[Congressional Bills 103th Congress]
[From the U.S. Government Publishing Office]
[H.R. 3869 Introduced in House (IH)]

103d CONGRESS
  2d Session
                                H. R. 3869

 To amend the Public Health Service Act to revise and extend programs 
   relating to the health of individuals who are members of minority 
                    groups, and for other purposes.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                           February 11, 1994

  Mr. Waxman (for himself, Mr. Synar, Mr. Richardson, Mr. Towns, Mr. 
   Washington, Mr. Upton, Mr. Franks of Connecticut, Mr. Mineta, Mr. 
   Matsui, Mr. Serrano, Mr. Gutierrez, Mr. Pastor, Mr. Menendez, Mr. 
   Romero-Barcelo, Ms. Velazquez, 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 to revise and extend programs 
   relating to the health of individuals who are members of minority 
                    groups, and for other purposes.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE; TABLE OF CONTENTS.

    (a) Short Title.--This Act may be cited as the ``Minority Health 
Improvement Act of 1994''.
    (b) Table of Contents.--The table of contents for this Act is as 
follows:

Sec. 1. Short title; table of contents.
                   TITLE I--OFFICE OF MINORITY HEALTH

Sec. 101. Revision and extension of programs of Office of Minority 
                            Health.
Sec. 102. Establishment of individual offices of minority health within 
                            agencies of Public Health Service.
                   TITLE II--PRIMARY HEALTH SERVICES

Sec. 201. Migrant health centers; community health centers.
Sec. 202. Health services for the homeless.
Sec. 203. Health services for residents of public housing.
Sec. 204. Grants to States for loan repayment programs regarding 
                            obligated service of health professionals.
Sec. 205. Grants to States for operation of State offices of rural 
                            health.
Sec. 206. Demonstration grants to States for community scholarship 
                            programs regarding obligated service of 
                            health professionals.
Sec. 207. Programs regarding birth defects.
Sec. 208. Healthy start for infants.
Sec. 209. Demonstration projects regarding diabetic-retinopathy.
                 TITLE III--HEALTH PROFESSIONS PROGRAMS

Sec. 301. Primary care scholarships for students from disadvantaged 
                            backgrounds.
Sec. 302. Scholarships generally; certain other purposes.
Sec. 303. Loan repayments and fellowships regarding faculty positions.
Sec. 304. Centers of Excellence.
Sec. 305. Educational assistance regarding undergraduates.
Sec. 306. Student loans regarding schools of nursing.
Sec. 307. Federally-supported student loans funds.
                           TITLE IV--RESEARCH

Sec. 401. Office of Research on Minority Health.
Sec. 402. Activities of Agency for Health Care Policy and Research.
Sec. 403. Data collection by National Center for Health Statistics.
                  TITLE V--NATIVE HAWAIIAN HEALTH CARE

Sec. 501. Clarification of 1992 amendments.
Sec. 502. Amendment of Native Hawaiian Health Care Improvement Act to 
                            reflect 1992 agreement.
Sec. 503. Repeal of Public Health Service Act provision.
                   TITLE VI--MISCELLANEOUS PROVISIONS

Sec. 601. Technical amendment to Indian Health Care Improvement Act.
Sec. 602. Health services for Pacific Islanders.
Sec. 603. Technical corrections regarding Public Law 103-183.
Sec. 604. Certain authorities of Centers for Disease Control and 
                            Prevention.
                     TITLE VII--GENERAL PROVISIONS

Sec. 701. Effective date.

                   TITLE I--OFFICE OF MINORITY HEALTH

SEC. 101. REVISION AND EXTENSION OF PROGRAMS OF OFFICE OF MINORITY 
              HEALTH.

    (a) In General.--Section 1707 of the Public Health Service Act (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 minority 
groups, the Secretary shall carry out the following:
            ``(1) In consultation with the advisory council under 
        subsection (c), establish goals and objectives regarding 
        disease prevention, health promotion, service delivery, and 
        research, and coordinate all activities within the Department 
        of Health and Human Services that relate to such goals and 
        objectives.
            ``(2) In consultation with such council, enter into 
        interagency agreements with other agencies of the Service, and 
        under such agreements provide amounts to such agencies, to 
        carry out the following:
                    ``(A) Support research, demonstrations and 
                evaluations to test new and innovative models of 
                delivering services.
                    ``(B) Increase knowledge and understanding of 
                health risk factors.
                    ``(C) Ensure that the National Center for Health 
                Statistics collects data on the health status of each 
                minority group.
                    ``(D) With respect to individuals who lack 
                proficiency in speaking the English language, enter 
                into contracts with public and nonprofit private 
                providers of primary health services for the purpose of 
                increasing the access of the individuals to such 
                services by developing and carrying out programs to 
                provide bilingual or interpretive services.
            ``(3) Establish by contract a 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) Facilitate access to such information.
                    ``(C) Assist in the analysis of issues and problems 
                relating to such matters.
                    ``(D) Provide technical assistance with respect to 
                the exchange of such information (including 
                facilitating the development of materials for such 
                technical assistance).
            ``(4)(A) Establish by contract a center for the purpose of 
        carrying out programs to improve access to health care services 
        for individuals who lack proficiency in speaking the English 
        language by developing and carrying out programs to provide 
        bilingual or interpretive services.
            ``(B) In carrying out subparagraph (A), ensure that--
                    ``(i) the center under such subparagraph conducts 
                research, develops and evaluates model projects, and 
                provides technical assistance to health care providers; 
                and
                    ``(ii) such center is not operated by the entity 
                that operates the center established under paragraph 
                (3).
    ``(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 
        carrying out paragraphs (1) and (2) of subsection (b) for each 
        minority group.
            ``(3) Composition.--
                    ``(A) The Committee shall be composed of 12 voting 
                members appointed in accordance with subparagraph (B) 
                and the nonvoting, ex officio members designated under 
                subparagraph (C).
                    ``(B) The voting members of the Committee shall be 
                appointed from among individuals who have expertise 
                regarding the health status of minority groups and the 
                access of such groups to health services, which 
                individuals are not officers or employees of the 
                Federal Government. The appointed membership of the 
                Committee shall be broadly representative of the 
                various minority groups.
                    ``(C) The Secretary shall designate as ex officio 
                members of the Committee the heads of the minority 
                health offices referred to in section 1707A.
    ``(d) Appropriate Context 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.
    ``(e) Equitable Allocation of Services.--The Secretary shall ensure 
that services provided under subsection (b) are equitably allocated 
among the various minority groups.
    ``(f) Consultation With Individual Minority Health Offices.--In 
carrying out subsection (b) regarding a specified agency, the Secretary 
shall consult with the head of the minority health office of the 
agency. For purposes of the preceding sentence, the terms `specified 
agency' and `minority health office' have the meaning given such terms 
in section 1707A(f).
    ``(g) Biennial Reports.--Not later than February 1 of fiscal year 
1996 and of each second year thereafter, the Secretary shall submit to 
the Committee on Energy and Commerce of the House of Representatives, 
and to the Committee on Labor and Human Resources of the Senate, a 
report describing the 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 minority 
groups. Each such report shall include the biennial reports submitted 
to the Secretary under section 1707A(e) for such years by the heads of 
the minority health offices.
    ``(h) Definition.--For purposes of this section, the term `minority 
groups' means African Americans, American Indians, Asian Americans, 
Hispanics, and Pacific Islanders.
    ``(i) Funding.--
            ``(1) Authorization of appropriations.--For the purpose of 
        carrying out this section, there is authorized to be 
        appropriated $21,000,000 for each of the fiscal years 1995 
        through 1997.
            ``(2) Allocation of funds by secretary.--Of the amounts 
        appropriated under paragraph (1) for a fiscal year, the 
        Secretary shall make available not less than $3,000,000 for 
        carrying out subsection (b)(2)(D).''.
    (b) Miscellaneous Amendment.--Section 1707 of the Public Health 
Service Act (42 U.S.C. 300u-6) is amended in the heading for the 
section by striking ``establishment of''.

SEC. 102. 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 minority groups 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 minority groups, no such group is disproportionately 
represented.
    ``(d) Duties.--Each Director of a minority health office shall 
monitor the programs of the specified agency of such office in order 
to--
            ``(A) determine the extent to which the purposes of the 
        programs are being carried out with respect to minority groups;
            ``(B) determine the extent to which members of such groups 
        are represented among the Federal officers and employees who 
        administer the programs; and
            ``(C) make recommendations to the head of such agency on 
        carrying out the programs with respect to such groups.
    ``(e) Biennial Reports to Secretary.--The head of each specified 
agency shall submit to the Secretary for inclusion in each biennial 
report under section 1707(g) (without change) a biennial report 
describing--
            ``(1) the extent to which the minority health office of the 
        agency employs individuals who are members of minority groups, 
        including a specification by minority group of the number of 
        such individuals employed by such office; and
            ``(2) the manner in which the agency is complying with 
        Public Law 94-311 (relating to data on Americans of Spanish 
        origin or descent).
    ``(f) 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 `minority group' has the meaning given such 
        term in section 1707(h).
            ``(3) The term `specified agency' means--
                    ``(A) an agency specified in subsection (b)(1); and
                    ``(B) the National Institutes of Health.
    ``(g) Funding.--
            (1) Allocations.--Of the amounts appropriated for a 
        specified agency for a fiscal year, the Secretary may reserve 
        not more than 0.5 percent for the purpose of carrying out 
        activities under this section through the minority health 
        office of the agency. In reserving an amount under the 
        preceding sentence for a minority health office for a fiscal 
        year, the Secretary shall reduce, by substantially the same 
        percentage, the amount that otherwise would be available for 
        each of the programs of the designated agency involved.
            ``(2) Availability of funds for staffing.--The purposes for 
        which amounts made available under paragraph (1) may be 
        expended by a minority health office include the costs of 
        employing staff for such office.''.

                   TITLE II--PRIMARY HEALTH SERVICES

SEC. 201. MIGRANT HEALTH CENTERS; COMMUNITY HEALTH CENTERS.

    (a) Migrant Health Centers.--
            (1) Treatment of pregnant women for substance abuse.--
        Section 329(a) of the Public Health Service Act (42 U.S.C. 
        254b(a)) is amended--
                    (A) in paragraph (1)(C)--
                            (i) by inserting ``(i)'' after ``(C)'';
                            (ii) in clause (i) (as so designated), by 
                        adding ``and'' after the comma at the end; and
                            (iii) by adding at the end the following 
                        clause:
            ``(ii) to the State official responsible for carrying out 
        programs under subpart II of part B of title XIX, and in 
        accordance with the provisions of section 543 regarding the 
        disclosure of information, a notification if a pregnant women 
        is provided a referral for the treatment of substance abuse but 
        the entity involved does not have the capacity to admit 
        additional individuals for treatment,''; and
                    (B) in paragraph (7)--
                            (i) in subparagraph (L), by striking 
                        ``and'' at the end;
                            (ii) by redesignating subparagraph (M) as 
                        subparagraph (N); and
                            (iii) by inserting after subparagraph (L) 
                        the following subparagraph:
            ``(M) treatment of pregnant women for substance abuse; 
        and''.
            (2) Overlap in catchment areas.--Section 329(a) of the 
        Public Health Service Act (42 U.S.C. 254b(a)) is amended by 
        adding at the end the following paragraph:
    ``(8) In making grants under subsections (c)(1) and (d)(1), the 
Secretary may provide for the development and operation of more than 
one migrant health center in a catchment area in any case in which the 
Secretary determines that in such area there are workers or other 
individuals described in subsection (a)(1) (in the matter after and 
below subparagraph (H)) who otherwise will have a shortage of personal 
health services. The preceding sentence may not be construed as 
requiring that, in such a case, the catchment areas of the centers 
involved be identical.''.
            (3) Offsite activities.--Section 329(a) of the Public 
        Health Service Act, as amended by paragraph (2) of this 
        subsection, is amended by adding at the end the following 
        paragraph:
    ``(9) In making grants under this section, the Secretary may, to 
the extent determined by the Secretary to be appropriate, authorize 
migrant health centers to provide services at locations other than the 
center.''.
            (4) Amount of grant; use of certain funds.--Section 
        329(d)(4) of the Public Health Service Act (42 U.S.C. 
        254b(d)(4)), as amended by section 309(a)(3) of Public Law 102-
        531 (106 Stat. 3500), is amended to read as follows:
    ``(4)(A) The amount of a grant under paragraph (1) or under 
subsection (c) for a migrant health center shall be determined by the 
Secretary, taking into account (for the period for which the grant is 
made)--
            ``(i) the costs that the center may reasonably be expected 
        to incur in carrying out the plan approved by the Secretary 
        pursuant to subsection (f)(3)(H), and
            ``(ii) the amounts that the center may reasonably be 
        expected to receive as State, local, and other operational 
        funding (exclusive of amounts to be provided in the grant under 
        this section) and as fees, premiums, and third-party 
        reimbursements.
    ``(B)(i) Subject to clause (ii), the Secretary may not restrict the 
purposes for which a migrant health center expends the amounts 
described in subparagraph (A)(ii) (including restrictions imposed 
pursuant to Federal cost principles).
    ``(ii) The Secretary may require that amounts described in 
subparagraph (A)(ii) be expended for purposes that are consistent with 
the purposes specified in this section.
    ``(C)(i) Payments under a grant under this section shall be made in 
advance or by way of reimbursement and in such installments as the 
Secretary finds necessary. Adjustments in such payments may be made for 
overpayments or underpayments, subject to clause (ii).
    ``(ii) If, for the period for which a grant is made under paragraph 
(1) to a migrant health center, the sum of the amount of the grant and 
the amounts described in subparagraph (A)(ii) that the center actually 
received exceeded the costs of the center in carrying out the plan 
approved by the Secretary pursuant to subsection (f)(3)(H), then the 
center is entitled to retain such excess amount if the center agrees to 
expend such amount only for the following purposes:
            ``(I) To expand and improve services.
            ``(II) To increase the number of persons served.
            ``(III) To acquire, modernize, or expand facilities, or to 
        construct facilities.
            ``(IV) To improve the administration of service programs.
            ``(V) To establish financial reserves.
    ``(D) With respect to funds that are amounts described in 
subparagraph (A)(ii) or excess amounts described in subparagraph 
(C)(ii), this paragraph may not be construed as limiting the authority 
of the Secretary to require the submission of such plans, budgets, and 
other information as may be necessary to ensure that the funds are 
expended in accordance with subparagraph (B)(ii), or clauses (I) 
through (V) of subparagraph (C)(ii), respectively.''.
            (5) Authorization of appropriations.--Section 329(h) of the 
        Public Health Service Act (42 U.S.C. 254b(h)) is amended--
                    (A) in paragraph (1)(A), by striking ``1994'' and 
                inserting ``1998''; and
                    (B) in paragraph (2)(A), by striking ``1994'' and 
                inserting ``1998''.
    (b) Community Health Centers.--
            (1) Treatment of pregnant women for substance abuse.--
        Section 330 of the Public Health Service Act (42 U.S.C. 254c) 
        is amended--
                    (A) in subsection (a)(3)--
                            (i) by inserting ``(A)'' after ``(3)'';
                            (ii) in subparagraph (A) (as so 
                        designated), by adding ``and'' after the comma 
                        at the end; and
                            (iii) by adding at the end the following 
                        subparagraph:
            ``(B) to the State official responsible for carrying out 
        programs under subpart II of part B of title XIX, and in 
        accordance with the provisions of section 543 regarding the 
        disclosure of information, a notification if a pregnant women 
        is provided a referral for the treatment of substance abuse but 
        the entity involved does not have the capacity to admit 
        additional individuals for treatment,''; and
                    (B) in subsection (b)(2)--
                            (i) in subparagraph (L), by striking 
                        ``and'' at the end;
                            (ii) by redesignating subparagraph (M) as 
                        subparagraph (N); and
                            (iii) by inserting after subparagraph (L) 
                        the following subparagraph:
            ``(M) treatment of pregnant women for substance abuse; 
        and''.
            (2) Overlap in catchment areas.--Section 330(b) of the 
        Public Health Service Act (42 U.S.C. 254c(b)) is amended by 
        adding at the end the following paragraph:
    ``(7) In making grants under subsections (c)(1) and (d)(1), the 
Secretary may provide for the development and operation of more than 
one community health center in a catchment area in any case in which 
the Secretary determines that there is a population group in such area 
that otherwise will have a shortage of personal health services. The 
preceding sentence may not be construed as requiring that, in such a 
case, the catchment areas of the centers involved be identical.''.
            (3) Offsite activities.--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 making grants under this section, the Secretary may, to 
the extent determined by the Secretary to be appropriate, authorize 
community health centers to provide services at locations other than 
the center.''.
            (4) Amount of grant; use of certain funds.--Section 
        330(d)(4) of the Public Health Service Act (42 U.S.C. 
        254c(d)(4)), as amended by section 309(b)(3) of Public Law 102-
        531 (106 Stat. 3501), is amended to read as follows:
    ``(4)(A) The amount of a grant under paragraph (1) or under 
subsection (c) for a community health center shall be determined by the 
Secretary, taking into account (for the period for which the grant is 
made)--
            ``(i) the costs that the center may reasonably be expected 
        to incur in carrying out the plan approved by the Secretary 
        pursuant to subsection (e)(3)(H), and
            ``(ii) the amounts that the center may reasonably be 
        expected to receive as State, local, and other operational 
        funding (exclusive of amounts to be provided in the grant under 
        this section) and as fees, premiums, and third-party 
        reimbursements.
    ``(B)(i) Subject to clause (ii), the Secretary may not restrict the 
purposes for which a community health center expends the amounts 
described in subparagraph (A)(ii) (including restrictions imposed 
pursuant to Federal cost principles).
    ``(ii) The Secretary may require that amounts described in 
subparagraph (A)(ii) be expended for purposes that are consistent with 
the purposes specified in this section.
    ``(C)(i) Payments under a grant under this section shall be made in 
advance or by way of reimbursement and in such installments as the 
Secretary finds necessary. Adjustments in such payments may be made for 
overpayments or underpayments, subject to clause (ii).
    ``(ii) If, for the period for which a grant is made under paragraph 
(1) to a community health center, the sum of the amount of the grant 
and the amounts described in subparagraph (A)(ii) that the center 
actually received exceeded the costs of the center in carrying out the 
plan approved by the Secretary pursuant to subsection (e)(3)(H), then 
the center is entitled to retain such excess amount if the center 
agrees to expend such amount only for the following purposes:
            ``(I) To expand and improve services.
            ``(II) To increase the number of persons served.
            ``(III) To acquire, modernize, or expand facilities, or to 
        construct facilities.
            ``(IV) To improve the administration of service programs.
            ``(V) To establish financial reserves.
    ``(D) With respect to funds that are amounts described in 
subparagraph (A)(ii) or excess amounts described in subparagraph 
(C)(ii), this paragraph may not be construed as limiting the authority 
of the Secretary to require the submission of such plans, budgets, and 
other information as may be necessary to ensure that the funds are 
expended in accordance with subparagraph (B)(ii), or clauses (I) 
through (V) of subparagraph (C)(ii), respectively.''.
            (5) Authorization of appropriations.--Section 330(g) of the 
        Public Health Service Act (42 U.S.C. 254c(g)) is amended--
                    (A) in paragraph (1)(A), by striking ``1994'' and 
                inserting ``1998''; and
                    (B) in paragraph (2)(A), by striking ``1994'' and 
                inserting ``1998''.

SEC. 202. HEALTH SERVICES FOR THE HOMELESS.

    Section 340(q)(1) of the Public Health Service Act (42 U.S.C. 
256(q)(1)) is amended by striking ``and 1994'' and inserting ``through 
1998''.

SEC. 203. HEALTH SERVICES FOR RESIDENTS OF PUBLIC HOUSING.

    Section 340A(p)(1) of the Public Health Service Act (42 U.S.C. 
256a(p)(1)) is amended by striking ``and 1993'' and inserting ``through 
1998''.

SEC. 204. GRANTS TO STATES FOR LOAN REPAYMENT PROGRAMS REGARDING 
              OBLIGATED SERVICE OF HEALTH PROFESSIONALS.

    Section 338I(c) of the Public Health Service Act (42 U.S.C. 254q-
1(c)) is amended by adding at the end the following paragraph:
            ``(4) Private practice.--
                    ``(A) In carrying out the program operated with a 
                grant under subsection (a), a State may waive the 
                requirement of paragraph (1) regarding the assignment 
                of a health professional if, subject to subparagraph 
                (B), the health professional enters into an agreement 
                with the State to provide primary health services in a 
                full-time private clinical practice in a health 
                professional shortage area.
                    ``(B) The Secretary may not make a grant under 
                subsection (a) unless the State involved agrees that, 
                if the State provides a waiver under subparagraph (A) 
                for a health professional, section 338D(b)(1) will 
                apply to the agreement under such subparagraph between 
                the State and the health professional to the same 
                extent and in the same manner as such section applies 
                to an agreement between the Secretary and a health 
                professional regarding a full-time private clinical 
                practice.''.

SEC. 205. GRANTS TO STATES FOR OPERATION OF STATE OFFICES OF RURAL 
              HEALTH.

    Section 338J of the Public Health Service Act (42 U.S.C. 254r) is 
amended--
            (1) in subsection (b)(1), in the matter preceding 
        subparagraph (A), by striking ``in cash''; and
            (2) in subsection (j)(1)--
                    (A) by striking ``and'' after ``1992''; and
                    (B) by inserting before the period the following: 
                ``, and such sums as may be necessary for each of the 
                fiscal years 1995 through 1997''.

SEC. 206. DEMONSTRATION GRANTS TO STATES FOR COMMUNITY SCHOLARSHIP 
              PROGRAMS REGARDING OBLIGATED SERVICE OF HEALTH 
              PROFESSIONALS.

    Section 338L of the Public Health Service Act (42 U.S.C. 254t) is 
amended--
            (1) by striking ``health manpower shortage'' each place 
        such term appears and inserting ``health professional 
        shortage'';
            (2) in subsection (e)--
                    (A) by striking paragraph (1);
                    (B) by redesignating paragraphs (2) through (6) as 
                paragraphs (1) through (5), respectively; and
                    (C) in paragraph (1) (as so redesignated), by 
                inserting after ``the individual'' the following: ``who 
                is to receive the scholarship under the contract'';
            (3) in subsection (k)(2), by striking ``internal medicine, 
        pediatrics,'' and inserting ``general internal medicine, 
        general pediatrics,''; and
            (4) in subsection (l)(1)--
                    (A) by striking ``and'' after ``1992,''; and
                    (B) by inserting before the period the following: 
                ``, and such sums as may be necessary for each of the 
                fiscal years 1995 through 1997''.

SEC. 207. PROGRAMS REGARDING BIRTH DEFECTS.

    Section 317C of the Public Health Service Act (42 U.S.C. 247b-4), 
as added by section 306 of Public Law 102-531 (106 Stat. 3494), is 
amended to read as follows:

                   ``programs regarding birth defects

    ``Sec. 317C. (a) The Secretary, acting through the Director of the 
Centers for Disease Control and Prevention, shall carry out programs--
            ``(1) to collect, analyze, and make available data on birth 
        defects (in manner that facilitates compliance with subsection 
        (d)(2)), including data on the causes of such defects and on 
        the incidence and prevalence of such defects;
            ``(2) to provide information and education to the public on 
        the prevention of such defects;
            ``(3) to improve the education, training, and clinical 
        skills of health professionals with respect to the prevention 
        of such defects;
            ``(4) to carry out demonstration projects for the 
        prevention of such defects; and
            ``(5) to operate regional centers for the conduct of 
        research on the prevention of such defects.
    ``(b) Additional Provisions Regarding Collection of Data.--
            ``(1) In general.--In carrying out subsection (a)(1), the 
        Secretary--
                    ``(A) shall collect and analyze data by gender and 
                by racial and ethnic group, including Hispanics, non-
                Hispanic whites, African Americans, Native Americans, 
                Asian Americans, and Pacific Islanders;
                    ``(B) shall collect data under subparagraph (A) 
                from birth certificates, death certificates, hospital 
                records, and such other sources as the Secretary 
                determines to be appropriate; and
                    ``(C) shall encourage States to establish or 
                improve programs for the collection and analysis of 
                epidemiological data on birth defects, and to make the 
                data available.
            ``(2) National clearinghouse.--In carrying out subsection 
        (a)(1), the Secretary shall establish and maintain a National 
        Information Clearinghouse on Birth Defects to collect and 
        disseminate to health professionals and the general public 
        information on birth defects, including the prevention of such 
        defects.
    ``(c) Grants and Contracts.--
            ``(1) In general.--In carrying out subsection (a), the 
        Secretary may make grants to and enter into contracts with 
        public and nonprofit private entities.
            ``(2) Supplies and services in lieu of award funds.--
                    ``(A) Upon the request of a recipient of an award 
                of a grant or contract under paragraph (1), the 
                Secretary may, subject to subparagraph (B), provide 
                supplies, equipment, and services for the purpose of 
                aiding the recipient in carrying out the purposes for 
                which the award is made and, for such purposes, may 
                detail to the recipient any officer or employee of the 
                Department of Health and Human Services.
                    ``(B) With respect to a request described in 
                subparagraph (A), the Secretary shall reduce the amount 
                of payments under the award involved by an amount equal 
                to the costs of detailing personnel and the fair market 
                value of any supplies, equipment, or services provided 
                by the Secretary. The Secretary shall, for the payment 
                of expenses incurred in complying with such request, 
                expend the amounts withheld.
            ``(3) Application for award.--The Secretary may make an 
        award of a grant or contract under paragraph (1) only if an 
        application for the award is submitted to the Secretary and the 
        application is in such form, is made in such manner, and 
        contains such agreements, assurances, and information as the 
        Secretary determines to be necessary to carry out the purposes 
        for which the award is to be made.
    ``(d) Biennial Report.--Not later than February 1 of fiscal year 
1995 and of every second such year thereafter, the Secretary shall 
submit to the Committee on Energy and Commerce of the House of 
Representatives, and the Committee on Labor and Human Resources of the 
Senate, a report that, with respect to the preceding 2 fiscal years--
            ``(1) contains information regarding the incidence and 
        prevalence of birth defects and the extent to which birth 
        defects have contributed to the incidence and prevalence of 
        infant mortality;
            ``(2) contains information under paragraph (1) that is 
        specific to various racial and ethnic groups (including 
        Hispanics, non-Hispanic whites, African Americans, Native 
        Americans, and Asian Americans);
            ``(3) contains an assessment of the extent to which various 
        approaches of preventing birth defects have been effective;
            ``(4) describes the activities carried out under this 
        section; and
            ``(5) contains any recommendations of the Secretary 
        regarding this section.
    ``(e) Authorization of Appropriations.--For the purpose of carrying 
out this section, there are authorized to be appropriated $5,000,000 
for fiscal year 1995, and such sums as may be necessary for each of the 
fiscal years 1996 and 1997.''.

SEC. 208. HEALTHY START FOR INFANTS.

    (a) In General.--Part D of title III of the Public Health Service 
Act (42 U.S.C. 254b et seq.) is amended by inserting after section 330 
the following section:

                      ``healthy start for infants

    ``Sec. 330A. (a) Grants for Comprehensive Services.--
            ``(1) In general.--The Secretary may make grants for the 
        operation of not more than 19 demonstration projects to provide 
        the services described in subsection (b) for the purpose of 
        reducing, in the geographic areas in which the projects are 
        carried out--
                    ``(A) the incidence of infant mortality and 
                morbidity;
                    ``(B) the incidence of fetal deaths;
                    ``(C) the incidence of maternal mortality;
                    ``(D) the incidence of fetal alcohol syndrome; and
                    ``(E) the incidence of low-birthweight births.
            ``(2) Achievement of year 2000 health status objectives.--
        With respect to the objectives established by the Secretary for 
        the health status of the population of the United States for 
        the year 2000, the Secretary shall, in providing for a 
        demonstration project under paragraph (1) in a geographic area, 
        seek to meet the objectives that are applicable to the purpose 
        described in such paragraph and the populations served by the 
        project.
    ``(b) Authorized Services.--
            ``(1) In general.--Subject to subsection (h), the services 
        referred to in this subsection are comprehensive services 
        (including preventive and primary health services for pregnant 
        women and infants and childhood immunizations in accordance 
        with the schedule recommended by the Secretary) for carrying 
        out the purpose described in subsection (a), including services 
        other than health services.
            ``(2) Certain providers.--The Secretary may make a grant 
        under subsection (a) only if the applicant involved agrees 
        that, in making any arrangements under which other entities 
        provide authorized services in the demonstration project 
        involved, the applicant will include among the entities with 
        which the arrangements are made grantees under any of sections 
        329, 330, 340, and 340A, if such grantees are providing 
        services in the service area of such project and the grantees 
        are willing to make such arrangements with the applicant.
    ``(c) Eligible Geographic Areas.--The Secretary may make a grant 
under subsection (a) only if--
            ``(1) the applicant for the grant specifies the geographic 
        area in which the demonstration project under such subsection 
        is to be carried out and agrees that the project will not be 
        carried out in other areas; and
            ``(2) for the fiscal year preceding the first fiscal year 
        for which the applicant is to receive such a grant, the rate of 
        infant mortality in the geographic area equals or exceeds 150 
        percent of the national average in the United States of such 
        rates.
    ``(d) Minimum Qualifications of Grantees.--
            ``(1) Public or nonprofit private entities.--The Secretary 
        may make a grant under subsection (a) only if the applicant for 
        the grant is a State or local department of health, or other 
        public or nonprofit private entity, or a consortium of public 
        or nonprofit private entities.
            ``(2) Approval of political subdivisions.--With respect to 
        a proposed demonstration project under subsection (a), the 
        Secretary may make a grant under such subsection only if--
                    ``(A) the chief executive officer of each political 
                subdivision in the service area of such project 
                approves the applicant for the grant as being qualified 
                to carry out the project; and
                    ``(B) the leadership of any Indian tribe or tribal 
                organization with jurisdiction over any portion of such 
                area so approves the applicant.
            ``(3) Status as medicaid provider.--
                    ``(A) In the case of any service described in 
                subsection (b) that is available pursuant to the State 
                plan approved under title XIX of the Social Security 
                Act for a State in which a demonstration project under 
                subsection (a) is carried out, the Secretary may make a 
                grant under such subsection for the project only if, 
                subject to subparagraph (B)--
                            ``(i) the applicant for the grant will 
                        provide the service directly, and the applicant 
                        has entered into a participation agreement 
                        under the State plan and is qualified to 
                        receive payments under such plan; or
                            ``(ii) the applicant will enter into an 
                        agreement with a public or private entity under 
                        which the entity will provide the service, and 
                        the entity has entered into such a 
                        participation agreement under the State plan 
                        and is qualified to receive such payments.
                    ``(B)(i) In the case of an entity making an 
                agreement pursuant to subparagraph (A)(ii) regarding 
                the provision of services, the requirement established 
                in such subparagraph regarding a participation 
                agreement shall be waived by the Secretary if the 
                entity does not, in providing health care services, 
                impose a charge or accept reimbursement available from 
                any third-party payor, including reimbursement under 
                any insurance policy or under any Federal or State 
                health benefits plan.
                    ``(ii) A determination by the Secretary of whether 
                an entity referred to in clause (i) meets the criteria 
                for a waiver under such clause shall be made without 
                regard to whether the entity accepts voluntary 
                donations regarding the provision of services to the 
                public.
    ``(e) State Approval of Project.--With respect to a proposed 
demonstration project under subsection (a), the Secretary may make a 
grant under such subsection to the applicant involved only if--
            ``(1) the chief executive officer of the State in which the 
        project is to be carried out approves the proposal of the 
        applicant for carrying out the project; and
            ``(2) the leadership of any Indian tribe or tribal 
        organization with jurisdiction over any portion of the service 
        area of the project so approves the proposal.
    ``(f) Eligibility for Services Provided With Grant Funds.--The 
Secretary may make a grant under subsection (a) only if the applicant 
involved agrees as follows:
            ``(1) With respect to any authorized service under 
        subsection (b), if the service is a service that the State 
        involved is required or has elected to provide under title XIX 
        of the Social Security Act, the grant will not be expended to 
        provide the service to any individual to whom the State is 
        required or has elected under such title to provide the 
        service.
            ``(2) The grant will not be expended to make payment for 
        any item or service to the extent that payment has been made, 
        or can reasonably be expected to be made, with respect to such 
        item or service--
                    ``(A) under a health insurance policy or plan 
                (including a group health plan or a prepaid health 
                plan);
                    ``(B) under any Federal or State health benefits 
                program, including any program under title V, XVIII, or 
                XIX of the Social Security Act; or
                    ``(C) under subpart II of part B of title XIX of 
                this Act.
    ``(g) Maintenance of Effort.--
            ``(1) Grantee.--With respect to authorized services under 
        subsection (b), the Secretary may make a grant under subsection 
        (a) only if the applicant involved agrees to maintain 
        expenditures of non-Federal amounts for such services at a 
        level that is not less than the level of such expenditures 
        maintained by the applicant for fiscal year 1991.
            ``(2) Relevant political subdivisions.--With respect to 
        authorized services under subsection (b), the Secretary may 
        make a grant under subsection (a) only if each political 
        subdivision in the service area of the demonstration project 
        involved agrees to maintain expenditures of non-Federal amounts 
        for such services at a level that is not less than the level of 
        such expenditures maintained by the political subdivision for 
        fiscal year 1991.
    ``(h) Restrictions on Expenditure of Grant.--
            ``(1) In general.--Except as provided in paragraph (3), the 
        Secretary may make a grant under subsection (a) only if the 
        applicant involved agrees that the grant will not be expended--
                    ``(A) to provide inpatient services, except with 
                respect to residential treatment for substance abuse 
                provided in settings other than hospitals;
                    ``(B) to make cash payments to intended recipients 
                of health services or mental health services; or
                    ``(C) to purchase or improve real property (other 
                than minor remodeling of existing improvements to real 
                property) or to purchase major medical equipment (other 
                than mobile medical units for providing ambulatory 
                prenatal services).
            ``(2) Administrative expenses; data collection.--The 
        Secretary may make a grant under subsection (a) only if the 
        applicant involved agrees that not more than an aggregate 10 
        percent of the grant will be expended for administering the 
        grant and the collection and analysis of data.
            ``(3) Waiver.--If the Secretary finds that the purpose 
        described in subsection (a) cannot otherwise be carried out, 
        the Secretary may, with respect to an otherwise qualified 
        applicant, waive the restriction established in paragraph 
        (1)(C).
    ``(i) Determination of Cause of Infant Deaths.--The Secretary may 
make a grant under subsection (a) only if the applicant involved--
            ``(1) agrees to provide for a determination of the cause of 
        each infant death in the service area of the demonstration 
        project involved; and
            ``(2) the applicant has made such arrangements with public 
        entities as may be necessary to carry out paragraph (1).
    ``(j) Annual Reports to Secretary.--The Secretary may make a grant 
under subsection (a) only if the applicant involved agrees that, for 
each fiscal year for which the applicant operates a demonstration 
project under such subsection the applicant will, not later than April 
1 of the subsequent fiscal year, submit to the Secretary a report 
providing the following information with respect to the project:
            ``(1) The number of individuals that received authorized 
        services, and the demographic characteristics of the population 
        of such individuals.
            ``(2) The types of authorized services provided, including 
        the types of ambulatory prenatal services provided and the 
        trimester of the pregnancy in which the services were provided.
            ``(3) The sources of payment for the authorized services 
        provided.
            ``(4) The extent to which children under age 2 receiving 
        authorized services have received the appropriate number and 
        variety of immunizations against vaccine-preventable diseases.
            ``(5) An analysis of the causes of death determined under 
        subsection (i).
            ``(6) The extent of progress being made toward meeting the 
        health status objectives specified in subsection (a)(2).
            ``(7) The extent to which, in the service area involved, 
        progress is being made toward meeting the participation goals 
        established for the State by the Secretary under section 
        1905(r) of the Social Security Act (relating to early periodic 
        screening, diagnostic, and treatment services for children 
        under the age of 21).
    ``(k) Community Participation.--The Secretary may make a grant 
under subsection (a) only if the applicant involved agrees that, in 
preparing the proposal of the applicant for the demonstration project 
involved, and in the operation of the project, the applicant will 
consult with the residents of the service area for the project and with 
public and nonprofit private entities that provide authorized services 
to such residents.
    ``(l) 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 subsection.
    ``(m) Report to Congress.--Not later than February 1, 1998, the 
Secretary shall submit to the Committee on Energy and Commerce of the 
House of Representatives, and the Committee on Labor and Human 
Resources of the Senate, a report--
            ``(1) summarizing the reports received by the Secretary 
        under subsection (j);
            ``(2) describing the extent to which the Secretary has, in 
        the service areas of such projects, been successful in meeting 
        the health status objectives specified in subsection (a)(2); 
        and
            ``(3) describing the extent to which demonstration projects 
        under subsection (a) have been cost effective.
    ``(n) Limitation on Certain Expenses of Secretary.--Of the amounts 
appropriated under subsection (p) for a fiscal year, the Secretary may 
not obligate more than an aggregate 5 percent for the administrative 
costs of the Secretary in carrying out this section, for the provision 
of technical assistance regarding demonstration projects under 
subsection (a), and for evaluations of such projects.
    ``(o) Definitions.--For purposes of this section:
            ``(1) The term `authorized services' means the services 
        specified in subsection (b).
            ``(2) The terms `Indian tribe' and `tribal organization' 
        have the meaning given such terms in section 4(b) and section 
        4(c) of the Indian Self-Determination and Education Assistance 
        Act.
            ``(3) The term `service area', with respect to a 
        demonstration project under subsection (a), means the 
        geographic area specified in subsection (c).
    ``(p) 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 1995 through 1997.
    ``(q) Sunset.--Effective October 1, 1997, this section is 
repealed.''.
    (b) Certain Provisions Regarding Reports.--
            (1) Fiscal year 1995.--With respect to grants under section 
        330A of the Public Health Service Act (as added by subsection 
        (a) of this section), the Secretary of Health and Human 
        Services may make a grant under such section for fiscal year 
        1995 only if the applicant for the grant agrees to submit to 
        the Secretary, not later than April 1 of such year, a report on 
        any federally-supported project of the applicant that is 
        substantially similar to the demonstration projects authorized 
        in such section 330A, which report provides, to the extent 
        practicable, the information described in subsection (j) of 
        such section.
            (2) Fiscal year 1997.--With respect to grants for fiscal 
        year 1997 under section 330A of the Public Health Service Act 
        (as added by subsection (a) of this section), the requirement 
        under subsection (j) of such section that a report be submitted 
        not later than April 1, 1998, remains in effect notwithstanding 
        the repeal of such section pursuant to subsection (q) of such 
        section.
    (c) Lapse of Funds.--Effective October 1, 1997, all unexpended 
portions of amounts appropriated for grants under 330A of the Public 
Health Service Act (as added by subsection (a) of this section) are 
unavailable for obligation or expenditure, without regard to whether 
the amounts have been received by the grantees involved.
    (d) Use of General Authority Under Public Health Service Act.--With 
respect to the program established in section 330A of the Public Health 
Service Act (as added by subsection (a) of this section), section 301 
of such Act may not be construed as providing to the Secretary of 
Health and Human Services any authority to carry out, during any fiscal 
year in which such program is in operation, any demonstration project 
to provide any of the services specified in subsection (b) of such 
section 330A.

SEC. 209. DEMONSTRATION PROJECTS REGARDING DIABETIC-RETINOPATHY.

    (a) In General.--The Secretary of Health and Human Services, acting 
through the Director of the Centers for Disease Control and Prevention 
and in consultation with the Director of the National Eye Institute, 
may make grants to public and nonprofit private entities for 
demonstration projects to serve the populations specified in subsection 
(b) by carrying out, with respect to the eye disorder known as diabetic 
retinopathy, activities regarding information, identification, 
dissemination, education, and prevention.
    (b) Relevant Populations.--The populations referred to in 
subsection (a) are minority populations that are at significant risk of 
contracting diabetes mellitus.
    (c) Authorization of Appropriations.--For the purpose of carrying 
out this section, there is authorized to be appropriated $1,000,000 for 
each of the fiscal years 1995 through 1997.

                 TITLE III--HEALTH PROFESSIONS PROGRAMS

SEC. 301. PRIMARY CARE SCHOLARSHIPS FOR STUDENTS FROM DISADVANTAGED 
              BACKGROUNDS.

    (a) In General.--Section 736 of the Public Health Service Act (42 
U.S.C. 293) is amended to read as follows:

``SEC. 736. PRIMARY CARE SCHOLARSHIPS FOR STUDENTS FROM DISADVANTAGED 
              BACKGROUNDS.

    ``(a) In General.--The Secretary may in accordance with this 
section award scholarships to individuals described in subsection (b) 
for the purpose of assisting the individuals with the costs of 
attending schools of medicine or osteopathic medicine, schools of 
dentistry, schools of nursing (as defined in section 853), graduate 
programs in mental health practice, and programs for the training of 
physician assistants.
    ``(b) Eligible Individuals.--An individual referred to in 
subsection (a) is any individual meeting the following conditions:
            ``(1) The individual is from a disadvantaged background.
            ``(2) The individual is enrolled (or accepted for 
        enrollment) at an eligible school as a full-time student in a 
        program leading to a degree in a health profession.
            ``(3) The individual enters into the contract required 
        pursuant to subsection (d) as a condition of receiving the 
        scholarship (relating to an agreement to provide primary health 
        services in a health professional shortage area designated 
        under section 332).
    ``(c) Preferences Regarding Awards; Special Consideration.--In 
awarding scholarships under subsection (a), the Secretary shall--
            ``(1) give preference to eligible individuals for whom the 
        costs of attending the school involved would constitute a 
        severe financial hardship; and
            ``(2) give special consideration to eligible individuals 
        who received scholarships pursuant to this section, section 
        737, or section 740(d)(2) for fiscal year 1993 or 1994 and are 
        seeking scholarships for attendance at eligible schools that 
        received a grant under any of such sections for any of such 
        fiscal years.
    ``(d) Applicability of Certain Provisions.--Except as inconsistent 
with this section, the provisions of subpart III of part D of title III 
apply to an award of a scholarship under subsection (a) to the same 
extent and in the same manner as such provisions apply to an award of a 
scholarship under section 338A. This section shall be carried out by 
the bureau that administers such subpart III.
    ``(e) Definitions.--For purposes of this section:
            ``(1) The term `eligible individual' means an individual 
        described in subsection (b).
            ``(2) The term `eligible school' means a school or program 
        specified in subsection (a).
    ``(f) Funding.--
            ``(1) Authorization of appropriations.--For the purpose of 
        carrying out this section, there are authorized to be 
        appropriated $34,000,000 for fiscal year 1995, $50,000,000 for 
        fiscal year 1996, and $65,000,000 for fiscal year 1997.
            ``(2) Allocations by secretary.--Of the amounts 
        appropriated for a fiscal year under paragraph (1), the 
        Secretary shall make available--
                    ``(A) 20 percent for scholarships under subsection 
                (a) for attendance at schools of nursing; and
                    ``(B) 15 percent for scholarships under such 
                subsection for attendance at graduate programs in 
                mental health practice.''.
    (b) Certain Programs of Obligated Service.--
            (1) Repeal.--Section 795 of the Public Health Service Act 
        (42 U.S.C. 295n) is repealed.
            (2) Rule of construction.--Paragraph (1) does not terminate 
        agreements in effect on the day before the date of the 
        enactment of this Act pursuant to section 795 of the Public 
        Health Service Act. Such agreements continue in effect in 
        accordance with the terms of the agreements. With respect to 
        compliance with such agreements, any period of practice as a 
        provider of primary health services (whether provided pursuant 
        to other agreements with the Federal Government or whether 
        provided otherwise) counts toward satisfaction of the 
        requirement of practice pursuant to such section 795.

SEC. 302. SCHOLARSHIPS GENERALLY; CERTAIN OTHER PURPOSES.

    (a) Relevant Health Professions Schools.--Section 737(a)(3) of the 
Public Health Service Act (42 U.S.C. 293a(a)(3)) is amended--
            (1) by striking ``medicine,'' and all that follows through 
        ``dentistry,''; and
            (2) by striking ``allied health,'' and all that follows and 
        inserting ``allied health.''.
    (b) Eligible Individuals.--
            (1) In general.--Section 737(a)(2) of the Public Health 
        Service Act (42 U.S.C. 293a(a)(2)) is amended to read as 
        follows:
            ``(2) Eligible individuals.--An individual referred to in 
        paragraph (1) is any individual meeting the following 
        conditions:
                    ``(A) The individual is from a disadvantaged 
                background.
                    ``(B) The individual is enrolled (or accepted for 
                enrollment) as a full-time student in a health 
                professions school specified in paragraph (3).
                    ``(C) The individual enters into the contract 
                required pursuant to subsection (e) as a condition of 
                receiving the scholarship under paragraph (1) (relating 
                to an agreement to provide services).''.
            (2) Certain requirement.--Section 737 of the Public Health 
        Service Act (42 U.S.C. 293a) is amended--
                    (A) in subsection (a)(1), by striking ``subsection 
                (e)'' and inserting ``subsection (f)'';
                    (B) by redesignating subsections (e) through (h) as 
                subsections (f) through (i), respectively; and
                    (C) by inserting after subsection (d) the following 
                subsection:
    ``(e) Applicability of Certain Provisions.--
            ``(1) In general.--Except as inconsistent with this 
        section, and subject to paragraph (2), the provisions of 
        subpart III of part D of title III apply to an award of a 
        scholarship under subsection (a) to the same extent and in the 
        same manner as such provisions apply to an award of a 
        scholarship under section 338A. This section shall be carried 
        out by the bureau that administers such subpart III.
            ``(2) Certain individuals.--
                    ``(A) In the case of an individual who receives a 
                scholarship under subsection (a) for attendance at a 
                school of veterinary medicine, the contract referred to 
                in subsection (a)(2)(C) is a contract under which the 
                individual agrees that, after completing training in 
                such medicine, the individual will, in accordance with 
                requirements established under subparagraph (B), 
                conduct or assist in the conduct of research regarding 
                human health or safety. Except as inconsistent with 
                this section, the provisions specified in paragraph (1) 
                with respect to title III apply to such a scholarship 
                to the same extent and in the same manner as such 
                provisions apply to an award of a scholarship under 
                section 338A.
                    ``(B) The Secretary shall establish requirements 
                regarding contracts under subparagraph (A).''.
    (c) Funding.--Section 737(i) of the Public Health Service Act, as 
redesignated by subsection (b)(2) of this section, is amended--
            (1) in paragraph (1), by inserting before the period the 
        following: ``, and $6,000,000 for each of the fiscal years 1994 
        through 1997''; and
            (2) in paragraph (2)(A), by striking ``30 percent'' and all 
        that follows and inserting the following: ``50 percent for such 
        grants to schools of allied health; and''.

SEC. 303. LOAN REPAYMENTS AND FELLOWSHIPS REGARDING FACULTY POSITIONS.

    (a) Loan Repayments.--Section 738(a) of the Public Health Service 
Act (42 U.S.C. 293b(a)) is amended--
            (1) by striking paragraphs (4) and (6);
            (2) by redesignating paragraphs (5) and (7) as paragraphs 
        (4) and (5), respectively; and
            (3) in paragraph (4) (as so redesignated), by amending 
        subparagraph (B) to read as follows:
                    ``(B) the contract referred to in subparagraph (A) 
                provides that the school, in making a determination of 
                the amount of compensation to be provided by the school 
                to the individual for serving as a member of the 
                faculty, will make the determination without regard to 
                the amount of payments made (or to be made) to the 
                individual by the Federal Government under paragraph 
                (1).''.
    (b) Authorization of Appropriations Regarding Loan Repayments and 
Fellowships.--Section 738(c) of the Public Health Service Act (42 
U.S.C. 293b(c)) is amended by striking ``there is'' and all that 
follows and inserting the following: ``there is authorized to be 
appropriated $1,000,000 for each of the fiscal years 1995 through 
1997.''.

SEC. 304. CENTERS OF EXCELLENCE.

    (a) References to Schools.--Section 739 of the Public Health 
Service Act (42 U.S.C. 293c) is amended--
            (1) by striking ``health professions schools'' each place 
        such term appears and inserting ``designated health professions 
        schools''; and
            (2) by striking ``health professions school'' each place 
        such term appears and inserting ``designated health professions 
        school''.
    (b) Required Uses of Funds.--Section 739(b) of the Public Health 
Service Act (42 U.S.C. 293c(b)), as amended by subsection (a), is 
amended--
            (1) by striking paragraph (2);
            (2) by redesignating paragraph (1) as paragraph (2);
            (3) by inserting before paragraph (2) (as so redesignated) 
        the following paragraph:
            ``(1) to collaborate with public and nonprofit private 
        entities to carry out community-based programs to recruit 
        students of secondary schools and institutions of higher 
        education and to prepare the students academically for 
        attendance at the designated health professions school;'';
            (4) in paragraph (5)--
                    (A) by striking ``faculty and student research'' 
                and inserting ``student research''; and
                    (B) by inserting before the period the following: 
                ``, including research on issues relating to the 
                delivery of health care''; and
            (5)(A) in paragraph (4), by striking ``and'' after the 
        semicolon at the end;
            (B) in paragraph (5), by striking the period at the end and 
        inserting ``; and''; and
            (C) by adding at the end the following paragraph:
            ``(6) to carry out a program to train students of the 
        school in providing health services to minority individuals, 
        which program includes training provided 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.''.
    (c) Requirements Regarding Consortia.--
            (1) In general.--Section 739(c)(1) of the Public Health 
        Service Act (42 U.S.C. 293c(c)(1)), as amended by subsection 
        (a), is amended--
                    (A) in subparagraph (A), in the matter preceding 
                clause (i), by striking ``specified in subparagraph 
                (B)'' and inserting ``specified in subparagraphs (B) 
                and (C)'';
                    (B) by redesignating subparagraph (C) as 
                subparagraph (D); and
                    (C) by inserting after subparagraph (B) the 
                following subparagraph:
                    ``(C) The condition specified in this subparagraph 
                is that, in accordance with subsection (e)(1), the 
                designated health professions school involved has with 
                other health profession schools (designated or 
                otherwise) formed a consortium to carry out the 
                purposes described in subsection (b) at the schools of 
                the consortium. The grant involved may be expended with 
                respect to the other schools without regard to whether 
                such schools meet the conditions specified in 
                subparagraph (B).''.
            (2) Certain requirements.--Section 739(e) of the Public 
        Health Service Act (42 U.S.C. 293c(e)), as amended by 
        subsection (a), is amended to read as follows:
    ``(e) Provisions Regarding Consortia.--
            ``(1) Requirements.--For purposes of subsection (c)(1)(C), 
        a consortium of schools has been formed in accordance with this 
        subsection if--
                    ``(A) the consortium consists of--
                            ``(i) the designated health professions 
                        school seeking the grant under subsection (a); 
                        and
                            ``(ii) 1 or more schools of medicine, 
                        osteopathic medicine, dentistry, pharmacy, 
                        nursing, allied health, or public 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.
            ``(2) Authority regarding native americans centers of 
        excellence.--With respect to meeting the conditions specified 
        in subsection (c)(4), the Secretary may make a grant under 
        subsection (a) to a designated health professions school that 
        does not meet such conditions if--
                    ``(A) the school has formed a consortium in 
                accordance with paragraph (1); and
                    ``(B) the schools of the consortium collectively 
                meet such conditions, without regard to whether the 
                schools individually meet such conditions.''.
            (3) Conforming amendments.--Section 739 of the Public 
        Health Service Act (42 U.S.C. 293c), as amended by subsection 
        (a), is amended--
                    (A) in subsection (b), in the matter preceding 
                paragraph (1), by inserting ``, subject to subsection 
                (c)(1)(C),'' after ``agrees''; and
                    (B) in subsection (d)--
                            (i) in paragraph (3), by striking ``(e)'' 
                        and inserting ``(e)(2)''; and
                            (ii) by adding at the end the following 
                        paragraph:
            ``(4) Rule of construction.--Except as provided in 
        paragraph (3) regarding a consortium under subsection (e)(2), a 
        health professions school that does not meet the conditions 
        specified in subsection (c)(1)(B) may not be designated as a 
        center of excellence for purposes of this section. The 
        preceding sentence applies without regard to whether a grant 
        under subsection (a) is, pursuant to subsection (c)(1)(C), 
        being expended with respect to the school.''.
    (d) Definition of Health Professions School.--
            (1) Graduate programs in mental health practice.--Section 
        739(h)(1)(A) of the Public Health Service Act (42 U.S.C. 
        293c(h)(1)(A)), as amended by subsection (a), is amended by--
                    (A) by striking ``or'' after ``dentistry''; and
                    (B) by inserting before the period the following: 
                ``, or a graduate program in mental health practice''.
            (2) Limitation.--During the fiscal years 1995 through 1997, 
        the Secretary of Health and Human Services may not make more 
        than one grant under section 739 of the Public Health Service 
        Act directly to a graduate program in mental health practice 
        (as defined in section 799 of such Act).
    (e) Funding.--Section 739(i) of the Public Health Service Act (42 
U.S.C. 293c(i)), as amended by subsection (a), is amended to read as 
follows:
    ``(i) Funding.--
            ``(1) Authorization of appropriations.--For the purpose of 
        making grants under subsection (a), there are authorized to be 
        appropriated $28,000,000 for fiscal year 1995, $30,000,000 for 
        fiscal year 1996, and $32,000,000 for fiscal year 1997.
            ``(2) Allocations by secretary.--
                    ``(A) Of the amounts appropriated under paragraph 
                (1) for a fiscal year, the Secretary shall make 
                available $12,000,000 for grants under subsection (a) 
                to health professions schools that are eligible for 
                such grants pursuant to meeting the conditions 
                described in paragraph (2)(A) of subsection (c).
                    ``(B) Of the amounts appropriated under paragraph 
                (1) for a fiscal year and available after compliance 
                with subparagraph (A), the Secretary shall make 
                available 65 percent for grants under subsection (a) to 
                health professions schools that are eligible for such 
                grants pursuant to meeting the conditions described in 
                paragraph (3) or (4) of subsection (c) (including 
                meeting conditions pursuant to subsection (e)(2)).
                    ``(C)(i) Of the amounts appropriated under 
                paragraph (1) for a fiscal year and available after 
                compliance with subparagraph (A), the Secretary shall 
                make available 35 percent for grants under subsection 
                (a) to health professions schools that are eligible for 
                such grants pursuant to meeting the conditions 
                described in paragraph (5) of subsection (c).
                    ``(ii) With respect to a fiscal year, a grant under 
                subsection (a) that includes amounts available under 
                subparagraph (A) may not include amounts available 
                under clause (i) unless each of the following 
                conditions is met:
                            ``(I) In the case of amounts available 
                        under subparagraph (B) or clause (i) and 
                        included in grants made pursuant to subsection 
                        (c)(3), the aggregate number of such grants is 
                        not less than such aggregate number for the 
                        preceding fiscal year, and one or more of such 
                        grants is made in an amount that is not less 
                        than the lowest amount among grants made from 
                        amounts available under subparagraph (A).
                            ``(II) In the case of amounts available 
                        under subparagraph (B) or clause (i) and 
                        included in grants made pursuant to subsection 
                        (c)(4), the aggregate number of such grants is 
                        not less than such aggregate number for the 
                        preceding fiscal year, and one or more of such 
                        grants is made in an amount that is not less 
                        than the lowest amount among grants made from 
                        amounts available under subparagraph (A).
                            ``(III) In the case of amounts available 
                        under clause (i) and included in grants made 
                        pursuant to subsection (c)(5) (exclusive of 
                        grants that include amounts available under 
                        subparagraph (A) or (B)), the aggregate number 
                        of such grants is not less than such aggregate 
                        number for the preceding fiscal year, and one 
                        or more of such grants is made in an amount 
                        that is not less than the lowest amount among 
                        grants made from amounts available under 
                        subparagraph (A).
                            ``(IV) The aggregate amount of grants under 
                        subsection (a) made from amounts available 
                        under subparagraph (B) and clause (i) (other 
                        than grants that include amounts available 
                        under subparagraph (A)) is not less than such 
                        aggregate amount for the preceding fiscal 
                        year.''.
    (f) Conforming Amendments.--Section 739(b) of the Public Health 
Service Act (42 U.S.C. 293c(b)), as amended by subsection (a), is 
amended--
            (1) in paragraph (3)(B), by striking ``the designated 
        health professions school'' and inserting ``the school''; and
            (2) in paragraph (4), in each of subparagraphs (B) and (C), 
        by striking ``the designated health professions school'' and 
        inserting ``the school''.
    (g) Transitional and Savings Provisions.--
            (1) In general.--In the case of any entity receiving a 
        grant under section 739 of the Public Health Service Act for 
        fiscal year 1994, the Secretary of Health and Human Services 
        may, during the period specified in paragraph (2), waive any or 
        all of the additional requirements established pursuant to this 
        section for the receipt or expenditure of such a grant, subject 
        to the entity providing assurances satisfactory to the 
        Secretary that the entity is making progress toward meeting 
        such requirements.
            (2) Relevant period.--In the case of any entity receiving a 
        grant under section 739 of the Public Health Service Act for 
        fiscal year 1994, the period referred to in paragraph (1) is 
        the period that, in first approving the grant, the Secretary 
        specified as the duration of the grant.

SEC. 305. EDUCATIONAL ASSISTANCE REGARDING UNDERGRADUATES.

    (a) In General.--Section 740 of the Public Health Service Act (42 
U.S.C. 293d) is amended to read as follows:

``SEC. 740. ASSISTANCE REGARDING HEALTH PROFESSIONS AS CAREER CHOICE.

    ``(a) In General.--
            ``(1) Academic preparation of students.--Subject to the 
        provisions of this section, the Secretary may make grants and 
        enter into contracts for purposes of--
                    ``(A) identifying individuals who--
                            ``(i) are students of elementary schools, 
                        or students or graduates of secondary schools 
                        or of institutions of higher education;
                            ``(ii) are from disadvantaged backgrounds; 
                        and
                            ``(iii) are interested in a career in the 
                        health professions; and
                    ``(B) providing to such individuals academic 
                assistance, counseling, and other services to prepare 
                the students to meet the academic requirements for 
                entry into health professions schools.
            ``(2) Recipients of grants and contracts.--The Secretary 
        may make an award of a grant or contract under paragraph (1) 
        only if the applicant for the award is a nonprofit private 
        community-based organization or other public or nonprofit 
        private entity. Such other entities include schools of 
        medicine, osteopathic medicine, public health, dentistry, 
        veterinary medicine, optometry, pharmacy, allied health, 
        chiropractic, and podiatric medicine, and include graduate 
        programs in mental health practice.
            ``(3) Certain uses of awards.--The purposes for which the 
        Secretary may authorize an award under paragraph (1) to be 
        expended include the following:
                    ``(A) Assisting elementary and secondary schools 
                and institutions of higher education in developing or 
                improving programs to prepare students to meet the 
                academic requirements for entry into health professions 
                schools.
                    ``(B) Establishing arrangements with nonprofit 
                private community-based providers of primary health 
                services under which students are provided with 
                opportunities to visit or work at facilities of such 
                providers and gain experience regarding a career in a 
                field of primary health care.
                    ``(C) Developing or improving programs to enhance 
                the academic preparation of advanced, prehealth 
                professions students or postbaccalaureate individuals 
                to successfully enter a health professions school.
                    ``(D) In the case of an award under paragraph (1) 
                that the Secretary has authorized to be expended for 
                the purpose described in subparagraph (B) or (C), 
                paying such stipends as the Secretary may approve for 
                individuals from disadvantaged backgrounds for any 
                period of education in student-enhancement programs 
                (other than regular courses), except that such a 
                stipend may not be provided to an individual for more 
                than 12 months, and such a stipend shall be in an 
                amount of $25 per day (notwithstanding any other 
                provision of law regarding the amount of stipends).
    ``(b) Minimum Requirements for Awards.--
            ``(1) Assurances regarding financial capacity.--The 
        Secretary may make an award of a grant or contract under 
        subsection (a) only if the applicant provides assurances 
        satisfactory to the Secretary that, with respect to the 
        activities for which the award is to be made, the applicant has 
        or will have the financial capacity to continue the activities 
        after the eligibility of the applicant for such awards for such 
        activities is terminated pursuant to subsection (e).
            ``(2) Collaboration among various entities.--The Secretary 
        may make an award of a grant or contract under subsection (a) 
        only if the applicant for the award has entered into an 
        agreement with any schools, institutions, community-based 
        organizations, or other entities with which the applicant will 
        collaborate in carrying out activities under the award, and the 
        agreement specifies whether and to what extent the award will 
        be allocated among the applicant and the entities.
            ``(3) Matching funds.--
                    ``(A) With respect to the costs of the activities 
                to be carried out under subsection (a) by an applicant, 
                the Secretary may make an award of a grant or contract 
                under such subsection only if the applicant agrees to 
                make available (directly or through donations from 
                public or private entities), in cash, non-Federal 
                contributions toward such costs in an amount that--
                            ``(i) for any second fiscal year for which 
                        the applicant receives such a grant, is not 
                        less than 20 percent of such costs;
                            ``(ii) for any third such fiscal year, is 
                        not less than 20 percent of such costs;
                            ``(iii) for any fourth such fiscal year, is 
                        not less than 40 percent of such costs;
                            ``(iv) for any fifth such fiscal year, is 
                        not less than 60 percent of such costs; and
                            ``(v) for any sixth or subsequent such 
                        fiscal year, is not less than 80 percent of 
                        such costs.
                    ``(B) Amounts provided by the Federal Government 
                may not be included in determining the amount of non-
                Federal contributions required in subparagraph (A).
                    ``(C) The Secretary may not require non-Federal 
                contributions for the first fiscal year for which an 
                applicant receives a grant under subsection (a).
    ``(c) Preference in Making Awards.--
            ``(1) In general.--Subject to paragraph (2), in making 
        awards of grants and contracts under subsection (a), the 
        Secretary shall give preference to any applicant that has made 
        an arrangement with 1 or more elementary schools, an 
        arrangement with 1 or more secondary schools, an arrangement 
        with 1 or more institutions of higher education, an arrangement 
        with 1 or more health professions schools, and an arrangement 
        with 1 or more community-based organizations, the purpose of 
        which arrangements is to establish a program as follows:
                    ``(A) With respect to the elementary schools 
                involved, the program carries out the purposes 
                described in subsection (a)(1).
                    ``(B) After a student identified pursuant to 
                paragraph (1) enters the secondary school involved, the 
                program continues to carry out such purposes with 
                respect to the student.
                    ``(C) After graduating from the secondary school, 
                the student enters the institution of higher education 
                involved, subject to meeting reasonable academic 
                requirements, and the program continues to carry out 
                such purposes with respect to the student.
                    ``(D) After graduating from the institution of 
                higher education, the student enters the health 
                professions school involved, subject to meeting 
                reasonable academic requirements.
            ``(2) Requirement regarding schools and institutions.--For 
        purposes of paragraph (1), an applicant may not receive 
        preference unless the schools or institutions with which 
        arrangements have been made are schools or institutions whose 
        enrollment of students includes a significant number of 
        individuals from disadvantaged backgrounds.
    ``(d) Limitation on Years of Funding for Particular Activities.--
With respect to a particular activity carried out under paragraph (1) 
or (3) of subsection (a) by an entity, the Secretary may not, for the 
activity involved, provide more than 6 years of financial assistance 
under such subsection to the entity.
    ``(e) Funding.--
            ``(1) Authorization of appropriations.--For the purpose of 
        carrying out this section and section 736, there are authorized 
        to be appropriated $32,000,000 for fiscal year 1995, 
        $36,000,000 for fiscal year 1996, and $38,000,000 for fiscal 
        year 1997.
            ``(2) Allocations.--Of the amounts appropriated under 
        paragraph (1) for a fiscal year, the Secretary shall obligate 
        not less than 20 percent for carrying out subsection (a)(3)(B) 
        and not less than 20 percent for providing scholarships under 
        section 736.''.
    (b) Transitional and Savings Provision.--In the case of an entity 
that received an award of a grant or contract for fiscal year 1994 
under section 740 of the Public Health Service Act, the Secretary of 
Health and Human Services may continue in effect the award in 
accordance with the terms of the award, subject to the duration of the 
award not exceeding the period determined by the Secretary in first 
approving the award. The preceding sentence applies notwithstanding the 
amendment made by subsection (a) of this section.

SEC. 306. STUDENT LOANS REGARDING SCHOOLS OF NURSING.

    Section 836(b) of the Public Health Service Act (42 U.S.C. 297b(b)) 
is amended--
            (1) in paragraph (1), by striking the period at the end and 
        inserting a semicolon;
            (2) in paragraph (2)--
                    (A) in subparagraph (A), by striking ``and'' at the 
                end; and
                    (B) by inserting before the semicolon at the end 
                the following: ``, and (C) such additional periods 
                under the terms of paragraph (8) of this subsection'';
            (3) in paragraph (7), by striking the period at the end and 
        inserting ``; and''; and
            (4) by adding at the end the following paragraph:
            ``(8) pursuant to uniform criteria established by the 
        Secretary, the repayment period established under paragraph (2) 
        for any student borrower who during the repayment period failed 
        to make consecutive payments and who, during the last 12 months 
        of the repayment period, has made at least 12 consecutive 
        payments may be extended for a period not to exceed 10 
        years.''.

SEC. 307. FEDERALLY-SUPPORTED STUDENT LOAN FUNDS.

    (a) Authorization of Appropriations Regarding Certain Medical 
Schools.--
            (1) In general.--Subpart II of part A of title VII of the 
        Public Health Service Act (42 U.S.C. 292q et seq.) is amended--
                    (A) by transferring subsection (f) of section 735 
                from the current placement of the subsection;
                    (B) by adding the subsection at the end of section 
                723;
                    (C) by redesignating the subsection as subsection 
                (e); and
                    (D) in subsection (e)(1) of section 723 (as so 
                redesignated), by striking ``1996'' and inserting 
                ``1997''.
            (2) Conforming amendments.--Section 723 of the Public 
        Health Service Act (42 U.S.C. 292s), as amended by paragraph 
        (1) of this subsection, is amended in subsection (e)(2)(A)--
                    (A) by striking ``section 723(b)(2)'' and inserting 
                ``subsection (b)(2)''; and
                    (B) by striking ``such section'' and inserting 
                ``such subsection''.
    (b) Authorization of Appropriations Regarding Individuals From 
Disadvantaged Backgrounds.--Section 724(f)(1) of the Public Health 
Service Act (42 U.S.C. 292t(f)(1)) is amended to read as follows:
            ``(1) In general.--With respect to making Federal capital 
        contributions to student loan funds for purposes of subsection 
        (a), other than the student loan fund of any school of medicine 
        or osteopathic medicine, there is authorized to be appropriated 
        $5,000,000 for each of the fiscal years 1995 through 1997.''.

                           TITLE IV--RESEARCH

SEC. 401. OFFICE OF RESEARCH ON MINORITY HEALTH.

    Section 404 of the Public Health Service Act, as added by section 
151 of Public Law 103-43, is amended by adding at the end the following 
subsections:
    ``(c) Plan.--Subject to applicable law, the Director of the Office, 
in consultation with the advisory committee established under 
subsection (d), shall develop and implement a plan for carrying out the 
duties established in subsection (b). The Director shall review the 
plan not less than annually, and revise the plan as appropriate.
    ``(d) Advisory Committee.--
            ``(1) In carrying out subsection (b), the Director of the 
        Office shall establish an advisory committee to be known as the 
        Advisory Committee on Research on Minority Health (in this 
        subsection referred to as the `Committee').
            ``(2)(A) The Committee shall be composed of nonvoting, ex 
        offico members designated in accordance with subparagraph (B) 
        and voting members appointed in accordance with subparagraph 
        (C).
            ``(B) The Secretary shall designate as ex officio members 
        of the Committee the Directors of each of the national research 
        institutes and the Deputy Assistant Secretary for Minority 
        Health (except that any of such officials may designate another 
        officer or employee of the office or agency involved to serve 
        as a member of the Committee in lieu of the official).
            ``(C) The Director of the Office shall appoint as voting 
        members of the Committee not fewer than 12 and not more than 18 
        individuals who are not officers or employees of the Federal 
        Government. The appointments shall be made from among 
        scientists and health professionals whose clinical practice, 
        research specialization, or professional expertise includes 
        significant expertise in research on minority health. The 
        appointed membership of the Advisory Committee shall be broadly 
        representative of the various minority groups.
            ``(3) The Director of the Office shall serve as the chair 
        of the Committee.
            ``(4) The Committee 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)(A) The Advisory Committee shall prepare biennial 
        reports describing the activities of the Committee, including 
        findings made by the Committee 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) Each report under subparagraph (A) shall be submitted 
        to the Director of NIH for inclusion in the report required in 
        section 403 for the period involved.
    ``(e) Representation of Minorities Among Researchers.--The 
Secretary, acting through the Assistant Secretary for Personnel and in 
collaboration with the Director of the Office, shall determine the 
extent to which the various minority groups are represented among 
administrators, senior physicians, and scientists of the national 
research institutes and among physicians and scientists conducting 
research with funds provided by such institutes, and as appropriate, 
carry out activities to increase the extent of such representation.
    ``(f) Requirement Regarding Grants and Contracts.--Any award of a 
grant, cooperative agreement, or contract that the Director of the 
Office is authorized to make shall be made only on a competitive basis.
    ``(g) Definitions.--For purposes of this section:
            ``(1) 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)--
                    ``(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 clinical research involving such 
                individuals as subjects or insufficient clinical data 
                on such individuals.
            ``(2) The term `research on minority health' means research 
        on minority health conditions, including research on preventing 
        such conditions.
            ``(3) The term `minority groups' has the meaning given such 
        term in section 1707(h).''.

SEC. 402. ACTIVITIES OF AGENCY FOR HEALTH CARE POLICY AND RESEARCH.

    Title IX of the Public Health Service Act (42 U.S.C. 299 et seq.) 
is amended--
            (1) in section 902, by amending subsection (b) 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) the populations of medically underserved urban or 
        rural areas (including frontier areas); and
            ``(2) low-income groups, minority groups, and the 
        elderly.''; and
            (2) in section 926(a), by adding at the end the following 
        sentence: ``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).''.

SEC. 403. DATA COLLECTION BY NATIONAL CENTER FOR HEALTH STATISTICS.

    Section 306(n) of the Public Health Service Act (42 U.S.C. 
242k(n)), as redesignated by section 501(a)(5)(B) of Public Law 103-183 
(107 Stat. 2237), is amended to read as follows:
    ``(n)(1) For health statistical and epidemiological activities 
undertaken or supported under this section, there are authorized to be 
appropriated such sums as may be necessary for each of the fiscal years 
1995 through 1998.
    ``(2) Of the amounts appropriated under paragraph (1) for a fiscal 
year, the Secretary shall obligate not less than an aggregate 
$5,000,000 for carrying out subsections (h), (l), and (m) with respect 
to particular racial and ethnic population groups, except that not more 
than $100,000 may be expended in the aggregate for the administration 
of activities under subsection (m) and for activities described in 
paragraph (2) of such subsection.''.

                  TITLE V--NATIVE HAWAIIAN HEALTH CARE

SEC. 501. CLARIFICATION OF 1992 AMENDMENTS.

    (a) Clarification of Date of Passage.--Section 9168 of the 
Department of Defense Appropriations Act, 1993 (106 Stat. 1948) is 
amended by striking ``September 12, 1992,'' and inserting ``August 7, 
1992,''.
    (b) Effective Date.--The amendment made by subsection (a) shall 
take effect as of October 6, 1992.

SEC. 502. AMENDMENT OF NATIVE HAWAIIAN HEALTH CARE IMPROVEMENT ACT TO 
              REFLECT 1992 AGREEMENT.

    Effective on the date of enactment of this Act, the Native Hawaiian 
Health Care Improvement Act (42 U.S.C. 11701 et seq.) is amended to 
read as follows:

``SECTION 1. SHORT TITLE.

    ``This Act may be cited as the `Native Hawaiian Health Care 
Improvement Act'.

``SEC. 2. FINDINGS; DECLARATION OF POLICY; INTENT OF CONGRESS.

    ``(a) Findings.--The Congress finds that--
            ``(1) the United States retains the legal responsibility to 
        enforce the administration of the public trust responsibility 
        of the State of Hawaii for the betterment of the conditions of 
        Native Hawaiians under section 5(f) of Public Law 86-3 (73 
        Stat. 6; commonly referred to as the `Hawaii Statehood 
        Admissions Act');
            ``(2) in furtherance of the State of Hawaii's public trust 
        responsibility for the betterment of the conditions of Native 
        Hawaiians, contributions by the United States to the provision 
        of comprehensive health promotion and disease prevention 
        services to maintain and improve the health status of Native 
        Hawaiians are consistent with the historical and unique legal 
        relationship of the United States with the government that 
        represented the indigenous native people of Hawaii; and
            ``(3) it is the policy of the United States to raise the 
        health status of Native Hawaiians to the highest possible level 
        and to encourage the maximum participation of Native Hawaiians 
        in order to achieve this objective.
    ``(b) Declaration of Policy.--The Congress hereby declares that it 
is the policy of the United States in fulfillment of its special 
responsibilities and legal obligations to the indigenous people of 
Hawaii resulting from the unique and historical relationship between 
the United States and the Government of the indigenous people of 
Hawaii--
            ``(1) to raise the health status of Native Hawaiians to the 
        highest possible health level; and
            ``(2) to provide existing Native Hawaiian health care 
        programs with all resources necessary to effectuate this 
        policy.
    ``(c) Intent of Congress.--It is the intent of the Congress that 
the Nation meet the following health objectives with respect to Native 
Hawaiians by the year 2000:
            ``(1) Reduce coronary heart disease deaths to no more than 
        100 per 100,000.
            ``(2) Reduce stroke deaths to no more than 20 per 100,000.
            ``(3) Increase control of high blood pressure to at least 
        50 percent of people with high blood pressure.
            ``(4) Reduce blood cholesterol to an average of no more 
        than 200 mg/dl.
            ``(5) Slow the rise in lung cancer deaths to achieve a rate 
        of no more than 42 per 100,000.
            ``(6) Reduce breast cancer deaths to no more than 20.6 per 
        100,000 women.
            ``(7) Increase Pap tests every 1 to 3 years to at least 85 
        percent of women age 18 and older.
            ``(8) Increase fecal occult blood testing every 1 to 2 
        years to at least 50 percent of people age 50 and older.
            ``(9) Reduce diabetes-related deaths to no more than 34 per 
        100,000.
            ``(10) Reduce the most severe complications of diabetes as 
        follows:
                    ``(A) End-stage renal disease to no more than 1.4 
                in 1,000;
                    ``(B) Blindness to no more than 1.4 in 1,000;
                    ``(C) Lower extremity amputation to no more than 
                4.9 in 1,000;
                    ``(D) Perinatal mortality to no more than 2 
                percent; and
                    ``(E) Major congenital malformations to no more 
                than 4 percent.
            ``(11) Reduce infant mortality to no more than 7 deaths per 
        1,000 live births.
            ``(12) Reduce low birth weight to no more than 5 percent of 
        live births.
            ``(13) Increase first trimester prenatal care to at least 
        90 percent of live births.
            ``(14) Reduce teenage pregnancies to no more than 50 per 
        1,000 girls age 17 and younger.
            ``(15) Reduce unintended pregnancies to no more than 30 
        percent of pregnancies.
            ``(16) Increase to at least 60 percent the proportion of 
        primary care providers who provide age-appropriate 
        preconception care and counseling.
            ``(17) Increase years of healthy life to at least 65 years.
            ``(18) Eliminate financial barriers to clinical preventive 
        services.
            ``(19) Increase childhood immunization levels to at least 
        90 percent of 2-year-olds.
            ``(20) Reduce the prevalence of dental caries to no more 
        than 35 percent of children by age 8.
            ``(21) Reduce untreated dental caries so that the 
        proportion of children with untreated caries (in permanent or 
        primary teeth) is no more than 20 percent among children age 6 
        through 8 and no more than 15 percent among adolescents age 15.
            ``(22) Reduce edentulism to no more than 20 percent in 
        people age 65 and older.
            ``(23) Increase moderate daily physical activity to at 
        least 30 percent of the population.
            ``(24) Reduce sedentary lifestyles to no more than 15 
        percent of the population.
            ``(25) Reduce overweight to a prevalence of no more than 20 
        percent of the population.
            ``(26) Reduce dietary fat intake to an average of 30 
        percent of calories or less.
            ``(27) Increase to at least 75 percent the proportion of 
        primary care providers who provide nutrition assessment and 
        counseling or referral to qualified nutritionists or 
        dieticians.
            ``(28) Reduce cigarette smoking prevalence to no more than 
        15 percent of adults.
            ``(29) Reduce initiation of smoking to no more than 15 
        percent by age 20.
            ``(30) Reduce alcohol-related motor vehicle crash deaths to 
        no more than 8.5 per 100,000 adjusted for age.
            ``(31) Reduce alcohol use by school children age 12 to 17 
        to less than 13 percent.
            ``(32) Reduce marijuana use by youth age 18 to 25 to less 
        than 8 percent.
            ``(33) Reduce cocaine use by youth age 18 to 25 to less 
        than 3 percent.
            ``(34) Confine HIV infection to no more than 800 per 
        100,000.
            ``(35) Reduce gonorrhea infections to no more than 225 per 
        100,000.
            ``(36) Reduce syphilis infections to no more that 10 per 
        100,000.
            ``(37) Reduce significant hearing impairment to a 
        prevalance of no more than 82 per 1,000.
            ``(38) Reduce acute middle ear infections among children 
        age 4 and younger, as measured by days of restricted activity 
        or school absenteeism, to no more than 105 days per 100 
        children.
            ``(39) Reduce indigenous cases of vaccine-preventable 
        diseases as follows:
                    ``(A) Diphtheria among individuals age 25 and 
                younger to 0;
                    ``(B) Tetanus among individuals age 25 and younger 
                to 0;
                    ``(C) Polio (wild-type virus) to 0;
                    ``(D) Measles to 0;
                    ``(E) Rubella to 0;
                    ``(F) Congenital Rubella Syndrome to 0;
                    ``(G) Mumps to 500; and
                    ``(H) Pertussis to 1,000; and
            ``(40) Reduce significant visual impairment to a prevalence 
        of no more than 30 per 1,000.
    ``(d) Report.--The Secretary shall submit to the President, for 
inclusion in each report required to be transmitted to the Congress 
under section 9, a report on the progress made toward meeting each of 
the objectives described in subsection (c).

``SEC. 3. COMPREHENSIVE HEALTH CARE MASTER PLAN FOR NATIVE HAWAIIANS.

    ``The Secretary may make a grant to, or enter into a contract with, 
Papa Ola Lokahi for the purpose of coordinating, implementing, and 
updating a Native Hawaiian comprehensive health care master plan 
designed to promote comprehensive health promotion and disease 
prevention services and to maintain and improve the health status of 
Native Hawaiians. The master plan shall be based upon an assessment of 
the health care status and health care needs of Native Hawaiians. To 
the extent practicable, assessments made as of the date of such grant 
or contract shall be used by Papa Ola Lokahi, except that any such 
assessment shall be updated as appropriate.

``SEC. 4. NATIVE HAWAIIAN HEALTH CARE SYSTEMS.

    ``(a) Comprehensive Health Promotion, Disease Prevention, and 
Primary Health Services.--(1)(A) The Secretary, in consultation with 
Papa Ola Lokahi, may make grants to, or enter into contracts with, any 
qualified entity for the purpose of providing comprehensive health 
promotion and disease prevention services as well as primary health 
services to Native Hawaiians.
    ``(B) In making grants and entering into contracts under this 
paragraph, the Secretary shall give preference to Native Hawaiian 
health care systems and Native Hawaiian organizations, and, to the 
extent feasible, health promotion and disease prevention services shall 
be performed through Native Hawaiian health care systems.
    ``(2) In addition to paragraph (1), the Secretary may make a grant 
to, or enter into a contract with, Papa Ola Lokahi for the purpose of 
planning Native Hawaiian health care systems to serve the health needs 
of Native Hawaiian communities on the islands of O'ahu, Moloka'i, Maui, 
Hawai'i, Lana'i, Kaua'i, and Ni'ihau in the State of Hawaii.
    ``(b) Qualified Entity.--An entity is a qualified entity for 
purposes of subsection (a)(1) if the entity is a Native Hawaiian health 
care system.
    ``(c) Services To Be Provided.--(1) Each recipient of funds under 
subsection (a)(1) shall provide the following services:
            ``(A) Outreach services to inform Native Hawaiians of the 
        availability of health services.
            ``(B) Education in health promotion and disease prevention 
        of the Native Hawaiian population by (wherever possible) Native 
        Hawaiian health care practitioners, community outreach workers, 
        counselors, and cultural educators.
            ``(C) Services of physicians, physicians' assistants, or 
        nurse practitioners.
            ``(D) Immunizations.
            ``(E) Prevention and control of diabetes, high blood 
        pressure, and otitis media.
            ``(F) Pregnancy and infant care.
            ``(G) Improvement of nutrition.
    ``(2) In addition to the mandatory services under paragraph (1), 
the following services may be provided pursuant to subsection (a)(1):
            ``(A) Identification, treatment, control, and reduction of 
        the incidence of preventable illnesses and conditions endemic 
        to Native Hawaiians.
            ``(B) Collection of data related to the prevention of 
        diseases and illnesses among Native Hawaiians.
            ``(C) Services within the meaning of the terms `health 
        promotion', `disease prevention', and `primary health 
        services', as such terms are defined in section 10, which are 
        not specifically referred to in paragraph (1) of this 
        subsection.
    ``(3) The health care services referred to in paragraphs (1) and 
(2) which are provided under grants or contracts under subsection 
(a)(1) may be provided by traditional Native Hawaiian healers.
    ``(d) Limitation on Number of Entities.--During a fiscal year, the 
Secretary under this Act may make a grant to, or hold a contract with, 
not more than 5 Native Hawaiian health care systems.
    ``(e) Matching Funds.--(1) The Secretary may not make a grant or 
provide funds pursuant to a contract under subsection (a)(1) to an 
entity--
            ``(A) in an amount exceeding 75 percent of the costs of 
        providing health services under the grant or contract; and
            ``(B) unless the entity agrees that the entity will make 
        available, directly or through donations to the entity, non-
        Federal contributions toward such costs in an amount equal to 
        not less than $1 (in cash or in kind under paragraph (2)) for 
        each $3 of Federal funds provided in such grant or contract.
    ``(2) 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.
    ``(3) The Secretary may waive the requirement established in 
paragraph (1) if--
            ``(A) the entity involved is a nonprofit private entity 
        described in subsection (b); and
            ``(B) the Secretary, in consultation with Papa Ola Lokahi, 
        determines that it is not feasible for the entity to comply 
        with such requirement.
    ``(f) Restriction on Use of Grant and Contract Funds.--The 
Secretary may not make a grant to, or enter into a contract with, an 
entity under subsection (a)(1) unless the entity agrees that amounts 
received pursuant to such subsection will not, directly or through 
contract, be expended--
            ``(1) for any purpose other than the purposes described in 
        subsection (c);
            ``(2) to provide inpatient services;
            ``(3) to make cash payments to intended recipients of 
        health services; or
            ``(4) to purchase or improve real property (other than 
        minor remodeling of existing improvements to real property) or 
        to purchase major medical equipment.
    ``(g) Limitation on Charges for Services.--The Secretary may not 
make a grant, or enter into a contract with, an entity under subsection 
(a)(1) unless the entity agrees that, whether health services are 
provided directly or through contract--
            ``(1) health services under the grant or contract will be 
        provided without regard to ability to pay for the health 
        services; and
            ``(2) the entity will impose a charge for the delivery of 
        health services, and such charge--
                    ``(A) will be made according to a schedule of 
                charges that is made available to the public, and
                    ``(B) will be adjusted to reflect the income of the 
                individual involved.

``SEC. 5. FUNCTIONS OF, AND GRANTS TO, PAPA OLA LOKAHI.

    ``(a) Functions.--Papa Ola Lokahi shall--
            ``(1) coordinate, implement, and update, as appropriate, 
        the comprehensive health care master plan developed pursuant to 
        section 3;
            ``(2) to the maximum extent possible, coordinate and assist 
        the health care programs and services provided to Native 
        Hawaiians;
            ``(3) provide for the training of the persons described in 
        section 4(c)(1)(B);
            ``(4) develop an action plan outlining the contributions 
        that each member organization of Papa Ola Lokahi will make in 
        carrying out this Act;
            ``(5) serve as a clearinghouse for--
                    ``(A) the collection and maintenance of data 
                associated with the health status of Native Hawaiians;
                    ``(B) the identification of and research into 
                diseases affecting Native Hawaiians;
                    ``(C) the availability of Native Hawaiian project 
                funds, research projects, and publications; and
                    ``(D) the timely dissemination of information 
                relating to Native Hawaiian health care systems;
            ``(6) perform the recognition and certification functions 
        specified in sections 10(6)(F) and 10(6)(G); and
            ``(7) provide technical support and coordination of 
        training and technical assistance to Native Hawaiian health 
        care systems.
    ``(b) Special Project Funds.--Papa Ola Lokahi may receive project 
funds that may be appropriated for the purpose of research on the 
health status of Native Hawaiians or for the purpose of addressing the 
health care needs of Native Hawaiians.
    ``(c) Grants.--In addition to any other grant or contract under 
this Act, the Secretary may make grants to, or enter into contracts 
with, Papa Ola Lokahi for--
            ``(1) carrying out the functions described in subsection 
        (a); and
            ``(2) administering any special project funds received 
        under the authority of subsection (b).
    ``(d) Relationships With Other Agencies.--Papa Ola Lokahi may enter 
into agreements or memoranda of understanding with relevant agencies or 
organizations that are capable of providing resources or services to 
Native Hawaiian health care systems.

``SEC. 6. ADMINISTRATION OF GRANTS AND CONTRACTS.

    ``(a) Terms and Conditions.--The Secretary shall include in any 
grant made or contract entered into under this Act such terms and 
conditions as the Secretary considers necessary or appropriate to 
ensure that the objectives of such grant or contract are achieved.
    ``(b) Periodic Review.--The Secretary shall periodically evaluate 
the performance of, and compliance with, grants and contracts under 
this Act.
    ``(c) Administrative Requirements.--The Secretary may not make a 
grant or enter into a contract under this Act with an entity unless the 
entity--
            ``(1) agrees to establish such procedures for fiscal 
        control and fund accounting as may be necessary to ensure 
        proper disbursement and accounting with respect to the grant or 
        contract;
            ``(2) agrees to ensure the confidentiality of records 
        maintained on individuals receiving health services under the 
        grant or contract;
            ``(3) with respect to providing health services to any 
        population of Native Hawaiians a substantial portion of which 
        has a limited ability to speak the English language--
                    ``(A) has developed and has the ability to carry 
                out a reasonable plan to provide health services under 
                the grant or contract through individuals who are able 
                to communicate with the population involved in the 
                language and cultural context that is most appropriate; 
                and
                    ``(B) has designated at least one individual, 
                fluent in both English and the appropriate language, to 
                assist in carrying out the plan;
            ``(4) with respect to health services that are covered in 
        the plan of the State of Hawaii approved under title XIX of the 
        Social Security Act--
                    ``(A) if the entity will provide under the grant or 
                contract any such health services directly--
                            ``(i) the entity has entered into a 
                        participation agreement under such plan; and
                            ``(ii) the entity is qualified to receive 
                        payments under such plan; and
                    ``(B) if the entity will provide under the grant or 
                contract any such health services through a contract 
                with an organization--
                            ``(i) the organization has entered into a 
                        participation agreement under such plan; and
                            ``(ii) the organization is qualified to 
                        receive payments under such plan; and
            ``(5) agrees to submit to the Secretary and to Papa Ola 
        Lokahi an annual report that describes the utilization and 
        costs of health services provided under the grant or contract 
        (including the average cost of health services per user) and 
        that provides such other information as the Secretary 
        determines to be appropriate.
    ``(d) Contract Evaluation.--(1) If, as a result of evaluations 
conducted by the Secretary, the Secretary determines that an entity has 
not complied with or satisfactorily performed a contract entered into 
under section 4, the Secretary shall, prior to renewing such contract, 
attempt to resolve the areas of noncompliance or unsatisfactory 
performance and modify such contract to prevent future occurrences of 
such noncompliance or unsatisfactory performance. If the Secretary 
determines that such noncompliance or unsatisfactory performance cannot 
be resolved and prevented in the future, the Secretary shall not renew 
such contract with such entity and is authorized to enter into a 
contract under section 4 with another entity referred to in section 
4(b) that provides services to the same population of Native Hawaiians 
which is served by the entity whose contract is not renewed by reason 
of this subsection.
    ``(2) In determining whether to renew a contract entered into with 
an entity under this Act, the Secretary shall consider the results of 
evaluation under this section.
    ``(3) All contracts entered into by the Secretary under this Act 
shall be in accordance with all Federal contracting laws and 
regulations except that, in the discretion of the Secretary, such 
contracts may be negotiated without advertising and may be exempted 
from the provisions of the Act of August 24, 1935 (40 U.S.C. 270a et 
seq.).
    ``(4) Payments made under any contract entered into under this Act 
may be made in advance, by means of reimbursement, or in installments 
and shall be made on such conditions as the Secretary deems necessary 
to carry out the purposes of this Act.
    ``(e) Limitation on Use of Funds for Administrative Expenses.--
Except for grants and contracts under section 5(c), the Secretary may 
not make a grant to, or enter into a contract with, an entity under 
this Act unless the entity agrees that the entity will not expend more 
than 10 percent of amounts received pursuant to this Act for the 
purpose of administering the grant or contract.
    ``(f) Report.--(1) For each fiscal year during which an entity 
receives or expends funds pursuant to a grant or contract under this 
Act, such entity shall submit to the Secretary and to Papa Ola Lokahi a 
quarterly report on--
            ``(A) activities conducted by the entity under the grant or 
        contract;
            ``(B) the amounts and purposes for which Federal funds were 
        expended; and
            ``(C) such other information as the Secretary may request.
    ``(2) The reports and records of any entity which concern any grant 
or contract under this Act shall be subject to audit by the Secretary, 
the Inspector General of Health and Human Services, and the Comptroller 
General of the United States.
    ``(g) Annual Private Audit.--The Secretary shall allow as a cost of 
any grant made or contract entered into under this Act the cost of an 
annual private audit conducted by a certified public accountant.

``SEC. 7. ASSIGNMENT OF PERSONNEL.

    ``(a) In General.--The Secretary is authorized to enter into an 
agreement with any entity under which the Secretary is authorized to 
assign personnel of the Department of Health and Human Services with 
expertise identified by such entity to such entity on detail for the 
purposes of providing comprehensive health promotion and disease 
prevention services to Native Hawaiians.
    ``(b) Applicable Federal Personnel Provisions.--Any assignment of 
personnel made by the Secretary under any agreement entered into under 
the authority of subsection (a) shall be treated as an assignment of 
Federal personnel to a local government that is made in accordance with 
subchapter VI of chapter 33 of title 5, United States Code.

``SEC. 8. NATIVE HAWAIIAN HEALTH SCHOLARSHIPS.

    ``(a) Eligibility.--The Secretary is authorized to make scholarship 
grants to students who--
            ``(1) meet the requirements of section 338A(b) of the 
        Public Health Service Act (42 U.S.C. 254l(b)); and
            ``(2) are Native Hawaiians.
    ``(b) Terms and Conditions.--(1) Scholarship grants provided under 
subsection (a) shall be provided under the same terms and subject to 
the same conditions, regulations, and rules that apply to scholarship 
grants provided under section 338A of the Public Health Service Act (42 
U.S.C. 254l), except that--
            ``(A) the provision of scholarships in each type of health 
        care profession training shall correspond to the need for each 
        type of health care professional to serve Native Hawaiian 
        health care systems, as identified by Papa Ola Lokahi;
            ``(B) in selecting scholarship recipients, the Secretary 
        shall give priority to individuals included on a list of 
        eligible applicants submitted by the Kamehameha Schools/Bishop 
        Estate;
            ``(C) the obligated service requirement for each 
        scholarship recipient shall be fulfilled through service, in 
        order of priority, in--
                    ``(i) any one of the five Native Hawaiian health 
                care systems which, during the fiscal year in which the 
                obligated service requirement is assigned, has received 
                a grant or entered into a contract pursuant to section 
                4; or
                    ``(ii) health professions shortage areas, medically 
                underserved areas, or geographic areas or facilities 
                similarly designated by the United States Public Health 
                Service in the State of Hawaii.
    ``(2) The Secretary shall enter into a cooperative agreement with 
the Kamehameha Schools/Bishop Estate under which such organization 
shall provide recruitment, retention, counseling, and other support 
services intended to improve the operation of the scholarship program 
established under this section.
    ``(3) The Native Hawaiian Health Scholarship program shall not be 
administered by or through the Indian Health Service.

``SEC. 9. REPORT.

    ``The President shall, at the time the budget is submitted under 
section 1105 of title 31, United States Code, for each fiscal year 
transmit to the Congress the report required pursuant to section 2(d).

``SEC. 10. DEFINITIONS.

    ``For purposes of this Act:
            ``(1) Disease prevention.--The term `disease prevention' 
        includes--
                    ``(A) immunizations,
                    ``(B) control of high blood pressure,
                    ``(C) control of sexually transmittable diseases,
                    ``(D) prevention and control of diabetes,
                    ``(E) control of toxic agents,
                    ``(F) occupational safety and health,
                    ``(G) accident prevention,
                    ``(H) fluoridation of water,
                    ``(I) control of infectious agents, and
                    ``(J) provision of mental health care.
            ``(2) Health promotion.--The term `health promotion' 
        includes--
                    ``(A) pregnancy and infant care, including 
                prevention of fetal alcohol syndrome,
                    ``(B) cessation of tobacco smoking,
                    ``(C) reduction in the misuse of alcohol and drugs,
                    ``(D) improvement of nutrition,
                    ``(E) improvement in physical fitness,
                    ``(F) family planning, and
                    ``(G) control of stress.
            ``(3) Native hawaiian.--The term `Native Hawaiian' means 
        any individual who is--
                    ``(A) a citizen of the United States; and
                    ``(B) a descendant of the aboriginal people, who 
                prior to 1778, occupied and exercised sovereignty in 
                the area that now constitutes the State of Hawaii, as 
                evidenced by--
                            ``(i) genealogical records;
                            ``(ii) Kupuna (elders) or Kama'aina (long-
                        term community residents) verification; or
                            ``(iii) birth records of the State of 
                        Hawaii.
            ``(4) Native hawaiian health center.--The term `Native 
        Hawaiian health center' means an entity--
                    ``(A) which is organized under the laws of the 
                State of Hawaii,
                    ``(B) which provides or arranges for health care 
                services through practitioners licensed by the State of 
                Hawaii, where licensure requirements are applicable,
                    ``(C) which is a public or nonprofit private 
                entity, and
                    ``(D) in which Native Hawaiian health practitioners 
                significantly participate in the planning, management, 
                monitoring, and evaluation of health services.
            ``(5) Native hawaiian organization.--The term `Native 
        Hawaiian organization' means any organization--
                    ``(A) which serves the interests of Native 
                Hawaiians,
                    ``(B) which is--
                            ``(i) recognized by Papa Ola Lokahi for the 
                        purpose of planning, conducting, or 
                        administering programs (or portions of 
                        programs) authorized under this Act for the 
                        benefit of Native Hawaiians, and
                            ``(ii) certified by Papa Ola Lokahi as 
                        having the qualifications and capacity to 
                        provide the services, and meet the 
                        requirements, under the contract the 
                        organization enters into with, or grant the 
                        organization receives from, the Secretary under 
                        this Act,
                    ``(C) in which Native Hawaiian health practitioners 
                significantly participate in the planning, management, 
                monitoring, and evaluation of health services, and
                    ``(D) which is a public or nonprofit private 
                entity.
            ``(6) Native hawaiian health care system.--The term `Native 
        Hawaiian health care system' means an entity--
                    ``(A) which is organized under the laws of the 
                State of Hawaii;
                    ``(B) which provides or arranges for health care 
                services through practitioners licensed by the State of 
                Hawaii, where licensure requirements are applicable;
                    ``(C) which is a public or nonprofit private 
                entity;
                    ``(D) in which Native Hawaiian health practitioners 
                significantly participate in the planning, management, 
                monitoring, and evaluation of health care services;
                    ``(E) which may be composed of as many Native 
                Hawaiian health centers as necessary to meet the health 
                care needs of Native Hawaiians residing on the island 
                or islands served by such entity;
                    ``(F) which is recognized by Papa Ola Lokahi for 
                the purpose of providing comprehensive health promotion 
                and disease prevention services as well as primary 
                health services to Native Hawaiians under this Act; and
                    ``(G) which is certified by Papa Ola Lokahi as 
                having the qualifications and the capacity to provide 
                the services and meet the requirements of a contract 
                entered into, or a grant received, under section 4.
            ``(7) Papa ola lokahi.--(A) Subject to subparagraph (B), 
        the term `Papa Ola Lokahi' means an organization composed of--
                    ``(i) E Ola Mau;
                    ``(ii) the Office of Hawaiian Affairs of the State 
                of Hawaii;
                    ``(iii) Alu Like Inc.;
                    ``(iv) the University of Hawaii;
                    ``(v) the Office of Hawaiian Health of the Hawaii 
                State Department of Health;
                    ``(vi) Ho'ola Lahui Hawaii, or a health care system 
                serving the islands of Kaua'i and Ni'ihau;
                    ``(vii) Ke Ola Mamo, or a health care system 
                serving the island of O'ahu;
                    ``(viii) Na Pu'uwai or a health care system serving 
                the islands of Moloka'i and Lana'i;
                    ``(ix) Hui No Ke Ola Pono, or a health care system 
                serving the island of Maui;
                    ``(x) Hui Malama Ola Ha'Oiwi or a health care 
                system serving the island of Hawaii; and
                    ``(xi) such other member organizations as the Board 
                of Papa Ola Lokahi may admit from time to time, based 
                upon satisfactory demonstration of a record of 
                contribution to the health and well-being of Native 
                Hawaiians, and upon satisfactory development of a 
                mission statement in relation to this Act, including 
                clearly defined goals and objectives, a 5-year action 
                plan outlining the contributions that each organization 
                will make in carrying out the policy of this Act, and 
                an estimated budget.
            ``(B) Such term does not include any organization 
        identified in subparagraph (A) if the Secretary determines that 
        such organization does not have a mission statement with 
        clearly defined goals and objectives for the contributions the 
        organization will make to Native Hawaiian health care systems 
        and an action plan for carrying out such goals and objectives.
            ``(8) Primary health services.--The term `primary health 
        services' means--
                    ``(A) services of physicians, physicians' 
                assistants and nurse practitioners;
                    ``(B) diagnostic laboratory and radiologic 
                services;
                    ``(C) preventive health services (including 
                children's eye and ear examinations to determine the 
                need for vision and hearing correction, perinatal 
                services, well child services, and family planning 
                services);
                    ``(D) emergency medical services;
                    ``(E) transportation services as required for 
                adequate patient care;
                    ``(F) preventive dental services; and
                    ``(G) pharmaceutical services, as may be 
                appropriate for particular health centers.
            ``(9) Secretary.--The term `Secretary' means the Secretary 
        of Health and Human Services.
            ``(10) Traditional native hawaiian healer.--The term 
        `traditional Native Hawaiian healer' means a practitioner--
                    ``(A) who--
                            ``(i) is of Hawaiian ancestry, and
                            ``(ii) has the knowledge, skills, and 
                        experience in direct personal health care of 
                        individuals, and
                    ``(B) whose knowledge, skills, and experience are 
                based on a demonstrated learning of Native Hawaiian 
                healing practices acquired by--
                            ``(i) direct practical association with 
                        Native Hawaiian elders, and
                            ``(ii) oral traditions transmitted from 
                        generation to generation.

``SEC. 11. RULE OF CONSTRUCTION.

    ``Nothing in this Act shall be construed to restrict the authority 
of the State of Hawaii to license health practitioners.

``SEC. 12. COMPLIANCE WITH BUDGET ACT.

    ``Any new spending authority (described in subsection (c)(2) (A) or 
(B) of section 401 of the Congressional Budget Act of 1974) which is 
provided under this Act shall be effective for any fiscal year only to 
such extent or in such amounts as are provided in appropriation Acts.

``SEC. 13. SEVERABILITY.

    ``If any provision of this Act, or the application of any such 
provision to any person or circumstances is held to be invalid, the 
remainder of this Act, and the application of such provision or 
amendment to persons or circumstances other than those to which it is 
held invalid, shall not be affected thereby.

``SEC. 14. AUTHORIZATION OF APPROPRIATIONS.

    ``There is authorized to be appropriated for each of the fiscal 
years 1994, 1995, 1996, 1997, 1998, 1999, and 2000 such sums as may be 
necessary to carry out the purposes of this Act.

``SEC. 15. PROHIBITION AGAINST EXCLUSION FROM PARTICIPATION.

    ``Notwithstanding any other provision of this Act, no person shall, 
on the basis of race, color, or national origin, be excluded from 
participation in, or be denied the benefits of, or be subjected to 
discrimination under, any program or activity receiving Federal 
financial assistance under this Act.''.

SEC. 503. REPEAL OF PUBLIC HEALTH SERVICE ACT PROVISION.

    The Public Health Service Act (42 U.S.C. 201 et seq.), as amended 
by section 206 of this Act, is amended by repealing section 338K and 
redesignating section 338L as section 338K. Such repeal shall not be 
construed to terminate contracts in effect under such section on the 
date of the enactment of this Act. Any such contracts shall continue 
according to the terms and conditions of such contracts.

                   TITLE VI--MISCELLANEOUS PROVISIONS

SEC. 601. TECHNICAL AMENDMENT TO INDIAN HEALTH CARE IMPROVEMENT ACT.

    The last sentence of section 818(e)(3) of the Indian Health Care 
Improvement Act (25 U.S.C. 1680h(e)(3)) is amended--
            (1) by striking ``services,'' and inserting ``services''; 
        and
            (2) by striking ``, shall be recoverable.'' and inserting a 
        period.

SEC. 602. 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) by striking paragraphs (5) and (6);
                    (B) by redesignating paragraphs (7) and (8) as 
                paragraphs (5) and (6), respectively;
                    (C) in paragraph (1) (as so redesignated)--
                            (i) by inserting ``substance abuse'' after 
                        ``availability of health''; and
                            (ii) by striking ``, including improved 
                        health data systems''; and
                    (D) in paragraph (2) (as so redesignated)--
                            (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; and
            (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 ``$3,000,000 for 
                each of the fiscal years 1995 through 1997''.

SEC. 603. TECHNICAL CORRECTIONS REGARDING PUBLIC LAW 103-183.

    (a) Amendatory Instructions.--Public Law 103-183 is amended--
            (1) in section 301(a), by striking ``(42 U.S.C. 242 et 
        seq.)'' and inserting ``(42 U.S.C. 243 et seq.)'';
            (2) in section 601--
                    (A) in subsection (b), in the matter preceding 
                paragraph (1), by striking ``Section 1201 of the Public 
                Health Service Act (42 U.S.C. 300d)'' and inserting 
                ``Title XII of the Public Health Service Act (42 U.S.C. 
                300d et seq.)''; and
                    (B) in subsection (f)(1), by striking ``in section 
                1204(c)'' and inserting ``in section 1203(c) (as 
                redesignated by subsection (b)(2) of this section)'';
            (3) in section 602, by striking ```for the purpose'' and 
        inserting ```For the purpose''; and
            (4) in section 705(b), by striking ``317D((l)(1)'' and 
        inserting ``317D(l)(1)''.
    (b) Public Health Service Act.--The Public Health Service Act, as 
amended by Public Law 103-183 and by subsection (a) of this section, is 
amended--
            (1) in section 317E(g)(2), by striking ``making grants 
        under subsection (b)'' and inserting ``carrying out subsection 
        (b)'';
            (2) in section 318, in subsection (e) as in effect on the 
        day before the date of the enactment of Public Law 103-183, by 
        redesignating the subsection as subsection (f);
            (3) in part D of title III, by inserting before section 
        340D the following subpart heading:

``Subpart IX--Miscellaneous Provisions Regarding Primary Health Care'';

            (4) in subpart 6 of part C of title IV--
                    (A) by transferring the first section 447 (added by 
                section 302 of Public Law 103-183) from the current 
                placement of the section;
                    (B) by redesignating the section as section 447A; 
                and
                    (C) by inserting the section after section 447;
            (5) in section 1213(a)(8), by striking ``provides for for'' 
        and inserting ``provides for'';
            (6) in section 1501, by redesignating the second subsection 
        (c) (added by section 101(f) of Public Law 103-183) as 
        subsection (d); and
            (7) in section 1505(3), by striking ``nonprofit''.
    (c) Miscellaneous Correction.--Section 401(c)(3) of Public Law 103-
183 is amended in the matter preceding subparagraph (A) by striking 
``(d)(5)'' and inserting ``(e)(5)''.

SEC. 604. CERTAIN AUTHORITIES OF CENTERS FOR DISEASE CONTROL AND 
              PREVENTION.

    Part B of title III of the Public Health Service Act (42 U.S.C. 243 
et seq.), as amended pursuant to section 603(a)(1) of this Act and as 
amended by section 703 of Public Law 103-183, is amended by inserting 
after section 317F the following section:

 ``miscellaneous authorities regarding centers for disease control and 
                               prevention

    ``Sec. 317G. (a) Technical and Scientific Peer Review Groups.--The 
Secretary, acting through the Director of the Centers for Disease 
Control and Prevention, may, without regard to the provisions of title 
5, United States Code, governing appointments in the competitive 
service, and without regard to the provisions of chapter 51 and 
subchapter III of chapter 53 of such title relating to classification 
and General Schedule pay rates, establish such technical and scientific 
peer review groups and scientific program advisory committees as are 
needed to carry out the functions of such Centers and appoint and pay 
the members of such groups, except that officers and employees of the 
United States shall not receive additional compensation for service as 
members of such groups. The Federal Advisory Committee Act shall not 
apply to the duration of such peer review groups. Not more than one-
fourth of the members of any such group shall be officers or employees 
of the United States.
    ``(b) Fellowship and Training Programs.--The Secretary, acting 
through the Director of the Centers for Disease Control and Prevention, 
shall establish fellowship and training programs to be conducted by 
such Centers to train individuals to develop skills in epidemiology, 
surveillance, laboratory analysis, and other disease detection and 
prevention methods. Such programs shall be designed to enable health 
professionals and health personnel trained under such programs to work, 
after receiving such training, in local State, national, and 
international efforts toward the prevention and control of diseases, 
injuries, and disabilities. Such fellowships and training may be 
administered through the use of either appointment or nonappointment 
procedures.''.

                     TITLE VII--GENERAL PROVISIONS

SEC. 701. EFFECTIVE DATE.

    Except as otherwise provided in this Act, this Act takes effect 
October 1, 1994, or upon the date of the enactment of this Act, 
whichever occurs later.

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