Summary: H.R.4487 — 101st Congress (1989-1990)All Information (Except Text)

Bill summaries are authored by CRS.

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Conference report filed in House (10/25/1990)

National Health Service Corps Revitalization Amendments of 1990 -Title I: Revisions in General Program for National Health Service Corps - Amends the Public Health Service Act provisions relating to the purpose of the National Health Service Corps to require that the Secretary of Health and Human Services use the Corps to provide primary health services in health manpower shortage areas. Authorizes the Secretary to establish fellowship programs to enable certain health professionals to gain expertise in the delivery of primary health services in health manpower shortage areas.

Removes a limitation on the dollar amount of pay increases which may be granted to a Corps member during the first 36 months of service.

Removes provisions directing the Secretary, in assigning Corps members, to: (1) give priority to meeting Indian Health Service and other indian tribe or tribal organization needs; and (2) provide special consideration to homeless populations who do not have access to primary health care services.

Applies certain definitions to provisions relating to Corps scholarship and loan programs as well as to provisions relating directly to the Corps.

Requires that a complete descriptive list of health manpower shortage areas be published in the Federal Register by July 1 of each year.

Includes in the definition of "medical facility": (1) a facility operated by a city or county health department; (2) health programs or facilities operated by a tribe or tribal organization; and (3) facilities used in connection with provisions relating to health services for homeless individuals.

Allows the Secretary to assign members of the Corps to an entity to provide health services in a health manpower shortage area only if there has been (currently, will be) appropriate and efficient use of Corps members assigned to that entity for the area.

Removes certain provisions relating to procedures, priorities, and considerations in assigning Corps personnel, replacing some such provisions with similarly worded provisions. Sets forth the exclusive factors the Secretary may consider in determining the areas with the greatest shortages. Requires preparations of a list of areas that are to be given priority in the assignment of Corps members and notification of entities authorized to receive assignments of Corps members. Limits the number of entities offered as assignment choices in the Scholarship Program if the number of available Corps members is below a specified base number. Allows the Secretary, by regulation, to increase or decrease the base number.

Revises requirements regarding cost sharing with regard to small health centers.

Makes it unlawful for any hospital to deny an authorized Corps members (currently, an authorized physician or dentist Corps member) admitting privileges when other requirements are met.

Replaces provisions relating to grants and contracts for programs respecting preparation for practice of individuals subject to a service obligation with provisions: (1) concerning consideration of characteristics of Corps members in making assignments; (2) requiring certain types of counseling of Corps members; (3) authorizing the Secretary to make grants and contracts for programs to prepare individuals in the Scholarship or Loan Programs for the provision of primary health services in their assigned shortage areas; (4) requiring assistance to Corps members in establishing local professional relationships; (5) directing the Secretary to provide assistance regarding temporary relief from Corps duties in order to pursue continuing education or other interests, including vacations; and (6) directing the Secretary to form a group of health professionals to provide the temporary relief; and (7) directing the Secretary to carry out activities to determine the characteristics of health professionals who are more likely to remain in shortage areas after completion of Corps service, to determine the characteristics of shortage areas and of assignment entities that are more likely to retain Corps members after completion of corps service, and to determine the appropriate conditions for the assignment of certified nurse practitioners, certified nurse midwives, and physician assistants.

Authorizes appropriations.

Title II: Scholarship and Loan Repayment Programs of National Health Service Corps - Replaces measures providing for the establishment of the National Health Service Corps Scholarship Program with similar provisions directing the Secretary to establish such a Scholarship Program to assure, with respect to primary health services, an adequate supply of health professionals. (Current law makes no reference to primary health services.) Requires that the scholarship contract include an agreement to work as a provider of primary health services in a shortage area (currently, an agreement to work in a shortage area).

Provides for measures to recruit individuals into the Scholarship Program and to retain them in the shortage area after their period of obligated service, including authorizing the Secretary to provide assistance in the transition to private practice from obligated service for a professional remaining in a shortage area.

Alters the priorities in providing contracts under the Scholarship Program to include: (1) an individual with characteristics that increase the probability that the individual will continue to serve in a shortage area after completion of obligated service; and (2) an individual from a disadvantaged background.

Changes the required contents of an annual report mandated by current law regarding the Scholarship Program.

Replaces measures providing for the establishment of the National Health Service Corps Loan Repayment Program with similar provisions directing the Secretary to establish such a Loan Repayment Program to assure, with respect to the provision of primary health services, an adequate supply of health professionals. (Current law makes no reference to primary health services.) Requires that an agreement to work as a provider of primary health services in a shortage area (currently, an agreement to work in a shortage area) be a part of the loan repayment contract.

Changes eligibility criteria and procedures for the Loan Repayment Program.

Provides for measures to recruit individuals into the Loan Repayment Program and to retain them in the shortage area after their period of obligated service, including authorizing the Secretary to provide assistance in the transition to private practice from obligated service for a professional remaining in a shortage area.

Replaces provisions governing priorities in providing loan repayment contracts with provisions directing the Secretary to give priority to: (1) an individual who has characteristics that increase the probability that the individual will continue to serve in a shortage area after completion of obligated service; and (2) an individual from a disadvantaged background.

Allows the Secretary, if the individual agrees, to extend the aggregate period of obligated service beyond four years.

Allows Loan Program payments to be for undergraduate or graduate education, or both.

Increases the limit on the amount the Secretary may pay for each year of obligated service.

Removes provisions allowing fulfillment of a service obligation in the Indian Health Service or in a program or facility operated by a tribe or a tribal organization.

Directs the Secretary to pay, for the purpose of reimbursing an individual for tax liability which arises as a result of the loan repayments, an amount equal to 39 percent of the loan payments. Allows the Secretary to pay additional amounts for such reimbursements.

Changes the required contents of an annual report mandated by current law regarding the Loan Repayment Program.

Applies bankruptcy provisions of the Scholarship and Loan Programs to a former program known as the Public Health and National Health Service Corps Scholarship Training Program.

Establishes in the Treasury the National Health Service Corps Member Replacement Fund. Authorizes appropriations to the Fund. Allows Fund amounts to be used to make recruiting and employing payments to any entity to which a Corps member was assigned that has a need for a health professional because the Corps member breached the service contract.

Changes the due date and requires that an annual report concerning the Scholarship Program and the Loan Repayment Program cover the next five years rather than the next three years.

Authorizes appropriations, requiring set-asides in certain percentages for new scholarship recipients and for scholarship recipients in specified fields.

Title III: Grants to States for Improvements Regarding Health Services - Directs the Secretary, in making grants under existing provisions to States for State loan repayment programs, to act through the Administrator of the Health Resources and Services Administration. Requires non-Federal matching funds. Prohibits State programs from offering terms more favorable to health professionals than the Federal Program. Requires, subject to waiver, that the grants be reduced relative to the number of breached contracts. Authorizes appropriations.

Authorizes the Secretary, through the Director of the Office of Rural Health Policy, to make grants to States for improving health care in rural areas through the operation of State offices of rural health.

Requires recipient States to agree that such office will be provided with a minimum annual budget.

Authorizes appropriations.

Prohibits making grants under this program after the aggregate amounts appropriated reach a specified level.

Title IV: Health Professional Shortage Areas - Substitutes references to health professional shortage areas for references to health manpower shortage areas in specified provisions of the Public Health Service Act, the Uniformed Services Health Professions Revitalization Act of 1972, the Social Security Act, the Comprehensive Health Manpower Training Act of 1971, and the Head Start Act.

Title V: General Provisions - Specifies the effective dates of provisions of this Act.