[Congressional Bills 103th Congress]
[From the U.S. Government Publishing Office]
[H.R. 3804 Introduced in House (IH)]
103d CONGRESS
2d Session
H. R. 3804
To amend the Public Health Service Act to revise and extend programs
relating to the health of individuals who are members of minority
groups, and for other purposes.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
February 3, 1994
Mr. Waxman introduced the following bill; which was referred to the
Committee on Energy and Commerce
_______________________________________________________________________
A BILL
To amend the Public Health Service Act to revise and extend programs
relating to the health of individuals who are members of minority
groups, 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 ``Minority Health
Improvement Act of 1994''.
(b) Table of Contents.--The table of contents for this Act is as
follows:
Sec. 1. Short title; table of contents.
TITLE I--OFFICE OF MINORITY HEALTH
Sec. 101. Revision and extension of programs of Office of Minority
Health.
Sec. 102. Establishment of individual offices of minority health within
agencies of Public Health Service.
TITLE II--PRIMARY HEALTH SERVICES
Sec. 201. Migrant health centers; community health centers.
Sec. 202. Health services for the homeless.
Sec. 203. Health services for residents of public housing.
Sec. 204. Grants to States for loan repayment programs regarding
obligated service of health professionals.
Sec. 205. Grants to States for operation of State offices of rural
health.
Sec. 206. Demonstration grants to States for community scholarship
programs regarding obligated service of
health professionals.
Sec. 207. Programs regarding birth defects.
Sec. 208. Healthy start for infants.
TITLE III--HEALTH PROFESSIONS PROGRAMS
Sec. 301. Primary care scholarships for students from disadvantaged
backgrounds.
Sec. 302. Scholarships generally; certain other purposes.
Sec. 303. Loan repayments and fellowships regarding faculty positions.
Sec. 304. Centers of Excellence.
Sec. 305. Educational assistance regarding undergraduates.
Sec. 306. Student loans regarding schools of nursing.
Sec. 307. Federally-supported student loans funds.
TITLE IV--RESEARCH
Sec. 401. Office of Research on Minority Health.
Sec. 402. Activities of Agency for Health Care Policy and Research.
TITLE V--NATIVE HAWAIIAN HEALTH CARE
Sec. 501. Clarification of 1992 amendments.
Sec. 502. Amendment of Native Hawaiian Health Care Improvement Act to
reflect 1992 agreement.
Sec. 503. Repeal of Public Health Service Act provision.
TITLE VI--MISCELLANEOUS PROVISIONS
Sec. 601. Technical amendment to Indian Health Care Improvement Act.
Sec. 602. Health services for Pacific Islanders.
Sec. 603. Technical corrections regarding Public Law 103-183.
Sec. 604. Certain authorities of Centers for Disease Control and
Prevention.
TITLE VII--GENERAL PROVISIONS
Sec. 701. Effective date.
TITLE I--OFFICE OF MINORITY HEALTH
SEC. 101. REVISION AND EXTENSION OF PROGRAMS OF OFFICE OF MINORITY
HEALTH.
(a) In General.--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 minority
groups, the Secretary shall carry out the following:
``(1) In consultation with the advisory council under
subsection (c), establish goals and objectives regarding
disease prevention, health promotion, service delivery, and
research, and coordinate all activities within the Department
of Health and Human Services that relate to such goals and
objectives.
``(2) In consultation with such council, enter into
interagency agreements with other agencies of the Service, and
under such agreements provide amounts to such agencies, to
carry out the following:
``(A) Support research, demonstrations and
evaluations to test new and innovative models of
delivering services.
``(B) Increase knowledge and understanding of
health risk factors.
``(C) Ensure that the National Center for Health
Statistics collects data on the health status of each
minority group.
``(D) 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.
``(3) Establish by contract a 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).
``(4)(A) Establish by contract a center for the purpose of
carrying out programs to improve access to health care services
for individuals who lack proficiency in speaking the English
language by developing and carrying out programs to provide
bilingual or interpretive services.
``(B) In carrying out subparagraph (A), ensure that--
``(i) the center under such subparagraph conducts
research, develops and evaluates model projects, and
provides technical assistance to health care providers;
and
``(ii) such center is not operated by the entity
that operates the center established under paragraph
(3).
``(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
Secretary on carrying out this section, including advice on
carrying out paragraphs (1) and (2) of subsection (b) for each
minority group.
``(3) Composition.--
``(A) The Committee shall be composed of 12 voting
members appointed in accordance with subparagraph (B)
and the nonvoting, ex officio members designated under
subparagraph (C).
``(B) The voting members of the Committee shall be
appointed from among individuals who have expertise
regarding the health status of minority groups and the
access of such groups to health services, which
individuals are not officers or employees of the
Federal Government. The appointed membership of the
Committee shall be broadly representative of the
various minority groups.
``(C) The Secretary shall designate as ex officio
members of the Committee the heads of the minority
health offices referred to in section 1707A.
``(d) Appropriate Context of Services.--The Secretary shall ensure
that information and services provided pursuant to subsection (b) are
provided in the language and cultural context that is most appropriate
for the individuals for whom the information and services are intended.
``(e) Equitable Allocation of Services.--The Secretary shall ensure
that services provided under subsection (b) are equitably allocated
among the various minority groups.
``(f) Consultation With Individual Minority Health Offices.--In
carrying out subsection (b) regarding a specified agency, the Secretary
shall consult with the head of the minority health office of the
agency. For purposes of the preceding sentence, the terms `specified
agency' and `minority health office' have the meaning given such terms
in section 1707A(f).
``(g) Biennial Reports.--Not later than February 1 of fiscal year
1996 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 minority
groups. Each such report shall include the biennial reports submitted
to the Secretary under section 1707A(e) for such years by the heads of
the minority health offices.
``(h) Definition.--For purposes of this section, the term `minority
groups' means African Americans, American Indians, Asian Americans,
Hispanics, and Pacific Islanders.
``(i) Funding.--
``(1) Authorization of appropriations.--For the purpose of
carrying out this section, there is authorized to be
appropriated $21,000,000 for each of the fiscal years 1995
through 1997.
``(2) Allocation of funds by secretary.--Of the amounts
appropriated under paragraph (1) for a fiscal year, the
Secretary shall make available not less than $3,000,000 for
carrying out subsection (b)(2)(D).''.
(b) Miscellaneous Amendment.--Section 1707 of the Public Health
Service Act (42 U.S.C. 300u-6) is amended in the heading for the
section by striking ``establishment of''.
SEC. 102. ESTABLISHMENT OF INDIVIDUAL OFFICES OF MINORITY HEALTH WITHIN
AGENCIES OF PUBLIC HEALTH SERVICE.
Title XVII of the Public Health Service Act (42 U.S.C. 300u et
seq.), as amended by section 302 of Public Law 102-531 (106 Stat.
3483), is amended by inserting after section 1707 the following
section:
``individual offices of minority health within public health service
``Sec. 1707A. (a) In General.--The head of each agency specified in
subsection (b)(1) shall establish within the agency an office to be
known as the Office of Minority Health. Each such Office shall be
headed by a director, who shall be appointed by the head of the agency
within which the Office is established, and who shall report directly
to the head of the agency. The head of such agency shall carry out this
section (as this section relates to the agency) acting through such
Director.
``(b) Specified Agencies.--
``(1) In general.--The agencies referred to in subsection
(a) are the following:
``(A) The Centers for Disease Control and
Prevention.
``(B) The Agency for Health Care Policy and
Research.
``(C) The Health Resources and Services
Administration.
``(D) The Substance Abuse and Mental Health
Services Administration.
``(2) National institutes of health.--For purposes of
subsection (c) and the subsequent provisions of this section,
the term `minority health office' includes the Office of
Research on Minority Health established within the National
Institutes of Health. The Director of the National Institutes
of Health shall carry out this section (as this section relates
to the agency) acting through the Director of such Office.
``(c) Composition.--The head of each specified agency shall ensure
that the officers and employees of the minority health office of the
agency are, collectively, experienced in carrying out community-based
health programs for each of the various minority groups that are
present in significant numbers in the United States. The head of such
agency shall ensure that, of such officers and employees who are
members of minority groups, no such group is disproportionately
represented.
``(d) Duties.--Each Director of a minority health office shall
monitor the programs of the specified agency of such office in order
to--
``(1) determine the extent to which the purposes of the
programs are being carried out with respect to minority groups;
``(2) determine the extent to which members of such groups
are represented among the Federal officers and employees who
administer the programs; and
``(3) make recommendations to the head of such agency on
carrying out the programs with respect to such groups.
``(e) Biennial Reports to Secretary.--The head of each specified
agency shall submit to the Secretary for inclusion in each biennial
report under section 1707(g) (without change) a biennial report
describing--
``(1) the extent to which the minority health office of the
agency employs individuals who are members of minority groups,
including a specification by minority group of the number of
such individuals employed by such office; and
``(2) the manner in which the agency is complying with
Public Law 94-311 (relating to data on Americans of Spanish
origin or descent).
``(f) Definitions.--For purposes of this section:
``(1) The term `minority health office' means an office
established under subsection (a), subject to subsection (b)(2).
``(2) The term `minority group' has the meaning given such
term in section 1707(h).
``(3) The term `specified agency' means--
``(A) an agency specified in subsection (b)(1); and
``(B) the National Institutes of Health.
``(g) Funding.--
``(1) Allocations.--Of the amounts appropriated for a
specified agency for a fiscal year, the Secretary may reserve
not more than 0.5 percent for the purpose of carrying out
activities under this section through the minority health
office of the agency. In reserving an amount under the
preceding sentence for a minority health office for a fiscal
year, the Secretary shall reduce, by substantially the same
percentage, the amount that otherwise would be available for
each of the programs of the designated agency involved.
``(2) Availability of funds for staffing.--The purposes for
which amounts made available under paragraph (1) may be
expended by a minority health office include the costs of
employing staff for such office.''.
TITLE II--PRIMARY HEALTH SERVICES
SEC. 201. MIGRANT HEALTH CENTERS; COMMUNITY HEALTH CENTERS.
(a) Migrant Health Centers.--
(1) Treatment of pregnant women for substance abuse.--
Section 329(a) of the Public Health Service Act (42 U.S.C.
254b(a)) is amended--
(A) in paragraph (1)(C)--
(i) by inserting ``(i)'' after ``(C)'';
(ii) in clause (i) (as so designated), by
adding ``and'' after the comma at the end; and
(iii) by adding at the end the following
clause:
``(ii) in the case of referrals of pregnant women for the
treatment of substance abuse, notification of the referrals to
the State official responsible for carrying out programs under
subpart II of part B of title XIX,''; and
(B) in paragraph (7)--
(i) in subparagraph (L), by striking
``and'' at the end;
(ii) by redesignating subparagraph (M) as
subparagraph (N); and
(iii) by inserting after subparagraph (L)
the following subparagraph:
``(M) treatment of pregnant women for substance abuse;
and''.
(2) Overlap in catchment areas.--Section 329(a) of the
Public Health Service Act (42 U.S.C. 254b(a)) is amended by
adding at the end the following paragraph:
``(8) In making grants under subsections (c)(1) and (d)(1), the
Secretary may provide for the development and operation of more than
one migrant health center in a catchment area in any case in which the
Secretary determines that in such area there are workers or other
individuals described in subsection (a)(1) (in the matter after and
below subparagraph (H)) who otherwise will have a shortage of personal
health services. The preceding sentence may not be construed as
requiring that, in such a case, the catchment areas of the centers
involved be identical.''.
(3) Offsite activities.--Section 329(a) of the Public
Health Service Act, as amended by paragraph (2) of this
subsection, is amended by adding at the end the following
paragraph:
``(9) In making grants under this section, the Secretary may, to
the extent determined by the Secretary to be appropriate, authorize
migrant health centers to provide services at locations other than the
center.''.
(4) Amount of grant; use of certain funds.--Section
329(d)(4) of the Public Health Service Act (42 U.S.C.
254b(d)(4)), as amended by section 309(a)(3) of Public Law 102-
531 (106 Stat. 3500), is amended to read as follows:
``(4)(A) The amount of a grant under paragraph (1) or under
subsection (c) for a migrant health center shall be determined by the
Secretary, taking into account (for the period for which the grant is
made)--
``(i) the costs that the center may reasonably be expected
to incur in carrying out the plan approved by the Secretary
pursuant to subsection (f)(3)(H), and
``(ii) the amounts that the center may reasonably be
expected to receive as State, local, and other operational
funding (exclusive of amounts to be provided in the grant under
this section) and as fees, premiums, and third-party
reimbursements.
``(B)(i) Subject to clause (ii), the Secretary may not restrict the
purposes for which a migrant health center expends the amounts
described in subparagraph (A)(ii) (including restrictions imposed
pursuant to Federal cost principles).
``(ii) The Secretary may require that amounts described in
subparagraph (A)(ii) be expended for purposes that are consistent with
the purposes specified in this section.
``(C)(i) Payments under a grant under this section shall be made in
advance or by way of reimbursement and in such installments as the
Secretary finds necessary. Adjustments in such payments may be made for
overpayments or underpayments, subject to clause (ii).
``(ii) If, for the period for which a grant is made under paragraph
(1) to a migrant health center, the sum of the amount of the grant and
the amounts described in subparagraph (A)(ii) that the center actually
received exceeded the costs of the center in carrying out the plan
approved by the Secretary pursuant to subsection (f)(3)(H), then the
center is entitled to retain such excess amount if the center agrees to
expend such amount only for the following purposes:
``(I) To expand and improve services.
``(II) To increase the number of persons served.
``(III) To acquire, modernize, or expand facilities, or to
construct facilities.
``(IV) To improve the administration of service programs.
``(V) To establish financial reserves.
``(D) With respect to funds that are amounts described in
subparagraph (A)(ii) or excess amounts described in subparagraph
(C)(ii), this paragraph may not be construed as limiting the authority
of the Secretary to require the submission of such plans, budgets, and
other information as may be necessary to ensure that the funds are
expended in accordance with subparagraph (B)(ii), or clauses (I)
through (V) of subparagraph (C)(ii), respectively.''.
(5) Authorization of appropriations.--Section 329(h) of the
Public Health Service Act (42 U.S.C. 254b(h)) is amended--
(A) in paragraph (1)(A), by striking ``1994'' and
inserting ``1998''; and
(B) in paragraph (2)(A), by striking ``1994'' and
inserting ``1998''.
(b) Community Health Centers.--
(1) Treatment of pregnant women for substance abuse.--
Section 330 of the Public Health Service Act (42 U.S.C. 254c)
is amended--
(A) in subsection (a)(3)--
(i) by inserting ``(A)'' after ``(3)'';
(ii) in subparagraph (A) (as so
designated), by adding ``and'' after the comma
at the end; and
(iii) by adding at the end the following
subparagraph:
``(B) in the case of referrals of pregnant women for the
treatment of substance abuse, notification of the referrals to
the State official responsible for carrying out programs under
subpart II of part B of title XIX,''; and
(B) in subsection (b)(2)--
(i) in subparagraph (L), by striking
``and'' at the end;
(ii) by redesignating subparagraph (M) as
subparagraph (N); and
(iii) by inserting after subparagraph (L)
the following subparagraph:
``(M) treatment of pregnant women for substance abuse;
and''.
(2) Overlap in catchment areas.--Section 330(b) of the
Public Health Service Act (42 U.S.C. 254c(b)) is amended by
adding at the end the following paragraph:
``(7) In making grants under subsections (c)(1) and (d)(1), the
Secretary may provide for the development and operation of more than
one community health center in a catchment area in any case in which
the Secretary determines that there is a population group in such area
that otherwise will have a shortage of personal health services. The
preceding sentence may not be construed as requiring that, in such a
case, the catchment areas of the centers involved be identical.''.
(3) Offsite activities.--Section 330(b) of the Public
Health Service Act, as amended by paragraph (2) of this
subsection, is amended by adding at the end the following
paragraph:
``(8) In making grants under this section, the Secretary may, to
the extent determined by the Secretary to be appropriate, authorize
community health centers to provide services at locations other than
the center.''.
(4) Amount of grant; use of certain funds.--Section
330(d)(4) of the Public Health Service Act (42 U.S.C.
254c(d)(4)), as amended by section 309(b)(3) of Public Law 102-
531 (106 Stat. 3501), is amended to read as follows:
``(4)(A) The amount of a grant under paragraph (1) or under
subsection (c) for a community health center shall be determined by the
Secretary, taking into account (for the period for which the grant is
made)--
``(i) the costs that the center may reasonably be expected
to incur in carrying out the plan approved by the Secretary
pursuant to subsection (e)(3)(H), and
``(ii) the amounts that the center may reasonably be
expected to receive as State, local, and other operational
funding (exclusive of amounts to be provided in the grant under
this section) and as fees, premiums, and third-party
reimbursements.
``(B)(i) Subject to clause (ii), the Secretary may not restrict the
purposes for which a community health center expends the amounts
described in subparagraph (A)(ii) (including restrictions imposed
pursuant to Federal cost principles).
``(ii) The Secretary may require that amounts described in
subparagraph (A)(ii) be expended for purposes that are consistent with
the purposes specified in this section.
``(C)(i) Payments under a grant under this section shall be made in
advance or by way of reimbursement and in such installments as the
Secretary finds necessary. Adjustments in such payments may be made for
overpayments or underpayments, subject to clause (ii).
``(ii) If, for the period for which a grant is made under paragraph
(1) to a community health center, the sum of the amount of the grant
and the amounts described in subparagraph (A)(ii) that the center
actually received exceeded the costs of the center in carrying out the
plan approved by the Secretary pursuant to subsection (e)(3)(H), then
the center is entitled to retain such excess amount if the center
agrees to expend such amount only for the following purposes:
``(I) To expand and improve services.
``(II) To increase the number of persons served.
``(III) To acquire, modernize, or expand facilities, or to
construct facilities.
``(IV) To improve the administration of service programs.
``(V) To establish financial reserves.
``(D) With respect to funds that are amounts described in
subparagraph (A)(ii) or excess amounts described in subparagraph
(C)(ii), this paragraph may not be construed as limiting the authority
of the Secretary to require the submission of such plans, budgets, and
other information as may be necessary to ensure that the funds are
expended in accordance with subparagraph (B)(ii), or clauses (I)
through (V) of subparagraph (C)(ii), respectively.''.
(5) Authorization of appropriations.--Section 330(g) of the
Public Health Service Act (42 U.S.C. 254c(g)) is amended--
(A) in paragraph (1)(A), by striking ``1994'' and
inserting ``1998''; and
(B) in paragraph (2)(A), by striking ``1994'' and
inserting ``1998''.
SEC. 202. HEALTH SERVICES FOR THE HOMELESS.
Section 340(q)(1) of the Public Health Service Act (42 U.S.C.
256(q)(1)) is amended by striking ``and 1994'' and inserting ``through
1998''.
SEC. 203. HEALTH SERVICES FOR RESIDENTS OF PUBLIC HOUSING.
Section 340A(p)(1) of the Public Health Service Act (42 U.S.C.
256a(p)(1)) is amended by striking ``and 1993'' and inserting ``through
1998''.
SEC. 204. GRANTS TO STATES FOR LOAN REPAYMENT PROGRAMS REGARDING
OBLIGATED SERVICE OF HEALTH PROFESSIONALS.
Section 338I(c) of the Public Health Service Act (42 U.S.C. 254q-
1(c)) is amended by adding at the end the following paragraph:
``(4) Private practice.--
``(A) In carrying out the program operated with a
grant under subsection (a), a State may waive the
requirement of paragraph (1) regarding the assignment
of a health professional if, subject to subparagraph
(B), the health professional enters into an agreement
with the State to provide primary health services in a
full-time private clinical practice in a health
professional shortage area.
``(B) The Secretary may not make a grant under
subsection (a) unless the State involved agrees that,
if the State provides a waiver under subparagraph (A)
for a health professional, section 338D(b)(1) will
apply to the agreement under such subparagraph between
the State and the health professional to the same
extent and in the same manner as such section applies
to an agreement between the Secretary and a health
professional regarding a full-time private clinical
practice.''.
SEC. 205. GRANTS TO STATES FOR OPERATION OF 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 1995 through 1997''.
SEC. 206. DEMONSTRATION GRANTS TO STATES FOR COMMUNITY SCHOLARSHIP
PROGRAMS REGARDING OBLIGATED SERVICE OF HEALTH
PROFESSIONALS.
Section 338L of the Public Health Service Act (42 U.S.C. 254t) is
amended--
(1) by striking ``health manpower shortage'' each place
such term appears and inserting ``health professional
shortage'';
(2) in subsection (e)--
(A) by striking paragraph (1);
(B) by redesignating paragraphs (2) through (6) as
paragraphs (1) through (5), respectively; and
(C) in paragraph (1) (as so redesignated), by
inserting after ``the individual'' the following: ``who
is to receive the scholarship under the contract'';
(3) in subsection (k)(2), by striking ``internal medicine,
pediatrics,'' and inserting ``general internal medicine,
general pediatrics,''; and
(4) in subsection (l)(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 1995 through 1997''.
SEC. 207. PROGRAMS REGARDING BIRTH DEFECTS.
Section 317C of the Public Health Service Act (42 U.S.C. 247b-4),
as added by section 306 of Public Law 102-531 (106 Stat. 3494), is
amended to read as follows:
``programs regarding birth defects
``Sec. 317C. (a) The Secretary, acting through the Director of the
Centers for Disease Control and Prevention, shall carry out programs--
``(1) to collect, analyze, and make available data on birth
defects (in manner that facilitates compliance with subsection
(d)(2)), including data on the causes of such defects and on
the incidence and prevalence of such defects;
``(2) to provide information and education to the public on
the prevention of such defects;
``(3) to improve the education, training, and clinical
skills of health professionals with respect to the prevention
of such defects;
``(4) to carry out demonstration projects for the
prevention of such defects; and
``(5) to operate regional centers for the conduct of
research on the prevention of such defects.
``(b) Additional Provisions Regarding Collection of Data.--
``(1) In general.--In carrying out subsection (a)(1), the
Secretary--
``(A) shall collect and analyze data by gender and
by racial and ethnic group, including Hispanics, non-
Hispanic whites, African Americans, Native Americans,
Asian Americans, and Pacific Islanders;
``(B) shall collect data under subparagraph (A)
from birth certificates, death certificates, hospital
records, and such other sources as the Secretary
determines to be appropriate; and
``(C) shall encourage States to establish or
improve programs for the collection and analysis of
epidemiological data on birth defects, and to make the
data available.
``(2) National clearinghouse.--In carrying out subsection
(a)(1), the Secretary shall establish and maintain a National
Information Clearinghouse on Birth Defects to collect and
disseminate to health professionals and the general public
information on birth defects, including the prevention of such
defects.
``(c) Grants and Contracts.--
``(1) In general.--In carrying out subsection (a), the
Secretary may make grants to and enter into contracts with
public and nonprofit private entities.
``(2) Supplies and services in lieu of award funds.--
``(A) Upon the request of a recipient of an award
of a grant or contract under paragraph (1), the
Secretary may, subject to subparagraph (B), provide
supplies, equipment, and services for the purpose of
aiding the recipient in carrying out the purposes for
which the award is made and, for such purposes, may
detail to the recipient any officer or employee of the
Department of Health and Human Services.
``(B) With respect to a request described in
subparagraph (A), the Secretary shall reduce the amount
of payments under the award involved by an amount equal
to the costs of detailing personnel and the fair market
value of any supplies, equipment, or services provided
by the Secretary. The Secretary shall, for the payment
of expenses incurred in complying with such request,
expend the amounts withheld.
``(3) Application for award.--The Secretary may make an
award of a grant or contract under paragraph (1) only if an
application for the award is submitted to the Secretary and the
application is in such form, is made in such manner, and
contains such agreements, assurances, and information as the
Secretary determines to be necessary to carry out the purposes
for which the award is to be made.
``(d) Biennial Report.--Not later than February 1 of fiscal year
1995 and of every second such year thereafter, the Secretary shall
submit to the Committee on Energy and Commerce of the House of
Representatives, and the Committee on Labor and Human Resources of the
Senate, a report that, with respect to the preceding 2 fiscal years--
``(1) contains information regarding the incidence and
prevalence of birth defects and the extent to which birth
defects have contributed to the incidence and prevalence of
infant mortality;
``(2) contains information under paragraph (1) that is
specific to various racial and ethnic groups (including
Hispanics, non-Hispanic whites, African Americans, Native
Americans, and Asian Americans);
``(3) contains an assessment of the extent to which various
approaches of preventing birth defects have been effective;
``(4) describes the activities carried out under this
section; and
``(5) contains any recommendations of the Secretary
regarding this section.
``(e) Authorization of Appropriations.--For the purpose of carrying
out this section, there are authorized to be appropriated $5,000,000
for fiscal year 1995, and such sums as may be necessary for each of the
fiscal years 1996 and 1997.''.
SEC. 208. HEALTHY START FOR INFANTS.
(a) In General.--Part D of title III of the Public Health Service
Act (42 U.S.C. 254b et seq.) is amended by inserting after section 330
the following section:
``healthy start for infants
``Sec. 330A. (a) Grants for Comprehensive Services.--
``(1) In general.--The Secretary may make grants for the
operation of not more than 19 demonstration projects to provide
the services described in subsection (b) for the purpose of
reducing, in the geographic areas in which the projects are
carried out--
``(A) the incidence of infant mortality and
morbidity;
``(B) the incidence of fetal deaths;
``(C) the incidence of maternal mortality;
``(D) the incidence of fetal alcohol syndrome; and
``(E) the incidence of low-birthweight births.
``(2) Achievement of year 2000 health status objectives.--
With respect to the objectives established by the Secretary for
the health status of the population of the United States for
the year 2000, the Secretary shall, in providing for a
demonstration project under paragraph (1) in a geographic area,
seek to meet the objectives that are applicable to the purpose
described in such paragraph and the populations served by the
project.
``(b) Authorized Services.--
``(1) In general.--Subject to subsection (h), the services
referred to in this subsection are comprehensive services
(including preventive and primary health services for pregnant
women and infants and childhood immunizations in accordance
with the schedule recommended by the Secretary) for carrying
out the purpose described in subsection (a), including services
other than health services.
``(2) Certain providers.--The Secretary may make a grant
under subsection (a) only if the applicant involved agrees
that, in making any arrangements under which other entities
provide authorized services in the demonstration project
involved, the applicant will include among the entities with
which the arrangements are made grantees under any of sections
329, 330, 340, and 340A, if such grantees are providing
services in the service area of such project and the grantees
are willing to make such arrangements with the applicant.
``(c) Eligible Geographic Areas.--The Secretary may make a grant
under subsection (a) only if--
``(1) the applicant for the grant specifies the geographic
area in which the demonstration project under such subsection
is to be carried out and agrees that the project will not be
carried out in other areas; and
``(2) for the fiscal year preceding the first fiscal year
for which the applicant is to receive such a grant, the rate of
infant mortality in the geographic area equals or exceeds 150
percent of the national average in the United States of such
rates.
``(d) Minimum Qualifications of Grantees.--
``(1) Public or nonprofit private entities.--The Secretary
may make a grant under subsection (a) only if the applicant for
the grant is a State or local department of health, or other
public or nonprofit private entity, or a consortium of public
or nonprofit private entities.
``(2) Approval of political subdivisions.--With respect to
a proposed demonstration project under subsection (a), the
Secretary may make a grant under such subsection only if--
``(A) the chief executive officer of each political
subdivision in the service area of such project
approves the applicant for the grant as being qualified
to carry out the project; and
``(B) the leadership of any Indian tribe or tribal
organization with jurisdiction over any portion of such
area so approves the applicant.
``(3) Status as medicaid provider.--
``(A) In the case of any service described in
subsection (b) that is available pursuant to the State
plan approved under title XIX of the Social Security
Act for a State in which a demonstration project under
subsection (a) is carried out, the Secretary may make a
grant under such subsection for the project only if,
subject to subparagraph (B)--
``(i) the applicant for the grant will
provide the service directly, and the applicant
has entered into a participation agreement
under the State plan and is qualified to
receive payments under such plan; or
``(ii) the applicant will enter into an
agreement with a public or private entity under
which the entity will provide the service, and
the entity has entered into such a
participation agreement under the State plan
and is qualified to receive such payments.
``(B)(i) In the case of an entity making an
agreement pursuant to subparagraph (A)(ii) regarding
the provision of services, the requirement established
in such subparagraph regarding a participation
agreement shall be waived by the Secretary if the
entity does not, in providing health care services,
impose a charge or accept reimbursement available from
any third-party payor, including reimbursement under
any insurance policy or under any Federal or State
health benefits plan.
``(ii) A determination by the Secretary of whether
an entity referred to in clause (i) meets the criteria
for a waiver under such clause shall be made without
regard to whether the entity accepts voluntary
donations regarding the provision of services to the
public.
``(e) State Approval of Project.--With respect to a proposed
demonstration project under subsection (a), the Secretary may make a
grant under such subsection to the applicant involved only if--
``(1) the chief executive officer of the State in which the
project is to be carried out approves the proposal of the
applicant for carrying out the project; and
``(2) the leadership of any Indian tribe or tribal
organization with jurisdiction over any portion of the service
area of the project so approves the proposal.
``(f) Eligibility for Services Provided With Grant Funds.--The
Secretary may make a grant under subsection (a) only if the applicant
involved agrees as follows:
``(1) With respect to any authorized service under
subsection (b), if the service is a service that the State
involved is required or has elected to provide under title XIX
of the Social Security Act, the grant will not be expended to
provide the service to any individual to whom the State is
required or has elected under such title to provide the
service.
``(2) The grant will not be expended to make payment for
any item or service to the extent that payment has been made,
or can reasonably be expected to be made, with respect to such
item or service--
``(A) under a health insurance policy or plan
(including a group health plan or a prepaid health
plan);
``(B) under any Federal or State health benefits
program, including any program under title V, XVIII, or
XIX of the Social Security Act; or
``(C) under subpart II of part B of title XIX of
this Act.
``(g) Maintenance of Effort.--
``(1) Grantee.--With respect to authorized services under
subsection (b), the Secretary may make a grant under subsection
(a) only if the applicant involved agrees to maintain
expenditures of non-Federal amounts for such services at a
level that is not less than the level of such expenditures
maintained by the applicant for fiscal year 1991.
``(2) Relevant political subdivisions.--With respect to
authorized services under subsection (b), the Secretary may
make a grant under subsection (a) only if each political
subdivision in the service area of the demonstration project
involved agrees to maintain expenditures of non-Federal amounts
for such services at a level that is not less than the level of
such expenditures maintained by the political subdivision for
fiscal year 1991.
``(h) Restrictions on Expenditure of Grant.--
``(1) In general.--Except as provided in paragraph (3), the
Secretary may make a grant under subsection (a) only if the
applicant involved agrees that the grant will not be expended--
``(A) to provide inpatient services, except with
respect to residential treatment for substance abuse
provided in settings other than hospitals;
``(B) to make cash payments to intended recipients
of health services or mental health services; or
``(C) to purchase or improve real property (other
than minor remodeling of existing improvements to real
property) or to purchase major medical equipment (other
than mobile medical units for providing ambulatory
prenatal services).
``(2) Administrative expenses; data collection.--The
Secretary may make a grant under subsection (a) only if the
applicant involved agrees that not more than an aggregate 10
percent of the grant will be expended for administering the
grant and the collection and analysis of data.
``(3) Waiver.--If the Secretary finds that the purpose
described in subsection (a) cannot otherwise be carried out,
the Secretary may, with respect to an otherwise qualified
applicant, waive the restriction established in paragraph
(1)(C).
``(i) Determination of Cause of Infant Deaths.--The Secretary may
make a grant under subsection (a) only if the applicant involved--
``(1) agrees to provide for a determination of the cause of
each infant death in the service area of the demonstration
project involved; and
``(2) the applicant has made such arrangements with public
entities as may be necessary to carry out paragraph (1).
``(j) Annual Reports to Secretary.--The Secretary may make a grant
under subsection (a) only if the applicant involved agrees that, for
each fiscal year for which the applicant operates a demonstration
project under such subsection the applicant will, not later than April
1 of the subsequent fiscal year, submit to the Secretary a report
providing the following information with respect to the project:
``(1) The number of individuals that received authorized
services, and the demographic characteristics of the population
of such individuals.
``(2) The types of authorized services provided, including
the types of ambulatory prenatal services provided and the
trimester of the pregnancy in which the services were provided.
``(3) The sources of payment for the authorized services
provided.
``(4) The extent to which children under age 2 receiving
authorized services have received the appropriate number and
variety of immunizations against vaccine-preventable diseases.
``(5) An analysis of the causes of death determined under
subsection (i).
``(6) The extent of progress being made toward meeting the
health status objectives specified in subsection (a)(2).
``(7) The extent to which, in the service area involved,
progress is being made toward meeting the participation goals
established for the State by the Secretary under section
1905(r) of the Social Security Act (relating to early periodic
screening, diagnostic, and treatment services for children
under the age of 21).
``(k) Community Participation.--The Secretary may make a grant
under subsection (a) only if the applicant involved agrees that, in
preparing the proposal of the applicant for the demonstration project
involved, and in the operation of the project, the applicant will
consult with the residents of the service area for the project and with
public and nonprofit private entities that provide authorized services
to such residents.
``(l) Application for Grant.--The Secretary may make a grant under
subsection (a) only if an application for the grant is submitted to the
Secretary and the application is in such form, is made in such manner,
and contains such agreements, assurances, and information as the
Secretary determines to be necessary to carry out this subsection.
``(m) Report to Congress.--Not later than February 1, 1998, the
Secretary shall submit to the Committee on Energy and Commerce of the
House of Representatives, and the Committee on Labor and Human
Resources of the Senate, a report--
``(1) summarizing the reports received by the Secretary
under subsection (j);
``(2) describing the extent to which the Secretary has, in
the service areas of such projects, been successful in meeting
the health status objectives specified in subsection (a)(2);
and
``(3) describing the extent to which demonstration projects
under subsection (a) have been cost effective.
``(n) Limitation on Certain Expenses of Secretary.--Of the amounts
appropriated under subsection (p) for a fiscal year, the Secretary may
not obligate more than an aggregate 5 percent for the administrative
costs of the Secretary in carrying out this section, for the provision
of technical assistance regarding demonstration projects under
subsection (a), and for evaluations of such projects.
``(o) Definitions.--For purposes of this section:
``(1) The term `authorized services' means the services
specified in subsection (b).
``(2) The terms `Indian tribe' and `tribal organization'
have the meaning given such terms in section 4(b) and section
4(c) of the Indian Self-Determination and Education Assistance
Act.
``(3) The term `service area', with respect to a
demonstration project under subsection (a), means the
geographic area specified in subsection (c).
``(p) Authorization of Appropriations.--For the purpose of carrying
out this section, there are authorized to be appropriated such sums as
may be necessary for each of the fiscal years 1995 through 1997.
``(q) Sunset.--Effective October 1, 1997, this section is
repealed.''.
(b) Certain Provisions Regarding Reports.--
(1) Fiscal year 1995.--With respect to grants under section
330A of the Public Health Service Act (as added by subsection
(a) of this section), the Secretary of Health and Human
Services may make a grant under such section for fiscal year
1995 only if the applicant for the grant agrees to submit to
the Secretary, not later than April 1 of such year, a report on
any federally-supported project of the applicant that is
substantially similar to the demonstration projects authorized
in such section 330A, which report provides, to the extent
practicable, the information described in subsection (j) of
such section.
(2) Fiscal year 1997.--With respect to grants for fiscal
year 1997 under section 330A of the Public Health Service Act
(as added by subsection (a) of this section), the requirement
under subsection (j) of such section that a report be submitted
not later than April 1, 1998, remains in effect notwithstanding
the repeal of such section pursuant to subsection (q) of such
section.
(c) Lapse of Funds.--Effective October 1, 1997, all unexpended
portions of amounts appropriated for grants under 330A of the Public
Health Service Act (as added by subsection (a) of this section) are
unavailable for obligation or expenditure, without regard to whether
the amounts have been received by the grantees involved.
(d) Use of General Authority Under Public Health Service Act.--With
respect to the program established in section 330A of the Public Health
Service Act (as added by subsection (a) of this section), section 301
of such Act may not be construed as providing to the Secretary of
Health and Human Services any authority to carry out, during any fiscal
year in which such program is in operation, any demonstration project
to provide any of the services specified in subsection (b) of such
section 330A.
TITLE III--HEALTH PROFESSIONS PROGRAMS
SEC. 301. PRIMARY CARE SCHOLARSHIPS FOR STUDENTS FROM DISADVANTAGED
BACKGROUNDS.
(a) In General.--Section 736 of the Public Health Service Act (42
U.S.C. 293) is amended to read as follows:
``SEC. 736. PRIMARY CARE SCHOLARSHIPS FOR STUDENTS FROM DISADVANTAGED
BACKGROUNDS.
``(a) In General.--The Secretary may in accordance with this
section award scholarships to individuals described in subsection (b)
for the purpose of assisting the individuals with the costs of
attending schools of medicine or osteopathic medicine, schools of
dentistry, schools of nursing (as defined in section 853), graduate
programs in mental health practice, and programs for the training of
physician assistants.
``(b) Eligible Individuals.--An individual referred to in
subsection (a) is any individual meeting the following conditions:
``(1) The individual is from a disadvantaged background.
``(2) The individual is enrolled (or accepted for
enrollment) at an eligible school as a full-time student in a
program leading to a degree in a health profession.
``(3) The costs of attending such school would constitute a
severe financial hardship for the individual.
``(4) The individual enters into the contract required
pursuant to (d) as a condition of receiving the scholarship
(relating to an agreement to provide primary health services in
a health professional shortage area designated under section
332).
``(c) Special Consideration Regarding Certain Awards.--In awarding
scholarships under subsection (a), the Secretary shall give special
consideration to eligible individuals who received scholarships
pursuant to this section or section 737 for fiscal year 1993 or 1994
and are seeking scholarships for attendance at eligible schools that
received a grant under either of such sections for either of such
fiscal years.
``(d) Applicability of Certain Provisions.--Except as inconsistent
with this section, the provisions of subpart III of part D of title III
apply to an award of a scholarship under subsection (a) to the same
extent and in the same manner as such provisions apply to an award of a
scholarship under section 338A. This section shall be carried out by
the bureau that administers such subpart III.
``(e) Definitions.--For purposes of this section:
``(1) The term `eligible individual' means an individual
described in subsection (b).
``(2) The term `eligible school' means a school or program
specified in subsection (a).
``(f) Funding.--
``(1) Authorization of appropriations.--For the purpose of
carrying out this section, there are authorized to be
appropriated $34,000,000 for fiscal year 1995, $50,000,000 for
fiscal year 1996, and $65,000,000 for fiscal year 1997.
``(2) Allocations by secretary.--Of the amounts
appropriated for a fiscal year under paragraph (1), the
Secretary shall make available--
``(A) 20 percent for scholarships under subsection
(a) for attendance at schools of nursing; and
``(B) 15 percent for scholarships under such
subsection for attendance at graduate programs in
mental health practice.''.
(b) Certain Programs Of Obligated Service.--
(1) Repeal.--Section 795 of the Public Health Service Act
(42 U.S.C. 295n) is repealed.
(2) Rule of construction.--Paragraph (1) does not terminate
agreements in effect on the day before the date of the
enactment of this Act pursuant to section 795 of the Public
Health Service Act. Such agreements 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 (whether provided pursuant
to other agreements with the Federal Government or whether
provided otherwise) counts toward satisfaction of the
requirement of practice pursuant to such section 795.
SEC. 302. SCHOLARSHIPS GENERALLY; CERTAIN OTHER PURPOSES.
(a) Relevant Health Professions Schools.--Section 737(a)(3) of the
Public Health Service Act (42 U.S.C. 293a(a)(3)) is amended--
(1) by striking ``medicine,'' and all that follows through
``dentistry,''; and
(2) by striking ``allied health,'' and all that follows and
inserting ``allied health.''.
(b) Funding.--Section 737(h) of the Public Health Service Act (42
U.S.C. 293a(h)) is amended--
(1) in paragraph (1), by inserting before the period the
following: ``, and $6,000,000 for each of the fiscal years 1994
through 1997''; and
(2) in paragraph (2)(A), by striking ``30 percent'' and all
that follows and inserting the following: ``50 percent for such
grants to schools of allied health; and''.
SEC. 303. LOAN REPAYMENTS AND FELLOWSHIPS REGARDING FACULTY POSITIONS.
(a) Loan Repayments.--Section 738(a) of the Public Health Service
Act (42 U.S.C. 293b(a)) is amended--
(1) by striking paragraphs (4) and (6);
(2) by redesignating paragraphs (5) and (7) as paragraphs
(4) and (5), respectively; and
(3) in paragraph (4) (as so redesignated), by amending
subparagraph (B) to read as follows:
``(B) the contract referred to in subparagraph (A)
provides that 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).''.
(b) Authorization of Appropriations Regarding Loan Repayments and
Fellowships.--Section 738(c) of the Public Health Service Act (42
U.S.C. 293b(c)) is amended by striking ``there is'' and all that
follows and inserting the following: ``there is authorized to be
appropriated $1,000,000 for each of the fiscal years 1995 through
1997.''.
SEC. 304. CENTERS OF EXCELLENCE.
(a) References to Schools.--Section 739 of the Public Health
Service Act (42 U.S.C. 293c) is amended--
(1) by striking ``health professions schools'' each place
such term appears and inserting ``designated health professions
schools''; and
(2) by striking ``health professions school'' each place
such term appears and inserting ``designated health professions
school''.
(b) Required Uses of Funds.--Section 739(b) of the Public Health
Service Act (42 U.S.C. 293c(b)), as amended by subsection (a), is
amended--
(1) by striking paragraph (2);
(2) by redesignating paragraph (1) as paragraph (2);
(3) by inserting before paragraph (2) (as so redesignated)
the following paragraph:
``(1) to collaborate with public and nonprofit private
entities to carry out community-based programs to recruit
students of secondary schools and institutions of higher
education and to prepare the students academically for
attendance at the designated health professions school;'';
(4) in paragraph (5)--
(A) by striking ``faculty and student research''
and inserting ``student research''; and
(B) by inserting before the period the following:
``, including research on issues relating to the
delivery of health care''; and
(5)(A) in paragraph (4), by striking ``and'' after the
semicolon at the end;
(B) in paragraph (5), by striking the period at the end and
inserting ``; and''; and
(C) by adding at the end the following paragraph:
``(6) to carry out a program to train students of the
school in providing health services to minority individuals,
which program includes training provided at community-based
health facilities that provide such services to a significant
number of minority individuals and that are located at a site
remote from the main site of the teaching facilities of the
school.''.
(c) Requirements Regarding Consortia.--
(1) In general.--Section 739(c)(1) of the Public Health
Service Act (42 U.S.C. 293c(c)(1)), as amended by subsection
(a), is amended--
(A) in subparagraph (A), in the matter preceding
clause (i), by striking ``specified in subparagraph
(B)'' and inserting ``specified in subparagraphs (B)
and (C)'';
(B) by redesignating subparagraph (C) as
subparagraph (D); and
(C) by inserting after subparagraph (B) the
following subparagraph:
``(C) The condition specified in this subparagraph
is that, in accordance with subsection (e)(1), the
designated health professions 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. The grant involved may be expended with
respect to the other schools without regard to whether
such schools meet the conditions specified in
subparagraph (B).''.
(2) Certain requirements.--Section 739(e) of the Public
Health Service Act (42 U.S.C. 293c(e)), as amended by
subsection (a), is amended to read as follows:
``(e) Provisions Regarding Consortia.--
``(1) Requirements.--For purposes of subsection (c)(1)(C),
a consortium of schools has been formed in accordance with this
subsection if--
``(A) the consortium consists of--
``(i) the designated health professions
school seeking the grant under subsection (a);
and
``(ii) 1 or more schools of medicine,
osteopathic medicine, dentistry, pharmacy,
nursing, allied health, or public health, or
graduate programs in mental health practice;
``(B) the schools of the consortium have entered
into an agreement for the allocation of such grant
among the schools; and
``(C) each of the schools agrees to expend the
grant in accordance with this section.
``(2) Authority regarding native americans 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--
``(A) the school has formed a consortium in
accordance with paragraph (1); and
``(B) the schools of the consortium collectively
meet such conditions, without regard to whether the
schools individually meet such conditions.''.
(3) Conforming amendments.--Section 739 of the Public
Health Service Act (42 U.S.C. 293c), as amended by subsection
(a), is amended--
(A) in subsection (b), in the matter preceding
paragraph (1), by inserting ``, subject to subsection
(c)(1)(C),'' after ``agrees''; and
(B) in subsection (d)--
(i) in paragraph (3), by striking ``(e)''
and inserting ``(e)(2)''; and
(ii) by adding at the end the following
paragraph:
``(4) Rule of construction.--Except as provided in
paragraph (3) regarding a consortium under subsection (e)(2), a
health professions school that does not meet the conditions
specified in subsection (c)(1)(B) may not be designated as a
center of excellence for purposes of this section. The
preceding sentence applies without regard to whether a grant
under subsection (a) is, pursuant to subsection (c)(1)(C),
being expended with respect to the school.''.
(d) Modifications Regarding Historically Black Colleges and
Universities.--Section 739(c)(2) of the Public Health Service Act (42
U.S.C. 293c(c)(2), as amended by subsection (a), is amended to read as
follows:
``(2) African-american centers of excellence.--
``(A) The conditions specified in this paragraph
are that--
``(i) with respect to African American
individuals, each of clauses (i) through (iv)
of paragraph (1)(B) applies to the designated
health professions school involved; and
``(ii) the school agree, as a condition of
receiving a grant under subsection (a), that
the school will, in carrying out the duties
described in subsection (b), give priority to
carrying out the duties with respect to African
American individuals.
``(B) The following historically black colleges or
universities shall be considered to meet the conditions
specified in subparagraph (A): Meharry Medical College
School of Medicine. Meharry Medical College School of
Dentistry. Morehouse School of Medicine. Tuskegee
University School of Veterinary Medicine. Florida A&M
University College of Pharmacy. Texas Southern
University College of Pharmacy. Xavier University
College of Pharmacy. Howard Medical College. Charles R.
Drew University of Medicine and Science.''.
(e) Definition of Health Professions School.--
(1) Graduate programs in mental health practice.--Section
739(h)(1)(A) of the Public Health Service Act (42 U.S.C.
293c(h)(1)(A)), as amended by subsection (a), is amended by--
(A) by striking ``or'' after ``dentistry''; and
(B) by inserting before the period the following:
``, or a graduate program in mental health practice''.
(2) Limitation.--During the fiscal years 1995 through 1997,
the Secretary of Health and Human Services may not make more
than one grant under section 739 of the Public Health Service
Act directly to a graduate program in mental health practice
(as defined in section 799 of such Act).
(f) Funding.--Section 739(i) of the Public Health Service Act (42
U.S.C. 293c(i)), as amended by subsection (a), is amended to read as
follows:
``(i) Funding.--
``(1) Authorization of appropriations.--For the purpose of
making grants under subsection (a), there are authorized to be
appropriated $24,000,000 for fiscal year 1995, $26,000,000 for
fiscal year 1996, and $28,000,000 for fiscal year 1997.
``(2) Allocations by secretary.--
``(A) Of the amounts appropriated under paragraph
(1) for a fiscal year, the Secretary shall reserve an
amount equal to the amount appropriated for carrying
out this section for fiscal year 1994, and shall make
the amount so reserved available as follows:
``(i) The Secretary shall make available
$13,700,000 for grants under subsection (a) to
designated health professions schools that are
eligible for such grants pursuant to meeting
the conditions described in paragraph (2) of
subsection (c).
``(ii) Of the amounts so reserved and
available after compliance with clause (i), the
Secretary shall make available $7,200,000 for
grants under subsection (a) to designated
health professions schools that are eligible
for such grants pursuant to meeting the
conditions described in paragraph (3) or (4) of
subsection (c) (including meeting conditions
pursuant to subsection (e)(2)).
``(iii)(I) Of the amounts so reserved and
available after compliance with clause (i), the
Secretary shall, subject to subclause (II),
make available $2,500,000 for grants under
subsection (a) to designated health professions
schools that are eligible for such grants
pursuant to meeting the conditions described in
paragraph (5) of subsection (c).
``(II) A grant under subsection (a) that
includes amounts available under clause (i) or
(ii) may not include amounts available under
this clause.
``(B) In the case of amounts appropriated under
paragraph (1) for a fiscal year and available after the
Secretary reserves the amount required in subparagraph
(A), the following applies: Grants under subsection (a)
from such amounts may be made to a designated health
professions school only if--
``(i) the school has not previously
received any grant under such subsection (or
under section 782 as in effect on the day
before the date of the enactment of Public Law
102-408); or
``(ii) the amount of the most recent grant
under subsection (a) (or under such section
782, as the case may be) that the school
received before such year is below the mean
average amount of the grants that were made
under such subsection for the fiscal year
involved.''.
(g) Conforming Amendments.--Section 739(b) of the Public Health
Service Act (42 U.S.C. 293c(b)), as amended by subsection (a), is
amended--
(1) in paragraph (3)(B), by striking ``the designated
health professions school'' and inserting ``the school''; and
(2) in paragraph (4), in each of subparagraphs (B) and (C),
by striking ``the designated health professions school'' and
inserting ``the school''.
(h) Transitional and Savings Provisions.--
(1) In general.--In the case of any entity receiving a
grant under section 739 of the Public Health Service Act for
fiscal year 1994, the Secretary of Health and Human Services
may, during the period specified in paragraph (2), waive any or
all of the additional requirements established pursuant to this
section for the receipt or expenditure of such a grant, subject
to the entity providing assurances satisfactory to the
Secretary that the entity is making progress toward meeting
such requirements.
(2) Relevant period.--In the case of any entity receiving a
grant under section 739 of the Public Health Service Act for
fiscal year 1994, the period referred to in paragraph (1) is
the period that, in first approving the grant, the Secretary
specified as the duration of the grant.
SEC. 305. EDUCATIONAL ASSISTANCE REGARDING UNDERGRADUATES.
(a) In General.--Section 740 of the Public Health Service Act (42
U.S.C. 293d) is amended to read as follows:
``SEC. 740. ASSISTANCE REGARDING HEALTH PROFESSIONS AS CAREER CHOICE.
``(a) In General.--
``(1) Academic preparation of students.--Subject to the
provisions of this section, the Secretary may make grants and
enter into contracts for purposes of--
``(A) identifying individuals who--
``(i) are students of elementary schools,
or students or graduates of secondary schools
or of institutions of higher education;
``(ii) are from disadvantaged backgrounds;
and
``(iii) are interested in a career in the
health professions; and
``(B) providing to such individuals academic
assistance, counseling, and other services to prepare
the students to meet the academic requirements for
entry into health professions schools.
``(2) Recipients of grants and contracts.--The Secretary
may make an award of a grant or contract under paragraph (1)
only if the applicant for the award is a nonprofit private
community-based organization or other public or nonprofit
private entity. Such other entities include schools of
medicine, osteopathic medicine, public health, dentistry,
veterinary medicine, optometry, pharmacy, allied health,
chiropractic, and podiatric medicine, and include graduate
programs in mental health practice.
``(3) Certain uses of awards.--The purposes for which the
Secretary may authorize an award under paragraph (1) to be
expended include the following:
``(A) Assisting elementary and secondary schools
and institutions of higher education in developing or
improving programs to prepare students to meet the
academic requirements for entry into health professions
schools.
``(B) Establishing arrangements with nonprofit
private community-based providers of primary health
services under which students are provided with
opportunities to visit or work at facilities of such
providers and gain experience regarding a career in a
field of primary health care.
``(C) Developing or improving programs to enhance
the academic preparation of advanced, prehealth
professions students or postbaccalaureate individuals
to successfully enter a health professions school.
``(D) In the case of an award under paragraph (1)
that the Secretary has authorized to be expended for
the purpose described in subparagraph (B) or (C),
paying such stipends as the Secretary may approve for
individuals from disadvantaged backgrounds 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 of $25 per day (notwithstanding any other
provision of law regarding the amount of stipends).
``(b) Minimum Requirements for Awards.--
``(1) Assurances regarding financial capacity.--The
Secretary may make an award of a grant or contract under
subsection (a) only if the applicant provides assurances
satisfactory to the Secretary that, with respect to the
activities for which the award is to be made, the applicant has
or will have the financial capacity to continue the activities
after the eligibility of the applicant for such awards for such
activities is terminated pursuant to subsection (e).
``(2) Collaboration among various entities.--The Secretary
may make an award of a grant or contract under subsection (a)
only if the applicant for the award has entered into an
agreement with any schools, institutions, community-based
organizations, or other entities with which the applicant will
collaborate in carrying out activities under the award, and the
agreement specifies whether and to what extent the award will
be allocated among the applicant and the entities.
``(3) Matching funds.--
``(A) With respect to the costs of the activities
to be carried out under subsection (a) by an applicant,
the Secretary may make an award of a grant or contract
under such subsection only if the applicant agrees to
make available (directly or through donations from
public or private entities), in cash, non-Federal
contributions toward such costs in an amount that--
``(i) for any second fiscal year for which
the applicant receives such a grant, is not
less than 20 percent of such costs;
``(ii) for any third such fiscal year, is
not less than 20 percent of such costs;
``(iii) for any fourth such fiscal year, is
not less than 40 percent of such costs;
``(iv) for any fifth such fiscal year, is
not less than 60 percent of such costs; and
``(v) for any sixth or subsequent such
fiscal year, is not less than 80 percent of
such costs.
``(B) Amounts provided by the Federal Government
may not be included in determining the amount of non-
Federal contributions required in subparagraph (A).
``(C) The Secretary may not require non-Federal
contributions for the first fiscal year for which an
applicant receives a grant under subsection (a).
``(c) Preference in Making Awards.--
``(1) In general.--Subject to paragraph (2), in making
awards of grants and contracts under subsection (a), the
Secretary shall give preference to any applicant that has made
an arrangement with 1 or more elementary schools, an
arrangement with 1 or more secondary schools, an arrangement
with 1 or more institutions of higher education, an arrangement
with 1 or more health professions schools, and an arrangement
with 1 or more community-based organizations, the purpose of
which arrangements is to establish a program as follows:
``(A) With respect to the elementary schools
involved, the program carries out the purposes
described in subsection (a)(1).
``(B) After a student identified pursuant to
paragraph (1) enters the secondary school involved, the
program continues to carry out such purposes with
respect to the student.
``(C) After graduating from the secondary school,
the student enters the institution of higher education
involved, subject to meeting reasonable academic
requirements, and the program continues to carry out
such purposes with respect to the student.
``(D) After graduating from the institution of
higher education, the student enters the health
professions school involved, subject to meeting
reasonable academic requirements.
``(2) Requirement regarding schools and institutions.--For
purposes of paragraph (1), an applicant may not receive
preference unless the schools or institutions with which
arrangements have been made are schools or institutions whose
enrollment of students includes a significant number of
individuals from disadvantaged backgrounds.
``(d) Limitation on Years of Funding for Particular Activities.--
With respect to a particular activity carried out under paragraph (1)
or (3) of subsection (a) by an entity, the Secretary may not, for the
activity involved, provide more than 6 years of financial assistance
under such subsection to the entity.
``(e) Funding.--
``(1) Authorization of appropriations.--For the purpose of
carrying out this section and section 736, there are authorized
to be appropriated $32,000,000 for fiscal year 1995,
$36,000,000 for fiscal year 1996, and $38,000,000 for fiscal
year 1997.
``(2) Allocations.--Of the amounts appropriated under
paragraph (1) for a fiscal year, the Secretary shall obligate
not less than 20 percent for carrying out subsection (a)(3)(B)
and not less than 20 percent for providing scholarships under
section 736.''.
(b) Transitional and Savings Provision.--In the case of an entity
that received an award of a grant or contract for fiscal year 1994
under section 740 of the Public Health Service Act, the Secretary of
Health and Human Services may continue in effect the award in
accordance with the terms of the award, subject to the duration of the
award not exceeding the period determined by the Secretary in first
approving the award. The preceding sentence applies notwithstanding the
amendment made by subsection (a) of this section.
SEC. 306. STUDENT LOANS REGARDING SCHOOLS OF NURSING.
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.''.
SEC. 307. FEDERALLY-SUPPORTED STUDENT LOAN FUNDS.
(a) Authorization of Appropriations Regarding Certain Medical
Schools.--
(1) In general.--Subpart II of part A of title VII of the
Public Health Service Act (42 U.S.C. 292q et seq.) is amended--
(A) by transferring subsection (f) of section 735
from the current placement of the subsection;
(B) by adding the subsection at the end of section
723;
(C) by redesignating the subsection as subsection
(e); and
(D) in subsection (e)(1) of section 723 (as so
redesignated), by striking ``1996'' and inserting
``1997''.
(2) Conforming amendments.--Section 723 of the Public
Health Service Act (42 U.S.C. 292s), as amended by paragraph
(1) of this subsection, is amended in subsection (e)(2)(A)--
(A) by striking ``section 723(b)(2)'' and inserting
``subsection (b)(2)''; and
(B) by striking ``such section'' and inserting
``such subsection''.
(b) Authorization of Appropriations Regarding Individuals From
Disadvantaged Backgrounds.--Section 724(f)(1) of the Public Health
Service Act (42 U.S.C. 292t(f)(1)) is amended to read as follows:
``(1) In general.--With respect to making Federal capital
contributions to student loan funds for purposes of subsection
(a), other than the student loan fund of any school of medicine
or osteopathic medicine, there is authorized to be appropriated
$5,000,000 for each of the fiscal years 1995 through 1997.''.
TITLE IV--RESEARCH
SEC. 401. OFFICE OF RESEARCH ON MINORITY HEALTH.
Section 404 of the Public Health Service Act, as added by section
151 of Public Law 103-43, is amended by adding at the end the following
subsections:
``(c) Plan.--Subject to applicable law, the Director of the Office,
in consultation with the advisory committee established under
subsection (d), shall develop and implement a plan for carrying out the
duties established in subsection (b). The Director shall review the
plan not less than annually, and revise the plan as appropriate.
``(d) Advisory Committee.--
``(1) In carrying out subsection (b), the Director of the
Office shall establish an advisory committee to be known as the
Advisory Committee on Research on Minority Health (in this
subsection referred to as the `Committee').
``(2)(A) The Committee shall be composed of nonvoting, ex
offico members designated in accordance with subparagraph (B)
and voting members appointed in accordance with subparagraph
(C).
``(B) The Secretary shall designate as ex officio members
of the Committee the Directors of each of the national research
institutes and the Deputy Assistant Secretary for Minority
Health (except that any of such officials may designate another
officer or employee of the office or agency involved to serve
as a member of the Committee in lieu of the official).
``(C) The Director of the Office shall appoint as voting
members of the Committee not fewer than 12 and not more than 18
individuals who are not officers or employees of the Federal
Government. The appointments shall be made from among
scientists and health professionals whose clinical practice,
research specialization, or professional expertise includes
significant expertise in research on minority health. The
appointed membership of the Advisory Committee shall be broadly
representative of the various minority groups.
``(3) The Director of the Office shall serve as the chair
of the Committee.
``(4) The Committee shall--
``(A) advise the Director of the Office on
appropriate research activities to be undertaken by the
national research institutes with respect to--
``(i) research on minority health;
``(ii) research on racial and ethnic
differences in clinical drug trials, including
responses to pharmacological drugs;
``(iii) research on racial and ethnic
differences in disease etiology, course, and
treatment; and
``(iv) research on minority health
conditions which require a multidisciplinary
approach;
``(B) report to the Director of the Office on such
research;
``(C) provide recommendations to such Director
regarding activities of the Office (including
recommendations on priorities in carrying out research
described in subparagraph (A)); and
``(D) assist in monitoring compliance with section
492B regarding the inclusion of minorities in clinical
research.
``(5)(A) The Advisory Committee shall prepare biennial
reports describing the activities of the Committee, including
findings made by the Committee regarding--
``(i) compliance with section 492B;
``(ii) the extent of expenditures made for research
on minority health by the agencies of the National
Institutes of Health; and
``(iii) the level of funding needed for such
research.
``(B) Each report under subparagraph (A) shall be submitted
to the Director of NIH for inclusion in the report required in
section 403 for the period involved.
``(e) Representation of Minorities Among Researchers.--The
Secretary, acting through the Assistant Secretary for Personnel and in
collaboration with the Director of the Office, shall determine the
extent to which the various minority groups are represented among
administrators, senior physicians, and scientists of the national
research institutes and among physicians and scientists conducting
research with funds provided by such institutes, and as appropriate,
carry out activities to increase the extent of such representation.
``(f) Requirement Regarding Grants and Contracts.--Any award of a
grant, cooperative agreement, or contract that the Director of the
Office is authorized to make shall be made only on a competitive basis.
``(g) Definitions.--For purposes of this section:
``(1) The term `minority health conditions', with respect
to individuals who are members of minority groups, means all
diseases, disorders, and conditions (including with respect to
mental health)--
``(A) unique to, more serious, or more prevalent in
such individuals;
``(B) for which the factors of medical risk or
types of medical intervention are different for such
individuals, or for which it is unknown whether such
factors or types are different for such individuals; or
``(C) with respect to which there has been
insufficient clinical research involving such
individuals as subjects or insufficient clinical data
on such individuals.
``(2) The term `research on minority health' means research
on minority health conditions, including research on preventing
such conditions.
``(3) The term `minority groups' has the meaning given such
term in section 1707(h).''.
SEC. 402. ACTIVITIES OF AGENCY FOR HEALTH CARE POLICY AND RESEARCH.
Title IX of the Public Health Service Act (42 U.S.C. 299 et seq.)
is amended--
(1) in section 902, by amending subsection (b) to read as
follows:
``(b) Requirements With Respect to Certain Populations.--In
carrying out subsection (a), the Administrator shall undertake and
support research, demonstration projects, and evaluations with respect
to the health status of, and the delivery of health care to--
``(1) the populations of medically underserved urban or
rural areas (including frontier areas); and
``(2) low-income groups, minority groups, and the
elderly.''; and
(2) in section 926(a), by adding at the end the following
sentence: ``Of the amounts appropriated under the preceding
sentence for a fiscal year, the Administrator shall reserve not
less than 8 percent for carrying out section 902(b)(2).''.
TITLE V--NATIVE HAWAIIAN HEALTH CARE
SEC. 501. CLARIFICATION OF 1992 AMENDMENTS.
(a) Clarification of Date of Passage.--Section 9168 of the
Department of Defense Appropriations Act, 1993 (106 Stat. 1948) is
amended by striking ``September 12, 1992,'' and inserting ``August 7,
1992,''.
(b) Effective Date.--The amendment made by subsection (a) shall
take effect as of October 6, 1992.
SEC. 502. AMENDMENT OF NATIVE HAWAIIAN HEALTH CARE IMPROVEMENT ACT TO
REFLECT 1992 AGREEMENT.
Effective on the date of enactment of this Act, the Native Hawaiian
Health Care Improvement Act (42 U.S.C.11701 et seq.) is amended to read
as follows:
``SECTION 1. SHORT TITLE.
``This Act may be cited as the `Native Hawaiian Health Care
Improvement Act'.
``SEC. 2. FINDINGS; DECLARATION OF POLICY; INTENT OF CONGRESS.
``(a) Findings.--The Congress finds that--
``(1) the United States retains the legal responsibility to
enforce the administration of the public trust responsibility
of the State of Hawaii for the betterment of the conditions of
Native Hawaiians under section 5(f) of Public Law 86-3 (73
Stat. 6; commonly referred to as the `Hawaii Statehood
Admissions Act');
``(2) in furtherance of the State of Hawaii's public trust
responsibility for the betterment of the conditions of Native
Hawaiians, contributions by the United States to the provision
of comprehensive health promotion and disease prevention
services to maintain and improve the health status of Native
Hawaiians are consistent with the historical and unique legal
relationship of the United States with the government that
represented the indigenous native people of Hawaii; and
``(3) it is the policy of the United States to raise the
health status of Native Hawaiians to the highest possible level
and to encourage the maximum participation of Native Hawaiians
in order to achieve this objective.
``(b) Declaration of Policy.--The Congress hereby declares that it
is the policy of the United States in fulfillment of its special
responsibilities and legal obligations to the indigenous people of
Hawaii resulting from the unique and historical relationship between
the United States and the Government of the indigenous people of
Hawaii--
``(1) to raise the health status of Native Hawaiians to the
highest possible health level; and
``(2) to provide existing Native Hawaiian health care
programs with all resources necessary to effectuate this
policy.
``(c) Intent of Congress.--It is the intent of the Congress that
the Nation meet the following health objectives with respect to Native
Hawaiians by the year 2000:
``(1) Reduce coronary heart disease deaths to no more than
100 per 100,000.
``(2) Reduce stroke deaths to no more than 20 per 100,000.
``(3) Increase control of high blood pressure to at least
50 percent of people with high blood pressure.
``(4) Reduce blood cholesterol to an average of no more
than 200 mg/dl.
``(5) Slow the rise in lung cancer deaths to achieve a rate
of no more than 42 per 100,000.
``(6) Reduce breast cancer deaths to no more than 20.6 per
100,000 women.
``(7) Increase Pap tests every 1 to 3 years to at least 85
percent of women age 18 and older.
``(8) Increase fecal occult blood testing every 1 to 2
years to at least 50 percent of people age 50 and older.
``(9) Reduce diabetes-related deaths to no more than 34 per
100,000.
``(10) Reduce the most severe complications of diabetes as
follows:
``(A) End-stage renal disease to no more than 1.4
in 1,000.
``(B) Blindness to no more than 1.4 in 1,000.
``(C) Lower extremity amputation to no more than
4.9 in 1,000.
``(D) Perinatal mortality to no more than 2
percent.
``(E) Major congenital malformations to no more
than 4 percent.
``(11) Reduce infant mortality to no more than 7 deaths per
1,000 live births.
``(12) Reduce low birth weight to no more than 5 percent of
live births.
``(13) Increase first trimester prenatal care to at least
90 percent of live births.
``(14) Reduce teenage pregnancies to no more than 50 per
1,000 girls age 17 and younger.
``(15) Reduce unintended pregnancies to no more than 30
percent of pregnancies.
``(16) Increase to at least 60 percent the proportion of
primary care providers who provide age-appropriate
preconception care and counseling.
``(17) Increase years of healthy life to at least 65 years.
``(18) Eliminate financial barriers to clinical preventive
services.
``(19) Increase childhood immunization levels to at least
90 percent of 2-year-olds.
``(20) Reduce the prevalence of dental caries to no more
than 35 percent of children by age 8.
``(21) Reduce untreated dental caries so that the
proportion of children with untreated caries (in permanent or
primary teeth) is no more than 20 percent among children age 6
through 8 and no more than 15 percent among adolescents age 15.
``(22) Reduce edentulism to no more than 20 percent in
people age 65 and older.
``(23) Increase moderate daily physical activity to at
least 30 percent of the population.
``(24) Reduce sedentary lifestyles to no more than 15
percent of the population.
``(25) Reduce overweight to a prevalence of no more than 20
percent of the population.
``(26) Reduce dietary fat intake to an average of 30
percent of calories or less.
``(27) Increase to at least 75 percent the proportion of
primary care providers who provide nutrition assessment and
counseling or referral to qualified nutritionists or
dieticians.
``(28) Reduce cigarette smoking prevalence to no more than
15 percent of adults.
``(29) Reduce initiation of smoking to no more than 15
percent by age 20.
``(30) Reduce alcohol-related motor vehicle crash deaths to
no more than 8.5 per 100,000 adjusted for age.
``(31) Reduce alcohol use by school children age 12 to 17
to less than 13 percent.
``(32) Reduce marijuana use by youth age 18 to 25 to less
than 8 percent.
``(33) Reduce cocaine use by youth age 18 to 25 to less
than 3 percent.
``(34) Confine HIV infection to no more than 800 per
100,000.
``(35) Reduce gonorrhea infections to no more than 225 per
100,000.
``(36) Reduce syphilis infections to no more that 10 per
100,000.
``(37) Reduce significant hearing impairment to a
prevalance of no more than 82 per 1,000.
``(38) Reduce acute middle ear infections among children
age 4 and younger, as measured by days of restricted activity
or school absenteeism, to no more than 105 days per 100
children.
``(39) Reduce indigenous cases of vaccine-preventable
diseases as follows:
``(A) Diphtheria among individuals age 25 and
younger to 0.
``(B) Tetanus among individuals age 25 and younger
to 0.
``(C) Polio (wild-type virus) to 0.
``(D) Measles to 0.
``(E) Rubella to 0.
``(F) Congenital Rubella Syndrome to 0.
``(G) Mumps to 500.
``(H) Pertussis to 1,000.
``(40) Reduce significant visual impairment to a prevalence
of no more than 30 per 1,000.
``(d) Report.--The Secretary shall submit to the President, for
inclusion in each report required to be transmitted to the Congress
under section 9, a report on the progress made toward meeting each of
the objectives described in subsection (c).
``SEC. 3. COMPREHENSIVE HEALTH CARE MASTER PLAN FOR NATIVE HAWAIIANS.
``The Secretary may make a grant to, or enter into a contract with,
Papa Ola Lokahi for the purpose of coordinating, implementing, and
updating a Native Hawaiian comprehensive health care master plan
designed to promote comprehensive health promotion and disease
prevention services and to maintain and improve the health status of
Native Hawaiians. The master plan shall be based upon an assessment of
the health care status and health care needs of Native Hawaiians. To
the extent practicable, assessments made as of the date of such grant
or contract shall be used by Papa Ola Lokahi, except that any such
assessment shall be updated as appropriate.
``SEC. 4. NATIVE HAWAIIAN HEALTH CARE SYSTEMS.
``(a) Comprehensive Health Promotion, Disease Prevention, and
Primary Health Services.--(1)(A) The Secretary, in consultation with
Papa Ola Lokahi, may make grants to, or enter into contracts with, any
qualified entity for the purpose of providing comprehensive health
promotion and disease prevention services as well as primary health
services to Native Hawaiians.
``(B) In making grants and entering into contracts under this
paragraph, the Secretary shall give preference to Native Hawaiian
health care systems and Native Hawaiian organizations, and, to the
extent feasible, health promotion and disease prevention services shall
be performed through Native Hawaiian health care systems.
``(2) In addition to paragraph (1), the Secretary may make a grant
to, or enter into a contract with, Papa Ola Lokahi for the purpose of
planning Native Hawaiian health care systems to serve the health needs
of Native Hawaiian communities on the islands of O'ahu, Moloka'i, Maui,
Hawai'i, Lana'i, Kaua'i, and Ni'ihau in the State of Hawaii.
``(b) Qualified Entity.--An entity is a qualified entity for
purposes of subsection (a)(1) if the entity is a Native Hawaiian health
care system.
``(c) Services To Be Provided.--(1) Each recipient of funds under
subsection (a)(1) shall provide the following services:
``(A) Outreach services to inform Native Hawaiians of the
availability of health services.
``(B) Education in health promotion and disease prevention
of the Native Hawaiian population by (wherever possible) Native
Hawaiian health care practitioners, community outreach workers,
counselors, and cultural educators.
``(C) Services of physicians, physicians' assistants, or
nurse practitioners.
``(D) Immunizations.
``(E) Prevention and control of diabetes, high blood
pressure, and otitis media.
``(F) Pregnancy and infant care.
``(G) Improvement of nutrition.
``(2) In addition to the mandatory services under paragraph (1),
the following services may be provided pursuant to subsection (a)(1):
``(A) Identification, treatment, control, and reduction of
the incidence of preventable illnesses and conditions endemic
to Native Hawaiians.
``(B) Collection of data related to the prevention of
diseases and illnesses among Native Hawaiians.
``(C) Services within the meaning of the terms `health
promotion', `disease prevention', and `primary health
services', as such terms are defined in section 10, which are
not specifically referred to in paragraph (1) of this
subsection.
``(3) The health care services referred to in paragraphs (1) and
(2) which are provided under grants or contracts under subsection
(a)(1) may be provided by traditional Native Hawaiian healers.
``(d) Limitation on Number of Entities.--During a fiscal year, the
Secretary under this Act may make a grant to, or hold a contract with,
not more than 5 Native Hawaiian health care systems.
``(e) Matching Funds.--(1) The Secretary may not make a grant or
provide funds pursuant to a contract under subsection (a)(1) to an
entity--
``(A) in an amount exceeding 75 percent of the costs of
providing health services under the grant or contract; and
``(B) unless the entity agrees that the entity will make
available, directly or through donations to the entity, non-
Federal contributions toward such costs in an amount equal to
not less than $1 (in cash or in kind under paragraph (2)) for
each $3 of Federal funds provided in such grant or contract.
``(2) Non-Federal contributions required in paragraph (1) may be in
cash or in kind, fairly evaluated, including plant, equipment, or
services. Amounts provided by the Federal Government or services
assisted or subsidized to any significant extent by the Federal
Government may not be included in determining the amount of such non-
Federal contributions.
``(3) The Secretary may waive the requirement established in
paragraph (1) if--
``(A) the entity involved is a nonprofit private entity
described in subsection (b); and
``(B) the Secretary, in consultation with Papa Ola Lokahi,
determines that it is not feasible for the entity to comply
with such requirement.
``(f) Restriction on Use of Grant and Contract Funds.--The
Secretary may not make a grant to, or enter into a contract with, an
entity under subsection (a)(1) unless the entity agrees that amounts
received pursuant to such subsection will not, directly or through
contract, be expended--
``(1) for any purpose other than the purposes described in
subsection (c);
``(2) to provide inpatient services;
``(3) to make cash payments to intended recipients of
health services; or
``(4) to purchase or improve real property (other than
minor remodeling of existing improvements to real property) or
to purchase major medical equipment.
``(g) Limitation on Charges for Services.--The Secretary may not
make a grant, or enter into a contract with, an entity under subsection
(a)(1) unless the entity agrees that, whether health services are
provided directly or through contract--
``(1) health services under the grant or contract will be
provided without regard to ability to pay for the health
services; and
``(2) the entity will impose a charge for the delivery of
health services, and such charge--
``(A) will be made according to a schedule of
charges that is made available to the public, and
``(B) will be adjusted to reflect the income of the
individual involved.
``SEC. 5. FUNCTIONS OF, AND GRANTS TO, PAPA OLA LOKAHI.
``(a) Functions.--Papa Ola Lokahi shall--
``(1) coordinate, implement, and update, as appropriate,
the comprehensive health care master plan developed pursuant to
section 3;
``(2) to the maximum extent possible, coordinate and assist
the health care programs and services provided to Native
Hawaiians;
``(3) provide for the training of the persons described in
section 4(c)(1)(B);
``(4) develop an action plan outlining the contributions
that each member organization of Papa Ola Lokahi will make in
carrying out this Act;
``(5) serve as a clearinghouse for--
``(A) the collection and maintenance of data
associated with the health status of Native Hawaiians;
``(B) the identification of and research into
diseases affecting Native Hawaiians;
``(C) the availability of Native Hawaiian project
funds, research projects, and publications;
``(D) the timely dissemination of information
relating to Native Hawaiian health care systems;
``(6) perform the recognition and certification functions
specified in sections 10(6)(F) and 10(6)(G); and
``(7) provide technical support and coordination of
training and technical assistance to Native Hawaiian health
care systems.
``(b) Special Project Funds.--Papa Ola Lokahi may receive project
funds that may be appropriated for the purpose of research on the
health status of Native Hawaiians or for the purpose of addressing the
health care needs of Native Hawaiians.
``(c) Grants.--In addition to any other grant or contract under
this Act, the Secretary may make grants to, or enter into contracts
with, Papa Ola Lokahi for--
``(1) carrying out the functions described in subsection
(a); and
``(2) administering any special project funds received
under the authority of subsection (b).
``(d) Relationships With Other Agencies.--Papa Ola Lokahi may enter
into agreements or memoranda of understanding with relevant agencies or
organizations that are capable of providing resources or services to
Native Hawaiian health care systems.
``SEC. 6. ADMINISTRATION OF GRANTS AND CONTRACTS.
``(a) Terms and Conditions.--The Secretary shall include in any
grant made or contract entered into under this Act such terms and
conditions as the Secretary considers necessary or appropriate to
ensure that the objectives of such grant or contract are achieved.
``(b) Periodic Review.--The Secretary shall periodically evaluate
the performance of, and compliance with, grants and contracts under
this Act.
``(c) Administrative Requirements.--The Secretary may not make a
grant or enter into a contract under this Act with an entity unless the
entity--
``(1) agrees to establish such procedures for fiscal
control and fund accounting as may be necessary to ensure
proper disbursement and accounting with respect to the grant or
contract;
``(2) agrees to ensure the confidentiality of records
maintained on individuals receiving health services under the
grant or contract;
``(3) with respect to providing health services to any
population of Native Hawaiians a substantial portion of which
has a limited ability to speak the English language--
``(A) has developed and has the ability to carry
out a reasonable plan to provide health services under
the grant or contract through individuals who are able
to communicate with the population involved in the
language and cultural context that is most appropriate;
and
``(B) has designated at least one individual,
fluent in both English and the appropriate language, to
assist in carrying out the plan;
``(4) with respect to health services that are covered in
the plan of the State of Hawaii approved under title XIX of the
Social Security Act--
``(A) if the entity will provide under the grant or
contract any such health services directly--
``(i) the entity has entered into a
participation agreement under such plan; and
``(ii) the entity is qualified to receive
payments under such plan; and
``(B) if the entity will provide under the grant or
contract any such health services through a contract
with an organization--
``(i) the organization has entered into a
participation agreement under such plan; and
``(ii) the organization is qualified to
receive payments under such plan; and
``(5) agrees to submit to the Secretary and to Papa Ola
Lokahi an annual report that describes the utilization and
costs of health services provided under the grant or contract
(including the average cost of health services per user) and
that provides such other information as the Secretary
determines to be appropriate.
``(d) Contract Evaluation.--(1) If, as a result of evaluations
conducted by the Secretary, the Secretary determines that an entity has
not complied with or satisfactorily performed a contract entered into
under section 4, the Secretary shall, prior to renewing such contract,
attempt to resolve the areas of noncompliance or unsatisfactory
performance and modify such contract to prevent future occurrences of
such noncompliance or unsatisfactory performance. If the Secretary
determines that such noncompliance or unsatisfactory performance cannot
be resolved and prevented in the future, the Secretary shall not renew
such contract with such entity and is authorized to enter into a
contract under section 4 with another entity referred to in section
4(b) that provides services to the same population of Native Hawaiians
which is served by the entity whose contract is not renewed by reason
of this subsection.
``(2) In determining whether to renew a contract entered into with
an entity under this Act, the Secretary shall consider the results of
evaluation under this section.
``(3) All contracts entered into by the Secretary under this Act
shall be in accordance with all Federal contracting laws and
regulations except that, in the discretion of the Secretary, such
contracts may be negotiated without advertising and may be exempted
from the provisions of the Act of August 24, 1935 (40 U.S.C. 270a et
seq.).
``(4) Payments made under any contract entered into under this Act
may be made in advance, by means of reimbursement, or in installments
and shall be made on such conditions as the Secretary deems necessary
to carry out the purposes of this Act.
``(e) Limitation on Use of Funds for Administrative Expenses.--
Except for grants and contracts under section 5(c), the Secretary may
not make a grant to, or enter into a contract with, an entity under
this Act unless the entity agrees that the entity will not expend more
than 10 percent of amounts received pursuant to this Act for the
purpose of administering the grant or contract.
``(f) Report.--(1) For each fiscal year during which an entity
receives or expends funds pursuant to a grant or contract under this
Act, such entity shall submit to the Secretary and to Papa Ola Lokahi a
quarterly report on--
``(A) activities conducted by the entity under the grant or
contract;
``(B) the amounts and purposes for which Federal funds were
expended; and
``(C) such other information as the Secretary may request.
``(2) The reports and records of any entity which concern any grant
or contract under this Act shall be subject to audit by the Secretary,
the Inspector General of Health and Human Services, and the Comptroller
General of the United States.
``(g) Annual Private Audit.--The Secretary shall allow as a cost of
any grant made or contract entered into under this Act the cost of an
annual private audit conducted by a certified public accountant.
``SEC. 7. ASSIGNMENT OF PERSONNEL.
``(a) In General.--The Secretary is authorized to enter into an
agreement with any entity under which the Secretary is authorized to
assign personnel of the Department of Health and Human Services with
expertise identified by such entity to such entity on detail for the
purposes of providing comprehensive health promotion and disease
prevention services to Native Hawaiians.
``(b) Applicable Federal Personnel Provisions.--Any assignment of
personnel made by the Secretary under any agreement entered into under
the authority of subsection (a) shall be treated as an assignment of
Federal personnel to a local government that is made in accordance with
subchapter VI of chapter 33 of title 5, United States Code.
``SEC. 8. NATIVE HAWAIIAN HEALTH SCHOLARSHIPS.
``(a) Eligibility.--The Secretary is authorized to make scholarship
grants to students who--
``(1) meet the requirements of section 338A(b) of the
Public Health Service Act (42 U.S.C. 254l(b)); and
``(2) are Native Hawaiians.
``(b) Terms and Conditions.--(1) Scholarship grants provided under
subsection (a) shall be provided under the same terms and subject to
the same conditions, regulations, and rules that apply to scholarship
grants provided under section 338A of the Public Health Service Act (42
U.S.C. 254l), except that--
``(A) the provision of scholarships in each type of health
care profession training shall correspond to the need for each
type of health care professional to serve Native Hawaiian
health care systems, as identified by Papa Ola Lokahi;
``(B) in selecting scholarship recipients, the Secretary
shall give priority to individuals included on a list of
eligible applicants submitted by the Kamehameha Schools/Bishop
Estate;
``(C) the obligated service requirement for each
scholarship recipient shall be fulfilled through service, in
order of priority, in--
``(i) any one of the five Native Hawaiian health
care systems which, during the fiscal year in which the
obligated service requirement is assigned, has received
a grant or entered into a contract pursuant to section
4; or
``(ii) health professions shortage areas, medically
underserved areas, or geographic areas or facilities
similarly designated by the United States Public Health
Service in the State of Hawaii.
``(2) The Secretary shall enter into a cooperative agreement with
the Kamehameha Schools/Bishop Estate under which such organization
shall provide recruitment, retention, counseling, and other support
services intended to improve the operation of the scholarship program
established under this section.
``(3) The Native Hawaiian Health Scholarship program shall not be
administered by or through the Indian Health Service.
``SEC. 9. REPORT.
``The President shall, at the time the budget is submitted under
section 1105 of title 31, United States Code, for each fiscal year
transmit to the Congress the report required pursuant to section 2(d).
``SEC. 10. DEFINITIONS.
``For purposes of this Act:
``(1) Disease prevention.--The term `disease prevention'
includes--
``(A) immunizations,
``(B) control of high blood pressure,
``(C) control of sexually transmittable diseases,
``(D) prevention and control of diabetes,
``(E) control of toxic agents,
``(F) occupational safety and health,
``(G) accident prevention,
``(H) fluoridation of water,
``(I) control of infectious agents, and
``(J) provision of mental health care.
``(2) Health promotion.--The term `health promotion'
includes--
``(A) pregnancy and infant care, including
prevention of fetal alcohol syndrome,
``(B) cessation of tobacco smoking,
``(C) reduction in the misuse of alcohol and drugs,
``(D) improvement of nutrition,
``(E) improvement in physical fitness,
``(F) family planning, and
``(G) control of stress.
``(3) Native hawaiian.--The term `Native Hawaiian' means
any individual who is--
``(A) a citizen of the United States; and
``(B) a descendant of the aboriginal people, who
prior to 1778, occupied and exercised sovereignty in
the area that now constitutes the State of Hawaii, as
evidenced by--
``(i) genealogical records;
``(ii) Kupuna (elders) or Kama'aina (long-
term community residents) verification; or
``(iii) birth records of the State of
Hawaii.
``(4) Native hawaiian health center.--The term `Native
Hawaiian health center' means an entity--
``(A) which is organized under the laws of the
State of Hawaii,
``(B) which provides or arranges for health care
services through practitioners licensed by the State of
Hawaii, where licensure requirements are applicable,
``(C) which is a public or nonprofit private
entity, and
``(D) in which Native Hawaiian health practitioners
significantly participate in the planning, management,
monitoring, and evaluation of health services.
``(5) Native hawaiian organization.--The term `Native
Hawaiian organization' means any organization--
``(A) which serves the interests of Native
Hawaiians,
``(B) which is--
``(i) recognized by Papa Ola Lokahi for the
purpose of planning, conducting, or
administering programs (or portions of
programs) authorized under this Act for the
benefit of Native Hawaiians, and
``(ii) certified by Papa Ola Lokahi as
having the qualifications and capacity to
provide the services, and meet the
requirements, under the contract the
organization enters into with, or grant the
organization receives from, the Secretary under
this Act,
``(C) in which Native Hawaiian health practitioners
significantly participate in the planning, management,
monitoring, and evaluation of health services, and
``(D) which is a public or nonprofit private
entity.
``(6) Native hawaiian health care system.--The term `Native
Hawaiian health care system' means an entity--
``(A) which is organized under the laws of the
State of Hawaii;
``(B) which provides or arranges for health care
services through practitioners licensed by the State of
Hawaii, where licensure requirements are applicable;
``(C) which is a public or nonprofit private
entity;
``(D) in which Native Hawaiian health practitioners
significantly participate in the planning, management,
monitoring, and evaluation of health care services;
``(E) which may be composed of as many Native
Hawaiian health centers as necessary to meet the health
care needs of Native Hawaiians residing on the island
or islands served by such entity;
``(F) which is recognized by Papa Ola Lokahi for
the purpose of providing comprehensive health promotion
and disease prevention services as well as primary
health services to Native Hawaiians under this Act; and
``(G) which is certified by Papa Ola Lokahi as
having the qualifications and the capacity to provide
the services and meet the requirements of a contract
entered into, or a grant received, under section 4.
``(7) Papa ola lokahi.--(A) Subject to subparagraph (B),
the term `Papa Ola Lokahi' means an organization composed of--
``(i) E Ola Mau;
``(ii) the Office of Hawaiian Affairs of the State
of Hawaii;
``(iii) Alu Like Inc.;
``(iv) the University of Hawaii;
``(v) the Office of Hawaiian Health of the Hawaii
State Department of Health;
``(vi) Ho'ola Lahui Hawaii, or a health care system
serving the islands of Kaua'i and Ni'ihau;
``(vii) Ke Ola Mamo, or a health care system
serving the island of O'ahu;
``(viii) Na Pu'uwai or a health care system serving
the islands of Moloka'i and Lana'i;
``(ix) Hui No Ke Ola Pono, or a health care system
serving the island of Maui;
``(x) Hui Malama Ola Ha'Oiwi or a health care
system serving the island of Hawaii; and
``(xi) such other member organizations as the Board
of Papa Ola Lokahi may admit from time to time, based
upon satisfactory demonstration of a record of
contribution to the health and well-being of Native
Hawaiians, and upon satisfactory development of a
mission statement in relation to this Act, including
clearly defined goals and objectives, a 5-year action
plan outlining the contributions that each organization
will make in carrying out the policy of this Act, and
an estimated budget.
``(B) Such term does not include any organization
identified in subparagraph (A) if the Secretary determines that
such organization does not have a mission statement with
clearly defined goals and objectives for the contributions the
organization will make to Native Hawaiian health care systems
and an action plan for carrying out such goals and objectives.
``(8) Primary health services.--The term `primary health
services' means--
``(A) services of physicians, physicians'
assistants and nurse practitioners;
``(B) diagnostic laboratory and radiologic
services;
``(C) preventive health services (including
children's eye and ear examinations to determine the
need for vision and hearing correction, perinatal
services, well child services, and family planning
services);
``(D) emergency medical services;
``(E) transportation services as required for
adequate patient care;
``(F) preventive dental services; and
``(G) pharmaceutical services, as may be
appropriate for particular health centers.
``(9) Secretary.--The term `Secretary' means the Secretary
of Health and Human Services.
``(10) Traditional native hawaiian healer.--The term
`traditional Native Hawaiian healer' means a practitioner--
``(A) who--
``(i) is of Hawaiian ancestry, and
``(ii) has the knowledge, skills, and
experience in direct personal health care of
individuals, and
``(B) whose knowledge, skills, and experience are
based on a demonstrated learning of Native Hawaiian
healing practices acquired by--
``(i) direct practical association with
Native Hawaiian elders, and
``(ii) oral traditions transmitted from
generation to generation.
``SEC. 11. RULE OF CONSTRUCTION.
``Nothing in this Act shall be construed to restrict the authority
of the State of Hawaii to license health practitioners.
``SEC. 12. COMPLIANCE WITH BUDGET ACT.
``Any new spending authority (described in subsection (c)(2) (A) or
(B) of section 401 of the Congressional Budget Act of 1974) which is
provided under this Act shall be effective for any fiscal year only to
such extent or in such amounts as are provided in appropriation Acts.
``SEC. 13. SEVERABILITY.
``If any provision of this Act, or the application of any such
provision to any person or circumstances is held to be invalid, the
remainder of this Act, and the application of such provision or
amendment to persons or circumstances other than those to which it is
held invalid, shall not be affected thereby.
``SEC. 14. AUTHORIZATION OF APPROPRIATIONS.
``There is authorized to be appropriated for each of the fiscal
years 1994, 1995, 1996, 1997, 1998, 1999, and 2000 such sums as may be
necessary to carry out the purposes of this Act.
``SEC. 15. PROHIBITION AGAINST EXCLUSION FROM PARTICIPATION.
``Notwithstanding any other provision of this Act, no person shall,
on the basis of race, color, or national origin, be excluded from
participation in, or be denied the benefits of, or be subjected to
discrimination under, any program or activity receiving Federal
financial assistance under this Act.''.
SEC. 503. REPEAL OF PUBLIC HEALTH SERVICE ACT PROVISION.
The Public Health Service Act (42 U.S.C. 201 et seq.), as amended
by section 206 of this Act, is amended by repealing section 338K and
redesignating section 338L as section 338K. Such repeal shall not be
construed to terminate contracts in effect under such section on the
date of the enactment of this Act. Any such contracts shall continue
according to the terms and conditions of such contracts.
TITLE VI--MISCELLANEOUS PROVISIONS
SEC. 601. TECHNICAL AMENDMENT TO INDIAN HEALTH CARE IMPROVEMENT ACT.
The last sentence of section 818(e)(3) of the Indian Health Care
Improvement Act (25 U.S.C. 1680h(e)(3)) is amended--
(1) by striking ``services,'' and inserting ``services'';
and
(2) by striking ``, shall be recoverable.'' and inserting a
period.
SEC. 602. HEALTH SERVICES FOR PACIFIC ISLANDERS.
Section 10 of the Disadvantaged Minority Health Improvement Act of
1990 (42 U.S.C. 254c-1) is amended--
(1) in subsection (b)--
(A) by striking paragraphs (5) and (6);
(B) by redesignating paragraphs (7) and (8) as
paragraphs (5) and (6), respectively;
(C) in paragraph (1) (as so redesignated)--
(i) by inserting ``substance abuse'' after
``availability of health''; and
(ii) by striking ``, including improved
health data systems''; and
(D) in paragraph (2) (as so redesignated)--
(i) by striking ``manpower'' and inserting
``care providers''; and
(ii) by striking ``by--'' and all that
follows through the end thereof and inserting a
semicolon; and
(2) in subsection (f)--
(A) by striking ``there is'' and inserting ``there
are''; and
(B) by striking ``$10,000,000'' and all that
follows through ``1993'' and inserting ``$3,000,000 for
each of the fiscal years 1995 through 1997''.
SEC. 603. TECHNICAL CORRECTIONS REGARDING PUBLIC LAW 103-183.
(a) Amendatory Instructions.--Public Law 103-183 is amended--
(1) in section 301(a), by striking ``(42 U.S.C. 242 et
seq.)'' and inserting ``(42 U.S.C. 243 et seq.)'';
(2) 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)'';
(3) in section 602, by striking ```for the purpose'' and
inserting ```For the purpose''; and
(4) 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 part D of title III, by inserting before section
340D the following subpart heading:
``Subpart IX--Miscellaneous Provisions Regarding Primary Health Care'';
(4) 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;
(5) in section 1213(a)(8), by striking ``provides for for''
and inserting ``provides for'';
(6) in section 1501, by redesignating the second subsection
(c) (added by section 101(f) of Public Law 103-183) as
subsection (d); and
(7) 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)''.
SEC. 604. CERTAIN AUTHORITIES OF CENTERS FOR DISEASE CONTROL AND
PREVENTION.
Part B of title III of the Public Health Service Act (42 U.S.C. 243
et seq.), as amended pursuant to section 603(a)(1) of this Act and as
amended by section 703 of Public Law 103-183, is amended by inserting
after section 317F the following section:
``miscellaneous authorities regarding centers for disease control and
prevention
``Sec. 317G. (a) Technical and Scientific Peer Review Groups.--The
Secretary, acting through the Director of the Centers for Disease
Control and Prevention, may, without regard to the provisions of title
5, United States Code, governing appointments in the competitive
service, and without regard to the provisions of chapter 51 and
subchapter III of chapter 53 of such title relating to classification
and General Schedule pay rates, establish such technical and scientific
peer review groups and scientific program advisory committees as are
needed to carry out the functions of such Centers and appoint and pay
the members of such groups, except that officers and employees of the
United States shall not receive additional compensation for service as
members of such groups. The Federal Advisory Committee Act shall not
apply to the duration of such peer review groups. Not more than one-
fourth of the members of any such group shall be officers or employees
of the United States.
``(b) Fellowship and Training Programs.--The Secretary, acting
through the Director of the Centers for Disease Control and Prevention,
shall establish fellowship and training programs to be conducted by
such Centers to train individuals to develop skills in epidemiology,
surveillance, laboratory analysis, and other disease detection and
prevention methods. Such programs shall be designed to enable health
professionals and health personnel trained under such programs to work,
after receiving such training, in local State, national, and
international efforts toward the prevention and control of diseases,
injuries, and disabilities. Such fellowships and training may be
administered through the use of either appointment or nonappointment
procedures.''.
TITLE VII--GENERAL PROVISIONS
SEC. 701. EFFECTIVE DATE.
Except as otherwise provided in this Act, this Act takes effect
October 1, 1994, or upon the date of the enactment of this Act,
whichever occurs later.
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