[Congressional Record Volume 140, Number 36 (Friday, March 25, 1994)]
[House]
[Page H]
From the Congressional Record Online through the Government Printing Office [www.gpo.gov]
[Congressional Record: March 25, 1994]
From the Congressional Record Online via GPO Access [wais.access.gpo.gov]
PREVENTIVE HEALTH SERVICES AND HEALTH PROFESSIONS AMENDMENTS ACT OF
1993
Mr. MITCHELL. Madam President, I ask unanimous consent that the
Senate now proceed to the immediate consideration of Calendar No. 327,
S. 1569, a disadvantaged minority health improvement act of 1993.
The PRESIDING OFFICER. Without objection, the clerk will report.
The legislative clerk read as follows:
A bill (S. 1569) to amend the Public Health Service Act to
establish, reauthorize and revise provisions to improve the
health of individuals from disadvantaged backgrounds, and for
other purposes.
The PRESIDING OFFICER. Is there objection to the immediate
consideration of the bill?
There being no objection, the Senate proceeded to consider the bill,
which had been reported from the Committee on Labor and Human
Resources, with an amendment to strike all after the enacting clause
and inserting in lieu thereof the following:
S. 1569
Be it enacted by the Senate and House of Representatives of
the United States of America in Congress assembled,
SECTION 1. SHORT TITLE; REFERENCE; TABLE OF CONTENTS.
(a) Short Title.--This Act may be cited as the
``Disadvantaged Minority Health Improvement Act of 1993''.
(b) Reference.--Except as otherwise expressly provided,
whenever in this Act an amendment or a repeal is expressed in
terms of an amendment to, or a repeal of, a section or other
provision, the reference shall be considered to be made to a
section or other provision of the Public Health Service Act
(42 U.S.C. 201 et seq.).
(c) Table of Contents.--The table of contents is as
follows:
Sec. 1. Short title; reference; table of contents.
Sec. 2. Findings.
TITLE I--HEALTH POLICY
Sec. 101. Office of Minority Health.
Sec. 102. Agency Offices of Minority Health.
Sec. 103. State Offices of Minority Health.
Sec. 104. Assistant Secretary of Health and Human Services for Civil
Rights.
TITLE II--HEALTH SERVICES
Sec. 201. Community scholarship programs.
Sec. 202. Health services for residents of public housing.
Sec. 203. Issuance of regulations regarding language as impediment to
receipt of services.
Sec. 204. Health services for Pacific Islanders.
TITLE III--HEALTH PROFESSIONS
Sec. 301. Loans for disadvantaged students.
Sec. 302. Cesar Chavez primary care scholarship program.
Sec. 303. Thurgood Marshall scholarship program.
Sec. 304. Loan repayments and fellowships regarding faculty positions
at health professions schools.
Sec. 305. Centers of excellence.
Sec. 306. Educational assistance regarding undergraduates.
Sec. 307. Area health education centers.
TITLE IV--RESEARCH AND DATA COLLECTION
Sec. 401. Office of Research on Minority Health.
Sec. 402. National Center for Health Statistics.
Sec. 403. Activities of Agency for Health Care Policy and Research.
TITLE V--MISCELLANEOUS
Sec. 501. Revision and extension of program for State Offices of Rural
Health.
Sec. 502. Technical corrections relating to health professions.
Sec. 503. Clinical traineeships.
Sec. 504. Demonstration project grants to States for alzheimer's
disease.
Sec. 505. Medically underserved area study.
Sec. 506. Programs regarding birth defects.
TITLE VI--GENERAL PROVISIONS
Sec. 601. Effective date.
SEC. 2. FINDINGS.
Section 1(b) of the Disadvantaged Minority Health
Improvement Act of 1990 (42 U.S.C. 300u-6 note) is amended to
read as follows--
``(b) Findings.--Congress finds that--
``(1) the health status of individuals from racial and
ethnic minorities in the United States is significantly lower
than the health status of the general population and has not
improved significantly since the issuance of the 1985 report
entitled ``Report of the Secretary's Task Force on Black and
Minority Health'';
``(2) racial and ethnic minorities are disproportionately
represented among the poor;
``(3) racial and ethnic minorities suffer
disproportionately high rates of cancer, heart disease,
diabetes, substance abuse, acquired immune deficiency
syndrome, and other diseases and disorders;
``(4) the incidence of infant mortality among African
Americans is almost double that for the general population;
``(5) Mexican-American and Puerto Rican adults have
diabetes rates twice that of non-Hispanic whites;
``(6) a third of American Indian deaths occur before the
age of 45;
``(7) according to the 1990 Census, African Americans,
Hispanics, American Indians, and Asian/Pacific Islanders
constitute approximately 12.1 percent, 9 percent, 0.08
percent, and 2.9 percent, respectively, of the population of
the United States;
``(8) minority health professionals have historically
tended to practice in low-income areas, medically underserved
areas, and to serve racial and ethnic minorities;
``(9) minority health professionals have historically
tended to engage in the general practice of medicine and
specialties providing primary care;
``(10) reports published in leading medical journals
indicate that access to health care among minorities can be
substantially improved by increasing the number of minority
professionals;
``(11) diversity in the faculty and student body of health
professions schools enhances the quality of education for all
students attending the schools; and
``(12) health professionals need greater access to
continuing medical education programs to enable such
professionals to upgrade their skills (including linguistic
and cultural competence skills) and improve the quality of
medical care rendered in minority communities.''.
TITLE I--HEALTH POLICY
SEC. 101. OFFICE OF MINORITY HEALTH.
Section 1707 (42 U.S.C. 300u-6) is amended by striking
subsection (b) and all that follows and inserting the
following:
``(b) Duties.--With respect to improving the health of
racial and ethnic minorities, the Secretary, acting through
the Deputy Assistant Secretary for Minority Health, shall
carry out the following:
``(1) Establish short-range and long-range goals and
objectives and coordinate all other activities within the
Public Health Service that relate to disease prevention,
health promotion, service delivery, and research concerning
such individuals. The Director of the Centers for Disease
Control and Prevention, the Administrator of the Health
Resources and Services Administration, the Director of the
Agency for Health Care Policy and Research, the Administrator
of the Substance Abuse and Mental Health Services
Administration and the Director of the National Institutes of
Health shall consult with the Deputy Assistant Secretary for
Minority Health to ensure the coordination of all activities
within the Public Health Service as they relate to disease
prevention, health promotion, service delivery, and research
concerning such individuals.
``(2) Carry out the following types of activities by
entering into interagency agreements with other agencies of
the Public Health Service:
``(A) Support research, demonstrations and evaluations to
test new and innovative models.
``(B) Increase knowledge and understanding of health risk
factors.
``(C) Develop mechanisms that support better information
dissemination, education, prevention, and service delivery to
individuals from disadvantaged backgrounds, including racial
and ethnic minorities.
``(3) Support a national minority health resource center to
carry out the following:
``(A) Facilitate the exchange of information regarding
matters relating to health information and health promotion,
preventive health services, and education in the appropriate
use of health care.
``(B) Facilitate access to such information.
``(C) Assist in the analysis of issues and problems
relating to such matters.
``(D) Provide technical assistance with respect to the
exchange of such information (including facilitating the
development of materials for such technical assistance).
``(4) Establish a national center that shall carry out
programs to improve access to health care services for
individuals with limited English proficiency by facilitating
the removal of impediments to the receipt of health care that
result from such limitation.
``(5) With respect to grants and contracts that are
available under certain minority health programs, the
Secretary shall ensure that the agencies of the Public Health
Service--
``(A) inform entities, as appropriate, that the entities
may be eligible for the awards;
``(B) provide technical assistance to such entities in the
process of preparing and submitting applications for the
awards in accordance with the policies of the Secretary
regarding such application; and
``(C) inform populations, as appropriate, that members of
the populations may be eligible to receive services or
otherwise participate in the activities carried out with such
awards.
``(6) Not later than September 1 of each year, the Deputy
Assistant Secretary of Minority Health shall prepare and
submit to the Secretary a report summarizing the activities
of each Office of Minority Health within the Public Health
Service, including the Office of Research on Minority Health
at the National Institutes of Health.
``(c) Advisory committee.--
``(1) In general.--The Secretary shall establish an
advisory committee to be known as the Advisory Committee on
Minority Health (in this subsection referred to as the
`Committee').
``(2) Duties.--The Committee shall provide advice to the
Secretary on carrying out this section, including advice on
the development of goals and specific program activities
under subsection (b)(1) for each racial and ethnic group.
``(3) Chairperson.--The Deputy Assistant Secretary for
Minority Health shall serve as the Chairperson of the
Committee.
``(4) Composition.--The Committee shall be composed of no
fewer than 12, and not more than 18 individuals, who are not
officers or employees of the Federal Government. The
Secretary shall appoint the members of the Committee from
among individuals with expertise regarding issues of minority
health. The membership of the Committee shall be equitably
representative of the various racial and ethnic groups. The
Secretary may appoint representatives from selected Federal
agencies to serve as ex officio, non-voting members of the
Committee.
``(5) Terms.--Each member of the Committee shall serve for
a term of 4 years, except that the Secretary shall initially
appoint a portion of the members to terms of 1 year, 2 years,
and 3 years.
``(6) Vacancies.--If a vacancy occurs on the Committee, a
new member shall be appointed by the Secretary within 90 days
from the date that the vacancy occurs, and serve for the
remainder of the term for which the predecessor of such
member was appointed. The vacancy shall not affect the power
of the remaining members to execute the duties of the
Committee.
``(7) Compensation.--Members of the Committee who are
officers or employees of the United States shall serve
without compensation. Members of the Committee who are not
officers or employees of the United States shall receive, for
each day (including travel time) they are engaged in the
performance of the functions of the Committee, compensation
at rates that do not exceed the daily equivalent of the
annual rate in effect for grade GS-18 of the General Schedule
under title 5, United States Code.
``(d) Certain Requirements Regarding Duties.--
``(1) Recommendations regarding language as impediment to
health care.--The Secretary, acting through the Director of
the Office of Refugee Health, the Director of the Office of
Civil Rights, and the Director of the Office of Minority
Health of the Health Resources and Services Administration,
shall make recommendations regarding activities under
subsection (b)(4).
``(2) Equitable allocation regarding activities.--In
awarding grants or contracts under section 338A, 338B, 340A,
724, 737, 738, or 1707, the Secretary shall ensure that such
awards are equitably allocated with respect to the various
racial and ethnic populations.
``(3) Cultural competency of services.--The Secretary shall
ensure that information and services provided pursuant to
subsection (b) are provided in the language and cultural
context that is most appropriate for the individuals for whom
the information and services are intended.
``(4) Peer review.--The Secretary shall ensure that each
application for a grant, contract or cooperative agreement
under this section undergoes appropriate peer review.
``(e) Reports.--Not later than January 31 of fiscal year
1995 and of each second year thereafter, the Secretary shall
submit to the Congress a report describing the activities
carried out under this section during the preceding 2 fiscal
years and evaluating the extent to which such activities have
been effective in improving the health of racial and ethnic
minorities.
``(f) Grants and Contracts Regarding Duties.--
``(1) Authority.--In carrying out subsection (b), the
Secretary may enter into grants and contracts with public and
nonprofit private entities.
``(2) Evaluation and dissemination.--The Secretary shall,
directly or through contracts with public and private
entities, provide for evaluations of projects carried out
with financial assistance provided under paragraph (1) during
the preceding 2 fiscal years. The report shall be included in
the report required under subsection (e) for the fiscal year
involved.
``(g) Definition.--As used in this section, the term
`racial and ethnic minority group' means Hispanics, Blacks,
Asian Americans, Pacific Islanders, Native Americans, and
Alaskan Natives. The term `Hispanic' means individuals whose
origin is Mexican, Puerto Rican, Cuban, Central or South
American, or any other Spanish-speaking country, including
Spain or the Caribbean Islands, and individuals identifying
themselves as Hispanic, Latino, Spanish, or Spanish-American.
``(h) Funding.--
``(1) Authorization of appropriations.--For the purpose of
carrying out this section, there is authorized to be
appropriated $20,500,000 for fiscal year 1994, and such sums
as may be necessary for each of the fiscal years 1995 through
1998.
``(2) Allocation of funds by secretary.--Of the amounts
appropriated under paragraph (1) for a fiscal year in excess
of $15,000,000, the Secretary shall make available not less
than $3,000,000 for activities to improve access to health
care services for individuals with limited English
proficiency, including activities identified in subsection
(b)(4).''.
SEC. 102. AGENCY OFFICES OF MINORITY HEALTH.
Title XVII (42 U.S.C. 300u et seq.) is amended by adding at
the end the following new section:
``SEC. 1709. AGENCY OFFICES OF MINORITY HEALTH.
``(a) In General.--The Secretary shall ensure that an
Office of Minority Health is operating at the Centers for
Disease Control and Prevention, the Health Resources and
Services Administration, the Substance Abuse and Mental
Health Services Administration, and the Agency for Health
Care Policy and Research. Such Offices shall ensure that
services and programs carried out within each such respective
agency or office--
``(1) are equitably delivered with respect to racial and
ethnic groups;
``(2) provide culturally and linguistically competent
services; and
``(3) utilize racial and ethnic minority community-based
organizations to deliver services.
``(b) Reports.--Each Office of Minority Health within the
Public Health Service, including the Office of Research on
Minority Health at the National Institutes of Health, shall
submit a report, not later than May 1 of each year, to the
Deputy Assistant Secretary for Minority Health (as provided
for in section 1707(b)) describing the accomplishments or
programs of the plan, the budget allocation and expenditures
for, and the development and implementation of, such health
programs targeting racial and ethnic minority populations.
The Secretary shall ensure the participation and cooperation
of each Agency in the development of the annual report.''.
SEC. 103. STATE OFFICES OF MINORITY HEALTH.
Title XVII (42 U.S.C. 300u et seq.), as amended by section
102, is further amended by adding at the end the following
new section:
``SEC. 1710. GRANTS TO STATES FOR OPERATION OF OFFICES OF
MINORITY HEALTH.
``(a) In General.--The Secretary, acting through the Deputy
Assistant Secretary for Minority Health (as provided for in
section 1707), may make grants to States for the purpose of
improving the health status in minority communities, through
the operation of State offices of minority health established
to monitor and facilitate the achievement of the Health
Objectives for the Year 2000 as they affect minority
populations.
``(b) Administration of Program.--The Secretary may not
make a grant to a State under subsection (a) unless such
State agrees that the program carried out by the State with
amounts received under the grant will be administered
directly by a single State agency.
``(c) Certain Required Activities.--The Secretary may not
make a grant to a State under subsection (a) unless such
State agrees that activities carried out by an office
operated under the grant received pursuant to such subsection
will--
``(1) establish and maintain within the State a
clearinghouse for collecting and disseminating information
on--
``(A) minority health care issues;
``(B) research findings relating to minority health care;
and
``(C) innovative approaches to the delivery of health care
and social services in minority communities;
``(2) coordinate the activities carried out in the State
that relate to minority health care, including providing
coordination for the purpose of avoiding redundancy in such
activities;
``(3) identify Federal and State programs regarding
minority health, and providing technical assistance to public
and nonprofit entities regarding participation in such
program; and
``(4) develop additional Healthy People 2000 objectives for
the State that are necessary to address the most prevalent
morbidity, mortality and disability concerns for racial and
ethnic minority groups in the State.
``(d) Requirement Regarding Annual Budget for the Office.--
The Secretary may not make a grant to a State under
subsection (a) unless such State agrees that, for any fiscal
year for which the State receives such a grant, the office
operated under such grant will be provided with an annual
budget of not less than $75,000.
``(e) Certain Uses of Funds.--
``(1) Restrictions.--The Secretary may not make a grant to
a State under subsection (a) unless such State agrees that--
``(A) if research with respect to minority health is
conducted pursuant to the grant, not more than 10 percent of
the amount received under the grant will be expended for such
research; and
``(B) amounts provided under the grant will not be
expended--
``(i) to provide health care (including providing cash
payments regarding such care);
``(ii) to conduct activities for which Federal funds are
expended--
``(I) within the State to provide technical and other
nonfinancial assistance under subsection (m) of section 340A;
``(II) under a memorandum of agreement entered into with
the State under subsection (h) of such section; or
``(III) under a grant under section 388I;
``(iii) to purchase medical equipment, to purchase
ambulances, aircraft, or other vehicles, or to purchase major
communications equipment;
``(iv) to purchase or improve real property; or
``(v) to carry out any activity regarding a certificate of
need.
``(2) Authorities.--Activities for which a State may expend
amounts received under a grant under subsection (a) include--
``(A) paying the costs of establishing an office of
minority health for purposes of subsection (a);
``(B) subject to paragraph (1)(B)(ii)(III), paying the
costs of any activity carried out with respect to recruiting
and retaining health professionals to serve in minority
communities or underserved areas in the State; and
``(C) providing grants and contracts to public and
nonprofit entities to carry out activities authorized in this
section.
``(f) Reports.--The Secretary may not make a grant to a
State under subsection (a) unless such State agrees--
``(1) to submit to the Secretary reports containing such
information as the Secretary may require regarding activities
carried out under this section by the State; and
``(2) to submit a report not later than January 10 of each
fiscal year immediately following any fiscal year for which
the State has received such a grant.
``(g) Reimbursement of Application.--The Secretary may not
make a grant to a State under subsection (a) unless an
application for the grant is submitted to the Secretary and
the application in such form, is made in such manner, and
contains such agreements, assurances, and information as the
Secretary determines to be necessary to carry out such
subsection.
``(h) Noncompliance.--The Secretary may not make payments
under subsection (a) to a State for any fiscal year
subsequent to the first fiscal year of such payments unless
the Secretary determines that, for the immediately preceding
fiscal year, the State has complied with each of the
agreements made by the State under this section.
``(i) Authorization of Appropriations.--
``(1) In general.--For purposes of making grants under
subsection (a) there are authorized to be appropriated
$3,000,000 for fiscal year 1995, $4,000,000 for fiscal year
1996, and $3,000,000 for fiscal year 1997.
``(2) Availability.--Amounts appropriated under paragraph
(1) shall remain available until expended.
``(j) Termination of Program.--No grant may be made under
this section after the aggregate amounts appropriated under
subsection (i)(1) are equal to $10,000,000.''.
SEC. 104. ASSISTANT SECRETARY OF HEALTH AND HUMAN SERVICES
FOR CIVIL RIGHTS.
(a) In General.--Part A of title II (42 U.S.C. 202 et
seq.), as amended by section 2010 of Public Law 103-43, is
amended by adding at the end the following new section:
``SEC. 229. ASSISTANT SECRETARY FOR CIVIL RIGHTS.
``(a) Establishment of Position.--There shall be in the
Department of Health and Human Services an Assistant
Secretary for Civil Rights, who shall be appointed by the
President, by and with the advice and consent of the Senate.
``(b) Responsibilities.--The Assistant Secretary shall
perform such functions relating to civil rights as the
Secretary may assign.''.
(b) Conforming Amendment.--Section 5315 of title 5, United
States Code, is amended, in the item relating to Assistant
Secretaries of Health and Human Services, by striking ``(5)''
and inserting ``(6)''.
TITLE II--HEALTH SERVICES
SEC. 201. COMMUNITY SCHOLARSHIP PROGRAMS.
Section 338L (42 U.S.C. 254t) is amended--
(1) in subsection (a), by striking ``health manpower
shortage areas'' and inserting ``a Federally-designated
health professional shortage areas'';
(2) in subsection (c)--
(A) by striking ``health manpower shortage areas'' and
inserting ``Federally-designated health professional shortage
areas'' in the matter preceding paragraph (1); and
(B) by striking ``in the health manpower shortage areas in
which the community organizations are located,'' and
inserting ``in a Federally-designated health professional
shortage area that is served by the community organization
awarding the scholarship,'' in paragraph (2);
(3) in subsection (e)(1)--
(A) by striking ``health manpower shortage area'' and
inserting ``a Federally-designated health professional
shortage area''; and
(B) by striking ``in which the community'' and all that
follows through ``located'';
(4) in subsection (k)(2), by striking ``internal medicine''
and all that follows through the end thereof and inserting
``general internal medicine, general pediatrics, obstetrics
and gynecology, dentistry, or mental health, that are
provided by physicians or other health professionals.''; and
(5) in subsection (l)(1), by striking ``$5,000,000'' and
all that follows through ``1993'' and inserting ``$1,000,000
for fiscal year 1994, and such sums as may be necessary for
each of the fiscal years 1995 and 1996''.
SEC. 202. HEALTH SERVICES FOR RESIDENTS OF PUBLIC HOUSING.
Section 340A(p)(1) (42 U.S.C. 256a(p)(1)) is amended--
(1) by striking ``$35,000,000 for fiscal year 1991'' and
inserting ``$12,000,000 for fiscal year 1994''; and
(2) by striking ``1992 and 1993'' and inserting ``1995 and
1996''.
SEC. 203. ISSUANCE OF REGULATIONS REGARDING LANGUAGE AS
IMPEDIMENT TO RECEIPT OF SERVICES.
(a) Proposed Rule.--Not later than the expiration of the
90-day period beginning on the date of the enactment of this
Act, the Secretary of Health and Human Services (in this
section referred to as the ``Secretary'') shall issue a
proposed rule regarding policies to reduce the extent to
which having limited English proficiency constitutes a
significant impediment to individuals in establishing the
eligibility of the individuals for--
(1) participation in health programs under the Public
Health Service Act;
(2) the receipt of services under such programs and under
programs under titles XVIII and XIX of the Social Security
Act; or
(3) participation in programs or activities otherwise
receiving financial assistance from the Secretary or
receiving services under such programs or activities.
(b) Final Rule.--
(1) In general.--Not later than the expiration of the 1-
year period beginning on the date of the enactment of this
Act, the Secretary shall issue a final rule regarding the
policies described in subsection (a).
(2) Failure to issue by date certain.--If the Secretary
fails to issue a final rule under paragraph (1) before the
expiration of the period specified in such paragraph, the
proposed rule issued under subsection (a) is upon such
expiration deemed to be the final rule under paragraph (1)
(and shall remain in effect until the Secretary issues a
final rule under such paragraph).
SEC. 204. HEALTH SERVICES FOR PACIFIC ISLANDERS.
Section 10 of the Disadvantaged Minority Health Improvement
Act of 1990 (42 U.S.C. 254c-1) is amended--
(1) in subsection (b)--
(A) in paragraph (2)--
(i) by inserting ``, substance abuse'' after ``availability
of health''; and
(ii) by striking ``, including improved health data
systems'';
(B) in paragraph (3)--
(i) by striking ``manpower'' and inserting ``care
providers''; and
(ii) by striking ``by--'' and all that follows through the
end thereof and inserting a semicolon;
(C) by striking paragraphs (5) and (6);
(D) by redesignating paragraphs (7), and (8) as paragraphs
(5) and (6), respectively;
(E) in paragraph (5) (as so redesignated), by striking
``and'' at the end thereof;
(F) in paragraph (6) (as so redesignated), by striking the
period and inserting a semicolon; and
(G) by inserting after paragraph (6) (as so redesignated),
the following new paragraphs:
``(7) to provide primary health care, preventive health
care, and related training to American Samoan health care
professionals; and
``(8) to improve access to health promotion and disease
prevention services for rural American Samoa.'';
(2) in subsection (f)--
(A) by striking ``there is'' and inserting ``there are'';
and
(B) by striking ``$10,000,000'' and all that follows
through ``1993'' and inserting ``$3,000,000 for fiscal year
1994, and such sums as may be necessary for each of the
fiscal years 1995 and 1996''; and
(3) by adding at the end thereof the following new
subsection:
``(g) Study and Report.--
``(1) Study.--Not later than 180 days after the date of
enactment of this subsection, the Secretary, acting through
the Administrator of the Health Resources and Services
Administration, shall enter into a contract with a public or
nonprofit private entity for the conduct of a study to
determine the effectiveness of projects funded under this
section.
``(2) Report.--Not later than July 1, 1995, the Secretary
shall prepare and submit to the Committee on Labor and Human
Resources of the Senate and the Committee on Energy and
Commerce of the House of Representatives a report describing
the findings made with respect to the study conducted under
paragraph (1).''.
TITLE III--HEALTH PROFESSIONS
SEC. 301. LOANS FOR DISADVANTAGED STUDENTS.
Section 724(f)(1) (42 U.S.C. 292t(f)(1)) is amended--
(1) by striking ``there is'' and inserting ``there are'';
and
(2) by striking ``$15,000,000 for fiscal year 1993'' and
inserting ``$8,000,000 for fiscal year 1994, and such sums as
may be necessary for each of the fiscal years 1995 and
1996''.
SEC. 302. CESAR CHAVEZ PRIMARY CARE SCHOLARSHIP PROGRAM.
Section 736 (42 U.S.C. 293) is amended--
(1) by striking the section heading and inserting the
following:
``SEC. 736. CESAR CHAVEZ PRIMARY CARE SCHOLARSHIP PROGRAM.
(2) in subsection (c)--
(A) by striking ``there is'' and inserting ``there are'';
and
(B) by striking ``$11,000,000 for fiscal year 1993'' and
inserting ``$10,500,000 for fiscal year 1994, and such sums
as may be necessary for each of the fiscal years 1995 and
1996''.
SEC. 303. THURGOOD MARSHALL SCHOLARSHIP PROGRAM.
Section 737 (42 U.S.C. 293a) is amended--
(1) by striking the section heading and inserting the
following:
``SEC. 737. THURGOOD MARSHALL SCHOLARSHIP PROGRAM.'';
(2) in subsection (a)--
(A) in paragraph (1), by inserting ``(to be known as
Thurgood Marshall Scholars)'' after ``providing scholarships
to individuals''; and
(B) in paragraph (3), by inserting ``schools offering
programs for the training of physician assistants,'' after
``public health,''; and
(3) in subsection (h), by striking paragraph (1) and
inserting the following new paragraph:
``(1) Authorization of appropriations.--For the purpose of
carrying out this section, there are authorized to be
appropriated $17,100,000 for fiscal year 1994, and such sums
as may be necessary for each of the fiscal years 1995 and
1996.''.
SEC. 304. LOAN REPAYMENTS AND FELLOWSHIPS REGARDING FACULTY
POSITIONS AT HEALTH PROFESSIONS SCHOOLS.
Section 738 (42 U.S.C. 293b) is amended--
(1) in subsection (a)--
(A) in paragraph (2), by striking ``disadvantaged
backgrounds who--'' and inserting ``racial or ethnic groups
that are underrepresented in the health professions who--''
(B) in paragraph (5)--
(i) by striking ``; and'' in subparagraph (A) and inserting
a period;
(ii) by striking ``unless--'' and all that follows through
``the individual involved'' in subparagraph (A) and inserting
``unless the individual involved''; and
(iii) striking subparagraph (B);
(C) by striking paragraph (6); and
(D) by redesignating paragraph (7) as paragraph (6); and
(2) in subsection (b)(2)(B), by striking ``$30,000'' and
inserting ``$50,000'';
(3) in subsection (c)--
(A) by striking ``there is'' and inserting ``there are'';
and
(B) by striking ``$4,000,000 for fiscal year 1993'' and
inserting ``$1,100,000 for fiscal year 1994, and such sums as
may be necessary for each of the fiscal years 1995 and
1996''.
SEC. 305. CENTERS OF EXCELLENCE.
Section 739 (42 U.S.C. 293c) is amended--
(1) in subsection (b)--
(A) in paragraph (2), by inserting before the semicolon the
following: ``through collaboration with public and nonprofit
private entities to carry out community-based programs to
prepare students in secondary schools and institutions of
higher education for attendance at the health professions
school'';
(B) in paragraph (4), by striking ``and'' at the end
thereof;
(C) in paragraph (5), by striking the period and inserting
``; and''; and
(D) by adding at the end thereof the following new
paragraph:
``(6) to train the students of the school at community-
based health facilities that provide health services to a
significant number of minority individuals and that are
located at a site remote from the main site of the teaching
facilities of the school.'';
(2) in subsection (e)--
(A) by striking the subsection heading and inserting
``Authority Regarding Consortia.--'';
(B) by striking paragraph (1) and inserting the following
new paragraph:
``(1) In general.--The Secretary may make a grant under
subsection (a) to any school of medicine, osteopathic
medicine, dentistry, clinical psychology, or pharmacy that
has in accordance with paragraph (2) formed a consortium of
schools.'';
(C) in paragraph (2), by striking subparagraphs (A) through
(D) and inserting the following new subparagraphs:
``(A) the consortium consists of--
``(i) the health professions school seeking the grant under
subsection (a); and
``(ii) one or more schools of medicine, osteopathic
medicine, dentistry, pharmacy, nursing, allied health, or
public health, or graduate programs in mental health
practice;
``(B) the schools of the consortium have entered into an
agreement for the allocation of such grant among the schools;
and
``(C) each of the schools agrees to expend the grant in
accordance with this section.''; and
(D) by adding at the end the following paragraph:
``(3) Authority for collectively meeting relevant
requirements in certain cases.--With respect to meeting the
conditions specified in subsection (c)(4) for Native American
Centers of Excellence, the Secretary may make a grant to any
school that has in accordance with paragraphs (1) and (2)
formed a consortium of schools that meets such conditions
(without regard to whether the schools of the consortium
individually meet such conditions).''; and
(3) in subsection (i)--
(A) in paragraph (1), by striking ``such sums as may be
necessary for fiscal year 1993'' and inserting ``$25,000,000
for fiscal year 1994, and such sums as may be necessary for
each of the fiscal years 1995 and 1996''; and
(B) in paragraph (2)(C) by adding at the end the following:
``Health professions schools described in subsection
(c)(2)(A) shall be eligible for grants under this
subparagraph in a fiscal year if the amount appropriated for
the fiscal year under paragraph (1) is greater than
$23,500,000. Such schools shall be eligible to apply only for
grants made from the portion of such amount that exceeds
$23,500,000.''.
SEC. 306. EDUCATIONAL ASSISTANCE REGARDING UNDERGRADUATES.
Section 740 (42 U.S.C. 293d) is amended--
(1) in subsection (a)(1), by adding at the end the
following new sentence: ``To be eligible for such a grant, a
school shall have in place a program to assist individuals
from disadvantaged backgrounds in gaining entry into a health
professions school or completing the course of study at such
a school.'';
(2) in subsection (d)(1)--
(A) by striking ``there is'' and inserting ``there are'';
and
(B) by striking ``1993'' and inserting ``1994, and such
sums as may be necessary for each of the fiscal years 1995
and 1996''.
(3) in subsection (d)(2)(B), by adding at the end thereof
the following new sentence: ``Scholarship recipients under
this section shall be known as `Cesar Chavez Primary Care
Scholars.''.
SEC. 307. AREA HEALTH EDUCATION CENTERS.
Section 746(d)(2)(D) (42 U.S.C. 293j(d)(2)(D)) is amended
by inserting ``and minority health'' after ``disease
prevention''.
TITLE IV--RESEARCH AND DATA COLLECTION
SEC. 401. OFFICE OF RESEARCH ON MINORITY HEALTH.
Section 404 (42 U.S.C. 283b), as added by section 151 of
Public Law 103-43, is amended by adding at the end the
following subsections:
``(c) Plan.--The Director of the Office, shall collaborate
with the Deputy Assistant Secretary for Minority Health (as
provided for in section 1707), to develop and implement a
plan for carrying out the duties required by subsection (b).
The Director, in consultation with the Deputy Assistant
Secretary for Minority Health, shall review the plan not less
often than annually, and revise the plan as appropriate.
``(d) Equity Regarding Various Groups.--The Director of the
Office shall ensure that activities under subsection (b)
address equitably all minority groups.
``(e) Advisory Committee.--
``(1) Establishment.--In carrying out subsection (b), the
Secretary shall establish an advisory committee to be known
as the Advisory Committee on Research on Minority Health (in
this subsection referred to as the `Advisory Committee').
``(2) Composition.--
``(A) Voting and nonvoting members.--The Advisory Committee
shall be composed of voting members appointed in accordance
with subparagraph (B) and the ex officio nonvoting members
described in subparagraph (C).
``(B) Voting members.--The Advisory Committee shall include
not fewer than 12, and not more than 18, voting members who
are not officers or employees of the Federal Government. The
Director of the Office shall appoint such members to the
Advisory Committee from among physicians, practitioners,
scientists, consumers and other health professionals, whose
clinical practices, research specialization, or professional
expertise includes a significant focus on research on
minority health or on the barriers that minorities must
overcome to participate in clinical trials. The membership of
the Advisory Committee shall be equitably representative of
the minority groups served by the Office.
``(C) Ex officio nonvoting members.--The Deputy Assistant
Secretary for Minority Health and the Directors of each of
the national research entities shall serve as ex officio
nonvoting members of the Advisory Committee (except that any
of such Directors may designate an official of the institute
involved to serve as such member of the Committee in lieu of
the Director).
``(3) Chairperson.--The Director of the Office shall serve
as the chairperson of the Advisory Committee.
``(4) Duties.--The Advisory Committee shall--
``(A) advise the Director of the Office on appropriate
research activities to be undertaken by the national research
institutes with respect to--
``(i) research on minority health;
``(ii) research on racial and ethnic differences in
clinical drug trials, including responses to pharmacological
drugs;
``(iii) research on racial and ethnic differences in
disease etiology, course, and treatment; and
``(iv) research on minority health conditions which require
a multidisciplinary approach;
``(B) report to the Director of the Office on such
research;
``(C) provide recommendations to such Director regarding
activities of the Office (including recommendations on
priorities in carrying out research described in subparagraph
(A)); and
``(D) assist in monitoring compliance with section 492B
regarding the inclusion of minorities in clinical research.
``(5) Biennial report.--
``(A) Preparation.--The Advisory Committee shall prepare a
biennial report describing the activities of the Committee,
including findings made by the Committee regarding--
``(i) compliance with section 492B;
``(ii) the extent of expenditures made for research on
minority health by the agencies of the National Institutes of
Health; and
``(iii) the level of funding needed for such research.
``(B) Submission.--The report required in subparagraph (A)
shall be submitted to the Director of the National Institutes
of Health for inclusion in the report required in section
403.
``(f) Representatives of Minorities Among Researchers.--The
Secretary, acting through the Assistant Secretary for
Personnel Administration and in collaboration with the
Director of the Office, shall determine the extent to which
minorities are represented among senior physicians and
scientists of the national research institutes and among
physicians and scientists conducting research with funds
provided by such institutes, and as appropriate, carry out
activities to increase the extent of such representation.
``(g) Definitions.--For purposes of this part:
``(1) Minority health conditions.--The term `minority
health conditions', with respect to individuals who are
members of minority groups, means all diseases, disorders,
and conditions (including with respect to mental health)--
``(A) unique to, more serious, or more prevalent in such
individuals;
``(B) for which the factors of medical risk or types of
medical intervention are different for such individuals, or
for which it is unknown whether such factors or types are
different for such individuals; or
``(C) with respect to which there has been insufficient
research involving such individuals as subjects or
insufficient data on such individuals.
``(2) Research on minority health.--The term `research on
minority health' means research on minority health
conditions, including research on preventing such conditions.
``(3) Minority groups.--The term `minority groups' means
Blacks, American Indians, Alaskan Natives, Asian/Pacific
Islanders, and Hispanics, including subpopulations of such
groups.''.
SEC. 402. NATIONAL CENTER FOR HEALTH STATISTICS.
(a) In General.--Section 306 (42 U.S.C. 242k) is amended--
(1) in subsection (c), by striking ``Committee on Human
Resources'' and inserting ``Committee on Labor and Human
Resources'';
(2) in subsection (g), by striking ``data which shall be
published'' and all that follows and inserting ``data.'';
(3) in subsection (k)(2)--
(A) in subparagraph (A)--
(i) by striking the subparagraph designation; and
(ii) by striking ``Except as provided in subparagraph (B),
members'' and inserting ``Members''; and
(B) by striking subparagraph (B);
(4) in subsection (l)--
(A) by striking paragraph (3);
(B) by redesignating paragraph (4) as paragraph (3); and
(C) in paragraph (3) (as so redesignated), by striking
``paragraphs (1), (2), and (3),'' and inserting ``paragraphs
(1) and (2),''; and
(5) in subsection (o)--
(A) in paragraph (1), by striking ``1991 through 1993'' and
inserting ``1994 through 1997''; and
(B) in paragraph (2), by striking ``$5,000,000'' and all
that follows through ``1993'' and inserting ``$1,100,000 for
fiscal year 1994, and such sums as may be necessary for each
of the fiscal years 1995 through 1997''.
(b) General Authority Respecting Research, Evaluations, and
Demonstrations.--Section 304 (42 U.S.C. 242b) is amended by
striking subsection (d).
(c) General Provisions Respecting Effectiveness,
Efficiency, and Quality of Health Services.--Section 308 (42
U.S.C. 242m) is amended--
(1) in subsection (a)--
(A) in paragraph (1)--
(i) by striking subparagraph (A); and
(ii) by redesignating subparagraphs (B) through (E) as
subparagraphs (A) through (D), respectively; and
(B) in paragraph (2), by striking ``reports required by
subparagraphs'' and all that follows through ``Center'' and
inserting the following: ``reports required in paragraph (1)
shall be prepared through the National Center'';
(2)(A) by striking subsection (c);
(B) by transferring paragraph (2) of subsection (g) from
the current location of the paragraph;
(C) by redesignating such paragraph as subsection (c);
(D) by inserting subsection (c) (as so redesignated) after
subsection (b); and
(E) by striking the remainder of subsection (g);
(3) in subsection (c) (as so redesignated)--
(A) by striking ``shall (A) take'' and inserting ``shall
take''; and
(B) by striking ``and (B) publish'' and inserting ``and
shall publish'';
(4) in subsection (f), by striking ``sections 3648'' and
all that follows and inserting ``section 3324 of title 31,
United States Code, and section 3709 of the Revised Statutes
(41 U.S.C. 5).''; and
(5) by striking subsection (h).
SEC. 403. ACTIVITIES OF AGENCY FOR HEALTH CARE POLICY AND
RESEARCH.
Section 902(b) (42 U.S.C. 299a(b)) is amended to read as
follows:
``(b) Requirements With Respect to Certain Populations.--In
carrying out subsection (a), the Administrator shall
undertake and support research, demonstration projects, and
evaluations with respect to the health status of, and the
delivery of health care to--
``(1) the populations of medically underserved urban or
rural areas (including frontier areas); and
``(2) low-income groups, minority groups, and the
elderly.''.
TITLE V--MISCELLANEOUS
SEC. 501. REVISION AND EXTENSION OF PROGRAM FOR STATE OFFICES
OF RURAL HEALTH.
(a) Matching Funds.--Section 338J(b) (42 U.S.C. 254r(b)) is
amended to read as follows:
``(b) Requirement of Matching Funds.--
``(1) In general.--With respect to the costs to be incurred
by a State in carrying out the purpose described in
subsection (a), the Secretary may not make a grant under such
subsection unless the State agrees to provide non-Federal
contributions toward such costs, in cash, in an amount that
is not less than $1 for each $1 of Federal funds provided in
the grant.
``(2) Determination of amount contributed.--In determining
the amount of non-Federal contributions in cash that a State
has provided pursuant to paragraph (1), the Secretary may not
include any amounts provided to the State by the Federal
Government.''.
(b) Authorization of Appropriations.--Section 338J(j)(1)
(42 U.S.C. 254r(j)(1)) is amended--
(1) by striking ``and'' after ``1992,''; and
(2) by inserting before the period the following: ``, and
$5,000,000 for each of the fiscal years 1994 through 1996''.
(c) Termination of Program.--Section 338J(k) (42 U.S.C.
254r(k)) is amended by striking $10,000,000'' and inserting
``$20,000,000''.
SEC. 502. TECHNICAL CORRECTIONS RELATING TO HEALTH
PROFESSIONS.
(a) Health Education Assistance Loan Deferment for
Borrowers Providing Health Services to Indians.--
(1) In general.--Section 705(a)(2)(C) is amended by
striking ``and (x)'' and inserting ``(x) not in excess of
three years, during which the borrower is providing health
care services to Indians through an Indian health program (as
defined in section 108(a)(2)(A) of the Indian Health Care
Improvement Act (25 U.S.C. 1616a(a)(2)(A)); and (xi)''.
(2) Conforming amendments.--Section 705(a)(2)(C) is further
amended--
(A) in clause (xi) (as so redesignated) by striking
``(ix)'' and inserting ``(x)''; and
(B) in the matter following such clause (xi), by striking
``(x)'' and inserting ``(xi)''.
(3) Effective date.--The amendments made by this subsection
shall apply with respect to services provided on or after the
first day of the third month that begins after the date of
enactment of this Act.
(b) Maximum Student Loan Provision.--
(1) In general.--Section 722(a)(1) (42 U.S.C. 292r(a)(1)),
as amended by section 2014(b)(1) of Public Law 103-43, is
amended by striking ``the sum of'' and all that follows
through the end thereof and inserting ``the cost of
attendance (including tuition, other reasonable educational
expenses, and reasonable living costs) for that year at the
educational institution attended by the student (as
determined by such educational institution).''.
(2) Third and fourth years.--Section 722(a)(2) (42 U.S.C.
292r(a)(2)), as amended by section 2014(b)(1) of Public Law
103-43, is amended by striking ``the amount $2,500'' and all
that follows through ``including such $2,500'' and inserting
``the amount of the loan may, in the case of the third or
fourth year of a student at school of medicine or osteopathic
medicine, be increased to the extent necessary''.
(c) Requirement for Schools.--Section 723(b)(1) (42 U.S.C.
292s(b)(1)), as amended by section 2014(c)(2)(A)(ii) of
Public Law 103-43 (107 Stat. 216), is amended by striking ``3
years before'' and inserting ``4 years before''.
(d) Service Requirement for Primary Care Loan Borrowers.--
Section 723(a) (42 U.S.C. 292s(a)) is amended in subparagraph
(B) of paragraph (1), by striking ``through the date on which
the loan is repaid in full'' and inserting ``for 5 years
after completing the residency program''.
(e) Preference and Required Information in Certain
Programs.--
(1) Title vii.--Section 791 (42 U.S.C. 295j) is amended by
adding at the end thereof the following subsection:
``(d) Exceptions.--
``(1) In general.--To permit new programs to compete
equitably for funding under this section, those new programs
that meet the criteria described in paragraph (3) shall
qualify for a funding preference under this section.
``(2) Definition.--As used in this subsection, the term
`new program' means any program that has graduated less than
three classes. Upon graduating at least three classes, a
program shall have the capability to provide the information
necessary to qualify the program for the general funding
preferences described in subsection (a).
``(3) Criteria.--The criteria referred to in paragraph (1)
are the following:
``(A) The mission statement of the program identifies a
specific purpose of the program as being the preparation of
health professionals to serve underserved populations.
``(B) The curriculum of the program includes content which
will help to prepare practitioners to serve underserved
populations.
``(C) Substantial clinical training experience is required
under the program in medically underserved communities.
``(D) A minimum of 20 percent of the faculty of the program
spend at least 50 percent of their time providing or
supervising care in medically underserved communities.
``(E) The entire program or a substantial portion of the
program is physically located in a medically underserved
community.
``(F) Student assistance, which is linked to service in
medically underserved communities following graduation, is
available to the students in the program.
``(G) The program provides a placement mechanism for
deploying graduates to medically underserved communities.''.
(2) Title viii.--Section 860 (42 U.S.C. 298b-7) is amended
by adding at the end thereof the following subsection:
``(f) Exceptions.--
``(1) In general.--To permit new programs to compete
equitably for funding under this section, those new programs
that meet the criteria described in paragraph (3) shall
qualify for a funding preference under this section.
``(2) Definition.--As used in this subsection, the term
`new program' means any program that has graduated less than
three classes. Upon graduating at least three classes, a
program shall have the capability to provide the information
necessary to qualify the program for the general funding
preferences described in subsection (a).
``(3) Criteria.--The criteria referred to in paragraph (1)
are the following:
``(A) The mission statement of the program identifies a
specific purpose of the program as being the preparation of
health professionals to serve underserved populations.
``(B) The curriculum of the program includes content which
will help to prepare practitioners to serve underserved
populations.
``(C) Substantial clinical training experience is required
under the program in medically underserved communities.
``(D) A minimum of 20 percent of the faculty of the program
spend at least 50 percent of their time providing or
supervising care in medically underserved communities.
``(E) The entire program or a substantial portion of the
program is physically located in a medically underserved
community.
``(F) Student assistance, which is linked to service in
medically underserved communities following graduation, is
available to the students in the program.
``(G) The program provides a placement mechanism for
deploying graduates to medically underserved communities.''.
(f) Definitions.--Section 799(6) (42 U.S.C. 295p(6)) is
amended--
(1) in subparagraph (B) by striking ``; or'' at the end
thereof;
(2) in subparagraph (C) by striking the period and
inserting a semicolon; and
(3) by adding at the end thereof the following:
``(D) ambulatory practice sites designated by State
Governors as shortage areas or medically underserved
communities for purposes of State scholarships or loan
repayment or related programs; or
``(E) practices or facilities in which not less than 50
percent of the patients are recipients of aid under title XIX
of the Social Security Act or eligible and uninsured.''.
(g) Generally Applicable Modifications Regarding Obligated
Service.--
(1) In general.--Section 795(a)(2) (42 U.S.C. 295n(a)(2)),
is amended--
(A) in subparagraph (A), by striking ``speciality in'' and
inserting ``field of''; and
(B) in subparagraph (B), by striking ``speciality'' and
inserting ``field''; and
(2) Effective date.--Each amendment made by paragraph (1)
shall take effect as if such subsection had been enacted
immediately after the enactment of the Health Professions
Education Extension Amendments of 1992.
(h) Recovery.--Part G of title VII (42 U.S.C. 295j et seq.)
is amended by inserting after section 795, the following new
section:
``SEC. 796. RECOVERY.
``(a) In General.--If at any time within 20 years (or
within such shorter period as the Secretary may prescribe by
regulation for an interim facility) after the completion of
construction of a facility with respect to which funds have
been paid under section 720(a) (as such section existed one
day prior to the date of enactment of the Health Professions
Education Extension Amendments of 1992 (Public Law 102-408)--
``(1)(A) in case of a facility which was an affiliated
hospital or outpatient facility with respect to which funds
have been paid under such section 720(a)(1), the owner of the
facility ceases to be a public or other nonprofit agency that
would have been qualified to file an application under
section 605;
``(B) in case of a facility which was not an affiliated
hospital or outpatient facility but was a facility with
respect to which funds have been paid under paragraph (1) or
(3) of such section 720(a), the owner of the facility ceases
to be a public or nonprofit school, or
``(C) in case of a facility which was a facility with
respect to which funds have been paid under such section
720(a)(2), the owner of the facility ceases to be a public or
nonprofit entity,
``(2) the facility ceases to be used for the teaching or
training purposes (or other purposes permitted under section
722 (as such section existed one day prior to the date of
enactment of the Health Professions Education Extension
Amendments of 1992 (Public Law 102-408)) for which it was
constructed, or
``(3) the facility is used for sectarian instruction or as
a place for religious worship,
the United States shall be entitled to recover from the owner
of the facility the base amount prescribed by subsection
(c)(1) plus the interest (if any) prescribed by subsection
(c)(2).
``(b) Notice.--The owner of a facility which ceases to be a
public or nonprofit agency, school, or entity as described in
subparagraph (A), (B), or (C) of subsection (a)(1), as the
case may be, or the owner of a facility the use of which
changes as described in paragraph (2) or (3) of subsection
(a), shall provide the Secretary written notice of such
cessation or change of use within 10 days after the date on
which such cessation or change of use occurs or within 30
days after the date of enactment of this subsection,
whichever is later.
``(c) Amount.--
``(1) Base amount.--The base amount that the United States
is entitled to recover under subsection (a) is the amount
bearing the same ratio to the then value (as determined by
the agreement of the parties or in an action brought in the
district court of the United States for the district in which
the facility is situated) of the facility as the amount of
the Federal participation bore to the cost of construction.
``(2) Interest.--
``(A) In general.--The interest that the United States is
entitled to recover under subsection (a) is the interest for
the period (if any) described in subparagraph (B) at a rate
(determined by the Secretary) based on the average of the
bond equivalent rates of ninety-one-day Treasury bills
auctioned during that period.
``(B) Period.--The period referred to in subparagraph (A)
is the period beginning--
``(i) if notice is provided as prescribed by subsection
(b), 191 days after the date on which the owner of the
facility ceases to be a public or nonprofit agency, school,
or entity as described in subparagraph (A), (B), or (C) of
subsection (a)(1), as the case may be, or 191 days after the
date on which the use of the facility changes as described in
paragraph (2) or (3) of subsection (a), or
``(ii) if notice is not provided as prescribed by
subsection (b), 11 days after the date on which such
cessation or change of use occurs,
and ending on the date the amount the United States is
entitled to recover is collected.
``(d) Waiver.--The Secretary may waive the recovery rights
of the United States under subsection (a)(2) with respect to
a facility (under such conditions as the Secretary may
establish by regulation) if the Secretary determines that
there is good cause for waiving such rights.
``(e) Lien.--The right of recovery of the United States
under subsection (a) shall not, prior to judgment, constitute
a lien on any facility.''.
SEC. 503. CLINICAL TRAINEESHIPS.
Section 303(d)(1) (42 U.S.C. 242a(d)(1)) is amended by
inserting ``counseling'' after ``family therapy,''.
SEC. 504. DEMONSTRATION PROJECT GRANTS TO STATES FOR
ALZHEIMER'S DISEASE.
(a) In General.--Section 398(a) (42 U.S.C. 280c-3(a)) is
amended--
(1) in the matter preceding paragraph (1), by striking
``not less than 5, and not more than 15,'';
(2) in paragraph (2)--
(A) by inserting after ``disorders'' the following: ``who
are living in single family homes or in congregate
settings''; and
(B) by striking ``and'' at the end;
(3) by redesignating paragraph (3) as paragraph (4); and
(4) by inserting after paragraph (2) the following:
``(3) to improve access for individuals with Alzheimer's
disease or related disorders, particularly such individuals
from ethnic, cultural, or language minorities and such
individuals who are living in isolated rural areas, to
services that--
``(A) are home-based or community-based long-term care
services; and
``(B) exist on the date of enactment of this paragraph;
and''.
(b) Duration.--Section 398A (42 U.S.C. 280c-4) is amended--
(1) in the title, by striking ``LIMITATION ON'';
(2) in subsection (a)--
(A) in the heading, by striking ``Limitation on''; and
(B) by striking ``may not exceed'' and inserting ``may
exceed''; and
(3) in subsection (b), in paragraphs (1)(C) and (2)(C), by
inserting ``, and any subsequent year,'' after ``third
year''.
(c) Authorization of Appropriations.--Section 398B(e) (42
U.S.C. 280c-5(e)) is amended by striking ``and 1993'' and
inserting ``through 1998''.
SEC. 505. MEDICALLY UNDERSERVED AREA STUDY.
(a) In General.--The Secretary of Health and Human Services
shall conduct a study concerning the feasibility and
desirability of, and the criteria to be used for, combining
the designations of ``health professional shortage area'' and
``medically underserved area'' into a single health
professional shortage area designation.
(b) Requirements.--As part of the study conducted under
subsection (a), the Secretary of Health and Human Services,
in considering the statutory and regulatory requirements
necessary for the creation of a single health professional
shortage area designation, shall--
(1) review and report on the application of current
statutory and regulatory criteria used--
(A) in designating an area as a health professional
shortage area;
(B) in designating an area as a medically underserved area;
and
(C) by a State in the determination of the health
professional shortage area designations of such State; and
(2) review the suggestions of public health and primary
care experts.
(c) Report.--Not later than 1 year after the date of
enactment of this Act, the Secretary of Health and Human
Services shall prepare and submit to the appropriate
committees of Congress a report concerning the findings of
the study conducted under subsection (a) together with the
recommendations of the Secretary.
(d) Recommendations.--In making recommendations under
subsection (c), the Secretary of Health and Human Services
shall give special consideration to (and describe in the
report) the unique impact of designation criteria on
different rural and urban populations, and ethnic and racial
minorities, including--
(1) rational service areas, and their application to
frontier areas and inner-city communities;
(2) indicators of high medical need, including fertility
rates, infant mortality rates, pediatric population, elderly
population, poverty rates, and physician to population
ratios; and
(3) indicators of insufficient service capacity, including
language proficiency criteria for ethnic populations, annual
patient visits per physician, waiting times for appointments,
waiting times in a primary care physician office, excessive
use of emergency facilities, low annual office visit rate,
and demand on physicians in contiguous rural or urban areas.
SEC. 506. PROGRAMS REGARDING BIRTH DEFECTS.
Section 317C of the Public Health Service Act (42 U.S.C.
247b-4), as added by section 306 of Public Law 102-531 (106
Stat. 3494), is amended to read as follows:
``programs regarding birth defects
``Sec. 317C. (a) The Secretary, acting through the Director
of the Centers for Disease Control and Prevention, shall
carry out programs--
``(1) to collect, analyze, and make available data on birth
defects, including data on the causes of such defects and on
the incidence and prevalence of such defects;
``(2) to provide information and education to the public on
the prevention of such defects;
``(3) to operate centers for the conduct of applied
epidemiologic research and study of such defects, and to
improve the education, training, and clinical skills of
health professionals with respect to the prevention of such
defects; and
``(4) to carry out demonstration projects for the
prevention of such defects.
``(b) National clearinghouse.--In carrying out subsection
(a)(1), the Secretary shall establish and maintain a National
Information Clearinghouse on Birth Defects to collect and
disseminate to health professionals and the general public
information on birth defects, including the prevention of
such defects.
``(c) Grants and Contracts.--
``(1) In general.--In carrying out subsection (a), the
Secretary may make grants to and enter into contracts with
public and nonprofit private entities. Recipients of
assistance under this subsection shall collect and analyze
demographic data utilizing appropriate sources as determined
by the Secretary.
``(2) Supplies and services in lieu of award funds.--
``(A) Upon the request of a recipient of an award of a
grant or contract under paragraph (1), the Secretary may,
subject to subparagraph (B), provide supplies, equipment, and
services for the purpose of aiding the recipient in carrying
out the purposes for which the award is made and, for such
purposes, may detail to the recipient any officer or employee
of the Department of Health and Human Services.
``(B) With respect to a request described in subparagraph
(A), the Secretary shall reduce the amount of payments under
the award involved by an amount equal to the costs of
detailing personnel and the fair market value of any
supplies, equipment, or services provided by the Secretary.
The Secretary shall, for the payment of expenses incurred in
complying with such request, expend the amounts withheld.
``(3) Application for award.--The Secretary may make an
award of a grant or contract under paragraph (1) only if an
application for the award is submitted to the Secretary and
the application is in such form, is made in such manner, and
contains such agreements, assurances, and information as the
Secretary determines to be necessary to carry out the
purposes for which the award is to be made.
``(d) Biennial Report.--Not later than February 1 of fiscal
year 1995 and of every second such year thereafter, the
Secretary shall submit to the Committee on Energy and
Commerce of the House of Representatives, and the Committee
on Labor and Human Resources of the Senate, a report that,
with respect to the preceding 2 fiscal years--
``(1) contains information regarding the incidence and
prevalence of birth defects and the extent to which birth
defects have contributed to the incidence and prevalence of
infant mortality;
``(2) contains information under paragraph (1) that is
specific to various racial and ethnic groups; and
``(3) contains an assessment of the extent to which each
approach to preventing birth defects has been effective,
including a description of effectiveness in relation to cost;
``(4) describes the activities carried out under this
section; and
``(5) contains any recommendations of the Secretary
regarding this section.
``(e) Authorization of Appropriations.--For the purpose of
carrying out this section, there are authorized to be
appropriated such sums as may be necessary for each of the
fiscal years 1994 through 1997.''.
TITLE VI--GENERAL PROVISIONS
SEC. 601. EFFECTIVE DATE.
This Act and the amendments made by this Act shall take
effect October 1, 1993, or upon the date of the enactment of
this Act, whichever occurs later.
amendment no. 1605
(Purpose: To provide for a substitute amendment)
Mr. MITCHELL. Madam President, I ask unanimous consent that a
substitute amendment in behalf of Senator Kennedy be sent to the desk.
The PRESIDING OFFICER. The clerk will report.
The legislative clerk read as follows:
The Senator from Maine [Mr. Mitchell] for Mr. Kennedy,
proposes an amendment numbered 1605.
(The text of the amendment is printed in today's Record under
``Amendments Submitted.'')
Mr. KENNEDY. Madam President, I urge the Senate to support the
Disadvantaged Minority Health Improvement Act of 1993. This legislation
reauthorizes several vital health programs and establishes new
initiatives for improving the health status of racial and ethnic
minorities.
Despite impressive gains in scientific knowledge and the increased
ability to diagnose, prevent and cure disease, too many minority
citizens in America do not benefit from these advances. The Nation
spends over $800 billion a year on health care, yet the health status
of racial and ethnic minorities lags far behind the rest of the Nation.
Today, African-Americans, Hispanics, Native Americans, and Asian
Pacific Islanders are often in poorer health than typical citizens of
Third World countries.
Because minorities are less likely to receive health care services,
their children are at risk of being born prematurely or with physical
disabilities or not being vaccinated against preventable diseases.
Minority adults have a higher likelihood of dying from diseases that
most physicians consider preventable.
The latest annual report card on the Nation's health shows that a
number serious health problems disproportionately affecting people of
color have not improved or have become worse.
In 1990, Congress enacted the Disadvantaged Minority Health
Improvement Act to reduce these barriers and the unnecessary diseases
and deaths that disproportionately affecting minorities. The act
established an Office of Minority Health in the Department of Health
and Human Services to coordinate activities relating to health
promotion, disease prevention, service delivery, and research involving
racial and ethnic minorities. The act also established a loan and
scholarship program to provide financial assistance to minority
students pursuing careers as health professionals. In addition, the act
strengthened and revised health service delivery programs for
disadvantaged racial and ethnic minorities.
There is clearly a need for more research on minority health
issues, better data collection on racial and ethnic minorities, and
more effective programs to improve minorities access to health care,
and train minority health professionals.
The pending legislation reauthorizes and revises activities of the
Office of Minority Health. It supports the National Minority Health
Resource Center, which disseminates information on health promotion,
disease prevention, and preventive health services for racial and
ethnic minorities.
This legislation also establishes a national center to address the
problems facing individuals with limited English skills who are seeking
health care services. The legislation also revises and extends the
Health Careers Opportunity Program, the Faculty Development Loan
Repayment Program, the Centers of Excellence Program and scholarship
and loan programs for disadvantaged students. These programs will
increase the number of minority students pursuing careers in medicine,
dentistry, and clinical psychology by providing financial aid to
students and grants to schools committed to training minority students.
In addition, the legislation codifies new Offices of Minority Health
in four agencies--the Centers for Disease Control and Prevention, the
Health Resources and Services Administration, the Substance Abuse and
Mental Health Services Administration, and the Agency for Health Care
Policy and Research. These important offices will help ensure that
disadvantaged minority groups have access to health promotion and
disease prevention services provided by the Public Health Service.
In addition, the bill authorizes $3 million in grants to States to
establish their own Offices of Minority Health. These offices will act
as clearinghouses to collect and disseminate information, develop
innovative methods of delivering health care and social services to
minority communities, and coordinate State activities relating to
health promotion and disease prevention.
Finally, the bill establishes an Advisory Committee on Research on
Minority Health at the National Institutes of Health. The Committee
will be composed of scientists, physicians and other providers with
expertise in minority health research and in eliminating barriers to
health care. The committee will analyze current research and design new
research on all aspects of the relationships between disease and race
and ethnicity, such as the onset of disease and responses to
pharmaceutical drugs and other treatments.
We have begun to make worthwhile progress in this area in recent
years, but much more remains to be done. This is bipartisan
legislation, and I particularly commend Senator Hatch and his staff for
their support and assistance in developing the measures to improve the
health of minorities. I urge the Senate to approve it.
Amendment No. 1606
(Purpose: To prohibit an agency, or entity, that receives Federal
assistance and is involved in adoption or foster care programs from
delaying or denying the placement of a child based on the race, color,
or national origin of the child or adoptive or foster parent or parents
involved)
Mr. MITCHELL. Madam President, in behalf of Senator Metzenbaum, I
send an amendment to the substitute and ask for its immediate
consideration.
The PRESIDING OFFICER. The clerk will report.
The legislative clerk read as follows:
The Senator from Maine [Mr. Mitchell] for Mr. Metzenbaum
(for himself, Ms. Moseley-Braun, Mr. Inouye, Mr. Simon, Mrs.
Kassebaum, and Mrs. Feinstein) proposes an amendment numbered
1606.
At the appropriate place, insert the following new title:
TITLE --MULTIETHNIC PLACEMENT
SECTION 01. SHORT TITLE.
This Act may be cited as the ``Multiethnic Placement Act of
1994''.
SEC. 02. FINDINGS AND PURPOSE.
(a) Findings.--Congress finds that--
(1) nearly 500,000 children are in foster care in the
United States;
(2) tens of thousands of children in foster care are
waiting for adoption;
(3) 2 years and 8 months is the median length of time that
children wait to be adopted;
(4) child welfare agencies should work to eliminate racial,
ethnic, and national origin discrimination and bias in
adoption and foster care recruitment, selection, and
placement procedures; and
(5) active, creative, and diligent efforts are needed to
recruit parents, from every race and culture, for children
needing foster care or adoptive parents.
(b) Purpose.--It is the purpose of this Act to decrease the
length of time that children wait to be adopted and to
prevent discrimination in the placement of children on the
basis of race, color, or national origin.
SEC. 03. MULTIETHNIC PLACEMENTS.
(a) Activities.--
(1) Prohibition.--An agency, or entity, that receives
Federal assistance and is involved in adoption or foster care
placements may not--
(A) categorically deny to any person the opportunity to
become an adoptive or a foster parent, solely on the basis of
the race, color, or national origin of the adoptive or foster
parent, or the child, involved; or
(B) delay or deny the placement of a child for adoption or
into foster care, or otherwise discriminate in making a
placement decision, solely on the basis of the race, color,
or national origin of the adoptive or foster parent, or the
child, involved.
(2) Permissible consideration.--An agency or entity to
which paragraph (1) applies may consider the race, color, or
national origin of a child as a factor in making a placement
decision if such factor is relevant to the best interests of
the child involved and is considered in conjunction with
other factors.
(3) Definition.--As used in this subsection the term
``placement decision'' means the decision to place, or to
delay or deny the placement of, a child in a foster care or
an adoptive home, and includes the decision of the agency or
entity involved to seek the termination of birth parent
rights or otherwise make a child legally available for
adoptive placement.
(b) Limitation.--The Secretary of Health and Human Services
shall not provide placement and administrative funds under
section 474(a)(3) of the Social Security Act (42 U.S.C.
674(a)(3)) to an agency or entity described in subsection (a)
that is not in compliance with subsection (a).
(c) Equitable Relief.--Any individual who is aggrieved by
an action in violation of subsection (a), taken by an agency
or entity described in subsection (a), shall have the right
to bring an action seeking relief in a United States district
court of appropriate jurisdiction.
(d) Construction.--Nothing in this section shall be
construed to affect the application of the Indian Child
Welfare Act of 1978 (25 U.S.C. 1901 et seq.).
multiethnic placement act
Mr. METZENBAUM. Madam President, I introduced the
Multiethnic Placement Act, S. 1224 with one goal in mind--encouraging
transracial adoption when an appropriate same race placement is not
available. I strongly believe that it is better for children to be
adopted by parents of another race than not to be adopted at all.
Policies that virtually prohibit multiethnic foster care and adoption
are unconstitutional, harmful and must be stopped.
There has been an explosion in the number of children in the foster
care system, from 276,000 in 1986 to 450,000 in 1992. The goal for
these children is a loving and stable home. This goal can be achieved
by placement in either an appropriate same race or interracial home.
Although interracial foster and adoptive families may face a variety of
problems that same race families do not, the evidence indicates that
transracial adoption is often a positive experience for all involved.
Despite this evidence, formal and informal policies against
multiethnic placements still persist. S. 1224 would prohibit any agency
which receives Federal funds from denying a foster care or adoption
placement solely on the basis of race, color, or national origin. For
example, it would prohibit child welfare agencies from categorically
denying anyone the opportunity to become an adoptive or foster parent
on the basis of race, color, or national origin.
The bill would provide for injunctive and equitable relief and
require HHS to withhold adoption assistance funds from any agency that
violated the law. S. 1224 has the support of Senators Carol Moseley-
Braun, Daniel Inouye, Dan Coats, Nancy Kassebaum, Paul
Simon, Dianne Feinstein, and Dave Durenberger. It also enjoys the
support of Marian Wright Edelman of the Children's Defense Fund, the
Reverend Jesse Jackson of the National Rainbow Coalition, and the
National Council for Adoption.
Although an appropriate transracial placement is often a positive
experience, it is also true that a same race, language, or ethnic group
placement can go a long way in helping children make the psychological,
social, and cultural adjustment to their new family. Given the obvious
benefits of same race placement, the Multiethnic Placement Act also
makes it clear that race, color, or national origin can be a factor in
making foster care and adoptive placements, if and only if: First, the
consideration of these factors are in the child's best interest, and
second, race, color, or national origin is considered along with other
factors, such as age, sex, member of a sibling group, religion,
disability, language, and whether the child has already bonded with the
prospective parents.
This commonsense approach to the consideration of race in making
foster care and adoption placements is in keeping with long standing
Federal adoption legislation that encourages the recruitment of
prospective parents of all races. Federal and State case law and HHS
guidelines also specifically allow race to be one factor in making
foster care and adoptive placements. In addition, every single major
child welfare and adoption organization advocates the consideration of
race as one of many factors in making out of home placements if such a
consideration is in the child's best interests.
Many child welfare and adoption advocates also believe that the
permanent placement of a child may be postponed, but not for an undue
period of time, in order to affect a same race or ethnic group adoptive
placement. They recognize that recruiting prospective parents of all
races of children in need of homes requires time and effort.
I would prefer that no child be required to spend any extra time in
foster care limbo in order to effectuate a same race placement.
Ideally, appropriate prospective parents of all races should be waiting
to care for a child the moment he or she needs an out of home
placement. But given the difficulties in finding appropriate same race
placements, S. 1224 was amended at an executive session of the U.S.
Senate Committee on Labor and Human Resources, to state that agencies
receiving Federal funds may not unduly delay in making foster care and
adoptive placements on the basis of race, color, or national origin.
The amended version of the Multiethnic Placement Act also contains
additional findings that stress the importance of eliminating racial,
ethnic, and national origin discrimination and bias in adoption and
foster care recruitment, selection, and placement procedures. Child
welfare agencies are encouraged to use active, creative, and diligent
efforts to recruit parents from every race and culture for children
needing out of home placements. The amended bill was adopted by voice
vote by the U.S. Senate Committee on Labor and Human Resources on
October 6, 1993.
The lack of definition for the term ``unduly delay'' in S. 1224 has
caused some concern among the foster care and adoption community. Some
who otherwise support S. 1224, fear that the term ``unduly'' will not
or cannot be defined in a manner consistent with the goals of the bill.
In order to make it clear that appropriate out of home placements
should be made as soon as possible, the latest version of S. 1224 has
eliminated the term ``unduly''.
The passage and enactment of the Multiethnic Placement Act is my
highest legislative priority of my remaining time in the Senate. I
realize that this bill will not solve all the problems of the child
welfare system. But S. 1224 can make a difference in lives of thousands
of children who languish in foster care and temporary placements
because of policies against transracial placements. I thank my Senate
colleagues for their support of this legislation and will work hard for
its passage in the House.
the multiethnic placement act
Mr. COATS. As the Senator from Ohio knows, the goal of ending
discrimination in adoption placements is one which we both share, as
cosponsors of S. 1224, the Multiethnic Placement Act of 1993. I believe
that this bill is an important step toward the goal of ending policies
which categorically deny adoption placements on the basis of race,
color or national origin.
Although the issue of transracial adoption is both controversial and
complicated, you and I agree on certain basic principles. First, that
it is generally preferable for children to be placed with families of
their own ethnic origin when such homes are available and in the
child's best interest. Second, that transracial placement is a positive
and effective means of providing a child with a loving and permanent
home, particularly when faced with the alternative of long-term foster
care. Finally, that children should not be forced into prolonged
temporary care when good, stable families are ready, willing, and able
to adopt.
Mr. METZENBAUM. I have long been impressed by Senator Coats'
dedication to helping children and protecting their best interests. I
share his commitment to placing children in loving and permanent homes
as quickly as possible. I also believe that transracial adoption should
be encouraged when an appropriate same race placement is not available.
Mr. COATS. I am glad that Senator Metzenbaum and I are in agreement
on this issue. I would like to ask for clarification of one section in
the bill that states that a covered agency may consider race, color, or
national origin as a factor in making placement decisions if it is
relevant to the best interests of the child involved and is considered
in conjunction with other factors. Does the Senator intend that this
section allow the use of race, color, or national origin as a
determining factor between two otherwise appropriate and available
families, when to do so is in the best interests of the child? The
reason I am asking this question is that the bill also prohibits denial
of adoption based on race. This appear to be a contradiction.
Mr. METZENBAUM. Perhaps this could have been worked more clearly--but
the intent is to allow race to be considered as one of many factors and
to allow race to be the determinative factor between two otherwise
appropriate and available families, if and only if the consideration of
race is in the child's best interest.
Mr. COATS. So, I gather from the Senator's response that the primary
concern of this bill is the child's best interest.
Mr. METZENBAUM. That is correct--and prolonged foster care is not in
the child's best interest.
Mr. COATS. I agree--but does the Senator intend that other factors
such as religion, language, and cultural identity be considered when
determining the child's best interests?
Mr. METZENBAUM. Yes. Any factors which contribute to a child's
development should be taken into consideration when making placement
decisions and determining the child's best interest.
Mr. COATS. I thank the Senator for his response. S. 1224 also
prohibits any delay in making an adoption placement. While I have
expressed concern about the effect of this prohibition I have
determined that it is the best legislative approach we can take at this
time. I do, however, want to reiterate my concern that this not be
perceived as an excuse for agencies not to aggressively recruit
prospective adoptive parents. Agencies should, on an ongoing basis--
consistently, creatively, and vigorously recruit and study families of
every race and culture of children needing adoptive families.
Mr. METZENBAUM. The Senator is correct--and anyone who uses this bill
as an excuse not to recruit will have gone against the very spirit we
have intended here.
Mr. COATS. I thank the Senator.
The PRESIDING OFFICER. Without objection, the amendment is agreed to.
So the amendment (No. 1606) was agreed to.
Mr. HATCH. Madam President, I rise in support of the Disadvantaged
Minority Health Improvement Act of 1993, S. 1569, which I have
cosponsored with my distinguished colleague, the chairman of the Labor
and Human Resources Committee, Senator Kennedy.
The Disadvantaged Minority Health Improvement Act has done much to
improve the health and well being of minority communities since it was
first enacted in 1990. The measure before us today will further enhance
and improve upon the existing programs aimed at the delivery of health
and human services in racial and ethnic minority communities.
As cited so aptly in the committee report, despite impressive gains
in scientific knowledge and the increased ability to diagnose, prevent
and cure diseases, many minority citizens in America still do not
benefit from these advances. Minorities suffer disproportionately high
rates of cancer, stroke, heart disease, diabetes, substance abuse,
acquired immune deficiency syndrome, and other diseases and disorders.
The statistics are compelling and shocking. For instance, an African-
American child is twice as likely to die in the first year of life as a
white child. In addition, African-Americans die as a result of heart
disease twice as often as Whites, and their life expectancy is 6 years
fewer.
Hispanics are more likely than other Americans to contract certain
cancers--stomach, esophagus, pancreas, cervix--as well as tuberculosis
and diabetes. In addition, Hispanics have twice the percentage of AIDS
cases, and three times the percentage of female and pediatric AIDS
cases.
Among Native Americans, a large proportion of the population dies
before the age of 45. Cirrhosis and diabetes are two chronic diseases
that afflict Native Americans more frequently than other groups.
Diabetes is now so prevalent that in many tribes more than 20 percent
of the members have this disease.
With respect to Asian and Pacific Islander Americans, diseases
normally preventable with appropriate health care service affect these
groups at shocking rates. Hepatitis B is seventeen times more prevalent
in Southeast Asian Americans than Whites. The incidence of tuberculosis
is five times higher among Asians than it is among Whites. And,
Hawaiian women have the highest incidence of breast cancer among all
racial and ethnic groups.
Accordingly, I believe it is important to strengthen our Federal
commitment to provide medical care and educational services to
minorities as well as to train and upgrade the skills of minority
health professionals in improving the quality of medical care provided
in minority communities.
This legislation helps to correct the way we view health in minority
communities by placing new priority on morbidity measures. In
particular, the bill encourages the Secretary of Health and Human
Resources to include morbidity measures in the Federal designation of
Medically Underserved Areas [MUAs], and to launch a study on how to
include morbidity measures under Federal MUA designations.
In addition to ensuring that Federal designations accurately reflect
a community's health status, it is necessary to empower community-based
organizations to meet the needs of the communities they serve.
In this area, I would like to applaud the work of the National
Coalition of Hispanic Health and Human Services Organizations [COSSMHO]
which has for over 20 years developed exemplary models for community-
based delivery of health services in underserved Hispanic communities
throughout the Nation.
Certainly, in Salt Lake City, the Institute for Human Resources
Development, which has been part of and serving the needs of the
Hispanic community for two decades, can make far better decisions on
how to meet the needs of the community than can a federal agency.
To support the continued movement toward community-based programs,
the bill establishes State Offices of Minority Health charged with
ensuring the support and development of community-based initiatives in
underserved racial and ethnic communities.
Hand-in-hand with the movement toward community-based programs, title
IV of S. 1569 also contains several provisions to ensure that we have
the necessary data on the health status of racial and ethnic minority
communities.
This is something we spent a great deal of time in developing as the
bill was drafted, and I think these are very important provisions. It
is abundantly clear that we simply do not have adequate data on the
health outcomes of minority populations. The committee found, for
example, absence of comprehensive epidemiologic information on the
Hispanic population. A review we conducted of 15 national data systems
showed that most did not have useful data on Hispanics. The same is
true for other populations, such as Asian-Americans.
Madam President, such a lack of good data hampers us in our ability
to craft public health programs which respond to the needs of the
disadvantaged communities, and thus precludes the Disadvantaged
Minority Health Improvement Act from reaching its full potential.
Accordingly, we have directed the Secretary, when making grants, to
give special consideration to existing minority community data analysis
infrastructures, such as the Hispanic Health Research Consortium and
the Asian and Pacific Islander American Health Forum. We also expect
HHS to develop--and use--distinct, straightforward and consistent
policies in all their data-gathering activities, including major health
surveys and health studies, so that we have adequate information about
the health problems affecting Hispanics and Asian-Americans.
It is important that HHS involve the National Institutes of Health,
particularly the National Institute on Aging and the National Institute
of Diabetes, Digestive and Kidney Diseases in this effort.
On one minor point, while I am not convinced that it is necessary to
elevate the Director of the Office for Civil Rights to an Assistant
Secretary position, I will defer to the administration's request for
this organizational change.
On balance, S. 1569 is a significant step in addressing minority
health issues and in enabling the Department of Health and Human
Services to do a fair and equitable job in fulfilling the legislation's
mandate.
I want to thank Senator Kennedy and his staff for their leadership
and diligent efforts in fashioning a solid piece of legislation which
will go far in improving the health status of minority populations.
Madam President, I am pleased to be a cosponsor of the Kennedy-Hatch
Disadvantaged Minority Health Improvement Act of 1993. I urge my
colleagues in the Senate to support its passage.
Mr. COCHRAN. Madam President, I support S. 1569, the Preventive
Health Services and Health Professions Amendments Act of 1993, which
reauthorizes and revises programs to help improve the health of
individuals from disadvantaged backgrounds. I commend my colleague from
Massachusetts for this bill. It has broad support among those who are
interested in rural health issues and problems.
I especially want to thank the Chairman for adding to his bill a
title similar to S. 1082, my bill which reauthorizes the State Offices
of Rural Health, first authorized in 1990. S. 1082 responds to growing
health care provider shortages in rural America by providing matching
grants for States to establish and maintain offices of rural health.
When the national initiative began, there were only 9 State offices.
Today there are 50.
It is important for each State to continue building its own
infrastructure to facilitate coordinated approaches to solving rural
health care problems. It is also important that these offices are not
hampered with federal regulations, but are given maximum flexibility to
meet the needs of each individual State.
Under the program, States decide how to organize these offices,
whether within another agency, through an educational institution, or
through a private contracting organization. However organized, the aim
of these State Offices of Rural Health is the integration of State,
Federal, and private sector activities and the development of
innovative solutions for improving access to quality care in rural
communities.
Activities of these offices also include examining rural health care
delivery and recommending improvement in quality and cost
effectiveness; assisting in the recruitment and retention of health
professionals; providing technical assistance to attract more Federal,
State, and foundation funding for rural health; and coordinating rural
health interests and activities across the State.
This reauthorization will make one major change to the existing
program. It will require only $1 in State matching funds for each
Federal dollar. Currently a 3 to 1 match is required. However, the
State's portion must be a cash contribution, rather than in-kind
contributions. This will alleviate the confusion that has existed under
the current program over what constitutes an appropriate State
contribution.
Madam President, I am very pleased that the State Offices of Rural
Health reauthorization could be included in this important legislation.
Mr. DURENBERGER. Madam President, I have a question for the
distinguished sponsor of the Multiethnic Placement Act, Senator
Metzenbaum, related to the placement practices of my home State.
Minnesota has a policy, absent good cause to the contrary, of first
attempting to place a child with relatives. If that is not workable,
the State agency attempts to place the child with a family of the same
racial or ethnic heritage. If that is not feasible, the final
preference is for a family of different heritage that knows and
appreciates the child's racial and ethnic heritage. The search for
relatives or families of similar race and ethicity must be completed
within a short and specified time period.
Would the Multiethnic Placement Act prevent a State from implementing
such a policy of preferences?
Mr. METZENBAUM. Consistent with the best interests of the child, the
bill would not prevent such policies.
Mr. DURENBERGER. I thank my distinguished colleague.
amendment no. 1607 to amendment no. 1605
(Purpose: To permit the Secretary of Health and Human Services to
facilitate mutually requested voluntary reunions between adult adopted
children, and their birth parents or adult adopted siblings, at no net
expense to the Federal Government)
Mr. MITCHELL. Madam President, on behalf of Senator Levin and Senator
Kassebaum, I send an amendment to the desk and ask for its immediate
consideration.
The PRESIDING OFFICER. The clerk will report.
The legislative clerk read as follows:
The Senator from Maine [Mr. Mitchell], for Mr. Levin and
Mrs. Kassebaum, proposes an amendment numbered 1607 to
amendment 1605.
Mr. MITCHELL. Madam President, I ask unanimous consent that reading
of the amendment be dispensed with.
The PRESIDING OFFICER. Without objection, it is so ordered.
The amendment reads as follows:
At the end of the amendment, insert the following:
TITLE --VOLUNTARY MUTUAL REUNIONS
SEC. . FACILITATION OF REUNIONS.
The Secretary of Health and Human Services, in the
discretion of the Secretary and at no net expense to the
Federal Government, may use the facilities of the Department
of Health and Human Services to facilitate the voluntary,
mutually requested reunion of an adult adopted child who is
21 or older with--
(1) any birth parent of the adult child; or
(2) any adult adopted sibling, who is 21 or older, of the
adult child,
if all such persons involved in any such reunion have, on
their own initiative, expressed a desire for reunion.
Mr. LEVIN. Madam President, the amendment which I am offering with
Senator Kassebaum is aimed at humanizing the process through which
adult biological relatives separated by adoption, who are looking for
each other, can make contact. Currently, for hundreds of thousands of
persons seeking one another the process is often costly, cumbersome,
and futile. Aside from the natural, human desire of many to know one's
family roots and genetic heritage, there are other reasons many wish to
to make contact with birth relatives. For instance, many of these
individuals need to have access to information which may affect their
own mental and physical health and influence their own family
decisions.
My amendment would permit the Secretary of Health and Human Services,
at no net expense to the Federal Government, to facilitate the
voluntary, mutually requested reunions between adult adopted children
21 years of age and over, and their birth parents or adult adopted
siblings 21 years of age and over.
I would like to make clear, Mr. President, that under this amendment,
there could be no searching for one party at the request of another.
All parties would have to, on their own, mutually and voluntarily seek
one another.
Madam President, currently, over half the States provide for
voluntary and mutual reunion facilitation. But even those systems are
restricted, by nature, to the geographic boundaries of the State. Since
we are a mobile society, that limitation reduces the utility of State-
based networks. Adoptions are often started in one State but finalized
in another. Additionally, the adult adoptee, birth parent, or sibling
may be a resident of several different States during their lifetimes.
Madam President, the amendment does not mandate, but simply gives the
Secretary the discretion to facilitate voluntary, mutual reunions, if
she so chooses.
I urge my colleague to support this humane legislation.
The PRESIDING OFFICER. Without objection, the amendment is agreed to.
So the amendment (No. 1607) was agreed to.
Mr. MITCHELL. Madam President, I ask unanimous consent that the
substitute, as amended, be agreed to, the bill, as amended, be read
three times, passed, and the motion to reconsider be laid upon the
table.
The PRESIDING OFFICER. Without objection, it is so ordered.
So the substitute amendment (No. 1605), as amended, was agreed to.
So the bill (S. 1569), as amended, was passed, as follows:
[The bill (S. 1569) will appear in a subsequent issue of the Record.]
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