[Congressional Bills 103th Congress]
[From the U.S. Government Publishing Office]
[S. 1 Enrolled Bill (ENR)]

        S.1
                       One Hundred Third Congress

                                 of the

                        United States of America


                          AT THE FIRST SESSION

          Begun and held at the City of Washington on Tuesday,
  the fifth day of January, one thousand nine hundred and ninety-three


                                 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.

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

SECTION 1. SHORT TITLE; TABLE OF CONTENTS.

    (a) Short Title.--This Act may be cited as the ``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. Inapplicability 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. Regulations.

           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 and Social Sciences 
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 bone 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.

           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 Research.
Sec. 504. Authorization of appropriations.
Sec. 505. Prevention and control programs.

   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 and health services research on eye care and 
diabetes.

   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.
Sec. 1602. Service payback requirements.

             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 Certain Agencies

Sec. 1631. Establishment of programs for National Institutes of Health.
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. National Foundation for Biomedical Research.

    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. Life-threatening illnesses.
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. Relationship between the consumption of legal and illegal 
drugs.
Sec. 1909. Reducing administrative health care costs.
Sec. 1910. Sentinel disease concept study.
Sec. 1911. Potential environmental and other risks contributing to 
incidence of breast cancer.
Sec. 1912. Support for bioengineering research.
Sec. 1913. Cost of care in last 6 months of life.

                   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.
Sec. 2006. Loan repayment program.
Sec. 2007. Exclusion of aliens infected with the agent for acquired 
immune deficiency syndrome.
Sec. 2008. Technical corrections.
Sec. 2009. Biennial report on carcinogens.
Sec. 2010. Transfer of provisions of title XXVII.
Sec. 2011. Authorization of appropriations.
Sec. 2012. Vaccine injury compensation program.
Sec. 2013. Technical corrections with respect to the Agency for Health 
Care Policy and Research.
Sec. 2014. Technical corrections with respect to the Health Professions 
Education Extension Amendments of 1992.
Sec. 2015. Prohibitions against SHARP adult sex survey and the American 
teenage sex survey.
Sec. 2016. Health services research.
Sec. 2017. Childhood mental health.
Sec. 2018. Expenditures from certain account.

                       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 
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 proposal for the National 
    Institutes of Health to conduct or support research, the Secretary 
    may not approve or fund any proposal that is subject to technical 
    and scientific peer review under section 492 unless the proposal has 
    undergone such 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 funds for the research because of 
    ethical considerations unless--
            ``(A) the Secretary convenes an advisory board in accordance 
        with paragraph (5) to study such considerations; and
            ``(B)(i) the majority of the advisory board recommends that, 
        because of such considerations, the Secretary withhold funds for 
        the research; or
            ``(ii) the majority of such board recommends that the 
        Secretary not withhold funds for the research because of such 
        considerations, but the Secretary finds, on the basis of the 
        report submitted under paragraph (5)(B)(ii), that the 
        recommendation is arbitrary and capricious.
        ``(2) Rules of construction.--Paragraph (1) may not be construed 
    as prohibiting the Secretary from withholding funds for research on 
    the basis of--
            ``(A) the inadequacy of the qualifications of the entities 
        that would be involved with the conduct of the research 
        (including the entity that would directly receive the funds from 
        the Secretary), subject to the condition that, with respect to 
        the process of review through which the research was recommended 
        for approval for purposes of subsection (a), all findings 
        regarding such qualifications made in such process are 
        conclusive; or
            ``(B) the priorities established by the Secretary for the 
        allocation of funds among projects of research that have been so 
        recommended.
        ``(3) Applicability.--The limitation established in paragraph 
    (1) regarding the authority to withhold funds because of ethical 
    considerations shall apply without regard to whether the withholding 
    of funds on such basis is characterized as a disapproval, a 
    moratorium, a prohibition, or other characterization.
        ``(4) 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.
        ``(5) Ethics advisory boards.--
            ``(A) Any advisory board convened for purposes of paragraph 
        (1) shall be known as an ethics advisory board (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 (4)(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.
        ``(6) Definition.--For purposes of this subsection, the term 
    `ethical considerations' means considerations as to whether the 
    nature of the research involved is such that it is unethical to 
    conduct or support the research.''.

          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 
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 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.--Subject to subsection (b)(2) of section 492A of 
    the Public Health Service Act (as added by section 101 of this Act), 
    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 
        subsection (a) of such section 492A;
            (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)(5)(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 the nature of the research is such that it is 
        not unethical to conduct or support 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 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 are being 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 prepare biennial reports describing 
the manner in which the institute has complied with this section. Each 
such report shall be submitted to the Director of the institute involved 
for inclusion in the biennial report under section 403.
    ``(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 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. INAPPLICABILITY 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 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 (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 (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 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.

    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) In General.--
        ``(1) Establishment of office.--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 (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) Appointment of 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.
        ``(3) Definitions.--
            ``(A) The Secretary shall by regulation establish a 
        definition for the term `research misconduct' for purposes of 
        this section.
            ``(B) For purposes of this section, the term `financial 
        assistance' means a grant, contract, or cooperative agreement.
    ``(b) Existence of Administrative Processes as Condition of Funding 
for Research.--The Secretary shall by regulation require that each 
entity that applies for financial assistance 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 assistance--
        ``(1) assurances satisfactory to the Secretary that such entity 
    has established and has in effect (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;
        ``(2) an agreement that the entity will report to the Director 
    any investigation of alleged research misconduct in connection with 
    projects for which funds have been made available under this Act 
    that appears substantial; and
        ``(3) an agreement that the entity will comply with regulations 
    issued under this section.
    ``(c) Process for Response of Director.--The Secretary shall by 
regulation establish 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.''.

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;
        (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 
    paragraph (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 
subsection:
    ``(e) 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 by 
    regulation establish 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.''.

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.--The Secretary shall by 
regulation define 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 subsection (b), 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.
    ``(b) Relevant Projects.--A project of research referred to in 
subsection (a) 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.
    ``(c) Identifying and Reporting to Secretary.--The Secretary shall 
by regulation require that each entity described in subsection (a) that 
applies for assistance under this Act for any project described in 
subsection (b) submit in or with its application for such assistance--
        ``(1) assurances satisfactory to the Secretary that such entity 
    has established and has in effect an administrative process under 
    subsection (a) to identify financial interests (as defined under 
    subsection (a)) that exist regarding the project; and
        ``(2) an agreement that the entity will report to the Secretary 
    such interests identified by the entity and how any such interests 
    identified by the entity will be managed or eliminated in order that 
    the project in question will be protected from bias that may stem 
    from such interests; and
        ``(3) an agreement that the entity will comply with regulations 
    issued under this section.
    ``(d) Monitoring of Process.--The Secretary shall monitor the 
establishment and conduct of the administrative process established by 
an entity pursuant to subsection (a).
    ``(e) Response.--In any case in which the Secretary determines that 
an entity has failed to comply with subsection (c) regarding a project 
of research described in subsection (b), the Secretary--
        ``(1) shall require that, as a condition of receiving 
    assistance, the entity disclose the existence of a financial 
    interest (as defined under subsection (a)) in each public 
    presentation of the results of such project; and
        ``(2) may take such other actions as the Secretary determines to 
    be appropriate.
    ``(f) Definitions.--For purposes of this section:
        ``(1) The term `financial interest' includes the receipt of 
    consulting fees or honoraria and the ownership of stock or equity.
        ``(2) The term `assistance', with respect to conducting a 
    project of research, means a grant, contract, or cooperative 
    agreement.''.

SEC. 165. REGULATIONS.

    (a) Issuance of Final Rules.--
        (1) In general.--Not later than 180 days after the date of the 
    enactment of this Act, the Secretary shall, subject to paragraph 
    (2), issue the final rule for each regulation required in section 
    493 or 493A of the Public Health Service Act.
        (2) Definition of research misconduct.--Not later than 90 days 
    after the date on which the report required in section 162(e) is 
    submitted to the Secretary, the Secretary shall issue the final rule 
    for the regulations required in section 493 of the Public Health 
    Service Act with respect to the definition of the term ``research 
    misconduct''.
    (b) Applicability to Ongoing Investigations.--The final rule issued 
pursuant to subsection (a) for investigations under section 493 of the 
Public Health Service Act does not apply to investigations commenced 
before the date of the enactment of this Act under authority of such 
section as in effect before such date.
    (c) Definitions.--For purposes of this section:
        (1) The term ``section 493 of the Public Health Service Act'' 
    means such section as amended by sections 161 and 163 of this Act, 
    except as indicated otherwise in subsection (b).
        (2) The term ``section 493A of the Public Health Service Act'' 
    means such section as added by section 164 of this Act.
        (3) The term ``Secretary'' means the Secretary of Health and 
    Human Services.
           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 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 AND SOCIAL SCIENCES 
              RESEARCH.

    (a) In General.--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 section:


            ``office of behavioral and social sciences 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 and 
Social Sciences 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--
        ``(A) coordinate research conducted or supported by the agencies 
    of the National Institutes of Health; and
        ``(B) identify projects of behavioral and social sciences 
    research that should be conducted or supported by the national 
    research institutes, and develop such projects in cooperation with 
    such institutes.
    ``(2) Research authorized under paragraph (1) includes research on 
teen pregnancy, infant mortality, violent behavior, suicide, and 
homelessness. Such research does not include neurobiological research, 
or research in which the behavior of an organism is observed for the 
purpose of determining activity at the cellular or molecular level.''.
    (b) Report.--Not later than February 1, 1994, the Director of the 
Office of Behavioral and Social Sciences Research (established in 
section 404A of the Public Health Service Act, as added by subsection 
(a) of this section) 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 extent to 
which the national research institutes of the National Institutes of 
Health conduct and support behavioral research and social sciences 
research. In preparing the report, such Director shall (subject to 
subsection (b)(2) of such section 404A) state the definitions used in 
the report for the terms ``behavioral research'' and ``social sciences 
research'', and shall apply the definitions uniformly to such institutes 
for purposes of the report.
    (c) Effective Dates.--The amendment described in subsection (a) is 
made upon the date of the enactment of this Act and takes effect July 1, 
1993. Subsection (b) takes effect on such date.

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 
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 $20,000,000 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 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 (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, which 
    representatives shall include not less than one veterinarian with 
    expertise in laboratory-animal medicine.''.
    (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 
subsection:
    ``(h) The Secretary, acting through the Director of NIH and the 
Directors of the agencies of the National Institutes of Health, shall, 
in conducting and supporting programs for research, research training, 
recruitment, and other activities, provide for an increase in the number 
of women and individuals from disadvantaged backgrounds (including 
racial and ethnic minorities) 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 
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 
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 
alternative medical treatment modalities, including acupuncture and 
Oriental medicine, homeopathic medicine, and physical manipulation 
therapies.
    ``(c) The Secretary shall establish an advisory council for the 
purpose of providing advice to the Director of the Office on carrying 
out this section. Section 222 applies to such council to the same extent 
and in the same manner as such section applies to committees or councils 
established under such section.
    ``(d) 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)(A) prepare biennial reports on the activities carried out 
    or to be carried out by the Office; and
        ``(B) submit each such report to the Director of NIH for 
    inclusion in the biennial report under section 403.''.

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<!!>
        (3) by adding at the end the following paragraph:
        ``(5) ensure that, after January 1, 1994, all new or revised 
    health education and promotion materials developed or funded by the 
    National Institutes of Health and intended for the general public 
    are 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 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 subparagraph:
        ``(C) shall, subject to section 2353(d)(2), 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 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, the National Institute of Dental Research, 
and the National Institute of Diabetes and 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 (in this section referred to as the 
`Director'), shall establish a comprehensive program of conducting basic 
and clinical research on trauma (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 December 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 (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 subsection:
    ``(k) The Director of NIH shall carry out the program established in 
part F 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 
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 October 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 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 October 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 section:


                     ``authorization of appropriations

    ``Sec. 417B. (a) Activities Generally.--For the purpose of carrying 
out this subpart, there are authorized to be appropriated $2,728,000,000 
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)''.
           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 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 the following 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 RESEARCH.

    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 
section:


               ``national center on sleep disorders research

    ``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 Research (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--
        ``(1) the conduct and support of research, training, health 
    information dissemination, and other activities with respect to 
    sleep disorders, including biological and circadian rhythm research, 
    basic understanding of sleep, chronobiological and other sleep 
    related research; and
        ``(2) to coordinate the activities of the Center with similar 
    activities of other Federal agencies, including the other agencies 
    of the National Institutes of Health, and similar activities of 
    other public entities and nonprofit entities.
    ``(c)(1) The Director of the National Institutes of Health shall 
establish a board to be known as the Sleep Disorders Research Advisory 
Board (in this section referred to as the `Advisory Board').
    ``(2) The Advisory Board shall advise, assist, consult with, and 
make recommendations to the Director of the National Institutes of 
Health, through the Director of the Institute, and the Director of the 
Center concerning matters relating to the scientific activities carried 
out by and through the Center and the policies respecting such 
activities, including recommendations with respect to the plan required 
in subsection (c).
    ``(3)(A) The Director of the National Institutes of Health shall 
appoint to the Advisory Board 12 appropriately qualified representatives 
of the public who are not officers or employees of the Federal 
Government. Of such members, eight shall be representatives of health 
and scientific disciplines with respect to sleep disorders and four 
shall be individuals representing the interests of individuals with or 
undergoing treatment for sleep disorders.
    ``(B) The following officials shall serve as ex officio members of 
the Advisory Board:
        ``(i) The Director of the National Institutes of Health.
        ``(ii) The Director of the Center.
        ``(iii) The Director of the National Heart, Lung and Blood 
    Institute.
        ``(iv) The Director of the National Institute of Mental Health.
        ``(v) The Director of the National Institute on Aging.
        ``(vi) The Director of the National Institute of Child Health 
    and Human Development.
        ``(vii) The Director of the National Institute of Neurological 
    Disorders and Stroke.
        ``(viii) The Assistant Secretary for Health.
        ``(ix) The Assistant Secretary of Defense (Health Affairs).
        ``(x) The Chief Medical Director of the Veterans' 
    Administration.
    ``(4) The members of the Advisory Board shall, from among the 
members of the Advisory Board, designate an individual to serve as the 
chair of the Advisory Board.
    ``(5) Except as inconsistent with, or inapplicable to, this section, 
the provisions of section 406 shall apply to the advisory board 
established under this section in the same manner as such provisions 
apply to any advisory council established under such section.
    ``(d)(1) After consultation with the Director of the Center and the 
advisory board established under subsection (c), the Director of the 
National Institutes of Health shall develop a comprehensive plan for the 
conduct and support of sleep disorders research.
    ``(2) The plan developed under paragraph (1) shall identify 
priorities with respect to such research and shall provide for the 
coordination of such research conducted or supported by the agencies of 
the National Institutes of Health.
    ``(3) The Director of the National Institutes of Health (after 
consultation with the Director of the Center and the advisory board 
established under subsection (c)) shall revise the plan developed under 
paragraph (1) as appropriate.
    ``(e) The Director of the Center, in cooperation with the Centers 
for Disease Control and Prevention, is authorized to coordinate 
activities with the Department of Transportation, the Department of 
Defense, the Department of Education, the Department of Labor, and the 
Department of Commerce to collect data, conduct studies, and disseminate 
public information concerning the impact of sleep disorders and sleep 
deprivation.''.

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.''.

SEC. 505. PREVENTION AND CONTROL PROGRAMS.

    Section 419 of the Public Health Service Act (42 U.S.C. 285b-1) is 
amended by striking ``The Director of the Institute'' and all that 
follows and inserting the following: ``(a) The Director of the Institute 
shall conduct and support programs for the prevention and control of 
heart, blood vessel, lung, and blood diseases. Such programs shall 
include community-based and population-based programs carried out in 
cooperation with other Federal agencies, with public health agencies of 
State or local governments, with nonprofit private entities that are 
community-based health agencies, or with other appropriate public or 
nonprofit private entities.
    ``(b) In carrying out programs under subsection (a), the Director of 
the Institute shall give special consideration to the prevention and 
control of heart, blood vessel, lung, and blood diseases in children, 
and in populations that are at increased risk with respect to such 
diseases.''.
   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 
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 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 the following 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 the following subsection:
    ``(f) Not later than October 1, 1993, 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 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 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 (in this 
    section referred to as the `Council')''; and
        (2) by adding at the end the following 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 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 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 contracts 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, except 
as inconsistent with subsection (a) of this section, 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 available 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 made available.''.
         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 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 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 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 AND HEALTH SERVICES RESEARCH ON EYE CARE AND 
DIABETES.
    (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 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 
research grants to one or more Diabetes Eye Research Institutions for 
the support of programs in clinical or health services aimed at--
        ``(1) providing comprehensive eye care services for people with 
    diabetes, including a full complement of preventive, diagnostic and 
    treatment procedures;
        ``(2) developing new and improved techniques of patient care 
    through basic and clinical research;
        ``(3) assisting in translation of the latest research advances 
    into clinical practice; and
        ``(4) expanding the knowledge of the eye and diabetes through 
    further research.
    ``(b) Use of Funds.--Amounts received under a grant awarded under 
this section shall be used for the following:
        ``(1) Establishing the biochemical, cellular, and genetic 
    mechanisms associated with diabetic eye disease and the earlier 
    detection of pending eye abnormalities. The focus of work under this 
    paragraph shall require that ophthalmologists have training in the 
    most up-to-date molecular and cell biological methods.
        ``(2) Establishing new frontiers in technology, such as video-
    based diagnostic and research resources, to--
            ``(A) provide improved patient care;
            ``(B) provide for the evaluation of retinal physiology and 
        its affect on diabetes; and
            ``(C) provide for the assessment of risks for the 
        development and progression of diabetic eye disease and a more 
        immediate evaluation of various therapies aimed at preventing 
        diabetic eye disease.
    Such technologies shall be designed to permit evaluations to be 
    performed both in humans and in animal models.
        ``(3) The translation of the results of vision research into the 
    improved care of patients with diabetic eye disease. Such 
    translation shall require the application of institutional resources 
    that encompass patient care, clinical research and basic laboratory 
    research.
        ``(4) The conduct of research concerning the outcomes of eye 
    care treatments and eye health education programs as they relate to 
    patients with diabetic eye disease, including the evaluation of 
    regional approaches to such research.
    ``(c) Authorized Expenditures.--The purposes for which a grant under 
subsection (a) may be expended include equipment for the research 
described in such subsection.''.
    (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 
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 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: ``(in this subpart referred to as the `Institute')''.
                 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 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-5(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 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 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 (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 
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 (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 
        (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 whose population 
            includes a significant number of individuals with a health-
            status deficit, and the applicant provides health services 
            to such individuals; 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 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(h) $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 (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 
        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 18 
months after the date of the enactment of this Act, 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 
    subparagraph:
        ``(D) The National Center for Human Genome Research.''; and
        (2) in part E, by adding at the end the following 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 (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 (including legal 
    issues regarding patents).
    ``(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 (including racial and ethnic minorities), into 
fields of biomedical or behavioral research and in the provision of 
research training to women and such individuals.''.

SEC. 1602. SERVICE PAYBACK REQUIREMENTS.

    Section 487(c) of the Public Health Service Act (42 U.S.C. 288(c)) 
is amended by striking paragraphs (1) and (2) and inserting the 
following: ``(1) Each individual who is awarded a National Research 
Service Award for postdoctoral research training shall, in accordance 
with paragraph (3), engage in research training, research, or teaching 
that is health-related (or any combination thereof) for the period 
specified in paragraph (2). Such period shall be served in accordance 
with the usual patterns of scientific employment.
    ``(2)(A) The period referred to in paragraph (1) is 12 months, or 
one month for each month for which the individual involved receives a 
National Research Service Award for postdoctoral research training, 
whichever is less.
    ``(B) With respect to postdoctoral research training, in any case in 
which an individual receives a National Research Service Award for more 
than 12 months, the 13th month and each subsequent month of performing 
activities under the Award shall be considered to be activities engaged 
in toward satisfaction of the requirement established in paragraph (1) 
regarding a period of service.''.
             Subtitle B--Acquired Immune Deficiency Syndrome

SEC. 1611. LOAN REPAYMENT PROGRAM.

    (a) In General.--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.--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.
    ``(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.''.
    (b) Applicability.--The amendment made by subsection (a) does not 
apply to any agreement entered into under section 487A of the Public 
Health Service Act before the date of the enactment of this Act. Each 
such agreement continues to be subject to the terms of the agreement in 
effect on the day before such date.
            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 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 contracts 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.''.
     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 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 
    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. NATIONAL FOUNDATION FOR BIOMEDICAL RESEARCH.

    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) by inserting ``, acting through the Director of NIH,'' 
        after ``Secretary shall''; and
            (B) by striking ``, except for'' and all that follows 
        through ``Transfer Act,'';
        (2) by redesignating subsections (c), (d), (e), (f), (g), (h), 
    and (i) as subsections (d), (f), (g), (h), (i), (j), and (m), 
    respectively;
        (3) by striking subsection (b) and inserting the following 
    subsections:
    ``(b) Purpose of Foundation.--The purpose of the Foundation shall be 
to support the National Institutes of Health in its mission, and to 
advance collaboration with biomedical researchers from universities, 
industry, and nonprofit organizations.
    ``(c) Certain Activities of Foundation.--
        ``(1) In general.--In carrying out subsection (b), the 
    Foundation may solicit and accept gifts, grants, and other 
    donations, establish accounts, and invest and expend funds in 
    support of the following activities with respect to the purpose 
    described in such subsection:
            ``(A) A program to provide and administer endowed positions 
        that are associated with the research program of the National 
        Institutes of Health. Such endowments may be expended for the 
        compensation of individuals holding the positions, for staff, 
        equipment, quarters, travel, and other expenditures that are 
        appropriate in supporting the endowed positions.
            ``(B) A program to provide and administer fellowships and 
        grants to research personnel in order to work and study in 
        association with the National Institutes of Health. Such 
        fellowships and grants may include stipends, travel, health 
        insurance benefits and other appropriate expenses. The 
        recipients of fellowships shall be selected by the donors and 
        the Foundation upon the recommendation of the National 
        Institutes of Health employees in the laboratory where the 
        fellow would serve, and shall be subject to the agreement of the 
        Director of the National Institutes of Health and the Executive 
        Director of the Foundation.
            ``(C) Supplementary programs to provide for--
                ``(i) scientists of other countries to serve in research 
            capacities in the United States in association with the 
            National Institutes of Health or elsewhere, or opportunities 
            for employees of the National Institutes of Health or other 
            public health officials in the United States to serve in 
            such capacities in other countries, or both;
                ``(ii) the conduct and support of studies, projects, and 
            research, which may include stipends, travel and other 
            support for personnel in collaboration with national and 
            international non-profit and for-profit organizations;
                ``(iii) the conduct and support of forums, meetings, 
            conferences, courses, and training workshops that may 
            include undergraduate, graduate, post-graduate, and post-
            doctoral accredited courses and the maintenance of 
            accreditation of such courses by the Foundation at the State 
            and national level for college or continuing education 
            credits or for degrees;
                ``(iv) programs to support and encourage teachers and 
            students of science at all levels of education and programs 
            for the general public which promote the understanding of 
            science;
                ``(v) programs for writing, editing, printing, 
            publishing, and vending of books and other materials; and
                ``(vi) the conduct of other activities to carry out and 
            support the purpose described in subsection (b).
        ``(2) Fees.--The Foundation may assess fees for the provision of 
    professional, administrative and management services by the 
    Foundation in amounts determined reasonable and appropriate by the 
    Executive Director.
        ``(3) Authority of foundation.--The Foundation shall be the sole 
    entity responsible for carrying out the activities described in this 
    subsection.'';
        (4) in subsection (d) (as so redesignated)--
            (A) in paragraph (1)--
                (i) by striking ``members of the Foundation'' in 
            subparagraph (A) and inserting ``appointed members of the 
            Board'';
                (ii) by striking ``Council'' in subparagraph (B) and 
            inserting ``Board'';
                (iii) by striking ``Council'' in subparagraph (C) and 
            inserting ``Board''; and
                (iv) by adding at the end the following subparagraphs:
            ``(D)(i) Not later than 30 days after the date of the 
        enactment of the National Institutes of Health Revitalization 
        Act of 1993, the Director of the National Institutes of Health 
        shall convene a meeting of the ex officio members of the Board 
        to--
                ``(I) incorporate the Foundation and establish the 
            general policies of the Foundation for carrying out the 
            purposes of subsection (b), including the establishment of 
            the bylaws of the Foundation; and
                ``(II) appoint the members of the Board in accordance 
            with subparagraph (C).
            ``(ii) Upon the appointment of the members of the Board 
        under clause (i)(II), the terms of service of the ex officio 
        members of the Board as members of the Board shall terminate.
            ``(E) The agreement of not less than three-fifths of the 
        members of the ex officio members of the Board shall be required 
        for the appointment of each member to the initial Board.
            ``(F) No employee of the National Institutes of Health shall 
        be appointed as a member of the Board.
            ``(G) The Board may, through amendments to the bylaws of the 
        Foundation, provide that the number of members of the Board 
        shall be greater than the number specified in subparagraph 
        (C).'';
            (B) in paragraph (2)--
                (i) by striking ``The ex officio'' and inserting the 
            following:
            ``(A) The ex officio'';
                (ii) by striking ``an appointed member of the Board to 
            serve as the Chair'' and inserting ``an individual to serve 
            as the initial Chair''; and
                (iii) by adding at the end the following subparagraph:
        ``(B) Upon the termination of the term of service of the initial 
    Chair of the Board, the appointed members of the Board shall elect a 
    member of the Board to serve as the Chair of the Board.'';
            (C) in paragraph (3)(A), by striking ``(2)(C)'' and 
        inserting ``(1)(C)''; and
            (D) by adding at the end the following paragraphs:
        ``(5) Meetings and quorum.--A majority of the members of the 
    Board shall constitute a quorum for purposes of conducting the 
    business of the Board.
        ``(6) Certain bylaws.--
            ``(A) In establishing bylaws under this subsection, the 
        Board shall ensure that the following are provided for:
                ``(i) Policies for the selection of the officers, 
            employees, agents, and contractors of the Foundation.
                ``(ii) Policies, including ethical standards, for the 
            acceptance, solicitation, and disposition of donations and 
            grants to the Foundation and for the disposition of the 
            assets of the Foundation. Policies with respect to ethical 
            standards shall ensure that officers, employees and agents 
            of the Foundation (including members of the Board) avoid 
            encumbrances that would result in a conflict of interest, 
            including a financial conflict of interest or a divided 
            allegiance. Such policies shall include requirements for the 
            provision of information concerning any ownership or 
            controlling interest in entities related to the activities 
            of the Foundation by such officers, employees and agents and 
            their spouses and relatives.
                ``(iii) Policies for the conduct of the general 
            operations of the Foundation.
                ``(iv) Policies for writing, editing, printing, 
            publishing, and vending of books and other materials.
            ``(B) In establishing bylaws under this subsection, the 
        Board shall ensure that such bylaws (and activities carried out 
        under the bylaws) do not--
                ``(i) reflect unfavorably upon the ability of the 
            Foundation or the National Institutes of Health to carry out 
            its responsibilities or official duties in a fair and 
            objective manner; or
                ``(ii) compromise, or appear to compromise, the 
            integrity of any governmental agency or program, or any 
            officer or employee involved in such program.'';
        (5) in subsection (i) (as so redesignated)--
            (A) in paragraph (4), by inserting ``, and define the duties 
        of the officers and employees'' before the semicolon at the end;
            (B) by striking paragraph (5);
            (C) by redesignating paragraphs (6) through (14), as 
        paragraphs (5) through (13), respectively;
            (D) in paragraph (7) (as so redesignated), by striking 
        ``this subtitle'' and inserting ``this part'';
            (E) by striking paragraph (8) (as so redesignated), and 
        inserting the following paragraph:
        ``(8) establish a process for the selection of candidates for 
    positions under subsection (c);''
            (F) by inserting ``solicit'' after the paragraph designation 
        in paragraph (11) (as so redesignated);
            (G) by striking ``and'' at the end of paragraph (13) (as so 
        redesignated);
            (H) by inserting after paragraph (13) (as so redesignated), 
        the following paragraph:
        ``(14) enter into such other contracts, leases, cooperative 
    agreements, and other transactions as the Executive Director 
    considers appropriate to conduct the activities of the Foundation; 
    and''; and
            (I) in paragraph (15), by striking ``this subtitle'' and 
        inserting ``this part'';
        (6) by inserting after subsection (j) (as so redesignated), the 
    following subsections:
    ``(k) General Provisions.--
        ``(1) Foundation integrity.--The members of the Board shall be 
    accountable for the integrity of the operations of the Foundation 
    and shall ensure such integrity through the development and 
    enforcement of criteria and procedures relating to standards of 
    conduct (including those developed under subsection 
    (d)(2)(B)(i)(II)), financial disclosure statements, conflict of 
    interest rules, recusal and waiver rules, audits and other matter 
    determined appropriate by the Board.
        ``(2) Financial conflicts of interest.--Any individual who is an 
    officer, employee, or member of the Board of the Foundation may not 
    (in accordance with policies and requirements developed under 
    subsection (d)(2)(B)(i)(II)) personally or substantially participate 
    in the consideration or determination by the Foundation of any 
    matter that would directly or predictably affect any financial 
    interest of the individual or a relative (as such term is defined in 
    section 109(16) of the Ethics in Government Act of 1978) of the 
    individual, of any business organization or other entity, or of 
    which the individual is an officer or employee, or is negotiating 
    for employment, or in which the individual has any other financial 
    interest.
        ``(3) Audits; availability of records.--The Foundation shall--
            ``(A) provide for annual audits of the financial condition 
        of the Foundation; and
            ``(B) make such audits, and all other records, documents, 
        and other papers of the Foundation, available to the Secretary 
        and the Comptroller General of the United States for examination 
        or audit.
        ``(4) Reports.--
            ``(A) Not later than 5 months following the end of each 
        fiscal year, the Foundation shall publish a report describing 
        the activities of the Foundation during the preceding fiscal 
        year. Each such report shall include for the fiscal year 
        involved a comprehensive statement of the operations, 
        activities, financial condition, and accomplishments of the 
        Foundation.
            ``(B) With respect to the financial condition of the 
        Foundation, each report under subparagraph (A) shall include the 
        source, and a description of, all gifts or grants to the 
        Foundation of real or personal property, and the source and 
        amount of all gifts or grants to the Foundation of money. Each 
        such report shall include a specification of any restrictions on 
        the purposes for which gifts or grants to the Foundation may be 
        used.
            ``(C) The Foundation shall make copies of each report 
        submitted under subparagraph (A) available for public 
        inspection, and shall upon request provide a copy of the report 
        to any individual for a charge not exceeding the cost of 
        providing the copy.
            ``(D) The Board shall annually hold a public meeting to 
        summarize the activities of the Foundation and distribute 
        written reports concerning such activities and the scientific 
        results derived from such activities.
        ``(5) Service of federal employees.--Federal employees may serve 
    on committees advisory to the Foundation and otherwise cooperate 
    with and assist the Foundation in carrying out its function, so long 
    as the employees do not direct or control Foundation activities.
        ``(6) Relationship with existing entities.--The Foundation may, 
    pursuant to appropriate agreements, merge with, acquire, or use the 
    resources of existing nonprofit private corporations with missions 
    similar to the purposes of the Foundation, such as the Foundation 
    for Advanced Education in the Sciences.
        ``(7) Intellectual property rights.--The Board shall adopt 
    written standards with respect to the ownership of any intellectual 
    property rights derived from the collaborative efforts of the 
    Foundation prior to the commencement of such efforts.
        ``(8) National institutes of health amendments of 1990.--The 
    activities conducted in support of the National Institutes of Health 
    Amendments of 1990 (Public Law 101-613), and the amendments made by 
    such Act, shall not be nullified by the enactment of this section.
        ``(9) Limitation of activities.--The Foundation shall exist 
    solely as an entity to work in collaboration with the research 
    programs of the National Institutes of Health. The Foundation may 
    not undertake activities (such as the operation of independent 
    laboratories or competing for Federal research funds) that are 
    independent of those of the National Institutes of Health research 
    programs.
        ``(10) Transfer of funds.--The Foundation may not transfer funds 
    to the National Institutes of Health.
    ``(l) Duties of the Director.--
        ``(1) Applicability of certain standards to non-federal 
    employees.--In the case of any individual who is not an employee of 
    the Federal Government and who serves in association with the 
    National Institutes of Health, with respect to financial assistance 
    received from the Foundation, the Foundation may not provide the 
    assistance of, or otherwise permit the work at the National 
    Institutes of Health to begin until a memorandum of understanding 
    between the individual and the Director of the National Institutes 
    of Health, or the designee of such Director, has been executed 
    specifying that the individual shall be subject to such ethical and 
    procedural standards of conduct relating to duties performed at the 
    National Institutes of Health, as the Director of the National 
    Institutes of Health determines is appropriate.
        ``(2) Support services.--The Director of the National Institutes 
    of Health may provide facilities, utilities and support services to 
    the Foundation if it is determined by the Director to be 
    advantageous to the research programs of the National Institutes of 
    Health.'';
        (7) in subsection (m) (as so redesignated), by amending the 
    subsection to read as follows:
    ``(m) Funding.--
        ``(1) Authorization of appropriations.--For the purpose of 
    carrying out this part, there is authorized to be appropriated an 
    aggregate $200,000 for the fiscal years 1994 and 1995.
        ``(2) Limitation regarding other funds.--Amounts appropriated 
    under any provision of law other than paragraph (1) may not be 
    expended to establish or operate the Foundation.''; and
        (8) by adding at the end the following subsection:
    ``(n) Report on Adequacy of Compliance.--
        ``(1) In general.--With respect to the mission and function of 
    the Foundation, the Comptroller General of the United States shall 
    conduct an audit to determine--
            ``(A) whether the Foundation is in compliance with the 
        guidelines established under this section; and
            ``(B) whether the procedures utilized under this section are 
        adequate to prevent conflicts of interest involving the 
        Foundation, the employees of the Foundation or members of the 
        Board of the Foundation.
        ``(2) Report.--Not later than 18 months after the date on which 
    the Foundation is incorporated, the Comptroller General of the 
    United States shall complete the audit required under paragraph (1) 
    and 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 describing the findings made with 
    respect to such audit.''.
    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. In carrying out the preceding sentence, the Director of the 
    Office shall evaluate the AIDS activities of each of such agencies 
    and shall provide for the periodic reevaluation of such activities.
        ``(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.
        ``(3) Coordination.--The Director of the Office shall act as the 
    primary Federal official with responsibility for overseeing all AIDS 
    research conducted or supported by the National Institutes of 
    Health, and
            ``(A) shall serve to represent the National Institutes of 
        Health AIDS Research Program at all relevant Executive branch 
        task forces and committees; and
            ``(B) shall maintain communications with all relevant Public 
        Health Service agencies and with various other departments of 
        the Federal Government, to ensure the timely transmission of 
        information concerning advances in AIDS research and the 
        clinical treatment of acquired immune deficiency syndrome and 
        its related conditions, between these various agencies for 
        dissemination to affected communities and health care providers.

``SEC. 2352. ADVISORY COUNCIL; COORDINATING COMMITTEES.

    ``(a) Advisory Council.--
        ``(1) 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 subsection as the `Advisory Council'.)
        ``(2) 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--
            ``(A) in addition to the ex officio members specified in 
        section 406(b)(2), there shall serve as such members of the 
        Advisory Council a representative from the advisory council of 
        each of the National Cancer Institute and the National Institute 
        on Allergy and Infectious Diseases; and
            ``(B) with respect to the other national research 
        institutes, there shall serve as ex officio members of such 
        Council, in addition to such members specified in subparagraph 
        (A), a representative from the advisory council of each of the 2 
        institutes that receive the greatest funding for AIDS 
        activities.
    ``(b) Individual Coordinating Committees Regarding Research 
Disciplines.--
        ``(1) In general.--The Director of the Office shall establish, 
    for each research discipline in which any activity under the plan 
    required in section 2353 is carried out, a committee for the purpose 
    of providing advice to the Director of the Office on carrying out 
    this part with respect to such discipline. (Each such committee is 
    referred to in this subsection as a `coordinating committee'.)
        ``(2) Composition.--Each coordinating committee shall be 
    composed of representatives of the agencies of the National 
    Institutes of Health with significant responsibilities regarding the 
    research discipline involved.

``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) Receipt of funds.--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 Office 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) Allocations for agencies.--
            ``(A) Each fiscal year the Director of the Office shall, 
        from the amounts received under paragraph (2) for the fiscal 
        year, allocate to the agencies of the National Institutes of 
        Health (in accordance with the Plan) all amounts available for 
        such year for carrying out the AIDS activities specified in 
        subsection (c)(2)(B)(ii)(I) for such year. Such allocation 
        shall, to the extent practicable, be made not later than 15 days 
        after the date on which the Director receives amounts under 
        paragraph (2).
            ``(B) Each fiscal year the Director of the Office shall, 
        from the amounts received under paragraph (2) for the fiscal 
        year, allocate to the agencies of the National Institutes of 
        Health (in accordance with the Plan) all amounts available for 
        such year for carrying out AIDS activities that are not referred 
        to in subparagraph (A). Such allocation shall, to the extent 
        practicable, be made not later than 30 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 AIDS activities, including projects of AIDS 
    research, as may be authorized in this Act for the National 
    Institutes of Health.
        ``(2) Preconditions to use of fund.--Amounts in the Fund may be 
    expended only if--
            ``(A) the Director identifies the particular set of AIDS 
        activities for which such amounts are to be expended;
            ``(B) the set of activities so identified constitutes either 
        a new project or additional AIDS activities for an existing 
        project;
            ``(C) the Director of the Office has made a determination 
        that there is a significant need for such set of activities; and
            ``(D) 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 identified set of AIDS activities, obligations of amounts in the 
    Fund may not be made for such set of activities after the expiration 
    of the 2-year period beginning on the date on which the initial 
    obligation of such amounts is made for such set.
    ``(b) Peer Review.--With respect to an identified set of AIDS 
activities 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 identified set of AIDS activities, or a 
        category of AIDS activities, 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 identified sets of AIDS 
activities 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 identified sets 
of AIDS activities carried out during the preceding fiscal year with 
amounts in the Fund. The report shall provide a description of each such 
set of activities and an explanation of the reasons underlying the use 
of the Fund for the set.
    ``(f) Definitions.--For purposes of this section:
        ``(1) The term `Fund' means the fund established in subsection 
    (a).
        ``(2) The term `identified set of AIDS activities' means a 
    particular set of AIDS activities identified under subsection 
    (a)(2)(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 and shall ensure that such support takes maximum advantage of 
existing administrative structures at the agencies of the National 
Institutes of Health.
    ``(b) Evaluation and Report.--
        ``(1) Evaluation.--Not later than 5 years after the date of the 
    enactment of National Institutes of Health Revitalization Act of 
    1993, the Secretary shall conduct an evaluation to--
            ``(A) determine the effect of this section on the planning 
        and coordination of the AIDS research programs at the 
        institutes, centers and divisions of the National Institutes of 
        Health;
            ``(B) evaluate the extent to which this part has eliminated 
        the duplication of administrative resources among such 
        Institutes, centers and divisions; and
            ``(C) provide recommendations concerning future alterations 
        with respect to this part.
        ``(2) Report.--Not later than 1 year after the date on which the 
    evaluation is commenced under paragraph (1), the Secretary shall 
    prepare and submit to the Committee on Labor and Human Resources of 
    the Senate, and the Committee on Energy and Commerce of the House of 
    Representatives, a report concerning the results of such evaluation.
    ``(c) 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. LIFE-THREATENING ILLNESSES.

    (a) Third-Party Payments Regarding Certain Clinical Trials and 
Certain Life-Threatening Illnesses.--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, cancer, and other life-
    threatening illnesses; and
        (2) developing recommendations regarding such policies.
    (b) 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) Authorization of appropriations.--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 and 
    Related Research Program established by section 5311(a) of Public 
    Law 101-445 (7 U.S.C. 5301 et seq.), 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 for each day engaged in carrying out the duties of 
        the panel, 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.
            (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 
October 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 the 
Secretary of Defense and with the heads of 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 of 
Health and Human Services 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. Such Secretary shall 
submit the report not later than 12 months after the date of the 
enactment of this Act. The Secretary shall provide a copy of the report 
to the House and Senate Committees on Armed Services.

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 agencies of such Institutes, shall conduct a 
study for the purpose of determining the incidence in the United States 
of cases of chronic pain (including chronic pain resulting from back 
injuries) 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 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. RELATIONSHIP BETWEEN THE CONSUMPTION OF LEGAL AND ILLEGAL 
DRUGS.
    (a) In General.--The Secretary of Health and Human Services shall 
review and consider all existing relevant data and research concerning 
whether there is a relationship between an individual's receptivity to 
use or consume legal drugs and the consumption or abuse by the 
individual of illegal drugs. On the basis of such review, the Secretary 
shall determine whether additional research is necessary. If the 
Secretary determines additional research is required, the Secretary 
shall conduct a study of those subjects where the Secretary's review 
indicates additional research is needed, including, if necessary, a 
review of--
        (1) the effect of advertising and marketing campaigns that 
    promote the use of legal drugs on the public;
        (2) the correlation of legal drug abuse with illegal drug abuse; 
    and
        (3) other matters that the Secretary determines appropriate.
    (b) Report.--Not later than 12 months after the date of enactment of 
this Act, the Secretary shall prepare and submit, to the Committee on 
Energy and Commerce of the House of Representatives and Committee on 
Labor and Human Resources of the Senate, a report containing the results 
of the review conducted under subsection (b). If the Secretary 
determines additional research is required, no later than 2 years after 
the date of enactment of this Act, the Secretary shall prepare and 
submit, to the Committee on Energy and Commerce of the House of 
Representatives and Committee on Labor and Human Resources of the 
Senate, a report containing the results of the additional research 
conducted under subsection (b).

SEC. 1909. REDUCING ADMINISTRATIVE HEALTH CARE COSTS.

    The Secretary of Health and Human Services, acting through the 
Agency for Health Care Policy and Research and, to the extent possible, 
in consultation with the Health Care Financing Administration, may fund 
research to develop a text-based standardized billing process, through 
the utilization of text-based information retrieval and natural language 
processing techniques applied to automatic coding and analysis of 
textual patient discharge summaries and other text-based electronic 
medical records, within a parallel general purpose (shared memory) high 
performance computing environment. The Secretary shall determine whether 
such a standardized approach to medical billing, through the utilization 
of the text-based hospital discharge summary as well as electronic 
patient records can reduce the administrative billing costs of health 
care delivery.

SEC. 1910. SENTINEL DISEASE CONCEPT STUDY.

    (a) In General.--The Secretary of Health and Human Services, in 
cooperation with the Agency for Toxic Substances and Disease Registry 
and the Centers for Disease Control and Prevention, shall design and 
implement a pilot sentinel disease surveillance system, and as 
appropriate, a follow-up system.
    (b) Purpose.--The purpose of the study conducted under subsection 
(a) shall be to determine the applicability of and the difficulties 
associated with the implementation of the sentinel disease concept for 
identifying the relationship between the occupation of household members 
and the incidence of subsequent conditions or diseases in other members 
of the household.
    (c) Report.--Not later than 4 years after the date of enactment of 
this Act, the Director of the National Institutes of Health shall 
prepare and submit to the appropriate committees of Congress, a report 
concerning the results of the study conducted under subsection (a).
SEC. 1911. POTENTIAL 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-control study to assess biological 
    markers of environmental and other potential 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, 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 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).

SEC. 1912. SUPPORT FOR BIOENGINEERING RESEARCH.

    (a) Study.--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 sources and amounts of public and private 
    funding devoted to basic research in bioengineering, including 
    biomaterials sciences, cellular bioprocessing, tissue and 
    rehabilitation engineering;
        (2) evaluating whether that commitment is sufficient to maintain 
    the innovative edge that the United States has in these 
    technologies;
        (3) evaluating the role of the National Institutes of Health or 
    any other Federal agency to achieve a greater commitment to 
    innovation in bioengineering; and
        (4) evaluating the need for better coordination and 
    collaboration among Federal agencies and between the public and 
    private sectors.
In conducting such study, the Director shall work in conjunction with 
appropriate organizations and representatives including academics, 
industry leaders, bioengineering societies, and public agencies.
    (b) Report.--Not later than 1 year after the date of enactment of 
this Act, the Secretary of Health and Human Services shall prepare and 
submit to the Committee on Labor and Human Resources of the Senate, and 
the Committee on Energy and Commerce of the House of Representatives, a 
report containing the findings of the study conducted under subsection 
(a) together with recommendations concerning the enactment of 
legislation to implement the results of such study.

SEC. 1913. COST OF CARE IN LAST 6 MONTHS OF LIFE.

    (a) Study.--
        (1) In general.--The Secretary of Health and Human Services (in 
    this section referred to as the ``Secretary''), acting through the 
    Agency for Health Care Policy and Research and, to the degree 
    possible, in consultation with the Health Care Financing 
    Administration, shall conduct a study, using the most recent 
    National Medical Expenditure Survey database, to estimate the 
    average amount of health care expenditures incurred during the last 
    6 months of life by--
            (A) the population of individuals who are 65 years of age 
        and older; and
            (B) the total population, broken down based on 
        noninstitutionalized and institutionalized populations.
        (2) Elements of study.--The study conducted under paragraph (1) 
    shall--
            (A) be designed in a manner that will produce estimates of 
        health care costs expended for health care provided to 
        individuals during the last 6 months of life;
            (B) be designed to produce estimates of such costs for the 
        populations identified in subparagraphs (A) and (B) of paragraph 
        (1);
            (C) include a calculation of the estimated amount of total 
        health care expenditures during such periods of time; and
            (D) include a calculation of the estimate described in 
        subparagraph (C)--
                (i) as a percentage of the total national health care 
            expenditures; and
                (ii) for those age 65 years and over, as a percentage of 
            the total Medicare expenditures for those age 65 years and 
            over.
    (b) Report.--Not later than 6 months after the date of the enactment 
of this Act, the Secretary shall prepare and submit to the Committee on 
Labor and Human Resources of the Senate and the Committee on Energy and 
Commerce of the House of Representatives, a report containing the 
findings resulting from the study described in subsection (a).
    (c) 1996 National Medical Expenditure Survey.--
        (1) In general.--The Secretary, acting through the Agency for 
    Health Care Policy and Research, shall ensure that the 1996 National 
    Medical Expenditure Survey is designed in a manner that will produce 
    an estimate of the amount expended for health care provided to 
    individuals during the last 6 months of life.
        (2) Populations.--In designing the Survey under paragraph (1), 
    the Secretary shall ensure that such Survey produces the data 
    required under such paragraph for the population of individuals who 
    are 65 years of age or older, broken down based on 
    noninstitutionalized and institutionalized populations.
                   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 500 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 (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 June 1, 1994, 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.

    (a) Compliance With Buy American Act.--No funds appropriated 
pursuant to this Act for any of the fiscal years 1994 through 1996 may 
be expended by an entity unless the entity agrees that in expending the 
assistance the entity will comply with sections 2 through 4 of the Act 
of March 3, 1933 (41 U.S.C. 10a-10c, popularly known as the ``Buy 
American Act'').
    (b) Sense of Congress; Requirement Regarding Notice.--
        (1) Purchase of american-made equipment and products.--In the 
    case of any equipment or product that may be authorized to be 
    purchased with financial assistance provided pursuant to this Act 
    for any of the fiscal years 1994 through 1996, it is the sense of 
    the Congress that entities receiving such assistance should, in 
    expending the assistance, purchase only American-made equipment and 
    products.
        (2) Notice to recipients of assistance.--In providing financial 
    assistance pursuant to this Act, the Secretary of Health and Human 
    Services shall provide to each recipient of the assistance a notice 
    describing the statement made in paragraph (1) by the Congress.

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) unless--
        (1) the proposal for funding for the project has undergone 
    review in accordance with the applicable requirements of section 491 
    of the Public Health Service Act on restrictions regarding 
    institutional review boards and ethics guidance;
        (2) the proposal for funding for the project has undergone 
    review in accordance with the applicable requirements of section 492 
    of such Act on restrictions regarding peer review;
        (3) the Secretary of Health and Human Services, in accordance 
    with section 492A of such Act (as added by section 101 of this Act), 
    makes a determination that the project will assist--
            (A) in reducing the incidence of infection with the human 
        immunodeficiency virus;
            (B) in reducing the incidence of sexually transmitted 
        diseases; or
            (C) in reducing the incidence of tuberculosis; and
        (4) the data to be collected through the project cannot be 
    obtained in any other manner.

SEC. 2006. LOAN REPAYMENT PROGRAM.

    Chapter IX of the Federal Food, Drug, and Cosmetic Act (21 U.S.C. 
391 et seq.), as amended by Public Law 101-635, is amended--
        (1) by redesignating the second section 903 as section 904; and
        (2) by adding at the end the following section:

``SEC. 905. LOAN REPAYMENT PROGRAM.

    ``(a) In General.--
        ``(1) Authority for program.--Subject to paragraph (2), the 
    Secretary shall carry out a program of entering into contracts with 
    appropriately qualified health professionals under which such health 
    professionals agree to conduct research, as employees of the Food 
    and Drug Administration, 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 Food and Drug 
        Administration 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 of the Public Health Service Act, the 
provisions of such subpart shall, except as inconsistent with subsection 
(a) of this section, apply to the program established in such subsection 
in the same manner and to the same extent as such provisions apply to 
the National Health Service Corps Loan Repayment Program.
    ``(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.''.
SEC. 2007. EXCLUSION OF ALIENS INFECTED WITH THE AGENT FOR ACQUIRED 
IMMUNE DEFICIENCY SYNDROME.
    (a) Exclusion of Aliens on Health-Related Grounds.--Section 
212(a)(1)(A)(i) of the Immigration and Nationality Act (8 U.S.C. 
1182(a)(1)(A)(i)) is amended by adding at the end the following: ``which 
shall include infection with the etiologic agent for acquired immune 
deficiency syndrome,''.
    (b) Effective Date.--The amendment made by subsection (a) shall take 
effect 30 days after the date of the enactment of this Act.

SEC. 2008. TECHNICAL CORRECTIONS.

    (a) Title III.--Section 316 of the Public Health Service Act (42 
U.S.C. 247a(c)) is amended by striking subsection (c).
    (b) Title IV.--Title IV of the Public Health Service Act (42 U.S.C. 
281 et seq.) is amended--
        (1) in section 406--
            (A) in subsection (b)(2)(A), by striking ``Veterans' 
        Administration'' each place such term appears and inserting 
        ``Department of Veterans Affairs''; and
            (B) in subsection (h)(2)(A)(v), by striking ``Veterans' 
        Administration'' and inserting ``Department of Veterans 
        Affairs'';
        (2) in section 408, in subsection (b) (as redesignated by 
    section 501(c)(1)(C) of this Act), by striking ``Veterans' 
    Administration'' and inserting ``Department of Veterans Affairs'';
        (3) in section 421(b)(1), by inserting a comma after ``may'';
        (4) in section 428(b), in the matter preceding paragraph (1), by 
    striking ``the the'' and inserting ``the'';
        (5) in section 430(b)(2)(A)(i), by striking ``Veterans' 
    Administration'' and inserting ``Department of Veterans Affairs'';
        (6) in section 439(b), by striking ``Veterans' Administration'' 
    and inserting ``Department of Veterans Affairs'';
        (7) in section 442(b)(2)(A), by striking ``Veterans' 
    Administration'' and inserting ``Department of Veterans Affairs'';
        (8) in section 464D(b)(2)(A), by striking ``Veterans' 
    Administration'' and inserting ``Department of Veterans Affairs'';
        (9) in section 464E--
            (A) in subsection (d), in the first sentence, by inserting 
        ``Coordinating'' before ``Committee''; and
            (B) in subsection (e), by inserting ``Coordinating'' before 
        ``Committee'' the first place such term appears;
        (10) in section 464P(b)(6) (as added by section 123 of Public 
    Law 102-321 (106 Stat. 362)), by striking ``Administration'' and 
    inserting ``Institute'';
        (11) in section 466(a)(1)(B), by striking ``Veterans' 
    Administration'' and inserting ``Department of Veterans Affairs'';
        (12) in section 480(b)(2)(A), by striking ``Veterans' 
    Administration'' and inserting ``Department of Veterans Affairs'';
        (13) in section 485(b)(2)(A), by striking ``Veterans' 
    Administration'' and inserting ``Department of Veterans Affairs'';
        (14) in section 487(d)(3), by striking ``section 304(a)(3)'' and 
    inserting ``section 304(a)''; and
        (15) in section 496(a), by striking ``Such appropriations,'' and 
    inserting the following: ``Appropriations to carry out the purposes 
    of this title,''.
    (c) Title XV.--
        (1) Limited authority regarding for-profit entities.--Section 
    1501(b) of the Public Health Service Act (42 U.S.C. 300k(b)) is 
    amended--
            (A) by striking ``States.--A State'' and all that follows 
        through ``may expend'' and inserting the following: ``States.--
        ``(1) In general.--A State receiving a grant under subsection 
    (a) may, subject to paragraph (2), expend''; and
            (B) by adding at the end the following paragraph:
        ``(2) Limited authority regarding other entities.--In addition 
    to the authority established in paragraph (1) for a State with 
    respect to grants and contracts, the State may provide for 
    screenings under subsection (a)(1) through entering into contracts 
    with private entities. The amount paid by a State to a private 
    entity under the preceding sentence for a screening procedure may 
    not exceed the amount that would be paid under part B of title XVIII 
    of the Social Security Act if payment were made under such part for 
    furnishing the procedure to a woman enrolled under such part.''.
        (2) Conforming amendment.--Section 1505(3) of the Public Health 
    Service Act (42 U.S.C. 300n-1(3)) is amended by inserting before the 
    semicolon the following: ``(and additionally, in the case of 
    services and activities under section 1501(a)(1), with any similar 
    services or activities of private entities)''.
    (d) Title XXIII.--Part A of title XXIII of the Public Health Service 
Act (42 U.S.C. 300cc et seq.) is amended--
        (1) in section 2304--
            (A) in the heading for the section, by striking ``CLINICAL 
        RESEARCH REVIEW COMMITTEE'' and inserting ``RESEARCH ADVISORY 
        COMMITTEE''; and
            (B) in subsection (a), by striking ``AIDS Clinical Research 
        Review Committee'' and inserting ``AIDS Research Advisory 
        Committee'';
        (2) in section 2312(a)(2)(A), by striking ``AIDS Clinical 
    Research Review Committee'' and inserting ``AIDS Research Advisory 
    Committee'';
        (3) in section 2314(a)(1), in the matter preceding subparagraph 
    (A), by striking ``Clinical Research Review Committee'' and 
    inserting ``AIDS Research Advisory Committee'';
        (4) in section 2317(d)(1), by striking ``Clinical Research 
    Review Committee'' and inserting ``AIDS Research Advisory Committee 
    established under section 2304''; and
        (5) in section 2318(b)(3), by striking ``Clinical Research 
    Review Committee'' and inserting ``AIDS Research Advisory 
    Committee''.
    (e) Secretary.--Section 2(c) of the Public Health Service Act (42 
U.S.C. 201(c)) is amended by striking ``Health, Education, and Welfare'' 
and inserting ``Health and Human Services''.
    (f) Department.--Section 201 of the Public Health Service Act (42 
U.S.C. 202) is amended--
        (1) by striking ``Health, Education, and Welfare'' and inserting 
    ``Health and Human Services''; and
        (2) by striking ``Surgeon General'' and inserting ``Assistant 
    Secretary for Health''.
    (g) Department.--Section 202 of the Public Health Service Act (42 
U.S.C. 203) is amended--
        (1) by striking ``Surgeon General'' the second and subsequent 
    times that such term appears and inserting ``Secretary''; and
        (2) by inserting ``, and the Agency for Health Care Policy and 
    Research'' before the first period.
    (h) Volunteer Services.--Section 223 of the Public Health Service 
Act (42 U.S.C. 217b) is amended by striking ``Health, Education, and 
Welfare'' and inserting ``Health and Human Services''.
    (i) Miscellaneous.--
        (1) Amendatory instructions.--
            (A) Section 602(a) of Public Law 102-585 (106 Stat. 4967) is 
        amended by striking ``by adding the following subpart'' and 
        inserting ``by adding at the end the following subpart''.
            (B) Public Law 102-531 is amended--
                (i) in section 303(b) (106 Stat. 3488)--

                    (I) by striking ``Part A of title III'' and 
                inserting ``Part B of title III''; and
                    (II) by striking ``241 et seq.'' and inserting ``243 
                et seq.'';

                (ii) in section 304 (106 Stat. 3490)--

                    (I) by striking ``Part A of title III'' and 
                inserting ``Part B of title III''; and
                    (II) by striking ``241 et seq.'' and inserting ``243 
                et seq.'';

                (iii) in section 306 (106 Stat. 3494), by striking 
            ``Part A of title III'' and inserting ``Part B of title 
            III''; and
                (iv) in section 308 (106 Stat. 3495), by striking ``Part 
            A of title III'' and inserting ``Part B of title III'';
        (2) Title III of public health service act.--Title III of the 
    Public Health Service Act (42 U.S.C. 241 et seq.), as amended by 
    Public Law 102-321, Public Law 102-515, Public Law 102-531, and 
    Public Law 102-585, by section 121(a) of this Act, and by paragraph 
    (1) of this subsection, is amended--
            (A) in part D--
                (i) by transferring subpart VIII from the current 
            placement of the subpart and inserting the subpart after 
            subpart VII; and
                (ii) by redesignating section 340B of subpart VIII as 
            section 340C; and
            (B)(i) by redesignating parts K and L as parts J and K, 
        respectively; and
            (ii) by redesignating the part M added by Public Law 102-321 
        as part L.
        (3) Title VII of public health service act.--Section 746(i)(1) 
    of the Public Health Service Act (42 U.S.C. 293j(i)(1)), as added by 
    section 102 of Public Law 102-408 (106 Stat. 1994) and amended by 
    section 313(a)(2)(B) of Public Law 102-531 (106 Stat. 3507), is 
    amended to read as if the amendment made by such section 
    313(a)(2)(B) had not been enacted.

SEC. 2009. BIENNIAL REPORT ON CARCINOGENS.

    Section 301(b)(4) of the Public Health Service Act (42 U.S.C. 
241(b)(4)) is amended by striking ``an annual'' and inserting ``a 
biennial''.

SEC. 2010. TRANSFER OF PROVISIONS OF TITLE XXVII.

    (a) In General.--The Public Health Service Act (42 U.S.C. 201 et 
seq.), as amended by section 101 of Public Law 101-381 and section 304 
of Public Law 101-509, is amended--
        (1) by transferring sections 2701 through 2714 to title II;
        (2) by redesignating such sections as sections 231 through 244, 
    respectively;
        (3) by inserting such sections, in the appropriate sequence, 
    after section 228;
        (4) by inserting before section 201 the following heading:

                     ``Part A--Administration''; and

        (5) by inserting before section 231 (as redesignated by 
    paragraph (2) of this subsection) the following heading:

                  ``Part B--Miscellaneous Provisions''.

    (b) Conforming Amendments.--The Public Health Service Act (42 U.S.C. 
201 et seq.) is amended--
        (1) in the heading for title II, by inserting ``AND 
    MISCELLANEOUS PROVISIONS'' after ``ADMINISTRATION'';
        (2) in section 406(a)(2), by striking ``2701'' and inserting 
    ``231'';
        (3) in section 465(f), by striking ``2701'' and inserting 
    ``231'';
        (4) in section 480(a)(2), by striking ``2701'' and inserting 
    ``231'';
        (5) in section 485(a)(2), by striking ``2701'' and inserting 
    ``231'';
        (6) in section 497, by striking ``2701'' and inserting ``231'';
        (7) in section 505(a)(2), by striking ``2701'' and inserting 
    ``231'';
        (8) in section 926(b), by striking ``2711'' each place such term 
    appears and inserting ``241''; and
        (9) in title XXVII, by striking the heading for such title.

SEC. 2011. AUTHORIZATION OF APPROPRIATIONS.

    Section 2602 of the Low-Income Home Energy Assistance Act of 1981 
(42 U.S.C. 8621) is amended--
        (1) in the first sentence of subsection (b), by striking ``1993 
    and 1994'' and inserting ``1993, 1994, and 1995''; and
        (2) in subsection (d), by striking ``in each of the fiscal years 
    1993 and 1994'' and inserting ``for each of the fiscal years 1993, 
    1994, and 1995''.

SEC. 2012. VACCINE INJURY COMPENSATION PROGRAM.

    Section 2111(a) of the Public Health Service Act (42 U.S.C. 300aa-
11(a)) is amended by adding at the end the following paragraph:
        ``(10) The Clerk of the United States Claims Court is authorized 
    to continue to receive, and forward, petitions for compensation for 
    a vaccine-related injury or death associated with the administration 
    of a vaccine on or after October 1, 1992.''.
SEC. 2013. TECHNICAL CORRECTIONS WITH RESPECT TO THE AGENCY FOR HEALTH 
CARE POLICY AND RESEARCH.
    Title IX of the Public Health Service Act is amended--
        (1) in section 904(d) (42 U.S.C. 299a-2(d))--
            (A) by striking ``In general'' in paragraph (1) and 
        inserting ``Additional assessments'';
            (B) by redesignating paragraphs (1) and (2) as paragraphs 
        (3) and (4), respectively;
            (C) by inserting after the subsection designation the 
        following paragraphs:
        ``(1) Recommendations with respect to health care technology.--
    The Administrator shall make recommendations to the Secretary with 
    respect to whether specific health care technologies should be 
    reimbursable under federally financed health programs, including 
    recommendations with respect to any conditions and requirements 
    under which any such reimbursements should be made.
        ``(2) Considerations of certain factors.--In making 
    recommendations respecting health care technologies, the 
    Administrator shall consider the safety, efficacy, and 
    effectiveness, and, as appropriate, the appropriate uses of such 
    technologies. The Administrator shall also consider the cost 
    effectiveness of such technologies where cost information is 
    available and reliable.''; and
            (D) by adding at the end the following paragraph:
        ``(5) Consultations.--In carrying out this subsection, the 
    Administrator shall cooperate and consult with the Director of the 
    National Institutes of Health, the Commissioner of Food and Drugs, 
    and the heads of any other interested Federal department or 
    agency.''; and
        (2) in section 914(a)(2)(C), by striking ``904(c)(2)'' and 
    inserting ``904(d)(2)''.
SEC. 2014. TECHNICAL CORRECTIONS WITH RESPECT TO THE HEALTH PROFESSIONS 
EDUCATION EXTENSION AMENDMENTS OF 1992.
    (a) Insured Health Education Assistance Loans to Graduate 
Students.--Subpart I of part A of title VII of the Public Health Service 
Act (42 U.S.C. 292 et seq.), as added by section 102 of Public Law 102-
408 (106 Stat. 1994), is amended--
        (1) in section 705(a)(2)--
            (A) in subparagraph (G), by inserting ``and'' after the 
        semicolon at the end;
            (B) by striking subparagraph (H); and
            (C) by redesignating subparagraph (I) as subparagraph (H); 
        and
        (2) in section 707--
            (A) in subsection (g), by amending paragraph (1) to read as 
        follows:
        ``(1) after the expiration of the seven-year period beginning on 
    the first date when repayment of such loan is required, exclusive of 
    any period after such date in which the obligation to pay 
    installments on the loan is suspended;''; and
            (B) by adding at the end the following subsection:
    ``(j) School Collection Assistance.--An institution or postgraduate 
training program attended by a borrower may assist in the collection of 
any loan of that borrower made under this subpart which becomes 
delinquent, including providing information concerning the borrower to 
the Secretary and to past and present lenders and holders of the 
borrower's loans, contacting the borrower in order to encourage 
repayment, and withholding services in accordance with regulations 
issued by the Secretary under section 715(a)(7). The institution or 
postgraduate training program shall not be subject to section 809 of the 
Fair Debt Collection Practices Act for purposes of carrying out 
activities authorized by this section.''.
    (b) Loan Provisions.--Section 722 of the Public Health Service Act 
(42 U.S.C. 292r), as added by section 102 of Public Law 102-408 (106 
Stat. 1994), is amended--
        (1) in subsection (a), by amending the subsection to read as 
    follows:
    ``(a) Amount of Loan.--
        ``(1) In general.--Loans from a student loan fund (established 
    under an agreement with a school under section 721) may not, subject 
    to paragraph (2), exceed for any student for a school year (or its 
    equivalent) the sum of--
            ``(A) the cost of tuition for such year at such school, and
            ``(B) $2,500.
        ``(2) Third and fourth years of medical school.--For purposes of 
    paragraph (1), the amount $2,500 may, in the case of the third or 
    fourth year of a student at school of medicine or osteopathic 
    medicine, be increased to the extent necessary (including such 
    $2,500) to pay the balances of loans that, from sources other than 
    the student loan fund under section 721, were made to the individual 
    for attendance at the school. The authority to make such an increase 
    is subject to the school and the student agreeing that such amount 
    (as increased) will be expended to pay such balances.''; and
        (2) in subsection (b)--
            (A) in paragraph (1), by adding ``and'' after the semicolon 
        at the end;
            (B) by striking paragraph (2); and
            (C) by redesignating paragraph (3) as paragraph (2).
    (c) Medical Schools and Primary Health Care.--
        (1) Requirements for students.--Section 723(a) of the Public 
    Health Service Act (42 U.S.C. 292s(a)), as added by section 102 of 
    Public Law 102-408 (106 Stat. 1994), is amended by adding at the end 
    the following paragraph:
        ``(4) Waivers.--
            ``(A) With respect to the obligation of an individual under 
        an agreement made under paragraph (1) as a student, the 
        Secretary shall provide for the partial or total waiver or 
        suspension of the obligation whenever compliance by the 
        individual is impossible, or would involve extreme hardship to 
        the individual, and if enforcement of the obligation with 
        respect to the individual would be unconscionable.
            ``(B) For purposes of subparagraph (A), the obligation of an 
        individual shall be waived if--
                ``(i) the status of the individual as a student of the 
            school involved is terminated before graduation from the 
            school, whether voluntarily or involuntarily; and
                ``(ii) the individual does not, after such termination, 
            resume attendance at the school or begin attendance at any 
            other school of medicine or osteopathic medicine.
            ``(C) If an individual resumes or begins attendance for 
        purposes of subparagraph (B), the obligation of the individual 
        under the agreement under paragraph (1) shall be considered to 
        have been suspended for the period in which the individual was 
        not in attendance.
            ``(D) This paragraph may not be construed as authorizing the 
        waiver or suspension of the obligation of a student to repay, in 
        accordance with section 722, loans from student loan funds under 
        section 721.''.
        (2) Requirements for schools.--Section 723(b) of the Public 
    Health Service Act (42 U.S.C. 292s(b)), as added by section 102 of 
    Public Law 102-408 (106 Stat. 1994), is amended--
            (A) in paragraph (1)--
                (i) by striking ``1994,'' and inserting ``1997;''; and
                (ii) by striking ``4 years before'' and inserting ``3 
            years before'';
            (B) in paragraph (2)(B), by striking ``15 percent'' and 
        inserting ``25 percent''; and
            (C) in paragraph (4)(B)--
                (i) in clause (i), by striking ``1994,'' and inserting 
            ``1997,''; and
                (ii) in clause (ii), by striking ``1995,'' and inserting 
            ``1998,''.
    (d) Authorization of Appropriations Regarding Medical Schools.--
Section 735 of the Public Health Service Act (42 U.S.C. 292y), as added 
by section 102 of Public Law 102-408 (106 Stat. 1994), is amended by 
adding at the end the following subsection:
    ``(f) Funding for Certain Medical Schools.--
        ``(1) Authorization of appropriations.--For the purpose of 
    making Federal capital contributions to student loan funds 
    established under section 721 by schools of medicine or osteopathic 
    medicine, there is authorized to be appropriated $10,000,000 for 
    each of the fiscal years 1994 through 1996.
        ``(2) Minimum requirements.--
            ``(A) Subject to subparagraph (B), the Secretary may make a 
        Federal capital contribution pursuant to paragraph (1) only if 
        the school of medicine or osteopathic medicine involved meets 
        the conditions described in subparagraph (A) of section 
        723(b)(2) or the conditions described in subparagraph (C) of 
        such section.
            ``(B) For purposes of subparagraph (A), the conditions 
        referred to in such subparagraph shall be applied with respect 
        to graduates of the school involved whose date of graduation 
        occurred approximately 3 years before June 30 of the fiscal year 
        preceding the fiscal year for which the Federal capital 
        contribution involved is made.
    (e) Public Health Traineeships.--Section 761(b)(3) of the Public 
Health Service Act (42 U.S.C. 294(b)(3)), as added by section 102 of 
Public Law 102-408 (106 Stat. 1994), is amended by striking ``and 
nutrition'' and inserting ``nutrition, and maternal and child health''.
    (f) Traineeships for Advanced Nurse Education.--Section 830(a) of 
the Public Health Service Act, as added by section 206 of Public Law 
102-408 (106 Stat. 2073), is amended--
        (1) by striking ``meet the cost of traineeships for 
    individuals'' and inserting the following: ``meet the costs of--
        ``(1) traineeships for individuals'';
        (2) by striking the period at the end and inserting ``; and''; 
    and
        (3) by adding at the end the following paragraph:
        ``(2) traineeships for participation in certificate nurse 
    midwifery programs that conform to guidelines established by the 
    Secretary under section 822(b).''.
    (g) Certain Generally Applicable Provisions.--Section 860(d) of the 
Public Health Service Act (42 U.S.C. 298b-7(d)), as added by section 209 
of Public Law 102-408 (106 Stat. 2075), is amended in the first sentence 
by striking ``821, 822, 830, and 831'' and inserting ``821, 822, and 
827''.
SEC. 2015. PROHIBITION AGAINST SHARP ADULT SEX SURVEY AND THE AMERICAN 
TEENAGE SEX SURVEY.
    The Secretary of Health and Human Services may not during fiscal 
year 1993 or any subsequent fiscal year conduct or support the SHARP 
survey of adult sexual behavior or the American Teenage Study of 
adolescent sexual behavior. This section becomes effective on the date 
of the enactment of this Act.

SEC. 2016. HEALTH SERVICES RESEARCH.

    (a) Definition.--Section 409 of the Public Health Service Act (42 
U.S.C. 284d), as added by section 121(b) of Public Law 102-321 (106 
Stat. 358), is amended by adding at the end the following sentence: 
``Such term does not include research on the efficacy of services to 
prevent, diagnose, or treat medical conditions.''.
    (b) Required Allocations.--
        (1) In general.--With respect to the allocation for health 
    services research required in each of the provisions of law 
    specified in paragraph (2), the term ``15 percent'' appearing in 
    each of such provisions is, in the case of allocations for fiscal 
    year 1993, deemed to be 12 percent.
        (2) Relevant provisions of law.--The provisions of law referred 
    to in paragraph (1) are--
            (A) section 464H(d)(2) of the Public Health Service Act, as 
        added by section 122 of Public Law 102-321 (106 Stat. 358);
            (B) section 464L(d)(2) of the Public Health Service Act, as 
        added by section 123 of Public Law 102-321 (106 Stat. 360); and
            (C) section 464R(f)(2) of the Public Health Service Act, as 
        added by section 124 of Public Law 102-321 (106 Stat. 364).
    (c) Report.--Section 494A(b) of the Public Health Service Act (42 
U.S.C. 289c-1(b)), as added by section 125 of Public Law 102-321 (106 
Stat. 366), is amended by striking ``May 3, 1993,'' and inserting 
``September 30, 1993,''.

SEC. 2017. CHILDHOOD MENTAL HEALTH.

    Part E of title V of the Public Health Service Act (42 U.S.C. 290ff 
et seq.), as added by section 119 of Public Law 102-321 (106 Stat. 349), 
is amended--
        (1) in section 561--
            (A) in subsection (a)(2), by striking ``this subpart'' and 
        inserting ``this part''; and
            (B) in subsection (b)(1), by striking ``is receiving such 
        payments'' each place such term appears and inserting ``is such 
        a grantee''; and
        (2) in section 565--
            (A) in subsection (c)(1), by striking ``this subpart'' and 
        inserting ``this part'';
            (B) in subsection (d), by striking ``this subpart'' and 
        inserting ``this part''; and
            (C) in subsection (f)--
                (i) in paragraph (1), by striking ``this subpart'' and 
            inserting ``this part''; and
                (ii) by amending paragraph (2) to read as follows:
    ``(2) Limitation regarding technical assistance.--Not more than 10 
percent of the amounts appropriated under paragraph (1) for a fiscal 
year may be expended for carrying out subsection (b).''.

SEC. 2018. EXPENDITURES FROM CERTAIN ACCOUNT.

    With respect to amounts appropriated in title II of Public Law 102-
394 for buildings and facilities of the National Institutes of Health, 
the purposes for which such amounts may be expended include repairing, 
improving, or constructing (or any combination thereof) roads on non-
Federal property in close proximity to the main campus of the National 
Institutes of Health in Bethesda, Maryland, subject to the agreement of 
the appropriate officials of Montgomery County, Maryland, or the 
appropriate officials of the State of Maryland, or both, as the case may 
be. None of such amounts may be used for the non-Federal share of the 
cost of any project or activity under title 23, United States Code, the 
Intermodal Surface Transportation Efficiency Act of 1991, or any law 
amended by such Act.
                       TITLE XXI--EFFECTIVE DATES

SEC. 2101. EFFECTIVE DATES.

    Subject to section 203(c), this Act and the amendments made by this 
Act take effect upon the date of the enactment of this Act.







                                Speaker of the House of Representatives.







                             Vice President of the United States and    
                                                President of the Senate.