[Congressional Record Volume 144, Number 106 (Friday, July 31, 1998)]
[Senate]
[Pages S9629-S9647]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




         HEALTH PROFESSIONS EDUCATION PARTNERSHIPS ACT OF 1998

  Mr. GORTON. Mr. President, I ask unanimous consent that the Senate 
now proceed to the consideration of Calendar No. 424, S. 1754.
  The PRESIDING OFFICER. The clerk will report.
  The legislative clerk read as follows:

       A bill (S. 1754) to amend the Public Health Service Act to 
     consolidate and reauthorize health professions 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 all after the enacting clause 
and insert in lieu thereof the following:

     SECTION 1. SHORT TITLE; TABLE OF CONTENTS.

       (a) Short Title.--This Act may be cited as the ``Health 
     Professions Education Partnerships Act of 1998''.
       (b) Table of Contents.--The table of contents of this Act 
     is as follows:

Sec. 1. Short title; table of contents.

TITLE I--HEALTH PROFESSIONS EDUCATION AND FINANCIAL ASSISTANCE PROGRAMS

           Subtitle A--Health Professions Education Programs

Sec. 101. Under-represented minority health professions grant program.
Sec. 102. Training in primary care medicine and dentistry.
Sec. 103. Interdisciplinary, community-based linkages.
Sec. 104. Health professions workforce information and analysis.
Sec. 105. Public health workforce development.
Sec. 106. General provisions.
Sec. 107. Preference in certain programs.

[[Page S9630]]

Sec. 108. Definitions.
Sec. 109. Technical amendment on National Health Service Corps.
Sec. 110. Savings provision.

               Subtitle B--Nursing Workforce Development

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

                    Subtitle C--Financial Assistance

              CHAPTER 1--SCHOOL-BASED REVOLVING LOAN FUNDS

Sec. 131. Primary care loan program.
Sec. 132. Loans for disadvantaged students.
Sec. 133. Student loans regarding schools of nursing.
Sec. 134. General provisions.

   CHAPTER 2--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.
Sec. 144. HEAL bankruptcy.
Sec. 145. HEAL refinancing.

                  TITLE II--OFFICE OF MINORITY HEALTH

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

                    TITLE III--SELECTED INITIATIVES

Sec. 301. State offices of rural health.
Sec. 302. Demonstration projects regarding Alzheimer's Disease.
Sec. 303. Project grants for immunization services.

                   TITLE IV--MISCELLANEOUS PROVISIONS

Sec. 401. Technical corrections regarding Public Law 103-183.
Sec. 402. Miscellaneous amendments regarding PHS commissioned officers.
Sec. 403. Clinical traineeships.
Sec. 404. Project grants for screenings, referrals, and education 
              regarding lead poisoning.
Sec. 405. Project grants for preventive health services regarding 
              tuberculosis.
Sec. 406. CDC loan repayment program.
Sec. 407. Community programs on domestic violence.
Sec. 408. State loan repayment program.
Sec. 409. Authority of the director of NIH.
Sec. 410. Raise in maximum level of loan repayments.
Sec. 411. Construction of regional centers for research on primates.
Sec. 412. Peer review.
Sec. 413. Funding for trauma care.
Sec. 414. Health information and health promotion.
Sec. 415. Emergency medical services for children.
Sec. 416. Administration of certain requirements.
Sec. 417. Aids drug assistance program.
Sec. 418. National Foundation for Biomedical Research.

TITLE I--HEALTH PROFESSIONS EDUCATION AND FINANCIAL ASSISTANCE PROGRAMS

           Subtitle A--Health Professions Education Programs

     SEC. 101. UNDER-REPRESENTED MINORITY 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--HEALTH PROFESSIONS TRAINING FOR DIVERSITY

     ``SEC. 736. CENTERS OF EXCELLENCE.

       ``(a) In General.--The Secretary shall make grants to, and 
     enter into contracts with, designated health professions 
     schools described in subsection (c), and other public and 
     nonprofit health or educational entities, for the purpose of 
     assisting the schools in supporting programs of excellence in 
     health professions education for under-represented minority 
     individuals.
       ``(b) Required Use of Funds.--The Secretary may not make a 
     grant under subsection (a) unless the designated health 
     professions school involved agrees, subject to subsection 
     (c)(1)(C), to expend the grant--
       ``(1) to develop a large competitive applicant pool through 
     linkages with institutions of higher education, local school 
     districts, and other community-based entities and establish 
     an education pipeline for health professions careers;
       ``(2) to establish, strengthen, or expand programs to 
     enhance the academic performance of under-represented 
     minority students attending the school;
       ``(3) to improve the capacity of such school to train, 
     recruit, and retain under-represented minority faculty 
     including the payment of such stipends and fellowships as the 
     Secretary may determine appropriate;
       ``(4) to carry out activities to improve the information 
     resources, clinical education, curricula and cultural 
     competence of the graduates of the school, as it relates to 
     minority health issues;
       ``(5) to facilitate faculty and student research on health 
     issues particularly affecting under-represented minority 
     groups, including research on issues relating to the delivery 
     of health care;
       ``(6) to carry out a program to train students of the 
     school in providing health services to a significant number 
     of under-represented minority individuals through training 
     provided to such students at community-based health 
     facilities that--
       ``(A) provide such health services; and
       ``(B) are located at a site remote from the main site of 
     the teaching facilities of the school; and
       ``(7) to provide stipends as the Secretary determines 
     appropriate, in amounts as the Secretary determines 
     appropriate.
       ``(c) Centers of Excellence.--
       ``(1) Designated schools.--
       ``(A) In general.--The designated health professions 
     schools referred to in subsection (a) are such schools that 
     meet each of the conditions specified in subparagraphs (B) 
     and (C), and that--
       ``(i) meet each of the conditions specified in paragraph 
     (2)(A);
       ``(ii) meet each of the conditions specified in paragraph 
     (3);
       ``(iii) meet each of the conditions specified in paragraph 
     (4); or
       ``(iv) meet each of the conditions specified in paragraph 
     (5).
       ``(B) General conditions.--The conditions specified in this 
     subparagraph are that a designated health professions 
     school--
       ``(i) has a significant number of under-represented 
     minority individuals enrolled in the school, including 
     individuals accepted for enrollment in the school;
       ``(ii) has been effective in assisting under-represented 
     minority students of the school to complete the program of 
     education and receive the degree involved;
       ``(iii) has been effective in recruiting under-represented 
     minority individuals to enroll in and graduate from the 
     school, including providing scholarships and other financial 
     assistance to such individuals and encouraging under-
     represented minority students from all levels of the 
     educational pipeline to pursue health professions careers; 
     and
       ``(iv) has made significant recruitment efforts to increase 
     the number of under-represented minority individuals serving 
     in faculty or administrative positions at the school.
       ``(C) Consortium.--The condition specified in this 
     subparagraph is that, in accordance with subsection (e)(1), 
     the designated health profession school involved has with 
     other health profession schools (designated or otherwise) 
     formed a consortium to carry out the purposes described in 
     subsection (b) at the schools of the consortium.
       ``(D) Application of criteria to other programs.--In the 
     case of any criteria established by the Secretary for 
     purposes of determining whether schools meet the conditions 
     described in subparagraph (B), this section may not, with 
     respect to racial and ethnic minorities, be construed to 
     authorize, require, or prohibit the use of such criteria in 
     any program other than the program established in this 
     section.
       ``(2) Centers of excellence at certain historically black 
     colleges and universities.--
       ``(A) Conditions.--The conditions specified in this 
     subparagraph are that a designated health professions 
     school--
       ``(i) is a school described in section 799B(1); and
       ``(ii) received a contract under section 788B for fiscal 
     year 1987, as such section was in effect for such fiscal 
     year.
       ``(B) Use of grant.--In addition to the purposes described 
     in subsection (b), a grant under subsection (a) to a 
     designated health professions school meeting the conditions 
     described in subparagraph (A) may be expended--
       ``(i) to develop a plan to achieve institutional 
     improvements, including financial independence, to enable the 
     school to support programs of excellence in health 
     professions education for under-represented minority 
     individuals; and
       ``(ii) to provide improved access to the library and 
     informational resources of the school.
       ``(C) Exception.--The requirements of paragraph (1)(C) 
     shall not apply to a historically black college or university 
     that receives funding under paragraphs (2) or (5).
       ``(3) Hispanic centers of excellence.--The conditions 
     specified in this paragraph are that--
       ``(A) with respect to Hispanic individuals, each of clauses 
     (i) through (iv) of paragraph (1)(B) applies to the 
     designated health professions school involved;
       ``(B) the school agrees, as a condition of receiving a 
     grant under subsection (a), that the school will, in carrying 
     out the duties described in subsection (b), give priority to 
     carrying out the duties with respect to Hispanic individuals; 
     and
       ``(C) the school agrees, as a condition of receiving a 
     grant under subsection (a), that--
       ``(i) the school will establish an arrangement with 1 or 
     more public or nonprofit community based Hispanic serving 
     organizations, or public or nonprofit private institutions of 
     higher education, including schools of nursing, whose 
     enrollment of students has traditionally included a 
     significant number of Hispanic individuals, the purposes of 
     which will be to carry out a program--

       ``(I) to identify Hispanic students who are interested in a 
     career in the health profession involved; and
       ``(II) to facilitate the educational preparation of such 
     students to enter the health professions school; and

       ``(ii) the school will make efforts to recruit Hispanic 
     students, including students who have participated in the 
     undergraduate or other matriculation program carried out 
     under arrangements established by the school pursuant to 
     clause (i)(II) and will assist Hispanic students regarding 
     the completion of the educational requirements for a degree 
     from the school.
       ``(4) Native american centers of excellence.--Subject to 
     subsection (e), the conditions specified in this paragraph 
     are that--
       ``(A) with respect to Native Americans, each of clauses (i) 
     through (iv) of paragraph (1)(B) applies to the designated 
     health professions school involved;
       ``(B) the school agrees, as a condition of receiving a 
     grant under subsection (a), that the school will, in carrying 
     out the duties described in subsection (b), give priority to 
     carrying out the duties with respect to Native Americans; and

[[Page S9631]]

       ``(C) the school agrees, as a condition of receiving a 
     grant under subsection (a), that--
       ``(i) the school will establish an arrangement with 1 or 
     more public or nonprofit private institutions of higher 
     education, including schools of nursing, whose enrollment of 
     students has traditionally included a significant number of 
     Native Americans, the purpose of which arrangement will be to 
     carry out a program--

       ``(I) to identify Native American students, from the 
     institutions of higher education referred to in clause (i), 
     who are interested in health professions careers; and
       ``(II) to facilitate the educational preparation of such 
     students to enter the designated health professions school; 
     and

       ``(ii) the designated health professions school will make 
     efforts to recruit Native American students, including 
     students who have participated in the undergraduate program 
     carried out under arrangements established by the school 
     pursuant to clause (i) and will assist Native American 
     students regarding the completion of the educational 
     requirements for a degree from the designated health 
     professions school.
       ``(5) Other centers of excellence.--The conditions 
     specified in this paragraph are--
       ``(A) with respect to other centers of excellence, the 
     conditions described in clauses (i) through (iv) of paragraph 
     (1)(B); and
       ``(B) that the health professions school involved has an 
     enrollment of under-represented minorities above the national 
     average for such enrollments of health professions schools.
       ``(d) Designation as Center of Excellence.--
       ``(1) In general.--Any designated health professions school 
     receiving a grant under subsection (a) and meeting the 
     conditions described in paragraph (2) or (5) of subsection 
     (c) shall, for purposes of this section, be designated by the 
     Secretary as a Center of Excellence in Under-Represented 
     Minority Health Professions Education.
       ``(2) Hispanic centers of excellence.--Any designated 
     health professions school receiving a grant under subsection 
     (a) and meeting the conditions described in subsection (c)(3) 
     shall, for purposes of this section, be designated by the 
     Secretary as a Hispanic Center of Excellence in Health 
     Professions Education.
       ``(3) Native american centers of excellence.--Any 
     designated health professions school receiving a grant under 
     subsection (a) and meeting the conditions described in 
     subsection (c)(4) shall, for purposes of this section, be 
     designated by the Secretary as a Native American Center of 
     Excellence in Health Professions Education. Any consortium 
     receiving such a grant pursuant to subsection (e) shall, for 
     purposes of this section, be so designated.
       ``(e) Authority Regarding Native American Centers of 
     Excellence.--With respect to meeting the conditions specified 
     in subsection (c)(4), the Secretary may make a grant under 
     subsection (a) to a designated health professions school that 
     does not meet such conditions if--
       ``(1) the school has formed a consortium in accordance with 
     subsection (d)(1); and
       ``(2) the schools of the consortium collectively meet such 
     conditions, without regard to whether the schools 
     individually meet such conditions.
       ``(f) Duration of Grant.--The period during which payments 
     are made under a grant under subsection (a) may not exceed 5 
     years. Such payments shall be subject to annual approval by 
     the Secretary and to the availability of appropriations for 
     the fiscal year involved to make the payments.
       ``(g) Definitions.--In this section:
       ``(1) Designated health professions school.--
       ``(A) In general.--The term `health professions school' 
     means, except as provided in subparagraph (B), a school of 
     medicine, a school of osteopathic medicine, a school of 
     dentistry, a school of pharmacy, or a graduate program in 
     behavioral or mental health.
       ``(B) Exception.--The definition established in 
     subparagraph (A) shall not apply to the use of the term 
     `designated health professions school' for purposes of 
     subsection (c)(2).
       ``(2) Program of excellence.--The term `program of 
     excellence' means any program carried out by a designated 
     health professions school with a grant made under subsection 
     (a), if the program is for purposes for which the school 
     involved is authorized in subsection (b) or (c) to expend the 
     grant.
       ``(3) Native americans.--The term `Native Americans' means 
     American Indians, Alaskan Natives, Aleuts, and Native 
     Hawaiians.
       ``(h) Funding.--
       ``(1) Authorization of appropriations.--For the purpose of 
     making grants under subsection (a), there authorized to be 
     appropriated $26,000,000 for fiscal year 1998, and such sums 
     as may be necessary for each of the fiscal years 1999 through 
     2002.
       ``(2) Allocations.--Based on the amount appropriated under 
     paragraph (1) for a fiscal year, one of the following 
     subparagraphs shall apply:
       ``(A) In general.--If the amounts appropriated under 
     paragraph (1) for a fiscal year are $24,000,000 or less--
       ``(i) the Secretary shall make available $12,000,000 for 
     grants under subsection (a) to health professions schools 
     that meet the conditions described in subsection (c)(2)(A); 
     and
       ``(ii) and available after grants are made with funds under 
     clause (i), the Secretary shall make available--

       ``(I) 60 percent of such amount for grants under subsection 
     (a) to health professions schools that meet the conditions 
     described in paragraph (3) or (4) of subsection (c) 
     (including meeting the conditions under subsection (e)); and
       ``(II) 40 percent of such amount for grants under 
     subsection (a) to health professions schools that meet the 
     conditions described in subsection (c)(5).

       ``(B) Funding in excess of $24,000,000.--If amounts 
     appropriated under paragraph (1) for a fiscal year exceed 
     $24,000,000 but are less than $30,000,000--
       ``(i) 80 percent of such excess amounts shall be made 
     available for grants under subsection (a) to health 
     professions schools that meet the requirements described in 
     paragraph (3) or (4) of subsection (c) (including meeting 
     conditions pursuant to subsection (e)); and
       ``(ii) 20 percent of such excess amount shall be made 
     available for grants under subsection (a) to health 
     professions schools that meet the conditions described in 
     subsection (c)(5).
       ``(C) Funding in excess of $30,000,000.--If amounts 
     appropriated under paragraph (1) for a fiscal year are 
     $30,000,000 or more, the Secretary shall make available--
       ``(i) not less than $12,000,000 for grants under subsection 
     (a) to health professions schools that meet the conditions 
     described in subsection (c)(2)(A);
       ``(ii) not less than $12,000,000 for grants under 
     subsection (a) to health professions schools that meet the 
     conditions described in paragraph (3) or (4) of subsection 
     (c) (including meeting conditions pursuant to subsection 
     (e));
       ``(iii) not less than $6,000,000 for grants under 
     subsection (a) to health professions schools that meet the 
     conditions described in subsection (c)(5); and
       ``(iv) after grants are made with funds under clauses (i) 
     through (iii), any remaining funds for grants under 
     subsection (a) to health professions schools that meet the 
     conditions described in paragraph (2)(A), (3), (4), or (5) of 
     subsection (c).
       ``(3) No limitation.--Nothing in this subsection shall be 
     construed as limiting the centers of excellence referred to 
     in this section to the designated amount, or to preclude such 
     entities from competing for other grants under this section.
       ``(4) Maintenance of effort.--
       ``(A) In general.--With respect to activities for which a 
     grant made under this part are authorized to be expended, the 
     Secretary may not make such a grant to a center of excellence 
     for any fiscal year unless the center agrees 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 center for the fiscal year preceding the 
     fiscal year for which the school receives such a grant.
       ``(B) Use of federal funds.--With respect to any Federal 
     amounts received by a center of excellence and available for 
     carrying out activities for which a grant under this part is 
     authorized to be expended, the Secretary may not make such a 
     grant to the center for any fiscal year unless the center 
     agrees that the center will, before expending the grant, 
     expend the Federal amounts obtained from sources other than 
     the grant.

     ``SEC. 737. SCHOLARSHIPS FOR DISADVANTAGED STUDENTS.

       ``(a) In General.--The Secretary may make a grant to an 
     eligible entity (as defined in subsection (d)(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 (d). Such scholarships may be expended only for 
     tuition expenses, other reasonable educational expenses, and 
     reasonable living expenses incurred in the attendance of such 
     school.
       ``(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 agree 
     that, in providing scholarships pursuant to the grant, the 
     schools will give preference to students for whom the costs 
     of attending the schools 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 underrepresented minority students, 
     and the proportion of graduates working in medically 
     underserved communities.
       ``(d) Definitions.--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, chiropractic, or allied health, a school offering a 
     graduate program in behavioral and mental health practice, or 
     an entity providing programs for the training of physician 
     assistants; 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 professions or nursing school as a full-time 
     student in a program leading to a degree in a health 
     profession or nursing.

     ``SEC. 738. LOAN REPAYMENTS AND FELLOWSHIPS REGARDING FACULTY 
                   POSITIONS.

       ``(a) Loan Repayments.--
       ``(1) Establishment of program.--The Secretary shall 
     establish a program of entering into contracts with 
     individuals described in paragraph (2) under which the 
     individuals agree to serve as members of the faculties of 
     schools described in paragraph (3) in consideration of the 
     Federal Government agreeing to pay, for each

[[Page S9632]]

     year of such service, not more than $20,000 of the principal 
     and interest of the educational loans of such individuals.
       ``(2) Eligible individuals.--The individuals referred to in 
     paragraph (1) are individuals from disadvantaged backgrounds 
     who--
       ``(A) have a degree in medicine, osteopathic medicine, 
     dentistry, nursing, or another health profession;
       ``(B) are enrolled in an approved graduate training program 
     in medicine, osteopathic medicine, dentistry, nursing, or 
     other health profession; or
       ``(C) are enrolled as full-time students--
       ``(i) in an accredited (as determined by the Secretary) 
     school described in paragraph (3); and
       ``(ii) in the final year of a course of a study or program, 
     offered by such institution and approved by the Secretary, 
     leading to a degree from such a school.
       ``(3) Eligible health professions schools.--The schools 
     described in this paragraph are schools of medicine, nursing 
     (as schools of nursing are defined in section 801), 
     osteopathic medicine, dentistry, pharmacy, allied health, 
     podiatric medicine, optometry, veterinary medicine, or public 
     health, or schools offering graduate programs in behavioral 
     and mental health.
       ``(4) Requirements regarding faculty positions.--The 
     Secretary may not enter into a contract under paragraph (1) 
     unless--
       ``(A) the individual involved has entered into a contract 
     with a school described in paragraph (3) to serve as a member 
     of the faculty of the school for not less than 2 years; and
       ``(B) the contract referred to in subparagraph (A) provides 
     that--
       ``(i) the school will, for each year for which the 
     individual will serve as a member of the faculty under the 
     contract with the school, make payments of the principal and 
     interest due on the educational loans of the individual for 
     such year in an amount equal to the amount of such payments 
     made by the Secretary for the year;
       ``(ii) the payments made by the school pursuant to clause 
     (i) on behalf of the individual will be in addition to the 
     pay that the individual would otherwise receive for serving 
     as a member of such faculty; and
       ``(iii) the school, in making a determination of the amount 
     of compensation to be provided by the school to the 
     individual for serving as a member of the faculty, will make 
     the determination without regard to the amount of payments 
     made (or to be made) to the individual by the Federal 
     Government under paragraph (1).
       ``(5) Applicability of certain provisions.--The provisions 
     of sections 338C, 338G, and 338I shall apply to the program 
     established in paragraph (1) to the same extent and in the 
     same manner as such provisions apply to the National Health 
     Service Corps Loan Repayment Program established in subpart 
     III of part D of title III, including the applicability of 
     provisions regarding reimbursements for increased tax 
     liability and regarding bankruptcy.
       ``(6) Waiver regarding school contributions.--The Secretary 
     may waive the requirement established in paragraph (4)(B) if 
     the Secretary determines that the requirement will impose an 
     undue financial hardship on the school involved.
       ``(b) Fellowships.--
       ``(1) In general.--The Secretary may make grants to and 
     enter into contracts with eligible entities to assist such 
     entities in increasing the number of underrepresented 
     minority individuals who are members of the faculty of such 
     schools.
       ``(2) Applications.--To be eligible to receive a grant or 
     contract under this subsection, an entity shall provide an 
     assurance, in the application submitted by the entity, that--
       ``(A) amounts received under such a grant or contract will 
     be used to award a fellowship to an individual only if the 
     individual meets the requirements of paragraphs (3) and (4); 
     and
       ``(B) each fellowship awarded pursuant to the grant or 
     contract will include--
       ``(i) a stipend in an amount not exceeding 50 percent of 
     the regular salary of a similar faculty member for not to 
     exceed 3 years of training; and
       ``(ii) an allowance for other expenses, such as travel to 
     professional meetings and costs related to specialized 
     training.
       ``(3) Eligibility.--To be eligible to receive a grant or 
     contract under paragraph (1), an applicant shall demonstrate 
     to the Secretary that such applicant has or will have the 
     ability to--
       ``(A) identify, recruit and select underrepresented 
     minority individuals who have the potential for teaching, 
     administration, or conducting research at a health 
     professions institution;
       ``(B) provide such individuals with the skills necessary to 
     enable them to secure a tenured faculty position at such 
     institution, which may include training with respect to 
     pedagogical skills, program administration, the design and 
     conduct of research, grants writing, and the preparation of 
     articles suitable for publication in peer reviewed journals;
       ``(C) provide services designed to assist such individuals 
     in their preparation for an academic career, including the 
     provision of counselors; and
       ``(D) provide health services to rural or medically 
     underserved populations.
       ``(4) Requirements.--To be eligible to receive a grant or 
     contract under paragraph (1) an applicant shall--
       ``(A) provide an assurance that such applicant will make 
     available (directly through cash donations) $1 for every $1 
     of Federal funds received under this section for the 
     fellowship;
       ``(B) provide an assurance that institutional support will 
     be provided for the individual for the second and third years 
     at a level that is equal to the total amount of institutional 
     funds provided in the year in which the grant or contract was 
     awarded;
       ``(C) provide an assurance that the individual that will 
     receive the fellowship will be a member of the faculty of the 
     applicant school; and
       ``(D) provide an assurance that the individual that will 
     receive the fellowship will have, at a minimum, appropriate 
     advanced preparation (such as a master's or doctoral degree) 
     and special skills necessary to enable such individual to 
     teach and practice.
       ``(5) Definition.--For purposes of this subsection, the 
     term `underrepresented minority individuals' means 
     individuals who are members of racial or ethnic minority 
     groups that are underrepresented in the health professions 
     including nursing.

     ``SEC. 739. EDUCATIONAL ASSISTANCE IN THE HEALTH PROFESSIONS 
                   REGARDING INDIVIDUALS FROM DISADVANTAGED 
                   BACKGROUNDS.

       ``(a) In General.--
       ``(1) Authority for grants.--For the purpose of assisting 
     individuals from disadvantaged backgrounds, as determined in 
     accordance with criteria prescribed by the Secretary, to 
     undertake education to enter a health profession, the 
     Secretary may make grants to and enter into contracts with 
     schools of medicine, osteopathic medicine, public health, 
     dentistry, veterinary medicine, optometry, pharmacy, allied 
     health, chiropractic, and podiatric medicine, public and 
     nonprofit private schools that offer graduate programs in 
     behavioral and mental health, programs for the training of 
     physician assistants, and other public or private nonprofit 
     health or educational entities to assist in meeting the costs 
     described in paragraph (2).
       ``(2) Authorized expenditures.--A grant or contract under 
     paragraph (1) may be used by the entity to meet the cost of--
       ``(A) identifying, recruiting, and selecting individuals 
     from disadvantaged backgrounds, as so determined, for 
     education and training in a health profession;
       ``(B) facilitating the entry of such individuals into such 
     a school;
       ``(C) providing counseling, mentoring, or other services 
     designed to assist such individuals to complete successfully 
     their education at such a school;
       ``(D) providing, for a period prior to the entry of such 
     individuals into the regular course of education of such a 
     school, preliminary education and health research training 
     designed to assist them to complete successfully such regular 
     course of education at such a school, or referring such 
     individuals to institutions providing such preliminary 
     education;
       ``(E) publicizing existing sources of financial aid 
     available to students in the education program of such a 
     school or who are undertaking training necessary to qualify 
     them to enroll in such a program;
       ``(F) paying such scholarships as the Secretary may 
     determine for such individuals for any period of health 
     professions education at a health professions school;
       ``(G) paying such stipends as the Secretary may approve for 
     such individuals for any period of education in student-
     enhancement programs (other than regular courses), except 
     that such a stipend may not be provided to an individual for 
     more than 12 months, and such a stipend shall be in an amount 
     determined appropriate by the Secretary (notwithstanding any 
     other provision of law regarding the amount of stipends);
       ``(H) carrying out programs under which such individuals 
     gain experience regarding a career in a field of primary 
     health care through working at facilities of public or 
     private nonprofit community-based providers of primary health 
     services; and
       ``(I) conducting activities to develop a larger and more 
     competitive applicant pool through partnerships with 
     institutions of higher education, school districts, and other 
     community-based entities.
       ``(3) Definition.--In this section, the term `regular 
     course of education of such a school' as used in subparagraph 
     (D) includes a graduate program in behavioral or mental 
     health.
       ``(b) Requirements for Awards.--In making awards to 
     eligible entities under subsection (a)(1), the Secretary 
     shall give preference to approved applications for programs 
     that involve a comprehensive approach by several public or 
     nonprofit private health or educational entities to 
     establish, enhance and expand educational programs that will 
     result in the development of a competitive applicant pool of 
     individuals from disadvantaged backgrounds who desire to 
     pursue health professions careers. In considering awards for 
     such a comprehensive partnership approach, the following 
     shall apply with respect to the entity involved:
       ``(1) The entity shall have a demonstrated commitment to 
     such approach through formal agreements that have common 
     objectives with institutions of higher education, school 
     districts, and other community-based entities.
       ``(2) Such formal agreements shall reflect the coordination 
     of educational activities and support services, increased 
     linkages, and the consolidation of resources within a 
     specific geographic area.
       ``(3) The design of the educational activities involved 
     shall provide for the establishment of a competitive health 
     professions applicant pool of individuals from disadvantaged 
     backgrounds by enhancing the total preparation (academic and 
     social) of such individuals to pursue a health professions 
     career.
       ``(4) The programs or activities under the award shall 
     focus on developing a culturally competent health care 
     workforce that will serve the unserved and underserved 
     populations within the geographic area.
       ``(c) Equitable Allocation of Financial Assistance.--The 
     Secretary, to the extent practicable, shall ensure that 
     services and activities under subsection (a) are adequately 
     allocated among the various racial and ethnic populations who 
     are from disadvantaged backgrounds.

[[Page S9633]]

       ``(d) Matching Requirements.--The Secretary may require 
     that an entity that applies for a grant or contract under 
     subsection (a), provide non-Federal matching funds, as 
     appropriate, to ensure the institutional commitment of the 
     entity to the projects funded under the grant or contract. 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. 740. AUTHORIZATION OF APPROPRIATION.

       ``(a) Scholarships.--There are authorized to be 
     appropriated to carry out section 737, $37,000,000 for fiscal 
     year 1998, and such sums as may be necessary for each of the 
     fiscal years 1999 through 2002. 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.
       ``(b) Loan Repayments and Fellowships.--For the purpose of 
     carrying out section 738, there is authorized to be 
     appropriated $1,100,000 for fiscal year 1998, and such sums 
     as may be necessary for each of the fiscal years 1999 through 
     2002.
       ``(c) Educational Assistance in Health Professions 
     Regarding Individuals for Disadvantaged Backgrounds.--For the 
     purpose of grants and contracts under section 739(a)(1), 
     there is authorized to be appropriated $29,400,000 for fiscal 
     year 1998, and such sums as may be necessary for each of the 
     fiscal years 1999 through 2002. The Secretary may use not to 
     exceed 20 percent of the amount appropriated for a fiscal 
     year under this subsection to provide scholarships under 
     section 739(a)(2)(F).
       ``(d) Report.--Not later than 6 months after the date of 
     enactment of this part, the Secretary shall prepare and 
     submit to the appropriate committees of Congress a report 
     concerning the efforts of the Secretary to address the need 
     for a representative mix of individuals from historically 
     minority health professions schools, or from institutions or 
     other entities that historically or by geographic location 
     have a demonstrated record of training or educating 
     underrepresented minorities, within various health 
     professions disciplines, on peer review councils.''.
       (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 PRIMARY CARE MEDICINE AND 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, PHYSICIAN ASSISTANTS, GENERAL DENTISTRY, 
     AND PEDIATRIC DENTISTRY'';
       (2) by repealing section 746 (42 U.S.C. 293j);
       (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, GENERAL DENTISTRY, 
                   PEDIATRIC 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 ``(including 
     geriatrics), general internal medicine or general 
     pediatrics'' after ``family medicine'';
       (iv) in paragraph (3), by striking ``and'' at the end 
     thereof;
       (v) 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; and
       ``(6) to meet the costs of planning, developing, or 
     operating programs, and to provide financial assistance to 
     residents in such programs, of general dentistry or pediatric 
     dentistry.

     For purposes of paragraph (6), entities eligible for such 
     grants or contracts shall include entities that have programs 
     in dental schools, approved residency programs in the general 
     or pediatric practice of dentistry, approved advanced 
     education programs in the general or pediatric practice of 
     dentistry, or approved residency programs in pediatric 
     dentistry.'';
       (C) in subsection (b)--
       (i) in paragraphs (1) and (2)(A), by inserting ``, general 
     internal medicine, or general pediatrics'' after ``family 
     medicine'';
       (ii) in paragraph (2)--

       (I) in subparagraph (A), by striking ``or'' at the end; and
       (II) in subparagraph (B), by striking the period and 
     inserting ``; or''; and

       (iii) by adding at the end the following:
       ``(3) Priority in making awards.--In making awards of 
     grants and contracts under paragraph (1), the Secretary shall 
     give priority to any qualified applicant for such an award 
     that proposes a collaborative project between departments of 
     primary care.'';
       (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.--
       ``(1) In general.--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 or 
     pediatric dentistry.
       ``(2) Disadvantaged individuals.--With respect to programs 
     for the training of interns, residents, or physician 
     assistants, the Secretary shall give priority in awarding 
     grants under this section to qualified applicants that have a 
     record of training individuals who are from disadvantaged 
     backgrounds (including racial and ethnic minorities 
     underrepresented among primary care practice or general or 
     pediatric dentistry).
       ``(3) Special consideration.--In awarding grants under this 
     section the Secretary shall give special consideration to 
     projects which prepare practitioners to care for underserved 
     populations and other high risk groups such as the elderly, 
     individuals with HIV-AIDS, substance abusers, homeless, and 
     victims of domestic violence.''; 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 ``$78,300,000 for fiscal year 
     1998, and such sums as may be necessary for each of the 
     fiscal years 1999 through 2002.''; and
       (ii) by striking paragraph (2) and inserting the following:
       ``(2) Allocation.--
       ``(A) In general.--Of the amounts appropriated under 
     paragraph (1) for a fiscal year, the Secretary shall make 
     available--
       ``(i) not less than $49,300,000 for awards of grants and 
     contracts under subsection (a) to programs of family 
     medicine, of which not less than $8,600,000 shall be made 
     available for awards of grants and contracts under subsection 
     (b) for family medicine academic administrative units;
       ``(ii) not less than $17,700,000 for awards of grants and 
     contracts under subsection (a) to programs of general 
     internal medicine and general pediatrics;
       ``(iii) not less than $6,800,000 for awards of grants and 
     contracts under subsection (a) to programs relating to 
     physician assistants; and
       ``(iv) not less than $4,500,000 for awards of grants and 
     contracts under subsection (a) to programs of general or 
     pediatric dentistry.
       ``(B) Ratable reduction.--If amounts appropriated under 
     paragraph (1) for any fiscal year are less than the amount 
     required to comply with subparagraph (A), the Secretary shall 
     ratably reduce the amount to be made available under each of 
     clauses (i) through (iv) of such subparagraph accordingly.''; 
     and
       (4) by repealing sections 748 through 752 (42 U.S.C. 293l 
     through 293p) and inserting the following:

     ``SEC. 748. ADVISORY COMMITTEE ON TRAINING IN PRIMARY CARE 
                   MEDICINE AND DENTISTRY.

       ``(a) Establishment.--The Secretary shall establish an 
     advisory committee to be known as the Advisory Committee on 
     Training in Primary Care Medicine and Dentistry (in this 
     section referred to as the `Advisory Committee').
       ``(b) Composition.--
       ``(1) In general.--The Secretary shall determine the 
     appropriate number of individuals to serve on the Advisory 
     Committee. Such individuals shall not be officers or 
     employees of the Federal Government.
       ``(2) Appointment.--Not later than 90 days after the date 
     of enactment of this Act, the Secretary shall appoint the 
     members of the Advisory Committee from among individuals who 
     are health professionals. In making such appointments, the 
     Secretary shall ensure a fair balance between the health 
     professions, that at least 75 percent of the members of the 
     Advisory Committee are health professionals, a broad 
     geographic representation of members and a balance between 
     urban and rural members. Members shall be appointed based on 
     their competence, interest, and knowledge of the mission of 
     the profession involved.
       ``(3) Minority representation.--In appointing the members 
     of the Advisory Committee under paragraph (2), the Secretary 
     shall ensure the adequate representation of women and 
     minorities.
       ``(c) Terms.--
       ``(1) In general.--A member of the Advisory Committee shall 
     be appointed for a term of 3 years, except that of the 
     members first appointed--
       ``(A) \1/3\ of such members shall serve for a term of 1 
     year;
       ``(B) \1/3\ of such members shall serve for a term of 2 
     years; and
       ``(C) \1/3\ of such members shall serve for a term of 3 
     years.

[[Page S9634]]

       ``(2) Vacancies.--
       ``(A) In general.--A vacancy on the Advisory Committee 
     shall be filled in the manner in which the original 
     appointment was made and shall be subject to any conditions 
     which applied with respect to the original appointment.
       ``(B) Filling unexpired term.--An individual chosen to fill 
     a vacancy shall be appointed for the unexpired term of the 
     member replaced.
       ``(d) Duties.--The Advisory Committee shall--
       ``(1) provide advice and recommendations to the Secretary 
     concerning policy and program development and other matters 
     of significance concerning the activities under section 747; 
     and
       ``(2) not later than 3 years after the date of enactment of 
     this section, and annually thereafter, prepare and submit to 
     the Secretary, and the Committee on Labor and Human Resources 
     of the Senate, and the Committee on Commerce of the House of 
     Representatives, a report describing the activities of the 
     Committee, including findings and recommendations made by the 
     Committee concerning the activities under section 747.
       ``(e) Meetings and Documents.--
       ``(1) Meetings.--The Advisory Committee shall meet not less 
     than 2 times each year. Such meetings shall be held jointly 
     with other related entities established under this title 
     where appropriate.
       ``(2) Documents.--Not later than 14 days prior to the 
     convening of a meeting under paragraph (1), the Advisory 
     Committee shall prepare and make available an agenda of the 
     matters to be considered by the Advisory Committee at such 
     meeting. At any such meeting, the Advisory Council shall 
     distribute materials with respect to the issues to be 
     addressed at the meeting. Not later than 30 days after the 
     adjourning of such a meeting, the Advisory Committee shall 
     prepare and make available a summary of the meeting and any 
     actions taken by the Committee based upon the meeting.
       ``(f) Compensation and Expenses.--
       ``(1) Compensation.--Each member of the Advisory Committee 
     shall be compensated at a rate equal to the daily equivalent 
     of the annual rate of basic pay prescribed for level IV of 
     the Executive Schedule under section 5315 of title 5, United 
     States Code, for each day (including travel time) during 
     which such member is engaged in the performance of the duties 
     of the Committee.
       ``(2) Expenses.--The members of the Advisory Committee 
     shall be allowed travel expenses, including per diem in lieu 
     of subsistence, at rates authorized for employees of agencies 
     under subchapter I of chapter 57 of title 5, United States 
     Code, while away from their homes or regular places of 
     business in the performance of services for the Committee.
       ``(g) FACA.--The Federal Advisory Committee Act shall apply 
     to the Advisory Committee under this section only to the 
     extent that the provisions of such Act do not conflict with 
     the requirements of this section.''.

     SEC. 103. INTERDISCIPLINARY, COMMUNITY-BASED LINKAGES.

       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--INTERDISCIPLINARY, COMMUNITY-BASED LINKAGES

     ``SEC. 750. GENERAL PROVISIONS.

       ``(a) Collaboration.--To be eligible to receive assistance 
     under this part, an academic institution shall use such 
     assistance in collaboration with 2 or more disciplines.
       ``(b) Activities.--An entity shall use assistance under 
     this part to carry out innovative demonstration projects for 
     strategic workforce supplementation activities as needed to 
     meet national goals for interdisciplinary, community-based 
     linkages. Such assistance may be used consistent with this 
     part--
       ``(1) to develop and support training programs;
       ``(2) for faculty development;
       ``(3) for model demonstration programs;
       ``(4) for the provision of stipends for fellowship 
     trainees;
       ``(5) to provide technical assistance; and
       ``(6) for other activities that will produce outcomes 
     consistent with the purposes of this part.

     ``SEC. 751. AREA HEALTH EDUCATION CENTERS.

       ``(a) Authority for Provision of Financial Assistance.--
       ``(1) Assistance for planning, development, and operation 
     of programs.--
       ``(A) In general.--The Secretary shall award grants to and 
     enter into contracts with schools of medicine and osteopathic 
     medicine, and incorporated consortia made up of such schools, 
     or the parent institutions of such schools, for projects for 
     the planning, development and operation of area health 
     education center programs that--
       ``(i) improve the recruitment, distribution, supply, 
     quality and efficiency of personnel providing health services 
     in underserved rural and urban areas and personnel providing 
     health services to populations having demonstrated serious 
     unmet health care needs;
       ``(ii) increase the number of primary care physicians and 
     other primary care providers who provide services in 
     underserved areas through the offering of an educational 
     continuum of health career recruitment through clinical 
     education concerning underserved areas in a comprehensive 
     health workforce strategy;
       ``(iii) carry out recruitment and health career awareness 
     programs to recruit individuals from underserved areas and 
     under-represented populations, including minority and other 
     elementary or secondary students, into the health 
     professions;
       ``(iv) prepare individuals to more effectively provide 
     health services to underserved areas or underserved 
     populations through field placements, preceptorships, the 
     conduct of or support of community-based primary care 
     residency programs, and agreements with community-based 
     organizations such as community health centers, migrant 
     health centers, Indian health centers, public health 
     departments and others;
       ``(v) conduct health professions education and training 
     activities for students of health professions schools and 
     medical residents;
       ``(vi) conduct at least 10 percent of medical student 
     required clinical education at sites remote to the primary 
     teaching facility of the contracting institution; and
       ``(vii) provide information dissemination and educational 
     support to reduce professional isolation, increase retention, 
     enhance the practice environment, and improve health care 
     through the timely dissemination of research findings using 
     relevant resources.
       ``(B) Other eligible entities.--With respect to a State in 
     which no area health education center program is in 
     operation, the Secretary may award a grant or contract under 
     subparagraph (A) to a school of nursing.
       ``(C) Project terms.--
       ``(i) In general.--Except as provided in clause (ii), the 
     period during which payments may be made under an award under 
     subparagraph (A) may not exceed--

       ``(I) in the case of a project, 12 years or
       ``(II) in the case of a center within a project, 6 years.

       ``(ii) Exception.--The periods described in clause (i) 
     shall not apply to projects that have completed the initial 
     period of Federal funding under this section and that desire 
     to compete for model awards under paragraph (2)(A).
       ``(2) Assistance for operation of model programs.--
       ``(A) In general.--In the case of any entity described in 
     paragraph (1)(A) that--
       ``(i) has previously received funds under this section;
       ``(ii) is operating an area health education center 
     program; and
       ``(iii) is no longer receiving financial assistance under 
     paragraph (1);

     the Secretary may provide financial assistance to such entity 
     to pay the costs of operating and carrying out the 
     requirements of the program as described in paragraph (1).
       ``(B) Matching requirement.--With respect to the costs of 
     operating a model program under subparagraph (A), an entity, 
     to be eligible for financial assistance under subparagraph 
     (A), shall make available (directly or through contributions 
     from State, county or municipal governments, or the private 
     sector) recurring non-Federal contributions in cash toward 
     such costs in an amount that is equal to not less than 50 
     percent of such costs.
       ``(C) Limitation.--The aggregate amount of awards provided 
     under subparagraph (A) to entities in a State for a fiscal 
     year may not exceed the lesser of--
       ``(i) $2,000,000; or
       ``(ii) an amount equal to the product of $250,000 and the 
     aggregate number of area health education centers operated in 
     the State by such entities.
       ``(b) Requirements for Centers.--
       ``(1) General requirement.--Each area health education 
     center that receives funds under this section shall encourage 
     the regionalization of health professions schools through the 
     establishment of partnerships with community-based 
     organizations.
       ``(2) Service area.--Each area health education center that 
     receives funds under this section shall specifically 
     designate a geographic area or medically underserved 
     population to be served by the center. Such area or 
     population shall be in a location removed from the main 
     location of the teaching facilities of the schools 
     participating in the program with such center.
       ``(3) Other requirements.--Each area health education 
     center that receives funds under this section shall--
       ``(A) assess the health personnel needs of the area to be 
     served by the center and assist in the planning and 
     development of training programs to meet such needs;
       ``(B) arrange and support rotations for students and 
     residents in family medicine, general internal medicine or 
     general pediatrics, with at least one center in each program 
     being affiliated with or conducting a rotating osteopathic 
     internship or medical residency training program in family 
     medicine (including geriatrics), general internal medicine 
     (including geriatrics), or general pediatrics in which no 
     fewer than 4 individuals are enrolled in first-year 
     positions;
       ``(C) conduct and participate in interdisciplinary training 
     that involves physicians and other health personnel 
     including, where practicable, public health professionals, 
     physician assistants, nurse practitioners, nurse midwives, 
     and behavioral and mental health providers; and
       ``(D) have an advisory board, at least 75 percent of the 
     members of which shall be individuals, including both health 
     service providers and consumers, from the area served by the 
     center.
       ``(c) Certain Provisions Regarding Funding.--
       ``(1) Allocation to center.--Not less than 75 percent of 
     the total amount of Federal funds provided to an entity under 
     this section shall be allocated by an area health education 
     center program to the area health education center. Such 
     entity shall enter into an agreement with each center for 
     purposes of specifying the allocation of such 75 percent of 
     funds.
       ``(2) Operating costs.--With respect to the operating costs 
     of the area health education center program of an entity 
     receiving funds under this section, the entity shall make 
     available (directly or through contributions from State, 
     county or municipal governments, or the private sector) non-
     Federal contributions in cash toward such costs in an amount 
     that is

[[Page S9635]]

     equal to not less than 50 percent of such costs, except that 
     the Secretary may grant a waiver for up to 75 percent of the 
     amount of the required non-Federal match in the first 3 years 
     in which an entity receives funds under this section.

     ``SEC. 752. HEALTH EDUCATION AND TRAINING CENTERS.

       ``(a) In General.--To be eligible for funds under this 
     section, a health education training center shall be an 
     entity otherwise eligible for funds under section 751 that--
       ``(1) addresses the persistent and severe unmet health care 
     needs in States along the border between the United States 
     and Mexico and in the State of Florida, and in other urban 
     and rural areas with populations with serious unmet health 
     care needs;
       ``(2) establishes an advisory board comprised of health 
     service providers, educators and consumers from the service 
     area;
       ``(3) conducts training and education programs for health 
     professions students in these areas;
       ``(4) conducts training in health education services, 
     including training to prepare community health workers; and
       ``(5) supports health professionals (including nursing) 
     practicing in the area through educational and other 
     services.
       ``(b) Allocation of Funds.--The Secretary shall make 
     available 50 percent of the amounts appropriated for each 
     fiscal year under section 752 for the establishment or 
     operation of health education training centers through 
     projects in States along the border between the United States 
     and Mexico and in the State of Florida.

     ``SEC. 753. EDUCATION AND TRAINING RELATING TO GERIATRICS.

       ``(a) Geriatric Education Centers.--
       ``(1) In general.--The Secretary shall award grants or 
     contracts under this section to entities described in 
     paragraphs (1), (3), or (4) of section 799B, and section 
     853(2), for the establishment or operation of geriatric 
     education centers.
       ``(2) Requirements.--A geriatric education center is a 
     program that--
       ``(A) improves the training of health professionals in 
     geriatrics, including geriatric residencies, traineeships, or 
     fellowships;
       ``(B) develops and disseminates curricula relating to the 
     treatment of the health problems of elderly individuals;
       ``(C) supports the training and retraining of faculty to 
     provide instruction in geriatrics;
       ``(D) supports continuing education of health professionals 
     who provide geriatric care; and
       ``(E) provides students with clinical training in 
     geriatrics in nursing homes, chronic and acute disease 
     hospitals, ambulatory care centers, and senior centers.
       ``(b) Geriatric Training Regarding Physicians and 
     Dentists.--
       ``(1) In general.--The Secretary may make grants to, and 
     enter into contracts with, schools of medicine, schools of 
     osteopathic medicine, teaching hospitals, and graduate 
     medical education programs, for the purpose of providing 
     support (including residencies, traineeships, and 
     fellowships) for geriatric training projects to train 
     physicians, dentists and behavioral and mental health 
     professionals who plan to teach geriatric medicine, geriatric 
     behavioral or mental health, or geriatric dentistry.
       ``(2) Requirements.--Each project for which a grant or 
     contract is made under this subsection shall--
       ``(A) be staffed by full-time teaching physicians who have 
     experience or training in geriatric medicine or geriatric 
     behavioral or mental health;
       ``(B) be staffed, or enter into an agreement with an 
     institution staffed by full-time or part-time teaching 
     dentists who have experience or training in geriatric 
     dentistry;
       ``(C) be staffed, or enter into an agreement with an 
     institution staffed by full-time or part-time teaching 
     behavioral mental health professionals who have experience or 
     training in geriatric behavioral or mental health;
       ``(D) be based in a graduate medical education program in 
     internal medicine or family medicine or in a department of 
     geriatrics or behavioral or mental health;
       ``(E) provide training in geriatrics and exposure to the 
     physical and mental disabilities of elderly individuals 
     through a variety of service rotations, such as geriatric 
     consultation services, acute care services, dental services, 
     geriatric behavioral or mental health units, day and home 
     care programs, rehabilitation services, extended care 
     facilities, geriatric ambulatory care and comprehensive 
     evaluation units, and community care programs for elderly 
     mentally retarded individuals; and
       ``(F) provide training in geriatrics through one or both of 
     the training options described in subparagraphs (A) and (B) 
     of paragraph (3).
       ``(3) Training options.--The training options referred to 
     in subparagraph (F) of paragraph (2) shall be as follows:
       ``(A) A 1-year retraining program in geriatrics for--
       ``(i) physicians who are faculty members in departments of 
     internal medicine, family medicine, gynecology, geriatrics, 
     and behavioral or mental health at schools of medicine and 
     osteopathic medicine;
       ``(ii) dentists who are faculty members at schools of 
     dentistry or at hospital departments of dentistry; and
       ``(iii) behavioral or mental health professionals who are 
     faculty members in departments of behavioral or mental 
     health; and
       ``(B) A 2-year internal medicine or family medicine 
     fellowship program providing emphasis in geriatrics, which 
     shall be designed to provide training in clinical geriatrics 
     and geriatrics research for--
       ``(i) physicians who have completed graduate medical 
     education programs in internal medicine, family medicine, 
     behavioral or mental health, neurology, gynecology, or 
     rehabilitation medicine;
       ``(ii) dentists who have demonstrated a commitment to an 
     academic career and who have completed postdoctoral dental 
     training, including postdoctoral dental education programs or 
     who have relevant advanced training or experience; and
       ``(iii) behavioral or mental health professionals who have 
     completed graduate medical education programs in behavioral 
     or mental health.
       ``(4) Definitions.--For purposes of this subsection:
       ``(A) The term `graduate medical education program' means a 
     program sponsored by a school of medicine, a school of 
     osteopathic medicine, a hospital, or a public or private 
     institution that--
       ``(i) offers postgraduate medical training in the 
     specialties and subspecialties of medicine; and
       ``(ii) has been accredited by the Accreditation Council for 
     Graduate Medical Education or the American Osteopathic 
     Association through its Committee on Postdoctoral Training.
       ``(B) The term `post-doctoral dental education program' 
     means a program sponsored by a school of dentistry, a 
     hospital, or a public or private institution that--
       ``(i) offers post-doctoral training in the specialties of 
     dentistry, advanced education in general dentistry, or a 
     dental general practice residency; and
       ``(ii) has been accredited by the Commission on Dental 
     Accreditation.
       ``(c) Geriatric Faculty Fellowships.--
       ``(1) Establishment of program.--The Secretary shall 
     establish a program to provide Geriatric Academic Career 
     Awards to eligible individuals to promote the career 
     development of such individuals as academic geriatricians.
       ``(2) Eligible individuals.--To be eligible to receive an 
     Award under paragraph (1), an individual shall--
       ``(A) be board certified or board eligible in internal 
     medicine, family practice, or psychiatry;
       ``(B) have completed an approved fellowship program in 
     geriatrics; and
       ``(C) have a junior faculty appointment at an accredited 
     (as determined by the Secretary) school of medicine or 
     osteopathic medicine.
       ``(3) Limitations.--No Award under paragraph (1) may be 
     made to an eligible individual unless the individual--
       ``(A) has submitted to the Secretary an application, at 
     such time, in such manner, and containing such information as 
     the Secretary may require, and the Secretary has approved 
     such application; and
       ``(B) provides, in such form and manner as the Secretary 
     may require, assurances that the individual will meet the 
     service requirement described in subsection (e).
       ``(4) Amount and term.--
       ``(A) Amount.--The amount of an Award under this section 
     shall equal $50,000 for fiscal year 1998, adjusted for 
     subsequent fiscal years to reflect the increase in the 
     Consumer Price Index.
       ``(B) Term.--The term of any Award made under this 
     subsection shall not exceed 5 years.
       ``(5) Service requirement.--An individual who receives an 
     Award under this subsection shall provide training in 
     clinical geriatrics, including the training of 
     interdisciplinary teams of health care professionals. The 
     provision of such training shall constitute at least 75 
     percent of the obligations of such individual under the 
     Award.

     ``SEC. 754. RURAL INTERDISCIPLINARY TRAINING GRANTS.

       ``(a) Grants.--The Secretary may make grants or contracts 
     under this section to help entities fund authorized 
     activities under an application approved under subsection 
     (c).
       ``(b) Use of Amounts.--
       ``(1) In general.--Amounts provided under subsection (a) 
     shall be used by the recipients to fund interdisciplinary 
     training projects designed to--
       ``(A) use new and innovative methods to train health care 
     practitioners to provide services in rural areas;
       ``(B) demonstrate and evaluate innovative interdisciplinary 
     methods and models designed to provide access to cost-
     effective comprehensive health care;
       ``(C) deliver health care services to individuals residing 
     in rural areas;
       ``(D) enhance the amount of relevant research conducted 
     concerning health care issues in rural areas; and
       ``(E) increase the recruitment and retention of health care 
     practitioners from rural areas and make rural practice a more 
     attractive career choice for health care practitioners.
       ``(2) Methods.--A recipient of funds under subsection (a) 
     may use various methods in carrying out the projects 
     described in paragraph (1), including--
       ``(A) the distribution of stipends to students of eligible 
     applicants;
       ``(B) the establishment of a post-doctoral fellowship 
     program;
       ``(C) the training of faculty in the economic and 
     logistical problems confronting rural health care delivery 
     systems; or
       ``(D) the purchase or rental of transportation and 
     telecommunication equipment where the need for such equipment 
     due to unique characteristics of the rural area is 
     demonstrated by the recipient.
       ``(3) Administration.--
       ``(A) In general.--An applicant shall not use more than 10 
     percent of the funds made available to such applicant under 
     subsection (a) for administrative expenses.
       ``(B) Training.--Not more than 10 percent of the 
     individuals receiving training with funds made available to 
     an applicant under subsection (a) shall be trained as doctors 
     of medicine or doctors of osteopathy.

[[Page S9636]]

       ``(C) Limitation.--An institution that receives a grant 
     under this section shall use amounts received under such 
     grant to supplement, not supplant, amounts made available by 
     such institution for activities of the type described in 
     subsection (b)(1) in the fiscal year preceding the year for 
     which the grant is received.
       ``(c) Applications.--Applications submitted for assistance 
     under this section shall--
       ``(1) be jointly submitted by at least two eligible 
     applicants with the express purpose of assisting individuals 
     in academic institutions in establishing long-term 
     collaborative relationships with health care providers in 
     rural areas; and
       ``(2) designate a rural health care agency or agencies for 
     clinical treatment or training, including hospitals, 
     community health centers, migrant health centers, rural 
     health clinics, community behavioral and mental health 
     centers, long-term care facilities, Native Hawaiian health 
     centers, or facilities operated by the Indian Health Service 
     or an Indian tribe or tribal organization or Indian 
     organization under a contract with the Indian Health Service 
     under the Indian Self-Determination Act.
       ``(d) Definitions.--For the purposes of this section, the 
     term `rural' means geographic areas that are located outside 
     of standard metropolitan statistical areas.

     ``SEC. 755. ALLIED HEALTH AND OTHER DISCIPLINES.

       ``(a) In General.--The Secretary may make grants or 
     contracts under this section to help entities fund activities 
     of the type described in subsection (b).
       ``(b) Activities.--Activities of the type described in this 
     subsection include the following:
       ``(1) Assisting entities in meeting the costs associated 
     with expanding or establishing programs that will increase 
     the number of individuals trained in allied health 
     professions. Programs and activities funded under this 
     paragraph may include--
       ``(A) those that expand enrollments in allied health 
     professions with the greatest shortages or whose services are 
     most needed by the elderly;
       ``(B) those that provide rapid transition training programs 
     in allied health fields to individuals who have baccalaureate 
     degrees in health-related sciences;
       ``(C) those that establish community-based allied health 
     training programs that link academic centers to rural 
     clinical settings;
       ``(D) those that provide career advancement training for 
     practicing allied health professionals;
       ``(E) those that expand or establish clinical training 
     sites for allied health professionals in medically 
     underserved or rural communities in order to increase the 
     number of individuals trained;
       ``(F) those that develop curriculum that will emphasize 
     knowledge and practice in the areas of prevention and health 
     promotion, geriatrics, long-term care, home health and 
     hospice care, and ethics;
       ``(G) those that expand or establish interdisciplinary 
     training programs that promote the effectiveness of allied 
     health practitioners in geriatric assessment and the 
     rehabilitation of the elderly;
       ``(H) those that expand or establish demonstration centers 
     to emphasize innovative models to link allied health clinical 
     practice, education, and research;
       ``(I) those that provide financial assistance (in the form 
     of traineeships) to students who are participants in any such 
     program; and
       ``(i) who plan to pursue a career in an allied health field 
     that has a demonstrated personnel shortage; and
       ``(ii) who agree upon completion of the training program to 
     practice in a medically underserved community;

     that shall be utilized to assist in the payment of all or 
     part of the costs associated with tuition, fees and such 
     other stipends as the Secretary may consider necessary; and
       ``(J) those to meet the costs of projects to plan, develop, 
     and operate or maintain graduate programs in behavioral and 
     mental health practice.
       ``(2) Planning and implementing projects in preventive and 
     primary care training for podiatric physicians in approved or 
     provisionally approved residency programs that shall provide 
     financial assistance in the form of traineeships to residents 
     who participate in such projects and who plan to specialize 
     in primary care.
       ``(3) Carrying out demonstration projects in which 
     chiropractors and physicians collaborate to identify and 
     provide effective treatment for spinal and lower-back 
     conditions.

     ``SEC. 756. ADVISORY COMMITTEE ON INTERDISCIPLINARY, 
                   COMMUNITY-BASED LINKAGES.

       ``(a) Establishment.--The Secretary shall establish an 
     advisory committee to be known as the Advisory Committee on 
     Interdisciplinary, Community-Based Linkages (in this section 
     referred to as the `Advisory Committee').
       ``(b) Composition.--
       ``(1) In general.--The Secretary shall determine the 
     appropriate number of individuals to serve on the Advisory 
     Committee. Such individuals shall not be officers or 
     employees of the Federal Government.
       ``(2) Appointment.--Not later than 90 days after the date 
     of enactment of this Act, the Secretary shall appoint the 
     members of the Advisory Committee from among individuals who 
     are health professionals from schools of the types described 
     in sections 751(a)(1)(A), 751(a)(1)(B), 753(b), 754(3)(A), 
     and 755(b). In making such appointments, the Secretary shall 
     ensure a fair balance between the health professions, that at 
     least 75 percent of the members of the Advisory Committee are 
     health professionals, a broad geographic representation of 
     members and a balance between urban and rural members. 
     Members shall be appointed based on their competence, 
     interest, and knowledge of the mission of the profession 
     involved.
       ``(3) Minority representation.--In appointing the members 
     of the Advisory Committee under paragraph (2), the Secretary 
     shall ensure the adequate representation of women and 
     minorities.
       ``(c) Terms.--
       ``(1) In general.--A member of the Advisory Committee shall 
     be appointed for a term of 3 years, except that of the 
     members first appointed--
       ``(A) \1/3\ of the members shall serve for a term of 1 
     year;
       ``(B) \1/3\ of the members shall serve for a term of 2 
     years; and
       ``(C) \1/3\ of the members shall serve for a term of 3 
     years.
       ``(2) Vacancies.--
       ``(A) In general.--A vacancy on the Advisory Committee 
     shall be filled in the manner in which the original 
     appointment was made and shall be subject to any conditions 
     which applied with respect to the original appointment.
       ``(B) Filling unexpired term.--An individual chosen to fill 
     a vacancy shall be appointed for the unexpired term of the 
     member replaced.
       ``(d) Duties.--The Advisory Committee shall--
       ``(1) provide advice and recommendations to the Secretary 
     concerning policy and program development and other matters 
     of significance concerning the activities under this part; 
     and
       ``(2) not later than 3 years after the date of enactment of 
     this section, and annually thereafter, prepare and submit to 
     the Secretary, and the Committee on Labor and Human Resources 
     of the Senate, and the Committee on Commerce of the House of 
     Representatives, a report describing the activities of the 
     Committee, including findings and recommendations made by the 
     Committee concerning the activities under this part.
       ``(e) Meetings and Documents.--
       ``(1) Meetings.--The Advisory Committee shall meet not less 
     than 3 times each year. Such meetings shall be held jointly 
     with other related entities established under this title 
     where appropriate.
       ``(2) Documents.--Not later than 14 days prior to the 
     convening of a meeting under paragraph (1), the Advisory 
     Committee shall prepare and make available an agenda of the 
     matters to be considered by the Advisory Committee at such 
     meeting. At any such meeting, the Advisory Council shall 
     distribute materials with respect to the issues to be 
     addressed at the meeting. Not later than 30 days after the 
     adjourning of such a meeting, the Advisory Committee shall 
     prepare and make available a summary of the meeting and any 
     actions taken by the Committee based upon the meeting.
       ``(f) Compensation and Expenses.--
       ``(1) Compensation.--Each member of the Advisory Committee 
     shall be compensated at a rate equal to the daily equivalent 
     of the annual rate of basic pay prescribed for level IV of 
     the Executive Schedule under section 5315 of title 5, United 
     States Code, for each day (including travel time) during 
     which such member is engaged in the performance of the duties 
     of the Committee.
       ``(2) Expenses.--The members of the Advisory Committee 
     shall be allowed travel expenses, including per diem in lieu 
     of subsistence, at rates authorized for employees of agencies 
     under subchapter I of chapter 57 of title 5, United States 
     Code, while away from their homes or regular places of 
     business in the performance of services for the Committee.
       ``(g) FACA.--The Federal Advisory Committee Act shall apply 
     to the Advisory Committee under this section only to the 
     extent that the provisions of such Act do not conflict with 
     the requirements of this section.

     ``SEC. 757. AUTHORIZATION OF APPROPRIATIONS.

       ``(a) In General.--There are authorized to be appropriated 
     to carry out this part, $55,600,000 for fiscal year 1998, and 
     such sums as may be necessary for each of the fiscal years 
     1999 through 2002.
       ``(b) Allocation.--
       ``(1) In general.--Of the amounts appropriated under 
     subsection (a) for a fiscal year, the Secretary shall make 
     available--
       ``(A) not less than $28,587,000 for awards of grants and 
     contracts under section 751;
       ``(B) not less than $3,765,000 for awards of grants and 
     contracts under section 752, of which not less than 50 
     percent of such amount shall be made available for centers 
     described in subsection (a)(1) of such section; and
       ``(C) not less than $22,631,000 for awards of grants and 
     contracts under sections 753, 754, and 755.
       ``(2) Ratable reduction.--If amounts appropriated under 
     subsection (a) for any fiscal year are less than the amount 
     required to comply with paragraph (1), the Secretary shall 
     ratably reduce the amount to be made available under each of 
     subparagraphs (A) through (C) of such paragraph accordingly.
       ``(3) Increase in amounts.--If amounts appropriated for a 
     fiscal year under subsection (a) exceed the amount authorized 
     under such subsection for such fiscal year, the Secretary may 
     increase the amount to be made available for programs and 
     activities under this part without regard to the amounts 
     specified in each of subparagraphs (A) through (C) of 
     paragraph (2).
       ``(c) Obligation of Certain Amounts.--
       ``(1) Area health education center programs.--Of the 
     amounts made available under subsection (b)(1)(A) for each 
     fiscal year, the Secretary may obligate for awards under 
     section 751(a)(2)--
       ``(A) not less than 23 percent of such amounts in fiscal 
     year 1998;
       ``(B) not less than 30 percent of such amounts in fiscal 
     year 1999;
       ``(C) not less than 35 percent of such amounts in fiscal 
     year 2000;

[[Page S9637]]

       ``(D) not less than 40 percent of such amounts in fiscal 
     year 2001; and
       ``(E) not less than 45 percent of such amounts in fiscal 
     year 2002.
       ``(2) Sense of congress.--It is the sense of the Congress 
     that--
       ``(A) every State have an area health education center 
     program in effect under this section; and
       ``(B) the ratio of Federal funding for the model program 
     under section 751(a)(2) should increase over time and that 
     Federal funding for other awards under this section shall 
     decrease so that the national program will become entirely 
     comprised of programs that are funded at least 50 percent by 
     State and local partners.''.

     SEC. 104. HEALTH PROFESSIONS WORKFORCE INFORMATION AND 
                   ANALYSIS.

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

        ``PART E--HEALTH PROFESSIONS AND PUBLIC HEALTH WORKFORCE

   ``Subpart 1--Health Professions Workforce Information and Analysis

     ``SEC. 761. HEALTH PROFESSIONS WORKFORCE INFORMATION AND 
                   ANALYSIS.

       ``(a) Purpose.--It is the purpose of this section to--
       ``(1) provide for the development of information describing 
     the health professions workforce and the analysis of 
     workforce related issues; and
       ``(2) provide necessary information for decision-making 
     regarding future directions in health professions and nursing 
     programs in response to societal and professional needs.
       ``(b) Grants or Contracts.--The Secretary may award grants 
     or contracts to State or local governments, health 
     professions schools, schools of nursing, academic health 
     centers, community-based health facilities, and other 
     appropriate public or private nonprofit entities to provide 
     for--
       ``(1) targeted information collection and analysis 
     activities related to the purposes described in subsection 
     (a);
       ``(2) research on high priority workforce questions;
       ``(3) the development of a non-Federal analytic and 
     research infrastructure related to the purposes described in 
     subsection (a); and
       ``(4) the conduct of program evaluation and assessment.
       ``(c) Authorization of Appropriations.--
       ``(1) In general.--There are authorized to be appropriated 
     to carry out this section, $750,000 for fiscal year 1998, and 
     such sums as may be necessary for each of the fiscal years 
     1999 through 2002.
       ``(2) Reservation.--Of the amounts appropriated under 
     subsection (a) for a fiscal year, the Secretary shall reserve 
     not less than $600,000 for conducting health professions 
     research and for carrying out data collection and analysis in 
     accordance with section 792.
       ``(3) Availability of additional funds.--Amounts otherwise 
     appropriated for programs or activities under this title may 
     be used for activities under subsection (b) with respect to 
     the programs or activities from which such amounts were made 
     available.''.
       (b) 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 
     ``2002'';
       (2) in subsection (k), by striking ``1995'' and inserting 
     ``2002'';
       (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 762; and
       (6) by inserting such section after section 761.

     SEC. 105. PUBLIC HEALTH WORKFORCE DEVELOPMENT.

       Part E of title VII of the Public Health Service Act (as 
     amended by section 104) is further amended by adding at the 
     end the following:

                  ``Subpart 2--Public Health Workforce

     ``SEC. 765. GENERAL PROVISIONS.

       ``(a) In General.--The Secretary may award grants or 
     contracts to eligible entities to increase the number of 
     individuals in the public health workforce, to enhance the 
     quality of such workforce, and to enhance the ability of the 
     workforce to meet national, State, and local health care 
     needs.
       ``(b) Eligibility.--To be eligible to receive a grant or 
     contract under subsection (a) an entity shall--
       ``(1) be--
       ``(A) a health professions school, including an accredited 
     school or program of public health, health administration, 
     preventive medicine, or dental public health or a school 
     providing health management programs;
       ``(B) an academic health center;
       ``(C) a State or local government; or
       ``(D) any other appropriate public or private nonprofit 
     entity; and
       ``(2) prepare and submit to the Secretary an application at 
     such time, in such manner, and containing such information as 
     the Secretary may require.
       ``(c) Preference.--In awarding grants or contracts under 
     this section the Secretary may grant a preference to 
     entities--
       ``(1) serving individuals who are from disadvantaged 
     backgrounds (including underrepresented racial and ethnic 
     minorities); and
       ``(2) graduating large proportions of individuals who serve 
     in underserved communities.
       ``(d) Activities.--Amounts provided under a grant or 
     contract awarded under this section may be used for--
       ``(1) the costs of planning, developing, or operating 
     demonstration training programs;
       ``(2) faculty development;
       ``(3) trainee support;
       ``(4) technical assistance;
       ``(5) 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 and dental public health, 
     that have available full-time faculty members with training 
     and experience in the fields of preventive medicine and 
     dental public health; and
       ``(B) to provide financial assistance to residency trainees 
     enrolled in such programs;
       ``(6) the retraining of existing public health workers as 
     well as for increasing the supply of new practitioners to 
     address priority public health, preventive medicine, public 
     health dentistry, and health administration needs;
       ``(7) preparing public health professionals for employment 
     at the State and community levels; or
       ``(8) other activities that may produce outcomes that are 
     consistent with the purposes of this section
       ``(e) Traineeships.--
       ``(1) In general.--With respect to amounts used under this 
     section for the training of health professionals, such 
     training programs shall be designed to--
       ``(A) make public health education more accessible to the 
     public and private health workforce;
       ``(B) increase the relevance of public health academic 
     preparation to public health practice in the future;
       ``(C) provide education or training for students from 
     traditional on-campus programs in practice-based sites; or
       ``(D) develop educational methods and distance-based 
     approaches or technology that address adult learning 
     requirements and increase knowledge and skills related to 
     community-based cultural diversity in public health 
     education.
       ``(2) Severe shortage disciplines.--Amounts provided under 
     grants or contracts under this section may be used for the 
     operation of programs designed to award traineeships to 
     students in accredited schools of public health who enter 
     educational programs in fields where there is a severe 
     shortage of public health professionals, including 
     epidemiology, biostatistics, environmental health, 
     toxicology, public health nursing, nutrition, preventive 
     medicine, maternal and child health, and behavioral and 
     mental health professions.

     ``SEC. 766. PUBLIC HEALTH TRAINING CENTERS.

       ``(a) In General.--The Secretary may make grants or 
     contracts for the operation of public health training 
     centers.
       ``(b) Eligible Entities.--
       ``(1) In general.--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.
       ``(2) Preference.--In awarding grants or contracts under 
     this section the Secretary shall give preference to 
     accredited schools of public health.
       ``(c) Certain Requirements.--With respect to a public 
     health training center, an award may not be made under 
     subsection (a) unless the program agrees that it--
       ``(1) will establish or strengthen field placements for 
     students in public or nonprofit private health agencies or 
     organizations;
       ``(2) will involve faculty members and students in 
     collaborative projects to enhance public health services to 
     medically underserved communities;
       ``(3) will specifically designate a geographic area or 
     medically underserved population to be served by the center 
     that shall be in a location removed from the main location of 
     the teaching facility of the school that is participating in 
     the program with such center; and
       ``(4) will assess the health personnel needs of the area to 
     be served by the center and assist in the planning and 
     development of training programs to meet such needs.

     ``SEC. 767. PUBLIC HEALTH TRAINEESHIPS.

       ``(a) In General.--The Secretary may make grants to 
     accredited schools of public health, and to other public or 
     nonprofit private institutions accredited for the provision 
     of graduate or specialized training in public health, for the 
     purpose of assisting such schools and institutions in 
     providing traineeships to individuals described in subsection 
     (b)(3).
       ``(b) Certain Requirements.--
       ``(1) Amount.--The amount of any grant under this section 
     shall be determined by the Secretary.
       ``(2) Use of grant.--Traineeships awarded under grants made 
     under subsection (a) shall provide for tuition and fees and 
     such stipends and allowances (including travel and 
     subsistence expenses and dependency allowances) for the 
     trainees as the Secretary may deem necessary.
       ``(3) Eligible individuals.--The individuals referred to in 
     subsection (a) are individuals who are pursuing a course of 
     study in a health professions field in which there is a 
     severe shortage of health professionals (which fields include 
     the fields of epidemiology, environmental health, 
     biostatistics, toxicology, nutrition, and maternal and child 
     health).

[[Page S9638]]

     ``SEC. 768. PREVENTIVE MEDICINE; DENTAL PUBLIC HEALTH.

       ``(a) In General.--The Secretary may make grants to and 
     enter into contracts with schools of medicine, osteopathic 
     medicine, public health, and dentistry to meet the costs of 
     projects--
       ``(1) to plan and develop new residency training programs 
     and to maintain or improve existing residency training 
     programs in preventive medicine and dental public health; and
       ``(2) to provide financial assistance to residency trainees 
     enrolled in such programs.
       ``(b) Administration.--
       ``(1) Amount.--The amount of any grant under subsection (a) 
     shall be determined by the Secretary.
       ``(2) Eligibility.--To be eligible for a grant under 
     subsection (a), the applicant must demonstrate to the 
     Secretary that it has or will have available full-time 
     faculty members with training and experience in the fields of 
     preventive medicine or dental public health and support from 
     other faculty members trained in public health and other 
     relevant specialties and disciplines.
       ``(3) Other funds.--Schools of medicine, osteopathic 
     medicine, dentistry, and public health may use funds 
     committed by State, local, or county public health officers 
     as matching amounts for Federal grant funds for residency 
     training programs in preventive medicine.

     ``SEC. 769. HEALTH ADMINISTRATION TRAINEESHIPS AND SPECIAL 
                   PROJECTS.

       ``(a) In General.--The Secretary may make grants to State 
     or local governments (that have in effect preventive medical 
     and dental public health residency programs) or public or 
     nonprofit private educational entities (including graduate 
     schools of social work and business schools that have health 
     management programs) that offer a program described in 
     subsection (b)--
       ``(1) to provide traineeships for students enrolled in such 
     a program; and
       ``(2) to assist accredited programs health administration 
     in the development or improvement of programs to prepare 
     students for employment with public or nonprofit private 
     entities.
       ``(b) Relevant Programs.--The program referred to in 
     subsection (a) is an accredited program in health 
     administration, hospital administration, or health policy 
     analysis and planning, which program is accredited by a body 
     or bodies approved for such purpose by the Secretary of 
     Education and which meets such other quality standards as the 
     Secretary of Health and Human Services by regulation may 
     prescribe.
       ``(c) Preference in Making Grants.--In making grants under 
     subsection (a), the Secretary shall give preference to 
     qualified applicants that meet the following conditions:
       ``(1) Not less than 25 percent of the graduates of the 
     applicant are engaged in full-time practice settings in 
     medically underserved communities.
       ``(2) The applicant recruits and admits students from 
     medically underserved communities.
       ``(3) For the purpose of training students, the applicant 
     has established relationships with public and nonprofit 
     providers of health care in the community involved.
       ``(4) In training students, the applicant emphasizes 
     employment with public or nonprofit private entities.
       ``(d) Certain Provisions Regarding Traineeships.--
       ``(1) Use of grant.--Traineeships awarded under grants made 
     under subsection (a) shall provide for tuition and fees and 
     such stipends and allowances (including travel and 
     subsistence expenses and dependency allowances) for the 
     trainees as the Secretary may deem necessary.
       ``(2) Preference for certain students.--Each entity 
     applying for a grant under subsection (a) for traineeships 
     shall assure to the satisfaction of the Secretary that the 
     entity will give priority to awarding the traineeships to 
     students who demonstrate a commitment to employment with 
     public or nonprofit private entities in the fields with 
     respect to which the traineeships are awarded.

     ``SEC. 770. AUTHORIZATION OF APPROPRIATIONS.

       ``(a) In General.--For the purpose of carrying out this 
     subpart, there is authorized to be appropriated $9,100,000 
     for fiscal year 1998, and such sums as may be necessary for 
     each of the fiscal years 1999 through 2002.
       ``(b) Limitation Regarding Certain Program.--In obligating 
     amounts appropriated under subsection (a), the Secretary may 
     not obligate more than 30 percent for carrying out section 
     767.''.

     SEC. 106. 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 
     health professions 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. To the extent practicable, grantees 
     under this section shall establish linkages with health care 
     providers who provide care for underserved communities and 
     populations.

     ``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, 
     dissemination of information, and exploring new policy 
     directions, 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) Eligible Entities.--Unless specifically required 
     otherwise in this title, the Secretary shall accept 
     applications for grants or contracts under this title from 
     health professions schools, academic health centers, State or 
     local governments, or other appropriate public or private 
     nonprofit entities for funding and participation in health 
     professions and nursing training activities. The Secretary 
     may accept applications from for-profit private entities if 
     determined appropriate by the Secretary.
       ``(c) Information Requirements.--
       ``(1) In general.--Recipients of grants and contracts under 
     this title shall meet information requirements as specified 
     by the Secretary.
       ``(2) Data collection.--The Secretary shall establish 
     procedures to ensure that, with respect to any data 
     collection required under this title, such data is collected 
     in a manner that takes into account age, sex, race, and 
     ethnicity.
       ``(3) Use of funds.--The Secretary shall establish 
     procedures to permit the use of amounts appropriated under 
     this title to be used for data collection purposes.
       ``(4) Evaluations.--The Secretary shall establish 
     procedures to ensure the annual evaluation of programs and 
     projects operated by recipients of grants or contracts under 
     this title. Such procedures shall ensure that continued 
     funding for such programs and projects will be conditioned 
     upon a demonstration that satisfactory progress has been made 
     by the program or project in meeting the objectives of the 
     program or project.
       ``(d) Training Programs.--Training programs conducted with 
     amounts received under this title shall meet applicable 
     accreditation and quality standards.
       ``(e) 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.
       ``(f) Peer Review Regarding Certain Programs.--

[[Page S9639]]

       ``(1) In general.--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.
       ``(2) Composition.--Each peer review group under this 
     subsection shall be composed principally of individuals who 
     are not officers or employees of the Federal Government. In 
     providing for the establishment of peer review groups and 
     procedures, the Secretary shall ensure sex, racial, ethnic, 
     and geographic balance among the membership of such groups.
       ``(3) Administration.--This subsection shall be carried out 
     by the Secretary acting through the Administrator of the 
     Health Resources and Services Administration.
       ``(g) 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.
       ``(h) Analytic Activities.--The Secretary shall ensure 
     that--
       ``(1) cross-cutting workforce analytical activities are 
     carried out as part of the workforce information and analysis 
     activities under section 761; and
       ``(2) discipline-specific workforce information and 
     analytical activities are carried out as part of--
       ``(A) the community-based linkage program under part D; and
       ``(B) the health workforce development program under 
     subpart 2 of part E.
       ``(i) Osteopathic Schools.--For purposes of this title, any 
     reference to--
       ``(1) medical schools shall include osteopathic medical 
     schools; and
       ``(2) medical students shall include osteopathic medical 
     students.

     ``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.''.
       (b) Professional Counselors as Mental Health 
     Professionals.--Section 792(a) of the Public Health Service 
     Act (42 U.S.C. 295k(a)) is amended by inserting 
     ``professional counselors,'' after ``clinical 
     psychologists,''.

     SEC. 107. 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 at least 4 of 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. 108. DEFINITIONS.

       (a) Graduate Program in Behavioral and Mental Health 
     Practice.--Section 799B(1)(D) of the Public Health Service 
     Act (42 U.S.C. 295p(1)(D)) (as so redesignated by section 
     106(a)(2)(E)) is amended--
       (1) by inserting ``behavioral health and'' before 
     ``mental''; and
       (2) by inserting ``behavioral health and mental health 
     practice,'' before ``clinical''.
       (b) Professional Counseling as a Behavioral and Mental 
     Health Practice.--Section 799B of the Public Health Service 
     Act (42 U.S.C. 295p) (as so redesignated by section 
     106(a)(2)(E)) is amended--
       (1) in paragraph (1)--
       (A) in subparagraph (C)--
       (i) by inserting ``and `graduate program in professional 
     counseling' '' after ``graduate program in marriage and 
     family therapy' ''; and
       (ii) by inserting before the period the following: ``and a 
     concentration leading to a graduate degree in counseling'';
       (B) in subparagraph (D), by inserting ``professional 
     counseling,'' after ``social work,''; and
       (C) in subparagraph (E), by inserting ``professional 
     counseling,'' after ``social work,''; and
       (2) in paragraph (5)(C), by inserting before the period the 
     following: ``or a degree in counseling or an equivalent 
     degree''.
       (c) 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 ``; or''; and
       (3) by adding at the end the following:
       ``(D) is designated by a State Governor (in consultation 
     with the medical community) as a shortage area or medically 
     underserved community.''.
       (d) 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.''.
       (e) Psychologist.--Section 799B of the Public Health 
     Service Act (42 U.S.C. 295p) (as so redesignated by section 
     105(a)(2)(E)) is amended by adding at the end the following:
       ``(11) The term `psychologist' means an individual who--
       ``(A) holds a doctoral degree in psychology; and
       ``(B) is licensed or certified on the basis of the doctoral 
     degree in psychology, by the State in which the individual 
     practices, at the independent practice level of psychology to 
     furnish diagnostic, assessment, preventive, and therapeutic 
     services directly to individuals.''.

     SEC. 109. TECHNICAL AMENDMENT ON NATIONAL HEALTH SERVICE 
                   CORPS.

       Section 338B(b)(1)(B) of the Public Health Service Act (42 
     U.S.C. 254l-1(b)(1)(B)) is amended by striking ``or other 
     health profession'' and inserting ``behavioral and mental 
     health, or other health profession''.

     SEC. 110. 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 Workforce Development

     SEC. 121. SHORT TITLE.

       This title may be cited as the ``Nursing Education and 
     Practice Improvement Act of 1998''.

     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 subpart II of part B and sections 846 and 855; and 
     inserting the following:

             ``TITLE VIII--NURSING WORKFORCE DEVELOPMENT'';

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

                       ``PART E--STUDENT LOANS'';

       (3) by striking section 837;
       (4) 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, academic health 
     centers, State or local governments, and other public or 
     private nonprofit 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

[[Page S9640]]

     science, bachelor of nursing, or to an equivalent degree, or 
     to a graduate degree in nursing, or to an equivalent degree, 
     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 program 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 program 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 a program.
       ``(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.--
       ``(1) In general.--Recipients of grants and contracts under 
     this title shall meet information requirements as specified 
     by the Secretary.
       ``(2) Evaluations.--The Secretary shall establish 
     procedures to ensure the annual evaluation of programs and 
     projects operated by recipients of grants under this title. 
     Such procedures shall ensure that continued funding for such 
     programs and projects will be conditioned upon a 
     demonstration that satisfactory progress has been made by the 
     program or project in meeting the objectives of the program 
     or project.
       ``(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.--
       ``(1) In general.--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.
       ``(2) Composition.--Each peer review group under this 
     subsection shall be composed principally of individuals who 
     are not officers or employees of the Federal Government. In 
     providing for the establishment of peer review groups and 
     procedures, the Secretary shall, except as otherwise 
     provided, ensure sex, racial, ethnic, and geographic 
     representation among the membership of such groups.
       ``(3) Administration.--This subsection shall be carried out 
     by the Secretary acting through the Administrator of the 
     Health Resources and Services Administration.
       ``(f) Analytic Activities.--The Secretary shall ensure 
     that--
       ``(1) cross-cutting workforce analytical activities are 
     carried out as part of the workforce information and analysis 
     activities under this title; and
       ``(2) discipline-specific workforce information is 
     developed and analytical activities are carried out as part 
     of--
       ``(A) the advanced practice nursing activities under part 
     B;
       ``(B) the workforce diversity activities under part C; and
       ``(C) basic nursing education and practice activities under 
     part D.
       ``(g) State and Regional Priorities.--Activities under 
     grants or contracts under this title shall, to the extent 
     practicable, be consistent with related Federal, State, or 
     regional nursing professions program plans and priorities.
       ``(h) Filing of Applications.--
       ``(1) In general.--Applications for grants or contracts 
     under this title may be submitted by health professions 
     schools, schools of nursing, academic health centers, State 
     or local governments, or other appropriate public or private 
     nonprofit entities as determined appropriate by the Secretary 
     in accordance with this title.
       ``(2) For profit entities.--Notwithstanding paragraph (1), 
     a for-profit entity may be eligible for a grant or contract 
     under this title as determined appropriated by the Secretary.

     ``SEC. 807. 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.

[[Page S9641]]

``PART B--NURSE PRACTITIONERS, NURSE MIDWIVES, NURSE ANESTHETISTS, 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 
     individuals 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, 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, clinical nurse 
     specialists, nurse midwives, nurse anesthetists, nurse 
     educators, nurse administrators, 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, acute care, and other 
     health care settings.
       ``(d) Authorized Nurse Anesthesia Programs.--Nurse 
     anesthesia programs eligible for support under this section 
     are education programs that--
       ``(1) provide registered nurses with full-time anesthetist 
     education; and
       ``(2) are accredited by the Council on Accreditation of 
     Nurse Anesthesia Educational Programs.
       ``(e) Other Authorized Educational Programs.--The Secretary 
     shall prescribe guidelines as appropriate for other advanced 
     practice nurse education programs eligible for support under 
     this section.
       ``(f) 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, Second and Third Invitational Congresses for 
     Minority Nurse Leaders on `Caring for the Emerging Majority,' 
     in 1992, 1993 and 1997, and consult with nursing associations 
     including the American Nurses Association, the National 
     League for Nursing, the American Association of Colleges of 
     Nursing, the National Black Nurses Association, the National 
     Association of Hispanic Nurses, the Association of Asian 
     American and Pacific Islander Nurses, the Native American 
     Indian and Alaskan Nurses Association, and the National 
     Council of State Boards of Nursing.
       ``(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 individuals from disadvantaged backgrounds and 
     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 educational mix and utilization of 
     the basic nursing workforce by strengthening programs that 
     provide basic nurse education, such as through--
       ``(1) establishing or expanding nursing practice 
     arrangements in noninstitutional settings to demonstrate 
     methods to improve access to primary health care in medically 
     underserved communities;
       ``(2) providing care for underserved populations and other 
     high-risk groups such as the elderly, individuals with HIV-
     AIDS, substance abusers, the homeless, and victims of 
     domestic violence;
       ``(3) providing managed care, quality improvement, and 
     other skills needed to practice in existing and emerging 
     organized health care systems;
       ``(4) developing cultural competencies among nurses;
       ``(5) expanding the enrollment in baccalaureate nursing 
     programs;
       ``(6) promoting career mobility for nursing personnel in a 
     variety of training settings and cross training or specialty 
     training among diverse population groups;
       ``(7) providing education in informatics, including 
     distance learning methodologies; or
       ``(8) other priority areas as determined by the 
     Secretary.'';
       (5) by adding at the end the following:

               ``PART F--AUTHORIZATION OF APPROPRIATIONS

     ``SEC. 841. AUTHORIZATION OF APPROPRIATIONS.

       ``There are authorized to be appropriated to carry out 
     sections 811, 821, and 831, $65,000,000 for fiscal year 1998, 
     and such sums as may be necessary in each of the fiscal years 
     1999 through 2002.

  ``PART G--NATIONAL ADVISORY COUNCIL ON NURSE EDUCATION AND PRACTICE

     ``SEC. 845. NATIONAL ADVISORY COUNCIL ON NURSE EDUCATION AND 
                   PRACTICE.

       ``(a) Establishment.--The Secretary shall establish an 
     advisory council to be known as the National Advisory Council 
     on Nurse Education and Practice (in this section referred 
     to as the `Advisory Council').
       ``(b) Composition.--
       ``(1) In general.--The Advisory Council shall be composed 
     of
       ``(A) not less than 21, nor more than 23 individuals, who 
     are not officers or employees of the Federal Government, 
     appointed by the Secretary without regard to the Federal 
     civil service laws, of which--
       ``(i) 2 shall be selected from full-time students enrolled 
     in schools of nursing;
       ``(ii) 2 shall be selected from the general public;
       ``(iii) 2 shall be selected from practicing professional 
     nurses; and
       ``(iv) 9 shall be selected from among the leading 
     authorities in the various fields of nursing, higher, 
     secondary education, and associate degree schools of nursing, 
     and from representatives of advanced practice nursing groups 
     (such as nurse practitioners, nurse midwives, and nurse 
     anesthetists), hospitals, and other institutions and 
     organizations which provide nursing services; and
       ``(B) the Secretary (or the delegate of the Secretary (who 
     shall be an ex officio member and shall serve as the 
     Chairperson)).
       ``(2) Appointment.--Not later than 90 days after the date 
     of enactment of this Act, the Secretary shall appoint the 
     members of the Advisory Council and each such member shall 
     serve a 4 year term. In making such appointments, the 
     Secretary shall ensure a fair balance between the nursing 
     professions, a broad geographic representation of members and 
     a balance between urban and rural members. Members shall be 
     appointed based on their competence, interest, and knowledge 
     of the mission of the profession involved. A majority of the 
     members shall be nurses.
       ``(3) Minority representation.--In appointing the members 
     of the Advisory Council under paragraph (1), the Secretary 
     shall ensure the adequate representation of minorities.
       ``(c) Vacancies.--
       ``(1) In general.--A vacancy on the Advisory Council shall 
     be filled in the manner in which the original appointment was 
     made and shall be subject to any conditions which applied 
     with respect to the original appointment.
       ``(2) Filling unexpired term.--An individual chosen to fill 
     a vacancy shall be appointed for the unexpired term of the 
     member replaced.
       ``(d) Duties.--The Advisory Council shall--
       ``(1) provide advice and recommendations to the Secretary 
     and Congress concerning policy matters arising in the 
     administration of this title, including the range of issues 
     relating to the nurse workforce, education, and practice 
     improvement;
       ``(2) provide advice to the Secretary and Congress in the 
     preparation of general regulations and with respect to policy 
     matters arising in the administration of this title, 
     including the range of issues relating to nurse supply, 
     education and practice improvement; and
       ``(3) not later than 3 years after the date of enactment of 
     this section, and annually thereafter, prepare and submit to 
     the Secretary, the Committee on Labor and Human Resources of 
     the Senate, and the Committee on Commerce of

[[Page S9642]]

     the House of Representatives, a report describing the 
     activities of the Council, including findings and 
     recommendations made by the Council concerning the activities 
     under this title.
       ``(e) Meetings and Documents.--
       ``(1) Meetings.--The Advisory Council shall meet not less 
     than 2 times each year. Such meetings shall be held jointly 
     with other related entities established under this title 
     where appropriate.
       ``(2) Documents.--Not later than 14 days prior to the 
     convening of a meeting under paragraph (1), the Advisory 
     Council shall prepare and make available an agenda of the 
     matters to be considered by the Advisory Council at such 
     meeting. At any such meeting, the Advisory Council shall 
     distribute materials with respect to the issues to be 
     addressed at the meeting. Not later than 30 days after the 
     adjourning of such a meeting, the Advisory Council shall 
     prepare and make available a summary of the meeting and any 
     actions taken by the Council based upon the meeting.
       ``(f) Compensation and Expenses.--
       ``(1) Compensation.--Each member of the Advisory Council 
     shall be compensated at a rate equal to the daily equivalent 
     of the annual rate of basic pay prescribed for level IV of 
     the Executive Schedule under section 5315 of title 5, United 
     States Code, for each day (including travel time) during 
     which such member is engaged in the performance of the duties 
     of the Council. All members of the Council who are officers 
     or employees of the United States shall serve without 
     compensation in addition to that received for their services 
     as officers or employees of the United States.
       ``(2) Expenses.--The members of the Advisory Council shall 
     be allowed travel expenses, including per diem in lieu of 
     subsistence, at rates authorized for employees of agencies 
     under subchapter I of chapter 57 of title 5, United States 
     Code, while away from their homes or regular places of 
     business in the performance of services for the Council.
       ``(g) Funding.--Amounts appropriated under this title may 
     be utilized by the Secretary to support the nurse education 
     and practice activities of the Council.
       ``(h) FACA.--The Federal Advisory Committee Act shall apply 
     to the Advisory Committee under this section only to the 
     extent that the provisions of such Act do not conflict with 
     the requirements of this section.''; 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

              CHAPTER 1--SCHOOL-BASED REVOLVING LOAN FUNDS

     SEC. 131. 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) Noncompliance.--Section 723(a)(3) of the Public Health 
     Service Act (42 U.S.C. 292s(a)(3)) is amended to read as 
     follows:
       ``(3) Noncompliance by student.--Each agreement entered 
     into with a student pursuant to paragraph (1) shall provide 
     that, if the student fails to comply with such agreement, the 
     loan involved will begin to accrue interest at a rate of 18 
     percent per year beginning on the date of such 
     noncompliance.''.
       (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. 132. 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 1998 
     through 2002''.
       (b) Repeal.--Effective October 1, 2002, paragraph (1) of 
     section 724(f) of the Public Health Service Act (42 U.S.C. 
     292t(f)(1)) is repealed.

     SEC. 133. 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.
       (d) Breach of Agreements.--Section 846 of the Public Health 
     Service Act (42 U.S.C. 297n) is amended by adding at the end 
     thereof the following new subsection:
       ``(h) 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. 134. GENERAL PROVISIONS.

       (a) Maximum Student Loan Provisions and Minimum Payments.--

[[Page S9643]]

       (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, at the discretion of the institution, 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.''.

   CHAPTER 2--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.''.
       (d) Program Eligibility.--
       (1) Limitations on loans.--Section 703(a) of the Public 
     Health Service Act (42 U.S.C. 292b(a)) is amended by striking 
     ``or clinical psychology'' and inserting ``or behavioral and 
     mental health practice, including clinical psychology''.
       (2) Definition of eligible institution.--Section 719(1) of 
     the Public Health Service Act (42 U.S.C. 292o(1)) is amended 
     by striking ``or clinical psychology'' and inserting ``or 
     behavioral and mental health practice, including clinical 
     psychology''.

     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.''.

[[Page S9644]]

       (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 ``$350,000,000 for fiscal year 
     1998, $375,000,000 for fiscal year 1999, and $425,000,000 for 
     each of the fiscal years 2000 through 2002'';
       (2) by striking ``obtained prior loans insured under this 
     subpart'' and inserting ``obtained loans insured under this 
     subpart in fiscal year 2002 or in prior fiscal years'';
       (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.''; and
       (4) by striking ``September 30, 1998'' and inserting 
     ``September 30, 2005''.
       (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''.

     SEC. 144. HEAL BANKRUPTCY.

       (a) In General.--Section 707(g) of the Public Health 
     Service Act (42 U.S.C. 292f(g)) is amended in the first 
     sentence by striking ``A debt which is a loan insured'' and 
     inserting ``Notwithstanding any other provision of Federal or 
     State law, a debt that is a loan insured''.
       (b) Application.--The amendment made by subsection (a) 
     shall apply to any loan insured under the authority of 
     subpart I of part A of title VII of the Public Health Service 
     Act (42 U.S.C. 292 et seq.) that is listed or scheduled by 
     the debtor in a case under title XI, United States Code, 
     filed--
       (1) on or after the date of enactment of this Act; or
       (2) prior to such date of enactment in which a discharge 
     has not been granted.

     SEC. 145. HEAL REFINANCING.

       Section 706 of the Public Health Service Act (42 U.S.C. 
     292e) is amended--
       (1) in subsection (d)--
       (A) in the subsection heading, by striking 
     ``Consolidation'' and inserting ``Refinancing or 
     Consolidation''; and
       (B) in the first sentence, by striking ``indebtedness'' and 
     inserting ``indebtedness or the refinancing of a single 
     loan''; and
       (2) in subsection (e)--
       (A) in the subsection heading, by striking ``Debts'' and 
     inserting ``Debts and Refinancing'';
       (B) in the first sentence, by striking ``all of the 
     borrower's debts into a single instrument'' and inserting 
     ``all of the borrower's loans insured under this subpart into 
     a single instrument (or, if the borrower obtained only 1 loan 
     insured under this subpart, refinancing the loan 1 time)''; 
     and
       (C) in the second sentence, by striking ``consolidation'' 
     and inserting ``consolidation or refinancing''.

                  TITLE II--OFFICE OF MINORITY HEALTH

     SEC. 201. REVISION AND EXTENSION OF PROGRAMS OF OFFICE OF 
                   MINORITY HEALTH.

       (a) Duties and Requirements.--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) Enter into interagency agreements with other agencies 
     of the Public Health Service.
       ``(3) Support research, demonstrations and evaluations to 
     test new and innovative models.
       ``(4) Increase knowledge and understanding of health risk 
     factors.
       ``(5) 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.
       ``(6) Ensure that the National Center for Health Statistics 
     collects data on the health status of each minority group.
       ``(7) 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.
       ``(8) 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).
       ``(9) Carry out programs to improve access to health care 
     services for individuals with limited proficiency in speaking 
     the English language. Activities under the preceding sentence 
     shall include developing and evaluating model projects.
       ``(c) Advisory Committee.--
       ``(1) In general.--The Secretary shall establish an 
     advisory committee to be known as the Advisory Committee on 
     Minority Health (in this subsection referred to as the 
     `Committee').
       ``(2) Duties.--The Committee shall provide advice to the 
     Deputy Assistant Secretary carrying out this section, 
     including advice on the development of goals and specific 
     program activities under paragraphs (1) through (9) of 
     subsection (b) for each racial and ethnic minority group.
       ``(3) Chair.--The chairperson of the Committee shall be 
     selected by the Secretary from among the members of the 
     voting members of the Committee. The term of office of the 
     chairperson shall be 2 years.
       ``(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 such 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 
     International and Refugee Health, the Director of the Office 
     of Civil Rights, and the Directors of other appropriate 
     Departmental entities regarding recommendations for carrying 
     out activities under subsection (b)(9).
       ``(2) Equitable allocation regarding activities.--In 
     carrying out subsection (b), the Secretary shall ensure that 
     services provided under such subsection are equitably 
     allocated among all groups served under this section by the 
     Secretary.
       ``(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 
     Secretary acting through 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, to the extent practical, 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.
       ``(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) Reports.--
       ``(1) In general.--Not later than February 1 of fiscal year 
     1999 and of each second year thereafter, the Secretary shall 
     submit to the Committee on Energy and Commerce of the House 
     of Representatives, and to the Committee on Labor and Human 
     Resources of the Senate, a report describing the activities 
     carried out under this section during the preceding 2 fiscal 
     years and evaluating the extent to which such activities have 
     been effective in improving the health of racial and ethnic 
     minority groups. Each such report shall include the biennial 
     reports submitted under sections 201(e)(3) and 201(f)(2) for 
     such years by the heads of the Public Health Service 
     agencies.
       ``(2) Agency reports.--Not later than February 1, 1999, and 
     biennially thereafter, 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.

[[Page S9645]]

       ``(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.--
       ``(1) Authorization of appropriations.--For the purpose of 
     carrying out this section, there are authorized to be 
     appropriated $30,000,000 for fiscal year 1998, such sums as 
     may be necessary for each of the fiscal years 1999 through 
     2002.''.
       (b) Authorization for National Center for Health 
     Statistics.--Section 306 of the Public Health Service Act (42 
     U.S.C. 242k) is amended--
       (1) in subsection (m), by adding at the end the following:
       ``(4)(A) Subject to subparagraph (B), the Secretary, acting 
     through the Center, shall collect data on Hispanics and major 
     Hispanic subpopulation groups and American Indians, and for 
     developing special area population studies on major Asian 
     American and Pacific Islander populations.
       ``(B) The provisions of subparagraph (A) shall be effective 
     with respect to a fiscal year only to the extent that funds 
     are appropriated pursuant to paragraph (3) of subsection (n), 
     and only if the amounts appropriated for such fiscal year 
     pursuant to each of paragraphs (1) and (2) of subsection (n) 
     equal or exceed the amounts so appropriated for fiscal year 
     1997.'';
       (2) in subsection (n)(1), by striking ``through 1998'' and 
     inserting ``through 2003''; and
       (3) in subsection (n)
       (A) in the first sentence of paragraph (2)--
       (i) by striking ``authorized in subsection (m)'' and 
     inserting ``authorized in paragraphs (1) through (3) of 
     subsection (m)''; and
       (ii) by striking ``$5,000,000'' and all that follows 
     through the period and inserting ``such sums as may be 
     necessary for each of the fiscal years 1999 through 2003.''; 
     and
       (B) by adding at the end the following:
       ``(3) For activities authorized in subsection (m)(4), there 
     are authorized to be appropriated $1,000,000 for fiscal year 
     1998, and such sums as may be necessary for each of the 
     fiscal years 1999 through 2002.''.
       (c) Miscellaneous Amendments.--Section 1707 of the Public 
     Health Service Act (42 U.S.C. 300u-6) is amended--
       (1) in the heading for the section by striking 
     ``establishment of''; and
       (2) in subsection (a), by striking ``Office of the 
     Assistant Secretary for Health'' and inserting ``Office of 
     Public Health and Science''.

                    TITLE III--SELECTED INITIATIVES

     SEC. 301. STATE OFFICES OF RURAL HEALTH.

       Section 338J of the Public Health Service Act (42 U.S.C. 
     254r) is amended--
       (1) in subsection (b)(1), in the matter preceding 
     subparagraph (A), by striking ``in cash''; and
       (2) in subsection (j)(1)--
       (A) by striking ``and'' after ``1992,''; and
       (B) by inserting before the period the following: ``, and 
     such sums as may be necessary for each of the fiscal years 
     1998 through 2002''; and
       (3) in subsection (k), by striking ``$10,000,000'' and 
     inserting ``$36,000,000''.

     SEC. 302. 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; and
       (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--
       (1) by striking ``and such sums'' and inserting ``such 
     sums''; and
       (2) by inserting before the period the following: ``, 
     $8,000,000 for fiscal year 1998, and such sums as may be 
     necessary for each of the fiscal years 1999 through 2002''.

     SEC. 303. PROJECT GRANTS FOR IMMUNIZATION SERVICES.

       Section 317(j) of the Public Health Service Act (42 U.S.C. 
     247b(j)) is amended--
       (1) in paragraph (1), by striking ``individuals against 
     vaccine-preventable diseases'' and all that follows through 
     the first period and inserting the following: ``children, 
     adolescents, and adults against vaccine-preventable diseases, 
     there are authorized to be appropriated such sums as may be 
     necessary for each of the fiscal years 1998 through 2002.''; 
     and
       (2) in paragraph (2), by striking ``1990'' and inserting 
     ``1997''.

                   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 ``nonprofit''.
       (c) Miscellaneous Correction.--Section 401(c)(3) of Public 
     Law 103-183 is amended in the matter preceding subparagraph 
     (A) by striking ``(d)(5)'' and inserting ``(e)(5)''.
       (d) Conforming Amendment.--Section 308(b) of the Public 
     Health Service Act (42 U.S.C. 242m(b)) is amended--
       (1) in paragraph (2)(A), by striking ``306(n)'' and 
     inserting ``306(m)''; and
       (2) in paragraph (2)(C), by striking ``306(n)'' and 
     inserting ``306(m)''.
       (e) Effective Date.--This section is deemed to have taken 
     effect immediately after the enactment of Public Law 103-183.

     SEC. 402. MISCELLANEOUS AMENDMENTS REGARDING PHS COMMISSIONED 
                   OFFICERS.

       (a) Anti-Discrimination Laws.--Amend section 212 of the 
     Public Health Service Act (42 U.S.C. 213) by adding the 
     following new subsection at the end thereof:
       ``(f) Active service of commissioned officers of the 
     Service shall be deemed to be active military service in the 
     Armed Forces of the United States for purposes of all laws 
     related to discrimination on the basis of race, color, sex, 
     ethnicity, age, religion, and disability.''
       (b) Training in Leave Without Pay Status.--Section 218 of 
     the Public Health Service Act (42 U.S.C. 218a) is amended by 
     adding at the end the following:
       ``(c) A commissioned officer may be placed in leave without 
     pay status while attending an educational institution or 
     training program whenever the Secretary determines that such 
     status is in the best interest of the Service. For purposes 
     of computation of basic pay, promotion, retirement, 
     compensation for injury or death, and the benefits provided 
     by sections 212 and 224, an officer in such status pursuant 
     to the preceding sentence shall be considered as performing 
     service in the Service and shall have an active service 
     obligation as set forth in subsection (b) of this section.''.
       (c) Utilization of Alcohol and Drug Abuse Records That 
     Apply to the Armed Forces.--Section 543(e) of the Public 
     Health Service Act (42 U.S.C. 290dd-2(e)) is amended by 
     striking ``Armed Forces'' each place that such term appears 
     and inserting ``Uniformed Services''.

     SEC. 403. 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. 404. PROJECT GRANTS FOR SCREENINGS, REFERRALS, AND 
                   EDUCATION REGARDING LEAD POISONING.

       Section 317A(l)(1) of the Public Health Service Act (42 
     U.S.C. 247b-1(l)(1)) is amended by striking ``1998'' and 
     inserting ``2002''.

     SEC. 405. PROJECT GRANTS FOR PREVENTIVE HEALTH SERVICES 
                   REGARDING TUBERCULOSIS.

       Section 317E(g) of the Public Health Service Act (42 U.S.C. 
     247b-6(g)(1)) is amended--
       (1) in paragraph (1)--
       (A) in subparagraph (A), by striking ``1998'' and inserting 
     ``2002''; and
       (B) in subparagraph (B), by striking ``$50,000,000'' and 
     inserting ``25 percent''; and
       (2) in paragraph (2), by striking ``1998'' and inserting 
     ``2002''.

     SEC. 406. CDC LOAN REPAYMENT PROGRAM.

       Section 317F of the Public Health Service Act (42 U.S.C. 
     247b-7) is amended--
       (1) in subsection (a)(1), by striking ``$20,000'' and 
     inserting ``$35,000'';
       (2) in subsection (c), by striking ``1998'' and inserting 
     ``2002''; and

[[Page S9646]]

       (3) by adding at the end the following:
       ``(d) Availability of Appropriations.--Amounts appropriated 
     for a fiscal year for contracts under subsection (a) shall 
     remain available until the expiration of the second fiscal 
     year beginning after the fiscal year for which the amounts 
     were appropriated.''.

     SEC. 407. COMMUNITY PROGRAMS ON DOMESTIC VIOLENCE.

       (a) In General.--Section 318(h)(2) of the Family Violence 
     Prevention and Services Act (42 U.S.C. 10418(h)(2)) is 
     amended by striking ``fiscal year 1997'' and inserting ``for 
     each of the fiscal years 1997 through 2002''.
       (b) Study.--The Secretary of Health and Human Services 
     shall request that the Institute of Medicine conduct a study 
     concerning the training needs of health professionals with 
     respect to the detection and referral of victims of family or 
     acquaintance violence. Not later than 2 years after the date 
     of enactment of this Act, the Institute of Medicine shall 
     prepare and submit to Congress a report concerning the study 
     conducted under this subsection.

     SEC. 408. STATE LOAN REPAYMENT PROGRAM.

       Section 338I(i)(1) of the Public Health Service Act (42 
     U.S.C. 254q-1(i)(1)) is amended by inserting before the 
     period ``, and such sums as may be necessary for each of the 
     fiscal years 1998 through 2002''.

     SEC. 409. AUTHORITY OF THE DIRECTOR OF NIH.

       Section 402(b) of the Public Health Service Act (42 U.S.C. 
     282(b)) is amended--
       (1) in paragraph (11), by striking ``and'' at the end 
     thereof;
       (2) in paragraph (12), by striking the period and inserting 
     a semicolon; and
       (3) by adding after paragraph (12), the following new 
     paragraphs:
       ``(13) may conduct and support research training--
       ``(A) for which fellowship support is not provided under 
     section 487; and
       ``(B) which does not consist of residency training of 
     physicians or other health professionals; and
       ``(14) may appoint physicians, dentists, and other health 
     care professionals, subject to the provisions of title 5, 
     United States Code, relating to appointments and 
     classifications in the competitive service, and may 
     compensate such professionals subject to the provisions of 
     chapter 74 of title 38, United States Code.''.

     SEC. 410. RAISE IN MAXIMUM LEVEL OF LOAN REPAYMENTS.

       (a) Repayment Programs With Respect to AIDS.--Section 487A 
     of the Public Health Service Act (42 U.S.C. 288-1) is 
     amended--
       (1) in subsection (a), by striking ``$20,000'' and 
     inserting ``$35,000''; and
       (2) in subsection (c), by striking ``1996'' and inserting 
     ``2001''.
       (b) Repayment Programs With Respect to Contraception and 
     Infertility.--Section 487B(a) of the Public Health Service 
     Act (42 U.S.C. 288-2(a)) is amended by striking ``$20,000'' 
     and inserting ``$35,000''.
       (c) Repayment Programs With Respect to Research 
     Generally.--Section 487C(a)(1) of the Public Health Service 
     Act (42 U.S.C. 288-3(a)(1)) is amended by striking 
     ``$20,000'' and inserting ``$35,000''.
       (d) Repayment Programs With Respect to Clinical Researchers 
     From Disadvantaged Backgrounds.--Section 487E(a) of the 
     Public Health Service Act (42 U.S.C. 288-5(a)) is amended--
       (1) in paragraph (1), by striking ``$20,000'' and inserting 
     ``$35,000''; and
       (2) in paragraph (3), by striking ``338C'' and inserting 
     ``338B, 338C''.

     SEC. 411. 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--
       (1) by striking ``shall'' and inserting ``may''; and
       (2) by striking ``$5,000,000'' and inserting ``up to 
     $2,500,000''.

     SEC. 412. PEER REVIEW.

       Section 504(d)(2) of the Public Health Service Act (42 
     U.S.C. 290aa-3(d)(2)) is amended by striking ``cooperative 
     agreement, or contract'' each place that such appears and 
     inserting ``or cooperative agreement''.

     SEC. 413. FUNDING FOR TRAUMA CARE.

       Section 1232(a) of the Public Health Service Act (42 U.S.C. 
     300d-32) is amended by striking ``and 1996'' and inserting 
     ``through 2002''.

     SEC. 414. HEALTH INFORMATION AND HEALTH PROMOTION.

       Section 1701(b) of the Public Health Service Act (42 U.S.C. 
     300u(b)) is amended by striking ``through 1996'' and 
     inserting ``through 2002''.

     SEC. 415. EMERGENCY MEDICAL SERVICES FOR CHILDREN.

       Section 1910 of the Public Health Service Act (42 U.S.C. 
     300w-9) is amended--
       (1) in subsection (a)--
       (A) by striking ``two-year period'' and inserting ``3-year 
     period (with an optional 4th year based on performance)''; 
     and
       (B) by striking ``one grant'' and inserting ``3 grants''; 
     and
       (2) in subsection (d), by striking ``1997'' and inserting 
     ``2005''.

     SEC. 416. 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. 417. AIDS DRUG ASSISTANCE PROGRAM.

       Section 2618(b)(3) of the Public Health Service Act (42 
     U.S.C. 300ff-28(b)(3)) is amended--
       (1) in subparagraph (A), by striking ``and the Commonwealth 
     of Puerto Rico'' and inserting ``, the Commonwealth of Puerto 
     Rico, the Virgin Islands, and Guam''; and
       (2) in subparagraph (B), by striking ``the Virgin Islands, 
     Guam''.

     SEC. 418. NATIONAL FOUNDATION FOR BIOMEDICAL RESEARCH.

       Part I of title IV of the Public Health Service Act (42 
     U.S.C. 290b et seq.) is amended--
       (1) by striking the part heading and inserting the 
     following:

     ``PART I--FOUNDATION FOR THE NATIONAL INSTITUTES OF HEALTH'';

     and
       (2) in section 499--
       (A) in subsection (a), by striking ``National Foundation 
     for Biomedical Research'' and inserting ``Foundation for the 
     National Institutes of Health'';
       (B) in subsection (k)(10)--
       (i) by striking ``not''; and
       (ii) by adding at the end the following: ``Any funds 
     transferred under this paragraph shall be subject to all 
     Federal limitations relating to Federally-funded research.''; 
     and
       (C) in subsection (m)(1), by striking ``$200,000'' and all 
     that follows through ``1995'' and inserting ``$500,000 for 
     each fiscal year''.


                           Amendment No. 3484

      (Purpose: To strike the reauthorization of the HEAL program)

  Mr. GORTON. Mr. President, Senator Frist 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 Washington, [Mr. Gorton], for Mr. Frist, 
     proposes an amendment numbered 3484.

  Mr. GORTON. Mr. President, I ask unanimous consent that the reading 
of the amendment be dispensed with.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  The amendment is as follows:

       Beginning on page 299, strike line 20 and all that follows 
     through line 2 on page 300.
       On page 300, line 3, strike ``(d)'' and insert ``(c)''.
       Beginning on page 305, strike line 21 and all that follows 
     through line 14 on page 306, and insert the following:

     ``SEC. 143. INSURANCE PROGRAM.

       ``Section 710(a)(2)(B) of''.

  Mr. GORTON. Mr. President, I ask unanimous consent that the amendment 
be agreed to.
  The amendment (No. 3484) was agreed to.


                           Amendment No. 3485

(Purpose: To initiate a coordinated national effort to prevent, detect, 
  and educate the public concerning Fetal Alcohol Syndrome and Fetal 
 Alcohol Effect and to identify effective interventions for children, 
 adolescents, and adults with Fetal alcohol syndrome and Fetal Alcohol 
                                Effect)

  Mr. GORTON. Mr. President, I ask for the immediate consideration of 
Senator Daschle's amendment, which is also at the desk.
  The PRESIDING OFFICER. The clerk will report.
  The legislative clerk read as follows:

       The Senator from Washington [Mr. Gorton], for Mr. Daschle, 
     proposes an amendment numbered 3485.

  Mr. GORTON. Mr. President, I ask unanimous consent that the reading 
of the amendment be dispensed with.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  (The text of the amendment is printed in today's Record under 
``Amendments Submitted.'')
  Mr. GORTON. Mr. President, I ask unanimous consent that the amendment 
be agreed to.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  The amendment (No. 3485) was agreed to.
  Mr. GORTON. Mr. President, I ask unanimous consent that the committee 
amendment, as amended, be agreed to.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  The committee amendment, as amended, was agreed to.
  Mr. GORTON. Mr. President, I ask unanimous consent that the bill be 
considered read a third time and passed, as amended; that the motion to 
reconsider be laid upon the table; and

[[Page S9647]]

that any statements relating to the bill appear at the appropriate 
place in the Record.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  The bill (S. 1754), as amended, was considered read the third time 
and passed.

                          ____________________