[Congressional Bills 103th Congress]
[From the U.S. Government Publishing Office]
[H.R. 3699 Introduced in House (IH)]

103d CONGRESS
  1st Session
                                H. R. 3699

 To amend the Public Health Service Act to establish, reauthorize and 
      revise provisions to improve the health of individuals from 
           disadvantaged backgrounds, and for other purposes.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                           November 22, 1993

Mr. Stokes (for himself, Mr. Clay, Mrs. Meek, Mr. Lewis of Georgia, Mr. 
Dellums, Mr. Hilliard, Mr. Mfume, Mr. Jefferson, Mr. Towns, Mr. Bishop, 
 Ms. Norton, and Mr. Thompson of Mississippi) introduced the following 
  bill; which was referred jointly to the Committees on Education and 
                     Labor and Energy and Commerce

_______________________________________________________________________

                                 A BILL


 
 To amend the Public Health Service Act to establish, reauthorize and 
      revise provisions to improve the health of individuals from 
           disadvantaged backgrounds, 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; AMENDATORY REFERENCES; TABLE OF CONTENTS.

    (a) Short Title.--This Act may be cited as the ``Minority Health 
Improvement Act of 1993''.
    (b) Amendatory References.--Any reference in this Act to an 
amendment or repeal of a section or other provision shall be considered 
to be an amendment or repeal, respectively, of that provision of the 
Public Health Service Act, unless another public law is specified as 
being the subject of the amendment or repeal.
    (c) Table of Contents.--The table of contents of this Act is as 
follows:

Sec. 1. Short title; amendatory references; table of contents.
Sec. 2. Findings.
                         TITLE I--HEALTH POLICY

Sec. 101. Office of Minority Health.
Sec. 102. Agency Offices of Minority Health.
Sec. 103. State Offices of Minority Health.
Sec. 104. Assistant Secretary of Health and Human Services for Civil 
                            Rights.
                       TITLE II--HEALTH SERVICES

Sec. 201. Community scholarship programs.
Sec. 202. Health services for residents of public housing.
Sec. 203. Health services for Pacific Islanders.
                     TITLE III--HEALTH PROFESSIONS

Sec. 301. Loans for disadvantaged students.
Sec. 302. Cesar Chavez scholarship program.
Sec. 303. Thurgood Marshall scholarship program.
Sec. 304. Loan repayments and fellowships regarding faculty positions 
                            at health professions schools.
Sec. 305. Centers of excellence.
Sec. 306. Educational assistance regarding undergraduates.
Sec. 307. Area health education centers.
                 TITLE IV--RESEARCH AND DATA COLLECTION

Sec. 401. Office of Research on Minority Health.
Sec. 402. National Center for Health Statistics.
Sec. 403. Activities of Agency for Health Care Policy and Research.
                         TITLE V--MISCELLANEOUS

Sec. 501. Medically underserved area study.
Sec. 502. Federal and State offices regarding urban health.
Sec. 503. Grants regarding organ and bone marrow transplantation with 
                            respect to minority populations.
Sec. 504. Demonstration project grants to States for Alzheimer's 
                            disease.
Sec. 505. Waivers regarding obligated service in primary health care.

SEC. 2. FINDINGS.

    Section 1(b) of the Disadvantaged Minority Health Improvement Act 
of 1990 (42 U.S.C. 300u-6 note) is amended to read as follows--
    ``(b) Findings.--Congress finds that--
            ``(1) the health status of individuals from racial and 
        ethnic minorities in the United States is significantly lower 
        than the health status of the general population and has not 
        improved significantly since the issuance of the 1985 report 
        entitled ``Report of the Secretary's Task Force on Black and 
        Minority Health'';
            ``(2) racial and ethnic minorities are disproportionately 
        represented among the poor;
            ``(3) racial and ethnic minorities suffer 
        disproportionately high rates of cancer, heart disease, 
        diabetes, substance abuse, acquired immune deficiency syndrome, 
        and other diseases and disorders;
            ``(4) the incidence of infant mortality among African 
        Americans is almost double that for the general population;
            ``(5) Mexican-American and Puerto Rican adults have 
        diabetes rates twice that of non-Hispanic whites;
            ``(6) a third of American Indian deaths occur before the 
        age of 45;
            ``(7) the crisis in minority health continues while the 
        United States has the most sophisticated and elaborate medical 
        system in the world; while medical and technological 
        breakthroughs are affording Americans a longer life expectancy; 
        and while the United States continues to witness unprecedented 
        explosion in scientific knowledge and a phenomenal capacity to 
        treat and cure disease;
            ``(8) according to the 1990 Census, African Americans, 
        Hispanics, American Indians, Alaskan Natives, and Asian/Pacific 
        Islanders constitute approximately 12.1 percent, 9 percent, 
        0.08 percent, and 2.9 percent, respectively, of the population 
        of the United States;
            ``(9) minority health professionals have historically 
        tended to practice in low-income areas, medically underserved 
        areas, and to serve racial and ethnic minorities;
            ``(10) minority health professionals have historically 
        tended to engage in the general practice of medicine and 
        specialties providing primary care;
            ``(11) reports published in leading medical journals 
        indicate that access to health care among minorities can be 
        substantially improved by increasing the number of minority 
        professionals;
            ``(12) diversity in the faculty and student body of health 
        professions schools enhances the quality of education for all 
        students attending the schools; and
            ``(13) health professionals need greater access to 
        continuing medical education programs to enable such 
        professionals to upgrade their skills (including linguistic and 
        cultural competence skills) and improve the quality of medical 
        care rendered in minority communities.''.

                         TITLE I--HEALTH POLICY

SEC. 101. OFFICE OF MINORITY HEALTH.

    Section 1707 (42 U.S.C. 300u-6) is amended by striking subsection 
(b) and all that follows and inserting the following:
    ``(b) Duties.--With respect to improving the health of racial and 
ethnic minority groups, the Secretary, acting through the Deputy 
Assistant Secretary for Minority Health, shall carry out the following:
            ``(1) Establish short-range and long-range goals and 
        objectives and coordinate all other activities within the 
        Department of Health and Human Services that relate to disease 
        prevention, health promotion, service delivery, and research 
        concerning such individuals. The heads of the operating 
        divisions of the Department of Health and Human Services and 
        the heads of Public Health Service agencies shall consult with 
        the Deputy Assistant Secretary for Minority Health to assist in 
        the coordination of all activities within the Department as 
        they relate to disease prevention, health promotion, service 
        delivery, and research concerning such individuals.
            ``(2) Carry out the following types of activities by 
        entering into interagency agreements with other agencies of the 
        public health service:
                    ``(A) Support research, demonstrations and 
                evaluations to test new and innovative models.
                    ``(B) Increase knowledge and understanding of 
                health risk factors.
                    ``(C) Develop mechanisms that support better 
                information dissemination, education, prevention, and 
                service delivery to individuals from disadvantaged 
                backgrounds, including racial and ethnic minority 
                groups.
            ``(3) Establish a national minority health resource center 
        to carry out the following:
                    ``(A) Facilitate the exchange of information 
                regarding matters relating to health information and 
                health promotion, preventive health services, and 
                education in the appropriate use of health care.
                    ``(B) Target the most prevalent morbidity and 
                mortality concerns of the various racial and ethnic 
                minorities.
                    ``(C) Facilitate access to such information.
                    ``(D) Assist in the analysis of issues and problems 
                relating to such matters.
                    ``(E) Provide technical assistance with respect to 
                the exchange of such information (including 
                facilitating the development of materials for such 
                technical assistance).
                    ``(F) Improve access to health care services for 
                racial and ethnic minorities, including those with 
                limited English proficiency, by facilitating the 
                removal of impediments to the receipt of health care.
            ``(4) With respect to awards of grants and contracts that 
        are available under certain minority health programs, establish 
        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 application; 
                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.
    ``(c) Advisory committee.--
            ``(1) In general.--The Secretary shall establish an 
        advisory committee to be known as the Advisory Committee on 
        Minority Health (in this subsection referred to as the 
        `Committee').
            ``(2) Duties.--The Committee shall provide advice to the 
        Secretary on carrying out this section, including advice on the 
        development of goals and specific program activities under 
        subsection (b)(1) for each racial and ethnic minority group.
            ``(3) Chairperson.--The Deputy Assistant Secretary for 
        Minority Health shall serve as the Chairperson of the 
        Committee.
            ``(4) Composition.--The Committee shall be composed of no 
        fewer than 12, and not more than 18 individuals, who are not 
        officers or employees of the Federal Government. The Secretary 
        shall appoint the members of the Committee from among 
        individuals with expertise regarding issues of minority health. 
        The membership of the Committee shall be equitably 
        representative of the various racial and ethnic minority 
        groups. The Secretary may appoint representatives from selected 
        Federal agencies to serve as ex officio, non-voting members of 
        the Committee.
            ``(5) Terms.--Each member of the Committee shall serve for 
        a term of 4 years, except that the Secretary shall initially 
        appoint a portion of the members to terms of 1 year, 2 years, 
        and 3 years.
            ``(6) Vacancies.--If a vacancy occurs on the Committee, a 
        new member shall be appointed by the Secretary within 90 days 
        from the date that the vacancy occurs, and serve for the 
        remainder of the term for which the predecessor of such member 
        was appointed. The vacancy shall not affect the power of the 
        remaining members to execute the duties of the Committee.
            ``(7) Compensation.--Members of the Committee who are 
        officers or employees of the United States shall serve without 
        compensation. Members of the Committee who are not officers or 
        employees of the United States shall receive, for each day 
        (including travel time) they are engaged in the performance of 
        the functions of the Committee, compensation at rates that do 
        not exceed the daily equivalent of the annual rate in effect 
        for grade GS-18 of the General Schedule under title 5, United 
        States Code.
    ``(d) Certain Requirements Regarding Duties.--
            ``(1) Equitable allocation regarding activities.--In 
        awarding grants or contracts or cooperative agreements under 
        section 340A, 724, 737, 738, or 1707, the Secretary shall 
        ensure that such awards are allocated to address the most 
        prevalent morbidity and mortality concerns of the various 
        racial and ethnic minority groups.
            ``(2) Cultural competency of services.--The Secretary shall 
        ensure that information and services provided pursuant to 
        subsection (b) are provided in the language and cultural 
        context that is most appropriate for the individuals for whom 
        the information and services are intended.
            ``(3) Peer review.--The Secretary shall ensure that each 
        application for a grant, contract or cooperative agreement 
        under section 340A, 724, 737, or 1707 undergoes appropriate 
        peer review.
    ``(e) Reports.--Not later than January 31 of fiscal year 1995 and 
of each second year thereafter, the Secretary shall submit to the 
Congress a report describing the activities carried out under this 
section during the preceding 2 fiscal years and evaluating the extent 
to which such activities have been effective in improving the health of 
racial and ethnic minority groups.
    ``(f) Grants and Contracts and Cooperative Agreements Regarding 
Duties.--
            ``(1) Authority.--In carrying out subsection (b), the 
        Secretary may make grants to and enter into contracts and 
        cooperative agreements with public and nonprofit private 
        entities for activities described in paragraphs (3) of 
        subsection (b).
            ``(2) Evaluation and dissemination.--The Secretary shall, 
        directly or through contracts with public and private entities, 
        provide for evaluations of projects carried out with financial 
        assistance provided under paragraph (1) during the preceding 2 
        fiscal years. The report shall be included in the report 
        required under subsection (e) for the fiscal year involved.
    ``(g) Definition.--As used in this section, the term `racial and 
ethnic minority group' means Hispanics, Blacks, Asian Americans, 
Pacific Islanders, Native Americans, and Alaskan Natives.
    ``(h) Authorization of Appropriations.--For the purpose of carrying 
out this section, there is authorized to be appropriated such sums as 
may be necessary for each of the fiscal years 1994 through 1998.''.

SEC. 102. AGENCY OFFICES OF MINORITY HEALTH.

    Title XVII (42 U.S.C. 300u et seq.) is amended by adding at the end 
the following new section:

``SEC. 1709. AGENCY OFFICES OF MINORITY HEALTH.

    ``(a) In General.--The Secretary, acting through the Deputy 
Assistant Secretary for Minority Health, shall ensure that an Office of 
Minority Health is established and operating at the Centers for Disease 
Control and Prevention, the Health Resources and Services 
Administration, the Substance Abuse and Mental Health Administration, 
and the Agency for Health Care Policy and Research. Such Offices shall 
be established to ensure that services and programs carried out within 
each such respective agency or office--
            ``(1) address the most prevalent morbidity and mortality 
        concerns of racial and ethnic minority groups;
            ``(2) provide culturally competent services; and
            ``(3) utilize racial and ethnic minority community-based 
        organizations to deliver services.
    ``(b) Reports.--Each Office of Minority Health within the 
Department of Health and Human Services shall submit a report, not 
later than May 1 of each year, to the Deputy Assistant Secretary for 
Minority Health (as provided for in section 1707(a)) describing the 
accomplishments or programs of the plan, the budget allocation and 
expenditures for, and the development and implementation of, such 
health programs targeting racial and ethnic minority populations. The 
Secretary shall ensure the participation and cooperation of each Agency 
in the development of the annual report.
    ``(c) Funding.--Of the amounts appropriated for fiscal year 1995 or 
any subsequent fiscal year for an agency for which an Office of 
Minority Health is established under subsection (a), the Secretary 
shall reserve not less than 10 percent for the purpose of such Office 
to carry out minority health program activities.

SEC. 103. STATE OFFICES OF MINORITY HEALTH.

    Title XVII (42 U.S.C. 300u et seq.), as amended by section 102, is 
further amended by adding at the end the following new section:

``SEC. 1710. GRANTS TO STATES FOR OPERATION OF OFFICES OF MINORITY 
              HEALTH.

    ``(a) In General.--The Secretary, acting through the Deputy 
Assistant Secretary for Minority Health (as provided for in section 
1707), may make grants to States for the purpose of improving the 
health status in minority communities, through the operation of State 
offices of minority health established to monitor and facilitate the 
achievement of the Health Objectives for the Year 2000 as they affect 
minority populations.
    ``(b) Administration of Program.--The Secretary may not make a 
grant to a State under subsection (a) unless such State agrees that the 
program carried out by the State with amounts received under the grant 
will be administered directly by a single State agency.
    ``(c) Certain Required Activities.--The Secretary may not make a 
grant to a State under subsection (a) unless such State agrees that 
activities carried out by an office operated under the grant received 
pursuant to such subsection will--
            ``(1) establish and maintain within the State a 
        clearinghouse for collecting and disseminating information on--
                    ``(A) minority health issues, including health care 
                issues;
                    ``(B) research findings relating to minority 
                health, including findings relating to health care; and
                    ``(C) innovative approaches to the delivery of 
                health care and social services in minority 
                communities;
            ``(2) coordinate the activities carried out in the State 
        that relate to minority health, including activities relating 
        to health care, which activities include providing coordination 
        for the purpose of avoiding redundancy in such activities;
            ``(3) identify Federal and State programs regarding 
        minority health, and providing technical assistance to public 
        and nonprofit entities regarding participation in such program; 
        and
            ``(4) develop additional Healthy People 2000 objectives for 
        the State that are necessary to address the most prevalent 
        morbidity and mortality concerns of racial and ethnic minority 
        groups in the State.
    ``(d) Requirement Regarding Annual Budget Office.--The Secretary 
may not make a grant to a State under subsection (a) unless such State 
agrees that, for any fiscal year for which the State receives such a 
grant, the office operated under such grant will be provided with an 
annual budget of not less than $75,000.
    ``(e) Certain Uses of Funds.--
            ``(1) Restrictions.--The Secretary may not make a grant to 
        a State under subsection (a) unless such State agrees that--
                    ``(A) if research with respect to minority health 
                is conducted pursuant to the grant, not more than 10 
                percent of the amount received under the grant will be 
                expended for such research; and
                    ``(B) amounts provided under the grant will not be 
                expended--
                            ``(i) to provide health care (including 
                        providing cash payments regarding such care);
                            ``(ii) to conduct activities for which 
                        Federal funds are expended--
                                    ``(I) within the State to provide 
                                technical and other nonfinancial 
                                assistance under subsection (m) of 
                                section 340A;
                                    ``(II) under a memorandum of 
                                agreement entered into with the State 
                                under subsection (h) of such section; 
                                or
                                    ``(III) under a grant under section 
                                388I;
                            ``(iii) to purchase medical equipment, to 
                        purchase ambulances, aircraft, or other 
                        vehicles, or to purchase major communications 
                        equipment;
                            ``(iv) to purchase or improve real 
                        property; or
                            ``(v) to carry out any activity regarding a 
                        certificate of need.
            ``(2) Authorities.--Activities for which a State may expend 
        amounts received under a grant under subsection (a) include--
                    ``(A) paying the costs of establishing an office of 
                minority health for purposes of subsection (a);
                    ``(B) subject to paragraph (1)(B)(ii)(III), paying 
                the costs of any activity carried out with respect to 
                recruiting and retaining health professionals to serve 
                in minority communities or underserved areas in the 
                State; and
                    ``(C) providing grants and contracts to public and 
                nonprofit entities to carry out activities authorized 
                in this section.
    ``(f) Reports.--The Secretary may not make a grant to a State under 
subsection (a) unless such State agrees--
            ``(1) to submit to the Secretary reports containing such 
        information as the Secretary may require regarding activities 
        carried out under this section by the State; and
            ``(2) to submit a report not later than January 10 of each 
        fiscal year immediately following any fiscal year for which the 
        State has received such a grant.
    ``(g) Application for Grant.--The Secretary may not make a grant to 
a State under subsection (a) unless an application for the grant is 
submitted to the Secretary and the application in such form, is made in 
such manner, and contains such agreements, assurances, and information 
as the Secretary determines to be necessary to carry out such 
subsection.
    ``(h) Noncompliance.--The Secretary may not make payments under 
subsection (a) to a State for any fiscal year subsequent to the first 
fiscal year of such payments unless the Secretary determines that, for 
the immediately preceding fiscal year, the State has complied with each 
of the agreements made by the State under this section.
    ``(i) Authorization of Appropriations.--
            ``(1) In general.--For purposes of making grants under 
        subsection (a) there are authorized to be appropriated 
        $3,000,000 for fiscal year 1995, $4,000,000 for fiscal year 
        1996, and $3,000,000 for fiscal year 1997.
            ``(2) Availability.--Amounts appropriated under paragraph 
        (1) shall remain available until expended.
    ``(j) Termination of Program.--No grant may be made under this 
section after the aggregate amounts appropriated under subsection 
(i)(1) are equal to $10,000,000.''.

SEC. 104. ASSISTANT SECRETARY OF HEALTH AND HUMAN SERVICES FOR CIVIL 
              RIGHTS.

    (a) In General.--Part A of title II (42 U.S.C. 202 et seq.), as 
amended by section 2010 of Public Law 103-43, is amended by adding at 
the end the following new section:

``SEC. 229. ASSISTANT SECRETARY FOR CIVIL RIGHTS.

    ``(a) Establishment of Position.--There shall be in the Department 
of Health and Human Services an Assistant Secretary for Civil Rights, 
who shall be appointed by the President, by and with the advice and 
consent of the Senate.
    ``(b) Responsibilities.--The Assistant Secretary shall perform such 
functions relating to civil rights as the Secretary may assign.''.
    (b) Conforming Amendment.--Section 5315 of title 5, United States 
Code, is amended, in the item relating to Assistant Secretaries of 
Health and Human Services, by striking ``(5)'' and inserting ``(6)''.

                       TITLE II--HEALTH SERVICES

SEC. 201. COMMUNITY SCHOLARSHIP PROGRAMS.

    Section 338L (42 U.S.C. 254t) is amended--
            (1) in subsection (a), by striking ``health manpower 
        shortage areas'' and inserting ``Federally-designated health 
        professional shortage areas'';
            (2) in subsection (c)--
                    (A) by striking ``health manpower shortage areas'' 
                and inserting ``Federally-designated health 
                professional shortage areas'' in the matter preceding 
                paragraph (1); and
                    (B) by striking ``in the health manpower shortage 
                areas in which the community organizations are 
                located,'' and inserting ``in a Federally-designated 
                health professional shortage area that is served by the 
                community organization awarding the scholarship,'' in 
                paragraph (2);
            (3) in subsection (e)(1)--
                    (A) by striking ``health manpower shortage area'' 
                and inserting ``Federally-designated health 
                professional shortage area''; and
                    (B) by striking ``in which the community'' and all 
                that follows through ``located''; and
            (4) in subsection (l)(1), by striking ``$5,000,000'' and 
        all that follows through ``1993'' and inserting such sums as 
        may be necessary for each of the fiscal years 1994, 1995, and 
        1996''.

SEC. 202. HEALTH SERVICES FOR RESIDENTS OF PUBLIC HOUSING.

    Section 340A(p)(1) (42 U.S.C. 256a(p)(1)) is amended--
            (1) by inserting ``for fiscal years 1994, 1995, and 1996 
        such sums as necessary''; and
            (2) by striking ``1992 and 1993''.

SEC. 203. HEALTH SERVICES FOR PACIFIC ISLANDERS.

    Section 10 of the Disadvantaged Minority Health Improvement Act of 
1990 (42 U.S.C. 254c-1) is amended--
            (1) in subsection (b)--
                    (A) in paragraph (2)--
                            (i) by inserting ``, substance abuse'' 
                        after ``availability of health''; and
                            (ii) by striking ``, including improved 
                        health data systems'';
                    (B) in paragraph (3)--
                            (i) by striking ``manpower'' and inserting 
                        ``care providers''; and
                            (ii) by striking ``by--'' and all that 
                        follows through the end thereof and inserting a 
                        semicolon;
                    (C) by striking paragraphs (5) and (6);
                    (D) by redesignating paragraphs (7), and (8) as 
                paragraphs (5) and (6), respectively;
                    (E) in paragraph (5) (as so redesignated), by 
                striking ``and'' at the end thereof;
                    (F) in paragraph (6) (as so redesignated), by 
                striking the period and inserting a semicolon; and
                    (G) by inserting after paragraph (6) (as so 
                redesignated), the following new paragraphs:
            ``(7) to provide primary health care, preventive health 
        care, and related training to American Samoan health care 
        professionals; and
            ``(8) to improve access to health promotion and disease 
        prevention services for rural American Samoa.'';
            (2) in subsection (f)--
                    (A) by striking ``there is'' and inserting ``there 
                are''; and
                    (B) by striking ``$10,000,000'' and all that 
                follows through ``1993'' and inserting ``such sums as 
                may be necessary for each of the fiscal years 1994 
                through 1996''; and
            (3) by adding at the end thereof the following new 
        subsection:
    ``(g) Study and Report.--
            ``(1) Study.--Not later than 180 days after the date of 
        enactment of this subsection, the Secretary, acting through the 
        Administrator of the Health Resources and Services 
        Administration, shall enter into a contract with a public or 
        nonprofit private entity for the conduct of a study to 
        determine the effectiveness of projects funded under this 
        section.
            ``(2) Report.--Not later than July 1, 1995, the Secretary 
        shall prepare and 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 findings made with respect to the study 
        conducted under paragraph (1).''.

                     TITLE III--HEALTH PROFESSIONS

SEC. 301. LOANS FOR DISADVANTAGED STUDENTS.

    Subpart II of part A of title VII (42 U.S.C. 292q) is amended--
            (1) in section 723--
                    (A) in subsection (a)(2), by adding at the end the 
                following subparagraph:
                    ``(C) The requirement established in paragraph (1) 
                regarding a a student does not apply to students from 
                disadvantaged backgrounds who are underrepresented in 
                the health professions.''; and
                    (B) in subsection (b), by adding at the end the 
                following paragraph:
            ``(7) Inapplicability to certain schools.--The requirement 
        established in paragraph (1) regarding a school does not apply 
        if the school is a historically black college or university.''; 
        and
            (2) in section 724(f)(1)--
                    (A) by striking ``there is'' and inserting ``there 
                are''; and
                    (B) by striking ``$15,000,000 for fiscal year 
                1993'' and inserting ``such sums as may be necessary 
                for each of the fiscal years 1994, 1995, and 1996''.

SEC. 302. CESAR CHAVEZ SCHOLARSHIP PROGRAM.

    Section 736 (42 U.S.C. 293) is amended--
            (1) by striking the section heading and inserting the 
        following:

``SEC. 736. CESAR CHAVEZ SCHOLARSHIP PROGRAM.'';

            (2) in subsection (a), by striking ``need, subject to'' and 
        all that follows and inserting ``need.''; and
            (3) in subsection (c)--
                    (A) by striking ``there is'' and inserting ``there 
                are''; and
                    (B) by striking ``$11,000,000 for fiscal year 
                1993'' and inserting ``such sums as may be necessary 
                for each fiscal year 1994, 1995, and 1996''.

SEC. 303. THURGOOD MARSHALL SCHOLARSHIP PROGRAM.

    Section 737 (42 U.S.C. 293a) is amended--
            (1) by striking the section heading and inserting the 
        following:

``SEC. 737. THURGOOD MARSHALL SCHOLARSHIP PROGRAM.'';

            (2) in subsection (a)--
                    (A) in paragraph (1), by inserting ``(to be known 
                as Thurgood Marshall Scholars)'' after ``providing 
                scholarships to individuals''; and
                    (B) by adding at the end the following paragraph:
            ``(4) Inapplicability of certain requirements.--Any 
        obligation under this section regarding practicing in primary 
        health care is waived for students from disadvantaged 
        backgrounds who are underrepresented in the health 
        professions.''; and
            (3) in subsection (h), by striking paragraph (1) and 
        inserting the following new paragraph:
            ``(1) Authorization of appropriations.--For the purpose of 
        carrying out this section, there are authorized to be 
        appropriated such sums as may be necessary for each of the 
        fiscal years 1994, 1995, and 1996.''.

SEC. 304. LOAN REPAYMENTS AND FELLOWSHIPS REGARDING FACULTY POSITIONS 
              AT HEALTH PROFESSIONS SCHOOLS.

    Section 738 (42 U.S.C. 293b) is amended--
            (1) in subsection (a)--
                    (A) in paragraph (2), by striking ``disadvantaged 
                backgrounds who--'' and inserting ``racial or ethnic 
                groups that are underrepresented in the health 
                professions who--''
                    (B) in paragraph (5)--
                            (i) by striking ``; and'' in subparagraph 
                        (A) and inserting a period;
                            (ii) by striking ``unless--'' and all that 
                        follows through ``the individual involved'' in 
                        subparagraph (A) and inserting ``unless the 
                        individual involved''; and
                            (iii) striking subparagraph (B);
                    (C) by striking paragraph (6); and
                    (D) by redesignating paragraph (7) as paragraph 
                (6); and
            (2) in subsection (b)(2)(B), by striking ``$30,000'' and 
        inserting ``$50,000'';
            (3) in subsection (c)--
                    (A) by striking ``there is'' and inserting ``there 
                are''; and
                    (B) by striking ``$4,000,000 for fiscal year 1993'' 
                and inserting ``such sums as may be necessary for each 
                of the fiscal years 1994, 1995, and 1996''.

SEC. 305. CENTERS OF EXCELLENCE.

    Section 739 (42 U.S.C. 293c) is amended--
            (1) in subsection (b)--
                    (A) in paragraph (2), by inserting before the 
                semicolon the following: ``through collaboration with 
                public and nonprofit private entities to carry out 
                community-based programs to prepare students in 
                secondary schools and institutions of higher education 
                for attendance at the health professions school'';
                    (B) in paragraph (4), by striking ``and'' at the 
                end thereof;
                    (C) in paragraph (5), by striking the period and 
                inserting ``; and''; and
                    (D) by adding at the end thereof the following new 
                paragraph:
            ``(6) to carry out a program to provide training to the 
        students of the school to enable such students to provide 
        health services to minority individuals at community-based 
        health facilities that provide such services to a significant 
        number of minority individuals and that are located at a site 
        remote from the main site of the teaching facilities of the 
        school.'';
            (2) in subsection (c)--
                    (A) in paragraph (1)(B), by amending clause (i) to 
                read as follows:
                            ``(i) whose most recent graduating class 
                        included a significant number of minority 
                        individuals, which number constituted (except 
                        as provided in paragraph (4)(A)) not less than 
                        25 percent of such class;''; and
                    (B) in paragraph (4)(A), by inserting before the 
                semicolon the following: ``(except that the requirement 
                in paragraph (1)(B)(i) regarding 25 percent does not 
                apply for purposes of this subparagraph)'';
            (3) in subsection (e)--
                    (A) by striking the subsection heading and 
                inserting ``Authority Regarding Consortia.--'';
                    (B) by striking paragraph (1) and inserting the 
                following new paragraph:
            ``(1) In general.--The Secretary may make a grant under 
        subsection (a) to a school of medicine, a school of osteopathic 
        medicine, a school of dentistry, or a school or pharmacy, that 
        has in accordance with paragraph (2) formed a consortium of 
        schools.'';
                    (C) in paragraph (2), by striking subparagraphs (A) 
                through (D) and inserting the following new 
                subparagraphs:
                    ``(A) the consortium consists of--
                            ``(i) the health professions school seeking 
                        the grant under subsection (a); and
                            ``(ii) one or more schools of medicine or 
                        osteopathic medicine, schools of nursing (as 
                        defined in section 853), schools of dentistry, 
                        schools of pharmacy, schools of podiatric 
                        medicine, schools of optometry, schools of 
                        veterinary medicine, schools of public health, 
                        schools of allied health, or graduate programs 
                        in mental health practice;
                    ``(B) the schools of the consortium have entered 
                into an agreement for the allocation of such grant 
                among the schools; and
                    ``(C) each of the schools agrees to expend the 
                grant in accordance with this section.''; and
                    (D) by adding at the end the following paragraph:
            ``(3) Authority for collectively meeting relevant 
        requirements in certain cases.--With respect to meeting the 
        conditions specified in subsection (c)(4) for Native American 
        Centers of Excellence, the Secretary may make a grant to any 
        school that has in accordance with paragraphs (1) and (2) 
        formed a consortium of schools that meets such conditions 
        (without regard to whether the schools of the consortium 
        individually meet such conditions).'';
            (4)(A) by redesignating subsections (h) and (i) as 
        subsections (i) and (j), respectively; and
            (B) by inserting after subsection (g) the following 
        subsection:
    ``(h) Collaboration With National Institutes of Health.--The 
Director of the National Institutes of Health, acting through the 
Director of the Office of Research on Minority Health (or as 
appropriate through other officials of such Institutes), may enter into 
collaborative grant programs and other program initiatives with Centers 
of Excellence under this section for the purposes of collaborative 
research efforts, research program activity, training, and supplemental 
biomedical and health services research linkages between the National 
Institutes of Health and the Health Resources and Services 
Administration.''; and
            (5) in subsection (j) (as redesignated by paragraph (4) of 
        this subsection)--
                    (A) in paragraph (1), by striking ``such sums as 
                may be necessary for fiscal year 1993'' and inserting 
                ``such sums as may be necessary for each of the fiscal 
                years 1994, 1995, and 1996''; and
                    (B) in paragraph (2)(C) by adding at the end the 
                following: ``Health professions schools described in 
                subsection (c)(2)(A) shall be eligible for grants under 
                this subparagraph in a fiscal year if the amount 
                appropriated for the fiscal year under paragraph (1) is 
                greater than $23,500,000. Such schools shall be 
                eligible to apply only for grants made from the portion 
                of such amount that exceeds $23,500,000.''.

SEC. 306. EDUCATIONAL ASSISTANCE REGARDING UNDERGRADUATES.

    Section 740 (42 U.S.C. 293d) is amended--
            (1) in subsection (a)(1), by adding at the end the 
        following new sentence: ``To be eligible for such a grant, a 
        school shall have in place a program which with supplemental 
        support may assist individuals from disadvantaged backgrounds 
        in gaining entry into a health professions school or completing 
        the course of study at such a school.''; and
            (2) in subsection (d)--
                    (A) in paragraph (1)--
                            (i) by striking ``there is'' and inserting 
                        ``there are''; and
                            (ii) by striking ``1993'' and inserting 
                        ``such sums as may be necessary for each of the 
                        fiscal years 1994, 1995, and 1996''; and
                    (B) in paragraph (2)(B), by striking ``The 
                provision of'' and all that follows through ``health 
                care).''.

SEC. 307. AREA HEALTH EDUCATION CENTERS.

    Section 746(d)(2)(D) (42 U.S.C. 293j(d)(2)(D)) is amended by 
inserting ``and minority health'' after ``disease prevention''.

                 TITLE IV--RESEARCH AND DATA COLLECTION

SEC. 401. OFFICE OF RESEARCH ON MINORITY HEALTH.

    Section 404 (42 U.S.C. 283b), as added by section 151 of Public Law 
103-43, is amended by adding at the end the following subsections:
    ``(c) Plan.--The Director of the Office, shall collaborate with the 
Deputy Assistant Secretary for Minority Health (as provided for in 
section 1707), to develop and implement a plan for carrying out the 
duties required by subsection (b).
    ``(d) Equity Regarding Various Groups.--The Director of the Office 
shall ensure that activities under subsection (b) address health 
research and research training needs of minorities with respect to the 
most prevalent morbidity and mortality concerns of the various racial 
and ethnic minority groups.
    ``(e) Advisory Subcommittee.--
            ``(1) Establishment.--In carrying out subsection (b), the 
        Secretary shall establish a subcommittee of the Advisory 
        Committee to the Director of the National Institutes of Health, 
        an advisory subcommittee to be known as the Advisory 
        Subcommittee on Research on Minority Health (in this subsection 
        referred to as the `Advisory Subcommittee').
            ``(2) Composition.--
                    ``(A) Voting and nonvoting members.--The Advisory 
                Subcommittee shall be composed of voting members 
                appointed in accordance with subparagraph (B) and the 
                ex officio nonvoting members described in subparagraph 
                (C).
                    ``(B) Voting members.--The Advisory Subcommittee 
                shall include not fewer than 12, and not more than 18, 
                voting members who are not officers or employees of the 
                Federal Government. The Director of the Office shall 
                appoint such members to the Advisory Subcommittee from 
                among physicians, practitioners, scientists, consumers 
                and other health professionals, whose clinical 
                practices, research specialization, or professional 
                expertise includes a significant focus on research on 
                minority health or on the barriers that minorities must 
                overcome to participate in clinical trials. The 
                membership of the Advisory Subcommittee shall be 
                equitably representative of the minority groups served 
                by the Office.
                    ``(C) Ex officio nonvoting members.--The Deputy 
                Assistant Secretary for Minority Health and the 
                Directors of each of the national research entities 
                shall serve as ex officio nonvoting members of the 
                Advisory Subcommittee (except that any of such 
                Directors may designate an official of the institute 
                involved to serve as such member of the Subcommittee in 
                lieu of the Director).
            ``(3) Chairperson.--The Director of the Office shall serve 
        as the chairperson of the Advisory Subcommittee.
            ``(4) Duties.--The Advisory Subcommittee shall--
                    ``(A) advise the Director of the Office on 
                appropriate research activities to be undertaken by the 
                national research institutes with respect to--
                            ``(i) research on minority health;
                            ``(ii) research on racial and ethnic 
                        differences in clinical drug trials, including 
                        responses to pharmacological drugs;
                            ``(iii) research on racial and ethnic 
                        differences in disease etiology, course, and 
                        treatment; and
                            ``(iv) research on minority health 
                        conditions which require a multidisciplinary 
                        approach;
                    ``(B) report to the Director of the Office on such 
                research;
                    ``(C) provide recommendations to such Director 
                regarding activities of the Office (including 
                recommendations on priorities in carrying out research 
                described in subparagraph (A)); and
                    ``(D) assist in monitoring compliance with section 
                492B regarding the inclusion of minorities in clinical 
                research.
            ``(5) Biennial report.--
                    ``(A) Preparation.--The Advisory Subcommittee shall 
                prepare a biennial report describing the activities of 
                the Subcommittee, including findings made by the 
                Subcommittee regarding--
                            ``(i) compliance with section 492B;
                            ``(ii) the extent of expenditures made for 
                        research on minority health by the agencies of 
                        the National Institutes of Health; and
                            ``(iii) the level of funding needed for 
                        such research.
                    ``(B) Submission.--The report required in 
                subparagraph (A) shall be submitted to the Director of 
                the National Institutes of Health for inclusion in the 
                report required in section 403.
    ``(f) Representatives of Minorities Among Researchers.--The 
Secretary, acting through the Assistant Secretary for Personnel 
Administration and in collaboration with the Director of the Office, 
shall determine the extent to which minorities are represented among 
senior physicians and scientists employed by the national research 
institutes and among physicians and scientists employed by and 
conducting research with funds provided by such institutes, and as 
appropriate, carry out activities to increase the extent of such 
representation and the number of minorities receiving doctorates in the 
biomedical sciences, including targeting minorities at all points in 
the education pipeline to increase minority participation in general in 
biomedical research.
    ``(g) Definitions.--For purposes of this part:
            ``(1) Minority health conditions.--The term `minority 
        health conditions', with respect to individuals who are members 
        of minority groups, means all diseases, disorders, and 
        conditions (including with respect to mental health and 
        substance abuse)--
                    ``(A) unique to, more serious, or more prevalent in 
                such individuals;
                    ``(B) for which the factors of medical risk or 
                types of medical intervention are different for such 
                individuals, or for which it is unknown whether such 
                factors or types are different for such individuals; or
                    ``(C) with respect to which there has been 
                insufficient research involving such individuals as 
                subjects or insufficient data on such individuals.
            ``(2) Research on minority health.--The term `research on 
        minority health' means research on minority health conditions, 
        including research on preventing such conditions.
            ``(3) Minority groups.--The term `minority groups' means 
        Blacks, American Indians, Alaskan Natives, Asian/Pacific 
        Islanders, and Hispanics.''.

SEC. 402. NATIONAL CENTER FOR HEALTH STATISTICS.

    (a) In General.--Section 306 (42 U.S.C. 242k) is amended--
            (1) in subsection (c), by striking ``Committee on Human 
        Resources'' and inserting ``Committee on Labor and Human 
        Resources'';
            (2) in subsection (g), by striking ``data which shall be 
        published'' and all that follows and inserting ``data.'';
            (3) in subsection (k)(2)--
                    (A) in subparagraph (A)--
                            (i) by striking the subparagraph 
                        designation; and
                            (ii) by striking ``Except as provided in 
                        subparagraph (B), members'' and inserting 
                        ``Members''; and
                    (B) by striking subparagraph (B);
            (4) in subsection (l)--
                    (A) by striking paragraph (3);
                    (B) by redesignating paragraph (4) as paragraph 
                (3); and
                    (C) in paragraph (3) (as so redesignated), by 
                striking ``paragraphs (1), (2), and (3),'' and 
                inserting ``paragraphs (1) and (2),''; and
            (5) in subsection (o)--
                    (A) in paragraph (1), by striking ``1991 through 
                1993'' and inserting ``1994 through 1997''; and
                    (B) in paragraph (2), by striking ``$5,000,000'' 
                and all that follows through ``1993'' and inserting 
                ``such sums as may be necessary for each of the fiscal 
                years 1994 through 1997''.
    (b) General Authority Respecting Research, Evaluations, and 
Demonstrations.--Section 304 (42 U.S.C. 242b) is amended by striking 
subsection (d).
    (c) General Provisions Respecting Effectiveness, Efficiency, and 
Quality of Health Services.--Section 308 (42 U.S.C. 242m) is amended--
            (1) in subsection (a)--
                    (A) in paragraph (1)--
                            (i) by striking subparagraph (A); and
                            (ii) by redesignating subparagraphs (B) 
                        through (E) as subparagraphs (A) through (D), 
                        respectively; and
                    (B) in paragraph (2), by striking ``reports 
                required by subparagraphs'' and all that follows 
                through ``Center'' and inserting the following: 
                ``reports required in paragraph (1) shall be prepared 
                through the National Center'';
            (2)(A) by striking subsection (c);
            (B) by transferring paragraph (2) of subsection (g) from 
        the current location of the paragraph;
            (C) by redesignating such paragraph as subsection (c);
            (D) by inserting subsection (c) (as so redesignated) after 
        subsection (b); and
            (E) by striking the remainder of subsection (g);
            (3) in subsection (c) (as so redesignated)--
                    (A) by striking ``shall (A) take'' and inserting 
                ``shall take''; and
                    (B) by striking ``and (B) publish'' and inserting 
                ``and shall publish'';
            (4) in subsection (f), by striking ``sections 3648'' and 
        all that follows and inserting ``section 3324 of title 31, 
        United States Code, and section 3709 of the Revised Statutes 
        (41 U.S.C. 5).''; and
            (5) by striking subsection (h).

SEC. 403. ACTIVITIES OF AGENCY FOR HEALTH CARE POLICY AND RESEARCH.

    Section 902(b) (42 U.S.C. 299a(b)) is amended to read as follows:
    ``(b) Requirements With Respect to Certain Populations.--In 
carrying out subsection (a), the Administrator shall undertake and 
support research, demonstration projects, and evaluations with respect 
to the health status of, and the delivery of health care to--
            ``(1) racial and ethnic minority groups residing in 
        medically underserved urban or rural areas (including frontier 
        areas); and
            ``(2) low-income groups, including the elderly, women, and 
        children with low incomes.''.

                         TITLE V--MISCELLANEOUS

SEC. 501. MEDICALLY UNDERSERVED AREA STUDY.

    (a) In General.--The Secretary of Health and Human Services shall 
conduct a study concerning the feasibility and desirability of, and the 
criteria to be used for, combining the designations of ``health 
professional shortage area'' and ``medically underserved area'' into a 
single health professional shortage area designation.
    (b) Requirements.--As part of the study conducted under subsection 
(a), the Secretary of Health and Human Services, in considering the 
statutory and regulatory requirements necessary for the creation of a 
single health professional shortage area designation, shall--
            (1) review and report on the application of current 
        statutory and regulatory criteria used--
                    (A) in designating an area as a health professional 
                shortage area;
                    (B) in designating an area as a medically 
                underserved area; and
                    (C) by a State in the determination of the health 
                professional shortage area designations of such State; 
                and
            (2) review the suggestions of public health and primary 
        care experts.
    (c) Report.--Not later than 1 year after the date of enactment of 
this Act, the Secretary of Health and Human Services shall prepare and 
submit to the appropriate committees of Congress a report concerning 
the findings of the study conducted under subsection (a) together with 
the recommendations of the Secretary.
    (d) Recommendations.--In making recommendations under subsection 
(c), the Secretary of Health and Human Services shall give special 
consideration to (and describe in the report) the unique impact of 
designation criteria on different rural and urban populations, and 
ethnic and racial minorities, including--
            (1) rational service areas, and their application to 
        frontier areas and inner-city communities;
            (2) indicators of high medical need, including fertility 
        rates, infant mortality rates, pediatric population, elderly 
        population, poverty rates, and physician to population ratios; 
        and
            (3) indicators of insufficient service capacity, including 
        language proficiency criteria for ethnic populations, annual 
        patient visits per physician, waiting times for appointments, 
        waiting times in a primary care physician office, excessive use 
        of emergency facilities, low annual office visit rate, and 
        demand on physicians in contiguous rural or urban areas.

SEC. 502. FEDERAL AND STATE OFFICES REGARDING URBAN HEALTH.

    (a) Federal Office of Urban Health Policy.--Title XVII, as amended 
by section 103 of this Act, is amended by adding at the end the 
following section:

``SEC. 1711. OFFICE OF URBAN HEALTH POLICY.

    ``(a) In General.--There is established in the Department of Health 
and Human Services an office to be known as the Office of Urban Health 
Policy (in this section referred to as the `Office'). The Office shall 
be headed by a director, who shall be appointed by the Secretary. The 
Secretary shall carry out this section acting through the Director of 
the Office.
    ``(b) Advice Regarding Programs Policies and Changes.--With respect 
to current policies on and proposed statutory, regulatory, 
administrative, and budgetary changes in Federal health programs, the 
Director of the Office shall advise the Secretary on the effects of 
such policies and changes on the ability of underserved urban areas to 
attract and retain physicians and other health professionals, and 
access to (and the quality of) health care in such areas.
    ``(c) Clearinghouse.--The Director of the Office shall, with 
respect to underserved urban areas, establish and maintain a 
clearinghouse for collecting and disseminating information on--
            ``(1) health care issues relating to such areas;
            ``(2) research findings relating to the health care needs 
        of such areas; and
            ``(3) innovative approaches to the delivery of health care 
        in such areas.
    ``(d) Other Duties.--The Director of the Office shall--
            ``(1) coordinate activities within the Department of Health 
        and Human Services that relate to health care for residents of 
        underserved urban areas; and
            ``(2) provide information to the Secretary and others in 
        such Department with respect to the activities of other Federal 
        departments and agencies that relate to health care for such 
        residents (including activities relating to mental health, 
        infant mortality, occupational safety, and the promotion of 
        preventive health services).''.
    (b) State Offices of Urban Health.--Subpart III of part D of title 
III (42 U.S.C. 254 et seq.) is amended by adding at the end the 
following section:

``SEC. 338M. GRANTS TO STATES FOR OPERATION OF OFFICES OF URBAN HEALTH.

    ``(a) In General.--The Secretary, acting through the Director of 
the Office of Urban Health Policy, may make grants to States for the 
purpose of improving health care in underserved urban areas through the 
operation of State offices of urban health.
    ``(b) Requirement of Matching Funds.--
            ``(1) In general.--With respect to the costs to be incurred 
        by a State in carrying out the purpose described in subsection 
        (a), the Secretary may not make a grant under such subsection 
        unless the State agrees to provide non-Federal contributions 
        toward such costs in an amount equal to--
                    ``(A) for the first fiscal year of payments under 
                the grant, not less than $1 for each $3 of Federal 
                funds provided in the grant;
                    ``(B) for any second fiscal year of such payments, 
                not less than $1 for each $1 of Federal funds provided 
                in the grant; and
                    ``(C) for any third fiscal year of such payments, 
                not less than $3 for each $1 of Federal funds provided 
                in the grant.
            ``(2) Determination of amount of non-federal 
        contribution.--
                    ``(A) Subject to subparagraph (B), non-Federal 
                contributions required in paragraph (1) may be in cash 
                or in kind, fairly evaluated, including plant, 
                equipment, or services. Amounts provided by the Federal 
                Government, or services assisted or subsidized to any 
                significant extent by the Federal Government, may not 
                be included in determining the amount of such non-
                Federal contributions.
                    ``(B) The Secretary may not make a grant under 
                subsection (a) unless the State involved agrees that--
                            ``(i) for the first fiscal year of payments 
                        under the grant, 100 percent or less of the 
                        non-Federal contributions required in paragraph 
                        (1) will be provided in the form of in-kind 
                        contributions;
                            ``(ii) for any second fiscal year of such 
                        payments, not more than 50 percent of such non-
                        Federal contributions will be provided in the 
                        form of in-kind contributions; and
                            ``(iii) for any third fiscal year of such 
                        payments, such non-Federal contributions will 
                        be provided solely in the form of cash.
    ``(c) Certain Required Activities.--The Secretary may not make a 
grant under subsection (a) unless the State involved agrees that 
activities carried out by an office operated pursuant to such 
subsection will, with respect to underserved urban areas, include--
            ``(1) establishing and maintaining within the State a 
        clearinghouse for collecting and disseminating information on--
                    ``(A) health care issues relating to such areas;
                    ``(B) research findings relating to the health care 
                needs of such areas; and
                    ``(C) innovative approaches to the delivery of 
                health care in such areas;
            ``(2) coordinating the activities carried out in the State 
        that relate to the health care needs in such areas, including 
        providing coordination for the purpose of avoiding redundancy 
        in such activities; and
            ``(3) identifying Federal and State programs relating to 
        the health care needs of residents of such areas, and providing 
        technical assistance to public and nonprofit private entities 
        regarding participation in such programs.
    ``(d) Requirement Regarding Annual Budget for Office.--The 
Secretary may not make a grant under subsection (a) unless the State 
involved agrees that, for any fiscal year for which the State receives 
such a grant, the office operated pursuant to subsection (a) will be 
provided with an annual budget of not less than $75,000.
    ``(e) Certain Uses of Funds.--
            ``(1) Restrictions.--The Secretary may not make a grant 
        under subsection (a) unless the State involved agrees that--
                    ``(A) if research with respect to the health of 
                residents of underserved urban areas is conducted 
                pursuant to the grant, not more than 10 percent of the 
                grant will be expended for such research; and
                    ``(B) the grant will not be expended--
                            ``(i) to provide health care (including 
                        providing cash payments regarding such care);
                            ``(ii) to conduct activities for which 
                        Federal funds are expended--
                                    ``(I) within the State to provide 
                                technical and other nonfinancial 
                                assistance under subsection (f) of 
                                section 330;
                                    ``(II) under a memorandum of 
                                agreement entered into with the State 
                                under subsection (h) of such section; 
                                or
                                    ``(III) under a grant under section 
                                338I;
                            ``(iii) to purchase medical equipment, to 
                        purchase ambulances, aircraft, or other 
                        vehicles, or to purchase major communications 
                        equipment;
                            ``(iv) to purchase or improve real 
                        property; or
                            ``(v) to carry out any activity regarding a 
                        certificate of need.
            ``(2) Authorities.--Activities for which a State may expend 
        a grant under subsection (a) include--
                    ``(A) paying the costs of establishing an office of 
                urban health for purposes of subsection (a);
                    ``(B) subject to paragraph (1)(B)(ii)(III), paying 
                the costs of any activity carried out with respect to 
                recruiting and retaining health professionals to serve 
                in underserved urban areas of the State; and
                    ``(C) providing grants and contracts to public and 
                nonprofit private entities to carry out activities 
                authorized in this section.
    ``(f) Reports.--The Secretary may not make a grant under subsection 
(a) unless the State involved agrees--
            ``(1) to submit to the Secretary reports containing such 
        information as the Secretary may require regarding activities 
        carried out under this section by the State; and
            ``(2) to submit such a report not later than January 10 of 
        each fiscal year immediately following any fiscal year for 
        which the State has received such a grant.
    ``(g) Requirement of 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 
such subsection.
    ``(h) Noncompliance.--The Secretary may not make payments under 
subsection (a) to a State for any fiscal year subsequent to the first 
fiscal year of such payments unless the Secretary determines that, for 
the immediately preceding fiscal year, the State has complied with each 
of the agreements made by the State under this section.
    ``(i) Definitions.--For purposes of this section, the term `State' 
means each of the several States.
    ``(j) Authorization of Appropriations.--
            ``(1) In general.--For the purpose of making grants under 
        subsection (a), there are authorized to be appropriated 
        $3,000,000 for fiscal year 1994, $4,000,000 for fiscal year 
        1995, and $3,000,000 for fiscal year 1996.
            ``(2) Availability.--Amounts appropriated under paragraph 
        (1) shall remain available until expended.
    ``(k) Termination of Program.--No grant may be made under this 
section after the aggregate amounts appropriated under subsection 
(j)(1) are equal to $10,000,000.''.

SEC. 503. GRANTS AND CONTRACTS REGARDING ORGAN AND BONE MARROW 
              TRANSPLANTATION WITH RESPECT TO MINORITY POPULATIONS.

    (a) Transplantation of Organs.--Section 371(a) (42 U.S.C. 273(a)) 
is amended--
            (1) by striking paragraphs (2) and (3); and
            (2) by inserting after paragraph (1) the following 
        paragraph:
    ``(2)(A) The Secretary may make grants to, and enter into contracts 
with, qualified organ procurement organizations described in subsection 
(b) and other public or nonprofit private entities for the purpose of--
            ``(i) planning and conducting programs to provide 
        information and education to the public on the need for organ 
        and tissues donations, with priority given to such information 
        and education for members of racial and ethnic minority groups; 
        and
            ``(ii) training individuals in requesting such donations.
    ``(B) In making awards of grants and contracts under subparagraph 
(A), the Secretary shall give priority to carrying out the purpose 
described in such subparagraph with respect to minority populations. 
For purposes of complying with the preceding sentence, the Secretary 
shall reserve not less than 50 percent of the amounts appropriated for 
such grants and contracts for a fiscal year.
    ``(C) In making awards of grants and contracts under subparagraph 
(A), the Secretary shall give preference to community-based 
organizations.''.
    (b) Transplantation of Bone Marrow.--Part I of title III (42 U.S.C. 
274k et seq.) is amended by inserting after section 379A the following 
section:

                 ``information, education, and training

    ``Sec. 379B. (a) In General.--The Secretary may make grants to, and 
enter into contracts with, public or nonprofit private entities for the 
purpose of--
            ``(1) planning and conducting programs to provide 
        information and education to the public on the need for 
        donations of bone marrow, with priority given to such 
        information and education for members of racial and ethnic 
        minority groups; and
            ``(2) training individuals in requesting such donations.
    ``(b) Priorities Regarding Certain Activities.--In making awards of 
grants and contracts under subsection (a), the Secretary shall give 
priority to carrying out the purpose described in such subsection with 
respect to minority populations. For purposes of complying with the 
preceding sentence, the Secretary shall reserve not less than 50 
percent of the amounts appropriated for such grants and contracts for a 
fiscal year.
    ``(c) Preferences Regarding Certain Applicants.--In making awards 
of grants and contracts under subsection (a), the Secretary shall give 
preference to community-based organizations.''.

SEC. 504. DEMONSTRATION PROJECT GRANTS TO STATES FOR ALZHEIMER'S 
              DISEASE.

    Section 398(a) (42 U.S.C. 280c-3(a)) is amended--
            (1) in the matter preceding paragraph (1), by striking 
        ``not less than 5, and not more than 15,'';
            (2) in paragraph (2)--
                    (A) by inserting after ``disorders'' the following: 
                ``who are living in single family homes or in 
                congregate settings''; and
                    (B) by striking ``and'' at the end;
            (3) by redesignating paragraph (3) as paragraph (4); and
            (4) by inserting after paragraph (2) the following:
            ``(3) to improve access for individuals with Alzheimer's 
        disease or related disorders, particularly such individuals 
        from ethnic, cultural, or language minorities and such 
        individuals who are living in isolated rural areas, to services 
        that are home-based or community-based long-term care services; 
        and''.

SEC. 505. WAIVERS REGARDING OBLIGATED SERVICE IN PRIMARY HEALTH CARE.

    Section 795 (42 U.S.C. 295N) is amended by adding at the end the 
following subsection:
    ``(c) Inapplicability to Certain Individuals.--Any obligation under 
this section regarding training or practicing in primary health care is 
waived for individuals from disadvantaged backgrounds who are 
underrepresented in the health professions.''.

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