Text: H.R.3508 — 102nd Congress (1991-1992)All Information (Except Text)

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--H.R.3508--
H.R.3508
One Hundred Second Congress of the United States of America
AT THE SECOND SESSION
Begun and held at the City of Washington on Friday, the third day of January,
one thousand nine hundred and ninety-two
An Act
To amend the Public Health Service Act to revise and extend certain programs
relating to the education of individuals as health professionals, 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
  Extension Amendments of 1992'.
  (b) TABLE OF CONTENTS- The table of contents for this Act is as follows:
Sec. 1. Short title; table of contents.
TITLE I--HEALTH PROFESSIONS EDUCATION
Sec. 101. Table of contents regarding revised title VII of Public Health
Service Act.
Sec. 102. Revision of title VII of Public Health Service Act.
Sec. 103. Effective date.
TITLE II--NURSE EDUCATION
Sec. 201. Short title.
Sec. 202. Special project grants and contracts.
Sec. 203. Advanced nurse education.
Sec. 204. Nurse practitioner and nurse midwife programs.
Sec. 205. Special projects regarding disadvantaged individuals.
Sec. 206. Traineeships for advanced education of professional nurses.
Sec. 207. Nurse anesthetists.
Sec. 208. Student loans.
Sec. 209. Certain generally applicable provisions.
Sec. 210. Demonstration program regarding service in certain health care
facilities.
Sec. 211. Transfer of loan repayment program.
Sec. 212. Advisory council on nurses education; review committee.
Sec. 213. Evaluations.
TITLE III--MISCELLANEOUS PROVISIONS
Sec. 301. Advisory Council on Graduate Medical Education.
Sec. 302. Commission on allied health.
Sec. 303. Study regarding clinical laboratory technologists for medically
underserved and rural communities.
Sec. 304. Residency training programs in emergency medicine.
Sec. 305. Certain clinical traineeships.
Sec. 306. Special consolidated loan program.
Sec. 307. National Advisory Council on Medical Licensure.
Sec. 308. Required assurances regarding bloodborne diseases.
Sec. 309. Study on effectiveness of health professions programs.
Sec. 310. Delayed applicability of certain provisions.
Sec. 311. Certain application procedures.
Sec. 312. Certain projects.
TITLE I--HEALTH PROFESSIONS EDUCATION
SEC. 101. TABLE OF CONTENTS REGARDING REVISED TITLE VII OF PUBLIC HEALTH
SERVICE ACT.
  A table describing the contents of title VII of the Public Health Service
  Act, as amended by section 102 of this Act, is as follows:
TITLE VII--HEALTH PROFESSIONS EDUCATION
Part A--Student Loans
Subpart I--Insured Health Education Assistance Loans to Graduate Students
Sec. 701. Statement of purpose.
Sec. 702. Scope and duration of loan insurance program.
Sec. 703. Limitations on individual insured loans and on loan insurance.
Sec. 704. Sources of funds.
Sec. 705. Eligibility of borrowers and terms of insured loans.
Sec. 706. Certificate of loan insurance; effective date of insurance.
Sec. 707. Default of borrower.
Sec. 708. Risk-based premiums.
Sec. 709. Office for Health Education Assistance Loan Default Reduction.
Sec. 710. Insurance account.
Sec. 711. Powers and responsibilities of Secretary.
Sec. 712. Participation by Federal credit unions in Federal, State, and
private student loan insurance programs.
Sec. 713. Determination of eligible students.
Sec. 714. Repayment by Secretary of loans of deceased or disabled borrowers.
Sec. 715. Additional requirements for institutions and lenders.
Sec. 719. Definitions.
Sec. 720. Authorization of appropriations.
Subpart II--Federally-Supported Student Loan Funds
Sec. 721. Agreements for operation of school loan funds.
Sec. 722. Loan provisions.
Sec. 723. Medical schools and primary health care.
Sec. 724. Individuals from disadvantaged backgrounds.
Sec. 725. Administrative provisions.
Sec. 726. Provision by schools of information to students.
Sec. 727. Procedures for appeal of termination of agreements.
Sec. 728. Distribution of assets from loan funds.
Sec. 735. Authorization of appropriations; certain other funding issues.
Part B--Students From Disadvantaged Backgrounds
Sec. 736. Scholarships for students of exceptional financial need.
Sec. 737. Scholarships generally; certain other purposes.
Sec. 738. Loan repayments and fellowships regarding faculty positions.
Sec. 739. Centers of excellence.
Sec. 740. Educational assistance regarding undergraduates.
Part C--Training in Primary Health Care
Sec. 746. Area health education center programs.
Sec. 747. Family medicine.
Sec. 748. General internal medicine and general pediatrics.
Sec. 749. General practice of dentistry.
Sec. 750. Physician assistants.
Sec. 751. Podiatric medicine.
Sec. 752. General provisions for certain programs.
Part D--Training in Certain Health Professions
Subpart I--Public Health and Preventive Medicine
Sec. 761. Public health traineeships.
Sec. 762. Public health special projects.
Sec. 763. Preventive medicine; dental public health.
Sec. 765. Authorization of appropriations.
Subpart II--Allied Health Professions
Sec. 766. Traineeships.
Sec. 767. Project grants and contracts.
Subpart III--Health Administration
Sec. 771. Traineeships and special projects.
Part E--Special Training Projects
Sec. 776. Acquired immune deficiency syndrome.
Sec. 777. Geriatrics.
Part F--Miscellaneous Programs
Sec. 781. Research on certain health professions issues.
Sec. 782. Chiropractic demonstration projects.
Part G--General Provisions
Sec. 791. Preferences and required information in certain programs.
Sec. 792. Health professions data.
Sec. 793. Statistics; annual report.
Sec. 794. Prohibition against discrimination on basis of sex.
Sec. 795. Obligated service regarding certain programs.
Sec. 798. Certain general provisions.
Sec. 799. Definitions.
SEC. 102. REVISION OF TITLE VII OF PUBLIC HEALTH SERVICE ACT.
  Title VII of the Public Health Service Act (42 U.S.C. 292a et seq.) is
  amended to read as follows:
`TITLE VII--HEALTH PROFESSIONS EDUCATION
`PART A--STUDENT LOANS
`Subpart I--Insured Health Education Assistance Loans to Graduate Students
`SEC. 701. STATEMENT OF PURPOSE.
  `The purpose of this subpart is to enable the Secretary to provide a
  Federal program of student loan insurance for students in (and certain
  former students of) eligible institutions (as defined in section 719).
`SEC. 702. SCOPE AND DURATION OF LOAN INSURANCE PROGRAM.
  `(a) IN GENERAL- The total principal amount of new loans made and
  installments paid pursuant to lines of credit (as defined in section 719)
  to borrowers covered by Federal loan insurance under this subpart shall not
  exceed $350,000,000 for fiscal year 1993, $375,000,000 for fiscal year 1994,
  and $425,000,000 for fiscal year 1995. If the total amount of new loans
  made and installments paid pursuant to lines of credit in any fiscal year
  is less than the ceiling established for such year, the difference between
  the loans made and installments paid and the ceiling shall be carried
  over to the next fiscal year and added to the ceiling applicable to that
  fiscal year, and if in any fiscal year no ceiling has been established,
  any difference carried over shall constitute the ceiling for making new
  loans (including loans to new borrowers) and paying installments for such
  fiscal year. Thereafter, Federal loan insurance pursuant to this subpart may
  be granted only for loans made (or for loan installments paid pursuant to
  lines of credit) to enable students, who have obtained prior loans insured
  under this subpart, to continue or complete their educational program or
  to obtain a loan under section 705(a)(1)(B) to pay interest on such prior
  loans; but no insurance may be granted for any loan made or installment
  paid after September 30, 1998.  The total principal amount of Federal loan
  insurance available under this subsection shall be granted by the Secretary
  without regard to any apportionment for the purpose of chapter 15 of title
  31, United States Code, and without regard to any similar limitation.
  `(b) CERTAIN LIMITATIONS AND PRIORITIES-
  `(1) LIMITATIONS REGARDING LENDERS, STATES, OR AREAS- The Secretary may,
  if necessary to assure an equitable distribution of the benefits of this
  subpart, assign, within the maximum amounts specified in subsection (a),
  Federal loan insurance quotas applicable to eligible lenders, or to States
  or areas, and may from time to time reassign unused portions of these quotas.
  `(2) PRIORITY FOR CERTAIN LENDERS- In providing certificates of insurance
  under section 706 through comprehensive contracts, the Secretary shall
  give priority to eligible lenders that agree--
  `(A) to make loans to students at interest rates below the rates prevailing,
  during the period involved, for loans covered by Federal loan insurance
  pursuant to this subpart; or
  `(B) to make such loans under terms that are otherwise favorable to the
  student relative to the terms under which eligible lenders are generally
  making such loans during such period.
  `(c) AUTHORITY OF STUDENT LOAN MARKETING ASSOCIATION-
  `(1) IN GENERAL- Subject to paragraph (2), the Student Loan Marketing
  Association, established under part B of title IV of the Higher Education
  Act of 1965, is authorized to make advances on the security of, purchase,
  service, sell, consolidate, or otherwise deal in loans which are insured by
  the Secretary under this subpart, except that if any loan made under this
  subpart is included in a consolidated loan pursuant to the authority of the
  Association under part B of title IV of the Higher Education Act of 1965,
  the interest rate on such consolidated loan shall be set at the weighted
  average interest rate of all such loans offered for consolidation and the
  resultant per centum shall be rounded downward to the nearest one-eighth
  of 1 per centum, except that the interest rate shall be no less than the
  applicable interest rate of the guaranteed student loan program established
  under part B of title IV of the Higher Education Act of 1965. In the case
  of such a consolidated loan, the borrower shall be responsible for any
  interest which accrues prior to the beginning of the repayment period of
  the loan, or which accrues during a period in which principal need not
  be paid (whether or not such principal is in fact paid) by reason of any
  provision of the Higher Education Act of 1965.
  `(2) APPLICABILITY OF CERTAIN FEDERAL REGULATIONS- With respect to Federal
  regulations for lenders, this subpart may not be construed to preclude the
  applicability of such regulations to the Student Loan Marketing Association
  or to any other entity in the business of purchasing student loans, including
  such regulations with respect to applications, contracts, and due diligence.
`SEC. 703. LIMITATIONS ON INDIVIDUAL INSURED LOANS AND ON LOAN INSURANCE.
  `(a) IN GENERAL- The total of the loans made to a student in any academic
  year or its equivalent (as determined by the Secretary) which may be covered
  by Federal loan insurance under this subpart may not exceed $20,000 in the
  case of a student enrolled in a school of medicine, osteopathic medicine,
  dentistry, veterinary medicine, optometry, or podiatric medicine, and
  $12,500 in the case of a student enrolled in a school of pharmacy, public
  health, allied health, or chiropractic, or a graduate program in health
  administration or clinical psychology. The aggregate insured unpaid principal
  amount for all such insured loans made to any borrower shall not at any time
  exceed $80,000 in the case of a borrower who is or was a student enrolled in
  a school of medicine, osteopathic medicine, dentistry, veterinary medicine,
  optometry, or podiatric medicine, and $50,000 in the case of a borrower who
  is or was a student enrolled in a school of pharmacy, public health, allied
  health, or chiropractic, or a graduate program in health administration
  or clinical psychology. The annual insurable limit per student shall not
  be exceeded by a line of credit under which actual payments by the lender
  to the borrower will not be made in any year in excess of the annual limit.
  `(b) EXTENT OF INSURANCE LIABILITY- The insurance liability on any loan
  insured by the Secretary under this subpart shall be 100 percent of the
  unpaid balance of the principal amount of the loan plus interest. The full
  faith and credit of the United States is pledged to the payment of all
  amounts which may be required to be paid under the provisions of section
  707 or 714.
`SEC. 704. SOURCES OF FUNDS.
  `Loans made by eligible lenders in accordance with this subpart shall be
  insurable by the Secretary whether made from funds fully owned by the
  lender or from funds held by the lender in a trust or similar capacity
  and available for such loans.
`SEC. 705. ELIGIBILITY OF BORROWERS AND TERMS OF INSURED LOANS.
  `(a) IN GENERAL- A loan by an eligible lender shall be insurable by the
  Secretary under the provisions of this subpart only if--
  `(1) made to--
  `(A) a student who--
  `(i)(I) has been accepted for enrollment at an eligible institution, or
  (II) in the case of a student attending an eligible institution, is in
  good standing at that institution, as determined by the institution;
  `(ii) is or will be a full-time student at the eligible institution;
  `(iii) has agreed that all funds received under such loan shall be used
  solely for tuition, other reasonable educational expenses, including fees,
  books, and laboratory expenses, and reasonable living expenses, incurred
  by such students;
  `(iv) if required under section 3 of the Military Selective Service Act
  to present himself for and submit to registration under such section,
  has presented himself and submitted to registration under such section; and
  `(v) in the case of a pharmacy student, has satisfactorily completed three
  years of training; or
  `(B) an individual who--
  `(i) has previously had a loan insured under this subpart when the individual
  was a full-time student at an eligible institution;
  `(ii) is in a period during which, pursuant to paragraph (2), the principal
  amount of such previous loan need not be paid;
  `(iii) has agreed that all funds received under the proposed loan shall
  be used solely for repayment of interest due on previous loans made under
  this subpart; and
  `(iv) if required under section 3 of the Military Selective Service Act
  to present himself for and submit to registration under such section,
  has presented himself and submitted to registration under such section;
  `(2) evidenced by a note or other written agreement which--
  `(A) is made without security and without endorsement, except that if
  the borrower is a minor and such note or other written agreement executed
  by him would not, under the applicable law, create a binding obligation,
  an endorsement may be required;
  `(B) provides for repayment of the principal amount of the loan in
  installments over a period of not less than 10 years (unless sooner repaid)
  nor more than 25 years beginning not earlier than 9 months nor later than
  12 months after the date of--
  `(i) the date on which--
  `(I) the borrower ceases to be a participant in an accredited internship
  or residency program of not more than four years in duration;
  `(II) the borrower completes the fourth year of an accredited internship
  or residency program of more than four years in duration; or
  `(III) the borrower, if not a participant in a program described in
  subclause (I) or (II), ceases to carry, at an eligible institution, the
  normal full-time academic workload as determined by the institution; or
  `(ii) the date on which a borrower who is a graduate of an eligible
  institution ceases to be a participant in a fellowship training program
  not in excess of two years or a participant in a full-time educational
  activity not in excess of two years, which--
  `(I) is directly related to the health profession for which the borrower
  prepared at an eligible institution, as determined by the Secretary; and
  `(II) may be engaged in by the borrower during such a two-year period
  which begins within twelve months after the completion of the borrower's
  participation in a program described in subclause (I) or (II) of clause (i)
  or prior to the completion of the borrower's participation in such program,
except as provided in subparagraph (C), except that the period of the loan
may not exceed 33 years from the date of execution of the note or written
agreement evidencing it, and except that the note or other written instrument
may contain such provisions relating to repayment in the event of default in
the payment of interest or in the payment of the costs of insurance premiums,
or other default by the borrower, as may be authorized by regulations of
the Secretary in effect at the time the loan is made;
  `(C) provides that periodic installments of principal and interest need not
  be paid, but interest shall accrue, during any period (i) during which the
  borrower is pursuing a full-time course of study at an eligible institution
  (or at an institution defined by section 481(a) of the Higher Education
  Act of 1965); (ii) not in excess of four years during which the borrower is
  a participant in an accredited internship or residency program (including
  any period in such a program described in subclause (I) or subclause (II)
  of subparagraph (B)(i)); (iii) not in excess of three years, during which
  the borrower is a member of the Armed Forces of the United States; (iv)
  not in excess of three years during which the borrower is in service as a
  volunteer under the Peace Corps Act; (v) not in excess of three years during
  which the borrower is a member of the National Health Service Corps; (vi)
  not in excess of three years during which the borrower is in service as a
  full-time volunteer under title I of the Domestic Volunteer Service Act of
  1973; (vii) not in excess of 3 years, for a borrower who has completed an
  accredited internship or residency training program in osteopathic general
  practice, family medicine, general internal medicine, preventive medicine,
  or general pediatrics and who is practicing primary care; (viii) not in
  excess of 1 year, for borrowers who are graduates of schools of chiropractic;
  (ix) any period not in excess of two years which is described in subparagraph
  (B)(ii); and (x) in addition to all other deferments for which the borrower
  is eligible under clauses (i) through (ix), any period during which the
  borrower is a member of the Armed Forces on active duty during the Persian
  Gulf conflict, and any period described in clauses (i) through (x) shall not
  be included in determining the 25-year period described in subparagraph (B);
  `(D) provides for interest on the unpaid principal balance of the loan at
  a yearly rate, not exceeding the applicable maximum rate prescribed and
  defined by the Secretary (within the limits set forth in subsection (b))
  on a national, regional, or other appropriate basis, which interest shall be
  compounded not more frequently than annually and payable in installments over
  the period of the loan except as provided in subparagraph (C), except that
  the note or other written agreement may provide that payment of any interest
  may be deferred until not later than the date upon which repayment of the
  first installment of principal falls due or the date repayment of principal
  is required to resume (whichever is applicable) and may further provide
  that, on such date, the amount of the interest which has so accrued may be
  added to the principal for the purposes of calculating a repayment schedule;
  `(E) offers, in accordance with criteria prescribed by regulation by the
  Secretary, a schedule for repayment of principal and interest under which
  payment of a portion of the principal and interest otherwise payable at
  the beginning of the repayment period (as defined in such regulations)
  is deferred until a later time in the period;
  `(F) entitles the borrower to accelerate without penalty repayment of the
  whole or any part of the loan;
  `(G) provides that the check for the proceeds of the loan shall be made
  payable jointly to the borrower and the eligible institution in which the
  borrower is enrolled;
  `(H) notwithstanding the provisions of the Fair Debt Collection Practices
  Act, authorizes an institution or postgraduate training program attended by
  the borrower to assist in the collection of any loan that becomes delinquent,
  including providing information concerning the borrower to the Secretary
  and to past and present lenders and holders of the borrower's loans; and
  `(I) contains such other terms and conditions consistent with the provisions
  of this subpart and with the regulations issued by the Secretary pursuant to
  this subpart, as may be agreed upon by the parties to such loan, including,
  if agreed upon, a provision requiring the borrower to pay to the lender, in
  addition to principal and interest, amounts equal to the insurance premiums
  payable by the lender to the Secretary with respect to such loan; and
  `(3) subject to the consent of the student and subject to applicable law,
  the eligible lender has obtained from the student appropriate demographic
  information regarding the student, including racial or ethnic background.
  `(b) LIMITATION ON RATE OF INTEREST- The rate of interest prescribed and
  defined by the Secretary for the purpose of subsection (a)(2)(D) may not
  exceed the average of the bond equivalent rates of the 91-day Treasury
  bills auctioned for the previous quarter plus 3 percentage points, rounded
  to the next higher one-eighth of 1 percent.
  `(c) MINIMUM ANNUAL PAYMENT BY BORROWER- The total of the payments by
  a borrower during any year or any repayment period with respect to the
  aggregate amount of all loans to that borrower which are insured under
  this subpart shall not be less than the annual interest on the outstanding
  principal, except as provided in subsection (a)(2)(C), unless the borrower,
  in the written agreement described in subsection (a)(2), agrees to make
  payments during any year or any repayment period in a lesser amount.
  `(d) APPLICABILITY OF CERTAIN LAWS ON RATE OR AMOUNT OF INTEREST- No
  provision of any law of the United States (other than subsections (a)(2)(D)
  and (b)) or of any State that limits the rate or amount of interest payable
  on loans shall apply to a loan insured under this subpart.
  `(e) DETERMINATION REGARDING FORBEARANCE- Any period of time granted to a
  borrower under this subpart in the form of forbearance on the loan shall
  not be included in the 25-year total loan repayment period under subsection
  (a)(2)(C).
  `(f) LOAN REPAYMENT SCHEDULE- Lenders and holders under this subpart shall
  offer borrowers graduated loan repayment schedules that, during the first
  5 years of loan repayment, are based on the borrower's debt-to-income ratio.
  `(g) RULE OF CONSTRUCTION REGARDING DETERMINATION OF NEED OF STUDENTS- With
  respect to any determination of the financial need of a student for a loan
  covered by Federal loan insurance under this subpart, this subpart may not
  be construed to limit the authority of any school to make such allowances
  for students with special circumstances as the school determines appropriate.
  `(h) DEFINITIONS- For purposes of this section:
  `(1) The term `active duty' has the meaning given such term in section
  101(18) of title 37, United States Code, except that such term does not
  include active duty for training.
  `(2) The term `Persian Gulf conflict' means the period beginning on August
  2, 1990, and ending on the date thereafter prescribed by Presidential
  proclamation or by law.
`SEC. 706. CERTIFICATE OF LOAN INSURANCE; EFFECTIVE DATE OF INSURANCE.
  `(a) IN GENERAL-
  `(1) AUTHORITY FOR ISSUANCE OF CERTIFICATE- If, upon application by an
  eligible lender, made upon such form, containing such information, and
  supported by such evidence as the Secretary may require, and otherwise in
  conformity with this section, the Secretary finds that the applicant has
  made a loan to an eligible borrower which is insurable under the provisions
  of this subpart, he may issue to the applicant a certificate of insurance
  covering the loan and setting forth the amount and terms of the insurance.
  `(2) EFFECTIVE DATE OF INSURANCE- Insurance evidenced by a certificate of
  insurance pursuant to subsection (a)(1) shall become effective upon the date
  of issuance of the certificate, except that the Secretary is authorized, in
  accordance with regulations, to issue commitments with respect to proposed
  loans, or with respect to lines (or proposed lines) of credit, submitted by
  eligible lenders, and in that event, upon compliance with subsection (a)(1)
  by the lender, the certificate of insurance may be issued effective as of
  the date when any loan, or any payment by the lender pursuant to a line of
  credit, to be covered by such insurance is made to a student described in
  section 705(a)(1). Such insurance shall cease to be effective upon 60 days'
  default by the lender in the payment of any installment of the premiums
  payable pursuant to section 708.
  `(3) CERTAIN AGREEMENTS FOR LENDERS- An application submitted pursuant to
  subsection (a)(1) shall contain--
  `(A) an agreement by the applicant to pay, in accordance with regulations,
  the premiums fixed by the Secretary pursuant to section 708; and
  `(B) an agreement by the applicant that if the loan is covered by insurance
  the applicant will submit such supplementary reports and statements during
  the effective period of the loan agreement, upon such forms, at such
  times, and containing such information as the Secretary may prescribe by
  or pursuant to regulation.
  `(b) AUTHORITY REGARDING COMPREHENSIVE INSURANCE COVERAGE-
  `(1) IN GENERAL- In lieu of requiring a separate insurance application and
  issuing a separate certificate of insurance for each loan made by an eligible
  lender as provided in subsection (a), the Secretary may, in accordance
  with regulations consistent with section 702, issue to any eligible lender
  applying therefor a certificate of comprehensive insurance coverage which
  shall, without further action by the Secretary, insure all insurable loans
  made by that lender, on or after the date of the certificate and before
  a specified cutoff date, within the limits of an aggregate maximum amount
  stated in the certificate. Such regulations may provide for conditioning
  such insurance, with respect to any loan, upon compliance by the lender
  with such requirements (to be stated or incorporated by reference in the
  certificate) as in the Secretary's judgment will best achieve the purpose
  of this subsection while protecting the financial interest of the United
  States and promoting the objectives of this subpart, including (but not
  limited to) provisions as to the reporting of such loans and information
  relevant thereto to the Secretary and as to the payment of initial and
  other premiums and the effect of default therein, and including provision
  for confirmation by the Secretary from time to time (through endorsement of
  the certificate) of the coverage of specific new loans by such certificate,
  which confirmation shall be incontestable by the Secretary in the absence
  of fraud or misrepresentation of fact or patent error.
  `(2) LINES OF CREDIT BEYOND CUTOFF DATE- If the holder of a certificate
  of comprehensive insurance coverage issued under this subsection grants to
  a borrower a line of credit extending beyond the cutoff date specified in
  that certificate, loans or payments thereon made by the holder after that
  date pursuant to the line of credit shall not be deemed to be included in
  the coverage of that certificate except as may be specifically provided
  therein; but, subject to the limitations of section 702, the Secretary
  may, in accordance with regulations, make commitments to insure such future
  loans or payments, and such commitments may be honored either as provided in
  subsection (a) or by inclusion of such insurance in comprehensive coverage
  under this subsection for the period or periods in which such future loans
  or payments are made.
  `(c) ASSIGNMENT OF INSURANCE RIGHTS- The rights of an eligible lender
  arising under insurance evidenced by a certificate of insurance issued to
  it under this section may be assigned by such lender, subject to regulation
  by the Secretary, only to--
  `(1) another eligible lender (including a public entity in the business
  of purchasing student loans); or
  `(2) the Student Loan Marketing Association.
  `(d) EFFECT OF CONSOLIDATION OF OBLIGATIONS- The consolidation of the
  obligations of two or more federally insured loans obtained by a borrower
  in any fiscal year into a single obligation evidenced by a single instrument
  of indebtedness shall not affect the insurance by the United States. If the
  loans thus consolidated are covered by separate certificates of insurance
  issued under subsection (a), the Secretary may upon surrender of the original
  certificates issue a new certificate of insurance in accordance with that
  subsection upon the consolidated obligation. If the loans thus consolidated
  are covered by a single comprehensive certificate issued under subsection
  (b), the Secretary may amend that certificate accordingly.
  `(e) RULE OF CONSTRUCTION REGARDING CONSOLIDATION OF DEBTS- Nothing in
  this section shall be construed to preclude the lender and the borrower,
  by mutual agreement, from consolidating all of the borrower's debts into a
  single instrument under the terms applicable to an insured loan made at the
  same time as the consolidation. The lender or loan holder should provide full
  information to the borrower concerning the advantages and disadvantages of
  loan consolidation. Nothing in this section shall be construed to preclude
  the consolidation of the borrower's loans insured under this subpart under
  section 428C of the Higher Education Act of 1965. Any loans insured pursuant
  to this subpart that are consolidated under section 428C of such Act shall
  not be eligible for special allowance payments under section 438 of such Act.
`SEC. 707. DEFAULT OF BORROWER.
  `(a) CONDITIONS FOR PAYMENT TO BENEFICIARY- Upon default by the borrower on
  any loan covered by Federal loan insurance pursuant to this subpart, and
  after a substantial collection effort (including, subject to subsection
  (h), commencement and prosecution of an action) as determined under
  regulations of the Secretary, the insurance beneficiary shall promptly
  notify the Secretary and the Secretary shall, if requested (at that time
  or after further collection efforts) by the beneficiary, or may on his
  own motion, if the insurance is still in effect, pay to the beneficiary
  the amount of the loss sustained by the insured upon that loan as soon as
  that amount has been determined. Not later than one year after the date
  of the enactment of the Health Professions Education Extension Amendments
  of 1992, the Secretary shall establish performance standards for lenders
  and holders of loans under this subpart, including fees to be imposed for
  failing to meet such standards.
  `(b) SUBROGATION- Upon payment by the Secretary of the amount of the loss
  pursuant to subsection (a), the United States shall be subrogated for
  all of the rights of the holder of the obligation upon the insured loan
  and shall be entitled to an assignment of the note or other evidence of
  the insured loan by the insurance beneficiary. If the net recovery made
  by the Secretary on a loan after deduction of the cost of that recovery
  (including reasonable administrative costs) exceeds the amount of the
  loss, the excess shall be paid over to the insured. The Secretary may sell
  without recourse to eligible lenders (or other entities that the Secretary
  determines are capable of dealing in such loans) notes or other evidence
  of loans received through assignment under the first sentence.
  `(c) FORBEARANCE- Nothing in this section or in this subpart shall be
  construed to preclude any forbearance for the benefit of the borrower which
  may be agreed upon by the parties to the insured loan and approved by the
  Secretary or to preclude forbearance by the Secretary in the enforcement
  of the insured obligation after payment on that insurance.
  `(d) REASONABLE CARE AND DILIGENCE REGARDING LOANS- Nothing in this
  section or in this subpart shall be construed to excuse the eligible
  lender or holder of a federally insured loan from exercising reasonable
  care and diligence in the making of loans under the provisions of this
  subpart and from exercising a substantial effort in the collection of loans
  under the provisions of this subpart. If the Secretary, after reasonable
  notice and opportunity for hearing to an eligible lender, finds that the
  lender has failed to exercise such care and diligence, to exercise such
  substantial efforts, to make the reports and statements required under
  section 706(a)(3), or to pay the required Federal loan insurance premiums,
  he shall disqualify that lender from obtaining further Federal insurance
  on loans granted pursuant to this subpart until he is satisfied that its
  failure has ceased and finds that there is reasonable assurance that the
  lender will in the future exercise necessary care and diligence, exercise
  substantial effort, or comply with such requirements, as the case may be.
  `(e) DEFINITIONS- For purposes of this section:
  `(1) The term `insurance beneficiary' means the insured or its authorized
  assignee in accordance with section 706(c).
  `(2) The term `amount of the loss' means, with respect to a loan, unpaid
  balance of the principal amount and interest on such loan, less the amount
  of any judgment collected pursuant to default proceedings commenced by
  the eligible lender or holder involved.
  `(3) The term `default' includes only such defaults as have existed for
  120 days.
  `(f) REDUCTIONS IN FEDERAL REIMBURSEMENTS OR PAYMENTS FOR DEFAULTING
  BORROWERS- The Secretary shall, after notice and opportunity for a hearing,
  cause to be reduced Federal reimbursements or payments for health services
  under any Federal law to borrowers who are practicing their professions and
  have defaulted on their loans insured under this subpart in amounts up to
  the remaining balance of such loans. Procedures for reduction of payments
  under the medicare program are provided under section 1892 of the Social
  Security Act. Notwithstanding such section 1892, any funds recovered under
  this subsection shall be deposited in the insurance fund established under
  section 710.
  `(g) CONDITIONS FOR DISCHARGE OF DEBT IN BANKRUPTCY- A debt which is
  a loan insured under the authority of this subpart may be released by a
  discharge in bankruptcy under any chapter of title 11, United States Code,
  only if such discharge is granted--
  `(1) after the expiration of the five-year period beginning on the first
  date, as specified in subparagraphs (B) and (C) of section 705(a)(2),
  when repayment of such loan is required;
  `(2) upon a finding by the Bankruptcy Court that the nondischarge of such
  debt would be unconscionable; and
  `(3) upon the condition that the Secretary shall not have waived the
  Secretary's rights to apply subsection (f) to the borrower and the
  discharged debt.
  `(h) REQUIREMENT REGARDING ACTIONS FOR DEFAULT-
  `(1) IN GENERAL- With respect to the default by a borrower on any loan
  covered by Federal loan insurance under this subpart, the Secretary shall,
  under subsection (a), require an eligible lender or holder to commence
  and prosecute an action for such default unless--
  `(A) in the determination of the Secretary--
  `(i) the eligible lender or holder has made reasonable efforts to serve
  process on the borrower involved and has been unsuccessful with respect
  to such efforts, or
  `(ii) prosecution of such an action would be fruitless because of the
  financial or other circumstances of the borrower;
  `(B) for such loans made before the date of the enactment of the Health
  Professions Reauthorization Act of 1988, the loan involved was made in an
  amount of less than $5,000; or
  `(C) for such loans made after such date, the loan involved was made in
  an amount of less than $2,500.
  `(2) RELATIONSHIP TO CLAIM FOR PAYMENT- With respect to an eligible lender
  or holder that has commenced an action pursuant to subsection (a), the
  Secretary shall make the payment required in such subsection, or deny the
  claim for such payment, not later than 60 days after the date on which the
  Secretary determines that the lender or holder has made reasonable efforts
  to secure a judgment and collect on the judgment entered into pursuant to
  this subsection.
  `(3) STATE COURT JUDGMENTS- With respect to any State court judgment that
  is obtained by a lender or holder against a borrower for default on a loan
  insured under this subpart and that is subrogated to the United States under
  subsection (b), any United States attorney may register such judgment with
  the Federal courts for enforcement.
  `(i) INAPPLICABILITY OF FEDERAL AND STATE STATUTE OF LIMITATIONS ON ACTIONS
  FOR LOAN COLLECTION- Notwithstanding any other provision of Federal or
  State law, there shall be no limitation on 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 the Secretary, the Attorney General,
  or other administrative head of another Federal agency, as the case may be,
  for the repayment of the amount due from a borrower on a loan made under
  this subpart that has been assigned to the Secretary under subsection (b).
`SEC. 708. RISK-BASED PREMIUMS.
  `(a) AUTHORITY- With respect to a loan made under this subpart on or
  after January 1, 1993, the Secretary, in accordance with subsection (b),
  shall assess a risk-based premium on an eligible borrower and, if required
  under this section, an eligible institution that is based on the default
  rate of the eligible institution involved (as defined in section 719).
  `(b) ASSESSMENT OF PREMIUM- Except as provided in subsection (d)(2), the
  risk-based premium to be assessed under subsection (a) shall be as follows:
  `(1) LOW-RISK RATE- With respect to an eligible borrower seeking to obtain
  a loan for attendance at an eligible institution that has a default rate
  of not to exceed five percent, such borrower shall be assessed a risk-based
  premium in an amount equal to 6 percent of the principal amount of the loan.
  `(2) MEDIUM-RISK RATE-
  `(A) IN GENERAL- With respect to an eligible borrower seeking to obtain
  a loan for attendance at an eligible institution that has a default rate
  of in excess of five percent but not to exceed 10 percent--
  `(i) such borrower shall be assessed a risk-based premium in an amount
  equal to 8 percent of the principal amount of the loan; and
  `(ii) such institution shall be assessed a risk-based premium in an amount
  equal to 5 percent of the principal amount of the loan.
  `(B) DEFAULT MANAGEMENT PLAN- An institution of the type described in
  subparagraph (A) shall prepare and submit to the Secretary for approval, an
  annual default management plan, that shall specify the detailed short-term
  and long-term procedures that such institution will have in place to
  minimize defaults on loans to borrowers under this subpart. Under such plan
  the institution shall, among other measures, provide an exit interview to
  all borrowers that includes information concerning repayment schedules,
  loan deferments, forbearance, and the consequences of default.
  `(3) HIGH-RISK RATE-
  `(A) IN GENERAL- With respect to an eligible borrower seeking to obtain
  a loan for attendance at an eligible institution that has a default rate
  of in excess of 10 percent but not to exceed 20 percent--
  `(i) such borrower shall be assessed a risk-based premium in an amount
  equal to 8 percent of the principal amount of the loan; and
  `(ii) such institution shall be assessed a risk-based premium in an amount
  equal to 10 percent of the principal amount of the loan.
  `(B) DEFAULT MANAGEMENT PLAN- An institution of the type described in
  subparagraph (A) shall prepare and submit to the Secretary for approval
  a plan that meets the requirements of paragraph (2)(B).
  `(4) INELIGIBILITY- An individual shall not be eligible to obtain a loan
  under this subpart for attendance at an institution that has a default
  rate in excess of 20 percent.
  `(c) REDUCTION OF RISK-BASED PREMIUM- Lenders shall reduce by 50 percent
  the risk-based premium to eligible borrowers if a credit worthy parent or
  other responsible party co-signs the loan note.
  `(d) ADMINISTRATIVE WAIVERS-
  `(1) HEARING- The Secretary shall afford an institution not less than one
  hearing, and may consider mitigating circumstances, prior to making such
  institution ineligible for participation in the program under this subpart.
  `(2) EXCEPTIONS- In carrying out this section with respect to an institution,
  the Secretary may grant an institution a waiver of requirements of paragraphs
  (2) through (4) of subsection (b) if the Secretary determines that the
  default rate for such institution is not an accurate indicator because
  the volume of the loans under this subpart made by such institution has
  been insufficient.
  `(3) TRANSITION FOR CERTAIN INSTITUTIONS- During the 3-year period
  beginning on the effective date of the Health Professions Education
  Extension Amendments of 1992--
  `(A) subsection (b)(4) shall not apply with respect to any eligible
  institution that is a Historically Black College or University; and
  `(B) any such institution that has a default rate in excess of 20 percent,
  and any eligible borrower seeking a loan for attendance at the institution,
  shall be subject to subsection (b)(3) to the same extent and in the same
  manner as eligible institutions and borrowers described in such subsection.
  `(e) PAYOFF TO REDUCE RISK CATEGORY- An institution may pay off the
  outstanding principal and interest owed by the borrowers of such institution
  who have defaulted on loans made under this subpart in order to reduce
  the risk category of the institution.
`SEC. 709. OFFICE FOR HEALTH EDUCATION ASSISTANCE LOAN DEFAULT REDUCTION.
  `(a) ESTABLISHMENT- The Secretary shall establish, within the Division of
  Student Assistance of the Bureau of Health Professions, an office to be
  known as the Office for Health Education Assistance Loan Default Reduction
  (in this section referred to as the `Office').
  `(b) PURPOSE AND FUNCTIONS- It shall be the purpose of the Office to achieve
  a reduction in the number and amounts of defaults on loans guaranteed
  under this subpart. In carrying out such purpose the Office shall--
  `(1) conduct analytical and evaluative studies concerning loans and loan
  defaults;
  `(2) carry out activities designed to reduce loan defaults;
  `(3) respond to special circumstances that may exist in the financial
  lending environment that may lead to loan defaults;
  `(4) coordinate with other Federal entities that are involved with student
  loan programs, including--
  `(A) with respect to the Department of Education, in the development of a
  single student loan application form, a single student loan deferment form,
  a single disability form, and a central student loan database; and
  `(B) with respect to the Department of Justice, in the recovery of payments
  from health professionals who have defaulted on loans guaranteed under
  this subpart;
  `(5) provide technical assistance to borrowers, lenders, holders, and
  institutions concerning deferments and collection activities; and
  `(6)  prepare  and  submit  a  report  not  later  than March 31, 1993,
  and annually, thereafter, to the Committee on Labor and Human Resources
  of the Senate and the Committee on Energy and Commerce of the House of
  Representatives concerning--
  `(A) the default rates for each--
  `(i) institution described in section 719(1) that is participating in the
  loan programs under this subpart;
  `(ii) lender participating in the loan program under this subpart; and
  `(iii) loan holder under this subpart;
  `(B) the total amounts recovered pursuant to section 707(b) during the
  preceding fiscal year; and
  `(C) a plan for improving the extent of such recoveries during the current
  fiscal year.
  `(c) ADDITIONAL DUTIES- In conjunction with the report submitted under
  subsection (b), the Office shall--
  `(1) compile, and publish in the Federal Register, a list of the borrowers
  who are in default under this subpart; and
  `(2) send the report and notices of default with respect to these
  borrowers to relevant Federal agencies and to schools, school associations,
  professional and specialty associations, State licensing boards, hospitals
  with which such borrowers may be associated, and any other relevant
  organizations.
  `(d) ALLOCATION OF FUNDS FOR OFFICE- In the case of amounts reserved under
  section 710(a)(2)(B) for obligation under this subsection, the Secretary may
  obligate the amounts for the purpose of administering the Office, including
  7 full-time equivalent employment positions for such Office. With respect
  to such purpose, amounts made available under the preceding sentence are
  in addition to amounts made available to the Health Resources and Services
  Administration for program management for the fiscal year involved. With
  respect to such employment positions, the positions are in addition to
  the number of full-time equivalent employment positions that otherwise is
  authorized for the Department of Health and Human Services for the fiscal
  year involved.
`SEC. 710. INSURANCE ACCOUNT.
  `(a) IN GENERAL-
  `(1) ESTABLISHMENT- There is hereby established a student loan insurance
  account (in this section referred to as the `Account') which shall be
  available without fiscal year limitation to the Secretary for making
  payments in connection with the collection and default of loans insured
  under this subpart by the Secretary.
  `(2) FUNDING-
  `(A) Except as provided in subparagraph (B), all amounts received by the
  Secretary as premium charges for insurance and as receipts, earnings, or
  proceeds derived from any claim or other assets acquired by the Secretary
  in connection with his operations under this subpart, and any other moneys,
  property, or assets derived by the Secretary from the operations of the
  Secretary in connection with this section, shall be deposited in the Account.
  `(B) With respect to amounts described in subparagraph (A) that are
  received by the Secretary for any of the fiscal years 1993 through 1996, the
  Secretary may, before depositing such amounts in the Account, reserve from
  the amounts each such fiscal year not more than $1,000,000 for obligation
  under section 709(d).
  `(3) EXPENDITURES- All payments in connection with the default of loans
  insured by the Secretary under this subpart shall be paid from the Account.
  `(b) CONTINGENT AUTHORITY FOR ISSUANCE OF NOTES OR OTHER OBLIGATIONS- If
  at any time the moneys in the Account are insufficient to make payments
  in connection with the collection or default of any loan insured by the
  Secretary under this subpart, the Secretary of the Treasury may lend the
  Account such amounts as may be necessary to make the payments involved,
  subject to the Federal Credit Reform Act of 1990.
`SEC. 711. POWERS AND RESPONSIBILITIES OF SECRETARY.
  `(a) IN GENERAL- In the performance of, and with respect to, the functions,
  powers, and duties vested in the Secretary by this subpart, the Secretary
  is authorized as follows:
  `(1) To prescribe such regulations as may be necessary to carry out the
  purposes of this subpart.
  `(2) To sue and be sued in any district court of the United States. Such
  district courts shall have jurisdiction of civil actions arising under
  this subpart without regard to the amount in controversy, and any action
  instituted under this subsection by or against the Secretary shall survive
  notwithstanding any change in the person occupying the office of Secretary
  or any vacancy in that office. No attachment, injunction, garnishment,
  or other similar process, mesne or final, shall be issued against the
  Secretary or property under the control of the Secretary. Nothing herein
  shall be constructed to except litigation arising out of activities under
  this subpart from the application of sections 517 and 547 of title 28 of
  the United States Code.
  `(3) To include in any contract for Federal loan insurance such terms,
  conditions, and covenants relating to repayment of principal and payments
  of interest, relating to his obligations and rights and to those of eligible
  lenders, and borrowers in case of default, and relating to such other matters
  as the Secretary determines to be necessary to assure that the purposes
  of this subpart will be achieved. Any term, condition, and covenant made
  pursuant to this paragraph or any other provisions of this subpart may be
  modified by the Secretary if the Secretary determines that modification
  is necessary to protect the financial interest of the United States.
  `(4) Subject to the specific limitations in the subpart, to consent to
  the modification of any note or other instrument evidencing a loan which
  has been insured by him under this subpart (including modifications with
  respect to the rate of interest, time of payment of any installment of
  principal and interest or any portion thereof, or any other provision).
  `(5) To enforce, pay, compromise, waive, or release any right, title,
  claim, lien, or demand, however acquired, including any equity or any
  right or redemption.
  `(b) ANNUAL BUDGET; ACCOUNTS- The Secretary shall, with respect to the
  financial operations arising by reason of this subpart--
  `(1) prepare annually and submit a budget program as provided for wholly
  owned Government corporations by the Government Corporation Control Act; and
  `(2) maintain with respect to insurance under this subpart an integral
  set of accounts.
`SEC. 712. PARTICIPATION BY FEDERAL CREDIT UNIONS IN FEDERAL, STATE, AND
PRIVATE STUDENT LOAN INSURANCE PROGRAMS.
  `Notwithstanding any other provision of law, Federal credit unions shall,
  pursuant to regulations of the Administrator of the National Credit Union
  Administration, have power to make insured loans to eligible students
  in accordance with the provisions of this subpart relating to Federal
  insured loans.
`SEC. 713. DETERMINATION OF ELIGIBLE STUDENTS.
  `For purposes of determining eligible students under this part, in the case
  of a public school in a State that offers an accelerated, integrated program
  of study combining undergraduate premedical education and medical education
  leading to advanced entry, by contractual agreement, into an accredited
  four-year school of medicine which provides the remaining training leading
  to a degree of doctor of medicine, whenever in this part a provision refers
  to a student at a school of medicine, such reference shall include only
  a student enrolled in any of the last four years of such accelerated,
  integrated program of study.
`SEC. 714. REPAYMENT BY SECRETARY OF LOANS OF DECEASED OR DISABLED BORROWERS.
  `If a borrower who has received a loan dies or becomes permanently and
  totally disabled (as determined in accordance with regulations of the
  Secretary), the Secretary shall discharge the borrower's liability on the
  loan by repaying the amount owed on the loan from the account established
  under section 710.
`SEC. 715. ADDITIONAL REQUIREMENTS FOR INSTITUTIONS AND LENDERS.
  `(a) IN GENERAL- Notwithstanding any other provision of this subpart, the
  Secretary is authorized to prescribe such regulations as may be necessary
  to provide for--
  `(1) a fiscal audit of an eligible institution with regard to any funds
  obtained from a borrower who has received a loan insured under this subpart;
  `(2) the establishment of reasonable standards of financial responsibility
  and appropriate institutional capability for the administration by an
  eligible institution of a program of student financial aid with respect
  to funds obtained from a student who has received a loan insured under
  this subpart;
  `(3) the limitation, suspension, or termination of the eligibility under
  this subpart of any otherwise eligible institution, whenever the Secretary
  has determined, after notice and affording an opportunity for hearing,
  that such institution has violated or failed to carry out any regulation
  prescribed under this subpart;
  `(4) the collection of information from the borrower, lender, or eligible
  institution to assure compliance with the provisions of section 705;
  `(5) the assessing of tuition or fees to borrowers in amounts that are the
  same or less than the amount of tuition and fees assessed to nonborrowers;
  `(6) the submission, by the institution or the lender to the Office of Health
  Education Assistance Loan Default Reduction, of information concerning
  each loan made under this subpart, including the date when each such loan
  was originated, the date when each such loan is sold, the identity of the
  loan holder and information concerning a change in the borrower's status;
  `(7) the withholding of services, including academic transcripts, financial
  aid transcripts, and alumni services, by an institution from a borrower
  upon the default of such borrower of a loan under this subpart, except in
  case of a borrower who has filed for bankruptcy; and
  `(8) the offering, by the lender to the borrower, of a variety of repayment
  options, including fixed-rate, graduated repayment with negative amortization
  permitted, and income dependent payments for a limited period followed by
  level monthly payments.
  `(b) RECORDING BY INSTITUTION OF INFORMATION ON STUDENTS- The Secretary
  shall require an eligible institution to record, and make available to the
  lender and to the Secretary upon request, the name, address, postgraduate
  destination, and other reasonable identifying information for each student
  of such institution who has a loan insured under this subpart.
  `(c) WORKSHOP FOR STUDENT BORROWERS- Each participating eligible institution
  must have, at the beginning of each academic year, a workshop concerning
  the provisions of this subpart that all student borrowers shall be required
  to attend.
`SEC. 719. DEFINITIONS.
  `For purposes of this subpart:
  `(1) The term `eligible institution' means, with respect to a fiscal year,
  a school of medicine, osteopathic medicine, dentistry, veterinary medicine,
  optometry, podiatric medicine, pharmacy, public health, allied health, or
  chiropractic, or a graduate program in health administration or clinical
  psychology.
  `(2) The term `eligible lender' means an eligible institution that became
  a lender under this subpart prior to September 15, 1992, an agency or
  instrumentality of a State, a financial or credit institution (including
  an insurance company) which is subject to examination and supervision by
  an agency of the United States or of any State, a pension fund approved by
  the Secretary for this purpose, or a nonprofit private entity designated
  by the State, regulated by the State, and approved by the Secretary.
  `(3) The term `line of credit' means an arrangement or agreement between
  the lender and the borrower whereby a loan is paid out by the lender to
  the borrower in annual installments, or whereby the lender agrees to make,
  in addition to the initial loan, additional loans in subsequent years.
  `(4) The term `school of allied health' means a program in a school of
  allied health (as defined in section 799) which leads to a masters' degree
  or a doctoral degree.
  `(5)(A) The term `default rate', in the case of an eligible entity, means
  the percentage constituted by the ratio of--
  `(i) the principal amount of loans insured under this subpart--
  `(I) that are made with respect to the entity and that enter repayment
  status after April 7, 1987; and
  `(II) for which amounts have been paid under section 707(a) to insurance
  beneficiaries, exclusive of any loan for which amounts have been so
  paid as a result of the death or total and permanent disability of the
  borrower; exclusive of any loan for which the borrower begins payments to
  the Secretary on the loan pursuant to section 707(b) and maintains payments
  for 12 consecutive months in accordance with the agreement involved (with
  the loan subsequently being included or excluded, as the case may be, as
  amounts paid under section 707(a) according to whether further defaults
  occur and whether with respect to the default involved compliance with such
  requirement regarding 12 consecutive months occurs); and exclusive of any
  loan on which payments may not be recovered by reason of the obligation
  under the loan being discharged in bankruptcy under title 11, United States
  Code; to
  `(ii) the total principal amount of loans insured under this subpart that
  are made with respect to the entity and that enter repayment status after
  April 7, 1987.
  `(B) For purposes of subparagraph (A), a loan insured under this subpart
  shall be considered to have entered repayment status if the applicable period
  described in subparagraph (B) of section 705(a)(2) regarding the loan has
  expired (without regard to whether any period described in subparagraph
  (C) of such section is applicable regarding the loan).
  `(C) For purposes of subparagraph (A),  the term `eligible entity' means
  an eligible institution, an eligible lender, or a holder, as the case may be.
  `(D) For purposes of subparagraph (A), a loan is made with respect to an
  eligible entity if--
  `(i) in the case of an eligible institution, the loan was made to students
  of the institution;
  `(ii) in the case of an eligible lender, the loan was made by the lender; and
  `(iii) in the case of a holder, the loan was purchased by the holder.
`SEC. 720. AUTHORIZATION OF APPROPRIATIONS.
  `(a) IN GENERAL- For fiscal year 1993 and subsequent fiscal years, there
  are authorized to be appropriated such sums as may be necessary for the
  adequacy of the student loan insurance account under this subpart and for
  the purpose of administering this subpart.
  `(b) AVAILABILITY OF SUMS- Sums appropriated under subsection (a) shall
  remain available until expended.
`Subpart II--Federally-Supported Student Loan Funds
`SEC. 721. AGREEMENTS FOR OPERATION OF SCHOOL LOAN FUNDS.
  `(a) FUND AGREEMENTS- The Secretary is authorized to enter into an agreement
  for the establishment and operation of a student loan fund in accordance
  with this subpart with any public or other nonprofit school of medicine,
  osteopathic medicine, dentistry, pharmacy, podiatric medicine, optometry,
  or veterinary medicine.
  `(b) REQUIREMENTS- Each agreement entered into under this section shall--
  `(1) provide for establishment of a student loan fund by the school;
  `(2) provide for deposit in the fund of--
  `(A) the Federal capital contributions to the fund;
  `(B) an amount equal to not less than one-ninth of such Federal capital
  contributions, contributed by such institution;
  `(C) collections of principal and interest on loans made from the fund;
  `(D) collections pursuant to section 722(j); and
  `(E) any other earnings of the fund;
  `(3) provide that the fund shall be used only for loans to students of
  the school in accordance with the agreement and for costs of collection
  of such loans and interest thereon;
  `(4) provide that loans may be made from such funds only to students
  pursuing a full-time course of study at the school leading to a degree of
  doctor of medicine, doctor of dentistry or an equivalent degree, doctor
  of osteopathy, bachelor of science in pharmacy or an equivalent degree,
  doctor of pharmacy or an equivalent degree, doctor of podiatric medicine
  or an equivalent degree, doctor of optometry or an equivalent degree,
  or doctor of veterinary medicine or an equivalent degree;
  `(5) provide that the school shall advise, in writing, each applicant for
  a loan from the student loan fund of the provisions of section 722 under
  which outstanding loans from the student loan fund may be paid (in whole
  or in part) by the Secretary; and
  `(6) contain such other provisions as are necessary to protect the financial
  interests of the United States.
  `(c) FAILURE OF SCHOOL TO COLLECT LOANS-
  `(1) IN GENERAL- Any standard established by the Secretary by regulation
  for the collection by schools of medicine, osteopathic medicine, dentistry,
  pharmacy, podiatric medicine, optometry, or veterinary medicine of loans
  made pursuant to loan agreements under this subpart shall provide that
  the failure of any such school to collect such loans shall be measured in
  accordance with this subsection. This subsection may not be construed to
  require such schools to reimburse the student loan fund under this subpart
  for loans that became uncollectible prior to August 1985 or to penalize
  such schools with respect to such loans.
  `(2) EXTENT OF FAILURE- The measurement of a school's failure to collect
  loans made under this subpart shall be the ratio (stated as a percentage)
  that the defaulted principal amount outstanding of such school bears to
  the matured loans of such school.
  `(3) DEFINITIONS- For purposes of this subsection:
  `(A) The term `default' means the failure of a borrower of a loan made
  under this subpart to--
  `(i) make an installment payment when due; or
  `(ii) comply with any other term of the promissory note for such loan,
except that a loan made under this subpart shall not be considered to be in
default if the loan is discharged in bankruptcy or if the school reasonably
concludes from written contracts with the borrower that the borrower intends
to repay the loan.
  `(B) The term `defaulted principal amount outstanding' means the total amount
  borrowed from the loan fund of a school that has reached the repayment stage
  (minus any principal amount repaid or canceled) on loans--
  `(i) repayable monthly and in default for at least 120 days; and
  `(ii) repayable less frequently than monthly and in default for at least
  180 days;
  `(C) The term `grace period' means the period of one year beginning on
  the date on which the borrower ceases to pursue a full-time course of
  study at a school of medicine, osteopathic medicine, dentistry, pharmacy,
  podiatric medicine, optometry, or veterinary medicine; and
  `(D) The term `matured loans' means the total principal amount of all loans
  made by a school under this subpart minus the total principal amount of
  loans made by such school to students who are--
  `(i) enrolled in a full-time course of study at such school; or
  `(ii) in their grace period.
`SEC. 722. LOAN PROVISIONS.
  `(a) LIMITATION ON AMOUNT- Loans from a student loan fund (established
  under an agreement with a school under section 721) may not exceed for
  any student for each school year (or its equivalent) the sum of--
  `(1) the cost of tuition for such year at such school, and
  `(2) $2,500.
  `(b) TERMS AND CONDITIONS- Subject to section 723, any such loans shall
  be made on such terms and conditions as the school may determine, but may
  be made only to a student--
  `(1) who is in need of the amount thereof to pursue a full-time course
  of study at the school leading to a degree of doctor of medicine, doctor
  of dentistry or an equivalent degree, doctor of osteopathy, bachelor of
  science in pharmacy or an equivalent degree, doctor of pharmacy or an
  equivalent degree, doctor of podiatric medicine or an equivalent degree,
  doctor of optometry or an equivalent degree, or doctor of veterinary
  medicine or an equivalent degree;
  `(2) who, if pursuing a full-time course of study at the school leading to
  a degree of doctor of medicine or doctor of osteopathy, is of exceptional
  financial need (as defined by regulations of the Secretary); and
  `(3) who, if required under section 3 of the Military Selective Service
  Act to present himself for and submit to registration under such section,
  has presented himself and submitted to registration under such section.
  `(c) REPAYMENT; EXCLUSIONS FROM TEN-YEAR PERIOD- Such loans shall be
  repayable in equal or graduated periodic installments (with the right of
  the borrower to accelerate repayment) over the ten-year period which begins
  one year after the student ceases to pursue a full-time course of study at
  a school of medicine, osteopathic medicine, dentistry, pharmacy, podiatry,
  optometry, or veterinary medicine, excluding from such ten-year period--
  `(1) all periods--
  `(A) not in excess of three years of active duty performed by the borrower
  as a member of a uniformed service;
  `(B) not in excess of three years during which the borrower serves as a
  volunteer under the Peace Corps Act;
  `(C) during which the borrower participates in advanced professional
  training, including internships and residencies; and
  `(D) during which the borrower is pursuing a full-time course of study at
  such a school; and
  `(2) a period--
  `(A) not in excess of two years during which a borrower who is a full-time
  student in such a school leaves the school, with the intent to return
  to such school as a full-time student, in order to engage in a full-time
  educational activity which is directly related to the health profession
  for which the borrower is preparing, as determined by the Secretary; or
  `(B) not in excess of two years during which a borrower who is a graduate
  of such a school is a participant in a fellowship training program or a
  full-time educational activity which--
  `(i) is directly related to the health profession for which such borrower
  prepared at such school, as determined by the Secretary; and
  `(ii) may be engaged in by the borrower during such a two-year period
  which begins within twelve months after the completion of the borrower's
  participation in advanced professional training described in paragraph (1)(C)
  or prior to the completion of such borrower's participation in such training.
  `(d) CANCELLATION OF LIABILITY- The liability to repay the unpaid balance
  of such a loan and accrued interest thereon shall be canceled upon the
  death of the borrower, or if the Secretary determines that he has become
  permanently, and totally disabled.
  `(e) RATE OF INTEREST- Such loans shall bear interest, on the unpaid balance
  of the loan, computed only for periods for which the loan is repayable,
  at the rate of 5 percent per year.
  `(f) SECURITY OR ENDORSEMENT- Loans shall be made under this subpart
  without security or endorsement, except that if the borrower is a minor
  and the note or other evidence of obligation executed by him would not,
  under the applicable law, create a binding obligation, either security or
  endorsement may be required.
  `(g) TRANSFERRING AND ASSIGNING LOANS- No note or other evidence of a
  loan made under this subpart may be transferred or assigned by the school
  making the loan except that, if the borrowers transfer to another school
  participating in the program under this subpart, such note or other evidence
  of a loan may be transferred to such other school.
  `(h) CHARGE WITH RESPECT TO INSURANCE FOR CERTAIN CANCELLATIONS- Subject to
  regulations of the Secretary, a school may assess a charge with respect to
  loans made this subpart to cover the costs of insuring against cancellation
  of liability under subsection (d).
  `(i) CHARGE WITH RESPECT TO LATE PAYMENTS- Subject to regulations of the
  Secretary, and in accordance with this section, a school shall assess
  a charge with respect to a loan made under this subpart for failure of
  the borrower to pay all or any part of an installment when it is due and,
  in the case of a borrower who is entitled to deferment of the loan under
  subsection (c), for any failure to file timely and satisfactory evidence
  of such entitlement. No such charge may be made if the payment of such
  installment or the filing of such evidence is made within 60 days after the
  date on which such installment or filing is due. The amount of any such
  charge may not exceed an amount equal to 6 percent of the amount of such
  installment. The school may elect to add the amount of any such charge to
  the principal amount of the loan as of the first day after the day on which
  such installment or evidence was due, or to make the amount of the charge
  payable to the school not later than the due date of the next installment
  after receipt by the borrower of notice of the assessment of the charge.
  `(j) AUTHORITY OF SCHOOLS REGARDING RATE OF PAYMENT- A school may provide,
  in accordance with regulations of the Secretary, that during the repayment
  period of a loan from a loan fund established pursuant to an agreement
  under this subpart payments of principal and interest by the borrower
  with respect to all the outstanding loans made to him from loan funds so
  established shall be at a rate equal to not less than $15 per month.
  `(k) AUTHORITY REGARDING REPAYMENTS BY SECRETARY- Upon application by a
  person who received, and is under an obligation to repay, any loan made
  to such person as a health professions student to enable him to study
  medicine, osteopathy, dentistry, veterinary medicine, optometry, pharmacy,
  or podiatry, the Secretary may undertake to repay (without liability to
  the applicant) all or any part of such loan, and any interest or portion
  thereof outstanding thereon, upon his determination, pursuant to regulations
  establishing criteria therefor, that the applicant--
  `(1) failed to complete such studies leading to his first professional
  degree;
  `(2) is in exceptionally needy circumstances;
  `(3) is from a low-income or disadvantaged family as those terms may be
  defined by such regulations; and
  `(4) has not resumed, or cannot reasonably be expected to resume, the
  study of medicine, osteopathy, dentistry, veterinary medicine, optometry,
  pharmacy, or podiatric medicine, within two years following the date upon
  which he terminated such studies.
  `(l) COLLECTION EFFORTS BY SECRETARY- The Secretary is authorized to
  attempt to collect any loan which was made under this subpart, which is in
  default, and which was referred to the Secretary by a school with which
  the Secretary has an agreement under this subpart, on behalf of that
  school under such terms and conditions as the Secretary may prescribe
  (including reimbursement from the school's student loan fund for expenses
  the Secretary may reasonably incur in attempting collection), but only
  if the school has complied with such requirements as the Secretary may
  specify by regulation with respect to the collection of loans under this
  subpart. A loan so referred shall be treated as a debt subject to section
  5514 of title 5, United States Code. Amounts collected shall be deposited
  in the school's student loan fund. Whenever the Secretary desires the
  institution of a civil action regarding any such loan, the Secretary shall
  refer the matter to the Attorney General for appropriate action.
`SEC. 723. MEDICAL SCHOOLS AND PRIMARY HEALTH CARE.
  `(a) REQUIREMENTS FOR STUDENTS-
  `(1) IN GENERAL- Subject to the provisions of this subsection, in the case
  of student loan funds established under section 721 by schools of medicine
  or osteopathic medicine, each agreement entered into under such section
  with such a school shall provide (in addition to the provisions required
  in subsection (b) of such section) that the school will make a loan from
  such fund to a student only if the student agrees--
  `(A) to enter and complete a residency training program in primary health
  care not later than 4 years after the date on which the student graduates
  from such school; and
  `(B) to practice in such care through the date on which the loan is repaid
  in full.
  `(2) INAPPLICABILITY TO CERTAIN STUDENTS-
  `(A) The requirement established in paragraph (1) regarding the student
  loan fund of a school does not apply to a student if--
  `(i) the first loan to the student from such fund is made before July 1,
  1993; or
  `(ii) the loan is made from--
  `(I) a Federal capital contribution under section 721 that is made from
  amounts appropriated under section 724(f) (in this section referred to as an
  `exempt Federal capital contribution'); or
  `(II) a school contribution made under section 721 pursuant to such a
  Federal capital contribution (in this section referred to as an `exempt
  school contribution').
  `(B) A Federal capital contribution under section 721 may not be construed
  as being an exempt Federal capital contribution if the contribution was made
  from amounts appropriated before October 1, 1990. A school contribution under
  section 721 may not be construed as being an exempt school contribution
  if the contribution was made pursuant to a Federal capital contribution
  under such section that was made from amounts appropriated before such date.
  `(3) NONCOMPLIANCE BY STUDENT- Each agreement entered into with a student
  pursuant to paragraph (1) shall provide that, if the student fails to
  comply with the agreement--
  `(A) the balance due on the loan involved will be immediately recomputed
  from the date of issuance at an interest rate of 12 percent per year,
  compounded annually; and
  `(B) the recomputed balance will be paid not later than the expiration
  of the 3-year period beginning on the date on which the student fails to
  comply with the agreement.
  `(b) REQUIREMENTS FOR SCHOOLS-
  `(1) IN GENERAL- Subject to the provisions of this subsection, in the
  case of student loan funds established under section 721 by schools of
  medicine or osteopathic medicine, each agreement entered into under such
  section with such a school shall provide (in addition to the provisions
  required in subsection (b) of such section) that, for the 1-year period
  ending on June 30, 1994, and for the 1-year period ending on June 30 of
  each subsequent fiscal year, the school will meet not less than 1 of the
  conditions described in paragraph (2) with respect to graduates of the
  school whose date of graduation from the school occurred approximately 4
  years before the end of the 1-year period involved.
  `(2) DESCRIPTION OF CONDITIONS- With respect to graduates described in
  paragraph (1) (in this paragraph referred to as `designated graduates'),
  the conditions referred to in such paragraph for a school for a 1-year
  period are as follows:
  `(A) Not less than 50 percent of designated graduates of the school meet
  the criterion of either being in a residency training program in primary
  health care, or being engaged in a practice in such care (having completed
  such a program).
  `(B) Not less than 15 percent of the designated graduates of the school
  meet such criterion, and such percentage is not less than 5 percentage
  points above the percentage of such graduates meeting such criterion for
  the preceding 1-year period.
  `(C) In the case of schools of medicine or osteopathic medicine with student
  loans funds under section 721, the school involved is at or above the 75th
  percentile of such schools whose designated graduates meet such criterion.
  `(3) DETERMINATIONS BY SECRETARY- Not later than 90 days after the close
  of each 1-year period described in paragraph (1), the Secretary shall
  make a determination of whether the school involved has for such period
  complied with such paragraph and shall in writing inform the school of the
  determination. Such determination shall be made only after consideration
  of the report submitted to the Secretary by the school under paragraph (6).
  `(4) NONCOMPLIANCE BY SCHOOL-
  `(A)(i) Subject to subparagraph (C), each agreement under section 721 with
  a school of medicine or osteopathic medicine shall provide that, if the
  school fails to comply with paragraph (1) for a 1-year period under such
  paragraph, the school--
  `(I) will pay to the Secretary the amount applicable under subparagraph
  (B) for the period; and
  `(II) will pay such amount not later than 90 days after the school
  is informed under paragraph (3) of the determination of the Secretary
  regarding such period.
  `(ii) Any amount that a school is required to pay under clause (i) may be
  paid from the student loan fund of the school under section 721.
  `(B) For purposes of subparagraph (A), the amount applicable for a school,
  subject to subparagraph (C), is--
  `(i) for the 1-year period ending June 30, 1994, an amount equal to 10
  percent of the income received during such period by the student loan fund
  of the school under section 721;
  `(ii) for the 1-year period ending June 30, 1995, an amount equal to 20
  percent of the income received during such period by the student loan
  fund; and
  `(iii) for any subsequent 1-year period under paragraph (1), an amount
  equal to 30 percent of the income received during such period by the
  student loan fund.
  `(C) In determining the amount of income that a student loan fund has
  received for purposes of subparagraph (B), the Secretary shall exclude any
  income derived from exempt contributions. Payments made to the Secretary
  under subparagraph (A) may not be made with such contributions or with
  income derived from such contributions.
  `(5) EXPENDITURE OF PAYMENTS-
  `(A) Amounts paid to the Secretary under paragraph (4) shall be expended
  to make Federal capital contributions to student loan funds under section
  721 of schools that are in compliance with paragraph (1).
  `(B) A Federal capital contribution under section 721 may not be construed
  as being an exempt Federal capital contribution if the contribution is
  made from payments under subparagraph (A). A school contribution under
  such section may not be construed as being an exempt school contribution
  if the contribution is made pursuant to a Federal capital contribution
  from such payments.
  `(6) REPORTS BY SCHOOLS- Each agreement under section 721 with a school of
  medicine or osteopathic medicine shall provide that the school will submit
  to the Secretary a report for each 1-year period under paragraph (1) that
  provides such information as the Secretary determines to be necessary for
  carrying out this subsection. Each such report shall include statistics
  concerning the current training or practice status of all graduates of such
  school whose date of graduation from the school occurred approximately 4
  years before the end of the 1-year period involved.
  `(c) REPORTS BY SECRETARY- The Secretary shall each fiscal year submit to the
  Committee on Energy and Commerce of the House of Representatives, and the
  Committee on Labor and Human Resources of the Senate, a report regarding
  the administration of this section, including the extent of compliance
  with the requirements of this section, during the preceding fiscal year.
  `(d) DEFINITIONS- For purposes of this section:
  `(1) The term `exempt contributions' means exempt Federal capital
  contributions and exempt school contributions.
  `(2) The term `exempt Federal capital contribution' means a Federal capital
  contribution described in subclause (I) of subsection (a)(2)(A)(ii).
  `(3) The term `exempt school contribution' means a school contribution
  described in subclause (II) of subsection (a)(2)(A)(ii).
  `(4) The term `income', with respect to a student fund under section 721,
  means payments of principal and interest on any loan made from the fund,
  and any other earnings of the fund.
  `(5) The term `primary health care' means family medicine, general internal
  medicine, general pediatrics, preventive medicine, or osteopathic general
  practice.
`SEC. 724. INDIVIDUALS FROM DISADVANTAGED BACKGROUNDS.
  `(a) FUND AGREEMENTS REGARDING CERTAIN AMOUNTS- With respect to amounts
  appropriated under subsection (f), each agreement entered into under
  section 721 with a school shall provide (in addition to the provisions
  required in subsection (b) of such section) that--
  `(1) any Federal capital contribution made to the student loan fund of the
  school from such amounts, together with the school contribution appropriate
  under subsection (b)(2)(B) of such section to the amount of the Federal
  capital contribution, will be utilized only for the purpose of--
  `(A) making loans to individuals from disadvantaged backgrounds; and
  `(B) the costs of the collection of the loans and interest on the loans; and
  `(2) collections of principal and interest on loans made pursuant to
  paragraph (1), and any other earnings of the student loan fund attributable
  to amounts that are in the fund pursuant to such paragraph, will be utilized
  only for the purpose described in such paragraph.
  `(b) MINIMUM QUALIFICATIONS FOR SCHOOLS- The Secretary may not make a
  Federal capital contribution for purposes of subsection (a) for a fiscal
  year unless the health professions school involved--
  `(1) is carrying out a program for recruiting and retaining students from
  disadvantaged backgrounds, including racial and ethnic minorities; and
  `(2) is carrying out a program for recruiting and retaining minority faculty.
  `(c) CERTAIN AGREEMENTS REGARDING EDUCATION OF STUDENTS; DATE CERTAIN FOR
  COMPLIANCE- The Secretary may not make a Federal capital contribution for
  purposes of subsection (a) for a fiscal year unless the health professions
  school involved agrees--
  `(1) to ensure that adequate instruction regarding minority health issues
  is provided for in the curricula of the school;
  `(2) with respect to health clinics providing services to a significant
  number of individuals who are from disadvantaged backgrounds, including
  members of minority groups, to enter into arrangements with 1 or more such
  clinics for the purpose of providing students of the school with experience
  in providing clinical services to such individuals;
  `(3) with respect to public or nonprofit private secondary educational
  institutions and undergraduate institutions of higher education, to enter
  into arrangements with 1 or more such institutions for the purpose of
  carrying out programs regarding the educational preparation of disadvantaged
  students, including minority students, to enter the health professions and
  regarding the recruitment of such individuals into the health professions;
  `(4) to establish a mentor program for assisting disadvantaged students,
  including minority students, regarding the completion of the educational
  requirements for degrees from the school;
  `(5) to be carrying out each of the activities specified in any of paragraphs
  (1) through (4) by not later than 1 year after the date on which the first
  Federal capital contribution is made to the school for purposes of subsection
  (a); and
  `(6) to continue carrying out such activities, and the activities specified
  in paragraphs (1) and (2) of subsection (b), throughout the period during
  which the student loan fund established pursuant to section 721(b) is
  in operation.
  `(d) AVAILABILITY OF OTHER AMOUNTS- With respect to Federal capital
  contributions to student loan funds under agreements under section 721(b),
  any such contributions made before October 1, 1990, together with the
  school contributions appropriate under paragraph (2)(B) of such section
  to the amount of the Federal capital contributions, may be utilized for
  the purpose of making loans to individuals from disadvantaged backgrounds,
  subject to section 723(a)(2)(B).
  `(e) DEFINITION- For purposes of this section, the term `disadvantaged',
  with respect to an individual, shall be defined by the Secretary.
  `(f) AUTHORIZATION OF APPROPRIATIONS-
  `(1) IN GENERAL- With respect to making Federal capital contributions to
  student loan funds for purposes of subsection (a), there is authorized to
  be appropriated for such contributions $15,000,000 for fiscal year 1993.
  `(2) SPECIAL CONSIDERATION FOR CERTAIN SCHOOLS- In making Federal capital
  contributions to student loan funds for purposes of subsection (a), the
  Secretary shall give special consideration to health professions schools
  that have enrollments of underrepresented minorities above the national
  average for health professions schools.
`SEC. 725. ADMINISTRATIVE PROVISIONS.
  `The Secretary may agree to modifications of agreements or loans made
  under this subpart, and may compromise, waive, or release any right, title,
  claim, or demand of the United States arising or acquired under this subpart.
`SEC. 726. PROVISION BY SCHOOLS OF INFORMATION TO STUDENTS.
  `(a) IN GENERAL- With respect to loans made by a school under this subpart
  after June 30, 1986, each school, in order to carry out the provisions of
  sections 721 and 722, shall, at any time such school makes such a loan to a
  student under this subpart, provide thorough and adequate loan information
  on loans made under this subpart to the student. The loan information
  required to be provided to the student by this subsection shall include--
  `(1) the yearly and cumulative maximum amounts that may be borrowed by
  the student;
  `(2) the terms under which repayment of the loan will begin;
  `(3) the maximum number of years in which the loan must be repaid;
  `(4) the interest rate that will be paid by the borrower and the minimum
  amount of the required monthly payment;
  `(5) the amount of any other fees charged to the borrower by the lender;
  `(6) any options the borrower may have for deferral, cancellation,
  prepayment, consolidation, or other refinancing of the loan;
  `(7) a definition of default on the loan and a specification of the
  consequences which will result to the borrower if the borrower defaults,
  including a description of any arrangements which may be made with credit
  bureau organizations;
  `(8) to the extent practicable, the effect of accepting the loan on the
  eligibility of the borrower for other forms of student assistance; and
  `(9) a description of the actions that may be taken by the Federal Government
  to collect the loan, including a description of the type of information
  concerning the borrower that the Federal Government may disclose to (A)
  officers, employees, or agents of the Department of Health and Human
  Services, (B) officers, employees, or agents of schools with which the
  Secretary has an agreement under this subpart, or (C) any other person
  involved in the collection of a loan under this subpart.
  `(b) STATEMENT REGARDING LOAN- Each school shall, immediately prior to
  the graduation from such school of a student who receives a loan under
  this subpart after June 30, 1986, provide such student with a statement
  specifying--
  `(1) each amount borrowed by the student under this subpart;
  `(2) the total amount borrowed by the student under this subpart; and
  `(3) a schedule for the repayment of the amounts borrowed under this subpart,
  including the number, amount, and frequency of payments to be made.
`SEC. 727. PROCEDURES FOR APPEAL OF TERMINATION OF AGREEMENTS.
  `In any case in which the Secretary intends to terminate an agreement with
  a school under this subpart, the Secretary shall provide the school with a
  written notice specifying such intention and stating that the school may
  request a formal hearing with respect to such termination. If the school
  requests such a hearing within 30 days after the receipt of such notice,
  the Secretary shall provide such school with a hearing conducted by an
  administrative law judge.
`SEC. 728. DISTRIBUTION OF ASSETS FROM LOAN FUNDS.
  `(a) DISTRIBUTION AFTER TERMINATION OF FUND- If a school terminates a
  loan fund established under an agreement pursuant to section 721(b), or
  if the Secretary for good cause terminates the agreement with the school,
  there shall be a capital distribution as follows:
  `(1) The Secretary shall first be paid an amount which bears the same
  ratio to such balance in such fund on the date of termination of the fund
  as the total amount of the Federal capital contributions to such fund by
  the Secretary pursuant to section 721(b)(2)(A) bears to the total amount
  in such fund derived from such Federal capital contributions and from
  funds deposited therein pursuant to section 721(b)(2)(B).
  `(2) The remainder of such balance shall be paid to the school.
  `(b) PAYMENT OF PROPORTIONATE SHARE TO SECRETARY- If a capital distribution
  is made under subsection (a), the school involved shall, after the 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 pursuant
  to section 721(b) as was determined by the Secretary under subsection (a).
`SEC. 735. GENERAL PROVISIONS.
  `(a) DATE CERTAIN FOR APPLICATIONS- The Secretary shall from time to time
  set dates by which schools must file applications for Federal capital
  contributions.
  `(b) CONTINGENT REDUCTION IN ALLOTMENTS- If the total of the amounts
  requested for any fiscal year in such applications exceeds the amounts
  appropriated under this section for that fiscal year, the allotment to
  the loan fund of each such school shall be reduced to whichever of the
  following is the smaller: the amount requested in its application; or an
  amount which bears the same ratio to the amounts appropriated as the number
  of students estimated by the Secretary to be enrolled in such school during
  such fiscal year bears to the estimated total number of students in all
  such schools during such year. Amounts remaining after allotment under
  the preceding sentence shall be reallotted in accordance with clause (B)
  of such sentence among schools whose applications requested more than the
  amounts so allotted to their loan funds, but with such adjustments as may
  be necessary to prevent the total allotted to any such school's loan fund
  from exceeding the total so requested by it.
  `(c) ALLOTMENT OF EXCESS FUNDS- Funds available in any fiscal year for
  payment to schools under this subpart which are in excess of the amount
  appropriated pursuant to this section for that year shall be allotted
  among schools in such manner as the Secretary determines will best carry
  out the purposes of this subpart.
  `(d) PAYMENT OF INSTALLMENTS TO SCHOOLS- Allotments to a loan fund of a
  school shall be paid to it from time to time in such installments as the
  Secretary determines will not result in unnecessary accumulations in the
  loan fund at such school.
  `(e) DISPOSITION OF FUNDS RETURNED TO SECRETARY-
  `(1) EXPENDITURE FOR FEDERAL CAPITAL CONTRIBUTIONS- Subject to section
  723(b)(5), any amounts from student loan funds under section 721 that are
  returned to the Secretary by health professions schools shall be expended
  to make Federal capital contributions to such funds.
  `(2) DATE CERTAIN FOR CONTRIBUTIONS- Amounts described in paragraph (1)
  that are returned to the Secretary before the fourth quarter of a fiscal
  year shall be obligated before the end of such fiscal year, and may not be
  obligated before the fourth quarter. For purposes of the preceding sentence,
  amounts returned to the Secretary during the last quarter of a fiscal year
  are deemed to have been returned during the first three quarters of the
  succeeding fiscal year.
  `(3) PREFERENCE IN MAKING CONTRIBUTIONS- In making Federal capital
  contributions to student loans funds under section 721 for a fiscal
  year from amounts described in paragraph (1), the Secretary shall give
  preference to health professions schools of the same disciplines as
  the health professions schools returning such amounts for the period
  during which the amounts expended for such contributions were received
  by the Secretary. Any such amounts that, prior to being so returned, were
  available only for the purpose of loans under this subpart to individuals
  from disadvantaged backgrounds shall be available only for such purpose.
`PART B--STUDENTS FROM DISADVANTAGED BACKGROUNDS
`SEC. 736. SCHOLARSHIPS FOR STUDENTS OF EXCEPTIONAL FINANCIAL NEED.
  `(a) IN GENERAL- The Secretary shall make grants to public and nonprofit
  private schools of medicine, osteopathic medicine, and dentistry for
  scholarships to be awarded by the schools to full-time students thereof
  who are of exceptional financial need, subject to section 795 (relating
  to residency training and practice in primary health care).
  `(b) REQUIREMENTS REGARDING SCHOLARSHIPS-
  `(1) ACCEPTANCE FOR FULL-TIME ENROLLMENT- Scholarships may be awarded by
  a school from a grant under subsection (a) only to individuals who have
  been accepted by it for enrollment as full-time students.
  `(2) AUTHORIZED EXPENDITURES- A scholarship provided to a student for a
  school year under a grant under subsection (a) shall  consist of payment to,
  or (in accordance with paragraph (4)) on behalf of, the student of an amount
  (except as provided in section 798(c)) equivalent to the amount of--
  `(A) the tuition of the student in such school year; and
  `(B) all other reasonable educational expenses, including fees, books,
  and laboratory expenses, incurred by the student in such year.
  `(3) AUTHORITY REGARDING PAYMENTS TO EDUCATIONAL INSTITUTION- The Secretary
  may contract with an educational institution in which is enrolled a student
  who has received a scholarship with a grant under subsection (a) for the
  payment to the educational institution of the amounts of tuition and other
  reasonable educational expenses described in paragraph (2). Payment to such
  an educational institution may be made without regard to section 3324 of
  title 31, United States Code.
  `(c) AUTHORIZATION OF APPROPRIATIONS- For the purpose of making grants
  under this section, there is authorized to be appropriated $11,000,000
  for fiscal year 1993.
`SEC. 737. SCHOLARSHIPS GENERALLY; CERTAIN OTHER PURPOSES.
  `(a) ESTABLISHMENT OF PROGRAM-
  `(1) IN GENERAL- Subject to subsection (e), the Secretary may make grants
  to health professions schools for the purpose of assisting such schools
  in providing scholarships to individuals described in paragraph (2).
  `(2) ELIGIBLE INDIVIDUALS- The individuals referred to in paragraph (1)
  are individuals who--
  `(A) are from disadvantaged backgrounds; and
  `(B) are enrolled (or accepted for enrollment) as full-time students in
  such schools.
  `(3) HEALTH PROFESSIONS SCHOOLS- For purposes of this section, the term
  `health professions schools' means schools of medicine, nursing (as
  schools of nursing are defined in section 853), osteopathic medicine,
  dentistry, pharmacy, podiatric medicine, optometry, veterinary medicine,
  public health, or allied health, or schools offering graduate programs in
  clinical psychology.
  `(b) MINIMUM QUALIFICATIONS OF GRANTEES- The Secretary may not make a
  grant under subsection (a) unless the health professions school--
  `(1) is carrying out a program for recruiting and retaining students from
  disadvantaged backgrounds, including racial and ethnic minorities; and
  `(2) is carrying out a program for recruiting and retaining minority faculty.
  `(c) PREFERENCES IN PROVIDING SCHOLARSHIPS- The Secretary may not make a
  grant under subsection (a) unless the health professions school involved
  agrees that, in providing scholarships pursuant to the grant, the school
  will give preference to students--
  `(1) who are from disadvantaged backgrounds; and
  `(2) for whom the costs of attending the school would constitute a severe
  financial hardship.
  `(d) USE OF SCHOLARSHIP- A scholarship provided pursuant to subsection
  (a) for attendance at a health professions school--
  `(1) may be expended only for tuition expenses, other reasonable educational
  expenses, and reasonable living expenses incurred in such attendance; and
  `(2) may not, for any year of such attendance for which the scholarship
  is provided, provide an amount exceeding the total amount required for
  the year for the expenses specified in paragraph (1).
  `(e) PROVISIONS REGARDING PURPOSES OTHER THAN SCHOLARSHIPS-
  `(1) AUTHORITY REGARDING ASSISTANCE FOR UNDERGRADUATES- With respect to
  undergraduates who have demonstrated a commitment to pursuing a career in
  the health professions, a health professions school may expend not more than
  25 percent of a grant under subsection (a) for the purpose of providing
  financial assistance to such undergraduates in order to facilitate the
  completion of the educational requirements for such careers.
  `(2) REQUIRED ACTIVITIES OF SCHOOL- The Secretary may not make a grant
  under subsection (a) unless the health professions school involved agrees--
  `(A) to ensure that adequate instruction regarding minority health issues
  is provided for in the curricula of the school;
  `(B) with respect to health clinics providing services to a significant
  number of individuals who are from disadvantaged backgrounds, including
  members of minority groups, to enter into arrangements with 1 or more such
  clinics for the purpose of providing students of the school with experience
  in providing clinical services to such individuals;
  `(C) with respect to public or nonprofit secondary educational institutions
  and undergraduate institutions of higher education, to enter into
  arrangements with 1 or more such institutions for the purpose of carrying out
  programs regarding the educational preparation of disadvantaged students,
  including minority students, to enter the health professions and regarding
  the recruitment of such students into the health professions;
  `(D) to establish a mentor program for assisting disadvantaged students,
  including minority students, regarding the completion of the educational
  requirements for degrees from the school;
  `(E) to be carrying out the activities specified in subparagraphs (A)
  through (D) by not later than 1 year after the date on which a grant under
  subsection (a) is first made to the school; and
  `(F) to continue carrying out such activities, and the activities specified
  in paragraphs (1) and (2) of subsection (b), throughout the period during
  which the school is receiving a grant under subsection (a).
  `(3) RESTRICTIONS ON USE OF GRANT- The Secretary may not make a grant
  under subsection (a) for a fiscal year unless the health professions
  school involved agrees that the grant will not be expended to carry out
  the activities specified in paragraph (1) or (2) of subsection (b), or in
  any of subparagraphs (A) through (D) of paragraph (2) of this subsection.
  `(f) REQUIREMENT OF APPLICATION- The Secretary may not make a grant under
  subsection (a) unless an application for the grant is submitted to the
  Secretary and the application is in such form, is made in such manner,
  and contains such agreements, assurances, and information as the Secretary
  determines to be necessary to carry out this section.
  `(g) DEFINITION- For purposes of this section, the term `school of nursing'
  has the meaning given such term in section 853.
  `(h) FUNDING-
  `(1) AUTHORIZATION OF APPROPRIATIONS- For the purpose of carrying out
  this section, there are authorized to be appropriated such sums as may be
  necessary for fiscal year 1993.
  `(2) ALLOCATIONS BY SECRETARY- In making grants under subsection (a),
  the Secretary--
  `(A) shall, of the amounts appropriated under paragraph (1), make available
  30 percent for such grants to schools of nursing; and
  `(B) shall give special consideration to health professions schools that
  have enrollments of underrepresented minorities above the national average
  for health professions schools.
`SEC. 738. LOAN REPAYMENTS AND FELLOWSHIPS REGARDING FACULTY POSITIONS.
  `(a) LOAN REPAYMENTS-
  `(1) ESTABLISHMENT OF PROGRAM- The Secretary shall establish a program
  of entering into contracts with individuals described in subsection (b)
  under which the individuals agree to serve as members of the faculties of
  schools described in paragraph (3) in consideration of the Federal Government
  agreeing to pay, for each year of such service, not more than $20,000 of
  the principal and interest of the educational loans of such individuals.
  `(2) ELIGIBLE INDIVIDUALS- The individuals referred to in paragraph (1)
  are individuals from disadvantaged backgrounds who--
  `(A) have a degree in medicine, osteopathic medicine, dentistry, or another
  health profession;
  `(B) are enrolled in an approved graduate training program in medicine,
  osteopathic medicine, dentistry, or other health profession; or
  `(C) are enrolled as a full-time student--
  `(i) in an accredited (as determined by the Secretary) school described
  in paragraph (3); and
  `(ii) in the final year of a course of a study or program, offered by such
  institution and approved by the Secretary, leading to a degree from such
  a school.
  `(3) ELIGIBLE HEALTH PROFESSIONS SCHOOLS- The schools described in this
  paragraph are schools of medicine, nursing (as schools of nursing are
  defined in section 853), osteopathic medicine, dentistry, pharmacy,
  podiatric medicine, optometry, veterinary medicine, or public health,
  or schools offering graduate programs in clinical psychology.
  `(4) ADDITIONAL LIMITATION ON AMOUNT OF REPAYMENTS- Payments made under
  this subsection regarding the educational loans of an individual may not,
  for any year for which the payments are made, exceed an amount equal to
  20 percent of the outstanding principal and interest on the loans.
  `(5) REQUIREMENTS REGARDING FACULTY POSITIONS- The Secretary may not enter
  into a contract under paragraph (1) unless--
  `(A) the individual involved has entered into a contract with a school
  described in paragraph (3) to serve as a member of the faculty of the school
  for not less than 2 years, and the individual has not been a member of the
  faculty of any school at any time during the 18-month period preceding the
  date on which the Secretary receives the request of the individual for a
  contract under paragraph (1); and
  `(B) the contract referred to in subparagraph (A) provides that--
  `(i) the school will, for each year for which the individual will serve as a
  member of the faculty under the contract with the school, make payments of
  the principal and interest due on the educational loans of the individual
  for such year in an amount equal to the amount of such payments made by
  the Secretary for the year; and
  `(ii) the payments made by the school pursuant to clause (i) on behalf of
  the individual will be in addition to the pay that the individual would
  otherwise receive for serving as a member of such faculty.
  `(6) WAIVER REGARDING SCHOOL CONTRIBUTIONS- The Secretary may waive the
  requirement established in paragraph (5)(B) if the Secretary determines
  that the requirement will impose an undue financial hardship on the school
  involved. If the Secretary grants such a waiver, paragraph (4) shall not
  apply with respect to the individual involved.
  `(7) APPLICABILITY OF CERTAIN PROVISIONS- The provisions of sections 338B,
  338C, and 338E shall apply to the program established in paragraph (1) to the
  same extent and in the same manner as such provisions apply to the National
  Health Service Corps Loan Repayment Program established in subpart III of
  part D of title III, including the applicability of provisions regarding
  reimbursements for increased tax liability and regarding bankruptcy.
  `(b) FELLOWSHIPS-
  `(1) IN GENERAL- The Secretary may make grants to and enter into contracts
  with schools of medicine, osteopathic medicine, dentistry, veterinary
  medicine, optometry, podiatric medicine, pharmacy, public health, health
  administration, clinical psychology, and other public or private nonprofit
  health or educational entities of the type described in section 799, to
  assist such schools in increasing the number of underrepresented minority
  faculty members at such schools.
  `(2) APPLICATIONS- To be eligible to receive a grant or contract under
  this subsection, a school shall prepare and submit to the Secretary an
  application at such time, in such manner, and containing such information
  as the Secretary may require, including an assurance that--
  `(A) amounts received under such a grant or contract will be used to award
  a fellowship to an individual only if--
  `(i) the individual has not been a member of the faculty of any school
  at any time during the 18-month period preceding the date on which the
  individual submits a request for the fellowship; and
  `(ii) the individual meets the requirements of paragraphs (3) and (4); and
  `(B) each fellowship awarded pursuant to the grant or contract will include
  a stipend in an amount not exceeding 50 percent of the regular salary of
  a similar faculty member, or $30,000, whichever is less.
  `(3) ELIGIBILITY- To be eligible to receive a grant or contract under
  paragraph (1), an applicant shall demonstrate to the Secretary that such
  applicant has or will have the ability to--
  `(A) identify, recruit and select individuals from underrepresented
  minorities in health professions who have the potential for teaching,
  administration, or conducting research at a health professions institution;
  `(B) provide such individuals with the skills necessary to enable them to
  secure a tenured faculty position at such institution, which may include
  training with respect to pedagogical skills, program administration,
  the design and conduct of research, grants writing, and the preparation
  of articles suitable for publication in peer reviewed journals;
  `(C) provide services designed to assist such individuals in their
  preparation for an academic career, including the provision of mentors; and
  `(D) provide health services to rural or medically underserved populations.
  `(4) REQUIREMENTS- To be eligible to receive a grant or contract under
  paragraph (1) an applicant shall--
  `(A) provide an assurance that such applicant will make available (directly
  through cash donations) $1 for every $1 of Federal funds received under
  this section for the fellowship;
  `(B) provide an assurance that institutional support will be provided
  for the individual for a second year at a level that is not less than the
  total amount of Federal and institutional funds provided in the year in
  which the grant or contract was awarded;
  `(C) provide an assurance that the individual that will receive the
  fellowship will be a member of the faculty of the applicant school; and
  `(D) provide an assurance that the individual that will receive the
  fellowship will have, at a minimum, appropriate advanced preparation
  (such as a master's or doctoral degree) and special skills necessary to
  enable such individual to teach and practice.
  `(5) DEFINITION- For purposes of this subsection, the term `minority'
  means an individual from a racial or ethnic group that is underrepresented
  in the health professions.
  `(c) AUTHORIZATION OF APPROPRIATIONS- For the purpose of carrying out
  this section, there is authorized to be appropriated $4,000,000 for fiscal
  year 1993.
`SEC. 739. CENTERS OF EXCELLENCE.
  `(a) IN GENERAL- The Secretary shall make grants to health professions
  schools described in subsection (c) for the purpose of assisting the schools
  in supporting programs of excellence in health professions education for
  minority individuals.
  `(b) REQUIRED USE OF FUNDS- The Secretary may not make a grant under
  subsection (a) unless the health professions school involved agrees to
  expend the grant--
  `(1) to establish, strengthen, or expand programs to enhance the academic
  performance of minority students attending the school;
  `(2) to establish, strengthen, or expand programs to increase the number
  and quality of minority applicants to the school;
  `(3) to improve the capacity of such school to train, recruit, and retain
  minority faculty;
  `(4) with respect to minority health issues, to carry out activities to
  improve the information resources and curricula of the school and clinical
  education at the school; and
  `(5) to facilitate faculty and student research on health issues particularly
  affecting minority groups.
  `(c) CENTERS OF EXCELLENCE-
  `(1) IN GENERAL-
  `(A) The health professions schools referred to in subsection (a) are such
  schools that meet each of the conditions specified in subparagraph (B),
  and that--
  `(i) meet each of the conditions specified in paragraph (2)(A);
  `(ii) meet each of the conditions specified in paragraph (3);
  `(iii) meet each of the conditions specified in paragraph (4); or
  `(iv) meet each of the conditions specified in paragraph (5).
  `(B) The conditions specified in this subparagraph are that a health
  professions school--
  `(i) has a significant number of minority individuals enrolled in the
  school, including individuals accepted for enrollment in the school;
  `(ii) has been effective in assisting minority students of the school to
  complete the program of education and receive the degree involved;
  `(iii) has been effective in recruiting minority individuals to attend the
  school, including providing scholarships and other financial assistance to
  such individuals and encouraging minority students of secondary educational
  institutions to attend the health professions school; and
  `(iv) has made significant recruitment efforts to increase the number of
  minority individuals serving in faculty or administrative positions at
  the school.
  `(C) In the case of any criteria established by the Secretary for purposes
  of determining whether schools meet the conditions described in subparagraph
  (B), this section may not, with respect to racial and ethnic minorities,
  be construed to authorize, require, or prohibit the use of such criteria
  in any program other than the program established in this section.
  `(2) CENTERS OF EXCELLENCE AT CERTAIN HISTORICALLY BLACK COLLEGES AND
  UNIVERSITIES-
  `(A) The conditions specified in this subparagraph are that a health
  professions school--
  `(i) is a school described in section 799(1); and
  `(ii) received a contract under section 788B for fiscal year 1987, as such
  section was in effect for such fiscal year.
  `(B) In addition to the purposes described in subsection (b), a grant
  under subsection (a) to a health professions school meeting the conditions
  described in subparagraph (A) may be expended--
  `(i) to develop a plan to achieve institutional improvements, including
  financial independence, to enable the school to support programs of
  excellence in health professions education for minority individuals; and
  `(ii) to provide improved access to the library and informational resources
  of the school.
  `(3) HISPANIC CENTERS OF EXCELLENCE- The conditions specified in this
  paragraph are that--
  `(A) with respect to Hispanic individuals, each of clauses (i) through (iv)
  of paragraph (1)(B) applies to the health professions school involved; and
  `(B) the health professions school agree, as a condition of receiving a
  grant under subsection (a), that the school will, in carrying out the
  duties described in subsection (b), give priority to carrying out the
  duties with respect to Hispanic individuals.
  `(4) NATIVE AMERICAN CENTERS OF EXCELLENCE- Subject to subsection (e),
  the conditions specified in this paragraph are that--
  `(A) with respect to Native Americans, each of clauses (i) through (iv)
  of paragraph (1)(B) applies to the health professions school involved;
  `(B) the health professions school agree, as a condition of receiving a
  grant under subsection (a), that the school will, in carrying out the
  duties described in subsection (b), give priority to carrying out the
  duties with respect to Native Americans; and
  `(C) the health professions school agree, as a condition of receiving a
  grant under subsection (a), that--
  `(i) the school will establish an arrangement with 1 or more public
  or nonprofit private institutions of higher education whose enrollment
  of students has traditionally included a significant number of Native
  Americans, the purpose of which arrangement will be to carry out a program--
  `(I) to identify Native American students of the institution who are
  interested in a career in the health profession or professions involved; and
  `(II) to facilitate the educational preparation of such students to enter
  the health professions school; and
  `(ii) the health professions school will make efforts to recruit Native
  American students, including students who have participated in the
  undergraduate program carried out under arrangements established by the
  school pursuant to clause (i) and will assist Native American students
  regarding the completion of the educational requirements for a degree from
  the health professions school.
  `(5) OTHER CENTERS OF EXCELLENCE- The conditions specified in this paragraph
  are that a health professions school has an enrollment of underrepresented
  minorities above the national average for such enrollments of health
  professions schools.
  `(d) DESIGNATION AS CENTER OF EXCELLENCE-
  `(1) IN GENERAL- Any health professions school receiving a grant under
  subsection (a) and meeting the conditions described in paragraph (2) or (5)
  of subsection (c) shall, for purposes of this section, be designated by the
  Secretary as a Center of Excellence in Minority Health Professions Education.
  `(2) HISPANIC CENTERS OF EXCELLENCE- Any health professions school receiving
  a grant under subsection (a) and meeting the conditions described in
  subsection (c)(3) shall, for purposes of this section, be designated by the
  Secretary as a Hispanic Center of Excellence in Health Professions Education.
  `(3) NATIVE AMERICAN CENTERS OF EXCELLENCE- Any health professions school
  receiving a grant under subsection (a) and meeting the conditions described
  in subsection (c)(4) shall, for purposes of this section, be designated
  by the Secretary as a Native American Center of Excellence in Health
  Professions Education. Any consortium receiving such a grant pursuant to
  subsection (e) shall, for purposes of this section, be so designated.
  `(e) AUTHORITY REGARDING NATIVE AMERICAN CENTERS OF EXCELLENCE-
  `(1) AUTHORITY FOR COLLECTIVELY MEETING RELEVANT REQUIREMENTS- With respect
  to meeting the conditions specified in subsection (c)(4), the Secretary may
  make a grant under subsection (a) to any school of medicine, osteopathic
  medicine, dentistry, or pharmacy that has in accordance with paragraph (2)
  formed a consortium of schools that meets such conditions (without regard
  to whether the schools of the consortium individually meet such conditions).
  `(2) REQUIREMENTS REGARDING CONSORTIUM- A consortium of schools has been
  formed in accordance with this paragraph if--
  `(A) the consortium consists of a school seeking a grant pursuant to
  paragraph (1) and 1 or more schools of medicine, osteopathic medicine,
  dentistry, pharmacy, nursing, allied health, or public health;
  `(B) the schools of the consortium have entered into an agreement for the
  allocation of such grant among the schools;
  `(C) each of the schools agrees to expend the grant in accordance with
  this section; and
  `(D) each of the schools of the consortium--
  `(i) is part of the same institution of higher education as the school
  seeking the grant; or
  `(ii) is located not farther than 50 miles from the school seeking the grant.
  `(f) DURATION AND AMOUNT OF GRANT-
  `(1) DURATION- The period during which payments are made under a grant under
  subsection (a) may not exceed 3 years. Such payments shall be subject to
  annual approval by the Secretary and to the availability of appropriations
  for the fiscal year involved to make the payments.
  `(2) AMOUNT- A grant under subsection (a) for a fiscal year may not be
  made in an amount that is less than $500,000.
  `(g) MAINTENANCE OF EFFORT-
  `(1) IN GENERAL- With respect to activities for which a grant under
  subsection (a) is authorized to be expended, the Secretary may not make
  such a grant to a health professions school for any fiscal year unless
  the school agrees to maintain expenditures of non-Federal amounts for such
  activities at a level that is not less than the level of such expenditures
  maintained by the school for the fiscal year preceding the fiscal year
  for which the school receives such a grant.
  `(2) USE OF FEDERAL FUNDS- With respect to any Federal amounts received
  by a health professions school and available for carrying out activities
  for which a grant under subsection (a) is authorized to be expended,
  the Secretary may not make such a grant to the school for any fiscal year
  unless the school agrees that the school will, before expending the grant,
  expend the Federal amounts obtained from sources other than the grant.
  `(h) DEFINITIONS- For purposes of this section:
  `(1)(A) The term `health professions school' means, except as provided in
  subparagraph (B), a school of medicine, a school of osteopathic medicine,
  a school of dentistry, or a school of pharmacy.
  `(B) The definition established in subparagraph (A) shall not apply to
  the use of the term `health professions school' for purposes of subsection
  (c)(2).
  `(2) The term `program of excellence' means any program carried out by a
  health professions school with a grant made under subsection (a), if the
  program is for purposes for which the school involved is authorized in
  subsection (b) or (c) to expend the grant.
  `(3) The term `Native Americans' means American Indians, Alaskan Natives,
  Aleuts, and Native Hawaiians.
  `(i) FUNDING-
  `(1) AUTHORIZATION OF APPROPRIATIONS- For the purpose of making grants
  under subsection (a), there are authorized to be appropriated such sums
  as may be necessary for fiscal year 1993.
  `(2) ALLOCATIONS BY SECRETARY-
  `(A) Of the amounts appropriated under paragraph (1) for a fiscal year,
  the Secretary shall make available $12,000,000 for grants under subsection
  (a) to health professions schools that are eligible for such grants pursuant
  to meeting the conditions described in paragraph (2)(A) of subsection (c).
  `(B) Of the amounts appropriated under paragraph (1) for a fiscal year and
  available after compliance with subparagraph (A), the Secretary shall make
  available 60 percent for grants under subsection (a) to health professions
  schools that are eligible for such grants pursuant to meeting the conditions
  described in paragraph (3) or (4) of subsection (c) (including meeting
  conditions pursuant to subsection (e)).
  `(C) Of the amounts appropriated under paragraph (1) for a fiscal year and
  available after compliance with subparagraph (A), the Secretary shall make
  available 40 percent for grants under subsection (a) to health professions
  schools that are eligible for such grants pursuant to meeting the conditions
  described in paragraph (5) of subsection (c).
`SEC. 740. EDUCATIONAL ASSISTANCE REGARDING UNDERGRADUATES.
  `(a) IN GENERAL-
  `(1) AUTHORITY FOR GRANTS- For the purpose of assisting individuals from
  disadvantaged backgrounds, as determined in accordance with criteria
  prescribed by the Secretary, to undertake education to enter a health
  profession, the Secretary may make grants to and enter into contracts
  with schools of medicine, osteopathic medicine, public health, dentistry,
  veterinary medicine, optometry, pharmacy, allied health, chiropractic,
  and podiatric medicine, public and nonprofit private schools which offer
  graduate programs in clinical psychology, and other public or private
  nonprofit health or educational entities to assist in meeting the costs
  described in paragraph (2).
  `(2) AUTHORIZED EXPENDITURES- A grant or contract under paragraph (1)
  may be used by the health or educational entity to meet the cost of--
  `(A) identifying, recruiting, and selecting individuals from disadvantaged
  backgrounds, as so determined, for education and training in a health
  profession,
  `(B) facilitating the entry of such individuals into such a school,
  `(C) providing counseling or other services designed to assist such
  individuals to complete successfully their education at such a school,
  `(D) providing, for a period prior to the entry of such individuals into
  the regular course of education of such a school, preliminary education
  designed to assist them to complete successfully such regular course of
  education at such a school, or referring such individuals to institutions
  providing such preliminary education,
  `(E) publicizing existing sources of financial aid available to students
  in the education program of such a school or who are undertaking training
  necessary to qualify them to enroll in such a program,
  `(F) paying such scholarships as the Secretary may determine for such
  individuals for any period of health professions education at a school of
  medicine, osteopathic medicine, or dentistry,
  `(G) paying such stipends as the Secretary may approve for such individuals
  for any period of education in student-enhancement programs (other than
  regular courses) at any school described in subsection (a)(1), except that
  such a stipend may not be provided to an individual for more than 12 months,
  and such a stipend shall be in an amount of $40 per day (notwithstanding
  any other provision of law regarding the amount of stipends).
The term `regular course of education of such a school' as used in subparagraph
(D) includes a graduate program in clinical psychology.
  `(b) REQUIREMENTS REGARDING ENROLLMENT; PRIORITY IN MAKING GRANTS-
  `(1) INCREASED ENROLLMENT OF INDIVIDUALS FROM DISADVANTAGED BACKGROUNDS-
  Schools of medicine, osteopathic medicine, public health, dentistry,
  veterinary medicine, optometry, pharmacy, allied health, chiropractic,
  podiatric medicine and public and nonprofit schools that offer graduate
  programs in clinical psychology that receive a grant under subsection
  (a) shall, during a period of 3 years commencing on the date of the award
  of the grant, increase their first year enrollments of individuals from
  disadvantaged backgrounds by at least 20 percent over enrollments in the
  base year 1987.
  `(2) CONDITIONS FOR SCHOOLS TO RECEIVE PRIORITY- The Secretary shall give
  priority for funding, in years subsequent to the expiration of the 3-year
  period described in paragraph (1)--
  `(A) to schools that attain such increase in their first year enrollment
  by the end of such 3-year period, and
  `(B) to schools that attain a 20 percent increase over such base year
  enrollment.
  `(3) APPLICABILITY OF CERTAIN CONDITION FOR PRIORITY- The requirement
  for at least a 20 percent increase in such enrollment shall apply only
  to those schools referred to in paragraph (1) that have a proportionate
  enrollment of such individuals from disadvantaged backgrounds that is less
  than 200 percent of the national average percentage of such individuals
  in all schools of each health professions discipline.
  `(4) DETERMINATION OF ENROLLMENT- Determination of both first year and
  total enrollment of such individuals shall be made by the Secretary in
  accordance with section 792.
  `(c) EQUITABLE ALLOCATION OF FINANCIAL ASSISTANCE- The Secretary shall
  ensure that services and activities under subsection (a) are equitably
  allocated among the various racial and ethnic populations.
  `(d) FUNDING-
  `(1) AUTHORIZATION OF APPROPRIATIONS- For the purpose of grants and contracts
  under subsection (a)(1), there is authorized to be appropriated $31,500,000
  for fiscal year 1993.
  `(2) ALLOCATIONS- Of the amounts appropriated under paragraph (1) for
  any fiscal year, the Secretary shall obligate amounts in accordance with
  the following:
  `(A) 70 percent shall be obligated for grants or contracts to institutions
  of higher education.
  `(B) 20 percent shall be obligated for scholarships under subsection
  (a)(2)(F) to individuals of exceptional financial need (as defined by
  the Secretary under section 736) who are students at schools of medicine,
  osteopathic medicine, or dentistry. The provision of such scholarships to
  such individuals shall be subject to section 795 (relating to residency
  training and practice in primary health care). Such scholarships shall
  be administered and awarded in the same manner and subject to the same
  requirements as scholarships under section 736.
  `(C) 10 percent shall be obligated for community-based programs.
  `(D) Not more than 5 percent may be obligated for grants and contracts
  having the primary purpose of informing individuals about the existence
  and general nature of health careers.
`PART C--TRAINING IN PRIMARY HEALTH CARE
`SEC. 746. AREA HEALTH EDUCATION CENTER PROGRAMS.
  `(a) AUTHORITY FOR PROVISION OF FINANCIAL ASSISTANCE-
  `(1) ASSISTANCE FOR PLANNING, DEVELOPMENT, AND OPERATION OF PROGRAMS-
  `(A) The Secretary shall provide financial assistance to schools of medicine
  and osteopathic medicine for the planning, development, and operation of
  area health education center programs.
  `(B)(i) Subject to clause (ii), the period during which payments are made
  from an award under subparagraph (A) may not exceed 12 years. The provision
  of the payments shall be subject to annual approval by the Secretary of
  the payments and subject to the availability of appropriations for the
  fiscal year involved to make the payments. The preceding sentence may not
  be construed as establishing a limitation on the number of awards under
  such subparagraph that may be made to the school involved.
  `(ii) In the case of an area health education center planned, developed,
  or operated with an award under subparagraph (A), the period during which
  the award is expended for the center may not exceed 6 years.
  `(2) ASSISTANCE FOR CERTAIN PROJECTS OF EXISTING PROGRAMS-
  `(A) The Secretary shall provide financial assistance to schools of medicine
  and osteopathic medicine--
  `(i) which have previously received Federal financial assistance for
  an area health education center program under section 802 of the Health
  Professionals Educational Assistance Act of 1976 in fiscal year 1979 or
  under paragraph (1), or
  `(ii) which are receiving assistance under paragraph (1),
to carry out projects described in subparagraph (B) through area health
education centers for which Federal financial assistance was provided under
paragraph (1) and which are no longer eligible to receive such assistance.
  `(B) Projects for which assistance may be provided under subparagraph
  (A) are--
  `(i) projects to improve the distribution, supply, quality, utilization,
  and efficiency of health personnel in the health services delivery system;
  `(ii) projects to encourage the regionalization of educational
  responsibilities of the health professions schools; and
  `(iii) projects designed to prepare, through preceptorships and other
  programs, individuals subject to a service obligation under the National
  Health Service Corps Scholarship Program to effectively provide health
  services in health professional shortage areas.
  `(C) In the case of the requirement established in section 3804(e)(1) of
  part 57 of title 42, Code of Federal Regulations (42 CFR 57.3804(e)(1))
  (relating to the location of area health education centers), the Secretary
  shall waive such requirement with respect to an area health education center
  having, at the time of initial application for financial assistance under
  this section or under a previous authorizing law, an operating program
  supported by both appropriations of a State legislature and local resources.
  `(3) ASSISTANCE FOR OPERATION OF MODEL PROGRAMS-
  `(A) In the case of any school of medicine or osteopathic medicine that
  is operating an area health education center program and that is not
  receiving financial assistance under paragraph (1), the Secretary may
  provide financial assistance to the school for the costs of operating the
  program, and for carrying out activities described in subparagraph (E), if
  the school makes the agreements described in subparagraphs (B) through (D).
  `(B)(i) For purposes of subparagraph (A), the agreement described in this
  subparagraph for a school is that, with respect to the costs of operating
  the area health education center program of the school, the school will make
  available (directly or through donations from public or private entities)
  non-Federal contributions in cash toward such costs in an amount that is
  not less than 50 percent of such costs.
  `(ii) Amounts provided by the Federal Government may not be included
  in determining the amount of non-Federal contributions in cash made for
  purposes of the requirement established in clause (i).
  `(C) For purposes of subparagraph (A), the agreement described in this
  subparagraph for a school is that, in operating the area health education
  program of the school, the school will--
  `(i) coordinate the activities of the program with the activities of any
  office of rural health established by the State or States in which the
  program is operating;
  `(ii) conduct health professions education and training activities consistent
  with national and State priorities in the area served by the program in
  coordination with the National Health Service Corps, entities receiving
  funds under section 329 or 330, and public health departments; and
  `(iii) cooperate with any entities that are in operation in the area
  served by the program and that receive Federal or State funds to carry out
  activities regarding the recruitment and retention of health care providers.
  `(D) For purposes of subparagraph (A), the agreement described in this
  subparagraph for a school is that, with respect to the costs of operating
  the area health education center program of the school, the school will
  maintain expenditures of non-Federal amounts for such costs at a level
  that is not less than the level of such expenditures maintained by the
  school for the fiscal year preceding the first fiscal year for which the
  school receives an award under subparagraph (A).
  `(E) A school may expend not more than 10 percent of an award under
  subparagraph (A) for demonstration projects for any or all of the following
  purposes:
  `(i) The establishment of computer-based information programs or
  telecommunication networks that will link health science centers and
  service delivery sites.
  `(ii) The provision of disease specific educational programs for health
  providers and students in areas of concern to the United States.
  `(iii) The development of information dissemination models to make available
  new information and technologies emerging from biological research centers
  to the practicing medical community.
  `(iv) The institution of new minority recruitment and retention programs,
  targeted to improved service delivery in areas the program determines to
  be medically underserved.
  `(v) The establishment of programs to place physicians from health manpower
  shortage areas into similar areas to encourage retention of physicians and
  to provide flexibility to States in filling positions in health professional
  shortage areas.
  `(vi) The establishment or improvement of education and training programs
  for State emergency medical systems.
  `(vii) The establishment of programs to train health care providers in
  the identification and referral of cases of domestic violence.
  `(F) The aggregate amount of awards provided under subparagraph (A) to
  schools in a State for a fiscal year may not exceed the lesser of--
  `(i) $2,000,000; and
  `(ii) an amount equal to the product of $250,000 and the aggregate number
  of area health education centers operated in the State by the schools.
  `(b) STRUCTURE OF PROGRAMS-
  `(1) IN GENERAL- An area health education center program shall be a
  cooperative program of one or more medical (M.D. and D.O.) schools and
  one or more nonprofit private or public area health education centers.
  `(2) CERTAIN REQUIREMENTS- With respect to an area health education
  center program, a school may not receive an award under paragraph (1)
  of subsection (a) for operational expenses, or an award under paragraph
  (2) or (3) of such subsection, unless the program--
  `(A) maintains preceptorship educational experiences for health science
  students;
  `(B) maintains community-based primary care residency programs or is
  affiliated with such programs;
  `(C) maintains continuing education programs for health professionals or
  coordinates with such programs;
  `(D) maintains learning resource and dissemination systems for information
  identification and retrieval;
  `(E) has agreements with community-based organizations for the delivery
  of education and training in the health professions;
  `(F) is involved in the training of health professionals (including nurses
  and allied health professionals), except to the extent inconsistent with
  the law of the State in which the training is conducted; and
  `(G) carries out recruitment programs for the health science professions,
  or programs for health-career awareness, among minority and other elementary
  or secondary students from areas the program has determined to be medically
  underserved.
  `(c) REQUIREMENTS FOR SCHOOLS- Each medical (M.D. and D.O.) school
  participating in an area health education center program shall--
  `(1) provide for the active participation in such program by individuals
  who are associated with the administration of the school and each of
  the departments (or specialties if the school has no such departments)
  of internal medicine, pediatrics, obstetrics and gynecology, surgery,
  psychiatry, and family medicine;
  `(2) provide that no less than 10 percent of all undergraduate medical
  (M.D. and D.O.) clinical education of the school will be conducted in an
  area health education center and at locations under the sponsorship of
  such center;
  `(3) be responsible for, or conduct, a program for the training of physician
  assistants (as defined in section 799) or nurse practitioners (as defined
  under section 822) which gives special consideration to the enrollment of
  individuals from, or intending to practice in, the area served by the area
  health education center of the program; and
  `(4) provide for the active participation of at least 2 schools or programs
  of other health professions (including a school of dentistry and a graduate
  program of mental health practice if there are ones affiliated with the
  university with which the school of medicine or osteopathic medicine is
  affiliated) in the educational program conducted in the area served by
  the area health education center.
The requirement of paragraph (3) shall not apply to a medical (M.D. and
D.O.) school participating in an area health education center program if
another such school participating in the same program meets the requirement
of that paragraph.
  `(d) REQUIREMENTS FOR CENTERS-
  `(1) SERVICE AREA- Each area health education center shall specifically
  designate a geographic area in which it will serve, or shall specifically
  designate a medically underserved population it will serve (such area or
  population with respect to such center in this section referred to as `the
  area served by the center'), which area or population is in a location
  remote from the main site of the teaching facilities of the school or
  schools which participate in the program with such center.
  `(2) OTHER REQUIREMENTS- Each area health education center shall--
  `(A) provide for or conduct training in health education services, including
  education in nutrition evaluation and counseling, in the area served by
  the center;
  `(B) assess the health manpower needs of the area served by the center
  and assist in the planning and development of training programs to meet
  such needs;
  `(C) provide for or conduct a rotating osteopathic internship or a medical
  residency training program in family medicine, general internal medicine,
  or general pediatrics in which no fewer than four individuals are enrolled
  in first-year positions in such program;
  `(D) provide opportunities for continuing medical education (including
  education in disease prevention) to all physicians and other health
  professionals (including allied health personnel) practicing within the
  area served by the center;
  `(E) provide continuing medical education and other educational support
  services to the National Health Service Corps members serving within the
  area served by the center;
  `(F) conduct interdisciplinary training and practice involving physicians and
  other health personnel including, where practicable, physician assistants,
  nurse practitioners, and nurse midwives;
  `(G) arrange and support educational opportunities for medical and other
  students at health facilities, ambulatory care centers, and health agencies
  throughout the area served by the center; and
  `(H) have an advisory board of which at least 75 percent of the members
  shall be individuals, including both health service providers and consumers,
  from the area served by the center.
Any area health education center which is participating in an area health
education center program in which another center has a medical residency
training program described in subparagraph (C) need not provide for or
conduct such a medical residency training program.
  `(e) CERTAIN PROVISIONS REGARDING FUNDING-
  `(1) PROGRAMS- Subject to paragraph (2), in providing financial assistance
  under this section to a school, the Secretary shall assure that--
  `(A) at least 75 percent of the total funds provided to the school are
  expended by an area health education center program in the area health
  education centers, and that the school enters into an agreement with each
  of such centers for purposes of specifying the allocation of such 75 percent;
  `(B) with respect to the operating costs of the area health education
  program of the school, non-Federal contributions for such costs are made
  in an amount that is not less than 25 percent of such costs; and
  `(C) no award provides funds solely for the planning or development of
  such a program for a period exceeding two years.
  The Secretary may vest in entities which have received financial assistance
  under section 802 of the Health Professions Educational Assistance Act of
  1976, section 774 as in effect before October 1, 1977, or under subsection
  (a) of this section for area health education centers programs title to
  any property acquired on behalf of the United States by that entity (or
  furnished to that entity by the United States) under that award.
  `(2) CENTERS- With respect to the period during which an area health
  education center is planned, developed or operated pursuant to an award
  under subsection (a)(1), not more than 55 percent of the total amounts
  expended for the center in any fifth or sixth year of such period may be
  provided by the Secretary, subject to paragraph (3).
  `(3) APPLICABILITY OF PROVISION REGARDING CENTERS- Paragraph (2) shall apply
  only in the case of an area health education center program for which the
  initial award under subsection (a)(1) is provided on or after the date of the
  enactment of the Health Professions Education Extension Amendments of 1992.
  `(f) HEALTH EDUCATION AND TRAINING CENTERS-
  `(1) IN GENERAL- The Secretary shall provide financial assistance to
  schools of medicine and osteopathic medicine for the purpose of planning,
  developing, establishing, maintaining, and operating health education and
  training centers--
  `(A) to improve the supply, distribution, quality, and efficiency of
  personnel providing health services in the State of Florida or (in the
  United States) along the border between the United States and Mexico;
  `(B) to improve the supply, distribution, quality, and efficiency of
  personnel providing, in other urban and rural areas (including frontier
  areas) of the United States, health services to any population group,
  including Hispanic individuals, that has demonstrated serious unmet health
  care needs; and
  `(C) to encourage health promotion and disease prevention through public
  education in the areas described.
  `(2) ARRANGEMENTS WITH OTHER ENTITIES- The Secretary may not provide
  financial assistance under paragraph (1) unless the applicant for such
  assistance agrees, in carrying out the purpose described in such paragraph,
  to enter into arrangements with one or more public or nonprofit private
  entities in the State that have expertise in providing health education
  to the public.
  `(3) SERVICE AREA- The Secretary shall, after consultation with health
  education and training centers, designate the geographic area in which each
  such center will carry out the purpose described in paragraph (1). The
  service area of such a center shall be located entirely within the State
  in which the center is located. Each border health education and training
  center shall be located in a county (or other political subdivision) of the
  State in close proximity to the border between the United States and Mexico.
  `(4) ADVISORY GROUP; OPERATIONAL PLAN- The Secretary may not provide
  financial assistance under paragraph (1) unless the applicant for such
  assistance agrees--
  `(A) to establish an advisory group comprised of health service providers,
  educators and consumers from the service area and of faculty from
  participating schools;
  `(B) after consultation with such advisory group, to develop a plan for
  carrying out the purpose described in paragraph (1) in the service area;
  `(C) to enter into contracts, as needed, with other institutions or entities
  to carry out such plan; and
  `(D) to be responsible for the evaluation of the program.
  `(5) CERTAIN ACTIVITIES- The Secretary may not provide financial assistance
  under paragraph (1) unless the applicant for such assistance agrees--
  `(A) to evaluate the specific service needs for health care personnel in
  the service area;
  `(B) to assist in the planning, development, and conduct of training
  programs to meet the needs identified pursuant to subparagraph (A);
  `(C) to conduct or support not less than one training and education program
  for physicians and one program for nurses for at least a portion of the
  clinical training of such students;
  `(D) to conduct or support training in health education services, including
  training to prepare community health workers to implement health education
  programs in communities, health departments, health clinics, and public
  schools that are located in the service area;
  `(E) to conduct or support continuing medical education programs for
  physicians and other health professionals (including allied health personnel)
  practicing in the service area;
  `(F) to support health career educational opportunities designed to
  provide students residing in the service area with counseling, education,
  and training in the health professions;
  `(G) with respect to border health education and training centers, to
  assist in coordinating its activities and programs carried out pursuant
  to paragraph (1)(A) with any similar programs and activities carried out
  in Mexico along the border between the United States and Mexico;
  `(H) to make available technical assistance in the service area in the
  aspects of health care organization, financing and delivery; and
  `(I) in the case of any school of public health located in the service area
  of the health education and training center operated with the assistance,
  to permit any such school to participate in the program of the center if
  the school makes a request to so participate.
  `(6) ALLOCATION OF FUNDS BY CENTERS- In carrying out this subsection,
  the Secretary shall ensure that--
  `(A) not less than 75 percent of the total funds provided to a school
  or schools of medicine or osteopathic medicine will be expended in the
  development and operation of the health education and training center in
  the service area of such program;
  `(B) to the maximum extent feasible, the school of medicine or osteopathic
  medicine will obtain from nongovernmental sources the amount of the total
  operating funds for such program which are not provided by the Secretary;
  `(C) no award shall provide funds solely for the planning or development
  of a health education and training center program for a period in excess
  of two years;
  `(D) not more than 10 percent of the annual budget of each program may be
  utilized for the renovation and equipping of clinical teaching sites; and
  `(E) no award shall provide funds to be used outside the United States
  except as the Secretary may prescribe for travel and communications purposes
  related to the conduct of a border health education and training center.
  `(7) DEFINITIONS- For purposes of this subsection:
  `(A) The term `border health education and training center' means an
  entity that is a recipient of an award under paragraph (1) and that is
  carrying out (or will carry out) the purpose described in subparagraph
  (A) of such paragraph.
  `(B) The term `health education and training center' means an entity that
  is a recipient of an award under paragraph (1).
  `(C) The term `service area' means, with respect to a health education
  and training center, the geographic area designated for the center under
  paragraph (3).
  `(8) ALLOCATION OF FUNDS BY SECRETARY-
  `(A) Of the amounts appropriated pursuant to subsection (i)(2) for a fiscal
  year, the Secretary shall make available 50 percent for allocations each
  fiscal year for applications approved by the Secretary for border health
  education and training centers. The amount of the allocation for each such
  center shall be determined in accordance with subparagraph (B).
  `(B) The amount of an allocation under subparagraph (A) for a fiscal year
  shall be determined in accordance with a formula prescribed by the Secretary,
  which formula shall be based--
  `(i) with respect to the service area of the border health education and
  training center involved, on the low-income population, including Hispanic
  individuals, in the State of Florida and along the border between the
  United States and Mexico, and the growth rate of such population;
  `(ii) on the need of such population for additional personnel to provide
  health care services along such border; and
  `(iii) on the most current information concerning mortality and morbidity
  and other indicators of health status for such population.
  `(g) DEFINITIONS- For purposes of this section:
  `(1) The term `area health education center program' means a program which
  is organized as provided in subsection (b) and under which the participating
  medical (M.D. and D.O.) schools and the area health education centers meet
  the requirements of subsections (c) and (d).
  `(2) The term `award' means an award of financial assistance.
  `(3) The term `financial assistance' means a grant, cooperative agreement,
  or contract.
  `(h) CRITERIA AND STANDARDS- The Secretary shall establish standards and
  criteria for the requirements of this section.
  `(i) AUTHORIZATION OF APPROPRIATIONS-
  `(1) AREA HEALTH EDUCATION CENTER PROGRAMS-
  `(A) For the purpose of carrying out this section other than subsection
  (f), there is authorized to be appropriated $25,000,000 for each of the
  fiscal years 1993 through 1995.
  `(B) Of the amounts appropriated under paragraph (1) for a fiscal year, the
  Secretary may not obligate more than 20 percent for awards under subsection
  (a)(2).
  `(C) Of the amounts appropriated under paragraph (1) for fiscal year
  1993, the Secretary shall obligate for awards under subsection (a)(3)
  such amounts as are appropriated in excess of $19,200,000. Of the amounts
  appropriated under paragraph (1) for each of the fiscal years 1994 and
  1995, the Secretary shall obligate for such awards such amounts as are
  appropriated in excess of $18,700,000.
  `(2) HEALTH EDUCATION AND TRAINING CENTERS- For the purpose of carrying
  out subsection (f), there is authorized to be appropriated $5,000,000 for
  each of the fiscal years 1993 through 1995.
`SEC. 747. FAMILY MEDICINE.
  `(a) TRAINING GENERALLY- The Secretary may make grants to, or enter into
  contracts with, any public or nonprofit private hospital, school of medicine
  or osteopathic medicine, or to or with a public or private nonprofit entity
  (which the Secretary has determined is capable of carrying out such grant
  or contract)--
  `(1) to plan, develop, and operate, or participate in, an approved
  professional training program (including an approved residency or
  internship program) in the field of family medicine for medical (M.D. and
  D.O.) students, interns (including interns in internships in osteopathic
  medicine), residents, or practicing physicians;
  `(2) to provide financial assistance (in the form of traineeships and
  fellowships) to medical (M.D. and D.O.) students, interns (including interns
  in internships in osteopathic medicine), residents, practicing physicians,
  or other medical personnel, who are in need thereof, who are participants
  in any such program, and who plan to specialize or work in the practice
  of family medicine;
  `(3) to plan, develop, and operate a program for the training of physicians
  who plan to teach in family medicine training programs; and
  `(4) to provide financial assistance (in the form of traineeships and
  fellowships) to physicians who are participants in any such program and
  who plan to teach in a family medicine training program.
  `(b) ACADEMIC ADMINISTRATIVE UNITS-
  `(1) IN GENERAL- The Secretary may make grants to or enter into contracts
  with schools of medicine or osteopathic medicine to meet the costs of
  projects to establish, maintain, or improve academic administrative units
  (which may be departments, divisions, or other units) to provide clinical
  instruction in family medicine.
  `(2) PREFERENCE IN MAKING AWARDS- In making awards of grants and contracts
  under paragraph (1), the Secretary shall give preference to any qualified
  applicant for such an award that agrees to expend the award for the
  purpose of--
  `(A) establishing an academic administrative unit for programs in family
  medicine; or
  `(B) substantially expanding the programs of such a unit.
  `(c) DURATION OF AWARD- The period during which payments are made to an
  entity from an award of a grant or contract under subsection (a) may not
  exceed 5 years. The provision of such payments shall be subject to annual
  approval by the Secretary of the payments and subject to the availability
  of appropriations for the fiscal year involved to make the payments.
  `(d) FUNDING-
  `(1) AUTHORIZATION OF APPROPRIATIONS- For the purpose of carrying out this
  section, there is authorized to be appropriated $54,000,000 for each of
  the fiscal years 1993 through 1995.
  `(2) ALLOCATION- Of the amounts appropriated under paragraph (1) for a
  fiscal year, the Secretary shall make available not less than 20 percent
  for awards of grants and contracts under subsection (b).
`SEC. 748. GENERAL INTERNAL MEDICINE AND GENERAL PEDIATRICS.
  `(a) IN GENERAL- The Secretary may make grants to and enter into contracts
  with schools of medicine and osteopathic medicine, public or private
  nonprofit hospital, or any other public or private nonprofit entity to
  meet the costs of projects--
  `(1) to plan, develop, and operate, or participate in, an approved
  professional training program (including an approved residency or internship
  program) in the field of internal medicine or pediatrics for medical
  (M.D. and D.O.) students, interns (including interns in internships in
  osteopathic medicine), residents, or practicing physicians, which training
  program emphasizes training for the practice of general internal medicine
  or general pediatrics (as defined by the Secretary in regulations);
  `(2) to provide financial assistance (in the form of traineeships and
  fellowships) to medical (M.D. and D.O.) students, interns (including interns
  in internships in osteopathic medicine), residents, practicing physicians,
  or other medical personnel, who are in need thereof, who are participants
  in any such training program, and who plan to specialize in or work in
  the practice of general internal medicine or general pediatrics;
  `(3) to plan, develop, and operate a program for the training of physicians
  who will teach in a general internal medicine or general pediatrics training
  program; and
  `(4) which provide financial assistance (in the form of traineeships and
  fellowships) to physicians who are participants in any such program and
  who plan to teach in a general internal medicine or general pediatrics
  training program.
  `(b) DURATION OF AWARD- The period during which payments are made to an
  entity from an award of a grant or contract under subsection (a) may not
  exceed 5 years. The provision of such payments shall be subject to annual
  approval by the Secretary of the payments and subject to the availability
  of appropriations for the fiscal year involved to make the payments.
  `(c) AUTHORIZATION OF APPROPRIATIONS- For the purpose of carrying out this
  section, there is authorized to be appropriated $25,000,000 for each of
  the fiscal years 1993 through 1995.
`SEC. 749. GENERAL PRACTICE OF DENTISTRY.
  `(a) IN GENERAL- The Secretary may make grants to, and enter into contracts
  with, any public or nonprofit private school of dentistry or accredited
  postgraduate dental training institution--
  `(1) to plan, develop, and operate an approved residency program in the
  general practice of dentistry or an approved advanced educational program
  in the general practice of dentistry;
  `(2) to provide financial assistance (in the form of traineeships and
  fellowships) to participants in such a program who are in need of financial
  assistance and who plan to specialize in the practice of general dentistry;
  and
  `(3) to fund innovative, nontraditional models for the provision of
  postdoctoral General Dentistry training.
  `(b) AUTHORIZATION OF APPROPRIATIONS- For the purpose of carrying out
  this section, there is authorized to be appropriated $6,000,000 for each
  of the fiscal years 1993 through 1995.
`SEC. 750. PHYSICIAN ASSISTANTS.
  `(a) IN GENERAL- The Secretary may make grants to and enter into contracts
  with public or nonprofit private schools of medicine and osteopathic
  medicine and other public or nonprofit private entities to meet the costs
  of projects to plan, develop, and operate or maintain programs--
  `(1) for the training of physician assistants (as defined in section
  799); and
  `(2) for the training of individuals who will teach programs of such
  training.
  `(b) REGULATIONS- After consultation with appropriate organizations, the
  Secretary shall prescribe regulations for programs receiving assistance
  under subsection (a) for the training of physician assistants. Such
  regulations shall, as a minimum, require that such a program--
  `(1) extend for at least one academic year and consist of--
  `(A) supervised clinical practice; and
  `(B) at least four months (in the aggregate) of classroom instruction,
  directed toward preparing students to deliver health care;
  `(2) have an enrollment of not less than eight students; and
  `(3) train students in primary care, disease prevention, health promotion,
  geriatric medicine, and home health care.
  `(c) PLACEMENT OF GRADUATES- No grant or contract may be made under
  subsection (a) unless the school or other entity involved provides
  assurances satisfactory to the Secretary that the school or entity has
  appropriate mechanisms for placing graduates of the training program with
  respect to which the application is submitted in positions for which they
  have been trained.
  `(d) FUNDING-
  `(1) AUTHORIZATION OF APPROPRIATIONS- For the purpose of carrying out
  this section, there is authorized to be appropriated $9,000,000 for each
  of the fiscal years 1993 through 1995.
  `(2) LIMITATION- Not more than 10 percent of the amounts appropriated
  under paragraph (1) may be expended for carrying out subsection (a)(2).
`SEC. 751. PODIATRIC MEDICINE.
  `(a) IN GENERAL- The Secretary may make grants to, and enter into contracts
  with, public and nonprofit private hospitals and schools of podiatric
  medicine for the purpose of planning and implementing projects in primary
  care training for podiatric physicians in approved or provisionally approved
  residency programs which shall provide financial assistance in the form
  of traineeships to residents who participate in such projects and who plan
  to specialize in primary care.
  `(b) PREFERENCE IN MAKING GRANTS- In making grants under subsection
  (a), the Secretary shall give preference to qualified applicants that
  provide clinical training in podiatric medicine in a variety of medically
  underserved communities.
  `(c) AUTHORIZATION OF APPROPRIATIONS- For the purpose of carrying out
  this section, there is authorized to be appropriated $1,000,000 for each
  of the fiscal years 1993 through 1995.
`SEC. 752. GENERAL PROVISIONS.
  `(a) TRAINEESHIPS AND FELLOWSHIPS-
  `(1) TRAINEESHIPS- Payments by recipients of grants or contracts under this
  part for traineeships shall be limited to such amounts as the Secretary
  finds necessary to cover the cost of tuition and fees of, and stipends
  and allowances (including travel and subsistence expenses and dependency
  allowances) for the trainees.
  `(2) FELLOWSHIPS- Payments by recipients of grants or contracts under this
  part for fellowships shall be limited to such amounts as the Secretary finds
  necessary to cover the cost of advanced study by, and stipends and allowances
  (including travel and subsistence expenses and dependency allowances) for,
  the fellows.
  `(b) AMOUNT OF GRANT- The amount of any grant or contract under this part
  shall be determined by the Secretary.
`PART D--TRAINING IN CERTAIN HEALTH PROFESSIONS
`Subpart I--Public Health and Preventive Medicine
`SEC. 761. PUBLIC HEALTH TRAINEESHIPS.
  `(a) IN GENERAL- The Secretary may make grants to accredited schools
  of public health, and to other public or nonprofit private institutions
  accredited for the provision of graduate or specialized training in public
  health, for the purpose of assisting such schools and institutions in
  providing traineeships to individuals described in subsection (b)(3).
  `(b) CERTAIN REQUIREMENTS-
  `(1) APPLICATION FOR GRANT- No grant for traineeships may be made under
  subsection (a) unless an application therefor has been submitted to, and
  approved by, the Secretary. Such application shall be in such form, be
  submitted in such manner, and contain such information, as the Secretary by
  regulation may prescribe. Traineeships under such a grant shall be awarded
  in accordance with such regulations as the Secretary shall prescribe. The
  amount of any such grant shall be determined by the Secretary.
  `(2) USE OF GRANT- Traineeships awarded under grants made under subsection
  (a) shall provide for tuition and fees and such stipends and allowances
  (including travel and subsistence expenses and dependency allowances)
  for the trainees as the Secretary may deem necessary.
  `(3) ELIGIBLE INDIVIDUALS- The individuals referred to in subsection (a) are
  individuals who are 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, and nutrition).
`SEC. 762. PUBLIC HEALTH SPECIAL PROJECTS.
  `(a) IN GENERAL- The Secretary may make grants to and enter into contracts
  with accredited schools of public health for the costs of planning,
  developing, demonstrating, operating, and evaluating projects that are in
  furtherance of the goals established by the Secretary for the year 2000
  in the area of--
  `(1) preventive medicine;
  `(2) health promotion and disease prevention;
  `(3) improving access to and quality of health services in medically
  underserved communities; or
  `(4) reducing the incidence of domestic violence.
  `(b) PREFERENCES IN MAKING AWARDS- In making awards of grants and contracts
  under subsection (a), the Secretary shall give preference to qualified
  schools agreeing that the project for which the award is made--
  `(1) will establish or strengthen field placements for students in public
  or nonprofit private health agencies or organizations; and
  `(2) will involve faculty members and students in collaborative projects
  to enhance public health services to medically underserved communities.
  `(c) PARTICIPATION AND TRAINING OF STUDENTS- The Secretary may make an award
  of a grant or contract under subsection (a) only if the school involved
  agrees that the students of the school will, through participation in the
  project for which the award is made, receive training in the activities
  carried out by the project.
  `(d) APPLICATION FOR AWARD- The Secretary may make an award of a grant
  or contract under subsection (a) only if an application for the award is
  submitted to the Secretary and the application is in such form, is made
  in such manner, and contains such agreements, assurances, and information
  as the Secretary determines to be necessary to carry out this section.
  `(e) ESTABLISHMENT OF GOALS; RELATED REPORTS-
  `(1) GOALS-
  `(A) The Secretary shall establish goals for projects under subsection (a)
  (including goals regarding the training of students), and shall require
  that, as a condition of the receipt of grants and contracts under such
  subsection, schools carry out activities in furtherance of meeting the goals.
  `(B) The Secretary shall establish and implement a methodology for measuring
  the extent of progress that has been made toward the goals established under
  subparagraph (A) by schools receiving grants or contracts under subsection
  (a).
  `(2) REPORTS- Not later than February 1, 1994, the Secretary shall submit
  to the Committee on Energy and Commerce of the House of Representatives,
  and the Committee on Labor and Human Resources of the Senate, a report
  describing the progress made by projects under subsection (a) during the
  preceding fiscal years toward the goals established under paragraph (1). For
  purposes of the report, the extent of such progress shall be measured
  through the methodology established under subparagraph (B) of such paragraph.
`SEC. 763. 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) APPLICATION- No grant may be made under subsection (a) unless an
  application therefor is submitted to and approved by the Secretary. Such
  an application shall be in such form, submitted in such manner, and contain
  such information, as the Secretary shall by regulation prescribe.
  `(3) ELIGIBILTY- 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.
  `(4) 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. 765. AUTHORIZATION OF APPROPRIATIONS.
  `(a) IN GENERAL- For the purpose of carrying out this subpart, there is
  authorized to be appropriated $15,500,000 for each of the fiscal years
  1993 through 1995.
  `(b) LIMITATION REGARDING CERTAIN PROGRAM- In obligating amounts appropriated
  under subsection (a), the Secretary may not obligate more than 40 percent
  for carrying out section 762.
`Subpart II--Allied Health Professions
`SEC. 766. ADVANCED TRAINING.
  `(a) IN GENERAL- The Secretary may award grants to and enter into contracts
  with eligible entities to assist such entities in meeting the costs
  associated with projects designed to--
  `(1) plan, develop, establish or expand postbaccalaureate programs for
  the advanced training of allied health professionals; and
  `(2) provide financial assistance, in the form of traineeships or
  fellowships, to postbaccalaureate students who are participants in any such
  program and who commit to teaching in the allied health profession involved.
  `(b) PREFERENCE- In awarding grants under subsection (a), the Secretary
  shall give preference to qualified projects demonstrating that not less
  than 50 percent of the graduates of such schools or programs during the
  preceding 2-year period are engaged as full-time teaching faculty in an
  allied health shortage specialty.
  `(c) LIMITATION- The Secretary shall limit grants and contracts awarded
  or entered into under subsection (a) to those allied health fields or
  specialties as the Secretary shall, from time to time, determine to have--
  `(1) the most significant national or regional shortages of practitioners;
  `(2) insufficient numbers of qualified faculty in entry level or advanced
  educational programs; or
  `(3) a significant role in the care and rehabilitation of patients who
  are elderly or disabled including physical therapists and occupational
  therapists.
  `(d) ELIGIBLE ENTITIES- For purposes of this section, the term `eligible
  entities' means entities that are--
  `(1) public or private nonprofit schools, universities, or other educational
  entities that provide for education and training in the allied health
  professions and that meet such standards as the Secretary may by regulation
  prescribe; or
  `(2) public or nonprofit private entities capable, as determined by the
  Secretary, of carrying out projects described in subsection (a).
  `(e) AUTHORIZATION OF APPROPRIATIONS- For the purpose of carrying out
  this section, there is authorized to be appropriated $5,000,000 for each
  of the fiscal years 1993 through 1995.
`SEC. 767. PROJECT GRANTS AND CONTRACTS.
  `(a) PROJECTS RELATED TO STRENGTHENING TRAINING AND INCREASING ENROLLMENT
  IN THE ALLIED HEALTH PROFESSIONS- The Secretary may make grants to and
  enter into contracts with eligible entities to assist such entities in
  meeting the costs associated with expanding or establishing programs
  that will increase the number of individuals trained in allied health
  professions. Programs and activities funded under this section may include--
  `(1) those that expand enrollments in allied health professions with the
  greatest shortages or whose services are most needed by the elderly;
  `(2) those that provide rapid transition training programs in allied health
  fields to individuals who have baccalaureate degrees in health-related
  sciences;
  `(3) those that establish community-based allied health training programs
  that link academic centers to rural clinical settings;
  `(4) those that provide career advancement training for practicing allied
  health professionals;
  `(5) those that expand or establish clinical training sites for allied
  health professionals in medically underserved or rural communities in
  order to increase the number of individuals trained;
  `(6) those that develop curriculum that will emphasize knowledge and
  practice in the areas of prevention and health promotion, geriatrics,
  long-term care, home health and hospice care, and ethics;
  `(7) those that expand or establish interdisciplinary training programs
  that promote the effectiveness of allied health practitioners in geriatric
  assessment and the rehabilitation of the elderly;
  `(8) those that expand or establish demonstration centers to emphasize
  innovative models to link allied health clinical practice, education,
  and research; and
  `(9) those that provide financial assistance (in the form of traineeships)
  to students who are participants in any such program; and
  `(A) who plan to pursue a career in an allied health field that has a
  demonstrated personnel shortage; and
  `(B) who agree upon completion of the training program to practice in a
  medically underserved community;
that shall be utilized to assist in the payment of all or part of the costs
associated with tuition, fees and such other stipends as the Secretary may
consider necessary.
  `(b) APPLICATION-
  `(1) REQUIREMENT- No grant may be awarded or contract entered into under
  this section unless an application therefore has been submitted to,
  and approved by, the Secretary. Such application shall be in such form,
  submitted in such manner, and contain such information, as the Secretary
  shall by regulation prescribe.
  `(2) PREFERENCE- In considering an application submitted for a grant
  under this section, the Secretary shall give preference to qualified
  applicants that--
  `(A) expand and maintain first-year enrollment by not less than 10 percent
  over enrollments in base year 1992; or
  `(B) demonstrate that not less than 20 percent of the graduates of such
  training programs during the preceding 2-year period are working in
  medically underserved communities.
  `(c) ELIGIBLE ENTITIES- For purposes of this section, the term `eligible
  entities' has the meaning given such term in section 766.
  `(d) AUTHORIZATION OF APPROPRIATION- For the purpose of carrying out this
  section, there is authorized to be appropriated $5,000,000 for each of
  the fiscal years 1993 through 1995.
`Subpart III--Health Administration
`SEC. 771. TRAINEESHIPS AND SPECIAL PROJECTS.
  `(a) IN GENERAL- The Secretary may make grants to public or nonprofit
  private educational entities (including graduate schools of social work
  but excluding accredited schools of public health) that offer a program
  described in subsection (b)--
  `(1) to provide traineeships for students enrolled in such a program; and
  `(2) to assist programs of 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
  a 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.
  `(e) APPLICATION FOR GRANT- No grant may be made under subsection (a)
  unless an application therefor has been submitted to, and approved by,
  the Secretary. Such application shall be in such form, be submitted
  in such manner, and contain such information, as the Secretary may
  prescribe. Traineeships under such a grant shall be awarded in accordance
  with such requirements as the Secretary shall prescribe. The amount of
  any such grant shall be determined by the Secretary.
  `(f) FUNDING-
  `(1) AUTHORIZATION OF APPROPRIATIONS- For payments under grants under
  subsection (a), there is authorized to be appropriated $2,500,000 for each
  of the fiscal years 1993 through 1995.
  `(2) LIMITATION- In obligating amounts appropriated under paragraph (1)
  for a fiscal year, the Secretary may not obligate more than 30 percent
  for grants under subsection (a)(2).
`PART E--SPECIAL TRAINING PROJECTS
`SEC. 776. ACQUIRED IMMUNE DEFICIENCY SYNDROME.
  `(a) SCHOOLS; CENTERS-
  `(1) IN GENERAL- The Secretary may make grants and enter into contracts
  to assist public and nonprofit private entities and schools and academic
  health science centers in meeting the costs of projects--
  `(A) to train the faculty of schools of, and graduate departments or programs
  of, medicine, nursing, osteopathic medicine, dentistry, public health, allied
  health, and mental health practice to teach health professions students
  to provide for the health care needs of individuals with HIV disease;
  `(B) to train practitioners to provide for the health care needs of such
  individuals;
  `(C) with respect to improving clinical skills in the diagnosis, treatment,
  and prevention of such disease, to educate and train the health professionals
  and clinical staff of schools of medicine, osteopathic medicine, and
  dentistry; and
  `(D) to develop and disseminate curricula and resource materials relating to
  the care and treatment of individuals with such disease and the prevention
  of the disease among individuals who are at risk of contracting the disease.
  `(2) PREFERENCE IN MAKING GRANTS- In making grants under paragraph (1),
  the Secretary shall give preference to qualified projects which will--
  `(A) train, or result in the training of, health professionals who will
  provide treatment for minority individuals with HIV disease and other
  individuals who are at high risk of contracting such disease; and
  `(B) train, or result in the training of, minority health professionals and
  minority allied health professionals to provide treatment for individuals
  with such disease.
  `(3) APPLICATION- No grant or contract may be made under paragraph (1)
  unless an application is submitted to the Secretary in such form, at such
  time, and containing such information, as the Secretary may prescribe.
  `(b) DENTAL SCHOOLS-
  `(1) IN GENERAL- The Secretary may make grants to assist dental schools
  and programs described in section 777(b)(4)(B) with respect to oral health
  care to patients with HIV disease.
  `(2) APPLICATION- Each dental school or program described in section
  777(b)(4)(B) may annually submit an application documenting the unreimbursed
  costs of oral health care provided to patients with HIV disease by that
  school or hospital during the prior year.
  `(3) DISTRIBUTION- The Secretary shall distribute the available funds among
  all eligible applicants, taking into account the number of patients with
  HIV disease served and the unreimbursed oral health care costs incurred
  by each institution as compared with the total number of patients served
  and costs incurred by all eligible applicants.
  `(4) MAINTENANCE OF EFFORT- The Secretary shall not make a grant under
  this subsection if doing so would result in any reduction in State funding
  allotted for such purposes.
  `(c) DEFINITION- For purposes of this section:
  `(1) The term `HIV disease' means infection with the human immunodeficiency
  virus, and includes any condition arising from such infection.
  `(2) The term `human immunodeficiency virus' means the etiologic agent
  for acquired immune deficiency syndrome.
  `(d) AUTHORIZATION OF APPROPRIATIONS-
  `(1) SCHOOLS; CENTERS- For the purpose of grants under subsection (a),
  there is authorized to be appropriated $23,000,000 for each of the fiscal
  years 1993 through 1995.
  `(2) DENTAL SCHOOLS- For the purpose of grants under subsection (b), there
  is authorized to be appropriated $7,000,000 for each of the fiscal years
  1993 through 1995.
`SEC. 777. GERIATRICS.
  `(a) GERIATRIC EDUCATION CENTERS- The Secretary may make grants to and
  enter into contracts with accredited health professions schools or programs
  described in paragraph (1), (3), or (4) of section 799 or in section 853(2)
  to assist in meeting the costs of such schools or programs of projects to--
  `(1) improve the training of health professionals in geriatrics;
  `(2) develop and disseminate curricula relating to the treatment of the
  health problems of elderly individuals;
  `(3) expand and strengthen instruction in methods of such treatment;
  `(4) support the training and retraining of faculty to provide such
  instruction;
  `(5) support continuing education of health professionals and allied health
  professionals who provide such treatment; and
  `(6) establish new affiliations with nursing homes, chronic and acute
  disease hospitals, ambulatory care centers, and senior centers in order
  to provide students with clinical training in geriatric medicine.
  `(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 and dentists who plan
  to teach geriatric medicine, geriatric psychiatry, 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 psychiatry;
  `(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 based in a graduate medical education program in internal medicine
  or family medicine or in a department of geriatrics or psychiatry;
  `(D) 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 psychiatry 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
  `(E) 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 psychiatry at schools of
  medicine and osteopathic medicine; and
  `(ii) dentists who are faculty members at schools of dentistry or at
  hospital departments of dentistry.
  `(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, psychiatry, neurology, gynecology,
  or rehabilitation medicine; and
  `(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.
  `(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 TRAINING REGARDING OPTOMETRISTS- The Secretary may make
  grants to, and enter into contracts with, schools and colleges of optometry
  for the purpose of providing support for projects--
  `(1) to plan, develop, and operate projects in postgraduate geriatric care
  training for optometrists who will teach geriatric optometry;
  `(2) to provide financial assistance (in the form of residencies,
  traineeships, and fellowships) to participants in such projects; and
  `(3) to establish new affiliations with nursing homes, ambulatory care
  centers, senior centers, and other public or nonprofit private entities.
  `(d) AUTHORIZATION OF APPROPRIATIONS-
  `(1) EDUCATION CENTERS; TRAINING- For grants and contracts under subsections
  (a) and (b), there is authorized to be appropriated $17,000,000 for each
  of the fiscal years 1993 through 1995.
  `(2) OPTOMETRY- For grants and contracts under subsection (c), there is
  authorized to be appropriated $400,000 for each of the fiscal years 1993
  through 1995.
`SEC. 778. RURAL AREAS.
  `(a) GRANTS- The Secretary may make grants to, or enter into contracts with,
  any eligible applicant to help such applicant fund authorized activities
  under an application approved under subsection (d).
  `(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
  in 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) ELIGIBLE APPLICANTS- Applicants eligible to obtain funds under
  subsection (a) shall include local health departments, nonprofit
  organizations and public or nonprofit colleges, universities, or schools of,
  or programs that specialize in, nursing, mental health practice, optometry,
  public health, dentistry, osteopathy, physicians assistants, pharmacy,
  podiatry, medicine, chiropractic, and allied health professions if such
  applicants submit applications approved by the Secretary under subsection
  (d). Applicants eligible to obtain funds under subsection (a) shall not
  include for-profit entities, either directly or through a subcontract
  or subgrant.
  `(d) APPLICATIONS-
  `(1) SUBMISSION- In order to receive a grant under subsection (a) an entity
  shall submit an application to the Secretary.
  `(2) FORMS- An application submitted under this subsection shall be in
  such form, be submitted by such date, and contain such information as the
  Secretary shall require.
  `(3) APPLICATIONS- Applications submitted under this subsection shall--
  `(A) 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;
  `(B) 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 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; and
  `(C) provide any additional information required by the Secretary.
  `(e) DEFINITIONS- For the purposes of this section, the term `rural'
  means geographic areas that are located outside of standard metropolitan
  statistical areas.
  `(f) AUTHORIZATION OF APPROPRIATIONS- For the purpose of carrying out
  this section, there is authorized to be appropriated $7,000,000 for each
  of the fiscal years 1993 through 1995.
`PART F--MISCELLANEOUS PROGRAMS
`SEC. 781. RESEARCH ON CERTAIN HEALTH PROFESSIONS ISSUES.
  `(a) EDUCATIONAL INDEBTEDNESS-
  `(1) IN GENERAL- Subject to paragraph (2), the Secretary may make grants
  to and enter into contracts with public and nonprofit private entities
  for the purpose of conducting research on the extent to which the debt
  incurred by medical students for attendance at educational institutions
  has had a detrimental effect on the decisions made by the students on
  entering primary care specialities.
  `(2) EVALUATION OF RATE OF INCREASE- In carrying out paragraph (1), the
  Secretary shall provide for a determination of the reasons underlying the
  rate of increase occurring since January 1, 1981, in tuition and fees for
  attending health professions schools. The Secretary shall ensure that the
  determination includes the justifications of such schools for such rate.
  `(b) EFFECT OF PROGRAMS FOR MINORITY AND DISADVANTAGED INDIVIDUALS-
  `(1) IN GENERAL- The Secretary may make grants to and enter into contracts
  with public and nonprofit private entities for the purpose of conducting
  research on the effects that federally-funded educational programs or
  policies for minority or disadvantaged individuals have on--
  `(A) the number of such individuals attending health professions school;
  `(B) the number of such individuals completing the programs of education
  involved; and
  `(C) the decisions made by such individuals on which of the health
  professions specialities to enter.
  `(2) SEPARATE SPECIFICATIONS FOR CERTAIN CATEGORIES OF SCHOOLS- The
  Secretary may provide a grant or contract under paragraph (1) only if the
  applicant involved agrees that in conducting research under such paragraph
  the applicant will make findings specific to the following categories of
  health professions schools:
  `(A) Health professions schools of historically black colleges and
  universities.
  `(B) Other health professions schools attended by a substantial number of
  minority individuals.
  `(C) Health professions schools generally.
  `(c) EXTENT OF INVESTIGATIONS AND DISCIPLINARY ACTIONS BY STATE LICENSING
  AUTHORITIES- The Secretary may make grants to and enter into contracts with
  public and nonprofit private entities for the purpose of conducting research
  on the effectiveness of the States in protecting the public health through--
  `(1) identifying health care providers with respect to whom investigations
  of professional qualifications are warranted;
  `(2) conducting such investigations; and
  `(3) taking disciplinary actions against health care providers determined
  through such investigations to have engaged in conduct inconsistent with
  protecting the public health.
  `(d) PRIMARY HEALTH CARE-
  `(1) IN GENERAL- The Secretary may make grants to and enter into contracts
  with public and nonprofit private entities for the purpose of conducting
  research--
  `(A) to determine the extent to which Federal programs and related financial
  incentives influence the percentage of medical school graduates selecting
  a primary care career;
  `(B) to determine the extent to which Federal programs and related
  financial incentives adequately support the training of mid-level primary
  care providers relative to other health professions education receiving
  Federal assistance;
  `(C) to assess the impact that direct and indirect payments for graduate
  medical education (including the appropriateness of payments for independent,
  ambulatory training sites) have on increasing the percentage of physicians
  graduating from medical school who enter primary care careers;
  `(D) to assess the impact of medical school admission policies on specialty
  selection and recommend ways admission policies can better facilitate and
  promote the selection of primary care as a medical career;
  `(E) to assess the impact that Federal funding for biomedical research
  influences the design of medical school curriculum and the availability
  of primary care educational opportunities;
  `(F) to assess the impact of medical school curriculum, including the
  availability of clinical training in ambulatory care settings, influences the
  percentage of physicians selecting primary care residencies and selecting
  primary care as a medical career; and
  `(G) to assess the extent to which current physician payment policies under
  resource based relative value scale are sufficient to encourage physicians
  graduating from medical school to enter and remain in primary care careers.
  `(2) DEFINITIONS- For purposes of this subsection:
  `(A) The term `primary care careers', with respect to medicine, means
  family practice, general internal medicine and general pediatrics.
  `(B) The term `mid-level primary care health professions' means physician
  assistants, nurse practitioners, and nurse midwives.
  `(e) AUTHORIZATION OF APPROPRIATIONS- For the purpose of carrying out
  this section, there is authorized to be appropriated $4,000,000 for each
  of the fiscal years 1993 through 1995.
`SEC. 782. CHIROPRACTIC DEMONSTRATION PROJECTS.
  `(a) IN GENERAL- The Secretary may make grants to and enter into contracts
  with schools, colleges, and universities of chiropractic for the purpose of
  carrying out demonstration projects in which chiropractors and physicians
  collaborate to identify and provide effective treatment for spinal and
  lower-back conditions.
  `(b) PARTICIPATION OF MEDICAL SCHOOLS- The Secretary may make an award of
  a grant or contract under subsection (a) only if the applicant involved
  has entered into such agreements as may be necessary to ensure that in the
  project under such subsection a school of medicine or osteopathic medicine
  will participate in the project.
  `(c) PEER REVIEW- Each peer review group under section 798(a) reviewing
  proposals for grants or contracts under subsection (a) shall include no
  fewer than two, and no more than three, chiropractors.
  `(d) REPORT TO CONGRESS-
  `(1) IN GENERAL- The Secretary shall prepare a report that--
  `(A) summarizes the applications submitted to the Secretary for grants or
  contracts under subsection (a);
  `(B) specifies the identity of entities receiving the grants or contracts;
  and
  `(C) evaluates the effectiveness of the programs operated with the grants
  and contracts.
  `(2) DATE CERTAIN FOR SUBMISSION- Not later than February 10, 1995,
  the Secretary shall complete the report required in paragraph (1) and
  submit the report to the Committee on Energy and Commerce of the House of
  Representatives and the Committee on Labor and Human Resources of the Senate.
  `(e) AUTHORIZATION OF APPROPRIATIONS- For the purpose of carrying out
  this section, there is authorized to be appropriated $1,000,000 for each
  of the fiscal years 1993 through 1995.
`PART G--GENERAL PROVISIONS
`SEC. 791. PREFERENCES AND REQUIRED INFORMATION IN CERTAIN PROGRAMS.
  `(a) PREFERENCES IN MAKING AWARDS-
  `(1) IN GENERAL- Subject to paragraph (2), in making awards of grants
  or contracts under any of sections 747 through 751, under section 763,
  or under section 766 or 767, the Secretary shall give preference to any
  qualified applicant that--
  `(A) has a high rate for placing graduates in practice settings having the
  principal focus of serving residents of medically underserved communities; or
  `(B) during the 2-year period preceding the fiscal year for which such
  an award is sought, has achieved a significant increase in the rate of
  placing graduates in such settings.
  `(2) LIMITATION REGARDING PEER REVIEW- For purposes of paragraph (1),
  the Secretary may not give an applicant preference if the proposal of the
  applicant is ranked at or below the 20th percentile of proposals that have
  been recommended for approval by peer review groups under section 798(a).
  `(b) REQUIRED SUBMISSION OF INFORMATION- The Secretary may make an award of
  a grant or contract under any of sections 747 through 751 or under section
  763 only if the applicant for the award submits to the Secretary (through
  the application required in section 752(a)) the following information
  regarding the programs of the applicant:
  `(1) A description of rotations or preceptorships for students, or clinical
  training programs for residents, that have the principal focus of providing
  health care to medically underserved communities.
  `(2) The number of faculty on admissions committees who have a clinical
  practice in community-based ambulatory settings in medically underserved
  communities.
  `(3) With respect to individuals who are from disadvantaged backgrounds
  or from medically underserved communities, the number of such individuals
  who are recruited for academic programs of the applicant, the number of
  such individuals who are admitted to such programs, and the number of such
  individuals who graduate from such programs.
  `(4) If applicable, the number of recent graduates who have chosen careers
  in primary health care.
  `(5) The number of recent graduates whose practices are serving medically
  underserved communities.
  `(6) A description of whether and to what extent the applicant is able to
  operate without Federal assistance under this title.
  `(c) DEFINITION- For purposes of this section, the term `graduate' means,
  unless otherwise specified, an individual who has successfully completed
  all training and residency requirements necessary for full certification
  in the health profession selected by the individual.
`SEC. 792. HEALTH PROFESSIONS DATA.
  `(a) IN GENERAL- The Secretary shall establish a program, including a
  uniform health professions data reporting system, to collect, compile,
  and analyze data on health professions personnel which program shall
  initially include data respecting all physicians and dentists in the
  States. The Secretary is authorized to expand the program to include,
  whenever he determines it necessary, the collection, compilation,
  and analysis of data respecting pharmacists, optometrists, podiatrists,
  veterinarians, public health personnel, audiologists, speech pathologists,
  health care administration personnel, nurses, allied health personnel,
  medical technologists, chiropractors, clinical psychologists, and any other
  health personnel in States designated by the Secretary to be included
  in the program. Such data shall include data respecting the training,
  licensure status (including permanent, temporary, partial, limited, or
  institutional), place or places of practice, professional specialty, practice
  characteristics, place and date of birth, sex, and socioeconomic background
  of health professions personnel and such other demographic information
  regarding health professions personnel as the Secretary may require.
  `(b) CERTAIN AUTHORITIES AND REQUIREMENTS-
  `(1) SOURCES OF INFORMATION- In carrying out subsection (a), the Secretary
  shall collect available information from appropriate local, State, and
  Federal agencies and other appropriate sources.
  `(2) CONTRACTS FOR STUDIES OF HEALTH PROFESSIONS- The Secretary shall
  conduct or enter into contracts for the conduct of analytic and descriptive
  studies of the health professions, including evaluations and projections of
  the supply of, and requirements for, the health professions by specialty
  and geographic location. Such studies shall include studies determining
  by specialty and geographic location the number of health professionals
  (including allied health professionals and health care administration
  personnel) who are members of minority groups, including Hispanics, and
  studies providing by specialty and geographic location evaluations and
  projections of the supply of, and requirements for, health professionals
  (including allied health professionals and health care administration
  personnel) to serve minority groups, including Hispanics.
  `(3) GRANTS AND CONTRACTS REGARDING STATES- The Secretary is authorized
  to make grants and to enter into contracts with States (or an appropriate
  nonprofit private entity in any State) for the purpose of participating in
  the program established under subsection (a). The Secretary shall determine
  the amount and scope of any such grant or contract. To be eligible for a
  grant or contract under this paragraph a State or entity shall submit an
  application in such form and manner and containing such information as
  the Secretary shall require. Such application shall include reasonable
  assurance, satisfactory to the Secretary, that--
  `(A) such State (or nonprofit entity within a State) will establish
  a program of mandatory annual registration of the health professions
  personnel described in subsection (a) who reside or practice in such State
  and of health institutions licensed by such State, which registration shall
  include such information as the Secretary shall determine to be appropriate;
  `(B) such State or entity shall collect such information and report it to
  the Secretary in such form and manner as the Secretary shall prescribe; and
  `(C) such State or entity shall comply with the requirements of subsection
  (e).
  `(d) REPORTS TO CONGRESS- The Secretary shall submit to the Congress on
  October 1, 1993, and biennially thereafter, the following reports:
  `(1) A comprehensive report regarding the status of health personnel
  according to profession, including a report regarding the analytic and
  descriptive studies conducted under this section.
  `(2) A comprehensive report regarding applicants to, and students enrolled
  in, programs and institutions for the training of health personnel,
  including descriptions and analyses of student indebtedness, student need
  for financial assistance, financial resources to meet the needs of students,
  student career choices such as practice specialty and geographic location and
  the relationship, if any, between student indebtedness and career choices.
  `(e) REQUIREMENTS REGARDING PERSONAL DATA-
  `(1) IN GENERAL- The Secretary and each program entity shall in securing
  and maintaining any record of individually identifiable personal data
  (hereinafter in this subsection referred to as `personal data') for purposes
  of this section--
  `(A) inform any individual who is asked to supply personal data whether
  he is legally required, or may refuse, to supply such data and inform him
  of any specific consequences, known to the Secretary or program entity,
  as the case may be, of providing or not providing such data;
  `(B) upon request, inform any individual if he is the subject of personal
  data secured or maintained by the Secretary or program entity, as the case
  may be, and make the data available to him in a form comprehensible to him;
  `(C) assure that no use is made of personal data which use is not within
  the purposes of this section unless an informed consent has been obtained
  from the individual who is the subject of such data; and
  `(D) upon request, inform any individual of the use being made of personal
  data respecting such individual and of the identity of the individuals and
  entities which will use the data and their relationship to the programs
  under this section.
  `(2) CONSENT AS PRECONDITION TO DISCLOSURE- Any entity which maintains a
  record of personal data and which receives a request from the Secretary
  or a program entity for such data for purposes of this section shall not
  transfer any such data to the Secretary or to a program entity unless the
  individual whose personal data is to be so transferred gives an informed
  consent for such transfer.
  `(3) DISCLOSURE BY SECRETARY-
  `(A) Notwithstanding any other provision of law, personal data collected
  by the Secretary or any program entity under this section may not be
  made available or disclosed by the Secretary or any program entity to any
  person other than the individual who is the subject of such data unless
  (i) such person requires such data for purposes of this section, or (ii)
  in response to a demand for such data made by means of compulsory legal
  process. Any individual who is the subject of personal data made available
  or disclosed under clause (ii) shall be notified of the demand for such data.
  `(B) Subject to all applicable laws regarding confidentiality, only the
  data collected by the Secretary under this section which is not personal
  data shall be made available to bona fide researchers and policy analysts
  (including the Congress) for the purposes of assisting in the conduct of
  studies respecting health professions personnel.
  `(4) DEFINITION- For purposes of this subsection, the term `program entity'
  means any public or private entity which collects, compiles, or analyzes
  health professions data under a grant, contract, or other arrangement with
  the Secretary under this section.
  `(g) TECHNICAL ASSISTANCE- The Secretary shall provide technical assistance
  to the States and political subdivisions thereof in the development of
  systems (including model laws) concerning confidentiality and comparability
  of data collected pursuant to this section.
  `(h) GRANTS AND CONTRACTS REGARDING NONPROFIT ENTITIES-
  `(1) IN GENERAL- In carrying out subsection (a), the Secretary may make
  grants, or enter into contracts and cooperative agreements with, and
  provide technical assistance to, any nonprofit entity in order to establish
  a uniform allied health professions data reporting system to collect,
  compile, and analyze data on the allied health professions personnel.
  `(2) REPORTS- With respect to reports required in subsection (d), each
  such report made on or after October 1, 1991, shall include a description
  and analysis of data collected pursuant to paragraph (1).
`SEC. 793. STATISTICS; ANNUAL REPORT.
  `(a) STATISTICS AND OTHER INFORMATION- The Secretary shall, in coordination
  with the National Center for Health Statistics (established under section
  306), continuously develop, publish, and disseminate on a nationwide basis
  statistics and other information respecting public and community health
  personnel, including--
  `(1) detailed descriptions of the various types of activities in which
  public and community health personnel are engaged,
  `(2) the current and anticipated needs for the various types of public
  and community health personnel, and
  `(3) the number, employment, geographic locations, salaries, and surpluses
  and shortages of public and community health personnel, the educational
  and licensure requirements for the various types of such personnel, and
  the cost of training such personnel.
  `(b) REQUIREMENTS REGARDING PERSONAL DATA-
  `(1) IN GENERAL- The Secretary and each program entity shall in securing and
  maintaining any record of individually identifiable personal data (in this
  subsection referred to as `personal data') for purposes of this section--
  `(A) inform any individual who is asked to supply personal data whether
  he is legally required, or may refuse, to supply such data and inform him
  of any specific consequences, known to the Secretary or program entity as
  the case may be, of providing or not providing such data;
  `(B) upon request, inform any individual if he is the subject of personal
  data secured or maintained by the Secretary or program entity, as the case
  may be, and make the data available to him in a form comprehensible to him;
  `(C) assure that no use is made of personal data which is not within the
  purposes of this section unless an informed consent has been obtained from
  the individual who is the subject of such data; and
  `(D) upon request, inform any individual of the use being made of personal
  data respecting such individual and of the identity of the individuals and
  entities which will use the data and their relationship to the activities
  conducted under this section.
  `(2) CONSENT AS PRECONDITION TO TRANSFER OF INFORMATION- Any entity which
  maintains a record of personal data and which receives a request from
  the Secretary or a program entity to use such data for purposes of this
  section shall not transfer any such data to the Secretary or to a program
  entity unless the individual whose personal data is to be so transferred
  gives an informed consent for such transfer.
  `(3) DISCLOSURE BY SECRETARY-
  `(A) Notwithstanding any other provision of law, personal data collected by
  the Secretary or any program entity for purposes of this section may not be
  made available or disclosed by the Secretary or any program entity to any
  person other than the individual who is the subject of such data unless
  (i) such person requires such data for purposes of this section, or (ii)
  in response to a demand for such data made by means of compulsory legal
  process. Any individual who is the subject of personal data made available
  or disclosed under clause (ii) shall be notified of the demand for such data.
  `(B) Subject to all applicable laws regarding confidentiality, only the
  data collected by the Secretary under this section which is not personal
  data shall be made available to bona fide researchers and policy analysts
  (including the Congress) for the purposes of assisting in the conduct of
  studies respecting health professions personnel.
  `(4) DEFINITIONS- For purposes of this subsection, the term `program
  entity' means any public or private entity which collects, compiles, or
  analyzes health professions data under an arrangement with the Secretary
  for purposes of this section.
  `(c) REPORT- The Secretary shall submit biennially to the Committee on
  Energy and Commerce of the House of Representatives and to the Committee
  on Labor and Human Resources of the Senate a report on--
  `(1) the statistics and other information developed pursuant to subsection
  (a); and
  `(2) the activities conducted under subparts I and II of part D, including
  an evaluation of such activities.
Such report shall contain such recommendations for legislation as the
Secretary determines are needed to improve the programs authorized under
such subparts. The Office of Management and Budget may review such report
before its submission to such Committees, but the Office may not revise the
report or delay its submission beyond the date prescribed for its submission
and may submit to such Committees its comments respecting such report.
  `(d) DEFINITIONS- For purposes of this section, the term `public and
  community health personnel' means individuals who are engaged in--
  `(1) the planning, development, monitoring, or management of health care
  or health care institutions, organizations, or systems,
  `(2) research on health care development and the collection and analysis
  of health statistics, data on the health of population groups, and any
  other health data,
  `(3) the development and improvement of individual and community knowledge
  of health (including environmental health and preventive medicine) and
  the health care system, or
  `(4) the planning and development of a healthful environment and control
  of environmental health hazards.
`SEC. 794. PROHIBITION AGAINST DISCRIMINATION ON BASIS OF SEX.
  `The Secretary may not make a grant, loan guarantee, or interest subsidy
  payment under this title to, or for the benefit of, any school of medicine,
  osteopathic medicine, dentistry, veterinary medicine, optometry, pharmacy,
  podiatric medicine, or public health or any training center for allied
  health personnel, or graduate program in clinical psychology, unless the
  application for the grant, loan guarantee, or interest subsidy payment
  contains assurances satisfactory to the Secretary that the school or
  training center will not discriminate on the basis of sex in the admission
  of individuals to its training programs. The Secretary may not enter into
  a contract under this title with any such school or training center unless
  the school, training center, or graduate program furnishes assurances
  satisfactory to the Secretary that it will not discriminate on the basis
  of sex in the admission of individuals to its training programs. In the
  case of a school of medicine which--
  `(1) on the date of the enactment of this sentence is in the process of
  changing its status as an institution which admits only female students to
  that of an institution which admits students without regard to their sex, and
  `(2) is carrying out such change in accordance with a plan approved by
  the Secretary,
the provisions of the preceding sentences of this section shall apply only
with respect to a grant, contract, loan guarantee, or interest subsidy to,
or for the benefit of such a school for a fiscal year beginning after June
30, 1979.
`SEC. 795. OBLIGATED SERVICE REGARDING CERTAIN PROGRAMS.
  `(a) IN GENERAL- In the case of any program under this title under which
  a scholarship, stipend, or other financial assistance is provided to an
  individual with respect to education as a health professional (including a
  program that provides for the repayment of loans), if the program provides
  that the provision of the financial assistance involved is subject to this
  section, then the assistance may be provided only if the individual makes
  agreements as follows:
  `(1) The individual will complete the program of education with respect
  to which such assistance is provided (in the case of assistance provided
  for purposes other than the repayment of loans).
  `(2) In the case of an individual who receives such assistance with
  respect to attendance at a school of medicine or osteopathic medicine,
  the individual will--
  `(A) enter and complete a residency training program in a specialty in
  primary health care not later than 4 years after completing the program
  of education described in paragraph (1); and
  `(B) practice in the specialty for 5 years after completing the residency
  training program.
  `(3) in the case of an individual who receives such assistance with respect
  to attendance at a school of dentistry, the individual will practice in
  general dentistry for 5 years (exclusive of any period during which the
  individual is attending a residency training program in general dentistry).
  `(4) Subsection (b) applies with respect to the breach of agreements made
  under any of paragraphs (1) through (3).
  `(b) BREACH OF AGREEMENTS-
  `(1) IN GENERAL- For purposes of subsection (a)(4), the following applies:
  `(A) In the case of a program under this title that provides financial
  assistance for attendance at a program of education in a health profession,
  the individual is liable to the Federal Government for the amount of the
  award (including amounts provided for expenses related to such attendance),
  and for interest on such amount at the maximum legal prevailing rate,
  if the individual--
  `(i) fails to maintain an acceptable level of academic standing in the
  program of education (as indicated by such program in accordance with
  requirements established by the Secretary);
  `(ii) is dismissed from the program for disciplinary reasons; or
  `(iii) voluntarily terminates the program.
  `(B) The individual is liable to the Federal Government for the amount of the
  award (including amounts provided for expenses related to such attendance),
  and for interest on such amount at the maximum legal prevailing rate, if the
  individual fails to comply with the agreement made under subsection (a)(2).
  `(2) WAIVER OR SUSPENSION OF LIABILITY- In the case of an individual
  making agreements under subsection (a), the Secretary shall provide for
  the waiver or suspension of liability under paragraph (1) if compliance
  by the individual with the agreements involved is impossible, or would
  involve extreme hardship to the individual, and if enforcement of the
  agreements with respect to the individual would be unconscionable.
  `(3) DATE CERTAIN FOR RECOVERY- Subject to paragraph (2), any amount that
  the Federal Government is entitled to recover under paragraph (1) shall be
  paid to the United States not later than the expiration of the three-year
  period beginning on the date the United States becomes so entitled.
`SEC. 798. CERTAIN GENERAL PROVISIONS.
  `(a) PEER REVIEW- Each application for a grant or contract under this
  title shall be submitted to a peer review group for an evaluation of the
  merits of the proposals made in the application. The Secretary may not
  approve such an application unless a peer review group has recommended the
  application for approval. Each peer review group under this subsection shall
  be composed principally of individuals who are not officers or employees
  of the Federal Government. This subsection shall be carried out by the
  Secretary acting through the Administrator of the Health Resources and
  Services Administration.
  `(b) DELEGATION OF AUTHORITY OF SECRETARY- The Secretary may delegate
  the authority to administer any program authorized by this title to the
  administrator of a central or regional office or offices of the Department,
  except that the authority to make such a grant, enter into such a contract,
  continue such a grant or contract, or modify such a contract, shall not
  be delegated to any administrator of, or officer in, a regional office or
  offices of the Department.
  `(c) DIFFERENTIAL TUITION AND FEES- The Secretary may not enter into a
  contract with, or make a grant, loan guarantee, or interest subsidy payment
  under this title or title VIII, to or for the benefit of, any school,
  program, or training center if the tuition levels or educational fees at
  such school, program, or training center are higher for certain students
  solely on the basis that such students are the recipients of traineeships,
  loans, loan guarantees, service scholarships, or interest subsidies from
  the Federal Government.
  `(d) APPLICABILITY OF CERTAIN PROVISIONS ON CONTRACTS- Contracts authorized
  by this title may be entered into without regard to section 3324 of title 31,
  United States Code, or section 3709 of the Revised Statutes (41 U.S.C. 5).
  `(e) RECORDS AND AUDITS-
  `(1) MAINTENANCE OF RECORDS-
  `(A) Each entity which receives a grant, loan, loan guarantee, or interest
  subsidy or which enters into a contract with the Secretary under this
  title, shall establish and maintain such records as the Secretary shall
  by regulation or order require.
  `(B) The Secretary may specify, by regulation, the form and manner in
  which such records, required by subparagraph (A), shall be established
  and maintained.
  `(2) BIENNIAL AUDITS- Each entity which received a grant or entered into a
  contract under this title shall provide for a biennial financial audit of
  any books, accounts, financial records, files, and other papers and property
  which relate to the disposition or use of the funds received under such grant
  or contract and such other funds received by or allocated to the project
  or undertaking for which such grant or contract was made. For purposes of
  assuring accurate, current, and complete disclosure of the disposition or
  use of the funds received, each such audit shall be conducted in accordance
  with such requirements concerning the individual or agency which conducts
  the audit, and such standards applicable to the performance of the audit,
  as the Secretary may by regulation provide. A report of each such audit
  shall be filed with the Secretary at such time and in such manner as he
  may require.
  `(3) APPLICABILITY TO STUDENTS- A student recipient of a scholarship,
  traineeship, loan, or loan guarantee under this title shall not be required
  to establish or maintain the records required in paragraph (1) or provide
  for an audit required in paragraph (2).
  `(4) AVAILABILITY OF DOCUMENTS, ETC-
  `(A) Each entity which is required to establish and maintain records or to
  provide for an audit under this subsection shall make such books, documents,
  papers, and records available to the Secretary or the Comptroller General
  of the United States, or any of their duly authorized representatives,
  for examination, copying, or mechanical reproduction on or off the premises
  of such entity upon a reasonable request therefor.
  `(B) The Secretary and the Comptroller General of the United States, or
  any of their duly authorized representatives, shall have the authority to
  carry out the purposes of this paragraph.
  `(f) MISCELLANEOUS PROVISIONS-
  `(1) PAYMENTS UNDER GRANTS- Grants made under this title may be paid (A)
  in advance or by way of reimbursement, (B) at such intervals and on such
  conditions as the Secretary may find necessary, and (C) with appropriate
  adjustments on account of overpayments or underpayments previously made.
  `(2) APPLICATIONS FOR GRANTS AND CONTRACTS- No grant may be made or
  contract entered into under this title unless an application therefor has
  been submitted to and approved by the Secretary. Such application shall
  be in such form, submitted in such manner, and contain such information,
  as the Secretary shall by regulation prescribe.
  `(3) ASSURANCES- Whenever in this title an applicant is required to provide
  assurances to the Secretary, or an application is required to contain
  assurances or be supported by assurances, the Secretary shall determine
  before approving the application that the assurances provided are made in
  good faith.
  `(4) TECHNICAL ASSISTANCE- Funds appropriated under this title may be
  used by the Secretary to provide technical assistance in relation to any
  of the authorities under this title.
  `(5) GRADUATES OF FOREIGN MEDICAL SCHOOLS- The Secretary may make an award
  of a grant, cooperative agreement, or contract under this title to an
  entity (including a school) that provides graduate training in the health
  professions only if the entity agrees that, in considering applications
  for admissions to a program of such training, the entity will not refuse
  to consider an application solely on the basis that the application is
  submitted by a graduate of a foreign medical school. This paragraph may
  not be construed as establishing any private right of action.
`SEC. 799. DEFINITIONS.
  `For purposes of this title:
  `(1)(A) The terms `school of medicine', `school of dentistry', `school
  of osteopathic medicine', `school of pharmacy', `school of optometry',
  `school of podiatric medicine', `school of veterinary medicine', `school
  of public health', and `school of chiropractic' mean an accredited public
  or nonprofit private school in a State that provides training leading,
  respectively, to a degree of doctor of medicine, a degree of doctor of
  dentistry or an equivalent degree, a degree of doctor of osteopathy,
  a degree of bachelor of science in pharmacy or an equivalent degree or a
  degree of doctor of pharmacy or an equivalent degree, a degree of doctor of
  optometry or an equivalent degree, a degree of doctor of podiatric medicine
  or an equivalent degree, a degree of doctor of veterinary medicine or an
  equivalent degree, a graduate degree in public health or an equivalent
  degree, and a degree of doctor of chiropractic or an equivalent degree,
  and including advanced training related to such training provided by any
  such school.
  `(B) The terms `graduate program in health administration' and `graduate
  program in clinical psychology' mean an accredited graduate program in a
  public or nonprofit private institution in a State that provides training
  leading, respectively, to a graduate degree in health administration or
  an equivalent degree and a doctoral degree in clinical psychology or an
  equivalent degree.
  `(C) The terms `graduate program in clinical social work' and `graduate
  program in marriage and family therapy' mean an accredited graduate program
  in a public or nonprofit private institution in a State that provides
  training, respectively, in a concentration in health or mental health care
  leading to a graduate degree in social work and a concentration leading
  to a graduate degree in marriage and family therapy.
  `(D) The term `graduate program in mental health practice' means a graduate
  program in clinical psychology, clinical social work, or marriage and
  family therapy.
  `(E) The term `accredited', when applied to a school of medicine,
  osteopathic medicine, dentistry, veterinary medicine, optometry, podiatry,
  pharmacy, public health, or chiropractic, or a graduate program in health
  administration, clinical psychology, clinical social work, or marriage and
  family therapy, means a school or program that is accredited by a recognized
  body or bodies approved for such purpose by the Secretary of Education,
  except that a new school or program that, by reason of an insufficient
  period of operation, is not, at the time of application for a grant or
  contract under this title, eligible for accreditation by such a recognized
  body or bodies, shall be deemed accredited for purposes of this title, if
  the Secretary of Education finds, after consultation with the appropriate
  accreditation body or bodies, that there is reasonable assurance that the
  school or program will meet the accreditation standards of such body or
  bodies prior to the beginning of the academic year following the normal
  graduation date of the first entering class in such school or program.
  `(2) The term `teaching facilities' means areas dedicated for use by
  students, faculty, or administrative or maintenance personnel for clinical
  purposes, research activities, libraries, classrooms, offices, auditoriums,
  dining areas, student activities, or other related purposes necessary for,
  and appropriate to, the conduct of comprehensive programs of education. Such
  term includes interim facilities but does not include off-site improvements
  or living quarters.
  `(3) The term `program for the training of physician assistants' means an
  educational program that--
  `(A) has as its objective the education of individuals who will, upon
  completion of their studies in the program, be qualified to provide primary
  health care under the supervision of a physician; and
  `(B) meets regulations prescribed by the Secretary in accordance with
  section 750(b).
  `(4) The term `school of allied health' means a public or nonprofit private
  college, junior college, or university or hospital-based educational
  entity that--
  `(A) provides, or can provide, programs of education to enable individuals
  to become allied health professionals or to provide additional training
  for allied health professionals;
  `(B) provides training for not less than a total of twenty persons in the
  allied health curricula (except that this subparagraph shall not apply to
  any hospital-based educational entity);
  `(C) includes or is affiliated with a teaching hospital; and
  `(D) is accredited by a recognized body or bodies approved for such
  purposes by the Secretary of Education, or which provides to the Secretary
  satisfactory assurance by such accrediting body or bodies that reasonable
  progress is being made toward accreditation.
  `(5) The term `allied health professionals' means a health professional
  (other than a registered nurse or physician assistant)--
  `(A) who has received a certificate, an associate's degree, a bachelor's
  degree, a master's degree, a doctoral degree, or postbaccalaureate training,
  in a science relating to health care;
  `(B) who shares in the responsibility for the delivery of health care
  services or related services, including--
  `(i) services relating to the identification, evaluation, and prevention
  of disease and disorders;
  `(ii) dietary and nutrition services;
  `(iii) health promotion services;
  `(iv) rehabilitation services; or
  `(v) health systems management services; and
  `(C) who has not received a degree of doctor of medicine, a degree of
  doctor of osteopathy, a degree of doctor of dentistry or an equivalent
  degree, a degree of doctor of veterinary medicine or an equivalent degree,
  a degree of doctor of optometry or an equivalent degree, a degree of
  doctor of podiatric medicine or an equivalent degree, a degree of bachelor
  of science in pharmacy or an equivalent degree, a degree of doctor of
  pharmacy or an equivalent degree, a graduate degree in public health or
  an equivalent degree, a degree of doctor of chiropractic or an equivalent
  degree, a graduate degree in health administration or an equivalent degree,
  a doctoral degree in clinical psychology or an equivalent degree, or a
  degree in social work or an equivalent degree.
  `(6) The term `medically underserved community' means an urban or rural
  area or population that--
  `(A) is eligible for designation under section 332 as a health professional
  shortage area;
  `(B) is eligible to be served by a migrant health center under section
  329, a community health center under section 330, a grantee under section
  340 (relating to homeless individuals), or a grantee under section 340A
  (relating to residents of public housing); or
  `(C) has a shortage of personal health services, as determined under
  criteria issued by the Secretary under section 1861(aa)(2) of the Social
  Security Act (relating to rural health clinics).
  `(7) The term `Department' means the Department of Health and Human Services.
  `(8) The term `nonprofit' refers to the status of an entity 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.
  `(9) The term `State' includes, in addition to the several States, only
  the District of Columbia, the Commonwealth of Puerto Rico, the Commonwealth
  of the Northern Mariana Islands, the Virgin Islands, Guam, American Samoa,
  and the Trust Territory of the Pacific Islands.
  `(10)(A) Subject to subparagraph (B), the term `underrepresented minorities'
  means, with respect to a health profession, racial and ethnic populations
  that are underrepresented in the health profession relative to the number
  of individuals who are members of the population involved.
  `(B) For purposes of subparagraph (A), Asian individuals shall be considered
  by the various subpopulations of such individuals.'.
SEC. 103. EFFECTIVE DATE.
  The amendment made by section 102 takes effect on the date of the enactment
  of this Act, except that section 708 of the Public Health Service Act,
  as added by section 102 of this Act, takes effect January 1, 1993. Until
  such date, section 732(c) of the Public Health Service Act, as in effect on
  the day before the date of the enactment of this Act, continues in effect
  in lieu of such section 708.
TITLE II--NURSE EDUCATION
SEC. 201. SHORT TITLE.
  This title may be referred to as the Nurse Education and Practice Improvement
  Amendments of 1992.
SEC. 202. SPECIAL PROJECT GRANTS AND CONTRACTS.
  (a) IN GENERAL- Section 820 of the Public Health Service Act (42 U.S.C. 296k)
  is amended to read as follows:
`SPECIAL PROJECT GRANTS AND CONTRACTS
  `SEC. 820. (a) EXPANSION OF ENROLLMENT IN PROFESSIONAL NURSING PROGRAMS-
  `(1) IN GENERAL- The Secretary may make grants to and enter into contracts
  with public and nonprofit private schools of nursing with programs of
  education in professional nursing for the purpose of assisting the schools
  in increasing the number of students enrolled in such programs. Such a
  grant or contract may be made only with respect to such programs that
  are in operation on the date of the enactment of the Health Professions
  Education Extension Amendments of 1992.
  `(2) PREFERENCE- In making awards of grants and contracts under paragraph
  (1), the Secretary shall give preference to any qualified school that
  provides students of the school with clinical training in the provision
  of primary health care in publicly-funded--
  `(A) urban or rural outpatient facilities, home health agencies, or public
  health agencies; or
  `(B) rural hospitals.
  `(3) MATCHING FUNDS-
  `(A) With respect to the costs of the program to be carried out by a
  school pursuant to paragraph (1), the Secretary may provide an award of a
  grant or contract under such paragraph only if the school agrees to make
  available (directly or through donations from public or private entities)
  non-Federal contributions toward such costs in an amount that--
  `(i) for the first fiscal year for which the school receives such an award,
  is not less than $1 for each $9 of Federal funds provided through the award
  (10 percent of such costs);
  `(ii) for any second such fiscal year, is not less than $1 for each $3 of
  Federal funds provided through the award (25 percent of such costs);
  `(iii) for any third such fiscal year, is not less than $1 for each $1 of
  Federal funds provided through the award (50 percent of such costs); and
  `(iv) for any fourth or fifth such fiscal year, is not less than $3 for each
  $1 of Federal funds provided through the award (75 percent of such costs).
  `(B) Non-Federal contributions required in subparagraph (A) may be in cash or
  in kind, fairly evaluated, including plant, equipment, or services. Amounts
  provided by the Federal Government, or services assisted or subsidized to
  any significant extent by the Federal Government, may not be included in
  determining the amount of such non-Federal contributions.
  `(b) PRIMARY HEALTH CARE IN NONINSTITUTIONAL SETTINGS-
  `(1) IN GENERAL- The Secretary may make grants to and enter into contracts
  with public and nonprofit private schools of nursing for the establishment
  or expansion of nursing practice arrangements in noninstitutional settings
  to demonstrate methods to improve access to primary health care in medically
  underserved communities.
  `(2) OPERATION AND STAFFING OF PROGRAMS- The Secretary may make an award
  of a grant or contract under paragraph (1) only if the school involved
  agrees that the program carried out with the award will be operated and
  staffed by the faculty and students of the school.
  `(3) DESIGN- The Secretary may make an award of a grant or contract under
  paragraph (1) only if the program to be carried out under such paragraph
  by the school involved is designed to provide at least 25 percent of the
  students of the school with a structured clinical experience in primary
  health care.
  `(c) CONTINUING EDUCATION FOR NURSES IN MEDICALLY UNDERSERVED COMMUNITIES-
  The Secretary may make grants to and enter into contracts with public
  and nonprofit private entities for the purpose of providing continuing
  education for nurses serving in medically underserved communities.
  `(d) LONG-TERM CARE FELLOWSHIPS FOR CERTAIN PARAPROFESSIONALS-
  `(1) IN GENERAL- The Secretary may make grants to and enter into contracts
  with public and nonprofit private entities that operate accredited programs
  of education in professional nursing, or State-board approved programs of
  practical or vocational nursing, for the purpose of providing fellowships
  to individuals described in paragraph (2) for attendance in such programs.
  `(2) ELIGIBLE INDIVIDUALS- The individuals referred to in paragraph (1)
  are individuals who are employed by nursing facilities or home health
  agencies as nursing paraprofessionals.
  `(3) PREFERENCE FOR SCHOOLS WITH RAPID TRANSITION PROGRAMS- In making
  awards of grants and contracts under paragraph (1), the Secretary shall
  give preference to any qualified applicant operating an accredited program
  of education in professional nursing that provides for the rapid transition
  to status as a professional nurse from status as a nursing paraprofessional.
  `(4) PREFERENCE IN AWARD OF FELLOWSHIPS- The Secretary may make an award
  of a grant or contract under paragraph (1) only if the applicant involved
  agrees that, in providing fellowships under the award, the applicant will
  give preference to individuals described in paragraph (2) who--
  `(A) are economically disadvantaged individuals, particularly such
  individuals who are members of a minority group that is underrepresented
  among registered nurses; or
  `(B) are employed by a nursing facility that will assist in paying the costs
  or expenses described in paragraph (5)(A) with respect to the individuals.
  `(5) USE OF AWARD- The Secretary may make an award of a grant or contract
  under paragraph (1) only if the applicant involved agrees that fellowships
  provided with the award will pay all or part of the costs of--
  `(A) the tuition, books, and fees of the program of nursing with respect
  to which the fellowship is provided; and
  `(B) reasonable living expenses of the individual during the period for
  which the fellowship is provided.
  `(6) DEFINITION- For purposes of this section:
  `(A) The term `home health agency' has the meaning given such term in
  section 1861 of the Social Security Act.
  `(B) The term `nursing facility' has the meaning given such term in section
  1919 of the Social Security Act.
  `(e) AUTHORIZATION OF APPROPRIATIONS- For the purpose of carrying out this
  section, there is authorized to be appropriated $10,500,000 for each of
  the fiscal years 1993 and 1994.'.
  (b) DEFINITION OF MEDICALLY UNDERSERVED COMMUNITIES- Section 853 of the
  Public Health Service Act (42 U.S.C. 298b) is amended by adding at the
  end the following new paragraph:
  `(11) The term `medically underserved community' has the meaning given
  such term in section 799.'.
  (c) SAVINGS PROVISION FOR CURRENT PROJECTS- In the case of any authority for
  making awards of grants or contracts that is terminated by the amendment
  made by subsection (a), 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.
SEC. 203. ADVANCED NURSE EDUCATION.
  Section 821 of the Public Health Service Act (42 U.S.C. 296l) is amended
  to read as follows:
`ADVANCED NURSE EDUCATION
  `SEC. 821. (a) IN GENERAL- The Secretary may make grants to and enter into
  contracts with public and nonprofit private collegiate schools of nursing
  to meet the costs of projects that, in the case of programs described in
  susbsection (b)--
  `(1) plan, develop, and operate new such programs; or
  `(2) significantly expand existing such programs.
  `(b) AUTHORIZED PROGRAMS- The programs referred to in subsection (a) are
  programs leading to advanced degrees that prepare nurses to serve as nurse
  educators or public health nurses, or in other clinical nurse specialties
  determined by the Secretary to require advanced education.
  `(c) FUNDING-
  `(1) AUTHORIZATION OF APPROPRIATIONS- For the purpose of carrying out this
  section, there are authorized to be appropriated $12,000,000 for each of
  the fiscal years 1993 and 1994.
  `(2) LIMITATION- Of the amounts appropriated under paragraph (1), the
  Secretary may not obligate more than 10 percent for providing grants or
  contracts under subsection (a) for programs leading to doctoral degrees.'.
SEC. 204. NURSE PRACTITIONER AND NURSE MIDWIFE PROGRAMS.
  Section 822 of the Public Health Service Act (42 U.S.C. 296m) is amended
  to read as follows:
`NURSE PRACTITIONER AND NURSE MIDWIFE PROGRAMS
  `SEC. 822. (a) IN GENERAL- The Secretary may make grants to and enter into
  contracts with public and nonprofit private schools of nursing or other
  public and nonprofit private entities to meet the costs of projects that,
  with respect to programs described in subsection (b)--
  `(1) plan, develop, and operate new such programs; or
  `(2) maintain or significantly expand existing such programs.
  `(b) AUTHORIZED PROGRAMS-
  `(1) IN GENERAL- The programs referred to in subsection (a) are educational
  programs for registered nurses (irrespective of the type of school of
  nursing in which the nurses received their training) that--
  `(A) meet guidelines prescribed by the Secretary in accordance with paragraph
  (2); and
  `(B) have as their objective the education of nurses who will, upon
  completion of their studies in such programs, be qualified to effectively
  provide primary health care, including primary health care in homes and
  in ambulatory care facilities, long-term care facilities and other health
  care institutions.
  `(2) GUIDELINES- After consultation with appropriate educational
  organizations and professional nursing and medical organizations, the
  Secretary shall prescribe guidelines for programs described in paragraph
  (1). Such guidelines shall, as a minimum, require that such a program--
  `(A) extend for at least one academic year and consist of--
  `(i) supervised clinical practice directed toward preparing nurses to
  deliver primary health care; and
  `(ii) at least four months (in the aggregate) of classroom instruction
  that is so directed; and
  `(B) have an enrollment of not less than six full-time equivalent students.
  `(c) CERTAIN CONSIDERATIONS IN MAKING AWARDS-
  `(1) PREFERENCE- In making awards of grants and contracts under subsection
  (a), the Secretary shall give preference to any qualified applicant that,
  with respect to programs described in subsection (b), agrees to expend the
  award to plan, develop, and operate new such programs or to significantly
  expand existing such programs.
  `(2) SPECIAL CONSIDERATION- In making awards of grants and contracts under
  subsection (a), the Secretary shall give special consideration to qualified
  applicants that agree to expend the award to train individuals as nurse
  practitioners and nurse midwives who will practice in health professional
  shortage areas designated under section 332.
  `(d) AUTHORIZATION OF APPROPRIATIONS- For the purpose of carrying out this
  section, there is authorized to be appropriated $20,000,000 for each of
  the fiscal years 1993 and 1994.'.
SEC. 205. SPECIAL PROJECTS REGARDING DISADVANTAGED INDIVIDUALS.
  Section 827(c) of the Public Health Service Act (42 U.S.C. 296r(c))
  is amended--
  (1) by striking `and' after `1990,'; and
  (2) by inserting before the period the following: `, $5,000,000 for fiscal
  year 1993, and $6,000,000 for fiscal year 1994'.
SEC. 206. TRAINEESHIPS FOR ADVANCED EDUCATION OF PROFESSIONAL NURSES.
  Section 830 of the Public Health Service Act (42 U.S.C. 297) is amended
  to read as follows:
`TRAINEESHIPS FOR ADVANCED EDUCATION OF PROFESSIONAL NURSES
  `SEC. 830. (a) IN GENERAL- The Secretary may make grants to public and
  nonprofit private entities to meet the cost of traineeships for individuals
  in advanced-degree programs in order to educate the individuals to serve
  in and prepare for practice as nurse practitioners, nurse midwives, nurse
  educators, public health nurses, or in other clinical nursing specialties
  determined by the Secretary to require advanced education.
  `(b) SPECIAL CONSIDERATION IN MAKING GRANTS- In making grants for
  traineeships under subsection (a), the Secretary shall give special
  consideration to applications for traineeship programs that conform to
  guidelines established by the Secretary under section 822(b)(2).
  `(c) PREFERENCE IN PROVISION OF TRAINEESHIPS- The Secretary may make a
  grant under subsection (a) only if the applicant involved agrees that,
  in providing traineeships under such subsection, the applicant will give
  preference to individuals who are residents of health professional shortage
  areas designated under section 332.
  `(d) ELIGIBILITY OF INDIVIDUALS IN MASTER'S DEGREE PROGRAMS- The Secretary
  may make a grant under subsection (a) only if the applicant involved agrees
  that the applicant will not provide a traineeship under such subsection to
  an individual enrolled in a masters of nursing program unless the individual
  has completed basic nursing preparation, as determined by the applicant.
  `(e) USE OF GRANT- The Secretary may make a grant under subsection (a)
  only if the applicant involved agrees that traineeships provided with the
  grant will pay all or part of the costs of--
  `(A) the tuition, books, and fees of the program of nursing with respect
  to which the traineeship is provided; and
  `(B) reasonable living expenses of the individual during the period for
  which the traineeship is provided.
  `(f) FUNDING-
  `(1) AUTHORIZATION OF APPROPRIATIONS- For the purpose of carrying out this
  section, there is authorized to be appropriated $20,000,000 for each of
  the fiscal years 1993 and 1994.
  `(2) LIMITATION REGARDING CERTAIN TRAINEESHIPS- Of the amounts appropriated
  under paragraph (1) for a fiscal year, the Secretary may not obligate
  more than 10 percent for providing traineeships under subsection (a)
  for individuals in doctoral degree programs.'.
SEC. 207. NURSE ANESTHETISTS.
  (a) PREFERENCES REGARDING GRANTS AND TRAINEESHIPS; USE OF GRANT- Section
  831(a) of the Public Health Service Act (42 U.S.C. 297-1(a)) is amended--
  (1) by striking paragraph (2); and
  (2) by inserting after paragraph (1) the following paragraphs:
  `(2)(A) In making grants under paragraph (1), the Secretary shall give
  preference to qualified applicants carrying out traineeship programs whose
  participants gain significant experience in providing health services at
  rural health facilities.
  `(B) The Secretary may make a grant under paragraph (1) only if the
  institution involved agrees that, in providing traineeships under such
  paragraph, the institution will give preference to individuals who are
  residents of health professional shortage areas designated under section 332.
  `(3) The Secretary may make a grant under paragraph (1) only if the applicant
  involved agrees that traineeships provided with the grant will pay all or
  part of the costs of--
  `(A) the tuition, books, and fees of the program of nursing with respect
  to which the traineeship is provided; and
  `(B) reasonable living expenses of the individual during the period for
  which the traineeship is provided.'.
  (b) AUTHORIZATION OF APPROPRIATIONS- Section 831(c) of the Public Health
  Service Act (42 U.S.C. 297-1(c)) is amended in the first sentence by
  inserting before the period the following: `, $3,000,000 for fiscal year
  1993, and $4,000,000 for fiscal year 1994'.
SEC. 208. STUDENT LOANS.
  (a) ALLOTMENTS AND PAYMENTS OF FEDERAL CAPITAL CONTRIBUTIONS- Section
  838(a)(3) of the Public Health Service Act (42 U.S.C. 297d(a)(3))
  is amended--
  (1) by striking subparagraph (B); and
  (2) in subparagraph (A)--
  (A) in the first sentence, by striking `available for allotment' and all
  that follows and inserting the following: `available for allotment until
  expended.';
  (B) in the second sentence, by striking `this subpart, except' and all
  that follows and inserting `this subpart.'; and
  (C) by striking the subparagraph designation.
  (b) DISTRIBUTION OF ASSETS FROM LOAN FUNDS- Section 839 of the Public
  Health Service Act (42 U.S.C. 297e) is amended--
  (1) in subsection (a), by striking out `1991' and inserting in lieu thereof
  `1996'; and
  (2) in subsections (a) and (b), by striking `1994' each place such term
  appears and inserting `1999'.
SEC. 209. CERTAIN GENERALLY APPLICABLE PROVISIONS.
  Title VIII of the Public Health Service Act (42 U.S.C. 296k et seq.) is
  amended by adding at the end the following section:
`CERTAIN GENERALLY APPLICABLE PROVISIONS
  `SEC. 860. (a) APPLICATION FOR GRANTS, COOPERATIVE AGREEMENTS, OR CONTRACTS-
  The Secretary may make an award of a grant, cooperative agreement, or
  contract under this title only if an application for the award is submitted
  to the Secretary and the application is in such form, is made in such manner,
  and contains such agreements, assurances, and information as the Secretary
  determines to be necessary to carry out the program authorizing the award.
  `(b) DURATION OF ASSISTANCE-
  `(1) IN GENERAL- Subject to paragraph (2), in the case of an award to an
  entity of a grant, cooperative agreement, or contract under this title,
  the period during which payments are made to the entity under the award
  may not exceed 5 years. The provision of payments under the award shall be
  subject to annual approval by the Secretary of the payments and subject to
  the availability of appropriations for the fiscal year involved to make
  the payments. This paragraph may not be construed as limiting the number
  of awards under the program involved that may be made to the entity.
  `(2) LIMITATION- In the case of an award to an entity of a grant, cooperative
  agreement, or contract under this title, paragraph (1) shall apply only
  to the extent not inconsistent with any other provision of this title that
  relates to the period during which payments may be made under the award.
  `(c) BREACH OF AGREEMENTS FOR OBLIGATED SERVICE-
  `(1) IN GENERAL- In the case of any program under this title under which
  an individual makes an agreement to provide health services for a period
  of time in accordance with such program in consideration of receiving
  an award of Federal funds regarding education as a nurse (including an
  award for the repayment of loans), the following applies if the agreement
  provides that this subsection is applicable:
  `(A) In the case of a program under this title that makes an award of
  Federal funds for attending an accredited program of nursing (in this
  subsection referred to as `nursing program'), the individual is liable to
  the Federal Government for the amount of such award (including amounts
  provided for expenses related to such attendance), and for interest on
  such amount at the maximum legal prevailing rate, if the individual--
  `(i) fails to maintain an acceptable level of academic standing in the
  nursing program (as indicated by the program in accordance with requirements
  established by the Secretary);
  `(ii) is dismissed from the nursing program for disciplinary reasons; or
  `(iii) voluntarily terminates the nursing program.
  `(B) The individual is liable to the Federal Government for the amount
  of such award (including amounts provided for expenses related to such
  attendance), and for interest on such amount at the maximum legal prevailing
  rate, if the individual fails to provide health services in accordance
  with the program under this title for the period of time applicable under
  the program.
  `(2) WAIVER OR SUSPENSION OF LIABILITY- In the case of an individual or
  health facility making an agreement for purposes of paragraph (1), the
  Secretary shall provide for the waiver or suspension of liability under such
  paragraph if compliance by the individual or the health facility, as the case
  may be, with the agreements involved is impossible, or would involve extreme
  hardship to the individual or facility, and if enforcement of the agreements
  with respect to the individual or facility would be unconscionable.
  `(3) DATE CERTAIN FOR RECOVERY- Subject to paragraph (2), any amount that
  the Federal Government is entitled to recover under paragraph (1) shall be
  paid to the United States not later than the expiration of the three-year
  period beginning on the date the United States becomes so entitled.
  `(4) AVAILABILITY- Amounts recovered under paragraph (1) with respect to
  a program under this title shall be available for the purposes of such
  program, and shall remain available for such purposes until expended.
  `(d) PEER REVIEW REGARDING CERTAIN PROGRAMS- Each application for a
  grant or contract under any of sections 821, 822, 830, and 831 shall be
  submitted to a peer review group for an evaluation of the merits of the
  proposals made in the application. The Secretary may not approve such an
  application unless a peer review group has recommended the application
  for approval. Each peer review group under this subsection shall be
  composed principally of individuals who are not officers or employees
  of the Federal Government. This subsection shall be carried out by the
  Secretary acting through the Administrator of the Health Resources and
  Services Administration.
  `(e) PREFERENCES AND REQUIRED INFORMATION IN CERTAIN PROGRAMS-
  `(1) PREFERENCES IN MAKING AWARDS-
  `(A) Subject to subparagraph (B), in awarding grants or contracts under
  any of sections 821, 822, 830, and 831, the Secretary shall give preference
  to any qualified applicant that--
  `(i) has a high rate for placing graduates in practice settings having the
  principal focus of serving residents of medically underserved communities; or
  `(ii) during the 2-year period preceding the fiscal year for which such
  an award is sought, has achieved a significant increase in the rate of
  placing graduates in such settings.
  `(B) For purposes of subparagraph (A), the Secretary may not give an
  applicant preference if the proposal of the applicant is ranked at or below
  the 20th percentile of proposals that have been recommended for approval
  by peer review groups under subsection (d).
  `(2) REQUIRED SUBMISSION OF INFORMATION- The Secretary may make an award of
  a grant or contract under any of sections 821, 822, 830, and 831 only if the
  applicant for the award submits to the Secretary (through the application for
  the award) the following information regarding the programs of the applicant:
  `(A) A description of rotations or preceptorships for students that have
  the principal focus of providing health care to medically underserved
  communities.
  `(B) The number of faculty on admissions committees who have a clinical
  practice in community-based ambulatory settings in medically underserved
  or rural communities.
  `(C) With respect to individuals who are from disadvantaged backgrounds
  or from medically underserved communities, the number of such individuals
  who are recruited for academic programs of the applicant, the number of
  such individuals who are admitted to such programs, and the number of such
  individuals who graduate from such programs.
  `(D) If applicable to the applicant, the number of recent graduates who
  have chosen careers in primary health care.
  `(E) The number of recent graduates whose practices are serving medically
  underserved communities.
  `(F) A description of whether and to what extent the applicant is able to
  operate without Federal assistance under this title.
  `(3) DEFINITION- For purposes of this subsection, the term `graduate'
  means, unless otherwise specified, an individual who has successfully
  completed all training requirements necessary for full certification in
  the health profession selected by the individual.'.
SEC. 210. DEMONSTRATION PROGRAM REGARDING SERVICE IN CERTAIN HEALTH CARE
FACILITIES.
  Part B of title VIII of the Public Health Service Act (42 U.S.C. 297 et
  seq.) is amended by striking subpart IV.
SEC. 211. TRANSFER OF LOAN REPAYMENT PROGRAM.
  (a) IN GENERAL- Part B of title VIII of the Public Health Service Act,
  as amended by section 210 of this Act, is amended--
  (1) in section 836--
  (A) by striking subsection (h); and
  (B) by redesignating subsections (i) through (k) as subsections (h) through
  (j), respectively;
  (2) by striking section 837A; and
  (3) by adding at the end the following subpart:
`Subpart IV--Loan Repayment Program
`LOAN REPAYMENT PROGRAM
  `SEC. 846. (a) IN GENERAL- In the case of any individual--
  `(1) who has received a baccalaureate or associate degree in nursing (or
  an equivalent degree), a diploma in nursing, or a graduate degree in nursing;
  `(2) who obtained (A) one or more loans from a loan fund established under
  subpart II, or (B) any other educational loan for nurse training costs; and
  `(3) who enters into an agreement with the Secretary to serve as nurse for
  a period of not less than two years in an Indian Health Service health
  center, in a Native Hawaiian health center, in a public hospital, in a
  migrant health center, in a community health center, in a rural health
  clinic, or in a public or nonprofit private health facility determined by
  the Secretary to have a critical shortage of nurses;
the Secretary shall make payments in accordance with subsection (b), for and
on behalf of that individual, on the principal of and interest on any loan
of that individual described in paragraph (2) of this subsection which is
outstanding on the date the individual begins the service specified in the
agreement described in paragraph (3) of this subsection.
  `(b) MANNER OF PAYMENTS- The payments described in subsection (a) shall
  be made by the Secretary as follows:
  `(1) Upon completion by the individual for whom the payments are to be made
  of the first year of the service specified in the agreement entered into with
  the Secretary under subsection (a), the Secretary shall pay 30 percent of
  the principal of, and the interest on each loan of such individual described
  in subsection (a)(2) which is outstanding on the date he began such practice.
  `(2) Upon completion by that individual of the second year of such service,
  the Secretary shall pay another 30 percent of the principal of, and the
  interest on each such loan.
  `(3) Upon completion by that individual of a third year of such service,
  the Secretary shall pay another 25 percent of the principal of, and the
  interest on each such loan.
  `(c) PAYMENT BY DUE DATE- Notwithstanding the requirement of completion
  of practice specified in subsection (b), the Secretary shall, on or before
  the due date thereof, pay any loan or loan installment which may fall due
  within the period of service for which the borrower may receive payments
  under this subsection, upon the declaration of such borrower, at such times
  and in such manner as the Secretary may prescribe (and supported by such
  other evidence as the Secretary may reasonably require), that the borrower
  is then serving as described by subsection (a)(3), and that the borrower
  will continue to so serve for the period required (in the absence of this
  subsection) to entitle the borrower to have made the payments provided by
  this subsection for such period; except that not more than 85 percent of
  the principal of any such loan shall be paid pursuant to this subsection.
  `(d) BREACH OF AGREEMENT- The Secretary may make payments under subsection
  (a) on behalf of an individual only if the agreement under such subsection
  provides that section 860(c) is applicable to the individual.
  `(e) PREFERENCES REGARDING PARTICIPANTS- In entering into agreements under
  subsection (a), the Secretary shall give preference--
  `(1) to qualified applicants with the greatest financial need; and
  `(2) to qualified applicants that, with respect to health facilities
  described in such subsection, agree to serve in such health facilities
  located in geographic areas with a shortage of and need for nurses, as
  determined by the Secretary.
  `(f) DEFINITIONS- For purposes of this section:
  `(1) The term `community health center' has the meaning given such term
  in section 330(a).
  `(2) The term `migrant health center' has the meaning given such term in
  section 329(a)(1).
  `(3) The term `rural health clinic' has the meaning given such term in
  section 1861(aa)(2) of the Social Security Act.
  `(g) AUTHORIZATION OF APPROPRIATIONS- For the purpose of payments under
  agreements entered into under subsection (a), there are authorized to be
  appropriated $5,000,000 for fiscal year 1993, and $6,000,000 for fiscal
  year 1994.'.
  (b) RULE OF CONSTRUCTION- With respect to section 836(h) of the Public Health
  Service Act, as in effect prior to the date of the enactment of this Act, any
  agreement entered into under such section that is in effect on the day before
  such date remains in effect in accordance with the terms of the agreement,
  notwithstanding the amendment made by subsection (a) of this section.
SEC. 212. ADVISORY COUNCIL ON NURSES EDUCATION; REVIEW COMMITTEE.
  Section 851 of the Public Health Service Act (42 U.S.C. 298) is amended--
  (1) in subsection (a), in the first sentence, by striking `Advisory'
  and all that follows through `consisting' and inserting the following:
  `National Advisory Council on Nurse Education and Practice (in this section
  referred to as the `Council'), consisting'; and
  (2) in the heading for the section, by striking `NURSES EDUCATION;' and
  inserting `NURSE EDUCATION AND PRACTICE;'.
SEC. 213. EVALUATIONS.
  Section 859(b) of the Public Health Service Act (42 U.S.C. 298b-6(b))
  is amended--
  (1) by striking paragraph (1); and
  (2) in paragraph (2)--
  (A) by striking `(2)'; and
  (B) by striking `not later than' and all that follows through `submit'
  and inserting the following: `not later than January 10, 1994, and every
  2 years thereafter, submit'.
TITLE III--MISCELLANEOUS PROVISIONS
SEC. 301. ADVISORY COUNCIL ON GRADUATE MEDICAL EDUCATION.
  (a) ESTABLISHMENT; DUTIES- There is established the Council on Graduate
  Medical Education (in this section referred to as the `Council'). The
  Council shall--
  (1) make recommendations to the Secretary of Health and Human Services
  (in this section referred to as the `Secretary'), and to the Committee on
  Labor and Human Resources of the Senate, and the Committee on Energy and
  Commerce of the House of Representatives, with respect to--
  (A) the supply and distribution of physicians in the United States;
  (B) current and future shortages or excesses of physicians in medical and
  surgical specialties and subspecialties;
  (C) issues relating to foreign medical school graduates;
  (D) appropriate Federal policies with respect to the matters specified
  in subparagraphs (A), (B), and (C), including policies concerning changes
  in the financing of undergraduate and graduate medical education programs
  and changes in the types of medical education training in graduate medical
  education programs;
  (E) appropriate efforts to be carried out by hospitals, schools of medicine,
  schools of osteopathic medicine, and accrediting bodies with respect to
  the matters specified in subparagraphs (A), (B), and (C), including efforts
  for changes in undergraduate and graduate medical education programs; and
  (F) deficiencies in, and needs for improvements in, existing data bases
  concerning the supply and distribution of, and postgraduate training
  programs for, physicians in the United States and steps that should be
  taken to eliminate those deficiencies; and
  (2) encourage entities providing graduate medical education to conduct
  activities to voluntarily achieve the recommendations of the Council under
  paragraph (1)(E).
  (b) COMPOSITION- The Council shall be composed of--
  (1) the Assistant Secretary for Health or the designee of the Assistant
  Secretary;
  (2) the Administrator of the Health Care Financing Administration;
  (3) the Chief Medical Director of the Department of Veterans Affairs;
  (4) 6 members appointed by the Secretary to include representatives of
  practicing primary care physicians, national and specialty physician
  organizations, foreign medical graduates, and medical student and house
  staff associations;
  (5) 4 members appointed by the Secretary to include representatives
  of schools of medicine and osteopathic medicine and public and private
  teaching hospitals; and
  (6) 4 members appointed by the Secretary to include representatives of
  health insurers, business, and labor.
  (c) TERMS OF APPOINTED MEMBERS-
  (1) IN GENERAL; STAGGERED ROTATION- Members of the Council appointed under
  paragraphs (4), (5), and (6) of subsection (b) shall be appointed for a term
  of 4 years, except that the term of office of the members first appointed
  shall expire, as designated by the Secretary at the time of appointment,
  4 at the end of 1 year, 4 at the end of 2 years, 3 at the end of 3 years,
  and 3 at the end of 4 years.
  (2) DATE CERTAIN FOR APPOINTMENT- The Secretary shall appoint the first
  members to the Council under paragraphs (4), (5), and (6) of subsection
  (b) within 60 days after the date of enactment of this section.
  (d) CHAIR- The Council shall elect one of its members as Chairman of
  the Council.
  (e) QUORUM- Nine members of the Council shall constitute a quorum, but a
  lesser number may hold hearings.
  (f) VACANCIES- Any vacancy in the Council shall not affect its power
  to function.
  (g) COMPENSATION- Each member of the Council who is not otherwise employed
  by the United States Government shall receive compensation at a rate equal to
  the daily rate prescribed for GS-18 under the General Schedule under section
  5332 of title 5, United States Code, for each day, including traveltime,
  such member is engaged in the actual performance of duties as a member of
  the Council. A member of the Council who is an officer or employee of the
  United States Government shall serve without additional compensation. All
  members of the Council shall be reimbursed for travel, subsistence, and
  other necessary expenses incurred by them in the performance of their duties.
  (h) CERTAIN AUTHORITIES AND DUTIES-
  (1) AUTHORITIES- In order to carry out the provisions of this section,
  the Council is authorized to--
  (A) collect such information, hold such hearings, and sit and act at such
  times and places, either as a whole or by subcommittee, and request the
  attendance and testimony of such witnesses and the production of such books,
  records, correspondence, memoranda, papers, and documents as the Council
  or such subcommittee may consider available; and
  (B) request the cooperation and assistance of Federal departments, agencies,
  and instrumentalities, and such departments, agencies, and instrumentalities
  are authorized to provide such cooperation and assistance.
  (2) COORDINATION OF ACTIVITIES- The Council shall coordinate its activities
  with the activities of the Secretary under section 792 of the Public
  Health Service Act. The Secretary shall, in cooperation with the Council
  and pursuant to the recommendations of the Council, take such steps as are
  practicable to eliminate deficiencies in the data base established under
  such section 792 and shall make available in its reports such comprehensive
  data sets as are developed pursuant to this section.
  (i) REQUIREMENT REGARDING REPORTS- In the reports required under subsection
  (a), the Council shall specify its activities during the period for which
  the report is made.
  (j) FINAL REPORT- Not later than April 1, 1995, the Council shall submit
  a final report under subsection (a).
  (k)  TERMINATION- The  Council  shall  terminate  September 30, 1995.
SEC. 302. COMMISSION ON ALLIED HEALTH.
  (a) ESTABLISHMENT- There is established an advisory council to be known
  as the National Commission on Allied Health (in this section referred to
  as the `Commission'), which shall meet at least twice annually until such
  time as the final report is submitted under subsection (e).
  (b) DUTIES- The Commission shall--
  (1) make recommendations to the Secretary of Health and Human Services
  (in this section referred to as the `Secretary'), the Committee on Labor
  and Human Resources of the Senate, and the Committee on Energy and Commerce
  of the House of Representatives, with respect to--
  (A) the supply and distribution of allied health personnel throughout the
  United States;
  (B) current and future shortages or excesses of allied health personnel,
  particularly in medically underserved and rural communities;
  (C) priority research needs within the allied health professions;
  (D) appropriate Federal policies relating to the matters described in
  subparagraphs (A) through (C), including policies concerning changes in
  the financing of undergraduate and graduate allied health programs, changes
  in the types of allied health education, and the appropriate Federal role
  in the development of a research base in the allied health professions;
  (E) appropriate efforts to be carried out by health care facilities,
  schools and programs of allied health, and professional associations with
  respect to the matter referred to in subparagraph (A), including efforts
  for changes in undergraduate and graduate allied health education programs,
  and private support for research initiatives;
  (F) deficiencies and needs for improvements in existing data bases
  concerning the supply and distribution of training programs for allied
  health in the United States and steps that should be taken to eliminate
  such deficiencies; and
  (G) problems, and recommendations for the resolution of such problems,
  relating to the roles and functions of professionals within the allied
  health fields and other fields such as medicine and dentistry; and
  (2) encourage entities providing allied health education to conduct
  activities to voluntarily achieve the recommendations of the Commission.
  (c) COMPOSITION- The Commission shall be composed of--
  (1) the Assistant Secretary for Health;
  (2) the Administrator of the Health Care Financing Administration;
  (3) the Assistant Secretary for Defense for Health Affairs;
  (4) the Chief Medical Director of the Department of Veterans Affairs;
  (5) the Commissioner of the Bureau of Labor Statistics of the Department
  of Labor;
  (6) a representative of the National Center for Education Statistics of
  the Department of Education;
  (7) a representative of the Bureau of Health Professions, Health Resources
  and Services Administration to be appointed by the Secretary;
  (8) five individuals appointed by the Secretary to represent allied health
  professionals, of which--
  (A) two such individuals shall be representatives of allied health
  professionals who provide occupational, speech, respiratory or physical
  therapy services;
  (B) two such individuals shall be health professionals who provide services
  in underserved areas or to underserved populations; and
  (C) one such individual shall be a health professional who provides services
  to the elderly;
  (9) five individuals appointed by the Secretary, including representatives
  of schools and programs of allied health, health care facility employers
  of allied health personnel, health insurers, and professional organizations
  representing the allied health professions;
  (10) a professional knowledgeable about health occupations and professions
  and data policy to be appointed by the Secretary; and
  (11) a representative of the general public to be appointed by the Secretary.
  (d) DATE CERTAIN FOR APPOINTMENTS- Not later than 90 days after the date
  of the enactment of the Health Professions Education Extension Amendments
  of 1992, the Secretary shall appoint the members of the Commission in
  accordance with subsection (c).
  (e) REPORTS- Not later than October 1, 1993, the Commission shall prepare
  and submit to the individual and entities described in subsection (b)(1) a
  progress report concerning the activities of the Commission. Not later than
  April 1, 1994, the Commission shall prepare and submit to such individuals
  and entities a final report.
  (f) RESOURCES FOR COUNCIL- The Secretary shall ensure that necessary
  resources are made available to implement the provisions of this section.
  (g) TERMINATION- The Commission shall terminate 60 days after the submission
  of the final report required under subsection (e).
SEC. 303. STUDY REGARDING CLINICAL LABORATORY TECHNOLOGISTS FOR MEDICALLY
UNDERSERVED AND RURAL COMMUNITIES.
  (a) IN GENERAL- With respect to the shortage of clinical laboratory
  technologists, the Secretary of Health and Human Services (in this section
  referred to as the `Secretary') shall conduct a study for the purpose of--
  (1) determining whether there are special or unique factors affecting the
  supply of clinical laboratory technologists in medically underserved and
  rural communities; and
  (2) assessing alternative routes for certification of the competence of
  individuals to serve as such technologists, with consideration of the role
  of entities providing such certifications.
  (b) DATE CERTAIN FOR REPORT- Not later than October 1, 1993, the Secretary
  shall complete the study required in subsection (a) and 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 findings made as result of the study.
SEC. 304. RESIDENCY TRAINING PROGRAMS IN EMERGENCY MEDICINE.
  Title XII of the Public Health Service Act (42 U.S.C. 300d et seq.), as
  amended by title VI of Public Law 102-321, is amended by adding at the
  end the following part:
`Part E--Miscellaneous Programs
`SEC. 1251. RESIDENCY TRAINING PROGRAMS IN EMERGENCY MEDICINE.
  `(a) IN GENERAL- The Secretary may make grants to public and nonprofit
  private entities for the purpose of planning and developing approved
  residency training programs in emergency medicine.
  `(b) IDENTIFICATION AND REFERRAL OF DOMESTIC VIOLENCE- The Secretary may
  make a grant under subsection (a) only if the applicant involved agrees
  that training programs under subsection (a) will provide education and
  training in identifying and referring cases of domestic violence.
  `(c) AUTHORIZATION OF APPROPRIATIONS- For the purpose of carrying out this
  section, there is authorized to be appropriated $400,000 for each of the
  fiscal years 1993 through 1995.'.
SEC. 305. CERTAIN CLINICAL TRAINEESHIPS.
  Section 303(d)(2) of the Public Health Service Act (42 U.S.C. 242a(d)(2))
  is amended--
  (1) by striking `or' at the end of subparagraph (B);
  (2) by inserting `or' after the comma at the end of subparagraph (C); and
  (3) by inserting after subparagraph (C) the following subparagraph:
  `(D) in a Federal or State correctional facility,'.
SEC. 306. SPECIAL CONSOLIDATED LOAN PROGRAM.
  (a) IN GENERAL- Section 428C of the Higher Education Act of 1965 (20
  U.S.C. 1078-3) is amended--
  (1) by redesignating subsection (d) as subsection (e); and
  (2) by inserting after subsection (c) the following new subsection:
  `(d) SPECIAL PROGRAM AUTHORIZED-
  `(1) GENERAL RULE AND DEFINITION OF ELIGIBLE STUDENT LOAN-
  `(A) IN GENERAL- Subject to the provisions of this subsection, the
  Secretary or a guaranty agency shall enter into agreements with eligible
  lenders described in subparagraphs (A), (B), and (C) of subsection (a)(1)
  for the consolidation of eligible student loans.
  `(B) APPLICABILITY RULE- Unless otherwise provided in this subsection,
  the agreements entered into under subparagraph (A) and the loans made
  under such agreements for the consolidation of eligible student loans
  under this subsection shall have the same terms, conditions, and benefits
  as all other agreements and loans made under this section.
  `(C) DEFINITION- For the purpose of this subsection, the term `eligible
  student loans' means loans--
  `(i) of the type described in subparagraphs (A), (B), and (C) of subsection
  (a)(4); and
  `(ii) made under subpart I of part A of title VII of the Public Health
  Service Act.
  `(2) INTEREST RATE RULE-
  `(A) IN GENERAL- The portion of each consolidated loan that is attributable
  to an eligible student loan described in paragraph (1)(C)(ii) shall bear
  interest at a rate not to exceed the rate determined under subparagraph (B).
  `(B) DETERMINATION OF THE MAXIMUM INTEREST RATE- For the 12-month period
  beginning after July 1, 1992, and for each 12-month period thereafter,
  beginning on July 1 and ending on June 30, the interest rate applicable
  under subparagraph (A) shall be equal to the average of the bond equivalent
  rates of the 91-day Treasury bills auctioned for the quarter prior to July 1,
  for each 12-month period for which the determination is made, plus 3 percent.
  `(C) PUBLICATION OF MAXIMUM INTEREST RATE- The Secretary shall determine
  the applicable rate of interest under subparagraph (B) after consultation
  with the Secretary of the Treasury and shall publish such rate in the
  Federal Register as soon as practicable after the date of such determination.
  `(3) SPECIAL RULES-
  `(A) NO SPECIAL ALLOWANCE RULE- No special allowance under section 438
  shall be paid with respect to the portion of any consolidated loan under
  this subsection that is attributable to any loan described in paragraph
  (1)(C)(ii).
  `(B) NO INTEREST SUBSIDY RULE- No interest subsidy under section 428(a)
  shall be paid on behalf of any eligible borrower for any portion of a
  consolidated loan under this subsection that is attributable to any loan
  described in paragraph (1)(C)(ii).
  `(C) ADDITIONAL RESERVE RULE- Notwithstanding any other provision of this
  Act, additional reserves shall not be required for any guaranty agency
  with respect to a loan made under this subsection.
  `(D) INSURANCE RULE- Any insurance premium paid by the borrower under
  subpart I of part A of title VII of the Public Health Service Act with
  respect to a loan made under that subpart and consolidated under this
  subsection shall be retained by the student loan insurance fund established
  under section 710 of the Public Health Service Act.
  `(4) REGULATIONS- The Secretary is authorized to promulgate such regulations
  as may be necessary to facilitate carrying out the provisions of this
  subsection.'.
  (b) TECHNICAL AMENDMENT- Section 428(e) of the Higher Education Act of
  1965 (as redesignated by subsection (a)) is amended by striking `1992'
  and inserting `1997'.
  (c) EFFECTIVE DATE- The amendments made by this section take effect 60
  days after the date of enactment of this Act.
SEC. 307. NATIONAL ADVISORY COUNCIL ON MEDICAL LICENSURE.
  (a) ADVISORY COUNCIL-
  (1) IN GENERAL- The Secretary of Health and Human Services shall establish
  an advisory council to be known as the `National Advisory Council on
  Medical Licensure'.
  (2) Duties-
  (A) ADVICE- The Council shall provide advice to the Secretary regarding the
  operation of the system established by the American Medical Association
  for the purpose of verifying and maintaining information regarding the
  qualifications of individuals to practice medicine, and advice regarding
  the establishment and operation of any similar system.
  (B) ACTIVITIES- In carrying out subparagraph (A), the Council shall--
  (i) monitor and review the operation of the private credentials verification
  system and develop recommendations regarding methods by which the system
  can be improved, and make recommendations for the establishment of
  nondiscriminatory policies and practices for the operation of the system;
  (ii) determine to what extent the system has expedited and otherwise improved
  the efficiency and equitable operation of the process in the States for
  licensing individuals to practice medicine who previously have been licensed
  by another State (commonly known as licensure by endorsement); and
  (iii) review the policies and practices of the States (including any relevant
  laws) in licensing international medical graduates and in licensing domestic
  medical graduates, and determine the effects of the policies.
  (3) COMPOSITION-
  (A) IN GENERAL- The Council shall be composed of 15 voting members selected
  in accordance with subparagraphs (B) and (C).
  (B) HEALTH RESOURCES AND SERVICES ADMINISTRATION- The Secretary shall
  designate one official or employee of the Health Resources and Services
  Administration to serve as a member of the Council. The official or
  employee so designated shall be a graduate of a medical school located in
  the United States.
  (C) APPOINTMENTS- From among individuals who are not officers or employees
  of the Federal Government, the Secretary shall, subject to subparagraph
  (D), make appointments to the Council as follows:
  (i) One individual from an organization representing State authorities
  that license individuals to practice medicine.
  (ii) One individual representing a national organization that represents
  practicing physicians in the United States.
  (iii) One individual representing an organization in the United States
  that tests international medical graduates regarding medical knowledge.
  (iv) One individual representing an organization in the United States
  that tests individuals who are graduates of medical schools located in
  the United States regarding medical knowledge.
  (v) One physician representing one or more medical schools located in the
  United States.
  (vi) One individual who is a representative of the private credentials
  verification system.
  (vii) One individual who is a graduate of a medical school located in the
  United States, who has been licensed to practice medicine by a State and
  has been so licensed by such State for a continuous period of at least
  20 years, and who has applied for and received licensure by endorsement
  during the 5-year period ending on the date of the enactment of this Act.
  (viii) One individual who is a graduate of a medical school located in
  the United States and who represents a State authority that licenses
  individuals to practice medicine, which State either has a significant
  number of practicing physicians who are international medical graduates
  or has a significant shortage of physicians.
  (ix) One individual who is an international medical graduate and who
  represents a coalition representing such graduates.
  (x) One individual who is an international medical graduate and who is a
  native of the United States.
  (xi) One individual who is a native of a country located in southern or
  eastern Asia (including southern or eastern Asian islands) and who is an
  international medical graduate by virtue of being a graduate of a medical
  school located in such a country.
  (xii) One individual who is a native of a European country or of Australia
  or New Zealand and who is an international medical graduate by virtue of
  being a graduate of a medical school located in such a country.
  (xiii) One individual who is a native of a Latin American or Caribbean
  country and who is an international medical graduate by virtue of being
  a graduate of a medical school located in such a country.
  (xiv) One individual who is a native of a country located in sub-Saharan
  Africa and who is an international medical graduate by virtue of being a
  graduate of a medical school located in such a country.
At least one member appointed by the Secretary under this subparagraph shall
be a physician who is practicing in a medically underserved community, as
defined in section 799 of the Public Health Service Act. A physician may
serve on the Council only if the physician is licensed by one or more States
to practice medicine.
  (D) CONSULTATION- The Secretary shall make the appointments described
  in subparagraph (C) only after consultation with relevant organizations
  and coalitions.
  (4) CHAIR- From among the members appointed under paragraph (3)(C), the
  Council shall designate an individual to serve as the chair of the Council.
  (5) DURATION- The Council shall continue in existence until the submission
  of the report required under paragraph (7), or not later than September 30,
  1995, whichever is earlier.
  (6) INTERIM REPORT- Not later than September 30, 1993, the Council shall
  submit to the Secretary, the Committee on Labor and Human Resources
  of the Senate and the Committee on Energy and Commerce of the House
  of Representatives, an interim report describing the findings and
  recommendations of the Council pursuant to the duties established in
  paragraph (2). The Secretary shall provide a copy of the report to the
  private credentials verification system.
  (7) FINAL REPORT-
  (A) IN GENERAL- Not later than September 30, 1995, the Council shall
  prepare and submit to the Secretary, the Committee on Labor and Human
  Resources of the Senate and the Committee on Energy and Commerce of the
  House of Representatives, a final report that shall include recommendations
  regarding activities conducted pursuant to paragraph (2), that shall include
  a determination as to whether the private credentials verification system
  is operating with a reasonable degree of efficiency and whether the policies
  and practices of the system are nondiscriminatory.
  (B) RECOMMENDATIONS- If the Secretary determines that the private credentials
  verification system fails to meet either of the criteria with respect to the
  determination described in subparagraph (A), the Secretary, in consultation
  with the Council and relevant organizations, shall make a recommendation
  concerning the establishment of an alternative private system and concerning
  the specifications for such a system as described in paragraph (2)(B).
  (b) STUDY OF STATE LICENSURE PROCESS-
  (1) IN GENERAL- With respect to the licensure by the States of individuals
  to practice medicine, the Secretary, in consultation with the Council, shall
  conduct a study of not less than 10 States for the purpose of determining--
  (A) the average length of time required for the States involved to
  process the licensure applications of domestic medical graduates and the
  average length of time required for the States to process the licensure
  applications of international medical graduates, and the reasons underlying
  any significant differences in such times; and
  (B) the percentage of licensure applications from domestic medical
  graduates that are approved and the percentage of licensure applications
  from graduates of international medical schools that are approved, and
  the reasons underlying any significant differences in such percentages.
  (2) REPORT- Not later than September 30, 1994, the Secretary shall submit to
  the Committee on Labor and Human Resources of the Senate and the Committee
  on Energy and Commerce of the House of Representatives a report describing
  the findings made as a result of the study required in paragraph (1)
  for the fiscal year.
  (c) DEFINITIONS- For purposes of this section:
  (1) COUNCIL- The term `Council' means the National Advisory Council on
  Medical Licensure established in subsection (a)(1).
  (2) DOMESTIC MEDICAL GRADUATE- The term `domestic medical graduate' means
  an individual who is a graduate of a medical school located in the United
  States or Canada.
  (3) INTERNATIONAL MEDICAL GRADUATE- The term `international medical graduate'
  means an individual who is a graduate of a medical school located in a
  country other than the United States or Canada.
  (4) MEDICAL SCHOOL- The term `medical school' means a school of medicine
  or a school of osteopathic medicine, as such terms are defined in section
  799 of the Public Health Service Act.
  (5) NONDISCRIMINATORY- The term `nondiscriminatory', with respect to policies
  and practices, means that such policies and practices do not discriminate
  on the basis of race, color, religion, gender, national origin, age,
  disability, marital status, or educational affiliation.
  (6) PRIVATE CREDENTIALS VERIFICATION SYSTEM- The term `private credentials
  verification system' means the system described in subsection (a)(2)(A)
  and established by the American Medical Association.
  (7) SECRETARY- The term `Secretary' means the Secretary of Health and
  Human Services.
  (8) STATE- The term `State' means each of the several States, the District
  of Columbia, the Commonwealth of Puerto Rico, American Samoa, Guam, the
  Commonwealth of the Northern Mariana Islands, and the Trust Territory of
  the Pacific Islands.
  (d) NECESSARY RESOURCES- The Secretary shall ensure that necessary resources
  are made available to implement the provisions of this section.
SEC. 308. REQUIRED ASSURANCES REGARDING BLOODBORNE DISEASES.
  With respect to awards of grants or contracts under title VII or VIII of the
  Public Health Service Act, the Secretary of Health and Human Services may
  make such an award for the provision of traineeships only if the applicant
  for the award provides assurances satisfactory to the Secretary that all
  trainees will, as appropriate, receive instruction in the utilization of
  universal precautions and infection control procedures for the prevention
  of the transmission of bloodborne diseases.
SEC. 309. STUDY ON EFFECTIVENESS OF HEALTH PROFESSIONS PROGRAMS.
  (a) IN GENERAL- The Comptroller General of the United States shall conduct
  a study of the programs carried out under titles VII and VIII of the Public
  Health Service Act (as amended by this Act) for the purpose of determining
  the effectiveness of such programs in--
  (1) increasing the number of primary care providers (physicians, physician
  assistants, nurse midwives, nurse practitioners and general dentists),
  nurses and allied health personnel;
  (2) improving the geographic distribution of health professionals in
  medically underserved and rural areas; and
  (3) recruiting and retaining as students in health professions schools
  individuals who are members of a minority group.
  (b) CERTAIN REQUIREMENTS- The study conducted under subsection (a) shall
  determine--
  (1) whether funding under title VII of the Public Health Service Act has
  increased the number of primary care practitioners (family medicine,
  general internal medicine, general pediatrics, general dentistry, and
  physician assistants) in medically underserved communities (as defined in
  section 799 of such Act);
  (2) whether or not funding under such title VII has increased the number
  of allied health professionals in medically underserved or rural communities;
  (3) whether or not funding under title VIII of such Act has increased the
  number of nurses in medically underserved or rural communities;
  (4) whether or not the various mechanisms under such titles VII and VIII
  (such as scholarships, fellowships, traineeships, loan repayment programs,
  project grants, and education centers) have been effective in producing
  health care professionals who work or practice in medically underserved and
  rural communities and the relative impact or effectiveness of each mechanism;
  (5) the duration of service in medically underserved communities (as
  defined in section 799 of such Act) of health professionals whose training
  was funded by such titles or who received financial incentives under such
  titles to practice in such communities;
  (6) the geographic distribution of former trainees under such titles who
  are practicing in medically underserved communities (as so defined);
  (7) with respect to the programs of such titles whose purpose is improving
  the health of individuals who are members of minority groups, whether such
  programs have had a significant impact on the number of such individuals
  entering the health professions; and
  (8) such other factors as may be relevant to the reauthorization of such
  title VII or VIII.
  (c) REPORT- Not later than January 1, 1994, the Comptroller General of
  the United States shall complete the study required in subsection (a)
  and submit to the Committee on Labor and Human Resources of the Senate,
  and the Committee on Energy and Commerce of the House of Representatives,
  a report describing the findings made as a result of the study and making
  such recommendations regarding the programs carried out under titles
  VII and VIII of the Public Health Service Act as the Comptroller General
  determines to be appropriate.
SEC. 310. DELAYED APPLICABILITY OF CERTAIN PROVISIONS.
  Notwithstanding any other provision of law, section 403A(a)(1) of the
  Federal Food, Drug, and Cosmetic Act (21 U.S.C. 343-1(a)(1)) shall not
  apply with respect to any requirement of any State or political subdivision
  regarding maple syrup until September 1, 1994.
SEC. 311. CERTAIN APPLICATION PROCEDURES.
  Section 633 of Public Law 100-607 (42 U.S.C. 295g-10a) is repealed.
SEC. 312. CERTAIN PROJECTS.
  (a) IN GENERAL- Section 205(a)(2)(B) of Public Law 102-321 is amended by
  adding at the end the following clause:
  `(iii) In the case of amounts reserved under this subparagraph for programs
  of services in the city of San Francisco, California, the Secretary shall
  ensure that such amounts are administered by such city and shall authorize
  the city to select providers for such programs and determine the allocation
  of such payments among the providers.'.
  (b) CONFORMING AMENDMENT- Section 205(a)(2)(B)(i) of Public Law 102-321
  is amended--
  (1) in subclause (I), by striking `clause (ii)' and inserting `clauses
  (ii) and (iii)'; and
  (2) in subclause (II), by inserting `, subject to clause (iii)' before
  the period.
Speaker of the House of Representatives.
Vice President of the United States and
President of the Senate.