[Congressional Record Volume 140, Number 145 (Friday, October 7, 1994)]
[Senate]
[Page S]
From the Congressional Record Online through the Government Printing Office [www.gpo.gov]


[Congressional Record: October 7, 1994]
From the Congressional Record Online via GPO Access [wais.access.gpo.gov]

 
        NURSING EDUCATION CONSOLIDATION AND REAUTHORIZATION ACT

  The text of the bill (S. 2433) to amend title VIII of the Public 
Health Service Act to consolidate and reauthorize nursing education 
programs under such title, and for other purposes, as passed by the 
Senate on October 6, 1994, is as follows:

                                S. 2433

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

     SECTION 1. SHORT TITLE.

       This Act may be cited as the ``Nursing Education 
     Consolidation and Reauthorization Act of 1994''.

     SEC. 2. PURPOSE.

       It is the purpose of this Act to restructure the nurse 
     education authorities of title VIII of the Public Health 
     Service Act to permit a comprehensive, flexible, and 
     effective approach to Federal support for nursing workforce 
     development.

     SEC. 3. AMENDMENTS TO PUBLIC HEALTH SERVICE ACT.

       Title VIII of the Public Health Service Act (42 U.S.C. 296k 
     et seq.) is amended--
       (1) by striking the title heading and all that follows 
     except for subparts II and III of part B and section 855; and 
     inserting the following:
             ``TITLE VIII--NURSING WORKFORCE DEVELOPMENT'';
       (2) in subpart II of part B, by striking the subpart 
     heading and inserting the following:

                        ``PART E--STUDENT LOANS

                    ``Subpart I--General Program'';

       (3) by redesignating subpart III as subpart II;
       (4) by striking section 837;
       (5) in section 846, by striking subsection (d) and 
     inserting the following new subsection:
       ``(d) Breach of Agreements for Obligated Service.--
       ``(1) In general.--In the case of any program under this 
     section under which an individual makes an agreement to 
     provide health services for a period of time in accordance 
     with such program in consideration of receiving an award of 
     Federal funds regarding education as a nurse (including an 
     award for the repayment of loans), the following applies if 
     the agreement provides that this subsection is applicable:
       ``(A) In the case of a program under this section that 
     makes an award of Federal funds for attending an accredited 
     program of nursing (in this subsection referred to as a 
     `nursing program'), the individual is liable to the Federal 
     Government for the amount of such award (including amounts 
     provided for expenses related to such attendance), and for 
     interest on such amount at the maximum legal prevailing rate, 
     if the individual--
       ``(i) fails to maintain an acceptable level of academic 
     standing in the nursing program (as indicated by the program 
     in accordance with requirements established by the 
     Secretary);
       ``(ii) is dismissed from the nursing program for 
     disciplinary reasons; or
       ``(iii) voluntarily terminates the nursing program.
       ``(B) The individual is liable to the Federal Government 
     for the amount of such award (including amounts provided for 
     expenses related to such attendance), and for interest on 
     such amount at the maximum legal prevailing rate, if the 
     individual fails to provide health services in accordance 
     with the program under this section for the period of time 
     applicable under the program.
       ``(2) Waiver or suspension of liability.--In the case of an 
     individual or health facility making an agreement for 
     purposes of paragraph (1), the Secretary shall provide for 
     the waiver or suspension of liability under such paragraph if 
     compliance by the individual or the health facility, as the 
     case may be, with the agreements involved is impossible, or 
     would involve extreme hardship to the individual or facility, 
     and if enforcement of the agreements with respect to the 
     individual or facility would be unconscionable.
       ``(3) Date certain for recovery.--Subject to paragraph (2), 
     any amount that the Federal Government is entitled to recover 
     under paragraph (1) shall be paid to the United States not 
     later than the expiration of the 3-year period beginning on 
     the date the United States becomes so entitled.
       ``(4) Availability.--Amounts recovered under paragraph (1) 
     with respect to a program under this section shall be 
     available for the purposes of such program, and shall remain 
     available for such purposes until expended.'';
       (6) by inserting after the title heading the following new 
     parts:

                      ``PART A--GENERAL PROVISIONS

     ``SEC. 801. DEFINITIONS.

       ``As used in this title:
       ``(1) Eligible entities.--The term `eligible entities' 
     means schools of nursing, nursing centers, State or local 
     governments, and other public or nonprofit private entities 
     determined appropriate by the Secretary that submit to the 
     Secretary an application in accordance with section 802.
       ``(2) School of nursing.--The term `school of nursing' 
     means a collegiate, associate degree, or diploma school of 
     nursing in a State.
       ``(3) Collegiate school of nursing.--The term `collegiate 
     school of nursing' means a department, division, or other 
     administrative unit in a college or university which provides 
     primarily or exclusively a program of education in 
     professional nursing and related subjects leading to the 
     degree of bachelor of arts, bachelor of science, bachelor of 
     nursing, or to an equivalent degree, or to a graduate degree 
     in nursing, and including advanced training related to such 
     program of education provided by such school, but only if 
     such program, or such unit, college or university is 
     accredited.
       ``(4) Associate degree school of nursing.--The term 
     `associate degree school of nursing' means a department, 
     division, or other administrative unit in a junior college, 
     community college, college, or university which provides 
     primarily or exclusively a two-year program of education in 
     professional nursing and allied subjects leading to an 
     associate degree in nursing or to an equivalent degree, but 
     only if such program, or such unit, college, or university is 
     accredited.
       ``(5) Diploma school of nursing.--The term `diploma school 
     of nursing' means a school affiliated with a hospital or 
     university, or an independent school, which provides 
     primarily or exclusively a program of education in 
     professional nursing and allied subjects leading to a diploma 
     or to equivalent indicia that such program has been 
     satisfactorily completed, but only if such program, or such 
     affiliated school or such hospital or university or such 
     independent school is accredited.
       ``(6) Accredited.--
       ``(A) In general.--Except as provided in subparagraph (B), 
     the term `accredited' when applied to any program of nurse 
     education means a program accredited by a recognized body or 
     bodies, or by a State agency, approved for such purpose by 
     the Secretary of Education and when applied to a hospital, 
     school, college, or university (or a unit thereof) means a 
     hospital, school, college, or university (or a unit thereof) 
     which is accredited by a recognized body or bodies, or by a 
     State agency, approved for such purpose by the Secretary of 
     Education. For the purpose of this paragraph, the Secretary 
     of Education shall publish a list of recognized accrediting 
     bodies, and of State agencies, which the Secretary of 
     Education determines to be reliable authority as to the 
     quality of education offered.
       ``(B) New programs.--A new school of nursing that, by 
     reason of an insufficient period of operation, is not, at the 
     time of the submission of an application for a grant or 
     contract under this title, eligible for accreditation by such 
     a recognized body or bodies or State agency, shall be deemed 
     accredited for purposes of this title if the Secretary of 
     Education finds, after consultation with the appropriate 
     accreditation body or bodies, that there is reasonable 
     assurance that the school will meet the accreditation 
     standards of such body or bodies prior to the beginning of 
     the academic year following the normal graduation date of 
     students of the first entering class in such school.
       ``(7) Nonprofit.--The term `nonprofit' as applied to any 
     school, agency, organization, or institution means one which 
     is a corporation or association, or is owned and operated by 
     one or more corporations or associations, no part of the net 
     earnings of which inures, or may lawfully inure, to the 
     benefit of any private shareholder or individual.
       ``(8) State.--The term `State' means a State, the 
     Commonwealth of Puerto Rico, the District of Columbia, the 
     Commonwealth of the Northern Mariana Islands, Guam, American 
     Samoa, the Virgin Islands, or the Trust Territory of the 
     Pacific Islands.

     ``SEC. 802. APPLICATION.

       ``(a) In General.--To be eligible to receive a grant or 
     contract under this title, an eligible entity shall prepare 
     and submit to the Secretary an application that meets the 
     requirements of this section, at such time, in such manner, 
     and containing such information as the Secretary may require.
       ``(b) Plan.--An application submitted under this section 
     shall contain the plan of the applicant for carrying out a 
     project with amounts received under this title. Such plan 
     shall be consistent with relevant Federal, State, or regional 
     program plans.
       ``(c) Performance Outcome Standards.--An application 
     submitted under this section shall contain a specification by 
     the applicant entity of performance outcome standards that 
     the project to be funded under the grant or contract will be 
     measured against. Such standards shall address relevant 
     national nursing needs that the project will meet. The 
     recipient of a grant or contract under this section shall 
     meet the standards set forth in the grant or contract 
     application.
       ``(d) Linkages.--An application submitted under this 
     section shall contain a description of the linkages with 
     relevant educational and health care entities, including 
     training programs for other health professionals as 
     appropriate, that the project to be funded under the grant or 
     contract will establish.

     ``SEC. 803. USE OF FUNDS.

       ``(a) In General.--Amounts provided under a grant or 
     contract awarded under this title may be used for training 
     program development and support, faculty development, model 
     demonstrations, trainee support including tuition, books, 
     program fees and reasonable living expenses during the period 
     of training, technical assistance, workforce analysis, and 
     dissemination of information, as appropriate to meet 
     recognized nursing objectives, in accordance with this title.
       ``(b) Maintenance of Effort.--With respect to activities 
     for which a grant awarded under this title is to be expended, 
     the entity shall agree to maintain expenditures of non-
     Federal amounts for such activities at a level that is not 
     less than the level of such expenditures maintained by the 
     entity for the fiscal year preceding the fiscal year for 
     which the entity receives such a grant.

     ``SEC. 804. MATCHING REQUIREMENT.

       ``The Secretary may require that an entity that applies for 
     a grant or contract under this title provide non-Federal 
     matching funds, as appropriate, to ensure the institutional 
     commitment of the entity to the projects funded under the 
     grant. Such non-Federal matching funds may be provided 
     directly or through donations from public or private entities 
     and may be in cash or in-kind, fairly evaluated, including 
     plant, equipment, or services.

     ``SEC. 805. PREFERENCE.

       ``In awarding grants or contracts under this title, the 
     Secretary shall give preference to applicants with projects 
     that will substantially benefit rural or underserved 
     populations.

     ``SEC. 806. GENERALLY APPLICABLE PROVISIONS.

       ``(a) Awarding of Grants and Contracts.--The Secretary 
     shall ensure that grants and contracts under this title are 
     awarded on a competitive basis to carry out innovative 
     demonstration projects or provide for strategic workforce 
     supplementation activities as needed to meet national nursing 
     service goals and in accordance with this title.
       ``(b) Information Requirements.--Recipients of grants and 
     contracts under this title shall meet information 
     requirements as specified by the Secretary.
       ``(c) Training Programs.--Training programs conducted with 
     amounts received under this title shall meet applicable 
     accreditation and quality standards.
       ``(d) Duration of Assistance.--
       ``(1) In general.--Subject to paragraph (2), in the case of 
     an award to an entity of a grant, cooperative agreement, or 
     contract under this title, the period during which payments 
     are made to the entity under the award may not exceed 5 
     years. The provision of payments under the award shall be 
     subject to annual approval by the Secretary of the payments 
     and subject to the availability of appropriations for the 
     fiscal year involved to make the payments. This paragraph may 
     not be construed as limiting the number of awards under the 
     program involved that may be made to the entity.
       ``(2) Limitation.--In the case of an award to an entity of 
     a grant, cooperative agreement, or contract under this title, 
     paragraph (1) shall apply only to the extent not inconsistent 
     with any other provision of this title that relates to the 
     period during which payments may be made under the award.
       ``(e) Peer Review Regarding Certain Programs.--Each 
     application for a grant under this title, except advanced 
     nurse traineeship grants under section 811(a)(2), shall be 
     submitted to a peer review group for an evaluation of the 
     merits of the proposals made in the application. The 
     Secretary may not approve such an application unless a peer 
     review group has recommended the application for approval. 
     Each peer review group under this subsection shall be 
     composed principally of individuals who are not officers or 
     employees of the Federal Government. This subsection shall be 
     carried out by the Secretary acting through the Administrator 
     of the Health Resources and Services Administration.

     ``SEC. 807. NATIONAL ADVISORY COUNCIL ON NURSE EDUCATION AND 
                   PRACTICE.

       ``(a) Establishment.--There is hereby established a 
     National Advisory Council on Nurse Education and Practice (in 
     this section referred to as the `Council'), consisting of the 
     Secretary or the delegate of the Secretary (who shall be an 
     ex officio member and shall serve as the Chairperson), and 15 
     members appointed by the Secretary without regard to the 
     Federal civil service laws, of which--
       ``(1) 2 shall be selected from full-time students enrolled 
     in schools of nursing;
       ``(2) 3 shall be selected from the general public;
       ``(3) 2 shall be selected from practicing professional 
     nurses; and
       ``(4) 8 shall be selected from among the leading 
     authorities in the various fields of nursing, higher, and 
     secondary education, and from representatives of hospitals 
     and other institutions and organizations which provide 
     nursing services.

     A majority of the members shall be nurses. The student-
     members of the Council shall be appointed for terms of one 
     year and shall be eligible for reappointment to the Council.
       ``(b) Duties.--The Council shall advise the Secretary in 
     the preparation of general regulations and with respect to 
     policy matters arising in the administration of this title, 
     including the range of issues relating to nurse supply, 
     education and practice improvement.
       ``(c) Funding.--Amounts appropriated under this title may 
     be utilized by the Secretary to support the nurse education 
     and practice activities of the Council.

     ``SEC. 808. TECHNICAL ASSISTANCE.

       ``Funds appropriated under this title may be used by the 
     Secretary to provide technical assistance in relation to any 
     of the authorities under this title.

     ``SEC. 809. RECOVERY FOR CONSTRUCTION ASSISTANCE.

       ``(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 subpart I of part A (as such subpart was in 
     effect on September 30, 1985)--
       ``(1) the owner of the facility ceases to be a public or 
     nonprofit school,
       ``(2) the facility ceases to be used for the training 
     purposes 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 of Change in Status.--The owner of a facility 
     which ceases to be a public or nonprofit school as described 
     in paragraph (1) of subsection (a), or the owner of a 
     facility the use of which changes as described in paragraph 
     (2) or (3) of such subsection 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 the 
     Health Professions Training Assistance Act of 1985, whichever 
     is later.
       ``(c) Amount of Recovery.--
       ``(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 the 
     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 91-day Treasury bills auctioned 
     during such period.
       ``(B) Time 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 school as 
     described in paragraph (1) of subsection (a), or 191 days 
     after the date on which the use of the facility changes as 
     described in paragraph (2) or (3) of such subsection, 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 if collected.
       ``(d) Waiver of Rights.--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) Limitation on Liens.--The right of recovery of the 
     United States under subsection (a) shall not, prior to 
     judgment, constitute a lien on any facility.

   ``PART B--NURSE PRACTITIONERS, NURSE MIDWIVES, AND OTHER ADVANCED 
                            PRACTICE NURSES

     ``SEC. 811. ADVANCED PRACTICE NURSING GRANTS.

       ``(a) In General.--The Secretary may award grants to and 
     enter into contracts with eligible entities to meet the costs 
     of--
       ``(1) projects that support the enhancement of advanced 
     practice nursing education and practice; and
       ``(2) traineeships for individuals in advanced practice 
     nursing programs.
       ``(b) Definition of Advanced Practice Nurses.--For purposes 
     of this section, the term `advanced practice nurses' means 
     nurses trained in advanced degree programs including 
     individuals in combined R.N./Master's degree programs, post-
     nursing master's certificate programs, or, in the case of 
     nurse midwives or nurse anesthetists, in certificate programs 
     that received funding under this title on the date that is 
     one day prior to the date of enactment of this section, to 
     serve as nurse practitioners, nurse midwives, nurse 
     anesthetists, nurse educators, or public health nurses, or in 
     other nurse specialties determined by the secretary to 
     require advanced education.
       ``(c) Authorized Nurse Practitioner and Nurse-Midwifery 
     Programs.--
       ``(1) In general.--Nurse practitioner and nurse midwifery 
     programs eligible for support under this section are 
     educational programs for registered nurses (irrespective of 
     the type of school of nursing in which the nurses received 
     their training) that--
       ``(A) meet guidelines prescribed by the Secretary in 
     accordance with paragraph (2); and
       ``(B) have as their objective the education of nurses who 
     will upon completion of their studies in such programs, be 
     qualified to effectively provide primary health care, 
     including primary health care in homes and in ambulatory care 
     facilities, long-term care facilities and other health care 
     institutions.
       ``(2) Guidelines.--After consultation with appropriate 
     educational organizations and professional nursing and 
     medical organizations, the Secretary shall prescribe 
     guidelines for programs described in paragraph (1). Such 
     guidelines shall, as a minimum, require that such a program--
       ``(A) extend for at least one academic year and consist 
     of--
       ``(i) supervised clinical practice directed toward 
     preparing nurses to deliver primary health care; and
       ``(ii) at least four months (in the aggregate) of classroom 
     instruction that is so directed; and
       ``(B) have an enrollment of not less than six full-time 
     equivalent students.
       ``(d) Other Authorized Educational Programs.--The Secretary 
     shall prescribe guidelines as appropriate for other advanced 
     practice nurse education programs eligible for support under 
     this section.
       ``(e) Traineeships.--
       ``(1) In general.--The Secretary may not award a grant to 
     an applicant under subsection (a) unless the applicant 
     involved agrees that traineeships provided with the grant 
     will pay all or part of the costs of--
       ``(A) the tuition, books, and fees of the program of 
     advanced nursing practice with respect to which the 
     traineeship is provided; and
       ``(B) the reasonable living expenses of the individual 
     during the period for which the traineeship is provided.
       ``(2) Doctoral programs.--The Secretary may not obligate 
     more than 10 percent of the traineeships under subsection (a) 
     for individuals in doctorate degree programs.
       ``(3) Special consideration.--In making awards of grants 
     and contracts under subsection (a)(2), the Secretary shall 
     give special consideration to an eligible entity that agrees 
     to expend the award to train advanced practice nurses who 
     will practice in health professional shortage areas 
     designated under section 332.
       ``(f) Authorization of Appropriations.--
       ``(1) In general.--There are authorized to be appropriated 
     to carry out this section, $50,000,000 for fiscal year 1995, 
     and such sums as may be necessary for each of the fiscal 
     years 1996 and 1997.
       ``(2) Set asides.--Of the amount appropriated under 
     paragraph (1) for a fiscal year--
       ``(A) not less than 60 percent of such amount shall be made 
     available for projects to enhance the training and practice 
     of nurse practitioners and nurse midwives; and
       ``(B) not less than 6 percent of such amounts shall be made 
     available for projects to enhance the training and practice 
     of nurse anesthetists.

            ``PART C--INCREASING NURSING WORKFORCE DIVERSITY

     ``SEC. 821. WORKFORCE DIVERSITY GRANTS.

       ``(a) In General.--The Secretary may award grants to and 
     enter into contracts with eligible entities to meet the costs 
     of special projects to increase nursing education 
     opportunities for individuals who are from disadvantaged 
     racial and ethnic backgrounds underrepresented among 
     registered nurses by providing student scholarships or 
     stipends, pre-entry preparation, and retention activities.
       ``(b) Guidance.--In carrying out subsection (a), the 
     Secretary shall take into consideration the recommendations 
     of the First and Second Invitational Congresses for Minority 
     Nurse Leaders on `Caring for the Emerging Majority,' in 1992 
     and 1993, and consult with nursing associations including the 
     American Nurses Association, the National League for Nursing, 
     the American Association of Colleges of Nursing, the Black 
     Nurses Association, the Association of Hispanic Nurses, the 
     Association of Asian American and Pacific Islander Nurses, 
     the National Nurses Association, the Native American Indian 
     and Alaskan Nurses Association.
       ``(c) Required Information and Conditions for Award 
     Recipients.--
       ``(1) In general.--Recipients of awards under this section 
     may be required, where requested, to report to the Secretary 
     concerning the annual admission, retention, and graduation 
     rates for ethnic and racial minorities in the school or 
     schools involved in the projects.
       ``(2) Falling rates.--If any of the rates reported under 
     paragraph (1) fall below the average of the two previous 
     years, the grant or contract recipient shall provide the 
     Secretary with plans for immediately improving such rates.
       ``(3) Ineligibility.--A recipient described in paragraph 
     (2) shall be ineligible for continued funding under this 
     section if the plan of the recipient fails to improve the 
     rates within the 1-year period beginning on the date such 
     plan is implemented.
       ``(d) 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.

``PART D--STRENGTHENING CAPACITY FOR BASIC NURSE EDUCATION AND PRACTICE

     ``SEC. 831. BASIC NURSE EDUCATION AND PRACTICE GRANTS.

       ``(a) In General.--The Secretary may award grants to and 
     enter into contracts with eligible entities for projects to 
     strengthen capacity for basic nurse education and practice.
       ``(b) Priority Areas.--In awarding grants or contracts 
     under this section the Secretary shall give priority to 
     entities that will use amounts provided under such a grant or 
     contract to enhance the education mix and utilization of the 
     basic nursing workforce by strengthening programs that 
     provide basic nurse education for purposes of--
       ``(1) improving nursing services in schools and other 
     community settings;
       ``(2) providing care for underserved populations and other 
     high-risk groups such as the elderly, individuals with HIV-
     AIDS, substance abusers, homeless, and battered women;
       ``(3) providing case management, quality improvement, 
     delegation and supervision, other skills needed under new 
     health care systems;
       ``(4) developing cultural competencies among nurses;
       ``(5) providing emergency health services;
       ``(6) promoting career mobility for nursing personnel in a 
     variety of training settings and cross training or specialty 
     training among diverse population groups; or
       ``(7) other priority areas as determined by the Secretary.
       ``(c) Authorization of Appropriations.--There are 
     authorized to be appropriated to carry out this section, 
     $12,000,000 for fiscal year 1995, and such sums as may be 
     necessary for each of the fiscal years 1996 and 1997.''; and
       (7) by redesignating section 855 as section 810, and 
     transferring such section so as to appear after section 809 
     (as added by the amendment made by paragraph (6)).

     SEC. 4. SAVINGS PROVISION AND TECHNICAL AMENDMENTS.

       (a) Savings Provision.--In the case of any authority for 
     making awards of grants or contracts that is terminated by 
     the amendment made by section 3, the Secretary of Health and 
     Human Services may, notwithstanding the termination of the 
     authority, continue in effect any grant or contract made 
     under the authority that is in effect on the day before the 
     date of the enactment of this Act, subject to the duration of 
     any such grant or contract not exceeding the period 
     determined by the Secretary in first approving such financial 
     assistance, or in approving the most recent request made 
     (before the date of such enactment) for continuation of such 
     assistance, as the case may be.
       (b) Clinical Researchers.--Paragraph (3) of section 487E(a) 
     of the Public Health Service Act (42 U.S.C. 288-5(a)(3)) is 
     amended to read as follows:
       ``(3) Applicability of certain provisions regarding 
     obligated service.--With respect to the National Health 
     Service Corps loan repayment program established in subpart 
     III of part D of title III, the provisions of such subpart 
     shall, except as inconsistent with this section, apply to the 
     program established in subsection (a) in the same manner and 
     to the same extent as such provisions apply to the National 
     Health Service Corps loan repayment programs.''.
       (c) Technical Amendments.--Section 839 of such Act (42 
     U.S.C. 297e) is amended--
       (1) in subsection (a)--
       (A) by striking the matter preceding paragraph (1) and 
     inserting the following:
       ``(a) If a school terminates a loan fund established under 
     an agreement pursuant to section 835(b), or if the Secretary 
     for good cause terminates the agreement with the school, 
     there shall be a capital distribution as follows:''; and
       (B) in paragraph (1), by striking ``at the close of 
     September 30, 1999,'' and inserting ``on the date of 
     termination of the fund''; and
       (2) in subsection (b), to read as follows:
       ``(b) If a capital distribution is made under subsection 
     (a), the school involved shall, after such capital 
     distribution, pay to the Secretary, not less often than 
     quarterly, the same proportionate share of amounts received 
     by the school in payment of principal or interest on loans 
     made from the loan fund established under section 835(b) as 
     determined by the Secretary under subsection (a).''.

     SEC. 5. EFFECTIVE DATE.

       This Act shall take effect on October 1, 1994, or the date 
     of enactment of this Act, whichever is later.

                          ____________________