[Congressional Record Volume 140, Number 144 (Thursday, October 6, 1994)]
[House]
[Page H]
From the Congressional Record Online through the Government Printing Office [www.gpo.gov]


[Congressional Record: October 6, 1994]
From the Congressional Record Online via GPO Access [wais.access.gpo.gov]

 
 CONFERENCE REPORT ON S. 1669, MINORITY HEALTH IMPROVEMENT ACT OF 1994

  Mr. WAXMAN submitted the following conference report and statement on 
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:

                  Conference Report (H. Rept. 103-843)

       The committee of conference on the disagreeing votes of the 
     two Houses on the amendments of the House to the 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, having met, after full and free conference, have 
     agreed to recommend and do recommend to their respective 
     Houses as follows:
       That the Senate recede from its disagreement to the 
     amendment of the House to the text of the bill and agree to 
     the same with an amendment as follows:
       In lieu of the matter proposed to be inserted by the House 
     amendment, insert the following:

     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--OFFICES OF MINORITY HEALTH; ASSISTANT SECRETARY FOR CIVIL 
                                 RIGHTS

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.
Sec. 103. Assistant Secretary of Health and Human Services for Civil 
              Rights.

                   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.
Sec. 210. Issuance of regulations regarding language as impediment to 
              receipt of services.

                 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.
Sec. 308. Area health education centers.

                           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.
Sec. 808. Demonstration projects regarding Alzheimer's disease.
Sec. 809. Technical corrections relating to health professions 
              programs.
Sec. 810. Clinical traineeships.
Sec. 811. Construction of regional centers for research on primates.

                      TITLE IX--GENERAL PROVISIONS

Sec. 901. Effective date.

   TITLE I--OFFICE OF MINORITY HEALTH; ASSISTANT SECRETARY FOR CIVIL 
                                 RIGHTS

     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 
     racial and ethnic minority groups, the Secretary, acting 
     through the Deputy Assistant Secretary for Minority Health 
     (in this section referred to as the `Deputy Assistant 
     Secretary'), 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 heads of each of the agencies of the 
     Service shall consult with the Deputy Assistant Secretary to 
     ensure the coordination of such activities.
       ``(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 
     individiuals who are members of racial or ethnic minority 
     groups.
       ``(D) Ensure that the National Center for Health Statistics 
     collects data on the health status of each minority group.
       ``(E) 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) 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) Carry out programs to improve access to health care 
     services for individuals with limited proficiency in speaking 
     the English language by facilitating the removal of 
     impediments to the receipt of health care that result from 
     such limitation. Activities under the preceding sentence 
     shall include conducting research and developing and 
     evaluating model projects.
       ``(5) Not later than June 8 of each year, the Deputy 
     Assistant Secretary shall submit to the Secretary a report 
     summarizing the activities of each of the minority health 
     offices under section 1707A.
       ``(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'). The Deputy Assistant Secretary shall consult 
     with the Committee in carrying out this section.
       ``(2) Duties.--The Committee shall provide advice to the 
     Deputy Assistant Secretary carrying out this section, 
     including advice on the development of goals and specific 
     program activities under paragraphs (1) and (2) of subsection 
     (b) for each racial and ethnic minority group.
       ``(3) Chair.--The Deputy Assistant Secretary shall serve as 
     the chair of the Committee.
       ``(4) Composition.--
       ``(A) The Committee shall be composed of 12 voting members 
     appointed in accordance with subparagraph (B), and nonvoting, 
     ex officio members designated in subparagraph (C).
       ``(B) The voting members of the Committee shall be 
     appointed by the Secretary from among individuals who are not 
     officers or employees of the Federal Government and who have 
     expertise regarding issues of minority health. The racial and 
     ethnic minority groups shall be equally represented among 
     such members.
       ``(C) The nonvoting, ex officio members of the Committee 
     shall be the directors of each of the minority health offices 
     established under section 1707A, and such additional 
     officials of the Department of Health and Human Services as 
     the Secretary determines to be appropriate.
       ``(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. Such 
     compensation may not be in an amount in excess of the daily 
     equivalent of the annual maximum rate of basic pay payable 
     under the General Schedule (under title 5, United States 
     Code) for positions above GS-15.
       ``(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 to the Deputy Assistant Secretary 
     regarding activities under subsection (b)(4).
       ``(2) Equitable allocation regarding activities.--
       ``(A) In making awards of grants, cooperative agreements, 
     or contracts under this section or section 338A, 338B, 340A, 
     404, 724, 736, 737, 738, or 740, the Secretary, acting as 
     appropriate through the Deputy Assistant Secretary or the 
     Administrator of the Health Resources and Services 
     Administration, shall ensure that such awards are equitably 
     allocated with respect to the various racial and minority 
     populations.
       ``(B) With respect to grants, cooperative agreements, and 
     contracts that are available under the sections specified in 
     subparagraph (A), the Secretary shall--
       ``(i) carry out activities to inform entities, as 
     appropriate, that the entities may be eligible for awards of 
     such assistance;
       ``(ii) 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
       ``(iii) 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.
       ``(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.
       ``(e) Grants and Contracts Regarding Duties.--
       ``(1) In general.--In carrying out subsection (b), the 
     Deputy Assistant Secretary may make awards of grants, 
     cooperative agreements, and contracts to public and nonprofit 
     private entities.
       ``(2) Process for making awards.--The Deputy Assistant 
     Secretary shall ensure that awards under paragraph (1) are 
     made only on a competitive basis, and that an award is made 
     for a proposal only if the proposal has been recommended for 
     such an award through a process of peer review and has been 
     so recommended by the advisory committee established under 
     subsection (c).
       ``(3) Evaluation and dissemination.--The Deputy Assistant 
     Secretary, directly or through contracts with public and 
     private entities, shall provide for evaluations of projects 
     carried out with awards made under paragraph (1) during the 
     preceding 2 fiscal years. The report shall be included in the 
     report required under subsection (f) for the fiscal year 
     involved.
       ``(f) Biennial Reports.--Not later than February 1 of 
     fiscal year 1996 and of each second year thereafter, the 
     Deputy Assistant 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 racial and ethnic minority groups. 
     Each such report shall include the biennial reports submitted 
     to the Deputy Assistant Secretary under section 1707A(e) for 
     such years by the heads of the minority health offices.
       ``(g) Definition.--For purposes of this section:
       ``(1) The term `racial and ethnic minority group' means 
     American Indians (including Alaskan Natives, Eskimos, and 
     Aleuts); Asian Americans and Pacific Islanders; Blacks; and 
     Hispanics.
       ``(2) The term `Hispanic' means individuals whose origin is 
     Mexican, Puerto Rican, Cuban, Central or South American, or 
     any other Spanish-speaking country.
       ``(h) Funding.--
       ``(1) Authorization of appropriations.--For the purpose of 
     carrying out this section, there are authorized to be 
     appropriated $21,000,000 for fiscal year 1995, $25,000,000 
     for fiscal year 1996, and $28,000,000 for fiscal year 1997.
       ``(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 carrying out subsection (b)(2)(E).''.
       (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 racial and ethnic 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 racial and ethnic 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 carry out the following:
       ``(1) Determine the extent to which the purposes of the 
     programs are being carried out with respect to racial and 
     ethnic 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. In the 
     case of programs that provide services, such recommendations 
     shall include recommendations toward ensuring that--
       ``(A) the services are equitably delivered with respect to 
     racial and ethnic minority groups;
       ``(B) the programs provide the services in the language and 
     cultural context that is most appropriate for the individuals 
     for whom the services are intended; and
       ``(C) the programs utilize racial and ethnic minority 
     community-based organizations to deliver the services.
       ``(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 racial and 
     ethnic 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 `racial and ethnic minority group' has the 
     meaning given such term in section 1707(g).
       ``(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.''.

     SEC. 103. ASSISTANT SECRETARY OF HEALTH AND HUMAN SERVICES 
                   FOR CIVIL RIGHTS.

       (a) In General.--Part A of title II of the Public Health 
     Service Act (42 U.S.C. 202 et seq.) is amended by adding at 
     the end the following new section:


                 ``assistant secretary for civil rights

       ``Sec. 229. (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--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) 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 
     ``1996''; and
       (B) in paragraph (2)(A), by striking ``1994'' and inserting 
     ``1996''.
       (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) Criteria regarding specific shortages.--Section 
     330(b)(4)(B) of the Public Health Service Act (42 U.S.C. 
     254c(b)(4)(B)) is amended by striking ``include'' and all 
     that follows through ``the ability of the residents'' and 
     inserting the following: ``include factors indicative of the 
     health status of the residents of an area or the health 
     status of a population group, such as infant mortality in an 
     area or population group, the ability of the residents''.
       (3) 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.''.
       (4) Offsite activities.--Section 330(b) of the Public 
     Health Service Act, as amended by paragraph (3) 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.''.
       (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 
     ``1996''; and
       (B) in paragraph (2)(A), by striking ``1994'' and inserting 
     ``1996''.

     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''; and
       (3) in subsection (k), by striking ``$10,000,000'' and 
     inserting ``$20,000,000''.

     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, Blacks, 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, Blacks, 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 22 demonstration projects to 
     provide the services described in subsection (b)(1)(A) for 
     the purpose of reducing, in the geographic areas in which the 
     projects are carried out--
       ``(A) the incidence of infant mortality;
       ``(B) the incidence of low-birthweight births; and
       ``(C) the incidence of maternal mortality.
       ``(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) Eligible Uses of Grant.--
       ``(1) Authorized services.--
       ``(A) In general.--Subject to subsection (h), the services 
     referred to in this subsection are comprehensive services 
     (including preventive and primary health services for 
     pregnant and postpartum women and infants and infant 
     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.
       ``(B) Use of certain providers.--
       ``(i) 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 the entities described in clause (ii) if such 
     entities are providing services in the service area of such 
     project and the entities are willing to make such 
     arrangements with the applicant.
       ``(ii) For purposes of clause (i), the entities described 
     in this clause are the following: Grantees under any of 
     sections 329, 330, 340, and 340A; the public health agencies 
     of the States and localities involved; and social service 
     agencies, local hospitals, and community-based organizations 
     that are public or nonprofit private entities and have a 
     history of serving the populations served by the 
     demonstration project involved.
       ``(C) Confidentiality.--The Secretary may make a grant 
     under subsection (a) only if the applicant for the grant, and 
     each provider of services in the demonstration project 
     involved, agree to ensure the confidentiality of records that 
     the project maintains on individuals who receive the services 
     of the project.
       ``(2) Other uses.--The Secretary shall authorize grantees 
     under subsection (a) to expend the grant for following:
       ``(A) The development of community-based partnerships for 
     the organization and delivery of services to pregnant women 
     and to infants.
       ``(B) The development and operation of data systems 
     necessary for monitoring the provision of services to the 
     individuals served by the demonstration project involved and 
     determining the outcomes of such services.
       ``(C) Carrying out infant mortality reviews.
       ``(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) during a period designated by the Secretary, 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 applicant by 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)(1)(A) 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 Proposal for 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 that 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--
       ``(1) under a health insurance policy or plan (including a 
     group health plan or a prepaid health plan);
       ``(2) under any Federal or State health benefits program, 
     including any program under title V, XVIII, or XIX of the 
     Social Security Act; or
       ``(3) under subpart II of part B of title XIX of this Act.
       ``(g) Maintenance of Effort.--With respect to expenditures 
     for authorized services under subsection (b), the Secretary 
     may make a grant under subsection (a) only if the following 
     agreements are made:
       ``(1) The applicant involved agrees that, in the case of 
     non-Federal amounts the expenditure of which is within the 
     discretion of the applicant, the applicant will maintain 
     expenditures of such amounts for authorized services at a 
     level that is not less than the level of such expenditures 
     maintained by the applicant for fiscal year 1993.
       ``(2) The State in which the demonstration project will be 
     carried out (or the appropriate agencies of the State) agrees 
     to maintain expenditures of non-Federal amounts for 
     authorized services at a level that is not less than the 
     level of such expenditures maintained by the political 
     subdivision for fiscal year 1993.
       ``(3) Each political subdivision in the service area of the 
     demonstration project 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 1993.
       ``(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) Activities other than provision of services.--The 
     Secretary may make a grant under subsection (a) only if the 
     applicant involved agrees that not more than 15 percent of 
     the grant will be expended for administering the grant, 
     collecting and analyzing data, and carrying out the 
     activities described in subsection (b)(2).
       ``(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.--
       ``(1) In general.--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:
       ``(A) The number of individuals that received authorized 
     services, and the demographic characteristics of the 
     population of such individuals.
       ``(B) 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.
       ``(C) The sources of payment for the authorized services 
     provided.
       ``(D) An analysis of the causes of death determined under 
     subsection (i).
       ``(E) The extent of progress being made toward meeting the 
     health status objectives specified in subsection (a)(2) for 
     the populations served.
       ``(F) The extent to which children under age 1 served by 
     the project have received the appropriate number and variety 
     of immunizations against vaccine-preventable diseases.
       ``(G) With respect to the populations served by the 
     project, the extent to which 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).
       ``(2) Cooperation of state regarding medicaid goals for 
     participation.--With respect to the State in which a proposed 
     demonstration project under subsection (a) is to be carried 
     out, the Secretary may make a grant under such subsection for 
     the project only if the State (or the appropriate agency of 
     the State) agrees to provide to the applicant involved, in a 
     timely manner, the information needed by the applicant for 
     purposes of paragraph (1)(G).
       ``(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 include, as participants, 
     residents of the service area of the project and 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 section.
       ``(m) Evaluation.--The Secretary shall provide for an 
     evaluation of demonstration projects carried out under 
     subsection (a), other than any such project for which a grant 
     under such subsection was first provided during fiscal year 
     1994.
       ``(n) Reports to Congress.--
       ``(1) In general.--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, two reports regarding this section. 
     The first such report shall be submitted not later than 
     February 1, 1997, and shall be an interim report providing 
     such components of the information described in paragraph (2) 
     as may be available during the period involved. The second 
     such report shall be submitted not later than February 1, 
     1998, and shall be a final report providing the information 
     so described.
       ``(2) Contents.--For purposes of paragraph (1), the 
     information described in this paragraph is--
       ``(A) a summary of the reports received by the Secretary 
     under subsection (j);
       ``(B) a summary of the evaluation conducted by the 
     Secretary under subsection (m);
       ``(C) a description of the extent to which the Secretary 
     has, in the service areas of demonstration projects under 
     subsection (a), been successful in meeting the health status 
     objectives specified in subsection (a)(2); and
       ``(D) a description of the extent to which such projects 
     have been cost effective.
       ``(o) Definitions.--For purposes of this section:
       ``(1) The term `authorized services' means the services 
     specified in subsection (b)(1)(A).
       ``(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) Funding.--
       ``(1) 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.
       ``(2) Limitations.--
       ``(A) Of the amounts appropriated under paragraph (1) for a 
     fiscal year, the Secretary may not obligate more than 2 
     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 activities to provide information and education 
     to the public.
       ``(B) Of the amounts appropriated under paragraph (1) 
     through fiscal year 1997, the Secretary may not expend more 
     than an aggregate $6,000,000 for evaluations under subsection 
     (m).
       ``(q) Sunset.--Effective October 1, 1997, this section is 
     repealed.''.
       (c) 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.
       (d) 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.
       (e) 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 any program providing for 
     the development or operation of demonstration projects 
     substantially similar to the demonstration projects carried 
     out under such section 340E.

     SEC. 209. DEMONSTRATION PROJECTS REGARDING DIABETIC-
                   RETINOPATHY.

       (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) Establishment of Program.--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:


        ``demonstration projects regarding diabetic-retinopathy

       ``Sec. 317G. (a) In General.--The Secretary, acting through 
     the Director of the Center for Chronic Disease Prevention and 
     Health Promotion (of the Centers for Disease Control and 
     Prevention) and in consultation with the Director of the 
     National Eye Institute, shall 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 have diabetes 
     mellitus.''.

     SEC. 210. ISSUANCE OF REGULATIONS REGARDING LANGUAGE AS 
                   IMPEDIMENT TO RECEIPT OF SERVICES.

       (a) Proposed Rule.--Not later than the expiration of the 
     180-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 to establish regulations for policies to reduce 
     the extent to which having limited proficiency in speaking 
     the English language constitutes a significant impediment to 
     individuals in participating in, or receiving the benefits 
     of, any program or activity--
       (1) under the Public Health Service Act;
       (2) under titles XVIII or XIX of the Social Security Act; 
     or
       (3) for which the Secretary otherwise provides financial 
     assistance.
       (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 to establish the 
     regulations 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).

                 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. CESAR CHAVEZ PROGRAM FOR PRIMARY CARE 
                   SCHOLARSHIPS.

       ``(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), and graduate programs in 
     mental health practice.
       ``(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 has a financial need for a scholarship 
     under such subsection.
       ``(3) 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.
       ``(4) 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.--
       ``(1) In general.--In awarding scholarships under 
     subsection (a), the Secretary shall give preference to 
     eligible individuals for whom the costs of attending the 
     school involved would constitute a severe financial hardship.
       ``(2) Additional preferences.--Of the eligible individuals 
     receiving preference for purposes of paragraph (1), the 
     Secretary shall give additional preference to individuals 
     meeting any of the following conditions:
       ``(A) The individuals received scholarships pursuant to 
     this section, section 737, or section 740(d)(2) for fiscal 
     year 1994.
       ``(B) The individuals are seeking scholarships for 
     attendance at eligible schools that received a grant under 
     any of such sections for such fiscal year.
       ``(C) The individuals are bilingual.
       ``(D) The individuals participate in a program or activity 
     carried out under section 739 by a grantee under such 
     section.
       ``(d) Applicability of Certain Provisions.--
       ``(1) In general.--Except as provided in paragraph (2), and 
     except as otherwise 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.
       ``(2) Option regarding certain medical fields.--
       ``(A) With respect to amounts that the Secretary reserves 
     for scholarships under subsection (a) for attendance at 
     schools of medicine or osteopathic medicine, the Secretary 
     shall obligate 30 percent for such scholarships for 
     individuals whose contracts made pursuant to paragraph (1) 
     provide to the individuals, subject to subparagraph (B), the 
     option of performing obligated service under the contract in 
     a medical field not providing primary health services.
       ``(B) In the case of an individual whose contract made 
     pursuant to paragraph (1) provides the option described in 
     subparagraph (A), the contract shall provide that, in the 
     event that the individual exercises the option, the period of 
     obligated service applicable under the contract is 2 years 
     for each school year for which the scholarship involved is 
     provided.
       ``(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 $25,000,000 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(f)(2)(B).
       ``(2) Allocations by secretary.--
       ``(A) Of the amounts appropriated under paragraph (1) for a 
     fiscal year and of the amounts available under section 
     740(f)(2)(B) for the year, the Secretary shall obligate 
     amounts in accordance with the following:
       ``(i) 19 percent shall be obligated for scholarships under 
     subsection (a) for attendance at schools of dentistry.
       ``(ii) 16 percent shall be obligated for scholarships under 
     such subsection for attendance at schools of nursing.
       ``(iii) 10 percent shall be obligated for scholarships 
     under such subsection for attendance at graduate programs in 
     mental health practice.
       ``(B) The requirements of subparagraph (A) apply only to 
     the extent that a sufficient number of eligible individuals 
     seeks the scholarships involved.''.
       (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.

       Section 737 of the Public Health Service Act (42 U.S.C. 
     293a) is amended to read as follows:

     ``SEC. 737. THURGOOD MARSHALL PROGRAM FOR HEALTH SERVICES 
                   SCHOLARSHIPS.

       ``(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 the health professions schools 
     described in subsection (c).
       ``(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 has a financial need for a scholarship 
     under such subsection.
       ``(3) 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.
       ``(4) The individual enters into the contract required 
     pursuant to subsection (e) 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) Eligible Schools.--A health professions school 
     referred to in subsection (a) is a health professions school 
     meeting the following conditions:
       ``(1) The school is a school of veterinary medicine, 
     optometry, pharmacy, podiatric medicine, or public health, or 
     a designated school of allied health (as defined in 
     subsection (f)).
       ``(2) The school is carrying out a program for recruiting 
     and retaining students from disadvantaged backgrounds, 
     including students who are members of racial and ethnic 
     minority groups.
       ``(d) Preferences Regarding Awards.--
       ``(1) In general.--In awarding scholarships under 
     subsection (a), the Secretary shall give preference to 
     eligible individuals for whom the costs of attending the 
     school involved would constitute a severe financial hardship.
       ``(2) Additional preferences.--Of the eligible individuals 
     receiving preference for purposes of paragraph (1), the 
     Secretary shall give additional preference to individuals 
     meeting any of the following conditions:
       ``(A) The individuals received scholarships pursuant to 
     this section for fiscal year 1994.
       ``(B) The individuals are seeking scholarships for 
     attendance at eligible schools that received a grant under 
     this section for such fiscal year.
       ``(C) The individuals are bilingual.
       ``(D) The individuals participate in a program or activity 
     carried out under section 739 by a grantee under such 
     section.
       ``(e) Applicability of Certain Provisions.--
       ``(1) In general.--Except as provided in paragraph (2), and 
     except as otherwise 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.
       ``(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 made pursuant to 
     paragraph (1) shall provide that the individual agrees that, 
     after completing training in such medicine, the individual 
     will, in accordance with requirements established under 
     subparagraph (B)--
       ``(i) serve in a position in which the individual conducts 
     or assists in the conduct of research regarding human health 
     or safety; or
       ``(ii) serve in a position with a public health agency of a 
     State or a political subdivision of a State.
       ``(B) The Secretary shall establish requirements regarding 
     contracts under subparagraph (A).
       ``(f) Definitions.--For purposes of this section:
       ``(1) The term `designated school of allied health' means a 
     school of allied health providing training in occupational 
     therapy, physical therapy, dental hygiene, medical 
     technology, or radiologic technology.
       ``(2) The term `eligible individual' means an individual 
     described in subsection (b).
       ``(3) The term `eligible school' means a school described 
     in subsection (c).
       ``(g) Funding.--
       ``(1) Authorization of appropriations.--For the purpose of 
     carrying out this section, there are authorized to be 
     appropriated $5,000,000 for fiscal year 1995, $8,000,000 for 
     fiscal year 1996, and $10,000,000 for fiscal year 1997.
       ``(2) Allocations by secretary.--With respect to 
     scholarships under subsection (a) for attendance at 
     designated schools of allied health, the Secretary shall 
     obligate for such scholarships 25 percent of the amounts 
     appropriated under paragraph (1) for each of the fiscal years 
     1995 through 1997. The requirement of the preceding sentence 
     applies only to the extent that a sufficient number of 
     eligible individuals seeks such scholarships.''.

     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) Fellowships.--
       (1) In general.--Section 738(b) of the Public Health 
     Service Act (42 U.S.C. 293b(b)) is amended--
       (A) in paragraph (2)(B), by striking ``$30,000'' and 
     inserting ``$50,000''; and
       (B) in paragraph (3)--
       (i) in subparagraph (B), by inserting ``and'' after the 
     semicolon at the end;
       (ii) in subparagraph (C), by striking ``; and'' and 
     inserting a period; and
       (iii) by striking subparagraph (D).
       (2) Definition.--Section 738(b) of the Public Health 
     Service Act (42 U.S.C. 293b(b)) is amended--
       (A) in paragraph (1), by striking ``the number'' and all 
     that follows and inserting the following: ``the number of 
     underrepresented minority individuals who are members of the 
     faculty of the schools.'';
       (B) in paragraph (3)(A), by striking ``individuals from 
     underrepresented minorities in the health professions'' and 
     inserting ``underrepresented minority individuals''; and
       (C) in paragraph (5), by striking ``the term'' and all that 
     follows and inserting the following: ``the term 
     `underrepresented minority individuals' means individuals who 
     are members of racial or ethnic minority groups that are 
     underrepresented in the health professions.''.
       (c) Authorization of Appropriations.--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 
     $1,100,000 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 interest 
     students of secondary schools and institutions of higher 
     education in pursuing careers in the health professions, and 
     to prepare interested students academically for such 
     careers;'';
       (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 $24,000,000 for fiscal year 1995, $28,000,000 
     for fiscal year 1996, and $33,000,000 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 1996, not 
     less than the sum of such aggregate amount for fiscal year 
     1995 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 1997 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.--During the period specified in paragraph 
     (2)--
       (A) the amendments made by subsections (a) through (f) do 
     not apply to any entity that received a grant for fiscal year 
     1994 under section 739 of the Public Health Service Act; and
       (B) such a grant to the entity for fiscal year 1995 or 
     subsequent fiscal years shall be made and expended in 
     accordance with the provisions of such section as in effect 
     on the day before the date of the enactment of this Act.
       (2) Relevant period.--In the case of an entity that 
     received a grant for fiscal year 1994 under section 739 of 
     the Public Health Service Act, 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. HEALTH CAREERS OPPORTUNITY PROGRAM.

       ``(a) In General.--Subject to the provisions of this 
     section, the Secretary may make grants and enter into 
     cooperative agreements and contracts for any of the following 
     purposes:
       ``(1) Identifying and recruiting individuals who--
       ``(A) are students of elementary schools, or students or 
     graduates of secondary schools or of institutions of higher 
     education;
       ``(B) are from disadvantaged backgrounds; and
       ``(C) are interested in a career in the health professions.
       ``(2) Facilitating the entry of such individuals into a 
     health professions school.
       ``(3) Providing counseling or other services designed to 
     assist such individuals in successfully completing their 
     education at such a school.
       ``(4) Providing, for a period prior to the entry of such 
     individuals into the regular course of education of such a 
     school, preliminary education designed to assist the 
     individuals in successfully completing such regular course of 
     education at such a school, or referring such individuals to 
     institutions providing such preliminary education,
       ``(5) Paying such stipends as the Secretary may approve for 
     such individuals for any period of education in student-
     enhancement programs (other than regular courses) at a health 
     professions schools, except that such a stipend may not be 
     provided to an individual for more than 12 months, and such a 
     stipend may not exceed $25 per day (notwithstanding any other 
     provision of law regarding the amount of stipends).
       ``(6) Carrying out programs under which such individuals 
     both--
       ``(A) gain experience regarding a career in a field of 
     primary health care through working at facilities of 
     nonprofit private community-based providers of primary health 
     services; and
       ``(B) receive academic instruction to assist in preparing 
     the individuals to enter health professions schools in such 
     fields.
       ``(b) Receipt of Award.--
       ``(1) Eligible entities; requirement of consortium.--The 
     Secretary may make an award under subsection (a) only if the 
     following conditions are met:
       ``(A) The applicant for the award is a public or nonprofit 
     private entity, and the applicant has established a 
     consortium consisting of nonprofit private community-based 
     organizations and health professions schools.
       ``(B) The health professions schools of the consortium are 
     schools of medicine or osteopathic medicine, public health, 
     dentistry, veterinary medicine, optometry, pharmacy, allied 
     health, chiropractic, or podiatric medicine, or graduate 
     programs in mental health practice (including such programs 
     in clinical psychology).
       ``(C) Except as provided in subparagraph (D), the 
     membership of the consortium includes not less than one 
     nonprofit private community-based organization and not less 
     than three health professions schools.
       ``(D) In the case of an applicant whose exclusive activity 
     under the award will be carrying out one or more programs 
     described in subsection (a)(6), the membership of the 
     consortium includes not less than one nonprofit private 
     community-based organization and not less than one health 
     professions schools.
       ``(E) The members of the consortium have entered into an 
     agreement specifying--
       ``(i) that each of the members will comply with the 
     conditions upon which the award is made; and
       ``(ii) whether and to what extent the award will be 
     allocated among the members.
       ``(2) Requirement of Competitive Awards.--Awards under 
     subsection (a) shall be made only on a competitive basis.
       ``(c) Financial Requirements.--
       ``(1) Assurances regarding capacity.--The Secretary may 
     make an award under subsection (a) only if the Secretary 
     determines that, in the case of activities carried out under 
     the award that prove to be effective toward achieving the 
     purposes of the activities--
       ``(A) the members of the consortium involved have or will 
     have the financial capacity to continue the activities, 
     regardless of whether financial assistance under subsection 
     (a) continues to be available; and
       ``(B) the members of the consortium demonstrate to the 
     satisfaction of the Secretary a commitment to continue such 
     activities, regardless of whether such assistance continues 
     to be available.
       ``(2) 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 under such subsection only if the 
     applicant agrees to make available in cash (directly or 
     through donations from public or private entities) non-
     Federal contributions toward such costs in an amount that, 
     for any fourth or subsequent fiscal year for which the 
     applicant receives such an award, is not less than 50 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 three fiscal years for which an 
     applicant receives a grant under subsection (a).
       ``(d) Preference in Making Awards.--
       ``(1) In general.--
       ``(A) In making awards under subsection (a), the Secretary 
     shall, subject to paragraph (3), give preference to any 
     applicant that, for the purpose described in subparagraph 
     (B), has made an arrangement with not less than one entity 
     from each of the following categories of entities: Community-
     based organizations, elementary schools, secondary schools, 
     institutions of higher education, and health professions 
     schools.
       ``(B) The purpose of arrangements under subparagraph (A) is 
     to establish a program for individuals identified under 
     subsection (a) under which--
       ``(i) the activities described in such subsection are 
     carried out on behalf of the individuals; and
       ``(ii) health professions schools make a commitment to 
     admit as students of the schools such individuals who 
     participate in the program, subject to the individuals 
     meeting reasonable academic standards for admission to the 
     schools.
       ``(2) Additional preferences.--Of the applicants under 
     subsection (a) that are receiving preference for purposes of 
     paragraph (1), the Secretary shall, subject to paragraph (3), 
     give additional preference to applicants whose consortium 
     under subsection (b) includes as members one or more health 
     professions schools that have not previously received any 
     award under this section (including this section as in effect 
     prior to fiscal year 1995).
       ``(3) Limitation.--An applicant may not receive preference 
     for purposes of paragraph (1) or (2) unless the consortium 
     under subsection (b) includes not less than one health 
     professions school that has demonstrated success in enrolling 
     students from disadvantaged backgrounds.
       ``(e) Objectives Under Awards.--
       ``(1) Establishment of objectives.--Before making a first 
     award to an applicant under subsection (a), the Secretary 
     shall establish objectives regarding the activities to be 
     carried out under the award, which objectives are applicable 
     until the next fiscal year for which such award is made after 
     a competitive process of review. In making an award after 
     such a review, the Secretary shall establish additional 
     objectives for the applicant.
       ``(2) Precondition for subsequent awards.--In the case of 
     an applicant seeking an award under subsection (a) pursuant 
     to a competitive process of review, the Secretary may make 
     the award only if the applicant demonstrates to the 
     satisfaction of the Secretary that the applicant has met the 
     objectives that were applicable under paragraph (1) to the 
     preceding awards under such subsection.
       ``(f) Funding.--
       ``(1) Authorization of appropriations.--For the purpose of 
     carrying out this section and section 736, there are 
     authorized to be appropriated $33,000,000 for fiscal year 
     1995, $37,000,000 for fiscal year 1996, and $40,000,000 for 
     fiscal year 1997.
       ``(2) Allocations.--Of the amounts appropriated under 
     paragraph (1) for a fiscal year, the Secretary shall obligate 
     amounts as follows:
       ``(A) For carrying out subsection (a)(6), not less than 20 
     percent.
       ``(B) For providing scholarships under section 736, an 
     amount equal to the amount provided for such purpose under 
     this section for fiscal year 1994, plus an amount for 
     offsetting the effects of inflation occurring after October 
     1, 1994.''.
       (b) Transitional and Savings Provisions.--
       (1) In general.--During the period specified in paragraph 
     (2)--
       (A) the amendment made by subsection (a) does not apply to 
     any entity that received a grant for fiscal year 1994 under 
     section 740 of the Public Health Service Act; and
       (B) such a grant to the entity for fiscal year 1995 or 
     subsequent fiscal years shall be made and expended in 
     accordance with the provisions of such section as in effect 
     on the day before the date of the enactment of this Act.
       (2) Relevant period.--In the case of an entity that 
     received a grant for fiscal year 1994 under section 740 of 
     the Public Health Service Act, 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. 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 $8,000,000 for each of the 
     fiscal years 1995 through 1997.''.

     SEC. 308. AREA HEALTH EDUCATION CENTERS.

       (a) Requirements for Centers.--Section 746(d)(2)(D) of the 
     Public Health Service Act (42 U.S.C. 293j(d)(2)(D)) is 
     amended by inserting ``and minority health'' after ``disease 
     prevention''.
       (b) Funding.--Section 746(i)(2)(C) of the Public Health 
     Service Act (42 U.S.C. 293j(i)(2)(C)) is amended in the 
     second sentence by inserting before the period the following: 
     ``(except that in the case of fiscal year 1995, amounts 
     appropriated in excess of the amount appropriated for fiscal 
     year 1994 shall be obligated for carrying out subsection 
     (a)(1) in rural States without an area health education 
     center program)''.

                           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.--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) Equity Regarding Various Groups.--The Director of the 
     Office shall ensure that activities under subsection (b) 
     equitably address all racial and ethnic 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 
     12 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 racial and ethnic minority groups shall 
     be equally represented among such members.
       ``(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) Chair.--The Director of the Office shall serve as the 
     chair 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) 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.
       ``(h) Definitions.--For purposes of this part:
       ``(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 
     research involving such individuals as subjects or 
     insufficient 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 `racial and ethnic minority group' has the 
     meaning given such term in section 1707(g).''.

     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, racial and ethnic 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 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) In General.--Part B of Title III of the Public Health 
     Service Act (42 U.S.C. 243 et seq.), As Amended by Section 
     209 of This Act, Is Amended by Inserting After Section 317G 
     the Following Section:


                 ``prevention of traumatic brain injury

       ``Sec. 317H. (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 incidence 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) in paragraph (2)--
       (i) by inserting ``, substance abuse'' after ``availability 
     of health''; and
       (ii) by striking ``, including improved health data 
     systems'';
       (B) in paragraph (3)--
       (i) by striking ``manpower'' and inserting ``care 
     providers''; and
       (ii) by striking ``by--'' and all that follows through the 
     end thereof and inserting a semicolon;
       (C) by striking paragraphs (5) and (6);
       (D) by redesignating paragraphs (7), and (8) as paragraphs 
     (5) and (6), respectively;
       (E) in paragraph (5) (as so redesignated), by striking 
     ``and'' at the end thereof;
       (F) in paragraph (6) (as so redesignated), by striking the 
     period and inserting a semicolon; and
       (G) by inserting after paragraph (6) (as so redesignated), 
     the following new paragraphs:
       ``(7) to provide primary health care, preventive health 
     care, and related training to American Samoan health care 
     professionals; and
       ``(8) to improve access to health promotion and disease 
     prevention services for rural American Samoa.'';
       (2) in subsection (f)--
       (A) by striking ``there is'' and inserting ``there are''; 
     and
       (B) by striking ``$10,000,000'' and all that follows 
     through ``1993'' and inserting ``$3,000,000 for fiscal year 
     1995, $4,000,000 for fiscal year 1996, and $5,000,000 for 
     fiscal year 1997''; 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).''.

     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 317H the following 
     section:


 ``miscellaneous authorities regarding centers for disease control and 
                               prevention

       ``Sec. 317I. (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 is deemed to have taken 
     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 serve the region in the United 
     States along the international border between the United 
     States and Mexico, and shall be established in the United 
     States in close proximity to such border.
       (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 each of the 
     fiscal years 1995 through 1997.

     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.

     SEC. 808. DEMONSTRATION PROJECTS REGARDING ALZHEIMER'S 
                   DISEASE.

       (a) In General.--Section 398(a) of the Public Health 
     Service Act (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 the access of such individuals to home-
     based or community-based long-term care services (subject to 
     the services being provided by entities that were providing 
     such services in the State involved as of October 1, 1995), 
     particularly such individuals who are members of racial or 
     ethnic minority groups, who have limited proficiency in 
     speaking the English language, or who live in rural areas; 
     and''.
       (b) Duration.--Section 398A of the Public Health Service 
     Act (42 U.S.C. 280c-4) is amended--
       (1) in the heading for the section, by striking 
     ``limitation'' and all that follows and inserting 
     ``requirement of matching funds'';
       (2) by striking subsection (a);
       (3) by redesignating subsections (b) and (c) as subsections 
     (a) and (b), respectively;
       (4) in subsection (a) (as so redesignated), in each of 
     paragraphs (1)(C) and (2)(C), by striking ``third year'' and 
     inserting ``third or subsequent year''.
       (c) Authorization of Appropriations.--Section 398B(e) of 
     the Public Health Service Act (42 U.S.C. 280c-5(e)) is 
     amended by striking ``and 1993'' and inserting ``through 
     1998''.

     SEC. 809. TECHNICAL CORRECTIONS RELATING TO HEALTH 
                   PROFESSIONS PROGRAMS.

       (a) Health Education Assistance Loan Deferment for 
     Borrowers Providing Health Services to Indians.--
       (1) In general.--Section 705(a)(2)(C) of the Public Health 
     Service Act 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) of the 
     Public Health Service Act 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 
     the enactment of this Act.
       (b) Maximum Student Loan Provision.--
       (1) In general.--Section 722(a)(1) of the Public Health 
     Service Act (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) of the 
     Public Health Service Act (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) of the 
     Public Health Service Act (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) of the Public Health Service Act (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 of the Public Health Service 
     Act (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 of the Public Health Service 
     Act (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) of the Public Health 
     Service Act (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) Recovery.--Part G of title VII of the Public Health 
     Service Act (42 U.S.C. 295j et seq.), as amended by section 
     301(b)(1) of this Act, is amended by inserting after section 
     794 the following section:

     ``SEC. 795. 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. 810. CLINICAL TRAINEESHIPS.

       Section 303(d)(1) of the Public Health Service Act (42 
     U.S.C. 242a(d)(1)) is amended by inserting ``counseling'' 
     after ``family therapy,''.

     SEC. 811. CONSTRUCTION OF REGIONAL CENTERS FOR RESEARCH ON 
                   PRIMATES.

       Section 481B(a) of the Public Health Service Act (42 U.S.C. 
     287a-3(a)) is amended by striking ``$5,000,000'' and 
     inserting ``$2,500,000''.

                      TITLE IX--GENERAL PROVISIONS

     SEC. 901. EFFECTIVE DATE.

       Except as otherwise provided in this Act, this Act takes 
     effect upon the date of the enactment of this Act.
       And the House agree to the same.
       That the Senate recede from its disagreement to the 
     amendment of the House to the title of the bill and agree to 
     the same with an amendment as follows:
       In lieu of the matter proposed to be inserted by the House 
     amendment, insert the following: ``An Act to amend the Public 
     Health Service Act to revise and extend programs relating to 
     the health of individuals who are members of racial and 
     ethnic minority groups, and for other purposes.''.
       And the House agree to the same.
     John D. Dingell,
     Henry A. Waxman,
     Bill Richardson,
     Edolphus Towns,
     Craig A. Washington,
     Carlos J. Moorhead,
     Tom Bliley,
     Mike Bilirakis,
     Sam Gibbons,
     Harold Ford,
                                Managers on the Part of the House.

     From the Committee on Ways and Means, for consideration of 
     titles VI and VII of the Senate bill, and modifications 
     committed to conference:
     Edward M. Kennedy,
     Howard M. Metzenbaum,
     Paul Simon,
     Nancy Landon Kassebaum,
     Orrin G. Hatch,
                               Managers on the Part of the Senate.

       JOINT EXPLANATORY STATEMENT OF THE COMMITTEE OF CONFERENCE

       The managers on the part of the House and the Senate at the 
     conference on the disagreeing votes of the two Houses on the 
     amendments of the House to the 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, submit the 
     following joint statement to the House and the Senate in 
     explanation of the effect of the action agreed upon by the 
     managers and recommended in the accompanying conference 
     report.
       The House amendment struck all of the Senate bill after the 
     enacting clause and inserted a substitute text.
       The Senate recedes from its disagreement to the amendment 
     of the House with an amendment that is a substitute for the 
     Senate bill and the House amendment. The differences between 
     the Senate bill, the House amendment, and the substitute 
     agreed to in conference are noted below, except for clerical 
     corrections, conforming changes made necessary by agreements 
     reached by the conferees, and minor drafting and clerical 
     changes.

                    Primary Health Care Scholarships

       The Conference agreement revises the primary care 
     scholarship program into a targeted initiative designed to 
     complement the National Health Service Corps and to increase 
     the opportunities for disadvantaged students to obtain 
     Federal scholarships to meet the costs of attending health 
     professions schools. The agreement consolidates existing 
     federal assistance for students attending medical, 
     osteopathic, dental, nursing or mental health practice 
     schools. The revised Primary Health Care Scholarship program 
     will target aid directly to students, increase the level of 
     financial assistance, and allow scholarship recipients to 
     attend the school of their choice. In addition to scholarship 
     assistance, recipients will receive a stipend that covers 
     reasonable living expenses equivalent to those provided to 
     recipients of the National Health Service Corps scholarships.
       The nation's chronic shortage of primary care physicians is 
     a major cause of poor health status within minority and other 
     disadvantaged communities. These shortages cannot be remedied 
     without greater incentives for talented medical students to 
     pursue primary care careers and to be willing, at least for a 
     limited number of years, to repay the taxpayers who financed 
     their education by providing care to critically underserved 
     and often indigent populations.
       The Conference agreement acknowledges the uncertainty that 
     some medical students experience in committing to undertake a 
     career in primary care early in their educational career. 
     Although the Conferees are aware that the Department of 
     Health and Human Services receives hundreds of applications 
     from medical students seeking scholarships and admission to 
     the National Health Service Corps (NHSC). Unfortunately, 
     current funding levels preclude the award of scholarships to 
     more than 2 out of 10 applicants. The conferees are persuaded 
     that notwithstanding the high demand for scholarships for 
     students already committed to primary care, it would be 
     appropriate to make available a limited number of 
     scholarships for students who have not decided on a specific 
     medical field or who may desire to pursue an area of study 
     other than the primary care fields of general pediatrics, 
     general internal medicine or family medicine.
       Under the Conference agreement, 30 percent of all 
     scholarship funds available to medical or osteopathic 
     students will be reserved for students who are undecided on a 
     specialty. The Conferees are aware that not all students who 
     would be willing to provide a service commitment are prepared 
     early in their student career to commit to primary care 
     field, Nondeclared scholarship recipients will incur a 
     service obligation but the commitment may be discharged 
     through service in any clinical field of medicine. Indeed 
     some students who are fully committed to performing national 
     service may desire to pursue a career in one of the medical 
     specialties. Moreover, disadvantaged minority students 
     continue to be grossly under-represented across all medical 
     specialties.
       Nondeclared students will be those who meet the eligibility 
     criteria established by the Secretary but who elect to defer 
     the election of a medical field at the time of application. 
     In the event a student pursues a medical specialty, the 
     Conference agreement provides that a service obligation 
     through the National Health Service Corps is incurred and 
     will be discharged at a rate of two years of service for each 
     year of assistance. In determining appropriate service sites 
     for such physicians, the conferees expect that the needs of 
     the Indian Health Service and the nation's public hospital 
     system should be given priority. Individuals who select a 
     ``Nondeclared'' scholarship but ultimately pursue a primary 
     care service commitment will incur the same service 
     obligation as students awarded primary care scholarships.
       In determining appropriate placement sites for discharging 
     any service commitment, including primary care commitments, 
     the Conferees believe recipients should be given a choice of 
     three locations at least one of which should reflect or be 
     complementary of the applicant's cultural or ethnic heritage. 
     Although this scholarship program is patterned after the 
     NHSC, the conferees do not intend the placement options to be 
     as limited as those which currently apply to the Corps.
       For example, the conferees intend that a scholarship 
     recipient of Hispanic heritage who grew up in a rural setting 
     should be offered at least one service site option that is 
     reflective of this heritage and will provide the community 
     the benefit not only of the physicians medical training, but 
     also his or her cultural and linguistic experience. An 
     additional example might involve the desire of a physician of 
     African American ancestry to discharge a service commitment 
     in a predominantly African American community. In making 
     placements, the Secretary is encouraged to identify sites 
     which will enhance the possibility of longterm retention 
     while maintaining a priority for those communities whose 
     populations have the greatest need for medical personnel. To 
     the extent practical the Secretary should offer scholarship 
     recipients a choice of urban and rural sites.
       The Conferees anticipate strong demand for scholarships and 
     have included language giving students in severe financial 
     hardship preference consistent with the Secretary's 
     assessment of an applicant's commitment and willingness to 
     complete the service obligation. The conferees expect the 
     Secretary to make special efforts to make scholarships 
     available to qualified students from racial and ethnic 
     minority communities. By providing such special 
     consideration, the conferees believe additional opportunities 
     will be opened for students unable to participate in the 
     National Health Service Corps because of the Corps limited 
     funding.
       The Conference agreement provides an authorization of $25 
     million for FY 1995 which is consistent with the Fiscal Year 
     1995 appropriation but does not include additional 
     scholarship funding pursuant to section 740(e) of the Act. To 
     assure an equitable division of limited scholarship funds 
     among diverse groups of health professions students, the 
     agreement provides specific allocations to ensure that the 
     various eligible professions are treated fairly consistent 
     with the relative need among underserved communities. 19% of 
     funds are required to be made available for dental 
     scholarships. 16% of funds are to be made available for 
     nursing scholarships. 10% of funds are to be made available 
     for scholarships at graduate programs in mental health 
     practice. The remaining 55% of funds will be made available 
     for the award of scholarships to individuals attending 
     schools of medicine or osteopathic medicine. As noted 
     earlier, one-third of medical and osteopathic medicine 
     scholarships will be made available to students who elect not 
     to declare primary care as a field of study or who elect not 
     to declare a field at the time of application.
       The Conferees are especially concerned about the severe 
     underrepresentation of racial and ethnic minorities in the 
     mental health professions. As mental health services become 
     more accessible, the demand will increase for mental health 
     professionals who are competent to deal with language 
     barriers and cultural issues in highly interactive mental 
     health encounters. Mental health services are in great demand 
     in a number of public settings, including community mental 
     health centers, Community and Migrant Health Centers, 
     immigration intake points, and public health or mental health 
     departments. These are appropriate sites for completing 
     service commitments.
       The conference agreement also provides that 16 percent of 
     available appropriations should be made available for 
     students attending schools of nursing. The percentage 
     maintains the relative amount of funding reserved for nursing 
     under the former Scholarships for Disadvantaged Students 
     (SDS) program. The agreement also reflects the Conferees' 
     intent that undergraduate nurses continue to be eligible for 
     scholarships under this program as they were under the former 
     SDS program. There continues to be a great need for 
     registered nurses in a variety of non-profit or public 
     community based settings or tertiary care settings in many 
     underserved areas.
       Finally, the agreement preserves balance within the 
     scholarship program by requiring a minimum level of funds for 
     scholarships in general dentistry. The conferees are aware of 
     the relatively small number of scholarships for dental 
     students available under the NHSC and have included this 
     requirement to assure an adequate level of support. The 
     agreement is intended to preserve funding for dental 
     scholarships at the same level of support as under the 
     earlier Exceptionally Financially Needy (EFN), Financial 
     Assistance to Disadvantaged Health Professions Students 
     (FADHPS) and SDS programs.
       Finally, the agreement reflects the Senate provision that 
     the new primary care scholarships be named in honor of Cesar 
     Chavez, whose life was dedicated to promoting the health and 
     civil rights of disadvantaged populations. The legacy of 
     Cesar Chavez is one of caring for those who have no voice and 
     a selfless dedication to the welfare of others. The conferees 
     intend that scholarship recipients will be referred to as 
     Cesar Chavez Scholars and are available to all disadvantaged 
     students (including all racial and ethnic minorities.)


 veterinary, optometry, pharmacy, public health, podiatry, and allied 
        health (vopppa) scholarships for disadvantaged students

       The agreement places priority on providing scholarship 
     assistance directly to eligible students and requiring a 
     service commitment in a medically underserved community, 
     public hospital settings or, in the case of veterinary 
     medicine students, an area involving human health. The 
     agreement includes a setaside for allied health scholarships. 
     The conference agreement reflects the heightened importance 
     the conferees place on expanding the number of opportunities 
     for disadvantaged minority students to enter the allied 
     health professions of occupational therapy, physical therapy, 
     dental hygiene, medical technology, and radiologic 
     technology. The need for an increasing level of scholarship 
     support to allied health students reflects the Conferees 
     concern about a lack of equity and balance in the allocation 
     of funds among eligible professions in the previous SDS 
     program. Finally, the agreement names this scholarship 
     program in honor of the late Supreme Court Justice and civil 
     rights advocate Thurgood Marshall. The Conferees intend that 
     scholarship recipients be referred to as Thurgood Marshall 
     Scholars and are available to all disadvantaged students 
     (including all racial and ethnic minorities).


                       office of minority health

       House recedes with the following amendments: The Office of 
     Minority Health will conduct duties specified in (b) by means 
     of interagency agreements. With respect to the activities of 
     the National Center for Health Statistics in subsection 
     (b)(2)(D), the Office of Minority Health shall provide 
     assistance, including funding, to ensure that NCHS collects 
     adequate information in all its surveys on members of 
     minority groups, including their subpopulations. The 
     agreement also reflects the House language on programs 
     relating to the provision of bilingual and interpretive 
     services.
       The agreement revises the Senate language on the advisory 
     committee to require the committee to provide advice on the 
     activities under (b)(2). It clarifies that the voting 
     membership be equally representative of the various racial 
     and ethnic groups and specifically that a quarter of the 
     membership be selected from each of the four major racial and 
     ethnic groups, respectively: American Indians, including 
     Alaska Natives, Aleuts and Eskimos; Asian and Pacific 
     Islanders; Blacks; and Hispanics. Consideration should be 
     given to representation from diverse subpopulation groups and 
     geographic regions of the country. It also clarifies that PHS 
     Office of Minority Health directors be designated non-voting 
     ex officio members of the Committee.
       The agreement clarifies that all OMH grants, contracts, and 
     cooperative agreements must be awarded on a competitive basis 
     and include peer review by a committee representative of all 
     the racial and ethnic groups served by the Office. The 
     Conferees intend that the Office or its partners in 
     interagency agreements cease the practice constructing 
     requests for proposals intended for a specific entity or 
     devised in such a manner as to hinder the full competitive 
     participation of applicants representing all racial and 
     ethnic groups served by the Office.
       The agreement clarifies the definition of ``racial and 
     ethnic groups'' to reflect more commonly accepted 
     terminology.
       The agreement clarifies that the setaside of appropriations 
     described in section (h)(2) refers to the programs described 
     in subsection (b)(2)(D). The conferees reemphasize language 
     from the House report that directs the OMH to count toward 
     the set-aside only those activities specifically designed to 
     remove language barriers to the receipt of health care 
     through interpretive services or enhanced training of 
     bilingual health professionals to facilitate delivery of 
     health care to individuals with limited English proficiency. 
     While the emphasis on primary care is intended to include 
     mental health and substance abuse treatment, and may include 
     as partners hospitals or other tertiary care providers who 
     also provide primary care services, the Secretary is 
     encouraged to allocate other OMH funds to enhance the 
     delivery of bilingual and interpretive services in the 
     delivery of emergency and speciality care. For example, after 
     complying with the $3 million setaside, the Director of OMH 
     would be authorized and encouraged to award grants to the 
     emergency room or cancer treatment center of a public 
     hospital for the purpose of removing language barriers to 
     care.
       With respect to the provision ensuring equitable allocation 
     of grants and contracts among racial and ethnic groups, the 
     Conferees intend that in programs where participation has 
     been lacking by members of certain racial and ethnic groups 
     the Secretary take additional efforts to inform and educate 
     such potential grantees of the availability of awards, and 
     provide technical assistance in the preparation of 
     applications. The Secretary shall, through the biennial 
     reports described in (f), report on the progress toward this 
     requirement and outline specific steps toward its 
     achievement.


            public health service offices of minority health

       The Senate recedes with an amendment to add criteria from 
     the Senate bill regarding the authorities of the office and 
     to make necessary conforming amendments.


                     state offices of rural health

       The Senate recedes with an amendment to raise from $10 
     million to $20 million the statutory ceiling on the level of 
     Federal appropriations.


                         centers of excellence

       The Senate recedes with amendments to clarify that none of 
     the changes required by the agreements will apply to 
     currently funded centers until their grants (or in the case 
     of Centers funded through a contract) are recompeted. The new 
     requirements will apply to the funding of any new centers in 
     FY 1995 or later fiscal years. The conference agreement also 
     includes a prohibition on actions which restrict centers 
     (including currently funded centers) from undertaking 
     activities designed to involve students and faculty members 
     based at institutions other than the recipient center. The 
     conferees note concern that the medical school at Drew 
     University may not be eligible under current law to be 
     designated at a Center of Excellence. The conferees want to 
     clarify the Drew University may apply directly for assistance 
     under this program and be designated a Centers of Excellence 
     if its application includes a formal affiliation with an 
     accredited 4 years medical school.


                   health career opportunity program

       The conferees support strategies to increase enrollment of 
     underrepresented minorities that include both traditional 
     short-term efforts (focusing on students in the last two 
     years of college with recruitment campaigns, summer academic 
     enrichment programs, financial aid and the implementation of 
     culturally sensitive admission criteria) as well as the long-
     term strategies targeting younger students early in the 
     educational pipeline. The scarcity of qualified African 
     American, Mexican American, mainland Puerto Rican, American 
     Indian, Pacific Islanders, and certain Asian American 
     subpopulations students largely reflects fundamental 
     deficiencies in the pre-college and undergraduate educational 
     opportunities available to these students.
       The conferees recognize that the Health Careers Opportunity 
     Program has been successful in facilitating entry for 
     minority students into medical school, dental school, and 
     many of the other health professions schools. The Conferees 
     are aware that in 1985, there were 191 HCOP projects funded 
     and 29 projects approved not funded. In 1993, there were 143 
     HCOP projects funded and 139 projects approved but not 
     funded. The Conferees are concerned about the increasing 
     number of meritorious applicants who have never been funded.
       In order to maximize the available resources, increase the 
     number of minority students in the pipeline and increase the 
     number of minority students in health professions that 
     continue to have a shortage of racial ethnic minority health 
     professionals, the agreement incorporates substantial changes 
     to increase the authorization of appropriations and the 
     number of health professions schools participating in the 
     program.
       The agreement requires new applicants to form a consortium 
     of at least one community-based organization and three health 
     professionals schools. For example, a medical school could 
     collaborate with a dental school, nursing school or graduate 
     program in clinical psychology and a community health center. 
     The agreement gives preference to applicants that develop a 
     program for students who can enter at any stage (K-12) and 
     upon their successful completion of the program, will be 
     guaranteed admission to a member school of the consortium. 
     The Conferees commend Baylor University School of Medicine 
     for their successful K12 program and Boston University School 
     of Medicine for their innovative Early Selection Program. The 
     Conferees urge the Secretary to support and encourage the 
     development of similar models in other medical schools and 
     among other health professions.
       In addition, the agreement requires that any program 
     competing for a competitive grant renewal provide 50% of the 
     cost of the program. The consortium can not avoid the 
     matching requirement by changing members of the consortium 
     unless they can demonstrate that they have expanded the 
     number of health professions schools and developed a new 
     program with new objectives.
       As described in the House report, the Conferees strongly 
     support community-based clinical experience for HCOP 
     participants. The agreement requires that any community-based 
     HCOP program have an academic enhancement component with at 
     least one health profession school.
       The Conferees strongly supports the Association of American 
     Medical Schools 3000 by 2000 Project and encourages the other 
     health profession disciplines to develop similar projects. 
     The Conferees expect the Health Careers Opportunity Program 
     to increase the number of kindergarten through 12th grade 
     project grants.
       The agreement requires that the Secretary develop binding 
     outcome objectives for all grantees. These objectives should 
     include retention rates, enrollment rates, and graduation 
     rates. Only programs that have been successful in meeting the 
     objectives established by the Secretary would be eligible to 
     receive a competing renewal grant.
       The conferees agree that with the new program authority and 
     expansion, no existing Health Career Opportunity Grant will 
     be modified or reduced as a result of changes in the program. 
     The conferees expect that grants funded prior to 1995 will be 
     carried out as intended until the end of the agreed upon 
     grant period.


                 nih office of minority health research

        House recedes with an amendment making technical or 
     conforming changes and requiring that the Director of the NIH 
     Office of Minority Health Research award all grants, 
     contracts, and cooperative agreements on a competitive basis.


             agency for health care policy research (ahcpr)

        House recedes with amendment requiring that in any fiscal 
     year 8% of AHCPR research be spent on research, 
     demonstrations and evaluations with respect to the health of 
     low-income groups, racial and ethnic minority groups and the 
     elderly.


                         faculty loan repayment

        Senate recedes with amendment making technical and 
     conforming changes and raising the fellowship ceiling from 
     $30,000 to $50,000.


                             birth defects

        Senate recedes.


                             healthy start

       The conference agreement includes the House bill with the 
     following modifications: (1) the purpose of the projects is 
     narrowed to reducing the incidence of infant mortality, the 
     incidence of maternal mortality, and the incidence of low-
     birthweight births; (2) The Secretary is authorized to expend 
     up to $6 million over the duration of the demonstration to 
     conduct a national evaluation of the 15 projects first funded 
     prior to fiscal year 1994; (3) the limit on the amounts that 
     the Secretary of HHS is authorized to expend for technical 
     assistance and public information and education in relation 
     to the demonstration projects is reduced from 5 percent to 2 
     percent of the amounts appropriated under section 340E in a 
     fiscal year; (4) the limit on the amount spent by any grantee 
     on data collection and analysis, the development of community 
     partnerships, and administration is increased from 10 to 15 
     percent of the grant in any fiscal year; (5) the base year 
     for the maintenance of effort requirement with respect to the 
     non-Federal funds provided by applicants, States, and 
     political subdivisions is changed from fiscal year 1991 to 
     fiscal year 1993; and (6) the Secretary is directed to 
     provide an interim report on the demonstrations to the 
     Congress by February 1, 1997, to enable the Congress to 
     determine whether the sunset date of October 1, 1997, should 
     be extended.
       The conferees intend that the number of demonstration 
     projects to be funded under this authority not exceed 22. The 
     Department recently announced 7 additional projects (59 Fed. 
     Reg. 13731, March 23, 1994). The conferees intend that 
     funding for these grantees be limited in the aggregate to 
     7.2% of the amounts appropriated under this authority in each 
     fiscal year.


                          diabetic-retinopathy

       The Senate recedes with an amendment clarifying the 
     responsibility of the Centers for Disease Control and 
     Prevention (CDC). The conferees expect the CDC's Center for 
     Chronic Disease Prevention and Health Promotion to initiate 
     diabetic-retinopathy prevention programs without the need for 
     separate or additional appropriations. The agreement reflects 
     the conferees agreement that the Center should move 
     expeditiously to initiate a program targeted to high risk 
     diabetes patients during FY 1995. The conferees believe that 
     the CDC should make at least 5 grants in FY 1995 which 
     include at least two racial and ethnic minority groups. These 
     groups should be awarded in a fashion that allows for 
     geographic diversity and that will serve both urban and rural 
     populations.


                             nursing loans

       The Senate recedes.


                 health profession student loans (hpsl)

       The Senate recedes


                   State HSC Private Practice Option

       The Senate recedes.


                             Women's Health

       The Senate recedes.


                         Traumatic Brain Injury

       The Senate recedes.


                   Indian Health Care Improvement Act

       The Senate recedes.


                 Health Services for Pacific Islanders

       The House recedes with an amendment extending the 
     authorization period from FY 1996 to FY 1997 and authorizing 
     appropriations at a level of $3 million, $4 million and $5 
     million in FY 1995, 1996 and 1997 respectively.


              Technical Corrections regarding P.L. 103-183

       The Senate recedes.


               Centers for Disease Control and Prevention

       The Senate recedes.


                  Border Health Analytical Laboratory

       The Senate recedes with an amendment clarifying that the 
     laboratory may be located in any of the border states of 
     Texas, California, Arizona, or New Mexico. In carrying out 
     this authority, the conferees agreed that geographic 
     proximity to the entire border region is important to the 
     success and effectiveness of the laboratory and that this new 
     facility should be located in an urban center within 25 miles 
     of the Mexican border. Although the conferees anticipate that 
     the Secretary will establish a single laboratory, the 
     conference agreement would permit the laboratory to utilize 
     mobile sites in the collection and analysis of samples and 
     the conduct of environmental surveillance activities in the 
     various border states and communities. In addition, the 
     conference agreement authorizes appropriations for the fiscal 
     years 1995-1997. The conferees expect that when determining 
     the location of the laboratory, priority should be given to 
     an urban center with existing federal environmental and 
     health facilities with which to coordinate efforts.


                 Administration of Certain Requirements

       The Senate recedes.


   Revisions to Eligibility Requirements for Entries Subject to Drug 
                          Pricing Limitations

       The Senate recedes. The conferees note that on September 
     19, 1994, the Public Health Service issued final guidelines 
     clarifying which hospital-related outpatient facilities are 
     eligible for drug discounts under the Veterans Health Care 
     Act of 1992. The purpose of this amendment is to guarantee 
     the eligibility of outpatient facilities owned by New York 
     City Health & Hospitals Corporation that do not qualify under 
     the PHS guidelines.


                             Effective Date

       The Senate recedes.


                  Assistant Secretary for Civil Rights

       The House recedes. The conferees are concerned about the 
     backlog of complaints and the length of time which elapses 
     between the filing of a complaint and the final internal 
     administrative resolution of the complaint within the 
     Department of Health and Human Services, Office of Civil 
     Rights. The Conferees strongly urge the Department to take 
     all appropriate steps to reduce the time from filing to final 
     resolution of discrimination complaints without compromising 
     due process. The conferees believe the elevation of the 
     position of Director of the Office of Civil Rights to the 
     rank of Assistance Secretary will assist in reducing the 
     backlog and the processing time for complaints filed with the 
     Office.


          Reauthorization of Loans for Disadvantaged Students

       The Senate recedes with an amendment increasing the 
     appropriations level. The agreement provides that beginning 
     in FY 1995 funding available for disadvantaged students 
     attending medical or osteopathic schools will be provided 
     through the primary care medical student loan program. An 
     authorization of appropriations for the recapitalization of 
     this important loan fund is authorized by section 723 of the 
     Public Health Service Act at a level of $10 million in fiscal 
     years 1995-1997.


             Language as Impediment to receipt of services

       The House recedes with an amendment extending the deadline 
     for issuing proposed regulations from 90 to 180 days and 
     making necessary technical changes.


                     Area Health Education Centers

       The House recedes with an amendment to clarify that with 
     respect to use of appropriations in FY 1995, the Secretary 
     should allocate any funding increases over the level of 
     program funding in FY 1994 for the purpose of awarding new 
     AHEC starts in rural states.


                     health professions amendments

       House recedes with a technical amendment.


        eligibility of ``counseling'' for clinical traineeships

       House recedes with an amendment to clarify that recipients 
     of mental health clinical traineeships under this authority 
     are subject to the same limitations on the discharge of 
     service obligations in bankruptcy as are recipients of 
     National Health Service Corps scholarships.


                    alzheimer's demonstration grants

       The House recedes with an amendment to clarify the program 
     authority.


                    health professions shortage area

       The Senate recedes on the language regarding a study of 
     health professions shortage areas with an amendment 
     clarifying that the Secretary is to consider a number of 
     criteria in determining the designation of a medically 
     underserved area. The conferees expect the Secretary to 
     continue developing policies to permit the awarding of grants 
     to organizations that will serve population groups with 
     particular health status problems, which lack the ability to 
     pay for health services (including the lack of insurance), or 
     which lack access to appropriate health services.


               regional centers for research on primates

       The House recedes with an amendment restoring the 
     availability of ``first dollar'' NIH extramural construction 
     funds for qualified primate center programs. The conferees 
     agree to reemphasize the importance of the National 
     Institutes of Health adhering strictly to the current 
     requirements of the Public Health Service Act which require 
     that funding for extramural construction be made available 
     for the purpose of making grants to qualified primate 
     centers. The primate center program represents a national 
     resource which benefits thousands of researchers nationally. 
     Addressing the construction and rehabilitation needs of these 
     facilities is important to maintaining the Nation's 
     preeminence in biomedical and behavioral research. The 
     conferees recognize during periods of fiscal restraint it may 
     be appropriate to reduce the level of ``first dollar'' 
     support relative to other eligible grantees. Accordingly, the 
     conference agreement reduces from $5 million to $2.5 million 
     the requirement that extramural construction funds be 
     reserved each year for this purpose.


                      native hawaiian health care

       The Senate recedes.


                         multiethnic placement

       The Senate recedes.


                       voluntary mutual reunions

       The Senate recedes.


                  community and migrant health centers

       The Senate recedes with an amendment extending the 
     authorization of appropriations for FY 1995 and FY 1996, and 
     deleting the proposed statutory exemption over CHC budgets 
     involving non-Federal funds. The conferees understand that a 
     resolution of this matter can be accomplished through 
     administrative action and that such action is pending within 
     the Department of Health and Human Services. The conferees 
     believe that while the agreement provides the CHC program a 
     multi-year reauthorization, thorough oversight hearings on 
     the operation of CHCs and the administration of the CHC 
     program will be held during the 104th Congress.
       The conferees recognize that primary care dental care is an 
     important part of comprehensive preventive health care. 
     Conferees are encouraged that over half of the community 
     health centers in the nation now provide these services. 
     Conferees understand that many other centers would like to 
     provide these services but, particularly in rural areas, may 
     be constrained from doing so because of difficulties in 
     recruiting or contracting with the necessary health 
     professionals. The Conferees would encourage these centers to 
     give priority to the provision of primary dental care 
     services as resources may be available. Conferees urge the 
     Secretary to work closely with community health centers to 
     assist them in the development of the strategies and 
     resources necessary to achieve this objective.


                                homeless

       The conferees intend the reauthorization of the Health Care 
     for the Homeless program to include extension of the Primary 
     Health Services for Homeless Children program. This program 
     provides federal funding for outreach and primary health 
     services for children who lack access to health care, placing 
     them at increased risk of serious health problems from 
     undiagnosed or poorly controlled illnesses and lack of 
     preventive health services. The Primary Health Services for 
     Homeless Children Program supports projects offering 
     comprehensive services with extensive follow-up systems, 
     including substance abuse prevention and counseling, and 
     mental health services. Children to be served include 
     homeless children, runaways, and children in foster care who 
     have no consistent access to health care. The conferees 
     commend the successful and innovative outreach models, such 
     as pediatric mobile vans, which identify and serve children 
     at risk.


                             public housing

       The Senate recedes.


                            data collection

       The Senate recedes. The conferees believe the Secretary of 
     Health and Human Services must ensure that all federally-
     funded health data systems collect racial and ethnic 
     identifiers in order to access health status, health care 
     access, and health services. The availability of this 
     information is necessary in the effective enforcement of 
     Title VI of the Civil Rights Act of 1964. At a minimum, the 
     conferees believe data collection activities must be in 
     compliance with OMB Directive No. 15 and subsequent racial 
     and ethnic standards for federal statistics and 
     administrative reporting requirements. The agreement provides 
     for collection of such information on subpopulations of these 
     racial and ethnic groups; however Federal agencies must be 
     able to collapse more detailed categories into basic racial/
     ethnic categories.
       The conferees are aware that an April 1994 survey by the 
     Office of Minority Health's Division of Policy Coordination 
     established that compliance with OMB Directive No. 15 is not 
     uniform among PHS health data systems. Some agencies collect 
     no information on race or ethnicity, other use categories 
     which could not be collapsed into those listed in OMB 
     Directive No. 15. Meaningful reporting becomes impossible. 
     These practices must stop.
       The conferees are particularly concerned that future health 
     data systems may rely on a hospital discharge form (i.e. UB-
     92) which does not record the race or ethnicity of the 
     patient receiving care. The use of such a form would 
     perpetuate the government's inability to monitor the 
     compliance of health care providers with civil rights law and 
     cripple minority health research.
     John D. Dingell,
     Henry A. Waxman,
     Bill Richardson,
     Edolphus Towns,
     Craig A. Washington,
     Carlos J. Moorhead,
     Tom Bliley,
     Mike Bilirakis,
                                Managers on the Part of the House.

     From the Committee on Ways and Means, for consideration of 
     titles VI and VII of the Senate bill, and modifications 
     committed to conference:
     Sam Gibbons,
     Harold Ford,
                                Managers on the Part of the House.

     Edward M. Kennedy,
     Howard M. Metzenbaum,
     Paul Simon,
     Nancy Landon Kassebaum,
     Orrin G. Hatch,
                               Managers on the Part of the Senate.