[Congressional Bills 103th Congress]
[From the U.S. Government Publishing Office]
[S. 1569 Engrossed in Senate (ES)]
103d CONGRESS
2d Session
S. 1569
_______________________________________________________________________
AN ACT
To amend the Public Health Service Act to establish, reauthorize and
revise provisions to improve the health of individuals from
disadvantaged backgrounds, and for other purposes.
103d CONGRESS
2d Session
S. 1569
_______________________________________________________________________
AN ACT
To amend the Public Health Service Act to establish, reauthorize and
revise provisions to improve the health of individuals from
disadvantaged backgrounds, 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; REFERENCE; TABLE OF CONTENTS.
(a) Short Title.--This Act may be cited as the ``Disadvantaged
Minority Health Improvement Act of 1994''.
(b) Reference.--Except as otherwise expressly provided, whenever in
this Act an amendment or a repeal is expressed in terms of an amendment
to, or a repeal of, a section or other provision, the reference shall
be considered to be made to a section or other provision of the Public
Health Service Act (42 U.S.C. 201 et seq.).
(c) Table of Contents.--The table of contents is as follows:
Sec. 1. Short title; reference; table of contents.
Sec. 2. Findings.
TITLE I--HEALTH POLICY
Sec. 101. Office of Minority Health.
Sec. 102. Agency Offices of Minority Health.
Sec. 103. State Offices of Minority Health.
Sec. 104. Assistant Secretary of Health and Human Services for Civil
Rights.
TITLE II--HEALTH SERVICES
Sec. 201. Health services for residents of public housing.
Sec. 202. Issuance of regulations regarding language as impediment to
receipt of services.
Sec. 203. Health services for Pacific Islanders.
TITLE III--HEALTH PROFESSIONS
Sec. 301. Loans for disadvantaged students.
Sec. 302. Cesar Chavez primary care scholarship program.
Sec. 303. Thurgood Marshall scholarship program.
Sec. 304. Loan repayments and fellowships regarding faculty positions
at health professions schools.
Sec. 305. Centers of excellence.
Sec. 306. Educational assistance regarding undergraduates.
Sec. 307. Area health education centers.
TITLE IV--RESEARCH AND DATA COLLECTION
Sec. 401. Office of Research on Minority Health.
Sec. 402. Activities of Agency for Health Care Policy and Research.
Sec. 403. Data collection by National Center for Health Statistics.
TITLE V--MISCELLANEOUS
Sec. 501. Revision and extension of program for State Offices of Rural
Health.
Sec. 502. Technical corrections relating to health professions.
Sec. 503. Clinical traineeships.
Sec. 504. Demonstration project grants to States for Alzheimer's
disease.
Sec. 505. Medically underserved area study.
Sec. 506. Programs regarding birth defects.
Sec. 507. Demonstration projects regarding diabetic-retinopathy.
Sec. 508. Mexican Border State Analytical Laboratories.
Sec. 509. Construction of regional centers for research on primates.
TITLE VI--MULTIETHNIC PLACEMENT
Sec. 601. Short title.
Sec. 602. Findings and purpose.
Sec. 603. Multiethnic placements.
TITLE VII--VOLUNTARY MUTUAL REUNIONS
Sec. 701. Facilitation of reunions.
TITLE VIII--GENERAL PROVISIONS
Sec. 801. Effective date.
SEC. 2. FINDINGS.
Section 1(b) of the Disadvantaged Minority Health Improvement Act
of 1990 (42 U.S.C. 300u-6 note) is amended to read as follows--
``(b) Findings.--Congress finds that--
``(1) the health status of individuals from racial and
ethnic minorities in the United States is significantly lower
than the health status of the general population and has not
improved significantly since the issuance of the 1985 report
entitled ``Report of the Secretary's Task Force on Black and
Minority Health'';
``(2) racial and ethnic minorities are disproportionately
represented among the poor;
``(3) racial and ethnic minorities suffer
disproportionately high rates of cancer, heart disease,
diabetes, substance abuse, acquired immune deficiency syndrome,
and other diseases and disorders;
``(4) the incidence of infant mortality among African
Americans is almost double that for the general population;
``(5) Mexican-American and Puerto Rican adults have
diabetes rates twice that of non-Hispanic whites;
``(6) a third of American Indian deaths occur before the
age of 45;
``(7) according to the 1990 Census, African Americans,
Hispanics, American Indians, and Asian/Pacific Islanders
constitute approximately 12.1 percent, 9 percent, 0.08 percent,
and 2.9 percent, respectively, of the population of the United
States;
``(8) minority health professionals have historically
tended to practice in low-income areas, medically underserved
areas, and to serve racial and ethnic minorities;
``(9) minority health professionals have historically
tended to engage in the general practice of medicine and
specialties providing primary care;
``(10) reports published in leading medical journals
indicate that access to health care among minorities can be
substantially improved by increasing the number of minority
professionals;
``(11) diversity in the faculty and student body of health
professions schools enhances the quality of education for all
students attending the schools; and
``(12) health professionals need greater access to
continuing medical education programs to enable such
professionals to upgrade their skills (including linguistic and
cultural competence skills) and improve the quality of medical
care rendered in minority communities.''.
TITLE I--HEALTH POLICY
SEC. 101. OFFICE OF MINORITY HEALTH.
Section 1707 (42 U.S.C. 300u-6) is amended by striking subsection
(b) and all that follows and inserting the following:
``(b) Duties.--With respect to improving the health of racial and
ethnic minorities, the Secretary, acting through the Deputy Assistant
Secretary for Minority Health, shall carry out the following:
``(1) Establish short-range and long-range goals and
objectives and coordinate all other activities within the
Public Health Service that relate to disease prevention, health
promotion, service delivery, and research concerning such
individuals. The Director of the Centers for Disease Control
and Prevention, the Administrator of the Health Resources and
Services Administration, the Director of the Agency for Health
Care Policy and Research, the Administrator of the Substance
Abuse and Mental Health Services Administration and the
Director of the National Institutes of Health shall consult
with the Deputy Assistant Secretary for Minority Health to
ensure the coordination of all activities within the Public
Health Service as they relate to disease prevention, health
promotion, service delivery, and research concerning such
individuals.
``(2) Carry out the following types of activities by
entering into interagency agreements with other agencies of the
Public Health Service:
``(A) Support research, demonstrations and
evaluations to test new and innovative models.
``(B) Increase knowledge and understanding of
health risk factors.
``(C) Develop mechanisms that support better
information dissemination, education, prevention, and
service delivery to individuals from disadvantaged
backgrounds, including racial and ethnic minorities.
``(3) Support a national minority health resource center to
carry out the following:
``(A) Facilitate the exchange of information
regarding matters relating to health information and
health promotion, preventive health services, and
education in the appropriate use of health care.
``(B) Facilitate access to such information.
``(C) Assist in the analysis of issues and problems
relating to such matters.
``(D) Provide technical assistance with respect to
the exchange of such information (including
facilitating the development of materials for such
technical assistance).
``(4) Establish a national center that shall carry out
programs to improve access to health care services for
individuals with limited English proficiency by facilitating
the removal of impediments to the receipt of health care that
result from such limitation.
``(5) With respect to grants and contracts that are
available under certain minority health programs, the Secretary
shall ensure that the agencies of the Public Health Service--
``(A) inform entities, as appropriate, that the
entities may be eligible for the awards;
``(B) provide technical assistance to such entities
in the process of preparing and submitting applications
for the awards in accordance with the policies of the
Secretary regarding such application; and
``(C) inform populations, as appropriate, that
members of the populations may be eligible to receive
services or otherwise participate in the activities
carried out with such awards.
``(6) Not later than September 1 of each year, the Deputy
Assistant Secretary of Minority Health shall prepare and submit
to the Secretary a report summarizing the activities of each
Office of Minority Health within the Public Health Service,
including the Office of Research on Minority Health at the
National Institutes of Health.
``(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 the
development of goals and specific program activities under
subsection (b)(1) for each racial and ethnic group.
``(3) Chairperson.--The Deputy Assistant Secretary for
Minority Health shall serve as the Chairperson of the
Committee.
``(4) Composition.--The Committee shall be composed of no
fewer than 12, and not more than 18 individuals, who are not
officers or employees of the Federal Government. The Secretary
shall appoint the members of the Committee from among
individuals with expertise regarding issues of minority health.
The membership of the Committee shall be equitably
representative of the various racial and ethnic groups. The
Secretary may appoint representatives from selected Federal
agencies to serve as ex officio, non-voting members of the
Committee.
``(5) Terms.--Each member of the Committee shall serve for
a term of 4 years, except that the Secretary shall initially
appoint a portion of the members to terms of 1 year, 2 years,
and 3 years.
``(6) Vacancies.--If a vacancy occurs on the Committee, a
new member shall be appointed by the Secretary within 90 days
from the date that the vacancy occurs, and serve for the
remainder of the term for which the predecessor of such member
was appointed. The vacancy shall not affect the power of the
remaining members to execute the duties of the Committee.
``(7) Compensation.--Members of the Committee who are
officers or employees of the United States shall serve without
compensation. Members of the Committee who are not officers or
employees of the United States shall receive, for each day
(including travel time) they are engaged in the performance of
the functions of the Committee, compensation at rates that do
not exceed the daily equivalent of the annual rate in effect
for grade GS-18 of the General Schedule under title 5, United
States Code.
``(d) Certain Requirements Regarding Duties.--
``(1) Recommendations regarding language as impediment to
health care.--The Secretary, acting through the Director of the
Office of Refugee Health, the Director of the Office of Civil
Rights, and the Director of the Office of Minority Health of
the Health Resources and Services Administration, shall make
recommendations regarding activities under subsection (b)(4).
``(2) Equitable allocation regarding activities.--In
awarding grants or contracts under section 338A, 338B, 340A,
724, 737, 738, or 1707, the Secretary shall ensure that such
awards are equitably allocated with respect to the various
racial and ethnic populations.
``(3) Cultural competency 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.
``(4) Peer review.--The Secretary shall ensure that each
application for a grant, contract or cooperative agreement
under this section undergoes appropriate peer review.
``(e) Reports.--Not later than January 31 of fiscal year 1995 and
of each second year thereafter, the Secretary shall submit to the
Congress a report describing the activities carried out under this
section during the preceding 2 fiscal years and evaluating the extent
to which such activities have been effective in improving the health of
racial and ethnic minorities.
``(f) Grants and Contracts Regarding Duties.--
``(1) Authority.--In carrying out subsection (b), the
Secretary may enter into grants and contracts with public and
nonprofit private entities.
``(2) Evaluation and dissemination.--The Secretary shall,
directly or through contracts with public and private entities,
provide for evaluations of projects carried out with financial
assistance provided under paragraph (1) during the preceding 2
fiscal years. The report shall be included in the report
required under subsection (e) for the fiscal year involved.
``(g) Definition.--As used in this section, the term `racial and
ethnic minority group' means Hispanics, Blacks, Asian Americans,
Pacific Islanders, Native Americans, and Alaskan Natives. The term
`Hispanic' means individuals whose origin is Mexican, Puerto Rican,
Cuban, Central or South American, or any other Spanish-speaking
country, including Spain or the Caribbean Islands, and individuals
identifying themselves as Hispanic, Latino, Spanish, or Spanish-
American.
``(h) Funding.--
``(1) Authorization of appropriations.--For the purpose of
carrying out this section, there is authorized to be
appropriated $20,500,000 for fiscal year 1994, and such sums as
may be necessary for each of the fiscal years 1995 through
1998.
``(2) Allocation of funds by secretary.--Of the amounts
appropriated under paragraph (1) for a fiscal year in excess of
$15,000,000, the Secretary shall make available not less than
$3,000,000 for activities to improve access to health care
services for individuals with limited English proficiency,
including activities identified in subsection (b)(4).''.
SEC. 102. AGENCY OFFICES OF MINORITY HEALTH.
Title XVII (42 U.S.C. 300u et seq.) is amended by adding at the end
the following new section:
``SEC. 1709. AGENCY OFFICES OF MINORITY HEALTH.
``(a) In General.--The Secretary shall ensure that an Office of
Minority Health is operating at the Centers for Disease Control and
Prevention, the Health Resources and Services Administration, the
Substance Abuse and Mental Health Services Administration, and the
Agency for Health Care Policy and Research. Such Offices shall ensure
that services and programs carried out within each such respective
agency or office--
``(1) are equitably delivered with respect to racial and
ethnic groups;
``(2) provide culturally and linguistically competent
services; and
``(3) utilize racial and ethnic minority community-based
organizations to deliver services.
``(b) Reports.--Each Office of Minority Health within the Public
Health Service, including the Office of Research on Minority Health at
the National Institutes of Health, shall submit a report, not later
than May 1 of each year, to the Deputy Assistant Secretary for Minority
Health (as provided for in section 1707(b)) describing the
accomplishments or programs of the plan, the budget allocation and
expenditures for, and the development and implementation of, such
health programs targeting racial and ethnic minority populations. The
Secretary shall ensure the participation and cooperation of each Agency
in the development of the annual report.''.
SEC. 103. STATE OFFICES OF MINORITY HEALTH.
Title XVII (42 U.S.C. 300u et seq.), as amended by section 102, is
further amended by adding at the end the following new section:
``SEC. 1710. GRANTS TO STATES FOR OPERATION OF OFFICES OF MINORITY
HEALTH.
``(a) In General.--The Secretary, acting through the Deputy
Assistant Secretary for Minority Health (as provided for in section
1707), may make grants to States for the purpose of improving the
health status in minority communities, through the operation of State
offices of minority health established to monitor and facilitate the
achievement of the Health Objectives for the Year 2000 as they affect
minority populations.
``(b) Administration of Program.--The Secretary may not make a
grant to a State under subsection (a) unless such State agrees that the
program carried out by the State with amounts received under the grant
will be administered directly by a single State agency.
``(c) Certain Required Activities.--The Secretary may not make a
grant to a State under subsection (a) unless such State agrees that
activities carried out by an office operated under the grant received
pursuant to such subsection will--
``(1) establish and maintain within the State a
clearinghouse for collecting and disseminating information on--
``(A) minority health care issues;
``(B) research findings relating to minority health
care; and
``(C) innovative approaches to the delivery of
health care and social services in minority
communities;
``(2) coordinate the activities carried out in the State
that relate to minority health care, including providing
coordination for the purpose of avoiding redundancy in such
activities;
``(3) identify Federal and State programs regarding
minority health, and providing technical assistance to public
and nonprofit entities regarding participation in such program;
and
``(4) develop additional Healthy People 2000 objectives for
the State that are necessary to address the most prevalent
morbidity, mortality and disability concerns for racial and
ethnic minority groups in the State.
``(d) Requirement Regarding Annual Budget for the Office.--The
Secretary may not make a grant to a State under subsection (a) unless
such State agrees that, for any fiscal year for which the State
receives such a grant, the office operated under such grant will be
provided with an annual budget of not less than $75,000.
``(e) Certain Uses of Funds.--
``(1) Restrictions.--The Secretary may not make a grant to
a State under subsection (a) unless such State agrees that--
``(A) if research with respect to minority health
is conducted pursuant to the grant, not more than 10
percent of the amount received under the grant will be
expended for such research; and
``(B) amounts provided under the grant will not be
expended--
``(i) to provide health care (including
providing cash payments regarding such care);
``(ii) to conduct activities for which
Federal funds are expended--
``(I) within the State to provide
technical and other nonfinancial
assistance under subsection (m) of
section 340A;
``(II) under a memorandum of
agreement entered into with the State
under subsection (h) of such section;
or
``(III) under a grant under section
388I;
``(iii) to purchase medical equipment, to
purchase ambulances, aircraft, or other
vehicles, or to purchase major communications
equipment;
``(iv) to purchase or improve real
property; or
``(v) to carry out any activity regarding a
certificate of need.
``(2) Authorities.--Activities for which a State may expend
amounts received under a grant under subsection (a) include--
``(A) paying the costs of establishing an office of
minority health for purposes of subsection (a);
``(B) subject to paragraph (1)(B)(ii)(III), paying
the costs of any activity carried out with respect to
recruiting and retaining health professionals to serve
in minority communities or underserved areas in the
State; and
``(C) providing grants and contracts to public and
nonprofit entities to carry out activities authorized
in this section.
``(f) Reports.--The Secretary may not make a grant to a State under
subsection (a) unless such State agrees--
``(1) to submit to the Secretary reports containing such
information as the Secretary may require regarding activities
carried out under this section by the State; and
``(2) to submit a report not later than January 10 of each
fiscal year immediately following any fiscal year for which the
State has received such a grant.
``(g) Reimbursement of Application.--The Secretary may not make a
grant to a State under subsection (a) unless an application for the
grant is submitted to the Secretary and the application 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
such subsection.
``(h) Noncompliance.--The Secretary may not make payments under
subsection (a) to a State for any fiscal year subsequent to the first
fiscal year of such payments unless the Secretary determines that, for
the immediately preceding fiscal year, the State has complied with each
of the agreements made by the State under this section.
``(i) Authorization of Appropriations.--
``(1) In general.--For purposes of making grants under
subsection (a) there are authorized to be appropriated
$3,000,000 for fiscal year 1995, $4,000,000 for fiscal year
1996, and $3,000,000 for fiscal year 1997.
``(2) Availability.--Amounts appropriated under paragraph
(1) shall remain available until expended.
``(j) Termination of Program.--No grant may be made under this
section after the aggregate amounts appropriated under subsection
(i)(1) are equal to $10,000,000.''.
SEC. 104. ASSISTANT SECRETARY OF HEALTH AND HUMAN SERVICES FOR CIVIL
RIGHTS.
(a) In General.--Part A of title II (42 U.S.C. 202 et seq.), as
amended by section 2010 of Public Law 103-43, is amended by adding at
the end the following new section:
``SEC. 229. ASSISTANT SECRETARY FOR CIVIL RIGHTS.
``(a) Establishment of Position.--There shall be in the Department
of Health and Human Services an Assistant Secretary for Civil Rights,
who shall be appointed by the President, by and with the advice and
consent of the Senate.
``(b) Responsibilities.--The Assistant Secretary shall perform such
functions relating to civil rights as the Secretary may assign.''.
(b) Conforming Amendment.--Section 5315 of title 5, United States
Code, is amended, in the item relating to Assistant Secretaries of
Health and Human Services, by striking ``(5)'' and inserting ``(6)''.
TITLE II--HEALTH SERVICES
SEC. 201. HEALTH SERVICES FOR RESIDENTS OF PUBLIC HOUSING.
Section 340A(p)(1) (42 U.S.C. 256a(p)(1)) is amended--
(1) by striking ``$35,000,000 for fiscal year 1991'' and
inserting ``$12,000,000 for fiscal year 1994''; and
(2) by striking ``1992 and 1993'' and inserting ``1995 and
1996''.
SEC. 202. ISSUANCE OF REGULATIONS REGARDING LANGUAGE AS IMPEDIMENT TO
RECEIPT OF SERVICES.
(a) Proposed Rule.--Not later than the expiration of the 90-day
period beginning on the date of the enactment of this Act, the
Secretary of Health and Human Services (in this section referred to as
the ``Secretary'') shall issue a proposed rule regarding policies to
reduce the extent to which having limited English proficiency
constitutes a significant impediment to individuals in establishing the
eligibility of the individuals for--
(1) participation in health programs under the Public
Health Service Act;
(2) the receipt of services under such programs and under
programs under titles XVIII and XIX of the Social Security Act;
or
(3) participation in programs or activities otherwise
receiving financial assistance from the Secretary or receiving
services under such programs or activities.
(b) Final Rule.--
(1) In general.--Not later than the expiration of the 1-
year period beginning on the date of the enactment of this Act,
the Secretary shall issue a final rule regarding the policies
described in subsection (a).
(2) Failure to issue by date certain.--If the Secretary
fails to issue a final rule under paragraph (1) before the
expiration of the period specified in such paragraph, the
proposed rule issued under subsection (a) is upon such
expiration deemed to be the final rule under paragraph (1) (and
shall remain in effect until the Secretary issues a final rule
under such paragraph).
SEC. 203. 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) in paragraph (2)--
(i) by inserting ``, substance abuse''
after ``availability of health''; and
(ii) by striking ``, including improved
health data systems'';
(B) in paragraph (3)--
(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;
(C) by striking paragraphs (5) and (6);
(D) by redesignating paragraphs (7), and (8) as
paragraphs (5) and (6), respectively;
(E) in paragraph (5) (as so redesignated), by
striking ``and'' at the end thereof;
(F) in paragraph (6) (as so redesignated), by
striking the period and inserting a semicolon; and
(G) by inserting after paragraph (6) (as so
redesignated), the following new paragraphs:
``(7) to provide primary health care, preventive health
care, and related training to American Samoan health care
professionals; and
``(8) to improve access to health promotion and disease
prevention services for rural American Samoa.'';
(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 ``$5,000,000 for
fiscal year 1994, and such sums as may be necessary for
each of the fiscal years 1995 and 1996''; and
(3) by adding at the end thereof the following new
subsection:
``(g) Study and Report.--
``(1) Study.--Not later than 180 days after the date of
enactment of this subsection, the Secretary, acting through the
Administrator of the Health Resources and Services
Administration, shall enter into a contract with a public or
nonprofit private entity for the conduct of a study to
determine the effectiveness of projects funded under this
section.
``(2) Report.--Not later than July 1, 1995, the Secretary
shall prepare and submit to the Committee on Labor and Human
Resources of the Senate and the Committee on Energy and
Commerce of the House of Representatives a report describing
the findings made with respect to the study conducted under
paragraph (1).''.
TITLE III--HEALTH PROFESSIONS
SEC. 301. LOANS FOR DISADVANTAGED STUDENTS.
Section 724(f)(1) (42 U.S.C. 292t(f)(1)) is amended--
(1) by striking ``there is'' and inserting ``there are'';
and
(2) by striking ``$15,000,000 for fiscal year 1993'' and
inserting ``$8,000,000 for fiscal year 1994, and such sums as
may be necessary for each of the fiscal years 1995 and 1996''.
SEC. 302. CESAR CHAVEZ PRIMARY CARE SCHOLARSHIP PROGRAM.
Section 736 (42 U.S.C. 293) is amended--
(1) by striking the section heading and inserting the
following:
``SEC. 736. CESAR CHAVEZ PRIMARY CARE SCHOLARSHIP PROGRAM.'';
(2) in subsection (c)--
(A) by striking ``there is'' and inserting ``there
are''; and
(B) by striking ``$11,000,000 for fiscal year
1993'' and inserting ``$10,500,000 for fiscal year
1994, and such sums as may be necessary for each of the
fiscal years 1995 and 1996''.
SEC. 303. THURGOOD MARSHALL SCHOLARSHIP PROGRAM.
Section 737 (42 U.S.C. 293a) is amended--
(1) by striking the section heading and inserting the
following:
``SEC. 737. THURGOOD MARSHALL SCHOLARSHIP PROGRAM.'';
(2) in subsection (a)--
(A) in paragraph (1), by inserting ``(to be known
as Thurgood Marshall Scholars)'' after ``providing
scholarships to individuals''; and
(B) in paragraph (3), by inserting ``schools
offering programs for the training of physician
assistants,'' after ``public health,''; and
(3) in subsection (h), by striking paragraph (1) and
inserting the following new paragraph:
``(1) Authorization of appropriations.--For the purpose of
carrying out this section, there are authorized to be
appropriated $17,100,000 for fiscal year 1994, and such sums as
may be necessary for each of the fiscal years 1995 and 1996.''.
SEC. 304. LOAN REPAYMENTS AND FELLOWSHIPS REGARDING FACULTY POSITIONS
AT HEALTH PROFESSIONS SCHOOLS.
Section 738 (42 U.S.C. 293b) is amended--
(1) in subsection (a)--
(A) in paragraph (2), by striking ``disadvantaged
backgrounds who--'' and inserting ``racial or ethnic
groups that are under-represented in the health
professions who--''
(B) in paragraph (5)--
(i) by striking ``; and'' in subparagraph
(A) and inserting a period;
(ii) by striking ``unless--'' and all that
follows through ``the individual involved'' in
subparagraph (A) and inserting ``unless the
individual involved''; and
(iii) striking subparagraph (B);
(C) by striking paragraph (6); and
(D) by redesignating paragraph (7) as paragraph
(6); and
(2) in subsection (b)(2)(B), by striking ``$30,000'' and
inserting ``$50,000'';
(3) in subsection (c)--
(A) by striking ``there is'' and inserting ``there
are''; and
(B) by striking ``$4,000,000 for fiscal year 1993''
and inserting ``$1,100,000 for fiscal year 1994, and
such sums as may be necessary for each of the fiscal
years 1995 and 1996''.
SEC. 305. CENTERS OF EXCELLENCE.
Section 739 (42 U.S.C. 293c) is amended--
(1) in subsection (b)--
(A) in paragraph (2), by inserting before the
semicolon the following: ``through collaboration with
public and nonprofit private entities to carry out
community-based programs to prepare students in
secondary schools and institutions of higher education
for attendance at the health professions school'';
(B) in paragraph (4), by striking ``and'' at the
end thereof;
(C) in paragraph (5), by striking the period and
inserting ``; and''; and
(D) by adding at the end thereof the following new
paragraph:
``(6) to train the students of the school at community-
based health facilities that provide health 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.'';
(2) in subsection (e)--
(A) by striking the subsection heading and
inserting ``Authority Regarding Consortia.--'';
(B) by striking paragraph (1) and inserting the
following new paragraph:
``(1) In general.--The Secretary may make a grant under
subsection (a) to any school of medicine, osteopathic medicine,
dentistry, clinical psychology, or pharmacy that has in
accordance with paragraph (2) formed a consortium of
schools.'';
(C) in paragraph (2), by striking subparagraphs (A)
through (D) and inserting the following new
subparagraphs:
``(A) the consortium consists of--
``(i) the health professions school seeking
the grant under subsection (a); and
``(ii) one 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.''; and
(D) by adding at the end the following paragraph:
``(3) Authority for collectively meeting relevant
requirements in certain cases.--With respect to meeting the
conditions specified in subsection (c)(4) for Native American
Centers of Excellence, the Secretary may make a grant to any
school that has in accordance with paragraphs (1) and (2)
formed a consortium of schools that meets such conditions
(without regard to whether the schools of the consortium
individually meet such conditions).''; and
(3) in subsection (i)--
(A) in paragraph (1), by striking ``such sums as
may be necessary for fiscal year 1993'' and inserting
``$25,000,000 for fiscal year 1994, and such sums as
may be necessary for each of the fiscal years 1995 and
1996''; and
(B) in paragraph (2)(C) by adding at the end the
following: ``Health professions schools described in
subsection (c)(2)(A) shall be eligible for grants under
this subparagraph in a fiscal year if the amount
appropriated for the fiscal year under paragraph (1) is
greater than $23,500,000. Such schools shall be
eligible to apply only for grants made from the portion
of such amount that exceeds $23,500,000.''.
SEC. 306. EDUCATIONAL ASSISTANCE REGARDING UNDERGRADUATES.
Section 740 (42 U.S.C. 293d) is amended--
(1) in subsection (a)(1), by adding at the end the
following new sentence: ``To be eligible for such a grant, a
school shall have in place a program to assist individuals from
disadvantaged backgrounds in gaining entry into a health
professions school or completing the course of study at such a
school.'';
(2) in subsection (d)(1)--
(A) by striking ``there is'' and inserting ``there
are''; and
(B) by striking ``1993'' and inserting ``1994, and
such sums as may be necessary for each of the fiscal
years 1995 and 1996''.
(3) in subsection (d)(2)(B), by adding at the end thereof
the following new sentence: ``Scholarship recipients under this
section shall be known as `Cesar Chavez Primary Care
Scholars'.''.
SEC. 307. AREA HEALTH EDUCATION CENTERS.
Section 746(d)(2)(D) (42 U.S.C. 293j(d)(2)(D)) is amended by
inserting ``and minority health'' after ``disease prevention''.
TITLE IV--RESEARCH AND DATA COLLECTION
SEC. 401. OFFICE OF RESEARCH ON MINORITY HEALTH.
Section 404 (42 U.S.C. 283b), as added by section 151 of Public Law
103-43, is amended by adding at the end the following subsections:
``(c) Plan.--The Director of the Office, shall collaborate with the
Deputy Assistant Secretary for Minority Health (as provided for in
section 1707), to develop and implement a plan for carrying out the
duties required by subsection (b). The Director, in consultation with
the Deputy Assistant Secretary for Minority Health, shall review the
plan not less often than annually, and revise the plan as appropriate.
``(d) Equity Regarding Various Groups.--The Director of the Office
shall ensure that activities under subsection (b) address equitably all
minority groups.
``(e) Advisory Committee.--
``(1) Establishment.--In carrying out subsection (b), the
Secretary shall establish an advisory committee to be known as
the Advisory Committee on Research on Minority Health (in this
subsection referred to as the `Advisory Committee').
``(2) Composition.--
``(A) Voting and nonvoting members.--The Advisory
Committee shall be composed of voting members appointed
in accordance with subparagraph (B) and the ex officio
nonvoting members described in subparagraph (C).
``(B) Voting members.--The Advisory Committee shall
include not fewer than 12, and not more than 18, voting
members who are not officers or employees of the
Federal Government. The Director of the Office shall
appoint such members to the Advisory Committee from
among physicians, practitioners, scientists, consumers
and other health professionals, whose clinical
practices, research specialization, or professional
expertise includes a significant focus on research on
minority health or on the barriers that minorities must
overcome to participate in clinical trials. The
membership of the Advisory Committee shall be equitably
representative of the minority groups served by the
Office.
``(C) Ex officio nonvoting members.--The Deputy
Assistant Secretary for Minority Health and the
Directors of each of the national research entities
shall serve as ex officio nonvoting members of the
Advisory Committee (except that any of such Directors
may designate an official of the institute involved to
serve as such member of the Committee in lieu of the
Director).
``(3) Chairperson.--The Director of the Office shall serve
as the chairperson of the Advisory Committee.
``(4) Duties.--The Advisory 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) Biennial report.--
``(A) Preparation.--The Advisory Committee shall
prepare a biennial report 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) Submission.--The report required in
subparagraph (A) shall be submitted to the Director of
the National Institutes of Health for inclusion in the
report required in section 403.
``(f) Representatives of Minorities Among Researchers.--The
Secretary, acting through the Assistant Secretary for Personnel
Administration and in collaboration with the Director of the Office,
shall determine the extent to which minorities are represented among
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.
``(g) Definitions.--For purposes of this part:
``(1) Minority health conditions.--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 research involving such individuals as
subjects or insufficient data on such individuals.
``(2) Research on minority health.--The term `research on
minority health' means research on minority health conditions,
including research on preventing such conditions.
``(3) Minority groups.--The term `minority groups' means
Blacks, American Indians, Alaskan Natives, Asian/Pacific
Islanders, and Hispanics, including subpopulations of such
groups.''.
SEC. 402. ACTIVITIES OF AGENCY FOR HEALTH CARE POLICY AND RESEARCH.
Section 902(b) (42 U.S.C. 299a(b)) is amended 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.''.
SEC. 403. DATA COLLECTION BY NATIONAL CENTER FOR HEALTH STATISTICS.
Section 306(n) of the Public Health Service Act (42 U.S.C.
242k(n)), as redesignated by section 501(a)(5)(B) of Public Law 103-183
(107 Stat. 2237), is amended to read as follows:
``(n)(1) For health statistical and epidemiological activities
undertaken or supported under this section, there are authorized to be
appropriated such sums as may be necessary for each of the fiscal years
1995 through 1998.
``(2) Of the amounts appropriated under paragraph (1) for a fiscal
year, the Secretary shall obligate not more than an aggregate
$5,000,000 for carrying out subsections (h), (l), and (m) with respect
to particular racial and ethnic population groups, except that not more
than $100,000 may be expended in the aggregate for the administration
of activities under subsection (m) and for activities described in
paragraph (2) of such subsection.''.
TITLE V--MISCELLANEOUS
SEC. 501. REVISION AND EXTENSION OF PROGRAM FOR STATE OFFICES OF RURAL
HEALTH.
(a) Matching Funds.--Section 338J(b) (42 U.S.C. 254r(b)) is amended
to read as follows:
``(b) Requirement of Matching Funds.--
``(1) In general.--With respect to the costs to be incurred
by a State in carrying out the purpose described in subsection
(a), the Secretary may not make a grant under such subsection
unless the State agrees to provide non-Federal contributions
toward such costs, in cash, in an amount that is not less than
$1 for each $1 of Federal funds provided in the grant.
``(2) Determination of amount contributed.--In determining
the amount of non-Federal contributions in cash that a State
has provided pursuant to paragraph (1), the Secretary may not
include any amounts provided to the State by the Federal
Government.''.
(b) Authorization of Appropriations.--Section 338J(j)(1) (42 U.S.C.
254r(j)(1)) is amended--
(1) by striking ``and'' after ``1992,''; and
(2) by inserting before the period the following: ``, and
$5,000,000 for each of the fiscal years 1994 through 1996''.
(c) Termination of Program.--Section 338J(k) (42 U.S.C. 254r(k)) is
amended by striking $10,000,000'' and inserting ``$20,000,000''.
SEC. 502. TECHNICAL CORRECTIONS RELATING TO HEALTH PROFESSIONS.
(a) Health Education Assistance Loan Deferment for Borrowers
Providing Health Services to Indians.--
(1) In general.--Section 705(a)(2)(C) is amended by
striking ``and (x)'' and inserting ``(x) not in excess of three
years, during which the borrower is providing health care
services to Indians through an Indian health program (as
defined in section 108(a)(2)(A) of the Indian Health Care
Improvement Act (25 U.S.C. 1616a(a)(2)(A)); and (xi)''.
(2) Conforming amendments.--Section 705(a)(2)(C) is further
amended--
(A) in clause (xi) (as so redesignated) by striking
``(ix)'' and inserting ``(x)''; and
(B) in the matter following such clause (xi), by
striking ``(x)'' and inserting ``(xi)''.
(3) Effective date.--The amendments made by this subsection
shall apply with respect to services provided on or after the
first day of the third month that begins after the date of
enactment of this Act.
(b) Maximum Student Loan Provision.--
(1) In general.--Section 722(a)(1) (42 U.S.C. 292r(a)(1)),
as amended by section 2014(b)(1) of Public Law 103-43, is
amended by striking ``the sum of'' and all that follows through
the end thereof and inserting ``the cost of attendance
(including tuition, other reasonable educational expenses, and
reasonable living costs) for that year at the educational
institution attended by the student (as determined by such
educational institution).''.
(2) Third and fourth years.--Section 722(a)(2) (42 U.S.C.
292r(a)(2)), as amended by section 2014(b)(1) of Public Law
103-43, is amended by striking ``the amount $2,500'' and all
that follows through ``including such $2,500'' and inserting
``the amount of the loan may, in the case of the third or
fourth year of a student at school of medicine or osteopathic
medicine, be increased to the extent necessary''.
(c) Requirement for Schools.--Section 723(b)(1) (42 U.S.C.
292s(b)(1)), as amended by section 2014(c)(2)(A)(ii) of Public Law 103-
43 (107 Stat. 216), is amended by striking ``3 years before'' and
inserting ``4 years before''.
(d) Service Requirement for Primary Care Loan Borrowers.--Section
723(a) (42 U.S.C. 292s(a)) is amended in subparagraph (B) of paragraph
(1), by striking ``through the date on which the loan is repaid in
full'' and inserting ``for 5 years after completing the residency
program''.
(e) Preference and Required Information in Certain Programs.--
(1) Title vii.--Section 791 (42 U.S.C. 295j) is amended by
adding at the end thereof the following subsection:
``(d) Exceptions.--
``(1) In general.--To permit new programs to compete
equitably for funding under this section, those new programs
that meet the criteria described in paragraph (3) shall qualify
for a funding preference under this section.
``(2) Definition.--As used in this subsection, the term
`new program' means any program that has graduated less than
three classes. Upon graduating at least three classes, a
program shall have the capability to provide the information
necessary to qualify the program for the general funding
preferences described in subsection (a).
``(3) Criteria.--The criteria referred to in paragraph (1)
are the following:
``(A) The mission statement of the program
identifies a specific purpose of the program as being
the preparation of health professionals to serve
underserved populations.
``(B) The curriculum of the program includes
content which will help to prepare practitioners to
serve underserved populations.
``(C) Substantial clinical training experience is
required under the program in medically underserved
communities.
``(D) A minimum of 20 percent of the faculty of the
program spend at least 50 percent of their time
providing or supervising care in medically underserved
communities.
``(E) The entire program or a substantial portion
of the program is physically located in a medically
underserved community.
``(F) Student assistance, which is linked to
service in medically underserved communities following
graduation, is available to the students in the
program.
``(G) The program provides a placement mechanism
for deploying graduates to medically underserved
communities.''.
(2) Title viii.--Section 860 (42 U.S.C. 298b-7) is amended
by adding at the end thereof the following subsection:
``(f) Exceptions.--
``(1) In general.--To permit new programs to compete
equitably for funding under this section, those new programs
that meet the criteria described in paragraph (3) shall qualify
for a funding preference under this section.
``(2) Definition.--As used in this subsection, the term
`new program' means any program that has graduated less than
three classes. Upon graduating at least three classes, a
program shall have the capability to provide the information
necessary to qualify the program for the general funding
preferences described in subsection (a).
``(3) Criteria.--The criteria referred to in paragraph (1)
are the following:
``(A) The mission statement of the program
identifies a specific purpose of the program as being
the preparation of health professionals to serve
underserved populations.
``(B) The curriculum of the program includes
content which will help to prepare practitioners to
serve underserved populations.
``(C) Substantial clinical training experience is
required under the program in medically underserved
communities.
``(D) A minimum of 20 percent of the faculty of the
program spend at least 50 percent of their time
providing or supervising care in medically underserved
communities.
``(E) The entire program or a substantial portion
of the program is physically located in a medically
underserved community.
``(F) Student assistance, which is linked to
service in medically underserved communities following
graduation, is available to the students in the
program.
``(G) The program provides a placement mechanism
for deploying graduates to medically underserved
communities.''.
(f) Definitions.--Section 799(6) (42 U.S.C. 295p(6)) is amended--
(1) in subparagraph (B) by striking ``; or'' at the end
thereof;
(2) in subparagraph (C) by striking the period and
inserting a semicolon; and
(3) by adding at the end thereof the following:
``(D) ambulatory practice sites designated by State
Governors as shortage areas or medically underserved
communities for purposes of State scholarships or loan
repayment or related programs; or
``(E) practices or facilities in which not less
than 50 percent of the patients are recipients of aid
under title XIX of the Social Security Act or eligible
and uninsured.''.
(g) Generally Applicable Modifications Regarding Obligated
Service.--
(1) In general.--Section 795(a)(2) (42 U.S.C. 295n(a)(2)),
is amended--
(A) in subparagraph (A), by striking ``speciality
in'' and inserting ``field of''; and
(B) in subparagraph (B), by striking ``speciality''
and inserting ``field''; and
(2) Effective date.--Each amendment made by paragraph (1)
shall take effect as if such subsection had been enacted
immediately after the enactment of the Health Professions
Education Extension Amendments of 1992.
(h) Recovery.--Part G of title VII (42 U.S.C. 295j et seq.) is
amended by inserting after section 795, the following new section:
``SEC. 796. RECOVERY.
``(a) In General.--If at any time within 20 years (or within such
shorter period as the Secretary may prescribe by regulation for an
interim facility) after the completion of construction of a facility
with respect to which funds have been paid under section 720(a) (as
such section existed one day prior to the date of enactment of the
Health Professions Education Extension Amendments of 1992 (Public Law
102-408)--
``(1)(A) in case of a facility which was an affiliated
hospital or outpatient facility with respect to which funds
have been paid under such section 720(a)(1), the owner of the
facility ceases to be a public or other nonprofit agency that
would have been qualified to file an application under section
605;
``(B) in case of a facility which was not an affiliated
hospital or outpatient facility but was a facility with respect
to which funds have been paid under paragraph (1) or (3) of
such section 720(a), the owner of the facility ceases to be a
public or nonprofit school, or
``(C) in case of a facility which was a facility with
respect to which funds have been paid under such section
720(a)(2), the owner of the facility ceases to be a public or
nonprofit entity,
``(2) the facility ceases to be used for the teaching or
training purposes (or other purposes permitted under section
722 (as such section existed one day prior to the date of
enactment of the Health Professions Education Extension
Amendments of 1992 (Public Law 102-408)) for which it was
constructed, or
``(3) the facility is used for sectarian instruction or as
a place for religious worship,
the United States shall be entitled to recover from the owner of the
facility the base amount prescribed by subsection (c)(1) plus the
interest (if any) prescribed by subsection (c)(2).
``(b) Notice.--The owner of a facility which ceases to be a public
or nonprofit agency, school, or entity as described in subparagraph
(A), (B), or (C) of subsection (a)(1), as the case may be, or the owner
of a facility the use of which changes as described in paragraph (2) or
(3) of subsection (a), shall provide the Secretary written notice of
such cessation or change of use within 10 days after the date on which
such cessation or change of use occurs or within 30 days after the date
of enactment of this subsection, whichever is later.
``(c) Amount.--
``(1) Base amount.--The base amount that the United States
is entitled to recover under subsection (a) is the amount
bearing the same ratio to the then value (as determined by the
agreement of the parties or in an action brought in the
district court of the United States for the district in which
the facility is situated) of the facility as the amount of the
Federal participation bore to the cost of construction.
``(2) Interest.--
``(A) In general.--The interest that the United
States is entitled to recover under subsection (a) is
the interest for the period (if any) described in
subparagraph (B) at a rate (determined by the
Secretary) based on the average of the bond equivalent
rates of ninety-one-day Treasury bills auctioned during
that period.
``(B) Period.--The period referred to in
subparagraph (A) is the period beginning--
``(i) if notice is provided as prescribed
by subsection (b), 191 days after the date on
which the owner of the facility ceases to be a
public or nonprofit agency, school, or entity
as described in subparagraph (A), (B), or (C)
of subsection (a)(1), as the case may be, or
191 days after the date on which the use of the
facility changes as described in paragraph (2)
or (3) of subsection (a), or
``(ii) if notice is not provided as
prescribed by subsection (b), 11 days after the
date on which such cessation or change of use
occurs,
and ending on the date the amount the United States is
entitled to recover is collected.
``(d) Waiver.--The Secretary may waive the recovery rights of the
United States under subsection (a)(2) with respect to a facility (under
such conditions as the Secretary may establish by regulation) if the
Secretary determines that there is good cause for waiving such rights.
``(e) Lien.--The right of recovery of the United States under
subsection (a) shall not, prior to judgment, constitute a lien on any
facility.''.
SEC. 503. CLINICAL TRAINEESHIPS.
Section 303(d)(1) (42 U.S.C. 242a(d)(1)) is amended by inserting
``counseling'' after ``family therapy,''.
SEC. 504. DEMONSTRATION PROJECT GRANTS TO STATES FOR ALZHEIMER'S
DISEASE.
(a) In General.--Section 398(a) (42 U.S.C. 280c-3(a)) is amended--
(1) in the matter preceding paragraph (1), by striking
``not less than 5, and not more than 15,'';
(2) in paragraph (2)--
(A) by inserting after ``disorders'' the following:
``who are living in single family homes or in
congregate settings''; and
(B) by striking ``and'' at the end;
(3) by redesignating paragraph (3) as paragraph (4); and
(4) by inserting after paragraph (2) the following:
``(3) to improve access for individuals with Alzheimer's
disease or related disorders, particularly such individuals
from ethnic, cultural, or language minorities and such
individuals who are living in isolated rural areas, to services
that--
``(A) are home-based or community-based long-term
care services; and
``(B) exist on the date of enactment of this
paragraph; and''.
(b) Duration.--Section 398A (42 U.S.C. 280c-4) is amended--
(1) in the title, by striking ``LIMITATION ON'';
(2) in subsection (a)--
(A) in the heading, by striking ``Limitation on'';
and
(B) by striking ``may not exceed'' and inserting
``may exceed''; and
(3) in subsection (b), in paragraphs (1)(C) and (2)(C), by
inserting ``, and any subsequent year,'' after ``third year''.
(c) Authorization of Appropriations.--Section 398B(e) (42 U.S.C.
280c-5(e)) is amended by striking ``and 1993'' and inserting ``through
1998''.
SEC. 505. MEDICALLY UNDERSERVED AREA STUDY.
(a) In General.--The Secretary of Health and Human Services shall
conduct a study concerning the feasibility and desirability of, and the
criteria to be used for, combining the designations of ``health
professional shortage area'' and ``medically underserved area'' into a
single health professional shortage area designation.
(b) Requirements.--As part of the study conducted under subsection
(a), the Secretary of Health and Human Services, in considering the
statutory and regulatory requirements necessary for the creation of a
single health professional shortage area designation, shall--
(1) review and report on the application of current
statutory and regulatory criteria used--
(A) in designating an area as a health professional
shortage area;
(B) in designating an area as a medically
underserved area; and
(C) by a State in the determination of the health
professional shortage area designations of such State;
and
(2) review the suggestions of public health and primary
care experts.
(c) Report.--Not later than 1 year after the date of enactment of
this Act, the Secretary of Health and Human Services shall prepare and
submit to the appropriate committees of Congress a report concerning
the findings of the study conducted under subsection (a) together with
the recommendations of the Secretary.
(d) Recommendations.--In making recommendations under subsection
(c), the Secretary of Health and Human Services shall give special
consideration to (and describe in the report) the unique impact of
designation criteria on different rural and urban populations, and
ethnic and racial minorities, including--
(1) rational service areas, and their application to
frontier areas and inner-city communities;
(2) indicators of high medical need, including fertility
rates, infant mortality rates, pediatric population, elderly
population, poverty rates, and physician to population ratios;
and
(3) indicators of insufficient service capacity, including
language proficiency criteria for ethnic populations, annual
patient visits per physician, waiting times for appointments,
waiting times in a primary care physician office, excessive use
of emergency facilities, low annual office visit rate, and
demand on physicians in contiguous rural or urban areas.
SEC. 506. 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, 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 operate centers for the conduct of applied
epidemiologic research and study of such defects, and to
improve the education, training, and clinical skills of health
professionals with respect to the prevention of such defects;
and
``(4) to carry out demonstration projects for the
prevention of such defects.
``(b) 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. Recipients of assistance
under this subsection shall collect and analyze demographic
data utilizing appropriate sources as determined by the
Secretary.
``(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; and
``(3) contains an assessment of the extent to which each
approach to preventing birth defects has been effective,
including a description of effectiveness in relation to cost;
``(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 such sums as
may be necessary for each of the fiscal years 1994 through 1997.''.
SEC. 507. DEMONSTRATION PROJECTS REGARDING DIABETIC-RETINOPATHY.
(a) In General.--The Secretary of Health and Human Services, acting
through the Director of the National Eye Institute and in consultation
with the Director of the Centers for Disease Control and Prevention,
may make grants to public and nonprofit private entities for
demonstration projects to serve the populations specified in subsection
(b) by carrying out, with respect to the eye disorder known as diabetic
retinopathy, all activities regarding information, dissemination, early
detection, education, and prevention.
(b) Relevant Populations.--The populations referred to in
subsection (a) are minority populations that have diabetes mellitus.
(c) Authorization of Appropriations.--For the purpose of carrying
out this section, there is authorized to be appropriated $1,000,000 for
each of the fiscal years 1995 through 1997.
SEC. 508. MEXICAN BORDER STATE ANALYTICAL LABORATORIES.
(a) In General.--The Secretary of Health and Human Services, acting
through the Director of the Centers for Disease Control and Prevention,
may make grants to eligible entities to establish and operate State
laboratories to analyze human, wildlife, air, water, and soil samples.
The laboratories shall serve the border region.
(b) Eligible Entity.--To be eligible to receive a grant under
subsection (a), an entity shall be a State that borders Mexico.
(c) Applications Requirements.--No grant may be made under
subsection (a) unless an application has been submitted to and approved
by the Secretary of Health and Human Services.
(d) Authorization of Appropriations.--For the purpose of carrying
out subsection (a), there are authorized to be appropriated such sums
as may be necessary for each of the fiscal years 1995 through 1997.
SEC. 509. CONSTRUCTION OF REGIONAL CENTERS FOR RESEARCH ON PRIMATES.
Section 481B of the Public Health Service Act (42 U.S.C. 287a-3),
as added by section 1503 of Public Law 103-43 (107 Stat. 178), is
amended to read as follows:
``construction of regional centers for research on primates
``Sec. 481B. With respect to activities carried out by the National
Center for Research Resources to support regional centers for research
on primates, the Director of NIH may, for each of the fiscal years 1994
through 1996, reserve from the amounts appropriated under section
481A(h) not more than $3,000,000 for the purpose of making awards of
grants and contracts to public and non-profit private entities to
construct, renovate, or otherwise improve such regional centers. The
reservation of such amounts for any fiscal year is subject to the
availability of qualified applicants for such awards.''.
TITLE VI--MULTIETHNIC PLACEMENT
SEC. 601. SHORT TITLE.
This title may be cited as the ``Multiethnic Placement Act of
1994''.
SEC. 602. FINDINGS AND PURPOSE.
(a) Findings.--Congress finds that--
(1) nearly 500,000 children are in foster care in the
United States;
(2) tens of thousands of children in foster care are
waiting for adoption;
(3) 2 years and 8 months is the median length of time that
children wait to be adopted;
(4) child welfare agencies should work to eliminate racial,
ethnic, and national origin discrimination and bias in adoption
and foster care recruitment, selection, and placement
procedures; and
(5) active, creative, and diligent efforts are needed to
recruit parents, from every race and culture, for children
needing foster care or adoptive parents.
(b) Purpose.--It is the purpose of this Act to decrease the length
of time that children wait to be adopted and to prevent discrimination
in the placement of children on the basis of race, color, or national
origin.
SEC. 603. MULTIETHNIC PLACEMENTS.
(a) Activities.--
(1) Prohibition.--An agency, or entity, that receives
Federal assistance and is involved in adoption or foster care
placements may not--
(A) categorically deny to any person the
opportunity to become an adoptive or a foster parent,
solely on the basis of the race, color, or national
origin of the adoptive or foster parent, or the child,
involved; or
(B) delay or deny the placement of a child for
adoption or into foster care, or otherwise discriminate
in making a placement decision, solely on the basis of
the race, color, or national origin of the adoptive or
foster parent, or the child, involved.
(2) Permissible consideration.--An agency or entity to
which paragraph (1) applies may consider the race, color, or
national origin of a child as a factor in making a placement
decision if such factor is relevant to the best interests of
the child involved and is considered in conjunction with other
factors.
(3) Definition.--As used in this subsection, the term
``placement decision'' means the decision to place, or to delay
or deny the placement of, a child in a foster care or an
adoptive home, and includes the decision of the agency or
entity involved to seek the termination of birth parent rights
or otherwise make a child legally available for adoptive
placement.
(b) Limitation.--The Secretary of Health and Human Services shall
not provide placement and administrative funds under section 474(a)(3)
of the Social Security Act (42 U.S.C. 674(a)(3)) to an agency or entity
described in subsection (a) that is not in compliance with subsection
(a).
(c) Equitable Relief.--Any individual who is aggrieved by an action
in violation of subsection (a), taken by an agency or entity described
in subsection (a), shall have the right to bring an action seeking
relief in a United States district court of appropriate jurisdiction.
(d) Construction.--Nothing in this section shall be construed to
affect the application of the Indian Child Welfare Act of 1978 (25
U.S.C. 1901 et seq.).
TITLE VII--VOLUNTARY MUTUAL REUNIONS
SEC. 701. FACILITATION OF REUNIONS.
The Secretary of Health and Human Services, in the discretion of
the Secretary and at no net expense to the Federal Government, may use
the facilities of the Department of Health and Human Services to
facilitate the voluntary, mutually requested reunion of an adult
adopted child who is 21 or older with--
(1) any birth parent of the adult child; or
(2) any adult adopted sibling, who is 21 or older, of the
adult child,
if all such persons involved in any such reunion have, on their own
initiative, expressed a desire for a reunion.
TITLE VIII--GENERAL PROVISIONS
SEC. 801. EFFECTIVE DATE.
This Act and the amendments made by this Act shall take effect
October 1, 1993, or upon the date of the enactment of this Act,
whichever occurs later.
Passed the Senate March 26 (legislative day, February 22),
1994.
Attest:
Secretary.
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