[Congressional Record Volume 142, Number 137 (Saturday, September 28, 1996)]
[Senate]
[Pages S11670-S11695]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




   HEALTH PROFESSIONS EDUCATION CONSOLIDATION AND REAUTHORIZATION ACT

  Mr. LOTT. I ask unanimous consent to proceed to the immediate 
consideration of Calendar No. 121, S. 555.
  The PRESIDING OFFICER. The clerk will report.
  The legislative clerk read as follows:

       A bill (S. 555) to amend the Public Health Service Act to 
     consolidate and reauthorize health professional and minority 
     and disadvantaged health education programs, and for other 
     purposes.

  The PRESIDING OFFICER. Is there objection to the immediate 
consideration of the bill?
  There being no objection, the Senate proceeded to consider the 
bill, which had been reported from the Committee on Labor and Human 
Resources, with an amendment to strike out all after the enacting 
clause, and inserting in lieu thereof the following:

     SECTION 1. SHORT TITLE.

       (a) Short Title.--This Act may be cited as the ``Health 
     Professions Education Consolidation and Reauthorization Act 
     of 1995''.
       (b) Table of Contents.--The table of contents for this Act 
     is as follows:

Sec. 1. Short title.

TITLE I--HEALTH PROFESSIONS EDUCATION AND FINANCIAL ASSISTANCE PROGRAMS

           Subtitle A--Health Professions Education Programs

Sec. 101. Minority and disadvantaged health professions grant program.
Sec. 102. Training in family medicine, general internal medicine, 
              general pediatrics, preventive medicine, physician 
              assistants, and general dentistry.
Sec. 103. Enhanced health education and training.
Sec. 104. Health professions workforce development.
Sec. 105. General provisions.
Sec. 106. Preference in certain programs.
Sec. 107. Definitions.
Sec. 108. Savings provision.

                     Subtitle B--Nursing Education

Sec. 121. Short title.
Sec. 122. Purpose.
Sec. 123. Amendments to Public Health Service Act.
Sec. 124. Savings provision.

                    Subtitle C--Financial Assistance

  Part 1--National Health Service Corps Financial Assistance Programs

Sec. 131. General amendments with respect to federally supported loans.
Sec. 132. Restructuring and technical amendments.
Sec. 133. Definition of underserved areas.
Sec. 134. Conforming amendments.

               Part 2--School-based Revolving Loan Funds

Sec. 135. Primary care loan program.
Sec. 136. Loans for disadvantaged students.
Sec. 137. Student loans regarding schools of nursing.
Sec. 138. General provisions.

 Part 3--Insured Health Education Assistance Loans to Graduate Students

Sec. 141. Health education assistance loan program.
Sec. 142. HEAL lender and holder performance standards.
Sec. 143. Reauthorization.

            Part 4--Scholarships for Disadvantaged Students

Sec. 151. Scholarships for disadvantaged students.

                  TITLE II--OFFICE OF MINORITY HEALTH

Sec. 201. Revision and extension of programs of Office of Minority 
              Health.

                    TITLE III--SELECTED INITIATIVES

Sec. 301. Programs regarding birth defects.

[[Page S11671]]

Sec. 302. Traumatic brain injury.
Sec. 303. State offices of rural health.
Sec. 304. Health services for Pacific Islanders.
Sec. 305. Demonstration projects regarding Alzheimer's Disease.

                   TITLE IV--MISCELLANEOUS PROVISIONS

Sec. 401. Technical corrections regarding Public Law 103-183.
Sec. 402. Certain authorities of Centers for Disease Control and 
              Prevention.
Sec. 403. Administration of certain requirements.
Sec. 404. Technical corrections relating to health professions 
              programs.
Sec. 405. Clinical traineeships.
Sec. 406. Construction of regional centers for research on primates.
Sec. 407. Required consultation by Secretary.
TITLE I--HEALTH PROFESSIONS EDUCATION AND FINANCIAL ASSISTANCE PROGRAMS
           Subtitle A--Health Professions Education Programs

     SEC. 101. MINORITY AND DISADVANTAGED HEALTH PROFESSIONS GRANT 
                   PROGRAM.

       (a) In General.--Part B of title VII of the Public Health 
     Service Act (42 U.S.C. 293 et seq.) is amended to read as 
     follows:

          ``PART B--DISADVANTAGED HEALTH PROFESSIONS TRAINING

     ``SEC. 736. STATEMENT OF PURPOSE.

       ``(a) In General.--The Secretary shall make grants to or 
     enter into contracts with eligible entities for the purpose 
     of establishing, enhancing, and expanding programs to 
     increase the number and the quality of disadvantaged health 
     professionals, particularly those who provide health services 
     to disadvantaged populations or in medically underserved 
     areas or rural areas.
       ``(b) Use of Funds.--Amounts provided under a grant or 
     contract awarded under this part may be used for costs of 
     planning, developing, or operating centers of excellence in 
     minority health professions education, programs for assisting 
     individuals from disadvantaged backgrounds to enter a health 
     profession, minority faculty development, minority faculty 
     loan repayment or fellowships, trainee support, technical 
     assistance, workforce analysis, and dissemination of 
     information.
       ``(c) Consortium.--Schools within a consortium that applies 
     for a grant or contract under this part shall enter into an 
     agreement to allocate the funds received under the grant or 
     contract among such schools and expend such funds in 
     accordance with the application for such grant or contract.

     ``SEC. 737. PREFERENCES.

       ``In awarding grants or contracts to eligible entities 
     under this part, the Secretary shall give preference to--
       ``(1) projects that involve more than one health 
     professions discipline or training institution and have an 
     above average record of retention and graduation of 
     individuals from disadvantaged backgrounds; and
       ``(2) centers of excellence at Historically Black Colleges 
     and Universities (as defined in section 739) beginning in 
     fiscal year 1999 and for each fiscal year thereafter.

     ``SEC. 738. AUTHORIZATION OF APPROPRIATION.

       ``(a) In General.--There are authorized to be appropriated 
     to carry out this part, $51,000,000 for fiscal year 1996, and 
     such sums as may be necessary for each of the fiscal years 
     1997 through 1999.
       ``(b) Set-Aside.--With respect to each of the fiscal years 
     1996, 1997 and 1998, the Secretary shall set-aside 
     $12,000,000 of the amount appropriated under subsection (a) 
     in each such fiscal year for the purpose of making grants 
     under section 736 to centers of excellence at certain 
     Historically Black Colleges and Universities.
       ``(c) No Limitation.--Nothing in this section shall be 
     construed as limiting the centers of excellence referred to 
     in subsection (b) to the set-aside amount, or to preclude 
     such entities from competing for other grants under section 
     736.

     ``SEC. 739. DEFINITIONS.

       ``As used in this part:
       ``(1) Centers of excellence.--The term `centers of 
     excellence' means a health professions school that--
       ``(A)(i) has a significant number of minority individuals 
     enrolled in the school, including individuals accepted for 
     enrollment in the school;
       ``(ii) has been effective in assisting minority students of 
     the school to complete the program of education and receive 
     the degree involved;
       ``(iii) has been effective in recruiting minority 
     individuals to attend the school and encouraging minority 
     students of secondary educational institutions to attend the 
     health professions school; and
       ``(iv) has made significant recruitment efforts to increase 
     the number of minority individuals serving in faculty or 
     administrative positions at the school; or
       ``(B) is a center of excellence at certain Historically 
     Black Colleges and Universities.
       ``(2) Consortium.--The term `consortium' means the 
     designated eligible entity seeking a grant under this part 
     and one or more schools of medicine, osteopathic medicine, 
     dentistry, pharmacy, nursing, allied health, public health, 
     or graduate programs in mental health practice.
       ``(3) Eligible entities.--The term `eligible entities' 
     means schools of medicine, osteopathic medicine, dentistry, 
     pharmacy, podiatric medicine, optometry, veterinary medicine, 
     public health, or allied health or schools offering graduate 
     programs in mental health practice, State or local 
     governments, and other public or nonprofit private entities 
     determined appropriate by the Secretary that submit to the 
     Secretary an application.
       ``(4) Historically black colleges and universities.--The 
     term `Historically Black Colleges and Universities' means a 
     school described in section 799B(1) that has received a 
     contract under section 788B for fiscal year 1987, as such 
     section was in effect for such fiscal year.''.
       (b) Repeal.--
       (1) In general.--Section 795 of the Public Health Service 
     Act (42 U.S.C. 295n) is repealed.
       (2) Nontermination of authority.--The amendments made by 
     this section shall not be construed to terminate agreements 
     that, on the day before the date of enactment of this Act, 
     are in effect pursuant to section 795 of the Public Health 
     Service Act (42 U.S.C. 795) as such section existed on such 
     date. Such agreements shall 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 shall be counted towards the 
     satisfaction of the requirement of practice pursuant to such 
     section 795.
       (c) Conforming Amendments.--Section 481A(c)(3)(D)(i) of the 
     Public Health Service Act (42 U.S.C. 287a-2(c)(3)(D)(i)) is 
     amended by striking ``section 739'' and inserting ``part B of 
     title VII''.

     SEC. 102. TRAINING IN FAMILY MEDICINE, GENERAL INTERNAL 
                   MEDICINE, GENERAL PEDIATRICS, PREVENTIVE 
                   MEDICINE, PHYSICIAN ASSISTANTS, AND GENERAL 
                   DENTISTRY.

       Part C of title VII of the Public Health Service Act (42 
     U.S.C. 293 et seq.) is amended--
       (1) in the part heading by striking ``PRIMARY HEALTH CARE'' 
     and inserting ``FAMILY MEDICINE, GENERAL INTERNAL MEDICINE, 
     GENERAL PEDIATRICS, PREVENTIVE MEDICINE, PHYSICIAN 
     ASSISTANTS, AND GENERAL DENTISTRY'';
       (2) by repealing section 746 and sections 748 through 752 
     (42 U.S.C. 293j and 293l through 293p); and
       (3) in section 747 (42 U.S.C. 293k)--
       (A) by striking the section heading and inserting the 
     following:

     ``SEC. 747. FAMILY MEDICINE, GENERAL INTERNAL MEDICINE, 
                   GENERAL PEDIATRICS, PREVENTIVE MEDICINE, 
                   GENERAL DENTISTRY, AND PHYSICIAN ASSISTANTS.'';

       (B) in subsection (a)--
       (i) in paragraph (1)--

       (I) by inserting ``, internal medicine, or pediatrics'' 
     after ``family medicine''; and
       (II) by inserting before the semicolon the following: 
     ``that emphasizes training for the practice of family 
     medicine, general internal medicine, or general pediatrics 
     (as defined by the Secretary)'';

       (ii) in paragraph (2), by inserting ``, general internal 
     medicine, or general pediatrics'' before the semicolon;
       (iii) in paragraphs (3) and (4), by inserting ``, general 
     internal medicine (including geriatrics), or general 
     pediatrics'' after ``family medicine'';
       (iv) in paragraphs (3) and (4), by inserting ``(including 
     geriatrics) after ``family medicine'';
       (v) in paragraph (3), by striking ``and'' at the end 
     thereof;
       (vi) in paragraph (4), by striking the period and inserting 
     a semicolon; and
       (vii) by adding at the end thereof the following new 
     paragraphs:
       ``(5) to meet the costs of projects to plan, develop, and 
     operate or maintain programs for the training of physician 
     assistants (as defined in section 799B), and for the training 
     of individuals who will teach in programs to provide such 
     training;
       ``(6) to meet the costs of projects--
       ``(A) to plan and develop new residency training programs 
     and to maintain or improve existing residency training 
     programs in preventive medicine, that have available full-
     time faculty members with training and experience in the 
     fields of preventive medicine; and
       ``(B) to provide financial assistance to residency trainees 
     enrolled in such programs; and
       ``(7) to meet the costs of planning, developing, or 
     operating programs, and to provide financial assistance to 
     residents in such programs, that would lead to a 
     significantly greater ratio of participating individuals in 
     such programs eventually entering practice in general 
     dentistry in rural and medically underserved communities 
     compared to the current ratio of all dentists nationally 
     practicing general dentistry in rural and medically 
     underserved communities.

     For purposes of paragraph (7), entities eligible for such 
     grants or contracts shall include entities that have programs 
     in dental schools, approved residency programs in the general 
     practice of dentistry, or approved advanced education 
     programs in the general practice of dentistry. The Secretary 
     may only fund programs under such paragraph if such programs 
     provide a significant amount of care for underserved 
     populations and other high-risk groups, and if the Secretary 
     determines that there is a national shortage of general 
     dentists.'';
       (C) in paragraphs (1) and (2)(A) of subsection (b), by 
     inserting ``, general internal medicine, or general 
     pediatrics'' after ``family medicine'';
       (D) by redesignating subsections (c) and (d) as subsections 
     (d) and (e), respectively;
       (E) by inserting after subsection (b), the following new 
     subsection:
       ``(c) Priority and Limitation.--
       ``(1) Priority.--With respect to programs for the training 
     of interns or residents, the Secretary shall give priority in 
     awarding grants under this section to qualified applicants 
     that have a record of training the greatest percentage of 
     providers, or that have demonstrated significant improvements 
     in the percentage of providers, which enter and remain in 
     primary care practice or general dentistry upon completion of 
     their first period of training required to obtain initial 
     board certification. Each program shall designate the primary 
     care training or general dentistry positions that such 
     program shall provide with grant funding to support and for 
     which such program shall be held accountable

[[Page S11672]]

     regarding the primary care or general dentistry requirement 
     set forth in this section.
       ``(2) Limitation.--With respect to programs for the 
     training and education of medical students, the Secretary may 
     only provide grants or contracts under this section to 
     administrative units in general pediatrics or general 
     internal medicine if a qualified administrative unit 
     applicant demonstrates that its medical school has--
       ``(A) a mission statement that has a primary care medical 
     education objective;
       ``(B) faculty role models and administrative units in 
     primary care; and
       ``(C) required undergraduate ambulatory medical student 
     clerkships in family medicine, internal medicine, and 
     pediatrics.

     Where a medical school does not have an administrative unit 
     in family medicine, clerkships in family medicine shall not 
     be required.''; and
       (F) in subsection (e) (as so redesignated by subparagraph 
     (D))--
       (i) in paragraph (1), by striking ``$54,000,000'' and all 
     that follows and inserting ``$76,000,000 for fiscal year 
     1996, and such sums as may be necessary for each of the 
     fiscal years 1997 through 1999.''; and
       (ii) in paragraph (2)--

       (I) by striking ``20'' and inserting ``12''; and
       (II) by inserting ``for family medicine academic 
     administrative units'' after ``under subsection (b)''.

     SEC. 103. ENHANCED HEALTH EDUCATION AND TRAINING.

       Part D of title VII of the Public Health Service Act (42 
     U.S.C. 294 et seq.) is amended to read as follows:

                ``PART D--AREA HEALTH EDUCATION CENTERS

     ``SEC. 750. AREA HEALTH EDUCATION CENTERS.

       ``(a) In General.--The Secretary may award grants to and 
     enter into contracts with eligible entities for projects 
     which --
       ``(1) improve the recruitment, distribution, supply, 
     quality, utilization, and efficiency of personnel providing 
     health services in urban and rural areas and to populations 
     that have demonstrated serious unmet health care need;
       ``(2) encourage the regionalization of educational 
     responsibilities of the health professions schools;
       ``(3) are designed to prepare, through field placements, 
     preceptorships, the conduct of or affiliation with community-
     based primary care residency programs, agreements with 
     community-based organizations for the delivery of education 
     and training in the health professions, and other programs, 
     individuals to effectively provide health services in health 
     professional shortage areas;
       ``(4) conduct health professions education and training 
     activities consistent with national and State priorities, 
     including geriatrics;
       ``(5) encourage health promotion and disease prevention 
     activities;
       ``(6) conduct interdisciplinary training and practice 
     involving other health professionals;
       ``(7) conduct continuing education programs for health 
     professionals or coordinate with such programs; and
       ``(8) address other areas as determined appropriate by the 
     Secretary.
       ``(b) Preferences.--In awarding grants or contracts to 
     eligible entities under this part, the Secretary shall give 
     preference to projects that--
       ``(1) involve more than one health professions discipline 
     or training institution; and
       ``(2) have a good record of retention and graduation of 
     individuals that enter practice in medically underserved 
     communities.
       ``(c) Other Eligible Programs.--
       ``(1) Geriatric education centers.--The Secretary shall 
     award grants or contracts under this section for the 
     establishment or operation of geriatric education centers.
       ``(2) Public health training centers.--
       ``(A) In general.--The Secretary shall award grants or 
     contracts under this section for the operation of public 
     health training centers.
       ``(B) Eligible entities.--A public health training center 
     shall be an accredited school of public health, or another 
     public or nonprofit private institution accredited for the 
     provision of graduate or specialized training in public 
     health, that plans, develops, operates, and evaluates 
     projects that are in furtherance of the goals established by 
     the Secretary for the year 2000 in the areas of preventive 
     medicine, health promotion and disease prevention, or 
     improving access to and quality of health services in 
     medically underserved communities.
       ``(C) Certain requirements.--With respect to a public 
     health training center, an award may not be made under 
     subparagraph (A) unless the program agrees that it--
       ``(i) will establish or strengthen field placements for 
     students in public or nonprofit private health agencies or 
     organizations; and
       ``(ii) will involve faculty members and students in 
     collaborative projects to enhance public health services to 
     medically underserved communities.
       ``(d) Eligible Entities.--As used in this part, the term 
     `eligible entities' means schools of medicine, osteopathic 
     medicine, dentistry, pharmacy, podiatric medicine, optometry, 
     veterinary medicine, public health, or allied health or 
     schools offering graduate programs in mental health practice 
     or physician assistant training programs, State or local 
     governments, and other public or nonprofit private entities 
     determined appropriate by the Secretary that submit to the 
     Secretary an application.
       ``(e) Geriatric Education Centers.--A geriatric education 
     center shall be an accredited health professions school or 
     program that--
       ``(1) improves the training of health professionals in 
     geriatrics, including geriatric residencies, traineeships, or 
     fellowships;
       ``(2) develops and disseminates curricula relating to the 
     treatment of the health problems of elderly individuals;
       ``(3) supports the training and retraining of faculty to 
     provide instruction in geriatrics;
       ``(4) supports continuing education of health professionals 
     who provide geriatric care; and
       ``(5) provides students with clinical training in 
     geriatrics in nursing homes, chronic and acute disease 
     hospitals, ambulatory care centers, and senior centers.

     ``SEC. 751. AUTHORIZATION OF APPROPRIATIONS.

       ``There are authorized to be appropriated to carry out this 
     part, $43,000,000 for fiscal year 1996, such sums as may be 
     necessary for each of the fiscal years 1997 and 1998, and 
     $29,000,000 for fiscal year 1999.''.

     SEC. 104. HEALTH PROFESSIONS WORKFORCE DEVELOPMENT.

       (a) In General.--Part E of title VII of the Public Health 
     Service Act (42 U.S.C. 294n et seq.) is amended--
       (1) in the part heading to read as follows:

         ``PART E--HEALTH PROFESSIONS WORKFORCE DEVELOPMENT'';

       (2) by redesignating section 776 (42 U.S.C. 294n) as 
     section 761; and
       (3) by striking sections 777 and 778 (42 U.S.C. 294o and 
     294p) and inserting the following new section:

     ``SEC. 762. HEALTH PROFESSIONS WORKFORCE DEVELOPMENT.

       ``(a) In General.--The Secretary may award grants to and 
     enter into contracts with eligible entities for projects to 
     strengthen capacity for health professions education and 
     practice.
       ``(b) Eligible Applicants.--Applicants eligible to obtain 
     funds under subsection (a) shall include schools of medicine, 
     osteopathic medicine, dentistry, veterinary medicine, 
     pharmacy, podiatric medicine, chiropractic medicine, 
     optometry, public health, or allied health, graduate programs 
     in mental health practice, physician assistant training 
     programs, and other public and nonprofit private entities.
       ``(c) Priority Areas.--In awarding grants or contracts 
     under subsection (a), the Secretary shall give priority to 
     entities that will use amounts provided under such grants or 
     contracts to enhance the education of health professionals 
     for purposes of--
       ``(1) providing care for underserved populations and other 
     high-risk groups;
       ``(2) increasing the number of individuals who are pursuing 
     a course of study in a health professions field in which 
     there is a severe shortage of health professionals;
       ``(3) conducting health professions research and data 
     collection; and
       ``(4) carrying out other activities in areas determined 
     appropriate by the Secretary.
       ``(d) Authorization of Appropriations.--
       ``(1) In general.--There are authorized to be appropriated 
     to carry out this section, $16,000,000 for fiscal year 1996, 
     and such sums as may be necessary for each of the fiscal 
     years 1997 through 1999.
       ``(2) Reservation.--Of the amounts appropriated under 
     subsection (a) for a fiscal year, the Secretary shall reserve 
     not less than $2,000,000 for conducting health professions 
     research and for carrying out data collection and analysis in 
     accordance with section 792.''.
       (b) Health Professions Data.--The second sentence of 
     section 792(a) of the Public Health Service Act (42 U.S.C. 
     295k(a)) is amended--
       (1) by striking ``is authorized to'' and inserting 
     ``shall''; and
       (2) by inserting ``clinical social workers,'' after 
     ``clinical psychologists,''.
       (c) Council on Graduate Medical Education.--Section 301 of 
     the Health Professions Education Extension Amendments of 1992 
     (Public Law 102-408) is amended--
       (1) in subsection (j), by striking ``1995'' and inserting 
     ``1999'';
       (2) in subsection (k), by striking ``1995'' and inserting 
     ``1999'';
       (3) by adding at the end thereof the following new 
     subsection:
       ``(l) Funding.--Amounts otherwise appropriated under this 
     title may be utilized by the Secretary to support the 
     activities of the Council.'';
       (4) by transferring such section to part E of title VII of 
     the Public Health Service Act (as amended by subsection (a));
       (5) by redesignating such section as section 763; and
       (6) by inserting such section after section 762.

     SEC. 105. GENERAL PROVISIONS.

       (a) In General.--
       (1) Part F of title VII of the Public Health Service Act 
     (42 U.S.C. 295 et seq.) is repealed.
       (2) Part G of title VII of the Public Health Service Act 
     (42 U.S.C. 295j et seq.) is amended--
       (A) by redesignating such part as part F;
       (B) in section 791 (42 U.S.C. 295j)--
       (i) by striking subsection (b); and
       (ii) redesignating subsection (c) as subsection (b);
       (C) by repealing section 793 (42 U.S.C. 295l);
       (D) by repealing section 798;
       (E) by redesignating section 799 as section 799B; and
       (F) by inserting after section 794, the following new 
     sections:

     ``SEC. 796. 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

[[Page S11673]]

     of performance outcome standards that the project to be 
     funded under the grant or contract will be measured against. 
     Such standards shall address relevant health workforce 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. 797. 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 health workforce 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. 798. 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. As determined by the Secretary, 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. 799. 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, as appropriate, to carry out 
     innovative demonstration projects or provide for strategic 
     workforce supplementation activities as needed to meet health 
     workforce goals and in accordance with this title. Contracts 
     may be entered into under this title with public or private 
     entities as may be necessary.
       ``(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 any 
     scholarship or loan program, including those under sections 
     701, 721, or 723, 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.
       ``(f) Preference or Priority Considerations.--In 
     considering a preference or priority for funding which is 
     based on outcome measures for an eligible entity under this 
     title, the Secretary may also consider the future ability of 
     the eligible entity to meet the outcome preference or 
     priority through improvements in the eligible entity's 
     program design.

     ``SEC. 799A. 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. 106. PREFERENCE IN CERTAIN PROGRAMS.

       (a) In General.--Section 791 of the Public Health Service 
     Act (42 U.S.C. 295j), as amended by section 105(a)(2)(B), is 
     further amended by adding at the end thereof the following 
     subsection:
       ``(c) Exceptions for New Programs.--
       ``(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 clinical 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.''.
       (b) Conforming Amendments.--Section 791(a) of the Public 
     Health Service Act (42 U.S.C. 295j(a)) is amended--
       (1) in paragraph (1), by striking ``sections 747'' and all 
     that follows through ``767'' and inserting ``section 747''; 
     and
       (2) in paragraph (2), by striking ``under section 798(a)''.

     SEC. 107. DEFINITIONS.

       (a) Professional Psychology.--Section 799B(1)(B) of the 
     Public Health Service Act (42 U.S.C. 295p(1)(B)) (as so 
     redesignated by section 105(a)(2)(E)) is amended by striking 
     ``program in clinical psychology'' and inserting ``graduate 
     programs in professional psychology''.
       (b) Medically Underserved Community.--Section 799B(6) of 
     the Public Health Service Act (42 U.S.C. 295p(6)) (as so 
     redesignated by section 105(a)(2)(E)) 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 the following new subparagraphs:
       ``(D) is a State or local health department that has a 
     severe shortage of public health personnel as determined 
     under criteria established by the Secretary;
       ``(E) has 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
       ``(F) has 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.''.
       (c) Programs for the Training of Physician Assistants.--
     Paragraph (3) of section 799B of the Public Health Service 
     Act (42 U.S.C. 295p) (as so redesignated by section 
     105(a)(2)(E)) is amended to read as follows:
       ``(3) The term `program for the training of physician 
     assistants' means an educational program that--
       ``(A) has as its objective the education of individuals who 
     will, upon completion of their studies in the program, be 
     qualified to provide primary care under the supervision of a 
     physician;
       ``(B) extends for at least one academic year and consists 
     of--
       ``(i) supervised clinical practice; and
       ``(ii) at least four months (in the aggregate) of classroom 
     instruction, directed toward preparing students to deliver 
     health care;
       ``(C) has an enrollment of not less than eight students; 
     and
       ``(D) trains students in primary care, disease prevention, 
     health promotion, geriatric medicine, and home health 
     care.''.

     SEC. 108. SAVINGS PROVISION.

       In the case of any authority for making awards of grants or 
     contracts that is terminated by the amendments made by this 
     subtitle, 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.
                     Subtitle B--Nursing Education

     SEC. 121. SHORT TITLE.

       This title may be cited as the ``Nursing Education 
     Consolidation and Reauthorization Act of 1995''.

     SEC. 122. PURPOSE.

       It is the purpose of this title 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. 123. 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) by redesignating subpart III of part B as subpart II;

[[Page S11674]]

       (3) in subpart II of part B, by striking the subpart 
     heading and inserting the following:

                        ``PART E--STUDENT LOANS

                    ``Subpart I--General Program'';

       (4) by striking section 837;
       (5) 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, or help meet public health nursing needs in 
     State or local health departments.

     ``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, as appropriate, 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. Contracts may be entered into under this title with 
     public or private entities as determined necessary by the 
     Secretary.
       ``(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

[[Page S11675]]

     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 is 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 
     in existence 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.--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--
       ``(1) meet guidelines prescribed by the Secretary; and
       ``(2) 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.
       ``(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 only 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.

            ``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 
     backgrounds (including racial and ethnic minorities 
     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, and 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.

``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 managed care, quality improvement, and 
     other skills needed under new systems of organized 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.

               ``PART F--AUTHORIZATION OF APPROPRIATIONS

     ``SEC. 841. AUTHORIZATION OF APPROPRIATIONS.

       ``There are authorized to be appropriated to carry out 
     sections 811, 821, and 831, $62,000,000 for fiscal year 1996, 
     such sums as may be necessary in each of the fiscal years 
     1997 and 1998, and $59,000,000 for fiscal year 1999.''; and
       (6) 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 (5)).

     SEC. 124. SAVINGS PROVISION.

       In the case of any authority for making awards of grants or 
     contracts that is terminated by the amendment made by section 
     123, 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

[[Page S11676]]

     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.
                    Subtitle C--Financial Assistance

  PART 1--NATIONAL HEALTH SERVICE CORPS FINANCIAL ASSISTANCE PROGRAMS

     SEC. 131. GENERAL AMENDMENTS WITH RESPECT TO FEDERALLY 
                   SUPPORTED LOANS.

       (a) Loan Repayment Program.--Section 338B of the Public 
     Health Service Act (42 U.S.C. 254l-1) is amended--
       (1) in subsection (a)--
       (A) in the matter preceding paragraph (1), by inserting 
     ``and public health disease prevention and health promotion 
     activities'' before the dash; and
       (B) in paragraph (1), by striking ``and physician 
     assistants'' and inserting ``physician assistants, and public 
     health professionals'';
       (2) in subsection (b)(1)--
       (A) in subparagraph (A), by inserting ``public health,'' 
     after ``dentistry,'';
       (B) in subparagraph (B), by inserting ``public health,'' 
     after ``dentistry,''; and
       (C) in subparagraph (C), by inserting ``public health,'' 
     after ``dentistry,'';
       (3) in subsection (c)(4)--
       (A) in subparagraph (A), by inserting ``and schools of 
     public health'' after ``professions schools'';
       (B) in subparagraph (B)(i)--
       (i) by inserting ``or public health professional'' after 
     ``any health professional''; and
       (ii) by inserting ``or public health disease prevention and 
     health promotion activities'' before the period;
       (C) in subparagraph (C)--
       (i) by inserting ``or public health disease prevention and 
     health promotion activities,'' after ``primary health 
     services,'';
       (ii) by inserting ``or public health professions'' after 
     ``health professions''; and
       (iii) by inserting ``or public health professionals'' after 
     ``health professionals'' each place that such occurs;
       (4) in subsection (f)(1)(B)(iv), by inserting ``or public 
     health disease prevention and health promotion activities'' 
     after ``primary health services'';
       (5) in subsection (g)(2)(A)(iii)--
       (A) by inserting ``or public health professional'' after 
     ``the health professional''; and
       (B) by inserting ``or public health disease prevention and 
     health promotion activities'' after ``primary health 
     services''; and
       (6) in subsection (i)(8),--
       (A) by inserting ``or public health professionals'' after 
     ``health professionals''; and
       (B) by inserting ``or public health disease prevention and 
     health promotion activities'' after ``primary health 
     services''.
       (b) Obligated Service.--Section 338C(b)(5) of the Public 
     Health Service Act (42 U.S.C. 254m(b)(5)) is amended--
       (1) in subparagraph (A), by inserting ``public health,'' 
     after ``dentistry,''; and
       (2) in subparagraph (E)--
       (A) in clause (ii), by inserting ``public health,'' after 
     ``dentistry,''; and
       (B) in clause (iii), by inserting ``public health,'' after 
     ``dentistry,''.
       (c) Authorization of Appropriations.--Section 338H of the 
     Public Health Service Act (42 U.S.C. 254q) is amended to read 
     as follows:

     ``SEC. 338H. AUTHORIZATION OF APPROPRIATIONS.

       ``(a) Authorization of Appropriations.--For the purpose of 
     carrying out this subpart, there are authorized to be 
     appropriated $90,000,000 for fiscal year 1996 and such sums 
     as may be necessary for each of the fiscal years 1997 through 
     2000.
       ``(b) Distribution of Amounts.--The Secretary shall 
     determine the most appropriate manner in which to allocate 
     amounts appropriated under subsection (a) between the 
     programs authorized in chapter 1, chapter 2, and chapter 3. 
     In determining the manner in which to allocate such amounts, 
     the Secretary shall give priority to funding State-based 
     programs as appropriate under chapter 3. The Secretary shall 
     distribute such amounts among the various programs in such 
     chapters in a manner which furthers both Federal and State 
     needs for health professionals in underserved areas.''.
       (d) Grants for Loan Repayment Program.--Section 338I of the 
     Public Health Service Act (42 U.S.C. 254q-1) is amended--
       (1) in subsection (a)--
       (A) in paragraph (1), by striking ``in health professional 
     shortage areas'' and inserting ``or public health disease 
     prevention and health promotion activities in Federal health 
     professional shortage areas or approved State designated 
     health professional shortage areas''; and
       (B) in paragraph (2)--
       (i) by inserting ``or public health professionals'' after 
     ``health professionals''; and
       (ii) by striking ``in health professional shortage areas'' 
     and inserting ``or public health disease prevention and 
     health promotion activities in Federal health professional 
     shortage areas or approved State designated health 
     professional shortage areas'';
       (2) in subsection (c)--
       (A) in paragraph (1)--
       (i) in the paragraph heading, by striking ``federal'' and 
     inserting ``federal or approved state''; and
       (ii) by inserting before the period the following: ``or 
     approved State designated health professional shortage 
     areas'';
       (B) in paragraph (2), by inserting ``or public health 
     professionals'' after ``health professionals'';
       (C) in paragraph (3)--
       (i) in subparagraph (A)--

       (I) in the matter preceding clause (i), by inserting ``or 
     public health professionals'' after ``health professionals''; 
     and
       (II) in clause (ii), by striking health'';

       (ii) in subparagraph (B)--

       (I) in the matter preceding clause (i), by inserting ``or 
     public health professional'' after ``health professional''; 
     and
       (II) in clause (ii)--

       (aa) by inserting ``or public health professional'' after 
     ``the health professional''; and
       (bb) by striking ``services in a'' and inserting ``services 
     or public health disease prevention and health promotion 
     activities in a Federal''; and
       (D) by adding at the end thereof the following new 
     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.''; and
       (3) in subsection (h), to read as follows:
       ``(h) Definitions.--Unless specifically provided otherwise, 
     as used in this subpart and section 338F:
       ``(1) Approved state designated health professional 
     shortage area.--The term `approved State designated health 
     professional shortage area' means an area designated by the 
     State as underserved using specific methodology and criteria 
     to identify such areas. Such criteria and methodology shall 
     be approved by the Secretary.
       ``(2) Community organization.--The term `community 
     organization' means a public or nonprofit private entity.
       ``(3) Primary health care.--The term `primary health care' 
     means health services regarding family medicine, general 
     internal medicine, general pediatrics, or may include 
     obstetrics and gynecology, that are provided by 
     physicians, certified nurse practitioners, certified nurse 
     midwives, or physician assistants.
       ``(4) State.--The term `State' means each of the several 
     States and the District of Columbia.''.
       (e) Community Scholarship Programs.--Section 338L of the 
     Public Health Service Act (42 U.S.C. 254t) is amended--
       (1) in the section heading, by striking ``demonstration 
     grants to states for'';
       (2) in subsection (a), by striking ``health manpower 
     shortage areas'' and inserting ``Federal health professional 
     shortage areas and in approved State designated health 
     professional shortage areas'';
       (3) in subsection (c)--
       (A) in the matter preceding paragraph (1), by striking 
     ``health manpower shortage areas'' and inserting ``Federal 
     health professional shortage areas and in approved State 
     designated health professional shortage areas''; and
       (B) in paragraph (2), by striking ``health manpower 
     shortage areas'' and inserting ``Federal health professional 
     shortage areas and in approved State designated health 
     professional shortage areas'';
       (4) in subsection (e)(1), by striking ``health manpower 
     shortage areas'' and inserting ``Federal health professional 
     shortage areas and in approved State designated health 
     professional shortage areas'';
       (5) in subsection (f)(1)(A), by striking ``health manpower 
     shortage areas'' and inserting ``Federal health professional 
     shortage areas and in approved State designated health 
     professional shortage areas'';
       (6) in subsection (g), by striking ``health manpower 
     shortage areas'' each place that such appears and inserting 
     ``Federal health professional shortage areas and in approved 
     State designated health professional shortage areas''; and
       (7) by striking subsections (j) through (l).

     SEC. 132. RESTRUCTURING AND TECHNICAL AMENDMENTS.

       (a) Redesignations.--Subpart III of part D of title III of 
     the Public Health Service Act (42 U.S.C. 254l et seq.) is 
     amended--
       (1) by redesignating sections 338J and 338K (42 U.S.C. 254s 
     and 254t) as sections 338M and 338N, respectively;
       (2) by redesignating sections 338C through 338H (42 U.S.C. 
     254m through 254q) as sections 338G through 338L, 
     respectively;
       (3) by redesignating section 338I (as such section exists 
     one day prior to the date of enactment of this Act) (42 
     U.S.C. 254r) as section 338E;
       (4) by redesignating section 338L (as such section exists 
     one day prior to the date of enactment of this Act) (42 
     U.S.C. 254u) as section 338F;
       (b) Consolidation of Certain Programs.--Subpart III of part 
     D of title III of the Public Health Service Act (42 U.S.C. 
     254l et seq.) (as amended by subsection (a)) is further 
     amended--
       (1) by striking the subpart heading and inserting the 
     following:

       ``Subpart III--Federally Supported Scholarships and Loans

  ``CHAPTER 1--NATIONAL HEALTH SERVICE CORPS SCHOLARSHIPS PROGRAMS'';

       (2) by redesignating section 338B as section 338C;

[[Page S11677]]

       (3) by inserting before section 338C (as so redesignated) 
     the following:

   ``CHAPTER 2--NATIONAL HEALTH SERVICE CORPS LOAN REPAYMENT PROGRAMS

               ``Subchapter A--Loan Repayment Program'';

       and
       (4) by inserting after section 338C (as so redesignated) 
     the following:

           ``Subchapter B--Nursing Loan Repayment Program''.

       (c) Transfers and Redesignations of Nursing Loan Repayment 
     Program.--Subpart II of part E of title VIII (42 U.S.C. 297n 
     et seq.) (as so redesignated by section 123(3)) is amended--
       (1) by striking the subpart heading;
       (2) by transferring section 846 (42 U.S.C. 297n) to 
     subchapter B of chapter 2 of subpart III of part D of title 
     III (as added by subsection (b)(4)); and
       (3) in section 846--
       (A) by striking the section heading and inserting the 
     following:

     ``SEC. 338D. NURSING LOAN REPAYMENT PROGRAM.'';

       (B) by striking subsection (d); and
       (C) by striking subsection (g).
       (d) Transfers and Redesignations of State Loan Repayment 
     and Community Scholarship Programs.--Subpart III of part D of 
     title III of the Public Health Service Act (42 U.S.C. 254l et 
     seq.) (as amended by subsections (a) through (c)) is further 
     amended--
       (1) by inserting after section 338D (as so transferred and 
     redesignated by subsection (c)(3)) the following:

  ``CHAPTER 3--STATE LOAN REPAYMENT AND COMMUNITY SCHOLARSHIP PROGRAMS

            ``Subchapter A--State Loan Repayment Programs'';

       (2) by transferring section 338E (as so redesignated by 
     subsection (a)(3)) to subchapter A of chapter 3 of such 
     subpart (as added by paragraph (1));
       (3) by inserting after section 338E (as transferred by 
     paragraph (2)) the following:

           ``Subchapter B--Community Scholarship Programs'';

       (4) by transferring section 338F (as so redesignated by 
     subsection (a)(4)) to subchapter B of chapter 3 of such 
     subpart (as added by paragraph (3)); and
       (5) by inserting after section 338F (as transferred by 
     paragraph (4)) the following:

                   ``CHAPTER 4--GENERAL PROVISIONS''.

       (e) 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.''.

     SEC. 133. DEFINITION OF UNDERSERVED AREAS.

       Section 332(a)(1) of the Public Health Service Act (42 
     U.S.C. 254e(a)(1)) is amended in the first sentence--
       (1) by striking ``, or (C)'' and inserting ``, (C)''; and
       (2) by inserting before the period the following: ``, or 
     (D) a State or local health department that has a severe 
     shortage of public health personnel as determined under 
     criteria established by the Secretary''.

     SEC. 134. CONFORMING AMENDMENTS.

       Title III of the Public Health Service Act (42 U.S.C. 241 
     et seq.) is amended--
       (1) in subparagraphs (A) and (B) of section 303(d)(4) (42 
     U.S.C. 242a(d)(4)(A) and (B)), by striking ``338C or 338D'' 
     each place that such occurs and inserting ``338G or 338H'';
       (2) in section 331(c) (42 U.S.C. 254d(c)), by striking 
     ``338D'' and inserting ``338H'';
       (3) in section 337(a) (42 U.S.C. 254j(a)), by striking 
     ``338G'' and inserting ``338K'';
       (4) in 338A (42 U.S.C. 254l)--
       (A) in subsection (c)(1)--
       (i) in subparagraph (A), by striking ``338D'' and inserting 
     ``338I''; and
       (ii) in subparagraph (B), by striking ``338C'' and 
     inserting ``338H'';
       (B) in subsection (f)(3), by striking ``338D'' and 
     inserting ``338I''; and
       (C) in subsection (i)(5)--
       (i) in subparagraph (A), by striking ``338E'' and inserting 
     ``338I''; and
       (ii) in subparagraph (B)(ii), by striking ``338E'' and 
     inserting ``338I'';
       (5) in section 338C (as so redesignated) (42 U.S.C. 254l-
     1)--
       (A) in subsection (c)(1)--
       (i) in subparagraph (A), by striking ``338E'' and inserting 
     ``338I''; and
       (ii) in subparagraph (B), by striking ``338D'' and 
     inserting ``338H'';
       (B) in subsection (f)(1)(B)(iv), by striking ``338D'' and 
     inserting ``338H'';
       (C) in subsection (f)(4), by striking ``338E'' and 
     inserting ``338I''; and
       (D) in subsection (i)(7)--
       (i) in subparagraph (A), by striking ``338E'' and inserting 
     ``338I''; and
       (ii) in subparagraph (B)(ii), by striking ``338E'' and 
     inserting ``338I'';
       (6) in section 338E(d)(1)(C) (as so redesignated by section 
     132), by striking ``338J'' and inserting ``338M'';
       (7) in section 338G (as so redesignated by section 132)--
       (A) in subsection (a)--
       (i) by striking ``338D'' and inserting ``338H''; and
       (ii) by striking ``338B'' and inserting ``338C''; and
       (B) in subsection (c)(2), by striking ``338D'' and 
     inserting ``338H'';
       (8) in section 338H (as so redesignated by section 132)--
       (A) in subsection (a), by striking ``338C'' and inserting 
     ``338G''; and
       (B) in subsection (c), by striking ``338B'' and inserting 
     ``338C'';
       (9) in section 338I (as so redesignated by section 132)--
       (A) in subsection (b)(1)(A)--
       (i) by striking ``338F'' and inserting ``338J'';
       (ii) by striking ``338C or 338D'' and inserting ``338G or 
     338H'';
       (iii) by striking ``338C'' and inserting ``338G''; and
       (iv) by striking ``338D'' and inserting ``338H''; and
       (B) in subsection (c)(1)--
       (i) by striking ``338F'' and inserting ``338K'';
       (ii) by striking ``338B'' and inserting ``338C''; and
       (iii) by striking ``338C or 338D'' and inserting ``338G or 
     338H'';
       (10) in section 338J(b) (as so redesignated by section 
     132)--
       (A) in paragraph (1)--
       (i) by striking ``338E'' and inserting ``338I''; and
       (ii) by striking ``338B'' and inserting ``338C''; and
       (B) in paragraph (2), by striking ``338I'' and inserting 
     ``338E'';
       (11) in section 338K (as so redesignated by section 132)--
       (A) in subsection (a)(2), by striking ``338D'' and 
     inserting ``338H''; and
       (B) in subsection (d)(1), by striking ``338E'' and 
     inserting ``338I''; and
       (12) in section 338M(e)(1)(B)(ii)(III) (as so redesignated 
     by section 132), by striking ``338I'' and inserting ``338E''.

               PART 2--SCHOOL-BASED REVOLVING LOAN FUNDS

     SEC. 135. PRIMARY CARE LOAN PROGRAM.

       (a) 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''.
       (b) 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''.
       (c) Report Requirement.--Section 723 of the Public Health 
     Service Act (42 U.S.C. 292s) is amended--
       (1) by striking subsection (c); and
       (2) by redesignating subsection (d) as subsection (c).

     SEC. 136. LOANS FOR DISADVANTAGED STUDENTS.

       (a) Authorization of Appropriations.--Section 724(f)(1) of 
     the Public Health Service Act (42 U.S.C. 292t(f)(1)) is 
     amended by striking ``$15,000,000 for fiscal year 1993'' and 
     inserting ``$8,000,000 for each of the fiscal years 1996 
     through 1998''.
       (b) Repeal.--Effective October 1, 1998, paragraph (1) of 
     section 724(f) of the Public Health Service Act (42 U.S.C. 
     292t(f)(1)) is repealed.

     SEC. 137. STUDENT LOANS REGARDING SCHOOLS OF NURSING.

       (a) In General.--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.''.
       (b) Minimum Monthly Payments.--Section 836(g) of the Public 
     Health Service Act (42 U.S.C. 297b(g)) is amended by striking 
     ``$15'' and inserting ``$40''.
       (c) Elimination of Statute of Limitation for Loan 
     Collections.--
       (1) In general.--Section 836 of the Public Health Service 
     Act (42 U.S.C. 297b) is amended by adding at the end the 
     following new subsection:
       ``(l) Elimination of Statute of Limitation for Loan 
     Collections.--
       ``(1) Purpose.--It is the purpose of this subsection to 
     ensure that obligations to repay loans under this section are 
     enforced without regard to any Federal or State statutory, 
     regulatory, or administrative limitation on the period within 
     which debts may be enforced.
       ``(2) Prohibition.--Notwithstanding any other provision of 
     Federal or State law, no limitation shall terminate the 
     period within which suit may be filed, a judgment may be 
     enforced, or an offset, garnishment, or other action may be 
     initiated or taken by a school of nursing that has an 
     agreement with the Secretary pursuant to section 835 that is 
     seeking the repayment of the amount due from a borrower on a 
     loan made under this subpart after the default of the 
     borrower on such loan.''.
       (2) Effective date.--The amendment made by paragraph (1) 
     shall be effective with respect to actions pending on or 
     after the date of enactment of this Act.

[[Page S11678]]

       (d) Breach of Agreements.--Section 338D of the Public 
     Health Service Act (as so redesignated and amended under 
     section 132(c)) is amended by adding at the end thereof the 
     following new subsection:
       ``(g) Breach of Agreement.--
       ``(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 section 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 subsection 
     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.''.
       (e) Technical Amendments.--Section 839 of the Public Health 
     Service 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. 138. GENERAL PROVISIONS.

       (a) Maximum Student Loan Provisions and Minimum Payments.--
       (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 a school of medicine or osteopathic medicine, be 
     increased to the extent necessary''.
       (3) Repayment period.--Section 722(c) of the Public Health 
     Service Act (42 U.S.C. 292r(c)), as amended by section 
     2014(b)(1) of Public Law 103-43, is amended--
       (A) in the subsection heading by striking ``Ten-Year'' and 
     inserting ``Repayment'';
       (B) by striking ``ten-year period which begins'' and 
     inserting ``period of not less than 10 years nor more than 25 
     years which begins''; and
       (C) by striking ``such ten-year period'' and inserting 
     ``such period''.
       (4) Minimum payments.--Section 722(j) of the Public Health 
     Service Act (42 U.S.C. 292r(j)), as amended by section 
     2014(b)(1) of Public Law 103-43, is amended by striking 
     ``$15'' and inserting $40''.
       (b) Elimination of Statute of Limitation for Loan 
     Collections.--
       (1) In general.--Section 722 of the Public Health Service 
     Act (42 U.S.C. 292r), as amended by section 2014(b)(1) of 
     Public Law 103-43, is amended by adding at the end the 
     following new subsection:
       ``(m) Elimination of Statute of Limitation for Loan 
     Collections.--
       ``(1) Purpose.--It is the purpose of this subsection to 
     ensure that obligations to repay loans under this section are 
     enforced without regard to any Federal or State statutory, 
     regulatory, or administrative limitation on the period within 
     which debts may be enforced.
       ``(2) Prohibition.--Notwithstanding any other provision of 
     Federal or State law, no limitation shall terminate the 
     period within which suit may be filed, a judgment may be 
     enforced, or an offset, garnishment, or other action may be 
     initiated or taken by a school that has an agreement with the 
     Secretary pursuant to section 721 that is seeking the 
     repayment of the amount due from a borrower on a loan made 
     under this subpart after the default of the borrower on such 
     loan.''.
       (2) Effective date.--The amendment made by paragraph (1) 
     shall be effective with respect to actions pending on or 
     after the date of enactment of this Act.
       (c) Date Certain for Contributions.--Paragraph (2) of 
     section 735(e) of the Public Health Service Act (42 U.S.C. 
     292y(e)(2)) is amended to read as follows:
       ``(2) Date certain for contributions.--Amounts described in 
     paragraph (1) that are returned to the Secretary shall be 
     obligated before the end of the succeeding fiscal year.''.

 PART 3--INSURED HEALTH EDUCATION ASSISTANCE LOANS TO GRADUATE STUDENTS

     SEC. 141. HEALTH EDUCATION ASSISTANCE LOAN PROGRAM.

       (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 (42 U.S.C. 292d(a)(2)(C)) is amended by striking 
     ``and (x)'' and inserting ``(x) not in excess of three years, 
     during which the borrower is providing health care services 
     to Indians through an Indian health program (as defined in 
     section 108(a)(2)(A) of the Indian Health Care Improvement 
     Act (25 U.S.C. 1616a(a)(2)(A)); and (xi)''.
       (2) Conforming amendments.--Section 705(a)(2)(C) of the 
     Public Health Service Act (42 U.S.C. 292d(a)(2)(C)) is 
     further amended--
       (A) in clause (xi) (as so redesignated) by striking 
     ``(ix)'' and inserting ``(x)''; and
       (B) in the matter following such clause (xi), by striking 
     ``(x)'' and inserting ``(xi)''.
       (3) Effective date.--The amendments made by this subsection 
     shall apply with respect to services provided on or after the 
     first day of the third month that begins after the date of 
     the enactment of this Act.
       (b) Report Requirement.--Section 709(b) of the Public 
     Health Service Act (42 U.S.C. 292h(b)) is amended--
       (1) in paragraph (4)(B), by adding ``and'' after the 
     semicolon;
       (2) in paragraph (5), by striking ``; and'' and inserting a 
     period; and
       (3) by striking paragraph (6).
       (c) Collection from Estates.--Section 714 of the Public 
     Health Service Act (42 U.S.C. 292m) is amended by adding at 
     the end the following new sentence: ``Notwithstanding the 
     first sentence, the Secretary may, in the case of a borrower 
     who dies, collect any remaining unpaid balance owed to the 
     lender, the holder of the loan, or the Federal Government 
     from the borrower's estate.''.

     SEC. 142. HEAL LENDER AND HOLDER PERFORMANCE STANDARDS.

       (a) General Amendments.--Section 707(a) of the Public 
     Health Service Act (42 U.S.C. 292f) is amended--
       (1) by striking the last sentence;
       (2) by striking ``determined.'' and inserting ``determined, 
     except that, if the insurance beneficiary including any 
     servicer of the loan is not designated for `exceptional 
     performance', as set forth in paragraph (2), the Secretary 
     shall pay to the beneficiary a sum equal to 98 percent of the 
     amount of the loss sustained by the insured upon that 
     loan.'';
       (3) by striking ``Upon'' and inserting:
       ``(1) In general.--Upon''; and
       (4) by adding at the end the following new paragraph:
       ``(2) Exceptional performance.--
       ``(A) Authority.--Where the Secretary determines that an 
     eligible lender, holder, or servicer has a compliance 
     performance rating that equals or exceeds 97 percent, the 
     Secretary shall designate that eligible lender, holder, or 
     servicer, as the case may be, for exceptional performance.
       ``(B) Compliance performance rating.--For purposes of 
     subparagraph (A), a compliance performance rating is 
     determined with respect to compliance with due diligence in 
     the disbursement, servicing, and collection of loans under 
     this subpart for each year for which the determination is 
     made. Such rating shall be equal to the percentage of all due 
     diligence requirements applicable to each loan, on average, 
     as established by the Secretary, with respect to loans 
     serviced during the period by the eligible lender, holder, or 
     servicer.
       ``(C) Annual audits for lenders, holders, and servicers.--
     Each eligible lender, holder, or servicer desiring a 
     designation under subparagraph (A) shall have an annual 
     financial and compliance audit conducted with respect to the 
     loan portfolio of such eligible lender, holder, or servicer, 
     by a qualified independent organization from a list of 
     qualified organizations identified by the Secretary and in 
     accordance with standards established by the Secretary. The 
     standards shall measure the lender's, holder's, or servicer's 
     compliance with due diligence

[[Page S11679]]

     standards and shall include a defined statistical sampling 
     technique designed to measure the performance rating of the 
     eligible lender, holder, or servicer for the purpose of this 
     section. Each eligible lender, holder, or servicer shall 
     submit the audit required by this section to the Secretary.
       ``(D) Secretary's determinations.--The Secretary shall make 
     the determination under subparagraph (A) based upon the 
     audits submitted under this paragraph and any information in 
     the possession of the Secretary or submitted by any other 
     agency or office of the Federal Government.
       ``(E) Quarterly compliance audit.--To maintain its status 
     as an exceptional performer, the lender, holder, or servicer 
     shall undergo a quarterly compliance audit at the end of each 
     quarter (other than the quarter in which status as an 
     exceptional performer is established through a financial and 
     compliance audit, as described in subparagraph (C)), and 
     submit the results of such audit to the Secretary. The 
     compliance audit shall review compliance with due diligence 
     requirements for the period beginning on the day after the 
     ending date of the previous audit, in accordance with 
     standards determined by the Secretary.
       ``(F) Revocation authority.--The Secretary shall revoke the 
     designation of a lender, holder, or servicer under 
     subparagraph (A) if any quarterly audit required under 
     subparagraph (E) is not received by the Secretary by the date 
     established by the Secretary or if the audit indicates the 
     lender, holder, or servicer has failed to meet the standards 
     for designation as an exceptional performer under 
     subparagraph (A). A lender, holder, or servicer receiving a 
     compliance audit not meeting the standard for designation as 
     an exceptional performer may reapply for designation under 
     subparagraph (A) at any time.
       ``(G) Documentation.--Nothing in this section shall 
     restrict or limit the authority of the Secretary to require 
     the submission of claims documentation evidencing servicing 
     performed on loans, except that the Secretary may not require 
     exceptional performers to submit greater documentation than 
     that required for lenders, holders, and servicers not 
     designated under subparagraph (A).
       ``(H) Cost of audits.--Each eligible lender, holder, or 
     servicer shall pay for all the costs associated with the 
     audits required under this section.
       ``(I) Additional revocation authority.--Notwithstanding any 
     other provision of this section, a designation under 
     subparagraph (A) may be revoked at any time by the Secretary 
     if the Secretary determines that the eligible lender, holder, 
     or servicer has failed to maintain an overall level of 
     compliance consistent with the audit submitted by the 
     eligible lender, holder, or servicer under this paragraph or 
     if the Secretary asserts that the lender, holder, or servicer 
     may have engaged in fraud in securing designation under 
     subparagraph (A) or is failing to service loans in accordance 
     with program requirements.
       ``(J) Noncompliance.--A lender, holder, or servicer 
     designated under subparagraph (A) that fails to service loans 
     or otherwise comply with applicable program regulations shall 
     be considered in violation of the Federal False Claims 
     Act.''.
       (b) Definition.--Section 707(e) of the Public Health 
     Service Act (42 U.S.C. 292f(e)) is amended by adding at the 
     end the following new paragraph:
       ``(4) The term `servicer' means any agency acting on behalf 
     of the insurance beneficiary.''.
       (c) Effective Date.--The amendments made by subsections (a) 
     and (b) shall apply with respect to loans submitted to the 
     Secretary for payment on or after the first day of the sixth 
     month that begins after the date of enactment of this Act.

     SEC. 143. REAUTHORIZATION.

       (a) Loan Program.--Section 702(a) of the Public Health 
     Service Act (42 U.S.C. 292a(a)) is amended--
       (1) by striking ``1993'' and inserting ``1996'';
       (2) by striking ``1994'' and inserting ``1997'';
       (3) by striking ``fiscal year 1995'' and inserting ``each 
     of the fiscal years 1998 and 1999''; and
       (4) by striking ``September 30, 1998'' and inserting 
     ``September 20, 2002''.
       (b) Insurance Program.--Section 710(a)(2)(B) of the Public 
     Health Service Act (42 U.S.C. 292i(a)(2)(B)) is amended by 
     striking ``any of the fiscal years 1993 through 1996'' and 
     inserting ``fiscal year 1993 and subsequent fiscal years''.

            PART 4--SCHOLARSHIPS FOR DISADVANTAGED STUDENTS

     SEC. 151. SCHOLARSHIPS FOR DISADVANTAGED STUDENTS.

       Part B of title VII of the Public Health Service Act (as 
     amended by section 101(a)) is further amended by adding at 
     the end thereof the following new section:

     ``SEC. 740. SCHOLARSHIPS FOR DISADVANTAGED STUDENTS.

       ``(a) In General.--The Secretary may make a grant to an 
     eligible entity (as defined in subsection (f)(1)) under this 
     section for the awarding of scholarships by schools to any 
     full-time student who is an eligible individual as defined in 
     subsection (f). Such scholarships may be expended only for 
     tuition expenses, other reasonable educational expenses, and 
     reasonable living expenses incurred in the attendance of such 
     school, and may not, for any year of such attendance for 
     which the scholarship is provided, provide an amount 
     exceeding the total amount required for the year.
       ``(b) Preference in Providing Scholarships.--The Secretary 
     may not make a grant to an entity under subsection (a) unless 
     the health professions and nursing schools involved agrees 
     that, in providing scholarships pursuant to the grant, the 
     school will give preference to students for whom the costs of 
     attending the school would constitute a severe financial 
     hardship and, notwithstanding other provisions of this 
     section, to former recipients of scholarships under sections 
     736 and 740(d)(2)(B) (as such sections existed on the day 
     before the date of enactment of this section).
       ``(c) Amount of Award.--In awarding grants to eligible 
     entities that are health professions and nursing schools, the 
     Secretary shall give priority to eligible entities based on 
     the proportion of graduating students going into primary 
     care, the proportion of minority students, and the proportion 
     of graduates working in medically underserved areas.
       ``(d) Maximum Scholarship Award.--The maximum scholarship 
     that an individual may receive in any year from an eligible 
     entity that is a health professions and nursing schools shall 
     be $3000.
       ``(e) Authorization of Appropriations.--There are 
     authorized to be appropriated to carry out this section, 
     $32,000,000 for each of the fiscal years 1996 through 1999. 
     Of the amount appropriated in any fiscal year, the Secretary 
     shall ensure that not less than 16 percent shall be 
     distributed to schools of nursing.
       ``(f) Definitions.--As used in this section:
       ``(1) Eligible entities.--The term `eligible entities' 
     means an entity that--
       ``(A) is a school of medicine, osteopathic medicine, 
     dentistry, nursing (as defined in section 801), pharmacy, 
     podiatric medicine, optometry, veterinary medicine, public 
     health, or allied health, a school offering a graduate 
     program in mental health practice, or an entity providing 
     programs for the training of physician assistant; and
       ``(B) is carrying out a program for recruiting and 
     retaining students from disadvantaged backgrounds, including 
     students who are members of racial and ethnic minority 
     groups.
       ``(2) Eligible individual.--The term `eligible individual' 
     means an individual who--
       ``(A) is from a disadvantaged background;
       ``(B) has a financial need for a scholarship; and
       ``(C) is enrolled (or accepted for enrollment) at an 
     eligible health profession or nursing school as a full-time 
     student in a program leading to a degree in a health 
     profession or nursing.''.
                  TITLE II--OFFICE OF MINORITY HEALTH

     SEC. 201. 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 
     individuals 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 heads of the 
     Public Health Service agencies shall submit to the Deputy 
     Assistant Secretary a report summarizing the minority health 
     activities of each of the respective agencies.
       ``(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.

[[Page S11680]]

       ``(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, 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 
     compensation, 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 Deputy Assistant Secretary for Minority 
     Health shall consult with 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, and other 
     appropriate offices, regarding recommendations for carrying 
     out 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, or 724, or part B of title VII, 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, educational, 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 a grant is awarded 
     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 201(b)(5) for 
     such years by the heads of the Public Health Service 
     agencies.
       ``(g) Definition.--For purposes of this section:
       ``(1) The term `racial and ethnic minority group' means 
     American Indians (including Alaska 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.--For the purpose of carrying out this 
     section, there are authorized to be appropriated $21,000,000 
     for fiscal year 1996, such sums as may be necessary for each 
     of the fiscal years 1997 and 1998, and $19,000,000 for fiscal 
     year 1999.''.
       (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''.
                    TITLE III--SELECTED INITIATIVES

     SEC. 301. 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; 
     and
       ``(2) 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 1997 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.''.

     SEC. 302. TRAUMATIC BRAIN INJURY.

       (a) Programs of National Institutes of Health.--Section 
     1261 of the Public Health Service Act (42 U.S.C. 300d-61) is 
     amended--

[[Page S11681]]

       (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.''.
       (b) 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 new 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 date of 
     enactment of this section, 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.''.
       (c) Study; Consensus Conference.--
       (1) Study.--
       (A) In general.--The Secretary of Health and Human Services 
     (in this subsection 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:
       (i) 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.

       (ii) 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.

       (iii) Develop practice guidelines for the rehabilitation of 
     traumatic brain injury at such time as appropriate scientific 
     research becomes available.
       (B) Dates certain for reports.--
       (i) Not later than 18 months after the date of enactment of 
     this Act, the Secretary shall submit to the Committee on 
     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 subparagraph (A)(i).
       (ii) Not later than 3 years after the date of enactment of 
     this Act, the Secretary shall submit to the Committees 
     specified in clause (i) a report describing the findings made 
     as a result of carrying out clauses (ii) and (iii) of 
     subparagraph (A).
       (2) 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.
       (3) Definition.--For purposes of this subsection, 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. 303. STATE OFFICES OF RURAL HEALTH.

       (a) In General.--Section 338M of the Public Health Service 
     Act (as so redesignated by section 132) 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 
     1996 through 1997''; and
       (3) in subsection (k), by striking ``$10,000,000'' and 
     inserting ``$20,000,000''.
       (b) Repeal.--Effective on October 1, 1997, section 338M of 
     the Public Health Service Act (as so redesignated by section 
     132) is repealed.

     SEC. 304. 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:

[[Page S11682]]

       ``(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, 1996, 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. 305. 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''.
                   TITLE IV--MISCELLANEOUS PROVISIONS

     SEC. 401. 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 ``nonprivate'' and 
     inserting ``private''.
       (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. 402. CERTAIN AUTHORITIES OF CENTERS FOR DISEASE CONTROL 
                   AND PREVENTION.

       (a) In General.--Part B of title III of the Public Health 
     Service 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, 1995.

     SEC. 403. 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. 404. TECHNICAL CORRECTIONS RELATING TO HEALTH 
                   PROFESSIONS PROGRAMS.

       Part G of title VII of the Public Health Service Act (42 
     U.S.C. 295j et seq.) is amended by inserting after section 
     794 the following section:

     ``SEC. 794A. 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 the 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 the 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 the 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--

[[Page S11683]]

       ``(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. 405. 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. 406. 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''.

     SEC. 407. REQUIRED CONSULTATION BY SECRETARY.

       The Secretary of Health and Human Services, regarding the 
     programs under parts B, C, D, and E of title VII, and parts 
     B, C, and D of title VIII, of the Public Health Service Act, 
     as amended by this Act, shall--
       (1) publish in the Federal Register a general program 
     description for the funding of awards under such parts;
       (2) solicit and receive written and oral comments 
     concerning such description, including the holding of a 
     public forum at which interested individuals and groups may 
     provide comment; and
       (3) take into consideration information received under 
     paragraph (2).


                           Amendment No. 5416

          (Purpose: To make various modifications in the bill)

  Mr. LOTT. Senator Kassebaum has an amendment at the desk, and I ask 
for its immediate consideration.
  The PRESIDING OFFICER. The clerk will report.
  The legislative clerk read as follows:

       The Senator from Mississippi [Mr. Lott] for Mrs. Kassebaum, 
     proposes an amendment numbered 5416.

  The amendment is as follows:
       On page 116, lines 18, and 19, strike ``With'' and all that 
     follows through ``the'' and insert ``The''.
       On page 116, line 21, strike ``such''.
       On page 122, line 22, strike ``, and'' and all that follows 
     through ``dentists'' on line 24.
       On page 126, strike lines 16 through 23.
       On page 126, line 24, strike ``(c)'' and insert ``(b)''.
       On page 128, line 9, strike ``(d)'' and insert ``(c)''.
       On page 128, line 18, strike ``(e)'' and insert ``(d)''.
       On page 140, line 3, strike ``tion'' and insert ``tions 747 
     and 750''.
       On page 170, line 1, insert ``dentistry,'' after the comma.
       On page 170, line 2, insert ``dentists,'' after the comma.
       On page 196, strike lines 4 through 11, and insert the 
     following:
       (a) Loan Program.--Section 702(a) of the Public Health 
     Service Act (42 U.S.C. 292a(a)) is amended--
       (1) by striking ``$350,000,000'' and all that follows 
     through ``1995'' and inserting ``$260,000,000 for fiscal year 
     1996, ``$160,000,000 for fiscal year 1997, and $80,000,000 
     for fiscal year 1998'';
       (2) by striking ``obtained prior loans insured under this 
     subpart'' and inserting ``obtained loans insured under this 
     subpart in fiscal year 1996 or in prior fiscal years''; and
       (3) by adding at the end thereof the following new 
     sentence: ``The Secretary may establish guidelines and 
     procedures that lenders must follow in distributing funds 
     under this subpart.''.
       Beginning on page 212, strike line 10 and all that follows 
     through line 14 on page 220.
       On page 220, line 15, strike ``303'' and insert ``302''.
       On page 221, line 6, strike ``304'' and insert ``303''.
       On page 222, line 12, strike ``305'' and insert ``304''.

  Mr. LOTT. I ask unanimous consent the amendment be agreed to, the 
committee amendment be agreed to, the bill be deemed read the third 
time, passed, the motion to reconsider be laid upon the table, and that 
any statements relating to the bill be placed at the appropriate place 
in the Record.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  The committee amendment in the nature of a substitute, as amended, 
was agreed to.
  The amendment (No. 5416) was agreed to.
  The bill (S. 555), as amended, was deemed read for a third time and 
passed, as follows:

                                 S. 555

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

     SECTION 1. SHORT TITLE.

       (a) Short Title.--This Act may be cited as the ``Health 
     Professions Education Consolidation and Reauthorization Act 
     of 1996''.
       (b) Table of Contents.--The table of contents for this Act 
     is as follows:

Sec. 1. Short title.

TITLE I--HEALTH PROFESSIONS EDUCATION AND FINANCIAL ASSISTANCE PROGRAMS

           Subtitle A--Health Professions Education Programs

Sec. 101. Minority and disadvantaged health professions grant program.
Sec. 102. Training in family medicine, general internal medicine, 
              general pediatrics, preventive medicine, physician 
              assistants, and general dentistry.
Sec. 103. Enhanced health education and training.
Sec. 104. Health professions workforce development.
Sec. 105. General provisions.
Sec. 106. Preference in certain programs.
Sec. 107. Definitions.
Sec. 108. Savings provision.

                     Subtitle B--Nursing Education

Sec. 121. Short title.
Sec. 122. Purpose.
Sec. 123. Amendments to Public Health Service Act.
Sec. 124. Savings provision.

                    Subtitle C--Financial Assistance

  Part 1--National Health Service Corps Financial Assistance Programs

Sec. 131. General amendments with respect to federally supported loans.
Sec. 132. Restructuring and technical amendments.
Sec. 133. Definition of underserved areas.
Sec. 134. Conforming amendments.

               Part 2--School-based Revolving Loan Funds

Sec. 135. Primary care loan program.
Sec. 136. Loans for disadvantaged students.
Sec. 137. Student loans regarding schools of nursing.
Sec. 138. General provisions.

 Part 3--Insured Health Education Assistance Loans to Graduate Students

Sec. 141. Health education assistance loan program.
Sec. 142. HEAL lender and holder performance standards.
Sec. 143. Reauthorization.

            Part 4--Scholarships for Disadvantaged Students

Sec. 151. Scholarships for disadvantaged students.

                  TITLE II--OFFICE OF MINORITY HEALTH

Sec. 201. Revision and extension of programs of Office of Minority 
              Health.

                    TITLE III--SELECTED INITIATIVES

Sec. 301. Programs regarding birth defects.
Sec. 302. State offices of rural health.
Sec. 303. Health services for Pacific Islanders.
Sec. 304. Demonstration projects regarding Alzheimer's Disease.

                   TITLE IV--MISCELLANEOUS PROVISIONS

Sec. 401. Technical corrections regarding Public Law 103-183.
Sec. 402. Certain authorities of Centers for Disease Control and 
              Prevention.
Sec. 403. Administration of certain requirements.
Sec. 404. Technical corrections relating to health professions 
              programs.
Sec. 405. Clinical traineeships.
Sec. 406. Construction of regional centers for research on primates.
Sec. 407. Required consultation by Secretary.
TITLE I--HEALTH PROFESSIONS EDUCATION AND FINANCIAL ASSISTANCE PROGRAMS
           Subtitle A--Health Professions Education Programs

     SEC. 101. MINORITY AND DISADVANTAGED HEALTH PROFESSIONS GRANT 
                   PROGRAM.

       (a) In General.--Part B of title VII of the Public Health 
     Service Act (42 U.S.C. 293 et seq.) is amended to read as 
     follows:

          ``PART B--DISADVANTAGED HEALTH PROFESSIONS TRAINING

     ``SEC. 736. STATEMENT OF PURPOSE.

       ``(a) In General.--The Secretary shall make grants to or 
     enter into contracts with eligible entities for the purpose 
     of establishing, enhancing, and expanding programs to 
     increase the number and the quality of disadvantaged health 
     professionals, particularly those who provide health services 
     to disadvantaged populations or in medically underserved 
     areas or rural areas.
       ``(b) Use of Funds.--Amounts provided under a grant or 
     contract awarded under this part may be used for costs of 
     planning, developing, or operating centers of excellence in 
     minority health professions education, programs for assisting 
     individuals from disadvantaged backgrounds to enter a health 
     profession, minority faculty development, minority faculty 
     loan repayment or fellowships, trainee support, technical 
     assistance, workforce analysis, and dissemination of 
     information.
       ``(c) Consortium.--Schools within a consortium that applies 
     for a grant or contract

[[Page S11684]]

     under this part shall enter into an agreement to allocate the 
     funds received under the grant or contract among such schools 
     and expend such funds in accordance with the application for 
     such grant or contract.

     ``SEC. 737. PREFERENCES.

       ``In awarding grants or contracts to eligible entities 
     under this part, the Secretary shall give preference to--
       ``(1) projects that involve more than one health 
     professions discipline or training institution and have an 
     above average record of retention and graduation of 
     individuals from disadvantaged backgrounds; and
       ``(2) centers of excellence at Historically Black Colleges 
     and Universities (as defined in section 739) beginning in 
     fiscal year 1999 and for each fiscal year thereafter.

     ``SEC. 738. AUTHORIZATION OF APPROPRIATION.

       ``(a) In General.--There are authorized to be appropriated 
     to carry out this part, $51,000,000 for fiscal year 1996, and 
     such sums as may be necessary for each of the fiscal years 
     1997 through 1999.
       ``(b) Set-Aside.--The Secretary shall set-aside $12,000,000 
     of the amount appropriated under subsection (a) in each 
     fiscal year for the purpose of making grants under section 
     736 to centers of excellence at certain Historically Black 
     Colleges and Universities.
       ``(c) No Limitation.--Nothing in this section shall be 
     construed as limiting the centers of excellence referred to 
     in subsection (b) to the set-aside amount, or to preclude 
     such entities from competing for other grants under section 
     736.

     ``SEC. 739. DEFINITIONS.

       ``As used in this part:
       ``(1) Centers of excellence.--The term `centers of 
     excellence' means a health professions school that--
       ``(A)(i) has a significant number of minority individuals 
     enrolled in the school, including individuals accepted for 
     enrollment in the school;
       ``(ii) has been effective in assisting minority students of 
     the school to complete the program of education and receive 
     the degree involved;
       ``(iii) has been effective in recruiting minority 
     individuals to attend the school and encouraging minority 
     students of secondary educational institutions to attend the 
     health professions school; and
       ``(iv) has made significant recruitment efforts to increase 
     the number of minority individuals serving in faculty or 
     administrative positions at the school; or
       ``(B) is a center of excellence at certain Historically 
     Black Colleges and Universities.
       ``(2) Consortium.--The term `consortium' means the 
     designated eligible entity seeking a grant under this part 
     and one or more schools of medicine, osteopathic medicine, 
     dentistry, pharmacy, nursing, allied health, public health, 
     or graduate programs in mental health practice.
       ``(3) Eligible entities.--The term `eligible entities' 
     means schools of medicine, osteopathic medicine, dentistry, 
     pharmacy, podiatric medicine, optometry, veterinary medicine, 
     public health, or allied health or schools offering graduate 
     programs in mental health practice, State or local 
     governments, and other public or nonprofit private entities 
     determined appropriate by the Secretary that submit to the 
     Secretary an application.
       ``(4) Historically black colleges and universities.--The 
     term `Historically Black Colleges and Universities' means a 
     school described in section 799B(1) that has received a 
     contract under section 788B for fiscal year 1987, as such 
     section was in effect for such fiscal year.''.
       (b) Repeal.--
       (1) In general.--Section 795 of the Public Health Service 
     Act (42 U.S.C. 295n) is repealed.
       (2) Nontermination of authority.--The amendments made by 
     this section shall not be construed to terminate agreements 
     that, on the day before the date of enactment of this Act, 
     are in effect pursuant to section 795 of the Public Health 
     Service Act (42 U.S.C. 795) as such section existed on such 
     date. Such agreements shall 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 shall be counted towards the 
     satisfaction of the requirement of practice pursuant to such 
     section 795.
       (c) Conforming Amendments.--Section 481A(c)(3)(D)(i) of the 
     Public Health Service Act (42 U.S.C. 287a-2(c)(3)(D)(i)) is 
     amended by striking ``section 739'' and inserting ``part B of 
     title VII''.

     SEC. 102. TRAINING IN FAMILY MEDICINE, GENERAL INTERNAL 
                   MEDICINE, GENERAL PEDIATRICS, PREVENTIVE 
                   MEDICINE, PHYSICIAN ASSISTANTS, AND GENERAL 
                   DENTISTRY.

       Part C of title VII of the Public Health Service Act (42 
     U.S.C. 293 et seq.) is amended--
       (1) in the part heading by striking ``PRIMARY HEALTH CARE'' 
     and inserting ``FAMILY MEDICINE, GENERAL INTERNAL MEDICINE, 
     GENERAL PEDIATRICS, PREVENTIVE MEDICINE, PHYSICIAN 
     ASSISTANTS, AND GENERAL DENTISTRY'';
       (2) by repealing section 746 and sections 748 through 752 
     (42 U.S.C. 293j and 293l through 293p); and
       (3) in section 747 (42 U.S.C. 293k)--
       (A) by striking the section heading and inserting the 
     following:

     ``SEC. 747. FAMILY MEDICINE, GENERAL INTERNAL MEDICINE, 
                   GENERAL PEDIATRICS, PREVENTIVE MEDICINE, 
                   GENERAL DENTISTRY, AND PHYSICIAN ASSISTANTS.'';

       (B) in subsection (a)--
       (i) in paragraph (1)--

       (I) by inserting ``, internal medicine, or pediatrics'' 
     after ``family medicine''; and
       (II) by inserting before the semicolon the following: 
     ``that emphasizes training for the practice of family 
     medicine, general internal medicine, or general pediatrics 
     (as defined by the Secretary)'';

       (ii) in paragraph (2), by inserting ``, general internal 
     medicine, or general pediatrics'' before the semicolon;
       (iii) in paragraphs (3) and (4), by inserting ``, general 
     internal medicine (including geriatrics), or general 
     pediatrics'' after ``family medicine'';
       (iv) in paragraphs (3) and (4), by inserting ``(including 
     geriatrics) after ``family medicine'';
       (v) in paragraph (3), by striking ``and'' at the end 
     thereof;
       (vi) in paragraph (4), by striking the period and inserting 
     a semicolon; and
       (vii) by adding at the end thereof the following new 
     paragraphs:
       ``(5) to meet the costs of projects to plan, develop, and 
     operate or maintain programs for the training of physician 
     assistants (as defined in section 799B), and for the training 
     of individuals who will teach in programs to provide such 
     training;
       ``(6) to meet the costs of projects--
       ``(A) to plan and develop new residency training programs 
     and to maintain or improve existing residency training 
     programs in preventive medicine, that have available full-
     time faculty members with training and experience in the 
     fields of preventive medicine; and
       ``(B) to provide financial assistance to residency trainees 
     enrolled in such programs; and
       ``(7) to meet the costs of planning, developing, or 
     operating programs, and to provide financial assistance to 
     residents in such programs, that would lead to a 
     significantly greater ratio of participating individuals in 
     such programs eventually entering practice in general 
     dentistry in rural and medically underserved communities 
     compared to the current ratio of all dentists nationally 
     practicing general dentistry in rural and medically 
     underserved communities.

     For purposes of paragraph (7), entities eligible for such 
     grants or contracts shall include entities that have programs 
     in dental schools, approved residency programs in the general 
     practice of dentistry, or approved advanced education 
     programs in the general practice of dentistry. The Secretary 
     may only fund programs under such paragraph if such programs 
     provide a significant amount of care for underserved 
     populations and other high-risk groups.'';
       (C) in paragraphs (1) and (2)(A) of subsection (b), by 
     inserting ``, general internal medicine, or general 
     pediatrics'' after ``family medicine'';
       (D) by redesignating subsections (c) and (d) as subsections 
     (d) and (e), respectively;
       (E) by inserting after subsection (b), the following new 
     subsection:
       ``(c) Priority and Limitation.--
       ``(1) Priority.--With respect to programs for the training 
     of interns or residents, the Secretary shall give priority in 
     awarding grants under this section to qualified applicants 
     that have a record of training the greatest percentage of 
     providers, or that have demonstrated significant improvements 
     in the percentage of providers, which enter and remain in 
     primary care practice or general dentistry upon completion of 
     their first period of training required to obtain initial 
     board certification. Each program shall designate the primary 
     care training or general dentistry positions that such 
     program shall provide with grant funding to support and for 
     which such program shall be held accountable regarding the 
     primary care or general dentistry requirement set forth in 
     this section.
       ``(2) Limitation.--With respect to programs for the 
     training and education of medical students, the Secretary may 
     only provide grants or contracts under this section to 
     administrative units in general pediatrics or general 
     internal medicine if a qualified administrative unit 
     applicant demonstrates that its medical school has--
       ``(A) a mission statement that has a primary care medical 
     education objective;
       ``(B) faculty role models and administrative units in 
     primary care; and
       ``(C) required undergraduate ambulatory medical student 
     clerkships in family medicine, internal medicine, and 
     pediatrics.

     Where a medical school does not have an administrative unit 
     in family medicine, clerkships in family medicine shall not 
     be required.''; and
       (F) in subsection (e) (as so redesignated by subparagraph 
     (D))--
       (i) in paragraph (1), by striking ``$54,000,000'' and all 
     that follows and inserting ``$76,000,000 for fiscal year 
     1996, and such sums as may be necessary for each of the 
     fiscal years 1997 through 1999.''; and
       (ii) in paragraph (2)--

       (I) by striking ``20'' and inserting ``12''; and
       (II) by inserting ``for family medicine academic 
     administrative units'' after ``under subsection (b)''.

[[Page S11685]]

     SEC. 103. ENHANCED HEALTH EDUCATION AND TRAINING.

       Part D of title VII of the Public Health Service Act (42 
     U.S.C. 294 et seq.) is amended to read as follows:

                ``PART D--AREA HEALTH EDUCATION CENTERS

     ``SEC. 750. AREA HEALTH EDUCATION CENTERS.

       ``(a) In General.--The Secretary may award grants to and 
     enter into contracts with eligible entities for projects 
     which --
       ``(1) improve the recruitment, distribution, supply, 
     quality, utilization, and efficiency of personnel providing 
     health services in urban and rural areas and to populations 
     that have demonstrated serious unmet health care need;
       ``(2) encourage the regionalization of educational 
     responsibilities of the health professions schools;
       ``(3) are designed to prepare, through field placements, 
     preceptorships, the conduct of or affiliation with community-
     based primary care residency programs, agreements with 
     community-based organizations for the delivery of education 
     and training in the health professions, and other programs, 
     individuals to effectively provide health services in health 
     professional shortage areas;
       ``(4) conduct health professions education and training 
     activities consistent with national and State priorities, 
     including geriatrics;
       ``(5) encourage health promotion and disease prevention 
     activities;
       ``(6) conduct interdisciplinary training and practice 
     involving other health professionals;
       ``(7) conduct continuing education programs for health 
     professionals or coordinate with such programs; and
       ``(8) address other areas as determined appropriate by the 
     Secretary.
       ``(b) Other Eligible Programs.--
       ``(1) Geriatric education centers.--The Secretary shall 
     award grants or contracts under this section for the 
     establishment or operation of geriatric education centers.
       ``(2) Public health training centers.--
       ``(A) In general.--The Secretary shall award grants or 
     contracts under this section for the operation of public 
     health training centers.
       ``(B) Eligible entities.--A public health training center 
     shall be an accredited school of public health, or another 
     public or nonprofit private institution accredited for the 
     provision of graduate or specialized training in public 
     health, that plans, develops, operates, and evaluates 
     projects that are in furtherance of the goals established by 
     the Secretary for the year 2000 in the areas of preventive 
     medicine, health promotion and disease prevention, or 
     improving access to and quality of health services in 
     medically underserved communities.
       ``(C) Certain requirements.--With respect to a public 
     health training center, an award may not be made under 
     subparagraph (A) unless the program agrees that it--
       ``(i) will establish or strengthen field placements for 
     students in public or nonprofit private health agencies or 
     organizations; and
       ``(ii) will involve faculty members and students in 
     collaborative projects to enhance public health services to 
     medically underserved communities.
       ``(c) Eligible Entities.--As used in this part, the term 
     `eligible entities' means schools of medicine, osteopathic 
     medicine, dentistry, pharmacy, podiatric medicine, optometry, 
     veterinary medicine, public health, or allied health or 
     schools offering graduate programs in mental health practice 
     or physician assistant training programs, State or local 
     governments, and other public or nonprofit private entities 
     determined appropriate by the Secretary that submit to the 
     Secretary an application.
       ``(d) Geriatric Education Centers.--A geriatric education 
     center shall be an accredited health professions school or 
     program that--
       ``(1) improves the training of health professionals in 
     geriatrics, including geriatric residencies, traineeships, or 
     fellowships;
       ``(2) develops and disseminates curricula relating to the 
     treatment of the health problems of elderly individuals;
       ``(3) supports the training and retraining of faculty to 
     provide instruction in geriatrics;
       ``(4) supports continuing education of health professionals 
     who provide geriatric care; and
       ``(5) provides students with clinical training in 
     geriatrics in nursing homes, chronic and acute disease 
     hospitals, ambulatory care centers, and senior centers.

     ``SEC. 751. AUTHORIZATION OF APPROPRIATIONS.

       ``There are authorized to be appropriated to carry out this 
     part, $43,000,000 for fiscal year 1996, such sums as may be 
     necessary for each of the fiscal years 1997 and 1998, and 
     $29,000,000 for fiscal year 1999.''.

     SEC. 104. HEALTH PROFESSIONS WORKFORCE DEVELOPMENT.

       (a) In General.--Part E of title VII of the Public Health 
     Service Act (42 U.S.C. 294n et seq.) is amended--
       (1) in the part heading to read as follows:

         ``PART E--HEALTH PROFESSIONS WORKFORCE DEVELOPMENT'';

       (2) by redesignating section 776 (42 U.S.C. 294n) as 
     section 761; and
       (3) by striking sections 777 and 778 (42 U.S.C. 294o and 
     294p) and inserting the following new section:

     ``SEC. 762. HEALTH PROFESSIONS WORKFORCE DEVELOPMENT.

       ``(a) In General.--The Secretary may award grants to and 
     enter into contracts with eligible entities for projects to 
     strengthen capacity for health professions education and 
     practice.
       ``(b) Eligible Applicants.--Applicants eligible to obtain 
     funds under subsection (a) shall include schools of medicine, 
     osteopathic medicine, dentistry, veterinary medicine, 
     pharmacy, podiatric medicine, chiropractic medicine, 
     optometry, public health, or allied health, graduate programs 
     in mental health practice, physician assistant training 
     programs, and other public and nonprofit private entities.
       ``(c) Priority Areas.--In awarding grants or contracts 
     under subsection (a), the Secretary shall give priority to 
     entities that will use amounts provided under such grants or 
     contracts to enhance the education of health professionals 
     for purposes of--
       ``(1) providing care for underserved populations and other 
     high-risk groups;
       ``(2) increasing the number of individuals who are pursuing 
     a course of study in a health professions field in which 
     there is a severe shortage of health professionals;
       ``(3) conducting health professions research and data 
     collection; and
       ``(4) carrying out other activities in areas determined 
     appropriate by the Secretary.
       ``(d) Authorization of Appropriations.--
       ``(1) In general.--There are authorized to be appropriated 
     to carry out this section, $16,000,000 for fiscal year 1996, 
     and such sums as may be necessary for each of the fiscal 
     years 1997 through 1999.
       ``(2) Reservation.--Of the amounts appropriated under 
     subsection (a) for a fiscal year, the Secretary shall reserve 
     not less than $2,000,000 for conducting health professions 
     research and for carrying out data collection and analysis in 
     accordance with section 792.''.
       (b) Health Professions Data.--The second sentence of 
     section 792(a) of the Public Health Service Act (42 U.S.C. 
     295k(a)) is amended--
       (1) by striking ``is authorized to'' and inserting 
     ``shall''; and
       (2) by inserting ``clinical social workers,'' after 
     ``clinical psychologists,''.
       (c) Council on Graduate Medical Education.--Section 301 of 
     the Health Professions Education Extension Amendments of 1992 
     (Public Law 102-408) is amended--
       (1) in subsection (j), by striking ``1995'' and inserting 
     ``1999'';
       (2) in subsection (k), by striking ``1995'' and inserting 
     ``1999'';
       (3) by adding at the end thereof the following new 
     subsection:
       ``(l) Funding.--Amounts otherwise appropriated under this 
     title may be utilized by the Secretary to support the 
     activities of the Council.'';
       (4) by transferring such section to part E of title VII of 
     the Public Health Service Act (as amended by subsection (a));
       (5) by redesignating such section as section 763; and
       (6) by inserting such section after section 762.

     SEC. 105. GENERAL PROVISIONS.

       (a) In General.--
       (1) Part F of title VII of the Public Health Service Act 
     (42 U.S.C. 295 et seq.) is repealed.
       (2) Part G of title VII of the Public Health Service Act 
     (42 U.S.C. 295j et seq.) is amended--
       (A) by redesignating such part as part F;
       (B) in section 791 (42 U.S.C. 295j)--
       (i) by striking subsection (b); and
       (ii) redesignating subsection (c) as subsection (b);
       (C) by repealing section 793 (42 U.S.C. 295l);
       (D) by repealing section 798;
       (E) by redesignating section 799 as section 799B; and
       (F) by inserting after section 794, the following new 
     sections:

     ``SEC. 796. 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 
     health workforce 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. 797. 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,

[[Page S11686]]

     as appropriate to meet recognized health workforce 
     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. 798. 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. As determined by the Secretary, 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. 799. 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, as appropriate, to carry out 
     innovative demonstration projects or provide for strategic 
     workforce supplementation activities as needed to meet health 
     workforce goals and in accordance with this title. Contracts 
     may be entered into under this title with public or private 
     entities as may be necessary.
       ``(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 any 
     scholarship or loan program, including those under sections 
     701, 721, or 723, 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.
       ``(f) Preference or priority Considerations.--In 
     considering a preference or priority for funding which is 
     based on outcome measures for an eligible entity under this 
     title, the Secretary may also consider the future ability of 
     the eligible entity to meet the outcome preference or 
     priority through improvements in the eligible entity's 
     program design.

     ``SEC. 799A. 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. 106. PREFERENCE IN CERTAIN PROGRAMS.

       (a) In General.--Section 791 of the Public Health Service 
     Act (42 U.S.C. 295j), as amended by section 105(a)(2)(B), is 
     further amended by adding at the end thereof the following 
     subsection:
       ``(c) Exceptions for New Programs.--
       ``(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 clinical 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.''.
       (b) Conforming Amendments.--Section 791(a) of the Public 
     Health Service Act (42 U.S.C. 295j(a)) is amended--
       (1) in paragraph (1), by striking ``sections 747'' and all 
     that follows through ``767'' and inserting ``sections 747 and 
     750''; and
       (2) in paragraph (2), by striking ``under section 798(a)''.

     SEC. 107. DEFINITIONS.

       (a) Professional Psychology.--Section 799B(1)(B) of the 
     Public Health Service Act (42 U.S.C. 295p(1)(B)) (as so 
     redesignated by section 105(a)(2)(E)) is amended by striking 
     ``program in clinical psychology'' and inserting ``graduate 
     programs in professional psychology''.
       (b) Medically Underserved Community.--Section 799B(6) of 
     the Public Health Service Act (42 U.S.C. 295p(6)) (as so 
     redesignated by section 105(a)(2)(E)) 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 the following new subparagraphs:
       ``(D) is a State or local health department that has a 
     severe shortage of public health personnel as determined 
     under criteria established by the Secretary;
       ``(E) has 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
       ``(F) has 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.''.
       (c) Programs for the Training of Physician Assistants.--
     Paragraph (3) of section 799B of the Public Health Service 
     Act (42 U.S.C. 295p) (as so redesignated by section 
     105(a)(2)(E)) is amended to read as follows:
       ``(3) The term `program for the training of physician 
     assistants' means an educational program that--
       ``(A) has as its objective the education of individuals who 
     will, upon completion of their studies in the program, be 
     qualified to provide primary care under the supervision of a 
     physician;
       ``(B) extends for at least one academic year and consists 
     of--
       ``(i) supervised clinical practice; and
       ``(ii) at least four months (in the aggregate) of classroom 
     instruction, directed toward preparing students to deliver 
     health care;
       ``(C) has an enrollment of not less than eight students; 
     and
       ``(D) trains students in primary care, disease prevention, 
     health promotion, geriatric medicine, and home health 
     care.''.

     SEC. 108. SAVINGS PROVISION.

       In the case of any authority for making awards of grants or 
     contracts that is terminated by the amendments made by this 
     subtitle, 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.
                     Subtitle B--Nursing Education

     SEC. 121. SHORT TITLE.

       This title may be cited as the ``Nursing Education 
     Consolidation and Reauthorization Act of 1996''.

     SEC. 122. PURPOSE.

       It is the purpose of this title 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. 123. 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) by redesignating subpart III of part B as subpart II;
       (3) in subpart II of part B, by striking the subpart 
     heading and inserting the following:

                        ``PART E--STUDENT LOANS

                    ``Subpart I--General Program'';

       (4) by striking section 837;
       (5) by inserting after the title heading the following new 
     parts:

[[Page S11687]]

                      ``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, or help meet public health nursing needs in 
     State or local health departments.

     ``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, as appropriate, 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. Contracts may be entered into under this title with 
     public or private entities as determined necessary by the 
     Secretary.
       ``(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

[[Page S11688]]

     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 is 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 
     in existence 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.--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--
       ``(1) meet guidelines prescribed by the Secretary; and
       ``(2) 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.
       ``(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 only 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.

            ``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 
     backgrounds (including racial and ethnic minorities 
     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, and 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.

``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 managed care, quality improvement, and 
     other skills needed under new systems of organized 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.

               ``PART F--AUTHORIZATION OF APPROPRIATIONS

     ``SEC. 841. AUTHORIZATION OF APPROPRIATIONS.

       ``There are authorized to be appropriated to carry out 
     sections 811, 821, and 831,

[[Page S11689]]

     $62,000,000 for fiscal year 1996, such sums as may be 
     necessary in each of the fiscal years 1997 and 1998, and 
     $59,000,000 for fiscal year 1999.''; and
       (6) 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 (5)).

     SEC. 124. SAVINGS PROVISION.

       In the case of any authority for making awards of grants or 
     contracts that is terminated by the amendment made by section 
     123, 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.
                    Subtitle C--Financial Assistance

  PART 1--NATIONAL HEALTH SERVICE CORPS FINANCIAL ASSISTANCE PROGRAMS

     SEC. 131. GENERAL AMENDMENTS WITH RESPECT TO FEDERALLY 
                   SUPPORTED LOANS.

       (a) Loan Repayment Program.--Section 338B of the Public 
     Health Service Act (42 U.S.C. 254l-1) is amended--
       (1) in subsection (a)--
       (A) in the matter preceding paragraph (1), by inserting 
     ``and public health disease prevention and health promotion 
     activities'' before the dash; and
       (B) in paragraph (1), by striking ``and physician 
     assistants'' and inserting ``physician assistants, and public 
     health professionals'';
       (2) in subsection (b)(1)--
       (A) in subparagraph (A), by inserting ``public health,'' 
     after ``dentistry,'';
       (B) in subparagraph (B), by inserting ``public health,'' 
     after ``dentistry,''; and
       (C) in subparagraph (C), by inserting ``public health,'' 
     after ``dentistry,'';
       (3) in subsection (c)(4)--
       (A) in subparagraph (A), by inserting ``and schools of 
     public health'' after ``professions schools'';
       (B) in subparagraph (B)(i)--
       (i) by inserting ``or public health professional'' after 
     ``any health professional''; and
       (ii) by inserting ``or public health disease prevention and 
     health promotion activities'' before the period;
       (C) in subparagraph (C)--
       (i) by inserting ``or public health disease prevention and 
     health promotion activities,'' after ``primary health 
     services,'';
       (ii) by inserting ``or public health professions'' after 
     ``health professions''; and
       (iii) by inserting ``or public health professionals'' after 
     ``health professionals'' each place that such occurs;
       (4) in subsection (f)(1)(B)(iv), by inserting ``or public 
     health disease prevention and health promotion activities'' 
     after ``primary health services'';
       (5) in subsection (g)(2)(A)(iii)--
       (A) by inserting ``or public health professional'' after 
     ``the health professional''; and
       (B) by inserting ``or public health disease prevention and 
     health promotion activities'' after ``primary health 
     services''; and
       (6) in subsection (i)(8), --
       (A) by inserting ``or public health professionals'' after 
     ``health professionals''; and
       (B) by inserting ``or public health disease prevention and 
     health promotion activities'' after ``primary health 
     services''.
       (b) Obligated Service.--Section 338C(b)(5) of the Public 
     Health Service Act (42 U.S.C. 254m(b)(5)) is amended--
       (1) in subparagraph (A), by inserting ``public health,'' 
     after ``dentistry,''; and
       (2) in subparagraph (E)--
       (A) in clause (ii), by inserting ``public health,'' after 
     ``dentistry,''; and
       (B) in clause (iii), by inserting ``public health,'' after 
     ``dentistry,''.
       (c) Authorization of Appropriations.--Section 338H of the 
     Public Health Service Act (42 U.S.C. 254q) is amended to read 
     as follows:

     ``SEC. 338H. AUTHORIZATION OF APPROPRIATIONS.

       ``(a) Authorization of Appropriations.--For the purpose of 
     carrying out this subpart, there are authorized to be 
     appropriated $90,000,000 for fiscal year 1996 and such sums 
     as may be necessary for each of the fiscal years 1997 through 
     2000.
       ``(b) Distribution of Amounts.--The Secretary shall 
     determine the most appropriate manner in which to allocate 
     amounts appropriated under subsection (a) between the 
     programs authorized in chapter 1, chapter 2, and chapter 3. 
     In determining the manner in which to allocate such amounts, 
     the Secretary shall give priority to funding State-based 
     programs as appropriate under chapter 3. The Secretary shall 
     distribute such amounts among the various programs in such 
     chapters in a manner which furthers both Federal and State 
     needs for health professionals in underserved areas.''.
       (d) Grants for Loan Repayment Program.--Section 338I of the 
     Public Health Service Act (42 U.S.C. 254q-1) is amended--
       (1) in subsection (a)--
       (A) in paragraph (1), by striking ``in health professional 
     shortage areas'' and inserting ``or public health disease 
     prevention and health promotion activities in Federal health 
     professional shortage areas or approved State designated 
     health professional shortage areas''; and
       (B) in paragraph (2)--
       (i) by inserting ``or public health professionals'' after 
     ``health professionals''; and
       (ii) by striking ``in health professional shortage areas'' 
     and inserting ``or public health disease prevention and 
     health promotion activities in Federal health professional 
     shortage areas or approved State designated health 
     professional shortage areas'';
       (2) in subsection (c)--
       (A) in paragraph (1)--
       (i) in the paragraph heading, by striking ``federal'' and 
     inserting ``federal or approved state''; and
       (ii) by inserting before the period the following: ``or 
     approved State designated health professional shortage 
     areas'';
       (B) in paragraph (2), by inserting ``or public health 
     professionals'' after ``health professionals'';
       (C) in paragraph (3)--
       (i) in subparagraph (A)--

       (I) in the matter preceding clause (i), by inserting ``or 
     public health professionals'' after ``health professionals''; 
     and
       (II) in clause (ii), by striking health'';

       (ii) in subparagraph (B)--

       (I) in the matter preceding clause (i), by inserting ``or 
     public health professional'' after ``health professional''; 
     and
       (II) in clause (ii)--

       (aa) by inserting ``or public health professional'' after 
     ``the health professional''; and
       (bb) by striking ``services in a'' and inserting ``services 
     or public health disease prevention and health promotion 
     activities in a Federal''; and
       (D) by adding at the end thereof the following new 
     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.''; and
       (3) in subsection (h), to read as follows:
       ``(h) Definitions.--Unless specifically provided otherwise, 
     as used in this subpart and section 338F:
       ``(1) Approved state designated health professional 
     shortage area.--The term `approved State designated health 
     professional shortage area' means an area designated by the 
     State as underserved using specific methodology and criteria 
     to identify such areas. Such criteria and methodology shall 
     be approved by the Secretary.
       ``(2) Community organization.--The term `community 
     organization' means a public or nonprofit private entity.
       ``(3) Primary health care.--The term `primary health care' 
     means health services regarding family medicine, general 
     internal medicine, general pediatrics, dentistry, or may 
     include obstetrics and gynecology, that are provided by 
     physicians, dentists, certified nurse practitioners, 
     certified nurse midwives, or physician assistants.
       ``(4) State.--The term `State' means each of the several 
     States and the District of Columbia.''.
       (e) Community Scholarship Programs.--Section 338L of the 
     Public Health Service Act (42 U.S.C. 254t) is amended--
       (1) in the section heading, by striking ``demonstration 
     grants to states for'';
       (2) in subsection (a), by striking ``health manpower 
     shortage areas'' and inserting ``Federal health professional 
     shortage areas and in approved State designated health 
     professional shortage areas'';
       (3) in subsection (c)--
       (A) in the matter preceding paragraph (1), by striking 
     ``health manpower shortage areas'' and inserting ``Federal 
     health professional shortage areas and in approved State 
     designated health professional shortage areas''; and
       (B) in paragraph (2), by striking ``health manpower 
     shortage areas'' and inserting ``Federal health professional 
     shortage areas and in approved State designated health 
     professional shortage areas'';
       (4) in subsection (e)(1), by striking ``health manpower 
     shortage areas'' and inserting ``Federal health professional 
     shortage areas and in approved State designated health 
     professional shortage areas'';
       (5) in subsection (f)(1)(A), by striking ``health manpower 
     shortage areas'' and inserting ``Federal health professional 
     shortage areas and in approved State designated health 
     professional shortage areas'';
       (6) in subsection (g), by striking ``health manpower 
     shortage areas'' each place that such appears and inserting 
     ``Federal health professional shortage areas and in approved 
     State designated health professional shortage areas''; and
       (7) by striking subsections (j) through (l).

     SEC. 132. RESTRUCTURING AND TECHNICAL AMENDMENTS.

       (a) Redesignations.--Subpart III of part D of title III of 
     the Public Health Service Act (42 U.S.C. 254l et seq.) is 
     amended--

[[Page S11690]]

       (1) by redesignating sections 338J and 338K (42 U.S.C. 254s 
     and 254t) as sections 338M and 338N, respectively;
       (2) by redesignating sections 338C through 338H (42 U.S.C. 
     254m through 254q) as sections 338G through 338L, 
     respectively;
       (3) by redesignating section 338I (as such section exists 
     one day prior to the date of enactment of this Act) (42 
     U.S.C. 254r) as section 338E;
       (4) by redesignating section 338L (as such section exists 
     one day prior to the date of enactment of this Act) (42 
     U.S.C. 254u) as section 338F;
       (b) Consolidation of Certain Programs.--Subpart III of part 
     D of title III of the Public Health Service Act (42 U.S.C. 
     254l et seq.) (as amended by subsection (a)) is further 
     amended--
       (1) by striking the subpart heading and inserting the 
     following:

       ``Subpart III--Federally Supported Scholarships and Loans

   ``CHAPTER 1--NATIONAL HEALTH SERVICE CORPS SCHOLARSHIPS PROGRAMS''

       (2) by redesignating section 338B as section 338C;
       (3) by inserting before section 338C (as so redesignated) 
     the following:

   ``CHAPTER 2--NATIONAL HEALTH SERVICE CORPS LOAN REPAYMENT PROGRAMS

               ``Subchapter A--Loan Repayment Program'';

       and
       (4) by inserting after section 338C (as so redesignated) 
     the following:

           ``Subchapter B--Nursing Loan Repayment Program''.

       (c) Transfers and Redesignations of Nursing Loan Repayment 
     Program.--Subpart II of part E of title VIII (42 U.S.C. 297n 
     et seq.) (as so redesignated by section 123(3)) is amended--
       (1) by striking the subpart heading;
       (2) by transferring section 846 (42 U.S.C. 297n) to 
     subchapter B of chapter 2 of subpart III of part D of title 
     III (as added by subsection (b)(4)); and
       (3) in section 846--
       (A) by striking the section heading and inserting the 
     following:

     ``SEC. 338D. NURSING LOAN REPAYMENT PROGRAM.'';

       (B) by striking subsection (d); and
       (C) by striking subsection (g).
       (d) Transfers and Redesignations of State Loan Repayment 
     and Community Scholarship Programs.--Subpart III of part D of 
     title III of the Public Health Service Act (42 U.S.C. 254l et 
     seq.) (as amended by subsections (a) through (c)) is further 
     amended--
       (1) by inserting after section 338D (as so transferred and 
     redesignated by subsection (c)(3)) the following:

  ``CHAPTER 3--STATE LOAN REPAYMENT AND COMMUNITY SCHOLARSHIP PROGRAMS

            ``Subchapter A--State Loan Repayment Programs'';

       (2) by transferring section 338E (as so redesignated by 
     subsection (a)(3)) to subchapter A of chapter 3 of such 
     subpart (as added by paragraph (1));
       (3) by inserting after section 338E (as transferred by 
     paragraph (2)) the following:

           ``Subchapter B--Community Scholarship Programs'';

       (4) by transferring section 338F (as so redesignated by 
     subsection (a)(4)) to subchapter B of chapter 3 of such 
     subpart (as added by paragraph (3)); and
       (5) by inserting after section 338F (as transferred by 
     paragraph (4)) the following:

                   ``CHAPTER 4--GENERAL PROVISIONS''.

       (e) 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.''.

     SEC. 133. DEFINITION OF UNDERSERVED AREAS.

       Section 332(a)(1) of the Public Health Service Act (42 
     U.S.C. 254e(a)(1)) is amended in the first sentence--
       (1) by striking ``, or (C)'' and inserting ``, (C)''; and
       (2) by inserting before the period the following: ``, or 
     (D) a State or local health department that has a severe 
     shortage of public health personnel as determined under 
     criteria established by the Secretary''.

     SEC. 134. CONFORMING AMENDMENTS.

       Title III of the Public Health Service Act (42 U.S.C. 241 
     et seq.) is amended--
       (1) in subparagraphs (A) and (B) of section 303(d)(4) (42 
     U.S.C. 242a(d)(4)(A) and (B)), by striking ``338C or 338D'' 
     each place that such occurs and inserting ``338G or 338H'';
       (2) in section 331(c) (42 U.S.C. 254d(c)), by striking 
     ``338D'' and inserting ``338H'';
       (3) in section 337(a) (42 U.S.C. 254j(a)), by striking 
     ``338G'' and inserting ``338K'';
       (4) in 338A (42 U.S.C. 254l)--
       (A) in subsection (c)(1)--
       (i) in subparagraph (A), by striking ``338D'' and inserting 
     ``338I''; and
       (ii) in subparagraph (B), by striking ``338C'' and 
     inserting ``338H'';
       (B) in subsection (f)(3), by striking ``338D'' and 
     inserting ``338I''; and
       (C) in subsection (i)(5)--
       (i) in subparagraph (A), by striking ``338E'' and inserting 
     ``338I''; and
       (ii) in subparagraph (B)(ii), by striking ``338E'' and 
     inserting ``338I'';
       (5) in section 338C (as so redesignated) (42 U.S.C. 254l-
     1)--
       (A) in subsection (c)(1)--
       (i) in subparagraph (A), by striking ``338E'' and inserting 
     ``338I''; and
       (ii) in subparagraph (B), by striking ``338D'' and 
     inserting ``338H'';
       (B) in subsection (f)(1)(B)(iv), by striking ``338D'' and 
     inserting ``338H'';
       (C) in subsection (f)(4), by striking ``338E'' and 
     inserting ``338I''; and
       (D) in subsection (i)(7)--
       (i) in subparagraph (A), by striking ``338E'' and inserting 
     ``338I''; and
       (ii) in subparagraph (B)(ii), by striking ``338E'' and 
     inserting ``338I'';
       (6) in section 338E(d)(1)(C) (as so redesignated by section 
     132), by striking ``338J'' and inserting ``338M'';
       (7) in section 338G (as so redesignated by section 132)--
       (A) in subsection (a)--
       (i) by striking ``338D'' and inserting ``338H''; and
       (ii) by striking ``338B'' and inserting ``338C''; and
       (B) in subsection (c)(2), by striking ``338D'' and 
     inserting ``338H'';
       (8) in section 338H (as so redesignated by section 132)--
       (A) in subsection (a), by striking ``338C'' and inserting 
     ``338G''; and
       (B) in subsection (c), by striking ``338B'' and inserting 
     ``338C'';
       (9) in section 338I (as so redesignated by section 132)--
       (A) in subsection (b)(1)(A)--
       (i) by striking ``338F'' and inserting ``338J'';
       (ii) by striking ``338C or 338D'' and inserting ``338G or 
     338H'';
       (iii) by striking ``338C'' and inserting ``338G''; and
       (iv) by striking ``338D'' and inserting ``338H''; and
       (B) in subsection (c)(1)--
       (i) by striking ``338F'' and inserting ``338K'';
       (ii) by striking ``338B'' and inserting ``338C''; and
       (iii) by striking ``338C or 338D'' and inserting ``338G or 
     338H'';
       (10) in section 338J(b) (as so redesignated by section 
     132)--
       (A) in paragraph (1)--
       (i) by striking ``338E'' and inserting ``338I''; and
       (ii) by striking ``338B'' and inserting ``338C''; and
       (B) in paragraph (2), by striking ``338I'' and inserting 
     ``338E'';
       (11) in section 338K (as so redesignated by section 132)--
       (A) in subsection (a)(2), by striking ``338D'' and 
     inserting ``338H''; and
       (B) in subsection (d)(1), by striking ``338E'' and 
     inserting ``338I''; and
       (12) in section 338M(e)(1)(B)(ii)(III) (as so redesignated 
     by section 132), by striking ``338I'' and inserting ``338E''.

               PART 2--SCHOOL-BASED REVOLVING LOAN FUNDS

     SEC. 135. PRIMARY CARE LOAN PROGRAM.

       (a) 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''.
       (b) 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''.
       (c) Report Requirement.--Section 723 of the Public Health 
     Service Act (42 U.S.C. 292s) is amended--
       (1) by striking subsection (c); and
       (2) by redesignating subsection (d) as subsection (c).

     SEC. 136. LOANS FOR DISADVANTAGED STUDENTS.

       (a) Authorization of Appropriations.--Section 724(f)(1) of 
     the Public Health Service Act (42 U.S.C. 292t(f)(1)) is 
     amended by striking ``$15,000,000 for fiscal year 1993'' and 
     inserting ``$8,000,000 for each of the fiscal years 1996 
     through 1998''.
       (b) Repeal.--Effective October 1, 1998, paragraph (1) of 
     section 724(f) of the Public Health Service Act (42 U.S.C. 
     292t(f)(1)) is repealed.

     SEC. 137. STUDENT LOANS REGARDING SCHOOLS OF NURSING.

       (a) In General.--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:

[[Page S11691]]

       ``(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.''.
       (b) Minimum Monthly Payments.--Section 836(g) of the Public 
     Health Service Act (42 U.S.C. 297b(g)) is amended by striking 
     ``$15'' and inserting ``$40''.
       (c) Elimination of Statute of Limitation for Loan 
     Collections.--
       (1) In general.--Section 836 of the Public Health Service 
     Act (42 U.S.C. 297b) is amended by adding at the end the 
     following new subsection:
       ``(l) Elimination of Statute of Limitation for Loan 
     Collections.--
       ``(1) Purpose.--It is the purpose of this subsection to 
     ensure that obligations to repay loans under this section are 
     enforced without regard to any Federal or State statutory, 
     regulatory, or administrative limitation on the period within 
     which debts may be enforced.
       ``(2) Prohibition.--Notwithstanding any other provision of 
     Federal or State law, no limitation shall terminate the 
     period within which suit may be filed, a judgment may be 
     enforced, or an offset, garnishment, or other action may be 
     initiated or taken by a school of nursing that has an 
     agreement with the Secretary pursuant to section 835 that is 
     seeking the repayment of the amount due from a borrower on a 
     loan made under this subpart after the default of the 
     borrower on such loan.''.
       (2) Effective date.--The amendment made by paragraph (1) 
     shall be effective with respect to actions pending on or 
     after the date of enactment of this Act.
       (d) Breach of Agreements.--Section 338D of the Public 
     Health Service Act (as so redesignated and amended under 
     section 132(c)) is amended by adding at the end thereof the 
     following new subsection:
       ``(g) Breach of Agreement.--
       ``(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 section 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 subsection 
     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.''.
       (e) Technical Amendments.--Section 839 of the Public Health 
     Service 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. 138. GENERAL PROVISIONS.

       (a) Maximum Student Loan Provisions and Minimum Payments.--
       (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 a school of medicine or osteopathic medicine, be 
     increased to the extent necessary''.
       (3) Repayment period.--Section 722(c) of the Public Health 
     Service Act (42 U.S.C. 292r(c)), as amended by section 
     2014(b)(1) of Public Law 103-43, is amended--
       (A) in the subsection heading by striking ``Ten-Year'' and 
     inserting ``Repayment'';
       (B) by striking ``ten-year period which begins'' and 
     inserting ``period of not less than 10 years nor more than 25 
     years which begins''; and
       (C) by striking ``such ten-year period'' and inserting 
     ``such period''.
       (4) Minimum payments.--Section 722(j) of the Public Health 
     Service Act (42 U.S.C. 292r(j)), as amended by section 
     2014(b)(1) of Public Law 103-43, is amended by striking 
     ``$15'' and inserting $40''.
       (b) Elimination of Statute of Limitation for Loan 
     Collections.--
       (1) In general.--Section 722 of the Public Health Service 
     Act (42 U.S.C. 292r), as amended by section 2014(b)(1) of 
     Public Law 103-43, is amended by adding at the end the 
     following new subsection:
       ``(m) Elimination of Statute of Limitation for Loan 
     Collections.--
       ``(1) Purpose.--It is the purpose of this subsection to 
     ensure that obligations to repay loans under this section are 
     enforced without regard to any Federal or State statutory, 
     regulatory, or administrative limitation on the period within 
     which debts may be enforced.
       ``(2) Prohibition.--Notwithstanding any other provision of 
     Federal or State law, no limitation shall terminate the 
     period within which suit may be filed, a judgment may be 
     enforced, or an offset, garnishment, or other action may be 
     initiated or taken by a school that has an agreement with the 
     Secretary pursuant to section 721 that is seeking the 
     repayment of the amount due from a borrower on a loan made 
     under this subpart after the default of the borrower on such 
     loan.''.
       (2) Effective date.--The amendment made by paragraph (1) 
     shall be effective with respect to actions pending on or 
     after the date of enactment of this Act.
       (c) Date Certain for Contributions.--Paragraph (2) of 
     section 735(e) of the Public Health Service Act (42 U.S.C. 
     292y(e)(2)) is amended to read as follows:
       ``(2) Date certain for contributions.--Amounts described in 
     paragraph (1) that are returned to the Secretary shall be 
     obligated before the end of the succeeding fiscal year.''.

 PART 3--INSURED HEALTH EDUCATION ASSISTANCE LOANS TO GRADUATE STUDENTS

     SEC. 141. HEALTH EDUCATION ASSISTANCE LOAN PROGRAM.

       (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 (42 U.S.C. 292d(a)(2)(C)) is amended by striking 
     ``and (x)'' and inserting ``(x) not in excess of three years, 
     during which the borrower is providing health care services 
     to Indians through an Indian health program (as defined in 
     section 108(a)(2)(A) of the Indian Health Care Improvement 
     Act (25 U.S.C. 1616a(a)(2)(A)); and (xi)''.
       (2) Conforming amendments.--Section 705(a)(2)(C) of the 
     Public Health Service Act (42 U.S.C. 292d(a)(2)(C)) is 
     further amended--
       (A) in clause (xi) (as so redesignated) by striking 
     ``(ix)'' and inserting ``(x)''; and
       (B) in the matter following such clause (xi), by striking 
     ``(x)'' and inserting ``(xi)''.
       (3) Effective date.--The amendments made by this subsection 
     shall apply with respect to services provided on or after the 
     first day of the third month that begins after the date of 
     the enactment of this Act.
       (b) Report Requirement.--Section 709(b) of the Public 
     Health Service Act (42 U.S.C. 292h(b)) is amended--
       (1) in paragraph (4)(B), by adding ``and'' after the 
     semicolon;
       (2) in paragraph (5), by striking ``; and'' and inserting a 
     period; and
       (3) by striking paragraph (6).
       (c) Collection from Estates.--Section 714 of the Public 
     Health Service Act (42 U.S.C. 292m) is amended by adding at 
     the end the

[[Page S11692]]

     following new sentence: ``Notwithstanding the first sentence, 
     the Secretary may, in the case of a borrower who dies, 
     collect any remaining unpaid balance owed to the lender, the 
     holder of the loan, or the Federal Government from the 
     borrower's estate.''.

     SEC. 142. HEAL LENDER AND HOLDER PERFORMANCE STANDARDS.

       (a) General Amendments.--Section 707(a) of the Public 
     Health Service Act (42 U.S.C. 292f) is amended--
       (1) by striking the last sentence;
       (2) by striking ``determined.'' and inserting ``determined, 
     except that, if the insurance beneficiary including any 
     servicer of the loan is not designated for `exceptional 
     performance', as set forth in paragraph (2), the Secretary 
     shall pay to the beneficiary a sum equal to 98 percent of the 
     amount of the loss sustained by the insured upon that 
     loan.'';
       (3) by striking ``Upon'' and inserting:
       ``(1) In general.--Upon''; and
       (4) by adding at the end the following new paragraph:
       ``(2) Exceptional performance.--
       ``(A) Authority.--Where the Secretary determines that an 
     eligible lender, holder, or servicer has a compliance 
     performance rating that equals or exceeds 97 percent, the 
     Secretary shall designate that eligible lender, holder, or 
     servicer, as the case may be, for exceptional performance.
       ``(B) Compliance performance rating.--For purposes of 
     subparagraph (A), a compliance performance rating is 
     determined with respect to compliance with due diligence in 
     the disbursement, servicing, and collection of loans under 
     this subpart for each year for which the determination is 
     made. Such rating shall be equal to the percentage of all due 
     diligence requirements applicable to each loan, on average, 
     as established by the Secretary, with respect to loans 
     serviced during the period by the eligible lender, holder, or 
     servicer.
       ``(C) Annual audits for lenders, holders, and servicers.--
     Each eligible lender, holder, or servicer desiring a 
     designation under subparagraph (A) shall have an annual 
     financial and compliance audit conducted with respect to the 
     loan portfolio of such eligible lender, holder, or servicer, 
     by a qualified independent organization from a list of 
     qualified organizations identified by the Secretary and in 
     accordance with standards established by the Secretary. The 
     standards shall measure the lender's, holder's, or servicer's 
     compliance with due diligence standards and shall include a 
     defined statistical sampling technique designed to measure 
     the performance rating of the eligible lender, holder, or 
     servicer for the purpose of this section. Each eligible 
     lender, holder, or servicer shall submit the audit required 
     by this section to the Secretary.
       ``(D) Secretary's determinations.--The Secretary shall make 
     the determination under subparagraph (A) based upon the 
     audits submitted under this paragraph and any information in 
     the possession of the Secretary or submitted by any other 
     agency or office of the Federal Government.
       ``(E) Quarterly compliance audit.--To maintain its status 
     as an exceptional performer, the lender, holder, or servicer 
     shall undergo a quarterly compliance audit at the end of each 
     quarter (other than the quarter in which status as an 
     exceptional performer is established through a financial and 
     compliance audit, as described in subparagraph (C)), and 
     submit the results of such audit to the Secretary. The 
     compliance audit shall review compliance with due diligence 
     requirements for the period beginning on the day after the 
     ending date of the previous audit, in accordance with 
     standards determined by the Secretary.
       ``(F) Revocation authority.--The Secretary shall revoke the 
     designation of a lender, holder, or servicer under 
     subparagraph (A) if any quarterly audit required under 
     subparagraph (E) is not received by the Secretary by the date 
     established by the Secretary or if the audit indicates the 
     lender, holder, or servicer has failed to meet the standards 
     for designation as an exceptional performer under 
     subparagraph (A). A lender, holder, or servicer receiving a 
     compliance audit not meeting the standard for designation as 
     an exceptional performer may reapply for designation under 
     subparagraph (A) at any time.
       ``(G) Documentation.--Nothing in this section shall 
     restrict or limit the authority of the Secretary to require 
     the submission of claims documentation evidencing servicing 
     performed on loans, except that the Secretary may not require 
     exceptional performers to submit greater documentation than 
     that required for lenders, holders, and servicers not 
     designated under subparagraph (A).
       ``(H) Cost of audits.--Each eligible lender, holder, or 
     servicer shall pay for all the costs associated with the 
     audits required under this section.
       ``(I) Additional revocation authority.--Notwithstanding any 
     other provision of this section, a designation under 
     subparagraph (A) may be revoked at any time by the Secretary 
     if the Secretary determines that the eligible lender, holder, 
     or servicer has failed to maintain an overall level of 
     compliance consistent with the audit submitted by the 
     eligible lender, holder, or servicer under this paragraph or 
     if the Secretary asserts that the lender, holder, or servicer 
     may have engaged in fraud in securing designation under 
     subparagraph (A) or is failing to service loans in accordance 
     with program requirements.
       ``(J) Noncompliance.--A lender, holder, or servicer 
     designated under subparagraph (A) that fails to service loans 
     or otherwise comply with applicable program regulations shall 
     be considered in violation of the Federal False Claims 
     Act.''.
       (b) Definition.--Section 707(e) of the Public Health 
     Service Act (42 U.S.C. 292f(e)) is amended by adding at the 
     end the following new paragraph:
       ``(4) The term `servicer' means any agency acting on behalf 
     of the insurance beneficiary.''.
       (c) Effective Date.--The amendments made by subsections (a) 
     and (b) shall apply with respect to loans submitted to the 
     Secretary for payment on or after the first day of the sixth 
     month that begins after the date of enactment of this Act.

     SEC. 143. REAUTHORIZATION.

       (a) Loan Program.--Section 702(a) of the Public Health 
     Service Act (42 U.S.C. 292a(a)) is amended--
       (1) by striking ``$350,000,000'' and all that follows 
     through ``1995'' and inserting ``$260,000,000 for fiscal year 
     1996, $160,000,000 for fiscal year 1997, and $80,000,000 for 
     fiscal year 1998'';
       (2) by striking ``obtained prior loans insured under this 
     subpart'' and inserting ``obtained loans insured under this 
     subpart in fiscal year 1996 or in prior fiscal years''; and
       (3) by adding at the end thereof the following new 
     sentence: ``The Secretary may establish guidelines and 
     procedures that lenders must follow in distributing funds 
     under this subpart.''.
       (b) Insurance Program.--Section 710(a)(2)(B) of the Public 
     Health Service Act (42 U.S.C. 292i(a)(2)(B)) is amended by 
     striking ``any of the fiscal years 1993 through 1996'' and 
     inserting ``fiscal year 1993 and subsequent fiscal years''.

            PART 4--SCHOLARSHIPS FOR DISADVANTAGED STUDENTS

     SEC. 151. SCHOLARSHIPS FOR DISADVANTAGED STUDENTS.

       Part B of title VII of the Public Health Service Act (as 
     amended by section 101(a)) is further amended by adding at 
     the end thereof the following new section:

     ``SEC. 740. SCHOLARSHIPS FOR DISADVANTAGED STUDENTS.

       ``(a) In General.--The Secretary may make a grant to an 
     eligible entity (as defined in subsection (f)(1)) under this 
     section for the awarding of scholarships by schools to any 
     full-time student who is an eligible individual as defined in 
     subsection (f). Such scholarships may be expended only for 
     tuition expenses, other reasonable educational expenses, and 
     reasonable living expenses incurred in the attendance of such 
     school, and may not, for any year of such attendance for 
     which the scholarship is provided, provide an amount 
     exceeding the total amount required for the year.
       ``(b) Preference in Providing Scholarships.--The Secretary 
     may not make a grant to an entity under subsection (a) unless 
     the health professions and nursing schools involved agrees 
     that, in providing scholarships pursuant to the grant, the 
     school will give preference to students for whom the costs of 
     attending the school would constitute a severe financial 
     hardship and, notwithstanding other provisions of this 
     section, to former recipients of scholarships under sections 
     736 and 740(d)(2)(B) (as such sections existed on the day 
     before the date of enactment of this section).
       ``(c) Amount of Award.--In awarding grants to eligible 
     entities that are health professions and nursing schools, the 
     Secretary shall give priority to eligible entities based on 
     the proportion of graduating students going into primary 
     care, the proportion of minority students, and the proportion 
     of graduates working in medically underserved areas.
       ``(d) Maximum Scholarship Award.--The maximum scholarship 
     that an individual may receive in any year from an eligible 
     entity that is a health professions and nursing schools shall 
     be $3,000.
       ``(e) Authorization of Appropriations.--There are 
     authorized to be appropriated to carry out this section, 
     $32,000,000 for each of the fiscal years 1996 through 1999. 
     Of the amount appropriated in any fiscal year, the Secretary 
     shall ensure that not less than 16 percent shall be 
     distributed to schools of nursing.
       ``(f) Definitions.--As used in this section:
       ``(1) Eligible entities.--The term `eligible entities' 
     means an entity that--
       ``(A) is a school of medicine, osteopathic medicine, 
     dentistry, nursing (as defined in section 801), pharmacy, 
     podiatric medicine, optometry, veterinary medicine, public 
     health, or allied health, a school offering a graduate 
     program in mental health practice, or an entity providing 
     programs for the training of physician assistant; and
       ``(B) is carrying out a program for recruiting and 
     retaining students from disadvantaged backgrounds, including 
     students who are members of racial and ethnic minority 
     groups.
       ``(2) Eligible individual.--The term `eligible individual' 
     means an individual who--
       ``(A) is from a disadvantaged background;
       ``(B) has a financial need for a scholarship; and
       ``(C) is enrolled (or accepted for enrollment) at an 
     eligible health profession or nursing school as a full-time 
     student in a program leading to a degree in a health 
     profession or nursing.''.

[[Page S11693]]

                  TITLE II--OFFICE OF MINORITY HEALTH

     SEC. 201. 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 
     individuals 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 heads of the 
     Public Health Service agencies shall submit to the Deputy 
     Assistant Secretary a report summarizing the minority health 
     activities of each of the respective agencies.
       ``(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, 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 
     compensation, 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 Deputy Assistant Secretary for Minority 
     Health shall consult with 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, and other 
     appropriate offices, regarding recommendations for carrying 
     out 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, or 724, or part B of title VII, 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, educational, 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 a grant is awarded 
     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 201(b)(5) for 
     such years by the heads of the Public Health Service 
     agencies.
       ``(g) Definition.--For purposes of this section:
       ``(1) The term `racial and ethnic minority group' means 
     American Indians (including Alaska 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.--For the purpose of carrying out this 
     section, there are authorized to be appropriated $21,000,000 
     for fiscal year 1996, such sums as may be necessary for each 
     of the fiscal years 1997 and 1998, and $19,000,000 for fiscal 
     year 1999.''.
       (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''.

[[Page S11694]]

                    TITLE III--SELECTED INITIATIVES

     SEC. 301. 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; 
     and
       ``(2) 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 1997 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.''.

     SEC. 302. STATE OFFICES OF RURAL HEALTH.

       (a) In General.--Section 338M of the Public Health Service 
     Act (as so redesignated by section 132) 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 
     1996 through 1997''; and
       (3) in subsection (k), by striking ``$10,000,000'' and 
     inserting ``$20,000,000''.
       (b) Repeal.--Effective on October 1, 1997, section 338M of 
     the Public Health Service Act (as so redesignated by section 
     132) is repealed.

     SEC. 303. 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, 1996, 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. 304. 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''.
                   TITLE IV--MISCELLANEOUS PROVISIONS

     SEC. 401. 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)'';

[[Page S11695]]

       (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 ``nonprivate'' and 
     inserting ``private''.
       (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. 402. CERTAIN AUTHORITIES OF CENTERS FOR DISEASE CONTROL 
                   AND PREVENTION.

       (a) In General.--Part B of title III of the Public Health 
     Service 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, 1995.

     SEC. 403. 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. 404. TECHNICAL CORRECTIONS RELATING TO HEALTH 
                   PROFESSIONS PROGRAMS.

       Part G of title VII of the Public Health Service Act (42 
     U.S.C. 295j et seq.) is amended by inserting after section 
     794 the following section:

     ``SEC. 794A. 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 the 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 the 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 the 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. 405. 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. 406. 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''.

     SEC. 407. REQUIRED CONSULTATION BY SECRETARY.

       The Secretary of Health and Human Services, regarding the 
     programs under parts B, C, D, and E of title VII, and parts 
     B, C, and D of title VIII, of the Public Health Service Act, 
     as amended by this Act, shall--
       (1) publish in the Federal Register a general program 
     description for the funding of awards under such parts;
       (2) solicit and receive written and oral comments 
     concerning such description, including the holding of a 
     public forum at which interested individuals and groups may 
     provide comment; and
       (3) take into consideration information received under 
     paragraph (2).

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