[Congressional Bills 103th Congress]
[From the U.S. Government Publishing Office]
[S. 241 Introduced in Senate (IS)]
103d CONGRESS
1st Session
S. 241
To provide incentives to health care providers serving rural areas, to
provide grants to county health departments providing preventative
health services within rural areas, to establish State health service
corps demonstration projects, and for other purposes.
_______________________________________________________________________
IN THE SENATE OF THE UNITED STATES
January 27 (legislative day, January 5), 1993
Mr. Pryor (for himself, Mr. Packwood, Mr. Boren, Mr. Cohen, Mr. Glenn,
Mr. Bryan, Mr. Conrad, and Mr. Leahy) introduced the following bill;
which was read twice and referred to the Committee on Finance
_______________________________________________________________________
A BILL
To provide incentives to health care providers serving rural areas, to
provide grants to county health departments providing preventative
health services within rural areas, to establish State health service
corps demonstration projects, 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.
This Act may be cited as the ``Rural Primary Care Act of 1993''.
TITLE I--TAX PROVISIONS
SEC. 101. NONREFUNDABLE CREDIT FOR CERTAIN PRIMARY HEALTH SERVICES
PROVIDERS.
(a) In General.--Subpart A of part IV of subchapter A of chapter 1
of the Internal Revenue Code of 1986 (relating to nonrefundable
personal credits) is amended by inserting after section 25 the
following new section:
``SEC. 25A. PRIMARY HEALTH SERVICES PROVIDERS.
``(a) Allowance of Credit.--In the case of a qualified primary
health services provider, there is allowed as a credit against the tax
imposed by this chapter for any taxable year in a mandatory service
period an amount equal to the product of--
``(1) the lesser of--
``(A) the number of months of such period occurring
in such taxable year, or
``(B) 36 months, reduced by the number of months
taken into account under this paragraph with respect to
such provider for all preceding taxable years (whether
or not in the same mandatory service period),
multiplied by
``(2) $1,000 ($500 in the case of a qualified health
services provider who is a physician assistant or a nurse
practitioner).
``(b) Qualified Primary Health Services Provider.--For purposes of
this section, the term `qualified primary health services provider'
means any physician, physician assistant, or nurse practitioner who for
any month during a mandatory service period is certified by the Bureau
to be a primary health services provider who--
``(1) is providing primary health services--
``(A) full time, and
``(B) to individuals at least 80 percent of whom
reside in a rural health professional shortage area,
``(2) is not receiving during such year a scholarship under
the National Health Service Corps Scholarship Program or a loan
repayment under the National Health Service Corps Loan
Repayment Program,
``(3) is not fulfilling service obligations under such
Programs, and
``(4) has not defaulted on such obligations.
``(c) Mandatory Service Period.--For purposes of this section, the
term `mandatory service period' means the period of 60 consecutive
calendar months beginning with the first month the taxpayer is a
qualified primary health services provider.
``(d) Definitions and Special Rules.--For purposes of this
section--
``(1) Bureau.--The term `Bureau' means the Bureau of Health
Care Delivery and Assistance, Health Resources and Services
Administration of the United States Public Health Service.
``(2) Physician.--The term `physician' has the meaning
given to such term by section 1861(r) of the Social Security
Act.
``(3) Physician assistant; nurse practitioner.--The terms
`physician assistant' and `nurse practitioner' have the
meanings given to such terms by section 1861(aa)(5) of the
Social Security Act.
``(4) Primary health services provider.--The term `primary
health services provider' means a provider of primary health
services (as defined in section 330(b)(1) of the Public Health
Service Act).
``(5) Rural health professional shortage area.--The term
`rural health professional shortage area' means--
``(A) a class 1 or class 2 health professional
shortage area (as defined in section 332(a)(1)(A) of
the Public Health Service Act) in a rural area (as
determined under section 1886(d)(2)(D) of the Social
Security Act), or
``(B) an area which is determined by the Secretary
of Health and Human Services as equivalent to an area
described in subparagraph (A) and which is designated
by the Bureau of the Census as not urbanized.
``(e) Recapture of Credit.--
``(1) In general.--If, during any taxable year, there is a
recapture event, then the tax of the taxpayer under this
chapter for such taxable year shall be increased by an amount
equal to the product of--
``(A) the applicable percentage, and
``(B) the aggregate unrecaptured credits allowed to
such taxpayer under this section for all prior taxable
years.
``(2) Applicable recapture percentage.--
``(A) In general.--For purposes of this subsection,
the applicable recapture percentage shall be determined
from the following table:
``If the recapture
The applicable recap-
event occurs during:
ture percentage is:
Months 1-24.............. 100
Months 25-36............. 75
Months 37-48............. 50
Months 49-60............. 25
Months 61 and thereafter. 0.
``(B) Timing.--For purposes of subparagraph (A),
month 1 shall begin on the first day of the mandatory
service period.
``(3) Recapture event defined.--
``(A) In general.--For purposes of this subsection,
the term `recapture event' means the failure of the
taxpayer to be a qualified primary health services
provider for any month during any mandatory service
period.
``(B) Cessation of designation.--The cessation of
the designation of any area as a rural health
professional shortage area after the beginning of the
mandatory service period for any taxpayer shall not
constitute a recapture event.
``(C) Secretarial waiver.--The Secretary may waive
any recapture event caused by extraordinary
circumstances.
``(4) No credits against tax.--Any increase in tax under
this subsection shall not be treated as a tax imposed by this
chapter for purposes of determining the amount of any credit
under subpart A, B, or D of this part.''.
(b) Clerical Amendment.--The table of sections for subpart A of
part IV of subchapter A of chapter 1 of the Internal Revenue Code of
1986 is amended by inserting after the item relating to section 25 the
following new item:
``Sec. 25A. Primary health services
providers.''.
(c) Effective Date.--The amendments made by this section shall
apply to taxable years beginning after December 31, 1993.
SEC. 102. NATIONAL HEALTH SERVICE CORPS LOAN REPAYMENTS EXCLUDED FROM
GROSS INCOME.
(a) In General.--Part III of subchapter B of chapter 1 of the
Internal Revenue Code of 1986 (relating to items specifically excluded
from gross income) is amended by redesignating section 137 as section
138 and by inserting after section 136 the following new section:
``SEC. 137. NATIONAL HEALTH SERVICE CORPS LOAN REPAYMENTS.
``(a) General Rule.--Gross income shall not include any qualified
loan repayment.
``(b) Qualified Loan Repayment.--For purposes of this section, the
term `qualified loan repayment' means any payment made on behalf of the
taxpayer by the National Health Service Corps Loan Repayment Program
under section 338B(g) of the Public Health Service Act.''.
(b) Clerical Amendment.--The table of sections for part III of
subchapter B of chapter 1 of the Internal Revenue Code of 1986 is
amended by striking the item relating to section 137 and inserting the
following:
``Sec. 137. National Health Service Corps
loan repayments.
``Sec. 138. Cross references to other
Acts.''.
(c) Effective Date.--The amendments made by this section shall
apply to payments made under section 338B(g) of the Public Health
Service Act after the date of the enactment of this Act.
SEC. 103. EXPENSING OF MEDICAL EQUIPMENT.
(a) In General.--Section 179 of the Internal Revenue Code of 1986
(relating to election to expense certain depreciable business assets)
is amended--
(1) by striking paragraph (1) of subsection (b) and
inserting the following:
``(1) Dollar limitation.--
``(A) General rule.--The aggregate cost which may
be taken into account under subsection (a) for any
taxable year shall not exceed $10,000.
``(B) Rural health care property.--In the case of
rural health care property, the aggregate cost which
may be taken into account under subsection (a) for any
taxable year shall not exceed $25,000, reduced by the
amount otherwise taken into account under subsection
(a) for such year.''; and
(2) by adding at the end of subsection (d) the following
new paragraph:
``(11) Rural health care property.--For purposes of this
section, the term `rural health care property' means section
179 property used by a physician (as defined in section 1861(r)
of the Social Security Act) in the active conduct of such
physician's full-time trade or business of providing primary
health services (as defined in section 330(b)(1) of the Public
Health Service Act) in a rural health professional shortage
area (as defined in section 25A(d)(5)).''.
(b) Effective Date.--The amendments made by this section shall
apply to property placed in service after December 31, 1993, in taxable
years ending after such date.
SEC. 104. STUDY OF EXPANSION OF CREDIT TO CERTAIN URBAN AREAS.
(a) Study.--The Secretary of Health and Human Services or the
Secretary's delegate shall determine the present number of, and future
need for, physician and nonphysician primary care providers in
medically underserved urban areas. Such determination shall form the
basis for a study of the feasibility (including cost estimates) of
extending the tax credit provided by the amendments made by section 101
of this title to such providers.
(b) Reports.--An interim report of the study described in paragraph
(1) shall be submitted by the Secretary of Health and Human Services to
the Congress 1 year after the date of the enactment of this Act. A
final report of such study shall be submitted to the Congress within 2
years of such date of enactment.
TITLE II--PUBLIC HEALTH SERVICE PROVISIONS
SEC. 201. PREVENTATIVE HEALTH SERVICES.
Part A of title XIX of the Public Health Service Act (42 U.S.C.
300w et seq.) is amended--
(1) in section 1901, by adding at the end thereof the
following new subsection:
``(c) Of the amounts appropriated for each fiscal year under
subsection (a), the Secretary shall make available not less than
$5,000,000 in each such fiscal year to carry out section 1910A.''; and
(2) by adding at the end thereof the following new section:
``SEC. 1910A. PREVENTATIVE GRANTS FOR COUNTY HEALTH DEPARTMENTS.
``(a) In General.--From amounts made available under section
1901(c), the Secretary shall make grants to county health departments
to enable such departments to provide preventative health services in
areas within the county which the Bureau of the Census determines to be
not urbanized.
``(b) Application.--To be eligible to receive a grant under
subsection (a), a county health department shall prepare and submit, to
the Secretary, an application at such time, in such form, and
containing such information as the Secretary shall require.
``(c) Use of Funds.--A county health department shall use amounts
provided through a grant received under this section to--
``(1) provide immunization services to control the spread
of infectious diseases;
``(2) improve maternal and infant health;
``(3) reduce adolescent pregnancy and improve reproductive
health; and
``(4) provide such other services as the Secretary
determines appropriate.
``(d) Definition.--Not later than 30 days after the date of
enactment of this section, the Secretary shall promulgate regulations
that define `county health department' for purposes of this section.''.
TITLE III--STATE HEALTH SERVICE CORPS DEMONSTRATION PROJECTS
SEC. 301. SHORT TITLE.
This title may be cited as the ``State Health Service Corps
Demonstration Act''.
SEC. 302. PURPOSE.
It is the purpose of this title--
(1) to promote recruitment and training of physicians and
other primary care providers from among the poor and from
disadvantaged populations;
(2) to place physicians from health professional shortage
areas into similar areas in order to encourage retention of
physicians in health professional shortage areas; and
(3) to provide flexibility to States in filling positions
in health professional shortage areas.
SEC. 303. STATE HEALTH SERVICE CORPS DEMONSTRATION PROJECTS.
The Public Health Service Act is amended by inserting after section
338L (42 U.S.C. 254t) the following new sections:
``SEC. 338M. STATE HEALTH SERVICE CORPS DEMONSTRATION PROJECTS.
``(a) Definitions.--For purposes of this section:
``(1) Area health education center.--The term `area health
education center' means--
``(A) a cooperative program of one or more medical
schools (or the parent institutions of such schools)
and one or more nonprofit private or public area health
education centers; or
``(B) a regional or statewide network of the
cooperative programs described in subparagraph (A).
``(2) Health professional shortage area.--The term `health
professional shortage area' has the meaning provided in section
332(a)(1).
``(3) Medical school.--The term `medical school' means a
school conferring the degree of Doctor of Medicine or Doctor of
Osteopathy.
``(4) Nonphysician provider.--The term `nonphysician
provider' means an occupational therapist, physical therapist,
nurse, nurse midwife, nurse practitioner, social worker, or
optometrist.
``(5) Nurse.--The term `nurse' means a registered nurse, or
an individual with a baccalaureate or master's degree in
nursing.
``(6) Parent institution.--The term `parent institution'
means any health sciences university housing a medical school
and one or more other health professions schools.
``(7) Physician provider.--The term `physician provider'
means--
``(A) a physician specializing in general practice,
family medicine, general internal medicine, pediatrics,
obstetrics and gynecology, general surgery, psychiatry,
preventive medicine and public health, or physiatry; or
``(B) a dentist.
``(8) Project.--The term `Project' means a State Health
Service Corps Demonstration Project established under
subsection (b).
``(9) Service area.--The term `service area' means an area
designated in subsection (d)(2)(A).
``(b) Grants.--The Secretary shall establish a State Health Service
Corps Demonstration Project under which the Secretary shall make grants
to up to 10 States to pay for the Federal share of the costs of
conducting Projects for the training and employment of eligible
participants as physician and nonphysician providers serving health
professional shortage areas.
``(c) State Participation.--
``(1) Requirements.--In order for a State to be eligible to
receive a grant under this section, the State shall--
``(A) enter into an agreement with an area health
education center to administer the Project in
accordance with subsection (d);
``(B) provide for evaluation of the Project in
accordance with subsection (e);
``(C) establish a State Health Service Corps
Scholarship Program in accordance with section 338N;
and
``(D) meet such other requirements as the Secretary
may establish for the proper and efficient
implementation of the Project.
``(2) Grant awards.--In allocating grants under subsection
(b), the Secretary shall give priority to States that have
demonstrated a commitment to developing and funding area health
education center programs.
``(3) Application.--To be eligible to receive a grant under
this section, the State shall submit an application at such
time, in such manner and containing such agreements,
assurances, and information as the Secretary determines to be
necessary to carry out this section. At a minimum, the
application shall contain--
``(A) information specifying the actions the State
will take against individuals, and the methods the
State will use to recover all funds paid under section
338N(i) to individuals, who breach contracts described
in section 338N(g); and
``(B) assurances that the State will reimburse the
Secretary for all funds recovered from individuals who
breach contracts described in section 338N(g).
``(4) Duration.--A Project under this section shall be for
a maximum duration of 8 years, plus up to 6 months for final
evaluation and reporting.
``(d) State Agreements With Area Health Education Centers.--
``(1) In general.--To be eligible for a grant under this
section, a State shall enter into an agreement with an area
health education center for the planning, development, and
operation of a program to train and employ eligible
participants as physician and nonphysician providers.
``(2) Requirements.--Under an agreement entered into under
paragraph (1), an area health education center shall agree to--
``(A) designate a health professional shortage area
or areas as the service area for the area health
education center;
``(B) provide for or conduct training in health
education services in the service area;
``(C) assess the health professional needs of the
service area and assist in the planning and development
of training programs to meet the needs;
``(D) provide for or conduct a rotating internship
or residency training program in the service area;
``(E) provide opportunities for continuing
education to physician and nonphysician providers
practicing within the service area;
``(F) conduct interdisciplinary training and
practice involving physician and nonphysician providers
in the service area;
``(G) arrange and support educational opportunities
for students studying to become physician or
nonphysician providers at health facilities, ambulatory
care centers, and health agencies throughout the
service area;
``(H) provide for the active participation in the
Project by individuals who are associated with the
administration of the sponsoring health professions and
each of the departments or specialties of physician or
nonphysician providers (if any) which are offered under
the Project; and
``(I) have an advisory board of which at least 75
percent of the members shall be individuals, including
both health service providers and consumers, from the
service area.
``(e) Evaluation.--Not later than March 30, 1998, and March 30,
2002, each State receiving a grant under this section shall, through
grants to or contracts with public and private entities, provide for--
``(1) an evaluation of Projects--
``(A) which were carried out pursuant to this
section during any fiscal year preceding the fiscal
year in which such date occurs, and
``(B) for which no prior evaluation under this
subsection was made, and
``(2) a review of the area health education center
providing services under the Projects. The evaluation shall
include an evaluation of the effectiveness of the Projects in
increasing the recruitment and retention of physician and
nonphysician providers in health professional shortage areas.
``(f) Federal Share.--The Federal share of the costs of any program
established under this section with respect to any State shall be the
percentage of such costs equal to the Federal medical assistance
percentage applicable to such State under section 1905(b) of the Social
Security Act. The State may include as a part or all of the non-Federal
share of grants--
``(1) any State funds supporting area health education
centers, and
``(2) the value of in-kind contributions made by the State,
including tuition remission and other benefits for students
participating in the State Health Service Corps Scholarship
Program established under section 338N.
``(g) Authorization of Appropriations.--
``(1) In general.--There are authorized to be appropriated
for each of the 1994 through 2001 fiscal years to carry out the
purposes of this section an amount equal to the product of--
``(A) $250,000, multiplied by
``(B) the number of States receiving grants under
this section for such fiscal year.
Any amount appropriated under this section shall be available
without fiscal year limitation.
``(2) Cost recovery.--No more than 10 percent of the funds
spent under paragraph (1) may be used for purposes of
recovering funds or taking other action against individuals who
breach the provisions of a contract entered into under section
338N(g).
``SEC. 338N. STATE HEALTH SERVICE CORPS SCHOLARSHIP PROGRAMS.
``(a) Definitions.--For purposes of this section:
``(1) Area health education center.--The term `area health
education center' means--
``(A) a cooperative program of one or more medical
schools (or the parent institutions (as defined in
section 338M(a)(6)) of such schools) and one or more
nonprofit private or public area health education
centers; or
``(B) a regional or statewide network of the
cooperative programs described in subparagraph (A).
``(2) Graduate education.--The term `graduate education'
means a course of study at a medical school or other health
professions school leading to a degree in a field practiced by
a physician or nonphysician provider.
``(3) Health professional shortage area.--The term `health
professional shortage area' has the meaning provided in section
332(a)(1).
``(4) Medical school.--The term `medical school' means a
school conferring the degree of Doctor of Medicine or Doctor of
Osteopathy.
``(5) Nonphysician provider.--The term `nonphysician
provider' means an occupational therapist, physical therapist,
nurse, nurse midwife, nurse practitioner, social worker, or
optometrist.
``(6) Nurse.--The term `nurse' means a registered nurse, or
an individual with a baccalaureate or master's degree in
nursing.
``(7) Physician provider.--The term `physician provider'
means--
``(A) a physician specializing in family medicine,
general internal medicine, pediatrics, obstetrics and
gynecology, general surgery, psychiatry, preventive
medicine, or physiatry; or
``(B) a dentist.
``(8) Program.--The term `Program' means a State Health
Service Corps Scholarship Program established under subsection
(b).
``(9) Service area.--The term `service area' means an area
designated in section 338M(d)(2)(A).
``(10) State official.--The term `State official' means an
individual designated by the head of the agency designated in
subsection (b)(2) to carry out the Program in the State.
``(11) Undergraduate education.--The term `undergraduate
education' means a course of study at a health sciences
university or a 4-year college that affords an appropriate
basis for professional training or graduate education to become
a physician or nonphysician provider.
``(b) Establishment.--
``(1) In general.--Each State carrying out a State Health
Services Corps Demonstration Project established under section
338M shall establish a State Health Service Corps Scholarship
Program, in accordance with this section, to ensure an adequate
supply of trained physician or nonphysician providers in health
professional shortage areas in the State.
``(2) State agency.--A State participating in the Program
shall designate a State agency to administer or be responsible
for the administration of the Program within the State.
``(c) Eligibility.--To be eligible to participate in the Program,
an individual must--
``(1)(A) be accepted for enrollment, or be enrolled, as a
full-time student in a health professions program in a health
sciences university or a 4-year college; or
``(B) be accepted to participate in, or be participating
in, a professional internship or residency as preparation to
become a physician or nonphysician provider;
``(2) reside within a health professional shortage area;
``(3) submit an application to participate in the Program;
and
``(4) sign and submit to the State, at the time of
submission of the application, a written contract containing
the information specified in subsection (g) to accept payment
of a scholarship and, if appropriate, of loans, and to serve in
the service area.
``(d) Selection.--Individuals described in subsection (c)(1)(B)--
``(1) shall comprise not more than 50 percent of all
individuals selected to participate in the Program during
fiscal year 1994;
``(2) shall comprise not more than 40 percent of all
individuals selected to participate in the Program during
fiscal year 1995;
``(3) shall comprise not more than 30 percent of all
individuals selected to participate in the Program during
fiscal year 1996;
``(4) shall comprise not more than 20 percent of all
individuals selected to participate in the Program during
fiscal year 1997;
``(5) shall comprise not more than 10 percent of all
individuals selected to participate in the Program during
fiscal year 1998; and
``(6) shall not be selected to participate in the Program
during fiscal years 1999 through 2001.
``(e) Information on Service Obligation.--In disseminating
application forms and contract forms to individuals desiring to
participate in the Program, the State official shall include with the
forms--
``(1) a fair summary of the rights and liabilities of an
individual whose application is approved (and whose contract is
accepted) by the State official, including in the summary a
clear explanation of the remedies to which the State is
entitled in the case of breach of the contract by the
individual; and
``(2) such information as may be necessary for the
individual to understand the prospective participation of the
individual in the Program and the service obligation of the
individual.
``(f) Application Forms.--The application form, contract form, and
all other information furnished by the Secretary under this section
shall be written in a manner calculated to be understood by the average
individual applying to participate in the Program. The State official
shall make the application forms, contract forms, and other information
available to individuals desiring to participate in the Program on a
date sufficiently early to ensure that the individuals have adequate
time to carefully review and evaluate the forms and information.
``(g) Contract.--The written contract between the State official
and an individual shall contain--
``(1) a statement that the State official agrees--
``(A) to provide the individual with a scholarship
for a period of up to 8 years, during which period the
individual is--
``(i) pursuing an undergraduate education
described in subsection (a)(11);
``(ii) pursuing graduate education; or
``(iii) participating in an internship or
residency program as preparation to become a
physician or nonphysician provider; and
``(B) to place the individual into obligated
service, taking into account the specialization of the
individual and the needs of health professional
shortage areas for service, in--
``(i) a rural health professional shortage
area, if the individual resided in a rural
health professional shortage area at the time
of acceptance into the Program; or
``(ii) an urban health professional
shortage area, if the individual resided in an
urban health professional shortage area at the
time of acceptance into the Program;
``(2) a statement that the individual agrees--
``(A) to accept provision of the scholarship, and
if appropriate, loans, to the individual;
``(B) to maintain enrollment in a program of
undergraduate or graduate education or participation in
an internship or residency described in subsection
(c)(1)(B) until the individual completes the program,
internship, or residency;
``(C) while enrolled in a program of undergraduate
or graduate education, to maintain an acceptable level
of academic standing (as determined under regulations
of the State by the educational institution offering
the course of study); and
``(D) to serve in the service area or on the
clinical staff of the area health education center or
the medical school for a time period equal to the
shorter of--
``(i)(I) 1 year for each year in which the
individual received a scholarship under the
Program; and
``(II) 1 month for each $1,000 in loans
that the individual received under the Program;
or
``(ii) 6 years;
``(3) a statement of the damages to which the State is
entitled for breach of contract by the individual; and
``(4) other statements of the rights and liabilities of the
State and of the individual, not inconsistent with this
section.
``(h) Acceptance.--
``(1) Approval.--An individual shall become a participant
in the Program only on approval by the State official of the
application submitted by the individual under subsection (c)(3)
and acceptance of the contract submitted by the individual
under subsection (c)(4).
``(2) Notification.--The State official shall provide
written notice to an individual of participation in the Program
promptly on acceptance of the individual into the Program.
``(i) Scholarship and Loans.--
``(1) Payment.--In providing a loan to an individual under
subsection (g)(1)(A) or a scholarship to an individual under
subsection (g)(1)(B), the State official shall pay--
``(A) to an individual undertaking a program of
undergraduate or graduate education, or on behalf of
the individual in accordance with paragraph (2)--
``(i) the amount of the tuition of the
individual in the school year;
``(ii) the amount of all other reasonable
educational expenses, including fees, books,
and laboratory expenses, incurred by the
individual in the school year; and
``(iii) a stipend; and
``(B) to an individual described in subsection
(c)(1)(B)--
``(i) the amount of expenses for medical
equipment necessary to the practice of a
physician or nonphysician provider;
``(ii) the amount of expenses for travel to
and from clinical sites; and
``(iii) a stipend.
``(2) Payment to an educational institution.--The State
official may contract with an educational institution, in which
a participant in the Program is enrolled, for the payment to
the educational institution of the amounts of tuition and other
reasonable educational expenses described in clauses (i) and
(ii) of paragraph (1)(A).
``(j) Report.--The State official shall report to the Secretary on
January 1 of each year--
``(1) the number, and type of health profession training,
of students receiving scholarships under the Program in the
preceding year;
``(2) the educational institutions at which the students
are receiving their training;
``(3) the number of applications filed under this section
in the school year in the preceding year and in prior school
years; and
``(4) the amount of tuition paid in the aggregate and at
each educational institution for the school year in the
preceding year and in prior school years.''.
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