[Congressional Record Volume 140, Number 65 (Monday, May 23, 1994)]
[House]
[Page H]
From the Congressional Record Online through the Government Printing Office [www.gpo.gov]


[Congressional Record: May 23, 1994]
From the Congressional Record Online via GPO Access [wais.access.gpo.gov]

 
                MINORITY HEALTH IMPROVEMENT ACT OF 1994

  Mr. WAXMAN. Mr. Speaker, I move to suspend the rules and pass the 
bill (H.R. 3869) to amend the Public Health Service Act to revise and 
extend programs relating to the health of individuals who are members 
of minority groups, and for other purposes, as amended.
  The Clerk read as follows:

                               H.R. 3869

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

     SECTION 1. SHORT TITLE; TABLE OF CONTENTS.

       (a) Short Title.--This Act may be cited as the ``Minority 
     Health Improvement Act of 1994''.
       (b) Table of Contents.--The table of contents for this Act 
     is as follows:

Sec. 1. Short title; table of contents.

                   TITLE I--OFFICE OF MINORITY HEALTH

Sec. 101. Revision and extension of programs of Office of Minority 
              Health.
Sec. 102. Establishment of individual offices of minority health within 
              agencies of Public Health Service.

                   TITLE II--PRIMARY HEALTH SERVICES

Sec. 201. Migrant health centers; community health centers.
Sec. 202. Health services for the homeless.
Sec. 203. Health services for residents of public housing.
Sec. 204. Grants to States for loan repayment programs regarding 
              obligated service of health professionals.
Sec. 205. Grants to States for operation of State offices of rural 
              health.
Sec. 206. Demonstration grants to States for community scholarship 
              programs regarding obligated service of health 
              professionals.
Sec. 207. Programs regarding birth defects.
Sec. 208. Healthy start for infants.
Sec. 209. Demonstration projects regarding diabetic-retinopathy.

                 TITLE III--HEALTH PROFESSIONS PROGRAMS

Sec. 301. Primary care scholarships for students from disadvantaged 
              backgrounds.
Sec. 302. Scholarships generally; certain other purposes.
Sec. 303. Loan repayments and fellowships regarding faculty positions.
Sec. 304. Centers of Excellence.
Sec. 305. Educational assistance regarding undergraduates.
Sec. 306. Student loans regarding schools of nursing.
Sec. 307. Federally-supported student loans funds.

                           TITLE IV--RESEARCH

Sec. 401. Office of Research on Minority Health.
Sec. 402. Activities of Agency for Health Care Policy and Research.
Sec. 403. Data collection by National Center for Health Statistics.

                  TITLE V--NATIVE HAWAIIAN HEALTH CARE

Sec. 501. Clarification of 1992 amendments.
Sec. 502. Amendment of Native Hawaiian Health Care Improvement Act to 
              reflect 1992 agreement.
Sec. 503. Repeal of Public Health Service Act provision.

                        TITLE VI--WOMEN'S HEALTH

Sec. 601. Establishment of Office of Women's Health.
Sec. 602. Women's scientific employment regarding National Institutes 
              of Health.
Sec. 603. Information and education regarding female genital 
              mutilation.
Sec. 604. Study regarding curricula of medical schools and women's 
              health conditions.

                   TITLE VII--TRAUMATIC BRAIN INJURY

Sec. 701. Programs of Centers for Disease Control and Prevention.
Sec. 702. Programs of National Institutes of Health.
Sec. 703. Programs of Health Resources and Services Administration.
Sec. 704. Study; consensus conference.

                  TITLE VIII--MISCELLANEOUS PROVISIONS

Sec. 801. Technical amendment to Indian Health Care Improvement Act.
Sec. 802. Health services for Pacific Islanders.
Sec. 803. Technical corrections regarding Public Law 103-183.
Sec. 804. Certain authorities of Centers for Disease Control and 
              Prevention.
Sec. 805. Establishment of public health analytical laboratory.
Sec. 806. Administration of certain requirements.
Sec. 807. Revisions to eligibility requirements for entities subject to 
              drug pricing limitations.

                      TITLE IX--GENERAL PROVISIONS

Sec. 901. Effective date.
                   TITLE I--OFFICE OF MINORITY HEALTH

     SEC. 101. REVISION AND EXTENSION OF PROGRAMS OF OFFICE OF 
                   MINORITY HEALTH.

       (a) In General.--Section 1707 of the Public Health Service 
     Act (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 
     minority groups, the Secretary shall carry out the following:
       ``(1) In consultation with the advisory council under 
     subsection (c), establish goals and objectives regarding 
     disease prevention, health promotion, service delivery, and 
     research, and coordinate all activities within the Department 
     of Health and Human Services that relate to such goals and 
     objectives.
       ``(2) In consultation with such council, enter into 
     interagency agreements with other agencies of the Service, 
     and under such agreements provide amounts to such agencies, 
     to carry out the following:
       ``(A) Support research, demonstrations and evaluations to 
     test new and innovative models of delivering services.
       ``(B) Increase knowledge and understanding of health risk 
     factors.
       ``(C) Ensure that the National Center for Health Statistics 
     collects data on the health status of each minority group.
       ``(D) With respect to individuals who lack proficiency in 
     speaking the English language, enter into contracts with 
     public and nonprofit private providers of primary health 
     services for the purpose of increasing the access of the 
     individuals to such services by developing and carrying out 
     programs to provide bilingual or interpretive services.
       ``(3) Establish by contract a 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)(A) Establish by contract a center for the purpose of 
     carrying out programs to improve access to health care 
     services for individuals who lack proficiency in speaking the 
     English language by developing and carrying out programs to 
     provide bilingual or interpretive services.
       ``(B) In carrying out subparagraph (A), ensure that--
       ``(i) the center under such subparagraph conducts research, 
     develops and evaluates model projects, and provides technical 
     assistance to health care providers; and
       ``(ii) such center is not operated by the entity that 
     operates the center established under paragraph (3).
       ``(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 
     carrying out paragraphs (1) and (2) of subsection (b) for 
     each minority group.
       ``(3) Composition.--
       ``(A) The Committee shall be composed of 12 voting members 
     appointed in accordance with subparagraph (B) and the 
     nonvoting, ex officio members designated under subparagraph 
     (C).
       ``(B) The voting members of the Committee shall be 
     appointed from among individuals who have expertise regarding 
     the health status of minority groups and the access of such 
     groups to health services, which individuals are not officers 
     or employees of the Federal Government. The appointed 
     membership of the Committee shall be broadly representative 
     of the various minority groups.
       ``(C) The Secretary shall designate as ex officio members 
     of the Committee the heads of the minority health offices 
     referred to in section 1707A.
       ``(d) Appropriate Context 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.
       ``(e) Equitable Allocation of Services.--The Secretary 
     shall ensure that services provided under subsection (b) are 
     equitably allocated among the various minority groups.
       ``(f) Consultation With Individual Minority Health 
     Offices.--In carrying out subsection (b) regarding a 
     specified agency, the Secretary shall consult with the head 
     of the minority health office of the agency. For purposes of 
     the preceding sentence, the terms `specified agency' and 
     `minority health office' have the meaning given such terms in 
     section 1707A(f).
       ``(g) Biennial Reports.--Not later than February 1 of 
     fiscal year 1996 and of each second year thereafter, the 
     Secretary shall submit to the Committee on Energy and 
     Commerce of the House of Representatives, and to the 
     Committee on Labor and Human Resources of the Senate, a 
     report describing the activities 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 minority groups. Each such report 
     shall include the biennial reports submitted to the Secretary 
     under section 1707A(e) for such years by the heads of the 
     minority health offices.
       ``(h) Definition.--For purposes of this section, the term 
     `minority groups' means African Americans, American Indians, 
     Asian Americans, Hispanics, and Pacific Islanders.
       ``(i) Funding.--
       ``(1) Authorization of appropriations.--For the purpose of 
     carrying out this section, there is authorized to be 
     appropriated $21,000,000 for each of the fiscal years 1995 
     through 1997.
       ``(2) Allocation of funds by secretary.--Of the amounts 
     appropriated under paragraph (1) for a fiscal year, the 
     Secretary shall make available not less than $3,000,000 for 
     carrying out subsection (b)(2)(D).''.
       (b) Miscellaneous Amendment.--Section 1707 of the Public 
     Health Service Act (42 U.S.C. 300u-6) is amended in the 
     heading for the section by striking ``establishment of''.

     SEC. 102. ESTABLISHMENT OF INDIVIDUAL OFFICES OF MINORITY 
                   HEALTH WITHIN AGENCIES OF PUBLIC HEALTH 
                   SERVICE.

       Title XVII of the Public Health Service Act (42 U.S.C. 300u 
     et seq.) is amended by inserting after section 1707 the 
     following section:


  ``individual offices of minority health within public health service

       ``Sec. 1707A. (a) In General.--The head of each agency 
     specified in subsection (b)(1) shall establish within the 
     agency an office to be known as the Office of Minority 
     Health. Each such Office shall be headed by a director, who 
     shall be appointed by the head of the agency within which the 
     Office is established, and who shall report directly to the 
     head of the agency. The head of such agency shall carry out 
     this section (as this section relates to the agency) acting 
     through such Director.
       ``(b) Specified Agencies.--
       ``(1) In general.--The agencies referred to in subsection 
     (a) are the following:
       ``(A) The Centers for Disease Control and Prevention.
       ``(B) The Agency for Health Care Policy and Research.
       ``(C) The Health Resources and Services Administration.
       ``(D) The Substance Abuse and Mental Health Services 
     Administration.
       ``(2) National institutes of health.--For purposes of 
     subsection (c) and the subsequent provisions of this section, 
     the term `minority health office'' includes the Office of 
     Research on Minority Health established within the National 
     Institutes of Health. The Director of the National Institutes 
     of Health shall carry out this section (as this section 
     relates to the agency) acting through the Director of such 
     Office.
       ``(c) Composition.--The head of each specified agency shall 
     ensure that the officers and employees of the minority health 
     office of the agency are, collectively, experienced in 
     carrying out community-based health programs for each of the 
     various minority groups that are present in significant 
     numbers in the United States. The head of such agency shall 
     ensure that, of such officers and employees who are members 
     of minority groups, no such group is disproportionately 
     represented.
       ``(d) Duties.--Each Director of a minority health office 
     shall monitor the programs of the specified agency of such 
     office in order to--
       ``(1) determine the extent to which the purposes of the 
     programs are being carried out with respect to minority 
     groups;
       ``(2) determine the extent to which members of such groups 
     are represented among the Federal officers and employees who 
     administer the programs; and
       ``(3) make recommendations to the head of such agency on 
     carrying out the programs with respect to such groups.
       ``(e) Biennial Reports to Secretary.--The head of each 
     specified agency shall submit to the Secretary for inclusion 
     in each biennial report under section 1707(g) (without 
     change) a biennial report describing--
       ``(1) the extent to which the minority health office of the 
     agency employs individuals who are members of minority 
     groups, including a specification by minority group of the 
     number of such individuals employed by such office; and
       ``(2) the manner in which the agency is complying with 
     Public Law 94-311 (relating to data on Americans of Spanish 
     origin or descent).
       ``(f) Definitions.--For purposes of this section:
       ``(1) The term `minority health office' means an office 
     established under subsection (a), subject to subsection 
     (b)(2).
       ``(2) The term `minority group' has the meaning given such 
     term in section 1707(h).
       ``(3) The term `specified agency' means--
       ``(A) an agency specified in subsection (b)(1); and
       ``(B) the National Institutes of Health.
       ``(g) Funding.--
       ``(1) Allocations.--Of the amounts appropriated for a 
     specified agency for a fiscal year, the Secretary may reserve 
     not more than 0.5 percent for the purpose of carrying out 
     activities under this section through the minority health 
     office of the agency. In reserving an amount under the 
     preceding sentence for a minority health office for a fiscal 
     year, the Secretary shall reduce, by substantially the same 
     percentage, the amount that otherwise would be available for 
     each of the programs of the designated agency involved.
       ``(2) Availability of funds for staffing.--The purposes for 
     which amounts made available under paragraph (1) may be 
     expended by a minority health office include the costs of 
     employing staff for such office.''.
                   TITLE II--PRIMARY HEALTH SERVICES

     SEC. 201. MIGRANT HEALTH CENTERS; COMMUNITY HEALTH CENTERS.

       (a) Migrant Health Centers.--
       (1) Treatment of pregnant women for substance abuse.--
     Section 329(a) of the Public Health Service Act (42 U.S.C. 
     254b(a)) is amended--
       (A) in paragraph (1)(C)--
       (i) by inserting ``(i)'' after ``(C)'';
       (ii) in clause (i) (as so designated), by adding ``and'' 
     after the comma at the end; and
       (iii) by adding at the end the following clause:
       ``(ii) to the State official responsible for carrying out 
     programs under subpart II of part B of title XIX, and in 
     accordance with the provisions of section 543 regarding the 
     disclosure of information, a notification if a pregnant woman 
     is provided a referral for the treatment of substance abuse 
     but the entity involved does not have the capacity to admit 
     additional individuals for treatment,''; and
       (B) in paragraph (7)--
       (i) in subparagraph (L), by striking ``and'' at the end;
       (ii) by redesignating subparagraph (M) as subparagraph (N); 
     and
       (iii) by inserting after subparagraph (L) the following 
     subparagraph:
       ``(M) treatment of pregnant women for substance abuse; 
     and''.
       (2) Overlap in catchment areas.--Section 329(a) of the 
     Public Health Service Act (42 U.S.C. 254b(a)) is amended by 
     adding at the end the following paragraph:
       ``(8) In making grants under subsections (c)(1) and (d)(1), 
     the Secretary may provide for the development and operation 
     of more than one migrant health center in a catchment area in 
     any case in which the Secretary determines that in such area 
     there are workers or other individuals described in 
     subsection (a)(1) (in the matter after and below subparagraph 
     (H)) who otherwise will have a shortage of personal health 
     services. The preceding sentence may not be construed as 
     requiring that, in such a case, the catchment areas of the 
     centers involved be identical.''.
       (3) Offsite activities.--Section 329(a) of the Public 
     Health Service Act, as amended by paragraph (2) of this 
     subsection, is amended by adding at the end the following 
     paragraph:
       ``(9) In making grants under this section, the Secretary 
     may, to the extent determined by the Secretary to be 
     appropriate, authorize migrant health centers to provide 
     services at locations other than the center.''.
       (4) Amount of grant; use of certain funds.--Section 
     329(d)(4) of the Public Health Service Act (42 U.S.C. 
     254b(d)(4)) is amended to read as follows:
       ``(4)(A) The amount of a grant under paragraph (1) or under 
     subsection (c) for a migrant health center shall be 
     determined by the Secretary, taking into account (for the 
     period for which the grant is made)--
       ``(i) the costs that the center may reasonably be expected 
     to incur in carrying out the plan approved by the Secretary 
     pursuant to subsection (f)(3)(H), and
       ``(ii) the amounts that the center may reasonably be 
     expected to receive as State, local, and other operational 
     funding (exclusive of amounts to be provided in the grant 
     under this section) and as fees, premiums, and third-party 
     reimbursements.
       ``(B)(i) Subject to clause (ii), the Secretary may not 
     restrict the purposes for which a migrant health center 
     expends the amounts described in subparagraph (A)(ii) 
     (including restrictions imposed pursuant to Federal cost 
     principles).
       ``(ii) The Secretary may require that amounts described in 
     subparagraph (A)(ii) be expended for purposes that are 
     consistent with the purposes specified in this section.
       ``(C)(i) Payments under a grant under this section shall be 
     made in advance or by way of reimbursement and in such 
     installments as the Secretary finds necessary. Adjustments in 
     such payments may be made for overpayments or underpayments, 
     subject to clause (ii).
       ``(ii) If, for the period for which a grant is made under 
     paragraph (1) to a migrant health center, the sum of the 
     amount of the grant and the amounts described in subparagraph 
     (A)(ii) that the center actually received exceeded the costs 
     of the center in carrying out the plan approved by the 
     Secretary pursuant to subsection (f)(3)(H), then the center 
     is entitled to retain such excess amount if the center agrees 
     to expend such amount only for the following purposes:
       ``(I) To expand and improve services.
       ``(II) To increase the number of persons served.
       ``(III) To acquire, modernize, or expand facilities, or to 
     construct facilities.
       ``(IV) To improve the administration of service programs.
       ``(V) To establish financial reserves.
       ``(D) With respect to funds that are amounts described in 
     subparagraph (A)(ii) or excess amounts described in 
     subparagraph (C)(ii), this paragraph may not be construed as 
     limiting the authority of the Secretary to require the 
     submission of such plans, budgets, and other information as 
     may be necessary to ensure that the funds are expended in 
     accordance with subparagraph (B)(ii), or clauses (I) through 
     (V) of subparagraph (C)(ii), respectively.''.
       (5) Authorization of appropriations.--Section 329(h) of the 
     Public Health Service Act (42 U.S.C. 254b(h)) is amended--
       (A) in paragraph (1)(A), by striking ``1994'' and inserting 
     ``1998''; and
       (B) in paragraph (2)(A), by striking ``1994'' and inserting 
     ``1998''.
       (b) Community Health Centers.--
       (1) Treatment of pregnant women for substance abuse.--
     Section 330 of the Public Health Service Act (42 U.S.C. 254c) 
     is amended--
       (A) in subsection (a)(3)--
       (i) by inserting ``(A)'' after ``(3)'';
       (ii) in subparagraph (A) (as so designated), by adding 
     ``and'' after the comma at the end; and
       (iii) by adding at the end the following subparagraph:
       ``(B) to the State official responsible for carrying out 
     programs under subpart II of part B of title XIX, and in 
     accordance with the provisions of section 543 regarding the 
     disclosure of information, a notification if a pregnant woman 
     is provided a referral for the treatment of substance abuse 
     but the entity involved does not have the capacity to admit 
     additional individuals for treatment,''; and
       (B) in subsection (b)(2)--
       (i) in subparagraph (L), by striking ``and'' at the end;
       (ii) by redesignating subparagraph (M) as subparagraph (N); 
     and
       (iii) by inserting after subparagraph (L) the following 
     subparagraph:
       ``(M) treatment of pregnant women for substance abuse; 
     and''.
       (2) Overlap in catchment areas.--Section 330(b) of the 
     Public Health Service Act (42 U.S.C. 254c(b)) is amended by 
     adding at the end the following paragraph:
       ``(7) In making grants under subsections (c)(1) and (d)(1), 
     the Secretary may provide for the development and operation 
     of more than one community health center in a catchment area 
     in any case in which the Secretary determines that there is a 
     population group in such area that otherwise will have a 
     shortage of personal health services. The preceding sentence 
     may not be construed as requiring that, in such a case, the 
     catchment areas of the centers involved be identical.''.
       (3) Offsite activities.--Section 330(b) of the Public 
     Health Service Act, as amended by paragraph (2) of this 
     subsection, is amended by adding at the end the following 
     paragraph:
       ``(8) In making grants under this section, the Secretary 
     may, to the extent determined by the Secretary to be 
     appropriate, authorize community health centers to provide 
     services at locations other than the center.''.
       (4) Amount of grant; use of certain funds.--Section 
     330(d)(4) of the Public Health Service Act (42 U.S.C. 
     254c(d)(4)) is amended to read as follows:
       ``(4)(A) The amount of a grant under paragraph (1) or under 
     subsection (c) for a community health center shall be 
     determined by the Secretary, taking into account (for the 
     period for which the grant is made)--
       ``(i) the costs that the center may reasonably be expected 
     to incur in carrying out the plan approved by the Secretary 
     pursuant to subsection (e)(3)(H), and
       ``(ii) the amounts that the center may reasonably be 
     expected to receive as State, local, and other operational 
     funding (exclusive of amounts to be provided in the grant 
     under this section) and as fees, premiums, and third-party 
     reimbursements.
       ``(B)(i) Subject to clause (ii), the Secretary may not 
     restrict the purposes for which a community health center 
     expends the amounts described in subparagraph (A)(ii) 
     (including restrictions imposed pursuant to Federal cost 
     principles).
       ``(ii) The Secretary may require that amounts described in 
     subparagraph (A)(ii) be expended for purposes that are 
     consistent with the purposes specified in this section.
       ``(C)(i) Payments under a grant under this section shall be 
     made in advance or by way of reimbursement and in such 
     installments as the Secretary finds necessary. Adjustments in 
     such payments may be made for overpayments or underpayments, 
     subject to clause (ii).
       ``(ii) If, for the period for which a grant is made under 
     paragraph (1) to a community health center, the sum of the 
     amount of the grant and the amounts described in subparagraph 
     (A)(ii) that the center actually received exceeded the costs 
     of the center in carrying out the plan approved by the 
     Secretary pursuant to subsection (e)(3)(H), then the center 
     is entitled to retain such excess amount if the center agrees 
     to expend such amount only for the following purposes:
       ``(I) To expand and improve services.
       ``(II) To increase the number of persons served.
       ``(III) To acquire, modernize, or expand facilities, or to 
     construct facilities.
       ``(IV) To improve the administration of service programs.
       ``(V) To establish financial reserves.
       ``(D) With respect to funds that are amounts described in 
     subparagraph (A)(ii) or excess amounts described in 
     subparagraph (C)(ii), this paragraph may not be construed as 
     limiting the authority of the Secretary to require the 
     submission of such plans, budgets, and other information as 
     may be necessary to ensure that the funds are expended in 
     accordance with subparagraph (B)(ii), or clauses (I) through 
     (V) of subparagraph (C)(ii), respectively.''.
       (5) Authorization of appropriations.--Section 330(g) of the 
     Public Health Service Act (42 U.S.C. 254c(g)) is amended--
       (A) in paragraph (1)(A), by striking ``1994'' and inserting 
     ``1998''; and
       (B) in paragraph (2)(A), by striking ``1994'' and inserting 
     ``1998''.

     SEC. 202. HEALTH SERVICES FOR THE HOMELESS.

       Section 340(q)(1) of the Public Health Service Act (42 
     U.S.C. 256(q)(1)) is amended by striking ``and 1994'' and 
     inserting ``through 1998''.

     SEC. 203. HEALTH SERVICES FOR RESIDENTS OF PUBLIC HOUSING.

       Section 340A(p)(1) of the Public Health Service Act (42 
     U.S.C. 256a(p)(1)) is amended by striking ``and 1993'' and 
     inserting ``through 1998''.

     SEC. 204. GRANTS TO STATES FOR LOAN REPAYMENT PROGRAMS 
                   REGARDING OBLIGATED SERVICE OF HEALTH 
                   PROFESSIONALS.

       Section 338I(c) of the Public Health Service Act (42 U.S.C. 
     254q-1(c)) is amended by adding at the end the following 
     paragraph:
       ``(4) Private practice.--
       ``(A) In carrying out the program operated with a grant 
     under subsection (a), a State may waive the requirement of 
     paragraph (1) regarding the assignment of a health 
     professional if, subject to subparagraph (B), the health 
     professional enters into an agreement with the State to 
     provide primary health services in a full-time private 
     clinical practice in a health professional shortage area.
       ``(B) The Secretary may not make a grant under subsection 
     (a) unless the State involved agrees that, if the State 
     provides a waiver under subparagraph (A) for a health 
     professional, section 338D(b)(1) will apply to the agreement 
     under such subparagraph between the State and the health 
     professional to the same extent and in the same manner as 
     such section applies to an agreement between the Secretary 
     and a health professional regarding a full-time private 
     clinical practice.''.

     SEC. 205. GRANTS TO STATES FOR OPERATION OF STATE OFFICES OF 
                   RURAL HEALTH.

       Section 338J of the Public Health Service Act (42 U.S.C. 
     254r) is amended--
       (1) in subsection (b)(1), in the matter preceding 
     subparagraph (A), by striking ``in cash''; and
       (2) in subsection (j)(1)--
       (A) by striking ``and'' after ``1992,''; and
       (B) by inserting before the period the following: ``, and 
     such sums as may be necessary for each of the fiscal years 
     1995 through 1997''.

     SEC. 206. DEMONSTRATION GRANTS TO STATES FOR COMMUNITY 
                   SCHOLARSHIP PROGRAMS REGARDING OBLIGATED 
                   SERVICE OF HEALTH PROFESSIONALS.

       Section 338L of the Public Health Service Act (42 U.S.C. 
     254t) is amended--
       (1) by striking ``health manpower shortage'' each place 
     such term appears and inserting ``health professional 
     shortage'';
       (2) in subsection (e)--
       (A) by striking paragraph (1);
       (B) by redesignating paragraphs (2) through (6) as 
     paragraphs (1) through (5), respectively; and
       (C) in paragraph (1) (as so redesignated), by inserting 
     after ``the individual'' the following: ``who is to receive 
     the scholarship under the contract'';
       (3) in subsection (k)(2), by striking ``internal medicine, 
     pediatrics,'' and inserting ``general internal medicine, 
     general pediatrics,''; and
       (4) in subsection (l)(1)--
       (A) by striking ``and'' after ``1992,''; and
       (B) by inserting before the period the following: ``, and 
     such sums as may be necessary for each of the fiscal years 
     1995 through 1997''.

     SEC. 207. PROGRAMS REGARDING BIRTH DEFECTS.

       Section 317C of the Public Health Service Act (42 U.S.C. 
     247b-4) 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 (in a manner that facilitates compliance with 
     subsection (d)(2)), including data on the causes of such 
     defects and on the incidence and prevalence of such defects;
       ``(2) to support primary birth-defect prevention, including 
     information and education to the public on the prevention of 
     such defects;
       ``(3) to improve the education, training, and clinical 
     skills of health professionals with respect to the prevention 
     of such defects;
       ``(4) to carry out demonstration projects for the 
     prevention of such defects; and
       ``(5) to operate regional centers for the conduct of 
     applied epidemiological research on the prevention of such 
     defects.
       ``(b) Additional Provisions Regarding Collection of Data.--
       ``(1) In general.--In carrying out subsection (a)(1), the 
     Secretary--
       ``(A) shall collect and analyze data by gender and by 
     racial and ethnic group, including Hispanics, non-Hispanic 
     whites, African Americans, Native Americans, Asian Americans, 
     and Pacific Islanders;
       ``(B) shall collect data under subparagraph (A) from birth 
     certificates, death certificates, hospital records, and such 
     other sources as the Secretary determines to be appropriate; 
     and
       ``(C) shall encourage States to establish or improve 
     programs for the collection and analysis of epidemiological 
     data on birth defects, and to make the data available.
       ``(2) 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.
       ``(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 (including 
     Hispanics, non-Hispanic whites, African Americans, Native 
     Americans, and Asian Americans);
       ``(3) contains an assessment of the extent to which various 
     approaches of preventing birth defects have been effective;
       ``(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 1995 through 1997.''.

     SEC. 208. HEALTHY START FOR INFANTS.

       (a) Technical Correction Regarding Amendatory 
     Instructions.--Part D of title III of the Public Health 
     Service Act (42 U.S.C 254b et seq.), as amended by section 
     104 of Public Law 103-183 (107 Stat. 2230), is amended in the 
     heading for subpart VIII by striking ``Bulk'' and all that 
     follows and inserting the following: ``Miscellaneous 
     Provisions Regarding Primary Health Care''. The amendment 
     made by the preceding sentence is deemed to have taken effect 
     immediately after the enactment of Public Law 103-183.
       (b) Healthy Start for Infants.--Part D of title III of the 
     Public Health Service Act, as amended by subsection (a) of 
     this section, is amended by adding at the end of subpart VIII 
     the following section:


                      ``healthy start for infants

       ``Sec. 340E. (a) Grants for Comprehensive Services.--
       ``(1) In general.--The Secretary may make grants for the 
     operation of not more than 19 demonstration projects to 
     provide the services described in subsection (b) for the 
     purpose of reducing, in the geographic areas in which the 
     projects are carried out--
       ``(A) the incidence of infant mortality and morbidity;
       ``(B) the incidence of fetal deaths;
       ``(C) the incidence of maternal mortality;
       ``(D) the incidence of fetal alcohol syndrome; and
       ``(E) the incidence of low-birthweight births.
       ``(2) Achievement of year 2000 health status objectives.--
     With respect to the objectives established by the Secretary 
     for the health status of the population of the United States 
     for the year 2000, the Secretary shall, in providing for a 
     demonstration project under paragraph (1) in a geographic 
     area, seek to meet the objectives that are applicable to the 
     purpose described in such paragraph and the populations 
     served by the project.
       ``(b) Authorized Services.--
       ``(1) In general.--Subject to subsection (h), the services 
     referred to in this subsection are comprehensive services 
     (including preventive and primary health services for 
     pregnant women and infants and childhood immunizations in 
     accordance with the schedule recommended by the Secretary) 
     for carrying out the purpose described in subsection (a), 
     including services other than health services.
       ``(2) Certain providers.--The Secretary may make a grant 
     under subsection (a) only if the applicant involved agrees 
     that, in making any arrangements under which other entities 
     provide authorized services in the demonstration project 
     involved, the applicant will include among the entities with 
     which the arrangements are made grantees under any of 
     sections 329, 330, 340, and 340A, if such grantees are 
     providing services in the service area of such project and 
     the grantees are willing to make such arrangements with the 
     applicant.
       ``(c) Eligible Geographic Areas.--The Secretary may make a 
     grant under subsection (a) only if--
       ``(1) the applicant for the grant specifies the geographic 
     area in which the demonstration project under such subsection 
     is to be carried out and agrees that the project will not be 
     carried out in other areas; and
       ``(2) for the fiscal year preceding the first fiscal year 
     for which the applicant is to receive such a grant, the rate 
     of infant mortality in the geographic area equals or exceeds 
     150 percent of the national average in the United States of 
     such rates.
       ``(d) Minimum Qualifications of Grantees.--
       ``(1) Public or nonprofit private entities.--The Secretary 
     may make a grant under subsection (a) only if the applicant 
     for the grant is a State or local department of health, or 
     other public or nonprofit private entity, or a consortium of 
     public or nonprofit private entities.
       ``(2) Approval of political subdivisions.--With respect to 
     a proposed demonstration project under subsection (a), the 
     Secretary may make a grant under such subsection only if--
       ``(A) the chief executive officer of each political 
     subdivision in the service area of such project approves the 
     applicant for the grant as being qualified to carry out the 
     project; and
       ``(B) the leadership of any Indian tribe or tribal 
     organization with jurisdiction over any portion of such area 
     so approves the applicant.
       ``(3) Status as medicaid provider.--
       ``(A) In the case of any service described in subsection 
     (b) that is available pursuant to the State plan approved 
     under title XIX of the Social Security Act for a State in 
     which a demonstration project under subsection (a) is carried 
     out, the Secretary may make a grant under such subsection for 
     the project only if, subject to subparagraph (B)--
       ``(i) the applicant for the grant will provide the service 
     directly, and the applicant has entered into a participation 
     agreement under the State plan and is qualified to receive 
     payments under such plan; or
       ``(ii) the applicant will enter into an agreement with a 
     public or private entity under which the entity will provide 
     the service, and the entity has entered into such a 
     participation agreement under the State plan and is qualified 
     to receive such payments.
       ``(B)(i) In the case of an entity making an agreement 
     pursuant to subparagraph (A)(ii) regarding the provision of 
     services, the requirement established in such subparagraph 
     regarding a participation agreement shall be waived by the 
     Secretary if the entity does not, in providing health care 
     services, impose a charge or accept reimbursement available 
     from any third-party payor, including reimbursement under any 
     insurance policy or under any Federal or State health 
     benefits plan.
       ``(ii) A determination by the Secretary of whether an 
     entity referred to in clause (i) meets the criteria for a 
     waiver under such clause shall be made without regard to 
     whether the entity accepts voluntary donations regarding the 
     provision of services to the public.
       ``(e) State Approval of Project.--With respect to a 
     proposed demonstration project under subsection (a), the 
     Secretary may make a grant under such subsection to the 
     applicant involved only if--
       ``(1) the chief executive officer of the State in which the 
     project is to be carried out approves the proposal of the 
     applicant for carrying out the project; and
       ``(2) the leadership of any Indian tribe or tribal 
     organization with jurisdiction over any portion of the 
     service area of the project so approves the proposal.
       ``(f) Eligibility for Services Provided With Grant Funds.--
     The Secretary may make a grant under subsection (a) only if 
     the applicant involved agrees as follows:
       ``(1) With respect to any authorized service under 
     subsection (b), if the service is a service that the State 
     involved is required or has elected to provide under title 
     XIX of the Social Security Act, the grant will not be 
     expended to provide the service to any individual to whom the 
     State is required or has elected under such title to provide 
     the service.
       ``(2) The grant will not be expended to make payment for 
     any item or service to the extent that payment has been made, 
     or can reasonably be expected to be made, with respect to 
     such item or service--
       ``(A) under a health insurance policy or plan (including a 
     group health plan or a prepaid health plan);
       ``(B) under any Federal or State health benefits program, 
     including any program under title V, XVIII, or XIX of the 
     Social Security Act; or
       ``(C) under subpart II of part B of title XIX of this Act.
       ``(g) Maintenance of Effort.--
       ``(1) Grantee.--With respect to authorized services under 
     subsection (b), the Secretary may make a grant under 
     subsection (a) only if the applicant involved agrees to 
     maintain expenditures of non-Federal amounts for such 
     services at a level that is not less than the level of such 
     expenditures maintained by the applicant for fiscal year 
     1991.
       ``(2) Relevant political subdivisions.--With respect to 
     authorized services under subsection (b), the Secretary may 
     make a grant under subsection (a) only if each political 
     subdivision in the service area of the demonstration project 
     involved agrees to maintain expenditures of non-Federal 
     amounts for such services at a level that is not less than 
     the level of such expenditures maintained by the political 
     subdivision for fiscal year 1991.
       ``(h) Restrictions on Expenditure of Grant.--
       ``(1) In general.--Except as provided in paragraph (3), the 
     Secretary may make a grant under subsection (a) only if the 
     applicant involved agrees that the grant will not be 
     expended--
       ``(A) to provide inpatient services, except with respect to 
     residential treatment for substance abuse provided in 
     settings other than hospitals;
       ``(B) to make cash payments to intended recipients of 
     health services or mental health services; or
       ``(C) to purchase or improve real property (other than 
     minor remodeling of existing improvements to real property) 
     or to purchase major medical equipment (other than mobile 
     medical units for providing ambulatory prenatal services).
       ``(2) Administrative expenses; data collection.--The 
     Secretary may make a grant under subsection (a) only if the 
     applicant involved agrees that not more than an aggregate 10 
     percent of the grant will be expended for administering the 
     grant and the collection and analysis of data.
       ``(3) Waiver.--If the Secretary finds that the purpose 
     described in subsection (a) cannot otherwise be carried out, 
     the Secretary may, with respect to an otherwise qualified 
     applicant, waive the restriction established in paragraph 
     (1)(C).
       ``(i) Determination of Cause of Infant Deaths.--The 
     Secretary may make a grant under subsection (a) only if the 
     applicant involved--
       ``(1) agrees to provide for a determination of the cause of 
     each infant death in the service area of the demonstration 
     project involved; and
       ``(2) the applicant has made such arrangements with public 
     entities as may be necessary to carry out paragraph (1).
       ``(j) Annual Reports to Secretary.--The Secretary may make 
     a grant under subsection (a) only if the applicant involved 
     agrees that, for each fiscal year for which the applicant 
     operates a demonstration project under such subsection the 
     applicant will, not later than April 1 of the subsequent 
     fiscal year, submit to the Secretary a report providing the 
     following information with respect to the project:
       ``(1) The number of individuals that received authorized 
     services, and the demographic characteristics of the 
     population of such individuals.
       ``(2) The types of authorized services provided, including 
     the types of ambulatory prenatal services provided and the 
     trimester of the pregnancy in which the services were 
     provided.
       ``(3) The sources of payment for the authorized services 
     provided.
       ``(4) The extent to which children under age 2 receiving 
     authorized services have received the appropriate number and 
     variety of immunizations against vaccine-preventable 
     diseases.
       ``(5) An analysis of the causes of death determined under 
     subsection (i).
       ``(6) The extent of progress being made toward meeting the 
     health status objectives specified in subsection (a)(2).
       ``(7) The extent to which, in the service area involved, 
     progress is being made toward meeting the participation goals 
     established for the State by the Secretary under section 
     1905(r) of the Social Security Act (relating to early 
     periodic screening, diagnostic, and treatment services for 
     children under the age of 21).
       ``(k) Community Participation.--The Secretary may make a 
     grant under subsection (a) only if the applicant involved 
     agrees that, in preparing the proposal of the applicant for 
     the demonstration project involved, and in the operation of 
     the project, the applicant will consult with the residents of 
     the service area for the project and with public and 
     nonprofit private entities that provide authorized services 
     to such residents.
       ``(l) Application for Grant.--The Secretary may make a 
     grant under subsection (a) only if an application for the 
     grant 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 this subsection.
       ``(m) Report to Congress.--Not later than February 1, 1998, 
     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--
       ``(1) summarizing the reports received by the Secretary 
     under subsection (j);
       ``(2) describing the extent to which the Secretary has, in 
     the service areas of such projects, been successful in 
     meeting the health status objectives specified in subsection 
     (a)(2); and
       ``(3) describing the extent to which demonstration projects 
     under subsection (a) have been cost effective.
       ``(n) Limitation on Certain Expenses of Secretary.--Of the 
     amounts appropriated under subsection (p) for a fiscal year, 
     the Secretary may not obligate more than an aggregate 5 
     percent for the administrative costs of the Secretary in 
     carrying out this section, for the provision of technical 
     assistance regarding demonstration projects under subsection 
     (a), and for evaluations of such projects.
       ``(o) Definitions.--For purposes of this section:
       ``(1) The term `authorized services' means the services 
     specified in subsection (b).
       ``(2) The terms `Indian tribe' and `tribal organization' 
     have the meaning given such terms in section 4(b) and section 
     4(c) of the Indian Self-Determination and Education 
     Assistance Act.
       ``(3) The term `service area', with respect to a 
     demonstration project under subsection (a), means the 
     geographic area specified in subsection (c).
       ``(p) 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 1995 through 1997.
       ``(q) Sunset.--Effective October 1, 1997, this section is 
     repealed.''.
       (b) Certain Provisions Regarding Reports.--
       (1) Fiscal year 1995.--With respect to grants under section 
     340E of the Public Health Service Act (as added by subsection 
     (b) of this section), the Secretary of Health and Human 
     Services may make a grant under such section for fiscal year 
     1995 only if the applicant for the grant agrees to submit to 
     the Secretary, not later than April 1 of such year, a report 
     on any federally-supported project of the applicant that is 
     substantially similar to the demonstration projects 
     authorized in such section 340E, which report provides, to 
     the extent practicable, the information described in 
     subsection (j) of such section.
       (2) Fiscal year 1997.--With respect to grants for fiscal 
     year 1997 under section 340E of the Public Health Service Act 
     (as added by subsection (b) of this section), the requirement 
     under subsection (j) of such section that a report be 
     submitted not later than April 1, 1998, remains in effect 
     notwithstanding the repeal of such section pursuant to 
     subsection (q) of such section.
       (c) Lapse of Funds.--Effective October 1, 1997, all 
     unexpended portions of amounts appropriated for grants under 
     340E of the Public Health Service Act (as added by subsection 
     (b) of this section) are unavailable for obligation or 
     expenditure, without regard to whether the amounts have been 
     received by the grantees involved.
       (d) Use of General Authority Under Public Health Service 
     Act.--With respect to the program established in section 340E 
     of the Public Health Service Act (as added by subsection (b) 
     of this section), section 301 of such Act may not be 
     construed as providing to the Secretary of Health and Human 
     Services any authority to carry out, during any fiscal year 
     in which such program is in operation, any demonstration 
     project to provide any of the services specified in 
     subsection (b) of such section 340E.

     SEC. 209. DEMONSTRATION PROJECTS REGARDING DIABETIC-
                   RETINOPATHY.

       (a) In General.--The Secretary of Health and Human 
     Services, acting through the Director of the Centers for 
     Disease Control and Prevention and in consultation with the 
     Director of the National Eye Institute, may make grants to 
     public and nonprofit private entities for demonstration 
     projects to serve the populations specified in subsection (b) 
     by carrying out, with respect to the eye disorder known as 
     diabetic retinopathy, activities regarding information, 
     identification, dissemination, education, and prevention.
       (b) Relevant Populations.--The populations referred to in 
     subsection (a) are minority populations that are at 
     significant risk of contracting diabetes mellitus.
       (c) Authorization of Appropriations.--For the purpose of 
     carrying out this section, there is authorized to be 
     appropriated $1,000,000 for each of the fiscal years 1995 
     through 1997.
                 TITLE III--HEALTH PROFESSIONS PROGRAMS

     SEC. 301. PRIMARY CARE SCHOLARSHIPS FOR STUDENTS FROM 
                   DISADVANTAGED BACKGROUNDS.

       (a) In General.--Section 736 of the Public Health Service 
     Act (42 U.S.C. 293) is amended to read as follows:

     ``SEC. 736. PRIMARY CARE SCHOLARSHIPS FOR STUDENTS FROM 
                   DISADVANTAGED BACKGROUNDS.

       ``(a) In General.--The Secretary may in accordance with 
     this section award scholarships to individuals described in 
     subsection (b) for the purpose of assisting the individuals 
     with the costs of attending schools of medicine or 
     osteopathic medicine, schools of dentistry, schools of 
     nursing (as defined in section 853), graduate programs in 
     mental health practice, and programs for the training of 
     physician assistants.
       ``(b) Eligible Individuals.--An individual referred to in 
     subsection (a) is any individual meeting the following 
     conditions:
       ``(1) The individual is from a disadvantaged background.
       ``(2) The individual is enrolled (or accepted for 
     enrollment) at an eligible school as a full-time student in a 
     program leading to a degree in a health profession.
       ``(3) The individual enters into the contract required 
     pursuant to subsection (d) as a condition of receiving the 
     scholarship (relating to an agreement to provide primary 
     health services in a health professional shortage area 
     designated under section 332).
       ``(c) Preferences Regarding Awards; Special 
     Consideration.--In awarding scholarships under subsection 
     (a), the Secretary shall--
       ``(1) give preference to eligible individuals for whom the 
     costs of attending the school involved would constitute a 
     severe financial hardship; and
       ``(2) give special consideration to eligible individuals 
     who received scholarships pursuant to this section, section 
     737, or section 740(d)(2) for fiscal year 1993 or 1994 and 
     are seeking scholarships for attendance at eligible schools 
     that received a grant under any of such sections for any of 
     such fiscal years.
       ``(d) Applicability of Certain Provisions.--Except as 
     inconsistent with this section, the provisions of subpart III 
     of part D of title III apply to an award of a scholarship 
     under subsection (a) to the same extent and in the same 
     manner as such provisions apply to an award of a scholarship 
     under section 338A. This section shall be carried out by the 
     bureau that administers such subpart III.
       ``(e) Definitions.--For purposes of this section:
       ``(1) The term `eligible individual' means an individual 
     described in subsection (b).
       ``(2) The term `eligible school' means a school or program 
     specified in subsection (a).
       ``(f) Funding.--
       ``(1) Authorization of appropriations.--For the purpose of 
     carrying out this section, there are authorized to be 
     appropriated $28,000,000 for fiscal year 1995, $38,000,000 
     for fiscal year 1996, and $48,000,000 for fiscal year 1997. 
     Such authorization is in addition to the authorization of 
     appropriations established in section 740(e).
       ``(2) Allocations by secretary.--Of the amounts 
     appropriated for a fiscal year under paragraph (1), the 
     Secretary shall make available--
       ``(A) 20 percent for scholarships under subsection (a) for 
     attendance at schools of nursing; and
       ``(B) 15 percent for scholarships under such subsection for 
     attendance at graduate programs in mental health practice.''.
       (b) Certain Programs Of Obligated Service.--
       (1) Repeal.--Section 795 of the Public Health Service Act 
     (42 U.S.C. 295n) is repealed.
       (2) Rule of construction.--Paragraph (1) does not terminate 
     agreements that, on the day before the effective date under 
     section 901, are in effect pursuant to section 795 of the 
     Public Health Service Act. Such agreements continue in effect 
     in accordance with the terms of the agreements. With respect 
     to compliance with such agreements, any period of practice as 
     a provider of primary health services (whether provided 
     pursuant to other agreements with the Federal Government or 
     whether provided otherwise) counts toward satisfaction of the 
     requirement of practice pursuant to such section 795.

     SEC. 302. SCHOLARSHIPS GENERALLY; CERTAIN OTHER PURPOSES.

       (a) Relevant Health Professions Schools.--Section 737(a)(3) 
     of the Public Health Service Act (42 U.S.C. 293a(a)(3)) is 
     amended--
       (1) by striking ``medicine,'' and all that follows through 
     ``dentistry,''; and
       (2) by striking ``allied health,'' and all that follows and 
     inserting ``allied health.''.
       (b) Eligible Individuals.--
       (1) In general.--Section 737(a)(2) of the Public Health 
     Service Act (42 U.S.C. 293a(a)(2)) is amended to read as 
     follows:
       ``(2) Eligible individuals.--An individual referred to in 
     paragraph (1) is any individual meeting the following 
     conditions:
       ``(A) The individual is from a disadvantaged background.
       ``(B) The individual is enrolled (or accepted for 
     enrollment) as a full-time student in a health professions 
     school specified in paragraph (3).
       ``(C) The individual enters into the contract required 
     pursuant to subsection (e) as a condition of receiving the 
     scholarship under paragraph (1) (relating to an agreement to 
     provide services).''.
       (2) Certain requirement.--Section 737 of the Public Health 
     Service Act (42 U.S.C. 293a) is amended--
       (A) in subsection (a)(1), by striking ``subsection (e)'' 
     and inserting ``subsection (f)'';
       (B) by redesignating subsections (e) through (h) as 
     subsections (f) through (i), respectively; and
       (C) by inserting after subsection (d) the following 
     subsection:
       ``(e) Applicability of Certain Provisions.--
       ``(1) In general.--Except as inconsistent with this 
     section, and subject to paragraph (2), the provisions of 
     subpart III of part D of title III apply to an award of a 
     scholarship under subsection (a) to the same extent and in 
     the same manner as such provisions apply to an award of a 
     scholarship under section 338A. This section shall be carried 
     out by the bureau that administers such subpart III.
       ``(2) Certain individuals.--
       ``(A) In the case of an individual who receives a 
     scholarship under subsection (a) for attendance at a school 
     of veterinary medicine, the contract referred to in 
     subsection (a)(2)(C) is a contract under which the individual 
     agrees that, after completing training in such medicine, the 
     individual will, in accordance with requirements established 
     under subparagraph (B), conduct or assist in the conduct of 
     research regarding human health or safety. Except as 
     inconsistent with this section, the provisions specified in 
     paragraph (1) with respect to title III apply to such a 
     scholarship to the same extent and in the same manner as such 
     provisions apply to an award of a scholarship under section 
     338A.
       ``(B) The Secretary shall establish requirements regarding 
     contracts under subparagraph (A).''.
       (c) Funding.--Section 737(i) of the Public Health Service 
     Act, as redesignated by subsection (b)(2) of this section, is 
     amended--
       (1) in paragraph (1), by inserting before the period the 
     following: ``, and $6,000,000 for each of the fiscal years 
     1994 through 1997''; and
       (2) in paragraph (2)(A), by striking ``30 percent'' and all 
     that follows and inserting the following: ``50 percent for 
     such grants to schools of allied health; and''.

     SEC. 303. LOAN REPAYMENTS AND FELLOWSHIPS REGARDING FACULTY 
                   POSITIONS.

       (a) Loan Repayments.--Section 738(a) of the Public Health 
     Service Act (42 U.S.C. 293b(a)) is amended--
       (1) by striking paragraphs (4) and (6);
       (2) by redesignating paragraphs (5) and (7) as paragraphs 
     (4) and (5), respectively; and
       (3) in paragraph (4) (as so redesignated), by amending 
     subparagraph (B) to read as follows:
       ``(B) the contract referred to in subparagraph (A) provides 
     that the school, in making a determination of the amount of 
     compensation to be provided by the school to the individual 
     for serving as a member of the faculty, will make the 
     determination without regard to the amount of payments made 
     (or to be made) to the individual by the Federal Government 
     under paragraph (1).''.
       (b) Authorization of Appropriations Regarding Loan 
     Repayments and Fellowships.--Section 738(c) of the Public 
     Health Service Act (42 U.S.C. 293b(c)) is amended by striking 
     ``there is'' and all that follows and inserting the 
     following: ``there is authorized to be appropriated 
     $1,000,000 for each of the fiscal years 1995 through 1997.''.

     SEC. 304. CENTERS OF EXCELLENCE.

       (a) References to Schools.--Section 739 of the Public 
     Health Service Act (42 U.S.C. 293c) is amended--
       (1) by striking ``health professions schools'' each place 
     such term appears and inserting ``designated health 
     professions schools''; and
       (2) by striking ``health professions school'' each place 
     such term appears and inserting ``designated health 
     professions school''.
       (b) Required Uses of Funds.--Section 739(b) of the Public 
     Health Service Act (42 U.S.C. 293c(b)), as amended by 
     subsection (a), is amended--
       (1) by striking paragraph (2);
       (2) by redesignating paragraph (1) as paragraph (2);
       (3) by inserting before paragraph (2) (as so redesignated) 
     the following paragraph:
       ``(1) to collaborate with public and nonprofit private 
     entities to carry out community-based programs to recruit 
     students of secondary schools and institutions of higher 
     education and to prepare the students academically for 
     pursuing a career in the health professions;'';
       (4) in paragraph (5)--
       (A) by striking ``faculty and student research'' and 
     inserting ``student research''; and
       (B) by inserting before the period the following: ``, 
     including research on issues relating to the delivery of 
     health care''; and
       (5)(A) in paragraph (4), by striking ``and'' after the 
     semicolon at the end;
       (B) in paragraph (5), by striking the period at the end and 
     inserting ``; and''; and
       (C) by adding at the end the following paragraph:
       ``(6) to carry out a program to train students of the 
     school in providing health services through training provided 
     at community-based health facilities that provide such 
     services to a significant number of disadvantaged individuals 
     and that are located at a site remote from the main site of 
     the teaching facilities of the school.''.
       (c) Requirements Regarding Consortia.--
       (1) In general.--Section 739(c)(1) of the Public Health 
     Service Act (42 U.S.C. 293c(c)(1)), as amended by subsection 
     (a), is amended--
       (A) in subparagraph (A), in the matter preceding clause 
     (i), by striking ``specified in subparagraph (B)'' and 
     inserting ``specified in subparagraphs (B) and (C)'';
       (B) by redesignating subparagraph (C) as subparagraph (D); 
     and
       (C) by inserting after subparagraph (B) the following 
     subparagraph:
       ``(C) The condition specified in this subparagraph is that, 
     in accordance with subsection (e)(1), the designated health 
     professions school involved has with other health profession 
     schools (designated or otherwise) formed a consortium to 
     carry out the purposes described in subsection (b) at the 
     schools of the consortium. The grant involved may be expended 
     with respect to the other schools without regard to whether 
     such schools meet the conditions specified in subparagraph 
     (B).''.
       (2) Certain requirements.--Section 739(e) of the Public 
     Health Service Act (42 U.S.C. 293c(e)), as amended by 
     subsection (a), is amended to read as follows:
       ``(e) Provisions Regarding Consortia.--
       ``(1) Requirements.--For purposes of subsection (c)(1)(C), 
     a consortium of schools has been formed in accordance with 
     this subsection if--
       ``(A) the consortium consists of--
       ``(i) the designated health professions school seeking the 
     grant under subsection (a); and
       ``(ii) 1 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.
       ``(2) Authority regarding native americans centers of 
     excellence.--With respect to meeting the conditions specified 
     in subsection (c)(4), the Secretary may make a grant under 
     subsection (a) to a designated health professions school that 
     does not meet such conditions if--
       ``(A) the school has formed a consortium in accordance with 
     paragraph (1); and
       ``(B) the schools of the consortium collectively meet such 
     conditions, without regard to whether the schools 
     individually meet such conditions.''.
       (3) Conforming amendments.--Section 739 of the Public 
     Health Service Act (42 U.S.C. 293c), as amended by subsection 
     (a), is amended--
       (A) in subsection (b), in the matter preceding paragraph 
     (1), by inserting ``, subject to subsection (c)(1)(C),'' 
     after ``agrees''; and
       (B) in subsection (d)--
       (i) in paragraph (3), by striking ``(e)'' and inserting 
     ``(e)(2)''; and
       (ii) by adding at the end the following paragraph:
       ``(4) Rule of construction.--Except as provided in 
     paragraph (3) regarding a consortium under subsection (e)(2), 
     a health professions school that does not meet the conditions 
     specified in subsection (c)(1)(B) may not be designated as a 
     center of excellence for purposes of this section. The 
     preceding sentence applies without regard to whether a grant 
     under subsection (a) is, pursuant to subsection (c)(1)(C), 
     being expended with respect to the school.''.
       (d) Definition of Health Professions School.--
       (1) Graduate programs in mental health practice.--Section 
     739(h)(1)(A) of the Public Health Service Act (42 U.S.C. 
     293c(h)(1)(A)), as amended by subsection (a), is amended by--
       (A) by striking ``or'' after ``dentistry''; and
       (B) by inserting before the period the following: ``, or a 
     graduate program in mental health practice''.
       (2) Limitation.--During the fiscal years 1995 through 1997, 
     the Secretary of Health and Human Services may not make more 
     than one grant under section 739 of the Public Health Service 
     Act directly to a graduate program in mental health practice 
     (as defined in section 799 of such Act).
       (e) Funding.--Section 739(i) of the Public Health Service 
     Act (42 U.S.C. 293c(i)), as amended by subsection (a), is 
     amended to read as follows:
       ``(i) Funding.--
       ``(1) Authorization of appropriations.--For the purpose of 
     making grants under subsection (a), there are authorized to 
     be appropriated $28,000,000 for fiscal year 1995, $30,000,000 
     for fiscal year 1996, and $32,000,000 for fiscal year 1997.
       ``(2) Allocations by secretary.--
       ``(A) Of the amounts appropriated under paragraph (1) for a 
     fiscal year, the Secretary shall make available $12,000,000 
     for grants under subsection (a) to health professions schools 
     that are eligible for such grants pursuant to meeting the 
     conditions described in paragraph (2)(A) of subsection (c).
       ``(B) Of the amounts appropriated under paragraph (1) for a 
     fiscal year and available after compliance with subparagraph 
     (A), the Secretary shall make available 65 percent for grants 
     under subsection (a) to health professions schools that are 
     eligible for such grants pursuant to meeting the conditions 
     described in paragraph (3) or (4) of subsection (c) 
     (including meeting conditions pursuant to subsection (e)(2)).
       ``(C)(i) Of the amounts appropriated under paragraph (1) 
     for a fiscal year and available after compliance with 
     subparagraph (A), the Secretary shall make available 35 
     percent for grants under subsection (a) to health professions 
     schools that are eligible for such grants pursuant to meeting 
     the conditions described in paragraph (5) of subsection (c).
       ``(ii) With respect to a fiscal year, a grant under 
     subsection (a) that includes amounts available under 
     subparagraph (A) may not include amounts available under 
     clause (i) unless each of the following conditions is met:
       ``(I) In the case of amounts available under subparagraph 
     (B) or clause (i) and included in grants made pursuant to 
     subsection (c)(3), the aggregate number of such grants is not 
     less than such aggregate number for the preceding fiscal 
     year, and one or more of such grants is made in an amount 
     that is not less than the lowest amount among grants made 
     from amounts available under subparagraph (A).
       ``(II) In the case of amounts available under subparagraph 
     (B) or clause (i) and included in grants made pursuant to 
     subsection (c)(4), the aggregate number of such grants is not 
     less than such aggregate number for the preceding fiscal 
     year, and one or more of such grants is made in an amount 
     that is not less than the lowest amount among grants made 
     from amounts available under subparagraph (A).
       ``(III) In the case of amounts available under clause (i) 
     and included in grants made pursuant to subsection (c)(5) 
     (exclusive of grants that include amounts available under 
     subparagraph (A) or (B)), the aggregate number of such grants 
     is not less than such aggregate number for the preceding 
     fiscal year, and one or more of such grants is made in an 
     amount that is not less than the lowest amount among grants 
     made from amounts available under subparagraph (A).
       ``(IV) The aggregate amount of grants under subsection (a) 
     made from amounts available under subparagraph (B) and clause 
     (i) (other than grants that include amounts available under 
     subparagraph (A)) is, in the case of fiscal year 1995, not 
     less than the sum of such aggregate amount for fiscal year 
     1994 and the total amount by which grants are required under 
     subclauses (I) through (III) to be increased; and is, in the 
     case of fiscal year 1996 and each subsequent fiscal year, not 
     less than such aggregate amount for the preceding fiscal 
     year.''.
       (f) Conforming Amendments.--Section 739(c) of the Public 
     Health Service Act (42 U.S.C. 293c(c)), as amended by 
     subsection (a), is amended--
       (1) in paragraph (3)(B), by striking ``the designated 
     health professions school'' and inserting ``the school''; and
       (2) in paragraph (4), in each of subparagraphs (B) and (C), 
     by striking ``the designated health professions school'' and 
     inserting ``the school''.
       (g) Transitional and Savings Provisions.--
       (1) In general.--In the case of any entity receiving a 
     grant under section 739 of the Public Health Service Act for 
     fiscal year 1994, the Secretary of Health and Human Services 
     shall, during the period specified in paragraph (2), waive 
     any or all of the additional requirements established 
     pursuant to this section for the receipt or expenditure of 
     such a grant, subject to the entity providing assurances 
     satisfactory to the Secretary that the entity is making 
     progress toward meeting such requirements.
       (2) Relevant period.--In the case of any entity receiving a 
     grant under section 739 of the Public Health Service Act for 
     fiscal year 1994, the period referred to in paragraph (1) is 
     the period that, in first approving the grant, the Secretary 
     specified as the duration of the grant.

     SEC. 305. EDUCATIONAL ASSISTANCE REGARDING UNDERGRADUATES.

       (a) In General.--Section 740 of the Public Health Service 
     Act (42 U.S.C. 293d) is amended to read as follows:

     ``SEC. 740. ASSISTANCE REGARDING HEALTH PROFESSIONS AS CAREER 
                   CHOICE.

       ``(a) In General.--
       ``(1) Academic preparation of students.--Subject to the 
     provisions of this section, the Secretary may make grants and 
     enter into contracts for purposes of--
       ``(A) identifying individuals who--
       ``(i) are students of elementary schools, or students or 
     graduates of secondary schools or of institutions of higher 
     education;
       ``(ii) are from disadvantaged backgrounds; and
       ``(iii) are interested in a career in the health 
     professions; and
       ``(B) providing to such individuals academic assistance, 
     counseling, and other services to prepare the students to 
     meet the academic requirements for entry into health 
     professions schools.
       ``(2) Recipients of grants and contracts.--The Secretary 
     may make an award of a grant or contract under paragraph (1) 
     only if the applicant for the award is a nonprofit private 
     community-based organization or other public or nonprofit 
     private entity. Such other entities include schools of 
     medicine, osteopathic medicine, public health, dentistry, 
     veterinary medicine, optometry, pharmacy, allied health, 
     chiropractic, and podiatric medicine, and include graduate 
     programs in mental health practice.
       ``(3) Certain uses of awards.--The purposes for which the 
     Secretary may authorize an award under paragraph (1) to be 
     expended include the following:
       ``(A) Assisting elementary and secondary schools and 
     institutions of higher education in developing or improving 
     programs to prepare students to meet the academic 
     requirements for entry into health professions schools.
       ``(B) Establishing arrangements with nonprofit private 
     community-based providers of primary health services under 
     which students are provided with opportunities to visit or 
     work at facilities of such providers and gain experience 
     regarding a career in a field of primary health care.
       ``(C) Developing or improving programs to enhance the 
     academic preparation of advanced, prehealth professions 
     students or postbaccalaureate individuals to successfully 
     enter a health professions school.
       ``(D) In the case of an award under paragraph (1) that the 
     Secretary has authorized to be expended for the purpose 
     described in subparagraph (B) or (C), paying such stipends as 
     the Secretary may approve for individuals from disadvantaged 
     backgrounds for any period of education in student-
     enhancement programs (other than regular courses), except 
     that such a stipend may not be provided to an individual for 
     more than 12 months, and such a stipend shall be in an amount 
     of $25 per day (notwithstanding any other provision of law 
     regarding the amount of stipends).
       ``(b) Minimum Requirements for Awards.--
       ``(1) Assurances regarding financial capacity.--The 
     Secretary may make an award of a grant or contract under 
     subsection (a) only if the applicant provides assurances 
     satisfactory to the Secretary that, with respect to the 
     activities for which the award is to be made, the applicant 
     has or will have the financial capacity to continue the 
     activities after the eligibility of the applicant for such 
     awards for such activities is terminated pursuant to 
     subsection (d).
       ``(2) Collaboration among various entities.--The Secretary 
     may make an award of a grant or contract under subsection (a) 
     only if the applicant for the award has entered into an 
     agreement with any schools, institutions, community-based 
     organizations, or other entities with which the applicant 
     will collaborate in carrying out activities under the award, 
     and the agreement specifies whether and to what extent the 
     award will be allocated among the applicant and the entities.
       ``(3) Matching funds.--
       ``(A) With respect to the costs of the activities to be 
     carried out under subsection (a) by an applicant, the 
     Secretary may make an award of a grant or contract under such 
     subsection only if the applicant agrees to make available 
     (directly or through donations from public or private 
     entities), in cash, non-Federal contributions toward such 
     costs in an amount that--
       ``(i) for any second fiscal year for which the applicant 
     receives such a grant, is not less than 20 percent of such 
     costs;
       ``(ii) for any third such fiscal year, is not less than 20 
     percent of such costs;
       ``(iii) for any fourth such fiscal year, is not less than 
     40 percent of such costs;
       ``(iv) for any fifth such fiscal year, is not less than 60 
     percent of such costs; and
       ``(v) for any sixth or subsequent such fiscal year, is not 
     less than 80 percent of such costs.
       ``(B) Amounts provided by the Federal Government may not be 
     included in determining the amount of non-Federal 
     contributions required in subparagraph (A).
       ``(C) The Secretary may not require non-Federal 
     contributions for the first fiscal year for which an 
     applicant receives a grant under subsection (a).
       ``(c) Preference in Making Awards.--
       ``(1) In general.--Subject to paragraph (2), in making 
     awards of grants and contracts under subsection (a), the 
     Secretary shall give preference to any applicant that has 
     made an arrangement with 1 or more elementary schools, an 
     arrangement with 1 or more secondary schools, an arrangement 
     with 1 or more institutions of higher education, an 
     arrangement with 1 or more health professions schools, and an 
     arrangement with 1 or more community-based organizations, the 
     purpose of which arrangements is to establish a program as 
     follows:
       ``(A) With respect to the elementary schools involved, the 
     program carries out the purposes described in subsection 
     (a)(1).
       ``(B) After a student identified pursuant to paragraph (1) 
     enters the secondary school involved, the program continues 
     to carry out such purposes with respect to the student.
       ``(C) After graduating from the secondary school, the 
     student enters the institution of higher education involved, 
     subject to meeting reasonable academic requirements, and the 
     program continues to carry out such purposes with respect to 
     the student.
       ``(D) After graduating from the institution of higher 
     education, the student enters the health professions school 
     involved, subject to meeting reasonable academic 
     requirements.
       ``(2) Requirement regarding schools and institutions.--For 
     purposes of paragraph (1), an applicant may not receive 
     preference unless the schools or institutions with which 
     arrangements have been made are schools or institutions whose 
     enrollment of students includes a significant number of 
     individuals from disadvantaged backgrounds.
       ``(d) Limitation on Years of Funding for Particular 
     Activities.--With respect to a particular activity carried 
     out under paragraph (1) or (3) of subsection (a) by an 
     entity, the Secretary may not, for the activity involved, 
     provide more than 6 years of financial assistance under such 
     subsection to the entity.
       ``(e) Funding.--
       ``(1) Authorization of appropriations.--For the purpose of 
     carrying out this section and section 736, there are 
     authorized to be appropriated $32,000,000 for fiscal year 
     1995, $36,000,000 for fiscal year 1996, and $38,000,000 for 
     fiscal year 1997.
       ``(2) Allocations.--Of the amounts appropriated under 
     paragraph (1) for a fiscal year, the Secretary shall obligate 
     not less than 20 percent for carrying out subsection 
     (a)(3)(B) and not less than 20 percent for providing 
     scholarships under section 736.''.
       (b) Transitional and Savings Provision.--In the case of an 
     entity that received an award of a grant or contract for 
     fiscal year 1994 under section 740 of the Public Health 
     Service Act, the Secretary of Health and Human Services may 
     continue in effect the award in accordance with the terms of 
     the award, subject to the duration of the award not exceeding 
     the period determined by the Secretary in first approving the 
     award. The preceding sentence applies notwithstanding the 
     amendment made by subsection (a) of this section.

     SEC. 306. STUDENT LOANS REGARDING SCHOOLS OF NURSING.

       Section 836(b) of the Public Health Service Act (42 U.S.C. 
     297b(b)) is amended--
       (1) in paragraph (1), by striking the period at the end and 
     inserting a semicolon;
       (2) in paragraph (2)--
       (A) in subparagraph (A), by striking ``and'' at the end; 
     and
       (B) by inserting before the semicolon at the end the 
     following: ``, and (C) such additional periods under the 
     terms of paragraph (8) of this subsection'';
       (3) in paragraph (7), by striking the period at the end and 
     inserting ``; and''; and
       (4) by adding at the end the following paragraph:
       ``(8) pursuant to uniform criteria established by the 
     Secretary, the repayment period established under paragraph 
     (2) for any student borrower who during the repayment period 
     failed to make consecutive payments and who, during the last 
     12 months of the repayment period, has made at least 12 
     consecutive payments may be extended for a period not to 
     exceed 10 years.''.

     SEC. 307. FEDERALLY-SUPPORTED STUDENT LOAN FUNDS.

       (a) Authorization of Appropriations Regarding Certain 
     Medical Schools.--
       (1) In general.--Subpart II of part A of title VII of the 
     Public Health Service Act (42 U.S.C. 292q et seq.) is 
     amended--
       (A) by transferring subsection (f) of section 735 from the 
     current placement of the subsection;
       (B) by adding the subsection at the end of section 723;
       (C) by redesignating the subsection as subsection (e); and
       (D) in subsection (e)(1) of section 723 (as so 
     redesignated), by striking ``1996'' and inserting ``1997''.
       (2) Conforming amendments.--Section 723 of the Public 
     Health Service Act (42 U.S.C. 292s), as amended by paragraph 
     (1) of this subsection, is amended in subsection (e)(2)(A)--
       (A) by striking ``section 723(b)(2)'' and inserting 
     ``subsection (b)(2)''; and
       (B) by striking ``such section'' and inserting ``such 
     subsection''.
       (b) Authorization of Appropriations Regarding Individuals 
     From Disadvantaged Backgrounds.--Section 724(f)(1) of the 
     Public Health Service Act (42 U.S.C. 292t(f)(1)) is amended 
     to read as follows:
       ``(1) In general.--With respect to making Federal capital 
     contributions to student loan funds for purposes of 
     subsection (a), other than the student loan fund of any 
     school of medicine or osteopathic medicine, there is 
     authorized to be appropriated $5,000,000 for each of the 
     fiscal years 1995 through 1997.''.
                           TITLE IV--RESEARCH

     SEC. 401. OFFICE OF RESEARCH ON MINORITY HEALTH.

       Section 404 of the Public Health Service Act (42 U.S.C. 
     283(b)) is amended by adding at the end the following 
     subsections:
       ``(c) Plan.--Subject to applicable law, the Director of the 
     Office, in consultation with the advisory committee 
     established under subsection (d), shall develop and implement 
     a plan for carrying out the duties established in subsection 
     (b). The Director shall review the plan not less than 
     annually, and revise the plan as appropriate.
       ``(d) Advisory Committee.--
       ``(1) In carrying out subsection (b), the Director of the 
     Office shall establish an advisory committee to be known as 
     the Advisory Committee on Research on Minority Health (in 
     this subsection referred to as the `Committee').
       ``(2)(A) The Committee shall be composed of nonvoting, ex 
     officio members designated in accordance with subparagraph 
     (B) and voting members appointed in accordance with 
     subparagraph (C).
       ``(B) The Secretary shall designate as ex officio members 
     of the Committee the Directors of each of the national 
     research institutes and the Deputy Assistant Secretary for 
     Minority Health (except that any of such officials may 
     designate another officer or employee of the office or agency 
     involved to serve as a member of the Committee in lieu of the 
     official).
       ``(C) The Director of the Office shall appoint as voting 
     members of the Committee not fewer than 12 and not more than 
     18 individuals who are not officers or employees of the 
     Federal Government. The appointments shall be made from among 
     scientists and health professionals whose clinical practice, 
     research specialization, or professional expertise includes 
     significant expertise in research on minority health. The 
     appointed membership of the Advisory Committee shall be 
     broadly representative of the various minority groups.
       ``(3) The Director of the Office shall serve as the chair 
     of the Committee.
       ``(4) The 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)(A) The Advisory Committee shall prepare biennial 
     reports 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) Each report under subparagraph (A) shall be submitted 
     to the Director of NIH for inclusion in the report required 
     in section 403 for the period involved.
       ``(e) Representation of Minorities Among Researchers.--The 
     Secretary, acting through the Assistant Secretary for 
     Personnel and in collaboration with the Director of the 
     Office, shall determine the extent to which the various 
     minority groups are represented among administrators, senior 
     physicians, and scientists of the national research 
     institutes and among physicians and scientists conducting 
     research with funds provided by such institutes, and as 
     appropriate, carry out activities to increase the extent of 
     such representation.
       ``(f) Requirement Regarding Grants and Contracts.--Any 
     award of a grant, cooperative agreement, or contract that the 
     Director of the Office is authorized to make shall be made 
     only on a competitive basis.
       ``(g) Definitions.--For purposes of this section:
       ``(1) 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 
     clinical research involving such individuals as subjects or 
     insufficient clinical data on such individuals.
       ``(2) The term `research on minority health' means research 
     on minority health conditions, including research on 
     preventing such conditions.
       ``(3) The term `minority groups' has the meaning given such 
     term in section 1707(h).''.

     SEC. 402. ACTIVITIES OF AGENCY FOR HEALTH CARE POLICY AND 
                   RESEARCH.

       Title IX of the Public Health Service Act (42 U.S.C. 299 et 
     seq.) is amended--
       (1) in section 902, by amending subsection (b) 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.''; and
       (2) in section 926(a), by adding at the end the following 
     sentence: ``Of the amounts appropriated under the preceding 
     sentence for a fiscal year, the Administrator shall reserve 
     not less than 8 percent for carrying out section 
     902(b)(2).''.

     SEC. 403. DATA COLLECTION BY NATIONAL CENTER FOR HEALTH 
                   STATISTICS.

       Section 306(n) of the Public Health Service Act (42 U.S.C. 
     242k(n)), as redesignated by section 501(a)(5)(B) of Public 
     Law 103-183 (107 Stat. 2237), is amended to read as follows:
       ``(n)(1) For health statistical and epidemiological 
     activities undertaken or supported under this section, there 
     are authorized to be appropriated such sums as may be 
     necessary for each of the fiscal years 1995 through 1998.
       ``(2) Of the amounts appropriated under paragraph (1) for a 
     fiscal year, the Secretary shall obligate not less than an 
     aggregate $5,000,000 for carrying out subsections (h), (l), 
     and (m) with respect to particular racial and ethnic 
     population groups.''.
                  TITLE V--NATIVE HAWAIIAN HEALTH CARE

     SEC. 501. CLARIFICATION OF 1992 AMENDMENTS.

       (a) Clarification of Date of Passage.--Section 9168 of the 
     Department of Defense Appropriations Act, 1993 (106 Stat. 
     1948) is amended by striking ``September 12, 1992,'' and 
     inserting ``August 7, 1992,''.
       (b) Effective Date.--The amendment made by subsection (a) 
     shall take effect as of October 6, 1992.

     SEC. 502. AMENDMENT OF NATIVE HAWAIIAN HEALTH CARE 
                   IMPROVEMENT ACT TO REFLECT 1992 AGREEMENT.

       Effective on the date of enactment of this Act, the Native 
     Hawaiian Health Care Improvement Act (42 U.S.C. 11701 et 
     seq.) is amended to read as follows:

     ``SECTION 1. SHORT TITLE.

       ``This Act may be cited as the `Native Hawaiian Health Care 
     Improvement Act'.

     ``SEC. 2. FINDINGS; DECLARATION OF POLICY; INTENT OF 
                   CONGRESS.

       ``(a) Findings.--The Congress finds that--
       ``(1) the United States retains the legal responsibility to 
     enforce the administration of the public trust responsibility 
     of the State of Hawaii for the betterment of the conditions 
     of Native Hawaiians under section 5(f) of Public Law 86-3 (73 
     Stat. 6; commonly referred to as the `Hawaii Statehood 
     Admissions Act');
       ``(2) in furtherance of the State of Hawaii's public trust 
     responsibility for the betterment of the conditions of Native 
     Hawaiians, contributions by the United States to the 
     provision of comprehensive health promotion and disease 
     prevention services to maintain and improve the health status 
     of Native Hawaiians are consistent with the historical and 
     unique legal relationship of the United States with the 
     government that represented the indigenous native people of 
     Hawaii; and
       ``(3) it is the policy of the United States to raise the 
     health status of Native Hawaiians to the highest possible 
     level and to encourage the maximum participation of Native 
     Hawaiians in order to achieve this objective.
       ``(b) Declaration of Policy.--The Congress hereby declares 
     that it is the policy of the United States in fulfillment of 
     its special responsibilities and legal obligations to the 
     indigenous people of Hawaii resulting from the unique and 
     historical relationship between the United States and the 
     Government of the indigenous people of Hawaii--
       ``(1) to raise the health status of Native Hawaiians to the 
     highest possible health level; and
       ``(2) to provide existing Native Hawaiian health care 
     programs with all resources necessary to effectuate this 
     policy.
       ``(c) Intent of Congress.--It is the intent of the Congress 
     that the Nation meet the following health objectives with 
     respect to Native Hawaiians by the year 2000:
       ``(1) Reduce coronary heart disease deaths to no more than 
     100 per 100,000.
       ``(2) Reduce stroke deaths to no more than 20 per 100,000.
       ``(3) Increase control of high blood pressure to at least 
     50 percent of people with high blood pressure.
       ``(4) Reduce blood cholesterol to an average of no more 
     than 200 mg/dl.
       ``(5) Slow the rise in lung cancer deaths to achieve a rate 
     of no more than 42 per 100,000.
       ``(6) Reduce breast cancer deaths to no more than 20.6 per 
     100,000 women.
       ``(7) Increase Pap tests every 1 to 3 years to at least 85 
     percent of women age 18 and older.
       ``(8) Increase fecal occult blood testing every 1 to 2 
     years to at least 50 percent of people age 50 and older.
       ``(9) Reduce diabetes-related deaths to no more than 34 per 
     100,000.
       ``(10) Reduce the most severe complications of diabetes as 
     follows:
       ``(A) End-stage renal disease to no more than 1.4 in 1,000.
       ``(B) Blindness to no more than 1.4 in 1,000.
       ``(C) Lower extremity amputation to no more than 4.9 in 
     1,000.
       ``(D) Perinatal mortality to no more than 2 percent.
       ``(E) Major congenital malformations to no more than 4 
     percent.
       ``(11) Reduce infant mortality to no more than 7 deaths per 
     1,000 live births.
       ``(12) Reduce low birth weight to no more than 5 percent of 
     live births.
       ``(13) Increase first trimester prenatal care to at least 
     90 percent of live births.
       ``(14) Reduce teenage pregnancies to no more than 50 per 
     1,000 girls age 17 and younger.
       ``(15) Reduce unintended pregnancies to no more than 30 
     percent of pregnancies.
       ``(16) Increase to at least 60 percent the proportion of 
     primary care providers who provide age-appropriate 
     preconception care and counseling.
       ``(17) Increase years of healthy life to at least 65 years.
       ``(18) Eliminate financial barriers to clinical preventive 
     services.
       ``(19) Increase childhood immunization levels to at least 
     90 percent of 2-year-olds.
       ``(20) Reduce the prevalence of dental caries to no more 
     than 35 percent of children by age 8.
       ``(21) Reduce untreated dental caries so that the 
     proportion of children with untreated caries (in permanent or 
     primary teeth) is no more than 20 percent among children age 
     6 through 8 and no more than 15 percent among adolescents age 
     15.
       ``(22) Reduce edentulism to no more than 20 percent in 
     people age 65 and older.
       ``(23) Increase moderate daily physical activity to at 
     least 30 percent of the population.
       ``(24) Reduce sedentary lifestyles to no more than 15 
     percent of the population.
       ``(25) Reduce overweight to a prevalence of no more than 20 
     percent of the population.
       ``(26) Reduce dietary fat intake to an average of 30 
     percent of calories or less.
       ``(27) Increase to at least 75 percent the proportion of 
     primary care providers who provide nutrition assessment and 
     counseling or referral to qualified nutritionists or 
     dieticians.
       ``(28) Reduce cigarette smoking prevalence to no more than 
     15 percent of adults.
       ``(29) Reduce initiation of smoking to no more than 15 
     percent by age 20.
       ``(30) Reduce alcohol-related motor vehicle crash deaths to 
     no more than 8.5 per 100,000 adjusted for age.
       ``(31) Reduce alcohol use by school children age 12 to 17 
     to less than 13 percent.
       ``(32) Reduce marijuana use by youth age 18 to 25 to less 
     than 8 percent.
       ``(33) Reduce cocaine use by youth age 18 to 25 to less 
     than 3 percent.
       ``(34) Confine HIV infection to no more than 800 per 
     100,000.
       ``(35) Reduce gonorrhea infections to no more than 225 per 
     100,000.
       ``(36) Reduce syphilis infections to no more that 10 per 
     100,000.
       ``(37) Reduce significant hearing impairment to a 
     prevalance of no more than 82 per 1,000.
       ``(38) Reduce acute middle ear infections among children 
     age 4 and younger, as measured by days of restricted activity 
     or school absenteeism, to no more than 105 days per 100 
     children.
       ``(39) Reduce indigenous cases of vaccine-preventable 
     diseases as follows:
       ``(A) Diphtheria among individuals age 25 and younger to 0.
       ``(B) Tetanus among individuals age 25 and younger to 0.
       ``(C) Polio (wild-type virus) to 0.
       ``(D) Measles to 0.
       ``(E) Rubella to 0.
       ``(F) Congenital Rubella Syndrome to 0.
       ``(G) Mumps to 500.
       ``(H) Pertussis to 1,000.
       ``(40) Reduce significant visual impairment to a prevalence 
     of no more than 30 per 1,000.
       ``(d) Report.--The Secretary shall submit to the President, 
     for inclusion in each report required to be transmitted to 
     the Congress under section 9, a report on the progress made 
     toward meeting each of the objectives described in subsection 
     (c).

     ``SEC. 3. COMPREHENSIVE HEALTH CARE MASTER PLAN FOR NATIVE 
                   HAWAIIANS.

       ``The Secretary may make a grant to, or enter into a 
     contract with, Papa Ola Lokahi for the purpose of 
     coordinating, implementing, and updating a Native Hawaiian 
     comprehensive health care master plan designed to promote 
     comprehensive health promotion and disease prevention 
     services and to maintain and improve the health status of 
     Native Hawaiians. The master plan shall be based upon an 
     assessment of the health care status and health care needs of 
     Native Hawaiians. To the extent practicable, assessments made 
     as of the date of such grant or contract shall be used by 
     Papa Ola Lokahi, except that any such assessment shall be 
     updated as appropriate.

     ``SEC. 4. NATIVE HAWAIIAN HEALTH CARE SYSTEMS.

       ``(a) Comprehensive Health Promotion, Disease Prevention, 
     and Primary Health Services.--(1)(A) The Secretary, in 
     consultation with Papa Ola Lokahi, may make grants to, or 
     enter into contracts with, any qualified entity for the 
     purpose of providing comprehensive health promotion and 
     disease prevention services as well as primary health 
     services to Native Hawaiians.
       ``(B) In making grants and entering into contracts under 
     this paragraph, the Secretary shall give preference to Native 
     Hawaiian health care systems and Native Hawaiian 
     organizations, and, to the extent feasible, health promotion 
     and disease prevention services shall be performed through 
     Native Hawaiian health care systems.
       ``(2) In addition to paragraph (1), the Secretary may make 
     a grant to, or enter into a contract with, Papa Ola Lokahi 
     for the purpose of planning Native Hawaiian health care 
     systems to serve the health needs of Native Hawaiian 
     communities on the islands of O'ahu, Moloka'i, Maui, Hawai'i, 
     Lana'i, Kaua'i, and Ni'ihau in the State of Hawaii.
       ``(b) Qualified Entity.--An entity is a qualified entity 
     for purposes of subsection (a)(1) if the entity is a Native 
     Hawaiian health care system.
       ``(c) Services To Be Provided.--(1) Each recipient of funds 
     under subsection (a)(1) shall provide the following services:
       ``(A) Outreach services to inform Native Hawaiians of the 
     availability of health services.
       ``(B) Education in health promotion and disease prevention 
     of the Native Hawaiian population by (wherever possible) 
     Native Hawaiian health care practitioners, community outreach 
     workers, counselors, and cultural educators.
       ``(C) Services of physicians, physicians' assistants, or 
     nurse practitioners.
       ``(D) Immunizations.
       ``(E) Prevention and control of diabetes, high blood 
     pressure, and otitis media.
       ``(F) Pregnancy and infant care.
       ``(G) Improvement of nutrition.
       ``(2) In addition to the mandatory services under paragraph 
     (1), the following services may be provided pursuant to 
     subsection (a)(1):
       ``(A) Identification, treatment, control, and reduction of 
     the incidence of preventable illnesses and conditions endemic 
     to Native Hawaiians.
       ``(B) Collection of data related to the prevention of 
     diseases and illnesses among Native Hawaiians.
       ``(C) Services within the meaning of the terms `health 
     promotion', `disease prevention', and `primary health 
     services', as such terms are defined in section 10, which are 
     not specifically referred to in paragraph (1) of this 
     subsection.
       ``(3) The health care services referred to in paragraphs 
     (1) and (2) which are provided under grants or contracts 
     under subsection (a)(1) may be provided by traditional Native 
     Hawaiian healers.
       ``(d) Limitation on Number of Entities.--During a fiscal 
     year, the Secretary under this Act may make a grant to, or 
     hold a contract with, not more than 5 Native Hawaiian health 
     care systems.
       ``(e) Matching Funds.--(1) The Secretary may not make a 
     grant or provide funds pursuant to a contract under 
     subsection (a)(1) to an entity--
       ``(A) in an amount exceeding 75 percent of the costs of 
     providing health services under the grant or contract; and
       ``(B) unless the entity agrees that the entity will make 
     available, directly or through donations to the entity, non-
     Federal contributions toward such costs in an amount equal to 
     not less than $1 (in cash or in kind under paragraph (2)) for 
     each $3 of Federal funds provided in such grant or contract.
       ``(2) Non-Federal contributions required in paragraph (1) 
     may be in cash or in kind, fairly evaluated, including plant, 
     equipment, or services. Amounts provided by the Federal 
     Government or services assisted or subsidized to any 
     significant extent by the Federal Government may not be 
     included in determining the amount of such non-Federal 
     contributions.
       ``(3) The Secretary may waive the requirement established 
     in paragraph (1) if--
       ``(A) the entity involved is a nonprofit private entity 
     described in subsection (b); and
       ``(B) the Secretary, in consultation with Papa Ola Lokahi, 
     determines that it is not feasible for the entity to comply 
     with such requirement.
       ``(f) Restriction on Use of Grant and Contract Funds.--The 
     Secretary may not make a grant to, or enter into a contract 
     with, an entity under subsection (a)(1) unless the entity 
     agrees that amounts received pursuant to such subsection will 
     not, directly or through contract, be expended--
       ``(1) for any purpose other than the purposes described in 
     subsection (c);
       ``(2) to provide inpatient services;
       ``(3) to make cash payments to intended recipients of 
     health services; or
       ``(4) to purchase or improve real property (other than 
     minor remodeling of existing improvements to real property) 
     or to purchase major medical equipment.
       ``(g) Limitation on Charges for Services.--The Secretary 
     may not make a grant, or enter into a contract with, an 
     entity under subsection (a)(1) unless the entity agrees that, 
     whether health services are provided directly or through 
     contract--
       ``(1) health services under the grant or contract will be 
     provided without regard to ability to pay for the health 
     services; and
       ``(2) the entity will impose a charge for the delivery of 
     health services, and such charge--
       ``(A) will be made according to a schedule of charges that 
     is made available to the public, and
       ``(B) will be adjusted to reflect the income of the 
     individual involved.

     ``SEC. 5. FUNCTIONS OF, AND GRANTS TO, PAPA OLA LOKAHI.

       ``(a) Functions.--Papa Ola Lokahi shall--
       ``(1) coordinate, implement, and update, as appropriate, 
     the comprehensive health care master plan developed pursuant 
     to section 3;
       ``(2) to the maximum extent possible, coordinate and assist 
     the health care programs and services provided to Native 
     Hawaiians;
       ``(3) provide for the training of the persons described in 
     section 4(c)(1)(B);
       ``(4) develop an action plan outlining the contributions 
     that each member organization of Papa Ola Lokahi will make in 
     carrying out this Act;
       ``(5) serve as a clearinghouse for--
       ``(A) the collection and maintenance of data associated 
     with the health status of Native Hawaiians;
       ``(B) the identification of and research into diseases 
     affecting Native Hawaiians;
       ``(C) the availability of Native Hawaiian project funds, 
     research projects, and publications; and
       ``(D) the timely dissemination of information relating to 
     Native Hawaiian health care systems;
       ``(6) perform the recognition and certification functions 
     specified in sections 10(6)(F) and 10(6)(G); and
       ``(7) provide technical support and coordination of 
     training and technical assistance to Native Hawaiian health 
     care systems.
       ``(b) Special Project Funds.--Papa Ola Lokahi may receive 
     project funds that may be appropriated for the purpose of 
     research on the health status of Native Hawaiians or for the 
     purpose of addressing the health care needs of Native 
     Hawaiians.
       ``(c) Grants.--In addition to any other grant or contract 
     under this Act, the Secretary may make grants to, or enter 
     into contracts with, Papa Ola Lokahi for--
       ``(1) carrying out the functions described in subsection 
     (a); and
       ``(2) administering any special project funds received 
     under the authority of subsection (b).
       ``(d) Relationships With Other Agencies.--Papa Ola Lokahi 
     may enter into agreements or memoranda of understanding with 
     relevant agencies or organizations that are capable of 
     providing resources or services to Native Hawaiian health 
     care systems.

     ``SEC. 6. ADMINISTRATION OF GRANTS AND CONTRACTS.

       ``(a) Terms and Conditions.--The Secretary shall include in 
     any grant made or contract entered into under this Act such 
     terms and conditions as the Secretary considers necessary or 
     appropriate to ensure that the objectives of such grant or 
     contract are achieved.
       ``(b) Periodic Review.--The Secretary shall periodically 
     evaluate the performance of, and compliance with, grants and 
     contracts under this Act.
       ``(c) Administrative Requirements.--The Secretary may not 
     make a grant or enter into a contract under this Act with an 
     entity unless the entity--
       ``(1) agrees to establish such procedures for fiscal 
     control and fund accounting as may be necessary to ensure 
     proper disbursement and accounting with respect to the grant 
     or contract;
       ``(2) agrees to ensure the confidentiality of records 
     maintained on individuals receiving health services under the 
     grant or contract;
       ``(3) with respect to providing health services to any 
     population of Native Hawaiians a substantial portion of which 
     has a limited ability to speak the English language--
       ``(A) has developed and has the ability to carry out a 
     reasonable plan to provide health services under the grant or 
     contract through individuals who are able to communicate with 
     the population involved in the language and cultural context 
     that is most appropriate; and
       ``(B) has designated at least one individual, fluent in 
     both English and the appropriate language, to assist in 
     carrying out the plan;
       ``(4) with respect to health services that are covered in 
     the plan of the State of Hawaii approved under title XIX of 
     the Social Security Act--
       ``(A) if the entity will provide under the grant or 
     contract any such health services directly--
       ``(i) the entity has entered into a participation agreement 
     under such plan; and
       ``(ii) the entity is qualified to receive payments under 
     such plan; and
       ``(B) if the entity will provide under the grant or 
     contract any such health services through a contract with an 
     organization--
       ``(i) the organization has entered into a participation 
     agreement under such plan; and
       ``(ii) the organization is qualified to receive payments 
     under such plan; and
       ``(5) agrees to submit to the Secretary and to Papa Ola 
     Lokahi an annual report that describes the utilization and 
     costs of health services provided under the grant or contract 
     (including the average cost of health services per user) and 
     that provides such other information as the Secretary 
     determines to be appropriate.
       ``(d) Contract Evaluation.--(1) If, as a result of 
     evaluations conducted by the Secretary, the Secretary 
     determines that an entity has not complied with or 
     satisfactorily performed a contract entered into under 
     section 4, the Secretary shall, prior to renewing such 
     contract, attempt to resolve the areas of noncompliance or 
     unsatisfactory performance and modify such contract to 
     prevent future occurrences of such noncompliance or 
     unsatisfactory performance. If the Secretary determines that 
     such noncompliance or unsatisfactory performance cannot be 
     resolved and prevented in the future, the Secretary shall not 
     renew such contract with such entity and is authorized to 
     enter into a contract under section 4 with another entity 
     referred to in section 4(b) that provides services to the 
     same population of Native Hawaiians which is served by the 
     entity whose contract is not renewed by reason of this 
     subsection.
       ``(2) In determining whether to renew a contract entered 
     into with an entity under this Act, the Secretary shall 
     consider the results of evaluation under this section.
       ``(3) All contracts entered into by the Secretary under 
     this Act shall be in accordance with all Federal contracting 
     laws and regulations except that, in the discretion of the 
     Secretary, such contracts may be negotiated without 
     advertising and may be exempted from the provisions of the 
     Act of August 24, 1935 (40 U.S.C. 270a et seq.).
       ``(4) Payments made under any contract entered into under 
     this Act may be made in advance, by means of reimbursement, 
     or in installments and shall be made on such conditions as 
     the Secretary deems necessary to carry out the purposes of 
     this Act.
       ``(e) Limitation on Use of Funds for Administrative 
     Expenses.--Except for grants and contracts under section 
     5(c), the Secretary may not make a grant to, or enter into a 
     contract with, an entity under this Act unless the entity 
     agrees that the entity will not expend more than 10 percent 
     of amounts received pursuant to this Act for the purpose of 
     administering the grant or contract.
       ``(f) Report.--(1) For each fiscal year during which an 
     entity receives or expends funds pursuant to a grant or 
     contract under this Act, such entity shall submit to the 
     Secretary and to Papa Ola Lokahi a quarterly report on--
       ``(A) activities conducted by the entity under the grant or 
     contract;
       ``(B) the amounts and purposes for which Federal funds were 
     expended; and
       ``(C) such other information as the Secretary may request.
       ``(2) The reports and records of any entity which concern 
     any grant or contract under this Act shall be subject to 
     audit by the Secretary, the Inspector General of Health and 
     Human Services, and the Comptroller General of the United 
     States.
       ``(g) Annual Private Audit.--The Secretary shall allow as a 
     cost of any grant made or contract entered into under this 
     Act the cost of an annual private audit conducted by a 
     certified public accountant.

     ``SEC. 7. ASSIGNMENT OF PERSONNEL.

       ``(a) In General.--The Secretary is authorized to enter 
     into an agreement with any entity under which the Secretary 
     is authorized to assign personnel of the Department of Health 
     and Human Services with expertise identified by such entity 
     to such entity on detail for the purposes of providing 
     comprehensive health promotion and disease prevention 
     services to Native Hawaiians.
       ``(b) Applicable Federal Personnel Provisions.--Any 
     assignment of personnel made by the Secretary under any 
     agreement entered into under the authority of subsection (a) 
     shall be treated as an assignment of Federal personnel to a 
     local government that is made in accordance with subchapter 
     VI of chapter 33 of title 5, United States Code.

     ``SEC. 8. NATIVE HAWAIIAN HEALTH SCHOLARSHIPS.

       ``(a) Eligibility.--The Secretary is authorized to make 
     scholarship grants to students who--
       ``(1) meet the requirements of section 338A(b) of the 
     Public Health Service Act (42 U.S.C. 254l(b)); and
       ``(2) are Native Hawaiians.
       ``(b) Terms and Conditions.--(1) Scholarship grants 
     provided under subsection (a) shall be provided under the 
     same terms and subject to the same conditions, regulations, 
     and rules that apply to scholarship grants provided under 
     section 338A of the Public Health Service Act (42 U.S.C. 
     254l), except that--
       ``(A) the provision of scholarships in each type of health 
     care profession training shall correspond to the need for 
     each type of health care professional to serve Native 
     Hawaiian health care systems, as identified by Papa Ola 
     Lokahi;
       ``(B) in selecting scholarship recipients, the Secretary 
     shall give priority to individuals included on a list of 
     eligible applicants submitted by the Kamehameha Schools/
     Bishop Estate; and
       ``(C) the obligated service requirement for each 
     scholarship recipient shall be fulfilled through service, in 
     order of priority, in--
       ``(i) any one of the five Native Hawaiian health care 
     systems which, during the fiscal year in which the obligated 
     service requirement is assigned, has received a grant or 
     entered into a contract pursuant to section 4; or
       ``(ii) health professions shortage areas, medically 
     underserved areas, or geographic areas or facilities 
     similarly designated by the United States Public Health 
     Service in the State of Hawaii.
       ``(2) The Secretary shall enter into a cooperative 
     agreement with the Kamehameha Schools/Bishop Estate under 
     which such organization shall provide recruitment, retention, 
     counseling, and other support services intended to improve 
     the operation of the scholarship program established under 
     this section.
       ``(3) The Native Hawaiian Health Scholarship program shall 
     not be administered by or through the Indian Health Service.

     ``SEC. 9. REPORT.

       ``The President shall, at the time the budget is submitted 
     under section 1105 of title 31, United States Code, for each 
     fiscal year transmit to the Congress the report required 
     pursuant to section 2(d).

     ``SEC. 10. DEFINITIONS.

       ``For purposes of this Act:
       ``(1) Disease prevention.--The term `disease prevention' 
     includes--
       ``(A) immunizations,
       ``(B) control of high blood pressure,
       ``(C) control of sexually transmittable diseases,
       ``(D) prevention and control of diabetes,
       ``(E) control of toxic agents,
       ``(F) occupational safety and health,
       ``(G) accident prevention,
       ``(H) fluoridation of water,
       ``(I) control of infectious agents, and
       ``(J) provision of mental health care.
       ``(2) Health promotion.--The term `health promotion' 
     includes--
       ``(A) pregnancy and infant care, including prevention of 
     fetal alcohol syndrome,
       ``(B) cessation of tobacco smoking,
       ``(C) reduction in the misuse of alcohol and drugs,
       ``(D) improvement of nutrition,
       ``(E) improvement in physical fitness,
       ``(F) family planning, and
       ``(G) control of stress.
       ``(3) Native hawaiian.--The term `Native Hawaiian' means 
     any individual who is--
       ``(A) a citizen of the United States; and
       ``(B) a descendant of the aboriginal people, who prior to 
     1778, occupied and exercised sovereignty in the area that now 
     constitutes the State of Hawaii, as evidenced by--
       ``(i) genealogical records;
       ``(ii) Kupuna (elders) or Kama'aina (long-term community 
     residents) verification; or
       ``(iii) birth records of the State of Hawaii.
       ``(4) Native hawaiian health center.--The term `Native 
     Hawaiian health center' means an entity--
       ``(A) which is organized under the laws of the State of 
     Hawaii,
       ``(B) which provides or arranges for health care services 
     through practitioners licensed by the State of Hawaii, where 
     licensure requirements are applicable,
       ``(C) which is a public or nonprofit private entity, and
       ``(D) in which Native Hawaiian health practitioners 
     significantly participate in the planning, management, 
     monitoring, and evaluation of health services.
       ``(5) Native hawaiian organization.--The term `Native 
     Hawaiian organization' means any organization--
       ``(A) which serves the interests of Native Hawaiians,
       ``(B) which is--
       ``(i) recognized by Papa Ola Lokahi for the purpose of 
     planning, conducting, or administering programs (or portions 
     of programs) authorized under this Act for the benefit of 
     Native Hawaiians, and
       ``(ii) certified by Papa Ola Lokahi as having the 
     qualifications and capacity to provide the services, and meet 
     the requirements, under the contract the organization enters 
     into with, or grant the organization receives from, the 
     Secretary under this Act,
       ``(C) in which Native Hawaiian health practitioners 
     significantly participate in the planning, management, 
     monitoring, and evaluation of health services, and
       ``(D) which is a public or nonprofit private entity.
       ``(6) Native hawaiian health care system.--The term `Native 
     Hawaiian health care system' means an entity--
       ``(A) which is organized under the laws of the State of 
     Hawaii;
       ``(B) which provides or arranges for health care services 
     through practitioners licensed by the State of Hawaii, where 
     licensure requirements are applicable;
       ``(C) which is a public or nonprofit private entity;
       ``(D) in which Native Hawaiian health practitioners 
     significantly participate in the planning, management, 
     monitoring, and evaluation of health care services;
       ``(E) which may be composed of as many Native Hawaiian 
     health centers as necessary to meet the health care needs of 
     Native Hawaiians residing on the island or islands served by 
     such entity;
       ``(F) which is recognized by Papa Ola Lokahi for the 
     purpose of providing comprehensive health promotion and 
     disease prevention services as well as primary health 
     services to Native Hawaiians under this Act; and
       ``(G) which is certified by Papa Ola Lokahi as having the 
     qualifications and the capacity to provide the services and 
     meet the requirements of a contract entered into, or a grant 
     received, under section 4.
       ``(7) Papa ola lokahi.--(A) Subject to subparagraph (B), 
     the term `Papa Ola Lokahi' means an organization composed 
     of--
       ``(i) E Ola Mau;
       ``(ii) the Office of Hawaiian Affairs of the State of 
     Hawaii;
       ``(iii) Alu Like Inc.;
       ``(iv) the University of Hawaii;
       ``(v) the Office of Hawaiian Health of the Hawaii State 
     Department of Health;
       ``(vi) Ho'ola Lahui Hawaii, or a health care system serving 
     the islands of Kaua'i and Ni'ihau;
       ``(vii) Ke Ola Mamo, or a health care system serving the 
     island of O'ahu;
       ``(viii) Na Pu'uwai or a health care system serving the 
     islands of Moloka'i and Lana'i;
       ``(ix) Hui No Ke Ola Pono, or a health care system serving 
     the island of Maui;
       ``(x) Hui Malama Ola Ha'Oiwi or a health care system 
     serving the island of Hawaii; and
       ``(xi) such other member organizations as the Board of Papa 
     Ola Lokahi may admit from time to time, based upon 
     satisfactory demonstration of a record of contribution to the 
     health and well-being of Native Hawaiians, and upon 
     satisfactory development of a mission statement in relation 
     to this Act, including clearly defined goals and objectives, 
     a 5-year action plan outlining the contributions that each 
     organization will make in carrying out the policy of this 
     Act, and an estimated budget.
       ``(B) Such term does not include any organization 
     identified in subparagraph (A) if the Secretary determines 
     that such organization does not have a mission statement with 
     clearly defined goals and objectives for the contributions 
     the organization will make to Native Hawaiian health care 
     systems and an action plan for carrying out such goals and 
     objectives.
       ``(8) Primary health services.--The term `primary health 
     services' means--
       ``(A) services of physicians, physicians' assistants and 
     nurse practitioners;
       ``(B) diagnostic laboratory and radiologic services;
       ``(C) preventive health services (including children's eye 
     and ear examinations to determine the need for vision and 
     hearing correction, perinatal services, well child services, 
     and family planning services);
       ``(D) emergency medical services;
       ``(E) transportation services as required for adequate 
     patient care;
       ``(F) preventive dental services; and
       ``(G) pharmaceutical services, as may be appropriate for 
     particular health centers.
       ``(9) Secretary.--The term `Secretary' means the Secretary 
     of Health and Human Services.
       ``(10) Traditional native hawaiian healer.--The term 
     `traditional Native Hawaiian healer' means a practitioner--
       ``(A) who--
       ``(i) is of Hawaiian ancestry, and
       ``(ii) has the knowledge, skills, and experience in direct 
     personal health care of individuals, and
       ``(B) whose knowledge, skills, and experience are based on 
     a demonstrated learning of Native Hawaiian healing practices 
     acquired by--
       ``(i) direct practical association with Native Hawaiian 
     elders, and
       ``(ii) oral traditions transmitted from generation to 
     generation.

     ``SEC. 11. RULE OF CONSTRUCTION.

       ``Nothing in this Act shall be construed to restrict the 
     authority of the State of Hawaii to license health 
     practitioners.

     ``SEC. 12. COMPLIANCE WITH BUDGET ACT.

       ``Any new spending authority (described in subsection 
     (c)(2) (A) or (B) of section 401 of the Congressional Budget 
     Act of 1974) which is provided under this Act shall be 
     effective for any fiscal year only to such extent or in such 
     amounts as are provided in appropriation Acts.

     ``SEC. 13. SEVERABILITY.

       ``If any provision of this Act, or the application of any 
     such provision to any person or circumstances is held to be 
     invalid, the remainder of this Act, and the application of 
     such provision or amendment to persons or circumstances other 
     than those to which it is held invalid, shall not be affected 
     thereby.

     ``SEC. 14. AUTHORIZATION OF APPROPRIATIONS.

       ``There is authorized to be appropriated for each of the 
     fiscal years 1994, 1995, 1996, 1997, 1998, 1999, and 2000 
     such sums as may be necessary to carry out the purposes of 
     this Act.

     ``SEC. 15. PROHIBITION AGAINST EXCLUSION FROM PARTICIPATION.

       ``Notwithstanding any other provision of this Act, no 
     person shall, on the basis of race, color, or national 
     origin, be excluded from participation in, or be denied the 
     benefits of, or be subjected to discrimination under, any 
     program or activity receiving Federal financial assistance 
     under this Act.''.

     SEC. 503. REPEAL OF PUBLIC HEALTH SERVICE ACT PROVISION.

       (a) In General.--The Public Health Service Act (42 U.S.C. 
     201 et seq.), as amended by section 206 of this Act, is 
     amended by repealing section 338K and redesignating section 
     338L as section 338K. Such repeal shall not be construed to 
     terminate contracts in effect under such section on the date 
     of the enactment of this Act. Any such contracts shall 
     continue according to the terms and conditions of such 
     contracts.
       (b) Effective Date.--Subsection (a) takes effect on the 
     date of the enactment of this Act.
                        TITLE VI--WOMEN'S HEALTH

     SEC. 601. ESTABLISHMENT OF OFFICE OF WOMEN'S HEALTH.

       Title XVII of the Public Health Service Act (42 U.S.C. 300u 
     et seq.), as amended by section 704 of Public Law 103-183 
     (107 Stat. 2240), is amended by adding at the end the 
     following section:


                       ``office of women's health

       ``Sec. 1710. (a) In General.--There is established an 
     Office of Women's Health within the Office of the Assistant 
     Secretary for Health. There shall be in the Department of 
     Health and Human Services a Deputy Assistant Secretary for 
     Women's Health, who shall be the head of the Office of 
     Women's Health. The Secretary, acting through such Deputy 
     Assistant Secretary, shall carry out this section.
       ``(b) Duties.--
       ``(1) In general.--The Secretary may conduct or support 
     programs and activities regarding women's health conditions. 
     In carrying out the preceding sentence, the Secretary shall--
       ``(A) monitor the programs and activities of the agencies 
     specified in paragraph (2) in order to determine the extent 
     to which the purposes of the programs and activities are 
     being carried out with respect to women's health conditions 
     (as defined in section 486);
       ``(B) provide advice to the heads of such agencies on 
     improving programs and activities that relate to such 
     conditions; and
       ``(C) coordinate such programs and activities of the 
     agencies.
       ``(2) Specified agencies.--For purposes of paragraph (1), 
     the agencies referred to in this paragraph are the following:
       ``(A) The Centers for Disease Control and Prevention.
       ``(B) The National Institutes of Health.
       ``(C) The Agency for Health Care Policy and Research.
       ``(D) The Health Resources and Services Administration.
       ``(E) The Substance Abuse and Mental Health Services 
     Administration.
       ``(F) The Food and Drug Administration.
       ``(c) Authorization of Appropriations.--For the purpose of 
     carrying out this section, there are authorized to be 
     appropriated $5,000,000 for fiscal year 1995, and such sums 
     as may be necessary for each of the fiscal years 1996 and 
     1997.''.

     SEC. 602. WOMEN'S SCIENTIFIC EMPLOYMENT REGARDING NATIONAL 
                   INSTITUTES OF HEALTH.

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


                    ``women's scientific employment

       ``Sec. 404F. (a) In General.--The Director of NIH shall--
       ``(1) establish policies for the National Institutes of 
     Health on matters relating to the employment by such 
     Institutes of women as scientists;
       ``(2) monitor the extent of compliance with such policies, 
     including through the implementation of an accountability 
     system under the Federal Equal Opportunity Recruitment 
     Program; and
       ``(3) establish and maintain a process for responding to 
     incidents of noncompliance with such policies.
       ``(b) Certain Policies.--In establishing policies under 
     subsection (a)(1), the Director of NIH shall provide for the 
     following policies regarding the employment of women as 
     scientists at the National Institutes of Health:
       ``(1) A policy on the granting of tenured status.
       ``(2) A policy on family leave.
       ``(3) A policy on the recruitment of minority women.
       ``(4) A policy on the inclusion of women scientists in 
     intramural and extramural conferences, workshops, 
     international congresses, and similar events funded or 
     sponsored by such Institutes.
       ``(c) Availability of Policies.--The Director of NIH shall 
     ensure that copies of policies established under subsection 
     (a) are available to scientists of the National Institutes of 
     Health.
       ``(d) Definition.--For purposes of this section, the term 
     `Federal Equal Opportunity Recruitment Program' means the 
     program carried out under part 720 of title 5, Code of 
     Federal Regulations (5 CFR 720).''.
       (b) Studies.--
       (1) Pay equity.--The Director of the National Institutes of 
     Health shall provide for a study to identify any pay 
     differences among men and women scientists employed (both 
     tenured and untenured) by the National Institutes of Health. 
     The study shall include recommendations on measures to adjust 
     any inequities, and on making available information on salary 
     ranges to all scientists of such Institutes.
       (2) Study on termination of employment.--The Comptroller 
     General of the United States shall conduct a study for the 
     purpose of determining the reasons underlying the employment 
     termination of scientists of the National Institutes of 
     Health. The study shall be carried out with respect to male 
     and female scientists, and with respect to voluntary and 
     involuntary terminations.
       (3) Reports.--Not later than 240 days after the date of the 
     enactment of this Act, the studies required in this 
     subsection shall be completed, and reports describing the 
     findings and recommendations of the studies shall be 
     submitted to the Committee on Energy and Commerce of the 
     House of Representatives and the Committee on Labor and Human 
     Resources of the Senate.

     SEC. 603. INFORMATION AND EDUCATION REGARDING FEMALE GENITAL 
                   MUTILATION.

       (a) In General.--The Secretary of Health and Human Services 
     shall ensure that the Deputy Assistant Secretary for Women's 
     Health and the Deputy Assistant Secretary for Minority Health 
     collaborate for the purpose of carrying out the following 
     activities:
       (1) Compile data on the number of females living in the 
     United States who have been subjected to female genital 
     mutilation (whether in the United States or in their 
     countries of origin), including a specification of the number 
     of girls under the age of 18 who have been subjected to such 
     mutilation.
       (2) Identify communities in the United States that practice 
     female genital mutilation, and design and carry out outreach 
     activities to educate individuals in the communities on the 
     physical and psychological health effects of such practice. 
     Such outreach activities shall be designed and implemented in 
     collaboration with representatives of the ethnic groups 
     practicing such mutilation and with representatives of 
     organizations with expertise in preventing such practice.
       (3) Develop recommendations for the education of students 
     of schools of medicine and osteopathic medicine regarding 
     female genital mutilation and complications arising from such 
     mutilation. Such recommendations shall be disseminated to 
     such schools.
       (b) Definition.--For purposes of this section, the term 
     ``female genital mutilation'' means the removal or 
     infibulation (or both) of the whole or part of the clitoris, 
     the labia minor, or the labia major.

     SEC. 604. STUDY REGARDING CURRICULA OF MEDICAL SCHOOLS AND 
                   WOMEN'S HEALTH CONDITIONS.

       (a) In General.--The Secretary of Health and Human 
     Services, acting through the Administrator of the Health 
     Resources and Services Administration, shall conduct a study 
     for the purpose of determining the contents of the curriculum 
     of schools of medicine and osteopathic medicine and whether 
     such curriculum provides adequate education to students on 
     women's health conditions.
       (b) Consultations.--The Secretary shall carry out 
     subsection (a) in consultation with the Deputy Assistant 
     Secretary for Women's Health and the Director of the Office 
     of Research on Women's Health (of the National Institutes of 
     Health).
       (c) Report.--Not later than April 1, 1995, the Secretary 
     shall complete the study required in subsection (a) and 
     submit to the Committee on Energy and Commerce of the House 
     of Representatives, and to the Committee on Labor and Human 
     Resources of the Senate, a report describing the findings 
     made as a result of the study and containing any 
     recommendations of the Secretary regarding such findings.
       (d) Definitions.--For purposes of this section:
       (1) The term ``Secretary'' means the Secretary of Health 
     and Human Services.
       (2) The term ``women's health conditions'' has the meaning 
     given such term in section 486 of the Public Health Service 
     Act.
                   TITLE VII--TRAUMATIC BRAIN INJURY

     SEC. 701. PROGRAMS OF CENTERS FOR DISEASE CONTROL AND 
                   PREVENTION.

       (a) Technical Correction Regarding Amendatory 
     Instructions.--Section 301(a) of Public Law 103-183 (107 
     Stat. 2233) is amended by striking ``(42 U.S.C. 242 et 
     seq.)'' and inserting ``(42 U.S.C. 243 et seq.)''. The 
     amendment made by the preceding sentence is deemed to have 
     taken effect immediately after the enactment of Public Law 
     103-183.
       (b) Programs of Centers for Disease Control and 
     Prevention.--Part B of title III of the Public Health Service 
     Act (42 U.S.C. 243 et seq.), as amended pursuant to 
     subsection (a) and as amended by section 703 of Public Law 
     103-183 (107 Stat. 2240), is amended by inserting after 
     section 317F the following section:


                 ``prevention of traumatic brain injury

       ``Sec. 317G. (a) The Secretary, acting through the Director 
     of the Centers for Disease Control and Prevention, may carry 
     out projects to reduce the incidence of traumatic brain 
     injury. Such projects may be carried out by the Secretary 
     directly or through awards of grants or contracts to public 
     or nonprofit private entities. The Secretary may directly or 
     through such awards provide technical assistance with respect 
     to the planning, development, and operation of such projects.
       ``(b) Certain Activities.--Activities under subsection (a) 
     may include--
       ``(1) the conduct of research into identifying effective 
     strategies for the prevention of traumatic brain injury; and
       ``(2) the implementation of public information and 
     education programs for the prevention of such injury and for 
     broadening the awareness of the public concerning the public 
     health consequences of such injury.
       ``(c) Coordination of Activities.--The Secretary shall 
     ensure that activities under this section are coordinated as 
     appropriate with other agencies of the Public Health Service 
     that carry out activities regarding traumatic brain injury.
       ``(d) Definition.--For purposes of this section, the term 
     `traumatic brain injury' means an acquired injury to the 
     brain. Such term does not include brain dysfunction caused by 
     congenital or degenerative disorders, nor birth trauma, but 
     may include brain injuries caused by anoxia due to near 
     drowning.''.

     SEC. 702. PROGRAMS OF NATIONAL INSTITUTES OF HEALTH.

       Section 1261 of the Public Health Service Act (42 U.S.C. 
     300d-61) is amended--
       (1) in subsection (d)--
       (A) in paragraph (2), by striking ``and'' after the 
     semicolon at the end;
       (B) in paragraph (3), by striking the period and inserting 
     ``; and''; and
       (C) by adding at the end the following paragraph:
       ``(4) the authority to make awards of grants or contracts 
     to public or nonprofit private entities for the conduct of 
     basic and applied research regarding traumatic brain injury, 
     which research may include--
       ``(A) the development of new methods and modalities for the 
     more effective diagnosis, measurement of degree of injury, 
     post-injury monitoring and prognostic assessment of head 
     injury for acute, subacute and later phases of care;
       ``(B) the development, modification and evaluation of 
     therapies that retard, prevent or reverse brain damage after 
     acute head injury, that arrest further deterioration 
     following injury and that provide the restitution of function 
     for individuals with long-term injuries;
       ``(C) the development of research on a continuum of care 
     from acute care through rehabilitation, designed, to the 
     extent practicable, to integrate rehabilitation and long-term 
     outcome evaluation with acute care research; and
       ``(D) the development of programs that increase the 
     participation of academic centers of excellence in head 
     injury treatment and rehabilitation research and training.''; 
     and
       (2) in subsection (h), by adding at the end the following 
     paragraph:
       ``(4) The term `traumatic brain injury' means an acquired 
     injury to the brain. Such term does not include brain 
     dysfunction caused by congenital or degenerative disorders, 
     nor birth trauma, but may include brain injuries caused by 
     anoxia due to near drowning.''.

     SEC. 703. PROGRAMS OF HEALTH RESOURCES AND SERVICES 
                   ADMINISTRATION.

       Part E of title XII of the Public Health Service Act (42 
     U.S.C. 300d-51 et seq.) is amended by adding at the end the 
     following section:

     ``SEC. 1252. STATE GRANTS FOR DEMONSTRATION PROJECTS 
                   REGARDING TRAUMATIC BRAIN INJURY.

       ``(a) In General.--The Secretary, acting through the 
     Administrator of the Health Resources and Services 
     Administration, may make grants to States for the purpose of 
     carrying out demonstration projects to improve the 
     availability of health services regarding traumatic brain 
     injury.
       ``(b) State Advisory Board.--
       ``(1) In general.--The Secretary may make a grant under 
     subsection (a) only if the State involved agrees to establish 
     an advisory board within the appropriate health department of 
     the State or within another department as designated by the 
     chief executive officer of the State.
       ``(2) Functions.--An advisory board established under 
     paragraph (1) shall be cognizant of findings and concerns of 
     Federal, State and local agencies, citizens groups, and 
     private industry (such as insurance, health care, automobile, 
     and other industry entities). Such advisory boards shall 
     encourage citizen participation through the establishment of 
     public hearings and other types of community outreach 
     programs.
       ``(3) Composition.--An advisory board established under 
     paragraph (1) shall be composed of--
       ``(A) representatives of--
       ``(i) the corresponding State agencies involved;
       ``(ii) public and nonprofit private health related 
     organizations;
       ``(iii) other disability advisory or planning groups within 
     the State;
       ``(iv) members of an organization or foundation 
     representing traumatic brain injury survivors in that State; 
     and
       ``(v) injury control programs at the State or local level 
     if such programs exist; and
       ``(B) a substantial number of individuals who are survivors 
     of traumatic brain injury, or the family members of such 
     individuals.
       ``(c) 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 make a grant under such 
     subsection only if the State agrees to make available, in 
     cash, non-Federal contributions toward such costs in an 
     amount that is not less than $1 for each $2 of Federal funds 
     provided under 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.
       ``(d) Application for Grant.--The Secretary may make a 
     grant under subsection (a) only if an application for the 
     grant 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 this section.
       ``(e) Coordination of Activities.--The Secretary shall 
     ensure that activities under this section are coordinated as 
     appropriate with other agencies of the Public Health Service 
     that carry out activities regarding traumatic brain injury.
       ``(f) Report.--Not later than 2 years after the effective 
     date under section 901 of the Minority Health Improvement Act 
     of 1994, the Secretary shall submit to the Committee on 
     Energy and Commerce of the House of Representatives, and to 
     the Committee on Labor and Human Resources of the Senate, a 
     report describing the findings and results of the programs 
     established under this section, including measures of 
     outcomes and consumer and surrogate satisfaction.
       ``(g) Definition.--For purposes of this section, the term 
     `traumatic brain injury' means an acquired injury to the 
     brain. Such term does not include brain dysfunction caused by 
     congenital or degenerative disorders, nor birth trauma, but 
     may include brain injuries caused by anoxia due to near 
     drowning.
       ``(h) Authorization of Appropriations.--There are 
     authorized to be appropriated to carry out this section, 
     $5,000,000 for fiscal year 1995, and such sums as may be 
     necessary for each of the fiscal years 1996 and 1997.''.

     SEC. 704. STUDY; CONSENSUS CONFERENCE.

       (a) Study.--
       (1) In general.--The Secretary of Health and Human Services 
     (in this section referred to as the ``Secretary''), acting 
     through the appropriate agencies of the Public Health 
     Service, shall conduct a study for the purpose of carrying 
     out the following with respect to traumatic brain injury:
       (A) In collaboration with appropriate State and local 
     health-related agencies--
       (i) determine the incidence and prevalence of traumatic 
     brain injury; and
       (ii) develop a uniform reporting system under which States 
     report incidences of traumatic brain injury, if the Secretary 
     determines that such a system is appropriate.
       (B) Identify common therapeutic interventions which are 
     used for the rehabilitation of individuals with such 
     injuries, and shall, subject to the availability of 
     information, include an analysis of--
       (i) the effectiveness of each such intervention in 
     improving the functioning of individuals with brain injuries;
       (ii) the comparative effectiveness of interventions 
     employed in the course of rehabilitation of individuals with 
     brain injuries to achieve the same or similar clinical 
     outcome; and
       (iii) the adequacy of existing measures of outcomes and 
     knowledge of factors influencing differential outcomes.
       (C) Develop practice guidelines for the rehabilitation of 
     traumatic brain injury at such time as appropriate scientific 
     research becomes available.
       (2) Dates certain for reports.--
       (A) Not later than 18 months after the effective date under 
     section 901, the Secretary shall submit to the Committee on 
     Energy and Commerce of the House of Representatives, and to 
     the Committee on Labor and Human Resources of the Senate, a 
     report describing the findings made as a result of carrying 
     out paragraph (1)(A).
       (B) Not later than 3 years after the effective date under 
     section 901, the Secretary shall submit to the Committees 
     specified in subparagraph (A) a report describing the 
     findings made as a result of carrying out subparagraphs (B) 
     and (C) of paragraph (1).
       (b) Consensus Conference.--The Secretary, acting through 
     the Director of the National Center for Medical 
     Rehabilitation Research within the National Institute for 
     Child Health and Human Development, shall conduct a national 
     consensus conference on managing traumatic brain injury and 
     related rehabilitation concerns.
       (c) Definition.--For purposes of this section, the term 
     ``traumatic brain injury'' means an acquired injury to the 
     brain. Such term does not include brain dysfunction caused by 
     congenital or degenerative disorders, nor birth trauma, but 
     may include brain injuries caused by anoxia due to near 
     drowning.
                  TITLE VIII--MISCELLANEOUS PROVISIONS

     SEC. 801. TECHNICAL AMENDMENT TO INDIAN HEALTH CARE 
                   IMPROVEMENT ACT.

       The last sentence of section 818(e)(3) of the Indian Health 
     Care Improvement Act (25 U.S.C. 1680h(e)(3)) is amended--
       (1) by striking ``services,'' and inserting ``services''; 
     and
       (2) by striking ``, shall be recoverable.'' and inserting a 
     period.

     SEC. 802. 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) by striking paragraphs (5) and (6);
       (B) by redesignating paragraphs (7) and (8) as paragraphs 
     (5) and (6), respectively;
       (C) in paragraph (2)--
       (i) by inserting ``substance abuse'' after ``availability 
     of health''; and
       (ii) by striking ``, including improved health data 
     systems''; and
       (D) in paragraph (3)--
       (i) by striking ``manpower'' and inserting ``care 
     providers''; and
       (ii) by striking ``by--'' and all that follows through the 
     end and inserting a semicolon; and
       (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 each of the 
     fiscal years 1995 through 1997''.

     SEC. 803. TECHNICAL CORRECTIONS REGARDING PUBLIC LAW 103-183.

       (a) Amendatory Instructions.--Public Law 103-183 is 
     amended--
       (1) in section 601--
       (A) in subsection (b), in the matter preceding paragraph 
     (1), by striking ``Section 1201 of the Public Health Service 
     Act (42 U.S.C. 300d)'' and inserting ``Title XII of the 
     Public Health Service Act (42 U.S.C. 300d et seq.)''; and
       (B) in subsection (f)(1), by striking ``in section 
     1204(c)'' and inserting ``in section 1203(c) (as redesignated 
     by subsection (b)(2) of this section)'';
       (2) in section 602, by striking ``for the purpose'' and 
     inserting ``For the purpose''; and
       (3) in section 705(b), by striking ``317D((l)(1)'' and 
     inserting ``317D(l)(1)''.
       (b) Public Health Service Act.--The Public Health Service 
     Act, as amended by Public Law 103-183 and by subsection (a) 
     of this section, is amended--
       (1) in section 317E(g)(2), by striking ``making grants 
     under subsection (b)'' and inserting ``carrying out 
     subsection (b)'';
       (2) in section 318, in subsection (e) as in effect on the 
     day before the date of the enactment of Public Law 103-183, 
     by redesignating the subsection as subsection (f);
       (3) in subpart 6 of part C of title IV--
       (A) by transferring the first section 447 (added by section 
     302 of Public Law 103-183) from the current placement of the 
     section;
       (B) by redesignating the section as section 447A; and
       (C) by inserting the section after section 447;
       (4) in section 1213(a)(8), by striking ``provides for for'' 
     and inserting ``provides for'';
       (5) in section 1501, by redesignating the second subsection 
     (c) (added by section 101(f) of Public Law 103-183) as 
     subsection (d); and
       (6) in section 1505(3), by striking ``nonprofit''.
       (c) Miscellaneous Correction.--Section 401(c)(3) of Public 
     Law 103-183 is amended in the matter preceding subparagraph 
     (A) by striking ``(d)(5)'' and inserting ``(e)(5)''.
       (d) Effective Date.--This section is deemed to have taken 
     effect immediately after the enactment of Public Law 103-183.

     SEC. 804. CERTAIN AUTHORITIES OF CENTERS FOR DISEASE CONTROL 
                   AND PREVENTION.

       (a) In General.--Part B of title III of the Public Health 
     Service Act, as amended by section 701 of this Act, is 
     amended by inserting after section 317G the following 
     section:


 ``miscellaneous authorities regarding centers for disease control and 
                               prevention

       ``Sec. 317H. (a) Technical and Scientific Peer Review 
     Groups.--The Secretary, acting through the Director of the 
     Centers for Disease Control and Prevention, may, without 
     regard to the provisions of title 5, United States Code, 
     governing appointments in the competitive service, and 
     without regard to the provisions of chapter 51 and subchapter 
     III of chapter 53 of such title relating to classification 
     and General Schedule pay rates, establish such technical and 
     scientific peer review groups and scientific program advisory 
     committees as are needed to carry out the functions of such 
     Centers and appoint and pay the members of such groups, 
     except that officers and employees of the United States shall 
     not receive additional compensation for service as members of 
     such groups. The Federal Advisory Committee Act shall not 
     apply to the duration of such peer review groups. Not more 
     than one-fourth of the members of any such group shall be 
     officers or employees of the United States.
       ``(b) Fellowship and Training Programs.--The Secretary, 
     acting through the Director of the Centers for Disease 
     Control and Prevention, shall establish fellowship and 
     training programs to be conducted by such Centers to train 
     individuals to develop skills in epidemiology, surveillance, 
     laboratory analysis, and other disease detection and 
     prevention methods. Such programs shall be designed to enable 
     health professionals and health personnel trained under such 
     programs to work, after receiving such training, in local, 
     State, national, and international efforts toward the 
     prevention and control of diseases, injuries, and 
     disabilities. Such fellowships and training may be 
     administered through the use of either appointment or 
     nonappointment procedures.''.
       (b) Effective Date.--This section takes effect July 1, 
     1994.

     SEC. 805. ESTABLISHMENT OF PUBLIC HEALTH ANALYTICAL 
                   LABORATORY.

       (a) In General.--The Secretary of Health and Human 
     Services, acting as appropriate through the Director of the 
     Centers for Disease Control and Prevention or through other 
     agencies, may make a grant for the establishment and 
     operation of a laboratory to protect the public health 
     through analyzing human, wildlife, air, water, and soil 
     samples. The laboratory shall be established within the 
     United States at the central point of the international 
     border between the United States and Mexico (as determined by 
     such Secretary), and the laboratory shall serve the border 
     region.
       (b) Authorization of Appropriations.--For the purpose of 
     carrying out subsection (a), there are authorized to be 
     appropriated such sums as may be necessary for fiscal year 
     1995 and each subsequent fiscal year.

     SEC. 806. ADMINISTRATION OF CERTAIN REQUIREMENTS.

       (a) In General.--Section 2004 of Public Law 103-43 (107 
     Stat. 209) is amended by striking subsection (a).
       (b) Conforming Amendments.--Section 2004 of Public Law 103-
     43, as amended by subsection (a) of this section, is 
     amended--
       (1) by striking ``(b) Sense'' and all that follows through 
     ``In the case'' and inserting the following:
       ``(a) Sense of Congress Regarding Purchase of American-Made 
     Equipment and Products.--In the case'';
       (2) by striking ``(2) Notice to recipients of assistance'' 
     and inserting the following:
       ``(b) Notice to Recipients of Assistance''; and
       (3) in subsection (b), as redesignated by paragraph (2) of 
     this subsection, by striking ``paragraph (1)'' and inserting 
     ``subsection (a)''.
       (c) Effective Date.--This section is deemed to have taken 
     effect immediately after the enactment of Public Law 103-43.

     SEC. 807. REVISIONS TO ELIGIBILITY REQUIREMENTS FOR ENTITIES 
                   SUBJECT TO DRUG PRICING LIMITATIONS.

       (a) Treatment of Certain Outpatient Clinics as Covered 
     Entities.--Section 340B(a)(4) of the Public Health Service 
     Act (42 U.S.C. 256b(a)(4)) is amended by adding at the end 
     the following subparagraph:
       ``(M) A diagnostic and treatment center owned and operated 
     by the New York City Health and Hospitals Corporation.''.
       (b) Limitation on Exclusion Based on Participation in Group 
     Purchasing Organization.--Section 340B(a)(4)(L) of the Public 
     Health Service Act (42 U.S.C. 256b(a)(4)(L)) is amended--
       (1) in clause (i), by striking ``under this title'' and 
     inserting ``under title XIX of such Act''; and
       (2) in clause (iii), by inserting before the period at the 
     end the following: ``, other than the Health Services 
     Purchasing Group under the control of Los Angeles County''.
       (c) Clarification of Effective Date of Exclusion Based on 
     Participation in Group Purchasing Organization.--The 
     Secretary of Health and Human Services may not find that the 
     hospital system for the Dallas County Hospital District of 
     Texas (commonly known as Parkland Memorial Hospital) fails to 
     meet the requirements for a covered entity under paragraph 
     (4)(L) of section 340B(a) of the Public Health Service Act 
     solely because the hospital used a group purchasing 
     organization or other group purchasing arrangement to obtain 
     a covered outpatient drug before the effective date of the 
     entity guidelines published by the Secretary pursuant to 
     section 602 of the Veterans Health Care Act of 1992 if, at 
     the time the hospital purchased the drug, the manufacturer of 
     the drug did not offer to furnish the drug to the hospital at 
     the price required to be paid for the drug under paragraph 
     (1) of such section.
       (d) Effective Dates.--Subsections (a) and (b) take effect 
     as if included in the enactment of the Veterans Health Care 
     Act of 1992. Subsection (c) takes effect on the date of the 
     enactment of this Act.
                      TITLE IX--GENERAL PROVISIONS

     SEC. 901. EFFECTIVE DATE.

       Except as otherwise provided in this Act, this Act takes 
     effect October 1, 1994, or upon the date of the enactment of 
     this Act, whichever occurs later.

  The SPEAKER pro tempore. Pursuant to the rule, the gentleman from 
California [Mr. Waxman] will be recognized for 20 minutes, and the 
gentleman from California [Mr. Moorhead] will be recognized for 20 
minutes.
  The Chair recognizes the gentleman from California [Mr. Waxman].


                             general leave

  Mr. WAXMAN. Mr. Speaker, I ask unanimous consent that all Members may 
have 5 legislative days in which to revise and extend their remarks, 
and include extraneous material, on H.R. 3869, the bill now under 
consideration.
  The SPEAKER pro tempore. Is there objection to the request of the 
gentleman from California?
  There was no objection.
  Mr. WAXMAN. Mr. Speaker, I yield myself such time as I may consume.
  Mr. Speaker, in 1990, the Congress enacted the Disadvantaged Minority 
Health Improvement Act, which created a number of new programs to 
improve the health status of minority communities in the United States 
by expanding the opportunities for disadvantaged students to attend and 
succeed in the health professions. This legislation was the product of 
a cooperative effort by Members of Congress representing many different 
minority communities, and had substantial bipartisan support.
  The legislation before us strengthens the ideals and objectives of 
the 1990 law. The committee bill reflects a careful evaluation of the 
impact of each of these programs and the community needs expressed by 
the Asian-Pacific, Black, and Hispanic Congressional Caucuses as well 
as representatives of Indian country. The result is a series of 
important reforms which address what we understand are the most 
critical needs of minority communities today: improving health status 
by increasing access to primary and preventive health care.
  Evidence shows that the programs and policies of the past haven't 
always furthered this objective. Let me mention a few examples:
  Over the last 20 years, we have spent hundreds of millions of dollars 
to recruit minorities into medicine and dentistry, yet the pool of 
applicants has increased little. In fact, in a report from the 
Institute of Medicine concluded that ``(m)inorities in the health 
professions are more underrepresented today than 15 years ago.''
  Although it is not uncommon for health professions students to 
accumulate $25,000 a year in debt while in school, Congress continues 
to support a fragmented and ineffective system of school administered 
health profession scholarship programs that give small grants of $500 
or $1,000.
  In the meantime, the Federal Government turned away more than 1,200 
minority students who applied for admission to the National Health 
Service corps due to a lack of funding. NHSC provides full tuition and 
living expenses for medical and other health professions students 
willing after graduation to work in a medically underserved community. 
Only 8 percent of minority applicants were able to receive Corps 
scholarships in fiscal year 1993.
  Enactment of H.R. 3869 will increase by 200 percent the number of 
disadvantaged students able to receive NHSC scholarships. The committee 
bill offers the hundreds of disadvantaged students who desire a primary 
care career the opportunity to attend school without the feat of 
unsurmountable debt. It allows students who desire to practice in 
minority communities the freedom to do so.
  Mr. Speaker, we know that discretionary funding next year is under 
tough budgetary caps. Common sense dictates that in times of fiscal 
austerity, we must prioritize Federal programs to address the most 
pressing needs. The reforms contained in H.R. 3869 will help increase 
access to health services and target limited Federal funding to those 
individuals and communities in greatest need.
  I would like to thank all my colleagues on the subcommittee for 
working cooperatively with each other to achieve these common goals. I 
am committed to preserving this spirit of cooperation during conference 
negotiations with the Senate. Members on both sides of the aisle share 
common objectives and can take great pride in the ideals and objectives 
embodied in this important legislation.
  Mr. Speaker, I urge support for the legislation.

                              {time}  1250

  Mr. Speaker, I reserve the balance of my time.
  Mr. MOORHEAD. Mr. Speaker, I yield myself such time as I may consume.
  Mr. Speaker, I rise in support of H.R. 3869. The bill reauthorizes a 
number of expiring programs in the Public Health Service Act. The 
purpose of many of these programs is to improve the health of 
individuals who are members of minority groups through the provision of 
health care services and by increasing the number of minorities who 
enter the health professions. The bill reauthorizes: (1) The Office of 
Minority Health; (2) several scholarship and loan programs for 
disadvantaged students; (3) the Migrant and Community Health Center 
Programs; (4) the Health Care for the Homeless Program; and (5) State 
offices of rural health.
  Mr. Speaker, I am especially pleased that this bill reauthorizes the 
Community Health Centers Program. These centers provide comprehensive, 
high-quality, primary health care to populations living in medically 
undeserved areas.
  Community health centers are located in areas throughout the country 
where there are financial, geographic, or cultural barriers to primary 
health care. In many communities, these centers are the sole providers 
of care. Currently, community health centers [CHC's] serve large 
proportions of poor and minority people. Sixty percent of CHC users are 
below the poverty level, 29 percent are between 100 and 200 percent of 
poverty and 11 percent are above 200 percent of poverty. In fiscal year 
1992, 44 percent of individuals receiving services were children from 
newborn to 19 years of age.
  Many of our Democratic colleagues and the President argue that 
universal insurance coverage is the only acceptable health reform 
option. However, universal coverage does not guarantee access to health 
care services. The health care capacity provided by CHC's will be 
particularly critical in health care reform. Even as financial barriers 
to care are overcome, providers and health plans will not be attracted 
to the neediest areas of the country. CHC's provide a health care 
infrastructure for the undeserved that is accessible and is designed to 
meet the specific needs of the community and its special populations.
  Recognizing the tremendous value of community health centers, H.R. 
3080, the Michel-Lott health reform bill provides a $1.5 billion 
increase in funding for community and migrant health centers over 5 
years, at the rate of an additional $100 million every year. The 
combined fiscal year 1994 funding for community health centers, migrant 
health centers, and homeless health care totals $725 million. To 
maintain the current level of services, funding must be increased by 4 
percent for fiscal year 1995. This adjustment will result in no new 
centers, no additional patients served, and would avoid closing 
existing centers.
  An increase of $50 million will enable 30 new centers to open and an 
additional 300,000 individuals to be served at an annual cost of 
approximately $100 per patient. There are currently 150 centers which 
have demonstrated need and met all criteria for funding, but cannot 
open due to lack of funds.
  The authorization provided in this bill is openended. I hope that the 
members of the Appropriations Committee will seriously consider 
increasing the level of funding for these centers. While we argue over 
the best way to reform the health care system, we can take this simple 
step to provide health care to thousands of individuals who otherwise 
would go without.
  I urge my colleagues to join me in supporting H.R. 3869.
  Mr. Speaker, I reserve the balance of my time.
  Mr. WAXMAN. Mr. Speaker, I yield 5 minutes to the gentleman from New 
Mexico [Mr. Richardson], a very important member of our subcommittee.
  (Mr. RICHARDSON asked and was given permission to revise and extend 
his remarks.)
  Mr. RICHARDSON. First, my thanks to the gentleman from California 
[Mr. Waxman], the gentleman from California, [Mr. Moorhead], and the 
gentleman from Ohio [Mr. Stokes]. I want to thank Mr. Stokes for being 
a generous appropriator for many of these programs.
  Mr. Speaker, what we are talking about in this legislation are 
resources. What this bill does is provide very needed resources to 
minority health programs around the country.
  First, we deal with the Office of Minority Health, a key component if 
we are going to provide minority assistance in the health care area. 
This legislation also creates a national resources minority center.
  In addition, we provide resources for migrant and community health 
centers, funding for State offices of rural health, a major effort at 
dealing with birth defect precautions and monitoring at the Centers for 
Disease Control; a number of prevention, training, and public 
information programs affecting minority health.
  This legislation also sets out a concrete strategy in minority 
communities to deal with the problems of infant mortality, fetal 
alcohol syndrome, which is a major problem on Indian reservations; low-
birthweight babies is dealt with in a very positive fashion in this 
bill; and we deal with a silent killer in minority communities, 
diabetic-related blindness.
  But most importantly, what this bill does is prepare us for the 
future. Education and scholarship programs are created for health 
professionals. The number of minority health professionals is 
staggering low. This includes doctors, nurses, nurse anesthetists, and 
medical assistants. Minorities who practice health care in minority 
communities are often more effective but when we do not have a 
sufficient number of minority graduates from not just medical schools 
but other health care programs, we have a problem. So what is created 
is an education and scholarship program for a number of health 
professions; physician assistants, nurses, and mental health 
practitioners. In addition, this legislation has a program of 1 year of 
medical service in exchange for each year of scholarship assistance, a 
very positive way to get more minority students back into their 
communities.
  What we also have is a major effort at women's minority health, 
problems of medical research involving women, in addition to strong 
requirements for the National Institutes of Health to have more women 
in the medical professions, especially at NIH.
  Mr. Speaker, I also wish to commend Mr. Jose Serrano, the chairman of 
the Congressional Hispanic Caucus, for working together with us and 
with Mr. Stokes and other members of the Hispanic minority community to 
reach an important compromise on the funding for Centers of Excellence.
  There are a number of very important institutions, Hispanic 
institutions that will be training health care professionals. What this 
legislation does is allow sufficient resources to permit all Centers of 
Excellence to do the job as they are supposed to do, which is to lead 
the way in advances in minority health.
  What this bill also does is add additional resources to the 
collection of data on minority health through the National Centers on 
Health Statistics. There are tremendous differences within the Hispanic 
community, for example, in the measures of health traditionally used by 
the Federal agencies responsible for this. We do not currently have in 
the health professions categories of illnesses relating to minorities, 
especially Hispanics.

                              {time}  1300

  The bill will give those agencies the resources they need to gather 
data for various population groups within the community.
  Mr. Speaker, this is an important bill, and I thank the chairman, the 
gentleman from California [Mr. Waxman], for having yielded to me, as 
well as the gentleman from California [Mr. Moorhead] for his excellent 
work. And again my thanks to the gentleman from Ohio [Mr. Stokes].
  Mr. Speaker, I rise in very strong support of the minority health 
improvement act.
  I want to thank Chairman Waxman and Chairman Dingell for their fine 
work in getting a strong bill to the floor that addresses health 
concerns of all minorities and Americans who have traditionally been 
underserved by our health care system.
  Even though we originally authorized the Minority Health Improvement 
Act 3 years ago, members of minority communities are still underserved.
  This bill before us today takes important steps to address the 
shortcomings that are still apparent after the Minority Health 
Improvement Act of 1990.
  Mr. Speaker, Mr. Serrano and I and other members of the Hispanic 
Caucus worked together with Mr. Stokes and the Black Caucus to reach an 
important compromise on the funding for Centers of Excellence.
  This will allow all Centers of Excellence to do the job that they are 
supposed to do, which is to lead the way in advances in minority 
health.
  I want to thank Mr. Stokes and the other Members of the Black Caucus 
for their work in reaching the compromise.
  Also, Mr. Speaker, this bill adds additional resources to the 
collection of data on minority health through the National Center on 
Health Statistics.
  There are tremendous differences with the Hispanic community in the 
measures of health traditionally used by the Federal agencies 
responsible for this.
  This bill will give those agencies the resources they need to gather 
data for various population groups within the Hispanic community.
  Finally, Mr. Speaker, I realize that there may be some disagreements 
from some respected Members about the primary care scholarships. I 
would like to assure those Members that we will address those concerns 
in the conference with the Senate.
  This is a good bill, Mr. Speaker, and I support it.
  Mr. WAXMAN. Mr. speaker, I yield 3 additional minutes to the 
gentleman from New Mexico [Mr. Richardson] so we can pursue a colloquy.
  Mr. RICHARDSON. Mr. Speaker, I would like to engage in a colloquy 
with the gentleman from California to clarify some issues in this 
legislation.
  I have been informed that certain interest groups are concerned that 
the primary care scholarships in H.R. 3869 may force minority students 
not interested in primary care to choose this specialty. Is this true?
  Mr. WAXMAN. Mr. Speaker, will the gentleman yield?
  Mr. RICHARDSON. I yield to the gentleman from California.
  Mr. WAXMAN. in fact, as I mentioned in my statement, there are more 
than 1,300 Hispanic, Indian, Asian/Pacific Islander, and African-
American health professions students each year who have registered 
interest in practicing primary care with the National Health Service 
Corps program. These students have not been forced into making 
applications--they are genuinely interested in delivering primary care 
to underserved communities. Yet only 8 percent of them were able to 
receive financial assistance last year.
  Mr. RICHARDSON. It would seem that meeting this demand would help us 
meet the objective of delivering basic health care services in minority 
communities. If there are limited Federal dollars, is there a reason we 
should give a scholarship to a student who wants to practice primary 
care instead of a specialty? The AMA says that the specter of a future 
where economic factors dictate career or specialty choice is abhorrent. 
Isn't that already happening?
  Mr. WAXMAN. Absolutely. Let us look at two minority students from the 
same school. Upon graduating from medical school, each one of them has 
$100,000 in loans that must be repaid starting in their first years of 
practice at a rate of approximately $1,000 a month. The student who is 
thinking about being a cardiologist has no worries--she will be 
bringing home $350,000 a year. But the student who wants to return to 
his home town to be a pediatrician has a serious problem. As a primary 
care physician in a poor community, he could bring home as little as 
$60,000 a year, and have to pay off his loans while supporting a family 
and setting up a practice.
  Contrary to the AMA's suggestion, H.R. 3869 is the only approach that 
truly gives students a choice of career or specialty given the current 
financial disincentives to choosing primary care.
  Mr. RICHARDSON. I know the community health center in my district 
have difficulty recruiting physicians for exactly that reason. Let me 
clarify another point: there is some concern that having students 
accept scholarships with a primary care obligation may face the 
terrifying prospect of not being accepted into a residency program. Is 
there any truth to this?
  Mr. WAXMAN. None at all. First, only half the primary care residency 
slots each year are filled. Second, the National Health Service Corps 
scholarship program has not had a single student unable to fulfill his 
or her obligation because he or she were unable to secure a primary 
care residency slot.
  Mr. WAXMAN. Mr. Speaker, I reserve the balance of my time.
  Mr. MOORHEAD. Mr. Speaker, I have no further requests for time, and I 
yield back the balance of my time.
  Mr. WAXMAN. Mr. Speaker, we have additional requests for time, and I 
yield 5 minutes to the gentleman from Ohio [Mr. Stokes].
  Mr. STOKES. Mr. Speaker, I rise in recognition of H.R. 3869, the 
Minority Health Improvement Act of 1994, introduced by my colleague, 
the distinguished gentleman, Mr. Henry Waxman, on behalf of the 
Subcommittee on Health and the Environment. I would like to commend the 
gentleman from California [Mr. Waxman] the chairman of that 
subcommittee, for the leadership he has demonstrated in promoting 
legislation which addresses the serious disparities in minority health 
care in our Nation. Additionally, I would like to commend the members 
of that subcommittee including the distinguished gentlemen Congressman 
Edolphus Towns, Congressman Craig Washington, and Congressman Bill 
Richardson for their steadfast commitment to improving the health 
status of and quality of life for disadvantaged minorities.
  Mr. Speaker, of all groups lacking access to health care and 
experiencing a diminished health status, African-Americans and other 
disadvantaged minorities continue to top the list. Mr. Speaker, while I 
am in support of increased Federal involvement with this critical 
issue, I must express serious concerns about H.R. 3869, in its current 
state. This bill does not address the many concerns about health 
disparity among minorities as does the Senate companion bill, the 
Disadvantaged Minority Health Improvement Act of 1993, S. 1569.
  I am satisfied with conversations that I have had with the 
distinguished gentleman [Mr. John Dingell], chairman of the Committee 
on Energy and Commerce, and his distinguished Subcommittee on Health 
and the Environment, Chairman Henry Waxman, that they will work with me 
and Congresswoman Cardiss Collins, Congressman Towns, and Congressman 
Washington in order to try and address these many serious concerns.
  Our President has issued a call, Mr. Speaker, to his administration, 
experts around the United States, and to the Congress to reform our 
health care system. In meeting this challenge, we must not only look 
closely at new solutions to these problems, but to also strengthen and 
improve those programs that we know to be effective in meeting the 
health care needs of African-Americans and other disadvantaged 
populations. These are the segments of our population that continue to 
suffer the most diminishing health status, and in turn a further 
diminished quality of life.
  Mr. Speaker, from my position as a member of the Labor-Health and 
Human Services Appropriations Subcommittee, and particularly as 
chairman of the Congressional Black Caucus health Braintrust, I know 
that if we listen and respond to the experts in the minority community 
and to others committed to closing the minority health disparity gap, 
we have at our fingertips many of the answers to this critical problem.
  Mr. Speaker, I was proud to know of the unified support out there 
around the country that crosses economic, social, racial, and ethnic 
lines to support improving the health status of disadvantaged 
minorities. The level of confidence that I have in these groups and my 
colleagues leads me, at this time, to just note my reservations and 
vote for the legislation. Working closely with them between now and 
conference to address these serious concerns will make H.R. 3869 a 
better bill for improving the health of disadvantaged minorities.
  Mr. WAXMAN. Mr. Speaker, I yield 4 minutes to the gentleman from New 
York [Mr. Serrano].
  (Mr. SERRANO asked and was given permission to revise and extend his 
remarks.)
  Mr. SERRANO. Mr. Speaker, I rise in strong support of H.R. 3869, the 
Minority Health Improvement Act of 1994. As chairman of the 
Congressional Hispanic Caucus, I strongly commend Chairman Waxman of 
the Health and Environment Subcommittee for, once again, demonstrating 
and uncommon leadership and sensitivity to the needs of minority 
communities and all Americans.
  The enactment of the original Minority Health Improvement Act in 1990 
was historic because it brought the health concerns of ethnic and 
racial minority communities to the forefront of Federal health policy.
  The reality in this country is that there continues to be huge 
disparities between the health status of minority communities and the 
majority population. There are also big differences in the health 
status of each racial and ethnic group. Latinos continue to face 
serious obstacles when seeking health care. What's more, Latinos do not 
receive timely and adequate health care and are the single group most 
likely to lack health insurance coverage. However, Latino-specific 
health data is very scarce or out dated.
  H.R. 3869 addresses this lamentable situation by authorizing and 
strengthening Federal programs designed to improve the health status of 
minority communities, while attempting to equitably balance the needs 
of all groups served.
  The legislation includes key provisions originally contained H.R. 
3230, the Minority Health Opportunity Enhancement [M-HOPE ] Act, which 
I introduced on behalf of the Hispanic Caucus last year. The M-HOPE act 
focused on enhancing the responsiveness of the Federal health programs 
in meeting the needs of Latinos across the country.
  Indeed, H.R. 3860, the bill before us today, improves and strengthens 
the health care capacity of community-based facilities, includes 
programs to help minority students enter in health professions, and 
improves research on the health status of ethic minorities.
  I, and the Hispanic Caucus, strongly support provisions included in 
the bill to improve and increase services for limited-English-
proficient persons so that care is provided in an appropriate language 
and cultural context.
  We applaud the Hispanic and African-American members of the committee 
in negotiating changes to the Centers of Excellence program, and 
support the compromise reached.
  The changes to the Health Careers Opportunities Program [HCOP], which 
is a pipeline program to increase the number of minority health 
professionals, will allow for more institutions who serve Latinos to 
participate in the program. We welcome these changes since Latinos are 
severely represented in the health professions. As the committee report 
notes, the participation rates of Latinos in this program and other 
programs authorized by this act are unacceptably low.
  This legislation reauthorizes the community and migrant health center 
programs, which are badly needed in Latino communities. Latinos who 
live in urban settings face severely limited health care options 
because there are too few providers and the health care facilities are 
overcrowded. Many urban Latinos are forced to delay care or receive 
disjointed care. Studies of Latino communities in New York City, like 
the one I represent, reveal that existing health care providers could 
only meet 50 percent of the residents' needs for primary health care 
visits. Latinos who live in rural areas also face a dearth of primary 
care facilities and health care providers. Many Latinos communities on 
the Unites States-Mexico border do not have a single doctor.
  Many Latino medical students who want to return to their underserved 
communities to practice complain that they are having problems choosing 
primary care as a health professional option because of the huge debt 
they must incur. This legislation includes scholarships for minority 
students interested in working in underserved communities, like those 
in New York City and along the United States-Mexico border, to choose a 
primary care specialty for career interest rather than not having it as 
an option because of economic reasons. This is sound policy.
  Again, let me express my deepest gratitude to Chairman Waxman for his 
leadership in crafting a truly outstanding piece of legislation. His 
guidance will serve the Members of the House well as we consider health 
reform.
  I strongly urge my colleagues to support this legislation.

                              {time}  1310

  This legislation reauthorizes the Community and Migrant Health Care 
Centers which are badly needed in Latino communities. Latinos who live 
in urban settings face severely limited health care options because 
there are too few providers and the health care facilities are 
overcrowded.
  Therefore, as we look at the bill, the Hispanic Caucus is in full 
support of it. We feel, as we said before, that all Members involved 
have done a great job of incorporating our concerns, and we would hope 
for a situation when we get to the Committee on Appropriations where we 
can all be very much supportive of bringing about these changes.
  Ms. SNOWE. Mr. Speaker, I rise today in support of H.R. 3869, the 
Minority Health Improvement Act of 1994. This legislation not only 
reauthorizes and expands health services, professional programs and 
research for minorities, but it also incorporates several provisions of 
the Women's Health Equity Act of 1993, which Congresswoman Schroeder 
and I sponsored, including sections of the Women's Health Offices Act, 
which I sponsored.
  For far too long, at the Federal level, women's health has been 
neglected. In recent years, several pieces of legislation have been 
passed to address the inadequacies and inequities in health care of and 
medical research on women. Early in the 1980's, a task force was formed 
to review and recommend a comprehensive women's health agenda. Although 
an Office of Women's Health was established in 1991 in the Public 
Health Service, it did not receive a direct appropriation until fiscal 
year 1994.
  H.R. 3869 statutorily establishes a Public Health Service Office of 
Women's Health, ensuring that it will continue uninterrupted, defining 
and funding its mission. The Office will be administered by the Deputy 
Assistant Secretary for Women's Health, who has the authority to 
develop and support programs concerning women's health and advise heads 
of PHS agencies and monitor activities that relate to women's health. 
An appropriation of $5 million is authorized for fiscal year 1995.
  I am pleased that the Office of Women's Health will have general 
authority to offer recommendations on all programs and activities 
conducted by the Public Health Service to assure that women's health 
care needs will be addressed through a comprehensive and coordinated 
policy. I encourage my colleagues to vote for passage of H.R. 3839, 
which will ensure that women's health concerns are integrated into all 
programs and activities of the Public Health Service and that they no 
longer are an afterthought in the annals of medical research and care.
  Mr. ORTIZ. Mr. Speaker, today I rise in support of H.R. 3869, the 
Minority Health Improvement Act. This legislation seeks to improve the 
health status of racial and ethnic minorities by improving several 
Federal health programs. I am delighted that this legislation addresses 
the issues of birth defects and public health in the United States-
Mexico border area. I am pleased to be a cosponsor and advocate of this 
much-needed legislation.
  The birth defects provisions of this legislation are important not 
only to the residents of my district, but to the Nation as a whole. I 
became more aware of birth defects through a tragedy in Cameron County, 
TX, when it was noticed that there was a high rate of spinal and neural 
tube birth defects in infants born in the border region of south Texas. 
When the matter was first brought to my attention, I was astonished 
that there was no national monitoring system with which to track and 
investigate such birth defects.
  As I learned more about birth defects, I was startled to discover 
that birth defects occur in an estimated 250,000 infants annually and 
account for 21.5 percent of all infant deaths. It is shocking that 
there is no national strategy to discover causes for birth defects nor 
to implement preventive measures. I therefore introduced legislation to 
establish a national clearinghouse to track the incidence of birth 
defects and to investigate causes and educate the public.
  That is why I wholeheartedly support H.R. 3869, which recognizes the 
need for a national tracking system to monitor birth defects. The 
monitoring and research programs could identify causes of birth defects 
and develop prevention strategies. Birth defects are a major national 
health problem which crosses all geographic areas and affects children 
of all races and economic classes.
  Another important provision in H.R. 3869 calls for the establishment 
of a public health analytical laboratory along the United States-Mexico 
border. This lab would specifically aid border areas which 
characteristically have a high incidence of infectious and communicable 
diseases. The establishment of such a lab could provide invaluable 
information concerning the health status of border areas while also 
serving as a resource to border State public health agencies. 
Acknowledging the need for this border laboratory is a clear sign that 
we realize that health issues do not recognize borders.
  I believe that H.R. 3869 acknowledges the need for some Federal 
programs to integrate and expand their activities to a more diverse 
group. I urge my colleagues to support this legislation which could 
benefit many people who are often overlooked in the health area. Not 
only would the Minority Health Improvement Act improve health issues 
pertinent to minority groups, but it would serve as an investment to 
the health of all people of the United States.
  Mr. JEFFERSON. Mr. Speaker, it is ironic that the bill that carries 
the title ``Minority Health Improvement Act of 1994'' is opposed by the 
National Medical Association, the largest association of African-
American physicians in the Nation.
  The reason for the opposition by the NMA is the limitation the bill 
places on the use of scholarships for minority health providers, to 
those seeking careers as primary care physicians only. Why is it they 
ask, should a minority student, just because of his or her ability to 
pay for a medical education, be denied the opportunity available to 
medical students of means to choose a field of medical practice?
  Why indeed. Most minority physicians are already primary care 
providers. In the future, most will be forced by the circumstances of 
their practice or their own consciences to become primary care 
physicians. But to tell them, in an act of Congress, that is all they 
can do and that is what they must become, places a premature and unfair 
restriction on their medical careers.
  Family economic or social status must not determine the career 
options of any student in this Nation, let alone medical students. 
Unfortunately, the scholarship provisions of this bill have that 
effect. Therefore, I urge that this matter be resolved in conference.
  Mr. GILMAN. Mr. Speaker, I rise today in support of H.R. 3869, the 
Minority Health Improvement Act. I would like to thank the gentleman 
from California [Mr. Waxman] for introducing this important measure, as 
well as his role in helping to improve our health care system.
  H.R. 3869 creates new programs, reauthorizes and revises old ones in 
the following five areas: The Office of Minority Health within the 
Public Health Service; primary health services such as migrant and 
community health centers, homeless health centers, State grants for 
rural health programs, and healthy start for infants; health 
professions programs which provide scholarships to poor students 
wishing to pursue careers in health care; national health research 
programs; and native Hawaiian health care programs.
  Additionally, this measure focuses on women's health by authorizing 
funding for the Public Health Service Office of Women's Health, as well 
as improving women's scientific employment at the National Institutes 
of Health.
  Moreover, H.R. 3869 defines traumatic brain injury as ``An acquired 
injury to the brain'' not including brain dysfunction caused by 
congenital or degenerative disorders. Each year, over 90,000 people 
become disabled as a result of brain injury. Many sufferers and their 
families want these kinds of injuries to be distinguished from other 
disabilities because of the serious consequences of, and the lack of 
education programs and treatment for, the injury.
  Mr. Speaker, the purpose of many of the programs in H.R. 3869 is to 
improve the health of individuals who are members of minority groups 
through the provision of health care services and to increase the 
number of minorities who enter the health professions.
  Accordingly, I urge my colleagues to vote in favor of this important 
measure.
  Mr. WHEAT. Mr. Speaker, I rise in general support of H.R. 3869, the 
Minority Health Improvement Act, and the request for a conference. For 
each of us, good health is a fundamental part of our lives, the 
foundation upon which everything else rests. The ability to be 
productive, to hold a job, to learn, even to care for ourselves and our 
families, are all dependent on retaining our good health. H.R. 3869, 
and its Senate counterpart, S. 1569, reauthorize a number of important 
minority health programs which increase minority communities' access to 
health care.
  Another fundamental part of our lives, especially for children, is a 
loving and secure environment. Unfortunately, for growing numbers of 
children, their birth homes are no longer safe, loving and caring and 
the children have been placed in foster care. In fact, the number of 
children in foster care has exploded from 276,000 in 1986 to almost 
500,000 at this time. Children are entering foster care at a young age 
and staying longer.
  Minority children wait longer for adoption, are less likely to be 
placed, and are disproportionately represented among children waiting 
to be adopted--African-American children make up 40 percent of the 
children in foster care. Both informal policies, and formal policies in 
some States, provide barriers to transracial adoptions, thus keeping 
minority children apart from permanent homes.
  Foster care is intended to be temporary, a shelter until the child 
can be united with a new family where that child can have the love, 
care, and sense of permanency that is so necessary for the positive 
development of all children. We must do all we can to ensure that 
foster children are placed in safe, loving, adoptive homes as quickly 
as possible, allowing them to grow to be the most that they can be. To 
that end, I introduced the Multiethnic Adoption Act and support the 
same provision included in the Senate minority health bill.
  I realize that there are diverse viewpoints regarding the issue of 
adoption across racial lines. Some firmly believe that the only way 
minority children can retain their sense of identity and appreciate 
their racial and cultural heritage is to be raised in a family of the 
same race.
  However, Professor Rita Simon, at American University, tracked over 
200 families who had adopted across racial lines. Her findings are that 
```Transracially adopted' children are as well adjusted as children who 
are adopted into same-race families. Adoption by whites, she concludes, 
is better for minority children than the revolving door of permanent 
foster care.''
  Let us not allow our children to languish in foster care until those 
problems are resolved. Let us not allow our children to languish in 
foster care only because same-race families have not yet been located. 
let us not allow our children to remain in foster care a day longer 
than necessary. Let us make sure that children are not denied a 
permanent family because of race, color, or national origin.
  Mrs. MINK of Hawaii. Mr. Speaker, I rise today in support of H.R. 
3869, the Minority Health Improvement Act of 1994, which includes a 
variety of measures to improve the health status of minority and low-
income populations and to increase the participation of minorities in 
the health professions.
  The expansion of primary care programs included in the bill will help 
improve access to health care for ethnic minorities and people in 
poverty. The establishment of a new resource center to improve the 
ability of health care providers to serve limited English-speaking 
populations will greatly enhance the ability of immigrants and newly 
arrived residents to utilize the health system.
  The establishment of an Office of Women's Health in the Public Health 
Service is an important step in recognizing the past discrimination 
against women in the area of health. It will improve the health 
delivery service for low-income and minority women, who continue to 
have some of the most severe health difficulties, including poor 
nutrition, lack of prenatal and postnatal care, high incidence of 
breast cancer, diabetes, and other fatal diseases.
  This bill is also of particular significance to the native people of 
my State of Hawaii as it includes the reauthorization of the Native 
Hawaiian Health Care Act. The Native Hawaiian Health Care Act, in 
existence since 1988, is of critical importance to the survival of the 
native population of the State of Hawaii.
  This program seeks ways to improve the dismal health of the native 
Hawaiian people through the establishment of community-based health 
care systems sensitive to the special needs, mores, history, tradition, 
and culture of the native Hawaiian people.
  Mr. Speaker, many Members of the Congress are unaware of the history 
of the native Hawaiian people. And I appreciate the opportunity to 
share with the Members of this House the history of the native Hawaiian 
people and the events that have led to the tragic situation they find 
themselves in today.
  Once a strong, healthy, and thriving community, the native people of 
our islands suffered greatly from the foreign influences that began to 
arrive in the late 18th century, and which eventually dominated the 
islands, calling upon the U.S. military to overthrow the Hawaiian 
monarchy, imprison Hawaii's queen, and establish a government and a 
society foreign to the people of Hawaii.
  January of 1993 marked the 100th anniversary of the overthrow of the 
Hawaiian kingdom. And over the last century the native Hawaiian people 
have struggled to cope with the loss of their nation and assimilate in 
the western society.
  But despite their efforts, the introduction of western diseases, the 
breakdown of their culture, and suppression of traditional healing 
practices has left a legacy of poor health and nutrition, poverty, and 
high mortality rates.
  The native Hawaiian people currently suffer from extraordinarily high 
rates of heart disease, cancer, and chronic conditions, such as 
diabetes.
  An Office of Technology Assessment study authorized by the Congress 
in 1984, which compared both Hawaiian and part-Hawaiians to other 
populations in the United States, found that overall native Hawaiians 
have a death rate that averages 34 percent higher than all other races 
in the United States.
  Pure-blooded Hawaiians have a death rate that is an astounding 146 
percent higher than other Americans.
  The study also revealed that native Hawaiians die from diabetes at a 
rate that is 222 percent higher than for al races in the United States.
  Recent dtudies in the State of Hawaii show that 44 percent of all 
infant deaths in the State are native Hawaiian children, cancer rates 
among native Hawaiians far exceed other ethnic populations in our 
State, and health care services are often lacking in native Hawaiian 
communities.
  The high incidence of mental illness and emotional disorders among 
native Hawaiians is attributed to the cultural isolation and alienation 
in a statewide population in which they now constitute about 20 
percent.
  Disenfranchised from their land, culture, and ability to self-govern, 
the native Hawaiian people have suffered a plight similar to that of 
the native American Indians on the continental United States. And it is 
the responsibility of the Federal Government to assist in our efforts 
to improve the health status of the native people of Hawaii.
  In 1988 the Congress recognized this tremendous need and enacted the 
Native Hawaiian Health Care Act, which has provided the native Hawaiian 
community the opportunity to assess its own health needs and find 
solutions that its native population can understand and relate to.
  Since 1990 the Congress has appropriated funds to implement this act. 
H.R. 3869 does not set specific funding increases for this program, but 
simply relies upon the appropriation process to provide funds necessary 
to implement the goals of this act. In fiscal year 1994 the Congress 
provided $4.3 million for this program, and the President requested the 
same amount in his fiscal year 1995 budget proposal.
  Mr. Speaker, the Native Hawaiian Health Care Act of 1988 is one of 
the many initiatives by the Congress to assure Hawaiian people of their 
right to the protections and benefits of Federal legislation created to 
acknowledge the special trust responsibility of this Nation's 
aboriginal peoples.
  For 18 years the Congress has recognized the native Hawaiians as 
native Americans, and on 37 occasions the Congress passed Federal laws 
that include native Hawaiians in programs or services that are designed 
to service native American communities, and Congress has consistently 
supported programs specifically designated for native Hawaiians.
  I urge my colleagues to support H.R. 3869, which will help fulfill 
the original goal of the Native Hawaiian Health Care Act, to elevate 
and promote the health and well-being of the native Hawaiian people, so 
that they may function effectively as citizens and leaders in their 
homeland; and help determine and participate in the future of their 
culture, their race, and their land.
  Mr. WAXMAN. Mr. Speaker, I have no further requests for time, and I 
yield back the balance of our time.
  Mr. MOORHEAD. Mr. Speaker, I yield back the balance of my time.
  The SPEAKER pro tempore (Mr. Montgomery). The question is on the 
motion offered by the gentleman from California [Mr. Waxman] that the 
House suspend the rules and pass the bill, H.R. 3869, as amended.
  The question was taken; and (two-thirds having voted in favor 
thereof) the rules were suspended and the bill, as amended, was passed.
  A motion to reconsider was laid on the table.
  Mr. WAXMAN. Mr. Speaker, I ask unanimous consent to take from the 
Speaker's table the Senate 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, and ask for its immediate consideration.
  The Clerk read the title of the Senate bill.
  The SPEAKER pro tempore. Is there objection to the request of the 
gentleman from California?
  There was no objection.
  The Clerk read the Senate bill, as follows:

                                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 1994''.
       (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. Health services for residents of public housing.
Sec. 202. Issuance of regulations regarding language as impediment to 
              receipt of services.
Sec. 203. 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. Activities of Agency for Health Care Policy and Research.
Sec. 403. Data collection by National Center for Health Statistics.

                         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.
Sec. 507. Demonstration projects regarding diabetic-retinopathy.
Sec. 508. Mexican Border State Analytical Laboratories.
Sec. 509. Construction of regional centers for research on primates.

                    TITLE VI--MULTIETHNIC PLACEMENT

Sec. 601. Short title.
Sec. 602. Findings and purpose.
Sec. 603. Multiethnic placements.

                  TITLE VII--VOLUNTARY MUTUAL REUNIONS

Sec. 701. Facilitation of reunions.

                     TITLE VIII--GENERAL PROVISIONS

Sec. 801. 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. 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. 202. 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. 203. 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 ``$5,000,000 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 under-represented 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. 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.''.

     SEC. 403. DATA COLLECTION BY NATIONAL CENTER FOR HEALTH 
                   STATISTICS.

       Section 306(n) of the Public Health Service Act (42 U.S.C. 
     242k(n)), as redesignated by section 501(a)(5)(B) of Public 
     Law 103-183 (107 Stat. 2237), is amended to read as follows:
       ``(n)(1) For health statistical and epidemiological 
     activities undertaken or supported under this section, there 
     are authorized to be appropriated such sums as may be 
     necessary for each of the fiscal years 1995 through 1998.
       ``(2) Of the amounts appropriated under paragraph (1) for a 
     fiscal year, the Secretary shall obligate not more than an 
     aggregate $5,000,000 for carrying out subsections (h), (l), 
     and (m) with respect to particular racial and ethnic 
     population groups, except that not more than $100,000 may be 
     expended in the aggregate for the administration of 
     activities under subsection (m) and for activities described 
     in paragraph (2) of such subsection.''.
                         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.''.

     SEC. 507. DEMONSTRATION PROJECTS REGARDING DIABETIC-
                   RETINOPATHY.

       (a) In General.--The Secretary of Health and Human 
     Services, acting through the Director of the National Eye 
     Institute and in consultation with the Director of the 
     Centers for Disease Control and Prevention, may make grants 
     to public and nonprofit private entities for demonstration 
     projects to serve the populations specified in subsection (b) 
     by carrying out, with respect to the eye disorder known as 
     diabetic retinopathy, all activities regarding information, 
     dissemination, early detection, education, and prevention.
       (b) Relevant Populations.--The populations referred to in 
     subsection (a) are minority populations that have diabetes 
     mellitus.
       (c) Authorization of Appropriations.--For the purpose of 
     carrying out this section, there is authorized to be 
     appropriated $1,000,000 for each of the fiscal years 1995 
     through 1997.

     SEC. 508. MEXICAN BORDER STATE ANALYTICAL LABORATORIES.

       (a) In General.--The Secretary of Health and Human 
     Services, acting through the Director of the Centers for 
     Disease Control and Prevention, may make grants to eligible 
     entities to establish and operate State laboratories to 
     analyze human, wildlife, air, water, and soil samples. The 
     laboratories shall serve the border region.
       (b) Eligible Entity.--To be eligible to receive a grant 
     under subsection (a), an entity shall be a State that borders 
     Mexico.
       (c) Applications Requirements.--No grant may be made under 
     subsection (a) unless an application has been submitted to 
     and approved by the Secretary of Health and Human Services.
       (d) Authorization of Appropriations.--For the purpose of 
     carrying out subsection (a), there are authorized to be 
     appropriated such sums as may be necessary for each of the 
     fiscal years 1995 through 1997.

     SEC. 509. CONSTRUCTION OF REGIONAL CENTERS FOR RESEARCH ON 
                   PRIMATES.

       Section 481B of the Public Health Service Act (42 U.S.C. 
     287a-3), as added by section 1503 of Public Law 103-43 (107 
     Stat. 178), is amended to read as follows:


      ``construction of regional centers for research on primates

       ``Sec. 481B. With respect to activities carried out by the 
     National Center for Research Resources to support regional 
     centers for research on primates, the Director of NIH may, 
     for each of the fiscal years 1994 through 1996, reserve from 
     the amounts appropriated under section 481A(h) not more than 
     $3,000,000 for the purpose of making awards of grants and 
     contracts to public and non-profit private entities to 
     construct, renovate, or otherwise improve such regional 
     centers. The reservation of such amounts for any fiscal year 
     is subject to the availability of qualified applicants for 
     such awards.''.
                    TITLE VI--MULTIETHNIC PLACEMENT

     SEC. 601. SHORT TITLE.

       This title may be cited as the ``Multiethnic Placement Act 
     of 1994''.

     SEC. 602. 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. 603. 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.).
                  TITLE VII--VOLUNTARY MUTUAL REUNIONS

     SEC. 701. 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 a reunion.
                     TITLE VIII--GENERAL PROVISIONS

     SEC. 801. 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.

                      Motion offered by Mr. Waxman

  Mr. WAXMAN. Mr. Speaker, I offer a motion.
  The Clerk read as follows:

       Mr. Waxman moves to strike all after the enacting clause of 
     the Senate bill, S. 1569, and insert in lieu thereof the 
     provisions of H.R. 3869 as passed by the House.

  The motion was agreed to.
  The Senate bill was ordered to be read a third time, was read the 
third time, and passed.
  The title of the Senate bill was amended so as to read: ``A bill to 
amend the Public Health Service Act to revise and extend programs 
relating to the health of individuals who are members of minority 
groups, and for other purposes.''
  A motion to reconsider was laid on the table.


                 Appointment of Conferees on H.R. 3869

  Mr. WAXMAN. Mr. Speaker, I ask unanimous consent that the House 
insist on its amendment to the Senate bill and request a conference 
with the Senate thereon.
  The SPEAKER pro tempore. Is there objection to the request of the 
gentleman from California? The Chair hears none and, without objection, 
appoints the following conferees: Messrs. Dingell, Waxman, Richardson, 
Towns, Washington, Moorhead, Bliley, and Bilirakis.
  There was no objection.

                          ____________________