101st CONGRESS
2d Session
H. R. 5702
AN ACT
To amend the Public Health Service Act to improve the health of individuals
who are members of minority groups and who are from  disadvantaged backgrounds,
and for other purposes.
HR 5702 EH
101st CONGRESS
2d Session
H. R. 5702
AN ACT
To amend the Public Health Service Act to improve the health of individuals
who are members of minority groups and who are 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,

19c086f2ef2401ece014e053d49e00d8954068be5b47e4de7dc22a99fcbd2434

(a) SHORT TITLE- This Act may be cited as the `Disadvantaged Minority
Health Improvement Act of 1990'.
(b) FINDINGS- The Congress finds that--
(1) racial and ethnic minorities are disproportionately represented among
individuals from disadvantaged backgrounds;
(2) the health status of individuals from disadvantaged backgrounds,
including racial and ethnic minorities, in the United States is significantly
lower than the health status of the general population of the United States;
(3) minorities suffer disproportionately high rates of cancer, stroke,
heart diseases; diabetes, substance abuse, acquired immune deficiency
syndrome, and other diseases and disorders;
(4) the incidence of infant mortality among minorities is almost double
that for the general population;
(5) Blacks, Hispanics, and Native Americans constitute approximately 12
percent, 7.9 percent, and 0.01 percent, respectively, of the population
of the United States;
(6) Blacks, Hispanics, and Native Americans in the United States constitute
approximately 3 percent, 4 percent, and less than 0.01 percent, respectively,
of physicians, 2.7 percent, 1.7 percent, and less than 0.01 percent,
respectively, of dentists, and 4.5 percent, 1.6 percent, and less than
0.01 percent, respectively, of nurses;
(7) the number of individuals who are from disadvantaged backgrounds in
health professions should be increased for the purpose of improving the
access of other such individuals to health services;
(8) minority health professionals have historically tended to practice in
low-income areas and to serve 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 health professionals;
(11) increasing the number of minorities serving on the faculties of health
professions schools can be an important factor in attracting minorities
to pursue a career in the health professions;
(12) diversity in the faculty and student body of health professions schools
enhances the quality of education for all students attending the schools;
(13) the Report of the Secretary's Task Force on Black and Minority Health
(prepared for the Secretary of Health and Human Services and issued in 1985)
described the health status problems of minorities, and made recommendations
concerning measures that should be implemented by the Secretary with respect
to improving the health status of minorities through programs for providing
health information and education; and
(14) the Office of Minority Health, created in 1985 by the Secretary
of Health and Human Services, should be authorized pursuant to statute
and should receive increased funding to support efforts to improve the
health of individuals from disadvantaged backgrounds, including minorities,
including the implementation of the recommendations made by the Secretary's
Task Force on Black and Minority Health.

1b7166cd4a18fe8a970cd4c5a0f73c6184ef3cdc8dd40fb67c7473a6ce450c4e

Title XVII of the Public Health Service Act (42 U.S.C. 300u et seq.) is
amended by adding at the end the following new section:
`ESTABLISHMENT OF OFFICE OF MINORITY HEALTH
`SEC. 1707. (a) IN GENERAL- There is established an Office of Minority Health
within the Office of the Assistant Secretary for Health. There shall be in
the Department of Health and Human Services a Deputy Assistant Secretary
for Minority Health, who shall be the head of the Office of Minority
Health. The Secretary, acting through such Deputy Assistant Secretary,
shall carry out this section.
`(b) DUTIES- The Secretary shall, with respect to the health concerns of
individuals from disadvantaged backgrounds, including racial and ethnic
minorities--
`(1) establish short-range and long-range goals and objectives and coordinate
all other activities within the Department of Health and Human Services
that relate to disease prevention, health promotion, service delivery,
and research concerning such individuals;
`(2) enter into interagency agreements with other agencies of the Service
to increase the participation of such individuals in health service and
promotion programs;
`(3) establish a national minority health resource center to 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, to facilitate access to such information,
to assist in the analysis of issues and problems relating to such matters,
and to provide technical assistance with respect to the exchange of such
information (including facilitating the development of materials for such
technical assistance);
`(4) support research, demonstrations and evaluations to test new and
innovative models, to increase knowledge and understanding of health
risk factors, and to develop mechanisms that support better information
dissemination, education, prevention, and service delivery to individuals
from disadvantaged backgrounds, including racial and ethnic minorities;
`(5) coordinate efforts to promote minority health programs and policies
in the voluntary and corporate sectors;
`(6) develop health information and health promotion materials and teaching
programs, including--
`(A) models for the training of health professionals;
`(B) model curriculums to be used in primary and secondary schools and
institutions of higher learning;
`(C) materials and programs for the continuing education of health
professionals;
`(D) materials for public service use by the print and broadcast media; and
`(E) materials and programs to assist health care professionals in providing
health education to their patients; and
`(7) assist providers of primary health care and preventive health services
in obtaining, with respect to the provision of such care and services, the
assistance of bilingual health professionals and other bilingual individuals
(including such assistance in the provision of services regarding maternal
and child health, nutrition, mental health, and substance abuse).
`(c) CERTAIN REQUIREMENTS REGARDING DUTIES-
`(1) EQUITABLE ALLOCATION OF SERVICES- In carrying out subsection (b),
the Secretary shall ensure that services provided under such subsection
are equitably allocated among all groups served under this section by
the Secretary.
`(2) APPROPRIATE CONTEXT OF SERVICES- In carrying out subsection (b),
the Secretary shall ensure that information and services provided under
such subsection are provided in the language and cultural context that is
most appropriate for the individuals for whom the information and services
are intended.
`(3) BILINGUAL ASSISTANCE REGARDING HEALTH CARE- In carrying out subsection
(b)(7), the Secretary shall give special consideration to the unique
linguistic needs of health care providers serving Asians, and American
Samoans and other Pacific Islanders, including such needs regarding
particular subpopulations of such groups.
`(d)  GRANTS AND CONTRACTS REGARDING DUTIES-
`(1) AUTHORITY- In carrying out subsection (b), the Secretary may make
grants to, and enter into cooperative agreements and contracts with,
public and nonprofit private entities.
`(2) EVALUATION AND DISSEMINATION-
`(A) 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) and for the dissemination
of information developed as result of such projects.
`(B) Not later than January 20 of fiscal year 1993 and of each second year
thereafter, the Secretary shall prepare a report summarizing evaluations
carried out under subparagraph (A) during the preceding 2 fiscal years. The
report shall be included in the report required in subsection (e) for the
fiscal year involved.
`(e) REPORTS- Not later than January 31 of fiscal year 1993 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.
`(f) FUNDING-
`(1) AUTHORIZATION OF APPROPRIATIONS- For the purpose of carrying out this
section, there is authorized to be appropriated $25,000,000 for each of
the fiscal year 1991 through 1993.
`(2) ALLOCATION OF FUNDS BY SECRETARY- Of the amounts appropriated under
paragraph (1) in excess of $15,000,000, the Secretary shall make available
not less than $3,000,000 to carry out subsection (b)(7).'.

9d54356f9e6e4c418011b3dde4976323ef8dbd70296b3a7a60e5c56f5504c57f

Part D of title III of the Public Health Service Act (42 U.S.C. 254b et
seq.) is amended by adding at the end the following new subpart:
`Subpart VI--Health Services for Residents of Public Housing
`HEALTH SERVICES FOR RESIDENTS OF PUBLIC HOUSING
`SEC. 340A. (a) ESTABLISHMENT-
`(1) The Secretary, acting through the Administrator of the Health Resources
and Services Administration, shall make grants for the purpose of enabling
grantees, directly or through contracts, to provide to residents of public
housing, subject to subsections (e) and (f)--
`(A) primary health services, including health screenings; and
`(B) health counseling and education services.
`(2) The Secretary may not make a grant under paragraph (1) unless the
applicant for the grant agrees to expend the grant to carry out each of
subparagraphs (A) and (B) of such paragraph.
`(3) In carrying out the program established in paragraph (1), the
Administrator shall consult with the Director of the Centers for Disease
Control.
`(b) MINIMUM QUALIFICATIONS OF GRANTEES-
`(1) Subject to paragraph (2), the Secretary may not make a grant under
subsection (a) to an applicant unless--
`(A) the applicant is a public or nonprofit private entity;
`(B) the applicant has the capacity to effectively administer a grant
under subsection (a); and
`(C) in the case of any service under this section that is available pursuant
to the State plan approved under title XIX of the Social Security Act for
the State in which the service will be provided--
`(i) the applicant for the grant will provide the service directly, and
the applicant has entered into a participation agreement under the State
plan and is qualified to receive payments under such plan; or
`(ii) the applicant for the grant will enter into an agreement with a
public or nonprofit private organization under which the organization
will provide the service, and the organization has entered into such a
participation agreement and is qualified to receive such payments.
`(2)(A) In the case of an organization making an agreement pursuant to
paragraph (1)(C)(ii) regarding the provision of services under subsection
(a), the requirement established in such paragraph regarding a participation
agreement shall be waived by the Secretary if the organization does not,
in providing services, impose a charge or accept reimbursement available
from any third-party payor, including reimbursement under any insurance
policy or under any Federal or State health benefits program.
`(B) A determination by the Secretary of whether an organization referred to
in subparagraph (A) meets the criteria for a waiver under such subparagraph
shall be made without regard to whether the organization accepts voluntary
donations regarding the provision of services to the public.
`(c) PREFERENCES IN MAKING GRANTS- The Secretary shall, in making grants
under subsection (a), give preference to qualified applicants that--
`(1) are resident management corporations under section 20 of the United
States Housing Act of 1937; or
`(2) are receiving funds under section 330 or 340.
`(d) REQUIREMENT OF MATCHING FUNDS FROM PUBLIC GRANTEES-
`(1) In the case of a public entity applying for a grant under subsection
(a), the Secretary may not make such a grant unless the public entity
agrees that, with respect to the costs to be incurred by such entity in
carrying out the purpose described in such subsection, the entity will make
available 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) In determining the amount of non-Federal contributions in cash that a
public entity has provided pursuant to paragraph (1), the Secretary may not
include any amounts provided to the public entity by the Federal Government.
`(e) REQUIREMENTS REGARDING SERVICES- The Secretary may not make a grant
under subsection (a) to an applicant unless the applicant agrees that the
applicant will, directly or through contract--
`(1) provide services under this section on the premises of public housing
projects or at other locations immediately accessible to residents of
public housing;
`(2) refer such residents, as appropriate, to qualified facilities and
practitioners for necessary follow-up services;
`(3) provide outreach services to inform such residents of the availability
of such services; and
`(4) aid such residents in establishing eligibility for assistance, and
in obtaining services, under Federal, State, and local programs providing
health services, mental health services, or social services.
`(f) OPTIONAL PROVISION OF CERTAIN SERVICES-
`(1) A grantee under subsection (a) may expend the grant--
`(A) to train residents of public housing to provide health screenings
and to provide educational services; and
`(B) to provide health services to individuals who are not residents of
public housing.
`(2) The Secretary may not make a grant under subsection (a) unless the
applicant for the grant agrees that if, pursuant to paragraph (1)(B), the
applicant provides health services to individuals who are not residents of
public housing, the health services will be provided to such individuals
under the same terms and conditions as such services are provided to
residents of public housing (including all terms and conditions in effect
pursuant to this section).
`(g) CONSULTATION WITH RESIDENTS- The Secretary may not make a grant under
subsection (a) unless, with respect to the residents of the public housing
involved, the applicant for the grant--
`(1) has consulted with the residents in the preparation of the application
for the grant; and
`(2) agrees to provide for ongoing consultation with the residents regarding
the planning and administration of the program carried out with the grant.
`(h) RESTRICTIONS ON USE OF GRANT FUNDS-
`(1) The Secretary may not, except as provided in paragraph (2), make a
grant under subsection (a) to an applicant unless the applicant agrees
that amounts received pursuant to such subsection will not, directly or
through contract, be expended--
`(A) for any purpose other than the purposes authorized in this section;
`(B) to provide inpatient services;
`(C) to make cash payments to intended recipients of services under this
section; or
`(D) to purchase or improve real property (other than minor remodeling
of existing improvements to real property) or to purchase major medical
equipment or motor vehicles.
`(2) If the Secretary finds that the purpose described in subsection
(a) cannot otherwise be carried out, the Secretary may, with respect to
an otherwise qualified applicant, waive the restriction established in
paragraph (1)(D).
`(i) LIMITATION ON CHARGES FOR SERVICES- The Secretary may not make a grant
under subsection (a) to an applicant unless the applicant agrees that,
whether the services are provided directly or through contract--
`(1) services under the grant will be provided without regard to ability
to pay for the services; and
`(2) if a charge is imposed for the delivery of the services, such charge--
`(A) will be made according to a schedule of charges that is made available
to the public;
`(B) will not be imposed on any resident of public housing with an income
less than the official poverty level; and
`(C) will be adjusted to reflect the income and resources of the resident
of public housing involved.
`(j) REQUIREMENTS REGARDING ADMINISTRATION- The Secretary may not make a
grant under subsection (a) to an applicant unless the applicant--
`(1) agrees to establish such procedures for fiscal control and fund
accounting as may be necessary to ensure proper disbursement and accounting
with respect to the grant;
`(2) agrees to establish an ongoing program of quality assurance with
respect to the services provided under the grant;
`(3) agrees to ensure the confidentiality of records maintained on residents
of public housing that are receiving such services;
`(4) with respect to providing services to any population of such residents
a substantial portion of which has a limited ability to speak the English
language--
`(A) has developed and has the ability to carry out a reasonable plan
to provide services under the grant through individuals who are able to
communicate with the population involved in the language and cultural
context that is most appropriate; and
`(B) has designated at least one individual, fluent in both English and
the appropriate language, to assist in carrying out the plan; and
`(5) agrees to submit to the Secretary an annual report that describes the
utilization and costs of services provided under the grant and that provides
such other information as the Secretary determines to be appropriate.
`(k) LIMITATION ON ADMINISTRATIVE EXPENSES OF GRANTEE- The Secretary may not
make a grant under subsection (a) to an applicant unless the applicant agrees
that the applicant will not expend more than 10 percent of amounts received
pursuant to such subsection for the purpose of administering the grant.
`(l) REQUIREMENT OF APPLICATION- The Secretary may not provide financial
assistance under subsection (a) unless--
`(1) an application for the assistance is submitted to the Secretary;
`(2) with respect to carrying out the purpose for which the assistance
is to be provided, the application provides assurances of compliance
satisfactory to the Secretary; and
`(3) the application otherwise is in such form, is made in such manner,
and contains such agreements, assurances, and information as the Secretary
determines to be necessary to carry out this section.
`(m) TECHNICAL ASSISTANCE-
`(1) The Secretary may provide technical assistance to applicants and
grantees under subsection (a) regarding the planning, development,
and operation of programs to carry out the purpose described in such
subsection. The Secretary may provide such technical assistance directly,
through contracts, or through grants.
`(2) Any technical assistance provided by the Secretary under paragraph (1)
shall be provided without charge to applicants and grantees under subsection
(a).
`(3) Of the amounts appropriated pursuant to subsection (p)(1) for a fiscal
year, the Secretary may expend not more than $2,000,000 for the purpose
of carrying out paragraph (1).
`(n) ANNUAL REPORTS BY SECRETARY- Not later than January 10 of each year, the
Secretary shall submit to the Congress a report describing the utilization
and costs of services provided under this section during the immediately
preceding fiscal year.
`(o) DEFINITIONS- For purposes of this section:
`(1) The term `official poverty level' means the nonfarm income official
poverty line defined by the Office of Management and Budget and revised
annually in accordance with section 673(2) of the Omnibus Budget
Reconciliation Act of 1981.
`(2) The term `organization' includes individuals, corporations,
partnerships, companies, and associations.
`(3) The term `primary health services' has the meaning given such term
in section 330(b)(1).
`(4) The term `public housing' has the meaning given such term in section
3(b)(1) of the United States Housing Act of 1937.
`(p) FUNDING-
`(1) For the purpose of carrying out this section, there are authorized
to be appropriated $35,000,000 for fiscal year 1991, and such sums as may
be necessary for each of the fiscal years 1992 and 1993.
`(2) Amounts received by a grantee pursuant to subsection (a) remaining
unobligated at the end of the fiscal year in which the amounts were received
shall remain available to the grantee during the succeeding fiscal year
for the purpose described in such subsection.'.

177a24635aa7632f6ff67e5b0b6f1e82f40d8ab24fe191bbdd0df58fbf40182c

EDUCATION.
(a) IN GENERAL- Section 782 of the Public Health Service Act (42
U.S.C. 295g-2) is amended to read as follows:
`PROGRAMS OF EXCELLENCE IN HEALTH PROFESSIONS EDUCATION FOR MINORITIES
`SEC. 782. (a) IN GENERAL- The Secretary shall make grants to health
profession schools described in subsection (c) for the purpose of assisting
the schools in supporting programs of excellence in health professions
education for minority individuals.
`(b) REQUIRED USE OF FUNDS- The Secretary may not make a grant under
subsection (a) unless the health professions school involved agrees to
expend the grant--
`(1) to establish, strengthen, or expand programs to enhance the academic
performance of minority students attending the school;
`(2) to establish, strengthen, or expand programs to increase the number
and quality of minority applicants to the school;
`(3) to improve the capacity of such school to train, recruit, and retain
minority faculty;
`(4) with respect to minority health issues, to carry out activities to
improve the information resources and curricula of the school and clinical
education at the school; and
`(5) to facilitate faculty and student research on health issues particularly
affecting minority groups.
`(c) CENTERS OF EXCELLENCE-
`(1) IN GENERAL-
`(A) The health professions schools referred to in subsection (a) are such
schools that meet each of the conditions specified in subparagraph (B),
and that--
`(i)  meet each of the conditions specified in paragraph (2)(A);
`(ii) meet each of the conditions specified in paragraph (3);
`(iii) meet each of the conditions specified in paragraph (4); or
`(iv) meet each of the conditions specified in paragraph (5).
`(B) The conditions specified in this subparagraph are that a health
professions school--
`(i) has a significant number of minority individuals enrolled in the
school, including individuals accepted for enrollment in the school;
`(ii) has been effective in assisting minority students of the school to
complete the program of education and receive the degree involved;
`(iii) has been effective in recruiting minority individuals to attend the
school, including providing scholarships and other financial assistance to
such individuals and encouraging minority students of secondary educational
institutions to attend the health professions school; and
`(iv) has made significant recruitment efforts to increase the number of
minority individuals serving in faculty or administrative positions at
the school.
`(C) In the case of any criteria established by the Secretary for purposes
of determining whether schools meet the conditions described in subparagraph
(B), this section may not, with respect to racial and ethnic minorities,
be construed to authorize, require, or prohibit the use of such criteria
in any program other than the program established in this section.
`(2) CENTERS OF EXCELLENCE AT CERTAIN HISTORICALLY BLACK COLLEGES AND
UNIVERSITIES-
`(A) The conditions specified in this subparagraph are that a health
professions school--
`(i) is a school described in section 701(4); and
`(ii) received a contract under section 788B for fiscal year 1987, as such
section was in effect for such fiscal year.
`(B) In addition to the purposes described in subsection (b), a grant
under subsection (a) to a health professions school meeting the conditions
described in subparagraph (A) may be expended--
`(i) to develop a plan to achieve institutional improvements, including
financial independence, to enable the school to support programs of
excellence in health professions education for minority individuals; and
`(ii) to provide improved access to the library and informational resources
of the school.
`(3) HISPANIC CENTERS OF EXCELLENCE- The conditions specified in this
subparagraph are that--
`(A) with respect to Hispanic individuals, each of clauses (i) through
(iv) of paragraph (1)(B) apply to the health professions school involved; and
`(B) the health professions school agree, as a condition of receiving a
grant under subsection (a), that the school will, in carrying out the
duties described in subsection (b), give priority to carrying out the
duties with respect to Hispanic individuals.
`(4) NATIVE AMERICAN CENTERS OF EXCELLENCE- The conditions specified in
this paragraph are that--
`(A) with respect to Native Americans, each of clauses (i) through (iv)
of paragraph (1)(B) apply to the health professions school involved;
`(B) the health professions school agree, as a condition of receiving a
grant under subsection (a), that the school will, in carrying out the
duties described in subsection (b), give priority to carrying out the
duties with respect to Native Americans; and
`(C) the health professions school agree, as a condition of receiving a
grant under subsection (a), that--
`(i) the school will establish an arrangement with 1 or more public
or nonprofit private institutions of higher education whose enrollment
of students has traditionally included a significant number of Native
Americans, the purpose of which arrangement will be to carry out a program--
`(I) to identify Native American students of the institution who are
interested in a career in the health profession or professions involved; and
`(II) to facilitate the educational preparation of such students to enter
the health professions school; and
`(ii) the health professions school will make efforts to recruit Native
American students, including students who have participated in the
undergraduate program carried out under arrangements established by the
school pursuant to subparagraph (A), and will assist Native American
students regarding the completion of the educational requirements for a
degree from the health professions school.
`(5) OTHER CENTERS OF EXCELLENCE- The conditions specified in this paragraph
are that a health professions school has an enrollment of underrepresented
minorities above the national average for such enrollments of health
professions schools.
`(d) DESIGNATION AS CENTER OF EXCELLENCE-
`(1) IN GENERAL- Any health professions school receiving a grant under
subsection (a) and meeting the conditions described in paragraph (2) or (5)
of subsection (c) shall, for purposes of this section, be designated by the
Secretary as a Center of Excellence in Minority Health Professions Education.
`(2) HISPANIC CENTERS OF EXCELLENCE- Any health professions school receiving
a grant under subsection (a) and meeting the conditions described in
subsection (c)(3) shall, for purposes of this section, be designated by the
Secretary as a Hispanic Center of Excellence in Health Professions Education.
`(3) NATIVE AMERICAN CENTERS OF EXCELLENCE- Any health professions school
receiving a grant under subsection (a) and meeting the conditions described
in subsection (c)(4) shall, for purposes of this section, be designated
by the Secretary as a Native American Center of Excellence in Health
Professions Education.
`(e) DURATION OF GRANT- The period during which payments are made under
a grant under subsection (a) may not exceed 3 years. Such payments shall
be subject to annual approval by the Secretary and to the availability of
appropriations for the fiscal year involved to make the payments.
`(f) MAINTENANCE OF EFFORT-
`(1) NON-FEDERAL FUNDS OF PUBLIC SCHOOLS- With respect to activities
for which a grant under subsection (a) is authorized to be expended, the
Secretary may not, in the case of a public health professions school, make
such a grant to the school for any fiscal year unless the school agrees
to maintain expenditures of non-Federal amounts for such activities at a
level equal to not less than the level of such expenditures maintained by
the school for the fiscal year preceding the first fiscal year for which
the school applies after fiscal year 1990 to receive such a grant.
`(2) NON-FEDERAL FUNDS OF PRIVATE SCHOOLS-
`(A) With respect to any non-Federal amounts received by a nonprofit
private health professions school and available for carrying out activities
for which a grant under subsection (a) is authorized to be expended,
the Secretary may not make such a grant to the school for any fiscal
year unless, subject to subparagraph (B), the school agrees to maintain
expenditures of such non-Federal amounts for such activities at a level
equal to not less than the level of such expenditures maintained by the
school for the fiscal year preceding the first fiscal year for which the
school applies after fiscal year 1990 to receive such a grant.
`(B) The Secretary may require a nonprofit private health professions
school to comply with an agreement made under subparagraph (A) by the
school only to the extent of the level of non-Federal amounts available
to the school for the activities to which the agreement applies.
`(3) USE OF FEDERAL FUNDS- With respect to any Federal amounts received
by a health professions school and available for carrying out activities
for which a grant under subsection (a) is authorized to be expended,
the Secretary may not make such a grant to the school for any fiscal year
unless the school agrees that the school will, before expending the grant,
expend the Federal amounts obtained from sources other than the grant.
`(g) DEFINITIONS- For purposes of this section:
`(1)(A) The term `health professions school' means, except as provided in
subparagraph (B), a school of medicine, a school of dentistry, or a school
of pharmacy.
`(B) The definition established in subparagraph (A) shall not apply to
the use of the term `health professions school' for purposes of subsection
(c)(2).
`(2) The term `program of excellence' means any program carried out by a
health professions school with a grant made under subsection (a), if the
program is for purposes for which the school involved is authorized in
subsection (b) or (c) to expend the grant.
`(3) The term `Native Americans' means American Indians, Alaskan Natives,
Aleuts, and Native Hawaiians.
`(h) FUNDING-
`(1) AUTHORIZATION OF APPROPRIATIONS- For the purpose of making grants
under subsection (a), there are authorized to be appropriated such sums
as may be necessary for each of the fiscal years 1991 through 1993.
`(2) ALLOCATIONS BY SECRETARY-
`(A) Of the amounts appropriated under paragraph (1) for a fiscal year,
the Secretary shall make available the first $12,000,000 for grants under
subsection (a) to health professions schools meeting the conditions
specified in paragraph (2)(A) of subsection (c) (in addition to the
conditions specified in paragraph (1)(B) of such subsection); and
`(B) Of the amounts appropriated under paragraph (1) for a fiscal year
in excess of $12,000,000, the Secretary shall make available the first
$2,500,000 for grants under subsection (a) to health professions schools
meeting the conditions specified in paragraph (3) or (4) of subsection
(c) (in addition to the conditions specified in paragraph (1)(B) of such
subsection).
`(3) ADDITIONAL PRIORITIES- In making grants under subsection (a) for
a fiscal year from such amounts as are available for the grants after
compliance with paragraph (2), the Secretary shall give priority to making
grants to health professions schools meeting the conditions specified in
any of paragraphs (3) through (5) of subsection (c) (in addition to the
conditions specified in paragraph (1)(B) of such subsection).'.

290fff98d7d2758dc8b6ea820bf5bfbd505a76660070282056367a199bc0e6e6

PURPOSES REGARDING DISADVANTAGED INDIVIDUALS.
(a) IN GENERAL- Section 740 of the Public Health Service Act (42 U.S.C. 294m)
is amended--
(1) by redesignating subsection (c) as subsection (d); and
(2) by inserting after subsection (b) the following new subsection:
`(c)(1) With respect to amounts appropriated under subsection (c)(1)
of section 742, each agreement entered into under this section with a
school shall provide (in addition to the provisions required in subsection
(b)) that--
`(A) any Federal capital contribution made to the student loan fund of the
school from such amounts, together with the school contribution appropriate
under subsection (b)(2)(B) to the amount of the Federal capital contribution,
will be utilized only for the purpose of--
`(i) making loans to individuals who are individuals from disadvantaged
backgrounds; and
`(ii) the costs of the collection of the loans and interest on the loans; and
`(B) collections of principal and interest on loans made pursuant
to subparagraph (A), and any other earnings of the student loan fund
attributable to amounts that are in the fund pursuant to such subparagraph,
will be utilized only for the purpose described in such paragraph.
`(2) The Secretary may not make a Federal capital contribution for purposes
of paragraph (1) for a fiscal year unless the health professions school
involved--
`(A) is carrying out a program for recruiting and retaining students from
disadvantaged backgrounds, including racial and ethnic minorities; and
`(B) is carrying out a program for recruiting and retaining minority faculty.
`(3) The Secretary may not make a Federal capital contribution for purposes
of paragraph (1) for a fiscal year unless the health professions school
involved agrees--
`(A) to ensure that adequate instruction regarding minority health issues
is provided for in the curricula of the school;
`(B) with respect to health clinics providing services to a significant
number of individuals who are from disadvantaged backgrounds, including
members of minority groups, to enter into arrangements with 1 or more such
clinics for the purpose of providing students of the school with experience
in providing clinical services to such individuals;
`(C) with respect to public or nonprofit private secondary educational
institutions and undergraduate institutions of higher education, to enter
into arrangements with 1 or more such institutions for the purpose of
carrying out programs regarding the educational preparation of disadvantaged
students, including minority students, to enter the health professions and
regarding the recruitment of such individuals into the health professions;
`(D) to establish a mentor program for assisting disadvantaged students,
including minority students, regarding the completion of the educational
requirements for degrees from the school;
`(E) to be carrying out each of the activities specified in any of
subparagraphs (A) through (D) by not later than 1 year after the date on
which the first Federal capital contribution is made to the school for
purposes of paragraph (1); and
`(F) to continue carrying out such activities, and the activities specified
in subparagraphs (A) and (B) of paragraph (2), throughout the period
during which the student loan fund established pursuant to subsection (b)
is in operation.
`(4) With respect to amounts appropriated under subsection (a) of section
742, Federal capital contributions made pursuant to an agreement under
subsection (b) of this subsection to the student loan fund of a school from
such amounts, together with the school contributions appropriate under
subsection (b)(2)(B) to the amount of the Federal capital contributions,
may be utilized for the purpose of making loans to individuals from
disadvantaged backgrounds.'.
(b) DEFINITION WITH RESPECT TO INDIVIDUALS FROM DISADVANTAGED BACKGROUNDS-
Section 740 of the Public Health Service Act, as amended by subsection (a) of
this section, is amended by adding at the end the following new subsection:
`(e) For purposes of this section, the term `disadvantaged', with respect
to an individual, shall be defined by the Secretary.'.
(c) AUTHORIZATION OF APPROPRIATIONS- Section 742 of the Public Health
Service Act (42 U.S.C. 294o) is amended by adding at the end the following
new subsection:
`(c)(1) With respect to making Federal capital contributions to student
loan funds for purposes of section 740(c), there is authorized to be
appropriated for such contributions $15,000,000 for each of the fiscal
years 1991 through 1993.
`(2) In making Federal capital contributions to student loan funds for
purposes of section 740(c), the Secretary shall give special consideration
to health professions schools that have enrollments of underrepresented
minorities above the national average for health professions schools.'.

589ea4447b7e0d0520db8fa2f1b4b4d1b75bee8474676714d9cb7c6e0cc2fe47

BACKGROUNDS.
Part C of title VII of the Public Health Service Act (42 U.S.C. 294 et
seq.) is amended by adding at the end thereof the following new subpart:
`Subpart VI--Assistance for Students From Disadvantaged Backgrounds
`SEC. 760. GRANTS FOR SCHOLARSHIPS AND OTHER PURPOSES.
`(a) ESTABLISHMENT OF PROGRAM-
`(1) IN GENERAL- The Secretary may make grants to health professions
schools for the purpose of assisting such schools, subject to subsection
(e), in providing scholarships to individuals who--
`(A) are individuals from disadvantaged backgrounds; and
`(B) are enrolled (or accepted for enrollment) as full-time students in
such schools.
`(2) HEALTH PROFESSIONS SCHOOLS- For purposes of this section, the term
`health professions schools' means schools of medicine, nursing (as
schools of nursing are defined in section 853), osteopathic medicine,
dentistry, pharmacy, podiatric medicine, optometry, veterinary medicine,
public health, or allied health, or schools offering graduate programs in
clinical psychology.
`(b) MINIMUM QUALIFICATIONS OF GRANTEES- The Secretary may not make a
grant under subsection (a) unless the health professions school--
`(1) is carrying out a program for recruiting and retaining students from
disadvantaged backgrounds, including racial and ethnic minorities; and
`(B) is carrying out a program for recruiting and retaining minority faculty.
`(c) PREFERENCES IN PROVIDING SCHOLARSHIPS- The Secretary may not make a
grant under subsection (a) unless the health professions school involved
agrees that, in providing scholarships pursuant to the grant, the school
will give preference to students--
`(1) who are from disadvantaged backgrounds; or
`(2) for whom the costs of attending the school would constitute a severe
financial hardship.
`(d) USE OF SCHOLARSHIP- A scholarship provided pursuant to subsection
(a) for attendance at a health professions school--
`(1) may be expended only for tuition expenses, other reasonable educational
expenses, and reasonable living expenses incurred in such attendance; and
`(2) may not, for any year of such attendance for which the scholarship
is provided, provide an amount exceeding the total amount required for
the year for the expenses specified in paragraph (1).
`(e) PROVISIONS REGARDING PURPOSES OTHER THAN SCHOLARSHIPS-
`(1) AUTHORITY REGARDING ASSISTANCE FOR UNDERGRADUATES- With respect to
undergraduates who have demonstrated a commitment to pursuing a career in
the health professions, a health professions school may expend not more than
25 percent of a grant under subsection (a) for the purpose of providing
financial assistance to such undergraduates in order to facilitate the
completion of the educational requirements for such careers.
`(2) REQUIRED ACTIVITIES OF SCHOOL- The Secretary may not make a grant
under subsection (a) unless the health professions school involved agrees--
`(A) to ensure that adequate instruction regarding minority health issues
is provided for in the curricula of the school;
`(B) with respect to health clinics providing services to a significant
number of individuals who are from disadvantaged backgrounds, including
members of minority groups, to enter into arrangements with 1 or more such
clinics for the purpose of providing students of the school with experience
in providing clinical services to such individuals;
`(C) with respect to public or nonprofit secondary educational institutions
and undergraduate institutions of higher education, to enter into
arrangements with 1 or more such institutions for the purpose of carrying out
programs regarding the educational preparation of disadvantaged students,
including minority students, to enter the health professions and regarding
the recruitment of such students into the health professions;
`(D) to establish a mentor program for assisting disadvantaged students,
including minority students, regarding the completion of the educational
requirements for degrees from the school;
`(E) to be carrying out the activities specified in subparagraphs (A)
through (D) by not later than 1 year after the date on which a grant under
subsection (a) is first made to the school; and
`(F) to continue carrying out such activities, and the activities specified
in paragraphs (1) and (2) of subsection (b), throughout the period during
which the school is receiving a grant under subsection (a).
`(3) RESTRICTIONS ON USE OF GRANT- The Secretary may not make a grant
under subsection (a) for a fiscal year unless the health professions
school involved agrees that the grant will not be expended to carry out
the activities specified in paragraph (1) or (2) of subsection (b), or in
any of subparagraphs (A) through (D) of paragraph (2) of this subsection.
`(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 this section.
`(g) FUNDING-
`(1) AUTHORIZATION OF APPROPRIATIONS- To carry out subsection (a), there
are authorized to be appropriated $17,000,000 for fiscal year 1991, and
such sums as may be necessary for each of the fiscal years 1992 and 1993.
`(2) ALLOCATIONS BY SECRETARY- In making grants under subsection (a),
the Secretary--
`(A) shall make available 30 percent for grants under subsection (a)
to health professions schools agreeing to expend the grants only for
scholarships under such subsection for nurses; and
`(B) shall give special consideration to health professions schools that
have enrollments of underrepresented minorities above the national average
for health professions schools.
`SEC. 761. LOAN REPAYMENT PROGRAM REGARDING SERVICE ON FACULTIES OF CERTAIN
HEALTH PROFESSIONS SCHOOLS.
`(a) ESTABLISHMENT OF PROGRAM- The Secretary shall establish a program of
entering into contracts with individuals described in subsection (b) under
which the individuals agree to serve as members of the faculties of schools
described in subsection (c) in consideration of the Federal Government
agreeing to pay, for each year of such service, not more than $20,000 of
the principal and interest of the educational loans of such individuals.
`(b) ELIGIBLE INDIVIDUALS- The individuals referred to in subsection (a)
are individuals from disadvantaged backgrounds who--
`(1) have a degree in medicine, osteopathic medicine, dentistry, or another
health profession;
`(2) are enrolled in an approved graduate training program in medicine,
osteopathic medicine, dentistry, or other health profession; or
`(3) are enrolled as a full-time student--
`(A) in an accredited (as determined by the Secretary) school described
in subsection (c); and
`(B) in the final year of a course of a study or program, offered by such
institution and approved by the Secretary, leading to a degree from such
a school.
`(c) ELIGIBLE HEALTH PROFESSIONS SCHOOL- The schools described in this
subsection are schools of medicine, nursing (as schools of nursing are
defined in section 853), osteopathic medicine, dentistry, pharmacy,
podiatric medicine, optometry, veterinary medicine, or public health,
or schools offering graduate programs in clinical psychology.
`(d) ADDITIONAL LIMITATION ON AMOUNT OF REPAYMENTS- Payments made by
the Secretary under subsection (a) regarding the educational loans of an
individual may not, for any year for which the payments are made, exceed
an amount equal to 50 percent of the principal and interest due on such
loans for such year.
`(e) REQUIREMENTS REGARDING FACULTY POSITIONS- The Secretary may not enter
into a contract under subsection (a) unless--
`(1) the individual involved has entered into a contract with a school
described in subsection (c) to serve as a member of the faculty of the
school for not less than 2 years; and
`(2) the contract referred to in paragraph (1) provides that--
`(A) the school will, for each year for which the individual will serve as a
member of the faculty under the contract with the school, make payments of
the principal and interest due on the educational loans of the individual
for such year in an amount equal to the amount of such payments made by
the Secretary for the year; and
`(B) the payments made by the school pursuant to subparagraph (A) on behalf
of the individual will be in addition to the pay that the individual would
otherwise receive for serving as a member of such faculty.
`(f) WAIVER REGARDING SCHOOL CONTRIBUTIONS- The Secretary may waive the
requirement established in subsection (e)(2) if the Secretary determines
that the requirement will impose an undue financial hardship on the school
involved. If the Secretary grants such a waiver, subsection (d) shall not
apply with respect to the individual involved.
`(g) APPLICABILITY OF CERTAIN PROVISIONS- The provisions of sections 338B,
338C, and 338E shall apply to the program established in subsection (a)
to the same extent and in the same manner as such provisions apply to
the National Health Service Corps Loan Repayment Program established
in subpart III of part D of title III, including the applicability of
provisions regarding reimbursements for increased tax liability and
regarding bankruptcy.
`(h) AUTHORIZATION OF APPROPRIATIONS- To carry out this section, there are
authorized to be appropriated $4,000,000 for each of the fiscal years 1991
through 1993.'.

d2b9dc805aa98b48b6ccf39ae2d717a478b22e4bde3ec3fbb211a5cf1f40a3e5

STATISTICS.
(a) ANNUAL COLLECTION OF DATA-
(1) DATA FROM RECORDS OF BIRTHS, DEATHS, ET CETERA, AMONG CERTAIN
POPULATIONS- Section 306(h) of the Public Health Service Act (42
U.S.C. 242k(h)) is amended by inserting after the second sentence
the following new sentence: `The Secretary shall encourage States and
registration areas to obtain detailed data on ethnic and racial populations,
including subpopulations of Hispanics, Asian Americans, and Pacific Islanders
with significant representation in the State or registration area.'.
(2)  DATA FROM SAMPLE REGARDING HEALTH, ILLNESS, AND DISABILITY STATUS-
Section 306(h) of the Public Health Service Act (42 U.S.C. 242k(h)),
as amended by paragraph (1), is amended--
(A) by inserting `(1)' after the subsection designation; and
(B) by adding at the end the following new paragraph:
`(2) There shall be an annual collection of data from a statistically valid
sample concerning the general health, illness, and disability status of the
civilian noninstitutionalized population. Specific topics to be addressed
under this paragraph, on an annual or periodic basis, shall include
the incidence of illness and accidental injuries, prevalence of chronic
diseases and impairments, disability, physician visits, hospitalizations,
and the relationship between demographic and socioeconomic characteristics
and health characteristics.'.
(b) COLLECTION OF DATA SPECIFIC TO PARTICULAR POPULATIONS-
(1) IN GENERAL- Section 306 of the Public Health Service Act (42 U.S.C. 242k)
is amended--
(A) by redesignating subsection (m) as subsection (o); and
(B) by inserting after subsection (l) the following new subsections:
`(m) In carrying out this section, the Secretary, acting through the
Center, shall collect and analyze adequate health data that is specific to
particular ethnic and racial populations, including data collected under
national health surveys. Activities carried out under this subsection
shall be in addition to any activities carried out under subsection (n).
`(n)(1) The Secretary, acting through the Center, may make grants to public
and nonprofit private entities for--
`(A) the conduct of special surveys or studies on the health of ethnic
and racial populations or subpopulations;
`(B) analysis of data on ethnic and racial populations and subpopulations;
and
`(C) research on improving methods for developing statistics on ethnic
and racial populations and subpopulations.
`(2) The Secretary, acting through the Center, may provide technical
assistance, standards, and methodologies to grantees supported by this
subsection in order to maximize the data quality and comparability with
other studies.
`(3) Provisions of section 308(d) do not apply to surveys or studies
conducted by grantees under this subsection unless the Secretary, in
accordance with regulations the Secretary may issue, determines that such
provisions are necessary for the conduct of the survey or study and receives
adequate assurance that the grantee will enforce such provisions.'.
(2) APPLICATION AND PEER REVIEW- Section 308(b)(2) of the Public Health
Service Act (42 U.S.C. 242m(b)(2)) is amended--
(A) in subparagraph (A), in the first sentence, by inserting after
`demonstration project,' the following: `, or for a grant under section
306(n),'; and
(B) in subparagraph (C), by inserting before the period at the end the
following: `, except that peer review groups regarding grants under section
306(n) may include appropriately qualified such officers and employees'.
(c) AUTHORIZATION OF APPROPRIATIONS- Section 306(o), as redesignated by
subsection (b) of this section, is amended to read as follows:
`(o)(1) For health statistical and epidemiological activities undertaken
or supported under subsections (a) through (m), there are authorized to
be appropriated such sums as may be necessary for each of the fiscal years
1991 through 1993.
`(2) For activities authorized in subsection (n), there are authorized to
be appropriated $5,000,000 for fiscal year 1991, $7,500,000 for fiscal year
1992, and $10,000,000 for fiscal year 1993. Of such amounts, the Secretary
shall use not more than 10 percent for administration and for activities
described in subsection (n)(2).'.
(d) REPEAL OF CERTAIN RESTRICTION ON FUNDING- Section 308(b)(3) of the
Public Health Service Act (42 U.S.C. 242m(3)) is repealed.

2926f11709990c64d513b00b1aee8d7ea6102cd11357dde841d36a9a1049f062

Subpart III of part D of title III of the Public Health Service Act (42
U.S.C 241 et seq.) is amended by inserting before subpart IV of such part
the following new section:
`SEC. 338L. DEMONSTRATION GRANTS TO STATES FOR COMMUNITY SCHOLARSHIP PROGRAMS.
`(a) IN GENERAL- The Secretary, acting through the Administrator of the
Health Resources and Services Administration, may make grants to States
for the purpose of carrying out demonstration programs to increase the
availability of primary health care in urban and rural health manpower
shortage areas through assisting community organizations of such areas in
educating individuals to serve as health professionals in such areas.
`(b) CERTAIN REQUIREMENTS FOR STATES-
`(1) MINIMUM QUALIFICATIONS- The Secretary may not make a grant under
subsection (a) unless the State involved will, under any provision of
this Act other than subsection (a), receive 1 or more grants, cooperative
agreements, or contracts for the fiscal year for which the State is applying
pursuant to subsection (h) to receive a grant under subsection (a).
`(2) ADMINISTRATION OF PROGRAM- The Secretary may not make a grant under
subsection (a) unless the State involved agrees that the program carried
out by the State with the grant will be administered directly by a single
State agency.
`(c) GRANTS BY STATES TO COMMUNITY ORGANIZATIONS FOR PROVISION OF SCHOLARSHIP
CONTRACTS- The Secretary may not make a grant under subsection (a) unless
the State involved agrees, subject to subsections (d) and (e), to carry out
the purpose described in subsection (a) only through operating a program
in which the State makes grants to community organizations located in
health manpower shortage areas in order to assist the organizations with
the costs of entering into contracts under which--
`(1) the community organizations agree to provide scholarships to individuals
for attendance at health professions schools; and
`(2) the individuals agree to provide, in the health manpower shortage areas
in which the community organizations are located, primary health care for--
`(A) a number of years equal to the number of years for which the
scholarships are provided, or for a period of 2 years, whichever period
is greater; or
`(B) such greater period of time as the individuals and the community
organizations may agree.
`(d) REQUIREMENT OF STATE AND LOCAL MATCHING FUNDS-
`(1) IN GENERAL- With respect to the costs of providing any scholarship
pursuant to subsection (c), the Secretary may not make a grant under
subsection (a) unless the State involved agrees that--
`(A) 40 percent of the costs of the scholarship will be paid from the
grant made under subsection (a) to the State; and
`(B) 60 percent of such costs will be paid from non-Federal contributions
made in cash by both the State and the community organization through
which the scholarship is provided, subject to--
`(i) the State making available through such contributions not less than
15 percent, nor more than 25 percent, of such costs; and
`(ii) the community organization making available through such contributions
not less than 35 percent, nor more than 45 percent, of such costs.
`(2) DETERMINATION OF AMOUNT OF NON-FEDERAL CONTRIBUTIONS- The Secretary
may not make a grant under subsection (a) unless the State involved agrees
that, in determining the amount of non-Federal contributions that have
been provided in cash for purposes of paragraph (1), the State will not
include any amounts provided by the Federal Government to the State or
community organization involved, or to any other entity.
`(3) USE OF DONATIONS- Non-Federal contributions required in paragraph (1)
may be provided directly by the State and community organization involved,
and may be provided through donations from public and private entities.
`(e) SPECIFICATIONS REGARDING SCHOLARSHIP CONTRACT- The Secretary may not
make a grant under subsection (a) unless the State involved agrees that
the State will make a grant to a community organization for a contract
described in subsection (c) only if--
`(1) the individual who is to receive the scholarship under the contract
is a resident of the health manpower shortage area in which the community
organization is located;
`(2) the individual is enrolled or accepted for enrollment as a full-time
student in a health professions school that is approved by the Secretary
for purposes of this section;
`(3) the individual agrees to maintain an acceptable level of academic
standing at the school (as determined by the school in accordance
with regulations issued by the Secretary for purposes of section
338A(f)(1)(B)(iii));
`(4) the individual and the community organization agree that the scholarship
provided pursuant to the contract--
`(A) will be expended only for--
`(i) tuition expenses, other reasonable educational expenses, and reasonable
living expenses incurred in attendance at the school; and
`(ii) payment to the individual of a monthly stipend of not more than the
amount authorized for purposes of section 338A(g)(1)(B); and
`(B) will not, for any year of such attendance for which the scholarship
is provided, be in an amount exceeding the total amount required for the
year for the purposes authorized in subparagraph (A);
`(5) the individual agrees to meet the educational and licensure requirements
necessary to be a physician, certified nurse practitioner, certified nurse
midwife, or physician assistant; and
`(6) the individual agrees that, in providing primary health care pursuant
to the scholarship, the individual--
`(A)  will not, in the case of an individual seeking such care, discriminate
against the individual on the basis of the ability of the individual to
pay for such care or on the basis that payment for such care will be made
pursuant to the program established in title XVIII of the Social Security
Act or pursuant to the program established in title XIX of such Act; and
`(B) will accept assignment under section 1842(b)(3)(B)(ii) of the Social
Security Act for all services for which payment may be made under part B of
title XVIII of such Act, and will enter into an appropriate agreement with
the State agency that administers the State plan for medical assistance
under title XIX of such Act to provide service to individuals entitled to
medical assistance under the plan.
`(f) REPORTS TO SECRETARY- The Secretary may not make a grant under
subsection (a) unless the State involved agrees--
`(1) for each fiscal year for which such a grant is received by the State,
to submit to the Secretary a report--
`(A) identifying the community organizations providing scholarships pursuant
to subsection (c) and the health manpower shortage areas in which the
organizations are located; and
`(B) providing the names of individuals receiving the scholarships, the
health professions in which the individuals will engage pursuant to the
scholarships, the number of years of service the individuals are obligated
to provide pursuant to the scholarships, and the extent of compliance with
the contracts under subsection (c) on the part of the individuals and the
community organizations; and
`(C) providing such information as the Secretary may determine to be
necessary for carrying out this section; and
`(2) to submit each such report not later than January 10 of the fiscal
year immediately following the fiscal year for which the report is prepared.
`(g) ESTIMATES REGARDING ALLOCATIONS BETWEEN URBAN AND RURAL AREAS-
The Secretary may not make a grant under subsection (a) unless the State
involved submits to the Secretary, as part of the application required
in subsection (h), an estimate of the amount of the grant that will be
expended regarding the provision of primary health care in urban health
manpower shortage areas of the State, and an estimate of the amount of
the grant that will be expended regarding the provision of such care in
rural health manpower shortage areas of the State.
`(h) 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 this section.
`(i) 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 under
subsection (c) with respect to which there has been an initial breach
by the community organizations or individuals involved during the fiscal
year preceding the fiscal year for which the State is applying to receive
the grant.
`(B) In the case of a 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 sum of--
`(i) an amount equal to the expenditures of Federal funds made regarding
the contracts involved; and
`(ii) an amount representing interest on the amount of such expenditures,
determined with respect to each contract on the basis of the maximum legal
rate prevailing for loans made during the time amounts were paid under
the contract, as determined by the Treasurer of the United States.
`(C) If a State is not receiving a grant under subsection (a) for a
fiscal year for which a reduction under subparagraph (B) would have been
made in the event that the State had received such a grant, the Secretary
shall reduce the amount of payments due to the State under other grants,
cooperative agreements, or contracts under this Act by the amount specified
in such subparagraph.
`(D) With respect to contracts provided under subsection (c), the Secretary
may carry out this paragraph on the basis of information submitted by the
States involved, or on the basis of information collected through such
other means as the Secretary determines to be appropriate.
`(j) REPORTS TO CONGRESS-
`(1) IN GENERAL- Each fiscal year the Secretary shall submit to the Committee
on Energy and Commerce of the House of Representatives, and to the Committee
on Labor and Human Resources of the Senate, a report summarizing information
received by the Secretary under subsection (f) for the preceding fiscal year.
`(2) DATE FOR SUBMISSION- With respect to a fiscal year, the report required
in paragraph (1) shall be submitted for purposes of such paragraph by
not later than the date on which the report required in section 338A(i)
is required to be submitted for purposes of such section.
`(k) DEFINITIONS- For purposes of this section:
`(1) COMMUNITY ORGANIZATION- The term `community organization' means a
public or nonprofit private entity.
`(2) PRIMARY HEALTH CARE- The term `primary health care' means health
services regarding family medicine, internal medicine, pediatrics, or
obstetrics and gynecology, that are provided by physicians, certified
nurse practitioners, certified nurse midwives, or physician assistants.
`(3) STATE- The term `State' means each of the several States and the
District of Columbia.
`(l) FUNDING-
`(1) AUTHORIZATION OF APPROPRIATIONS- For the purpose of making grants
under subsection (a), there are authorized to be appropriated $5,000,000
for fiscal year 1991, $10,000,000 for fiscal year 1992, and such sums as
may be necessary for fiscal year 1993.
`(2) AVAILABILITY- Amounts appropriated under paragraph (1) shall remain
available until expended.
`(3) ALLOCATIONS FOR RURAL AREAS-
`(A) In carrying out subsection (a), the Secretary shall, to the extent
practicable, ensure that not less than 50 percent of the amounts appropriated
under paragraph (1) are, in the aggregate, expended for making grants
pursuant to subsection (c) to community organizations that are located in
rural health manpower shortage areas.
`(B) Subparagraph (A) may not be construed to prohibit the Secretary from
making grants under subsection (a) to States in which no rural health
manpower shortage areas are located.
`(C) With respect to any fiscal year for which the Secretary is unable to
comply with subparagraph (A), the Secretary shall, not later than April 1 of
the subsequent fiscal year, submit to the Committee on Energy and Commerce
of the House of Representatives, and to the Committee on Labor and Human
Resources of the Senate, a report stating the fact of such noncompliance
and an explanation of the reasons underlying such noncompliance.'.

dba6250221f87160e98738b3c1a8420b9eb10d87adbc40b2f33326a56e0cc0de

(a) COMMUNITY HEALTH CENTERS-
(1) PARALLEL STATUS WITH MIGRANT HEALTH CENTERS REGARDING CERTAIN SERVICES-
Section 330 of the Public Health Service Act (42 U.S.C. 254c) is amended--
(A) in subsection (a)(5), by amending such section to read as follows:
`(5) information on the availability and proper use of health services
and services which promote and facilitate optimal use of health services,
including, if a substantial number of the individuals in the population
served by a center are of limited English-speaking ability, the services
of appropriate personnel fluent in the language spoken by a predominant
number of such individuals, and'; and
(B) in subsection (b)(2)--
(i) in subparagraph (L), by adding `and' after the semicolon at the end; and
(ii) by striking subparagraph (M) and redesignating subparagraph (N)
as subparagraph (M).
(2) AUTHORIZATION OF APPROPRIATIONS- Section 330(g) of the Public Health
Service Act (42 U.S.C. 254c(g)) is amended--
(1) in paragraph (1)(A)--
(A) by striking `1989 and' and inserting `1989,'; and
(B) by inserting before the period the following: `, and such sums as may
be necessary for each of the fiscal years 1992 through 1994'; and
(2) in paragraph (2)(A)--
(A) by striking `and' after `1990,'; and
(B) by inserting before the period the following: `, and such sums as may
be necessary for each of the fiscal years 1992 through 1994'.
(b) AUTHORIZATION OF APPROPRIATIONS FOR MIGRANT HEALTH CENTERS- Section
329(h) of the Public Health Service Act (42 U.S.C. 254b(h)) is amended--
(1) in paragraph (1)(A)--
(A) by striking `1989 and' and inserting `1989,'; and
(B) by inserting before the period the following: `, and such sums as may
be necessary for each of the fiscal years 1992 through 1994'; and
(2) in paragraph (2)(A)--
(A) by striking `and' after `1990,'; and
(B) by inserting before the period the following: `, and such sums as may
be necessary for each of the fiscal years 1992 through 1994'.

9786f05f3451d180bc10e2405f282cca193deba0e9c810e88ee5874c6eee2aa4

(a) GRANTS- The Secretary of Health and Human Services (hereafter in
this section referred to as the `Secretary') shall provide grants to, or
enter into contracts with, public or private nonprofit agencies that have
demonstrated experience in serving the health needs of Pacific Islanders
living in the Territory of American Samoa, the Commonwealth of Northern
Mariana Islands, the Territory of Guam, the Republic of the Marshall Islands,
the Republic of Palau, and the Federated States of Micronesia.
(b) USE OF GRANTS OR CONTRACTS- Grants or contracts made or entered into
under subsection (a) shall be used, among other items--
(1) to continue, as a priority, the medical officer training program in
Pohnpei, Federated States of Micronesia;
(2) to improve the quality and availability of health and mental health
services and systems, with an emphasis therein on preventive health
services and health promotion programs and projects, including improved
health data systems;
(3) to improve the quality and availability of health manpower, including
programs and projects to train new and upgrade the skills of existing
health professionals by--
(A) establishing dental officer, dental assistant, nurse practitioner,
or nurse clinical specialist training programs;
(B) providing technical training of new auxiliary health workers;
(C) upgrading the training of currently employed health personnel in
special areas of need;
(D) developing long-term plans for meeting health profession needs;
(E) developing or improving programs for faculty enhancement or post-doctoral
training; and
(F) providing innovative health professions training initiatives (including
scholarships) targeted toward ensuring that residents of the Pacific Basin
attend and graduate from recognized health professional programs;
(4) to improve the quality of health services, including laboratory, x-ray,
and pharmacy, provided in ambulatory and inpatient settings through quality
assurance, standard setting, and other culturally appropriate means;
(5) to improve facility and equipment repair and maintenance systems;
(6) to improve alcohol, drug abuse, and mental health prevention and
treatment services and systems;
(7) to improve local and regional health planning systems; and
(8) to improve basic local public health systems, with particular attention
to primary care and services to those most in need.
No funds under subsection (b) shall be used for capital construction.
(c) ADVISORY COUNCIL- The Secretary of Health and Human Services shall
establish a `Pacific Health Advisory Council' which shall consist of 12
members and shall include--
(1) the Directors of the Health Departments for the entities identified
in subsection (a); and
(2) 6 members, including a representative of the Rehabilitation Hospital
of the Pacific, representing organizations in the State of Hawaii actively
involved in the provision of health services or technical assistance to
the entities identified in subsection (a). The Secretary shall solicit the
advice of the Governor of the State of Hawaii in appointing the 5 Council
members in addition to the representative of the Rehabilitation Hospital
of the Pacific from the State of Hawaii.
The Secretary shall be responsible for providing sufficient staff support
to the Council.
(d) ADVISORY COUNCIL FUNCTIONS- The Council shall meet at least annually to--
(1) recommend priority areas of need for funding by the Public Health
Service under this section; and
(2) review progress in addressing priority areas and make recommendations
to the Secretary for needed program modifications.
(e) REPORT- The Secretary, in consultation with the Council, shall annually
prepare and submit to the appropriate committees of Congress a report
describing the expenditure of the funds authorized to be appropriated
under this section and any recommendations that the Secretary may have.
(f) AUTHORIZATION OF APPROPRIATION- There is authorized to be appropriated
to carry out this section $10,000,000 for each of the fiscal years 1991
through 1993.

d1389a7a1d44104ca8cddc868267f582772857ff65033bac2ac74c6865649378

Section 639 of Public Law 100-607 (42 U.S.C. 292h note) is repealed.

b28300c8ccd203804b2a6c6a784d159cc32d0cfcd4978ab3b15557c8ce6241e4

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 October 10, 1990.
Attest:
Clerk.
HR 5702 EH----2
HR 5702 EH----3
HR 5702 EH----4
HR 5702 EH----5

64f575ea3568e1df23452cca3d47f623131833c24d7b488cb27690a463f84492

Minority Health Improvement Act of 1990 — HR. 5702

Other Sections

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