[Congressional Bills 103th Congress] [From the U.S. Government Publishing Office] [H.R. 3230 Introduced in House (IH)] 103d CONGRESS 1st Session H. R. 3230 To amend the Public Health Service Act with respect to the health of individuals who are members of racial or ethnic minority groups. _______________________________________________________________________ IN THE HOUSE OF REPRESENTATIVES October 6, 1993 Mr. Serrano (for himself, Mr. Richardson, Mr. Gutierrez, Ms. Roybal- Allard, Mr. Pastor, Mr. Torres, Mr. Becerra, Ms. Velazquez, Mr. Romero- Barcelo, Mr. de Lugo, Mr. Ortiz, Mr. Menendez, Mr. Diaz-Balart, and Mr. Underwood) introduced the following bill; which was referred to the Committee on Energy and Commerce _______________________________________________________________________ A BILL To amend the Public Health Service Act with respect to the health of individuals who are members of racial or ethnic minority groups. Be it enacted by the Senate and House of Representatives of the United States of America in Congress assembled, SECTION 1. SHORT TITLE. This Act may be cited as the ``Minority Health Opportunity Enhancement Act of 1993''. SEC. 2. MODIFICATIONS REGARDING SECRETARY'S OFFICE OF MINORITY HEALTH. (a) Duties.--Section 1707(b) of the Public Health Service Act (42 U.S.C. 300u-6(b)) is amended-- (1) in paragraph (1), by striking ``that relate'' and all that follows and inserting the following: ``that relate to programs regarding the prevention of diseases; the promotion of health; the delivery of health services; research; the health professions; and training and technical assistance regarding such programs;''; and (2)(A) in paragraph (7), by striking ``and'' after the semicolon at the end; (B) in paragraph (8), by striking the period at the end and inserting ``; and''; and (C) by adding at the end the following paragraph: ``(9)(A) establish by contract a center for the purpose of carrying out programs to improve access to health care services for individuals who have the limitation of lacking proficiency in speaking the English language, which programs carry out such purpose by facilitating the removal of barriers to the receipt of health care that result from such limitation; and ``(B) in carrying out subparagraph (A), ensure that the center under such subparagraph conducts research, develops and evaluates model projects, and provides technical assistance to health care providers.''. (b) Definitions.--Section 1707 of the Public Health Service Act (42 U.S.C. 300u-6) is amended-- (1) by redesignating subsection (f) as subsection (h); and (2) by inserting before subsection (h) (as so redesignated) the following subsection: ``(g) Definition of Racial or Ethnic Minority Group.--The term `racial or ethnic minority group' means Hispanics, African Americans, Asian Americans, Pacific Islanders, Native Americans, Eskimos, and Aleuts. For purposes of the preceding sentence, the term `Hispanic' means individuals whose origin is Mexican, Puerto Rican, Cuban, Central or South American, or any other Spanish-speaking country, including Spain or the Caribbean Islands; and individuals indentifying themselves as Hispanic, Latino, Spanish, or Spanish-American.''. (c) Reports.--Section 1707(e) of the Public Health Service Act (42 U.S.C. 300u-6(e)) is amended by striking ``to the Congress'' and inserting the following: ``to the Committee on Energy and Commerce and the Committee on Appropriations of the House of Representatives, and to the Committee on Labor and Human Resources and the Committee on Appropriations of the Senate,''. (d) Conforming Amendment.--Section 1707(b) of the Public Health Service Act (42 U.S.C. 300u-6(b)) is amended in the matter preceding paragraph (1) by striking ``racial and ethnic minorities'' and inserting ``racial and ethnic minority groups''. SEC. 3. ESTABLISHMENT OF INDIVIDUAL OFFICES OF MINORITY HEALTH WITHIN AGENCIES OF PUBLIC HEALTH SERVICE. Title XVII of the Public Health Service Act (42 U.S.C. 300u et seq.), as amended by section 302 of Public Law 102-531 (106 Stat. 3483), is amended by inserting after section 1707 the following section: ``individual offices of minority health within public health service ``Sec. 1707A. (a) In General.--The head of each agency specified in subsection (b)(1) shall establish within the agency an office to be known as the Office of Minority Health. Each such Office shall be headed by a director, who shall be appointed by the head of the agency within which the Office is established and who shall report directly to the head of the agency. The head of such agency shall carry out this section (as this section relates to the agency) acting through such Director. ``(b) Specified Agencies.-- ``(1) In general.--The agencies referred to in subsection (a) are the following: ``(A) The Centers for Disease Control and Prevention. ``(B) The Agency for Health Care Policy and Research. ``(C) The Health Resources and Services Administration. ``(D) The Substance Abuse and Mental Health Services Administration. ``(2) National institutes of health.--For purposes of subsection (c) and the subsequent provisions of this section, the term `minority health office'' includes the Office of Research on Minority Health established within the National Institutes of Health. The Director of the National Institutes of Health shall carry out this section (as this section relates to the agency) acting through the Director of such Office. ``(c) Composition.--The head of each specified agency shall ensure that the officers and employees of the minority health office of the agency are, collectively, experienced in carrying out community-based health programs for each of the various racial and ethnic minority groups and subgroups that are present in significant numbers in the United States. The head of such agency shall ensure that, of such officers and employees who are members of racial and ethnic minority groups, no such group is disproportionately represented. ``(d) Collaboration With Secretary's Office of Minority Health.--In carrying out section 1707 regarding a specified agency, the Secretary shall collaborate with the Director of the minority health office of the agency. With respect to the health concerns of individuals who are members of racial or ethnic minority groups, the activities with respect to which such Director collaborates under the preceding sentence shall be-- ``(1) establishing short-range and long-range goals and objectives; ``(2) coordinating all other activities within the agency that relate to programs regarding the prevention of diseases; the promotion of health; the delivery of health services; research; the health professions; and training and technical assistance regarding such programs; and ``(3) all other activities carried out under section 1707. ``(e) Monitoring of Agency Programs.--Each Director of a minority health office shall monitor the programs of the specified agency of such office in order to-- ``(1) determine the extent to which the purposes of the programs are being carried out with respect to racial and ethnic minority groups; ``(2) determine the extent to which members of such groups are represented among the Federal officers and employees who administer the programs; and ``(3) make recommendations to the head of such agency on carrying out the programs with respect to such groups. ``(f) Reports.--The head of each specified agency shall submit to the Secretary a biennial report describing-- ``(1) the extent to which the minority health office of the agency employs individuals who are members of racial and ethnic minority groups, including a specification by racial and ethnic minority group of the number of such individuals employed by such office; and ``(2) the extent to which the agency has complied with Public Law 94-311 (relating to data on Americans of Spanish origin or descent). ``(g) Definitions.--For purposes of this section: ``(1) The term ``minority health office'' means an office established under subsection (a), subject to subsection (b)(2). ``(2) The term `racial or ethnic minority group' has the meaning given such term in section 1707(g). ``(3) The term `specified agency' means-- ``(A) an agency specified in subsection (b)(1); and ``(B) the National Institutes of Health. ``(h) Authorizations of Appropriations.-- ``(1) Individual authorizations.--For the purpose of carrying out activities under this section through the minority health offices of the specified agencies, there is authorized to be appropriated for each such office for each of the fiscal years 1994 through 1996 an amount equal to 5 percent of the amount appropriated for the preceding fiscal year for the specified agency of such office, or $3,000,000, whichever is greater. ``(2) Availability of funds for staffing.--The purposes for which amounts appropriated under paragraph (1) may be expended by a minority health office include the costs of employing staff for such office.''. SEC. 4. EQUITABLE ALLOCATIONS REGARDING CERTAIN PROGRAMS. (a) Generally Applicable Provisions.-- (1) Increase in authorizations of appropriations.-- (A) For the purpose of carrying out the programs specified in subparagraph (B), there is authorized to be appropriated for each such program for each of the fiscal years 1994 through 1996 an amount to 10 percent of the amount appropriated for the program for fiscal year 1993. The authorization established in the preceding sentence for such a program for a fiscal year is in addition to any other authorization of appropriations that is available for such purpose. (B) The programs referred to in subparagraph (A) are the following sections of the Public Health Service Act: Section 340A, section 724, section 737, section 738(a), 738(b), and 740. (2) Peer review.-- (A) In carrying out the designated programs, the Secretary shall ensure that each application for any grant, cooperative agreement, or contract authorized for the program is submitted to a peer review group for an evaluation of the merits of the proposals made in the application. The Secretary may not approve such an application unless a peer review group has recommended the application for approval. (B) Each peer review group under subparagraph (A) shall be composed principally of individuals who are not officers or employees of the Federal Government. Each such group shall be composed of individuals who are experienced in carrying out community-based health programs for each of the various racial and ethnic minority groups and subgroups that are present in significant numbers in the United States. The Secretary shall ensure that, of individuals comprising the peer review groups who are members of racial and ethnic minority groups, no racial or ethnic minority group is disproportionately represented. (3) Outreach.--With respect to awards of grants and contracts that are available under the designated programs, the Secretary shall carry out a program-- (A) to inform entities, as appropriate, that the entities may be eligible for the awards; (B) to provide technical assistance to such entities in the process of preparing and submitting applications for the awards in accordance with the policies of the Secretary regarding such applications; and (C) to inform populations, as appropriate, that members of the populations may be eligible to receive services or otherwise participate in the activities carried out with such awards. (4) Definitions.--For purposes of this subsection: (A) The term `racial or ethnic minority group' has the meaning given such term in section 1707(g) of the Public Health Service Act. (B) The term ``designated program'' means a program specified in paragraph (1)(B). (C) The term ``Secretary'' means the Secretary of Health and Human Services. (b) Equitable Allocations Regarding Racial and Ethnic Groups.-- Section 1707 of the Public Health Service Act, as amended by section 2 of this Act, is amended-- (1) by redesignating subsections (c) through (e) as subsections (d) through (f), respectively; (2) in subsection (d) (as so redesignated)-- (A) by striking paragraph (1); and (B) by redesignating paragraphs (2) and (3) as paragraphs (1) and (2), respectively; and (3) by inserting after subsection (b) the following subsection: ``(c) Equitable Allocations.-- ``(1) Applicability to designated programs.-- ``(A) This subsection applies-- ``(i) to activities carried out under any program established under this section; and ``(ii) to activities carried out under any program of this Act that specifies that this subsection is applicable to the program (subject to such limitations as may be established for the program involved). ``(B) With respect to a designated program, this subsection shall be carried out by the Secretary, acting through the head of the agency that carries out the program. ``(2) Equitable allocations.--In carrying out activities under a designated program on behalf of members of racial or ethnic minority groups, the Secretary shall ensure that the activities are equitably allocated among the various groups. In carrying out the preceding sentence, the Secretary shall, in the case of such a group, consider the following factors: ``(A) The extent to which the group has a disproportionate incidence or prevalence of any health condition relative to the incidence and prevalence of the condition in the general population. ``(B) The extent to which there is evidence that there has been discrimination against the group on the basis of race or national origin. ``(C) The percentage constituted by the ratio of the number of individuals who are members of the group to the number of individuals in the general population. ``(3) Reports.-- ``(A) Subject to subparagraph (C), not later than February 1 of fiscal year 1995 and of each subsequent fiscal year, the Secretary shall submit to the Committee on Energy and Commerce and the Committee on Appropriations of the House of Representatives, and to the Committee on Labor and Human Resources and the Committee on Appropriations of the Senate, a report describing the allocations that, under paragraph (2), were made for the preceding fiscal year under each designated program. ``(B) A report under subparagraph (A) shall specify the methodology that was used to make the allocations involved, the total amount that was expended on behalf of each of the racial and ethnic minority groups involved, and the total amount that was expended to employ staff to make the allocations. ``(C) With respect to reports under subparagraph (A), in any case in which a designated program is otherwise subject to a requirement that annual reports concerning the program be submitted to the Committees specified in such subparagraph, the reports under such subparagraph may be incorporated into such other reports. ``(4) Definitions.--For purposes of this subsection: ``(A) The term `designated program' means a program to which this subsection applies, as indicated pursuant to paragraph (1). ``(B) The term `racial or ethnic minority group' has the meaning given such term in subsection (g).''. (c) Designated Programs.-- (1) Health care for residents of public housing.--Section 340A of the Public Health Service Act (42 U.S.C. 256a), as amended by section 309(d) of Public Law 102-531 (106 Stat. 3502), is amended-- (A) by redesignating subsections (o) through (q) as subsections (p) through (r), respectively; and (B) by inserting after subsection (n) the following subsection: ``(o) Equitable Allocations.--The awarding of grants under subsection (a) is subject to section 1707(c).''. (2) Federally-supported loan funds regarding health professions schools.-- (1) In general.--Section 724(f) of the Public Health Service Act (42 U.S.C. 292t(f)), as added by section 102 of Public Law 102-408 (106 Stat. 1994), is amended by adding at the end the following paragraph: ``(3) Equitable allocations.--The awarding of Federal capital contributions for purposes of subsection (a) is subject to section 1707(c).''. (d) Grants for Scholarships and Other Purposes Regarding Health Professions Schools.-- (1) In general.--Section 737 of the Public Health Service Act (42 U.S.C. 293a), as added by section 102 of Public Law 102-408 (106 Stat. 1994), is amended-- (A) by redesignating subsections (g) and (h) as subsections (h) and (i), respectively; and (B) by inserting after subsection (f) the following subsection: ``(g) Equitable Allocations.--The awarding of grants under subsection (a) is subject to section 1707(c).''. (e) Loan Repayments and Fellowships Regarding Faculty Positions at Health Professions Schools.--Section 738 of the Public Health Service Act (42 U.S.C. 293b), as added by section 102 of Public Law 102-408 (106 Stat. 1994), is amended by adding at the end the following subsection: ``(c) Equitable Allocations.--The awarding of contracts under subsection (a), and the awarding of grants under subsection (b), are subject to section 1707(c).''. (f) Educational Assistance Regarding Undergraduates.-- (1) In general.--Section 740(c) of the Public Health Service Act (42 U.S.C. 293d(c)), as added by section 102 of Public Law 102-408 (106 Stat. 1994), is amended to read as follows: ``(c) Equitable Allocations.--The awarding of grants and contracts under subsection (a) is subject to section 1707(c).''. SEC. 5. MEDICALLY UNDERSERVED POPULATIONS; HEALTH PROFESSIONAL SHORTAGE AREAS. (a) Medically Underserved Populations.-- (1) Factors in designating populations.--Section 330(b)(4)(B) of the Public Health Service Act (42 U.S.C. 245c(b)(4)(B)) is amended to read as follows: ``(B) include the following factors regarding the population involved: ``(i) Factors indicating the health status of the population, including the following (which the Secretary shall consider to be of equal importance): The rate of infant mortality and morbidity; and the extent to which there is a substantial rate of morbidity resulting from complications in infectious, communicable, or chronic diseases that have progressed to a critical condition (as indicated by data provided pursuant to discharging patients from hospitals and pursuant to admissions to the emergency facilities of hospitals). ``(ii) The ability to pay for health services, including the rate of poverty and including the percentage of the population constituted by individuals and families that do not have health insurance. ``(iii) The percentage of the population constituted by members of racial or ethnic minority groups. ``(iv) With respect to community-based physicians who provide primary health services and who are accepting additional patients whose means of payment is through the program established in title XVIII or XIX of the Social Security Act, the following: The ratio of the number of such physicians to the number of individuals in the population. ``(v) The extent to which the individuals lack access to primary health services, taking into consideration barriers resulting from a lack of proficiency in speaking the English language or from other cultural factors; the distance to sites providing primary health services and the lack of transportation to such sites; and any other barriers encountered by the population.''. (2) Certain definitions.--Section 330(b) of the Public Health Service Act (42 U.S.C. 245c(b)) is amended by adding at the end the following paragraph: ``(7) For purposes of paragraph (4), the terms `population' and `population group' include Hispanics, African Americans, Native Americans, Asian Americans; Pacific Islanders, and subgroups of such racial or ethnic minority groups; individuals who lack proficiency in speaking the English language; tribes and tribal organizations; seasonal or migrant agricultural workers; homeless individuals; elderly individuals; and individuals with a disability.''. (3) Use of factors in making grants.--Section 330(b) of the Public Health Service Act, as amended by paragraph (2) of this subsection, is amended by adding at the end the following paragraph: ``(8) In considering applications for grants under subsections (c) and (d), the Secretary shall consider the extent to which the population involved has a shortage of personal health services, as indicated by the factors specified in paragraph (1) of this subsection.''. (4) Definition.--Section 330(b) of the Public Health Service Act, as amended by paragraph (3) of this subsection, is amended by adding at the end the following paragraph: ``(9) The term `racial or ethnic minority group' has the meaning given such term in section 1707(g).''. (b) Health Professional Shortage Areas.-- (1) Factors in designating shortage areas.-- (A) Section 332(b) of the Public Health Service Act (42 U.S.C. 254e(b)) is amended-- (i) by redesignating paragraph (3) as paragraph (6); and (ii) by striking paragraphs (1) and (2) and inserting the following: ``(1) Factors indicating the health status of the population, including the following (which the Secretary shall consider to be of equal importance): The rate of infant mortality and morbidity; and the extent to which there is a substantial rate of morbidity resulting from complications in infectious, communicable, or chronic diseases that have progressed to a critical condition (as indicated by data provided pursuant to discharging patients from hospitals and pursuant to admissions to the emergency facilities of hospitals). ``(2) The ability to pay for health services, including the rate of poverty and including the percentage of the population constituted by individuals and families that do not have health insurance. ``(3) The percentage of the population constituted by members of racial or ethnic minority groups. ``(4) With respect to community-based physicians who provide primary health services and who are accepting additional patients whose means of payment is through the program established in title XVIII or XIX, the following: The ratio of the number of such physicians to the number of individuals in the population. ``(5) The extent to which the individuals lack access to primary health services, taking into consideration barriers resulting from a lack of proficiency in speaking the English language or from other cultural factors; the distance to sites providing primary health services and the lack of transportation to such sites; and any other barriers encountered by the population.''. (B) Section 332(a)(3) of the Public Health Service Act (42 U.S.C. 254e(a)(3)) is amended to read as follows: ``(3) With respect to the consideration by the Secretary under paragraph (1) of the population of an area, the population served by a facility, or a population group, the terms `population' and `population group' include Hispanics, African Americans, Native Americans, Asian Americans; Pacific Islanders, and subgroups of such racial or ethnic minority groups; individuals who lack proficiency in speaking the English language; tribes and tribal organizations; seasonal or migrant agricultural workers; homeless individuals; elderly individuals; and individuals with a disability.''. (2) Priorities in assignment of corps personnel.--Section 333A(b) of the Public Health Service Act (42 U.S.C. 254f-1(b)) is amended by striking paragraphs (1) and (2) and inserting the following: ``(1) Factors indicating the health status of the population, including the following (which the Secretary shall consider to be of equal importance): The rate of infant mortality and morbidity; and the extent to which there is a substantial rate of morbidity resulting from complications in infectious, communicable, or chronic diseases that have progressed to a critical condition (as indicated by data provided pursuant to discharging patients from hospitals and pursuant to admissions to the emergency facilities of hospitals). ``(2) The ability to pay for health services, including the rate of poverty and including the percentage of the population constituted by individuals and families that do not have health insurance. ``(3) The percentage of the population constituted by members of racial or ethnic minority groups. ``(4) With respect to community-based physicians who provide primary health services and who are accepting additional patients whose means of payment is through the program established in title XVIII or XIX, the following: The ratio of the number of such physicians to the number of individuals in the population. ``(5) The extent to which the individuals lack access to primary health services, taking into consideration barriers resulting from a lack of proficiency in speaking the English language or from other cultural factors; the distance to sites providing primary health services and the lack of transportation to such sites; and any other barriers encountered by the population.''. (4) Definition.--Section 331(a)(3) of the Public Health Service Act (42 U.S.C. 254d(a)(3)) is amended by adding at the end the following subparagraph: ``(E) The term `racial or ethnic minority group' has the meaning given such term in section 1707(g).''. SEC. 6. LACK OF ENGLISH PROFICIENCY AS BARRIER TO OBTAINING HEALTH CARE. (a) Continuation of Certain Initiatives for Removal of Barriers.-- (1) Migrant health centers.--Section 329(h) of the Public Health Service Act (42 U.S.C. 254b(h)) is amended by adding at the end the following paragraph: ``(4)(A) For the purpose of carrying out subparagraph (B), there are authorized to be appropriated $3,000,000 for each of the fiscal years 1994 through 1996. ``(B) The Secretary may make grants to migrant health centers for programs to reduce the extent to which a lack of proficiency in speaking the English language (or other cultural factors) constitute a significant barrier to obtaining health services.''. (2) Community health centers.--Section 330(g) of the Public Health Service Act (42 U.S.C. 254c(g)) is amended by adding at the end the following paragraph: ``(4)(A) For the purpose of carrying out subparagraph (B), there are authorized to be appropriated $3,000,000 for each of the fiscal years 1994 through 1996. ``(B) The Secretary may make grants to community health centers for programs to reduce the extent to which a lack of proficiency in speaking the English language (or other cultural factors) constitute a significant barrier to obtaining health services.''. (b) Issuance of Regulations.-- (1) Proposed rule.--Not later than the expiration of the 90-day period beginning on the date of the enactment of this Act, the Secretary of Health and Human Services (in this section referred to as the ``Secretary'') shall issue a proposed rule to establish regulations for policies to reduce the extent to which a lack of proficiency in speaking the English language constitutes a significant barrier to individuals in establishing the eligibility of the individuals for participation in health programs under the Public Health Service Act or title XIX of the Social Security Act, or in receiving services under such programs. (2) Final rule.-- (A) In general.--Not later than the expiration of the 1-year period beginning the date of the enactment of this Act, the Secretary shall issue a final rule to establish the regulations described in paragraph (1). (B) Failure to issue by date certain.--If the Secretary fails to issue a final rule under subparagraph (A) before the expiration of the period specified in such subparagraph, the proposed rule issued under paragraph (1) is upon such expiration deemed to be the final rule under subparagraph (A) (and shall remain in effect until the Secretary issues a final rule under such subparagraph). SEC. 7. CENTERS OF EXCELLENCE IN HEALTH PROFESSIONS EDUCATION. (a) Use of Funds.--Section 739(b) of the Public Health Service Act (42 U.S.C. 293c(b)), as added by section 102 of Public Law 102-408 (106 Stat. 1994), is amended to read as follows: ``(b) Use of Funds.-- ``(1) Required uses.--The Secretary may not make a grant under subsection (a) unless the health professions school involved agrees to expend the grant for each of the following purposes: ``(A) To colloborate with public and nonprofit private entities to carry out community-based programs to recruit minority students of secondary schools and institutions of higher education and to prepare the students academically for attendance at the health professions school. ``(B) To improve the capacity of such school to train, recruit, and retain minority faculty. ``(C) 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. ``(D) To facilitate faculty and student research on health issues particularly affecting minority groups. ``(2) Relationship with other entities.--In expending a grant under subsection (a), a health professions school may permit public and nonprofit private entities to participate in the programs and activities that the school carries out under such subsection. The preceding sentence applies without regard to whether such entities have been designated under subsection (d) as centers of excellence.''. (b) Definition.--Section 739(h) of the Public Health Service Act (42 U.S.C. 293c(h)) is amended by adding at the end the following paragraph: ``(4) The term `minority'', with respect to an individual, means an individual who is a member of a racial or ethnic minority group, as defined in section 1707(g).''. (c) Funding.--Section 739(i) of the Public Health Service Act (42 U.S.C. 293c(i)), as added by section 102 of Public Law 102-408 (106 Stat. 1994), is amended-- (1) in paragraph (1), by inserting before the period the following: ``, and $27,000,000 for each of the fiscal years 1994 through 1996''; and (2) in paragraph (2)-- (A) in subparagraph (B), by striking ``60 percent'' and inserting ``80 percent''; and (B) in subparagraph (C), by striking ``40 percent'' and inserting ``20 percent''. SEC. 8. FUNDING FOR ACTIVITIES OF AGENCY FOR HEALTH CARE POLICY AND RESEARCH. Section 926(a) of the Public Health Service Act (42 U.S.C. 299c- 5(a)) is amended by adding at the end the following sentences: ``Of the amounts appropriated under the preceding sentence for a fiscal year, the Administrator shall reserve not less than 8 percent for carrying out section 902(b)(2). The activities carried out by the Secretary with the amounts so reserved shall include activities regarding Hispanic individuals (as defined in section 1707(g)).''. SEC. 9. FUNDING FOR CERTAIN ACTIVITIES OF NATIONAL CENTER FOR HEALTH STATISTICS. Section 306(o) of the Public Health Service Act (42 U.S.C. 242k(o)) is amended-- (1) in paragraph (1)-- (A) by striking ``subsections (a) through (m)'' and inserting ``this section''; and (B) by striking ``1993.'' and inserting ``1993, $65,000,000 for fiscal year 1994, and such sums as may be necessary for each of the fiscal years 1995 and 1996.''; and (2) by amending paragraph (2) to read as follows: ``(2) Of the amounts appropriated under paragraph (1) for a fiscal year, the Secretary shall obligate not less than an aggregate $10,000,000 for carrying out subsections (h), (m), and (n), except that not more than $100,000 may be expended in the aggregate for the administration of activities under subsection (n) and for activities described in paragraph (2) of such subsection.''. SEC. 10. DEMONSTRATION PROJECTS REGARDING DIABETES-RELATED EYE DISORDERS. (a) In General.--The Secretary may make grants to public and nonprofit private entities for the purpose of carrying out demonstration projects that, for Hispanics, African Americans, and any other populations that are at significant risk of contracting diabetes mellitus-- (1) provide screenings for eye disorders for which diabetes mellitus is a significant causal factor; (2) provide appropriate referrals for services for individuals who are screened pursuant to paragraph (1) and ensure, to the extent practicable, the provision of appropriate follow-up services; (3) develop and disseminate public information and education programs for the detection and control of such eye disorders; and (4) improve the education, training, and skills of health professionals (including allied health professionals) in the detection and control of such eye disorders. (b) Priority Regarding Diabetic Retinopathy.--The Secretary may make a grant under subsection (a) only if the applicant involved agrees to give priority to carrying out paragraphs (1) through (4) of such subsection with respect to the eye disorder known as diabetic retinopathy. (c) Application for Grant.--The Secretary may make a grant under subsection (a) only if 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. (d) Definitions.--For purposes of this section, the term ``Secretary'' means the Secretary of Health and Human Services. (e) Authorization of Appropriations.--For the purpose of carrying out this section, there are authorized to be appropriated $100,000 for fiscal year 1994, and such sums as may be necessary for each of the fiscal years 1995 and 1996. <all> HR 3230 IH----2 HR 3230 IH----3 HR 3230 IH----4