S.1754
One
Hundred Fifth Congress of the United States of America AT THE SECOND
SESSION Begun and held at the City of Washington on Tuesday, the
twenty-seventh day of January, one thousand nine hundred and ninety-eight
An Act
To amend the
Public Health Service Act to consolidate and reauthorize health
professions and minority and disadvantaged health education programs,
and for other purposes.
Be it enacted
by the Senate and House of Representatives of the United States
of America in Congress assembled,
SECTION 1.
SHORT TITLE; TABLE OF CONTENTS.
(a) SHORT TITLE- This Act may be cited as the Health Professions
Education Partnerships Act of 1998'.
(b) TABLE OF CONTENTS- The table of contents of this Act is as follows:
Sec. 1. Short title; table of contents.
TITLE I--HEALTH
PROFESSIONS EDUCATION AND FINANCIAL ASSISTANCE PROGRAMS
Subtitle A--Health
Professions Education Programs
SEC. 101. UNDER-REPRESENTED
MINORITY HEALTH PROFESSIONS GRANT PROGRAM.
(a) IN GENERAL-
Part B of title VII of the Public Health Service Act (42 U.S.C.
293 et seq.) is amended to read as follows:
PART B--HEALTH
PROFESSIONS TRAINING FOR DIVERSITY
SEC. 736. CENTERS
OF EXCELLENCE.
(a) IN GENERAL-
The Secretary shall make grants to, and enter into contracts with,
designated health professions schools described in subsection (c),
and other public and nonprofit health or educational entities, for
the purpose of assisting the schools in supporting programs of excellence
in health professions education for under-represented minority individuals.
(b) REQUIRED
USE OF FUNDS- The Secretary may not make a grant under subsection
(a) unless the designated health professions school involved agrees,
subject to subsection (c)(1)(C), to expend the grant--
(1) to develop
a large competitive applicant pool through linkages with institutions
of higher education, local school districts, and other community-based
entities and establish an education pipeline for health professions
careers;
(2) to establish,
strengthen, or expand programs to enhance the academic performance
of under-represented minority students attending the school;
(3) to improve
the capacity of such school to train, recruit, and retain under-represented
minority faculty including the payment of such stipends and fellowships
as the Secretary may determine appropriate;
(4) to carry
out activities to improve the information resources, clinical education,
curricula and cultural competence of the graduates of the school,
as it relates to minority health issues;
(5) to facilitate
faculty and student research on health issues particularly affecting
under-represented minority groups, including research on issues
relating to the delivery of health care;
(6) to carry
out a program to train students of the school in providing health
services to a significant number of under-represented minority individuals
through training provided to such students at community-based health
facilities that--
(A) provide
such health services; and
(B) are located
at a site remote from the main site of the teaching facilities of
the school; and
(7) to provide
stipends as the Secretary determines appropriate, in amounts as
the Secretary determines appropriate.
(c) CENTERS
OF EXCELLENCE-
(1) DESIGNATED
SCHOOLS-
(A) IN GENERAL-
The designated health professions schools referred to in subsection
(a) are such schools that meet each of the conditions specified
in subparagraphs (B) and (C), and that--
(i) meet each
of the conditions specified in paragraph (2)(A);
(ii) meet each
of the conditions specified in paragraph (3);
(iii) meet
each of the conditions specified in paragraph (4); or
(iv) meet each
of the conditions specified in paragraph (5).
(B) GENERAL
CONDITIONS- The conditions specified in this subparagraph are that
a designated health professions school--
(i) has a significant
number of under-represented minority individuals enrolled in the
school, including individuals accepted for enrollment in the school;
(ii) has been
effective in assisting under-represented minority students of the
school to complete the program of education and receive the degree
involved;
(iii) has been
effective in recruiting under-represented minority individuals to
enroll in and graduate from the school, including providing scholarships
and other financial assistance to such individuals and encouraging
under-represented minority students from all levels of the educational
pipeline to pursue health professions careers; and
(iv) has made
significant recruitment efforts to increase the number of under-represented
minority individuals serving in faculty or administrative positions
at the school.
(C) CONSORTIUM-
The condition specified in this subparagraph is that, in accordance
with subsection (e)(1), the designated health profession school
involved has with other health profession schools (designated or
otherwise) formed a consortium to carry out the purposes described
in subsection (b) at the schools of the consortium.
(D) APPLICATION
OF CRITERIA TO OTHER PROGRAMS- In the case of any criteria established
by the Secretary for purposes of determining whether schools meet
the conditions described in subparagraph (B), this section may not,
with respect to racial and ethnic minorities, be construed to authorize,
require, or prohibit the use of such criteria in any program other
than the program established in this section.
(2) CENTERS
OF EXCELLENCE AT CERTAIN HISTORICALLY BLACK COLLEGES AND UNIVERSITIES-
(A) CONDITIONS-
The conditions specified in this subparagraph are that a designated
health professions school--
(i) is a school
described in section 799B(1); and
(ii) received
a contract under section 788B for fiscal year 1987, as such section
was in effect for such fiscal year.
(B) USE OF
GRANT- In addition to the purposes described in subsection (b),
a grant under subsection (a) to a designated health professions
school meeting the conditions described in subparagraph (A) may
be expended--
(i) to develop
a plan to achieve institutional improvements, including financial
independence, to enable the school to support programs of excellence
in health professions education for under-represented minority individuals;
and
(ii) to provide
improved access to the library and informational resources of the
school.
(C) EXCEPTION-
The requirements of paragraph (1)(C) shall not apply to a historically
black college or university that receives funding under paragraphs
(2) or (5).
(3) HISPANIC
CENTERS OF EXCELLENCE- The conditions specified in this paragraph
are that--
(A) with respect
to Hispanic individuals, each of clauses (i) through (iv) of paragraph
(1)(B) applies to the designated health professions school involved;
(B) the school
agrees, as a condition of receiving a grant under subsection (a),
that the school will, in carrying out the duties described in subsection
(b), give priority to carrying out the duties with respect to Hispanic
individuals; and
(C) the school
agrees, as a condition of receiving a grant under subsection (a),
that--
(i) the school
will establish an arrangement with 1 or more public or nonprofit
community based Hispanic serving organizations, or public or nonprofit
private institutions of higher education, including schools of nursing,
whose enrollment of students has traditionally included a significant
number of Hispanic individuals, the purposes of which will be to
carry out a program--
(I) to identify
Hispanic students who are interested in a career in the health profession
involved; and
(II) to facilitate
the educational preparation of such students to enter the health
professions school; and
(ii) the school
will make efforts to recruit Hispanic students, including students
who have participated in the undergraduate or other matriculation
program carried out under arrangements established by the school
pursuant to clause (i)(II) and will assist Hispanic students regarding
the completion of the educational requirements for a degree from
the school.
(4) NATIVE
AMERICAN CENTERS OF EXCELLENCE- Subject to subsection (e), the conditions
specified in this paragraph are that--
(A) with respect
to Native Americans, each of clauses (i) through (iv) of paragraph
(1)(B) applies to the designated health professions school involved;
(B) the school
agrees, as a condition of receiving a grant under subsection (a),
that the school will, in carrying out the duties described in subsection
(b), give priority to carrying out the duties with respect to Native
Americans; and
(C) the school
agrees, as a condition of receiving a grant under subsection (a),
that--
(i) the school
will establish an arrangement with 1 or more public or nonprofit
private institutions of higher education, including schools of nursing,
whose enrollment of students has traditionally included a significant
number of Native Americans, the purpose of which arrangement will
be to carry out a program--
(I) to identify
Native American students, from the institutions of higher education
referred to in clause (i), who are interested in health professions
careers; and
(II) to facilitate
the educational preparation of such students to enter the designated
health professions school; and
(ii) the designated
health professions school will make efforts to recruit Native American
students, including students who have participated in the undergraduate
program carried out under arrangements established by the school
pursuant to clause (i) and will assist Native American students
regarding the completion of the educational requirements for a degree
from the designated health professions school.
(5) OTHER CENTERS
OF EXCELLENCE- The conditions specified in this paragraph are--
(A) with respect
to other centers of excellence, the conditions described in clauses
(i) through (iv) of paragraph (1)(B); and
(B) that the
health professions school involved has an enrollment of under-represented
minorities above the national average for such enrollments of health
professions schools.
(d) DESIGNATION
AS CENTER OF EXCELLENCE-
(1) IN GENERAL-
Any designated health professions school receiving a grant under
subsection (a) and meeting the conditions described in paragraph
(2) or (5) of subsection (c) shall, for purposes of this section,
be designated by the Secretary as a Center of Excellence in Under-Represented
Minority Health Professions Education.
(2) HISPANIC
CENTERS OF EXCELLENCE- Any designated health professions school
receiving a grant under subsection (a) and meeting the conditions
described in subsection (c)(3) shall, for purposes of this section,
be designated by the Secretary as a Hispanic Center of Excellence
in Health Professions Education.
(3) NATIVE
AMERICAN CENTERS OF EXCELLENCE- Any designated health professions
school receiving a grant under subsection (a) and meeting the conditions
described in subsection (c)(4) shall, for purposes of this section,
be designated by the Secretary as a Native American Center of Excellence
in Health Professions Education. Any consortium receiving such a
grant pursuant to subsection (e) shall, for purposes of this section,
be so designated.
(e) AUTHORITY
REGARDING NATIVE AMERICAN CENTERS OF EXCELLENCE- With respect to
meeting the conditions specified in subsection (c)(4), the Secretary
may make a grant under subsection (a) to a designated health professions
school that does not meet such conditions if--
(1) the school
has formed a consortium in accordance with subsection (d)(1); and
(2) the schools
of the consortium collectively meet such conditions, without regard
to whether the schools individually meet such conditions.
(f) DURATION
OF GRANT- The period during which payments are made under a grant
under subsection (a) may not exceed 5 years. Such payments shall
be subject to annual approval by the Secretary and to the availability
of appropriations for the fiscal year involved to make the payments.
(g) DEFINITIONS-
In this section:
(1) DESIGNATED
HEALTH PROFESSIONS SCHOOL-
(A) IN GENERAL-
The term health professions school' means, except as provided in
subparagraph (B), a school of medicine, a school of osteopathic
medicine, a school of dentistry, a school of pharmacy, or a graduate
program in behavioral or mental health.
(B) EXCEPTION-
The definition established in subparagraph (A) shall not apply to
the use of the term designated health professions school' for purposes
of subsection (c)(2).
(2) PROGRAM
OF EXCELLENCE- The term program of excellence' means any program
carried out by a designated health professions school with a grant
made under subsection (a), if the program is for purposes for which
the school involved is authorized in subsection (b) or (c) to expend
the grant.
(3) NATIVE
AMERICANS- The term Native Americans' means American Indians, Alaskan
Natives, Aleuts, and Native Hawaiians.
(h) FUNDING-
(1) AUTHORIZATION
OF APPROPRIATIONS- For the purpose of making grants under subsection
(a), there are authorized to be appropriated $26,000,000 for fiscal
year 1998, and such sums as may be necessary for each of the fiscal
years 1999 through 2002.
(2) ALLOCATIONS-
Based on the amount appropriated under paragraph (1) for a fiscal
year, one of the following subparagraphs shall apply:
(A) IN GENERAL-
If the amounts appropriated under paragraph (1) for a fiscal year
are $24,000,000 or less--
(i) the Secretary
shall make available $12,000,000 for grants under subsection (a)
to health professions schools that meet the conditions described
in subsection (c)(2)(A); and
(ii) and available
after grants are made with funds under clause (i), the Secretary
shall make available--
(I) 60 percent
of such amount for grants under subsection (a) to health professions
schools that meet the conditions described in paragraph (3) or (4)
of subsection (c) (including meeting the conditions under subsection
(e)); and
(II) 40 percent
of such amount for grants under subsection (a) to health professions
schools that meet the conditions described in subsection (c)(5).
(B) FUNDING
IN EXCESS OF $24,000,000- If amounts appropriated under paragraph
(1) for a fiscal year exceed $24,000,000 but are less than $30,000,000--
(i) 80 percent
of such excess amounts shall be made available for grants under
subsection (a) to health professions schools that meet the requirements
described in paragraph (3) or (4) of subsection (c) (including meeting
conditions pursuant to subsection (e)); and
(ii) 20 percent
of such excess amount shall be made available for grants under subsection
(a) to health professions schools that meet the conditions described
in subsection (c)(5).
(C) FUNDING
IN EXCESS OF $30,000,000- If amounts appropriated under paragraph
(1) for a fiscal year are $30,000,000 or more, the Secretary shall
make available--
(i) not less
than $12,000,000 for grants under subsection (a) to health professions
schools that meet the conditions described in subsection (c)(2)(A);
(ii) not less
than $12,000,000 for grants under subsection (a) to health professions
schools that meet the conditions described in paragraph (3) or (4)
of subsection (c) (including meeting conditions pursuant to subsection
(e));
(iii) not less
than $6,000,000 for grants under subsection (a) to health professions
schools that meet the conditions described in subsection (c)(5);
and
(iv) after
grants are made with funds under clauses (i) through (iii), any
remaining funds for grants under subsection (a) to health professions
schools that meet the conditions described in paragraph (2)(A),
(3), (4), or (5) of subsection (c).
(3) NO LIMITATION-
Nothing in this subsection shall be construed as limiting the centers
of excellence referred to in this section to the designated amount,
or to preclude such entities from competing for other grants under
this section.
(4) MAINTENANCE
OF EFFORT-
(A) IN GENERAL-
With respect to activities for which a grant made under this part
are authorized to be expended, the Secretary may not make such a
grant to a center of excellence for any fiscal year unless the center
agrees to maintain expenditures of non-Federal amounts for such
activities at a level that is not less than the level of such expenditures
maintained by the center for the fiscal year preceding the fiscal
year for which the school receives such a grant.
(B) USE OF
FEDERAL FUNDS- With respect to any Federal amounts received by a
center of excellence and available for carrying out activities for
which a grant under this part is authorized to be expended, the
Secretary may not make such a grant to the center for any fiscal
year unless the center agrees that the center will, before expending
the grant, expend the Federal amounts obtained from sources other
than the grant.
SEC. 737. SCHOLARSHIPS
FOR DISADVANTAGED STUDENTS.
(a) IN GENERAL-
The Secretary may make a grant to an eligible entity (as defined
in subsection (d)(1)) under this section for the awarding of scholarships
by schools to any full-time student who is an eligible individual
as defined in subsection (d). Such scholarships may be expended
only for tuition expenses, other reasonable educational expenses,
and reasonable living expenses incurred in the attendance of such
school.
(b) PREFERENCE
IN PROVIDING SCHOLARSHIPS- The Secretary may not make a grant to
an entity under subsection (a) unless the health professions and
nursing schools involved agree that, in providing scholarships pursuant
to the grant, the schools will give preference to students for whom
the costs of attending the schools would constitute a severe financial
hardship and, notwithstanding other provisions of this section,
to former recipients of scholarships under sections 736 and 740(d)(2)(B)
(as such sections existed on the day before the date of enactment
of this section).
(c) AMOUNT
OF AWARD- In awarding grants to eligible entities that are health
professions and nursing schools, the Secretary shall give priority
to eligible entities based on the proportion of graduating students
going into primary care, the proportion of underrepresented minority
students, and the proportion of graduates working in medically underserved
communities.
(d) DEFINITIONS-
In this section:
(1) ELIGIBLE
ENTITIES- The term eligible entities' means an entity that--
(A) is a school
of medicine, osteopathic medicine, dentistry, nursing (as defined
in section 801), pharmacy, podiatric medicine, optometry, veterinary
medicine, public health, chiropractic, or allied health, a school
offering a graduate program in behavioral and mental health practice,
or an entity providing programs for the training of physician assistants;
and
(B) is carrying
out a program for recruiting and retaining students from disadvantaged
backgrounds, including students who are members of racial and ethnic
minority groups.
(2) ELIGIBLE
INDIVIDUAL- The term eligible individual' means an individual who--
(A) is from
a disadvantaged background;
(B) has a financial
need for a scholarship; and
(C) is enrolled
(or accepted for enrollment) at an eligible health professions or
nursing school as a full-time student in a program leading to a
degree in a health profession or nursing.
SEC. 738. LOAN
REPAYMENTS AND FELLOWSHIPS REGARDING FACULTY POSITIONS.
(a) LOAN REPAYMENTS-
(1) ESTABLISHMENT
OF PROGRAM- The Secretary shall establish a program of entering
into contracts with individuals described in paragraph (2) under
which the individuals agree to serve as members of the faculties
of schools described in paragraph (3) in consideration of the Federal
Government agreeing to pay, for each year of such service, not more
than $20,000 of the principal and interest of the educational loans
of such individuals.
(2) ELIGIBLE
INDIVIDUALS- The individuals referred to in paragraph (1) are individuals
from disadvantaged backgrounds who--
(A) have a
degree in medicine, osteopathic medicine, dentistry, nursing, or
another health profession;
(B) are enrolled
in an approved graduate training program in medicine, osteopathic
medicine, dentistry, nursing, or other health profession; or
(C) are enrolled
as full-time students--
(i) in an accredited
(as determined by the Secretary) school described in paragraph (3);
and
(ii) in the
final year of a course of a study or program, offered by such institution
and approved by the Secretary, leading to a degree from such a school.
(3) ELIGIBLE
HEALTH PROFESSIONS SCHOOLS- The schools described in this paragraph
are schools of medicine, nursing (as schools of nursing are defined
in section 801), osteopathic medicine, dentistry, pharmacy, allied
health, podiatric medicine, optometry, veterinary medicine, or public
health, or schools offering graduate programs in behavioral and
mental health.
(4) REQUIREMENTS
REGARDING FACULTY POSITIONS- The Secretary may not enter into a
contract under paragraph (1) unless--
(A) the individual
involved has entered into a contract with a school described in
paragraph (3) to serve as a member of the faculty of the school
for not less than 2 years; and
(B) the contract
referred to in subparagraph (A) provides that--
(i) the school
will, for each year for which the individual will serve as a member
of the faculty under the contract with the school, make payments
of the principal and interest due on the educational loans of the
individual for such year in an amount equal to the amount of such
payments made by the Secretary for the year;
(ii) the payments
made by the school pursuant to clause (i) on behalf of the individual
will be in addition to the pay that the individual would otherwise
receive for serving as a member of such faculty; and
(iii) the school,
in making a determination of the amount of compensation to be provided
by the school to the individual for serving as a member of the faculty,
will make the determination without regard to the amount of payments
made (or to be made) to the individual by the Federal Government
under paragraph (1).
(5) APPLICABILITY
OF CERTAIN PROVISIONS- The provisions of sections 338C, 338G, and
338I shall apply to the program established in paragraph (1) to
the same extent and in the same manner as such provisions apply
to the National Health Service Corps Loan Repayment Program established
in subpart III of part D of title III, including the applicability
of provisions regarding reimbursements for increased tax liability
and regarding bankruptcy.
(6) WAIVER
REGARDING SCHOOL CONTRIBUTIONS- The Secretary may waive the requirement
established in paragraph (4)(B) if the Secretary determines that
the requirement will impose an undue financial hardship on the school
involved.
(b) FELLOWSHIPS-
(1) IN GENERAL-
The Secretary may make grants to and enter into contracts with eligible
entities to assist such entities in increasing the number of underrepresented
minority individuals who are members of the faculty of such schools.
(2) APPLICATIONS-
To be eligible to receive a grant or contract under this subsection,
an entity shall provide an assurance, in the application submitted
by the entity, that--
(A) amounts
received under such a grant or contract will be used to award a
fellowship to an individual only if the individual meets the requirements
of paragraphs (3) and (4); and
(B) each fellowship
awarded pursuant to the grant or contract will include--
(i) a stipend
in an amount not exceeding 50 percent of the regular salary of a
similar faculty member for not to exceed 3 years of training; and
(ii) an allowance
for other expenses, such as travel to professional meetings and
costs related to specialized training.
(3) ELIGIBILITY-
To be eligible to receive a grant or contract under paragraph (1),
an applicant shall demonstrate to the Secretary that such applicant
has or will have the ability to--
(A) identify,
recruit and select underrepresented minority individuals who have
the potential for teaching, administration, or conducting research
at a health professions institution;
(B) provide
such individuals with the skills necessary to enable them to secure
a tenured faculty position at such institution, which may include
training with respect to pedagogical skills, program administration,
the design and conduct of research, grants writing, and the preparation
of articles suitable for publication in peer reviewed journals;
(C) provide
services designed to assist such individuals in their preparation
for an academic career, including the provision of counselors; and
(D) provide
health services to rural or medically underserved populations.
(4) REQUIREMENTS-
To be eligible to receive a grant or contract under paragraph (1)
an applicant shall--
(A) provide
an assurance that such applicant will make available (directly through
cash donations) $1 for every $1 of Federal funds received under
this section for the fellowship;
(B) provide
an assurance that institutional support will be provided for the
individual for the second and third years at a level that is equal
to the total amount of institutional funds provided in the year
in which the grant or contract was awarded;
(C) provide
an assurance that the individual that will receive the fellowship
will be a member of the faculty of the applicant school; and
(D) provide
an assurance that the individual that will receive the fellowship
will have, at a minimum, appropriate advanced preparation (such
as a master's or doctoral degree) and special skills necessary to
enable such individual to teach and practice.
(5) DEFINITION-
For purposes of this subsection, the term underrepresented minority
individuals' means individuals who are members of racial or ethnic
minority groups that are underrepresented in the health professions
including nursing.
SEC. 739. EDUCATIONAL
ASSISTANCE IN THE HEALTH PROFESSIONS REGARDING INDIVIDUALS FROM
DISADVANTAGED BACKGROUNDS.
(a) IN GENERAL-
(1) AUTHORITY
FOR GRANTS- For the purpose of assisting individuals from disadvantaged
backgrounds, as determined in accordance with criteria prescribed
by the Secretary, to undertake education to enter a health profession,
the Secretary may make grants to and enter into contracts with schools
of medicine, osteopathic medicine, public health, dentistry, veterinary
medicine, optometry, pharmacy, allied health, chiropractic, and
podiatric medicine, public and nonprofit private schools that offer
graduate programs in behavioral and mental health, programs for
the training of physician assistants, and other public or private
nonprofit health or educational entities to assist in meeting the
costs described in paragraph (2).
(2) AUTHORIZED
EXPENDITURES- A grant or contract under paragraph (1) may be used
by the entity to meet the cost of--
(A) identifying,
recruiting, and selecting individuals from disadvantaged backgrounds,
as so determined, for education and training in a health profession;
(B) facilitating
the entry of such individuals into such a school;
(C) providing
counseling, mentoring, or other services designed to assist such
individuals to complete successfully their education at such a school;
(D) providing,
for a period prior to the entry of such individuals into the regular
course of education of such a school, preliminary education and
health research training designed to assist them to complete successfully
such regular course of education at such a school, or referring
such individuals to institutions providing such preliminary education;
(E) publicizing
existing sources of financial aid available to students in the education
program of such a school or who are undertaking training necessary
to qualify them to enroll in such a program;
(F) paying
such scholarships as the Secretary may determine for such individuals
for any period of health professions education at a health professions
school;
(G) paying
such stipends as the Secretary may approve for such individuals
for any period of education in student-enhancement programs (other
than regular courses), except that such a stipend may not be provided
to an individual for more than 12 months, and such a stipend shall
be in an amount determined appropriate by the Secretary (notwithstanding
any other provision of law regarding the amount of stipends);
(H) carrying
out programs under which such individuals gain experience regarding
a career in a field of primary health care through working at facilities
of public or private nonprofit community-based providers of primary
health services; and
(I) conducting
activities to develop a larger and more competitive applicant pool
through partnerships with institutions of higher education, school
districts, and other community-based entities.
(3) DEFINITION-
In this section, the term regular course of education of such a
school' as used in subparagraph (D) includes a graduate program
in behavioral or mental health.
(b) REQUIREMENTS
FOR AWARDS- In making awards to eligible entities under subsection
(a)(1), the Secretary shall give preference to approved applications
for programs that involve a comprehensive approach by several public
or nonprofit private health or educational entities to establish,
enhance and expand educational programs that will result in the
development of a competitive applicant pool of individuals from
disadvantaged backgrounds who desire to pursue health professions
careers. In considering awards for such a comprehensive partnership
approach, the following shall apply with respect to the entity involved:
(1) The entity
shall have a demonstrated commitment to such approach through formal
agreements that have common objectives with institutions of higher
education, school districts, and other community-based entities.
(2) Such formal
agreements shall reflect the coordination of educational activities
and support services, increased linkages, and the consolidation
of resources within a specific geographic area.
(3) The design
of the educational activities involved shall provide for the establishment
of a competitive health professions applicant pool of individuals
from disadvantaged backgrounds by enhancing the total preparation
(academic and social) of such individuals to pursue a health professions
career.
(4) The programs
or activities under the award shall focus on developing a culturally
competent health care workforce that will serve the unserved and
underserved populations within the geographic area.
(c) EQUITABLE
ALLOCATION OF FINANCIAL ASSISTANCE- The Secretary, to the extent
practicable, shall ensure that services and activities under subsection
(a) are adequately allocated among the various racial and ethnic
populations who are from disadvantaged backgrounds.
(d) MATCHING
REQUIREMENTS- The Secretary may require that an entity that applies
for a grant or contract under subsection (a), provide non-Federal
matching funds, as appropriate, to ensure the institutional commitment
of the entity to the projects funded under the grant or contract.
As determined by the Secretary, such non-Federal matching funds
may be provided directly or through donations from public or private
entities and may be in cash or in-kind, fairly evaluated, including
plant, equipment, or services.
SEC. 740. AUTHORIZATION
OF APPROPRIATION.
(a) SCHOLARSHIPS-
There are authorized to be appropriated to carry out section 737,
$37,000,000 for fiscal year 1998, and such sums as may be necessary
for each of the fiscal years 1999 through 2002. Of the amount appropriated
in any fiscal year, the Secretary shall ensure that not less than
16 percent shall be distributed to schools of nursing.
(b) LOAN REPAYMENTS
AND FELLOWSHIPS- For the purpose of carrying out section 738, there
is authorized to be appropriated $1,100,000 for fiscal year 1998,
and such sums as may be necessary for each of the fiscal years 1999
through 2002.
(c) EDUCATIONAL
ASSISTANCE IN HEALTH PROFESSIONS REGARDING INDIVIDUALS FOR DISADVANTAGED
BACKGROUNDS- For the purpose of grants and contracts under section
739(a)(1), there is authorized to be appropriated $29,400,000 for
fiscal year 1998, and such sums as may be necessary for each of
the fiscal years 1999 through 2002. The Secretary may use not to
exceed 20 percent of the amount appropriated for a fiscal year under
this subsection to provide scholarships under section 739(a)(2)(F).
(d) REPORT-
Not later than 6 months after the date of enactment of this part,
the Secretary shall prepare and submit to the appropriate committees
of Congress a report concerning the efforts of the Secretary to
address the need for a representative mix of individuals from historically
minority health professions schools, or from institutions or other
entities that historically or by geographic location have a demonstrated
record of training or educating underrepresented minorities, within
various health professions disciplines, on peer review councils.'.
(b) REPEAL-
(1) IN GENERAL-
Section 795 of the Public Health Service Act (42 U.S.C. 295n) is
repealed.
(2) NONTERMINATION
OF AUTHORITY- The amendments made by this section shall not be construed
to terminate agreements that, on the day before the date of enactment
of this Act, are in effect pursuant to section 795 of the Public
Health Service Act (42 U.S.C. 795) as such section existed on such
date. Such agreements shall continue in effect in accordance with
the terms of the agreements. With respect to compliance with such
agreements, any period of practice as a provider of primary health
services shall be counted towards the satisfaction of the requirement
of practice pursuant to such section 795.
(c) CONFORMING
AMENDMENTS- Section 481A(c)(3)(D)(i) of the Public Health Service
Act (42 U.S.C. 287a-2(c)(3)(D)(i)) is amended by striking section
739' and inserting part B of title VII'.
SEC. 102. TRAINING
IN PRIMARY CARE MEDICINE AND DENTISTRY.
Part C of title
VII of the Public Health Service Act (42 U.S.C. 293 et seq.) is
amended--
(1) in the
part heading by striking PRIMARY HEALTH CARE' and inserting FAMILY
MEDICINE, GENERAL INTERNAL MEDICINE, GENERAL PEDIATRICS, PHYSICIAN
ASSISTANTS, GENERAL DENTISTRY, AND PEDIATRIC DENTISTRY';
(2) by repealing
section 746 (42 U.S.C. 293j);
(3) in section
747 (42 U.S.C. 293k)--
(A) by striking
the section heading and inserting the following:
SEC. 747. FAMILY
MEDICINE, GENERAL INTERNAL MEDICINE, GENERAL PEDIATRICS, GENERAL
DENTISTRY, PEDIATRIC DENTISTRY, AND PHYSICIAN ASSISTANTS.';
(B) in subsection
(a)--
(i) in paragraph
(1)--
(I) by inserting
, internal medicine, or pediatrics' after family medicine'; and
(II) by inserting
before the semicolon the following: that emphasizes training for
the practice of family medicine, general internal medicine, or general
pediatrics (as defined by the Secretary)';
(ii) in paragraph
(2), by inserting , general internal medicine, or general pediatrics'
before the semicolon;
(iii) in paragraphs
(3) and (4), by inserting (including geriatrics), general internal
medicine or general pediatrics' after family medicine';
(iv) in paragraph
(3), by striking and' at the end thereof;
(v) in paragraph
(4), by striking the period and inserting a semicolon; and
(vii) by adding
at the end thereof the following new paragraphs:
(5) to meet
the costs of projects to plan, develop, and operate or maintain
programs for the training of physician assistants (as defined in
section 799B), and for the training of individuals who will teach
in programs to provide such training; and
(6) to meet
the costs of planning, developing, or operating programs, and to
provide financial assistance to residents in such programs, of general
dentistry or pediatric dentistry.
For purposes
of paragraph (6), entities eligible for such grants or contracts
shall include entities that have programs in dental schools, approved
residency programs in the general or pediatric practice of dentistry,
approved advanced education programs in the general or pediatric
practice of dentistry, or approved residency programs in pediatric
dentistry.';
(C) in subsection
(b)--
(i) in paragraphs
(1) and (2)(A), by inserting , general internal medicine, or general
pediatrics' after family medicine';
(ii) in paragraph
(2)--
(I) in subparagraph
(A), by striking or' at the end; and
(II) in subparagraph
(B), by striking the period and inserting ; or'; and
(iii) by adding
at the end the following:
(3) PRIORITY
IN MAKING AWARDS- In making awards of grants and contracts under
paragraph (1), the Secretary shall give priority to any qualified
applicant for such an award that proposes a collaborative project
between departments of primary care.';
(D) by redesignating
subsections (c) and (d) as subsections (d) and (e), respectively;
(E) by inserting
after subsection (b), the following new subsection:
(c) PRIORITY-
(1) IN GENERAL-
With respect to programs for the training of interns or residents,
the Secretary shall give priority in awarding grants under this
section to qualified applicants that have a record of training the
greatest percentage of providers, or that have demonstrated significant
improvements in the percentage of providers, which enter and remain
in primary care practice or general or pediatric dentistry.
(2) DISADVANTAGED
INDIVIDUALS- With respect to programs for the training of interns,
residents, or physician assistants, the Secretary shall give priority
in awarding grants under this section to qualified applicants that
have a record of training individuals who are from disadvantaged
backgrounds (including racial and ethnic minorities underrepresented
among primary care practice or general or pediatric dentistry).
(3) SPECIAL
CONSIDERATION- In awarding grants under this section the Secretary
shall give special consideration to projects which prepare practitioners
to care for underserved populations and other high risk groups such
as the elderly, individuals with HIV-AIDS, substance abusers, homeless,
and victims of domestic violence.'; and
(F) in subsection
(e) (as so redesignated by subparagraph (D))--
(i) in paragraph
(1), by striking $54,000,000' and all that follows and inserting
$78,300,000 for fiscal year 1998, and such sums as may be necessary
for each of the fiscal years 1999 through 2002.'; and
(ii) by striking
paragraph (2) and inserting the following:
(2) ALLOCATION-
(A) IN GENERAL-
Of the amounts appropriated under paragraph (1) for a fiscal year,
the Secretary shall make available--
(i) not less
than $49,300,000 for awards of grants and contracts under subsection
(a) to programs of family medicine, of which not less than $8,600,000
shall be made available for awards of grants and contracts under
subsection (b) for family medicine academic administrative units;
(ii) not less
than $17,700,000 for awards of grants and contracts under subsection
(a) to programs of general internal medicine and general pediatrics;
(iii) not less
than $6,800,000 for awards of grants and contracts under subsection
(a) to programs relating to physician assistants; and
(iv) not less
than $4,500,000 for awards of grants and contracts under subsection
(a) to programs of general or pediatric dentistry.
(B) RATABLE
REDUCTION- If amounts appropriated under paragraph (1) for any fiscal
year are less than the amount required to comply with subparagraph
(A), the Secretary shall ratably reduce the amount to be made available
under each of clauses (i) through (iv) of such subparagraph accordingly.';
and
(4) by repealing
sections 748 through 752 (42 U.S.C. 293l through 293p) and inserting
the following:
SEC. 748. ADVISORY
COMMITTEE ON TRAINING IN PRIMARY CARE MEDICINE AND DENTISTRY.
(a) ESTABLISHMENT-
The Secretary shall establish an advisory committee to be known
as the Advisory Committee on Training in Primary Care Medicine and
Dentistry (in this section referred to as the Advisory Committee').
(b) COMPOSITION-
(1) IN GENERAL-
The Secretary shall determine the appropriate number of individuals
to serve on the Advisory Committee. Such individuals shall not be
officers or employees of the Federal Government.
(2) APPOINTMENT-
Not later than 90 days after the date of enactment of this Act,
the Secretary shall appoint the members of the Advisory Committee
from among individuals who are health professionals. In making such
appointments, the Secretary shall ensure a fair balance between
the health professions, that at least 75 percent of the members
of the Advisory Committee are health professionals, a broad geographic
representation of members and a balance between urban and rural
members. Members shall be appointed based on their competence, interest,
and knowledge of the mission of the profession involved.
(3) MINORITY
REPRESENTATION- In appointing the members of the Advisory Committee
under paragraph (2), the Secretary shall ensure the adequate representation
of women and minorities.
(c) TERMS-
(1) IN GENERAL-
A member of the Advisory Committee shall be appointed for a term
of 3 years, except that of the members first appointed--
(A) 1/3 of
such members shall serve for a term of 1 year;
(B) 1/3 of
such members shall serve for a term of 2 years; and
(C) 1/3 of
such members shall serve for a term of 3 years.
(2) VACANCIES-
(A) IN GENERAL-
A vacancy on the Advisory Committee shall be filled in the manner
in which the original appointment was made and shall be subject
to any conditions which applied with respect to the original appointment.
(B) FILLING
UNEXPIRED TERM- An individual chosen to fill a vacancy shall be
appointed for the unexpired term of the member replaced.
(d) DUTIES-
The Advisory Committee shall--
(1) provide
advice and recommendations to the Secretary concerning policy and
program development and other matters of significance concerning
the activities under section 747; and
(2) not later
than 3 years after the date of enactment of this section, and annually
thereafter, prepare and submit to the Secretary, and the Committee
on Labor and Human Resources of the Senate, and the Committee on
Commerce of the House of Representatives, a report describing the
activities of the Committee, including findings and recommendations
made by the Committee concerning the activities under section 747.
(e) MEETINGS
AND DOCUMENTS-
(1) MEETINGS-
The Advisory Committee shall meet not less than 2 times each year.
Such meetings shall be held jointly with other related entities
established under this title where appropriate.
(2) DOCUMENTS-
Not later than 14 days prior to the convening of a meeting under
paragraph (1), the Advisory Committee shall prepare and make available
an agenda of the matters to be considered by the Advisory Committee
at such meeting. At any such meeting, the Advisory Council shall
distribute materials with respect to the issues to be addressed
at the meeting. Not later than 30 days after the adjourning of such
a meeting, the Advisory Committee shall prepare and make available
a summary of the meeting and any actions taken by the Committee
based upon the meeting.
(f) COMPENSATION
AND EXPENSES-
(1) COMPENSATION-
Each member of the Advisory Committee shall be compensated at a
rate equal to the daily equivalent of the annual rate of basic pay
prescribed for level IV of the Executive Schedule under section
5315 of title 5, United States Code, for each day (including travel
time) during which such member is engaged in the performance of
the duties of the Committee.
(2) EXPENSES-
The members of the Advisory Committee shall be allowed travel expenses,
including per diem in lieu of subsistence, at rates authorized for
employees of agencies under subchapter I of chapter 57 of title
5, United States Code, while away from their homes or regular places
of business in the performance of services for the Committee.
(g) FACA- The
Federal Advisory Committee Act shall apply to the Advisory Committee
under this section only to the extent that the provisions of such
Act do not conflict with the requirements of this section.'.
SEC. 103. INTERDISCIPLINARY,
COMMUNITY-BASED LINKAGES.
Part D of title
VII of the Public Health Service Act (42 U.S.C. 294 et seq.) is
amended to read as follows:
PART D--INTERDISCIPLINARY,
COMMUNITY-BASED LINKAGES
SEC. 750. GENERAL
PROVISIONS.
(a) COLLABORATION-
To be eligible to receive assistance under this part, an academic
institution shall use such assistance in collaboration with 2 or
more disciplines.
(b) ACTIVITIES-
An entity shall use assistance under this part to carry out innovative
demonstration projects for strategic workforce supplementation activities
as needed to meet national goals for interdisciplinary, community-based
linkages. Such assistance may be used consistent with this part--
(1) to develop
and support training programs;
(2) for faculty
development;
(3) for model
demonstration programs;
(4) for the
provision of stipends for fellowship trainees;
(5) to provide
technical assistance; and
(6) for other
activities that will produce outcomes consistent with the purposes
of this part.
SEC. 751. AREA
HEALTH EDUCATION CENTERS.
(a) AUTHORITY
FOR PROVISION OF FINANCIAL ASSISTANCE-
(1) ASSISTANCE
FOR PLANNING, DEVELOPMENT, AND OPERATION OF PROGRAMS-
(A) IN GENERAL-
The Secretary shall award grants to and enter into contracts with
schools of medicine and osteopathic medicine, and incorporated consortia
made up of such schools, or the parent institutions of such schools,
for projects for the planning, development and operation of area
health education center programs that--
(i) improve
the recruitment, distribution, supply, quality and efficiency of
personnel providing health services in underserved rural and urban
areas and personnel providing health services to populations having
demonstrated serious unmet health care needs;
(ii) increase
the number of primary care physicians and other primary care providers
who provide services in underserved areas through the offering of
an educational continuum of health career recruitment through clinical
education concerning underserved areas in a comprehensive health
workforce strategy;
(iii) carry
out recruitment and health career awareness programs to recruit
individuals from underserved areas and under-represented populations,
including minority and other elementary or secondary students, into
the health professions;
(iv) prepare
individuals to more effectively provide health services to underserved
areas or underserved populations through field placements, preceptorships,
the conduct of or support of community-based primary care residency
programs, and agreements with community-based organizations such
as community health centers, migrant health centers, Indian health
centers, public health departments and others;
(v) conduct
health professions education and training activities for students
of health professions schools and medical residents;
(vi) conduct
at least 10 percent of medical student required clinical education
at sites remote to the primary teaching facility of the contracting
institution; and
(vii) provide
information dissemination and educational support to reduce professional
isolation, increase retention, enhance the practice environment,
and improve health care through the timely dissemination of research
findings using relevant resources.
(B) OTHER ELIGIBLE
ENTITIES- With respect to a State in which no area health education
center program is in operation, the Secretary may award a grant
or contract under subparagraph (A) to a school of nursing.
(C) PROJECT
TERMS-
(i) IN GENERAL-
Except as provided in clause (ii), the period during which payments
may be made under an award under subparagraph (A) may not exceed--
(I) in the
case of a project, 12 years or
(II) in the
case of a center within a project, 6 years.
(ii) EXCEPTION-
The periods described in clause (i) shall not apply to projects
that have completed the initial period of Federal funding under
this section and that desire to compete for model awards under paragraph
(2)(A).
(2) ASSISTANCE
FOR OPERATION OF MODEL PROGRAMS-
(A) IN GENERAL-
In the case of any entity described in paragraph (1)(A) that--
(i) has previously
received funds under this section;
(ii) is operating
an area health education center program; and
(iii) is no
longer receiving financial assistance under paragraph (1);
the Secretary
may provide financial assistance to such entity to pay the costs
of operating and carrying out the requirements of the program as
described in paragraph (1).
(B) MATCHING
REQUIREMENT- With respect to the costs of operating a model program
under subparagraph (A), an entity, to be eligible for financial
assistance under subparagraph (A), shall make available (directly
or through contributions from State, county or municipal governments,
or the private sector) recurring non-Federal contributions in cash
toward such costs in an amount that is equal to not less than 50
percent of such costs.
(C) LIMITATION-
The aggregate amount of awards provided under subparagraph (A) to
entities in a State for a fiscal year may not exceed the lesser
of--
(i) $2,000,000;
or
(ii) an amount
equal to the product of $250,000 and the aggregate number of area
health education centers operated in the State by such entities.
(b) REQUIREMENTS
FOR CENTERS-
(1) GENERAL
REQUIREMENT- Each area health education center that receives funds
under this section shall encourage the regionalization of health
professions schools through the establishment of partnerships with
community-based organizations.
(2) SERVICE
AREA- Each area health education center that receives funds under
this section shall specifically designate a geographic area or medically
underserved population to be served by the center. Such area or
population shall be in a location removed from the main location
of the teaching facilities of the schools participating in the program
with such center.
(3) OTHER REQUIREMENTS-
Each area health education center that receives funds under this
section shall--
(A) assess
the health personnel needs of the area to be served by the center
and assist in the planning and development of training programs
to meet such needs;
(B) arrange
and support rotations for students and residents in family medicine,
general internal medicine or general pediatrics, with at least one
center in each program being affiliated with or conducting a rotating
osteopathic internship or medical residency training program in
family medicine (including geriatrics), general internal medicine
(including geriatrics), or general pediatrics in which no fewer
than 4 individuals are enrolled in first-year positions;
(C) conduct
and participate in interdisciplinary training that involves physicians
and other health personnel including, where practicable, public
health professionals, physician assistants, nurse practitioners,
nurse midwives, and behavioral and mental health providers; and
(D) have an
advisory board, at least 75 percent of the members of which shall
be individuals, including both health service providers and consumers,
from the area served by the center.
(c) CERTAIN
PROVISIONS REGARDING FUNDING-
(1) ALLOCATION
TO CENTER- Not less than 75 percent of the total amount of Federal
funds provided to an entity under this section shall be allocated
by an area health education center program to the area health education
center. Such entity shall enter into an agreement with each center
for purposes of specifying the allocation of such 75 percent of
funds.
(2) OPERATING
COSTS- With respect to the operating costs of the area health education
center program of an entity receiving funds under this section,
the entity shall make available (directly or through contributions
from State, county or municipal governments, or the private sector)
non-Federal contributions in cash toward such costs in an amount
that is equal to not less than 50 percent of such costs, except
that the Secretary may grant a waiver for up to 75 percent of the
amount of the required non-Federal match in the first 3 years in
which an entity receives funds under this section.
SEC. 752. HEALTH
EDUCATION AND TRAINING CENTERS.
(a) IN GENERAL-
To be eligible for funds under this section, a health education
training center shall be an entity otherwise eligible for funds
under section 751 that--
(1) addresses
the persistent and severe unmet health care needs in States along
the border between the United States and Mexico and in the State
of Florida, and in other urban and rural areas with populations
with serious unmet health care needs;
(2) establishes
an advisory board comprised of health service providers, educators
and consumers from the service area;
(3) conducts
training and education programs for health professions students
in these areas;
(4) conducts
training in health education services, including training to prepare
community health workers; and
(5) supports
health professionals (including nursing) practicing in the area
through educational and other services.
(b) ALLOCATION
OF FUNDS- The Secretary shall make available 50 percent of the amounts
appropriated for each fiscal year under section 752 for the establishment
or operation of health education training centers through projects
in States along the border between the United States and Mexico
and in the State of Florida.
SEC. 753. EDUCATION
AND TRAINING RELATING TO GERIATRICS.
(a) GERIATRIC
EDUCATION CENTERS-
(1) IN GENERAL-
The Secretary shall award grants or contracts under this section
to entities described in paragraphs (1), (3), or (4) of section
799B, and section 853(2), for the establishment or operation of
geriatric education centers.
(2) REQUIREMENTS-
A geriatric education center is a program that--
(A) improves
the training of health professionals in geriatrics, including geriatric
residencies, traineeships, or fellowships;
(B) develops
and disseminates curricula relating to the treatment of the health
problems of elderly individuals;
(C) supports
the training and retraining of faculty to provide instruction in
geriatrics;
(D) supports
continuing education of health professionals who provide geriatric
care; and
(E) provides
students with clinical training in geriatrics in nursing homes,
chronic and acute disease hospitals, ambulatory care centers, and
senior centers.
(b) GERIATRIC
TRAINING REGARDING PHYSICIANS AND DENTISTS-
(1) IN GENERAL-
The Secretary may make grants to, and enter into contracts with,
schools of medicine, schools of osteopathic medicine, teaching hospitals,
and graduate medical education programs, for the purpose of providing
support (including residencies, traineeships, and fellowships) for
geriatric training projects to train physicians, dentists and behavioral
and mental health professionals who plan to teach geriatric medicine,
geriatric behavioral or mental health, or geriatric dentistry.
(2) REQUIREMENTS-
Each project for which a grant or contract is made under this subsection
shall--
(A) be staffed
by full-time teaching physicians who have experience or training
in geriatric medicine or geriatric behavioral or mental health;
(B) be staffed,
or enter into an agreement with an institution staffed by full-time
or part-time teaching dentists who have experience or training in
geriatric dentistry;
(C) be staffed,
or enter into an agreement with an institution staffed by full-time
or part-time teaching behavioral mental health professionals who
have experience or training in geriatric behavioral or mental health;
(D) be based
in a graduate medical education program in internal medicine or
family medicine or in a department of geriatrics or behavioral or
mental health;
(E) provide
training in geriatrics and exposure to the physical and mental disabilities
of elderly individuals through a variety of service rotations, such
as geriatric consultation services, acute care services, dental
services, geriatric behavioral or mental health units, day and home
care programs, rehabilitation services, extended care facilities,
geriatric ambulatory care and comprehensive evaluation units, and
community care programs for elderly mentally retarded individuals;
and
(F) provide
training in geriatrics through one or both of the training options
described in subparagraphs (A) and (B) of paragraph (3).
(3) TRAINING
OPTIONS- The training options referred to in subparagraph (F) of
paragraph (2) shall be as follows:
(A) A 1-year
retraining program in geriatrics for--
(i) physicians
who are faculty members in departments of internal medicine, family
medicine, gynecology, geriatrics, and behavioral or mental health
at schools of medicine and osteopathic medicine;
(ii) dentists
who are faculty members at schools of dentistry or at hospital departments
of dentistry; and
(iii) behavioral
or mental health professionals who are faculty members in departments
of behavioral or mental health; and
(B) A 2-year
internal medicine or family medicine fellowship program providing
emphasis in geriatrics, which shall be designed to provide training
in clinical geriatrics and geriatrics research for--
(i) physicians
who have completed graduate medical education programs in internal
medicine, family medicine, behavioral or mental health, neurology,
gynecology, or rehabilitation medicine;
(ii) dentists
who have demonstrated a commitment to an academic career and who
have completed postdoctoral dental training, including postdoctoral
dental education programs or who have relevant advanced training
or experience; and
(iii) behavioral
or mental health professionals who have completed graduate medical
education programs in behavioral or mental health.
(4) DEFINITIONS-
For purposes of this subsection:
(A) The term
graduate medical education program' means a program sponsored by
a school of medicine, a school of osteopathic medicine, a hospital,
or a public or private institution that--
(i) offers
postgraduate medical training in the specialties and subspecialties
of medicine; and
(ii) has been
accredited by the Accreditation Council for Graduate Medical Education
or the American Osteopathic Association through its Committee on
Postdoctoral Training.
(B) The term
post-doctoral dental education program' means a program sponsored
by a school of dentistry, a hospital, or a public or private institution
that--
(i) offers
post-doctoral training in the specialties of dentistry, advanced
education in general dentistry, or a dental general practice residency;
and
(ii) has been
accredited by the Commission on Dental Accreditation.
(c) GERIATRIC
FACULTY FELLOWSHIPS-
(1) ESTABLISHMENT
OF PROGRAM- The Secretary shall establish a program to provide Geriatric
Academic Career Awards to eligible individuals to promote the career
development of such individuals as academic geriatricians.
(2) ELIGIBLE
INDIVIDUALS- To be eligible to receive an Award under paragraph
(1), an individual shall--
(A) be board
certified or board eligible in internal medicine, family practice,
or psychiatry;
(B) have completed
an approved fellowship program in geriatrics; and
(C) have a
junior faculty appointment at an accredited (as determined by the
Secretary) school of medicine or osteopathic medicine.
(3) LIMITATIONS-
No Award under paragraph (1) may be made to an eligible individual
unless the individual--
(A) has submitted
to the Secretary an application, at such time, in such manner, and
containing such information as the Secretary may require, and the
Secretary has approved such application; and
(B) provides,
in such form and manner as the Secretary may require, assurances
that the individual will meet the service requirement described
in subsection (e).
(4) AMOUNT
AND TERM-
(A) AMOUNT-
The amount of an Award under this section shall equal $50,000 for
fiscal year 1998, adjusted for subsequent fiscal years to reflect
the increase in the Consumer Price Index.
(B) TERM- The
term of any Award made under this subsection shall not exceed 5
years.
(5) SERVICE
REQUIREMENT- An individual who receives an Award under this subsection
shall provide training in clinical geriatrics, including the training
of interdisciplinary teams of health care professionals. The provision
of such training shall constitute at least 75 percent of the obligations
of such individual under the Award.
SEC. 754. QUENTIN
N. BURDICK PROGRAM FOR RURAL INTERDISCIPLINARY TRAINING.
(a) GRANTS-
The Secretary may make grants or contracts under this section to
help entities fund authorized activities under an application approved
under subsection (c).
(b) USE OF
AMOUNTS-
(1) IN GENERAL-
Amounts provided under subsection (a) shall be used by the recipients
to fund interdisciplinary training projects designed to--
(A) use new
and innovative methods to train health care practitioners to provide
services in rural areas;
(B) demonstrate
and evaluate innovative interdisciplinary methods and models designed
to provide access to cost-effective comprehensive health care;
(C) deliver
health care services to individuals residing in rural areas;
(D) enhance
the amount of relevant research conducted concerning health care
issues in rural areas; and
(E) increase
the recruitment and retention of health care practitioners from
rural areas and make rural practice a more attractive career choice
for health care practitioners.
(2) METHODS-
A recipient of funds under subsection (a) may use various methods
in carrying out the projects described in paragraph (1), including--
(A) the distribution
of stipends to students of eligible applicants;
(B) the establishment
of a post-doctoral fellowship program;
(C) the training
of faculty in the economic and logistical problems confronting rural
health care delivery systems; or
(D) the purchase
or rental of transportation and telecommunication equipment where
the need for such equipment due to unique characteristics of the
rural area is demonstrated by the recipient.
(3) ADMINISTRATION-
(A) IN GENERAL-
An applicant shall not use more than 10 percent of the funds made
available to such applicant under subsection (a) for administrative
expenses.
(B) TRAINING-
Not more than 10 percent of the individuals receiving training with
funds made available to an applicant under subsection (a) shall
be trained as doctors of medicine or doctors of osteopathy.
(C) LIMITATION-
An institution that receives a grant under this section shall use
amounts received under such grant to supplement, not supplant, amounts
made available by such institution for activities of the type described
in subsection (b)(1) in the fiscal year preceding the year for which
the grant is received.
(c) APPLICATIONS-
Applications submitted for assistance under this section shall--
(1) be jointly
submitted by at least two eligible applicants with the express purpose
of assisting individuals in academic institutions in establishing
long-term collaborative relationships with health care providers
in rural areas; and
(2) designate
a rural health care agency or agencies for clinical treatment or
training, including hospitals, community health centers, migrant
health centers, rural health clinics, community behavioral and mental
health centers, long-term care facilities, Native Hawaiian health
centers, or facilities operated by the Indian Health Service or
an Indian tribe or tribal organization or Indian organization under
a contract with the Indian Health Service under the Indian Self-Determination
Act.
(d) DEFINITIONS-
For the purposes of this section, the term rural' means geographic
areas that are located outside of standard metropolitan statistical
areas.
SEC. 755. ALLIED
HEALTH AND OTHER DISCIPLINES.
(a) IN GENERAL-
The Secretary may make grants or contracts under this section to
help entities fund activities of the type described in subsection
(b).
(b) ACTIVITIES-
Activities of the type described in this subsection include the
following:
(1) Assisting
entities in meeting the costs associated with expanding or establishing
programs that will increase the number of individuals trained in
allied health professions. Programs and activities funded under
this paragraph may include--
(A) those that
expand enrollments in allied health professions with the greatest
shortages or whose services are most needed by the elderly;
(B) those that
provide rapid transition training programs in allied health fields
to individuals who have baccalaureate degrees in health-related
sciences;
(C) those that
establish community-based allied health training programs that link
academic centers to rural clinical settings;
(D) those that
provide career advancement training for practicing allied health
professionals;
(E) those that
expand or establish clinical training sites for allied health professionals
in medically underserved or rural communities in order to increase
the number of individuals trained;
(F) those that
develop curriculum that will emphasize knowledge and practice in
the areas of prevention and health promotion, geriatrics, long-term
care, home health and hospice care, and ethics;
(G) those that
expand or establish interdisciplinary training programs that promote
the effectiveness of allied health practitioners in geriatric assessment
and the rehabilitation of the elderly;
(H) those that
expand or establish demonstration centers to emphasize innovative
models to link allied health clinical practice, education, and research;
(I) those that
provide financial assistance (in the form of traineeships) to students
who are participants in any such program; and
(i) who plan
to pursue a career in an allied health field that has a demonstrated
personnel shortage; and
(ii) who agree
upon completion of the training program to practice in a medically
underserved community;
that shall
be utilized to assist in the payment of all or part of the costs
associated with tuition, fees and such other stipends as the Secretary
may consider necessary; and
(J) those to
meet the costs of projects to plan, develop, and operate or maintain
graduate programs in behavioral and mental health practice.
(2) Planning
and implementing projects in preventive and primary care training
for podiatric physicians in approved or provisionally approved residency
programs that shall provide financial assistance in the form of
traineeships to residents who participate in such projects and who
plan to specialize in primary care.
(3) Carrying
out demonstration projects in which chiropractors and physicians
collaborate to identify and provide effective treatment for spinal
and lower-back conditions.
SEC. 756. ADVISORY
COMMITTEE ON INTERDISCIPLINARY, COMMUNITY-BASED LINKAGES.
(a) ESTABLISHMENT-
The Secretary shall establish an advisory committee to be known
as the Advisory Committee on Interdisciplinary, Community-Based
Linkages (in this section referred to as the Advisory Committee').
(b) COMPOSITION-
(1) IN GENERAL-
The Secretary shall determine the appropriate number of individuals
to serve on the Advisory Committee. Such individuals shall not be
officers or employees of the Federal Government.
(2) APPOINTMENT-
Not later than 90 days after the date of enactment of this Act,
the Secretary shall appoint the members of the Advisory Committee
from among individuals who are health professionals from schools
of the types described in sections 751(a)(1)(A), 751(a)(1)(B), 753(b),
754(3)(A), and 755(b). In making such appointments, the Secretary
shall ensure a fair balance between the health professions, that
at least 75 percent of the members of the Advisory Committee are
health professionals, a broad geographic representation of members
and a balance between urban and rural members. Members shall be
appointed based on their competence, interest, and knowledge of
the mission of the profession involved.
(3) MINORITY
REPRESENTATION- In appointing the members of the Advisory Committee
under paragraph (2), the Secretary shall ensure the adequate representation
of women and minorities.
(c) TERMS-
(1) IN GENERAL-
A member of the Advisory Committee shall be appointed for a term
of 3 years, except that of the members first appointed--
(A) 1/3 of
the members shall serve for a term of 1 year;
(B) 1/3 of
the members shall serve for a term of 2 years; and
(C) 1/3 of
the members shall serve for a term of 3 years.
(2) VACANCIES-
(A) IN GENERAL-
A vacancy on the Advisory Committee shall be filled in the manner
in which the original appointment was made and shall be subject
to any conditions which applied with respect to the original appointment.
(B) FILLING
UNEXPIRED TERM- An individual chosen to fill a vacancy shall be
appointed for the unexpired term of the member replaced.
(d) DUTIES-
The Advisory Committee shall--
(1) provide
advice and recommendations to the Secretary concerning policy and
program development and other matters of significance concerning
the activities under this part; and
(2) not later
than 3 years after the date of enactment of this section, and annually
thereafter, prepare and submit to the Secretary, and the Committee
on Labor and Human Resources of the Senate, and the Committee on
Commerce of the House of Representatives, a report describing the
activities of the Committee, including findings and recommendations
made by the Committee concerning the activities under this part.
(e) MEETINGS
AND DOCUMENTS-
(1) MEETINGS-
The Advisory Committee shall meet not less than 3 times each year.
Such meetings shall be held jointly with other related entities
established under this title where appropriate.
(2) DOCUMENTS-
Not later than 14 days prior to the convening of a meeting under
paragraph (1), the Advisory Committee shall prepare and make available
an agenda of the matters to be considered by the Advisory Committee
at such meeting. At any such meeting, the Advisory Council shall
distribute materials with respect to the issues to be addressed
at the meeting. Not later than 30 days after the adjourning of such
a meeting, the Advisory Committee shall prepare and make available
a summary of the meeting and any actions taken by the Committee
based upon the meeting.
(f) COMPENSATION
AND EXPENSES-
(1) COMPENSATION-
Each member of the Advisory Committee shall be compensated at a
rate equal to the daily equivalent of the annual rate of basic pay
prescribed for level IV of the Executive Schedule under section
5315 of title 5, United States Code, for each day (including travel
time) during which such member is engaged in the performance of
the duties of the Committee.
(2) EXPENSES-
The members of the Advisory Committee shall be allowed travel expenses,
including per diem in lieu of subsistence, at rates authorized for
employees of agencies under subchapter I of chapter 57 of title
5, United States Code, while away from their homes or regular places
of business in the performance of services for the Committee.
(g) FACA- The
Federal Advisory Committee Act shall apply to the Advisory Committee
under this section only to the extent that the provisions of such
Act do not conflict with the requirements of this section.
SEC. 757. AUTHORIZATION
OF APPROPRIATIONS.
(a) IN GENERAL-
There are authorized to be appropriated to carry out this part,
$55,600,000 for fiscal year 1998, and such sums as may be necessary
for each of the fiscal years 1999 through 2002.
(b) ALLOCATION-
(1) IN GENERAL-
Of the amounts appropriated under subsection (a) for a fiscal year,
the Secretary shall make available--
(A) not less
than $28,587,000 for awards of grants and contracts under section
751;
(B) not less
than $3,765,000 for awards of grants and contracts under section
752, of which not less than 50 percent of such amount shall be made
available for centers described in subsection (a)(1) of such section;
and
(C) not less
than $22,631,000 for awards of grants and contracts under sections
753, 754, and 755.
(2) RATABLE
REDUCTION- If amounts appropriated under subsection (a) for any
fiscal year are less than the amount required to comply with paragraph
(1), the Secretary shall ratably reduce the amount to be made available
under each of subparagraphs (A) through (C) of such paragraph accordingly.
(3) INCREASE
IN AMOUNTS- If amounts appropriated for a fiscal year under subsection
(a) exceed the amount authorized under such subsection for such
fiscal year, the Secretary may increase the amount to be made available
for programs and activities under this part without regard to the
amounts specified in each of subparagraphs (A) through (C) of paragraph
(2).
(c) OBLIGATION
OF CERTAIN AMOUNTS-
(1) AREA HEALTH
EDUCATION CENTER PROGRAMS- Of the amounts made available under subsection
(b)(1)(A) for each fiscal year, the Secretary may obligate for awards
under section 751(a)(2)--
(A) not less
than 23 percent of such amounts in fiscal year 1998;
(B) not less
than 30 percent of such amounts in fiscal year 1999;
(C) not less
than 35 percent of such amounts in fiscal year 2000;
(D) not less
than 40 percent of such amounts in fiscal year 2001; and
(E) not less
than 45 percent of such amounts in fiscal year 2002.
(2) SENSE OF
CONGRESS- It is the sense of the Congress that--
(A) every State
have an area health education center program in effect under this
section; and
(B) the ratio
of Federal funding for the model program under section 751(a)(2)
should increase over time and that Federal funding for other awards
under this section shall decrease so that the national program will
become entirely comprised of programs that are funded at least 50
percent by State and local partners.'.
SEC. 104. HEALTH
PROFESSIONS WORKFORCE INFORMATION AND ANALYSIS.
(a) IN GENERAL-
Part E of title VII of the Public Health Service Act (42 U.S.C.
294n et seq.) is amended to read as follows:
PART E--HEALTH
PROFESSIONS AND PUBLIC HEALTH WORKFORCE
Subpart 1--Health
Professions Workforce Information and Analysis
SEC. 761. HEALTH
PROFESSIONS WORKFORCE INFORMATION AND ANALYSIS.
(a) PURPOSE-
It is the purpose of this section to--
(1) provide
for the development of information describing the health professions
workforce and the analysis of workforce related issues; and
(2) provide
necessary information for decision-making regarding future directions
in health professions and nursing programs in response to societal
and professional needs.
(b) GRANTS
OR CONTRACTS- The Secretary may award grants or contracts to State
or local governments, health professions schools, schools of nursing,
academic health centers, community-based health facilities, and
other appropriate public or private nonprofit entities to provide
for--
(1) targeted
information collection and analysis activities related to the purposes
described in subsection (a);
(2) research
on high priority workforce questions;
(3) the development
of a non-Federal analytic and research infrastructure related to
the purposes described in subsection (a); and
(4) the conduct
of program evaluation and assessment.
(c) AUTHORIZATION
OF APPROPRIATIONS-
(1) IN GENERAL-
There are authorized to be appropriated to carry out this section,
$750,000 for fiscal year 1998, and such sums as may be necessary
for each of the fiscal years 1999 through 2002.
(2) RESERVATION-
Of the amounts appropriated under subsection (a) for a fiscal year,
the Secretary shall reserve not less than $600,000 for conducting
health professions research and for carrying out data collection
and analysis in accordance with section 792.
(3) AVAILABILITY
OF ADDITIONAL FUNDS- Amounts otherwise appropriated for programs
or activities under this title may be used for activities under
subsection (b) with respect to the programs or activities from which
such amounts were made available.'.
(b) COUNCIL
ON GRADUATE MEDICAL EDUCATION- Section 301 of the Health Professions
Education Extension Amendments of 1992 (Public Law 102-408) is amended--
(1) in subsection
(j), by striking 1995' and inserting 2002';
(2) in subsection
(k), by striking 1995' and inserting 2002';
(3) by adding
at the end thereof the following new subsection:
(l) FUNDING-
Amounts otherwise appropriated under this title may be utilized
by the Secretary to support the activities of the Council.';
(4) by transferring
such section to part E of title VII of the Public Health Service
Act (as amended by subsection (a));
(5) by redesignating
such section as section 762; and
(6) by inserting
such section after section 761.
SEC. 105. PUBLIC
HEALTH WORKFORCE DEVELOPMENT.
Part E of title
VII of the Public Health Service Act (as amended by section 104)
is further amended by adding at the end the following:
Subpart 2--Public
Health Workforce
SEC. 765. GENERAL
PROVISIONS.
(a) IN GENERAL-
The Secretary may award grants or contracts to eligible entities
to increase the number of individuals in the public health workforce,
to enhance the quality of such workforce, and to enhance the ability
of the workforce to meet national, State, and local health care
needs.
(b) ELIGIBILITY-
To be eligible to receive a grant or contract under subsection (a)
an entity shall--
(1) be--
(A) a health
professions school, including an accredited school or program of
public health, health administration, preventive medicine, or dental
public health or a school providing health management programs;
(B) an academic
health center;
(C) a State
or local government; or
(D) any other
appropriate public or private nonprofit entity; and
(2) prepare
and submit to the Secretary an application at such time, in such
manner, and containing such information as the Secretary may require.
(c) PREFERENCE-
In awarding grants or contracts under this section the Secretary
may grant a preference to entities--
(1) serving
individuals who are from disadvantaged backgrounds (including underrepresented
racial and ethnic minorities); and
(2) graduating
large proportions of individuals who serve in underserved communities.
(d) ACTIVITIES-
Amounts provided under a grant or contract awarded under this section
may be used for--
(1) the costs
of planning, developing, or operating demonstration training programs;
(2) faculty
development;
(3) trainee
support;
(4) technical
assistance;
(5) to meet
the costs of projects--
(A) to plan
and develop new residency training programs and to maintain or improve
existing residency training programs in preventive medicine and
dental public health, that have available full-time faculty members
with training and experience in the fields of preventive medicine
and dental public health; and
(B) to provide
financial assistance to residency trainees enrolled in such programs;
(6) the retraining
of existing public health workers as well as for increasing the
supply of new practitioners to address priority public health, preventive
medicine, public health dentistry, and health administration needs;
(7) preparing
public health professionals for employment at the State and community
levels; or
(8) other activities
that may produce outcomes that are consistent with the purposes
of this section.
(e) TRAINEESHIPS-
(1) IN GENERAL-
With respect to amounts used under this section for the training
of health professionals, such training programs shall be designed
to--
(A) make public
health education more accessible to the public and private health
workforce;
(B) increase
the relevance of public health academic preparation to public health
practice in the future;
(C) provide
education or training for students from traditional on-campus programs
in practice-based sites; or
(D) develop
educational methods and distance-based approaches or technology
that address adult learning requirements and increase knowledge
and skills related to community-based cultural diversity in public
health education.
(2) SEVERE
SHORTAGE DISCIPLINES- Amounts provided under grants or contracts
under this section may be used for the operation of programs designed
to award traineeships to students in accredited schools of public
health who enter educational programs in fields where there is a
severe shortage of public health professionals, including epidemiology,
biostatistics, environmental health, toxicology, public health nursing,
nutrition, preventive medicine, maternal and child health, and behavioral
and mental health professions.
SEC. 766. PUBLIC
HEALTH TRAINING CENTERS.
(a) IN GENERAL-
The Secretary may make grants or contracts for the operation of
public health training centers.
(b) ELIGIBLE
ENTITIES-
(1) IN GENERAL-
A public health training center shall be an accredited school of
public health, or another public or nonprofit private institution
accredited for the provision of graduate or specialized training
in public health, that plans, develops, operates, and evaluates
projects that are in furtherance of the goals established by the
Secretary for the year 2000 in the areas of preventive medicine,
health promotion and disease prevention, or improving access to
and quality of health services in medically underserved communities.
(2) PREFERENCE-
In awarding grants or contracts under this section the Secretary
shall give preference to accredited schools of public health.
(c) CERTAIN
REQUIREMENTS- With respect to a public health training center, an
award may not be made under subsection (a) unless the program agrees
that it--
(1) will establish
or strengthen field placements for students in public or nonprofit
private health agencies or organizations;
(2) will involve
faculty members and students in collaborative projects to enhance
public health services to medically underserved communities;
(3) will specifically
designate a geographic area or medically underserved population
to be served by the center that shall be in a location removed from
the main location of the teaching facility of the school that is
participating in the program with such center; and
(4) will assess
the health personnel needs of the area to be served by the center
and assist in the planning and development of training programs
to meet such needs.
SEC. 767. PUBLIC
HEALTH TRAINEESHIPS.
(a) IN GENERAL-
The Secretary may make grants to accredited schools of public health,
and to other public or nonprofit private institutions accredited
for the provision of graduate or specialized training in public
health, for the purpose of assisting such schools and institutions
in providing traineeships to individuals described in subsection
(b)(3).
(b) CERTAIN
REQUIREMENTS-
(1) AMOUNT-
The amount of any grant under this section shall be determined by
the Secretary.
(2) USE OF
GRANT- Traineeships awarded under grants made under subsection (a)
shall provide for tuition and fees and such stipends and allowances
(including travel and subsistence expenses and dependency allowances)
for the trainees as the Secretary may deem necessary.
(3) ELIGIBLE
INDIVIDUALS- The individuals referred to in subsection (a) are individuals
who are pursuing a course of study in a health professions field
in which there is a severe shortage of health professionals (which
fields include the fields of epidemiology, environmental health,
biostatistics, toxicology, nutrition, and maternal and child health).
SEC. 768. PREVENTIVE
MEDICINE; DENTAL PUBLIC HEALTH.
(a) IN GENERAL-
The Secretary may make grants to and enter into contracts with schools
of medicine, osteopathic medicine, public health, and dentistry
to meet the costs of projects--
(1) to plan
and develop new residency training programs and to maintain or improve
existing residency training programs in preventive medicine and
dental public health; and
(2) to provide
financial assistance to residency trainees enrolled in such programs.
(b) ADMINISTRATION-
(1) AMOUNT-
The amount of any grant under subsection (a) shall be determined
by the Secretary.
(2) ELIGIBILITY-
To be eligible for a grant under subsection (a), the applicant must
demonstrate to the Secretary that it has or will have available
full-time faculty members with training and experience in the fields
of preventive medicine or dental public health and support from
other faculty members trained in public health and other relevant
specialties and disciplines.
(3) OTHER FUNDS-
Schools of medicine, osteopathic medicine, dentistry, and public
health may use funds committed by State, local, or county public
health officers as matching amounts for Federal grant funds for
residency training programs in preventive medicine.
SEC. 769. HEALTH
ADMINISTRATION TRAINEESHIPS AND SPECIAL PROJECTS.
(a) IN GENERAL-
The Secretary may make grants to State or local governments (that
have in effect preventive medical and dental public health residency
programs) or public or nonprofit private educational entities (including
graduate schools of social work and business schools that have health
management programs) that offer a program described in subsection
(b)--
(1) to provide
traineeships for students enrolled in such a program; and
(2) to assist
accredited programs health administration in the development or
improvement of programs to prepare students for employment with
public or nonprofit private entities.
(b) RELEVANT
PROGRAMS- The program referred to in subsection (a) is an accredited
program in health administration, hospital administration, or health
policy analysis and planning, which program is accredited by a body
or bodies approved for such purpose by the Secretary of Education
and which meets such other quality standards as the Secretary of
Health and Human Services by regulation may prescribe.
(c) PREFERENCE
IN MAKING GRANTS- In making grants under subsection (a), the Secretary
shall give preference to qualified applicants that meet the following
conditions:
(1) Not less
than 25 percent of the graduates of the applicant are engaged in
full-time practice settings in medically underserved communities.
(2) The applicant
recruits and admits students from medically underserved communities.
(3) For the
purpose of training students, the applicant has established relationships
with public and nonprofit providers of health care in the community
involved.
(4) In training
students, the applicant emphasizes employment with public or nonprofit
private entities.
(d) CERTAIN
PROVISIONS REGARDING TRAINEESHIPS-
(1) USE OF
GRANT- Traineeships awarded under grants made under subsection (a)
shall provide for tuition and fees and such stipends and allowances
(including travel and subsistence expenses and dependency allowances)
for the trainees as the Secretary may deem necessary.
(2) PREFERENCE
FOR CERTAIN STUDENTS- Each entity applying for a grant under subsection
(a) for traineeships shall assure to the satisfaction of the Secretary
that the entity will give priority to awarding the traineeships
to students who demonstrate a commitment to employment with public
or nonprofit private entities in the fields with respect to which
the traineeships are awarded.
SEC. 770. AUTHORIZATION
OF APPROPRIATIONS.
(a) IN GENERAL-
For the purpose of carrying out this subpart, there is authorized
to be appropriated $9,100,000 for fiscal year 1998, and such sums
as may be necessary for each of the fiscal years 1999 through 2002.
(b) LIMITATION
REGARDING CERTAIN PROGRAM- In obligating amounts appropriated under
subsection (a), the Secretary may not obligate more than 30 percent
for carrying out section 767.'.
SEC. 106. GENERAL
PROVISIONS.
(a) IN GENERAL-
(1) Part F
of title VII of the Public Health Service Act (42 U.S.C. 295 et
seq.) is repealed.
(2) Part G
of title VII of the Public Health Service Act (42 U.S.C. 295j et
seq.) is amended--
(A) by redesignating
such part as part F;
(B) in section
791 (42 U.S.C. 295j)--
(i) by striking
subsection (b); and
(ii) redesignating
subsection (c) as subsection (b);
(C) by repealing
section 793 (42 U.S.C. 295l);
(D) by repealing
section 798;
(E) by redesignating
section 799 as section 799B; and
(F) by inserting
after section 794, the following new sections:
SEC. 796. APPLICATION.
(a) IN GENERAL-
To be eligible to receive a grant or contract under this title,
an eligible entity shall prepare and submit to the Secretary an
application that meets the requirements of this section, at such
time, in such manner, and containing such information as the Secretary
may require.
(b) PLAN- An
application submitted under this section shall contain the plan
of the applicant for carrying out a project with amounts received
under this title. Such plan shall be consistent with relevant Federal,
State, or regional health professions program plans.
(c) PERFORMANCE
OUTCOME STANDARDS- An application submitted under this section shall
contain a specification by the applicant entity of performance outcome
standards that the project to be funded under the grant or contract
will be measured against. Such standards shall address relevant
health workforce needs that the project will meet. The recipient
of a grant or contract under this section shall meet the standards
set forth in the grant or contract application.
(d) LINKAGES-
An application submitted under this section shall contain a description
of the linkages with relevant educational and health care entities,
including training programs for other health professionals as appropriate,
that the project to be funded under the grant or contract will establish.
To the extent practicable, grantees under this section shall establish
linkages with health care providers who provide care for underserved
communities and populations.
SEC. 797. USE
OF FUNDS.
(a) IN GENERAL-
Amounts provided under a grant or contract awarded under this title
may be used for training program development and support, faculty
development, model demonstrations, trainee support including tuition,
books, program fees and reasonable living expenses during the period
of training, technical assistance, workforce analysis, dissemination
of information, and exploring new policy directions, as appropriate
to meet recognized health workforce objectives, in accordance with
this title.
(b) MAINTENANCE
OF EFFORT- With respect to activities for which a grant awarded
under this title is to be expended, the entity shall agree to maintain
expenditures of non-Federal amounts for such activities at a level
that is not less than the level of such expenditures maintained
by the entity for the fiscal year preceding the fiscal year for
which the entity receives such a grant.
SEC. 798. MATCHING
REQUIREMENT.
The Secretary
may require that an entity that applies for a grant or contract
under this title provide non-Federal matching funds, as appropriate,
to ensure the institutional commitment of the entity to the projects
funded under the grant. As determined by the Secretary, such non-Federal
matching funds may be provided directly or through donations from
public or private entities and may be in cash or in-kind, fairly
evaluated, including plant, equipment, or services.
SEC. 799. GENERALLY
APPLICABLE PROVISIONS.
(a) AWARDING
OF GRANTS AND CONTRACTS- The Secretary shall ensure that grants
and contracts under this title are awarded on a competitive basis,
as appropriate, to carry out innovative demonstration projects or
provide for strategic workforce supplementation activities as needed
to meet health workforce goals and in accordance with this title.
Contracts may be entered into under this title with public or private
entities as may be necessary.
(b) ELIGIBLE
ENTITIES- Unless specifically required otherwise in this title,
the Secretary shall accept applications for grants or contracts
under this title from health professions schools, academic health
centers, State or local governments, or other appropriate public
or private nonprofit entities for funding and participation in health
professions and nursing training activities. The Secretary may accept
applications from for-profit private entities if determined appropriate
by the Secretary.
(c) INFORMATION
REQUIREMENTS-
(1) IN GENERAL-
Recipients of grants and contracts under this title shall meet information
requirements as specified by the Secretary.
(2) DATA COLLECTION-
The Secretary shall establish procedures to ensure that, with respect
to any data collection required under this title, such data is collected
in a manner that takes into account age, sex, race, and ethnicity.
(3) USE OF
FUNDS- The Secretary shall establish procedures to permit the use
of amounts appropriated under this title to be used for data collection
purposes.
(4) EVALUATIONS-
The Secretary shall establish procedures to ensure the annual evaluation
of programs and projects operated by recipients of grants or contracts
under this title. Such procedures shall ensure that continued funding
for such programs and projects will be conditioned upon a demonstration
that satisfactory progress has been made by the program or project
in meeting the objectives of the program or project.
(d) TRAINING
PROGRAMS- Training programs conducted with amounts received under
this title shall meet applicable accreditation and quality standards.
(e) DURATION
OF ASSISTANCE-
(1) IN GENERAL-
Subject to paragraph (2), in the case of an award to an entity of
a grant, cooperative agreement, or contract under this title, the
period during which payments are made to the entity under the award
may not exceed 5 years. The provision of payments under the award
shall be subject to annual approval by the Secretary of the payments
and subject to the availability of appropriations for the fiscal
year involved to make the payments. This paragraph may not be construed
as limiting the number of awards under the program involved that
may be made to the entity.
(2) LIMITATION-
In the case of an award to an entity of a grant, cooperative agreement,
or contract under this title, paragraph (1) shall apply only to
the extent not inconsistent with any other provision of this title
that relates to the period during which payments may be made under
the award.
(f) PEER REVIEW
REGARDING CERTAIN PROGRAMS-
(1) IN GENERAL-
Each application for a grant under this title, except any scholarship
or loan program, including those under sections 701, 721, or 723,
shall be submitted to a peer review group for an evaluation of the
merits of the proposals made in the application. The Secretary may
not approve such an application unless a peer review group has recommended
the application for approval.
(2) COMPOSITION-
Each peer review group under this subsection shall be composed principally
of individuals who are not officers or employees of the Federal
Government. In providing for the establishment of peer review groups
and procedures, the Secretary shall ensure sex, racial, ethnic,
and geographic balance among the membership of such groups.
(3) ADMINISTRATION-
This subsection shall be carried out by the Secretary acting through
the Administrator of the Health Resources and Services Administration.
(g) PREFERENCE
OR PRIORITY CONSIDERATIONS- In considering a preference or priority
for funding which is based on outcome measures for an eligible entity
under this title, the Secretary may also consider the future ability
of the eligible entity to meet the outcome preference or priority
through improvements in the eligible entity's program design.
(h) ANALYTIC
ACTIVITIES- The Secretary shall ensure that--
(1) cross-cutting
workforce analytical activities are carried out as part of the workforce
information and analysis activities under section 761; and
(2) discipline-specific
workforce information and analytical activities are carried out
as part of--
(A) the community-based
linkage program under part D; and
(B) the health
workforce development program under subpart 2 of part E.
(i) OSTEOPATHIC
SCHOOLS- For purposes of this title, any reference to--
(1) medical
schools shall include osteopathic medical schools; and
(2) medical
students shall include osteopathic medical students.
SEC. 799A. TECHNICAL
ASSISTANCE.
Funds appropriated
under this title may be used by the Secretary to provide technical
assistance in relation to any of the authorities under this title.'.
(b) PROFESSIONAL
COUNSELORS AS MENTAL HEALTH PROFESSIONALS- Section 792(a) of the
Public Health Service Act (42 U.S.C. 295k(a)) is amended by inserting
professional counselors,' after clinical psychologists,'.
SEC. 107. PREFERENCE
IN CERTAIN PROGRAMS.
(a) IN GENERAL-
Section 791 of the Public Health Service Act (42 U.S.C. 295j), as
amended by section 105(a)(2)(B), is further amended by adding at
the end thereof the following subsection:
(c) EXCEPTIONS
FOR NEW PROGRAMS-
(1) IN GENERAL-
To permit new programs to compete equitably for funding under this
section, those new programs that meet at least 4 of the criteria
described in paragraph (3) shall qualify for a funding preference
under this section.
(2) DEFINITION-
As used in this subsection, the term new program' means any program
that has graduated less than three classes. Upon graduating at least
three classes, a program shall have the capability to provide the
information necessary to qualify the program for the general funding
preferences described in subsection (a).
(3) CRITERIA-
The criteria referred to in paragraph (1) are the following:
(A) The mission
statement of the program identifies a specific purpose of the program
as being the preparation of health professionals to serve underserved
populations.
(B) The curriculum
of the program includes content which will help to prepare practitioners
to serve underserved populations.
(C) Substantial
clinical training experience is required under the program in medically
underserved communities.
(D) A minimum
of 20 percent of the clinical faculty of the program spend at least
50 percent of their time providing or supervising care in medically
underserved communities.
(E) The entire
program or a substantial portion of the program is physically located
in a medically underserved community.
(F) Student
assistance, which is linked to service in medically underserved
communities following graduation, is available to the students in
the program.
(G) The program
provides a placement mechanism for deploying graduates to medically
underserved communities.'.
(b) CONFORMING
AMENDMENTS- Section 791(a) of the Public Health Service Act (42
U.S.C. 295j(a)) is amended--
(1) in paragraph
(1), by striking sections 747' and all that follows through 767'
and inserting sections 747 and 750'; and
(2) in paragraph
(2), by striking under section 798(a)'.
SEC. 108. DEFINITIONS.
(a) GRADUATE
PROGRAM IN BEHAVIORAL AND MENTAL HEALTH PRACTICE- Section 799B(1)(D)
of the Public Health Service Act (42 U.S.C. 295p(1)(D)) (as so redesignated
by section 106(a)(2)(E)) is amended--
(1) by inserting
behavioral health and' before mental'; and
(2) by inserting
behavioral health and mental health practice,' before clinical'.
(b) PROFESSIONAL
COUNSELING AS A BEHAVIORAL AND MENTAL HEALTH PRACTICE- Section 799B
of the Public Health Service Act (42 U.S.C. 295p) (as so redesignated
by section 106(a)(2)(E)) is amended--
(1) in paragraph
(1)--
(A) in subparagraph
(C)--
(i) by inserting
and graduate program in professional counseling' after graduate
program in marriage and family therapy'; and
(ii) by inserting
before the period the following: and a concentration leading to
a graduate degree in counseling';
(B) in subparagraph
(D), by inserting professional counseling,' after social work,';
and
(C) in subparagraph
(E), by inserting professional counseling,' after social work,';
and
(2) in paragraph
(5)(C), by inserting before the period the following: or a degree
in counseling or an equivalent degree'.
(c) MEDICALLY
UNDERSERVED COMMUNITY- Section 799B(6) of the Public Health Service
Act (42 U.S.C. 295p(6)) (as so redesignated by section 105(a)(2)(E))
is amended--
(1) in subparagraph
(B), by striking or' at the end thereof;
(2) in subparagraph
(C), by striking the period and inserting ; or'; and
(3) by adding
at the end the following:
(D) is designated
by a State Governor (in consultation with the medical community)
as a shortage area or medically underserved community.'.
(d) PROGRAMS
FOR THE TRAINING OF PHYSICIAN ASSISTANTS- Paragraph (3) of section
799B of the Public Health Service Act (42 U.S.C. 295p) (as so redesignated
by section 105(a)(2)(E)) is amended to read as follows:
(3) The term
program for the training of physician assistants' means an educational
program that--
(A) has as
its objective the education of individuals who will, upon completion
of their studies in the program, be qualified to provide primary
care under the supervision of a physician;
(B) extends
for at least one academic year and consists of--
(i) supervised
clinical practice; and
(ii) at least
four months (in the aggregate) of classroom instruction, directed
toward preparing students to deliver health care;
(C) has an
enrollment of not less than eight students; and
(D) trains
students in primary care, disease prevention, health promotion,
geriatric medicine, and home health care.'.
(e) PSYCHOLOGIST-
Section 799B of the Public Health Service Act (42 U.S.C. 295p) (as
so redesignated by section 105(a)(2)(E)) is amended by adding at
the end the following:
(11) The term
psychologist' means an individual who--
(A) holds a
doctoral degree in psychology; and
(B) is licensed
or certified on the basis of the doctoral degree in psychology,
by the State in which the individual practices, at the independent
practice level of psychology to furnish diagnostic, assessment,
preventive, and therapeutic services directly to individuals.'.
SEC. 109. TECHNICAL
AMENDMENT ON NATIONAL HEALTH SERVICE CORPS.
Section 338B(b)(1)(B)
of the Public Health Service Act (42 U.S.C. 254l-1(b)(1)(B)) is
amended by striking or other health profession' and inserting behavioral
and mental health, or other health profession'.
SEC. 110. SAVINGS
PROVISION.
In the case
of any authority for making awards of grants or contracts that is
terminated by the amendments made by this subtitle, the Secretary
of Health and Human Services may, notwithstanding the termination
of the authority, continue in effect any grant or contract made
under the authority that is in effect on the day before the date
of the enactment of this Act, subject to the duration of any such
grant or contract not exceeding the period determined by the Secretary
in first approving such financial assistance, or in approving the
most recent request made (before the date of such enactment) for
continuation of such assistance, as the case may be.
Subtitle B--Nursing
Workforce Development
SEC. 121. SHORT
TITLE.
This subtitle
may be cited as the Nursing Education and Practice Improvement Act
of 1998'.
SEC. 122. PURPOSE.
It is the purpose
of this subtitle to restructure the nurse education authorities
of title VIII of the Public Health Service Act to permit a comprehensive,
flexible, and effective approach to Federal support for nursing
workforce development.
SEC. 123. AMENDMENTS
TO PUBLIC HEALTH SERVICE ACT.
Title VIII
of the Public Health Service Act (42 U.S.C. 296k et seq.) is amended--
(1) by striking
the title heading and all that follows except for subpart II of
part B and sections 846 and 855; and inserting the following:
TITLE VIII--NURSING
WORKFORCE DEVELOPMENT';
(2) in subpart
II of part B, by striking the subpart heading and inserting the
following:
PART E--STUDENT
LOANS';
(3) by striking
section 837;
(4) by inserting
after the title heading the following new parts:
PART A--GENERAL
PROVISIONS
SEC. 801. DEFINITIONS.
As used in
this title:
(1) ELIGIBLE
ENTITIES- The term eligible entities' means schools of nursing,
nursing centers, academic health centers, State or local governments,
and other public or private nonprofit entities determined appropriate
by the Secretary that submit to the Secretary an application in
accordance with section 802.
(2) SCHOOL
OF NURSING- The term school of nursing' means a collegiate, associate
degree, or diploma school of nursing in a State.
(3) COLLEGIATE
SCHOOL OF NURSING- The term collegiate school of nursing' means
a department, division, or other administrative unit in a college
or university which provides primarily or exclusively a program
of education in professional nursing and related subjects leading
to the degree of bachelor of arts, bachelor of science, bachelor
of nursing, or to an equivalent degree, or to a graduate degree
in nursing, or to an equivalent degree, and including advanced training
related to such program of education provided by such school, but
only if such program, or such unit, college or university is accredited.
(4) ASSOCIATE
DEGREE SCHOOL OF NURSING- The term associate degree school of nursing'
means a department, division, or other administrative unit in a
junior college, community college, college, or university which
provides primarily or exclusively a two-year program of education
in professional nursing and allied subjects leading to an associate
degree in nursing or to an equivalent degree, but only if such program,
or such unit, college, or university is accredited.
(5) DIPLOMA
SCHOOL OF NURSING- The term diploma school of nursing' means a school
affiliated with a hospital or university, or an independent school,
which provides primarily or exclusively a program of education in
professional nursing and allied subjects leading to a diploma or
to equivalent indicia that such program has been satisfactorily
completed, but only if such program, or such affiliated school or
such hospital or university or such independent school is accredited.
(6) ACCREDITED-
(A) IN GENERAL-
Except as provided in subparagraph (B), the term accredited' when
applied to any program of nurse education means a program accredited
by a recognized body or bodies, or by a State agency, approved for
such purpose by the Secretary of Education and when applied to a
hospital, school, college, or university (or a unit thereof) means
a hospital, school, college, or university (or a unit thereof) which
is accredited by a recognized body or bodies, or by a State agency,
approved for such purpose by the Secretary of Education. For the
purpose of this paragraph, the Secretary of Education shall publish
a list of recognized accrediting bodies, and of State agencies,
which the Secretary of Education determines to be reliable authority
as to the quality of education offered.
(B) NEW PROGRAMS-
A new program of nursing that, by reason of an insufficient period
of operation, is not, at the time of the submission of an application
for a grant or contract under this title, eligible for accreditation
by such a recognized body or bodies or State agency, shall be deemed
accredited for purposes of this title if the Secretary of Education
finds, after consultation with the appropriate accreditation body
or bodies, that there is reasonable assurance that the program will
meet the accreditation standards of such body or bodies prior to
the beginning of the academic year following the normal graduation
date of students of the first entering class in such a program.
(7) NONPROFIT-
The term nonprofit' as applied to any school, agency, organization,
or institution means one which is a corporation or association,
or is owned and operated by one or more corporations or associations,
no part of the net earnings of which inures, or may lawfully inure,
to the benefit of any private shareholder or individual.
(8) STATE-
The term State' means a State, the Commonwealth of Puerto Rico,
the District of Columbia, the Commonwealth of the Northern Mariana
Islands, Guam, American Samoa, the Virgin Islands, or the Trust
Territory of the Pacific Islands.
SEC. 802. APPLICATION.
(a) IN GENERAL-
To be eligible to receive a grant or contract under this title,
an eligible entity shall prepare and submit to the Secretary an
application that meets the requirements of this section, at such
time, in such manner, and containing such information as the Secretary
may require.
(b) PLAN- An
application submitted under this section shall contain the plan
of the applicant for carrying out a project with amounts received
under this title. Such plan shall be consistent with relevant Federal,
State, or regional program plans.
(c) PERFORMANCE
OUTCOME STANDARDS- An application submitted under this section shall
contain a specification by the applicant entity of performance outcome
standards that the project to be funded under the grant or contract
will be measured against. Such standards shall address relevant
national nursing needs that the project will meet. The recipient
of a grant or contract under this section shall meet the standards
set forth in the grant or contract application.
(d) LINKAGES-
An application submitted under this section shall contain a description
of the linkages with relevant educational and health care entities,
including training programs for other health professionals as appropriate,
that the project to be funded under the grant or contract will establish.
SEC. 803. USE
OF FUNDS.
(a) IN GENERAL-
Amounts provided under a grant or contract awarded under this title
may be used for training program development and support, faculty
development, model demonstrations, trainee support including tuition,
books, program fees and reasonable living expenses during the period
of training, technical assistance, workforce analysis, and dissemination
of information, as appropriate to meet recognized nursing objectives,
in accordance with this title.
(b) MAINTENANCE
OF EFFORT- With respect to activities for which a grant awarded
under this title is to be expended, the entity shall agree to maintain
expenditures of non-Federal amounts for such activities at a level
that is not less than the level of such expenditures maintained
by the entity for the fiscal year preceding the fiscal year for
which the entity receives such a grant.
SEC. 804. MATCHING
REQUIREMENT.
The Secretary
may require that an entity that applies for a grant or contract
under this title provide non-Federal matching funds, as appropriate,
to ensure the institutional commitment of the entity to the projects
funded under the grant. Such non-Federal matching funds may be provided
directly or through donations from public or private entities and
may be in cash or in-kind, fairly evaluated, including plant, equipment,
or services.
SEC. 805. PREFERENCE.
In awarding
grants or contracts under this title, the Secretary shall give preference
to applicants with projects that will substantially benefit rural
or underserved populations, or help meet public health nursing needs
in State or local health departments.
SEC. 806. GENERALLY
APPLICABLE PROVISIONS.
(a) AWARDING
OF GRANTS AND CONTRACTS- The Secretary shall ensure that grants
and contracts under this title are awarded on a competitive basis,
as appropriate, to carry out innovative demonstration projects or
provide for strategic workforce supplementation activities as needed
to meet national nursing service goals and in accordance with this
title. Contracts may be entered into under this title with public
or private entities as determined necessary by the Secretary.
(b) INFORMATION
REQUIREMENTS-
(1) IN GENERAL-
Recipients of grants and contracts under this title shall meet information
requirements as specified by the Secretary.
(2) EVALUATIONS-
The Secretary shall establish procedures to ensure the annual evaluation
of programs and projects operated by recipients of grants under
this title. Such procedures shall ensure that continued funding
for such programs and projects will be conditioned upon a demonstration
that satisfactory progress has been made by the program or project
in meeting the objectives of the program or project.
(c) TRAINING
PROGRAMS- Training programs conducted with amounts received under
this title shall meet applicable accreditation and quality standards.
(d) DURATION
OF ASSISTANCE-
(1) IN GENERAL-
Subject to paragraph (2), in the case of an award to an entity of
a grant, cooperative agreement, or contract under this title, the
period during which payments are made to the entity under the award
may not exceed 5 years. The provision of payments under the award
shall be subject to annual approval by the Secretary of the payments
and subject to the availability of appropriations for the fiscal
year involved to make the payments. This paragraph may not be construed
as limiting the number of awards under the program involved that
may be made to the entity.
(2) LIMITATION-
In the case of an award to an entity of a grant, cooperative agreement,
or contract under this title, paragraph (1) shall apply only to
the extent not inconsistent with any other provision of this title
that relates to the period during which payments may be made under
the award.
(e) PEER REVIEW
REGARDING CERTAIN PROGRAMS-
(1) IN GENERAL-
Each application for a grant under this title, except advanced nurse
traineeship grants under section 811(a)(2), shall be submitted to
a peer review group for an evaluation of the merits of the proposals
made in the application. The Secretary may not approve such an application
unless a peer review group has recommended the application for approval.
(2) COMPOSITION-
Each peer review group under this subsection shall be composed principally
of individuals who are not officers or employees of the Federal
Government. In providing for the establishment of peer review groups
and procedures, the Secretary shall, except as otherwise provided,
ensure sex, racial, ethnic, and geographic representation among
the membership of such groups.
(3) ADMINISTRATION-
This subsection shall be carried out by the Secretary acting through
the Administrator of the Health Resources and Services Administration.
(f) ANALYTIC
ACTIVITIES- The Secretary shall ensure that--
(1) cross-cutting
workforce analytical activities are carried out as part of the workforce
information and analysis activities under this title; and
(2) discipline-specific
workforce information is developed and analytical activities are
carried out as part of--
(A) the advanced
education nursing activities under part B;
(B) the workforce
diversity activities under part C; and
(C) basic nursing
education and practice activities under part D.
(g) STATE AND
REGIONAL PRIORITIES- Activities under grants or contracts under
this title shall, to the extent practicable, be consistent with
related Federal, State, or regional nursing professions program
plans and priorities.
(h) FILING
OF APPLICATIONS-
(1) IN GENERAL-
Applications for grants or contracts under this title may be submitted
by health professions schools, schools of nursing, academic health
centers, State or local governments, or other appropriate public
or private nonprofit entities as determined appropriate by the Secretary
in accordance with this title.
(2) FOR-PROFIT
ENTITIES- Notwithstanding paragraph (1), a for-profit entity may
be eligible for a grant or contract under this title as determined
appropriate by the Secretary.
SEC. 807. TECHNICAL
ASSISTANCE.
Funds appropriated
under this title may be used by the Secretary to provide technical
assistance in relation to any of the authorities under this title.
PART B--NURSE
PRACTITIONERS, NURSE MIDWIVES, NURSE ANESTHETISTS, AND OTHER ADVANCED
EDUCATION NURSES
SEC. 811. ADVANCED
EDUCATION NURSING GRANTS.
(a) IN GENERAL-
The Secretary may award grants to and enter into contracts with
eligible entities to meet the costs of--
(1) projects
that support the enhancement of advanced nursing education and practice;
and
(2) traineeships
for individuals in advanced nursing education programs.
(b) DEFINITION
OF ADVANCED EDUCATION NURSES- For purposes of this section, the
term advanced education nurses' means individuals trained in advanced
degree programs including individuals in combined R.N./Master's
degree programs, post-nursing master's certificate programs, or,
in the case of nurse midwives, in certificate programs in existence
on the date that is one day prior to the date of enactment of this
section, to serve as nurse practitioners, clinical nurse specialists,
nurse midwives, nurse anesthetists, nurse educators, nurse administrators,
or public health nurses, or in other nurse specialties determined
by the Secretary to require advanced education.
(c) AUTHORIZED
NURSE PRACTITIONER AND NURSE MIDWIFERY PROGRAMS- Nurse practitioner
and nurse midwifery programs eligible for support under this section
are educational programs for registered nurses (irrespective of
the type of school of nursing in which the nurses received their
training) that--
(1) meet guidelines
prescribed by the Secretary; and
(2) have as
their objective the education of nurses who will upon completion
of their studies in such programs, be qualified to effectively provide
primary health care, including primary health care in homes and
in ambulatory care facilities, long-term care facilities, acute
care, and other health care settings.
(d) AUTHORIZED
NURSE ANESTHESIA PROGRAMS- Nurse anesthesia programs eligible for
support under this section are education programs that--
(1) provide
registered nurses with full-time anesthetist education; and
(2) are accredited
by the Council on Accreditation of Nurse Anesthesia Educational
Programs.
(e) OTHER AUTHORIZED
EDUCATIONAL PROGRAMS- The Secretary shall prescribe guidelines as
appropriate for other advanced nurse education programs eligible
for support under this section.
(f) TRAINEESHIPS-
(1) IN GENERAL-
The Secretary may not award a grant to an applicant under subsection
(a) unless the applicant involved agrees that traineeships provided
with the grant will only pay all or part of the costs of--
(A) the tuition,
books, and fees of the program of advanced nurse education with
respect to which the traineeship is provided; and
(B) the reasonable
living expenses of the individual during the period for which the
traineeship is provided.
(2) DOCTORAL
PROGRAMS- The Secretary may not obligate more than 10 percent of
the traineeships under subsection (a) for individuals in doctorate
degree programs.
(3) SPECIAL
CONSIDERATION- In making awards of grants and contracts under subsection
(a)(2), the Secretary shall give special consideration to an eligible
entity that agrees to expend the award to train advanced education
nurses who will practice in health professional shortage areas designated
under section 332.
PART C--INCREASING
NURSING WORKFORCE DIVERSITY
SEC. 821. WORKFORCE
DIVERSITY GRANTS.
(a) IN GENERAL-
The Secretary may award grants to and enter into contracts with
eligible entities to meet the costs of special projects to increase
nursing education opportunities for individuals who are from disadvantaged
backgrounds (including racial and ethnic minorities underrepresented
among registered nurses) by providing student scholarships or stipends,
pre-entry preparation, and retention activities.
(b) GUIDANCE-
In carrying out subsection (a), the Secretary shall take into consideration
the recommendations of the First, Second and Third Invitational
Congresses for Minority Nurse Leaders on Caring for the Emerging
Majority,' in 1992, 1993 and 1997, and consult with nursing associations
including the American Nurses Association, the National League for
Nursing, the American Association of Colleges of Nursing, the National
Black Nurses Association, the National Association of Hispanic Nurses,
the Association of Asian American and Pacific Islander Nurses, the
Native American Indian and Alaskan Nurses Association, and the National
Council of State Boards of Nursing.
(c) REQUIRED
INFORMATION AND CONDITIONS FOR AWARD RECIPIENTS-
(1) IN GENERAL-
Recipients of awards under this section may be required, where requested,
to report to the Secretary concerning the annual admission, retention,
and graduation rates for individuals from disadvantaged backgrounds
and ethnic and racial minorities in the school or schools involved
in the projects.
(2) FALLING
RATES- If any of the rates reported under paragraph (1) fall below
the average of the two previous years, the grant or contract recipient
shall provide the Secretary with plans for immediately improving
such rates.
(3) INELIGIBILITY-
A recipient described in paragraph (2) shall be ineligible for continued
funding under this section if the plan of the recipient fails to
improve the rates within the 1-year period beginning on the date
such plan is implemented.
PART D--STRENGTHENING
CAPACITY FOR BASIC NURSE EDUCATION AND PRACTICE
SEC. 831. BASIC
NURSE EDUCATION AND PRACTICE GRANTS.
(a) IN GENERAL-
The Secretary may award grants to and enter into contracts with
eligible entities for projects to strengthen capacity for basic
nurse education and practice.
(b) PRIORITY
AREAS- In awarding grants or contracts under this section the Secretary
shall give priority to entities that will use amounts provided under
such a grant or contract to enhance the educational mix and utilization
of the basic nursing workforce by strengthening programs that provide
basic nurse education, such as through--
(1) establishing
or expanding nursing practice arrangements in noninstitutional settings
to demonstrate methods to improve access to primary health care
in medically underserved communities;
(2) providing
care for underserved populations and other high-risk groups such
as the elderly, individuals with HIV-AIDS, substance abusers, the
homeless, and victims of domestic violence;
(3) providing
managed care, quality improvement, and other skills needed to practice
in existing and emerging organized health care systems;
(4) developing
cultural competencies among nurses;
(5) expanding
the enrollment in baccalaureate nursing programs;
(6) promoting
career mobility for nursing personnel in a variety of training settings
and cross training or specialty training among diverse population
groups;
(7) providing
education in informatics, including distance learning methodologies;
or
(8) other priority
areas as determined by the Secretary.';
(5) by adding
at the end the following:
PART F--FUNDING
SEC. 841. FUNDING.
(a) AUTHORIZATION
OF APPROPRIATIONS- For the purpose of carrying out parts B, C, and
D (subject to section 845(g)), there are authorized to be appropriated
$65,000,000 for fiscal year 1998, and such sums as may be necessary
for each of the fiscal years 1999 through 2002.
(b) ALLOCATIONS
FOR FISCAL YEARS 1998 THROUGH 2002-
(1) NURSE PRACTITIONERS;
NURSE MIDWIVES-
(A) FISCAL
YEAR 1998- Of the amount appropriated under subsection (a) for fiscal
year 1998, the Secretary shall reserve not less than $17,564,000
for making awards of grants and contracts under section 822 as such
section was in effect for fiscal year 1998.
(B) FISCAL
YEARS 1999 THROUGH 2002- Of the amount appropriated under subsection
(a) for fiscal year 1999 or any of the fiscal years 2000 through
2002, the Secretary, subject to subsection (d), shall reserve for
the fiscal year involved, for making awards of grants and contracts
under part B with respect to nurse practitioners and nurse midwives,
not less than the percentage constituted by the ratio of the amount
appropriated under section 822 as such section was in effect for
fiscal year 1998 to the total of the amounts appropriated under
this title for such fiscal year. For purposes of the preceding sentence,
the Secretary, in determining the amount that has been reserved
for the fiscal year involved, shall include any amounts appropriated
under subsection (a) for the fiscal year that are obligated by the
Secretary to continue in effect grants or contracts under section
822 as such section was in effect for fiscal year 1998.
(2) NURSE ANESTHETISTS-
(A) FISCAL
YEAR 1998- Of the amount appropriated under subsection (a) for fiscal
year 1998, the Secretary shall reserve not less than $2,761,000
for making awards of grants and contracts under section 831 as such
section was in effect for fiscal year 1998.
(B) FISCAL
YEARS 1999 THROUGH 2002- Of the amount appropriated under subsection
(a) for fiscal year 1999 or any of the fiscal years 2000 through
2002, the Secretary, subject to subsection (d), shall reserve for
the fiscal year involved, for making awards of grants and contracts
under part B with respect to nurse anesthetists, not less than the
percentage constituted by the ratio of the amount appropriated under
section 831 as such section was in effect for fiscal year 1998 to
the total of the amounts appropriated under this title for such
fiscal year. For purposes of the preceding sentence, the Secretary,
in determining the amount that has been reserved for the fiscal
year involved, shall include any amounts appropriated under subsection
(a) for the fiscal year that are obligated by the Secretary to continue
in effect grants or contracts under section 831 as such section
was in effect for fiscal year 1998.
(c) ALLOCATIONS
AFTER FISCAL YEAR 2002-
(1) IN GENERAL-
For fiscal year 2003 and subsequent fiscal years, amounts appropriated
under subsection (a) for the fiscal year involved shall be allocated
by the Secretary among parts B, C, and D (and programs within such
parts) according to a methodology that is developed in accordance
with paragraph (2). The Secretary shall enter into a contract with
a public or private entity for the purpose of developing the methodology.
The contract shall require that the development of the methodology
be completed not later than February 1, 2002.
(2) USE OF
CERTAIN FACTORS- The contract under paragraph (1) shall provide
that the methodology under such paragraph will be developed in accordance
with the following:
(A) The methodology
will take into account the need for and the distribution of health
services among medically underserved populations, as determined
according to the factors that apply under section 330(b)(3).
(B) The methodology
will take into account the need for and the distribution of health
services in health professional shortage areas, as determined according
to the factors that apply under section 332(b).
(C) The methodology
will take into account the need for and the distribution of mental
health services among medically underserved populations and in health
professional shortage areas.
(D) The methodology
will be developed in consultation with individuals in the field
of nursing, including registered nurses, nurse practitioners, nurse
midwives, nurse anesthetists, clinical nurse specialists, nursing
educators and educational institutions, nurse executives, pediatric
nurse associates and practitioners, and women's health, obstetric,
and neonatal nurses.
(E) The methodology
will take into account the following factors with respect to the
States:
(i) A provider
population ratio equivalent to a managed care formula of 1/1,500
for primary care services.
(ii) The use
of whole rather than fractional counts in determining the number
of health care providers.
(iii) The counting
of only employed health care providers in determining the number
of health care providers.
(iv) The number
of families whose income is less than 200 percent of the official
poverty line (as established by the Director of the Office of Management
and Budget and revised by the Secretary in accordance with section
673(2) of the Omnibus Budget Reconciliation Act of 1981).
(v) The rate
of infant mortality and the rate of low-birthweight births.
(vi) The percentage
of the general population constituted by individuals who are members
of racial or ethnic minority groups, stated both by minority group
and in the aggregate.
(vii) The percentage
of the general population constituted by individuals who are of
Hispanic ethnicity.
(viii) The
number of individuals residing in health professional shortage areas,
and the number of individuals who are members of medically underserved
populations.
(ix) The percentage
of the general population constituted by elderly individuals.
(x) The extent
to which the populations served have a choice of providers.
(xi) The impact
of care on hospitalizations and emergency room use.
(xii) The number
of individuals who lack proficiency in speaking the English language.
(xiii) Such
additional factors as the Secretary determines to be appropriate.
(3) REPORT
TO CONGRESS- Not later than 30 days after the completion of the
development of the methodology required in paragraph (1), the Secretary
shall submit to the Committee on Commerce of the House of Representatives,
and to the Committee on Labor and Human Resources of the Senate,
a report describing the methodology and explaining the effects of
the methodology on the allocation among parts B, C, and D (and programs
within such parts) of amounts appropriated under subsection (a)
for the first fiscal year for which the methodology will be in effect.
Such explanation shall include a comparison of the allocation for
such fiscal year with the allocation made under this section for
the preceding fiscal year.
(d) USE OF
METHODOLOGY BEFORE FISCAL YEAR 2003- With respect to the fiscal
years 1999 through 2002, if the report required in subsection (c)(3)
is submitted in accordance with such subsection not later than 90
days before the beginning of such a fiscal year, the Secretary may
for such year implement the methodology described in the report
(rather than implementing the methodology in fiscal year 2003),
in which case subsection (b) ceases to be in effect. The authority
under the preceding sentence is subject to the condition that the
fiscal year for which the methodology is implemented be the same
fiscal year identified in such report as the fiscal year for which
the methodology will first be in effect.
(e) AUTHORITY
FOR USE OF ADDITIONAL FACTORS IN METHODOLOGY-
(1) IN GENERAL-
The Secretary shall make the determinations specified in paragraph
(2). For any fiscal year beginning after the first fiscal year for
which the methodology under subsection (c)(1) is in effect, the
Secretary may alter the methodology by including the information
from such determinations as factors in the methodology.
(2) RELEVANT
DETERMINATIONS- The determinations referred to in paragraph (1)
are as follows:
(A) The need
for and the distribution of health services among populations for
which it is difficult to determine the number of individuals who
are in the population, such as homeless individuals; migratory and
seasonal agricultural workers and their families; individuals infected
with the human immunodeficiency virus, and individuals who abuse
drugs.
(B) In the
case of a population for which the determinations under subparagraph
(A) are made, the extent to which the population includes individuals
who are members of racial or ethnic minority groups and a specification
of the skills needed to provide health services to such individuals
in the language and the educational and cultural context that is
most appropriate to the individuals.
(C) Data, obtained
from the Director of the Centers for Disease Control and Prevention,
on rates of morbidity and mortality among various populations (including
data on the rates of maternal and infant mortality and data on the
rates of low-birthweight births of living infants).
(D) Data from
the Health Plan Employer Data and Information Set, as appropriate.
PART G--NATIONAL
ADVISORY COUNCIL ON NURSE EDUCATION AND PRACTICE
SEC. 845. NATIONAL
ADVISORY COUNCIL ON NURSE EDUCATION AND PRACTICE.
(a) ESTABLISHMENT-
The Secretary shall establish an advisory council to be known as
the National Advisory Council on Nurse Education and Practice (in
this section referred to as the Advisory Council').
(b) COMPOSITION-
(1) IN GENERAL-
The Advisory Council shall be composed of--
(A) not less
than 21, nor more than 23 individuals, who are not officers or employees
of the Federal Government, appointed by the Secretary without regard
to the Federal civil service laws, of which--
(i) 2 shall
be selected from full-time students enrolled in schools of nursing;
(ii) 2 shall
be selected from the general public;
(iii) 2 shall
be selected from practicing professional nurses; and
(iv) 9 shall
be selected from among the leading authorities in the various fields
of nursing, higher, secondary education, and associate degree schools
of nursing, and from representatives of advanced education nursing
groups (such as nurse practitioners, nurse midwives, and nurse anesthetists),
hospitals, and other institutions and organizations which provide
nursing services; and
(B) the Secretary
(or the delegate of the Secretary (who shall be an ex officio member
and shall serve as the Chairperson)).
(2) APPOINTMENT-
Not later than 90 days after the date of enactment of this Act,
the Secretary shall appoint the members of the Advisory Council
and each such member shall serve a 4 year term. In making such appointments,
the Secretary shall ensure a fair balance between the nursing professions,
a broad geographic representation of members and a balance between
urban and rural members. Members shall be appointed based on their
competence, interest, and knowledge of the mission of the profession
involved. A majority of the members shall be nurses.
(3) MINORITY
REPRESENTATION- In appointing the members of the Advisory Council
under paragraph (1), the Secretary shall ensure the adequate representation
of minorities.
(c) VACANCIES-
(1) IN GENERAL-
A vacancy on the Advisory Council shall be filled in the manner
in which the original appointment was made and shall be subject
to any conditions which applied with respect to the original appointment.
(2) FILLING
UNEXPIRED TERM- An individual chosen to fill a vacancy shall be
appointed for the unexpired term of the member replaced.
(d) DUTIES-
The Advisory Council shall--
(1) provide
advice and recommendations to the Secretary and Congress concerning
policy matters arising in the administration of this title, including
the range of issues relating to the nurse workforce, education,
and practice improvement;
(2) provide
advice to the Secretary and Congress in the preparation of general
regulations and with respect to policy matters arising in the administration
of this title, including the range of issues relating to nurse supply,
education and practice improvement; and
(3) not later
than 3 years after the date of enactment of this section, and annually
thereafter, prepare and submit to the Secretary, the Committee on
Labor and Human Resources of the Senate, and the Committee on Commerce
of the House of Representatives, a report describing the activities
of the Council, including findings and recommendations made by the
Council concerning the activities under this title.
(e) MEETINGS
AND DOCUMENTS-
(1) MEETINGS-
The Advisory Council shall meet not less than 2 times each year.
Such meetings shall be held jointly with other related entities
established under this title where appropriate.
(2) DOCUMENTS-
Not later than 14 days prior to the convening of a meeting under
paragraph (1), the Advisory Council shall prepare and make available
an agenda of the matters to be considered by the Advisory Council
at such meeting. At any such meeting, the Advisory Council shall
distribute materials with respect to the issues to be addressed
at the meeting. Not later than 30 days after the adjourning of such
a meeting, the Advisory Council shall prepare and make available
a summary of the meeting and any actions taken by the Council based
upon the meeting.
(f) COMPENSATION
AND EXPENSES-
(1) COMPENSATION-
Each member of the Advisory Council shall be compensated at a rate
equal to the daily equivalent of the annual rate of basic pay prescribed
for level IV of the Executive Schedule under section 5315 of title
5, United States Code, for each day (including travel time) during
which such member is engaged in the performance of the duties of
the Council. All members of the Council who are officers or employees
of the United States shall serve without compensation in addition
to that received for their services as officers or employees of
the United States.
(2) EXPENSES-
The members of the Advisory Council shall be allowed travel expenses,
including per diem in lieu of subsistence, at rates authorized for
employees of agencies under subchapter I of chapter 57 of title
5, United States Code, while away from their homes or regular places
of business in the performance of services for the Council.
(g) FUNDING-
Amounts appropriated under this title may be utilized by the Secretary
to support the nurse education and practice activities of the Council.
(h) FACA- The
Federal Advisory Committee Act shall apply to the Advisory Committee
under this section only to the extent that the provisions of such
Act do not conflict with the requirements of this section.'; and
(6) by redesignating
section 855 as section 810, and transferring such section so as
to appear after section 809 (as added by the amendment made by paragraph
(5)).
SEC. 124. SAVINGS
PROVISION.
In the case
of any authority for making awards of grants or contracts that is
terminated by the amendment made by section 123, the Secretary of
Health and Human Services may, notwithstanding the termination of
the authority, continue in effect any grant or contract made under
the authority that is in effect on the day before the date of the
enactment of this Act, subject to the duration of any such grant
or contract not exceeding the period determined by the Secretary
in first approving such financial assistance, or in approving the
most recent request made (before the date of such enactment) for
continuation of such assistance, as the case may be.
Subtitle C--Financial
Assistance
CHAPTER 1--SCHOOL-BASED
REVOLVING LOAN FUNDS
SEC. 131. PRIMARY
CARE LOAN PROGRAM.
(a) REQUIREMENT
FOR SCHOOLS- Section 723(b)(1) of the Public Health Service Act
(42 U.S.C. 292s(b)(1)), as amended by section 2014(c)(2)(A)(ii)
of Public Law 103-43 (107 Stat. 216), is amended by striking 3 years
before' and inserting 4 years before'.
(b) NONCOMPLIANCE-
Section 723(a)(3) of the Public Health Service Act (42 U.S.C. 292s(a)(3))
is amended to read as follows:
(3) NONCOMPLIANCE
BY STUDENT- Each agreement entered into with a student pursuant
to paragraph (1) shall provide that, if the student fails to comply
with such agreement, the loan involved will begin to accrue interest
at a rate of 18 percent per year beginning on the date of such noncompliance.'.
(c) REPORT
REQUIREMENT- Section 723 of the Public Health Service Act (42 U.S.C.
292s) is amended--
(1) by striking
subsection (c); and
(2) by redesignating
subsection (d) as subsection (c).
SEC. 132. LOANS
FOR DISADVANTAGED STUDENTS.
(a) AUTHORIZATION
OF APPROPRIATIONS- Section 724(f)(1) of the Public Health Service
Act (42 U.S.C. 292t(f)(1)) is amended by striking $15,000,000 for
fiscal year 1993' and inserting $8,000,000 for each of the fiscal
years 1998 through 2002'.
(b) REPEAL-
Effective October 1, 2002, paragraph (1) of section 724(f) of the
Public Health Service Act (42 U.S.C. 292t(f)(1)) is repealed.
SEC. 133. STUDENT
LOANS REGARDING SCHOOLS OF NURSING.
(a) IN GENERAL-
Section 836(b) of the Public Health Service Act (42 U.S.C. 297b(b))
is amended--
(1) in paragraph
(1), by striking the period at the end and inserting a semicolon;
(2) in paragraph
(2)--
(A) in subparagraph
(A), by striking and' at the end; and
(B) by inserting
before the semicolon at the end the following: , and (C) such additional
periods under the terms of paragraph (8) of this subsection';
(3) in paragraph
(7), by striking the period at the end and inserting ; and'; and
(4) by adding
at the end the following paragraph:
(8) pursuant
to uniform criteria established by the Secretary, the repayment
period established under paragraph (2) for any student borrower
who during the repayment period failed to make consecutive payments
and who, during the last 12 months of the repayment period, has
made at least 12 consecutive payments may be extended for a period
not to exceed 10 years.'.
(b) MINIMUM
MONTHLY PAYMENTS- Section 836(g) of the Public Health Service Act
(42 U.S.C. 297b(g)) is amended by striking $15' and inserting $40'.
(c) ELIMINATION
OF STATUTE OF LIMITATION FOR LOAN COLLECTIONS-
(1) IN GENERAL-
Section 836 of the Public Health Service Act (42 U.S.C. 297b) is
amended by adding at the end the following new subsection:
(l) ELIMINATION
OF STATUTE OF LIMITATION FOR LOAN COLLECTIONS-
(1) PURPOSE-
It is the purpose of this subsection to ensure that obligations
to repay loans under this section are enforced without regard to
any Federal or State statutory, regulatory, or administrative limitation
on the period within which debts may be enforced.
(2) PROHIBITION-
Notwithstanding any other provision of Federal or State law, no
limitation shall terminate the period within which suit may be filed,
a judgment may be enforced, or an offset, garnishment, or other
action may be initiated or taken by a school of nursing that has
an agreement with the Secretary pursuant to section 835 that is
seeking the repayment of the amount due from a borrower on a loan
made under this subpart after the default of the borrower on such
loan.'.
(2) EFFECTIVE
DATE- The amendment made by paragraph (1) shall be effective with
respect to actions pending on or after the date of enactment of
this Act.
(d) BREACH
OF AGREEMENTS- Section 846 of the Public Health Service Act (42
U.S.C. 297n) is amended by adding at the end thereof the following
new subsection:
(h) BREACH
OF AGREEMENT-
(1) IN GENERAL-
In the case of any program under this section under which an individual
makes an agreement to provide health services for a period of time
in accordance with such program in consideration of receiving an
award of Federal funds regarding education as a nurse (including
an award for the repayment of loans), the following applies if the
agreement provides that this subsection is applicable:
(A) In the
case of a program under this section that makes an award of Federal
funds for attending an accredited program of nursing (in this section
referred to as a nursing program'), the individual is liable to
the Federal Government for the amount of such award (including amounts
provided for expenses related to such attendance), and for interest
on such amount at the maximum legal prevailing rate, if the individual--
(i) fails to
maintain an acceptable level of academic standing in the nursing
program (as indicated by the program in accordance with requirements
established by the Secretary);
(ii) is dismissed
from the nursing program for disciplinary reasons; or
(iii) voluntarily
terminates the nursing program.
(B) The individual
is liable to the Federal Government for the amount of such award
(including amounts provided for expenses related to such attendance),
and for interest on such amount at the maximum legal prevailing
rate, if the individual fails to provide health services in accordance
with the program under this section for the period of time applicable
under the program.
(2) WAIVER
OR SUSPENSION OF LIABILITY- In the case of an individual or health
facility making an agreement for purposes of paragraph (1), the
Secretary shall provide for the waiver or suspension of liability
under such subsection if compliance by the individual or the health
facility, as the case may be, with the agreements involved is impossible,
or would involve extreme hardship to the individual or facility,
and if enforcement of the agreements with respect to the individual
or facility would be unconscionable.
(3) DATE CERTAIN
FOR RECOVERY- Subject to paragraph (2), any amount that the Federal
Government is entitled to recover under paragraph (1) shall be paid
to the United States not later than the expiration of the 3-year
period beginning on the date the United States becomes so entitled.
(4) AVAILABILITY-
Amounts recovered under paragraph (1) with respect to a program
under this section shall be available for the purposes of such program,
and shall remain available for such purposes until expended.'.
(e) TECHNICAL
AMENDMENTS- Section 839 of the Public Health Service Act (42 U.S.C.
297e) is amended--
(1) in subsection
(a)--
(A) by striking
the matter preceding paragraph (1) and inserting the following:
(a) If a school
terminates a loan fund established under an agreement pursuant to
section 835(b), or if the Secretary for good cause terminates the
agreement with the school, there shall be a capital distribution
as follows:'; and
(B) in paragraph
(1), by striking at the close of September 30, 1999,' and inserting
on the date of termination of the fund'; and
(2) in subsection
(b), to read as follows:
(b) If a capital
distribution is made under subsection (a), the school involved shall,
after such capital distribution, pay to the Secretary, not less
often than quarterly, the same proportionate share of amounts received
by the school in payment of principal or interest on loans made
from the loan fund established under section 835(b) as determined
by the Secretary under subsection (a).'.
SEC. 134. GENERAL
PROVISIONS.
(a) MAXIMUM
STUDENT LOAN PROVISIONS AND MINIMUM PAYMENTS-
(1) IN GENERAL-
Section 722(a)(1) of the Public Health Service Act (42 U.S.C. 292r(a)(1)),
as amended by section 2014(b)(1) of Public Law 103-43, is amended
by striking the sum of' and all that follows through the end thereof
and inserting the cost of attendance (including tuition, other reasonable
educational expenses, and reasonable living costs) for that year
at the educational institution attended by the student (as determined
by such educational institution).'.
(2) THIRD AND
FOURTH YEARS- Section 722(a)(2) of the Public Health Service Act
(42 U.S.C. 292r(a)(2)), as amended by section 2014(b)(1) of Public
Law 103-43, is amended by striking the amount $2,500' and all that
follows through including such $2,500)' and inserting the amount
of the loan may, in the case of the third or fourth year of a student
at a school of medicine or osteopathic medicine, be increased to
the extent necessary'.
(3) REPAYMENT
PERIOD- Section 722(c) of the Public Health Service Act (42 U.S.C.
292r(c)), as amended by section 2014(b)(1) of Public Law 103-43,
is amended--
(A) in the
subsection heading by striking TEN-YEAR' and inserting REPAYMENT';
(B) by striking
ten-year period which begins' and inserting period of not less than
10 years nor more than 25 years, at the discretion of the institution,
which begins'; and
(C) by striking
such ten-year period' and inserting such period'.
(4) MINIMUM
PAYMENTS- Section 722(j) of the Public Health Service Act (42 U.S.C.
292r(j)), as amended by section 2014(b)(1) of Public Law 103-43,
is amended by striking $15' and inserting $40'.
(b) ELIMINATION
OF STATUTE OF LIMITATION FOR LOAN COLLECTIONS-
(1) IN GENERAL-
Section 722 of the Public Health Service Act (42 U.S.C. 292r), as
amended by section 2014(b)(1) of Public Law 103-43, is amended by
adding at the end the following new subsection:
(m) ELIMINATION
OF STATUTE OF LIMITATION FOR LOAN COLLECTIONS-
(1) PURPOSE-
It is the purpose of this subsection to ensure that obligations
to repay loans under this section are enforced without regard to
any Federal or State statutory, regulatory, or administrative limitation
on the period within which debts may be enforced.
(2) PROHIBITION-
Notwithstanding any other provision of Federal or State law, no
limitation shall terminate the period within which suit may be filed,
a judgment may be enforced, or an offset, garnishment, or other
action may be initiated or taken by a school that has an agreement
with the Secretary pursuant to section 721 that is seeking the repayment
of the amount due from a borrower on a loan made under this subpart
after the default of the borrower on such loan.'.
(2) EFFECTIVE
DATE- The amendment made by paragraph (1) shall be effective with
respect to actions pending on or after the date of enactment of
this Act.
(c) DATE CERTAIN
FOR CONTRIBUTIONS- Paragraph (2) of section 735(e) of the Public
Health Service Act (42 U.S.C. 292y(e)(2)) is amended to read as
follows:
(2) DATE CERTAIN
FOR CONTRIBUTIONS- Amounts described in paragraph (1) that are returned
to the Secretary shall be obligated before the end of the succeeding
fiscal year.'.
CHAPTER 2--INSURED
HEALTH EDUCATION ASSISTANCE LOANS TO GRADUATE STUDENTS
SEC. 141. HEALTH
EDUCATION ASSISTANCE LOAN PROGRAM.
(a) HEALTH
EDUCATION ASSISTANCE LOAN DEFERMENT FOR BORROWERS PROVIDING HEALTH
SERVICES TO INDIANS-
(1) IN GENERAL-
Section 705(a)(2)(C) of the Public Health Service Act (42 U.S.C.
292d(a)(2)(C)) is amended by striking and (x)' and inserting (x)
not in excess of three years, during which the borrower is providing
health care services to Indians through an Indian health program
(as defined in section 108(a)(2)(A) of the Indian Health Care Improvement
Act (25 U.S.C. 1616a(a)(2)(A)); and (xi)'.
(2) CONFORMING
AMENDMENTS- Section 705(a)(2)(C) of the Public Health Service Act
(42 U.S.C. 292d(a)(2)(C)) is further amended--
(A) in clause
(xi) (as so redesignated) by striking (ix)' and inserting (x)';
and
(B) in the
matter following such clause (xi), by striking (x)' and inserting
(xi)'.
(3) EFFECTIVE
DATE- The amendments made by this subsection shall apply with respect
to services provided on or after the first day of the third month
that begins after the date of the enactment of this Act.
(b) REPORT
REQUIREMENT- Section 709(b) of the Public Health Service Act (42
U.S.C. 292h(b)) is amended--
(1) in paragraph
(4)(B), by adding and' after the semicolon;
(2) in paragraph
(5), by striking ; and' and inserting a period; and
(3) by striking
paragraph (6).
(c) PROGRAM
ELIGIBILITY-
(1) LIMITATIONS
ON LOANS- Section 703(a) of the Public Health Service Act (42 U.S.C.
292b(a)) is amended by striking or clinical psychology' and inserting
or behavioral and mental health practice, including clinical psychology'.
(2) DEFINITION
OF ELIGIBLE INSTITUTION- Section 719(1) of the Public Health Service
Act (42 U.S.C. 292o(1)) is amended by striking or clinical psychology'
and inserting or behavioral and mental health practice, including
clinical psychology'.
SEC. 142. HEAL
LENDER AND HOLDER PERFORMANCE STANDARDS.
(a) GENERAL
AMENDMENTS- Section 707(a) of the Public Health Service Act (42
U.S.C. 292f) is amended--
(1) by striking
the last sentence;
(2) by striking
determined.' and inserting determined, except that, if the insurance
beneficiary including any servicer of the loan is not designated
for exceptional performance', as set forth in paragraph (2), the
Secretary shall pay to the beneficiary a sum equal to 98 percent
of the amount of the loss sustained by the insured upon that loan.';
(3) by striking
Upon' and inserting:
(1) IN GENERAL-
Upon'; and
(4) by adding
at the end the following new paragraph:
(2) EXCEPTIONAL
PERFORMANCE-
(A) AUTHORITY-
Where the Secretary determines that an eligible lender, holder,
or servicer has a compliance performance rating that equals or exceeds
97 percent, the Secretary shall designate that eligible lender,
holder, or servicer, as the case may be, for exceptional performance.
(B) COMPLIANCE
PERFORMANCE RATING- For purposes of subparagraph (A), a compliance
performance rating is determined with respect to compliance with
due diligence in the disbursement, servicing, and collection of
loans under this subpart for each year for which the determination
is made. Such rating shall be equal to the percentage of all due
diligence requirements applicable to each loan, on average, as established
by the Secretary, with respect to loans serviced during the period
by the eligible lender, holder, or servicer.
(C) ANNUAL
AUDITS FOR LENDERS, HOLDERS, AND SERVICERS- Each eligible lender,
holder, or servicer desiring a designation under subparagraph (A)
shall have an annual financial and compliance audit conducted with
respect to the loan portfolio of such eligible lender, holder, or
servicer, by a qualified independent organization from a list of
qualified organizations identified by the Secretary and in accordance
with standards established by the Secretary. The standards shall
measure the lender's, holder's, or servicer's compliance with due
diligence standards and shall include a defined statistical sampling
technique designed to measure the performance rating of the eligible
lender, holder, or servicer for the purpose of this section. Each
eligible lender, holder, or servicer shall submit the audit required
by this section to the Secretary.
(D) SECRETARY'S
DETERMINATIONS- The Secretary shall make the determination under
subparagraph (A) based upon the audits submitted under this paragraph
and any information in the possession of the Secretary or submitted
by any other agency or office of the Federal Government.
(E) QUARTERLY
COMPLIANCE AUDIT- To maintain its status as an exceptional performer,
the lender, holder, or servicer shall undergo a quarterly compliance
audit at the end of each quarter (other than the quarter in which
status as an exceptional performer is established through a financial
and compliance audit, as described in subparagraph (C)), and submit
the results of such audit to the Secretary. The compliance audit
shall review compliance with due diligence requirements for the
period beginning on the day after the ending date of the previous
audit, in accordance with standards determined by the Secretary.
(F) REVOCATION
AUTHORITY- The Secretary shall revoke the designation of a lender,
holder, or servicer under subparagraph (A) if any quarterly audit
required under subparagraph (E) is not received by the Secretary
by the date established by the Secretary or if the audit indicates
the lender, holder, or servicer has failed to meet the standards
for designation as an exceptional performer under subparagraph (A).
A lender, holder, or servicer receiving a compliance audit not meeting
the standard for designation as an exceptional performer may reapply
for designation under subparagraph (A) at any time.
(G) DOCUMENTATION-
Nothing in this section shall restrict or limit the authority of
the Secretary to require the submission of claims documentation
evidencing servicing performed on loans, except that the Secretary
may not require exceptional performers to submit greater documentation
than that required for lenders, holders, and servicers not designated
under subparagraph (A).
(H) COST OF
AUDITS- Each eligible lender, holder, or servicer shall pay for
all the costs associated with the audits required under this section.
(I) ADDITIONAL
REVOCATION AUTHORITY- Notwithstanding any other provision of this
section, a designation under subparagraph (A) may be revoked at
any time by the Secretary if the Secretary determines that the eligible
lender, holder, or servicer has failed to maintain an overall level
of compliance consistent with the audit submitted by the eligible
lender, holder, or servicer under this paragraph or if the Secretary
asserts that the lender, holder, or servicer may have engaged in
fraud in securing designation under subparagraph (A) or is failing
to service loans in accordance with program requirements.
(J) NONCOMPLIANCE-
A lender, holder, or servicer designated under subparagraph (A)
that fails to service loans or otherwise comply with applicable
program regulations shall be considered in violation of the Federal
False Claims Act.'.
(b) DEFINITION-
Section 707(e) of the Public Health Service Act (42 U.S.C. 292f(e))
is amended by adding at the end the following new paragraph:
(4) The term
servicer' means any agency acting on behalf of the insurance beneficiary.'.
(c) EFFECTIVE
DATE- The amendments made by subsections (a) and (b) shall apply
with respect to loans submitted to the Secretary for payment on
or after the first day of the sixth month that begins after the
date of enactment of this Act.
SEC. 143. INSURANCE
PROGRAM.
Section 710(a)(2)(B)
of the Public Health Service Act (42 U.S.C. 292i(a)(2)(B)) is amended
by striking any of the fiscal years 1993 through 1996' and inserting
fiscal year 1993 and subsequent fiscal years'.
SEC. 144. HEAL
BANKRUPTCY.
(a) IN GENERAL-
Section 707(g) of the Public Health Service Act (42 U.S.C. 292f(g))
is amended in the first sentence by striking A debt which is a loan
insured' and inserting Notwithstanding any other provision of Federal
or State law, a debt that is a loan insured'.
(b) APPLICATION-
The amendment made by subsection (a) shall apply to any loan insured
under the authority of subpart I of part A of title VII of the Public
Health Service Act (42 U.S.C. 292 et seq.) that is listed or scheduled
by the debtor in a case under title XI, United States Code, filed--
(1) on or after
the date of enactment of this Act; or
(2) prior to
such date of enactment in which a discharge has not been granted.
SEC. 145. HEAL
REFINANCING.
Section 706
of the Public Health Service Act (42 U.S.C. 292e) is amended--
(1) in subsection
(d)--
(A) in the
subsection heading, by striking CONSOLIDATION' and inserting REFINANCING
OR CONSOLIDATION'; and
(B) in the
first sentence, by striking indebtedness' and inserting indebtedness
or the refinancing of a single loan'; and
(2) in subsection
(e)--
(A) in the
subsection heading, by striking DEBTS' and inserting DEBTS AND REFINANCING';
(B) in the
first sentence, by striking all of the borrower's debts into a single
instrument' and inserting all of the borrower's loans insured under
this subpart into a single instrument (or, if the borrower obtained
only 1 loan insured under this subpart, refinancing the loan 1 time)';
and
(C) in the
second sentence, by striking consolidation' and inserting consolidation
or refinancing'.
TITLE II--OFFICE
OF MINORITY HEALTH
SEC. 201. REVISION
AND EXTENSION OF PROGRAMS OF OFFICE OF MINORITY HEALTH.
(a) DUTIES
AND REQUIREMENTS- Section 1707 of the Public Health Service Act
(42 U.S.C. 300u-6) is amended by striking subsection (b) and all
that follows and inserting the following:
(b) DUTIES-
With respect to improving the health of racial and ethnic minority
groups, the Secretary, acting through the Deputy Assistant Secretary
for Minority Health (in this section referred to as the Deputy Assistant
Secretary'), shall carry out the following:
(1) Establish
short-range and long-range goals and objectives and coordinate all
other activities within the Public Health Service that relate to
disease prevention, health promotion, service delivery, and research
concerning such individuals. The heads of each of the agencies of
the Service shall consult with the Deputy Assistant Secretary to
ensure the coordination of such activities.
(2) Enter into
interagency agreements with other agencies of the Public Health
Service.
(3) Support
research, demonstrations and evaluations to test new and innovative
models.
(4) Increase
knowledge and understanding of health risk factors.
(5) Develop
mechanisms that support better information dissemination, education,
prevention, and service delivery to individuals from disadvantaged
backgrounds, including individuals who are members of racial or
ethnic minority groups.
(6) Ensure
that the National Center for Health Statistics collects data on
the health status of each minority group.
(7) With respect
to individuals who lack proficiency in speaking the English language,
enter into contracts with public and nonprofit private providers
of primary health services for the purpose of increasing the access
of the individuals to such services by developing and carrying out
programs to provide bilingual or interpretive services.
(8) Support
a national minority health resource center to carry out the following:
(A) Facilitate
the exchange of information regarding matters relating to health
information and health promotion, preventive health services, and
education in the appropriate use of health care.
(B) Facilitate
access to such information.
(C) Assist
in the analysis of issues and problems relating to such matters.
(D) Provide
technical assistance with respect to the exchange of such information
(including facilitating the development of materials for such technical
assistance).
(9) Carry out
programs to improve access to health care services for individuals
with limited proficiency in speaking the English language. Activities
under the preceding sentence shall include developing and evaluating
model projects.
(c) ADVISORY
COMMITTEE-
(1) IN GENERAL-
The Secretary shall establish an advisory committee to be known
as the Advisory Committee on Minority Health (in this subsection
referred to as the Committee').
(2) DUTIES-
The Committee shall provide advice to the Deputy Assistant Secretary
carrying out this section, including advice on the development of
goals and specific program activities under paragraphs (1) through
(9) of subsection (b) for each racial and ethnic minority group.
(3) CHAIR-
The chairperson of the Committee shall be selected by the Secretary
from among the members of the voting members of the Committee. The
term of office of the chairperson shall be 2 years.
(4) Composition-
(A) The Committee
shall be composed of 12 voting members appointed in accordance with
subparagraph (B), and nonvoting, ex officio members designated in
subparagraph (C).
(B) The voting
members of the Committee shall be appointed by the Secretary from
among individuals who are not officers or employees of the Federal
Government and who have expertise regarding issues of minority health.
The racial and ethnic minority groups shall be equally represented
among such members.
(C) The nonvoting,
ex officio members of the Committee shall be such officials of the
Department of Health and Human Services as the Secretary determines
to be appropriate.
(5) TERMS-
Each member of the Committee shall serve for a term of 4 years,
except that the Secretary shall initially appoint a portion of the
members to terms of 1 year, 2 years, and 3 years.
(6) VACANCIES-
If a vacancy occurs on the Committee, a new member shall be appointed
by the Secretary within 90 days from the date that the vacancy occurs,
and serve for the remainder of the term for which the predecessor
of such member was appointed. The vacancy shall not affect the power
of the remaining members to execute the duties of the Committee.
(7) COMPENSATION-
Members of the Committee who are officers or employees of the United
States shall serve without compensation. Members of the Committee
who are not officers or employees of the United States shall receive
compensation, for each day (including travel time) they are engaged
in the performance of the functions of the Committee. Such compensation
may not be in an amount in excess of the daily equivalent of the
annual maximum rate of basic pay payable under the General Schedule
(under title 5, United States Code) for positions above GS-15.
(d) CERTAIN
REQUIREMENTS REGARDING DUTIES-
(1) RECOMMENDATIONS
REGARDING LANGUAGE AS IMPEDIMENT TO HEALTH CARE- The Deputy Assistant
Secretary for Minority Health shall consult with the Director of
the Office of International and Refugee Health, the Director of
the Office of Civil Rights, and the Directors of other appropriate
departmental entities regarding recommendations for carrying out
activities under subsection (b)(9).
(2) EQUITABLE
ALLOCATION REGARDING ACTIVITIES- In carrying out subsection (b),
the Secretary shall ensure that services provided under such subsection
are equitably allocated among all groups served under this section
by the Secretary.
(3) CULTURAL
COMPETENCY OF SERVICES- The Secretary shall ensure that information
and services provided pursuant to subsection (b) are provided in
the language, educational, and cultural context that is most appropriate
for the individuals for whom the information and services are intended.
(e) GRANTS
AND CONTRACTS REGARDING DUTIES-
(1) IN GENERAL-
In carrying out subsection (b), the Secretary acting through the
Deputy Assistant Secretary may make awards of grants, cooperative
agreements, and contracts to public and nonprofit private entities.
(2) PROCESS
FOR MAKING AWARDS- The Deputy Assistant Secretary shall ensure that
awards under paragraph (1) are made, to the extent practical, only
on a competitive basis, and that a grant is awarded for a proposal
only if the proposal has been recommended for such an award through
a process of peer review.
(3) EVALUATION
AND DISSEMINATION- The Deputy Assistant Secretary, directly or through
contracts with public and private entities, shall provide for evaluations
of projects carried out with awards made under paragraph (1) during
the preceding 2 fiscal years. The report shall be included in the
report required under subsection (f) for the fiscal year involved.
(f) REPORTS-
(1) IN GENERAL-
Not later than February 1 of fiscal year 1999 and of each second
year thereafter, the Secretary shall submit to the Committee on
Energy and Commerce of the House of Representatives, and to the
Committee on Labor and Human Resources of the Senate, a report describing
the activities carried out under this section during the preceding
2 fiscal years and evaluating the extent to which such activities
have been effective in improving the health of racial and ethnic
minority groups. Each such report shall include the biennial reports
submitted under sections 201(e)(3) and 201(f)(2) for such years
by the heads of the Public Health Service agencies.
(2) AGENCY
REPORTS- Not later than February 1, 1999, and biennially thereafter,
the heads of the Public Health Service agencies shall submit to
the Deputy Assistant Secretary a report summarizing the minority
health activities of each of the respective agencies.
(g) DEFINITION-
For purposes of this section:
(1) The term
racial and ethnic minority group' means American Indians (including
Alaska Natives, Eskimos, and Aleuts); Asian Americans and Pacific
Islanders; Blacks; and Hispanics.
(2) The term
Hispanic' means individuals whose origin is Mexican, Puerto Rican,
Cuban, Central or South American, or any other Spanish-speaking
country.
(h) FUNDING-
(1) AUTHORIZATION
OF APPROPRIATIONS- For the purpose of carrying out this section,
there are authorized to be appropriated $30,000,000 for fiscal year
1998, and such sums as may be necessary for each of the fiscal years
1999 through 2002.'.
(b) AUTHORIZATION
FOR NATIONAL CENTER FOR HEALTH STATISTICS- Section 306 of the Public
Health Service Act (42 U.S.C. 242k) is amended--
(1) in subsection
(m), by adding at the end the following:
(4)(A) Subject
to subparagraph (B), the Secretary, acting through the Center, shall
collect data on Hispanics and major Hispanic subpopulation groups
and American Indians, and for developing special area population
studies on major Asian American and Pacific Islander populations.
(B) The provisions
of subparagraph (A) shall be effective with respect to a fiscal
year only to the extent that funds are appropriated pursuant to
paragraph (3) of subsection (n), and only if the amounts appropriated
for such fiscal year pursuant to each of paragraphs (1) and (2)
of subsection (n) equal or exceed the amounts so appropriated for
fiscal year 1997.';
(2) in subsection
(n)(1), by striking through 1998' and inserting through 2003'; and
(3) in subsection
(n)--
(A) in the
first sentence of paragraph (2)--
(i) by striking
authorized in subsection (m)' and inserting authorized in paragraphs
(1) through (3) of subsection (m)'; and
(ii) by striking
$5,000,000' and all that follows through the period and inserting
such sums as may be necessary for each of the fiscal years 1999
through 2003.'; and
(B) by adding
at the end the following:
(3) For activities
authorized in subsection (m)(4), there are authorized to be appropriated
$1,000,000 for fiscal year 1998, and such sums as may be necessary
for each of the fiscal years 1999 through 2002.'.
(c) MISCELLANEOUS
AMENDMENTS- Section 1707 of the Public Health Service Act (42 U.S.C.
300u-6) is amended--
(1) in the
heading for the section by striking ESTABLISHMENT OF'; and
(2) in subsection
(a), by striking Office of the Assistant Secretary for Health' and
inserting Office of Public Health and Science'.
TITLE III--SELECTED
INITIATIVES
SEC. 301. STATE
OFFICES OF RURAL HEALTH.
Section 338J
of the Public Health Service Act (42 U.S.C. 254r) is amended--
(1) in subsection
(b)(1), in the matter preceding subparagraph (A), by striking in
cash'; and
(2) in subsection
(j)(1)--
(A) by striking
and' after 1992,'; and
(B) by inserting
before the period the following: , and such sums as may be necessary
for each of the fiscal years 1998 through 2002'; and
(3) in subsection
(k), by striking $10,000,000' and inserting $36,000,000'.
SEC. 302. DEMONSTRATION
PROJECTS REGARDING ALZHEIMER'S DISEASE.
(a) IN GENERAL-
Section 398(a) of the Public Health Service Act (42 U.S.C. 280c-3(a))
is amended--
(1) in the
matter preceding paragraph (1), by striking not less than 5, and
not more than 15,';
(2) in paragraph
(2)--
(A) by inserting
after disorders' the following: who are living in single family
homes or in congregate settings'; and
(B) by striking
and' at the end;
(3) by redesignating
paragraph (3) as paragraph (4); and
(4) by inserting
after paragraph (2) the following:
(3) to improve
the access of such individuals to home-based or community-based
long-term care services (subject to the services being provided
by entities that were providing such services in the State involved
as of October 1, 1995), particularly such individuals who are members
of racial or ethnic minority groups, who have limited proficiency
in speaking the English language, or who live in rural areas; and'.
(b) DURATION-
Section 398A of the Public Health Service Act (42 U.S.C. 280c-4)
is amended--
(1) in the
heading for the section, by striking LIMITATION' and all that follows
and inserting REQUIREMENT OF MATCHING FUNDS';
(2) by striking
subsection (a);
(3) by redesignating
subsections (b) and (c) as subsections (a) and (b), respectively;
and
(4) in subsection
(a) (as so redesignated), in each of paragraphs (1)(C) and (2)(C),
by striking third year' and inserting third or subsequent year'.
(c) AUTHORIZATION
OF APPROPRIATIONS- Section 398B(e) of the Public Health Service
Act (42 U.S.C. 280c-5(e)) is amended--
(1) by striking
and such sums' and inserting such sums'; and
(2) by inserting
before the period the following: , $8,000,000 for fiscal year 1998,
and such sums as may be necessary for each of the fiscal years 1999
through 2002'.
SEC. 303. PROJECT
GRANTS FOR IMMUNIZATION SERVICES.
Section 317(j)
of the Public Health Service Act (42 U.S.C. 247b(j)) is amended--
(1) in paragraph
(1), by striking individuals against vaccine-preventable diseases'
and all that follows through the first period and inserting the
following: children, adolescents, and adults against vaccine-preventable
diseases, there are authorized to be appropriated such sums as may
be necessary for each of the fiscal years 1998 through 2002.'; and
(2) in paragraph
(2), by striking 1990' and inserting 1997'.
TITLE IV--MISCELLANEOUS
PROVISIONS
SEC. 401. TECHNICAL
CORRECTIONS REGARDING PUBLIC LAW 103-183.
(a) AMENDATORY
INSTRUCTIONS- Public Law 103-183 is amended--
(1) in section
601--
(A) in subsection
(b), in the matter preceding paragraph (1), by striking Section
1201 of the Public Health Service Act (42 U.S.C. 300d)' and inserting
Title XII of the Public Health Service Act (42 U.S.C. 300d et seq.)';
and
(B) in subsection
(f)(1), by striking in section 1204(c)' and inserting in section
1203(c) (as redesignated by subsection (b)(2) of this section)';
(2) in section
602, by striking for the purpose' and inserting For the purpose';
and
(3) in section
705(b), by striking 317D((l)(1)' and inserting 317D(l)(1)'.
(b) PUBLIC
HEALTH SERVICE ACT- The Public Health Service Act, as amended by
Public Law 103-183 and by subsection (a) of this section, is amended--
(1) in section
317E(g)(2), by striking making grants under subsection (b)' and
inserting carrying out subsection (b)';
(2) in section
318, in subsection (e) as in effect on the day before the date of
the enactment of Public Law 103-183, by redesignating the subsection
as subsection (f);
(3) in subpart
6 of part C of title IV--
(A) by transferring
the first section 447 (added by section 302 of Public Law 103-183)
from the current placement of the section;
(B) by redesignating
the section as section 447A; and
(C) by inserting
the section after section 447;
(4) in section
1213(a)(8), by striking provides for for' and inserting provides
for';
(5) in section
1501, by redesignating the second subsection (c) (added by section
101(f) of Public Law 103-183) as subsection (d); and
(6) in section
1505(3), by striking nonprofit'.
(c) MISCELLANEOUS
CORRECTION- Section 401(c)(3) of Public Law 103-183 is amended in
the matter preceding subparagraph (A) by striking (d)(5)' and inserting
(e)(5)'.
(d) CONFORMING
AMENDMENT- Section 308(b) of the Public Health Service Act (42 U.S.C.
242m(b)) is amended--
(1) in paragraph
(2)(A), by striking 306(n)' and inserting 306(m)'; and
(2) in paragraph
(2)(C), by striking 306(n)' and inserting 306(m)'.
(e) EFFECTIVE
DATE- This section is deemed to have taken effect immediately after
the enactment of Public Law 103-183.
SEC. 402. MISCELLANEOUS
AMENDMENTS REGARDING PHS COMMISSIONED OFFICERS.
(a) ANTI-DISCRIMINATION
LAWS- Amend section 212 of the Public Health Service Act (42 U.S.C.
213) by adding the following new subsection at the end thereof:
(f) Active
service of commissioned officers of the Service shall be deemed
to be active military service in the Armed Forces of the United
States for purposes of all laws related to discrimination on the
basis of race, color, sex, ethnicity, age, religion, and disability.'.
(b) TRAINING
IN LEAVE WITHOUT PAY STATUS- Section 218 of the Public Health Service
Act (42 U.S.C. 218a) is amended by adding at the end the following:
(c) A commissioned
officer may be placed in leave without pay status while attending
an educational institution or training program whenever the Secretary
determines that such status is in the best interest of the Service.
For purposes of computation of basic pay, promotion, retirement,
compensation for injury or death, and the benefits provided by sections
212 and 224, an officer in such status pursuant to the preceding
sentence shall be considered as performing service in the Service
and shall have an active service obligation as set forth in subsection
(b) of this section.'.
(c) UTILIZATION
OF ALCOHOL AND DRUG ABUSE RECORDS THAT APPLY TO THE ARMED FORCES-
Section 543(e) of the Public Health Service Act (42 U.S.C. 290dd-2(e))
is amended by striking Armed Forces' each place that such term appears
and inserting Uniformed Services'.
SEC. 403. CLINICAL
TRAINEESHIPS.
Section 303(d)(1)
of the Public Health Service Act (42 U.S.C. 242a(d)(1)) is amended
by inserting counseling,' after family therapy,'.
SEC. 404. PROJECT
GRANTS FOR SCREENINGS, REFERRALS, AND EDUCATION REGARDING LEAD POISONING.
Section 317A(l)(1)
of the Public Health Service Act (42 U.S.C. 247b-1(l)(1)) is amended
by striking 1998' and inserting 2002'.
SEC. 405. PROJECT
GRANTS FOR PREVENTIVE HEALTH SERVICES REGARDING TUBERCULOSIS.
Section 317E(g)
of the Public Health Service Act (42 U.S.C. 247b-6(g)(1)) is amended--
(1) in paragraph
(1)--
(A) in subparagraph
(A), by striking 1998' and inserting 2002'; and
(B) in subparagraph
(B), by striking $50,000,000' and inserting 25 percent'; and
(2) in paragraph
(2), by striking 1998' and inserting 2002'.
SEC. 406. CDC
LOAN REPAYMENT PROGRAM.
Section 317F
of the Public Health Service Act (42 U.S.C. 247b-7) is amended--
(1) in subsection
(a)(1), by striking $20,000' and inserting $35,000';
(2) in subsection
(c), by striking 1998' and inserting 2002'; and
(3) by adding
at the end the following:
(d) AVAILABILITY
OF APPROPRIATIONS- Amounts appropriated for a fiscal year for contracts
under subsection (a) shall remain available until the expiration
of the second fiscal year beginning after the fiscal year for which
the amounts were appropriated.'.
SEC. 407. COMMUNITY
PROGRAMS ON DOMESTIC VIOLENCE.
(a) IN GENERAL-
Section 318(h)(2) of the Family Violence Prevention and Services
Act (42 U.S.C. 10418(h)(2)) is amended by striking fiscal year 1997'
and inserting for each of the fiscal years 1997 through 2002'.
(b) STUDY-
The Secretary of Health and Human Services shall request that the
Institute of Medicine conduct a study concerning the training needs
of health professionals with respect to the detection and referral
of victims of family or acquaintance violence. Not later than 2
years after the date of enactment of this Act, the Institute of
Medicine shall prepare and submit to Congress a report concerning
the study conducted under this subsection.
SEC. 408. STATE
LOAN REPAYMENT PROGRAM.
Section 338I(i)(1)
of the Public Health Service Act (42 U.S.C. 254q-1(i)(1)) is amended
by inserting before the period , and such sums as may be necessary
for each of the fiscal years 1998 through 2002'.
SEC. 409. AUTHORITY
OF THE DIRECTOR OF NIH.
Section 402(b)
of the Public Health Service Act (42 U.S.C. 282(b)) is amended--
(1) in paragraph
(11), by striking and' at the end thereof;
(2) in paragraph
(12), by striking the period and inserting a semicolon; and
(3) by adding
after paragraph (12), the following new paragraphs:
(13) may conduct
and support research training--
(A) for which
fellowship support is not provided under section 487; and
(B) which does
not consist of residency training of physicians or other health
professionals; and
(14) may appoint
physicians, dentists, and other health care professionals, subject
to the provisions of title 5, United States Code, relating to appointments
and classifications in the competitive service, and may compensate
such professionals subject to the provisions of chapter 74 of title
38, United States Code.'.
SEC. 410. RAISE
IN MAXIMUM LEVEL OF LOAN REPAYMENTS.
(a) REPAYMENT
PROGRAMS WITH RESPECT TO AIDS- Section 487A of the Public Health
Service Act (42 U.S.C. 288-1) is amended--
(1) in subsection
(a), by striking $20,000' and inserting $35,000'; and
(2) in subsection
(c), by striking 1996' and inserting 2001'.
(b) REPAYMENT
PROGRAMS WITH RESPECT TO CONTRACEPTION AND INFERTILITY- Section
487B(a) of the Public Health Service Act (42 U.S.C. 288-2(a)) is
amended by striking $20,000' and inserting $35,000'.
(c) REPAYMENT
PROGRAMS WITH RESPECT TO RESEARCH GENERALLY- Section 487C(a)(1)
of the Public Health Service Act (42 U.S.C. 288-3(a)(1)) is amended
by striking $20,000' and inserting $35,000'.
(d) REPAYMENT
PROGRAMS WITH RESPECT TO CLINICAL RESEARCHERS FROM DISADVANTAGED
BACKGROUNDS- Section 487E(a) of the Public Health Service Act (42
U.S.C. 288-5(a)) is amended--
(1) in paragraph
(1), by striking $20,000' and inserting $35,000'; and
(2) in paragraph
(3), by striking 338C' and inserting 338B, 338C'.
SEC. 411. CONSTRUCTION
OF REGIONAL CENTERS FOR RESEARCH ON PRIMATES.
Section 481B(a)
of the Public Health Service Act (42 U.S.C. 287a-3(a)) is amended--
(1) by striking
shall' and inserting may'; and
(2) by striking
$5,000,000' and inserting up to $2,500,000'.
SEC. 412. PEER
REVIEW.
Section 504(d)(2)
of the Public Health Service Act (42 U.S.C. 290aa-3(d)(2)) is amended
by striking cooperative agreement, or contract' each place that
such term appears and inserting or cooperative agreement'.
SEC. 413. FUNDING
FOR TRAUMA CARE.
Section 1232(a)
of the Public Health Service Act (42 U.S.C. 300d-32) is amended
by striking and 1996' and inserting through 2002'.
SEC. 414. HEALTH
INFORMATION AND HEALTH PROMOTION.
Section 1701(b)
of the Public Health Service Act (42 U.S.C. 300u(b)) is amended
by striking through 1996' and inserting through 2002'.
SEC. 415. EMERGENCY
MEDICAL SERVICES FOR CHILDREN.
Section 1910
of the Public Health Service Act (42 U.S.C. 300w-9) is amended--
(1) in subsection
(a)--
(A) by striking
two-year period' and inserting 3-year period (with an optional 4th
year based on performance)'; and
(B) by striking
one grant' and inserting 3 grants'; and
(2) in subsection
(d), by striking 1997' and inserting 2005'.
SEC. 416. ADMINISTRATION
OF CERTAIN REQUIREMENTS.
(a) IN GENERAL-
Section 2004 of Public Law 103-43 (107 Stat. 209) is amended by
striking subsection (a).
(b) CONFORMING
AMENDMENTS- Section 2004 of Public Law 103-43, as amended by subsection
(a) of this section, is amended--
(1) by striking
(b) SENSE' and all that follows through In the case' and inserting
the following:
(a) SENSE OF
CONGRESS REGARDING PURCHASE OF AMERICAN-MADE EQUIPMENT AND PRODUCTS-
In the case';
(2) by striking
(2) NOTICE TO RECIPIENTS OF ASSISTANCE' and inserting the following:
(b) NOTICE
TO RECIPIENTS OF ASSISTANCE'; and
(3) in subsection
(b), as redesignated by paragraph (2) of this subsection, by striking
paragraph (1)' and inserting subsection (a)'.
(c) EFFECTIVE
DATE- This section is deemed to have taken effect immediately after
the enactment of Public Law 103-43.
SEC. 417. AIDS
DRUG ASSISTANCE PROGRAM.
Section 2618(b)(3)
of the Public Health Service Act (42 U.S.C. 300ff-28(b)(3)) is amended--
(1) in subparagraph
(A), by striking and the Commonwealth of Puerto Rico' and inserting
, the Commonwealth of Puerto Rico, the Virgin Islands, and Guam';
and
(2) in subparagraph
(B), by striking the Virgin Islands, Guam'.
SEC. 418. NATIONAL
FOUNDATION FOR BIOMEDICAL RESEARCH.
Part I of title
IV of the Public Health Service Act (42 U.S.C. 290b et seq.) is
amended--
(1) by striking
the part heading and inserting the following:
PART I--FOUNDATION
FOR THE NATIONAL INSTITUTES OF HEALTH';
and
(2) in section
499--
(A) in subsection
(a), by striking National Foundation for Biomedical Research' and
inserting Foundation for the National Institutes of Health';
(B) in subsection
(k)(10)--
(i) by striking
not'; and
(ii) by adding
at the end the following: Any funds transferred under this paragraph
shall be subject to all Federal limitations relating to federally-funded
research.'; and
(C) in subsection
(m)(1), by striking $200,000' and all that follows through 1995'
and inserting $500,000 for each fiscal year'.
SEC. 419. FETAL
ALCOHOL SYNDROME PREVENTION AND SERVICES.
(a) SHORT TITLE-
This section may be cited as the Fetal Alcohol Syndrome and Fetal
Alcohol Effect Prevention and Services Act'.
(b) FINDINGS-
Congress finds that--
(1) Fetal Alcohol
Syndrome is the leading preventable cause of mental retardation,
and it is 100 percent preventable;
(2) estimates
on the number of children each year vary, but according to some
researchers, up to 12,000 infants are born in the United States
with Fetal Alcohol Syndrome, suffering irreversible physical and
mental damage;
(3) thousands
more infants are born each year with Fetal Alcohol Effect, also
known as Alcohol Related Neurobehavioral Disorder (ARND), a related
and equally tragic syndrome;
(4) children
of women who use alcohol while pregnant have a significantly higher
infant mortality rate (13.3 per 1,000) than children of those women
who do not use alcohol (8.6 per 1,000);
(5) Fetal Alcohol
Syndrome and Fetal Alcohol Effect are national problems which can
impact any child, family, or community, but their threat to American
Indians and Alaska Natives is especially alarming;
(6) in some
American Indian communities, where alcohol dependency rates reach
50 percent and above, the chances of a newborn suffering Fetal Alcohol
Syndrome or Fetal Alcohol Effect are up to 30 times greater than
national averages;
(7) in addition
to the immeasurable toll on children and their families, Fetal Alcohol
Syndrome and Fetal Alcohol Effect pose extraordinary financial costs
to the Nation, including the costs of health care, education, foster
care, job training, and general support services for affected individuals;
(8) the total
cost to the economy of Fetal Alcohol Syndrome was approximately
$2,500,000,000 in 1995, and over a lifetime, health care costs for
one Fetal Alcohol Syndrome child are estimated to be at least $1,400,000;
(9) researchers
have determined that the possibility of giving birth to a baby with
Fetal Alcohol Syndrome or Fetal Alcohol Effect increases in proportion
to the amount and frequency of alcohol consumed by a pregnant woman,
and that stopping alcohol consumption at any point in the pregnancy
reduces the emotional, physical, and mental consequences of alcohol
exposure to the baby; and
(10) though
approximately 1 out of every 5 pregnant women drink alcohol during
their pregnancy, we know of no safe dose of alcohol during pregnancy,
or of any safe time to drink during pregnancy, thus, it is in the
best interest of the Nation for the Federal Government to take an
active role in encouraging all women to abstain from alcohol consumption
during pregnancy.
(c) PURPOSE-
It is the purpose of this section to establish, within the Department
of Health and Human Services, a comprehensive program to help prevent
Fetal Alcohol Syndrome and Fetal Alcohol Effect nationwide and to
provide effective intervention programs and services for children,
adolescents and adults already affected by these conditions. Such
program shall--
(1) coordinate,
support, and conduct national, State, and community-based public
awareness, prevention, and education programs on Fetal Alcohol Syndrome
and Fetal Alcohol Effect;
(2) coordinate,
support, and conduct prevention and intervention studies as well
as epidemiologic research concerning Fetal Alcohol Syndrome and
Fetal Alcohol Effect;
(3) coordinate,
support and conduct research and demonstration projects to develop
effective developmental and behavioral interventions and programs
that foster effective advocacy, educational and vocational training,
appropriate therapies, counseling, medical and mental health, and
other supportive services, as well as models that integrate or coordinate
such services, aimed at the unique challenges facing individuals
with Fetal Alcohol Syndrome or Fetal Alcohol Effect and their families;
and
(4) foster
coordination among all Federal, State and local agencies, and promote
partnerships between research institutions and communities that
conduct or support Fetal Alcohol Syndrome and Fetal Alcohol Effect
research, programs, surveillance, prevention, and interventions
and otherwise meet the general needs of populations already affected
or at risk of being impacted by Fetal Alcohol Syndrome and Fetal
Alcohol Effect.
(d) ESTABLISHMENT
OF PROGRAM- Title III of the Public Health Service Act (42 U.S.C.
241 et seq.) is amended by adding at the end the following:
PART O--FETAL
ALCOHOL SYNDROME PREVENTION AND SERVICES PROGRAM
SEC. 399G.
ESTABLISHMENT OF FETAL ALCOHOL SYNDROME PREVENTION AND SERVICES
PROGRAM.
(a) FETAL ALCOHOL
SYNDROME PREVENTION, INTERVENTION AND SERVICES DELIVERY PROGRAM-
The Secretary shall establish a comprehensive Fetal Alcohol Syndrome
and Fetal Alcohol Effect prevention, intervention and services delivery
program that shall include--
(1) an education
and public awareness program to support, conduct, and evaluate the
effectiveness of--
(A) educational
programs targeting medical schools, social and other supportive
services, educators and counselors and other service providers in
all phases of childhood development, and other relevant service
providers, concerning the prevention, identification, and provision
of services for children, adolescents and adults with Fetal Alcohol
Syndrome and Fetal Alcohol Effect;
(B) strategies
to educate school-age children, including pregnant and high risk
youth, concerning Fetal Alcohol Syndrome and Fetal Alcohol Effect;
(C) public
and community awareness programs concerning Fetal Alcohol Syndrome
and Fetal Alcohol Effect; and
(D) strategies
to coordinate information and services across affected community
agencies, including agencies providing social services such as foster
care, adoption, and social work, medical and mental health services,
and agencies involved in education, vocational training and civil
and criminal justice;
(2) a prevention
and diagnosis program to support clinical studies, demonstrations
and other research as appropriate to--
(A) develop
appropriate medical diagnostic methods for identifying Fetal Alcohol
Syndrome and Fetal Alcohol Effect; and
(B) develop
effective prevention services and interventions for pregnant, alcohol-dependent
women; and
(3) an applied
research program concerning intervention and prevention to support
and conduct service demonstration projects, clinical studies and
other research models providing advocacy, educational and vocational
training, counseling, medical and mental health, and other supportive
services, as well as models that integrate and coordinate such services,
that are aimed at the unique challenges facing individuals with
Fetal Alcohol Syndrome or Fetal Alcohol Effect and their families.
(b) GRANTS
AND TECHNICAL ASSISTANCE- The Secretary may award grants, cooperative
agreements and contracts and provide technical assistance to eligible
entities described in section 399H to carry out subsection (a).
(c) DISSEMINATION
OF CRITERIA- In carrying out this section, the Secretary shall develop
a procedure for disseminating the Fetal Alcohol Syndrome and Fetal
Alcohol Effect diagnostic criteria developed pursuant to section
705 of the ADAMHA Reorganization Act (42 U.S.C. 485n note) to health
care providers, educators, social workers, child welfare workers,
and other individuals.
(d) NATIONAL
TASK FORCE-
(1) IN GENERAL-
The Secretary shall establish a task force to be known as the National
Task Force on Fetal Alcohol Syndrome and Fetal Alcohol Effect (referred
to in this subsection as the Task Force') to foster coordination
among all governmental agencies, academic bodies and community groups
that conduct or support Fetal Alcohol Syndrome and Fetal Alcohol
Effect research, programs, and surveillance, and otherwise meet
the general needs of populations actually or potentially impacted
by Fetal Alcohol Syndrome and Fetal Alcohol Effect.
(2) MEMBERSHIP-
The Task Force established pursuant to paragraph (1) shall--
(A) be chaired
by an individual to be appointed by the Secretary and staffed by
the Administration; and
(B) include
the Chairperson of the Interagency Coordinating Committee on Fetal
Alcohol Syndrome of the Department of Health and Human Services,
individuals with Fetal Alcohol Syndrome and Fetal Alcohol Effect,
and representatives from advocacy and research organizations such
as the Research Society on Alcoholism, the FAS Family Resource Institute,
the National Organization of Fetal Alcohol Syndrome, the Arc, the
academic community, and Federal, State and local government agencies
and offices.
(3) FUNCTIONS-
The Task Force shall--
(A) advise
Federal, State and local programs and research concerning Fetal
Alcohol Syndrome and Fetal Alcohol Effect, including programs and
research concerning education and public awareness for relevant
service providers, school-age children, women at-risk, and the general
public, medical diagnosis, interventions for women at-risk of giving
birth to children with Fetal Alcohol Syndrome and Fetal Alcohol
Effect, and beneficial services for individuals with Fetal Alcohol
Syndrome and Fetal Alcohol Effect and their families;
(B) coordinate
its efforts with the Interagency Coordinating Committee on Fetal
Alcohol Syndrome of the Department of Health and Human Services;
and
(C) report
on a biennial basis to the Secretary and relevant committees of
Congress on the current and planned activities of the participating
agencies.
(4) TIME FOR
APPOINTMENT- The members of the Task Force shall be appointed by
the Secretary not later than 6 months after the date of enactment
of this part.
SEC. 399H. ELIGIBILITY.
To be eligible
to receive a grant, or enter into a cooperative agreement or contract
under this part, an entity shall--
(1) be a State,
Indian tribal government, local government, scientific or academic
institution, or nonprofit organization; and
(2) prepare
and submit to the Secretary an application at such time, in such
manner, and containing such information as the Secretary may prescribe,
including a description of the activities that the entity intends
to carry out using amounts received under this part.
SEC. 399I. AUTHORIZATION
OF APPROPRIATIONS.
(a) IN GENERAL-
There are authorized to be appropriated to carry out this part,
$27,000,000 for each of the fiscal years 1999 through 2003.
(b) TASK FORCE-
From amounts appropriated for a fiscal year under subsection (a),
the Secretary may use not to exceed $2,000,000 of such amounts for
the operations of the National Task Force under section 399G(d).
SEC. 399J. SUNSET
PROVISION.
This part shall
not apply on the date that is 7 years after the date on which all
members of the National Task Force have been appointed under section
399G(d)(1).'.
Speaker of the
House of Representatives. Vice President of the United States and
President of the Senate.
END
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