[Congressional Bills 103th Congress]
[From the U.S. Government Publishing Office]
[S. 1569 Introduced in Senate (IS)]

103d CONGRESS
  1st Session
                                S. 1569

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


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

             October 19 (legislative day, October 13), 1993

Mr. Kennedy (for himself and Mr. Hatch) introduced the following bill; 
 which was read twice and referred to the Committee on Labor and Human 
                               Resources

_______________________________________________________________________

                                 A BILL


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

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

SECTION 1. SHORT TITLE; REFERENCE; TABLE OF CONTENTS.

    (a) Short Title.--This Act may be cited as the ``Preventive Health 
Services and Health Professions Amendments Act of 1993''.
    (b) Reference.--Except as otherwise expressly provided, whenever in 
this Act an amendment or a repeal is expressed in terms of an amendment 
to, or a repeal of, a section or other provision, the reference shall 
be considered to be made to a section or other provision of the Public 
Health Service Act (42 U.S.C. 201 et seq.).
    (c) Table of Contents.--The table of contents is as follows:

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

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

Sec. 201. Community scholarship programs.
Sec. 202. Health services for residents of public housing.
Sec. 203. Issuance of regulations regarding language as impediment to 
                            receipt of services.
Sec. 204. Health services for Pacific Islanders.
                     TITLE III--HEALTH PROFESSIONS

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

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

Sec. 501. Revision and extension of program for State Offices of Rural 
                            Health.
Sec. 502. Technical corrections relating to health professions.
Sec. 503. Clinical traineeships.
Sec. 504. Demonstration project grants to States for alzheimer's 
                            disease.
Sec. 505. Medically underserved area study.
Sec. 506. Programs regarding birth defects.
                      TITLE VI--GENERAL PROVISIONS

Sec. 601. Effective date.

SEC. 2. FINDINGS.

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

                         TITLE I--HEALTH POLICY

SEC. 101. OFFICE OF MINORITY HEALTH.

    Section 1707 (42 U.S.C. 300u-6) is amended by striking subsection 
(b) and all that follows and inserting the following:
    ``(b) Duties.--With respect to improving the health of racial and 
ethnic minorities, the Secretary, acting through the Deputy Assistant 
Secretary for Minority Health, shall carry out the following:
            ``(1) Establish short-range and long-range goals and 
        objectives and coordinate all other activities within the 
        Department of Health and Human Services that relate to disease 
        prevention, health promotion, service delivery, and research 
        concerning such individuals. The heads of the operating 
        divisions of the Department of Health and Human Services and 
        the heads of Public Health Service agencies shall consult with 
        the Deputy Assistant Secretary for Minority Health to assist in 
        the coordination of all activities within the Department as 
        they relate to disease prevention, health promotion, service 
        delivery, and research concerning such individuals.
            ``(2) Carry out the following types of activities by 
        entering into interagency agreements with other agencies of the 
        public health service:
                    ``(A) Support research, demonstrations and 
                evaluations to test new and innovative models.
                    ``(B) Increase knowledge and understanding of 
                health risk factors.
                    ``(C) Develop mechanisms that support better 
                information dissemination, education, prevention, and 
                service delivery to individuals from disadvantaged 
                backgrounds, including racial and ethnic minorities.
            ``(3) Establish a national minority health resource center 
        to carry out the following:
                    ``(A) Facilitate the exchange of information 
                regarding matters relating to health information and 
                health promotion, preventive health services, and 
                education in the appropriate use of health care.
                    ``(B) 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) Establish a national center that shall carry out 
        programs to improve access to health care services for 
        individuals with limited English proficiency by facilitating 
        the removal of impediments to the receipt of health care that 
        result from such limitation.
            ``(5) With respect to awards of grants and contracts that 
        are available under certain minority health programs, establish 
        a program--
                    ``(A) to inform entities, as appropriate, that the 
                entities may be eligible for the awards;
                    ``(B) to provide technical assistance to such 
                entities in the process of preparing and submitting 
                applications for the awards in accordance with the 
                policies of the Secretary regarding such application; 
                and
                    ``(C) to inform populations, as appropriate, that 
                members of the populations may be eligible to receive 
                services or otherwise participate in the activities 
                carried out with such awards.
    ``(c) Advisory Committee.--
            ``(1) In general.--The Secretary shall establish an 
        advisory committee to be known as the Advisory Committee on 
        Minority Health (in this subsection referred to as the 
        `Committee').
            ``(2) Duties.--The Committee shall provide advice to the 
        Secretary on carrying out this section, including advice on the 
        development of goals and specific program activities under 
        subsection (b)(1) for each racial and ethnic group.
            ``(3) Chairperson.--The Deputy Assistant Secretary for 
        Minority Health shall serve as the Chairperson of the 
        Committee.
            ``(4) Composition.--The Committee shall be composed of no 
        fewer than 12, and not more than 18 individuals, who are not 
        officers or employees of the Federal Government. The Secretary 
        shall appoint the members of the Committee from among 
        individuals with expertise regarding issues of minority health. 
        The membership of the Committee shall be equitably 
        representative of the various racial and ethnic groups. The 
        Secretary may appoint representatives from selected Federal 
        agencies to serve as ex officio, non-voting members of the 
        Committee.
            ``(5) Terms.--Each member of the Committee shall serve for 
        a term of 4 years, except that the Secretary shall initially 
        appoint a portion of the members to terms of 1 year, 2 years, 
        and 3 years.
            ``(6) Vacancies.--If a vacancy occurs on the Committee, a 
        new member shall be appointed by the Secretary within 90 days 
        from the date that the vacancy occurs, and serve for the 
        remainder of the term for which the predecessor of such member 
        was appointed. The vacancy shall not affect the power of the 
        remaining members to execute the duties of the Committee.
            ``(7) Compensation.--Members of the Committee who are 
        officers or employees of the United States shall serve without 
        compensation. Members of the Committee who are not officers or 
        employees of the United States shall receive, for each day 
        (including travel time) they are engaged in the performance of 
        the functions of the Committee, compensation at rates that do 
        not exceed the daily equivalent of the annual rate in effect 
        for grade GS-18 of the General Schedule under title 5, United 
        States Code.
    ``(d) Certain Requirements Regarding Duties.--
            ``(1) Recommendations regarding language as impediment to 
        health care.--The Secretary, acting through the Director of the 
        Office of Refugee Health, the Director of the Office of Civil 
        Rights, and the Director of the Office of Minority Health of 
        the Health Resources and Services Administration, shall make 
        recommendations regarding activities under subsection (b)(4).
            ``(2) Equitable allocation regarding activities.--In 
        awarding grants or contracts under section 340A, 724, 737, 738, 
        or 1707, the Secretary shall ensure that such awards are 
        equitably allocated with respect to the various racial and 
        ethnic populations.
            ``(3) Cultural competency of services.--The Secretary shall 
        ensure that information and services provided pursuant to 
        subsection (b) are provided in the language and cultural 
        context that is most appropriate for the individuals for whom 
        the information and services are intended.
            ``(4) Peer review.--The Secretary shall ensure that each 
        application for a grant, contract or cooperative agreement 
        under section 340A, 724, 737, or 1707 undergoes appropriate 
        peer review.
    ``(e) Reports.--Not later than January 31 of fiscal year 1995 and 
of each second year thereafter, the Secretary shall submit to the 
Congress a report describing the activities carried out under this 
section during the preceding 2 fiscal years and evaluating the extent 
to which such activities have been effective in improving the health of 
racial and ethnic minorities.
    ``(f) Grants and Contracts Regarding Duties.--
            ``(1) Authority.--In carrying out subsection (b), the 
        Secretary may enter into contracts with public and nonprofit 
        private entities for activities described in paragraphs (3) and 
        (4) of subsection (b).
            ``(2) Evaluation and dissemination.--The Secretary shall, 
        directly or through contracts with public and private entities, 
        provide for evaluations of projects carried out with financial 
        assistance provided under paragraph (1) during the preceding 2 
        fiscal years. The report shall be included in the report 
        required under subsection (e) for the fiscal year involved.
    ``(g) Definition.--As used in this section, the term `racial and 
ethnic minority group' means Hispanics, Blacks, Asian Americans, 
Pacific Islanders, Native Americans, and Alaskan Natives. The term 
`Hispanic' means individuals whose origin is Mexican, Puerto Rican, 
Cuban, Central or South American, or any other Spanish-speaking 
country, including Spain or the Caribbean Islands, and individuals 
identifying themselves as Hispanic, Latino, Spanish, or Spanish-
American.
    ``(h) Funding.--
            ``(1) Authorization of appropriations.--For the purpose of 
        carrying out this section, there is authorized to be 
        appropriated $20,500,000 for fiscal year 1994, and such sums as 
        may be necessary for each of the fiscal years 1995 through 
        1998.
            ``(2) Allocation of funds by secretary.--Of the amounts 
        appropriated under paragraph (1) for a fiscal year in excess of 
        $15,000,000, the Secretary shall make available not less than 
        $3,000,000 for activities to improve access to health care 
        services for individuals with limited English proficiency, 
        including activities identified in subsection (b)(4).''.

SEC. 102. AGENCY OFFICES OF MINORITY HEALTH.

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

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

    ``(a) In General.--The Secretary, acting through the Deputy 
Assistant Secretary for Minority Health, shall ensure that an Office of 
Minority Health is established and operating at the Centers for Disease 
Control and Prevention, the Health Resources and Services 
Administration, the Substance Abuse and Mental Health Administration, 
and the Agency for Health Care Policy and Research. Such Offices shall 
be established to ensure that services and programs carried out within 
each such respective agency or office--
            ``(1) are equitably delivered with respect to racial and 
        ethnic groups;
            ``(2) provide culturally competent services; and
            ``(3) utilize racial and ethnic minority community-based 
        organizations to deliver services.
    ``(b) Reports.--Each Office of Minority Health within the 
Department of Health and Human Services shall submit a report, not 
later than May 1 of each year, to the Deputy Assistant Secretary for 
Minority Health (as provided for in section 1707(a)) describing the 
accomplishments or programs of the plan, the budget allocation and 
expenditures for, and the development and implementation of, such 
health programs targeting racial and ethnic minority populations. The 
Secretary shall ensure the participation and cooperation of each Agency 
in the development of the annual report.''.

SEC. 103. STATE OFFICES OF MINORITY HEALTH.

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

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

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

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

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

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

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

                       TITLE II--HEALTH SERVICES

SEC. 201. COMMUNITY SCHOLARSHIP PROGRAMS.

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

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

    Section 340A(p)(1) (42 U.S.C. 256a(p)(1)) is amended--
            (1) by striking ``$35,000,000 for fiscal year 1991'' and 
        inserting ``$12,000,000 for fiscal year 1994''; and
            (2) by striking ``1992 and 1993'' and inserting ``1995 and 
        1996''.

SEC. 203. ISSUANCE OF REGULATIONS REGARDING LANGUAGE AS IMPEDIMENT TO 
              RECEIPT OF SERVICES.

    (a) Proposed Rule.--Not later than the expiration of the 90-day 
period beginning on the date of the enactment of this Act, the 
Secretary of Health and Human Services (in this section referred to as 
the ``Secretary'') shall issue a proposed rule regarding policies to 
reduce the extent to which having limited English proficiency 
constitutes a significant impediment to individuals in establishing the 
eligibility of the individuals for participation in health programs 
under the Public Health Service Act or in receiving services under such 
programs.
    (b) Final Rule.--
            (1) In general.--Not later than the expiration of the 1-
        year period beginning on the date of the enactment of this Act, 
        the Secretary shall issue a final rule regarding the policies 
        described in subsection (a).
            (2) Failure to issue by date certain.--If the Secretary 
        fails to issue a final rule under paragraph (1) before the 
        expiration of the period specified in such paragraph, the 
        proposed rule issued under subsection (a) is upon such 
        expiration deemed to be the final rule under paragraph (1) (and 
        shall remain in effect until the Secretary issues a final rule 
        under such paragraph).

SEC. 204. HEALTH SERVICES FOR PACIFIC ISLANDERS.

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

                     TITLE III--HEALTH PROFESSIONS

SEC. 301. LOANS FOR DISADVANTAGED STUDENTS.

    Section 724(f)(1) (42 U.S.C. 292t(f)(1)) is amended--
            (1) by striking ``there is'' and inserting ``there are''; 
        and
            (2) by striking ``$15,000,000 for fiscal year 1993'' and 
        inserting ``$8,000,000 for fiscal year 1994, and such sums as 
        may be necessary for each of the fiscal years 1995 and 1996''.

SEC. 302. CESAR CHAVEZ SCHOLARSHIP PROGRAM.

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

``SEC. 736. CESAR CHAVEZ SCHOLARSHIP PROGRAM.

            (2) in subsection (c)--
                    (A) by striking ``there is'' and inserting ``there 
                are''; and
                    (B) by striking ``$11,000,000 for fiscal year 
                1993'' and inserting ``$10,500,000 for fiscal year 
                1994, and such sums as may be necessary for each of the 
                fiscal years 1995 and 1996''.

SEC. 303. THURGOOD MARSHALL SCHOLARSHIP PROGRAM.

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

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

            (2) in subsection (a)--
                    (A) in paragraph (1), by inserting ``(to be known 
                as Thurgood Marshall Scholars)'' after ``providing 
                scholarships to individuals''; and
                    (B) in paragraph (3), by inserting after ``public 
                health,'' schools offering programs for the training of 
                physician assistants,''.
            (3) in subsection (h), by striking paragraph (1) and 
        inserting the following new paragraph:
            ``(1) Authorization of appropriations.--For the purpose of 
        carrying out this section, there are authorized to be 
        appropriated $17,100,000 for fiscal year 1994, and such sums as 
        may be necessary for each of the fiscal years 1995 and 1996.''.

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

    Section 738 (42 U.S.C. 293b) is amended--
            (1) in subsection (a)--
                    (A) in paragraph (2), by striking ``disadvantaged 
                backgrounds who--'' and inserting ``racial or ethnic 
                groups that are underrepresented in the health 
                professions who--''
                    (B) in paragraph (5)--
                            (i) by striking ``; and'' in subparagraph 
                        (A) and inserting a period;
                            (ii) by striking ``unless--'' and all that 
                        follows through ``the individual involved'' in 
                        subparagraph (A) and inserting ``unless the 
                        individual involved''; and
                            (iii) striking subparagraph (B);
                    (C) by striking paragraph (6); and
                    (D) by redesignating paragraph (7) as paragraph 
                (6); and
            (2) in subsection (b)(2)(B), by striking ``$30,000'' and 
        inserting ``$50,000'';
            (3) in subsection (c)--
                    (A) by striking ``there is'' and inserting ``there 
                are''; and
                    (B) by striking ``$4,000,000 for fiscal year 1993'' 
                and inserting ``$1,100,000 for fiscal year 1994, and 
                such sums as may be necessary for each of the fiscal 
                years 1995 and 1996''.

SEC. 305. CENTERS OF EXCELLENCE.

    Section 739 (42 U.S.C. 293c) is amended--
            (1) in subsection (b)--
                    (A) in paragraph (2), by inserting before the 
                semicolon the following: ``through collaboration with 
                public and nonprofit private entities to carry out 
                community-based programs to prepare students in 
                secondary schools and institutions of higher education 
                for attendance at the health professions school'';
                    (B) in paragraph (4), by striking ``and'' at the 
                end thereof;
                    (C) in paragraph (5), by striking the period and 
                inserting ``; and''; and
                    (D) by adding at the end thereof the following new 
                paragraph:
            ``(6) to carry out a program to provide training to the 
        students of the school to enable such students to provide 
        health services to minority individuals at community-based 
        health facilities that provide such services to a significant 
        number of minority individuals and that are located at a site 
        remote from the main site of the teaching facilities of the 
        school.'';
            (2) in subsection (e)--
                    (A) by striking the subsection heading and 
                inserting ``Authority Regarding Consortia.--'';
                    (B) by striking paragraph (1) and inserting the 
                following new paragraph:
            ``(1) In general.--The Secretary may make a grant under 
        subsection (a) to any school of medicine, osteopathic medicine, 
        dentistry, clinical psychology, or pharmacy that has in 
        accordance with paragraph (2) formed a consortium of 
        schools.'';
                    (C) in paragraph (2), by striking subparagraphs (A) 
                through (D) and inserting the following new 
                subparagraphs:
                    ``(A) the consortium consists of--
                            ``(i) the health professions school seeking 
                        the grant under subsection (a); and
                            ``(ii) one or more schools of medicine, 
                        osteopathic medicine, dentistry, pharmacy, 
                        nursing, allied health, public health, clinical 
                        psychology, or graduate programs in mental 
                        health practice;
                    ``(B) the schools of the consortium have entered 
                into an agreement for the allocation of such grant 
                among the schools; and
                    ``(C) each of the schools agrees to expend the 
                grant in accordance with this section.''; and
                    (D) by adding at the end the following paragraph:
            ``(3) Authority for collectively meeting relevant 
        requirements in certain cases.--With respect to meeting the 
        conditions specified in subsection (c)(4) for Native American 
        Centers of Excellence, the Secretary may make a grant to any 
        school that has in accordance with paragraphs (1) and (2) 
        formed a consortium of schools that meets such conditions 
        (without regard to whether the schools of the consortium 
        individually meet such conditions).''; and
            (3) in subsection (i)--
                    (A) in paragraph (1), by striking ``such sums as 
                may be necessary for fiscal year 1993'' and inserting 
                ``$25,000,000 for fiscal year 1994, and such sums as 
                may be necessary for each of the fiscal years 1995 and 
                1996''; and
                    (B) in paragraph (2)(C) by adding at the end the 
                following: ``Health professions schools described in 
                subsection (c)(2)(A) shall be eligible for grants under 
                this subparagraph in a fiscal year if the amount 
                appropriated for the fiscal year under paragraph (1) is 
                greater than $23,500,000. Such schools shall be 
                eligible to apply only for grants made from the portion 
                of such amount that exceeds $23,500,000.''.

SEC. 306. EDUCATIONAL ASSISTANCE REGARDING UNDERGRADUATES.

    Section 740 (42 U.S.C. 293d) is amended--
            (1) in subsection (a)(1), by adding at the end the 
        following new sentence: ``To be eligible for such a grant, a 
        school shall have in place a program to assist individuals from 
        disadvantaged backgrounds in gaining entry into a health 
        professions school or completing the course of study at such a 
        school.'';
            (2) in subsection (d)(1)--
                    (A) by striking ``there is'' and inserting ``there 
                are''; and
                    (B) by striking ``1993'' and inserting ``1994, and 
                such sums as may be necessary for each of the fiscal 
                years 1995 and 1996''.
            (3) in subsection (d)(2)(B), by adding at the end thereof 
        the following new sentence: ``Scholarship recipients under this 
        section shall be known as `Cesar Chavez Primary Care 
        Scholars.''.

SEC. 307. AREA HEALTH EDUCATION CENTERS.

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

                 TITLE IV--RESEARCH AND DATA COLLECTION

SEC. 401. OFFICE OF RESEARCH ON MINORITY HEALTH.

    Section 404 (42 U.S.C. 283b), as added by section 151 of Public Law 
103-43, is amended by adding at the end the following subsections:
    ``(c) Plan.--The Director of the Office, shall collaborate with the 
Deputy Assistant Secretary for Minority Health (as provided for in 
section 1707), to develop and implement a plan for carrying out the 
duties required by subsection (b). The Director, in consultation with 
the Deputy Assistant Secretary for Minority Health, shall review the 
plan not less often than annually, and revise the plan as appropriate.
    ``(d) Equity Regarding Various Groups.--The Director of the Office 
shall ensure that activities under subsection (b) address equitably all 
minority groups.
    ``(e) Advisory Committee.--
            ``(1) Establishment.--In carrying out subsection (b), the 
        Secretary shall establish an advisory committee to be known as 
        the Advisory Committee on Research on Minority Health (in this 
        subsection referred to as the `Advisory Committee').
            ``(2) Composition.--
                    ``(A) Voting and nonvoting members.--The Advisory 
                Committee shall be composed of voting members appointed 
                in accordance with subparagraph (B) and the ex officio 
                nonvoting members described in subparagraph (C).
                    ``(B) Voting members.--The Advisory Committee shall 
                include not fewer than 12, and not more than 18, voting 
                members who are not officers or employees of the 
                Federal Government. The Director of the Office shall 
                appoint such members to the Advisory Committee from 
                among physicians, practitioners, scientists, consumers 
                and other health professionals, whose clinical 
                practices, research specialization, or professional 
                expertise includes a significant focus on research on 
                minority health or on the barriers that minorities must 
                overcome to participate in clinical trials. The 
                membership of the Advisory Committee shall be equitably 
                representative of the minority groups served by the 
                Office.
                    ``(C) Ex officio nonvoting members.--The Deputy 
                Assistant Secretary for Minority Health and the 
                Directors of each of the national research entities 
                shall serve as ex officio nonvoting members of the 
                Advisory Committee (except that any of such Directors 
                may designate an official of the institute involved to 
                serve as such member of the Committee in lieu of the 
                Director).
            ``(3) Chairperson.--The Director of the Office shall serve 
        as the chairperson of the Advisory Committee.
            ``(4) Duties.--The Advisory 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) Biennial report.--
                    ``(A) Preparation.--The Advisory Committee shall 
                prepare a biennial report 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) Submission.--The report required in 
                subparagraph (A) shall be submitted to the Director of 
                the National Institutes of Health for inclusion in the 
                report required in section 403.
    ``(f) Representatives of Minorities Among Researchers.--The 
Secretary, acting through the Assistant Secretary for Personnel 
Administration and in collaboration with the Director of the Office, 
shall determine the extent to which minorities are represented among 
senior physicians and scientists 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.
    ``(g) Definitions.--For purposes of this part:
            ``(1) Minority health conditions.--The term `minority 
        health conditions', with respect to individuals who are members 
        of minority groups, means all diseases, disorders, and 
        conditions (including with respect to mental health)--
                    ``(A) unique to, more serious, or more prevalent in 
                such individuals;
                    ``(B) for which the factors of medical risk or 
                types of medical intervention are different for such 
                individuals, or for which it is unknown whether such 
                factors or types are different for such individuals; or
                    ``(C) with respect to which there has been 
                insufficient research involving such individuals as 
                subjects or insufficient data on such individuals.
            ``(2) Research on minority health.--The term `research on 
        minority health' means research on minority health conditions, 
        including research on preventing such conditions.
            ``(3) Minority groups.--The term `minority groups' means 
        Blacks, American Indians, Alaskan Natives, Asian/Pacific 
        Islanders, and Hispanics, including subpopulations of such 
        groups.''.

SEC. 402. NATIONAL CENTER FOR HEALTH STATISTICS.

    (a) In General.--Section 306 (42 U.S.C. 242k) is amended--
            (1) in subsection (c), by striking ``Committee on Human 
        Resources'' and inserting ``Committee on Labor and Human 
        Resources'';
            (2) in subsection (g), by striking ``data which shall be 
        published'' and all that follows and inserting ``data.'';
            (3) in subsection (k)(2)--
                    (A) in subparagraph (A)--
                            (i) by striking the subparagraph 
                        designation; and
                            (ii) by striking ``Except as provided in 
                        subparagraph (B), members'' and inserting 
                        ``Members''; and
                    (B) by striking subparagraph (B);
            (4) in subsection (l)--
                    (A) by striking paragraph (3);
                    (B) by redesignating paragraph (4) as paragraph 
                (3); and
                    (C) in paragraph (3) (as so redesignated), by 
                striking ``paragraphs (1), (2), and (3),'' and 
                inserting ``paragraphs (1) and (2),''; and
            (5) in subsection (o)--
                    (A) in paragraph (1), by striking ``1991 through 
                1993'' and inserting ``1994 through 1997''; and
                    (B) in paragraph (2), by striking ``$5,000,000'' 
                and all that follows through ``1993'' and inserting 
                ``$1,100,000 for fiscal year 1994, and such sums as may 
                be necessary for each of the fiscal years 1995 through 
                1997''.
    (b) General Authority Respecting Research, Evaluations, and 
Demonstrations.--Section 304 (42 U.S.C. 242b) is amended by striking 
subsection (d).
    (c) General Provisions Respecting Effectiveness, Efficiency, and 
Quality of Health Services.--Section 308 (42 U.S.C. 242m) is amended--
            (1) in subsection (a)--
                    (A) in paragraph (1)--
                            (i) by striking subparagraph (A); and
                            (ii) by redesignating subparagraphs (B) 
                        through (E) as subparagraphs (A) through (D), 
                        respectively; and
                    (B) in paragraph (2), by striking ``reports 
                required by subparagraphs'' and all that follows 
                through ``Center'' and inserting the following: 
                ``reports required in paragraph (1) shall be prepared 
                through the National Center'';
            (2)(A) by striking subsection (c);
            (B) by transferring paragraph (2) of subsection (g) from 
        the current location of the paragraph;
            (C) by redesignating such paragraph as subsection (c);
            (D) by inserting subsection (c) (as so redesignated) after 
        subsection (b); and
            (E) by striking the remainder of subsection (g);
            (3) in subsection (c) (as so redesignated)--
                    (A) by striking ``shall (A) take'' and inserting 
                ``shall take''; and
                    (B) by striking ``and (B) publish'' and inserting 
                ``and shall publish'';
            (4) in subsection (f), by striking ``sections 3648'' and 
        all that follows and inserting ``section 3324 of title 31, 
        United States Code, and section 3709 of the Revised Statutes 
        (41 U.S.C. 5).''; and
            (5) by striking subsection (h).

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

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

                         TITLE V--MISCELLANEOUS

SEC. 501. REVISION AND EXTENSION OF PROGRAM FOR STATE OFFICES OF RURAL 
              HEALTH.

    (a) Matching Funds.--Section 338J(b) (42 U.S.C. 254r(b)) is amended 
to read as follows:
    ``(b) Requirement of Matching Funds.--
            ``(1) In general.--With respect to the costs to be incurred 
        by a State in carrying out the purpose described in subsection 
        (a), the Secretary may not make a grant under such subsection 
        unless the State agrees to provide non-Federal contributions 
        toward such costs, in cash, in an amount that is not less than 
        $1 for each $1 of Federal funds provided in the grant.
            ``(2) Determination of amount contributed.--In determining 
        the amount of non-Federal contributions in cash that a State 
        has provided pursuant to paragraph (1), the Secretary may not 
        include any amounts provided to the State by the Federal 
        Government.''.
    (b) Authorization of Appropriations.--Section 338J(j)(1) (42 U.S.C. 
254r(j)(1)) is amended--
            (1) by striking ``and'' after ``1992,''; and
            (2) by inserting before the period the following: ``, and 
        $5,000,000 for each of the fiscal years 1994 through 1996''.
    (c) Termination of Program.--Section 338J(k) (42 U.S.C. 254r(k)) is 
amended by striking $10,000,000'' and inserting ``$20,000,000''.

SEC. 502. TECHNICAL CORRECTIONS RELATING TO HEALTH PROFESSIONS.

    (a) Health Education Assistance Loan Deferment for Borrowers 
Providing Health Services to Indians.--
            (1) In general.--Section 705(a)(2)(C) is amended by 
        striking ``and (x)'' and inserting ``(x) not in excess of three 
        years, during which the borrower is providing health care 
        services to Indians through an Indian health program (as 
        defined in section 108(a)(2)(A) of the Indian Health Care 
        Improvement Act (25 U.S.C. 1616a(a)(2)(A)); and (xi)''.
            (2) Conforming amendments.--Section 705(a)(2)(C) is further 
        amended--
                    (A) in clause (xi) (as so redesignated) by striking 
                ``(ix)'' and inserting ``(x)''; and
                    (B) in the matter following such clause (xi), by 
                striking ``(x)'' and inserting ``(xi)''.
            (3) Effective date.--The amendments made by this subsection 
        shall apply with respect to services provided on or after the 
        first day of the third month that begins after the date of 
        enactment of this Act.
    (b) Maximum Student Loan Provision.--Section 722(a)(1) (42 U.S.C. 
292r(a)(1)), as amended by section 2014(b)(1) of Public Law 103-43, is 
amended by striking ``the sum of'' and all that follows through the end 
thereof and inserting ``the cost of attendance (including tuition, 
other reasonable educational expenses, and reasonable living costs) for 
that year at the educational institution attended by the student (as 
determined by such educational institution).''.
    (c) Requirement for Schools.--Section 723(b)(1) (42 U.S.C. 
292s(b)(1)), as amended by section 2014(c)(2)(A)(ii) of Public Law 103-
43 (107 Stat. 216), is amended by striking ``3 years before'' and 
inserting ``4 years before''.
    (d) Service Requirement for Primary Care Loan Borrowers.--Section 
723(a) (42 U.S.C. 292s(a)) is amended in subparagraph (B) of paragraph 
(1), by striking ``through the date on which the loan is repaid in 
full'' and inserting ``for 5 years after completing the residency 
program''.
    (e) Preference and Required Information in Certain Programs.--
Section 791 (42 U.S.C. 295j) is amended by adding at the end thereof 
the following subsection:
    ``(d) Exceptions.--
            ``(1) In general.--To permit new programs to compete 
        equitably for funding under this section, those new programs 
        that meet the criteria described in paragraph (3) shall qualify 
        for a funding preference under this section.
            ``(2) Definition.--As used in this subsection, the term 
        `new program' means any program that has graduated less than 
        three classes. Upon graduating at least three classes, a 
        program shall have the capability to provide the information 
        necessary to qualify the program for the general funding 
        preferences described in subsection (a).
            ``(3) Criteria.--The criteria referred to in paragraph (1) 
        are the following:
                    ``(A) The mission statement of the program 
                identifies a specific purpose of the program as being 
                the preparation of health professionals to serve 
                underserved populations.
                    ``(B) The curriculum of the program includes 
                content which will help to prepare practitioners to 
                serve underserved populations.
                    ``(C) Substantial clinical training experience is 
                required under the program in medically underserved 
                communities.
                    ``(D) A minimum of 20 percent of the faculty of the 
                program spend at least 50 percent of their time 
                providing or supervising care in medically underserved 
                communities.
                    ``(E) The entire program or a substantial portion 
                of the program is physically located in a medically 
                underserved community.
                    ``(F) Student assistance, which is linked to 
                service in medically underserved communities following 
                graduation, is available to the students in the 
                program.
                    ``(G) The program provides a placement mechanism 
                for deploying graduates to medically underserved 
                communities.''.
    (f) Preferences in Making Awards.--
            (1) Title vii.--Section 791(a)(1)(A) (42 U.S.C. 
        295j(a)(1)(A)) is amended by striking ``communities; or'' and 
        inserting ``communities including--
                            ``(i) ambulatory practice sites designated 
                        by State Governors as shortage areas or 
                        medically underserved communities for purposes 
                        of State scholarships or loan repayment or 
                        related programs; and
                            ``(ii) practices or facilities in which not 
                        less than 50 percent of the patients are 
                        recipients of aid under title XIX of the Social 
                        Security Act or eligible and uninsured; or''.
            (2) Title viii.--Section 860(e)(1)(A)(i) (42 U.S.C. 298b-
        7(e)(1)(A)(i)) is amended by striking ``communities; or'' and 
        inserting ``communities including--
                            ``(i) ambulatory practice sites designated 
                        by State Governors as shortage areas or 
                        medically underserved communities for purposes 
                        of State scholarships or loan repayment or 
                        related programs; and
                            ``(ii) practices or facilities in which not 
                        less than 50 percent of the patients are 
                        recipients of aid under title XIX of the Social 
                        Security Act or eligible and uninsured; or''.
    (g) Generally Applicable Modifications Regarding Obligated 
Service.--
            (1) In general.--Section 795 (42 U.S.C. 295n), is amended--
                    (A) in subsection (a)(2)--
                            (i) in subparagraph (A), by striking 
                        ``speciality in'' and inserting ``field of''; 
                        and
                            (ii) in subparagraph (B), by striking 
                        ``speciality'' and inserting ``field''; and
                    (B) in subsection (b)(1), in each of subparagraphs 
                (A) and (B), by striking ``interest on such amount at 
                the maximum legal prevailing rate'' and inserting 
                ``interest on such amount at the rate of 12 percent per 
                year (compounded annually)''.
            (2) Effective date.--Each amendment made by paragraph (1) 
        shall take effect as if such subsection had been enacted 
        immediately after the enactment of the Health Professions 
        Education Extension Amendments of 1992.
    (h) Recovery.--Part G of title VII (42 U.S.C. 295j et seq.) is 
amended by inserting after section 795, the following new section:

``SEC. 796. RECOVERY.

    ``(a) In General.--If at any time within 20 years (or within such 
shorter period as the Secretary may prescribe by regulation for an 
interim facility) after the completion of construction of a facility 
with respect to which funds have been paid under section 720(a) (as 
such section existed one day prior to the date of enactment of the 
Health Professions Education Extension Amendments of 1992 (Public Law 
102-408)--
            ``(1)(A) in case of a facility which was an affiliated 
        hospital or outpatient facility with respect to which funds 
        have been paid under such section 720(a)(1), the owner of the 
        facility ceases to be a public or other nonprofit agency that 
        would have been qualified to file an application under section 
        605;
            ``(B) in case of a facility which was not an affiliated 
        hospital or outpatient facility but was a facility with respect 
        to which funds have been paid under paragraph (1) or (3) of 
        such section 720(a), the owner of the facility ceases to be a 
        public or nonprofit school, or
            ``(C) in case of a facility which was a facility with 
        respect to which funds have been paid under such section 
        720(a)(2), the owner of the facility ceases to be a public or 
        nonprofit entity,
            ``(2) the facility ceases to be used for the teaching or 
        training purposes (or other purposes permitted under section 
        722 (as such section existed one day prior to the date of 
        enactment of the Health Professions Education Extension 
        Amendments of 1992 (Public Law 102-408)) for which it was 
        constructed, or
            ``(3) the facility is used for sectarian instruction or as 
        a place for religious worship,
the United States shall be entitled to recover from the owner of the 
facility the base amount prescribed by subsection (c)(1) plus the 
interest (if any) prescribed by subsection (c)(2).
    ``(b) Notice.--The owner of a facility which ceases to be a public 
or nonprofit agency, school, or entity as described in subparagraph 
(A), (B), or (C) of subsection (a)(1), as the case may be, or the owner 
of a facility the use of which changes as described in paragraph (2) or 
(3) of subsection (a), shall provide the Secretary written notice of 
such cessation or change of use within 10 days after the date on which 
such cessation or change of use occurs or within 30 days after the date 
of enactment of this subsection, whichever is later.
    ``(c) Amount.--
            ``(1) Base amount.--The base amount that the United States 
        is entitled to recover under subsection (a) is the amount 
        bearing the same ratio to the then value (as determined by the 
        agreement of the parties or in an action brought in the 
        district court of the United States for the district in which 
        the facility is situated) of the facility as the amount of the 
        Federal participation bore to the cost of construction.
            ``(2) Interest.--
                    ``(A) In general.--The interest that the United 
                States is entitled to recover under subsection (a) is 
                the interest for the period (if any) described in 
                subparagraph (B) at a rate (determined by the 
                Secretary) based on the average of the bond equivalent 
                rates of ninety-one-day Treasury bills auctioned during 
                that period.
                    ``(B) Period.--The period referred to in 
                subparagraph (A) is the period beginning--
                            ``(i) if notice is provided as prescribed 
                        by subsection (b), 191 days after the date on 
                        which the owner of the facility ceases to be a 
                        public or nonprofit agency, school, or entity 
                        as described in subparagraph (A), (B), or (C) 
                        of subsection (a)(1), as the case may be, or 
                        191 days after the date on which the use of the 
                        facility changes as described in paragraph (2) 
                        or (3) of subsection (a), or
                            ``(ii) if notice is not provided as 
                        prescribed by subsection (b), 11 days after the 
                        date on which such cessation or change of use 
                        occurs,
                and ending on the date the amount the United States is 
                entitled to recover is collected.
    ``(d) Waiver.--The Secretary may waive the recovery rights of the 
United States under subsection (a)(2) with respect to a facility (under 
such conditions as the Secretary may establish by regulation) if the 
Secretary determines that there is good cause for waiving such rights.
    ``(e) Lien.--The right of recovery of the United States under 
subsection (a) shall not, prior to judgment, constitute a lien on any 
facility.''.

SEC. 503. CLINICAL TRAINEESHIPS.

    Section 303(d)(1) (42 U.S.C. 242a(d)(1)) is amended by inserting 
``counseling'' after ``family therapy,''.

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

    (a) In General.--Section 398(a) (42 U.S.C. 280c-3(a)) is amended--
            (1) in the matter preceding paragraph (1), by striking 
        ``not less than 5, and not more than 15,'';
            (2) in paragraph (2)--
                    (A) by inserting after ``disorders'' the following: 
                ``who are living in single family homes or in 
                congregate settings''; and
                    (B) by striking ``and'' at the end;
            (3) by redesignating paragraph (3) as paragraph (4); and
            (4) by inserting after paragraph (2) the following:
            ``(3) to improve access for individuals with Alzheimer's 
        disease or related disorders, particularly such individuals 
        from ethnic, cultural, or language minorities and such 
        individuals who are living in isolated rural areas, to services 
        that--
                    ``(A) are home-based or community-based long-term 
                care services; and
                    ``(B) exist on the date of enactment of this 
                paragraph; and''.
    (b) Duration.--Section 398A (42 U.S.C. 280c-4) is amended--
            (1) in the title, by striking ``LIMITATION ON'';
            (2) in subsection (a)--
                    (A) in the heading, by striking ``Limitation on''; 
                and
                    (B) by striking ``may not exceed'' and inserting 
                ``may exceed''; and
            (3) in subsection (b), in paragraphs (1)(C) and (2)(C), by 
        inserting ``, and any subsequent year,'' after ``third year''.
    (c) Authorization of Appropriations.--Section 398B(e) (42 U.S.C. 
280c-5(e)) is amended by striking ``and 1993'' and inserting ``through 
1998''.

SEC. 505. MEDICALLY UNDERSERVED AREA STUDY.

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

SEC. 506. 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, 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 operate regional centers for the conduct of 
        epidemiologic research and study of such defects, and to 
        improve the education, training, and clinical skills of health 
        professionals with respect to the prevention of such defects; 
        and
            ``(4) to carry out demonstration projects for the 
        prevention of such defects.
    ``(b) 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. Recipients of assistance 
        under this subsection shall collect and analyze demographic 
        data utilizing appropriate sources as determined by the 
        Secretary.
            ``(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; and
            ``(3) contains an assessment of the extent to which each 
        approach to preventing birth defects has been effective, 
        including a description of effectiveness in relation to cost;
            ``(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 such sums as 
may be necessary for each of the fiscal years 1994 through 1997.''.

                      TITLE VI--GENERAL PROVISIONS

SEC. 601. EFFECTIVE DATE.

    This Act and the amendments made by this Act shall take effect 
October 1, 1993, or upon the date of the enactment of this Act, 
whichever occurs later.

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