[Congressional Bills 105th Congress]
[From the U.S. Government Publishing Office]
[S. 1754 Engrossed Amendment House (EAH)]
2d Session
S. 1754
_______________________________________________________________________
AMENDMENT
In the House of Representatives, U. S.,
October 13, 1998.
Resolved, That the bill from the Senate (S. 1754) entitled ``An Act to amend
the Public Health Service Act to consolidate and reauthorize health professions
and minority and disadvantaged health education programs, and for other
purposes'', do pass with the following
AMENDMENT:
Strike out all after the enacting clause and insert:
SECTION 1. SHORT TITLE; TABLE OF CONTENTS.
(a) Short Title.--This Act may be cited as the ``Health Professions
Education Partnerships Act of 1998''.
(b) Table of Contents.--The table of contents of this Act is as
follows:
Sec. 1. Short title; table of contents.
TITLE I--HEALTH PROFESSIONS EDUCATION AND FINANCIAL ASSISTANCE PROGRAMS
Subtitle A--Health Professions Education Programs
Sec. 101. Under-represented minority health professions grant program.
Sec. 102. Training in primary care medicine and dentistry.
Sec. 103. Interdisciplinary, community-based linkages.
Sec. 104. Health professions workforce information and analysis.
Sec. 105. Public health workforce development.
Sec. 106. General provisions.
Sec. 107. Preference in certain programs.
Sec. 108. Definitions.
Sec. 109. Technical amendment on National Health Service Corps.
Sec. 110. Savings provision.
Subtitle B--Nursing Workforce Development
Sec. 121. Short title.
Sec. 122. Purpose.
Sec. 123. Amendments to Public Health Service Act.
Sec. 124. Savings provision.
Subtitle C--Financial Assistance
CHAPTER 1--SCHOOL-BASED REVOLVING LOAN FUNDS
Sec. 131. Primary care loan program.
Sec. 132. Loans for disadvantaged students.
Sec. 133. Student loans regarding schools of nursing.
Sec. 134. General provisions.
CHAPTER 2--INSURED HEALTH EDUCATION ASSISTANCE LOANS TO GRADUATE
STUDENTS
Sec. 141. Health Education Assistance Loan Program.
Sec. 142. HEAL lender and holder performance standards.
Sec. 143. Insurance Program.
Sec. 144. HEAL bankruptcy.
Sec. 145. HEAL refinancing.
TITLE II--OFFICE OF MINORITY HEALTH
Sec. 201. Revision and extension of programs of Office of Minority
Health.
TITLE III--SELECTED INITIATIVES
Sec. 301. State offices of rural health.
Sec. 302. Demonstration projects regarding Alzheimer's Disease.
Sec. 303. Project grants for immunization services.
TITLE IV--MISCELLANEOUS PROVISIONS
Sec. 401. Technical corrections regarding Public Law 103-183.
Sec. 402. Miscellaneous amendments regarding PHS commissioned officers.
Sec. 403. Clinical traineeships.
Sec. 404. Project grants for screenings, referrals, and education
regarding lead poisoning.
Sec. 405. Project grants for preventive health services regarding
tuberculosis.
Sec. 406. CDC loan repayment program.
Sec. 407. Community programs on domestic violence.
Sec. 408. State loan repayment program.
Sec. 409. Authority of the director of NIH.
Sec. 410. Raise in maximum level of loan repayments.
Sec. 411. Construction of regional centers for research on primates.
Sec. 412. Peer review.
Sec. 413. Funding for trauma care.
Sec. 414. Health information and health promotion.
Sec. 415. Emergency medical services for children.
Sec. 416. Administration of certain requirements.
Sec. 417. Aids drug assistance program.
Sec. 418. National Foundation for Biomedical Research.
Sec. 419. Fetal Alcohol Syndrome prevention and services.
TITLE I--HEALTH PROFESSIONS EDUCATION AND FINANCIAL ASSISTANCE PROGRAMS
Subtitle A--Health Professions Education Programs
SEC. 101. UNDER-REPRESENTED MINORITY HEALTH PROFESSIONS GRANT PROGRAM.
(a) In General.--Part B of title VII of the Public Health Service
Act (42 U.S.C. 293 et seq.) is amended to read as follows:
``PART B--HEALTH PROFESSIONS TRAINING FOR DIVERSITY
``SEC. 736. CENTERS OF EXCELLENCE.
``(a) In General.--The Secretary shall make grants to, and enter
into contracts with, designated health professions schools described in
subsection (c), and other public and nonprofit health or educational
entities, for the purpose of assisting the schools in supporting
programs of excellence in health professions education for under-
represented minority individuals.
``(b) Required Use of Funds.--The Secretary may not make a grant
under subsection (a) unless the designated health professions school
involved agrees, subject to subsection (c)(1)(C), to expend the grant--
``(1) to develop a large competitive applicant pool through
linkages with institutions of higher education, local school
districts, and other community-based entities and establish an
education pipeline for health professions careers;
``(2) to establish, strengthen, or expand programs to
enhance the academic performance of under-represented minority
students attending the school;
``(3) to improve the capacity of such school to train,
recruit, and retain under-represented minority faculty
including the payment of such stipends and fellowships as the
Secretary may determine appropriate;
``(4) to carry out activities to improve the information
resources, clinical education, curricula and cultural
competence of the 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 $24,000,000
or less--
``(i) the Secretary shall make available
$12,000,000 for grants under subsection (a) to
health professions schools that meet the
conditions described in subsection (c)(2)(A);
and
``(ii) and available after grants are made
with funds under clause (i), the Secretary
shall make available--
``(I) 60 percent of such amount for
grants under subsection (a) to health
professions schools that meet the
conditions described in paragraph (3)
or (4) of subsection (c) (including
meeting the conditions under subsection
(e)); and
``(II) 40 percent of such amount
for grants under subsection (a) to
health professions schools that meet
the conditions described in subsection
(c)(5).
``(B) Funding in excess of $24,000,000.--If amounts
appropriated under paragraph (1) for a fiscal year
exceed $24,000,000 but are less than $30,000,000--
``(i) 80 percent of such excess amounts
shall be made available for grants under
subsection (a) to health professions schools
that meet the requirements described in
paragraph (3) or (4) of subsection (c)
(including meeting conditions pursuant to
subsection (e)); and
``(ii) 20 percent of such excess amount
shall be made available for grants under
subsection (a) to health professions schools
that meet the conditions described in
subsection (c)(5).
``(C) Funding in excess of $30,000,000.--If amounts
appropriated under paragraph (1) for a fiscal year are
$30,000,000 or more, the Secretary shall make
available--
``(i) not less than $12,000,000 for grants
under subsection (a) to health professions
schools that meet the conditions described in
subsection (c)(2)(A);
``(ii) not less than $12,000,000 for grants
under subsection (a) to health professions
schools that meet the conditions described in
paragraph (3) or (4) of subsection (c)
(including meeting conditions pursuant to
subsection (e));
``(iii) not less than $6,000,000 for grants
under subsection (a) to health professions
schools that meet the conditions described in
subsection (c)(5); and
``(iv) after grants are made with funds
under clauses (i) through (iii), any remaining
funds for grants under subsection (a) to health
professions schools that meet the conditions
described in paragraph (2)(A), (3), (4), or (5)
of subsection (c).
``(3) No limitation.--Nothing in this subsection shall be
construed as limiting the centers of excellence referred to in
this section to the designated amount, or to preclude such
entities from competing for other grants under this section.
``(4) Maintenance of effort.--
``(A) In general.--With respect to activities for
which a grant made under this part are authorized to be
expended, the Secretary may not make such a grant to a
center of excellence for any fiscal year unless the
center agrees to maintain expenditures of non-Federal
amounts for such activities at a level that is not less
than the level of such expenditures maintained by the
center for the fiscal year preceding the fiscal year
for which the school receives such a grant.
``(B) Use of federal funds.--With respect to any
Federal amounts received by a center of excellence and
available for carrying out activities for which a grant
under this part is authorized to be expended, the
Secretary may not make such a grant to the center for
any fiscal year unless the center agrees that the
center will, before expending the grant, expend the
Federal amounts obtained from sources other than the
grant.
``SEC. 737. SCHOLARSHIPS FOR DISADVANTAGED STUDENTS.
``(a) In General.--The Secretary may make a grant to an eligible
entity (as defined in subsection (d)(1)) under this section for the
awarding of scholarships by schools to any full-time student who is an
eligible individual as defined in subsection (d). Such scholarships may
be expended only for tuition expenses, other reasonable educational
expenses, and reasonable living expenses incurred in the attendance of
such school.
``(b) Preference in Providing Scholarships.--The Secretary may not
make a grant to an entity under subsection (a) unless the health
professions and nursing schools involved agree that, in providing
scholarships pursuant to the grant, the schools will give preference to
students for whom the costs of attending the schools would constitute a
severe financial hardship and, notwithstanding other provisions of this
section, to former recipients of scholarships under sections 736 and
740(d)(2)(B) (as such sections existed on the day before the date of
enactment of this section).
``(c) Amount of Award.--In awarding grants to eligible entities
that are health professions and nursing schools, the Secretary shall
give priority to eligible entities based on the proportion of
graduating students going into primary care, the proportion of
underrepresented minority students, and the proportion of graduates
working in medically underserved communities.
``(d) Definitions.--In this section:
``(1) Eligible entities.--The term `eligible entities'
means an entity that--
``(A) is a school of medicine, osteopathic
medicine, dentistry, nursing (as defined in section
801), pharmacy, podiatric medicine, optometry,
veterinary medicine, public health, chiropractic, or
allied health, a school offering a graduate program in
behavioral and mental health practice, or an entity
providing programs for the training of physician
assistants; and
``(B) is carrying out a program for recruiting and
retaining students from disadvantaged backgrounds,
including students who are members of racial and ethnic
minority groups.
``(2) Eligible individual.--The term `eligible individual'
means an individual who--
``(A) is from a disadvantaged background;
``(B) has a financial need for a scholarship; and
``(C) is enrolled (or accepted for enrollment) at
an eligible health professions or nursing school as a
full-time student in a program leading to a degree in a
health profession or nursing.
``SEC. 738. LOAN REPAYMENTS AND FELLOWSHIPS REGARDING FACULTY
POSITIONS.
``(a) Loan Repayments.--
``(1) Establishment of program.--The Secretary shall
establish a program of entering into contracts with individuals
described in paragraph (2) under which the individuals agree to
serve as members of the faculties of schools described in
paragraph (3) in consideration of the Federal Government
agreeing to pay, for each year of such service, not more than
$20,000 of the principal and interest of the educational loans
of such individuals.
``(2) Eligible individuals.--The individuals referred to in
paragraph (1) are individuals from disadvantaged backgrounds
who--
``(A) have a degree in medicine, osteopathic
medicine, dentistry, nursing, or another health
profession;
``(B) are enrolled in an approved graduate training
program in medicine, osteopathic medicine, dentistry,
nursing, or other health profession; or
``(C) are enrolled as full-time students--
``(i) in an accredited (as determined by
the Secretary) school described in paragraph
(3); and
``(ii) in the final year of a course of a
study or program, offered by such institution
and approved by the Secretary, leading to a
degree from such a school.
``(3) Eligible health professions schools.--The schools
described in this paragraph are schools of medicine, nursing
(as schools of nursing are defined in section 801), osteopathic
medicine, dentistry, pharmacy, allied health, podiatric
medicine, optometry, veterinary medicine, or public health, or
schools offering graduate programs in behavioral and mental
health.
``(4) Requirements regarding faculty positions.--The
Secretary may not enter into a contract under paragraph (1)
unless--
``(A) the individual involved has entered into a
contract with a school described in paragraph (3) to
serve as a member of the faculty of the school for not
less than 2 years; and
``(B) the contract referred to in subparagraph (A)
provides that--
``(i) the school will, for each year for
which the individual will serve as a member of
the faculty under the contract with the school,
make payments of the principal and interest due
on the educational loans of the individual for
such year in an amount equal to the amount of
such payments made by the Secretary for the
year;
``(ii) the payments made by the school
pursuant to clause (i) on behalf of the
individual will be in addition to the pay that
the individual would otherwise receive for
serving as a member of such faculty; and
``(iii) the school, in making a
determination of the amount of compensation to
be provided by the school to the individual for
serving as a member of the faculty, will make
the determination without regard to the amount
of payments made (or to be made) to the
individual by the Federal Government under
paragraph (1).
``(5) Applicability of certain provisions.--The provisions
of sections 338C, 338G, and 338I shall apply to the program
established in paragraph (1) to the same extent and in the same
manner as such provisions apply to the National Health Service
Corps Loan Repayment Program established in subpart III of part
D of title III, including the applicability of provisions
regarding reimbursements for increased tax liability and
regarding bankruptcy.
``(6) Waiver regarding school contributions.--The Secretary
may waive the requirement established in paragraph (4)(B) if
the Secretary determines that the requirement will impose an
undue financial hardship on the school involved.
``(b) Fellowships.--
``(1) In general.--The Secretary may make grants to and
enter into contracts with eligible entities to assist such
entities in increasing the number of underrepresented minority
individuals who are members of the faculty of such schools.
``(2) Applications.--To be eligible to receive a grant or
contract under this subsection, an entity shall provide an
assurance, in the application submitted by the entity, that--
``(A) amounts received under such a grant or
contract will be used to award a fellowship to an
individual only if the individual meets the
requirements of paragraphs (3) and (4); and
``(B) each fellowship awarded pursuant to the grant
or contract will include--
``(i) a stipend in an amount not exceeding
50 percent of the regular salary of a similar
faculty member for not to exceed 3 years of
training; and
``(ii) an allowance for other expenses,
such as travel to professional meetings and
costs related to specialized training.
``(3) Eligibility.--To be eligible to receive a grant or
contract under paragraph (1), an applicant shall demonstrate to
the Secretary that such applicant has or will have the ability
to--
``(A) identify, recruit and select underrepresented
minority individuals who have the potential for
teaching, administration, or conducting research at a
health professions institution;
``(B) provide such individuals with the skills
necessary to enable them to secure a tenured faculty
position at such institution, which may include
training with respect to pedagogical skills, program
administration, the design and conduct of research,
grants writing, and the preparation of articles
suitable for publication in peer reviewed journals;
``(C) provide services designed to assist such
individuals in their preparation for an academic
career, including the provision of counselors; and
``(D) provide health services to rural or medically
underserved populations.
``(4) Requirements.--To be eligible to receive a grant or
contract under paragraph (1) an applicant shall--
``(A) provide an assurance that such applicant will
make available (directly through cash donations) $1 for
every $1 of Federal funds received under this section
for the fellowship;
``(B) provide an assurance that institutional
support will be provided for the individual for the
second and third years at a level that is equal to the
total amount of institutional funds provided in the
year in which the grant or contract was awarded;
``(C) provide an assurance that the individual that
will receive the fellowship will be a member of the
faculty of the applicant school; and
``(D) provide an assurance that the individual that
will receive the fellowship will have, at a minimum,
appropriate advanced preparation (such as a master's or
doctoral degree) and special skills necessary to enable
such individual to teach and practice.
``(5) Definition.--For purposes of this subsection, the
term `underrepresented minority individuals' means individuals
who are members of racial or ethnic minority groups that are
underrepresented in the health professions including nursing.
``SEC. 739. EDUCATIONAL ASSISTANCE IN THE HEALTH PROFESSIONS REGARDING
INDIVIDUALS FROM DISADVANTAGED BACKGROUNDS.
``(a) In General.--
``(1) Authority for grants.--For the purpose of assisting
individuals from disadvantaged backgrounds, as determined in
accordance with criteria prescribed by the Secretary, to
undertake education to enter a health profession, the Secretary
may make grants to and enter into contracts with schools of
medicine, osteopathic medicine, public health, dentistry,
veterinary medicine, optometry, pharmacy, allied health,
chiropractic, and podiatric medicine, public and nonprofit
private schools that offer graduate programs in behavioral and
mental health, programs for the training of physician
assistants, and other public or private nonprofit health or
educational entities to assist in meeting the costs described
in paragraph (2).
``(2) Authorized expenditures.--A grant or contract under
paragraph (1) may be used by the entity to meet the cost of--
``(A) identifying, recruiting, and selecting
individuals from disadvantaged backgrounds, as so
determined, for education and training in a health
profession;
``(B) facilitating the entry of such individuals
into such a school;
``(C) providing counseling, mentoring, or other
services designed to assist such individuals to
complete successfully their education at such a school;
``(D) providing, for a period prior to the entry of
such individuals into the regular course of education
of such a school, preliminary education and health
research training designed to assist them to complete
successfully such regular course of education at such a
school, or referring such individuals to institutions
providing such preliminary education;
``(E) publicizing existing sources of financial aid
available to students in the education program of such
a school or who are undertaking training necessary to
qualify them to enroll in such a program;
``(F) paying such scholarships as the Secretary may
determine for such individuals for any period of health
professions education at a health professions school;
``(G) paying such stipends as the Secretary may
approve for such individuals for any period of
education in student-enhancement programs (other than
regular courses), except that such a stipend may not be
provided to an individual for more than 12 months, and
such a stipend shall be in an amount determined
appropriate by the Secretary (notwithstanding any other
provision of law regarding the amount of stipends);
``(H) carrying out programs under which such
individuals gain experience regarding a career in a
field of primary health care through working at
facilities of public or private nonprofit community-
based providers of primary health services; and
``(I) conducting activities to develop a larger and
more competitive applicant pool through partnerships
with institutions of higher education, school
districts, and other community-based entities.
``(3) Definition.--In this section, the term `regular
course of education of such a school' as used in subparagraph
(D) includes a graduate program in behavioral or mental health.
``(b) Requirements for Awards.--In making awards to eligible
entities under subsection (a)(1), the Secretary shall give preference
to approved applications for programs that involve a comprehensive
approach by several public or nonprofit private health or educational
entities to establish, enhance and expand educational programs that
will result in the development of a competitive applicant pool of
individuals from disadvantaged backgrounds who desire to pursue health
professions careers. In considering awards for such a comprehensive
partnership approach, the following shall apply with respect to the
entity involved:
``(1) The entity shall have a demonstrated commitment to
such approach through formal agreements that have common
objectives with institutions of higher education, school
districts, and other community-based entities.
``(2) Such formal agreements shall reflect the coordination
of educational activities and support services, increased
linkages, and the consolidation of resources within a specific
geographic area.
``(3) The design of the educational activities involved
shall provide for the establishment of a competitive health
professions applicant pool of individuals from disadvantaged
backgrounds by enhancing the total preparation (academic and
social) of such individuals to pursue a health professions
career.
``(4) The programs or activities under the award shall
focus on developing a culturally competent health care
workforce that will serve the unserved and underserved
populations within the geographic area.
``(c) Equitable Allocation of Financial Assistance.--The Secretary,
to the extent practicable, shall ensure that services and activities
under subsection (a) are adequately allocated among the various racial
and ethnic populations who are from disadvantaged backgrounds.
``(d) Matching Requirements.--The Secretary may require that an
entity that applies for a grant or contract under subsection (a),
provide non-Federal matching funds, as appropriate, to ensure the
institutional commitment of the entity to the projects funded under the
grant or contract. As determined by the Secretary, such non-Federal
matching funds may be provided directly or through donations from
public or private entities and may be in cash or in-kind, fairly
evaluated, including plant, equipment, or services.
``SEC. 740. AUTHORIZATION OF APPROPRIATION.
``(a) Scholarships.--There are authorized to be appropriated to
carry out section 737, $37,000,000 for fiscal year 1998, and such sums
as may be necessary for each of the fiscal years 1999 through 2002. Of
the amount appropriated in any fiscal year, the Secretary shall ensure
that not less than 16 percent shall be distributed to schools of
nursing.
``(b) Loan Repayments and Fellowships.--For the purpose of carrying
out section 738, there is authorized to be appropriated $1,100,000 for
fiscal year 1998, and such sums as may be necessary for each of the
fiscal years 1999 through 2002.
``(c) Educational Assistance in Health Professions Regarding
Individuals for Disadvantaged Backgrounds.--For the purpose of grants
and contracts under section 739(a)(1), there is authorized to be
appropriated $29,400,000 for fiscal year 1998, and such sums as may be
necessary for each of the fiscal years 1999 through 2002. The Secretary
may use not to exceed 20 percent of the amount appropriated for a
fiscal year under this subsection to provide scholarships under section
739(a)(2)(F).
``(d) Report.--Not later than 6 months after the date of enactment
of this part, the Secretary shall prepare and submit to the appropriate
committees of Congress a report concerning the efforts of the Secretary
to address the need for a representative mix of individuals from
historically minority health professions schools, or from institutions
or other entities that historically or by geographic location have a
demonstrated record of training or educating underrepresented
minorities, within various health professions disciplines, on peer
review councils.''.
(b) Repeal.--
(1) In general.--Section 795 of the Public Health Service
Act (42 U.S.C. 295n) is repealed.
(2) Nontermination of authority.--The amendments made by
this section shall not be construed to terminate agreements
that, on the day before the date of enactment of this Act, are
in effect pursuant to section 795 of the Public Health Service
Act (42 U.S.C. 795) as such section existed on such date. Such
agreements shall continue in effect in accordance with the
terms of the agreements. With respect to compliance with such
agreements, any period of practice as a provider of primary
health services shall be counted towards the satisfaction of
the requirement of practice pursuant to such section 795.
(c) Conforming Amendments.--Section 481A(c)(3)(D)(i) of the Public
Health Service Act (42 U.S.C. 287a-2(c)(3)(D)(i)) is amended by
striking ``section 739'' and inserting ``part B of title VII''.
SEC. 102. TRAINING IN PRIMARY CARE MEDICINE AND DENTISTRY.
Part C of title VII of the Public Health Service Act (42 U.S.C. 293
et seq.) is amended--
(1) in the part heading by striking ``PRIMARY HEALTH CARE''
and inserting ``FAMILY MEDICINE, GENERAL INTERNAL MEDICINE,
GENERAL PEDIATRICS, PHYSICIAN ASSISTANTS, GENERAL DENTISTRY,
AND PEDIATRIC DENTISTRY'';
(2) by repealing section 746 (42 U.S.C. 293j);
(3) in section 747 (42 U.S.C. 293k)--
(A) by striking the section heading and inserting
the following:
``SEC. 747. FAMILY MEDICINE, GENERAL INTERNAL MEDICINE, GENERAL
PEDIATRICS, GENERAL DENTISTRY, PEDIATRIC DENTISTRY, AND
PHYSICIAN ASSISTANTS.'';
(B) in subsection (a)--
(i) in paragraph (1)--
(I) by inserting ``, internal
medicine, or pediatrics'' after
``family medicine''; and
(II) by inserting before the
semicolon the following: ``that
emphasizes training for the practice of
family medicine, general internal
medicine, or general pediatrics (as
defined by the Secretary)'';
(ii) in paragraph (2), by inserting ``,
general internal medicine, or general
pediatrics'' before the semicolon;
(iii) in paragraphs (3) and (4), by
inserting ``(including geriatrics), general
internal medicine or general pediatrics'' after
``family medicine'';
(iv) in paragraph (3), by striking ``and''
at the end thereof;
(v) in paragraph (4), by striking the
period and inserting a semicolon; and
(vii) by adding at the end thereof the
following new paragraphs:
``(5) to meet the costs of projects to plan, develop, and
operate or maintain programs for the training of physician
assistants (as defined in section 799B), and for the training
of individuals who will teach in programs to provide such
training; and
``(6) to meet the costs of planning, developing, or
operating programs, and to provide financial assistance to
residents in such programs, of general dentistry or pediatric
dentistry.
For purposes of paragraph (6), entities eligible for such grants or
contracts shall include entities that have programs in dental schools,
approved residency programs in the general or pediatric practice of
dentistry, approved advanced education programs in the general or
pediatric practice of dentistry, or approved residency programs in
pediatric dentistry.'';
(C) in subsection (b)--
(i) in paragraphs (1) and (2)(A), by
inserting ``, general internal medicine, or
general pediatrics'' after ``family medicine'';
(ii) in paragraph (2)--
(I) in subparagraph (A), by
striking ``or'' at the end; and
(II) in subparagraph (B), by
striking the period and inserting ``;
or''; and
(iii) by adding at the end the following:
``(3) Priority in making awards.--In making awards of
grants and contracts under paragraph (1), the Secretary shall
give priority to any qualified applicant for such an award that
proposes a collaborative project between departments of primary
care.'';
(D) by redesignating subsections (c) and (d) as
subsections (d) and (e), respectively;
(E) by inserting after subsection (b), the
following new subsection:
``(c) Priority.--
``(1) In general.--With respect to programs for the
training of interns or residents, the Secretary shall give
priority in awarding grants under this section to qualified
applicants that have a record of training the greatest
percentage of providers, or that have demonstrated significant
improvements in the percentage of providers, which enter and
remain in primary care practice or general or pediatric
dentistry.
``(2) Disadvantaged individuals.--With respect to programs
for the training of interns, residents, or physician
assistants, the Secretary shall give priority in awarding
grants under this section to qualified applicants that have a
record of training individuals who are from disadvantaged
backgrounds (including racial and ethnic minorities
underrepresented among primary care practice or general or
pediatric dentistry).
``(3) Special consideration.--In awarding grants under this
section the Secretary shall give special consideration to
projects which prepare practitioners to care for underserved
populations and other high risk groups such as the elderly,
individuals with HIV-AIDS, substance abusers, homeless, and
victims of domestic violence.''; and
(F) in subsection (e) (as so redesignated by
subparagraph (D))--
(i) in paragraph (1), by striking
``$54,000,000'' and all that follows and
inserting ``$78,300,000 for fiscal year 1998,
and such sums as may be necessary for each of
the fiscal years 1999 through 2002.''; and
(ii) by striking paragraph (2) and
inserting the following:
``(2) Allocation.--
``(A) In general.--Of the amounts appropriated
under paragraph (1) for a fiscal year, the Secretary
shall make available--
``(i) not less than $49,300,000 for awards
of grants and contracts under subsection (a) to
programs of family medicine, of which not less
than $8,600,000 shall be made available for
awards of grants and contracts under subsection
(b) for family medicine academic administrative
units;
``(ii) not less than $17,700,000 for awards
of grants and contracts under subsection (a) to
programs of general internal medicine and
general pediatrics;
``(iii) not less than $6,800,000 for awards
of grants and contracts under subsection (a) to
programs relating to physician assistants; and
``(iv) not less than $4,500,000 for awards
of grants and contracts under subsection (a) to
programs of general or pediatric dentistry.
``(B) Ratable reduction.--If amounts appropriated
under paragraph (1) for any fiscal year are less than
the amount required to comply with subparagraph (A),
the Secretary shall ratably reduce the amount to be
made available under each of clauses (i) through (iv)
of such subparagraph accordingly.''; and
(4) by repealing sections 748 through 752 (42 U.S.C. 293l
through 293p) and inserting the following:
``SEC. 748. ADVISORY COMMITTEE ON TRAINING IN PRIMARY CARE MEDICINE AND
DENTISTRY.
``(a) Establishment.--The Secretary shall establish an advisory
committee to be known as the Advisory Committee on Training in Primary
Care Medicine and Dentistry (in this section referred to as the
`Advisory Committee').
``(b) Composition.--
``(1) In general.--The Secretary shall determine the
appropriate number of individuals to serve on the Advisory
Committee. Such individuals shall not be officers or employees
of the Federal Government.
``(2) Appointment.--Not later than 90 days after the date
of enactment of this Act, the Secretary shall appoint the
members of the Advisory Committee from among individuals who
are health professionals. In making such appointments, the
Secretary shall ensure a fair balance between the health
professions, that at least 75 percent of the members of the
Advisory Committee are health professionals, a broad geographic
representation of members and a balance between urban and rural
members. Members shall be appointed based on their competence,
interest, and knowledge of the mission of the profession
involved.
``(3) Minority representation.--In appointing the members
of the Advisory Committee under paragraph (2), the Secretary
shall ensure the adequate representation of women and
minorities.
``(c) Terms.--
``(1) In general.--A member of the Advisory Committee shall
be appointed for a term of 3 years, except that of the members
first appointed--
``(A) \1/3\ of such members shall serve for a term
of 1 year;
``(B) \1/3\ of such members shall serve for a term
of 2 years; and
``(C) \1/3\ of such members shall serve for a term
of 3 years.
``(2) Vacancies.--
``(A) In general.--A vacancy on the Advisory
Committee shall be filled in the manner in which the
original appointment was made and shall be subject to
any conditions which applied with respect to the
original appointment.
``(B) Filling unexpired term.--An individual chosen
to fill a vacancy shall be appointed for the unexpired
term of the member replaced.
``(d) Duties.--The Advisory Committee shall--
``(1) provide advice and recommendations to the Secretary
concerning policy and program development and other matters of
significance concerning the activities under section 747; and
``(2) not later than 3 years after the date of enactment of
this section, and annually thereafter, prepare and submit to
the Secretary, and the Committee on Labor and Human Resources
of the Senate, and the Committee on Commerce of the House of
Representatives, a report describing the activities of the
Committee, including findings and recommendations made by the
Committee concerning the activities under section 747.
``(e) Meetings and Documents.--
``(1) Meetings.--The Advisory Committee shall meet not less
than 2 times each year. Such meetings shall be held jointly
with other related entities established under this title where
appropriate.
``(2) Documents.--Not later than 14 days prior to the
convening of a meeting under paragraph (1), the Advisory
Committee shall prepare and make available an agenda of the
matters to be considered by the Advisory Committee at such
meeting. At any such meeting, the Advisory Council shall
distribute materials with respect to the issues to be addressed
at the meeting. Not later than 30 days after the adjourning of
such a meeting, the Advisory Committee shall prepare and make
available a summary of the meeting and any actions taken by the
Committee based upon the meeting.
``(f) Compensation and Expenses.--
``(1) Compensation.--Each member of the Advisory Committee
shall be compensated at a rate equal to the daily equivalent of
the annual rate of basic pay prescribed for level IV of the
Executive Schedule under section 5315 of title 5, United States
Code, for each day (including travel time) during which such
member is engaged in the performance of the duties of the
Committee.
``(2) Expenses.--The members of the Advisory Committee
shall be allowed travel expenses, including per diem in lieu of
subsistence, at rates authorized for employees of agencies
under subchapter I of chapter 57 of title 5, United States
Code, while away from their homes or regular places of business
in the performance of services for the Committee.
``(g) FACA.--The Federal Advisory Committee Act shall apply to the
Advisory Committee under this section only to the extent that the
provisions of such Act do not conflict with the requirements of this
section.''.
SEC. 103. INTERDISCIPLINARY, COMMUNITY-BASED LINKAGES.
Part D of title VII of the Public Health Service Act (42 U.S.C. 294
et seq.) is amended to read as follows:
``PART D--INTERDISCIPLINARY, COMMUNITY-BASED LINKAGES
``SEC. 750. GENERAL PROVISIONS.
``(a) Collaboration.--To be eligible to receive assistance under
this part, an academic institution shall use such assistance in
collaboration with 2 or more disciplines.
``(b) Activities.--An entity shall use assistance under this part
to carry out innovative demonstration projects for strategic workforce
supplementation activities as needed to meet national goals for
interdisciplinary, community-based linkages. Such assistance may be
used consistent with this part--
``(1) to develop and support training programs;
``(2) for faculty development;
``(3) for model demonstration programs;
``(4) for the provision of stipends for fellowship
trainees;
``(5) to provide technical assistance; and
``(6) for other activities that will produce outcomes
consistent with the purposes of this part.
``SEC. 751. AREA HEALTH EDUCATION CENTERS.
``(a) Authority for Provision of Financial Assistance.--
``(1) Assistance for planning, development, and operation
of programs.--
``(A) In general.--The Secretary shall award grants
to and enter into contracts with schools of medicine
and osteopathic medicine, and incorporated consortia
made up of such schools, or the parent institutions of
such schools, for projects for the planning,
development and operation of area health education
center programs that--
``(i) improve the recruitment,
distribution, supply, quality and efficiency of
personnel providing health services in
underserved rural and urban areas and personnel
providing health services to populations having
demonstrated serious unmet health care needs;
``(ii) increase the number of primary care
physicians and other primary care providers who
provide services in underserved areas through
the offering of an educational continuum of
health career recruitment through clinical
education concerning underserved areas in a
comprehensive health workforce strategy;
``(iii) carry out recruitment and health
career awareness programs to recruit
individuals from underserved areas and under-
represented populations, including minority and
other elementary or secondary students, into
the health professions;
``(iv) prepare individuals to more
effectively provide health services to
underserved areas or underserved populations
through field placements, preceptorships, the
conduct of or support of community-based
primary care residency programs, and agreements
with community-based organizations such as
community health centers, migrant health
centers, Indian health centers, public health
departments and others;
``(v) conduct health professions education
and training activities for students of health
professions schools and medical residents;
``(vi) conduct at least 10 percent of
medical student required clinical education at
sites remote to the primary teaching facility
of the contracting institution; and
``(vii) provide information dissemination
and educational support to reduce professional
isolation, increase retention, enhance the
practice environment, and improve health care
through the timely dissemination of research
findings using relevant resources.
``(B) Other eligible entities.--With respect to a
State in which no area health education center program
is in operation, the Secretary may award a grant or
contract under subparagraph (A) to a school of nursing.
``(C) Project terms.--
``(i) In general.--Except as provided in
clause (ii), the period during which payments
may be made under an award under subparagraph
(A) may not exceed--
``(I) in the case of a project, 12
years or
``(II) in the case of a center
within a project, 6 years.
``(ii) Exception.--The periods described in
clause (i) shall not apply to projects that
have completed the initial period of Federal
funding under this section and that desire to
compete for model awards under paragraph
(2)(A).
``(2) Assistance for operation of model programs.--
``(A) In general.--In the case of any entity
described in paragraph (1)(A) that--
``(i) has previously received funds under
this section;
``(ii) is operating an area health
education center program; and
``(iii) is no longer receiving financial
assistance under paragraph (1);
the Secretary may provide financial assistance to such
entity to pay the costs of operating and carrying out
the requirements of the program as described in
paragraph (1).
``(B) Matching requirement.--With respect to the
costs of operating a model program under subparagraph
(A), an entity, to be eligible for financial assistance
under subparagraph (A), shall make available (directly
or through contributions from State, county or
municipal governments, or the private sector) recurring
non-Federal contributions in cash toward such costs in
an amount that is equal to not less than 50 percent of
such costs.
``(C) Limitation.--The aggregate amount of awards
provided under subparagraph (A) to entities in a State
for a fiscal year may not exceed the lesser of--
``(i) $2,000,000; or
``(ii) an amount equal to the product of
$250,000 and the aggregate number of area
health education centers operated in the State
by such entities.
``(b) Requirements for Centers.--
``(1) General requirement.--Each area health education
center that receives funds under this section shall encourage
the regionalization of health professions schools through the
establishment of partnerships with community-based
organizations.
``(2) Service area.--Each area health education center that
receives funds under this section shall specifically designate
a geographic area or medically underserved population to be
served by the center. Such area or population shall be in a
location removed from the main location of the teaching
facilities of the schools participating in the program with
such center.
``(3) Other requirements.--Each area health education
center that receives funds under this section shall--
``(A) assess the health personnel needs of the area
to be served by the center and assist in the planning
and development of training programs to meet such
needs;
``(B) arrange and support rotations for students
and residents in family medicine, general internal
medicine or general pediatrics, with at least one
center in each program being affiliated with or
conducting a rotating osteopathic internship or medical
residency training program in family medicine
(including geriatrics), general internal medicine
(including geriatrics), or general pediatrics in which
no fewer than 4 individuals are enrolled in first-year
positions;
``(C) conduct and participate in interdisciplinary
training that involves physicians and other health
personnel including, where practicable, public health
professionals, physician assistants, nurse
practitioners, nurse midwives, and behavioral and
mental health providers; and
``(D) have an advisory board, at least 75 percent
of the members of which shall be individuals, including
both health service providers and consumers, from the
area served by the center.
``(c) Certain Provisions Regarding Funding.--
``(1) Allocation to center.--Not less than 75 percent of
the total amount of Federal funds provided to an entity under
this section shall be allocated by an area health education
center program to the area health education center. Such entity
shall enter into an agreement with each center for purposes of
specifying the allocation of such 75 percent of funds.
``(2) Operating costs.--With respect to the operating costs
of the area health education center program of an entity
receiving funds under this section, the entity shall make
available (directly or through contributions from State, county
or municipal governments, or the private sector) non-Federal
contributions in cash toward such costs in an amount that is
equal to not less than 50 percent of such costs, except that
the Secretary may grant a waiver for up to 75 percent of the
amount of the required non-Federal match in the first 3 years
in which an entity receives funds under this section.
``SEC. 752. HEALTH EDUCATION AND TRAINING CENTERS.
``(a) In General.--To be eligible for funds under this section, a
health education training center shall be an entity otherwise eligible
for funds under section 751 that--
``(1) addresses the persistent and severe unmet health care
needs in States along the border between the United States and
Mexico and in the State of Florida, and in other urban and
rural areas with populations with serious unmet health care
needs;
``(2) establishes an advisory board comprised of health
service providers, educators and consumers from the service
area;
``(3) conducts training and education programs for health
professions students in these areas;
``(4) conducts training in health education services,
including training to prepare community health workers; and
``(5) supports health professionals (including nursing)
practicing in the area through educational and other services.
``(b) Allocation of Funds.--The Secretary shall make available 50
percent of the amounts appropriated for each fiscal year under section
752 for the establishment or operation of health education training
centers through projects in States along the border between the United
States and Mexico and in the State of Florida.
``SEC. 753. EDUCATION AND TRAINING RELATING TO GERIATRICS.
``(a) Geriatric Education Centers.--
``(1) In general.--The Secretary shall award grants or
contracts under this section to entities described in
paragraphs (1), (3), or (4) of section 799B, and section
853(2), for the establishment or operation of geriatric
education centers.
``(2) Requirements.--A geriatric education center is a
program that--
``(A) improves the training of health professionals
in geriatrics, including geriatric residencies,
traineeships, or fellowships;
``(B) develops and disseminates curricula relating
to the treatment of the health problems of elderly
individuals;
``(C) supports the training and retraining of
faculty to provide instruction in geriatrics;
``(D) supports continuing education of health
professionals who provide geriatric care; and
``(E) provides students with clinical training in
geriatrics in nursing homes, chronic and acute disease
hospitals, ambulatory care centers, and senior centers.
``(b) Geriatric Training Regarding Physicians and Dentists.--
``(1) In general.--The Secretary may make grants to, and
enter into contracts with, schools of medicine, schools of
osteopathic medicine, teaching hospitals, and graduate medical
education programs, for the purpose of providing support
(including residencies, traineeships, and fellowships) for
geriatric training projects to train physicians, dentists and
behavioral and mental health professionals who plan to teach
geriatric medicine, geriatric behavioral or mental health, or
geriatric dentistry.
``(2) Requirements.--Each project for which a grant or
contract is made under this subsection shall--
``(A) be staffed by full-time teaching physicians
who have experience or training in geriatric medicine
or geriatric behavioral or mental health;
``(B) be staffed, or enter into an agreement with
an institution staffed by full-time or part-time
teaching dentists who have experience or training in
geriatric dentistry;
``(C) be staffed, or enter into an agreement with
an institution staffed by full-time or part-time
teaching behavioral mental health professionals who
have experience or training in geriatric behavioral or
mental health;
``(D) be based in a graduate medical education
program in internal medicine or family medicine or in a
department of geriatrics or behavioral or mental
health;
``(E) provide training in geriatrics and exposure
to the physical and mental disabilities of elderly
individuals through a variety of service rotations,
such as geriatric consultation services, acute care
services, dental services, geriatric behavioral or
mental health units, day and home care programs,
rehabilitation services, extended care facilities,
geriatric ambulatory care and comprehensive evaluation
units, and community care programs for elderly mentally
retarded individuals; and
``(F) provide training in geriatrics through one or
both of the training options described in subparagraphs
(A) and (B) of paragraph (3).
``(3) Training options.--The training options referred to
in subparagraph (F) of paragraph (2) shall be as follows:
``(A) A 1-year retraining program in geriatrics
for--
``(i) physicians who are faculty members in
departments of internal medicine, family
medicine, gynecology, geriatrics, and
behavioral or mental health at schools of
medicine and osteopathic medicine;
``(ii) dentists who are faculty members at
schools of dentistry or at hospital departments
of dentistry; and
``(iii) behavioral or mental health
professionals who are faculty members in
departments of behavioral or mental health; and
``(B) A 2-year internal medicine or family medicine
fellowship program providing emphasis in geriatrics,
which shall be designed to provide training in clinical
geriatrics and geriatrics research for--
``(i) physicians who have completed
graduate medical education programs in internal
medicine, family medicine, behavioral or mental
health, neurology, gynecology, or
rehabilitation medicine;
``(ii) dentists who have demonstrated a
commitment to an academic career and who have
completed postdoctoral dental training,
including postdoctoral dental education
programs or who have relevant advanced training
or experience; and
``(iii) behavioral or mental health
professionals who have completed graduate
medical education programs in behavioral or
mental health.
``(4) Definitions.--For purposes of this subsection:
``(A) The term `graduate medical education program'
means a program sponsored by a school of medicine, a
school of osteopathic medicine, a hospital, or a public
or private institution that--
``(i) offers postgraduate medical training
in the specialties and subspecialties of
medicine; and
``(ii) has been accredited by the
Accreditation Council for Graduate Medical
Education or the American Osteopathic
Association through its Committee on
Postdoctoral Training.
``(B) The term `post-doctoral dental education
program' means a program sponsored by a school of
dentistry, a hospital, or a public or private
institution that--
``(i) offers post-doctoral training in the
specialties of dentistry, advanced education in
general dentistry, or a dental general practice
residency; and
``(ii) has been accredited by the
Commission on Dental Accreditation.
``(c) Geriatric Faculty Fellowships.--
``(1) Establishment of program.--The Secretary shall
establish a program to provide Geriatric Academic Career Awards
to eligible individuals to promote the career development of
such individuals as academic geriatricians.
``(2) Eligible individuals.--To be eligible to receive an
Award under paragraph (1), an individual shall--
``(A) be board certified or board eligible in
internal medicine, family practice, or psychiatry;
``(B) have completed an approved fellowship program
in geriatrics; and
``(C) have a junior faculty appointment at an
accredited (as determined by the Secretary) school of
medicine or osteopathic medicine.
``(3) Limitations.--No Award under paragraph (1) may be
made to an eligible individual unless the individual--
``(A) has submitted to the Secretary an
application, at such time, in such manner, and
containing such information as the Secretary may
require, and the Secretary has approved such
application; and
``(B) provides, in such form and manner as the
Secretary may require, assurances that the individual
will meet the service requirement described in
subsection (e).
``(4) Amount and term.--
``(A) Amount.--The amount of an Award under this
section shall equal $50,000 for fiscal year 1998,
adjusted for subsequent fiscal years to reflect the
increase in the Consumer Price Index.
``(B) Term.--The term of any Award made under this
subsection shall not exceed 5 years.
``(5) Service requirement.--An individual who receives an
Award under this subsection shall provide training in clinical
geriatrics, including the training of interdisciplinary teams
of health care professionals. The provision of such training
shall constitute at least 75 percent of the obligations of such
individual under the Award.
``SEC. 754. QUENTIN N. BURDICK PROGRAM FOR RURAL INTERDISCIPLINARY
TRAINING.
``(a) Grants.--The Secretary may make grants or contracts under
this section to help entities fund authorized activities under an
application approved under subsection (c).
``(b) Use of Amounts.--
``(1) In general.--Amounts provided under subsection (a)
shall be used by the recipients to fund interdisciplinary
training projects designed to--
``(A) use new and innovative methods to train
health care practitioners to provide services in rural
areas;
``(B) demonstrate and evaluate innovative
interdisciplinary methods and models designed to
provide access to cost-effective comprehensive health
care;
``(C) deliver health care services to individuals
residing in rural areas;
``(D) enhance the amount of relevant research
conducted concerning health care issues in rural areas;
and
``(E) increase the recruitment and retention of
health care practitioners from rural areas and make
rural practice a more attractive career choice for
health care practitioners.
``(2) Methods.--A recipient of funds under subsection (a)
may use various methods in carrying out the projects described
in paragraph (1), including--
``(A) the distribution of stipends to students of
eligible applicants;
``(B) the establishment of a post-doctoral
fellowship program;
``(C) the training of faculty in the economic and
logistical problems confronting rural health care
delivery systems; or
``(D) the purchase or rental of transportation and
telecommunication equipment where the need for such
equipment due to unique characteristics of the rural
area is demonstrated by the recipient.
``(3) Administration.--
``(A) In general.--An applicant shall not use more
than 10 percent of the funds made available to such
applicant under subsection (a) for administrative
expenses.
``(B) Training.--Not more than 10 percent of the
individuals receiving training with funds made
available to an applicant under subsection (a) shall be
trained as doctors of medicine or doctors of
osteopathy.
``(C) Limitation.--An institution that receives a
grant under this section shall use amounts received
under such grant to supplement, not supplant, amounts
made available by such institution for activities of
the type described in subsection (b)(1) in the fiscal
year preceding the year for which the grant is
received.
``(c) Applications.--Applications submitted for assistance under
this section shall--
``(1) be jointly submitted by at least two eligible
applicants with the express purpose of assisting individuals in
academic institutions in establishing long-term collaborative
relationships with health care providers in rural areas; and
``(2) designate a rural health care agency or agencies for
clinical treatment or training, including hospitals, community
health centers, migrant health centers, rural health clinics,
community behavioral and mental health centers, long-term care
facilities, Native Hawaiian health centers, or facilities
operated by the Indian Health Service or an Indian tribe or
tribal organization or Indian organization under a contract
with the Indian Health Service under the Indian Self-
Determination Act.
``(d) Definitions.--For the purposes of this section, the term
`rural' means geographic areas that are located outside of standard
metropolitan statistical areas.
``SEC. 755. ALLIED HEALTH AND OTHER DISCIPLINES.
``(a) In General.--The Secretary may make grants or contracts under
this section to help entities fund activities of the type described in
subsection (b).
``(b) Activities.--Activities of the type described in this
subsection include the following:
``(1) Assisting entities in meeting the costs associated
with expanding or establishing programs that will increase the
number of individuals trained in allied health professions.
Programs and activities funded under this paragraph may
include--
``(A) those that expand enrollments in allied
health professions with the greatest shortages or whose
services are most needed by the elderly;
``(B) those that provide rapid transition training
programs in allied health fields to individuals who
have baccalaureate degrees in health-related sciences;
``(C) those that establish community-based allied
health training programs that link academic centers to
rural clinical settings;
``(D) those that provide career advancement
training for practicing allied health professionals;
``(E) those that expand or establish clinical
training sites for allied health professionals in
medically underserved or rural communities in order to
increase the number of individuals trained;
``(F) those that develop curriculum that will
emphasize knowledge and practice in the areas of
prevention and health promotion, geriatrics, long-term
care, home health and hospice care, and ethics;
``(G) those that expand or establish
interdisciplinary training programs that promote the
effectiveness of allied health practitioners in
geriatric assessment and the rehabilitation of the
elderly;
``(H) those that expand or establish demonstration
centers to emphasize innovative models to link allied
health clinical practice, education, and research;
``(I) those that provide financial assistance (in
the form of traineeships) to students who are
participants in any such program; and
``(i) who plan to pursue a career in an
allied health field that has a demonstrated
personnel shortage; and
``(ii) who agree upon completion of the
training program to practice in a medically
underserved community;
that shall be utilized to assist in the payment of all
or part of the costs associated with tuition, fees and
such other stipends as the Secretary may consider
necessary; and
``(J) those to meet the costs of projects to plan,
develop, and operate or maintain graduate programs in
behavioral and mental health practice.
``(2) Planning and implementing projects in preventive and
primary care training for podiatric physicians in approved or
provisionally approved residency programs that shall provide
financial assistance in the form of traineeships to residents
who participate in such projects and who plan to specialize in
primary care.
``(3) Carrying out demonstration projects in which
chiropractors and physicians collaborate to identify and
provide effective treatment for spinal and lower-back
conditions.
``SEC. 756. ADVISORY COMMITTEE ON INTERDISCIPLINARY, COMMUNITY-BASED
LINKAGES.
``(a) Establishment.--The Secretary shall establish an advisory
committee to be known as the Advisory Committee on Interdisciplinary,
Community-Based Linkages (in this section referred to as the `Advisory
Committee').
``(b) Composition.--
``(1) In general.--The Secretary shall determine the
appropriate number of individuals to serve on the Advisory
Committee. Such individuals shall not be officers or employees
of the Federal Government.
``(2) Appointment.--Not later than 90 days after the date
of enactment of this Act, the Secretary shall appoint the
members of the Advisory Committee from among individuals who
are health professionals from schools of the types described in
sections 751(a)(1)(A), 751(a)(1)(B), 753(b), 754(3)(A), and
755(b). In making such appointments, the Secretary shall ensure
a fair balance between the health professions, that at least 75
percent of the members of the Advisory Committee are health
professionals, a broad geographic representation of members and
a balance between urban and rural members. Members shall be
appointed based on their competence, interest, and knowledge of
the mission of the profession involved.
``(3) Minority representation.--In appointing the members
of the Advisory Committee under paragraph (2), the Secretary
shall ensure the adequate representation of women and
minorities.
``(c) Terms.--
``(1) In general.--A member of the Advisory Committee shall
be appointed for a term of 3 years, except that of the members
first appointed--
``(A) \1/3\ of the members shall serve for a term
of 1 year;
``(B) \1/3\ of the members shall serve for a term
of 2 years; and
``(C) \1/3\ of the members shall serve for a term
of 3 years.
``(2) Vacancies.--
``(A) In general.--A vacancy on the Advisory
Committee shall be filled in the manner in which the
original appointment was made and shall be subject to
any conditions which applied with respect to the
original appointment.
``(B) Filling unexpired term.--An individual chosen
to fill a vacancy shall be appointed for the unexpired
term of the member replaced.
``(d) Duties.--The Advisory Committee shall--
``(1) provide advice and recommendations to the Secretary
concerning policy and program development and other matters of
significance concerning the activities under this part; and
``(2) not later than 3 years after the date of enactment of
this section, and annually thereafter, prepare and submit to
the Secretary, and the Committee on Labor and Human Resources
of the Senate, and the Committee on Commerce of the House of
Representatives, a report describing the activities of the
Committee, including findings and recommendations made by the
Committee concerning the activities under this part.
``(e) Meetings and Documents.--
``(1) Meetings.--The Advisory Committee shall meet not less
than 3 times each year. Such meetings shall be held jointly
with other related entities established under this title where
appropriate.
``(2) Documents.--Not later than 14 days prior to the
convening of a meeting under paragraph (1), the Advisory
Committee shall prepare and make available an agenda of the
matters to be considered by the Advisory Committee at such
meeting. At any such meeting, the Advisory Council shall
distribute materials with respect to the issues to be addressed
at the meeting. Not later than 30 days after the adjourning of
such a meeting, the Advisory Committee shall prepare and make
available a summary of the meeting and any actions taken by the
Committee based upon the meeting.
``(f) Compensation and Expenses.--
``(1) Compensation.--Each member of the Advisory Committee
shall be compensated at a rate equal to the daily equivalent of
the annual rate of basic pay prescribed for level IV of the
Executive Schedule under section 5315 of title 5, United States
Code, for each day (including travel time) during which such
member is engaged in the performance of the duties of the
Committee.
``(2) Expenses.--The members of the Advisory Committee
shall be allowed travel expenses, including per diem in lieu of
subsistence, at rates authorized for employees of agencies
under subchapter I of chapter 57 of title 5, United States
Code, while away from their homes or regular places of business
in the performance of services for the Committee.
``(g) FACA.--The Federal Advisory Committee Act shall apply to the
Advisory Committee under this section only to the extent that the
provisions of such Act do not conflict with the requirements of this
section.
``SEC. 757. AUTHORIZATION OF APPROPRIATIONS.
``(a) In General.--There are authorized to be appropriated to carry
out this part, $55,600,000 for fiscal year 1998, and such sums as may
be necessary for each of the fiscal years 1999 through 2002.
``(b) Allocation.--
``(1) In general.--Of the amounts appropriated under
subsection (a) for a fiscal year, the Secretary shall make
available--
``(A) not less than $28,587,000 for awards of
grants and contracts under section 751;
``(B) not less than $3,765,000 for awards of grants
and contracts under section 752, of which not less than
50 percent of such amount shall be made available for
centers described in subsection (a)(1) of such section;
and
``(C) not less than $22,631,000 for awards of
grants and contracts under sections 753, 754, and 755.
``(2) Ratable reduction.--If amounts appropriated under
subsection (a) for any fiscal year are less than the amount
required to comply with paragraph (1), the Secretary shall
ratably reduce the amount to be made available under each of
subparagraphs (A) through (C) of such paragraph accordingly.
``(3) Increase in amounts.--If amounts appropriated for a
fiscal year under subsection (a) exceed the amount authorized
under such subsection for such fiscal year, the Secretary may
increase the amount to be made available for programs and
activities under this part without regard to the amounts
specified in each of subparagraphs (A) through (C) of paragraph
(2).
``(c) Obligation of Certain Amounts.--
``(1) Area health education center programs.--Of the
amounts made available under subsection (b)(1)(A) for each
fiscal year, the Secretary may obligate for awards under
section 751(a)(2)--
``(A) not less than 23 percent of such amounts in
fiscal year 1998;
``(B) not less than 30 percent of such amounts in
fiscal year 1999;
``(C) not less than 35 percent of such amounts in
fiscal year 2000;
``(D) not less than 40 percent of such amounts in
fiscal year 2001; and
``(E) not less than 45 percent of such amounts in
fiscal year 2002.
``(2) Sense of congress.--It is the sense of the Congress
that--
``(A) every State have an area health education
center program in effect under this section; and
``(B) the ratio of Federal funding for the model
program under section 751(a)(2) should increase over
time and that Federal funding for other awards under
this section shall decrease so that the national
program will become entirely comprised of programs that
are funded at least 50 percent by State and local
partners.''.
SEC. 104. HEALTH PROFESSIONS WORKFORCE INFORMATION AND ANALYSIS.
(a) In General.--Part E of title VII of the Public Health Service
Act (42 U.S.C. 294n et seq.) is amended to read as follows:
``PART E--HEALTH PROFESSIONS AND PUBLIC HEALTH WORKFORCE
``Subpart 1--Health Professions Workforce Information and Analysis
``SEC. 761. HEALTH PROFESSIONS WORKFORCE INFORMATION AND ANALYSIS.
``(a) Purpose.--It is the purpose of this section to--
``(1) provide for the development of information describing
the health professions workforce and the analysis of workforce
related issues; and
``(2) provide necessary information for decision-making
regarding future directions in health professions and nursing
programs in response to societal and professional needs.
``(b) Grants or Contracts.--The Secretary may award grants or
contracts to State or local governments, health professions schools,
schools of nursing, academic health centers, community-based health
facilities, and other appropriate public or private nonprofit entities
to provide for--
``(1) targeted information collection and analysis
activities related to the purposes described in subsection (a);
``(2) research on high priority workforce questions;
``(3) the development of a non-Federal analytic and
research infrastructure related to the purposes described in
subsection (a); and
``(4) the conduct of program evaluation and assessment.
``(c) Authorization of Appropriations.--
``(1) In general.--There are authorized to be appropriated
to carry out this section, $750,000 for fiscal year 1998, and
such sums as may be necessary for each of the fiscal years 1999
through 2002.
``(2) Reservation.--Of the amounts appropriated under
subsection (a) for a fiscal year, the Secretary shall reserve
not less than $600,000 for conducting health professions
research and for carrying out data collection and analysis in
accordance with section 792.
``(3) Availability of additional funds.--Amounts otherwise
appropriated for programs or activities under this title may be
used for activities under subsection (b) with respect to the
programs or activities from which such amounts were made
available.''.
(b) Council on Graduate Medical Education.--Section 301 of the
Health Professions Education Extension Amendments of 1992 (Public Law
102-408) is amended--
(1) in subsection (j), by striking ``1995'' and inserting
``2002'';
(2) in subsection (k), by striking ``1995'' and inserting
``2002'';
(3) by adding at the end thereof the following new
subsection:
``(l) Funding.--Amounts otherwise appropriated under this title may
be utilized by the Secretary to support the activities of the
Council.'';
(4) by transferring such section to part E of title VII of
the Public Health Service Act (as amended by subsection (a));
(5) by redesignating such section as section 762; and
(6) by inserting such section after section 761.
SEC. 105. PUBLIC HEALTH WORKFORCE DEVELOPMENT.
Part E of title VII of the Public Health Service Act (as amended by
section 104) is further amended by adding at the end the following:
``Subpart 2--Public Health Workforce
``SEC. 765. GENERAL PROVISIONS.
``(a) In General.--The Secretary may award grants or contracts to
eligible entities to increase the number of individuals in the public
health workforce, to enhance the quality of such workforce, and to
enhance the ability of the workforce to meet national, State, and local
health care needs.
``(b) Eligibility.--To be eligible to receive a grant or contract
under subsection (a) an entity shall--
``(1) be--
``(A) a health professions school, including an
accredited school or program of public health, health
administration, preventive medicine, or dental public
health or a school providing health management
programs;
``(B) an academic health center;
``(C) a State or local government; or
``(D) any other appropriate public or private
nonprofit entity; and
``(2) prepare and submit to the Secretary an application at
such time, in such manner, and containing such information as
the Secretary may require.
``(c) Preference.--In awarding grants or contracts under this
section the Secretary may grant a preference to entities--
``(1) serving individuals who are from disadvantaged
backgrounds (including underrepresented racial and ethnic
minorities); and
``(2) graduating large proportions of individuals who serve
in underserved communities.
``(d) Activities.--Amounts provided under a grant or contract
awarded under this section may be used for--
``(1) the costs of planning, developing, or operating
demonstration training programs;
``(2) faculty development;
``(3) trainee support;
``(4) technical assistance;
``(5) to meet the costs of projects--
``(A) to plan and develop new residency training
programs and to maintain or improve existing residency
training programs in preventive medicine and dental
public health, that have available full-time faculty
members with training and experience in the fields of
preventive medicine and dental public health; and
``(B) to provide financial assistance to residency
trainees enrolled in such programs;
``(6) the retraining of existing public health workers as
well as for increasing the supply of new practitioners to
address priority public health, preventive medicine, public
health dentistry, and health administration needs;
``(7) preparing public health professionals for employment
at the State and community levels; or
``(8) other activities that may produce outcomes that are
consistent with the purposes of this section
``(e) Traineeships.--
``(1) In general.--With respect to amounts used under this
section for the training of health professionals, such training
programs shall be designed to--
``(A) make public health education more accessible
to the public and private health workforce;
``(B) increase the relevance of public health
academic preparation to public health practice in the
future;
``(C) provide education or training for students
from traditional on-campus programs in practice-based
sites; or
``(D) develop educational methods and distance-
based approaches or technology that address adult
learning requirements and increase knowledge and skills
related to community-based cultural diversity in public
health education.
``(2) Severe shortage disciplines.--Amounts provided under
grants or contracts under this section may be used for the
operation of programs designed to award traineeships to
students in accredited schools of public health who enter
educational programs in fields where there is a severe shortage
of public health professionals, including epidemiology,
biostatistics, environmental health, toxicology, public health
nursing, nutrition, preventive medicine, maternal and child
health, and behavioral and mental health professions.
``SEC. 766. PUBLIC HEALTH TRAINING CENTERS.
``(a) In General.--The Secretary may make grants or contracts for
the operation of public health training centers.
``(b) Eligible Entities.--
``(1) In general.--A public health training center shall be
an accredited school of public health, or another public or
nonprofit private institution accredited for the provision of
graduate or specialized training in public health, that plans,
develops, operates, and evaluates projects that are in
furtherance of the goals established by the Secretary for the
year 2000 in the areas of preventive medicine, health promotion
and disease prevention, or improving access to and quality of
health services in medically underserved communities.
``(2) Preference.--In awarding grants or contracts under
this section the Secretary shall give preference to accredited
schools of public health.
``(c) Certain Requirements.--With respect to a public health
training center, an award may not be made under subsection (a) unless
the program agrees that it--
``(1) will establish or strengthen field placements for
students in public or nonprofit private health agencies or
organizations;
``(2) will involve faculty members and students in
collaborative projects to enhance public health services to
medically underserved communities;
``(3) will specifically designate a geographic area or
medically underserved population to be served by the center
that shall be in a location removed from the main location of
the teaching facility of the school that is participating in
the program with such center; and
``(4) will assess the health personnel needs of the area to
be served by the center and assist in the planning and
development of training programs to meet such needs.
``SEC. 767. PUBLIC HEALTH TRAINEESHIPS.
``(a) In General.--The Secretary may make grants to accredited
schools of public health, and to other public or nonprofit private
institutions accredited for the provision of graduate or specialized
training in public health, for the purpose of assisting such schools
and institutions in providing traineeships to individuals described in
subsection (b)(3).
``(b) Certain Requirements.--
``(1) Amount.--The amount of any grant under this section
shall be determined by the Secretary.
``(2) Use of grant.--Traineeships awarded under grants made
under subsection (a) shall provide for tuition and fees and
such stipends and allowances (including travel and subsistence
expenses and dependency allowances) for the trainees as the
Secretary may deem necessary.
``(3) Eligible individuals.--The individuals referred to in
subsection (a) are individuals who are pursuing a course of
study in a health professions field in which there is a severe
shortage of health professionals (which fields include the
fields of epidemiology, environmental health, biostatistics,
toxicology, nutrition, and maternal and child health).
``SEC. 768. PREVENTIVE MEDICINE; DENTAL PUBLIC HEALTH.
``(a) In General.--The Secretary may make grants to and enter into
contracts with schools of medicine, osteopathic medicine, public
health, and dentistry to meet the costs of projects--
``(1) to plan and develop new residency training programs
and to maintain or improve existing residency training programs
in preventive medicine and dental public health; and
``(2) to provide financial assistance to residency trainees
enrolled in such programs.
``(b) Administration.--
``(1) Amount.--The amount of any grant under subsection (a)
shall be determined by the Secretary.
``(2) Eligibility.--To be eligible for a grant under
subsection (a), the applicant must demonstrate to the Secretary
that it has or will have available full-time faculty members
with training and experience in the fields of preventive
medicine or dental public health and support from other faculty
members trained in public health and other relevant specialties
and disciplines.
``(3) Other funds.--Schools of medicine, osteopathic
medicine, dentistry, and public health may use funds committed
by State, local, or county public health officers as matching
amounts for Federal grant funds for residency training programs
in preventive medicine.
``SEC. 769. HEALTH ADMINISTRATION TRAINEESHIPS AND SPECIAL PROJECTS.
``(a) In General.--The Secretary may make grants to State or local
governments (that have in effect preventive medical and dental public
health residency programs) or public or nonprofit private educational
entities (including graduate schools of social work and business
schools that have health management programs) that offer a program
described in subsection (b)--
``(1) to provide traineeships for students enrolled in such
a program; and
``(2) to assist accredited programs health administration
in the development or improvement of programs to prepare
students for employment with public or nonprofit private
entities.
``(b) Relevant Programs.--The program referred to in subsection (a)
is an accredited program in health administration, hospital
administration, or health policy analysis and planning, which program
is accredited by a body or bodies approved for such purpose by the
Secretary of Education and which meets such other quality standards as
the Secretary of Health and Human Services by regulation may prescribe.
``(c) Preference in Making Grants.--In making grants under
subsection (a), the Secretary shall give preference to qualified
applicants that meet the following conditions:
``(1) Not less than 25 percent of the graduates of the
applicant are engaged in full-time practice settings in
medically underserved communities.
``(2) The applicant recruits and admits students from
medically underserved communities.
``(3) For the purpose of training students, the applicant
has established relationships with public and nonprofit
providers of health care in the community involved.
``(4) In training students, the applicant emphasizes
employment with public or nonprofit private entities.
``(d) Certain Provisions Regarding Traineeships.--
``(1) Use of grant.--Traineeships awarded under grants made
under subsection (a) shall provide for tuition and fees and
such stipends and allowances (including travel and subsistence
expenses and dependency allowances) for the trainees as the
Secretary may deem necessary.
``(2) Preference for certain students.--Each entity
applying for a grant under subsection (a) for traineeships
shall assure to the satisfaction of the Secretary that the
entity will give priority to awarding the traineeships to
students who demonstrate a commitment to employment with public
or nonprofit private entities in the fields with respect to
which the traineeships are awarded.
``SEC. 770. AUTHORIZATION OF APPROPRIATIONS.
``(a) In General.--For the purpose of carrying out this subpart,
there is authorized to be appropriated $9,100,000 for fiscal year 1998,
and such sums as may be necessary for each of the fiscal years 1999
through 2002.
``(b) Limitation Regarding Certain Program.--In obligating amounts
appropriated under subsection (a), the Secretary may not obligate more
than 30 percent for carrying out section 767.''.
SEC. 106. GENERAL PROVISIONS.
(a) In General.--
(1) Part F of title VII of the Public Health Service Act
(42 U.S.C. 295 et seq.) is repealed.
(2) Part G of title VII of the Public Health Service Act
(42 U.S.C. 295j et seq.) is amended--
(A) by redesignating such part as part F;
(B) in section 791 (42 U.S.C. 295j)--
(i) by striking subsection (b); and
(ii) redesignating subsection (c) as
subsection (b);
(C) by repealing section 793 (42 U.S.C. 295l);
(D) by repealing section 798;
(E) by redesignating section 799 as section 799B;
and
(F) by inserting after section 794, the following
new sections:
``SEC. 796. APPLICATION.
``(a) In General.--To be eligible to receive a grant or contract
under this title, an eligible entity shall prepare and submit to the
Secretary an application that meets the requirements of this section,
at such time, in such manner, and containing such information as the
Secretary may require.
``(b) Plan.--An application submitted under this section shall
contain the plan of the applicant for carrying out a project with
amounts received under this title. Such plan shall be consistent with
relevant Federal, State, or regional health professions program plans.
``(c) Performance Outcome Standards.--An application submitted
under this section shall contain a specification by the applicant
entity of performance outcome standards that the project to be funded
under the grant or contract will be measured against. Such standards
shall address relevant health workforce needs that the project will
meet. The recipient of a grant or contract under this section shall
meet the standards set forth in the grant or contract application.
``(d) Linkages.--An application submitted under this section shall
contain a description of the linkages with relevant educational and
health care entities, including training programs for other health
professionals as appropriate, that the project to be funded under the
grant or contract will establish. To the extent practicable, grantees
under this section shall establish linkages with health care providers
who provide care for underserved communities and populations.
``SEC. 797. USE OF FUNDS.
``(a) In General.--Amounts provided under a grant or contract
awarded under this title may be used for training program development
and support, faculty development, model demonstrations, trainee support
including tuition, books, program fees and reasonable living expenses
during the period of training, technical assistance, workforce
analysis, dissemination of information, and exploring new policy
directions, as appropriate to meet recognized health workforce
objectives, in accordance with this title.
``(b) Maintenance of Effort.--With respect to activities for which
a grant awarded under this title is to be expended, the entity shall
agree to maintain expenditures of non-Federal amounts for such
activities at a level that is not less than the level of such
expenditures maintained by the entity for the fiscal year preceding the
fiscal year for which the entity receives such a grant.
``SEC. 798. MATCHING REQUIREMENT.
``The Secretary may require that an entity that applies for a grant
or contract under this title provide non-Federal matching funds, as
appropriate, to ensure the institutional commitment of the entity to
the projects funded under the grant. As determined by the Secretary,
such non-Federal matching funds may be provided directly or through
donations from public or private entities and may be in cash or in-
kind, fairly evaluated, including plant, equipment, or services.
``SEC. 799. GENERALLY APPLICABLE PROVISIONS.
``(a) Awarding of Grants and Contracts.--The Secretary shall ensure
that grants and contracts under this title are awarded on a competitive
basis, as appropriate, to carry out innovative demonstration projects
or provide for strategic workforce supplementation activities as needed
to meet health workforce goals and in accordance with this title.
Contracts may be entered into under this title with public or private
entities as may be necessary.
``(b) Eligible Entities.--Unless specifically required otherwise in
this title, the Secretary shall accept applications for grants or
contracts under this title from health professions schools, academic
health centers, State or local governments, or other appropriate public
or private nonprofit entities for funding and participation in health
professions and nursing training activities. The Secretary may accept
applications from for-profit private entities if determined appropriate
by the Secretary.
``(c) Information Requirements.--
``(1) In general.--Recipients of grants and contracts under
this title shall meet information requirements as specified by
the Secretary.
``(2) Data collection.--The Secretary shall establish
procedures to ensure that, with respect to any data collection
required under this title, such data is collected in a manner
that takes into account age, sex, race, and ethnicity.
``(3) Use of funds.--The Secretary shall establish
procedures to permit the use of amounts appropriated under this
title to be used for data collection purposes.
``(4) Evaluations.--The Secretary shall establish
procedures to ensure the annual evaluation of programs and
projects operated by recipients of grants or contracts under
this title. Such procedures shall ensure that continued funding
for such programs and projects will be conditioned upon a
demonstration that satisfactory progress has been made by the
program or project in meeting the objectives of the program or
project.
``(d) Training Programs.--Training programs conducted with amounts
received under this title shall meet applicable accreditation and
quality standards.
``(e) Duration of Assistance.--
``(1) In general.--Subject to paragraph (2), in the case of
an award to an entity of a grant, cooperative agreement, or
contract under this title, the period during which payments are
made to the entity under the award may not exceed 5 years. The
provision of payments under the award shall be subject to
annual approval by the Secretary of the payments and subject to
the availability of appropriations for the fiscal year involved
to make the payments. This paragraph may not be construed as
limiting the number of awards under the program involved that
may be made to the entity.
``(2) Limitation.--In the case of an award to an entity of
a grant, cooperative agreement, or contract under this title,
paragraph (1) shall apply only to the extent not inconsistent
with any other provision of this title that relates to the
period during which payments may be made under the award.
``(f) Peer Review Regarding Certain Programs.--
``(1) In general.--Each application for a grant under this
title, except any scholarship or loan program, including those
under sections 701, 721, or 723, shall be submitted to a peer
review group for an evaluation of the merits of the proposals
made in the application. The Secretary may not approve such an
application unless a peer review group has recommended the
application for approval.
``(2) Composition.--Each peer review group under this
subsection shall be composed principally of individuals who are
not officers or employees of the Federal Government. In
providing for the establishment of peer review groups and
procedures, the Secretary shall ensure sex, racial, ethnic, and
geographic balance among the membership of such groups.
``(3) Administration.--This subsection shall be carried out
by the Secretary acting through the Administrator of the Health
Resources and Services Administration.
``(g) Preference or Priority Considerations.--In considering a
preference or priority for funding which is based on outcome measures
for an eligible entity under this title, the Secretary may also
consider the future ability of the eligible entity to meet the outcome
preference or priority through improvements in the eligible entity's
program design.
``(h) Analytic Activities.--The Secretary shall ensure that--
``(1) cross-cutting workforce analytical activities are
carried out as part of the workforce information and analysis
activities under section 761; and
``(2) discipline-specific workforce information and
analytical activities are carried out as part of--
``(A) the community-based linkage program under
part D; and
``(B) the health workforce development program
under subpart 2 of part E.
``(i) Osteopathic Schools.--For purposes of this title, any
reference to--
``(1) medical schools shall include osteopathic medical
schools; and
``(2) medical students shall include osteopathic medical
students.
``SEC. 799A. TECHNICAL ASSISTANCE.
``Funds appropriated under this title may be used by the Secretary
to provide technical assistance in relation to any of the authorities
under this title.''.
(b) Professional Counselors as Mental Health Professionals.--
Section 792(a) of the Public Health Service Act (42 U.S.C. 295k(a)) is
amended by inserting ``professional counselors,'' after ``clinical
psychologists,''.
SEC. 107. PREFERENCE IN CERTAIN PROGRAMS.
(a) In General.--Section 791 of the Public Health Service Act (42
U.S.C. 295j), as amended by section 105(a)(2)(B), is further amended by
adding at the end thereof the following subsection:
``(c) Exceptions for New Programs.--
``(1) In general.--To permit new programs to compete
equitably for funding under this section, those new programs
that meet at least 4 of the criteria described in paragraph (3)
shall qualify for a funding preference under this section.
``(2) Definition.--As used in this subsection, the term
`new program' means any program that has graduated less than
three classes. Upon graduating at least three classes, a
program shall have the capability to provide the information
necessary to qualify the program for the general funding
preferences described in subsection (a).
``(3) Criteria.--The criteria referred to in paragraph (1)
are the following:
``(A) The mission statement of the program
identifies a specific purpose of the program as being
the preparation of health professionals to serve
underserved populations.
``(B) The curriculum of the program includes
content which will help to prepare practitioners to
serve underserved populations.
``(C) Substantial clinical training experience is
required under the program in medically underserved
communities.
``(D) A minimum of 20 percent of the clinical
faculty of the program spend at least 50 percent of
their time providing or supervising care in medically
underserved communities.
``(E) The entire program or a substantial portion
of the program is physically located in a medically
underserved community.
``(F) Student assistance, which is linked to
service in medically underserved communities following
graduation, is available to the students in the
program.
``(G) The program provides a placement mechanism
for deploying graduates to medically underserved
communities.''.
(b) Conforming Amendments.--Section 791(a) of the Public Health
Service Act (42 U.S.C. 295j(a)) is amended--
(1) in paragraph (1), by striking ``sections 747'' and all
that follows through ``767'' and inserting ``sections 747 and
750''; and
(2) in paragraph (2), by striking ``under section 798(a)''.
SEC. 108. DEFINITIONS.
(a) Graduate Program in Behavioral and Mental Health Practice.--
Section 799B(1)(D) of the Public Health Service Act (42 U.S.C.
295p(1)(D)) (as so redesignated by section 106(a)(2)(E)) is amended--
(1) by inserting ``behavioral health and'' before
``mental''; and
(2) by inserting ``behavioral health and mental health
practice,'' before ``clinical''.
(b) Professional Counseling as a Behavioral and Mental Health
Practice.--Section 799B of the Public Health Service Act (42 U.S.C.
295p) (as so redesignated by section 106(a)(2)(E)) is amended--
(1) in paragraph (1)--
(A) in subparagraph (C)--
(i) by inserting ``and `graduate program in
professional counseling''' after ``graduate
program in marriage and family therapy'''; and
(ii) by inserting before the period the
following: ``and a concentration leading to a
graduate degree in counseling'';
(B) in subparagraph (D), by inserting
``professional counseling,'' after ``social work,'';
and
(C) in subparagraph (E), by inserting
``professional counseling,'' after ``social work,'';
and
(2) in paragraph (5)(C), by inserting before the period the
following: ``or a degree in counseling or an equivalent
degree''.
(c) Medically Underserved Community.--Section 799B(6) of the Public
Health Service Act (42 U.S.C. 295p(6)) (as so redesignated by section
105(a)(2)(E)) is amended--
(1) in subparagraph (B), by striking ``or'' at the end
thereof;
(2) in subparagraph (C), by striking the period and
inserting ``; or''; and
(3) by adding at the end the following:
``(D) is designated by a State Governor (in
consultation with the medical community) as a shortage
area or medically underserved community.''.
(d) Programs for the Training of Physician Assistants.--Paragraph
(3) of section 799B of the Public Health Service Act (42 U.S.C. 295p)
(as so redesignated by section 105(a)(2)(E)) is amended to read as
follows:
``(3) The term `program for the training of physician
assistants' means an educational program that--
``(A) has as its objective the education of
individuals who will, upon completion of their studies
in the program, be qualified to provide primary care
under the supervision of a physician;
``(B) extends for at least one academic year and
consists of--
``(i) supervised clinical practice; and
``(ii) at least four months (in the
aggregate) of classroom instruction, directed
toward preparing students to deliver health
care;
``(C) has an enrollment of not less than eight
students; and
``(D) trains students in primary care, disease
prevention, health promotion, geriatric medicine, and
home health care.''.
(e) Psychologist.--Section 799B of the Public Health Service Act
(42 U.S.C. 295p) (as so redesignated by section 105(a)(2)(E)) is
amended by adding at the end the following:
``(11) The term `psychologist' means an individual who--
``(A) holds a doctoral degree in psychology; and
``(B) is licensed or certified on the basis of the
doctoral degree in psychology, by the State in which
the individual practices, at the independent practice
level of psychology to furnish diagnostic, assessment,
preventive, and therapeutic services directly to
individuals.''.
SEC. 109. TECHNICAL AMENDMENT ON NATIONAL HEALTH SERVICE CORPS.
Section 338B(b)(1)(B) of the Public Health Service Act (42 U.S.C.
254l-1(b)(1)(B)) is amended by striking ``or other health profession''
and inserting ``behavioral and mental health, or other health
profession''.
SEC. 110. SAVINGS PROVISION.
In the case of any authority for making awards of grants or
contracts that is terminated by the amendments made by this subtitle,
the Secretary of Health and Human Services may, notwithstanding the
termination of the authority, continue in effect any grant or contract
made under the authority that is in effect on the day before the date
of the enactment of this Act, subject to the duration of any such grant
or contract not exceeding the period determined by the Secretary in
first approving such financial assistance, or in approving the most
recent request made (before the date of such enactment) for
continuation of such assistance, as the case may be.
Subtitle B--Nursing Workforce Development
SEC. 121. SHORT TITLE.
This subtitle may be cited as the ``Nursing Education and Practice
Improvement Act of 1998''.
SEC. 122. PURPOSE.
It is the purpose of this subtitle to restructure the nurse
education authorities of title VIII of the Public Health Service Act to
permit a comprehensive, flexible, and effective approach to Federal
support for nursing workforce development.
SEC. 123. AMENDMENTS TO PUBLIC HEALTH SERVICE ACT.
Title VIII of the Public Health Service Act (42 U.S.C. 296k et
seq.) is amended--
(1) by striking the title heading and all that follows
except for subpart II of part B and sections 846 and 855; and
inserting the following:
``TITLE VIII--NURSING WORKFORCE DEVELOPMENT'';
(2) in subpart II of part B, by striking the subpart
heading and inserting the following:
``PART E--STUDENT LOANS'';
(3) by striking section 837;
(4) by inserting after the title heading the following new
parts:
``PART A--GENERAL PROVISIONS
``SEC. 801. DEFINITIONS.
``As used in this title:
``(1) Eligible entities.--The term `eligible entities'
means schools of nursing, nursing centers, academic health
centers, State or local governments, and other public or
private nonprofit entities determined appropriate by the
Secretary that submit to the Secretary an application in
accordance with section 802.
``(2) School of nursing.--The term `school of nursing'
means a collegiate, associate degree, or diploma school of
nursing in a State.
``(3) Collegiate school of nursing.--The term `collegiate
school of nursing' means a department, division, or other
administrative unit in a college or university which provides
primarily or exclusively a program of education in professional
nursing and related subjects leading to the degree of bachelor
of arts, bachelor of science, bachelor of nursing, or to an
equivalent degree, or to a graduate degree in nursing, or to an
equivalent degree, and including advanced training related to
such program of education provided by such school, but only if
such program, or such unit, college or university is
accredited.
``(4) Associate degree school of nursing.--The term
`associate degree school of nursing' means a department,
division, or other administrative unit in a junior college,
community college, college, or university which provides
primarily or exclusively a two-year program of education in
professional nursing and allied subjects leading to an
associate degree in nursing or to an equivalent degree, but
only if such program, or such unit, college, or university is
accredited.
``(5) Diploma school of nursing.--The term `diploma school
of nursing' means a school affiliated with a hospital or
university, or an independent school, which provides primarily
or exclusively a program of education in professional nursing
and allied subjects leading to a diploma or to equivalent
indicia that such program has been satisfactorily completed,
but only if such program, or such affiliated school or such
hospital or university or such independent school is
accredited.
``(6) Accredited.--
``(A) In general.--Except as provided in
subparagraph (B), the term `accredited' when applied to
any program of nurse education means a program
accredited by a recognized body or bodies, or by a
State agency, approved for such purpose by the
Secretary of Education and when applied to a hospital,
school, college, or university (or a unit thereof)
means a hospital, school, college, or university (or a
unit thereof) which is accredited by a recognized body
or bodies, or by a State agency, approved for such
purpose by the Secretary of Education. For the purpose
of this paragraph, the Secretary of Education shall
publish a list of recognized accrediting bodies, and of
State agencies, which the Secretary of Education
determines to be reliable authority as to the quality
of education offered.
``(B) New programs.--A new program of nursing that,
by reason of an insufficient period of operation, is
not, at the time of the submission of an application
for a grant or contract under this title, eligible for
accreditation by such a recognized body or bodies or
State agency, shall be deemed accredited for purposes
of this title if the Secretary of Education finds,
after consultation with the appropriate accreditation
body or bodies, that there is reasonable assurance that
the program will meet the accreditation standards of
such body or bodies prior to the beginning of the
academic year following the normal graduation date of
students of the first entering class in such a program.
``(7) Nonprofit.--The term `nonprofit' as applied to any
school, agency, organization, or institution means one which is
a corporation or association, or is owned and operated by one
or more corporations or associations, no part of the net
earnings of which inures, or may lawfully inure, to the benefit
of any private shareholder or individual.
``(8) State.--The term `State' means a State, the
Commonwealth of Puerto Rico, the District of Columbia, the
Commonwealth of the Northern Mariana Islands, Guam, American
Samoa, the Virgin Islands, or the Trust Territory of the
Pacific Islands.
``SEC. 802. APPLICATION.
``(a) In General.--To be eligible to receive a grant or contract
under this title, an eligible entity shall prepare and submit to the
Secretary an application that meets the requirements of this section,
at such time, in such manner, and containing such information as the
Secretary may require.
``(b) Plan.--An application submitted under this section shall
contain the plan of the applicant for carrying out a project with
amounts received under this title. Such plan shall be consistent with
relevant Federal, State, or regional program plans.
``(c) Performance Outcome Standards.--An application submitted
under this section shall contain a specification by the applicant
entity of performance outcome standards that the project to be funded
under the grant or contract will be measured against. Such standards
shall address relevant national nursing needs that the project will
meet. The recipient of a grant or contract under this section shall
meet the standards set forth in the grant or contract application.
``(d) Linkages.--An application submitted under this section shall
contain a description of the linkages with relevant educational and
health care entities, including training programs for other health
professionals as appropriate, that the project to be funded under the
grant or contract will establish.
``SEC. 803. USE OF FUNDS.
``(a) In General.--Amounts provided under a grant or contract
awarded under this title may be used for training program development
and support, faculty development, model demonstrations, trainee support
including tuition, books, program fees and reasonable living expenses
during the period of training, technical assistance, workforce
analysis, and dissemination of information, as appropriate to meet
recognized nursing objectives, in accordance with this title.
``(b) Maintenance of Effort.--With respect to activities for which
a grant awarded under this title is to be expended, the entity shall
agree to maintain expenditures of non-Federal amounts for such
activities at a level that is not less than the level of such
expenditures maintained by the entity for the fiscal year preceding the
fiscal year for which the entity receives such a grant.
``SEC. 804. MATCHING REQUIREMENT.
``The Secretary may require that an entity that applies for a grant
or contract under this title provide non-Federal matching funds, as
appropriate, to ensure the institutional commitment of the entity to
the projects funded under the grant. Such non-Federal matching funds
may be provided directly or through donations from public or private
entities and may be in cash or in-kind, fairly evaluated, including
plant, equipment, or services.
``SEC. 805. PREFERENCE.
``In awarding grants or contracts under this title, the Secretary
shall give preference to applicants with projects that will
substantially benefit rural or underserved populations, or help meet
public health nursing needs in State or local health departments.
``SEC. 806. GENERALLY APPLICABLE PROVISIONS.
``(a) Awarding of Grants and Contracts.--The Secretary shall ensure
that grants and contracts under this title are awarded on a competitive
basis, as appropriate, to carry out innovative demonstration projects
or provide for strategic workforce supplementation activities as needed
to meet national nursing service goals and in accordance with this
title. Contracts may be entered into under this title with public or
private entities as determined necessary by the Secretary.
``(b) Information Requirements.--
``(1) In general.--Recipients of grants and contracts under
this title shall meet information requirements as specified by
the Secretary.
``(2) Evaluations.--The Secretary shall establish
procedures to ensure the annual evaluation of programs and
projects operated by recipients of grants under this title.
Such procedures shall ensure that continued funding for such
programs and projects will be conditioned upon a demonstration
that satisfactory progress has been made by the program or
project in meeting the objectives of the program or project.
``(c) Training Programs.--Training programs conducted with amounts
received under this title shall meet applicable accreditation and
quality standards.
``(d) Duration of Assistance.--
``(1) In general.--Subject to paragraph (2), in the case of
an award to an entity of a grant, cooperative agreement, or
contract under this title, the period during which payments are
made to the entity under the award may not exceed 5 years. The
provision of payments under the award shall be subject to
annual approval by the Secretary of the payments and subject to
the availability of appropriations for the fiscal year involved
to make the payments. This paragraph may not be construed as
limiting the number of awards under the program involved that
may be made to the entity.
``(2) Limitation.--In the case of an award to an entity of
a grant, cooperative agreement, or contract under this title,
paragraph (1) shall apply only to the extent not inconsistent
with any other provision of this title that relates to the
period during which payments may be made under the award.
``(e) Peer Review Regarding Certain Programs.--
``(1) In general.--Each application for a grant under this
title, except advanced nurse traineeship grants under section
811(a)(2), shall be submitted to a peer review group for an
evaluation of the merits of the proposals made in the
application. The Secretary may not approve such an application
unless a peer review group has recommended the application for
approval.
``(2) Composition.--Each peer review group under this
subsection shall be composed principally of individuals who are
not officers or employees of the Federal Government. In
providing for the establishment of peer review groups and
procedures, the Secretary shall, except as otherwise provided,
ensure sex, racial, ethnic, and geographic representation among
the membership of such groups.
``(3) Administration.--This subsection shall be carried out
by the Secretary acting through the Administrator of the Health
Resources and Services Administration.
``(f) Analytic Activities.--The Secretary shall ensure that--
``(1) cross-cutting workforce analytical activities are
carried out as part of the workforce information and analysis
activities under this title; and
``(2) discipline-specific workforce information is
developed and analytical activities are carried out as part
of--
``(A) the advanced education nursing activities
under part B;
``(B) the workforce diversity activities under part
C; and
``(C) basic nursing education and practice
activities under part D.
``(g) State and Regional Priorities.--Activities under grants or
contracts under this title shall, to the extent practicable, be
consistent with related Federal, State, or regional nursing professions
program plans and priorities.
``(h) Filing of Applications.--
``(1) In general.--Applications for grants or contracts
under this title may be submitted by health professions
schools, schools of nursing, academic health centers, State or
local governments, or other appropriate public or private
nonprofit entities as determined appropriate by the Secretary
in accordance with this title.
``(2) For profit entities.--Notwithstanding paragraph (1),
a for-profit entity may be eligible for a grant or contract
under this title as determined appropriate by the Secretary.
``SEC. 807. TECHNICAL ASSISTANCE.
``Funds appropriated under this title may be used by the Secretary
to provide technical assistance in relation to any of the authorities
under this title.
``PART B--NURSE PRACTITIONERS, NURSE MIDWIVES, NURSE ANESTHETISTS, AND
OTHER ADVANCED EDUCATION NURSES
``SEC. 811. ADVANCED EDUCATION NURSING GRANTS.
``(a) In General.--The Secretary may award grants to and enter into
contracts with eligible entities to meet the costs of--
``(1) projects that support the enhancement of advanced
nursing education and practice; and
``(2) traineeships for individuals in advanced nursing
education programs.
``(b) Definition of Advanced Education Nurses.--For purposes of
this section, the term `advanced education nurses' means individuals
trained in advanced degree programs including individuals in combined
R.N./Master's degree programs, post-nursing master's certificate
programs, or, in the case of nurse midwives, in certificate programs in
existence on the date that is one day prior to the date of enactment of
this section, to serve as nurse practitioners, clinical nurse
specialists, nurse midwives, nurse anesthetists, nurse educators, nurse
administrators, or public health nurses, or in other nurse specialties
determined by the Secretary to require advanced education.
``(c) Authorized Nurse Practitioner and Nurse-Midwifery Programs.--
Nurse practitioner and nurse midwifery programs eligible for support
under this section are educational programs for registered nurses
(irrespective of the type of school of nursing in which the nurses
received their training) that--
``(1) meet guidelines prescribed by the Secretary; and
``(2) have as their objective the education of nurses who
will upon completion of their studies in such programs, be
qualified to effectively provide primary health care, including
primary health care in homes and in ambulatory care facilities,
long-term care facilities, acute care, and other health care
settings.
``(d) Authorized Nurse Anesthesia Programs.--Nurse anesthesia
programs eligible for support under this section are education programs
that--
``(1) provide registered nurses with full-time anesthetist
education; and
``(2) are accredited by the Council on Accreditation of
Nurse Anesthesia Educational Programs.
``(e) Other Authorized Educational Programs.--The Secretary shall
prescribe guidelines as appropriate for other advanced nurse education
programs eligible for support under this section.
``(f) Traineeships.--
``(1) In general.--The Secretary may not award a grant to
an applicant under subsection (a) unless the applicant involved
agrees that traineeships provided with the grant will only pay
all or part of the costs of--
``(A) the tuition, books, and fees of the program
of advanced nurse education with respect to which the
traineeship is provided; and
``(B) the reasonable living expenses of the
individual during the period for which the traineeship
is provided.
``(2) Doctoral programs.--The Secretary may not obligate
more than 10 percent of the traineeships under subsection (a)
for individuals in doctorate degree programs.
``(3) Special consideration.--In making awards of grants
and contracts under subsection (a)(2), the Secretary shall give
special consideration to an eligible entity that agrees to
expend the award to train advanced education nurses who will
practice in health professional shortage areas designated under
section 332.
``PART C--INCREASING NURSING WORKFORCE DIVERSITY
``SEC. 821. WORKFORCE DIVERSITY GRANTS.
``(a) In General.--The Secretary may award grants to and enter into
contracts with eligible entities to meet the costs of special projects
to increase nursing education opportunities for individuals who are
from disadvantaged backgrounds (including racial and ethnic minorities
underrepresented among registered nurses) by providing student
scholarships or stipends, pre-entry preparation, and retention
activities.
``(b) Guidance.--In carrying out subsection (a), the Secretary
shall take into consideration the recommendations of the First, Second
and Third Invitational Congresses for Minority Nurse Leaders on `Caring
for the Emerging Majority,' in 1992, 1993 and 1997, and consult with
nursing associations including the American Nurses Association, the
National League for Nursing, the American Association of Colleges of
Nursing, the National Black Nurses Association, the National
Association of Hispanic Nurses, the Association of Asian American and
Pacific Islander Nurses, the Native American Indian and Alaskan Nurses
Association, and the National Council of State Boards of Nursing.
``(c) Required Information and Conditions for Award Recipients.--
``(1) In general.--Recipients of awards under this section
may be required, where requested, to report to the Secretary
concerning the annual admission, retention, and graduation
rates for individuals from disadvantaged backgrounds and ethnic
and racial minorities in the school or schools involved in the
projects.
``(2) Falling rates.--If any of the rates reported under
paragraph (1) fall below the average of the two previous years,
the grant or contract recipient shall provide the Secretary
with plans for immediately improving such rates.
``(3) Ineligibility.--A recipient described in paragraph
(2) shall be ineligible for continued funding under this
section if the plan of the recipient fails to improve the rates
within the 1-year period beginning on the date such plan is
implemented.
``PART D--STRENGTHENING CAPACITY FOR BASIC NURSE EDUCATION AND PRACTICE
``SEC. 831. BASIC NURSE EDUCATION AND PRACTICE GRANTS.
``(a) In General.--The Secretary may award grants to and enter into
contracts with eligible entities for projects to strengthen capacity
for basic nurse education and practice.
``(b) Priority Areas.--In awarding grants or contracts under this
section the Secretary shall give priority to entities that will use
amounts provided under such a grant or contract to enhance the
educational mix and utilization of the basic nursing workforce by
strengthening programs that provide basic nurse education, such as
through--
``(1) establishing or expanding nursing practice
arrangements in noninstitutional settings to demonstrate
methods to improve access to primary health care in medically
underserved communities;
``(2) providing care for underserved populations and other
high-risk groups such as the elderly, individuals with HIV-
AIDS, substance abusers, the homeless, and victims of domestic
violence;
``(3) providing managed care, quality improvement, and
other skills needed to practice in existing and emerging
organized health care systems;
``(4) developing cultural competencies among nurses;
``(5) expanding the enrollment in baccalaureate nursing
programs;
``(6) promoting career mobility for nursing personnel in a
variety of training settings and cross training or specialty
training among diverse population groups;
``(7) providing education in informatics, including
distance learning methodologies; or
``(8) other priority areas as determined by the
Secretary.'';
(5) by adding at the end the following:
``PART F--FUNDING
``SEC. 841. FUNDING.
``(a) Authorization of Appropriations.--For the purpose of carrying
out parts B, C, and D (subject to section 845(g)), there are authorized
to be appropriated $65,000,000 for fiscal year 1998, and such sums as
may be necessary for each of the fiscal years 1999 through 2002.
``(b) Allocations for Fiscal Years 1998 Through 2002.--
``(1) Nurse practitioners; nurse midwives.--
``(A) Fiscal year 1998.--Of the amount appropriated
under subsection (a) for fiscal year 1998, the
Secretary shall reserve not less than $17,564,000 for
making awards of grants and contracts under section 822
as such section was in effect for fiscal year 1998.
``(B) Fiscal years 1999 through 2002.--Of the
amount appropriated under subsection (a) for fiscal
year 1999 or any of the fiscal years 2000 through 2002,
the Secretary, subject to subsection (d), shall reserve
for the fiscal year involved, for making awards of
grants and contracts under part B with respect to nurse
practitioners and nurse midwives, not less than the
percentage constituted by the ratio of the amount
appropriated under section 822 as such section was in
effect for fiscal year 1998 to the total of the amounts
appropriated under this title for such fiscal year. For
purposes of the preceding sentence, the Secretary, in
determining the amount that has been reserved for the
fiscal year involved, shall include any amounts
appropriated under subsection (a) for the fiscal year
that are obligated by the Secretary to continue in
effect grants or contracts under section 822 as such
section was in effect for fiscal year 1998.
``(2) Nurse anesthetists.--
``(A) Fiscal year 1998.--Of the amount appropriated
under subsection (a) for fiscal year 1998, the
Secretary shall reserve not less than $2,761,000 for
making awards of grants and contracts under section 831
as such section was in effect for fiscal year 1998.
``(B) Fiscal years 1999 through 2002.--Of the
amount appropriated under subsection (a) for fiscal
year 1999 or any of the fiscal years 2000 through 2002,
the Secretary, subject to subsection (d), shall reserve
for the fiscal year involved, for making awards of
grants and contracts under part B with respect to nurse
anesthetists, not less than the percentage constituted
by the ratio of the amount appropriated under section
831 as such section was in effect for fiscal year 1998
to the total of the amounts appropriated under this
title for such fiscal year. For purposes of the
preceding sentence, the Secretary, in determining the
amount that has been reserved for the fiscal year
involved, shall include any amounts appropriated under
subsection (a) for the fiscal year that are obligated
by the Secretary to continue in effect grants or
contracts under section 831 as such section was in
effect for fiscal year 1998.
``(c) Allocations After Fiscal Year 2002.--
``(1) In general.--For fiscal year 2003 and subsequent
fiscal years, amounts appropriated under subsection (a) for the
fiscal year involved shall be allocated by the Secretary among
parts B, C, and D (and programs within such parts) according to
a methodology that is developed in accordance with paragraph
(2). The Secretary shall enter into a contract with a public or
private entity for the purpose of developing the methodology.
The contract shall require that the development of the
methodology be completed not later than February 1, 2002.
``(2) Use of certain factors.--The contract under paragraph
(1) shall provide that the methodology under such paragraph
will be developed in accordance with the following:
``(A) The methodology will take into account the
need for and the distribution of health services among
medically underserved populations, as determined
according to the factors that apply under section
330(b)(3).
``(B) The methodology will take into account the
need for and the distribution of health services in
health professional shortage areas, as determined
according to the factors that apply under section
332(b).
``(C) The methodology will take into account the
need for and the distribution of mental health services
among medically underserved populations and in health
professional shortage areas.
``(D) The methodology will be developed in
consultation with individuals in the field of nursing,
including registered nurses, nurse practitioners, nurse
midwives, nurse anesthetists, clinical nurse
specialists, nursing educators and educational
institutions, nurse executives, pediatric nurse
associates and practitioners, and women's health,
obstetric, and neonatal nurses.
``(E) The methodology will take into account the
following factors with respect to the States:
``(i) A provider population ratio
equivalent to a managed care formula of 1/1,500
for primary care services.
``(ii) The use of whole rather than
fractional counts in determining the number of
health care providers.
``(iii) The counting of only employed
health care providers in determining the number
of health care providers.
``(iv) The number of families whose income
is less than 200 percent of the official
poverty line (as established by the Director of
the Office of Management and Budget and revised
by the Secretary in accordance with section
673(2) of the Omnibus Budget Reconciliation Act
of 1981).
``(v) The rate of infant mortality and the
rate of low-birthweight births.
``(vi) The percentage of the general
population constituted by individuals who are
members or racial or ethnic minority groups,
stated both by minority group and in the
aggregate.
``(vii) The percentage of the general
population constituted by individuals who are
of Hispanic ethnicity.
``(viii) The number of individuals residing
in health professional shortage areas, and the
number of individuals who are members of
medically underserved populations.
``(ix) The percentage of the general
population constituted by elderly individuals.
``(x) The extent to which the populations
served have a choice of providers.
``(xi) The impact of care on
hospitalizations and emergency room use.
``(xii) The number of individuals who lack
proficiency in speaking the English language.
``(xiii) Such additional factors as the
Secretary determines to be appropriate.
``(3) Report to congress.--Not later than 30 days after the
completion of the development of the methodology required in
paragraph (1), the Secretary shall submit to the Committee on
Commerce of the House of Representatives, and to the Committee
on Labor and Human Resources of the Senate, a report describing
the methodology and explaining the effects of the methodology
on the allocation among parts B, C, and D (and programs within
such parts) of amounts appropriated under subsection (a) for
the first fiscal year for which the methodology will be in
effect. Such explanation shall include a comparison of the
allocation for such fiscal year with the allocation made under
this section for the preceding fiscal year.
``(d) Use of Methodology Before Fiscal Year 2003.--With respect to
the fiscal years 1999 through 2002, if the report required in
subsection (c)(3) is submitted in accordance with such subsection not
later than 90 days before the beginning of such a fiscal year, the
Secretary may for such year implement the methodology described in the
report (rather than implementing the methodology in fiscal year 2003),
in which case subsection (b) ceases to be in effect. The authority
under the preceding sentence is subject to the condition that the
fiscal year for which the methodology is implemented be the same fiscal
year identified in such report as the fiscal year for which the
methodology will first be in effect.
``(e) Authority for Use of Additional Factors in Methodology.--
``(1) In general.--The Secretary shall make the
determinations specified in paragraph (2). For any fiscal year
beginning after the first fiscal year for which the methodology
under subsection (c)(1) is in effect, the Secretary may alter
the methodology by including the information from such
determinations as factors in the methodology.
``(2) Relevant determinations.--The determinations referred
to in paragraph (1) are as follows:
``(A) The need for and the distribution of health
services among populations for which it is difficult to
determine the number of individuals who are in the
population, such as homeless individuals; migratory and
seasonal agricultural workers and their families;
individuals infected with the human immunodeficiency
virus, and individuals who abuse drugs.
``(B) In the case of a population for which the
determinations under subparagraph (A) are made, the
extent to which the population includes individuals who
are members of racial or ethnic minority groups and a
specification of the skills needed to provide health
services to such individuals in the language and the
educational and cultural context that is most
appropriate to the individuals.
``(C) Data, obtained from the Director of the
Centers for Disease Control and Prevention, on rates of
morbidity and mortality among various populations
(including data on the rates of maternal and infant
mortality and data on the rates of low-birthweight
births of living infants).
``(D) Data from the Health Plan Employer Data and
Information Set, as appropriate.
``PART G--NATIONAL ADVISORY COUNCIL ON NURSE EDUCATION AND PRACTICE
``SEC. 845. NATIONAL ADVISORY COUNCIL ON NURSE EDUCATION AND PRACTICE.
``(a) Establishment.--The Secretary shall establish an advisory
council to be known as the National Advisory Council on Nurse Education
and Practice (in this section referred to as the `Advisory Council').
``(b) Composition.--
``(1) In general.--The Advisory Council shall be composed
of
``(A) not less than 21, nor more than 23
individuals, who are not officers or employees of the
Federal Government, appointed by the Secretary without
regard to the Federal civil service laws, of which--
``(i) 2 shall be selected from full-time
students enrolled in schools of nursing;
``(ii) 2 shall be selected from the general
public;
``(iii) 2 shall be selected from practicing
professional nurses; and
``(iv) 9 shall be selected from among the
leading authorities in the various fields of
nursing, higher, secondary education, and
associate degree schools of nursing, and from
representatives of advanced education nursing
groups (such as nurse practitioners, nurse
midwives, and nurse anesthetists), hospitals,
and other institutions and organizations which
provide nursing services; and
``(B) the Secretary (or the delegate of the
Secretary (who shall be an ex officio member and shall
serve as the Chairperson)).
``(2) Appointment.--Not later than 90 days after the date
of enactment of this Act, the Secretary shall appoint the
members of the Advisory Council and each such member shall
serve a 4 year term. In making such appointments, the Secretary
shall ensure a fair balance between the nursing professions, a
broad geographic representation of members and a balance
between urban and rural members. Members shall be appointed
based on their competence, interest, and knowledge of the
mission of the profession involved. A majority of the members
shall be nurses.
``(3) Minority representation.--In appointing the members
of the Advisory Council under paragraph (1), the Secretary
shall ensure the adequate representation of minorities.
``(c) Vacancies.--
``(1) In general.--A vacancy on the Advisory Council shall
be filled in the manner in which the original appointment was
made and shall be subject to any conditions which applied with
respect to the original appointment.
``(2) Filling unexpired term.--An individual chosen to fill
a vacancy shall be appointed for the unexpired term of the
member replaced.
``(d) Duties.--The Advisory Council shall--
``(1) provide advice and recommendations to the Secretary
and Congress concerning policy matters arising in the
administration of this title, including the range of issues
relating to the nurse workforce, education, and practice
improvement;
``(2) provide advice to the Secretary and Congress in the
preparation of general regulations and with respect to policy
matters arising in the administration of this title, including
the range of issues relating to nurse supply, education and
practice improvement; and
``(3) not later than 3 years after the date of enactment of
this section, and annually thereafter, prepare and submit to
the Secretary, the Committee on Labor and Human Resources of
the Senate, and the Committee on Commerce of the House of
Representatives, a report describing the activities of the
Council, including findings and recommendations made by the
Council concerning the activities under this title.
``(e) Meetings and Documents.--
``(1) Meetings.--The Advisory Council shall meet not less
than 2 times each year. Such meetings shall be held jointly
with other related entities established under this title where
appropriate.
``(2) Documents.--Not later than 14 days prior to the
convening of a meeting under paragraph (1), the Advisory
Council shall prepare and make available an agenda of the
matters to be considered by the Advisory Council at such
meeting. At any such meeting, the Advisory Council shall
distribute materials with respect to the issues to be addressed
at the meeting. Not later than 30 days after the adjourning of
such a meeting, the Advisory Council shall prepare and make
available a summary of the meeting and any actions taken by the
Council based upon the meeting.
``(f) Compensation and Expenses.--
``(1) Compensation.--Each member of the Advisory Council
shall be compensated at a rate equal to the daily equivalent of
the annual rate of basic pay prescribed for level IV of the
Executive Schedule under section 5315 of title 5, United States
Code, for each day (including travel time) during which such
member is engaged in the performance of the duties of the
Council. All members of the Council who are officers or
employees of the United States shall serve without compensation
in addition to that received for their services as officers or
employees of the United States.
``(2) Expenses.--The members of the Advisory Council shall
be allowed travel expenses, including per diem in lieu of
subsistence, at rates authorized for employees of agencies
under subchapter I of chapter 57 of title 5, United States
Code, while away from their homes or regular places of business
in the performance of services for the Council.
``(g) Funding.--Amounts appropriated under this title may be
utilized by the Secretary to support the nurse education and practice
activities of the Council.
``(h) FACA.--The Federal Advisory Committee Act shall apply to the
Advisory Committee under this section only to the extent that the
provisions of such Act do not conflict with the requirements of this
section.''; and
(6) by redesignating section 855 as section 810, and
transferring such section so as to appear after section 809 (as
added by the amendment made by paragraph (5)).
SEC. 124. SAVINGS PROVISION.
In the case of any authority for making awards of grants or
contracts that is terminated by the amendment made by section 123, the
Secretary of Health and Human Services may, notwithstanding the
termination of the authority, continue in effect any grant or contract
made under the authority that is in effect on the day before the date
of the enactment of this Act, subject to the duration of any such grant
or contract not exceeding the period determined by the Secretary in
first approving such financial assistance, or in approving the most
recent request made (before the date of such enactment) for
continuation of such assistance, as the case may be.
Subtitle C--Financial Assistance
CHAPTER 1--SCHOOL-BASED REVOLVING LOAN FUNDS
SEC. 131. PRIMARY CARE LOAN PROGRAM.
(a) Requirement for Schools.--Section 723(b)(1) of the Public
Health Service Act (42 U.S.C. 292s(b)(1)), as amended by section
2014(c)(2)(A)(ii) of Public Law 103-43 (107 Stat. 216), is amended by
striking ``3 years before'' and inserting ``4 years before''.
(b) Noncompliance.--Section 723(a)(3) of the Public Health Service
Act (42 U.S.C. 292s(a)(3)) is amended to read as follows:
``(3) Noncompliance by student.--Each agreement entered
into with a student pursuant to paragraph (1) shall provide
that, if the student fails to comply with such agreement, the
loan involved will begin to accrue interest at a rate of 18
percent per year beginning on the date of such
noncompliance.''.
(c) Report Requirement.--Section 723 of the Public Health Service
Act (42 U.S.C. 292s) is amended--
(1) by striking subsection (c); and
(2) by redesignating subsection (d) as subsection (c).
SEC. 132. LOANS FOR DISADVANTAGED STUDENTS.
(a) Authorization of Appropriations.--Section 724(f)(1) of the
Public Health Service Act (42 U.S.C. 292t(f)(1)) is amended by striking
``$15,000,000 for fiscal year 1993'' and inserting ``$8,000,000 for
each of the fiscal years 1998 through 2002''.
(b) Repeal.--Effective October 1, 2002, paragraph (1) of section
724(f) of the Public Health Service Act (42 U.S.C. 292t(f)(1)) is
repealed.
SEC. 133. STUDENT LOANS REGARDING SCHOOLS OF NURSING.
(a) In General.--Section 836(b) of the Public Health Service Act
(42 U.S.C. 297b(b)) is amended--
(1) in paragraph (1), by striking the period at the end and
inserting a semicolon;
(2) in paragraph (2)--
(A) in subparagraph (A), by striking ``and'' at the
end; and
(B) by inserting before the semicolon at the end
the following: ``, and (C) such additional periods
under the terms of paragraph (8) of this subsection'';
(3) in paragraph (7), by striking the period at the end and
inserting ``; and''; and
(4) by adding at the end the following paragraph:
``(8) pursuant to uniform criteria established by the
Secretary, the repayment period established under paragraph (2)
for any student borrower who during the repayment period failed
to make consecutive payments and who, during the last 12 months
of the repayment period, has made at least 12 consecutive
payments may be extended for a period not to exceed 10
years.''.
(b) Minimum Monthly Payments.--Section 836(g) of the Public Health
Service Act (42 U.S.C. 297b(g)) is amended by striking ``$15'' and
inserting ``$40''.
(c) Elimination of Statute of Limitation for Loan Collections.--
(1) In general.--Section 836 of the Public Health Service
Act (42 U.S.C. 297b) is amended by adding at the end the
following new subsection:
``(l) Elimination of Statute of Limitation for Loan Collections.--
``(1) Purpose.--It is the purpose of this subsection to
ensure that obligations to repay loans under this section are
enforced without regard to any Federal or State statutory,
regulatory, or administrative limitation on the period within
which debts may be enforced.
``(2) Prohibition.--Notwithstanding any other provision of
Federal or State law, no limitation shall terminate the period
within which suit may be filed, a judgment may be enforced, or
an offset, garnishment, or other action may be initiated or
taken by a school of nursing that has an agreement with the
Secretary pursuant to section 835 that is seeking the repayment
of the amount due from a borrower on a loan made under this
subpart after the default of the borrower on such loan.''.
(2) Effective date.--The amendment made by paragraph (1)
shall be effective with respect to actions pending on or after
the date of enactment of this Act.
(d) Breach of Agreements.--Section 846 of the Public Health Service
Act (42 U.S.C. 297n) is amended by adding at the end thereof the
following new subsection:
``(h) Breach of Agreement.--
``(1) In general.--In the case of any program under this
section under which an individual makes an agreement to provide
health services for a period of time in accordance with such
program in consideration of receiving an award of Federal funds
regarding education as a nurse (including an award for the
repayment of loans), the following applies if the agreement
provides that this subsection is applicable:
``(A) In the case of a program under this section
that makes an award of Federal funds for attending an
accredited program of nursing (in this section referred
to as a `nursing program'), the individual is liable to
the Federal Government for the amount of such award
(including amounts provided for expenses related to
such attendance), and for interest on such amount at
the maximum legal prevailing rate, if the individual--
``(i) fails to maintain an acceptable level
of academic standing in the nursing program (as
indicated by the program in accordance with
requirements established by the Secretary);
``(ii) is dismissed from the nursing
program for disciplinary reasons; or
``(iii) voluntarily terminates the nursing
program.
``(B) The individual is liable to the Federal
Government for the amount of such award (including
amounts provided for expenses related to such
attendance), and for interest on such amount at the
maximum legal prevailing rate, if the individual fails
to provide health services in accordance with the
program under this section for the period of time
applicable under the program.
``(2) Waiver or suspension of liability.--In the case of an
individual or health facility making an agreement for purposes
of paragraph (1), the Secretary shall provide for the waiver or
suspension of liability under such subsection if compliance by
the individual or the health facility, as the case may be, with
the agreements involved is impossible, or would involve extreme
hardship to the individual or facility, and if enforcement of
the agreements with respect to the individual or facility would
be unconscionable.
``(3) Date certain for recovery.--Subject to paragraph (2),
any amount that the Federal Government is entitled to recover
under paragraph (1) shall be paid to the United States not
later than the expiration of the 3-year period beginning on the
date the United States becomes so entitled.
``(4) Availability.--Amounts recovered under paragraph (1)
with respect to a program under this section shall be available
for the purposes of such program, and shall remain available
for such purposes until expended.''.
(e) Technical Amendments.--Section 839 of the Public Health Service
Act (42 U.S.C. 297e) is amended--
(1) in subsection (a)--
(A) by striking the matter preceding paragraph (1)
and inserting the following:
``(a) If a school terminates a loan fund established under an
agreement pursuant to section 835(b), or if the Secretary for good
cause terminates the agreement with the school, there shall be a
capital distribution as follows:''; and
(B) in paragraph (1), by striking ``at the close of
September 30, 1999,'' and inserting ``on the date of
termination of the fund''; and
(2) in subsection (b), to read as follows:
``(b) If a capital distribution is made under subsection (a), the
school involved shall, after such capital distribution, pay to the
Secretary, not less often than quarterly, the same proportionate share
of amounts received by the school in payment of principal or interest
on loans made from the loan fund established under section 835(b) as
determined by the Secretary under subsection (a).''.
SEC. 134. GENERAL PROVISIONS.
(a) Maximum Student Loan Provisions and Minimum Payments.--
(1) In general.--Section 722(a)(1) of the Public Health
Service Act (42 U.S.C. 292r(a)(1)), as amended by section
2014(b)(1) of Public Law 103-43, is amended by striking ``the
sum of'' and all that follows through the end thereof and
inserting ``the cost of attendance (including tuition, other
reasonable educational expenses, and reasonable living costs)
for that year at the educational institution attended by the
student (as determined by such educational institution).''.
(2) Third and fourth years.--Section 722(a)(2) of the
Public Health Service Act (42 U.S.C. 292r(a)(2)), as amended by
section 2014(b)(1) of Public Law 103-43, is amended by striking
``the amount $2,500'' and all that follows through ``including
such $2,500)'' and inserting ``the amount of the loan may, in
the case of the third or fourth year of a student at a school
of medicine or osteopathic medicine, be increased to the extent
necessary''.
(3) Repayment period.--Section 722(c) of the Public Health
Service Act (42 U.S.C. 292r(c)), as amended by section
2014(b)(1) of Public Law 103-43, is amended--
(A) in the subsection heading by striking ``Ten-
Year'' and inserting ``Repayment'';
(B) by striking ``ten-year period which begins''
and inserting ``period of not less than 10 years nor
more than 25 years, at the discretion of the
institution, which begins''; and
(C) by striking ``such ten-year period'' and
inserting ``such period''.
(4) Minimum payments.--Section 722(j) of the Public Health
Service Act (42 U.S.C. 292r(j)), as amended by section
2014(b)(1) of Public Law 103-43, is amended by striking ``$15''
and inserting $40''.
(b) Elimination of Statute of Limitation for Loan Collections.--
(1) In general.--Section 722 of the Public Health Service
Act (42 U.S.C. 292r), as amended by section 2014(b)(1) of
Public Law 103-43, is amended by adding at the end the
following new subsection:
``(m) Elimination of Statute of Limitation for Loan Collections.--
``(1) Purpose.--It is the purpose of this subsection to
ensure that obligations to repay loans under this section are
enforced without regard to any Federal or State statutory,
regulatory, or administrative limitation on the period within
which debts may be enforced.
``(2) Prohibition.--Notwithstanding any other provision of
Federal or State law, no limitation shall terminate the period
within which suit may be filed, a judgment may be enforced, or
an offset, garnishment, or other action may be initiated or
taken by a school that has an agreement with the Secretary
pursuant to section 721 that is seeking the repayment of the
amount due from a borrower on a loan made under this subpart
after the default of the borrower on such loan.''.
(2) Effective date.--The amendment made by paragraph (1)
shall be effective with respect to actions pending on or after
the date of enactment of this Act.
(c) Date Certain for Contributions.--Paragraph (2) of section
735(e) of the Public Health Service Act (42 U.S.C. 292y(e)(2)) is
amended to read as follows:
``(2) Date certain for contributions.--Amounts described in
paragraph (1) that are returned to the Secretary shall be
obligated before the end of the succeeding fiscal year.''.
CHAPTER 2--INSURED HEALTH EDUCATION ASSISTANCE LOANS TO GRADUATE
STUDENTS
SEC. 141. HEALTH EDUCATION ASSISTANCE LOAN PROGRAM.
(a) Health Education Assistance Loan Deferment for Borrowers
Providing Health Services to Indians.--
(1) In general.--Section 705(a)(2)(C) of the Public Health
Service Act (42 U.S.C. 292d(a)(2)(C)) is amended by striking
``and (x)'' and inserting ``(x) not in excess of three years,
during which the borrower is providing health care services to
Indians through an Indian health program (as defined in section
108(a)(2)(A) of the Indian Health Care Improvement Act (25
U.S.C. 1616a(a)(2)(A)); and (xi)''.
(2) Conforming amendments.--Section 705(a)(2)(C) of the
Public Health Service Act (42 U.S.C. 292d(a)(2)(C)) is further
amended--
(A) in clause (xi) (as so redesignated) by striking
``(ix)'' and inserting ``(x)''; and
(B) in the matter following such clause (xi), by
striking ``(x)'' and inserting ``(xi)''.
(3) Effective date.--The amendments made by this subsection
shall apply with respect to services provided on or after the
first day of the third month that begins after the date of the
enactment of this Act.
(b) Report Requirement.--Section 709(b) of the Public Health
Service Act (42 U.S.C. 292h(b)) is amended--
(1) in paragraph (4)(B), by adding ``and'' after the
semicolon;
(2) in paragraph (5), by striking ``; and'' and inserting a
period; and
(3) by striking paragraph (6).
(c) Program Eligibility.--
(1) Limitations on loans.--Section 703(a) of the Public
Health Service Act (42 U.S.C. 292b(a)) is amended by striking
``or clinical psychology'' and inserting ``or behavioral and
mental health practice, including clinical psychology''.
(2) Definition of eligible institution.--Section 719(1) of
the Public Health Service Act (42 U.S.C. 292o(1)) is amended by
striking ``or clinical psychology'' and inserting ``or
behavioral and mental health practice, including clinical
psychology''.
SEC. 142. HEAL LENDER AND HOLDER PERFORMANCE STANDARDS.
(a) General Amendments.--Section 707(a) of the Public Health
Service Act (42 U.S.C. 292f) is amended--
(1) by striking the last sentence;
(2) by striking ``determined.'' and inserting ``determined,
except that, if the insurance beneficiary including any
servicer of the loan is not designated for `exceptional
performance', as set forth in paragraph (2), the Secretary
shall pay to the beneficiary a sum equal to 98 percent of the
amount of the loss sustained by the insured upon that loan.'';
(3) by striking ``Upon'' and inserting:
``(1) In general.--Upon''; and
(4) by adding at the end the following new paragraph:
``(2) Exceptional performance.--
``(A) Authority.--Where the Secretary determines
that an eligible lender, holder, or servicer has a
compliance performance rating that equals or exceeds 97
percent, the Secretary shall designate that eligible
lender, holder, or servicer, as the case may be, for
exceptional performance.
``(B) Compliance performance rating.--For purposes
of subparagraph (A), a compliance performance rating is
determined with respect to compliance with due
diligence in the disbursement, servicing, and
collection of loans under this subpart for each year
for which the determination is made. Such rating shall
be equal to the percentage of all due diligence
requirements applicable to each loan, on average, as
established by the Secretary, with respect to loans
serviced during the period by the eligible lender,
holder, or servicer.
``(C) Annual audits for lenders, holders, and
servicers.--Each eligible lender, holder, or servicer
desiring a designation under subparagraph (A) shall
have an annual financial and compliance audit conducted
with respect to the loan portfolio of such eligible
lender, holder, or servicer, by a qualified independent
organization from a list of qualified organizations
identified by the Secretary and in accordance with
standards established by the Secretary. The standards
shall measure the lender's, holder's, or servicer's
compliance with due diligence standards and shall
include a defined statistical sampling technique
designed to measure the performance rating of the
eligible lender, holder, or servicer for the purpose of
this section. Each eligible lender, holder, or servicer
shall submit the audit required by this section to the
Secretary.
``(D) Secretary's determinations.--The Secretary
shall make the determination under subparagraph (A)
based upon the audits submitted under this paragraph
and any information in the possession of the Secretary
or submitted by any other agency or office of the
Federal Government.
``(E) Quarterly compliance audit.--To maintain its
status as an exceptional performer, the lender, holder,
or servicer shall undergo a quarterly compliance audit
at the end of each quarter (other than the quarter in
which status as an exceptional performer is established
through a financial and compliance audit, as described
in subparagraph (C)), and submit the results of such
audit to the Secretary. The compliance audit shall
review compliance with due diligence requirements for
the period beginning on the day after the ending date
of the previous audit, in accordance with standards
determined by the Secretary.
``(F) Revocation authority.--The Secretary shall
revoke the designation of a lender, holder, or servicer
under subparagraph (A) if any quarterly audit required
under subparagraph (E) is not received by the Secretary
by the date established by the Secretary or if the
audit indicates the lender, holder, or servicer has
failed to meet the standards for designation as an
exceptional performer under subparagraph (A). A lender,
holder, or servicer receiving a compliance audit not
meeting the standard for designation as an exceptional
performer may reapply for designation under
subparagraph (A) at any time.
``(G) Documentation.--Nothing in this section shall
restrict or limit the authority of the Secretary to
require the submission of claims documentation
evidencing servicing performed on loans, except that
the Secretary may not require exceptional performers to
submit greater documentation than that required for
lenders, holders, and servicers not designated under
subparagraph (A).
``(H) Cost of audits.--Each eligible lender,
holder, or servicer shall pay for all the costs
associated with the audits required under this section.
``(I) Additional revocation authority.--
Notwithstanding any other provision of this section, a
designation under subparagraph (A) may be revoked at
any time by the Secretary if the Secretary determines
that the eligible lender, holder, or servicer has
failed to maintain an overall level of compliance
consistent with the audit submitted by the eligible
lender, holder, or servicer under this paragraph or if
the Secretary asserts that the lender, holder, or
servicer may have engaged in fraud in securing
designation under subparagraph (A) or is failing to
service loans in accordance with program requirements.
``(J) Noncompliance.--A lender, holder, or servicer
designated under subparagraph (A) that fails to service
loans or otherwise comply with applicable program
regulations shall be considered in violation of the
Federal False Claims Act.''.
(b) Definition.--Section 707(e) of the Public Health Service Act
(42 U.S.C. 292f(e)) is amended by adding at the end the following new
paragraph:
``(4) The term `servicer' means any agency acting on behalf
of the insurance beneficiary.''.
(c) Effective Date.--The amendments made by subsections (a) and (b)
shall apply with respect to loans submitted to the Secretary for
payment on or after the first day of the sixth month that begins after
the date of enactment of this Act.
SEC. 143. INSURANCE PROGRAM.
Section 710(a)(2)(B) of the Public Health Service Act (42 U.S.C.
292i(a)(2)(B)) is amended by striking ``any of the fiscal years 1993
through 1996'' and inserting ``fiscal year 1993 and subsequent fiscal
years''.
SEC. 144. HEAL BANKRUPTCY.
(a) In General.--Section 707(g) of the Public Health Service Act
(42 U.S.C. 292f(g)) is amended in the first sentence by striking ``A
debt which is a loan insured'' and inserting ``Notwithstanding any
other provision of Federal or State law, a debt that is a loan
insured''.
(b) Application.--The amendment made by subsection (a) shall apply
to any loan insured under the authority of subpart I of part A of title
VII of the Public Health Service Act (42 U.S.C. 292 et seq.) that is
listed or scheduled by the debtor in a case under title XI, United
States Code, filed--
(1) on or after the date of enactment of this Act; or
(2) prior to such date of enactment in which a discharge
has not been granted.
SEC. 145. HEAL REFINANCING.
Section 706 of the Public Health Service Act (42 U.S.C. 292e) is
amended--
(1) in subsection (d)--
(A) in the subsection heading, by striking
``Consolidation'' and inserting ``Refinancing or
Consolidation''; and
(B) in the first sentence, by striking
``indebtedness'' and inserting ``indebtedness or the
refinancing of a single loan''; and
(2) in subsection (e)--
(A) in the subsection heading, by striking
``Debts'' and inserting ``Debts and Refinancing'';
(B) in the first sentence, by striking ``all of the
borrower's debts into a single instrument'' and
inserting ``all of the borrower's loans insured under
this subpart into a single instrument (or, if the
borrower obtained only 1 loan insured under this
subpart, refinancing the loan 1 time)''; and
(C) in the second sentence, by striking
``consolidation'' and inserting ``consolidation or
refinancing''.
TITLE II--OFFICE OF MINORITY HEALTH
SEC. 201. REVISION AND EXTENSION OF PROGRAMS OF OFFICE OF MINORITY
HEALTH.
(a) Duties and Requirements.--Section 1707 of the Public Health
Service Act (42 U.S.C. 300u-6) is amended by striking subsection (b)
and all that follows and inserting the following:
``(b) Duties.--With respect to improving the health of racial and
ethnic minority groups, the Secretary, acting through the Deputy
Assistant Secretary for Minority Health (in this section referred to as
the `Deputy Assistant Secretary'), shall carry out the following:
``(1) Establish short-range and long-range goals and
objectives and coordinate all other activities within the
Public Health Service that relate to disease prevention, health
promotion, service delivery, and research concerning such
individuals. The heads of each of the agencies of the Service
shall consult with the Deputy Assistant Secretary to ensure the
coordination of such activities.
``(2) Enter into interagency agreements with other agencies
of the Public Health Service.
``(3) Support research, demonstrations and evaluations to
test new and innovative models.
``(4) Increase knowledge and understanding of health risk
factors.
``(5) Develop mechanisms that support better information
dissemination, education, prevention, and service delivery to
individuals from disadvantaged backgrounds, including
individuals who are members of racial or ethnic minority
groups.
``(6) Ensure that the National Center for Health Statistics
collects data on the health status of each minority group.
``(7) With respect to individuals who lack proficiency in
speaking the English language, enter into contracts with public
and nonprofit private providers of primary health services for
the purpose of increasing the access of the individuals to such
services by developing and carrying out programs to provide
bilingual or interpretive services.
``(8) Support a national minority health resource center to
carry out the following:
``(A) Facilitate the exchange of information
regarding matters relating to health information and
health promotion, preventive health services, and
education in the appropriate use of health care.
``(B) Facilitate access to such information.
``(C) Assist in the analysis of issues and problems
relating to such matters.
``(D) Provide technical assistance with respect to
the exchange of such information (including
facilitating the development of materials for such
technical assistance).
``(9) Carry out programs to improve access to health care
services for individuals with limited proficiency in speaking
the English language. Activities under the preceding sentence
shall include developing and evaluating model projects.
``(c) Advisory Committee.--
``(1) In general.--The Secretary shall establish an
advisory committee to be known as the Advisory Committee on
Minority Health (in this subsection referred to as the
`Committee').
``(2) Duties.--The Committee shall provide advice to the
Deputy Assistant Secretary carrying out this section, including
advice on the development of goals and specific program
activities under paragraphs (1) through (9) of subsection (b)
for each racial and ethnic minority group.
``(3) Chair.--The chairperson of the Committee shall be
selected by the Secretary from among the members of the voting
members of the Committee. The term of office of the chairperson
shall be 2 years.
``(4) Composition.--
``(A) The Committee shall be composed of 12 voting
members appointed in accordance with subparagraph (B),
and nonvoting, ex officio members designated in
subparagraph (C).
``(B) The voting members of the Committee shall be
appointed by the Secretary from among individuals who
are not officers or employees of the Federal Government
and who have expertise regarding issues of minority
health. The racial and ethnic minority groups shall be
equally represented among such members.
``(C) The nonvoting, ex officio members of the
Committee shall be such officials of the Department of
Health and Human Services as the Secretary determines
to be appropriate.
``(5) Terms.--Each member of the Committee shall serve for
a term of 4 years, except that the Secretary shall initially
appoint a portion of the members to terms of 1 year, 2 years,
and 3 years.
``(6) Vacancies.--If a vacancy occurs on the Committee, a
new member shall be appointed by the Secretary within 90 days
from the date that the vacancy occurs, and serve for the
remainder of the term for which the predecessor of such member
was appointed. The vacancy shall not affect the power of the
remaining members to execute the duties of the Committee.
``(7) Compensation.--Members of the Committee who are
officers or employees of the United States shall serve without
compensation. Members of the Committee who are not officers or
employees of the United States shall receive compensation, for
each day (including travel time) they are engaged in the
performance of the functions of the Committee. Such
compensation may not be in an amount in excess of the daily
equivalent of the annual maximum rate of basic pay payable
under the General Schedule (under title 5, United States Code)
for positions above GS-15.
``(d) Certain Requirements Regarding Duties.--
``(1) Recommendations regarding language as impediment to
health care.--The Deputy Assistant Secretary for Minority
Health shall consult with the Director of the Office of
International and Refugee Health, the Director of the Office of
Civil Rights, and the Directors of other appropriate
Departmental entities regarding recommendations for carrying
out activities under subsection (b)(9).
``(2) Equitable allocation regarding activities.--In
carrying out subsection (b), the Secretary shall ensure that
services provided under such subsection are equitably allocated
among all groups served under this section by the Secretary.
``(3) Cultural competency of services.--The Secretary shall
ensure that information and services provided pursuant to
subsection (b) are provided in the language, educational, and
cultural context that is most appropriate for the individuals
for whom the information and services are intended.
``(e) Grants and Contracts Regarding Duties.--
``(1) In general.--In carrying out subsection (b), the
Secretary acting through the Deputy Assistant Secretary may
make awards of grants, cooperative agreements, and contracts to
public and nonprofit private entities.
``(2) Process for making awards.--The Deputy Assistant
Secretary shall ensure that awards under paragraph (1) are
made, to the extent practical, only on a competitive basis, and
that a grant is awarded for a proposal only if the proposal has
been recommended for such an award through a process of peer
review.
``(3) Evaluation and dissemination.--The Deputy Assistant
Secretary, directly or through contracts with public and
private entities, shall provide for evaluations of projects
carried out with awards made under paragraph (1) during the
preceding 2 fiscal years. The report shall be included in the
report required under subsection (f) for the fiscal year
involved.
``(f) Reports.--
``(1) In general.--Not later than February 1 of fiscal year
1999 and of each second year thereafter, the Secretary shall
submit to the Committee on Energy and Commerce of the House of
Representatives, and to the Committee on Labor and Human
Resources of the Senate, a report describing the activities
carried out under this section during the preceding 2 fiscal
years and evaluating the extent to which such activities have
been effective in improving the health of racial and ethnic
minority groups. Each such report shall include the biennial
reports submitted under sections 201(e)(3) and 201(f)(2) for
such years by the heads of the Public Health Service agencies.
``(2) Agency reports.--Not later than February 1, 1999, and
biennially thereafter, the heads of the Public Health Service
agencies shall submit to the Deputy Assistant Secretary a
report summarizing the minority health activities of each of
the respective agencies.
``(g) Definition.--For purposes of this section:
``(1) The term `racial and ethnic minority group' means
American Indians (including Alaska Natives, Eskimos, and
Aleuts); Asian Americans and Pacific Islanders; Blacks; and
Hispanics.
``(2) The term `Hispanic' means individuals whose origin is
Mexican, Puerto Rican, Cuban, Central or South American, or any
other Spanish-speaking country.
``(h) Funding.--
``(1) Authorization of appropriations.--For the purpose of
carrying out this section, there are authorized to be
appropriated $30,000,000 for fiscal year 1998, such sums as may
be necessary for each of the fiscal years 1999 through 2002.''.
(b) Authorization for National Center for Health Statistics.--
Section 306 of the Public Health Service Act (42 U.S.C. 242k) is
amended--
(1) in subsection (m), by adding at the end the following:
``(4)(A) Subject to subparagraph (B), the Secretary, acting through
the Center, shall collect data on Hispanics and major Hispanic
subpopulation groups and American Indians, and for developing special
area population studies on major Asian American and Pacific Islander
populations.
``(B) The provisions of subparagraph (A) shall be effective with
respect to a fiscal year only to the extent that funds are appropriated
pursuant to paragraph (3) of subsection (n), and only if the amounts
appropriated for such fiscal year pursuant to each of paragraphs (1)
and (2) of subsection (n) equal or exceed the amounts so appropriated
for fiscal year 1997.'';
(2) in subsection (n)(1), by striking ``through 1998'' and
inserting ``through 2003''; and
(3) in subsection (n)
(A) in the first sentence of paragraph (2)--
(i) by striking ``authorized in subsection
(m)'' and inserting ``authorized in paragraphs
(1) through (3) of subsection (m)''; and
(ii) by striking ``$5,000,000'' and all
that follows through the period and inserting
``such sums as may be necessary for each of the
fiscal years 1999 through 2003.''; and
(B) by adding at the end the following:
``(3) For activities authorized in subsection (m)(4), there are
authorized to be appropriated $1,000,000 for fiscal year 1998, and such
sums as may be necessary for each of the fiscal years 1999 through
2002.''.
(c) Miscellaneous Amendments.--Section 1707 of the Public Health
Service Act (42 U.S.C. 300u-6) is amended--
(1) in the heading for the section by striking
``establishment of''; and
(2) in subsection (a), by striking ``Office of the
Assistant Secretary for Health'' and inserting ``Office of
Public Health and Science''.
TITLE III--SELECTED INITIATIVES
SEC. 301. STATE OFFICES OF RURAL HEALTH.
Section 338J of the Public Health Service Act (42 U.S.C. 254r) is
amended--
(1) in subsection (b)(1), in the matter preceding
subparagraph (A), by striking ``in cash''; and
(2) in subsection (j)(1)--
(A) by striking ``and'' after ``1992,''; and
(B) by inserting before the period the following:
``, and such sums as may be necessary for each of the
fiscal years 1998 through 2002''; and
(3) in subsection (k), by striking ``$10,000,000'' and
inserting ``$36,000,000''.
SEC. 302. DEMONSTRATION PROJECTS REGARDING ALZHEIMER'S DISEASE.
(a) In General.--Section 398(a) of the Public Health Service Act
(42 U.S.C. 280c-3(a)) is amended--
(1) in the matter preceding paragraph (1), by striking
``not less than 5, and not more than 15,'';
(2) in paragraph (2)--
(A) by inserting after ``disorders'' the following:
``who are living in single family homes or in
congregate settings''; and
(B) by striking ``and'' at the end;
(3) by redesignating paragraph (3) as paragraph (4); and
(4) by inserting after paragraph (2) the following:
``(3) to improve the access of such individuals to home-
based or community-based long-term care services (subject to
the services being provided by entities that were providing
such services in the State involved as of October 1, 1995),
particularly such individuals who are members of racial or
ethnic minority groups, who have limited proficiency in
speaking the English language, or who live in rural areas;
and''.
(b) Duration.--Section 398A of the Public Health Service Act (42
U.S.C. 280c-4) is amended--
(1) in the heading for the section, by striking
``LIMITATION'' and all that follows and inserting ``REQUIREMENT
OF MATCHING FUNDS'';
(2) by striking subsection (a);
(3) by redesignating subsections (b) and (c) as subsections
(a) and (b), respectively; and
(4) in subsection (a) (as so redesignated), in each of
paragraphs (1)(C) and (2)(C), by striking ``third year'' and
inserting ``third or subsequent year''.
(c) Authorization of Appropriations.--Section 398B(e) of the Public
Health Service Act (42 U.S.C. 280c-5(e)) is amended--
(1) by striking ``and such sums'' and inserting ``such
sums''; and
(2) by inserting before the period the following: ``,
$8,000,000 for fiscal year 1998, and such sums as may be
necessary for each of the fiscal years 1999 through 2002''.
SEC. 303. PROJECT GRANTS FOR IMMUNIZATION SERVICES.
Section 317(j) of the Public Health Service Act (42 U.S.C. 247b(j))
is amended--
(1) in paragraph (1), by striking ``individuals against
vaccine-preventable diseases'' and all that follows through the
first period and inserting the following: ``children,
adolescents, and adults against vaccine-preventable diseases,
there are authorized to be appropriated such sums as may be
necessary for each of the fiscal years 1998 through 2002.'';
and
(2) in paragraph (2), by striking ``1990'' and inserting
``1997''.
TITLE IV--MISCELLANEOUS PROVISIONS
SEC. 401. TECHNICAL CORRECTIONS REGARDING PUBLIC LAW 103-183.
(a) Amendatory Instructions.--Public Law 103-183 is amended--
(1) in section 601--
(A) in subsection (b), in the matter preceding
paragraph (1), by striking ``Section 1201 of the Public
Health Service Act (42 U.S.C. 300d)'' and inserting
``Title XII of the Public Health Service Act (42 U.S.C.
300d et seq.)''; and
(B) in subsection (f)(1), by striking ``in section
1204(c)'' and inserting ``in section 1203(c) (as
redesignated by subsection (b)(2) of this section)'';
(2) in section 602, by striking ``for the purpose'' and
inserting ``For the purpose''; and
(3) in section 705(b), by striking ``317D((l)(1)'' and
inserting ``317D(l)(1)''.
(b) Public Health Service Act.--The Public Health Service Act, as
amended by Public Law 103-183 and by subsection (a) of this section, is
amended--
(1) in section 317E(g)(2), by striking ``making grants
under subsection (b)'' and inserting ``carrying out subsection
(b)'';
(2) in section 318, in subsection (e) as in effect on the
day before the date of the enactment of Public Law 103-183, by
redesignating the subsection as subsection (f);
(3) in subpart 6 of part C of title IV--
(A) by transferring the first section 447 (added by
section 302 of Public Law 103-183) from the current
placement of the section;
(B) by redesignating the section as section 447A;
and
(C) by inserting the section after section 447;
(4) in section 1213(a)(8), by striking ``provides for for''
and inserting ``provides for'';
(5) in section 1501, by redesignating the second subsection
(c) (added by section 101(f) of Public Law 103-183) as
subsection (d); and
(6) in section 1505(3), by striking ``nonprofit''.
(c) Miscellaneous Correction.--Section 401(c)(3) of Public Law 103-
183 is amended in the matter preceding subparagraph (A) by striking
``(d)(5)'' and inserting ``(e)(5)''.
(d) Conforming Amendment.--Section 308(b) of the Public Health
Service Act (42 U.S.C. 242m(b)) is amended--
(1) in paragraph (2)(A), by striking ``306(n)'' and
inserting ``306(m)''; and
(2) in paragraph (2)(C), by striking ``306(n)'' and
inserting ``306(m)''.
(e) Effective Date.--This section is deemed to have taken effect
immediately after the enactment of Public Law 103-183.
SEC. 402. MISCELLANEOUS AMENDMENTS REGARDING PHS COMMISSIONED OFFICERS.
(a) Anti-Discrimination Laws.--Amend section 212 of the Public
Health Service Act (42 U.S.C. 213) by adding the following new
subsection at the end thereof:
``(f) Active service of commissioned officers of the Service shall
be deemed to be active military service in the Armed Forces of the
United States for purposes of all laws related to discrimination on the
basis of race, color, sex, ethnicity, age, religion, and disability.''
(b) Training in Leave Without Pay Status.--Section 218 of the
Public Health Service Act (42 U.S.C. 218a) is amended by adding at the
end the following:
``(c) A commissioned officer may be placed in leave without pay
status while attending an educational institution or training program
whenever the Secretary determines that such status is in the best
interest of the Service. For purposes of computation of basic pay,
promotion, retirement, compensation for injury or death, and the
benefits provided by sections 212 and 224, an officer in such status
pursuant to the preceding sentence shall be considered as performing
service in the Service and shall have an active service obligation as
set forth in subsection (b) of this section.''.
(c) Utilization of Alcohol and Drug Abuse Records That Apply to the
Armed Forces.--Section 543(e) of the Public Health Service Act (42
U.S.C. 290dd-2(e)) is amended by striking ``Armed Forces'' each place
that such term appears and inserting ``Uniformed Services''.
SEC. 403. CLINICAL TRAINEESHIPS.
Section 303(d)(1) of the Public Health Service Act (42 U.S.C.
242a(d)(1)) is amended by inserting ``counseling,'' after ``family
therapy,''.
SEC. 404. PROJECT GRANTS FOR SCREENINGS, REFERRALS, AND EDUCATION
REGARDING LEAD POISONING.
Section 317A(l)(1) of the Public Health Service Act (42 U.S.C.
247b-1(l)(1)) is amended by striking ``1998'' and inserting ``2002''.
SEC. 405. PROJECT GRANTS FOR PREVENTIVE HEALTH SERVICES REGARDING
TUBERCULOSIS.
Section 317E(g) of the Public Health Service Act (42 U.S.C. 247b-
6(g)(1)) is amended--
(1) in paragraph (1)--
(A) in subparagraph (A), by striking ``1998'' and
inserting ``2002''; and
(B) in subparagraph (B), by striking
``$50,000,000'' and inserting ``25 percent''; and
(2) in paragraph (2), by striking ``1998'' and inserting
``2002''.
SEC. 406. CDC LOAN REPAYMENT PROGRAM.
Section 317F of the Public Health Service Act (42 U.S.C. 247b-7) is
amended--
(1) in subsection (a)(1), by striking ``$20,000'' and
inserting ``$35,000'';
(2) in subsection (c), by striking ``1998'' and inserting
``2002''; and
(3) by adding at the end the following:
``(d) Availability of Appropriations.--Amounts appropriated for a
fiscal year for contracts under subsection (a) shall remain available
until the expiration of the second fiscal year beginning after the
fiscal year for which the amounts were appropriated.''.
SEC. 407. COMMUNITY PROGRAMS ON DOMESTIC VIOLENCE.
(a) In General.--Section 318(h)(2) of the Family Violence
Prevention and Services Act (42 U.S.C. 10418(h)(2)) is amended by
striking ``fiscal year 1997'' and inserting ``for each of the fiscal
years 1997 through 2002''.
(b) Study.--The Secretary of Health and Human Services shall
request that the Institute of Medicine conduct a study concerning the
training needs of health professionals with respect to the detection
and referral of victims of family or acquaintance violence. Not later
than 2 years after the date of enactment of this Act, the Institute of
Medicine shall prepare and submit to Congress a report concerning the
study conducted under this subsection.
SEC. 408. STATE LOAN REPAYMENT PROGRAM.
Section 338I(i)(1) of the Public Health Service Act (42 U.S.C.
254q-1(i)(1)) is amended by inserting before the period ``, and such
sums as may be necessary for each of the fiscal years 1998 through
2002''.
SEC. 409. AUTHORITY OF THE DIRECTOR OF NIH.
Section 402(b) of the Public Health Service Act (42 U.S.C. 282(b))
is amended--
(1) in paragraph (11), by striking ``and'' at the end
thereof;
(2) in paragraph (12), by striking the period and inserting
a semicolon; and
(3) by adding after paragraph (12), the following new
paragraphs:
``(13) may conduct and support research training--
``(A) for which fellowship support is not provided
under section 487; and
``(B) which does not consist of residency training
of physicians or other health professionals; and
``(14) may appoint physicians, dentists, and other health
care professionals, subject to the provisions of title 5,
United States Code, relating to appointments and
classifications in the competitive service, and may compensate
such professionals subject to the provisions of chapter 74 of
title 38, United States Code.''.
SEC. 410. RAISE IN MAXIMUM LEVEL OF LOAN REPAYMENTS.
(a) Repayment Programs With Respect to AIDS.--Section 487A of the
Public Health Service Act (42 U.S.C. 288-1) is amended--
(1) in subsection (a), by striking ``$20,000'' and
inserting ``$35,000''; and
(2) in subsection (c), by striking ``1996'' and inserting
``2001''.
(b) Repayment Programs With Respect to Contraception and
Infertility.--Section 487B(a) of the Public Health Service Act (42
U.S.C. 288-2(a)) is amended by striking ``$20,000'' and inserting
``$35,000''.
(c) Repayment Programs With Respect to Research Generally.--Section
487C(a)(1) of the Public Health Service Act (42 U.S.C. 288-3(a)(1)) is
amended by striking ``$20,000'' and inserting ``$35,000''.
(d) Repayment Programs With Respect to Clinical Researchers From
Disadvantaged Backgrounds.--Section 487E(a) of the Public Health
Service Act (42 U.S.C. 288-5(a)) is amended--
(1) in paragraph (1), by striking ``$20,000'' and inserting
``$35,000''; and
(2) in paragraph (3), by striking ``338C'' and inserting
``338B, 338C''.
SEC. 411. CONSTRUCTION OF REGIONAL CENTERS FOR RESEARCH ON PRIMATES.
Section 481B(a) of the Public Health Service Act (42 U.S.C. 287a-
3(a)) is amended--
(1) by striking ``shall'' and inserting ``may''; and
(2) by striking ``$5,000,000'' and inserting ``up to
$2,500,000''.
SEC. 412. PEER REVIEW.
Section 504(d)(2) of the Public Health Service Act (42 U.S.C.
290aa-3(d)(2)) is amended by striking ``cooperative agreement, or
contract'' each place that such appears and inserting ``or cooperative
agreement''.
SEC. 413. FUNDING FOR TRAUMA CARE.
Section 1232(a) of the Public Health Service Act (42 U.S.C. 300d-
32) is amended by striking ``and 1996'' and inserting ``through 2002''.
SEC. 414. HEALTH INFORMATION AND HEALTH PROMOTION.
Section 1701(b) of the Public Health Service Act (42 U.S.C.
300u(b)) is amended by striking ``through 1996'' and inserting
``through 2002''.
SEC. 415. EMERGENCY MEDICAL SERVICES FOR CHILDREN.
Section 1910 of the Public Health Service Act (42 U.S.C. 300w-9) is
amended--
(1) in subsection (a)--
(A) by striking ``two-year period'' and inserting
``3-year period (with an optional 4th year based on
performance)''; and
(B) by striking ``one grant'' and inserting ``3
grants''; and
(2) in subsection (d), by striking ``1997'' and inserting
``2005''.
SEC. 416. ADMINISTRATION OF CERTAIN REQUIREMENTS.
(a) In General.--Section 2004 of Public Law 103-43 (107 Stat. 209)
is amended by striking subsection (a).
(b) Conforming Amendments.--Section 2004 of Public Law 103-43, as
amended by subsection (a) of this section, is amended--
(1) by striking ``(b) Sense'' and all that follows through
``In the case'' and inserting the following:
``(a) Sense of Congress Regarding Purchase of American-Made
Equipment and Products.--In the case'';
(2) by striking ``(2) Notice to recipients of assistance''
and inserting the following:
``(b) Notice to Recipients of Assistance''; and
(3) in subsection (b), as redesignated by paragraph (2) of
this subsection, by striking ``paragraph (1)'' and inserting
``subsection (a)''.
(c) Effective Date.--This section is deemed to have taken effect
immediately after the enactment of Public Law 103-43.
SEC. 417. AIDS DRUG ASSISTANCE PROGRAM.
Section 2618(b)(3) of the Public Health Service Act (42 U.S.C.
300ff-28(b)(3)) is amended--
(1) in subparagraph (A), by striking ``and the Commonwealth
of Puerto Rico'' and inserting ``, the Commonwealth of Puerto
Rico, the Virgin Islands, and Guam''; and
(2) in subparagraph (B), by striking ``the Virgin Islands,
Guam''.
SEC. 418. NATIONAL FOUNDATION FOR BIOMEDICAL RESEARCH.
Part I of title IV of the Public Health Service Act (42 U.S.C. 290b
et seq.) is amended--
(1) by striking the part heading and inserting the
following:
``PART I--FOUNDATION FOR THE NATIONAL INSTITUTES OF HEALTH'';
and
(2) in section 499--
(A) in subsection (a), by striking ``National
Foundation for Biomedical Research'' and inserting
``Foundation for the National Institutes of Health'';
(B) in subsection (k)(10)--
(i) by striking ``not''; and
(ii) by adding at the end the following:
``Any funds transferred under this paragraph
shall be subject to all Federal limitations
relating to Federally-funded research.''; and
(C) in subsection (m)(1), by striking ``$200,000''
and all that follows through ``1995'' and inserting
``$500,000 for each fiscal year''.
SEC. 419. FETAL ALCOHOL SYNDROME PREVENTION AND SERVICES.
(a) Short Title.--This section may be cited as the ``Fetal Alcohol
Syndrome and Fetal Alcohol Effect Prevention and Services Act''.
(b) Findings.--Congress finds that--
(1) Fetal Alcohol Syndrome is the leading preventable cause
of mental retardation, and it is 100 percent preventable;
(2) estimates on the number of children each year vary, but
according to some researchers, up to 12,000 infants are born in
the United States with Fetal Alcohol Syndrome, suffering
irreversible physical and mental damage;
(3) thousands more infants are born each year with Fetal
Alcohol Effect, also known as Alcohol Related Neurobehavioral
Disorder (ARND), a related and equally tragic syndrome;
(4) children of women who use alcohol while pregnant have a
significantly higher infant mortality rate (13.3 per 1000) than
children of those women who do not use alcohol (8.6 per 1000);
(5) Fetal Alcohol Syndrome and Fetal Alcohol Effect are
national problems which can impact any child, family, or
community, but their threat to American Indians and Alaska
Natives is especially alarming;
(6) in some American Indian communities, where alcohol
dependency rates reach 50 percent and above, the chances of a
newborn suffering Fetal Alcohol Syndrome or Fetal Alcohol
Effect are up to 30 times greater than national averages;
(7) in addition to the immeasurable toll on children and
their families, Fetal Alcohol Syndrome and Fetal Alcohol Effect
pose extraordinary financial costs to the Nation, including the
costs of health care, education, foster care, job training, and
general support services for affected individuals;
(8) the total cost to the economy of Fetal Alcohol Syndrome
was approximately $2,500,000,000 in 1995, and over a lifetime,
health care costs for one Fetal Alcohol Syndrome child are
estimated to be at least $1,400,000;
(9) researchers have determined that the possibility of
giving birth to a baby with Fetal Alcohol Syndrome or Fetal
Alcohol Effect increases in proportion to the amount and
frequency of alcohol consumed by a pregnant woman, and that
stopping alcohol consumption at any point in the pregnancy
reduces the emotional, physical, and mental consequences of
alcohol exposure to the baby; and
(10) though approximately 1 out of every 5 pregnant women
drink alcohol during their pregnancy, we know of no safe dose
of alcohol during pregnancy, or of any safe time to drink
during pregnancy, thus, it is in the best interest of the
Nation for the Federal Government to take an active role in
encouraging all women to abstain from alcohol consumption
during pregnancy.
(c) Purpose.--It is the purpose of this section to establish,
within the Department of Health and Human Services, a comprehensive
program to help prevent Fetal Alcohol Syndrome and Fetal Alcohol Effect
nationwide and to provide effective intervention programs and services
for children, adolescents and adults already affected by these
conditions. Such program shall--
(1) coordinate, support, and conduct national, State, and
community-based public awareness, prevention, and education
programs on Fetal Alcohol Syndrome and Fetal Alcohol Effect;
(2) coordinate, support, and conduct prevention and
intervention studies as well as epidemiologic research
concerning Fetal Alcohol Syndrome and Fetal Alcohol Effect;
(3) coordinate, support and conduct research and
demonstration projects to develop effective developmental and
behavioral interventions and programs that foster effective
advocacy, educational and vocational training, appropriate
therapies, counseling, medical and mental health, and other
supportive services, as well as models that integrate or
coordinate such services, aimed at the unique challenges facing
individuals with Fetal Alcohol Syndrome or Fetal Alcohol Effect
and their families; and
(4) foster coordination among all Federal, State and local
agencies, and promote partnerships between research
institutions and communities that conduct or support Fetal
Alcohol Syndrome and Fetal Alcohol Effect research, programs,
surveillance, prevention, and interventions and otherwise meet
the general needs of populations already affected or at risk of
being impacted by Fetal Alcohol Syndrome and Fetal Alcohol
Effect.
(d) Establishment of Program.--Title III of the Public Health
Service Act (42 U.S.C. 241 et seq.) is amended by adding at the end the
following:
``PART O--FETAL ALCOHOL SYNDROME PREVENTION AND SERVICES PROGRAM
``SEC. 399G. ESTABLISHMENT OF FETAL ALCOHOL SYNDROME PREVENTION AND
SERVICES PROGRAM.
``(a) Fetal Alcohol Syndrome Prevention, Intervention and Services
Delivery Program.--The Secretary shall establish a comprehensive Fetal
Alcohol Syndrome and Fetal Alcohol Effect prevention, intervention and
services delivery program that shall include--
``(1) an education and public awareness program to support,
conduct, and evaluate the effectiveness of--
``(A) educational programs targeting medical
schools, social and other supportive services,
educators and counselors and other service providers in
all phases of childhood development, and other relevant
service providers, concerning the prevention,
identification, and provision of services for children,
adolescents and adults with Fetal Alcohol Syndrome and
Fetal Alcohol Effect;
``(B) strategies to educate school-age children,
including pregnant and high risk youth, concerning
Fetal Alcohol Syndrome and Fetal Alcohol Effect;
``(C) public and community awareness programs
concerning Fetal Alcohol Syndrome and Fetal Alcohol
Effect; and
``(D) strategies to coordinate information and
services across affected community agencies, including
agencies providing social services such as foster care,
adoption, and social work, medical and mental health
services, and agencies involved in education,
vocational training and civil and criminal justice;
``(2) a prevention and diagnosis program to support
clinical studies, demonstrations and other research as
appropriate to--
``(A) develop appropriate medical diagnostic
methods for identifying Fetal Alcohol Syndrome and
Fetal Alcohol Effect; and
``(B) develop effective prevention services and
interventions for pregnant, alcohol-dependent women;
and
``(3) an applied research program concerning intervention
and prevention to support and conduct service demonstration
projects, clinical studies and other research models providing
advocacy, educational and vocational training, counseling,
medical and mental health, and other supportive services, as
well as models that integrate and coordinate such services,
that are aimed at the unique challenges facing individuals with
Fetal Alcohol Syndrome or Fetal Alcohol Effect and their
families.
``(b) Grants and Technical Assistance.--The Secretary may award
grants, cooperative agreements and contracts and provide technical
assistance to eligible entities described in section 399H to carry out
subsection (a).
``(c) Dissemination of Criteria.--In carrying out this section, the
Secretary shall develop a procedure for disseminating the Fetal Alcohol
Syndrome and Fetal Alcohol Effect diagnostic criteria developed
pursuant to section 705 of the ADAMHA Reorganization Act (42 U.S.C.
485n note) to health care providers, educators, social workers, child
welfare workers, and other individuals.
``(d) National Task Force.--
``(1) In general.--The Secretary shall establish a task
force to be known as the National task force on Fetal Alcohol
Syndrome and Fetal Alcohol Effect (referred to in this
subsection as the `task force') to foster coordination among
all governmental agencies, academic bodies and community groups
that conduct or support Fetal Alcohol Syndrome and Fetal
Alcohol Effect research, programs, and surveillance, and
otherwise meet the general needs of populations actually or
potentially impacted by Fetal Alcohol Syndrome and Fetal
Alcohol Effect.
``(2) Membership.--The Task Force established pursuant to
paragraph (1) shall--
``(A) be chaired by an individual to be appointed
by the Secretary and staffed by the Administration; and
``(B) include the Chairperson of the Interagency
Coordinating Committee on Fetal Alcohol Syndrome of the
Department of Health and Human Services, individuals
with Fetal Alcohol Syndrome and Fetal Alcohol Effect,
and representatives from advocacy and research
organization such as the Research Society on
Alcoholism, the FAS Family Resource Institute, the
National Organization of Fetal Alcohol Syndrome, the
Arc, the academic community, and Federal, State and
local government agencies and offices.
``(3) Functions.--The Task Force shall--
``(A) advise Federal, State and local programs and
research concerning Fetal Alcohol Syndrome and Fetal
Alcohol Effect, including programs and research
concerning education and public awareness for relevant
service providers, school-age children, women at-risk,
and the general public, medical diagnosis,
interventions for women at-risk of giving birth to
children with Fetal Alcohol Syndrome and Fetal Alcohol
Effect, and beneficial services for individuals with
Fetal Alcohol Syndrome and Fetal Alcohol Effect and
their families;
``(B) coordinate its efforts with the Interagency
Coordinating Committee on Fetal Alcohol Syndrome of the
Department of Health and Human Services; and
``(C) report on a biennial basis to the Secretary
and relevant committees of Congress on the current and
planned activities of the participating agencies.
``(4) Time for appointment.--The members of the Task Force
shall be appointed by the Secretary not later than 6 months
after the date of enactment of this part.
``SEC. 399H. ELIGIBILITY.
``To be eligible to receive a grant, or enter into a cooperative
agreement or contract under this part, an entity shall--
``(1) be a State, Indian tribal government, local
government, scientific or academic institution, or nonprofit
organization; and
``(2) prepare and submit to the Secretary an application at
such time, in such manner, and containing such information as
the Secretary may prescribe, including a description of the
activities that the entity intends to carry out using amounts
received under this part.
``SEC. 399I. AUTHORIZATION OF APPROPRIATIONS.
``(a) In General.--There are authorized to be appropriated to carry
out this part, $27,000,000 for each of the fiscal years 1999 through
2003.
``(b) Task Force.--From amounts appropriate for a fiscal year under
subsection (a), the Secretary may use not to exceed $2,000,000 of such
amounts for the operations of the National Task Force under section
399G(d).
``SEC. 399J. SUNSET PROVISION.
``This part shall not apply on the date that is 7 years after the
date on which all members of the national task force have been
appointed under section 399G(d)(1).''.
Attest:
Clerk.