Public Health Service Act-Title VII (Health Professions Education)
PUBLIC HEALTH SERVICE ACT
119–44
Statute Compilation
United States House of Representatives
Office of the Legislative Counsel
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Public Health Service Act-TITLE VII (Health Professions Education)
Public Health Service Act
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Public Health Service Act-Title VII (Health Professions Education)
[As Amended Through P.L. 119–44, Enacted December 1, 2025]
[Currency: This publication is a compilation of the text of title VII of Chapter 373 of the 78th Congress. It was last amended by the public law listed in the As Amended Through note above and below at the bottom of each page of the pdf version and reflects current law through the date of the enactment of the public law listed at https://www.govinfo.gov/app/collection/comps/]
[Note: While this publication does not represent an official version of any Federal statute, substantial efforts have been made to ensure the accuracy of its contents. The official version of Federal law is found in the United States Statutes at Large and in the United States Code. The legal effect to be given to the Statutes at Large and the United States Code is established by statute (1 U.S.C. 112, 204).]
TITLE VII—

HEALTH PROFESSIONS EDUCATION
PART A—

STUDENT LOANS
Subpart I—

Insured Health Education Assistance Loans to Graduate Students
SEC. 701.
[292]

STATEMENT OF PURPOSE.
The purpose of this subpart is to enable the Secretary to provide a Federal program of student loan insurance for students in (and certain former students of) eligible institutions (as defined in section 719).
SEC. 702.
[292a]

SCOPE AND DURATION OF LOAN INSURANCE PROGRAM.
(a)

In General.—
The total principal amount of new loans made and installments paid pursuant to lines of credit (as defined in section 719) to borrowers covered by Federal loan insurance under this subpart shall not exceed $350,000,000 for fiscal year 1993, $375,000,000 for fiscal year 1994, and $425,000,000 for fiscal year 1995. If the total amount of new loans made and installments paid pursuant to lines of credit in any fiscal year is less than the ceiling established for such year, the difference between the loans made and installments paid and the ceiling shall be carried over to the next fiscal year and added to the ceiling applicable to that fiscal year, and if in any fiscal year no ceiling has been established, any difference carried over shall constitute the ceiling for making new loans (including loans to new borrowers) and paying installments for such fiscal year. Thereafter, Federal loan insurance pursuant to this subpart may be granted only for loans made (or for loan installments paid pursuant to lines of credit) to enable students, who have obtained prior loans insured under this subpart, to continue or complete their educational program or to obtain a loan under section 705(a)(1)(B) to pay interest on such prior loans; but no insurance may be granted for any loan made or installment paid after September 30, 1998. The total principal amount of Federal loan insurance available under this subsection shall be granted by the Secretary without regard to any apportionment for the purpose of chapter 15 of title 31, United States Code, and without regard to any similar limitation.
(b)

Certain Limitations and Priorities.—
(1)

Limitations regarding lenders, states, or areas.—
The Secretary may, if necessary to assure an equitable distribution of the benefits of this subpart, assign, within the maximum amounts specified in subsection (a), Federal loan insurance quotas applicable to eligible lenders, or to States or areas, and may from time to time reassign unused portions of these quotas.
(2)

Priority for certain lenders.—
In providing certificates of insurance under section 706 through comprehensive contracts, the Secretary shall give priority to eligible lenders that agree—
(A)
to make loans to students at interest rates below the rates prevailing, during the period involved, for loans covered by Federal loan insurance pursuant to this subpart; or
(B)
to make such loans under terms that are otherwise favorable to the student relative to the terms under which eligible lenders are generally making such loans during such period.
(c)

Authority of Student Loan Marketing Association.—
(1)

In general.—
Subject to paragraph (2), the Student Loan Marketing Association, established under part B of title IV of the Higher Education Act of 1965, is authorized to make advances on the security of, purchase, service, sell, consolidate, or otherwise deal in loans which are insured by the Secretary under this subpart, except that if any loan made under this subpart is included in a consolidated loan pursuant to the authority of the Association under part B of title IV of the Higher Education Act of 1965, the interest rate on such consolidated loan shall be set at the weighted average interest rate of all such loans offered for consolidation and the resultant per centum shall be rounded downward to the nearest one-eighth of 1 per centum, except that the interest rate shall be no less than the applicable interest rate of the guaranteed student loan program established under part B of title IV of the Higher Education Act of 1965. In the case of such a consolidated loan, the borrower shall be responsible for any interest which accrues prior to the beginning of the repayment period of the loan, or which accrues during a period in which principal need not be paid (whether or not such principal is in fact paid) by reason of any provision of the Higher Education Act of 1965.
(2)

Applicability of certain federal regulations.—
With respect to Federal regulations for lenders, this subpart may not be construed to preclude the applicability of such regulations to the Student Loan Marketing Association or to any other entity in the business of purchasing student loans, including such regulations with respect to applications, contracts, and due diligence.
SEC. 703.
[292b]

LIMITATIONS ON INDIVIDUAL INSURED LOANS AND ON LOAN INSURANCE.
(a)

In General.—
The total of the loans made to a student in any academic year or its equivalent (as determined by the Secretary) which may be covered by Federal loan insurance under this subpart may not exceed $20,000 in the case of a student enrolled in a school of medicine, osteopathic medicine, dentistry, veterinary medicine, optometry, or podiatric medicine, and $12,500 in the case of a student enrolled in a school of pharmacy, public health, allied health, or chiropractic, or a graduate program in health administration or behavioral and mental health practice, including clinical psychology. The aggregate insured unpaid principal amount for all such insured loans made to any borrower shall not at any time exceed $80,000 in the case of a borrower who is or was a student enrolled in a school of medicine, osteopathic medicine, dentistry, veterinary medicine, optometry, or podiatric medicine, and $50,000 in the case of a borrower who is or was a student enrolled in a school of pharmacy, public health, allied health, or chiropractic, or a graduate program in health administration or clinical psychology. The annual insurable limit per student shall not be exceeded by a line of credit under which actual payments by the lender to the borrower will not be made in any year in excess of the annual limit.
(b)

Extent of Insurance Liability.—
The insurance liability on any loan insured by the Secretary under this subpart shall be 100 percent of the unpaid balance of the principal amount of the loan plus interest. The full faith and credit of the United States is pledged to the payment of all amounts which may be required to be paid under the provisions of section 707 or 714.
SEC. 704.
[292c]

SOURCES OF FUNDS.
Loans made by eligible lenders in accordance with this subpart shall be insurable by the Secretary whether made from funds fully owned by the lender or from funds held by the lender in a trust or similar capacity and available for such loans.
SEC. 705.
[292d]

ELIGIBILITY OF BORROWERS AND TERMS OF INSURED LOANS.
(a)

In General.—
A loan by an eligible lender shall be insurable by the Secretary under the provisions of this subpart only if—
(1)
made to—
(A)
a student who—
(i)
(I)
has been accepted for enrollment at an eligible institution, or (II) in the case of a student attending an eligible institution, is in good standing at that institution, as determined by the institution;
(ii)
is or will be a full-time student at the eligible institution;
(iii)
has agreed that all funds received under such loan shall be used solely for tuition, other reasonable educational expenses, including fees, books, and laboratory expenses, and reasonable living expenses, incurred by such students; and
(iv)
in the case of a pharmacy student, has satisfactorily completed three years of training; or
(B)
an individual who—
(i)
has previously had a loan insured under this subpart when the individual was a full-time student at an eligible institution;
(ii)
is in a period during which, pursuant to paragraph (2), the principal amount of such previous loan need not be paid; and
(iii)
has agreed that all funds received under the proposed loan shall be used solely for repayment of interest due on previous loans made under this subpart;
(2)
evidenced by a note or other written agreement which—
(A)
is made without security and without endorsement, except that if the borrower is a minor and such note or other written agreement executed by him would not, under the applicable law, create a binding obligation, an endorsement may be required;
(B)
provides for repayment of the principal amount of the loan in installments over a period of not less than 10 years (unless sooner repaid) nor more than 25 years beginning not earlier than 9 months nor later than 12 months after the date of—
(i)
the date on which—
(I)
the borrower ceases to be a participant in an accredited internship or residency program of not more than four years in duration;
(II)
the borrower completes the fourth year of an accredited internship or residency program of more than four years in duration; or
(III)
the borrower, if not a participant in a program described in subclause (I) or (II), ceases to carry, at an eligible institution, the normal full-time academic workload as determined by the institution; or
(ii)
the date on which a borrower who is a graduate of an eligible institution ceases to be a participant in a fellowship training program not in excess of two years or a participant in a full-time educational activity not in excess of two years, which—
(I)
is directly related to the health profession for which the borrower prepared at an eligible institution, as determined by the Secretary; and
(II)
may be engaged in by the borrower during such a two-year period which begins within twelve months after the completion of the borrower's participation in a program described in subclause (I) or (II) of clause (i) or prior to the completion of the borrower's participation in such program,
except as provided in subparagraph (C), except that the period of the loan may not exceed 33 years from the date of execution of the note or written agreement evidencing it, and except that the note or other written instrument may contain such provisions relating to repayment in the event of default in the payment of interest or in the payment of the costs of insurance premiums, or other default by the borrower, as may be authorized by regulations of the Secretary in effect at the time the loan is made;
(C)
provides that periodic installments of principal and interest need not be paid, but interest shall accrue, during any period (i) during which the borrower is pursuing a full-time course of study at an eligible institution (or at an institution defined by section 102(a) of the Higher Education Act of 1965); (ii) not in excess of four years during which the borrower is a participant in an accredited internship or residency program (including any period in such a program described in subclause (I) or subclause (II) of subparagraph (B)(i)); (iii) not in excess of three years, during which the borrower is a member of the Armed Forces of the United States; (iv) not in excess of three years during which the borrower is in service as a volunteer under the Peace Corps Act; (v) not in excess of three years during which the borrower is a member of the National Health Service Corps; (vi) not in excess of three years during which the borrower is in service as a full-time volunteer under title I of the Domestic Volunteer Service Act of 1973; (vii) not in excess of 3 years, for a borrower who has completed an accredited internship or residency training program in osteopathic general practice, family medicine, general internal medicine, preventive medicine, or general pediatrics and who is practicing primary care; (viii) not in excess of 1 year, for borrowers who are graduates of schools of chiropractic; (ix) any period not in excess of two years which is described in subparagraph (B)(ii); (x) not in excess of three years, during which the borrower is providing health care services to Indians through an Indian health program (as defined in section 108(a)(2)(A) of the Indian Health Care Improvement Act (25 U.S.C. 1616a(a)(2)(A))1; and (xi) in addition to all other deferments for which the borrower is eligible under clauses (i) through (x), any period during which the borrower is a member of the Armed Forces on active duty during the Persian Gulf conflict, and any period described in clauses (i) through (xi) shall not be included in determining the 25-year period described in subparagraph (B);
^1
So in law. Probably should include another closing parenthesis.
(D)
provides for interest on the unpaid principal balance of the loan at a yearly rate, not exceeding the applicable maximum rate prescribed and defined by the Secretary (within the limits set forth in subsection (b)) on a national, regional, or other appropriate basis, which interest shall be compounded not more frequently than annually and payable in installments over the period of the loan except as provided in subparagraph (C), except that the note or other written agreement may provide that payment of any interest may be deferred until not later than the date upon which repayment of the first installment of principal falls due or the date repayment of principal is required to resume (whichever is applicable) and may further provide that, on such date, the amount of the interest which has so accrued may be added to the principal for the purposes of calculating a repayment schedule;
(E)
offers, in accordance with criteria prescribed by regulation by the Secretary, a schedule for repayment of principal and interest under which payment of a portion of the principal and interest otherwise payable at the beginning of the repayment period (as defined in such regulations) is deferred until a later time in the period;
(F)
entitles the borrower to accelerate without penalty repayment of the whole or any part of the loan;
(G)
provides that the check for the proceeds of the loan shall be made payable jointly to the borrower and the eligible institution in which the borrower is enrolled; and
(H)
contains such other terms and conditions consistent with the provisions of this subpart and with the regulations issued by the Secretary pursuant to this subpart, as may be agreed upon by the parties to such loan, including, if agreed upon, a provision requiring the borrower to pay to the lender, in addition to principal and interest, amounts equal to the insurance premiums payable by the lender to the Secretary with respect to such loan; and
(3)
subject to the consent of the student and subject to applicable law, the eligible lender has obtained from the student appropriate demographic information regarding the student, including racial or ethnic background.
(b)

Limitation on Rate of Interest.—
The rate of interest prescribed and defined by the Secretary for the purpose of subsection (a)(2)(D) may not exceed the average of the bond equivalent rates of the 91-day Treasury bills auctioned for the previous quarter plus 3 percentage points, rounded to the next higher one-eighth of 1 percent.
(c)

Minimum Annual Payment by Borrower.—
The total of the payments by a borrower during any year or any repayment period with respect to the aggregate amount of all loans to that borrower which are insured under this subpart shall not be less than the annual interest on the outstanding principal, except as provided in subsection (a)(2)(C), unless the borrower, in the written agreement described in subsection (a)(2), agrees to make payments during any year or any repayment period in a lesser amount.
(d)

Applicability of Certain Laws on Rate or Amount of Interest.—
No provision of any law of the United States (other than subsections (a)(2)(D) and (b)) or of any State that limits the rate or amount of interest payable on loans shall apply to a loan insured under this subpart.
(e)

Determination Regarding Forbearance.—
Any period of time granted to a borrower under this subpart in the form of forbearance on the loan shall not be included in the 25-year total loan repayment period under subsection (a)(2)(C).
(f)

Loan Repayment Schedule.—
Lenders and holders under this subpart shall offer borrowers graduated loan repayment schedules that, during the first 5 years of loan repayment, are based on the borrower's debt-to-income ratio.
(g)

Rule of Construction Regarding Determination of Need of Students.—
With respect to any determination of the financial need of a student for a loan covered by Federal loan insurance under this subpart, this subpart may not be construed to limit the authority of any school to make such allowances for students with special circumstances as the school determines appropriate.
(h)

Definitions.—
For purposes of this section:
(1)
The term “active duty” has the meaning given such term in section 101(18) of title 37, United States Code, except that such term does not include active duty for training.
(2)
The term “Persian Gulf conflict” means the period beginning on August 2, 1990, and ending on the date thereafter prescribed by Presidential proclamation or by law.
SEC. 706.
[292e]

CERTIFICATE OF LOAN INSURANCE; EFFECTIVE DATE OF INSURANCE.
(a)

In General.—
(1)

Authority for issuance of certificate.—
If, upon application by an eligible lender, made upon such form, containing such information, and supported by such evidence as the Secretary may require, and otherwise in conformity with this section, the Secretary finds that the applicant has made a loan to an eligible borrower which is insurable under the provisions of this subpart, he may issue to the applicant a certificate of insurance covering the loan and setting forth the amount and terms of the insurance.
(2)

Effective date of insurance.—
Insurance evidenced by a certificate of insurance pursuant to subsection (a)(1) shall become effective upon the date of issuance of the certificate, except that the Secretary is authorized, in accordance with regulations, to issue commitments with respect to proposed loans, or with respect to lines (or proposed lines) of credit, submitted by eligible lenders, and in that event, upon compliance with subsection (a)(1) by the lender, the certificate of insurance may be issued effective as of the date when any loan, or any payment by the lender pursuant to a line of credit, to be covered by such insurance is made to a student described in section 705(a)(1). Such insurance shall cease to be effective upon 60 days' default by the lender in the payment of any installment of the premiums payable pursuant to section 708.
(3)

Certain agreements for lenders.—
An application submitted pursuant to subsection (a)(1) shall contain—
(A)
an agreement by the applicant to pay, in accordance with regulations, the premiums fixed by the Secretary pursuant to section 708; and
(B)
an agreement by the applicant that if the loan is covered by insurance the applicant will submit such supplementary reports and statements during the effective period of the loan agreement, upon such forms, at such times, and containing such information as the Secretary may prescribe by or pursuant to regulation.
(b)

Authority Regarding Comprehensive Insurance Coverage.—
(1)

In general.—
In lieu of requiring a separate insurance application and issuing a separate certificate of insurance for each loan made by an eligible lender as provided in subsection (a), the Secretary may, in accordance with regulations consistent with section 702, issue to any eligible lender applying therefor a certificate of comprehensive insurance coverage which shall, without further action by the Secretary, insure all insurable loans made by that lender, on or after the date of the certificate and before a specified cutoff date, within the limits of an aggregate maximum amount stated in the certificate. Such regulations may provide for conditioning such insurance, with respect to any loan, upon compliance by the lender with such requirements (to be stated or incorporated by reference in the certificate) as in the Secretary's judgment will best achieve the purpose of this subsection while protecting the financial interest of the United States and promoting the objectives of this subpart, including (but not limited to) provisions as to the reporting of such loans and information relevant thereto to the Secretary and as to the payment of initial and other premiums and the effect of default therein, and including provision for confirmation by the Secretary from time to time (through endorsement of the certificate) of the coverage of specific new loans by such certificate, which confirmation shall be incontestable by the Secretary in the absence of fraud or misrepresentation of fact or patent error.
(2)

Lines of credit beyond cutoff date.—
If the holder of a certificate of comprehensive insurance coverage issued under this subsection grants to a borrower a line of credit extending beyond the cutoff date specified in that certificate, loans or payments thereon made by the holder after that date pursuant to the line of credit shall not be deemed to be included in the coverage of that certificate except as may be specifically provided therein; but, subject to the limitations of section 702, the Secretary may, in accordance with regulations, make commitments to insure such future loans or payments, and such commitments may be honored either as provided in subsection (a) or by inclusion of such insurance in comprehensive coverage under this subsection for the period or periods in which such future loans or payments are made.
(c)

Assignment of Insurance Rights.—
The rights of an eligible lender arising under insurance evidenced by a certificate of insurance issued to it under this section may be assigned by such lender, subject to regulation by the Secretary, only to—
(1)
another eligible lender (including a public entity in the business of purchasing student loans); or
(2)
the Student Loan Marketing Association.
(d)

Effect of Refinancing or Consolidation of Obligations.—
The consolidation of the obligations of two or more federally insured loans obtained by a borrower in any fiscal year into a single obligation evidenced by a single instrument of indebtedness or the refinancing of a single loan shall not affect the insurance by the United States. If the loans thus consolidated are covered by separate certificates of insurance issued under subsection (a), the Secretary may upon surrender of the original certificates issue a new certificate of insurance in accordance with that subsection upon the consolidated obligation. If the loans thus consolidated are covered by a single comprehensive certificate issued under subsection (b), the Secretary may amend that certificate accordingly.
(e)

Rule of Construction Regarding Consolidation of Debts and Refinancing.—
Nothing in this section shall be construed to preclude the lender and the borrower, by mutual agreement, from consolidating all of the borrower's loans insured under this subpart into a single instrument (or, if the borrower obtained only 1 loan insured under this subpart, refinancing the loan 1 time) under the terms applicable to an insured loan made at the same time as the consolidation. The lender or loan holder should provide full information to the borrower concerning the advantages and disadvantages of loan consolidation or refinancing. Nothing in this section shall be construed to preclude the consolidation of the borrower's loans insured under this subpart under section 428C of the Higher Education Act of 1965. Any loans insured pursuant to this subpart that are consolidated under section 428C of such Act shall not be eligible for special allowance payments under section 438 of such Act.
SEC. 707.
[292f]

DEFAULT OF BORROWER.
(a)

Conditions for Payment to Beneficiary.—
(1)

In general.—
Upon default by the borrower on any loan covered by Federal loan insurance pursuant to this subpart, and after a substantial collection effort (including, subject to subsection (h), commencement and prosecution of an action) as determined under regulations of the Secretary, the insurance beneficiary shall promptly notify the Secretary and the Secretary shall, if requested (at that time or after further collection efforts) by the beneficiary, or may on his own motion, if the insurance is still in effect, pay to the beneficiary the amount of the loss sustained by the insured upon that loan as soon as that amount has been determined, except that, if the insurance beneficiary including any servicer of the loan is not designated for “exceptional performance”, as set forth in paragraph (2), the Secretary shall pay to the beneficiary a sum equal to 98 percent of the amount of the loss sustained by the insured upon that loan.
(2)

Exceptional performance.—
(A)

Authority.—
Where the Secretary determines that an eligible lender, holder, or servicer has a compliance performance rating that equals or exceeds 97 percent, the Secretary shall designate that eligible lender, holder, or servicer, as the case may be, for exceptional performance.
(B)

Compliance performance rating.—
For purposes of subparagraph (A), a compliance performance rating is determined with respect to compliance with due diligence in the disbursement, servicing, and collection of loans under this subpart for each year for which the determination is made. Such rating shall be equal to the percentage of all due diligence requirements applicable to each loan, on average, as established by the Secretary, with respect to loans serviced during the period by the eligible lender, holder, or servicer.
(C)

Annual audits for lenders, holders, and servicers.—
Each eligible lender, holder, or servicer desiring a designation under subparagraph (A) shall have an annual financial and compliance audit conducted with respect to the loan portfolio of such eligible lender, holder, or servicer, by a qualified independent organization from a list of qualified organizations identified by the Secretary and in accordance with standards established by the Secretary. The standards shall measure the lender's, holder's, or servicer's compliance with due diligence standards and shall include a defined statistical sampling technique designed to measure the performance rating of the eligible lender, holder, or servicer for the purpose of this section. Each eligible lender, holder, or servicer shall submit the audit required by this section to the Secretary.
(D)

Secretary's determinations.—
The Secretary shall make the determination under subparagraph (A) based upon the audits submitted under this paragraph and any information in the possession of the Secretary or submitted by any other agency or office of the Federal Government.
(E)

Quarterly compliance audit.—
To maintain its status as an exceptional performer, the lender, holder, or servicer shall undergo a quarterly compliance audit at the end of each quarter (other than the quarter in which status as an exceptional performer is established through a financial and compliance audit, as described in subparagraph (C)), and submit the results of such audit to the Secretary. The compliance audit shall review compliance with due diligence requirements for the period beginning on the day after the ending date of the previous audit, in accordance with standards determined by the Secretary.
(F)

Revocation authority.—
The Secretary shall revoke the designation of a lender, holder, or servicer under subparagraph (A) if any quarterly audit required under subparagraph (E) is not received by the Secretary by the date established by the Secretary or if the audit indicates the lender, holder, or servicer has failed to meet the standards for designation as an exceptional performer under subparagraph (A). A lender, holder, or servicer receiving a compliance audit not meeting the standard for designation as an exceptional performer may reapply for designation under subparagraph (A) at any time.
(G)

Documentation.—
Nothing in this section shall restrict or limit the authority of the Secretary to require the submission of claims documentation evidencing servicing performed on loans, except that the Secretary may not require exceptional performers to submit greater documentation than that required for lenders, holders, and servicers not designated under subparagraph (A).
(H)

Cost of audits.—
Each eligible lender, holder, or servicer shall pay for all the costs associated with the audits required under this section.
(I)

Additional revocation authority.—
Notwithstanding any other provision of this section, a designation under subparagraph (A) may be revoked at any time by the Secretary if the Secretary determines that the eligible lender, holder, or servicer has failed to maintain an overall level of compliance consistent with the audit submitted by the eligible lender, holder, or servicer under this paragraph or if the Secretary asserts that the lender, holder, or servicer may have engaged in fraud in securing designation under subparagraph (A) or is failing to service loans in accordance with program requirements.
(J)

Noncompliance.—
A lender, holder, or servicer designated under subparagraph (A) that fails to service loans or otherwise comply with applicable program regulations shall be considered in violation of the Federal False Claims Act.
(b)

Subrogation.—
Upon payment by the Secretary of the amount of the loss pursuant to subsection (a), the United States shall be subrogated for all of the rights of the holder of the obligation upon the insured loan and shall be entitled to an assignment of the note or other evidence of the insured loan by the insurance beneficiary. If the net recovery made by the Secretary on a loan after deduction of the cost of that recovery (including reasonable administrative costs) exceeds the amount of the loss, the excess shall be paid over to the insured. The Secretary may sell without recourse to eligible lenders (or other entities that the Secretary determines are capable of dealing in such loans) notes or other evidence of loans received through assignment under the first sentence.
(c)

Forbearance.—
Nothing in this section or in this subpart shall be construed to preclude any forbearance for the benefit of the borrower which may be agreed upon by the parties to the insured loan and approved by the Secretary or to preclude forbearance by the Secretary in the enforcement of the insured obligation after payment on that insurance.
(d)

Reasonable Care and Diligence Regarding Loans.—
Nothing in this section or in this subpart shall be construed to excuse the eligible lender or holder of a federally insured loan from exercising reasonable care and diligence in the making of loans under the provisions of this subpart and from exercising a substantial effort in the collection of loans under the provisions of this subpart. If the Secretary, after reasonable notice and opportunity for hearing to an eligible lender, finds that the lender has failed to exercise such care and diligence, to exercise such substantial efforts, to make the reports and statements required under section 706(a)(3), or to pay the required Federal loan insurance premiums, he shall disqualify that lender from obtaining further Federal insurance on loans granted pursuant to this subpart until he is satisfied that its failure has ceased and finds that there is reasonable assurance that the lender will in the future exercise necessary care and diligence, exercise substantial effort, or comply with such requirements, as the case may be.
(e)

Definitions.—
For purposes of this section:
(1)
The term “insurance beneficiary” means the insured or its authorized assignee in accordance with section 706(c).
(2)
The term “amount of the loss” means, with respect to a loan, unpaid balance of the principal amount and interest on such loan, less the amount of any judgment collected pursuant to default proceedings commenced by the eligible lender or holder involved.
(3)
The term “default” includes only such defaults as have existed for 120 days.
(4)
The term “servicer” means any agency acting on behalf of the insurance beneficiary.
(f)

Reductions in Federal Reimbursements or Payments for Defaulting Borrowers.—
The Secretary shall, after notice and opportunity for a hearing, cause to be reduced Federal reimbursements or payments for health services under any Federal law to borrowers who are practicing their professions and have defaulted on their loans insured under this subpart in amounts up to the remaining balance of such loans. Procedures for reduction of payments under the medicare program are provided under section 1892 of the Social Security Act. Notwithstanding such section 1892, any funds recovered under this subsection shall be deposited in the insurance fund established under section 710.
(g)

Conditions for Discharge of Debt in Bankruptcy.—
Notwithstanding any other provision of Federal or State law, a debt that is a loan insured under the authority of this subpart may be released by a discharge in bankruptcy under any chapter of title 11, United States Code, only if such discharge is granted—
(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;
(2)
upon a finding by the Bankruptcy Court that the nondischarge of such debt would be unconscionable; and
(3)
upon the condition that the Secretary shall not have waived the Secretary's rights to apply subsection (f) to the borrower and the discharged debt.
(h)

Requirement Regarding Actions for Default.—
(1)

In general.—
With respect to the default by a borrower on any loan covered by Federal loan insurance under this subpart, the Secretary shall, under subsection (a), require an eligible lender or holder to commence and prosecute an action for such default unless—
(A)
in the determination of the Secretary—
(i)
the eligible lender or holder has made reasonable efforts to serve process on the borrower involved and has been unsuccessful with respect to such efforts, or
(ii)
prosecution of such an action would be fruitless because of the financial or other circumstances of the borrower;
(B)
for such loans made before the date of the enactment of the Health Professions Reauthorization Act of 1988, the loan involved was made in an amount of less than $5,000; or
(C)
for such loans made after such date, the loan involved was made in an amount of less than $2,500.
(2)

Relationship to claim for payment.—
With respect to an eligible lender or holder that has commenced an action pursuant to subsection (a), the Secretary shall make the payment required in such subsection, or deny the claim for such payment, not later than 60 days after the date on which the Secretary determines that the lender or holder has made reasonable efforts to secure a judgment and collect on the judgment entered into pursuant to this subsection.
(3)

State court judgments.—
With respect to any State court judgment that is obtained by a lender or holder against a borrower for default on a loan insured under this subpart and that is subrogated to the United States under subsection (b), any United States attorney may register such judgment with the Federal courts for enforcement.
(i)

Inapplicability of Federal and State Statute of Limitations on Actions for Loan Collection.—
Notwithstanding any other provision of Federal or State law, there shall be no limitation on the period within which suit may be filed, a judgment may be enforced, or an offset, garnishment, or other action may be initiated or taken by the Secretary, the Attorney General, or other administrative head of another Federal agency, as the case may be, for the repayment of the amount due from a borrower on a loan made under this subpart that has been assigned to the Secretary under subsection (b).
(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.
SEC. 708.
[292g]

RISK-BASED PREMIUMS.
(a)

Authority.—
With respect to a loan made under this subpart on or after January 1, 1993, the Secretary, in accordance with subsection (b), shall assess a risk-based premium on an eligible borrower and, if required under this section, an eligible institution that is based on the default rate of the eligible institution involved (as defined in section 719).
(b)

Assessment of Premium.—
Except as provided in subsection (d)(2), the risk-based premium to be assessed under subsection (a) shall be as follows:
(1)

Low-risk rate.—
With respect to an eligible borrower seeking to obtain a loan for attendance at an eligible institution that has a default rate of not to exceed five percent, such borrower shall be assessed a risk-based premium in an amount equal to 6 percent of the principal amount of the loan.
(2)

Medium-risk rate.—
(A)

In general.—
With respect to an eligible borrower seeking to obtain a loan for attendance at an eligible institution that has a default rate of in excess of five percent but not to exceed 10 percent—
(i)
such borrower shall be assessed a risk-based premium in an amount equal to 8 percent of the principal amount of the loan; and
(ii)
such institution shall be assessed a risk-based premium in an amount equal to 5 percent of the principal amount of the loan.
(B)

Default management plan.—
An institution of the type described in subparagraph (A) shall prepare and submit to the Secretary for approval, an annual default management plan, that shall specify the detailed short-term and long-term procedures that such institution will have in place to minimize defaults on loans to borrowers under this subpart. Under such plan the institution shall, among other measures, provide an exit interview to all borrowers that includes information concerning repayment schedules, loan deferments, forbearance, and the consequences of default.
(3)

High-risk rate.—
(A)

In general.—
With respect to an eligible borrower seeking to obtain a loan for attendance at an eligible institution that has a default rate of in excess of 10 percent but not to exceed 20 percent—
(i)
such borrower shall be assessed a risk-based premium in an amount equal to 8 percent of the principal amount of the loan; and
(ii)
such institution shall be assessed a risk-based premium in an amount equal to 10 percent of the principal amount of the loan.
(B)

Default management plan.—
An institution of the type described in subparagraph (A) shall prepare and submit to the Secretary for approval a plan that meets the requirements of paragraph (2)(B).
(4)

Ineligibility.—
An individual shall not be eligible to obtain a loan under this subpart for attendance at an institution that has a default rate in excess of 20 percent.
(c)

Reduction of Risk-Based Premium.—
Lenders shall reduce by 50 percent the risk-based premium to eligible borrowers if a credit worthy parent or other responsible party co-signs the loan note.
(d)

Administrative Waivers.—
(1)

Hearing.—
The Secretary shall afford an institution not less than one hearing, and may consider mitigating circumstances, prior to making such institution ineligible for participation in the program under this subpart.
(2)

Exceptions.—
In carrying out this section with respect to an institution, the Secretary may grant an institution a waiver of requirements of paragraphs (2) through (4) of subsection (b) if the Secretary determines that the default rate for such institution is not an accurate indicator because the volume of the loans under this subpart made by such institution has been insufficient.
(3)

Transition for certain institutions.—
During the 3-year period beginning on the effective date of the Health Professions Education Extension Amendments of 1992—
(A)
subsection (b)(4) shall not apply with respect to any eligible institution that is a Historically Black College or University; and
(B)
any such institution that has a default rate in excess of 20 percent, and any eligible borrower seeking a loan for attendance at the institution, shall be subject to subsection (b)(3) to the same extent and in the same manner as eligible institutions and borrowers described in such subsection.
(e)

Payoff To Reduce Risk Category.—
An institution may pay off the outstanding principal and interest owed by the borrowers of such institution who have defaulted on loans made under this subpart in order to reduce the risk category of the institution.
SEC. 709.
[292h]

OFFICE FOR HEALTH EDUCATION ASSISTANCE LOAN DEFAULT REDUCTION.
(a)

Establishment.—
The Secretary shall establish, within the Division of Student Assistance of the Bureau of Health Professions, an office to be known as the Office for Health Education Assistance Loan Default Reduction (in this section referred to as the “Office”).
(b)

Purpose and Functions.—
It shall be the purpose of the Office to achieve a reduction in the number and amounts of defaults on loans guaranteed under this subpart. In carrying out such purpose the Office shall—
(1)
conduct analytical and evaluative studies concerning loans and loan defaults;
(2)
carry out activities designed to reduce loan defaults;
(3)
respond to special circumstances that may exist in the financial lending environment that may lead to loan defaults;
(4)
coordinate with other Federal entities that are involved with student loan programs, including—
(A)
with respect to the Department of Education, in the development of a single student loan application form, a single student loan deferment form, a single disability form, and a central student loan database; and
(B)
with respect to the Department of Justice, in the recovery of payments from health professionals who have defaulted on loans guaranteed under this subpart; and
(5)
provide technical assistance to borrowers, lenders, holders, and institutions concerning deferments and collection activities.
(c)

Additional Duties.—
In conjunction with the report submitted under subsection (b), the Office shall—
(1)
compile, and publish in the Federal Register, a list of the borrowers who are in default under this subpart; and
(2)
send the report and notices of default with respect to these borrowers to relevant Federal agencies and to schools, school associations, professional and specialty associations, State licensing boards, hospitals with which such borrowers may be associated, and any other relevant organizations.
(d)

Allocation of Funds for Office.—
In the case of amounts reserved under section 710(a)(2)(B) for obligation under this subsection, the Secretary may obligate the amounts for the purpose of administering the Office, including 7 full-time equivalent employment positions for such Office. With respect to such purpose, amounts made available under the preceding sentence are in addition to amounts made available to the Health Resources and Services Administration for program management for the fiscal year involved. With respect to such employment positions, the positions are in addition to the number of full-time equivalent employment positions that otherwise is authorized for the Department of Health and Human Services for the fiscal year involved.
SEC. 710.
[292i]

INSURANCE ACCOUNT.
(a)

In General.—
(1)

Establishment.—
There is hereby established a student loan insurance account (in this section referred to as the “Account”) which shall be available without fiscal year limitation to the Secretary for making payments in connection with the collection and default of loans insured under this subpart by the Secretary.
(2)

Funding.—
(A)
Except as provided in subparagraph (B), all amounts received by the Secretary as premium charges for insurance and as receipts, earnings, or proceeds derived from any claim or other assets acquired by the Secretary in connection with his operations under this subpart, and any other moneys, property, or assets derived by the Secretary from the operations of the Secretary in connection with this section, shall be deposited in the Account.
(B)
With respect to amounts described in subparagraph (A) that are received by the Secretary for fiscal year 1993 and subsequent fiscal years, the Secretary may, before depositing such amounts in the Account, reserve from the amounts each such fiscal year not more than $1,000,000 for obligation under section 709(d).
(3)

Expenditures.—
All payments in connection with the default of loans insured by the Secretary under this subpart shall be paid from the Account.
(b)

Contingent Authority for Issuance of Notes or Other Obligations.—
If at any time the moneys in the Account are insufficient to make payments in connection with the collection or default of any loan insured by the Secretary under this subpart, the Secretary of the Treasury may lend the Account such amounts as may be necessary to make the payments involved, subject to the Federal Credit Reform Act of 1990.
SEC. 711.
[292j]

POWERS AND RESPONSIBILITIES OF SECRETARY.
(a)

In General.—
In the performance of, and with respect to, the functions, powers, and duties vested in the Secretary by this subpart, the Secretary is authorized as follows:
(1)
To prescribe such regulations as may be necessary to carry out the purposes of this subpart.
(2)
To sue and be sued in any district court of the United States. Such district courts shall have jurisdiction of civil actions arising under this subpart without regard to the amount in controversy, and any action instituted under this subsection by or against the Secretary shall survive notwithstanding any change in the person occupying the office of Secretary or any vacancy in that office. No attachment, injunction, garnishment, or other similar process, mesne or final, shall be issued against the Secretary or property under the control of the Secretary. Nothing herein shall be constructed to except litigation arising out of activities under this subpart from the application of sections 517 and 547 of title 28 of the United States Code.
(3)
To include in any contract for Federal loan insurance such terms, conditions, and covenants relating to repayment of principal and payments of interest, relating to his obligations and rights and to those of eligible lenders, and borrowers in case of default, and relating to such other matters as the Secretary determines to be necessary to assure that the purposes of this subpart will be achieved. Any term, condition, and covenant made pursuant to this paragraph or any other provisions of this subpart may be modified by the Secretary if the Secretary determines that modification is necessary to protect the financial interest of the United States.
(4)
Subject to the specific limitations in the subpart, to consent to the modification of any note or other instrument evidencing a loan which has been insured by him under this subpart (including modifications with respect to the rate of interest, time of payment of any installment of principal and interest or any portion thereof, or any other provision).
(5)
To enforce, pay, compromise, waive, or release any right, title, claim, lien, or demand, however acquired, including any equity or any right or2 redemption.
^2
So in law. See section 102 of Public Law 102–408 (106 Stat. 1994). Probably should be “right of redemption”.
(b)

Annual Budget; Accounts.—
The Secretary shall, with respect to the financial operations arising by reason of this subpart—
(1)
prepare annually and submit a budget program as provided for wholly owned Government corporations by the Government Corporation Control Act; and
(2)
maintain with respect to insurance under this subpart an integral set of accounts.
SEC. 712.
[292k]

PARTICIPATION BY FEDERAL CREDIT UNIONS IN FEDERAL, STATE, AND PRIVATE STUDENT LOAN INSURANCE PROGRAMS.
Notwithstanding any other provision of law, Federal credit unions shall, pursuant to regulations of the Administrator of the National Credit Union Administration, have power to make insured loans to eligible students in accordance with the provisions of this subpart relating to Federal insured loans.
SEC. 713.
[292l]

DETERMINATION OF ELIGIBLE STUDENTS.
For purposes of determining eligible students under this part, in the case of a public school in a State that offers an accelerated, integrated program of study combining undergraduate premedical education and medical education leading to advanced entry, by contractual agreement, into an accredited four-year school of medicine which provides the remaining training leading to a degree of doctor of medicine, whenever in this part a provision refers to a student at a school of medicine, such reference shall include only a student enrolled in any of the last four years of such accelerated, integrated program of study.
SEC. 714.
[292m]

REPAYMENT BY SECRETARY OF LOANS OF DECEASED OR DISABLED BORROWERS.
If a borrower who has received a loan dies or becomes permanently and totally disabled (as determined in accordance with regulations of the Secretary), the Secretary shall discharge the borrower's liability on the loan by repaying the amount owed on the loan from the account established under section 710.
SEC. 715.
[292n]

ADDITIONAL REQUIREMENTS FOR INSTITUTIONS AND LENDERS.
(a)

In General.—
Notwithstanding any other provision of this subpart, the Secretary is authorized to prescribe such regulations as may be necessary to provide for—
(1)
a fiscal audit of an eligible institution with regard to any funds obtained from a borrower who has received a loan insured under this subpart;
(2)
the establishment of reasonable standards of financial responsibility and appropriate institutional capability for the administration by an eligible institution of a program of student financial aid with respect to funds obtained from a student who has received a loan insured under this subpart;
(3)
the limitation, suspension, or termination of the eligibility under this subpart of any otherwise eligible institution, whenever the Secretary has determined, after notice and affording an opportunity for hearing, that such institution has violated or failed to carry out any regulation prescribed under this subpart;
(4)
the collection of information from the borrower, lender, or eligible institution to assure compliance with the provisions of section 705;
(5)
the assessing of tuition or fees to borrowers in amounts that are the same or less than the amount of tuition and fees assessed to nonborrowers;
(6)
the submission, by the institution or the lender to the Office of Health Education Assistance Loan Default Reduction, of information concerning each loan made under this subpart, including the date when each such loan was originated, the date when each such loan is sold, the identity of the loan holder and information concerning a change in the borrower's status;
(7)
the withholding of services, including academic transcripts, financial aid transcripts, and alumni services, by an institution from a borrower upon the default of such borrower of a loan under this subpart, except in case of a borrower who has filed for bankruptcy; and
(8)
the offering, by the lender to the borrower, of a variety of repayment options, including fixed-rate, graduated repayment with negative amortization permitted, and income dependent payments for a limited period followed by level monthly payments.
(b)

Recording by Institution of Information on Students.—
The Secretary shall require an eligible institution to record, and make available to the lender and to the Secretary upon request, the name, address, postgraduate destination, and other reasonable identifying information for each student of such institution who has a loan insured under this subpart.
(c)

Workshop for Student Borrowers.—
Each participating eligible institution must have, at the beginning of each academic year, a workshop concerning the provisions of this subpart that all student borrowers shall be required to attend.
SEC. 719.
[292o]

DEFINITIONS.
For purposes of this subpart:
(1)
The term “eligible institution” means, with respect to a fiscal year, a school of medicine, osteopathic medicine, dentistry, veterinary medicine, optometry, podiatric medicine, pharmacy, public health, allied health, or chiropractic, or a graduate program in health administration or behavioral and mental health practice, including clinical psychology.
(2)
The term “eligible lender” means an eligible institution that became a lender under this subpart prior to September 15, 1992, an agency or instrumentality of a State, a financial or credit institution (including an insurance company) which is subject to examination and supervision by an agency of the United States or of any State, a pension fund approved by the Secretary for this purpose, or a nonprofit private entity designated by the State, regulated by the State, and approved by the Secretary.
(3)
The term “line of credit” means an arrangement or agreement between the lender and the borrower whereby a loan is paid out by the lender to the borrower in annual installments, or whereby the lender agrees to make, in addition to the initial loan, additional loans in subsequent years.
(4)
The term “school of allied health” means a program in a school of allied health (as defined in section 799) which leads to a masters' degree or a doctoral degree.
(5)
(A)
The term “default rate”, in the case of an eligible entity, means the percentage constituted by the ratio of—
(i)
the principal amount of loans insured under this subpart—
(I)
that are made with respect to the entity and that enter repayment status after April 7, 1987; and
(II)
for which amounts have been paid under section 707(a) to insurance beneficiaries, exclusive of any loan for which amounts have been so paid as a result of the death or total and permanent disability of the borrower; exclusive of any loan for which the borrower begins payments to the Secretary on the loan pursuant to section 707(b) and maintains payments for 12 consecutive months in accordance with the agreement involved (with the loan subsequently being included or excluded, as the case may be, as amounts paid under section 707(a) according to whether further defaults occur and whether with respect to the default involved compliance with such requirement regarding 12 consecutive months occurs); and exclusive of any loan on which payments may not be recovered by reason of the obligation under the loan being discharged in bankruptcy under title 11, United States Code; to
(ii)
the total principal amount of loans insured under this subpart that are made with respect to the entity and that enter repayment status after April 7, 1987.
(B)
For purposes of subparagraph (A), a loan insured under this subpart shall be considered to have entered repayment status if the applicable period described in subparagraph (B) of section 705(a)(2) regarding the loan has expired (without regard to whether any period described in subparagraph (C) of such section is applicable regarding the loan).
(C)
For purposes of subparagraph (A), the term “eligible entity” means an eligible institution, an eligible lender, or a holder, as the case may be.
(D)
For purposes of subparagraph (A), a loan is made with respect to an eligible entity if—
(i)
in the case of an eligible institution, the loan was made to students of the institution;
(ii)
in the case of an eligible lender, the loan was made by the lender; and
(iii)
in the case of a holder, the loan was purchased by the holder.
(6)
The term “Secretary” means the Secretary of Education.
SEC. 720.
[292p]

AUTHORIZATION OF APPROPRIATIONS.
(a)

In General.—
For fiscal year 1993 and subsequent fiscal years, there are authorized to be appropriated such sums as may be necessary for the adequacy of the student loan insurance account under this subpart and for the purpose of administering this subpart.
(b)

Availability of Sums.—
Sums appropriated under subsection (a) shall remain available until expended.
Subpart II—

Federally-Supported Student Loan Funds
SEC. 721.
[292q]

AGREEMENTS FOR OPERATION OF SCHOOL LOAN FUNDS.
(a)

Fund Agreements.—
The Secretary is authorized to enter into an agreement for the establishment and operation of a student loan fund in accordance with this subpart with any public or other nonprofit school of medicine, osteopathic medicine, dentistry, pharmacy, podiatric medicine, optometry, or veterinary medicine.
(b)

Requirements.—
Each agreement entered into under this section shall—
(1)
provide for establishment of a student loan fund by the school;
(2)
provide for deposit in the fund of—
(A)
the Federal capital contributions to the fund;
(B)
an amount equal to not less than one-ninth of such Federal capital contributions, contributed by such institution;
(C)
collections of principal and interest on loans made from the fund;
(D)
collections pursuant to section 722(j); and
(E)
any other earnings of the fund;
(3)
provide that the fund shall be used only for loans to students of the school in accordance with the agreement and for costs of collection of such loans and interest thereon;
(4)
provide that loans may be made from such funds only to students pursuing a full-time course of study at the school leading to a degree of doctor of medicine, doctor of dentistry or an equivalent degree, doctor of osteopathy, bachelor of science in pharmacy or an equivalent degree, doctor of pharmacy or an equivalent degree, doctor of podiatric medicine or an equivalent degree, doctor of optometry or an equivalent degree, or doctor of veterinary medicine or an equivalent degree;
(5)
provide that the school shall advise, in writing, each applicant for a loan from the student loan fund of the provisions of section 722 under which outstanding loans from the student loan fund may be paid (in whole or in part) by the Secretary; and
(6)
contain such other provisions as are necessary to protect the financial interests of the United States.
(c)

Failure of School To Collect Loans.—
(1)

In general.—
Any standard established by the Secretary by regulation for the collection by schools of medicine, osteopathic medicine, dentistry, pharmacy, podiatric medicine, optometry, or veterinary medicine of loans made pursuant to loan agreements under this subpart shall provide that the failure of any such school to collect such loans shall be measured in accordance with this subsection. This subsection may not be construed to require such schools to reimburse the student loan fund under this subpart for loans that became uncollectible prior to August 1985 or to penalize such schools with respect to such loans.
(2)

Extent of failure.—
The measurement of a school's failure to collect loans made under this subpart shall be the ratio (stated as a percentage) that the defaulted principal amount outstanding of such school bears to the matured loans of such school.
(3)

Definitions.—
For purposes of this subsection:
(A)
The term “default” means the failure of a borrower of a loan made under this subpart to—
(i)
make an installment payment when due; or
(ii)
comply with any other term of the promissory note for such loan,
except that a loan made under this subpart shall not be considered to be in default if the loan is discharged in bankruptcy or if the school reasonably concludes from written contracts with the borrower that the borrower intends to repay the loan.
(B)
The term “defaulted principal amount outstanding” means the total amount borrowed from the loan fund of a school that has reached the repayment stage (minus any principal amount repaid or canceled) on loans—
(i)
repayable monthly and in default for at least 120 days; and
(ii)
repayable less frequently than monthly and in default for at least 180 days;
(C)
The term “grace period” means the period of one year beginning on the date on which the borrower ceases to pursue a full-time course of study at a school of medicine, osteopathic medicine, dentistry, pharmacy, podiatric medicine, optometry, or veterinary medicine; and
(D)
The term “matured loans” means the total principal amount of all loans made by a school under this subpart minus the total principal amount of loans made by such school to students who are—
(i)
enrolled in a full-time course of study at such school; or
(ii)
in their grace period.
SEC. 722.
[292r]

LOAN PROVISIONS.
(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 cost of attendance (including tuition, other reasonable educational expenses, and reasonable living costs) for that year at the educational institution attended by the student (as determined by such educational institution).
(2)

Third and fourth years of medical school.—
For purposes of paragraph (1), the amount of the loan may, in the case of the third or fourth year of a student at a school of medicine or osteopathic medicine, be increased to the extent necessary 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.
(b)

Terms and Conditions.—
Subject to section 723, any such loans shall be made on such terms and conditions as the school may determine, but may be made only to a student who is in need of the amount thereof to pursue a full-time course of study at the school leading to a degree of doctor of medicine, doctor of dentistry or an equivalent degree, doctor of osteopathy, bachelor of science in pharmacy or an equivalent degree, doctor of pharmacy or an equivalent degree, doctor of podiatric medicine or an equivalent degree, doctor of optometry or an equivalent degree, or doctor of veterinary medicine or an equivalent degree.
(c)

Repayment; Exclusions From Repayment Period.—
Such loans shall be repayable in equal or graduated periodic installments (with the right of the borrower to accelerate repayment) over the period of not less than 10 years nor more than 25 years, at the discretion of the institution, which begins one year after the student ceases to pursue a full-time course of study at a school of medicine, osteopathic medicine, dentistry, pharmacy, podiatry, optometry, or veterinary medicine, excluding from such period—
(1)
all periods—
(A)
not in excess of three years of active duty performed by the borrower as a member of a uniformed service;
(B)
not in excess of three years during which the borrower serves as a volunteer under the Peace Corps Act;
(C)
during which the borrower participates in advanced professional training, including internships and residencies; and
(D)
during which the borrower is pursuing a full-time course of study at such a school; and
(2)
a period—
(A)
not in excess of two years during which a borrower who is a full-time student in such a school leaves the school, with the intent to return to such school as a full-time student, in order to engage in a full-time educational activity which is directly related to the health profession for which the borrower is preparing, as determined by the Secretary; or
(B)
not in excess of two years during which a borrower who is a graduate of such a school is a participant in a fellowship training program or a full-time educational activity which—
(i)
is directly related to the health profession for which such borrower prepared at such school, as determined by the Secretary; and
(ii)
may be engaged in by the borrower during such a two-year period which begins within twelve months after the completion of the borrower's participation in advanced professional training described in paragraph (1)(C) or prior to the completion of such borrower's participation in such training.
(d)

Cancellation of Liability.—
The liability to repay the unpaid balance of such a loan and accrued interest thereon shall be canceled upon the death of the borrower, or if the Secretary determines that he has become permanently, and totally disabled.
(e)

Rate of Interest.—
Such loans shall bear interest, on the unpaid balance of the loan, computed only for periods for which the loan is repayable, at the rate of 5 percent per year.
(f)

Security or Endorsement.—
Loans shall be made under this subpart without security or endorsement, except that if the borrower is a minor and the note or other evidence of obligation executed by him would not, under the applicable law, create a binding obligation, either security or endorsement may be required.
(g)

Transferring and Assigning Loans.—
No note or other evidence of a loan made under this subpart may be transferred or assigned by the school making the loan except that, if the borrowers transfer to another school participating in the program under this subpart, such note or other evidence of a loan may be transferred to such other school.
(h)

Charge With Respect to Insurance for Certain Cancellations.—
Subject to regulations of the Secretary, a school may assess a charge with respect to loans made this3 subpart to cover the costs of insuring against cancellation of liability under subsection (d).
^3
So in law. See section 102 of Public Law 102–408 (106 Stat. 1994). Probably should be “made under this subpart”.
(i)

Charge With Respect to Late Payments.—
Subject to regulations of the Secretary, and in accordance with this section, a school shall assess a charge with respect to a loan made under this subpart for failure of the borrower to pay all or any part of an installment when it is due and, in the case of a borrower who is entitled to deferment of the loan under subsection (c), for any failure to file timely and satisfactory evidence of such entitlement. No such charge may be made if the payment of such installment or the filing of such evidence is made within 60 days after the date on which such installment or filing is due. The amount of any such charge may not exceed an amount equal to 6 percent of the amount of such installment. The school may elect to add the amount of any such charge to the principal amount of the loan as of the first day after the day on which such installment or evidence was due, or to make the amount of the charge payable to the school not later than the due date of the next installment after receipt by the borrower of notice of the assessment of the charge.
(j)

Authority of Schools Regarding Rate of Payment.—
A school may provide, in accordance with regulations of the Secretary, that during the repayment period of a loan from a loan fund established pursuant to an agreement under this subpart payments of principal and interest by the borrower with respect to all the outstanding loans made to him from loan funds so established shall be at a rate equal to not less than $40 per month.
(k)

Authority Regarding Repayments by Secretary.—
Upon application by a person who received, and is under an obligation to repay, any loan made to such person as a health professions student to enable him to study medicine, osteopathy, dentistry, veterinary medicine, optometry, pharmacy, or podiatry, the Secretary may undertake to repay (without liability to the applicant) all or any part of such loan, and any interest or portion thereof outstanding thereon, upon his determination, pursuant to regulations establishing criteria therefor, that the applicant—
(1)
failed to complete such studies leading to his first professional degree;
(2)
is in exceptionally needy circumstances;
(3)
is from a low-income or disadvantaged family as those terms may be defined by such regulations; and
(4)
has not resumed, or cannot reasonably be expected to resume, the study of medicine, osteopathy, dentistry, veterinary medicine, optometry, pharmacy, or podiatric medicine, within two years following the date upon which he terminated such studies.
(l)

Collection Efforts by Secretary.—
The Secretary is authorized to attempt to collect any loan which was made under this subpart, which is in default, and which was referred to the Secretary by a school with which the Secretary has an agreement under this subpart, on behalf of that school under such terms and conditions as the Secretary may prescribe (including reimbursement from the school's student loan fund for expenses the Secretary may reasonably incur in attempting collection), but only if the school has complied with such requirements as the Secretary may specify by regulation with respect to the collection of loans under this subpart. A loan so referred shall be treated as a debt subject to section 5514 of title 5, United States Code. Amounts collected shall be deposited in the school's student loan fund. Whenever the Secretary desires the institution of a civil action regarding any such loan, the Secretary shall refer the matter to the Attorney General for appropriate action.
(m)

Elimination of Statute of Limitation for Loan Collections.—
(1)

Purpose.—
It is the purpose of this subsection to ensure that obligations to repay loans under this section are enforced without regard to any Federal or State statutory, regulatory, or administrative limitation on the period within which debts may be enforced.
(2)

Prohibition.—
Notwithstanding any other provision of Federal or State law, no limitation shall terminate the period within which suit may be filed, a judgment may be enforced, or an offset, garnishment, or other action may be initiated or taken by a school that has an agreement with the Secretary pursuant to section 721 that is seeking the repayment of the amount due from a borrower on a loan made under this subpart after the default of the borrower on such loan.
SEC. 723.
[292s]

MEDICAL SCHOOLS AND PRIMARY HEALTH CARE.
(a)

Requirements for Students.—
(1)

In general.—
Subject to the provisions of this subsection, in the case of student loan funds established under section 721 by schools of medicine or osteopathic medicine, each agreement entered into under such section with such a school shall provide (in addition to the provisions required in subsection (b) of such section) that the school will make a loan from such fund to a student only if the student agrees—
(A)
to enter and complete a residency training program in primary health care not later than 4 years after the date on which the student graduates from such school; and
(B)
to practice in such care for 10 years (including residency training in primary health care) or through the date on which the loan is repaid in full, whichever occurs first.
(2)

Inapplicability to certain students.—
(A)
The requirement established in paragraph (1) regarding the student loan fund of a school does not apply to a student if—
(i)
the first loan to the student from such fund is made before July 1, 1993; or
(ii)
the loan is made from—
(I)
a Federal capital contribution under section 721 that is made from amounts appropriated under section 724(f) (in this section referred to as an “exempt Federal capital contribution”); or
(II)
a school contribution made under section 721 pursuant to such a Federal capital contribution (in this section referred to as an “exempt school contribution”).
(B)
A Federal capital contribution under section 721 may not be construed as being an exempt Federal capital contribution if the contribution was made from amounts appropriated before October 1, 1990. A school contribution under section 721 may not be construed as being an exempt school contribution if the contribution was made pursuant to a Federal capital contribution under such section that was made from amounts appropriated before such date.
(3)

Noncompliance by student.—
Each agreement entered into with a student pursuant to paragraph (1) shall provide that, if the student fails to comply with such agreement, the loan involved will begin to accrue interest at a rate of 2 percent per year greater than the rate at which the student would pay if compliant in such year.
(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.
(b)

Requirements for Schools.—
(1)

In general.—
Subject to the provisions of this subsection, in the case of student loan funds established under section 721 by schools of medicine or osteopathic medicine, each agreement entered into under such section with such a school shall provide (in addition to the provisions required in subsection (b) of such section) that, for the 1-year period ending on June 30, 1997;4 and for the 1-year period ending on June 30 of each subsequent fiscal year, the school will meet not less than 1 of the conditions described in paragraph (2) with respect to graduates of the school whose date of graduation from the school occurred approximately 4 years before the end of the 1-year period involved.
^4
So in law. See section 2014(c)(2)(A)(i) of Public Law 103–43 (107 Stat. 216). The semicolon probably should be a comma.
(2)

Description of conditions.—
With respect to graduates described in paragraph (1) (in this paragraph referred to as “designated graduates”), the conditions referred to in such paragraph for a school for a 1-year period are as follows:
(A)
Not less than 50 percent of designated graduates of the school meet the criterion of either being in a residency training program in primary health care, or being engaged in a practice in such care (having completed such a program).
(B)
Not less than 25 percent of the designated graduates of the school meet such criterion, and such percentage is not less than 5 percentage points above the percentage of such graduates meeting such criterion for the preceding 1-year period.
(C)
In the case of schools of medicine or osteopathic medicine with student loans funds under section 721, the school involved is at or above the 75th percentile of such schools whose designated graduates meet such criterion.
(3)

Determinations by secretary.—
Not later than 90 days after the close of each 1-year period described in paragraph (1), the Secretary shall make a determination of whether the school involved has for such period complied with such paragraph and shall in writing inform the school of the determination. Such determination shall be made only after consideration of the report submitted to the Secretary by the school under paragraph (6).
(4)

Noncompliance by school.—
(A)
(i)
Subject to subparagraph (C), each agreement under section 721 with a school of medicine or osteopathic medicine shall provide that, if the school fails to comply with paragraph (1) for a 1-year period under such paragraph, the school—
(I)
will pay to the Secretary the amount applicable under subparagraph (B) for the period; and
(II)
will pay such amount not later than 90 days after the school is informed under paragraph (3) of the determination of the Secretary regarding such period.
(ii)
Any amount that a school is required to pay under clause (i) may be paid from the student loan fund of the school under section 721.
(B)
For purposes of subparagraph (A), the amount applicable for a school, subject to subparagraph (C), is—
(i)
for the 1-year period ending June 30, 1997, an amount equal to 10 percent of the income received during such period by the student loan fund of the school under section 721;
(ii)
for the 1-year period ending June 30, 1998, an amount equal to 20 percent of the income received during such period by the student loan fund; and
(iii)
for any subsequent 1-year period under paragraph (1), an amount equal to 30 percent of the income received during such period by the student loan fund.
(C)
In determining the amount of income that a student loan fund has received for purposes of subparagraph (B), the Secretary shall exclude any income derived from exempt contributions. Payments made to the Secretary under subparagraph (A) may not be made with such contributions or with income derived from such contributions.
(5)

Expenditure of payments.—
(A)
Amounts paid to the Secretary under paragraph (4) shall be expended to make Federal capital contributions to student loan funds under section 721 of schools that are in compliance with paragraph (1).
(B)
A Federal capital contribution under section 721 may not be construed as being an exempt Federal capital contribution if the contribution is made from payments under subparagraph (A). A school contribution under such section may not be construed as being an exempt school contribution if the contribution is made pursuant to a Federal capital contribution from such payments.
(6)

Reports by schools.—
Each agreement under section 721 with a school of medicine or osteopathic medicine shall provide that the school will submit to the Secretary a report for each 1-year period under paragraph (1) that provides such information as the Secretary determines to be necessary for carrying out this subsection. Each such report shall include statistics concerning the current training or practice status of all graduates of such school whose date of graduation from the school occurred approximately 4 years before the end of the 1-year period involved.
(c)

Definitions.—
For purposes of this section:
(1)
The term “exempt contributions” means exempt Federal capital contributions and exempt school contributions.
(2)
The term “exempt Federal capital contribution” means a Federal capital contribution described in subclause (I) of subsection (a)(2)(A)(ii).
(3)
The term “exempt school contribution” means a school contribution described in subclause (II) of subsection (a)(2)(A)(ii).
(4)
The term “income”, with respect to a student fund under section 721, means payments of principal and interest on any loan made from the fund, and any other earnings of the fund.
(5)
The term “primary health care” means family medicine, general internal medicine, general pediatrics, preventive medicine, or osteopathic general practice.
(d)

Sense of Congress.—
It is the sense of Congress that funds repaid under the loan program under this section should not be transferred to the Treasury of the United States or otherwise used for any other purpose other than to carry out this section.
SEC. 724.
[292t]

INDIVIDUALS FROM DISADVANTAGED BACKGROUNDS.
(a)

Fund Agreements Regarding Certain Amounts.—
With respect to amounts appropriated under subsection (f), each agreement entered into under section 721 with a school shall provide (in addition to the provisions required in subsection (b) of such section) that—
(1)
any Federal capital contribution made to the student loan fund of the school from such amounts, together with the school contribution appropriate under subsection (b)(2)(B) of such section to the amount of the Federal capital contribution, will be utilized only for the purpose of—
(A)
making loans to individuals from disadvantaged backgrounds; and
(B)
the costs of the collection of the loans and interest on the loans; and
(2)
collections of principal and interest on loans made pursuant to paragraph (1), and any other earnings of the student loan fund attributable to amounts that are in the fund pursuant to such paragraph, will be utilized only for the purpose described in such paragraph.
(b)

Minimum Qualifications for Schools.—
The Secretary may not make a Federal capital contribution for purposes of subsection (a) for a fiscal year unless the health professions school involved—
(1)
is carrying out a program for recruiting and retaining students from disadvantaged backgrounds, including racial and ethnic minorities; and
(2)
is carrying out a program for recruiting and retaining minority faculty.
(c)

Certain Agreements Regarding Education of Students; Date Certain for Compliance.—
The Secretary may not make a Federal capital contribution for purposes of subsection (a) for a fiscal year unless the health professions school involved agrees—
(1)
to ensure that adequate instruction regarding minority health issues is provided for in the curricula of the school;
(2)
with respect to health clinics providing services to a significant number of individuals who are from disadvantaged backgrounds, including members of minority groups, to enter into arrangements with 1 or more such clinics for the purpose of providing students of the school with experience in providing clinical services to such individuals;
(3)
with respect to public or nonprofit private secondary educational institutions and undergraduate institutions of higher education, to enter into arrangements with 1 or more such institutions for the purpose of carrying out programs regarding the educational preparation of disadvantaged students, including minority students, to enter the health professions and regarding the recruitment of such individuals into the health professions;
(4)
to establish a mentor program for assisting disadvantaged students, including minority students, regarding the completion of the educational requirements for degrees from the school;
(5)
to be carrying out each of the activities specified in any of paragraphs (1) through (4) by not later than 1 year after the date on which the first Federal capital contribution is made to the school for purposes of subsection (a); and
(6)
to continue carrying out such activities, and the activities specified in paragraphs (1) and (2) of subsection (b), throughout the period during which the student loan fund established pursuant to section 721(b) is in operation.
(d)

Availability of Other Amounts.—
With respect to Federal capital contributions to student loan funds under agreements under section 721(b), any such contributions made before October 1, 1990, together with the school contributions appropriate under paragraph (2)(B) of such section to the amount of the Federal capital contributions, may be utilized for the purpose of making loans to individuals from disadvantaged backgrounds, subject to section 723(a)(2)(B).
(e)

Definition.—
For purposes of this section, the term “disadvantaged”, with respect to an individual, shall be defined by the Secretary.
(f)

Authorization of Appropriations.—
[(1)
Repealed by section 132(b) of Public Law 105–392 (112 Stat. 3575).]
(2)

Special consideration for certain schools.—
In making Federal capital contributions to student loan funds for purposes of subsection (a), the Secretary shall give special consideration to health professions schools that have enrollments of underrepresented minorities above the national average for health professions schools.
SEC. 725.
[292u]

ADMINISTRATIVE PROVISIONS.
The Secretary may agree to modifications of agreements or loans made under this subpart, and may compromise, waive, or release any right, title, claim, or demand of the United States arising or acquired under this subpart.
SEC. 726.
[292v]

PROVISION BY SCHOOLS OF INFORMATION TO STUDENTS.
(a)

In General.—
With respect to loans made by a school under this subpart after June 30, 1986, each school, in order to carry out the provisions of sections 721 and 722, shall, at any time such school makes such a loan to a student under this subpart, provide thorough and adequate loan information on loans made under this subpart to the student. The loan information required to be provided to the student by this subsection shall include—
(1)
the yearly and cumulative maximum amounts that may be borrowed by the student;
(2)
the terms under which repayment of the loan will begin;
(3)
the maximum number of years in which the loan must be repaid;
(4)
the interest rate that will be paid by the borrower and the minimum amount of the required monthly payment;
(5)
the amount of any other fees charged to the borrower by the lender;
(6)
any options the borrower may have for deferral, cancellation, prepayment, consolidation, or other refinancing of the loan;
(7)
a definition of default on the loan and a specification of the consequences which will result to the borrower if the borrower defaults, including a description of any arrangements which may be made with credit bureau organizations;
(8)
to the extent practicable, the effect of accepting the loan on the eligibility of the borrower for other forms of student assistance; and
(9)
a description of the actions that may be taken by the Federal Government to collect the loan, including a description of the type of information concerning the borrower that the Federal Government may disclose to (A) officers, employees, or agents of the Department of Health and Human Services, (B) officers, employees, or agents of schools with which the Secretary has an agreement under this subpart, or (C) any other person involved in the collection of a loan under this subpart.
(b)

Statement Regarding Loan.—
Each school shall, immediately prior to the graduation from such school of a student who receives a loan under this subpart after June 30, 1986, provide such student with a statement specifying—
(1)
each amount borrowed by the student under this subpart;
(2)
the total amount borrowed by the student under this subpart; and
(3)
a schedule for the repayment of the amounts borrowed under this subpart, including the number, amount, and frequency of payments to be made.
SEC. 727.
[292w]

PROCEDURES FOR APPEAL OF TERMINATION OF AGREEMENTS.
In any case in which the Secretary intends to terminate an agreement with a school under this subpart, the Secretary shall provide the school with a written notice specifying such intention and stating that the school may request a formal hearing with respect to such termination. If the school requests such a hearing within 30 days after the receipt of such notice, the Secretary shall provide such school with a hearing conducted by an administrative law judge.
SEC. 728.
[292x]

DISTRIBUTION OF ASSETS FROM LOAN FUNDS.
(a)

Distribution After Termination of Fund.—
If a school terminates a loan fund established under an agreement pursuant to section 721(b), or if the Secretary for good cause terminates the agreement with the school, there shall be a capital distribution as follows:
(1)
The Secretary shall first be paid an amount which bears the same ratio to such balance in such fund on the date of termination of the fund as the total amount of the Federal capital contributions to such fund by the Secretary pursuant to section 721(b)(2)(A) bears to the total amount in such fund derived from such Federal capital contributions and from funds deposited therein pursuant to section 721(b)(2)(B).
(2)
The remainder of such balance shall be paid to the school.
(b)

Payment of Proportionate Share to Secretary.—
If a capital distribution is made under subsection (a), the school involved shall, after the capital distribution, pay to the Secretary, not less often than quarterly, the same proportionate share of amounts received by the school in payment of principal or interest on loans made from the loan fund established pursuant to section 721(b) as was determined by the Secretary under subsection (a).
SEC. 735.5
[292y]

GENERAL PROVISIONS.
^5
Title VII does not have sections 729 through 734. See section 102 of Public Law 102–408 (106 Stat. 1994, 2021).
(a)

Date Certain for Applications.—
The Secretary shall from time to time set dates by which schools must file applications for Federal capital contributions.
(b)

Contingent Reduction in Allotments.—
If the total of the amounts requested for any fiscal year in such applications exceeds the amounts appropriated under this section for that fiscal year, the allotment to the loan fund of each such school shall be reduced to whichever of the following is the smaller: (A) the amount requested in its application; or (B) an amount which bears the same ratio to the amounts appropriated as the number of students estimated by the Secretary to be enrolled in such school during such fiscal year bears to the estimated total number of students in all such schools during such year. Amounts remaining after allotment under the preceding sentence shall be reallotted in accordance with clause (B) of such sentence among schools whose applications requested more than the amounts so allotted to their loan funds, but with such adjustments as may be necessary to prevent the total allotted to any such school's loan fund from exceeding the total so requested by it.
(c)

Allotment of Excess Funds.—
Funds available in any fiscal year for payment to schools under this subpart which are in excess of the amount appropriated pursuant to this section for that year shall be allotted among schools in such manner as the Secretary determines will best carry out the purposes of this subpart.
(d)

Payment of Installments to Schools.—
Allotments to a loan fund of a school shall be paid to it from time to time in such installments as the Secretary determines will not result in unnecessary accumulations in the loan fund at such school.
(e)

Disposition of Funds Returned to Secretary.—
(1)

Expenditure for federal capital contributions.—
Subject to section 723(b)(5), any amounts from student loan funds under section 721 that are returned to the Secretary by health professions schools shall be expended to make Federal capital contributions to such funds.
(2)

Date certain for contributions.—
Amounts described in paragraph (1) that are returned to the Secretary shall be obligated before the end of the succeeding fiscal year.
(3)

Preference in making contributions.—
In making Federal capital contributions to student loans funds under section 721 for a fiscal year from amounts described in paragraph (1), the Secretary shall give preference to health professions schools of the same disciplines as the health professions schools returning such amounts for the period during which the amounts expended for such contributions were received by the Secretary. Any such amounts that, prior to being so returned, were available only for the purpose of loans under this subpart to individuals from disadvantaged backgrounds shall be available only for such purpose.
(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.
PART B—

HEALTH PROFESSIONS TRAINING FOR DIVERSITY
SEC. 736.
[293]

CENTERS OF EXCELLENCE.
(a)

In General.—
The Secretary shall make grants to, and enter into contracts with, designated health professions schools described in subsection (c), and other public and nonprofit health or educational entities, for the purpose of assisting the schools in supporting programs of excellence in health professions education for under-represented minority individuals.
(b)

Required Use of Funds.—
The Secretary may not make a grant under subsection (a) unless the designated health professions school involved agrees, subject to subsection (c)(1)(C), to expend the grant—
(1)
to develop a large competitive applicant pool through linkages with institutions of higher education, local school districts, and other community-based entities and establish an education pipeline for health professions careers;
(2)
to establish, strengthen, or expand programs to enhance the academic performance of under-represented minority students attending the school;
(3)
to improve the capacity of such school to train, recruit, and retain under-represented minority faculty including the payment of such stipends and fellowships as the Secretary may determine appropriate;
(4)
to carry out activities to improve the information resources, clinical education, curricula and cultural competence of the graduates of the school, as it relates to minority health issues;
(5)
to facilitate faculty and student research on health issues particularly affecting under-represented minority groups, including research on issues relating to the delivery of health care;
(6)
to carry out a program to train students of the school in providing health services to a significant number of under-represented minority individuals through training provided to such students at community-based health facilities that—
(A)
provide such health services; and
(B)
are located at a site remote from the main site of the teaching facilities of the school; and
(7)
to provide stipends as the Secretary determines appropriate, in amounts as the Secretary determines appropriate.
(c)

Centers of Excellence.—
(1)

Designated schools.—
(A)

In general.—
The designated health professions schools referred to in subsection (a) are such schools that meet each of the conditions specified in subparagraphs (B) and (C), and that—
(i)
meet each of the conditions specified in paragraph (2)(A);
(ii)
meet each of the conditions specified in paragraph (3);
(iii)
meet each of the conditions specified in paragraph (4); or
(iv)
meet each of the conditions specified in paragraph (5).
(B)

General conditions.—
The conditions specified in this subparagraph are that a designated health professions school—
(i)
has a significant number of under-represented minority individuals enrolled in the school, including individuals accepted for enrollment in the school;
(ii)
has been effective in assisting under-represented minority students of the school to complete the program of education and receive the degree involved;
(iii)
has been effective in recruiting under-represented minority individuals to enroll in and graduate from the school, including providing scholarships and other financial assistance to such individuals and encouraging under-represented minority students from all levels of the educational pipeline to pursue health professions careers; and
(iv)
has made significant recruitment efforts to increase the number of under-represented minority individuals serving in faculty or administrative positions at the school.
(C)

Consortium.—
The condition specified in this subparagraph is that, in accordance with subsection (e)(1), the designated health profession school involved has with other health profession schools (designated or otherwise) formed a consortium to carry out the purposes described in subsection (b) at the schools of the consortium.
(D)

Application of criteria to other programs.—
In the case of any criteria established by the Secretary for purposes of determining whether schools meet the conditions described in subparagraph (B), this section may not, with respect to racial and ethnic minorities, be construed to authorize, require, or prohibit the use of such criteria in any program other than the program established in this section.
(2)

Centers of excellence at certain historically black colleges and universities.—
(A)

Conditions.—
The conditions specified in this subparagraph are that a designated health professions school—
(i)
is a school described in section 799B(1); and
(ii)
received a contract under section 788B for fiscal year 1987, as such section was in effect for such fiscal year.
(B)

Use of grant.—
In addition to the purposes described in subsection (b), a grant under subsection (a) to a designated health professions school meeting the conditions described in subparagraph (A) may be expended—
(i)
to develop a plan to achieve institutional improvements, including financial independence, to enable the school to support programs of excellence in health professions education for under-represented minority individuals; and
(ii)
to provide improved access to the library and informational resources of the school.
(C)

Exception.—
The requirements of paragraph (1)(C) shall not apply to a historically black college or university that receives funding under paragraphs (2) or (5)6.
^6
So in law. Probably should read “paragraph (2) or (5)”.
(3)

Hispanic centers of excellence.—
The conditions specified in this paragraph are that—
(A)
with respect to Hispanic individuals, each of clauses (i) through (iv) of paragraph (1)(B) applies to the designated health professions school involved;
(B)
the school agrees, as a condition of receiving a grant under subsection (a), that the school will, in carrying out the duties described in subsection (b), give priority to carrying out the duties with respect to Hispanic individuals; and
(C)
the school agrees, as a condition of receiving a grant under subsection (a), that—
(i)
the school will establish an arrangement with 1 or more public or nonprofit community based Hispanic serving organizations, or public or nonprofit private institutions of higher education, including schools of nursing, whose enrollment of students has traditionally included a significant number of Hispanic individuals, the purposes of which will be to carry out a program—
(I)
to identify Hispanic students who are interested in a career in the health profession involved; and
(II)
to facilitate the educational preparation of such students to enter the health professions school; and
(ii)
the school will make efforts to recruit Hispanic students, including students who have participated in the undergraduate or other matriculation program carried out under arrangements established by the school pursuant to clause (i)(II) and will assist Hispanic students regarding the completion of the educational requirements for a degree from the school.
(4)

Native american centers of excellence.—
Subject to subsection (e), the conditions specified in this paragraph are that—
(A)
with respect to Native Americans, each of clauses (i) through (iv) of paragraph (1)(B) applies to the designated health professions school involved;
(B)
the school agrees, as a condition of receiving a grant under subsection (a), that the school will, in carrying out the duties described in subsection (b), give priority to carrying out the duties with respect to Native Americans; and
(C)
the school agrees, as a condition of receiving a grant under subsection (a), that—
(i)
the school will establish an arrangement with 1 or more public or nonprofit private institutions of higher education, including schools of nursing, whose enrollment of students has traditionally included a significant number of Native Americans, the purpose of which arrangement will be to carry out a program—
(I)
to identify Native American students, from the institutions of higher education referred to in clause (i), who are interested in health professions careers; and
(II)
to facilitate the educational preparation of such students to enter the designated health professions school; and
(ii)
the designated health professions school will make efforts to recruit Native American students, including students who have participated in the undergraduate program carried out under arrangements established by the school pursuant to clause (i) and will assist Native American students regarding the completion of the educational requirements for a degree from the designated health professions school.
(5)

Other centers of excellence.—
The conditions specified in this paragraph are—
(A)
with respect to other centers of excellence, the conditions described in clauses (i) through (iv) of paragraph (1)(B); and
(B)
that the health professions school involved has an enrollment of under-represented minorities above the national average for such enrollments of health professions schools.
(d)

Designation as Center of Excellence.—
(1)

In general.—
Any designated health professions school receiving a grant under subsection (a) and meeting the conditions described in paragraph (2) or (5) of subsection (c) shall, for purposes of this section, be designated by the Secretary as a Center of Excellence in Under-Represented Minority Health Professions Education.
(2)

Hispanic centers of excellence.—
Any designated health professions school receiving a grant under subsection (a) and meeting the conditions described in subsection (c)(3) shall, for purposes of this section, be designated by the Secretary as a Hispanic Center of Excellence in Health Professions Education.
(3)

Native american centers of excellence.—
Any designated health professions school receiving a grant under subsection (a) and meeting the conditions described in subsection (c)(4) shall, for purposes of this section, be designated by the Secretary as a Native American Center of Excellence in Health Professions Education. Any consortium receiving such a grant pursuant to subsection (e) shall, for purposes of this section, be so designated.
(e)

Authority Regarding Native American Centers of Excellence.—
With respect to meeting the conditions specified in subsection (c)(4), the Secretary may make a grant under subsection (a) to a designated health professions school that does not meet such conditions if—
(1)
the school has formed a consortium in accordance with subsection (d)(1); and
(2)
the schools of the consortium collectively meet such conditions, without regard to whether the schools individually meet such conditions.
(f)

Duration of Grant.—
The period during which payments are made under a grant under subsection (a) may not exceed 5 years. Such payments shall be subject to annual approval by the Secretary and to the availability of appropriations for the fiscal year involved to make the payments.
(g)

Definitions.—
In this section:
(1)

Designated health professions school.—
(A)

In general.—
The term “health professions school” means, except as provided in subparagraph (B), a school of medicine, a school of osteopathic medicine, a school of dentistry, a school of pharmacy, or a graduate program in behavioral or mental health.
(B)

Exception.—
The definition established in subparagraph (A) shall not apply to the use of the term “designated health professions school” for purposes of subsection (c)(2).
(2)

Program of excellence.—
The term “program of excellence” means any program carried out by a designated health professions school with a grant made under subsection (a), if the program is for purposes for which the school involved is authorized in subsection (b) or (c) to expend the grant.
(3)

Native americans.—
The term “Native Americans” means American Indians, Alaskan Natives, Aleuts, and Native Hawaiians.
(h)

Formula for Allocations.—
(1)

Allocations.—
Based on the amount appropriated under subsection (i) for a fiscal year, the following subparagraphs shall apply as appropriate:
(A)

In general.—
If the amounts appropriated under subsection (i) for a fiscal year are $24,000,000 or less—
(i)
the Secretary shall make available $12,000,000 for grants under subsection (a) to health professions schools that meet the conditions described in subsection (c)(2)(A); and
(ii)
and available after grants are made with funds under clause (i), the Secretary shall make available—
(I)
60 percent of such amount for grants under subsection (a) to health professions schools that meet the conditions described in paragraph (3) or (4) of subsection (c) (including meeting the conditions under subsection (e)); and
(II)
40 percent of such amount for grants under subsection (a) to health professions schools that meet the conditions described in subsection (c)(5).
(B)

Funding in excess of $24,000,000.—
If amounts appropriated under subsection (i) for a fiscal year exceed $24,000,000 but are less than $30,000,000—
(i)
80 percent of such excess amounts shall be made available for grants under subsection (a) to health professions schools that meet the requirements described in paragraph (3) or (4) of subsection (c) (including meeting conditions pursuant to subsection (e)); and
(ii)
20 percent of such excess amount shall be made available for grants under subsection (a) to health professions schools that meet the conditions described in subsection (c)(5).
(C)

Funding in excess of $30,000,000.—
If amounts appropriated under subsection (i) for a fiscal year exceed $30,000,000 but are less than $40,000,000, the Secretary shall make available—
(i)
not less than $12,000,000 for grants under subsection (a) to health professions schools that meet the conditions described in subsection (c)(2)(A);
(ii)
not less than $12,000,000 for grants under subsection (a) to health professions schools that meet the conditions described in paragraph (3) or (4) of subsection (c) (including meeting conditions pursuant to subsection (e));
(iii)
not less than $6,000,000 for grants under subsection (a) to health professions schools that meet the conditions described in subsection (c)(5); and
(iv)
after grants are made with funds under clauses (i) through (iii), any remaining excess amount for grants under subsection (a) to health professions schools that meet the conditions described in paragraph (2)(A), (3), (4), or (5) of subsection (c).
(D)

Funding in excess of $40,000,000.—
If amounts appropriated under subsection (i) for a fiscal year are $40,000,000 or more, the Secretary shall make available—
(i)
not less than $16,000,000 for grants under subsection (a) to health professions schools that meet the conditions described in subsection (c)(2)(A);
(ii)
not less than $16,000,000 for grants under subsection (a) to health professions schools that meet the conditions described in paragraph (3) or (4) of subsection (c) (including meeting conditions pursuant to subsection (e));
(iii)
not less than $8,000,000 for grants under subsection (a) to health professions schools that meet the conditions described in subsection (c)(5); and
(iv)
after grants are made with funds under clauses (i) through (iii), any remaining funds for grants under subsection (a) to health professions schools that meet the conditions described in paragraph (2)(A), (3), (4), or (5) of subsection (c).
(2)

No limitation.—
Nothing in this subsection shall be construed as limiting the centers of excellence referred to in this section to the designated amount, or to preclude such entities from competing for grants under this section.
(3)

Maintenance of effort.—
(A)

In general.—
With respect to activities for which a grant made under this part are authorized to be expended, the Secretary may not make such a grant to a center of excellence for any fiscal year unless the center agrees to maintain expenditures of non-Federal amounts for such activities at a level that is not less than the level of such expenditures maintained by the center for the fiscal year preceding the fiscal year for which the school receives such a grant.
(B)

Use of federal funds.—
With respect to any Federal amounts received by a center of excellence and available for carrying out activities for which a grant under this part is authorized to be expended, the center shall, before expending the grant, expend the Federal amounts obtained from sources other than the grant, unless given prior approval from the Secretary.
(i)

Authorization of Appropriations.—
To carry out this section, there is authorized to be appropriated $23,711,000 for each of fiscal years 2021 through 2025.
SEC. 737.
[293a]

SCHOLARSHIPS FOR DISADVANTAGED STUDENTS.
(a)

In General.—
The Secretary may make a grant to an eligible entity (as defined in subsection (d)(1)) under this section for the awarding of scholarships by schools to any full-time student who is an eligible individual as defined in subsection (d). Such scholarships may be expended only for tuition expenses, other reasonable educational expenses, and reasonable living expenses incurred in the attendance of such school.
(b)

Preference in Providing Scholarships.—
The Secretary may not make a grant to an entity under subsection (a) unless the health professions and nursing schools involved agree that, in providing scholarships pursuant to the grant, the schools will give preference to students for whom the costs of attending the schools would constitute a severe financial hardship and, notwithstanding other provisions of this section, to former recipients of scholarships under sections 736 and 740(d)(2)(B) (as such sections existed on the day before the date of enactment of this section).
(c)

Amount of Award.—
In awarding grants to eligible entities that are health professions and nursing schools, the Secretary shall give priority to eligible entities based on the proportion of graduating students going into primary care, the proportion of underrepresented minority students, and the proportion of graduates working in medically underserved communities.
(d)

Definitions.—
In this section:
(1)

Eligible entities.—
The term “eligible entities” means an entity that—
(A)
is a school of medicine, osteopathic medicine, dentistry, nursing (as defined in section 801), pharmacy, podiatric medicine, optometry, veterinary medicine, public health, chiropractic, or allied health, a school offering a graduate program in behavioral and mental health practice, or an entity providing programs for the training of physician assistants; and
(B)
is carrying out a program for recruiting and retaining students from disadvantaged backgrounds, including students who are members of racial and ethnic minority groups.
(2)

Eligible individual.—
The term “eligible individual” means an individual who—
(A)
is from a disadvantaged background;
(B)
has a financial need for a scholarship; and
(C)
is enrolled (or accepted for enrollment) at an eligible health professions or nursing school as a full-time student in a program leading to a degree in a health profession or nursing.
SEC. 738.
[293b]

LOAN REPAYMENTS AND FELLOWSHIPS REGARDING FACULTY POSITIONS.
(a)

Loan Repayments.—
(1)

Establishment of program.—
The Secretary shall establish a program of entering into contracts with individuals described in paragraph (2) under which the individuals agree to serve as members of the faculties of schools described in paragraph (3) in consideration of the Federal Government agreeing to pay, for each year of such service, not more than $30,000 of the principal and interest of the educational loans of such individuals.
(2)

Eligible individuals.—
The individuals referred to in paragraph (1) are individuals from disadvantaged backgrounds who—
(A)
have a degree in medicine, osteopathic medicine, dentistry, nursing, or another health profession;
(B)
are enrolled in an approved graduate training program in medicine, osteopathic medicine, dentistry, nursing, or other health profession; or
(C)
are enrolled as full-time students—
(i)
in an accredited (as determined by the Secretary) school described in paragraph (3); and
(ii)
in the final year of a course of a study or program, offered by such institution and approved by the Secretary, leading to a degree from such a school.
(3)

Eligible health professions schools.—
The schools described in this paragraph are schools of medicine, nursing (as schools of nursing are defined in section 801), osteopathic medicine, dentistry, pharmacy, allied health, podiatric medicine, optometry, veterinary medicine, or public health, schools offering physician assistant education programs, or schools offering graduate programs in behavioral and mental health.
(4)

Requirements regarding faculty positions.—
The Secretary may not enter into a contract under paragraph (1) unless—
(A)
the individual involved has entered into a contract with a school described in paragraph (3) to serve as a member of the faculty of the school for not less than 2 years; and
(B)
the contract referred to in subparagraph (A) provides that—
(i)
the school will, for each year for which the individual will serve as a member of the faculty under the contract with the school, make payments of the principal and interest due on the educational loans of the individual for such year in an amount equal to the amount of such payments made by the Secretary for the year;
(ii)
the payments made by the school pursuant to clause (i) on behalf of the individual will be in addition to the pay that the individual would otherwise receive for serving as a member of such faculty; and
(iii)
the school, in making a determination of the amount of compensation to be provided by the school to the individual for serving as a member of the faculty, will make the determination without regard to the amount of payments made (or to be made) to the individual by the Federal Government under paragraph (1).
(5)

Applicability of certain provisions.—
The provisions of sections 338C, 338G, and 338I 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 subpart III of part D of title III, including the applicability of provisions regarding reimbursements for increased tax liability and regarding bankruptcy.
(6)

Waiver regarding school contributions.—
The Secretary may waive the requirement established in paragraph (4)(B) if the Secretary determines that the requirement will impose an undue financial hardship on the school involved.
(b)

Fellowships.—
(1)

In general.—
The Secretary may make grants to and enter into contracts with eligible entities to assist such entities in increasing the number of underrepresented minority individuals who are members of the faculty of such schools.
(2)

Applications.—
To be eligible to receive a grant or contract under this subsection, an entity shall provide an assurance, in the application submitted by the entity, that—
(A)
amounts received under such a grant or contract will be used to award a fellowship to an individual only if the individual meets the requirements of paragraphs (3) and (4); and
(B)
each fellowship awarded pursuant to the grant or contract will include—
(i)
a stipend in an amount not exceeding 50 percent of the regular salary of a similar faculty member for not to exceed 3 years of training; and
(ii)
an allowance for other expenses, such as travel to professional meetings and costs related to specialized training.
(3)

Eligibility.—
To be eligible to receive a grant or contract under paragraph (1), an applicant shall demonstrate to the Secretary that such applicant has or will have the ability to—
(A)
identify, recruit and select underrepresented minority individuals who have the potential for teaching, administration, or conducting research at a health professions institution;
(B)
provide such individuals with the skills necessary to enable them to secure a tenured faculty position at such institution, which may include training with respect to pedagogical skills, program administration, the design and conduct of research, grants writing, and the preparation of articles suitable for publication in peer reviewed journals;
(C)
provide services designed to assist such individuals in their preparation for an academic career, including the provision of counselors; and
(D)
provide health services to rural or medically underserved populations.
(4)

Requirements.—
To be eligible to receive a grant or contract under paragraph (1) an applicant shall—
(A)
provide an assurance that such applicant will make available (directly through cash donations) $1 for every $1 of Federal funds received under this section for the fellowship;
(B)
provide an assurance that institutional support will be provided for the individual for the second and third years at a level that is equal to the total amount of institutional funds provided in the year in which the grant or contract was awarded;
(C)
provide an assurance that the individual that will receive the fellowship will be a member of the faculty of the applicant school; and
(D)
provide an assurance that the individual that will receive the fellowship will have, at a minimum, appropriate advanced preparation (such as a master's or doctoral degree) and special skills necessary to enable such individual to teach and practice.
(5)

Definition.—
For purposes of this subsection, the term “underrepresented minority individuals” means individuals who are members of racial or ethnic minority groups that are underrepresented in the health professions including nursing.
SEC. 739.
[293c]

EDUCATIONAL ASSISTANCE IN THE HEALTH PROFESSIONS REGARDING INDIVIDUALS FROM DISADVANTAGED BACKGROUNDS.
(a)

In General.—
(1)

Authority for grants.—
For the purpose of assisting individuals from disadvantaged backgrounds, as determined in accordance with criteria prescribed by the Secretary, to undertake education to enter a health profession, the Secretary may make grants to and enter into contracts with schools of medicine, osteopathic medicine, public health, dentistry, veterinary medicine, optometry, pharmacy, allied health, chiropractic, and podiatric medicine, public and nonprofit private schools that offer graduate programs in behavioral and mental health, programs for the training of physician assistants, and other public or private nonprofit health or educational entities to assist in meeting the costs described in paragraph (2).
(2)

Authorized expenditures.—
A grant or contract under paragraph (1) may be used by the entity to meet the cost of—
(A)
identifying, recruiting, and selecting individuals from disadvantaged backgrounds, as so determined, for education and training in a health profession;
(B)
facilitating the entry of such individuals into such a school;
(C)
providing counseling, mentoring, or other services designed to assist such individuals to complete successfully their education at such a school;
(D)
providing, for a period prior to the entry of such individuals into the regular course of education of such a school, preliminary education and health research training designed to assist them to complete successfully such regular course of education at such a school, or referring such individuals to institutions providing such preliminary education;
(E)
publicizing existing sources of financial aid available to students in the education program of such a school or who are undertaking training necessary to qualify them to enroll in such a program;
(F)
paying such scholarships as the Secretary may determine for such individuals for any period of health professions education at a health professions school;
(G)
paying such stipends as the Secretary may approve for such individuals for any period of education in student-enhancement programs (other than regular courses), except that such a stipend may not be provided to an individual for more than 12 months, and such a stipend shall be in an amount determined appropriate by the Secretary (notwithstanding any other provision of law regarding the amount of stipends);
(H)
carrying out programs under which such individuals gain experience regarding a career in a field of primary health care through working at facilities of public or private nonprofit community-based providers of primary health services; and
(I)
conducting activities to develop a larger and more competitive applicant pool through partnerships with institutions of higher education, school districts, and other community-based entities.
(3)

Definition.—
In this section, the term “regular course of education of such a school” as used in subparagraph (D) includes a graduate program in behavioral or mental health.
(b)

Requirements for Awards.—
In making awards to eligible entities under subsection (a)(1), the Secretary shall give preference to approved applications for programs that involve a comprehensive approach by several public or nonprofit private health or educational entities to establish, enhance and expand educational programs that will result in the development of a competitive applicant pool of individuals from disadvantaged backgrounds who desire to pursue health professions careers. In considering awards for such a comprehensive partnership approach, the following shall apply with respect to the entity involved:
(1)
The entity shall have a demonstrated commitment to such approach through formal agreements that have common objectives with institutions of higher education, school districts, and other community-based entities.
(2)
Such formal agreements shall reflect the coordination of educational activities and support services, increased linkages, and the consolidation of resources within a specific geographic area.
(3)
The design of the educational activities involved shall provide for the establishment of a competitive health professions applicant pool of individuals from disadvantaged backgrounds by enhancing the total preparation (academic and social) of such individuals to pursue a health professions career.
(4)
The programs or activities under the award shall focus on developing a culturally competent health care workforce that will serve the unserved and underserved populations within the geographic area.
(c)

Equitable Allocation of Financial Assistance.—
The Secretary, to the extent practicable, shall ensure that services and activities under subsection (a) are adequately allocated among the various racial and ethnic populations who are from disadvantaged backgrounds.
(d)

Matching Requirements.—
The Secretary may require that an entity that applies for a grant or contract under subsection (a), provide non-Federal matching funds, as appropriate, to ensure the institutional commitment of the entity to the projects funded under the grant or contract. As determined by the Secretary, such non-Federal matching funds may be provided directly or through donations from public or private entities and may be in cash or in-kind, fairly evaluated, including plant, equipment, or services.
SEC. 740.
[293d]

AUTHORIZATION OF APPROPRIATION.
(a)

Scholarships.—
There are authorized to be appropriated to carry out section 737, $51,470,000 for each of fiscal years 2021 through 2025. Of the amount appropriated in any fiscal year, the Secretary shall ensure that not less than 16 percent shall be distributed to schools of nursing.
(b)

Loan Repayments and Fellowships.—
For the purpose of carrying out section 738, there is authorized to be appropriated, $1,190,000 for each of fiscal years 2021 through 2025.
(c)

Educational Assistance in Health Professions Regarding Individuals for Disadvantaged Backgrounds.—
For the purpose of grants and contracts under section 739(a)(1), there is authorized to be appropriated $15,000,000 for each of fiscal years 2021 through 2025. The Secretary may use not to exceed 20 percent of the amount appropriated for a fiscal year under this subsection to provide scholarships under section 739(a)(2)(F).
(d)7

Report.—
Not later than September 30, 2025, and every five years thereafter, the Secretary shall prepare and submit to the Committee on Health, Education, Labor, and Pensions of the Senate, and the Committee on Energy and Commerce of the House of Representatives, a report concerning the efforts of the Secretary to address the need for a representative mix of individuals from historically minority health professions schools, or from institutions or other entities that historically or by geographic location have a demonstrated record of training or educating underrepresented minorities, within various health professions disciplines, on peer review councils.
^7
The amendment made to subsection (d) by section 3401(2)(D) of division A of Public Law 116–136 was carried out to reflect the probable intent of Congress. Such amendment struck “Not [L]ater than...” and inserted new text, however, it should have been made to strike “Not later than...”.
SEC. 741.
[293e]

GRANTS FOR HEALTH PROFESSIONS EDUCATION.
(a)

Cultural Competency, Prevention, and Public Health and Individuals With Disability Grants.—
(1)

In general.—
The Secretary, acting through the Administrator of the Health Resources and Services Administration, may make awards of grants, contracts, or cooperative agreements to public and nonprofit private entities (including tribal entities) for the development, evaluation, and dissemination of research, demonstration projects, and model curricula for cultural competency, prevention, public health proficiency, reducing health disparities, and aptitude for working with individuals with disabilities training for use in health professions schools and continuing education programs, and for other purposes determined as appropriate by the Secretary.
(2)

Eligible entities.—
Unless specifically required otherwise in this title, the Secretary shall accept applications for grants or contracts under this section from health professions schools, academic health centers, State or local governments, or other appropriate public or private nonprofit entities (or consortia of entities, including entities promoting multidisciplinary approaches) for funding and participation in health professions training activities. The Secretary may accept applications from for-profit private entities as determined appropriate by the Secretary.
(b)

Collaboration.—
In carrying out subsection (a), the Secretary shall collaborate with health professional societies, licensing and accreditation entities, health professions schools, and experts in minority health and cultural competency, prevention, and public health and disability groups, community-based organizations, and other organizations as determined appropriate by the Secretary. The Secretary shall coordinate with curricula and research and demonstration projects developed under section 807.
(c)

Dissemination.—
(1)

In general.—
Model curricula developed under this section shall be disseminated through the Internet Clearinghouse under section 270 and such other means as determined appropriate by the Secretary.
(2)

Evaluation.—
The Secretary shall evaluate the adoption and the implementation of cultural competency, prevention, and public health, and working with individuals with a disability training curricula, and the facilitate inclusion of these competency measures in quality measurement systems as appropriate.
(d)

Authorization of Appropriations.—
There is authorized to be appropriated to carry out this section such sums as may be necessary for each of fiscal years 2010 through 2015.
PART C—

TRAINING IN FAMILY MEDICINE, GENERAL INTERNAL MEDICINE, GENERAL PEDIATRICS, PHYSICIAN ASSISTANTS, GENERAL DENTISTRY, AND PEDIATRIC DENTISTRY
Subpart I—

Medical Training Generally
SEC. 747.
[293k]

PRIMARY CARE TRAINING AND ENHANCEMENT.
(a)

Support and Development of Primary Care Training Programs.—
(1)

In general.—
The Secretary may make grants to, or enter into contracts with, an accredited public or nonprofit private hospital, school of medicine or osteopathic medicine, academically affiliated physician assistant training program, or a public or private nonprofit entity which the Secretary has determined is capable of carrying out such grant or contract—
(A)
to plan, develop, operate, or participate in an accredited professional training program, including an accredited residency or internship program in the field of family medicine, general internal medicine, or general pediatrics for medical students, interns, residents, or practicing physicians as defined by the Secretary;
(B)
to provide need-based financial assistance in the form of traineeships and fellowships to medical students, interns, residents, practicing physicians, or other medical personnel, who are participants in any such program, and who plan to specialize or work in the practice of the fields defined in subparagraph (A);
(C)
to plan, develop, and operate a program for the training of physicians who plan to teach in family medicine, general internal medicine, or general pediatrics training programs;
(D)
to plan, develop, and operate a program for the training of physicians teaching in community-based settings;
(E)
to provide financial assistance in the form of traineeships and fellowships to physicians who are participants in any such programs and who plan to teach or conduct research in a family medicine, general internal medicine, or general pediatrics training program;
(F)
to plan, develop, and operate a physician assistant education program, and for the training of individuals who will teach in programs to provide such training;
(G)
to plan, develop, and operate a program that identifies or develops innovative models of providing care, and trains primary care physicians on such models and in new competencies, as recommended by the Advisory Committee on Training in Primary Care Medicine and Dentistry and the National Health Care Workforce Commission established in section 5101 of the Patient Protection and Affordable Care Act, which may include—
(i)
providing training to primary care physicians relevant to providing care through patient-centered medical homes (as defined by the Secretary for purposes of this section);
(ii)
developing tools and curricula relevant to patient-centered medical homes; and
(iii)
providing continuing education to primary care physicians relevant to patient-centered medical homes; and
(H)
to plan, develop, and operate joint degree programs to provide interdisciplinary and interprofessional graduate training in public health and other health professions to provide training in environmental health, infectious disease control, disease prevention and health promotion, epidemiological studies and injury control.
(2)

Duration of awards.—
The period during which payments are made to an entity from an award of a grant or contract under this subsection shall be 5 years.
(3)

Priorities in making awards.—
In awarding grants or contracts under paragraph (1), the Secretary may give priority to qualified applicants that train residents in rural areas, including for Tribes or Tribal Organizations in such areas.
(b)

Capacity Building in Primary Care.—
(1)

In general.—
The Secretary may make grants to or enter into contracts with accredited schools of medicine or osteopathic medicine to establish, maintain, or improve—
(A)
academic units or programs that improve clinical teaching and research in fields defined in subsection (a)(1)(A); or
(B)
programs that integrate academic administrative units in fields defined in subsection (a)(1)(A) to enhance interdisciplinary recruitment, training, and faculty development.
(2)

Preference in making awards under this subsection.—
In making awards of grants and contracts under paragraph (1), the Secretary shall give preference to any qualified applicant for such an award that agrees to expend the award for the purpose of—
(A)
establishing academic units or programs in fields defined in subsection (a)(1)(A); or
(B)
substantially expanding such units or programs.
(3)

Priorities in making awards.—
In awarding grants or contracts under paragraph (1), the Secretary shall give priority to qualified applicants that—
(A)
proposes a collaborative project between academic administrative units of primary care;
(B)
proposes innovative approaches to clinical teaching using models of primary care, such as the patient centered medical home, team management of chronic disease, and interprofessional integrated models of health care that incorporate transitions in health care settings and integration physical and mental health provision;
(C)
have a record of training the greatest percentage of providers, or that have demonstrated significant improvements in the percentage of providers trained, who enter and remain in primary care practice;
(D)
have a record of training individuals who are from underrepresented minority groups or from a rural or disadvantaged background;
(E)
provide training in the care of vulnerable populations such as children, older adults, homeless individuals, victims of abuse or trauma, individuals with mental health or substance use disorders, individuals with HIV/AIDS, and individuals with disabilities;
(F)
establish formal relationships and submit joint applications with federally qualified health centers, rural health clinics, area health education centers, or clinics located in underserved areas or that serve underserved populations;
(G)
teach trainees the skills to provide interprofessional, integrated care through collaboration among health professionals;
(H)
provide training in enhanced communication with patients, evidence-based practice, chronic disease management, preventive care, health information technology, or other competencies as recommended by the Advisory Committee on Training in Primary Care Medicine and Dentistry and the National Health Care Workforce Commission established in section 5101 of the Patient Protection and Affordable Care Act; or
(I)
provide training in cultural competency and health literacy.
(4)

Duration of awards.—
The period during which payments are made to an entity from an award of a grant or contract under this subsection shall be 5 years.
(c)

Authorization of Appropriations.—
(1)

In general.—
For purposes of carrying out this section (other than subsection (b)(1)(B)), there are authorized to be appropriated $48,924,000 for each of fiscal years 2021 through 2025.
(2)

Training programs.—
Fifteen percent of the amount appropriated pursuant to paragraph (1) in each such fiscal year shall be allocated to the physician assistant training programs described in subsection (a)(1)(F), which prepare students for practice in primary care.
(3)

Integrating academic administrative units.—
For purposes of carrying out subsection (b)(1)(B), there are authorized to be appropriated $750,000 for each of fiscal years 2010 through 2014.
SEC. 747A.
[293k–1]

TRAINING OPPORTUNITIES FOR DIRECT CARE WORKERS.
(a)

In General.—
The Secretary shall award grants to eligible entities to enable such entities to provide new training opportunities for direct care workers who are employed in long-term care settings such as nursing homes (as defined in section 1908(e)(1) of the Social Security Act (42 U.S.C. 1396g(e)(1)), assisted living facilities and skilled nursing facilities, intermediate care facilities for individuals with mental retardation, home and community based settings, and any other setting the Secretary determines to be appropriate.
(b)

Eligibility.—
To be eligible to receive a grant under this section, an entity shall—
(1)
be an institution of higher education (as defined in section 102 of the Higher Education Act of 1965 (20 U.S.C. 1002)) that—
(A)
is accredited by a nationally recognized accrediting agency or association listed under section 101(c) of the Higher Education Act of 1965 (20 U.S.C. 1001(c)); and
(B)
has established a public-private educational partnership with a nursing home or skilled nursing facility, agency or entity providing home and community based services to individuals with disabilities, or other long-term care provider; and
(2)
submit to the Secretary an application at such time, in such manner, and containing such information as the Secretary may require.
(c)

Use of Funds.—
An eligible entity shall use amounts awarded under a grant under this section to provide assistance to eligible individuals to offset the cost of tuition and required fees for enrollment in academic programs provided by such entity.
(d)

Eligible Individual.—
(1)

Eligibility.—
To be eligible for assistance under this section, an individual shall be enrolled in courses provided by a grantee under this subsection and maintain satisfactory academic progress in such courses.
(2)

Condition of assistance.—
As a condition of receiving assistance under this section, an individual shall agree that, following completion of the assistance period, the individual will work in the field of geriatrics, disability services, long term services and supports, or chronic care management for a minimum of 2 years under guidelines set by the Secretary.
(e)

Authorization of Appropriations.—
There is authorized to be appropriated to carry out this section, $10,000,000 for the period of fiscal years 2011 through 2013.
SEC. 748.
[293k–2]

TRAINING IN GENERAL, PEDIATRIC, AND PUBLIC HEALTH DENTISTRY.
(a)

Support and Development of Dental Training Programs.—
(1)

In general.—
The Secretary may make grants to, or enter into contracts with, a school of dentistry, public or nonprofit private hospital, or a public or private nonprofit entity which the Secretary has determined is capable of carrying out such grant or contract—
(A)
to plan, develop, and operate, or participate in, an approved professional training program in the field of general dentistry, pediatric dentistry, or public health dentistry for dental students, residents, practicing dentists, dental hygienists, or other approved primary care dental trainees, that emphasizes training for general, pediatric, or public health dentistry;
(B)
to provide financial assistance to dental students, residents, practicing dentists, and dental hygiene students who are in need thereof, who are participants in any such program, and who plan to work in the practice of general, pediatric, public heath dentistry, or dental hygiene;
(C)
to plan, develop, and operate a program for the training of oral health care providers who plan to teach in general, pediatric, public health dentistry, or dental hygiene;
(D)
to provide financial assistance in the form of traineeships and fellowships to dentists who plan to teach or are teaching in general, pediatric, or public health dentistry;
(E)
to meet the costs of projects to establish, maintain, or improve dental faculty development programs in primary care (which may be departments, divisions or other units);
(F)
to meet the costs of projects to establish, maintain, or improve predoctoral and postdoctoral training in primary care programs;
(G)
to create a loan repayment program for faculty in dental programs; and
(H)
to provide technical assistance to pediatric training programs in developing and implementing instruction regarding the oral health status, dental care needs, and risk-based clinical disease management of all pediatric populations with an emphasis on underserved children.
(2)

Faculty loan repayment.—
(A)

In general.—
A grant or contract under subsection (a)(1)(G) may be awarded to a program of general, pediatric, or public health dentistry described in such subsection to plan, develop, and operate a loan repayment program under which—
(i)
individuals agree to serve full-time as faculty members; and
(ii)
the program of general, pediatric or public health dentistry agrees to pay the principal and interest on the outstanding student loans of the individuals.
(B)

Manner of payments.—
With respect to the payments described in subparagraph (A)(ii), upon completion by an individual of each of the first, second, third, fourth, and fifth years of service, the program shall pay an amount equal to 10, 15, 20, 25, and 30 percent, respectively, of the individual's student loan balance as calculated based on principal and interest owed at the initiation of the agreement.
(b)

Eligible Entity.—
For purposes of this subsection, entities eligible for such grants or contracts in general, pediatric, or public health dentistry shall include entities that have programs in dental or dental hygiene schools, or approved residency or advanced education programs in the practice of general, pediatric, or public health dentistry. Eligible entities may partner with schools of public health to permit the education of dental students, residents, and dental hygiene students for a master's year in public health at a school of public health.
(c)

Priorities in Making Awards.—
With respect to training provided for under this section, the Secretary shall give priority in awarding grants or contracts to the following:
(1)
Qualified applicants that propose collaborative projects between departments of primary care medicine and departments of general, pediatric, or public health dentistry.
(2)
Qualified applicants that have a record of training the greatest percentage of providers, or that have demonstrated significant improvements in the percentage of providers, who enter and remain in general, pediatric, or public health dentistry.
(3)
Qualified applicants that have a record of training individuals who are from a rural or disadvantaged background, or from underrepresented minorities.
(4)
Qualified applicants that establish formal relationships with Federally qualified health centers, rural health centers, or accredited teaching facilities and that conduct training of students, residents, fellows, or faculty at the center or facility.
(5)
Qualified applicants that conduct teaching programs targeting vulnerable populations such as older adults, homeless individuals, victims of abuse or trauma, individuals with mental health or substance use disorders, individuals with disabilities, and individuals with HIV/AIDS, and in the risk-based clinical disease management of all populations.
(6)
Qualified applicants that include educational activities in cultural competency and health literacy.
(7)
Qualified applicants that have a high rate for placing graduates in practice settings that serve underserved areas or health disparity populations, or who achieve a significant increase in the rate of placing graduates in such settings.
(8)
Qualified applicants that intend to establish a special populations oral health care education center or training program for the didactic and clinical education of dentists, dental health professionals, and dental hygienists who plan to teach oral health care for people with developmental disabilities, cognitive impairment, complex medical problems, significant physical limitations, and vulnerable elderly.
(d)

Application.—
An eligible entity desiring a grant under this section shall submit to the Secretary an application at such time, in such manner, and containing such information as the Secretary may require.
(e)

Duration of Award.—
The period during which payments are made to an entity from an award of a grant or contract under subsection (a) shall be 5 years. The provision of such payments shall be subject to annual approval by the Secretary and subject to the availability of appropriations for the fiscal year involved to make the payments.
(f)

Authorizations of Appropriations.—
For the purpose of carrying out subsections (a) and (b), there is authorized to be appropriated $28,531,000 for each of fiscal years 2021 through 2025.
(g)

Carryover Funds.—
An entity that receives an award under this section may carry over funds from 1 fiscal year to another without obtaining approval from the Secretary. In no case may any funds be carried over pursuant to the preceding sentence for more than 3 years.
SEC. 749.
[293l]

ADVISORY COMMITTEE ON TRAINING IN PRIMARY CARE MEDICINE AND DENTISTRY.
(a)

Establishment.—
The Secretary shall establish an advisory committee to be known as the Advisory Committee on Training in Primary Care Medicine and Dentistry (in this section referred to as the “Advisory Committee”).
(b)

Composition.—
(1)

In general.—
The Secretary shall determine the appropriate number of individuals to serve on the Advisory Committee. Such individuals shall not be officers or employees of the Federal Government.
(2)

Appointment.—
Not later than 90 days after the date of enactment of this Act8, the Secretary shall appoint the members of the Advisory Committee from among individuals who are health professionals. In making such appointments, the Secretary shall ensure a fair balance between the health professions, that at least 75 percent of the members of the Advisory Committee are health professionals, a broad geographic representation of members and a balance between urban and rural members. Members shall be appointed based on their competence, interest, and knowledge of the mission of the profession involved.
^8
So in law. The reference to “this Act” means the Public Health Service Act, which was enacted July 1, 1944. Probably should be a reference to the Health Professions Education Partnerships Act of 1998, which added section 748. That Act is Public Law 105–392, enacted November 13, 1998. (Section 102(4) of that Public Law (112 Stat. 3539) added section 748.)
(3)

Minority representation.—
In appointing the members of the Advisory Committee under paragraph (2), the Secretary shall ensure the adequate representation of women and minorities.
(c)

Terms.—
(1)

In general.—
A member of the Advisory Committee shall be appointed for a term of 3 years, except that of the members first appointed—
(A)
⅓ of such members shall serve for a term of 1 year;
(B)
⅓ of such members shall serve for a term of 2 years; and
(C)
⅓ of such members shall serve for a term of 3 years.
(2)

Vacancies.—
(A)

In general.—
A vacancy on the Advisory Committee shall be filled in the manner in which the original appointment was made and shall be subject to any conditions which applied with respect to the original appointment.
(B)

Filling unexpired term.—
An individual chosen to fill a vacancy shall be appointed for the unexpired term of the member replaced.
(d)

Duties.—
The Advisory Committee shall—
(1)
provide advice and recommendations to the Secretary concerning policy and program development and other matters of significance concerning the activities under section 747;
(2)
not later than 3 years after the date of enactment of this section, and annually thereafter, prepare and submit to the Secretary, and the Committee on Health, Education, Labor, and Pensions of the Senate, and the Committee on Energy and Commerce of the House of Representatives, a report describing the activities of the Committee, including findings and recommendations made by the Committee concerning the activities under section 747;
(3)
develop, publish, and implement performance measures for programs under this part;
(4)
develop and publish guidelines for longitudinal evaluations (as described in section 761(d)(2)) for programs under this part; and
(5)
recommend appropriation levels for programs under this part.
(e)

Meetings and Documents.—
(1)

Meetings.—
The Advisory Committee shall meet not less than 2 times each year. Such meetings shall be held jointly with other related entities established under this title where appropriate.
(2)

Documents.—
Not later than 14 days prior to the convening of a meeting under paragraph (1), the Advisory Committee shall prepare and make available an agenda of the matters to be considered by the Advisory Committee at such meeting. At any such meeting, the Advisory Council9 shall distribute materials with respect to the issues to be addressed at the meeting. Not later than 30 days after the adjourning of such a meeting, the Advisory Committee shall prepare and make available a summary of the meeting and any actions taken by the Committee based upon the meeting.
^9
So in law. Probably should be “Advisory Committee”. See section 102(4) of Public Law 105–392 (112 Stat. 3539).
(f)

Compensation and Expenses.—
(1)

Compensation.—
Each member of the Advisory Committee shall be compensated at a rate equal to the daily equivalent of the annual rate of basic pay prescribed for level IV of the Executive Schedule under section 5315 of title 5, United States Code, for each day (including travel time) during which such member is engaged in the performance of the duties of the Committee.
(2)

Expenses.—
The members of the Advisory Committee shall be allowed 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, while away from their homes or regular places of business in the performance of services for the Committee.
(g)

Chapter 10 of Title 5, United States Code.—
Chapter 10 of title 5, United States Code, shall apply to the Advisory Committee under this section only to the extent that the provisions of chapter 10 of title 5, United States Code, do not conflict with the requirements of this section.
SEC. 749A.
[293l–1]

TEACHING HEALTH CENTERS DEVELOPMENT GRANTS.
(a)

Program Authorized.—
The Secretary may award grants under this section to teaching health centers for the purpose of establishing new accredited or expanded primary care residency programs.
(b)

Amount and Duration.—
Grants awarded under this section shall be for a term of not more than 3 years and the maximum award may not be more than $500,000.
(c)

Use of Funds.—
Amounts provided under a grant under this section shall be used to cover the costs of—
(1)
establishing or expanding a primary care residency training program described in subsection (a), including costs associated with—
(A)
curriculum development;
(B)
recruitment, training and retention of residents and faculty:
(C)
accreditation by the Accreditation Council for Graduate Medical Education (ACGME), the American Dental Association (ADA), or the American Osteopathic Association (AOA); and
(D)
faculty salaries during the development phase; and
(2)
technical assistance provided by an eligible entity.
(d)

Application.—
A teaching health center seeking a grant under this section shall submit an application to the Secretary at such time, in such manner, and containing such information as the Secretary may require.
(e)

Preference for Certain Applications.—
In selecting recipients for grants under this section, the Secretary shall give preference to any such application that documents an existing affiliation agreement with an area health education center program as defined in sections 751 and 799B.
(f)

Definitions.—
In this section:
(1)

Eligible entity.—
The term “eligible entity” means an organization capable of providing technical assistance including an area health education center program as defined in sections 751 and 799B.
(2)

Primary care residency program.—
The term “primary care residency program” means an approved graduate medical residency training program (as defined in section 340H) in family medicine, internal medicine, pediatrics, internal medicine-pediatrics, obstetrics and gynecology, psychiatry, general dentistry, pediatric dentistry, and geriatrics.
(3)

Teaching health center.—
(A)

In general.—
The term “teaching health center” means an entity that—
(i)
is a community based, ambulatory patient care center; and
(ii)
operates a primary care residency program.
(B)

Inclusion of certain entities.—
Such term includes the following:
(i)
A Federally qualified health center (as defined in section 1905(l)(2)(B), of the Social Security Act).
(ii)
A community mental health center (as defined in section 1861(ff)(3)(B) of the Social Security Act).
(iii)
A rural health clinic, as defined in section 1861(aa) of the Social Security Act.
(iv)
A health center operated by the Indian Health Service, an Indian tribe or tribal organization, or an urban Indian organization (as defined in section 4 of the Indian Health Care Improvement Act).
(v)
An entity receiving funds under title X of the Public Health Service Act.
(g)

Authorization of Appropriations.—
There is authorized to be appropriated, $25,000,000 for fiscal year 2010, $50,000,000 for fiscal year 2011, $50,000,000 for fiscal year 2012, and such sums as may be necessary for each fiscal year thereafter to carry out this section. Not to exceed $5,000,000 annually may be used for technical assistance program grants.
Subpart II—

Training in Underserved Communities
SEC. 749B.
[293m]

RURAL PHYSICIAN TRAINING GRANTS.
(a)

In General.—
The Secretary, acting through the Administrator of the Health Resources and Services Administration, shall establish a grant program for the purposes of assisting eligible entities in recruiting students most likely to practice medicine in underserved rural communities, providing rural-focused training and experience, and increasing the number of recent allopathic and osteopathic medical school graduates who practice in underserved rural communities.
(b)

Eligible Entities.—
In order to be eligible to receive a grant under this section, an entity shall—
(1)
be a school of allopathic or osteopathic medicine accredited by a nationally recognized accrediting agency or association approved by the Secretary for this purpose, or any combination or consortium of such schools; and
(2)
submit an application to the Secretary that includes a certification that such entity will use amounts provided to the institution as described in subsection (d)(1).
(c)

Priority.—
In awarding grant funds under this section, the Secretary shall give priority to eligible entities that—
(1)
demonstrate a record of successfully training students, as determined by the Secretary, who practice medicine in underserved rural communities;
(2)
demonstrate that an existing academic program of the eligible entity produces a high percentage, as determined by the Secretary, of graduates from such program who practice medicine in underserved rural communities;
(3)
demonstrate rural community institutional partnerships, through such mechanisms as matching or contributory funding, documented in-kind services for implementation, or existence of training partners with interprofessional expertise in community health center training locations or other similar facilities; or
(4)
submit, as part of the application of the entity under subsection (b), a plan for the long-term tracking of where the graduates of such entity practice medicine.
(d)

Use of Funds.—
(1)

Establishment.—
An eligible entity receiving a grant under this section shall use the funds made available under such grant to establish, improve, or expand a rural-focused training program (referred to in this section as the “Program”) meeting the requirements described in this subsection and to carry out such program.
(2)

Structure of program.—
An eligible entity shall—
(A)
enroll no fewer than 10 students per class year into the Program; and
(B)
develop criteria for admission to the Program that gives priority to students—
(i)
who have originated from or lived for a period of 2 or more years in an underserved rural community; and
(ii)
who express a commitment to practice medicine in an underserved rural community.
(3)

Curricula.—
The Program shall require students to enroll in didactic coursework and clinical experience particularly applicable to medical practice in underserved rural communities, including—
(A)
clinical rotations in underserved rural communities, and in applicable specialties, or other coursework or clinical experience deemed appropriate by the Secretary; and
(B)
in addition to core school curricula, additional coursework or training experiences focused on medical issues prevalent in underserved rural communities.
(4)

Residency placement assistance.—
Where available, the Program shall assist all students of the Program in obtaining clinical training experiences in locations with postgraduate programs offering residency training opportunities in underserved rural communities, or in local residency training programs that support and train physicians to practice in underserved rural communities.
(5)

Program student cohort support.—
The Program shall provide and require all students of the Program to participate in group activities designed to further develop, maintain, and reinforce the original commitment of such students to practice in an underserved rural community.
(e)

Annual Reporting.—
An eligible entity receiving a grant under this section shall submit an annual report to the Secretary on the success of the Program, based on criteria the Secretary determines appropriate, including the residency program selection of graduating students who participated in the Program.
(f)

Regulations.—
Not later than 60 days after the date of enactment of this section, the Secretary shall by regulation define “underserved rural community” for purposes of this section.
(g)

Supplement Not Supplant.—
Any eligible entity receiving funds under this section shall use such funds to supplement, not supplant, any other Federal, State, and local funds that would otherwise be expended by such entity to carry out the activities described in this section.
(h)

Maintenance of Effort.—
With respect to activities for which funds awarded under this section are to be expended, the entity shall agree to maintain expenditures of non-Federal amounts for such activities at a level that is not less than the level of such expenditures maintained by the entity for the fiscal year preceding the fiscal year for which the entity receives a grant under this section.
(i)

Authorization of Appropriations.—
There are authorized to be appropriated $4,000,000 for each of the fiscal years 2010 through 2013.
PART D—

INTERDISCIPLINARY, COMMUNITY-BASED LINKAGES
SEC. 750.
[294]

GENERAL PROVISIONS.
(a)

Collaboration.—
To be eligible to receive assistance under this part, an academic institution shall use such assistance in collaboration with 2 or more disciplines.
(b)

Activities.—
An entity shall use assistance under this part to carry out innovative demonstration projects for strategic workforce supplementation activities as needed to meet national goals for interdisciplinary, community-based linkages. Such assistance may be used consistent with this part—
(1)
to develop and support training programs;
(2)
for faculty development;
(3)
for model demonstration programs;
(4)
for the provision of stipends for fellowship trainees;
(5)
to provide technical assistance; and
(6)
for other activities that will produce outcomes consistent with the purposes of this part.
SEC. 751.
[294a]

AREA HEALTH EDUCATION CENTERS.
(a)

Establishment of Awards.—
The Secretary shall make the following 2 types of awards in accordance with this section:
(1)

Infrastructure development award.—
The Secretary shall make awards to eligible entities to enable such entities to initiate health care workforce educational programs or to continue to carry out comparable programs that are operating at the time the award is made by planning, developing, operating, and evaluating an area health education center program.
(2)

Point of service maintenance and enhancement award.—
The Secretary shall make awards to eligible entities to maintain and improve the effectiveness and capabilities of an existing area health education center program, and make other modifications to the program that are appropriate due to changes in demographics, needs of the populations served, or other similar issues affecting the area health education center program. For the purposes of this section, the term “Program” refers to the area health education center program.
(b)

Eligible Entities; Application.—
(1)

Eligible entities.—
(A)

Infrastructure development.—
For purposes of subsection (a)(1), the term “eligible entity” means a school of medicine or osteopathic medicine, an incorporated consortium of such schools, or the parent institutions of such a school. With respect to a State in which no area health education center program is in operation, the Secretary may award a grant or contract under subsection (a)(1) to a school of nursing.
(B)

Point of service maintenance and enhancement.—
For purposes of subsection (a)(2), the term “eligible entity” means an entity that has received funds under this section, is operating an area health education center program, including an area health education center or centers, and has a center or centers that are no longer eligible to receive financial assistance under subsection (a)(1).
(2)

Application.—
An eligible entity desiring to receive an award under this section shall submit to the Secretary an application at such time, in such manner, and containing such information as the Secretary may require.
(c)

Use of Funds.—
(1)

Required activities.—
An eligible entity shall use amounts awarded under a grant under subsection (a)(1) or (a)(2) to carry out the following activities:
(A)
Develop and implement strategies, in coordination with the applicable one-stop delivery system under section 121(e) of the Workforce Innovation and Opportunity Act, to recruit individuals from underrepresented minority populations or from disadvantaged or rural backgrounds into health professions, and support such individuals in attaining such careers.
(B)
Develop and implement strategies to foster and provide community-based training and education to individuals seeking careers in health professions within underserved areas for the purpose of developing and maintaining a diverse health care workforce that is prepared to deliver high-quality care, with an emphasis on primary care, in underserved areas or for health disparity populations, in collaboration with other Federal and State health care workforce development programs, the State workforce agency, and local workforce investment boards, and in health care safety net sites.
(C)
Prepare individuals to more effectively provide health services to underserved areas and health disparity populations through field placements or preceptorships in conjunction with community-based organizations, accredited primary care residency training programs, Federally qualified health centers, rural health clinics, public health departments, or other appropriate facilities.
(D)
Conduct and participate in interdisciplinary training that involves physicians, physician assistants, nurse practitioners, nurse midwives, dentists, psychologists, pharmacists, optometrists, community health workers, public and allied health professionals, or other health professionals, as practicable.
(E)
Deliver or facilitate continuing education and information dissemination programs for health care professionals, with an emphasis on individuals providing care in underserved areas and for health disparity populations.
(F)
Propose and implement effective program and outcomes measurement and evaluation strategies.
(G)
Establish a youth public health program to expose and recruit high school students into health careers, with a focus on careers in public health.
(2)

Innovative opportunities.—
An eligible entity may use amounts awarded under a grant under subsection (a)(1) or subsection (a)(2) to carry out any of the following activities:
(A)
Develop and implement innovative curricula in collaboration with community-based accredited primary care residency training programs, Federally qualified health centers, rural health clinics, behavioral and mental health facilities, public health departments, or other appropriate facilities, with the goal of increasing the number of primary care physicians and other primary care providers prepared to serve in underserved areas and health disparity populations.
(B)
Coordinate community-based participatory research with academic health centers, and facilitate rapid flow and dissemination of evidence-based health care information, research results, and best practices to improve quality, efficiency, and effectiveness of health care and health care systems within community settings.
(C)
Develop and implement other strategies to address identified workforce needs and increase and enhance the health care workforce in the area served by the area health education center program.
(d)

Requirements.—
(1)

Area health education center program.—
In carrying out this section, the Secretary shall ensure the following:
(A)
An entity that receives an award under this section shall conduct at least 10 percent of clinical education required for medical students in community settings that are removed from the primary teaching facility of the contracting institution for grantees that operate a school of medicine or osteopathic medicine. In States in which an entity that receives an award under this section is a nursing school or its parent institution, the Secretary shall alternatively ensure that—
(i)
the nursing school conducts at least 10 percent of clinical education required for nursing students in community settings that are remote from the primary teaching facility of the school; and
(ii)
the entity receiving the award maintains a written agreement with a school of medicine or osteopathic medicine to place students from that school in training sites in the area health education center program area.
(B)
An entity receiving funds under subsection (a)(2) does not distribute such funding to a center that is eligible to receive funding under subsection (a)(1).
(2)

Area health education center.—
The Secretary shall ensure that each area health education center program includes at least 1 area health education center, and that each such center—
(A)
is a public or private organization whose structure, governance, and operation is independent from the awardee and the parent institution of the awardee;
(B)
is not a school of medicine or osteopathic medicine, the parent institution of such a school, or a branch campus or other subunit of a school of medicine or osteopathic medicine or its parent institution, or a consortium of such entities;
(C)
designates an underserved area or population to be served by the center which is in a location removed from the main location of the teaching facilities of the schools participating in the program with such center and does not duplicate, in whole or in part, the geographic area or population served by any other center;
(D)
fosters networking and collaboration among communities and between academic health centers and community-based centers;
(E)
serves communities with a demonstrated need of health professionals in partnership with academic medical centers;
(F)
addresses the health care workforce needs of the communities served in coordination with the public workforce investment system; and
(G)
has a community-based governing or advisory board that reflects the diversity of the communities involved.
(e)

Matching Funds.—
With respect to the costs of operating a program through a grant under this section, to be eligible for financial assistance under this section, an entity shall make available (directly or through contributions from State, county or municipal governments, or the private sector) recurring non-Federal contributions in cash or in kind, toward such costs in an amount that is equal to not less than 50 percent of such costs. At least 25 percent of the total required non-Federal contributions shall be in cash. An entity may apply to the Secretary for a waiver of not more than 75 percent of the matching fund amount required by the entity for each of the first 3 years the entity is funded through a grant under subsection (a)(1).
(f)

Limitation.—
Not less than 75 percent of the total amount provided to an area health education center program under subsection (a)(1) or (a)(2) shall be allocated to the area health education centers participating in the program under this section. To provide needed flexibility to newly funded area health education center programs, the Secretary may waive the requirement in the sentence for the first 2 years of a new area health education center program funded under subsection (a)(1).
(g)

Award.—
An award to an entity under this section shall be not less than $250,000 annually per area health education center included in the program involved. If amounts appropriated to carry out this section are not sufficient to comply with the preceding sentence, the Secretary may reduce the per center amount provided for in such sentence as necessary, provided the distribution established in subsection (j)(2) is maintained.
(h)

Project Terms.—
(1)

In general.—
Except as provided in paragraph (2), the period during which payments may be made under an award under subsection (a)(1) may not exceed—
(A)
in the case of a program, 12 years; or
(B)
in the case of a center within a program, 6 years.
(2)

Exception.—
The periods described in paragraph (1) shall not apply to programs receiving point of service maintenance and enhancement awards under subsection (a)(2) to maintain existing centers and activities.
(i)

Inapplicability of Provision.—
Notwithstanding any other provision of this title, section 791(a) shall not apply to an area health education center funded under this section.
(j)

Authorization of Appropriations.—
(1)

In general.—
There is authorized to be appropriated to carry out this section $41,250,000 for each of fiscal years 2021 through 2025.
(2)

Requirements.—
Of the amounts appropriated for a fiscal year under paragraph (1)—
(A)
not more than 35 percent shall be used for awards under subsection (a)(1);
(B)
not less than 60 percent shall be used for awards under subsection (a)(2);
(C)
not more than 1 percent shall be used for grants and contracts to implement outcomes evaluation for the area health education centers; and
(D)
not more than 4 percent shall be used for grants and contracts to provide technical assistance to entities receiving awards under this section.
(3)

Carryover funds.—
An entity that receives an award under this section may carry over funds from 1 fiscal year to another without obtaining approval from the Secretary. In no case may any funds be carried over pursuant to the preceding sentence for more than 3 years.
(k)

Sense of Congress.—
It is the sense of the Congress that every State have an area health education center program in effect under this section.
SEC. 752.
[294b]

CONTINUING EDUCATIONAL SUPPORT FOR HEALTH PROFESSIONALS SERVING IN RURAL AND UNDERSERVED COMMUNITIES.
(a)

In General.—
The Secretary , as appropriate, shall make grants to, and enter into contracts with, eligible entities to support access to accredited continuing medical education for primary care physicians and health care providers at community health centers or rural health clinics to improve and increase access to care for patients in rural and medically underserved areas. Such grants or contracts may be used to improve health care, increase retention, increase representation of minority health care providers, enhance the practice environment, increase primary care physician and health care provider knowledge, and provide information dissemination and educational support to reduce professional isolation through the timely dissemination of research findings using relevant resources.
(b)

Eligible Entities.—
For purposes of this section, the term “eligible entity” means an entity described in section 799(b), such as a community health center or rural health clinic.
(c)

Application.—
An eligible entity desiring to receive an award under this section shall submit to the Secretary an application at such time, in such manner, and containing such information as the Secretary may require 10.
^{10}
Section 2227(4) of division (FF) of Public Law 117-328 amends section 752(c) by striking “by require.” and inserting the following: “may require, including—
(1)
a description of how participation in activities funded under this section will help improve access to, and quality of, health care services and training needs of primary care physicians and health care providers; and
(2)
a plan for providing peer-to-peer training, as appropriate.”.
The amendment should have struck may require. and therefore does not execute.
(d)

Use of Funds.—
(1)

In general.—
An eligible entity shall use amounts awarded under a grant or contract under this section to provide innovative supportive activities to enhance education for primary care physicians and health care providers described in subsection (a) through distance learning, continuing educational activities, collaborative conferences, and electronic and telelearning activities, with priority for primary care providers who are seeking additional education in specialty fields such as infectious disease, endocrinology, pediatrics, mental health and substance use disorders, pain management, geriatrics, and other areas, as appropriate, in order to—
(A)
improve retention of primary care physicians and health care providers and increase access to specialty health care services for patients; and
(B)
support access to the integration of specialty care through existing service delivery locations and care across settings.
(2)

Clarification.—
Entities may use amounts awarded under a grant or contract under this section for continuing educational activities that include a clinical training component, including in-person patient care, in the respective community health center or rural health clinic, with the primary care physician or health care provider at such site and the clinical specialist from whom such additional training is being provided.
(e)

Administrative Expenses.—
An entity that revives a grant or contract under this section shall use not more than 5 percent of the amounts received under the grant or contract under this section for administrative expenses.
(f)

Non-duplication of Effort.—
The Secretary shall ensure that activities under this section do not unnecessarily duplicate efforts of other programs overseen by the Health Resources and Services Administration, including activities described in section 330N.
(g)

Authorization.—
There is authorized to be appropriated to carry out this section $5,000,000 for each of fiscal years 2023 through 2025.
SEC. 753.
[294c]

EDUCATION AND TRAINING RELATING TO GERIATRICS.
(a)

Geriatrics Workforce Enhancement Program.—
(1)

In general.—
The Secretary shall award grants, contracts, or cooperative agreements under this subsection to entities described in paragraph (1), (3), or (4) of section 799B, section 801(2), or section 865(d), or other health professions schools or programs approved by the Secretary, for the establishment or operation of Geriatrics Workforce Enhancement Programs that meet the requirements of paragraph (2).
(2)

Requirements.—
(A)

In general.—
A Geriatrics Workforce Enhancement Program receiving an award under this section shall support the training of health professionals in geriatrics, including traineeships or fellowships. Such programs shall emphasize, as appropriate, patient and family engagement, integration of geriatrics with primary care and other appropriate specialties, and collaboration with community partners to address gaps in health care for older adults.
(B)

Activities.—
Activities conducted by a program under this section may include the following:
(i)
Clinical training on providing integrated geriatrics and primary care delivery services.
(ii)
Interprofessional training to practitioners from multiple disciplines and specialties, including training on the provision of care to older adults.
(iii)
Establishing or maintaining training-related community-based programs for older adults and caregivers to improve health outcomes for older adults.
(iv)
Providing education on Alzheimer's disease and related dementias to families and caregivers of older adults, direct care workers, and health professions students, faculty, and providers.
(3)

Duration.—
Each grant, contract, or cooperative agreement or contract awarded under paragraph (1) shall be for a period not to exceed 5 years.
(4)

Applications.—
To be eligible to receive a grant, contract, or cooperative agreement under paragraph (1), an entity described in such paragraph shall submit to the Secretary an application at such time, in such manner, and containing such information as the Secretary may require.
(5)

Program requirements.—
(A)

In general.—
In awarding grants, contracts, and cooperative agreements under paragraph (1), the Secretary—
(i)
shall give priority to programs that demonstrate coordination with another Federal or State program or another public or private entity;
(ii)
shall give priority to applicants with programs or activities that are expected to substantially benefit rural or medically underserved populations of older adults, or serve older adults in Indian Tribes or Tribal organizations; and
(iii)
may give priority to any program that—
(I)
integrates geriatrics into primary care practice;
(II)
provides training to integrate geriatric care into other specialties across care settings, including practicing clinical specialists, health care administrators, faculty without backgrounds in geriatrics, and students from all health professions;
(III)
emphasizes integration of geriatric care into existing service delivery locations and care across settings, including primary care clinics, medical homes, Federally qualified health centers, ambulatory care clinics, critical access hospitals, emergency care, assisted living and nursing facilities, and home- and community-based services, which may include adult daycare;
(IV)
supports the training and retraining of faculty, primary care providers, other direct care providers, and other appropriate professionals on geriatrics;
(V)
emphasizes education and engagement of family caregivers on disease management and strategies to meet the needs of caregivers of older adults; or
(VI)
proposes to conduct outreach to communities that have a shortage of geriatric workforce professionals.
(B)

Special consideration.—
In awarding grants, contracts, and cooperative agreements under this section, the Secretary shall give special consideration to entities that provide services in areas with a shortage of geriatric workforce professionals.
(6)

Priority.—
The Secretary may provide awardees with additional support for activities in areas of demonstrated need, which may include education and training for home health workers, family caregivers, and direct care workers on care for older adults.
(7)

Reporting.—
(A)

Reports from entities.—
Each entity awarded a grant, contract, or cooperative agreement under this section shall submit an annual report to the Secretary on the activities conducted under such grant, contract, or cooperative agreement, which may include information on the number of trainees, the number of professions and disciplines, the number of partnerships with health care delivery sites, the number of faculty and practicing professionals who participated in such programs, and other information, as the Secretary may require.
(B)

Report to congress.—
Not later than 4 years after the date of enactment of the Coronavirus Aid, Relief, and Economic Security Act and every 5 years thereafter, the Secretary shall submit to the Committee on Health, Education, Labor, and Pensions of the Senate and the Committee on Energy and Commerce of the House of Representatives a report that provides a summary of the activities and outcomes associated with grants, contracts, and cooperative agreements made under this section. Such reports shall include—
(i)
information on the number of trainees, faculty, and professionals who participated in programs under this section;
(ii)
information on the impact of the program conducted under this section on the health status of older adults, including in areas with a shortage of health professionals; and
(iii)
information on outreach and education provided under this section to families and caregivers of older adults.
(C)

Public availability.—
The Secretary shall make reports submitted under paragraph (B) publically available on the internet website of the Department of Health and Human Services.
(b)

Geriatric Academic Career Awards.—
(1)

Establishment of program.—
The Secretary shall, as appropriate, establish or maintain a program to provide geriatric academic career awards to eligible entities applying on behalf of eligible individuals to promote the career development of such individuals as academic geriatricians or other academic geriatrics health professionals.
(2)

Eligibility.—
(A)

Eligible entity.—
For purposes of this subsection, the term “eligible entity” means—
(i)
an entity described in paragraph (1), (3), or (4) of section 799B or section 801(2); or
(ii)
another accredited health professions school or graduate program approved by the Secretary.
(B)

Eligible individual.—
For purposes of this subsection, the term “eligible individual” means an individual who—
(i)
(I)
is board certified or board eligible in internal medicine, family practice, psychiatry, or licensed dentistry, or has completed required training in a discipline and is employed in an accredited health professions school or graduate program that is approved by the Secretary; or
(II)
has completed an approved fellowship program in geriatrics, or has completed specialty training in geriatrics as required by the discipline and any additional geriatrics training as required by the Secretary; and
(ii)
has a junior, nontenured, faculty appointment at an accredited health professions school or graduate program in geriatrics or a geriatrics health profession.
(C)

Clarification.—
If an eligible individual is promoted during the period of an award under this subsection and thereby no longer meets the criteria of subparagraph (B)(ii), the individual shall continue to be treated as an eligible individual through the term of the award.
(3)

Application requirements.—
In order to receive an award under paragraph (1), an eligible entity, on behalf of an eligible individual, shall—
(A)
submit to the Secretary an application, at such time, in such manner, and containing such information as the Secretary may require;
(B)
provide, in such form and manner as the Secretary may require, assurances that the eligible individual will meet the service requirement described in paragraph (6); and
(C)
provide, in such form and manner as the Secretary may require, assurances that the individual has a full-time faculty appointment in a health professions institution and documented commitment from such eligible entity that the individual will spend 75 percent of the individual's time that is supported by the award on teaching and developing skills in interdisciplinary education in geriatrics.
(4)

Equitable distribution.—
In making awards under this subsection, the Secretary shall seek to ensure geographical distribution among award recipients, including among rural or medically underserved areas of the United States.
(5)

Amount and duration.—
(A)

Amount.—
The amount of an award under this subsection shall be at least $75,000 for fiscal year 2021, adjusted for subsequent years in accordance with the consumer price index. The Secretary shall determine the amount of an award under this subsection for individuals who are not physicians.
(B)

Duration.—
The Secretary shall make awards under paragraph (1) for a period not to exceed 5 years.
(6)

Service requirement.—
An individual who receives an award under this subsection shall provide training in clinical geriatrics, including the training of interprofessional teams of health care professionals. The provision of such training shall constitute at least 75 percent of the obligations of such individual under the award.
(c)

Nonapplicability of Provision.—
Notwithstanding any other provision of this title, section 791(a) shall not apply to awards made under this section.
(d)

Authorization of Appropriations.—
There is authorized to be appropriated $40,737,000 for each of fiscal years 2021 through 2025 for purposes of carrying out this section.
SEC. 754.
[294d]

QUENTIN N. BURDICK PROGRAM FOR RURAL INTERDISCIPLINARY TRAINING.
(a)

Grants.—
The Secretary may make grants or contracts under this section to help entities fund authorized activities under an application approved under subsection (c).
(b)

Use of Amounts.—
(1)

In general.—
Amounts provided under subsection (a) shall be used by the recipients to fund interdisciplinary training projects designed to—
(A)
use innovative or evidence-based methods to train health care practitioners to provide services in rural areas;
(B)
demonstrate and evaluate innovative interdisciplinary methods and models designed to provide access to cost-effective comprehensive health care;
(C)
deliver health care services to individuals residing in rural areas;
(D)
enhance the amount of relevant research conducted concerning health care issues in rural areas; and
(E)
increase the recruitment and retention of health care practitioners from rural areas and make rural practice a more attractive career choice for health care practitioners.
(2)

Methods.—
A recipient of funds under subsection (a) may use various methods in carrying out the projects described in paragraph (1), including—
(A)
the distribution of stipends to students of eligible applicants;
(B)
the establishment of a post-doctoral fellowship program;
(C)
the training of faculty in the economic and logistical problems confronting rural health care delivery systems; or
(D)
the purchase or rental of transportation and telecommunication equipment where the need for such equipment due to unique characteristics of the rural area is demonstrated by the recipient.
(3)

Administration.—
(A)

In general.—
An applicant shall not use more than 10 percent of the funds made available to such applicant under subsection (a) for administrative expenses.
(B)

Training.—
Not more than 10 percent of the individuals receiving training with funds made available to an applicant under subsection (a) shall be trained as doctors of medicine or doctors of osteopathy.
(C)

Limitation.—
An institution that receives a grant under this section shall use amounts received under such grant to supplement, not supplant, amounts made available by such institution for activities of the type described in subsection (b)(1) in the fiscal year preceding the year for which the grant is received.
(c)

Applications.—
Applications submitted for assistance under this section shall—
(1)
be jointly submitted by at least two eligible applicants with the express purpose of assisting individuals in academic institutions in establishing long-term collaborative relationships with health care providers in rural areas; and
(2)
designate a rural health care agency or agencies for clinical treatment or training, including hospitals, community health centers, migrant health centers, rural health clinics, community behavioral and mental health centers, long-term care facilities, Native Hawaiian health centers, or facilities operated by the Indian Health Service or an Indian tribe or tribal organization or Indian organization under a contract with the Indian Health Service under the Indian Self-Determination Act.
(d)

Definitions.—
For the purposes of this section, the term “rural” means geographic areas that are located outside of standard metropolitan statistical areas.
SEC. 755.
[294e]

ALLIED HEALTH AND OTHER DISCIPLINES.
(a)

In General.—
The Secretary may make grants or contracts under this section to help entities fund activities of the type described in subsection (b).
(b)

Activities.—
Activities of the type described in this subsection include the following:
(1)
Assisting entities in meeting the costs associated with expanding or establishing programs that will increase the number of individuals trained in allied health professions. Programs and activities funded under this paragraph may include—
(A)
those that expand enrollments in allied health professions with the greatest shortages or whose services are most needed by geriatric populations or for maternal and child health;
(B)
those that provide rapid transition training programs in allied health fields to individuals who have baccalaureate degrees in health-related sciences;
(C)
those that establish community-based allied health training programs that link academic centers to rural clinical settings;
(D)
those that provide career advancement training for practicing allied health professionals;
(E)
those that expand or establish clinical training sites for allied health professionals in medically underserved or rural communities in order to increase the number of individuals trained;
(F)
those that develop curriculum that will emphasize knowledge and practice in the areas of prevention and health promotion, geriatrics, long-term care, home health and hospice care, and ethics;
(G)
those that expand or establish interdisciplinary training programs that promote the effectiveness of allied health practitioners in geriatric assessment and the rehabilitation of the elderly;
(H)
those that expand or establish demonstration centers to emphasize innovative models to link allied health clinical practice, education, and research;
(I)
those that provide financial assistance (in the form of traineeships) to students who are participants in any such program; and
(i)
who plan to pursue a career in an allied health field that has a demonstrated personnel shortage; and
(ii)
who agree upon completion of the training program to practice in a medically underserved community;
that shall be utilized to assist in the payment of all or part of the costs associated with tuition, fees and such other stipends as the Secretary may consider necessary; and
(J)
those to meet the costs of projects to plan, develop, and operate or maintain graduate programs in behavioral and mental health practice.
(2)
Planning and implementing projects in preventive and primary care training for podiatric physicians in approved or provisionally approved residency programs that shall provide financial assistance in the form of traineeships to residents who participate in such projects and who plan to specialize in primary care.
(3)
Carrying out demonstration projects in which chiropractors and physicians collaborate to identify and provide effective treatment for spinal and lower-back conditions.
(4)
Increasing educational opportunities in physical therapy, occupational therapy, respiratory therapy, audiology, and speech-language pathology professions, which may include offering scholarships or stipends and carrying out other activities to improve retention, for individuals from disadvantaged backgrounds or individuals who are underrepresented in such professions.
SEC. 756.
[294e–1]

MENTAL AND BEHAVIORAL HEALTH EDUCATION AND TRAINING GRANTS.
(a)

Grants Authorized.—
The Secretary may award grants to eligible institutions to support the recruitment of students for, and education and clinical experience of the students in—
(1)
accredited institutions of higher education or accredited professional training programs that are establishing or expanding internships or other field placement programs in mental health in psychiatry, psychology, school psychology, behavioral pediatrics, psychiatric nursing (which may include master’s and doctoral level programs), social work, school social work, substance use disorder prevention and treatment, marriage and family therapy, occupational therapy (which may include master’s and doctoral level programs), school counseling, or professional counseling, including such programs with a focus on child and adolescent mental health, trauma, and transitional-age youth;
(2)
accredited doctoral, internship, and post-doctoral residency programs of health service psychology (including clinical psychology, counseling, and school psychology) for the development and implementation of interdisciplinary training of psychology graduate students for providing behavioral health services, including trauma-informed care and substance use disorder prevention and treatment services, as well as the development of faculty in health service psychology;
(3)
accredited master’s and doctoral degree programs of social work for the development and implementation of interdisciplinary training of social work graduate students for providing behavioral health services, including trauma-informed care and substance use disorder prevention and treatment services, and the development of faculty in social work; and
(4)
State-licensed mental health nonprofit and for-profit organizations to enable such organizations to pay for programs for preservice or in-service training in a behavioral health-related paraprofessional field with preference for preservice or in-service training of paraprofessional child and adolescent mental health workers, including training to increase skills and capacity to meet the needs of children and adolescents who have experienced trauma.
(b)

Eligibility Requirements.—
To be eligible for a grant under this section, an institution shall demonstrate—
(1)
an ability to recruit and place the students described in subsection (a) in areas with a high need and high demand population;
(2)
participation in the institutions' programs of individuals and groups from different racial, ethnic, cultural, geographic, religious, linguistic, and class backgrounds, and different genders and sexual orientations;
(3)
knowledge and understanding of the concerns of the individuals and groups described in paragraph (2), especially individuals with mental disorder symptoms or diagnoses, particularly children and adolescents, and transitional-age youth;
(4)
any internship or other field placement program assisted under the grant will prioritize cultural and linguistic competency; and
(5)
the institution will provide to the Secretary such data, assurances, and information as the Secretary may require.
(c)

Institutional Requirement.—
For grants awarded under paragraphs (2) and (3) of subsection (a), at least 4 of the grant recipients shall be historically black colleges or universities or other minority-serving institutions.
(d)

Priority.—
In selecting grant recipients under this section, the Secretary shall give priority to—
(1)
programs that have demonstrated the ability to train psychology, psychiatry, and social work professionals to work in integrated care settings for purposes of recipients under paragraphs (1), (2), and (3) of subsection (a); and
(2)
programs for paraprofessionals that emphasize the role of the family and the lived experience of the consumer and family-paraprofessional partnerships for purposes of recipients under subsection (a)(4).
(e)

Report to Congress.—
Not later than 4 years after the date of enactment of the Helping Families in Mental Health Crisis Reform Act of 2016, the Secretary shall include in the biennial report submitted to Congress under section 501(m) an assessment on the effectiveness of the grants under this section in—
(1)
providing graduate students support for experiential training (internship or field placement);
(2)
recruiting students interested in behavioral health practice;
(3)
recruiting students in accordance with subsection (b)(1);
(4)
developing and implementing interprofessional training and integration within primary care;
(5)
developing and implementing accredited field placements and internships; and
(6)
collecting data on the number of students trained in behavioral health care and the number of available accredited internships and field placements.
(f)

Authorization of Appropriations.—
For each of fiscal years 2026 through 2030, there are authorized to be appropriated to carry out this section $50,000,000, to be allocated as follows:
(1)
For grants described in subsection (a)(1), $15,000,000.
(2)
For grants described in subsection (a)(2), $15,000,000.
(3)
For grants described in subsection (a)(3), $10,000,000.
(4)
For grants described in subsection (a)(4), $10,000,000.
SEC. 757.
[294f]

ADVISORY COMMITTEE ON INTERDISCIPLINARY, COMMUNITY-BASED LINKAGES.
(a)

Establishment.—
The Secretary shall establish an advisory committee to be known as the Advisory Committee on Interdisciplinary, Community-Based Linkages (in this section referred to as the “Advisory Committee”).
(b)

Composition.—
(1)

In general.—
The Secretary shall determine the appropriate number of individuals to serve on the Advisory Committee. Such individuals shall not be officers or employees of the Federal Government.
(2)

Appointment.—
Not later than 90 days after the date of enactment of this Act 11, the Secretary shall appoint the members of the Advisory Committee from among individuals who are health professionals from schools of the types described in sections 751(b)(1)(A), 753(b), and 755(b). In making such appointments, the Secretary shall ensure a fair balance between the health professions, that at least 75 percent of the members of the Advisory Committee are health professionals, a broad geographic representation of members and a balance between urban and rural members. Members shall be appointed based on their competence, interest, and knowledge of the mission of the profession involved.
^{11}
So in law. The reference to “this Act” means the Public Health Service Act, which was enacted July 1, 1944. Probably should be a reference to the Health Professions Education Partnerships Act of 1998, which added section 756. That Act is Public Law 105–392, enacted November 13, 1998. (Section 103 of that Public Law (112 Stat. 3541) added section 756.)
(3)

Minority representation.—
In appointing the members of the Advisory Committee under paragraph (2), the Secretary shall ensure the adequate representation of women and minorities.
(c)

Terms.—
(1)

In general.—
A member of the Advisory Committee shall be appointed for a term of 3 years, except that of the members first appointed—
(A)
⅓ of the members shall serve for a term of 1 year;
(B)
⅓ of the members shall serve for a term of 2 years; and
(C)
⅓ of the members shall serve for a term of 3 years.
(2)

Vacancies.—
(A)

In general.—
A vacancy on the Advisory Committee shall be filled in the manner in which the original appointment was made and shall be subject to any conditions which applied with respect to the original appointment.
(B)

Filling unexpired term.—
An individual chosen to fill a vacancy shall be appointed for the unexpired term of the member replaced.
(d)

Duties.—
The Advisory Committee shall—
(1)
provide advice and recommendations to the Secretary concerning policy and program development and other matters of significance concerning the activities under this part;
(2)
not later than 3 years after the date of enactment of this section, and annually thereafter, prepare and submit to the Secretary, and the Committee on Labor and Human Resources of the Senate, and the Committee on Commerce of the House of Representatives, a report describing the activities of the Committee, including findings and recommendations made by the Committee concerning the activities under this part;
(3)
develop, publish, and implement performance measures for programs under this part;
(4)
develop and publish guidelines for longitudinal evaluations (as described in section 761(d)(2)) for programs under this part; and
(5)
recommend appropriation levels for programs under this part.
(e)

Meetings and Documents.—
(1)

Meetings.—
The Advisory Committee shall meet not less than 3 times each year. Such meetings shall be held jointly with other related entities established under this title where appropriate.
(2)

Documents.—
Not later than 14 days prior to the convening of a meeting under paragraph (1), the Advisory Committee shall prepare and make available an agenda of the matters to be considered by the Advisory Committee at such meeting. At any such meeting, the Advisory Council 12 shall distribute materials with respect to the issues to be addressed at the meeting. Not later than 30 days after the adjourning of such a meeting, the Advisory Committee shall prepare and make available a summary of the meeting and any actions taken by the Committee based upon the meeting.
^{12}
So in law. Probably should be “Advisory Committee”. See section 103 of Public Law 105–392 (112 Stat. 3541).
(f)

Compensation and Expenses.—
(1)

Compensation.—
Each member of the Advisory Committee shall be compensated at a rate equal to the daily equivalent of the annual rate of basic pay prescribed for level IV of the Executive Schedule under section 5315 of title 5, United States Code, for each day (including travel time) during which such member is engaged in the performance of the duties of the Committee.
(2)

Expenses.—
The members of the Advisory Committee shall be allowed 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, while away from their homes or regular places of business in the performance of services for the Committee.
(g)

Chapter 10 of Title 5, United States Code.—
Chapter 10 of title 5, United States Code, shall apply to the Advisory Committee under this section only to the extent that the provisions of chapter 10 of title 5, United States Code, do not conflict with the requirements of this section.
[Note: Section 758 was repealed by section 501(b)(2) of Public Law 113–4; enacted March 7, 2013, 127 Stat. 54.]
SEC. 759.
[294i]

PROGRAM FOR EDUCATION AND TRAINING IN PAIN CARE.
(a)

In General.—
The Secretary may make awards of grants, cooperative agreements, and contracts to health professions schools, hospices, tribal health programs (as defined in section 4 of the Indian Health Care Improvement Act), and other public and nonprofit private entities for the development and implementation of programs to provide education and training to health care professionals in pain care.
(b)

Certain Topics.—
An entity receiving an award under this section shall develop a comprehensive education and training plan that includes information and education on—
(1)
recognized means for assessing, diagnosing, preventing, treating, and managing pain and related signs and symptoms, including non-addictive medical products and non-pharmacologic treatments and the medically appropriate use of controlled substances;
(2)
applicable Federal, State, and local laws, regulations, rules, and policies on controlled substances, including opioids;
(3)
interdisciplinary approaches to the delivery of pain care, including delivery through specialized centers providing comprehensive pain care treatment expertise, integrated, evidence-based pain management, and, as appropriate, non-pharmacotherapy;
(4)
cultural, linguistic, literacy, geographic, and other barriers to care in underserved populations;
(5)
recent findings, developments, and advancements in pain care research and the provision of pain care, which may include non-addictive medical products and non-pharmacologic treatments intended to treat pain; and
(6)
the dangers of opioid abuse and misuse, detection of early warning signs of opioid use disorders (which may include best practices related to screening for opioid use disorders, training on screening, brief intervention, and referral to treatment), and safe disposal options for prescription medications (including such options provided by law enforcement or other innovative deactivation mechanisms).
(c)

Evaluation of Programs.—
The Secretary shall (directly or through grants or contracts) provide for the evaluation of programs implemented under subsection (a) in order to determine the effect of such programs on knowledge and practice of pain care.
(d)

Pain Care Defined.—
For purposes of this section the term “pain care” means the assessment, diagnosis, prevention, treatment, or management of acute or chronic pain regardless of causation or body location.
(e)

Authorization of Appropriations.—
There is authorized to be appropriated to carry out this section, such sums as may be necessary for each of the fiscal years 2019 through 2023. Amounts appropriated under this subsection shall remain available until expended.
SEC. 760.
[294k]

TRAINING DEMONSTRATION PROGRAM.
(a)

In General.—
The Secretary shall establish a training demonstration program to award grants to eligible entities to support—
(1)
training for medical residents and fellows to practice psychiatry and addiction medicine in underserved, community-based settings that integrate primary care with mental health and substance use disorder prevention and treatment services;
(2)
training (including for individuals completing clinical training requirements for licensure) for nurse practitioners, physician assistants, health service psychologists, counselors, nurses, and social workers to provide mental health and substance use disorder services in underserved community-based settings that integrate primary care and mental health and substance use disorder services, including such settings that serve pediatric populations; and
(3)
establishing, maintaining, or improving academic units or programs that—
(A)
provide training for students or faculty, including through clinical experiences and research, to improve the ability to be able to recognize, diagnose, and treat mental health and substance use disorders, with a special focus on addiction or pediatric populations; or
(B)
develop evidence-based practices or recommendations for the design of the units or programs described in subparagraph (A), including curriculum content standards.
(b)

Activities.—
(1)

Training for residents and fellows.—
A recipient of a grant under subsection (a)(1)—
(A)
shall use the grant funds—
(i)
(I)
to plan, develop, and operate a training program for medical psychiatry residents and fellows in addiction medicine practicing in eligible entities described in subsection (c)(1); or
(II)
to train new psychiatric residents and fellows in addiction medicine to provide and expand access to integrated mental health and substance use disorder services; and
(ii)
to provide at least 1 training track that is—
(I)
a virtual training track that includes an in-person rotation at a teaching health center or in a community-based setting, followed by a virtual rotation in which the resident or fellow continues to support the care of patients at the teaching health center or in the community-based setting through the use of health information technology and, as appropriate, telehealth services;
(II)
an in-person training track that includes a rotation, during which the resident or fellow practices at a teaching health center or in a community-based setting; or
(III)
an in-person training track that includes a rotation during which the resident practices in a community-based setting that specializes in the treatment of infants, children, adolescents, or pregnant or postpartum women; and
(B)
may use the grant funds to provide additional support for the administration of the program or to meet the costs of projects to establish, maintain, or improve faculty development, or departments, divisions, or other units necessary to implement such training.
(2)

Training for other providers.—
A recipient of a grant under subsection (a)(2)—
(A)
shall use the grant funds to plan, develop, or operate a training program to provide mental health and substance use disorder services in underserved, community-based settings (including such settings that serve pediatric populations), as appropriate, that integrate primary care and mental health and substance use disorder prevention and treatment services; and
(B)
may use the grant funds to provide additional support for the administration of the program or to meet the costs of projects to establish, maintain, or improve faculty development, or departments, divisions, or other units necessary to implement such program.
(3)

Academic units or programs.—
A recipient of a grant under subsection (a)(3) shall enter into a partnership with organizations such as an education accrediting organization (such as the Liaison Committee on Medical Education, the Accreditation Council for Graduate Medical Education, the Commission on Osteopathic College Accreditation, the Accreditation Commission for Education in Nursing, the Commission on Collegiate Nursing Education, the Accreditation Council for Pharmacy Education, the Council on Social Work Education, American Psychological Association Commission on Accreditation, or the Accreditation Review Commission on Education for the Physician Assistant) to carry out activities under subsection (a)(3).
(c)

Eligible Entities.—
(1)

Training for residents and fellows.—
To be eligible to receive a grant under subsection (a)(1), an entity shall—
(A)
be a consortium consisting of—
(i)
at least one teaching health center; and
(ii)
the sponsoring institution (or parent institution of the sponsoring institution) of—
(I)
a psychiatry residency program that is accredited by the Accreditation Council of Graduate Medical Education (or the parent institution of such a program); or
(II)
a fellowship in addiction medicine, as determined appropriate by the Secretary; or
(B)
be an entity described in subparagraph (A)(ii) that provides opportunities for residents or fellows to train in community-based settings that integrate primary care with mental health and substance use disorder prevention and treatment services.
(2)

Training for other providers.—
To be eligible to receive a grant under subsection (a)(2), an entity shall be—
(A)
a teaching health center (as defined in section 749A(f));
(B)
a Federally qualified health center (as defined in section 1905(l)(2)(B) of the Social Security Act);
(C)
a community mental health center (as defined in section 1861(ff)(3)(B) of the Social Security Act);
(D)
a rural health clinic (as defined in section 1861(aa) of the Social Security Act);
(E)
a health center operated by the Indian Health Service, an Indian tribe, a tribal organization, or an urban Indian organization (as defined in section 4 of the Indian Health Care Improvement Act); or
(F)
an entity with a demonstrated record of success in providing training for nurse practitioners, physician assistants, health service psychologists counselors, nurses,,13 and social workers, including such entities that serve pediatric populations.
^{13}
Double comma so in law. See the amendment made by section 1311(b)(5)(A) of division FF of Public Law 117-328.
(3)

Academic units or programs.—
To be eligible to receive a grant under subsection (a)(3), an entity shall be a school of medicine or osteopathic medicine, a nursing school, a physician assistant training program, a school of pharmacy, a school of social work, an accredited public or nonprofit private hospital, an accredited medical residency program, or a public or private nonprofit entity which the Secretary has determined is capable of carrying out such grant.
(d)

Priority.—
(1)

In general.—
In awarding grants under subsection (a)(1) or (a)(2), the Secretary shall give priority to eligible entities that—
(A)
demonstrate sufficient size, scope, and capacity to undertake the requisite training of an appropriate number of psychiatric residents, fellows, health service psychologists, nurses 14 nurse practitioners, physician assistants14counselors,,15 or social workers in addiction medicine per year to meet the needs of the area served;
^{14}
Lack of commas so in law. See the amendments made by section 1311(b)(6)(A) and (B) of division FF of Public Law 117-328.
^{15}
Double comma so in law. See the amendment made by section 1311(b)(6)(B) of division FF of Public Law 117-328.
(B)
demonstrate experience in training providers to practice team-based care that integrates mental health and substance use disorder prevention and treatment services with primary care in community-based settings, which may include such settings that serve pediatric populations;
(C)
demonstrate experience in using health information technology and, as appropriate, telehealth to support—
(i)
the delivery of mental health and substance use disorder services at the eligible entities described in subsections (c)(1) and (c)(2); and
(ii)
community health centers in integrating primary care and mental health and substance use disorder treatment; or
(D)
have the capacity to expand access to mental health and substance use disorder services in areas with demonstrated need, as determined by the Secretary, such as tribal, rural, or other underserved communities.
(2)

Academic units or programs.—
In awarding grants under subsection (a)(3), the Secretary shall give priority to eligible entities that—
(A)
have a record of training the greatest percentage of mental health and substance use disorder providers who enter and remain in these fields or who enter and remain in settings with integrated primary care and mental and substance use disorder prevention and treatment services;
(B)
have a record of training individuals who are from underrepresented minority groups, including native populations, or from a rural or disadvantaged background;
(C)
provide training in the care (which may include trauma-informed care, as appropriate) of vulnerable populations such as infants, children, adolescents, pregnant and postpartum women, older adults, homeless individuals, victims of abuse or trauma, individuals with disabilities, and other groups as defined by the Secretary;
(D)
teach trainees the skills to provide interprofessional, integrated care through collaboration among health professionals; or
(E)
provide training in cultural competency and health literacy.
(e)

Duration.—
Grants awarded under this section shall be for a minimum of 5 years.
(f)

Study and Report.—
(1)

Study.—
(A)

In general.—
The Secretary, acting through the Administrator of the Health Resources and Services Administration, shall conduct a study on the results of the demonstration program under this section.
(B)

Data submission.—
Not later than 90 days after the completion of the first year of the training program and each subsequent year that the program is in effect, each recipient of a grant under subsection (a) shall submit to the Secretary such data as the Secretary may require for analysis for the report described in paragraph (2).
(2)

Report to congress.—
Not later than 1 year after receipt of the data described in paragraph (1)(B), the Secretary shall submit to Congress a report that includes—
(A)
an analysis of the effect of the demonstration program under this section on the quality, quantity, and distribution of mental health and substance use disorder services;
(B)
an analysis of the effect of the demonstration program on the prevalence of untreated mental health and substance use disorders in the surrounding communities of health centers participating in the demonstration; and
(C)
recommendations on whether the demonstration program should be expanded.
(g)

Authorization of Appropriations.—
There are authorized to be appropriated to carry out this section, and $31,700,000 for each of fiscal years 2023 through 2027.
PART E—

HEALTH PROFESSIONS AND PUBLIC HEALTH WORKFORCE
Subpart 1—

Health Professions Workforce Information and Analysis
SEC. 761.
[294n]

HEALTH PROFESSIONS WORKFORCE INFORMATION AND ANALYSIS.
(a)

Purpose.—
It is the purpose of this section to—
(1)
provide for the development of information describing the health professions workforce and the analysis of workforce related issues; and
(2)
provide necessary information for decision-making regarding future directions in health professions and nursing programs in response to societal and professional needs.
(b)

National Center for Health Care Workforce Analysis.—
(1)

Establishment.—
The Secretary shall establish the National Center for Health Workforce Analysis (referred to in this section as the “National Center”).
(2)

Purposes.—
The National Center, in coordination to the extent practicable with the National Health Care Workforce Commission (established in section 5101 of the Patient Protection and Affordable Care Act), and relevant regional and State centers and agencies, shall—
(A)
provide for the development of information describing and analyzing the health care workforce and workforce related issues;
(B)
carry out the activities under section 792(a);
(C)
annually evaluate programs under this title;
(D)
develop and publish performance measures and benchmarks for programs under this title; and
(E)
establish, maintain, and publicize a national Internet registry of each grant awarded under this title and a database to collect data from longitudinal evaluations (as described in subsection (d)(2)) on performance measures (as developed under sections 749(d)(3), 757(d)(3), and 762(a)(3)).
(3)

Collaboration and data sharing.—
(A)

In general.—
The National Center shall collaborate with Federal agencies and relevant professional and educational organizations or societies for the purpose of linking data regarding grants awarded under this title.
(B)

Contracts for health workforce analysis.—
For the purpose of carrying out the activities described in subparagraph (A), the National Center may enter into contracts with relevant professional and educational organizations or societies.
(c)

State and Regional Centers for Health Workforce Analysis.—
(1)

In general.—
The Secretary shall award grants to, or enter into contracts with, eligible entities for purposes of—
(A)
collecting, analyzing, and reporting data regarding programs under this title to the National Center and to the public; and
(B)
providing technical assistance to local and regional entities on the collection, analysis, and reporting of data.
(2)

Eligible entities.—
To be eligible for a grant or contract under this subsection, an entity shall—
(A)
be a State, a State workforce investment board, a public health or health professions school, an academic health center, or an appropriate public or private nonprofit entity; and
(B)
submit to the Secretary an application at such time, in such manner, and containing such information as the Secretary may require.
(d)

Increase in Grants for Longitudinal Evaluations.—
(1)

In general.—
The Secretary shall increase the amount awarded to an eligible entity under this title for a longitudinal evaluation of individuals who have received education, training, or financial assistance from programs under this title.
(2)

Capability.—
A longitudinal evaluation shall be capable of—
(A)
studying practice patterns; and
(B)
collecting and reporting data on performance measures developed under sections 749(d)(3), 757(d)(3), and 762(a)(3).
(3)

Guidelines.—
A longitudinal evaluation shall comply with guidelines issued under sections 749(d)(4), 757(d)(4), and 762(a)(4).
(4)

Eligible entities.—
To be eligible to obtain an increase under this section, an entity shall be a recipient of a grant or contract under this title.
(e)

Authorization of Appropriations.—
(1)

In general.—
(A)

National center.—
To carry out subsection (b), there are authorized to be appropriated $5,663,000 for each of fiscal years 2021 through 2025.
(B)

State and regional centers.—
To carry out subsection (c), there are authorized to be appropriated $4,500,000 for each of fiscal years 2010 through 2014.
(C)

Grants for longitudinal evaluations.—
To carry out subsection (d), there are authorized to be appropriated such sums as may be necessary for fiscal years 2010 through 2014.
(2)

Reservation.—
Of the amounts appropriated under paragraph (1) for a fiscal year, the Secretary shall reserve not less than $600,000 for conducting health professions research and for carrying out data collection and analysis in accordance with section 792.
(3)

Availability of additional funds.—
Amounts otherwise appropriated for programs or activities under this title may be used for activities under subsection (b) with respect to the programs or activities from which such amounts were made available.
SEC. 762.
[294o]

ADVISORY COUNCIL ON GRADUATE MEDICAL EDUCATION.
(a)

Establishment; Duties.—
There is established the Council on Graduate Medical Education (in this section referred to as the “Council”). The Council shall—
(1)
make recommendations to the Secretary of Health and Human Services (in this section referred to as the “Secretary”), and to the Committee on Health, Education, Labor, and Pensions of the Senate, and the Committee on Energy and Commerce of the House of Representatives, with respect to—
(A)
the supply and distribution of physicians in the United States;
(B)
current and future shortages or excesses of physicians in medical and surgical specialties and subspecialties;
(C)
issues relating to foreign medical school graduates;
(D)
appropriate Federal policies with respect to the matters specified in subparagraphs (A), (B), and (C), including policies concerning changes in the financing of undergraduate and graduate medical education programs and changes in the types of medical education training in graduate medical education programs;
(E)
appropriate efforts to be carried out by hospitals, schools of medicine, schools of osteopathic medicine, and accrediting bodies with respect to the matters specified in subparagraphs (A), (B), and (C), including efforts for changes in undergraduate and graduate medical education programs; and
(F)
deficiencies in, and needs for improvements in, existing data bases concerning the supply and distribution of, and postgraduate training programs for, physicians in the United States and steps that should be taken to eliminate those deficiencies;
(2)
encourage entities providing graduate medical education to conduct activities to voluntarily achieve the recommendations of the Council under paragraph (1)(E);
(3)
develop, publish, and implement performance measures for programs under this title, except for programs under part C or D;
(4)
develop and publish guidelines for longitudinal evaluations (as described in section 761(d)(2)) for programs under this title, except for programs under part C or D; and
(5)
recommend appropriation levels for programs under this title, except for programs under part C or D.
(b)

Composition.—
The Council shall be composed of—
(1)
the Assistant Secretary for Health or the designee of the Assistant Secretary;
(2)
the Administrator of the Centers for Medicare & Medicaid Services;
(3)
the Chief Medical Director of the Department of Veterans Affairs;
(4)
the Administrator of the Health Resources and Services Administration;
(5)
6 members appointed by the Secretary to include representatives of practicing primary care physicians, national and specialty physician organizations, foreign medical graduates, and medical student and house staff associations;
(6)
4 members appointed by the Secretary to include representatives of schools of medicine and osteopathic medicine and public and private teaching hospitals; and
(7)
4 members appointed by the Secretary to include representatives of health insurers, business, and labor.
(c)

Terms of Appointed Members.—
(1)

In general; staggered rotation.—
Members of the Council appointed under paragraphs (4), (5), and (6) of subsection (b) shall be appointed for a term of 4 years, except that the term of office of the members first appointed shall expire, as designated by the Secretary at the time of appointment, 4 at the end of 1 year, 4 at the end of 2 years, 3 at the end of 3 years, and 3 at the end of 4 years.
(2)

Date certain for appointment.—
The Secretary shall appoint the first members to the Council under paragraphs (4), (5), and (6) of subsection (b) within 60 days after the date of enactment of this section.
(d)

Chair.—
The Council shall elect one of its members as Chairman of the Council.
(e)

Quorum.—
Nine members of the Council shall constitute a quorum, but a lesser number may hold hearings.
(f)

Vacancies.—
Any vacancy in the Council shall not affect its power to function.
(g)

Compensation.—
Each member of the Council who is not otherwise employed by the United States Government shall receive compensation at a rate equal to the daily rate prescribed for GS–18 under the General Schedule under section 5332 of title 5, United States Code, for each day, including traveltime, such member is engaged in the actual performance of duties as a member of the Council. A member of the Council who is an officer or employee of the United States Government shall serve without additional compensation. All members of the Council shall be reimbursed for travel, subsistence, and other necessary expenses incurred by them in the performance of their duties.
(h)

Certain Authorities and Duties.—
(1)

Authorities.—
In order to carry out the provisions of this section, the Council is authorized to—
(A)
collect such information, hold such hearings, and sit and act at such times and places, either as a whole or by subcommittee, and request the attendance and testimony of such witnesses and the production of such books, records, correspondence, memoranda, papers, and documents as the Council or such subcommittee may consider available; and
(B)
request the cooperation and assistance of Federal departments, agencies, and instrumentalities, and such departments, agencies, and instrumentalities are authorized to provide such cooperation and assistance.
(2)

Coordination of activities.—
The Council shall coordinate its activities with the activities of the Secretary under section 792 of the Public Health Service Act. The Secretary shall, in cooperation with the Council and pursuant to the recommendations of the Council, take such steps as are practicable to eliminate deficiencies in the data base established under such section 792 and shall make available in its reports such comprehensive data sets as are developed pursuant to this section.
(i)

Reports.—
Not later than September 30, 2023, and not less than every 5 years thereafter, the Council 16 shall submit to the Secretary, and to the Committee on Health, Education, Labor, and Pensions of the Senate and the Committee on Energy and Commerce of the House of Representatives, a report on the recommendations described in subsection (a).
(j)

Funding.—
Amounts otherwise appropriated under this title may be utilized by the Secretary to support the activities of the Council.
^{16}
Appropriations Acts for the Department of Health and Human Services for fiscal years 2004 and 2005 provided for the continued operation of the Council. See section 219 of division E of Public Law 108–199 (118 Stat. 255) and section 218 of division F of Public Law 108–447 (118 Stat. 3141). Each of such sections refers to “the Council on Graduate Education established by section 301 of Public Law 102–408”. Such section 301 was transferred to the Public Health Service Act as section 762 above by section 104(b) of Public Law 105–392 (112 Stat. 3552).
SEC. 763.
[294p]

TRAINING FOR HEALTH CARE PROVIDERS.
(a)

Grant Program.—
The Secretary shall establish a program to award grants to accredited schools of allopathic medicine, osteopathic medicine, and nursing, and other health professional training programs for the training of health care professionals to improve the provision of prenatal care, labor care, birthing, and postpartum care for racial and ethnic minority populations, including with respect to perceptions and biases that may affect the approach to, and provision of, care.
(b)

Eligibility.—
To be eligible for a grant under subsection (a), an entity described in such subsection shall submit to the Secretary an application at such time, in such manner, and containing such information as the Secretary may require.
(c)

Reporting Requirements.—
(1)

Periodic grantee reports.—
Each entity awarded a grant under this section shall periodically submit to the Secretary a report on the status of activities conducted using the grant, including a description of the impact of such training on patient outcomes, as applicable.
(2)

Report to congress.—
Not later than September 30, 2026, the Secretary shall submit a report to Congress on the activities conducted using grants under subsection (a) and any best practices identified and disseminated under subsection (d).
(d)

Best Practices.—
The Secretary may identify and disseminate best practices for the training described in subsection (a).
(e)

Authorization of Appropriations.—
To carry out this section, there are authorized to be appropriated $5,000,000 for each of fiscal years 2023 through 2027.
SEC. 764.
[294s]

RURAL MATERNAL AND OBSTETRIC CARE TRAINING DEMONSTRATION.17
(a)

In General.—
The Secretary shall award grants to accredited schools of allopathic medicine, osteopathic medicine, and nursing, and other appropriate health professional training programs, to establish a training demonstration program to support—
(1)
training for physicians, medical residents, fellows, nurse practitioners, physician assistants, nurses, certified nurse midwives, relevant home visiting workforce professionals and paraprofessionals, or other professionals who meet relevant State training and licensing requirements, as applicable, to reduce preventable maternal mortality and severe maternal morbidity by improving prenatal care, labor care, birthing, and postpartum care in rural community-based settings; and
(2)
developing recommendations for such training programs.
^{17}
There are two sections designated as section 764. For details, see footnote in second section 764 below.
(b)

Application.—
To be eligible to receive a grant under subsection (a), an entity shall submit to the Secretary an application at such time, in such manner, and containing such information as the Secretary may require.
(c)

Activities.—
(1)

Training for health care professionals.—
A recipient of a grant under subsection (a)—
(A)
shall use the grant funds to plan, develop, and operate a training program to provide prenatal care, labor care, birthing, and postpartum care in rural areas; and
(B)
may use the grant funds to provide additional support for the administration of the program or to meet the costs of projects to establish, maintain, or improve faculty development, or departments, divisions, or other units necessary to implement such training.
(2)

Training program requirements.—
The recipient of a grant under subsection (a) shall ensure that training programs carried out under the grant are evidence-based and address improving prenatal care, labor care, birthing, and postpartum care in rural areas, and such programs may include training on topics such as—
(A)
maternal mental health, including perinatal depression and anxiety;
(B)
substance use disorders;
(C)
social determinants of health that affect individuals living in rural areas; and
(D)
improving the provision of prenatal care, labor care, birthing, and postpartum care for racial and ethnic minority populations, including with respect to perceptions and biases that may affect the approach to, and provision of, care.
(d)

Evaluation and Report.—
(1)

Evaluation.—
(A)

In general.—
The Secretary shall evaluate the outcomes of the demonstration program under this section.
(B)

Data submission.—
Recipients of a grant under subsection (a) shall submit to the Secretary performance metrics and other related data in order to evaluate the program for the report described in paragraph (2).
(2)

Report to congress.—
Not later than January 1, 2026, the Secretary shall submit to Congress a report that includes—
(A)
an analysis of the effects of the demonstration program under this section on the quality, quantity, and distribution of maternal health care services, including prenatal care, labor care, birthing, and postpartum care services, and the demographics of the recipients of those services;
(B)
an analysis of maternal and infant health outcomes (including quality of care, morbidity, and mortality) before and after implementation of the program in the communities served by entities participating in the demonstration; and
(C)
recommendations on whether the demonstration program should be continued.
(e)

Authorization of Appropriations.—
There are authorized to be appropriated to carry out this section $5,000,000 for each of fiscal years 2023 through 2027.
SEC. 764.
[294t]

PROGRAMS TO PROMOTE MENTAL HEALTH AMONG THE HEALTH PROFESSIONAL WORKFORCE.18
(a)

Programs to Promote Mental Health Among Health Care Professionals.—
(1)

In general.—
The Secretary shall award grants or contracts to health care entities, including entities that provide health care services, such as hospitals, community health centers, and rural health clinics, or to medical professional associations, to establish or enhance evidence-based or evidence-informed programs dedicated to improving mental health and resiliency for health care professionals.
(2)

Use of funds.—
An eligible entity receiving a grant or contract under this subsection shall use funds received through the grant or contract to implement a new program or enhance an existing program to promote mental health among health care professionals, which may include—
(A)
improving awareness among health care professionals about risk factors for, and signs of, suicide and mental health or substance use disorders, in accordance with evidence-based or evidence-informed practices;
(B)
establishing new, or enhancing existing, evidence-based or evidence-informed programs for preventing suicide and improving mental health and resiliency among health care professionals;
(C)
establishing new, or enhancing existing, peer-support programs among health care professionals; or
(D)
providing mental health care, follow-up services and care, or referral for such services and care, as appropriate.
(3)

Priority.—
In awarding grants and contracts under this subsection, the Secretary shall give priority to eligible entities in health professional shortage areas or rural areas.
^{18}
Second section 764 is so in law. See amendment made by section 4 of P.L. 117-105.
(b)

Training Grants.—
The Secretary may establish a program to award grants to health professions schools, academic health centers, State or local governments, Indian Tribes or Tribal organizations, or other appropriate public or private nonprofit entities (or consortia of entities, including entities promoting multidisciplinary approaches) to support the training of health care students, residents, or health care professionals in evidence-based or evidence-informed strategies to address mental and substance use disorders and improve mental health and resiliency among health care professionals.
(c)

Grant Terms.—
A grant or contract awarded under subsection (a) or (b) shall be for a period of 3 years.
(d)

Application Submission.—
An entity seeking a grant or contract under subsection (a) or (b) shall submit an application to the Secretary at such time, in such manner, and accompanied by such information as the Secretary may require.
(e)

Reporting.—
An entity awarded a grant or contract under subsection (a) or (b) shall periodically submit to the Secretary a report evaluating the activities supported by the grant or contract.
(f)

Authorization of Appropriations.—
To carry out this section and section 5 of the Dr. Lorna Breen Health Care Provider Protection Act, there are authorized to be appropriated $35,000,000 for each of fiscal years 2022 through 2024.
Subpart 2—

Public Health Workforce
SEC. 765.
[295]

GENERAL PROVISIONS.
(a)

In General.—
The Secretary may award grants or contracts to eligible entities to increase the number of individuals in the public health workforce, to enhance the quality of such workforce, and to enhance the ability of the workforce to meet national, State, and local health care needs.
(b)

Eligibility.—
To be eligible to receive a grant or contract under subsection (a) an entity shall—
(1)
be—
(A)
a health professions school, including an accredited school or program of public health, health administration, preventive medicine, or dental public health or a school providing health management programs;
(B)
an academic health center;
(C)
a State or local government; or
(D)
any other appropriate public or private nonprofit entity; and
(2)
prepare and submit to the Secretary an application at such time, in such manner, and containing such information as the Secretary may require.
(c)

Preference.—
In awarding grants or contracts under this section the Secretary may grant a preference to entities—
(1)
serving individuals who are from disadvantaged backgrounds (including underrepresented racial and ethnic minorities); and
(2)
graduating large proportions of individuals who serve in underserved communities.
(d)

Activities.—
Amounts provided under a grant or contract awarded under this section may be used for—
(1)
the costs of planning, developing, or operating demonstration training programs;
(2)
faculty development;
(3)
trainee support;
(4)
technical assistance;
(5)
to meet the costs of projects—
(A)
to plan and develop new residency training programs and to maintain or improve existing residency training programs in preventive medicine and dental public health, that have available full-time faculty members with training and experience in the fields of preventive medicine and dental public health; and
(B)
to provide financial assistance to residency trainees enrolled in such programs;
(6)
the retraining of existing public health workers as well as for increasing the supply of new practitioners to address priority public health, preventive medicine, public health dentistry, and health administration needs;
(7)
preparing public health professionals for employment at the State and community levels;
(8)
public health workforce loan repayment programs; or
(9)
other activities that may produce outcomes that are consistent with the purposes of this section.
(e)

Traineeships.—
(1)

In general.—
With respect to amounts used under this section for the training of health professionals, such training programs shall be designed to—
(A)
make public health education more accessible to the public and private health workforce;
(B)
increase the relevance of public health academic preparation to public health practice in the future;
(C)
provide education or training for students from traditional on-campus programs in practice-based sites; or
(D)
develop educational methods and distance-based approaches or technology that address adult learning requirements and increase knowledge and skills related to community-based cultural diversity in public health education.
(2)

Severe shortage disciplines.—
Amounts provided under grants or contracts under this section may be used for the operation of programs designed to award traineeships to students in accredited schools of public health who enter educational programs in fields where there is a severe shortage of public health professionals, including epidemiology, biostatistics, environmental health, toxicology, public health nursing, nutrition, preventive medicine, maternal and child health, and behavioral and mental health professions.
SEC. 766.
[295a]

PUBLIC HEALTH TRAINING CENTERS.
(a)

In General.—
The Secretary may make grants or contracts for the operation of public health training centers.
(b)

Eligible Entities.—
(1)

In general.—
A public health training center shall be an accredited school of public health, or another public or nonprofit private institution accredited for the provision of graduate or specialized training in public health, that plans, develops, operates, and evaluates projects to improve preventive medicine, health promotion and disease prevention, or access to and quality of health care services in rural or medically underserved communities.
(2)

Preference.—
In awarding grants or contracts under this section the Secretary shall give preference to accredited schools of public health.
(c)

Certain Requirements.—
With respect to a public health training center, an award may not be made under subsection (a) unless the program agrees that it—
(1)
will establish or strengthen field placements for students in public or nonprofit private health agencies or organizations;
(2)
will involve faculty members and students in collaborative projects to enhance public health services to medically underserved communities;
(3)
will specifically designate a geographic area or medically underserved population to be served by the center that shall be in a location removed from the main location of the teaching facility of the school that is participating in the program with such center; and
(4)
will assess the health personnel needs of the area to be served by the center and assist in the planning and development of training programs to meet such needs.
SEC. 767.
[295b]

PUBLIC HEALTH TRAINEESHIPS.
(a)

In General.—
The Secretary may make grants to accredited schools of public health, and to other public or nonprofit private institutions accredited for the provision of graduate or specialized training in public health, for the purpose of assisting such schools and institutions in providing traineeships to individuals described in subsection (b)(3).
(b)

Certain Requirements.—
(1)

Amount.—
The amount of any grant under this section shall be determined by the Secretary.
(2)

Use of grant.—
Traineeships awarded under grants made under subsection (a) shall provide for tuition and fees and such stipends and allowances (including travel and subsistence expenses and dependency allowances) for the trainees as the Secretary may deem necessary.
(3)

Eligible individuals.—
The individuals referred to in subsection (a) are individuals who are pursuing a course of study in a health professions field in which there is a severe shortage of health professionals (which fields include the fields of epidemiology, environmental health, biostatistics, toxicology, nutrition, and maternal and child health).
SEC. 768.
[295c]

PREVENTIVE MEDICINE AND PUBLIC HEALTH TRAINING GRANT PROGRAM.
(a)

Grants.—
The Secretary, acting through the Administrator of the Health Resources and Services Administration and in consultation with the Director of the Centers for Disease Control and Prevention, shall award grants to, or enter into contracts with, eligible entities to provide training to graduate medical residents in preventive medicine specialties.
(b)

Eligibility.—
To be eligible for a grant or contract under subsection (a), an entity shall be—
(1)
an accredited school of public health or school of medicine or osteopathic medicine;
(2)
an accredited public or private nonprofit hospital;
(3)
a State, local, or tribal health department; or
(4)
a consortium of 2 or more entities described in paragraphs (1) through (3).
(c)

Use of Funds.—
Amounts received under a grant or contract under this section shall be used to—
(1)
plan, develop (including the development of curricula), operate, or participate in an accredited residency or internship program in preventive medicine or public health;
(2)
defray the costs of practicum experiences, as required in such a program; and
(3)
establish, maintain, or improve—
(A)
academic administrative units (including departments, divisions, or other appropriate units) in preventive medicine and public health; or
(B)
programs that improve clinical teaching in preventive medicine and public health.
(d)

Report.—
The Secretary shall submit to the Congress an annual report on the program carried out under this section.
SEC. 769.
[295d]

HEALTH ADMINISTRATION TRAINEESHIPS AND SPECIAL PROJECTS.
(a)

In General.—
The Secretary may make grants to State or local governments (that have in effect preventive medical and dental public health residency programs) or public or nonprofit private educational entities (including graduate schools of social work and business schools that have health management programs) that offer a program described in subsection (b)—
(1)
to provide traineeships for students enrolled in such a program; and
(2)
to assist accredited programs health administration in the development or improvement of programs to prepare students for employment with public or nonprofit private entities.
(b)

Relevant Programs.—
The program referred to in subsection (a) is an accredited program in health administration, hospital administration, or health policy analysis and planning, which program is accredited by a body or bodies approved for such purpose by the Secretary of Education and which meets such other quality standards as the Secretary of Health and Human Services by regulation may prescribe.
(c)

Preference in Making Grants.—
In making grants under subsection (a), the Secretary shall give preference to qualified applicants that meet the following conditions:
(1)
Not less than 25 percent of the graduates of the applicant are engaged in full-time practice settings in medically underserved communities.
(2)
The applicant recruits and admits students from medically underserved communities.
(3)
For the purpose of training students, the applicant has established relationships with public and nonprofit providers of health care in the community involved.
(4)
In training students, the applicant emphasizes employment with public or nonprofit private entities.
(d)

Certain Provisions Regarding Traineeships.—
(1)

Use of grant.—
Traineeships awarded under grants made under subsection (a) shall provide for tuition and fees and such stipends and allowances (including travel and subsistence expenses and dependency allowances) for the trainees as the Secretary may deem necessary.
(2)

Preference for certain students.—
Each entity applying for a grant under subsection (a) for traineeships shall assure to the satisfaction of the Secretary that the entity will give priority to awarding the traineeships to students who demonstrate a commitment to employment with public or nonprofit private entities in the fields with respect to which the traineeships are awarded.
SEC. 770.
[295e]

AUTHORIZATION OF APPROPRIATIONS.
(a)

In General.—
For the purpose of carrying out this subpart, there is authorized to be appropriated $17,000,000 for each of fiscal years 2021 through 2025.
(b)

Limitation Regarding Certain Program.—
In obligating amounts appropriated under subsection (a), the Secretary may not obligate more than 30 percent for carrying out section 767.
Subpart 3—

Recruitment and Retention Programs
SEC. 775.
[295f]

INVESTMENT IN TOMORROW'S PEDIATRIC HEALTH CARE WORKFORCE.
(a)

Establishment.—
The Secretary shall establish and carry out a pediatric specialty loan repayment program under which the eligible individual agrees to be employed full-time for a specified period (which shall not be less than 2 years) in providing pediatric medical subspecialty, pediatric surgical specialty, or child and adolescent mental and behavioral health care, including substance abuse prevention and treatment services.
(b)

Program Administration.—
Through the program established under this section, the Secretary shall enter into contracts with qualified health professionals under which—
(1)
such qualified health professionals will agree to provide pediatric medical subspecialty, pediatric surgical specialty, or child and adolescent mental and behavioral health care in an area with a shortage of the specified pediatric subspecialty that has a sufficient pediatric population to support such pediatric subspecialty, as determined by the Secretary; and
(2)
the Secretary agrees to make payments on the principal and interest of undergraduate, graduate, or graduate medical education loans of professionals described in paragraph (1) of not more than $35,000 a year for each year of agreed upon service under such paragraph for a period of not more than 3 years during the qualified health professional's—
(A)
participation in an accredited pediatric medical subspecialty, pediatric surgical specialty, or child and adolescent mental health subspecialty residency or fellowship; or
(B)
employment as a pediatric medical subspecialist, pediatric surgical specialist, or child and adolescent mental health professional serving an area or population described in such paragraph.
(c)

In General.—
(1)

Eligible individuals.—
(A)

Pediatric medical specialists and pediatric surgical specialists.—
For purposes of contracts with respect to pediatric medical specialists and pediatric surgical specialists, the term “qualified health professional” means a licensed physician who—
(i)
is entering or receiving training in an accredited pediatric medical subspecialty or pediatric surgical specialty residency or fellowship; or
(ii)
has completed (but not prior to the end of the calendar year in which this section is enacted) the training described in subparagraph (B).
(B)

Child and adolescent mental and behavioral health.—
For purposes of contracts with respect to child and adolescent mental and behavioral health care, the term “qualified health professional” means a health care professional who—
(i)
has received specialized training or clinical experience in child and adolescent mental health in psychiatry, psychology, school psychology, behavioral pediatrics, psychiatric nursing, social work, school social work, substance abuse disorder prevention and treatment, marriage and family therapy, school counseling, or professional counseling;
(ii)
has a license or certification in a State to practice allopathic medicine, osteopathic medicine, psychology, school psychology, psychiatric nursing, social work, school social work, marriage and family therapy, school counseling, or professional counseling; or
(iii)
is a mental health service professional who completed (but not before the end of the calendar year in which this section is enacted) specialized training or clinical experience in child and adolescent mental health described in clause (i).
(2)

Additional eligibility requirements.—
The Secretary may not enter into a contract under this subsection with an eligible individual unless—
(A)
the individual agrees to work in, or for a provider serving, a health professional shortage area or medically underserved area, or to serve a medically underserved population;
(B)
the individual is a United States citizen or a permanent legal United States resident; and
(C)
if the individual is enrolled in a graduate program, the program is accredited, and the individual has an acceptable level of academic standing (as determined by the Secretary).
(d)

Priority.—
In entering into contracts under this subsection, the Secretary shall give priority to applicants who—
(1)
are or will be working in a school or other pre-kindergarten, elementary, or secondary education setting;
(2)
have familiarity with evidence-based methods and cultural and linguistic competence health care services; and
(3)
demonstrate financial need.
(e)

Authorization of Appropriations.—
There is authorized to be appropriated such sums as may be necessary for each of fiscal years 2021 through 2025.
SEC. 776.
[295f–1]

PUBLIC HEALTH WORKFORCE LOAN REPAYMENT PROGRAM.
(a)

Establishment.—
The Secretary shall establish the Public Health Workforce Loan Repayment Program (referred to in this section as the “Program”) to assure an adequate supply of, and encourage recruitment and retention of, public health professionals to eliminate critical public health workforce shortages in State, local, and Tribal public health agencies.
(b)

Eligibility.—
To be eligible to participate in the Program, an individual shall—
(1)
(A)
(i)
be accepted for enrollment, or be enrolled, as a student in an accredited institution of higher education or school of public health in the final semester (or equivalent) of a program leading to a certificate or degree, including a master’s or doctoral degree, in public health, epidemiology, laboratory sciences, data systems, data science, data analytics, informatics, statistics, or another subject matter related to public health; and
(ii)
be employed by, or have accepted employment with, a State, local, or Tribal public health agency, or a related training fellowship at such State, local, or Tribal public health agency, as recognized by the Secretary, to commence upon graduation; or
(B)
(i)
have graduated, during the preceding 10-year period, from an accredited institution of higher education or school of public health and received a certificate or degree, including a master’s or doctoral degree, in public health, epidemiology, laboratory sciences, data systems, data science, data analytics, informatics, statistics, or another subject matter related to public health; and
(ii)
be employed by, or have accepted employment with, a State, local, or Tribal public health agency or a related training fellowship at such State, local, or Tribal public health agency, as recognized by the Secretary;
(2)
be a United States citizen; and
(3)
(A)
submit an application to the Secretary to participate in the Program;
(B)
execute a written contract as required in subsection (c); and
(4)
not have received, for the same service, a reduction of loan obligations under section 455(m), 428J, 428K, 428L, or 460 of the Higher Education Act of 1965.
(c)

Contract.—
The written contract (referred to in this section as the “written contract”) between the Secretary and an individual shall contain—
(1)
an agreement on the part of the Secretary that the Secretary will repay on behalf of the individual loans incurred by the individual in the pursuit of the relevant degree or certificate in accordance with the terms of the contract;
(2)
an agreement on the part of the individual that the individual will serve in the full-time employment of a State, local, or Tribal public health agency or a related fellowship program in a position related to the course of study or program for which the contract was awarded for a period of time (referred to in this section as the “period of obligated service”) of at least 3 consecutive years;
(3)
an agreement, as appropriate, on the part of the individual to relocate to a priority service area (as determined by the Secretary) in exchange for an additional loan repayment incentive amount to be determined by the Secretary;
(4)
a provision that any financial obligation of the United States arising out of a contract entered into under this section and any obligation of the individual that is conditioned thereon, is contingent on funds being appropriated for loan repayments under this section;
(5)
a statement of the damages to which the United States is entitled, under this section for the individual's breach of the contract; and
(6)
such other statements of the rights and liabilities of the Secretary and of the individual, not inconsistent with this section.
(d)

Payments.—
(1)

In general.—
A loan repayment provided for an individual under a written contract under the Program shall consist of payment, in accordance with paragraph (2), for the individual toward the outstanding principal and interest on education loans incurred by the individual in the pursuit of the relevant degree or certificate described in subsection (b)(1) in accordance with the terms of the contract.
(2)

Payments for years served.—
(A)

In general.—
For each year of obligated service that an individual contracts to serve under subsection (c) the Secretary may pay up to $50,000 on behalf of the individual for loans described in paragraph (1). With respect to participants under the Program whose total eligible loans are less than $150,000, the Secretary shall pay an amount that does not exceed ⅓ of the eligible loan balance for each year of obligated service of the individual.
(B)

Considerations.—
The Secretary may take action in making awards under this section to ensure that—
(i)
an appropriate proportion of contracts are awarded to individuals who are eligible to participate in the program pursuant to subsection (b)(1)(A); and
(ii)
contracts awarded under this section are equitably distributed among—
(I)
the geographical regions of the United States;
(II)
local, State, and Tribal public health departments; and
(III)
such public health departments under subclause (II) serving rural and urban areas.
(3)

Tax liability.—
For the purpose of providing reimbursements for tax liability resulting from payments under paragraph (2) on behalf of an individual, the Secretary shall, in addition to such payments, make payments to the individual in an amount not to exceed 39 percent of the total amount of loan repayments made for the taxable year involved.
(e)

Postponing Obligated Service.—
With respect to an individual with a contract to serve under subsection (c), the date of the initiation of the period of obligated service may be postponed as approved by the Secretary.
(f)

Breach of Contract.—
An individual who fails to comply with the contract entered into under subsection (c) shall be subject to the same financial penalties as provided for under section 338E for breaches of loan repayment contracts under section 338B. In the event that a participant fails to either begin or complete the obligated service requirement of the loan repayment contract under this section, the Secretary may waive or suspend either the unfulfilled service or the assessed damages as provided for under section 338E(d), as appropriate.
(g)

Eligible Loans.—
The loans eligible for repayment under this section are each of the following:
(1)
Any loan for education or training for employment by a health department.
(2)
Any loan under part E of title VIII (relating to nursing student loans).
(3)
Any Federal Direct Stafford Loan, Federal Direct PLUS Loan, Federal Direct Unsubsidized Stafford Loan, or Federal Direct Consolidation Loan (as such terms are used in section 455 of the Higher Education Act of 1965).
(4)
Any Federal Perkins Loan under part E of title I of the Higher Education Act of 1965.
(5)
Any other Federal loan, as the Secretary determines appropriate.
(h)

Pilot Program.—
(1)

In general.—
The Secretary shall, as appropriate, establish a pilot program, to be known as the Bio-Preparedness Workforce Pilot Program, to provide for loan repayment for health professionals with expertise in infectious diseases and emergency preparedness and response activities to ensure an adequate supply of such professionals. Such program shall be administered consistent with the requirements of this section, except that, to be eligible to participate in the pilot program, an individual shall—
(A)
(i)
be accepted for enrollment, or be enrolled, as a student in an accredited institution of higher education in the final semester (or equivalent) of a program leading to a health professions degree or certificate program relevant to such program; or
(ii)
have graduated, during the preceding 10-year period, from an accredited institution of higher education with a health professions degree or certificate program relevant to such program; and
(B)
be employed by, or have accepted employment with—
(i)
a Federal health care facility;
(ii)
a nonprofit health care facility that is located in a health professional shortage area (as defined in section 332), a frontier health professional shortage area (as defined in section 799B), or a medically underserved community (as defined in section 799B);
(iii)
an entity receiving assistance under title XXVI for the provision of clinical services;
(iv)
a health program, or a facility, operated by an Indian Tribe or Tribal organization (as those terms are defined in section 4 of the Indian Self-Determination and Education Assistance Act) or by an urban Indian organization (as defined in section 4 of the Indian Health Care Improvement Act); or
(v)
another relevant entity determined appropriate by the Secretary, as a health professional with expertise in infectious diseases or emergency preparedness and response.
(2)

Non-duplication of effort.—
The Secretary shall ensure that the pilot program established under paragraph (1) does not unnecessarily duplicate the National Health Service Corps Loan Repayment Program, or any other loan repayment program operated by the Department of Health and Human Services.
(3)

Evaluation and report to congress.—
(A)

In general.—
The Secretary shall evaluate the pilot program at the conclusion of the first cycle of recipients funded by the pilot program.
(B)

Report.—
(i)

In general.—
The Secretary shall submit to the Committee on Health, Education, Labor, and Pensions of the Senate and the Committee on Energy and Commerce of the House of Representatives a report on the evaluation under subparagraph (A). The report shall include, at a minimum, outcomes information from the pilot program, including any impact on recruitment and retention of health professionals with expertise in infectious diseases and emergency preparedness and response activities.
(ii)

Recommendation.—
The report under this subparagraph shall include a recommendation by the Secretary as to whether the pilot program under this subsection should be extended.
(i)

Authorization of Appropriations.—
There is authorized to be appropriated to carry out this section $100,000,000 for each of fiscal years 2023 through 2025.
SEC. 777.
[295f–2]

TRAINING FOR MID-CAREER PUBLIC AND ALLIED HEALTH PROFESSIONALS.
(a)

In General.—
The Secretary may make grants to, or enter into contracts with, any eligible entity to award scholarships to eligible individuals to enroll in degree or professional training programs for the purpose of enabling mid-career professionals in the public health and allied health workforce to receive additional training in the field of public health and allied health.
(b)

Eligibility.—
(1)

Eligible entity.—
The term “eligible entity” indicates an accredited educational institution that offers a course of study, certificate program, or professional training program in public or allied health or a related discipline, as determined by the Secretary
(2)

Eligible individuals.—
The term “eligible individuals” includes those individuals employed in public and allied health positions at the Federal, State, tribal, or local level who are interested in retaining or upgrading their education.
(c)

Authorization of Appropriations.—
There is authorized to be appropriated to carry out this section, $60,000,000 for fiscal year 2010 and such sums as may be necessary for each of fiscal years 2011 through 2015. Fifty percent of appropriated funds shall be allotted to public health mid-career professionals and 50 percent shall be allotted to allied health mid-career professionals.
SEC. 778.
[295f–3]

FELLOWSHIP TRAINING IN APPLIED PUBLIC HEALTH EPIDEMIOLOGY, PUBLIC HEALTH LABORATORY SCIENCE, PUBLIC HEALTH INFORMATICS, AND EXPANSION OF THE EPIDEMIC INTELLIGENCE SERVICE.
(a)

In General.—
The Secretary may carry out activities to address documented workforce shortages in State and local health departments in the critical areas of applied public health epidemiology and public health laboratory science and informatics and may expand the Epidemic Intelligence Service.
(b)

Specific Uses.—
In carrying out subsection (a), the Secretary shall provide for the expansion of existing fellowship programs operated through the Centers for Disease Control and Prevention in a manner that is designed to alleviate shortages of the type described in subsection (a).
(c)

Other Programs.—
The Secretary may provide for the expansion of other applied epidemiology training programs that meet objectives similar to the objectives of the programs described in subsection (b).
(d)

Work Obligation.—
Participation in fellowship training programs under this section shall be deemed to be service for purposes of satisfying work obligations stipulated in contracts under section 338I(j).
(e)

General Support.—
Amounts may be used from grants awarded under this section to expand the Public Health Informatics Fellowship Program at the Centers for Disease Control and Prevention to better support all public health systems at all levels of government.
(f)

Authorization of Appropriations.—
There are authorized to be appropriated to carry out this section $39,500,000 for each of fiscal years 2010 through 2013, of which—
(1)
$5,000,000 shall be made available in each such fiscal year for epidemiology fellowship training program activities under subsections (b) and (c);
(2)
$5,000,000 shall be made available in each such fiscal year for laboratory fellowship training programs under subsection (b);
(3)
$5,000,000 shall be made available in each such fiscal year for the Public Health Informatics Fellowship Program under subsection (e); and
(4)
$24,500,000 shall be made available for expanding the Epidemic Intelligence Service under subsection (a).
PART F—

SUBSTANCE USE DISORDER TREATMENT WORKFORCE
SEC. 781.
[295h]

LOAN REPAYMENT PROGRAM FOR SUBSTANCE USE DISORDER TREATMENT WORKFORCE.
(a)

In General.—
The Secretary, acting through the Administrator of the Health Resources and Services Administration, shall carry out a program under which—
(1)
the Secretary enters into agreements with individuals to make payments in accordance with subsection (b) on the principal of and interest on any eligible loan; and
(2)
the individuals each agree to the requirements of service in substance use disorder treatment employment, as described in subsection (d).
(b)

Payments.—
For each year of obligated service by an individual pursuant to an agreement under subsection (a), the Secretary shall make a payment to such individual as follows:
(1)

Service in a shortage area.—
The Secretary shall pay—
(A)
for each year of obligated service by an individual pursuant to an agreement under subsection (a), ⅙ of the principal of and interest on each eligible loan of the individual which is outstanding on the date the individual began service pursuant to the agreement; and
(B)
for completion of the sixth and final year of such service, the remainder of such principal and interest.
(2)

Maximum amount.—
The total amount of payments under this section to any individual shall not exceed $250,000.
(c)

Eligible Loans.—
The loans eligible for repayment under this section are each of the following:
(1)
Any loan for education or training for a substance use disorder treatment employment.
(2)
Any loan under part E of title VIII (relating to nursing student loans).
(3)
Any Federal Direct Stafford Loan, Federal Direct PLUS Loan, Federal Direct Unsubsidized Stafford Loan, or Federal Direct Consolidation Loan (as such terms are used in section 455 of the Higher Education Act of 1965).
(4)
Any Federal Perkins Loan under part E of title I of the Higher Education Act of 1965.
(5)
Any other Federal loan as determined appropriate by the Secretary.
(d)

Requirements of Service.—
Any individual receiving payments under this program as required by an agreement under subsection (a) shall agree to an annual commitment to full-time employment, with no more than 1 year passing between any 2 years of covered employment, in substance use disorder treatment employment in the United States in—
(1)
a Mental Health Professional Shortage Area, as designated under section 332; or
(2)
a county (or a municipality, if not contained within any county) where the mean drug overdose death rate per 100,000 people over the past 3 years for which official data is available from the State, is higher than the most recent available national average overdose death rate per 100,000 people, as reported by the Centers for Disease Control and Prevention.
(e)

Ineligibility for Double Benefits.—
No borrower may, for the same service, receive a reduction of loan obligations or a loan repayment under both—
(1)
this section; and
(2)
any Federally supported loan forgiveness program, including under section 338B, 338I, or 846 of this Act, or section 428J, 428L, 455(m), or 460 of the Higher Education Act of 1965.
(f)

Breach.—
(1)

Liquidated damages formula.—
The Secretary may establish a liquidated damages formula to be used in the event of a breach of an agreement entered into under subsection (a).
(2)

Limitation.—
The failure by an individual to complete the full period of service obligated pursuant to such an agreement, taken alone, shall not constitute a breach of the agreement, so long as the individual completed in good faith the years of service for which payments were made to the individual under this section.
(g)

Additional Criteria.—
The Secretary—
(1)
may establish such criteria and rules to carry out this section as the Secretary determines are needed and in addition to the criteria and rules specified in this section; and
(2)
shall give notice to the committees specified in subsection (h) of any criteria and rules so established.
(h)

Report to Congress.—
Not later than 5 years after the date of enactment of this section, and every other year thereafter, the Secretary shall prepare and submit to the Committee on Energy and Commerce of the House of Representatives and the Committee on Health, Education, Labor, and Pensions of the Senate a report on—
(1)
the number and location of borrowers who have qualified for loan repayments under this section; and
(2)
the impact of this section on the availability of substance use disorder treatment employees nationally and in shortage areas and counties described in subsection (d).
(i)

Definition.—
In this section:
(1)
The terms “Indian tribe” and “tribal organization” have the meanings given those terms in section 4 of the Indian Self-Determination and Education Assistance Act.
(2)
The term “municipality” means a city, town, or other public body created by or pursuant to State law, or an Indian tribe.
(3)
The term “substance use disorder treatment employment” means full-time employment (including a fellowship)—
(A)
where the primary intent and function of the position is the direct treatment or recovery support of patients with or in recovery from a substance use disorder, including master’s level social workers, psychologists, counselors, marriage and family therapists, psychiatric mental health practitioners, occupational therapists, psychology doctoral interns, and behavioral health paraprofessionals and physicians, physician assistants, and nurses, who are licensed or certified in accordance with applicable State and Federal laws; and
(B)
which is located at a substance use disorder treatment program, private physician practice, hospital or health system-affiliated inpatient treatment center or outpatient clinic (including an academic medical center-affiliated treatment program), correctional facility or program, youth detention center or program, inpatient psychiatric facility, crisis stabilization unit, community health center, community mental health or other specialty community behavioral health center, recovery center, school, community-based organization, telehealth platform, migrant health center, health program or facility operated by an Indian tribe or tribal organization, Federal medical facility, or any other facility as determined appropriate for purposes of this section by the Secretary.
(j)

Authorization of Appropriations.—
There are authorized to be appropriated to carry out this section $40,000,000 for each of fiscal years 2026 through 2030.
PART G—

GENERAL PROVISIONS
SEC. 791.
[295j]

PREFERENCES AND REQUIRED INFORMATION IN CERTAIN PROGRAMS.
(a)

Preferences in Making Awards.—
(1)

In general.—
Subject to paragraph (2), in making awards of grants or contracts under any of sections 747 and 750, the Secretary shall give preference to any qualified applicant that—
(A)
has a high rate for placing graduates in practice settings having the principal focus of serving residents of medically underserved communities;
(B)
during the 2-year period preceding the fiscal year for which such an award is sought, has achieved a significant increase in the rate of placing graduates in such settings; or
(C)
utilizes a longitudinal evaluation (as described in section 761(d)(2)) and reports data from such system to the national workforce database (as established under section 761(b)(2)(E)).
(2)

Limitation regarding peer review.—
For purposes of paragraph (1), the Secretary may not give an applicant preference if the proposal of the applicant is ranked at or below the 20th percentile of proposals that have been recommended for approval by peer review groups.
(b)

Definition.—
For purposes of this section, the term “graduate” means, unless otherwise specified, an individual who has successfully completed all training and residency requirements necessary for full certification in the health profession selected by the individual.
(c)

Exceptions for New Programs.—
(1)

In general.—
To permit new programs to compete equitably for funding under this section, those new programs that meet at least 4 of the criteria described in paragraph (3) shall qualify for a funding preference under this section.
(2)

Definition.—
As used in this subsection, the term “new program” means any program that has graduated less than three classes. Upon graduating at least three classes, a program shall have the capability to provide the information necessary to qualify the program for the general funding preferences described in subsection (a).
(3)

Criteria.—
The criteria referred to in paragraph (1) are the following:
(A)
The mission statement of the program identifies a specific purpose of the program as being the preparation of health professionals to serve underserved populations.
(B)
The curriculum of the program includes content which will help to prepare practitioners to serve underserved populations.
(C)
Substantial clinical training experience is required under the program in medically underserved communities.
(D)
A minimum of 20 percent of the clinical faculty of the program spend at least 50 percent of their time providing or supervising care in medically underserved communities.
(E)
The entire program or a substantial portion of the program is physically located in a medically underserved community.
(F)
Student assistance, which is linked to service in medically underserved communities following graduation, is available to the students in the program.
(G)
The program provides a placement mechanism for deploying graduates to medically underserved communities.
SEC. 792.
[295k]

HEALTH PROFESSIONS DATA.
(a)

In General.—
The Secretary shall establish a program, including a uniform health professions data reporting system, to collect, compile, and analyze data on health professions personnel which program shall initially include data respecting all physicians and dentists in the States. The Secretary is authorized to expand the program to include, whenever he determines it necessary, the collection, compilation, and analysis of data respecting pharmacists, optometrists, podiatrists, veterinarians, public health personnel, audiologists, speech pathologists, health care administration personnel, nurses, allied health personnel, medical technologists, chiropractors, clinical psychologists, professional counselors, and any other health personnel in States designated by the Secretary to be included in the program. Such data shall include data respecting the training, licensure status (including permanent, temporary, partial, limited, or institutional), place or places of practice, professional specialty, practice characteristics, place and date of birth, sex, and socioeconomic background of health professions personnel and such other demographic information regarding health professions personnel as the Secretary may require.
(b)

Certain Authorities and Requirements.—
(1)

Sources of information.—
In carrying out subsection (a), the Secretary shall collect available information from appropriate local, State, and Federal agencies and other appropriate sources.
(2)

Contracts for studies of health professions.—
The Secretary shall conduct or enter into contracts for the conduct of analytic and descriptive studies of the health professions, including evaluations and projections of the supply of, and requirements for, the health professions by specialty and geographic location. Such studies shall include studies determining by specialty and geographic location the number of health professionals (including allied health professionals and health care administration personnel) who are members of minority groups, including Hispanics, and studies providing by specialty and geographic location evaluations and projections of the supply of, and requirements for, health professionals (including allied health professionals and health care administration personnel) to serve minority groups, including Hispanics.
(3)

Grants and contracts regarding states.—
The Secretary is authorized to make grants and to enter into contracts with States (or an appropriate nonprofit private entity in any State) for the purpose of participating in the program established under subsection (a). The Secretary shall determine the amount and scope of any such grant or contract. To be eligible for a grant or contract under this paragraph a State or entity shall submit an application in such form and manner and containing such information as the Secretary shall require. Such application shall include reasonable assurance, satisfactory to the Secretary, that—
(A)
such State (or nonprofit entity within a State) will establish a program of mandatory annual registration of the health professions personnel described in subsection (a) who reside or practice in such State and of health institutions licensed by such State, which registration shall include such information as the Secretary shall determine to be appropriate;
(B)
such State or entity shall collect such information and report it to the Secretary in such form and manner as the Secretary shall prescribe; and
(C)
such State or entity shall comply with the requirements of subsection (e).
(d)19

Reports to Congress.—
The Secretary shall submit to the Congress on October 1, 1993, and biennially thereafter, the following reports:
^{19}
So in law. Probably should be redesignated as (c).
(1)
A comprehensive report regarding the status of health personnel according to profession, including a report regarding the analytic and descriptive studies conducted under this section.
(2)
A comprehensive report regarding applicants to, and students enrolled in, programs and institutions for the training of health personnel, including descriptions and analyses of student indebtedness, student need for financial assistance, financial resources to meet the needs of students, student career choices such as practice specialty and geographic location and the relationship, if any, between student indebtedness and career choices.
(e)20

Requirements Regarding Personal Data.—
(1)

In general.—
The Secretary and each program entity shall in securing and maintaining any record of individually identifiable personal data (hereinafter in this subsection referred to as “personal data”) for purposes of this section—
^{20}
So in law. Probably should be redesignated as (d).
(A)
inform any individual who is asked to supply personal data whether he is legally required, or may refuse, to supply such data and inform him of any specific consequences, known to the Secretary or program entity, as the case may be, of providing or not providing such data;
(B)
upon request, inform any individual if he is the subject of personal data secured or maintained by the Secretary or program entity, as the case may be, and make the data available to him in a form comprehensible to him;
(C)
assure that no use is made of personal data which use is not within the purposes of this section unless an informed consent has been obtained from the individual who is the subject of such data; and
(D)
upon request, inform any individual of the use being made of personal data respecting such individual and of the identity of the individuals and entities which will use the data and their relationship to the programs under this section.
(2)

Consent as precondition to disclosure.—
Any entity which maintains a record of personal data and which receives a request from the Secretary or a program entity for such data for purposes of this section shall not transfer any such data to the Secretary or to a program entity unless the individual whose personal data is to be so transferred gives an informed consent for such transfer.
(3)

Disclosure by secretary.—
(A)
Notwithstanding any other provision of law, personal data collected by the Secretary or any program entity under this section may not be made available or disclosed by the Secretary or any program entity to any person other than the individual who is the subject of such data unless (i) such person requires such data for purposes of this section, or (ii) in response to a demand for such data made by means of compulsory legal process. Any individual who is the subject of personal data made available or disclosed under clause (ii) shall be notified of the demand for such data.
(B)
Subject to all applicable laws regarding confidentiality, only the data collected by the Secretary under this section which is not personal data shall be made available to bona fide researchers and policy analysts (including the Congress) for the purposes of assisting in the conduct of studies respecting health professions personnel.
(4)

Definition.—
For purposes of this subsection, the term “program entity” means any public or private entity which collects, compiles, or analyzes health professions data under a grant, contract, or other arrangement with the Secretary under this section.
(g)21

Technical Assistance.—
The Secretary shall provide technical assistance to the States and political subdivisions thereof in the development of systems (including model laws) concerning confidentiality and comparability of data collected pursuant to this section.
^{21}
So in law. Probably should be redesignated as (e).
(h)22

Grants and Contracts Regarding Nonprofit Entities.—
^{22}
So in law. Probably should be redesignated as (f).
(1)

In general.—
In carrying out subsection (a), the Secretary may make grants, or enter into contracts and cooperative agreements with, and provide technical assistance to, any nonprofit entity in order to establish a uniform allied health professions data reporting system to collect, compile, and analyze data on the allied health professions personnel.
(2)

Reports.—
With respect to reports required in subsection (d), each such report made on or after October 1, 1991, shall include a description and analysis of data collected pursuant to paragraph (1).
SEC. 794.23
[295m]

PROHIBITION AGAINST DISCRIMINATION ON BASIS OF SEX.
^{23}
Section 793 was repealed by section 106(a)(2)(C) of Public Law 105–392 (112 Stat. 3557).
The Secretary may not make a grant, loan guarantee, or interest subsidy payment under this title to, or for the benefit of, any school of medicine, osteopathic medicine, dentistry, veterinary medicine, optometry, pharmacy, podiatric medicine, or public health or any training center for allied health personnel, or graduate program in clinical psychology, unless the application for the grant, loan guarantee, or interest subsidy payment contains assurances satisfactory to the Secretary that the school or training center will not discriminate on the basis of sex in the admission of individuals to its training programs. The Secretary may not enter into a contract under this title with any such school or training center unless the school, training center, or graduate program furnishes assurances satisfactory to the Secretary that it will not discriminate on the basis of sex in the admission of individuals to its training programs. In the case of a school of medicine which—
(1)
on the date of the enactment of this sentence is in the process of changing its status as an institution which admits only female students to that of an institution which admits students without regard to their sex, and
(2)
is carrying out such change in accordance with a plan approved by the Secretary,
the provisions of the preceding sentences of this section shall apply only with respect to a grant, contract, loan guarantee, or interest subsidy to, or for the benefit of such a school for a fiscal year beginning after June 30, 1979.
SEC. 796.24
[295n–1]

APPLICATION.
^{24}
Section 795 was repealed by section 101(b)(1) of Public Law 105–392 (112 Stat. 3537).
(a)

In General.—
To be eligible to receive a grant or contract under this title, an eligible entity shall prepare and submit to the Secretary an application that meets the requirements of this section, at such time, in such manner, and containing such information as the Secretary may require.
(b)

Plan.—
An application submitted under this section shall contain the plan of the applicant for carrying out a project with amounts received under this title. Such plan shall be consistent with relevant Federal, State, or regional health professions program plans.
(c)

Performance Outcome Standards.—
An application submitted under this section shall contain a specification by the applicant entity of performance outcome standards that the project to be funded under the grant or contract will be measured against. Such standards shall address relevant health workforce needs that the project will meet. The recipient of a grant or contract under this section shall meet the standards set forth in the grant or contract application.
(d)

Linkages.—
An application submitted under this section shall contain a description of the linkages with relevant educational and health care entities, including training programs for other health professionals as appropriate, that the project to be funded under the grant or contract will establish. To the extent practicable, grantees under this section shall establish linkages with health care providers who provide care for underserved communities and populations.
SEC. 797.
[295n–2]

USE OF FUNDS.
(a)

In General.—
Amounts provided under a grant or contract awarded under this title may be used for training program development and support, faculty development, model demonstrations, trainee support including tuition, books, program fees and reasonable living expenses during the period of training, technical assistance, workforce analysis, dissemination of information, and exploring new policy directions, as appropriate to meet recognized health workforce objectives, in accordance with this title.
(b)

Maintenance of Effort.—
With respect to activities for which a grant awarded under this title is to be expended, the entity shall agree to maintain expenditures of non-Federal amounts for such activities at a level that is not less than the level of such expenditures maintained by the entity for the fiscal year preceding the fiscal year for which the entity receives such a grant.
SEC. 798.
[295o]

MATCHING REQUIREMENT.
The Secretary may require that an entity that applies for a grant or contract under this title provide non-Federal matching funds, as appropriate, to ensure the institutional commitment of the entity to the projects funded under the grant. As determined by the Secretary, such non-Federal matching funds may be provided directly or through donations from public or private entities and may be in cash or in-kind, fairly evaluated, including plant, equipment, or services.
SEC. 799.
[295o–1]

GENERALLY APPLICABLE PROVISIONS.
(a)

Awarding of Grants and Contracts.—
The Secretary shall ensure that grants and contracts under this title are awarded on a competitive basis, as appropriate, to carry out innovative demonstration projects or provide for strategic workforce supplementation activities as needed to meet health workforce goals and in accordance with this title. Contracts may be entered into under this title with public or private entities as may be necessary.
(b)

Eligible Entities.—
Unless specifically required otherwise in this title, the Secretary shall accept applications for grants or contracts under this title from health professions schools, academic health centers, State or local governments, or other appropriate public or private nonprofit entities for funding and participation in health professions and nursing training activities. The Secretary may accept applications from for-profit private entities if determined appropriate by the Secretary.
(c)

Information Requirements.—
(1)

In general.—
Recipients of grants and contracts under this title shall meet information requirements as specified by the Secretary.
(2)

Data collection.—
The Secretary shall establish procedures to ensure that, with respect to any data collection required under this title, such data is collected in a manner that takes into account age, sex, race, and ethnicity.
(3)

Use of funds.—
The Secretary shall establish procedures to permit the use of amounts appropriated under this title to be used for data collection purposes.
(4)

Evaluations.—
The Secretary shall establish procedures to ensure the annual evaluation of programs and projects operated by recipients of grants or contracts under this title. Such procedures shall ensure that continued funding for such programs and projects will be conditioned upon a demonstration that satisfactory progress has been made by the program or project in meeting the objectives of the program or project.
(d)

Training Programs.—
Training programs conducted with amounts received under this title shall meet applicable accreditation and quality standards.
(e)

Duration of Assistance.—
(1)

In general.—
Subject to paragraph (2), in the case of an award to an entity of a grant, cooperative agreement, or contract under this title, the period during which payments are made to the entity under the award may not exceed 5 years. The provision of payments under the award shall be subject to annual approval by the Secretary of the payments and subject to the availability of appropriations for the fiscal year involved to make the payments. This paragraph may not be construed as limiting the number of awards under the program involved that may be made to the entity.
(2)

Limitation.—
In the case of an award to an entity of a grant, cooperative agreement, or contract under this title, paragraph (1) shall apply only to the extent not inconsistent with any other provision of this title that relates to the period during which payments may be made under the award.
(f)

Peer Review Regarding Certain Programs.—
(1)

In general.—
Each application for a grant under this title, except any scholarship or loan program, including those under sections 25 701, 721, or 723, shall be submitted to a peer review group for an evaluation of the merits of the proposals made in the application. The Secretary may not approve such an application unless a peer review group has recommended the application for approval.
^{25}
So in law. Probably should read “section”.
(2)

Composition.—
Each peer review group under this subsection shall be composed principally of individuals who are not officers or employees of the Federal Government. In providing for the establishment of peer review groups and procedures, the Secretary shall ensure sex, racial, ethnic, and geographic balance among the membership of such groups.
(3)

Administration.—
This subsection shall be carried out by the Secretary acting through the Administrator of the Health Resources and Services Administration.
(g)

Preference or Priority Considerations.—
In considering a preference or priority for funding which is based on outcome measures for an eligible entity under this title, the Secretary may also consider the future ability of the eligible entity to meet the outcome preference or priority through improvements in the eligible entity's program design.
(h)

Analytic Activities.—
The Secretary shall ensure that—
(1)
cross-cutting workforce analytical activities are carried out as part of the workforce information and analysis activities under section 761; and
(2)
discipline-specific workforce information and analytical activities are carried out as part of—
(A)
the community-based linkage program under part D; and
(B)
the health workforce development program under subpart 2 of part E.
(i)

Osteopathic Schools.—
For purposes of this title, any reference to—
(1)
medical schools shall include osteopathic medical schools; and
(2)
medical students shall include osteopathic medical students.
SEC. 799A.
[295o–2]

TECHNICAL ASSISTANCE.
Funds appropriated under this title may be used by the Secretary to provide technical assistance in relation to any of the authorities under this title.
SEC. 799B.
[295p]

DEFINITIONS.
For purposes of this title:
(1)
(A)
The terms “school of medicine”, “school of dentistry”, “school of osteopathic medicine”, “school of pharmacy”, “school of optometry”, “school of podiatric medicine”, “school of veterinary medicine”, “school of public health”, and “school of chiropractic” mean an accredited public or nonprofit private school in a State that provides training leading, respectively, to a degree of doctor of medicine, a degree of doctor of dentistry or an equivalent degree, a degree of doctor of osteopathy, a degree of bachelor of science in pharmacy or an equivalent degree or a degree of doctor of pharmacy or an equivalent degree, a degree of doctor of optometry or an equivalent degree, a degree of doctor of podiatric medicine or an equivalent degree, a degree of doctor of veterinary medicine or an equivalent degree, a graduate degree in public health or an equivalent degree, and a degree of doctor of chiropractic or an equivalent degree, and including advanced training related to such training provided by any such school.
(B)
The terms “graduate program in health administration” and “graduate program in clinical psychology” mean an accredited graduate program in a public or nonprofit private institution in a State that provides training leading, respectively, to a graduate degree in health administration or an equivalent degree and a doctoral degree in clinical psychology or an equivalent degree.
(C)
The terms “graduate program in clinical social work” and “graduate program in marriage and family therapy” and “graduate program in professional counseling” mean an accredited graduate program in a public or nonprofit private institution in a State that provides training, respectively, in a concentration in health or mental health care leading to a graduate degree in social work and a concentration leading to a graduate degree in marriage and family therapy and a concentration leading to a graduate degree in counseling.
(D)26
The term “graduate program in behavioral health and mental health practice” means a graduate program in clinical psychology, clinical social work, professional counseling, or marriage and family therapy.
^{26}
Section 108(a)(2) of Public Law 105–392 (112 Stat. 3560) provides that paragraph (1)(D) is amended by inserting “behavioral health and mental health practice,” before “clinical”. The amendment cannot be executed because the amendment does not specify to which instance of the term “clinical” the amendment applies.
(E)
The term “accredited”, when applied to a school of medicine, osteopathic medicine, dentistry, veterinary medicine, optometry, podiatry, pharmacy, public health, or chiropractic, or a graduate program in health administration, clinical psychology, clinical social work, professional counseling, or marriage and family therapy, means a school or program that is accredited by a recognized body or bodies approved for such purpose by the Secretary of Education, except that a new school or program that, by reason of an insufficient period of operation, is not, at the time of application for a grant or contract under this title, eligible for accreditation by such a recognized body or bodies, shall be deemed accredited for purposes of this title, if the Secretary of Education finds, after consultation with the appropriate accreditation body or bodies, that there is reasonable assurance that the school or program will meet the accreditation standards of such body or bodies prior to the beginning of the academic year following the normal graduation date of the first entering class in such school or program.
(2)
The term “teaching facilities” means areas dedicated for use by students, faculty, or administrative or maintenance personnel for clinical purposes, research activities, libraries, classrooms, offices, auditoriums, dining areas, student activities, or other related purposes necessary for, and appropriate to, the conduct of comprehensive programs of education. Such term includes interim facilities but does not include off-site improvements or living quarters.
(3)

Physician assistant education program.—
The term “physician assistant education program” means an educational program in a public or private institution in a State that—
(A)
has as its objective the education of individuals who, upon completion of their studies in the program, be qualified to provide primary care medical services with the supervision of a physician; and
(B)
is accredited by the Accreditation Review Commission on Education for the Physician Assistant.
(4)
The term “school of allied health” means a public or nonprofit private college, junior college, or university or hospital-based educational entity that—
(A)
provides, or can provide, programs of education to enable individuals to become allied health professionals or to provide additional training for allied health professionals;
(B)
provides training for not less than a total of twenty persons in the allied health curricula (except that this subparagraph shall not apply to any hospital-based educational entity);
(C)
includes or is affiliated with a teaching hospital; and
(D)
is accredited by a recognized body or bodies approved for such purposes by the Secretary of Education, or which provides to the Secretary satisfactory assurance by such accrediting body or bodies that reasonable progress is being made toward accreditation.
(5)
The term “allied health professionals” means a health professional (other than a registered nurse or physician assistant)—
(A)
who has received a certificate, an associate's degree, a bachelor's degree, a master's degree, a doctoral degree, or postbaccalaureate training, in a science relating to health care;
(B)
who shares in the responsibility for the delivery of health care services or related services, including—
(i)
services relating to the identification, evaluation, and prevention of disease and disorders;
(ii)
dietary and nutrition services;
(iii)
health promotion services;
(iv)
rehabilitation services; or
(v)
health systems management services; and
(C)
who has not received a degree of doctor of medicine, a degree of doctor of osteopathy, a degree of doctor of dentistry or an equivalent degree, a degree of doctor of veterinary medicine or an equivalent degree, a degree of doctor of optometry or an equivalent degree, a degree of doctor of podiatric medicine or an equivalent degree, a degree of bachelor of science in pharmacy or an equivalent degree, a degree of doctor of pharmacy or an equivalent degree, a graduate degree in public health or an equivalent degree, a degree of doctor of chiropractic or an equivalent degree, a graduate degree in health administration or an equivalent degree, a doctoral degree in clinical psychology or an equivalent degree, or a degree in social work or an equivalent degree or a degree in counseling or an equivalent degree.
(6)
The term “medically underserved community” means an urban or rural area or population that—
(A)
is eligible for designation under section 332 as a health professional shortage area;
(B)
is eligible to be served by a migrant health center under section 32927, a community health center under section 33027, a grantee under section 330(h) (relating to homeless individuals), or a grantee under section 340A 27 (relating to residents of public housing);
^{27}
The reference in paragraph (6)(B) to sections 329 and 330 refers to sections 329 and 330 of the Act of July 1, 1944, which was omitted in the general amendment of subpart I of part D of this title by section 2 of Public Law 104-299 (110 Stat. 3626; October 11, 1996). Section 340A, referred to in paragraph (6)(B), was repealed by section 4(a)(3) of Public Law 104-299.
(C)
has a shortage of personal health services, as determined under criteria issued by the Secretary under section 1861(aa)(2) of the Social Security Act (relating to rural health clinics); or
(D)
is designated by a State Governor (in consultation with the medical community) as a shortage area or medically underserved community.
(7)
The term “Department” means the Department of Health and Human Services.
(8)
The term “nonprofit” refers to the status of an entity owned and operated by one or more corporations or associations no part of the net earnings of which inures, or may lawfully inure, to the benefit of any private shareholder or individual.
(9)
The term “State” includes, in addition to the several States, only the District of Columbia, the Commonwealth of Puerto Rico, the Commonwealth of the Northern Mariana Islands, the Virgin Islands, Guam, American Samoa, and the Trust Territory of the Pacific Islands.
(10)
(A)
Subject to subparagraph (B), the term “underrepresented minorities” means, with respect to a health profession, racial and ethnic populations that are underrepresented in the health profession relative to the number of individuals who are members of the population involved.
(B)
For purposes of subparagraph (A), Asian individuals shall be considered by the various subpopulations of such individuals.
(11)
The term “psychologist” means an individual who—
(A)
holds a doctoral degree in psychology; and
(B)
is licensed or certified on the basis of the doctoral degree in psychology, by the State in which the individual practices, at the independent practice level of psychology to furnish diagnostic, assessment, preventive, and therapeutic services directly to individuals.
(12)

Area health education center.—
The term “area health education center” means a public or nonprofit private organization that has a cooperative agreement or contract in effect with an entity that has received an award under subsection (a)(1) or (a)(2) of section 751, satisfies the requirements in section 751(d)(1), and has as one of its principal functions the operation of an area health education center. Appropriate organizations may include hospitals, health organizations with accredited primary care training programs, accredited physician assistant educational programs associated with a college or university, and universities or colleges not operating a school of medicine or osteopathic medicine.
(13)

Area health education center program.—
The term “area health education center program” means cooperative program consisting of an entity that has received an award under subsection (a)(1) or (a)(2) of section 751 for the purpose of planning, developing, operating, and evaluating an area health education center program and one or more area health education centers, which carries out the required activities described in section 751(c), satisfies the program requirements in such section, has as one of its principal functions identifying and implementing strategies and activities that address health care workforce needs in its service area, in coordination with the local workforce investment boards.
(14)

Clinical social worker.—
The term “clinical social worker” has the meaning given the term in section 1861(hh)(1) of the Social Security Act (42 U.S.C. 1395x(hh)(1)).
(15)

Cultural competency.—
The term “cultural competency” shall be defined by the Secretary in a manner consistent with section 1707(d)(3).
(16)

Direct care worker.—
The term “direct care worker” has the meaning given that term in the 2010 Standard Occupational Classifications of the Department of Labor for Home Health Aides [31–1011], Psychiatric Aides [31–1013], Nursing Assistants [31–1014], and Personal Care Aides [39–9021].
(17)

Federally qualified health center.—
The term “Federally qualified health center” has the meaning given that term in section 1861(aa) of the Social Security Act (42 U.S.C. 1395x(aa)).
(18)

Frontier health professional shortage area.—
The term “frontier health professional shortage area” means an area—
(A)
with a population density less than 6 persons per square mile within the service area; and
(B)
with respect to which the distance or time for the population to access care is excessive.
(19)

Graduate psychology.—
The term “graduate psychology” means an accredited program in professional psychology.
(20)

Health disparity population.—
The term “health disparity population” has the meaning given such term in section 903(d)(1).
(21)

Health literacy.—
The term “health literacy” means the degree to which an individual has the capacity to obtain, communicate, process, and understand health information and services in order to make appropriate health decisions.
(22)

Mental health service professional.—
The term “mental health service professional” means an individual with a graduate or postgraduate degree from an accredited institution of higher education in psychiatry, psychology, school psychology, behavioral pediatrics, psychiatric nursing, social work, school social work, substance abuse disorder prevention and treatment, marriage and family counseling, school counseling, or professional counseling.
(23)

One-stop delivery system center.—
The term “one-stop delivery system” means a one-stop delivery system described in section 121(e) of the Workforce Innovation and Opportunity Act.
(24)

Paraprofessional child and adolescent mental health worker.—
The term “paraprofessional child and adolescent mental health worker” means an individual who is not a mental or behavioral health service professional, but who works at the first stage of contact with children and families who are seeking mental or behavioral health services, including substance abuse prevention and treatment services.
(25)

Racial and ethnic minority group; racial and ethnic minority population.—
The terms “racial and ethnic minority group” and “racial and ethnic minority population” have the meaning given the term “racial and ethnic minority group” in section 1707.
(26)

Rural health clinic.—
The term “rural health clinic” has the meaning given that term in section 1861(aa) of the Social Security Act (42 U.S.C. 1395x(aa)).