[Congressional Bills 103th Congress]
[From the U.S. Government Publishing Office]
[S. 1 Engrossed Amendment House (EAH)]

103d CONGRESS

  1st Session

                                  S. 1

_______________________________________________________________________

                               AMENDMENT
                In the House of Representatives, U. S.,

                                                        March 10, 1993.
      Resolved, That the bill from the Senate (S. 1) entitled ``An Act 
to amend the Public Health Service Act to revise and extend the 
programs of the National Institutes of Health, and for other 
purposes'', do pass with the following

                               AMENDMENT:

        Strike out all after the enacting clause, and insert:

SECTION 1. SHORT TITLE; TABLE OF CONTENTS.

    (a) Short Title.--This Act may be cited as the ``National 
Institutes of Health Revitalization Act of 1993''.
    (b) Table of Contents.--The table of contents for this Act is as 
follows:

Sec. 1. Short title; table of contents.

TITLE I--GENERAL PROVISIONS REGARDING TITLE IV OF PUBLIC HEALTH SERVICE 
                                  ACT

                      Subtitle A--Research Freedom

   Part I--Review of Proposals for Biomedical and Behavioral Research

Sec. 101. Establishment of certain provisions regarding research 
                            conducted or supported by National 
                            Institutes of Health.

          Part II--Research on Transplantation of Fetal Tissue

Sec. 111. Establishment of authorities.
Sec. 112. Purchase of human fetal tissue; solicitation or acceptance of 
                            tissue as directed donation for use in 
                            transplantation.
Sec. 113. Nullification of moratorium.
Sec. 114. Report by General Accounting Office on adequacy of 
                            requirements.

                    Part III--Miscellaneous Repeals

Sec. 121. Repeals.

  Subtitle B--Clinical Research Equity Regarding Women and Minorities

     Part I--Women and Minorities as Subjects in Clinical Research

Sec. 131. Requirement of inclusion in research.
Sec. 132. Peer review.
Sec. 133. Applicability to current projects.

             Part II--Office of Research on Women's Health

Sec. 141. Establishment.

            Part III--Office of Research on Minority Health

Sec. 151. Establishment.

                     Subtitle C--Research Integrity

Sec. 161. Establishment of Office of Research Integrity.
Sec. 162. Commission on Research Integrity.
Sec. 163. Protection of whistleblowers.
Sec. 164. Requirement of regulations regarding protection against 
                            financial conflicts of interest in certain 
                            projects of research.
Sec. 165. Effective dates.

           TITLE II--NATIONAL INSTITUTES OF HEALTH IN GENERAL

Sec. 201. Health promotion research dissemination.
Sec. 202. Programs for increased support regarding certain States and 
                            researchers.
Sec. 203. Establishment of Office of Behavioral Research.
Sec. 204. Children's vaccine initiative.
Sec. 205. Plan for use of animals in research.
Sec. 206. Increased participation of women and disadvantaged 
                            individuals in fields of biomedical and 
                            behavioral research.
Sec. 207. Requirements regarding surveys of sexual behavior.
Sec. 208. Discretionary fund of Director of National Institutes of 
                            Health.
Sec. 209. Establishment of Office of Alternative Medicine.
Sec. 210. Miscellaneous provisions.

 TITLE III--GENERAL PROVISIONS RESPECTING NATIONAL RESEARCH INSTITUTES

Sec. 301. Appointment and authority of Directors of national research 
                            institutes.
Sec. 302. Program of research on osteoporosis, Paget's disease, and 
                            related disorders.
Sec. 303. Establishment of interagency program for trauma research.

                  TITLE IV--NATIONAL CANCER INSTITUTE

Sec. 401. Expansion and intensification of activities regarding breast 
                            cancer.
Sec. 402. Expansion and intensification of activities regarding 
                            prostate cancer.
Sec. 403. Authorization of appropriations.
Sec. 404. Study of environmental and other risks contributing to 
                            incidence of breast cancer.

           TITLE V--NATIONAL HEART, LUNG, AND BLOOD INSTITUTE

Sec. 501. Education and training.
Sec. 502. Centers for the study of pediatric cardiovascular diseases.
Sec. 503. National Center on Sleep Disorders.
Sec. 504. Authorization of appropriations.

   TITLE VI--NATIONAL INSTITUTE ON DIABETES AND DIGESTIVE AND KIDNEY 
                                DISEASES

Sec. 601. Provisions regarding nutritional disorders.

TITLE VII--NATIONAL INSTITUTE ON ARTHRITIS AND MUSCULOSKELETAL AND SKIN 
                                DISEASES

Sec. 701. Juvenile arthritis.

                TITLE VIII--NATIONAL INSTITUTE ON AGING

Sec. 801. Alzheimer's disease registry.
Sec. 802. Aging processes regarding women.
Sec. 803. Authorization of appropriations.
Sec. 804. Conforming amendment.

    TITLE IX--NATIONAL INSTITUTE OF ALLERGY AND INFECTIOUS DISEASES

Sec. 901. Tropical diseases.
Sec. 902. Chronic fatigue syndrome.

   TITLE X--NATIONAL INSTITUTE OF CHILD HEALTH AND HUMAN DEVELOPMENT

Subtitle A--Research Centers With Respect to Contraception and Research 
                  Centers With Respect to Infertility

Sec. 1001. Grants and contracts for research centers.
Sec. 1002. Loan repayment program for research with respect to 
                            contraception and infertility.

        Subtitle B--Program Regarding Obstetrics and Gynecology

Sec. 1011. Establishment of program.

               Subtitle C--Child Health Research Centers

Sec. 1021. Establishment of centers.

             Subtitle D--Study Regarding Adolescent Health

Sec. 1031. Prospective longitudinal study.

                    TITLE XI--NATIONAL EYE INSTITUTE

Sec. 1101. Clinical research on diabetes eye care.

   TITLE XII--NATIONAL INSTITUTE OF NEUROLOGICAL DISORDERS AND STROKE

Sec. 1201. Research on multiple sclerosis.

    TITLE XIII--NATIONAL INSTITUTE OF ENVIRONMENTAL HEALTH SCIENCES

Sec. 1301. Applied Toxicological Research and Testing Program.

                TITLE XIV--NATIONAL LIBRARY OF MEDICINE

                     Subtitle A--General Provisions

Sec. 1401. Additional authorities.
Sec. 1402. Authorization of appropriations.

                    Subtitle B--Financial Assistance

Sec. 1411. Establishment of program of grants for development of 
                            education technologies.

Subtitle C--National Information Center on Health Services Research and 
                         Health Care Technology

Sec. 1421. Establishment of Center.
Sec. 1422. Conforming provisions.

       TITLE XV--OTHER AGENCIES OF NATIONAL INSTITUTES OF HEALTH

               Subtitle A--Division of Research Resources

Sec. 1501. Redesignation of Division as National Center for Research 
                            Resources.
Sec. 1502. Biomedical and behavioral research facilities.
Sec. 1503. Construction program for national primate research center.

            Subtitle B--National Center for Nursing Research

Sec. 1511. Redesignation of National Center for Nursing Research as 
                            National Institute of Nursing Research.
Sec. 1512. Study on adequacy of number of nurses.

         Subtitle C--National Center for Human Genome Research

Sec. 1521. Purpose of Center.

                     TITLE XVI--AWARDS AND TRAINING

              Subtitle A--National Research Service Awards

Sec. 1601. Requirement regarding women and individuals from 
                            disadvantaged backgrounds.

            Subtitle B--Acquired Immune Deficiency Syndrome

Sec. 1611. Loan repayment program.

           Subtitle C--Loan Repayment for Research Generally

Sec. 1621. Establishment of program.

     Subtitle D--Scholarship and Loan Repayment Programs Regarding 
      Professional Skills Needed by National Institutes of Health

Sec. 1631. Establishment of programs.
Sec. 1632. Funding.

         Subtitle E--Funding for Awards and Training Generally

Sec. 1641. Authorization of appropriations.

        TITLE XVII--NATIONAL FOUNDATION FOR BIOMEDICAL RESEARCH

Sec. 1701. Date certain for appointment of Board members.
Sec. 1702. Miscellaneous provisions.

   TITLE XVIII--RESEARCH WITH RESPECT TO ACQUIRED IMMUNE DEFICIENCY 
                                SYNDROME

                  Subtitle A--Office of AIDS Research

Sec. 1801. Establishment of Office.
Sec. 1802. Establishment of emergency discretionary fund.
Sec. 1803. General provisions.

                      Subtitle B--Certain Programs

Sec. 1811. Revision and extension of certain programs.

                           TITLE XIX--STUDIES

Sec. 1901. Acquired immune deficiency syndrome.
Sec. 1902. Malnutrition in the elderly.
Sec. 1903. Research activities on chronic fatigue syndrome.
Sec. 1904. Report on medical uses of biological agents in development 
                            of defenses against biological warfare.
Sec. 1905. Personnel study of recruitment, retention and turnover.
Sec. 1906. Procurement.
Sec. 1907. Chronic pain conditions.
Sec. 1908. Back injuries.

                   TITLE XX--MISCELLANEOUS PROVISIONS

Sec. 2001. Designation of Senior Biomedical Research Service in honor 
                            of Silvio O. Conte; limitation on number of 
                            members.
Sec. 2002. Master plan for physical infrastructure for research.
Sec. 2003. Certain authorization of appropriations.
Sec. 2004. Buy-American provisions.
Sec. 2005. Prohibition against further funding for Project Aries.

                       TITLE XXI--EFFECTIVE DATES

Sec. 2101. Effective dates.

TITLE I--GENERAL PROVISIONS REGARDING TITLE IV OF PUBLIC HEALTH SERVICE 
                                  ACT

                      Subtitle A--Research Freedom

   PART I--REVIEW OF PROPOSALS FOR BIOMEDICAL AND BEHAVIORAL RESEARCH

SEC. 101. ESTABLISHMENT OF CERTAIN PROVISIONS REGARDING RESEARCH 
              CONDUCTED OR SUPPORTED BY NATIONAL INSTITUTES OF HEALTH.

    Part G of title IV of the Public Health Service Act (42 U.S.C. 289 
et seq.) is amended by inserting after section 492 the following new 
section:

  ``certain provisions regarding review and approval of proposals for 
                                research

    ``Sec. 492A. (a) Review as Precondition to Research.--
            ``(1) Protection of human research subjects.--
                    ``(A) In the case of any application submitted to 
                the Secretary for financial assistance to conduct 
                research, the Secretary may not approve or fund any 
                application that is subject to review under section 
                491(a) by an Institutional Review Board unless the 
                application has undergone review in accordance with 
                such section and has been recommended for approval by a 
                majority of the members of the Board conducting such 
                review.
                    ``(B) In the case of research that is subject to 
                review under procedures established by the Secretary 
                for the protection of human subjects in clinical 
                research conducted by the National Institutes of 
                Health, the Secretary may not authorize the conduct of 
                the research unless the research has, pursuant to such 
                procedures, been recommended for approval.
            ``(2) Peer review.--In the case of any application 
        submitted to the Secretary for financial assistance to conduct 
        research, the Secretary may not approve or fund any application 
        that is subject to technical and scientific peer review under 
        section 492(a) unless the application has undergone peer review 
        in accordance with such section and has been recommended for 
        approval by a majority of the members of the entity conducting 
        such review.
    ``(b) Ethical Review of Research.--
            ``(1) Procedures regarding withholding of funds.--If 
        research has been recommended for approval for purposes of 
        subsection (a), the Secretary may not withhold funding for the 
        research on ethical grounds unless--
                    ``(A) the Secretary convenes an advisory board in 
                accordance with paragraph (4) to study the ethical 
                implications of the research; and
                    ``(B)(i) the majority of the advisory board 
                recommends that, on ethical grounds, the Secretary 
                withhold funds for the research; or
                    (ii) the majority of such board recommends that the 
                Secretary not withhold funds for the research on 
                ethical grounds, but the Secretary finds, on the basis 
                of the report submitted under paragraph (4)(B)(ii), 
                that the recommendation is arbitrary and capricious.
            ``(2) Applicability.--The limitation established in 
        paragraph (1) regarding the authority to withhold funds on 
        ethical grounds shall apply without regard to whether the 
        withholding of funds on such grounds is characterized as a 
        disapproval, a moratorium, a prohibition, or other description.
            ``(3) Preliminary matters regarding use of procedures.--
                    ``(A) If the Secretary makes a determination that 
                an advisory board should be convened for purposes of 
                paragraph (1), the Secretary shall, through a statement 
                published in the Federal Register, announce the 
                intention of the Secretary to convene such a board.
                    ``(B) A statement issued under subparagraph (A) 
                shall include a request that interested individuals 
                submit to the Secretary recommendations specifying the 
                particular individuals who should be appointed to the 
                advisory board involved. The Secretary shall consider 
                such recommendations in making appointments to the 
                board.
                    ``(C) The Secretary may not make appointments to an 
                advisory board under paragraph (1) until the expiration 
                of the 30-day period beginning on the date on which the 
                statement required in subparagraph (A) is made with 
                respect to the board.
            ``(4) Ethics advisory boards.--
                    ``(A) Any advisory board convened for purposes of 
                paragraph (1) shall be known as an ethics advisory 
                board (hereafter in this paragraph referred to as an 
                `ethics board').
                    ``(B)(i) An ethics board shall advise, consult 
                with, and make recommendations to the Secretary 
                regarding the ethics of the project of biomedical or 
                behavioral research with respect to which the board has 
                been convened.
                    ``(ii) Not later than 180 days after the date on 
                which the statement required in paragraph (3)(A) is 
                made with respect to an ethics board, the board shall 
                submit to the Secretary, and 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 describing the findings of the board regarding 
                the project of research involved and making a 
                recommendation under clause (i) of whether the 
                Secretary should or should not withhold funds for the 
                project. The report shall include the information 
                considered in making the findings.
                    ``(C) An ethics board shall be composed of no fewer 
                than 14, and no more than 20, individuals who are not 
                officers or employees of the United States. The 
                Secretary shall make appointments to the board from 
                among individuals with special qualifications and 
                competence to provide advice and recommendations 
                regarding ethical matters in biomedical and behavioral 
                research. Of the members of the board--
                            ``(i) no fewer than 1 shall be an attorney;
                            ``(ii) no fewer than 1 shall be an 
                        ethicist;
                            ``(iii) no fewer than 1 shall be a 
                        practicing physician;
                            ``(iv) no fewer than 1 shall be a 
                        theologian; and
                            ``(v) no fewer than one-third, and no more 
                        than one-half, shall be scientists with 
                        substantial accomplishments in biomedical or 
                        behavioral research.
                    ``(D) The term of service as a member of an ethics 
                board shall be for the life of the board. If such a 
                member does not serve the full term of such service, 
                the individual appointed to fill the resulting vacancy 
                shall be appointed for the remainder of the term of the 
                predecessor of the individual.
                    ``(E) A member of an ethics board shall be subject 
                to removal from the board by the Secretary for neglect 
                of duty or malfeasance or for other good cause shown.
                    ``(F) The Secretary shall designate an individual 
                from among the members of an ethics board to serve as 
                the chair of the board.
                    ``(G) In carrying out subparagraph (B)(i) with 
                respect to a project of research, an ethics board shall 
                conduct inquiries and hold public hearings.
                    ``(H) In carrying out subparagraph (B)(i) with 
                respect to a project of research, an ethics board shall 
                have access to all relevant information possessed by 
                the Department of Health and Human Services, or 
                available to the Secretary from other agencies.
                    ``(I) Members of an ethics board shall receive 
                compensation for each day engaged in carrying out the 
                duties of the board, including time engaged in 
                traveling for purposes of such duties. Such 
                compensation may not be provided in an amount in excess 
                of the maximum rate of basic pay payable for GS-18 of 
                the General Schedule.
                    ``(J) The Secretary, acting through the Director of 
                the National Institutes of Health, shall provide to 
                each ethics board reasonable staff and assistance to 
                carry out the duties of the board.
                    ``(K) An ethics board shall terminate 30 days after 
                the date on which the report required in subparagraph 
                (B)(ii) is submitted to the Secretary and the 
                congressional committees specified in such 
                subparagraph.''.

          PART II--RESEARCH ON TRANSPLANTATION OF FETAL TISSUE

SEC. 111. ESTABLISHMENT OF AUTHORITIES.

    Part G of title IV of the Public Health Service Act (42 U.S.C. 289 
et seq.) is amended by inserting after section 498 the following new 
section:

             ``research on transplantation of fetal tissue

    ``Sec. 498A. (a) Establishment of Program.--
            ``(1) In general.--The Secretary may conduct or support 
        research on the transplantation of human fetal tissue for 
        therapeutic purposes.
            ``(2) Source of tissue.--Human fetal tissue may be used in 
        research carried out under paragraph (1) regardless of whether 
        the tissue is obtained pursuant to a spontaneous or induced 
        abortion or pursuant to a stillbirth.
    ``(b) Informed Consent of Donor.--
            ``(1) In general.--In research carried out under subsection 
        (a), human fetal tissue may be used only if the woman providing 
        the tissue makes a statement, made in writing and signed by the 
        woman, declaring that--
                    ``(A) the woman donates the fetal tissue for use in 
                research described in subsection (a);
                    ``(B) the donation is made without any restriction 
                regarding the identity of individuals who may be the 
                recipients of transplantations of the tissue; and
                    ``(C) the woman has not been informed of the 
                identity of any such individuals.
            ``(2) Additional statement.--In research carried out under 
        subsection (a), human fetal tissue may be used only if the 
        attending physician with respect to obtaining the tissue from 
        the woman involved makes a statement, made in writing and 
        signed by the physician, declaring that--
                    ``(A) in the case of tissue obtained pursuant to an 
                induced abortion--
                            ``(i) the consent of the woman for the 
                        abortion was obtained prior to requesting or 
                        obtaining consent for a donation of the tissue 
                        for use in such research;
                            ``(ii) no alteration of the timing, method, 
                        or procedures used to terminate the pregnancy 
                        was made solely for the purposes of obtaining 
                        the tissue; and
                            ``(iii) the abortion was performed in 
                        accordance with applicable State law;
                    ``(B) the tissue has been donated by the woman in 
                accordance with paragraph (1); and
                    ``(C) full disclosure has been provided to the 
                woman with regard to--
                            ``(i) such physician's interest, if any, in 
                        the research to be conducted with the tissue; 
                        and
                            ``(ii) any known medical risks to the woman 
                        or risks to her privacy that might be 
                        associated with the donation of the tissue and 
                        that are in addition to risks of such type that 
                        are associated with the woman's medical care.
    ``(c) Informed Consent of Researcher and Donee.--In research 
carried out under subsection (a), human fetal tissue may be used only 
if the individual with the principal responsibility for conducting the 
research involved makes a statement, made in writing and signed by the 
individual, declaring that the individual--
            ``(1) is aware that--
                    ``(A) the tissue is human fetal tissue;
                    ``(B) the tissue may have been obtained pursuant to 
                a spontaneous or induced abortion or pursuant to a 
                stillbirth; and
                    ``(C) the tissue was donated for research purposes;
            ``(2) has provided such information to other individuals 
        with responsibilities regarding the research;
            ``(3) will require, prior to obtaining the consent of an 
        individual to be a recipient of a transplantation of the 
        tissue, written acknowledgment of receipt of such information 
        by such recipient; and
            ``(4) has had no part in any decisions as to the timing, 
        method, or procedures used to terminate the pregnancy made 
        solely for the purposes of the research.
    ``(d) Availability of Statements for Audit.--
            ``(1) In general.--In research carried out under subsection 
        (a), human fetal tissue may be used only if the head of the 
        agency or other entity conducting the research involved 
        certifies to the Secretary that the statements required under 
        subsections (b) (2) and (c) will be available for audit by the 
        Secretary.
            ``(2) Confidentiality of audit.--Any audit conducted by the 
        Secretary pursuant to paragraph (1) shall be conducted in a 
        confidential manner to protect the privacy rights of the 
        individuals and entities involved in such research, including 
        such individuals and entities involved in the donation, 
        transfer, receipt, or transplantation of human fetal tissue. 
        With respect to any material or information obtained pursuant 
        to such audit, the Secretary shall--
                    ``(A) use such material or information only for the 
                purposes of verifying compliance with the requirements 
                of this section;
                    ``(B) not disclose or publish such material or 
                information, except where required by Federal law, in 
                which case such material or information shall be coded 
                in a manner such that the identities of such 
                individuals and entities are protected; and
                    ``(C) not maintain such material or information 
                after completion of such audit, except where necessary 
                for the purposes of such audit.
    ``(e) Applicability of State and Local Law.--
            ``(1) Research conducted by recipients of assistance.--The 
        Secretary may not provide support for research under subsection 
        (a) unless the applicant for the financial assistance involved 
        agrees to conduct the research in accordance with applicable 
        State law.
            ``(2) Research conducted by secretary.--The Secretary may 
        conduct research under subsection (a) only in accordance with 
        applicable State and local law.
    ``(f) Report.--The Secretary shall annually 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 fiscal year, including a description of whether and to what 
extent research under subsection (a) has been conducted in accordance 
with this section.
    ``(g) Definition.--For purposes of this section, the term `human 
fetal tissue' means tissue or cells obtained from a dead human embryo 
or fetus after a spontaneous or induced abortion, or after a 
stillbirth.''.

SEC. 112. PURCHASE OF HUMAN FETAL TISSUE; SOLICITATION OR ACCEPTANCE OF 
              TISSUE AS DIRECTED DONATION FOR USE IN TRANSPLANTATION.

    Part G of title IV of the Public Health Service Act, as amended by 
section 111 of this Act, is amended by inserting after section 498A the 
following new section:

              ``prohibitions regarding human fetal tissue

    ``Sec. 498B. (a) Purchase of Tissue.--It shall be unlawful for any 
person to knowingly acquire, receive, or otherwise transfer any human 
fetal tissue for valuable consideration if the transfer affects 
interstate commerce.
    ``(b) Solicitation or Acceptance of Tissue as Directed Donation for 
Use in Transplantation.--It shall be unlawful for any person to solicit 
or knowingly acquire, receive, or accept a donation of human fetal 
tissue for the purpose of transplantation of such tissue into another 
person if the donation affects interstate commerce, the tissue will be 
or is obtained pursuant to an induced abortion, and--
            ``(1) the donation will be or is made pursuant to a promise 
        to the donating individual that the donated tissue will be 
        transplanted into a recipient specified by such individual;
            ``(2) the donated tissue will be transplanted into a 
        relative of the donating individual; or
            ``(3) the person who solicits or knowingly acquires, 
        receives, or accepts the donation has provided valuable 
        consideration for the costs associated with such abortion.
    ``(c) Criminal Penalties for Violations.--
            ``(1) In general.--Any person who violates subsection (a) 
        or (b) shall be fined in accordance with title 18, United 
        States Code, subject to paragraph (2), or imprisoned for not 
        more than 10 years, or both.
            ``(2) Penalties applicable to persons receiving 
        consideration.--With respect to the imposition of a fine under 
        paragraph (1), if the person involved violates subsection (a) 
        or (b)(3), a fine shall be imposed in an amount not less than 
        twice the amount of the valuable consideration received.
    ``(d) Definitions.--For purposes of this section:
            ``(1) The term `human fetal tissue' has the meaning given 
        such term in section 498A(f).
            ``(2) The term `interstate commerce' has the meaning given 
        such term in section 201(b) of the Federal Food, Drug, and 
        Cosmetic Act.
            ``(3) The term `valuable consideration' does not include 
        reasonable payments associated with the transportation, 
        implantation, processing, preservation, quality control, or 
        storage of human fetal tissue.''.

SEC. 113. NULLIFICATION OF MORATORIUM.

    (a) In General.--Except as provided in subsection (c), no official 
of the executive branch may impose a policy that the Department of 
Health and Human Services is prohibited from conducting or supporting 
any research on the transplantation of human fetal tissue for 
therapeutic purposes. Such research shall be carried out in accordance 
with section 498A of the Public Health Service Act (as added by section 
111 of this Act), without regard to any such policy that may have been 
in effect prior to the date of the enactment of this Act.
    (b) Prohibition Against Withholding of Funds in Cases of Technical 
and Scientific Merit.--
            (1) In general.--In the case of any proposal for research 
        on the transplantation of human fetal tissue for therapeutic 
        purposes, the Secretary of Health and Human Services may not 
        withhold funds for the research if--
                    (A) the research has been approved for purposes of 
                section 492A(a) of the Public Health Service Act (as 
                added by section 101 of this Act);
                    (B) the research will be carried out in accordance 
                with section 498A of such Act (as added by section 111 
                of this Act); and
                    (C) there are reasonable assurances that the 
                research will not utilize any human fetal tissue that 
                has been obtained in violation of section 498B(a) of 
                such Act (as added by section 112 of this Act).
            (2) Standing approval regarding ethical status.--In the 
        case of any proposal for research on the transplantation of 
        human fetal tissue for therapeutic purposes, the issuance in 
        December 1988 of the Report of the Human Fetal Tissue 
        Transplantation Research Panel shall be deemed to be a report--
                    (A) issued by an ethics advisory board pursuant to 
                section 492A(b)(4)(B)(ii) of the Public Health Service 
                Act (as added by section 101 of this Act); and
                    (B) finding, on a basis that is neither arbitrary 
                nor capricious, that there are no ethical grounds for 
                withholding funds for the research.
    (c) Authority for Withholding Funds From Research.--In the case of 
any research on the transplantation of human fetal tissue for 
therapeutic purposes, the Secretary of Health and Human Services may 
withhold funds for the research if any of the conditions specified in 
any of subparagraphs (A) through (C) of subsection (b)(1) are not met 
with respect to the research.
    (d) Definition.--For purposes of this section, the term ``human 
fetal tissue'' has the meaning given such term in section 498A(f) of 
the Public Health Service Act (as added by section 111 of this Act).

SEC. 114. REPORT BY GENERAL ACCOUNTING OFFICE ON ADEQUACY OF 
              REQUIREMENTS.

    (a) In General.--With respect to research on the transplantation of 
human fetal tissue for therapeutic purposes, the Comptroller General of 
the United States shall conduct an audit for the purpose of 
determining--
            (1) whether and to what extent such research conducted or 
        supported by the Secretary of Health and Human Services has 
        been conducted in accordance with section 498A of the Public 
        Health Service Act (as added by section 111 of this Act); and
            (2) whether and to what extent there have been violations 
        of section 498B of such Act (as added by section 112 of this 
        Act).
    (b) Report.--Not later than May 19, 1995, the Comptroller General 
of the United States shall complete the audit required in subsection 
(a) and submit to the Committee on Energy and Commerce of the House of 
Representatives, and to the Committee on Labor and Human Resources of 
the Senate, a report describing the findings made pursuant to the 
audit.

                    PART III--MISCELLANEOUS REPEALS

SEC. 121. REPEALS.

    (a) Certain Biomedical Ethics Board.--Title III of the Public 
Health Service Act (42 U.S.C. 241 et seq.) is amended by striking part 
J.
    (b) Other Repeals.--Part G of title IV of the Public Health Service 
Act (42 U.S.C. 289 et seq.) is amended--
            (1) in section 498, by striking subsection (c); and
            (2) by striking section 499; and
            (3) by redesignating section 499A as section 499.
    (c) Nullification of Certain Provisions.--The provisions of 
Executive Order 12806 (57 Fed. Reg. 21589 (May 21, 1992)) shall not 
have any legal effect. The provisions of section 204(d) of part 46 of 
title 45 of the Code of Federal Regulations (45 CFR 46.204(d)) shall 
not have any legal effect.

  Subtitle B--Clinical Research Equity Regarding Women and Minorities

     PART I--WOMEN AND MINORITIES AS SUBJECTS IN CLINICAL RESEARCH

SEC. 131. REQUIREMENT OF INCLUSION IN RESEARCH.

    Part G of title IV of the Public Health Service Act, as amended by 
section 101 of this Act, is amended by inserting after section 492A the 
following new section:

        ``inclusion of women and minorities in clinical research

    ``Sec. 492B. (a) Requirement of Inclusion.--
            ``(1) In general.--In conducting or supporting clinical 
        research for purposes of this title, the Director of NIH shall, 
        subject to subsection (b), ensure that--
                    ``(A) women are included as subjects in each 
                project of such research; and
                    ``(B) members of minority groups are included as 
                subjects in such research.
            ``(2) Outreach regarding participation as subjects.--The 
        Director of NIH, in consultation with the Director of the 
        Office of Research on Women's Health and the Director of the 
        Office of Research on Minority Health, shall conduct or support 
        outreach programs for the recruitment of women and members of 
        minority groups as subjects in projects of clinical research.
    ``(b) Inapplicability of Requirement.--The requirement established 
in subsection (a) regarding women and members of minority groups shall 
not apply to a project of clinical research if the inclusion, as 
subjects in the project, of women and members of minority groups, 
respectively--
            ``(1) is inappropriate with respect to the health of the 
        subjects;
            ``(2) is inappropriate with respect to the purpose of the 
        research; or
            ``(3) is inappropriate under such other circumstances as 
        the Director of NIH may designate.
    ``(c) Design of Clinical Trials.--In the case of any clinical trial 
in which women or members of minority groups will under subsection (a) 
be included as subjects, the Director of NIH shall ensure that the 
trial is designed and carried out in a manner sufficient to provide for 
a valid analysis of whether the variables being studied in the trial 
affect women or members of minority groups, as the case may be, 
differently than other subjects in the trial.
    ``(d) Guidelines.--
            ``(1) In general.--Subject to paragraph (2), the Director 
        of NIH, in consultation with the Director of the Office of 
        Research on Women's Health and the Director of the Office of 
        Research on Minority Health, shall establish guidelines 
        regarding the requirements of this section. The guidelines 
        shall include guidelines regarding--
                    ``(A) the circumstances under which the inclusion 
                of women and minorities as subjects in projects of 
                clinical research is inappropriate for purposes of 
                subsection (b);
                    ``(B) the manner in which clinical trials are 
                required to be designed and carried out for purposes of 
                subsection (c); and
                    ``(C) the operation of outreach programs under 
                subsection (a).
            ``(2) Certain provisions.--With respect to the 
        circumstances under which the inclusion of women or members of 
        minority groups (as the case may be) as subjects in a project 
        of clinical research is inappropriate for purposes of 
        subsection (b), the following applies to guidelines under 
        paragraph (1):
                    ``(A)(i) In the case of a clinical trial, the 
                guidelines shall provide that the costs of such 
                inclusion in the trial is not a permissible 
                consideration in determining whether such inclusion is 
                inappropriate.
                    ``(ii) In the case of other projects of clinical 
                research, the guidelines shall provide that the costs 
                of such inclusion in the project is not a permissible 
                consideration in determining whether such inclusion is 
                inappropriate unless the data regarding women or 
                members of minority groups, respectively, that would be 
                obtained in such project (in the event that such 
                inclusion were required) have been or will be obtained 
                through other means that provide data of comparable 
                quality.
                    ``(B) In the case of a clinical trial, the 
                guidelines may provide that such inclusion in the trial 
                is not required if there is substantial scientific data 
                demonstrating that there is no significant difference 
                between--
                            ``(i) the effects that the variables to be 
                        studied in the trial have on women or members 
                        of minority groups, respectively; and
                            ``(ii) the effects that the variables have 
                        on the individuals who would serve as subjects 
                        in the trial in the event that such inclusion 
                        were not required.
    ``(e) Date Certain for Guidelines; Applicability.--
            ``(1) Date certain.--The guidelines required in subsection 
        (d) shall be established and published in the Federal Register 
        not later than 180 days after the date of the enactment of the 
        National Institutes of Health Revitalization Act of 1993.
            ``(2) Applicability.--For fiscal year 1995 and subsequent 
        fiscal years, the Director of NIH may not approve any proposal 
        of clinical research to be conducted or supported by any agency 
        of the National Institutes of Health unless the proposal 
        specifies the manner in which the research will comply with 
        this section.
    ``(f) Reports by Advisory Councils.--The advisory council of each 
national research institute shall annually submit to the Director of 
NIH and the Director of the institute involved a report describing the 
manner in which the agency has complied with this section.
    ``(g) Definitions.--For purposes of this section:
            ``(1) The term `project of clinical research' includes a 
        clinical trial.
            ``(2) The term `minority group' includes subpopulations of 
        minority groups. The Director of NIH shall, through the 
        guidelines established under subsection (d), define the terms 
        `minority group' and `subpopulation' for purposes of the 
        preceding sentence.''.

SEC. 132. PEER REVIEW.

    Section 492 of the Public Health Service Act (42 U.S.C. 289a) is 
amended by adding at the end the following new subsection:
    ``(c)(1) In technical and scientific peer review under this section 
of proposals for clinical research, the consideration of any such 
proposal (including the initial consideration) shall, except as 
provided in paragraph (2), include an evaluation of the technical and 
scientific merit of the proposal regarding compliance with section 
492B.
    ``(2) Paragraph (1) shall not apply to any proposal for clinical 
research that, pursuant to subsection (b) of section 492B, is not 
subject to the requirement of subsection (a) of such section regarding 
the inclusion of women and members of minority groups as subjects in 
clinical research.''.

SEC. 133. APPLICABILITY TO CURRENT PROJECTS.

    Section 492B of the Public Health Service Act, as added by section 
131 of this Act, shall not apply with respect to projects of clinical 
research for which initial funding was provided prior to the date of 
the enactment of this Act. With respect to the inclusion of women and 
minorities as subjects in clinical research conducted or supported by 
the National Institutes of Health, any policies of the Secretary of 
Health and Human Services regarding such inclusion that are in effect 
on the day before the date of the enactment of this Act shall continue 
to apply to the projects referred to in the preceding sentence.

             PART II--OFFICE OF RESEARCH ON WOMEN'S HEALTH

SEC. 141. ESTABLISHMENT.

    (a) In General.--Title IV of the Public Health Service Act, as 
amended by the preceding provisions of this title, is amended--
            (1) by redesignating section 486 as section 485A;
            (2) by redesignating parts F through H as parts G through 
        I, respectively; and
            (3) by inserting after part E the following new part:

                  ``Part F--Research on Women's Health

``SEC. 486. OFFICE OF RESEARCH ON WOMEN'S HEALTH.

    ``(a) Establishment.--There is established within the Office of the 
Director of NIH an office to be known as the Office of Research on 
Women's Health (in this part referred to as the `Office'). The Office 
shall be headed by a director, who shall be appointed by the Director 
of NIH.
    ``(b) Purpose.--The Director of the Office shall--
            ``(1) identify projects of research on women's health that 
        should be conducted or supported by the national research 
        institutes;
            ``(2) identify multidisciplinary research relating to 
        research on women's health that should be so conducted or 
        supported;
            ``(3) carry out paragraphs (1) and (2) with respect to the 
        aging process in women, with priority given to menopause;
            ``(4) promote coordination and collaboration among entities 
        conducting research identified under any of paragraphs (1) 
        through (3);
            ``(5) encourage the conduct of such research by entities 
        receiving funds from the national research institutes;
            ``(6) recommend an agenda for conducting and supporting 
        such research;
            ``(7) promote the sufficient allocation of the resources of 
        the national research institutes for conducting and supporting 
        such research;
            ``(8) assist in the administration of section 492B with 
        respect to the inclusion of women as subjects in clinical 
        research; and
            ``(9) prepare the report required in section 486B.
    ``(c) Coordinating Committee.--
            ``(1) In carrying out subsection (b), the Director of the 
        Office shall establish a committee to be known as the 
        Coordinating Committee on Research on Women's Health (hereafter 
        in this subsection referred to as the `Coordinating 
        Committee').
            ``(2) The Coordinating Committee shall be composed of the 
        Directors of the national research institutes (or the designees 
        of the Directors).
            ``(3) The Director of the Office shall serve as the chair 
        of the Coordinating Committee.
            ``(4) With respect to research on women's health, the 
        Coordinating Committee shall assist the Director of the Office 
        in--
                    ``(A) identifying the need for such research, and 
                making an estimate each fiscal year of the funds needed 
                to adequately support the research;
                    ``(B) identifying needs regarding the coordination 
                of research activities, including intramural and 
                extramural multidisciplinary activities;
                    ``(C) supporting the development of methodologies 
                to determine the circumstances in which obtaining data 
                specific to women (including data relating to the age 
                of women and the membership of women in ethnic or 
                racial groups) is an appropriate function of clinical 
                trials of treatments and therapies;
                    ``(D) supporting the development and expansion of 
                clinical trials of treatments and therapies for which 
                obtaining such data has been determined to be an 
                appropriate function; and
                    ``(E) encouraging the national research institutes 
                to conduct and support such research, including such 
                clinical trials.
    ``(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 Women's Health (hereafter in 
        this subsection referred to as the `Advisory Committee').
            ``(2) The Advisory 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 Director of the 
        Office shall make appointments to the Advisory Committee from 
        among physicians, practitioners, scientists, and other health 
        professionals, whose clinical practice, research 
        specialization, or professional expertise includes a 
        significant focus on research on women's health. A majority of 
        the members of the Advisory Committee shall be women.
            ``(3) The Director of the Office shall serve as the chair 
        of the Advisory Committee.
            ``(4) 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 women's health;
                            ``(ii) research on gender differences in 
                        clinical drug trials, including responses to 
                        pharmacological drugs;
                            ``(iii) research on gender differences in 
                        disease etiology, course, and treatment;
                            ``(iv) research on obstetrical and 
                        gynecological health conditions, diseases, and 
                        treatments; and
                            ``(v) research on women's 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 the development of the methodologies 
                described in subsection (c)(4)(C) and recommendations 
                on priorities in carrying out research described in 
                subparagraph (A)); and
                    ``(D) assist in monitoring compliance with section 
                492B regarding the inclusion of women in clinical 
                research.
            ``(5)(A) 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 women's health by the agencies of the National 
                Institutes of Health; and
                    ``(iii) the level of funding needed for such 
                research.
            ``(B) The report required in subparagraph (A) shall be 
        submitted to the Director of NIH for inclusion in the report 
        required in section 403.
    ``(e) Representation of Women 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 women 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.
    ``(f) Definitions.--For purposes of this part:
            ``(1) The term `women's health conditions', with respect to 
        women of all age, ethnic, and racial groups, means all 
        diseases, disorders, and conditions (including with respect to 
        mental health)--
                    ``(A) unique to, more serious, or more prevalent in 
                women;
                    ``(B) for which the factors of medical risk or 
                types of medical intervention are different for women, 
                or for which it is unknown whether such factors or 
                types are different for women; or
                    ``(C) with respect to which there has been 
                insufficient clinical research involving women as 
                subjects or insufficient clinical data on women.
            ``(2) The term `research on women's health' means research 
        on women's health conditions, including research on preventing 
        such conditions.

``SEC. 486A. NATIONAL DATA SYSTEM AND CLEARINGHOUSE ON RESEARCH ON 
              WOMEN'S HEALTH.

    ``(a) Data System.--
            ``(1) The Director of NIH, in consultation with the 
        Director of the Office and the Director of the National Library 
        of Medicine, shall establish a data system for the collection, 
        storage, analysis, retrieval, and dissemination of information 
        regarding research on women's health that is conducted or 
        supported by the national research institutes. Information from 
        the data system shall be available through information systems 
        available to health care professionals and providers, 
        researchers, and members of the public.
            ``(2) The data system established under paragraph (1) shall 
        include a registry of clinical trials of experimental 
        treatments that have been developed for research on women's 
        health. Such registry shall include information on subject 
        eligibility criteria, sex, age, ethnicity or race, and the 
        location of the trial site or sites. Principal investigators of 
        such clinical trials shall provide this information to the 
        registry within 30 days after it is available. Once a trial has 
        been completed, the principal investigator shall provide the 
        registry with information pertaining to the results, including 
        potential toxicities or adverse effects associated with the 
        experimental treatment or treatments evaluated.
    ``(b) Clearinghouse.--The Director of NIH, in consultation with the 
Director of the Office and with the National Library of Medicine, shall 
establish, maintain, and operate a program to provide information on 
research and prevention activities of the national research institutes 
that relate to research on women's health.

``SEC. 486B. BIENNIAL REPORT.

    ``(a) In General.--With respect to research on women's health, the 
Director of the Office shall, not later than February 1, 1994, and 
biennially thereafter, prepare a report--
            ``(1) describing and evaluating the progress made during 
        the preceding 2 fiscal years in research and treatment 
        conducted or supported by the National Institutes of Health;
            ``(2) describing and analyzing the professional status of 
        women physicians and scientists of such Institutes, including 
        the identification of problems and barriers regarding 
        advancements;
            ``(3) summarizing and analyzing expenditures made by the 
        agencies of such Institutes (and by such Office) during the 
        preceding 2 fiscal years; and
            ``(4) making such recommendations for legislative and 
        administrative initiatives as the Director of the Office 
        determines to be appropriate.
    ``(b) Inclusion in Biennial Report of Director of NIH.--The 
Director of the Office shall submit each report prepared under 
subsection (a) to the Director of NIH for inclusion in the report 
submitted to the President and the Congress under section 403.''.
    (b) Requirement of Sufficient Allocation of Resources of 
Institutes.--Section 402(b) of the Public Health Service Act (42 U.S.C. 
282(b)) is amended--
            (1) in paragraph (10), by striking ``and'' after the 
        semicolon at the end;
            (2) in paragraph (11), by striking the period at the end 
        and inserting ``; and''; and
            (3) by inserting after paragraph (11) the following new 
        paragraph:
            ``(12) after consultation with the Director of the Office 
        of Research on Women's Health, shall ensure that resources of 
        the National Institutes of Health are sufficiently allocated 
        for projects of research on women's health that are identified 
        under section 486(b).''.

            PART III--OFFICE OF RESEARCH ON MINORITY HEALTH

SEC. 151. ESTABLISHMENT.

    Part A of title IV of the Public Health Service Act (42 U.S.C. 281 
et seq.) is amended by adding at the end the following section:

                ``office of research on minority health

    ``Sec. 404. (a) Establishment.--There is established within the 
Office of the Director of NIH an office to be known as the Office of 
Research on Minority Health (in this section referred to as the 
`Office'). The Office shall be headed by a director, who shall be 
appointed by the Director of NIH.
    ``(b) Purpose.--The Director of the Office shall--
            ``(1) identify projects of research on minority health that 
        should be conducted or supported by the national research 
        institutes;
            ``(2) identify multidisciplinary research relating to 
        research on minority health that should be so conducted or 
        supported;
            ``(3) promote coordination and collaboration among entities 
        conducting research identified under paragraph (1) or (2);
            ``(4) encourage the conduct of such research by entities 
        receiving funds from the national research institutes;
            ``(5) recommend an agenda for conducting and supporting 
        such research;
            ``(6) promote the sufficient allocation of the resources of 
        the national research institutes for conducting and supporting 
        such research; and
            ``(7) assist in the administration of section 492B with 
        respect to the inclusion of members of minority groups as 
        subjects in clinical research.''.

                     Subtitle C--Research Integrity

SEC. 161. ESTABLISHMENT OF OFFICE OF RESEARCH INTEGRITY.

    (a) In General.--Section 493 of the Public Health Service Act (42 
U.S.C. 289b) is amended to read as follows:

                     ``office of research integrity

    ``Sec. 493. (a) Establishment.--
            ``(1) In general.--Not later than 90 days after the date of 
        enactment of this section, the Secretary shall establish an 
        office to be known as the Office of Research Integrity 
        (hereafter referred to in this section as the `Office'), which 
        shall be established as an independent entity in the Department 
        of Health and Human Services.
            ``(2) Director.--The Office shall be headed by a Director, 
        who shall be appointed by the Secretary, be experienced and 
        specially trained in the conduct of research, and have 
        experience in the conduct of investigations of research 
        misconduct. The Secretary shall carry out this section acting 
        through the Director of the Office. The Director shall report 
        to the Secretary.
    ``(b) Existence of Administrative Processes as Condition of Funding 
for Research.--The Secretary shall by regulation require that each 
entity that applies for a grant, contract, or cooperative agreement 
under this Act for any project or program that involves the conduct of 
biomedical or behavioral research submit in or with its application for 
such grant, contract, or cooperative agreement assurances satisfactory 
to the Secretary that such entity--
            ``(1) has established (in accordance with regulations which 
        the Secretary shall prescribe) an administrative process to 
        review reports of research misconduct in connection with 
        biomedical and behavioral research conducted at or sponsored by 
        such entity; and
            ``(2) will report to the Director any investigation of 
        alleged research misconduct in connection with projects for 
        which funds have been <plus-minus>made available under this Act 
        that appears substantial.
    ``(c) Process for Response of Director.--The Secretary shall 
establish by regulation a process to be followed by the Director for 
the prompt and appropriate--
            ``(1) response to information provided to the Director 
        respecting research misconduct in connection with projects for 
        which funds have been made available under this Act;
            ``(2) receipt of reports by the Director of such 
        information from recipients of funds under this Act;
            ``(3) conduct of investigations, when appropriate; and
            ``(4) taking of other actions, including appropriate 
        remedies, with respect to such misconduct.
    ``(d) Monitoring by Director.--The Secretary shall by regulation 
establish procedures for the Director to monitor administrative 
processes and investigations that have been established or carried out 
under this section.
    ``(e) Effect on Present Investigations.--Nothing in this section 
shall affect investigations which have been or will be commenced prior 
to the promulgation of final regulations under this section.''.
    (b) Establishment of Definition of Research Misconduct.--Not later 
than 90 days after the date on which the report required under section 
162(d) is submitted to the Secretary of Health and Human Services, such 
Secretary shall by regulation establish a definition for the term 
``research misconduct'' for purposes of section 493 of the Public 
Health Service Act, as amended by subsection (a) of this section.

SEC. 162. COMMISSION ON RESEARCH INTEGRITY.

    (a) In General.--Not later than 90 days after the date of the 
enactment of this Act, the Secretary of Health and Human Services shall 
establish a commission to be known as the Commission on Research 
Integrity (in this section referred to as the ``Commission'').
    (b) Duties.--The Commission shall develop recommendations for the 
Secretary of Health and Human Services on the administration of section 
493 of the Public Health Service Act (as amended and added by section 
161 of this Act).
    (c) Composition.--The Commission shall be composed of 12 members to 
be appointed by the Secretary of Health and Human Services. Not more 
than 3 members of the Commission may be officers or employees of the 
United States. Of the members of the Commission--
            (1) three shall be scientists with substantial 
        accomplishments in biomedical or behavioral research;
            (2) three shall be individuals with experience in 
        investigating allegations of misconduct with respect to 
        research research;
            (3) three shall be representatives of institutions of 
        higher education at which biomedical or behavioral research is 
        conducted; and
            (4) three shall be individuals who are not described in 
        paragraphs (1), (2), or (3), at least one of whom shall be an 
        attorney and at least one of whom shall be an ethicist.
    (d) Compensation.--Members of the Commission may not receive 
compensation for service on the Commission. Members may be reimbursed 
for travel, subsistence, and other necessary expenses incurred in 
carrying out the duties of the Commission.
    (e) Report.--Not later than 120 days after the date on which the 
Commission is established under subsection (a), the Commission shall 
prepare and submit to the Secretary of Health and Human Services, the 
Committee on Energy and Commerce of the House of Representatives, and 
the Committee on Labor and Human Resources of the Senate, a report 
containing the recommendations developed under subsection (b).

SEC. 163. PROTECTION OF WHISTLEBLOWERS.

    Section 493 of the Public Health Service Act, as amended by section 
161 of this Act, is amended by adding at the end the following new 
subsection:
    ``(f) Protection of Whistleblowers.--
            ``(1) In general.--In the case of any entity required to 
        establish administrative processes under subsection (b), the 
        Secretary shall by regulation establish standards for 
        preventing, and for responding to the occurrence of retaliation 
        by such entity, its officials or agents, against an employee in 
        the terms and conditions of employment in response to the 
        employee having in good faith--
                    ``(A) made an allegation that the entity, its 
                officials or agents, has engaged in or failed to 
                adequately respond to an allegation of research 
                misconduct; or
                    ``(B) cooperated with an investigation of such an 
                allegation.
            ``(2) Monitoring by secretary.--The Secretary shall 
        establish by regulation procedures for the Director to monitor 
        the implementation of the standards established by an entity 
        under paragraph (1) for the purpose of determining whether the 
        procedures have been established, and are being utilized, in 
        accordance with the standards established under such paragraph.
            ``(3) Noncompliance.--The Secretary shall by regulation 
        establish remedies for noncompliance by an entity, its 
        officials or agents, which has engaged in retaliation in 
        violation of the standards established under paragraph (1). 
        Such remedies may include termination of funding provided by 
        the Secretary for such project or recovery of funding being 
        provided by the Secretary for such project, or other actions as 
        appropriate.
            ``(4) Final rule for regulations.--The Secretary shall 
        issue a final rule for the regulations required in paragraph 
        (1) not later than 180 days after the date of the enactment of 
        the National Institutes of Health Revitalization Act of 1993.
            ``(5) Required agreements.--For any fiscal year beginning 
        after the date on which the regulations required in paragraph 
        (1) are issued, the Secretary may not provide a grant, 
        cooperative agreement, or contract under this Act for 
        biomedical or behavioral research unless the entity seeking 
        such financial assistance agrees that the entity--
                    ``(A) will maintain the procedures described in the 
                regulations; and
                    ``(B) will otherwise be subject to the 
                regulations.''.

SEC. 164. REQUIREMENT OF REGULATIONS REGARDING PROTECTION AGAINST 
              FINANCIAL CONFLICTS OF INTEREST IN CERTAIN PROJECTS OF 
              RESEARCH.

    Part H of title IV of the Public Health Service Act, as 
redesignated by section 141(a)(2) of this Act, is amended by inserting 
after section 493 the following new section:

    ``protection against financial conflicts of interest in certain 
                          projects of research

    ``Sec. 493A. (a) Issuance of Regulations.--
            ``(1) In general.--The Secretary shall define by 
        regulation, the specific circumstances that constitute the 
        existence of a financial interest in a project on the part of 
        an entity or individual that will, or may be reasonably 
        expected to, create a bias in favor of obtaining results in 
        such project that are consistent with such financial interest. 
        Such definition shall apply uniformly to each entity or 
        individual conducting a research project under this Act. In the 
        case of any entity or individual receiving assistance from the 
        Secretary for a project of research described in paragraph (2), 
        the Secretary shall by regulation establish standards for 
        responding to, including managing, reducing, or eliminating, 
        the existence of such a financial interest. The entity may 
        adopt individualized procedures for implementing the standards.
            ``(2) Relevant projects.--A project of research referred to 
        in paragraph (1) is a project of clinical research whose 
        purpose is to evaluate the safety or effectiveness of a drug, 
        medical device, or treatment and for which such entity is 
        receiving assistance from the Secretary.
            ``(3) Identifying and reporting to the director.--The 
        Secretary shall ensure that the standards established under 
        paragraph (1) specify that as a condition of receiving 
        assistance from the Secretary for the project involved, an 
        entity described in such subsection is required--
                    ``(A) to have in effect at the time the entity 
                applies for the assistance and throughout the period 
                during which the assistance is received, a process for 
                identifying such financial interests as defined in 
                paragraph (1) that exist regarding the project; and
                    ``(B) to report to the Director such financial 
                interest as defined in paragraph (1) identified by the 
                entity and how any such financial interest identified 
                by the entity will be managed or eliminated such that 
                the project in question will be protected from bias 
                that may stem from such financial interest.
            ``(4) Monitoring of process.--The Secretary shall monitor 
        the establishment and conduct of the process established by an 
        entity pursuant to paragraph (1).
            ``(5) Response.--In any case in which the Secretary 
        determines that an entity has failed to comply with paragraph 
        (3) regarding a project of research described in paragraph (1), 
        the Secretary--
                    ``(A) shall require that, as a condition of 
                receiving assistance, the entity disclose the existence 
                of a financial interest as defined in paragraph (1) in 
                each public presentation of the results of such 
                project; and
                    ``(B) may take such other actions as the Secretary 
                determines to be appropriate.
            ``(6) Definition.--As used in this section:
                    ``(A) The term `financial interest' includes the 
                receipt of consulting fees or honoraria and the 
                ownership of stock or equity.
                    ``(B) The term `assistance', with respect to 
                conducting a project of research, means a grant, 
                contract, or cooperative agreement.
    ``(b) Final Rule for Regulations.--The Secretary shall issue a 
final rule for the regulations required in subsection (a) not later 
than 180 days after the date of the enactment of the National 
Institutes of Health Revitalization Act of 1993.''.

SEC. 165. EFFECTIVE DATES.

    (a) In General.--The amendments made by this subtitle shall become 
effective on the date that occurs 180 days after the date on which the 
final rule required under section 493(f)(4) of the Public Health 
Service Act, as amended by sections 161 and 163, is published in the 
Federal Register.
    (b) Agreements as a Condition of Funding.--The requirements of 
subsection (f)(5) of section 493 of the Public Health Service Act, as 
amended by sections 161 and 163, with respect to agreements as a 
condition of funding shall not be effective in the case of projects of 
research for which initial funding under the Public Health Service Act 
was provided prior to the effective date described in subsection (a).

           TITLE II--NATIONAL INSTITUTES OF HEALTH IN GENERAL

SEC. 201. HEALTH PROMOTION RESEARCH DISSEMINATION.

    Section 402(f) of the Public Health Service Act (42 U.S.C. 282(f)) 
is amended by striking ``other public and private entities.'' and all 
that follows through the end and inserting ``other public and private 
entities, including elementary, secondary, and post-secondary schools. 
The Associate Director shall--
            ``(1) annually review the efficacy of existing policies and 
        techniques used by the national research institutes to 
        disseminate the results of disease prevention and behavioral 
        research programs;
            ``(2) recommend, coordinate, and oversee the modification 
        or reconstruction of such policies and techniques to ensure 
        maximum dissemination, using advanced technologies to the 
        maximum extent practicable, of research results to such 
        entities; and
            ``(3) annually prepare and submit to the Director of NIH a 
        report concerning the prevention and dissemination activities 
        undertaken by the Associate Director, including--
                    ``(A) a summary of the Associate Director's review 
                of existing dissemination policies and techniques 
                together with a detailed statement concerning any 
                modification or restructuring, or recommendations for 
                modification or restructuring, of such policies and 
                techniques; and
                    ``(B) a detailed statement of the expenditures made 
                for the prevention and dissemination activities 
                reported on and the personnel used in connection with 
                such activities.''.

SEC. 202. PROGRAMS FOR INCREASED SUPPORT REGARDING CERTAIN STATES AND 
              RESEARCHERS.

    Section 402 of the Public Health Service Act (42 U.S.C. 282) is 
amended by adding at the end the following new subsection:
    ``(g)(1)(A) In the case of entities described in subparagraph (B), 
the Director of NIH, acting through the Director of the National Center 
for Research Resources, shall establish a program to enhance the 
competitiveness of such entities in obtaining funds from the national 
research institutes for conducting biomedical and behavioral research.
    ``(B) The entities referred to in subparagraph (A) are entities 
that conduct biomedical and behavioral research and are located in a 
State in which the aggregate success rate for applications to the 
national research institutes for assistance for such research by the 
entities in the State has historically constituted a low success rate 
of obtaining such funds, relative to such aggregate rate for such 
entities in other States.
    ``(C) With respect to enhancing competitiveness for purposes of 
subparagraph (A), the Director of NIH, in carrying out the program 
established under such subparagraph, may--
            ``(i) provide technical assistance to the entities 
        involved, including technical assistance in the preparation of 
        applications for obtaining funds from the national research 
        institutes;
            ``(ii) assist the entities in developing a plan for 
        biomedical or behavioral research proposals; and
            ``(iii) assist the entities in implementing such plan.
    ``(2) The Director of NIH shall establish a program of supporting 
projects of biomedical or behavioral research whose principal 
researchers are individuals who have not previously served as the 
principal researchers of such projects supported by the Director.''.

SEC. 203. ESTABLISHMENT OF OFFICE OF BEHAVIORAL RESEARCH.

    Part A of title IV of the Public Health Service Act, as amended by 
section 151 of this Act, is amended by adding at the end the following 
new section:

                    ``office of behavioral research

    ``Sec. 404A. (a) There is established within the Office of the 
Director of NIH an office to be known as the Office of Behavioral 
Research (in this section referred to as the `Office'). The Office 
shall be headed by a director, who shall be appointed by the Director 
of NIH.
    ``(b)(1) With respect to research on the relationship between human 
behavior and the development, treatment, and prevention of medical 
conditions, the Director of the Office shall coordinate research 
conducted or supported by the agencies of the National Institutes of 
Health.
    ``(2) Research authorized under paragraph (1) includes research on 
teen pregnancy, infant mortality, violent behavior, suicide, and 
homelessness.
    ``(3) The sole responsibility of the Director of the Office shall 
be carrying out paragraph (1).''.

SEC. 204. CHILDREN'S VACCINE INITIATIVE.

    Part A of title IV of the Public Health Service Act, as amended by 
section 203 of this Act, is amended by adding at the end the following 
new section:

                    ``children's vaccine initiative

    ``Sec. 404B. (a) Development of New Vaccines.--The Secretary, in 
consultation with the Director of the National Vaccine Program under 
title XXI and acting through the Directors of the National Institute 
for Allergy and Infectious Diseases, the National Institute for Child 
Health and Human Development, the National Institute for Aging, and 
other public and private programs, shall carry out activities, which 
shall be consistent with the global Children's Vaccine Initiative, to 
develop affordable new and improved vaccines to be used in the United 
States and in the developing world that will increase the efficacy and 
efficiency of the prevention of infectious diseases. In carrying out 
such activities, the Secretary shall, to the extent practicable, 
develop and make available vaccines that require fewer contacts to 
deliver, that can be given early in life, that provide long lasting 
protection, that obviate refrigeration, needles and syringes, and that 
protect against a larger number of diseases.
    ``(b) Report.--In the report required in section 2104, the 
Secretary, acting through the Director of the National Vaccine Program 
under title XXI, shall include information with respect to activities 
and the progress made in implementing the provisions of this section 
and achieving its goals.
    ``(c) Authorization of Appropriations.--In addition to any other 
amounts authorized to be appropriated for activities of the type 
described in this section, there are authorized to be appropriated to 
carry out this section $50,000,000 for fiscal year 1994, and such sums 
as may be necessary for each of the fiscal years 1995 and 1996.''.

SEC. 205. PLAN FOR USE OF ANIMALS IN RESEARCH.

    (a) In General.--Part A of title IV of the Public Health Service 
Act, as amended by section 204 of this Act, is amended by adding at the 
end the following new section:

                 ``plan for use of animals in research

    ``Sec. 404C. (a) The Director of NIH, after consultation with the 
committee established under subsection (e), shall prepare a plan--
            ``(1) for the National Institutes of Health to conduct or 
        support research into--
                    ``(A) methods of biomedical research and 
                experimentation that do not require the use of animals;
                    ``(B) methods of such research and experimentation 
                that reduce the number of animals used in such 
                research;
                    ``(C) methods of such research and experimentation 
                that produce less pain and distress in such animals; 
                and
                    ``(D) methods of such research and experimentation 
                that involve the use of marine life (other than marine 
                mammals);
            ``(2) for establishing the validity and reliability of the 
        methods described in paragraph (1);
            ``(3) for encouraging the acceptance by the scientific 
        community of such methods that have been found to be valid and 
        reliable; and
            ``(4) for training scientists in the use of such methods 
        that have been found to be valid and reliable.
    ``(b) Not later than October 1, 1993, the Director of NIH 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, the plan required in subsection (a) and shall begin 
implementation of the plan.
    ``(c) The Director of NIH shall periodically review, and as 
appropriate, make revisions in the plan required under subsection (a). 
A description of any revision made in the plan shall be included in the 
first biennial report under section 403 that is submitted after the 
revision is made.
    ``(d) The Director of NIH shall take such actions as may be 
appropriate to convey to scientists and others who use animals in 
biomedical or behavioral research or experimentation information 
respecting the methods found to be valid and reliable under subsection 
(a)(2).
    ``(e)(1) The Director of NIH shall establish within the National 
Institutes of Health a committee to be known as the Interagency 
Coordinating Committee on the Use of Animals in Research (hereafter in 
this subsection referred to as the `Committee').
    ``(2) The Committee shall provide advice to the Director of NIH on 
the preparation of the plan required in subsection (a).
    ``(3) The Committee shall be composed of--
            ``(A) the Directors of each of the national research 
        institutes and the Director of the Center for Research 
        Resources (or the designees of such Directors); and
            ``(B) representatives of the Environmental Protection 
        Agency, the Food and Drug Administration, the Consumer Product 
        Safety Commission, the National Science Foundation, and such 
        additional agencies as the Director of NIH determines to be 
        appropriate.''.
    (b) Conforming Amendment.--Section 4 of the Health Research 
Extension Act of 1985 (Public Law 99-158; 99 Stat. 880) is repealed.

SEC. 206. INCREASED PARTICIPATION OF WOMEN AND DISADVANTAGED 
              INDIVIDUALS IN FIELDS OF BIOMEDICAL AND BEHAVIORAL 
              RESEARCH.

    Section 402 of the Public Health Service Act, as amended by section 
202 of this Act, is amended by adding at the end the following new 
subsection:
    ``(h) The Secretary, acting through the Director of NIH and the 
Directors of the agencies of the National Institutes of Health, may 
conduct and support programs for research, research training, 
recruitment, and other activities to provide for an increase in the 
number of women and individuals from disadvantaged backgrounds in the 
fields of biomedical and behavioral research.''.

SEC. 207. REQUIREMENTS REGARDING SURVEYS OF SEXUAL BEHAVIOR.

    Part A of title IV of the Public Health Service Act, as amended by 
section 205 of this Act, is amended by adding at the end the following 
new section:

          ``requirements regarding surveys of sexual behavior

    ``Sec. 404D. With respect to any survey of human sexual behavior 
proposed to be conducted or supported through the National Institutes 
of Health, the survey may not be carried out unless--
            ``(1) the proposal has undergone review in accordance with 
        any applicable requirements of sections 491 and 492; and
            ``(2) the Secretary, in accordance with section 492A, makes 
        a determination that the information expected to be obtained 
        through the survey will assist--
                    ``(A) in reducing the incidence of sexually 
                transmitted diseases, the incidence of infection with 
                the human immunodeficiency virus, or the incidence of 
                any other infectious disease; or
                    ``(B) in improving reproductive health or other 
                conditions of health.''.

SEC. 208. DISCRETIONARY FUND OF DIRECTOR OF NATIONAL INSTITUTES OF 
              HEALTH.

    Section 402 of the Public Health Service Act, as amended by section 
206 of this Act, is amended by adding at the end the following new 
subsection:
    ``(i)(1) There is established a fund, consisting of amounts 
appropriated under paragraph (3) and made available for the fund, for 
use by the Director of NIH to carry out the activities authorized in 
this Act for the National Institutes of Health. The purposes for which 
such fund may be expended include--
            ``(A) providing for research on matters that have not 
        received significant funding relative to other matters, 
        responding to new issues and scientific emergencies, and acting 
        on research opportunities of high priority;
            ``(B) supporting research that is not exclusively within 
        the authority of any single agency of such Institutes; and
            ``(C) purchasing or renting equipment and quarters for 
        activities of such Institutes.
    ``(2) Not later than February 10 of each fiscal year, 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 undertaken and 
expenditures made under this section during the preceding fiscal year. 
The report may contain such comments of the Secretary regarding this 
section as the Secretary determines to be appropriate.
    ``(3) For the purpose of carrying out this subsection, there are 
authorized to be appropriated $25,000,000 for fiscal year 1994, and 
such sums as may be necessary for each of the fiscal years 1995 and 
1996.''.

SEC. 209. ESTABLISHMENT OF OFFICE OF ALTERNATIVE MEDICINE.

    Part A of title IV of the Public Health Service Act, as amended by 
section 207 of this Act, is amended by adding at the end the following 
section:

                    ``office of alternative medicine

    ``Sec. 404E. (a) There is established within the Office of the 
Director of NIH an office to be known as the Office of Alternative 
Medicine (in this section referred to as the `Office'), which shall be 
headed by a director appointed by the Director of NIH.
    ``(b) The purpose of the Office is to facilitate the evaluation of 
various alternative medicine treatment modalities, including 
acupuncture and Oriental medicine, homeopathic medicine, and physical 
manipulation therapies.
    ``(c) In carrying out subsection (b), the Director of the Office 
shall--
            ``(1) establish an information clearinghouse to exchange 
        information with the public about alternative medicine;
            ``(2) support research training--
                    ``(A) for which fellowship support is not provided 
                under section 487; and
                    ``(B) that is not residency training of physicians 
                or other health professionals; and
            ``(3) submit an annual report on past and future activities 
        of the Office, each of which reports shall be submitted to the 
        Committee on Energy and Commerce of the House of 
        Representatives and the Committee on Labor and Human Resources 
        of the Senate.''.

SEC. 210. MISCELLANEOUS PROVISIONS.

    (a) Term of Office for Members of Advisory Councils.--Section 
406(c) of the Public Health Service Act (42 U.S.C. 284a(c)) is amended 
in the second sentence by striking ``until a successor has taken 
office'' and inserting the following: ``for 180 days after the date of 
such expiration''.
    (b) Literacy Requirements.--Section 402(e) of the Public Health 
Service Act (42 U.S.C. 282(e)) is amended--
            (1) in paragraph (3), by striking ``and'' at the end;
            (2) in paragraph (4), by striking the period and inserting 
        ``; and''; and<plus-minus>
            (3) by adding at the end thereof the following new 
        paragraph:
            ``(5) ensure that, after January 1, 1994, at least one-half 
        of all new or revised health education and promotion materials 
        developed or funded by the National Institutes of Health is in 
        a form that does not exceed a level of functional literacy, as 
        defined in the National Literacy Act of 1991 (Public Law 102-
        73).''.
    (c) Day Care Regarding Children of Employees.--Section 402 of the 
Public Health Service Act, as amended by section 208 of this Act, is 
amended by adding at the end the following new subsection:
    ``(j)(1) The Director of NIH may establish a program to provide day 
care services for the employees of the National Institutes of Health 
similar to those services provided by other Federal agencies (including 
the availability of day care service on a 24-hour-a-day basis).
    ``(2) Any day care provider at the National Institutes of Health 
shall establish a sliding scale of fees that takes into consideration 
the income and needs of the employee.
    ``(3) For purposes regarding the provision of day care services, 
the Director of NIH may enter into rental or lease purchase 
agreements.''.

 TITLE III--GENERAL PROVISIONS RESPECTING NATIONAL RESEARCH INSTITUTES

SEC. 301. APPOINTMENT AND AUTHORITY OF DIRECTORS OF NATIONAL RESEARCH 
              INSTITUTES.

    (a) Establishment of General Authority Regarding Direct Funding.--
            (1) In general.--Section 405(b)(2) of the Public Health 
        Service Act (42 U.S.C. 284(b)(2)) is amended--
                    (A) in subparagraph (A), by striking ``and'' after 
                the semicolon at the end;
                    (B) in subparagraph (B), by striking the period at 
                the end and inserting ``; and''; and
                    (C) by adding at the end the following new 
                subparagraph:
            ``(C) shall receive from the President and the Office of 
        Management and Budget directly all funds appropriated by the 
        Congress for obligation and expenditure by the Institute.''.
            (2) Conforming amendment.--Section 413(b)(9) of the Public 
        Health Service Act (42 U.S.C. 285a-2(b)(9)) is amended--
                    (A) by striking ``(A)'' after ``(9)''; and
                    (B) by striking ``advisory council;'' and all that 
                follows and inserting ``advisory council.''.
    (b) Appointment and Duration of Technical and Scientific Peer 
Review Groups.--Section 405(c) of the Public Health Service Act (42 
U.S.C. 284(c)) is amended--
            (1) by amending paragraph (3) to read as follows:
            ``(3) may, in consultation with the advisory council for 
        the Institute and with the approval of the Director of NIH--
                    ``(A) establish technical and scientific peer 
                review groups in addition to those appointed under 
                section 402(b)(6); and
                    ``(B) appoint the members of peer review groups 
                established under subparagraph (A); and''; and
            (2) by adding after and below paragraph (4) the following:
``The Federal Advisory Committee Act shall not apply to the duration of 
a peer review group appointed under paragraph (3).''.

SEC. 302. PROGRAM OF RESEARCH ON OSTEOPOROSIS, PAGET'S DISEASE, AND 
              RELATED BONE DISORDERS.

    Part B of title IV of the Public Health Service Act (42 U.S.C. 284 
et seq.), as amended by section 121(b) of Public Law 102-321 (106 Stat. 
358), is amended by adding at the end the following new section:

``research on osteoporosis, paget's disease, and related bone disorders

    ``Sec. 409A. (a) Establishment.--The Directors of the National 
Institute of Arthritis and Musculoskeletal and Skin Diseases, the 
National Institute on Aging, and the National Institute of Diabetes, 
Digestive and Kidney Diseases, shall expand and intensify the programs 
of such Institutes with respect to research and related activities 
concerning osteoporosis, Paget's disease, and related bone disorders.
    ``(b) Coordination.--The Directors referred to in subsection (a) 
shall jointly coordinate the programs referred to in such subsection 
and consult with the Arthritis and Musculoskeletal Diseases Interagency 
Coordinating Committee and the Interagency Task Force on Aging 
Research.
    ``(c) Information Clearinghouse.--
            ``(1) In general.--In order to assist in carrying out the 
        purpose described in subsection (a), the Director of NIH shall 
        provide for the establishment of an information clearinghouse 
        on osteoporosis and related bone disorders to facilitate and 
        enhance knowledge and understanding on the part of health 
        professionals, patients, and the public through the effective 
        dissemination of information.
            ``(2) Establishment through grant or contract.--For the 
        purpose of carrying out paragraph (1), the Director of NIH 
        shall enter into a grant, cooperative agreement, or contract 
        with a nonprofit private entity involved in activities 
        regarding the prevention and control of osteoporosis and 
        related bone disorders.
    ``(d) Authorization of Appropriations.--For the purpose of carrying 
out this section, there are authorized to be appropriated $40,000,000 
for fiscal year 1994, and such sums as may be necessary for each of the 
fiscal years 1995 and 1996.''.

SEC. 303. ESTABLISHMENT OF INTERAGENCY PROGRAM FOR TRAUMA RESEARCH.

    (a) In General.--Title XII of the Public Health Service Act (42 
U.S.C. 300d et seq.), as amended by title VI of Public Law 102-321 (106 
Stat. 433) and section 304 of Public Law 102-408 (106 Stat. 2084), is 
amended by adding at the end the following part:

           ``Part F--Interagency Program for Trauma Research

``SEC. 1261. ESTABLISHMENT OF PROGRAM.

    ``(a) In General.--The Secretary, acting through the Director of 
the National Institutes of Health (hereafter in this section referred 
to as the `Director'), shall establish a comprehensive program of 
conducting basic and clinical research on trauma (hereafter in this 
section referred to as the `Program'). The Program shall include 
research regarding the diagnosis, treatment, rehabilitation, and 
general management of trauma.
    ``(b) Plan for Program.--
            ``(1) In general.--The Director, in consultation with the 
        Trauma Research Interagency Coordinating Committee established 
        under subsection (g), shall establish and implement a plan for 
        carrying out the activities of the Program, including the 
        activities described in subsection (d). All such activities 
        shall be carried out in accordance with the plan. The plan 
        shall be periodically reviewed, and revised as appropriate.
            ``(2) Submission to congress.--Not later than June 1, 1993, 
        the Director shall submit the plan required in paragraph (1) to 
        the Committee on Energy and Commerce of the House of 
        Representatives, and to the Committee on Labor and Human 
        Resources of the Senate, together with an estimate of the funds 
        needed for each of the fiscal years 1994 through 1996 to 
        implement the plan.
    ``(c) Participating Agencies; Coordination and Collaboration.--The 
Director--
            ``(1) shall provide for the conduct of activities under the 
        Program by the Directors of the agencies of the National 
        Institutes of Health involved in research with respect to 
        trauma;
            ``(2) shall ensure that the activities of the Program are 
        coordinated among such agencies; and
            ``(3) shall, as appropriate, provide for collaboration 
        among such agencies in carrying out such activities.
    ``(d) Certain Activities of Program.--The Program shall include--
            ``(1) studies with respect to all phases of trauma care, 
        including prehospital, resuscitation, surgical intervention, 
        critical care, infection control, wound healing, nutritional 
        care and support, and medical rehabilitation care;
            ``(2) basic and clinical research regarding the response of 
        the body to trauma and the acute treatment and medical 
        rehabilitation of individuals who are the victims of trauma; 
        and
            ``(3) basic and clinical research regarding trauma care for 
        pediatric and geriatric patients.
    ``(e) Mechanisms of Support.--In carrying out the Program, the 
Director, acting through the Directors of the agencies referred to in 
subsection (c)(1), may make grants to public and nonprofit entities, 
including designated trauma centers.
    ``(f) Resources.--The Director shall assure the availability of 
appropriate resources to carry out the Program, including the plan 
established under subsection (b) (including the activities described in 
subsection (d)).
    ``(g) Coordinating Committee.--
            ``(1) In general.--There shall be established a Trauma 
        Research Interagency Coordinating Committee (hereafter in this 
        section referred to as the `Coordinating Committee').
            ``(2) Duties.--The Coordinating Committee shall make 
        recommendations regarding--
                    ``(A) the activities of the Program to be carried 
                out by each of the agencies represented on the 
                Committee and the amount of funds needed by each of the 
                agencies for such activities; and
                    ``(B) effective collaboration among the agencies in 
                carrying out the activities.
            ``(3) Composition.--The Coordinating Committee shall be 
        composed of the Directors of each of the agencies that, under 
        subsection (c), have responsibilities under the Program, and 
        any other individuals who are practitioners in the trauma field 
        as designated by the Director of the National Institutes of 
        Health.
    ``(h) Definitions.--For purposes of this section:
            ``(1) The term `designated trauma center' has the meaning 
        given such term in section 1231(1).
            ``(2) The term `Director' means the Director of the 
        National Institutes of Health.
            ``(3) The term `trauma' means any serious injury that could 
        result in loss of life or in significant disability and that 
        would meet pre-hospital triage criteria for transport to a 
        designated trauma center.''.
    (b) Conforming Amendment.--Section 402 of the Public Health Service 
Act, as amended by section 210(c) of this Act, is amended by adding at 
the end the following new subsection:
    ``(k) The Director of NIH shall carry out the program established 
in part E of title XII (relating to interagency research on trauma).''.

                  TITLE IV--NATIONAL CANCER INSTITUTE

SEC. 401. EXPANSION AND INTENSIFICATION OF ACTIVITIES REGARDING BREAST 
              CANCER.

    Subpart 1 of part C of title IV of the Public Health Service Act 
(42 U.S.C. 285 et seq.) is amended by adding at the end the following 
new section:

                   ``breast and gynecological cancers

    ``Sec. 417. (a) Expansion and Coordination of Activities.--The 
Director of the Institute, in consultation with the National Cancer 
Advisory Board, shall expand, intensify, and coordinate the activities 
of the Institute with respect to research on breast cancer, ovarian 
cancer, and other cancers of the reproductive system of women.
    ``(b) Coordination With Other Institutes.--The Director of the 
Institute shall coordinate the activities of the Director under 
subsection (a) with similar activities conducted by other national 
research institutes and agencies of the National Institutes of Health 
to the extent that such Institutes and agencies have responsibilities 
that are related to breast cancer and other cancers of the reproductive 
system of women.
    ``(c) Programs for Breast Cancer.--
            ``(1) In general.--In carrying out subsection (a), the 
        Director of the Institute shall conduct or support research to 
        expand the understanding of the cause of, and to find a cure 
        for, breast cancer. Activities under such subsection shall 
        provide for an expansion and intensification of the conduct and 
        support of--
                    ``(A) basic research concerning the etiology and 
                causes of breast cancer;
                    ``(B) clinical research and related activities 
                concerning the causes, prevention, detection and 
                treatment of breast cancer;
                    ``(C) control programs with respect to breast 
                cancer in accordance with section 412, including 
                community-based programs designed to assist women who 
                are members of medically underserved populations, low-
                income populations, or minority groups;
                    ``(D) information and education programs with 
                respect to breast cancer in accordance with section 
                413; and
                    ``(E) research and demonstration centers with 
                respect to breast cancer in accordance with section 
                414, including the development and operation of centers 
                for breast cancer research to bring together basic and 
                clinical, biomedical and behavioral scientists to 
                conduct basic, clinical, epidemiological, psychosocial, 
                prevention and treatment research and related 
                activities on breast cancer.
        Not less than six centers shall be operated under subparagraph 
        (E). Activities of such centers should include supporting new 
        and innovative research and training programs for new 
        researchers. Such centers shall give priority to expediting the 
        transfer of research advances to clinical applications.
            ``(2) Implementation of plan for programs.--
                    ``(A) The Director of the Institute shall ensure 
                that the research programs described in paragraph (1) 
                are implemented in accordance with a plan for the 
                programs. Such plan shall include comments and 
                recommendations that the Director of the Institute 
                considers appropriate, with due consideration provided 
                to the professional judgment needs of the Institute as 
                expressed in the annual budget estimate prepared in 
                accordance with section 413(9). The Director of the 
                Institute, in consultation with the National Cancer 
                Advisory Board, shall periodically review and revise 
                such plan.
                    ``(B) Not later than May 1, 1993, the Director of 
                the Institute shall submit a copy of the plan to the 
                President's Cancer Panel, the Secretary and the 
                Director of NIH.
                    ``(C) The Director of the Institute shall submit 
                any revisions of the plan to the President's Cancer 
                Panel, the Secretary, and the Director of NIH.
                    ``(D) The Secretary shall provide a copy of the 
                plan submitted under subparagraph (A), and any 
                revisions submitted under subparagraph (C), to the 
                Committee on Energy and Commerce of the House of 
                Representatives and the Committee on Labor and Human 
                Resources of the Senate.
    ``(d) Other Cancers.--In carrying out subsection (a), the Director 
of the Institute shall conduct or support research on ovarian cancer 
and other cancers of the reproductive system of women. Activities under 
such subsection shall provide for the conduct and support of--
            ``(1) basic research concerning the etiology and causes of 
        ovarian cancer and other cancers of the reproductive system of 
        women;
            ``(2) clinical research and related activities into the 
        causes, prevention, detection and treatment of ovarian cancer 
        and other cancers of the reproductive system of women;
            ``(3) control programs with respect to ovarian cancer and 
        other cancers of the reproductive system of women in accordance 
        with section 412;
            ``(4) information and education programs with respect to 
        ovarian cancer and other cancers of the reproductive system of 
        women in accordance with section 413; and
            ``(5) research and demonstration centers with respect to 
        ovarian cancer and cancers of the reproductive system in 
        accordance with section 414.
    ``(e) Report.--The Director of the Institute shall prepare, for 
inclusion in the biennial report submitted under section 407, a report 
that describes the activities of the National Cancer Institute under 
the research programs referred to in subsection (a), that shall 
include--
            ``(1) a description of the research plan with respect to 
        breast cancer prepared under subsection (c);
            ``(2) an assessment of the development, revision, and 
        implementation of such plan;
            ``(3) a description and evaluation of the progress made, 
        during the period for which such report is prepared, in the 
        research programs on breast cancer and cancers of the 
        reproductive system of women;
            ``(4) a summary and analysis of expenditures made, during 
        the period for which such report is made, for activities with 
        respect to breast cancer and cancers of the reproductive system 
        of women conducted and supported by the National Institutes of 
        Health; and
            ``(5) such comments and recommendations as the Director 
        considers appropriate.''.

SEC. 402. EXPANSION AND INTENSIFICATION OF ACTIVITIES REGARDING 
              PROSTATE CANCER.

    Subpart 1 of part C of title IV of the Public Health Service Act, 
as amended by section 401 of this Act, is amended by adding at the end 
the following new section:

                           ``prostate cancer

    ``Sec. 417A. (a) Expansion and Coordination of Activities.--The 
Director of the Institute, in consultation with the National Cancer 
Advisory Board, shall expand, intensify, and coordinate the activities 
of the Institute with respect to research on prostate cancer.
    ``(b) Coordination With Other Institutes.--The Director of the 
Institute shall coordinate the activities of the Director under 
subsection (a) with similar activities conducted by other national 
research institutes and agencies of the National Institutes of Health 
to the extent that such Institutes and agencies have responsibilities 
that are related to prostate cancer.
    ``(c) Programs.--
            ``(1) In general.--In carrying out subsection (a), the 
        Director of the Institute shall conduct or support research to 
        expand the understanding of the cause of, and to find a cure 
        for, prostate cancer. Activities under such subsection shall 
        provide for an expansion and intensification of the conduct and 
        support of--
                    ``(A) basic research concerning the etiology and 
                causes of prostate cancer;
                    ``(B) clinical research and related activities 
                concerning the causes, prevention, detection and 
                treatment of prostate cancer;
                    ``(C) prevention and control and early detection 
                programs with respect to prostate cancer in accordance 
                with section 412, particularly as it relates to 
                intensifying research on the role of prostate specific 
                antigen for the screening and early detection of 
                prostate cancer;
                    ``(D) an Inter-Institute Task Force, under the 
                direction of the Director of the Institute, to provide 
                coordination between relevant National Institutes of 
                Health components of research efforts on prostate 
                cancer;
                    ``(E) control programs with respect to prostate 
                cancer in accordance with section 412;
                    ``(F) information and education programs with 
                respect to prostate cancer in accordance with section 
                413; and
                    ``(G) research and demonstration centers with 
                respect to prostate cancer in accordance with section 
                414, including the development and operation of centers 
                for prostate cancer research to bring together basic 
                and clinical, biomedical and behavioral scientists to 
                conduct basic, clinical, epidemiological, psychosocial, 
                prevention and control, treatment, research, and 
                related activities on prostate cancer.
        Not less than six centers shall be operated under subparagraph 
        (G). Activities of such centers should include supporting new 
        and innovative research and training programs for new 
        researchers. Such centers shall give priority to expediting the 
        transfer of research advances to clinical applications.
            ``(2) Implementation of plan for programs.--
                    ``(A) The Director of the Institute shall ensure 
                that the research programs described in paragraph (1) 
                are implemented in accordance with a plan for the 
                programs. Such plan shall include comments and 
                recommendations that the Director of the Institute 
                considers appropriate, with due consideration provided 
                to the professional judgment needs of the Institute as 
                expressed in the annual budget estimate prepared in 
                accordance with section 413(9). The Director of the 
                Institute, in consultation with the National Cancer 
                Advisory Board, shall periodically review and revise 
                such plan.
                    ``(B) Not later than May 1, 1993, the Director of 
                the Institute shall submit a copy of the plan to the 
                President's Cancer Panel, the Secretary and the 
                Director of NIH.
                    ``(C) The Director of the Institute shall submit 
                any revisions of the plan to the President's Cancer 
                Panel, the Secretary, and the Director of NIH.
                    ``(D) The Secretary shall provide a copy of the 
                plan submitted under subparagraph (A), and any 
                revisions submitted under subparagraph (C), to the 
                Committee on Energy and Commerce of the House of 
                Representatives and the Committee on Labor and Human 
                Resources of the Senate.''.

SEC. 403. AUTHORIZATION OF APPROPRIATIONS.

    (a) In General.--Subpart 1 of part C of title IV of the Public 
Health Service Act, as amended by section 402 of this Act, is amended 
by adding at the end the following new section:

                   ``authorization of appropriations

    ``Sec. 417B. (a) Activities Generally.--For the purpose of carrying 
out this subpart, there are authorized to be appropriated 
$3,200,000,000 for fiscal year 1994, and such sums as may be necessary 
for each of the fiscal years 1995 and 1996.
    ``(b) Breast Cancer and Gynecological Cancers.--
            ``(1) Breast cancer.--
                    ``(A) For the purpose of carrying out subparagraph 
                (A) of section 417(c)(1), there are authorized to be 
                appropriated $225,000,000 for fiscal year 1994, and 
                such sums as may be necessary for each of the fiscal 
                years 1995 and 1996. Such authorizations of 
                appropriations are in addition to the authorizations of 
                appropriations established in subsection (a) with 
                respect to such purpose.
                    ``(B) For the purpose of carrying out subparagraphs 
                (B) through (E) of section 417(c)(1), there are 
                authorized to be appropriated $100,000,000 for fiscal 
                year 1994, and such sums as may be necessary for each 
                of the fiscal years 1995 and 1996. Such authorizations 
                of appropriations are in addition to the authorizations 
                of appropriations established in subsection (a) with 
                respect to such purpose.
            ``(2) Other cancers.--For the purpose of carrying out 
        subsection (d) of section 417, there are authorized to be 
        appropriated $75,000,000 for fiscal year 1994, and such sums as 
        are necessary for each of the fiscal years 1995 and 1996. Such 
        authorizations of appropriations are in addition to the 
        authorizations of appropriations established in subsection (a) 
        with respect to such purpose.
    ``(c) Prostate Cancer.--For the purpose of carrying out section 
417A, there are authorized to be appropriated $72,000,000 for fiscal 
year 1994, and such sums as may be necessary for each of the fiscal 
years 1995 and 1996. Such authorizations of appropriations are in 
addition to the authorizations of appropriations established in 
subsection (a) with respect to such purpose.
    ``(d) Allocation Regarding Cancer Control.--
            ``(1) In general.--Of the amounts appropriated for the 
        National Cancer Institute for a fiscal year, the Director of 
        the Institute shall make available not less than the applicable 
        percentage specified in paragraph (2) for carrying out the 
        cancer control activities authorized in section 412 and for 
        which budget estimates are made under section 413(b)(9) for the 
        fiscal year.
            ``(2) Applicable percentage.--The percentage referred to in 
        paragraph (1) is--
                    ``(A) 7 percent, in the case of fiscal year 1994;
                    ``(B) 9 percent, in the case of fiscal year 1995; 
                and
                    ``(C) 10 percent, in the case of fiscal year 1996 
                and each subsequent fiscal year.''.
    (b) Conforming Amendments.--
            (1) In general.--Section 408 of the Public Health Service 
        Act (42 U.S.C. 284c) is amended--
                    (A) by striking subsection (a);
                    (B) by redesignating subsection (b) as subsection 
                (a);
                    (C) by redesignating paragraph (5) of subsection 
                (a) (as so redesignated) as subsection (b); and
                    (D) by amending the heading for the section to read 
                as follows:

                       ``certain uses of funds''.

            (2) Cross-reference.--Section 464F of the Public Health 
        Service Act (42 U.S.C. 285m-6) is amended by striking ``section 
        408(b)(1)'' and inserting ``section 408(a)(1)''.

SEC. 404. STUDY OF ENVIRONMENTAL AND OTHER RISKS CONTRIBUTING TO 
              INCIDENCE OF BREAST CANCER.

    (a) Requirement of Study.--
            (1) In general.--The Director of the National Cancer 
        Institute (in this section referred to as the ``Director''), in 
        collaboration with the Director of the National Institute of 
        Environmental Health Sciences, shall conduct a case-controlled 
        study to assess biological markers of environmental and other 
        risk factors contributing to the incidence of breast cancer 
        in--
                    (A) the Counties of Nassau and Suffolk, in the 
                State of New York; and
                    (B) the 2 counties in the northeastern United 
                States that, as identified in the report specified in 
                paragraph (2), had the highest age-adjusted mortality 
                rate of such cancer that reflected not less than 30 
                deaths during the 5-year period for which findings are 
                made in the report.
            (2) Relevant report.--The report referred to in paragraph 
        (1)(B) is the report of the findings made in the study entitled 
        ``Survival, Epidemiology, and End Results'', relating to cases 
        of cancer during the years 1983 through 1987.
    (b) Certain Elements of Study.--Activities of the Director in 
carrying out the study under subsection (a) shall include the use of a 
geographic system to evaluate the current and past exposure of 
individuals, incuding direct monitoring and cumulative estimates of 
exposure, to--
            (1) contaminated drinking water;
            (2) sources of indoor and ambient air pollution, including 
        emissions from aircraft;
            (3) electromagnetic fields;
            (4) pesticides and other toxic chemicals;
            (5) hazardous and municipal waste; and
            (6) such other factors as the Director determines to be 
        appropriate.
    (c) Report.--Not later than 30 months after the date of the 
enactment of this Act, the Director shall complete the study required 
in subsection (a) and submit to the Committee on Energy and Commerce of 
the House of Representatives, and to the Committee on Labor and Human 
Resources of the Senate, a report describing the findings made as a 
result of the study.
    (d) Funding.--Of the amounts appropriated for fiscal years 1994 and 
1995 for the National Institute of Environmental Health Sciences and 
the National Cancer Institute, the Director of the National Institutes 
of Health shall make available amounts for carrying out the study 
required in subsection (a).

           TITLE V--NATIONAL HEART, LUNG, AND BLOOD INSTITUTE

SEC. 501. EDUCATION AND TRAINING.

    Section 421(b) of the Public Health Service Act (42 U.S.C. 285b-
3(b)) is amended--
            (1) in paragraph (3), by striking ``and'' after the 
        semicolon at the end;
            (2) in paragraph (4), by striking the period at the end and 
        inserting ``; and''; and
            (3) by inserting after paragraph (4) the following new 
        paragraph:
            ``(5) shall, in consultation with the advisory council for 
        the Institute, conduct appropriate intramural training and 
        education programs, including continuing education and 
        laboratory and clinical research training programs.''.

SEC. 502. CENTERS FOR THE STUDY OF PEDIATRIC CARDIOVASCULAR DISEASES.

    Section 422(a)(1) of the Public Health Service Act (42 U.S.C. 285b-
4(a)(1)) is amended--
            (1) in subparagraph (B), by striking ``and'' at the end;
            (2) in subparagraph (C), by striking the period and 
        inserting ``; and''; and
            (3) by adding at the end thereof the following new 
        subparagraph:
            ``(D) three centers for basic and clinical research into, 
        training in, and demonstration of, advanced diagnostic, 
        prevention, and treatment (including genetic studies, 
        intrauterine environment studies, postnatal studies, heart 
        arrhythmias, and acquired heart disease and preventive 
        cardiology) for cardiovascular diseases in children.''.

SEC. 503. NATIONAL CENTER ON SLEEP DISORDERS.

    Subpart 2 of part C of title IV of the Public Health Service Act 
(42 U.S.C. 285b et seq.) is amended by adding at the end the following 
new section:

                  ``national center on sleep disorders

    ``Sec. 424. (a) Not later than 1 year after the date of the 
enactment of the National Institutes of Health Revitalization Act of 
1993, the Director of the Institute shall establish the National Center 
on Sleep Disorders (in this section referred to as the `Center'). The 
Center shall be headed by a director, who shall be appointed by the 
Director of the Institute.
    ``(b) The general purpose of the Center is the conduct and support 
of research, training, health information dissemination, and other 
activities with respect to sleep disorders.
    ``(c) The Director of the Center may coordinate the activities of 
the Center with similar activities of other agencies of the Federal 
Government, including the other agencies of the National Institutes of 
Health, and with similar activities of other public entities and of 
private entities.''.

SEC. 504. AUTHORIZATION OF APPROPRIATIONS.

    Subpart 2 of part C of title IV of the Public Health Service Act, 
as amended by section 503 of this Act, is amended by adding at the end 
the following section:

                   ``authorization of appropriations

    ``Sec. 425. For the purpose of carrying out this subpart, there are 
authorized to be appropriated $1,500,000,000 for fiscal year 1994, and 
such sums as may be necessary for each of the fiscal years 1995 and 
1996.''.

   TITLE VI--NATIONAL INSTITUTE ON DIABETES AND DIGESTIVE AND KIDNEY 
                                DISEASES

SEC. 601. PROVISIONS REGARDING NUTRITIONAL DISORDERS.

    Subpart 3 of part C of title IV of the Public Health Service Act 
(42 U.S.C. 285c et seq.) is amended by adding at the end the following 
new section:

                    ``nutritional disorders program

    ``Sec. 434. (a) The Director of the Institute, in consultation with 
the Director of NIH, shall establish a program of conducting and 
supporting research, training, health information dissemination, and 
other activities with respect to nutritional disorders, including 
obesity.
    ``(b) In carrying out the program established under subsection (a), 
the Director of the Institute shall conduct and support each of the 
activities described in such subsection.
    ``(c) In carrying out the program established under subsection (a), 
the Director of the Institute shall carry out activities to facilitate 
and enhance knowledge and understanding of nutritional disorders, 
including obesity, on the part of health professionals, patients, and 
the public through the effective dissemination of information.''.
    (b) Development and Expansion of Research and Training Centers.--
Section 431 of the Public Health Service Act (42 U.S.C. 285c-5) is 
amended--
            (1) by redesignating subsection (d) as subsection (e); and
            (2) by inserting after subsection (c) the following new 
        subsection:
    ``(d)(1) The Director of the Institute shall, subject to the extent 
of amounts made available in appropriations Acts, provide for the 
development or substantial expansion of centers for research and 
training regarding nutritional disorders, including obesity.
    ``(2) The Director of the Institute shall carry out paragraph (1) 
in collaboration with the Director of the National Cancer Institute and 
with the Directors of such other agencies of the National Institutes of 
Health as the Director of NIH determines to be appropriate.
    ``(3) Each center developed or expanded under paragraph (1) shall--
            ``(A) utilize the facilities of a single institution, or be 
        formed from a consortium of cooperating institutions, meeting 
        such research and training qualifications as may be prescribed 
        by the Director;
            ``(B) conduct basic and clinical research into the cause, 
        diagnosis, early detection, prevention, control and treatment 
        of nutritional disorders, including obesity and the impact of 
        nutrition and diet on child development;
            ``(C) conduct training programs for physicians and allied 
        health professionals in current methods of diagnosis and 
        treatment of such diseases and complications, and in research 
        in such disorders; and
            ``(D) conduct information programs for physicians and 
        allied health professionals who provide primary care for 
        patients with such disorders or complications.''.

TITLE VII--NATIONAL INSTITUTE ON ARTHRITIS AND MUSCULOSKELETAL AND SKIN 
                                DISEASES

SEC. 701. JUVENILE ARTHRITIS.

    (a) Purpose.--Section 435 of the Public Health Service Act (42 
U.S.C. 285d) is amended by striking ``and other programs'' and all that 
follows and inserting the following: ``and other programs with respect 
to arthritis and musculoskeletal and skin diseases (including sports-
related disorders), with particular attention to the effect of these 
diseases on children.''.
    (b) Programs.--Section 436 (42 U.S.C. 285d-1) is amended--
            (1) in subsection (a), by inserting after the second 
        sentence, the following: ``The plan shall place particular 
        emphasis upon expanding research into better understanding the 
        causes and the development of effective treatments for 
        arthritis affecting children.''; and
            (2) in subsection (b)--
                    (A) by striking ``and'' at the end of paragraph 
                (3);
                    (B) by striking the period at the end of paragraph 
                (4) and inserting ``; and''; and
                    (C) by adding at the end thereof the following new 
                paragraph:
            ``(5) research into the causes of arthritis affecting 
        children and the development, trial, and evaluation of 
        techniques, drugs and devices used in the diagnosis, treatment 
        (including medical rehabilitation), and prevention of arthritis 
        in children.''.
    (c) Centers.--Section 441 of the Public Health Service Act (42 
U.S.C. 286d-6) is amended by adding at the end thereof the following 
new subsection:
    ``(f) Not later than October 1, 1994, the Director shall establish 
a multipurpose arthritis and musculoskeletal disease center for the 
purpose of expanding the level of research into the cause, diagnosis, 
early detection, prevention, control, and treatment of, and 
rehabilitation of children with arthritis and musculoskeletal 
diseases.''.
    (d) Advisory Board.--
            (1) Title.--Section 442(a) of the Public Health Service Act 
        (42 U.S.C. 285d-7(a)) is amended by inserting after 
        ``Arthritis'' the following: ``and Musculoskeletal and Skin 
        Diseases''.
            (2) Composition.--Section 442(b) of the Public Health 
        Service Act (42 U.S.C. 285d-7(b)) is amended--
                    (A) in the matter preceding paragraph (1), by 
                striking ``eighteen'' and inserting ``twenty''; and
                    (B) in paragraph (1)(B)--
                            (i) by striking ``six'' and inserting 
                        ``eight''; and
                            (ii) by striking ``including'' and all that 
                        follows and inserting the following: 
                        ``including one member who is a person who has 
                        such a disease, one person who is the parent of 
                        an adult with such a disease, and two members 
                        who are parents of children with arthritis.''.
            (3) Annual report.--Section 442(j) of the Public Health 
        Service Act (42 U.S.C. 285d-7(j)) is amended--
            (1) by striking ``and'' at the end of paragraph (3);
            (2) by striking the period at the end of paragraph (4) and 
        inserting ``; and''; and
            (3) by adding at the end the following paragraph:
            ``(5) contains recommendations for expanding the 
        Institute's funding of research directly applicable to the 
        cause, diagnosis, early detection, prevention, control, and 
        treatment of, and rehabilitation of children with arthritis and 
        musculoskeletal diseases.''.

                TITLE VIII--NATIONAL INSTITUTE ON AGING

SEC. 801. ALZHEIMER'S DISEASE REGISTRY.

    (a) In General.--Section 12 of Public Law 99-158 (99 Stat. 885) 
is--
            (1) transferred to subpart 5 of part C of title IV of the 
        Public Health Service Act (42 U.S.C. 285e et seq.);
            (2) redesignated as section 445G; and
            (3) inserted after section 445F of such Act.
    (b) Technical and Conforming Amendments.--Section 445G of the 
Public Health Service Act, as transferred and inserted by subsection 
(a) of this section, is amended--
            (1) by striking the section heading and all that follows 
        through ``may make a grant'' in subsection (a) and inserting 
        the following:

                     ``alzheimer's disease registry

    ``Sec. 445G. (a) In General.--The Director of the Institute may 
make a grant''; and
            (2) by striking subsection (c).

SEC. 802. AGING PROCESSES REGARDING WOMEN.

    Subpart 5 of part C of title IV of the Public Health Service Act, 
as amended by section 801 of this Act, is amended by adding at the end 
the following new section:

                   ``aging processes regarding women

    ``Sec. 445H. The Director of the Institute, in addition to other 
special functions specified in section 444 and in cooperation with the 
Directors of the other national research institutes and agencies of the 
National Institutes of Health, shall conduct research into the aging 
processes of women, with particular emphasis given to the effects of 
menopause and the physiological and behavioral changes occurring during 
the transition from pre- to post-menopause, and into the diagnosis, 
disorders, and complications related to aging and loss of ovarian 
hormones in women.''.

SEC. 803. AUTHORIZATION OF APPROPRIATIONS.

    Subpart 5 of part C of title IV of the Public Health Service Act, 
as amended by section 802 of this Act, is amended by adding at the end 
the following new section:

                   ``authorization of appropriations

    ``Sec. 445I. For the purpose of carrying out this subpart, there 
are authorized to be appropriated $500,000,000 for fiscal year 1994, 
and such sums as may be necessary for each of the fiscal years 1995 and 
1996.''.

SEC. 804. CONFORMING AMENDMENT.

    Section 445C of the Public Health Service Act (42 U.S.C. 285e-5), 
as amended by section 9 of Public Law 102-507 (106 Stat. 3287), is 
amended--
            (1) in subsection (b)(1), in the first sentence, by 
        inserting after ``Council'' the following: ``on Alzheimer's 
        Disease (hereafter in this section referred to as the 
        `Council')''; and
            (2) by adding at the end the following new subsection:
    ``(e) For purposes of this section, the term `Council on 
Alzheimer's Disease' means the council established in section 911(a) of 
Public Law 99-660.''.

    TITLE IX--NATIONAL INSTITUTE OF ALLERGY AND INFECTIOUS DISEASES

SEC. 901. TROPICAL DISEASES.

    Section 446 of the Public Health Service Act (42 U.S.C. 285f) is 
amended by inserting before the period the following: ``, including 
tropical diseases''.

SEC. 902. CHRONIC FATIGUE SYNDROME.

    (a) Research Centers.--Subpart 6 of part C of title IV of the 
Public Health Service Act (42 U.S.C. 285f) is amended by adding at the 
end the following new section:

         ``research centers regarding chronic fatigue syndrome

    ``Sec. 447. (a) The Director of the Institute, after consultation 
with the advisory council for the Institute, may make grants to, or 
enter into contracts with, public or nonprofit private entities for the 
development and operation of centers to conduct basic and clinical 
research on chronic fatigue syndrome.
    ``(b) Each center assisted under this section shall use the 
facilities of a single institution, or be formed from a consortium of 
cooperating institutions, meeting such requirements as may be 
prescribed by the Director of the Institute.''.
    (b) Extramural Study Section.--Not later than 6 months after the 
date of enactment of this Act, the Secretary of Health and Human 
Services shall establish an extramural study section for chronic 
fatigue syndrome research.
    (c) Representatives.--The Secretary of Health and Human Services, 
acting through the Director of the National Institutes of Health, shall 
ensure that appropriate individuals with expertise in chronic fatigue 
syndrome or neuromuscular diseases and representative of a variety of 
disciplines and fields within the research community are appointed to 
appropriate National Institutes of Health advisory committees and 
boards.

   TITLE X--NATIONAL INSTITUTE OF CHILD HEALTH AND HUMAN DEVELOPMENT

Subtitle A--Research Centers With Respect to Contraception and Research 
                  Centers With Respect to Infertility

SEC. 1001. GRANTS AND CONTRACTS FOR RESEARCH CENTERS.

    Subpart 7 of part C of title IV of the Public Health Service Act, 
as amended by section 3 of Public Law 101-613, is amended by adding at 
the end the following new section:

    ``research centers with respect to contraception and infertility

    ``Sec. 452A. (a) The Director of the Institute, after consultation 
with the advisory council for the Institute, shall make grants to, or 
enter into contracts with, public or nonprofit private entities for the 
development and operation of centers to conduct activities for the 
purpose of improving methods of contraception and centers to conduct 
activities for the purpose of improving methods of diagnosis and 
treatment of infertility.
    ``(b) In carrying out subsection (a), the Director of the Institute 
shall, subject to the extent of amounts made available in 
appropriations Acts, provide for the establishment of three centers 
with respect to contraception and for two centers with respect to 
infertility.
    ``(c)(1) Each center assisted under this section shall, in carrying 
out the purpose of the center involved--
            ``(A) conduct clinical and other applied research, 
        including--
                    ``(i) for centers with respect to contraception, 
                clinical trials of new or improved drugs and devices 
                for use by males and females (including barrier 
                methods); and
                    ``(ii) for centers with respect to infertility, 
                clinical trials of new or improved drugs and devices 
                for the diagnosis and treatment of infertility in males 
                and females;
            ``(B) develop protocols for training physicians, 
        scientists, nurses, and other health and allied health 
        professionals;
            ``(C) conduct training programs for such individuals;
            ``(D) develop model continuing education programs for such 
        professionals; and
            ``(E) disseminate information to such professionals and the 
        public.
    ``(2) A center may use funds provided under subsection (a) to 
provide stipends for health and allied health professionals enrolled in 
programs described in subparagraph (C) of paragraph (1), and to provide 
fees to individuals serving as subjects in clinical trials conducted 
under such paragraph.
    ``(d) The Director of the Institute shall, as appropriate, provide 
for the coordination of information among the centers assisted under 
this section.
    ``(e) Each center assisted under subsection (a) shall use the 
facilities of a single institution, or be formed from a consortium of 
cooperating institutions, meeting such requirements as may be 
prescribed by the Director of the Institute.
    ``(f) Support of a center under subsection (a) may be for a period 
not exceeding 5 years. Such period may be extended for one or more 
additional periods not exceeding 5 years if the operations of such 
center have been reviewed by an appropriate technical and scientific 
peer review group established by the Director and if such group has 
recommended to the Director that such period should be extended.
    ``(g) For the purpose of carrying out this section, there are 
authorized to be appropriated $30,000,000 for fiscal year 1994, and 
such sums as may be necessary for each of the fiscal years 1995 and 
1996.''.

SEC. 1002. LOAN REPAYMENT PROGRAM FOR RESEARCH WITH RESPECT TO 
              CONTRACEPTION AND INFERTILITY.

    Part G of title IV of the Public Health Service Act, as 
redesignated by section 141(a)(2) of this Act, is amended by inserting 
after section 487A the following section:

``loan repayment program for research with respect to contraception and 
                              infertility

    ``Sec. 487B. (a) The Secretary, in consultation with the Director 
of the National Institute of Child Health and Human Development, shall 
establish a program of entering into agreements with qualified health 
professionals (including graduate students) under which such health 
professionals agree to conduct research with respect to contraception, 
or with respect to infertility, in consideration of the Federal 
Government agreeing to repay, for each year of such service, not more 
than $20,000 of the principal and interest of the educational loans of 
such health professionals.
    ``(b) The provisions of sections 338B, 338C, and 338E shall apply 
to the program established in subsection (a) to the same extent and in 
the same manner as such provisions apply to the National Health Service 
Corps Loan Repayment Program established in subpart III of part D of 
title III.
    ``(c) Amounts appropriated for carrying out this section shall 
remain available until the expiration of the second fiscal year 
beginning after the fiscal year for which the amounts were 
appropriated.''.

        Subtitle B--Program Regarding Obstetrics and Gynecology

SEC. 1011. ESTABLISHMENT OF PROGRAM.

    Subpart 7 of part C of title IV of the Public Health Service Act, 
as amended by section 1001 of this Act, is amended by adding at the end 
the following new section:

             ``program regarding obstetrics and gynecology

    ``Sec. 452B. The Director of the Institute shall establish and 
maintain within the Institute an intramural laboratory and clinical 
research program in obstetrics and gynecology.''.

               Subtitle C--Child Health Research Centers

SEC. 1021. ESTABLISHMENT OF CENTERS.

    Subpart 7 of part C of title IV of the Public Health Service Act, 
as amended by section 1011 of this Act, is amended by adding at the end 
the following new section:

                    ``child health research centers

    ``Sec. 452C. The Director of the Institute shall develop and 
support centers for conducting research with respect to child health. 
Such centers shall give priority to the expeditious transfer of 
advances from basic science to clinical applications and improving the 
care of infants and children.''.

             Subtitle D--Study Regarding Adolescent Health

SEC. 1031. PROSPECTIVE LONGITUDINAL STUDY.

    Subpart 7 of part C of title IV of the Public Health Service Act, 
as amended by section 1021 of this Act, is amended by adding at the end 
the following new section:

         ``prospective longitudinal study on adolescent health

    ``Sec. 452D. (a) In General.--Not later than October 1, 1993, the 
Director of the Institute shall commence a study for the purpose of 
providing information on the general health and well-being of 
adolescents in the United States, including, with respect to such 
adolescents, information on--
            ``(1) the behaviors that promote health and the behaviors 
        that are detrimental to health; and
            ``(2) the influence on health of factors particular to the 
        communities in which the adolescents reside.
    ``(b) Design of Study.--
            ``(1) In general.--The study required in subsection (a) 
        shall be a longitudinal study in which a substantial number of 
        adolescents participate as subjects. With respect to the 
        purpose described in such subsection, the study shall monitor 
        the subjects throughout the period of the study to determine 
        the health status of the subjects and any change in such status 
        over time.
            ``(2) Population-specific analyses.--The study required in 
        subsection (a) shall be conducted with respect to the 
        population of adolescents who are female, the population of 
        adolescents who are male, various socioeconomic populations of 
        adolescents, and various racial and ethnic populations of 
        adolescents. The study shall be designed and conducted in a 
        manner sufficient to provide for a valid analysis of whether 
        there are significant differences among such populations in 
        health status and whether and to what extent any such 
        differences are due to factors particular to the populations 
        involved.
    ``(c) Coordination With Women's Health Initiative.--With respect to 
the national study of women being conducted by the Secretary and known 
as the Women's Health Initiative, the Secretary shall ensure that such 
study is coordinated with the component of the study required in 
subsection (a) that concerns adolescent females, including coordination 
in the design of the 2 studies.''.

                    TITLE XI--NATIONAL EYE INSTITUTE

SEC. 1101. CLINICAL RESEARCH ON DIABETES EYE CARE.

    (a) In General.--Subpart 9 of part C of title IV of the Public 
Health Service Act (42 U.S.C. 285i) is amended by adding at the end the 
following new section:

              ``clinical research on eye care and diabetes

    ``Sec. 456. (a) Program of Grants.--The Director of the Institute, 
in consultation with the advisory council for the Institute, may award 
not more than three grants for the establishment and support of centers 
for clinical research on eye care for individuals with diabetes.
    ``(b) Authorized Expenditures.--The purposes for which a grant 
under subsection (a) may be expended include equipment for the research 
described in such subsection and the construction and modernization of 
facilities for such research.''.
    (b) Conforming Amendment.--Section 455 of the Public Health Service 
Act (42 U.S.C. 285i) is amended in the second sentence by striking 
``The Director'' and inserting ``Subject to section 456, the 
Director''.

   TITLE XII--NATIONAL INSTITUTE OF NEUROLOGICAL DISORDERS AND STROKE

SEC. 1201. RESEARCH ON MULTIPLE SCLEROSIS.

    Subpart 10 of part C of title IV of the Public Health Service Act 
(42 U.S.C. 285j et seq.) is amended by adding at the end the following 
new section:

                    ``research on multiple sclerosis

    ``Sec. 460. The Director of the Institute shall conduct and support 
research on multiple sclerosis, especially research on effects of 
genetics and hormonal changes on the progress of the disease.''.

    TITLE XIII--NATIONAL INSTITUTE OF ENVIRONMENTAL HEALTH SCIENCES

SEC. 1301. APPLIED TOXICOLOGICAL RESEARCH AND TESTING PROGRAM.

    (a) In General.--Subpart 12 of part C of title IV of the Public 
Health Service Act (42 U.S.C. 285l) is amended by adding at the end the 
following new section:

          ``applied toxicological research and testing program

    ``Sec. 463A. (a) There is established within the Institute a 
program for conducting applied research and testing regarding 
toxicology, which program shall be known as the Applied Toxicological 
Research and Testing Program.
    ``(b) In carrying out the program established under subsection (a), 
the Director of the Institute shall, with respect to toxicology, carry 
out activities--
            ``(1) to expand knowledge of the health effects of 
        environmental agents;
            ``(2) to broaden the spectrum of toxicology information 
        that is obtained on selected chemicals;
            ``(3) to develop and validate assays and protocols, 
        including alternative methods that can reduce or eliminate the 
        use of animals in acute or chronic safety testing;
            ``(4) to establish criteria for the validation and 
        regulatory acceptance of alternative testing and to recommend a 
        process through which scientifically validated alternative 
        methods can be accepted for regulatory use;
            ``(5) to communicate the results of research to government 
        agencies, to medical, scientific, and regulatory communities, 
        and to the public; and
            ``(6) to integrate related activities of the Department of 
        Health and Human Services.''.
    (b) Technical Amendment.--Section 463 of the Public Health Service 
Act (42 U.S.C. 285l) is amended by inserting after ``Sciences'' the 
following: ``(hereafter in this subpart referred to as the 
`Institute')''.

SEC. 1302. STUDY OF ENVIRONMENTAL AND OTHER RISKS CONTRIBUTING TO 
              INCIDENCE OF BREAST AND PROSTATE CANCER.

    (a) In General.--The Director of the National Institute of 
Environmental Health Sciences (in this section referred to as the 
``Director''), in collaboration with the Director of the National 
Cancer Institute, shall conduct a case-controlled study to assess 
biological markers of environmental and other risk factors contributing 
to the incidence of breast and prostate cancer in the Counties of 
Nassau and Suffolk, in the State of New York.
    (b) Certain Elements of Study.--Activities of the Director in 
carrying out the study under subsection (a) shall include the use of a 
geographic system to evaluate the current and past exposure of 
individuals, including direct monitoring and cumulative estimates of 
exposure, to--
            (1) contaminated drinking water;
            (2) sources of indoor and ambient air pollution, including 
        emissions from aircraft;
            (3) electromagnetic fields;
            (4) pesticides and other toxic chemicals;
            (5) hazardous and municipal waste; and
            (6) such other factors as the Director determines to be 
        appropriate.
    (c) Report.--Not later than 24 months after the date of the 
enactment of this Act, the Director shall complete the study required 
in subsection (a) and submit to the Committee on Energy and Commerce of 
the House of Representatives, and to the Committee on Labor and Human 
Resources of the Senate, a report describing the findings made as a 
result of the study.
    (d) Funding.--Of the amounts appropriated for fiscal years 1994 and 
1995 for the National Institute of Environmental Health Sciences and 
the National Cancer Institute, the Director of the National Institutes 
of Health shall make available amounts for carrying out the study 
required in subsection (a).

                TITLE XIV--NATIONAL LIBRARY OF MEDICINE

                     Subtitle A--General Provisions

SEC. 1401. ADDITIONAL AUTHORITIES.

    (a) In General.--Section 465(b) of the Public Health Service Act 
(42 U.S.C. 286(b)) is amended--
            (1) by striking ``and'' after the semicolon at the end of 
        paragraph (5);
            (2) by redesignating paragraph (6) as paragraph (8); and
            (3) by inserting after paragraph (5) the following new 
        paragraphs:
            ``(6) publicize the availability from the Library of the 
        products and services described in any of paragraphs (1) 
        through (5);
            ``(7) promote the use of computers and telecommunications 
        by health professionals (including health professionals in 
        rural areas) for the purpose of improving access to biomedical 
        information for health care delivery and medical research; 
        and''.
    (b) Limitation Regarding Grants.--Section 474(b)(2) of the Public 
Health Service Act (42 U.S.C. 286b-S(b)(2)) is amended by striking 
``$750,000'' and inserting ``$1,000,000''.
    (c) Technical and Conforming Amendments.--
            (1) Repeal of certain authority.--Section 215 of the 
        Department of Health and Human Services Appropriations Act, 
        1988, as contained in section 101(h) of Public Law 100-202 (101 
        Stat. 1329-275), is repealed.
            (2) Applicability of certain new authority.--With respect 
        to the authority established for the National Library of 
        Medicine in section 465(b)(6) of the Public Health Service Act, 
        as added by subsection (a) of this section, such authority 
        shall be effective as if the authority had been established on 
        December 22, 1987.

SEC. 1402. AUTHORIZATION OF APPROPRIATIONS.

    (a) Establishment of Single Authorization.--Subpart 1 of part D of 
title IV of the Public Health Service Act (42 U.S.C. 286 et seq.) is 
amended by adding at the end the following section:

                   ``authorization of appropriations

    ``Sec. 468. (a) For the purpose of carrying out this part, there 
are authorized to be appropriated $150,000,000 for fiscal year 1994, 
and such sums as may be necessary for each of the fiscal years 1995 and 
1996.
    ``(b) Amounts appropriated under subsection (a) and made available 
for grants or contracts under any of sections 472 through 476 shall 
remain available until the end of the fiscal year following the fiscal 
year for which the amounts were appropriated.''.
    (b) Conforming Amendments.--Part D of title IV of the Public Health 
Service Act (42 U.S.C. 286 et seq.) is amended by striking section 469 
and section 478(c).

                    Subtitle B--Financial Assistance

SEC. 1411. ESTABLISHMENT OF PROGRAM OF GRANTS FOR DEVELOPMENT OF 
              EDUCATION TECHNOLOGIES.

    Section 473 of the Public Health Service Act (42 U.S.C. 286b-4) is 
amended by adding at the end the following new subsection:
    ``(c)(1) The Secretary shall make grants to public or nonprofit 
private institutions for the purpose of carrying out projects of 
research on, and development and demonstration of, new education 
technologies.
    ``(2) The purposes for which a grant under paragraph (1) may be 
made include projects concerning--
            ``(A) computer-assisted teaching and testing of clinical 
        competence at health professions and research institutions;
            ``(B) the effective transfer of new information from 
        research laboratories to appropriate clinical applications;
            ``(C) the expansion of the laboratory and clinical uses of 
        computer-stored research databases; and
            ``(D) the testing of new technologies for training health 
        care professionals.
    ``(3) The Secretary may not make a grant under paragraph (1) unless 
the applicant for the grant agrees to make the projects available with 
respect to--
            ``(A) assisting in the training of health professions 
        students; and
            ``(B) enhancing and improving the capabilities of health 
        professionals regarding research and teaching.''.

Subtitle C--National Information Center on Health Services Research and 
                         Health Care Technology

SEC. 1421. ESTABLISHMENT OF CENTER.

    Part D of title IV of the Public Health Service Act (42 U.S.C. 286 
et seq.) is amended by adding at the end the following new subpart:

 ``Subpart 4--National Information Center on Health Services Research 
                       and Health Care Technology

                     ``national information center

    ``Sec. 478A. (a) There is established within the Library an entity 
to be known as the National Information Center on Health Services 
Research and Health Care Technology (in this section referred to as the 
`Center').
    ``(b) The purpose of the Center is the collection, storage, 
analysis, retrieval, and dissemination of information on health 
services research, clinical practice guidelines, and on health care 
technology, including the assessment of such technology. Such purpose 
includes developing and maintaining data bases and developing and 
implementing methods of carrying out such purpose.
    ``(c) The Director of the Center shall ensure that information 
under subsection (b) concerning clinical practice guidelines is 
collected and maintained electronically and in a convenient format. 
Such Director shall develop and publish criteria for the inclusion of 
practice guidelines and technology assessments in the information 
center database.
    ``(d) The Secretary, acting through the Center, shall coordinate 
the activities carried out under this section through the Center with 
related activities of the Administrator for Health Care Policy and 
Research.''.

SEC. 1422. CONFORMING PROVISIONS.

    (a) In General.--Section 903 of the Public Health Service Act, as 
amended by section 3 of Public Law 102-410 (106 Stat. 2094), is amended 
by amending subsection (e) to read as follows:
    ``(e) Required Interagency Agreement.--The Administrator and the 
Director of the National Library of Medicine shall enter into an 
agreement providing for the implementation of section 478A.''.
    (b) Rule of Construction.--The amendments made by section 3 of 
Public Law 102-410 (106 Stat. 2094), by section 1421 of this Act, and 
by subsection (a) of this section may not be construed as terminating 
the information center on health care technologies and health care 
technology assessment established under section 904 of the Public 
Health Service Act, as in effect on the day before the date of the 
enactment of Public Law 102-410. Such center shall be considered to be 
the center established in section 478A of the Public Health Service 
Act, as added by section 1421 of this Act, and shall be subject to the 
provisions of such section 478A.

       TITLE XV--OTHER AGENCIES OF NATIONAL INSTITUTES OF HEALTH

               Subtitle A--Division of Research Resources

SEC. 1501. REDESIGNATION OF DIVISION AS NATIONAL CENTER FOR RESEARCH 
              RESOURCES.

    Title IV of the Public Health Service Act (42 U.S.C. 281 et seq.) 
is amended--
            (1) in section 401(b)(2)(B), by amending such subparagraph 
        to read as follows:
            ``(B) The National Center for Research Resources.''; and
            (2) in part E--
                    (A) in the heading for subpart 1, by striking 
                ``Division of'' and inserting ``National Center for'';
                    (B) in section 479, by striking ``the Division of 
                Research Resources'' and inserting the following: ``the 
                National Center for Research Resources (hereafter in 
                this subpart referred to as the `Center')'';
                    (C) in sections 480 and 481, by striking ``the 
                Division of Research Resources'' each place such term 
                appears and inserting ``the Center''; and
                    (D) in sections 480 and 481, as amended by 
                subparagraph (C), by striking ``the Division'' each 
                place such term appears and inserting ``the Center''.

SEC. 1502. BIOMEDICAL AND BEHAVIORAL RESEARCH FACILITIES.

    Subpart 1 of part E of title IV of the Public Health Service Act 
(42 U.S.C. 287 et seq.) is amended by adding at the end the following 
new section:

            ``biomedical and behavioral research facilities

    ``Sec. 481A. (a) Modernization and Construction of Facilities.--
            ``(1) In general.--The Director of NIH, acting through the 
        Director of the Center, may make grants to public and nonprofit 
        private entities to expand, remodel, renovate, or alter 
        existing research facilities or construct new research 
        facilities, subject to the provisions of this section.
            ``(2) Construction and cost of construction.--For purposes 
        of this section, the terms `construction' and `cost of 
        construction' include the construction of new buildings and the 
        expansion, renovation, remodeling, and alteration of existing 
        buildings, including architects' fees, but do not include the 
        cost of acquisition of land or off-site improvements.
    ``(b) Scientific and Technical Review Boards for Merit-Based Review 
of Proposals.--
            ``(1) In general; approval as precondition to grants.--
                    ``(A) There is established within the Center a 
                Scientific and Technical Review Board on Biomedical and 
                Behavioral Research Facilities (hereafter referred to 
                in this section as the `Board').
                    ``(B) The Director of the Center may approve an 
                application for a grant under subsection (a) only if 
                the Board has under paragraph (2) recommended the 
                application for approval.
            ``(2) Duties.--
                    ``(A) The Board shall provide advice to the 
                Director of the Center and the advisory council 
                established under section 480 (hereafter in this 
                section referred to as the `Advisory Council') on 
                carrying out this section.
                    ``(B) In carrying out subparagraph (A), the Board 
                shall make a determination of the merit of each 
                application submitted for a grant under subsection (a), 
                after consideration of the requirements established in 
                subsection (c), and shall report the results of the 
                determination to the Director of the Center and the 
                Advisory Council. Such determinations shall be 
                conducted in a manner consistent with procedures 
                established under section 492.
                    ``(C) In carrying out subparagraph (A), the Board 
                shall, in the case of applications recommended for 
                approval, make recommendations to the Director and the 
                Advisory Council on the amount that should be provided 
                in the grant.
                    ``(D) In carrying out subparagraph (A), the Board 
                shall prepare an annual report for the Director of the 
                Center and the Advisory Council describing the 
                activities of the Board in the fiscal year for which 
                the report is made. Each such report shall be available 
                to the public, and shall--
                            ``(i) summarize and analyze expenditures 
                        made under this section;
                            ``(ii) provide a summary of the types, 
                        numbers, and amounts of applications that were 
                        recommended for grants under subsection (a) but 
                        that were not approved by the Director of the 
                        Center; and
                            ``(iii) contain the recommendations of the 
                        Board for any changes in the administration of 
                        this section.
            ``(3) Membership.--
                    ``(A) Subject to subparagraph (B), the Board shall 
                be composed of 9 appointed members, and such ex officio 
                members as the Director of the Center determines to be 
                appropriate.
                    ``(B) Not more than 3 individuals who are officers 
                or employees of the Federal Government may serve as 
                members of the Board.
            ``(4) Certain requirements regarding membership.--In 
        selecting individuals for membership on the Board, the Director 
        of the Center shall ensure that the members are individuals 
        who, by virtue of their training or experience, are eminently 
        qualified to perform peer review functions. In selecting such 
        individuals for such membership, the Director of the Center 
        shall ensure that the members of the Board collectively--
                    ``(A) are experienced in the planning, 
                construction, financing, and administration of entities 
                that conduct biomedical or behavioral research 
                sciences;
                    ``(B) are knowledgeable in making determinations of 
                the need of entities for biomedical or behavioral 
                research facilities, including such facilities for the 
                dentistry, nursing, pharmacy, and allied health 
                professions;
                    ``(C) are knowledgeable in evaluating the relative 
                priorities for applications for grants under subsection 
                (a) in view of the overall research needs of the United 
                States; and
                    ``(D) are experienced with emerging centers of 
                excellence, as described in subsection (c)(3).
            ``(5) Certain authorities.--
                    ``(A) In carrying out paragraph (2), the Board may 
                convene workshops and conferences, and collect data as 
                the Board considers appropriate.
                    ``(B) In carrying out paragraph (2), the Board may 
                establish subcommittees within the Board. Such 
                subcommittees may hold meetings as determined necessary 
                to enable the subcommittee to carry out its duties.
            ``(6) Terms.--
                    ``(A) Except as provided in subparagraph (B), each 
                appointed member of the Board shall hold office for a 
                term of 4 years. Any member appointed to fill a vacancy 
                occurring prior to the expiration of the term for which 
                such member's predecessor was appointed shall be 
                appointed for the remainder of the term of the 
                predecessor.
                    ``(B) Of the initial members appointed to the Board 
                (as specified by the Director of the Center when making 
                the appointments)--
                            ``(i) 3 shall hold office for a term of 3 
                        years;
                            ``(ii) 3 shall hold office for a term of 2 
                        years; and
                            ``(iii) 3 shall hold office for a term of 1 
                        year.
                    ``(C) No member is eligible for reappointment to 
                the Board until 1 year has elapsed after the end of the 
                most recent term of the member.
            ``(7) Compensation.--Members of the Board who are not 
        officers or employees of the United States shall receive for 
        each day the members are engaged in the performance of the 
        functions of the Board compensation at the same rate received 
        by members of other national advisory councils established 
        under this title.
    ``(c) Requirements for Grants.--
            ``(1) In general.--The Director of the Center may make a 
        grant under subsection (a) only if the applicant for the grant 
        meets the following conditions:
                    ``(A) The applicant is determined by such Director 
                to be competent to engage in the type of research for 
                which the proposed facility is to be constructed.
                    ``(B) The applicant provides assurances 
                satisfactory to the Director that--
                            ``(i) for not less than 20 years after 
                        completion of the construction, the facility 
                        will be used for the purposes of research for 
                        which it is to be constructed;
                            ``(ii) sufficient funds will be available 
                        to meet the non-Federal share of the cost of 
                        constructing the facility;
                            ``(iii) sufficient funds will be available, 
                        when construction is completed, for the 
                        effective use of the facility for the research 
                        for which it is being constructed; and
                            ``(iv) the proposed construction will 
                        expand the applicant's capacity for research, 
                        or is necessary to improve or maintain the 
                        quality of the applicant's research.
                    ``(C) The applicant meets reasonable qualifications 
                established by the Director with respect to--
                            ``(i) the relative scientific and technical 
                        merit of the applications, and the relative 
                        effectiveness of the proposed facilities, in 
                        expanding the capacity for biomedical or 
                        behavioral research and in improving the 
                        quality of such research;
                            ``(ii) the quality of the research or 
                        training, or both, to be carried out in the 
                        facilities involved;
                            ``(iii) the need of the applicant for such 
                        facilities in order to maintain or expand the 
                        applicant's research and training mission;
                            ``(iv) the congruence of the research 
                        activities to be carried out within the 
                        facility with the research and investigator 
                        manpower needs of the United States; and
                            ``(v) the age and condition of existing 
                        research facilities and equipment.
                    ``(D) The applicant has demonstrated a commitment 
                to enhancing and expanding the research productivity of 
                the applicant.
            ``(2) Consideration of certain factors.--In making grants 
        under subsection (a), the Director of the Center may, in 
        addition to the requirements established in paragraph (1), 
        consider the following factors:
                    ``(A) To what extent the applicant has the capacity 
                to broaden the scope of research and research training 
                programs of the applicant by promoting--
                            ``(i) interdisciplinary research;
                            ``(ii) research on emerging technologies, 
                        including those involving novel analytical 
                        techniques or computational methods; or
                            ``(iii) other novel research mechanisms or 
                        programs.
                    ``(B) To what extent the applicant has broadened 
                the scope of research and research training programs of 
                qualified institutions by promoting genomic research 
                with an emphasis on interdisciplinary research, 
                including research related to pediatric investigations.
            ``(3) Institutions of emerging excellence.--Of the amounts 
        appropriated under subsection (h) for a fiscal year, the 
        Director of the Center shall make available 25 percent for 
        grants under subsection (a) to applicants that, in addition to 
        meeting the requirements established in paragraph (1), have 
        demonstrated emerging excellence in biomedical or behavioral 
        research, as follows:
                    ``(A) The applicant has a plan for research or 
                training advancement and possesses the ability to carry 
                out the plan.
                    ``(B) The applicant carries out research and 
                research training programs that have a special 
                relevance to a problem, concern, or unmet health need 
                of the United States.
                    ``(C) The applicant has been productive in research 
                or research development and training.
                    ``(D) The applicant--
                            ``(i) has been designated as a center of 
                        excellence under section 739;
                            ``(ii) is located in a geographic area a 
                        significant percentage of whose population has 
                        a health-status deficit, and the applicant 
                        provides health services to such population; or
                            ``(iii) is located in a geographic area in 
                        which a deficit in health care technology, 
                        services, or research resources may adversely 
                        affect health status of the population of the 
                        area in the future, and the applicant is 
                        carrying out activities with respect to 
                        protecting the health status of such 
                        population.
    ``(d) Requirement of Application.--The Director of the Center may 
make a grant under subsection (a) only if an application for the grant 
is submitted to the Director and the application is in such form, is 
made in such manner, and contains such agreements, assurances, and 
information as the Director determines to be necessary to carry out 
this section.
    ``(e) Amount of Grant; Payments.--
            ``(1)  Amount.--The amount of any grant awarded under 
        subsection (a) shall be determined by the Director of the 
        Center, except that such amount shall not exceed--
                    ``(A) 50 percent of the necessary cost of the 
                construction of a proposed facility as determined by 
                the Director; or
                    ``(B) in the case of a multipurpose facility, 40 
                percent of that part of the necessary cost of 
                construction that the Director determines to be 
                proportionate to the contemplated use of the facility.
            ``(2)  Reservation of amounts.--On approval of any 
        application for a grant under subsection (a), the Director of 
        the Center shall reserve, from any appropriation available 
        therefore, the amount of such grant, and shall pay such amount, 
        in advance or by way of reimbursement, and in such installments 
        consistent with the construction progress, as the Director may 
        determine appropriate. The reservation of the Director of any 
        amount by the Director under this paragraph may be amended by 
        the Director, either on the approval of an amendment of the 
        application or on the revision of the estimated cost of 
        construction of the facility.
            ``(3)  Exclusion of certain costs.--In determining the 
        amount of any grant under this subsection (a), there shall be 
        excluded from the cost of construction an amount equal to the 
        sum of--
                    ``(A) the amount of any other Federal grant that 
                the applicant has obtained, or is assured of obtaining, 
                with respect to construction that is to be financed in 
                part by a grant authorized under this section; and
                    ``(B) the amount of any non-Federal funds required 
                to be expended as a condition of such other Federal 
                grant.
            ``(4)  Waiver of limitations.--The limitations imposed by 
        paragraph (1) may be waived at the discretion of the Director 
        for applicants meeting the conditions described in paragraphs 
        (1) and (2) of subsection (c).
    ``(f) Recapture of Payments.--If, not later than 20 years after the 
completion of construction for which a grant has been awarded under 
subsection (a)--
            ``(1) the applicant or other owner of the facility shall 
        cease to be a public or nonprofit private entity; or
            ``(2) the facility shall cease to be used for the research 
        purposes for which it was constructed (unless the Director 
        determines, in accordance with regulations, that there is good 
        cause for releasing the applicant or other owner from 
        obligation to do so);
the United States shall be entitled to recover from the applicant or 
other owner of the facility the amount bearing the same ratio to the 
current value (as determined by an agreement between the parties or by 
action brought in the United States District Court for the district in 
which such facility is situated) of the facility as the amount of the 
Federal participation bore to the cost of the construction of such 
facility.
    ``(g) Guidelines.--Not later than 6 months after the date of the 
enactment of this section, the Director of the Center, after 
consultation with the Advisory Council, shall issue guidelines with 
respect to grants under subsection (a).
    ``(h) Authorization of Appropriations.--For the purpose of carrying 
out this section, there are authorized to be appropriated $150,000,000 
for fiscal year 1994, and such sums as may be necessary for each of the 
fiscal years 1995 and 1996.''.

SEC. 1503. CONSTRUCTION PROGRAM FOR NATIONAL PRIMATE RESEARCH CENTER.

    Subpart 1 of part E of title IV of the Public Health Service Act, 
as amended by section 1502 of this Act, is amended by adding at the end 
the following new section:

      ``construction of regional centers for research on primates

    ``Sec. 481B. (a) With respect to activities carried out by the 
National Center for Research Resources to support regional centers for 
research on primates, the Director of NIH shall, for each of the fiscal 
years 1994 through 1996, reserve from the amounts appropriated under 
section 481A(i) $5,000,000 for the purpose of making awards of grants 
and contracts to public or nonprofit private entities to construct, 
renovate, or otherwise improve such regional centers. The reservation 
of such amounts for any fiscal year is subject to the availability of 
qualified applicants for such awards.
    ``(b) The Director of NIH may not make a grant or enter into a 
contract under subsection (a) unless the applicant for such assistance 
agrees, with respect to the costs to be incurred by the applicant in 
carrying out the purpose described in such subsection, to make 
available (directly or through donations from public or private 
entities) non-Federal contributions in cash toward such costs in an 
amount equal to not less than $1 for each $4 of Federal funds provided 
in such assistance.''.

            Subtitle B--National Center for Nursing Research

SEC. 1511. REDESIGNATION OF NATIONAL CENTER FOR NURSING RESEARCH AS 
              NATIONAL INSTITUTE OF NURSING RESEARCH.

    (a) In General.--Subpart 3 of part E of title IV of the Public 
Health Service Act (42 U.S.C. 287c et seq.) is amended--
            (1) in section 483--
                    (A) in the heading for the section, by striking 
                ``center'' and inserting ``institute''; and
                    (B) by striking ``The general purpose'' and all 
                that follows through ``is'' and inserting the 
                following: ``The general purpose of the National 
                Institute of Nursing Research (hereafter in this 
                subpart referred to as the `Institute') is'';
            (2) in section 484, by striking ``Center'' each place such 
        term appears and inserting ``Institute'';
            (3) in section 485--
                    (A) in subsection (a), in each of paragraphs (1) 
                through (3), by striking ``Center'' each place such 
                term appears and inserting ``Institute'';
                    (B) in subsection (b)--
                            (i) in paragraph (2)(A), by striking 
                        ``Center'' and inserting ``Institute''; and
                            (ii) in paragraph (3)(A), in the first 
                        sentence, by striking ``Center'' and inserting 
                        ``Institute''; and
                    (C) in subsections (d) through (g), by striking 
                ``Center'' each place such term appears and inserting 
                ``Institute''; and
            (4) in section 485A (as redesignated by section 141(a)(1) 
        of this Act), by striking ``Center'' each place such term 
        appears and inserting ``Institute''.
    (b) Conforming Amendments.--
            (1) Organization of national institutes of health.--Section 
        401(b) of the Public Health Service Act (42 U.S.C. 281(b)) is 
        amended--
                    (A) in paragraph (1), by adding at the end the 
                following new subparagraph:
            ``(Q) The National Institute of Nursing Research.''; and
                    (B) in paragraph (2), by striking subparagraph (D).
            (2) Transfer of statutory provisions.--The Public Health 
        Service Act, as amended by subsection (a) of this section and 
        by section 124 of Public Law 102-321 (106 Stat. 364), is 
        amended--
                    (A) by transferring sections 483 through 485A to 
                part C of title IV;
                    (B) by redesignating such sections as sections 464V 
                through 464Y of such part; and
                    (C) by adding such sections, in the appropriate 
                sequence, at the end of such part.
            (3) Heading for new subpart.--Title IV of the Public Health 
        Service Act, as amended by the preceding provisions of this 
        section, is amended--
                    (A) in part C, by inserting before section 464V the 
                following:

      ``Subpart 17--National Institute of Nursing Research''; and

                    (B) by striking the subpart designation and heading 
                for subpart 3 of part E.
            (4) Cross-references.--Title IV of the Public Health 
        Service Act, as amended by the preceding provisions of this 
        section, is amended in subpart 17 of part C--
                    (A) in section 464W, by striking ``section 483'' 
                and inserting ``section 464V'';
                    (B) in section 464X(g), by striking ``section 486'' 
                and inserting ``section 464Y''; and
                    (C) in section 464Y, in the last sentence, by 
                striking ``section 485(g)'' and inserting ``section 
                464X(g)''.

SEC. 1512. STUDY ON ADEQUACY OF NUMBER OF NURSES.

    (a) In General.--The Secretary of Health and Human Services, acting 
through the Director of the National Institute of Nursing Research, 
shall enter into a contract with a public or nonprofit private entity 
to conduct a study for the purpose of determining whether and to what 
extent there is a need for an increase in the number of nurses in 
hospitals and nursing homes in order to promote the quality of patient 
care and reduce the incidence among nurses of work-related injuries and 
stress.
    (b) National Academy of Sciences.--The Secretary shall request the 
Institute of Medicine of the National Academy of Sciences to enter into 
the contract under subsection (a) to conduct the study described in 
such subsection. If such Institute declines to conduct the study, the 
Secretary shall carry out such subsection through another public or 
nonprofit private entity.
    (c) Definitions.--For purposes of this section:
            (1) The term ``nurse'' means a registered nurse, a licensed 
        practical nurse, a licensed vocational nurse, and a nurse 
        assistant.
            (2) The term ``Secretary'' means the Secretary of Health 
        and Human Services.
    (d) Report.--The Secretary shall ensure that, not later than 
October 1, 1994, the study required in subsection (a) is completed and 
a report describing the findings made as a result of the study is 
submitted to the Committee on Energy and Commerce of the House of 
Representatives, and to the Committee on Labor and Human Resources of 
the Senate.

         Subtitle C--National Center for Human Genome Research

SEC. 1521. PURPOSE OF CENTER.

    Title IV of the Public Health Service Act, as amended by section 
141(a)(1) of this Act and by paragraphs (1)(B) and (3)(B) of section 
1511(b) of this Act, is amended--
            (1) in section 401(b)(2), by adding at the end the 
        following new subparagraph:
            ``(D) The National Center for Human Genome Research.''; and
            (2) in part E, by adding at the end the following new 
        subpart:

         ``Subpart 3--National Center for Human Genome Research

                        ``purpose of the center

    ``Sec. 485B. (a) The general purpose of the National Center for 
Human Genome Research (hereafter in this subpart referred to as the 
`Center') is to characterize the structure and function of the human 
genome, including the mapping and sequencing of individual genes. Such 
purpose includes--
            ``(1) planning and coordinating the research goal of the 
        genome project;
            ``(2) reviewing and funding research proposals;
            ``(3) developing training programs;
            ``(4) coordinating international genome research;
            ``(5) communicating advances in genome science to the 
        public; and
            ``(6) reviewing and funding proposals to address the 
        ethical and legal issues associated with the genome project.
    ``(b) The Director of the Center may conduct and support research 
training--
            ``(1) for which fellowship support is not provided under 
        section 487; and
            ``(2) that is not residency training of physicians or other 
        health professionals.
    ``(c)(1) Except as provided in paragraph (2), of the amounts 
appropriated to carry out subsection (a) for a fiscal year, the 
Director of the Center shall make available not less than 5 percent for 
carrying out paragraph (6) of such subsection.
    ``(2) With respect to providing funds under subsection (a)(6) for 
proposals to address the ethical issues associated with the genome 
project, paragraph (1) shall not apply for a fiscal year if the 
Director of the Center certifies to the Committee on Energy and 
Commerce of the House of Representatives, and to the Committee on Labor 
and Human Resources of the Senate, that the Director has determined 
that an insufficient number of such proposals meet the applicable 
requirements of sections 491 and 492.''.

                     TITLE XVI--AWARDS AND TRAINING

              Subtitle A--National Research Service Awards

SEC. 1601. REQUIREMENT REGARDING WOMEN AND INDIVIDUALS FROM 
              DISADVANTAGED BACKGROUNDS.

    Section 487(a) of the Public Health Service Act (42 U.S.C. 
288(a)(4)) is amended by adding at the end the following paragraph:
    ``(4) The Secretary shall carry out paragraph (1) in a manner that 
will result in the recruitment of women, and individuals from 
disadvantaged backgrounds, into fields of biomedical or behavioral 
research and in the provision of research training to women and such 
individuals.''.

            Subtitle B--Acquired Immune Deficiency Syndrome

SEC. 1611. LOAN REPAYMENT PROGRAM.

    Section 487A of the Public Health Service Act (42 U.S.C. 288-1) is 
amended to read as follows:

 ``loan repayment program for research with respect to acquired immune 
                          deficiency syndrome

    ``Sec. 487A. (a) In General.--
            ``(1) Authority for program.--Subject to paragraph (2), the 
        Secretary shall carry out a program of entering into agreements 
        with appropriately qualified health professionals under which 
        such health professionals agree to conduct, as employees of the 
        National Institutes of Health, research with respect to 
        acquired immune deficiency syndrome in consideration of the 
        Federal Government agreeing to repay, for each year of such 
        service, not more than $20,000 of the principal and interest of 
        the educational loans of such health professionals.
            ``(2) Limitation.--The Secretary may not enter into an 
        agreement with a health professional pursuant to paragraph (1) 
        unless such professional--
                    ``(A) has a substantial amount of educational loans 
                relative to income; and
                    ``(B) agrees to serve as an employee of the 
                National Institutes of Health for purposes of paragraph 
                (1) for a period of not less than 3 years.
    ``(b) Applicability of Certain Provisions.--With respect to the 
National Health Service Corps Loan Repayment Program established in 
subpart III of part D of title III, the provisions of such subpart 
shall, except as inconsistent with subsection (a) of this section, 
apply to the program established in such subsection (a) in the same 
manner and to the same extent as such provisions apply to the National 
Health Service Corps Loan Repayment Program established in such 
subpart.
    ``(c) 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 1996.''.

           Subtitle C--Loan Repayment for Research Generally

SEC. 1621. ESTABLISHMENT OF PROGRAM.

    Part G of title IV of the Public Health Service Act, as 
redesignated by section 141(a)(2) of this Act and as amended by section 
1002 of this Act, is amended by inserting after section 487B the 
following new section:

            ``loan repayment program for research generally

    ``Sec. 487C. (a) In General.--
            ``(1) Authority for program.--Subject to paragraph (2), the 
        Secretary shall carry out a program of entering into agreements 
        with appropriately qualified health professionals under which 
        such health professionals agree to conduct research, as 
        employees of the National Institutes of Health, in 
        consideration of the Federal Government agreeing to repay, for 
        each year of such service, not more than $20,000 of the 
        principal and interest of the educational loans of such health 
        professionals.
            ``(2) Limitation.--The Secretary may not enter into an 
        agreement with a health professional pursuant to paragraph (1) 
        unless such professional--
                    ``(A) has a substantial amount of educational loans 
                relative to income; and
                    ``(B) agrees to serve as an employee of the 
                National Institutes of Health for purposes of paragraph 
                (1) for a period of not less than 3 years.
    ``(b) Applicability of Certain Provisions.--With respect to the 
National Health Service Corps Loan Repayment Program established in 
subpart III of part D of title III, the provisions of such subpart 
shall, except as inconsistent with subsection (a) of this section, 
apply to the program established in such subsection (a) in the same 
manner and to the same extent as such provisions apply to the National 
Health Service Corps Loan Repayment Program established in such 
subpart.
    ``(c) Authorization of Appropriations.--For the purpose of carrying 
out this section other than with respect to acquired immune deficiency 
syndrome, there are authorized to be appropriated such sums as may be 
necessary for each of the fiscal years 1994 through 1996.''.

     Subtitle D--Scholarship and Loan Repayment Programs Regarding 
             Professional Skills Needed by Certain Agencies

SEC. 1631. ESTABLISHMENT OF PROGRAMS FOR NATIONAL INSTITUTES OF HEALTH.

    Part G of title IV of the Public Health Service Act, as 
redesignated by section 141(a)(2) of this Act and as amended by section 
1621 of this Act, is amended by inserting after section 487C the 
following new sections:

  ``undergraduate scholarship program regarding professions needed by 
                      national research institutes

    ``Sec. 487D. (a) Establishment of Program.--
            ``(1) In general.--Subject to section 487(a)(1)(C), the 
        Secretary, acting through the Director of NIH, may carry out a 
        program of entering into contracts with individuals described 
        in paragraph (2) under which--
                    ``(A) the Director of NIH agrees to provide to the 
                individuals scholarships for pursuing, as 
                undergraduates at accredited institutions of higher 
                education, academic programs appropriate for careers in 
                professions needed by the National Institutes of 
                Health; and
                    ``(B) the individuals agree to serve as employees 
                of the National Institutes of Health, for the period 
                described in subsection (c), in positions that are 
                needed by the National Institutes of Health and for 
                which the individuals are qualified.
            ``(2) Individuals from disadvantaged backgrounds.--The 
        individuals referred to in paragraph (1) are individuals who--
                    ``(A) are enrolled or accepted for enrollment as 
                full-time undergraduates at accredited institutions of 
                higher education; and
                    ``(B) are from disadvantaged backgrounds.
    ``(b) Facilitation of Interest of Students in Careers at National 
Institutes of Health.--In providing employment to individuals pursuant 
to contracts under subsection (a)(1), the Director of NIH shall carry 
out activities to facilitate the interest of the individuals in 
pursuing careers as employees of the National Institutes of Health.
    ``(c) Period of Obligated Service.--
            ``(1) Duration of service.--For purposes of subparagraph 
        (B) of subsection (a)(1), the period of service for which an 
        individual is obligated to serve as an employee of the National 
        Institutes of Health is, subject to paragraph (2)(A), 12 months 
        for each academic year for which the scholarship under such 
        subsection is provided.
            ``(2) Schedule for service.--
                    ``(A) Subject to subparagraph (B), the Director of 
                NIH may not provide a scholarship under subsection (a) 
                unless the individual applying for the scholarship 
                agrees that--
                            ``(i) the individual will serve as an 
                        employee of the National Institutes of Health 
                        full-time for not less than 10 consecutive 
                        weeks of each year during which the individual 
                        is attending the educational institution 
                        involved and receiving such a scholarship;
                            ``(ii) the period of service as such an 
                        employee that the individual is obligated to 
                        provide under clause (i) is in addition to the 
                        period of service as such an employee that the 
                        individual is obligated to provide under 
                        subsection (a)(1)(B); and
                            ``(iii) not later than 60 days after 
                        obtaining the educational degree involved, the 
                        individual will begin serving full-time as such 
                        an employee in satisfaction of the period of 
                        service that the individual is obligated to 
                        provide under subsection (a)(1)(B).
                    ``(B) The Director of NIH may defer the obligation 
                of an individual to provide a period of service under 
                subsection (a)(1)(B), if the Director determines that 
                such a deferral is appropriate.
            ``(3) Applicability of certain provisions relating to 
        appointment and compensation.--For any period in which an 
        individual provides service as an employee of the National 
        Institutes of Health in satisfaction of the obligation of the 
        individual under subsection (a)(1)(B) or paragraph (2)(A)(i), 
        the individual may be appointed as such an employee without 
        regard to the provisions of title 5, United States Code, 
        relating to appointment and compensation.
    ``(d) Provisions Regarding Scholarship.--
            ``(1) Approval of academic program.--The Director of NIH 
        may not provide a scholarship under subsection (a) for an 
        academic year unless--
                    ``(A) the individual applying for the scholarship 
                has submitted to the Director a proposed academic 
                program for the year and the Director has approved the 
                program; and
                    ``(B) the individual agrees that the program will 
                not be altered without the approval of the Director.
            ``(2) Academic standing.--The Director of NIH may not 
        provide a scholarship under subsection (a) for an academic year 
        unless the individual applying for the scholarship agrees to 
        maintain an acceptable level of academic standing, as 
        determined by the educational institution involved in 
        accordance with regulations issued by the Secretary.
            ``(3) Limitation on amount.--The Director of NIH may not 
        provide a scholarship under subsection (a) for an academic year 
        in an amount exceeding $20,000.
            ``(4) Authorized uses.--A scholarship provided under 
        subsection (a) may be expended only for tuition expenses, other 
        reasonable educational expenses, and reasonable living expenses 
        incurred in attending the school involved.
            ``(5) Contract regarding direct payments to institution.--
        In the case of an institution of higher education with respect 
        to which a scholarship under subsection (a) is provided, the 
        Director of NIH may enter into a contract with the institution 
        under which the amounts provided in the scholarship for tuition 
        and other educational expenses are paid directly to the 
        institution.
    ``(e) Penalties for Breach of Scholarship Contract.--The provisions 
of section 338E shall apply to the program established in subsection 
(a) to the same extent and in the same manner as such provisions apply 
to the National Health Service Corps Loan Repayment Program established 
in section 338B.
    ``(f) Requirement of Application.--The Director of NIH may not 
provide a scholarship under subsection (a) unless an application for 
the scholarship is submitted to the Director and the application is in 
such form, is made in such manner, and contains such agreements, 
assurances, and information as the Director determines to be necessary 
to carry out this section.
    ``(g) Availability of Authorization of Appropriations.--Amounts 
appropriated for a fiscal year for scholarships under this section 
shall remain available until the expiration of the second fiscal year 
beginning after the fiscal year for which the amounts were 
appropriated.

     ``loan repayment program regarding clinical researchers from 
                       disadvantaged backgrounds

    ``Sec. 487E. (a) Implementation of Program.--
            ``(1) In general.--Subject to section 487(a)(1)(C), the 
        Secretary, acting through the Director of NIH may, subject to 
        paragraph (2), carry out a program of entering into contracts 
        with appropriately qualified health professionals who are from 
        disadvantaged backgrounds under which such health professionals 
        agree to conduct clinical research as employees of the National 
        Institutes of Health in consideration of the Federal Government 
        agreeing to pay, for each year of such service, not more than 
        $20,000 of the principal and interest of the educational loans 
        of the health professionals.
            ``(2) Limitation.--The Director of NIH may not enter into a 
        contract with a health professional pursuant to paragraph (1) 
        unless such professional has a substantial amount of education 
        loans relative to income.
            ``(3) Applicability of certain provisions regarding 
        obligated service.--Except to the extent inconsistent with this 
        section, the provisions of sections 338C and 338E shall apply 
        to the program established in paragraph (1) to the same extent 
        and in the same manner as such provisions apply to the National 
        Health Service Corps Loan Repayment Program established in 
        section 338B.
    ``(b) Availability of Authorization of Appropriations.--Amounts 
appropriated for a fiscal year for contracts under subsection (a) shall 
remain available until the expiration of the second fiscal year 
beginning after the fiscal year for which the amounts were 
appropriated.''.

SEC. 1632. FUNDING.

    Section 487(a)(1) of the Public Health Service Act (42 U.S.C. 
288(a)(1)) is amended--
            (1) in subparagraph (A), by striking ``and'' after the 
        semicolon at the end;
            (2) in subparagraph (B), by striking the period at the end 
        and inserting ``; and''; and
            (3) by inserting after subparagraph (B) the following new 
        subparagraph:
            ``(C) provide contracts for scholarships and loan 
        repayments in accordance with sections 487D and 487E, subject 
        to providing not more than an aggregate 50 such contracts 
        during the fiscal years 1994 through 1996.''.

                          Subtitle E--Funding

SEC. 1641. AUTHORIZATION OF APPROPRIATIONS.

    Section 487(d) of the Public Health Service Act (42 U.S.C. 288(d)) 
is amended--
            (1) in the first sentence, by amending the sentence to read 
        as follows: ``For the purpose of carrying out this section, 
        there are authorized to be appropriated $400,000,000 for fiscal 
        year 1994, and such sums as may be necessary for each of the 
        fiscal years 1995 and 1996.''; and
            (2) in paragraph (3)--
                    (A) by striking ``one-half of one percent'' each 
                place such term appears and inserting ``1 percent''; 
                and
                    (B) by striking ``780, 784, or 786,'' and inserting 
                ``747, 748, or 749,''.

        TITLE XVII--NATIONAL FOUNDATION FOR BIOMEDICAL RESEARCH

SEC. 1701. DATE CERTAIN FOR APPOINTMENT OF BOARD MEMBERS.

    Section 499 of the Public Health Service Act, as redesignated by 
section 121(b)(3) of this Act, is amended in subsection (c)(1)(C) by 
inserting after and below clause (iii) the following:
                ``Not later than April 1, 1993, the Secretary shall 
                convene a meeting of the ex officio members of the 
                Board for the purpose of making the appointments 
                required in this subparagraph.''.

SEC. 1702. MISCELLANEOUS PROVISIONS.

    Section 499 of the Public Health Service Act, as redesignated by 
section 121(b)(3) of this Act, is amended--
            (1) in subsection (a)--
                    (A) in the first sentence, by inserting after 
                ``Secretary'' the following: ``, acting through the 
                Director of NIH,''; and
                    (B) in the second sentence, by striking ``the 
                purposes of'' and all that follows through ``Transfer 
                Act,'' and inserting the following: ``the purposes of 
                the Ethics in Government Act of 1978 and the Stevenson-
                Wydler Technology Innovation Act of 1980,'';
            (2) in subsection (b)(2), by striking ``Ethics'' and all 
        that follows and inserting the following: ``Ethics in 
        Government Act of 1978, and the Stevenson-Wydler Technology 
        Innovation Act of 1980.'';
            (3) in subsection (c)--
                    (A) in paragraph (1)--
                            (i) in subparagraph (A), in the second 
                        sentence, by inserting ``, except the ex 
                        officio members,'' after ``Foundation'';
                            (ii) in subparagraph (B), in the matter 
                        preceding clause (i), by striking ``Council'' 
                        and inserting ``Board''; and
                            (iii) in subparagraph (C), in the first 
                        sentence, by striking ``Council'' and inserting 
                        ``Board''; and
                    (B) in paragraph (3)(A), by striking ``paragraph 
                (2)(C)'' and inserting ``paragraph (1)(C)'';
            (4) in subsection (g)(8), by striking ``subtitle'' and 
        inserting ``part''; and
            (5) in subsection (i)(1), by striking ``1995'' and 
        inserting ``1996''.

   TITLE XVIII--RESEARCH WITH RESPECT TO ACQUIRED IMMUNE DEFICIENCY 
                                SYNDROME

                  Subtitle A--Office of AIDS Research

SEC. 1801. ESTABLISHMENT OF OFFICE.

    (a) In General.--Part D of title XXIII of the Public Health Service 
Act (42 U.S.C. 300cc-41 et seq.) is amended--
            (1) by striking the part designation and the heading for 
        the part;
            (2) by redesignating section 2351 as section 2354; and
            (3) by inserting before section 2354 (as so redesignated) 
        the following:

                   ``Part D--Office of AIDS Research

          ``Subpart I--Interagency Coordination of Activities

``SEC. 2351. ESTABLISHMENT OF OFFICE.

    ``(a) In General.--There is established within the National 
Institutes of Health an office to be known as the Office of AIDS 
Research. The Office shall be headed by a director, who shall be 
appointed by the Secretary.
    ``(b) Duties.--
            ``(1) Interagency coordination of aids activities.--With 
        respect to acquired immune deficiency syndrome, the Director of 
        the Office shall plan, coordinate, and evaluate research and 
        other activities conducted or supported by the agencies of the 
        National Institutes of Health.
            ``(2) Consultations.--The Director of the Office shall 
        carry out this subpart (including developing and revising the 
        plan required in section 2353) in consultation with the heads 
        of the agencies of the National Institutes of Health, with the 
        advisory councils of the agencies, and with the advisory 
        council established under section 2352.

``SEC. 2352. ADVISORY COUNCIL.

    ``(a) In General.--The Secretary shall establish an advisory 
council for the purpose of providing advice to the Director of the 
Office on carrying out this part. (Such council is referred to in this 
section as the `Advisory Council'.)
    ``(b) Composition, Compensation, Terms, Chair, Etc.--Subsections 
(b) through (g) of section 406 apply to the Advisory Council to the 
same extent and in the same manner as such subsections apply to 
advisory councils for the national research institutes, except that, in 
addition to the ex officio members specified in section 406(b)(2), 
there shall serve as ex officio members of the Advisory Council the 
chairs of the advisory councils for each of the National Cancer 
Institute, the National Institute on Allergy and Infectious Diseases, 
the National Institute on Drug Abuse, and the National Institute on 
Mental Health.

``SEC. 2353. COMPREHENSIVE PLAN FOR EXPENDITURE OF APPROPRIATIONS.

    ``(a) In General.--Subject to the provisions of this section and 
other applicable law, the Director of the Office, in carrying out 
section 2351, shall--
            ``(1) establish a comprehensive plan for the conduct and 
        support of all AIDS activities of the agencies of the National 
        Institutes of Health (which plan shall be first established 
        under this paragraph not later than 12 months after the date of 
        the enactment of the National Institutes of Health 
        Revitalization Act of 1993);
            ``(2) ensure that the Plan establishes priorities among the 
        AIDS activities that such agencies are authorized to carry out;
            ``(3) ensure that the Plan establishes objectives regarding 
        such activities, describes the means for achieving the 
        objectives, and designates the date by which the objectives are 
        expected to be achieved;
            ``(4) ensure that all amounts appropriated for such 
        activities are expended in accordance with the Plan;
            ``(5) review the Plan not less than annually, and revise 
        the Plan as appropriate; and
            ``(6) ensure that the Plan serves as a broad, binding 
        statement of policies regarding AIDS activities of the 
        agencies, but does not remove the responsibility of the heads 
        of the agencies for the approval of specific programs or 
        projects, or for other details of the daily administration of 
        such activities, in accordance with the Plan.
    ``(b) Certain Components of Plan.--With respect to AIDS activities 
of the agencies of the National Institutes of Health, the Director of 
the Office shall ensure that the Plan--
            ``(1) provides for basic research;
            ``(2) provides for applied research;
            ``(3) provides for research that is conducted by the 
        agencies;
            ``(4) provides for research that is supported by the 
        agencies;
            ``(5) provides for proposals developed pursuant to 
        solicitations by the agencies and for proposals developed 
        independently of such solicitations; and
            ``(6) provides for behavioral research and social sciences 
        research.
    ``(c) Budget Estimates.--
            ``(1) Full-funding budget.--
                    ``(A) With respect to a fiscal year, the Director 
                of the Office shall prepare and submit directly to the 
                President, for review and transmittal to the Congress, 
                a budget estimate for carrying out the Plan for the 
                fiscal year, after reasonable opportunity for comment 
                (but without change) by the Secretary, the Director of 
                the National Institutes of Health, and the advisory 
                council established under section 2352. The budget 
                estimate shall include an estimate of the number and 
                type of personnel needs for the Office.
                    ``(B) The budget estimate submitted under 
                subparagraph (A) shall estimate the amounts necessary 
                for the agencies of the National Institutes of Health 
                to carry out all AIDS activities determined by the 
                Director of the Office to be appropriate, without 
                regard to the probability that such amounts will be 
                appropriated.
            ``(2) Alternative budgets.--
                    ``(A) With respect to a fiscal year, the Director 
                of the Office shall prepare and submit to the Secretary 
                and the Director of the National Institutes of Health 
                the budget estimates described in subparagraph (B) for 
                carrying out the Plan for the fiscal year. The 
                Secretary and such Director shall consider each of such 
                estimates in making recommendations to the President 
                regarding a budget for the Plan for such year.
                    ``(B) With respect to the fiscal year involved, the 
                budget estimates referred to in subparagraph (A) for 
                the Plan are as follows:
                            ``(i) The budget estimate submitted under 
                        paragraph (1).
                            ``(ii) A budget estimate developed on the 
                        assumption that the amounts appropriated will 
                        be sufficient only for--
                                    ``(I) continuing the conduct by the 
                                agencies of the National Institutes of 
                                Health of existing AIDS activities (if 
                                approved for continuation), and 
                                continuing the support of such 
                                activities by the agencies in the case 
                                of projects or programs for which the 
                                agencies have made a commitment of 
                                continued support; and
                                    ``(II) carrying out, of activities 
                                that are in addition to activities 
                                specified in subclause (I), only such 
                                activities for which the Director 
                                determines there is the most 
                                substantial need.
                            ``(iii) Such other budget estimates as the 
                        Director of the Office determines to be 
                        appropriate.
    ``(d) Funding.--
            ``(1) Authorization of appropriations.--For the purpose of 
        carrying out AIDS activities under the Plan, there are 
        authorized to be appropriated such sums as may be necessary for 
        each of the fiscal years 1994 through 1996.
            ``(2) Direct receipt by director of national institutes of 
        health.--For the first fiscal year beginning after the date on 
        which the Plan first established under section 2353(a)(1) has 
        been in effect for 12 months, and for each subsequent fiscal 
        year, the Director of the National Institutes of Health shall 
        receive directly from the President and the Director of the 
        Office of Management and Budget all funds available for AIDS 
        activities of the National Institutes of Health.
            ``(3) Disbursement to agencies.--
                    ``(A) With respect to the disbursement by the 
                Director of the National Institutes of Health of 
                amounts for carrying out AIDS activities specified in 
                subsection (c)(2)(B)(ii)(I) for the fiscal year 
                involved, the Director shall, to the extent 
                practicable, disburse all of such amounts to the 
                agencies of such Institutes not later than 30 days 
                after the date on which the Director receives amounts 
                under paragraph (2).
                    ``(B) With respect to the disbursement by the 
                Director of the National Institutes of Health of 
                amounts for carrying out AIDS activities of the 
                National Institutes of Health in addition to the 
                activities specified in subparagraph (A) for the fiscal 
                year, the Director shall, to the extent practicable, 
                disburse all of such amounts to the agencies of the 
                National Institutes of Health not later than 90 days 
                after the date on which the Director receives amounts 
                under paragraph (2).''.
    (b) Conforming Amendments.--Section 2354 of the Public Health 
Service Act, as redesignated by subsection (a)(2) of this section, is 
amended--
            (1) in the heading for the section, by striking 
        ``establishment of'' and inserting ``additional'';
            (2) in subsection (a)--
                    (A) in the matter preceding paragraph (1), by 
                striking ``In carrying out'' and all that follows and 
                inserting the following: ``In carrying out AIDS 
                research, the Director of the Office--'';
                    (B) by striking paragraphs (1) and (2) and 
                redesignating paragraphs (3) through (8) as paragraphs 
                (1) through (6);
                    (C) in paragraph (3) (as so redesignated), by 
                striking ``may'' and all that follows in the matter 
                preceding subparagraph (A) and inserting the following: 
                ``may support--'';
                    (D) in paragraph (5) (as so redesignated)--
                            (i) in subparagraph (A)--
                                    ``(I) by striking ``may'' and all 
                                that follows through ``acquire,'' and 
                                inserting ``may acquire,''; and
                                    ``(II) by striking ``Director'' and 
                                all that follows through ``determines'' 
                                and inserting ``Director of the Office 
                                determines'';
                            (ii) in subparagraph (B), by striking 
                        ``may'' and all that follows through ``make 
                        grants'' and inserting ``may make grants''; and
                            (iii) in subparagraph (C), by striking 
                        ``may'' and all that follows through 
                        ``acquire,'' and inserting ``may acquire,''; 
                        and
                    (E) in each of paragraphs (2), (3)(A), and (4) (as 
                so redesignated), by striking ``research relating to 
                acquired immune deficiency syndrome'' and inserting 
                ``AIDS research'';
            (3) in subsection (b), in the matter preceding paragraph 
        (1), by striking ``The Director'' and all that follows through 
        ``shall'' and inserting ``The Director of the Office shall''; 
        and
            (4) in subsection (c), by striking ``the Director'' and all 
        that follows through ``shall'' and inserting ``the Director of 
        the Office shall''.

SEC. 1802. ESTABLISHMENT OF EMERGENCY DISCRETIONARY FUND.

    Part D of title XXIII of the Public Health Service Act, as amended 
by section 1801 of this Act, is amended by adding at the end the 
following subpart:

               ``Subpart II--Emergency Discretionary Fund

``SEC. 2356. EMERGENCY DISCRETIONARY FUND.

    ``(a) In General.--
            ``(1) Establishment.--There is established a fund 
        consisting of such amounts as may be appropriated under 
        subsection (g). Subject to the provisions of this section, the 
        Director of the Office, after consultation with the advisory 
        council established under section 2352, may expend amounts in 
        the Fund for the purpose of conducting and supporting such 
        projects of AIDS research and other AIDS activities as may be 
        authorized in this Act for the National Institutes Health.
            ``(2) Preconditions to use of fund.--Amounts in the Fund 
        may be expended for an AIDS project only if--
                    ``(A) the Director of the Office has made a 
                determination that there is a significant need for the 
                project; and
                    ``(B) as of June 30 of the fiscal year preceding 
                the fiscal year in which the determination is made, 
                such need was not provided for in any appropriations 
                Act passed by the House of Representatives to make 
                appropriations for the Departments of Labor, Health and 
                Human Services (including the National Institutes of 
                Health), Education, and related agencies for the fiscal 
                year in which the determination is made.
            ``(3) Two-year use of fund for project involved.--In the 
        case of an AIDS project, obligations of amounts in the Fund may 
        not be made for the project after the expiration of the 2-year 
        period beginning on the date on which the initial obligation of 
        such amounts is made for the project.
    ``(b) Peer Review.--With respect to an AIDS project carried out 
with amounts in the Fund, this section may not be construed as waiving 
applicable requirements for peer review.
    ``(c) Limitations on Use of Fund.--
            ``(1) Construction of facilities.--Amounts in the Fund may 
        not be used for the construction, renovation, or relocation of 
        facilities, or for the acquisition of land.
            ``(2) Congressional disapproval of projects.--
                    ``(A) Amounts in the Fund may not be expended for 
                the fiscal year involved for an AIDS project, or 
                category of such projects, for which--
                            ``(i)(I) amounts were made available in an 
                        appropriations Act for the preceding fiscal 
                        year; and
                            ``(II) amounts are not made available in 
                        any appropriations Act for the fiscal year 
                        involved; or
                            ``(ii) amounts are by law prohibited from 
                        being expended.
                    ``(B) A determination under subparagraph (A)(i) of 
                whether amounts have been made available in 
                appropriations Acts for a fiscal year shall be made 
                without regard to whether such Acts make available 
                amounts for the Fund.
            ``(3) Investment of fund amounts.--Amounts in the Fund may 
        not be invested.
    ``(d) Applicability of Limitation Regarding Number of Employees.--
The purposes for which amounts in the Fund may be expended include the 
employment of individuals necessary to carry out AIDS projects approved 
under subsection (a). Any individual employed under the preceding 
sentence may not be included in any determination of the number of 
full-time equivalent employees for the Department of Health and Human 
Services for the purpose of any limitation on the number of such 
employees established by law prior to, on, or after the date of the 
enactment of the National Institutes of Health Revitalization Act of 
1993.
    ``(e) Report to Congress.--Not later than February 1 of each fiscal 
year, the Director of the Office 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 on the 
AIDS projects carried out during the preceding fiscal year with amounts 
in the Fund. The report shall provide a description of each such 
project and an explanation of the reasons underlying the use of the 
Fund for the project.
    ``(f) Definitions.--For purposes of this section:
            ``(1) The term `AIDS project' means a project described in 
        subsection (a).
            ``(2) The term `Fund' means the fund established in 
        subsection (a).
    ``(g) Funding.--
            ``(1) Authorization of appropriations.--For the purpose of 
        providing amounts for the Fund, there is authorized to be 
        appropriated $100,000,000 for each of the fiscal years 1994 
        through 1996.
            ``(2) Availability.--Amounts appropriated for the Fund are 
        available until expended.''.

SEC. 1803. GENERAL PROVISIONS.

    Part D of title XXIII of the Public Health Service Act, as amended 
by section 1802 of this Act, is amended by adding at the end the 
following subpart:

                   ``Subpart III--General Provisions

``SEC. 2359. GENERAL PROVISIONS REGARDING THE OFFICE.

    ``(a) Administrative Support for Office.--The Secretary, acting 
through the Director of the National Institutes of Health, shall 
provide administrative support and support services to the Director of 
the Office.
    ``(b) Definitions.--For purposes of this part:
            ``(1) The term `AIDS activities' means AIDS research and 
        other activities that relate to acquired immune deficiency 
        syndrome.
            ``(2) The term `AIDS research' means research with respect 
        to acquired immune deficiency syndrome.
            ``(3) The term `Office' means the Office of AIDS Research.
            ``(4) The term `Plan' means the plan required in section 
        2353(a)(1).''.

                      Subtitle B--Certain Programs

SEC. 1811. REVISION AND EXTENSION OF CERTAIN PROGRAMS.

    Title XXIII of the Public Health Service Act (42 U.S.C. 300cc et 
seq.) is amended--
            (1) in section 2304(c)(1)--
                    (A) in the matter preceding subparagraph (A), by 
                inserting after ``Director of such Institute'' the 
                following: ``(and may provide advice to the Directors 
                of other agencies of the National Institutes of Health, 
                as appropriate)''; and
                    (B) in subparagraph (A), by inserting before the 
                semicolon the following: ``, including recommendations 
                on the projects of research with respect to diagnosing 
                immune deficiency and with respect to predicting, 
                diagnosing, preventing, and treating opportunistic 
                cancers and infectious diseases'';
            (2) in section 2311(a)(1), by inserting before the 
        semicolon the following: ``, including evaluations of methods 
        of diagnosing immune deficiency and evaluations of methods of 
        predicting, diagnosing, preventing, and treating opportunistic 
        cancers and infectious diseases'';
            (3) in section 2315--
                    (A) in subsection (a)(2), by striking 
                ``international research'' and all that follows and 
                inserting ``international research and training 
                concerning the natural history and pathogenesis of the 
                human immunodeficiency virus and the development and 
                evaluation of vaccines and treatments for acquired 
                immune deficiency syndrome and opportunistic 
                infections.''; and
                    (B) in subsection (f), by striking ``there are 
                authorized'' and all that follows and inserting ``there 
                are authorized to be appropriated such sums as may be 
                necessary for each fiscal year.'';
            (4) in section 2318--
                    (A) in subsection (a)(1)--
                            (i) by inserting after ``The Secretary'' 
                        the following: ``, acting through the Director 
                        of the National Institutes of Health and after 
                        consultation with the Administrator for Health 
                        Care Policy and Research,''; and
                            (ii) by striking ``syndrome'' and inserting 
                        ``syndrome, including treatment and prevention 
                        of HIV infection and related conditions among 
                        women''; and
                    (B) in subsection (e), by striking ``1991.'' and 
                inserting the following: ``1991, and such sums as may 
                be necessary for each of the fiscal years 1994 through 
                1996.'';
            (5) in section 2320(b)(1)(A), by striking ``syndrome'' and 
        inserting ``syndrome and the natural history of such 
        infection'';
            (6) in section 2320(e)(1), by striking ``there are 
        authorized'' and all that follows and inserting ``there are 
        authorized to be appropriated such sums as may be necessary for 
        each fiscal year.'';
            (7) in section 2341(d), by striking ``there are 
        authorized'' and all that follows and inserting ``there are 
        authorized to be appropriated such sums as may be necessary for 
        each fiscal year.''; and
            (8) in section 2361, by striking ``For purposes'' and all 
        that follows and inserting the following:
    ``For purposes of this title:
            ``(1) The term `infection', with respect to the etiologic 
        agent for acquired immune deficiency syndrome, includes 
        opportunistic cancers and infectious diseases and any other 
        conditions arising from infection with such etiologic agent.
            ``(2) The term `treatment', with respect to the etiologic 
        agent for acquired immune deficiency syndrome, includes primary 
        and secondary prophylaxis.''.

                           TITLE XIX--STUDIES

SEC. 1901. ACQUIRED IMMUNE DEFICIENCY SYNDROME.

    (a) Third-Party Payments Regarding Certain Clinical Trials.--The 
Secretary of Health and Human Services, acting through the Director of 
the National Institutes of Health, shall conduct a study for the 
purpose of--
            (1) determining the policies of third-party payors 
        regarding the payment of the costs of appropriate health 
        services that are provided incident to the participation of 
        individuals as subjects in clinical trials conducted in the 
        development of drugs with respect to acquired immune deficiency 
        syndrome; and
            (2) developing recommendations regarding such policies.
    (b) Advisory Committees.--The Secretary of Health and Human 
Services, acting through the Director of the National Institutes of 
Health, shall conduct a study for the purpose of determining--
            (1) whether the activities of the various advisory 
        committees established in the National Institutes of Health 
        regarding acquired immune deficiency syndrome are being 
        coordinated sufficiently; and
            (2) whether the functions of any of such advisory 
        committees should be modified in order to achieve greater 
        efficiency.
    (c) Vaccines for Human Immunodeficiency Virus.--
            (1) In general.--The Secretary of Health and Human 
        Services, acting through the National Institutes of Health, 
        shall develop a plan for the appropriate inclusion of HIV-
        infected women, including pregnant women, HIV-infected infants, 
        and HIV-infected children in studies conducted by or through 
        the National Institutes of Health concerning the safety and 
        efficacy of HIV vaccines for the treatment and prevention of 
        HIV infection. Such plan shall ensure the full participation of 
        other Federal agencies currently conducting HIV vaccine studies 
        and require that such studies conform fully to the requirements 
        of part 46 of title 45, Code of Federal Regulations.
            (2) Report.--Not later than 180 days after the date of the 
        enactment of this Act, the Secretary of Health and Human 
        Services shall prepare and 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 concerning 
        the plan developed under paragraph (1).
            (3) Implementation.--Not later than 12 months after the 
        date of the enactment of this Act, the Secretary of Health and 
        Human Services shall implement the plan developed under 
        paragraph (1), including measures for the full participation of 
        other Federal agencies currently conducting HIV vaccine 
        studies.
            (4) For the purpose of carrying out this subsection, there 
        are authorized to be appropriated such sums as may be necessary 
        for each of the fiscal years 1994 through 1996.

SEC. 1902. MALNUTRITION IN THE ELDERLY.

    (a) Study.--
            (1) In general.--The Secretary of Health and Human Services 
        (referred to in this section as the ``Secretary''), acting 
        through the National Institute on Aging, coordinating with the 
        Agency for Health Care Policy and Research and, to the degree 
        possible, in consultation with the head of the National 
        Nutrition Monitoring System established under section 1428 of 
        the Food and Agriculture Act of 1977 (7 U.S.C. 3178), shall 
        conduct a 3-year nutrition screening and intervention 
        activities study of the elderly.
            (2) Efficacy and cost-effectiveness of nutrition screening 
        and intervention activities.--In conducting the study, the 
        Secretary shall determine the efficacy and cost-effectiveness 
        of nutrition screening and intervention activities conducted in 
        the elderly health and long-term care continuum, and of a 
        program that would institutionalize nutrition screening and 
        intervention activities. In evaluating such a program, the 
        Secretary shall determine--
                    (A) if health or quality of life is measurably 
                improved for elderly individuals who receive routine 
                nutritional screening and treatment;
                    (B) if federally subsidized home or institutional 
                care is reduced because of increased independence of 
                elderly individuals resulting from improved nutritional 
                status;
                    (C) if a multidisciplinary approach to nutritional 
                care is effective in addressing the nutritional needs 
                of elderly individuals; and
                    (D) if reimbursement for nutrition screening and 
                intervention activities is a cost-effective approach to 
                improving the health status of elderly individuals.
            (3) Populations.--The populations of elderly individuals in 
        which the study will be conducted shall include populations of 
        elderly individuals who are--
                    (A) living independently, including--
                            (i) individuals who receive home and 
                        community-based services or family support;
                            (ii) individuals who do not receive 
                        additional services and support;
                            (iii) individuals with low incomes; and
                            (iv) individuals who are minorities;
                    (B) hospitalized, including individuals admitted 
                from home and from institutions; and
                    (C) institutionalized in residential facilities 
                such as nursing homes and adult homes.
    (b) Malnutrition Study.--The Secretary, acting through the National 
Institute on Aging, shall conduct a 3-year study to determine the 
extent of malnutrition in elderly individuals in hospitals and long-
term care facilities and in elderly individuals who are living 
independently.
    (c) Report.--The Secretary shall submit a report to the Committee 
on Labor and Human Resources of the Senate and the Committee on Energy 
and Commerce of the House of Representatives containing the findings 
resulting from the studies described in subsections (a) and (b), 
including a determination regarding whether a program that would 
institutionalize nutrition screening and intervention activities should 
be adopted, and the rationale for the determination.
    (d) Advisory Panel.--
            (1) Establishment.--The Secretary, acting through the 
        Director of the National Institute on Aging, shall establish an 
        advisory panel that shall oversee the design, implementation, 
        and evaluation of the studies described in subsections (a) and 
        (b).
            (2) Composition.--The advisory panel shall include 
        representatives appointed for the life of the panel by the 
        Secretary from the Health Care Financing Administration, the 
        Social Security Administration, the National Center for Health 
        Statistics, the Administration on Aging, the National Council 
        on the Aging, the American Dietetic Association, the American 
        Academy of Family Physicians, and such other agencies or 
        organizations as the Secretary determines to be appropriate.
            (3) Compensation and expenses.--
                    (A) Compensation.--Each member of the advisory 
                panel who is not an employee of the Federal Government 
                shall receive compensation at the daily equivalent of 
                the rate specified for level V of the Executive 
                Schedule under section 5316 of title 5, United States 
                Code, for each day the member is engaged in the 
                performance of duties for the advisory panel, including 
                attendance at meetings and conferences of the panel, 
                and travel to conduct the duties of the panel.
                    (B) Travel expenses.--Each member of the advisory 
                panel shall receive travel expenses, including per diem 
                in lieu of subsistence, at rates authorized for 
                employees of agencies under subchapter I of chapter 57 
                of title 5, United States Code, for each day the member 
                is engaged in the performance of duties away from the 
                home or regular place of business of the member.
            (4)  Detail of federal employees.--On the request of the 
        advisory panel, the head of any Federal agency shall detail, 
        without reimbursement, any of the personnel of the agency to 
        the advisory panel to assist the advisory panel in carrying out 
        its duties. Any detail shall not interrupt or otherwise affect 
        the civil service status or privileges of the Federal employee.
            (5)  Technical assistance.--On the request of the advisory 
        panel, the head of a Federal agency shall provide such 
        technical assistance to the advisory panel as the advisory 
        panel determines to be necessary to carry out its duties.
            (6) Termination.--Notwithstanding section 15 of the Federal 
        Advisory Committee Act (5 U.S.C. App.), the advisory panel 
        shall terminate 3 years after the date of enactment of this 
        Act.

SEC. 1903. RESEARCH ACTIVITIES ON CHRONIC FATIGUE SYNDROME.

    The Secretary of Health and Human Services shall, not later than 
May 1, 1993, and annually thereafter for the next 3 years, prepare and 
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 summarizes the research activities conducted or 
supported by the National Institutes of Health concerning chronic 
fatigue syndrome. Such report should include information concerning 
grants made, cooperative agreements or contracts entered into, 
intramural activities, research priorities and needs, and a plan to 
address such priorities and needs.

SEC. 1904. REPORT ON MEDICAL USES OF BIOLOGICAL AGENTS IN DEVELOPMENT 
              OF DEFENSES AGAINST BIOLOGICAL WARFARE.

    The Secretary of Health and Human Services, in consultation with 
other appropriate executive agencies, shall report to the House Energy 
and Commerce Committee and the Senate Labor and Human Resources 
Committee on the appropriateness and impact of the National Institutes 
of Health assuming responsibility for the conduct of all Federal 
research, development, testing, and evaluation functions relating to 
medical countermeasures against biowarfare threat agents. In preparing 
the report, the Secretary shall identify the extent to which such 
activities are carried out by agencies other than the National 
Institutes of Health, and assess the impact (positive and negative) of 
the National Institutes of Health assuming responsibility for such 
activities, including the impact under the Budget Enforcement Act and 
the Omnibus Budget Reconciliation Act of 1990 on existing National 
Institutes of Health research programs as well as other programs within 
the category of domestic discretionary spending. The Secretary shall 
submit the report not later than 12 months after the date of the 
enactment of this Act.

SEC. 1905. PERSONNEL STUDY OF RECRUITMENT, RETENTION AND TURNOVER.

    (a) Study of Personnel System.--Not later than 1 year after the 
date of the enactment of this Act, the Secretary of Health and Human 
Services, acting through the Director of the National Institutes of 
Health, shall conduct a study to review the retention, recruitment, 
vacancy and turnover rates of support staff, including firefighters, 
law enforcement, procurement officers, technicians, nurses and clerical 
employees, to ensure that the National Institutes of Health is 
adequately supporting the conduct of efficient, effective and high 
quality research for the American public. The Director of NIH shall 
work in conjunction with appropriate employee organizations and 
representatives in developing such a study.
    (b) Submission to Congress.--Not later than 1 year after the date 
of the enactment of this Act, the Secretary of Health and Human 
Services shall prepare and submit to the Committee on Energy and 
Commerce of the House of Representatives, and to the Committee on Labor 
and Human Resources of the Senate, a report containing the study 
conducted under subsection (a) together with the recommendations of the 
Secretary concerning the enactment of legislation to implement the 
results of such study.

SEC. 1906. PROCUREMENT.

    (a) In General.--The Director of the National Institutes of Health 
and the Administrator of the General Services Administration shall 
jointly conduct a study to develop a streamlined procurement system for 
the National Institutes of Health that complies with the requirements 
of Federal law.
    (b) Report.--Not later than March 1, 1994, the officials specified 
in subsection (a) shall complete the study required in such subsection 
and 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 describing the findings made as a result of the 
study.

SEC. 1907. CHRONIC PAIN CONDITIONS.

    (a) In General.--The Director of the National Institutes of Health 
(in this section referred to as the `Director'), acting through the 
Director of the National Institute of Dental Research and as 
appropriate through the heads of other agenices of such Institutes, 
shall conduct a study for the purpose of determining the incidence in 
the United States of cases of chronic pain and the effect of such cases 
on the costs of health care in the United States.
    (b) Certain Elements of Study.--The cases of chronic pain with 
respect to which the study required in subsection (a) is conducted 
shall include reflex sympathetic dystrophy syndrome, temporomandibular 
joint disorder, post-herpetic neuropathy, painful diabetic neuropathy, 
phantom pain, and post-stroke pain.
    (c) Report.--Not later than 2 years after the date of the enactment 
of this Act, the Director shall complete the study required in 
subsection (a) and submit to the 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 findings made as 
a result of the study.

SEC. 1908. BACK INJURIES.

    (a) In General.--The Director of the National Institutes of Health, 
acting through the appropriate national research institute, shall 
conduct a study of back injuries, with consideration of the following:
            (1) Accurate diagnosis, and the appropriate form of 
        treatment.
            (2) Providing for return to employment as soon as is 
        practicable.
            (3) Minimizing the probability of recurrence.
            (4) A comparison of conventional treatments and alternative 
        treatments.
            (5) Costs to the health care system.
            (6) Costs to the economy generally.
    (b) Report.--Not later than 1 year after the date of the enactment 
of this Act, the Director of the National Institute of Health shall 
complete the study required in subsection (a) and submit to the 
Committee on Energy and Commerce of the House of Representatives, and 
to the Committee on Labor and Human Resources of the Senate, a report 
describing the findings made as a result of the study.

                   TITLE XX--MISCELLANEOUS PROVISIONS

SEC. 2001. DESIGNATION OF SENIOR BIOMEDICAL RESEARCH SERVICE IN HONOR 
              OF SILVIO O. CONTE; LIMITATION ON NUMBER OF MEMBERS.

    (a) In General.--Section 228(a) of the Public Health Service Act 
(42 U.S.C. 237(a)), as added by section 304 of Public Law 101-509, is 
amended to read as follows:
    ``(a)(1) There shall be in the Public Health Service a Silvio O. 
Conte Senior Biomedical Research Service, not to exceed 750 members.
    ``(2) The authority established in paragraph (1) regarding the 
number of members in the Silvio O. Conte Senior Biomedical Research 
Service is in addition to any authority established regarding the 
number of members in the commissioned Regular Corps, in the Reserve 
Corps, and in the Senior Executive Service. Such paragraph may not be 
construed to require that the number of members in the commissioned 
Regular Corps, in the Reserve Corps, or in the Senior Executive Service 
be reduced to offset the number of members serving in the Silvio O. 
Conte Senior Biomedical Research Service (hereafter in this section 
referred to as the `Service').''.
    (b) Conforming Amendment.--Section 228 of the Public Health Service 
Act (42 U.S.C. 237), as added by section 304 of Public Law 101-509, is 
amended in the heading for the section by amending the heading to read 
as follows:

        ``silvio o. conte senior biomedical research service''.

SEC. 2002. MASTER PLAN FOR PHYSICAL INFRASTRUCTURE FOR RESEARCH.

    Not later than 18 months after the date of the enactment of this 
Act, the Secretary of Health and Human Services, acting through the 
Director of the National Institutes of Health, shall present to the 
Congress a master plan to provide for the replacement or refurbishment 
of less than adequate buildings, utility equipment and distribution 
systems (including the resources that provide electrical and other 
utilities, chilled water, air handling, and other services that the 
Secretary, acting through the Director, deems necessary), roads, 
walkways, parking areas, and grounds that underpin the laboratory and 
clinical facilities of the National Institutes of Health. Such plan may 
make recommendations for the undertaking of new projects that are 
consistent with the objectives of this section, such as encircling the 
National Institutes of Health Federal enclave with an adequate chilled 
water conduit.

SEC. 2003. CERTAIN AUTHORIZATION OF APPROPRIATIONS.

    Section 399L(a) of the Public Health Service Act (42 U.S.C. 280e-
4(a)), as added by Public Law 102-515 (106 Stat. 3376), is amended--
            (1) in the first sentence, by striking ``the Secretary'' 
        and all that follows and inserting the following: ``there are 
        authorized to be appropriated $30,000,000 for fiscal year 1994, 
        and such sums as may be necessary for each of the fiscal years 
        1995 through 1996.''; and
            (2) in the second sentence, by striking ``Out of any 
        amounts used'' and inserting ``Of the amounts appropriated 
        under the preceding sentence''.

SEC. 2004. BUY-AMERICAN PROVISIONS.

    No funds appropriated pursuant to this Act may be used to fund a 
grant or contract unless the recipient agrees that substantially all 
goods and services acquired with such grant or contract assistance will 
be produced in the United States.

                       TITLE XXI--EFFECTIVE DATES

SEC. 2101. EFFECTIVE DATES.

    Subject to section 165, this Act and the amendments made by this 
Act take effect upon the date of the enactment of this Act.

SEC. 2005. PROHIBITION AGAINST FURTHER FUNDING FOR PROJECT ARIES.

    For fiscal year 1994 and each subsequent fiscal year, the project 
administered by the University of Washington at Seattle and known as 
Project Aries may not receive any funding from any agency of the 
National Institutes of Health, other than payments under awards made 
for fiscal year 1993 or prior fiscal years.
            Attest:






                                                                 Clerk.
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