Appendix A

PUBLIC LAW 101-527—NOV. 6, 1990

104 STAT. 2311

Public Law 101-527
101st Congress
An Act
To amend the Public Health Service Act to improve the health of individuals who are
^^ „ -.gnn
members of minority groups and who are from disadvantaged backgrounds, and for —
_ '
—
other purposes.
LH.R. 5702]

Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
Disadvantaged
SECTION 1. SHORT TITLE AND FINDINGS.

Minority Health
Improvement

(a) SHORT TITLE.—This Act may be cited as the "Disadvantaged 42^use 201 note.
Minority Health Improvement Act of 1990".
OJ) FINDINGS.—The Congress finds that—
42U8C300u-6
(1) racial and ethnic minorities are disproportionately rep- '^°*®resented among individuals from disadvantaged backgrounds;
(2) the health status of individuals from disadvantaged backgrounds, including racial and ethnic minorities, in the United
States is significantly lower than the health status of the general population of the United States;
(3) minorities suffer disproportionately high rates of cancer,
stroke, heart diseases, diabetes, substance abuse, acquired
immune deficiency sjnidrome, and other diseases and disorders;
(4) the incidence of infant mortality among minorities is
almost double that for the general population;
(5) Blacks, Hispanics, and Native Americans constitute
approximately 12 percent, 7.9 percent, and 0.01 percent, respectively, of the population of the United States;
(6) Blacks, Hispanics, and Native Americans in the United
States constitute approximately 3 percent, 4 percent, and less
than 0.01 percent, respectively, of physicians, 2.7 percent, 1.7
percent, and less than 0.01 percent, respectively, of dentists, and
4.5 percent, 1.6 percent, and less than 0.01 percent, respectively,
of nurses;
(7) the number of individuals who are from disadvantaged
backgrounds in health professions should be increased for the
purpose of improving the access of other such individuals to
health services;
(8) minority health professionals have historically tended to
practice in low-income areas and to serve minorities;
(9) minority health professionals have historically tended to
engage in the general practice of medicine and specialties
providing primary care;
(10) reports published in leading medical journals indicate
that access to health care among minorities can be substantially
improved by increasing the number of minority health professionals;
(11) increasing the number of minorities serving on the faculties of health professions schools can be an important factor
in attracting minorities to pursue a career in the health
professions;

49-139 O - 90 (527)

104 STAT. 2312

PUBLIC LAW 101-527—NOV. 6, 1990
(12) diversity in the faculty and student body of health professions schools enhances the quality of education for all students
attending the schools;
(13) the Report of the Secretary's Task Force on Black and
Minority Health (prepared for the Secretary of Health and
Human Services and issued in 1985) described the health status
problems of minorities, and made recommendations concerning
measures that should be implemented by the Secretary with
respect to improving the health status of minorities through
programs for providing health information and education; and
(14) the Office of Minority Health, created in 1985 by the
Secretary of Health and Human Services, should be authorized
pursuant to statute and should receive increased funding to
support efforts to improve the health of individuals from disadvantaged backgrounds, including minorities, including the
implementation of the recommendations made by the Secretary's Task Force on Black and Minority Health.

SEC. 2. ESTABLISHMENT OF OFFICE OF MINORITY HEALTH.

Title XVII of the Public Health Service Act (42 U.S.C. 300u et seq.)
is amended by adding at the end the following new section:
"ESTABLISHMENT OF OFFICE OF MINORITY HEALTH

42 use 300U-6.

Government
contracts.
Public
information.

"SEC. 1707. (a) I N GENERAL.—There is established an Office of
Minority Health within the Office of the Assistant Secretary for
Health. There shall be in the Department of Health and Human
Services a Deputy Assistant Secretary for Minority Health, who
shall be the head of the Office of Minority Health. The Secretary,
acting through such Deputy Assistant Secretary, shall carry out this
section.
"(b) DUTIES.—The Secretary shall, with respect to the health
concerns of individuals from disadv£mtaged backgrounds, including
racial and ethnic minorities—
"(1) establish short-range and long-range goals and objectives
and coordinate all other activities within the Department of
Health and Human Services that relate to disease prevention,
health promotion, service delivery, and research concerning
such individuals;
"(2) enter into interagency agreements with other agencies of
the Service to increase the participation of such individuals in
health service and promotion programs;
"(3) establish a national minority health resource center to
facilitate the exchange of information regarding matters relating to health information and health promotion, preventive
health services, and education in the appropriate use of health
care, to facilitate access to such information, to assist in the
analysis of issues and problems relating to such matters, and to
provide technical assistance with respect to the exchange of
such information (including facilitating the development of
materials for such technical assistance);
"(4) support research, demonstrations and evaluations to test
new and innovative models, to increase knowledge and understanding of health risk factors, and to develop mechanisms that
support better information dissemination, education, prevention, and service delivery to individuals from disadvantaged
bac^rounds, including racial and ethnic minorities;

PUBLIC LAW 101-527—NOV. 6, 1990

104 STAT. 2313

"(5) coordinate efforts to promote minority health progreims Volunteers.
and policies in the voluntary and corporate sectors;
"(6) develop health information and health promotion materials and teaching programs, including—
"(A) models for the training of health professionads;
"(B) model curriculums to be used in primary and second- Education.
ary schools and institutions of higher learning;
"(C) materials and programs for the continuing education
of health professionals;
"(D) materials for public service use by the print and Public
information.
broadcast media; and
"(E) materials and programs to assist health care professionals in providing health education to their patients; and
"(7) assist providers of primary health care and preventive
health services in obtaining, with respect to the provision of
such care and services, the assistance of bilingual health professionals £ind other bUingual individuals (including such assistance in the provision of services regarding maternal and child
health, nutrition, mental health, and substance abuse).
"(c) CERTAIN REQUIREMENTS REGARDING DUTIES.—
"(1) EQUITABLE ALLOCATION OF SERVICES.—In

carrying out
subsection (b), the Secretary shall ensure that services provided
under such subsection are equitably allocated among all groups
served under this section by the Secretary.
"(2)

APPROPRIATE CONTEXT OF SERVICES.—In c a n y i n g

out

subsection (b), the Secretary shall ensure that information and
services provided under such subsection are provided in the
langUEige and cultured context that is most appropriate for the
individuals for whom the information and services are intended.
"(3)

BlUNGUAL A S S I S T A N C E

REGARDING HEALTH CARE.—In

carrying out subsection (bX7), the Secretary shall give special
consideration to the unique linguistic needs of health care
providers serving Asians, and American Samoans and other
Pacific Islanders, including such needs regarding particular
subpopulations of such groups.
"(d) GRANTS AND CONTRACTS REGARDING DUTIES.—

"(1) AUTHORITY.—In carrjdng out subsection (b), the Secretary
may msike grants to, and enter into cooperative agreements £ind
contracts with, public and nonprofit private entities.
"(2) EVALUATION AND DISSEMINATION.—

"(A) The Secretary shall, directly or through contracts
with public and private entities, provide for evaluations of
projects carried out with financial Eissistance provided
under paragraph (1) and for the dissemination of information developed as result of such projects.
"(B) Not later than January 20 of fiscal year 1993 and of
each second year thereafter, the Secretary shall prepare a
report summarizing evaluations carried out under subparagraph (A) during the preceding 2 fiscal years. The report
shall be included in the report required in subsection (e) for
the fisc£d year involved.
"(e) REPORTS.—Not later than January 31 of fiscal year 1993 and
of each second year thereafter, the Secretary shall submit to the
CJongress a report describing the activities carried out under this
section during the preceding 2 fiscal years.
"(f) FUNDING.—

39-194 O - 91 - 31 : QL 3 Part 3

104 STAT. 2314

PUBLIC LAW 101-527—NOV. 6, 1990
"(1) AUTHORIZATION OF APPROPRIATIONS.—For the purpose of

carrying out this section, there is authorized to be appropriated
$25,000,000 for each of the fiscal year 1991 through 1993.
"(2) ALLOCATION OF FUNDS BY SECRETARY.—Of the amounts

appropriated under paragraph (1) in excess of $15,000,000, the
Secretary shall mgike available not less than $3,000,000 to carry
out subsection (bX7).".
SEC. 3. HEALTH SERVICES FOR RESIDENTS OF PUBLIC HOUSING.

Part D of title III of the Public Health Service Act (42 U.S.C. 254b
et seq.) is amended by adding at the end the following new subpart:
"Subpart VI—Health Services for Residents of Public Housing
"HEALTH SERVICES FOR RESIDENTS OF PUBUC HOUSING
Grant programs.
42 u s e 256a.

"SEC. 340A. (a) ESTABUSHMENT.—

"(1) The Secretary, acting through the Administrator of the
Health Resources and Services Administration, shall make
grants for the purpose of enabling grantees, directly or through
contracts, to provide to residents of public housing, subject to
subsections (e) and (f)—
"(A) primary health services, including health screenings;
and
"(B) health counseling and education services.
"(2) The Secretary may not make a grant under paragraph (1)
unless the applicant for the grant agrees to expend the grant to
carry out each of subparagraphs (A) and (B) of such paragraph.
"(3) In carrying out the program established in paragraph (1),
the Administrator shall consult with the Director of the Centers
for Disease Control.
"(b) MINIMUM QUALIFICATIONS OF GRANTEES.—

Government
contracts.

"(1) Subject to paragraph (2), the Secretary may not make a
grant under subsection (a) to an applicant unless—
"(A) the applicant is a public or nonprofit private entity;
"(B) the applicant has the capacity to effectively administer a grant under subsection (a); and
"(C) in the case of any service under this section that is
available pursuant to the State plan approved under title
XIX of the Social Security Act for the State in which the
service will be provided—
"(i) the applicant for the grant will provide the service directly, and the applicant has entered into a
participation agreement under the State plan and is
qualified to receive pa3mients under such plan; or
"(ii) the applicant for the grant will enter into an
agreement with a public or nonprofit private organization under which the organization will provide the
service, and the organization has entered into such a
participation agreement and is quEilified to receive such
pa5rments.
"(2)(A) In the case of an organization making an agreement
pursuant to paragraph (IXCXii) regarding the provision of services under subsection (a), the requirement established in such
paragraph regarding a participation agreement shall be waived
by the Secretary if the organization does not, in providing
services, impose a charge or accept reimbursement available

PUBLIC LAW 101-527—NOV. 6, 1990

104 STAT. 2315

from any third-party payor, including reimbursement under
any insurance policy or under any Federal or State health
benefits program.
"(B) A determination by the Secretary of whether an
organization referred to in subparagraph (A) meets the criteria
for a waiver under such subparagraph shall be made without
regard to whether the organization accepts voluntary donations
regarding the provision of services to the public.
"(c) PREFERENCES IN MAKING GRANTS.—The Secretary shall, in

making grants under subsection (a), give preference to qualified
applicants that—
"(1) are resident management corporations under section 20
of the United States Housing Act of 1937; or
"(2) are receiving funds under section 330 or 340.
"(d) REQUIREMENT OF MATCHING FUNDS FROM PUBLIC GRANTEES.—

"(1) In the case of a public entity applying for a grant under
subsection (a), the Secretary may not maJce such a grant unless
the public entity agrees that, with respect to the costs to be
incurred by such entity in carrying out the purpose described in
such subsection, the entity will make available non-Federal
contributions in cash toward such costs in an amount equal to
not less than $1 for each $1 of Federal funds provided in the
grant.
"(2) In determining the amount of non-Federal contributions
in cash that a public entity heis provided pursuant to paragraph
(1), the Secretary may not include any amounts provided to the
public entity by the Federal Grovernment.
"(e) REQUIREMENTS REGARDING SERVICES.—The Secretary may not

make a grant under subsection (a) to an applicant unless the
applicant agrees that the applicant will, directly or through
contract—
"(1) provide services under this section on the premises of
public housing projects or at other locations immediately accessible to residents of public housing;
"(2) refer such residents, as appropriate, to qualified facilities
and practitioners for necessary follow-up services;
"(3) provide outreach services to inform such residents of the
availability of such services; and
"(4) aid such residents in establishing eligibility for assistance, and in obtaining services, under Federal, State, and locEil
programs providing health services, mental health services, or
social services.
"(f) OPTIONAL PROVISION OF CERTAIN SERVICES.—

"(1) A grantee under subsection (a) may expend the grant—
"(A) to train residents of public housing to provide health
screenings and to provide educational services; and
"(B) to provide health services to individuals who are not
residents of public housing.
"(2) The Secretary may not make a grant under subsection (a)
unless the applicant for the grgmt agrees that if, pursuant to
parEigraph (IXB), the applicant provides health services to
individuals who are not residents of public housing, the health
services will be provided to such individuals under the same
terms and conditions as such services are provided to residents
of public housing (including all terms and conditions in effect
pursuant to this section).

'

i

.

;
|
j
I
!

104 STAT. 2316

PUBLIC LAW 101-527—NOV. 6, 1990
"(g) CONSULTATION WITH RESIDENTS.—The Secretary may not

make a grant under subsection (a) unless, with respect to the
residents of the public housing involved, the applicant for the
grant—
"(1) has consulted with the residents in the preparation of the
application for the grant; and
"(2) agrees to provide for ongoing consultation with the residents regarding the planning and administration of the program carried out with the grant.
"(h) RESTRICTIONS ON USE OF GRANT FUNDS.—

"(1) The Secretary may not, except as provided in paragraph
(2), make a grant under subsection (a) to an applicant unless the
applicant agrees that amounts received pursuant to such
subsection will not, directly or through contract, be expended—
"(A) for any purpose other than the purposes authorized
in this section;
"(B) to provide inpatient services;
"(C) to make cash payments to intended recipients of
services under this section; or
"(D) to purchase or improve real property (other than
minor remodeling of existing improvements to real property) or to purchase major medical equipment or motor
vehicles.
"(2) If the Secretary finds that the purpose described in
subsection (a) cannot otherwise be carried out, the Secretary
may, with respect to an otherwise qualified applicant, waive the
restriction established in paragraph (1)(D).
"(i) LIMITATION ON CHARGES FOR SERVICES.—The Secretary may

not make a grant under subsection (a) to an applicant unless the
applicant agrees that, whether the services are provided directly or
through contract—
"(1) services under the grant will be provided without regard
to ability to pay for the services; and
"(2) if a charge is imposed for the delivery of the services, such
charge—
"(A) will be made according to a schedule of charges that
is made available to the public;
"(B) will not be imposed on any resident of public housing
with an income less than the official poverty level; and
"(C) will be adjusted to reflect the income and resources
of the resident of public housing involved.
"(j) REQUIREMENTS REGARDING ADMINISTRATION.—The Secretary

may not make a grant under subsection (a) to an applicant unless
the applicant—
"(1) agrees to establish such procedures for fiscal control and
fund accounting as may be necessary to ensure proper disbursement and accounting with respect to the grant;
"(2) agrees to establish an ongoing program of quality assurance with respect to the services provided under the grant;
"(3) agrees to ensure the confidentiality of records maintained
on residents of public housing that are receiving such services;
"(4) with respect to providing services to any population of
such residents a substantial portion of which has a limited
ability to speak the English language—
"(A) has developed and has the ability to carry out a
reasonable plan to provide services under the grant
through individuals who are able to communicate with the

PUBLIC LAW 101-527—NOV. 6, 1990

104 STAT. 2317

population involved in the language and cultural context
that is most appropriate; and
"(B) has designated at least one individual, fluent in both
English and the appropriate language, to assist in carr3dng
out the plan; and
"(5) agrees to submit to the Secretary an annual report that
describes the utilization and costs of services provided under the
grant and that provides such other information as the Secretary
determines to be appropriate,
"(k) LIMITATION ON ADMINISTRATIVE EXPENSES OF GRANTEE.—The

Secretary may not make a grant under subsection (a) to an applicant
unless the applicant agrees that the applicant will not expend more
than 10 percent of amounts received pursuant to such subsection for
the purpose of administering the grant.
"(1) REQUIREMENT OF APPUCATION.—The Secretary may not provide financial assistance under subsection (a) unless—
"(1) an application for the assistance is submitted to the
Secretary;
"(2) with respect to carrying out the purpose for which the
assistance is to be provided, the application provides assurances
of compliance satisfactory to the Secretary; and
"(3) the application otherwise is in such form, is made in such
manner, and contains such agreements, assurances, and
information as the Secretary determines to be necessary to
carry out this section,
"(m) TECHNICAL ASSISTANCE.—

"(1) The Secretary may provide technical assistance to applicants and grantees under subsection (a) regarding the planning, development, and operation of programs to carry out the
purpose described in such subsection. The Secretary may provide such technical assistance directly, through contracts, or
through grants.
"(2) Any technical sissistance provided by the Secretary under
paragraph (1) shall be provided without charge to applicants
and grantees under subsection (a).
"(3) Of the amounts appropriated pursuant to subsection (pXD
for a fiscal year, the Secretary may expend not more than
$2,000,000 for the purpose of carrjdng out paragraph (1).
"(n) ANNUAL REPORTS BY SECRETARY.—Not later than January 10
of each year, the Secretary shall submit to the Congress a report
describing the utilization and costs of services provided under this
section during the immediately preceding fiscal year.
"(o) DEFINITIONS.—For purposes of this section:
"(1) The term 'official poverty level' means the nonfarm
income official poverty line defined by the Office of Management and Budget and revised annually in accordance with
section 673(2) of the Omnibus Budget Reconciliation Act of 1981.
"(2) The term 'organization' includes individuals, corporations, partnerships, companies, and £issociations.
"(3) The term 'primary health services' has the meaning
given such term in section 330(bXl).
"(4) The term 'public housing' has the meaning given such
term in section 3(bXl) of the United States Housing Act of 1937.
"(p) FUNDING.—

"(1) For the purpose of carrjdng out this section, there are
authorized to be appropriated $35,000,000 for fiscal year 1991,

104 STAT. 2318

PUBLIC LAW 101-527—NOV. 6, 1990
and such sums as may be necessary for each of the fiscal years
1992 and 1993.
"(2) Amounts received by a grantee pursuant to subsection (a)
remaining unobligated at the end of the fiscal year in which the
amounts were received shall remain available to the grantee
during the succeeding fiscal year for the purpose described in
such subsection.".

SEC. 4. REVISIONS IN PROGRAM FOR CENTERS OF EXCELLENCE IN
HEALTH PROFESSIONS EDUCATION.

(a) IN GENERAL.—Section 782 of the Public Health Service Act (42
U.S.C. 295g-2) is amended to read as follows:
" P R O G R A M S OF EXCELLENCE I N HEALTH PROFESSIONS EDUCATION FOR
MINORITIES

Grant programs.

"SEC. 782. (a) IN GENERAL.—The Secretary shall make grants to
health profession schools described in subsection (c) for the purpose
of assisting the schools in supporting programs of excellence in
health professions education for minority individuals.
"(b) REQUIRED USE OF FUNDS.—The Secretary may not make a
grant under subsection (a) unless the health professions school
involved agrees to expend the grant—
"(1) to establish, strengthen, or expand programs to enhance
the academic performance of minority students attending the
school;
"(2) to establish, strengthen, or expand programs to increase
the number and quality of minority applicants to the school;
"(3) to improve the capacity of such school to train, recruit,
and retain minority faculty;
"(4) with respect to minority health issues, to carry out
activities to improve the information resources and curricula of
the school and clinical education at the school; and
"(5) to facilitate faculty and student research on health issues
particularly affecting minority groups.
"(c) CENTERS OF EXCELLENCE.—
"(1) I N GENERAL.—

"(A) The health professions schools referred to in subsection (a) are such schools that meet each of the conditions
specified in subparagraph (B), and that—
"(i) meet each of the conditions specified in paragraph (2XA);
"(ii) meet each of the conditions specified in paragraph (3);
"(iii) meet each of the conditions specified in paragraph (4); or
"(iv) meet each of the conditions specified in paragraph (5).
"(B) The conditions specified in this subparagraph are
that a health professions school—
"(i) has a significant number of minority individuals
enrolled in the school, including individuals accepted
for enrollment in the school;
"(ii) has been effective in assisting minority students
of the school to complete the program of education and
receive the degree involved;

PUBLIC LAW 101-527—NOV. 6, 1990
"(iii) has been effective in recruiting minority
individuals to attend the school, including providing
scholarships and other financial assistance to such
individuals and encouraging minority students of
secondary educational institutions to attend the health
professions school; and
"(iv) has made significant recruitment efforts to increase the number of minority individuals serving in
faculty or administrative positions at the school.
"(C) In the case of any criteria established by the Secretary for purposes of determining whether schools meet
the conditions described in subparagraph (B), this section
may not, with respect to racial and ethnic minorities, be
construed to authorize, require, or prohibit the use of such
criteria in any program other than the program established
in this section.
"(2) CENTERS OF EXCELLENCE AT CERTAIN HISTORICALLY BLACK
COLLEGES AND UNIVERSITIES.—

"(A) The conditions specified in this subparagraph are
that a health professions school—
"(i) is a school described in section 701(4); and
"(ii) received a contract under section 788B for fiscal
year 1987, as such section was in effect for such fiscal
year.
"(B) In addition to the purposes described in subsection
(b), a grant under subsection (a) to a health professions
school meeting the conditions described in subparagraph
(A) may be expended—
(i) to develop a plan to achieve institutional
improvements, including financial independence, to
enable the school to support programs of excellence in
health professions education for minority individuals;
and
"(ii) to provide improved access to the library and
informational resources of the school.
"(3) HISPANIC CENTERS OF EXCELLENCE.—The conditions specified in this subparagraph are that—
"(A) with respect to Hispanic individuals, each of clauses
(i) through (iv) of paragraph (IXB) apply to the health
professions school involved; and
"(B) the health professions school agree, as a condition of
receiving a grant under subsection (a), that the school will,
in carrying out the duties described in subsection (b), give
priority to carrying out the duties with respect to Hispanic
individuals.
"(4) NATIVE AMERICAN CENTERS OF EXCELLENCE.—The conditions specified in this parsigraph are that—
(A) with respect to Native Americans, each of clauses (i)
through (iv) of paragraph (IXB) apply to the health professions school involved;
"(B) the health professions school agree, as a condition of
receiving a grant under subsection (a), that the school will,
in carrying out the duties described in subsection (b), give
priority to carrjdng out the duties with respect to Native
Americans; and
"(C) the health professions school agree, as a condition of
receiving a grant under subsection (a), that—

104 STAT. 2319

104 STAT. 2320

PUBLIC LAW 101-527—NOV. 6, 1990
"(i) the school will establish an arrangement with 1
or more public or nonprofit private institutions of
higher education whose enrollment of students has
traditionally included a significant number of Native
Americans, the purpose of which arrangement will be
to c a n y out a program—
(I) to identify Native American students of the
institution who are interested in a career in the
health profession or professions involved; and
"(ID to facilitate the educational preparation of
such students to enter the health professions
school; and
"(ii) the health professions school will make efforts to
recruit Native American students, including students
who have participated in the undergraduate program
carried out under arremgements established by the
school pursuant to subparagraph (A), and will assist
Native American students regarding the completion
of the educational requirements for a degree from the
health professions school.
"(5) OTHER CENTERS OF EXCELLENCE.—The conditions specified
in this paragraph are that a health professions school has an
enrollment of underrepresented minorities above the national
average for such enrollments of health professions schools.
"(d) DESIGNATION AS CENTER OF EXCELLENCE.—

"(1) I N GENERAL.—Any health professions school receiving a
grant under subsection (a) and meeting the conditions described
in paragraph (2) or (5) of subsection (c) shall, for purposes of this
section, be designated by the Secretary as a Center of Excellence in Minority Health Professions Education.
"(2) HISPANIC CENTERS OF EXCELLENCE.—Any health professions school receiving a grant under subsection (a) and
meeting the conditions described in subsection (cX3) shall, for
purposes of this section, be designated by the Secretary as a
Hispanic Center of Excellence in Health Professions Education.
"(3) NATIVE AMERICAN CENTERS OF EXCELLENCE.—Any health
professions school receiving a grant under subsection (a) and
meeting the conditions described in subsection (cX4) shall, for
purposes of this section, be designated by the Secretary as a
Native American Center of Excellence in Health Professions
Education.
"(e) DURATION OF GRANT.—The period during which pa5rments are
made under a grant under subsection (a) may not exceed 3 years.
Such pajrments shall be subject to annual approval by the Secretary
and to the availability of appropriations for the fiscal year involved
to make the pajnnents.
"(f) MAINTENANCE OF EFFORT.—
"(1) NON-FEDERAL FUNDS OF PUBUC SCHOOLS.—With respect to

activities for which a grant under subsection (a) is authorized to
be expended, the Secretary may not, in the case of a public
health professions school, make such a grant to the school for
any ^ c a l year unless the school agrees to maintain expenditures of non-Federal amounts for such activities at a level equal
to not less than the level of such expenditures maintained by
the school for the fiscal year preceding the first fiscal year for
which the school applies after fiscal year 1990 to receive such a
grant.

PUBLIC LAW 101-527—NOV. 6, 1990
"(2) NON-FEDERAL FUNDS OF PRIVATE SCHOOLS.—

"(A) With respect to any non-Federal amounts received
by a nonprofit private health professions school and available for carrying out activities for which a grant under
subsection (a) is authorized to be expended, the Secretary
may not make such a grant to the school for any fiscal year
unless, subject to subparagraph (B), the school agrees to
maintain expenditures of such non-Federal amounts for
such activities at a level equal to not less than the level of
such expenditures maintained by the school for the fiscal
year preceding the first fiscal year for which the school
applies after fiscal year 1990 to receive such a grant.
"(B) The Secretary may require a nonprofit private
health professions school to comply with an agreement
made under subparagraph (A) by the school only to the
extent of the level of non-Federal amounts available to the
school for the activities to which the agreement applies.
"(3) USE OF FEDERAL FUNDS.—With respect to any Federal

amounts received by a health professions school and available
for carrjdng out activities for which a grant under subsection (a)
is authorized to be expended, the Secretary may not make such
a grant to the school for any fiscal year unless the school agrees
that the school will, before expending the grant, expend the
Federal amounts obtained from sources other than the grant.
'(g) DEFINITIONS.—For purposes of this section:
"(1)(A) The term 'health professions school' means, except as
provided in subparagraph (B), a school of medicine, a school of
dentistry, or a school of pharmacy.
"(B) The definition established in subparagraph (A) shall not
apply to the use of the term 'health professions school' for
purposes of subsection (c)(2).
"(2) The term 'program of excellence' means any program
carried out by a health professions school with a grant made
under subsection (a), if the program is for purposes for which
the school involved is authorized in subsection (b) or (c) to
expend the grant,
(3) The term 'Native Americans' means American Indians,
Alaskan Natives, Aleuts, and Native Hawaiians.
'(h) FUNDING.—
"(1) AUTHORIZATION OF APPROPRIATIONS.—For the purpose of

making grants under subsection (a), there are authorized to be
appropriated such sums as may be necessary for each of the
fiscal years 1991 through 1993.
"(2) ALLOCATIONS BY SECRETARY.—

"(A) Of the amounts appropriated under paragraph (1) for
a fiscal year, the Secretary shall make available the first
$12,000,000 for grants under subsection (a) to health professions schools meeting the conditions specified in paragraph
(2XA) of subsection (c) (in addition to the conditions specified in paragraph (1)(B) of such subsection); and
"(B) Of the amounts appropriated under paragraph (1) for
a fiscal year in excess of $12,000,000, the Secretary shall
make available the first $2,500,000 for grants under subsection (a) to health professions schools meeting the conditions
specified in paragraph (3) or (4) of subsection (c) (in addition
to the conditions specified in paragraph (IXB) of such
subsection).

104 STAT. 2321

104 STAT. 2322

PUBLIC LAW 101-527—NOV. 6, 1990
"(3) ADDITIONAL PRIORITIES.—In making grants under subsection (a) for a fiscal year from such amounts as are available for
the grants after compliance with paragraph (2), the Secretary
shall give priority to making grants to health professions
schools meeting the conditions specified in any of paragraphs
(3) through (5) of subsection (c) (in addition to the conditions
specified in paragraph (1)(B) of such subsection).".

SEC. 5. FEDERAL CAPITAL CONTRIBUTIONS TO CERTAIN STUDENT LOAN
FUNDS FOR PURPOSES REGARDING DISADVANTAGED INDIVID.
UALS.

(a) I N GENERAL.—Section 740 of the Public Health Service Act (42
U.S.C. 294m) is amended—
(1) by redesignating subsection (c) as subsection (d); and
(2) by inserting after subsection (b) the following new subsection:
"(c)(1) With respect to amounts appropriated under subsection
(c)(1) of section 742, each agreement entered into under this section
with a school shall provide (in addition to the provisions required in
subsection (b)) that—
"(A) any Federal capital contribution made to the student
loan fund of the school from such amounts, together with the
school contribution appropriate under subsection (b)(2)(B) to the
amount of the Federal capital contribution, will be utilized only
for the purpose of—
' (i) making loans to individuals who are individuals from
disadvantaged backgrounds; and
"(ii) the costs of the collection of the lo£ins and interest on
the loans; and
"(B) collections of principal and interest on loans made pursuant to subparagraph (A), and any other earnings of the student
loan fund attributable to amounts that are in the fund pursuant
to such subparagraph, will be utilized only for the purpose
described in such paragraph.
"(2) The Secretary may not make a Federal capital contribution
for purposes of pareigraph (1) for a fiscEil year unless the health
professions school involved—
"(A) is carrying out a program for recruiting and retaining
students from disadvantaged backgrounds, including racial and
ethnic minorities; and
"(B) is canying out a program for recruiting and retaining
minority faculty.
"(3) The Secretary may not make a Federal capit£il contribution
for purposes of parsigraph (1) for a fiscal year unless the health
professions school involved agrees—
"(A) to ensure that adequate instruction regarding minority
heedth issues is provided for in the curricula of the school;
"(B) with respect to health clinics providing services to a
significant number of individuals who are from disadvantaged
backgrounds, including members of minority groups, to enter
into arrangements with 1 or more such clinics for the purpose of
providing students of the school with experience in providing
clinical services to such individuals;
"(C) with respect to public or nonprofit private secondary
educational institutions and undergraduate institutions of
higher education, to enter into arrangements with 1 or more
such institutions for the purpose of carrying out programs

PUBLIC LAW 101-527—NOV. 6, 1990

104 STAT. 2323

regarding the educational preparation of disadvantaged students, including minority students, to enter the health professions and regarding the recruitment of such individuals into the
health professions;
"(D) to establish a mentor program for assisting disadvantaged students, including minority students, regarding the
completion of the educational requirements for degrees from
the school;
"(E) to be canying out each of the activities specified in any of
subparagraphs (A) through (D) by not later than 1 year after the
date on which the first Federal capital contribution is made to
the school for purposes of paragraph (1); and
"(F) to continue carrying out such activities, and the activities
specified in subparagraphs (A) and (B) of paragraph (2), throughout the period during which the student loan fund established
pursuant to subsection (b) is in operation.
"(4) With respect to amounts appropriated under subsection (a) of
section 742, Federal capital contributions made pursuant to an
agreement under subsection (b) of this subsection to the student loan
fund of a school from such amounts, together with the school
contributions appropriate under subsection (bX2XB) to the amount of
the Federal capital contributions, may be utilized for the purpose of
making loans to individuals from disadvantaged backgrounds.'.
(b) DEFINITION WITH RESPECT TO INDIVIDUALS FROM DISADVANTAGED BACKGROUNDS.—Section 740 of the Public Health Service Act,

as amended by subsection (a) of this section, is amended by adding at
the end the following new subsection:
"(e) For purposes of this section, the term 'disadvantaged', with
respect to an individual, shall be defined by the Secretary.'.
(c) AUTHORIZATION OF APPROPRIATIONS.—Section 742 of the Public
Health Service Act (42 U.S.C. 294o) is amended by adding at the end
the following new subsection:
"(cXl) With respect to making Federal capital contributions to
student loan funds for purposes of section 740(c), there is authorized
to be appropriated for such contributions $15,000,000 for each of the
fiscal years 1991 through 1993.
"(2) In making Federal capitel contributions to student loan funds
for purposes of section 740(c), the Secretory shall give special consideration to health professions schools that have enrollments of
underrepresented minorities above the national average for health
professions schools.".
SEC. 6. ASSISTANCE PROGRAMS FOR HEALTH PROFESSIONS STUDENTS
FROM DISADVANTAGED BACKGROUNDS.

Part C of title VII of the Public Health Service Act (42 U.S.C. 294
et seq.) is amended by adding at the end thereof the following new
subpart:
"Subpart VI—Assistance for Students From Disadvantaged
Backgrounds
"SEC. 760. GRANTS FOR SCHOLARSHIPS AND OTHER PURPOSES.
"(a) ESTABLISHMENT OF PROGRAM.—

"(1) I N GENERAL.—The Secretory may make grants to health
professions schools for the purpose of assisting such schools,
subject to subsection (e), in providing scholarships to individuals
who—

42 USC 294bb.

104 STAT. 2324

PUBLIC LAW 101-527—NOV. 6, 1990
"(A) are individuals from disadvantaged backgrounds;
and
"(B) are enrolled (or accepted for enrollment) as full-time
students in such schools.
"(2) HEALTH PROFESSIONS SCHOOLS.—For purposes of this section, the term 'health professions schools' means schools of
medicine, nursing (as schools of nursing are defined in section
853), osteopathic medicine, dentistry, pharmacy, podiatric medicine, optometry, veterinary medicine, public health, or allied
health, or schools offering graduate programs in clinical
psychology.
"(b) MINIMUM QUAUFICATIONS OF GRANTEES.—The Secretary may

not make a grant under subsection (a) unless the health professions
school—
"(1) is carrying out a program for recruiting and retaining
students from disadvantaged backgrounds, including racial emd
ethnic minorities; and
"(2) is carrying out a program for recruiting and retaining
minority faculty.
"(c) PREFERENCES IN PROVIDING SCHOLARSHIPS.—The Secretary

may not make a grant under subsection (a) unless the health
professions school involved agrees that, in providing scholarships
pursuant to the grant, the school will give preference to students—
"(1) who are from disadvantaged backgrounds; or
"(2) for whom the costs of attending the school would constitute a severe financigd hardship.
"(d) USE OF SCHOLARSHIP.—A scholarship provided pursuant to
subsection (a) for attendance at a health professions school—
"(1) may be expended only for tuition expenses, other reasonable educational expenses, and reasonable living expenses
incurred in such attendance; and
"(2) may not, for any year of such attendance for which the
scholarship is provided, provide an amount exceeding the total
amount required for the year for the expenses specified in
paragraph (1).
"(e) PROVISIONS REGARDING PURPOSES OTHER THAN SCHOLARSHIPS.—
"(1) AUTHORITY REGARDING ASSISTANCE FOR UNDERGRADU-

ATES.—With respect to undergraduates who have demonstrated
a commitment to pursuing a career in the health professions, a
health professions school may expend not more than 25 percent
of a grant under subsection (a) for the purpose of providing
financial assistance to such undergraduates in order to facilitate the completion of the educational requirements for such
careers.
"(2) REQUIRED ACTIVITIES OF SCHOOL.—The Secretary may not

make a grant under subsection (a) unless the health professions
school involved agrees—
"(A) to ensure that adequate instruction regarding minority health issues is provided for in the curricula of the
school;
"(B) with respect to health clinics providing services to a
significant number of individuals who are from disadvantaged backgrounds, including members of minority groups,
to enter into arrangements with 1 or more such clinics for
the purpose of providing students of the school with experience in providing clinical services to such individuals;

PUBLIC LAW 101-527—NOV. 6, 1990

104 STAT. 2325

"(C) with respect to public or nonprofit secondary educational institutions and undergraduate institutions of
higher education, to enter into arrangements with 1 or
more such institutions for the purpose of carrying out
programs regarding the educational preparation of disadvantaged students, including minority students, to enter
the health professions and regarding the recruitment of
such students into the health professions;
"(D) to establish a mentor program for assisting disadvantaged students, including minority students, regarding the
completion of the educational requirements for degrees
from the school;
"(E) to be carrjdng out the activities specified in subparagraphs (A) through (D) by not later than 1 year after the
date on which a grant under subsection (a) is first made to
the school; and
"(F) to continue carrjdng out such activities, and the
activities specified in paragraphs (1) and (2) of subsection
(b), throughout the period during which the school is receiving a grant under subsection (a).
"(3) RESTRICTIONS ON USE OF GRANT.—The Secretary may

not

make a grant under subsection (a) for a fiscal year unless the
health professions school involved agrees that the grant will not
be expended to carry out the activities specified in paragraph (1)
or (2) of subsection (b), or in any of subparagraphs (A) through
(D) of paragraph (2) of this subsection.
"(f) REQUIREMENT OF APPUCATION.—The Secretary may not make
a grant under subsection (a) unless an application for the grant is
submitted to the Secretary and the application is in such form, is
made in such manner, and contains such agreements, assurances,
and information as the Secretary determines to be necessary to
carry out this section.
"(g) FUNDING.—
"(1) AUTHORIZATION OF APPROPRIATIONS.—To

carry out subsection (a), there are authorized to be appropriated $17,000,000 for
fiscal year 1991, and such sums as may be necessary for each of
the fiscal years 1992 and 1993.
"(2) AixocATiONS BY SECRETARY.—In making grsmts under
subsection (a), the Secretary—
"(A) shall make available 30 percent for grants under
subsection (a) to health professions schools agreeing to
expend the grants only for scholarships under such subsection for nurses; and
"(B) shall give special consideration to health professions
schools that have enrollments of underrepresented minorities above the national average for health professions
schools.

"SEC. 761. LOAN REPAYMENT PROGRAM REGARDING SERVICE ON FACULTIES OF CERTAIN HEALTH PROFESSIONS SCHOOLS.
"(a) ESTABUSHMENT OF PROGRAM.—The S e c r e t a r y s h a l l e s t a b l i s h a

42 USC 294cc.
Government

program of entering into contracts with individuals described in contracts.
subsection (b) under which the individuals agree to serve as members of the faculties of schools described in subsection (c) in consideration of the Federal Government agreeing to pay, for each year of
such service, not more than $20,000 of the principal and interest of
the educational loans of such individuals.

39-194 O - 91 - 33 : QL 3 Part 3

104 STAT. 2326

PUBLIC LAW 101-527—NOV. 6, 1990

"(b) EuGiBLE INDIVIDUALS.—The individuals referred to in subsection (a) are individuals from disadvantaged backgrounds who—
"(1) have a degree in medicine, osteopathic medicine, dentistry, or another health profession;
"(2) are enrolled in an approved graduate training program in
medicine, osteopathic medicine, dentistry, or other health
profession; or
"(3) are enrolled as a full-time student—
"(A) in an accredited (as determined by the Secretary)
school described in subsection (c); and
"(B) in the final year of a course of a study or program,
offered by such institution and approved by the Secretary,
leading to a degree from such a school.
"(c) EuGiBLE HEALTH PROFESSIONS SCHOOL.—The schools described

in this subsection are schools of medicine, nursing (as schools of
nursing are defined in section 853), osteopathic medicine, dentistry,
pharmacy, podiatric medicine, optometry, veterinary medicine, or
public health, or schools offering graduate programs in clinical
psychology.
"(d) ADDITIONAL LIMITATION ON AMOUNT OF REPAYMENTS.—Pay-

ments made by the Secretary under subsection (a) regarding the
educational loans of an individual may not, for any year for which
the payments are made, exceed an amount equal to 50 percent of the
principal and interest due on such loans for such year.
"(e) REQUIREMENTS REGARDING FACULTY POSITIONS.—The Secretary may not enter into a contract under subsection (a) unless—
"(1) the individual involved has entered into a contract with a
school described in subsection (c) to serve as a member of the
faculty of the school for not less than 2 years; and
"(2) the contract referred to in paragraph (1) provides that—
"(A) the school will, for each year for which the individual will serve as a member of the faculty under the contract
with the school, make payments of the principal and interest due on the educational loans of the individual for
such year in an amount equal to the amount of such
payments made by the Secretary for the year; and
(B) the pajrments made by the school pursuant to
subparagraph (A) on behalf of the individual will be in
addition to the pay that the individual would otherwise
receive for serving as a member of such faculty.
"(f) WAIVER REGARDING SCHOOL CONTRIBUTIONS.—The Secretary

may waive the requirement established in subsection (eX2) if the
Secretary determines that the requirement will impose an undue
financial hardship on the school involved. If the Secretary grants
such a waiver, subsection (d) shall not apply with respect to the
individual involved.
"(g) APPUCABILITY OF CERTAIN PROVISIONS.—The provisions of
sections 338B, 338C, and 338E shall apply to the program established
in subsection (a) to the same extent and in the same manner as such
provisions apply to the National Health Service Corps Loan Repayment Program established in subpart III of part D of title III,
including the applicability of provisions regarding reimbursements
for increased tax liability and regarding bankruptcy.
"(h) AUTHORIZATION OF APPROPRIATIONS.—To carry out this section, there are authorized to be appropriated $4,000,000 for each of
the fiscal years 1991 through 1993.".

PUBLIC LAW 101-527—NOV. 6, 1990

104 STAT. 2327

SEC. 7. REVISION AND EXTENSION OF PROGRAM FOR NATIONAL CENTER
FOR HEALTH STATISTICS.
(a) ANNUAL COLLECTION OF DATA,—
(1) DATA FROM RECORDS OF BIRTHS, DEATHS, ET CETERA, AMONG

CERTAIN POPULATIONS.—Section 306(h) of the Public Health
Service Act (42 U.S.C. 242k(h)) is amended by inserting after the
second sentence the following new sentence: "The Secretary
shall encourage States and registration areas to obtain detailed
data on ethnic and racial populations, including subpopulations
of Hispanics, Asian Americans, and Pacific Islanders with
significant representation in the State or registration area.".
(2)

DATA FROM SAMPLE REGARDING HEALTH, ILLNESS, AND

DISABILITY STATUS.—Section 306(h) of the Public Health Service Act (42 U.S.C. 242k(h)), as amended by paragraph (1), is
amended—
(A) by inserting "(1)" after the subsection designation;
and
(B) by adding at the end the following new paragraph:
"(2) There shall be an annual collection of data from a statistically
valid sample concerning the general health, illness, and disability
status of the civilian noninstitutionalized population. Specific topics
to be addressed under this paragraph, on an annual or periodic
basis, shall include the incidence of illness and accidental injuries,
prevalence of chronic diseases and impairments, disability, physician visits, hospitalizations, and the relationship between demographic and socioeconomic characteristics and health characteristics.".
(b) (COLLECTION OF DATA SPECIFIC TO PARTICULAR POPULATIONS.—

(1) IN GENERAL.—Section 306 of the Public Health Service Act
(42 U.S.C. 242k) is amended—
(A) by redesignating subsection (m) as subsection (o); and
(B) by inserting after subsection (1) the following new
subsections:
"(m) In canying out this section, the Secretary, acting through
the (Denter, shall collect and analyze adequate health data that is
specific to particular ethnic and racial populations, including data
collected under national health surveys. Activities carried out under
this subsection shall be in addition to any activities carried out
under subsection (n).
"(nXl) The Secretary, acting through the CJenter, may make
grants to public and nonprofit private entities for—
"(A) the conduct of special surveys or studies on the health of
ethnic and racial populations or subpopulations;
"(B) analysis of data on ethnic and racial populations and
subpopulations; and
"(C) research on improving methods for developing statistics
on ethnic and racial populations and subpopulations.
"(2) The Secretary, acting through the Center, may provide technical assistance, standards, and methodologies to grantees supported
by this subsection in order to maximize the data quality and comparability with other studies.
"(3) Provisions of section 308(d) do not apply to surveys or studies
conducted by grantees under this subsection unless the Secretary, in
accordance with regulations the Secretary may issue, determines
that such provisions are necessary for the conduct of the survey or

|

104 STAT. 2328

PUBLIC LAW 101-527—NOV. 6, 1990

study and receives adequate assurance that the grantee will enforce
such provisions.".
(2) APPLICATION AND PEER REVIEW.—Section 308(bX2) of the

Public Health Service Act (42 U.S.C. 242m(bX2)) is amended—
(A) in subparagraph (A), in the first sentence, bv inserting after "demonstration project," the following: ' or for a
grant under section 306(n),"; and
(B) in subparagraph (C), by inserting before the period at
the end the following: ", except that peer review groups
regarding grants under section 306(n) may include appropriately qualified such officers and employees".
(c) AUTHORIZATION OF APPROPRIATIONS.—Section 306(o), as redesig-

nated by subsection (b) of this section, is amended to read as follows:
"(oXl) For health statistical and epidemiological activities undertaken or supported under subsections (a) through (m), there are
authorized to be appropriated such sums as may be necessary for
each of the fiscal years 1991 through 1993.
"(2) For activities authorized in subsection (n), there are
authorized to be appropriated $5,000,000 for fiscal year 1991,
$7,500,000 for fiscal year 1992, and $10,000,000 for fiscal year 1993.
Of such amounts, the Secretary shall use not more than 10 percent
for administration and for activities described in subsection (nX2).".
(d)

REPEAL

OF CERTAIN

RESTRICTION ON FUNDING.—Section

308(bX3) of the Public Health Service Act (42 U.S.C. 242m(3)) is
repealed.
SEG. 8. DEMONSTRATION GRANTS TO STATES FOR COMMUNITY SCHOLARSHIP PROGRAMS.

Subpart III of part D of title III of the Public Health Service Act
(42 U.S.C 241 et seq.) is amended by inserting before subpart IV of
such part the following new section:
42 u s e 254u.

"SEC. 338L. DEMONSTRATION GRANTS TO STATES FOR COMMUNITY
SCHOLARSHIP PROGRAMS.

"(a) I N GENERAL.—The Secretary, acting through the Administrator of the Health Resources and Services Administration, may
make grants to States for the purpose of canying out demonstration
programs to increase the availability of primary health care in
urban and rural health manpower shortage areas through assisting
community organizations of such areas in educating individuals to
serve as health professionals in such areas.
"0>) CERTAIN REQUIREMENTS FOR STATES.—
"(1) MINIMUM QUALIFICATIONS.—The Secretary

may not make
a grant under subsection (a) unless the State involved will,
under any provision of this Act other than subsection (a),
receive 1 or more grants, cooperative agreements, or contracts
for the fiscal year for which the State is appl5dng pursuant to
subsection (h) to receive a grant under subsection (a).
"(2) ADMINISTRATION OF PROGRAM.—The Secretary may not

make a grant under subsection (a) unless the State involved
agrees that the program carried out by the State with the grant
will be administered directly by a single State agency.
"(c) GRANTS BY STATES TO COMMUNITY ORGANIZATIONS FOR PROVISION OF SCHOLARSHIP CONTRACTS.—The Secretary may not make a

grant under subsection (a) unless the State involved agrees, subject
to subsections (d) and (e), to carry out the purpose described in
subsection (a) only through operating a program in which the State

PUBLIC LAW 101-527—NOV. 6, 1990

104 STAT. 2329

makes grants to community organizations located in health manpower shortage areas in order to assist the organizations with the
costs of entering into contracts under which—
"(1) the community organizations agree to provide scholarships to individuals for attendance at hesdth professions schools;
and
"(2) the individuals agree to provide, in the health manpower
shortage areas in which the community organizations are
located, primary health care for—
"(A) a number of years equal to the number of years for
which the scholarships are provided, or for a period of 2
years, whichever period is greater; or
"(B) such greater period of time as the individuals and
the community organizations may agree.
"(d) REQUIREMENT OF STATE AND LOCAL MATCHING FUNDS.—

"(1) I N GENERAL.—With respect to the costs of providing any
scholarship pursuant to subsection (c), the Secretary may not
make a grant under subsection (a) unless the State involved
agrees that—
"(A) 40 percent of the costs of the scholarship will be paid
from the grant made under subsection (a) to the State; and
"(B) 60 percent of such costs will be paid from nonFederal contributions made in cash by both the State and
the community organization through which the scholarship
is provided, subject to—
"(i) the State making available through such contributions not less than 15 percent, nor more than 25
percent, of such costs; and
"(ii) the community organization making available
through such contributions not less than 35 percent,
nor more than 45 percent, of such costs.
"(2) DETERMINATION OF AMOUNT OF NON-FEDERAL CONTRIBU-

TIONS.—The Secretary may not make a grant under subsection
(a) unless the State involved agrees that, in determining the
amount of non-Federal contributions that have been provided in
cash for purposes of paragraph (1), the State will not include
any amounts provided by the Federal Government to the State
or community organization involved, or to any other entity.
"(3) USE OF DONATIONS.—Non-Federal contributions required
in paragraph (1) may be provided directly by the State and
community organization involved, and may be provided through
donations from public and private entities.
"(e) SPECIFICATIONS REGARDING SCHOLARSHIP CONTRACT.—The Secretary may not make a grant under subsection (a) unless the State
involved agrees that the State will make a grant to a community
organization for a contract described in subsection (c) only if—
"(1) the individual who is to receive the scholarship under the
contract is a resident of the health manpower shortage area in
which the community organization is located;
"(2) the individual is enrolled or accepted for enrollment as a
full-time student in a health professions school that is approved
by the Secretary for purposes of this section;
"(3) the individual agrees to maintain an acceptable level of
academic standing at the school (as determined by the school in
accordance with regulations issued by the Secretary for purposes of section 338A(fKlXBXiii));

104 STAT. 2330

PUBLIC LAW 101-527—NOV. 6, 1990

"(4) the individual and the community organization agree
that the scholarship provided pursuant to the contract—
"(A) will be expended only for—
*Xi) tuition expenses, other reasonable educational
expenses, and reasonable living expenses incurred in
attendance at the school; and
"(ii) payment to the individual of a monthly stipend
of not more than the amount authorized for purposes of
section 338A(gXlXB); and
"(B) will not, for any year of such attendance for which
the scholarship is provided, be in an amount exceeding the
total amount required for the year for the purposes
authorized in subparagraph (A);
"(5) the individual agrees to meet the educational and licensure requirements necessary to be a physician, certified nurse
practitioner, certified nurse midwife, or physician assistant; and
"(6) the individual agrees that, in providing primary health
care pursuant to the scholarship, the individusd—
"(A) will not, in the case of an individual seeking such
care, discriminate against the individual on the basis of the
ability of the individual to pay for such care or on the basis
that pajnnent for such care will be made pursuant to the
program established in title XVIII of the Social Security
Act or pursuant to the program established in title XIX of
such Act; and
"(B) will accept assignment under section 1842(bX3XBXii)
of the Social Security Act for all services for which pajnment
may be made under part B of title XVIII of such Act, and
will enter into an appropriate agreement with the State
agency that administers the State plan for medical assistance under title XIX of such Act to provide service to
individuals entitled to medical assistance under the plan.
"(f) REPORTS TO SECRETARY.—The Secretary may not make a grant
under subsection (a) unless the State involved agrees—
"(1) for each fiscal year for which such a grant is received by
the Stete, to submit to the Secretary a report—
"(A) identifying the community organizations providing
scholarships pursuant to subsection (c) and the health manpower shortage areas in which the organizations are
located;
"(B) providing the names of individuals receiving the
scholarships, the health professions in which the individuals will engage pursuant to the scholarships, the number
of years of service the individuals are obligated to provide
pursuant to the scholarships, and the extent of compliance
with the contracts under subsection (c) on the part of the
individuals and the community organizations; and
"(C) providing such information as the Secretary may
determine to be necessary for carrying out this section; and
"(2) to submit each such report not later than January 10 of
the fiscal year immediately following the fiscal year for which
the report is prepared.
"(g) ESTIMATES REGARDING ALLOCATIONS BETWEEN URBAN AND
RURAL AREAS.—The Secretary may not make a grant under subsec-

tion (a) unless the State involved submits to the Secretary, as part of
the application required in subsection (h), an estimate of the amount
of the grant that will be expended r ^ a r d i i ^ the provision of

PUBLIC LAW 101-527—NOV. 6, 1990

104 STAT. 2331

primary health care in urb£in health manpower shortage areas of
the State, and an estimate of the amount of the grant that will be
expended regarding the provision of such care in rural health
manpower shortage areas of the State.
"(h) REQUIREMENT OF APPUCATION.—The Secretary may not make
a grant under subsection (a) unless an application for the grant is
submitted to the Secretary and the application is in such form, is
made in such manner, and contains such agreements, assurances,
and information as the Secretary determines to be necessary to
carry out this section.
"(i) NONCOMPUANCE.—

"(1) IN GENERAL.—The Secretary may not make pajonents
under subsection (a) to a State for any fiscal year subsequent to
the first fiscal year of such pa3anents unless the Secretary
determines that, for the immediately preceding fiscal year, the
State has complied with each of the agreements made by the
State under this section.
"(2) REDUCTION IN GRANT RELATIVE TO NUMBER OF BREACHED
CONTRACTS.—

"(A) Before making a grant under subsection (a) to a
State for a fiscal year, the Secretary shall determine the
number of contracts provided under subsection (c) with
respect to which there has been an initial breach by the
community organizations or individuals involved during
the fiscal year preceding the fiscal year for which the State
is appl5dng to receive the grant.
"(B) In the case of a State with 1 or more initial breaches
for purposes of subparagraph (A), the Secretary shall
reduce the amount of a grant under subsection (a) to the
State for the fiscal year involved by an amount equal to the
sum of—
"(i) an amount equal to the expenditures of Federal
funds made regarding the contracts involved; and
"(ii) an amount representing interest on the amount
of such expenditures, determined with respect to each
contract on the basis of the maximum legal rate
prevailing for loans made during the time amounts
were paid under the contract, as determined by the
Treasurer of the United States.
"(C) If a State is not receiving a grant under subsection
(a) for a fiscal year for which a reduction under subparagraph (B) would have been made in the event that the State
had received such a grant, the Secretary shall reduce the
amount of payments due to the State under other grants,
cooperative agreements, or contracts under this Act by the
amount specified in such subparagraph.
"(D) With respect to contracts provided under subsection
(c), the Secretary may carry out this paragraph on the basis
of information submitted by the States involved, or on the
basis of information collected through such other means as
the Secretary determines to be appropriate.
"(j) REPORTS TO CONGRESS.—

"(1) I N GENERAL.—Each fiscal year the Secretary shall submit
to the Committee on Energy and Commerce of the House of
Representatives, and to the Committee on Labor and Human
Resources of the Senate, a report summarizing information

/
/

104 STAT. 2332

PUBLIC LAW 101-527—NOV. 6, 1990
received by the Secretary under subsection (f) for the preceding
fiscal year.
"(2) DATE FOR SUBMISSION.—With respect to a fiscal year, the

District of
Columbia.

report required in paragraph (1) shall be submitted for purposes
of such paragraph by not later than the date on which the
report required in section 338A(i) is required to be submitted for
purposes of such section,
"(k) DEFINITIONS.—For purposes of this section:
"(1) COMMUNITY ORGANIZATION.—The term 'community
organization' means a public or nonprofit private entity.
(2) PRIMARY HEALTH CARE.—The term 'primary health care'
means health services regarding family medicine, internal
medicine, pediatrics, or obstetrics and gynecology, that are
provided by physicians, certified nurse practitioners, certified
nurse midwives, or physician assistants.
"(3) STATE.—'The term 'State' means each of the several States
and the District of Columbia.
"G) FUNDING.—
"(1) AUTHORIZATION OF APPROPRIATIONS.—For the purpose of

making grants under subsection (a), there are authorized to be
appropriated $5,000,000 for fiscal year 1991, $10,000,000 for
fiscal year 1992, and such sums as may be necessary for fiscal
year 1993.
"(2) AVAILABILITY.—Amounts appropriated under paragraph
(1) shall remain available untU expended.
"(3) ALLOCATIONS FOR RURAL AREAS.—

Reports.

"(A) In canying out subsection (a), the Secretary shall, to
the extent practicable, ensure that not less than 50 percent
of the amounts appropriated under paragraph (1) are, in the
aggregate, expended for making grants pursuant to subsection (c) to community organizations that are located in
rural health manpower shortage areas.
"(B) Subparagraph (A) may not be construed to prohibit
the Secretary from making grants under subsection (a) to
States in which no rural health manpower shortage areas
are located.
"(C) With respect to any fiscal year for which the Secretary is unable to comply with subparagraph (A), the
Secretary shall, not later than April 1 of the sulxsequent
fiscal year, submit to the Committee on Energy and Commerce of the House of Representatives, and to the Committee on Labor and Human Resources of the Senate, a report
stating the fact of such noncompliance and an explanation
of the reasons underlying such noncompliance.".
SEC. 9. COMMUNITY AND MIGRANT HEALTH CENTERS.
(a) COMMUNITY HEALTH CENTERS.—
(1) PARALLEL STATUS WITH MIGRANT HEALTH CENTERS REGARDING CERTAIN SERVICES.—Section 330 of the Public Health Service

Act (42 U.S.C. 254c) is amended—
(A) in subsection (aX5), by amending such section to read
as follows:
"(5) information on the availability and proper use of health
services and services which promote and facilitate optimal use
of health services, including, if a substantial number of the
individuals in the population served by a center are of limited
English-speaking ability, the services of appropriate personnel

PUBLIC LAW 101-527—NOV. 6, 1990

104 STAT. 2333

fluent in the language spoken by a predominant number of such
individuals, and , and
(B) in subsection (bX2)—
(i) in subparagraph (L), by adding "and" after the
semicolon at the end; and
(ii) by striking subparsigraph (M) and redesignating
subparagraph (N) as subparagraph (M).
(2) AUTHORIZATION OF APPROPRIATIONS.—Section 330(g) of the
Public Health Service Act (42 U.S.C. 254cO?)) is amended—
(1) in paragraph (IXA)—
(A) by striking "1989 and" and inserting "1989,"; and
(B) by inserting before the period the following: ", and
such sums as may be necessary for each of the fiscsd years
1992 through 1994"; and
(2) in paragraph (2XA)—
(A) by striking "and" after "1990,"; and
(B) by inserting before the period the following: ", and
such sums as may be necessary for each of the fiscal years
1992 through 1994".
(b) AUTHORIZATION OF APPROPRIATIONS FOR MIGRANT HEALTH CEN-

TERS.—Section 329(h) of the Public Health Service Act (42 U.S.C.
254b(h)) is amended—
(1) in paragraph (IXA)—
(A) by striking "1989 and" and inserting "1989,"; and
(B) by inserting before the period the following: ", and
such sums as may be necessary for each of the fiscal years
1992 through 1994"; and
(2) in paragraph (2XA)—
(A) by striking "and" after "1990,"; and
(B) by inserting before the period the following: ", and
such sums as may be necessary for each of the fiscal years
1992 through 1994".
SEC. 10. GRANTS FOR HEALTH SERVICES FOR PACIFIC ISLANDERS.

(a) GRANTS.—The Secretary of Health and Human Services (hereafter in this section referred to as the "Secretary") shall provide
grants to, or enter into contracts with, public or private nonprofit
agencies that have demonstrated experience in serving the health
needs of Pacific Islanders living in the Territory of American
Samoa, the Commonwealth of Northern Mariana Islands, the Territory of Guam, the Republic of the Marshall Islands, the Republic of
Palau, and the Federated States of Micronesia.
(b) USE OF GRANTS OR CONTRACTS.—Grants or contracts made or
entered into under subsection (a) shall be used, among other items—
(1) to continue, as a priority, the medical officer training
program in Pohnpei, Federated States of Micronesia;
(2) to improve the quality and availability of health and
mental health services and systems, with an emphasis therein
on preventive health services and health promotion programs
and projects, including improved health data systems;
(3) to improve the quality and availability of health manpower, including programs and projects to train new and upgrade the skills of existing health professionals by—
(A) establishing dental officer, dental assistant, nurse
practitioner, or nurse clinical specialist training programs;
(B) providing technical training of new auxiliary health
workers;

42 USC 254c-l.

\

104 STAT. 2334

Hawaii.

PUBLIC LAW 101-527—NOV. 6, 1990

(C) upgrading the training of currently employed health
personnel in special areas of need;
(D) developing long-term plans for meeting health profession needs;
(E) developing or improving programs for faculty
enhancement or post-doctoral training; and
(F) providing innovative health professions training initiatives (including scholarships) targeted toward ensuring
that residents of the Pacific Basin attend and graduate
from recognized health professional programs;
(4) to improve the quality of health services, including laboratory, x-ray, and pharmacy, provided in ambulatory and
inpatient settings through quality assurance, standard setting,
and other culturally appropriate means;
(5) to improve facility and equipment repair and maintenance
systems;
(6) to improve alcohol, drug abuse, and mental health prevention and treatment services and systems;
(7) to improve local and regional health planning systems; and
(8) to improve basic local public health systems, with particular attention to primary care £ind services to those most in need.
No funds under subsection (b) shall be used for capital construction.
(c) ADVISORY COUNCIL.—The Secretary of Health and Human
Services shall establish a "Pacific Health Advisory Council" which
shall consist of 12 members and shall include—
(1) the Directors of the Health Departments for the entities
identified in subsection (a); and
(2) 6 members, including a representative of the Rehabilitation Hospital of the Pacific, representing organizations in the
State of Hawaii actively involved in the provision of health
services or technical assistance to the entities identified in
subsection (a). The Secretary shall solicit the advice of the
Governor of the State of Hawaii in appointing the 5 Council
members in addition to the representative of the Rehabilitation
Hospital of the Pacific from the State of Hawaii.
The Secretary shall be responsible for providing sufficient staff
support to the Council.
(d) ADVISORY COUNCIL FUNCTIONS.—The Council shall meet at
least annually to—
(1) recommend priority areas of need for funding by the
Public Health Service under this section; and
(2) review progress in addressing priority areas and make
recommendations to the Secretary for needed program modifications.
(e) REPORT.—The Secretary, in consultation with the Council, shall
annually prepare and submit to the appropriate committees of
Congress a report describing the expenditure of the funds
authorized to be appropriated under this section and any recommendations that the Secretary may have.
(f) AUTHORIZATION OF APPROPRIATION.—There is authorized to be
appropriated to carry out this section $10,000,000 for each of the
fiscal years 1991 through 1993.
SEC. 11. MISCELLANEOUS PROVISIONS.

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

PUBLIC LAW 101-527—NOV. 6, 1990

104 STAT. 2335

SEC. 12. EFFECTIVE DATE.

This Act and the amendments made by this Act shall take effect
October 1, 1990, or upon the date of the enactment of this Act,
whichever occurs later.
Approved November 6, 1990.

LEGISLATIVE HISTORY—H.R. 5702:
HOUSE REPORTS: No. 101-804 (Comm. on Education and Labor).
CONGRESSIONAL RECORD, Vol. 136 (1990):
Oct. 10, considered and passed House.
Oct. 16, considered and passed Senate.
WEEKLY COMPILATION OF PRESIDENTIAL DOCUMENTS, Vol. 26 (1990):
Nov. 6, Presidential statement.

42 USC 242k
note.