[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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