ol'@ 1,974 As raised in 'Ihe J2, 1974 Except as otherwise indicated, extensions are for three years, through FY 1977. TITLE I - GENERAL PROVISTO"@IS research Facilities Authorities repealed except to preserve- recapture pr OV4 sions. Guidelines for Trainin.EoL-l@T@ic.@i,n Assi.stanLs, etc. Secretary required to prescribe guidelines to be met by training programs for physician assistants, nurse practitioners, and e)-.pe@nde duty enta auxiliaries, by ilarct) 1, 1975, after consultation with professional organizations. Guidelines must rc-,,,tiire iiiiniiiiiiiii course of. study of one academic year and minimum enrollment of 25 students. national Ad-@7i.sory Council on Fi(@,altli Professions Education Groups to be represented on Council sp elled out in greater detail than in existin@ Records and Audits Each grant or contract recipient to keep such records as Secretarl, may -pres-ribe, and provide for annual audit of records or books. Scho ar- ship and -"ra4@neeship recipients 6xey@ipt-.ed. 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 in the T)eparti.-ient of Ilealth, Education, an We are, except that the authority (1) to review, and prepare comments on the merit of, any application for a grant or contract under any program authorized by this title for purposes of presenting such application to the National Advisory Council on Elealth Professions Education, or (2) to make such grant or enter inti such a contract, shall not be further delegated to any officer in any reaional office or offices. TITLE II - ASSISTANCE FOR CONSTRUCTION Construction Grants Authority extended. Conditions for grants essentially the same, except that single maximum Federal share of 80% of costs i,7culd re-place existing different maxiriuws for different tyiwe,.; of projects. In considering applications for Giants for teaching facilities for training of physicians, Secretary to give specii'L consideration to pro--ects in States having no such facilities. Such projects to I)o- entitled to 80/'. rratcliili(il unless Secretary detei,T;-@ill('.S grant !-can such of 0 costs not needed. Construction Loans a-,,id Interest prov:Ls@i..oji amend&d. to alloie F(@d.c@ral government. to IOCJ'",' ci or, I)rii)ci.pal. and --'iiterctst. S t U-@,l It:, f, 0I s led to stttcl-(., raised to co Pul).],ic St- of tiliti,()V, T.-,I@is ye ar. I'n t c@. r ci E; L r,,@ L e @i: ac-,, d, t f-) p c-, r c c n. t- for I.oaii. r-, r offl -rF, -@o@i(@itive- fo PHS Co-@ 'ssioned Co)-Ps, or Ca-vil-i,)n loyec-@s of ]@@lS@ Sttjd@,.:ir. loan fui-i-I i-cpcl_aled to alloys li@inor-.i-i,, of -i @, Iloar) F-, 1-@o U. SS t s i-i-i Fc) r(@i @.,i c,@l. S /@u t' re Exis t-@'Lti- li&.a'Ltli scliol-ar--Iiil-j pio-rLiiii Physici-ai@i Scliblnrship pro-ra-,Ft Lo be phased otit. h),,, Shoyt:i,)c,@ Area Sc@,c)' to 're pha,.;.@!c-i oiiL. Schol-ar3l@ii.ps to U.S. Sturient:,,-, iTi Forcj,@,,i S(--hoo.1-s A-ithbri'L-y repeated, Trai.n,--eE.'iii-ps to StudcliAts in Schools of Pl@lil-ic V for trainee ProVir3es separate. atithoi@@it- ships for Ft-ceicnts in Eclioo'Lo ,)-F hea.1ti-.. (I-o-,c public health, 13clcl title VI bel.ow.) Natioii,3.j- Health Sc@rvice Corp- Autt-tority @ztended and amended. Appropr,iatj.oii a@itlic@ri7,atiol@s of $'@75 for ITY 1975, $36 million for I@-Y 197'0, and $45 million '@-ar r,@ 197.. N@itional Seriii,-e Corl)s Schol.,irsli' Autliol-ity extended and a7iiiended. Eli,@i.bi.lity for s--.Iiolar-sli-',-ps to include '@l"OD and nursing students and, if needed by Corps or other unit of in sc'@iool-s of podiatry, optometry pii@irmacy, or i-)i).I)Iic health, raduzate- pr,)- r gi:a,,i@@i 1-@l heal.tli administration, and other heal.tli--r(,Iated specialties as dc--tei:l@@@Lned by Secretary. llay include physician assistant, expanded fut-@cti.on dental. au.xiliar,,,, or nurse practitioner students. llecipiel,-it-.s obligated to not less than ]- year for every year of triai.i)in,@, or 2 years. Scrv@l.ce to be performed in @-IIS Corvs or -n@ I-le -ttl lndia a @-i-Ser-,,,i.ce, specified other Federal having priorit-- other ripdical L'ac4.1-i-ty desiE,,-@ir@ted by Secretary as y need for health personnel, or other services, i.ii that c@r(IC-@-; or, alterna- tivc.]-y, services may be pc?rl--orTirLd in y)-ri.vq.te. y.)r,.ic,,ti,c.c@, of profession in @n area in x-ibiclii is I.c)cp.',-cd a medically und(.,i-scrved I)ol)i,il.zition dcsi.,,@,i-iited under Sec. 329'b). 'It.ridiv-'@-dLtals failinc, to coriipl-c,,to. service obl.i.,r,,@itions liOI)IEI to repay twice the amount TZiid to or on 1)(,Iialf of li'm. iii-iclc@-z the scliola)-sli-I il :L I.p progT",.Illl, pl,us !Interest, within 3 years. Approl,)r@Lations authorizations 01'7 $80 million for FY 1976 and $11)0 milli.O)A for VY 1977 (FY 1975 authorization of $40 million enacted in P.L. 93-385). T TITLE IV Gf@iN'TS FOR h based on Payments authorized for schools of l@IODVOPI,l full-tine enrollment only. Includes capitation for PA and expanded function dental auxiliary students (not nurse practitioner students). Separate appropriation authorizations for 1.101), P.A.'s and expanded fun.c- tion dental auxiliaries, PH, V, and OPP. In addition, "such sums as- T,ecessary'@' authorized to be appropriated in FYs 75-77 for continuation of grants based on enrollment bonus students" so designated prior to June 30, 1974. Amount of Cal)itation MOD - $2,100 per full-time student 650 per full-time physician assistant or expanded.function dental auxiliary student *@fOD - $2,000 per full-time student in PY 77 PH - 1,500 per full-time student V - 1,500 per full-time student 0 - 700 per full-time student Ph - 700 per fii.1-1-ti.Trp- student (in last 4 years, if program longer than 4 years) *Po - 1,500 per full-time student Eligibility for Capitation Grants All schools required to maintain first-year enrollment of the previous year and maintain non-Federal expenditures at level at least as great as amount in preceding fiscal year (formerly average of last three years). All schools must give assurance that in year following award of grant and in each year thereafter in which grant is received, school will enter into legally enforceable agreement with each student enrolled under which student agrees to repay, following graduation, the amount of capitation paid on his behalf, in a number of annual installments equal to number of years of capitation support given. However, no installment payable if individual is serving (i) as a member of the NHS Corps in area which is located a medically underserved population, (ii) as a member of the Indian Health Service, or (iii) in accordance with an agreement to ful- fill I\IHS Corps Scholarship service obligation through private pract ce in an area in which is located a medically underserved population. *Capitation requirements to take effect in academic year 1976-1977. Medical, ostc@o@,)@)tlii.c, and eic-@ntal scl-ic)c)ls would I)c- requi@-eeL also to (a ovi-r 1.973--74 base year or offer a program for the training of physician assistants or expanded function (leiital auxiliaries and (b) effective for FY 1976 gra-@its, have aii ipproved AIIEC-type plan to train students -(including PA and EL,'DA students) in part in areas geo- graphically remote from main campus. Waiver of enrollment increase requirement authorized if compliance impossible without lowering quality of education. Schools of ptibli@c health would be required also to expand first-year enrollment over .973-74 base year. Waiver authorized as for TIOD schools. Schools of veter.Iria ne@c-jD@ would be required also to expan.d :Irst-year enrollment over 1973-74 base year or enroll at least 20% of students from States without accredited school. No waiver provision. Schools of optometry. would be required also to expand first-year enroll- ment over 1973-74 base year. Waiver authorized as for @IOD schools. Sch ol8 of pharmacy would be requ ired also to expand first-year enroll- 0 ment improvement, or operation of at least two of three types of phar- macy teaching programs. No waiver provision. Schools of podiatry would be required also to expand first-year enrollment over 1973-74 base year or enroll at least 40% of students from tates without accredited sthool.. No waiver provision. Special PE cts Existing broad authority replaced by limited authority for aid to disadvantaged students (See under Title V below). 8tart-up and Conversion Grants Authorities extended and amended to make schools of veterinary medicine, optometry, pharmacy podiatry, and public health eligible for start-up grants (now only I-IOD schools eligible). 'Financial Distress Grants Authority extended and amended to add schools of public health to list of eligible schools. Standard Record All schools rec distress grants to be required nd reporting financial information to enable Secretary to determine costs of education. ting Sec. 776) million per year authorization level. T@,@TLEV SPE@IAL PF@OJI'CT GP-M@Tc, @.@D COI@T@.ACTS Traini,n2 in Fal-nilv @',;c-dici,-ie and Cc-,rieral Pr,.icti.cr-, of Dentistry Family medicine training authority (existin@, Sec. 767) extended and. ,aTr,ended to add authority for grants to dental schools or accredited postgraduate dental training institutions for residence programs 4TI general practice of dentistry. *Also gra'nts to 1.10 schools to establish and maintain academic instruction units in family medicine authorized at $10, $1-5, and $20 million for FY 75-77. Aid to Disadvantar@ed Students .A,uthorizes grants and contracts to health professions schools and other public or private nonprofit health or educational entities to assist stu- dents from disadvantaged backgrounds. No -pecific authority for stipends to students. To qualify for assistance, schools required to enroll in first-year class a number of students fron. disadvantaged backgrounds at least equal. to the lesser of (a) 5/'. of preceding yearts first-year students or (b) ten. *,Authorization level increased to $40 million per year, FY 75-77. Area Health-Education Centers Existing Section 774(a) @E4EIA authority substantially amended to (1) provide aid for A!IE.C projects only, (2) limit eligibility to educational entities in which at least three degree or diploma granting health pro- fessions education programs (of which one is a medical or osteopathic s6bool) agree to affiliate, (3) modify the purposes of the authority, adding a new purpose relaaed to health education of the public, (4) requireIapplicants to accomplish each (rather than one or more) of the listed purposes, and (5) spell out a detailed list of requirements for projects, covering such matters as designation of geographic boundaries, listing of manpower neeas, minimum amounts of training to be provided in centers, faculty, types of training to be provided, and coordination with related programs, among others. Secretary re- quired to assess program of grants under their authority and submit a report to Congress on the assessment by January 1,,1977. (Note: Existing Section 774(b) authority replaced by authority for special projects to aid disadvantaged students, described above.) Project Grants and Contracts for OPP'School-s Separate authority would be provided for grants and contracts to schools of optometry, pharmacy, and podiatry providing for closer association of OPP and other health professions training, and, in the case of pharmacy, projects to expand or improve specific types of pharmacy teaching programs. 6 -'@I@l.so. added two addi-,Liona.J,- purposes for w,].iieh schools of.optai;ietry could receive special project grants an(.L cc)nty.@acts; 1. planning, developing, and operating r(,sid(,ncv training programs in special optooetric services or in meeting the optoiiietric needs of special populations, or 2. planning, developing, and operating educational programs which provide training in the early detection and diagnosis of health problems which are accompanied by visual or ocul.ar symptoms. Postgraduate Training of Physicians a?-id Dentists (existing Sec. 768) Authority (never funded since enactment of 1971) repealed. Health Professic-@is Teacher Training (existing Sec. 769) Authority (not funded sinc@l,-@-5@-re-p-c-a--e *COTP@llit r@T-(,-@l O@-l-ogy Health Care Deraonstrations (,existing Sec. 769A) Authority extended for three years at $3 million per year authorization level. *Trai.ning of U.S. Graduates of Foreign @ledical Schools Authority to make grants to allow U.S. graduates of foreign medical §Chools to enter U.S. schools with advanced standing. Authorizations of $2 million, $3 million, and $4 million, FY 75-77. TITLE VI PUBLIC tVID ALLIED @'-EALTH PEITSOITN-EL Public Health Training Secs. 306 (public health t aineeships) and 309 (public health traininc, -project grants and formula-type grants to schools of public health) repealed, and replaced as follows: --Schools of public health to be eligible for capital-ion payment4 (See above.) --Students in schools of public health to be eligible for health professions student loans. (See "Student Loansyl above.) --Traineeship grants authorized for schools of public health (See "STUDENT ASSISTANCE" above) and, separately, for graduate programs in health administration, hospital. admihis-tratior,,-or health planning (proposed new Sec. 792). -Schools of public health to be eligible Llor start-up and financial distress grants. (See.above.) .--Accredited graduate programs in health administration, ho pita administration, oIr health planning (other than those in schools of public health) to be entitled to institutional grants (proposed new Sec. 791). Secretary reqai.red, in coordination with the National Center for Health Statistics, to collect and disseminate statistics and other information respecting public and comnrinity health personneL Annual reports to be submitted to Congress by Secretary, with legislative recommendations 98 needed. 'lpublic and community health personnels defined in bill (formerly no statutory definition). Al] ieci Trai. i@s E fi@,-,-,uthorl,ties for special project grants and contracts, advanced traineeship and grants and contracts to encourage 'full utilization of educational talent for allied health personnel training extended with relatively minor changes. -A-Added an amendment to make clear that two-year schools could qualify for allied health special project aid. Secretary required, in coordination with the National Center for Health Statistics, to collect and disseminate statistics and other information on Allied health personnel, and to report annually to Congress. "Allied health personnel" defined in bill (formerly no statutory definition). Medical raining Prop:riTps Tlil-would establish a-syste f-o. national control of the number of first- year positions in any accredited medical residency training program which may be made available in calendar year 1978 or thereafter, with the aggregate number in any year not to exceed 125% of medical school grad- uates in preceding calendar year. An entity including in a charge for services any amount based on compensation paid to a physician in an "unap- prov&d" residency position would be subject to a civil penalty of @5,000 for each such charge. No grant or contract under the PHS Act could be paid to any entity operating an unaccredited training.program or operating a program with an excess number of positions. For the purpose of accrediting programs, Secretary would be required to designate or establish a residency training program accrediting a-ency. The Liaison Committee for Graduate Medical Education of the Coordinating council for Medical Education., if it met requirements, would be the designated agency. If neither the Liaison Committee nor any other entity met requirements for designation by January 1, 1976, the Secretary would establish his own accrediting agency. For the purpose of establishing the Plumber of positions in each residency training program, Secretary would be required to designate or estabbsh an agency to carr.y out this function with an application from the Coordinating Council on Medical Education to have first pbrference. In assigning positions, this agency would be required to (1) take into consideration the report findings of the Study.of the Distribution of Physicians required by this bill (see below), (2) insure that positions were equitably distri- buted g6ographicall , (3) affor special consideration to positions in y AHEC programs, and (4) afford particular attention to the need for residency training programs in the primary care specialties of general internal medicine general pediatrics, and family medicine. *Obstetrics and Gynecology added to the list of "primary care specialties" to receive particular attention in the determination of positions to be allowed in each accredited residency program. ,',-Indi@cates amc@ndme nts at full Committee level. TITLE VIII - MIS@El,!,AIITEOUS ion of Physicians within 90 days to contract for the conduct of a $10 million study to analyze distribution of physicians by specialty and subspecialty by geographic area, project expected distributions, and develop methodology and project optimal numbers for the years 1980, 1985, and 1990. Type of organization to be selected as the contractor described in some detail in bill Final report on. study to be completed by October 31, 1976. No specific appropriation authorization. Allied Health Tra@ ual Assurances Secretary required to report to Congress in one year on any HEW programs directly or indirectly paying the costs of allied health personnel training and to take such action as may be required to provide assistance only to those programs meeting quality standards prescribed by Secretary. Allied Health Personnel Study Secretarv required to arrange for t@7o-year study to identify types of allied health determine costs of training, and identify shortages of allied health personnel. Study to be conducted by National Academy of Sciences or, if NAS is unwilling, by another appropriate nonprofit'private group. No specific appropriation authorization.