[Congressional Record Volume 144, Number 145 (Tuesday, October 13, 1998)]
[House]
[Pages H10748-H10771]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
HEALTH PROFESSIONS EDUCATION PARTNERSHIPS ACT OF 1998
Mr. BLILEY. Mr. Speaker, I move to suspend the rules and pass the
Senate 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, as
amended.
The Clerk read as follows:
S. 1754
Be it enacted by the Senate and House of Representatives of
the United States of America in Congress assembled,
SECTION 1. SHORT TITLE; TABLE OF CONTENTS.
(a) Short Title.--This Act may be cited as the ``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.
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. Insurance Program.
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.
Sec. 419. Fetal Alcohol Syndrome prevention and services.
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
[[Page H10749]]
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
``(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
[[Page H10750]]
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 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
[[Page H10751]]
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.
``(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,
[[Page H10752]]
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.
``(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.
[[Page H10753]]
``(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 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
[[Page H10754]]
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. QUENTIN N. BURDICK PROGRAM FOR RURAL
INTERDISCIPLINARY TRAINING.
``(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.
``(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
[[Page H10755]]
``(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;
[[Page H10756]]
``(C) not less than 35 percent of such amounts in fiscal
year 2000;
``(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.
[[Page H10757]]
``(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).
``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
[[Page H10758]]
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.--
``(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.
[[Page H10759]]
Subtitle B--Nursing Workforce Development
SEC. 121. SHORT TITLE.
This subtitle may be cited as the ``Nursing Education and
Practice Improvement Act of 1998''.
SEC. 122. PURPOSE.
It is the purpose of this subtitle 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 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.--
[[Page H10760]]
``(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 education 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 appropriate 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.
``PART B--NURSE PRACTITIONERS, NURSE MIDWIVES, NURSE ANESTHETISTS, AND
OTHER ADVANCED EDUCATION NURSES
``SEC. 811. ADVANCED EDUCATION 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
nursing education and practice; and
``(2) traineeships for individuals in advanced nursing
education programs.
``(b) Definition of Advanced Education Nurses.--For
purposes of this section, the term `advanced education
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
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 nurse education 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 education 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--FUNDING
``SEC. 841. FUNDING.
``(a) Authorization of Appropriations.--For the purpose of
carrying out parts B, C, and D (subject to section 845(g)),
there are authorized to be appropriated $65,000,000 for
fiscal year 1998, and such sums as may be necessary for each
of the fiscal years 1999 through 2002.
``(b) Allocations for Fiscal Years 1998 Through 2002.--
``(1) Nurse practitioners; nurse midwives.--
``(A) Fiscal year 1998.--Of the amount appropriated under
subsection (a) for fiscal
[[Page H10761]]
year 1998, the Secretary shall reserve not less than
$17,564,000 for making awards of grants and contracts under
section 822 as such section was in effect for fiscal year
1998.
``(B) Fiscal years 1999 through 2002.--Of the amount
appropriated under subsection (a) for fiscal year 1999 or any
of the fiscal years 2000 through 2002, the Secretary, subject
to subsection (d), shall reserve for the fiscal year
involved, for making awards of grants and contracts under
part B with respect to nurse practitioners and nurse
midwives, not less than the percentage constituted by the
ratio of the amount appropriated under section 822 as such
section was in effect for fiscal year 1998 to the total of
the amounts appropriated under this title for such fiscal
year. For purposes of the preceding sentence, the Secretary,
in determining the amount that has been reserved for the
fiscal year involved, shall include any amounts appropriated
under subsection (a) for the fiscal year that are obligated
by the Secretary to continue in effect grants or contracts
under section 822 as such section was in effect for fiscal
year 1998.
``(2) Nurse anesthetists.--
``(A) Fiscal year 1998.--Of the amount appropriated under
subsection (a) for fiscal year 1998, the Secretary shall
reserve not less than $2,761,000 for making awards of grants
and contracts under section 831 as such section was in effect
for fiscal year 1998.
``(B) Fiscal years 1999 through 2002.--Of the amount
appropriated under subsection (a) for fiscal year 1999 or any
of the fiscal years 2000 through 2002, the Secretary, subject
to subsection (d), shall reserve for the fiscal year
involved, for making awards of grants and contracts under
part B with respect to nurse anesthetists, not less than the
percentage constituted by the ratio of the amount
appropriated under section 831 as such section was in effect
for fiscal year 1998 to the total of the amounts appropriated
under this title for such fiscal year. For purposes of the
preceding sentence, the Secretary, in determining the amount
that has been reserved for the fiscal year involved, shall
include any amounts appropriated under subsection (a) for the
fiscal year that are obligated by the Secretary to continue
in effect grants or contracts under section 831 as such
section was in effect for fiscal year 1998.
``(c) Allocations After Fiscal Year 2002.--
``(1) In general.--For fiscal year 2003 and subsequent
fiscal years, amounts appropriated under subsection (a) for
the fiscal year involved shall be allocated by the Secretary
among parts B, C, and D (and programs within such parts)
according to a methodology that is developed in accordance
with paragraph (2). The Secretary shall enter into a contract
with a public or private entity for the purpose of developing
the methodology. The contract shall require that the
development of the methodology be completed not later than
February 1, 2002.
``(2) Use of certain factors.--The contract under paragraph
(1) shall provide that the methodology under such paragraph
will be developed in accordance with the following:
``(A) The methodology will take into account the need for
and the distribution of health services among medically
underserved populations, as determined according to the
factors that apply under section 330(b)(3).
``(B) The methodology will take into account the need for
and the distribution of health services in health
professional shortage areas, as determined according to the
factors that apply under section 332(b).
``(C) The methodology will take into account the need for
and the distribution of mental health services among
medically underserved populations and in health professional
shortage areas.
``(D) The methodology will be developed in consultation
with individuals in the field of nursing, including
registered nurses, nurse practitioners, nurse midwives, nurse
anesthetists, clinical nurse specialists, nursing educators
and educational institutions, nurse executives, pediatric
nurse associates and practitioners, and women's health,
obstetric, and neonatal nurses.
``(E) The methodology will take into account the following
factors with respect to the States:
``(i) A provider population ratio equivalent to a managed
care formula of 1/1,500 for primary care services.
``(ii) The use of whole rather than fractional counts in
determining the number of health care providers.
``(iii) The counting of only employed health care providers
in determining the number of health care providers.
``(iv) The number of families whose income is less than 200
percent of the official poverty line (as established by the
Director of the Office of Management and Budget and revised
by the Secretary in accordance with section 673(2) of the
Omnibus Budget Reconciliation Act of 1981).
``(v) The rate of infant mortality and the rate of low-
birthweight births.
``(vi) The percentage of the general population constituted
by individuals who are members or racial or ethnic minority
groups, stated both by minority group and in the aggregate.
``(vii) The percentage of the general population
constituted by individuals who are of Hispanic ethnicity.
``(viii) The number of individuals residing in health
professional shortage areas, and the number of individuals
who are members of medically underserved populations.
``(ix) The percentage of the general population constituted
by elderly individuals.
``(x) The extent to which the populations served have a
choice of providers.
``(xi) The impact of care on hospitalizations and emergency
room use.
``(xii) The number of individuals who lack proficiency in
speaking the English language.
``(xiii) Such additional factors as the Secretary
determines to be appropriate.
``(3) Report to congress.--Not later than 30 days after the
completion of the development of the methodology required in
paragraph (1), the Secretary shall submit to the Committee on
Commerce of the House of Representatives, and to the
Committee on Labor and Human Resources of the Senate, a
report describing the methodology and explaining the effects
of the methodology on the allocation among parts B, C, and D
(and programs within such parts) of amounts appropriated
under subsection (a) for the first fiscal year for which the
methodology will be in effect. Such explanation shall include
a comparison of the allocation for such fiscal year with the
allocation made under this section for the preceding fiscal
year.
``(d) Use of Methodology Before Fiscal Year 2003.--With
respect to the fiscal years 1999 through 2002, if the report
required in subsection (c)(3) is submitted in accordance with
such subsection not later than 90 days before the beginning
of such a fiscal year, the Secretary may for such year
implement the methodology described in the report (rather
than implementing the methodology in fiscal year 2003), in
which case subsection (b) ceases to be in effect. The
authority under the preceding sentence is subject to the
condition that the fiscal year for which the methodology is
implemented be the same fiscal year identified in such report
as the fiscal year for which the methodology will first be in
effect.
``(e) Authority for Use of Additional Factors in
Methodology.--
``(1) In general.--The Secretary shall make the
determinations specified in paragraph (2). For any fiscal
year beginning after the first fiscal year for which the
methodology under subsection (c)(1) is in effect, the
Secretary may alter the methodology by including the
information from such determinations as factors in the
methodology.
``(2) Relevant determinations.--The determinations referred
to in paragraph (1) are as follows:
``(A) The need for and the distribution of health services
among populations for which it is difficult to determine the
number of individuals who are in the population, such as
homeless individuals; migratory and seasonal agricultural
workers and their families; individuals infected with the
human immunodeficiency virus, and individuals who abuse
drugs.
``(B) In the case of a population for which the
determinations under subparagraph (A) are made, the extent to
which the population includes individuals who are members of
racial or ethnic minority groups and a specification of the
skills needed to provide health services to such individuals
in the language and the educational and cultural context that
is most appropriate to the individuals.
``(C) Data, obtained from the Director of the Centers for
Disease Control and Prevention, on rates of morbidity and
mortality among various populations (including data on the
rates of maternal and infant mortality and data on the rates
of low-birthweight births of living infants).
``(D) Data from the Health Plan Employer Data and
Information Set, as appropriate.
``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 education 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
[[Page H10762]]
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 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
[[Page H10763]]
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.--
(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) 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
[[Page H10764]]
day after the ending date of the previous audit, in
accordance with standards determined by the Secretary.
``(F) Revocation authority.--The Secretary shall revoke the
designation of a lender, holder, or servicer under
subparagraph (A) if any quarterly audit required under
subparagraph (E) is not received by the Secretary by the date
established by the Secretary or if the audit indicates the
lender, holder, or servicer has failed to meet the standards
for designation as an exceptional performer under
subparagraph (A). A lender, holder, or servicer receiving a
compliance audit not meeting the standard for designation as
an exceptional performer may reapply for designation under
subparagraph (A) at any time.
``(G) Documentation.--Nothing in this section shall
restrict or limit the authority of the Secretary to require
the submission of claims documentation evidencing servicing
performed on loans, except that the Secretary may not require
exceptional performers to submit greater documentation than
that required for lenders, holders, and servicers not
designated under subparagraph (A).
``(H) Cost of audits.--Each eligible lender, holder, or
servicer shall pay for all the costs associated with the
audits required under this section.
``(I) Additional revocation authority.--Notwithstanding any
other provision of this section, a designation under
subparagraph (A) may be revoked at any time by the Secretary
if the Secretary determines that the eligible lender, holder,
or servicer has failed to maintain an overall level of
compliance consistent with the audit submitted by the
eligible lender, holder, or servicer under this paragraph or
if the Secretary asserts that the lender, holder, or servicer
may have engaged in fraud in securing designation under
subparagraph (A) or is failing to service loans in accordance
with program requirements.
``(J) Noncompliance.--A lender, holder, or servicer
designated under subparagraph (A) that fails to service loans
or otherwise comply with applicable program regulations shall
be considered in violation of the Federal False Claims
Act.''.
(b) Definition.--Section 707(e) of the Public Health
Service Act (42 U.S.C. 292f(e)) is amended by adding at the
end the following new paragraph:
``(4) The term `servicer' means any agency acting on behalf
of the insurance beneficiary.''.
(c) Effective Date.--The amendments made by subsections (a)
and (b) shall apply with respect to loans submitted to the
Secretary for payment on or after the first day of the sixth
month that begins after the date of enactment of this Act.
SEC. 143. 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).
[[Page H10765]]
``(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.
``(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
[[Page H10766]]
(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
(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''.
SEC. 419. FETAL ALCOHOL SYNDROME PREVENTION AND SERVICES.
(a) Short Title.--This section may be cited as the ``Fetal
Alcohol Syndrome and Fetal Alcohol Effect Prevention and
Services Act''.
(b) Findings.--Congress finds that--
[[Page H10767]]
(1) Fetal Alcohol Syndrome is the leading preventable cause
of mental retardation, and it is 100 percent preventable;
(2) estimates on the number of children each year vary, but
according to some researchers, up to 12,000 infants are born
in the United States with Fetal Alcohol Syndrome, suffering
irreversible physical and mental damage;
(3) thousands more infants are born each year with Fetal
Alcohol Effect, also known as Alcohol Related Neurobehavioral
Disorder (ARND), a related and equally tragic syndrome;
(4) children of women who use alcohol while pregnant have a
significantly higher infant mortality rate (13.3 per 1000)
than children of those women who do not use alcohol (8.6 per
1000);
(5) Fetal Alcohol Syndrome and Fetal Alcohol Effect are
national problems which can impact any child, family, or
community, but their threat to American Indians and Alaska
Natives is especially alarming;
(6) in some American Indian communities, where alcohol
dependency rates reach 50 percent and above, the chances of a
newborn suffering Fetal Alcohol Syndrome or Fetal Alcohol
Effect are up to 30 times greater than national averages;
(7) in addition to the immeasurable toll on children and
their families, Fetal Alcohol Syndrome and Fetal Alcohol
Effect pose extraordinary financial costs to the Nation,
including the costs of health care, education, foster care,
job training, and general support services for affected
individuals;
(8) the total cost to the economy of Fetal Alcohol Syndrome
was approximately $2,500,000,000 in 1995, and over a
lifetime, health care costs for one Fetal Alcohol Syndrome
child are estimated to be at least $1,400,000;
(9) researchers have determined that the possibility of
giving birth to a baby with Fetal Alcohol Syndrome or Fetal
Alcohol Effect increases in proportion to the amount and
frequency of alcohol consumed by a pregnant woman, and that
stopping alcohol consumption at any point in the pregnancy
reduces the emotional, physical, and mental consequences of
alcohol exposure to the baby; and
(10) though approximately 1 out of every 5 pregnant women
drink alcohol during their pregnancy, we know of no safe dose
of alcohol during pregnancy, or of any safe time to drink
during pregnancy, thus, it is in the best interest of the
Nation for the Federal Government to take an active role in
encouraging all women to abstain from alcohol consumption
during pregnancy.
(c) Purpose.--It is the purpose of this section to
establish, within the Department of Health and Human
Services, a comprehensive program to help prevent Fetal
Alcohol Syndrome and Fetal Alcohol Effect nationwide and to
provide effective intervention programs and services for
children, adolescents and adults already affected by these
conditions. Such program shall--
(1) coordinate, support, and conduct national, State, and
community-based public awareness, prevention, and education
programs on Fetal Alcohol Syndrome and Fetal Alcohol Effect;
(2) coordinate, support, and conduct prevention and
intervention studies as well as epidemiologic research
concerning Fetal Alcohol Syndrome and Fetal Alcohol Effect;
(3) coordinate, support and conduct research and
demonstration projects to develop effective developmental and
behavioral interventions and programs that foster effective
advocacy, educational and vocational training, appropriate
therapies, counseling, medical and mental health, and other
supportive services, as well as models that integrate or
coordinate such services, aimed at the unique challenges
facing individuals with Fetal Alcohol Syndrome or Fetal
Alcohol Effect and their families; and
(4) foster coordination among all Federal, State and local
agencies, and promote partnerships between research
institutions and communities that conduct or support Fetal
Alcohol Syndrome and Fetal Alcohol Effect research, programs,
surveillance, prevention, and interventions and otherwise
meet the general needs of populations already affected or at
risk of being impacted by Fetal Alcohol Syndrome and Fetal
Alcohol Effect.
(d) Establishment of Program.--Title III of the Public
Health Service Act (42 U.S.C. 241 et seq.) is amended by
adding at the end the following:
``PART O--FETAL ALCOHOL SYNDROME PREVENTION AND SERVICES PROGRAM
``SEC. 399G. ESTABLISHMENT OF FETAL ALCOHOL SYNDROME
PREVENTION AND SERVICES PROGRAM.
``(a) Fetal Alcohol Syndrome Prevention, Intervention and
Services Delivery Program.--The Secretary shall establish a
comprehensive Fetal Alcohol Syndrome and Fetal Alcohol Effect
prevention, intervention and services delivery program that
shall include--
``(1) an education and public awareness program to support,
conduct, and evaluate the effectiveness of--
``(A) educational programs targeting medical schools,
social and other supportive services, educators and
counselors and other service providers in all phases of
childhood development, and other relevant service providers,
concerning the prevention, identification, and provision of
services for children, adolescents and adults with Fetal
Alcohol Syndrome and Fetal Alcohol Effect;
``(B) strategies to educate school-age children, including
pregnant and high risk youth, concerning Fetal Alcohol
Syndrome and Fetal Alcohol Effect;
``(C) public and community awareness programs concerning
Fetal Alcohol Syndrome and Fetal Alcohol Effect; and
``(D) strategies to coordinate information and services
across affected community agencies, including agencies
providing social services such as foster care, adoption, and
social work, medical and mental health services, and agencies
involved in education, vocational training and civil and
criminal justice;
``(2) a prevention and diagnosis program to support
clinical studies, demonstrations and other research as
appropriate to--
``(A) develop appropriate medical diagnostic methods for
identifying Fetal Alcohol Syndrome and Fetal Alcohol Effect;
and
``(B) develop effective prevention services and
interventions for pregnant, alcohol-dependent women; and
``(3) an applied research program concerning intervention
and prevention to support and conduct service demonstration
projects, clinical studies and other research models
providing advocacy, educational and vocational training,
counseling, medical and mental health, and other supportive
services, as well as models that integrate and coordinate
such services, that are aimed at the unique challenges facing
individuals with Fetal Alcohol Syndrome or Fetal Alcohol
Effect and their families.
``(b) Grants and Technical Assistance.--The Secretary may
award grants, cooperative agreements and contracts and
provide technical assistance to eligible entities described
in section 399H to carry out subsection (a).
``(c) Dissemination of Criteria.--In carrying out this
section, the Secretary shall develop a procedure for
disseminating the Fetal Alcohol Syndrome and Fetal Alcohol
Effect diagnostic criteria developed pursuant to section 705
of the ADAMHA Reorganization Act (42 U.S.C. 485n note) to
health care providers, educators, social workers, child
welfare workers, and other individuals.
``(d) National Task Force.--
``(1) In general.--The Secretary shall establish a task
force to be known as the National task force on Fetal Alcohol
Syndrome and Fetal Alcohol Effect (referred to in this
subsection as the `task force') to foster coordination among
all governmental agencies, academic bodies and community
groups that conduct or support Fetal Alcohol Syndrome and
Fetal Alcohol Effect research, programs, and surveillance,
and otherwise meet the general needs of populations actually
or potentially impacted by Fetal Alcohol Syndrome and Fetal
Alcohol Effect.
``(2) Membership.--The Task Force established pursuant to
paragraph (1) shall--
``(A) be chaired by an individual to be appointed by the
Secretary and staffed by the Administration; and
``(B) include the Chairperson of the Interagency
Coordinating Committee on Fetal Alcohol Syndrome of the
Department of Health and Human Services, individuals with
Fetal Alcohol Syndrome and Fetal Alcohol Effect, and
representatives from advocacy and research organization such
as the Research Society on Alcoholism, the FAS Family
Resource Institute, the National Organization of Fetal
Alcohol Syndrome, the Arc, the academic community, and
Federal, State and local government agencies and offices.
``(3) Functions.--The Task Force shall--
``(A) advise Federal, State and local programs and research
concerning Fetal Alcohol Syndrome and Fetal Alcohol Effect,
including programs and research concerning education and
public awareness for relevant service providers, school-age
children, women at-risk, and the general public, medical
diagnosis, interventions for women at-risk of giving birth to
children with Fetal Alcohol Syndrome and Fetal Alcohol
Effect, and beneficial services for individuals with Fetal
Alcohol Syndrome and Fetal Alcohol Effect and their families;
``(B) coordinate its efforts with the Interagency
Coordinating Committee on Fetal Alcohol Syndrome of the
Department of Health and Human Services; and
``(C) report on a biennial basis to the Secretary and
relevant committees of Congress on the current and planned
activities of the participating agencies.
``(4) Time for appointment.--The members of the Task Force
shall be appointed by the Secretary not later than 6 months
after the date of enactment of this part.
``SEC. 399H. ELIGIBILITY.
``To be eligible to receive a grant, or enter into a
cooperative agreement or contract under this part, an entity
shall--
``(1) be a State, Indian tribal government, local
government, scientific or academic institution, or nonprofit
organization; and
``(2) prepare and submit to the Secretary an application at
such time, in such manner, and containing such information as
the Secretary may prescribe, including a description of the
activities that the entity intends to carry out using amounts
received under this part.
``SEC. 399I. AUTHORIZATION OF APPROPRIATIONS.
``(a) In General.--There are authorized to be appropriated
to carry out this part, $27,000,000 for each of the fiscal
years 1999 through 2003.
``(b) Task Force.--From amounts appropriate for a fiscal
year under subsection (a), the Secretary may use not to
exceed $2,000,000 of such amounts for the operations
[[Page H10768]]
of the National Task Force under section 399G(d).
``SEC. 399J. SUNSET PROVISION.
``This part shall not apply on the date that is 7 years
after the date on which all members of the national task
force have been appointed under section 399G(d)(1).''.
The SPEAKER pro tempore. Pursuant to the rule, the gentleman from
Virginia (Mr. Bliley) and the gentleman from Ohio (Mr. Brown) each will
control 20 minutes.
The Chair recognizes the gentleman from Virginia (Mr. Bliley).
General Leave
Mr. BLILEY. Mr. Speaker, I ask unanimous consent that all Members may
have 5 legislative days within which to revise and extend their remarks
on this legislation, S. 1754.
The SPEAKER pro tempore. Is there objection to the request of the
gentleman from Virginia?
There was no objection.
Mr. BLILEY. Mr. Speaker, I yield myself 3 minutes.
Mr. Speaker, I rise today to urge support for S. 1754, the Health
Professions Education Partnerships Act of 1998. This bill is the result
of 2 years collaboration between the House and Senate, the
administration and health professions groups nationwide. The result is
the reauthorization bill that I believe will do much to advance health
care education in America.
Mr. Speaker, the act strengthens our programs to train future
doctors, nurses and other care givers by consolidating existing
programs into clusters. Where today we have 44 different Federal health
profession training programs, this act creates 7 general and flexible
categories of authority. Just as important, it places important
emphasis on the training of health practitioners for the rural and
underserved areas which most need them.
Again, Mr. Speaker, I would like to commend all those in the House
and Senate who have worked so hard on this bill. In particular, I would
like to thank my colleague, the gentleman from Michigan (Mr. Dingell),
for his help in resolving concerns with the Senate passed bill.
Mr. Speaker, I urge passage of S. 1754.
Mr. Speaker, I reserve the balance of my time.
Mr. BROWN of Ohio. Mr. Speaker, I yield myself such time as I may
consume.
Mr. Speaker, I rise in support of S. 1754, as amended by the
manager's amendment. This bill is a long overdue reauthorization of the
health professions programs contained in titles VII and VIII of the
Public Health Service Act. These programs touch almost the entire range
of health professions including nurses, physicians and others who make
up our health care work force.
This legislation does much more than simply reauthorize these
programs. It also significantly modifies them.
The basic nature of these changes to the existing structure of titles
VII and VIII is to provide flexibility to meet changing needs in the
health care work force. The Health Resources and Services
Administration part of the Department of Health and Human Services
administers these programs at the federal level and supports this
legislation.
The three basic elements of the health professions programs are to
increase the number of primary care professionals, one; second,
increase the racial and ethnic diversity of the health care work force;
and third, to provide access to health care to underserved in rural
areas. The bill recognizes that these goals are as complex as they are
worthy. The bill also recognizes that resources for health professions,
education and training are scarce.
The list of organizations that support this legislation is so long
that in naming them I risk leaving them out. These include the American
Nurses Association, the American Academy of Family Physicians, the
American Academy of Pediatrics, the American College of Physicians, the
American Association of Colleges of Osteopathic Medicine, the
Association of Minority Health Profession Schools, the Association of
American Medical Colleges, the American Geriatric Society, the
Association of Colleges of Pharmacy, the American Public Health
Association, the American Psychological Association, the American
Mental Health Counselors, the Working Group on Hispanic Health
Education, the National Association of Geriatric Education Centers, the
Area Health Education Centers, the American Dental Association, the
National Association of Social Workers, the American Association of
Colleges of Nursing, the American Organization of Nurse Executives and
the National League of Nursing among others.
I am pleased to note, Mr. Speaker, that the organizations I just
mentioned supported the bill when it passed the Senate and continue to
support it now with the manager's amendment. New additions to the list
of supporters of the bill because of the manager's amendment are the
American Academy of Nurse Practitioners, the American College of Nurse
Midwives, the National Association of Pediatric Nurse Associates and
Practitioners and the Association of Nurse Anesthetists. These are key
participants in this country's primary care nursing workforce.
As many of us know, the bill which passed the Senate did not have the
support of some of these groups. The manager's amendment represents a
consensus among nursing professions and is a remarkable achievement
made possible first of all by all of the title VIII stakeholders.
{time} 1445
They participated in a process that brought us to this day, and I
want to thank each of them for their tireless effort and cooperative
spirit and dedication to resolving these difficult issues.
This achievement also could not have been possible without a true
bipartisan effort among my colleagues. I know that Members from both
sides of the aisle played key roles in the negotiations that I just
described. I want to pay special tribute to the work of my friend and
colleague and the chairman of the Subcommittee on Health and
Environment, the gentleman from Florida (Mr. Bilirakis), as well as the
gentleman from Virginia (Chairman Bliley). Many other Members from the
chairman's side of the aisle helped to develop this bill, and I will
leave it to the chairman to recognize them.
On this side of the aisle, let me begin by saying we would not be
here today without the participation and leadership of my colleague,
the gentleman from New York (Mr. Towns). It is as simple as that. My
colleagues the gentleman from California (Mr. Waxman), the gentlewoman
from Colorado (Ms. DeGette), and, as always, the gentleman from
Michigan (Mr. Dingell), did great work also to get this bill for us
today.
I also want to recognize the fine efforts of staff on both sides of
the aisle, Brenda Pillors, Paul Kim, Libby Mullin, Kevin Brennan and
John Ford. Todd Tuten and Eric Berger did outstanding work on behalf of
the majority, and I thank them as well.
I know our schedule is hectic and many of my colleagues would like to
speak on this bill, so I will reserve the balance of my time.
Mr. BLILEY. Mr. Speaker, I yield three minutes to the gentleman from
Florida (Mr. Bilirakis), the very able chairman of the subcommittee.
Mr. BILIRAKIS. Mr. Speaker, this important legislation will improve
the supply and distribution of health professionals nationwide. It also
focuses, as has been so ably explained already, much needed attention
on the training of caregivers for our Nation's underserved communities.
For three decades the Public Health Service Act has played an
important role in funding the training of America's health
professionals. As chairman of the Subcommittee on Health and
Environment of the Committee on Commerce, I am proud of our bipartisan
efforts in support of these very critical education programs. The
challenge we face today is ensuring that the providers we train are
prepared to meet the diverse needs of America's many different
communities, and that is why this act replaces line items with
clusters, as the gentleman from Virginia (Mr. Bliley) has already
explained, to better match resources with needs.
This has not been an easy outcome to achieve. I would like to take a
moment to thank all of those who have dedicated their time and energy
to help us get here today. In particular I would like to commend the
members of America's nursing community. After bringing concerns they
had, and, God knows they did have concerns, with the
[[Page H10769]]
Senate-passed bill to our attention, the community as a whole worked
together to help us reach consensus.
S. 1754, as amended, represents that consensus, Mr. Speaker, and,
again, I am grateful for their efforts and, of course, those of the
gentleman from Virginia (Chairman Bliley), the gentleman from Michigan
(Mr. Dingell) and the gentleman from Ohio (Mr. Brown), and I also want
to acknowledge, as the gentleman from Ohio (Mr. Brown) was so very kind
to do, the hard work of our committee staffs on both sides of the aisle
working in a bipartisan basis. They were able to draft language that
enjoys the support of the entire public health community.
I urge passage of S. 1754, as amended.
Mr. BROWN of Ohio. Mr. Speaker, I yield two minutes to the gentleman
from Michigan (Mr. Dingell).
(Mr. DINGELL asked and was given permission to revise and extend his
remarks.)
Mr. DINGELL. Mr. Speaker, I thank the distinguished gentleman from
Ohio for yielding me time.
Mr. Speaker, this is a good bill. It has been produced by the
bipartisan efforts of Members on both sides of the aisle.
I want to commend my colleagues, the gentleman from New York (Mr.
Towns), the gentleman from Ohio (Mr. Brown), the gentleman from
California (Mr. Waxman), the gentlewoman from Colorado (Ms. DeGette)
and the gentlewoman from the Virgin Islands (Ms. Christian-Green).
In looking across the aisle, I want to express my admiration for the
fine leadership of the gentleman from Virginia (Chairman Bliley) and
the gentleman from Florida (Chairman Bilirakis), and also the staffs on
both sides of the aisle. In acknowledging my colleagues, I must pay
tribute to the staffs of all of the Members above and of the full
committee and of the minority, and also to Brenda Pillors of the staff
of the gentleman from New York (Mr. Towns). Her work on this matter was
extraordinary, as was the work of John Ford of the staff of the
minority.
Mr. Speaker, this bill reforms what had been previously a good bill,
but not one which was good enough. It ignored a large number of people
in the health care professions, particularly the nurses, whose work
merits the highest respect and the greatest attention. Happily, the
labors of Members on this side of the Capitol have corrected the faults
of the Senate bill, and we have here a bill which all of my colleagues
can support. I do again want to pay tribute to those who have made this
success possible.
Mr. BROWN of Ohio. Mr. Speaker, I yield four minutes to the gentleman
from New York (Mr. Towns), who worked so hard on this bill.
Mr. TOWNS. Mr. Speaker, I thank the gentleman for yielding me time.
Mr. Speaker, let me begin by thanking the chairman of the full
committee, the gentleman from Virginia (Mr. Bliley), for the
outstanding leadership, and, of course, the chairman of the
Subcommittee on Health and Environment, the gentleman from Florida (Mr.
Bilirakis), for his outstanding leadership.
On this side of the aisle let me thank the ranking member, the
gentleman from Michigan (Mr. Dingell), for his hard work in making this
a reality, and, of course, the ranking member of the subcommittee, my
good friend and a person that has worked very hard as well, the
gentleman from Ohio (Mr. Brown), for making it possible for us to be
here at this point and time.
The work of the committee and staff as well, I should recognize that
on both sides of the aisle, was vital in terms of bringing us to this
point in time as well. I would like to thank Mr. Eric Berger, and, of
course, John Ford, and, of course, Brenda Pillors of my staff, for
their work to improve this bill.
I want to express my support for the hold-harmless provision to
protect the nurse practitioners and nurse midwives funding levels until
a primary health care work study is implemented.
Let me commend the nursing community for their efforts to develop a
workable solution. They stayed there and they continued to have
dialogue and to have discussions to make it possible for us to come
together to have something that we all could sort of support and begin
to work with.
The nursing practitioners and nurse midwives who provide primary care
services and practice in underserved areas have a proven track record
in meeting the goals of this legislation.
This funding will continue until a study incorporating key factors as
part of its methodology can be done to provide data that will assist
HHS in making further funding decisions. This is so important, because
we want to make certain that we have the kind of information that we
need in order to move forward.
The House Committee on Commerce and the Senate Labor and Human
Resources Committee will receive reports from the department about the
study, and that will come back to us and then we will have that
information as well. We are hopeful that such a study will help us
identify Federal health professional education priorities, which is
needed and needed desperately.
Additionally I am pleased that S. 1754, as amended, does not
supersede years of state legislative efforts to establish a new Federal
definition for advanced practice nurses. This is something that a lot
of people are concerned with, and, of course, as a result of the hard
work we were able to resolve that issue as well.
The changes by the Committee on Commerce ensures that we will not
interfere with how nursing is treated at the state level or in the
private sector. This will not interfere with that in any way.
Mr. Speaker, I urge my colleagues to support this legislation. It is
not perfect legislation, but, I will tell you, it is legislation that
has taken a giant step in the right direction. This bill will go a long
way towards improving health professional education and making certain
that the programs will meet the kind of needs and be able to meet the
needs of those in underserved areas as well.
Mr. Speaker, I ask that we move forward, and ask my colleagues on
both sides of the aisle to support this legislation, and also to
recognize the hard work that has gone on on both sides of the aisle
among both Democrats and Republicans.
Mr. BROWN of Ohio. Mr. Speaker, I yield three minutes to the
gentlewoman from Oregon (Ms. Furse).
Ms. FURSE. Mr. Speaker, I rise today in support of S. 1754, the
Health Professional Educational Partnership Act, and I really want to
thank the people I worked with on this. This has been a wonderful
coordination and a bipartisan effort. The gentleman from Virginia
(Chairman Bliley) and the gentleman from Florida (Chairman Bilrakis)
have been so helpful to us, and the ranking member, the gentleman from
Michigan (Mr. Dingell) and the gentleman from Ohio (Mr. Brown). So this
has been something that we have had a good feeling about.
The Health Professional Education Partnership Act will reauthorize
for five years the health profession education programs which provide
medical training to thousands of health care providers each year. A
wonderful university in my district, Oregon Health Sciences University,
is very supportive of this.
I also want to thank the nurses and nurse practitioners who brought
this so much to our attention. I am also very pleased that section 407
of this legislation reauthorizes until 2002 the Center for Disease
Control's Coordinated Community Responses to Prevent Intimate Partner
Violence Program. This is a program which, along with Senator Mark
Hatfield of Oregon, I cosponsored and coauthored in the 1994 crime
bill. What it does is it better coordinates a community response to
domestic violence. It provides grants to communities that prepare a
comprehensive strategy to deal with domestic violence, incorporating
the efforts of local nonprofit organizations, businesses, social
service agencies, law enforcement and the courts.
Too often in the past different organizations all working on the same
goal of trying to reduce domestic violence had really little or no
knowledge of what their colleagues were doing. What this bill does is
it pulls together those coordinated programs, and we know that
preventing and effectively addressing domestic violence can only occur
when communities work together.
The Health Professions Education Partnership Act is a very good bill,
and I want to thank my colleagues for their fine work on this
legislation.
[[Page H10770]]
I urge the House to pass S. 1754.
Mr. BROWN of Ohio. Mr. Speaker, I yield two minutes to the
gentlewoman from Texas (Ms. Eddie Bernice Johnson).
Ms. EDDIE BERNICE JOHNSON of Texas. Mr. Speaker, I thank the
gentleman for yielding me time.
Mr. Speaker, I rise to offer support for this bill and speak on its
behalf, and I want to express my appreciation to the leaders of both
committees on both sides of the aisle.
The Nurse Education Act was last reauthorized, of course, in 1992,
and Congress has worked very hard since 1994 to get it reauthorized. So
I am delighted that we have come to this point.
This bill has a very noble goal, to expand access to health care in
rural and underserved areas, while increasing the number of minorities
who are trained as primary health care professionals. I have had dental
school as well as medical school representatives come into my office
expressing dismay that we do not have as many minorities going into the
health care professions as we did in the past, and it is causing,
especially in my home state, a great lack of health care professionals
in the neediest areas, especially in our border areas where we are
heavily populated with Hispanic persons, and we are trying very hard to
attract persons that are bilingual in order to service this population.
I am also pleased that the bill restructures Title 8 of the Health
Professionals Training Act to allow for more efficient, flexible and
comprehensive Federal financial support for nursing workforce
development.
Under the current authorization, there were so many different
categories, and this bill simply consolidates them into three areas of
authority, the advanced practice nursing education and training
programs, programs to increase nursing workforce diversity, and
projects to strengthen the capacity of basic nursing education.
{time} 1500
I, too, express my appreciation for the manager's amendment to this
bill, which contains a hold harmless provision that assures current
funding levels for the current authorizations until such time that HHS
has developed the methodology for a new streamlined financing process.
Mr. Speaker, I support the bill.
Mr. BROWN of Ohio. Mr. Speaker, I yield 2 minutes to the gentleman
from Illinois (Mr. Davis).
(Mr. DAVIS of Illinois asked and was given permission to revise and
extend his remarks.)
Mr. DAVIS of Illinois. Mr. Speaker, I want to thank the gentleman for
yielding time to me.
Mr. Speaker, I rise today to support the reauthorization of this
important program. The ongoing debate on national health care has
focused largely on the problems of access, costs, and quality. These
issues, however, cannot be addressed without dealing with the need to
train qualified health providers and insure that underserved rural and
inner city communities have the professional resources which they so
greatly need.
The reauthorization of this program insures that minorities from
disadvantaged backgrounds would have an opportunity to fulfill their
dreams and desires of becoming health care professionals.
Currently, African Americans make up 12 percent of the population,
but only 2 to 3 percent of the Nation's health professionals workforce.
Likewise, Hispanic Americans make up 9 percent of the population, but
only 5 percent of the physicians and 3 percent of the dentists.
The underrepresentation of minorities in the health care profession
has reduced access to our Nation's needy citizens. This bill seeks to
increase the number of health care professionals in shortage areas, and
increase the number of minorities in health care. It is a good bill. I
urge my colleagues to support it.
Ms. DeGETTE. Mr. Speaker, I rise in strong support of S. 1754, the
Health Professions Reauthorization Act of 1998. I deeply appreciate the
efforts of the gentleman from Florida, Chairman Bilirakis, of the House
Commerce Subcommittee on Health and Environment and the gentleman from
Michigan, Mr. Dingell, the ranking Democratic member of the House
Commerce Committee. They have worked innumerable hours to reach a
consensus on this legislation and to bring it to the floor today.
In particular, I wish to thank my colleagues for their leadership and
support in securing much needed changes in Title VIII, the Nursing
Education Act provisions. One of the most important improvements which
my colleagues and I on the subcommittee fought so aggressively for was
to restore the meaning of an Advance Practice Nursing Degree. Prior to
our changes, the Senate bill, for the first time ever, would have
established a federal definition of Advanced Practice Nurses which
would put clinical nurse specialists, nurse anesthetists, nurse-
midwives, and nurse practitioners into the same category as non-
clinicians.
This would not only have set a bad precedent but also have broad
implications for the future of nurse education funding and advanced
practice nursing at the state level and in the private sector. For
instance, in my own state of Colorado, we fought very hard to preserve
the meaning of an advanced practice nursing degree. It would be
dangerous of us to mislead the public into believing that all nurses
with a degree beyond the baccalaureate level are equivalent and have
clinical training.
I am also pleased by the inclusion of a ``hold harmless'' provision
to protect nurse practitioner and nurse midwife funding levels. S. 1754
as passed in the Senate, consolidated funding for nurse education and
eliminates specific funding line authority for nurse practitioners.
This would have jeopardized the ability of nurse practitioners to
continue providing primary care services in underserved rural areas and
inner cities.
I urge the Health Resources and Services Administration to give
special recognition to nurse practitioners who provide primary care
when it develops the new health care workforce study for nurses.
Mr. Speaker, I am proud to join my colleagues in urging swift passage
of this vital professional education program.
Mr. PALLONE. Mr. Speaker, I rise in support of S. 1754, the Health
Professions Education Act. This legislation provides badly needed
resources to a range of health professional educators and I am very
pleased that the concerns voiced by every Democrat on the Commerce
Committee's Health and Environment Subcommittee were addressed.
The Health Professions Education Partnerships Act has three main
objectives. The first is to assure that health professions are
generating primary care providers. The second is to ensure there is
diversity in the health professions workforce. And the third is to
provide adequate services to medically under-served areas. All of these
are extremely important objectives for very obvious reasons, and I
would urge all of my colleagues to support this bill so it can be sent
to the president as soon as possible for his signature. It is important
to patients and health educators all across this country and my home
state, including the University of Medicine and Dentistry of New
Jersey, which has facilities in my district.
Importantly, as I mentioned earlier, the bill before us today
addresses the concerns that every Democratic member of the Health and
Environment Subcommittee had with the version of this legislation
passed by the other body. That version expanded the definition of
Advance Practice Nurses in a manner that could have jeopardized the
resources available to train nurse practitioners who provide primary
care. It also would have discounted the importance of the extensive
education and training that nurse practitioners receive in preparation
for their careers, a step I believe would have been unfair and ill-
advised.
Democrats on the Health and Environment Subcommittee communicated
their concerns to Chairman Bilirakis about the definition in the Senate
passed version of the bill. Accordingly, the version we are considering
today changed the language of the bill to include an appropriate
definition of Advanced Nurse Practitioners, and I commend the Chairman
for working with us to change the language.
I would also like to commend the Chairman for working with us to
address our concerns about the new manner in which funding will be
distributed to the various health professions programs, an issue we
also raised in our letter. The other body's version of this bill block
granted funding for health professions education programs. The proposed
block granting gave rise to the same concern we had with the definition
of Advance Nurse Practitioners--namely, that the change might lead to a
lack of resources for the training of primary care practitioners.
To the Chairman's credit, the bill before us today includes a
transition rule, which allows for a change from line items to a data
driven methodology for health resources that matches the needs of the
workforce. Importantly, the bill includes a ``hold harmless'' provision
for Advance Nurse Practitioners. This ``hold harmless'' will ensure
adequate resources will be available for training primary
[[Page H10771]]
care nurses in the years to come, and I appreciate the Chairman's
willingness to work with us to get this in the bill.
Again, this is a very important piece of legislation, Mr. Speaker. It
is widely supported by Members of Congress in both chambers, and by the
health professions groups who fall under its jurisdiction. I urge all
of my colleagues to support its passage.
Mr. BROWN of Ohio. Mr. Speaker, I ask for support of the bill, I have
no further requests for time, and I yield back the balance of my time.
Mr. BLILEY. Mr. Speaker, I ask support for the bill, I have no
further requests for time, and I yield back the balance of my time.
The SPEAKER pro tempore (Mr. Barrett of Nebraska). The question is on
the motion offered by the gentleman from Virginia (Mr. Bliley) that the
House suspend the rules and pass the Senate bill, S. 1754, as amended.
The question was taken.
Mr. BROWN of Ohio. Mr. Speaker, I object to the vote on the ground
that a quorum is not present and make the point of order that a quorum
is not present.
The SPEAKER pro tempore. Pursuant to clause 5 of rule I and the
Chair's prior announcement, further proceedings on this motion will be
postponed.
The point of no quorum is considered withdrawn.
____________________