[Senate Report 105-220]
[From the U.S. Government Publishing Office]



                                                       Calendar No. 424
105th Congress                                                   Report
                                 SENATE

 2d Session                                                     105-220
_______________________________________________________________________


 
         HEALTH PROFESSIONS EDUCATION PARTNERSHIPS ACT OF 1998

                                _______
                                

                 June 23, 1998.--Ordered to be printed

_______________________________________________________________________


    Mr. Jeffords, from the Committee on Labor and Human Resources, 
                        submitted the following

                              R E P O R T

                             together with

                            ADDITIONAL VIEWS

                         [To accompany S. 1754]

    The Committee on Labor and Human Resources, to which was 
referred the bill (S. 1754) to amend the Public Health Service 
Act to consolidate and reauthorize health professions and 
minority and disadvantaged health education programs, and for 
other purposes, having considered the same, reports favorably 
thereon with an amendment in the nature of a substitute and 
recommends that the bill (as amended) do pass.

                                CONTENTS

                                                                   Page
  I. Summary of the bill..............................................2
 II. Background and need for legislation.............................12
III. Legislative history and committee action........................19
 IV. Committee views.................................................19
  V. Cost estimate...................................................31
 VI. Application of law to the legislative branch....................35
VII. Regulatory impact statement.....................................36
VIII.Section-by-section analysis.....................................36

 IX. Additional views................................................64
  X. Changes in existing law.........................................66

                         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.
    These 44 programs are consolidated into 7 general and 
flexible categories of authorities which are designed to train 
health practitioners most inclined to enter practice in rural 
and other medically underserved areas. The seven general 
authorities provide support for: The training of 
underrepresented minority and disadvantaged health professions 
students; the training of primary care and dental providers; 
the establishment and operation of interdisciplinary, 
community-based training activities; health professions work 
force information and analysis; public health workforce 
development; nursing education; and student financial 
assistance.

      A. 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 continue to have authority to fund projects which improve 
the number and quality of minority and disadvantaged health 
professionals. Three existing scholarship programs would be 
consolidated. An increased number of minority and disadvantaged 
providers may 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 
underrepresented in the health professions relative to their 
representation within the entire U.S. population.

Current law authorities included

    (1) Centers of Excellence in Minority Health.
    (2) Scholarships for Disadvantaged Students.
    (3) Financial Assistance for Disadvantaged Health 
Professions Students.
    (4) Exceptional Financial Need Scholarships.
    (5) Faculty Loan Repayment and Faculty Fellowships.
    (6) Health Careers Opportunity Program.

Summary of provisions

                           ELIGIBLE ENTITIES

    Centers of Excellence: Unless otherwise specified, schools 
of medicine, osteopathic medicine, dentistry, pharmacy, or 
graduate programs in behavioral or mental health which enroll 
significant numbers of minority students.
    Scholarships for Disadvantaged Students: Schools of 
medicine, osteopathic medicine, dentistry, nursing, pharmacy, 
podiatric medicine, optometry, veterinary medicine, public 
health, allied health, graduate programs in behavioral and 
mental health practice, physician assistant training programs, 
and entities carrying out programs of recruitment or retention 
of disadvantaged students.
    Faculty Loan Repayment and Faculty Fellowships: Health 
professionals and health professions students in the final year 
of training.
    Health Career Opportunities Program: Schools of medicine, 
osteopathic medicine, public health, dentistry, veterinary 
medicine, optometry, pharmacy, allied health, chiropractic, and 
podiatric medicine, programs in behavioral and mental health, 
physician assistant training programs, and other public or 
nonprofit educational entities.

                               ACTIVITIES

    Grants and contracts would be made, as appropriate, to 
plan, develop, or operate:
    (1) Programs of excellence in health professions 
institutions to increase the number of minority individuals 
trained in health professions disciplines.
    (2) Scholarship programs for financially needy health 
professions students from disadvantaged backgrounds.
    (3) Minority faculty development and loan repayment 
programs.
    (4) Programs to develop the pipeline for individuals from 
disadvantaged backgrounds to enter and remain in health 
professions schools.

                             AUTHORIZATION

    Centers of Excellence: There would be $26 million 
authorized for fiscal year 1998 and such sums as necessary 
through fiscal year 2002. Funding for this authority in fiscal 
year 1998 is $24.798 million. Funds each year would be 
allocated as follows:
    If appropriation is less than $24 million, the Secretary 
shall make available $12 million for four specified 
Historically Black Colleges and Universities (HBCU's); 60 
percent of the balance for Hispanic and Native American 
Schools; 40 percent of the balance for ``other'' COE's--health 
professions schools with above average enrollment of 
underrepresented minorities.
    If appropriation is between $24 million and $30 million, 
the following distribution would be used: 80 percent of the 
excess above $24 million would be for Hispanic and Native 
American COE's, and 20 percent for ``other'' COE's.
    If appropriation is above $30 million, the following 
formula would be used: $12 million for the four HBCU's; $12 
million for Hispanic and Native American COE's; $6 million for 
``other'' COE's; and the balance would be available for 
competition among all types of health professions schools that 
meet the conditions and requirements described in this section.
    Scholarships for Disadvantaged Students: There would be $37 
million authorized for fiscal year 1998 and such sums as 
necessary through fiscal year 2002. Funding in fiscal year 1998 
for the three existing scholarship programs being consolidated 
is $36.849 million.
    Loan Repayment and Faculty Fellowship Program: There would 
be $1.1 million authorized for fiscal year 1998 and such sums 
as necessary through fiscal year 2002. Funding for this 
authority in fiscal year 1998 is $1.065 million.
    Health Careers Opportunities Program: There would be $29.4 
million authorized for fiscal year 1998 and such sums as 
necessary through fiscal year 2002. Funding for this authority 
in fiscal year 1998 is $26.870 million.

  B. Family Medicine, General Internal Medicine, General Pediatrics, 
    Physician Assistants, General Dentistry, and Pediatric Dentistry

    Purposes: (1) Provide for the training of family 
physicians, general internists, general pediatricians, 
physician assistants, general dentists, and pediatric dentists 
to improve access to and quality of health care in underserved 
areas; (2) provide administrative flexibility and 
simplification; (3) assure outside input regarding primary care 
training programs.
    General Description: Under this provision, funding for 
family physician, general pediatrician, general internist, 
physician assistant, general dentistry and pediatric dentistry 
training would be authorized. Preference will be given to 
applicants that have a high rate for placing graduates in 
settings that serve residents of medically underserved 
communities or that show a significant increase in placing 
graduates in such settings. New programs will be eligible for 
this preference if they meet certain established criteria. 
Special consideration would be given to projects which prepare 
practitioners to care for underserved populations and other 
high-risk groups such as the frail elderly, individuals with 
HIV-AIDS, substance abusers, homeless, and victims of domestic 
violence.

Current law authorities consolidated

    (1) Family Medicine Training.
    (2) General Internal Medicine and General Pediatrics 
Training.
    (3) Physician Assistant Training.
    (4) General Dentistry Training.

Summary of provisions

                           eligible entities

    Public or nonprofit private hospitals, health professions 
schools, or other public or private nonprofit entities could 
apply.

                               activities

    Grants and contracts could be made to develop, operate, 
expand, or improve:
    1. Family medicine, general internal medicine, or general 
pediatrics academic administrative units.
    2. Residency training programs in family medicine, general 
internal medicine, general pediatrics, general dentistry, or 
pediatric dentistry.
    3. Faculty development programs in family medicine 
(including geriatrics), general internal medicine, or general 
pediatrics.
    4. Predoctoral education programs in family medicine, 
general internal medicine, or general pediatrics.
    5. Physician assistant training programs.
            Academic Administrative Units
    Family medicine, general internal medicine, and general 
pediatrics administrative units could be funded, with 
preference given to proposals to establish or substantially 
expand the programs of such units. Priority would be given to 
any qualified applicant who proposes a collaborative project 
between departments of primary care.
            Residency Training Programs
    Family medicine, general internal medicine, general 
pediatrics, and general and pediatric dentistry programs could 
be funded. Priority would be given to those programs training 
the greatest percentage of primary care or general or pediatric 
dentistry providers and to those training individuals from 
disadvantaged backgrounds.
            Faculty Development Programs
    Family medicine (including geriatrics), general internal 
medicine, and general pediatrics faculty development programs 
could be funded, including traineeships and fellowships.
            Predoctoral Programs
    Family medicine, general internal medicine, and general 
pediatrics predoctoral education programs could be funded.
            Physician Assistant Training Programs
    Physician assistant training programs and the training of 
individuals to teach in such programs may be funded. Priority 
would be given to those programs training individuals from 
disadvantaged backgrounds
            Advisory Committee on Training in Primary Care Medicine and 
                    Dentistry
    The Secretary would be required to establish a new outside 
advisory group to provide advice and recommendations to the 
Secretary with regard to the primary care and dentistry 
training programs authorized by this section.

                             authorization

    There would be $78.3 million authorized for fiscal year 
1998 and such sums as necessary through fiscal year 2002. 
Combined funding for these authorities in fiscal year 1998 is 
$77.298 million. Of the amounts appropriated each year, the 
Secretary would be required to make the following minimum 
allocations:
          $49.3 million for family medicine training, including 
        not less than $8.6 million for family medicine academic 
        administrative units;
          $17.7 million for general internal medicine and 
        general pediatrics;
          $6.8 million for physician assistant training; and
          $4.5 million for general or pediatric dentistry 
        training.
    If the amounts appropriated are less than the amounts 
required to comply with the minimal allocations, the Secretary 
would ratably reduce the amount to be available to each of the 
specific disciplines accordingly.

             C. Interdisciplinary, Community-based Linkages

    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 education and 
geriatric faculty fellowships; (3) Provide support for 
interdisciplinary training projects; (4) 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. All grantees would be 
required to assure the collaboration of two or more 
disciplines. Area Health Education Centers (AHEC's) are 
generally located in underserved areas. Exposure to practice in 
underserved areas during training and education is generally 
recognized as a determinant in whether a health professional 
returns to practice in such settings. In addition, these 
centers help support practicing providersin such areas through 
continuing medical education programs. Geriatric training centers, 
rural health interdisciplinary projects, allied health training 
projects, podiatric medicine training, and chiropractic training would 
also receive funding under this section.

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) Allied Health Training.
    (6) Podiatric Medicine Training.
    (7) Chiropractic Demonstrations.

Summary of provisions

                           Eligible Entities

    Health professions schools, academic health centers, State 
or local governments, or other appropriate public or private 
nonprofit entities. With respect to a state in which no AHEC 
program is in operation, the Secretary may award a grant to a 
school of nursing.

                               Activities

    I. Area Health Education Centers and Health Education and 
Training 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 to 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 professions 
education to professionals practicing in the underserved areas 
served by the grantee.
    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. In order to address the severe 
shortage of academic geriatricians, Geriatric Academic Career 
Awards would be created. This program would promote the career 
development of faculty in geriatrics.
    III. Other Interdisciplinary Projects. Grants and contracts 
would be made to support: rural interdisciplinary training 
projects; expansion or establishment of training programs in 
the allied health professions; preventive and primary care 
training of podiatric physicians; and demonstration projects 
which chiropractors and physicians collaborate on effective 
treatments for spinal and lower-back conditions.
    IV. Advisory Committee. A new Advisory Committee on 
Interdisciplinary, Community-Based Linkages would be 
established to provide advice and recommendations to the 
Secretary with regard to the activities supported under this 
section.

                             Authorization

    There would be $55.6 million authorized for fiscal year 
1998 and such sums as necessary through fiscal year 2002. 
Combined funding for these authorities in fiscal year 1998 is 
$50.983 million. Of the amounts appropriated each year, the 
Secretary would be required to make the following minimum 
allocations:
         $28.587 million for Area Health Education Centers;
         $3.765 million for Health Education and Training 
        Centers; and
         $22.631 million for Geriatric, Rural 
        Interdisciplinary, Allied Health, Podiatric Medicine, 
        and Chiropractic training.
    If the amounts appropriated are less than the amounts 
required to comply with the minimum allocations, the Secretary 
would ratably reduce the amount available to each of the 
specific activities accordingly.

       D. Health Professions Work Force Information and Analysis

    Purposes: (1) Provide for the development of information on 
the health professions work force and for the analysis of work 
force related issues; (2) Provide for the development of 
necessary information for decision-making regarding future 
directions in health professions and nursing programs; (3) 
Provide for continued analysis of issues affecting graduate 
medical education.

Current law authorities included

    (1) Health Professions Research.
    (2) Health Professions Data.
    (3) Council on Graduate Medical Education.

Summary of provisions

                           Eligible Entities

    State or local governments, health professions schools, 
schools of nursing, academic health centers, community-based 
health facilities, and other appropriate public or private 
nonprofit entities.

                               Activities

    Grants and contracts would be made as appropriate to 
support: targeted information collection and analysis 
activities; research on high priority work force questions; 
development of a non-Federal analytic and research 
infrastructure related to the health professions work force; 
and the conduct of program evaluation and assessment.
    The existing Council on Graduate Medical Education would be 
extended through fiscal year 2002.

                             Authorization

    There would be $750,000 authorized for fiscal year 1998 and 
such sums as necessary for fiscal years 1999 through fiscal 
year 2002. Combined funding for the data and statistics 
authorities in fiscal year 1998 is $689,000.

                E. Public Health Work Force Development

    Purpose: Provide for an increase in the number of 
individuals in the public health work force and enhance the 
quality of such work force.

Current law authorities included

    (1) Public Health Traineeships.
    (2) Public Health Special Projects.
    (3) Preventive Medicine and Dental Public Health.
    (4) Health Administration Traineeships and Special 
Projects.

Summary of provisions

                           Eligible Entities

    Health professions schools including schools or programs of 
public health, preventive medicine, dental public health, and 
programs in public health, health administration, and health 
management; academic health centers; State or local health 
departments and other appropriate public or private nonprofit 
entities.

                               Activities

    Grants and contracts would be made as appropriate for: 
demonstration training programs; faculty development; trainee 
support; technical assistance; support of residency programs in 
preventive medicine and dental public health; retraining of 
existing public health workers; preparing public health 
professionals for employment at the State and community levels; 
and other related activities.

                             Authorization

    There would be $9.1 million authorized for fiscal year 1998 
and such sums as necessary through fiscal year 2002. No more 
than 30 percent of the annual appropriation for this section 
may be allocated for Public Health Traineeships. Combined 
funding for these authorities in fiscal year 1998 is $9.124 
million.

                   F. Nursing Work Force Development

    Purposes: (1) Provide for the training of basic and 
advanced degree 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 the basic nurse work force and advanced practice 
nurses, including nurse practitioners, nurse midwives, nurse 
anesthetists, public health nurses, nurse educators, clinical 
nurse specialists, and other advanced degree 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 
populations, or those which meet public health nursing needs in 
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, nursing centers, academic health 
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 nurse training programs including 
programs for nurse practitioners, clinical nurse specialists, 
nurse midwives, nurse anesthetists, public health nurses, and 
other advanced degree nurses.
    2. Programs to increase nursing work force diversity.
    3. Projects to strengthen the capacity for basic nurse 
education and practice in certain priority areas.
    Amounts provided under any one of these areas could be used 
for program development and support, 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 preference to those projects which would 
substantially benefit rural or underserved populations or help 
to meet public health nursing needs in State or local health 
departments. 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 
underserved populations and to meet relevant national and state 
nursing work force goals.
    The National Advisory Council on Nurse Education and 
Practice would advise the Secretary and in addition would now 
advise Congress 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, 
funds would be used to provide traineeships. Such traineeships 
would cover the costs of tuition, books, fees, and provide 
stipends to cover 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 backgrounds 
underrepresented among the 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 and Practice
    Funding priority would be given to nurse education programs 
which will enhance the educational mix and utilization of the 
nursing work force such as through projects to: (1) establish 
or expand nursing practice arrangements in noninstitutional 
settings; (2) provide care for underserved populations and 
other high-risk groups such as the elderly, individuals with 
HIV-AIDS, substance abusers, homeless, and victims of domestic 
violence; (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 $65 million authorized for fiscal year 1998, 
and such sums as necessary through fiscal year 2002. Combined 
funding for these activities in fiscal year 1998 is $63.403 
million.

     F. Generally Applicable Provisions for Each Training Authority

Outcomes evaluation

    Each project funded would be required to set performance 
outcomes and would be held accountable for meeting such 
outcomes.

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. Financial Assistance

    Purposes: (1) 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; (2) Continue a loan program for the 
disadvantaged; and (3) Provide administrative flexibility and 
simplification.
    General Description: This proposal would reauthorize the 
Loans for Disadvantaged Students program; continue three loan 
programs which do not require appropriations but, rather, are 
revolving loan funds which currently exist at schools; and 
leave in place the current Health Education Assistance Loan 
Insurance program.

Current law authorities included

    (1) Nursing Student Loan.
    (2) Primary Care Loan Program.
    (3) Health Professional Student Loans.
    (4) Loans for Disadvantaged Students.
    (5) Health Education Assistance Loans.

Summary of provisions

A. 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 1998 through 2002 for the LDS program. For fiscal year 
2003, 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.

B. HEAL loans

                               ACTIVITIES

    The HEAL loan program would continue in its current form, 
with some minor and technical amendments.

                             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 program would be allowed to insure the following 
maximum annual amounts: $350 million for fiscal year 1998; $375 
million for fiscal year 1999; and $425 million for each of the 
fiscal years 2000 through 2002.

                      H. Office of Minority Health

    The authority for the office would be extended through 
fiscal year 2002. The authorization for OMH would be $30 
million for fiscal year 1998, such sums as may be necessary for 
each of the fiscal years 1999 through 2002.

                    I. State Offices of Rural Health

    There would be ``such sums as necessary'' authorized 
through fiscal year 2002. The cumulative appropriations would 
be capped at $20 million. The current appropriation for this 
program is $3 million.

        J. Demonstration Projects Regarding Alzheimer's Disease

    There would be $8 million authorized for fiscal year 1998 
and such sums as are necessary for fiscal years 1999 through 
2002. There are several technical revisions.

               K. Emergency Medical Services for Children

    To increase flexibility in the Emergency Medical Services 
for Children program, the legislation would remove the current 
one-grant-per-State limitation, and allow up to three grants 
per State. To improve program administration, the legislation 
would expand the allowable individual grant period from a 
current maximum of 2 years to a maximum of 4 years. There would 
be ``such sums as necessary'' authorized for fiscal years 1998 
through 2005.

                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 under served 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 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 flexibility and administrative 
simplification. Such flexibility 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 training and allied health. 
Title VIII of the PHS Act provides for a comprehensive set of 
nurse 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, 
traineeships, 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, and certified nurse anesthetists.

                       geographic maldistribution

    Today, there continues to be a national shortage of public 
health professionals and certain allied health professionals, 
and a shortage of primary care providers in certain areas of 
the country. 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 152.6 percent between 1965-
96 while the total U.S. population only grew by 34.6 percent. 
However, even with the growth in the overall number of 
physicians, some areas of the country are experiencing 
shortages of physicians and other health professionals. Health 
professions shortage areas (HPSA's) provide one measure of 
howadequately the supply of physicians is geographically distributed. 
As of December 1997, there are 2,723 communities designated by the 
Federal Government as HPSA's, in which an estimated 5,385 primary care 
providers are needed. The Office of Shortage Designation at HRSA 
estimates that there are over 29.9 million persons residing in these 
underserved areas.
    To address these concerns with respect to geographic 
distribution, the Council on Graduate Medical Education (COGME) 
in its recent Tenth Report has recommended support for the 
training of generalist physicians to serve populations lacking 
adequate access to physician services; expanding the service 
capacity of the National Health Service Corps; finding 
innovative techniques to utilize title VII to train physicians 
who are committed to serving medically underserved populations; 
and support for the work of the Bureau of Primary Health Care 
in the Health Resources and Services Administration to develop 
a better method of designating health professions shortage 
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. That percentage dropped further to 33 
percent in 1995 and rose only to 34 percent in 1996. 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, however, that the 
percentage of graduating medical students choosing primary care 
training since then has risen to 27.6 percent in 1995 and has 
further increased to 39.6 percent in 1997. Despite this 
increase, this percentage falls short of the Council on 
Graduate Medical Education estimate of 50 percent to assure an 
adequate supply of generalists in a future system dominated by 
managed care.
    During this period of increasing numbers of medical school 
graduates entering primary care training, there has been an 
even greater expansion of nonprimary care specialty 
residencies. In 1988, there were under 85,000 physicians (both 
allopathic and osteopathic) in residency training; by 1996, 
there were over 104,000 residents, representing a 22 percent 
increase in an eight-year period. Over the same period, the 
number of residents in the internal medicine subspecialties 
grew by nearly 60 percent and hospital support specialties grew 
by 45 percent.
    The Eighth Report of the Council on Graduate Medical 
Education (COGME) published in November 1996 includes physician 
supply projections incorporating COGME work force goals for the 
years 2000 and 2020. COGME estimates that generalist 
requirements in the years 2000 and 2020 will be in the range of 
60-80 patient care generalists per 100,000 population and that 
projected supply will lie in the lower levels of that range if 
past trends of specialty choice continue. COGME further 
estimates that the specialist requirements will be in the range 
of 85-105 specialists per 100,000 population and that projected 
supply imbalances will worsen assuming historical levels of 
specialist output. It should be noted that further increases in 
the generalist supply may facilitate dispersion of generalists 
to areas of need. At present the system has the capacity to 
absorb many additional generalists whereas the capacity for 
gainful employment of additional specialists is declining.
    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 under represented 
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 
under represented in most of the health professions. Taken 
together, African Americans, Hispanics and Native Americans 
constitute 24 percent of the U.S. population, but only 10 
percent of the total physician work force.
    African-Americans constitute about 12 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 has remained 
at less than 5 percent, and dentists at 1 percent. For 
Hispanics, who represent about 11 percent of the total U.S. 
population, the percentage of Hispanic physicians and nurses 
has remained at 5 percent.
    According to the COGME's Fourth Report, physician-to-
population ratios for the overall population of 264/100,000 are 
much higher than those for African Americans (99/100,000), 
Hispanics (126/100,000), or Native Americans (54/100,000). In 
1997, 1,770 underrepresented minorities entering medical 
schools represented 10.9 percent 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 and 1997 is 
the second year in which not only the percentage minority 
representation declined but the actual number of minorities 
declined as well.
    Most RN's are female white, non-Hispanics. Although there 
have been increases in the totalnumber of nurses, there has not 
been significant change in the proportionate number of underrepresented 
minority nurses. According to DHHS, in 1996 the number of RN's from 
racial/ethnic minority backgrounds accounted for 10.2 percent of all 
registered nurses compared to 9.4 percent in 1984. Although data is 
limited for other health professionals, the public health work force 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 remains 
small.

                   nurses and nonphysician providers

    According to the Department of Health and Human Services 
(DHHS) 1996 Sample Survey of Registered Nurses, there are 2.6 
million nurses in the U.S., with 83 percent actively employed. 
Over 60 percent of nurses are employed in hospitals. Nursing 
jobs outside the hospital setting have shown the strongest 
growth rate, and even within the hospital setting, nurse 
employment in outpatient departments grew by 25 percent between 
1992 and 1996. Nurse employment in public health and community 
settings also increased by 54 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 36,000 nurse practitioners, and over 5,700 
certified nurse-midwives. 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. Nurse anesthetists are the sole 
providers of anesthesia in 85 percent of hospitals in rural 
areas and provide 65 percent of the 26 million anesthesia 
services annually. Thirty-four percent of nurse anesthetists 
practice in communities of less than 50,000 and there continues 
to be a need for nurse anesthetists in rural areas. 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 medical nutrition therapy, occupational therapy, speech 
pathology/audiology, 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

    The 1992 amendments reauthorizing the Titles VII and VIII 
health professions education programs required the GAO to 
report on whether these programs were effective in advancing 
three key purposes--increasing the numbers of health 
professionals, improving distribution in locations that have 
shortages of health professionals, and adding minorities to 
their ranks. The GAO reported on these issues in July 1994, and 
provided a statement for the record to this subcommittee at the 
April 1997 hearing. GAO's overarching message was that the 
effectiveness of title VII and title VIII programs will remain 
difficult to measure as long as they are authorized to support 
a broad range of health care objectives without common goals, 
outcome measures, and reporting requirements. Without a clearer 
results orientation, the programs are difficult to evaluate.
    While in recent years budget justifications for titles VII 
and VIII programs have cited the need to improve the supply, 
distribution, and minority representation of health 
professionals, the programs address other objectives as well. 
GAO reported that this piecemeal approach for the large number 
of title VII and title VIII programs makes it difficult to 
evaluate their overall impact on the three key areas of 
improving the supply, distribution and minority representation 
of health professionals.
    Another problem GAO identified as hindering program 
evaluation is that none of the titles VII and VIII programs had 
established specific program outcome measures--that is, the 
desired results--against which to gauge effectiveness. GAO 
found that some grantees reported on the process they 
established to achieve results, rather than on the results 
themselves. For example, a grantee reported that it instituted 
a recruitment activity but did not report how many students 
were actually recruited through federal funding of that 
activity.
    Regarding the 1992 provision providing preferences for 
programs which train health professionals in underserved areas, 
the GAO identified problems in the data provided to HHS to 
qualify for the preference. The data were not necessarily 
complete or comparable among schools, and HHS had not 
established a way to validate the data provided. In addition to 
those problems, GAO also reported, in September 1995, that the 
underlying criteria used to identify some medically underserved 
communities need to be updated.
    GAO concluded that without valid criteria and data against 
which to measure grantee performance, it will be difficult to 
determine whether grantee efforts under titles VII and VIII 
programs are needed and would be successful, or if other 
Federal programs would be more appropriate.
    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 has not improved their availability in 
HPSA's.
    GAO pointed out that the implementation of the Government 
Performance and Results Act provides an opportunity to clarify 
the intended nature and extent of the impact of title VII and 
VIII programs, particularly as they relate to other Federal 
funding for training specialists or biomedical research at 
medical schools from the Medicare program and the National 
Institutes for Health.

Testimony received

    On April 25, 1997, the Subcommittee on Public Health and 
Safety of the Committee on Labor and Human Resources held a 
hearing on the Federal health professions and nursing programs. 
Despite the inconclusive results of the GAO evaluation, the 
testimony supported a continuation of Federal health 
professions training and distribution programs because many of 
the initiatives have been successful. According to Dr. Claude 
Earl Fox, Acting Administrator of the Health Resources and 
Services Administration in the Department of Health and Human 
Services:
          Thirty-three percent of the 1995 Family Practice 
        residency graduates of title VII programs entered 
        practices in medically under served communities.
          Over 69 percent of the graduates of currently funded 
        General Internal Medicine/General Pediatrics residency 
        training programs practice primary care, compared to 45 
        percent of a similar national sample of residents whose 
        training was not supported through title VII.
          Thirty-nine percent of the most recent physician 
        assistant graduates of title VII program practice in 
        medically under served communities. Thirty-two percent 
        of these graduates are themselves from under 
        represented minority backgrounds.
    Title VII and VIII programs have also been effective in 
improving the distribution of health care providers and 
encouraging collaboration among institutions and providers. 
Fifty-four percent of all graduates of the rural 
interdisciplinary program are employed in rural areas, and all 
of these programs target health professions shortage areas. 
According to Dr. J. Ocie Harris, Associate Dean for Community 
Based Programs, University of Florida College of Medicine, the 
Area Health Education Center Programs have made contributions 
to the Nation's work force distribution in both rural and urban 
under served communities. Dr. Robert Roush, Director of the 
Texas Consortium of Geriatric Education Centers states nearly 
90 percent of all Geriatric Education Centers are of a 
consortia of three or more colleges, universities, hospitals 
and community agencies.

             III. Legislative History and Committee Action

    S. 1754 was introduced on March 12, 1998, by Senators 
Frist, Kennedy, Jeffords, Bingaman, Cochran, and Inouye. The 
bill was referred to the Committee on Labor and Human 
Resources. The Committee on Labor and Human Resources 
considered S. 1754 in an executive session held on Wednesday 
April 1, 1998. Senator Frist offered an amendment in the nature 
of a substitute, and the bill as amended was adopted by voice 
vote and favorably reported to the full Senate.

                          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: (1) improve the distribution of 
and quality of health professionals needed to provide health 
services in under served areas; and (2) enhance 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 under served areas, but 
all areas of the country.
    Throughout 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 and whenever 
the term ``physician'' is used it shall mean both allopathic 
and osteopathic physicians.

           Subtitle A--Health professions education programs

Section 101. Underrepresented minority health professions grant 
        programs

    Scholarships for Disadvantaged Students--Funding 
Preferences and Priorities. The committee intends that the 
Department fund former recipients of Exceptional Financial Need 
(EFN)Scholarships and Financial Assistance for Disadvantaged 
Health Professions Students. (FADHPS) at levels comparable to what they 
would have received prior to phase out of these programs, before 
allocating SDS funds for other purposes. Following the allocation of 
SDS funds for former EBN and FADHPS recipients, the committee intends 
that the initial awarding of remaining SDS funds in each fiscal year be 
limited to schools that meet at least one of the three funding 
priorities. Schools which do not meet any of the funding priorities 
should receive funds only if there is money remaining after fully 
funding the needs of schools meeting one or more funding priorities. 
The committee also intends that any school interested in qualifying for 
a funding priority must provide the Secretary with whatever data the 
Secretary determines is necessary to assess whether the funding 
priority has been met.
    Scholarships for Disadvantaged Students--Allied Health; 
general eligibility. With regard to the eligibility of allied 
health schools under the revised Scholarships for Disadvantaged 
Students program, the committee instructs the Secretary, 
consistent with eligibility provisions under the current 
Scholarships for Disadvantaged Students program, to limit 
participation to the following baccalaureate or graduate degree 
allied health professions schools or programs: dental hygiene, 
medical laboratory technology, occupational therapy, physical 
therapy, radiologic technology, speech pathology, audiology, 
and registered dieticians.
    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 under served areas to a much greater 
degree than others.
    The committee expects the Secretary to apply appropriate 
standards in determining which schools from all eligible 
disciplines 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 the program. The 
existence of a recruitment and retention program for students 
from disadvantaged backgrounds should not, in itself, result in 
the eligibility of a school if the school is unable to 
demonstrate that the program has achieved success, based on the 
number and/or percentage of disadvantaged students who graduate 
from the school.
    Faculty Loan Repayment--Part-Time Faculty. The committee 
instructs the Department to allow part-time faculty members to 
participate in the Faculty Loan Repayment program. This would 
encourage more underrepresented minority health practitioners 
who want to maintain a practice in the community to become 
involved as faculty members of health profession schools.
    The committee recognizes that there are over 3,000 
accredited allied health programs and therefore instructs the 
Secretary to restrict eligibility to the following allied 
health professions schools or programs: dental hygiene, medical 
laboratory technology, occupational therapy, physical therapy, 
radiologic technology, speech pathology/ audiology, and medical 
nutrition therapy. The committee further intends that allied 
health eligibility be restricted to individuals from 
disadvantaged backgrounds who are faculty of baccalaureate or 
graduate degree allied health programs.
    Educational Assistance in the Health Professions--
Individuals from Disadvantaged Backgrounds. The committee 
recognizes the role that community colleges have in expanding 
the educational opportunities for students from disadvantaged 
backgrounds. The committee notes the Secretary will give 
preference to approved applications for programs that involve a 
comprehensive approach by several public or nonprofit private 
health or educational entities. The committee expects that 
community colleges will be given the opportunity to participate 
in a comprehensive approach to establish, enhance, and expand 
educational programs in health professions for students from 
disadvantaged backgrounds.

 Section 102. Training in family medicine, general internal medicine, 
        general pediatrics, physician assistants, general dentistry, 
        and pediatric 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, physician assistants, and advanced general and 
pediatric 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 should 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 other than the priority 
given to collaborative projects of administrative units of 
primary care. In addition, such consortia applicants should 
meet the program requirements as specified in the legislation.
    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.
    The legislation grants the Secretary the authority to make 
grants or enter into contracts with schools of allopathic or 
osteopathic medicine to meet the costs of projects to 
establish, maintain, or improve academic administrative units 
to provide clinical instruction in family medicine, general 
internal medicine, or general pediatrics, and to give priority 
to applicants that propose a collaborative project between 
departments of primary care. In this regard, it should be noted 
thatthis past year the Division of Medicine, Bureau of Health 
Professions, Health Resources and Services Administration, entered into 
a contract with the American Association of Colleges of Osteopathic 
Medicine to administer a subcontract program designed to promote the 
development and implementation of collaborative, multidisciplinary 
programs in schools of allopathic and osteopathic medicine. The 
demonstration program is entitled, ``Undergraduate Medical Education in 
the 21st century: A Demonstration of Curriculum Innovations to Keep 
Pace With A Changing Health Care Environment (UME-21).'' Because of the 
limited funding, only 8 schools would be funded through this 
demonstration. The fact that 54 schools submitted full proposals in 
response to the announcement of the subcontract program, demonstrates 
the level of interest among schools in establishing such programs and 
the very substantial need for funds to meet the cost of the programs. 
Given this experience, the committee strongly encourages the Secretary 
to assure that adequate funds are available to support academic 
administrative units in all three primary care disciplines (family 
medicine, general internal medicine, and general pediatrics) and to 
give consideration in making awards to medical schools that propose to 
develop and implement such collaborative clinical instruction programs 
involving the school's departments of primary care. The committee also 
believes this program should be expanded with additional flexibility 
and innovation.
    The committee supports programs that have been proven to 
increase the number of physicians who choose generalist 
careers, practice in rural and inner-city areas, and serve 
under served populations. The committee recognizes that our 
nation needs more family practice physicians in under served 
areas.
    The committee recognizes that the primary care combined 
specialty of Internal Medicine/Pediatrics is the fastest 
growing primary care specialty in the United States. Physicians 
trained in Internal Medicine and Pediatrics are able to provide 
cost-effective, preventive, episodic, and continuing care to 
both pediatric and adult patients who may suffer from 
complicated and disabling diseases. Three-quarters of general 
internal medicine and pediatric graduates practice primary care 
after graduation. The committee recognizes that our nation 
needs more general internists and pediatricians in underserved 
areas.
    The committee recognizes that General Dentistry and 
Pediatric Dentistry Programs are essential to meet the Nation's 
oral health needs, especially of the Nation's most vulnerable 
populations.
    The committee is concerned about the national problem of 
domestic violence and about reports that health professionals 
frequently may not be adequately trained to recognize, treat, 
and report domestic violence. The committee is aware of 
concerns that medical schools include, as part of their 
curriculum, training to recognize domestic violence. The 
committee strongly opposes any attempt by the Federal 
Government to dictate medical school curriculum. However, to 
address the articulated concern, the bill requires the 
Secretary to give special consideration to projects that 
prepare practitioners to care for victims of domestic violence. 
The committee expects the Secretary to provide appropriate 
technical assistance to grantees using title VII and VIII funds 
to focus attention on the domestic violence problem in the 
training of health professionals. The committee notes that the 
term domestic violence incorporates child and elder abuse, as 
well as other forms of domestic violence. In addition, the bill 
will further address this issue by requesting that the 
Institute of Medicine conduct a study on the training needs of 
health professionals with respect to the detection and referral 
of victims of family or acquaintance violence.

Section 103. Interdisciplinary, community-based linkages

    The committee recognizes the definition of a health service 
psychologist as an individual who: (1) holds a doctoral degree 
in psychology; and (2) is licensed or certified on the basis of 
the doctoral degree in psychology, by the state in which he/she 
practices, at the independent practice level of psychology to 
furnish diagnostic, assessment, preventive, and therapeutic 
services directly to individuals. Although one of the three 
categories of the National Health Service Corps' health 
professional shortage areas is behavioral and mental health, 
these professions are not specifically listed as eligible. The 
committee recognizes the need for behavioral and mental health 
professionals in underserved areas.
    The committee recognizes the valuable and important 
contributions made by the members of the allied health 
professions and expects the Secretary to continue to fund such 
projects. The committee notes that the allied health and other 
disciplines section of the bill authorizes a variety of 
activities associated with expanding or establishing programs 
that will increase the number of individuals trained in allied 
health professions. There are other nonallied health activities 
also authorized in this section. It is the intent of the 
committee that the program for allied health training continue 
to grow and develop. The inclusion of nonallied health 
disciplines should not diminish support for the allied health 
training disciplines.
    The committee recognizes that advances in telecommunication 
technology have resulted in the potential for increased access 
to educational opportunities for health care providers 
including those in rural areas. These advances lend themselves 
to the increased utilization of distance education as a more 
accessible and cost effective venue for initial and continuing 
education for health professionals who serve in under served 
areas.
    The committee recognizes the advantages of providing 
distance learning opportunities for nurses and encourages 
expansion of these services. Providing distance learning 
training in underserved areas increases the retention of nurses 
and other health professionals in these communities. 
Additionally, the committee encourages that these distance 
learning opportunities be offered in interdisciplinary settings 
with other health professionals such as physicians, 
psychologists, physical and occupational therapists, 
rehabilitation counselors and communication disorder 
specialists to encourage further provision of health care by 
interdisciplinary teams. Research has shown that 
interdisciplinary training decreases professional isolation and 
facilitates provision of health services by interdisciplinary 
teams, while enhancing the retention and recruitment of health 
professionals in rural and underserved areas.
    Area Health Education Centers (AHEC's) have successfully 
trained individuals to practice in under served 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.
    HRSA is directed to conduct an evaluative study of Area 
Health Education Centers (AHEC's) to identify key factors, 
characteristics, and methodologies employed by successful 
AHEC's; and factors, barriers and impediments in areas where 
AHEC's have not been able to cover their defined service areas, 
to involve other health professions, and to maintain an 
interdisciplinary focus. The results of the study should be 
used to define further the selection criteria program 
requirements essential for successful AHEC operations and to 
assure effectiveness in providing primary care to under served 
areas. This study should be performed in a timely manner.
    The committee notes that HRSA commissioned a strategic plan 
regarding geriatric education in this country, titled ``A 
National Agenda For Geriatric Education'', in 1995. The report 
concluded that the need for adequately trained health care 
providers to care for older people in this country is urgent 
and contained a package of recommendations to address this 
critical problem. Our population is aging and we should be 
prepared to meet the demand. Therefore, the committee urges the 
Secretary to enact the recommendations included in the 1995 
report. The committee directs the Secretary to submit to the 
committee, in a timely manner, an action plan regarding 
implementation of such recommendations that are within HHS' 
jurisdiction and a status report of recommendations that are 
outside of HHS' jurisdiction.

Section 104. Health professions work force information and analysis

    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 the specific 
amount authorized in this section 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.

Section 105. Public health work force development

    The committee recognizes the role of preventive medicine 
residency training, public health special projects and public 
health trainee ships in helping to reduce the risks of disease, 
disability, and death for individuals and specific population 
groups. There are currently shortages of epidemiologist, 
biostatisticians, environmental health experts and public 
health nurses and physicians. The committee urges the Secretary 
to continue funding these training programs, which are critical 
for a strong and viable public health infrastructure.

                     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 who will substantially benefit rural and unserved 
populations, but also if its program leads to individuals 
providing services in under served 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. This preference will 
only be applied to applications that rank above the 20th 
percentile of applications that have been recommended for 
approval by peer review groups under this section.
    The committee commends the National Advisory Council on 
Nurse Education (NACNEP) for its ``Report on the Basic Nurse 
Workforce'' and work in addressing key issues relating to 
enabling nursing to meet the health care needs of the public.

Section 123. Part B--Nurse practitioners, nurse midwives, nurse 
        anesthetists, and other advanced degree practice nurses

    The committee recognizes the important role that nurse 
practitioners, nurse midwives, and nurseanesthetists and other 
advanced practice nurses play in providing quality care to medically 
underserved and rural communities. The committee continues to support 
nurses pursuing advanced education, especially in primary care, public 
health, geriatrics, clinical nurse specialties, and administration. As 
long as the need for increasing the numbers of primary care providers 
continues, the committee expects that the Secretary will continue to 
give priority to programs preparing nurse practitioners and nurse 
midwives who provide primary care services and practice in underserved 
areas and among underserved populations.
    The committee acknowledges that nurse anesthetists help 
meet the goals of the legislation by providing critical 
anesthesia services in underserved areas. As the sole providers 
of anesthesia in about 70 percent of rural hospitals, nurse 
anesthetists can help increase access to health care services 
in rural and under served areas. Thus, the committee encourages 
the Secretary to give priority to those programs that educate 
nurse anesthetists to practice in rural and underserved areas.
    The committee recognizes that programs which prepare nurses 
to serve as nurse educators have proven to be a valuable 
investment. The need for nursing administration education 
continues to increase as the administrative component of 
nursing becomes more important to design, facilitate, and 
manage systems of health care meeting the needs of the 
underserved.
    Finally, the committee continues to support traineeships 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 expand its efforts to address the 
pipeline issues and to continue efforts to increase diversity 
among nurses to enable greater participation of nurses in 
leadership positions in community health, primary care, 
education, and administration. The committee urges the 
Department to encourage Schools of Nursing to work with local 
communities, local schools including elementary and secondary 
schools and health centers to provide individuals from 
disadvantaged backgrounds exposure to the nursing profession 
(including mentoring opportunities) to emphasize the importance 
of the basic education necessary to prepare for a career in 
nursing.

Section 123. Part D--Strengthening capacity for basic nurse education 
        and practice

    The Associate Degree Nurses (ADN) are capable of working in 
a variety of health-care settings, including hospitals (acute 
and critical care), rehabilitation centers, clinics, home 
health, and long-term care. The committee recognizes that ADN 
nursing programs offer accessible, affordable, quality 
instruction to individuals who seek entry into registered nurse 
(RN) practice.
    The Division of Nursing is encouraged to enable regional 
collaborative nursing work force 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

    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, skill mix, and quality of nursing professionals 
needed to provide services in underserved areas and to 
underrepresented populations 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 131. Primary Care Loans--measurement of graduates entering 
        primary care

    The committee intends that section 131(a), which amends the 
procedures for measuring compliance with the Primary Care Loan 
school conditions, be effective for the reporting period 
beginning July 1, 1998.

Section 132. Loans for disadvantaged students

    The committee intends that funding for this program should 
be repealed after 5 years. This should provide sufficient time 
to complete the establishment of these revolving loan funds 
atinstitutions currently operating such programs.

Section 134. Health professions student loans/Loans for disadvantaged 
        students/Primary care loans--Repayment period

    The committee intends that Section 134(a)(3), which extends 
the repayment period for various student loans from 10 to 25 
years, at the discretion of the educational institution, be 
available for any borrowers who have not yet completed 
repayment of their loans.

Section 142. HEAL lender and holder performance standards

    The committee intends that the exceptional performance 
requirements for HEAL lenders, holders, and services 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 service 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 
services, from the making of the loan through submission of a 
claim. Finally, it should be understood that lenders, holders, 
or services seeking designation as exceptional performers 
should be required to provide compliance audit results, in 
accord with established timeframes, 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 143. HEAL reauthorization

    This bill would reauthorize the Health Education Assistance 
Loan (HEAL) program, providing lending limits of $350 million 
for Fiscal Years 2000 through 2002. The committee recognizes 
that HEAL is a sound program which provides a cost-effective 
way of delivering financial aid and is responsive to the needs 
of the health professions students. It is the committee's 
belief that a combination of legislative, regulatory, and 
policy changes implemented since the early 1990's have 
eliminated the default problem which plagued the program during 
the 1980's. In addition, innovative management initiatives such 
as the competitive bidding process, have made HEAL loans less 
expensive than the Unsubsidized Stafford Loans for both the 
borrower and the tax payer.

                  TITLE II--OFFICE OF MINORITY HEALTH

    The committee expects that the Office of Minority Health 
will 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 services and 
health promotion, and to stimulate and undertake innovative 
projects. The committee expects that the interagency agreements 
will emphasize a collaboration between The Office of Minority 
Health and the individual agencies. It is the intent of the 
committee, that the agencies will contribute resources to 
collaborative projects. The committee expects that awards in 
general will be competitive while recognizing the need for OMH 
to make sole source awards in accordance with PHS procurement 
regulations. The committee recognizes the work accomplished 
under OMH's cooperative agreements with organizations having 
unique capabilities to address the health concerns of racial 
and ethnic minorities.
    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.
    The committee is concerned about the disproportionate 
number of underserved, disadvantaged individuals in urban areas 
that lack access to primary care. The committee urges the 
Office of Minority Health to continue to confront this problem 
by supporting projects such as the ``Integrated Health Delivery 
Systems in a Historically Underserved Community,'' that 
demonstrate how the collaboration between minority academic 
health centers and local governments can provide cost-
effective, high quality primary care to the medically indigent.
    The committee urges the Department to encourage Schools of 
Nursing to work with local communities, local schools including 
elementary and secondary schools and health centers to provide 
Hispanic and Native American students exposure to the nursing 
profession (including mentoring opportunities) to emphasize the 
importance of the basic education necessary to prepare for a 
career in nursing.

                    TITLE III--SELECTED INITIATIVES

Section 301. State offices of rural health

    The committee encourages the continuation of the state 
offices of rural health program. Funds authorized under this 
section are intended to help all States administer the 
activities of such offices.

Section 302. Demonstration projects regarding Alzheimer's disease

    The Alzheimer's Home and Community Care Demonstration 
project's reauthorization expandsthe 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.

Section. 303. Project grants for immunization services

    The committee recognizes that administration of safe and 
effective vaccines remains the most cost-effective method of 
preventing human suffering from vaccine preventable diseases. 
The committee commends the CDC for increasing immunization 
rates for children and recognizes the number of cases of 
vaccine-preventable diseases has been reduced to record low 
levels. Despite the progress on the immunization of children, 
the committee is concerned about the number of adults who 
suffer from vaccine-preventable diseases. The committee, as 
reflected in the new statutory language, places the emphasis of 
the program on children, adolescents, and adults. The committee 
urges the CDC to expand its activities to ensure that adults, 
adolescents, and children are all protected from vaccine-
preventable diseases.
    Grantees under this program are encouraged to develop 
programs to educate providers, the public, and employers about 
the availability of vaccines. The activity should focus on 
public health education, improving the infrastructure for 
vaccine delivery, and improving communication with providers 
about the importance of immunization in these populations.
    In order to maintain a healthy environment for vaccine 
research and development, the committee believes that CDC 
should consider working with industry to: 1. establish research 
priorities; 2. in the conduct of research, encourage a 
diversity of scientific approaches to the development of 
vaccines; and 3. support the use of preventative vaccines by 
the public.
    An important role of the CDC is to ensure that parents and 
providers have full information about the safety and efficacy 
of vaccines. The committee commends the work the CDC has done 
on informing health providers and consumers of the risks 
associated with vaccine-acquired paralytic polio. The committee 
encourages the CDC to develop an ongoing program to communicate 
the relationship of benefits versus risks of immunization. The 
committee is aware that the CDC is currently testing 
procurement policy. The committee is concerned that the 
procurement policy may eliminate a physicians choice of 
vaccines, thus discouraging competition and innovation which 
may raise public health concerns. The committee requests that 
the CDC report one year after enactment of this section on the 
progress of its procurement policy and address its concerns 
regarding the issue of vaccine choice.

                   TITLE IV--MISCELLANEOUS PROVISIONS

Section 405. Reauthorization of preventative health services regarding 
        tuberculosis

    The committee commends the CDC for the results that have 
been achieved under this program. In 1996, there were 21,337 
new cases of tuberculosis reported, a decline of 7 percent from 
the 22,860 new cases in 1995. Despite the success of this 
program the committee is concerned about the reports of 
sporadic outbreaks of drug-resistant tuberculosis over the past 
2 years. The committee recommends that under this program the 
Secretary should give priority to research concerning strains 
of drug-resistant tuberculosis.

Section 407. Community programs on domestic violence

    The committee is concerned about the national problem of 
domestic violence. The committee notes that the term domestic 
violence incorporates child and elder abuse, as well as other 
forms of domestic violence. The committee has requested an IOM 
study concerning the training needs of health professionals 
with respect to the detection and referral of victims of family 
or acquaintance violence. The committee requests the IOM 
consult with health educators and experts in the domestic 
violence field in carrying out this study. The committee 
expects that the study will identify any regulatory or 
legislative means that may be effective in encouraging training 
in the area of domestic violence, as well as the level of 
funding appropriate to accomplish such goals. In addition, the 
committee requests that the report determine the number of 
teaching institutions that incorporate training for health 
professionals in the area of domestic violence, assess whether 
the training in existing programs is adequate for both 
detection and referral of victims of domestic violence, and 
assess whether increased training is needed with respect to 
detection of domestic violence.

Section 413. Emergency Medical Services for Children

    The committee supports continuation of the Emergency 
Medical Services for Children (EMSC) program, which ensures 
state-of-the-art emergency medical care for ill or injured 
children and adolescents. Covering the entire spectrum of 
emergency services, including primary prevention, acute care, 
and rehabilitation, the EMSC program builds upon existing 
Emergency Medical Services (EMS) systems, which initially 
focused on adult emergency care with little attention to the 
special needs of children. Since 1984, all States, the District 
of Columbia, and four territories have received EMSC program 
funds to better address pediatric needs in EMS. The committee 
believes that loosening restrictions on the number and length 
of grants that may be awarded under the program will encourage 
greater flexibility in making EMSC funds available for broader-
based, more comprehensive State or community efforts.

                            V. Cost Estimate

                                     U.S. Congress,
                               Congressional Budget Office,
                                      Washington, DC, May 28, 1998.
Hon. James M. Jeffords,
Chairman, Committee on Labor and Human Resources,
U.S. Senate, Washington, DC.
    Dear Mr. Chairman: The Congressional Budget Office has 
prepared the enclosed cost estimate for S. 1754, Health 
Professions Education Partnerships Act of 1998.
    If you wish further details on this estimate, we will be 
pleased to provide them. The CBO staff contact is Cyndi 
Dudzinski.
            Sincerely,
                                         June E. O'Neill, Director.
    Enclosure.

               congressional budget office cost estimate

    S. 1754 would reauthorize, amend, and consolidate programs 
within the Public Health Service Act. These programs provide 
federal funding through grants and contracts for health 
professions students, schools, clinics, and demonstration 
projects. They focus on increasing the diversity and supply of 
health care providers and the care they provide to shortage 
areas, ethnic populations, and high-risk population groups. The 
legislation would authorize appropriations for fiscal years 
beginning in 1998 and, in most instances, ending in 2002. 
Assuming appropriation of the authorized amounts, CBO estimates 
that enacting S. 1754 would result in additional discretionary 
outlays of $334 million in 1999 and a total of $3.5 billion 
over the 1998-2003 period.
    Subtitle C would reauthorize the Health Education 
Assistance Loan (HEAL) program through 2002. This provision 
would increase direct spending by $17 million in fiscal year 
1998 and by $158 million during the 1998-2003 period. Because 
the bill would affect direct spending, pay-as-you-go procedures 
would apply.
    S. 1754 would waive any state statutes of limitations that 
govern the repayment of loans by nursing and other medical 
students. This preemption of State statutory authority would 
represent a mandate as defined by the Unfunded Mandates Reform 
Act (UMRA). However, CBO estimates that the mandate would have 
no impact on the budgets of state, local, or tribal 
governments. The legislation does not include any private-
sector mandates as defined in UMRA.
    Estimated cost to the Federal Government: The estimated 
budgetary impact of S. 1754 is shown in the following table.

                                    [By fiscal year, in millions of dollars]                                    
----------------------------------------------------------------------------------------------------------------
                                                              1998     1999     2000     2001     2002     2003 
----------------------------------------------------------------------------------------------------------------
                                        SPENDING SUBJECT TO APPROPRIATION                                       
                                                                                                                
Spending under current law:                                                                                     
    Budget authority 1....................................      828        0        0        0        0        0
    Estimated outlays.....................................      796      522      151       39      (2)        0
                                                                                                                
                                         WITH ADJUSTMENTS FOR INFLATION                                         
                                                                                                                
Proposed changes:                                                                                               
    Authorization level...................................       24      875      898      922      944       46
    Estimated outlays.....................................        0      334      724      862      924      618
Spending under S. 1754:                                                                                         
    Authorization level...................................      852      875      898      922      944       46
    Estimated outlays.....................................      796      856      875      901      924      618
                                                                                                                
                                        WITHOUT ADJUSTMENTS FOR INFLATION                                       
                                                                                                                
Proposed changes:                                                                                               
    Authorization level...................................       24      852      852      852      851       40
    Estimated outlays.....................................        0      326      698      813      851      561
Spending under S. 1754:                                                                                         
    Authorization level...................................      852      852      852      852      851       40
    Estimated outlays.....................................      796      848      849      852      852      561
                                                                                                                
                                                 DIRECT SPENDING                                                
                                                                                                                
Spending under current law:                                                                                     
    Estimated budget authority............................        1        0        0        0        0        0
    Estimated outlays.....................................        1        0        0        0        0        0
Proposed changes:                                                                                               
    Estimated budget authority............................       17       26       30       31       31       23
    Estimated outlays.....................................       17       26       30       31       31       23
Spending under S. 1754:                                                                                         
    Estimated budget authority............................       18       26       30       31       31       23
    Estimated outlays.....................................       18       26       30       31       31       23
----------------------------------------------------------------------------------------------------------------
\1\ The 1998 level is the amount appropriated for that year.                                                    
\2\ Less than $500,000.                                                                                         

    The costs of this legislation fall within budget function 
550 (health).
    Basis of estimate: S. 1754 would reauthorize and 
consolidate several programs within the Public Health Service 
Act. The initial and final year of the period of authorization 
would vary across programs. For years in which the bill 
specifies the amount authorized, CBO assumed that 
appropriations for each program would be made in the full 
amount of the authorization. For years in which the bill 
authorizes appropriation of such sums as may be necessary, CBO 
assumed that the specific amount appropriated in 1998 or 
authorized in a subsequent year would be increased by inflation 
and that the amount authorized would be appropriated.
    With the exception of 1998, CBO assumed that all amounts 
authorized by S. 1754 would be appropriated by the start of the 
fiscal year and that outlays would follow the historical 
spending patterns of the respective agencies. The estimate 
assumes that amounts authorized for 1998 would be appropriated 
late in the year and that outlays would begin in 1999.

Title I--Health Professions Education and Financial Assistance Programs

            Subtitle A--Health Professions Education Programs
    S. 1754 would reauthorize, amend, and consolidate the 
Health Professions Education Programs administered by the 
Health Resources and Services Administration (HRSA) and would 
include funding for behavioral or mental health providers and 
services under the Programs. It authorizes $237 million in 1998 
and such sums as necessary for 1999-2002. Assuming 
appropriation of the authorized amounts CBO estimates Subtitle 
A would result in additional discretionary outlays of $107 
million in 1999 and $985 million over the 1998-2003 period.
            Subtitle B--Nursing Workforce Development
    S. 1754 would reauthorize, amend, and consolidate the 
Nursing Workforce Development programs administered by HRSA. It 
authorizes $65 million in 1998 and such sums as necessary over 
the 1999-2002 period. CBO estimates that this subtitle would 
result in additional discretionary spending of $28 million in 
1999 and $269 million over the 1998-2003 period.
            Subtitle C--Financial Assistance
    Chapter 1--School-Based Revolving Loan Funds. S. 1745 would 
reauthorize and amend HRSA's school-based revolving loan funds. 
It authorizes $8 million in annual appropriations for 1998 
through 2002. CBO estimates this provision would result in 
additional discretionary outlays of $11 million in 1999 and $39 
million during the 1998-2003 period.
    Chapter 2--Insured Health Education Assistance Loans to 
Graduate Students. S. 1754 would reauthorize the HEAL program 
through 2002. Currently, the program's authorization expires at 
the end of 1998, and it is only authorized to make loans to 
students who received their first HEAL loan before 1995. 
Section 143 of the bill would reauthorize HEAL for 5 years, 
starting in 1998. The authorized loan limits would be $350 
million in 1998, $375 million in 1999, and $425 million a year 
for 2000 through 2002. Loans to new borrowers would not be 
issued after 2000, and no loans would be insured under the 
program after 2005. CBO assumes that loan disbursements would 
equal the amount authorized. CBO estimates that the average 
subsidy rate for these disbursements would be about 7 percent. 
Therefore, this provision would result in $17 million in direct 
spending in 1998 and a total of $158 million during the 1998-
2003 period.
    For lenders who fail to meet certain performance standards, 
the bill would also reduce federal payments from 100 percent to 
98 percent of losses incurred through loan defaults. In 
addition, the Secretary would have the authority to collect any 
unpaid balances from the estate of a deceased borrower. 
Finally, the proposal would grant a deferment to borrowers who 
furnish health care services to Indians through an Indian 
Health Service program.

Title II--Office of Minority Health

    S. 1754 would reauthorize the Office of Minority Health 
within the Office of the Assistant Secretary. It would also 
require the Secretary to establish the Advisory Committee on 
Minority Health. It would authorize appropriations of $30 
million for 1998 and such sums as necessary for 1999-2002.
    It would also reauthorize the National Center for Health 
Statistics (NCHS) within the Centers for Disease Control and 
Prevention (CDC), providing such sums as necessary for 1999 
through 2003. In addition, where current law provides a general 
authorization for NCHS to make grants to entities for data 
collection and analysis on racial and ethnic populations, S. 
1754 would authorize an additional grant program. The funding 
under this grant program would be used for collecting data 
specifically on Hispanics and major Hispanic subpopulation 
groups and on American Indians, and for developing special area 
population studies on major Asian American and Pacific Islander 
populations. For this additional grant program, it would 
authorize $1 million in appropriations for fiscal year 1998 and 
such sums as necessary for 1999-2002.
    CBO estimates the provisions under title II would result in 
additional discretionary outlays of $25 million in 1999 and 
$242 million during the 1998-2003 period.

Title III--Selected Initiatives and Title IV--Miscellaneous Provisions

    S. 1754 would amend and reauthorize several other grant 
programs within HRSA, CDC, the National Institutes of Health, 
and the Administration on Aging. Except for a few small 
programs where the bill specifies the authorization for one or 
more years, titles III and IV would provide such sums as 
necessary for the entire period of the authorization for these 
programs. In addition, it would provide a permanent 
authorization of $0.5 million a year for the Foundation for the 
National Institutes of Health.
    Assuming appropriation of the authorized amounts, CBO 
estimates that titles III and IV would result in additional 
discretionary spending of $163 million in 1999 and $1.9 billion 
over the 1998-2003 period.
    Pay-as-you-go considerations: The Balanced Budget and 
Emergency Deficit Control Act of 1985 sets up pay-as-you-go 
procedures for legislation affecting direct spending or 
receipts. Because section 143 of the bill would affect direct 
spending, pay-as-you-go procedures would apply. The impact of 
this provision on Federal outlays is shown in the following 
table. For the purposes of enforcing pay-as-you-go procedures, 
only the effects in the budget year and the succeeding four 
years are counted.

                                        SUMMARY OF PAY-AS-YOU-GO EFFECTS                                        
                                    [By fiscal year, in millions of dollars]                                    
----------------------------------------------------------------------------------------------------------------
                                             1998   1999   2000   2001   2002   2003   2004   2005   2006   2007
----------------------------------------------------------------------------------------------------------------
Change in outlays.........................     17     26     30     31     31     23     16      8      0      0
Change in receipts........................                                                                      
(9)Not applicable                                                                                               
----------------------------------------------------------------------------------------------------------------

    Estimated impact on State, local, and tribal governments: 
S. 1754 would waive any state statutes of limitations that 
govern the repayment of loans to nursing and other medical 
students. This preemption of state statutory authority would be 
a mandate as defined by the Unfunded Mandates Reform Act. 
However, CBO estimates that the mandate would have no impact on 
the budgets of State, local, or tribal governments.
    The bill would also authorize appropriations for a number 
of grant programs. State and local governments, as well as 
other public and private entities, would be eligible to receive 
funding from these grant programs as long as they meet certain 
grant conditions. Participation in these programs would be 
voluntary, and the overall budgetary effects to the 
participating governments would be favorable.
    Estimated impact on the private sector: S. 1754 does not 
include any private sector mandates as defined in the Unfunded 
Mandates Reform Act.
    Estimate prepared by: Federal costs: Cyndi Dudzinski; 
Impact on State, local, and tribal governments: Leo Lex; Impact 
on the private sector: Julia Matson.
    Estimate approved by: Paul N. Van de Water, Assistant 
Director for Budget Analysis.

            VI. Application of Law to the Legislative Branch

    Section 102(b)(3) of Public Law 104-1, the Congressional 
Accountability Act (CAA), requires a description of the 
application of this bill to the legislative branch. S. 1754 
reauthorizes the programs funded through titles VII and VIII of 
the Public Health Service Act and other selected initiatives in 
public health.
    S. 1754 does not amend any act that applies to the 
legislative branch. Therefore, the committee has determined 
that there will be no budgetary or administrative impact on the 
legislative branch as a result of this bill.
    S. 1754 will require one study and several reports and will 
result in additional information available to the Congress. The 
bill requires that no later than 2 years after the date of 
enactment of this Act, the Institute of Medicine report to the 
Congress the results of a study on victims of family or 
acquaintance violence. Not later than 6 months after enactment 
of the bill, the Secretary would be required to submit to 
Congress a report on efforts to address the need for a 
representative mix of individuals from historically minority 
health professions schools, or from institutions or other 
entities that have a demonstrated record of training and 
educating underrepresented minorities. The bill 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. The bill requires the Secretary to establish three 
advisory bodies. Not later than 3 years after enactment, and 
annually thereafter, each of these advisory bodies is required 
to submit to the Secretary and to Congress a report of its 
activities and any findings and recommendations.

                    VII. 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.

                   VIII. Section-by-Section Analysis

Section 1. Short Title; Table of Contents

    The title of the bill would be ``Health Professions 
Education Partnerships Act of 1998.''

TITLE I--HEALTH PROFESSIONS EDUCATION AND FINANCIAL ASSISTANCE PROGRAMS

           Subtitle A--Health Professions Education Programs

    Section 101. Under-Represented Minority Health Professions 
Grant Program. Amends PartB of title VII of the Public Health 
Service Act to read as follows: ``Part B--Health Professions Training 
For Diversity.''
    Section 736. Centers of Excellence (COE). The Secretary 
would be required to make grants to designated health 
professions schools for the purpose of assisting the schools in 
supporting programs of excellence in health professions 
education for underrepresented minority individuals. In order 
to receive a grant, a school would have to agree to expend the 
grant to: (1) develop a large competitive applicant pool 
through links to institutions of higher education, local school 
districts, and other community-based entities and establish an 
education pipeline for health professions careers; (2) 
establish, strengthen, or expand programs to enhance the 
academic performance of underrepresented minority students 
attending the school; (3) improve the capacity of the school to 
train, recruit, and retain underrepresented minority faculty, 
including the payment of such stipends and fellowships as the 
Secretary determined necessary; (4) carry out activities to 
improve the information resources, clinical education, 
curricula and cultural competence of the graduates of the 
school related to minority health issues; (5) facilitate 
faculty and student research on health issues particularly 
affecting underrepresented minority groups, including research 
on issues relating to the delivery of health care; (6) carry 
out a program to train students of the school in providing 
health services to a significant number of underrepresented 
minority individuals through training provided to such students 
at community-based health facilities that provide such health 
services, and were located on the teaching facilities of the 
school; and (7) provide stipends as the Secretary determines 
appropriate, in the amount as the Secretary determines 
appropriate.
    To be designated a COE, schools would be required to: (1) 
have a significant number of underrepresented minority 
individuals enrolled or accepted for enrollment in the school; 
(2) be effective in assisting underrepresented minority 
students in completing the educational program and receiving a 
degree; (3) be effective in recruiting underrepresented 
minority individuals to enroll in and graduate from the school 
by providing scholarships and other financial assistance, and 
encouraging underrepresented minority students from all levels 
of the educational pipeline to pursue health professions 
careers; and (4) make significant recruitment efforts to 
increase the number of underrepresented minority individuals 
serving in faculty or administrative positions at the school. 
Designated health professions schools, including Native 
American COE's, could be involved with other health professions 
schools (designated or not) in a consortium in order to be 
eligible to participate in the program. The criteria for the 
COE program established by this section, with respect to racial 
and ethnic minorities, could not be construed to authorize, 
require, or prohibit the use of such criteria in any other 
program.
    A COE in Historically Black Colleges and Universities would 
also be permitted to expend the grant to develop a plan to 
achieve institutional improvements including: financial 
independence; enabling the school to support programs of 
excellence in health professions for underrepresented minority 
individuals; and, providing improved access to the library and 
informational resources of the school. An exception is allowed 
to the consortium requirements for historically black COE's 
that receive other funding based on underrepresentation. 
Schools participating as Hispanic COE's would be required to 
give priority to Hispanic individuals. The school would agree, 
as a condition of getting a grant, that the school would enter 
into an arrangement with one or more public or nonprofit 
community-based, Hispanic serving organizations or public, or 
nonprofit private institutions of higher education, including 
schools of nursing, who have traditionally enrolled significant 
numbers of Hispanics, to identify Hispanic students interested 
in a health professions career and facilitate the educational 
preparation of such students. The school would also be required 
to make efforts to recruit Hispanic students, especially those 
students who were helped in an undergraduate or other 
matriculation program, and assist Hispanic students with the 
completion of the educational requirements for a degree from 
the school.
    Native American COE's would have to agree, as a condition 
of receiving a grant, to give priority to Native Americans. The 
school would be required to establish an arrangement with one 
or more public or nonprofit private institutions of higher 
education, including schools of nursing, whose enrollment of 
students has traditionally included a significant number of 
Native Americans. The school would be required to identify 
Native American students, facilitate the educational 
preparation of such students. Designated schools would be 
required to make efforts to recruit Native American students, 
including students who had participated in the undergraduate 
program, and agree to assist Native American students with the 
completion of the educational requirements for a degree. The 
Secretary would be permitted to make grants to schools that do 
not meet the requirements of participation if the school has 
formed a consortium and the schools in the consortium 
collectively meet such conditions.
    Grants could not exceed 5 years, and grant payments would 
be subject to annual review by the Secretary and to the 
availability of appropriations for a fiscal year.
    Unless otherwise specified, a health professions school 
would be defined as a school of medicine, osteopathic medicine, 
dentistry, pharmacy, or a graduate program in behavioral or 
mental health. Native Americans would be defined to include 
American Indians, Alaskan Natives, Aleuts, and native 
Hawaiians.
    To make these grants, the bill would authorize 
appropriations of $26 million for FY 1998, and such sums as 
necessary for fiscal years 1999-2002. If the appropriated 
amount was less than $24 million, $12 million would go to the 
Historically Black Colleges and University COE's, and 60 
percent of the remainder would go to Hispanic or Native 
American COE's, and the remaining 40 percent would go to 
consortia receiving COE grants. If appropriations were more 
than $24 million but less than $30 million, 80 percent of the 
excess amounts would be made available for grants to health 
professions schools that were, Hispanic or Native American 
COE's, and 20 percent of such excess would be made available 
for grants to other COE's. If appropriations were more than $30 
million, not less than $12 million would go to Historically 
Black Colleges and University COE's, not less than $12 million 
would go to Hispanic and Native American COE's, not less than 
$6 million would go to other COE's, and after grants were made 
with appropriated funds any remaining funds would go toward 
grants to health professions schools that met the conditions 
and requirements described in the authority for Historically 
BlackColleges and Universities, Hispanic, Native American, or 
other COE's.
    The bill would prohibit the Secretary from making grants to 
a COE for any fiscal year unless the center agreed to maintain 
expenditures of non-federal amounts for activities at a level 
that was not less than the level maintained by the center for 
the fiscal year preceding the fiscal year in which the school 
received such a grant. The Secretary would also be prohibited 
from making a grant unless the center agreed to spend Federal 
amounts obtained from other sources before expending the amount 
of the COE grant.
    Section 737. Scholarships for Disadvantaged Students. The 
Secretary would be authorized to make grants to eligible 
schools for the awarding of scholarships by schools to any 
full-time eligible student. Scholarships could only be expended 
for tuition expenses, other reasonable educational expenses, 
and reasonable living expenses incurred by attending the 
school. The Secretary would be prohibited from making a grant 
unless the health professions and nursing schools involved 
agreed that in providing scholarships under this grant, the 
schools would give preference to students for whom the cost of 
attending the school would constitute a severe financial 
hardship, as well as to students who had been former recipients 
under the Scholarships for Students of Exceptional Financial 
Need or the Health Career Opportunity Program (former sections 
736 and 740(d)(2)(B) of title VII). The Secretary would be 
required to give priority to eligible entities based on the 
proportion of graduating students going into primary care, the 
proportion of underrepresented minority students, and the 
proportion of graduates working in medically underserved areas.
    An eligible entity would be defined as a school of 
medicine, osteopathic medicine, dentistry, nursing, pharmacy, 
podiatric medicine, optometry, veterinary medicine, public 
health, allied health, schools offering graduate programs in 
behavioral and mental health practice, or an entity providing 
programs for the training of physician assistants. Eligible 
entities would be required to carry out a program for 
recruiting and retaining students from disadvantaged 
backgrounds, including students who were members of racial and 
ethnic minority groups.
    Section 738. Loan Repayments and Fellowships Regarding 
Faculty Positions. The Secretary would be required to establish 
a program for entering into contracts with individuals from 
disadvantaged backgrounds who had a degree in medicine, 
osteopathic medicine, dentistry, nursing, or other health 
profession, or were enrolled in the final year of a course of 
study or program offered by an institution leading to a degree 
in such a health profession. Eligible schools would be schools 
of medicine, nursing, osteopathic medicine, dentistry, 
pharmacy, allied health, podiatric medicine, optometry, 
veterinary medicine, public health, or schools offering 
graduate programs in behavioral and mental health.
    The Secretary would be prohibited from entering into a 
contract with an individual unless the individual had entered 
into a contract with an eligible school to serve as a member of 
the faculty for not less than 2 years. In addition, the 
contract must provide that (1) the school, for each year the 
individual served as a faculty member, make payments of the 
principal and interest due on educational loans of the 
individual for such year in an amount equal to the amount of 
such payments made by the Secretary; (2) the payments made by 
the school on behalf of the eligible individual be in addition 
to the pay that would otherwise be received by the individual; 
and (3) the school, in determining the amount of compensation 
to be provided by the school to the eligible individual for 
serving as a member of the faculty, make the determination, 
without regard to the amount of payments made to the individual 
by the federal government under this program.
    The provisions of the National Health Service Corps 
regarding Obligated Service, Special Loans for Former Corps 
Members to Enter Private Practice, and Grants to states for 
Loan Repayment Programs, would apply to this program, including 
the applicability of provisions regarding reimbursements for 
increased tax liability and bankruptcy.
    The Secretary would be authorized to make grants to and 
enter into contracts with eligible entities to assist them in 
increasing the number of underrepresented minority individuals 
on their faculty. To be eligible to receive a grant or 
contract, a school would be required to provide assurances in 
the application that amounts received under a grant or contract 
would be used to award fellowships to eligible individuals, and 
that each fellowship awarded would include a stipend in an 
amount not exceeding 50 percent of the regular salary of a 
similar faculty member for no more than 3 years of training, 
and an allowance for other expenses, such as travel to 
professional meetings and costs related to specialized 
training. Eligible schools would be required to demonstrate the 
ability to: (1) identify, recruit and select underrepresented 
minority individuals who had the potential for teaching, 
administration, or conducting research at a health professions 
institution; (2) provide such individuals with the skills 
necessary to enable them to secure a tenured faculty position 
at such an institution; (3) provide services designed to assist 
such individuals in their preparation for an academic career, 
including providing counselors; and (4) provide health services 
to rural or medically underserved populations.
    To be eligible to receive a grant or contract, the schools 
would be required to: (1) provide assurance that an applicant 
would match every $1 of federal funds received under this 
program for the fellowships; (2) provide assurance that 
institutional support would be provided for the individual for 
the second and third years at a level equal to the total amount 
of institutional funds provided; (3) provide assurance that the 
individual receiving the fellowship would be a member of the 
faculty of the school that was applying; and (4) provide 
assurance that the individual receiving the fellowship would 
have, at a minimum, appropriate advanced preparation and 
special skills necessary to enable such an individual to teach 
and practice.
    Underrepresented minority individuals would be defined as 
members of racial or ethnic minority groups that were 
underrepresented in the health professions, including nursing.
    Section 739. Educational Assistance in the Health 
Professions Regarding Individuals From Disadvantaged 
Backgrounds. The Secretary would be authorized to make grants 
for the purpose of assisting individuals from disadvantaged 
backgrounds to enter a health profession. TheSecretary would be 
authorized to make grants to and enter contracts with schools of 
medicine, osteopathic medicine, public health, dentistry, veterinary 
medicine, optometry, pharmacy, allied health, chiropractic, podiatric 
medicine, public and nonprofit private schools that offer graduate 
programs in behavioral and mental health, programs for training 
physician assistants, and other public or private nonprofit health or 
educational entities. The grants could be used to meet the cost of: (1) 
identifying, recruiting, and selecting individuals from disadvantaged 
backgrounds for education and training in a health profession; (2) 
facilitating the entry of such individuals in such a school; (3) 
providing counseling, mentoring, or other services designed to assist 
such individuals in successfully completing their education at such a 
school; (4) providing, for a period prior to entry into the regular 
course of education at such a school, preliminary education and health 
research training designed to assist them in successfully completing 
the regular course of education, including a graduate course in 
behavioral or mental health; (5) publicizing existing sources of 
financial aid available to students in the education program or who 
were undertaking training necessary to qualify them to enroll in such a 
program; (6) paying such scholarships as the Secretary determines for 
such individuals for any period of health professions education at a 
health professions school; (7) paying such stipends as the Secretary 
approves for any period of education in student-enhancement programs at 
any health professions school for no more than 12 months; (8) carrying 
out programs under which such individuals gain experience regarding a 
career in a field of primary health care through working at facilities 
of public or private non-profit community-based providers of primary 
health care services; and (9) conducting activities to develop a larger 
and more competitive applicant pool through partnerships with 
institutions of higher education, school districts, and other 
community-based entities.
    In making grants to eligible entities, the Secretary would 
be required to give preference to approved applications for 
programs that involve a comprehensive approach by several 
public or nonprofit private health or educational entities to 
establish, enhance and expand educational programs that would 
result in the development of a competitive applicant pool of 
individuals from disadvantaged backgrounds who were interested 
in pursuing health professions careers. In considering awards 
for such a comprehensive partnership approach, the following 
requirements would apply: (1) the entity would be required to 
have a demonstrated commitment to such approach through formal 
agreements that had common objectives with institutions of 
higher education, school districts, and other community-based 
entities; (2) such formal agreements would be required to 
reflect the coordination of educational activities and support 
services, increased linkages, and the consolidation of 
resources within a specified geographic area; (3) the design of 
the educational activities involved would be required to 
provide for the establishment of a competitive health 
professions applicant pool of individuals from disadvantaged 
backgrounds by enhancing the total preparation (academic and 
social) of such individuals to pursue a health professions 
career; and (4) the programs or activities under the award 
would be required to focus on developing a culturally competent 
health care workforce that would serve the unserved and 
underserved populations within the geographic area.
    The Secretary, to the extent practicable, would be required 
to ensure that services and activities under the grant program 
were adequately allocated among the various racial and ethnic 
populations who were from disadvantaged backgrounds. The 
Secretary would be authorized to require that an entity that 
applied for a grant or contract under this program provided 
non-federal matching funds, as appropriate, to ensure the 
institutional commitment of the entity to the projects funded 
under the grant or contract. The Secretary could determine that 
such non-federal matching funds could be provided directly or 
through donations from public or private entities and could be 
in cash or in kind, including plant, equipment, or services.
    Section 740. Authorization of Appropriation. The bill would 
authorize appropriations of $37 million for FY1998 and such 
sums as necessary for each of the fiscal years 1999 through 
2002 for section 737, Scholarships for Disadvantaged Students. 
The bill would also require that, of the amount appropriated 
for each year, not less than 16 percent be distributed to 
schools of nursing. For section 738, Loan Repayments and 
Fellowships Regarding Faculty Positions, the bill would 
authorize appropriations of $1.1 million for FY 1998, and such 
sums as may be necessary for fiscal years 1999 through 2002. 
For section 739, Educational Assistance in the Health 
Professions Regarding Individuals From Disadvantaged 
Backgrounds, the bill would authorize appropriations of $29.4 
million for FY1998, and such sums as may be necessary for 
fiscal years 1999 through 2002. The Secretary would be 
prohibited from using more than 20 percent of the appropriated 
amount for a fiscal year to provide undergraduate scholarships.
    The Secretary would be required to prepare and submit a 
report to the appropriate committees of Congress not later that 
6 months after enactment on the efforts of the Secretary to 
address the need for a representative mix of individuals from 
historically minority health professions schools, or from 
institutions or other entities that historically or by 
geographic location had a demonstrated record of training and 
educating underrepresented minorities, within various health 
professions disciplines, on peer review councils.
    The bill would repeal Section 795 of current law, which 
requires individuals receiving scholarships, stipends, or other 
financial assistance, including loan repayments, for health 
professions education to enter into an agreement to complete 
residency training in a primary care specialty no later than 4 
years after completing medical school, and agree to practice in 
the primary care specialty for 5 years after completing the 
program. Dentists would be required to practice general 
dentistry for 5 years after completing dental residency 
training under Section 795.
    Section 102. Training in Primary Care Medicine and 
Dentistry. Part C of Title VII of the PHS Act is amended by 
changing its title from ``Training in Primary Health Care'' to 
``Training in Family Medicine, General Internal Medicine, 
General Pediatrics, Physician Assistants, General Dentistry, 
and Pediatric Dentistry.''
    The bill would repeal section 746 which governs Area Health 
Education Center programs and replace section 747, which 
currently governs family medicine, with a new section described 
below.
    Section 747. Family Medicine, General Internal Medicine, 
General Pediatrics, General Dentistry, Pediatric Dentistry, and 
Physician Assistants. The bill would modify provisions that 
govern the Family Medicine training program to merge provisions 
that govern general internal medicine and general pediatrics 
training. The bill would add provisions that permit a grant 
under this program to be used to meet the costs of projects to 
plan, develop, and operate or maintain programs for the 
training of physician assistants and for the training of 
individuals to teach in programs providing such training. The 
bill would additionally permit the grants under this section to 
be used to meet the costs of planning, developing or operating 
programs, and to provide financial assistance to residents in 
general dentistry or pediatric dentistry programs.
    The Secretary, in awarding grants and contracts to 
qualified applicants (hospitals and medical schools), would be 
required to give priority to those applicants that propose a 
collaborative project between departments of primary care. With 
respect to programs to train interns or residents, the 
Secretary would be required to give priority in awarding grants 
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, who 
enter and remain in primary care practice or general or 
pediatric dentistry. The Secretary would be required to give 
priority in awarding grants to training programs for interns, 
residents, or physician assistants that have a record of 
training individuals from disadvantaged backgrounds (including 
racial and ethnic minorities underrepresented among primary 
care practice or general or pediatric dentistry). The Secretary 
would be required to give special consideration to projects 
which prepare practitioners to care for underserved populations 
and other high risk groups such as the elderly, individuals 
with HIV-AIDS, substance abusers, homeless, and victims of 
domestic violence.
    The bill would authorize appropriations of $78.3 million 
for FY1998, and such sums as necessary for each of the fiscal 
years 1999 through 2002. Of the appropriated amounts for a 
fiscal year, the Secretary would be required to allocate not 
less than $49.3 million for awards to programs of family 
medicine, of which not less than $8.6 million would be made 
available for grants and contracts for family medicine academic 
administrative units. Not less than $17.7 million would be 
allocated for awards of grants and contracts to programs of 
general internal medicine and general pediatrics; not less than 
$6.8 million for awards for physician assistants programs; and 
not less than $4.5 million would be allocated for programs 
related to general or pediatric dentistry. If the amounts 
appropriated for any fiscal year are less than the amounts 
required to comply with these allocations, the Secretary would 
be required to proportionately reduce the amounts allocated for 
each category of training program.
    The bill would repeal sections 748 through 752, the General 
Internal Medicine and General Pediatrics program, the General 
Practice of Dentistry program, the Physicians Assistants 
program, the Podiatric Medicine program, and the General 
Provisions section of Part C of the PHS Act.
    The bill would insert the following new section:
    Section 748. Advisory Committee on Training in Primary Care 
Medicine and Dentistry. The Secretary would be required to 
establish an advisory committee, the Advisory Committee on 
Training in Primary Care Medicine and Dentistry, made up of 
individuals who are not officers or employees of the federal 
government, the size of which would be determined by the 
Secretary. The Secretary would be required to appoint the 
members of the Advisory Committee, no later than 90 days after 
enactment of this bill, who represented a fair balance between 
the health professions, and ensure that at least 75 percent of 
the Advisory Committee are health professionals, and that the 
members represent broad geographic interests and were balanced 
between urban and rural areas. The Secretary would also be 
required to appoint members of the Advisory Committee that 
adequately represented the interests of women and minorities. 
The Advisory Committee would be required to advise and make 
recommendations to the Secretary concerning policy and program 
development, and other matters of significance concerning the 
Family Medicine, General Internal Medicine, General Pediatrics, 
General Dentistry, Pediatric Dentistry, and Physician 
Assistants program. No later than 3 years after enactment, and 
annually thereafter, the Advisory Committee would be required 
to prepare and submit to the Secretary and the Senate Labor and 
Human Resources Committee and the House Commerce Committee a 
report on the activities of the Advisory Committee and any 
findings and recommendations concerning the activities under 
section 747 of the bill.
    Section 103. Interdisciplinary, Community-Based Linkages. 
This section of the bill would amend Part D of title VI of the 
PHS Act to read as follows: ``Part D--Interdisciplinary, 
Community-Based Linkages.''
    Section 750. General Provisions. In order to receive 
assistance under this section, an academic institution would be 
required to use the assistance in collaboration with 2 or more 
disciplines. An entity would be required to use the assistance 
under this section to carry out innovative demonstration 
projects for strategic workforce supplementation activities 
necessary to meet national goals for interdisciplinary 
community-based linkages. The assistance provided by this 
section could be used: (1) to develop and support training 
programs; (2) for faculty development; (3) for model 
demonstration programs; (4) for the provision of stipends for 
fellowship trainees; (5) to provide technical assistance; and 
(6) for other activities that would produce outcomes consistent 
with the purposes of this program.
    Section 751. Area Health Education Centers. The Secretary 
would be required to award grants and enter into contracts with 
schools of medicine and osteopathic medicine, and incorporated 
consortia made up of such schools, or the parent institutions 
of such schools, for projects for planning, developing and 
operating area health education center (AHEC) programs. The 
AHEC programs would be required to: (1) improve the 
recruitment, distribution, supply, quality and efficiency of 
personnel providing health services in underserved rural and 
urban areas, and personnel providing health services to 
populations with serious unmet health care needs; (2) increase 
the number of primary care physicians and other primary care 
providers who serve in underserved areas by offering an 
educational continuum of health career recruitment through 
clinical education concerning underserved areas in a 
comprehensive health workforce strategy;(3) carry out 
recruitment and health career awareness programs to recruit individuals 
from underserved areas and underrepresented populations, including 
minority and other elementary or secondary students; (4) prepare 
individuals to more effectively provide health care services to 
underserved areas or underserved populations through field placements, 
preceptorships, the conduct of or support of community-based primary 
care residency programs, and agreements with community-based 
organizations such as community health centers, migrant health centers, 
Indian health centers, public health departments and others; (5) 
conduct health professions education and training activities for 
students of health professions schools and medical residents; (6) 
conduct at least 10 percent of medical students required clinical 
education at sites remote to the primary teaching facility of the 
contracting institution; and (7) provide information dissemination and 
educational support to reduce professional isolation, increase 
retention, enhance the practice environment, and improve health care 
through the timely dissemination of research findings using relevant 
resources.
    Project grants could not exceed 12 years, or 6 years in the 
case of an AHEC. However, the limitation would not apply to 
projects that had already completed the initial period of 
federal funding, and that wanted to compete for awards for 
model programs. The Secretary would be authorized to provide 
financial assistance to entities that had previously received 
funds under the AHEC program, were currently operating an AHEC 
program, and no longer received financial assistance from this 
program. The financial assistance provided to such an entity 
could be used to pay the costs of operating and carrying out 
the requirements of the new program, described above. In order 
to be eligible to receive a model program grant, an entity 
would be required to make available cash contributions from 
state, county, or municipal governments, or the private sector 
toward at least 50 percent of the program costs. The aggregate 
amount of awards to AHECs in a state for a fiscal year could 
not exceed the lesser of $2 million or the product of $250,000 
and the aggregate number of AHECs operated in a state.
    Each AHEC program receiving funds would be required to 
encourage the regionalization of health professions schools 
through the establishment of partnerships with community-based 
organizations. Each AHEC program would be required to 
specifically designate a geographic area or medically 
underserved population to be served by the center that was 
located away from the main location of the teaching facilities 
of the schools participating in the program. AHEC programs 
would also be required to: (1) assess the health personnel 
needs of the area to be served by the center and assist in the 
planning and development of training programs to meet such 
needs; (2) arrange and support rotations for students and 
residents in family medicine, general internal medicine, or 
general pediatrics, with at least one center in each program 
being affiliated with or conducting a rotating osteopathic 
internship or medical residency training program in these same 
medical specialties (including geriatrics), in which no fewer 
than 4 individuals were enrolled in first-year positions; (3) 
conduct and participate in interdisciplinary training that 
involves physicians and other health personnel; and (4) have an 
advisory board, of which at least 75 percent of members would 
be required to be both health care providers and consumers, 
from the area served by the center.
    At least 75 percent of federal funds provided to an AHEC 
program would be allocated by the program to the AHEC, with 
each center specifying the allocation of the 75 percent of 
funds. At least 50 percent of the operating costs of the AHEC 
program would be made available from non- federal 
contributions, except that the Secretary would be authorized to 
grant a waiver for up to 75 percent of the amount of non-
federal match in the first 3 years that funds were received.
    Section 752. Health Education and Training Centers (HETCs). 
In order to be eligible to receive funds, HETCs would be 
required to be an entity otherwise eligible for the AHECs 
funds, that (1) addressed the persistent and severe unmet 
health care needs in states along the border between the U.S. 
and Mexico, in the state of Florida, or other urban and rural 
areas with populations with serious unmet health care needs; 
(2) established an advisory board comprised of health service 
providers, educators, and consumers from the service area; (3) 
conducted training and education programs for health 
professions students in these areas; (4) conducted training in 
health education services, including training to prepare 
community health workers; and (5) supported health 
professionals (including nurses) practicing in the area through 
educational and other services.
    The Secretary would be required to make available 50 
percent of the amounts appropriated for each fiscal year under 
the HETCs program for the establishment or operation of HETCs 
through projects in states along the U.S. and Mexico border and 
the State of Florida.
    Section 753. Education and Training Relating to Geriatrics. 
The Secretary would be required to award grants or contracts 
for the establishment or operation of geriatric education 
centers (GECs) to health professions schools, academic health 
centers, state or local governments, or other appropriate 
public or private nonprofit entities for funding and 
participation in health professions and nurse training 
activities. A GEC would be a 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.
    The Secretary would also be allowed to make grants or enter 
into contracts with eligible entities for geriatric training in 
projects to train physicians and dentists who planned to teach 
geriatric medicine, geriatric psychiatry, or geriatric 
dentistry. The Secretary would also be required to establish a 
program to provide Geriatric Academic Career Awards to eligible 
individuals to promote the career development of such 
individuals in academic geriatrics. Eligible individuals must 
be board certified or board eligible in internal medicine, 
family practice, or psychiatry, have completed an approved 
fellowship program geriatrics and have a junior faculty 
appointment at an accredited school of medicine or osteopathic 
medicine. The amount of an award would equal $50,000 for FY 
1998, adjusted for subsequent years by the CPI, and the term of 
any award could not exceed 5 years. Individuals who received 
awards would be required to provide training inclinical 
geriatrics including the training of interdisciplinary teams of health 
care professionals. This training would constitute at least 75 percent 
of the obligations of an individual receiving an award.
    Section 754. Rural Interdisciplinary Training Grants. The 
Secretary would be authorized to make grants or enter contracts 
to help entities fund interdisciplinary training projects 
designed to: (1) use new and innovative methods to train health 
care practitioners to provide services in rural areas; (2) 
demonstrate and evaluate innovative interdisciplinary methods 
and models designed to provide access to cost-effective 
comprehensive health care; (3) deliver health care services to 
individuals residing in rural areas; (4) enhance the amount of 
relevant research conducted concerning health care issues in 
rural areas; and (5) increase the recruitment and retention of 
health care practitioners from rural areas and make rural 
practice a more attractive career choice for health care 
practitioners. Not more than 10 percent of the funds made 
available could be used for administrative expenses, and not 
more than 10 percent of the individuals receiving training with 
grant funds could be physicians. Applications would have to 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. 
Applications would also be required to designate a rural health 
care agency or agencies for clinical treatment or training, 
including hospitals, community health centers, migrant health 
centers, rural health clinics, community behavioral and mental 
health centers, or facilities operated by the Indian Health 
Service or an Indian tribe or tribal organization.
    Section 755. Allied Health and Other Disciplines. The 
Secretary would be authorized to make grants or enter into 
contracts with entities to help fund activities including (1) 
assisting entities in meeting the costs associated with 
expanding or establishing programs that would increase the 
number of individuals trained in allied health professions; (2) 
planning and implementing projects in preventive and primary 
care training for podiatric physicians in approved or 
provisionally approved residency programs that were required to 
provide financial assistance in the form of traineeships to 
residents who participated in such projects and who planned to 
specialize in primary care; and (3) carrying out demonstration 
projects in which chiropractors and physicians collaborated to 
identify and provide effective treatment for spinal and lower-
back conditions.
    Section 756. Advisory Committee on Interdisciplinary, 
Community-Based Linkages. The Secretary would be required to 
establish an advisory committee known as the Advisory Committee 
on Interdisciplinary, Community-Based Linkages, made up of 
members the Secretary determined appropriate and appointed no 
later than 90 days after enactment of this bill. The Advisory 
Committee would be required to provide advice and 
recommendations to the Secretary concerning policy and program 
development and other matters of significance to programs 
designed to promote interdisciplinary, community-based 
linkages. Not later than 3 years after enactment of the bill, 
and each year thereafter, the Advisory Committee would be 
required to prepare and submit a report describing the 
activities of the Committee, including findings and 
recommendations made by the Advisory Committee to the 
Secretary, the Senate Committee on Labor and Human Resources 
and the House Committee on Commerce.
    Section 757. Authorization of Appropriations. The bill 
would authorize appropriations of $55.6 million for FY 1998, 
and such sums as may be necessary for fiscal years 1999 through 
2002. Of these appropriated amounts, not less than $28.587 
million would be available for grants and contracts for AHECs; 
not less than $3.765 million would go for HETCs, of which not 
less than 50 percent would be required to be made available for 
centers that address the persistent and severe unmet health 
care needs along the U.S. and Mexico border and in the state of 
Florida; and not less than $22.631 million for awards grants 
and contracts for geriatrics, rural interdisciplinary grants, 
and allied health and other disciplines. If amounts 
appropriated for a fiscal year were less than the amount 
required for this allocation, the Secretary would be required 
to reduce the amounts available for each program accordingly. 
Of the amounts available for AHECs, the Secretary would be 
permitted to obligate certain amounts for the operation of 
model programs for each fiscal year of not less than 23 percent 
of such amounts in FY 1998, not less than 30 percent in FY 
1999, not less than 35 percent in FY 2000, not less than 40% in 
FY 2001, and not less than 45 percent in FY 2002.
    The bill would also include a Sense of the Congress that 
every state have an AHEC program in effect, and that the ratio 
of federal funding for model programs should be increased over 
time and that federal funding for other awards under this 
section shall decrease so that the national program becomes 
entirely comprised of programs funded at least 50 percent by 
state and local partners.
    Section 104. Health Professions Workforce Information and 
Analysis. Part E of title VII of the PHS Act would be amended 
to read as follows: ``Part E--Health Professions and Public 
Health Workforce, Subpart 1--Health Professions Workforce 
Information and Analysis.''
    Section 761. Health Professions Workforce Information and 
Analysis. The purpose of the section would be to provide for 
the development of information describing the health 
professions workforce and the analysis of workforce related 
issues, and to provide necessary information for decision-
making regarding future directions in health professions and 
nursing programs in response to societal and professional 
needs. The Secretary would be authorized to award grants or 
contracts to state or local governments, health professions 
schools, schools of nursing, academic health centers, 
community-based health facilities, and other appropriate public 
or private nonprofit entities to provide: (1) targeted 
information collection and analysis activities related to the 
purposes of health professions workforce analysis for future 
decision-making; (2) research on high priority workforce 
questions; (3) development of a non-federal analytic and 
research infrastructure; and (4) program evaluation and 
assessment.
    The bill would authorize appropriations of $750,000 for FY 
1998; and such sums as may be necessary for fiscal years 1999 
through 2002. Of the amounts appropriated, the Secretary would 
be required to reserve not less than $600,000 for conducting 
health professions research and for carrying out data 
collection and analysis in accordance with Section 792 of 
current law. Amounts otherwise appropriated could be used for 
activities of the Council on Graduate Medical Education 
(COGME).
    The bill would also amend current law (Section 301 of the 
PHS Act) to authorize COGME through FY 2002, and move that 
section into Part E of title VII of the PHS Act and redesignate 
the section as Section 763.
    Section 105. Public Health Workforce Development. Part E of 
title VII of the PHS Act, as amended by the bill, would be 
further amended by adding at the end the following: ``Subpart 
2--Public Health Workforce.''
    Section 765. General Provisions. The Secretary would be 
authorized to make grants or contracts to eligible entities to 
increase the number of individuals in the public health 
workforce, to enhance the quality of the workforce, and to 
enhance the ability of the workforce to meet national, state, 
and local health care needs. In order to receive a grant, an 
entity would be required to: (1) be a health professions 
school, including an accredited school or program of public 
health, health administration, preventive medicine, or dental 
public health or a school providing health management programs; 
an academic health center; a state or local government; or any 
other appropriate public or private nonprofit entity; and (2) 
prepare and submit to the Secretary an application at such 
time, in such manner, and containing the information required 
by the Secretary.
    In awarding grants or contracts, the Secretary would be 
authorized to grant a preference to entities serving 
individuals who are from disadvantaged backgrounds (including 
underrepresented racial and ethnic minorities), and graduating 
large proportions of individuals who serve in underserved 
communities. The grants could be used for: (1) the costs of 
planning, developing, or operating demonstration training 
programs; (2) faculty development; (3) trainee support; (4) 
technical assistance; (5) meeting the costs of projects to plan 
and develop new residency training programs and maintain or 
improve existing residency training programs in preventive 
medicine and dental public health, and provide financial 
assistance to residency trainees enrolled in such programs; (6) 
retraining existing public health workers as well as increasing 
the supply of new practitioners to address priority public 
health, preventive medicine, public health dentistry, and 
health administration needs; (7) preparing public health 
professionals for employment at the state and community levels; 
or (8) activities that could produce outcomes that were 
consistent with the purposes of this section.
    Traineeships would be required to be designed to: (1) make 
public health education more accessible to the public and 
private health workforce; (2) increase the relevance of public 
health academic preparation to public health practice in the 
future; (3) provide education or training for students from 
traditional on-campus programs in practice-based sites; or (4) 
develop educational methods and distance-based approaches or 
technology that address adult learning requirements and 
increase knowledge and skill related to community-based 
cultural diversity in public health education. Appropriated 
amounts for grants or contracts could be used for the operation 
of programs designed to award traineeships to students in 
accredited schools of public health who entered educational 
programs in fields where there was a severe shortage of public 
health professionals, including epidemiology, biostatistics, 
environmental health, toxicology, public health nursing, 
nutrition, preventive medicine, maternal and child health, and 
behavioral and mental health professions.
    Section 766. Public Health Training Centers. The Secretary 
would be authorized to make grants or contracts for the 
operation of public health training centers. A public health 
training center would be required to 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 to reach 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. The Secretary would be required to give preference 
to accredited schools of public health in awarding grants and 
contracts. In order to receive a grant or contract a public 
health training center would be required to agree to: (1) 
establish or strengthen field placements for students in public 
or nonprofit private health agencies or organizations; (2) 
involve faculty members and students in collaborative projects 
to enhance public health services to medically underserved 
communities; (3) designate a specific geographic area or 
medically underserved population to be served by the center 
that was geographically removed from the location of the 
teaching facility of the school that was participating in the 
program with the center; and (4) assess the health personnel 
needs of the area to be served by the center and assist in the 
planning and development of training programs to meet such 
needs.
    Section 767. Public Health Traineeships. The Secretary 
would be authorized to make grants to accredited schools of 
public health, and to other public or nonprofit private 
institutions accredited for the provision of graduate or 
specialized training in public health, for the purpose of 
assisting such schools and institutions in providing 
traineeships to individuals. The Secretary would be required to 
determine the amount of any grant awarded under this section. 
The traineeships awarded would be required to provide for 
tuition and fees and such stipends and allowances (including 
travel, subsistence expenses, and dependency allowances) for 
trainees as the Secretary determined necessary. Traineeship 
grants would be provided to eligible individuals who are 
pursuing a course of study in a health professions field in 
which there is a severe shortage of health professionals, 
including epidemiology, environmental health, biostatistics, 
toxicology, nutrition, and maternal and child health.
    Section 768. Preventive Medicine; Dental Public Health. The 
Secretary would be authorized to make grants and enter into 
contracts with schools of medicine, osteopathic medicine, 
public health, and dentistry to meet the costs of projects to: 
(1) plan and develop new residency training programs and to 
maintain or improve existing residency training programs in 
preventive medicine and dental public health; and (2) provide 
financial assistance to residency trainees enrolled in such 
programs. The Secretary would determine the amount of any grant 
under this section. To be eligible for a grant an applicant 
would be required to demonstrate that it had or would have 
available full-time faculty members with training and 
experience in the fields of preventive medicine or dental 
public health and support from other faculty members trained in 
public health. Schools of medicine, osteopathic medicine, 
dentistry, and public health would be allowed to usefunds 
committed by state, local, or county public health officers as matching 
amounts for federal grant funds for residency training programs in 
preventive medicine.
    Section 769. Health Administration Traineeships and Special 
Projects. The Secretary would be authorized to make grants to 
state or local governments that have in effect preventive 
medical and dental public health residency programs, or to 
public or nonprofit private educational entities, including 
graduate schools of social work and business schools or health 
management programs that offered a program in health 
administration, hospital administration, or health policy 
analysis and planning. The grants could be used to provide 
traineeships for students enrolled in such programs, and to 
assist accredited programs in health administration in the 
development or improvement of programs to prepare students for 
employment with public or nonprofit private entities.
    In making these grants, the Secretary would be required to 
give preference to qualified applicants who met the following 
conditions: (1) that not less than 25 percent of the graduates 
were engaged in full-time practice settings in medically 
underserved communities; (2) the educational entity recruited 
and admitted students from medically underserved communities; 
(3) for the purpose of training students, the entity had 
established relationships with public and nonprofit providers 
of health care in the community; and (4) in training students, 
the entity emphasized employment with public or nonprofit 
private entities. The traineeships awarded under the grants 
would be required to be used to provide tuition and fees and 
such stipends and allowances for the trainees as the Secretary 
decided are necessary. The entity applying for the grant would 
be required to assure the Secretary that priority would be 
given to students who demonstrated a commitment to employment 
with public or nonprofit private entities in the fields for 
which the traineeships were awarded.
    Section 770. Authorization of Appropriations. The bill 
would authorize appropriations of $9.1 million for FY 1998, and 
such sums as may be necessary for fiscal years 1999 through 
2002. The Secretary would be prohibited from obligating more 
than 30 percent of appropriated amounts for Section 767 of the 
bill, Public Health Traineeships.
    Section 106. General Provisions. Part F of title VII of the 
PHS Act, Miscellaneous Programs, would be repealed. Part G of 
title VII of the PHS Act, General Provisions, would be amended 
in section 791, Preferences and Required Information in Certain 
Programs, by striking subsection (b), Required Submission of 
Information, and redesignating subsection (c) as subsection 
(b). Part G would be further amended by repealing section 793, 
Statistics; Annual Report; repealing section 798, Certain 
General Provisions; by redesignating section 799 as section 
799B; and by inserting after section 794 the following:
    Section 796. Application. In order to receive a grant or 
contract under this title, an eligible entity would be required 
to prepare and submit an application to the Secretary that met 
the requirements of this section specified by the Secretary. An 
application submitted under this section would be required to 
contain the plan of the applicant for carrying out a project 
with amounts received under this title. The plan would be 
required to be consistent with relevant federal, state, or 
regional health professions program plans. An application would 
also be required to contain a specification by the applicant 
entity of performance outcome standards that the project being 
funded would be measured against, and the standards would 
address relevant health workforce needs that the project would 
meet. An application would also be required to contain a 
description of the linkages that would be established with 
relevant educational and health care entities, including 
training programs for other health professionals as 
appropriate. To the extent practicable, grantees would be 
required to establish linkages with health care providers who 
care for underserved communities and populations.
    Section 797. Use of Funds. In general, amounts provided 
under a grant or contract awarded under this title could 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 training period; technical assistance; workforce 
analysis; dissemination of information; and exploring new 
policy directions as appropriate to meet recognized health 
workforce objectives. The entity receiving the grant would be 
required to agree to maintain expenditures of non-federal 
amounts for grant-related activities at the level that was no 
less than the level of such expenditures by the entity in the 
fiscal year before receiving the grant.
    Section 798. Matching Requirement. The Secretary would be 
authorized to require that an entity that applied for a grant 
or contract under this title provide non-federal matching 
funds, as appropriate, to ensure the institutional commitment 
of the entity to projects funded under the grant. The Secretary 
would determine if such non-federal matching funds could be 
provided directly or through donations from public or private 
entities and could be in cash or in-kind, fairly evaluated, 
including plant, equipment, or services.
    Section 799. Generally Applicable Provisions. The Secretary 
would be required to 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 in accordance with this title. 
Contracts could be entered into with public or private entities 
as may be necessary.
    Unless otherwise required, the Secretary would be required 
to accept applications for grants or contracts from health 
professions schools, academic health centers, state or local 
governments, or other appropriate public or private nonprofit 
entities for funding and participation in health professions 
and nursing training activities. The Secretary would also be 
authorized to accept applications from for-profit private 
entities if determined to be appropriate by the Secretary.
    Grant and contract recipients would be required to meet 
information requirements specified by the Secretary. The 
Secretary would be required to establish procedures to ensure 
that, with respect to data collected under this title, the data 
was collected in a manner that takes into account age, gender, 
race, and ethnicity. The Secretary would be required to 
establish procedures to permit the use of amounts appropriated 
under this title to be used for data collection purposes. The 
Secretarywould be required to establish procedures to ensure 
the annual evaluation of programs and projects operated by recipients 
of grants or contracts under this title. The procedures would be 
required to ensure that continued funding for such programs and 
projects would be conditioned upon a demonstration that satisfactory 
progress has been made in meeting the objectives of the program or 
project. Training programs conducted with amounts received under this 
title would be required to meet applicable accreditation and quality 
standards.
    In general, the period of time during which payments would 
be made to an entity under this title could not exceed 5 years. 
The provision of payments under the award would be subject to 
annual approval by the Secretary. Each application for a grant 
under this title, except scholarships or loan programs, would 
be required to be submitted to a peer review group for 
evaluation of the merits of the proposals made in the 
application. The Secretary would be prohibited from approving 
an application unless a peer review group had recommended the 
application for approval.
    Section 799A. Technical Assistance. The Secretary would be 
authorized to use funds appropriated under this title to 
provide technical assistance in relation to the programs of 
this title. Section 792(a) of the PHS Act would be amended by 
including professional counselors as mental health 
professionals.
    Section 107. Preference in Certain Programs. Section 791 of 
the PHS Act, as amended by section 105(a)(2)(B) of the bill, 
would be further amended by adding the following subsection (c) 
``Exceptions for New Programs.'' New programs, defined as 
having graduating less than 3 classes, would be permitted to 
meet different criteria in order to qualify for funding. The 
criteria would be: (1) the mission statement of the program 
identified a specific purpose of the program as preparing 
health professionals to serve underserved populations; (2) the 
curriculum of the program included content which would help 
prepare practitioners to serve underserved populations; (3) 
substantial clinical training experience would be required to 
take place in medically underserved communities; (4) a minimum 
of 20 percent of the clinical faculty of the program would 
spend at least 50 percent of their time providing or 
supervising care in medically underserved areas; (5) the entire 
program, or a substantial portion of the program, would be 
physically located in a medically underserved community; (6) 
student assistance, linked to service in medically underserved 
communities following graduation, would be made available to 
students in the program; and (7) the program would provide a 
placement mechanism for deploying graduates to medically 
underserved communities.
    Section 108. Definitions. The bill would make conforming 
amendments and define certain terms including: (1) a graduate 
program in behavioral and mental health practice; (2) 
professional counseling as a behavioral and mental health 
practice; (3) a medically underserved community; and (4) 
programs for the training of physician assistants.
    Section 109. Technical Amendment on National Health Service 
Corps (NHSC). The bill would amend section 338B(b)(1)(B) of 
current law which provides for the NHSC loan repayment program 
for individuals enrolled in approved graduate training programs 
in medicine, osteopathic medicine, dentistry, or other health 
profession, by adding ``behavioral and mental health,'' in 
order to qualify individuals in graduate programs of behavioral 
and mental health for NHSC loan repayments.
    Section 110. Savings Provision. The Secretary would be 
permitted to continue in effect any grant or contract made 
under an authority of this title that was in effect on the day 
before the date of enactment of the bill, subject to the 
duration of the grant or determined by the Secretary in first 
approving such financial assistance.

               Subtitle B--Nursing Workforce Development

    Section 121. Short Title. This title would be named the 
Nursing Education and Practice Improvement Act of 1998.
    Section 122. Purpose. The nurse education authorities of 
title VIII of the PHS Act would be restructured to permit a 
comprehensive, flexible, and effective approach to federal 
support for nursing workforce development.
    Section 123. Amendments to Public Health Service Act. This 
section would amend Title VIII of the PHS Act to establish new 
provisions governing nurse education. The following current 
nurse education provisions would be maintained as new Part E: 
Student Loans: (1) the student loan program; and (2) the loan 
repayment program. The prohibition against discrimination by 
schools on the basis of sex would also be maintained. The new 
Title VIII: Nursing Workforce Development would be as follows:

Part A: General Provisions

    Section 801. Definitions. This section would define 
``eligible entities,'' ``school of nursing,'' ``collegiate 
school of nursing,'' and other terms.
    Section 802. Application. This section would describe 
procedures and requirements for eligible entities to receive a 
grant or contract under the nursing program.
    Section 803. Use of Funds. Grants or contracts would be 
allowed to be used for training program development and 
support, faculty development, model demonstrations, trainee 
support (including books, program fees, and reasonable living 
expenses), technical assistance, workforce analysis, and 
dissemination of information.
    Section 804. Matching Requirement. The Secretary could 
require an applicant to provide non-Federal matching funds. The 
funds could be provided directly or through donations from 
public or private entities and could be cash or in-kind, fairly 
evaluated, including plant, equipment, or services.
    Section 805. Preference. The Secretary would be required to 
give preference to applicants with projects that would 
substantially benefit rural or underserved populations, or help 
meet public health nursing needs in State or local health 
departments.
    Section 806. Generally Applicable Provisions. The Secretary 
would be required to ensure that grants and contracts were 
awarded on a competitive basis to carry out innovative 
demonstration projects or provide for strategic workforce 
supplementation activities as needed to meet national nursing 
service goals and in accordance with this title. The Secretary 
would be required to ensure the annual evaluation of programs 
and projects operated by grant recipients. Award payments to 
grantees could not exceed five years. Applications would be 
required to be approved by peer review groups, except 
applications for advanced nurse traineeship grants. The 
Secretary would be required to carry out specified analytic 
activities. Activities under this title, to the extent 
practicable, would be required to be consistent with related 
Federal, State, or regional nursing professions program plans 
and priorities.
    Section 807. Technical Assistance. The Secretary would be 
authorized to use funds under this title to provide technical 
assistance.

Part B: Nurse Practitioners, Nurse Midwives, Nurse Anesthetists, and 
        Other Advanced Practice Nurses

    Section 811. Advanced Practice Nursing Grants. The 
Secretary would be authorized to award grants and enter into 
contracts to meet the costs of: (1) projects that supported the 
enhancement of advanced practice nursing education and 
practice; and (2) traineeships for individuals in advanced 
practice nursing programs. Advanced practice nurses would be 
defined as individuals trained in advanced degree programs, or, 
in the case of nurse midwives, in certificate programs in 
existence on the date that was one day prior to the date of 
enactment of this section, to serve as nurse practitioners, 
clinical nurse specialists, nurse midwives, nurse anesthetists, 
nurse educators, nurse administrators, or public health nurses, 
or in other nurse specialties determined by the Secretary to 
require advanced education. Nurse anesthesia programs eligible 
for support under this section would be those programs that 
provided registered nurses with full-time anesthetist education 
and were accredited by the Council on Accreditation of Nurse 
Anesthesia Educational Programs. The Secretary would be 
prohibited from obligating more than 10 percent of the 
traineeships for advanced practice nursing programs for 
individuals in doctorate degree programs. The Secretary would 
be required to give special consideration to an entity that 
agreed to expend the award to train advanced practice nurses 
who would practice in health professions shortage areas.

Part C: Increasing Nursing Workforce Diversity

    Section 821. Workforce Diversity Grants. The Secretary 
would be authorized to award grants and enter into contracts 
with eligible entities to meet the costs of special projects to 
increase nursing education opportunities for individuals who 
were from disadvantaged backgrounds (including racial and 
ethnic minorities underrepresented among registered nurses) by 
providing student scholarships or stipends, pre-entry 
preparation, and retention activities. The Secretary, in the 
award of such grants, would be required 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 to consult 
with nursing associations. The grant recipients would be 
required to report to the Secretary on admission, retention, 
and graduation rates.

Part D: Strengthening Capacity for Basic Nurse Education and Practice

    Section 831. Basic Nurse Education and Practice Grants. The 
Secretary would be authorized to award grants to and enter into 
contracts with eligible entities for projects to strengthen 
capacity for basic nurse education and practice. The Secretary 
would be required to give priority to entities that would use 
grants to enhance the educational mix and utilization of the 
basic nursing workforce by strengthening programs that provide 
basic nurse education.

Part F: Authorization of Appropriations

    Section 841. Authorization of Appropriations. 
Appropriations would be authorized to carry out sections 811, 
821, and 831 in the amount of $65 million for FY 1998 and such 
sums as may be necessary in each of the fiscal years 1999 
through 2002.

Part G: National Advisory Council on Nurse Education and Practice

    Section 845. National Advisory Council on Nurse Education 
and Practice. The Secretary would be required to establish and 
appoint members to an advisory council to be known as the 
National Advisory Council on Nurse Education and Practice. The 
Secretary would be required to ensure a fair balance between 
the nursing professions, a broad geographic representation of 
members and a balance between urban and rural members. A 
majority of the members would be required to be nurses and the 
Secretary would be required to ensure the adequate 
representation of minorities. The Advisory Council would be 
required to: (1) advise and recommend to the Secretary and 
Congress on policy matters arising in the administration of 
this title, including the range of issues relating to the nurse 
workforce, education, and practice improvement; (2) advise the 
Secretary and Congress in the preparation of general 
regulations and with respect to policy matters arising under 
this title, including the range of issues relating to nurse 
supply, education and practice improvement; and (3) not later 
than three years after the date of enactment of this section, 
and annually thereafter, report to the Secretary, the Senate 
Committee on Labor and Human Resources, and the House Committee 
on Commerce on the activities of the Council, including 
findings and recommendations.
    Section 124. Savings Provision. The Secretary would be 
allowed to continue in effect any grant or contract made prior 
to enactment of section 123 of the bill for its duration.

                    Subtitle C--Financial Assistance

              CHAPTER 1--SCHOOL-BASED REVOLVING LOAN FUNDS

    Section 131. Primary Care Loan. The bill would make a 
technical amendment to section 723(b) requiring schools 
operating a loan program to meet certain conditions related to 
primary care residency training, to meet these conditions with 
respect to students who graduated from the school within the 
last 4 years rather than 3-years of each fiscal year. The bill 
would amend section 723(a)(3) to require that if a student 
failed to comply with the loan agreement, interest at a rate of 
18 percent per year would begin to accrue on the loan as of the 
date of noncompliance. The bill would also strike section 
723(c), eliminating the requirement that the Secretary report 
to the relevant committees of Congress on the administration of 
the loan program.
    Section 132. Loans for Disadvantaged Students. The bill 
would amend section 724(f)(1) of the PHS Act to authorize $8 
million for each of the fiscal years 1998 through 2002 for the 
loan program. The bill would also repeal the authority for 
appropriations for the loan program, effective October 1, 2002.
    Section 133. Student Loans Regarding Schools of Nursing. 
The bill would amend section 836(b), adding the requirement 
that, pursuant to uniform criteria established by the 
Secretary, the repayment period for a student borrower who had 
during the repayment period failed to make consecutive payments 
and had during the last 12 months made at least 12 consecutive 
payments, could be extended for a period not to exceed 10 
years. The bill would increase the minimum monthly loan 
repayment from $15 to $40. The bill would eliminate the statute 
of limitation for loan collections by nursing schools, 
including the period during which suit could be filed, a 
judgment could be enforced, or an offset, garnishment, or other 
action could be initiated or taken, effective with respect to 
actions pending on or after the date of enactment of the bill.
    The bill would amend section 846 of the PHS Act to add 
provisions for breach of agreements for the nurse student loan 
repayment for shortage area service program.
    The bill would also amend section 839 of the PHS Act, which 
provides for the distribution of capital assets from nurse 
student loan program, eliminating the stated dates for the 
distribution in current law (September 30, 1996 and December 
31, 1999). The bill would require instead that if a school 
terminated a loan fund, or the Secretary for good cause 
terminated the agreement with the school, there would be a 
capital distribution under which the Secretary would be first 
paid an amount which bears the same ratio to the balance in the 
loan fund on the date of termination of the fund. If a capital 
distribution was made, the school would be required to pay the 
Secretary not less than quarterly the same proportionate share 
of amounts received by the school in payment of principal or 
interest on loans made from the fund.
    Section 134. General Provisions. The bill would amend 
section 722(a)(1) of the PHS Act to provide that the maximum 
amount of a loan under this program would be equal to the cost 
of attendance (including tuition, other reasonable education 
expenses, and reasonable living costs) for that year at the 
educational institution attended by the student. The bill would 
amend section 722(a)(2), which provides loan amounts for third 
and fourth years of medical school, and would provide for a 
loan amount that could be increased to the extent necessary. 
The bill would amend section 722(c), which provides for 
repayment and exclusions from the ten-year repayment in current 
law, to provide for a repayment period of no less than 10 years 
and no more than 25 years, at the discretion of the 
institution, which would begin one year after the student was 
no longer in full-time course of study. The bill would strike 
the 10-year limit on exclusions from loan repayment and provide 
for exclusions of ``such period.'' The bill would increase 
minimum loan repayment amounts from $15 per month to $40 per 
month. The bill would also eliminate the statute of limitation 
for loan collections under section 722 of the PHS Act, 
effective with respect to actions pending on or after the date 
of enactment of the bill.

   CHAPTER 2--INSURED HEALTH EDUCATION ASSISTANCE LOANS TO GRADUATE 
                                STUDENTS

    Section 141. Health Education Assistance Loan Program 
(HEAL). The bill would amend section 705(a)(2)(C) of the PHS 
Act, which provides deferments for certain categories of HEAL 
borrowers, by adding a deferment of 3 years for borrowers 
providing health care services to Indians through an Indian 
health programs established by the Indian Health Care 
Improvement Act. The amendment would apply to services provided 
on or after the first day of the third month that begins after 
the date of enactment of the bill.
    The bill would eliminate the requirement that the Office of 
HEAL Default Reduction prepare and submit a report annually to 
the relevant congressional committees. The bill would amend 
section 714, Repayment by the Secretary of Loans of Deceased or 
Disabled Borrowers, to authorize the Secretary to, 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. The bill would also 
amend sections 703 and 719 of current law to add ``behavioral 
and mental health practice, including clinical psychology'' to 
eligibility definitions in place of ``clinical psychology.''
    Section 142. HEAL Lender and Holder Performance Standards. 
The bill would amend section 707 of current law which provides 
the conditions of payment to beneficiary when a borrower 
defaults on a loan, adding that if the insurance beneficiary 
was not designated for ``exceptional performance,'' as defined 
by the bill, the Secretary would be required to pay 98 percent 
of the amount of the loss sustained on a loan. The bill would 
define exceptional performance as an eligible lender, holder, 
or servicer of a loan with a compliance performance rating that 
equaled or exceeded 97 percent. A compliance performance rating 
would be determined based on compliance with due diligence in 
the disbursement, servicing, and collection of loans for each 
year for which the determination was made.
    Each eligible lender, holder, or servicer would be 
required, if seeking the designation of exceptional 
performance, to have an annual financial and compliance audit 
on its loan portfolio by a qualified independent organization 
from a list of such organizations identified by the Secretaryin 
accordance with standards established by the Secretary. The Secretary 
would be required to make the determinations of exceptional performance 
based on the audits and any information submitted by any other federal 
agency or office. To maintain its status as an exceptional performer, 
the lender, holder, or servicer would be required to undergo a 
quarterly compliance audit and submit the results of the audit to the 
Secretary. The Secretary would be required to revoke such designation 
of a lender, holder, or servicer if the quarterly audit was not 
received by the Secretary by a certain date, although if they did not 
meet the standard for designation they could reapply at any time. The 
cost of the audit would be paid for by the eligible lender, holder, or 
servicer of loans. The Secretary would be authorized to revoke the 
designation if it was determined that the lender, holder, or servicer 
had failed to maintain an overall level of compliance consistent with a 
submitted audit, or could have engaged in fraud in securing the 
designation. A lender, holder, or servicer that failed to service loans 
or otherwise comply with applicable program regulations would be 
considered to have violated the federal False Claims Act.
    Section 143. Reauthorization. The bill would amend section 
702 of the PHS Act authorizing federal loan insurance of $350 
million for FY 1998, $375 million for FY1999, and $425 million 
for fiscal years 2000-2002. The bill would provide continued 
federal loan insurance to enable students who had obtained 
insured loans in FY2001 or in prior fiscal years to complete 
their educations, and would extend the provision of federal 
loan insurance through September 30, 2005.
    Section 144. HEAL Bankruptcy. The bill would amend section 
707(g), Conditions for Discharge of Debt in Bankruptcy, to 
specify that the provision would apply notwithstanding any 
other provision of federal or state law, and the amended 
provision would apply to any loan insured on or after the date 
of enactment of the bill, or prior to enactment in cases in 
which a discharge had not yet been granted.
    Section 145. HEAL Refinancing. The bill would amend section 
706(d), Effect of Consolidations on Obligations, to add 
``Refinancing'' to the subsection title, and to provide for 
consolidation of indebtedness or refinancing of a single loan. 
The bill would also amend section 706(e), Rule of Construction 
Regarding Consolidation of Debts, to include ``Debts and 
Refinancing,'' and allow for the refinancing of a single HEAL 
loan.

                  TITLE II--OFFICE OF MINORITY HEALTH

    Section 201. Revision and Extension of Programs of Office 
of Minority Health. The bill amends section 1707 of the PHS Act 
providing for extension and revision of the Office of Minority 
Health authorities, 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) 
establish 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; (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; and, (5) submit an annual report by February 1 
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 Deputy Assistant Secretary would be required to 
ensure that awards are made, to the extent practical, on a 
competitive basis and that grant awards are peer reviewed. The 
use of sole source awards in accordance with PHS procurement 
regulations is allowed.
    Subject to the availability of appropriations to carry out 
the activities authorized under new section 306(m)(4) of the 
Public Health Service (PHS)Act, requires the National Center 
for Health Statistics to collect and report additional data on 
Hispanics and major Hispanic subgroups, American Indians and 
Alaska Natives, and develop special area population studies on 
major Asian American and Pacific Islander populations.
    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.
    Section 201 authorizes appropriations for OMH of $30 
million for fiscal year 1998, such sums as may be necessary for 
each of the fiscal years 1999 through 2002. Authorizes for 
section 306(n)(1) of the PHS Act such sums as necessary for 
each of fiscal years through 2003, and such sums as necessary 
for each of fiscal years 1999 through 2003 for section 
306(n)(2) of the same Act. In addition, authorizes 
appropriation of $1 million in FY 1998 for NCHS to carry out 
activities under new section 306(m)(4) of the PHS Act. Further 
authorizes for this purpose such sums as may be necessary for 
each of the fiscal years 1999 through 2002.

                    TITLE III--SELECTED INITIATIVES

    Section 301. State Offices of Rural Health. The bill would 
amend section 338J of the PHS Act to remove the requirement 
under the program for grants to states for the operation of 
offices of rural health that states match such federal grant 
amounts ``in cash.'' Appropriations would be authorized as 
necessary for each of the fiscal years 1998 through 2002. The 
program would be terminated when aggregate appropriations equal 
$20 million. The authority for the grant programwould be 
repealed effective October 1, 2002.
    Section 302. Demonstration Projects Regarding Alzheimer's 
Disease. The bill would amend section 398(a) of the PHS Act by 
removing the limitations on the number of grants that the 
Secretary of HHS would be authorized to award to states to 
assist in carrying out demonstration projects for planning, 
establishing, and operating programs regarding Alzheimer's 
disease. Respite care could be provided to individuals who were 
living in single family homes or in congregate settings. The 
Secretary would be required to make grants to states to improve 
the access of individuals with Alzheimer's disease to home-
based or community-based long-term care services, particularly 
such individuals who were members of racial or ethnic minority 
groups, who had limited English proficiency, or who lived in 
rural areas. The long-term care services would be subject to 
the services in the State involved as of October 1, 1995. The 
three-year limitation on the duration of demonstration grants 
would be removed. Appropriations of $8 million would be 
authorized for FY 1998, and such sums as may be necessary for 
each of the fiscal years 1999 through 2002.
    Section 303. Project Grants for Immunization Services. The 
bill would amend section 317(j) of the PHS Act by authorizing 
appropriations of such sums as may be necessary for each of the 
fiscal years 1998 through 2002 for grants for immunization 
services for children, adolescents, and adults. Appropriations 
would be authorized as necessary for preventive health service 
programs to provide without charge vaccines recommended and 
approved for routine use after October 1997.

                   TITLE IV--MISCELLANEOUS PROVISIONS

    Section 401. Technical Corrections Regarding Public Law 
103-183. The bill would make technical and amendatory 
corrections to the PHS Act as required by Public Law 103-183, 
the Preventive Health Amendments of 1993.
    Section 402. Miscellaneous Amendments Regarding PHS 
Commissioned Officers. The bill would amend section 212 of the 
PHS Act by declaring the active service of commissioned 
officers of the Public Health Service to be active military 
service in the armed forces for purposes of laws related to 
discrimination on the basis of race, color, gender, ethnicity, 
age, religion, and disability. Section 218 of the PHS Act would 
be amended to allow the Secretary to place a commissioned 
officer on leave without pay status while attending an 
educational institution or training program when the Secretary 
determined that such status would be in the best interest of 
the Service. Section 543(e) of the PHS Act, covering the 
confidentiality of alcohol and drug abuse records, would be 
made applicable to PHS commissioned officers.
    Section 403. Clinical Traineeships. The bill would amend 
section 303(d)(1) of the PHS Act to allow clinical traineeships 
in counseling with respect to mental health in the Public 
Health Service.
    Section 404. Project Grants for Screenings, Referrals, and 
Education Regarding Lead Poisoning. The bill would amend 
section 317A(l) of the PHS Act to extend authorized 
appropriations through fiscal year 2002 in such sums as may be 
necessary for project grants for screenings, referrals, and 
education regarding lead poisoning.
    Section 405. Project Grants for Preventive Health Services 
Regarding Tuberculosis. The bill would amend section 317E(g)(1) 
of the PHS Act by extending authorized appropriations of such 
sums as may be necessary through fiscal year 2002 for project 
grants for preventive health services regarding tuberculosis. 
The Secretary could reserve not more than 25 percent of such 
grants for any fiscal year for emergency grants for 
geographical areas with a substantial number of cases of 
tuberculosis or a substantial rate of increases in such cases.
    Section 406. CDC Loan Repayment Program. The bill would 
amend section 317F of the PHS Act to extend the loan repayment 
program of the Centers for Disease Control and Prevention (CDC) 
from FY 1998 through FY2002. It would also increase from 
$20,000 to $35,000 the amount paid for each year of service on 
the principal and interest on educational loans of health 
professionals that agree to conduct prevention activities as 
employees of CDC and the Agency for Toxic Substances and 
Disease Registry.
    Section 407. Community Programs on Domestic Violence. The 
bill would amend the Family Violence Prevention and Services 
Act to authorize appropriations of $6 million for each of the 
fiscal years 1997 through 2002 for the establishment and 
operation of community projects to coordinate intervention and 
prevention of domestic violence. The Secretary is required to 
request the Institute of Medicine (IOM) to conduct a study 
concerning the training needs of health professionals with 
respect to the detection and referral of victims of family or 
acquaintance violence. The IOM, not later than two years after 
the date of enactment of this Act, would be required to submit 
a report to Congress on the study.
    Section 408. State Loan Repayment Program. The bill would 
amend section 338I of the PHS Act to make such sums as may be 
necessary for each of the fiscal years 1998 through 2002 
available for the state loan repayment grant program. The 
program would assist states in providing for the increased 
availability of primary health services in health professional 
shortage areas.
    Section 409. Authority of the Director of NIH. The bill 
would amend section 402(b) of the PHS Act to authorize the 
Director of National Institutes of Health to: (1) conduct and 
support research training for which fellowships are not 
provided under the National Research Service Awards program and 
which do not consist of residency training of physicians or 
other health professionals; and (2) appoint physicians, 
dentists, and other health care professionals and compensate 
them in accordance with provisions of the Veterans Health 
Administration.
    Section 410. Raise in Maximum Level of Loan Repayments. The 
bill would amend sections 487A, 487B, 487C, and 487E to 
increase the maximum yearly loan repayment amount from$20,000 
to $35,000 annually for health professionals in the following programs: 
(1) research with respect to AIDS; (2) research with respect to 
contraception and fertility; (3) research generally; and (4) clinical 
researchers from disadvantaged backgrounds. Provides for the loan 
repayment for clinical researchers from disadvantaged background to 
include the tax reimbursement benefit.
    Section 411. Construction of Regional Centers for Research 
on Primates. The bill would amend section 481B(a) of the PHS 
Act, with respect to construction of regional centers for 
research on primates for FY1994 through FY1996, to allow the 
Director of NIH to decrease from $5 million to up to $2.5 
million, the amount that can be reserved for such construction.
    Section 412. Peer Review. The bill would amend section 
504(d)(2) of the PHS Act to remove the requirement for peer 
review of contracts administered through the Center for 
Substance Abuse Treatment, the Center for Substance Abuse 
Prevention, and the Center for Mental Health Services.
    Section 413. Funding for Trauma Care. The bill would amend 
section 1232(a) of the PHS Act to authorize appropriations for 
trauma care of such sums as may be necessary through FY2002.
    Section 414. Health Information and Health Promotion. The 
bill would amend section 1701(b) of the PHS Act to authorize 
appropriations of such sums as may be necessary through FY2002 
for health information and health promotion.
    Section 415. Emergency Medical Services for Children. The 
bill would amend section 1910(a) of the PHS Act with respect to 
the program for emergency medical services for children to 
change the two-year grant period to a three-year grant period, 
with an optional fourth year based on performance. Three grants 
may be made in a state in any fiscal year. The bill would 
authorize appropriations of such sums as may be necessary 
through FY2005 to carry out the program.
    Section 416. Administration of Certain Requirements. The 
bill would amend Public Law 103-43, National Institutes of 
Health Revitalization Act of 1993, to strike provisions 
requiring compliance with the Buy American Act for fiscal years 
1994 through 1996 check provision.
    Section 417. AIDS Drug Assistance Program. The bill would 
amend section 2618(b)(3) of the PHS Act with respect to the 
Ryan White CARE Act, to treat the Virgin Islands and Guam as 
states instead of territories for purposes of distributing 
funds for the AIDS Drug Assistance Program.
    Section 418. National Foundation for Biomedical Research. 
The bill would amend section 499 of the PHS Act to change the 
name of the National Foundation for Biomedical Research to the 
Foundation for the National Institutes of Health. The 
Foundation would be allowed to transfer funds to the National 
Institutes of Health and subjects such funds to federal 
limitations relating to federally-funded research. 
Appropriations of $500,000 are authorized for each fiscal year.

                          IX. Additional Views

                              ----------                              


 ADDITIONAL VIEWS OF SENATORS COATS, GREGG, FRIST, DeWINE, McCONNELL, 
                               HUTCHINSON

    In the weeks just prior to the markup of the Health 
Professions Education Partnerships Act of 1998, we became aware 
of an issue of enormous significance to faith-based and other 
community hospitals around the nation. Specifically, the issue 
is whether the Federal government, States or other governmental 
entities receiving Federal funds may discriminate against a 
hospital, provider sponsored organization, health maintenance 
organization, health plan or other health care entity because 
of its refusal to perform, refer for, or arrange for the 
provision of abortions.
    In our view, congress has already stated its intent with 
regard to this issue. Just 2 years ago, congress passed 
legislation in the context of a dispute over physician training 
in which we stated that: The Federal government, and any State 
or local government that receives Federal financial assistance 
may not subject any health care entity to discrimination on the 
basis that--
          1. The entity refuses to undergo training in the 
        performance of induced abortions, to require or provide 
        such training, to perform such abortions, or to provide 
        referrals for such training or such abortions;
          2. The entity refuses to make arrangements for any of 
        the activities specified in paragraph (1.) * * * 42 
        U.S.C. Sec. 238n (1996). added in H.R. 3019, Pub. L. 
        No. 104-134, 110 Stat. 1321 (April 26, 1996) (emphasis 
        added).
    Congress explained that ``the term `health care entity' 
includes an individual physician, a postgraduate physician 
training program, and a participant in a program of training in 
the health professions.'' 42 U.S.C. Sec. 238n(c)(2) (1996) 
(emphasis added).
    We believe that the term ``health care entity'' in 42 
U.S.C. Sec. 238n was intended to be read in the straightforward 
manner of ``including'' not only the specific entities 
mentioned, but also those which are routinely seen as health 
care entities in common usage and other Federal laws, such as a 
hospital, provider sponsored entity, health maintenance 
organization, health plan, or any other type of health care 
entity. By the word ``includes'' congress intended to add to, 
not subtract, from, the range of entities generally seen as 
``health care entities'' under Federal law. We intend to 
explore other means of definitively resolving this question of 
legislative intent.

                                   Bill Frist.
                                   Mitch McConnell.
                                   Judd Gregg.
                                   Tim Hutchinson.
                                   Dan Coats.
                                   Mike DeWine.

                       X. 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 of 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

           *       *       *       *       *       *       *


                           military benefits

    Sec. 212. [213] (a) * * *

           *       *       *       *       *       *       *

    (f) Active service of commissioned officers of the Service 
shall be deemed to be active military service in the Armed 
Forces of the United States for purposes of all laws related to 
discrimination on the basis of race, color, sex, ethnicity, 
age, religion, and disability.

           *       *       *       *       *       *       *


                          training of officers

    Sec. 218. [218a] (a) * * *

           *       *       *       *       *       *       *

    (c) A commissioned officer may be placed in leave without 
pay status while attending an educational institution or 
training program whenever the Secretary determines that such 
status is in the best interest of the Service. For purposes of 
computation of basic pay, promotion, retirement, compensation 
for injury or death, and the benefits provided by sections 212 
and 224, an officer in such status pursuant to the preceding 
sentence shall be considered as performing service in the 
Service and shall have an active service obligation as set 
forth in subsection (b) of this section.

           *       *       *       *       *       *       *


                             mental health

    Sec. 303. [242a] (a) In carrying out the purposes of 
section 301 with respect to mental health--
          (1) * * *

           *       *       *       *       *       *       *

    (d)(1) Any individual who has received a clinical 
traineeship, in psychology, psychiatry, nursing, marital and 
family therapy, or counseling 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.

           *       *       *       *       *       *       *


SEC. 338B. [254L-1] NATIONAL HEALTH SERVICE CORPS LOAN REPAYMENT 
                    PROGRAM.

    (a) Establishment.-- * * *

           *       *       *       *       *       *       *

         (B) be enrolled in an approved graduate training 
        program in medicine, osteopathic medicine, dentistry, 
        [or other health profession] behavioral and mental 
        health, or other health profession; or

           *       *       *       *       *       *       *


                 national center for health statistics

    Sec. 306. (a) * * *

           *       *       *       *       *       *       *

    (m)(1) * * *

           *       *       *       *       *       *       *

    (4)(A) Subject to subparagraph (B), the Secretary, acting 
through the Center, shall make grants to public and nonprofit 
private entities for collecting data on Hispanics and major 
Hispanic subpopulation groups and American Indians, and for 
developing special area population studies on major Asian 
American and Pacific Islander populations.
    (B) The provisions of subparagraph (A) shall be effective 
with respect to a fiscal year only to the extent that funds are 
appropriated pursuant to paragraph (3) of subsection (n), and 
only if the amounts appropriated for such fiscal year pursuant 
to each of paragraphs (1) and (2) of subsection (n) equal or 
exceed the amounts so appropriated for fiscal year 1997.
    (n)(1) For health statistical and epidemiological 
activities undertaken or supported under subsections (a) 
through (l), there are authorized to be appropriated such sums 
as may be necessary for each of the fiscal years 1991 [through 
1998] through 2003.
    (2) For activities [authorized in subsection (m)] 
authorized in paragraphs (1) through (3) of subsection (m), 
there are authorized to be appropriated [$5,000,000 for fiscal 
year 1991, $7,500,000 for fiscal year 1992, $10,000,000 for 
fiscal year 1993, and $10,000,000 for each of the fiscal years 
1994 through 1998.] such sums as may be necessary for each of 
the fiscal years 1999 through 2003. Of such amounts, the 
Secretary shall use not more than 10 percent for administration 
and for activities described in subsection (m)(2).
    (3) For activities authorized in subsection (m)(4), there 
are authorized to be appropriated $1,000,000 for fiscal year 
1998, and such sums as may be necessary for each of the fiscal 
years 1999 through 2002.

           *       *       *       *       *       *       *


             project grants for preventive health services

    Sec. 317. (a) * * *

           *       *       *       *       *       *       *

    (j)(1) Except for grants for immunization programs the 
authorization of appropriations for which are established in 
paragraph (2), for grants under subsections (a) and (k)(1) for 
preventive health service programs to immunize without charge 
[individuals against vaccine-preventable diseases, there are 
authorized to be appropriated $205,000,000 for fiscal year 
1991, and such sums as may be necessary for each of the fiscal 
years 1992 through 1995.] children, adolescents, and adults 
against vaccine-preventable diseases, there are authorized to 
be appropriated such sums as may be necessary for each of the 
fiscal years 1998 through 2002. Not more than 10 percent of the 
total amount appropriated under the preceding sentence for any 
fiscal year shall be available for grants under subsection 
(k)(1) for such fiscal year.
    (2) For grants under subsection (a) for preventive health 
service programs for the provisions without charge of 
immunizations with vaccines approved for use, and recommended 
for routine use, after October 1, [1990] 1997, there are 
authorized to be appropriated such sums as may be necessary.

           *       *       *       *       *       *       *


     screenings, referrals, and education regarding lead poisoning

    Sec. 327A. (a) Authority for Grants.--

           *       *       *       *       *       *       *

    (l) Funding.--
          (1) Authorization of Appropriations.--For the purpose 
        of carrying out this section, there are authorized to 
        be appropriated $40,000,000 for fiscal year 1993, and 
        such sums as may be necessary for each of the fiscal 
        year 1994 through [1998] 2002.

           *       *       *       *       *       *       *


           preventive health services regarding tuberculosis

    Sec. 317S. (a) In General.-- * * *

           *       *       *       *       *       *       *

    (g) Funding.--
          (1) In General; allocation for emergency grants.--
                  (A) For the purpose of making grants under 
                subsection (a), there are authorized to be 
                appropriated $200,000,000 for fiscal year 1994, 
                and such sums as may be necessary for each of 
                the fiscal years 1995 through [1998] 2002.
                  (B) Of the amounts appropriated under 
                subparagraph (A) for a fiscal year, the 
                Secretary may reserve not more than 
                [$50,000,000] 25 percent for emergency grants 
                under subsection (a) for any geographic area in 
                which there is, relative to other areas, a 
                substantial number of cases of tuberculosis or 
                a substantial rate of increase in such cases.
          (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] 2002.

           *       *       *       *       *       *       *


                         loan repayment program

    Sec. 317F. (a) In General.--
          (1) Authority.--Subject to paragraph (2), the 
        Secretary may carry out a program of entering into 
        contracts with appropriately qualified health 
        professionals under which such health professionals 
        agree to conduct prevention activities, as employees of 
        the Centers for Disease Control and Prevention and the 
        Agency for Toxic Substances and Disease Registry, in 
        consideration of the Federal Government agreeing to 
        repay, for each year of such service, not more than 
        [$20,000] of the principal and interest of the 
        educational loans of such health professionals.

           *       *       *       *       *       *       *

    (c) Authorization of Appropriations.--For the purpose of 
carrying out this section, there are authorized to be 
appropriated $500,000 for fiscal year 1994, and such sums as 
may be necessary for each of the fiscal years 1995 through 
[1998] 2002.
    (d) Availability of Appropriations.--Amounts appropriated 
for a fiscal year for contracts under subsection (a) shall 
remain available until the expiration of the second fiscal year 
beginning after the fiscal year for which the amounts were 
appropriated.

   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.

           *       *       *       *       *       *       *


SEC. 338I. GRANTS TO STATES FOR LOAN REPAYMENT PROGRAMS.

    (a) In General.--

           *       *       *       *       *       *       *

    (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, and such sums as may be necessary 
        for each of the fiscal years 1998 through 2002.

           *       *       *       *       *       *       *


SEC. 338J. 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--

           *       *       *       *       *       *       *

    (j) Authorization of Appropriations.--
          (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 1998 through 2002.
          (2) Availability.--Amounts appropriated under 
        paragraph (1) shall remain available until expended.
    (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.

           *       *       *       *       *       *       *


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

SEC. 398. 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) to coordinate the development and operation with 
        public and private organizations of diagnostic, 
        treatment, care management, respite care, legal 
        counseling, and education services provided within the 
        State to individuals with Alzheimer's disease or 
        related disorders and to the families and care 
        providers of such individuals;
          (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 
        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. [LIMITATION] REQUIREMENT OF MATCHING FUNDS ON DURATION OF 
                    GRANT AND 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) For the first year of payments to a State from 
        a grant under section 398(a), the Secretary may not 
        make such payments in an amount exceeding 75 percent of 
        the costs of services to be provided by the State 
        pursuant to such section.
          (B) For the second year of such payments to a State, 
        the Secretary may not make such payments in an amount 
        exceeding 65 percent of the costs of such services.
          (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) The Secretary may not make a grant under section 
        398(a) to a State unless the State agrees to make 
        available, directly or through donations from public or 
        private entities, non-Federal contributions toward the 
        costs of services to be provided pursuant to such 
        section in an amount equal to--
                  (A) for the first year of payments to the 
                State from the grant, not less than $25 (in 
                cash or in kind under subsection (c)) for each 
                $75 of Federal funds provided in the grant;
                  (B) for the second year of such payments to 
                the State, not less than $35 (in cash or in 
                kind under subsection (c)) for each $65 of such 
                Federal funds; and
                  (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)] (b) 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 determining the amount of such non-Federal 
contributions.

SEC. 398B. GENERAL PROVISIONS.

    (a) Limitation of Administration 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 1998 
through 1990, $7,500,000 for fiscal year 1991, [and such sums] 
such sums as may be necessary for each of the fiscal years 1992 
and 1993, $8,000,000 for fiscal year 1998, and such sums as may 
be necessary for each of the fiscal years 1999 through 2002.

           *       *       *       *       *       *       *


                TITLE IV--SEXUALLY TRANSMITTED DISEASES

SEC. 401. EXTENSION OF PROGRAM OF GRANTS REGARDING PREVENTION AND 
                    CONTROL OF SEXUALLY TRANSMITTED DISEASES.

    (a) Innovative, Interdisciplinary Approaches.-- * * *

           *       *       *       *       *       *       *

    (c) Technical Corrections.--Section 318 of the Public 
Health Service Act, as amended by subsection (a) of this 
section, is amended--
          (1) in subsection (b)(3), by striking ``, and'' and 
        inserting ``; and'';
          (2) in subsection (c)(3), by striking ``, and'' and 
        inserting ``; and''; and
          (3) in subsection [(d)(5)] (e)(5)--

           *       *       *       *       *       *       *


              Appointment and authority of director of NIH

    Sec. 402. (a) The National Institutes of Health shall be 
headed by the Director of the National Institutes of Health 
(hereafter in this title referred to as the ``Director of 
NIH'') who shall be appointed by the President by and with the 
advice and consent of the Senate. The Director of NIH shall 
perform functions as provided under subsection (b) and as the 
Secretary may otherwise prescribe.
    (b) In carrying out the purposes of section 301, the 
Secretary, acting through the Director of NIH--
          (1) * * *

           *       *       *       *       *       *       *

          (11) may perform such other administrative functions 
        as the Secretary determines are needed to effectively 
        carry out this title; [and]
          (12) after consultation with the Director of the 
        Office of Research of Women's Health, shall ensure that 
        resources of the National Institutes of Health are 
        sufficiently allocated for projects of research on 
        women's health that are identified under section 
        486(b)[.];
          (13) may conduct and support research training--
                  (A) for which fellowship support is not 
                provided under section 487; and
                  (B) which does not consist of residency 
                training of physicians or other health 
                professionals; and
          (14) may appoint physicians, dentists, and other 
        health care professionals, subject to the provisions of 
        title 5, United States Code, relating to appointments 
        and classifications in the competitive service, and may 
        compensate such professionals subject to the provisions 
        of chapter 74 of title 38, United States Code.

           *       *       *       *       *       *       *


          research centers regarding chronic fatigue syndrome

    Sec. 447. (a) The Director of the Institute, after 
consultation with the advisory council for the Institute, may 
make grants to, or enter into contracts with, public or 
nonprofit private entities for the development and operation of 
centers to conduct basic and clinical research on chronic 
fatigue syndrome.
    (b) Each center assisted under this section shall use the 
facilities of a single institution, or be formed from a 
consortium of cooperating institutions, meeting such 
requirements as may be prescribed by the Director of the 
Institute.

         research and research training regarding tuberculosis

    Sec. [447.] 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 purpose.

           *       *       *       *       *       *       *


             biomedical and behavioral research facilities

    Sec. 481A. [287a-2] (a) Modernization and Construction of 
Facilities.--
          (1) In general.-- * * *

           *       *       *       *       *       *       *

    (c) * * *

           *       *       *       *       *       *       *

                          (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. (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] 
may, for each of the fiscal years 1994 through 1996, reserve 
from the amounts appropriated under section 481A(h) 
[$5,000,000] up to $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 availability of qualified applicants for such 
awards.

  loan repayment program for research with respect to acquired immune 
                          deficiency syndrome

    Sec. 487A. (a) In General.--The Secretary shall carry out a 
program of entering into agreements with appropriately 
qualified health professionals under which such health 
professionals agree to conduct, as employees of the National 
Institutes of Health, research with respect to acquired immune 
deficiency syndrome in consideration of the Federal Government 
agreeing to repay, for each year of such service, not more than 
[$20,000] $35,000 of the principal and interest of the 
educational loans of such health professionals.
    (c) Authorization of Appropriations.--For the purpose of 
carrying out this section, there are authorized to be 
appropriated such sums as may be necessary for each of the 
fiscal years 1994 through [1996] 2001.

 loan repayment program for research with respect to contraception and 
                              infertility

    Sec. 487B. (a) The Secretary, in consultation with the 
Director of the National Institute of Child Health and Human 
Development, shall establish a program of entering into 
contracts with qualified health professionals (including 
graduate students) under which such health professionals agree 
to conduct research with respect to contraception, or with 
respect to infertility, in consideration of the Federal 
Government agreeing to repay, for each year of such service, 
not more than [$20,000] $35,000 of the principal and interest 
of the educational loans of such health professionals.

           *       *       *       *       *       *       *


             loan repayment program for research generally

    Sec. 487C. (a) In General.--
          (1) Authority for program.--Subject to paragraph (2), 
        the Secretary shall carry out a program of entering 
        into contracts with appropriately qualified health 
        professionals under which such health professionals 
        agree to conduct research, as employees of the National 
        Institutes of Health, in consideration of the Federal 
        Government agreeing to repay, for each year of such 
        service, not more than [$20,000] $35,000 of the 
        principal and interest of the educational loans of such 
        health professionals.

           *       *       *       *       *       *       *


      loan repayment program regarding clinical researchers from 
                       disadvantaged backgrounds

    Sec. 487E. (a) Implementation of Program.--
          (1) In general.--Subject to section 487(a)(1)(C), the 
        Secretary, acting through the Director of NIH may, 
        subject to paragraph (2), carry out a program of 
        entering into contracts with appropriately qualified 
        health professionals who are from disadvantaged 
        backgrounds under which such health professionals agree 
        to conduct clinical research as employees of the 
        National Institutes of Health in consideration of the 
        Federal Government agreeing to pay, for each year of 
        such service, not more than [$20,000] $35,000 of the 
        principal and interest of the educational loans of the 
        health professionals.

           *       *       *       *       *       *       *

          (3) Applicability of certain provisions regarding 
        obligated service.--Except to the extent inconsistent 
        with this section, the provisions of sections [338C] 
        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 section 338B.

           *       *       *       *       *       *       *


         [Part I--National Foundation for Biomedical Research]

        Part I_Foundation for the National Institutes of Health

SEC. 499. ESTABLISHMENT AND DUTIES OF FOUNDATION.

    (a) In General.--The Secretary shall, acting through the 
Director of NIH, establish a nonprofit corporation to be known 
as the [National Foundation for Biomedical Research] Foundation 
for the National Institutes of Health (hereafter in this 
section referred to as the ``Foundation''). The Foundation 
shall not be an agency or instrumentality of the United States 
Government.

           *       *       *       *       *       *       *


                              peer review

    Sec. 504. (a) In General.-- * * *

           *       *       *       *       *       *       *

    (d) Recommendations.--
          (1) In general.-- * * *
          (2) By appropriate advisory council.--If the direct 
        cost of a grant, [cooperative agreement, or contract] 
        or cooperative agreement (described in subsection (a)) 
        to be made exceeds $50,000, the Secretary may make such 
        grant, [cooperative agreement, or contract] or 
        cooperative agreement only if such grant, [cooperative 
        agreement, or contract] or cooperative agreement is 
        recommended--

           *       *       *       *       *       *       *


SEC. 543. CONFIDENTIALITY OF RECORDS.

    (a) Requirement.-- * * *

           *       *       *       *       *       *       *

    (e) Nonapplicability.--The prohibitions of this section do 
not apply to any interchange of records--
          (1) within the [Armed Forces] Uniformed Services or 
        within those components of the Department of Veterans 
        Affairs furnishing health care to veterans; or
          (2) between such components and the [Armed Forces] 
        Uniformed Services.

           *       *       *       *       *       *       *


                     TITLE VI--TRAUMA CARE SYSTEMS

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

    (a) General Authority.-- * * *

           *       *       *       *       *       *       *

    (b) Advisory Council.--[Section 1201 of the Public Health 
Service Act (42 U.S.C. 300)] Title XII of the Public Health 
Service Act (42 U.S.C. 300d et seq.) is amended--

           *       *       *       *       *       *       *

    (f) Technical Corrections.--Title XII of the Public Health 
Service Act (42 U.S.C. 300d et seq.) is amended--
          (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. 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 (as 
defined in section 719) to borrowers covered by Federal loan 
insurance under this subpart shall not exceed [$350,000,000 for 
fiscal year 1993, $375,000,000 for fiscal year 1994, and 
$425,000,000 for fiscal year 1995] $350,000,000 for fiscal year 
1998, $375,000,000 for fiscal year 1999, and $425,000,000 for 
each of the fiscal years 2000 through 2002. If the total amount 
of new loans made and installments paid pursuant to lines of 
credit in any fiscal year in 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] obtained loans insured under 
this subpart in fiscal year 2002 or in prior fiscal years, 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 30, 2005. 
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. The Secretary may establish guidelines and 
procedures that lenders must follow in distributing funds under 
this subpart.

           *       *       *       *       *       *       *


SEC. 703. LIMITATIONS ON INDIVIDUAL INSURED LOANS AND ON LOAN 
                    INSURANCE.

    (a) In General.--The total of the loans made to a student 
in any academic year or its equivalent (as determined by the 
Secretary) which may be covered by Federal loan insurance under 
this subpart may not exceed $20,000 in the case of a student 
enrolled in a school of medicine, osteopathic medicine, 
dentistry, veterinary medicine, optometry, or podiatric 
medicine, and $12,500 in the case of a student enrolled in a 
school of pharmacy, public health, allied health, or 
chiropractic, or a graduate program in health administration 
[or clinical psychology] or behavioral and mental health 
practice, including clinical psychology. The aggregate insured 
unpaid principal amount for all such insured loans made to any 
borrower shall not at any time exceed $80,000 in the case of a 
borrower who is or was a student enrolled in a school of 
medicine, osteopathic medicine, dentistry, veterinary medicine, 
optometry, or podiatric medicine, and $50,000 in the case of a 
borrower who is or was a student enrolled in a school of 
pharmacy, public health, allied health, or chiropractic, or a 
graduate program in health administration or clinical 
psychology. The annual insurable limit per student shall not be 
exceeded by a line of credit under which actual payments by the 
lender to the borrower will not be made in any year in excess 
of the annual limit.

           *       *       *       *       *       *       *


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) a student who--

           *       *       *       *       *       *       *

                  (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 1993; 
                (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 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. 706. CERTIFICATE OF LOAN INSURANCE; EFFECTIVE DATE OF INSURANCE.

    (a) In General.--

           *       *       *       *       *       *       *

    (d) Effect of [Consolidation] Refinancing or Consolidation 
of Obligations.--The consolidation of the obligations of two or 
more federally insured loans obtained by a borrower in any 
fiscal year into a single obligation evidenced by a single 
instrument of [indebtedness] indebtedness or the refinancing of 
a single loan shall not affect the insurance by the United 
States. If the loans thus consolidated are covered by separate 
certificate of insurance issued under subsection (a), the 
Secretary may upon surrender of the original certificates issue 
a new certificate of insurance in accordance with that 
subsection upon the consolidated obligation. If the loans thus 
consolidated are covered by a single comprehensive certificate 
issued under subsection (b), the Secretary may amend that 
certificate accordingly.
    (e) Rule of Construction Regarding Consolidation of [Debts] 
Debts and Refinancing.--Nothing in this section shall be 
construed to preclude the lender and the borrower, by mutual 
agreement, from consolidating [all of the borrower's debts into 
a single instrument] all of the borrower's loans insured under 
this subpart into a single instrument (or, if the borrower 
obtained only 1 loan insured under the subpart, refinancing the 
loan 1 time) under the terms applicable to an insured loan made 
at the same time as the consolidation. The lender or loan 
holder should provide full information to the borrower 
concerning the advantages and disadvantages of loan 
[consolidation] Consolidation or refinancing. Nothing in this 
section shall be construed to preclude the consolidation of the 
borrower's loans insured under this subpart under section 428C 
of the Higher Education Act of 1965. Any loans insured pursuant 
to this subpart that are consolidated under section 428C of 
such Act shall not be eligible for special allowance payments 
under section 438 of such Act.

SEC. 707. DEFAULT OF BORROWERS.

    (a) Conditions for Payment to Beneficiary.--[Upon] (1) In 
General.--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 
requested (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 this 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 servicer of the loan is not 
designated for exceptional performance, as set forth in 
paragraph (2), the Secretary shall pay to the beneficiary a sum 
equal to 98 percent of the amount of the loss sustained by the 
insured upon that loan.
    (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 quarters 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.

           *       *       *       *       *       *       *

    (e) Definitions.--For purposes of this section:
          (1) * * *

           *       *       *       *       *       *       *

          (4) The term servicer means any agency acting on 
        behalf of the insurance beneficiary.

           *       *       *       *       *       *       *

    (g) Conditions for Discharge of Debt in Bankruptcy.--[A 
debt which is a loan insured] Notwithstanding any other 
provision of Federal or State law, a debt that is a loan 
insured under the authority of this subpart may be released by 
a discharge in bankruptcy under any chapter of title 11, United 
States Code, only if such discharge is granted--

           *       *       *       *       *       *       *


SEC. 709. OFFICE HEALTH EDUCATION ASSISTANCE LOAN DEFAULT REDUCTION.

    (a) Establishment.-- * * *
    (b) Purpose and Functions.-- * * *

           *       *       *       *       *       *       *

          (4) * * *
                  (A) * * *
                  (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.--
          (1) Establishment.-- * * *
          (2) Funding.--
                  (A) * * *
                  (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. 719. DEFINITIONS.

    For purposes of this subpart:
          (1) The term ``eligible institution'' means, with 
        respect to a fiscal year, a school of medicine, 
        osteopathic medicine, dentistry, veterinary medicine, 
        optometry, pediatric medicine, pharmacy, public health, 
        allied health, chiropractic, or a graduate program in 
        health administration [or clinical psychology] or 
        behavioral and mental health practice, including 
        clinical psychology.

           *       *       *       *       *       *       *


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) 
        [for 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, at the 
discretion of the institution, 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) In general.-- * * *

           *       *       *       *       *       *       *

          [(3) Noncompliance by student.--Each agreement 
        entered into with a student pursuant to paragraph (1) 
        shall provide that, if the student fails to comply with 
        the agreement--
                  [(A) the balance due on the loan involved 
                will be immediately recomputed from the date of 
                issuance at an interest rate of 15 percent per 
                year, compounded annually; and
                  [(B) the recomputed balance will be paid not 
                later than the expiration of the 3-year period 
                beginning on the date on which the student 
                fails to comply with the agreement.]
          (3) Noncompliance by student.--Each agreement entered 
        into with a student pursuant to paragraph (1) shall 
        provide that, if the student fails to comply with such 
        agreement, the loan involved will begin to accrue 
        interest at a rate of 18 percent per year beginning on 
        the date of such noncompliance.

           *       *       *       *       *       *       *

    (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. INDIVIDUALS FROM DISADVANTAGED BACKGROUNDS.

    (a) Fund Agreements Regarding Certain Amounts.-- * * *

           *       *       *       *       *       *       *

    (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 1998 through 2002.

           *       *       *       *       *       *       *


SEC. 735. GENERAL PROVISIONS

    (a) Date Certain for Applications.-- * * *

           *       *       *       *       *       *       *

    (e) Disposition of Funds Returned to Secretary.--
          (1) Expenditure for federal capital contributions.-- 
        * * *

           *       *       *       *       *       *       *

    (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.

           *       *       *       *       *       *       *


                TITLE VII--HEALTH PROFESSIONS EDUCATION

PART A--STUDENT LOANS

           *       *       *       *       *       *       *


            [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 sub-section (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, 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 3324 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) Use 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 ormore 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 professions 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 underrepresented 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); or
                  [(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 the 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, forpurposes 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 bee 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 any 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 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, Alerts, 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 meet-ing 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 inthe 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 
                purpose of informing individuals about the 
                existence and general nature of health 
                careers.]

           PART B--HEALTH PROFESSIONS TRAINING FOR DIVERSITY

SEC. 736. CENTERS OF EXCELLENCE.

  (a) In General.--The Secretary shall make grants to, and 
enter into contracts with, designated health professions 
schools described in subsection (c), and other public and 
nonprofit health or educational entities, for the purpose of 
assisting the schools in supporting programs of excellence in 
health professions education for under-represented minority 
individuals.
  (b) Required Use of Funds.--The Secretary may not make a 
grant under subsection (a) unless the designated health 
professions school involved agrees, subject to subsection 
(c)(1)(C), to expend the grant--
          (1) to develop a large competitive applicant pool 
        through linkages with institutions of higher education, 
        local school districts, and other community-based 
        entities and establish an education pipeline for health 
        professions careers;
          (2) to establish, strengthen, or expand programs to 
        enhance the academic performance of under-represented 
        minority students attending the school;
          (3) to improve the capacity of such school to train, 
        recruit, and retain under-represented minority faculty 
        including the payment of such stipends and fellowships 
        as the Secretary may determine appropriate;
          (4) to carry out activities to improve the 
        information resources, clinical education, curricula 
        and cultural competence of the graduates of the school, 
        as it relates to minority health issues;
          (5) to facilitate faculty and student research on 
        health issues particularly affecting under-represented 
        minority groups, including research on issues relating 
        to the delivery of health care;
          (6) to carry out a program to train students of the 
        school in providing health services to a significant 
        number of under-represented minority individuals 
        through training provided to such students at 
        community-based health facilities that--
                  (A) provide such health services; and
                  (B) are located at a site remote from the 
                main site of the teaching facilities of the 
                school; and
          (7) to provide stipends as the Secretary determines 
        appropriate, in amounts as the Secretary determines 
        appropriate.
  (c) Centers of Excellence.--
          (1) Designated schools.--
                  (A) In general.--The designated health 
                professions schools referred to in subsection 
                (a) are such schools that meet each of the 
                conditions specified in subparagraphs (B) and 
                (C), and that--
                          (i) meet each of the conditions 
                        specified in paragraph (2)(A);
                          (ii) meet each of the conditions 
                        specified in paragraph (3);
                          (iii) meet each of the conditions 
                        specified in paragraph (4); or
                          (iv) meet each of the conditions 
                        specified in paragraph (5).
                  (B) General conditions.--The conditions 
                specified in this subparagraph are that a 
                designated health professions school--
                          (i) has a significant number of 
                        under-represented minority individuals 
                        enrolled in the school, including 
                        individuals accepted for enrollment in 
                        the school;
                          (ii) has been effective in assisting 
                        under-represented minority students of 
                        the school to complete the program of 
                        education and receive the degree 
                        involved;
                          (iii) has been effective in 
                        recruiting under-represented minority 
                        individuals to enroll in and graduate 
                        from the school, including providing 
                        scholarships and other financial 
                        assistance to such individuals and 
                        encouraging under-represented minority 
                        students from all levels of the 
                        educational pipeline to pursue health 
                        professions careers; and
                          (iv) has made significant recruitment 
                        efforts to increase the number of 
                        under-represented minority individuals 
                        serving in faculty or administrative 
                        positions at the school.
                  (C) Consortium.--The condition specified in 
                this subparagraph is that, in accordance with 
                subsection (e)(1), the designated health 
                profession school involved has with other 
                health profession schools (designated or 
                otherwise) formed a consortium to carry out the 
                purposes described in subsection (b) at the 
                schools of the consortium.
                  (D) Application of criteria to other 
                programs.--In the case of any criteria 
                established by the Secretary for purposes of 
                determining whether schools meet the conditions 
                described in subparagraph (B), this section may 
                not, with respect to racial and ethnic 
                minorities, be construed to authorize, require, 
                or prohibit the use of such criteria in any 
                program other than the program established in 
                this section.
          (2) Centers of excellence at certain historically 
        black colleges and universities.--
                  (A) Conditions.--The conditions specified in 
                this subparagraph are that a designated health 
                professions school--
                          (i) is a school described in section 
                        799B(1); and
                          (ii) received a contract under 
                        section 788B for fiscal year 1987, as 
                        such section was in effect for such 
                        fiscal year.
                  (B) Use of grant.--In addition to the 
                purposes described in subsection (b), a grant 
                under subsection (a) to a designated health 
                professions school meeting the conditions 
                described in subparagraph (A) may be expended--
                          (i) to develop a plan to achieve 
                        institutional improvements, including 
                        financial independence, to enable the 
                        school to support programs of 
                        excellence in health professions 
                        education for under-represented 
                        minority individuals; and
                          (ii) to provide improved access to 
                        the library and informational resources 
                        of the school.
                  (C) Exception.--The requirements of paragraph 
                (1)(C) shall not apply to a historically black 
                college or university that receives funding 
                under paragraphs (2) or (5).
          (3) Hispanic centers of excellence.--The conditions 
        specified in this paragraph are that--
                  (A) with respect to Hispanic individuals, 
                each of clauses (i) through (iv) of paragraph 
                (1)(B) applies to the designated health 
                professions school involved;
                  (B) the school agrees, as a condition of 
                receiving a grant under subsection (a), that 
                the school will, in carrying out the duties 
                described in subsection (b), give priority to 
                carrying out the duties with respect to 
                Hispanic individuals; and
                  (C) the school agrees, as a condition of 
                receiving a grant under subsection (a), that--
                          (i) the school will establish an 
                        arrangement with 1 or more public or 
                        nonprofit community based Hispanic 
                        serving organizations, or public or 
                        nonprofit private institutions of 
                        higher education, including schools of 
                        nursing, whose enrollment of students 
                        has traditionally included a 
                        significant number of Hispanic 
                        individuals, the purposes of which will 
                        be to carry out a program--
                                  (I) to identify Hispanic 
                                students who are interested in 
                                a career in the health 
                                profession involved; and
                                  (II) to facilitate the 
                                educational preparation of such 
                                students to enter the health 
                                professions school; and
                          (ii) the school will make efforts to 
                        recruit Hispanic students, including 
                        students who have participated in the 
                        undergraduate or other matriculation 
                        program carried out under arrangements 
                        established by the school pursuant to 
                        clause (i)(II) and will assist Hispanic 
                        students regarding the completion of 
                        the educational requirements for a 
                        degree from the school.
          (4) Native american centers of excellence.--Subject 
        to subsection (e), the conditions specified in this 
        paragraph are that--
                  (A) with respect to Native Americans, each of 
                clauses (i) through (iv) of paragraph (1)(B) 
                applies to the designated health professions 
                school involved;
                  (B) the school agrees, as a condition of 
                receiving a grant under subsection (a), that 
                the school will, in carrying out the duties 
                described in subsection (b), give priority to 
                carrying out the duties with respect to Native 
                Americans; and
                  (C) the school agrees, as a condition of 
                receiving a grant under subsection (a), that--
                          (i) the school will establish an 
                        arrangement with 1 or more public or 
                        nonprofit private institutions of 
                        higher education, including schools of 
                        nursing, whose enrollment of students 
                        has traditionally included a 
                        significant number of Native Americans, 
                        the purpose of which arrangement will 
                        be to carry out a program--
                                  (I) to identify Native 
                                American students, from the 
                                institutions of higher 
                                education referred to in clause 
                                (i), who are interested in 
                                health professions careers; and
                                  (II) to facilitate the 
                                educational preparation of such 
                                students to enter the 
                                designated health professions 
                                school; and
                          (ii) the designated health 
                        professions school will make efforts to 
                        recruit Native American students, 
                        including students who have 
                        participated in the undergraduate 
                        program carried out under arrangements 
                        established by the school pursuant to 
                        clause (i) and will assist Native 
                        American students regarding the 
                        completion of the educational 
                        requirements for a degree from the 
                        designated health professions school.
          (5) Other centers of excellence.--The conditions 
        specified in this paragraph are--
                  (A) with respect to other centers of 
                excellence, the conditions described in clauses 
                (i) through (iv) of paragraph (1)(B); and
                  (B) that the health professions school 
                involved has an enrollment of under-represented 
                minorities above the national average for such 
                enrollments of health professions schools.
  (d) Designation as Center of Excellence.--
          (1) In general.--Any designated health professions 
        school receiving a grant under subsection (a) and 
        meeting the conditions described in paragraph (2) or 
        (5) of subsection (c) shall, for purposes of this 
        section, be designated by the Secretary as a Center of 
        Excellence in Under-Represented Minority Health 
        Professions Education.
          (2) Hispanic centers of excellence.--Any designated 
        health professions school receiving a grant under 
        subsection (a) and meeting the conditions described in 
        subsection (c)(3) shall, for purposes of this section, 
        be designated by the Secretary as a Hispanic Center of 
        Excellence in Health Professions Education.
          (3) Native american centers of excellence.--Any 
        designated health professions school receiving a grant 
        under subsection (a) and meeting the conditions 
        described in subsection (c)(4) shall, for purposes of 
        this section, be designated by the Secretary as a 
        Native American Center of Excellence in Health 
        Professions Education. Any consortium receiving such a 
        grant pursuant to subsection (e) shall, for purposes of 
        this section, be so designated.
  (e) Authority Regarding Native American Centers of 
Excellence.--With respect to meeting the conditions specified 
in subsection (c)(4), the Secretary may make a grant under 
subsection (a) to a designated health professions school that 
does not meet such conditions if--
          (1) the school has formed a consortium in accordance 
        with subsection (d)(1); and
          (2) the schools of the consortium collectively meet 
        such conditions, without regard to whether the schools 
        individually meet such conditions.
  (f) Duration of Grant.--The period during which payments are 
made under a grant under subsection (a) may not exceed 5 years. 
Such payments shall be subject to annual approval by the 
Secretary and to the availability of appropriations for the 
fiscal year involved to make the payments.
  (g) Definitions.--In this section:
          (1) Designated health professions school.--
                  (A) In general.--The term ``health 
                professions school'' means, except as provided 
                in subparagraph (B), a school of medicine, a 
                school of osteopathic medicine, a school of 
                dentistry, a school of pharmacy, or a graduate 
                program in behavioral or mental health.
                  (B) Exception.--The definition established in 
                subparagraph (A) shall not apply to the use of 
                the term ``designated health professions 
                school'' for purposes of subsection (c)(2).
          (2) Program of excellence.--The term ``program of 
        excellence'' means any program carried out by a 
        designated health professions school with a grant made 
        under subsection (a), if the program is for purposes 
        for which the school involved is authorized in 
        subsection (b) or (c) to expend the grant.
          (3) Native americans.--The term ``Native Americans'' 
        means American Indians, Alaskan Natives, Aleuts, and 
        Native Hawaiians.
  (h) Funding.--
          (1) Authorization of appropriations.--For the purpose 
        of making grants under subsection (a), there authorized 
        to be appropriated $26,000,000 for fiscal year 1998, 
        and such sums as may be necessary for each of the 
        fiscal years 1999 through 2002.
          (2) Allocations.--Based on the amount appropriated 
        under paragraph (1) for a fiscal year, one of the 
        following subparagraphs shall apply:
                  (A) In general.--If the amounts appropriated 
                under paragraph (1) for a fiscal year are less 
                than $24,000,000--
                          (i) the Secretary shall make 
                        available $12,000,000 for grants under 
                        subsection (a) to health professions 
                        schools that meet the conditions 
                        described in subsection (c)(2)(A); and
                          (ii) and available after grants are 
                        made with funds under clause (i), the 
                        Secretary shall make available--
                                  (I) 60 percent of such amount 
                                for grants under subsection (a) 
                                to health professions schools 
                                that meet the conditions 
                                described in paragraph (3) or 
                                (4) of subsection (c) 
                                (including meeting the 
                                conditions under subsection 
                                (e)); and
                                  (II) 40 percent of such 
                                amount for grants under 
                                subsection (a) to health 
                                professions schools that meet 
                                the conditions described in 
                                subsection (c)(5).
                  (B) Funding in excess of $24,000,000.--If 
                amounts appropriated under paragraph (1) for a 
                fiscal year exceed $24,000,000 but are less 
                than $30,000,000--
                          (i) 80 percent of such excess amounts 
                        shall be made available for grants 
                        under subsection (a) to health 
                        professions schools that meet the 
                        requirements described in paragraph (3) 
                        or (4) of subsection (c) (including 
                        meeting conditions pursuant to 
                        subsection (e)); and
                          (ii) 20 percent of such excess amount 
                        shall be made available for grants 
                        under subsection (a) to health 
                        professions schools that meet the 
                        conditions described in subsection 
                        (c)(5).
                  (C) Funding in excess of $30,000,000.--If 
                amounts appropriated under paragraph (1) for a 
                fiscal year exceed $30,000,000, the Secretary 
                shall make available--
                          (i) not less than $12,000,000 for 
                        grants under subsection (a) to health 
                        professions schools that meet the 
                        conditions described in subsection 
                        (c)(2)(A);
                          (ii) not less than $12,000,000 for 
                        grants under subsection (a) to health 
                        professions schools that meet the 
                        conditions described in paragraph (3) 
                        or (4) of subsection (c) (including 
                        meeting conditions pursuant to 
                        subsection (e));
                          (iii) not less than $6,000,000 for 
                        grants under subsection (a) to health 
                        professions schools that meet the 
                        conditions described in subsection 
                        (c)(5); and
                          (iv) after grants are made with funds 
                        under clauses (i) through (iii), any 
                        remaining funds for grants under 
                        subsection (a) to health professions 
                        schools that meet the conditions 
                        described in paragraph (2)(A), (3), 
                        (4), or (5) of subsection (c).
          (3) No limitation.--Nothing in this subsection shall 
        be construed as limiting the centers of excellence 
        referred to in this section to the designated amount, 
        or to preclude such entities from competing for other 
        grants under this section.
          (4) Maintenance of effort.--
                  (A) In general.--With respect to activities 
                for which a grant made under this part are 
                authorized to be expended, the Secretary may 
                not make such a grant to a center of excellence 
                for any fiscal year unless the center agrees to 
                maintain expenditures of non-Federal amounts 
                for such activities at a level that is not less 
                than the level of such expenditures maintained 
                by the center for the fiscal year preceding the 
                fiscal year for which the school receives such 
                a grant.
                  (B) Use of federal funds.--With respect to 
                any Federal amounts received by a center of 
                excellence and available for carrying out 
                activities for which a grant under this part is 
                authorized to be expended, the Secretary may 
                not make such a grant to the center for any 
                fiscal year unless the center agrees that the 
                center will, before expending the grant, expend 
                the Federal amounts obtained from sources other 
                than the grant.

SEC. 737. SCHOLARSHIPS FOR DISADVANTAGED STUDENTS.

    (a) In General.--The Secretary may make a grant to an 
eligible entity (as defined in subsection (d)(1)) under this 
section for the awarding of scholarships by schools to any 
full-time student who is an eligible individual as defined in 
subsection (d). Such scholarships may be expended only for 
tuition expenses, other reasonable educational expenses, and 
reasonable living expenses incurred in the attendance of such 
school.
    (b) Preference in Providing Scholarships.--The Secretary 
may not make a grant to an entity under subsection (a) unless 
the health professions and nursing schools involved agree that, 
in providing scholarships pursuant to the grant, the schools 
will give preference to students for whom the costs of 
attending the schools would constitute a severe financial 
hardship and, notwithstanding other provisions of this section, 
to former recipients of scholarships under sections 736 and 
740(d)(2)(B) (as such sections existed on the day before the 
date of enactment of this section).
  (c) Amount of Award.--In awarding grants to eligible entities 
that are health professions and nursing schools, the Secretary 
shall give priority to eligible entities based on the 
proportion of graduating students going into primary care, the 
proportion of underrepresented minority students, and the 
proportion of graduates working in medically underserved 
communities.
  (d) Definitions.--In this section:
          (1) Eligible entities.--The term ``eligible 
        entities'' means an entity that--
                  (A) is a school of medicine, osteopathic 
                medicine, dentistry, nursing (as defined in 
                section 801), pharmacy, podiatric medicine, 
                optometry, veterinary medicine, public health, 
                or allied health, a school offering a graduate 
                program in behavioral and mental health 
                practice, or an entity providing programs for 
                the training of physician assistants; and
                  (B) is carrying out a program for recruiting 
                and retaining students from disadvantaged 
                backgrounds, including students who are members 
                of racial and ethnic minority groups.
          (2) Eligible individual.--The term ``eligible 
        individual'' means an individual who--
                  (A) is from a disadvantaged background;
                  (B) has a financial need for a scholarship; 
                and
                  (C) is enrolled (or accepted for enrollment) 
                at an eligible health professions or nursing 
                school as a full-time student in a program 
                leading to a degree in a health profession or 
                nursing.

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

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

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

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

SEC. 740. AUTHORIZATION OF APPROPRIATION.

  (a) Scholarships.--There are authorized to be appropriated to 
carry out section 737, $37,000,000 for fiscal year 1998, and 
such sums as may be necessary for each of the fiscal years 1999 
through 2002. Of the amount appropriated in any fiscal year, 
the Secretary shall ensure that not less than 16 percent shall 
be distributed to schools of nursing.
  (b) Loan Repayments and Fellowships.--For the purpose of 
carrying out section 738, there is authorized to be 
appropriated $1,100,000 for fiscal year 1998, and such sums as 
may be necessary for each of the fiscal years 1999 through 
2002.
  (c) Educational Assistance in Health Professions Regarding 
Individuals for Disadvantaged Backgrounds.--For the purpose of 
grants and contracts under section 739(a)(1), there is 
authorized to be appropriated $29,400,000 for fiscal year 1998, 
and such sums as may be necessary for each of the fiscal years 
1999 through 2002. The Secretary may use not to exceed 20 
percent of the amount appropriated for a fiscal year under this 
subsection to provide scholarships under section 739(a)(2)(F).
  (d) Report.--Not later than 6 months after the date of 
enactment of this part, the Secretary shall prepare and submit 
to the appropriate committees of Congress a report concerning 
the efforts of the Secretary to address the need for a 
representative mix of individuals from historically minority 
health professions schools, or from institutions or other 
entities that historically or by geographic location have a 
demonstrated record of training or educating underrepresented 
minorities, within various health professions disciplines, on 
peer review councils.

           *       *       *       *       *       *       *


  PART C--TRAINING IN [PRIMARY HEALTH CARE] FAMILY MEDICINE, GENERAL 
 INTERNAL MEDICINE, GENERAL PEDIATRICS, PHYSICIAN ASSISTANTS, GENERAL 
                   DENTISTRY, AND PEDIATRIC DENTISTRY

[SEC. 746. [293J] 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 of 
                        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 
                        filing 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 
                dissmenination 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, among 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 specialities 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 all 
        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 give 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 in another such school participating 
in the same program meets the requirement of that paragraph.
    [(d) Requirements for Center.--
          [(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 medial 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 affect before October 1, 1997, 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 he enactment of the Health Professions 
        Education Extension Amendment 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) Arrangement 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 are 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 locate in a county (or other 
        political subdivision) of the Sate in close proximity 
        to the border between the United States and Mexico.
          [(4) Adisory 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, educator 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 institution or entries 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 heath 
                education services, including training to 
                prepare community health workers to implement 
                health education program 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 center, 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, financial and delivery; and
                  [(I) in the case of any school of public 
                health located in the service area of the 
                health education and training centers 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 nongovernment sources the amount of 
                the total operating funds for such programs 
                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 years;
                  [(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 purpose 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) of 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 appropriate 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 final year shall be 
                determined in accordance with a formula 
                prescribed by the Secretary, which formula 
                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 
        subsection (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 be 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 years 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 years 1993 through 1995.]

           *       *       *       *       *       *       *


[SEC. 747. [288K] FAMILY MEDICINE.] SEC. 747. FAMILY MEDICINE, GENERAL 
                    INTERNAL MEDICINE, GENERAL PEDIATRICS, GENERAL 
                    DENTISTRY, PEDIATRIC DENTISTRY, AND PHYSICIAN 
                    ASSISTANCE.

    (a) Training Generally.--* * *

           *       *       *       *       *       *       *

          (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 
        medical (M.D. and D.O.) students interns (including 
        interns in interns in internships in osteopathic 
        medicine), residents, or practicing physicians that 
        emphasizes training for the practice of family 
        medicine, general internal medicine or 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 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 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 planning, developing, or 
        operating programs, and to provide financial assistance 
        to residents in such programs, of general dentistry or 
        pediatric dentistry.
For purposes of paragraph (6), entitles eligible for such 
grants or contracts shall include entities that have programs 
in dental schools, approved residency programs in the general 
or pediatric practice of dentistry, or approved residency 
programs in pediatric dentistry.
    (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 prediatrics; [or]
                  (B) substantially expanding the programs of 
                such a unit[.]; or
          (3) Priority in making awards.--In making awards of 
        grants and contracts under paragraph (1), the Secretary 
        shall give priority to any qualified applicant for such 
        an award that proposes a collaborative project between 
        departments of primary care.
    (c) Priority.--
          (1) In general.--With respect to programs for the 
        training of interns or residents, the Secretary shall 
        give priority in awarding grants under this section to 
        qualified applicants that have a record of training the 
        greatest percentage of providers, or that have 
        demonstrated significant improvements in the percentage 
        of providers, which enter and remain in primary care 
        practice or general or pediatric dentistry.
          (2) Disadvantaged individuals.--With respect to 
        programs for the training of interns, residents, or 
        physician assistants, the Secretary shall give priority 
        in awarding grants under this section qualified 
        applicants that have a record of training individuals 
        who are from disadvantaged backgrounds (including 
        racial and ethnic minorities underrepresented among 
        primary care practice or general or pediatric 
        dentistry).
          (3) Special consideration.--In awarding grants under 
        this section the Secretary shall give special 
        consideration to projects which prepare practitioners 
        to care for underserved populations and other high risk 
        groups such as the elderly, individuals with HIV-AIDS, 
        substance abusers, homeless, and victims of domestics 
        violence.
    [(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] $78,300,000 for fiscal year 1998, 
        and such sums as may be necessary for each of the 
        fiscal years 1999 through 2002.
          [(2) Allocation.--Of the amounts appropriated under 
        paragraph (1) for a fiscal year, the Secretary shall 
        make available not less than 20 percent for awards of 
        grants and contracts under subsection (b).]
          (2) Allocation.--
                (A) In general.--Of the amounts appropriated 
                under paragraph (1) for a fiscal year, the 
                Secretary shall make available--
                          (i) not less than $49,300,000 for 
                        awards of grants and contracts under 
                        subsection (a) to programs of family 
                        medicine, of which not less than 
                        $8,600,000 shall be made available for 
                        awards of grants and contracts under 
                        subsection (b) for family medicine 
                        academic administrative units;
                          (ii) not less than $17,700,000 for 
                        awards of grants and contracts under 
                        subsection (a) to programs of general 
                        internal medicine and general 
                        pediatrics;
                          (iii) not less than $6,800,000 for 
                        awards of grants and contracts under 
                        subsection (a) to programs relating to 
                        physician assistants; and
                          (iv) not less than $4,500,000 for 
                        awards of grants and contracts under 
                        subsection (a) to programs of general 
                        or pediatric dentistry.
                  (B) Ratable reduction.--If amounts 
                appropriated under paragraph (1) for any fiscal 
                year are less than the amount required to 
                comply with subparagraph (A), the Secretary 
                shall ratably reduce the amount to be made 
                available under each of clauses (i) through 
                (iv) of such subparagraph accordingly.

[SEC. 748. [293L] GENERAL INTERNAL MEDICINE AND GENERAL PEDIATRICS.

    [(a) In General.--The Secretary may make grants to and 
enter into contract with schools of medicine and osteopathic 
medicine, public or private nonprofit hospitals, or any of 
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. [293M] 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 and 
1995.

[SEC. 750. [293M] 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 tech 
        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) Limitations.--Not more than 10 percent of the 
        amounts appropriated under paragraph (1) may be 
        expended for carrying out subsection (a)(2).

[SEC. 751. [293O] 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. [293P] GENERAL PROVISIONS.

    [(a) Traineeships and Fellowship.--
          [(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 Grants.--The amount of any grant or contract 
under this part shall be determined by the Secretary.]

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

  (a) Establishment.--The Secretary shall establish an advisory 
committee to be known as the Advisory Committee on Training in 
Primary Care Medicine and Dentistry (in this section referred 
to as the ``Advisory Committee'').
  (b) Composition.--
          (1) In general.--The Secretary shall determine the 
        appropriate number of individuals to serve on the 
        Advisory Committee. Such individuals shall not be 
        officers or employees of the Federal Government.
          (2) Appointment.--Not later than 90 days after the 
        date of enactment of this Act, the Secretary shall 
        appoint the members of the Advisory Committee from 
        among individuals who are health professionals. In 
        making such appointments, the Secretary shall ensure a 
        fair balance between the health professions, that at 
        least 75 percent of the members of the Advisory 
        Committee are health professionals, a broad geographic 
        representation of members and a balance between urban 
        and rural members. Members shall be appointed based on 
        their competence, interest, and knowledge of the 
        mission of the profession involved.
          (3) Minority representation.--In appointing the 
        members of the Advisory Committee under paragraph (2), 
        the Secretary shall ensure the adequate representation 
        of women and minorities.
  (c) Terms.--
          (1) In general.--A member of the Advisory Committee 
        shall be appointed for a term of 3 years, except that 
        of the members first appointed--
                  (A) \1/3\ of such members shall serve for a 
                term of 1 year;
                  (B) \1/3\ of such members shall serve for a 
                term of 2 years; and
                  (C) \1/3\ of such members shall serve for a 
                term of 3 years.
          (2) Vacancies.--
                  (A) In general.--A vacancy on the Advisory 
                Committee shall be filled in the manner in 
                which the original appointment was made and 
                shall be subject to any conditions which 
                applied with respect to the original 
                appointment.
                  (B) Filling unexpired term.--An individual 
                chosen to fill a vacancy shall be appointed for 
                the unexpired term of the member replaced.
  (d) Duties.--The Advisory Committee shall--
          (1) provide advice and recommendations to the 
        Secretary concerning policy and program development and 
        other matters of significance concerning the activities 
        under section 747; and
          (2) not later than 3 years after the date of 
        enactment of this section, and annually thereafter, 
        prepare and submit to the Secretary, and the Committee 
        on Labor and Human Resources of the Senate, and the 
        Committee on Commerce of the House of Representatives, 
        a report describing the activities of the Committee, 
        including findings and recommendations made by the 
        Committee concerning the activities under section 747.
  (e) Meetings and Documents.--
          (1) Meetings.--The Advisory Committee shall meet not 
        less than 2 times each year. Such meetings shall be 
        held jointly with other related entities established 
        under this title where appropriate.
          (2) Documents.--Not later than 14 days prior to the 
        convening of a meeting under paragraph (1), the 
        Advisory Committee shall prepare and make available an 
        agenda of the matters to be considered by the Advisory 
        Committee at such meeting. At any such meeting, the 
        Advisory Council shall distribute materials with 
        respect to the issues to be addressed at the meeting. 
        Not later than 30 days after the adjourning of such a 
        meeting, the Advisory Committee shall prepare and make 
        available a summary of the meeting and any actions 
        taken by the Committee based upon the meeting.
  (f) Compensation and Expenses.--
          (1) Compensation.--Each member of the Advisory 
        Committee shall be compensated at a rate equal to the 
        daily equivalent of the annual rate of basic pay 
        prescribed for level IV of the Executive Schedule under 
        section 5315 of title 5, United States Code, for each 
        day (including travel time) during which such member is 
        engaged in the performance of the duties of the 
        Committee.
          (2) Expenses.--The members of the Advisory Committee 
        shall be allowed travel expenses, including per diem in 
        lieu of subsistence, at rates authorized for employees 
        of agencies under subchapter I of chapter 57 of title 
        5, United States Code, while away from their homes or 
        regular places of business in the performance of 
        services for the Committee.
  (g) FACA.--The Federal Advisory Committee Act shall apply to 
the Advisory Committee under this section only to the extent 
that the provisions of such Act do not conflict with the 
requirements of this section.

          PART D--INTERDISCIPLINARY, COMMUNITY-BASED LINKAGES

SEC. 750. GENERAL PROVISIONS.

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

SEC. 751. AREA HEALTH EDUCATION CENTERS.

  (a) Authority for Provision of Financial Assistance.--
          (1) Assistance for planning, development, and 
        operation of programs.--
                  (A) In general.--The Secretary shall award 
                grants to and enter into contracts with schools 
                of medicine and osteopathic medicine, and 
                incorporated consortia made up of such schools, 
                or the parent institutions of such schools, for 
                projects for the planning, development and 
                operation of area health education center 
                programs that--
                          (i) improve the recruitment, 
                        distribution, supply, quality and 
                        efficiency of personnel providing 
                        health services in underserved rural 
                        and urban areas and personnel providing 
                        health services to populations having 
                        demonstrated serious unmet health care 
                        needs;
                          (ii) increase the number of primary 
                        care physicians and other primary care 
                        providers who provide services in 
                        underserved areas through the offering 
                        of an educational continuum of health 
                        career recruitment through clinical 
                        education concerning underserved areas 
                        in a comprehensive health workforce 
                        strategy;
                          (iii) carry out recruitment and 
                        health career awareness programs to 
                        recruit individuals from underserved 
                        areas and under-represented 
                        populations, including minority and 
                        other elementary or secondary students, 
                        into the health professions;
                          (iv) prepare individuals to more 
                        effectively provide health services to 
                        underserved areas or underserved 
                        populations through field placements, 
                        preceptorships, the conduct of or 
                        support of community-based primary care 
                        residency programs, and agreements with 
                        community-based organizations such as 
                        community health centers, migrant 
                        health centers, Indian health centers, 
                        public health departments and others;
                          (v) conduct health professions 
                        education and training activities for 
                        students of health professions schools 
                        and medical residents;
                          (vi) conduct at least 10 percent of 
                        medical student required clinical 
                        education at sites remote to the 
                        primary teaching facility of the 
                        contracting institution; and
                          (vii) provide information 
                        dissemination and educational support 
                        to reduce professional isolation, 
                        increase retention, enhance the 
                        practice environment, and improve 
                        health care through the timely 
                        dissemination of research findings 
                        using relevant resources.
                  (B) Other eligible entities.--With respect to 
                a State in which no area health education 
                center program is in operation, the Secretary 
                may award a grant or contract under 
                subparagraph (A) to a school of nursing.
                  (C) Project terms.--
                          (i) In general.--Except as provided 
                        in clause (ii), the period during which 
                        payments may be made under an award 
                        under subparagraph (A) may not exceed--
                                  (I) in the case of a project, 
                                12 years or
                                  (II) in the case of a center 
                                within a project, 6 years.
                          (ii) Exception.--The periods 
                        described in clause (i) shall not apply 
                        toprojects that have completed the 
initial period of Federal funding under this section and that desire to 
compete for model awards under paragraph (2)(A).
          (2) Assistance for operation of model programs.--
                  (A) In general.--In the case of any entity 
                described in paragraph (1)(A) that--
                          (i) has previously received funds 
                        under this section;
                          (ii) is operating an area health 
                        education center program; and
                          (iii) is no longer receiving 
                        financial assistance under paragraph 
                        (1);
                the Secretary may provide financial assistance 
                to such entity to pay the costs of operating 
                and carrying out the requirements of the 
                program as described in paragraph (1).
                  (B) Matching requirement.--With respect to 
                the costs of operating a model program under 
                subparagraph (A), an entity, to be eligible for 
                financial assistance under subparagraph (A), 
                shall make available (directly or through 
                contributions from State, county or municipal 
                governments, or the private sector) recurring 
                non-Federal contributions in cash toward such 
                costs in an amount that is equal to not less 
                than 50 percent of such costs.
                  (C) Limitation.--The aggregate amount of 
                awards provided under subparagraph (A) to 
                entities in a State for a fiscal year may not 
                exceed the lesser of--
                          (i) $2,000,000; or
                          (ii) an amount equal to the product 
                        of $250,000 and the aggregate number of 
                        area health education centers operated 
                        in the State by such entities.
  (b) Requirements for Centers.--
          (1) General requirement.--Each area health education 
        center that receives funds under this section shall 
        encourage the regionalization of health professions 
        schools through the establishment of partnerships with 
        community-based organizations.
          (2) Service area.--Each area health education center 
        that receives funds under this section shall 
        specifically designate a geographic area or medically 
        underserved population to be served by the center. Such 
        area or population shall be in a location removed from 
        the main location of the teaching facilities of the 
        schools participating in the program with such center.
          (3) Other requirements.--Each area health education 
        center that receives funds under this section shall--
                  (A) assess the health personnel needs of the 
                area to be served by the center and assist in 
                the planning and development of training 
                programs to meet such needs;
                  (B) arrange and support rotations for 
                students and residents in family medicine, 
                general internal medicine or general 
                pediatrics, with at least one center in each 
                program being affiliated with or conducting a 
                rotating osteopathic internship or medical 
                residency training program in family medicine 
                (including geriatrics), general internal 
                medicine (including geriatrics), or general 
                pediatrics in which no fewer than 4 individuals 
                are enrolled in first-year positions;
                  (C) conduct and participate in 
                interdisciplinary training that involves 
                physicians and other health personnel 
                including, where practicable, public health 
                professionals, physician assistants, nurse 
                practitioners, nurse midwives, and behavioral 
                and mental health providers; and
                  (D) have an advisory board, at least 75 
                percent of the members of which shall be 
                individuals, including both health service 
                providers and consumers, from the area served 
                by the center.
  (c) Certain Provisions Regarding Funding.--
          (1) Allocation to center.--Not less than 75 percent 
        of the total amount of Federal funds provided to an 
        entity under this section shall be allocated by an area 
        health education center program to the area health 
        education center. Such entity shall enter into an 
        agreement with each center for purposes of specifying 
        the allocation of such 75 percent of funds.
          (2) Operating costs.--With respect to the operating 
        costs of the area health education center program of an 
        entity receiving funds under this section, the entity 
        shall make available (directly or through contributions 
        from State, county or municipal governments, or the 
        private sector) non-Federal contributions in cash 
        toward such costs in an amount that is equal to not 
        less than 50 percent of such costs, except that the 
        Secretary may grant a waiver for up to 75 percent of 
        the amount of the required non-Federal match in the 
        first 3 years in which an entity receives funds under 
        this section.

SEC. 752. HEALTH EDUCATION AND TRAINING CENTERS.

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

SEC. 753. EDUCATION AND TRAINING RELATING TO GERIATRICS.

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

SEC. 754. RURAL INTERDISCIPLINARY TRAINING GRANTS.

  (a) Grants.--The Secretary may make grants or contracts under 
this section to help entities fund authorized activities under 
an application approved under subsection (c).
  (b) Use of Amounts.--
          (1) In general.--Amounts provided under subsection 
        (a) shall be used by the recipients to fund 
        interdisciplinary training projects designed to--
                  (A) use new and innovative methods to train 
                health care practitioners to provide services 
                in rural areas;
                  (B) demonstrate and evaluate innovative 
                interdisciplinary methods and models designed 
                to provide access to cost-effective 
                comprehensive health care;
                  (C) deliver health care services to 
                individuals residing in rural areas;
                  (D) enhance the amount of relevant research 
                conducted concerning health care issues in 
                rural areas; and
                  (E) increase the recruitment and retention of 
                health care practitioners from rural areas and 
                make rural practice a more attractive career 
                choice for health care practitioners.
          (2) Methods.--A recipient of funds under subsection 
        (a) may use various methods in carrying out the 
        projects described in paragraph (1), including--
                  (A) the distribution of stipends to students 
                of eligible applicants;
                  (B) the establishment of a post-doctoral 
                fellowship program;
                  (C) the training of faculty in the economic 
                and logistical problems confronting rural 
                health care delivery systems; or
                  (D) the purchase or rental of transportation 
                and telecommunication equipment where the need 
                for such equipment due to unique 
                characteristics of the rural area is 
                demonstrated by the recipient.
          (3) Administration.--
                  (A) In general.--An applicant shall not use 
                more than 10 percent of the funds made 
                available to such applicant under subsection 
                (a) for administrative expenses.
                  (B) Training.--Not more than 10 percent of 
                the individuals receiving training with funds 
                made available to an applicant under subsection 
                (a) shall be trained as doctors of medicine or 
                doctors of osteopathy.
                  (C) Limitation.--An institution that receives 
                a grant under this section shall use amounts 
                received under such grant to supplement, not 
                supplant, amounts made available by such 
                institution for activities of the type 
                described in subsection (b)(1) in the fiscal 
                year preceding the year for which the grant is 
                received.
  (c) Applications.--Applications submitted for assistance 
under this section shall--
          (1) be jointly submitted by at least two eligible 
        applicants with the express purpose of assisting 
        individuals in academic institutions in establishing 
        long-term collaborative relationships with health care 
        providers in rural areas; and
          (2) designate a rural health care agency or agencies 
        for clinical treatment or training, including 
        hospitals, community health centers, migrant health 
        centers, rural health clinics, community behavioral and 
        mental health centers, long-term care facilities, 
        Native Hawaiian health centers, or facilities operated 
        by the Indian Health Service or an Indian tribe or 
        tribal organization or Indian organization under a 
        contract with the Indian Health Service under the 
        Indian Self-Determination Act.
  (d) Definitions.--For the purposes of this section, the term 
``rural'' means geographic areas that are located outside of 
standard metropolitan statistical areas.

SEC. 755. ALLIED HEALTH AND OTHER DISCIPLINES.

  (a) In General.--The Secretary may make grants or contracts 
under this section to help entities fund activities of the type 
described in subsection (b).
  (b) Activities.--Activities of the type described in this 
subsection include the following:
          (1) Assisting entities in meeting the costs 
        associated with expanding or establishing programs that 
        will increase the number of individuals trained in 
        allied health professions. Programs and activities 
        funded under this paragraph may include--
                  (A) those that expand enrollments in allied 
                health professions with the greatest shortages 
                or whose services are most needed by the 
                elderly;
                  (B) those that provide rapid transition 
                training programs in allied health fields to 
                individuals who have baccalaureate degrees in 
                health-related sciences;
                  (C) those that establish community-based 
                allied health training programs that link 
                academic centers to rural clinical settings;
                  (D) those that provide career advancement 
                training for practicing allied health 
                professionals;
                  (E) those that expand or establish clinical 
                training sites for allied health professionals 
                in medically underserved or rural communities 
                in order to increase the number of individuals 
                trained;
                  (F) those that develop curriculum that will 
                emphasize knowledge and practice in the areas 
                of prevention and health promotion, geriatrics, 
                long-term care, home health and hospice care, 
                and ethics;
                  (G) those that expand or establish 
                interdisciplinary training programs that 
                promote the effectiveness of allied health 
                practitioners in geriatric assessment and the 
                rehabilitation of the elderly;
                  (H) those that expand or establish 
                demonstration centers to emphasize innovative 
                models to link allied health clinical practice, 
                education, and research;
                  (I) those that provide financial assistance 
                (in the form of traineeships) to students who 
                are participants in any such program; and
                          (i) who plan to pursue a career in an 
                        allied health field that has a 
                        demonstrated personnel shortage; and
                          (ii) who agree upon completion of the 
                        training program to practice in a 
                        medically underserved community;
                that shall be utilized to assist in the payment 
                of all or part of the costs associated with 
                tuition, fees and such other stipends as the 
                Secretary may consider necessary; and
                  (J) those to meet the costs of projects to 
                plan, develop, and operate or maintain graduate 
                programs in behavioral and mental health 
                practice.
          (2) Planning and implementing projects in preventive 
        and primary care training for podiatric physicians in 
        approved or provisionally approved residency programs 
        that shall provide financial assistance in the form of 
        traineeships to residents who participate in such 
        projects and who plan to specialize in primary care.
          (3) Carrying out demonstration projects in which 
        chiropractors and physicians collaborate to identify 
        and provide effective treatment for spinal and lower-
        back conditions.

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

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

SEC. 757. AUTHORIZATION OF APPROPRIATIONS.

  (a) In General.--There are authorized to be appropriated to 
carry out this part, $55,600,000 for fiscal year 1998, and such 
sums as may be necessary for each of the fiscal years 1999 
through 2002.
  (b) Allocation.--
          (1) In general.--Of the amounts appropriated under 
        subsection (a) for a fiscal year, the Secretary shall 
        make available--
                  (A) not less than $28,587,000 for awards of 
                grants and contracts under section 751;
                  (B) not less than $3,765,000 for awards of 
                grants and contracts under section 752, of 
                which not less than 50 percent of such amount 
                shall be made available for centers described 
                in subsection (a)(1) of such section; and
                  (C) not less than $22,631,000 for awards of 
                grants and contracts under sections 753, 754, 
                and 755.
          (2) Ratable reduction.--If amounts appropriated under 
        subsection (a) for any fiscal year are less than the 
        amount required to comply with paragraph (1), the 
        Secretary shall ratably reduce the amount to be made 
        available under each of subparagraphs (A) through (C) 
        of such paragraph accordingly.
  (c) Obligation of Certain Amounts.--
          (1) Area health education center programs.--Of the 
        amounts made available under subsection (b)(1)(A) for 
        each fiscal year, the Secretary may obligate for awards 
        under section 751(a)(2)--
                  (A) not less than 23 percent of such amounts 
                in fiscal year 1998;
                  (B) not less than 30 percent of such amounts 
                in fiscal year 1999;
                  (C) not less than 35 percent of such amounts 
                in fiscal year 2000;
                  (D) not less than 40 percent of such amounts 
                in fiscal year 2001; and
                  (E) not less than 45 percent of such amounts 
                in fiscal year 2002.
          (2) Sense of congress.--It is the sense of the 
        Congress that--
                  (A) every State have an area health education 
                center program in effect under this section; 
                and
                  (B) the ratio of Federal funding for the 
                model program under section 751(a)(2) should 
                increase over time and that Federal funding for 
                other awards under this section shall decrease 
                so that the national program will become 
                entirely comprised of programs that are funded 
                at least 50 percent by State and local 
                partners.

           *       *       *       *       *       *       *


            [PART D--TRAINING IN CERTAIN HEALTH PROFESSIONS

           [Subpart I--Public Health and Preventive Medicine

[SEC. 761. [294] PUBLIC HEALTH TRAINEESHIPS.

    [(a) In General.--The Secretary may make grants to 
accredited schools of public health, and to other public or 
nonprofit private institutions accredited for the provision of 
graduate or specialized training in public health, for the 
purpose of assisting such schools and institutions in providing 
traineeships to individuals described in subsection (b)(3).
    [(b) Certain Requirements.--
          [(1) Application for grant.--No grant for 
        traineeships may be made under subsection (a) unless an 
        application therefor has been submitted to, and 
        approved by, the Secretary. Such application shall be 
        in such form, be submitted in such manner, and contain 
        such information, as the Secretary by regulation may 
        prescribe. Traineeships under such a grant shall be 
        awarded in accordance with such regulations as the 
        Secretary shall prescribe. The amount of any such grant 
        shall be determined by the Secretary.
          [(2) Use of grant.--Traineeships awarded under grants 
        made under subsection (a) shall provide for tuition and 
        fees and such stipends and allowances (including travel 
        and subsistence expenses and dependency allowances) for 
        the trainees as the Secretary may deem necessary.
          [(3) Eligible individuals.--The individuals referred 
        to in subsection (a) are individuals who are pursing a 
        course of study in a health professionals field in 
        which there is a severe shortage of health professions 
        (which fields include the fields of epidemiology, 
        environmental health, biostatistics, toxicology, 
        nutrition, and maternal and child heath).]

         PART E--HEALTH PROFESSIONS AND PUBLIC HEALTH WORKFORCE

    Subpart 1--Health Professions Workforce Information and Analysis

SEC. 761. HEALTH PROFESSIONS WORKFORCE INFORMATION AND ANALYSIS.

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

           *       *       *       *       *       *       *


[SEC. 762. [294A] PUBLIC HEALTH SPECIAL PROJECTS.

    [(a) In General.--The Secretary may make grants to and 
enter into contracts with accredited schools of public health 
for the costs of planning, developing, demonstrating, 
operating, and evaluating projects that are in furtherance of 
the goals established by the Secretary for the year 2000 in the 
area of--
          [(1) preventive medicine;
          [(2) health promotion and disease prevention;
          [(3) improving access to and quality of health 
        services in medically underserved communities; or
          [(4) reducing the incidence of domestic violence.
    [(b) Preference in Making Awards.--In making awards of 
grants and contracts under subsection (a), the Secretary shall 
give preference to qualified schools agreeing that the project 
for which the award is made--
          [(1) will establish or strengthen field placements 
        for students in public or nonprofit private health 
        agencies or organizations; and
          [(2) will involve faculty members and students in 
        collaborative projects to enhance public health 
        services to medically underserved communities.
    [(c) Participation and Training of Students.--The Secretary 
may make an award of a grant or contract under subsection (a) 
only if the school involved agrees that the students of the 
school will, through participation in the project for which the 
award is made, receive training in the activities carried out 
by the project.
    [(d) Application for Award.--The Secretary may make an 
award of a grant or contract under subsection (a) 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 this section.
    [(e) Establishment of Goals; Related Reports.--
          [(1) Goals.--
                  [(A) The Secretary shall establish goals for 
                projects under subsection (a) (including goals 
                regarding the training of students), and shall 
                require that, as a condition of the receipt of 
                grants and contracts under such subsection, 
                schools carry out activities in furtherance of 
                meeting the goals.
                  [(B) The Secretary shall establish and 
                implement a methodology for measuring the 
                extent of progress that has been made toward 
                the goals established under subparagraph (A) by 
                schools receiving grants or contracts under 
                subsection (a).
          [(2) Reports.--Not later than February 1, 1994, 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 the progress made by projects under 
        subsection (a) during the preceding fiscal years toward 
        the goals established under paragraph (1). For purposes 
        of the report, the extent of such progress shall be 
        measured through the methodology established under 
        subparagraph (B) of such paragraph.]

SEC. [301] 762. 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 subparagraph (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 deficienceies; 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 specialty 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.--
          [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 Activites.--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] 2002], 
the Council shall submit a final report under subsection (a).
    (k) Termination.--The Council shall terminate September 30, 
[1995 2002].
    (l) Funding.--Amounts otherwise appropriated under this 
title may be utilized by the Secretary to support the 
activities of the Council.

[SEC. 765. [294C] AUTHORIZATION OF APPROPRIATIONS.

    [(a) In General.--For the purpose of carrying out this 
subpart, there is authorized to be appropriated $15,500,000 for 
each of the fiscal years 1993 through 1995.
    [(b) Limitation Regarding Certain Program.--In obligating 
amounts appropriated under subsection (a), the Secretary may 
not obligate more than 40 percent for carrying out section 762.

                 Subpart II--Allied Health Professions

[SEC. 766. [294D] ADVANCED TRAINING.

    [(a) In General.--The Secretary may award grants to and 
enter into contracts with eligible entities to assist such 
entities in meeting the costs associated with projects designed 
to--
          [(1) plan, develop, establish or expand 
        postbaccalaureate programs for the advanced training of 
        allied health professionals; and
          [(2) provide financial assistance, in the form of 
        traineeships or fellowships, to postbaccalaureate 
        students who are participants in any such program and 
        who commit to teaching in the allied health profession 
        involved.
    [(b) Preference.--In awarding grants under subsection (a), 
the Secretary shall give preference to qualified projects 
demonstrating that not less than 50 percent of the graduates of 
such schools or programs during the preceding 2-year period are 
engaged as full-time teaching faculty in an allied health 
shortage specialty.
    [(c) Limitation.--The Secretary shall limit grants and 
contracts awarded or entered into under subsection (a) to those 
allied health fields or specialties as the Secretary shall, 
from time to time, determine to have--
          [(1) the most significant national or regional 
        shortages of practitioners;
          [(2) insufficient numbers of qualified faculty in 
        entry level or advanced educational programs; or
          [(3) a signficiant role in the care and 
        rehabilitation of patients who are elderly or disabled 
        including physical therapists and occupational 
        therapists.
    [(d) Eligible Entities.--For purposes of this section, the 
term ``eligible entities'' means entities that are--
          [(1) public or private nonprofit schools, 
        universities, or other educational entities that 
        provide for education and training in the allied health 
        professions and that meet such standards as the 
        Secretary may by regulation prescribe; or
          [(2) public or nonprofit private entities capable, as 
        determined by the Secretary, of carrying out projects 
        described in subsection (a).
    [(e) Authorization of Appropriation.--For the purpose of 
carrying out this section, there is authorized to be 
appropriated $5,000,000 for each of the fiscal years 1993 
through 1995.

[SEC. 767. [294E] PROJECT GRANTS AND CONTRACTS.

    [(a) Projects Related to Strengthening Training and 
Increasing Enrollment in the allied Health Professions.--The 
Secretary may make grants to and enter into contracts with 
eligible entities to assist such entities in meeting the costs 
associated with expanding or establishing programs that will 
increase the number of individuals trained in allied health 
professions. Programs and activities funded under this section 
may include--
          [(1) those that expand enrollments in allied health 
        professions with the greatest shortages or whose 
        services are most needed by the elderly;
          [(2) those that provide rapid transition training 
        programs in allied health fields to individuals who 
        have baccalaureate degrees in health-related sciences;
          [(3) those that establish community-based allied 
        health training programs that link academic centers to 
        rural clinical settings;
          [(4) those that provide career advancement training 
        for practicing allied health professionals;
          [(5) those that expand or establish clinical training 
        sites for allied health professionals in medically 
        underserved or rural communities in order to increase 
        the number of individuals trained;
          [(6) those that develop curriculum that will 
        emphasize knowledge and practice in the areas of 
        prevention and health promotion, geriatrics, long-term 
        care, home health and hospice care, and ethics;
          [(7) those that expand or establish interdisciplinary 
        training programs that promote the effectiveness of 
        allied health practitioners in geriatric assessment and 
        the rehabilitation of the elderly;
          [(8) those that expand or establish demonstration 
        centers to emphasize innovative models to link allied 
        health clinical practice, education, and research; and
                  [(A) who plan to pursue a career in an allied 
                health field that has a demonstrated personnel 
                shortage; and
                  [(B) who agree upon completion of the 
                training program to practice in a medically 
                underserved community; that shall be utilized 
                to assist in the payment of all or part of the 
                costs associated with tuition, fees and such 
                other stipends as the Secretary may consider 
                necessary.
    [(b) Application.--
          [(1) Requriement.--No grant may be awarded or 
        contract entered into under this section unless an 
        application therefore \1\ has been submitted to, and 
        approved by, the Secretary. Such application shall be 
        in such form, submittedd in such manner, and contain 
        such information, as the Secretary shall be regulation 
        prescribe.
          [(2) Preference.--In considering an application 
        submitted for a grant under this section, the Secretary 
        shall give preference to qualified applicants that--
                  [(A) expand and maintain first-year 
                enrollment by not less than 20 percent over 
                enrollments in base year 1992; or
                  [(B) demonstrate that not less than 20 
                percent of the graduates of such training 
                programs during the preceding 2-year period are 
                working in medically underserved communities.
    [(c) Eligible Entities.--For purposes of this section, the 
term ``eligible entities'' has the meaning given such term in 
section 766.
    [(d) Authorization of Appropriation.--For purposes of 
carrying out this section, there is authorized to be 
appropriated $5,000,000 for each of the fiscal years 1993 
through 1995.]

                   Subpart 2--Public Health Workforce

SEC. 765. GENERAL PROVISIONS.

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

SEC. 766. PUBLIC HEALTH TRAINING CENTERS.

    (a) In General.--The Secretary may make grants or contracts 
for the operation of public health training centers.
    (b) Eligible Entities.--
          (1) In general.--A public health training center 
        shall be an accredited school of public health, or 
        another public or nonprofit private institution 
        accredited for the provision of graduate or specialized 
        training in public health, that plans, develops, 
        operates, and evaluates projects that are in 
        furtherance of the goals established by the Secretary 
        for the year 2000 in the areas of preventive medicine, 
        health promotion and disease prevention, or improving 
        access to and quality of health services in medically 
        underserved communities.
          (2) Preference.--In awarding grants or contracts 
        under this section the Secretary shall give preference 
        to accredited schools of public health.
    (c) Certain Requirements.--With respect to a public health 
training center, an award may not be made under subsection (a) 
unless the program agrees that it--
          (1) will establish or strengthen field placements for 
        students in public or nonprofit private health agencies 
        or organizations;
          (2) will involve faculty members and students in 
        collaborative projects to enhance public health 
        services to medically underserved communities;
          (3) will specifically designate a geographic area or 
        medically underserved population to be served by the 
        center that shall be in a location removed from the 
        main location of the teaching facility of the school 
        that is participating in the program with such center; 
        and
          (4) will assess the health personnel needs of the 
        area to be served by the center and assist in the 
        planning and development of training programs to meet 
        such needs.

SEC. 767. PUBLIC HEALTH TRAINEESHIPS.

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

SEC. 768. PREVENTIVE MEDICINE; DENTAL PUBLIC HEALTH.

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

SEC. 769. HEALTH ADMINISTRATION TRAINEESHIPS AND SPECIAL PROJECTS.

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

SEC. 770. AUTHORIZATION OF APPROPRIATIONS.

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

           *       *       *       *       *       *       *


                    [PART F--MISCELLANEOUS PROGRAMS

[SEC. 781. [295] RESEARCH ON CERTAIN HEALTH PROFESSIONS ISSUES.

    [(a) Educational Indebtedness.--
          [(1) In general.--Subject to paragraph (2), the 
        Secretary may make grants to and enter into contracts 
        with public and nonprofit private entities for the 
        purpose of conducting research on the extent to which 
        the debt incurred by medical students for attendance at 
        educational institutions has had a detrimental effect 
        on the decisions made by the students on entering 
        primary care specialities.
          [(2) Evaluation of rate of increase.--In carrying out 
        paragraph (1), the Secretary shall provide for a 
        determination of the reasons underlying the rate of 
        increase occurring since January 1, 1981, in tuition 
        and fees for attending health professions schools. The 
        Secretary shall ensure that the determination includes 
        the justifications of such schools for such rate.
    [(b) Effect of Programs for Minority and Disadvantaged 
Individuals.--
          [(1) In general.--The Secretary may make grants to 
        and enter into contracts with public and nonprofit 
        private entities for the purpose of conducting research 
        on the effects that federally-funded educational 
        programs or policies for minority or disadvantaged 
        individuals have on--
                  [(A) the number of such individuals attending 
                health professions school;
                  [(B) the number of such individuals 
                completing the programs of education involved; 
                and
                  [(C) the decisions made by such individuals 
                on which of the health professions specialities 
                to enter.
          [(2) Separate specifications for certain categories 
        of schools.--The Secretary may provide a grant or 
        contract under paragraph (1) only if the applicant 
        involved agrees that in conducting research under such 
        paragraph the applicant will make findings specific to 
        the following categories of health professions schools;
                  [(A) Health professions schools of 
                historically black colleges and universities.
                  [(B) Other health professions schools 
                attended by a substantial number of minority 
                individuals.
                  [(C) Health professions schools generally.
    [(c) Extent of Investigations and Disciplinary Actions by 
State Licensing Authorities.--The Secretary may make grants to 
and enter into contracts with public and nonprofit private 
entities for the purpose of conducting research on the 
effectiveness of the States in protecting the public health 
through--
          [(1) identifying health care providers with respect 
        to whom investigations of professional qualifications 
        are warranted;
          [(2) conducting such investigations; and
          [(3) taking disciplinary actions against health care 
        providers determined through such investigations to 
        have engaged in conduct inconsistent with protecting 
        the public health.
    [(d) Primary Health Care.--
          [(1) In general.--The Secretary may make grants to 
        and enter into contracts with public and nonprofit 
        private entities for the purpose of conducting 
        research--
                  [(A) to determine the extent to which Federal 
                programs and related financial incentives 
                influence the percentage of medical school 
                graduates selecting a primary care career;
                  [(B) to determine the extent to which Federal 
                programs and related financial incentives 
                adequately support the training of mid-level 
                primary care providers relative to other health 
                professions education receiving Federal 
                assistance;
                  [(C) to assess the impact that direct and 
                indirect payments for graduate medical 
                education (including the appropriateness of 
                payments for independent, ambulatory training 
                sites) have on increasing the percentage of 
                physicians graduating from medical school who 
                enter primary care careers;
                  [(D) to assess the impact of medical school 
                admission policies on specialty selection and 
                recommend ways admission policies can better 
                facilitate and promote the selection of primary 
                care as a medical career;
                  [(E) to assess the impact that Federal 
                funding for bio-medical research influences the 
                design of medical school curriculum and the 
                availability of primary care educational 
                opportunities;
                  [(F) to assess the impact of medical school 
                curriculum, including the availability of 
                clinical training in ambulatory care settings, 
                influences the percentage of physicians 
                selecting primary care residencies and 
                selecting primary care as a medical career; and
                  [(G) to assess the extent to which current 
                physician payment policies under resource based 
                relative value scale are sufficient to 
                encourage physicians graduating from medical 
                school to enter and remain in primary care 
                careers.
          [(2) Definitions.--For purposes of this subsection:
                  [(A) the term ``primary care careers'', with 
                respect to medicine, means family practice, 
                general internal medicine and general 
                pediatrics.
                  [(B) The term ``mid-level primary care health 
                professions'' means physician assistants, nurse 
                practitioners, and nurse midwives.
    [(e) Authorization of Appropriations.--For the purpose of 
carrying out this section, there is authorized to be 
appropriated $4,000,000 for each of the fiscal years 1993 
through 1995.

[SEC. 782. [295A] CHIROPRACTIC DEMONSTRATION PROJECTS.

    [(a) In General.--The Secretary may make grants to and 
enter into contracts with schools, colleges, and universities 
of chiropractic for the purpose of carrying out demonstration 
projects in which chiropractors and physicians collaborate to 
identify and provide effective treatment for spinal and lower-
back conditions.
    [(b) Participation of Medical Schools.--The Secretary may 
make an award of a grant or contract under subsection (a) only 
if the applicant involved has entered into such agreements as 
may be necessary to ensure that in the project under such 
subsection a school of medicine or osteopathic medicine will 
participate in the project.
    [(c) Peer Review.--Each peer review group under section 
798(a) reviewing proposals for grants or contracts under 
subsection (a) shall include no fewer than two, and no more 
than three, chiropractors.
    [(d) Report to Congress.--
          [(1) In general.--The Secretary shall prepare a 
        report that
                  [(A) summarizes the applications submitted to 
                the Secretary for grants or contracts under 
                subsection (a);
                  [(B) specifies the identity of entities 
                receiving the grants or contracts; and
                  [(C) evaluates the effectiveness of the 
                programs operated with the grants and 
                contracts.
          [(2) Date certain for submission.--Not later than 
        February 10, 1995, the Secretary shall complete the 
        report required in paragraph (1) and submit the report 
        to the Committee on Energy and Commerce of the House of 
        Representatives and the Committee on Labor and Human 
        Resources of the Senate.
    [(e) 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 G] PART F--GENERAL PROVISIONS

SEC. 791. [295J] 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] sections 747 and 750, 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.--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 at least 4 of the criteria described 
        in paragraph (3) shall qualify for a funding preference 
        under this section.
          (2) Definition.--As used in this subsection, the term 
        `new program' means any program that has graduated less 
        than three classes. Upon graduating at least three 
        classes, a program shall have the capability to provide 
        the information necessary to qualify the program for 
        the general funding preferences described in subsection 
        (a).
          (3) Criteria.--The criteria referred to in paragraph 
        (1) are the following:
                  (A) The mission statement of the program 
                identifies a specific purpose of the program as 
                being the preparation of health professionals 
                to serve underserved populations.
                  (B) The curriculum of the program includes 
                content which will help to prepare 
                practitioners to serve underserved populations.
                  (C) Substantial clinical training experience 
                is required under the program in medically 
                underserved communities.
                  (D) A minimum of 20 percent of the clinical 
                faculty of the program spend at least 50 
                percent of their time providing or supervising 
                care in medically underserved communities.
                  (E) The entire program or a substantial 
                portion of the program is physically located in 
                a medically underserved community.
                  (F) Student assistance, which is linked to 
                service in medically underserved communities 
                following graduation, is available to the 
                students in the program.
                  (G) The program provides a placement 
                mechanism for deploying graduates to medically 
                underserved communities.

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 dentist in the States. The Secretary is 
authorized to 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, 
professional counselors, 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.

           *       *       *       *       *       *       *


[SEC. 793. [295L] STATISTICS; ANNUAL REPORT.

    [(a) Statistics and Other Information.--The Secretary 
shall, in coordination with the National Center for Health 
Statistics (established under section 306), continuously 
develop, publish, and disseminate on a nationwide basis 
statistics and other information respecting public and 
community health personnel, including--
          [(1) detailed descriptions of the various types of 
        activities in which public and community health 
        personnel are engaged,
          [(2) the current and anticipated needs for the 
        various types of public and community health personnel, 
        and
          [(3) the number, employment, geographic locations, 
        salaries, and surpluses and shortages of public and 
        community health personnel, the educational and 
        licensure requirements for the various types of such 
        personnel and the cost of training such personnel.
    [(b) Requirements Regarding Personal Data.--
          [(1) In general.--The Secretary and each program 
        entity shall in securing and maintaining any record of 
        individually identifiable personal data (in this 
        subsection referred to as ``personal data'') for 
        purposes of this section--
                  [(A) inform any individual who is asked to 
                supply personal data whether he is legally 
                required, or may refuse, to supply such data 
                and inform him of any specific consequences, 
                known to the Secretary or program entity as the 
                case may be, of providing or not providing such 
                data;
                  [(B) upon request, inform any individual if 
                he is the subject of personal data secured or 
                maintained by the Secretary or program entity, 
                as the case may be, and make the data available 
                to him in a form comprehensible to him;
                  [(C) assure that no use is made of personal 
                data which is not within the purposes of this 
                section unless an informed consent has been 
                obtained from the individual who is the subject 
                of such data; and
                  [(D) upon request, inform any individual of 
                the use being made of personal data respecting 
                such individual and of the identity of the 
                individuals and entities which will use the 
                data and their relationship to the activities 
                conducted under this section.
          [(2) Consent as precondition to transfer of 
        information.--Any entity which maintains a record of 
        personal data and which receives a request from the 
        Secretary or a program entity to use such data for 
        purposes of this section shall not transfer any such 
        data to the Secretary or to a program entity unless the 
        individual whose personal data is to be so transferred 
        gives an informed consent for such transfer.
          [(3) Disclosure by secretary.--
                  [(A) Notwithstanding any other provision of 
                law, personal data collected by the Secretary 
                or any program entity for purposes of this 
                section may not be made available or disclosed 
                by the Secretary or any program entity to any 
                person other than the individual who is the 
                subject of such data unless (i) such person 
                requires such data for purposes of this 
                section, or (ii) in response to a demand for 
                such data made by means of compulsory legal 
                process. Any individual who is the subject of 
                personal data made available or disclosed under 
                clause (ii) shall be notified of the demand for 
                such data.
                  [(B) Subject to all applicable laws regarding 
                confidentiality, only the data collected by the 
                Secretary under this section which is not 
                personal data shall be made available to bona 
                fide researchers and policy analysts (including 
                the Congress) for the purposes of assisting in 
                the conduct of studies respecting health 
                professions personnel.
          [(4) Definitions.--For purposes of this subsection, 
        the term ``program entity'' means any public or private 
        entity which collects, compiles, or analyzes health 
        professions data under an arrangement with the 
        Secretary for purposes of this section.
    [(c) Report.--The Secretary shall submit biennially 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 on--
          [(1) the statistics and other information developed 
        pursuant to subsection (a); and
          [(2) the activities conducted under this title, 
        including an evaluation of such activities.
Such report shall contain such recommendations for legislation 
as the Secretary determines are needed to improve the programs 
authorized under such subparts. The Office of Management and 
Budget may review such report before its submission to such 
Committees, but the Office may not revise the report or delay 
its submission beyond the date prescribed for its submission 
and may submit to such Committees its comments respecting such 
report.
    [(d) Definitions.--For purposes of this section, the term 
``public and community health personnel'' means individuals who 
are engaged in--
          [(1) the planning, development, monitoring, or 
        management of health care or health care institutions, 
        organizations, or systems,
          [(2) research on health care development and the 
        collection and analysis of health statics, data on the 
        health of population groups, and any other health data,
          [(3) the development and improvement of individual 
        and community knowledge of health (including 
        environmental health and preventive medicine) and the 
        health care system, or
          [(4) the planning and development of a healthful 
        environment and control of environmental health 
        hazards.]

           *       *       *       *       *       *       *


[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 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. 796. APPLICATION.

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

SEC. 797. USE OF FUNDS.

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

[SEC. 798. [295O] CERTAIN GENERAL PROVISIONS

    [(a) Peer Review.--Each application for a grant or contract 
under this title 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.
    [(b) Delegation of Authority of Secretary.--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 of the Department, except that the authority 
to make such a grant, enter into such a contract, continue such 
a grant or contract, or modify such a contract, shall not be 
delegated to any administrator of, or officer in, a regional 
office or offices of the Department.
    [(c) Differential Tuition and Fees.--The Secretary may not 
enter into a contract with, or make a grant, loan guarantee, or 
interest subsidy payment under this title or title VIII, to or 
for the benefit of, any school, program, or training center if 
the tuition levels or educational fees at such school, program, 
or training center are higher for certain students solely on 
the basis that such students are the recipients of 
traineeships, loans, loan guarantees, service scholarships, or 
interest subsidies from the Federal Government.
    [(d) Applicability of Certain Provisions on Contracts.--
Contracts authorized by this title may be entered into without 
regard to section 3324 of title 31, United States Code, or 
section 3709 of the Revised Statutes of the United States (41 
U.S.C. 5).
    [(e) Records and Audits.--
          [(1) Maintenance of records.--
                  [(A) Each entity which receives a grant, 
                loan, loan guarantee, or interest subsidy or 
                which enters into a contract with the Secretary 
                under this title, shall establish and maintain 
                such records as the Secretary shall by 
                regulation or order require.
                  [(B) The Secretary may specify, by 
                regulation, the form and manner in which such 
                records, required by subparagraph (A), shall be 
                established and maintained.
          [(2) Biennial audits.--Each entity which received a 
        grant or entered into a contract under this title shall 
        provide for a biennial financial audit of any books, 
        accounts, financial records, files, and other papers 
        and property which relate to the disposition or use of 
        the funds received under such grant or contract and 
        such other funds received by or allocated to the 
        project or undertaking for which such grant or contract 
        was made. For purposes of assuring accurate, current, 
        and complete disclosure of the disposition or use of 
        the funds received, each such audit shall be conducted 
        in accordance with such requirements concerning the 
        individual or agency which conducts the audit, and such 
        standards applicable to the performance of the audit, 
        as the Secretary may by regulation provide. A report of 
        each such audit shall be filed with the Secretary at 
        such time and in such manner as he may require.
          [(3) Applicability to students.--A student recipient 
        of a scholarship, traineeship, loan, or loan guarantee 
        under this title shall not be required to establish or 
        maintain the records required in paragraph (1) or 
        provide for an audit required in paragraph (2).
          [(4) Availability of documents, etc.--
                  [(A) Each entity which is required to 
                establish and maintain records or to provide 
                for an audit under this subsection shall make 
                such books, documents, papers, and records 
                available to the Secretary or the Comptroller 
                General of the United States, or any of their 
                duly authorized representatives, for 
                examination, copying, or mechanical 
                reproduction on or off the premises of such 
                entity upon a reasonable request therefor.
                  [(B) The Secretary and the Comptroller 
                General of the United States, or any of their 
                duly authorized representatives, shall have the 
                authority to carry out the purposes of this 
                paragraph.
    [(f) Miscellaneous Provisions.--
          [(1) Payments under grants.--Grants made under this 
        title may be paid (A) in advance or by way of 
        reimbursement, (B) at such intervals and on such 
        conditions as the Secretary may find necessary, and (C) 
        with appropriate adjustments on account of overpayments 
        or underpayments previously made.
          [(2) Applications for grants and contracts.--No grant 
        may be made or contract entered into under this title 
        unless an application therefor has been submitted to 
        and approved by the Secretary. Such application shall 
        be in such form, submitted in such manner, and contain 
        such information, as the Secretary shall by regulation 
        prescribe.
          [(3) Assurances.--Whenever in this title an applicant 
        is required to provide assurances to the Secretary, or 
        an application is required to contain assurances or be 
        supported by assurances, the Secretary shall determine 
        before approving the application that the assurances 
        provided are made in good faith.
          [(4) 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.
          [(5) Graduates of foreign medical schools.--The 
        Secretary may make an award of a grant, cooperative 
        agreement, or contract under this title to an entity 
        (including a school) that provides graduate training in 
        the health professions only if the entity agrees that, 
        in considering applications for admissions to a program 
        of such training the entity will not refuse to consider 
        an application solely on the basis that the application 
        is submitted by a graduate of a foreign medical school. 
        This paragraph may not be construed as establishing any 
        private right of action.]

SEC. 798. MATCHING REQUIREMENT.

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

SEC. 799. GENERALLY APPLICABLE PROVISIONS.

    (a) Awarding of Grants and Contracts.--The Secretary shall 
ensure that grants and contracts under this title are awarded 
on a competitive basis, as appropriate, to carry out innovative 
demonstration projects or provide for strategic workforce 
supplementation activities as needed to meet health workforce 
goals and in accordance with this title. Contracts may be 
entered into under this title with public or private entities 
as may be necessary.
    (b) Eligible Entities.--Unless specifically required 
otherwise in this title, the Secretary shall accept 
applications for grants or contracts under this title from 
health professions schools, academic health centers, State or 
local governments, or other appropriate public or private 
nonprofit entities for funding and participation in health 
professions and nursing training activities. The Secretary may 
accept applications from for-profit private entities if 
determined appropriate by the Secretary.
    (c) Information Requirements.--
          (1) In general.--Recipients of grants and contracts 
        under this title shall meet information requirements as 
        specified by the Secretary.
          (2) Data collection.--The Secretary shall establish 
        procedures to ensure that, with respect to any data 
        collection required under this title, such data is 
        collected in a manner that takes into account age, sex, 
        race, and ethnicity.
          (3) Use of funds.--The Secretary shall establish 
        procedures to permit the use of amounts appropriated 
        under this title to be used for data collection 
        purposes.
          (4) Evaluations.--The Secretary shall establish 
        procedures to ensure the annual evaluation of programs 
        and projects operated by recipients of grants or 
        contracts under this title. Such procedures shall 
        ensure that continued funding for such programs and 
        projects will be conditioned upon a demonstration that 
        satisfactory progress has been made by the program or 
        project in meeting the objectives of the program or 
        project.
    (d) Training Programs.--Training programs conducted with 
amounts received under this title shall meet applicable 
accreditation and quality standards.
    (e) Duration of Assistance.--
          (1) In general.--Subject to paragraph (2), in the 
        case of an award to an entity of a grant, cooperative 
        agreement, or contract under this title, the period 
        during which payments are made to the entity under the 
        award may not exceed 5 years. The provision of payments 
        under the award shall be subject to annual approval by 
        the Secretary of the payments and subject to the 
        availability of appropriations for the fiscal year 
        involved to make the payments. This paragraph may not 
        be construed as limiting the number of awards under the 
        program involved that may be made to the entity.
          (2) Limitation.--In the case of an award to an entity 
        of a grant, cooperative agreement, or contract under 
        this title, paragraph (1) shall apply only to the 
        extent not inconsistent with any other provision of 
        this title that relates to the period during which 
        payments may be made under the award.
    (f) Peer Review Regarding Certain Programs.--
          (1) In general.--Each application for a grant under 
        this title, except any scholarship or loan program, 
        including those under sections 701, 721, or 723, shall 
        be submitted to a peer review group for an evaluation 
        of the merits of the proposals made in the application. 
        The Secretary may not approve such an application 
        unless a peer review group has recommended the 
        application for approval.
          (2) Composition.--Each peer review group under this 
        subsection shall be composed principally of individuals 
        who are not officers or employees of the Federal 
        Government. In providing for the establishment of peer 
        review groups and procedures, the Secretary shall 
        ensure sex, racial, ethnic, and geographic balance 
        among the membership of such groups.
          (3) Administration.--This subsection shall be carried 
        out by the Secretary acting through the Administrator 
        of the Health Resources and Services Administration.
    (g) Preference or Priority Considerations.--In considering 
a preference or priority for funding which is based on outcome 
measures for an eligible entity under this title, the Secretary 
may also consider the future ability of the eligible entity to 
meet the outcome preference or priority through improvements in 
the eligible entity's program design.
    (h) Analytic Activities.--The Secretary shall ensure that--
          (1) cross-cutting workforce analytical activities are 
        carried out as part of the workforce information and 
        analysis activities under section 761; and
          (2) discipline-specific workforce information and 
        analytical activities are carried out as part of--
                  (A) the community-based linkage program under 
                part D; and
                  (B) the health workforce development program 
                under subpart 2 of part E.
    (i) Osteopathic Schools.--For purposes of this title, any 
reference to--
          (1) medical schools shall include osteopathic medical 
        schools; and
          (2) medical students shall include osteopathic 
        medical students.

SEC. 799A. TECHNICAL ASSISTANCE.

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

SEC. [799.] 799B. DEFINITIONS.

    For purposes of this title:
          (1)(A) * * *

           *       *       *       *       *       *       *

          (C) The terms ``graduate program in clinical social 
        work'' and ``graduate program in marriage and family 
        therapy'' and ``graduate program in professional 
        counseling'' mean an accredited graduate program in a 
        public or nonprofit private institution in a State that 
        provides training, respectively, in a concentration in 
        health or mental health care leading to a graduate 
        degree in social work and a concentration leading to a 
        graduate degree in marriage and family therapy and a 
        concentration leading to a graduate degree in 
        counseling.
          (D) The term ``graduate program in mental health 
        practice'' means a graduate program in clinical 
        psychology, clinical social work, professional 
        counseling, or marriage and family therapy.
          (E) The term ``accredited'', when applied to a school 
        of medicine, osteopathic medicine, dentistry, 
        veterinary medicine, optometry, podiatry, pharmacy, 
        public health, or chiropractic, or a graduate program 
        in health administration, clinical psychology, clinical 
        social work, professional counseling, or marriage and 
        family therapy, means a school or program that is 
        accredited by a recognized body or bodies approved for 
        such purpose by the Secretary of Education, except that 
        a new school or program that, by reason of an 
        insufficient period of operation, is not, at the time 
        of application for a grant or contract under this 
        title, eligible for accreditation by such a recognized 
        body or bodies, 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 or program will meet the accreditation 
        standards of such body or bodies prior to the beginning 
        of the academic year following the normal graduation 
        date of the first entering class in such school or 
        program.

           *       *       *       *       *       *       *

          [(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 
                physician; and
                  [(B) meets regulations prescribed by the 
                Secretary in accordance with section 750(b).]
          (3) The term ``program for the training of physician 
        assistants'' means an educational program that--
                  (A) has as its objective the education of 
                individuals who will, upon completion of their 
                studies in the program, be qualified to provide 
                primary care under the supervision of a 
                physician;
                  (B) extends for at least one academic year 
                and consists of--
                          (i) supervised clinical practice; and
                          (ii) at least four months (in the 
                        aggregate) of classroom instruction, 
                        directed toward preparing students to 
                        deliver health care;
                  (C) has an enrollment of not less than eight 
                students; and
                  (D) trains students in primary care, disease 
                prevention, health promotion, geriatric 
                medicine, and home health care.

           *       *       *       *       *       *       *

          (5) The term ``allied health professionals'' means a 
        health professional (other than a registered nurse or 
        physician assistant)--
                  (A) * * *

           *       *       *       *       *       *       *

                  (C) who has not received a degree of doctor 
                of medicine, a degree of doctor of osteopathy, 
                a degree of doctor of dentistry or an 
                equivalent degree, a degree of doctor of 
                veterinary medicine or an equivalent degree, a 
                degree of doctor of optometry or an equivalent 
                degree, a degree of doctor of podiatric 
                medicine or an equivalent degree, a degree of 
                bachelor of science in pharmacy or an 
                equivalent degree, a degree of doctor of 
                pharmacy or an equivalent degree, a graduate 
                degree in public health or an equivalent 
                degree, a degree of doctor of chiropractic or 
                an equivalent degree, a graduate degree in 
                health administration or an equivalent degree, 
                a doctoral degree in clinical psychology or an 
                equivalent degree, or a degree in social work 
                or an equivalent degree or a degree in 
                counseling or an equivalent degree.
          (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)[.]; or
                  (D) is designated by a State governor (in 
                consultation with the medical community) as a 
                shortage area or medically underserved 
                community.

           *       *       *       *       *       *       *


                       PART A--GENERAL PROVISIONS

SEC. 801. DEFINITIONS.

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

SEC. 804. MATCHING REQUIREMENT.

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

SEC. 805. PREFERENCE.

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

SEC. 806. GENERALLY APPLICABLE PROVISIONS.

    (a) Awarding of Grants and Contracts.--The Secretary shall 
ensure that grants and contracts under this title are awarded 
on a competitive basis, as appropriate, to carry out innovative 
demonstration projects or provide for strategic workforce 
supplementation activities as needed to meet national nursing 
service goals and in accordance with this title. Contracts may 
be entered into under this title with public or private 
entities as determined necessary by the Secretary.
    (b) Information Requirements.--
          (1) In general.--Recipients of grants and contracts 
        under this title shall meet information requirements as 
        specified by the Secretary.
          (2) Evaluations.--The Secretary shall establish 
        procedures to ensure the annual evaluation of programs 
        and projects operated by recipients of grants under 
        this title. Such procedures shall ensure that continued 
        funding for such programs and projects will be 
        conditioned upon a demonstration that satisfactory 
        progress has been made by the program or project in 
        meeting the objectives of the program or project.
    (c) Training Programs.--Training programs conducted with 
amounts received under this title shall meet applicable 
accreditation and quality standards.
    (d) Duration of Assistance.--
          (1) In general.--Subject to paragraph (2), in the 
        case of an award to an entity of a grant, cooperative 
        agreement, or contract under this title, the period 
        during which payments are made to the entity under the 
        award may not exceed 5 years. The provision of payments 
        under the award shall be subject to annual approval by 
        the Secretary of the payments and subject to the 
        availability of appropriations for the fiscal year 
        involved to make the payments. This paragraph may not 
        be construed as limiting the number of awards under the 
        program involved that may be made to the entity.
          (2) Limitation.--In the case of an award to an entity 
        of a grant, cooperative agreement, or contract under 
        this title, paragraph (1) shall apply only to the 
        extent not inconsistent with any other provision of 
        this title that relates to the period during which 
        payments may be made under the award.
    (e) Peer Review Regarding Certain Programs.--
          (1) In general.--Each application for a grant under 
        this title, except advanced nurse traineeship grants 
        under section 811(a)(2), shall be submitted to a peer 
        review group for an evaluation of the merits of the 
        proposals made in the application. The Secretary may 
        not approve such an application unless a peer review 
        group has recommended the application for approval.
          (2) Composition.--Each peer review group under this 
        subsection shall be composed principally of individuals 
        who are not officers or employees of the Federal 
        Government. In providing for the establishment of peer 
        review groups and procedures, the Secretary shall, 
        except as otherwise provided, ensure sex, racial, 
        ethnic, and geographic representation among the 
        membership of such groups.
          (3) Administration.--This subsection shall be carried 
        out by the Secretary acting through the Administrator 
        of the Health Resources and Services Administration.
    (f) Analytic Activities.--The Secretary shall ensure that--
          (1) cross-cutting workforce analytical activities are 
        carried out as part of the workforce information and 
        analysis activities under this title; and
          (2) discipline-specific workfoce information is 
        developed and analytical activities are carried out as 
        part of--
                  (A) the advanced practice nursing activities 
                under part B;
                  (B) the workforce diversity activities under 
                part C; and
                  (C) basic nursing education and practice 
                activities under part D.
    (g) State and Regional Priorities.--Activities under grants 
or contracts under this title shall, to extent practicable, be 
consistent with related Federal, State, or regional nursing 
professions program plans and priorities.
    (h) Filing of Applications..--
          (1) In general.--Applications for grants or contracts 
        under this title may be submitted by health professions 
        schools, schools of nursing, academic health centers, 
        State or local governments, or other appropriate public 
        or private nonprofit entities as determined appropriate 
        by the Secretary in accordance with this title.
          (2) For profit entities.--Notwithstanding paragraph 
        (1), a for-profit entity may be eligible for a grant or 
        contract under this title as determined appropriated by 
        the Secretary.

SEC. 807. TECHNICAL ASSISTANCE.

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

           *       *       *       *       *       *       *


   prohibition against discrimination by schools on the basis of sex

    Sec.[855.] 810. The Secretary may not make a grant, loan 
guarantee, or interest subsidy payment under this title to, or 
for the benefit of, any school of nursing unless the 
application for the grant, loan guarantee, or interest subsidy 
payment contains assurances satisfactory to the Secretary that 
the school will not discriminate on the basis of sex in the 
admission of individuals to its training programs. The 
Secretary may not enter into a contract under this title with 
any school unless the school furnishes assurances satisfactory 
to the Secretary that it will not discriminate on the basis of 
sex in the admission of individuals to its training programs.

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

SEC. 811. ADVANCED PRACTICE NURSING GRANTS.

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

             PART C--INCREASING NURSING WORKFORCE DIVERSITY

SEC. 821. WORKFORCE DIVERSITY GRANTS.

    (a) In General.--The Secretary may award grants to and 
enter into contracts with eligible entities to meet the costs 
of special projects to increase nursing education opportunities 
for individuals who are from disadvantaged backgrounds 
(including racial and ethnic minorities underrepresented among 
registered nurses) by providing student scholarships or 
stipends, pre-entry preparation, and retention activities.
    (b) Guidance.--In carrying out subsection (a), the 
Secretary shall take into consideration the recommendations of 
the First, Second and Third Invitational Congresses for 
Minority Nurse Leaders on ``Caring for the Emerging Majority,'' 
in 1992, 1993 and 1997, and consult with nursing associations 
including the American Nurses Association, the National League 
for Nursing, the American Association of Colleges of Nursing, 
the National Black Nurses Association, the National Association 
of Hispanic Nurses, the Association of Asian American and 
Pacific Islander Nurses, the Native American Indian and Alaskan 
Nurses Association, and the National Council of State Boards of 
Nursing.
    (c) Required Information and Conditions for Award 
Recipients.--
          (1) In general.--Recipients of awards under this 
        section may be required, where requested, to report to 
        the Secretary concerning the annual admission, 
        retention, and graduation rates for individuals from 
        disadvantaged backgrounds and ethnic and racial 
        minorities in the school or schools involved in the 
        projects.
          (2) Falling rates.--If any of the rates reported 
        under paragraph (1) fall below the average of the two 
        previous years, the grant or contract recipient shall 
        provide the Secretary with plans for immediately 
        improving such rates.
          (3) Ineligibility.--A recipient described in 
        paragraph (2) shall be ineligible for continued funding 
        under this section if the plan of the recipient fails 
        to improve the rates within the 1-year period beginning 
        on the date such plan is implemented.

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

SEC. 831. BASIC NURSE EDUCATION AND PRACTICE GRANTS.

    (a) In General.--The Secretary may award grants to and 
enter into contracts with eligible entities for projects to 
strengthen capacity for basic nurse education and practice.
    (b) Priority Areas.--In awarding grants or contracts under 
this section the Secretary shall give priority to entities that 
will use amounts provided under such a grant or contract to 
enhance the educational mix and utilization of the basic 
nursing workforce by strengthening programs that provide basic 
nurse education, such as through--
          (1) establishing or expanding nursing practice 
        arrangements in noninstitutional settings to 
        demonstrate methods to improve access to primary health 
        care in medically underserved communities;
          (2) providing care for underserved populations and 
        other high-risk groups such as the elderly, individuals 
        with HIV-AIDS, substance abusers, the homeless, and 
        victims of domestic violence;
          (3) providing managed care, quality improvement, and 
        other skills needed to practice in existing and 
        emerging organized health care systems;
          (4) developing cultural competencies among nurses;
          (5) expanding the enrollment in baccalaureate nursing 
        programs;
          (6) promoting career mobility for nursing personnel 
        in a variety of training settings and cross training or 
        specialty training among diverse population groups;
          (7) providing education in informatics, including 
        distance learning methodologies; or
          (8) other priority areas as determined by the 
        Secretary.

           *       *       *       *       *       *       *


                     [TITLE VIII--NURSE EDUCATION]

                TITLE VIII_NURSING WORKFORCE DEVELOPMENT

                       [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. 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 
                        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 of 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 or 
        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 of 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) individuals who are employed by 
        nursing facilities or home health agencies as nursing 
        paraprofessionals.
          [(3) Preferences 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 
        agrees 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 minoritygroup 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. [2961] (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. [296m] (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 
        medial 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. [296r] (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. [297] (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. [297-1] (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.

           *       *       *       *       *       *       *


                            loan provisions

    Sec. 836. (a) * * *

           *       *       *       *       *       *       *

    (b) * * *
          (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) periods (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 a 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 periods 
        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 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.

           *       *       *       *       *       *       *

    (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.

           *       *       *       *       *       *       *


                 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).
          (2) The remainder of such balance shall be paid to 
        the school.

           *       *       *       *       *       *       *

    [(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 of loans made from the loan 
fund established under section 835(b) as determined by the 
Secretary under subsection (a).

           *       *       *       *       *       *       *


                PART F--AUTHORIZATION OF APPROPRIATIONS

SEC. 841. AUTHORIZATION OF APPROPRIATIONS.

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

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

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

    (A) Establishment. The Secretary shall establish an 
advisory council to be known as the National Advisory Council 
on Nurse Education and Practice (in this section referred to as 
the ``Advisory Council'').
    (b) Composition.--
      (1) In general.--The Advisory Council shall be composed 
of
                  (A) not less than 21, nor more than 23 
                individuals, who are not officers or employees 
                of the Federal Government, appointed by the 
                Secretary without regard to the Federal civil 
                service laws, of which--
                          (i) 2 shall be selected from full-
                        time students enrolled in schools of 
                        nursing;
                          (ii) 2 shall be selected from the 
                        general public;
                          (iii) 2 shall be selected from 
                        practicing professional nurses; and
                          (iv) 9 shall be selected from among 
                        the leading authorities in the various 
                        fields of nursing, higher, and 
                        secondary education, and from 
                        representatives of advanced practice 
                        nursing groups (such as nurse 
                        practitioners, nurse midwives, and 
                        nurse anesthetists), hospitals, and 
                        other institutions and organizations 
                        which provide nursing services; and
                  (B) the Secretary (or the delegate of the 
                Secretary (who shall be an ex officio member 
                and shall serve as the Chairperson)).
          (2) Appointment.--Not later than 90 days after the 
        date of enactment of this Act, the Secretary shall 
        appoint the members of the Advisory Council and each 
        such member shall serve a 4 year term. In making such 
        appointments, the Secretary shall ensure a fair balance 
        between the nursing professions, a broad geographic 
        representation of members and a balance between urban 
        and rural members. Members shall be appointed based on 
        their competence, interest, and knowledge of the 
        mission of the profession involved. A majority of the 
        members shall be nurses.
          (3) Minority representation.--In appointing the 
        members of the Advisory Council under paragraph (1), 
        the Secretary shall ensure the adequate representation 
        of minorities.
    (c) Vacancies.--
          (1) In general.--A vacancy on the Advisory Council 
        shall be filled in the manner in which the original 
        appointment was made and shall be subject to any 
        conditions which applied with respect to the original 
        appointment.
          (2) Filling unexpired term.--An individual chosen to 
        fill a vacancy shall be appointed for the unexpired 
        term of the member replaced.
    (d) Duties.--The Advisory Council shall--
          (1) provide advice and recommendations to the 
        Secretary and Congress concerning policy matters 
        arising in the administration of this title, including 
        the range of issues relating to the nurse workforce, 
        education, and practice improvement;
          (2) provide advice to the Secretary and Congress in 
        the preparation of general regulations and with respect 
        to policy matters arising in the administration of this 
        title, including the range of issues relating to nurse 
        supply, education and practice improvement; and
          (3) not later than 3 years after the date of 
        enactment of this section, and annually thereafter 
        prepare and submit to the Secretary, the Committee on 
        Labor and Human Resources of the Senate, and the 
        Committee on Commerce of the House of Representatives, 
        a report describing the activities of the Council, 
        including findings and recommendations made by the 
        Council concerning the activities under this title.
    (e) Meetings and Documents.--
          (1) Meetings.--The Advisory Council shall meet not 
        less than 2 times each year. Such meetings shall be 
        held jointly with other related entities established 
        under this title where appropriate.
          (2) Documents.--Not later than 14 days prior to the 
        convening of a meeting under paragraph (1), the 
        Advisory Council shall prepare and make available an 
        agenda of the matters to be considered by the Advisory 
        Council at such meeting. At any such meeting, the 
        Advisory Council shall distribute materials with 
        respect to the issues to be addressed at the meeting. 
        Not later than 30 days after the adjourning of such a 
        meeting, the Advisory Council shall prepare and make 
        available a summary of the meeting and any actions 
        taken by the Council based upon the meeting.
    (f) Compensation and Expenses.--
          (1) Compensation.--Each member of the Advisory 
        Council shall be compensated at a rate equal to the 
        daily equivalent of the annual rate of basic pay 
        prescribed for level IV of the Executive Schedule under 
        section 5315 of title 5, United States Code, for each 
        day (including travel time) during which such member is 
        engaged in the performance of the duties of the 
        Council. All members of the Council who are officers or 
        employees of the United States shall serve without 
        compensation in addition to that received for their 
        services as officers or employees of the United States.
          (2) Expenses.--The members of the Advisory Council 
        shall be allowed travel expenses, including per diem in 
        lieu of subsistence, at rates authorized for employees 
        of agencies under subchapter I of chapter 57 of title 
        5, United States Code, while away from their homes or 
        regular places of business in the performance of 
        services for the Council.
    (g) Funding.--Amounts appropriated under this title may be 
utilized by the Secretary to support the nurse education and 
practice activities of the Council.
    (h) FACA.--The Federal Advisory Council Act shall apply to 
the Advisory Committee under this section only to the extent 
that the provisions of such Act do not conflict with the 
requirements of this section.

           *       *       *       *       *       *       *


                  Subpart III--Loan Repayment Program

                         loan repayment program

    Sec. 846. (a) * * *

           *       *       *       *       *       *       *

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

                            [Part C--General

  [Advisory Council on Nurse Education and Practice; Review Committee

    [Sec. 851. [298] (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 of 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 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. [298a] 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. [298b] For purposes of this title--
          [(1) The term ``State'' means a State, the 
        Commonwealth of Puerto Rico, the District 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 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) 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 
        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 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 ``building'' 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. [298b-1] Any appropriation Act which 
appropriates funds for any fiscal year for grants, contracts, 
or other payments under the 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 there-from for obligation for 
such payments before the fiscal year for which such funds are 
authorized to be appropriated.

           *       *       *       *       *       *       *


                              [Delegation

    [Sec. 856. [298b-3] 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. [298b-4] 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. [298b-5] (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 supbart was in 
effect on September 30, 1995)--
          [(1) the owner of the facility ceases to be a public 
        or non-profit 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 will 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 
non-profit 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)(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 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) 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 judgment, constitute a lien 
on any facility.

                [certain generally applicable provisions

    [Sec. 860. [298b-7] (a) Application for Grants, Cooperative 
Agreements, or Contracts.--The Secretary may make an award of a 
grant, cooperative agreement, or contract under this title 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 programs 
authorizing the award.
    [(b) 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.
    [(c) Breach of Agreements for Obligated Service.--
          [(1) In general.--In the case of any program under 
        this title 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 
                title that makes an award of Federal funds for 
                attending an accredited program of nursing (in 
                this subsection referred to as ``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 title for the period of time applicable 
                under the program.
          [(2) Waiver or suspension of liability.--In the case 
        of an individual or health facility making an agreement 
        for purposes of paragraph (1), the Secretary shall 
        provide for the waiver or suspension of liability under 
        such paragraph if compliance by the individual or the 
        health facility, as the case may be, with the 
        agreements involved is impossible, or would involve 
        extreme hardship to the individual or facility, and if 
        enforcement of the agreements with respect to the 
        individual or facility would be unconscionable.
          [(3) Date certain for recovery.--Subject to paragraph 
        (2), any amount that the Federal Government is entitled 
        to recover under paragraph (1) shall be paid to the 
        United States not later than the expiration of the 
        three-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 title shall be 
        available for the purposes of such program, and shall 
        remain available for such purposes until expended.
    [(d) Peer Review Regarding Certain Programs.--Each 
application for a grant or contract under any of sections 821, 
822, 827, 830, and 831 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.
    [(e) Preferences and Required Information in Certain 
Programs.--
          [(1) Preferences in making awards.--
                  [(A) Subject to subparagraph (B), in awarding 
                grants or contracts under any of sections 821, 
                822, 830, and 831, the Secretary shall give 
                preference to any qualified applicant that--
                          [(i) has a high rate for placing 
                        graduates in practice settings having 
                        the principal focus of serving 
                        residents of medically underserved 
                        communities; or
                          [(ii) during the 2-year period 
                        preceding the fiscal year for which 
                        such an award is sought, has achieved a 
                        significant increased in the rate of 
                        placing graduates in such settings.
                  [(B) For purposes of subparagraph (A), 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 subsection (d).
          [(2) Required submission of information.--The 
        Secretary may make an award of a grant or contract 
        under any of sections 821, 822, 830, and 831 only if 
        the applicant for the award submits to the Secretary 
        (through the application for the award) the following 
        information regarding the programs of the applicant:
                  [(A) A description of rotations or 
                preceptorships for students that have the 
                principal focus of providing health care to 
                medically underserved communities.
                  [(B) The number of faculty on admissions 
                committees who have a clinical practice in 
                community-based ambulatory settings in 
                medically underserved or rural communities.
                  [(C) 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.
                  [(D) If applicable to the applicant, the 
                number of recent graduates who have chosen 
                careers in primary health care.
                  [(E) The number of recent graduates whose 
                practices are serving medically underserved 
                communities.
                  [(F) A description of whether and to what 
                extent the applicant is able to operate without 
                Federal assistance under this title.
          [(3) Definition.--Fopr purposes of this subsection, 
        the term ``graduate'' means, unless otherwise 
        specified, an individual who has successfully completed 
        all training requirements necessary for full 
        certification in the health profession selected by the 
        individual.]
                  [(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 purposes 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).

                      [Subpart II--Student Loans]

PART E--STUDENT LOANS

           *       *       *       *       *       *       *


    [Sec. 837. [297c] 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 
1967, $30,000,000 for fiscal year 1997, $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 for at least seven years. A loan to such an individual 
may not exceed $500 for any academic year.]

           *       *       *       *       *       *       *


                  [Subpart III--Loan Repayment Program

[loan repayment program

           *       *       *       *       *       *       *


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

    (a) Trauma Care Modifications to State Plan for Emergency 
Medical Services.--
          (1) * * *

           *       *       *       *       *       *       *

          (8) [provides for for] provides for the use of 
        procedures by paramedics and emergency medical 
        technicians to assess the severity of the injuries 
        incurred by trauma patients;

           *       *       *       *       *       *       *


SEC. 1232. FUNDING.

    (a) Authorization of Appropriations.--For the purpose of 
carrying out parts A and B, there are authorized to be 
appropriated $6,000,0000 for fiscal year 1994, and such sums as 
may be necessary for each of the fiscal years 1995 [and 1996] 
through 2002.

           *       *       *       *       *       *       *


    TITLE XV--PREVENTIVE HEALTH MEASURES WITH RESPECT TO BREAST AND 
                            CERVICAL CANCERS

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

    (a) In General.--* * *

           *       *       *       *       *       *       *

    (c) Special Consideration for Certain States.--In making 
grants under subsection (a) to States whose initial grants 
under such subsection are made for fiscal year 1995 or any 
subsequent fiscal year, the Secretary shall give special 
consideration to any State whose proposal for carrying out 
programs under such subsection--
          (1) has been approved through a process of peer 
        review; and
          (2) is made with respect to geographic areas in which 
        there is--
                  (A) a substantial rate of mortality from 
                breast or cervical cancer; or
                  (B) a substantial incidence of either of such 
                cancers.
    [(c)] (d) Cooperating 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 
or private entities as the Secretary determines to be 
appropriate.

           *       *       *       *       *       *       *


SEC. 1505. DESCRIPTION OF INTENDED USES OF GRANT.

    The Secretary may not make a grant under section 1501 
unless--
          (1) * * *

           *       *       *       *       *       *       *

          (3) the description provides information relating to 
        the services and activities to be provided, including a 
        description of the manner in which the services and 
        activities will be coordinated with any similar 
        services or activities of public and [nonprofit] 
        private entities; and

           *       *       *       *       *       *       *


          TITLE XVII--HEALTH INFORMATION AND HEALTH PROMOTION

                           general authority

    Sec. 1701. (a) The Secretary shall--

           *       *       *       *       *       *       *

    (b) For the purpose of carrying out this section and 
sections 1702 through 1705, there are authorized to be 
appropriated $10,000,000 for fiscal year 1992, and such sums as 
may be necessary for each of the fiscal years 1993 [through 
1996 through 2002].

           *       *       *       *       *       *       *


              [establishment of] office of minority health

    Sec. 1707. (a) In General.--There is established an Office 
of Minority Health within the [Office of the Assistant 
Secretary for Health] Office of Public Health and Science. 
There shall be in the Department of Health and Human Services a 
Deputy Assistant Secretary for Minority Health, who shall be 
the head of the Office of Minority Health. The Secretary, 
acting through such Deputy Assistant Secretary, shall carry out 
this section.
    [(b) Duties.--The Secretary shall, with respect to the 
health concerns 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 matter 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 exchange 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 parents;
          [(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 as 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 subpopulations 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 
                project.
                  [(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) Report.--Not later than January 31 of fiscal year 1993 
and of each second year describing to activities carried out 
under this section during the preceding 2 fiscal years.
    [(f) Fundung.--
          [(1) Authorization of appropriations.--For the 
        purpose of carrying out this section, there is 
        authorized to be appropriate $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 carrying 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) Enter into interagency agreements with other 
        agencies of the Public Health Service.
          (3) Support research, demonstrations and evaluations 
        to test new and innovative models.
          (4) Increase knowledge and understanding of health 
        risk factors.
          (5) Develop mechanisms that support better 
        information dissemination, education, prevention, and 
        service delivery to individuals from disadvantaged 
        backgrounds, including individuals who are members of 
        racial or ethnic minority groups.
          (6) Ensure that the National Center for Health 
        Statistics collects data on the health status of each 
        minority group.
          (7) With respect to individuals who lack proficiency 
        in speaking the English language, enter into contracts 
        with public and nonprofit private providers of primary 
        health services for the purpose of increasing the 
        access of the individuals to such services by 
        developing and carrying out programs to provide 
        bilingual or interpretive services.
          (8) Support a national minority health resource 
        center to carry out the following:
                  (A) Facilitate the exchange of information 
                regarding matters relating to health 
                information and health promotion, preventive 
                health services, and education in the 
                appropriate use of health care.
                  (B) Facilitate access to such information.
                  (C) Assist in the analysis of issues and 
                problems relating to such matters.
                  (D) Provide technical assistance with respect 
                to the exchange of such information (including 
                facilitating the development of materials for 
                such technical assistance).
          (9) Carry out programs to improve access to health 
        care services for individuals with limited proficiency 
        in speaking the English language. Activitiesunder the 
preceding sentence shall include developing and evaluating model 
projects.
    (c) Advisory Committee.--
          (1) In general.--The Secretary shall establish an 
        advisory committee to be known as the Advisory 
        Committee on Minority Health (in this subsection 
        referred to as the `Committee').
          (2) Duties.--The Committee shall provide advice to 
        the Deputy Assistant Secretary carrying out this 
        section, including advice on the development of goals 
        and specific program activities under paragraphs (1) 
        through (9) of subsection (b) for each racial and 
        ethnic minority group.
          (3) Chair.--The chairperson of the Committee shall be 
        selected by the Secretary from among the members of the 
        voting members of the Committee. The term of office of 
        the chairperson shall be 2 years.
          (4) Composition.--
                  (A) The Committee shall be composed of 12 
                voting members appointed in accordance with 
                subparagraph (B), and nonvoting, ex officio 
                members designated in subparagraph (C).
                  (B) The voting members of the Committee shall 
                be appointed by the Secretary from among 
                individuals who are not officers or employees 
                of the Federal Government and who have 
                expertise regarding issues of minority health. 
                The racial and ethnic minority groups shall be 
                equally represented among such members.
                  (C) The nonvoting, ex officio members of the 
                Committee shall be such officials of the 
                Department of Health and Human Services as the 
                Secretary determines to be appropriate.
          (5) Terms.--Each member of the Committee shall serve 
        for a term of 4 years, except that the Secretary shall 
        initially appoint a portion of the members to terms of 
        1 year, 2 years, and 3 years.
          (6) Vacancies.--If a vacancy occurs on the Committee, 
        a new member shall be appointed by the Secretary within 
        90 days from the date that the vacancy occurs, and 
        serve for the remainder of the term for which the 
        predecessor of such member was appointed. The vacancy 
        shall not affect the power of the remaining members to 
        execute the duties of the Committee.
          (7) Compensation.--Members of the Committee who are 
        officers or employees of the United States shall serve 
        without compensation. Members of the Committee who are 
        not officers or employees of the United States shall 
        receive compensation, for each day (including travel 
        time) they are engaged in the performance of the 
        functions of the Committee. Such compensation may not 
        be in an amount in excess of the daily equivalent of 
        the annual maximum rate of basic pay payable under the 
        General Schedule (under title 5, United States Code) 
        for positions above GS-15.
    (d) Certain Requirements Regarding Duties.--
          (1) Recommendations regarding language as impediment 
        to health care.--The Deputy Assistant Secretary for 
        Minority Health shall consult with the Director of the 
        Office of International and Refugee Health, the 
        Director of the Office of Civil Rights, and the 
        Directors of other appropriate Departmental entities 
        regarding recommendations for carrying out activities 
        under subsection (b)(9).
          (2) Equitable allocation regarding activities.--In 
        carrying out subsection (b), the Secretary shall ensure 
        that services provided under such subsection are 
        equitably allocated among all groups served under this 
        section by the Secretary.
          (3) Cultural competency of services.--The Secretary 
        shall ensure that information and services provided 
        pursuant to subsection (b) are provided in the 
        language, educational, and cultural context that is 
        most appropriate for the individuals for whom the 
        information and services are intended.
    (e) Grants and Contracts Regarding Duties.--
          (1) In general.--In carrying out subsection (b), the 
        Secretary acting through the Deputy Assistant Secretary 
        may make awards of grants, cooperative agreements, and 
        contracts to public and nonprofit private entities.
          (2) Process for making awards.--The Deputy Assistant 
        Secretary shall ensure that awards under paragraph (1) 
        are made, to the extent practical, only on a 
        competitive basis, and that a grant is awarded for a 
        proposal only if the proposal has been recommended for 
        such an award through a process of peer review.
          (3) Evaluation and dissemination.--The Deputy 
        Assistant Secretary, directly or through contracts with 
        public and private entities, shall provide for 
        evaluations of projects carried out with awards made 
        under paragraph (1) during the preceding 2 fiscal 
        years. The report shall be included in the report 
        required under subsection (f) for the fiscal year 
        involved.
    (f) Reports.--
          (1) In general.--Not later than February 1 of fiscal 
        year 1999 and of each second year thereafter, the 
        Secretary shall submit to the Committee on Energy and 
        Commerce of the House of Representatives, and to the 
        Committee on Labor and Human Resources of the Senate, a 
        report describing the activities carried out under this 
        section during the preceding 2 fiscal years and 
        evaluating the extent to which such activities have 
        been effective in improving the health of racial and 
        ethnic minority groups. Each such report shall include 
        the biennial reports submitted under sections 201(e)(3) 
        and 201(f)(2) for such years by the heads of the Public 
        Health Service agencies.
          (2) Agency reports.--Not later than February 1, 1999, 
        and biennially thereafter, the heads of the Public 
        Health Service agencies shall submit to the Deputy 
        Assistant Secretary a report summarizing the minority 
        health activities of each of the respective agencies.
    (g) Definition.--For purposes of this section:
          (1) The term ``racial and ethnic minority group'' 
        means American Indians (including Alaska Natives, 
        Eskimos, and Aleuts); Asian Americans and Pacific 
        Islanders; Blacks; and Hispanics.
          (2) The term ``Hispanic'' means individuals whose 
        origin is Mexican, Puerto Rican, Cuban, Central or 
        South American, or any other Spanish-speaking country.
    (h) Funding.--
          (1) Authorization of appropriations.--For the purpose 
        of carrying out this section, there are authorized to 
        be appropriated $30,000,000 for fiscal year 1998, such 
        sums as may be necessary for each of the fiscal years 
        1999 through 2002.

           *       *       *       *       *       *       *


                emergency medical services for children

    Sec. 1910. (a) For activities in addition to the activities 
which may be carried out by States under section 1904(a)(1)(F), 
the Secretary may make grants to States or accredited schools 
of medicine in States to support a program of demonstration 
projects for the expansion and improvement of emergency medical 
services for children who need treatment for trauma or critical 
care. Any grant made under this subsection shall be for not 
more than a [two-year period] 3-year period (with an optional 
4th year based on performance), subject to annual evaluation by 
the Secretary. Only [one grant] (3 grants under this subsection 
may be made in a State (to a State or to a school of medicine 
in such State) in any fiscal year.

           *       *       *       *       *       *       *

    (d) To carry out this section, there are authorized to be 
appropriated $2,000,000 for fiscal year 1985 and for each of 
the two succeeding fiscal years, $3,000,000 for fiscal year 
1989, $4,000,000 for fiscal year 1990, $5,000,000 for each of 
the fiscal years 1991 and 1992, and such sums as may be 
necessary for each of the fiscal years 1993 through [1997] 
2005.

           *       *       *       *       *       *       *


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) Sense of Congress; Requirement Regarding Notice.--
          [(1) 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.

           *       *       *       *       *       *       *


SEC. 2618 DISTRIBUTION OF FUNDS.

    (b) Amount of Grant to State.--
          (1) Minimum Allotment.--* * *

           *       *       *       *       *       *       *

          (3) Definitions.--As used in this subsection--
                  (A) the term ``State'' means each of the 50 
                States, the District of Columbia [and the 
                Commonwealth of Puerto Rico], the Commonwealth 
                of Puerto Rico, the Virgin Islands, and Guam.
                  (B) the term ``territory of the United 
                States'' means [the Virgin Islands, Guam] 
                American Samoa, the Commonwealth of the 
                Northern Marina Islands, and the Republic of 
                the Marshall Islands.
    (k) General Provision.--
          (1) Foundation Integrity.--* * *

           *       *       *       *       *       *       *

          (10) Transfer of funds.--The Foundation may [not] 
        transfer funds to the National Institutes of Health. 
        Any funds transferred under this paragraph shall be 
        subject to all Federal limitations relating to 
        Federally-funded research.

           *       *       *       *       *       *       *

    (m) Funding.--
          [(1) Authorization of appropriations.--For the 
        purpose of carrying out this part, there is authorized 
        to be appropriated an aggregate [$200,000 for the 
        fiscal years 1994 and 1995] $500,000 for each fiscal 
        year.

           *       *       *       *       *       *       *


family violence prevention and service act

           *       *       *       *       *       *       *


SEC. 10418. DEMONSTRATION GRANTS FOR COMMUNITY INITIATIVES

    (a) In General.--

           *       *       *       *       *       *       *

    (h) Authorization of appropriations
    There are authorized to be appropriated to carry out this 
section--
          (1) $4,000,000 for fiscal year 1996; and
          (2) $6,000,000 for [fiscal year 1997] for each of the 
        fiscal years 1997 through 2002

           *       *       *       *       *       *       *


public law 103-183

           *       *       *       *       *       *       *


SEC. 706. ALIGNMENT OF CURRENT CENTERS FOR DISEASE CONTROL AND 
                    PREVENTION REAUTHORIZATION SCHEDULE.

    (a) Screenings, Education, and Referrals Regarding Lead 
Poisoning.--Section 317(A)(l)(1) of the Public Health Service 
Act (42 U.S.C. 247b-1(l)(1)) is amended by striking ``through 
1997'' and inserting ``through 1998''.
    (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''.

           *       *       *       *       *       *       *


                                
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