101st CONGRESS
2d Session
H. R. 4487
AN ACT
To amend the Public Health Service Act to revise and extend the program
for the National Health Service Corps, and to establish certain programs of
grants to the States for improving health services in the States.
HR 4487 EH
101st CONGRESS
2d Session
H. R. 4487
AN ACT
To amend the Public Health Service Act to revise and extend the program
for the National Health Service Corps, and to establish certain programs of
grants to the States for improving health services in the States.
Be it enacted by the Senate and House of Representatives of the United
States of America in Congress assembled,

31d7c4734a3caa291328126334193b40bd763a11373da6e536a472f68b36785d

This Act may be cited as the `National Health Service Corps Revitalization
Amendments of 1990'.

66f820409162294617bcd8fc06f1338ec72dde088510f180f41540031bbc280a

(a) PROVISION OF PRIMARY HEALTH SERVICES- Section 331(a) of the Public
Health Service Act (42 U.S.C. 254d(a)) is amended--
(1) in the matter preceding subparagraph (A) of paragraph (1)--
(A) by inserting `(1)' after the subsection designation; and
(B) by striking `There is' and all that follows and inserting the
following: `For the purpose of eliminating health manpower shortages in
health manpower shortage areas, there is established, within the Service,
the National Health Service Corps, which shall consist of--';
(2) by striking `States,' at the end of paragraph (1)(C) and all that
follows and inserting `States.'; and
(3) by adding at the end the following new paragraphs:
`(2) The Corps shall be utilized by the Secretary to provide primary health
services in health manpower shortage areas.
`(3) For purposes of this subpart and subpart III:
`(A) The term `Corps' means the National Health Service Corps.
`(B) The term `Corps member' means each of the officers, employees, and
individuals of which the Corps consists pursuant to paragraph (1).
`(C) The term `health manpower shortage area' has the meaning given such
term in section 332(a).
`(D) The term `primary health services' means health services regarding
family medicine, internal medicine, pediatrics, obstetrics and gynecology,
dentistry, or mental health, that are provided by physicians or other
health professionals.'.
(b) REMOVAL OF LIMITATION REGARDING SUPPLEMENTAL PAY DURING INITIAL
YEARS OF SERVICE- Section 331(d)(1)(A) of the Public Health Service Act
(42 U.S.C. 254d(d)(1)(A)) is amended by striking `(not to exceed $1,000)'.
(c) TECHNICAL AND CONFORMING AMENDMENTS-
(1) REGARDING ADDITIONAL PROVISIONS ON PRIORITY- Section 331 of the Public
Health Service Act (42 U.S.C. 254d) is amended by striking subsection (h)
and redesignating subsection (i) as subsection (h).
(2) REGARDING DEFINITIONS- Section 331(h) of the Public Health Service Act,
as redesignated by paragraph (1) of this subsection, is amended in the matter
preceding paragraph (1) by inserting `and subpart III' before the colon.

d3aa18b1f460fdc557ee20cc5b8675267f333011cdc8aeedab3b5d1c9c008dc0

TITLE I

-REVISIONS IN GENERAL PROGRAM FOR NATIONAL HEALTH SERVICE CORPS

(a) PUBLICATION OF DESIGNATIONS AND REVISIONS- Section 332(d) of the Public
Health Service Act (42 U.S.C. 254e(d)) is amended by inserting `(1)'
after the subsection designation and by adding at the end the following
new paragraph:
`(2) For purposes of paragraph (1), a complete descriptive list shall be
published in the Federal Register not later than July 1 of 1991 and each
subsequent year.'.
(b) DEFINITION OF MEDICAL FACILITY- Section 332(a)(2) of the Public Health
Service Act (42 U.S.C. 254e(a)(2)) is amended--
(1) in subparagraph (A), by inserting before `and community health center'
the following: `facility operated by a city or county health department,';
(2) in subparagraph (B), by inserting before the semicolon the following: `,
and a health program or facility operated by a tribe or tribal organization
under the Indian Self-Determination Act'; and
(3) in subparagraph (C)--
(A) by striking `sections 321' and inserting `section 321', by striking
`or' before `326', and by striking `or section 320' and inserting `320'; and
(B) by inserting before the semicolon at the end the following: `, or 340
(relating to the provision of health services to homeless individuals)'.
(c) REMOVAL OF SUPERFLUOUS REFERENCES- Section 332 of the Public Health
Service Act (42 U.S.C. 254e) is amended--
(1) in subsection (b), in the first sentence of the matter preceding
paragraph (1), by striking `, promulgated not later than May 1, 1977, ';
(2) in subsection (c), by striking paragraph (1) and redesignating paragraphs
(2) and (3) as paragraphs (1) and (2), respectively;
(3) in subsection (d)(1) (as designated by subsection (a) of this section),
by striking `, not later than November 1, 1977,'; and
(4) in subsection (f), by inserting `and' after the semicolon at the end
of paragraph (1), and by striking paragraph (2) and redesignating paragraph
(3) as paragraph (2).

adb7182c0fc848d4ea75b71aa88b8c30abe4e3e779459f5217331e3538c02c74

(a) REQUIREMENT OF APPROPRIATE AND EFFICIENT USE OF CURRENT PERSONNEL AS
CONDITION OF RECEIVING FURTHER PERSONNEL- Section 333(a)(1)(D)(ii)(II) of
the Public Health Service Act (42 U.S.C. 254f(a)(1)(D)(ii)(II)) is amended--
(1) by striking `will be' and inserting `has been'; and
(2) by inserting `any' before `Corps'.
(b) TECHNICAL AND CONFORMING AMENDMENTS REGARDING ADDITIONAL PROVISIONS ON
PRIORITY AND ON EFFECTIVE SERVICE OF PERSONNEL- Section 333 of the Public
Health Service Act (42 U.S.C. 254f) is amended--
(1) by striking subsections (b), (c), (f), (h), (j), and (k); and
(2) by redesignating subsections (d), (e), (g), and (i) as subsections (b),
(c), (d), and (e), respectively.

da27d4b89dd6798a6cb9992c3363ee43a72ffccf404c7d41464604fe7c3e5788

Subpart II of part D of title III of the Public Health Service Act
(42 U.S.C. 254d et seq.) is amended by inserting after section 333 the
following new section:
`SEC. 333A. PRIORITIES IN ASSIGNMENT OF CORPS PERSONNEL.
`(a) IN GENERAL- In approving applications made under section 333 for the
assignment of Corps members, the Secretary shall--
`(1) give priority to any such application that--
`(A) is made regarding the provision of primary health services to a health
manpower shortage area with the greatest such shortage, as determined in
accordance with subsection (b); and
`(B) is made by an entity that--
`(i) serves a health manpower shortage area described in subparagraph (A);
`(ii) coordinates the delivery of primary health services with related
health and social services;
`(iii) has a documented record of sound fiscal management; and
`(iv) will experience a negative impact on its capacity to provide primary
health services if a Corps member is not assigned to the entity;
`(2) with respect to the geographic area in which the health manpower
shortage area is located, take into consideration the willingness of
individuals in the geographic area, and of the appropriate governmental
agencies or health entities in the area, to assist and cooperate with the
Corps in providing effective primary health services; and
`(3) take into consideration comments of medical, osteopathic, dental,
or other health professional societies whose members deliver services to
the health manpower shortage area, or if no such societies exist, comments
of physicians, dentists, or other health professionals delivering services
to the area.
`(b) EXCLUSIVE FACTORS FOR DETERMINING GREATEST SHORTAGES- In making a
determination under subsection (a)(1)(A) of the health manpower shortage
areas with the greatest such shortages, the Secretary may consider only
the following factors:
`(1) The ratio of available health manpower to the number of individuals
in the area or population group involved, or served by the medical facility
or other public facility involved.
`(2) Indicators of need as follows:
`(A) The rate of low birthweight births.
`(B) The rate of infant mortality.
`(C) The rate of poverty.
`(D) Access to primary health services, taking into account the distance
to such services.
`(c) ESTABLISHMENT OF CRITERIA FOR DETERMINING PRIORITIES-
`(1) IN GENERAL- The Secretary shall establish criteria specifying the
manner in which the Secretary makes a determination under subsection
(a)(1)(A) of the health manpower shortage areas with the greatest such
shortages. Such criteria shall specify the manner in which the factors
described in subsection (b) are implemented regarding such a determination.
`(2) PUBLICATION OF CRITERIA- The criteria required in paragraph (1) shall
be published in the Federal Register not later than July 1, 1991. Any
revisions made in the criteria by the Secretary shall be effective upon
publication in the Federal Register.
`(d) NOTIFICATIONS REGARDING PRIORITIES-
`(1) PREPARATION OF LIST FOR APPLICABLE PERIOD- For the purpose of carrying
out paragraph (2), the Secretary shall prepare a list of health manpower
shortage areas that are receiving priority under subsection (a)(1) in the
assignment of Corps members for the period applicable under subsection
(f). Such list--
`(A) shall include a specification, for each such health manpower shortage
area, of the entities for which the Secretary has provided an authorization
to receive assignments of Corps members in the event that Corps members
are available for the assignments; and
`(B) shall, of the entities for which an authorization described in
subparagraph (A) has been provided, specify--
`(i) the entities provided such an authorization for the assignment of
Corps members who are participating in the Scholarship Program;
`(ii) the entities provided such an authorization for the assignment of
Corps members who are participating in the Loan Repayment Program; and
`(iii) the entities provided such an authorization for the assignment
of Corps members who have become Corps members other than pursuant to
contractual obligations under the Scholarship or Loan Repayment Programs.
The Secretary may set forth such specifications by medical specialty.
`(2) NOTIFICATION OF AFFECTED PARTIES-
`(A) Not later than 30 days after the preparation of each list under
paragraph (1), the Secretary shall notify entities specified for purposes
of subparagraph (A) of such paragraph of the fact that the entities have
been provided an authorization to receive assignments of Corps members in
the event that Corps members are available for the assignments.
`(B) In the case of individuals with respect to whom a period of obligated
service under the Scholarship Program will begin during the period
under subsection (f) for which a list under paragraph (1) is prepared,
the Secretary shall, not later than 30 days after the preparation of each
such list, provide to such individuals the names of each of the entities
specified for purposes of paragraph (1)(B)(i) that is appropriate to the
medical specialty of the individuals.
`(3) REVISIONS IN LIST- If the Secretary makes a revision in a list under
paragraph (1) during the period under subsection (f) to which the list is
applicable, and the revision alters the status of an entity with respect
to the list, the Secretary shall notify the entity of the effect on the
entity of the revision. Such notification shall be provided not later than
30 days after the date on which the revision is made.
`(e) LIMITATION ON NUMBER OF ENTITIES OFFERED AS ASSIGNMENT CHOICES IN
SCHOLARSHIP PROGRAM-
`(1) DETERMINATION OF AVAILABLE CORPS MEMBERS- The Secretary shall determine
the number of participants in the Scholarship Program who are available for
assignments under section 333 for the period applicable under subsection (f).
`(2) AVAILABILITY OF 500 OR FEWER MEMBERS- If the number of participants for
purposes of paragraph (1) is less than 500, the Secretary shall limit the
number of entities specified under subsection (d)(1)(B)(i) to the lesser of--
`(A) 500 such entities; and
`(B) a number of such entities constituting 300 percent of the number of
such participants available for assignment under section 333.
`(3) AVAILABILITY OF MORE THAN 500 MEMBERS- If the number of participants
for purposes of paragraph (1) is equal to or greater than 500, the Secretary
shall determine the number of entities to be specified under subsection
(d)(1)(B)(i), subject to ensuring that assignments of such participants
are made to 500 entities that serve health manpower shortage areas that
have chronic difficulty in recruiting and retaining health professionals
to provide primary health services.
`(4) ADJUSTMENT IN BASE NUMBER- The number 500, as used for purposes of
paragraphs (2) and (3), may by regulation be adjusted by the Secretary to
a greater or a lesser number.
`(f) APPLICABLE PERIOD REGARDING PRIORITIES-
`(1) IN GENERAL- With respect to determinations under subsection (a)(1)
of the applications that are to be given priority regarding the assignment
of Corps members, the Secretary shall make such a determination not less
than once each fiscal year. The first determination shall be made not later
than July 1 of the year preceding the year in which the period of obligated
service begins. If the Secretary revises the determination before July 1
of the following year, the revised determination shall be applicable with
respect to assignments of Corps members made during the period beginning
on the date of the issuance of the revised determination and ending on
July 1 of such year.
`(2) DATE CERTAIN FOR PREPARATION OF NOTIFICATION LIST- A list under
subsection (d)(1) shall be prepared for each of the periods decribed in
paragraph (1). Each such list shall be prepared not later than the date
on which a determination of priorities under such paragraph is required
to be made for the period involved.'.

53a600887f71f664d52fa8673982503d7ea4a48c3e91ed252af05a0180da7616

Section 334(f)(2) of the Public Health Service Act (42 U.S.C. 254g(f)(2))
is amended by adding at the end the following new subparagraph:
`(C)(i) A determination under subparagraph (B) regarding the revenues
and costs of an entity in an annual period shall be made by the Secretary
utilizing criteria specific to the entity and shall be made without regard
to whether the entity is making progress toward collecting sufficient
revenues to provide an adequate level of primary health services without
the assignment of Corps members.
`(ii) In making a determination referred to in clause (i)--
`(I) the Secretary may consider whether the proposed budget submitted under
subparagraph (A) provides a reasonable estimate regarding the revenues
and costs of the entity; and
`(II) may not consider the reasonableness of the amount of revenues
collected, or the amount of costs incurred by the entity, except to the
extent necessary to ensure that the entity is operating in good faith and
is operating efficiently with respect to fiscal matters within the control
of the entity.
`(iii) A determination of whether an entity is eligible for a waiver under
paragraph (3) shall be made by the Secretary without regard to the revenues
and costs determined by the Secretary under subparagraph (B).
`(iv) A determination of whether an entity is a small health center shall
be made by the Secretary without regard to the revenues and costs determined
by the Secretary under subparagraph (B).'.

35e6727a0e2143676ec53d39bc88ef7e6de7ddd8a40c6cb88c367e54f4a4e2a4

Section 336 of the Public Health Service Act (42 U.S.C. 254h-1) is amended
to read as follows:
`SEC. 336. FACILITATION OF EFFECTIVE PROVISION OF CORPS SERVICES.
`(a) CONSIDERATION OF INDIVIDUAL CHARACTERISTICS OF MEMBERS IN MAKING
ASSIGNMENTS- In making an assignment of a Corps member to an entity that
has had an application approved under section 333, the Secretary shall seek
to assign to the entity a Corps member who has (and whose spouse, if any,
has) characteristics that increase the probability that the member will
remain in the health manpower shortage area involved after the completion
of the period of service in the Corps.
`(b) COUNSELING ON SERVICE IN CORPS-
`(1) IN GENERAL- The Secretary shall, subject to paragraph (3), offer
appropriate counseling on service in the Corps to individuals during the
period of membership in the Corps, particularly during the initial period
of each assignment.
`(2) COUNSELING ON OBLIGATED SERVICE-
`(A) In the case of individuals who have entered into contracts for obligated
service under the Scholarship or Loan Repayment Program, counseling under
paragraph (1) shall include appropriate counseling on matters particular
to such obligated service.
`(B) With respect to the Scholarship Program, counseling under paragraph
(1) shall include counseling individuals during the period in which the
individuals are pursuing an educational degree in the health profession
involved, including counseling to prepare the individual for service in
the Corps.
`(3) EXTENT OF COUNSELING SERVICES- With respect to individuals who have
entered into contracts for obligated service under the Scholarship or Loan
Repayment Program, this subsection shall be carried out regarding such
individuals throughout the period of obligated service (and, additionally,
throughout the period specified in paragraph (2)(B), in the case of
the Scholarship Program). With respect to Corps members generally, this
subsection shall be carried out to the extent practicable.
`(c) GRANTS FOR PROGRAMS REGARDING PREPARATION FOR PRACTICE- With respect
to individuals who have entered into contracts for obligated service under
the Scholarship or Loan Repayment Program, the Secretary may make grants
to, and enter into contracts with, public and nonprofit private entities
for the conduct of programs designed to prepare such individuals for the
effective provision of primary health services in the health manpower
shortage areas to which the individuals are assigned.
`(d) ASSISTANCE IN ESTABLISHING LOCAL PROFESSIONAL RELATIONSHIPS-
The Secretary shall assist Corps members in establishing appropriate
professional relationships between the Corps member involved and the
health professions community of the geographic area with respect to which
the member is assigned, including such relationships with hospitals,
with health professions schools, with area health education centers under
section 781, with health education and training centers under such section,
and with border health education and training centers under such section.
`(e) TEMPORARY RELIEF FROM CORPS DUTIES-
`(1) IN GENERAL- The Secretary shall, subject to paragraph (4), provide
assistance to Corps members in establishing arrangements through which
Corps members may, as appropriate, be provided temporary relief from
duties in the Corps in order to pursue continuing education in the health
professions or to pursue other interests, including vacations.
`(2) ASSUMPTION OF DUTIES OF MEMBER- Temporary relief under paragraph
(1) may be provided only if the duties of the Corps member involved are
assumed by another health professional. Such duties may be assumed by
health professionals who are not Corps members, if the Secretary approves
the professionals for such purpose. Any health professional so approved by
the Secretary shall, during the period of providing such temporary relief,
be deemed to be a Corps member for purposes of section 224 (including
for purposes of the remedy described in such section), section 333(f),
and section 335(e).
`(3) RECRUITMENT FROM GENERAL HEALTH PROFESSIONS COMMUNITY- In carrying
out paragraph (1), the Secretary shall--
`(A) encourage health professionals who are not Corps members to enter
into arrangements under which the health professionals temporarily assume
the duties of Corps members for purposes of paragraph (1); and
`(B) with respect to the entities to which Corps members have been assigned
under section 333, encourage the entities to facilitate the development
of arrangements described in subparagraph (A).
`(4) LIMITATION- In carrying out paragraph (1), the Secretary may not,
except as provided in paragraph (5), obligate any amounts (other than for
incidental expenses) for the purpose of--
`(A) compensating a health professional who is not a Corps member for
assuming the duties of a Corps member; or
`(B) paying the costs of continuing education, a vacation, or other interests
that a Corps member may pursue during the period of temporary relief under
such paragraph.
`(5) SOLE PROVIDERS OF HEALTH SERVICES- In the case of any Corps member who
is the sole provider of health services in the geographic area involved,
the Secretary may, from amounts appropriated under section 338, obligate on
behalf of the member such sums as the Secretary determines to be necessary
for purposes of providing temporary relief under paragraph (1).
`(f) DETERMINATIONS REGARDING EFFECTIVE SERVICE- In carrying out subsection
(a) and sections 338A(d) and 338B(d), the Secretary shall carry out
activities to determine--
`(1) the characteristics of physicians, dentists, and other health
professionals who are more likely to remain in practice in health manpower
shortage areas after the completion of the period of service in the Corps;
`(2) the characteristics of health manpower shortage areas, and of entities
seeking assignments of Corps members, that are more likely to retain
Corps members after the members have completed the period of service in
the Corps; and
`(3) the appropriate conditions for the assignment and utilization in health
manpower shortage areas of certified nurse practitioners, certified nurse
midwives, and physician assistants.'.

fca000901d40fccbc003868b384b59a7cb5d42b40714636ed97576a9dd9fccd4

Section 337(a) of the Public Health Service Act (42 U.S.C. 254j(a))
is amended--
(1) by striking the second sentence; and
(2) by inserting `(1)' after the subsection designation, and adding at
the end the following new paragraph:
`(2) The Council shall be composed of 15 members appointed by the
Secretary. Of such members--
`(A) 1 shall be a Corps member who is providing obligated service pursuant
to the Scholarship Program;
`(B) 1 shall be a Corps member who is providing obligated service pursuant
to the Loan Repayment Program;
`(C) 1 shall be a resident of a frontier area;
`(D) 1 shall be a resident of a rural area other than a frontier area;
`(E) 1 shall be a resident of an urban area;
`(F) 1 shall be a physician assistant;
`(G) 1 shall be a certified nurse practitioner;
`(H) 1 shall be a certified nurse midwife;
`(I) 1 shall be a family practitioner;
`(J) 1 shall be a physician practicing obstetrics and gynecology;
`(K) 1 shall be a pediatrician; and
`(L) 1 shall be a physician practicing internal medicine.'.

b8aec2bb910fd26d887be21033a4884d1feb787709a3cd752b98d41579cb6f39

Section 338(a) of the Public Health Service Act (42 U.S.C. 254k) is amended
by striking `To carry ' and all that follows and inserting the following:
`For the purpose of carrying out this subpart, there are authorized to be
appropriated such sums as may be necessary for each of the fiscal years
1991 through 2000.'.
SERVICE CORPS

c7df6baeb70da932b58f987ce791f07284c0fa5567a853f00726b29c730e18f5

(a) PROVISION OF PRIMARY HEALTH SERVICES-
(1) IN GENERAL- Section 338A(a) of the Public Health Service Act (42
U.S.C. 254l(a)) is amended by striking `Corps Scholarship' and all that
follows and inserting the following: `Corps Scholarship Program to assure,
with respect to the provision of primary health services pursuant to
section 331(a)(2)--
`(1) an adequate supply of physicians, dentists, certified nurse midwives,
certified nurse practitioners, and physician assistants; and
`(2) if needed by the Corps, an adequate supply of other health
professionals.'.
(2) SCHOLARSHIP CONTRACT- Section 338A(f)(1)(B)(iv) of the Public Health
Service Act (42 U.S.C. 254l(f)(1)(B)(iv)) is amended in the matter after
and below subclause (II) by inserting `as a provider of primary health
services' before `in a health manpower shortage area'.
(b) PRIORITY IN AWARDING SCHOLARSHIPS- Section 338A(d) of the Public Health
Service Act (42 U.S.C. 254l(d)) is amended to read as follows:
`(d) In providing contracts under the Scholarship Program, the Secretary
shall give priority--
`(1) first, to any application for such a contract submitted by an
individual who has previously received a scholarship under this section
or under section 758; and
`(2) second, to any application for such a contract submitted by an
individual who has characteristics that increase the probability that the
individual will continue to serve in a health manpower shortage area after
the period of obligated service pursuant to subsection (f) is completed.'.
(c) REPORTS TO CONGRESS- Section 338A(i) of the Public Health Service Act
(42 U.S.C. 254l(i)) is amended by striking `and' after the semicolon at
the end of paragraph (3), by striking paragraph (4), and by adding at the
end the following new paragraphs:
`(4) the amount of scholarship payments made for each of tuition, stipends,
and other expenses, in the aggregate and at each educational institution
for the school year beginning in such year and for prior school years; and
`(5)(A) the number, and type of health professions training, of individuals
who have breached the contract under subsection (f) through any of the
actions specified in subsection (a) or (b) of section 338E; and
`(B) with respect to such individuals--
`(i) the educational institutions with respect to which payments have been
made or were to be made under the contract;
`(ii) the amounts for which the individuals are liable to the United States
under section 338E;
`(iii) the extent of payment by the individuals of such amounts; and
`(iv) if known, the basis for the decision of the individuals to breach
the contract under subsection (f).'.

12f12f7dce7a0223cb66ed88ee52cf984840351c83b4410f230294465323baac

TITLE II

-SCHOLARSHIP AND LOAN REPAYMENT PROGRAMS OF NATIONAL HEALTH

(a) PROVISION OF PRIMARY HEALTH SERVICES-
(1) IN GENERAL- Section 338B(a) of the Public Health Service Act (42
U.S.C. 254l-1(a)) is amended by striking `Corps Loan' and all that follows
and inserting the following: `Corps Loan Repayment Program to assure,
with respect to the provision of primary health services pursuant to
section 331(a)(2)--
`(1) an adequate supply of physicians, dentists, certified nurse midwives,
certified nurse practitioners, and physician assistants; and
`(2) if needed by the Corps, an adequate supply of other health
professionals.'.
(2) LOAN REPAYMENT CONTRACT- Section 338B(f)(1)(B)(iv) of the Public
Health Service Act (42 U.S.C. 254l(f)(1)(B)(iv)) is amended by inserting
`as a provider of primary health services' before `in a health manpower
shortage area'.
(b) ELIGIBILITY-
(1) IN GENERAL-
(A) Section 338B(b)(1) of the Public Health Service Act (42
U.S.C. 254l-1(b)(1)) is amended to read as follows:
`(1)(A) must have a degree in medicine, osteopathic medicine, dentistry,
or other health profession;
`(B) be enrolled in an approved graduate training program in medicine,
osteopathic medicine, dentistry, or other health profession; or
`(C) be enrolled as a full-time student--
`(i) in an accredited (as determined by the Secretary) educational
institution in a State; and
`(ii) in the final year of a course of a study or program, offered by such
institution and approved by the Secretary, leading to a degree in medicine,
osteopathic medicine, dentistry, or other health profession;'.
(B) Section 338B(f)(1)(B) of the Public Health Service Act (42
U.S.C. 254l-1(f)(1)(B)) is amended in clauses (ii) and (iii) by striking
`(b)(1)(A)' each place such term appears and inserting `(b)(1)(C)'.
(2) TIME FOR SUBMISSION OF CONTRACT-
(A) Section 338B(b) of the Public Health Service Act (42 U.S.C. 254l-1(b))
is amended--
(i) by adding `and' after the semicolon at the end of paragraph (2); and
(ii) by striking paragraphs (3) and (4), and by inserting after paragraph
(2) the following:
`(3) submit to the Secretary an application for a contract described in
subsection (f) (relating to the payment by the Secretary of the educational
loans of the individual in consideration of the individual serving for a
period of obligated service).'
(B) Section 338B(e) of the Public Health Service Act (42 U.S.C. 254l-1(e)) is
amended by striking `only' and all that follows and inserting the following:
`only upon the Secretary and the individual entering into a written contract
described in subsection (f).'.
(c) PRIORITY IN MAKING AWARDS- Section 338B(d) of the Public Health Service
Act (42 U.S.C. 254l-1(d)) is amended to read as follows:
`(d) In providing contracts under the Loan Repayment Program, the Secretary
shall give priority--
`(1) to any application for such a contract submitted by an individual
whose training is in a health profession or specialty determined by the
Secretary to be needed by the Corps; and
`(2) to any application for such a contract submitted by an individual
who has (and whose spouse, if any, has) characteristics that increase the
probability that the individual will continue to serve in a health manpower
shortage area after the period of obligated service pursuant to subsection
(f) is completed.'.
(d) CONTENTS OF CONTRACT- Section 338B(f)(2) of the Public Health Service
Act (42 U.S.C. 254l-1(f)(2)) is amended by inserting before the semicolon
the following: `, including extensions resulting in an aggregate period
of obligated service in excess of 4 years'.
(e) PAYMENTS-
(1) CLARIFICATION REGARDING UNDERGRADUATE LOANS- Section 338B(g)(1) of the
Public Health Service Act (42 U.S.C. 254l-1(g)(1)) is amended in the matter
preceding subparagraph (A) by striking `loans received by the individual
for--' and inserting the following: `loans received by the individual
regarding the undergraduate or graduate education of the individual (or
both), which loans were made for--'.
(2) ANNUAL AMOUNT OF REPAYMENTS- Section 338B(g)(2) of the Public Health
Service Act (42 U.S.C. 254l-1(g)(2)) is amended--
(A) in subparagraph (A), by striking `$20,000' and inserting `$35,000', and
by striking `Except' and all that follows through `for each' and inserting
`For each'; and
(B) by striking subparagraph (B) and redesignating subparagraph (C) as
subparagraph (B).
(f) TAX LIABILITY-
(1) IN GENERAL- Section 338B(g)(3) of the Public Health Service Act (42
U.S.C. 254l-1(g)(3)) is amended to read as follows:
`(3) TAX LIABILITY- For the purpose of providing reimbursements for tax
liability resulting from payments under paragraph (2) on behalf of an
individual--
`(A) the Secretary shall, in addition to such payments, make payments to
the individual in an amount equal to 39 percent of the total amount of
loan repayments made for the taxable year involved; and
`(B) may make such additional payments as the Secretary determines to be
appropriate with respect to such purpose.'.
(2) APPLICABILITY OF AMENDMENT- The amendment made by paragraph (1) shall
apply only with respect to contracts under section 338B of the Public
Health Service Act (relating to service in the National Health Service
Corps) that are entered into on or after the effective date of this Act.
(g) REPORTS TO CONGRESS- Section 338B(i) of the Public Health Service Act
(42 U.S.C. 254l-1(i)) is amended by striking paragraphs (1) through (4)
and inserting the following:
`(1) the total amount of loan payments made under the Loan Repayment
Program in the year for which the report is submitted;
`(2) the number of applications filed under this section in the school
year beginning in such year and in prior school years;
`(3) the number, and type of health profession training, of individuals
receiving loan repayments under such Program;
`(4) the educational institution at which such individuals received their
training;
`(5) the total amount of the indebtedness of such individuals for educational
loans as of the date on which the individuals become participants in
such Program;
`(6) the number of years of obligated service specified for such individuals
in the initial contracts under subsection (f), and, in the case of
individuals whose period of such service has been completed, the total
number of years for which the individuals served in the Corps (including
any extensions made for purposes of paragraph (2) of such subsection); and
`(7)(A) the number, and type of health professions training, of such
individuals who have breached the contract under subsection (f) through
any of the actions specified in subsection (a) or (b) of section 338E; and
`(B) with respect to such individuals--
`(i) the educational institutions with respect to which payments have been
made or were to be made under the contract;
`(ii) the amounts for which the individuals are liable to the United States
under section 338E;
`(iii) the extent of payment by the individuals of such amounts; and
`(iv) if known, the basis for the decision of the individuals to breach
the contract under subsection (f).'.

1845b3175b76ea7a47ea9c9eedd33bbb866835086e3195d1dc04bee0388da31a

Subpart III of part D of title III of the Public Health Service Act (42
U.S.C. 254l et seq.) is amended by redesignating sections 338F through
338H as sections 338G through sections 338I, respectively, and by inserting
after section 338E the following new section:
`SEC. 338F. FUND REGARDING USE OF AMOUNTS RECOVERED FOR CONTRACT BREACH TO
REPLACE SERVICES LOST AS RESULT OF BREACH.
`(a) ESTABLISHMENT OF FUND- There is established in the Treasury of the
United States a fund to be known as the National Health Service Corps
Member Replacement Fund (hereafter in this section referred to as the
`Fund'). The Fund shall consist of such amounts as may be appropriated
under subsection (b) to the Fund.
`(b) AUTHORIZATION OF APPROPRIATIONS TO FUND- For each fiscal year, there
is authorized to be appropriated to the Fund an amount equal to the sum of--
`(1) the amount collected during the preceding fiscal year by the Federal
Government pursuant to the liability of individuals under section 338E
for the breach of contracts entered into under section 338A or 338B;
`(2) the amount by which grants under section 338I have, for such preceding
fiscal year, been reduced under subsection (g)(2)(B) of such section; and
`(3) the aggregate of the amount of interest accruing during the preceding
fiscal year on obligations held in the Fund pursuant to subsection (d)
and the amount of proceeds from the sale or redemption of such obligations
during such fiscal year.
`(c) USE OF FUND-
`(1) PAYMENTS TO CERTAIN HEALTH FACILITIES- Amounts in the Fund and
available pursuant to appropriations Act may, subject to paragraph (2),
be expended by the Secretary to make payments to any entity--
`(A) to which a Corps member has been assigned under section 333; and
`(B) that has a need for a health professional to provide primary health
services as a result of the Corps member having breached the contract
entered into under section 338A or 338B by the individual.
`(2) PURPOSE OF PAYMENTS- An entity receiving payments pursuant to paragraph
(1) may expend the payments to recruit and employ a health professional to
provide primary health services to patients of the entity, or to enter into
a contract with such a professional to provide the services to the patients.
`(d) INVESTMENT-
`(1) IN GENERAL- The Secretary of the Treasury shall invest such amounts
of the Fund as such Secretary determines are not required to meet
current withdrawals from the Fund. Such investments may be made only
in interest-bearing obligations of the United States. For such purpose,
such obligations may be acquired on original issue at the issue price,
or by purchase of outstanding obligations at the market price.
`(2) SALE OF OBLIGATIONS- Any obligation acquired by the Fund may be sold
by the Secretary of the Treasury at the market price.'.

1084fc9f3e1396dd1906073597bd3998661b7408c032e148503d4ee56a6f1ca5

(a) INCREASE IN PERIOD FOR WHICH NEEDS PROJECTED- Section 338H(a) of the
Public Health Service Act, as redesignated by section 203 of this Act,
is amended in paragraphs (1) and (2) by striking `3 fiscal years' each
place such term appears and inserting `5 fiscal years'.
(b) FUNDING- Section 338H(b) of the Public Health Service Act, as
redesignated by section 203 of this Act, is amended to read as follows:
`(b) FUNDING-
`(1) AUTHORIZATION OF APPROPRIATIONS- For the purpose of carrying out this
subpart, there are authorized to be appropriated $63,900,000 for fiscal
year 1991, and such sums as may be necessary for each of the fiscal years
1992 through 2000.
`(2) RESERVATION OF AMOUNTS-
`(A) SCHOLARSHIPS FOR NEW PARTICIPANTS- Of the amounts appropriated under
paragraph (1) for a fiscal year, the Secretary shall obligate not less than
30 percent for the purpose of providing contracts for scholarships under this
subpart to individuals who have not previously received such scholarships.
`(B) SCHOLARSHIPS FOR FIRST-YEAR STUDY IN CERTAIN FIELDS- With respect
to certification as a nurse practitioner, nurse midwife, or physician
assistant, the Secretary shall, of the amounts appropriated under
paragraph (1) for a fiscal year, obligate not less than 10 percent for
the purpose of providing contracts for scholarships under this subpart
to individuals who are entering the first year of study in a course of
study or program described in subsection 338A(b)(1)(B) that leads to such
a certification. Amounts obligated under this subparagraph shall be in
addition to amounts obligated under subparagraph (A).'.

0a85661c4bb273971dc41e13a3671e8dfd06362089800d7cb45983b6865be46e

SERVICE IN HEALTH MANPOWER SHORTAGE AREAS.
Section 338I of the Public Health Service Act, as redesignated  by section
203 of this Act, is amended to read as follows:
`SEC. 338I. GRANTS TO STATES FOR LOAN REPAYMENT PROGRAMS.
`(a) IN GENERAL-
`(1) AUTHORITY FOR GRANTS- The Secretary, acting through the Administrator of
the Health Resources and Services Administration, may make grants to States
for the purpose of assisting the States in operating programs described
in paragraph (2) in order to provide for the increased availability of
primary health services in health manpower shortage areas.
`(2) LOAN REPAYMENT PROGRAMS- The programs referred to in paragraph (1) are,
subject to subsection (c), programs of entering into contracts under which
the State involved agrees to pay all or part of the principal, interest,
and related expenses of the educational loans of health professionals
in consideration of the professionals agreeing to provide primary health
services in health manpower shortage areas.
`(3) DIRECT ADMINISTRATION BY STATE AGENCY- The Secretary may not make a
grant under paragraph (1) unless the State involved agrees that the program
operated with the grant will be administered directly by a State agency.
`(b) REQUIREMENT OF MATCHING FUNDS-
`(1) IN GENERAL- The Secretary may not make a grant under subsection (a)
unless the State agrees that, with respect to the costs of making payments
on behalf of individuals under contracts made pursuant to paragraph (2)
of such subsection, the State will make available (directly or through
donations from public or private entities) non-Federal contributions in
cash toward such costs in an amount equal to not less than $1 for each $1
of Federal funds provided in the grant.
`(2) DETERMINATION OF AMOUNT OF NON-FEDERAL CONTRIBUTION- 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.
`(c) COORDINATION WITH FEDERAL PROGRAM-
`(1) ASSIGNMENTS FOR HEALTH MANPOWER SHORTAGE AREAS UNDER FEDERAL PROGRAM-
The Secretary may not make a grant under subsection (a) unless the State
involved agrees that, in carrying out the program operated with the grant,
the State will assign health professionals participating in the program
only to public and nonprofit private entities located in and providing
health services in health manpower shortage areas.
`(2) REMEDIES FOR BREACH OF CONTRACTS- The Secretary may not make a grant
under subsection (a) unless the State involved agrees that the contracts
provided by the State pursuant to paragraph (2) of such subsection will
provide remedies for any breach of the contracts by the health professionals
involved.
`(3) LIMITATION REGARDING CONTRACT INDUCEMENTS- The Secretary may not
make a grant under subsection (a) unless the State involved agrees
that the contracts provided by the State pursuant to paragraph (2) of
such subsection will not be provided on terms that are more favorable to
health professionals than the most favorable terms that the Secretary is
authorized to provide for contracts under the Loan Repayment Program under
section 338B, including terms regarding--
`(A) the annual amount of payments provided on behalf of the professionals
regarding educational loans; and
`(B) the availability of remedies for any breach of the contracts by the
health professionals involved.
`(d) RESTRICTIONS ON USE OF FUNDS- The Secretary may not make a grant
under subsection (a) unless the State involved agrees that the grant will
not be expended--
`(1) to conduct activities for which Federal funds are expended--
`(A) within the State to provide technical or other nonfinancial assistance
under subsection (f) of section 330;
`(B) under a memorandum of agreement entered into with the State under
subsection (h) of such section; or
`(C) under a grant under section 338J; or
`(2) for any purpose other than making payments on behalf of health
professionals under contracts entered into pursuant to subsection (a)(2).
`(e) REPORTS- The Secretary may not make a grant under subsection (a)
unless the State involved agrees--
`(1) to submit to the Secretary reports providing the same types of
information regarding the program operated pursuant to such subsection
as reports submitted pursuant to subsection (i) of section 338B provide
regarding the Loan Repayment Program under such section; and
`(2) to submit such 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.
`(f) REQUIREMENT OF APPLICATION- The Secretary may not make a grant under
subsection (a) unless an application for the grant is submitted to the
Secretary and the application is in such form, is made in such manner,
and contains such agreements, assurances, and information as the Secretary
determines to be necessary to carry out such subsection.
`(g) NONCOMPLIANCE-
`(1) IN GENERAL- 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.
`(2) REDUCTION IN GRANT RELATIVE TO NUMBER OF BREACHED CONTRACTS-
`(A) Before making a grant under subsection (a) to a State for a fiscal
year, the Secretary shall determine the number of contracts provided by
the State under paragraph (2) of such subsection with respect to which
there has been an initial breach by the health professionals involved
during the fiscal year preceding the fiscal year for which the State is
applying to receive the grant.
`(B) In the case of State with 1 or more initial breaches for purposes of
subparagraph (A), the Secretary shall reduce the amount of a grant under
subsection (a) to the State for the fiscal year involved by an amount equal
to the expenditures of Federal funds made regarding the contracts involved.
`(h) DEFINITIONS- For purposes of this section, the term `State' means
each of the several States.
`(i) AUTHORIZATION OF APPROPRIATIONS-
`(1) IN GENERAL- For the purpose of making grants under subsection (a),
there is authorized to be appropriated $10,000,000 for each of the fiscal
years 1991 through 1995.
`(2) AVAILABILITY- Amounts appropriated under paragraph (1) shall remain
available until expended.'.

0428a2981a1b17bb56be9f38a5efe13a2649edf2dec509520c7d792a21548e93

TITLE III

-GRANTS TO STATES FOR IMPROVEMENTS REGARDING HEALTH SERVICES

Subpart III of part D of title III of the Public Health Service Act, as
amended by section 203 of this Act, is amended by redesignating section
338J as section 338K, and by inserting after section 338I the following
new section:
`SEC. 338J. GRANTS TO STATES FOR OPERATION OF OFFICES OF RURAL HEALTH.
`(a) IN GENERAL- The Secretary, acting through the Director of the Office
of Rural Health Policy (established in section 711 of the Social Security
Act), may make grants to States for the purpose of improving health care
in rural areas through the operation of State offices of rural health.
`(b) REQUIREMENT OF MATCHING FUNDS-
`(1) IN GENERAL- The Secretary may not make a grant under subsection (a)
unless the State involved agrees, with respect to the costs to be incurred
by the State in carrying out the purpose described in such subsection, to
provide non-Federal contributions in cash toward such costs in an amount
equal to--
`(A) for the first fiscal year of payments under the grant, not less than
$1 for each $3 of Federal funds provided in the grant;
`(B) for any second year of such payments, not less than $1 for each $1
of Federal funds provided in the grant; and
`(C) for any third year of such payments, not less than $3 for each $1 of
Federal funds provided in the grant.
`(2) DETERMINATION OF AMOUNT OF NON-FEDERAL CONTRIBUTION- 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.
`(c) CERTAIN REQUIRED ACTIVITIES- The Secretary may not make a grant under
subsection (a) unless the State involved agrees that activities carried
out by an office operated pursuant to such subsection will include--
`(1) establishing and maintaining within the State a clearinghouse for
collecting and disseminating information on--
`(A) rural health care issues;
`(B) research findings relating to rural health care; and
`(C) innovative approaches to the delivery of health care in rural areas;
`(2) coordinating the activities carried out in the State that relate to
rural health care, including providing coordination for the purpose of
avoiding redundancy in such activities; and
`(3) identifying Federal and State programs regarding rural health, and
providing technical assistance to public and nonprofit private entities
regarding participation in such programs.
`(d) REQUIREMENT REGARDING ANNUAL BUDGET FOR OFFICE- The Secretary may not
make a grant under subsection (a) unless the State involved agrees that,
for any fiscal year for which the State receives such a grant, the office
operated pursuant to subsection (a) will be provided with an annual budget
of not less than $50,000.
`(e) CERTAIN USES OF FUNDS-
`(1) RESTRICTIONS- The Secretary may not make a grant under subsection
(a) unless the State involved agrees that--
`(A) if research with respect to rural health is conducted pursuant to
the grant, not more than 10 percent of the grant will be expended for such
research; and
`(B) 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 (f) of section 330;
`(II) under a memorandum of agreement entered into with the State under
subsection (h) of such section; or
`(III) under a grant under section 338I;
`(iii) to purchase medical equipment, to purchase ambulances, aircraft,
or other vehicles, or to purchase major communications equipment; or
`(iv) to purchase or improve real property.
`(2) AUTHORITIES- Activities for which a State may expend a grant under
subsection (a) include--
`(A) paying the costs of establishing an office of rural 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 rural areas of the State; and
`(C) providing grants and contracts to public and nonprofit private entities
to carry out activities authorized in this section.
`(f) REPORTS- The Secretary may not make a grant under subsection (a)
unless the State involved 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 such 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) REQUIREMENT OF APPLICATION- The Secretary may not make a grant under
subsection (a) unless an application for the grant is submitted to the
Secretary and the application is in such form, is made in such manner,
and contains such agreements, assurances, and information as the Secretary
determines to be necessary to carry out 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) DEFINITIONS- For purposes of this section, the term `State' means
each of the several States.
`(j) AUTHORIZATION OF APPROPRIATIONS-
`(1) IN GENERAL- For the purpose of making grants under subsection (a),
there are authorized to be appropriated $3,000,000 for fiscal year 1991,
$4,000,000 for fiscal year 1992, and $3,000,000 for fiscal year 1993.
`(2) AVAILABILITY- Amounts appropriated under paragraph (1) shall remain
available until expended.
`(k) TERMINATION OF PROGRAM- No grant may be made under this section after
the aggregate amounts appropriated under subsection (j)(1) are equal to
$10,000,000.'.

a6e23f136ca92129f2fe6c48fa1bd9b048cf56a5b67db475e2766f89b8d03316

This Act and the amendments made by this Act shall take effect October 1,
1990, or upon the date of the enactment of this Act, whichever occurs later.
Passed the House of Representatives July 30, 1990.
Attest:
Clerk.
HR 4487 EH----2
HR 4487 EH----3

eec6dca699dda3e515fc84d8c8f2cfd34e6b8018b27166fa4929eea0c1f7c321

National Health Service Corps Revitalization Amendments of 1990

Other Sections

TITLE I

TITLE II

TITLE III

TITLE IV

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