[Senate Report 104-93]
[From the U.S. Government Publishing Office]



                                                       Calendar No. 121
104th Congress                                                   Report
                                 SENATE

 1st Session                                                     104-93
_______________________________________________________________________


 
 HEALTH PROFESSIONS EDUCATION CONSOLIDATION AND REAUTHORIZATION ACT OF 
                                  1995

                                _______


     June 6 (legislative day, June 5), 1995.--Ordered to be printed

_______________________________________________________________________


   Mrs. Kassebaum, from the Committee on Labor and Human Resources, 
                        submitted the following

                              R E P O R T

                             together with

                            ADDITIONAL VIEWS

                         [To accompany S. 555]
    The Committee on Labor and Human Resources, to which was 
referred the bill (S. 555) to amend the Public Health Service 
Act to consolidate and reauthorize health professions and 
minority and disadvantaged health education programs, and for 
other purposes, having considered the same, reports favorably 
thereon with amendment 9 and recommends that the bill as 
amended do pass.
                                CONTENTS

                                                                   Page
  I. Summary of bill..................................................1
 II. Background and need for legislation.............................13
III. Legislative history and committee action........................19
 IV. Committee views.................................................20
  V. Cost estimate...................................................28
 VI. Regulatory impact statement.....................................33
VII. Section-by-section analysis.....................................33
VIII.
     Additional views................................................49
 IX. Changes in existing law.........................................49
                         I. Summary of the Bill

    The general focus of this legislation is to reauthorize and 
consolidate 44 different Federal health professions training 
programs currently authorized under titles VII and VIII of the 
Public Health Service Act. It also reauthorizes a variety of 
other public health service programs. As a result of this 
legislation, funding for these health professions efforts would 
be reduced from current appropriated levels by 7.5 percent 
during the reauthorization period.
    These 44 programs are consolidated into 6 general and 
flexible authorities which are designed to train health 
providers most inclined to enter practice in rural and other 
medically underserved areas. The six general authorities 
provide for: The training of primary care providers and 
minority and disadvantaged students, education financial 
assistance, the establishment and operation of area health 
education centers, nursing education, and general health care 
work-force development. To ensure that these programs are 
accountable and effective, each grant applicant would be 
required to have a strong evaluation component.

  A. Family Medicine, General Internal Medicine, General Pediatrics, 
    Preventive Medicine, Physician Assistants, and General Dentistry

    Purposes: (1) Provide for the training of family 
physicians, general internists, general pediatricians, 
preventive medicine physicians, physician assistants, and 
general dentists to improve access to and quality of health 
care in underserved areas and to enhance state and local public 
health infrastructure; (2) Provide administrative flexibility 
and simplification.
    General Description: Under this provision, funding for 
family physician, general pediatrician, general internist, 
preventive medicine physician, physician assistant, and general 
dentistry training would be authorized. These providers are 
generally needed to fill both rural and underserved health 
professional shortage areas and to help improve staffing in 
public health departments. Generally, priority would be given 
to programs which have a history of training health 
professionals who eventually enter practice in rural and urban 
underserved areas. In addition, general dentistry training 
would be funded if the Secretary first determines that such 
personnel are nationally in short supply.
    Current Law Authorities Consolidated:
          (1) Family Medicine Training
          (2) General Internal Medicine and General Pediatrics 
        Training
          (3) Physician Assistant Training
          (4) Preventive Medicine and Dental Public Health
          (5) Geriatric Medicine and Dentistry Faculty 
        Development
          (6) General Dentistry Training
    Summary of Provisions:

                           ELIGIBLE ENTITIES

    Health professions schools, academic health centers, or 
other public or private nonprofit entities could apply.

                               ACTIVITIES

    Grants and contracts would be made as appropriate to 
develop, operate, expand, or improve:
          1. Departments (or academic administrative units) of 
        family medicine.
          2. Residency training programs in family medicine, 
        general internal medicine, general pediatrics, 
        preventive medicine, or general dentistry.
          3. Physician assistant training programs.
          4. Faculty development initiatives in primary care, 
        including geriatrics.
          5. Medical school primary care training initiatives.

                     Departments of Family Medicine

    Departments of family medicine would be funded. Such units 
lead to a greater number of medical students choosing careers 
in primary care.

                      Residency Training Programs

    Family medicine, general internal medicine, and general 
pediatrics residency programs would compete with one other for 
funding. Two outcome standards would be established to 
determine a funding preference. First, those programs with the 
highest percentage of providers who enter primary care practice 
upon the completion of training would receive a priority. In 
addition, programs which successfully produce professionals who 
go on to provide service in underserved areas would receive a 
preference.
    Preventive medicine residencies would not compete for 
funding with family medicine, general internal medicine, or 
general pediatrics. Rather, they would receive an appropriate 
amount of funding, as determined by the Secretary. A preference 
would be given to those programs which train a high percentage 
of individuals who enter practice in state and local public 
health departments.
    In addition, general dentistry residencies would not 
compete for funding with the other residency programs. Rather, 
they would receive an appropriate amount of funding, as 
determined by the Secretary. These programs would only receive 
funding if the Secretary first determines that general dentists 
are nationally in short-supply.

                 Physician Assistant Training Programs

    Physician assistant training programs would receive an 
appropriate amount of funding, as determined by the Secretary, 
from the appropriation for this section. Those programs which 
have a higher output of providers who eventually enter practice 
in underserved areas would receive a preference for funding.

                          Faculty Development

    The Secretary would determine which type of faculty 
development projects to fund based on national and State work 
force goals. Geriatric fellowships and faculty development 
could be funded.

                  Medical School Primary Care Training

    Primary care training activities at medical schools would 
be funded through departments (or administrative units) of 
family medicine, general internal medicine, or general 
pediatrics. Applications from general internal medicine and 
general pediatrics administrative units would be required to 
demonstrate their institution's commitment to primary care 
education by: (1) a mission statement which has a primary care 
medical education objective; (2) faculty role models and 
administrative units in primary care, and (3) required 
undergraduate community-based medical student clerkships in 
family medicine, internal medicine, and pediatrics.

                             authorization

    There would be $76 million authorized for fiscal year 1996 
and such sums as necessary through fiscal year 1999. Combined 
funding for these authorities in fiscal year 1995 is $79.015 
million. Family medicine departments would receive no less than 
12 percent of the overall funding. This is consistent with the 
current set-aside that such departments receive.

      B. Minority and Disadvantaged Health Professionals Training

    Purposes: (1) Provide for the training of minority and 
disadvantaged health professionals to improve health care 
access in underserved areas and to improve representation in 
the health professions; and (2) Provide administrative 
flexibility and simplification.
    General Description: Under this provision, the Secretary 
would have broad discretion to fund projects which improve the 
number and quality of minority and disadvantaged health 
professionals. Many believe that an increased number of 
minority and disadvantaged providers would result in 
improvements of services in underserved areas because such 
individuals tend to practice in those areas more than others. 
Generally, most minority groups are currently under-represented 
in the health professions relative to their representation 
within the entire U.S. population.
    Current Law Authorities Consolidated:
          (1) Centers of Excellence in Minority Health
          (2) Health Careers Opportunity Program
          (3) Minority Faculty Fellowships
          (4) Faculty Loan Repayment
    Summary of Provisions:

                           eligible entities

    Schools of medicine, osteopathic medicine, dentistry, 
pharmacy, podiatric medicine, optometry, veterinary medicine, 
public health, allied health professions schools; schools 
offering graduate programs in mental health practice; State or 
local governments; a consortia of health professions schools; 
or other public or private nonprofit entities could apply.

                               activities

    Grants and contracts would be made, as appropriate, to 
plan, develop, or operate:
          (1) Demonstration programs.
          (2) Minority faculty development and loan repayment 
        programs.
          (3) Programs to develop the pipeline for individuals 
        from disadvantaged backgrounds to enter and remain in 
        health professions schools.
          (4) Programs of excellence in health professions 
        institutions to increase the number of minority 
        individuals trained in health professions disciplines.
          (5) For the provision of technical assistance, work 
        force analysis, and information dissemination.
    Any grant which is funded could incorporate one or all of 
these activities. In addition, a preference would be given to 
projects which involve more than one health profession 
discipline or training institution and, beginning in fiscal 
year 1999, for centers of excellence at certain Historically 
Black Colleges and Universities.
    The Secretary would fund grant applications which have the 
greatest chance of improving minority representation in the 
health professions and which have an above average record of 
retention and graduation of individuals from disadvantaged 
backgrounds.

                             authorization

    There would be $51 million authorized for fiscal year 1996 
and such sums as necessary through fiscal year 1999. Combined 
funding for these authorities in fiscal year 1995 is $50.806 
million. For fiscal years 1996 through 1998, there would be a 
$12 million set-a-side for the centers of excellence at certain 
Historically Black Colleges and Universities. This is 
consistent with the current set-aside that such institutions 
receive.

      C. Area Health Education Centers and Other Education Centers

    Purposes: (1) Provide support for training centers remote 
from health professions schools to improve and maintain the 
distribution of health providers in rural and urban underserved 
areas; (2) Provide support for geriatric training centers and 
public health training centers; (3) Provide administrative 
flexibility and simplification.
    General Description: This authority would enhance the 
community-based training in underserved areas of various health 
professionals. This goal would be achieved through greater 
flexibility in the design of such programs and through the 
leveraging of State and local resources. Area Health Education 
Centers (AHEC's) are generally located in underserved areas. 
Exposure to these settings is generally recognized as a 
determinant in whether a health professional returns to 
practice in such settings. In addition, these centers help 
support practicing providers in such areas through continuing 
medical education programs. Geriatric training centers and 
public health training centers would also receive funding from 
the combined appropriation for this provision.
    Current Law Authorities Consolidated:
          (1) Area Health Education Centers
          (2) Health Education and Training Centers
          (3) Geriatric Education Centers
          (4) Rural Health Interdisciplinary Training
          (5) Public Health Special Projects
    Summary of Provision:

                           eligible entities

    Health professions schools, academic health centers, State 
or local governments, or other appropriate public or private 
nonprofit entities.

                               activities

    I. Area Health Education Centers. Grants and contracts 
would be made as appropriate to plan, develop, operate, expand, 
conduct demonstration projects, and to provide trainee support, 
for projects which:
          1. Improve the distribution, supply, quality, 
        utilization, and efficiency of personnel providing 
        health services in urban and rural underserved 
        populations.
          2. Encourage the regionalization of educational 
        responsibilities of the health professions schools into 
        urban and rural underserved areas.
          3. Prepare individuals effectively to provide health 
        services in underserved areas through: preceptorships, 
        the conduct or affiliation with community-based primary 
        care residency programs, agreements with community-
        based organizations for the delivery of education and 
        training in the health professions, and other programs.
          4. Conduct interdisciplinary training of the various 
        health professions.
          5. Provide continuing medical and health professional 
        education to professionals practicing in the 
        underserved areas served by the grantee.
    A preference would be given to projects which involve one 
or more health professions discipline or training institution, 
train individuals who actually enter practice in underserved 
areas, and have a high output of graduates who enter primary 
care practice.
    II. Geriatric Education Centers. Grants and contracts would 
be made for the establishment of geriatric education centers. 
Such centers would be required to provide training 
opportunities for students, interns and residents, and 
practicing health providers.
    III. Public Health Training Centers. Grants and contracts 
would be made for the operation of public health training 
centers. Funded projects would be based on the goals and 
objectives of Healthy People 2000.

                             authorization

    There would be $43 million authorized for fiscal year 1996 
which would be reduced to $29 million by fiscal year 1999. 
Combined funding for these authorities in fiscal year 1995 is 
$41,541 million. The $14 million in funding reductions over the 
3 year period is equivalent to the current combined 
appropriations for the Health Education and Training Centers, 
Rural Health Interdisciplinary Training Programs, and the 
geriatric training centers. Funding will be phased down to 
allow for the completion of current project funding periods.

              D. Health Professions Work Force Development

    Purpose. Provide support to strengthen capacity for the 
education of individuals in certain health professions which 
the Secretary determines to have a severe shortage of personnel 
and to improve the care of underserved populations and other 
high-risk groups.
    Current Law Authorities Consolidated:
          (1) Health Administration Traineeships and Special 
        Projects
          (2) Geriatric Optometry Training
          (3) Allied Health Advanced Training and Special 
        Projects
          (4) Podiatric Primary Care Residency Training
          (5) Chiropractic Demonstration Projects
          (6) AIDS Dental Services
    Summary of Provisions:

                           eligible entities

    Schools of medicine, osteopathic medicine, public health, 
dentistry, allied health, optometry, podiatric medicine, 
chiropractic medicine, veterinary medicine, pharmacy, or 
graduate programs in mental health practice.

                               activities

    Grants and contracts would be made as appropriate to plan, 
develop, or operate programs to strengthen the capacity for 
health professions education and practice. The Secretary shall 
have broad discretion to fund projects, but shall give priority 
to projects which would improve care for underserved 
populations and other high-risk groups and which would increase 
the number of practitioners in any health professions field for 
which the Secretary determines there is a severe shortage of 
professionals.
    In general, funds under this section could be used to 
provide for faculty development, model demonstration projects, 
trainee support, technical assistance, or work force analysis.

                             authorization

    There would be $16 million authorized for fiscal year 1996 
and such sums as necessary for fiscal years 1997 through 1999. 
Combined funding for these authorities in fiscal year 1995 is 
$13.467 million.

                   E. Nursing Work Force Development

    Purposes: (1) Provide for the training of advanced degree 
nurses and other nurses to improve access to and quality of 
health care in underserved medical and public health areas; and 
(2) Provide administrative flexibility and simplification.
    General Description: This proposal would provide for the 
training of advanced degree nurses, including nurse 
practitioners, nurse midwives, nurse anesthetists, and public 
health nurses. In addition, projects to improve nursing work 
force personnel diversity and to expand the training of nurses 
in certain priority settings would be supported. The Secretary 
would have broad discretion to determine which projects to 
fund. Generally, projects which would ultimately lead to a 
greater number of nursing providers for rural and underserved 
areas, including local and state public health departments, 
would receive a funding preference.
    Current Law Authorities Consolidated:
          (1) Nursing Special Projects
          (2) Advanced Nurse Education
          (3) Nurse Practitioner/Nurse Midwife Education
          (4) Nurse Anesthetist Training
          (5) Nursing Education Opportunities for Individuals 
        from Disadvantaged Backgrounds
    6) Professional Nurse Traineeships
    Summary of Provisions:

                           eligible entities

    Schools of nursing (collegiate, associate degree, diploma), 
nursing centers, State or local governments, and other public 
or nonprofit private entities.

                               activities

    Grants and contracts would be made, as appropriate, to 
plan, develop, or operate:
          1. Advanced practice nurses training programs 
        including programs for nurse practitioners, nurse 
        midwives, nurse anesthetists, and public health nurses.
          2. Programs to increase nursing work force diversity.
          3. Projects to strengthen the capacity for basic 
        nurse education in certain priority areas.
    Amounts provided under any one of these areas could be used 
for faculty development, demonstrations, trainee support, work 
force analysis, technical assistance, and dissemination of 
information.
    In determining which projects to fund under each of these 
areas, the Secretary would give priority to those projects 
which would substantially benefit rural or underserved 
populations, including public health departments. Generally, 
those programs which tend to produce nurses for these areas, 
including primary care nurses, would receive funding priority. 
In addition, the Secretary would have broad discretion to 
distribute the appropriation among these different activity 
areas. Funds would be allocated among these activities to meet 
the priority for underserved areas and to meet relevant 
national and State nursing work force goals.
    The National Advisory Council on Nurse Education and 
Practice would continue to advise the Secretary regarding 
nursing issues. Funding for this council would be provided 
through the appropriations under this section.

                    Advance Practice Nurses Training

    Projects that support the enhancement of advanced practice 
nursing education and practice would be funded. In addition, a 
grantee could use a portion of the funds to provide for 
traineeships. Such traineeships would provide stipends to 
students to help cover the costs of tuition, books, fees, and 
reasonable living expenses. Programs which could receive 
support under this authority are those which train nurse 
practitioners, nurse midwives, nurse anesthetists, public 
health nurses, and other advanced degree nurses.

           Programs to Increase Nursing Work Force Diversity

    Projects to increase nursing education opportunities for 
individuals who are from disadvantaged racial and ethnic 
backgrounds under-represented among registered nurses would be 
funded. Such projects could provide student stipends or 
scholarships, pre-entry preparation, or retention activities.

              Projects to Strengthen Basic Nurse Education

    Funding priority would be given to basic nurse education 
programs designed to: (1) improve nursing services in schools 
and other community settings; (2) provide care for underserved 
populations and other high-risk groups such as elderly, 
individuals with HIV-AIDS, substance abusers, homeless, and 
battered women; (3) provide skills needed under new health care 
systems; (4) develop cultural competencies among nurses; (5) 
and serve other priority areas.
                             authorization

    There would be $62 million authorized for fiscal year 1996, 
which would be reduced to $59 million for fiscal year 1999.

     F. Generally Applicable Provisions for Each Training Authority

    Outcomes Evaluation:
    Each program would be required to set performance outcomes 
and would be held accountable for meeting such outcomes. The 
performance outcome standards would be consistent with State, 
local, and national work force development priorities.
    Non-federal Match:
    The Secretary would have discretion to require 
institutional or State and local government matching grants to 
ensure the continuation of the project once Federal aid ends.
    Transition:
    Current grantees would continue to operate under existing 
authorities through the remainder of their funding cycles. The 
new provisions would apply only to new grants.

      G. Consolidated Financial Assistance and Other Loan Programs

    Purposes: (1) Provide consolidation of current loan 
repayment, scholarship, and scholarship payback programs into a 
flexible National Health Service Corps program requiring 
service payback in underserved areas in return for Federal 
financial assistance; (2) Continue certain loan programs which 
do not require Federal appropriations or that guarantee the 
availability of loan sources in the market for health 
professions students; (3) Consolidate scholarship programs for 
the disadvantaged; and (4) Provide administrative flexibility 
and simplification.
    General Description: This proposal would combine most of 
the current targeted scholarship and loan repayment programs 
into the existing National Health Service Corps Scholarship and 
Loan Repayment program. As such, individuals would only receive 
``free'' financial support in return for service provided in 
underserved areas. This would help to eliminate the shortage of 
over 5,000 positions in primary care underserved areas and in 
underserved public health positions in State and local health 
departments.
    The three scholarship programs for minorities and 
disadvantaged students would also be consolidated into a single 
scholarship program for disadvantaged students.
    The authorities which would not be consolidated are those 
which do not require appropriations but, rather, are revolving 
loan funds which currently exist at schools. In addition, the 
current Health Education Assistance Loan Guarantee program 
would be left in place.
    Current Law Authorities Consolidated:
          (1) Scholarships for Disadvantaged Students
          (2) Exceptional Financial Need Scholarships
          (3) Financial Assistance to Disadvantaged Health 
        Professions Students
          (4) State Loan Repayment Program
          (5) Community Based Scholarship Program
          (6) Nursing Loan Repayment Program
          (7) National Health Service Corps Scholarship Program
          (8) National Health Service Corps Loan Repayment 
        Program
          (9) Public Health Traineeships
    Current Law Authorities Continued Without Consolidation: 
(These are revolving loan funds administered by schools which 
do or would not require appropriations.)
          (10) Nursing Student Loan
          (11) Primary Care Loan Program
          (12) Health Professional Student Loans
          (13) Loans for Disadvantaged Students
    Current Law Authority Requiring a Separate Appropriation:
          (14) Health Education Assistance Loans
    Summary of Provisions:

Part I. Consolidated Scholarships and Loans

            (A) National Health Service Corps Scholarship and Loan 
                    Payback

                           eligible entities

    Health professionals and public health professionals (for 
loan payback only).

                               activities

    The Secretary would have broad authority to offer the 
following scholarship or loan repayment options to persons who 
agree to provide services through the National Health Service 
Corps in underserved areas. This consolidated authority would 
be patterned after the existing National Health Service Corps 
Scholarship and Loan Repayment programs and would:
    1. Provide scholarships to health professional students in 
return for a commitment for such students to practice in the 
National Health Service Corps in underserved areas once their 
education is completed.
    2. Provide loan repayment to:
          a. Health professionals and public health personnel 
        in return for a commitment from such persons to 
        practice in the National Health Service Corps 
        designated underserved sites or, in the case of public 
        health personnel, State and local health departments 
        with public health professional shortages.
          b. Nurses for an amount no greater than 85 percent of 
        their debt for persons who agree to practice in 
        National Health Service Corps designated underserved 
        areas.
    3. Provide funding to State to operate their own loan 
repayment or scholarship programs. States could designate their 
own under-served areas utilizing their own criteria if such 
criteria were approved by the Secretary.
    The Secretary would determine how much to provide for each 
activity to meet the goals of providing service to underserved 
areas and retaining providers in underserved areas. States 
applying for grant funding to run their own programs would 
receive priority.

                             authorization

    There would be $90 million authorized for fiscal year 1996 
and such sums as necessary through fiscal year 1999. This 
amount of funding is consistent with the combined current 
appropriations for these programs.
            (B) Scholarships for Disadvantaged Students

                           eligible entities

    Health professions schools.

                               activities

    The Secretary would award grants to health professions 
schools for the awarding of scholarships to disadvantaged 
students. Eligible entities would receive a preference based on 
the proportion of graduating students going into primary care, 
the proportion of minority students, and the proportion of 
graduates working in medically underserved areas.

                             authorization

    There would be $32 million authorized for fiscal year 1996 
through 1999. This amount of funding is consistent with the 
combined current appropriation for these programs.

Part II. Current Loan Authorities Continued without Appropriations

                               activities

    The current Nursing Student Loan (NSL) program, Primary 
Care Loan (PCL) program, Health Professions Student Loan (HPSL) 
program, and the Loans for Disadvantaged Students (LDS) 
programs would continue. These programs would continue using 
the revolving funds which remain at health professions schools.

                             authorization

    There would be $8 million authorized in each of fiscal 
years 1996 through 1998 for the LDS program. For fiscal year 
1999, the authority for appropriations would be repealed after 
the revolving funds begin to be paid back by current loan 
recipients.
    The NSL, PCL, and HPSL programs, which do not currently 
receive appropriations, would not be authorized to receive 
appropriations.

Part III. Heal Loans

                               activities

    The HEAL loan program would continue in its current form.

                             authorization

    This program would continue to be authorized at such sums 
as necessary to guarantee sufficient funds for the insurance 
pool for loan defaulters. The current premiums provided by 
borrowers are insufficient to meet the needs of this fund. As a 
result of reforms made in this program in fiscal year 1992, HHS 
is improving its loan collection and the insurance fund is 
growing. Over time, this program may not require 
appropriations. The current appropriation is $24.972 million.

                      H. Office of Minority Health

    The authority for the office would be extended through 
fiscal year 1999. Furthermore, the provision assures that the 
office is only coordinating services--not conducting its own 
services and research program. The authorization would be $19 
million for each fiscal year through fiscal year 1999. This 
would be a 11 percent reduction from the current appropriation 
of $20.668 million.

                    I. State Offices of Rural Health

    There would be ``such sums as necessary'' authorized 
through fiscal year 1997. The cumulative appropriations would 
be capped at $20 million. In fiscal year, after these offices 
have been established in every State, the program would be 
repealed. The current appropriation for this program is $3.875 
million.

                            J. Birth Defects

    An enhanced intramural program for birth defects at the 
Centers for Disease Control and Prevention (CDC) would be 
authorized. Through this program, research centers would be 
established, epidemiologic review of data would occur, and a 
national information clearing house would be established. This 
program is consistent with current CDC plans in this area. No 
funds would be authorized specifically for this program, but 
funding would occur under the general CDC program authority.
                       K. Traumatic Brain Injury

    This provision would provide for the National Institutes of 
Health (NIH) to conduct research on traumatic brain injury 
without an authorization for a separate appropriation. It would 
also authorize $5 million a year for a demonstration program to 
be administered through the Health Resources and Services 
Administration, subject to the availability of funding for the 
development of State systems of care for persons with traumatic 
brain injury. Finally, the provision would authorize a 
consensus conference at NIH regarding the treatment of 
individual with this illness.

                L. Health Services for Pacific Islanders

    This would extend the Pacific Islands initiative, with 
technical changes only. The program would be authorized at $3 
million in fiscal year 1996 and in each year through fiscal 
year 1999. Finally, a study would be authorized to determine 
the usefulness of this initiative.

        M. Demonstration Projects Regarding Alzheimer's Disease

    There would be $5 million authorized in each of the fiscal 
years from fiscal year 1996 through fiscal year 1999. There are 
many technical revisions.

                II. Background and Need for Legislation

                                general

    Congress continues to be concerned with developing a 
national health professions work force policy to: (1) improve 
the distribution of and quality of health professionals needed 
to provide health services in underserved areas, (2) enhance 
the production and distribution of public health personnel to 
improve the State and local health infrastructure, and (3) 
provide accountability based on uniformly agreed upon outcome 
measures. This policy could be achieved by: (1) improving the 
national supply of certain health professionals, (2) improving 
the geographic distribution of health professionals in certain 
urban and rural areas, and (3) increasing minority 
representation in the pool of practicing health professionals.
    Under current law, 44 separate Federal programs to support 
the health professions education and training through 
individual and institutional support are authorized under the 
Public Health Service (PHS) Act in titles III, VII, and VIII. 
The programs are administered by the Health Resources and 
Services Administration (HRSA) at the Department of Health and 
Human Services (DHHS).
    Continuing Federal budget constraints necessitate program 
consolidation and administrative simplification. Such 
consolidation would result in a better targeting of limited 
resources to address national health work-force training and 
distribution deficits. In addition, an evaluation of each 
funded project would ensure that Federal resources are used 
wisely.

                              introduction

    Title VII of the PHS Act provides Federal support for 
health professions education in the fields of allopathic and 
osteopathic medicine, dentistry, veterinary medicine, 
optometry, podiatric medicine, chiropractic, pharmacy, public 
health, graduate programs in clinical psychology and health 
administration, physician assistant and allied health. Title 
VIII of the PHS Act provides for a comprehensive set of nursing 
education programs. Titles VII and VIII provide two forms of 
assistance: (1) institutional support to health professions and 
nursing schools in the form of grants and contracts; and (2) 
student assistance in the form of loans, loan guarantees, and 
scholarships for students enrolled in these schools.
    The Health Professions Educational Assistance Act of 1963 
(P.L. 88-129), authorized a 3-year program for medical school 
construction and loan programs for students in schools of 
medicine, dentistry, and osteopathy. This initial enactment of 
Federal support for health professions education was in 
response to a critical shortage of health manpower, and the 
1963 legislation was designed to increase enrollment at various 
health professions schools and assure the financial viability 
of these schools. However, by the mid-1970's when studies began 
to indicate that the supply of health professionals would be 
sufficient to meet the Nation's future needs, the focus of 
support under title VII began to change. Two areas of need were 
emerging: first, rural and inner-city communities experiencing 
shortages of health professionals and second, a relative 
shortage of primary care providers to specialists. Subsequent 
extensions of title VII programs began to focus Federal 
institutional and student assistance on projects designed to 
encourage health care personnel to practice in medically 
underserved shortage areas and increase the number of primary 
care providers. In particular, the 1992 reauthorization 
provided a preference for those programs which trained the 
greatest numbers of individuals who enter practice in 
underserved areas.
    Similarly, the Nurse Training Act of 1964 originally 
authorized support to nursing schools and students to improve 
the supply of well trained nurses through grants to 
institutions to strengthen and improve nurse education, and 
direct student assistance through low interest loans and 
scholarships. As national nursing needs changed, the programs 
of title VIII were modified to focus on the training of 
advanced practice nurses, such as nurse practitioners, nurse 
midwives, ad certified nurse anesthetists.
    Title III of the PHS Act authorizes the National Health 
Service Corps (NHSC) program, which was originally enacted by 
the Emergency Health Personnel Act of 1970 (P.L. 91-623) to 
respond to the geographic maldistribution of health 
professionals. The NHSC program was designed as the Federal 
Government's primary strategy to relieve health professions 
shortages. The NHSC program is currently authorized through the 
year 2000 (last amended in 1990 by P.L. 101-597), and is 
comprised of a field program that places an array of qualified 
health professionals in areas that have shortages of health 
personnel, and scholarship and loan repayment programs (added 
in the PHS Amendments of 1987, P.L. 100-177) that provide 
educational assistance to health professions students in return 
for a period of obligated service in shortage areas. 
Communities that apply for and are designated as health 
professions shortage areas (HPSA's) are eligible for placement 
of federally funded providers through the NHSC. The NHSC 
program has generally placed primary care providers, including 
allopathic and osteopathic physicians, dentists, nurse 
practitioners and other nonphysician providers, in federally 
designated HPSA's. Since program activities began in 1972, the 
NHSC field program has placed over 16,000 health care providers 
in HPSA's as of 1991.

                       Geographic Maldistribution

    Today, there continues to be national shortages of primary 
care providers, public health professionals, and certain allied 
health professionals. There is a continued need to improve the 
supply of these health professionals, and to improve the 
geographic distribution of health professionals in order to 
assure access to health care in medically underserved urban and 
rural communities.
    Some have argued that Federal support for the title VII 
programs over the past 20 years has resulted in overall 
surpluses of health practitioners and improved their 
distribution, and there is no longer a need for this 
legislation. According to the American Medical Association, the 
total number of physicians grew by 140.3 percent between 1965-
93 while the total U.S. population only grew by 32.3 percent. 
Since 1980 there has been a net entry of over 173,000 patient 
care physicians into the work force.
    However, others point to the fact that there continue to be 
areas of the country experiencing shortages of physicians and 
other health professionals. Health professions shortage areas 
provide one measure of how adequately the supply of physicians 
is geographically distributed. During part of this period of 
significant growth in the supply of physicians, from 1980 to 
1986, the number of HPSA's remained relatively constant. 
However, during the past 8 years the number of HPSA's has been 
increasing steadily. As of December 1994, there are 2,736 
communities designated by the Federal Government as HPSA's, in 
which an estimated 5,341 primary care providers are needed. The 
Office of Shortage Designation at HRSA estimates that there are 
over 27 million persons residing in these underserved areas.

                         Specialty Distribution

    Today, most experts agree that there is an imbalance 
between primary care and specialist physicians. In 1931 about 
87 percent of U.S. physicians were practicing primary care; by 
1970 the proportion had dropped to 38 percent, further falling 
to 34 percent in 1993. According to the Association of American 
Medical Colleges, between 1982 and 1993, the proportion of 
graduating medical students planning to become board-certified 
in family medicine, general internal medicine or general 
pediatrics fell from 36.1 percent to 19.3 percent. It is 
important to note that the percentage of graduating medical 
students choosing primary care training in 1993 had increased 
to 19.3 percent from only 14.2 percent in 1992.
    During this period of decreasing numbers of medical school 
graduates entering primary care training, there has been a 
significant expansion of nonprimary care specialties 
residencies. In 1988, there were under 85,000 physicians (both 
allopathic and osteopathic) in residency training; by 1992, 
there were over 101,000 residents, representing a 19 percent 
increase in a 4 year period. Over the same period, the number 
of residents in medical subspecialties grew by over 60 percent 
and other specialties grew by 28 percent.
    The Fourth Report of the Council on Graduate Medical 
Education (COGME) published in January 1994 includes physician 
supply projections of the Bureau of Health Professions (BHPr) 
within HRSA at DHHS. The BHPr, incorporating COGME work force 
goals for the years 2000 and 2020, estimates that there will be 
a shortage of 35,000 generalist physicians by the year 2000, 
assuming that there would be no changes in the current training 
pipeline of physicians and a health care delivery system 
dominated by managed care arrangements. The BHPr also estimates 
a projected surplus of 115,000 specialist physicians and an 
overall surplus of 80,000 patient care physicians by 2000. By 
2020, BHPr projects that the physician surplus and specialty 
imbalance would worsen and there would be a shortage of 80,000 
generalist physicians and a surplus of 200,000 specialists.

                        minority representation

    The committee continues to be concerned about the 
underrepresentation of minorities in the health professions 
compared to their proportion in the general population. The 
concern with increasing the number of underrepresented minority 
health care providers is part of an overall strategy to 
increase the availability and accessibility of health care 
providers to populations who have difficulty obtaining adequate 
health care, i.e. low-income and minority populations.
    African Americans, Hispanics, and Native Americans are 
considered to be underrepresented in most of the health 
professions. Taken together, African Americans, Hispanics and 
Native Americans constitute 22 percent of the U.S. population, 
but are only 7.1 percent of the total physician work force. 
African-Americans constitute about 12.1 percent of the U.S. 
population, and although the number of African American 
physicians has increased, the percentage of black physicians 
has remained at about 4 percent of the total physician work 
force. Similarly, the percentage of African American nurses has 
remained at about 8 percent, physician assistants at less than 
5 percent, and dentists at 1 percent. For Hispanics, who 
represent about 9 percent of the total U.S. population, the 
percentage of Hispanic physicians and nurses has remained at 
less than 5 percent.
    According to the COGME's Fourth Report, physician-to-
population rations for the overall population of 221/100,000 
are much higher than those for African Americans (67/100,000), 
Hispanics (121/100,000), or Native Americans (45/100,000). In 
1992, 2,309 underrepresented minorities entered medical 
schools, the largest number of minority entrants on record, 
representing 12.1% of the total number of entrants. However, 
the number of medical school entrants is significantly below 
the goal established by COGME of 3,350 underrepresented 
minority entrants by the year 2000.
    Most RNs are female white, non-Hispanics. Although there 
have been increases in the total number of nurses, there has 
not been significant change in the number of underrepresented 
minority nurses, and as a proportion of the total RN population 
racial/ethnic minority nurses actually declined. According to 
DHHS, in 1988 the number of RNs from racial/ethnic minority 
backgrounds accounted for only 7.6 percent of all registered 
nurses compared to 8.2 percent in 1984. Although data is 
limited for other health professionals, the public health 
workforce is considered to also have a problem of minority 
underrepresentation, although according to a survey of students 
by the Association of Public Health Schools 20 percent of 
students are minorities. Similarly, in many allied health 
professions the proportion of minorities remain small.
                   Nurses and Nonphysician Providers

    According to the Department of Health and Human Services 
(DHHS) 1992 Sample Survey of Registered Nurses, there are 2.2 
million nurses in the U.S., with 83 percent actively employed. 
Over two-thirds of nurses are employed in hospitals. Nursing 
jobs outside the hospital setting have shown the strongest 
growth rate, and even within the hospitals setting, nurse 
employment in outpatient departments grew by 66 percent between 
1988 and 1992. Nurse employment in public health and community 
settings also increased by 30 percent.
    There is some anecdotal information indicating that new 
nurses are having difficulty finding employment in hospitals 
due to hospital downsizing and decreasing patient lengths of 
stay. However, there are regions of the country that continue 
to have an unmet demand for hospital-based nurses, and many 
underserved rural areas and inner-city facilities continue to 
experience shortages of nurses. In addition, the demand for 
nurses is expected to continue to exceed the available supply 
in community-based care sites such as home health care 
agencies, long-term care facilities, independent clinical 
practice, nursing centers, school systems and birthing centers.
    A major source of primary care providers for medically 
underserved or rural communities are from nonphysician 
providers, who are generally nurse practitioners, certified 
nurse midwives, and physician assistants. Today in the U.S. 
there are over 20,000 nurse practitioners, and over 4,300 
certified nurse-midwives. Unfortunately, for every nurse 
practitioner or nurse that is trained today, there are at least 
4 medically underserved communities requiring their services. 
In addition, in 1978, approximately 74 percent of physician 
assistants (PA's) were working in primary care: by 1994, the 
figure had dropped to 48 percent. The percentage of PAs 
practicing in rural areas with populations of less than 10,000 
was 17.7 percent in 1994. According to the Academy of Physician 
Assistants, the possible reasons for more specialization among 
PA's and fewer PA's locating in rural areas are similar to 
those for physicians and other health professionals. These may 
include higher pay for specialty practice, more interesting and 
intellectually stimulating work in specialty practice, and 
greater professional and economic opportunities outside of 
isolated or small rural communities.
    The experience is similar for nurse anesthetists. Graduates 
of such training programs dropped by 44 percent from 1980 and 
1990. The number of training programs fell from 163 in 1980 to 
80 in 1990. Many rural hospitals rely on nurse anesthetists for 
anesthesia services. Without the service of these nurse 
anesthetists, important surgical procedures may often be 
postponed, thus limiting access to needed care.
    Studies, surveys, and reports by groups such as the 
American Medical Association, American Hospital Association, 
American Society of Allied Health Professions, the Department 
of Health and Human Services and the Institute of Medicine of 
the National Academy of Sciences provide further evidence of 
the diminishing pool of certain allied health personnel. The 
demand is high for allied health practitioners in physical 
therapy, occupational therapy, clinical laboratories, medical 
imaging, dental hygiene and respiratory therapy. It is 
projected that by the year 2000, the demand for physical 
therapists will increase by 57 percent, for occupational 
therapists by 49 percent, for laboratory technologists by 24 
percent, and for medical imaging technologists by 66 percent.

                   General Accounting Office Reports

    In July 1994, the U.S. General Accounting Office (GAO) 
released a report on the health professions education and 
training programs authorized in titles VII and VIII of the PHS. 
The report fulfilled the provisions enacted in the 1992 
amendments reauthorizing the programs which required the GAO to 
evaluate the effectiveness of these strategies and programs of 
titles VII and VIII.
    Generally, the GAO results were inconclusive regarding the 
direct impact of the titles VII and VIII programs. GAO 
concluded that, although the supply of nearly all health 
professions had increased faster than the population, no data 
were available to demonstrate that the increased supply had 
improved access to care in rural and urban underserve areas. 
Further, GAO reported that the programs under titles VII and 
VIII could not be shown to have had a significant effect on the 
changes that had occurred in the supply, distribution, and 
minority representation of health professionals. GAO found that 
it would be difficult to establish cause-and-effect 
relationships for the programs because many of the programs had 
other objectives besides improving supply, distribution, and 
minority recruitment among health professionals. In addition, 
because the programs had no common outcome goals or 
measurements of their effectiveness, the programs were 
difficult to evaluate.
    GAO also concluded that the 75 percent increase in the 
number of primary care physicians between 1975 and 1990 did not 
improve the geographic maldistribution between urban and rural 
areas. The increased numbers of primary care physicians in 
urban and rural areas had not improved their availability in 
HPSA's. However, the GAO did not assess the severity of 
shortages which would have resulted if the titles VII and VIII 
programs had not been in effect.
    One important change created in the 1992 reauthorization, 
which the GAO could not evaluate, was the effect of providing 
preferences for programs which train health professionals in 
underserved areas. Over time, the impact of this provision may 
help to draw providers to underserved areas. Many believe, and 
some limited data support, that individuals trained in 
underserved areas tend to enter practice in such settings once 
their training periods are completed.
    GAO recommended that the Congress rethink the role of the 
title VII and VIII programs and establish common outcome 
measures, goals and reporting requirements. The report also 
suggested that in redefining the objectives of titles VII and 
VIII, the Congress consider expanding the NHSC to have a more 
direct and immediate impact on relieving underserved 
communities.
    In 1990, the GAO also published a report on the NHSC, 
looking specifically at why the number of NHSC physicians had 
been declining and if the PHS Amendments of 1987 (P.L. 100-177) 
to the program which created the loan repayment program had 
offset the decline in NHSC physicians. GAO found that the 
significant reductions in funding for the NHSC since 1980 had 
resulted in the decline in the numbers of physicians available 
for placement in shortage areas through the NHSC. Facilities 
that relied on physicians provided through the NHSC and the 
populations served by these facilities were at risk of losing 
their access to health care services. In addition, GAO found 
that the NHSC loan repayment program enacted in the 1987 
amendments had not significantly reduced the shortage of 
providers needed by the Corps at that time, because limited 
funding had curtailed their effectiveness.

                           Testimony Received

    On March 8, 1995, the Committee on Labor and Human 
Resources held a hearing on the Federal health professions 
programs. Despite the inconclusive results of the GAO 
evaluation, the testimony supported a continuation of Federal 
health professions training and distribution programs because 
some of the initiatives have been successful. According to Dr. 
Philip Lee, Assistant Secretary for Health in the Department of 
Health and Human Resources:
          They have significantly enhanced the quality of 
        primary care curriculum and fostered a growth in the 
        interest of medical students in generalist practice.
          Funding of residency training opportunities in family 
        medicine, general internal medicine, and general 
        pediatrics have increased our national supply of much 
        needed primary care physicians.
          They have opened opportunities for greater numbers of 
        minorities to pursue and succeed in health professions 
        careers and thereby expanded the access of millions of 
        Americans to basic medical care.
          They have spurred an unprecedented growth in student 
        enrollment among the mid-level professions of nurse 
        practitioners, nurse midwives, nurse anesthetists and 
        physician assistants.
    In response to the GAO conclusions, Dr. David Kindig noted 
that the underserved situation would have been much worse if 
the health professions programs had not been funded. Dr. Kindig 
stated that improving access for underserved areas would 
require ``* * * targeted generalist physician education 
programs, as well as improving the infrastructure through 
community/migrant health centers, the National Health Service 
Corps, and Medicare and Medicaid programs.'' Furthermore, he 
testified, ``I do not believe it is possible to precisely 
separate the influence of each of these components, but I am 
quite certain that they have acted in concert to keep the 
number of shortage areas as low as they are.''

             III. Legislative History and Committee Action

    S. 555 was introduced on March 14, 1995, by Senators 
Kassebaum, Kennedy, and Frist. The bill was referred to the 
Committee on Labor and Human Resources.
    The Committee on Labor and Human Resources considered S. 
555 in an executive session held on Wednesday March 29, 1995. 
Senator Kassebaum offered an amendment in the nature of a 
substitute, and the committee approved an amendment by Senator 
Harkin. The bill as amended was adopted by voice vote and 
favorably reported to the full Senate.
    The Harkin amendment changed the authorization level for 
section 104, the health work force development provision, in 
fiscal year 1999 from $5 million to ``such sums as necessary.''

                          IV. Committee Views

title i--health professions education and financial assistance programs

General

    The committee sets two general goals for programs 
authorized under this title:
          A. Federal health professions education programs and 
        distribution programs should assure health through: (1) 
        improvements in the distribution of and quality of 
        health professionals needed to provide health services 
        in underserved areas; and (2) enhancement of the 
        production and distribution of public health personnel 
        to improve the state and local public health 
        infrastructure.
          B. The bureaucracy required to administer the 
        existing programs should be simplified and reduced.
    Furthermore, due to Federal fiscal constraints, the 
committee has only authorized funding for the training of 
health professions which it has determined to be in short-
supply nationally and for which an increased supply would 
benefit not only underserved areas, but all areas of the 
country.
    The only exception to this standard is for general 
dentistry training. Experts, including the Institute of 
Medicine, have not been able to conclude if there is a shortage 
of general dentists. For this reason, before funding general 
dentistry training under section 747 of the Public Health 
Service Act, the Secretary must first determine that there is a 
national, rather than regional, shortage of such professionals.
    Through out title I of this legislation, the committee 
intends that whenever the term ``medical school'' is used, it 
shall mean both allopathic and osteopathic medical schools. 
Furthermore, whenever the term ``medical students'' is used, it 
shall mean both allopathic and osteopathic medical students.

Subtitle A--Health professions, education programs

            Section 101. Minority and disadvantaged training
    The committee recognizes the benefits of training greater 
numbers of individuals from disadvantaged and minority 
backgrounds. Such individuals tend to enter primary care 
practice and practice in underserved areas to a much greater 
degree than others.
    The committee encourages the development of innovative 
initiatives to increase the supply of minority and 
disadvantaged individuals. However, the renewal of existing 
centers of excellence programs or health career opportunities 
programs could occur under this consolidated provision.
    Although historically black colleges and universities may 
apply for funding in addition to the $12 million set-a-side, 
the committee intends that this should be done as part of a 
single application from each entity. This would help provide 
administrative simplification over that afforded by the 
preparation and consideration of multiple grant proposals from 
a single entity.
            Section 102. Training in family medicine, general internal 
                    medicine, general pediatrics, preventive medicine, 
                    physician assistants, and general dentistry
    While the proposed authority would allow grants or 
contracts to be targeted in part toward training in a 
particular discipline (e.g., the various primary care medical 
specialities, preventive medicine, physician assistants, and 
advanced general dentistry), the committee intends that the 
Secretary encourage interested entities and groups to 
collaborate in efforts to meet primary care and related work 
force needs of communities, States, or regions served. When 
possible, applications could be submitted and goals established 
by consortia of health professions schools, health care 
facilities, community organizations, and other entities that 
can work together to address shared needs for ambulatory care 
training sites, curriculum improvement, faculty development, 
data analysis, and quality assurance. Such community-wide 
educational initiatives would accomplish educational goals and 
reduce repetitive administrative tasks for both the government 
and applicant institutions.
    In carrying out these directives, the committee does not 
intend that the department create a funding preference or 
priority for such consortia applicants. In addition, such 
consortia applicants should meet the program requirements as 
specified in the legislation. For instance, general internal 
medicine residency programs in a consortia should only receive 
priority consideration based on the actual output of 
individuals who enter practice in primary care.
    Regarding the priority based on an applicants success in 
actually training providers that practice primary care, the 
committee intends that entities with a record of training 
primary care providers be given the preponderance of priority 
points over applicants whose percentages increase over time. 
Significant weighting is an important way of promoting 
applications from those programs which are truly engaged in the 
primary task of producing generalists.
    The committee also intends that osteopathic internships 
continue to receive consideration for funding under this 
section. In general, individuals in osteopathic internships 
complete residency training and successfully enter practice in 
primary care.
    Finally, regarding the distribution of funding for each of 
the various options delineated in this section, the committee 
urges the Secretary to distribute such funding in a manner 
which meets the overall goals of this legislation as outlined 
above.
            Section 103. Enhanced health education and training
    Area health education centers have successfully trained 
individuals to practice in underserved settings. The committee 
continues to support this model of training. Because of fiscal 
constraints, the committee encourages applicants to obtain 
matching funds. In addition, the Secretary should place greater 
emphasis on providing funds for new entities or for the 
expansion and enhancement of existing entities.
    In the development of area health education center 
programs, there is need for emphasis on training of health 
professionals in managed care, quality improvement, and other 
skills needed under new systems of organizing health care.
    Regarding the distribution of funding between Area Health 
Education Centers, Geriatric Education Centers, and Public 
Health Training Centers, the committee urges the Secretary to 
meet the general goals of this legislation. In addition, the 
Secretary should consider the impact of other title VII and 
VIII programs in meeting the objectives of each of these 
programs.
            Section 104. Health professions work force development
    If the nation is to target Federal health professions 
educational initiatives effectively toward areas of greatest 
national and local need, additional information on those needs 
must be collected and analyzed. To allow responsible 
measurement of program outcomes, additional information also is 
required on the relative effectiveness of various ways of 
meeting health work force needs. In addition to reserving a 
minimum of $2 million in Health Professions Work Force 
Development funds specifically for health professions research 
and data activities, the committee encourages the 
administration and grant recipients to use the authority 
available under all of the title VII and VIII consolidated 
authorities to spend a portion of grant funds for data analysis 
as appropriate to meet recognized health work force objectives.
    The committee also notes that the chiropractic medical 
school demonstration projects program authorized under section 
782 of Public Law 102-408 has been consolidated under the Part 
E--Health Professions Work Force Development provision in this 
bill. In so doing, the committee does not in any way intend to 
diminish the importance of this innovative collaborative effort 
among chiropractors and physicians to enhance health 
professions training, education, and cooperation in the area of 
spinal injury and lower back pain conditions. The committee 
looks with interest on the outcome of this current 
demonstration project.
    In deciding whether to fund such collaborative efforts in 
the future under the requirements of this provision, the 
committee encourages the department to consider how much such 
continued collaboration between chiropractic colleges and 
medical schools could increase the number of women and 
minorities in the chiropractic health care professions; enhance 
the prospects for improved training in the area of lower back 
pain and spinal maladies; and improve the conduct of related 
health professions research and data collection by 
chiropractors and physicians.
    Furthermore, the committee also recognizes that in Alaska a 
limited variety of primary care for residents of remote 
villages is often provided by certified community health 
practitioners. The department is encouraged to consider 
entities which train such practitioners for funding under this 
provision.

Subtitle B--Nursing education

            Section 123. Part A--General provisions
    The committee strongly endorses the need for and 
reauthorization of the Nurse Education Act (NEA). Due to 
important differences between nursing and other health 
professions education, it is important that title VIII programs 
of the Public Health Service Act remain separate from title VII 
programs.
    The need for Federal support of nursing education 
continues. Particular educational support is needed to improve 
primary care delivery, management of care and chronic diseases, 
health promotion and disease prevention, and home and other 
care outside of the hospital.
    The committee urges the Department of Health and Human 
Services to fund creative approaches to nursing education. In 
addition, the committee believes that the central purpose of 
program support is to encourage creativity with start-up 
funding rather than to provide routine funding of long-term 
programs that could become self-sufficient.
    Section 802 is not intended to require linkages for all 
applications, but the Secretary has the discretion to decide 
whether a ``linkage'' is required. Regarding the funding 
preference in section 805, an applicant should receive 
consideration not only if it trains nurses in underserved 
areas, but also if its program leads to individuals providing 
services in underserved areas after their training is 
completed. Other applicants, which do not meet the preference 
criteria, should not be excluded from funding, but should not 
receive a funding preference.
            Section 123. Part B--Nurse practitioners, nurse midwives, 
                    and other advanced degree practice nurses
    The committee recognizes the important role that nurse 
practitioners, nurse midwives, and nurse anesthetists play in 
providing quality care to medically underserved and rural 
communities. The committee continues to support nurses pursuing 
advanced education, especially in the primary care, public 
health, and geriatrics. Support for programs leading to careers 
as nurse practitioners, nurse midwives, and nurse anesthetists 
are a priority. The committee recognizes that programs which 
prepared nurses to serve as nurse educators have proven to be a 
valuable investment. Finally, the committee continues to 
support traineeship to provide for advanced practice nursing 
students. Only students who have completed the requirements for 
the registered nursing degree should be eligible for these 
traineeships.
            Section 123. Part C--Increasing nursing work-force 
                    diversity
    The Division of Nursing has shown a strong commitment to 
enhancement of diversity in the nursing work-force. The 
Division is encouraged to focus its continuing efforts in this 
regard on enhancement of diversity among nurses prepared at the 
baccalaureate and graduate levels to enable greater 
participation of nurses in leadership positions in community 
health, primary care, education, and administration.
            Section 123. Part D--Strengthening capacity for basic nurse 
                    education and practice
    The Division of Nursing is encouraged to enable regional 
collaborative nursing workforce development projects. 
Developing pilot initiatives with such groups as regional 
educational compacts, State departments of public health, 
higher education councils or boards, and other key parties 
would be useful in those efforts.
    Recognizing the importance of telecommunications, 
informatics, and other advanced technology to both nursing 
education and practice, the division is encouraged to support 
innovative demonstrations in this area. The Division is also 
encouraged to provide leadership in this area, promoting 
dissemination of new technologies and outcomes of supported 
projects.
    The committee continues to support continuing education for 
nurses; appropriate retraining opportunities for nurses not 
currently practicing nursing; efforts to resolve geographic 
inequities in the distribution of registered nurses; support 
for clinical nursing programs which combine educational 
curricula and clinical practice in health care delivery 
organizations, including long-term care facilities and 
ambulatory care facilities.
            Section 123. Part F--Appropriations
    Given the rapidly changing nursing marketplace, the 
committee does not support set asides for the training of 
different types of nurses or for the different training 
activities, such as strengthening the capacity for basic nurse 
education and practice. In making a decision on how best to 
allocate funds under this section, the committee urges the 
Secretary to consider how the funds could best be utilized to: 
(1) Improve the distribution of and quality of nursing 
professionals needed to provide services in underserved areas 
and (2) enhance the production and distribution of public 
health personnel to improve the State and local public health 
infrastructure. To meet these goals, the Secretary should 
consider the relative benefit of training individuals from 
disadvantaged and minority populations.

Subtitle C--Financial assistance

            Section 132. Restructuring and technical amendments
    Under this program, the Secretary shall have different 
options to provide loan repayment or to provide scholarships. 
The committee encourages the Secretary to distribute funds 
between the various options in the manner most consistent with 
the general goals of this legislation as previously outlined. 
The committee continues to support the primary objective of the 
National Health Service Corps programs to enhance health care 
services in underserved areas.
            Section 136. Loans for disadvantaged students
    The committee intends that funding for this program should 
be repealed after 3 years. This should provide sufficient time 
to complete the establishment of these revolving loan funds at 
institutions currently operating such programs.
            Section 142. HEAL lender and performance standards
    The committee intends that the exceptional performance 
requirements for HEAL lenders, holders, and servicers be 
implemented in a manner similar to the exceptional performance 
provision for the Department of Education guaranteed loan 
programs. In addition, the committee intends that, in 
determining whether a lender, holder, or servicer demonstrates 
exceptional performance, the financial and compliance audit 
include a review of compliance with all requirements associated 
with the HEAL loan that are performed by the lender, holder, or 
servicer, from the making of the loan through submission of a 
claim. Finally, it should be understood that lenders, holders, 
or servicers seeking designation as exceptional performers 
should be required to provide compliance audit results, in 
accord with established time frames, to the Division of Student 
Assistance of the Bureau of Health Professions, Health 
Resources and Services Administration. Failure to do so should 
result in loss of the exceptional performance designation.
            Section 151. Scholarships for disadvantaged students
    With regard to the eligibility of allied health schools 
under the new Scholarships for Disadvantaged Students program, 
the committee recognizes that there are over 3,000 accredited 
allied health training programs and therefor expects that, 
consistent with eligibility provisions under the former 
Scholarships for Disadvantaged Students program, the Secretary 
will limit participation to the following baccalaureate or 
graduate degree allied health professions schools or programs: 
Dental hygiene, medical laboratory technology, occupational 
therapy, physical therapy, and radiologic technology.
    The committee intends that the primary care funding 
priority under the new Scholarships for Disadvantaged Students 
program be implemented as follows: (1) For schools of medicine 
and osteopathic medicine, by using conditions patterned after 
those in section 723(b)(2) of the act, which determine whether 
a school is eligible to maintain Primary Care Loan funds; and 
(2) for schools of nursing, by applying the priority to those 
programs leading to a baccalaureate or graduate degree in 
nursing, since one of the distinguishing features of these 
programs is the substantial focus on preparation for community 
health practice. Further, the committee intends that, in the 
event appropriations are insufficient to fund at a reasonable 
level the requests of all eligible schools, funding be limited 
to schools that meet at least one of the three funding 
priorities.
    The committee expects the Secretary to apply appropriate 
standards in determining which schools have complied with the 
requirement to be carrying out a program for recruiting and 
retaining students from disadvantaged backgrounds, using 
outcome-based measures that provide an indication of the 
success of any such program. The existence of such a program 
should not, in itself, result in the eligibility of a school if 
the school is unable to demonstrate that the program has 
achieved some measure of success, based on the number and/or 
percentage of disadvantaged students who graduate from the 
school.

                  Title II--Office of Minority Health

    The committee expects that the Office of Minority Health 
will continue to report directly to the Assistant Secretary of 
Health and that it will ensure coordination of all the programs 
under the Assistant Secretary's authority. The office should 
serve as a resource for the entire Public Health Service, and 
assure the appropriate sensitivity and attention to efforts to 
improve the health status of racial and ethnic minorities, 
among all Public Health Service programs.
    The committee urges the development and implementation of 
interagency agreements with Public Health Service agencies and 
staff offices to increase the participation of minorities in 
health service and health promotion, and to stimulate and 
undertake innovative projects. The committee expects that any 
interagency agreements will emphasize a collaboration between 
the Office of Minority Health and the agency. The committee 
expects that the agency will contribute resources to any 
collaborative project. The office should perform a coordinating 
role within the Public Health Service rather than operate or 
directly administer project grants.
    The committee urges better information dissemination, 
education, prevention, and service delivery to disadvantaged 
racial and ethnic minorities. The Secretary would also be 
authorized to provide grants and contracts to support new and 
innovative programs designed to reduce the incidence of 
specific illnesses and improve the health status of racial and 
ethnic minorities. The committee strongly encourages the 
Secretary to consider and support innovative proposals designed 
to reduce the incidence of specific illnesses among racial and 
ethnic minorities.

                    Title III--SELECTED INITIATIVES

Section 301. Programs regarding birth defects

    Birth defects are the leading cause of infant mortality in 
the United States, accounting for one in five infant deaths. In 
addition, birth defects cause significant morbidity. The 
committee is concerned that lack of birth defects surveillance 
and research has hindered the identification of causes of birth 
defects and development of prevention efforts.
    As such, the committee encourages the Centers for Disease 
Control and Prevention to address birth defects through its 
intramural program. Such activities should include the 
collection and analysis of birth defects information and the 
operation of regional centers for the conduct of applied 
epidemiological research on the prevention of such defects. 
Although states are encouraged to improve birth defects 
surveillance systems, the committee does not intend that States 
should be required to establish such systems as a condition of 
receiving any kind of financial or non-financial support from 
the Centers for Disease Control and Prevention.

Section 303. State offices of rural health

    The committee encourages the completion of the 
establishment of state offices of rural health. Funds 
authorized under this section are intended to help all states 
establish such offices, but are not intended to provide ongoing 
support. During this authorization period, the establishment of 
such offices in each State should be finalized. Thus, the 
appropriations for this program are repealed before fiscal year 
1998.

Section 304. Health services for Pacific islanders

    The committee expects the Secretary, through contract, to 
conduct a comprehensive study regarding the effectiveness of 
these programs to determine if such programs should continue to 
be funded in the future. In addition, if such programs are 
successful, the committee is interested in determining if they 
could be replicated in rural America, or for developing 
innovative health personnel training programs for inner-city 
populations.

 Section 305. Demonstration projects regarding Alzheimer's disease

    The Alzheimer's Home and Community Care Demonstration 
projects reauthorization expands the existing program which is 
designed to improve services to meet the special needs of 
persons with Alzheimer's and related dementias. This 
reauthorization removes the limit on the number of States that 
may participate in the program and allows extension for grants 
to States for more than 3 years.
    The purpose of the program is to encourage coordination 
among public and private agencies providing health and long 
term care services in the State, to expand access to existing 
services for persons with Alzheimer's and related dementia, and 
to develop services to fill gaps in the existing system. 
Special emphasis is placed on services that support family 
caregivers.

                   Title IV--Miscellaneous Provisions

Section 407. Required consultation by the secretary

    In general, the Secretary is provided broad authority to 
determine general funding priorities under titles VII and VIII 
of the Public Health Service Act. For instance, under the 
section 747 programs, the Secretary will decide how much 
funding to devote to predoctoral training versus residency 
training.
    The committee urges the Secretary to consider 
recommendations from all interested parties regarding the 
establishment of general priorities for each of the general 
programs authorized. The committee does not intend for the 
public and interested parties to become involved in the 
administrative details or selection process of grantees. It is 
the intent that all interested parties would comment on a 
general program description which the Secretary shall publish 
as frequently as the Secretary changes the general priorities. 
In no event is the publication of a general program description 
intended to be a rule-making process.

                            V. Cost Estimate
                                     U.S. Congress,
                               Congressional Budget Office,
                                      Washington, DC, May 22, 1995.
Hon. Nancy Landon Kassebaum,
Chairman, Committee on Labor and Human Resources,
U.S. Senate, Washington, DC.
    Dear Madam Chairman: The Congressional Budget Office has 
prepared the enclosed cost estimate for S. 555, the Health 
Professions Consolidation and Reauthorization Act of 1995, as 
ordered reported by the Senate Committee on Labor and Human 
Resources on March 29, 1995.
    Enactment of S. 555 would affect direct spending. 
Therefore, pay-as-you-go procedures would apply to the bill.
    If you wish further details on this estimate, we will be 
pleased to provide them.
            Sincerely,
                                              James L. Blum
                                             (For June E. O'Neill).
    Enclosure.

               congressional budget office cost estimate

    1. Bill number: S. 555.
    2. Bill title: Health Professions Consolidation and 
Reauthorization Act of 1995.
    3. Bill status: As ordered reported by the Senate Committee 
on Labor and Human Resources on March 29, 1995.
    4. Bill purpose: This bill would amend the Public Health 
Service Act to consolidate and reauthorize education programs 
for health professions and for minority and disadvantaged 
health professions students.
    5. Estimated cost to the Federal Government: Most of the 
spending that would occur under S. 555 would be subject to the 
availability of appropriated funds. For purposes of this 
estimate, CBO assumes that the bill will be enacted by the end 
of this fiscal year, and that all funds authorized by the bill 
for the 1995-2000 period will be appropriated. Estimated 
outlays are based on historical spending patterns of existing 
programs administered by the Health Resources and Services 
Administration (HRSA) and the Office of the Assistant Secretary 
for Health (OASH).
    This bill would affect direct spending by authorizing 
Health Education Assistance Loan (HEAL) guarantees for fiscal 
years 1996-1999. In addition, S. 555 could affect offsetting 
receipts by increasing collections from the estates of certain 
borrowers whose federally insured student loans were in 
default, but the amounts involved would be negligible.
    Table 1 summarizes the estimated budgetary impact of the 
bill under the assumption that where such sums as necessary are 
authorized, appropriations would be increased from the 1996 
authorization to account for discretionary inflation. The 
estimate assumes that appropriations would be reduced evenly 
for the intervening years when the bill specifies lower 
authorizations in 1999 than in 1996 and authorizes such sums as 
necessary in 1997 and 1998.

     TABLE 1. PROJECTED SPENDING UNDER S. 555--INCLUDING INFLATION ADJUSTMENT FOR UNSPECIFIED AUTHORIZATIONS    
                                    [By fiscal year, in millions of dollars]                                    
----------------------------------------------------------------------------------------------------------------
                                                   1995       1996       1997       1998       1999       2000  
----------------------------------------------------------------------------------------------------------------
Authorizations of Appropriations:                                                                               
    Specified authorizations..................          5        408         50         45        144  .........
    Estimated outlays \1\.....................          0        199        192         87         95         63
    Estimated authorizations \2\..............          0         12        373        366        262        106
    Estimated outlays \1\.....................          0          7        185        319        315        199
                                               =================================================================
      Total authorizations....................          5        420        423        411        406        106
      Total estimated outlays \1\.............          0        206        377        407        410        262
                                               =================================================================
Direct Spending:                                                                                                
    Estimated budget authority................          0          0         13         23         30         22
    Estimated outlays.........................          0          0         13         23         30        22 
----------------------------------------------------------------------------------------------------------------
\1\ Estimated outlays do not include spending from prior year budget authority.                                 
\2\ Estimated authorizations for programs with stated authorization amounts in 1996 and 1999 are prorated       
  between the amounts specified.                                                                                

    Table 2 summarizes the estimated budgetary impact of the 
bill under the assumption that appropriations would be kept at 
their 1996 level where such sums as necessary are authorized in 
succeeding years. The estimate assumes that appropriations 
would be reduced evenly for the intervening years when the bill 
specifies lower authorizations in 1999 than in 1996 and 
authorizes such sums as necessary in 1997 and 1998.

      TABLE 2. PROJECTED SPENDING UNDER S. 555--WITH NO INFLATION ADJUSTMENT FOR UNSPECIFIED AUTHORIZATIONS     
                                    [By fiscal year, in millions of dollars]                                    
----------------------------------------------------------------------------------------------------------------
                                                   1995       1996       1997       1998       1999       2000  
----------------------------------------------------------------------------------------------------------------
Authorizations of Appropriations:                                                                               
    Specified authorizations..................          5        408         50         45        144  .........
    Estimated outlays \1\.....................          0        199        192         87         95         63
    Estimated authorizations \2\..............          0         12        365        349        236         93
    Estimated outlays \1\.....................          0          7        181        308        295        180
                                               =================================================================
    Total authorizations......................          5        420        415        394        380         93
    Total estimated outlays \1\...............          0        206        373        395        390        243
                                               =================================================================
Direct Spending:                                                                                                
    Estimated budget authority................          0          0         13         23         30         22
    Estimated outlays.........................          0          0         13         23         30        22 
----------------------------------------------------------------------------------------------------------------
\1\ Estimated outlays do not include spending from prior year budget authority.                                 
\2\ Estimated authorizations for programs with stated authorization amounts in 1996 and 1999 are prorated       
  between the amounts specified.                                                                                

    Fiscal year 1995 appropriations for programs and activities 
authorized by the bill are $431 million.
    The costs of this bill fall within budget function 550.
    6. Basis of estimate: Title I--Health Professions Education 
and Financial Assistance Programs. This title would consolidate 
current programs providing support for health professions 
training and education into six new programs. It would also 
reauthorize several other programs without consolidating them. 
In addition, the bill would reauthorize guarantee authority for 
the Health Education Assistance Loan (HEAL) program. In 
general, 1996 authorization levels in this title are comparable 
to the amounts appropriated for 1995.
    Subtitle A would consolidate current programs authorized 
under Title VII of the Public Health Service Act and would 
authorize four new programs. Section 101 of this subtitle would 
permit the Secretary of Health and Human Services to make 
grants to or enter into contracts with health professions 
schools, state and local governments, and eligible nonprofit 
organizations. The funds provided could be used to plan, 
develop, or operate projects intended to increase the number 
and quality of minority and disadvantaged health professionals. 
This program would consolidate current authority for Centers of 
Excellence in Minority Health, the Health Careers Opportunity 
program, and the Minority Faculty Fellowships and Minority 
Faculty Loan Repayment programs. This section would authorize 
$51 million for 1996 and such sums as necessary for 1997 
through 1999. Funding for the programs consolidated under this 
section is $51 million in 1995.
    Section 102 would consolidate current authority for Family 
Medicine Training, General Internal Medicine and General 
Pediatrics Training, Physician Assistant Training, Preventive 
Medicine and Dental Public Health, Geriatric Medicine and 
Dentistry Faculty Development, and General Dentistry Training. 
The new program would permit the Secretary to make grants to or 
enter into contracts with health professions schools and 
eligible nonprofit organizations planning, developing, or 
operating projects to improve training in these areas. 
Preference would be given to programs with historical success 
in training health professionals who enter practice in 
underserved areas. This section would authorize $76 million for 
1996 and such sums as necessary for 1997 through 1999. Funding 
for the programs consolidated under this section is $79 million 
in 1995.
    Section 103 would provide support to eligible entities 
planning, developing, or operating projects to train health 
professionals in rural and underserved areas. It would also 
provide funding for geriatric training and public health 
training centers. Current authority for Area Health Education 
Centers, Health Education and Training Centers, Geriatric 
Education Centers, Rural Health Interdisciplinary Training, and 
Public Health Special Projects would be consolidated. This 
section would authorize $43 million for 1996, such sums as 
necessary for 1997 and 1998, and $29 million for 1999. Funding 
for the programs consolidated under this section is $42 million 
in 1995.
    Section 104 would permit the Secretary to award grants and 
enter into contracts with health professions schools and 
nonprofit organizations for projects to strengthen their 
capacity for the education of individuals in certain health 
professions determined to have a shortage of personnel. This 
section would consolidate current authority for Health 
Administration Traineeships, Geriatric Optometry Training, 
Allied Health Advanced Training and Special Projects, Podiatric 
Primary Care Residency Training, Chiropractic Demonstration 
Projects, and AIDS Dental Services. This section would 
authorize appropriations of $16 million for 1996 and such sums 
as necessary for 1997 through 1999. Funding for the programs 
consolidated under this section is $13 million in 1995.
    Subtitle B would consolidate six nursing education programs 
authorized under Title VIII of the Public Health Service Act. 
It would authorize the Secretary to make grants to or enter 
into contracts with schools of nursing, nursing centers, state 
or local governments, and other nonprofit organizations. 
Amounts provided could be used for training program development 
and support, faculty development, trainee support, and other 
specified purposes appropriate to meet recognized nursing 
objectives. Current authority for Nursing Special Projects, 
Advanced Nurse Education, Nurse Practitioner/Nurse Midwife 
Education, Nurse Anesthetist Training, Nursing Education for 
Disadvantaged Individuals, and Professional Nurse Traineeships 
would be consolidated into three grant programs. This subtitle 
would authorize $62 million for 1996, such sums as necessary 
for 1997 through 1998, and $59 million for 1999. Funding for 
the programs consolidated under this subtitle is $61 million in 
1995.
    Subtitle C would consolidate several loan repayment, 
scholarship, and scholarship payback programs, reauthorize 
without consolidating revolving loan programs operated by 
schools, and reauthorize the HEAL Guarantee program.
    Part 1 of this subtitle would consolidate Public Health 
Traineeships, and the State Loan Repayment, Community Based 
Scholarship, and Nursing Loan Repayment Programs into the 
existing National Health Service Corps Scholarship and Loan 
Repayment Program. This program provides support to health 
professionals and public health professionals in return for 
providing service in underserved areas. This part would 
authorize $90 million for 1996 and such sums as necessary for 
1997 through 2000. Funding for the programs consolidated under 
this part is $85 million in 1995.
    Part 2 of this subtitle would reauthorize four school-based 
revolving loan programs: the Nursing Student Loan (NSL) 
program; the Primary Care Loan (PCL) program; the Health 
Professions Student Loan (HPSL) program; and the Loans for 
Disadvantaged Students (LDS) program. The NSL, PCL, and HPSL 
programs would continue using revolving funds that remain 
available at health professions schools and would not be 
authorized to receive appropriations. This part would authorize 
$8 million annually for the 1996-1998 period for the LDS 
program. Authority for appropriations would be repeated for 
1999.
    Part 3 of this subtitle would reauthorize the Health 
Education Assistance Loan Guarantee program with minor changes. 
First, loan repayment would be delayed for borrowers who 
provide health care services to Indians through an Indian 
Health Service program. Second, this part would permit 
collections from the estates of deceased HEAL borrowers whose 
loans are in default. Third, for lenders not meeting specified 
performance standards, this part would reduce federal payments 
from 100 percent to 98 percent of any losses incurred through 
loan defaults. CBO estimates that these provisions would have a 
negligible effect on the federal budget.
    This part would authorize lending limits for HEAL of $350 
million for 1996, $375 million for 1997, and $425 million for 
1998 and 1999. A provision in current law that permits lending 
to previous borrowers after authority has expired means that 
the new authority in each year would be less than the lending 
limit for that year. For example, assuming that borrowers were 
in four-year programs, about 75 percent of 1995 authority would 
be estimated to carry over into 1996. Similarly, CBO estimates 
that 75 percent of the 1999 authorization would carry over into 
2000. For the purposes of this estimate, CBO assumes that loan 
disbursements would be equal to the amount authorized. Further, 
CBO estimates that these disbursements would entail an average 
subsidy rate of 7 percent. Thus, direct spending is estimated 
to be $5 million in 1996, rising to $30 million in 1999.
    Part 4 of this subtitle would consolidate three scholarship 
programs for minorities and disadvantaged students into a 
single program. This part would permit the Secretary to award 
grants to health professions schools for scholarships to 
disadvantaged individuals. This part would authorize $32 
million annually over the 1996-1999 period. Funding for the 
scholarship programs consolidated under this part was $36 
million in 1995.
    Title II--Office of Minority Health. This title would 
extend authority for the Office of Minority Health through 
1999. It would further ensure that the office only coordinates 
services, and does not conduct its own services and research 
program. This title would authorize $21 million for 1996, such 
sums as necessary for 1997 and 1998, and $19 million for 1999. 
Funding for this office was $21 million in 1995.
    Title III--Selected Initiatives. This title would authorize 
five research programs. First, Section 301 would authorize the 
Centers for Disease Control (CDC) to establish an intramural 
program for research on birth defects. Funding would occur 
under the general CDC appropriation; no specific authorization 
is made for this program and CBO has not basis for estimating 
the amount that would be spent on this type of research. 
Funding for the CDC was $2.1 billion in 1995.
    Section 302 would provide for the National Institutes of 
Health to conduct research on traumatic brain injury and would 
authorize a demonstration program on the development of state 
systems of care for people with traumatic brain injury. The 
demonstration program would be administered by the Health 
Research and Services Administration. This provision would 
authorize $5 million for 1995 and such sums as necessary for 
1996 and 1997.
    Section 303 of this title would extend authority for State 
Offices of Rural Health through 1997, after which the authority 
would be repealed. Such sums as necessary would be authorized 
for 1996 and 1997, with a cumulative limit of appropriations of 
$20 million. This estimate assumes appropriations of $4 million 
a year.
    Section 304 would extend the initiative that permits the 
Secretary to make grants to or enter into contracts with 
organizations serving the health needs of Pacific Islanders. 
This section would authorize $3 million for 1995, $4 million 
for 1996, and $5 million for 1997. The authority for 1995 is 
not included in the tables because an appropriation was made 
for that year, and the authorization would not result in 
additional spending.
    Finally, Section 305 would extend authority for 
demonstration projects regarding Alzheimer's disease. Such sums 
as necessary would be authorized for 1996 through 1998. Based 
on 1995 funding, this estimate assumes appropriations of about 
$5 million a year for this purpose.
    Title IV--Miscellaneous Provisions. This title makes a 
number of technical revisions. Section 404 would permit 
recovery of the federal share of construction costs with 
interest for facilities whose owners cease to be eligible for 
funding in support of health professions education. CBO has not 
basis on which to estimate the budgetary effects of this 
provision.
    7. Pay-as-you-go considerations: Section 252 of the 
Balanced Budget and Emergency Deficit Control Act of 1985 sets 
up pay-as-you-go procedures for legislation affecting direct 
spending or receipts through 1998. Enactment of S. 555 would 
affect spending for Health Education Assistance Loan 
guarantees, which are classified as mandatory under the Omnibus 
Budget Reconciliation Act of 1990. Enactment of S. 555 could 
also affect offsetting receipts because it would increase 
default collections from the estates of deceased borrowers. CBO 
estimates that the amounts of such collections would be 
negligible.

------------------------------------------------------------------------
                                 1995       1996       1997       1998  
------------------------------------------------------------------------
Change in outlays...........          0          5         13         23
Change in receipts..........      (\1\)      (\1\)      (\1\)      (\1\)
------------------------------------------------------------------------
\1\ Not applicable                                                      

    8. Estimated cost to State and local and governments: None.
    9. Estimate comparison: None.
    10. Previous CBO estimate: None.
    11. Estimate prepared by: Murray N. Ross.
    12. Estimate approved by: Robert A. Sunshine, for Paul N. 
Van de Water, Assistant Director for Budget Analysis.
                    VI. Regulatory Impact Statement

    The committee has determined that there will be no increase 
in the regulatory burden of paperwork as the result of this 
bill.

                    VII. Section-By-Section Analysis

title i. health professions education and financial assistance programs

Subtitle A--Health Professions Education Program

    Section 101 amends Part B of title VII of the PHS Act to 
create the Minority Health Professions Grant Program. Requires 
the Secretary to make grants or enter into contracts with 
eligible entities for establishing, enhancing, and expanding 
programs to increase the number and quality of disadvantaged 
health professionals, especially those who provide health 
services to disadvantaged populations or in medically 
underserved areas or rural areas. Requires the Secretary to 
provide preferences for: (1) projects involving more than one 
health professions discipline or training institution with an 
above average record of retentions and graduating individuals 
from disadvantaged backgrounds, and (2) centers of excellence 
at Historically Black Colleges and Universities beginning in 
fiscal year 1999 and thereafter. Authorizes appropriations of 
$51 million for fiscal year 1996, and such sums as may be 
necessary for fiscal year 1997 through fiscal year 1999. 
Further requires the Secretary to set-aside $12 million of the 
appropriated amounts in fiscal year 1996 through fiscal year 
1998 for making grants to centers of excellence at certain 
Historically Black Colleges and Universities.
    Repeals section 795 of the PHS Act, which requires 
individuals receiving scholarships, stipends, loan repayments, 
or other financial assistance under title VII, to complete 
their educational program, enter and complete a residency in 
primary care and practice in the primary care specialty for 5 
years if they attended a school of dentistry. Provides for the 
continuation of existing agreements in effect as of the day 
before enactment in effect in accordance with the terms of the 
original agreements. Counts any period of practice as a primary 
care provider toward satisfying of the requirement of practice 
in section 795.
    Section 102 amends Part C of title VII of the PHS Act to 
create Training in Primary Health Care and Preventive Medicine 
program. Repeals section 746, authorizing the Area Health 
Education Center Programs, and sections 748-752 authorizing 
General Provisions related to traineeships and fellowships 
awarded to individuals under these programs. Amends section 747 
to provide the Training in Family Medicine, General Internal 
Medicine, General Pediatrics, Preventive Medicine, Physicians 
Assistants, and General Dentistry authority. Under the new 
section 747, provides for grants to: (1) plan develop, and 
operate, or participate in approved professional training 
programs (including an approved residency or internship 
program) in the field of family medicine, or pediatrics, that 
emphasize training for the practice of family medicine, general 
internal medicine, or general pediatrics; (2) provide financial 
assistance to medical students, interns, residents, practicing 
physicians, or other medical personnel, who plan to specialize 
or work in the practice of family medicine, general internal 
medicine, or general pediatrics; (3) plan, develop, and operate 
a training program to teach family medicine, general internal 
medicine (including geriatrics), or general pediatrics; (4) 
provide financial assistance to physicians who are participants 
in any such program and plan to teach in a family medicine, 
general internal medicine (including geriatrics), or general 
pediatrics; (5) meet the costs of projects to plan, develop, 
and operate or maintain programs for the training of physician 
assistants, and for training of individuals who will teach such 
programs; (6) meet the costs of projects to plan and develop 
new residency training programs and to maintain or improve 
existing residency training programs in preventive medicine, 
that have available full-time faculty members trained and 
experienced in the field of preventive medicine, and for 
providing financial assistance to residency trainees enrolled 
in such programs; and (7) meet the costs of planning, 
developing, or operating programs that would lead to 
significantly greater ratio of participating individuals in 
such programs eventually entering practice in general dentistry 
in rural and medically underserved communities. Allows the 
Secretary to fund programs that provide a significant amount of 
care for underserved populations and other high-risk groups, 
including programs in general dentistry if the Secretary 
determines that there is a national shortage of general 
dentists.
    Expands the Secretary's authority to provide grants or 
contracts for academic administrative units of medical schools 
to meet the costs of projects providing clinical instruction to 
include family medicine, general internal medicine, or general 
pediatrics; provides preference in making awards to applicants 
agreeing to establish and operate an academic administrative 
unit, or substantially expand such a unit, for programs in 
family medicine, general internal medicine, or general 
pediatrics. Requires the Secretary to give priority in awarding 
grants to qualified applicants with a record of training the 
greatest percentage of providers, or that demonstrate 
significant improvements in the percentage of providers which 
enter and remain in primary care practice after completing 
their initial board certification. Prohibits the Secretary from 
providing grants or contracts for administrative units, unless 
the medical school has a mission statement that includes a 
primary care medical education objective, faculty role models 
and administrative units in primary care, and required 
undergraduate ambulatory medical student clerkships in family 
medicine, internal medicine, and pediatrics.
    Authorizes appropriations of $80 million for fiscal year 
1996, and such sums as may be necessary for fiscal year 1997-
99. Requires the Secretary to make available not less than 12 
percent of appropriated amounts for awards of grants and 
contracts to family medicine academic administrative units.
    Section 103 amends Part D of title VII providing for Area 
Health Education Centers (new section 750 of the PHS Act), 
authorizing the Secretary to make grants and enter contracts 
with eligible entities for projects to: (1) improve the 
recruitment, distribution, supply, quality, utilization, and 
efficiency of health personnel providing care for urban and 
rural areas with serious unmet health care needs; (2) encourage 
the regionalization of educational responsibilities of health 
professions schools; (3) design projects to prepare, through 
field placements, preceptorships, community-based primary care 
residency programs, agreements with community-based 
organizations, and other programs training individuals to 
effectively provide health services in health professions 
shortage areas [HPSAs]; (4) conduct health professions 
education and training activities consistent with national and 
State priorities, including geriatrics; (5) encourage health 
promotion and disease prevention activities; (6) conduct 
interdisciplinary training and practice involving other health 
professionals; (7) conduct continuing education programs for 
health professionals or coordinate with such programs; and (8) 
address other areas determined appropriate by the Secretary.
    Requires the Secretary to give preference in awarding 
grants or contracts to projects that involve more than one 
health professions discipline or training institution, and have 
a good record of retention and graduation of individuals that 
enter practice in medically underserved communities. Requires 
the Secretary to award grants or contracts for the 
establishment of geriatric education centers, making a 
determination to fund a center if the Secretary determines that 
a greater need exists for training through geriatric education 
centers rather than through other entities, taking into 
consideration the impact of programs under section 747, as 
amended by the bill, would have on the production of geriatric 
health professionals. Also authorizes the Secretary to award 
grants or contracts for the operation of public health training 
centers accredited for the provision of graduate or specialized 
training in public health, that plans, develops, operates, and 
evaluates projects furthering the Secretary's goals 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. 
Authorizes appropriations of $39 million for fiscal year 1996, 
and such sums as may be necessary for fiscal year 1997 and 
fiscal year 1998, and $25 million for fiscal year 1999.
    Section 104 amends Part E of title VII to provide the 
health Profession Workforce Development program by 
redesignating section 776 (Acquired Immune Deficiency Syndrome 
Special Training Project) as section 761 (Public Health 
Traineeships), and striking sections 777 (Geriatrics Special 
Training Project) and 778 (Rural Areas Special Training 
Project). Creates a new section 762, Health Profession 
Workforce Development program, authorizing the Secretary to 
award grants and enter contracts for projects to strengthen the 
capacity for health professions education and practice. 
Requires the Secretary to give priority in awarding grants and 
contracts to entities that will use grant amounts for the 
purposes of: (1) providing care for underserved populations and 
other high-risk groups; (2) increasing the number of 
individuals who are pursuing a course of study in a field in 
which there is a severe shortage of health professionals; (3) 
conducting health professions research and data collection; and 
(4) carrying out other activities in areas determined 
appropriate by the Secretary. Authorizes appropriations of $16 
million for fiscal year 1996, such sums as necessary for each 
of fiscal year 1997 and fiscal year 1998, and $5 million for 
fiscal year 1999. Further requires the Secretary to reserve $2 
million of the amount appropriated in a fiscal year for 
carrying out health professions research and data collection 
and analysis in accordance with section 792, which is amended 
to require the Secretary to expand the uniform health 
professions data reporting system when necessary and collect 
data on clinical social workers.
    Amends section 301 of the Health Professions Education 
Extension Amendment of 1992 (P.L. 102-408), to extend the 
required date for the Advisory Council on Graduate Medical 
Education's final report on health professions issues until 
April 1, 1999, and extends the termination date authorizing the 
Council until September 30, 1999. Authorizes the Secretary to 
provide funding for the Council from appropriations provided 
under title VII. Transfers the section to part E of title VII 
as section 763.
    Section 105 repeals Part F of title VII, Miscellaneous 
Programs; amends Part G of title VII by redesignating such part 
as Part F; strikes section 791(b) requiring applicants to 
submit information to the Secretary describing the program to 
be administered with such a grant; repeals section 793 
(Statistics; Annual Report) requiring the Secretary to collect, 
analyze, and report annually on health professions data; 
repeals section 798 (Certain General Provisions); and 
redesignates section 799 (Definitions) as section 799B. Inserts 
new section 796, requiring applicants for grants under this 
section to submit to the Secretary an application that meets 
the requirements of the section including a plan for carrying 
out a project consistent with Federal, State, or regional 
program plans, contains specification of performance outcome 
standards for the grant or contract, and includes a description 
of the linkages between relevant educational and health care 
entities. Also provides that grant or contract funds could be 
used for training program development and support, faculty 
development, model demonstrations, trainee support, technical 
assistance, workforce analysis, and the dissemination of 
information, as appropriate. Entities receiving grants or 
contracts would be required to agree to maintain expenditures 
of non-Federal amounts at a level of expenditures in the 
preceding fiscal year. Authorizes the Secretary to require the 
entity applying for a grant to provide non-Federal matching 
funds. Payments would be made under a grant, cooperative 
agreement, or contract for a period not exceeding 5 years, 
subject to annual approval by the Secretary. Grant applications 
submitted under this title to be evaluated by a peer review 
group. In considering a preference or priority for funding 
based on outcome measures for an eligible entity, allows the 
Secretary to consider the future ability of the eligible entity 
to meet the outcome preference or priority through improvements 
in the eligible entity's program design. Requires the Secretary 
to use appropriate funds to provide technical assistance.
    Section 106 amends section 791 by providing a preference, 
to permit new programs to compete more equitably for funding, 
for programs that meet certain criteria demonstrating that 
substantial clinical training of health professionals would be 
focused on preparation to serve in medically underserved areas, 
student assistance linked to service in medically underserved 
communities, and a placement mechanism for deploying graduates 
to medically underserved communities would be included.
    Section 107 amends section 799B, as amended by the bill, 
replacing, in the definition of an eligible entity, a program 
in clinical psychology with a graduate program leading to the 
licensure in professional psychology. Adds to the definition of 
a medically underserved community a: (1) State or local health 
department that has a severe shortage of public health 
personnel as determined under criteria established by the 
Secretary; (2) ambulatory practice sites designated by the 
State Governors as shortage areas or medically underserved 
communities for purposes of State scholarships or loan 
repayment programs; or (3) areas with practices or facilities 
in which not less than 50 percent of the patients are 
recipients of aid under Medicaid, or eligible and uninsured. 
Also defines programs to train physician assistants as programs 
that: (1) extend for at least one academic year and include 
supervised clinical practice and at least four months of 
classroom instruction to prepare students to deliver health 
care; (2) have enrollment of not less than eight students, and 
train students in primary care, disease prevention, health 
promotion, geriatric medicine, and home health care.
    Section 108 authorizes the Secretary to continue in effect 
any grant or contract made under the authority in effect the 
day before enactment of the bill, subject to the duration of 
such a grant or contract that was in place when the first 
financial assistance was approved, or in approving the most 
recent request made (before enactment) for continuation of such 
assistance.

Subtitle B--Nursing Education

    Section 121 provides the short title, the Nursing Education 
Consolidation and Reauthorization Act of 1995.
    Section 122 specifies that the purpose of this title is to 
restructure the nurse education authorities of title VIII of 
the PHS Act to permit a comprehensive, flexible, and effective 
approach to Federal support for nursing workforce development.
    Section 123 amends title VIII of the PHS Act by striking 
the title heading and all that follows except subparts II 
(Student Loans) and III (Loan Repayment Program) of Part B, and 
sections 855 (Prohibitions Against Discrimination by Schools on 
the Basis of Sex) and 860 (Certain Generally Applicable 
Provisions), and inserting new sections in title VIII. 
Redesignates subpart III as subpart II, strikes section 837 
(Authorization of Appropriations for Student Loan Funds). 
Inserts a new section under Part A (General Provisions) 
providing definitions of eligible entities, schools of nursing, 
accredited programs, nonprofit, and State. Requires eligible 
entities to submit an application to the Secretary with a plan 
for meeting the objectives of the title along with performance 
outcome standards relevant to national nursing needs, and a 
description of linkages with relevant educational and health 
care entities. Authorizes the use of grant or contract funds 
for nurse training program development and support, faculty 
development, model demonstrations, trainee support, technical 
assistance, workforce analysis, and dissemination of 
information appropriate to meet recognized nursing objectives. 
Also provides for maintenance of effort for activities 
supported by grants, requiring that entities agree to maintain 
expenditures of non-Federal amounts for such activities at a 
level that is not less than the entity maintained for the 
preceding fiscal year before getting the grant. Authorizes the 
Secretary to require an entity to provide non-Federal matching 
funds, as appropriate, to ensure the institutional commitment 
to the program. Requires the Secretary to give preference to 
applicants with projects that will substantially benefit rural 
or underserved populations, or public health personnel shortage 
professions in State or local health departments. Further 
requires the Secretary to ensure that grants and contracts are 
awarded on a competitive basis to carry out innovative 
demonstration projects to provide strategic workforce 
supplementation activities needed to meet national nursing 
service goals. Requires the Secretary to annually approve the 
payments of a grant or contract, and limits payments to a 
period that may not exceed 5 years. Applications for grants, 
except advanced nurse traineeship grants, would be required to 
be submitted to a peer review group for evaluation. Prohibits 
the Secretary from approving an application unless a peer 
review group has recommended the application for approval.
    Establishes a National Advisory Council on Nurse Education 
and Practice, consisting of the Secretary or delegate, and 15 
members appointed by the Secretary. Requires the Council to 
include full-time nursing students, the general public, 
practicing professional nurses, and leading authorities in the 
various fields of nursing, higher and secondary education, 
representative of hospitals and other institutions providing 
nursing services. Requires the Council to advise the Secretary 
in preparation of general regulations and with respect to 
policy matters related to administering nursing education 
programs in title VIII, including issues relating to nurse 
supply, education and practice improvement. Authorizes the 
Secretary to use amounts appropriated under title VIII to 
support the education and practice activities of the Council.
    Authorizes the Secretary to use funds appropriated under 
title VIII to provide technical assistance for the programs 
under this title.
    Provides for recovery of construction assistance, plus any 
interest, by the Federal government any time within 20 years 
after completion of construction of a facility, if the owner of 
the facility ceases to be a public or nonprofit school, the 
facility ceases to be used for the training purposes for which 
it was constructed, or the facility is used for sectarian 
instruction or as a place for religious worship.
    Provides for new Part B--Nurse Practitioners, Nurse 
Midwives, and other Advanced Practice Nurses program (section 
811), authorizing the Secretary to award grants and enter 
contracts with eligible entities for the costs of projects to 
support the enhancement of advanced practice nursing education 
and practice, and traineeships for individuals in advanced 
practice nursing programs. Requires the Secretary to prescribe 
guidelines for authorized programs for nurse practitioners and 
nurse-midwifery, and other advanced practice nurse education 
programs, designed to train such providers to be qualified to 
effectively provide primary health care in homes, ambulatory 
care facilities, long-term care facilities, and other health 
care institutions. The guidelines include, at a minimum, 
requirements that the program: (1) extend for at least one 
academic year and consist of supervised clinical practice to 
prepare nurses to deliver primary health care and include at 
least 4 months (in the aggregate) of classroom instruction 
directed at the delivery of primary care, and (2) have an 
enrollment of not less than six full-time equivalent students. 
Prohibits the Secretary from awarding a grant to an applicant 
unless the applicant agrees to provide traineeships to pay all 
or part of educational expenses and the reasonable living 
expenses of a student. Also prohibits the Secretary from 
obligating more than 10 percent of the traineeships for 
individuals in doctorate degree programs. Requires the 
Secretary to give special consideration to entities that agree 
to expend the award to train advanced practice nurses who will 
practice in designated HPSA's.
    Provides for new Part C--Increasing Nursing Workforce 
Diversity program (section 821), authorizing the Secretary to 
award grants and enter contracts to meet the costs of special 
projects to increase nursing education opportunities for 
individuals from disadvantaged racial and ethnic backgrounds 
underrepresented among registered nurses by providing student 
scholarships or stipends, pre-entry preparation, and retention 
activities. Requires the Secretary to take into consideration 
the recommendations of the First and Second Invitational 
congresses for Minority Nurse Leaders on ``Caring for the 
Emerging Majority'' in 1992 and 1993, and consult with nursing 
associations in carrying out this program. Authorizes the 
Secretary to request information on annual admission, 
retention, and graduation rates for ethnic and racial 
minorities from schools receiving grants, and if any of the 
rates reported fall below the average of the two previous 
years, the grant or contract would be required to provide the 
Secretary with plans for immediately improving the rates. If 
the grant recipient with falling rates fails to improve the 
rates within the 1-year period beginning on the date of 
implementing the plan, the grant recipient would become 
ineligible for continued funding.
    Provides for new Part D--Strengthening Capacity for Basic 
Nurse Education and Practice program (section 831), authorizing 
the Secretary to award grants and enter contracts with eligible 
entities for projects to strengthen capacity for basic nurse 
education and practice. Requires the Secretary to give priority 
to entities that will use amounts provided to enhance the 
education mix and utilization of the basic nursing workforce by 
strengthening programs that provide basic nurse education for 
purposes of: (1) improving nursing services in schools and 
other community settings; (2) providing care for underserved 
populations and other high-risk groups such as the elderly, 
individuals with HIV-AIDS, substance abusers, homeless persons, 
and battered women; (3) providing case management, quality 
improvements, delegation and supervision, other skills needed 
under new health care systems; (4) developing cultural 
competencies among nurses; (5) providing emergency health 
services; (6) promoting career mobility for nursing personnel 
in a variety of training settings and cross training or 
specialty training among diverse populations; or (7) other 
priority areas determined by the Secretary.
    Provides new Part E--Authorization of Appropriations, 
authorizing appropriations for new sections 811, 821 and 831 of 
$62 million for fiscal year 1996, and such sums as necessary in 
each of the fiscal years 1997 and 1998, and $59 million for 
fiscal year 1999.
    Section 124 authorizes the Secretary to continue in effect 
any grant or contract made under the authority in effect on the 
day before enactment, subject to the duration of such grant 
when it was first approved or most recently requested for 
continuation.
    Section 125 amends section 810A of the PHS Act, as amended 
by the bill, requiring that new nurse training programs be 
given preference to allow them to compete equitable for 
funding, as long as the program was designed to prepare nurses 
to serve in medically underserved communities and encourage 
practice among underserved populations.
    Section 126 provides an effective date for the provisions 
of this subtitle of October 1, 1995, or the date of enactment 
of the bill, whichever is later.

Subtitle C--Financial Assistance

            Part 1--National Health Service Corps Financial Assistance 
                    Programs
    Section 131 amends section 338B, the Loan Repayment 
Program, to include public health disease prevention and health 
promotion activities, public health professionals, and public 
health schools as eligible activities, individuals, and 
institutions to participate in the NHSC loan repayment program.
    Authorizes appropriations of $90 million for fiscal year 
1996, and such sums as may be necessary for fiscal years 1998 
through 2000. Requires the Secretary to determine the most 
appropriate manner to allocate amounts between the scholarship, 
loan repayment, and State loan repayment programs. Also 
requires the Secretary to give priority to funding State-based 
programs as appropriate under chapter 3, distributing amounts 
among the programs in a way that furthers both Federal and 
State needs for health professionals in underserved areas.
    Amends section 338I, Grants to States for Loan Repayment 
Programs, to include public health professionals among eligible 
health professionals, and amends references to HPSA's to 
include public health disease prevention and health promotion 
activities in Federal HPSA's or approved State designated 
HPSA's. Provides that a State may waive the requirement that a 
health professional be assigned only to public and nonprofit 
private entities to include service in a full-time private 
clinical practice in a HPSA. Expands the definitions applied to 
the section to include: (1) approved State designated HPSA, an 
area designated by a State as medically underserved based on 
criteria and methodology approved by the Secretary; (2) 
community organization, public or nonprofit private entities 
are eligible; (3) primary health care, health services of 
family medicine, general internal medicine, general pediatrics, 
or may include obstetrics and gynecology provided by 
physicians, certified nurse practitioners, certified nurse 
midwives, or physician assistants; and (4) State to include 
each of the several States and the District of Columbia.
    Amends section 338L, Demonstration Grants to States for 
Community Scholarship Programs, renaming the program the 
Community Scholarship Programs. Replaces references to manpower 
shortage areas with Federal HPSA and approved State designated 
HPSAs. Strikes the requirement that the Secretary report to the 
relevant congressional committees on the program, the section 
of definitions, and the section authorizing appropriations for 
the section.
    Section 132 provides restructuring and technical amendments 
to redesignated sections 338J (Grants to States for Operation 
of Offices of Rural Health) and 338K (Native Health 
scholarships) as section 338M and 338N; sections 338C through 
338H as 338G through 338L; section 338I (Grants to States for 
Loan Repayment Programs) as 338E; section 338L (Demonstration 
Grants to States for Community Scholarship Programs) as 338F.
    Consolidates certain sections of Subpart III of part D of 
title III by striking the subpart heading and inserting Subpart 
III--Federally Supported Scholarships and Loans, and Chapter 
1--National Health Service Corps Scholarships Programs, and 
redesignating section 338B (NHSC Loan Repayment Program) as 
338C, and inserting redesignated section 338C. Inserts new 
subchapter B--Nursing Loan Repayment Program, and inserts 
section 338D, the Nursing Loan Repayment Program. Transfers 
section 846 of subpart III of part B of title VIII (Nursing 
Loan Repayment Program) to follow after section 338C 
(subchapter B of chapter 2 of subpart III of part D of title 
III), as amended by the bill, striking subsections (d) and (g) 
related to breached agreements and authorizations of 
appropriations.
    Inserts after section 338D, new titles for Chapter 3--State 
Loan Repayment and Community Scholarship Programs, and 
transfers section 338E, as redesignated by the bill. Also adds 
new title for subchapter B--Community Scholarship Programs, and 
transfers section 338F, as redesignated by the bill. Inserts 
title for Chapter 4--General Provisions.
    Amends section 487E(a) of the PHS Act related to National 
Research Service Awards for biomedical and behavioral research 
at the National Institutes of Health, requiring that the period 
of obligated service required by the NHSC Loan Repayment 
Program apply to the National Research Service Awards program.
    Section 133 amends section 332(a)(1) of the PHS Act related 
to designating HPSAs to add to the definition of a HPSA a State 
or local health department that has a severe shortage of public 
health personnel as determined under criteria established by 
the Secretary.
    Section 134 provides confirming amendments to title III of 
the PHS Act.
            Part 2--School-Based Revolving Loan Funds
    Section 135 amends section 723(b)(1) of the PHS Act 
extending from 3 to 4 years after students graduate from the 
school before the requirement that the schools must meet 
certain requirements related to former students entering 
residency training programs in primary health care. Amends 
section 723(a) to require student loan recipients to practice 
primary health care for 5 years after completing the required 
residency program in primary health care.
    Section 136 amends section 724(f)(1) authorizing Federal 
capital contributions to student loan funds, authorizing 
appropriations of $8 million for each of the fiscal years 1996 
through 1998. Repeals the authority for appropriations 
effective October 1, 1998.
    Section 137 amends section 836(b) providing, pursuant to 
uniform criteria established by the Secretary, the 10-year 
repayment requirements for any nursing student borrower who 
during the repayment period failed to make consecutive payments 
and who, during the last 12 months of the repayment period, had 
made at least 12 consecutive payments could be extended for a 
period not to exceed 10 years. Amends section 836(g) requiring 
a minimum payment of $15 dollars per month during the repayment 
period of a loan from a loan fund, to require a $40 minimum 
payment. Eliminates the statute of limitation for loan 
collections by adding a new section to the end of section 836, 
providing that obligations to repay loans would be enforced 
without regard to any Federal or State statutory, regulatory, 
or administrative limitation on the period within which debts 
may be enforced. Also provides that no limitation would 
terminate the period within which a suit may be filed, a 
judgment enforced, or an offset, garnishment, or other action 
may be initiated or taken by a school of nursing with an 
agreement with the Secretary seeking the repayment of a student 
loan. Both statute of limitation provisions would be effective 
on enactment. Creates a new section for breach of agreements 
for nursing student loan recipients who agreed to provide 
health services for a period of time in return for receiving 
loan repayments, requiring recipients to repay the Federal 
Government for the amount of the award, plus interest at the 
maximum legal prevailing rate within a three-year period. 
Amends section 839 to include requirements for capital 
distribution when a school terminates a nursing loan fund.
    Section 138 amends section 735(e)(2) eliminating the 
requirement that Federal capital contribution amounts from 
student loan funds returned to the Secretary by health 
professions schools before the fourth quarter of a fiscal year 
may not be obligated before the fourth quarter.
            Part 3--Insured Health Education Assistance Loans to 
                    Graduate Students
    Section 141 amends section 705 of the PHS Act providing the 
Health Education Assistance Loans (HEAL) program, to allow that 
periodic installments of principal and interest need not be 
paid, but interest shall accrue, during any period not in 
excess of three years during which the borrower is providing 
health care services to Indians through an Indian health 
program. Includes conforming amendments and provides an 
effective date that applies to services provided on or after 
the first day of the third month that begins after the date of 
enactment. Also amends section 714 by allowing the Secretary, 
in the case of a borrower who dies, to collect any unpaid 
balance of a loan owed to the lender, holder of the loan, or 
the Federal Government from the borrower's estate.
    Amends section 722(a)(1) of the PHS Act, to provide a 
maximum student loan of the cost of attendance (including 
tuition, other reasonable educational expenses, and reasonable 
living costs) for the year at the educational institution 
attended by the student (determined by the educational 
institution). Also amends section 722(a)(2) providing that for 
third or fourth year medical students the amount of the loan 
may be increased to the extent necessary. Amends section 722(c) 
to extend the maximum loan repayment period from 10 years to 25 
years. Amends section 722(j) to require minimum monthly 
payments of $40 on unpaid loan balances. Adds new section 
eliminating any statute of limitation on schools with an 
agreement with the Secretary that is seeking the repayment of 
the amount due from a borrower on a loan.
    Section 142 amends section 707(a) requiring the Secretary 
to pay an insurance beneficiary not designated for exceptional 
performance a sum equal to 98 percent of the amount of the loss 
sustained by insured on a defaulted loan. Adds new section 
providing the Secretary to pay 100 percent of a loan loss, if 
the Secretary determines that an eligible lender, holder, or 
servicer of a loan has a compliance performance rating that 
equals or exceeds 97 percent. A compliance performance rating 
would be determined with respect to compliance with due 
diligence in the collection of loans for each year for which 
the determination was made, and eligible lenders interested in 
an exceptional performance designation would be subject to 
annual financial and compliance audits.
    Section 143 amends section 702(a) authorizing the total 
amount of new loans made to borrowers under the HEAL program in 
1996 of $350 million in 1997 of $375 million, and $425 million 
for each of the fiscal years 1998 and 1999. Amends section 
710(a)(2)(B) extending the Secretary's authority to reserve 
$1,000,000 from the amounts in the HEAL insurance account for 
funding the Office for HEAL Default Reduction for 1993 and 
subsequent fiscal years.
            Part 4--Scholarships for Disadvantaged Students
    Section 151 amends Part B of title VII adding a new section 
740, Scholarships for Disadvantaged Students, authorizing the 
Secretary to make grants or enter contracts with an eligible 
entity to award scholarships by schools to any eligible full-
time student, for tuition expenses, other reasonable 
educational expenses, and reasonable living expenses incurred 
in the attendance of such school. Prohibits the Secretary from 
making a grant or entering a contract unless the health 
professions and nursing schools agreed to give preference to 
students for whom the costs of attending the school would be a 
severe financial hardship. Requires the Secretary to give 
priority to such schools based on the proportion of graduating 
students going into primary care, the proportion of minority 
students, and the proportion of graduates working in medically 
underserved areas. Also establishes the maximum scholarship 
award for an individual in a year of $3,000. Authorizes 
appropriations of $32 million for each of fiscal years 1996-99. 
Requires the Secretary to ensure that not less than 16 percent 
of the appropriated amounts be distributed to schools of 
nursing.

                  Title II. Office of Minority Health

    Section 201 amends section 1707 of the PHS Act providing 
the Office of Minority Health, regarding the duties of the 
office to improve the health of racial and ethnic minority 
groups, requiring the Secretary to carry out the following: (1) 
establishing short-range and long-range goals and objectives 
and coordinate all other activities with the PHS Act related to 
disease prevention, health promotion, service delivery, and 
research on minority individuals; (2) carry out activities by 
entering into interagency agreements with PHS agencies 
supporting research, demonstrations and evaluations to test new 
and innovative models, increasing knowledge and understanding 
of risk factors, and support improvements in information 
dissemination, education, prevention, and service delivery to 
individuals from disadvantaged backgrounds, collect data on 
minority health resource center; (3) support a national 
minority health resource center to facilitate the exchange of 
health information, health promotion, preventive services, and 
education in the appropriate use of health care; (4) establish 
programs to improve access to health care services for 
individuals with limited proficiency in speaking English; (5) 
an annual report submitted by June 8 summarizing the minority 
health activities of each of the respective agencies.
    Requires the Secretary to establish the Advisory Committee 
on Minority Health, composed of 12 members, to provide advice 
to the Deputy Assistant Secretary on the Development of goals 
and specific program activities for each racial and ethnic 
minority. The Advisory Committee would be required to make 
recommendations regarding language as an impediment to health 
care, the equitable allocation of grant awards under certain 
programs with respect to various racial and minority 
populations, and require the Secretary to ensure that 
information and services are provided in the language, 
educational, and cultural context most appropriate. The Deputy 
Assistant Secretary would be required to ensure that grant, 
contracts awards, and cooperative agreements, are made to 
public and nonprofit private entities. Further requires the 
Deputy Assistant Secretary to submit to the relevant 
congressional committees a biennial report, describing the 
activities carried out in the preceding two fiscal years, and 
evaluate the extent to which such activities have been 
effective in improving the health of racial and ethnic 
minorities.
    Authorizes appropriations of $21 million for fiscal year 
1996, such sums as may be necessary for each of the fiscal 
years 1997, 1998, and $19 million for fiscal year 1999.

                    Title III. Selected Initiatives

    Section 301 amends section 317C of the PHS requiring the 
Secretary, acting through the Director of the Center for 
Disease Control and Prevention, to carry out programs regarding 
birth defects to collect, analyze, and make available data on 
birth defects, and operate regional centers for conducting 
applied epidemiological research on the prevention of such 
defects. Requires the Secretary to: (1) collect and analyze 
data by gender, and by racial and ethnic group; (2) collect 
data from birth certificates, death certificates, hospital 
records, and other appropriate sources; and (3) encourage 
States to establish or improve programs for collecting and 
analyzing epidemiological data on birth defects and make the 
data available. Also requires the Secretary to establish and 
maintain a National Information Clearinghouse on Birth Defects 
to collect and disseminated to health professionals and the 
general public information on birth defects, including the 
prevention of such defects. Authorizes the Secretary to make 
grants and enter into contracts with public and nonprofit 
private entities to carry out these programs. Not later than 
February 1 of fiscal year 1997, and every second year after, 
requires the Secretary to submit to the relevant congressional 
committees a report containing information regarding birth 
defects, including; (1) the incidence and prevalence of birth 
defects and the extent to which they contribute to infant 
mortality; (2) similar information specific to various racial 
and ethnic groups; (3) assessment of the effectiveness of 
various approaches of preventing birth defects; (4) a 
description of the activities of these programs; and (5) any 
recommendations regarding birth defects.
    Section 302 amends section 1261 of the PHS Act, the 
Interagency Program for Trauma Research, requiring that the 
program activities include the authority to make awards of 
grants or contracts to public or nonprofit private entities for 
the conduct of basic and applied research regarding traumatic 
brain injury. Also amends Part E of title XII of the PHS Act, 
Trauma Care, authorizing the Secretary to make grants to States 
for the purpose of carrying out demonstration projects to 
improve the availability of health services regarding traumatic 
brain injury. Authorizes the Secretary to make a grant only if 
the State involved agrees to establish an advisory board within 
the appropriate health department or another appropriate 
department required to be cognizant of findings and concerns of 
Federal, State and local agencies, citizens groups, and private 
industry. The advisory board would be required to encourage 
citizen participation through the establishment of public 
hearings and other types of community outreach programs. The 
bill authorizes the Secretary to make grants to States if the 
State agrees to make available in cash, non-Federal 
contributions toward the costs of not less than $1 for each $2 
of Federal funds provided under the grant.
    The bill authorizes appropriations of $5 million for fiscal 
1996, and such sums as may be necessary for each of the fiscal 
years 1997 through 1998. Requires the Secretary, acting through 
the appropriate agencies of the PHS, to conduct a study on 
traumatic brain injury to: (1) determine the incidence and 
prevalence of traumatic brain injury and develop a uniform 
reporting system for States to report such incidence; (2) 
identify common therapeutic interventions used for 
rehabilitation of individuals with such injuries, subject to 
the availability of information, and include an analysis of 
their effectiveness and adequacy of existing measures; and (3) 
develop practice guidelines for the rehabilitation of traumatic 
brain injury when the appropriate scientific research becomes 
available. Requires the Secretary to report to the relevant 
congressional committees not later than 18 months after 
enactment, on the findings on the incidence of traumatic brain 
injury. In addition, requires the Secretary to report to the 
relevant congressional committees not later than 3 years after 
enactment on the findings made as a result of identifying 
common therapeutic interventions and developing practice 
guidelines. Requires the Secretary, acting through the 
appropriate agencies, to conduct a national consensus 
conference on managing traumatic brain injury and related 
rehabilitation concerns.
    Section 303 amends section 338M, as redesignated by the 
bill, authorizing State Offices of Rural Health, authorizing 
States to provide non-Federal noncash matching contributions in 
order to receive a grant under the program. Authorizes 
appropriations of such sums as may be necessary for each of the 
fiscal years 1996 and 1997, and increases to $20 million the 
aggregate amount of grants that may be made under the section. 
Repeals section 338M, as redesignated by the bill, effective on 
October 1, 1997.
    Section 304 amends section 10, Grants for Health Services 
for Pacific Islanders, of the Disadvantaged Minority Health 
Improvement Act of 1990, expanding the use of the grants for 
improving the quality and availability of substance abuse 
services and eliminating the use of the grants for improved 
health data systems. Further amends the use of the grants for 
improving the quality and availability of health care 
providers, including programs and projects to train new and 
upgrade the skills of existing health professionals. Eliminates 
the use of the grants to improve facility and equipment repair 
and maintenance systems, and to improve alcohol, drug abuse, 
and mental health prevention and treatment services and 
systems, and redesignates the following paragraphs. Provides 
for grants to be used to: (1) provide primary health care, 
preventive health care and related training to American Samoan 
health care professionals; and (2) improve access to health 
promotion and disease prevention services for rural American 
Samoa. Authorizes appropriations of $3 million for fiscal year 
1995, $4 million for fiscal year 1996, and $5 million for 
fiscal year 1997. Requires the Secretary, acting through the 
Administrator of the Health Resources and Services 
Administration, to enter into a contract with a public or 
nonprofit private entity to conduct a study to determine the 
effectiveness of projects funded under this section not later 
than 180 days after the date of enactment. Requires the 
Secretary to prepare and submit to the relevant congressional 
committees, not later than July 1, 1996, a report describing 
the findings made by the study.
    Section 305 amends section 398 of the PHS Act eliminating 
the limit on the number of demonstration projects regarding 
Alzheimer's disease, and limits the provisions of respite care 
to individuals who are living in single family homes or in 
congregate settings. The bill would provide grants for programs 
to improve the access of such individuals to home-based or 
community-based long-term care services, particularly for 
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. Amends section 398A, 
eliminating the limitation on the duration of the grant, 
renaming the section as Requirement of Matching Funds, and 
continuing to provide a matching fund requirement. Also amends 
the matching fund requirement for the third year and subsequent 
years, under which the Secretary is prohibited from making 
payments exceeding 55 percent of the costs of such services. 
Authorizes appropriations of such sums as may be necessary 
through fiscal year 1998.

                   Title IV. Miscellaneous Provisions

    Seciton 401 provides miscellaneous technical corrections 
regarding P.L. 103-183.
    Section 402 amends Part B of title III of the PHS Act, 
authorizing grants for preventive health services, providing 
Miscellaneous Authorities Regarding Centers for Disease Control 
and Prevention (CDC). Requires the Secretary, acting through 
the Director of CDC, to establish technical and scientific peer 
review groups and scientific program advisory committees as 
needed to carry out the functions of the CDC. Requires the 
Secretary, acting through the Director of CDC, to also 
establish fellowship and training programs to be conducted by 
the CDC to train individuals to develop skills in epidemiology, 
surveillance, laboratory analysis, and other disease detection 
and prevention methods. Requires that the programs be designed 
to enable health professionals and health personnel trained in 
such programs to work, after the training, in local State, 
national, and international efforts toward the prevention and 
control of diseases, injuries, and disabilities. Provides an 
effective date for the section of July 1, 1995.
    Section 403 miscellaneous technical amendments regarding 
P.L. 103-43.
    Section 404 provides technical corrections relating to 
health professions programs, amending section 799B, as 
redesignated by the bill, including in the definition of 
medically underserved communities ambulatory practice sites 
designated by State Governors as shortage areas or medically 
underserved communities for purposes of State scholarships or 
loan repayment or related agreements, or practices or 
facilities in which not less than 50 percent of the patients 
are recipients of aid under Medicaid or eligible and uninsured. 
Amends Part G of title VII of the PHS Act, adding a provision 
for recovery of Federal funds for the completion of 
construction of a facility, if at any time within 20 years 
after the completion, the facility ceases to be a public or 
other nonprofit agency, or public nonprofit school, or the 
facility ceases to be used for the teaching or training 
purposes for which it was constructed, or the facility is used 
for sectarian instruction, or as a place of religious worship. 
Provides an effective date for the amendments in this section 
of one day prior to the date of enactment of the Health 
Professions Education Extension Amendments of 1992 (P.L. 102-
408).
    Section 405 amends section 303(d)(1) of the PHS Act to 
specify the term family therapy counseling as an eligible 
health professional to carry out the mental health general 
duties of the PHS.
    Section 406 amends section 481B(a) of the PHS Act to 
require the Director of National Institutes of Health reserve 
$2,500,000 in funding for the construction, renovation, or 
improvement of regional centers for research on primates for 
each of the fiscal years 1994 through 1996.
    Section 407 requires the Secretary, regarding programs 
under parts B, C, D, and E of title VII, and parts B, C, D of 
title VII of the PHS act, to periodically publish in the 
Federal Register program announcements for the funding of 
awards under these programs; solicit and receive written and 
oral comments concerning such guidelines, including holding 
public forums for comments from interested individuals and 
groups; and take into consideration the information received in 
the public forums.
  VIII. Additional Views of Senators Coats, Ashcroft, Gregg, Abraham, 
                           Gorton, and DeWine

    Sections 141-143 reauthorize the Health Education 
Assistance Loans to Graduate Students. Current HEAL loan 
regulations at 42 C.F.R. 60.11 may infringe on the civil rights 
or religious freedoms of certain health care providers by 
permitting deferral of HEAL loan repayment only if the loan 
recipient attends a residency program accredited by the 
Accreditation Council for Graduate Medical Education (ACGME). 
The ACGME has proposed standards that require accredited 
programs to provide or arrange for training in induced abortion 
procedures.
    An amendment by Senator Coats that would have addressed 
this situation was not offered after Members on both sides 
expressed concern with the new standard and an interest in 
working on acceptable language. In the meantime, the ACGME and 
other interested parties have agreed to meet and revisit the 
proposed standards.
    We reaffirm our resolve to ensure that this legislation 
does not violate the civil rights of health care providers by 
conditioning receipt of government benefits on a provider's 
willingness to perform or train induced abortions or to arrange 
for the performance or training of induced abortions.

                      IX. Changes in Existing Law

    In compliance with rule XXVI paragraph 12 of the Standing 
Rules of the Senate, the following provides a print of the 
statute or the part or section thereof to be amended or 
replaced (existing law proposed to be omitted is enclosed in 
black brackets, new matter is printed in italic, existing law 
in which no change is proposed is shown in roman):

                       Public Health Service Act

          * * * * * * *

 HEALTH PROFESSIONS EDUCATION CONSOLIDATION AND REAUTHORIZATION ACT OF 
                                  1995

          * * * * * * *
    Sec. 1. Short title.

TITLE I--HEALTH PROFESSIONS EDUCATION AND FINANCIAL ASSISTANCE PROGRAMS

           Subtitle A--Health Professions Education Programs

    Sec. 101. Minority and disadvantaged health professions 
grant program.
    Sec. 102. Training in [primary health care and preventive 
medicine] family medicine, general internal medicine, general 
pediatrics, preventive medicine, physician assistants, and 
general dentistry.
          * * * * * * *
    Sec. 104. Health profession[s] workforce development.
          * * * * * * *

               Part 2--School-Based Revolving Loan Funds

          * * * * * * *
    Sec. 138. General provisions.

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

          * * * * * * *
    Sec. 142. HEAL lender and holder performance standards.
    Sec. 143. Reauthorization.
          * * * * * * *

                   TITLE IV--MISCELLANEOUS PROVISIONS

          * * * * * * *
    Sec. 407. Required consultation by Secretary.
          * * * * * * *

     TITLE III--GENERAL POWERS AND DUTIES OF PUBLIC HEALTH SERVICE

          * * * * * * *

                      Part D--Primary Health Care

          * * * * * * *

     [Subpart III--Scholarship Program and Loan Repayment Program]

        Subpart III--Federally Supported Scholarships and Loans

     CHAPTER 1--NATIONAL HEALTH SERVICE CORPS SCHOLARSHIPS PROGRAMS
    CHAPTER 2--NATIONAL HEALTH SERVICE CORPS LOAN REPAYMENT PROGRAMS

                  Subchapter A--Loan Repayment Program

          * * * * * * *

                             MENTAL HEALTH

    Sec. 303. [242a] (a) In carrying out the purposes of 
section 301 with respect to mental health--
          * * * * * * *
    (d)(1) Any individual who has received a clinical 
traineeship, in psychology, psychiatry, nursing, marital and 
family therapy, counseling or social work, under subsection 
(a)(1) that was not of a limited duration or experimental 
nature (as determined by the Secretary) is obligated to serve, 
in service determined by the Secretary to be appropriate in the 
light of the individual's training and experience, at the rate 
of one year for each year (or academic year, whichever the 
Secretary determines to be appropriate) of the traineeship.
          * * * * * * *
    (4)(A) In the case of any individual any part of whose 
obligation to perform service under this subsection exists at 
the same time as any part of the individual's obligation to 
perform service under section [338C or 338D]338G or 338H 
(because of receipt of a scholarship under subpart II of part 
D) or the individual's obligation to perform service under 
section 472\1\ (because of receipt of a National Research 
Service Award), or both, the same service may not be used to 
any extent to meet more than one of those obligations.
    (B) In any case to which subparagraph (A) is applicable and 
in which one of the obligations is to perform service under 
section [338C or 338D]338G or 338H, the obligation to perform 
service under that section must be met (by performance of the 
required service or payment of damages) before the obligation 
to perform service under this subsection or under section 
472.\1\
          * * * * * * *

           PREVENTIVE HEALTH SERVICES REGARDING TUBERCULOSIS

    Sec. 317E. (a) * * *
          * * * * * * *
    (g) Funding.--
          (1) * * *
          (2) Research, demonstration projects, education, and 
        training.--For the purpose of [making grants under 
        subsection (b)]carrying out subsection (b), there are 
        authorized to be appropriated such sums as may be 
        necessary for each of the fiscal years 1994 through 
        1998.
          * * * * * * *
    [(c)(1) The base amount that the United States is entitled 
to recover under subsection (a) is the amount bearing the same 
ratio to the then value (as determined by the agreement of the 
parties or in an action brought in the district court of the 
United States for the district in which the facility is 
situated) of the facility as the amount of the Federal 
participation bore to the cost of the construction.
    [(2)(A) The interest that United States is entitled to 
recover under subsection (a) is the interest for the period (if 
any) described in subparagraph (B) at a rate (determined by the 
Secretary) based on the average of the bond equivalent rates of 
91-day Treasury bills auctioned during such period.
    [(B) The period referred to in subparagraph (A) is the 
period beginning--
          [(i) if notice is provided as prescribed by 
        subsection (b), 191 days after the date on which the 
        owner of the facility ceases to be a public or 
        nonprofit school as described in paragraph (1) of 
        subsection (a), or 191 days after the date on which the 
        use of the facility changes as described in paragraph 
        (2) or (3) of such subsection, or
          [(ii) if notice is not provided as prescribed by 
        subsection (b), 11 days after the date on which such 
        cessation or change of use occurs,
and ending on the date the amount the United States is entitled 
to recover if collected.
    [(d) The Secretary may waive the recovery rights of the 
United States under subsection (a)(2) with respect to a 
facility (under such conditions as the Secretary may establish 
by regulation) if the Secretary determines that there is good 
cause for waiving such rights.
    [(e) The right of recovery of the United States under 
subsection (a) shall not, prior to judgement, constitute a lien 
on any facility.

                              Evaluations

    [Sec. 859. (a) The Secretary shall, directly or through 
contracts with public and private entities, provide for 
evaluations of projects carried out pursuant to this title and 
for the dissemination of information developed as result of 
such projects. Such evaluations shall include an evaluation of 
the effectiveness of such projects in increasing the 
recruitment and retention of nurses.
    [(b) The Secretary shall, not later than January 10, 1994, 
and every 2 years thereafter, 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 
summarizing evaluations carried out pursuant to subsection (a) 
during the preceding two fiscal years.
    [(c) Of the amounts appropriated each fiscal year to carry 
out this title, the Secretary shall make available one percent 
to carry out this section.]
  miscellaneous authorities regarding centers for disease control and 
                               prevention


    Sec. 317I. (a) Technical and Scientific Peer Review 
Groups.--The Secretary, acting through the Director of the 
Centers for Disease Control and Prevention, may, without regard 
to the provisions of title 5, United States Code, governing 
appointments in the competitive service, and without regard to 
the provisions of chapter 51 and subchapter III of chapter 53 
of such title relating to classification and General Schedule 
pay rates, establish such technical and scientific peer review 
groups and scientific program advisory committees as are needed 
to carry out the functions of such Centers and appoint and pay 
the members of such groups, except that officers and employees 
of the United States shall not receive additional compensation 
for service as members of such groups. The Federal Advisory 
Committee Act shall not apply to the duration of such peer 
review groups. Not more than one-fourth of the members of any 
such group shall be officers or employees of the United States.
    (b) Fellowship and Training Programs.--The Secretary, 
acting through the Director of the Centers for Disease Control 
and Prevention, shall establish fellowship and training 
programs to be conducted by such Centers to train individuals 
to develop skills in epidemiology, surveillance, laboratory 
analysis, and other disease detection and prevention methods. 
Such programs shall be designed to enable health professionals 
and health personnel trained under such programs to work, after 
receiving such training, in local, State, national, and 
international efforts toward the prevention and control of 
diseases, injuries, and disabilities. Such fellowships and 
training may be administered through the use of either 
appointment or nonappointment procedures.
   projects and programs for the prevention and control of sexually 
                          transmitted diseases

    Sec. 318. (a) * * *
          * * * * * * *
    (3) in subsection [(d)(5)](e)(5)
          * * * * * * *

   projects and programs for the prevention and control of sexually 
                          transmitted diseases

    Sec. 318. (a) * * *
          * * * * * * *
    [(e)] (f) Nothing in this section shall be construed to 
require any State or any political subdivision of a State to 
have a sexually transmitted diseases program which would 
require any person, who objects to any treatment provided under 
such a program, to be treated under such a program.

           Subpart II--National Health Service Corps Program

                     national health service corps

    Sec. 331. (a)(1) * * *
          * * * * * * *
    (c) The Secretary may reimburse applicants for positions in 
the Corps (including individuals considering entering into a 
written agreement pursuant to section [338D]338H) for actual 
and reasonable expenses incurred in traveling to and from their 
places of residence to a health professional shortage area 
(designated under section 332) in which they may be assigned 
for the purpose of evaluating such area with regard to being 
assigned in such area. The Secretary shall not reimburse an 
applicant for more than one such trip.
          * * * * * * *
           designation of health professional shortage areas

    Sec. 332. (a)(1) For purposes of this subpart the term 
``health professional shortage area'' means (A) an area in an 
urban or rural area (which need not conform to the geographic 
boundaries of a political subdivision and which is a rational 
area for the delivery of health services) which the Secretary 
determines has a health manpower shortage, (B) a population 
group which the Secretary determines has such a shortage[, or 
(C)], (C) a public or nonprofit private medical facility or 
other public facility which the Secretary determines has such a 
shortage or (D) a State or local health department that has a 
severe shortage of public health personnel as determined under 
criteria established by the Secretary. The Secretary shall not 
remove an area from the areas determined to be health 
professional shortage areas under subparagraph (A) of the 
preceding sentence until the Secretary has afforded interested 
persons and groups in such area an opportunity to provide data 
and information in support of the designation as a health 
professional shortage area or a population group described in 
subparagraph (B) of such sentence or a facility described in 
subparagraph (C) of such sentence, and has made a determination 
on the basis of the data and information submitted by such 
persons and groups and other data and information available to 
the Secretary.
          * * * * * * *

                       national advisory council

    Sec. 337. (a) There is established a council to be known as 
the National Advisory Council on the National Health Service 
Corps (hereinafter in this section referred to as the 
``Council''). The Council shall be composed of fifteen members 
appointed by the Secretary. The Council shall consult with, 
advise, and make recommendations to, the Secretary with respect 
to his responsibilities in carrying out this subpart (other 
than section [338G] 338K, and shall review and comment upon 
regulations promulgated by the Secretary under this subpart.
          * * * * * * *

      Subpart III--Scholarship Program and Loan Repayment Program

           national health service corps scholarship program

    Sec. 338A. (a) * * *
          * * * * * * *
    (c)(1) In disseminating application forms and contract 
forms to individuals desiring to participate in the Scholarship 
Program, the Secretary shall include with such forms--
          (A) a fair summary of the rights and liabilities of 
        an individual whose application is approved (and whose 
        contract is accepted) by the Secretary, including in 
        the summary a clear explanation of the damages to which 
        the United States is entitled under section [338D] 338I 
        in the case of the individual's breach of the contract; 
        and
          (B) information respecting meeting a service 
        obligation through private practice under an agreement 
        under section [338C] 338H and such other information as 
        may be necessary for the individual to understand the 
        individual's prospective participation in the 
        Scholarship Program and service in the Corps, including 
        a statement of all factors considered in approving 
        applications for participation in the Program and in 
        making assignments for participants in the Program.
          * * * * * * *
    (f) The written contract (referred to in this subpart) 
between the Secretary and an individual shall contain--
          (1) * * *
          * * * * * * *
    (3) a statement of the damages to which the United States 
is entitled, under section [338D] 338I for the individual's 
breach of the contract; and
          * * * * * * *
    (i) Not later than March 1 of each year, the Secretary 
shall submit to the Congress a report providing, with respect 
to the preceding fiscal year--
          (1) * * *
          * * * * * * *
    (5)(A) the number, and type of health professions training, 
of individuals who have breached the contract under subsection 
(f) through any of the actions specified in subsection (a) or 
(b) of section [338F] 338I; and
    (B) with respect to such individuals--
          (i) the educational institutions with respect to 
        which payments have been made or were to be made under 
        the contract;
          (ii) the amounts for which the individuals are liable 
        to the United States under section [338E] 338I;
          * * * * * * *

SEC. 338B. NATIONAL HEALTH SERVICE CORPS LOAN REPAYMENT PROGRAM.

    (a) * * *
          * * * * * * *
    (c) Application, Contract, and Information Requirements.--
          (1) Summary and information.--In disseminating 
        application forms and contract forms to individuals 
        desiring to participate in the Loan Repayment Program, 
        the Secretary shall include with such forms--
                  (A) a fair summary of the rights and 
                liabilities of an individual whose application 
                is approved (and whose contract is accepted) by 
                the Secretary, including in the summary a clear 
                explanation of the damages to which the United 
                States is entitled under section [338E] 338I in 
                the case of the individual's breach of the 
                contract; and
                  (B) information respecting meeting a service 
                obligation through private practice under an 
                agreement under section [338D] 338H and such 
                other information as may be necessary for the 
                individual to understand the individual's 
                prospective participation in the Loan Repayment 
                Program and service in the Corps.
          * * * * * * *
    (f) Contents of Contracts.--The written contract (referred 
to in this subpart) between the Secretary and an individual 
shall contain--
          (1) an agreement that--
                  (A) subject to paragraph (3), the Secretary 
                agrees--
                          (i) * * *
          * * * * * * *
                          (iv) to serve for a time period 
                        (hereinafter in this subpart referred 
                        to as the ``period of obligated 
                        service'') equal to 2 years or such 
                        longer period as the individual may 
                        agree to, as a provider of primary 
                        health services in a health 
                        professional shortage area (designated 
                        under section 332) to which such 
                        individual is assigned by the Secretary 
                        as a member of the Corps or released 
                        under section [338D] 338H;
          * * * * * * *
          (4) a statement of the damages to which the United 
        States is entitled, under section [338E] 338I for the 
        individual's breach of the contract; and
          * * * * * * *
    (i) Report.--Not later than March 1 of each year, the 
Secretary shall submit to the Congress a report providing, with 
respect to the preceding fiscal year--
          (1) * * *
          * * * * * * *
          (7)(A) the number, and type of health professions 
        training, of such individuals who have breached the 
        contract under subsection (f) through any of the 
        actions specified in subsection (a) or (b) of section 
        [338E] 338I; and
          (B) with respect to such individuals--
                  (i) the educational institutions with respect 
                to which payments have been made or were to be 
                made under the contract;
                  (ii) the amounts for which the individuals 
                are liable to the United States under section 
                [338E] 338I;
          * * * * * * *

SEC. [338B.] 338C. NATIONAL HEALTH SERVICE CORPS LOAN REPAYMENT 
                    PROGRAM.

    (a) Establishment.--The Secretary shall establish a program 
to be known as the National Health Service Corps Loan Repayment 
Program to assure, with respect to the provision of primary 
health services pursuant to section 331(a)(2) and public health 
disease prevention and health promotion activities--
          (1) an adequate supply of physicians, dentists, 
        certified nurse midwives, certified nurse 
        practitioners, [and physician assistants] physician 
        assistants, and public health professionals; and
          * * * * * * *
          (1)(A) must have a degree in medicine, osteopathic 
        medicine, dentistry, public health, or other health 
        profession, or be certified as a nurse midwife, nurse 
        practioner, or physician assistant;
          (B) be enrolled in an approved graduate training 
        program in medicine, osteopathic medicine, dentistry, 
        public health, or other health profession; or
          (C) be enrolled as a full-time student--
                  (i) in an accredited (as determined by the 
                Secretary) educational institution in a State; 
                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 
                in medicine, osteopathic medicine, dentistry, 
                public health, or other health profession;
          * * * * * * *
    (c) Application, Contract, and Information Requirements.--
(1) * * *
          * * * * * * *
          (4) Recruitment and retention.--
                  (A) The Secretary shall distribute to health 
                professions schools and schools of public 
                health materials providing information on the 
                Loan Repayment Program and shall encourage the 
                schools to disseminate the materials to the 
                students of the schools.
                  (B)(i) In the case of any health professional 
                or public health professional whose period of 
                obligated service under the Loan Repayment 
                Program is nearing completion, the Secretary 
                shall encourage the individual to remain in a 
                health professional shortage area and to 
                continue providing primary health services or 
                public health disease prevention and health 
                promotion activities.
          * * * * * * *
                  (C) In the case of entities to which 
                participants in the Loan Repayment Program are 
                assigned under section 333, the Secretary shall 
                encourage the entities to provide options with 
                respect to assisting the participants in 
                remaining in the health professional shortage 
                areas involved, and in continuing to provide 
                primary health services, or public health 
                disease prevention and health promotion 
                activities, after the period of obligated 
                service under the Loan Repayment Program is 
                completed. The options with respect to which 
                the Secretary provides such encouragement may 
                include options regarding the sharing of a 
                single employment position in the health 
                professions or public health professions by 2 
                or more health professionals or public health 
                professionals, and options regarding the 
                recruitment of couples where both of the 
                individuals are health professionals or public 
                health professionals.
          * * * * * * *
    (f) Contents of Contracts.--The written contract (referred 
to in this subpart) between the Secretary and an individual 
shall contain--
          (1) an agreement that--
                  (A) subject to paragraph (3), the Secretary 
                agrees--
                          (i) * * *
          * * * * * * *
                          (iv) to serve for a time period 
                        (hereinafter in this subpart referred 
                        to as the ``period of obligation 
                        service'') equal to 2 years or such 
                        longer period as the individual may 
                        agree to, as a provider of primary 
                        health services or public health 
                        disease prevention and health promotion 
                        activities in a health professional 
                        shortage area (designated under section 
                        332) to which such individual is 
                        assigned by the Secretary as a member 
                        of the Corps or released under section 
                        338D;
          * * * * * * *
    (g) Payments.--
          (1) In General.-- * * *

           * * * * * * *
                          (iii) provides an incentive with 
                        respect to the health professional or 
                        public health professional involved 
                        remaining in a health professional 
                        shortage area, and continuing to 
                        provide primary health services, or 
                        public health disease prevention and 
                        health promotion activities, after the 
                        completion of the period of obligated 
                        service under the Loan Repayment 
                        Program.
           * * * * * * *
    (i) Reports.--* * *
           * * * * * * *
          (8) the effectiveness of the Secretary in recruiting 
        health professionals or public health professionals to 
        participate in the Loan Repayment Program, and in 
        encouraging and assisting such professionals with 
        respect to providing primary health services or public 
        health disease prevention and health promotion 
        activities to health professional shortage areas after 
        the completion of the period of obligated service under 
        such Program.

                 [Subpart III--Loan Repayment Program]

                         loan repayment program

    [Sec. 846.]

SEC. 338D. NURSING LOAN REPAYMENT PROGRAM

    (a) In General.--In the case of any individual--
           * * * * * * *
    [(d) Breach of Agreement.--The Secretary may make payments 
under subsection (a) on behalf of an individual only if the 
agreement under such subsection provides that section 860(c) is 
applicable to the individual.]
           * * * * * * *
    [(g) Authorization of Appropriations.--For the purpose of 
payments under agreements entered into under subsection (a), 
there are authorized to be appropriated $5,000,000 for fiscal 
year 1993, and $6,000,000 for fiscal year 1994.]
    (g) Breach of Agreement.--
          (1) In general.--In the case of any program under 
        this section under which an individual makes an 
        agreement to provide health services for a period of 
        time in accordance with such program in consideration 
        of receiving an award of Federal funds regarding 
        education as a nurse (including an award for the 
        repayment of loans), the following applies if the 
        agreement provides that this subsection is applicable:
                  (A) In the case of a program under this 
                section that makes an award of Federal funds 
                for attending an accredited program of nursing 
                (in this section referred to as a `nursing 
                program'), the individual is liable to the 
                Federal Government for the amount of such award 
                (including amounts provided for expenses 
                related to such attendance), and for interest 
                on such amount at the maximum legal prevailing 
                rate, if the individual--
                          (i) fails to maintain an acceptable 
                        level of academic standing in the 
                        nursing program (as indicated by the 
                        program in accordance with requirements 
                        established by the Secretary);
                          (ii) is dismissed from the nursing 
                        program for disciplinary reasons; or
                          (iii) voluntarily terminates the 
                        nursing program.
                  (B) The individual is liable to the Federal 
                Government for the amount of such award 
                (including amounts provided for expenses 
                related to such attendance), and for interest 
                on such amount at the maximum legal prevailing 
                rate, if the individual fails to provide health 
                services in accordance with the program under 
                this section for the period of time applicable 
                under the program.
          (2) Waiver or suspension of liability.--In the case 
        of an individual or health facility making an agreement 
        for purposes of paragraph (1), the Secretary shall 
        provide for the waiver or suspension of liability under 
        such subsection if compliance by the individual or the 
        health facility, as the case may be, with the 
        agreements involved is impossible, or would involve 
        extreme hardship to the individual or facility, and if 
        enforcement of the agreements with respect to the 
        individual or facility would be unconscionable.
          (3) Date certain for recovery.--Subject to paragraph 
        (2), any amount that the Federal Government is entitled 
        to recover under paragraph (1) shall be paid to the 
        United States not later than the expiration of the 3-
        year period beginning on the date the United States 
        becomes so entitled.
          (4) Availability.--Amounts recovered under paragraph 
        (1) with respect to a program under this section shall 
        be available for the purposes of such program, and 
        shall remain available for such purposes until 
        expended.
   CHAPTER 3--STATE LOAN REPAYMENT AND COMMUNITY SCHOLARSHIP PROGRAMS

              Subchapter A--State Loan Repayment Programs
SEC. [338I.] 338E. GRANTS TO STATES FOR LOAN REPAYMENT PROGRAMS.

    (a) In General.--
          (1) Authority for grants.--The Secretary, acting 
        through the Administrator of the Health Resources and 
        Services Administration, may make grants to States for 
        the purpose of assisting the States in operating 
        programs described in paragraph (2) in order to provide 
        for the increased availability of primary health 
        services [in health professional shortage areas] or 
        public health disease prevention and health promotion 
        activities in Federal health professional shortage 
        areas or approved State designated health professional 
        shortage areas.
          (2) Loan repayment programs.--The programs referred 
        to in paragraph (1) are, subject to subsection (c), 
        programs of entering into contracts under which the 
        State involved agrees to pay all or part of the 
        principal, interest, and related expenses of the 
        educational loans of health professionals or public 
        health professionals in consideration of the 
        professionals agreeing to provide primary health 
        services [in health professional shortage areas] or 
        public health disease prevention and health promotion 
        activities in Federal health professional shortage 
        areas or approved State designated health professional 
        shortage areas.
          * * * * * * *
    (c) Coordination With Federal Program.--
          (1) Assignments for health professional shortage 
        areas under [federal] federal or approved state 
        program.--The Secretary may not make a grant under 
        subsection (a) unless the State involved agrees that, 
        in carrying out the program operated with the grant, 
        the State will assign health professionals 
        participating in the program only to public and 
        nonprofit private entities located in and providing 
        health services in health professional shortage areas 
        or approved State designated health professional 
        shortage areas.
          (2) Remedies for breach of contracts.--The Secretary 
        may not make a grant under subsection (a) unless the 
        State involved agrees that the contracts provided by 
        the State pursuant to paragraph (2) of such subsection 
        will provide remedies for any breach of the contracts 
        by the health professionals or public health 
        professionals involved.
          (3) Limitation regarding, contract inducements.--
                  (A) Except as provided in subparagraph (B), 
                the Secretary may not make a grant under 
                subsection (a) unless the State involved agrees 
                that the contracts provided by the State 
                pursuant to paragraph (2) of such subsection 
                will not be provided on terms that are more 
                favorable to health professionals or public 
                health professionals than the most favorable 
                terms that the Secretary is authorized to 
                provide for contracts under the Loan Repayment 
                Program under section 338B, including terms 
                regarding--
          * * * * * * *
                          (ii) the availability of remedies for 
                        any breach of the contracts by the 
                        [health] professionals involved.
                  (B) With respect to the limitation 
                established in subparagraph (A) regarding the 
                annual amount of payments that may be provided 
                to a health professional or public health 
                professional under a contract provided by a 
                State pursuant to subsection (a)(2), such 
                limitation shall not apply with respect to a 
                contract if--
          * * * * * * *
                          (ii) the contract provides that the 
                        health professional or public health 
                        professional involved will satisfy the 
                        requirement of obligated service under 
                        the contract solely through the 
                        provision of primary health [services 
                        in a] services or public health disease 
                        prevention and health promotion 
                        activities in a Federal''; and  health 
                        professional shortage area that is 
                        receiving priority for purposes of 
                        section 333A(a)(1) and that is 
                        authorized to receive assignments under 
                        section 333 of individuals who are 
                        participating in the Scholarship 
                        Program under section 338A.
          (4) Private Practice.--
                  (A) In carrying out the program operated with 
                a grant under subsection (a), a State may waive 
                the requirement of paragraph (1) regarding the 
                assignment of health professional if, subject 
                to subparagraph (B), the health professional 
                enters into an agreement with the State to 
                provide primary health services in full-time 
                private clinical practice in a health 
                professional shortage area.
                  (B) The Secretary may not make a grant under 
                subsection (a) unless the State involved agrees 
                that, if the State provides a wavier under 
                subparagraph (A) for a health professional 
                section 338D(b)(1) will apply to the agreement 
                under such subparagraph between the State and 
                the health professional to the same extent and 
                in the same manner as such section applies to 
                an agreement between the Secretary and a health 
                professional regarding a full-time private 
                clinical practice.
          * * * * * * *
    (d) Restrictions on Use of Funds.--The Secretary may not 
make a grant under subsection (a) unless the State involved 
agrees that the grant will not be expended--
          (1) to conduct activities for which Federal funds are 
        expended--
                  (A) within the State to provide technical or 
                other non-financial assistance under subsection 
                (f) of section 330;
                  (B) under a memorandum of agreement entered 
                into with the State under subsection (h) of 
                such section; or
                  (C) under a grant under section [338J] 338M; 
                or
          * * * * * * *
    [(h) Definitions.--For purposes of this section, the term 
``State'' means each of the several States.
    [(i) Authorization of Appropriations.--
          [(1) In general.--For the purpose of making grants 
        under subsection (a), there is authorized to be 
        appropriated $10,000,000 for each of the fiscal years 
        1991 through 1995.
          [(2) Availability.--Amounts appropriated under 
        paragraph (1) shall remain available until expended.]
    (h) Definitions.--Unless specifically provided otherwise, 
as used in this subpart and section 338F:
          (1) Approved state designated health professional 
        shortage area.--The term ``approved State designated 
        health professional shortage area' means an area 
        designated by the State as underserved using specific 
        methodology and criteria to identify such areas. Such 
        criteria and mythology shall be approved by the 
        Secretary.
          (2) Community organization.--The term ``community 
        organization'' means a public or nonprofit private 
        entity.
          (3) Primary health care.--The term ``primary health 
        care'' means health services regarding family medicine, 
        general internal medicine, general pediatrics, or may 
        include obstetrics and gynecology, that are provided by 
        physicians, certified nurse practitioners, certified 
        nurse midwives, or physician assistants.
          (4) State.--The term ``State'' means each of the 
        several States and the District of Columbia.
          * * * * * * *

              Subchapter B--Community Scholarship Programs
SEC. [338L.] 338F. [DEMONSTRATION GRANTS TO STATES FOR] COMMUNITY 
                    SCHOLARSHIP PROGRAMS.

    (a) In General.--The Secretary, acting through the 
Administrator of the Health Resources and Services 
Administration, may make grants to States for the purpose of 
carrying out demonstration programs to increase the 
availability of primary health care in urban and rural health 
[manpower shortage areas] Federal health professional shortage 
areas and in approved State designated health professional 
shortage areas through assisting community organizations of 
such areas in educating individuals to serve as health 
professionals in such areas.
          * * * * * * *
    (c) Grants by States to Community Organizations for 
Provision of Scholarship Contracts.--The Secretary may not make 
a grant under subsection (a) unless the State involved agrees, 
subject to subsections (d) and (e) to carry out the purpose 
described in subsection (a) through operating a program in 
which the State makes grants to community organizations located 
in health [manpower shortage areas] Federal health professional 
shortage areas in order to assist the organizations with the 
costs of entering into contracts under which--
          * * * * * * *
          (2) the individuals agree to provide, in the health 
        [manpower shortage areas] Federal health professional 
        shortage areas in which the community organizations are 
        located, primary health care for--
          * * * * * * *
    (e) Specifications Regarding Scholarship Contract.--The 
Secretary may not make a grant under subsection (a) unless the 
State involved agrees that the State will make a grant to a 
community organization for a contract described in subsection 
(c) only if--
          (1) the individual who is to receive the scholarship 
        under the contract is a resident of the health 
        [manpower shortage area] Federal health professional 
        shortage areas and in approved State designated health 
        professional shortage areas in which the community 
        organization is located;
          * * * * * * *
    (f) Reports to Secretary.--The Secretary may not make a 
grant under subsection (a) unless the State involved agrees--
          (1) for each fiscal year for which such a grant is 
        received by the State, to submit to the Secretary a 
        report--
                  (A) identifying the community organizations 
                providing scholarships pursuant to subsection 
                (c) and the health [manpower shortage areas] 
                Federal health professional shortage areas and 
                in approved State designated health 
                professional shortage areas in which the 
                community organizations are located;
          * * * * * * *
    (g) Estimates Regarding allocations Between Urban and Rural 
Areas.--The Secretary may not make a grant under subsection (a) 
unless the State involved submits to the Secretary, as part of 
the application required in subsection (h), an estimate of the 
amount of the grant that will be expended regarding the 
provision of primary health care in urban health [manpower 
shortage areas] Federal health professional shortage areas and 
in approved State designated health professional shortage areas 
of the State, and an estimate of the amount of the grant that 
will be edpended regarding the provision of such care in rural 
health [manpower shortage areas] Federal health professional 
shortage areas and in approved State designated health 
professional shortage areas of the State.
          * * * * * * *
    [(j) Reports to Congress.--
          [(1) In general.--Each fiscal year 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 
        summarizing information received by the Secretary under 
        subsection (f) for the preceding fiscal year.
          [(2) Date for submission.--With respect to a fiscal 
        year, the report required in paragraph (1) shall be 
        submitted for purposes of such paragraph by not later 
        than the date on which the report required in section 
        339A(i) is required to be submitted for purposes of 
        such section.
    [(k) Definitions.--For purposes of this section:
          [(1) Community organization.--The term ``community 
        organization'' means a public or nonprofit private 
        entity.
          [(2) Primary health care.--The term ``primary health 
        care'' means health services regarding family medicine, 
        internal medicine, pediatrics, or obstetrics and 
        gynecology, that are provided by physicians, certified 
        nurse practitioners, certified nurse midwives, or 
        physician assistants.
          [(3) State.--The term ``State'' means each of the 
        several States and the District of Columbia.
    [(l) Funding.--
          [(1) Authorizaton of appropriations.--For the purpose 
        of making grants under subsection (a), there are 
        authorized to be appropriated $5,000,000 for fiscal 
        year 1991, $10,000,000 for fiscal year 1992, and such 
        sums as may be necessary for fiscal year 1993.
          [(2) Availability.--Amounts appropriated under 
        paragraph (1) shall remain available until expended.
          [(3) Allocations for rural areas.--
                  [(A) In carrying out subsection (a), the 
                Secretary shall, to the extent practicable, 
                ensure that not less than 50 percent of the 
                amounts appropriated under paragraph (1) are, 
                in the aggregate, expended for making grants 
                pursuant to subsection (c) to community 
                organizations that are located in rural health 
                manpower shortage areas.
                  [(B) Subparagraph (A) may not be construed to 
                prohibit the Secretary from making grants under 
                subsection (a) to States in which no rural 
                health manpower shortage areas are located.
                  [(C) With respect to any fiscal year for 
                which the Secretary is unable to comply with 
                subparagraph (A), the Secretary shall, not 
                later than April 1 of the subsequent fiscal 
                year, 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 stating the fact of 
                such noncompliance and an explanation of the 
                reasons underlying such noncompliance.]

                     CHAPTER 4--GENERAL PROVISIONS

              Subchapter B_Nursing Loan Repayment Program
                           obligated service

    Sec. [338C.] 338G. (a) Except as provided in section [338D] 
338H., each individual who has entered into a written contract 
with the Secretary under section 338A or 338B shall provide 
service in the full-time clinical practice of such individual's 
profession as a member of the Corps for the period of obligated 
service provided in such contract.
          * * * * * * *
    (5)(A) In the case of the Scholarship Program, with respect 
to an individual receiving a degree from a school of medicine, 
osteopathic medicine, dentistry, public health, veterinary 
medicine, optometry, podiatry, or pharmacy, the date referred 
to in paragraphs (1) through (4) shall be the date on which the 
individual completes the training required for such degree, 
except that--
          * * * * * * *
    (E) In the case of the Loan Repayment Program, if an 
individual is required to provide obligated service under such 
Program, the date referred to in paragraphs (1) through (4)--
          (i) shall be the date determined under subparagraph 
        (A), (B) or (D) in the case of an individual who is 
        enrolled in the final year of a course of study;
          (ii) shall, in the case of an individual who is 
        enrolled in an approved graduate training program in 
        medicine, osteopathic medicine, dentistry, public 
        health or other health profession, be the date the 
        individual completes such training program; and
          (iii) shall, in the case of an individual who has a 
        degree in medicine, osteopathic medicine, dentistry, 
        public health or other health profession, and who has 
        completed graduate training, be the date the individual 
        enters into an agreement with the Secretary under 
        section 338B.
    (c) An individual shall be considered to have begun serving 
a period of obligated service--
          (1) on the date such individual is appointed as an 
        officer in a Regular or Reserve Corps of the Service or 
        is designated as a member of the Corps under subsection 
        (b)(3) or (b)(4), or
          (2) In the case of an individual who has entered into 
        an agreement with the Secretary under section [338D] 
        338H., on the date specified in such agreement,
whichever is earlier.

                            private practice

    Sec. [338D] 338H. (a) The Secretary shall, to the extent 
permitted by, and consistent with, the requirements of 
applicable State law, release an individual from all or part of 
his service obligation under section [338O] 338G (a) or under 
section 225 (as in effect on September 30, 1977) if the 
individual applies for such a release under this section and 
enters into a written agreement with the Secretary under which 
the individual agrees to engage for a period equal to the 
remaining period of his service obligation in the full-time 
private clinical practice (including service as a salaried 
employee in an entity directly providing health services) of 
his health profession--
          * * * * * * *

       breach of scholarship contract or loan repayment contract

    Sec. [338E] 338I. (a)(1) An individual who has entered into 
a written contract with the Secretary under section 338A and 
who--
          * * * * * * *
    (b)(1)(A) Except as provided in paragraph (2) if (for any 
reason not specified in subsection (a) or section [338F] 338K 
(d)) an individual breaches his written contract by failing 
either to begin such individual's service obligation under 
section 338A in accordance with section [338C or 338D] 338G or 
338H or to complete such service obligation, the United States 
shall be entitled to recover from the individual an amount 
determined in accordance with the formula in which ``A'' is the 
amount the United States is entitled to recover, ``o'' is the 
sum of the amounts paid under this subpart to or on behalf of 
the individual and the interest on such amounts which would be 
payable if at the time the amounts were paid they were loans 
bearing interest at the maximum legal prevailing rate, as 
determined by the Treasurer of the United States; ``t'' is the 
total number of months in the individual's period of obligated 
service; and ``s'' is the number of months of such period 
served by him in accordance with section [338C] 338G or a 
written agreement under section [338D] 338H.
          * * * * * * *
    (c)(1) If (for any reason not specified in subsection (a) 
or section [338F] 338K (d)) an individual breaches the written 
contract of the individual under section 338B by failing either 
to begin such individual's service obligation in accordance 
with section [338C or 338D] 338G or 338H or to complete such 
service obligation, the United States shall be entitled to 
recover from the individual an amount equal to the sum of--
          * * * * * * *
SEC. [338F.] 338J. FUND REGARDING USE OF AMOUNTS RECOVERED FOR CONTRACT 
                    BREACH TO REPLACE SERVICES LOST AS RESULT OF 
                    BREACH.

    (a) * * *
    (b) Authorization of Appropriations to Fund.--For each 
fiscal year, there is authorized to be appropriated to the Fund 
an amount equal to the sum of--
          (1) the amount collected during the preceding fiscal 
        year by the Federal Government pursuant to the 
        liability of individuals under section [338I] 338I for 
        the breach of contracts entered into under section 338A 
        or 338B;
          (2) the amount by which grants under section [338I] 
        338E have, for such preceding fiscal year, been reduced 
        under subsection (g)(2)(B) of such section; and
          * * * * * * *

    special loans for former corps members to enter private practice

    Sec. [338G.] 338K. (a) The Secretary may, out of 
appropriations authorized under section 338, make one loan to a 
Corps member who has agreed in writing--
          (1) * * *
          * * * * * * *
          (2) to conduct such practice in accordance with 
        section [338D] 338H (b)(1); and
          * * * * * * *
          (1) in the case of an individual who has received a 
        grant under this section (as in effect prior to October 
        1, 1984), an amount determined under section [338E] 
        338I(b), except that in applying the formula contained 
        in such section ``'' shall be the sum of the 
        amount of the grant made under subsection (a) to such 
        individual and the interest on such amount which would 
        be payable if at the time it was paid it was a loan 
        bearing interest at the maximum legal prevailing rate, 
        ``t'' shall be the number of months that such 
        individual agreed to practice his profession under 
        agreement, and ``s'' shall be the number of months that 
        such individual practices his profession in accordance 
        with such agreement; and
          * * * * * * *

[SEC. 338H. REPORT AND AUTHORIZATION OF APPROPRIATIONS.

    [(a) Report.--The Secretary shall report on March 1 of each 
year to the Committee on Labor and Human Resources of the 
Senate, the Committee on Energy and Commerce of the House of 
Representatives, and the Committees on Appropriations of the 
Senate and the House of Representatives on--
          [(1) the number of providers of health care who will 
        be needed for the Corps during the 5 fiscal years 
        beginning after the date the report is filed; and
          [(2) the number--
                  [(A) of scholarships the Secretary proposes 
                to provide under the Scholarship Program during 
                such 5 fiscal years;
                  [(B) of individuals for whom the Secretary 
                proposes to make loan repayments under the Loan 
                Repayment Program during such 5 fiscal years; 
                and
                  [(C) of individuals who have no obligation 
                under section 338C and who the Secretary 
                proposes to have as members of the Corps during 
                such 5 fiscal years,
in order to provide such number of health care providers.
    [(b) Funding.--
          [(1) Authorization of appropriations.--For the 
        purpose of carrying out this subpart, there are 
        authorized to be appropriated $63,900,000 for fiscal 
        year 1991, and such sums as may be necessary for each 
        of the fiscal years 1992 through 2000.
          [(2) Reservation of amounts.--
                  [(A) Scholarships for new participants.--Of 
                the amounts appropriated under paragraph (1) 
                for a fiscal year, the Secretary shall obligate 
                not less than 30 percent for the purpose of 
                providing contracts for scholarships under this 
                subpart to individuals who have not previously 
                received such scholarships.
                  [(B) Scholarships for first-year study in 
                certain fields.--With respect to certification 
                as a nurse practitioner, nurse midwife, or 
                physician assistant, the Secretary shall, of 
                the amounts appropriated under paragraph (1) 
                for a fiscal year, obligate not less than 10 
                percent for the purpose of providing contracts 
                for scholarships under this subpart to 
                individuals who are entering the first year of 
                study in a course of study or program described 
                in subsection \1\ 338A(b)(1)(B) that leads to 
                such a certification. Amounts obligated under 
                this subparagraph shall be in addition to 
                amounts obligated under subparagraph (A).]
SEC. [338h.] 338L. AUTHORIZATION OF APPROPRIATIONS
    (a) Authorization of Appropriations.--For the purpose of 
carrying out this subpart, there are authorized to be 
appropriated $90,000,000 for fiscal year 1996 and such sums as 
may be necessary for each of the fiscal years 1997 through 
2000.
    (b) Distribution of Amounts.--The Secretary shall determine 
the most appropriate manner in which to allocate amounts 
appropriated under subsection (a) between the programs 
authorized in chapter 1, chapter 2, and chapter 3. In 
determining the manner in which to allocate such amounts, the 
Secretary shall give priority to funding State-based programs 
as appropriate under chapter 3. The Secretary shall distribute 
such amounts among the various programs in such chapters in a 
manner which furthers both Federal and State needs for health 
professionals in underserved areas.
SEC. [338J.] 338M. GRANTS TO STATES FOR OPERATION OF OFFICES OF RURAL 
                    HEALTH.

    (a) In General.--* * *
          * * * * * * *
    (b) Requirement of Matching Funds.--
          (1) In General.--The Secretary may not make a grant 
        under subsection (a) unless the State involved agrees, 
        with respect to the costs to be incurred by the State 
        in carrying out the purpose described in such 
        subsection, to provide non-Federal contributions [in 
        cash] toward such costs in an amount equal to--
          * * * * * * *
    (e) Certain Uses of Funds.--
          (1) Restrictions.--* * *
          * * * * * * *
    (III) under a grant under section [338I] 338E;
          * * * * * * *
    (j) Authorization of Appropriation.--
          (1) In general.--For the purpose of making grants 
        under subsection (a), there are authorized to be 
        appropriated $3,000,000 for fiscal year 1991, 
        $4,000,000 for fiscal year 1992, [and] $3,000,000 for 
        fiscal year 1993, and such sums as may be necessary for 
        each of the fiscal years 1996 through 1997.
          * * * * * * *
    (k) Termination of Program.--No grant may be made under 
this section after the aggregate amounts appropriated under 
subsection (j)(1) are equal to [$10,000,000] $20,000,000.

SEC. [338K.] 338N. NATIVE HAWAIIAN HEALTH SCHOLARSHIPS. 

    (a) * * *
          * * * * * * *

    Subpart II--Grants for Demonstrations Projects With Respect to 
                          Alzheimer's Disease

SEC. 398. [280c-3] ESTABLISHMENT OF PROGRAM.

    (a) In General.--The Secretary shall make [not less than 5, 
and not more than 15,] grants to States for the purpose of 
assisting grantees in carrying out demonstration projects for 
planning, establishing, and operating programs--
          (1) * * *
          * * * * * * *
          (2) to provide home health care, personal care, day 
        care, companion services, short-term care in health 
        facilities, and other respite care to individuals with 
        Alzheimer's disease or related disorders who are living 
        in single family homes or in congregate settings; [and]
          (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 
        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
          [(3)] (4) to provide to health care providers, to 
        individuals with Alzheimer's disease or related 
        disorders, to the families of such individuals, to 
        organizations established for such individuals and such 
        families, and to the general public, information with 
        respect to--
          * * * * * * *

SEC. 398A. [280c-4] [LIMITATION ON DURATION OF GRANT AND REQUIREMENT OF 
                    MATCHING FUNDS.] REQUIREMENT OF MATCHING FUNDS

    [(a) Limitation on Duration of Grant.--The period during 
which payments are made to a State from a grant under section 
398(a) may not exceed 3 years. Such payments shall be subject 
to annual evaluation by the Secretary.]
    [(b)] (a) [Requirement of Matching Funds.--
          (1)(A) * * *
          * * * * * * *
          (C) For the [third year] third or subsequent year of 
        such payments to a State, the Secretary may not make 
        such payments in an amount exceeding 55 percent of the 
        costs of such services.
          * * * * * * *
    (2) * * *
          * * * * * * *
          (A) * * *
          * * * * * * *
          (C) for the [third year] third or subsequent year of 
        such payments to the State, not less than $45 (in cash 
        or in kind under subsection (c)) for each $55 of such 
        Federal funds.
    [(c)] Determination of Amount of Non-Federal 
Contribution.--Non-Federal contributions required in subsection 
(b) may be in cash or in kind, fairly evaluated, including 
plant, equipment, or services. Amounts provided by the Federal 
Government, or services assisted or subsidized to any 
significant extent by the Federal Government, may not be 
included in determing the amount of such non-Federal 
contributions.

SEC. 398B. [280c-5] GENERAL PROVISIONS.

    (a) Limitation on Administrative Expenses.--* * *
          * * * * * * *
    (e) Authorizations of Appropriations.--For the purpose of 
carrying out this subpart, there are authorized to be 
appropriated $5,000,000 for each of the fiscal years 1988 
through 1990, $7,500,000 for fiscal year 1991, and such sums as 
may be necessary for each of the fiscal years 1992 [and 1993] 
through 1998.
          * * * * * * *
                 TITLE IV--NATIONAL RESEARCH INSTITUTES

                 Part A--National Institutes of Heatlh

           organization of the national institutes of health

    Sec. 401. (a) * * *
          * * * * * * *

      loan repayment program regarding clinical researchers from 
                       disadvantaged backgrounds

    Sec. 487E. (a) * * *
          * * * * * * *
          [(3) Applicability of certain provisions regarding 
        obligated service.--Except to the extent inconsistent 
        with this section, the provisions of sections 338C and 
        338E 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 section 
        338B.]
          (3) Applicability of certain provisions regarding 
        obligated service.--With respect to the National Health 
        Service Corps loan repayment program established in 
        subpart III of part D of title III, the provisions of 
        such subpart shall, except as inconsistent with this 
        section, apply to the program established in subsection 
        (a) in the same manner and to the same extent as such 
        provision apply to the National Health Service Corps 
        loan repayment programs.
          * * * * * * *


         research and research training regarding tuberculosis


    Sec. 447A. (a) In carrying out section 446, the Director of 
the Institute shall conduct or support research and research 
training regarding the cause, diagnosis, early detection, 
prevention and treatment of tuberculosis.
    (b) For the purpose of carrying out subsection (a), there 
are authorized to be appropriated $50,000,000 for fiscal year 
1994, and such sums as may be necessary for each of the fiscal 
years 1995 through 1998. Such authorization is in addition to 
any other authorization of appropriations that is available for 
such purposes.
                     Part E--Other Agencies of NIH

           Subpart 1--National Center for Research Resources

                            general purpose

    Sec. 479. * * *
          * * * * * * *

             biomedical and behavioral research facilities

    Sec. 481A. * * *
          * * * * * * *
          (D) The applicant--
                  (i) has been designated as a center of 
                excellence under [section 739] part B of title 
                VII;

       construction of regional centers for research on primates

    Sec. 481B. [287a-3] (a) With respect to activities carried 
out by the National Center for Research Resources to support 
regional centers for research on primates, the Director of NIH 
shall, for each of the fiscal years 1994 through 1996, reserve 
from the amounts appropriated under section 481A(h) 
[$5,000,000] $2,500,000 for the purpose of making awards of 
grants and contracts to public or nonprofit private entities to 
construct, renovate, or otherwise improve such regional 
centers. The reservation of such amounts for any fiscal year is 
subject to the availability of qualified applicants for such 
awards.
          * * * * * * *
                TITLE VII--HEALTH PROFESSIONS EDUCATION

                         PART A--STUDENT LOANS

   Subpart I--Insured Health Education Assistance Loans to Graduate 
                                Students

          * * * * * * *

SEC. 702. SCOPE AND DURATION OF LOAN INSURANCE PROGRAM.

    (a) In General.--The total principal amount of new loans 
made and installments paid pursuant to lines of credit (and 
defined in section 719) to borrowers covered by Federal loan 
insurance under this subpart shall not exceed $350,000,000 for 
fiscal year [1993] 1996, $375,000,000 for fiscal year [1994] 
1997, and $425,000,000 for [fiscal year 1995] each of the 
fiscal years 1998 and 1999. If the total amount of new loans 
made and installments paid pursuant to lines of credit in any 
fiscal year is less than the ceiling established for such year, 
the difference between the loans made and installments paid and 
the ceiling shall be carried over to the next fiscal year and 
added to the ceiling applicable to that fiscal year, and if in 
any fiscal year no ceiling has been established, any difference 
carried over shall constitute the ceiling for making new loans 
(including loans to new borrowers) and paying installments for 
such fiscal year. Thereafter, Federal loan insurance pursuant 
to this subpart may be granted only for loans made (or for loan 
installments paid pursuant to lines of credit) to enable 
students, who have obtained prior loans insured under this 
subpart, to continue or complete their educational program or 
to obtain a loan under section 705(a)(1)(B) to pay interest on 
such prior loans; but no insurance may be granted for any loan 
made or installment paid after [September 30, 1998] September 
20, 2002. The total principal amount of Federal loan insurance 
available under this subsection shall be granted by the 
Secretary without regard to any apportionment for the purpose 
of chapter 15 of title 31, United States Code, and without 
regard to any similar limitation.
          * * * * * * *

SEC. 705. ELIGIBILITY OF BORROWERS AND TERMS OF INSURED LOANS.

    (a) In General.--A loan by an eligible lender shall be 
insurable by the Secretary under the provisions of this subpart 
only if--
          (1) made to--
                  (A) * * *
          * * * * * * *
                  (C) provides that periodic installments of 
                principal and interest need not be paid, but 
                interest shall accrue, during any period (i) 
                during which the borrower is pursuing a full-
                time course of study at an eligible institution 
                (or at an institution defined by section 481(a) 
                of the Higher Education Act of 1965); (ii) not 
                in excess of four years during which the 
                borrower is a participant in an accredited 
                internship or residency program (including any 
                period in such a program described in subclause 
                (I) or subclause (II) of subparagraph (B)(i)); 
                (iii) not in excess of three years, during 
                which the borrower is a member of the Armed 
                Forces of the United States; (iv) not in excess 
                of three years during which the borrower is in 
                service as a volunteer under the Peace Corps 
                Act; (v) not in excess of three years during 
                which the borrower is a member of the National 
                Health Service Corps; (vi) not in excess of 
                three years during which the borrower is in 
                service as a full-time volunteer under title I 
                of the Domestic Volunteer Service Act of 1973; 
                (vii) not in excess of 3 years, for a borrower 
                who has completed an accredited internship or 
                residency training program in osteopathic 
                general practice, family medicine, general 
                internal medicine, preventive medicine, or 
                general pediatrics and who is practicing 
                primary care; (viii) not in excess of 1 year, 
                for borrowers who are graduates of schools of 
                chiropractic: (ix) any period not in excess of 
                two years which is described in subparagraph 
                (B)(ii); [and (x)] (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) in addition to all other deferments for 
                which the borrower is eligible under clauses 
                (i) through [(ix)] (x), any period during which 
                the borrower is a member of the Armed Forces on 
                active duty during the Persian Gulf conflict, 
                and any period described in clauses (i) through 
                [(x)] (xi) shall not be included in determining 
                the 25-year period described in subparagraph 
                (B);
          * * * * * * *
SEC. 707. DEFAULT OF BORROWER.

    (a) Conditions for Payment to Beneficiary.--Upon default by 
the borrower on any loan covered by Federal loan insurance 
pursuant to this subpart, and after a substantial collection 
effort (including, subject to subsection (h), commencement and 
prosecution of an action) as determined under regulations of 
the Secretary, the insurance beneficiary shall promptly notify 
the Secretary and the Secretary shall, if required (at that 
time or after further collection efforts) by the beneficiary, 
or may on his own motion, if the insurance is still in effect, 
pay to the beneficiary the amount of the loss sustained by the 
insured upon that loan as soon as that amount has been 
[determined. Not later than one year after the date of the 
enactment of the Health Professions Education Extension 
Amendments of 1992, the Secretary shall establish performance 
standards for lenders and holders of loans under this subpart, 
including fees to be imposed for failing to meet such 
standards.] determined, except that, if the insurance 
beneficiary including any services 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.
    (b) Subrogation.--[Upon] (1) In general._Upon payment by 
the Secretary of the amount of the loss pursuant to subsection 
(a), the United States shall be subrogated for all of the 
rights of the holder of the obligation upon the insured loan 
and shall be entitled to an assignment of the note or other 
evidence of the insured loan by the insurance beneficiary. If 
the net recovery made by the Secretary on a loan after 
deduction of the cost of that recovery (including reasonable 
administrative costs) exceeds the amount of the loss, the 
excess shall be paid over to the insured. The Secretary may 
sell without recourse to eligible lenders (or other entities 
that the Secretary determines are capable of dealing in such 
loans) notes or other evidence of loans received through 
assignment under the first sentence.
    (2) Exceptional performance.
          (A) Authority.--Where the Secretary determines that 
        an eligible lender, holder, or servicer has a 
        compliance performance rating that equals or exceeds 97 
        percent, the Secretary shall designate that eligible 
        lender, holder, or servicer, as the case may be, for 
        exceptional performance.
          (B) Compliance performance rating.--For purposes of 
        subparagraph (A), a compliance performance rating is 
        determined with respect to compliance with due 
        diligence in the disbursement, servicing, and 
        collection of loans under this subpart for each year 
        for which the determination is made. Such rating shall 
        be equal to the percentage of all due diligence 
        requirements applicable to each loan, on average, as 
        established by the Secretary, with respect to loans 
        serviced during the period by the eligible lender, 
        holder, or servicer.
          (C) Annual audits for lenders, holders, and 
        servicers.--Each eligible lender, holder, or servicer 
        desiring a designation under subparagraph (A) shall 
        have an annual financial and compliance audit conducted 
        with respect to the loan portfolio of such eligible 
        lender, holder, or servicer, by a qualified independent 
        organization from a list of qualified organizations 
        identified by the Secretary and in accordance with 
        standards established by the Secretary. The standards 
        shall measure the lender's, holder's, or servicer's 
        compliance with due diligence standards and shall 
        include a defined statistical sampling technique 
        designed to measure the performance rating of the 
        eligible lender, holder, or servicer for the purpose of 
        this section. Each eligible lender, holder, or servicer 
        shall submit the audit required by this section to the 
        Secretary.
          (D) Secretary's Determinations.--The Secretary shall 
        make the determination under subparagraph (A) based 
        upon the audits submitted under this paragraph and any 
        information in the possession of the Secretary or 
        submitted by any other agency or office of the Federal 
        Government.
          (E) Quarterly compliance audit.--To maintain its 
        status as an exceptional performer, the lender, holder, 
        or servicer shall undergo a quarterly compliance audit 
        at the end of each quarter (other than the quarter in 
        which status as an exceptional performer is established 
        through a financial and compliance audit, as described 
        in subparagraph (C)), and submit the results of such 
        audit to the Secretary. The compliance audit shall 
        review compliance with due diligence requirements for 
        the period beginning on the day after the ending date 
        of the previous audit, in accordance with standards 
        determined by the Secretary.
          (F) Revocation authority.--The Secretary shall revoke 
        the designation of a lender, holder, or servicer under 
        subparagraph (A) if any quarterly audit required under 
        subparagraph (E) is not received by the Secretary by 
        the date established by the Secretary or if the audit 
        indicates the lender, holder, or servicer has failed to 
        meet the standards for designation as an exceptional 
        performer under subparagraph (A). A lender, holder, or 
        servicer receiving a compliance audit not meeting the 
        standard for designation as an exceptional performer 
        may reapply for designation under subparagraph (A) at 
        any time.
          (G) Documentation.--Nothing in this section shall 
        restrict or limit the authority of the Secretary to 
        require the submission of claims documentation 
        evidencing servicing performed on loans, except that 
        the Secretary may not require exceptional performers to 
        submit greater documentation than that required for 
        lenders, holders, and servicers not designated under 
        subparagraph (A).
          (H) Cost of audits.--Each eligible lender, holder, or 
        servicer shall pay for all the costs associated with 
        the audits required under this section.
          (I) Additional revocation authority.--Notwithstanding 
        any other provision of this section, a designation 
        under subparagraph (A) may be revoked at any time by 
        the Secretary if the Secretary determines that the 
        eligible lender, holder, or servicer has failed to 
        maintain an overall level of compliance consistent with 
        the audit submitted by the eligible lender, holder, or 
        servicer under this paragraph or if the Secretary 
        asserts that the lender, holder, or servicer may have 
        engaged in fraud in securing designation under 
        subparagraph (A) or is failing to service loans in 
        accordance with program requirements.
          (J) Noncompliance.--A lender, holder, or servicer 
        designated under subparagraph (A) that fails to service 
        loans or otherwise comply with applicable program 
        regulations shall be considered in violation of the 
        Federal False Claims Act.
          * * * * * * *
    (4) The term ``servicer'' means any agency acting on behalf 
of the insurance beneficiary.
SEC. 709. OFFICE FOR HEALTH EDUCATION ASSISTANCE LOAN DEFAULT 
                    REDUCTION.

    (a) Establishment.--* * *
          * * * * * * *
          (4) coordinate with other Federal entities that are 
        involved with student loan programs, including--
          * * * * * * *
                  (B) with respect to the Department of 
                Justice, in the recovery of payments from 
                health professionals who have defaulted on 
                loans guaranteed under this subpart; and
          (5) provide technical assistance to borrowers, 
        lenders, holders, and institutions concerning 
        deferments and collection activities[; and].
          [(6) prepare and submit a report not later than March 
        31, 1993, and annually, thereafter, to the Committee on 
        Labor and Human Resources of the Senate and the 
        Committee on Energy and Commerce of the House of 
        Representatives concerning--
                  [(A) the default rates for each--
                          [(i) institution described in section 
                        719(1) that is participating in the 
                        loan programs under this subpart;
                          [(ii) lender participating in the 
                        loan program under this subpart; and
                          [(iii) loan holder under this 
                        subpart;
                  [(B) the total amounts recovered pursuant to 
                section 707(b) during the preceding fiscal 
                year; and
                  [(C) a plan for improving the extent of such 
                recoveries during the current fiscal year.]
          * * * * * * *
SEC. 710. INSURANCE ACCOUNT.

    (a) In General.--
          * * * * * * *
    (B) With respect to amounts described in subparagraph (A) 
that are received by the Secretary for [any of the fiscal years 
1993 through 1996] fiscal year 1993 and subsequent fiscal 
years, the Secretary may, before depositing such amounts in the 
Account, reserve from the amounts each such fiscal year not 
more than $1,000,000 for obligation under section 709(d).
          * * * * * * *

SEC. 714. REPAYMENT BY SECRETARY OF LOANS OF DECEASED OR DISABLED 
                    BORROWERS.

    If a borrower who has received a loan dies or becomes 
permanently and totally disabled (as determined in accordance 
with regulations of the Secretary), the Secretary shall 
discharge the borrower's liability on the loan by repaying the 
amount owed on the loan from the account established under 
section 710. Notwithstanding the first sentence, the Secretary 
may, in the case of a borrower who dies, collect any remaining 
unpaid balance owed to the lender, the holder of the loan, or 
the Federal Government from the borrower's estate.
          * * * * * * *

SEC. 722. LOAN PROVISIONS.

    (a) Amount of Loan.--
          (1) In general.--Loans from a student loan fund 
        (established under an agreement with a school under 
        section 721) may not, subject to paragraph (2), exceed 
        for any student for a school year (or its equivalent) 
        [the sum of--
                  [(A) the cost of tuition for such year at 
                such school, and
                  [(B) $2,500.] 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 of medical school.--For 
        purposes of paragraph (1), [the amount $2,500 may, in 
        the case of the third or fourth year of a student at 
        school of medicine or osteopathic medicine, be 
        increased to the extent necessary (including such 
        $2,500)] 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 to pay the balances of loans that, 
        from sources other than the student loan fund under 
        section 721, were made to the individual for attendance 
        at the school. The authority to make such an increase 
        is subject to the school and the student agreeing that 
        such amount (as increased) will be expended to pay such 
        balances.
          * * * * * * *
    (c) Repayment; Exclusions From [Ten-Year] Repayment 
Period.--Such loans shall be repayable in equal or graduated 
periodic installments (with the right of the borrower to 
accelerate repayment) over the [ten-year period which begins] 
period of not less than 10 years nor more than 25 years which 
begins one year after the student ceases to pursue a full-time 
course of study at a school of medicine, osteopathic medicine, 
dentistry, pharmacy, podiatry, optometry, or veterinary 
medicine, excluding from [such ten-year period] such period--
          * * * * * * *
    (j) Authority of Schools Regarding Rate of Payment.--A 
school may provide, in accordance with regulations of the 
Secretary, that during the repayment period of a loan from a 
loan fund established pursuant to an agreement under this 
subpart payments of principal and interest by the borrower with 
respect to all the outstanding loans made to him from loan 
funds so established shall be at a rate equal to not less than 
[$15] $40 per month.
          * * * * * * *
    (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.
SEC. 723. MEDICAL SCHOOLS AND PRIMARY HEALTH CARE.

    (a) Requirements for Students.--
          (1) * * *
          * * * * * * *
                (B) to practice in such care [through the date 
                on which the loan is repaid in full] for 5 
                years after completing the residency program.
          * * * * * * *
    (b) Requirements for Schools.--
          (1) In general.--Subject to the provisions of this 
        subsection, in the case of student loan funds 
        established under section 721 by schools of medicine or 
        osteopathic medicine, each agreement entered into under 
        such section with such a school shall provide (in 
        addition to the provisions required in subsection (b) 
        of such section) that, for the 1-year period ending on 
        June 30, 1997; and for the 1-year period ending on June 
        30 of each subsequent fiscal year, the school will meet 
        not less than 1 of the conditions described in 
        paragraph (2) with respect to graduates of the school 
        whose date of graduation from the school occurred 
        approximately [3 years before] 4 years before the end 
        of the 1-year period involved.
          * * * * * * *
    [(c) Reports by Secretary.--The Secretary shall each fiscal 
year submit to the Committee on Energy and Commerce of the 
House of Representatives, and the Committee on Labor and Human 
Resources of the Senate, a report regarding the administration 
of this section, including the extent of compliance with the 
requirements of this section, during the preceding fiscal 
year.]
    [(d)](c) Definitions.--For purposes of this section:
          * * * * * * *

SEC. 724. [292t] INDIVIDUALS FROM DISADVANTAGED BACKGROUNDS.

    (a) * * *
          * * * * * * *
    (f) Authorization of Appropriations.--
          (1) In general.--With respect to making Federal 
        capital contributions to student loan funds for 
        purposes of subsection (a) there is authorized to be 
        appropriated for such contributions [$15,000,000 for 
        fiscal year 1993] $8,000,000 for each of the fiscal 
        years 1996 through 1998.
          * * * * * * *

SEC. 735. GENERAL PROVISIONS.

    (a) * * *
          * * * * * * *
    (e) Disposition of Funds Returned to Secretary.--
          (1) * * *
          (2) Date certain for contributions.--Amounts 
        described in paragraph (1) that are returned to the 
        Secretary shall be obligated before the end of the 
        succeeding fiscal year.
          * * * * * * *
            [PART B--STUDENTS FROM DISADVANTAGED BACKGROUNDS

[SEC. 736. [293] SCHOLARSHIPS FOR STUDENTS OF EXCEPTIONAL FINANCIAL 
                    NEED.

    [(a) In General.--The Secretary shall make grants to public 
and nonprofit private schools of medicine, osteopathic 
medicine, and dentistry for scholarships to be awarded by the 
schools to full-time students thereof who are of exceptional 
financial need, subject to section 795 (relating to residency 
training and practice in primary health care).
    [(b) Requirements Regarding Scholarships.--
          [(1) Acceptance for full-time enrollment.--
        Scholarships may be awarded by a school from a grant 
        under subsection (a) only to individuals who have been 
        accepted by it for enrollment as full-time students.
          [(2) Authorized expenditures.--A scholarship provided 
        to a student for a school year under a grant under 
        subsection (a) shall consist of payment to, or (in 
        accordance with paragraph (4)) on behalf of, the 
        student of an amount (except as provided in section 
        798(c)) equivalent to the amount of--
                  [(A) the tuition of the student in such 
                school year; and
                  [(B) all other reasonable educational 
                expenses, including fees, books, and laboratory 
                expenses, incurred by the student in such year.
          [(3) Authority regarding payments to educational 
        institution.--The Secretary may contract with an 
        educational institution in which is enrolled a student 
        who has received a scholarship with a grant under 
        subsection (a) for the payment to the educational 
        institution of the amounts of tuition and other 
        reasonable educational expenses described in paragraph 
        (2). Payment to such an educational institution may be 
        made without regard to section 3224 of title 31, United 
        States Code.
    [(c) Authorization of Appropriations.--For the purpose of 
making grants under this section, there is authorized to be 
appropriated $11,000,000 for fiscal year 1993.

[SEC. 737. [293a] SCHOLARSHIPS GENERALLY; CERTAIN OTHER PURPOSES.

    [(a) Establishment of Program.--
          [(1) In general.--Subject to subsection (e), the 
        Secretary may make grants to health professions schools 
        for the purpose of assisting such schools in providing 
        scholarships to individuals described in paragraph (2).
          [(2) Eligible individuals.--The individuals referred 
        to in paragraph (1) are individuals who--
                  [(A) are from disadvantaged backgrounds; and
                  [(B) are enrolled (or accepted for 
                enrollment) as full-time students in such 
                schools.
          [(3) Health professions schools.--For purposes of 
        this section, the term ``health professions schools'' 
        means schools of medicine, nursing (as schools of 
        nursing are defined in section 853), osteopathic 
        medicine, dentistry, pharmacy, podiatric medicine, 
        optometry, veterinary medicine, public health, or 
        allied health, or schools offering graduate programs in 
        clinical psychology.
    [(b) Minimum Qualifications of Grantees.--The Secretary may 
not make a grant under subsection (a) unless the health 
professions school--
          [(1) is carrying out a program for recruiting and 
        retaining students from disadvantaged backgrounds, 
        including racial and ethnic minorities; and
          [(2) is carrying out a program for recruiting and 
        retaining minority faculty.
    [(c) Preferences in Providing Scholarships.--The Secretary 
may not make a grant under subsection (a) unless the health 
professions school involved agrees that, in providing 
scholarships pursuant to the grant, the school will give 
preference to students--
          [(1) who are from disadvantaged backgrounds; and
          [(2) for whom the costs of attending the school would 
        constitute a severe financial hardship.
    [(d) Ude of Scholarship.--A scholarship provided pursuant 
to subsection (a) for attendance at a health professions 
school--
          [(1) may be expended only for tuition expenses, other 
        reasonable educational expenses, and reasonable living 
        expenses incurred in such attendance; and
          [(2) may not, for any year of such attendance for 
        which the scholarship is provided, provide an amount 
        exceeding the total amount required for the year for 
        the expenses specified in paragraph (1).
    [(e) Provisions Regarding Purposes Other Than 
Scholarships.--
          [(1) Authority regarding assistance for 
        undergraduates.--With respect to undergraduates who 
        have demonstrated a commitment to pursuing a career in 
        the health professions, a health professions school may 
        expend not more than 25 percent of a grant under 
        subsection (a) for the purpose of providing financial 
        assistance to such undergraduates in order to 
        facilitate the completion of the educational 
        requirements for such careers.
          [(2) Required activities of school.--The Secretary 
        may not make a grant under subsection (a) unless the 
        health professions school involved agrees--
                  [(A) to ensure that adequate instruction 
                regarding minority health issues is provided 
                for in the curricula of the school;
                  [(B) with respect to health clinics providing 
                services to a significant number of individuals 
                who are from disadvantaged backgrounds, 
                including members of minority groups, to enter 
                into arrangements with 1 or more such clinics 
                for the purpose of providing students of the 
                school with experience in providing clinical 
                services to such individuals;
                  [(C) with respect to public or nonprofit 
                secondary educational institutions and 
                undergraduate institutions of higher education, 
                to enter into arrangements with 1 or more such 
                institutions for the purpose of carrying out 
                programs regarding the educational preparation 
                of disadvantaged students, including minority 
                students, to enter the health professions and 
                regarding the recruitment of such students into 
                the health professions;
                  [(D) to establish a mentor program for 
                assisting disadvantaged students, including 
                minority students, regarding the completion of 
                the educational requirements for degrees from 
                the school;
                  [(E) to be carrying out the activities 
                specified in subparagraphs (A) through (D) by 
                not later than 1 year after the date on which a 
                grant under subsection (a) is first made to the 
                school; and
                  [(F) to continue carrying out such 
                activities, and the activities specified in 
                paragraphs (1) and (2) of subsection (b), 
                throughout the period during which the school 
                is receiving a grant under subsection (a).
          [(3) Restrictions on use of grant.--The Secretary may 
        not make a grant under subsection (a) for a fiscal year 
        unless the health profession school involved agrees 
        that the grant will not be expended to carry out the 
        activities specified in paragraph (1) or (2) of 
        subsection (b), or in any of subparagraphs (A) through 
        (D) of paragraph (2) of this subsection.
    [(f) Requirement of Application.--The Secretary may not 
make a grant under subsection (a) unless an application for the 
grant is submitted to the Secretary and the application is in 
such form, is made in such manner, and contains such 
agreements, assurances, and information as the Secretary 
determines to be necessary to carry out this section.
    [(g) Definition.--For purposes of this section, the term 
``school of nursing'' has the meaning given such term in 
section 853.
    [(h) Funding.--
          [(1) Authorization of appropriations.--For the 
        purpose of carrying out this section, there are 
        authorized to be appropriated such sums as may be 
        necessary for fiscal year 1993.
          [(2) Allocations by secretary.--In making grants 
        under subsection (a), the Secretary--
                  [(A) shall, of the amounts appropriated under 
                paragraph (1), make available 30 percent for 
                such grants to schools of nursing; and
                  [(B) shall give special consideration to 
                health professions schools that have 
                enrollments of under represented minorities 
                above the national average for health 
                professions schools.
[SEC. 738. [293b] 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 subsection (b) 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, or another health 
                profession;
                  [(B) are enrolled in an approved graduate 
                training program in medicine, osteopathic 
                medicine, dentistry, or other health 
                profession; or
                  [(C) are enrolled as a full-time student--
                          [(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 853), osteopathic medicine, dentistry, 
        pharmacy, podiatric medicine, optometry, veterinary 
        medicine, or public health, or schools offering 
        graduate programs in clinical psychology.
          [(4) Additional limitation on amount of repayments.--
        Payments made under this subsection regarding the 
        educational loans of an individual may not, for any 
        year for which the payments are made, exceed an amount 
        equal to 20 percent of the outstanding principal and 
        interest on the loans.
          [(5) 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 the 
                individual has not been a member of the faculty 
                of any school at any time during the 18-month 
                period preceding the date on which the 
                Secretary receives the request of the 
                individual for a contract under paragraph (1); 
                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; and
                          [(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.
          [(6) Waiver regarding school contributions.--The 
        Secretary may waive the requirement established in 
        paragraph (5)(B) if the Secretary determines that the 
        requirement will impose an undue financial hardship on 
        the school involved. If the Secretary grants such a 
        waiver, paragraph (4) shall not apply with respect to 
        the individual involved.
          [(7) Applicability of certain provisions.--The 
        provisions of sections 338B, 338C, and 338E 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.
    [(b) Fellowships.--
          [(1) In general.--The Secretary may make grants to 
        and enter into contracts with schools of medicine, 
        osteopathic medicine, dentistry, veterinary medicine, 
        optometry, podiatric medicine, pharmacy, public health, 
        health administration, clinical psychology, and other 
        public or private nonprofit health or educational 
        entities of the type described in section 799, to 
        assist such schools in increasing the number of 
        underrepresented minority faculty members at such 
        schools.
          [(2) Applications.--To be eligible to receive a grant 
        or contract under this subsection, a school shall 
        prepare and submit to the Secretary an application at 
        such time, in such manner, and containing such 
        information as the Secretary may require, including an 
        assurance that--
                  [(A) amounts received under such a grant or 
                contract will be used to award a fellowship to 
                an individual only if--
                          [(i) the individual has not been a 
                        member of the faculty of any school at 
                        any time during the 18-month period 
                        preceding the date on which the 
                        individual submits a request for the 
                        fellowship; and
                          [(ii) the individual meets the 
                        requirements of paragraphs (3) and (4); 
                        and
                  [(B) each fellowship awarded pursuant to the 
                grant or contract will include a stipend in an 
                amount not exceeding 50 percent of the regular 
                salary of a similar faculty member, or $30,000, 
                whichever is less.
          [(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 individuals 
                from underrepresented minorities in health 
                professions 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 
                mentors; 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 
                a second year at a level that is not less than 
                the total amount of Federal and 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 ``minority'' means an individual from a racial 
        or ethnic group that is underrepresented in the health 
        professions.
    [(c) Authorization of Appropriations.--For the purpose of 
carrying out this section, there is authorized to be 
appropriated $4,000,000 for fiscal year 1993.

[SEC. 739. [293c] CENTERS OF EXCELLENCE

    [(a) In General.--The Secretary shall make grants to health 
professions schools described in subsection (c) for the purpose 
of assisting the schools in supporting programs of excellence 
in health professions education for minority individuals.
    [(b) Required Use of Funds.--The Secretary may not make a 
grant under subsection (a) unless the health professions school 
involved agrees to expend the grant--
          [(1) to establish, strengthen, or expand programs to 
        enhance the academic performance of minority students 
        attending the school;
          [(2) to establish, strengthen, or expand programs to 
        increase the number and quality of minority applicants 
        to the school;
          [(3) to improve the capacity of such school to train, 
        recruit, and retain minority faculty;
          [(4) with respect to minority health issues, to carry 
        out activities to improve the information resources and 
        curricula of the school and clinical education at the 
        school; and
          [(5) to facilitate faculty and student research on 
        health issues particularly affecting minority groups.
    [(c) Centers of Excellence.--
          [(1) In general.--
                  [(A) The health professions schools referred 
                to in subsection (a) are such schools that meet 
                each of the conditions specified in 
                subparagraph (B), 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) The conditions specified in this 
                subparagraph are that a health professions 
                school--
                          [(i) has a significant number of 
                        minority individuals enrolled in the 
                        school, including individuals accepted 
                        for enrollment in the school;
                          [(ii) has been effective in assisting 
                        minority students of the school to 
                        complete the program of education and 
                        receive the degree involved;
                          [(iii) has been effective in 
                        recruiting minority individuals to 
                        attend the school, including providing 
                        scholarships and other financial 
                        assistance to such individuals and 
                        encouraging minority students of 
                        secondary educational institutions to 
                        attend the health professions school; 
                        and
                          [(iv) has made significant 
                        recruitment efforts to increase the 
                        number of minority individuals serving 
                        in faculty or administrative positions 
                        at the school.
                  [(C) 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) The conditions specified in this 
                subparagraph are that a health professions 
                school--
                          [(i) is a school described in section 
                        799(1); and
                          [(ii) received a contract under 
                        section 788B for fiscal year 1987, as 
                        such section was in effect for such 
                        fiscal year.
                  [(B) In addition to the purposes described in 
                subsection (b), a grant under subsection (a) to 
                a 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 minority individuals; and
                          [(ii) to provide improved access to 
                        the library and informational resources 
                        of the school.
          [(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 health professions school 
                involved; and
                  [(B) the health professions school agree, 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.
          [(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 health professions school 
                involved;
                  [(B) the health professions school agree, 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 health professions school agree, 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 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 of the 
                                institution who are interested 
                                in a career in the health 
                                profession or professions 
                                involved; and
                                  [(II) to facilitate the 
                                educational preparation of such 
                                students to enter the health 
                                professions school; and
                          [(ii) the 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 
                        health professions school.
          [(5) Other centers of excellence.--The conditions 
        specified in this paragraph are that a health 
        professions school has an enrollment of 
        underrepresented minorities above the national average 
        for such enrollments of health professions schools.
    [(d) Designation as Center of Excellence.--
          [(1) In general.--Any 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 Minority Health Professions Education.
          [(2) Hispanic centers of excellence.--Any 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 
        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.--
          [(1) Authority for collectively meeting relevant 
        requirements.--With respect to meeting the conditions 
        specified in subsection (c)(4), the Secretary may make 
        a grant under subsection (a) to any school of medicine, 
        osteopathic medicine, dentistry, or pharmacy that has 
        in accordance with paragraph (2) formed a consortium of 
        schools that meets such conditions (without regard to 
        whether the schools of the consortium individually meet 
        such conditions).
          [(2) Requirements regarding consortium.--A consortium 
        of schools has been formed in accordance with this 
        paragraph if--
                  [(A) the consortium consists of a school 
                seeking a grant pursuant to paragraph (1) and 1 
                or more schools of medicine, osteopathic 
                medicine, dentistry, pharmacy, nursing, allied 
                health, or public health;
                  [(B) the schools of the consortium have 
                entered into an agreement for the allocation of 
                such grant among the schools;
                  [(C) each of the schools agrees to expend the 
                grant in accordance with this section; and
                  [(D) each of the schools of the consortium--
                          [(i) is part of the same institution 
                        of higher education as the school 
                        seeking the grant; or
                          [(ii) is located not farther than 50 
                        miles from the school seeking the 
                        grant.
    [(f) Duration and Amount of Grant.--
          [(1) Duration.--The period during which payments are 
        made under a grant under subsection (a) may not exceed 
        3 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.
          [(2) Amount.--A grant under subsection (a) for a 
        fiscal year may not be made in an amount that is less 
        than $500,000.
    [(g) Maintenance of Effort.--
          [(1) In general.--With respect to activities for 
        which a grant under subsection (a) is authorized to be 
        expended, the Secretary may not make such a grant to a 
        health professions school for any fiscal year unless 
        the school 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 school for the fiscal year preceding the fiscal 
        year for which the school receives such a grant.
          [(2) Use of federal funds.--With respect to any 
        Federal amounts received by a health professions school 
        and available for carrying out activities for which a 
        grant under subsection (a) is authorized to be 
        expended, the Secretary may not make such a grant to 
        the school for any fiscal year unless the school agrees 
        that the school will, before expending the grant, 
        expend the Federal amounts obtained from sources other 
        than the grant.

    [(h) Definitions.--For purposes of this section:

          [(1)(A) 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, or a school of pharmacy.

          [(B) The definition established in subparagraph (A) 
        shall not apply to the use of the term ``health 
        professions school'' for purposes of subsection (c)(2).

          [(2) The term ``program of excellence'' means any 
        program carried out by a 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) The term ``Native Americans'' means American 
        Indians, Alaskan Natives, Aleuts, and Native Hawaiians.

    [(i) Funding.--

          [(1) Authorization of appropriations.--For the 
        purpose of making grants under subsection (a), there 
        are authorized to be appropriated such sums as may be 
        necessary for fiscal year 1993.

          [(2) Allocations by secretary.--
                  [(A) Of the amounts appropriated under 
                paragraph (1) for a fiscal year, the Secretary 
                shall make available $12,000,000 for grants 
                under subsection (a) to health professions 
                schools that are eligible for such grants 
                pursuant to meeting the conditions described in 
                paragraph (2)(A) of subsection (c).

                  [(B) Of the amounts appropriated under 
                paragraph (1) for a fiscal year and available 
                after compliance with subparagraph (A), the 
                Secretary shall make available 60 percent for 
                grants under subsection (a) to health 
                professions schools that are eligible for such 
                grants pursuant to meeting the conditions 
                described in paragraph (3) or (4) of subsection 
                (c) (including meeting conditions pursuant to 
                subsection (e)).
                  [(C) Of the amounts appropriated under 
                paragraph (1) for a fiscal year and available 
                after compliance with subparagraph (A), the 
                Secretary shall make available 40 percent for 
                grants under subsection (a) to health 
                professions schools that are eligible for such 
                grants pursuant to meeting the conditions 
                described in paragraph (5) of subsection (c).

[SEC. 740. [293d] EDUCATIONAL ASSISTANCE REGARDING UNDERGRADUATES.

    [(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 which offer graduate programs 
        in clinical psychology, 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 health or 
        educational 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 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 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 school of medicine, osteopathic medicine, 
                or dentistry.
                  [(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) at any school 
                described in subsection (a)(1), 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 of $40 per day 
                (notwithstanding any other provision of law 
                regarding the amount of stipends).
        The term ``regular course of education of such a 
        school'' as used in subparagraph (D) includes a 
        graduate program in clinical psychology.
    [(b) Requirements Regarding Enrollment, Priority in Making 
Grants.--
          [(1) Increased enrollment of individuals from 
        disadvantaged backgrounds.--Schools of medicine, 
        osteopathic medicine, public health, dentistry, 
        veterinary medicine, optometry, pharmacy, allied 
        health, chiropractic, podiatric medicine and public and 
        nonprofit schools that offer graduate programs in 
        clinical psychology that receive a grant under 
        subsection (a) shall, during a period of 3 years 
        commencing on the date of the award of the grant, 
        increase their first year enrollments of individuals 
        from disadvantaged backgrounds by at least 20 percent 
        over enrollments in the base year 1987.
          [(2) Conditions for schools to receive priority.--The 
        Secretary shall give priority for funding, in years 
        subsequent to the expiration of the 3-year period 
        described in paragraph (1)--
                  [(A) to schools that attain such increase in 
                their first year enrollment by the end of such 
                3-year period, and
                  [(B) to schools that attain a 20 percent 
                increase over such base year enrollment.
          [(3) Applicability of certain condition for 
        priority.--The requirement for at least a 20 percent 
        increase in such enrollment shall apply only to those 
        schools referred to in paragraph (1) that have a 
        proportionate enrollment of such individuals from 
        disadvantaged backgrounds that is less than 200 percent 
        of the national average percentage of such individuals 
        in all schools of each health professions discipline.
          [(4) Determination of enrollment.--Determination of 
        both first year and total enrollment of such 
        individuals shall be made by the Secretary in 
        accordance with section 792.
    [(c) Equitable Allocation of Financial Assistance.--The 
Secretary shall ensure that services and activities under 
subsection (a) are equitably allocated among the various racial 
and ethnic populations.
      [(d) Funding.--
          [(1) Authorization of appropriations.--For the 
        purpose of grants and contracts under subsection 
        (a)(1), there is authorized to be appropriated 
        $31,500,000 for fiscal year 1993.
          [(2) Allocations.--Of the amounts appropriated under 
        paragraph (1) for any fiscal year, the Secretary shall 
        obligate amounts in accordance with the following.
                  [(A) 70 percent shall be obligated for grants 
                or contracts to institutions of higher 
                education.
                  [(B) 20 percent shall be obligated for 
                scholarships under subsection (a)(2)(F) to 
                individuals of exceptional financial need (as 
                defined by the Secretary under section 736) who 
                are students at schools of medicine, 
                osteopathic medicine, or dentistry. The 
                provision of such scholarships to such 
                individuals shall be subject to section 795 
                (relating to residency training and practice in 
                primary health care). Such scholarships shall 
                be administered and awarded in the same manner 
                and subject to the same requirements as 
                scholarships under section 736.
                  [(C) 10 percent shall be obligated for 
                community-based programs.
                  [(D) Not more than 5 percent may be obligated 
                for grants and contracts having the primary 
                purposes of informing individuals about the 
                existence and general nature of health careers.
          ``Part B--Disadvantaged Health Professions Training

``Sec. 736. Statement of purpose

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

Sec. 737. Preferences

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

Sec. 738. Authorization of appropriation

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

Sec. 739. Definitions

    As used in this part:
          (1) Centers of excellence.--The term ``centers of 
        excellence'' means a health professions school that--
                  (A)(i) has a significant number of minority 
                individuals enrolled in the school, including 
                individuals accepted for enrollment in the 
                school;
                  (ii) has been effective in assisting minority 
                students of the school to complete the program 
                of education and receive the degree involved;
                  (iii) has been effective in recruiting 
                minority individuals to attend the school and 
                encouraging minority students of secondary 
                educational institutions to attend the health 
                professions school; and
                  (iv) has made significant recruitment efforts 
                to increase the number of minority individuals 
                serving in faculty or administrative positions 
                at the school; or
                  (B) is a center of excellence at certain 
                Historically Black Colleges and Universities.
          (2) Consortium.--The term ``consortium'' means the 
        designated eligible entity seeking a grant under this 
        part and one or more schools of medicine, osteopathic 
        medicine, dentistry, pharmacy, nursing, allied health, 
        public health, or graduate programs in mental health 
        practice.
          (3) Eligible entities.--The term ``eligible 
        entities'' means schools of medicine, osteopathic 
        medicine, dentistry, pharmacy, podiatric medicine, 
        optometry, veterinary medicine, public health, or 
        allied health or schools offering graduate programs in 
        mental health practice, State or local governments, and 
        other public or nonprofit private entities determined 
        appropriate by the Secretary that submit to the 
        Secretary an application.
          (4) Historically black colleges and universities.--
        The term ``Historically Black Colleges and 
        Universities'' means a school described in section 
        799B(1) that has received a contract under section 788B 
        for fiscal year 1987, as such section was in effect for 
        such fiscal year.
          * * * * * * *

Sec. 740. Scholarships for disadvantaged students

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

[SEC. 746. AREA HEALTH EDUCATION CENTER PROGRAMS.

    [(a) Authority for Provision of Financial Assistance.--
          [(1) Assistance for planning, development, and 
        operation of programs.--
                  [(A) The Secretary shall provide financial 
                assistance to schools of medicine and 
                osteopathic medicine for the planning, 
                development, and operation of area health 
                education center programs.
                  [(B)(i) Subject to clause (ii), the period 
                during which payments are made from an award 
                under subparagraph (A) may not exceed 12 years. 
                The provision of the payments 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. The preceding sentence may 
                not be construed as establishing a limitation 
                on the number of awards under such subparagraph 
                that may be made to the school involved.
                  [(ii) In the case of an area health education 
                center planned, developed, or operated with an 
                award under subparagraph (A), the period during 
                which the award is expended for the center may 
                not exceed 6 years.
          [(2) Assistance for certain projects of existing 
        programs.--
                  [(A) The Secretary shall provide financial 
                assistance to schools of medicine and 
                osteopathic medicine--
                          [(i) which have previously received 
                        Federal financial assistance for an 
                        area health education center program 
                        under section 802 of the Health 
                        Professions Educational Assistance Act 
                        of 1976 in fiscal year 1979 or under 
                        paragraph (1), or
                          [(ii) which are receiving assistance 
                        under paragraph (1),
                to carry out projects described in subparagraph 
                (B) through area health education centers for 
                which Federal financial assistance was provided 
                under paragraph (1) and which are no longer 
                eligible to receive such assistance.
                  [(B) Projects for which assistance may be 
                provided under subparagraph (A) are--
                          [(i) projects to improve the 
                        distribution, supply, quality, 
                        utilization, and efficiency of health 
                        personnel in the health services 
                        delivery system;
                          [(ii) projects to encourage the 
                        regionalization of educational 
                        responsibilities of the health 
                        professions schools; and
                          [(iii) projects designed to prepare, 
                        through preceptorships and other 
                        programs, individuals subject to a 
                        service obligation under the National 
                        Health Service Corps Scholarship 
                        Program to effectively provide health 
                        services in health professional 
                        shortage areas.
                  [(C) In the case of the requirement 
                established in section 3804(e)(1) of part 57 of 
                title 42, Code of Federal Regulations (42 CFR 
                57.3804(e)(1)) (relating to the location of 
                area health education centers), the Secretary 
                shall waive such requirement with respect to an 
                area health education center having, at the 
                time of initial application for financial 
                assistance under this section or under a 
                previous authorizing law, an operating program 
                supported by both appropriations of a State 
                legislature and local resources.
          [(3) Assistance for Operation of Model Programs.--
                  [(A) In the case of any school of medicine or 
                osteopathic medicine that is operating an area 
                health education center program and that is not 
                receiving financial assistance under paragraph 
                (1), the Secretary may provide financial 
                assistance to the school for the costs of 
                operating the program, and for carrying out 
                activities described in subparagraph (E), if 
                the school makes the agreements described in 
                subparagraphs (B) through (D).
                  [(B)(i) For purposes of subparagraph (A), the 
                agreement described in this subparagraph for a 
                school is that, with respect to the costs of 
                operating the area health education center 
                program of the school, the school will make 
                available (directly or through donations from 
                public or private entities) non-Federal 
                contributions in cash toward such costs in an 
                amount that is not less than 50 percent of such 
                costs.
                  [(ii) Amounts provided by the Federal 
                Government may not be included in determining 
                the amount of non-Federal contributions in cash 
                made for purposes of the requirement 
                established in clause (i).
                  [(C) For purposes of subparagraph (A), the 
                agreement described in this subparagraph for a 
                school is that, in operating the area health 
                education program of the school, the school 
                will--
                          [(i) coordinate the activities of the 
                        program with the activities of any 
                        office of rural health established by 
                        the State or States in which the 
                        program is operating;
                          [(ii) conduct health professions 
                        education and training activities 
                        consistent with national and State 
                        priorities in the area served by the 
                        program in coordination with the 
                        National Health Service Corps, entities 
                        receiving funds under section 329 or 
                        330, and public health departments; and
                          [(iii) cooperate with any entities 
                        that are in operation in the area 
                        served by the program and that receive 
                        Federal or State funds to carry out 
                        activities regarding the recruitment 
                        and retention of health care providers.
                  [(D) For purposes of subparagraph (A), the 
                agreement described in this subparagraph for a 
                school is that, with respect to the costs of 
                operating the area health education center 
                program of the school, the school will maintain 
                expenditures of non-Federal amounts for such 
                costs at a level that is not less than the 
                level of such expenditures maintained by the 
                school for the fiscal year preceding the first 
                fiscal year for which the school receives an 
                award under subparagraph (A).
                  [(E) A school may expend not more than 10 
                percent of an award under subparagraph (A) for 
                demonstration projects for any or all of the 
                following purposes:
                          [(i) The establishment of computer-
                        based information programs or 
                        telecommunication networks that will 
                        link health science centers and service 
                        delivery sites.
                          [(ii) The provision of disease 
                        specific educational programs for 
                        health providers and students in areas 
                        of concern to the United States.
                          [(iii) The development of information 
                        dissemination models to make available 
                        new information and technologies 
                        emerging from biological research 
                        centers to the practicing medical 
                        community.
                          [(iv) The institution of new minority 
                        recruitment and retention programs, 
                        targeted to improved service delivery 
                        in areas the program determines to be 
                        medically underserved.
                          [(v) The establishment of programs to 
                        place physicians from health manpower 
                        shortage areas into similar areas to 
                        encourage retention of physicians and 
                        to provide flexibility to States in 
                        filling positions in health 
                        professional shortage areas.
                          [(vi) The establishment or 
                        improvement of education and training 
                        programs for State emergency medical 
                        systems.
                          [(vii) The establishment of programs 
                        to train health care providers in the 
                        identification and referral of cases of 
                        domestic violence.
                  [(F) The aggregate amount of awards provided 
                under subparagraph (A) to schools in a State 
                for a fiscal year may not exceed the lesser 
                of--
                          [(i) $2,000,000; and
                          [(ii) an amount equal to the product 
                        of $250,000 and the aggregate number of 
                        area health education centers operated 
                        in the State by the schools.
    [(b) Structure of Programs.--
          [(1) In general.--An area health education center 
        program shall be a cooperative program of one or more 
        medical (M.D. and D.O.) schools and one or more 
        nonprofit private or public area health education 
        centers.
          [(2) Certain requirements.--With respect to an area 
        health education center program, a school may not 
        receive an award under paragraph (1) of subsection (a) 
        for operational expenses, or an award under paragraph 
        (2) or (3) of such subsection, unless the program--
                  [(A) maintains preceptorship educational 
                experiences for health science students;
                  [(B) maintains community-based primary care 
                residency programs or is affiliated with such 
                programs;
                  [(C) maintains continuing education programs 
                for health professionals or coordinates with 
                such programs;
                  [(D) maintains learning resource and 
                dissemination systems for information 
                identification and retrieval;
                  [(E) has agreements with community-based 
                organizations for the delivery of education and 
                training in the health professions;
                  [(F) is involved in the training of health 
                professionals (including nurses and allied 
                health professionals), except to the extent 
                inconsistent with the law of the State in which 
                the training is conducted; and
                  [(G) carries out recruitment programs for the 
                health science professions, or programs for 
                health-career awareness, amount minority and 
                other elementary or secondary students from 
                areas the program has determined to be 
                medically underserved.
    [(c) Requirements for Schools.--Each medical (M.D. and 
D.O.) school participating in an area health education center 
program shall--
          [(1) provide for the active participation in such 
        program by individuals who are associated with the 
        administration of the school and each of the 
        departments (or specialties if the school has no such 
        departments) of internal medicine, pediatrics, 
        obstetrics and gynecology, surgery, psychiatry, and 
        family medicine;
          [(2) provide that no less than 10 percent of an 
        undergraduate medical (M.D. and D.O.) clinical 
        education of the school will be conducted in an area 
        health education center and at locations under the 
        sponsorship of such center;
          [(3) be responsible for, or conduct, a program for 
        the training of physician assistants (as defined in 
        section 799) or nurse practitioners (as defined under 
        section 822) which gives special consideration to the 
        enrollment of individuals from, or intending to 
        practice in, the area served by the area health 
        education center of the program; and
          [(4) provide for the active participation of at least 
        2 schools or programs of other health professions 
        (including a school of dentistry and a graduate program 
        of mental health practice if there are ones affiliated 
        with the university with which the school of medicine 
        or osteopathic medicine is affiliated) in the 
        educational program conducted in the area served by the 
        area health education center.
[The requirement of paragraph (3) shall not apply to a medical 
(M.D. and D.O.) school participating in an area health 
education center program if another school participating in the 
same program meets the requirement of that paragraph.
    [(d) Requirements for Centers.--
          [(1) Service area.--Each area health education center 
        shall specifically designate a geographic area in which 
        it will serve, or shall specifically designate a 
        medically underserved population it will serve (such 
        area or population with respect to such center in this 
        section referred to as ``the area served by the 
        center''), which area or population is in a location 
        remote from the main site of the teaching facilities of 
        the school or schools which participate in the program 
        with such center.
          [(2) Other requirements.--Each area health education 
        center shall--
                  [(A) provide for or conduct training in 
                health education services, including education 
                in nutrition evaluation and counseling, in the 
                area served by the center;
                  [(B) assess the health manpower needs of the 
                area served by the center and assist in the 
                planning and development of training programs 
                to meet such needs;
                  [(C) provide for or conduct a rotating 
                osteopathic internship or a medical residency 
                training program in family medicine, general 
                internal medicine, or general pediatrics in 
                which no fewer than four individuals are 
                enrolled in first-year positions in such 
                program;
                  [(D) provide opportunities for continuing 
                medical education (including education in 
                disease prevention) to all physicians and other 
                health professionals (including allied health 
                personnel) practicing within the area served by 
                the center;
                  [(E) provide continuing medical education and 
                other educational support services to the 
                National Health Service Corps members serving 
                within the area served by the center;
                  [(F) conduct interdisciplinary training and 
                practice involving physicians and other health 
                personnel including, where practicable, 
                physician assistants, nurse practitioners, and 
                nurse midwives;
                  [(G) arrange and support educational 
                opportunities for medical and other students at 
                health facilities, ambulatory care centers, and 
                health agencies throughout the area served by 
                the center; and
                  [(H) have an advisory board of which at least 
                75 percent of the members shall be individuals, 
                including both health service providers and 
                consumers, from the area served by the center.
[Any area health education center which is participating in an 
area health education center program in which another center 
has a medical residency training program described in 
subparagraph (C) need not provide for or conduct such a medical 
residency training program.
    [(e) Certain Provisions Regarding Funding.--
          [(1) Programs.--Subject to paragraph (2), in 
        providing financial assistance under this section to a 
        school, the Secretary shall assure that--
                  [(A) at least 75 percent of the total funds 
                provided to the school are expended by an area 
                health education center program in the area 
                health education centers, and that the school 
                enters into an agreement with each of such 
                centers for purposes of specifying the 
                allocation of such 75 percent;
                  [(B) with respect to the operating costs of 
                the area health education program of the 
                school, non-Federal contributions for such 
                costs are made in an amount that is not less 
                than 25 percent of such costs; and
                  [(C) no award provides funds solely for the 
                planning or development of such a program for a 
                period exceeding two years.
        [The Secretary may vest in entities which have received 
        financial assistance under section 802 of the Health 
        Professions Educational Assistance Act of 1976, section 
        774 as in effect before October 1, 1977, or under 
        subsection (a) of this section for area health 
        education centers programs title to any property 
        acquired on behalf of the United States by that entity 
        (or furnished to that entity by the United States) 
        under that award.
          [(2) Centers.--With respect to the period during 
        which an area health education center is planned, 
        developed or operated pursuant to an award under 
        subsection (a)(1), not more than 55 percent of the 
        total amounts expended for the center in any fifth or 
        sixth year of such period may be provided by the 
        Secretary, subject to paragraph (3).
          [(3) Applicability of provision regarding centers.-- 
        Paragraph (2) shall apply only in the case of an area 
        health education center program for which the initial 
        award under subsection (a)(1) is provided on or after 
        the date of the enactment of the Health Professionals 
        Education Extension Amendments of 1992.
    [(f) Health Education and Training Centers.--
          [(1) In general.--The Secretary shall provide 
        financial assistance to schools of medicine and 
        osteopathic medicine for the purpose of planning, 
        developing, establishing, maintaining, and operating 
        health education and training centers--
                  [(A) to improve the supply, distribution, 
                quality, and efficiency of personnel providing 
                health services in the State of Florida or (in 
                the United States) along the border between the 
                United States and Mexico;
                  [(B) to improve the supply, distribution, 
                quality, and efficiency of personnel providing, 
                in other urban and rural areas (including 
                frontier areas) of the United States, health 
                services to any population group, including 
                Hispanic individuals, that has demonstrated 
                serious unmet health care needs; and
                  [(C) to encourage health promotion and 
                disease prevention through public education in 
                the areas described.
          [(2) Arrangements with other entities.--The Secretary 
        may not provide financial assistance under paragraph 
        (1) unless the applicant for such assistance agrees, in 
        carrying out the purpose described in such paragraph, 
        to enter into arrangements with one or more public or 
        nonprofit private entities in the State that have 
        expertise in providing health education to the public.
          [(3) Service area.--The Secretary shall, after 
        consultation with health education and training 
        centers, designate the geographic area in which each 
        such center will carry out the purpose described in 
        paragraph (1). The service area of such a center shall 
        be located entirely within the State in which the 
        center is located. Each border health education and 
        training center shall be located in a county (or other 
        political subdivision) of the State in close proximity 
        to the border between the United States and Mexico.
          [(4) Advisory group; operational plan.--The Secretary 
        may not provide financial assistance under paragraph 
        (1) unless the applicant for such assistance agrees--
                  [(A) to establish an advisory group comprised 
                of health service providers, educators and 
                consumers from the service area and of faculty 
                from participating schools;
                  [(B) after consultation with such advisory 
                group, to develop a plan for carrying out the 
                purpose described in paragraph (1) in the 
                service area;
                  [(C) to enter into contracts, as needed, with 
                other institutions or entities to carry out 
                such plan; and
                [(D) to be responsible for the evaluation of 
                the program.
          [(5) Certain activities.--The Secretary may not 
        provide financial assistance under paragraph (1) unless 
        the applicant for such assistance agrees--
                  [(A) to evaluate the specific service needs 
                for health care personnel in the service area;
                  [(B) to assist in the planning, development, 
                and conduct of training programs to meet the 
                needs identified pursuant to subparagraph (A);
                  [(C) to conduct or support not less than one 
                training and education program for physicians 
                and one program for nurses for at least a 
                portion of the clinical training of such 
                students;
                  [(D) to conduct or support training in health 
                education services, including training to 
                prepare community health workers to implement 
                health education programs in communities, 
                health departments, health clinics, and public 
                schools that are located in the service area;
                  [(E) to conduct or support continuing medical 
                education programs for physicians and other 
                health professionals (including allied health 
                personnel) practicing in the service area;
                  [(F) to support health career educational 
                opportunities designed to provide students 
                residing in the service area with counseling, 
                education, and training in the health 
                professions;
                  [(G) with respect to border health education 
                and training centers, to assist in coordinating 
                its activities and programs carried out 
                pursuant to paragraph (1)(A) with any similar 
                programs and activities carried out in Mexico 
                along the border between the United States and 
                Mexico;
                  [(H) to make available technical assistance 
                in the service area in the aspects of health 
                care organization, financing and delivery; and
                  [(I) in the case of any school of public 
                health located in the service area of the 
                health education and training center operated 
                with the assistance, to permit any such school 
                to participate in the program of the center if 
                the school makes a request to so participate.
          [(6) Allocation of funds by centers.--In carrying out 
        this subsection, the Secretary shall ensure that--
                  [(A) not less than 75 percent of the total 
                funds provided to a school or schools of 
                medicine or osteopathic medicine will be 
                expended in the development and operation of 
                the health education and training center in the 
                service area of such program;
                  [(B) to the maximum extent feasible, the 
                school of medicine or osteopathic medicine will 
                obtain from nongovernmental sources the amount 
                of the total operating funds for such program 
                which are not provided by the Secretary;
                  [(C) no award shall provide funds solely for 
                the planning or development of a health 
                education and training center program for a 
                period in excess of two year;
                  [(D) not more than 10 percent of the annual 
                budget of each program may be utilized for the 
                renovation and equipping of clinical teaching 
                sites; and
                  [(E) no award shall provide funds to be used 
                outside the United States except as the 
                Secretary may prescribe for travel and 
                communications purposes related to the conduct 
                of a border health education and training 
                center.
          [(7) Definitions.--For purposes of this subsection:
                  [(A) The term ``border health education and 
                training center'' means an entity that is a 
                recipient of an award under paragraph (1) and 
                that is carrying out (or will carry out) the 
                purpose described in subparagraph (A) so such 
                paragraph.
                  [(B) The term ``health education and training 
                center'' means an entity that is a recipient of 
                an award under paragraph (1).
                  [(C) The term ``service area'' means, with 
                respect to a health education and training 
                center, the geographic area designated for the 
                center under paragraph (3).
          [(8) Allocation of funds by secretary.--
                  [(A) Of the amounts appropriated pursuant to 
                subsection (i)(2) for a fiscal year, the 
                Secretary shall make available 50 percent for 
                allocations each fiscal year for applications 
                approved by the Secretary for border health 
                education and training centers. The amount of 
                the allocation for each such center shall be 
                determined in accordance with subparagraph (B).
                  [(B) The amount of an allocation under 
                subparagraph (A) for a fiscal year shall be 
                determined in accordance with a formula 
                prescribed by the Secretary, which formal shall 
                be based--
                          [(i) with respect to the service area 
                        of the border health education and 
                        training center involved, on the low-
                        income population, including Hispanic 
                        individuals, in the State of Florida 
                        and along the border between the United 
                        States and Mexico, and the growth rate 
                        of such population;
                          [(ii) on the need of such population 
                        for additional personnel to provide 
                        health care services along such border; 
                        and
                          [(iii) on the most current 
                        information concerning mortality and 
                        morbidity and other indicators of 
                        health status for such population.
    [(g) Definitions.--For purposes of this section:
          [(1) The term ``area health education center 
        program'' means a program which is organized as 
        provided in subsection (b) and under which the 
        participating medical (M.D. and D.O.) schools and the 
        area health education centers meet the requirements of 
        subsections (c) and (d).
          [(2) The term ``award'' means an award of financial 
        assistance.
          [(3) The term ``financial assistance'' means a grant, 
        cooperative agreement, or contract.
    [(h) Criteria and Standards.--The Secretary shall establish 
standards and criteria for the requirements of this section.
    [(i) Authorization of Appropriations.--
          [(1) Area health education center programs.--
                  [(A) For the purpose of carrying out this 
                section other than subsection (f), there is 
                authorized to be appropriated $25,000,000 for 
                each of the fiscal year 1993 through 1995.
                  [(B) Of the amounts appropriated under 
                paragraph (1) for a fiscal year, the Secretary 
                may not obligate more than 20 percent for 
                awards under subsection (a)(2).
                  [(C) Of the amounts appropriated under 
                paragraph (1) for fiscal year 1993, the 
                Secretary shall obligate for awards under 
                subsection (a)(3) such amounts as are 
                appropriated in excess of $19,200,000. Of the 
                amounts appropriated under paragraph (1) for 
                each of the fiscal years 1994 and 1995, the 
                Secretary shall obligate for such awards such 
                amounts as are appropriated in excess of 
                $18,700,000.
          [(2) Health education and training centers.--For the 
        purpose of carrying out subsection (f), there is 
        authorized to be appropriated $5,000,000 for each of 
        the fiscal year 1993 through 1995.]

[SEC. 747. FAMILY MEDICINE.]

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

    (a) * * *
          (1) to plan, develop, and operate, or participate in, 
        an approved professional training program (including an 
        approved residency or internship program) in the field 
        of family medicine internal medicine, or pediatrics for 
        medial (M.D. and D.O.) students, interns (including 
        interns in internship in osteopathic medicine), 
        residents, or practicing physicians; that emphasizes 
        training for the practice of family medicine general 
        internal medicine, of general pediatrics (as defined by 
        the Secretary.)
          (2) to provide financial assistance (in the form of 
        traineeships and fellowships) to medical (M.D. and 
        D.O.) students, interns (including interns in 
        internships in osteopathic medicine), residents, 
        practicing physicians, or other medical personnel, who 
        are in need thereof, who are participants in any such 
        program, and who plan to specialize or work in the 
        practice of family medicine, general internal medicine, 
        or general pediatrics;
          (3) to plan, develop, and operate a program for the 
        training of physicians who plan to teach in family 
        medicine (including geriatrics), general internal 
        medicine (including geriatrics), or general pediatrics 
        training programs; [and]
          (4) to provide financial assistance (in the form of 
        traineeships and fellowships) to physicians who are 
        participants in any such program and who plan to teach 
        in a family medicine (including geriatrics), general 
        internal medicine (including geriatrics), or general 
        pediatrics training program[.];
          (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 projects--
                  (A) to plan and develop new residency 
                training programs and to maintain or improve 
                existing residency training programs in 
                preventive medicine, that have available full-
                time faculty members with training and 
                experience in the fields of preventive 
                medicine; and
                  (B) to provide financial assistance to 
                residency trainees enrolled in such programs.
    (b) Academic Administrative Units.--
          (1) In general.--The Secretary may make grants to or 
        enter into contracts with schools of medicine or 
        osteopathic medicine to meet the costs of projects to 
        establish, maintain, or improve academic administrative 
        units (which may be departments, divisions, or other 
        units) to provide clinical instruction in family 
        medicine, general internal medicine, or general 
        pediatrics.
          (2) Preference in making awards.--In making awards of 
        grants and contracts under paragraph (1), the Secretary 
        shall give preference to any qualified applicant for 
        such an award that agrees to expend the award for the 
        purpose of--
                  (A) establishing an academic administrative 
                unit for programs in family medicine, general 
                internal medicine, or general pediatrics; or
                  (B) substantially expanding the programs of 
                such a unit.
          (7) to meet the costs of planning, developing, or 
        operating programs, and to provide financial assistance 
        to residents in such programs, that would lead to a 
        significantly greater ratio of participating 
        individuals in such programs eventually entering 
        practice in general dentistry in rural and medically 
        underserved communities compared to the current ratio 
        of all dentists nationally practicing general dentistry 
        in rural and medically underserved communities.
For purposes of paragraph (7), entities eligible for such 
grants or contracts shall include entities that have programs 
in dental schools, approved residency programs in the general 
practice of dentistry, or approved advanced education programs 
in the general practice of dentistry. The Secretary may only 
fund programs under such paragraph if such programs provide a 
significant amount of care for underserved populations and 
other high-risk groups, and if the Secretary determines that 
there is a national shortage of general dentists.
    (c) Priority and Limitation.--
          (1) Priority.--With respect to programs for the 
        training of interns or residents, the Secretary shall 
        give priority in awarding grants under this section to 
        qualified applicants that have a record of training the 
        greatest percentage of providers, or that have 
        demonstrated significant improvements in the percentage 
        of providers, which enter and remain in primary care 
        practice or general dentistry upon completion of their 
        first period of training required to obtain initial 
        board certification. Each program shall designate the 
        primary care training or general dentistry positions 
        that such program shall provide with grant funding to 
        support and for which such program shall be held 
        accountable regarding the primary care or general 
        dentistry requirement set forth in this section.
          (2) Limitation.--With respect to programs for the 
        training and education of medical students, the 
        Secretary may only provide grants or contracts under 
        this section to administrative units in general 
        pediatrics or general internal medicine if a qualified 
        administrative unit applicant demonstrates that its 
        medical school has--
                  (A) a mission statement that has a primary 
                care medical education objection;
                  (B) faculty role models and administrative 
                units in primary care; and
                  (C) required undergraduate ambulatory medical 
                student clerkships in family medicine, internal 
                medicine, and pediatrics.
          Where a medical school does not have an 
        administrative unit in family medicine clerkships in 
        family medicine shall not be required.
    [(c)] (d) Duration of Award.--The period during which 
payments are made to an entity from an award of a grant or 
contract under subsection (a) may not exceed 5 years. The 
provision of such payments 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.
    [(d)] (e) Funding.--
          (1) Authorization of appropriations.--For the purpose 
        of carrying out this section, there is authorized to be 
        appropriated [$54,000,000 for each of the fiscal years 
        1993 through 1995.] $76,000,000 for fiscal year 1996, 
        and such sums as may be necessary for each of the 
        fiscal years 1997 through 1999.
          (2) Allocation.--Of the amounts appropriated under 
        paragraph (1) for a fiscal year, the Secretary shall 
        make available not less than [20] 12 percent for awards 
        of grants and contracts under subsection (b) for family 
        medicine academic administrative units.
[SEC. 748. GENERAL INTERNAL MEDICINE AND GENERAL PEDIATRICS.

    [(a) In General.--The Secretary may make grants to and 
enter into contracts with schools of medicine and osteopathic 
medicine, public or private nonprofit hospitals, or any other 
public or private nonprofit entity to meet the costs of 
projects--
          [(1) to plan, develop, and operate, or participate 
        in, an approved professional training program 
        (including an approved residency or internship program) 
        in the field of internal medicine or pediatrics for 
        medical (M.D. and D.O.) students, interns (including 
        interns in internships in osteopathic medicine), 
        residents, or practicing physicians, which training 
        program emphasizes training for the practice of general 
        internal medicine or general pediatrics (as defined by 
        the Secretary in regulations);
          [(2) to provide financial assistance (in the form of 
        traineeships and fellowships) to medical (M.D. and 
        D.O.) students, interns (including interns in 
        internships in osteopathic medicine), residents, 
        practicing physicians, or other medical personnel, who 
        are in need thereof, who are participants in any such 
        training program, and who plan to specialize in or work 
        in the practice of general internal medicine or general 
        pediatrics;
          [(3) to plan, develop, and operate a program for the 
        training of physicians who will teach in a general 
        internal medicine or general pediatrics training 
        program; and
          [(4) which provide financial assistance (in the form 
        of traineeships and fellowships) to physicians who are 
        participants in any such program and who plan to teach 
        in a general internal medicine or general pediatrics 
        training program.
    [(b) Duration of Award.--The period during which payments 
are made to an entity from an award of a grant or contract 
under subsection (a) may not exceed 5 years. The provision of 
such payments 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.
    [(c) Authorization of Appropriations.--For the purpose of 
carrying out this section, there is authorized to be 
appropriated $25,000,000 for each of the fiscal years 1993 
through 1995.

[SEC. 749. GENERAL PRACTICE OF DENTISTRY.

    [(a) In General.--The Secretary may make grants to, and 
enter into contracts with, any public or nonprofit private 
school of dentistry or accredited postgraduate dental training 
institution--
          [(1) to plan, develop, and operate an approved 
        residency program in the general practice of dentistry 
        or an approved advanced educational program in the 
        general practice of dentistry;
          [(2) to provide financial assistance (in the form of 
        traineeships and fellowships) to participants in such a 
        program who are in need of financial assistance and who 
        plan to specialize in the practice of general 
        dentistry; and
          [(3) to fund innovative, nontraditional models for 
        the provision of postdoctoral General Dentistry 
        training.
    [(b) Authorization of Appropriations.--For the purpose of 
carrying out this section, there is authorized to be 
appropriated $6,000,000 for each of the fiscal years 1993 
through 1995.

[SEC. 750. PHYSICIAN ASSISTANTS.

    [(a) In General.--The Secretary may make grants to and 
enter into contracts with public or nonprofit private schools 
of medicine and osteopathic medicine and other public or 
nonprofit private entities to meet the costs of projects to 
plan, develop, and operate or maintain programs--
          [(1) for the training of physician assistants (as 
        defined in section 799); and
          [(2) for the training of individuals who will teach 
        programs of such training.
    [(b) Regulations.--After consultation with appropriate 
organizations, the Secretary shall prescribe regulations for 
programs receiving assistance under subsection (a) for the 
training of physician assistants. Such regulations shall, as a 
minimum, require that such a program--
          [(1) extend for at least one academic year and 
        consist of--
                  [(A) supervised clinical practice; and
                  [(B) at least four months (in the aggregate) 
                of classroom instruction, directed toward 
                preparing students to deliver health care;
          [(2) have an enrollment of not less than eight 
        students; and
          [(3) train students in primary care, disease 
        prevention, health promotion, geriatric medicine, and 
        home health care.
    [(c) Placement of Graduates.--No grant or contract may be 
made under subsection (a) unless the school or other entity 
involved provides assurances satisfactory to the Secretary that 
the school or entity has appropriate mechanisms for placing 
graduates of the training program with respect to which the 
application is submitted in positions for which they have been 
trained.
    [(d) Funding.--
          [(1) Authorization of appropriations.--For the 
        purpose of carrying out this section, there is 
        authorized to be appropriated $9,000,000 for each of 
        the fiscal years 1993 through 1995.
          [(2) Limitation.--Not more than 10 percent of the 
        amounts appropriated under paragraph (1) may be 
        expended for carrying out subsection (a)(2).

[SEC. 751. PODIATRIC MEDICINE.

    [(a) In General.--The Secretary may make grants to, and 
enter into contracts with, public and nonprofit private 
hospitals and schools of podiatric medicine for the purpose of 
planning and implementing projects in primary care training for 
podiatric physicians in approved or provisionally approved 
residency programs which shall provide financial assistance in 
the form of traineeships to residents who participate in such 
projects and who plan to specialize in primary care.
    [(b) Preference in Making Grants.--In making grants under 
subsection (a), the Secretary shall give preference to 
qualified applicants that provide clinical training in 
podiatric medicine in a variety of medically underserved 
communities.
    [(c) Authorization of Appropriations.--For the purpose of 
carrying out this section, there is authorized to be 
appropriated $1,000,000 for each of the fiscal years 1993 
through 1995.

[SEC. 752. GENERAL PROVISIONS.

    [(a) Traineeships and Fellowships.--
          [(1) Traineeships.--Payments by recipients of grants 
        or contracts under this part for traineeships shall be 
        limited to such amounts as the Secretary finds 
        necessary to cover the cost of tuition and fees of, and 
        stipends and allowances (including travel and 
        subsistence expenses and dependency allowances) for the 
        trainees.
          [(2) Fellowships.--Payments by recipients of grants 
        or contracts under this part for fellowships shall be 
        limited to such amounts as the Secretary finds 
        necessary to cover the cost of advanced study by, and 
        stipends and allowances (including travel and 
        subsistence expenses and dependency allowances) for the 
        fellows.
    [(b) Amount of Grant.--The amount of any grant or contract 
under this part shall be determined by the Secretary.]

[SEC. 750. [293n] PHYSICIAN ASSISTANTS.

    [(a) In General.--The Secretary may make grants to and 
enter into contracts with public or nonprofit schools of 
medicine and osteopathic medicine and other public or nonprofit 
private entities to meet the costs of projects to plan, 
develop, and operate or maintain programs--
          [(1) for the training of physician assistants (as 
        defined in section 799); and
          [(2) for the training of individuals who will teach 
        programs of such training.
    [(b) Regulations.--After consultation with appropriate 
organizations, the Secretary shall prescribe regulations for 
programs receiving assistance under subsection (a) for the 
training of physician assistants. Such regulations shall, as a 
minimum, require that such a program--
          [(1) extend for at least one academic year and 
        consist of--
                  [(A) supervised clinical practice; and
                  [(B) at least four months (in the aggregate) 
                of classroom instruction, directed toward 
                preparing students to deliver health care;
          [(2) have an enrollment of not less than eight 
        students; and
          [(3) train students in primary care, disease 
        prevention, health promotion, geriatric medicine, and 
        home health care.
    [(c) Placement of Graduates.--No grant or contract may be 
made under subsection (a) unless the school or other entity 
involved provides assurances satisfactory of the Secretary that 
the school or entity has appropriate mechanisms for placing 
graduates of the training program with respect to which the 
application is submitted in positions for which they have been 
trained.
    [(d) Funding.--
          [(1) Authorization of appropriations.--For the 
        purpose of carrying out this section, there is 
        authorized to be appropriated $9,000,000 for each of 
        the fiscal years 1993 through 1995.
          [(2) Limitation.--Not more than 10 percent of the 
        amounts appropriated under paragraph (1) may be 
        expended for carrying out subsection (a)(2).

[SEC. 751. [293n] PODIATRIC MEDICINE.

    [(a) In General.--The Secretary may make grants to, and 
enter into contracts with, public and nonprofit private 
hospitals and schools of podiatric medicine for the purpose of 
planning and implementing projects in primary care training for 
podiatric physicians in approved or provisionally approved 
residency programs which shall provide financial assistance in 
the form of traineeships to residents who participate in such 
projects and who plan to specialize in primary care.
    [(b) Preference in Making Grants.--In making grants under 
subsection (a), the Secretary shall give preference to 
qualified applicants that provide clinical training in 
podiatric medicine in a variety of medically underserved 
communities.
    [(c) Authorization of Appropriations.--For the purpose of 
carrying out this section, there is authorized to be 
appropriated $1,000,000 for each of the fiscal years 1993 
through 1995.]

                 Part D--Area Health Education Centers

Sec. 750. Area health education centers
    (a) In General.--The Secretary may award grants to and 
enter into contracts with eligible entities for projects 
which--
          (1) improve the recruitment, distribution, supply, 
        quality, utilization, and efficiency of personnel 
        providing health services in urban and rural areas and 
        to populations that have demonstrated serious unmet 
        health care need;
          (2) encourage the regionalization of educational 
        responsibilities of the health professions schools;
          (3) are designed to prepare, through field 
        placements, preceptorships, the conduct of or 
        affiliation with community-based primary care residency 
        programs, agreements with community-based organizations 
        for the delivery of education and training in the 
        health professions, and other programs, individuals to 
        effectively provide health services in health 
        professional shortage areas;
          (4) conduct health professions education and training 
        activities consistent with national and State 
        priorities, including geriatrics;
          (5) encourage health promotion and disease prevention 
        activities;
          (6) conduct interdisciplinary training and practice 
        involving other health professionals;
          (7) conduct continuing education programs for health 
        professionals or coordinate with such programs; and
          (8) address other areas as determined appropriate by 
        the Secretary.
    (b) Preferences.--In awarding grants or contracts to 
eligible entities under this part, the Secretary shall give 
preference to projects that--
          (1) involve more than one health professions 
        discipline or training institution; and
          (2) have a good record of retention and graduation of 
        individuals that enter practice in medically 
        underserved communities.
    (c) Other Eligible Programs.--
          (1) Geriatric education centers.--The Secretary shall 
        award grants or contracts under this section for the 
        establishment or operation of geriatric education 
        centers.
          (2) Public health training centers.--
                  (A) In general.--The Secretary shall award 
                grants or contracts under this section for the 
                operation of public health training centers.
                  (B) Eligible entities.--A public health 
                training center shall be an accredited school 
                of public health, or another public or 
                nonprofit private institution accredited for 
                the provision of graduate or specialized 
                training in public health, that plans, 
                develops, operates, and evaluates projects that 
                are in furtherance of the goals established by 
                the Secretary for the year 2000 in the areas of 
                preventive medicine, health promotion and 
                disease prevention, or improving access to and 
                quality of health services in medically 
                underserved communities.
                  (C) Certain requirements.--With respect to a 
                public health training center, an award may not 
                be made with subparagraph (A) unless the 
                program agrees that it--
                          (i) will establish or strengthen 
                        field placements for students in public 
                        or non-profit private health agencies 
                        or organizations; and
                          (ii) will involve faculty members and 
                        students in collaborative projects to 
                        enhance public health services to 
                        medically underserved communities.
    (d) Eligible Entities.--As used in this part, the term 
``eligible entities'' means schools of medicine, osteopathic 
medicine, dentistry, pharmacy, podiatric medicine, optometry, 
veterinary medicine, public health, or allied health or schools 
offering graduate programs in mental health practice or 
physician assistant training programs, State or local 
governments, and other public or nonprofit private entities 
determined appropriate by the Secretary that submit to the 
Secretary an application.
    (e) Geriatric Education Centers.--A geriatric education 
center shall be an accredited health professions school or 
program that--
          (1) improves the training of health professionals in 
        geriatrics, including geriatric residencies, 
        traineeships, or fellowships;
          (2) develops and disseminates curricula relating to 
        the treatment of the health problems of elderly 
        individuals;
          (3) supports the training and retraining of faculty 
        to provide instruction in geriatrics;
          (4) supports continuing education of health 
        professionals who provide geriatric care; and
          (5) provides students with clinical training in 
        geriatrics in nursing homes, chronic and acute disease 
        hospitals, ambulatory care centers, and senior centers.
Sec. 751. Authorization of appropriations

    There are authorized to be appropriated to carry out this 
part, $43,000,000 for fiscal year 1996, such sums as may be 
necessary for each of the fiscal years 1997 and 1998, and 
$29,000,000 for fiscal year 1999.
          * * * * * * *
[SEC. 795. OBLIGATED SERVICE REGARDING CERTAIN PROGRAMS.

    [(a) In General.--In the case of any program under this 
title under which a scholarship, stipend, or other financial 
assistance is provided to an individual with respect to 
education as a health professional (including a program that 
provides for the repayment of loans), if the program provides 
that the provision of the financial assistance involved is 
subject to this section, then the assistance may be provided 
only if the individual makes agreements as follows:
          [(1) The individual will complete the program of 
        education with respect to which such assistance is 
        provided (in the case of assistance provided for 
        purposes other than the repayment of loans).
          [(2) In the case of an individual who receives such 
        assistance with respect to attendance at a school of 
        medicine or osteopathic medicine, the individual will--
                  [(A) enter and complete a residency training 
                program in a specialty in primary health care 
                not later than 4 years after completing the 
                program of education described in paragraph 
                (1); and
                  [(B) practice in the specialty for 5 years 
                after completing the residency training 
                program.
          [(3) In the case of an individual who receives such 
        assistance with respect to attendance at a school of 
        dentistry, the individual will practice in general 
        dentistry for 5 years (exclusive of any period during 
        which the individual is attending a residency training 
        program in general dentistry).
          [(4) Subsection (b) applies with respect to the 
        breach of agreements made under any of paragraphs (1) 
        through (3).
    [(b) Breach of Agreements.--
          [(1) In general.--For purposes of subsection (a)(4), 
        the following applies:
                  [(A) In the case of a program under this 
                title that provides financial assistance for 
                attendance at a program of education in a 
                health profession, the individual is liable to 
                the Federal Government for the amount of the 
                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 
                        program of education (as indicated by 
                        such program in accordance with 
                        requirements established by the 
                        Secretary);
                          [(ii) is dismissed from the program 
                        for disciplinary reasons; or
                          [(iii) voluntarily terminates the 
                        program.
                  [(B) The individual is liable to the Federal 
                Government for the amount of the 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 comply with 
                the agreement made under subsection (a)(2).
          [(2) Waiver or suspension of liability.--In the case 
        of an individual making agreements under subsection 
        (a), the Secretary shall provide for the waiver or 
        suspension of liability under paragraph (1) if 
        compliance by the individual with the agreements 
        involved is impossible, or would involve extreme 
        hardship to the individual, and if enforcement of the 
        agreements with respect to the individual 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 
        three-year period beginning on the date the United 
        States becomes so entitled.]
Sec. 762. Health professions workforce development

    (a) In General.--The Secretary may award grants to and 
enter into contracts with eligible entities for projects to 
strengthen capacity for health professions education and 
practice.
    (b) Eligible Applicants.--Applicants eligible to obtain 
funds under subsection (a) shall include schools of medicine, 
osteopathic medicine, dentistry, veterinary medicine, pharmacy, 
podiatric medicine, chiropractic medicine, optometry, public 
health, or allied health, graduate programs in mental health 
practice, physician assistant training programs, and other 
public and nonprofit private entities.
    (c) Priority Areas.--In awarding grants or contracts under 
subsection (a), the Secretary shall give priority to entities 
that will use amounts provided under such grants or contracts 
to enhance the education of health professionals for purposes 
of--
          (1) providing care for underserved populations and 
        other high-risk groups;
          (2) increasing the number of individuals who are 
        pursuing a course of study in a health professions 
        field in which there is a severe shortage of health 
        professionals;
          (3) conducting health professions research and data 
        collection; and
          (4) carrying out other activities in areas determined 
        appropriate by the Secretary.
    (d) Authorization of Appropriations.--
          (1) In general.--There are authorized to be 
        appropriated to carry out this section, $16,000,000 for 
        fiscal year 1996, such sums as may be necessary for 
        each of the fiscal years 1997 and 1998, and $5,000,000 
        for fiscal year 1999.
          (2) Reservation.--Of the amounts appropriated under 
        subsection (a) for a fiscal year, the Secretary shall 
        reserve not less than $2,000,000 for conducting health 
        professions research and for carrying out data 
        collection and analysis in accordance with section 792.
SEC. 792. HEALTH PROFESSIONS DATA.

    (a) In General.--The Secretary shall establish a program 
including a uniform health professions data reporting system, 
to collect, compile, and analyze data on health professions 
personnel which program shall initially include data respecting 
all physicians and dentists in the States. The Secretary [is 
authorized to] shall expand the program to include, whenever he 
determines it necessary, the collection, compilation, and 
analysis of data respecting pharmacists, optometrists, 
podiatrists, veterinarians, public health personnel, 
audiologists, speech pathologists, health care administration 
personnel, nurses, allied health personnel, medical 
technologists, chiropractors, clinical psychologists, clinical 
social workers, and any other health personnel in States 
designated by the Secretary to be included in the program. Such 
data shall include data respecting the training, licensure 
status (including permanent, temporary, partial, limited, or 
institutional), place or places of practice, professional 
specialty, practice characteristics, place and date of birth, 
sex, and socio-economic background of health professions 
personnel and such other demographic information regarding 
health professions personnel as the Secretary may require.

                  TITLE III--MISCELLANEOUS PROVISIONS

SEC. [301.] 763. ADVISORY COUNCIL ON GRADUATE MEDICAL EDUCATION.

    (a) Establishment; Duties.--There is established the 
Council on Graduate Medical Education (in this section referred 
to as the ``Council''). The Council shall--
          (1) make recommendations to the Secretary of Health 
        and Human Services (in this section referred to as the 
        ``Secretary''), and to the Committee on Labor and Human 
        Resources of the Senate, and the Committee on Energy 
        and Commerce of the House of Representatives, with 
        respect to--
                  (A) the supply and distribution of physicians 
                in the United States;
                  (B) current and future shortages or excesses 
                of physicians in medical and surgical 
                specialties and subspecialties;
                  (C) issues relating to foreign medical school 
                graduates;
                  (D) appropriate Federal policies with respect 
                to the matters specified in subparagraphs (A), 
                (B), and (C), including policies concerning 
                changes in the financing of undergraduate and 
                graduate medical education programs and changes 
                in the types of medical education training in 
                graduate medical education programs;
                  (E) appropriate efforts to be carried out by 
                hospitals, schools of medicine, schools of 
                osteopathic medicine, and accrediting bodies 
                with respect to the matters specified in 
                subparagraphs (A), (B), and (C), including 
                efforts for changes in undergraduate and 
                graduate medical education programs; and
                  (F) deficiencies in, and needs for 
                improvements in, existing data bases concerning 
                the supply and distribution of, and 
                postgraduate training programs for, physicians 
                in the United States and steps that should be 
                taken to eliminate those deficiencies; and
          (2) encourage entities providing graduate medical 
        education to conduct activities to voluntarily achieve 
        the recommendations of the Council under paragraph 
        (1)(E).
    (b) Composition.--The Council shall be composed of--
          (1) the Assistant Secretary for Health or the 
        designee of the Assistant Secretary;
          (2) the Administrator of the Health Care Financing 
        Administration;
          (3) the Chief Medical Director of the Department of 
        Veterans Affairs;
          (4) 6 members appointed by the Secretary to include 
        representatives of practicing primary care physicians, 
        national and speciality physician organizations, 
        foreign medical graduates, and medical student and 
        house staff associations;
          (5) 4 members appointed by the Secretary to include 
        representatives of schools of medicine and osteopathic 
        medicine and public and private teaching hospitals; and
          (6) 4 members appointed by the Secretary to include 
        representatives of health insurers, business, and 
        labor.
    (c) Terms of Appointed Members.--
          (1) In general; staggered rotation.--Members of the 
        Council appointed under paragraphs (4), (5), and (6) of 
        subsection (b) shall be appointed for a term of 4 
        years, except that the term of office of the members 
        first appointed shall expire, as designated by the 
        Secretary at the time of appointment, 4 at the end of 1 
        year, 4 at the end of 2 years, 3 at the end of 3 years, 
        and 3 at the end of 4 years.
          (2) Date certain for appointment.--The Secretary 
        shall appoint the first members to the Council under 
        paragraphs (4), (5), and (6) of subsection (b) within 
        60 days after the date of enactment of this section.
    (d) Chair.--The Council shall elect one of its members as 
Chairman of the Council.
    (e) Quorum.--Nine members of the Council shall constitute a 
quorum, but a lesser number may hold hearings.
    (f) Vacancies.--Any vacancy in the Council shall not affect 
its power to function.
    (g) Compensation.--Each member of the Council who is not 
otherwise employed by the United States Government shall 
receive compensation at a rate equal to the daily rate 
prescribed for GS-18 under the General Schedule under section 
5332 of title 5, United States Code, for each day, including 
traveltime, such member is engaged in the actual performance of 
duties as a member of the Council. A member of the Council who 
is an officer or employee of the United States Government shall 
serve without additional compensation. All members of the 
Council shall be reimbursed for travel, subsistence, and other 
necessary expenses incurred by them in the performance of their 
duties.
    (h) Certain Authorities and Duties.--
          (1) Authorities.--In order to carry out the 
        provisions of this section, the Council is authorized 
        to--
                  (A) collect such information, hold such 
                hearings, and sit and act at such times and 
                places, either as a whole or by subcommittee, 
                and request the attendance and testimony of 
                such witnesses and the production of such 
                books, records, correspondence, memoranda, 
                papers, and documents as the Council or such 
                subcommittee may consider available; and
                  (B) request the cooperation and assistance of 
                Federal departments, agencies, and 
                instrumentalities, and such departments, 
                agencies, and instrumentalities are authorized 
                to provide such cooperation and assistance.
          (2) Coordination of activities.--The Council shall 
        coordinate its activities with the activities of the 
        Secretary under section 792 of the Public Health 
        Service Act. The Secretary shall, in cooperation with 
        the Council and pursuant to the recommendations of the 
        Council, take such steps as are practicable to 
        eliminate deficiencies in the data base established 
        under such section 792 and shall make available in its 
        reports such comprehensive data sets as are developed 
        pursuant to this section.
    (i) Requirement Regarding Reports.--In the reports required 
under subsection (a), the Council shall specify its activities 
during the period for which the report is made.
    (j) Final Report.--Not later than April 1, [1995] 1999. the 
Council shall submit a final report under subsection (a).
    (k) Termination.--The Council shall terminate September 30, 
[1995] 1999.
    (l) Funding.--Amounts otherwise appropriated under this 
title may be utilized by the Secretary to support the 
activities of the Council.
                     PART [G] F--GENERAL PROVISIONS

SEC. 791. PREFERENCES AND REQUIRED INFORMATION IN CERTAIN PROGRAMS.

    (a) Preferences in Making Awards.--
          (1) In general.--Subject to paragraph (2), in making 
        awards of grants or contracts under any of [sections 
        747 through 751, under section 763, or under section 
        766 or 767] section 747, the Secretary shall give 
        preference to any qualified applicant that--
          * * * * * * *
          (2) Limitation regarding peer review.--For purposes 
        of paragraph (1), the Secretary may not give an 
        applicant preference if the proposal of the applicant 
        is ranked at or below the 20th percentile of proposals 
        that have been recommended for approval by peer review 
        groups [under section 798(a)].
          * * * * * * *
    [(b) Required Submission of Information.--The Secretary may 
make an award of a grant or contract under any of sections 747 
through 751 or under section 763, 766, or 767 only if the 
applicant for the award submits to the Secretary (through the 
application required in section 798(f)(2)) the following 
information regarding the programs of the applicant:
          [(1) A description of rotations or preceptorships for 
        students, or clinical training programs for residents, 
        that have the principal focus of providing health care 
        to medically underserved communities.
          [(2) The number of faculty on admissions committees 
        who have a clinical practice in community-based 
        ambulatory settings in medically underserved 
        communities.
          [(3) With respect to individuals who are from 
        disadvantaged backgrounds or from medically underserved 
        communities, the number of such individuals who are 
        recruited for academic programs of the applicant, the 
        number of such individuals who are admitted to such 
        programs, and the number of such individuals who 
        graduate from such programs.
          [(4) If applicable, the number of recent graduates 
        who have chosen careers in primary health care.
          [(5) The number of recent graduates whose practices 
        are serving medically underserved communities.
          [(6) A description of whether and to what extent the 
        applicant is able to operate without Federal assistance 
        under this title.]
    [(c)](b) Definition.--For purposes of this section, the 
term ``graduate'' means, unless otherwise specified, an 
individual who has successfully completed all training and 
residency requirements necessary for full certification in the 
health profession selected by the individual.
    (c) Exceptions for New Programs.--
          (1) In general.--To permit new programs to compete 
        equitably for funding under this section, those new 
        programs that meet the criteria described in paragraph 
        (3) shall qualify for a funding preference under this 
        section.
          (2) Definition.--As used in this subsection, the term 
        `new program' means any program that has graduated less 
        than three classes. Upon graduating at least three 
        classes, a program shall have the capability to provide 
        the information necessary to qualify the program for 
        the general funding preferences described in subsection 
        (a).
          (3) Criteria.--The criteria referred to in paragraph 
        (1) are the following:
                  (A) The mission statement of the program 
                identifies a specific purpose of the program as 
                being the preparation of health professionals 
                to serve underserved populations.
                  (B) The curriculum of the program includes 
                content which will help to prepare 
                practitioners to serve underserved populations.
                  (C) Substantial clinical training experience 
                is required under the program in medically 
                underserved communities.
                  (D) A minimum of 20 percent of the clinical 
                faculty of the program spend at least 50 
                percent of their time providing or supervising 
                care in medically underserved communities.
                  (E) The entire program or a substantial 
                portion of the program is physically located in 
                a medically underserved community.
                  (F) Student assistance, which is linked to 
                service in medically underserved communities 
                following graduation, is available to the 
                students in the program.
                  (G) The program provides a placement 
                mechanism for deploying graduates to medically 
                underserved communities.
                  [collection of data on birth defects

    [Sec. 317C. [247b-4] (a) State Programs.--
          [(1) In general.--The Secretary, acting through the 
        Director of the Centers for Disease Control and 
        Prevention, shall encourage States to establish or 
        improve programs for the collection and analysis of 
        epidemiological data on birth defects.
          [(2) Provision of assistance.--The Secretary may, 
        directly or through grants, cooperative agreements, or 
        contracts, provide assistance to States regarding the 
        purpose specified in subsection (a).
    [(b) National Clearinghouse.--The Secretary, acting through 
the Director of the Centers for Disease Control and Prevention, 
shall establish and maintain a National Information 
Clearinghouse on Birth Defects to collect and disseminate to 
health professionals and the general public information on 
birth defects, including the prevention of such defects.
    [(c) Report.--Not later than July 1, 1993, and biennially 
thereafter, the Secretary shall submit to the Committee on 
Energy and Commerce of the House of Representatives, and the 
Committee on Labor and Human Resources of the Senate, a report 
describing activities carried out under this section and 
containing any recommendations of the Secretary regarding this 
section.
    [(d) Authorization of Appropriations.--For the purpose of 
carrying out this section, there are authorized to be 
appropriated $5,000,000 for fiscal year 1993, and such sums as 
may be necessary for each of the fiscal years 1994 and 1995.]
                    programs regarding birth defects


    Sec. 317C. (a) The Secretary, acting through the Director 
of the Centers for Disease Control and Prevention, shall carry 
out programs--
          (1) to collect, analyze, and make available data on 
        birth defects (in a manner that facilitates compliance 
        with subsection (d)(2)), including data on the causes 
        of such defects and on the incidence and prevalence of 
        such defects; and
          (2) to operate regional centers for the conduct of 
        applied epidemiological research on the prevention of 
        such defects.
    (b) Additional Provisions Regarding Collection of Data.--
          (1) In general.--In carrying out subsection (a)(1), 
        the Secretary--
                  (A) shall collect and analyze data by gender 
                and by racial and ethnic group, including 
                Hispanics, non-Hispanic whites, Blacks, Native 
                Americans, Asian Americans, and Pacific 
                Islanders;
                  (B) shall collect data under subparagraph (A) 
                from birth certificates, death certificates, 
                hospital records, and such other sources as the 
                Secretary determines to be appropriate; and
                  (C) shall encourage States to establish or 
                improve programs for the collection and 
                analysis of epidemiological data on birth 
                defects, and to make the data available.
          (2) National clearinghouse.--In carrying out 
        subsection (a)(1), the Secretary shall establish and 
        maintain a National Information Clearinghouse on Birth 
        Defects to collect and disseminate to health 
        professionals and the general public information on 
        birth defects, including the prevention of such 
        defects.
    (c) Grants and Contracts.--
          (1) In general.--In carrying out subsection (a), the 
        Secretary may make grants to and enter into contracts 
        with public and nonprofit private entities.
          (2) Supplies and services in lieu of award funds.--
                  (A) Upon the request of a recipient of an 
                award of a grant or contract under paragraph 
                (1), the Secretary may, subject to subparagraph 
                (B), provide supplies, equipment, and services 
                for the purpose of aiding the recipient in 
                carrying out the purposes for which the award 
                is made and, for such purposes, may detail to 
                the recipient any officer or employee of the 
                Department of Health and Human Services.
                  (B) With respect to a request described in 
                subparagraph (A), the Secretary shall reduce 
                the amount of payments under the award involved 
                by an amount equal to the costs of detailing 
                personnel and the fair market value of any 
                supplies, equipment, or services provided by 
                the Secretary. The Secretary shall, for the 
                payment of expenses incurred in complying with 
                such request, expend the amounts withheld.
          (3) Application for award.--The Secretary may make an 
        award of a grant or contract under paragraph (1) only 
        if an application for the award is submitted to the 
        Secretary and the application is in such form, is made 
        in such manner, and contains such agreements, 
        assurances, and information as the Secretary determines 
        to be necessary to carry out the purposes for which the 
        award is to be made.
    (d) Biennial Report.--Not later than February 1 of fiscal 
year 1997 and of every second such year thereafter, the 
Secretary shall submit to the Committee on Energy and Commerce 
of the House of Representatives, and the Committee on Labor and 
Human Resources of the Senate, a report that, with respect to 
the preceding 2 fiscal years--
          (1) contains information regarding the incidence and 
        prevalence of birth defects and the extent to which 
        birth defects have contributed to the incidence and 
        prevalence of infant mortality;
          (2) contains information under paragraph (1) that is 
        specific to various racial and ethnic groups (including 
        Hispanics, non-Hispanic whites, Blacks, Native 
        Americans, and Asian Americans);
          (3) contains an assessment of the extent to which 
        various approaches of preventing birth defects have 
        been effective;
          (4) describes the activities carried out under this 
        section; and
          (5) contains any recommendations of the Secretary 
        regarding this section.
          * * * * * * *
                  [PART E--SPECIAL TRAINING PROJECTS]

             Part E_Health Profession Workforce Development

SEC. [776. [294n]] 761 ACQUIRED IMMUNE DEFICIENCY SYNDROME.

    (a) Schools; Centers.--
          * * * * * * *

[SEC. 777. [294o] GERIATRICS.

    [(a) Geriatic Education Centers.--The Secretary may make 
grants to and enter into contracts with accredited health 
professions schools or programs described in paragraph (1), 
(3), or (4) of section 799 or in section 853(2) to assist in 
meeting the costs of such schools or programs of projects to--
          [(1) improve the training of health professionals in 
        geriatrics;
          [(2) develop and disseminate curricula relating to 
        the treatment of the health problems of elderly 
        individuals;
          [(3) expand and strengthen instruction in methods of 
        such treatment;
          [(4) support the training and retraining of faculty 
        to provide such instruction;
          [(5) support continuing education of health 
        professionals and allied health professionals who 
        provide such treatment; and
          [(6) establish new affiliations with nursing homes, 
        chronic and acute disease hospitals, ambulatory care 
        centers, and senior centers in order to provide 
        students with clinical training in geriatric medicine.
    [(b) Geriatic 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 and dentists who plan to 
        teach geriatric medicine, geriatric psychiatry, 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 psychiatry;
                  [(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 based in a graduate medical education 
                program in internal medicine or family medicine 
                or in a department of geriatrics or psychiatry;
                  [(D) 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 psychiatry 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
                  [(E) 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 psychiatry at schools 
                        of medicine and osteopathic medicine; 
                        and
                          [(ii) dentists who are faculty 
                        members at schools of dentistry or at 
                        hospital departments of dentistry.
                  [(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, 
                        psychiatry, neurology, gynecology, or 
                        rehabilitation medicine; and
                          [(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.
          [(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 
                        subspecialities 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 specialities 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 Training Regarding Optometrists.--The 
Secretary may make grants to, and enter into contracts with, 
schools and colleges of optometry for the purpose of providing 
support for projects--
          [(1) to plan, develop, and operate projects in 
        postgraduate geriatric care training for optometrists 
        who will teach geriatric optometry;
          [(2) to provide financial assistance (in the form of 
        residencies, traineeships, and fellowships) to 
        participants in such projects; and
          [(3) to establish new affiliations with nursing 
        homes, ambulatory care centers, senior centers, and 
        other public or nonprofit private entities.
    [(d) Authorization of Appropriations.--
          [(1) Education centers; training.--For grants and 
        contracts under subsections (a) and (b), there is 
        authorized to be appropriated $17,000,000 for each of 
        the fiscal years 1993 through 1995.
          [(2) Optometry.--For grants and contracts under 
        subsection (c), there is authorized to be appropriated 
        $400,000 for each of the fiscal years 1993 through 
        1995.

[SEC. 778 [294P] RURAL AREAS.

    [(a) Grants.--The Secretary may make grants to, or enter 
into contracts with, any eligible applicant to help such 
applicant fund authorized activities under an application 
approved under subsection (d).
    [(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 in 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) Eligible Applicants.--Applicants eligible to obtain 
funds under subsection (a) shall include local health 
departments, nonprofit organizations and public or nonprofit 
colleges, universities, or schools of, or programs that 
specialize in, nursing, mental health practice, optometry, 
public health, dentistry, osteopathy, physicians assistants, 
pharmacy, podiatry, medicine, chiropractic, and allied health 
professions if such applicants submit applications approved by 
the Secretary under subsection (d). Applicants eligible to 
obtain funds under subsection (a) shall not include for-profit 
entities, either directly or through a subcontract or subgrant.
    [(d) Applications.--
          [(1) Submission.--In order to receive a grant under 
        subsection (a) an entity shall submit an application to 
        the Secretary.
          [(2) Forms.--An application submitted under the 
        subsection shall be in such form, be submitted by such 
        date, and contain such information as the Secretary 
        shall require.
          [(3) Applications.--Applications submitted under this 
        subsection shall--
                  [(A) 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;
                  [(B) 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 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; and
                  [(C) provide any additional information 
                required by the Secretary.
    [(e) Definitions.--For the purposes of this section, the 
term ``rural'' mans geographic areas that are located outside 
of standard metropolitan statistical areas.
    [(f) Authorization of Appropriations.--For the purpose of 
carrying out this section, there is authorized to be 
appropriated $7,000,000 for each of the fiscal years 1993 
through 1995.]
          * * * * * * *

                  [PART G] PART F--GENERAL PROVISIONS

SEC. 791. PREFERENCES AND REQUIRED INFORMATION IN CERTAIN PROGRAMS.

    (a) Preferences in Making Awards.--
          (1) In general.--Subject to paragraph (2), in making 
        awards of grants or contracts under any of [section 747 
        through 751, under section 763, or under section 766 or 
        767], section 747 the Secretary shall give preference 
        to any qualified applicant that--
          * * * * * * *
          (2) Limitation regarding peer review.--For purposes 
        of paragraph (1), the Secretary may not give an 
        applicant preference if the proposal of the applicant 
        is ranked at or below the 20th percentile of proposals 
        that have been recommended for approval by peer review 
        groups [under section 798(a)] as such section existed 
        one day prior to the date of enactment of the Health 
        Professions Education Consolidation and Reauthorization 
        Act of 1995.
    [(b) Required Submission of Information.--The Secretary may 
make an award of a grant or contract under any of sections 747 
through 751 or under section 763, 766, or 767 only if the 
applicant for the award submits to the Secretary (through the 
application required in section 798(f)(2)) the following 
information regarding the programs of the applicant;
          [(1) A description of rotations or preceptorships for 
        students, or clinical training programs for residents, 
        that have the principal focus of providing health care 
        to medically underserved communities.
          [(2) The number of faculty on admissions committees 
        who have a clinical practice in community-based 
        ambulatory settings in medically underserved 
        communities.
          [(3) With respect to individuals who are from 
        disadvantaged backgrounds or from medically underserved 
        communities, the number of such individuals who are 
        recruited for academic programs of the applicant, the 
        number of such individuals who are admitted to such 
        programs, and the number of such individuals who 
        graduate from such programs.
          [(4) If applicable, the number of recent graduates 
        who have chosen careers in primary health care.
          [(5) The number of recent graduates whose practices 
        are serving medically underserved communities.
          [(6) A description of whether and to what extent the 
        applicant is able to operate without Federal assistance 
        under this title.]
          * * * * * * *
    (d) Exceptions for New Programs.--
          (1) In general.--To permit new programs to compete 
        equitably for funding under this section, those new 
        programs that meet the criteria described in paragraph 
        (3) shall qualify for a funding preference under this 
        section.
          (2) Definition.--As used in this subsection, the term 
        `new program' means any program that has graduated less 
        than three classes. Upon graduating at least three 
        classes, a program shall have the capability to provide 
        the information necessary to qualify the program for 
        the general funding preferences described in subsection 
        (a).
          (3) Criteria.--The criteria referred to in paragraph 
        (1) are the following:
                  (A) The mission statement of the program 
                identifies a specific purpose of the program as 
                being the preparation of health professionals 
                to serve underserved populations.
                  (B) The curriculum of the program includes 
                content which will help to prepare 
                practitioners to serve underserved populations.
                  (C) Substantial clinical training experience 
                is required under the program in medically 
                underserved communities.
                  (D) A minimum of 20 percent of the clinical 
                faculty of the program spend at least 50 
                percent of their time providing or supervising 
                care in medically underserved communities.
                  (E) The entire program or a substantial 
                portion of the program is physically located in 
                a medically underserved community.
                  (F) Student assistance, which is linked to 
                service in medically underserved communities 
                following graduation, is available to the 
                students in the program.
                  (G) The program provides a placement 
                mechanism for deploying graduates to medically 
                underserved communities.
          * * * * * * *

SEC. 794. [295m] PROHIBITION AGAINST DISCRIMINATION ON BASIS OF SEX.

          * * * * * * *

Sec. 794a. Recovery

    (a) In General.--If at any time within 20 years (or within 
such shorter period as the Secretary may prescribe by 
regulation for an interim facility) after the completion of 
construction of a facility with respect to which funds have 
been paid under section 720(a) (as such section existed one day 
prior to the date of enactment of the Health Professions 
Education Extension Amendments of 1992 (Public Law 102-408)--
          (1)(A) in case of a facility which was an affiliated 
        hospital or outpatient facility with respect to which 
        funds have been paid under such section 720(a)(1), the 
        owner of the facility ceases to be a public or other 
        nonprofit agency that would have been qualified to file 
        an application under section 605;
          (B) in case of a facility which was not an affiliated 
        hospital or outpatient facility but was a facility with 
        respect to which funds have been paid under paragraph 
        (1) or (3) of such section 720(a), the owner of the 
        facility ceases to be a public or non-profit school, or
          (C) in case of a facility which was a facility with 
        respect to which funds have been paid under such 
        section 720(a)(2), the owner of the facility ceases to 
        be a public or nonprofit entity,
          (2) the facility ceases to be used for the teaching 
        or training purposes (or other purposes permitted under 
        section 722 (as such section existed one day prior to 
        the date of enactment of the Health Professions 
        Education Extension Amendments of 1992 (Public Law 102-
        408)) for which it was constructed, or
          (3) the facility is used for sectarian intrusion or 
        as a place for religious worship,
the United States shall be entitled to recover from the owner 
of the facility the base amount prescribed by subsection (c)(1) 
plus the interest (if any) prescribed by subsection (c)(2).
    (b) Notice.--The owner of a facility which ceases to be a 
public or nonprofit agency, school, or entity as described in 
subparagraph (A), (B), or (C) of subsection (a)(1), as the case 
may be, or the owner of a facility the use of which changes as 
described in paragraph (2) or (3) of subsection (a), shall 
provide the Secretary written notice of such cessation or 
change of use within 10 days after the date on which such 
cessation or change of use occurs or within 30 days after the 
date of enactment of this subsection, whichever is later.
    (c) Amount.--
          (1) Base Amount.--The base amount that the United 
        States is entitled to recover under subsection (a) is 
        the amount bearing the same ratio to the then value (as 
        determined by the agreement of the parties or in an 
        action brought in the district court of the United 
        States for the district in which the facility is 
        situated) of the facility as the amount of the Federal 
        participation bore to the cost of construction.
          (2) Interest.--
                  (A) In general.--The interest that the United 
                States is entitled to recover under subsection 
                (a) is the interest for the period (if any) 
                described in subparagraph (B) at a rate 
                (determined by the Secretary) based on the 
                average of the bond equivalent rates of ninety-
                one-day Treasury bills auctioned during that 
                period.
                  (B) Period.--The period referred to in 
                subparagraph (A) is the period beginning--
                          (i) if notice is provided as 
                        prescribed by subsection (b), 191 days 
                        after the date on which the owner of 
                        the facility ceases to be a public or 
                        nonprofit agency, school, or entity as 
                        described in subparagraph (A), (B), or 
                        (C) of subsection (a)(1), as the case 
                        may be, or 191 days after the date on 
                        which the use of the facility changes 
                        as described in paragraph (2) or (3) of 
                        subsection (a), or
                          (ii) if notice is not provided as 
                        prescribed by subsection (b), 11 days 
                        after the date on which such cessation 
                        or change of use occurs,
                and ending on the date the amount the United 
                States is entitled to recover is collected.
    (d) Waiver.--The Secretary may waive the recovery rights of 
the United States under subsection (a)(2) with respect to a 
facility (under such conditions as the Secretary may establish 
by regulation) if the Secretary determines that there is good 
cause for waiving such rights.
    (e) Lien.--The right of recovery of the United States under 
subsection (a) shall not, prior to judgment, constitute a lien 
on any facility.
          * * * * * * *
[SEC. 795. [295n] OBLIGATED SERVICE REGARDING CERTAIN PROGRAMS.

    [(a) In General.--In the case of any program under this 
title under which a scholarship, stipend, or other financial 
assistance is provided to an individual with respect to 
education as a health professional (including a program that 
provides for the repayment of loans), if the program provides 
that the provision of the financial assistance involved is 
subject to this section, then the assistance may be provided 
only if the individual makes agreements as follows:
          [(1) The individual will complete the program of 
        education with respect to which such assistance is 
        provided (in the case of assistance provided for 
        purposes other than the repayment of loans).
          [(2) In the case of an individual who receives such 
        assistance with respect to attendance at a school of 
        medicine or osteopathic medicine, the individual will--
                  [(A) enter and complete a residency training 
                program in a specialty in primary health care 
                not later than 4 years after completing the 
                program of education described in paragraph 
                (1); and
                  [(B) practice in the speciality for 5 years 
                after completion the residency training 
                program.
          [(3) In the case of an individual who receives such 
        assistance with respect to attendance at a school of 
        dentistry, the individual will practice in general 
        dentistry for 5 years (exclusive of any period during 
        which the individual is attending a residency training 
        program in general dentistry).
          [(4) Subsection (b) applies with respect to the 
        breach of agreements made under any of paragraphs (1) 
        through (3).
    [(b) Breach of Agreements.--
          [(1) In General.--For purposes of subsection (a)(4), 
        the following applies:
                  [(A) In the case of a program under this 
                title that provides financial assistance for 
                attendance at a program of education in a 
                health profession, the individual is liable to 
                the Federal Government for the amount of the 
                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 
                        program of education (as indicated by 
                        such program in accordance with 
                        requirements established by the 
                        Secretary);
                          [(ii) is dismissed from the program 
                        for disciplinary reasons; or
                          [(iii) voluntarily terminates the 
                        program.
                  [(B) The individual is liable to the Federal 
                Government for the amount of the 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 comply with 
                the agreement made under subsection (a)(2).
          [(2) Waiver or suspension of liability.--In the case 
        of an individual making agreements under subsection 
        (a), the Secretary shall provide for the waiver or 
        suspension of liability under paragraph (1) if 
        compliance by the individual with the agreements 
        involved is impossible, or would involve extreme 
        hardship to the individual, and if enforcement of the 
        agreements with respect to the individual 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 
        three-year period beginning on the date the United 
        States becomes so entitled.
Sec. 796. Application

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

Sec. 797. Use of funds

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

Sec. 798. Matching requirement

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

Sec. 799. Generally applicable provisions

    (a) Awarding of Grants and Contracts.--The Secretary shall 
ensure that grants and contracts under this title are awarded 
on a competitive basis, as appropriate, to carry out innovative 
demonstration projects or provide for strategic workforce 
supplementation activities as needed to meet health workforce 
goals and in accordance with this title. Contracts may be 
entered into under this title with public or private entities 
as may be necessary.
    (b) Information Requirements.--Recipients of grants and 
contracts under this title shall meet information requirements 
as specified by the Secretary .
    (c) Training Programs.--Training programs conducted with 
amounts received under this title shall meet applicable 
accreditation and quality standards.
    (d) Duration of Assistance.--
          (1) In general.--Subject to paragraph (2), in the 
        case of an award to an entity of a grant, cooperative 
        agreement, or contract under this title, the period 
        during which payments are made to the entity under the 
        award may not exceed 5 years. The provision of payments 
        under the award shall be subject to annual approval by 
        the Secretary of the payments and subject to the 
        availability of appropriations for the fiscal year 
        involved to make the payments. This paragraph may not 
        be construed as limiting the number of awards under the 
        program involved that may be made to the entity.
          (2) Limitation.--In the case of an award to an entity 
        of a grant, cooperative agreement, or contract under 
        this title, paragraph (1) shall apply only to the 
        extent not inconsistent with any other provision of 
        this title that relates to the period during which 
        payments may be made under the award.
    (e) Peer Review Regarding Certain Programs.--Each 
application for a grant under this title, except any 
scholarship or loan program, including those under sections 
701, 721, or 723, shall be submitted to a peer review group for 
an evaluation of the merits of the proposals made in the 
application. The Secretary may not approve such an application 
unless a peer review group has recommended the application for 
approval. Each peer review group under this subsection shall be 
composed principally of individuals who are not officers or 
employees of the Federal Government. This subsection shall be 
carried out by the Secretary acting through the Administrator 
of the Health Resources and Services Administration.
    (f) Preference or Priority Considerations.--In considering 
a preference or priority for funding which is based on outcome 
measures for an eligible entity under this title, the Secretary 
may also consider the future ability of the eligible entity to 
meet the outcome preference or priority through improvements in 
the eligible entity's program design.

SEC. 799A TECHNICAL ASSISTANCE.

    Funds appropriated under this title may be used by the 
Secretary to provide technical assistance in relation to any of 
the authorities under this title.
SEC. [799.] 799B. DEFINITIONS.

    For purposes of this title:
          (1)(A) * * *
           * * * * * * *
          (B) The terms ``graduate program in health 
        administration'' and ``graduate [program in clinical 
        psychology]'' graduate programs leading to licensure in 
        professional psychology mean an accredited graduate 
        program in a public or nonprofit private institution in 
        a State that provides training leading, respectively, 
        to a graduate degree in health administration or an 
        equivalent degree and a doctoral degree in clinical 
        psychology or an equivalent degree.
           * * * * * * *
          (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 [health] care under the supervision of 
                a physcian; and
                  [(B) meets regulations prescribed by the 
                Secretary in accordance with section 750(b).]
                  (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.
           * * * * * * *
          (6) The term ``medically underserved community'' 
        means an urban or rural area or population that--
                  (A) is eligible for designation under section 
                332 as a health professional shortage area;
                  (B) is eligible to be served by a migrant 
                health center under section 329, a community 
                health center under section 330, a grantee 
                under section 340 (relating to homeless 
                individuals), or a grantee under section 340A 
                (relating to residents of public housing); [or]
                  (C) has a shortage of personal health 
                services, as determined under criteria issued 
                by the Secretary under section 1861(aa)(2) of 
                the Social Security Act (relating to rural 
                health clinics[.];
                  (D) is a State or local health department 
                that has a severe shortage of public health 
                personnel as determined under criteria 
                established by the Secretary;
                  (E) has ambulatory practice sites designated 
                by State Governors as shortage areas or 
                medically underserved communities for purposes 
                of State scholarships or loan repayment or 
                related programs; or
                  (F) has practices or facilities in which not 
                less than 50 percent of the patients are 
                recipients of aid under title XIX of the Social 
                Security Act or eligible and uninsured.
          * * * * * * *
          (11) The term ``programs for the training of 
        physician assistants'' means a program that--
                  (A) 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;
                  (B) has an enrollment of not less than eight 
                students; and
                  (C) trains students in primary care, disease 
                prevention, health promotion, geriatric 
                medicine, and home health care.

                      [TITLE VIII--NURSE EDUCATION

                       [Part A--Special Projects

                [Subpart I--Special Projects in General

                 [special project grants and contracts

    [Sec. 820. (a) Expansion of Enrollment in Professional 
Nursing programs.--
          [(1) In general.--The Secretary may make grants to 
        and enter into contracts with public and nonprofit 
        private schools of nursing with programs of education 
        in professional nursing for the purpose of assisting 
        the schools in increasing the number of students 
        enrolled in such programs. Such a grant or contract may 
        be made only with respect to such programs that are in 
        operation on the date of the enactment of the Health 
        Professions Education Extension Amendments of 1992.
          [(2) Preference.--In making awards of grants and 
        contracts under paragraph (1), the Secretary shall give 
        preference to any qualified school that provides 
        students of the school with clinical training in the 
        provision of primary health care in publicly-funded--
                  [(A) urban or rural outpatient facilities, 
                home health agencies, or public health 
                agencies; or
                  [(B) rural hospitals.
          [(3) Matching funds.--
                  [(A) With respect to the costs of the program 
                to be carried out by a school pursuant to 
                paragraph (1), the Secretary may provide an 
                award of a grant or contract under such 
                paragraph only if the school agrees to make 
                available (directly or through donations from 
                public or private entities) non-Federal 
                contributions toward such costs in an amount 
                that--
                          [(i) for the first fiscal year for 
                        which the school receives such an 
                        award, is not less than $1 for each $9 
                        of Federal funds provided through the 
                        award (10 percent of such costs);
                          [(ii) for any second such fiscal 
                        year, is not less than $1 for each $3 
                        of Federal funds provided through the 
                        award (25 percent of such costs);
                          [(iii) for any third such fiscal 
                        year, is not less than $1 for each $1 
                        of Federal funds provided through the 
                        award (50 percent of such costs); and
                          [(iv) for any fourth or fifth such 
                        fiscal year, is not less than $3 for 
                        each $1 of Federal funds provided 
                        through the award (75 percent of such 
                        costs).
                  [(B) Non-Federal contributions required in 
                subparagraph (A) may be in cash or in kind, 
                fairly evaluated, including plant, equipment, 
                or services. Amounts provided by the Federal 
                Government, or services assisted or subsidized 
                to any significant extent by the Federal 
                Government, may not be included in determining 
                the amount of such non-Federal contributions.
    [(b) Primary Health Care in Noninstitutional Settings.--
          [(1) In general.--The Secretary may make grants to 
        and enter into contracts with public and nonprofit 
        private schools of nursing for the establishment of 
        expansion of nursing practice arrangements in 
        noninstitutional settings to demonstrate methods to 
        improve access to primary health care in medically 
        underserved communities.
          [(2) Operation and staffing programs.--The Secretary 
        may make an award of a grant or contract under 
        paragraph (1) only if the school involved agrees that 
        the program carried out with the award will be operated 
        and staffed by the faculty and students of the school.
          [(3) Design.--The Secretary may make an award of a 
        grant or contract under paragraph (1) only if the 
        program to be carried out under such paragraph by the 
        school involved is designed to provide at least 25 
        percent of the students of the school with a structured 
        clinical experience in primary health care.
    [(c) Continuing Education for Nurses in Medically 
Underserved Communities.--The Secretary may make grants to and 
enter into contracts with public and nonprofit private entities 
for the purpose of providing continuing education for nurses 
serving in medically underserved communities.
    [(d) Long-Term Care Fellowships for Certain 
Paraprofessionals.--
          [(1) In general.--The Secretary may make grants to 
        and enter into contracts with public and nonprofit 
        private entities that operate accredited programs of 
        education in professional nursing, or State-board 
        approved programs of practical or vocational nursing, 
        for the purpose of providing fellowships to individuals 
        described in paragraph (2) for attendance in such 
        programs.
          [(2) Eligible individuals.--The individuals referred 
        to in paragraph (1) are individuals who are employed by 
        nursing facilities or home health agencies as nursing 
        paraprofessionals.
          [(3) Preference for schools with rapid transition 
        programs.--In making awards of grants and contracts 
        under paragraph (1), the Secretary shall give 
        preference to any qualified applicant operating an 
        accredited program of education in professional nursing 
        that provides for the rapid transition to status as a 
        professional nurse from status as a nursing 
        paraprofessional.
          [(4) Preference in award of fellowships.--The 
        Secretary may make an award of a grant or contract 
        under paragraph (1) only if the applicant involved 
        agree that, in providing fellowships under the award, 
        the applicant will give preference to individuals 
        described in paragraph (2) who--
                  [(A) are economically disadvantaged 
                individuals, particularly such individuals who 
                are members of a minority group that is 
                underrepresented among registered nurses; or
                  [(B) are employed by a nursing facility that 
                will assist in paying the costs or expenses 
                described in paragraph (5)(A) with respect to 
                the individuals.
          [(5) Use of award.--The Secretary may make an award 
        of a grant or contract under paragraph (1) only if the 
        applicant involved agrees that fellowships provided 
        with the award will pay all or part of the costs of--
                  [(A) the tuition, books, and fees of the 
                program of nursing with respect to which the 
                fellowship is provided; and
                  [(B) reasonable living expenses of the 
                individual during the period for which the 
                fellowship is provided.
          [(6) Definition.--For purposes of this section:
                  [(A) The term ``home health agency'' has the 
                meaning given such term in section 1861 of the 
                Social Security Act.
                  [(B) The term ``nursing facility'' has the 
                meaning given such term in section 1919 of the 
                Social Security Act.
    [(e) Authorization of Appropriations.--For the purpose of 
carrying out this section, there is authorized to be 
appropriated $10,500,000 for each of the fiscal years 1993 and 
1994.

                       [advanced nurse education

    [Sec. 821. (a) In General.--The Secretary may make grants 
to and enter into contracts with public and nonprofit private 
collegiate schools of nursing to meet the costs of projects 
that, in the case of programs described in subsection (b)--
          [(1) plan, develop, and operate new such programs; or
          [(2) significantly expand existing such programs.
    [(b) Authorized Programs.--The programs referred to in 
subsection (a) are programs leading to advanced degrees that 
prepare nurses to serve as nurse educators or public health 
nurses, or in other clinical nurse specialties determined by 
the Secretary to require advanced education.
    [(c) Funding.--
          [(1) Authorization of appropriations.--For the 
        purpose of carrying out this section, there are 
        authorized to be appropriated $12,000,000 for each of 
        the fiscal years 1993 and 1994.
          [(2) Limitation.--Of the amounts appropriated under 
        paragraph (1), the Secretary may not obligate more than 
        10 percent for providing grants or contracts under 
        subsection (a) for programs leading to doctoral 
        degrees.

             [nurse practitioner and nurse midwife programs

    [Sec. 822. (a) In General.--The Secretary may make grants 
to and enter into contracts with public and nonprofit private 
schools of nursing or other public and nonprofit private 
entities to meet the costs of projects that, with respect to 
programs described in subsection (b)--
          [(1) plan, develop, and operate new such programs; or
          [(2) maintain or significantly expand existing such 
        programs.
    [(b) Authorized Programs.--
          [(1) In general.--The programs referred to in 
        subsection (a) are educational programs for registered 
        nurses (irrespective of the type of school of nursing 
        in which the nurses received their training) that--
                  [(A) meet guidelines prescribed by the 
                Secretary in accordance with paragraph (2); and
                  [(B) have as their objective the education of 
                nurses who will, upon completion of their 
                studies in such programs, be qualified to 
                effectively provide primary health care, 
                including primary health care in homes and in 
                ambulatory care facilities, long-term care 
                facilities and other health care institutions.
          [(2) Guidelines.--After consultation with appropriate 
        educational organizations and professional nursing and 
        medical organizations, the Secretary shall prescribe 
        guidelines for programs described in paragraph (1). 
        Such guidelines shall, as a minimum, require that such 
        a program--
                  [(A) extend for at least one academic year 
                and consist of--
                          [(i) supervised clinical practice 
                        directed toward preparing nurses to 
                        deliver primary health care; and
                          [(ii) at least four months (in the 
                        aggregate) of classroom instruction 
                        that is so directed; and
                  [(B) have an enrollment of not less than six 
                full-time equivalent students.
      [(c) Certain Considerations in Making Awards.--
          [(1) Preference.--In making awards of grants and 
        contracts under subsection (a), the Secretary shall 
        give preference to any qualified applicant that, with 
        respect to programs described in subsection (b), agrees 
        to expend the award to plan, develop, and operate new 
        such programs or to significantly expand existing such 
        programs.
          [(2) Special consideration.--In making awards of 
        grants and contracts under subsection (a), the 
        Secretary shall give special consideration to qualified 
        applicants that agree to expend the award to train 
        individuals as nurse practitioners and nurse midwives 
        who will practice in health professional shortage areas 
        designated under section 332.
    [(d) Authorization of Appropriations.--For the purpose of 
carrying out this section, there is authorized to be 
appropriated $20,000,000 for each of the fiscal years 1993 and 
1994.

   [Subpart II--Nursing Education Opportunities for Individuals From 
                       Disadvantaged Backgrounds

                           [special projects

    [Sec. 827. (a) The Secretary may make grants to public and 
nonprofit private schools of nursing and other public or 
nonprofit private entities, and enter into contracts with any 
public or private entity, to meet the costs of special projects 
to increase nursing education opportunities for individuals 
from disadvantaged backgrounds, as determined in accordance 
with criteria prescribed by the Secretary--
          [(1) by identifying, recruiting, and selecting such 
        individuals,
          [(2) by facilitating the entry of such individuals 
        into schools of nursing,
          [(3) by providing counseling or other services 
        designed to assist such individuals to complete 
        successfully their nursing education,
          [(4) by providing, for a period prior to the entry of 
        such individuals into the regular course of education 
        at a school of nursing, preliminary education designed 
        to assist them to complete successfully such regular 
        course of education,
          [(5) by paying such stipends (including allowances 
        for travel and dependents) as the Secretary may 
        determine for such individuals for any period of 
        nursing education,
          [(6) by publicizing, especially to licensed 
        vocational or practical nurses, existing sources of 
        financial aid available to persons enrolled in schools 
        of nursing or who are undertaking training necessary to 
        qualify them to enroll in such schools, and
          [(7) by providing training, information, or advice to 
        the faculty of such schools with respect to encouraging 
        such individuals to complete the programs of nursing 
        education in which the individuals are enrolled.
    [(b) No grant or contract may be made under this section 
unless an application therefor has been submitted to and 
approved by the Secretary. The Secretary may not approve or 
disapprove such an application except after consultation with 
the National Advisory Council on Nurse Education. Such an 
application shall provide for such fiscal control and 
accounting procedures and reports, and access to the records of 
the applicant, as the Secretary may require to assure proper 
disbursement of and accounting for Federal funds paid to the 
applicant under this section.
    [(c) For payments under grants and contracts under 
subsection (a), there are authorized to be appropriated 
$3,000,000 for fiscal year 1989, $4,000,000 for fiscal year 
1990, $5,000,000 for fiscal year 1991, $5,000,000 for fiscal 
year 1993, and $6,000,000 for fiscal year 1994.

                [Part B--Assistance to Nursing Students

                        [Subpart I--Traineeships

      [traineeships for advanced education of professional nurses

    [Sec. 830. (a) In General.--The Secretary may make grants 
to public and nonprofit private entities to meet the costs of--
          [(1) traineeships for individuals in advanced-degree 
        programs in order to educate the individuals to serve 
        in and prepare for practice as nurse practitioners, 
        nurse midwives, nurse educators, public health nurses, 
        or in other clinical nursing specialties determined by 
        the Secretary to require advanced education; and
          [(2) traineeships for participation in certificate 
        nurse mid-wifery programs that conform to guidelines 
        established by the Secretary under section 822(b).
    [(b) Special Consideration in Making Grants.--In making 
grants for traineeships under subsection (a), the Secretary 
shall give special consideration to applications for 
traineeship programs that conform to guidelines established by 
the Secretary under section 822(b)(2).
    [(c) Preference in Provision of Traineeships.--The 
Secretary may make a grant under subsection (a) only if the 
applicant involved agrees that, in providing traineeships under 
such subsection, the applicant will give preference to 
individuals who are residents of health professional shortage 
areas designated under section 332.
    [(d) Eligibility of Individuals in Master's Degree 
Programs.--The Secretary may make a grant under subsection (a) 
only if the applicant involved agrees that the applicant will 
not provide a traineeship under such subsection to an 
individual enrolled in a masters of nursing program unless the 
individual has completed basic nursing preparation, as 
determined by the applicant.
    [(e) Use of Grant.--The Secretary may make a grant under 
subsection (a) only if the applicant involved agrees that 
traineeships provided with the grant will pay all or part of 
the costs of--
          [(A) the tuition, books, and fees of the program of 
        nursing with respect to which the traineeship is 
        provided; and
          [(B) reasonable living expenses of the individual 
        during the period for which the traineeship is 
        provided.
    [(f) Funding.--
          [(1) Authorization of appropriations.--For the 
        purpose of carrying out this section, there is 
        authorized to be appropriated $20,000,000 for each of 
        the fiscal years 1993 and 1994.
          [(2) Limitation regarding certain traineeships.--Of 
        the amounts appropriated under paragraph (1) for a 
        fiscal year, the Secretary may not obligate more than 
        10 percent for providing traineeships under subsection 
        (a) for individuals in doctoral degree programs.

                           nurse anesthetists

    [Sec. 831. (a)(1) The Secretary may make grants to public 
or private nonprofit institutions to cover the costs of 
traineeships for licensed registered nurses to become nurse 
anesthetists and to cover the costs of projects to develop and 
operate programs for the education of nurse anesthetists. In 
order to be eligible for such a grant, the program of an 
institution must be accredited by an entity or entities 
designated by the Secretary of Education and must meet such 
requirements as the Secretary shall by regulation prescribe.
    [(2)(A) In making grants under paragraph (1), the Secretary 
shall give preference to qualified applicants carrying out 
traineeship programs whose participants gain significant 
experience in providing health services at rural health 
facilities.
    [(B) The Secretary may make a grant under paragraph (1) 
only if the institution involved agrees that, in providing 
traineeships under such paragraph, the institution will give 
preference to individuals who are residents of health 
professional shortage areas designated under section 332.
    [(3) The Secretary may make a grant under paragraph (1) 
only if the applicant involved agrees that traineeships 
provided with the grant will pay all or part of the costs of--
          [(A) the tuition, books, and fees of the program of 
        nursing with respect to which the traineeship is 
        provided; and
          [(B) reasonable living expenses of the individual 
        during the period for which the traineeship is 
        provided.
    [(b) The Secretary may make grants to public or private 
non-profit institutions to cover the cost of projects to 
improve existing programs for the education of nurse 
anesthetists which are accredited by an entity or entities 
designated by the Secretary of Education. Such grants shall 
include grants to such institutions for the purpose of 
providing financial assistance and support to certified 
registered nurse anesthetists who are faculty members of 
accredited programs to enable such nurse anesthetists to obtain 
advanced education relevant to their teaching functions.
    [(c) For the purpose of making grants under this section, 
there is authorized to be appropriated $1,800,000 for each of 
the fiscal years 1989 through 1991, $3,000,000 for fiscal year 
1993, and $4,000,000 for fiscal year 1994. Not more than 20 
percent of the amount appropriated under this section for any 
fiscal year shall be obligated for grants under the second 
sentence of subsection (b).]
               TITLE VIII--NURSING WORKFORCE DEVELOPMENT

                       Part A--General Provisions

Sec. 801. Definitions.

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

Sec. 802. Application

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

Sec. 803. Use of funds

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

Sec. 804. Matching requirement

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

Sec. 805. Preference

    In awarding grants or contracts under this title, the 
Secretary shall give preference to applicants with projects 
that will substantially benefit rural or underserved 
populations, or help meet public health nursing needs in State 
or local health departments.

Sec. 806. Generally applicable provisions

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

Sec. 807. National advisory council on nurse education and practice.

    (a) Establishment.--There is hereby established a National 
Advisory Council on Nurse Education and Practice (in this 
section referred to as the ``Council''), consisting of the 
Secretary or the delegate of the Secretary (who shall be an ex 
officio member and shall serve as the Chairperson), and 15 
members appointed by the Secretary without regard to the 
Federal civil service laws, of which--
          (1) 2 shall be selected from full-time students 
        enrolled in schools of nursing;
          (2) 3 shall be selected from the general public;
          (3) 2 shall be selected from practicing professional 
        nurses; and
          (4) 8 shall be selected from among the leading 
        authorities in the various fields of nursing, higher, 
        and secondary education, and from representatives of 
        hospitals and other institutions and organizations 
        which provide nursing services.
A majority of the members shall be nurses. The student-members 
of the Council shall be appointed for terms of one year and 
shall be eligible for reappointment to the Council.
    (b) Duties.--The Council shall advise the Secretary in the 
preparation of general regulations and with respect to policy 
matters arising in the administration of this title, including 
the range of issues relating to nurse supply, education and 
practice improvement.
    (c) Funding.--Amounts appropriated under this title may be 
utilized by the Secretary to support the nurse education and 
practice activities of the Council.

Sec. 808. Technical assistance

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

Sec. 809. Recovery for construction assistance

    (a) In General.--If at any time within 20 years (or within 
such shorter period as the Secretary may prescribe by 
regulation for an interim facility) after the completion of 
construction of a facility with respect to which funds have 
been paid under subpart I of part A (as such subpart was in 
effect on September 30, 1985)--
          (1) the owner of the facility ceases to be a public 
        or nonprofit school,
          (2) the facility ceases to be used for the training 
        purposes for which it was constructed, or
          (3) the facility is used for sectarian instruction or 
        as a place for religious worship,
the United States shall be entitled to recover from the owner 
of the facility the base amount prescribed by subsection (c)(1) 
plus the interest (if any) prescribed by subsection (c)(2).
    (b) Notice of Change in Status.--The owner of a facility 
which ceases to be a public or nonprofit school as described in 
paragraph (1) of subsection (a), or the owner of a facility the 
use of which changes as described in paragraph (2) or (3) of 
such subsection shall provide the Secretary written notice of 
such cessation or change of use within 10 days after the date 
on which such cessation or change of use occurs or within 30 
days after the date of enactment of the Health Professions 
Training Assistance Act of 1985, whichever is later.
    (c) Amount of Recovery.--
          (1) Base amount.--The base amount that the United 
        States is entitled to recover under subsection (a) is 
        the amount bearing the same ratio to the then value (as 
        determined by the agreement of the parties or in an 
        action brought in the district court of the United 
        States for the district in which the facility is 
        situated) of the facility as the amount of the Federal 
        participation bore to the cost of the construction.
          (2) Interest.--
                  (A) In general.--The interest that the United 
                States is entitled to recover under subsection 
                (a) is the interest for the period (if any) 
                described in subparagraph (B) at a rate 
                (determined by the Secretary) based on the 
                average of the bond equivalent rates of 91-day 
                Treasury bills auctioned during such period.
                  (B) Time period.--The period referred to in 
                subparagraph (A) is the period beginning--
                          (i) if notice is provided as 
                        prescribed by subsection (b), 191 days 
                        after the date on which the owner of 
                        the facility ceases to be a public or 
                        nonprofit school as described in 
                        paragraph (1) of subsection (a), or 191 
                        days after the date on which the use of 
                        the facility changes as described in 
                        paragraph (2) or (3) of such 
                        subsection, or
                          (ii) if notice is not provided as 
                        prescribed by subsection (b), 11 days 
                        after the date on which such cessation 
                        or change of use occurs,
                and ending on the date the amount the United 
                States is entitled to recover is collected.
    (d) Waiver of Rights.--The Secretary may waive the recovery 
rights of the United States under subsection (a)(2) with 
respect to a facility (under such conditions as the Secretary 
may establish by regulation) if the Secretary determines that 
there is good cause for waiving such rights.
    (e) Limitation on Liens.--The right of recovery of the 
United States under subsection (a) shall not, prior to 
judgment, constitute a lien on any facility.
   prohibition against discrimination by schools on the basis of sex
    Sec. [855. [298b-2]] 810 * * *
          * * * * * * *

                certain generally applicable provisions

    Sec. [860. [298b-7]] 810A (a) Application for Grants, 
Cooperative Agreements, or Contracts.-- * * *
          * * * * * * *
    (f) Exceptions.--
          (1) In general.--To permit new programs to compete 
        equitably for funding under this section, those new 
        programs that meet the criteria described in paragraph 
        (3) shall qualify for a funding preference under this 
        section.
          (2) Definition.--As used in this subsection, the term 
        ``new program'' means any program that has graduated 
        less than three classes. Upon graduating at least three 
        classes, a program shall have the capability to provide 
        the information necessary to qualify the program for 
        the general funding preferences described in subsection 
        (a).
          (3) Criteria.--The criteria referred to in paragraph 
        (1) are the following:
                  (A) The mission statement of the program 
                identifies a specific purpose of the program as 
                being the preparation of nurses to serve 
                underserved populations.
                  (B) The curriculum of the program includes 
                content which will help to prepare 
                practitioners to serve underserved populations.
                  (C) Substantial clinical training experience 
                is required under the program in medically 
                underserved communities.
                  (D) A minimum of 20 percent of the faculty of 
                the program spend at least 50 percent of their 
                time providing or supervising care in medically 
                underserved communities.
                  (E) The entire program or a substantial 
                portion of the program is physically located in 
                a medically underserved community.
                  (F) Student assistance, which is linked to 
                service in medically underserved communities 
                following graduation, is available to the 
                students in the program.
                  (G) The program provides a placement 
                mechanism for deploying graduates to medically 
                underserved communities.
    Part B--Nurse Practitioners, Nurse Midwives, and Other Advanced 
                            Practice Nurses

Sec. 811. Advanced practice nursing grants

    (a) In General.--The Secretary may award grants to and 
enter into contracts with eligible entities to meet the costs 
of--
          (1) projects that support the enhancement of advanced 
        practice nursing education and practice; and
          (2) traineeships for individuals in advanced practice 
        nursing programs.
    (b) Definition of Advanced Practice Nurses.--For purposes 
of this section, the term ``advanced practice nurses'' means 
nurses trained in advanced degree programs including 
individuals in combined R.N./Master's degree programs, post-
nursing master's certificate programs, or, in the case of nurse 
midwives or nurse anesthetists, in certificate programs in 
existence on the date that is one day prior to the date of 
enactment of this section, to serve as nurse practitioners, 
nurse midwives, nurse anesthetists, nurse educators, or public 
health nurses, or in other nurse specialties determined by the 
secretary to require advanced education.
    (c) Authorized Nurse Practitioner and Nurse-Midwifery 
Programs.--Nurse practitioner and nurse midwifery programs 
eligible for support under this section are educational 
programs for registered nurses (irrespective of the type of 
school of nursing in which the nurses received their training) 
that--
          (1) meet guidelines prescribed by the Secretary; and
          (2) have as their objective the education of nurses 
        who will upon completion of their studies in such 
        programs, be qualified to effectively provide primary 
        health care, including primary health care in homes and 
        in ambulatory care facilities, long-term care 
        facilities and other health care institutions.
    (d) Other Authorized Educational Programs.--The Secretary 
shall prescribe guidelines as appropriate for other advanced 
practice nurse education programs eligible for support under 
this section.
    (e) Traineeships.--
          (1) In general.--The Secretary may not award a grant 
        to an applicant under subsection (a) unless the 
        applicant involved agrees that traineeships provided 
        with the grant will only pay all or part of the costs 
        of--
                  (A) the tuition, books, and fees of the 
                program of advanced nursing practice with 
                respect to which the traineeship is provided; 
                and
                  (B) the reasonable living expenses of the 
                individual during the period for which the 
                traineeship is provided.
          (2) Doctoral programs.--The Secretary may not 
        obligate more than 10 percent of the traineeships under 
        subsection (a) for individuals in doctorate degree 
        programs.
          (3) Special consideration.--In making awards of 
        grants and contracts under subsection (a)(2), the 
        Secretary shall give special consideration to an 
        eligible entity that agrees to expend the award to 
        train advanced practice nurses who will practice in 
        health professional shortage areas designated under 
        section 332.
             Part C--Increasing Nursing Workforce Diversity

Sec. 821. Workforce diversity grants

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

 Part D--Strengthening Capacity for Basic Nurse Education and Practice

Sec. 831. Basic nurse education and practice grants

    (a) In General.--The Secretary may award grant to and enter 
into contracts with eligible entities for projects to 
strengthen capacity for basic nurse education and practice
    (b) Priority Areas.--In awarding grants or contracts under 
this section the Secretary shall give priority to entities that 
will use amounts provided under such a grant or contract to 
enhance the education mix and utilization of the basic nursing 
workforce by strengthening programs that provide basic nurse 
education for purposes of--
          (1) improving nursing services in schools and other 
        community settings;
          (2) providing care for underserved populations and 
        other high-risk groups such as the elderly, individuals 
        with HIV-AIDS, substance abusers, homeless, and 
        battered women;
          (3) providing managed care, quality improvement, and 
        other skills needed under new systems of organized 
        health care systems;
          (4) developing cultural competencies among nurses;
          (5) providing emergency health services;
          (6) promoting career mobility for nursing personnel 
        in a variety of training settings and cross training or 
        specialty training among diverse population groups; or
          (7) other priority areas as determined by the 
        Secretary.
                      [Subpart II--Student Loans]
                         Part E--Student Loans


                       subpart i--general program
                            loan agreements

    Sec. 835. (a) * * *
          * * * * * * *

                            loan provisions

    Sec. 836. (a) * * *
          * * * * * * *
          (1) such a loan may be made only to a student who (A) 
        is in need of the amount of the loan to pursue a full-
        time or half-time course of study at the school leading 
        to a baccalaureate or associate degree in nursing or an 
        equivalent degree, or a diploma in nursing, or a 
        graduate degree in nursing, (B) is capable, in the 
        opinion of the school, of maintaining good standing in 
        such course of study, and (C) with respect to any 
        student enrolling in the school after June 30, 1986, is 
        of financial need (as defined in regulations issued by 
        the Secretary)[.];
          [(2) such a loan shall be repayable in equal or 
        graduated periodic installments (with the right of the 
        borrower to accelerate repayment) over the ten-year 
        period which begins nine months after the student 
        ceases to pursue a full-time or half-time course of 
        study at a school of nursing, excluding from such 10-
        year period all (A) periods (up to three years) of (i) 
        active duty performed by the borrower as a member of a 
        uniformed service, or (ii) service as a volunteer under 
        the Peace Corps Act, [and] (B) period (up to ten years) 
        during which the borrower is pursuing a full-time or 
        half-time course of study at a collegiate school of 
        nursing leading to baccalaureate degree in nursing or 
        an equivalent degree, or to graduate degree in nursing, 
        or is otherwise pursuing advanced professional training 
        in nursing (or training to be a nurse anesthetist), and 
        (C) such additional period under the terms of paragraph 
        (8) of this subsection;
          * * * * * * *
          (7) no note or other evidence of any such loan may be 
        transferred or assigned by the school making the loan 
        except that, if the borrower transfers to another 
        school participating in the program under this subpart, 
        such note or other evidence of a loan may be 
        transferred to such other school[.]; and
          (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.
          * * * * * * *
    (g) A school may provide in accordance with regulations of 
the Secretary, that during the repayment period of a loan from 
a loan fund established pursuant to an agreement under this 
subpart payments of principal an interest by the borrower with 
respect to all the outstanding loans made to him from loan 
funds so established shall be at a rate equal to not less than 
[$15] $40 per month.
          * * * * * * *
    (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.
          * * * * * * *
        [authorization of appropriations for student loan funds

    [Sec. 837. There are authorized to be appropriated for 
allotments under section 838 to schools of nursing for Federal 
capital contributions to their student loan funds established 
under section 835, $25,000,000 for fiscal year 1976, 
$30,000,000 for fiscal year 1977, $35,000,000 for fiscal year 
1978, $13,500,000 for the fiscal year ending September 30, 
1980, $14,000,000 for the fiscal year ending September 30, 
1982, $16,000,000 for the fiscal year ending September 30, 
1983, and $18,000,000 for the fiscal year ending September 30, 
1984, For the fiscal year ending September 30, 1985, and for 
each of the next two succeeding fiscal years there are 
authorized to be appropriated such sums as may be necessary to 
enable students who have received a loan for any academic year 
ending before October 1, 1984, to continue or complete their 
education. Of the amount appropriated under the first sentence 
for the fiscal year ending September 30, 1982, and the two 
succeeding fiscal years, not less than $1,000,000 shall be 
obligated in each such fiscal year for loans from student loan 
funds established under section 835 to individuals who are 
qualified to receive such loans and who, on the date they 
receive the loan, have not been employed on a full-time basis 
or been enrolled in any educational institution on a full-time 
basis or for at least seven years. A loan to such an individual 
may not exceed $500 for any academic year.]
          * * * * * * *

                 distribution of assets from loan funds

    Sec. 839. [(a) After September 30, 1996, and not later than 
December 31, 1999, there shall be a capital distribution of the 
balance of the loan fund established under an agreement 
pursuant to section 835(b) by each school as follows:] (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:
          (1) The Secretary shall first be paid an amount which 
        bears the same ratio to such balance in such fund [at 
        the close of September 30, 1999,] on the date of 
        termination of the fund as the total amount of the 
        Federal capital contributions to such fund by the 
        Secretary pursuant to section 835(b)(2)(A) bears to the 
        total amount in such fund derived from such Federal 
        capital contributions and from funds deposited therein 
        pursuant to section 835(b)(2)(B).
          * * * * * * *
    [(b) After December 31, 1999, each school with which the 
Secretary has made an agreement under this subpart shall pay to 
the Secretary, not less often than quarterly, the same 
proportionate share of amounts received by the school after 
September 30, 1999, in payment of principal or interest on 
loans made from the loan fund established pursuant to such 
agreement as was determined for the Secretary under subsection 
(a).]
    (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).
          * * * * * * *
                Part E--Authorization of Appropriations

Sec. 841. Authorization of appropriations

    There are authorized to be appropriated to carry out 
section 811, 821, and 831, $62,000,000 for fiscal year 1996, 
such sums as may be necessary in each of the fiscal years 1997 
and 1998, and $59,000,000 for fiscal year 1999.
          * * * * * * *
Sec. 843. Breach of agreement

    ``(a) In General.--In the case of any program under this 
subpart 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 section is applicable:
          (1) In the case of a program under this subpart 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--
                  (A) 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);
                  (B) is dismissed from the nursing program for 
                disciplinary reasons; or
                  (C) voluntarily terminates the nursing 
                program.
          (2) 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 subpart for the period of time 
        applicable under the program.
    (b) Waiver or Suspension of Liability.--In the case of an 
individual or health facility making an agreement for purposes 
of subsection (a), 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 indivdiual or facility, and if 
enforcement of the agreements with respect to the individual or 
facility would be unconscionable.
    (c) Date Certain for Recovery.--Subject to subsection (b), 
any amount that the Federal Government is entitled to recover 
under subsection (a) 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.
    (d) Availability.--Amounts recovered under subsection (a) 
with respect to a program under this subpart shall be available 
for the purposes of such program, and shall remain available 
for such purposes until expended.

                Subpart [III] II--Loan Repayment Program


                         loan repayment program


    Sec. 846. (a) * * *
          * * * * * * *
                            [Part C--General

   [advisory council on nurse education and practice review committee

    [Sec. 851. (a) There is hereby established a National 
Advisory Council on Nurse Education and Practice (in this 
section referred to as the ``Council''), consisting of the 
Secretary or his delegate, who shall be Chairman, and an ex 
officio member, and twenty-one members appointed by the 
Secretary without regard to the civil service laws. Three of 
the appointed members shall be selected from full-time students 
enrolled in schools of nursing, four of the appointed members 
shall be selected from the general public, one of the appointed 
members shall be selected from practicing professional nurses, 
one of the appointed members shall be selected from among 
representatives of associate degree schools of nursing, and 
twelve shall be selected from among leading authorities in the 
various fields of nursing, higher, and secondary education, and 
from representatives of hospitals and other institutions and 
organizations which provide nursing services. The student-
members of the Council shall be appointed for terms of one year 
and shall be eligible for reappointment to the Council.
    [(b) The Council shall advise the Secretary or his delegate 
in the preparation of general regulations and with respect to 
policy matters arising in the administration of this title.

          [noninterference with administration of institutions

    [Sec. 852. Nothing contained in this title shall be 
construed as authorizing any department, agency, officer, or 
employee of the United States to exercise any direction, 
supervision, or control over, or impose any requirement or 
condition with respect to the personnel, curriculum, methods of 
instruction, or administration of any institution.

                              [definitions

    [Sec. 853. For purposes of this title--
    [(1) 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.
    [(2) The term ``school of nursing'' means a collegiate, 
associate degree, or diploma school of nursing in a State.
    [(3) 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 allied subjects 
leading to the degree of bachelor of arts, bachelor of science, 
bachelor of nursing, or to an equivalent degree, or to a 
graduate degree in nursing, and including advanced training 
related to such program of education provided by such school, 
but only if such program, or such unit, college or university 
is accredited.
    [(4) The term ``associate degree school of nursing'' means 
a departmental, 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) The term ``diploma school of nursing'' means a school 
affiliated with a hospital or university, or an independent 
school, which provides primary 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) 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, except that a school of nursing seeking an agreement 
under subpart II of part B for the establishment of a student 
loan fund, which is not, at the time of the application under 
such subpart, eligible for accreditation by such a recognized 
body or bodies or State agency, shall be deemed accredited for 
purposes of such subpart if the Secretary of Education finds, 
after consultation with the appropriate accreditation body or 
bodies, that there is reasonable assurances that the school 
will meet the accreditation standards of such body or bodies 
prior to the beginning of the academic year following the 
normal graduation date of students who are in their first year 
of instruction of such school during the fiscal year in which 
the agreement with such school is made under such subpart; 
except that the provisions of this clause shall not apply for 
purposes of section 836. 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.
    [(7) 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) The term ``secondary school'' means a school which 
provides secondary education, as determined under State law 
except that it does not include any education provided beyond 
grade 12.
    [(9) The terms ``construction'' and ``cost of 
construction'' include (A) the construction of new buildings, 
and the acquisition, expansion, remodeling, replacement, and 
alteration of existing buildings, including architects' fees 
but not including the cost of acquisition of land (except in 
the case of acquisition of an existing building), off-site 
improvements, living quarters, or patient-care facilities, and 
(B) equipping new buildings and existing buildings, whether or 
not acquired, expanded, remodeled, or altered. For purposes of 
this paragraph, the term ``buildings'' includes interim 
facilities.
    [(10) The term ``interim facilities'' means teaching 
facilities designed to provide teaching space on a short-term 
(less than ten years) basis while facilities of a more 
permanent nature are being planned and constructed.
    [(11) The term ``medically underserved community'' has the 
meaning given such term in section 799.

                            [advance funding

    [Sec. 854. Any appropriation Act which appropriates funds 
for any fiscal year for grants, contracts, or other payments 
under this title may also appropriate for the next fiscal year 
the funds that are authorized to be appropriated for such 
payments for such next fiscal year; but no funds may be made 
available therefrom for obligation for such payments before the 
fiscal year for which such funds are authorized to be 
appropriated.]
          * * * * * * *

                              [delegation

    [Sec. 856. The Secretary may delegate the authority to 
administer any program authorized by this title to the 
administrator of a central or regional office or offices in the 
Department of Health and Human Services, except that the 
authority--
          [(1) to review, and prepare comments on the merit of, 
        any application for a grant or contract under any 
        program authorized by this title for purposes of 
        presenting such application to the Advisory Council on 
        Nurses Education, or
          [(2) to make such a grant or enter into such a 
        contract, shall not be further delegated to any 
        administrator of, or officer in, any regional office or 
        offices in the Department.

                         [technical assistance

    [Sec. 857. 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.

                 [recovery for construction assistance

    [Sec. 858. (a) If at any time within 20 years (or within 
such shorter period as the Secretary may prescribe by 
regulation for an interim facility) after the completion of 
construction of a facility with respect to which funds have 
been paid under subpart I of part A (as such subpart was in 
effect on September 30, 1985)--
          [(1) the owner of the facility ceases to be a public 
        or nonprofit school,
          [(2) the facility ceases to be used for the training 
        purposes for which it was constructed, or
          [(3) the facility is used for sectarian instruction 
        or as a place for religious worship,
the United States shall be entitled to recover from the owner 
of the facility the base amount prescribed by subsection (c)(1) 
plus the interest (if any) prescribed by subsection (c)(2).
    [(b) The owner of a facility which ceases to be a public or 
nonprofit school as described in paragraph (1) of subsection 
(a), or the owner of a facility the use of which changes as 
described in paragraph (2) or (3) of such subsection shall 
provide the Secretary written notice of such cessation or 
change of use within 10 days after the date on which such 
cessation or change of use occurs or within 30 days after the 
date of enactment of the Health Professions Training Assistance 
Act of 1985, whichever is later.

SEC. 1213. REQUIREMENTS WITH RESPECT TO CARRYING OUT PURPOSE OF 
                    ALLOTMENTS.

    (a) * * *
          * * * * * * *
    (8) to provides for the use of procedures by paramedics and 
emergency medical technicians to assess the severity of the 
injuries incurred by trauma patients;
          * * * * * * *
                         TITLE XII--TRAUMA CARE

           Part A--General Authority and Duties of Secretary

SEC. 1201. [300d] ESTABLISHMENT.

    (a) In General.-- * * *
          * * * * * * *

                     Part E--Miscellaneous Programs

SEC. 1251. [300d-51] RESIDENCY TRAINING PROGRAMS IN EMERGENCY MEDICINE.

    (a) In General.-- * * *
          * * * * * * *
Sec. 1252. State grants for demonstration projects regarding traumatic 
                    brain injury

    (a) In General.--The Secretary, acting through the 
Administrator of the Health Resources and Services 
Administration, may make grants to States for the purpose of 
carrying out demonstration projects to improve the availability 
of health services regarding traumatic brain injury.
    (b) State Advisory Board.--
          (1) In General.--The Secretary may make a grant under 
        subsection (a) only if the State involved agrees to 
        establish an advisory board within the appropriate 
        health department of the State or within another 
        department as designated by the chief executive officer 
        of the State.
          (2) Functions.--An advisory board established under 
        paragraph (1) shall be cognizant of findings and 
        concerns of Federal, State and local agencies, citizens 
        groups, and private industry (such as insurance, health 
        care, automobile, and other industry entities). Such 
        advisory boards shall encourage citizen participation 
        through the establishment of public hearings and other 
        types of community outreach programs.
          (3) Composition.--An advisory board established under 
        paragraph (1) shall be composed of--
                  (A) representatives of--
                          (i) the corresponding State agencies 
                        involved;
                          (ii) public and nonprofit private 
                        health related organizations;
                          (iii) other disability advisory or 
                        planning groups within the State;
                          (iv) members of an organization or 
                        foundation representing traumatic brain 
                        injury survivors in that State; and
                          (v) injury control programs at the 
                        State or local level if such programs 
                        exist; and
                  (B) a substantial number of individuals who 
                are survivors of traumatic brain injury, or the 
                family members of such individuals.
    (c) Matching Funds.--
          (1) In general.--With respect to the costs to be 
        incurred by a State in carrying out the purpose 
        described in subsection (a), the Secretary may make a 
        grant under such subsection only if the State agrees to 
        make available, in cash, non-Federal contributions 
        toward such costs in an amount that is not less than $1 
        for each $2 of Federal funds provided under the grant.
          (2) Determination of amount contributed.--In 
        determining the amount of non-Federal contributions in 
        cash that a State has provided pursuant to paragraph 
        (1), the Secretary may not include any amounts provided 
        to the State by the Federal Government.
    (d) Application for Grant.--The Secretary may make a grant 
under subsection (a) only if an application for the grant is 
submitted to the Secretary and the application is in such form, 
is made in such manner, and contains such agreements, 
assurances, and information as the Secretary determines to be 
necessary to carry out this section.
    (e) Coordination of Activities.--The Secretary shall ensure 
that activities under this section are coordinated as 
appropriate with other agencies of the Public Health Service 
that carry out activities regarding traumatic brain injury.
    (f) Report.--Not later than 2 years after the date of 
enactment of this section, the Secretary shall submit to the 
Committee on Energy and Commerce of the House of 
Representatives, and to the Committee on Labor and Human 
Resources of the Senate, a report describing the findings and 
results of the programs established under this section, 
including measures of outcomes and consumer and surrogate 
satisfaction.
    (g) Definition.--For purposes of this section, the term 
`traumatic brain injury' means an acquired injury to the brain. 
Such term does not include brain dysfunction caused by 
congenital or degenerative disorders, nor birth trauma, but may 
include brain injuries caused by anoxia due to near drowning.
    (h) Authorization of Appropriations.--There are authorized 
to be appropriated to carry out this section, $5,000,000 for 
fiscal year 1996, and such sums as may be necessary for each of 
the fiscal years 1997 and 1998.
            Part F--Interagency Program for Trauma Research

SEC. 1261. [300d-61] ESTABLISHMENT OF PROGRAM.

    (a) In General.-- * * *
          * * * * * * *
    (d) Certain Activities of Program.--The Program shall 
include--
          (1) * * *
          * * * * * * *
          (2) basic and clinical research regarding the 
        response of the body to trauma and the acute treatment 
        and medical rehabilitation of individuals who are the 
        victims of trauma; [and]
          (3) basic and clinical research regarding trauma care 
        for pediatric and geriatric patients[.] ; and
          (4) the authority to make awards of grants or 
        contracts to public or nonprofit private entities for 
        the conduct of basic and applied research regarding 
        traumatic brain injury, which research may include--
                  (A) the development of new methods and 
                modalities for the more effective diagnosis, 
                measurement of degree of injury, post-injury 
                monitoring and prognostic assessment of head 
                injury for acute, subacute and later phases of 
                care;
                  (B) the development, modification and 
                evaluation of therapies that retard, prevent or 
                reverse brain damage after acute head injury, 
                that arrest further deterioration following 
                injury and that provide the restitution of 
                function for individuals with long-term 
                injuries;
                  (C) the development of research on a 
                continuum of care from acute care through 
                rehabilitation, designed, to the extent 
                practicable, to integrate rehabilitation and 
                long-term outcome evaluation with acute care 
                research; and
                  (D) the development of programs that increase 
                the participation of academic centers of 
                excellence in head injury treatment and 
                rehabilitation research and training.
    (h) * * *
          * * * * * * *
          (1) * * *
          * * * * * * *
          (4) The term ``traumatic brain injury'' means an 
        acquired injury to the brain. Such term does not 
        include brain dysfunction caused by congenital or 
        degenerative disorders, nor birth trauma, but may 
        include brain injuries caused by anoxia due to near 
        drowning.
          * * * * * * *
    TITLE XV--PREVENTIVE HEALTH MEASURES WITH RESPECT TO BREAST AND 
                            CERVICAL CANCERS

SEC. 1501. ESTABLISHMENT OF PROGRAM OF GRANTS TO STATES.

    (a) * * *
          * * * * * * *
    [(c)] (d) Coordinating Committee Regarding Year 2000 Health 
Objectives.--The Secretary, acting through the Director of the 
Centers for Disease Control and Prevention, shall establish a 
committee to coordinate the activities of the agencies of the 
Public Health Service (and other appropriate Federal agencies) 
that are carried out toward achieving the objectives 
established by the Secretary for reductions in the rate of 
mortality from breast and cervical cancer in the United States 
by the year 2000. Such committee shall be comprised of Federal 
officers or employees designated by the heads of the agencies 
involved to serve on the committee as representatives of the 
agencies, and such representatives from other public or private 
entities as the Secretary determines to be appropriate.
          * * * * * * *

              [establishment of] office of minority health

    Sec. 1707. [300u-6] (a) In General.-- * * *
          * * * * * * *
    [(b) Duties.--The Secretary shall, with respect to the 
health concern of individuals from disadvantaged backgrounds, 
including racial and ethnic minorities--
          [(1) establish short-range and long-range goals and 
        objectives and coordinate all other activities within 
        the Department of Health and Human Services that relate 
        to disease prevention, health promotion, service 
        delivery, and research concerning such individuals;
          [(2) enter into interagency agreements with other 
        agencies of the Service to increase the participation 
        of such individuals in health service and promotion 
        programs;
          [(3) establish a national minority health resource 
        center to 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, to 
        facilitate access to such information, to assist in the 
        analysis of issues and problems relating to such 
        matters, and to provide technical assistance with 
        respect to the exhange of such information (including 
        facilitating the development of materials for such 
        technical assistance);
          [(4) support research, demonstrations and evaluations 
        to test new and innovative models, to increase 
        knowledge and understanding of health risk factors, and 
        to develop mechanisms that support better information 
        dissemination, education, prevention, and service 
        delivery to individuals from disadvantaged backgrounds, 
        including racial and ethnic minorities;
          [(5) coordinate efforts to promote minority health 
        programs and policies in the voluntary and corporate 
        sectors;
          [(6) develop health information and health promotion 
        materials and teaching programs, including--
                  [(A) models for the training of health 
                professionals;
                  [(B) model curriculums to be used in primary 
                and secondary schools and institutions of 
                higher learning;
                  [(C) materials and programs for the 
                continuing education of health professionals;
                  [(D) materials for public service use by the 
                print and broadcast media; and
                  [(E) materials and programs to assist health 
                care professionals in providing health 
                education to their patients;
          [(7) assist providers of primary health care and 
        preventive health services in obtaining, with respect 
        to the provision of such care and services, the 
        assistance of bilingual health professionals and other 
        bilingual individuals (including such assistance in the 
        provision of services regarding maternal and child 
        health, nutrition, mental health, and substance abuse); 
        and
          [(8) support expansion and enhancement of tertiary 
        perinatal facilities in rural States with infant 
        mortality rates among individuals from disadvantaged 
        backgrounds, including minorities, that are 
        significantly above the national average for such 
        rates.
    [(c) Certain Requirements Regarding Duties.--
          [(1) Equitable allocation of services.--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.
          [(2) Appropriate context of services.--In carrying 
        out subsection (b), the Secretary shall ensure that 
        information and services provided under such subsection 
        are provided in the language and cultural context that 
        is most appropriate for the individuals for whom the 
        information and services are intended.
          [(3) Bilingual assistance regarding health care.--In 
        carrying out subsection (b)(7), the Secretary shall 
        give special consideration to the unique linguistic 
        needs of health care providers serving Asians, and 
        American Samoans and other Pacific Islanders, including 
        such needs regarding particular sub-populations of such 
        groups.
    [(d) Grants and Contracts Regarding Duties.--
          [(1) Authority.--In carrying out subsection (b), the 
        Secretary may make grants to, and enter into 
        cooperative agreements and contracts with, public and 
        nonprofit private entities.
          [(2) Evaluation and dissemination.--
                  [(A) The Secretary shall, directly or through 
                contracts with public and private entities, 
                provide for evaluations of projects carried out 
                with financial assistance provided under 
                paragraph (1) and for the dissemination of 
                information development as result of such 
                projects.
                  [(B) Not later than January 20 of fiscal year 
                1993 and of each second year thereafter, the 
                Secretary shall prepare a report summarizing 
                evaluations carried out under subparagraph (A) 
                during the preceding 2 fiscal years. The report 
                shall be included in the report required in 
                subsection (e) for the fiscal year involved.
    [(e) Reports.--Not later than January 31 of fiscal year 
1993 and of each second year thereafter, the Secretary shall 
submit to the Congress a report describing the activities 
carried out under this section during the preceding 2 fiscal 
years.
    [(f) Funding.--
          [(1) Authorization of appropriations.--For the 
        purpose of carrying out this section, there is 
        authorized to be appropriated $25,000,000 for each of 
        the fiscal year 1991 through 1993.
          [(2) Allocation of funds by secretary.--Of the 
        amounts appropriated under paragraph (1) in excess of 
        $15,000,000, the Secretary shall make available not 
        less than $3,000,000 to carry out subsection (b)(7).]
    (b) Duties.--With respect to improving the health of racial 
and ethnic minority groups, the Secretary, acting through the 
Deputy Assistant Secretary for Minority Health (in this section 
referred to as the ``Deputy Assistant Secretary''), shall carry 
out the following:
          (1) Establish short-range and long-range goals and 
        objectives and coordinate all other activities within 
        the Public Health Service that relate to disease 
        prevention, health promotion, service delivery, and 
        research concerning such individuals. The heads of each 
        of the agencies of the Service shall consult with the 
        Deputy Assistant Secretary to ensure the coordination 
        of such activities.
          (2) Carry out the following types of activities by 
        entering into interagency agreements with other 
        agencies of the Public Health Service:
                  (A) Support research, demonstrations and 
                evaluations to test new and innovative models.
                  (B) Increase knowledge and understanding of 
                health risk factors.
                  (C) Develop mechanisms that support better 
                information dissemination, education, 
                prevention, and service delivery to individuals 
                from disadvantaged backgrounds including 
                individuals who are members of racial or ethnic 
                minority groups.
                  (D) Ensure that the National Center for 
                Health Statistics collects data on the health 
                status of each minority group.
                  (E) With respect to individuals who lack 
                proficiency in speaking the English language, 
                enter into contracts with public and nonprofit 
                private providers of primary health services 
                for the purpose of increasing the access of the 
                individuals to such services by developing and 
                carrying out programs to provide bilingual or 
                interpretive services.
          (3) Support a national minority health resource 
        center to carry out the following:
                  (A) Facilitate the exchange of information 
                regarding matters relating to health 
                information and health promotion, prevention 
                health services, and education in the 
                appropriate use of health care.
                  (B) Facilitate access to such information.
                  (C) Assist in the analysis of issues and 
                problems relating to such matters.
                  (D) Provide technical assistance with respect 
                to the exchange of such information (including 
                facilitating the development of materials for 
                such technical assistance).
          (4) Carry out programs to improve access to health 
        care services for individuals with limited proficiency 
        in speaking the English language by facilitating the 
        removal of impediments to the receipt of health care 
        that result from such limitation. Activities under the 
        preceding sentence shall include conducting research 
        and developing and evaluating model projects.
          (5) Not later than June 8 of each year, the heads of 
        the Public Health Service agencies shall submit to the 
        Deputy Assistant Secretary a report summarizing the 
        minority health activities of each of the respective 
        agencies.
    (c) Advisory Committee.--
          (1) In general.--The Secretary shall establish an 
        advisory committee to be known as the Advisory 
        Committee on Minority Health (in this subsection 
        referred to as the ``Committee''). The Deputy Assistant 
        Secretary shall consult with the Committee in carrying 
        out this section.
          (2) Duties--The Committee shall provide advice to the 
        Deputy Assistant Secretary carrying out this section, 
        including advice on the development of goals and 
        specific program activities under paragraphs (1) and 
        (2) of subsection (b) for each racial and ethnic 
        minority group.
          (3) Chair.--The Deputy Assistant Secretary shall 
        service as the chair of the Committee.
          (4) Composition.--
                  (A) The Committee shall be composed of 12 
                voting members appointed in accordance with 
                subparagraph (B), and nonvoting, ex officio 
                members designated in subparagraph (C).
                  (B) The voting members of the Committee shall 
                be appointed by the Secretary from among 
                individuals who are not officers or employees 
                of the Federal Government and who have 
                expertise regarding issues of minority health. 
                The racial and ethnic minority groups shall be 
                equally represented among such members.
                  (C) The nonvoting, ex officio members of the 
                Committee shall be the directors of each of the 
                minority health offices, and such additional 
                official 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 effect the power of the remaining members to 
        execute the duties of the Committee.
          (7) Compensation.--Members of the Committee who are 
        officers or employees of the United States shall serve 
        without compensation. Members of the Committee who are 
        not officers or employees of the United States shall 
        receive compensation, for each day (including travel 
        time) they are engaged in the performance of the 
        functions of the Committee. Such compensation may not 
        be in an amount in excess of the daily equivalent of 
        the annual maximum rate of basic pay payable under the 
        General Schedule (under title 5, United States Code) 
        for positions above GS-15.
    (d) Certain Requirements Regarding Duties.--
          (1) Recommendations regarding language as impediment 
        to health care.--The Deputy Assistant Secretary for 
        Minority Health shall consult with the Director of the 
        Office of Refugee Health, the Director of the Office of 
        Civil Rights, and the Director of the Office of 
        Minority Health of the Health Resources and Services 
        Administration, and other appropriate offices, 
        regarding recommendations for carrying out activities 
        under subsection (b)(4).
          (2) Equitable allocation regarding activities.--
                  (A) In making awards of grants, cooperative 
                agreements, or contracts under this section of 
                section 338A, 338B, 340A, 404, or 724, or part 
                B of title VII, the Secretary, acting as 
                appropriate through the Deputy Assistant 
                Secretary or the Administrator of the Health 
                Resources and Services Administration, shall 
                ensure that such awards are equitably allocated 
                with respect to the various racial and minority 
                populations.
                  (B) With respect to grants, cooperative 
                agreements, and contracts that are available 
                under the sections specified in subparagraph 
                (A), the Secretary shall--
                          (i) carry out activities to inform 
                        entities, as appropriate, that the 
                        entities may be eligible for awards of 
                        such assistance;
                          (ii) provide technical assistance to 
                        such entities in the process of 
                        preparing and submitting applications 
                        for the awards in accordance with the 
                        policies of the Secretary regarding 
                        such application; and
                          (iii) inform populations, as 
                        appropriate, that members of the 
                        populations may be eligible to receive 
                        services or otherwise participate in 
                        the activities carried out with such 
                        awards.
          (3) Cultural competency of services.--The Secretary 
        shall ensure that information and services provided 
        pursuant to subsection (b) are provided in the 
        language, educational, and cultural context that is 
        most appropriate for the individuals for whom the 
        information and services are intended.
    (e) Grants and Contracts Regarding Duties.--
          (1) In general.--In carrying out subsection (b), the 
        Deputy Assistant Secretary may make awards of grants, 
        cooperative agreements, and contracts to public and 
        nonprofit private entities.
          (2) Process for making awards.--The Deputy Assistant 
        Secretary shall ensure that awards under paragraph (1) 
        are made only on a competitive basis, and that a grant 
        is awarded for a proposal only if the proposal has been 
        recommended for such an award through a process of peer 
        review and has been so recommended by the advisory 
        committee established under subsection (c).
          (3) Evaluation and dissemination.--The Deputy 
        Assistant Secretary, directly or through contracts with 
        public and private entities, shall provide for 
        evaluations of projects carried out with awards made 
        under paragraph (1) during the preceding 2 fiscal 
        years. The report shall be included in the report 
        required under subsection (f) for the fiscal year 
        involved.
    (f) Biennial Reports.--Not later than February 1 of fiscal 
year 1996 and of each second year thereafter, the Deputy 
Assistant Secretary shall submit to the Committee on Energy and 
Commerce of the House of Representatives, and to the Committee 
on Labor and Human Resources of the Senate, a report describing 
the activities carried out under this section during the 
preceding 2 fiscal yeas and evaluating the extent to which such 
activities have been effective in improving the health of 
racial and ethnic minority groups. Each such report shall 
include the biennial reports submitted to the Deputy Assistant 
Secretary under section 201(b)(5) for such years by the heads 
of the Public Health Service agencies.
    (g) Definition.--For purposes of this section:
          (1) The term `racial and ethnic minority group' means 
        American Indians (including Alaska Natives, Eskimos, 
        and Aleuts); Asian Americans and Pacific Islanders; 
        Blacks; and Hispanics.
          (2) The term ``Hispanic'' means individuals whose 
        origin is Mexican, Puerto Rican, Cuban, Central or 
        South American, or any other Spanish-speaking country.
    (h) Funding.--For the purpose of carrying out this section, 
there are authorized to be appropriated $21,000,000 for fiscal 
year 1996, such sums as may be necessary for each of the fiscal 
years 1997 and 1998, and $19,000,000 for fiscal year 1999.
          * * * * * * *
SEC. 2004. BUY-AMERICAN PROVISIONS.

    [(a) Compliance With Buy American Act.--No funds 
appropriated pursuant to this Act for any of the fiscal years 
1994 through 1996 may be expended by an entity unless the 
entity agrees that in expending the assistance the entity will 
comply with sections 2 through 4 of the Act of March 3, 1933 
(41 U.S.C. 10a-10c, popularly known as the ``Buy American 
Act'').
    [(b) Purchase of american-made equipment and products.--In 
the case
    (a) Sense of Congress Regarding Purchase of American-Made 
Equipment and Products._In the case of any equipment or product 
that may be authorized to be purchased with financial 
assistance provided pursuant to this Act for any of the fiscal 
years 1994 through 1996, it is the sense of the Congress that 
entities receiving such assistance should, in expending the 
assistance, purchase only American-made equipment and products.
    [(2) Notice to recipients of assistance]
    (b) Notice to Recipients of Assistance._In providing 
financial assistance pursuant to this Act, the Secretary of 
Health and Human Services shall provide to each recipient of 
the assistance a notice describing the statement made in 
[paragraph (1)] subsection (a) by the Congress.
                              ----------                              

                           PUBLIC LAW 103-183

                  PREVENTIVE HEALTH AMENDMENTS OF 1993

          * * * * * * *

                     TITLE VI--TRAUMA CARE SYSTEMS

SEC. 601. REVISIONS IN PROGRAMS RELATING TO TRAUMA CARE.

          * * * * * * *
    (b) Adisory Council.--[Section 1201 of the Public Health 
Service Act (42 U.S.C. 300d)] Title XII of the Public Health 
Service Act (42 U.S.C. 300d et seq.) is amended--
          * * * * * * *
    (f) * * *
          (1) [in section 1204(c)] in section 1203(c) as 
        redesignated by subsection (b)(2) of this section), by 
        inserting before the period the following: ``determines 
        to be necessary to carry out this section'';
          * * * * * * *

SEC. 602. AUTHORIZATION OF APPROPRIATIONS.

    Section 1232(a) of the Public Health Service Act (42 U.S.C. 
300d-32(a)) is amended by striking [for the purpose] For the 
purpose and all that follows and inserting the following: ``For 
the purpose of carrying out parts A and B, there are authorized 
to be appropriated $6,000,000 for fiscal year 1994, and such 
sums as may be necessary for each of the fiscal years 1995 and 
1996.''.
          * * * * * * *

SEC. 705. ALIGNMENT OF CURRENT CENTERS FOR DISEASE CONTROL AND 
                    PREVENTION REAUTHORIZATION SCHEDULE.

          * * * * * * *
    (B) Prostate Cancer Prevention.--Section [317D(l)(1)] 
317D(l)(1) of the Public Health Service Act (42 U.S.C. 247b--
5(l)(1)) is amended by striking ``through 1996'' and inserting 
``through ``1998''.
          * * * * * * *

         DISADVANTAGED MINORITY HEALTH IMPROVEMENT ACT OF 1990

                      Title 42--United States Code

          * * * * * * *

SEC. 254c-1. GRANTS FOR HEALTH SERVICES FOR PACIFIC ISLANDERS.

    (a) Grants.--
          * * * * * * *
    (b) Use of Grants or Contracts.--Grants or contracts made 
or entered into under subsection (a) of this section shall be 
used, among other items--
          (1) * * *
          * * * * * * *
          (2) to improve the quality and availability of 
        health, substance base and mental health services and 
        systems, with an emphasis therein on preventive health 
        services and health promotion programs and projects[, 
        including improved heath data systems];
          (3) to improve the quality and availability of health 
        [manpower] care providers, including programs and 
        projects to train new and upgrade the skills of 
        existing health professional [by--
                  [(A) establishing dental officer, dental 
                assistant, nurse practitioner, or nurse 
                clinical specialist training programs;
                  [(B) providing technical training of new 
                auxiliary health workers;
                  [(C) upgrading the training of currently 
                employed health personnel in special areas of 
                need;
                  [(D) developing long-term plans for meeting 
                health profession needs;
                  [(E) developing or improving programs for 
                faculty enhancement or post-doctoral training; 
                and
                  [(F) providing innovative health 
                professionals training initiatives (including 
                scholarships) targeted toward ensuring that 
                residents of the Pacific Basin attend and 
                graduate from recognized health professional 
                programs;]
          (4) * * *
          [(5) to improve facility and equipment repair and 
        maintenance systems;
          [(6) to improve alcohol, drug abuse, and mental 
        health prevention and treatment services and systems;]
          [(7)] to improve local and regional planning systems; 
        [and]
          [(8)] to improve basic local public health systems, 
        with particular attention to primary care and services 
        to those most in need[.];
          (7) to provide primary health care, preventive health 
        care, and related training to American Samoa health 
        care professionals; and
          (8) to improve access to health promotion and disease 
        prevention services for rural American Samoa.
          * * * * * * *
    (f) Authorization of Appropriation.--[There is] There are 
authorized to be appropriated to carry out this section 
[$10,000,000 for each of the fiscal years 1991 through 1993] 
$3,000,000 for fiscal year 1995, $4,000,000 for fiscal year 
1996, and $5,000,000 for fiscal year 1997
    (g) Study and Report._
          (1) Study.--Not later than 180 days after the date of 
        enactment of this subsection, the Secretary, acting 
        through the Administrator of the Health Resources and 
        Services Administration, shall enter into a contract 
        with a public or nonprofit private entity for the 
        conduct of a study to determine the effectiveness of 
        projects funded under this section.
          (2) Report.--Not later than July 1, 1996, the 
        Secretary shall prepare and submit to the Committee on 
        Labor and Human Resources of the Senate and the 
        Committee on Energy and Commerce of the House of 
        Representatives a report describing the findings made 
        with respect to the study conducted under paragraph 
        (1).
          * * * * * * *