Summary: S.1475 — 100th Congress (1987-1988)All Information (Except Text)

Bill summaries are authored by CRS.

Shown Here:
Passed Senate amended (11/18/1987)

(Measure passed Senate, amended)

Title I: Loan Repayment Program - Requires the Secretary of Health and Human Services to establish the Indian Health Service Loan Repayment Program in order to assure an adequate supply of trained physicians, dentists, nurses, and other health professionals for the Indian Health Service.

Limits participation in the program to individuals who: (1) are full-time students in the final year of a course of study in an accredited educational institution in a State approved by the Secretary; (2) are in a graduate training program in a course of study approved by the Secretary; (3) have a degree in medicine or other health profession which is approved by the Secretary; or (4) are employed by the Service on a voluntary basis without a service obligation in a qualified position.

Requires that an applicant for the Program be eligible for, or hold, an appointment as a commissioned officer in the Service or be eligible for selection for civilian employment by the Service.

Requires an applicant for the Program to submit an application and sign a contract to accept repayment of educational loans and remain in the Service for the applicable period of obligated service.

Requires the Secretary to include in the application and contract forms a summary of the rights and liabilities of an individual whose application is approved.

Allows the Secretary to approve only applications from individuals who are trained in a health profession or specialty needed for the Service and to extend a preference to Indians. Requires the Secretary to ensure nurses and other non-physician applicants equitable access to the Program.

Provides that an individual becomes a participant in the Program only upon the Secretary's approval of his application and acceptance of his contract.

Requires under the contract that: (1) the Secretary agree to pay educational loans on behalf of an individual and to accept such individual in the Service; and (2) the individual agree to accept such loan payments, remain in his course of study until completion, maintain an acceptable level of academic standing, provide certification of the degree awarded in the profession approved by the Secretary, and serve for at least two years in a health program maintained by the Service or by any Indian tribe or organization under a contract with the Secretary. Requires any contract to disclose: (1) that any financial obligation of the United States is contingent upon funds being appropriated; (2) a statement of damages to which the United States is entitled for an individual's breach of the contract; and (3) other statements of the rights and liabilities of the individual and the Secretary.

Prohibits any payments from being made under the Program to an individual unless and until the individual is a full-time employee of the Service.

Provides that a loan repayment will consist of a payment of the principal, interest, and related expenses on loans for: (1) tuition expenses; (2) other reasonable education expenses; and (3) reasonable living expenses. Limits to $25,000 the amount of loan repayments for each year of obligated service an individual agrees to service.

Provides that individuals who enter into written contracts while undergoing academic training will not be counted against any employment ceiling affecting the Department of Health and Human Services.

Requires the Secretary to submit to the Congress annual reports showing: (1) the number and type of health profession training of individuals receiving loan payments; (2) the educational institutions where such individuals are receiving their training; (3) the total number of applications filed and the number filed for each type of health profession; (4) the total number of contracts entered into and the number entered into for each profession; and (5) the amount of loan payments made.

Authorizes the Secretary to conduct recruiting programs for the Program.

Provides that the authority to detail the Service's personnel will not apply to individuals during their period of obligated service under the Program.

Requires each individual who has entered into a written contract with the Secretary to remain in the full-time clinical practice of his profession in the Service for the period required under the contract. Requires the Secretary to determine if the obligated service will be in the Regular or Reserve Corps of the Public Health Service or as a civilian employee of the Indian Health Service.

Requires the Secretary to give individuals information regarding the advantages and disadvantages of service as a commissioned officer in the Public Health Service or as a civilian employee of the Indian Health Service. Requires individuals to notify the Secretary before completing training of their desire to be an officer of the Public Health Service. Provides that if an individual does not qualify for appointment as a commissioned officer in the Public Health Service, the Secretary shall appoint such individual as a civilian employee of the Indian Health Service.

Allows the Secretary to defer an individual's training completion date to permit an internship, residency, or other advanced clinical training. Provides that no period of internship, residency, or other advanced clinical training shall be counted toward satisfying a period of obligated service.

Makes an individual liable for the amount the United States has paid on his behalf under the contract if the individual: (1) fails to maintain an acceptable level of academic standing, voluntarily terminates enrollment or is dismissed from an educational institution in the final year of a course of study; or (2) fails to complete a graduate training program.

Entitles the United States to recover specified damages from an individual who breaches his contract by failing either to begin a period of obligated service or to complete such a period. Provides that any obligation of an individual under the Loan Repayment will be cancelled upon his death. Authorizes the Secretary to waive or suspend any obligation under the Program if compliance is impossible or would involve extreme hardship. Describes conditions permitting obligations under the Program to be released by a discharge in bankruptcy.

Requires the Secretary to submit to the Congress annual reports on the number of providers of health care who will be needed for the Service, the number of scholarships the Secretary proposes to provide under the National Health Service Corps Scholarship program, and the number of individuals for whom the Secretary proposes to make loan repayments under the Loan Repayment Program during the next three fiscal years. Authorizes appropriations.

Title II: Other Recruitment and Retention Provisions - Authorizes the Secretary to reimburse health professionals seeking positions in the Service for travel expenses incurred in visiting an area where they may be assigned. Authorizes appropriations.

Requires the Secretary to award grants to Indian tribes to enable them to test innovative techniques to recruit, place, and retain health professionals. Authorizes appropriations.

Requires the Secretary to establish a program for all of the Service's employees to receive educational instruction in the history of the tribes they serve and the Service. Authorizes appropriations.

Authorizes the Secretary to provide grants to colleges and universities to expand and maintain the Indians into Medicine Program (INMED). Requires universities applying for such funds to agree to provide a program which: (1) provides recruitment for health professions to Native American communities; (2) incorporates an advisory board comprised of representatives of tribes and communities which will be served by the program; (3) provides summer preparatory programs for Native American students; (4) provides tutoring, counseling, and support for students enrolled in a health career program; and (5) employs qualified Native American staff. Requires the Secretary to report to the Congress on the INMED program. Authorizes appropriations.

Requires the Secretary to award grants to community colleges to establish or maintain programs which provide education leading to a degree or diploma in a health profession for individuals who desire to work on an Indian reservation or in a tribal clinic. Limits the first-year grant to a community college to $100,000.

Restricts the eligibility for such program to community colleges which: (1) are accredited; (2) have access to a hospital facility; (3) have entered into an agreement with an accredited college or university medical school to provide a program for recruiting students into advanced programs for health professionals and to stipulate sanctions or certifications necessary to approve internship; (4) have a qualified staff; and (5) are capable of obtaining State or regional accreditation.

Requires the Secretary to encourage community colleges to establish and maintain health training programs by providing: (1) personnel from the Service to teach courses; and (2) technical assistance to such colleges.

Directs community college health training programs receiving assistance under this Act to provide advanced training for any health professional who: (1) has received a degree or diploma in such health profession; and (2) provides clinical services on an Indian reservation, at a Service facility, or at a tribal clinic.

Authorizes appropriations.

Requires the Secretary to establish a program to enable health professionals who have worked for the Service for a substantial period to pursue advanced training or research in areas of study where a need exists. Authorizes appropriations.

Directs the Secretary to provide incentive special pay to: (1) commissioned medical officers of the Regular and Reserve Corps of the Public Health Service; assigned to positions for which recruitment or retention is difficult in the Indian Health Service; and (2) civilian medical officers of the Service assigned to positions for which recruitment is difficult. Directs the Secretary to establish and update annually a list of positions of health care professionals of the Service for which recruitment or retention is difficult and to pay a bonus to persons in such positions.

Directs the Secretary to: (1) establish programs using flexible and compressed work schedules for health professionals of the Service; and (2) report to the Congress on limitations on premium pay for overtime for Service employees. Authorizes appropriations.

Directs the Secretary to pay a retention bonus to employees of the Service who have: (1) completed three years of employment; or (2) completed service obligations as the result of acceptance of any Federal scholarship or any Federal education loan repayment; and (3) made an agreement with the Service for continued employment for at least one year. Requires that the retention bonus provide for a higher annual rate for multi-year agreements than for single year agreements, that the entire payment be made at the beginning of the term of service, and that physicians failing to complete the term of service refund the full amount. Authorizes appropriations.

Directs the Secretary to: (1) establish a three-year demonstration project which uses foreign medical graduates to assist in providing health care in Service facilities; and (2) develop a program to assess the abilities of each foreign medical graduate participating in the project, provide individualized orientation and work assignments to each participant, and prepare each participant to obtain a license as a physician assistant.

Directs the Secretary to select at least ten individuals to participate in the demonstration project who: (1) had been licensed to practice medicine in their countries of origin and had done so for at least five years; (2) are proficient in English; (3) are citizens or permanent residents of the United States; and (4) originate from countries which are friendly with the United States. Requires the Secretary to report to the Congress on the demonstration project. Authorizes appropriations.

Requires the Secretary to establish an advisory panel composed of physicians or other health professionals of the Service, representatives of tribal health boards, and a representative of an urban health care organization to investigate and report to the Congress on: (1) administrative policies and regulatory procedures which impede the recruitment of physicians and health care professionals by the Service; and (2) regulatory changes necessary to establish pay grades for Service health professionals that correspond to pay grades for health professionals of the Veterans Administration.

Amends the Indian Self-Determination and Education Assistance Act to make Indian tribes or organizations carrying out a contract, grant agreement, or cooperative agreement under this Act part of the Public Health Service with respect to claims for personal injury resulting from the performance of medical, surgical, dental, or related functions.