[Congressional Bills 105th Congress]
[From the U.S. Government Publishing Office]
[S. 1754 Enrolled Bill (ENR)]
S.1754
One Hundred Fifth Congress
of the
United States of America
AT THE SECOND SESSION
Begun and held at the City of Washington on Tuesday,
the twenty-seventh day of January, one thousand nine hundred and ninety-
eight
An Act
To amend the Public Health Service Act to consolidate and reauthorize
health professions and minority and disadvantaged health education
programs, and for other purposes.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,

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(a) Short Title.--This Act may be cited as the ``Health Professions
Education Partnerships Act of 1998''.
(b) Table of Contents.--The table of contents of this Act is as
follows:

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Subtitle A--Health Professions Education Programs

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Subtitle B--Nursing Workforce Development

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TITLE I

-HEALTH PROFESSIONS EDUCATION AND FINANCIAL ASSISTANCE PROGRAMS

Subtitle C--Financial Assistance
CHAPTER 1--SCHOOL-BASED REVOLVING LOAN FUNDS

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CHAPTER 2--INSURED HEALTH EDUCATION ASSISTANCE LOANS TO GRADUATE
STUDENTS

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TITLE II

-OFFICE OF MINORITY HEALTH

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TITLE IV

-MISCELLANEOUS PROVISIONS

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Part C of title VII of the Public Health Service Act (42 U.S.C. 293
et seq.) is amended--
(1) in the part heading by striking ``PRIMARY HEALTH CARE'' and
inserting ``FAMILY MEDICINE, GENERAL INTERNAL MEDICINE, GENERAL
PEDIATRICS, PHYSICIAN ASSISTANTS, GENERAL DENTISTRY, AND PEDIATRIC
DENTISTRY'';
(2) by repealing section 746 (42 U.S.C. 293j);
(3) in section 747 (42 U.S.C. 293k)--
(A) by striking the section heading and inserting the
following:
``SEC. 747. FAMILY MEDICINE, GENERAL INTERNAL MEDICINE, GENERAL
PEDIATRICS, GENERAL DENTISTRY, PEDIATRIC DENTISTRY, AND PHYSICIAN
ASSISTANTS.'';
(B) in subsection (a)--
(i) in paragraph (1)--
(I) by inserting ``, internal medicine, or
pediatrics'' after ``family medicine''; and
(II) by inserting before the semicolon the
following: ``that emphasizes training for the practice
of family medicine, general internal medicine, or
general pediatrics (as defined by the Secretary)'';
(ii) in paragraph (2), by inserting ``, general
internal medicine, or general pediatrics'' before the
semicolon;
(iii) in paragraphs (3) and (4), by inserting
``(including geriatrics), general internal medicine or
general pediatrics'' after ``family medicine'';
(iv) in paragraph (3), by striking ``and'' at the end
thereof;
(v) in paragraph (4), by striking the period and
inserting a semicolon; and
(vii) by adding at the end thereof the following new
paragraphs:
``(5) to meet the costs of projects to plan, develop, and
operate or maintain programs for the training of physician
assistants (as defined in section 799B), and for the training of
individuals who will teach in programs to provide such training;
and
``(6) to meet the costs of planning, developing, or operating
programs, and to provide financial assistance to residents in such
programs, of general dentistry or pediatric dentistry.
For purposes of paragraph (6), entities eligible for such grants or
contracts shall include entities that have programs in dental schools,
approved residency programs in the general or pediatric practice of
dentistry, approved advanced education programs in the general or
pediatric practice of dentistry, or approved residency programs in
pediatric dentistry.'';
(C) in subsection (b)--
(i) in paragraphs (1) and (2)(A), by inserting ``,
general internal medicine, or general pediatrics'' after
``family medicine'';
(ii) in paragraph (2)--
(I) in subparagraph (A), by striking ``or'' at the
end; and
(II) in subparagraph (B), by striking the period
and inserting ``; or''; and
(iii) by adding at the end the following:
``(3) Priority in making awards.--In making awards of grants
and contracts under paragraph (1), the Secretary shall give
priority to any qualified applicant for such an award that proposes
a collaborative project between departments of primary care.'';
(D) by redesignating subsections (c) and (d) as subsections
(d) and (e), respectively;
(E) by inserting after subsection (b), the following new
subsection:
``(c) Priority.--
``(1) In general.--With respect to programs for the training of
interns or residents, the Secretary shall give priority in awarding
grants under this section to qualified applicants that have a
record of training the greatest percentage of providers, or that
have demonstrated significant improvements in the percentage of
providers, which enter and remain in primary care practice or
general or pediatric dentistry.
``(2) Disadvantaged individuals.--With respect to programs for
the training of interns, residents, or physician assistants, the
Secretary shall give priority in awarding grants under this section
to qualified applicants that have a record of training individuals
who are from disadvantaged backgrounds (including racial and ethnic
minorities underrepresented among primary care practice or general
or pediatric dentistry).
``(3) Special consideration.--In awarding grants under this
section the Secretary shall give special consideration to projects
which prepare practitioners to care for underserved populations and
other high risk groups such as the elderly, individuals with HIV-
AIDS, substance abusers, homeless, and victims of domestic
violence.''; and
(F) in subsection (e) (as so redesignated by subparagraph
(D))--
(i) in paragraph (1), by striking ``$54,000,000'' and
all that follows and inserting ``$78,300,000 for fiscal
year 1998, and such sums as may be necessary for each of
the fiscal years 1999 through 2002.''; and
(ii) by striking paragraph (2) and inserting the
following:
``(2) Allocation.--
``(A) In general.--Of the amounts appropriated under
paragraph (1) for a fiscal year, the Secretary shall make
available--
``(i) not less than $49,300,000 for awards of grants
and contracts under subsection (a) to programs of family
medicine, of which not less than $8,600,000 shall be made
available for awards of grants and contracts under
subsection (b) for family medicine academic administrative
units;
``(ii) not less than $17,700,000 for awards of grants
and contracts under subsection (a) to programs of general
internal medicine and general pediatrics;
``(iii) not less than $6,800,000 for awards of grants
and contracts under subsection (a) to programs relating to
physician assistants; and
``(iv) not less than $4,500,000 for awards of grants
and contracts under subsection (a) to programs of general
or pediatric dentistry.
``(B) Ratable reduction.--If amounts appropriated under
paragraph (1) for any fiscal year are less than the amount
required to comply with subparagraph (A), the Secretary shall
ratably reduce the amount to be made available under each of
clauses (i) through (iv) of such subparagraph accordingly.'';
and
(4) by repealing sections 748 through 752 (42 U.S.C. 293l
through 293p) and inserting the following:
``SEC. 748. ADVISORY COMMITTEE ON TRAINING IN PRIMARY CARE MEDICINE AND
DENTISTRY.
``(a) Establishment.--The Secretary shall establish an advisory
committee to be known as the Advisory Committee on Training in Primary
Care Medicine and Dentistry (in this section referred to as the
`Advisory Committee').
``(b) Composition.--
``(1) In general.--The Secretary shall determine the
appropriate number of individuals to serve on the Advisory
Committee. Such individuals shall not be officers or employees of
the Federal Government.
``(2) Appointment.--Not later than 90 days after the date of
enactment of this Act, the Secretary shall appoint the members of
the Advisory Committee from among individuals who are health
professionals. In making such appointments, the Secretary shall
ensure a fair balance between the health professions, that at least
75 percent of the members of the Advisory Committee are health
professionals, a broad geographic representation of members and a
balance between urban and rural members. Members shall be appointed
based on their competence, interest, and knowledge of the mission
of the profession involved.
``(3) Minority representation.--In appointing the members of
the Advisory Committee under paragraph (2), the Secretary shall
ensure the adequate representation of women and minorities.
``(c) Terms.--
``(1) In general.--A member of the Advisory Committee shall be
appointed for a term of 3 years, except that of the members first
appointed--
``(A) \1/3\ of such members shall serve for a term of 1
year;
``(B) \1/3\ of such members shall serve for a term of 2
years; and
``(C) \1/3\ of such members shall serve for a term of 3
years.
``(2) Vacancies.--
``(A) In general.--A vacancy on the Advisory Committee
shall be filled in the manner in which the original appointment
was made and shall be subject to any conditions which applied
with respect to the original appointment.
``(B) Filling unexpired term.--An individual chosen to fill
a vacancy shall be appointed for the unexpired term of the
member replaced.
``(d) Duties.--The Advisory Committee shall--
``(1) provide advice and recommendations to the Secretary
concerning policy and program development and other matters of
significance concerning the activities under section 747; and
``(2) not later than 3 years after the date of enactment of
this section, and annually thereafter, prepare and submit to the
Secretary, and the Committee on Labor and Human Resources of the
Senate, and the Committee on Commerce of the House of
Representatives, a report describing the activities of the
Committee, including findings and recommendations made by the
Committee concerning the activities under section 747.
``(e) Meetings and Documents.--
``(1) Meetings.--The Advisory Committee shall meet not less
than 2 times each year. Such meetings shall be held jointly with
other related entities established under this title where
appropriate.
``(2) Documents.--Not later than 14 days prior to the convening
of a meeting under paragraph (1), the Advisory Committee shall
prepare and make available an agenda of the matters to be
considered by the Advisory Committee at such meeting. At any such
meeting, the Advisory Council shall distribute materials with
respect to the issues to be addressed at the meeting. Not later
than 30 days after the adjourning of such a meeting, the Advisory
Committee shall prepare and make available a summary of the meeting
and any actions taken by the Committee based upon the meeting.
``(f) Compensation and Expenses.--
``(1) Compensation.--Each member of the Advisory Committee
shall be compensated at a rate equal to the daily equivalent of the
annual rate of basic pay prescribed for level IV of the Executive
Schedule under section 5315 of title 5, United States Code, for
each day (including travel time) during which such member is
engaged in the performance of the duties of the Committee.
``(2) Expenses.--The members of the Advisory Committee shall be
allowed travel expenses, including per diem in lieu of subsistence,
at rates authorized for employees of agencies under subchapter I of
chapter 57 of title 5, United States Code, while away from their
homes or regular places of business in the performance of services
for the Committee.
``(g) FACA.--The Federal Advisory Committee Act shall apply to the
Advisory Committee under this section only to the extent that the
provisions of such Act do not conflict with the requirements of this
section.''.

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(a) In General.--Part E of title VII of the Public Health Service
Act (42 U.S.C. 294n et seq.) is amended to read as follows:
``PART E--HEALTH PROFESSIONS AND PUBLIC HEALTH WORKFORCE
``Subpart 1--Health Professions Workforce Information and Analysis
``SEC. 761. HEALTH PROFESSIONS WORKFORCE INFORMATION AND ANALYSIS.
``(a) Purpose.--It is the purpose of this section to--
``(1) provide for the development of information describing the
health professions workforce and the analysis of workforce related
issues; and
``(2) provide necessary information for decision-making
regarding future directions in health professions and nursing
programs in response to societal and professional needs.
``(b) Grants or Contracts.--The Secretary may award grants or
contracts to State or local governments, health professions schools,
schools of nursing, academic health centers, community-based health
facilities, and other appropriate public or private nonprofit entities
to provide for--
``(1) targeted information collection and analysis activities
related to the purposes described in subsection (a);
``(2) research on high priority workforce questions;
``(3) the development of a non-Federal analytic and research
infrastructure related to the purposes described in subsection (a);
and
``(4) the conduct of program evaluation and assessment.
``(c) Authorization of Appropriations.--
``(1) In general.--There are authorized to be appropriated to
carry out this section, $750,000 for fiscal year 1998, and such
sums as may be necessary for each of the fiscal years 1999 through
2002.
``(2) Reservation.--Of the amounts appropriated under
subsection (a) for a fiscal year, the Secretary shall reserve not
less than $600,000 for conducting health professions research and
for carrying out data collection and analysis in accordance with
section 792.
``(3) Availability of additional funds.--Amounts otherwise
appropriated for programs or activities under this title may be
used for activities under subsection (b) with respect to the
programs or activities from which such amounts were made
available.''.
(b) Council on Graduate Medical Education.--Section 301 of the
Health Professions Education Extension Amendments of 1992 (Public Law
102-408) is amended--
(1) in subsection (j), by striking ``1995'' and inserting
``2002'';
(2) in subsection (k), by striking ``1995'' and inserting
``2002'';
(3) by adding at the end thereof the following new subsection:
``(l) Funding.--Amounts otherwise appropriated under this title may
be utilized by the Secretary to support the activities of the
Council.'';
(4) by transferring such section to part E of title VII of the
Public Health Service Act (as amended by subsection (a));
(5) by redesignating such section as section 762; and
(6) by inserting such section after section 761.

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Part E of title VII of the Public Health Service Act (as amended by
section 104) is further amended by adding at the end the following:
``Subpart 2--Public Health Workforce
``SEC. 765. GENERAL PROVISIONS.
``(a) In General.--The Secretary may award grants or contracts to
eligible entities to increase the number of individuals in the public
health workforce, to enhance the quality of such workforce, and to
enhance the ability of the workforce to meet national, State, and local
health care needs.
``(b) Eligibility.--To be eligible to receive a grant or contract
under subsection (a) an entity shall--
``(1) be--
``(A) a health professions school, including an accredited
school or program of public health, health administration,
preventive medicine, or dental public health or a school
providing health management programs;
``(B) an academic health center;
``(C) a State or local government; or
``(D) any other appropriate public or private nonprofit
entity; and
``(2) prepare and submit to the Secretary an application at
such time, in such manner, and containing such information as the
Secretary may require.
``(c) Preference.--In awarding grants or contracts under this
section the Secretary may grant a preference to entities--
``(1) serving individuals who are from disadvantaged
backgrounds (including underrepresented racial and ethnic
minorities); and
``(2) graduating large proportions of individuals who serve in
underserved communities.
``(d) Activities.--Amounts provided under a grant or contract
awarded under this section may be used for--
``(1) the costs of planning, developing, or operating
demonstration training programs;
``(2) faculty development;
``(3) trainee support;
``(4) technical assistance;
``(5) to meet the costs of projects--
``(A) to plan and develop new residency training programs
and to maintain or improve existing residency training programs
in preventive medicine and dental public health, that have
available full-time faculty members with training and
experience in the fields of preventive medicine and dental
public health; and
``(B) to provide financial assistance to residency trainees
enrolled in such programs;
``(6) the retraining of existing public health workers as well
as for increasing the supply of new practitioners to address
priority public health, preventive medicine, public health
dentistry, and health administration needs;
``(7) preparing public health professionals for employment at
the State and community levels; or
``(8) other activities that may produce outcomes that are
consistent with the purposes of this section.
``(e) Traineeships.--
``(1) In general.--With respect to amounts used under this
section for the training of health professionals, such training
programs shall be designed to--
``(A) make public health education more accessible to the
public and private health workforce;
``(B) increase the relevance of public health academic
preparation to public health practice in the future;
``(C) provide education or training for students from
traditional on-campus programs in practice-based sites; or
``(D) develop educational methods and distance-based
approaches or technology that address adult learning
requirements and increase knowledge and skills related to
community-based cultural diversity in public health education.
``(2) Severe shortage disciplines.--Amounts provided under
grants or contracts under this section may be used for the
operation of programs designed to award traineeships to students in
accredited schools of public health who enter educational programs
in fields where there is a severe shortage of public health
professionals, including epidemiology, biostatistics, environmental
health, toxicology, public health nursing, nutrition, preventive
medicine, maternal and child health, and behavioral and mental
health professions.
``SEC. 766. PUBLIC HEALTH TRAINING CENTERS.
``(a) In General.--The Secretary may make grants or contracts for
the operation of public health training centers.
``(b) Eligible Entities.--
``(1) In general.--A public health training center shall be an
accredited school of public health, or another public or nonprofit
private institution accredited for the provision of graduate or
specialized training in public health, that plans, develops,
operates, and evaluates projects that are in furtherance of the
goals established by the Secretary for the year 2000 in the areas
of preventive medicine, health promotion and disease prevention, or
improving access to and quality of health services in medically
underserved communities.
``(2) Preference.--In awarding grants or contracts under this
section the Secretary shall give preference to accredited schools
of public health.
``(c) Certain Requirements.--With respect to a public health
training center, an award may not be made under subsection (a) unless
the program agrees that it--
``(1) will establish or strengthen field placements for
students in public or nonprofit private health agencies or
organizations;
``(2) will involve faculty members and students in
collaborative projects to enhance public health services to
medically underserved communities;
``(3) will specifically designate a geographic area or
medically underserved population to be served by the center that
shall be in a location removed from the main location of the
teaching facility of the school that is participating in the
program with such center; and
``(4) will assess the health personnel needs of the area to be
served by the center and assist in the planning and development of
training programs to meet such needs.
``SEC. 767. PUBLIC HEALTH TRAINEESHIPS.
``(a) In General.--The Secretary may make grants to accredited
schools of public health, and to other public or nonprofit private
institutions accredited for the provision of graduate or specialized
training in public health, for the purpose of assisting such schools
and institutions in providing traineeships to individuals described in
subsection (b)(3).
``(b) Certain Requirements.--
``(1) Amount.--The amount of any grant under this section shall
be determined by the Secretary.
``(2) Use of grant.--Traineeships awarded under grants made
under subsection (a) shall provide for tuition and fees and such
stipends and allowances (including travel and subsistence expenses
and dependency allowances) for the trainees as the Secretary may
deem necessary.
``(3) Eligible individuals.--The individuals referred to in
subsection (a) are individuals who are pursuing a course of study
in a health professions field in which there is a severe shortage
of health professionals (which fields include the fields of
epidemiology, environmental health, biostatistics, toxicology,
nutrition, and maternal and child health).
``SEC. 768. PREVENTIVE MEDICINE; DENTAL PUBLIC HEALTH.
``(a) In General.--The Secretary may make grants to and enter into
contracts with schools of medicine, osteopathic medicine, public
health, and dentistry to meet the costs of projects--
``(1) to plan and develop new residency training programs and
to maintain or improve existing residency training programs in
preventive medicine and dental public health; and
``(2) to provide financial assistance to residency trainees
enrolled in such programs.
``(b) Administration.--
``(1) Amount.--The amount of any grant under subsection (a)
shall be determined by the Secretary.
``(2) Eligibility.--To be eligible for a grant under subsection
(a), the applicant must demonstrate to the Secretary that it has or
will have available full-time faculty members with training and
experience in the fields of preventive medicine or dental public
health and support from other faculty members trained in public
health and other relevant specialties and disciplines.
``(3) Other funds.--Schools of medicine, osteopathic medicine,
dentistry, and public health may use funds committed by State,
local, or county public health officers as matching amounts for
Federal grant funds for residency training programs in preventive
medicine.
``SEC. 769. HEALTH ADMINISTRATION TRAINEESHIPS AND SPECIAL PROJECTS.
``(a) In General.--The Secretary may make grants to State or local
governments (that have in effect preventive medical and dental public
health residency programs) or public or nonprofit private educational
entities (including graduate schools of social work and business
schools that have health management programs) that offer a program
described in subsection (b)--
``(1) to provide traineeships for students enrolled in such a
program; and
``(2) to assist accredited programs health administration in
the development or improvement of programs to prepare students for
employment with public or nonprofit private entities.
``(b) Relevant Programs.--The program referred to in subsection (a)
is an accredited program in health administration, hospital
administration, or health policy analysis and planning, which program
is accredited by a body or bodies approved for such purpose by the
Secretary of Education and which meets such other quality standards as
the Secretary of Health and Human Services by regulation may prescribe.
``(c) Preference in Making Grants.--In making grants under
subsection (a), the Secretary shall give preference to qualified
applicants that meet the following conditions:
``(1) Not less than 25 percent of the graduates of the
applicant are engaged in full-time practice settings in medically
underserved communities.
``(2) The applicant recruits and admits students from medically
underserved communities.
``(3) For the purpose of training students, the applicant has
established relationships with public and nonprofit providers of
health care in the community involved.
``(4) In training students, the applicant emphasizes employment
with public or nonprofit private entities.
``(d) Certain Provisions Regarding Traineeships.--
``(1) Use of grant.--Traineeships awarded under grants made
under subsection (a) shall provide for tuition and fees and such
stipends and allowances (including travel and subsistence expenses
and dependency allowances) for the trainees as the Secretary may
deem necessary.
``(2) Preference for certain students.--Each entity applying
for a grant under subsection (a) for traineeships shall assure to
the satisfaction of the Secretary that the entity will give
priority to awarding the traineeships to students who demonstrate a
commitment to employment with public or nonprofit private entities
in the fields with respect to which the traineeships are awarded.
``SEC. 770. AUTHORIZATION OF APPROPRIATIONS.
``(a) In General.--For the purpose of carrying out this subpart,
there is authorized to be appropriated $9,100,000 for fiscal year 1998,
and such sums as may be necessary for each of the fiscal years 1999
through 2002.
``(b) Limitation Regarding Certain Program.--In obligating amounts
appropriated under subsection (a), the Secretary may not obligate more
than 30 percent for carrying out section 767.''.

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(a) In General.--
(1) Part F of title VII of the Public Health Service Act (42
U.S.C. 295 et seq.) is repealed.
(2) Part G of title VII of the Public Health Service Act (42
U.S.C. 295j et seq.) is amended--
(A) by redesignating such part as part F;
(B) in section 791 (42 U.S.C. 295j)--
(i) by striking subsection (b); and
(ii) redesignating subsection (c) as subsection (b);
(C) by repealing section 793 (42 U.S.C. 295l);
(D) by repealing section 798;
(E) by redesignating section 799 as section 799B; and
(F) by inserting after section 794, the following new
sections:
``SEC. 796. APPLICATION.
``(a) In General.--To be eligible to receive a grant or contract
under this title, an eligible entity shall prepare and submit to the
Secretary an application that meets the requirements of this section,
at such time, in such manner, and containing such information as the
Secretary may require.
``(b) Plan.--An application submitted under this section shall
contain the plan of the applicant for carrying out a project with
amounts received under this title. Such plan shall be consistent with
relevant Federal, State, or regional health professions program plans.
``(c) Performance Outcome Standards.--An application submitted
under this section shall contain a specification by the applicant
entity of performance outcome standards that the project to be funded
under the grant or contract will be measured against. Such standards
shall address relevant health workforce needs that the project will
meet. The recipient of a grant or contract under this section shall
meet the standards set forth in the grant or contract application.
``(d) Linkages.--An application submitted under this section shall
contain a description of the linkages with relevant educational and
health care entities, including training programs for other health
professionals as appropriate, that the project to be funded under the
grant or contract will establish. To the extent practicable, grantees
under this section shall establish linkages with health care providers
who provide care for underserved communities and populations.
``SEC. 797. USE OF FUNDS.
``(a) In General.--Amounts provided under a grant or contract
awarded under this title may be used for training program development
and support, faculty development, model demonstrations, trainee support
including tuition, books, program fees and reasonable living expenses
during the period of training, technical assistance, workforce
analysis, dissemination of information, and exploring new policy
directions, as appropriate to meet recognized health workforce
objectives, in accordance with this title.
``(b) Maintenance of Effort.--With respect to activities for which
a grant awarded under this title is to be expended, the entity shall
agree to maintain expenditures of non-Federal amounts for such
activities at a level that is not less than the level of such
expenditures maintained by the entity for the fiscal year preceding the
fiscal year for which the entity receives such a grant.
``SEC. 798. MATCHING REQUIREMENT.
``The Secretary may require that an entity that applies for a grant
or contract under this title provide non-Federal matching funds, as
appropriate, to ensure the institutional commitment of the entity to
the projects funded under the grant. As determined by the Secretary,
such non-Federal matching funds may be provided directly or through
donations from public or private entities and may be in cash or in-
kind, fairly evaluated, including plant, equipment, or services.
``SEC. 799. GENERALLY APPLICABLE PROVISIONS.
``(a) Awarding of Grants and Contracts.--The Secretary shall ensure
that grants and contracts under this title are awarded on a competitive
basis, as appropriate, to carry out innovative demonstration projects
or provide for strategic workforce supplementation activities as needed
to meet health workforce goals and in accordance with this title.
Contracts may be entered into under this title with public or private
entities as may be necessary.
``(b) Eligible Entities.--Unless specifically required otherwise in
this title, the Secretary shall accept applications for grants or
contracts under this title from health professions schools, academic
health centers, State or local governments, or other appropriate public
or private nonprofit entities for funding and participation in health
professions and nursing training activities. The Secretary may accept
applications from for-profit private entities if determined appropriate
by the Secretary.
``(c) Information Requirements.--
``(1) In general.--Recipients of grants and contracts under
this title shall meet information requirements as specified by the
Secretary.
``(2) Data collection.--The Secretary shall establish
procedures to ensure that, with respect to any data collection
required under this title, such data is collected in a manner that
takes into account age, sex, race, and ethnicity.
``(3) Use of funds.--The Secretary shall establish procedures
to permit the use of amounts appropriated under this title to be
used for data collection purposes.
``(4) Evaluations.--The Secretary shall establish procedures to
ensure the annual evaluation of programs and projects operated by
recipients of grants or contracts under this title. Such procedures
shall ensure that continued funding for such programs and projects
will be conditioned upon a demonstration that satisfactory progress
has been made by the program or project in meeting the objectives
of the program or project.
``(d) Training Programs.--Training programs conducted with amounts
received under this title shall meet applicable accreditation and
quality standards.
``(e) Duration of Assistance.--
``(1) In general.--Subject to paragraph (2), in the case of an
award to an entity of a grant, cooperative agreement, or contract
under this title, the period during which payments are made to the
entity under the award may not exceed 5 years. The provision of
payments under the award shall be subject to annual approval by the
Secretary of the payments and subject to the availability of
appropriations for the fiscal year involved to make the payments.
This paragraph may not be construed as limiting the number of
awards under the program involved that may be made to the entity.
``(2) Limitation.--In the case of an award to an entity of a
grant, cooperative agreement, or contract under this title,
paragraph (1) shall apply only to the extent not inconsistent with
any other provision of this title that relates to the period during
which payments may be made under the award.
``(f) Peer Review Regarding Certain Programs.--
``(1) In general.--Each application for a grant under this
title, except any scholarship or loan program, including those
under sections 701, 721, or 723, shall be submitted to a peer
review group for an evaluation of the merits of the proposals made
in the application. The Secretary may not approve such an
application unless a peer review group has recommended the
application for approval.
``(2) Composition.--Each peer review group under this
subsection shall be composed principally of individuals who are not
officers or employees of the Federal Government. In providing for
the establishment of peer review groups and procedures, the
Secretary shall ensure sex, racial, ethnic, and geographic balance
among the membership of such groups.
``(3) Administration.--This subsection shall be carried out by
the Secretary acting through the Administrator of the Health
Resources and Services Administration.
``(g) Preference or Priority Considerations.--In considering a
preference or priority for funding which is based on outcome measures
for an eligible entity under this title, the Secretary may also
consider the future ability of the eligible entity to meet the outcome
preference or priority through improvements in the eligible entity's
program design.
``(h) Analytic Activities.--The Secretary shall ensure that--
``(1) cross-cutting workforce analytical activities are carried
out as part of the workforce information and analysis activities
under section 761; and
``(2) discipline-specific workforce information and analytical
activities are carried out as part of--
``(A) the community-based linkage program under part D; and
``(B) the health workforce development program under
subpart 2 of part E.
``(i) Osteopathic Schools.--For purposes of this title, any
reference to--
``(1) medical schools shall include osteopathic medical
schools; and
``(2) medical students shall include osteopathic medical
students.
``SEC. 799A. TECHNICAL ASSISTANCE.
``Funds appropriated under this title may be used by the Secretary
to provide technical assistance in relation to any of the authorities
under this title.''.
(b) Professional Counselors as Mental Health Professionals.--
Section 792(a) of the Public Health Service Act (42 U.S.C. 295k(a)) is
amended by inserting ``professional counselors,'' after ``clinical
psychologists,''.

1936a44eadc12662ead0872d0803f2a1fd364521332c0c2c3324e9d6f87a7b9d

(a) In General.--Section 791 of the Public Health Service Act (42
U.S.C. 295j), as amended by section 105(a)(2)(B), is further amended by
adding at the end thereof the following subsection:
``(c) Exceptions for New Programs.--
``(1) In general.--To permit new programs to compete equitably
for funding under this section, those new programs that meet at
least 4 of the criteria described in paragraph (3) shall qualify
for a funding preference under this section.
``(2) Definition.--As used in this subsection, the term `new
program' means any program that has graduated less than three
classes. Upon graduating at least three classes, a program shall
have the capability to provide the information necessary to qualify
the program for the general funding preferences described in
subsection (a).
``(3) Criteria.--The criteria referred to in paragraph (1) are
the following:
``(A) The mission statement of the program identifies a
specific purpose of the program as being the preparation of
health professionals to serve underserved populations.
``(B) The curriculum of the program includes content which
will help to prepare practitioners to serve underserved
populations.
``(C) Substantial clinical training experience is required
under the program in medically underserved communities.
``(D) A minimum of 20 percent of the clinical faculty of
the program spend at least 50 percent of their time providing
or supervising care in medically underserved communities.
``(E) The entire program or a substantial portion of the
program is physically located in a medically underserved
community.
``(F) Student assistance, which is linked to service in
medically underserved communities following graduation, is
available to the students in the program.
``(G) The program provides a placement mechanism for
deploying graduates to medically underserved communities.''.
(b) Conforming Amendments.--Section 791(a) of the Public Health
Service Act (42 U.S.C. 295j(a)) is amended--
(1) in paragraph (1), by striking ``sections 747'' and all that
follows through ``767'' and inserting ``sections 747 and 750''; and
(2) in paragraph (2), by striking ``under section 798(a)''.

ba8c53841cf311da9a276c4c8c0b1436684865242314485bb4552f432dc2808a

(a) Graduate Program in Behavioral and Mental Health Practice.--
Section 799B(1)(D) of the Public Health Service Act (42 U.S.C.
295p(1)(D)) (as so redesignated by section 106(a)(2)(E)) is amended--
(1) by inserting ``behavioral health and'' before ``mental'';
and
(2) by inserting ``behavioral health and mental health
practice,'' before ``clinical''.
(b) Professional Counseling as a Behavioral and Mental Health
Practice.--Section 799B of the Public Health Service Act (42 U.S.C.
295p) (as so redesignated by section 106(a)(2)(E)) is amended--
(1) in paragraph (1)--
(A) in subparagraph (C)--
(i) by inserting ``and `graduate program in
professional counseling''' after ``graduate program in
marriage and family therapy'''; and
(ii) by inserting before the period the following:
``and a concentration leading to a graduate degree in
counseling'';
(B) in subparagraph (D), by inserting ``professional
counseling,'' after ``social work,''; and
(C) in subparagraph (E), by inserting ``professional
counseling,'' after ``social work,''; and
(2) in paragraph (5)(C), by inserting before the period the
following: ``or a degree in counseling or an equivalent degree''.
(c) Medically Underserved Community.--Section 799B(6) of the Public
Health Service Act (42 U.S.C. 295p(6)) (as so redesignated by section
105(a)(2)(E)) is amended--
(1) in subparagraph (B), by striking ``or'' at the end thereof;
(2) in subparagraph (C), by striking the period and inserting
``; or''; and
(3) by adding at the end the following:
``(D) is designated by a State Governor (in consultation
with the medical community) as a shortage area or medically
underserved community.''.
(d) Programs for the Training of Physician Assistants.--Paragraph
(3) of section 799B of the Public Health Service Act (42 U.S.C. 295p)
(as so redesignated by section 105(a)(2)(E)) is amended to read as
follows:
``(3) The term `program for the training of physician
assistants' means an educational program that--
``(A) has as its objective the education of individuals who
will, upon completion of their studies in the program, be
qualified to provide primary care under the supervision of a
physician;
``(B) extends for at least one academic year and consists
of--
``(i) supervised clinical practice; and
``(ii) at least four months (in the aggregate) of
classroom instruction, directed toward preparing students
to deliver health care;
``(C) has an enrollment of not less than eight students;
and
``(D) trains students in primary care, disease prevention,
health promotion, geriatric medicine, and home health care.''.
(e) Psychologist.--Section 799B of the Public Health Service Act
(42 U.S.C. 295p) (as so redesignated by section 105(a)(2)(E)) is
amended by adding at the end the following:
``(11) The term `psychologist' means an individual who--
``(A) holds a doctoral degree in psychology; and
``(B) is licensed or certified on the basis of the doctoral
degree in psychology, by the State in which the individual
practices, at the independent practice level of psychology to
furnish diagnostic, assessment, preventive, and therapeutic
services directly to individuals.''.

9d4e049e3f11249050fd799d9ab9fee2c2db9a0ae39967dc1f7aff0138e66e5b

Section 338B(b)(1)(B) of the Public Health Service Act (42 U.S.C.
254l-1(b)(1)(B)) is amended by striking ``or other health profession''
and inserting ``behavioral and mental health, or other health
profession''.

87b6e10148cf94a87cc85d458b4ca7886a6259acc53891fe5343660185a7d1af

In the case of any authority for making awards of grants or
contracts that is terminated by the amendments made by this subtitle,
the Secretary of Health and Human Services may, notwithstanding the
termination of the authority, continue in effect any grant or contract
made under the authority that is in effect on the day before the date
of the enactment of this Act, subject to the duration of any such grant
or contract not exceeding the period determined by the Secretary in
first approving such financial assistance, or in approving the most
recent request made (before the date of such enactment) for
continuation of such assistance, as the case may be.
Subtitle B--Nursing Workforce Development

654021cd04b921ad51088ee65f508f622e9da38bcf194c49bfb93c75eeec000c

This subtitle may be cited as the ``Nursing Education and Practice
Improvement Act of 1998''.

09810b4929136f38b671660f6ac6d24b4a496b58199189df07b6087f04b194bf

It is the purpose of this subtitle to restructure the nurse
education authorities of title VIII of the Public Health Service Act to
permit a comprehensive, flexible, and effective approach to Federal
support for nursing workforce development.

e17410aabe778d4150a79404dcbb845df4489f33014bf644890e65e1931188f8

1efd0b74d10c54071854cd8fa93c2b06016e5c2d510b7d2e14257007f003f470

In the case of any authority for making awards of grants or
contracts that is terminated by the amendment made by section 123, the
Secretary of Health and Human Services may, notwithstanding the
termination of the authority, continue in effect any grant or contract
made under the authority that is in effect on the day before the date
of the enactment of this Act, subject to the duration of any such grant
or contract not exceeding the period determined by the Secretary in
first approving such financial assistance, or in approving the most
recent request made (before the date of such enactment) for
continuation of such assistance, as the case may be.
Subtitle C--Financial Assistance
CHAPTER 1--SCHOOL-BASED REVOLVING LOAN FUNDS

0f5858d65c196754c703f259923be5dc3a11ed593f6878e44ac29398486cf4c4

(a) Requirement for Schools.--Section 723(b)(1) of the Public
Health Service Act (42 U.S.C. 292s(b)(1)), as amended by section
2014(c)(2)(A)(ii) of Public Law 103-43 (107 Stat. 216), is amended by
striking ``3 years before'' and inserting ``4 years before''.
(b) Noncompliance.--Section 723(a)(3) of the Public Health Service
Act (42 U.S.C. 292s(a)(3)) is amended to read as follows:
``(3) Noncompliance by student.--Each agreement entered into
with a student pursuant to paragraph (1) shall provide that, if the
student fails to comply with such agreement, the loan involved will
begin to accrue interest at a rate of 18 percent per year beginning
on the date of such noncompliance.''.
(c) Report Requirement.--Section 723 of the Public Health Service
Act (42 U.S.C. 292s) is amended--
(1) by striking subsection (c); and
(2) by redesignating subsection (d) as subsection (c).

56b3abbe9fbce284b078422cd4f7d2f5cbbc6942c45a5e426d8f572eb48723e5

(a) Authorization of Appropriations.--Section 724(f)(1) of the
Public Health Service Act (42 U.S.C. 292t(f)(1)) is amended by striking
``$15,000,000 for fiscal year 1993'' and inserting ``$8,000,000 for
each of the fiscal years 1998 through 2002''.
(b) Repeal.--Effective October 1, 2002, paragraph (1) of section
724(f) of the Public Health Service Act (42 U.S.C. 292t(f)(1)) is
repealed.

6268539ae9126c03ca02e0d32fca7f1d0020251b79daa14c0c173ee9d506cce9

(a) In General.--Section 836(b) of the Public Health Service Act
(42 U.S.C. 297b(b)) is amended--
(1) in paragraph (1), by striking the period at the end and
inserting a semicolon;
(2) in paragraph (2)--
(A) in subparagraph (A), by striking ``and'' at the end;
and
(B) by inserting before the semicolon at the end the
following: ``, and (C) such additional periods under the terms
of paragraph (8) of this subsection'';
(3) in paragraph (7), by striking the period at the end and
inserting ``; and''; and
(4) by adding at the end the following paragraph:
``(8) pursuant to uniform criteria established by the
Secretary, the repayment period established under paragraph (2) for
any student borrower who during the repayment period failed to make
consecutive payments and who, during the last 12 months of the
repayment period, has made at least 12 consecutive payments may be
extended for a period not to exceed 10 years.''.
(b) Minimum Monthly Payments.--Section 836(g) of the Public Health
Service Act (42 U.S.C. 297b(g)) is amended by striking ``$15'' and
inserting ``$40''.
(c) Elimination of Statute of Limitation for Loan Collections.--
(1) In general.--Section 836 of the Public Health Service Act
(42 U.S.C. 297b) is amended by adding at the end the following new
subsection:
``(l) Elimination of Statute of Limitation for Loan Collections.--
``(1) Purpose.--It is the purpose of this subsection to ensure
that obligations to repay loans under this section are enforced
without regard to any Federal or State statutory, regulatory, or
administrative limitation on the period within which debts may be
enforced.
``(2) Prohibition.--Notwithstanding any other provision of
Federal or State law, no limitation shall terminate the period
within which suit may be filed, a judgment may be enforced, or an
offset, garnishment, or other action may be initiated or taken by a
school of nursing that has an agreement with the Secretary pursuant
to section 835 that is seeking the repayment of the amount due from
a borrower on a loan made under this subpart after the default of
the borrower on such loan.''.
(2) Effective date.--The amendment made by paragraph (1) shall
be effective with respect to actions pending on or after the date
of enactment of this Act.
(d) Breach of Agreements.--Section 846 of the Public Health Service
Act (42 U.S.C. 297n) is amended by adding at the end thereof the
following new subsection:
``(h) Breach of Agreement.--
``(1) In general.--In the case of any program under this
section under which an individual makes an agreement to provide
health services for a period of time in accordance with such
program in consideration of receiving an award of Federal funds
regarding education as a nurse (including an award for the
repayment of loans), the following applies if the agreement
provides that this subsection is applicable:
``(A) In the case of a program under this section that
makes an award of Federal funds for attending an accredited
program of nursing (in this section referred to as a `nursing
program'), the individual is liable to the Federal Government
for the amount of such award (including amounts provided for
expenses related to such attendance), and for interest on such
amount at the maximum legal prevailing rate, if the
individual--
``(i) fails to maintain an acceptable level of academic
standing in the nursing program (as indicated by the
program in accordance with requirements established by the
Secretary);
``(ii) is dismissed from the nursing program for
disciplinary reasons; or
``(iii) voluntarily terminates the nursing program.
``(B) The individual is liable to the Federal Government
for the amount of such award (including amounts provided for
expenses related to such attendance), and for interest on such
amount at the maximum legal prevailing rate, if the individual
fails to provide health services in accordance with the program
under this section for the period of time applicable under the
program.
``(2) Waiver or suspension of liability.--In the case of an
individual or health facility making an agreement for purposes of
paragraph (1), the Secretary shall provide for the waiver or
suspension of liability under such subsection if compliance by the
individual or the health facility, as the case may be, with the
agreements involved is impossible, or would involve extreme
hardship to the individual or facility, and if enforcement of the
agreements with respect to the individual or facility would be
unconscionable.
``(3) Date certain for recovery.--Subject to paragraph (2), any
amount that the Federal Government is entitled to recover under
paragraph (1) shall be paid to the United States not later than the
expiration of the 3-year period beginning on the date the United
States becomes so entitled.
``(4) Availability.--Amounts recovered under paragraph (1) with
respect to a program under this section shall be available for the
purposes of such program, and shall remain available for such
purposes until expended.''.
(e) Technical Amendments.--Section 839 of the Public Health Service
Act (42 U.S.C. 297e) is amended--
(1) in subsection (a)--
(A) by striking the matter preceding paragraph (1) and
inserting the following:
``(a) If a school terminates a loan fund established under an
agreement pursuant to section 835(b), or if the Secretary for good
cause terminates the agreement with the school, there shall be a
capital distribution as follows:''; and
(B) in paragraph (1), by striking ``at the close of
September 30, 1999,'' and inserting ``on the date of
termination of the fund''; and
(2) in subsection (b), to read as follows:
``(b) If a capital distribution is made under subsection (a), the
school involved shall, after such capital distribution, pay to the
Secretary, not less often than quarterly, the same proportionate share
of amounts received by the school in payment of principal or interest
on loans made from the loan fund established under section 835(b) as
determined by the Secretary under subsection (a).''.

c4566b8f5eed857d86e885c905e9719ab735c0e0bbcd9080960ff7808abb9f28

(a) Maximum Student Loan Provisions and Minimum Payments.--
(1) In general.--Section 722(a)(1) of the Public Health Service
Act (42 U.S.C. 292r(a)(1)), as amended by section 2014(b)(1) of
Public Law 103-43, is amended by striking ``the sum of'' and all
that follows through the end thereof and inserting ``the cost of
attendance (including tuition, other reasonable educational
expenses, and reasonable living costs) for that year at the
educational institution attended by the student (as determined by
such educational institution).''.
(2) Third and fourth years.--Section 722(a)(2) of the Public
Health Service Act (42 U.S.C. 292r(a)(2)), as amended by section
2014(b)(1) of Public Law 103-43, is amended by striking ``the
amount $2,500'' and all that follows through ``including such
$2,500)'' and inserting ``the amount of the loan may, in the case
of the third or fourth year of a student at a school of medicine or
osteopathic medicine, be increased to the extent necessary''.
(3) Repayment period.--Section 722(c) of the Public Health
Service Act (42 U.S.C. 292r(c)), as amended by section 2014(b)(1)
of Public Law 103-43, is amended--
(A) in the subsection heading by striking ``Ten-Year'' and
inserting ``Repayment'';
(B) by striking ``ten-year period which begins'' and
inserting ``period of not less than 10 years nor more than 25
years, at the discretion of the institution, which begins'';
and
(C) by striking ``such ten-year period'' and inserting
``such period''.
(4) Minimum payments.--Section 722(j) of the Public Health
Service Act (42 U.S.C. 292r(j)), as amended by section 2014(b)(1)
of Public Law 103-43, is amended by striking ``$15'' and inserting
``$40''.
(b) Elimination of Statute of Limitation for Loan Collections.--
(1) In general.--Section 722 of the Public Health Service Act
(42 U.S.C. 292r), as amended by section 2014(b)(1) of Public Law
103-43, is amended by adding at the end the following new
subsection:
``(m) Elimination of Statute of Limitation for Loan Collections.--
``(1) Purpose.--It is the purpose of this subsection to ensure
that obligations to repay loans under this section are enforced
without regard to any Federal or State statutory, regulatory, or
administrative limitation on the period within which debts may be
enforced.
``(2) Prohibition.--Notwithstanding any other provision of
Federal or State law, no limitation shall terminate the period
within which suit may be filed, a judgment may be enforced, or an
offset, garnishment, or other action may be initiated or taken by a
school that has an agreement with the Secretary pursuant to section
721 that is seeking the repayment of the amount due from a borrower
on a loan made under this subpart after the default of the borrower
on such loan.''.
(2) Effective date.--The amendment made by paragraph (1) shall
be effective with respect to actions pending on or after the date
of enactment of this Act.
(c) Date Certain for Contributions.--Paragraph (2) of section
735(e) of the Public Health Service Act (42 U.S.C. 292y(e)(2)) is
amended to read as follows:
``(2) Date certain for contributions.--Amounts described in
paragraph (1) that are returned to the Secretary shall be obligated
before the end of the succeeding fiscal year.''.
CHAPTER 2--INSURED HEALTH EDUCATION ASSISTANCE LOANS TO GRADUATE
STUDENTS

be734445bb19f3047091a406cc53462c36025836634091f87b788c6753cb22d5

(a) Health Education Assistance Loan Deferment for Borrowers
Providing Health Services to Indians.--
(1) In general.--Section 705(a)(2)(C) of the Public Health
Service Act (42 U.S.C. 292d(a)(2)(C)) is amended by striking ``and
(x)'' and inserting ``(x) not in excess of three years, during
which the borrower is providing health care services to Indians
through an Indian health program (as defined in section
108(a)(2)(A) of the Indian Health Care Improvement Act (25 U.S.C.
1616a(a)(2)(A)); and (xi)''.
(2) Conforming amendments.--Section 705(a)(2)(C) of the Public
Health Service Act (42 U.S.C. 292d(a)(2)(C)) is further amended--
(A) in clause (xi) (as so redesignated) by striking
``(ix)'' and inserting ``(x)''; and
(B) in the matter following such clause (xi), by striking
``(x)'' and inserting ``(xi)''.
(3) Effective date.--The amendments made by this subsection
shall apply with respect to services provided on or after the first
day of the third month that begins after the date of the enactment
of this Act.
(b) Report Requirement.--Section 709(b) of the Public Health
Service Act (42 U.S.C. 292h(b)) is amended--
(1) in paragraph (4)(B), by adding ``and'' after the semicolon;
(2) in paragraph (5), by striking ``; and'' and inserting a
period; and
(3) by striking paragraph (6).
(c) Program Eligibility.--
(1) Limitations on loans.--Section 703(a) of the Public Health
Service Act (42 U.S.C. 292b(a)) is amended by striking ``or
clinical psychology'' and inserting ``or behavioral and mental
health practice, including clinical psychology''.
(2) Definition of eligible institution.--Section 719(1) of the
Public Health Service Act (42 U.S.C. 292o(1)) is amended by
striking ``or clinical psychology'' and inserting ``or behavioral
and mental health practice, including clinical psychology''.

d0fdca4aca4e9efbda6c77682d6b00428c1790fb69eb6457293f685a74367de6

(a) General Amendments.--Section 707(a) of the Public Health
Service Act (42 U.S.C. 292f) is amended--
(1) by striking the last sentence;
(2) by striking ``determined.'' and inserting ``determined,
except that, if the insurance beneficiary including any servicer of
the loan is not designated for `exceptional performance', as set
forth in paragraph (2), the Secretary shall pay to the beneficiary
a sum equal to 98 percent of the amount of the loss sustained by
the insured upon that loan.'';
(3) by striking ``Upon'' and inserting:
``(1) In general.--Upon''; and
(4) by adding at the end the following new paragraph:
``(2) Exceptional performance.--
``(A) Authority.--Where the Secretary determines that an
eligible lender, holder, or servicer has a compliance
performance rating that equals or exceeds 97 percent, the
Secretary shall designate that eligible lender, holder, or
servicer, as the case may be, for exceptional performance.
``(B) Compliance performance rating.--For purposes of
subparagraph (A), a compliance performance rating is determined
with respect to compliance with due diligence in the
disbursement, servicing, and collection of loans under this
subpart for each year for which the determination is made. Such
rating shall be equal to the percentage of all due diligence
requirements applicable to each loan, on average, as
established by the Secretary, with respect to loans serviced
during the period by the eligible lender, holder, or servicer.
``(C) Annual audits for lenders, holders, and servicers.--
Each eligible lender, holder, or servicer desiring a
designation under subparagraph (A) shall have an annual
financial and compliance audit conducted with respect to the
loan portfolio of such eligible lender, holder, or servicer, by
a qualified independent organization from a list of qualified
organizations identified by the Secretary and in accordance
with standards established by the Secretary. The standards
shall measure the lender's, holder's, or servicer's compliance
with due diligence standards and shall include a defined
statistical sampling technique designed to measure the
performance rating of the eligible lender, holder, or servicer
for the purpose of this section. Each eligible lender, holder,
or servicer shall submit the audit required by this section to
the Secretary.
``(D) Secretary's determinations.--The Secretary shall make
the determination under subparagraph (A) based upon the audits
submitted under this paragraph and any information in the
possession of the Secretary or submitted by any other agency or
office of the Federal Government.
``(E) Quarterly compliance audit.--To maintain its status
as an exceptional performer, the lender, holder, or servicer
shall undergo a quarterly compliance audit at the end of each
quarter (other than the quarter in which status as an
exceptional performer is established through a financial and
compliance audit, as described in subparagraph (C)), and submit
the results of such audit to the Secretary. The compliance
audit shall review compliance with due diligence requirements
for the period beginning on the day after the ending date of
the previous audit, in accordance with standards determined by
the Secretary.
``(F) Revocation authority.--The Secretary shall revoke the
designation of a lender, holder, or servicer under subparagraph
(A) if any quarterly audit required under subparagraph (E) is
not received by the Secretary by the date established by the
Secretary or if the audit indicates the lender, holder, or
servicer has failed to meet the standards for designation as an
exceptional performer under subparagraph (A). A lender, holder,
or servicer receiving a compliance audit not meeting the
standard for designation as an exceptional performer may
reapply for designation under subparagraph (A) at any time.
``(G) Documentation.--Nothing in this section shall
restrict or limit the authority of the Secretary to require the
submission of claims documentation evidencing servicing
performed on loans, except that the Secretary may not require
exceptional performers to submit greater documentation than
that required for lenders, holders, and servicers not
designated under subparagraph (A).
``(H) Cost of audits.--Each eligible lender, holder, or
servicer shall pay for all the costs associated with the audits
required under this section.
``(I) Additional revocation authority.--Notwithstanding any
other provision of this section, a designation under
subparagraph (A) may be revoked at any time by the Secretary if
the Secretary determines that the eligible lender, holder, or
servicer has failed to maintain an overall level of compliance
consistent with the audit submitted by the eligible lender,
holder, or servicer under this paragraph or if the Secretary
asserts that the lender, holder, or servicer may have engaged
in fraud in securing designation under subparagraph (A) or is
failing to service loans in accordance with program
requirements.
``(J) Noncompliance.--A lender, holder, or servicer
designated under subparagraph (A) that fails to service loans
or otherwise comply with applicable program regulations shall
be considered in violation of the Federal False Claims Act.''.
(b) Definition.--Section 707(e) of the Public Health Service Act
(42 U.S.C. 292f(e)) is amended by adding at the end the following new
paragraph:
``(4) The term `servicer' means any agency acting on behalf of
the insurance beneficiary.''.
(c) Effective Date.--The amendments made by subsections (a) and (b)
shall apply with respect to loans submitted to the Secretary for
payment on or after the first day of the sixth month that begins after
the date of enactment of this Act.

6a588a51d517234158a386511e095234b752240cb1a6e906bbd8bb948dcd0f6d

Section 710(a)(2)(B) of the Public Health Service Act (42 U.S.C.
292i(a)(2)(B)) is amended by striking ``any of the fiscal years 1993
through 1996'' and inserting ``fiscal year 1993 and subsequent fiscal
years''.

d49e56a6588b2a9b686b5aa7fdb26ba5f1d494b6eb766973e995ab62fea78f48

(a) In General.--Section 707(g) of the Public Health Service Act
(42 U.S.C. 292f(g)) is amended in the first sentence by striking ``A
debt which is a loan insured'' and inserting ``Notwithstanding any
other provision of Federal or State law, a debt that is a loan
insured''.
(b) Application.--The amendment made by subsection (a) shall apply
to any loan insured under the authority of subpart I of part A of title
VII of the Public Health Service Act (42 U.S.C. 292 et seq.) that is
listed or scheduled by the debtor in a case under title XI, United
States Code, filed--
(1) on or after the date of enactment of this Act; or
(2) prior to such date of enactment in which a discharge has
not been granted.

482e51d78fdec257312075bdb8b9b353513570cc75d4c31828a87316ee94e930

Section 706 of the Public Health Service Act (42 U.S.C. 292e) is
amended--
(1) in subsection (d)--
(A) in the subsection heading, by striking
``Consolidation'' and inserting ``Refinancing or
Consolidation''; and
(B) in the first sentence, by striking ``indebtedness'' and
inserting ``indebtedness or the refinancing of a single loan'';
and
(2) in subsection (e)--
(A) in the subsection heading, by striking ``Debts'' and
inserting ``Debts and Refinancing'';
(B) in the first sentence, by striking ``all of the
borrower's debts into a single instrument'' and inserting ``all
of the borrower's loans insured under this subpart into a
single instrument (or, if the borrower obtained only 1 loan
insured under this subpart, refinancing the loan 1 time)''; and
(C) in the second sentence, by striking ``consolidation''
and inserting ``consolidation or refinancing''.

1d273b0257cbe32757c08060a229e38be6178dc7d09e5a62681f6a709b9c9087

HEALTH.
(a) Duties and Requirements.--Section 1707 of the Public Health
Service Act (42 U.S.C. 300u-6) is amended by striking subsection (b)
and all that follows and inserting the following:
``(b) Duties.--With respect to improving the health of racial and
ethnic minority groups, the Secretary, acting through the Deputy
Assistant Secretary for Minority Health (in this section referred to as
the `Deputy Assistant Secretary'), shall carry out the following:
``(1) Establish short-range and long-range goals and objectives
and coordinate all other activities within the Public Health
Service that relate to disease prevention, health promotion,
service delivery, and research concerning such individuals. The
heads of each of the agencies of the Service shall consult with the
Deputy Assistant Secretary to ensure the coordination of such
activities.
``(2) Enter into interagency agreements with other agencies of
the Public Health Service.
``(3) Support research, demonstrations and evaluations to test
new and innovative models.
``(4) Increase knowledge and understanding of health risk
factors.
``(5) Develop mechanisms that support better information
dissemination, education, prevention, and service delivery to
individuals from disadvantaged backgrounds, including individuals
who are members of racial or ethnic minority groups.
``(6) Ensure that the National Center for Health Statistics
collects data on the health status of each minority group.
``(7) With respect to individuals who lack proficiency in
speaking the English language, enter into contracts with public and
nonprofit private providers of primary health services for the
purpose of increasing the access of the individuals to such
services by developing and carrying out programs to provide
bilingual or interpretive services.
``(8) Support a national minority health resource center to
carry out the following:
``(A) Facilitate the exchange of information regarding
matters relating to health information and health promotion,
preventive health services, and education in the appropriate
use of health care.
``(B) Facilitate access to such information.
``(C) Assist in the analysis of issues and problems
relating to such matters.
``(D) Provide technical assistance with respect to the
exchange of such information (including facilitating the
development of materials for such technical assistance).
``(9) Carry out programs to improve access to health care
services for individuals with limited proficiency in speaking the
English language. Activities under the preceding sentence shall
include developing and evaluating model projects.
``(c) Advisory Committee.--
``(1) In general.--The Secretary shall establish an advisory
committee to be known as the Advisory Committee on Minority Health
(in this subsection referred to as the `Committee').
``(2) Duties.--The Committee shall provide advice to the Deputy
Assistant Secretary carrying out this section, including advice on
the development of goals and specific program activities under
paragraphs (1) through (9) of subsection (b) for each racial and
ethnic minority group.
``(3) Chair.--The chairperson of the Committee shall be
selected by the Secretary from among the members of the voting
members of the Committee. The term of office of the chairperson
shall be 2 years.
``(4) Composition.--
``(A) The Committee shall be composed of 12 voting members
appointed in accordance with subparagraph (B), and nonvoting,
ex officio members designated in subparagraph (C).
``(B) The voting members of the Committee shall be
appointed by the Secretary from among individuals who are not
officers or employees of the Federal Government and who have
expertise regarding issues of minority health. The racial and
ethnic minority groups shall be equally represented among such
members.
``(C) The nonvoting, ex officio members of the Committee
shall be such officials of the Department of Health and Human
Services as the Secretary determines to be appropriate.
``(5) Terms.--Each member of the Committee shall serve for a
term of 4 years, except that the Secretary shall initially appoint
a portion of the members to terms of 1 year, 2 years, and 3 years.
``(6) Vacancies.--If a vacancy occurs on the Committee, a new
member shall be appointed by the Secretary within 90 days from the
date that the vacancy occurs, and serve for the remainder of the
term for which the predecessor of such member was appointed. The
vacancy shall not affect the power of the remaining members to
execute the duties of the Committee.
``(7) Compensation.--Members of the Committee who are officers
or employees of the United States shall serve without compensation.
Members of the Committee who are not officers or employees of the
United States shall receive compensation, for each day (including
travel time) they are engaged in the performance of the functions
of the Committee. Such compensation may not be in an amount in
excess of the daily equivalent of the annual maximum rate of basic
pay payable under the General Schedule (under title 5, United
States Code) for positions above GS-15.
``(d) Certain Requirements Regarding Duties.--
``(1) Recommendations regarding language as impediment to
health care.--The Deputy Assistant Secretary for Minority Health
shall consult with the Director of the Office of International and
Refugee Health, the Director of the Office of Civil Rights, and the
Directors of other appropriate departmental entities regarding
recommendations for carrying out activities under subsection
(b)(9).
``(2) Equitable allocation regarding activities.--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.
``(3) Cultural competency of services.--The Secretary shall
ensure that information and services provided pursuant to
subsection (b) are provided in the language, educational, and
cultural context that is most appropriate for the individuals for
whom the information and services are intended.
``(e) Grants and Contracts Regarding Duties.--
``(1) In general.--In carrying out subsection (b), the
Secretary acting through the Deputy Assistant Secretary may make
awards of grants, cooperative agreements, and contracts to public
and nonprofit private entities.
``(2) Process for making awards.--The Deputy Assistant
Secretary shall ensure that awards under paragraph (1) are made, to
the extent practical, only on a competitive basis, and that a grant
is awarded for a proposal only if the proposal has been recommended
for such an award through a process of peer review.
``(3) Evaluation and dissemination.--The Deputy Assistant
Secretary, directly or through contracts with public and private
entities, shall provide for evaluations of projects carried out
with awards made under paragraph (1) during the preceding 2 fiscal
years. The report shall be included in the report required under
subsection (f) for the fiscal year involved.
``(f) Reports.--
``(1) In general.--Not later than February 1 of fiscal year
1999 and of each second year thereafter, the Secretary shall submit
to the Committee on Energy and Commerce of the House of
Representatives, and to the Committee on Labor and Human Resources
of the Senate, a report describing the activities carried out under
this section during the preceding 2 fiscal years and evaluating the
extent to which such activities have been effective in improving
the health of racial and ethnic minority groups. Each such report
shall include the biennial reports submitted under sections
201(e)(3) and 201(f)(2) for such years by the heads of the Public
Health Service agencies.
``(2) Agency reports.--Not later than February 1, 1999, and
biennially thereafter, the heads of the Public Health Service
agencies shall submit to the Deputy Assistant Secretary a report
summarizing the minority health activities of each of the
respective agencies.
``(g) Definition.--For purposes of this section:
``(1) The term `racial and ethnic minority group' means
American Indians (including Alaska Natives, Eskimos, and Aleuts);
Asian Americans and Pacific Islanders; Blacks; and Hispanics.
``(2) The term `Hispanic' means individuals whose origin is
Mexican, Puerto Rican, Cuban, Central or South American, or any
other Spanish-speaking country.
``(h) Funding.--
``(1) Authorization of appropriations.--For the purpose of
carrying out this section, there are authorized to be appropriated
$30,000,000 for fiscal year 1998, and such sums as may be necessary
for each of the fiscal years 1999 through 2002.''.
(b) Authorization for National Center for Health Statistics.--
Section 306 of the Public Health Service Act (42 U.S.C. 242k) is
amended--
(1) in subsection (m), by adding at the end the following:
``(4)(A) Subject to subparagraph (B), the Secretary, acting through
the Center, shall collect data on Hispanics and major Hispanic
subpopulation groups and American Indians, and for developing special
area population studies on major Asian American and Pacific Islander
populations.
``(B) The provisions of subparagraph (A) shall be effective with
respect to a fiscal year only to the extent that funds are appropriated
pursuant to paragraph (3) of subsection (n), and only if the amounts
appropriated for such fiscal year pursuant to each of paragraphs (1)
and (2) of subsection (n) equal or exceed the amounts so appropriated
for fiscal year 1997.'';
(2) in subsection (n)(1), by striking ``through 1998'' and
inserting ``through 2003''; and
(3) in subsection (n)--
(A) in the first sentence of paragraph (2)--
(i) by striking ``authorized in subsection (m)'' and
inserting ``authorized in paragraphs (1) through (3) of
subsection (m)''; and
(ii) by striking ``$5,000,000'' and all that follows
through the period and inserting ``such sums as may be
necessary for each of the fiscal years 1999 through
2003.''; and
(B) by adding at the end the following:
``(3) For activities authorized in subsection (m)(4), there are
authorized to be appropriated $1,000,000 for fiscal year 1998, and such
sums as may be necessary for each of the fiscal years 1999 through
2002.''.
(c) Miscellaneous Amendments.--Section 1707 of the Public Health
Service Act (42 U.S.C. 300u-6) is amended--
(1) in the heading for the section by striking ``establishment
of''; and
(2) in subsection (a), by striking ``Office of the Assistant
Secretary for Health'' and inserting ``Office of Public Health and
Science''.

aedca90670c6c6a90ac2bd7000bc97044ecaf434b1cc868398cd1aece7bbdf62

Section 338J of the Public Health Service Act (42 U.S.C. 254r) is
amended--
(1) in subsection (b)(1), in the matter preceding subparagraph
(A), by striking ``in cash''; and
(2) in subsection (j)(1)--
(A) by striking ``and'' after ``1992,''; and
(B) by inserting before the period the following: ``, and
such sums as may be necessary for each of the fiscal years 1998
through 2002''; and
(3) in subsection (k), by striking ``$10,000,000'' and
inserting ``$36,000,000''.

e547b5ffa32c14120e7204c18c462d47ead6f57e6d94ca010af71bb9635a1682

TITLE III

-SELECTED INITIATIVES

(a) In General.--Section 398(a) of the Public Health Service Act
(42 U.S.C. 280c-3(a)) is amended--
(1) in the matter preceding paragraph (1), by striking ``not
less than 5, and not more than 15,'';
(2) in paragraph (2)--
(A) by inserting after ``disorders'' the following: ``who
are living in single family homes or in congregate settings'';
and
(B) by striking ``and'' at the end;
(3) by redesignating paragraph (3) as paragraph (4); and
(4) by inserting after paragraph (2) the following:
``(3) to improve the access of such individuals to home-based
or community-based long-term care services (subject to the services
being provided by entities that were providing such services in the
State involved as of October 1, 1995), particularly such
individuals who are members of racial or ethnic minority groups,
who have limited proficiency in speaking the English language, or
who live in rural areas; and''.
(b) Duration.--Section 398A of the Public Health Service Act (42
U.S.C. 280c-4) is amended--
(1) in the heading for the section, by striking ``LIMITATION''
and all that follows and inserting ``REQUIREMENT OF MATCHING
FUNDS'';
(2) by striking subsection (a);
(3) by redesignating subsections (b) and (c) as subsections (a)
and (b), respectively; and
(4) in subsection (a) (as so redesignated), in each of
paragraphs (1)(C) and (2)(C), by striking ``third year'' and
inserting ``third or subsequent year''.
(c) Authorization of Appropriations.--Section 398B(e) of the Public
Health Service Act (42 U.S.C. 280c-5(e)) is amended--
(1) by striking ``and such sums'' and inserting ``such sums'';
and
(2) by inserting before the period the following: ``,
$8,000,000 for fiscal year 1998, and such sums as may be necessary
for each of the fiscal years 1999 through 2002''.

d8f58f65c391e8e9691e64e352e653bffe3abb8807ec0dbfcb383011819c43cd

Section 317(j) of the Public Health Service Act (42 U.S.C. 247b(j))
is amended--
(1) in paragraph (1), by striking ``individuals against
vaccine-preventable diseases'' and all that follows through the
first period and inserting the following: ``children, adolescents,
and adults against vaccine-preventable diseases, there are
authorized to be appropriated such sums as may be necessary for
each of the fiscal years 1998 through 2002.''; and
(2) in paragraph (2), by striking ``1990'' and inserting
``1997''.

c1904a5b189bb0eadb08dcecf185f7fbedd3057ebfa8946a0e7cfd85d9445f9a

(a) Amendatory Instructions.--Public Law 103-183 is amended--
(1) in section 601--
(A) in subsection (b), in the matter preceding paragraph
(1), by striking ``Section 1201 of the Public Health Service
Act (42 U.S.C. 300d)'' and inserting ``Title XII of the Public
Health Service Act (42 U.S.C. 300d et seq.)''; and
(B) in subsection (f)(1), by striking ``in section
1204(c)'' and inserting ``in section 1203(c) (as redesignated
by subsection (b)(2) of this section)'';
(2) in section 602, by striking ``for the purpose'' and
inserting ``For the purpose''; and
(3) in section 705(b), by striking ``317D((l)(1)'' and
inserting ``317D(l)(1)''.
(b) Public Health Service Act.--The Public Health Service Act, as
amended by Public Law 103-183 and by subsection (a) of this section, is
amended--
(1) in section 317E(g)(2), by striking ``making grants under
subsection (b)'' and inserting ``carrying out subsection (b)'';
(2) in section 318, in subsection (e) as in effect on the day
before the date of the enactment of Public Law 103-183, by
redesignating the subsection as subsection (f);
(3) in subpart 6 of part C of title IV--
(A) by transferring the first section 447 (added by section
302 of Public Law 103-183) from the current placement of the
section;
(B) by redesignating the section as section 447A; and
(C) by inserting the section after section 447;
(4) in section 1213(a)(8), by striking ``provides for for'' and
inserting ``provides for'';
(5) in section 1501, by redesignating the second subsection (c)
(added by section 101(f) of Public Law 103-183) as subsection (d);
and
(6) in section 1505(3), by striking ``nonprofit''.
(c) Miscellaneous Correction.--Section 401(c)(3) of Public Law 103-
183 is amended in the matter preceding subparagraph (A) by striking
``(d)(5)'' and inserting ``(e)(5)''.
(d) Conforming Amendment.--Section 308(b) of the Public Health
Service Act (42 U.S.C. 242m(b)) is amended--
(1) in paragraph (2)(A), by striking ``306(n)'' and inserting
``306(m)''; and
(2) in paragraph (2)(C), by striking ``306(n)'' and inserting
``306(m)''.
(e) Effective Date.--This section is deemed to have taken effect
immediately after the enactment of Public Law 103-183.

3184dc8c913821f5e59542c648b07252c91957b38df3b37f67c4ab7d2e0c2871

OFFICERS.
(a) Anti-Discrimination Laws.--Amend section 212 of the Public
Health Service Act (42 U.S.C. 213) by adding the following new
subsection at the end thereof:
``(f) Active service of commissioned officers of the Service shall
be deemed to be active military service in the Armed Forces of the
United States for purposes of all laws related to discrimination on the
basis of race, color, sex, ethnicity, age, religion, and disability.''.
(b) Training in Leave Without Pay Status.--Section 218 of the
Public Health Service Act (42 U.S.C. 218a) is amended by adding at the
end the following:
``(c) A commissioned officer may be placed in leave without pay
status while attending an educational institution or training program
whenever the Secretary determines that such status is in the best
interest of the Service. For purposes of computation of basic pay,
promotion, retirement, compensation for injury or death, and the
benefits provided by sections 212 and 224, an officer in such status
pursuant to the preceding sentence shall be considered as performing
service in the Service and shall have an active service obligation as
set forth in subsection (b) of this section.''.
(c) Utilization of Alcohol and Drug Abuse Records That Apply to the
Armed Forces.--Section 543(e) of the Public Health Service Act (42
U.S.C. 290dd-2(e)) is amended by striking ``Armed Forces'' each place
that such term appears and inserting ``Uniformed Services''.

5babf0d63f96a89c649bd9094012e44bc69b8301163fd046779be737c7861c07

Section 303(d)(1) of the Public Health Service Act (42 U.S.C.
242a(d)(1)) is amended by inserting ``counseling,'' after ``family
therapy,''.

2639a447f57ece0c6cebc867e7d04383c4a87ef0145a9770e9ebcd55a4d6725d

REGARDING LEAD POISONING.
Section 317A(l)(1) of the Public Health Service Act (42 U.S.C.
247b-1(l)(1)) is amended by striking ``1998'' and inserting ``2002''.

75c19d331ed47d2df70a06822e98478d7c4c32f88661a95d4c1e5f85d29f6030

TUBERCULOSIS.
Section 317E(g) of the Public Health Service Act (42 U.S.C. 247b-
6(g)(1)) is amended--
(1) in paragraph (1)--
(A) in subparagraph (A), by striking ``1998'' and inserting
``2002''; and
(B) in subparagraph (B), by striking ``$50,000,000'' and
inserting ``25 percent''; and
(2) in paragraph (2), by striking ``1998'' and inserting
``2002''.

3dabb16abf3a8671980e5e7964c3356a1c80a3f84be79066dfc080960281e020

Section 317F of the Public Health Service Act (42 U.S.C. 247b-7) is
amended--
(1) in subsection (a)(1), by striking ``$20,000'' and inserting
``$35,000'';
(2) in subsection (c), by striking ``1998'' and inserting
``2002''; and
(3) by adding at the end the following:
``(d) Availability of Appropriations.--Amounts appropriated for a
fiscal year for contracts under subsection (a) shall remain available
until the expiration of the second fiscal year beginning after the
fiscal year for which the amounts were appropriated.''.

48bdd44ef5a4d160bdb1d5c9deb741d8999efa1c66c66aa5d9c8286b8f4dd0f8

(a) In General.--Section 318(h)(2) of the Family Violence
Prevention and Services Act (42 U.S.C. 10418(h)(2)) is amended by
striking ``fiscal year 1997'' and inserting ``for each of the fiscal
years 1997 through 2002''.
(b) Study.--The Secretary of Health and Human Services shall
request that the Institute of Medicine conduct a study concerning the
training needs of health professionals with respect to the detection
and referral of victims of family or acquaintance violence. Not later
than 2 years after the date of enactment of this Act, the Institute of
Medicine shall prepare and submit to Congress a report concerning the
study conducted under this subsection.

ba6f237dbdd768997a301027051c136cea5ee134ad7e812846f32aa91434a021

Section 338I(i)(1) of the Public Health Service Act (42 U.S.C.
254q-1(i)(1)) is amended by inserting before the period ``, and such
sums as may be necessary for each of the fiscal years 1998 through
2002''.

c2099dee721044678365f278e2a52586a80a6d513cb90cba42abd81d784be94b

Section 402(b) of the Public Health Service Act (42 U.S.C. 282(b))
is amended--
(1) in paragraph (11), by striking ``and'' at the end thereof;
(2) in paragraph (12), by striking the period and inserting a
semicolon; and
(3) by adding after paragraph (12), the following new
paragraphs:
``(13) may conduct and support research training--
``(A) for which fellowship support is not provided under
section 487; and
``(B) which does not consist of residency training of
physicians or other health professionals; and
``(14) may appoint physicians, dentists, and other health care
professionals, subject to the provisions of title 5, United States
Code, relating to appointments and classifications in the
competitive service, and may compensate such professionals subject
to the provisions of chapter 74 of title 38, United States Code.''.

7a4de29f9bf39a6e8d32efe8628ec42d1e22f7307ca04b92168e5ed16eee0da4

(a) Repayment Programs With Respect to AIDS.--Section 487A of the
Public Health Service Act (42 U.S.C. 288-1) is amended--
(1) in subsection (a), by striking ``$20,000'' and inserting
``$35,000''; and
(2) in subsection (c), by striking ``1996'' and inserting
``2001''.
(b) Repayment Programs With Respect to Contraception and
Infertility.--Section 487B(a) of the Public Health Service Act (42
U.S.C. 288-2(a)) is amended by striking ``$20,000'' and inserting
``$35,000''.
(c) Repayment Programs With Respect to Research Generally.--Section
487C(a)(1) of the Public Health Service Act (42 U.S.C. 288-3(a)(1)) is
amended by striking ``$20,000'' and inserting ``$35,000''.
(d) Repayment Programs With Respect to Clinical Researchers From
Disadvantaged Backgrounds.--Section 487E(a) of the Public Health
Service Act (42 U.S.C. 288-5(a)) is amended--
(1) in paragraph (1), by striking ``$20,000'' and inserting
``$35,000''; and
(2) in paragraph (3), by striking ``338C'' and inserting
``338B, 338C''.

466092bad90a5b03b2e30b06dd590435e58f1763f215fbd3d5c4a1a8ec306a08

PRIMATES.
Section 481B(a) of the Public Health Service Act (42 U.S.C. 287a-
3(a)) is amended--
(1) by striking ``shall'' and inserting ``may''; and
(2) by striking ``$5,000,000'' and inserting ``up to
$2,500,000''.

eb5b7d47214d765374f5ad44d335abc2a929f817290213d6efdc825228ab1b9d

Section 504(d)(2) of the Public Health Service Act (42 U.S.C.
290aa-3(d)(2)) is amended by striking ``cooperative agreement, or
contract'' each place that such term appears and inserting ``or
cooperative agreement''.

83afc73895a596d69e9097485ebf8af8a6662250651164b1b394fb4bae987b21

Section 1232(a) of the Public Health Service Act (42 U.S.C. 300d-
32) is amended by striking ``and 1996'' and inserting ``through 2002''.

544aacf168e316eb11cb16790de52adef33534db5f77354e18c11157efe9a352

Section 1701(b) of the Public Health Service Act (42 U.S.C.
300u(b)) is amended by striking ``through 1996'' and inserting
``through 2002''.

145508198e0ac322811150b27ed19633de4c1816d110395b6478faab7fa3952f

Section 1910 of the Public Health Service Act (42 U.S.C. 300w-9) is
amended--
(1) in subsection (a)--
(A) by striking ``two-year period'' and inserting ``3-year
period (with an optional 4th year based on performance)''; and
(B) by striking ``one grant'' and inserting ``3 grants'';
and
(2) in subsection (d), by striking ``1997'' and inserting
``2005''.

ac9dfb45322a6693b5de909a008de34f66e7e55811813659fa87f7e9e641a9d4

(a) In General.--Section 2004 of Public Law 103-43 (107 Stat. 209)
is amended by striking subsection (a).
(b) Conforming Amendments.--Section 2004 of Public Law 103-43, as
amended by subsection (a) of this section, is amended--
(1) by striking ``(b) Sense'' and all that follows through ``In
the case'' and inserting the following:
``(a) Sense of Congress Regarding Purchase of American-Made
Equipment and Products.--In the case'';
(2) by striking ``(2) Notice to recipients of assistance'' and
inserting the following:
``(b) Notice to Recipients of Assistance''; and
(3) in subsection (b), as redesignated by paragraph (2) of this
subsection, by striking ``paragraph (1)'' and inserting
``subsection (a)''.
(c) Effective Date.--This section is deemed to have taken effect
immediately after the enactment of Public Law 103-43.

a92c2e85366bac5687452ad5099de85ce4c9ef5e02361002880a7c6e025f3e3d

Section 2618(b)(3) of the Public Health Service Act (42 U.S.C.
300ff-28(b)(3)) is amended--
(1) in subparagraph (A), by striking ``and the Commonwealth of
Puerto Rico'' and inserting ``, the Commonwealth of Puerto Rico,
the Virgin Islands, and Guam''; and
(2) in subparagraph (B), by striking ``the Virgin Islands,
Guam''.

4cda38ca750ba3f86e387aa9948c2792d6bc5af9c69aba930cf15a04d1266d09

Part I of title IV of the Public Health Service Act (42 U.S.C. 290b
et seq.) is amended--
(1) by striking the part heading and inserting the following:
``PART I--FOUNDATION FOR THE NATIONAL INSTITUTES OF HEALTH'';
and
(2) in section 499--
(A) in subsection (a), by striking ``National Foundation
for Biomedical Research'' and inserting ``Foundation for the
National Institutes of Health'';
(B) in subsection (k)(10)--
(i) by striking ``not''; and
(ii) by adding at the end the following: ``Any funds
transferred under this paragraph shall be subject to all
Federal limitations relating to federally-funded
research.''; and
(C) in subsection (m)(1), by striking ``$200,000'' and all
that follows through ``1995'' and inserting ``$500,000 for each
fiscal year''.

519f59b9c6aa7c3518e8ba7e4d5c6f5b5587fe0f082413c2572421533cf2166e

(a) Short Title.--This section may be cited as the ``Fetal Alcohol
Syndrome and Fetal Alcohol Effect Prevention and Services Act''.
(b) Findings.--Congress finds that--
(1) Fetal Alcohol Syndrome is the leading preventable cause of
mental retardation, and it is 100 percent preventable;
(2) estimates on the number of children each year vary, but
according to some researchers, up to 12,000 infants are born in the
United States with Fetal Alcohol Syndrome, suffering irreversible
physical and mental damage;
(3) thousands more infants are born each year with Fetal
Alcohol Effect, also known as Alcohol Related Neurobehavioral
Disorder (ARND), a related and equally tragic syndrome;
(4) children of women who use alcohol while pregnant have a
significantly higher infant mortality rate (13.3 per 1,000) than
children of those women who do not use alcohol (8.6 per 1,000);
(5) Fetal Alcohol Syndrome and Fetal Alcohol Effect are
national problems which can impact any child, family, or community,
but their threat to American Indians and Alaska Natives is
especially alarming;
(6) in some American Indian communities, where alcohol
dependency rates reach 50 percent and above, the chances of a
newborn suffering Fetal Alcohol Syndrome or Fetal Alcohol Effect
are up to 30 times greater than national averages;
(7) in addition to the immeasurable toll on children and their
families, Fetal Alcohol Syndrome and Fetal Alcohol Effect pose
extraordinary financial costs to the Nation, including the costs of
health care, education, foster care, job training, and general
support services for affected individuals;
(8) the total cost to the economy of Fetal Alcohol Syndrome was
approximately $2,500,000,000 in 1995, and over a lifetime, health
care costs for one Fetal Alcohol Syndrome child are estimated to be
at least $1,400,000;
(9) researchers have determined that the possibility of giving
birth to a baby with Fetal Alcohol Syndrome or Fetal Alcohol Effect
increases in proportion to the amount and frequency of alcohol
consumed by a pregnant woman, and that stopping alcohol consumption
at any point in the pregnancy reduces the emotional, physical, and
mental consequences of alcohol exposure to the baby; and
(10) though approximately 1 out of every 5 pregnant women drink
alcohol during their pregnancy, we know of no safe dose of alcohol
during pregnancy, or of any safe time to drink during pregnancy,
thus, it is in the best interest of the Nation for the Federal
Government to take an active role in encouraging all women to
abstain from alcohol consumption during pregnancy.
(c) Purpose.--It is the purpose of this section to establish,
within the Department of Health and Human Services, a comprehensive
program to help prevent Fetal Alcohol Syndrome and Fetal Alcohol Effect
nationwide and to provide effective intervention programs and services
for children, adolescents and adults already affected by these
conditions. Such program shall--
(1) coordinate, support, and conduct national, State, and
community-based public awareness, prevention, and education
programs on Fetal Alcohol Syndrome and Fetal Alcohol Effect;
(2) coordinate, support, and conduct prevention and
intervention studies as well as epidemiologic research concerning
Fetal Alcohol Syndrome and Fetal Alcohol Effect;
(3) coordinate, support and conduct research and demonstration
projects to develop effective developmental and behavioral
interventions and programs that foster effective advocacy,
educational and vocational training, appropriate therapies,
counseling, medical and mental health, and other supportive
services, as well as models that integrate or coordinate such
services, aimed at the unique challenges facing individuals with
Fetal Alcohol Syndrome or Fetal Alcohol Effect and their families;
and
(4) foster coordination among all Federal, State and local
agencies, and promote partnerships between research institutions
and communities that conduct or support Fetal Alcohol Syndrome and
Fetal Alcohol Effect research, programs, surveillance, prevention,
and interventions and otherwise meet the general needs of
populations already affected or at risk of being impacted by Fetal
Alcohol Syndrome and Fetal Alcohol Effect.
(d) Establishment of Program.--Title III of the Public Health
Service Act (42 U.S.C. 241 et seq.) is amended by adding at the end the
following:
``PART O--FETAL ALCOHOL SYNDROME PREVENTION AND SERVICES PROGRAM
``SEC. 399G. ESTABLISHMENT OF FETAL ALCOHOL SYNDROME PREVENTION AND
SERVICES PROGRAM.
``(a) Fetal Alcohol Syndrome Prevention, Intervention and Services
Delivery Program.--The Secretary shall establish a comprehensive Fetal
Alcohol Syndrome and Fetal Alcohol Effect prevention, intervention and
services delivery program that shall include--
``(1) an education and public awareness program to support,
conduct, and evaluate the effectiveness of--
``(A) educational programs targeting medical schools,
social and other supportive services, educators and counselors
and other service providers in all phases of childhood
development, and other relevant service providers, concerning
the prevention, identification, and provision of services for
children, adolescents and adults with Fetal Alcohol Syndrome
and Fetal Alcohol Effect;
``(B) strategies to educate school-age children, including
pregnant and high risk youth, concerning Fetal Alcohol Syndrome
and Fetal Alcohol Effect;
``(C) public and community awareness programs concerning
Fetal Alcohol Syndrome and Fetal Alcohol Effect; and
``(D) strategies to coordinate information and services
across affected community agencies, including agencies
providing social services such as foster care, adoption, and
social work, medical and mental health services, and agencies
involved in education, vocational training and civil and
criminal justice;
``(2) a prevention and diagnosis program to support clinical
studies, demonstrations and other research as appropriate to--
``(A) develop appropriate medical diagnostic methods for
identifying Fetal Alcohol Syndrome and Fetal Alcohol Effect;
and
``(B) develop effective prevention services and
interventions for pregnant, alcohol-dependent women; and
``(3) an applied research program concerning intervention and
prevention to support and conduct service demonstration projects,
clinical studies and other research models providing advocacy,
educational and vocational training, counseling, medical and mental
health, and other supportive services, as well as models that
integrate and coordinate such services, that are aimed at the
unique challenges facing individuals with Fetal Alcohol Syndrome or
Fetal Alcohol Effect and their families.
``(b) Grants and Technical Assistance.--The Secretary may award
grants, cooperative agreements and contracts and provide technical
assistance to eligible entities described in section 399H to carry out
subsection (a).
``(c) Dissemination of Criteria.--In carrying out this section, the
Secretary shall develop a procedure for disseminating the Fetal Alcohol
Syndrome and Fetal Alcohol Effect diagnostic criteria developed
pursuant to section 705 of the ADAMHA Reorganization Act (42 U.S.C.
485n note) to health care providers, educators, social workers, child
welfare workers, and other individuals.
``(d) National Task Force.--
``(1) In general.--The Secretary shall establish a task force
to be known as the National Task Force on Fetal Alcohol Syndrome
and Fetal Alcohol Effect (referred to in this subsection as the
`Task Force') to foster coordination among all governmental
agencies, academic bodies and community groups that conduct or
support Fetal Alcohol Syndrome and Fetal Alcohol Effect research,
programs, and surveillance, and otherwise meet the general needs of
populations actually or potentially impacted by Fetal Alcohol
Syndrome and Fetal Alcohol Effect.
``(2) Membership.--The Task Force established pursuant to
paragraph (1) shall--
``(A) be chaired by an individual to be appointed by the
Secretary and staffed by the Administration; and
``(B) include the Chairperson of the Interagency
Coordinating Committee on Fetal Alcohol Syndrome of the
Department of Health and Human Services, individuals with Fetal
Alcohol Syndrome and Fetal Alcohol Effect, and representatives
from advocacy and research organizations such as the Research
Society on Alcoholism, the FAS Family Resource Institute, the
National Organization of Fetal Alcohol Syndrome, the Arc, the
academic community, and Federal, State and local government
agencies and offices.
``(3) Functions.--The Task Force shall--
``(A) advise Federal, State and local programs and research
concerning Fetal Alcohol Syndrome and Fetal Alcohol Effect,
including programs and research concerning education and public
awareness for relevant service providers, school-age children,
women at-risk, and the general public, medical diagnosis,
interventions for women at-risk of giving birth to children
with Fetal Alcohol Syndrome and Fetal Alcohol Effect, and
beneficial services for individuals with Fetal Alcohol Syndrome
and Fetal Alcohol Effect and their families;
``(B) coordinate its efforts with the Interagency
Coordinating Committee on Fetal Alcohol Syndrome of the
Department of Health and Human Services; and
``(C) report on a biennial basis to the Secretary and
relevant committees of Congress on the current and planned
activities of the participating agencies.
``(4) Time for appointment.--The members of the Task Force
shall be appointed by the Secretary not later than 6 months after
the date of enactment of this part.
``SEC. 399H. ELIGIBILITY.
``To be eligible to receive a grant, or enter into a cooperative
agreement or contract under this part, an entity shall--
``(1) be a State, Indian tribal government, local government,
scientific or academic institution, or nonprofit organization; and
``(2) prepare and submit to the Secretary an application at
such time, in such manner, and containing such information as the
Secretary may prescribe, including a description of the activities
that the entity intends to carry out using amounts received under
this part.
``SEC. 399I. AUTHORIZATION OF APPROPRIATIONS.
``(a) In General.--There are authorized to be appropriated to carry
out this part, $27,000,000 for each of the fiscal years 1999 through
2003.
``(b) Task Force.--From amounts appropriated for a fiscal year
under subsection (a), the Secretary may use not to exceed $2,000,000 of
such amounts for the operations of the National Task Force under
section 399G(d).
``SEC. 399J. SUNSET PROVISION.
``This part shall not apply on the date that is 7 years after the
date on which all members of the National Task Force have been
appointed under section 399G(d)(1).''.
Speaker of the House of Representatives.
Vice President of the United States and
President of the Senate.

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Nursing Education and Practice Improvement Act of 1998 — S. 1754

Other Sections

TITLE I

TITLE II

TITLE IV

TITLE III

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