
"SEC. 727. PROCEDURES FOR APPEAL OF TERMINATION OF AGREE-
MENTS. 
"In any case in which the Secretary intends to terminate an 
agreement with a school under »this subpart, the Secretary shall 
provide the school with a written notice specifying such intention 
and stating that the school may request a formal hearing with 
respect to such termination. If the school requests such a hearing 
within 30 days after the receipt of such notice, the Secretary shall 
PUBLIC LAW 102-408—OCT. 13, 1992 
106 STAT. 2021 
I
)rovide such school with a hearing conducted by an administrative 
aw judge. 
"SEC. 728. DISTRTOUTION OF ASSETS FROM LOAN FUNDS. 
42 USC 2l»2x. 
"(a) DISTRIBUTION AFTER TERMINATION OF FUND.—If a school 
terminates a loan fund established under an agreement pursuant 
to section 721(b), or if the Secretary for good cause terminates 
the agreement with the school, there shall be a capital distribution 
as follows: 
"(1) The Secretary shall first be paid an amount which 
bears the same ratio to such balance in such fund on the 
date of termination of the fund as the total amount of the 
Federal capital contributions to such fund by the Secretary 
pursuant to section 721(b)(2)(A) bears to the total amount in 
such fimd derived from such Federal capital contributions and 
from funds deposited therein pursuant to section 721(b)(2)(B). 
"(2) The remainder of such balance shall be paid to the 
school. 
"(b) PAYMENT OF PROPORTIONATE SHARE TO SECRETARY.—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 
721(b) as was determined by the Secretary imder subsection (a). 
•nSEC. 735. GENERAL PROVISIONS. 
42 USC 292y. 
"(a) DATE CERTAIN FOR APPLICATIONS.—The Secretary shall 
from time to time set dates by which schools must file applications 
for Federal capital contributions. 
"(b) CONTINGENT REDUCTION IN ALLOTMENTS.—If the total of 
the amounts requested for any fiscal year in such applications 
exceeds the amounts appropriated under this section for that fiscal 
vear, the allotment to the loan fund of each such school shall 
be reduced to whichever of the following is the smaller: the amount 
requested in its application; or an amount which bears the same 
ratio to the amounts appropriated as the number of students esti-
mated by the Secretary to be enrolled in such school during such 
fiscal year bears to the estimated total number of students in 
all such schools during such year. Amounts remaining after allot-
ment imder the preceding sentence shall be reallotted in accordance 
with clause (B) of such sentence among schools whose applications 
requested more than the amounts so allotted to their loan funds, 
but with such adjustments as may be necessary to prevent the 
total allotted to any such school's loan fund from exceeding the 
total so requested by it. 
"(c) ALLOTMENT OF EXCESS FUNDS.—Funds available in any 
fiscal year for payment to schools under this subpart which are 
in excess of the amount appropriated pursuant to this section 
for that year shall be allotted among schools in such manner as 
the Secretary determines will best carry out the purposes of this 
subpart. 
"(d) PAYMENT OF INSTALLMENTS TO SCHOOLS.—Allotments to 
a loan fund of a school shall be paid to it from time to time 
in such installments as the Secretary determines will not result 
in unnecessary accumulations in the loan fund at such school. 
"(e) DISPOSITION OF FUNDS RETURNED TO SECRETARY.— 
106 STAT. 2022 
PUBLIC LAW 102-408—OCT. 13, 1992 
"(1) EXPENDITURE FOR FEDERAL CAPITAL CONTRIBUTIONS.— 
Subject to section 723(bX5), any amounts from student loan 
funds under section 721 that are returned to the Secretary 
by health professions schools shall be expended to make Federal 
capital contributions to such funds. 
"(2) 
DATE 
CERTAIN 
FOR 
CONTRIBUTIONS.—Amounts 
described in paragraph (1) that are returned to the Secretary 
before the fourth quarter of a fiscal year shall be obligated 
before the end of such fiscal year, and may not be obligated 
before the fourth quarter. For purposes of the preceding sen-
tence, amounts returned to the Secretary during the last quar-
ter of a fiscal year are deemed to have been returned during 
the first three quarters of the succeeding fiscal year. 
"(3) PREFERENCE IN MAKING CONTRIBUTIONS.—In making 
Federal capital contributions to student loans funds under sec-
tion 721 for a fiscal vear from amounts described in paragraph 
(1), the Secretary shall give preference to health professions 
schools of the same disciplines as the health professions schools 
returning such amounts for the period during which the 
amounts expended for such contributions were received by the 
Secretary. Any such amounts that, prior to being so returned, 
were available only for the purpose of loans under this subpart 
to individuals from disadvantaged backgrounds shall be avail-
able only for such purpose. 
"PART B—STUDENTS FROM DISADVANTAGED 
BACKGROUNDS 
Grants. 
'<SEC. 736. SCHOLARSHIPS FOR STUDENTS OF EXCEPTIONAL FINAN-
42 use 293. 
CIALNEED. 
"(a) IN GENERAL.—^The Secretary shall make grants to public 
and nonprofit private schools of medicine, osteopathic medicine, 
and dentistry for scholarships to be awarded by the schools to 
full-time students thereof wno are of exceptional financial need, 
subject to section 795 (relating to residency training and practice 
in primary health care). 
"(b) REQUIREMENTS REGARDING SCHOLARSHIPS.— 
"(1) ACCEPTANCE FOR FULL-TIME ENROLLMENT.—Scholar-
ships may be awarded by a school from a grant under subsection 
(a) only to individuals who have been accepted by it for enroll-
ment as full-time students. 
"(2) AUTHORIZED EXPENDITURES.—A scholarship provided 
to a student for a school year under a grant under siibsection 
(a) shall consist of payment to, or (in accordance with paragraph 
(4)) on behalf of, tne student of an amount (except as provided 
in section 798(c)) equivalent to the amount o
f
— 
"(A) the tuition of the student in such school year; 
and 
''(B) all other reasonable educational expenses, includ-
ing fees, books, and laboratory expenses, incurred by the 
student in such year. 
"(3) AUTHORITY REGARDING PAYMENTS TO EDUCATIONAL 
INSTITUTION.—^The Secretary may contract with an educational 
institution in which is enrolled a student who has received 
a scholarship with a grant imder subsection (a) for the payment 
to the educational institution of the amounts of tuition and 
other reasonable educational expenses described in paragraph 
PUBLIC LAW 102-408—OCT. 13, 1992 
106 STAT. 2023 
(2). Payment to such an educational institution may be made 
without regard to section 3324 of title 31, United States Code. 
"(c) AUTHORIZATION OF APPROPRIATIONS.—For the purpose of 
making grants under this section, there is authorized to be appro-
priated $11,000,000 for fiscal year 1993. 
"SEC. 737. SCHOLARSHIPS GENERALLY; CERTAIN OTHER PURPOSES. 42 USC 293a. 
"(a) ESTABLISHMENT OF PROGRAM.— 
"(1) IN GENERAL.—Subject to subsection (e), the Secretary 
may make grants to health professions schools for the purpose 
of assisting such schools in providing scholarships to individuals 
described in paragraph (2). 
"(2) ELIGIBLE INDIVIDUALS.—The individuals referred to in 
paragraph (1) are individuals who— 
"(A) are from disadvantaged backgrounds; and 
"(B) are enrolled (or accepted for enrollment) as full-
time students in such schools. 
"(3) HEALTH PROFESSIONS SCHOOLS.—For purposes of this 
section, the term 'health professions schools' means schools 
of medicine, nursing (as schools of nursing are defined in section 
853), osteopathic medicine, dentistry, pharmacy, podiatric medi-
cine, optometry, veterinary medicine, public health, or allied 
health, or schools offering graduate programs in clinical 
psychology. 
"(b) MINIMUM QUALIFICATIONS OF GRANTEES.—The Secretary 
may not make a grant under subsection (a) unless the health 
professions school— 
"(1) is carrying out a program for recruiting and retaining 
students from disadvantaged backgrounds, including racial and 
ethnic minorities; and 
"(2) is carrying out a program for recruiting and retaining 
minority faculty. 
"(c) PREFERENCES IN PROVIDING SCHOLARSHIPS.—The Secretary 
may not make a grant under subsection (a) unless the health 
professions school involved agrees that, in providing scholarships 
pursuant to the grant, the school will give preference to students— 
"(1) who are from disadvantaged backgrounds; and 
"(2) for whom the costs of attending the school would 
constitute a severe financial hardship. 
"(d) USE OF SCHOLARSHIP.—^A scholarship provided pursuant 
to subsection (a) for attendance at a health professions school— 
"(1) may be expended only for tuition expenses, other 
reasonable 
educational 
expenses, and reasonable 
living 
expenses incurred in such attendance; and 
"(2) may not, for any year of such attendance for which 
the scholarship is provided, provide an amount exceeding the 
total amount required for the year for the expenses specified 
in paragraph (1). 
"(e) PROVISIONS REGARDING PURPOSES OTHER THAN SCHOLAR-
SHIPS.— 
"(1) AUTHORITY REGARDING ASSISTANCE FOR UNDERGRADU-
ATES.—^With respect to undergraduates who have demonstrated 
a commitment to pursuing a career in the health professions, 
a health professions school may expend not more than 25 
percent of a grant under subsection (a) for the purpose of 
providing financial assistance to such undergraduates in order 
106 STAT. 2024 
PUBLIC LAW 102-408—OCT. 13, 1992 
to facilitate the completion of the educational requirements 
for such careers. 
"(2) REQUIRED ACTIVITIES OF SCHOOL.—The Secretary may 
not make a grant under subsection (a) unless the health profes-
sions school involved agrees— 
"(A) to ensure that adequate instruction regarding 
minority health issues is provided for in the curricula of 
the school; 
"(B) with respect to health clinics providing services 
to a significant number of individuals who are from dis-
advantaged backgrounds, including members of minority 
groups, to enter into arrangements with 1 or more such 
clinics for the purpose of providing students of the school 
with experience in providing clinical services to such 
individuals; 
"(C) with respect to public or nonprofit secondary edu-
cational institutions and undergraduate institutions of 
higher education, to enter into arrangements with 1 or 
more such institutions for the purpose of carrying out pro-
grams regarding the educational preparation of disadvan-
taged students, including minority students, to enter the 
health professions and regarding the recruitment of such 
students into the health professions; 
"(D) to establish a mentor program for assisting dis-
advantaged students, including minority students, regard-
ing the completion of the educational requirements for 
degrees from the school; 
"(E) to be carrying, out the activities specified in sub-
paragraphs (A) through (D) by not later than 1 year after 
the date on which a grant under subsection (a) is first 
made to the school; and 
"(F) to continue carrying out such activities, and the 
activities specified in paragraphs (1) and (2) of subsection 
(b), throughout the period during which the school is receiv-
ing a grant under subsection (a). 
"(3) RESTRICTIONS ON USE OF GRANT.—The Secretary may 
not make a grant under subsection (a) for a fiscal year unless 
the health professions school involved agrees that the grant 
will not be expended to carry out the activities specified in 
paragraph (1) or (2) of subsection (b), or in any of subparagraphs 
(A) through (D) of paragraph (2) of this subsection. 
"(f) REQUIREMENT OF APPLICATION.—The Secretary may not 
make a grant under subsection (a) unless an application for the 
grant is submitted to the Secretary and the application is in such 
form, is made in such manner, and contains such agreements, 
assurances, and information as the Secretary determines to be 
necessary to carry out this section. 
"(g) DEFINITION.—For purposes of this section, the term 'school 
of nursing* has the meaning given such term in section 853. 
"(h) FUNDING.— 
"(1) AUTHORIZATION OF APPROPRIATIONS.—For the purpose 
of canying out this section, there are authorized to be appro-
priated such sums as may be necessary for fiscal year 1993. 
"(2) ALLOCATIONS BY SECRETARY.—In making grants under 
subsection (a), the Secretary— 
PUBLIC LAW 102-408—OCT. 13, 1992 
106 STAT. 2025 
"(A) shall, of the amounts appropriated under para-
graph (1), make available 30 percent for such grants to 
schools of nursing; and 
"(B) shall give special consideration to health profes-
sions schools that have enrollments of underrepresented 
minorities above the national average for health professions 
schools. 
"SEC. 738. LOAN REPAYMENTS AND FELLOWSHIPS REGARDING FAC- 42 USC 293b. 
ULTY POSITIONS. 
"(a) LOAN REPAYMENTS.— 
"(1) ESTABLISHMENT OF PROGRAM.—The Secretary shall 
Contracts. 
establish a program of entering into contracts with individuals 
described in subsection (b) under which the individuals agree 
to serve as members of the faculties of schools described in 
paragraph (3) in consideration of the Federal Government 
agreeing to pay, for each year of such service, not more than 
$20,000 of the principal and interest of the educational loans 
of such individuals. 
"(2) ELIGIBLE INDIVIDUALS.—The individuals referred to in 
paragraph (1) are individuals from disadvantaged backgrounds 
who— 
"(A) have a degree in medicine, osteopathic medicine, 
dentistry, or another health profession; 
"(B) are enrolled in an approved graduate training 
program in medicine, osteopathic medicine, dentistry, or 
other health profession; or 
"(C) are enrolled as a full-time student— 
"(i) in an accredited (as determined by the Sec-
retary) school described in paragraph (3); ana 
"(ii) in the final year of a course of a study or 
program, offered by such institution and approved by 
the Secretary, leading to a degree from such a school. 
"(3) ELIGIBLE HEALTH PROFESSIONS SCHOOLS.—The schools 
described in this paragraph are schools of medicine, nursing 
(as schools of nursing are defined in section 853), osteopathic 
medicine, dentistry, pharmacy, pediatric medicine, optometry, 
veterinary medicine, or public health, or schools offering grad-
uate programs in clinical psychology. 
"(4) ADDITIONAL LIMITATION ON AMOUNT OF REPAYMENTS.— 
Payments made under this subsection regarding the edu-
cational loans of an individual may not, for any year for which 
the payments are made, exceed an amount equal to 20 percent 
of the outstanding principal and interest on the loans. 
"(5) REQUIREMENTS REGARDING FACULTY POSITIONS.—The 
Secretary may not enter into a contract under paragraph (1) 
unless— 
"(A) the individual involved has entered into a contract 
with a school described in paragraph (3) to serve as a 
member of the faculty of the school for not less than 2 
years, and the individual has not been a member of the 
facultv of any school at any time during the 18-month 
period preceding the date on which the Secretary receives 
the request of the individual for a contract under paragraph 
(1); and 
"(B) the contract referred to in subparagraph (A) pro-
vides that— 
106 STAT. 2026 
PUBLIC LAW 102-408—OCT. 13, 1992 
"(i) the school will, for each year for which the 
individual will serve as a member of the facility under 
the contract with the school, make pa3naients of the 
principal and interest due on the educational loans 
of the individual for such year in an amount equal 
to the amount of such pa3maents made by the Secretary 
for the year; and 
"(ii) the pajrments made by the school pursuant 
to clause (i) on behalf of the individual will be in 
addition to the pay that the individual would otherwise 
receive for serving as a member of such faculty. 
"(6) WAIVER REGARDING SCHOOL CONTRIBUTIONS.—The Sec-
retary may waive the requirement established in paragraph 
(5XB) if the Secretary determines that the requirement will 
impose an imdue financial hardship on the school involved. 
If the Secretary grants such a waiver, paragraph (4) shall 
not apply with respect to the individual involved. 
"(7) APPLICABILITY OF CERTAIN PROVISIONS.—The provisions 
of sections 338B, 3380, and 338E shall apply to the program 
established in paragraph (1) to the same extent and in the 
same manner as such provisions apply to the National Health 
Service Corps Loan Repayment Program established in subpart 
III of part D of title III, including the applicability of provisions 
regarding reimbursements for increased tax liability and 
regarding bankruptcy, 
"(b) FELLOWSHIPS.— 
"(1) IN GENERAL.—^The Secretary may make grants to and 
enter into contracts with schools of medicine, osteopathic medi-
cine, dentistry, veterinary medicine, optometry, podiatric medi-
cine, pharmacy, public health, health administration, clinical 
psychology, and other public or private nonprofit health or 
educational entities of the type described in section 799, to 
assist 
such 
schools 
in 
increasing 
the 
number 
of 
underrepresented minority faculty members at such schools. 
**(2) APPLICATIONS.—^To be eligible to receive a grant or 
contract under this subsection, a school shall prepare and sub-
mit to the Secretary an application at sucn time, in such 
manner, and containing such information as the Secretary may 
reqmre, including an assurance that— 
"(A) amounts received under such a grant or contract 
will be used to award a fellowship to an individual only 
i
f
— 
''(i) the individual has not been a member of the 
faculty of any school at any time during the 18-month 
period preceding the date on which the individual sub-
mits a request for the fellowship; and 
''(ii) the individual meets the requirements of para-
graphs (3) and (4); and 
"(B) each fellowship awarded pursuant to the grant 
or contract will include a stipend in an amount not exceed-
ing 50 percent of the regular salary of a similar faculty 
member, or $30,000, whichever is less. 
"(3) ELIGIBILITY.—^To be eligible to receive a grant or con-
tract under paragraph (1), an applicant shall demonstrate to 
the Secretary that such applicant has or will have the ability 
to— 
PUBLIC LAW 102-408—OCT. 13, 1992 
106 STAT. 2027 
"(A) identify, recruit and select individuals from 
underrepresented minorities in health professions who have 
the potential for teaching, administration, or conducting 
research at a health professions institution; 
"(B) provide such individuals with the skills necessary 
to enable them to secure a tenured faculty position at 
such institution, which may include training with respect 
to pedagogical skills, program administration, the design 
and conduct of research, grants writing, and the prepara-
tion of articles suitable for publication in peer reviewed 
journals; 
"(C) provide services designed to assist such individuals 
in their preparation for an academic career, including the 
provision of mentors; and 
"(D) provide health services to rural or medically 
underserved populations. 
"(4) REQUIREMENTS.—^To be eligible to receive a grant or 
contract under paragraph (1) an applicant shall— 
"(A) provide an assurance that such applicant will 
make available (directly through cash donations) $1 for 
every $1 of Federal funds received under this section for 
the fellowship; 
"(B) provide an assurance that institutional support 
will be provided for the individual for a second year at 
a level that is not less than the total amount of Federal 
and institutional funds provided in the year in which the 
grant or contract was awarded; 
"(C) provide an assurance that the individual that will 
receive the fellowship will be a member of the faculty 
of the applicant school; and 
"(D) provide an assurance that the individual that 
will receive the fellowship will have, at a minimum, appro-
priate advanced preparation (such as a master's or doctoral 
degree) and special skills necessary to enable such individ-
ual to teach and practice. 
"(5) DEFINITION.—For purposes of this subsection, the term 
'minority* means an individual from a racial or ethnic group 
that is underrepresented in the health professions. 
"(c) AUTHORIZATION OF APPROPRIATIONS.—For the purpose of 
carrying out this section, there is authorized to be appropriated 
$4,000,000 for fiscal year 1993. 
"SEC. 739. CENTERS OF EXCELLENCE. 
Grants. 
"(a) IN GENERAL.—The Secretary shall make grants to health 
5^'u°S*'|9^ 
professions schools described in subsection (c) for the purpose of 
assisting the schools in supporting programs of excellence in health 
professions education for minority individuals. 
"(b) REQUIRED USE OF FUNDS.—The Secretary may not make 
a grant under subsection (a) unless the health professions school 
involved agrees to expend the grant— 
"(1) to establish, strengthen, or expand programs to 
enhance the academic performance of minority students attend-
ing the school; 
"(2) to establish, strengthen, or expand programs to 
increase the number and quality of minority applicants to the 
school; 
106 STAT. 2028 
PUBLIC LAW 102-408—OCT. 13, 1992 
"(3) to improve the capacity of such school to train, recruit, 
and retain minority faculty; 
"(4) with respect to minority health issues, to carry out 
activities to improve the information resources and curricula 
of the school and clinical education at the school; and 
"(5) to facilitate faculty and student research on health 
issues particularly affecting minority groups. 
"(c) CENTERS OF EXCELLENCE.— 
"(1) IN GENERAL.— 
"(A) The health professions schools referred to in sub-
section (a) are such schools that meet each of the conditions 
specified in subparagraph (B), and that— 
"(i) meet each of the conditions specified in para-
graph (2)(A); 
"(ii) meet each of the conditions specified in para-
graph (3); 
"(iii) meet each of the conditions specified in para-
graph (4); or 
"(iv) meet each of the conditions specified in para-
graph (5). 
"(B) The conditions specified in this subparagraph are 
that a health professions school— 
"(i) has a significant number of minority individ-
uals enrolled in the school, including individuals 
accepted for enrollment in the school; 
"(ii) has been effective in assisting minority stu-
dents of the school to complete the program of edu-
cation and receive the degree involved; 
"(iii) has been effective in recruiting minority 
individuals to attend the school, including providing 
scholarships and other financial assistance to such 
individuals and encouraging minority students of 
secondary educational institutions to attend the health 
professions school; and 
"(iv) has made significant recruitment efforts to 
increase the number of minority individuals serving 
in faculty or administrative positions at the school. 
"(C) In the case of any criteria established by the 
Secretary for purposes of determining whether schools meet 
the conditions described in subparagraph (B), this section 
may not, with respect to racial and ethnic minorities, be 
construed to authorize, require, or prohibit the use of such 
criteria in any program other than the program established 
in this section. 
"(2) CENTERS OF EXCELLENCE AT CERTAIN HISTORICALLY 
BLACK COLLEGES AND UNIVERSITIES.— 
"(A) The conditions specified in this subparagraph are 
that a health professions school— 
"(i) is a school described in section 799(1); and 
"(ii) received a contract under section 788B for 
fiscal year 1987, as such section was in effect for such 
fiscal year. 
"(B) In addition to the purposes described in subsection 
(b), a grant under subsection (a) to a health professions 
school meeting the conditions described in subparagraph 
(A) may be expended— 
PUBLIC LAW 102-408—OCT. 13, 1992 
106 STAT. 2029 
"(i) to develop a plan to achieve institutional 
improvements, including financial independence, to 
enable the school to support programs of excellence 
in health professions education for minority individ-
uals; and 
"(ii) to provide improved access to the library and 
informational resources of the school. 
"(3) HISPANIC CENTERS OF EXCELLENCE.—The conditions 
specified in this paragraph are that— 
"(A) with respect to Hispanic individuals, each of 
clauses (i) through (iv) of paragraph (1)(B) applies to the 
health professions school involved; and 
"(B) the health professions school agree, as a condition 
of receiving a grant under subsection (a), that the school 
will, in carrying out the duties described in subsection 
(b), give priority to carrying out the duties with respect 
to Hispanic individuals. 
"(4) NATIVE AMERICAN CENTERS OF EXCELLENCE.—Subject 
to subsection (e), the conditions specified in this paragraph 
are that— 
"(A) with respect to Native Americans, each of clauses 
(i) through (iv) of paragraph (1)(B) applies to the health 
professions school involved; 
"(B) the health professions school agree, as a condition 
of receiving a grant under subsection (a), that the school 
will, in carrying out the duties described in subsection 
(b), give priority to canying out the duties with respect 
to Native Americans; and 
"(C) the health professions school agree, as a condition 
of receiving a grant under subsection (a), that— 
"(i) the school will establish an arrangement with 
1 or more public or nonprofit private institutions of 
higher education whose enrollment of students has 
traditionally included a significant number of Native 
Americans, the purpose of which arrangement will be 
to carry out a program— 
"(I) to identify Native American students of 
the institution who are interested in a career in 
the health profession or professions involved; and 
"(H) to facilitate the educational preparation 
of such students to enter the health professions 
school; and 
"(ii) the health professions school will make efforts 
to recruit Native American students, including stu-
dents who have participated in the undergraduate pro-
gram carried out under arrangements established by 
the school pursuant to clause (i) and will assist Native 
American students regarding the completion of the 
educational requirements for a degree from the health 
professions school. 
"(5) OTHER CENTERS OF EXCELLENCE.—The conditions speci-
fied in this paragraph are that a health professions school 
has an enrollment of underrepresented minorities above the 
national average for such enrollments of health professions 
schools. 
"(d) DESIGNATION AS CENTER OF EXCELLENCE.— 
106 STAT. 2030 
PUBLIC LAW 102-408—OCT. 13, 1992 
"(1) IN GENERAL.—^Any health professions school receiving 
a grant under subsection (a) and meeting the conditions 
described in paragraph (2) or (5) of subsection (c) shall, for 
purposes of this section, be designated by the Secretary as 
a Center of Excellence in Minority Health Professions Edu-
cation. 
"(2) HISPANIC CENTERS OP EXCELLENCE.—Anv health profes-
sions school receiving a grant under subsection (a) and meeting 
the conditions described in subsection (c)(3) shall, for purposes 
of this section, be designated by the Secretary as a Hispanic 
Center of Excellence in Health Professions Education. 
"(3) 
NATIVE AMERICAN CENTERS OP EXCELLENCE.—Any 
health professions school receiving a grant under subsection 
(a) and meeting the conditions described in subsection (c)(4) 
shall, for purposes of this section, be designated by the Sec-
retary as a Native American Center of Excellence in Health 
Professions Education. Any consortium receiving such a grant 
pursuant to subsection (e) shall, for purposes of this section, 
oe so designated. 
"(e) 
AUTHORITY REGARDING NATIVE AMERICAN CENTERS OF 
EXCELLENCE.— 
"(1) 
AUTHORITY POR COLLECTIVELY MEETING RELEVANT 
REQUIREMENTS.—^With respect to meeting the conditions speci-
fied in subsection (cX4), the Secretary may make a grant under 
subsection (a) to any school of medicine, osteopathic medicine, 
dentistry, or pharmacy that has in accordance with paragraph 
(2) formed a consortium of schools that meets such conditions 
(without regard to whether the schools of the consortium 
individually meet such conditions). 
"(2) REQUIREMENTS REGARDING CONSORTIUM.^A consor-
tium of schools has been formed in accordance with this para-
graph if— 
"(A) the consortium consists of a school seeking a grant 
pursuant to paragraph (1) and 1 or more schools of medi-
cine, osteopathic medicine, dentistry, pharmacy, nursing, 
allied health, or public health; 
"(B) the schools of the consortium have entered into 
an agreement for the allocation of such grant among the 
schools; 
"(C) each of the schools agrees to expend the grant 
in accordance with this section; and 
**(D) each of the schools of the consortium— 
"(i) is part of the same institution of higher edu-
cation as the school seeking the grant; or 
"(ii) is located not farther than 50 miles from the 
school seeking the grant. 
"(0 DURATION AND AMOUNT OF GRANT.— 
"(1) DURATION.—^The period during which payments are 
made under a grant imder subsection (a) may not exceed 3 
years. Such payments shall be subject to annual approval by 
the Secretary and to the availability of appropriations for the 
fiscal year involved to make the payments. 
"(2) AMOUNT.—^A grant imder subsection (a) for a fiscal 
vear may not be made in an amoimt that is less than $500,000. 
'^(g) MAINTENANCE OP EFFORT.— 
"(1) IN GENERAL.—^With respect to activities for which a 
grant under subsection (a) is authorized to be expended, the 
PUBLIC LAW 102-408—OCT. 13, 1992 
106 STAT. 2031 
Secretary may not make such a grant to a health professions 
school for any fiscal year unless the school agrees to maintain 
expenditures of non-Federal amounts for such activities at a 
level that is not less than the level of such expenditures main-
tained by the school for the fiscal year preceding the fiscal 
year for which the school receives such a grant. 
"(2) USE OF FEDERAL FUNDS.—With respect to any Federal 
amounts received by a health professions school and available 
for carrying out activities for which a grant under subsection 
(a) is authorized to be expended, the Secretary may not make 
such a grant to the school for any fiscal year unless the school 
agrees that the school will, before expending the grant, expend 
the Federal amounts obtained from sources other than the 
grant. 
"(h) DEFINITIONS.—For purposes of this section: 
"(1)(A) The term 'health professions school' means, except 
as provided in subparagraph (B), a school of medicine, a school 
of osteopathic medicine, a school of dentistry, or a school of 
pharmacy. 
"(B) The definition established in subparagraph (A) shall 
not apply to the use of the term 'health professions school' 
for purposes of subsection (c)(2). 
"(2) The term 'program of excellence' means any program 
carried out by a health professions school with a grant made 
imder subsection (a), if the program is for purposes for which 
the school involved is authorized in subsection (b) or (c) to 
expend the grant. 
"(3) The term 'Native Americans' means American Indians, 
Alaskan Natives, Aleuts, and Native Hawaiians. 
"(i) FUNDING.— 
"(1) AUTHORIZATION OF APPROPRIATIONS.—For the purpose 
of making grants under subsection (a), there are authorized 
to be appropriated such sums as may be necessary for fiscal 
year 1993. 
"(2) ALLOCATIONS BY SECRETARY.— 
"(A) Of the amounts appropriated under paragraph 
(1) for a fiscal year, the Secretary shall make available 
$12,000,000 for grants under subsection (a) to health 
professions schools that are eligible for such grants pursu-
ant to meeting the conditions described in paragraph (2)(A) 
of subsection (c). 
"(B) Of the amoimts appropriated under paragraph 
(1) for a fiscal year and available after compliance with 
subparagraph (A), the Secretary shall make available 60 
percent for grants under subsection (a) to health professions 
schools that are eligible for such grants pursuant to meet-
ing the conditions described in paragraph (3) or (4) of 
subsection (c) (including meeting conditions pursuant to 
subsection (e)). 
"(C) Of the amounts appropriated under paragraph 
(1) for a fiscal year and available after compliance with 
subparagraph (A), the Secretary shall make available 40 
percent for grants under subsection (a) to health professions 
schools that are eligible for such grants pursuant to meet-
ing the conditions described in paragraph (5) of subsection 
(0. 
106 STAT. 2032 
PUBLIC LAW 102-408—OCT. 13, 1992 
42 use 293d. 
"SEC. 740. EDUCATIONAL ASSISTANCE REGARDING UNDERGRADU* 
Minorities. 
ATES. 
"(a) IN GENERAL.— 
"(1) AUTHORITY FOR GRANTS.—^For the purpose of assisting 
individuals from disadvantaged backgrounds, as determined 
in accordance with criteria prescribed by the Secretary, to 
undertake education to enter a health profession, the Secretary 
may make grants to and enter into contracts with schools 
of medicine, osteopathic medicine, public health, dentistry, vet-
erinary medicine, optometry, pharmacy, allied health, chiro-
practic, and pediatric medicine, public and nonprofit private 
schools which offer graduate programs in clinical psychology, 
and other public or private nonprofit health or educational 
entities to assist in meeting the costs described in paragraph 
(2). 
"(2) AUTHORIZED EXPENDITURES.—^A grant or contract under 
paragraph (1) mav be used by the health or educational entity 
to meet the cost OP— 
"(A) identif)dng, recruiting, and selecting individuals 
from disadvantaged backgrounds, as so determined, for 
education and training in a health profession, 
"(B) facilitating the entry of such individuals into such 
a school, 
"(C) providing counseling or other services designed 
to assist such individuals to complete successfully their 
education at such a school, 
"(D) providing, for a period prior to the entry of such 
individuals into the regular course of education of such 
a school, preliminary education designed to assist them 
to complete successfully such regular course of education 
at such a school, or referring such individuals to institu-
tions providing such preliminary education, 
"(E) publicizing existing sources of financial aid avail-
able to students in the education program of such a school 
or who are undertaking training necessary to qualify them 
to enroll in such a program, 
"(F) paying such scholarships as the Secretary may 
determine for such individuals for any period of health 
professions education at a school of medicine, osteopathic 
medicine, or dentistry, 
"(G) paying such stipends as the Secretary may 
approve for such individuals for any period of education 
in student-enhancement programs (other than regular 
courses) at any school described in subsection (aXl), except 
that such a stipend may not be provided to an individual 
for more than 12 months, and such a stipend shall be 
in an amoimt of $40 per day (notwithstanmng any other 
provision of law regardmg the amoimt of stipendfs). 
The term 'regular course of education of such a school* as 
used in subparagraph (D) includes a graduate program in clini-
cal psychology. 
"(b) REQUIREMENTS REGARDING ENROLLMENT; PRIORITY IN MAK-
ING GRANTS.— 
"(1) 
INCREASED ENROLLMENT OF INDIVIDUALS FROM DIS-
ADVANTAGED BACKGROUNDS.—Schools of medicine, osteopathic 
medicine, public health, dentistry, veterinary medicine, optom-
etry, pharmacy, allied health, chiropractic, podiatric medicine 
PUBLIC LAW 102-408—OCT. 13, 1992 
106 STAT. 2033 
and public and nonprofit schools that offer graduate programs 
in clinical psychology that receive a grant under subsection 
(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 backgroimds by at least 20 
percent over enrollments in the base year 1987. 
"(2) CONDITIONS FOR SCHOOLS TO RECEIVE PRIORITY.—^The 
Secretary shall give priority for funding, in years subsequent 
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. 
"(3) APPLICABILITY OF CERTAIN CONDITION FOR PRIORITY.— 
The requirement for at least a 20 percent increase in such 
enrollment shall apply only to those schools referred to in 
paragraph (1) that have a proportionate enrollment of such 
individuals from disadvantaged backgrounds that is less than 
200 percent of the national average percentage of such individ-
uals in all schools of each health professions discipline. 
"(4) DETERMINATION OF ENROLLMENT.—Determination of 
both first year and total enrollment of such individuals shall 
be made by the Secretary in accordance with section 792. 
"(c) EQUITABLE ALLOCATION OF FINANCIAL ASSISTANCE.—The 
Secretary shall ensure that services and activities under subsection 
(a) are equitably allocated among the various racial and ethnic 
populations. 
"(d) FUNDING.— 
"(1) AUTHORIZATION OF APPROPRIATIONS.—For the purpose 
of grants and contracts under subsection (aXD, there is author-
ized to be appropriated $31,500,000 for fiscal year 1993. 
"(2) ALLOCATIONS.—Of the amounts appropriated under 
paragraph (1) for any fiscal year, the Secretary shall obligate 
amoiints in accordance with the following: 
"(A) 70 percent shall be obligated for grants or con-
tracts to institutions of higher education. 
"(B) 20 percent shall be obligated for scholarships 
under subsection (a)(2)(F) to individuals of exceptional 
financial need (as defined by the Secretary under section 
736) who are students at schools of medicine, osteopathic 
medicine, or dentistry. The provision of such scholarships 
to such individuals shall be subject to section 795 (relating 
to residency training and practice in primary health care). 
Such scholarships shall be administered and awarded in 
the same manner and subject to the same requirements 
as scholarships imder section 736. 
"(C) 10 percent shall be obligated for community-based 
programs. 
"(D) Not more than 5 percent may be obligated for 
grants and contracts having the primary purpose of inform-
ing individuals about the existence and general nature 
of health careers. 
106 STAT. 2034 
PUBLIC LAW 102-408—OCT. 13, 1992 
"PART C—TRAINING IN PRIMARY HEALTH 
CARE 
42USC293J. 
"SEC. 746. AREA HEALTH EDUCATION CENTER PROGRAMS. 
"(a) AUTHORITY FOR PROVISION OF FINANCIAL ASSISTANCE.— 
"(1) ASSISTANCE FOR PLANNING, DEVELOPMENT, AND OPER-
ATION OF PROGRAMS.— 
"(A) The Secretary shall provide financial assistance 
to schools of medicine and osteopathic medicine for the 
planning, development, and operation of area health edu-
cation center programs. 
**(BXi) Subject to clause (ii), the period during which 
pa3nnents are made firom an award under subparagraph 
(A) may not exceed 12 years. The provision of the payments 
shall be subject to annual approval by the Secretary of 
the payments and subject to tne availability of appropria-
tions ror the fiscal year involved to make the payments. 
The preceding sentence may not be construed as establish-
ing a limitation on the number of awards under such 
subparagraph that may be made to the school involved. 
"(ii) In the case of an area health education center 
planned, developed, or operated with an award under 
subparagraph (A), the period during which the award is 
expended for the center may not exceed 6 years. 
*
*
(
2
) ASSISTANCE FOR CERTAIN PROJECTS OF EXISTING PRO-
GRAMS.— 
"(A) The Secretary shall provide financial assistance 
to schools of medicine and osteopathic medicine— 
**(i) which have previously received Federal finan-
cial assistance for an area health education center 
program under section 802 of the Health Professionals 
Educational Assistance Act of 1976 in fiscal year 1979 
or under paragraph (1), or 
"(ii) which are receiving assistance under para-
graph (1), 
to carry out projects described in subparagraph (B) through 
area health education centers for which Federal financial assist-
ance was provided under paragraph (1) and which are no longer 
eligible to receive such assistance. 
"(B) Projects for which assistance may be provided 
under subparagraph (A) are— 
"(i) proiects to improve the distribution, supply, 
quality, utilization, ana efficiency of health personnel 
in the health services delivery system; 
"(ii) projects to encourage the regionalization of 
educational responsibilities of the health professions 
schools; and 
"(iii) i>rojects designed to prepare, through 
preceptorships and other programs, individuals subject 
to a service obligation under the National Health Serv-
ice Corps Scholarship Program to effectively provide 
health services in health professional shortage areas. 
"(C) In the case of the requirement established in 
section 3804(eXl) of part 57 of title 42, Code of Federal 
Regulations (42 CFR 57.3804(eXl)) (relating to the location 
of area health education centers), the Secretary shall waive 
PUBLIC LAW 102-408—OCT. 13, 1992 
106 STAT. 2035 
such requirement with respect to an area health education 
center having, at the time of initial application for financial 
assistance under this section or under a previous authoriz-
ing law, an operating program supported by both appropria-
tions of a State legislature and local resources. 
"(3) ASSISTANCE FOR OPERATION OF MODEL PROGRAMS.— 
"(A) In the case of any school of medicine or osteopathic 
medicine that is operating an area health education center 
program and that is not receiving financial assistance 
under paragraph (1), the Secretary may provide financial 
assistance to the school for the costs of operating the pro-
gram, and for carrying out activities described in subpara-
graph (E), if the school makes the agreements described 
in subparagraphs (B) through (D). 
"(6Xi) For purposes of subparagraph (A), the agree-
ment described in this subparagraph for a school is that, 
with respect to the costs of operating the area health edu-
cation center program of the school, the school will make 
available (directly or through donations from public or pri-
vate entities) non-Federal contributions in cash toward 
such costs in an amoimt that is not less than 50 percent 
of such costs. 
"(ii) Amoimts provided by the Federal Grovemment may 
not be included in determining the amount of non-Federal 
contributions in cash made for purposes of the requirement 
established in clause (i). 
**(C) For purposes of subparagraph (A), the agreement 
described in this subparagraph for a school is that, in 
operating the area health education program of the school, 
the school will— 
"(i) coordinate the activities of the program with 
the activities of any office of rural health established 
by the State or States in which the program is operat-
ing; 
"(ii) conduct health professions education and 
training activities consistent with national and State 
priorities in the area served by the program in 
coordination with the National Health Service Corps, 
entities receiving funds under section 329 or 330, and 
public health departments; and 
"(iii) cooperate with any entities that are in oper-
ation in the area served by the program and that 
receive Federal or State funds to carry out activities 
regarding the recruitment and retention of health care 
providers. 
(D) For purposes of subparagraph (A), the agreement 
described in this subparagraph for a school is that, with 
respect to the costs oi operating the area health education 
center program of the school, the school will maintain 
expenditures of non-Federal amounts for such costs at a 
level that is not less than the level of such expenditures 
maintained by the school for the fiscal year preceding the 
first fiscal year for which the school receives an award 
imder subparagraph (A). 
"(E) A school may expend not more than 10 percent 
of an award under subparagraph (A) for demonstration 
projects for any or all of the following purposes: 
106 STAT. 2036 
PUBLIC LAW 102-408—OCT. 13, 1992 
"(i) The establishment of computer-based informa-
tion programs or telecommunication networks that will 
link nealth science centers and service delivery sites, 
"(ii) The provision of disease specific educational 
programs for health providers and students in areas 
of concern to the United States. 
"(iii) The development of information dissemina-
tion models to make available new information and 
technologies emerging from biological research centers 
to the practicing medical community. 
"(iv) The institution of new minority recruitment 
and retention programs, targeted to improved service 
delivery in areas the program determines to be medi-
cally underserved. 
y^*, ,,, 
"(v) The establishment of programs to place physi-
cians from health manpower shortage areas into simi-
lar areas to encourage retention of physicians and to 
provide flexibility to States in filling positions in health 
professional shortage areas. 
"(vi) The establishment or improvement of edu-
cation and training programs for State emergency 
medical systems. 
"(vii) The establishment of programs to train 
health care providers in the identification and referral 
of cases of domestic violence. 
"(F) The aggregate amount of awards provided under 
subparagraph (A) to schools in a State for a fiscal year 
may not exceed the lesser of— 
"(i) $2,000,000; and 
"(ii) an amount equal to the product of $250,000 
and the aggregate number of area health education 
centers operated in the State by the schools. 
"(b) STRUCTURE OF PROGRAMS.— 
"(1) IN GENERAL.—^An area health education center program 
shall be a cooperative program of one or more medical (M.D. 
and D.O.) schools and one or more nonprofit private or public 
area health education centers. 
"(2) CERTAIN REQUIREMENTS.—^With respect to an area 
health education center program, a school may not receive 
an award under paragraph (1) of subsection (a) for operational 
expenses, or an award under paragraph (2) or (3) of such 
subsection, unless the program— 
"(A) maintains preceptorship educational experiences 
for health science students; 
"(B) maintains community-based primary care resi-
dency programs or is affiliated with such programs; 
"(C) maintains continuing education programs for 
health professionals or coordinates with such programs; 
"(D) maintains learning resource and dissemination 
systems for information identification and retrieval; 
"(E) has agreements with community-based organiza-
tions for the delivery of education and training in the 
health professions; 
"(F) is involved in the training of health professionals 
(including nurses and allied health professionals), except 
to the extent inconsistent with the law of the State in 
which the training is conducted; and 
PUBLIC LAW 102-408—OCT. 13, 1992 
106 STAT. 2037 
"(G) carries out recruitment programs for the health 
science professions, or programs for health-career aware-
ness, among minority and other elementary or secondary 
students from areas the program has determined to be 
medically underserved. 
"(c) REQUIREMENTS FOR SCHOOLS.—Each medical (M.D. 
and 
D.O.) school participating in an area health education center pro-
gram shall— 
"(1) provide for the active participation in such program 
by individuals who are associated witn the administration of 
the school and each of the departments (or specialties if the 
school has no such departments) of internal medicine, pediat-
rics, obstetrics and gjoiecology, surgery, psychiatry, and family 
medicine; 
"(2) provide that no less than 10 percent of all undergradu-
ate medical (M.D. and D.O.) clinical education of the school 
will be conducted in an area health education center and at 
locations under the sponsorship of such center; 
"(3) be responsible for, or conduct, a program for the train-
ing of physician assistants (as defined in section 799) or nurse 
practitioners (as defined imder section 822) which gives special 
consideration to the enrollment of individuals from, or intending 
to practice in, the area served by the area health education 
center of the program; and 
"(4) provide for the active participation of at least 2 schools 
or programs of other health professions (including a school 
of dentistry and a graduate program of mental health practice 
if there are ones affiliated with the university with which 
the school of medicine or osteopathic medicine is affiliated) 
in the educational program conducted in the area served by 
the area health education center. 
The requirement of paragraph (3) shall not apply to a medical 
(M.D. and D.O.) school participating in an area health education 
center program if another sucn school participating in the same 
program meets the requirement of that paragraph. 
"(d) REQUIREMENTS FOR CENTERS.— 
"(1) SERVICE AREA.—Each area health education center 
shall specifically designate a geographic area in which it will 
serve, or shall specifically designate a medically imderserved 
population it will serve (such area or population with respect 
to such center in this section referred to as 'the area served 
by the center*), which area or population is in a location remote 
from the main site of the teaching facilities of the school or 
schools which participate in the program with such center. 
"(2) OTHER REQUIREMENTS.—Each area health education 
center shall— 
"(A) provide for or conduct training in health education 
services, including education in nutntion evaluation and 
coimseling, in the area served by the center; 
"(B) assess the health manpower needs of the area 
served by the center and assist in the planning and develop-
ment of training programs to meet such needs; 
"(C) provide for or conduct a rotating osteopathic 
internship or a medical residency training program in fam-
ily medicine, general internal medicine, or general pediat-
rics in which no fewer than four individuals are enrolled 
in first-year positions in such program; 
106 STAT. 2038 
PUBLIC LAW 102-408—OCT. 13, 1992 
Contracts. 
"(D) provide opportunities for continuing medical edu-
cation (including education in disease prevention) to all 
physicians and other health professionals (including allied 
health personnel) practicing within the area served by the 
center; 
"(E) provide continuing medical education and other 
educational support services to the National Health Service 
Corps members serving within the area served by the 
center; 
"(F) conduct interdisciplinary training and practice 
involving physicians and other health personnel including, 
where practicable, physician assistants, nurse practitioners, 
and nurse midwives; 
"(G) arrange and support educational opportunities for 
medical and other students at health facilities, ambulatory 
care centers, and health agencies throughout the area 
served by the center; and 
"(H) have an advisory board of which at least 75 per-
cent of the members shall be individuals, including both 
health service providers and consumers, from the area 
served by the center. 
Any area health education center which is participating in 
an area health education center program in which another 
center has a medical residency training program described in 
subparagraph (C) need not provide for or conduct such a medi-
cal residency training program. 
"(e) CERTAIN PROVISIONS REGARDING FUNDING.— 
"(1) PROGRAMS.—Subject to paragraph (2), in providing 
financial assistance under this section to a school, the Secretary 
shall assure that— 
"(A) at least 75 percent of the total funds provided 
to the school are expended by an area health education 
center program in the area health education centers, and 
that the school enters into an agreement with each of 
such centers for purposes of specifjdng the allocation of 
such 75 percent; 
"(B) with respect to the operating costs of the area 
health education program of the school, non-Federal con-
tributions for such costs are made in an amount that 
is not less than 25 percent of such costs; and 
"(C) no award provides funds solely for the planning 
or development of such a program for a period exceeding 
two years. 
The Secretary may vest in entities which have received 
financial assistance under section 802 of the Health Professions 
Educational Assistance Act of 1976, section 774 as in effect 
before October 1, 1977, or luider subsection (a) of this section 
for area health education centers programs title to any property 
acquired on behalf of the United States by that entity (or 
furnished to that entity by the United States) under that award. 
"(2) CENTERS.—^With respect to the period during which 
an area health education center is planned, developed or oper-
ated pursuant to an award under subsection (aXD, not more 
than 55 percent of the total amounts expended for the center 
in any fifth or sixth year of such period may be provided 
by the Secretary, subject to paragraph (3). 
PUBLIC LAW 102-408—OCT. 13, 1992 
106 STAT. 2039 
"(3) APPLICABILITY OF PROVISION REGARDING CENTERS.— 
Paragraph (2) shall apply only in the case of an area health 
education center program for which the initial award under 
subsection (aXD is provided on or after the date of the enact-
ment of the Health Professions Education Extension Amend-
ments of 1992. 
"(f) HEALTH EDUCATION AND TRAINING CENTERS.— 
**(1) IN GENERAL.—^The Secretary shall provide financial 
assistance to schools of medicine and osteopathic medicine for 
the purpose of planning, developing, establishing, maintaining, 
and operating health education and training centers— 
"(A) to improve the supply, distribution, quality, and 
efficiency of personnel provichng health services in the 
State of Florida or (in the United States) along the border 
between the United States and Mexico; 
"(B) to improve the supply, distribution, quality, and 
efficiency of personnel providing, 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 preven-
tion through public education in the areas described. 
"(2) ARRANGEMENTS WITH OTHER ENTITIES.—The Secretary 
may not provide financial assistance under paragraph (1) imless 
the applicant for such assistance agrees, in carrying out the 
purpose described in such paragraph, to enter into arrange-
ments with one or more public or nonprofit private entities 
in the State that have expertise in providing health education 
to the public. 
"(3) SERVICE AREA.—^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 subdivi-
sion) of the State in close proximity to the border between 
the United States and Mexico. 
"(4) ADVISORY GROUP; OPERATIONAL PLAN.—The Secretary 
may not provide financial assistance under paragraph (1) imless 
the applicant for such assistance agrees— 
"(A) to establish an advisory group comprised of health 
service providers, educators and consumers from the service 
area and of faculty from participating schools; 
"(B) after consultation with such advisory group, to 
develop a plan for canying 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) CERTAIN ACTIVITIES.—^The Secretary may not provide 
financial assistance under paragraph (1) unless the applicant 
for such assistance agrees— 
"(A) to evaluate the specific service needs for health 
care personnel in the service area; 
106 STAT. 2040 
PUBLIC LAW 102-408—OCT. 13, 1992 
"(B) to assist in the planning, development, and con-
duct of training programs 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 
services, including training to prepare community health 
workers to implement health education programs in 
commimities, health departments, health clinics, and public 
schools that are located in the service area; 
"(E) to conduct or support continuing medical education 
programs for physicians and other health professionals 
(including allied health personnel) practicing in the service 
area; 
"(F) to support health career educational opportunities 
designed to provide students residing in the service area 
with counseling, education, and training in the health 
professions; 
"(G) with respect to border health education and train-
ing centers, to assist in coordinating its activities and pro-
grams carried out pursuant to paragraph (1)(A) with any 
similar programs and activities carried out in Mexico along 
the border between the United States and Mexico; 
"(H) to make available technical assistance in the serv-
ice area in the aspects of health care organization, financing 
and delivery; and 
"(I) in the case of any school of public health located 
in the service area of the health education and training 
center operated with the assistance, to permit any such 
school to participate in the program of the center if the 
school makes a request to so participate. 
"(6) ALLOCATION OF FUNDS BY CENTERS.—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 osteopathic medicine 
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 osteopathic medicine will obtain from non-
governmental sources the amount of the total operating 
funds for such program which are not provided by the 
Secretary; 
"(C) no award shall provide funds solely for the plan-
ning or development of a health education and training 
center program 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 award shall provide funds to be used outside 
the United States except as the Secretary may prescribe 
for travel and communications purposes related to the con-
duct of a border health education and training center. 
"(7) DEFINITIONS.—For purposes of this subsection: 
PUBLIC LAW 102-408—OCT. 13, 1992 
106 STAT. 2041 
"(A) The term "border health education and training 
center* means an entity that is a recipient of an award 
under paragraph (1) and that is carrying out (or will cany 
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 an award under 
paragraph (1). 
"(C) The term 'service area' means, with respect to 
a health education and training center, the geographic 
area designated for the center imder paragraph (3). 
"(8) ALLOCATION OF FUNDS BY SECRETARY.— 
"(A) Of the amoimts appropriated pursuant to sub-
section (iX2) for a fiscal year, the Secretary shall make 
available 50 percent for allocations each fiscal year for 
applications approved by the Secretary for border health 
education and training centers. The amount of the alloca-
tion for each such center shall be determined in accordance 
with subparagraph (B). 
"(B) The amoimt of an allocation under subparagraph 
(A) for a fiscal year shall be determined in accordance 
with a formula prescribed 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 population, inclu(ung Hispanic individuals, 
in the State of Florida and 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. 
"(g) DEFINITIONS.—For purposes of this section: 
"(1) The term 'area nealth education center program' means 
a program which is organized as provided in subsection (b) 
and under which the participating medical (M.D. and D.O.) 
schools and the area health education centers meet the require-
ments of subsections (c) and (d). 
"(2) The term 'award' means an award of financial assist-
ance. 
"(3) The term 'financial assistance' means a grant, coopera-
tive agreement, or contract. 
"(h) (JRITERIA AND STANDARDS.—The Secretary shall establish 
standards and criteria for the requirements of this section, 
"(i) AUTHORIZATION OF APPROPRIATIONS.— 
"(1) AREA HEALTH EDUCATION CENTER PROGRAMS.— 
"(A) For the purpose of canying out this section other 
than subsection (f), there is authorized to be appropriated 
$25,000,000 for each of the fiscal years 1993 through 1995. 
"(B) Of the amounts appropriated under paragraph 
(1) for a fiscal year, the Secretary may not obligate more 
than 20 percent for awards under subsection (aX2). 
"(C) Of the amounts appropriated under paragraph 
(1) for fiscal year 1993, the Secretary shall obligate for 
106 STAT. 2042 
PUBLIC LAW 102-408—OCT. 13, 1992 
awards under subsection (aX3) such amounts as are appro-
priated in excess of $19,200,000. Of the amounts appro-
priated under paragraph (1) for each of the fiscal years 
1994 and 1995, the Secretary shall obligate for such awards 
such amoimts as are appropriated in excess of $18,700,000. 
Appropriation 
"(2) HEALTH EDUCATION AND TRAINING CENTERS.—For the 
authorization. 
purpose of carrving out subsection (f), there is authorized to 
oe appropriatea $5,000,000 for each of the fiscal years 1993 
through 1995. 
42 use 293k. 
"SEC. 747. FAMILY MEDICINE. 
"(a) TRAINING GENERALLY.—The Secretary may make grants 
to, or enter into contracts with, any public or nonprofit private 
hospital, school of medicine or osteopatnic medicine, or to or with 
a public or private nonprofit entity (which the Secretary has deter-
mined is capable of carrying out such grant or contract)— 
"(1) to plan, develop, £md operate, or participate in, an 
approved professional training program (including an approved 
residency or internship program) in the field of family medicine 
for medical (M.D. and D.O.) students, interns (including interns 
in internships in osteopathic medicine), residents, or practicing 
physicians; 
"(2) to provide financial assistsince (in the form of 
traineeships and fellowships) to medical (M.D. and D.O.) stu-
dents, interns (including interns in internships in osteopathic 
medicine), residents, practicing physicians, or other medical 
personnel, who are in need thereof, who are participants in 
any such program, and who plan to specialize or work in 
the practice of family medicine; 
"(3) to plan, develop, and operate a program for the training 
of physicians who plan to teach in family medicine training 
programs; and 
"(4) to provide financial assistance (in the form of 
traineeships and fellowships) to physicians who are participants 
in any sucii program and who plan to teach in a family medicine 
training program. 
"(b) ACADEMIC ADMINISTRATIVE UNITS.— 
"(1) IN GENERAL.—^The Secretary may make grants to or 
enter into contracts with schools of medicine or osteopathic 
medicine to meet the costs of projects to establish, maintain, 
or improve academic administrative units (which may be 
departments, divisions, or other units) to provide clinical 
instruction in family medicine. 
"(2) PREFERENCE IN MAKING AWARDS.—In making awards 
of grants and contracts under paragraph (1), the Secretary 
shall give preference to any qualified applicant for such an 
award that agrees to expend the award for the purpose of— 
"(A) establishing an academic administrative unit for 
programs in family medicine; or 
"(B) substantially expanding the programs of such a 
unit. 
"(c) DURATION OF AWARD.—^The period during which pajrments 
are made to an entity from an award of a grant or contract under 
subsection (a) may not exceed 5 years. The provision of such pay-
ments shall be subject to annual approval by the Secretary of 
the payments and subject to the availability of appropriations for 
the fiscal year involved to make the payments. 
PUBLIC LAW 102-408—OCT. 13, 1992 
106 STAT. 2043 
"(d) FUNDING.— 
"(1) AUTHORIZATION OF APPROPRIATIONS.—For the purpose 
of carrying out this section, there is authorized to be appro-
priated $54,000,000 for each of the fiscal years 1993 through 
1995. 
"(2) ALLOCATION.—Of the amounts appropriated under 
paragraph (1) for a fiscal year, the Secretary shall make avail-
able not less than 20 percent for awards of grants and contracts 
under subsection (b). 
"SEC. 748. GENERAL INTERNAL MEDICINE AND GENERAL PEDIAT- 42 USC 293/. 
mcs. 
"(a) IN GENERAL.—^The Secretary may make grants to and 
enter into contracts with schools of medicine and osteopathic medi-
cine, public or private nonprofit hospital, or any other public or 
private nonprofit entity to meet the costs of projects— 
"(1) to plan, develop, and operate, or participate in, an 
approved professional training program (including an approved 
residency or internship program) in the field of internal medi-
cine or pediatrics for medical (M.D. and D.O.) students, interns 
(including interns in internships in osteopathic medicine), resi-
dents, or practicing physicians, which training program empha-
sizes training for the practice of general internal medicine 
or general pediatrics (as defined by the Secretary in regula-
tions); 
"(2) to provide financial assistance (in the form of 
traineeships and fellowships) to medical (M.D. and D.O.) stu-
dents, interns (including interns in internships in osteopathic 
medicine), residents, practicing physicians, or other medical 
personnel, who are in need thereof, who are participants in 
any such training program, and who plan to specialize in or 
work in the practice of general internal medicine or general 
pediatrics; 
"(3) to plan, develop, and operate a program for the training 
of physicians who will teach in a general internal medicine 
or general pediatrics training program; and 
"(4) which provide financial assistance (in the form of 
traineeships and fellowships) to physicians who are participants 
in any such program and who plan to teach in a general 
internal medicine or general pediatrics training program. 
"(b) DURATION OF AWARD.—^The period during which payments 
are made to an entity from an award of a grant or contract imder 
subsection (a) may not exceed 5 years. The provision of such pay-
ments shall be subject to annual approval by the Secretary of 
the payments and subject to the availability or appropriations for 
the fiscal year involved to make the payments. 
"(c) AUTHORIZATION OF APPROPRIATIONS.—For the purpose of 
carrying out this section, there is authorized to be appropriated 
$25,000,000 for each of the fiscal years 1993 through 1995. 
<^EC. 749. GENERAL PRACTICE OF DENTISTRY. 
42 USC 293m. 
"(a) IN GENERAL.—^The Secretary may make grants to, and 
enter into contracts with, any pubUc or nonprofit private school 
of dentistry 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; 
106 STAT. 2044 
PUBLIC LAW 102-408—OCT. 13, 1992 
"(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 special-
ize in the practice of general dentistry; and 
"(3) to fund innovative, nontraditional models for the provi-
sion of postdoctoral (General Dentistry training. 
"(b) AUTHORIZATION OF APPROPRIATIONS.—For the purpose of 
canying out this section, there is authorized to be appropriated 
$6,000,000 for each of the fiscal years 1993 through 1995. 
42 use 293n. 
"SEC. 750. PHYSICIAN ASSISTANTS. 
"(a) IN GENERAL.—^The Secretary may meike grants to and 
enter into contracts with public or nonprofit private schools of 
medicine and osteopathic medicine and other public or nonprofit 
private entities to meet the costs of projects to plan, develop, and 
operate or maintain programs— 
"(1) for the training of physician assistants (as defined 
in section 799); and 
"(2) for the training of individuals who will teach programs 
of such training. 
"(b) 
REGULATIONS.—^Afler 
consultation 
with 
appropriate 
organizations, the Secretary shall prescribe regulations for pro-
grams receiving assistance under subsection (a) for the training 
of physician assistants. Such regulations shall, as a minimum, 
require that such a program— 
"(1) extend for at least one academic year and consist 
of— 
"(A) supervised clinical practice; and 
"(B) at least four months (in the aggregate) of class-
room instruction, directed toward preparing students to 
deliver health care; 
"(2) have an enrollment of not less than eight students; 
and 
"(3) train students in primary care, disease prevention, 
health promotion, geriatric medicine, and home health care. 
"(c) PLACEMENT OF GRADUATES.—^No grant or contract may 
be made under subsection (a) unless the school or other entity 
involved provides assurances satisfactorj^ to the Secretary that the 
school or entity 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. 
"(d) FUNDING.— 
"(1) AUTHORIZATION OF APPROPRIATIONS.—For the purpose 
of carrying out this section, there is authorized to be appro-
priated $9,000,000 for each of the fiscal years 1993 through 
1995. 
"(2) LIMITATION.—^Not more than 10 percent of the amounts 
appropriated under paragraph (1) may be expended for ceirrying 
out subsection (aX2). 
42 use 293o. 
"SEC. 751. PODIATRIC MEDICINE. 
"(a) IN GENERAL.—^The Secretary may make ^prants to, and 
enter into contracts with, public and nonprofit private hospitals 
and schools of podiatric medicine for the purpose of planning and 
implementing 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 
PUBLIC LAW 102-408—OCT. 13, 1992 
106 STAT. 2045 
to residents who participate in such projects and who plan to 
specialize in primary care. 
"(b) PREFERENCE IN MAKING GRANTS.—In making grants under 
subsection (a), the Secretary shall ^ve preference to qualified 
applicants that provide clinical training in podiatric medicine in 
a variety of medically imderserved communities. 
"(c) AUTHORIZATION OF APPROPRIATIONS.—For the purpose of 
carrying out this section, there is authorized to be appropriated 
$1,000,000 for each of the fiscal years 1993 through 1995. 
<^EC. 752. GENERAL PROVISIONS. 
42 U
S
C 293p. 
"(a) TRAINEESHIPS AND FELLOWSHIPS.— 
"(1) TRAlNEESHiPS.^Payments by recipients of ^ants or 
contracts under this part for traineeships shall be limited to 
such amounts as the Secretary finds necessary to cover the 
cost of tuition and fees of, and stipends and allowances (includ-
ing travel and subsistence expenses and dependency allow-
ances) for the trainees. 
"(2) FELLOWSHIPS.—Payments by recipients of ^ants or 
contracts under this part for fellowships shall be limited to 
such amounts as the Secretary finds necessary to cover the 
cost of advanced stud^ by, and stipends and allowances (includ-
ing travel and subsistence expenses and dependency allow-
ances) for, the fellows. 
"(b) AMOUNT OF GRANT.—^The amount of any grant or contract 
under this part shall be determined by the Secretary. 
"PART D—TRAINING IN CERTAIN HEALTH 
PROFESSIONS 
"Subpart I—^Public Health and Preventive 
Medicine 
"SEC. 761. PUBUC HEALTH TRAINEESHIPS. 
42 USC 294. 
"(a) IN GENERAL.—^The Secretary may make grants to accredited 
schools of public health, and to other public or nonprofit private 
institutions accredited for the provision of graduate or specialized 
training in public health, for the purpose of assisting such schools 
and institutions in providing traineeships to individuals described 
in subsection (bX3). 
"(b) CERTAIN REQUIREMENTS.— 
"(1) APPLICATION FOR GRANT.—No grant for traineeships 
may be made under subsection (a) unless an application there-
for has been submitted to, and approved by, the Secretary. 
Such application shall be in such lorm, be submitted in such 
manner, and contain such information, as the Secretary by 
regulation may prescribe. Traineeships under such a grant Grants. 
shall be awarded in accordance with such regulations as tiie Regulations. 
Secretary shall prescribe. The amount of any such grant shall 
be determined by the Secretary. 
"(2) USE OF GRANT.—^Traineeships awarded under grants 
made under subsection (a) shall provide for tuition and fees 
and such stipends and allowances (including travel and subsist-
ence expenses and dependency allowances) for the trainees 
as the Secretary may deem necessary. 
"(3) ELIGIBLE INDIVIDUALS.—The individuals referred to in 
subsection (a) are individuals who are pursuing a course of 
106 STAT. 2046 
PUBLIC LAW 102-408—OCT. 13, 1992 
study in a health professions field in which there is a severe 
shortage of health professionals (which fields include the fields 
of epidemiology, environmental health, biostatistics, toxicology, 
and nutrition). 
42 use 294a. 
"SEC. 762. PUBUC HEALTH SPECIAL PROJECTS. 
"(a) IN GENERAL.—^The Secretary may make grants to and 
enter into contracts with accredited schools of public health for 
the costs of planning, developing, demonstrating, operating, and 
evaluating projects that are in furtherance of the goals established 
by the Secretary for the year 2000 in the area of— 
"(1) preventive medicine; 
''(2) health promotion and disease prevention; 
"(3) improving access to and quality of health services 
in medically underserved communities; or 
"(4) reducing the incidence of domestic violence. 
"(b) PREFERENCES IN MAKING AWARDS.—In making awards of 
grants and contracts under subsection (a), the Secretary shall give 
preference to qualified schools agreeing that the project for which 
the award is made— 
"(1) will establish or strengthen field placements for stu-
dents in public or nonprofit private health agencies or organiza-
tions; and 
"(2) will involve faculty members and students in collabo-
rative projects to enhance public health services to medically 
imderserved communities. 
"(c) PARTICIPATION AND TRAINING OF STUDENTS.—The Secretary 
may make an award of a grant or contract under subsection (a) 
only if the school involved agrees that the students of the school 
will, through participation in the project for which the award is 
made, receive training in the activities carried out by the project. 
"(d) APPLICATION FOR AWARD.—^The Secretary may make an 
award of a grant or contract under subsection (a) only if an applica-
tion for the award is submitted to the Secretary and the application 
is in such form, is made in such manner, and contains such agree-
ments, assurances, and information as the Secretary determines 
to be necessary to carry out this section. 
"(e) ESTABLISHMENT OF GOALS; RELATED REPORTS.— 
"(1) GOALS.— 
"(A) The Secretary shall establish goals for projects 
under subsection (a) (including goals regarding the training 
of students), and shall require that, as a condition of the 
receipt of grants and contracts imder such subsection, 
schools carry out activities in furtherance of meeting the 
goals. 
"(B) The Secretary shall establish and implement a 
methodology for measuring the extent of progress that 
has been made toward the goals established under subpara-
graph (A) by schools receiving grants or contracts under 
subsection (a). 
"(2) REPORTS.—Not later than February 1, 1994, the Sec-
retary shall submit to the Committee on Energy and (IJommerce 
of the House of Representatives, and the Committee on Labor 
and Human Resources of the Senate, a report describing the 
progress made by projects under subsection (a) during the 
preceding fiscal years toward the goals established under para-
graph (1). For purposes of the report, the extent of such progress 
PUBLIC LAW 102-408—OCT. 13, 1992 
106 STAT. 2047 
shall be measured through the methodology established under 
subparagraph (B) of such paragraph. 
"SEC. 763. PREVENTIVB MEDICINE; DENTAL PUBUC HEALTH. 
42 USC 294b. 
"(a) IN GENERAL.—The Secretary may make grants to and 
enter into contracts with schools of medicine, osteopathic medicine, 
public health, and dentistry to meet the costs of projects— 
"(1) to plan and develop new residency training programs 
and to maintain or improve existing residency training pro-
grams in preventive medicine and dental public health; and 
"(2) to provide financial assistance to residency trainees 
enrolled in such programs. 
"(b) ADMINISTRATION.— 
"(1) AMOUNT.—^The amount of any grant under subsection 
(a) shall be determined by the Secretary. 
"(2) APPLICATION.—No grant may be made under subsection 
(a) unless an application therefor is submitted to and approved 
by the Secretary. Such an application shall be in sucn form. Regulations. 
submitted in such manner, and contain such information, as 
the Secretary shall by regulation prescribe. 
"(3) ELIGIBILTY.—To be eligible for a grant under subsection 
(a), the applicant must demonstrate to the Secretary that it 
has or will have available full-time faculty members with train-
ing and experience in the fields of preventive medicine or 
dental public health and support from other faculty members 
trained in public health and other relevant specialties and 
disciplines. 
"(4) OTHER FUNDS.—Schools of medicine, osteopathic medi-
cine, dentistry, and public health may use fimds committed 
by State, local, or county public health officers as matching 
amoiuits for Federal grant funds for residency training pro-
grams in preventive medicine. 
"SEC. 765. AUTHORIZATION OF APPROPRIATIONS. 
42 USC 294c. 
"(a) IN GENERAL.—For the purpose of canying out this subpart, 
there is authorized to be appropriated $15,600,000 for each of 
the fiscal years 1993 through 1995. 
"(b) LIMITATION REGARDING CERTAIN PROGRAM.—In obligating 
amounts appropriated under subsection (a), the Secretary may not 
obligate more than 40 percent for carrying out section 762. 
^'Subpart II—^Allied Health Professions 
"SEC. 766. ADVANCED TRAINING. 
42 USC 294d. 
"(a) IN GENERAL.—^The Secretary may award grants to and 
enter into contracts with eligible entities to assist such entities 
in meeting the costs associated with projects designed to— 
"(1) plan, develop, establisn or expand postbaccalaureate 
programs for the advanced training of allied health profes-
sionals; and 
"(2) provide financial assistance, in the form of traineeships 
or fellowships, to postbaccalaureate students who are partici-
pants in any such program and who commit to teaching in 
the allied health profession involved. 
"(b) PREFERENCE.—In awarding grants under subsection (a), 
the Secretary shall give preference to Qualified projects demonstrat-
ing that not less than 50 percent of the graduates of such schools 
106 STAT. 2048 
PUBLIC LAW 102-408—OCT. 13, 1992 
or programs during the preceding 2-year period are engaged as 
full-time teaching facility in an allied health shortage specialty. 
"(c) LIMITATION.—^The Secretary shall limit grants and contracts 
awarded or entered into under subsection (a) to those allied health 
fields or specialties as the Secretary shall, from time to time, 
determine to have— 
"(1) the most significant national or regional shortages 
of practitioners; 
"(2) insufficient numbers of qualified faculty in entry level 
or advanced educational programs; or 
"(3) a significant role in the care and rehabilitation of 
patients who are elderly or disabled including physical thera-
pists and occupational therapists. 
(d) ELIGIBLE ENTITIES.—For purposes of this section, the term 
'eligible entities' means entities that are— 
"(1) public or private nonprofit schools, universities, or 
other educational entities that provide for education and train-
ing in the allied health professions and that meet such stand-
ards as the Secretary may by regulation prescribe; or 
"(2) public or nonprofit private entities capable, as deter-
mined by the Secretary, of carrjdng out projects described in 
subsection (a). 
"(e) AUTHORIZATION OF APPROPRIATIONS.—For the purpose of 
carrying out this section, there is authorized to be appropriated 
$5,000,000 for each of the fiscal years 1993 through 1995. 
42 use 294e. 
"SEC. 767. PROJECT GRANTS AND CONTRACTS. 
"(a) 
PROJECTS RELATED TO STRENGTHENING TRAINING AND 
INCREASING ENROLLMENT IN THE ALLIED HEALTH PROFESSIONS.— 
The Secretary may make grants to and enter into contracts with 
eligible entities to assist such entities in meeting the costs associ-
ated with expanding or establishing programs that will increase 
the number of individuals trained in allied health professions. Pro-
grams and activities fimded imder this section may include— 
"(1) those that expand enrollments in allied health profes-
sions with the greatest shortages or whose services are most 
needed by the elderly; 
"(2) those that provide rapid transition training programs 
in allied health fields to individuals who have baccalaureate 
degrees in health-related sciences; 
"(3) those that establish community-based allied health 
training programs that link academic centers to rural clinical 
settings; 
"(4) those that provide career advancement training for 
practicing allied health professionals; 
"(5) those that expand or establish clinical training sites 
for allied health professionals in medically underserved or rural 
communities in order to increase the number of individuals 
trained; 
"(6) those that develop curriculum that will emphasize 
knowledge and practice in the areas of prevention and health 
promotion, seriatrics, long-term care, home health and hospice 
care, and ethics; 
"(7) those that expand or establish interdisciplinary train-
ing programs that promote the effectiveness of allied health 
practitioners in geriatric assessment and the rehabilitation of 
the elderly; 
PUBLIC LAW 102-408—OCT. 13, 1992 
106 STAT. 2049 
"(8) those that expand or establish demonstration centers 
to emphasize innovative models to link allied health clinical 
practice, education, and research; and 
"(9) those that provide financial assistance (in the form 
of traineeships) to students who are participants in any such 
program; and 
"(A) who plan to pursue a career in an allied health 
field that has a demonstrated personnel shortage; and 
"(B) who agree upon completion of the training program 
to practice in a medically underserved community; 
that shall be utilized to assist in the payment of all or part 
of the costs associated with tuition, fees and such other stipends 
as the Secretary may consider necessary. 
"(b) APPLICATION.— 
"(1) REQUIREMENT.—No grant may be awarded or contract 
Regulations. 
entered into under this section unless an application therefore 
has been submitted to, and approved by, the Secretary. Such 
application shall be in such form, submitted in such manner, 
and contain such information, as the Secretary shall by regula-
tion prescribe. 
"(2) PREFERENCE.—In considering an application submitted 
for a grant under this section, the Secretary shall give pref-
erence to qualified applicants that— 
"(A) expand and maintain first-year enrollment by not 
less than 10 percent over enrollments in base year 1992; 
or 
"(B) demonstrate that not less than 20 percent of the 
graduates of such training programs during the preceding 
2-year period are worlang in medically 
underserved 
communities. 
"(c) ELIGIBLE ENTITIES.—For purposes of this section, the term 
'eligible entities' has the meaning given such term in section 766. 
"(d) AUTHORIZATION OF APPROPRIATION.—For the purpose of 
carrying out this section, there is authorized to be appropriated 
$5,000,000 for each of the fiscal years 1993 through 1995. 
^Subpart III—^Health Administration 
-SEC. 771. TRAINEESHIPS AND SPECIAL PROJECTS. 
42 USC 294i. 
"(a) IN GENERAL.—^The Secretary may make grants to public 
or nonprofit private educational entities (including graduate schools 
of social work but excluding accredited schools of public health) 
that offer a program described in subsection (b)— 
"(1) to provide traineeships for students enrolled in such 
a program; and 
"(2) to assist programs of health administration in the 
development or improvement of programs to prepare students 
for employment with public or nonprofit private entities. 
"(b) RELEVANT PROGRAMS.—The program referred to in sub-
section (a) is a program in health administration, hospital adminis-
tration, or health policy analysis and planning, which program 
is accredited by a body or bodies approved for such purpose by 
the Secretary of Education and which meets such other quality 
standards as the Secretary of Health and Human Services by regu-
lation may prescribe. 
106 STAT. 2050 
PUBLIC LAW 102-408—OCT. 13, 1992 
"(c) PREFERENCE IN MAKING GRANTS.—In making grants under 
subsection (a), the Secretary shall give preference to qucQifled 
applicants that meet the following concUtions: 
"(1) Not less than 25 percent of the graduates of the 
applicant are engaged in full-time practice settings in medically 
underserved communities. 
"(2) The appliouit recruits and admits students from medi-
cally underserved communities. 
"(3) For the purpose of training students, the applicant 
has established relationships with public and nonprofit provid-
ers of health care in the community involved. 
"(4) In training students, the applicant emphasizes employ-
ment with public or nonprofit private entities. 
"(d) CERTAIN PROVISIONS REGARDING TRAINEESHIPS.— 
"(1) USE OF GRANT.—^Traineeships awarded under grants 
made imder subsection (a) shall provide for tuition and fees 
and such stipends and allowances (including travel and subsist-
ence expenses and dependency allowances) for the trainees 
as the Secretary may deem necessary. 
"(2) PREFERENCE FOR CERTAIN STUDENTS.—Each entitv 
applying for a grant under subsection (a) for traineeships shall 
assure to the satisfaction of the Secretary that the entity will 
give priority to awarding the traineeships to students who 
demonstrate a commitment to emplo3nnent with public or non-
profit private entities in the fields with respect to which the 
traineeships are awarded. 
"(e) APPLICATION FOR GRANT.—No grant may be made imder 
subsection (a) unless an application therefor has been submitted 
to, and approved by, the Secretary. Such application shall be in 
such form, be submitted in such manner, and contain such informa-
tion, as the Secretary may prescribe. Traineeships imder such a 
grant shall be awarded in accordance with such requirements as 
the Secretory shall prescribe. The amount of any such grant shall 
be determined by the Secretory. 
"(f) FUNDING.— 
"(1) AUTHORIZATION OF APPROPRIATIONS.—For payments 
under grants under subsection (a), there is authorized to be 
appropriated $2,500,000 for each of the fiscal years 1993 
through 1995. 
"(2) LIMITATION.—^In obligating amoimto appropriated 
under paragraph (1) for a fiscal year, the Secretary may not 
obligate more than 30 percent for grants under subsection 
(aX2). 
"PART E-SPECIAL TRAINING PROJECTS 
42 use 294n. 
*«£€. 776. ACQUIRED IMMUNE DEFICIENCY SYNDROME. 
"(a) SCHOOLS; CENTERS.— 
"(1) IN GENERAL.—^The Secretory may make grante and 
enter into contracte to assist public and nonprofit private enti-
ties and schools and academic health science centers in meeting 
the coste of projects— 
"(A) to train the faculty of schools of, and graduate 
departments or programs of, medicine, nursing, osteopathic 
miedicine, dentistry, public health, allied health, and mental 
health practice to teach health professions students to pro-
PUBLIC LAW 102-408—OCT. 13, 1992 
106 STAT. 2051 
vide for the health care needs of individuals with HIV 
disease; 
"(B) to train practitioners to provide for the health 
care needs of such individuals; 
"(C) with respect to improving clinical skills in the 
diagnosis, treatment, and prevention of such disease, to 
educate and train the health professionals and clinical 
staff of schools of medicine, osteopathic medicine, and den-
tistry; and 
"(D) to develop and disseminate curricula and resource 
materials relating to the care and treatment of individuals 
with such disease and the prevention of the disease among 
individuals who are at risk of contracting the disease. 
"(2) PREFERENCE IN MAKING GRANTS.—In making grants 
under paragraph (1), the Secretary shall give preference to 
qualified projects which will— 
"(A) train, or result in the training of, health profes-
sionals who will provide treatment for minority individuals 
with HIV disease and other individuals who are at high 
risk of contracting such disease; and 
"(B) train, or result in the training of, minority health 
professionals and minority allied health professionals to 
provide treatment for individuals with such disease. 
"(3) APPLICATION.—No grant or contract may be made 
under paragraph (1) unless an application is submitted to the 
Secretary in such form, at such time, and containing such 
information, as the Secretary may prescribe. 
"(b) DENTAL SCHOOLS.— 
"(1) IN GENERAL.—^The Secretary may make grants to assist 
dental schools and programs described in section 777(b)(4)(B) 
with respect to oral health care to patients with HIV disease. 
"(2) 
APPLICATION.—Each 
dental 
school 
or 
program 
described in section 777(b)(4)(B) may annually submit an 
application documenting the unreimbursed costs of oral health 
care provided to patients with HIV disease by that school 
or hospital during the prior year. 
"(3) DISTRIBUTION.—The Secretary shall distribute the 
available funds among all eligible applicants, taking into 
account the number of patients with HIV disease 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) MAINTENANCE OF EFFORT.—The Secretary shall not 
make a grant under this subsection if doing so would result 
in any reduction in State funding allotted for such purposes. 
"(c) DEFINITION.—For purposes of this section: 
"(1) The term 'HIV disease' means infection with the human 
immunodeficiency virus, and includes any condition arising 
from such infection. 
"(2) The term "human immunodeficiency virus' means the 
etiologic agent for acquired immune deficiency sjmdrome. 
"(d) AUTHORIZATION OF APPROPRL\TIONS.— 
"(1) SCHOOLS; CENTERS.—For the purpose of grants under 
subsection (a), there is authorized to be appropriated 
$23,000,000 for each of the fiscal years 1993 through 1995. 
59-194 O—93 
9 : QL 3 (Pt. 3) 
106 STAT. 2052 
PUBLIC LAW 102-408—OCT. 13, 1992 
**(2) DENTAL SCHOOLS.—For the purpose of grants under 
subsection (b), there is authorized to be appropriated $7,000,000 
for each of the fiscal years 1993 through 1995. 
42 use 294o. 
"SEC. 777. GERIATRICS. 
"(a) GERIATRIC EDUCATION CENTERS.—The Secretary may make 
grants to and enter into contracts with accredited health professions 
schools or programs described in paragraph (1), (3), or (4) of section 
799 or in section 853(2) to assist in meeting the costs of such 
schools or programs of projects to— 
**(1) improve the training of health professionals in geri-
atrics; 
"(2) develop and disseminate curricula relating to the treat-
ment of the health problems of elderly individuals; 
''(3) expand and strengthen instruction in methods of such 
treatment; 
"(4) support the training and retraining of faculty to provide 
such instruction; 
"(5) support continuing education of health professionals 
and allied health professionals who provide such treatment; 
and 
**(6) establish new affiliations with nursing homes, chronic 
and acute disease hospitals, ambulatory care centers, and senior 
centers in order to provide students with clinical training in 
geriatric medicine. 
^(b) GERIATRIC TRAINING REGARDING PHYSICIANS AND DEN-
TISTS.— 
"(1) IN GENERAL.—^The Secretary may make grants to, and 
enter into contracts with, schools of medicine, schools of osteo-
pathic medicine, teaching hospitals, and graduate medical edu-
cation programs, for the purpose of providing support (including 
residencies, traineeships, and fellowships) for geriatric training 
projects to train physicians and dentists who plan to teach 
geriatric medicine, geriatric psychiatry, or geriatric dentistry. 
"(2) REQUIREMENTS.—Each project for which a grant or 
contract is made under this subsection shall— 
"(A) be staffed by full-time teaching physicians who 
have experience or training in geriatric medicine or geri-
atric psychiatry; 
"(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 based in a graduate medical education program 
in internal medicine or family medicine or in a department 
of geriatrics or psychiatry; 
"(D) 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 
"(E) provide training in geriatrics through one or both 
of the training options described in subparagraphs (A) and 
(B) of paragraph (3). 
PUBLIC LAW 102-408—OCT. 13, 1992 
106 STAT. 2053 
"(3) TRAINING OPTIONS.—The training options referred to 
in subparagraph (F) of paragraph (2) shall be as follows: 
"(A) A 1-year retraining program in geriatrics for— 
"(i) physicians who are faculty members in depart-
ments of internal medicine, family medicine, gyne-
cology, geriatrics, and psychiatry at schools of medicine 
and osteopathic medicine; and 
"(ii) aentists who are faculty members at schools 
of dentistry or at hospital departments of dentistry. 
"(B) A 2-year internal medicine or family medicine 
fellowship program providing emphasis in geriatrics, which 
shall be designed to provide training in clinical geriatrics 
and geriatrics research for— 
"(i) physicians who have completed graduate medi-
cal education programs in internal medicine, family 
medicine, 
psychiatry, 
neurology, 
gynecology, 
or 
rehabilitation medicine; and 
"(ii) dentists who have demonstrated a commit-
ment to an academic career and who have completed 
postdoctoral dental training, including postdoctoral 
dental education programs or who have relevant 
advanced training or experience. 
"(4) DEFINITIONS.—For purposes of this subsection: 
"(A) The term 'graduate medical education program' 
means a program sponsored by a school of medicine, a 
school of osteopathic medicine, a hospital, or a public or 
private institution that— 
"(i) offers postgraduate medical training in the 
specialties and subspecialties of medicine; and 
"(ii) has been accredited by the Accreditation Coun-
cil for Graduate Medical Education or the American 
Osteopathic Association through its Committee on 
Postdoctoral Training. 
"(B) The term 'post-doctoral dental education program' 
means a program sponsored by a school of dentistry, a 
hospital, or a public or private institution that— 
"(i) offers post-doctoral training in the specialties 
of dentistry, advanced education in general dentistry, 
or a dental general practice residency; and 
"(ii) has been accredited by the Commission on 
Dental Accreditation. 
"(c) GERIATRIC TRAINING REGARDING OPTOMETRISTS.—The Sec-
retary may make grants to, and enter into contracts with, schools 
and colleges of optometry for the purpose of providing support 
for projects— 
"(1) to plan, develop, and operate projects in postgraduate 
geriatric care training for optometrists who will teach geriatric 
optometry; 
"(2) to provide financial assistance (in the form of 
residencies, traineeships, and fellowships) to participants in 
such projects; and 
"(3) to establish new affiliations with nursing homes, 
ambulatory care centers, senior centers, and other public or 
nonprofit private entities. 
"(d) AUTHORIZATION OF APPROPRIATIONS.— 
"(1) EDUCATION CENTERS; TRAINING.—For grants and con-
tracts under subsections (a) and (b), there is authorized to 
106 STAT. 2054 
PUBLIC LAW 102-408—OCT. 13, 1992 
be appropriated $17,000,000 for each of the fiscal years 1993 
through 1995. 
*'^) OPTOMETRY.—For grants and contracts under sub-
section (c), there is authorized to be appropriated $400,000 
for each of the fiscal years 1993 through 1995. 
42 use 294p. 
<«£€. 778. RURAL AREAS. 
"(a) GRANTS.—^The Secretary may make grants to, or enter 
into contracts with, any eligible applicant to help such applicant 
fund authorized activities iinder an application approved under 
subsection (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 con-
ducted 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.— 
"(A) IN GENERAL.—^An applicant shall not use more 
than 10 percent of the funds made available to such 
applicant imder subsection (a) for administrative expenses. 
"(B) TRAINING.—Not more than 10 percent of the 
individuals receiving training with funds made available 
to an applicant imdier subsection (a) shall be trained as 
doctors of medicine or doctors of osteopathy. 
"(C) LIMITATION.—^An institution that receives a grant 
under this section shall use amounts received under such 
grant to supplement, not supplant, amounts made available 
by such institution for activities of the type described in 
subsection (bXD in the fiscal year preceding the year for 
which the grant is received. 
"(c) EuGiBLE APPLICANTS.—Applicants eligible to obtain funds 
under subsection (a) shall include local health departments, non-
PUBLIC LAW 102-408—OCT. 13, 1992 
106 STAT. 2055 
profit organizations and public or nonprofit colleges, universities, 
or schools of, or programs that specialize in, nursing, mental health 
practice, optometry, public health, 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) APPLICATIONS.— 
"(1) SUBMISSION.—In order to receive a grant under sub-
section (a) an entity shall submit an application to the Sec-
retary. 
"(2) FORMS.—^An application submitted under this sub-
section shall be in such form, be submitted by such date, 
and contain such information as the Secretary shall require. 
"(3) APPLICATIONS.—^Applications submitted under this sub-
section shall— 
"(A) be jointly submitted by at least two eligible 
applicants 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, 
community health centers, migrant health centers, rural 
health clinics, community mental health centers, long-term 
care facilities, Native Hawaiian health centers, or facilities 
operated by the Indian Health Service or an Indian tribe 
or tribal organization or Indian organization under a con-
tract with the Indian Health Service under the Indian 
Self-Determination Act; and 
"(C) provide any additional information required by 
the Secretary. 
"(e) DEFINITIONS.—For the purposes of this section, the term 
'rural' means geographic areas that are located outside of standard 
metropolitan statistical areas. 
"(f) AUTHORIZATION OF APPROPRIATIONS.—For the purpose of 
carrying out this section, there is authorized to be appropriated 
$7,000,000 for each of the fiscal years 1993 through 1995. 
"PART F—MISCELLANEOUS PROGRAMS 
"SEC. 781. RESEARCH ON CERTAIN HEALTH PROFESSIONS ISSUES. 
42 USC 295. 
"(a) EDUCATIONAL INDEBTEDNESS.— 
"(1) IN GENERAL.—Subject to paragraph (2), the Secretary 
may make grants to and enter into contracts with public and 
nonprofit private entities for the purpose of conducting research 
on the extent to which the debt incurred by medical students 
for attendance at educational institutions has had a detrimental 
effect on the decisions made by the students on entering pri-
mary care specialities. 
"(2) EVALUATION OF RATE OF INCREASE.—In carrying out 
paragraph (1), the Secretary shall provide for a determination 
of the reasons underl3dng the rate of increase occurring since 
January 1, 1981, in tuition and fees for attending health profes-
sions schools. The Secretary shall ensure that the determination 
includes the justifications of such schools for such rate. 
106 STAT. 2056 
PUBLIC LAW 102-408—OCT. 13, 1992 
**(b) EFFECT OF PROGRAMS FOR MINORITY AND DISADVANTAGED 
INDIVIDUALS.— 
"(1) IN GENERAL.—^The Secretary may make grants to and 
enter into contracts with public and nonprofit private entities 
for the purpose of conducting research on the effects that feder-
ally-funded educational programs or policies for minority or 
disadvantaged individuals have on— 
"(A) the number of such individuals attending health 
professions school; 
"(B) the number of such individuals completing the 
programs of education involved; and 
''(C) the decisions made by such individuals on which 
of the health professions specialities to enter. 
"(2) SEPARATE SPECIFICATIONS FOR CERTAIN CATEGORIES OF 
SCHOOLS.—^The Secretary may provide a grant or contract under 
paragraph (1) only if the applicant involved agrees that in 
conductmg research under such paragraph the applicant will 
make findings specific to the following categories of health 
professions schools: 
"(A) Health professions schools of historically black 
colleges and universities. 
"(B) Other health professions schools attended by a 
substantial number of minority individuals. 
"(C) Health professions schools generally. 
"(c) EXTENT OF INVESTIGATIONS AND DISCIPLINARY ACTIONS BY 
STATE LICENSING AUTHORITIES.—^The Secretary may make grants 
to £md enter into contracts with public and nonprofit private entities 
for the purpose of conducting research on the effectiveness of the 
States in protecting the public health through— 
"(1) identifying health care providers with respect to whom 
investigations of professional qualifications are warranted; 
"(2) conducting such investigations; and 
"(3) taking disciplinary actions against health care provid-
ers determined through such investigations to have engaged 
in conduct inconsistent with protecting the public health. 
"(d) PRIMARY HEALTH CARE.— 
"(1) IN GENERAL.—^The Secretary may make grants to and 
enter into contracts with public and nonprofit private entities 
for the purpose of conducting research— 
"(A) to determine the extent to which Federal programs 
and related financial incentives influence the percentage 
of medical school graduates selecting a primary care career; 
"(B) to determine the extent to which Federal programs 
and related financial incentives adequately support the 
training of mid-level primary care providers relative to 
other health 
professions 
education receiving 
Federal 
assistance; 
"(C) to assess the impact that direct and indirect 
payments for graduate medical education (including the 
appropriateness of payments for independent, ambulatory 
training sites) have on increasing the percentage of physi-
cians graduating from medical school who enter primary 
care careers; 
"(D) to assess the impact of medical school admission 
policies on specialty selection and recommend ways admis-
sion policies can better facilitate and promote the selection 
of primary care as a medical career; 
PUBLIC LAW 102-408—OCT. 13, 1992 
106 STAT. 2057 
"(E) to assess the impact that Federal funding for 
biomedical research influences the design of medical school 
curriculum and the availability of primary care educational 
opportunities; 
"(F) to assess the impact of medical school curriculum, 
including the availability of clinical training in ambulatory 
care settings, influences the percentage of physicians select-
ing primary care residencies and selecting primary care 
as a medical career; and 
"(G) to assess the extent to which current physician 
payment policies under resource based relative value scale 
are sufficient to encourage physicians graduating from 
medical school to enter and remain in primary care careers. 
"(2) DEFINITIONS.—For purposes of this subsection: 
"(A) The term 'primary care careers', with respect to 
medicine, means family practice, general internal medicine 
and general pediatrics. 
"(B) The term 'mid-level primary care health profes-
sions' means physician assistants, nurse practitioners, and 
nurse midwives. 
"(e) AUTHORIZATION OF APPROPRIATIONS.—For the purpose of 
carrying out this section, there is authorized to be appropriated 
$4,000,000 for each of the fiscal years 1993 through 1995. 
"SEC. 782. CHIROPRACTIC DEMONSTRATION PROJECTS. 
42 USC 295a. 
"(a) IN GENERAL.—^The Secretary may make grants to and 
enter into contracts with schools, colleges, and universities of chiro-
practic for the purpose of carrying out demonstration projects in 
which chiropractors and physicians collaborate to identify and pro-
vide effective treatment for spinal and lower-back conditions. 
"(b) PARTICIPATION OF MEDICAL SCHOOLS.—The Secretary may 
make an award of a grant or contract under subsection (a) only 
if the applicant involved has entered into such agreements as 
may be necessary to ensure that in the project under such sub-
section a school of medicine or osteopathic medicine will participate 
in the project. 
"(c) PEER REVIEW.—Each peer review group under section 
798(a) reviewing proposals for grants or contracts under subsection 
(a) shall include no fewer than two, and no more than three, 
chiropractors. 
"(d) REPORT TO CONGRESS.— 
"(1) IN GENERAL.—The Secretary shall prepare a report 
that— 
"(A) summarizes the applications submitted to the Sec-
retary for grants or contracts under subsection (a); 
"(B) specifies the identity of entities receiving the 
grants or contracts; and 
"(C) evaluates the effectiveness of the programs oper-
ated with the grants and contracts. 
"(2) DATE CERTAIN FOR SUBMISSION.—Not later than Feb-
ruary 10, 1995, the Secretary shall complete the report required 
in paragraph (1) and submit the report to the Committee on 
Energy and Commerce of the House of Representatives and 
the Committee on Labor and Human Resources of the Senate. 
"(e) AUTHORIZATION OF APPROPRIATIONS.—For the purpose of 
carrying out this section, there is authorized to be appropriated 
$1,000,000 for each of the fiscal years 1993 through 1995. 
106 STAT. 2058 
PUBLIC LAW 102-408—OCT. 13, 1992 
"PART G—GENERAL PROVISIONS 
42 use 295j. 
"SEC. 791. PREFERENCES AND REQUIRED INFORMATION IN CERTAIN 
PROGRAMS. 
"(a) PREFERENCES IN MAKING AWARDS.— 
"(1) IN GENERAL.—Subject to paragraph (2), in making 
awards of grants or contracts under any of sections 747 through 
751, under section 763, or under section 766 or 767, the Sec-
retary sh£dl give preference to any quaUfied applicant that— 
''(A) has a high rate for placing graduates in practice 
settings having the principal focus of serving residents 
of medically imderserved communities; or 
"(B) during the 2-year period preceding the fiscal year 
for which such an award is sought, has achieved a signifi-
cant increase in the rate of placing graduates in such 
settings. 
"(2) LIMITATION REGARDING PEER REVIEW.—For purposes 
of paragraph (1), the Secretary may not give an applicant 
E
reference if the proposal of the applicant is ranked at or 
elow the 20th percentile of proposals that have been rec-
ommended for approval by peer review groups under section 
798(a). 
"(b) REQUIRED SUBMISSION OF INFORMATION.—The Secretary 
may make an award of a grant or contract under any of sections 
747 through 751 or under section 763 only if the applicant for 
the award submits to the Secretary (through the application 
required in section 752(a)) the following information regarding the 
programs of the applicant: 
"(1) A description of rotations or preceptorships for stu-
dents, or clinical training programs for residents, that have 
the principal focus of providing health care to medically imder-
served communities. 
"(2) The number of faculty on admissions committees who 
have a clinical practice in community-based ambulatory settings 
in medically underserved communities. 
"(3) With respect to individuals who are from disadvan-
taged backgrounds or from medically underserved communities, 
the number of such individuals who are recruited for academic 
programs of the applicant, the number of such individuals 
who are admitted to such programs, and the number of such 
individuals who graduate from such programs. 
"(4) If applicable, the number of recent graduates who 
have chosen careers in primary health care. 
"(5) The number of recent graduates whose practices are 
serving medically underserved communities. 
"(6) A description of whether and to what extent the 
applicant is able to operate without Federal assistance under 
this title. 
"(c) DEFINITION.—For purposes of this section, the term 'grad-
uate' means, unless otherwise specified, an individual who has 
successfully completed all training and residency requirements nec-
essary for full certification in the health profession selected by 
the individual. 
42 use 295k. 
"SEC. 792. HEALTH PROFESSIONS DATA. 
"(a) IN GENERAL.—^The Secretary shall establish a program, 
including a uniform health professions data reporting system, to 
PUBLIC LAW 102-408—OCT. 13, 1992 
106 STAT. 2059 
collect, compile, and analyze data on health professions personnel 
which program shall initially include data respecting all physicians 
and dentists in the States. The Secretary is authorized to expand 
the program to include, whenever he determines it necessary, the 
collection, compilation, and analysis of data respecting pharmacists, 
optometrists, podiatrists, veterinarians, public health personnel, 
audiologists, speech pathologists, health care administration person-
nel, nurses, allied health personnel, medical technologists, chiro-
practors, clinical psychologists, and any other health personnel 
in States designated by the Secretary to be included in the program. 
Such data shall include data respecting the training, licensure 
status (including permanent, temporary, partial, limited, or institu-
tional), place or places of practice, professional specialty, practice 
characteristics, place and date of birth, sex, and socioeconomic 
background of health professions personnel and such other demo-
graphic information regarding health professions personnel as the 
Secretary may require. 
"(b) CERTAIN AUTHORITIES AND REQUIREMENTS.— 
"(1) SOURCES OF INFORMATION.—In carrying out subsection 
(a), the Secretary shall collect available information from appro-
priate local. State, and Federal agencies and other appropriate 
sources. 
"(2) CONTRACTS FOR STUDIES OF HEALTH PROFESSIONS.— 
The Secretary shall conduct or enter into contracts for the 
conduct of analytic and descriptive studies of the health profes-
sions, including evaluations and projections of the supply of, 
and requirements for, the health professions by specialty and 
geographic location. Such studies shall include studies deter-
mining by specialty and geographic 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 geographic location evaluations and projections 
of the supply of, and requirements for, health professionals 
(including allied health professionals and health care adminis-
tration personnel) to serve minority groups, including His-
panics. 
"(3) GRANTS AND CONTRACTS REGARDING STATES.—The Sec-
retary is authorized to make grants and to enter into contracts 
with States (or an appropriate nonprofit private entity in any 
State) for the purpose of participating in the program estab-
lished under subsection (a). The Secretary shall determine the 
amount and scope of any such grant or contract. To be eligible 
for a grant or contract under this paragraph a State or entity 
shall submit an application in such form and manner and 
containing such information as the Secretary shall require. 
Such application shall include reasonable assurance, satisfac-
tory to the Secretary, that— 
"(A) such State (or nonprofit entity within a State) 
will establish a program of mandatory annual registration 
of the health professions personnel described in subsection 
(a) who reside or practice in such State and of health 
institutions licensed by such State, which registration shall 
include such information as the Secretary shall determine 
to be appropriate; 
106 STAT. 2060 
PUBLIC LAW 102-408—OCT. 13, 1992 
Reports- 
"(B) such State or entity shall collect such information 
and report it to the Secretary in such form and manner 
as the Secretary shall prescribe; and 
"(C) such State or entity shall comply with the require-
ments of subsection (e). 
"(d) REPORTS TO CONGRESS.—^The Secretary shall submit to 
the Congress on October 1, 1993, and biennially thereafter, the 
following reports: 
"(1) A comprehensive report regarding the status of health 
personnel according to profession, including a report regarding 
the analjrtic and descriptive studies conducted under this 
section. 
"(2) A comprehensive report regarding applicants to, and 
students enrolled in, programs and institutions for the training 
of health personnel, including descriptions and analyses of stu-
dent indebtedness, student need for financial assistance, finan-
cial resources to meet the needs of students, student career 
choices such as practice specialty and geographic location and 
the relationship, if any, between student indebtedness and 
career choices. 
"(e) REQUIREMENTS REGARDING PERSONAL DATA.— 
"(1) IN GENERAL.—^The Secretary and each program entity 
shall in securing and maintaining any record of individually 
identifiable personal data (hereinafter 
in this 
subsection 
referred to as 'personal data') for purposes of this section— 
"(A) inform any individual who is asked to supply 
personal data whether he is legally required, or may refuse, 
to supply such data and inform him of any specific con-
sequences, known to the Secretary or program entity, as 
the case may be, of providing or not providing such data; 
"(B) upon request, inform any individual if he is the 
subject of personal data secured or maintained by the Sec-
retary or program entity, as the case may be, and make 
the data available to him in a form comprehensible to 
him; 
"(C) assure that no use is made of personal data which 
use is not within the purposes of this section unless an 
informed consent has been obtained from the individual 
who is the subject of such data; and 
"(D) upon request, inform any individual of the use 
being made of personal data respecting such individual 
and of the identity of the individuals and entities which 
will use the data and their relationship to the programs 
under this section. 
"(2) CONSENT AS PRECONDITION TO DISCLOSURE.—Any entity 
which maintains a record of personal data and which receives 
a request from the Secretary or a program entity for such 
data for purposes of this section shall not transfer any such 
data to the Secretary or to a program entity unless the individ-
ual whose personal data is to be so transferred gives an 
informed consent for such transfer. 
"(3) DISCLOSURE BY SECRETARY.— 
"(A) Notwithstanding any other provision of law, per-
sonal data collected by the Secretary or any program entity 
under this section may not be made available or disclosed 
by the Secretary or any program entity to any person 
other than the individual who is the subject of such data 
PUBLIC LAW 102-408—OCT. 13, 1992 
106 STAT. 2061 
unless (i) such person requires such data for purposes 
of this section, or (ii) in response to a demand for such 
data made by means of compulsory legal process. Any 
individual who is the subject of personal data made avail-
able or disclosed under clause (ii) shall be notified of the 
demand for such data. 
"(B) Subject to all applicable laws regarding confiden-
tiality, only the data collected by the Secretary under this 
section which is not personal data shall be made available 
to bona fide researchers and policy analysts (including 
the Congress) for the purposes of assisting in the conduct 
of studies respecting health professions personnel. 
"(4) DEFINITION.—For purposes of this subsection, the term 
'program entit/ means any public or private entity which col-
lects, compiles, or analyzes health professions data under a 
grant, contract, or other arrangement with the Secretary imder 
this section. 
"(g) TECHNICAL ASSISTANCE.—The Secretary shall provide tech-
nical assistance to the States and political subdivisions thereof 
in the development of systems (including model laws) concerning 
confidentiality and comparability of data collected pursuant to this 
section. 
"(h) 
GRANTS 
AND 
CONTRACTS 
REGARDING 
NONPROFIT 
ENTITIES.— 
"(1) IN GENERAL.—In carrying out subsection (a), the Sec-
retary may make grants, or enter into contracts and cooperative 
agreements with, and provide technical assistance to, any non-
profit entity in order to establish a uniform allied health profes-
sions data reporting system to collect, compile, and analyze 
data on the allied health professions personnel. 
"(2) REPORTS.—^With respect to reports required in sub-
section (d), each such report made on or after October 1, 1991, 
shall include a description and analysis of data collected pursu-
ant to paragraph (1). 
"SEC. 793. STATISTICS; ANNUAL REPORT. 
42 USC 295/. 
"(a) STATISTICS AND OTHER INFORMATION.—The Secretary shall, 
in coordination with the National Center for Health Statistics 
(established under section 306), continuously develop, publish, and 
disseminate on a nationwide basis statistics and other information 
respecting public and community health personnel, including— 
"(1) detailed descriptions of the various types of activities 
in which public and community health personnel are engaged, 
"(2) the current and anticipated needs for the various types 
of public and community health personnel, and 
"(3) the number, employment, geographic locations, sala-
ries, and surpluses and shortages of public and community 
health personnel, the educational and licensure requirements 
for the various types of such personnel, and the cost of training 
such personnel. 
"(b) REQUIREMENTS REGARDING PERSONAL DATA.— 
"(1) IN GENERAL.—^The Secretary and each program entity 
shall in securing and maintaining any record of individually 
identifiable personal data (in this subsection referred to as 
'personal data') for purposes of this section— 
"(A) inform any individual who is asked to supply 
personal data whether he is legally required, or may refuse, 
106 STAT. 2062 
PUBLIC LAW 102-408—OCT. 13, 1992 
to supply such data and inform him of any specific con-
sequences, known to the Secretary or program entitv as 
the case may be, of providing or not providing such data; 
"(B) upon request, inform any individual if he is the 
subject of personal data secured or maintained by the Sec-
retary or program entity, as the case may be, and make 
the data available to him in a form comprehensible to 
him; 
"(C) assure that no use is made of personal data which 
is not within the purposes of this section unless an informed 
consent has been obtained from the individual who is the 
subject of such data; and 
"(D) upon request, inform any individual of the use 
being made of personal data respecting such individual 
and of the identity of the individuals and entities which 
will use the data and their relationship to the activities 
conducted under this section. 
"(2) CONSENT AS PRECONDITION TO TRANSFER OF INFORMA-
TION.—Any entity which maintains a record of personal data 
and which receives a request from the Secretary or a program 
entity to use such data for purposes of this section snail not 
transfer any such data to the Secretary or to a program entity 
unless the individual whose personal data is to be so transferred 
gives an informed consent for such transfer. 
"(3) DISCLOSURE BY SECRETARY.— 
"(A) Notwithstanding any other provision of law, per-
sonal data collected by the Secretary or any program entity 
for purposes of this section may not be made available 
or disclosed by the Secretary or any program entity to 
any person otner than the individual who is the subject 
of such data unless (i) such person requires such data 
for purposes of this section, or (ii) in response to a demand 
for such data made by means of compulsory legal process. 
Any individual who is the subject of personal data made 
available or disclosed under clause (li) shall be notified 
of the demand for such data. 
"(B) Subject to all applicable laws regarding confiden-
tiality, only the data collected by the Secretary under this 
section which is not personal data shall be made available 
to bona fide researchers and policy analysts (including 
the Congress) for the purposes of assisting in the conduct 
of studies respecting health professions personnel. 
"(4) DEFINITIONS.—For purposes of this subsection, the 
term 'program entity* means any public or private entity which 
collects, compiles, or analyzes health professions data under 
an arrangement with the Secretary for purposes of this section. 
**(c) REPORT.—^The Secretary shall submit biennially to the 
Committee on Energy and Commerce of the House of Representa-
tives and to the Committee on Labor and Human Resources of 
the Senate a report on— 
"(1) the statistics and other information developed pursuant 
to subsection (a); and 
"(2) the activities conducted under subparts I and H of 
part D, including an evaluation of such activities. 
Such report shall contain such recommendations for legislation 
as the Secretary determines are needed to improve the programs 
authorized under such subparts. The Ofilce of Management and 
PUBLIC LAW 102-408—OCT. 13, 1992 
106 STAT. 2063 
Budget may review such report before its submission to such 
Committees, but the Office may not revise the report or delay 
its submission beyond the date prescribed for its submission and 
may submit to such Committees its comments respecting such 
report. 
"(d) DEFINITIONS.—For purposes of this section, the term 'public 
and community health personnel' means individuals who are 
engaged in— 
"(1) the planning, development, monitoring, or management 
of health care or health care institutions, organizations, or 
systems, 
"(2) research on health care development and the collection 
and analysis of health statistics, data on the health of popu-
lation groups, and any other health data, 
"(3) the development and improvement of individual and 
community knowledge of health (including environmental 
health and preventive medicine) and the health care system, 
or 
"(4) the planning and development of a healthful environ-
ment and control of environmental health hazards. 
"SEC. 794. PROHIBITION AGAINST DISCRIMINATION ON BASIS OF SEX. 
42 USC 295m. 
"The Secretary may not make a grant, loan guarantee, or 
interest subsidy payment under this title to, or for the benefit 
of, any school of medicine, osteopathic medicine, dentistry, veteri-
nary medicine, optometry, pharmacy, podiatric medicine, or public 
health or any training center for allied health personnel, or graduate 
{)rogram in clinical psychology, unless the application for the grant, 
oan guarantee, or interest subsidy payment contains assurances 
satisfactory to the Secretary that the school or training center 
will not discriminate on the basis of sex in the admission of individ-
uals to its training programs. The Secretary may not enter into 
a contract under this title with any such school or training center 
imless the school, training center, or graduate program furnishes 
assurances satisfactory to the Secretary that it will not discriminate 
on the basis of sex in the admission of individuals to its training 
programs. In the case of a school of medicine which— 
"(1) on the date of the enactment of this sentence is in 
the process of changing its status as an institution which admits 
only female students to that of an institution which admits 
students without regard to their sex, and 
"(2) is carrying out such change in accordance with a plan 
approved by the Secretary, 
the provisions of the preceding sentences of this section shall apply 
only with respect to a grant, contract, loan guarantee, or interest 
subsidy to, or for the benefit of such a school for a fiscal year 
beginning after June 30,1979. 
"SEC. 795. OBLIGATED SERVICE REGARDING CERTAIN PROGRAMS. 
42 USC 295n. 
"(a) IN GENERAL.—In the case of any program under this title 
under which a scholarship, stipend, or other financial assistance 
is provided to an individual with respect to education as a health 
professional (including a program that provides for the repayment 
of loans), if the program provides that the provision of the financial 
assistance involved is subject to this section, then the assistance 
may be provided only if the individual makes agreements as follows: 
"(1) The individual will complete the program of education 
with respect to which such assistance is provided (in the case 
106 STAT. 2064 
PUBLIC LAW 102-408—OCT. 13, 1992 
of assistance provided for purposes other than the repayment 
of loans). 
"(2) In the case of an individual who receives such assist-
ance with respect to attendance at a school of medicine or 
osteopathic medicine, the individual will— 
"(A) enter and complete a residency training program 
in a specialty in primary health care not later than 4 
years after completing the program of education described 
in paragraph (1); and 
"(B) practice in the specialty for 5 years after complet-
ing the residency training program. 
"(3) in the case of an individual who receives such assist-
ance with respect to attendance at a school of dentistry, the 
individual will practice in general dentistry for 5 years (exclu-
sive of any period during which the individual is attending 
a residency training program in general dentistry). 
"(4) Subsection (b) applies with respect to the breach of 
agreements made under any of paragraphs (1) through (3). 
"(b) BREACH OF AGREEMENTS.— 
"(1) IN GENERAL.—For purposes of subsection (a)(4), the 
following applies: 
"(A) In the case of a program under this title that 
provides financial assistance for attendance at a program 
of education in a health profession, the individual is liable 
to the Federal Government for the amount of the award 
(including amounts provided for expenses related to such 
attendance), and for interest on such amount at the maxi-
mum legal prevailing rate, if the individual— 
"(i) fails to maintain an acceptable level of aca-
demic standing in the program of education (as 
indicated by such program in accordance with require-
ments established by the Secretary); 
"(ii) is dismissed from the program for disciplinary 
reasons; or 
"(iii) voluntarily terminates the program. 
"(B) The individual is liable to the Federal Government 
for the amount of the award (including amounts provided 
for expenses related to such attendance), and for interest 
on such amount at the maximum legal prevailing rate, 
if the individual fails to comply with the agreement made 
imder subsection (aX2). 
"(2) WAIVER OR SUSPENSION OF LIABILITY.—In the case of 
an individual making agreements under subsection (a), the 
Secretary shall provide for the waiver or suspension of liability 
under paragraph (1) if compliance by the individual with the 
agreements involved is impossible, or would involve extreme 
hardship to the individual, and if enforcement of the agree-
ments with respect to the individual would be unconscionable. 
"(3) DATE CERTAIN FOR RECOVERY.—Subject to paragraph 
(2), any amount that the Federal Government is entitled to 
recover under paragraph (1) shall be paid to the United States 
not later than the expiration of the three-year period beginning 
on the date the United States becomes so entitled. 
42 u s e 295o. 
«SEC. 798. CERTAIN GENERAL PROVISIONS. 
"(a) PEER REVIEW.—Each application for a grant or contract 
under this title shall be submitted to a peer review group for 
PUBLIC LAW 102-408—OCT. 13, 1992 
106 STAT. 2065 
an evaluation of the merits of the proposals made in the application. 
The Secretary may not approve such an application unless a peer 
review group has recommended the application for approval. Each 
peer review group under this subsection shall be composed prin-
cipally of individuals who are not officers or employees of the 
Federal Government. This subsection shall be carried out by the 
Secretary acting through the Administrator of the Health Resources 
and Services Administration. 
"(b) DELEGATION OF AUTHORITY OF SECRETARY.—The Secretary 
may delegate the authority to administer any program authorized 
by this title to the administrator of a central or regional office 
or offices of the Department, except that the authority to make 
such a grant, enter into such a contract, continue such a grant 
or contract, or modify such a contract, shall not be delegated to 
any administrator of, or officer in, a regional office or offices of 
the Department. 
"(c) DIFFERENTIAL TUITION AND FEES.—The Secretary may not 
enter into a contract with, or make a grant, loan guarantee, or 
interest subsidy pajmient under this title or title \^II, to or for 
the benefit of, any school, program, or training center if the tuition 
levels or educational fees at such school, program, or training 
center are higher for certain students solely on the basis that 
such students are the recipients of traineeships, loans, loan guaran-
tees, service scholarships, or interest subsidies from the Federal 
Government. 
"(d) APPLICABILITY OF CERTAIN PROVISIONS ON CONTRACTS.— 
Contracts authorized by this title may be entered into without 
regard to section 3324 of title 31, United States Code, or section 
3709 of the Revised Statutes (41 U.S.C. 5). 
"(e) RECORDS AND AUDITS.— 
"(1) MAINTENANCE OF RECORDS.— 
"(A) Each entity which receives a grant, loan, loan Regulations. 
guarantee, or interest subsidy or which enters into a con-
tract with the Secretary under this title, shall establish 
and maintain such records as the Secretary shall by regula-
tion or order require. 
"(B) The Secretary may specify, by regulation, the form 
and manner in which such records, required by subpara-
graph (A), shall be established and maintained. 
"(2) BIENNIAL AUDITS.—Each entity which received a grant 
or entered into a contract under this title shall provide for 
a biennial financial audit of any books, accounts, 
financial 
records, files, and other papers and property which relate to 
the disposition or use of the funds received under such grant 
or contract and such other funds received by or allocated to 
the project or undertaking for which such grant or contract 
was made. For purposes of assuring accurate, current, and 
complete disclosure of the disposition or use of the funds 
received, each such audit shall be conducted in accordance 
with such requirements concerning the individual or agency 
which conducts the audit, and such standards applicable to 
the performance of the audit, as the Secretary may by regula-
tion provide. A report of each such audit shall be filed with Reports, 
the Secretary at such time and in such manner as he may 
require. 
"(3) APPLICABILITY TO STUDENTS.—A student recipient of 
a scholarship, traineeship, loan, or loan guarantee under this 
106 STAT. 2066 
PUBLIC LAW 102-408—OCT. 13, 1992 
title shall not be required to establish or maintain the records 
required in paragraph (1) or provide for an audit required 
in paragraph (2). 
"(4) AVAILABILITY OF DOCUMENTS, ETC.— 
"(A) Each entity which is required to establish and 
maintain records or to provide for an audit under this 
subsection shall make such books, documents, papers, and 
records available to the Secretary or the Comptroller Gen-
eral of the United States, or any of their duly authorized 
representatives, for examination, copying, or mechanical 
reproduction on or off the premises of such entity upon 
a reasonable request therefor. 
"(B) The Secretary and the Comptroller General of 
the United States, or any of their duly authorized rep-
resentatives, shall have the authority to carry out the 
purposes of this paragraph. 
"(£) MISCELLANEOUS PROVISIONS.— 
**(1) PAYMENTS UNDER GRANTS.—Grants made under this 
title may be paid (A) in advance or by way of reimbursement, 
(B) at such intervals and on such conditions as the Secretary 
may find necessary, and (C) with appropriate adjustments on 
account of overpayments or underpayments previously made. 
"(2) APPLICATIONS FOR GRANTS AND CONTRACTS.—No grant 
may be made or contract entered into under this title unless 
an application therefor has been submitted to and approved 
Regulations. 
by the Secretary. Such application shall be in such form, 
submitted in such manner, and contain such information, as 
the Secretary shall by regulation prescribe. 
"(3) ASSURANCES.—^Whenever in this title an applicant is 
required to provide assurances to the Secretary, or an applica-
tion is required to contain assurances or be supported by assur-
ances, the Secretary shall determine before approving the 
application that the assurances provided are made in good 
faith. 
"(4) TECHNICAL ASSISTANCE.—Funds appropriated under 
this title may be used by the Secretary to provide technical 
assistance in relation to any of the authorities imder this title. 
"(5) GRADUATES OF FOREIGN MEDICAL SCHOOLS.—The Sec-
retary may make an award of a grant, cooperative agreement, 
or contract under this title to an entity (including a school) 
that provides graduate training in the health professions only 
if the entity agrees that, in considering applications for admis-
sions to a program of such training, the entity will not refuse 
to consider an application solely on the basis that the applica-
tion is submitted by a graduate of a foreign medical school. 
This paragraph may not be construed as establishing any pri-
vate right of action. 
42 use 295p. 
"SEC. 799. DEFINITIONS. 
"For purposes of this title: 
"(IXA) The terms 'school of medicine*, 'school of dentistr/, 
'school of osteopathic medicine', 'school of pharmacy, 'school 
of optometry*, 'school of pediatric medicine', 'school of veterinary 
medicine', 'school of public health', and 'school of chiropractic' 
mean an accredited public or nonprofit private school in a 
State that provides training leading, respectively, to a degree 
of doctor of medicine, a degree of doctor of dentistry or an 
PUBLIC LAW 102-408—OCT. 13, 1992 
106 STAT. 2067 
equivalent degree, a degree of doctor of osteopathy, a degree 
of bachelor of science in pharmacy or an equivalent degree 
or a degree of doctor of pharmacy or an equivalent degree, 
a degree of doctor of optometry or an equivalent degree, a 
degree of doctor of podiatric medicine or an equivalent degree, 
a degree of doctor of veterinary medicine or an equivalent 
degree, a graduate degree in public health or an equivalent 
degree, and a degree of doctor of chiropractic or an equivalent 
degree, and including advanced training related to such training 
provided by any such school. 
"(B) The terms 'graduate program in health administration' 
and 'graduate program in clinical psychology* mean an accred-
ited graduate program in a public or nonprofit private institu-
tion in a State that provides training leading, respectively, 
to a graduate degree in health administration or an equivalent 
degree and a doctoral degree in clinical psychology or an equiva-
lent degree. 
"(C) The terms 'graduate program in clinical social work' 
and 'graduate program in marriage and family therapy* mean 
an accredited graduate program in a public or nonprofit private 
institution in a State that provides training, respectively, in 
a concentration in health or mental health care leading to 
a graduate degree in social work and a concentration leading 
to a graduate degree in marriage and family therapy. 
"(D) The term 'graduate program in mental health practice' 
means a graduate program in clinical psychology, clinical social 
work, or marriage and family therapy. 
**(E) The term 'accredited', when applied to a school of 
medicine, osteopathic medicine, dentistry, veterinary medicine, 
optometry, podiatry, pharmacy, public health, or chiropractic, 
or a graduate program in health administration, clinical 
psychology, clinical social work, or marriage and family therapy, 
means a school or program that is accredited by a recognized 
body or bodies approved for such purpose by the Secretary 
of Education, except that a new scnooi or program that, by 
reason of an insufficient period of operation, is not, at the 
time of application for a grant or contract under this title, 
eligible for accreditation by such a recognized body or bodies, 
shall be deemed accredited for purposes of this title, if the 
Secretary of Education finds, after consultation with the appro-
priate accreditation body or bodies, that there is reasonable 
assurance that the school or program will meet the accredita-
tion standards of such body or bodies prior to the beginning 
of the academic year following the normal graduation date 
of the first entering class in such school or program. 
"(2) The term 'teaching facilities' means areas dedicated 
for use bv students, faculty, or administrative or maintenance 
personnel for clinical purposes, research activities, libraries, 
classrooms, offices, auditoriums, dining areas, student activi-
ties, or other related purposes necessary for, and appropriate 
to, the conduct of comprehensive programs of education. Such 
term includes interim facilities but does not include off-site 
improvements or living quarters. 
"(3) The term 'program for the training of physician assist-
ants' means an educational program that— 
"(A) has as its objective the education of individuals 
who will, upon completion of their studies in the program, 
106 STAT. 2068 
PUBLIC LAW 102-408—OCT. 13, 1992 
be qualified to provide primary health care under the super-
vision of a physician; and 
"(B) meets regulations prescribed by the Secretary in 
accordance with section 750(b). 
"(4) The term 'school of allied health' means a public or 
nonprofit private college, junior college, or university or hos-
pital-based educational entity that— 
"(A) provides, or can provide, programs of education 
to enable individuals to become allied health professionals 
or to provide additional training for allied health profes-
sionals; 
"(B) provides training for not less than a total of twenty 
persons in the allied health curricula (except that this 
subparagraph shall not apply to any hospital-based edu-
cational entity); 
"(C) includes or is affiliated with a teaching hospital; 
and 
"(D) is accredited by a recognized body or bodies 
approved for such purposes by the Secretary of Education, 
or which provides to the Secretary satisfactory assurance 
by such accrediting body or bodies that reasonable progress 
is being made toward accreditation. 
"(5) The term 'allied health professionals' means a health 
professional (other than a registered nurse or physician assist-
ant)— 
"(A) who has received a certificate, an associate's 
degree, a bachelor's degree, a master's degree, a doctoral 
degree, or postbaccalaureate training, in a science relating 
to health care; 
"(B) who shares in the responsibility for the delivery 
of health care services or related services, including— 
"(i) services relating to the identification, evalua-
tion, and prevention of disease and disorders; 
"(ii) dietary and nutrition services; 
"(iii) health promotion services; 
"(iv) rehabilitation services; or 
"(v) health systems management services; and 
"(C) who has not received a degree of doctor of medi-
cine, a degree of doctor of osteopathy, a degree of doctor 
of dentistry or an equivalent degree, a degree of doctor 
of veterinary medicine or an equivalent degree, a degree 
of doctor of optometry or an equivalent degree, a degree 
of doctor of pediatric medicine or an equivalent degree, 
a degree of bachelor of science in pharmacy or an equivalent 
degree, a degree of doctor of pharmacy or an equivalent 
degree, a graduate degree in public health or an equivalent 
degree, a degree of doctor of chiropractic or an equivalent 
degree, a graduate degree in health administration or an 
equivalent degree, a doctoral degree in clinical psychology 
or an equivalent degree, or a degree in social work or 
an equivalent degree. 
"(6) The term 'medically underserved community* means 
an urban or rural area or population that— 
"(A) is eligible for designation under section 332 as 
a health professional shortage area; 
"(B) is eligible to be served by a migrant health center 
under section 329, a community health center under section 
PUBLIC LAW 102-408—OCT. 13, 1992 
106 STAT. 2069 
330, a grantee under section 340 (relating to homeless 
individuals), or a grantee under section 340A (relating 
to residents of public housing); or 
"(C) has a shortage of personal health services, as 
determined under criteria issued by the Secretary under 
section 1861(aa)(2) of the Social Security Act (relating to 
rural health clinics). 
"(7) The term 'Department' means the Department of 
Health and Human Services. 
"(8) The term 'nonprofit' refers to the status of an entity 
owned and operated by one or more corporations or associations 
no part of the net earnings of which inures, or may lawfully 
inure, to the benefit of any private shareholder or individual. 
"(9) The term 'State' includes, in addition to the several 
States, only the District of Columbia, the Commonwealth of 
Puerto Rico, the Commonwealth of the Northern Mariana 
Islands, the Virgin Islands, Guam, American Samoa, and the 
Trust Territory of the Pacific Islands. 
"(10)(A) 
Subject 
to 
subparagraph 
(B), 
the 
term 
'underrepresented minorities' means, with respect to a health 
profession, 
racial 
and 
ethnic 
populations 
that 
are 
underrepresented in the health profession relative to the num-
ber of individuals who are members of the population involved. 
"(B) For purposes of subparagraph (A), Asian individuals 
shall be considered by the various subpopulations of such 
individuals.". 
SEC. 103. EFFECTIVE DATE. 
The amendment made by section 102 takes effect on the date 
of the enactment of this Act, except that section 708 of the Public 
Health Service Act, as added by section 102 of this Act, takes 
effect January 1, 1993. Until such date, section 732(c) of the Public 
Health Service Act, as in effect on the day before the date of 
the enactment of this Act, continues in effect in lieu of such section 
708. 
TITLE II—NURSE EDUCATION 
SEC. 201. SHORT TITLE. 
This title may be referred to as the Nurse Education and 
Practice Improvement Amendments of 1992. 
SEC. 202. SPECIAL PROJECT GRANTS AND CONTRACTS. 
(a) IN GENERAL.—Section 820 of the Public Health Service 
Act (42 U.S.C. 296k) is amended to read as follows: 
42 u s e 292 note. 
Nurse Education 
and Practice 
Improvement 
Amendments of 
1992. 
42 u s e 201 note. 
SPECIAL PROJECT GRANTS AND CONTRACTS 
" S E C 
820. 
(a) EXPANSION OF ENROLLMENT IN PROFESSIONAL 
NURSING PROGRAMS.— 
"(1) IN GENERAL.—The Secretary may make grants to and 
enter into contracts with public and nonprofit private schools 
of nursing with programs of education in professional nursing 
for the purpose of assisting the schools in increasing the number 
of students enrolled in such programs. Such a grant or contract 
may be made only with respect to such programs that are 
106 STAT. 2070 
PUBLIC LAW 102-408—OCT. 13, 1992 
in operation on the date of the enactment of the Health Profes-
sions Education Extension Amendments of 1992. 
**(2) PREFERENCE.—In making awards of grants and con-
tracts imder paragraph (1), the Secretary shall give preference 
to any qualified school that provides students of the school 
with clinical training in the provision of primary health care 
in publicly-fimded— 
"(A) urban or rural outpatient facilities, home health 
agencies, or public health agencies; or 
"(B) rural hospitals. 
"(3) MATCHING FUNDS.— 
"(A) With respect to the costs of the program to be 
carried out by a school pursuant to paragraph (1), the 
Secretary may provide an award of a grant or contract 
under such paragraph only if the school agrees to make 
available (directly or through donations from public or pri-
vate entities) non-Federal contributions toward such costs 
in an amount that— 
"(i) for the first fiscal year for which the school 
receives such an award, is not less than $1 for each 
$9 of Federal funds provided through the award (10 
percent of such costs); 
"(ii) for any second such fiscal year, is not less 
than $1 for each $3 of Federal funds provided through 
the award (25 percent of such costs); 
"(iii) for any third such fiscal year, is not less 
than $1 for each $1 of Federal funds provided through 
the award (50 percent of such costs); and 
"(iv) for any fourth or fifth such fiscal year, is 
not less than $3 for each $1 of Federal funds provided 
through the award (75 percent of such costs). 
"(B) Non-Federal contributions required in subpara-
graph (A) may be in cash or in kind, fairly evaluated, 
including plant, equipment, or services. Amounts provided 
by the Federal Government, or services assisted or sub-
sidized to any significant extent by the Federal Govern-
ment, may not be included in determining the amount 
of such non-Federal contributions. 
"(b) PRIMARY HEALTH CARE IN NONINSTITUTIONAL SETTINGS.— 
"(1) IN GENERAL.—^The Secretary may make grants to and 
enter into contracts with public and nonprofit private schools 
of nursing for the establishment or expansion of nursing prac-
tice arrangements in noninstitutional settings to demonstrate 
methods to improve access to primary health care in medically 
underserved communities. 
"(2) OPERATION AND STAFFING OF PROGRAMS.—^The Sec-
retary may make an award of a grant or contract under para-
graph (1) only if the school involved agrees that the program 
carried out with the award will be operated and staffed by 
the faculty and students of the school. 
"(3) DESIGN.—The Secretary may make an award of a 
grant or contract under paragraph (1) only if the program 
to be carried out under such paragraph by the school involved 
is designed to provide at least 25 percent of the students 
of the school with a structured clinical experience in primary 
health care. 
PUBLIC LAW 102-408—OCT. 13, 1992 
106 STAT. 2071 
"(c) CONTINUING EDUCATION FOR NURSES IN MEDICALLY UNDER-
SERVED COMMUNITIES.—^The Secretary may make grants to and 
enter into contracts with public and nonprofit private entities for 
the purpose of providing continuing education for nurses serving 
in medically underserved communities. 
"(d) LONG-TERM CARE FELLOWSHIPS FOR CERTAIN PARAPROFES-
SIONALS.— 
"(1) IN GENERAL.—^The Secretary may make grants to and 
enter into contracts with public and nonprofit private entities 
that operate accredited programs of education in professional 
nursing, or State-board approved programs of practical or voca-
tional nursing, for the purpose of providing fellowships to 
individuals described in paragraph (2) for attendance in such 
programs. 
"(2) ELIGIBLE INDIVIDUALS.—The individuals referred to in 
paragraph (1) are individuals who are employed by nursing 
facilities or home health agencies as nursing paraprofessionals. 
"(3) PREFERENCE FOR SCHOOLS WITH RAPID TRANSITION PRO-
GRAMS.—In making awards of grants and contracts under para-
graph (1), the Secretary shall g^ve preference to any qualified 
applicant operating an accredited program of education in 
professional nursing that provides for the rapid transition to 
status as a professional nurse from status as a nursing para-
professional. 
"(4) PREFERENCE IN AWARD OF FELLOWSHIPS.—The Sec-
retary may make an award of a grant or contract under para-
graph (1) only if the applicant involved agrees that, in providing 
fellowships under the award, the applicant will'give preference 
to individuals described in paragraph (2) who— 
"(A) are 
economically 
disadvantaged 
individuals, 
particularly such individuals who are members of a minor-
ity group that is underrepresented among registered 
nurses; or 
"(B) are employed by a nursing facility that will assist 
in paying the costs or expenses described in paragraph 
(5)(A) with respect to the individuals. 
"(5) USE OF AWARD.—^The Secretary may make an award 
of a grant or contract under paragraph (1) only if the applicant 
involved agrees that fellowships provided with the award will 
pay all or part of the costs of— 
"(A) the tuition, books, and fees of the program of 
nursing with respect to which the fellowship is provided; 
and 
"(B) reasonable living expenses of the individual during 
the period for which the fellowship is provided. 
"(6) DEFINITION.—^For purposes oi this section: 
"(A) The term 'home health agency* has the meaning 
given such term in section 1861 of the Social Security 
Act. 
"(B) The term 'nursing facility* has the meaning given 
such term in section 1919 of the Social Security Act. 
"(e) AUTHORIZATION OF APPROPRIATIONS.—For the purpose of 
carrying out this section, there is authorized to be appropriated 
$10,500,000 for each of the fiscal years 1993 and 1994.". 
(b) DEFINITION OF MEDICALLY UNDERSERVED COMMUNITIES.— 
Section 853 of the Public Health Service Act (42 U.S.C. 298b) 
is amended by adding at the end the following new paragraph: 
106 STAT. 2072 
PUBLIC LAW 102-408—OCT. 13, 1992 
"(11) The term 'medically underserved community* has the 
meaning given such term in section 799.". 
42 use 296k 
(c) SAVINGS PROVISION FOR CURRENT PROJECTS.—In the case 
"°*®- 
of any authority for making awards of grants or contracts that 
is terminated bv the amendment made by subsection (a), the Sec-
retary of Healtii and Himian Services may, notwithstanding the 
termination of the authority, continue in efTect any grant or contract 
made under the authority that is in effect on the day before the 
date of the enactment of this Act, subject to the duration of any 
such grant or contract not exceeding the period determined by 
the Secretary in first approving such financial assistance, or in 
approving the most recent request made (before the date of such 
enactment) for continuation of such assistance, as the case may 
be. 
SEC. 
203. 
ADVANCED 
NURSE 
EDUCATION. 
Section 821 of the Pubhc Health Service Act (42 U.S.C. 2961) 
is amended to read as follows: 
"ADVANCED NURSE EDUCATION 
"SEC. 821. (a) IN GENERAL.—The Secretary may make grants 
to and enter into contracts with public and nonprofit private colle-
giate schools of nursing to meet the costs of projects that, in the 
case of programs described in susbsection (b)— 
"(1) plan, develop, and operate new such programs; or 
"(2) significantly expand existing such programs. 
"(b) AUTHORIZED PROGRAMS.—^The programs referred to in sub-
section (a) are programs leading to advanced degrees that prepare 
nurses to serve as nurse educators or public health nurses, or 
in other clinical nurse specialties determined by the Secretary to 
require advanced education. 
"(c) FUNDING.— 
"(1) AUTHORIZATION OF APPROPRIATIONS.—For the purpose 
of carrying out this section, there are authorized to be appro-
priated $12,000,000 for each of the fiscal years 1993 and 1994. 
"(2) LIMITATION.—Of the amounts appropriated under para-
graph (1), the Secretary may not obligate more than 10 percent 
for providing grants or contracts under subsection (a) for pro-
grams leading to doctoral degrees.". 
SEC. 204. NURSE PRACTITIONER AND NURSE MIDWIFE PROGRAMS. 
Section 822 of the Public Health Service Act (42 U.S.C. 296m) 
is amended to read as follows: 
"NURSE PRACTITIONER AND NURSE MIDWIFE PROGRAMS 
"SEC. 822. (a) IN GENERAL.—The Secretary may make grants 
to and enter into contracts with public and nonprofit private schools 
of nursing or other public and nonprofit private entities to meet 
the costs of projects that, with respect to programs described in 
subsection (b)— 
"(1) plan, develop, and operate new such programs; or 
"(2) maintain or significantly expand existing such pro-
grams, 
^(b) AUTHORIZED PROGRAMS.— 
"(1) IN GENERAL.—^The programs referred to in subsection 
(a) are educational programs for registered nurses (irrespective 
PUBLIC LAW 102-408—OCT. 13, 1992 
106 STAT. 2073 
of the t5rpe of school of nursing in which the nurses received 
their training) that— 
"(A) meet guideUnes prescribed by the Secretary in 
accordance with paragraph (2); and 
"(B) have as their objective the education of nurses 
who will, upon completion of their studies in such pro-
grams, be qualified to effectively provide primary health 
care, including primary health care in homes and in 
ambulatory care facilities, long-term care facilities and 
other health care institutions. 
"(2) GUIDELINES.—^After consultation with appropriate edu-
cational organizations and professional nursing and medical 
organizations, the Secretary shall prescribe guidelines for pro-
grams described in paragraph (1). Such guidelines shall, as 
a minimum, require that such a program— 
"(A) extend for at least one academic year and consist 
of— 
"(i) supervised clinical practice directed toward 
preparing nurses to deliver primary health care; and 
"(ii) at least four months (in the aggregate) of 
classroom instruction that is so directed; and 
"(B) have an enrollment of not less than six full-time 
equivalent students. 
"(c) CERTAIN CONSIDERATIONS IN MAKING AWARDS.— 
"(1) PREFERENCE.—In making awards of grants and con-
tracts under subsection (a), the Secretary shall give preference 
to any qualified applicant that, with respect to programs 
described in subsection (b), agrees to expend the award to 
plan, develop, and operate new such programs or to significantly 
expand existing such programs. 
"(2) SPECIAL CONSIDERATION.—In making awards of grants 
and contracts under subsection (a), the Secretary shall give 
special consideration to qualified applicants that agree to 
expend the award to train individuals as nurse practitioners 
and nurse midwives who will practice in health professional 
shortage areas designated under section 332. 
"(d) AUTHORIZATION OF APPROPRIATIONS.—For the purpose of 
carr3dng out this section, there is authorized to be appropriated 
$20,000,000 for each of the fiscal years 1993 and 1994.". 
SEC. 205. SPECIAL PROJECTS REGARDING DISADVANTAGED INDIVID-
UALS. 
Section 827(c) of the PubUc Health Service Act (42 U.S.C. 
296r(c)) is amended— 
(1) by striking "and" after "1990,"; and 
(2) Dy inserting before the period the following: ", 
$5,000,000 for fiscal year 1993, and $6,000,000 for fiscal year 
1994". 
SEC. 206. TRAINEESHIPS FOR ADVANCED EDUCATION OF PROFES-
SIGNAL NURSES. 
Section 830 of the Public Health Service Act (42 U.S.C. 297) 
is amended to read as follows: 
"TRAINEESHIPS FOR ADVANCED EDUCATION OF PROFESSIONAL NURSES 
"SEC. 830. (a) IN GENERAL.—The Secretary may make grants 
to public and nonprofit private entities to meet the cost of 
106 STAT. 2074 
PUBLIC LAW 102-408—OCT. 13, 1992 
traineeships for individuals in advanced-degree programs in order 
to educate the individuals to serve in and prepare for practice 
as niu-se practitioners, nurse midwives, nurse educators, public 
health nurses, or in other clinical nursing specialties determined 
by the Secretary to require advanced education. 
"(b) SPECIAL CoNsroERATiON m MAKING GRANTS.—In making 
grants for traineeships under subsection (a), the Secretary shall 
give special consideration to applications for traineeship programs 
that conform to guidelines established by the Secretary under sec-
tion 822(bX2). 
"(c) PREFERENCE IN PROVISION OF TRAINEESHIPS.—The Sec-
retary may make a grant under subsection (a) only if the applicant 
involved agrees that, in providing traineeships under such sub-
section, the applicant will give preference to individuals who are 
residents of health professional shortage areas designated imder 
section 332. 
"(d) ELIGIBILITY OF INDIVIDUALS IN MASTER'S DEGREE PRO-
GRAMS.—The Secretary may make a grant imder subsection (a) 
only if the applicant involved agrees that the applicant will not 
provide a traineeship under such subsection to an individual 
enrolled in a masters of nursing program unless the individual 
has completed basic nursing preparation, as determined by the 
applicant. 
"(e) USE OF GRANT.—^The Secretary may make a grant under 
subsection (a) only if the applicant involved agrees that traineeships 
provided with the grant will pay all or part of the costs o^— 
"(A) the tuition, books, and fees of the program of 
nursing with respect to which the traineeship is provided; 
and 
"(B) reasonable living expenses of the individual during 
the period for which the traineeship is provided. 
"(0 FUNDING.— 
"(1) AUTHORIZATION OF APPROPRIATIONS.—For the purpose 
of canying out this section, there is authorized to be appro-
priated $20,000,000 for each of the fiscal years 1993 and 1994. 
"(2) LIMITATION REGARDING CERTAIN TRAINEESHIPS.—Of the 
amounts appropriated under paragraph (1) for a fiscal year, 
the Secretary may not obligate more than 10 percent for provid-
ing traineeships under subsection (a) for individuals in doctoral 
degree programs.**. 
SEC. 207. NURSE ANESTHETISTS. 
(a) PREFERENCES REGARDING GRANTS AI«) TRAINEESHIPS; U S E 
OF GRANT.—Section 831(a) of the Public Health Service Act (42 
U.S.C. 297-l(a)) is amended— 
(1) by striking paragraph (2); and 
(2) by inserting after paragraph (1) the following para-
graphs: 
"(2)(A) In making grants under paragraph (1), the Secretary 
shall give preference to qualified applicants carrying out traineeship 
programs whose participants gain significant experience in provid-
ing health services at rural health facilities. 
"(B) The Secretary may make a grant imder paragraph (1) 
only if the institution involved agrees that, in providing traineeships 
under such paragraph, the institution will give preference to individ-
uals who are residents of health professional shortage areas des-
ignated under section 332. 
PUBLIC LAW 102-408—OCT. 13, 1992 
106 STAT. 2075 
**(3) The Secretary may make a grant under paragraph (1) 
only if the applicant involved agrees that traineesnips provided 
with the grant will pay all or part of the costs of— 
"(A) the tuition, books, and fees of the program of nursing 
with respect to which the traineeship is provided; and 
"(B) reasonable living expenses of the individual during 
the period for which the traineeship is provided.". 
(b) AUTHORIZATION OF APPROPRIATIONS.—Section 831(c) of the 
Public Health Service Act (42 U.S.C. 297-l(c)) is amended in the 
first sentence by inserting before the period the following: *
*
, 
$3,000,000 for fiscal year 1993, and $4,000,000 for fiscal year 1994". 
SEC. 208. STUDENT LOANS. 
(a) ALLOTMENTS AND PAYMENTS OF FEDERAL CAPITAL CON-
TRIBUTIONS.—Section 838(aX3) of the Public Health Service Act 
(42 U.S.C. 297d(aX3)) is amended— 
(1) by striking subparagraph (B); and 
(2) in subparagrapn (A)— 
(A) in the first sentence, by striking ''available for 
allotment" and all that follows and inserting the following: 
''available for allotment until expended."; 
(B) in the second sentence, by striking "this subpart, 
except" and all that follows and inserting "this subpart."; 
and 
(C) by striking the subparagraph designation. 
(b) DISTRIBUTION OF ASSETS FROM LOAN FUNDS.—Section 839 
of the Public Health Service Act (42 U.S.C. 297e) is amended— 
(1) in subsection (a), by striking out "1991" and inserting 
in lieu thereof "1996"; and 
(2) in subsections (a) and (b), by striking "1994" each place 
such term appears and inserting "1999". 
SEC. 209. CERTAIN GENERALLY APPLICABLE PROVISIONS. 
Title Vin of the Public Health Service Act (42 U.S.C. 296k 
et seq.) is amended by adding at the end the following section: 
"CERTAIN G
E
N
E
R
A
L
L
Y APPLICABLE PROVISIONS 
"SEC 860. (a) APPLICATION FOR GRANTS, COOPERATIVE AGREE- 
42 use 298b-7. 
MENTS, O
R CONTRACTS.—^The Secretary may make an award of 
a grant, cooperative agreement, or contract under this title only 
if an application for the award 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 Sec-
retary determines to be necessary to carry out the program authoriz-
ing the award. 
"(b) DURATION OF ASSISTANCE.— 
"(1) IN GENERAL.—Subject to paragraph (2), in the case 
of an award to an entity of a grant, cooperative agreement, 
or contract imder this title, the period dunng which payments 
are made to the entity under the award may not exceed 5 
years. The provision of payments under the award shall be 
subject to annual approval by the Secretary of the payments 
and subject to the availability of appropriations for the fiscal 
year involved to make the payments. This paragraph may 
not be construed as limiting the number of awards under the 
program involved that may he made to the entity. 
106 STAT. 2076 
PUBLIC LAW 102-408—OCT. 13, 1992 
"(2) LIMITATION.—In the case of an award to an entity 
of a grant, cooperative agreement, or contract under this title, 
paragraph (1) shall apply only to the extent not inconsistent 
with any other provision of this title that relates to the period 
during which pa3anents may be made under the award. 
"(c) BREACH OF AGREEMENTS FOR OBLIGATED SERVICE.— 
"(1) IN GENERAL.—In the case of any program under this 
title under which an individual makes an agreement to provide 
health services for a period of time in accordance with such 
program in consideration of receiving an award of Federal 
funds regarding education as a nurse (including an award 
for the repayment of loans), the following applies if the agree-
ment provides that this subsection is applicable: 
"(A) In the case of a program imder this title that 
makes an award of Federal funds for attending an accred-
ited program of nursing (in this subsection referred to 
as 'nursing program'), the individual is liable to the Federal 
Government for the amount of such award (including 
amounts provided for expenses related to such attendance), 
and for interest on such amount at the maximum legal 
prevailing rate, if the individual— 
"(i) fails to maintain an acceptable level of aca-
demic standing in the nursing program (as indicated 
by the program in accordance with requirements estab-
lished by the Secretary); 
"(ii) is dismissed from the nursing program for 
disciplinary reasons; or 
"(iii) voluntarily terminates the nursing program. 
"(B) The individual is liable to the Federal (government 
for the amount of such award (including amounts provided 
for expenses related to such attendance), and for interest 
on such amount at the msiximum legal prevailing rate, 
if the individual fails to provide health services in accord-
ance with the program under this title for the period of 
time applicable undfer the program. 
"(2) WAIVER OR SUSPENSION OF LIABILITY.—In the case of 
an individual or health facility making an agreement for pur-
poses of paragraph (1), the Secretary shall provide for the 
waiver or suspension of liability under such paragraph if 
compliance by the individual or the health facility, as the 
case may be, with the agreements involved is impossible, or 
would involve extreme hardship to the individual or facility, 
and if enforcement of the agreements with respect to the 
individual or facility would be unconscionable. 
"(3) DATE CERTAIN FOR RECOVERY.—Subject to paragraph 
(2), any amount that the Federal Cxovernment is entitled to 
recover under paragraph (1) shall be paid to the United States 
not later than the expiration of the three-year period beginning 
on the date the United States becomes so entitled. 
"(4) AVAILABILITY.—^Amounts recovered under paragraph 
(1) with respect to a program under this title shall be available 
for the purposes of such program, and shall remain available 
for such purposes until expended. 
"(d) 
PEER 
REVIEW REGARDING CERTAIN PROGRAMS.—Each 
application for a grant or contract under any of sections 821, 822, 
830, and 831 shall be submitted to a peer review group for an 
evaluation of the merits of the proposals made in the application. 
PUBLIC LAW 102-408—OCT. 13, 1992 
106 STAT. 2077 
The Secretary may not approve such an application unless a peer 
review group has recommended the application for approval. Each 
peer review group imder this subsection shall be composed prin-
cipally of indivimials who are not officers or employees of the 
Federal Grovemment. This subsection shall be carried out by the 
Secretary acting through the Administrator of the Health Resources 
and Services Administration. 
"(e) PREFERENCES AND REQUIRED INFORMATION IN CERTAIN PRO-
GRAMS.— 
"(1) PREFERENCES IN MAKING AWARDS.— 
"(A) Subject to subparagraph (B), in awarding grants 
or contracts under any of sections 821, 822, 830, and 831, 
the Secretary shall give preference to any qualified 
applicant that— 
"(i) has a high rate for placing graduates in prac-
tice settings having the principal focus of serving resi-
dents of medically underserved communities; or 
"(ii) during the 2-year period preceding the fiscal 
year for which such an award is sought, has achieved 
a significant increase in the rate of placing graduates 
in such settings. 
"(B) For purposes of subparagraph (A), the Secretary 
may not give an applicant preference if the proposal of 
the applicant is ranked at or below the 20th percentile 
of proposals that have been recommended for approval 
by peer review groups under subsection (d). 
"(2) REQUIRED SUBMISSION OF INFORMATION.—The Sec-
retary may make an award of a grant or contract under any 
of sections 821, 822, 830, and 831 only if the applicant for 
the award submits to the Secretary (through the application 
for the award) the following information regarding the programs 
of the applicant: 
"(A) A description of rotations or preceptorships for 
students that have the principal focus of providing health 
care to medically imderserved communities. 
"(B) The number of faculty on admissions committees 
who have a clinical practice in community-based ambula-
tory settings in medically imderserved or rural commu-
nities. 
"(C) With respect to individuals who are from disadvan-
taged backgrounds or from medically underserved commu-
nities, the number of such individuals who are recruited 
for academic programs of the applicant, the number of 
such individuals who are admitted to such programs, and 
the number of such individuals who graduate from such 
programs. 
"(D) If applicable to the applicant, the number of recent 
graduates who have chosen careers in primary health care. 
"(E) The number of recent graduates whose practices 
are serving medically underserved commimities. 
"(F) A description of whether and to what extent the 
applicant is able to operate without Federal assistance 
under this title. 
"(3) DEFINITION.—For purposes of this subsection, the term 
'graduate' means, unless otherwise specified, an individual who 
has successfully completed all training requirements necessary 
106 STAT. 2078 
PUBLIC LAW 102-408—OCT. 13, 1992 
for full certification in the health profession selected by the 
individual.**. 
42 use 297n. 
SEC. 210. DEMONSTRATION PROGRAM REGARDING SERVICE IN CER^ 
TAIN HEALTH CARE FACIUTIES. 
Part B of title VIII of the Public Health Service Act (42 U.S.C. 
297 et seq.) is amended by striking subpart IV. 
SEC. 
211. 
TRANSFER 
OF 
LOAN 
REPAYMENT 
PROGRAM. 
(a) IN GENERAL.—Part B of title VIII of the Public Health 
Service Act, as amended by section 210 of this Act, is amended— 
42 use 297b. 
(1) in section 836— 
(A) by striking subsection (h); and 
(B) bv redesignating subsections (i) through (k) as sub-
sections (h) through (j), respectively; 
42 use 297C-1. 
(2) by striking section 837A; and 
(3) by adding at the end the following subpart: 
"Subpart IV—Loan Repayment Program 
"LOAN REPAYMENT PROGRAM 
42 use 297n. 
«SEC. 846. (a) IN GENERAL.—In the case of any individual— 
"(1) who has received a baccalaureate or associate degree 
in nursing (or an equivalent degree), a diploma in nursing, 
or a graduate degree in nursing; 
"(2) who obtained (A) one or more loans from a loan fund 
established under subpart II, or (B) any other educational loan 
for nurse training costs; and 
"(3) 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 rural health clinic, or 
in a public or nonprofit private health facility determined by 
the Secretary to have a critical shortage of nurses; 
the Secretary shall make payments in accordance with subsection 
(b), for and on behalf of that individual, on the principal of and 
interest on any loan of that individual described in paragraph 
(2) of this subsection which is outstanding on the date the individual 
begins the service specified in the agreement described in paragraph 
(3) of this subsection. 
"(b) MANNER OF PAYMENTS.—The payments described in sub-
section (a) shall be made by the Secretary as follows: 
"(1) Upon completion by the individual for whom the pay-
ments are to be made of the first year of the service specified 
in the agreement entered into with the Secretary under sub-
section (a), the Secretary shall pay 30 percent of the principal 
of, and the interest on each loan of such individual described 
in subsection (a)(2) which is outstanding on the date he began 
such practice. 
"(2) Upon completion by that individual of the second year 
of such service, the Secretary shall pay another 30 percent 
of the principal of, and the interest on each such loan. 
"(3) Upon completion by that individual of a third year 
of such service, the Secretary shall pay another 25 percent 
of the principal of, and the interest on eacn such loan. 
PUBLIC LAW 102-408—OCT. 13, 1992 
106 STAT. 2079 
"(c) PAYMENT BY DUE DATE.—^Notwithstanding the requirement 
of completion of practice specified in subsection (b), the Secretary 
shall, on or before the due date thereof, pay anv loan or loan 
installment which may fall due within the period of service for 
which the borrower may receive payments under this subsection, 
upon the declaration of such borrower, at such times and in such 
manner as the Secretary may prescribe (and supported by such 
other evidence as the Secretary may reasonably require), that the 
borrower is then serving as described by subsection (aX3), and 
that the borrower will continue to so serve for the period required 
(in the absence of this subsection) to entitle the borrower to have 
made the payments provided by this subsection for such period; 
except that not more than 85 percent of the principal of any such 
lo£ui shall be paid pursuant to this subsection. 
**(d) BREACH OF AGREEMENT.—^The Secretary may make pay-
ments under subsection (a) on beh£ilf of an individual only if the 
agreement under such subsection provides that section 860(c) is 
applicable to the individual. 
"(e) PREFERENCES REGARDING PARTICIPANTS.—In entering into 
agreements under subsection (a), the Secretary shall give 
preference— 
"(1) to qualified applicants with the greatest financial need; 
and 
"(2) to qualified applicants that, with respect to health 
facilities described in such subsection, agree to serve in such 
health facilities located in geographic areas with a shortage 
of and need for nurses, as determined by the Secretary. 
"(f) DEFINITIONS.—For purposes of this section: 
"(1) The term "community health center" has the meaning 
given such term in section 33(Ka). 
"(2) The term "migrant health center" has the meaning 
given such term in section 329(aXl). 
"(3) The term "rural health clinic" has the meaning given 
such term in section 1861(aaX2) of the Social Security Act. 
"(g) AUTHORIZATION OF APPROPRIATIONS.—For the purpose of 
pa3nnents under agreements entered into under subsection (a), there 
are authorized to be appropriated $5,000,000 for fiscal year 1993, 
and $6,000,000 for fiscal year 1994.". 
(b) RULE OF CONSTRUCTION.—With respect to section 836(h) 42 use 297b 
of the Public Health Service Act, as in effect prior to the date "
°
*
®
" 
of the enactment of this Act, any agreement entered into under 
such section that is in effect on the day before such date remains 
in effect in accordance with the terms of the agreement, notwith-
standing the amendment made by subsection (a) of this section. 
SEC. 212. ADVISORY COUNCIL ON NURSES EDUCATION; REVIEW 
COMMITTEE. 
Section 851 of the Public Health Service Act (42 U.S.C. 298) 
is amended— 
(1) in subsection (a), in the first sentence, by striking 
"Advisory" and all that follows through "consisting" and insert-
ing the following: "National Advisory Council on Nurse Edu-
cation and Practice (in this section referred to as the 'Council'), 
consisting"; and 
(2) in the heading for the section, by striking "NURSES 
EDUCATION;" and inserting "NURSE EDUCATION AND PRACTICE;". 
106 STAT. 2080 
PUBLIC LAW 102-408—OCT. 13, 1992 
SEC. 213. EVALUATIONS. 
Section 859(b) of the Public Health Service Act (42 U.S.C. 
298b-6(b)) is amended— 
(1) by striking paragraph (1); and 
(2) in paragraph (2>— 
(A) by striking "(2)"; and 
(B) by striking "not later than" and all that follows 
through "submit" and inserting the following: "not later 
than January 10, 1994, and every 2 years thereafter, sub-
mit". 
TITLE III—MISCELLANEOUS 
PROVISIONS 
42 use 295k 
SEC. 301. ADVISORY COUNCIL ON GRADUATE MEDICAL EDUCATION. 
^°^' 
(a) ESTABLISHMENT; DUTIES.—There is established the Council 
on Graduate Medical Education (in this section referred to as the 
"Council"). The Council shall— 
(1) make recommendations to the Secretary of Health and 
Human Services (in this section referred to as the "Secretary^), 
and to the Committee on Labor and Human Resources of the 
Senate, and the Committee on Energy and Commerce of the 
House of Representatives, with respect to— 
(A) the supply and distribution of physicians in the 
United States; 
(B) current and future shortages or excesses of physi-
cians in medical and surgical specialties and subspecialties; 
(C) issues relating to foreign medical school graduates; 
(D) appropriate Federal policies with respect to the 
matters specified in subparagraphs (A), (B), and (C), includ-
ing policies concerning changes in the financing of under-
graduate and graduate medical education programs and 
changes in the types of medical education training in grad-
uate medical education programs; 
(E) appropriate efforts to be carried out by hospitals, 
schools of medicine, schools of osteopathic medicine, and 
accrediting bodies with respect to tne matters specified 
in subparagraphs (A), (B), and (C), including efforts for 
changes in undergraduate and graduate medical education 
programs; and 
(F) deficiencies in, and needs for improvements in, 
existing data bases concerning the supply and distribution 
of, and postgraduate training programs for, physicians in 
the United States and steps that should be taken to elimi-
nate those deficiencies; and 
(2) encourage entities providing graduate medical education 
to conduct activities to voluntarily achieve the recommendations 
of the Council under paragraph (1)(E), 
(b) COMPOSITION.—^The Council shall be composed of— 
(1) the Assistant Secretary for Health or the designee of 
the Assistant Secretary; 
(2) the Administrator of the Health Care Financing 
Administration; 
(3) the Chief Medical Director of the Department of Veter-
ans Affairs; 
PUBLIC LAW 102-408—OCT. 13, 1992 
106 STAT. 2081 
(4) 6 members appointed by the Secretary to include rep-
resentatives of practicing primary care physicians, national 
and specialty physician organizations, foreign medical grad-
uates, and medical student and house staff associations; 
(5) 4 members appointed by the Secretary to include rep-
resentatives of schools of medicine and osteopathic medicine 
and public and private teaching hospitals; and 
(6) 4 members appointed by the Secretary to include rep-
resentatives of health insurers, business, and labor. 
(c) TERMS OF APPOINTED MEMBERS.— 
(1) IN GENERAL; STAGGERED ROTATION.—Members of 
the 
Council appointed under paragraphs (4), (5), and (6) of sub-
section (b) shall be appointed for a term of 4 years, except 
that the term of office of the members first appointed shall 
expire, as designated by the Secretary at the time of appoint-
ment, 4 at the end of 1 year, 4 at the end of 2 years, 3 
at the end of 3 years, and 3 at the end of 4 years. 
(2) DATE CERTAIN FOR APPOINTMENT.—^The Secretary shall 
appoint the first members to the Coimcil under paragraphs 
(4), (5), and (6) of subsection (b) within 60 days after the 
date of enactment of this section. 
(d) CHAIR.—^The Council shall elect one of its members as 
Chairman of the Council. 
(e) QUORUM.—Nine members of the Council shall constitute 
a quorum, but a lesser number may hold hearings. 
(f) VACANCIES.—^Any vacancy in the Council shall not affect 
its power to function. 
(g) COMPENSATION.—Each member of the Council who is not 
otherwise employed by the United States Gk)vemment shall receive 
compensation at a rate equal to the daily rate prescribed for GS-
18 under the General Schedule under section 5332 of title 5, United 
States Code, for each day, including traveltime, such member is 
engaged in the actual performance of duties as a member of the 
Council. A member of the Council who is an officer or employee 
of the United States Government shall serve without additional 
compensation. All members of the Council shall be reimbursed 
for travel, subsistence, and other necessary expenses incurred by 
them in the performance of their duties. 
(h) CERTAIN AUTHORITIES AND DUTIES.— 
(1) AUTHORITIES.—In order to carry out the provisions of 
this section, the Council is authorized to— 
(A) collect such information, hold such hearings, and 
sit and act at such times and places, either as a whole 
or by subcommittee, and request the attendance and testi-
mony of such witnesses and the production of such books, 
records, correspondence, memoranda, papers, and docu-
ments as the Council or such subcommittee may consider 
available; and 
(B) request the cooperation and assistance of Federal 
departments, agencies, and instrumentalities, and such 
departments, agencies, and instrumentalities are author-
ized to provide such cooperation and assistance. 
(2) COORDINATION OF ACTIVITIES.—The Council shall coordi-
nate its activities with the activities of the Secretary imder 
section 792 of the Public Health Service Act. The Secretary 
shall, in cooperation with the Council and pursuant to the 
recommendations of the Council, take such steps as are prac-
106 STAT. 2082 
PUBLIC LAW 102-408—OCT. 13, 1992 
ticable to eliminate deficiencies in the data base established 
under such section 792 and shall make available in its reports 
such comprehensive data sets as are developed pursuant to 
this section. 
(i) REQUIREMENT REGARDING REPORTS.—In the reports required 
under subsection (a), the Council shall specify its activities during 
the period for which the report is made. 
(j) FINAL REPORT.—Not later than April 1, 1995, the Council 
shall submit a final report under subsection (a). 
(k) TERMINATION.—The 
Council 
shall 
terminate 
Septem-
ber 30, 1995. 
42 use 295k 
SEC. 302. COMMISSION ON ALLIED HEALTH. 
(a) ESTABLISHMENT.—There is established an advisory council 
to be known as the National Commission on Allied Health (in 
this section referred to as the "Commission"), which shall meet 
at least twice annually until such time as the final report is submit-
ted under subsection (e). 
(b) DUTIES.—^The Commission shall— 
(1) make recommendations to the Secretary of Health and 
Human Services (in this section referred to as the "Secretary"), 
the Committee on Labor and Human Resources of the Senate, 
and the Committee on Energy and Commerce of the House 
of Representatives, with respect to— 
(A) the supply and distribution of allied health person-
nel throughout the United States; 
(B) current and future shortages or excesses of allied 
health personnel, particularly in medically underserved and 
rural communities; 
(C) priority research needs within the allied health 
professions; 
(D) appropriate Federal policies relating to the matters 
described in subparagraphs (A) through (C), including poli-
cies concerning changes in the financing of undergraduate 
and graduate allied health programs, changes in the types 
of allied health education, and the appropriate Federal 
role in the development of a research base in the allied 
health professions; 
(E) appropriate efforts to be carried out by health 
care facilities, schools and programs of allied health, and 
professional associations with respect to the matter referred 
to in subparagraph (A), including efforts for changes in 
undergraduate and graduate allied health education pro-
grams, and private support for research initiatives; 
(F) deficiencies and needs for improvements in existing 
data bases concerning the supply and distribution of train-
ing programs for allied health in the United States and 
steps that should be taken to eliminate such deficiencies; 
and 
(G) problems, and recommendations for the resolution 
of such problems, relating to the roles and functions of 
professionals within the allied health fields and other fields 
such as medicine and dentistry; and 
(2) encourage entities providing allied health education 
to conduct activities to voluntarily achieve the recommendations 
of the Commission. 
(c) COMPOSITION.—^The Commission shall be composed of— 
PUBLIC LAW 102-408—OCT. 13, 1992 
106 STAT. 2083 
(1) the Assistant Secretary for Health; 
(2) the Administrator of the Health Care Financing 
Administration; 
(3) the Assistant Secretary for Defense for Health Affairs; 
(4) the Chief Medical Director of the Department of Veter-
ans Affairs; 
(5) the Commissioner of the Bureau of Labor Statistics 
of the Department of Labor; 
(6) a representative of the National Center for Education 
Statistics of the Department of Education; 
(7) a representative of the Bureau of Health Professions, 
Health Resources and Services Administration to be appointed 
by the Secretary; 
(8) five individuals appointed by the Secretary to represent 
allied health professionals, of which— 
(A) two such individuals shall be representatives of 
allied health professionals who provide occupational, 
speech, respiratory or physical therapy services; 
(B) two such individuals shall be health professionals 
who provide services in underserved areas or to under-
served populations; and 
(C) one such individual shall be a health professional 
who provides services to the elderly; 
(9) five individuals appointed by the Secretary, including 
representatives of schools and programs of allied health, health 
care facility employers of allied health personnel, health insur-
ers, and professional organizations representing the allied 
health professions; 
(10) a professional knowledgeable about health occupations 
and professions and data policy to be appointed by the Sec-
retary; and 
(11) a representative of the general public to be appointed 
by the Secretary. 
(d) DATE CERTAIN FOR APPOINTMENTS.—Not later than 90 days 
after the date of the enactment of the Health Professions Education 
Extension Amendments of 1992, the Secretary shall appoint the 
members of the Commission in accordance with subsection (c). 
(e) REPORTS.—Not later than October 1, 1993, the Commission 
shall prepare and submit to the individual and entities described 
in subsection (b)(1) a progress report concerning the activities of 
the Commission. Not later than April 1, 1994, the Commission 
shall prepare and submit to such individuals and entities a final 
report. 
(f) RESOURCES FOR COUNCIL.—The Secretary shall ensure that 
necessary resources are made available to implement the provisions 
of this section. 
(g) TERMINATION.—^The Commission shall terminate 60 days 
after the submission of the final report required under subsection 
(e). 
SEC. 303. STUDY 
REGARDING 
CUNICAL 
LABORATORY 
TECH- 
42 USC 295k 
NOLOGISTS FOR MEDICALLY in^DERSERVED AND RURAL note. 
COMMUNITIES. 
(a) IN GENERAL.—^With respect to the shortage of clinical labora-
tory technologists, the Secretary of Health and Human Services 
(in this section referred to as the "Secretary") shall conduct a 
study for the purpose of— 
59-194 O—93 
10:QL3(Pt. 3) 
106 STAT. 2084 
PUBLIC LAW 102-408—OCT. 13, 1992 
(1) determining whether there are special or unique factors 
affecting the supply of clinical laboratory technologists in medi-
cally underserved and rural communities; and 
(2) assessing alternative routes for certification of the com-
petence of individuals to serve as such technologists, with 
consideration of the role of entities providing such certifications. 
(b) DATE CERTAIN FOR REPORT.—Not later than October 1, 
1993, the Secretary 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 Resources of the Senate, a report describing the find-
ings made as result of the study. 
SEC. 304. RESIDENCY TRAINING PROGRAMS IN EMERGENCY MEDI-
CINE. 
Title XII of the PubHc Health Service Act (42 U.S.C. 300d 
et seq.), as amended by title VI of Public Law 102-321, is amended 
by adding at the end the following part: 
"Part E—^Miscellaneous Programs 
42 use 300d-51. 
"SEC. 1251. RESIDENCY TRAINING PROGRAMS IN EMERGENCY MEDI-
CINE. 
"(a) IN GENERAL.—The Secretary may make grants to public 
and nonprofit private entities for the purpose of planning and 
developing approved residency training programs in emergency 
medicine. 
"(b) IDENTIFICATION AND REFERRAL OF DOMESTIC VIOLENCE.— 
The Secretary may make a grant under subsection (a) only if 
the applicant involved agrees that training programs under sub-
section (a) will provide education and training in identifying and 
referring cases of domestic violence. 
"(c) AUTHORIZATION OF APPROPRIATIONS.—For the purpose of 
carr)dng out this section, there is authorized to be appropriated 
$400,000 for each of the fiscal years 1993 through 1995.". 
SEC. 305. CERTAIN CLINICAL TRAINEESHIPS. 
Section 303(d)(2) of the Public Health Service Act (42 U.S.C. 
242a(d)(2)) is amended— 
(1) by striking "or" at the end of subparagraph (B); 
(2) by inserting "or" after the comma at the end of subpara-
graph (C); and 
(3) by inserting after subparagraph (C) the following 
subparagraph: 
"(D) in a Federal or State correctional facility,". 
SEC. 306. SPECIAL CONSOLIDATED LOAN PROGRAM. 
(a) IN GENERAL.—Section 428C of the Higher Education Act 
of 1965 (20 U.S.C. 1078-3) is amended— 
(1) by redesignating subsection (d) as subsection (e); and 
(2) by inserting after subsection (c) the following new sub-
section: 
Contracts. 
«(d) SPECIAL PROGRAM AUTHORIZED.— 
"(1) GENERAL RULE AND DEFINITION OF ELIGIBLE STUDENT 
LOAN.— 
"(A) IN GENERAL.—Subject to the provisions of this 
subsection, the Secretary or a guaranty agency shall enter 
into agreements with eligible lenders described in subpara-
PUBLIC LAW 102-408—OCT. 13, 1992 
106 STAT. 2085 
graphs (A), (B), and (C) of subsection (aXD for the consoli-
dation of eligible student loans. 
"(B) APPLICABILITY RULE.—Unless otherwise provided 
in this subsection, the agreements entered into under 
subparagraph (A) and the loans made under such agree-
ments for the consolidation of eligible student loans under 
this subsection shall have the same terms, conditions, and 
benefits as all other agreements and loans made under 
this section. 
"(C) DEFINITION.—For the purpose of this subsection, 
the term 'eligible student loans' means loans— 
"(i) of the type described in subparagraphs (A), 
(B), and (C) of subsection (aX4); and 
**(ii) made under subpart I of part A of title VII 
of the Public Health Service Act. 
"(2) INTEREST RATE RULE.— 
"(A) IN GENERAL.—^The portion of each consolidated 
loan that is attributable to an eligible student loan 
described in paragraph (IXCXii) shall bear interest at a 
rate not to exceed the rate determined under subparagraph 
(B). 
"(B) 
DETERMINATION 
OF THE MAXIMUM 
INTEREST 
RATE.—For the 12-month period beginning after July 1, 
1992, and for each 12-month period thereafter, beginning 
on July 1 and ending on Jime 30, the interest rate 
applicable under subparagraph (A) shall be equal to the 
average of the bond equivalent rates of the 91-day Treasury 
bills auctioned for the quarter prior to July 1, for each 
12-month period for which the determination is made, plus 
3 percent. 
"(C) PUBLICATION OF MAXIMUM INTEREST RATE.—The Federal 
Secretary shall determine the applicable rate of interest 
^uii^[-on 
imder subparagraph (B) after consultation with the Sec- ^" 
retary of the Treasury and shall publish such rate in the 
Federal Register as soon as practicable after the date of 
such determination. 
"(3) SPECIAL RULES.— 
"(A) No SPECIAL ALLOWANCE RULE.—NO special allow-
ance imder section 438 shall be paid with respect to the 
portion of any consolidated loan under this subsection that 
IS attributable to any loan described in paragraph (IXCXii). 
"(B) No INTEREST SUBSIDY RULE.—^No interest subsidy 
under section 428(a) shall be paid on behalf of any eligible 
borrower for any portion of a consolidated loan under this 
subsection that is attributable to any loan described in 
paragraph (IXCXii). 
"(C) ADDITIONAL RESERVE RULE.—Notwithstanding any 
other provision of this Act, additional reserves shaU not 
be required for any guaranty agency with respect to a 
loan made under this subsection. 
"(D) INSURANCE RULE.—^Any insurance premium paid 
by the borrower under subpart I of part A of title VII 
of the Public Health Service Act with respect to a loan 
made under that subpart and consolidated under this sub-
section shall be retained by the student loan insurance 
fund established under section 710 of the Public Health 
Service Act. 
106 STAT. 2086 
PUBLIC LAW 102-408—OCT. 13, 1992 
**(4) REGULATIONS.—^The Secretary is authorized to promul-
gate such regulations as may be necessary to facilitate canying 
out the provisions of this subsection.". 
(b) TECHNICAL AMENDMENT.—Section 428(e) of the Higher Edu-
20 use 1078-3. 
cation Act of 1965 (as redesignated by subsection (a)) is amended 
by striking "1992" and mserting "1997 . 
20 use 1078-3 
(c) EFFECTIVE DATE.—The amendments made bv this section 
note. 
f^Q effect 60 days after the date of enactment of this Act. 
42 use 295k 
SEC. 307. NATIONAL ADVISORY COUNCIL ON MEDICAL UCENSURK 
(a) ADVISORY COUNCIL.— 
Establishment. 
(1) IN GENERAL.—The Secretary of Health and Human 
Services shall establish an advisory council to be known as 
the "National Advisory Council on Medical Licensure". 
(2) DUTIES.— 
(A) ADVICE.—^The Council shall provide advice to the 
Secretary regarding the operation of the system established 
by the American Medicsd Association for the purpose of 
verifying and maintaining information regarding the quali-
fications of individuals to practice medicine, and advice 
regarding the establishment and operation of any similar 
system. 
(B) AcTFvrnES.—^In carrying out subparagraph (A), the 
Council shall— 
(i) monitor and review the operation of the private 
credentials 
verification 
system and develop rec-
ommendations regarding methods by which the system 
can be improved, and make recommendations for the 
establishment of nondiscriminatory policies and prac-
tices for the operation of the system; 
(ii) determine to what extent the system has expe-
dited and otherwise improved the efificienQr and equi-
table operation of the process in the States for licensing 
individuals to practice medicine who previously have 
been licensed by another State (commonly known as 
licensure by endorsement); and 
(iii) review the policies and practices of the States 
(including any relevant laws) in licensing international 
medical graduates and in licensing domestic medical 
graduates, and determine the effects of the policies. 
(3) (JOMPOsmoN.— 
(A) IN GENERAL.—^The Council shall be composed of 
15 voting members selected in accordance with subpara-
graphs (B) and (C). 
(B) HEALTH RESOURCES AND SERVICES ADMINISTRA-
TION.—^The Secretary shall designate one official or 
employee of the Health Resources and Services Administra-
tion to serve as a member of tiie Council. The official 
or employee so designated shall be a graduate of a medical 
school located in the United Stetes. 
(C) APPOINTMENTS.—^From among individuals who are 
not officers or employees of the Federal (jrovemment, the 
Secretary shall, subject to subparagraph (D), make appoint-
ments to the Council as follows: 
(i) One individual from an organization represent-
ing State authorities that license individuals to practice 
medicine. 
PUBLIC LAW 102-408—OCT. 13, 1992 
106 STAT. 2087 
(ii) 
One 
individual 
representing 
a 
national 
organization that represents practicing physicians in 
the United States. 
(iii) One individual representing an organization 
in the United States that tests international medical 
graduates regarding medical knowledge. 
(iv) One individual representing an organization 
in the United States that tests individuals who are 
G
raduates of medical schools located in the United 
tates regarding medical knowledge. 
(v) One physician representing one or more medical 
schools located in the United States. 
(vi) One individual who is a representative of the 
private credentials verification system. 
(vii) One individual who is a graduate of a medical 
school located in the United Stetes, who has been 
licensed to practice medicine by a State and has been 
so licensed by such State for a continuous period of 
at least 20 years, and who has applied for and received 
licensure by endorsement during the 5-year period end-
ing on the date of the enactment of this Act. 
(viii) One individual who is a graduate of a medical 
school located in the United States and who represents 
a State authority that licenses individuals to practice 
medicine, which State either has a significant number 
of practicing physicians who are international medical 
graduates or has a significant shortage of physicians. 
(ix) One individual who is an international medical 
graduate and who represents a coalition representing 
such graduates. 
(x) One individual who is an international medical 
graduate and who is a native of the United States. 
(xi) One individual who is a native of a country 
located in southern or eastern Asia (including southern 
or eastern Asian islands) and who is an international 
medical graduate by virtue of being a graduate of 
a medical school located in such a country. 
(xii) One individual who is a native of a European 
country or of Australia or New Zealand and who is 
an international medical graduate by virtue of being 
a graduate of a medical school located in such a coim-
try. 
(xiii) One individual who is a native of a Latin 
American or Caribbean country and who is an inter-
national medical graduate by virtue of being a graduate 
of a medical school located in such a coimtry. 
(xiv) One individual who is a native of a country 
located in sub-Saharan Africa and who is an inter-
national medical graduate by virtue of being a graduate 
of a medical school located in such a country. 
At least one member appointed by the Secretary under 
this subparagraph shall be a physician who is practicing 
in a medically underserved community, as defined in sec-
tion 799 of the Public Health Service Act. A physician 
may serve on the Council only if the physician is licensed 
by one or more Stetes to practice medicine. 
106 STAT. 2088 
PUBLIC LAW 102-408—OCT. 13, 1992 
(D) CONSULTATION.—The Secretary shall make the 
appointments described in subparagraph (C) only after con-
sultation with relevant organizations and coalitions. 
(4) CHAIR.—^From among the members appointed under 
paragraph (3XC), the Council shall designate an individual 
to serve as the chair of the Council. 
(5) DURATION.—^The Council shall continue in existence 
imtil the submission of the report required under paragraph 
(7), or not later than September 30, 1995, whichever is earlier. 
(6) INTERIM REPORT.—Not later than September 30, 1993, 
the Coimcil shall submit to the Secretary, the Committee on 
Labor and Human Resources of the Senate and the Committee 
on Energy and Commerce of the House of Representatives, 
an interim report describing the findings and recommendations 
of the Council pursuant to the duties established in paragraph 
(2). The Secretary shall provide a copy of the report to the 
private credentials verification system. 
(7) FINAL REPORT.— 
(A) IN GENERAL.—Not later than September 30, 1995, 
the Council shall prepare and submit to the Secretary, 
the Committee on Labor and Human Resources of the 
Senate and the Committee on Energy and Commerce of 
the House of Representatives, a final report that shall 
include recommendations regarding activities conducted 
pursuant to paragraph (2), that shall include a determina-
tion as to whether the private credentials verification sys-
tem is operating with a reasonable degree of efficiency 
and whether the policies and practices of the system are 
nondiscriminatory. 
(B) RECOMMENDATIONS.—If the Secretary determines 
that the private credentials verification system fails to 
meet either of the criteria with respect to the determination 
described in subparagraph (A), the Secretary, in consulta-
tion with the Council and releveint organizations, shall 
make a recommendation concerning the establishment of 
an alternative private system and concerning the specifica-
tions for such a system as described in paragraph (2XB). 
(b) STUDY OF STATE LICENSURE PROCESS.— 
(1) IN GENERAL.—^With respect to the licensure by the 
States of individuals to practice medicine, the Secretary, in 
consultation with the Council, shall conduct a study of not 
less than 10 States for the purpose of determining— 
(A) the average length of time required for the States 
involved to process the licensure applications of domestic 
medical graduates and the average length of time required 
for the States to process the licensure applications of inter-
national medical graduates, and the reasons underlying 
any significant difiTerences in such times; and 
(B) the percentage of licensure applications firom 
domestic medical graduates that are approved and the 
percentage of licensure applications from graduates of 
international medical schools that are approved, and the 
reasons underlying any significant differences in such 
percentages. 
(2) REPORT.—Not later than September 30, 1994, the Sec-
retary shall submit to the Committee on Labor and Human 
Resources of the Senate and the Committee on Energy and 
PUBLIC LAW 102-408—OCT. 13, 1992 
106 STAT. 2089 
Commerce of the House of Representatives a report describing 
the findings made as a result of the study required in paragraph 
(1) for the fiscal year. 
(c) DEFINITIONS.—For purposes of this section: 
(1) COUNCIL.—The term "Council" means the National 
Advisory Council on Medical Licensure established in sub-
section (a)(1). 
(2) DOMESTIC MEDICAL GRADUATE.—The term "domestic 
medical graduate" means an individual who is a graduate of 
a medical school located in the United States or Canada. 
(3) INTERNATIONAL MEDICAL GRADUATE.—The term "inter-
national medical graduate" means an individual who is a grad-
uate of a medical school located in a country other than the 
United States or Canada. 
(4) MEDICAL SCHOOL.—The term "medical school" means 
a school of medicine or a school of osteopathic medicine, as 
such terms are defined in section 799 of the Public Health 
Service Act. 
(5) NONDISCRIMINATORY.—^The term "nondiscriminatory", 
with respect to policies and practices, means that such policies 
and practices do not discriminate on the basis of race, color, 
religion, gender, national origin, age, disability, marital status, 
or educational affiliation. 
(6) PRIVATE CREDENTIALS VERIFICATION SYSTEM.—^The term 
"private credentials verification system" means the system 
described in subsection (a)(2)(A) and established by the Amer-
ican Medical Association. 
(7) SECRETARY.—^The term "Secretary" means the Secretary 
of Health and Human Services. 
(8) STATE.—^The term "State" means each of the several 
States, the District of Columbia, the Commonwealth of Puerto 
Rico, American Samoa, Guam, the Commonwealth of the North-
em Mariana Islands, and the Trust Territory of the Pacific 
Islands. 
(d) NECESSARY RESOURCES.—The Secretary shall ensure that 
necessary resources are made available to implement the provisions 
of this section. 
SEC. 308. REQUIRED ASSURANCES REGARDING BLOODBORNE DIS- 
42 USC 295j 
EASES. 
i^ote. 
With respect to awards of grants or contracts under title VII 
or VIII of the Public Health Service Act, the Secretary of Health 
and Human Services may make such an award for the provision 
of traineeships only if the applicant for the award provides assur-
ances satisfactory to the Secretary that all trainees will, as appro-
priate, receive instruction in the utilization of universal precautions 
and infection control procedures for the prevention of the trans-
mission of bloodbome diseases. 
SEC. 309. STUDY ON EFFECTIVENESS OF HEALTH PROFESSIONS PRO- 
42 USC 292 note. 
GRAMS. 
(a) IN GENERAL.—The Comptroller General of the United States 
shall conduct a study of the programs carried out under titles 
VII and VIII of the Public Health Service Act (as amended by 
this Act) for the purpose of determining the effectiveness of such 
programs in— 
106 STAT. 2090 
PUBLIC LAW 102-408—OCT. 13, 1992 
(1) increasing the number of primary care providers (physi-
cians, physician assistants, nurse midwives, nurse practitioners 
and general dentists), nurses and aUied health personnel; 
(2) improving the geographic distribution of health profes-
sionals in medically underserved and rural areas; and 
(3) recruiting and retaining as students in health profes-
sions schools individuals who are members of a minority group. 
(b) CERTAIN REQUIREMENTS.—The study conducted under sub-
section (a) shall determine— 
(1) whether funding under title VII of the Public Health 
Service Act has increased the number of primary care 
practitioners (family medicine, general internal medicine, gen-
eral pediatrics, general dentistry, and physician assistants) in 
medically underserved communities (as defined in section 799 
of such Act); 
(2) whether or not fxmding under such title VII has 
increased the number of allied health professionals in medically 
underserved or rural communities; 
(3) whether or not fimding under title VIII of such Act 
has increased the number of nurses in medically underserved 
or rural communities; 
(4) whether or not the various mechanisms imder such 
titles VII 
and 
VIII (such 
as 
scholarships, 
fellowships, 
traineeships, loan repayment programs, project grants, and 
education centers) have been effective in producing health care 
professionals who work or practice in medically underserved 
and rural communities and the relative impact or effectiveness 
of each mechanism; 
(5) the duration of service in medically underserved commu-
nities (as defined in section 799 of such Act) of health profes-
sionals whose training was funded by such titles or who 
received financial incentives under such titles to practice in 
such communities; 
(6) the geographic distribution of former trainees under 
such titles who are practicing in medically imderserved commu-
nities (as so defined); 
(7) with respect to the programs of such titles whose pur-
pose is improving the health of individuals who are members 
of minority groups, whether such programs have had a signifi-
cant impact on the number of such individuals entering the 
health professions; and 
(8) such other factors as may be relevant to the reauthoriza-
tion of such title VII or VIII. 
(c) REPORT.—Not later than January 1, 1994, the Comptroller 
General of the United States shall complete the study required 
in subsection (a) and submit to the Committee on Labor and Human 
Resources of the Senate, and the Committee on Energy and Com-
merce of the House of Representatives, a report describing the 
findings made as a result of the study and making such rec-
ommendations regarding the programs carried out under titles VII 
and VIII of the Public Health Service Act as the Comptroller Gen-
eral determines to be appropriate. 
21 use 343-1 
SEC. 310. DELAYED APPLICABILITY OF CERTAIN PROVISIONS. 
Notwithstanding any other provision of law, section 403A(a)(l) 
of the Federal Food, Drug, and Cosmetic Act (21 U.S.C. 343-
1(a)(1)) shall not apply with respect to any requirement of any 
PUBLIC LAW 102-408—OCT. 13, 1992 
106 STAT. 2091 
State or political subdivision regarding maple syrup until September 
1,1994. 
SEC. 311. CERTAIN APPUCATION PROCEDURES. 
Section 633 of Public Law 100-607 (42 U.S.C. 295g-10a) is 
repealed. 
SEC. 312. CERTAIN PROJECTS. 
42 USC 300x 
(a) IN GENERAL.—Section 205(aX2XB) of Public Law 102-321 "''*^ 
is amended by adding at the end the following clause: 
"(iii) In the case of amounts reserved under this 
subparagraph for programs of services in the city of 
San Francisco, California, the Secretary shall ensure 
that such amounts are administered by such city and 
shall authorize the city to select providers for such 
programs and determine the allocation of such pay-
ments among the providers.". 
(b) CONFORMING AMENDMENT.—Section 205(a)(2XBXi) of Public 
Law 102-321 is amended— 
(1) in subclause (I), by striking "clause (ii)" and inserting 
"clauses (ii) and (iii)"; and 
(2) in subclause (II), by inserting ", subject to clause (iii)" 
before the period. 
Approved October 13, 1992. 
LEGISLATIVE HISTORY—H.R. 3508: 
HOUSE REPORTS: Nos. 102-275 (Comm. on Energy and Commerce) and 102-925 
(Comm. of Conference). 
CONGRESSIONAL RECORD: 
Vol. 137 (1991): Nov. 12, considered and passed House. 
Nov. 26, considered and passed Senate, amended. 
Vol. 138 (1992): Sept. 25, Senate agreed to conference report. 
Sept. 29, House agreed to conference report.