[Congressional Bills 105th Congress]
[From the U.S. Government Publishing Office]
[S. 1754 Enrolled Bill (ENR)]
S.1754
One Hundred Fifth Congress
of the
United States of America
AT THE SECOND SESSION
Begun and held at the City of Washington on Tuesday,
the twenty-seventh day of January, one thousand nine hundred and ninety-
eight
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.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE; TABLE OF CONTENTS.
(a) Short Title.--This Act may be cited as the ``Health Professions
Education Partnerships Act of 1998''.
(b) Table of Contents.--The table of contents of this Act is as
follows:
Sec. 1. Short title; table of contents.
TITLE I--HEALTH PROFESSIONS EDUCATION AND FINANCIAL ASSISTANCE PROGRAMS
Subtitle A--Health Professions Education Programs
Sec. 101. Under-represented minority health professions grant program.
Sec. 102. Training in primary care medicine and dentistry.
Sec. 103. Interdisciplinary, community-based linkages.
Sec. 104. Health professions workforce information and analysis.
Sec. 105. Public health workforce development.
Sec. 106. General provisions.
Sec. 107. Preference in certain programs.
Sec. 108. Definitions.
Sec. 109. Technical amendment on National Health Service Corps.
Sec. 110. Savings provision.
Subtitle B--Nursing Workforce Development
Sec. 121. Short title.
Sec. 122. Purpose.
Sec. 123. Amendments to Public Health Service Act.
Sec. 124. Savings provision.
Subtitle C--Financial Assistance
CHAPTER 1--SCHOOL-BASED REVOLVING LOAN FUNDS
Sec. 131. Primary care loan program.
Sec. 132. Loans for disadvantaged students.
Sec. 133. Student loans regarding schools of nursing.
Sec. 134. General provisions.
CHAPTER 2--INSURED HEALTH EDUCATION ASSISTANCE LOANS TO GRADUATE
STUDENTS
Sec. 141. Health Education Assistance Loan Program.
Sec. 142. HEAL lender and holder performance standards.
Sec. 143. Insurance Program.
Sec. 144. HEAL bankruptcy.
Sec. 145. HEAL refinancing.
TITLE II--OFFICE OF MINORITY HEALTH
Sec. 201. Revision and extension of programs of Office of Minority
Health.
TITLE III--SELECTED INITIATIVES
Sec. 301. State offices of rural health.
Sec. 302. Demonstration projects regarding Alzheimer's Disease.
Sec. 303. Project grants for immunization services.
TITLE IV--MISCELLANEOUS PROVISIONS
Sec. 401. Technical corrections regarding Public Law 103-183.
Sec. 402. Miscellaneous amendments regarding PHS commissioned officers.
Sec. 403. Clinical traineeships.
Sec. 404. Project grants for screenings, referrals, and education
regarding lead poisoning.
Sec. 405. Project grants for preventive health services regarding
tuberculosis.
Sec. 406. CDC loan repayment program.
Sec. 407. Community programs on domestic violence.
Sec. 408. State loan repayment program.
Sec. 409. Authority of the director of NIH.
Sec. 410. Raise in maximum level of loan repayments.
Sec. 411. Construction of regional centers for research on primates.
Sec. 412. Peer review.
Sec. 413. Funding for trauma care.
Sec. 414. Health information and health promotion.
Sec. 415. Emergency medical services for children.
Sec. 416. Administration of certain requirements.
Sec. 417. Aids drug assistance program.
Sec. 418. National Foundation for Biomedical Research.
Sec. 419. Fetal Alcohol Syndrome prevention and services.
TITLE I--HEALTH PROFESSIONS EDUCATION AND FINANCIAL ASSISTANCE PROGRAMS
Subtitle A--Health Professions Education Programs
SEC. 101. UNDER-REPRESENTED MINORITY HEALTH PROFESSIONS GRANT
PROGRAM.
(a) In General.--Part B of title VII of the Public Health Service
Act (42 U.S.C. 293 et seq.) is amended to read as follows:
``PART B--HEALTH PROFESSIONS TRAINING FOR DIVERSITY
``SEC. 736. CENTERS OF EXCELLENCE.
``(a) In General.--The Secretary shall make grants to, and enter
into contracts with, designated health professions schools described in
subsection (c), and other public and nonprofit health or educational
entities, for the purpose of assisting the schools in supporting
programs of excellence in health professions education for under-
represented minority individuals.
``(b) Required Use of Funds.--The Secretary may not make a grant
under subsection (a) unless the designated health professions school
involved agrees, subject to subsection (c)(1)(C), to expend the grant--
``(1) to develop a large competitive applicant pool through
linkages with institutions of higher education, local school
districts, and other community-based entities and establish an
education pipeline for health professions careers;
``(2) to establish, strengthen, or expand programs to enhance
the academic performance of under-represented minority students
attending the school;
``(3) to improve the capacity of such school to train, recruit,
and retain under-represented minority faculty including the payment
of such stipends and fellowships as the Secretary may determine
appropriate;
``(4) to carry out activities to improve the information
resources, clinical education, curricula and cultural competence of
the 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 are 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 of 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, and 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 term 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 1,000) than
children of those women who do not use alcohol (8.6 per 1,000);
(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 organizations 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 appropriated 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).''.
Speaker of the House of Representatives.
Vice President of the United States and
President of the Senate.