H.R. 3240 — Disadvantaged Minority Health Improvement Act of 1989

 
HR 3240 IH
101st CONGRESS
1st Session
 H. R. 3240
To amend the Public Health Service Act to improve the health of individuals
who are members of minority groups and who are from disadvantaged backgrounds,
and for other purposes.
IN THE HOUSE OF REPRESENTATIVES
September 11, 1989
Mr. STOKES introduced the following bill; which was referred to the Committee
on Energy and Commerce
A BILL
To amend the Public Health Service Act to improve the health of individuals
who are members of minority groups and who are from disadvantaged backgrounds,
and for other purposes.
  Be it enacted by the Senate and House of Representatives of the United
  States of America in Congress assembled,
SECTION 1. SHORT TITLE.
  This Act may be cited as the `Disadvantaged Minority Health Improvement
  Act of 1989'.
SEC. 2. FINDINGS.
  Congress finds that--
  (1) the health status of racial and ethnic minorities in the United States
  is significantly lower than the health status of the general population
  of the United States;
  (2) minorities suffer disproportionately high rates of cancer, stroke,
  heart diseases; diabetes, substance abuse, acquired immune deficiency
  syndrome, and other diseases and disorders;
  (3) the incidence of infant mortality among minorities is almost double
  that for the general population;
  (4) Blacks, Hispanics, and Native Americans constitute approximately 12
  percent, 7.9 percent, and 0.01 percent, respectively, of the population
  of the United States;
  (5) 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;
  (6) the number of individuals who are both members of minority groups and
  from disadvantaged backgrounds in health professions should be increased
  for the purpose of improving the access of other such individuals to
  health services;
  (7) historically, the mission of minority health professions institutions
  has been to increase the number of minority health practitioners to serve
  the medically needy;
  (8) such institutions (and other health professions institutions), and
  disadvantaged minority individuals, should receive Federal financial
  assistance to facilitate an increase in the number of such individuals in
  the health professions;
  (9) 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
  (10) 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 minorities, including the implementation of the recommendations made
  by the Secretary's Task Force on Black and Minority Health.
TITLE I--HEALTH PROMOTION AND DISEASE PREVENTION FOR MINORITIES
Subtitle A--Programs for Minorities Generally
SEC. 101. ESTABLISHMENT OF OFFICE OF MINORITY HEALTH AND AUTHORITY OF OFFICE
TO MAKE GRANTS FOR PREVENTION AND CONTROL OF PREVALENT DISEASES.
  Title XVII of the Public Health Service Act (42 U.S.C. 300u et seq.) is
  amended by adding at the end thereof the following new section:
`SEC. 1707. ESTABLISHMENT OF OFFICE OF MINORITY HEALTH.
  `(a) IN GENERAL- The Secretary shall establish in the Office of the
  Assistant Secretary for Health an Office of Minority Health. The Secretary
  shall appoint a Deputy Assistant Secretary of Minority Health, who shall
  serve as Director of such Office.
  `(b) FUNCTIONS- The Office of Minority Health shall, with respect to the
  health concerns of the members of minority groups--
  `(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 minority health, prevention, health promotion, service delivery,
  and research;
  `(2) coordinate efforts to promote minority health programs and policies
  in the voluntary and corporate sectors;
  `(3) establish a national minority health resource center to facilitate the
  exchange of information concerning 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); and
  `(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 minority
  populations.
  `(c) GRANTS- The Secretary, acting through the Director of the Office of
  Minority Health, may under subsection (b)(4) make grants to, and enter
  into contracts with, public and nonprofit private entities for the purpose
  of conducting programs of research, training, education, epidemiological
  studies, and data collection, with respect to the prevention and control
  among minority groups of diseases or other adverse health conditions
  determined by the Secretary to be prevalent among such groups.
  `(d) AUTHORIZATION OF APPROPRIATIONS- For the purpose of carrying out this
  section, there are authorized to be appropriated $10,000,000 for fiscal
  year 1990, $12,000,000 for fiscal year 1991, and $15,000,000 for fiscal
  year 1992.'.
SEC. 102. DUTIES OF SECRETARY WITH RESPECT TO MINORITY HEALTH.
  Title XVII of the Public Health Service Act (42 U.S.C. 300u et seq.) (as
  amended by section 101), is further amended by adding at the end thereof
  the following new section:
`SEC. 1708. GENERAL AUTHORITY WITH RESPECT TO MINORITY HEALTH.
  `With respect to the health concerns of the members of minority groups,
  the Secretary shall administer this title in cooperation with health care
  providers, educators, voluntary and professional organizations, businesses,
  State and local health agencies, and other minority organizations.'.
SEC. 103. GRANTS TO IMPROVE THE HEALTH STATUS OF DISADVANTAGED MINORITIES.
  Title XVII of the Public Health Service Act (42 U.S.C. 300u et seq.) (as
  amended by sections 101 and 102), is further amended by adding at the end
  thereof the following new section:
`SEC. 1709. GRANTS TO IMPROVE THE HEALTH STATUS OF DISADVANTAGED MINORITIES.
  `(a) IN GENERAL- The Secretary, acting through the Director of the Office
  of Minority Health, shall make grants to, or enter into contracts with,
  public or private nonprofit entities to enable such entities to conduct
  and support new and innovative programs in health information and health
  promotion, preventive health services, and education in the appropriate
  use of health care, specifically targeted at improving the health status
  of disadvantaged minorities.
  `(b) SPECIFIC ILLNESSES- In supporting programs designed to reduce the
  incidence of specific illnesses among disadvantaged minorities, the
  Secretary may--
  `(1) support demonstration programs involving the provision of health
  care services;
  `(2) provide consultation and technical assistance to entities that request
  help in planning, operating and evaluating programs described in subsection
  (a);
  `(3) develop health information and health promotion materials and teaching
  programs, including--
  `(A) model curriculums for training the health professionals;
  `(B) model curriculums to be used in primary and secondary schools and
  institutions of higher learning;
  `(C) materials and programs for the continuing education of health
  professionals;
  `(D) materials for public service use by the print and broadcast media; and
  `(E) materials and programs to assist health care professionals in providing
  health education to their patients; and
  `(4) support demonstration and evaluation programs for individual and
  group self-help programs designed to assist the participant in using their
  capacities to reduce health risks.
  `(b) AUTHORIZATION OF APPROPRIATIONS- There are authorized to be appropriated
  $10,000,000 in fiscal year 1990, $20,000,000 in fiscal year 1991, and
  $30,000,000 in each of the fiscal years 1992 and 1993, to carry out this
  section.'.
Subtitle B--Programs for American Samoa
SEC. 111. HEALTH SERVICES FOR AMERICAN SAMOANS.
  Title XVII of the Public Health Service Act (42 U.S.C. 300u et seq.) (as
  amended by subtitle A), is further amended by adding at the end thereof
  the following new section:
`SEC. 1710. HEALTH SERVICES FOR AMERICAN SAMOANS.
  `(a) GRANTS- The Secretary shall provide grants to, or enter into contracts
  with, public or private nonprofit agencies that have demonstrated experience
  in serving the health and social service needs of American Samoans living
  in the State of Hawaii and the Continental United States.
  `(b) USE OF GRANTS OR CONTRACTS- Grants or contracts made or entered into
  under subsection (a) shall be used--
  `(1) to employ health professionals and bilingual individuals to provide
  health promotion and disease prevention services, focusing on specific
  problems such as maternal and child health, nutrition, mental illness,
  and adolescent violence, in the State of Hawaii; and
  `(2) to plan for extension of the services described in paragraph (1)
  to American Samoans living in the Continental United States.
  `(c) CONSULTATION- Prior to the awarding of any grant or contract under
  this section in the State of Hawaii, the Secretary shall consult the
  Governor of the State of Hawaii.
  `(d) AUTHORIZATION OF APPROPRIATIONS- There are authorized to be appropriated
  to carry out this section $1,000,000 for fiscal year 1990, $2,000,000 for
  fiscal year 1991, and $3,000,000 for each of the fiscal years 1992 and
  1993. Of the amounts appropriated to carry out this section, not more than
  $1,000,000 shall be used in fiscal year 1992, and not more than $2,000,000
  shall be used in fiscal year 1993, to provide grants to, or enter into
  contracts with, public or private nonprofit agencies in the Continental
  United States as provided in subsection (b)(2).'.
TITLE II--DISADVANTAGED MINORITIES IN HEALTH PROFESSIONS
Subtitle A--Health Professions Generally
SEC. 201. FEDERAL CAPITAL CONTRIBUTIONS TO CERTAIN STUDENT LOAN FUNDS.
  (a) IN GENERAL- Section 740 of the Public Health Service Act (42 U.S.C. 294m)
  is amended--
  (1) by redesignating subsection (c) as subsection (d); and
  (2) by inserting after subsection (b) the following new subsection:
  `(c)(1) Each agreement entered into under this section with a school shall
  provide (in addition to the provisions required under subsection (b))
  that any Federal capital contribution made to the student loan fund of the
  school from amounts appropriated pursuant to section 742(c)(1), 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 making loans to individuals who are members of underrepresented
  minority groups and who are from disadvantaged backgrounds.
  `(2) Repayments to the student loan fund involved shall be utilized only
  for the purpose described in paragraph (1).
  `(3) Federal capital contributions made pursuant to an agreement under
  subsection (a) to the student loan fund of a school from amounts
  appropriated pursuant to section 742(a), together with the school
  contributions appropriate under subsection (b)(2)(B) to the amount of the
  Federal capital contributions, may be utilized for the purpose of making
  loans to individuals as described in paragraph (1).'.
  (b) DEFINITION WITH RESPECT TO UNDERREPRESENTATION- Section 740 of the
  Public Health Service Act (42 U.S.C. 294m) is amended by adding at the
  end thereof the following new subsection:
  `(e) As used in this section the term `underrepresented minority group'
  means any minority group whose representation in the health professions,
  expressed in terms of percentages, is less than the percentage of the
  general population constituted by the number of individuals who are members
  of the minority group.'.
  (c) AUTHORIZATION OF APPROPRIATIONS- Section 742 of the Public Health
  Service Act (42 U.S.C. 294o) is amended by adding at the end thereof the
  following new subsection:
  `(c)(1) For the purpose of making Federal capital contributions to the
  student loan funds of schools that have established such funds under section
  740, and that have made agreements under subsection (c) of such section,
  there are authorized to be appropriated $20,000,000 for each of the fiscal
  years 1990 through 1992.
  `(2) The Secretary shall make available not less than 50 percent of
  the amounts appropriated under paragraph (1), to carry out paragraph (1)
  through schools described in such paragraph at which individuals described
  in section 740(c) constitute not less than 50 percent of the total number
  of individuals enrolled at the school.'.
SEC. 202. ASSISTANCE PROGRAMS FOR DISADVANTAGED MINORITY HEALTH STUDENTS.
  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 Disadvantaged Minority Students
`SEC. 760. GRANTS FOR SCHOLARSHIPS.
  `(a) Authority-
  `(1) IN GENERAL- The Secretary may make grants to health professions schools
  for the purpose of assisting such schools in providing scholarships to
  individuals who--
  `(A) are members of underrepresented minority groups (as defined in
  section 740(e));
  `(B) are from disadvantaged backgrounds; and
  `(C) are enrolled (or accepted for enrollment) as full-time students in
  such schools.
  `(2) HEALTH PROFESSIONS SCHOOLS- As used in this subpart the term `health
  professions schools' means schools--
  `(A) that are public or nonprofit private schools of medicine, osteopathic
  medicine, dentistry, pharmacy, podiatry, optometry, veterinary medicine,
  public health, allied health, or public and nonprofit private schools
  that offer graduate programs in clinical psychology that are accredited
  as provided in section 721(b)(1)(B); and
  `(B) at which individuals described in paragraph (1) constitute not less
  than 50 percent of the total number of individuals enrolled at the school.
  `(b) Form and Limitations on Scholarship-
  `(1) FORM OF SCHOLARSHIP- A scholarship provided to a student for a school
  year under a grant under subsection (a) may consist of all or part of--
  `(A) payment to, or (in accordance with paragraph (3)) on behalf of,
  the student of the amount of--
  `(i) the tuition of the student in such school year; and
  `(ii) all other reasonable educational expenses, including fees, books,
  and laboratory expenses, incurred by the student in such year; and
  `(B) payment to the student of a stipend not in excess $400 per month
  (adjusted in accordance with paragraph (4)) for each of the 12 consecutive
  months beginning with the first month of such school year.
  `(2) TOTAL AWARD- Notwithstanding paragraph (1), the total amount of a
  scholarship awarded to a student for each year shall not exceed the cost
  of attendance for that year at the educational institution attended by
  the student (as determined by such educational institution).
  `(3) CONTRACT WITH INSTITUTION- The Secretary may contract with an
  educational institution that has enrolled a student who has received
  a scholarship with a grant under subsection (a) for the payment to the
  educational institution of the amounts of tuition and other reasonable
  educational expenses described in paragraph (1)(A). Payment to such an
  educational institution may be made without regard to section 3324 of
  title 31, United States Code.
  `(4) ADJUSTMENT IN STIPEND- The amount of the maximum allowable monthly
  stipend, specified in paragraph (1)(B) and as previously adjusted (if at all)
  in accordance with this paragraph, shall be increased by the Secretary for
  each school year by an amount (rounded to the next highest multiple of $1)
  equal to the amount of such stipend multiplied by the overall percentage
  (as set forth in the report transmitted to the Congress under section 5305
  of title 5, United States Code) of the adjustment (if such adjustment is
  an increase) in the rates of pay under the General Schedule made effective
  in the fiscal year in which such school year ends.
  `(c) Application-
  `(1) REQUIREMENT- The Secretary shall not make a grant under subsection
  (a) unless an application for such grant is submitted to the Secretary.
  `(2) ASSURANCES- Applications submitted under paragraph (1) shall,
  provide assurances that the applicant will comply with this subpart and
  shall otherwise be in such form, made in such manner, and contain such
  agreements, assurances, and information as the Secretary determines to be
  necessary to carry out this section.
  `(d) Authorization of Appropriations-
  `(1) To carry out subsection (a), there are authorized to be appropriated
  $25,000,000 for fiscal year 1989, $30,000,000 for fiscal year 1990, and
  $35,000,000 for fiscal year 1991.
  `(2) The Secretary shall make available not less than 50 percent of
  the amounts appropriated under paragraph (1), to carry out paragraph (1)
  through schools described in such paragraph at which individuals described
  in section 740(c) constitute not less than 50 percent of the total number
  of individuals enrolled at the school.
`SEC. 761. LOAN REPAYMENT PROGRAM.
  `(a) Establishment-
  `(1) IN GENERAL- The Secretary shall establish a loan repayment program
  (hereinafter in this subpart referred to as the `program') in order to
  assure an adequate supply of trained physicians, dentists, and nurses,
  podiatrists, optometrists, pharmacists, clinical psychologists, graduates
  of schools of veterinary medicine, graduates of schools of public health,
  graduates of programs in health administration, graduates of programs for
  the training of physician assistants, expanded function dental auxiliaries,
  and nurse practitioners (as defined in section 822), and other health
  professionals, who are individuals of the type described in paragraph (2).
  `(2) MINORITIES- Individuals referred to in paragraph (1) are individuals
  who--
  `(A) are members of underrepresented minority groups (as defined in
  section 740(e));
  `(B) are from disadvantaged backgrounds;
  `(C) are enrolled (or accepted for enrollment) as full-time students at
  a school of the type described in section 760(a); and
  `(D) are in the final year of a course of study leading to a degree from
  the school.
  `(b) ELIGIBILITY- To be eligible to participate in the program, an
  individual shall--
  `(1) meet the requirements of subsection (a)(2);
  `(2)(A) be enrolled--
  `(i) as a full-time student--
  `(I) in an accredited (as determined by the Secretary) educational
  institution of the type described in section 760(a) in a State; and
  `(II) in the final year of a course of study or program, offered by such
  institution and approved by the Secretary, leading to a degree in medicine,
  osteopathic medicine, dentistry, pharmacy, podiatry, optometry, veterinary
  medicine, psychology, public health or allied health; or
  `(ii) in an approved graduate training program in medicine, osteopathic
  medicine, dentistry, pharmacy, podiatry, optometry, veterinary medicine,
  psychology, public health or allied health; or
  `(B) have--
  `(i) a degree in medicine, osteopathic medicine, dentistry, pharmacy,
  podiatry, optometry, veterinary medicine, psychology, public health or
  allied health;
  `(ii) completed an approved graduate training program in medicine,
  osteopathic medicine, dentistry, pharmacy, podiatry, optometry, veterinary
  medicine, psychology, public health or allied health, except that the
  Secretary may waive the completion requirement of this clause for good
  cause; and
  `(iii) a license to practice medicine, osteopathic medicine, dentistry,
  pharmacy, podiatry, optometry, veterinary medicine, psychology, public
  health or allied health in a State; or
  `(C) be enrolled in the final year of a graduate program in health
  administration, physician assistant training, dental auxiliary training,
  or nurse practitioner training;
  `(3) submit an application to participate in the program; and
  `(4) sign and submit to the Secretary, at the time of the submission of
  an application under paragraph (3), a written contract (as described in
  subsection (f)) to accept repayment of educational loans and to serve on
  the faculty of an institution as described in subsection (f)(1)(B).
  `(c) Application, Contract, and Information Requirements-
  `(1) SUMMARY AND INFORMATION- In disseminating application forms and
  contract forms to individuals desiring to participate in the program,
  the Secretary shall include with such forms--
  `(A) a fair summary of the rights and liabilities of an individual whose
  application is approved (and whose contract is accepted) by the Secretary,
  including in the summary a clear explanation of the damages to which the
  United States is entitled in the case of the individual's breach of the
  contract; and
  `(B) information respecting obtaining a full-time faculty appointment
  for not less than 2 years as provided in subsection (f)(2)(D) and such
  other information as may be necessary for the individual to understand
  the individual's prospective participation in the program.
  `(2) UNDERSTANDABILITY- The application form, contract form, and all other
  information furnished by the Secretary under this subpart shall be written
  in a manner calculated to be understood by the average individual applying
  to participate in the program.
  `(3) AVAILABILITY- The Secretary shall make such application forms,
  contract forms, and other information available to individuals desiring
  to participate in the program on a date sufficiently early to ensure that
  such individuals have adequate time to carefully review and evaluate such
  forms and information.
  `(d) PRIORITY- In determining which applications under the program to
  approve (and which contracts to accept), the Secretary shall give priority
  to applications made by individuals whose training is in a health profession
  or specialty determined by the Secretary to be the most desirable.
  `(e) Approval Required for Participation-
  `(1) IN GENERAL- An individual becomes a participant in the program only
  on the approval of the Secretary of the individual's application submitted
  under subsection (b)(3) and the acceptance by the Secretary of the contract
  entered into by the individual under subsection (b)(4).
  `(2) WRITTEN NOTICE- The Secretary shall provide written notice to an
  individual promptly on--
  `(A) the Secretary's approving, under paragraph (1), of the individual's
  participation in the program; or
  `(B) the Secretary's disapproving an individual's participation in such
  program.
  `(f) CONTENTS OF CONTRACTS- The written contract (referred to in this
  subpart) between the Secretary and an individual shall contain--
  `(1) an agreement that--
  `(A) subject to paragraph (3), the Secretary agrees to pay on behalf of
  the individual, loans in accordance with subsection (g);
  `(B) subject to paragraph (3), the individual agrees to accept an offer
  of any school described in subsection (a)(1)--
  `(i) at which individuals as described in subsection (a)(2)(A) constitute
  not less than 50 percent of the total number of individuals enrolled at
  the school; and
  `(ii) that offers the applicant a full-time faculty appointment at the
  school for not less than 2 years;
  `(2) an agreement by the applicant--
  `(A) to accept loan payments on behalf of the applicant;
  `(B) to maintain enrollment in a course of study or training described
  in subsection (b)(2) until the individual completes the course of study
  or training;
  `(C) that while enrolled in such course of study or training, the applicant
  shall maintain an acceptable level of academic standing (as determined
  under regulations of the Secretary by the educational institution offering
  such course of study or training);
  `(D) to serve for a time period (hereinafter in this subpart referred
  to as the `period of obligated service') equal to 2 years or such longer
  period as the individual may agree to, as a faculty member as described
  in paragraph (1)(B);
  `(E) to complete the requirements established by such school for a degree
  from the school; and
  `(F) that, with respect to any violation by the applicant of an agreement
  entered into pursuant to this subsection, to pay such liquidated damages
  for such violation as the Secretary may by regulation prescribe.
  `(3) a provision permitting the Secretary to extend for such longer
  additional periods, as the individual may agree to, the period of obligated
  service agreed to by the individual under paragraph (2)(D);
  `(4) a provision that any financial obligation of the United States arising
  out of a contract entered into under this subpart and any obligation of
  the individual that is conditioned thereon, is contingent on funds being
  appropriated for loan repayments under this subpart;
  `(5) a statement of the damages to which the United States is entitled to
  for the individual's breach of the contract; and
  `(6) such other statements of the rights and liabilities of the Secretary
  and of the individual, not inconsistent with this subpart.
  `(g) Payments-
  `(1) IN GENERAL- A loan repayment provided for an individual under a written
  contract under the program shall consist of payment, in accordance with
  paragraph (2), on behalf of the individual of the principal, interest,
  and related expenses on government and commercial loans received by the
  individual for--
  `(A) tuition expenses;
  `(B) all other reasonable educational expenses, including fees, books,
  and laboratory expenses, incurred by the individual; or
  `(C) reasonable living expenses as determined by the Secretary.
  `(2) Payments for years served-
  `(A) IN GENERAL- Except as provided in subparagraph (B) and paragraph (3),
  for each year for which an individual accepts, pursuant to subsection
  (f)(2)(D), an offer to serve as a member of the faculty of a school
  described in subsection (a)(1), the Secretary may, subject to paragraph
  (2), pay not more than $20,000 on behalf of the individual for loans
  described in such subsection.
  `(B) REPAYMENT SCHEDULE- Any arrangement made by the Secretary for the
  making of loan repayments in accordance with this subsection shall provide
  that any repayments for a year of obligated service shall be made no later
  than the end of the fiscal year in which the individual completes such
  year of service.
  `(C) MAXIMUM AMOUNT OF PAYMENTS- Payments made on behalf of an individual
  pursuant to subparagraph (A) shall not exceed $80,000.
  `(3) TAX LIABILITY- In addition to payments made under paragraph (2), in
  any case in which payments on behalf of an individual under the program
  result in an increase in Federal, State, or local income tax liability for
  such individual, the Secretary may, on the request of such individual,
  make payments to such individual in a reasonable amount, as determined
  by the Secretary, to reimburse such individual for all or part of the
  increased tax liability of the individual.
  `(4) PAYMENT SCHEDULE- The Secretary may enter into an agreement with
  the holder of any loan for which payments are made under the program to
  establish a schedule for the making of such payments.
  `(h) EMPLOYMENT CEILING- Notwithstanding any other provision of law,
  individuals who have entered into written contracts with the Secretary
  under this section, while undergoing academic or other training, shall
  not be counted against any employment ceiling affecting the Department.
  `(i) Termination, Waiver, or Suspension of Obligation-
  `(1) TERMINATION- Any obligation of an individual under a contract entered
  into under this section for service or payment of damages shall be terminated
  on the death of the individual.
  `(2) WAIVER OR SUSPENSION- The Secretary shall by regulation provide for
  the partial or total waiver or suspension of any obligation of service or
  payment by an individual under a contract entered into under this section
  (a) whenever compliance by the individual is impossible or would involve
  extreme hardship to the individual and if enforcement of such obligation
  with respect to any individual would be unconscionable.
  `(3) BANKRUPTCY- Any debt that is a loan insured under this section may
  be released by a discharge in bankruptcy under any chapter of title 11,
  United States Code, only if such discharge is granted--
  `(A) after the expiration of the 5-year period beginning on the date that
  payment of such debt is first required; and
  `(B) on a finding by the Bankruptcy Court that the nondischarge of such
  debt would be unconscionable.
  `(j) REPORTS- The Secretary shall, not later than March 1 of each year,
  prepare and submit to the appropriate Committees of Congress a report
  specifying--
  `(1) the number, and type of health profession training, of individuals
  receiving loan payments under the program;
  `(2) the educational institution at which such individuals are receiving
  their training;
  `(3) the number of applications filed under this section in the school
  year beginning in such year and in prior school years; and
  `(4) the amount of loan payments made in the year reported on.
  `(k) AUTHORIZATION OF APPROPRIATIONS- There are authorized to be appropriated
  to carry out this section $3,000,000 for each of the fiscal years 1990
  through 1992.'.
Subtitle B--Nursing
SEC. 211. ESTABLISHMENT OF ADDITIONAL ASSISTANCE PROGRAMS FOR DISADVANTAGED
MINORITY NURSING STUDENTS.
  Part B of title VIII of the Public Health Service Act (42 U.S.C. 297 et
  seq.) is amended by adding at the end thereof the following new subparts:
`Subpart V--Assistance for Disadvantaged Minority Students
`SEC. 848. SCHOLARSHIPS FOR MINORITY INDIVIDUALS.
  `(a) Grants-
  `(1) IN GENERAL- The Secretary may make grants to schools of nursing,
  as described in paragraph (2), for the purpose of assisting such schools
  in providing scholarships to individuals who--
  `(A) are members of underrepresented minority groups;
  `(B) are from disadvantaged backgrounds; and
  `(C) are enrolled (or accepted for enrollment) as full-time students in
  such schools.
  `(2) SCHOOLS OF NURSING-
  `(A) DEFINITION- As used in this section, the term `schools of nursing'
  means public or nonprofit private schools accredited for the education
  of professional nurses at which individuals described in paragraph (1)
  constitute not less than 50 percent of the total number of individuals
  enrolled at such school.
  `(B) USE OF FUNDS- The Secretary may use not to exceed 15 percent of the
  amounts appropriated under this section for grants to schools of nursing
  with programs for minority populations in rural America, notwithstanding
  the 50 percent minority requirement described in subparagraph (A) for
  individuals enrolled at such school.
  `(3) UNDERREPRESENTED MINORITY GROUP- As used in this section, the
  term `underrepresented minority group' means any minority group whose
  representation in the nursing profession, expressed in terms of percentages,
  is less than the percentage of the general population constituted by the
  number of individuals who are members of the minority group.
  `(b) USE OF SCHOLARSHIP- A scholarship provided pursuant to subsection (a)
  for attendance at a school described in paragraph (2) of such subsection--
  `(1) shall be expended for tuition expenses, other reasonable educational
  expenses, and reasonable living expenses incurred in such attendance; and
  `(2) shall 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).
  `(c) Application-
  `(1) REQUIREMENT- The Secretary shall not make a grant under subsection
  (a) unless an application for the grant is submitted to the Secretary.
  `(2) ASSURANCES- Applications submitted under paragraph (1) shall be in
  such form, made in such manner, and contain such agreements, assurances,
  and information as the Secretary determines to be necessary to carry out
  such subsection, and shall, with respect to carrying out the purpose for
  which the grant is to be made, provide assurances of compliance satisfactory
  to the Secretary.
  `(d) AUTHORIZATION OF APPROPRIATIONS- For the purpose of making grants
  under subsection (a), there are authorized to be appropriated $25,000,000
  for fiscal year 1990, $30,000,000 for fiscal year 1991, and $35,000,000
  for fiscal year 1992.
`SEC. 849. LOAN REPAYMENT PROGRAM FOR MINORITY INDIVIDUALS.
  `(a) Establishment-
  `(1) IN GENERAL- The Secretary shall establish a loan repayment program
  (hereinafter referred to in this subpart as the `program') for the purpose of
  assisting individuals who meet the requirements of paragraph (2) in paying
  the principal and interest on Government and commercial loans received
  by such individuals for tuition expenses, other reasonable educational
  expenses, and reasonable living expenses incurred by such individuals in
  attending schools of nursing.
  `(2) ELIGIBLE INDIVIDUALS- Individuals referred to in paragraph (1) are
  individuals who--
  `(A) are members of underrepresented minority groups (as defined in
  section 848(a)(3));
  `(B) are from disadvantaged backgrounds;
  `(C) are enrolled (or accepted for enrollment) as full-time students at
  a school described in paragraph (3); and
  `(D) are in the final year of a course of study leading to a degree from
  such school.
  `(3) SCHOOLS OF NURSING- As used in this section, the term `schools of
  nursing' means public or nonprofit private schools--
  `(A) that are accredited schools of nursing; and
  `(B) at which individuals described in paragraph (2) constitute not less
  than 50 percent of the total number of individuals enrolled at the school.
  `(b) ELIGIBILITY- To be eligible to participate in the program, an
  individual shall--
  `(1) meet the requirements of subsection (a)(2);
  `(2) submit an application to participate in the program; and
  `(3) sign and submit to the Secretary, at the time of the submission of
  an application under paragraph (2), a written contract (as described in
  subsection (e)) to accept repayment of educational loans and to serve on
  the faculty of an institution as described in subsection (e)(2)(D).
  `(c) Application, Contract, and Information Requirements-
  `(1) SUMMARY AND INFORMATION- In disseminating application forms and
  contract forms to individuals desiring to participate in the program,
  the Secretary shall include with such forms--
  `(A) a fair summary of the rights and liabilities of an individual whose
  application is approved (and whose contract is accepted) by the Secretary,
  including in the summary a clear explanation of the damages to which the
  United States is entitled in the case of the individual's breach of the
  contract; and
  `(B) information respecting obtaining a full-time faculty appointment
  for not less than 2 years as provided in subsection (e)(2)(D) and such
  other information as may be necessary for the individual to understand
  the individual's prospective participation in the program.
  `(2) UNDERSTANDABILITY- The application form, contract form, and all other
  information furnished by the Secretary under this subpart shall be written
  in a manner calculated to be understood by the average individual applying
  to participate in the program.
  `(3) AVAILABILITY- The Secretary shall make such application forms,
  contract forms, and other information available to individuals desiring
  to participate in the program on a date sufficiently early to ensure that
  such individuals have adequate time to carefully review and evaluate such
  forms and information.
  `(d) Approval Required for Participation-
  `(1) IN GENERAL- An individual becomes a participant in the program only
  on the approval of the Secretary of the individual's application submitted
  under subsection (b)(3) and the acceptance by the Secretary of the contract
  entered into by the individual under subsection (b)(3).
  `(2) WRITTEN NOTICE- The Secretary shall provide written notice to an
  individual promptly on--
  `(A) the Secretary's approving, under paragraph (1), of the individual's
  participation in the program; or
  `(B) the Secretary's disapproving an individual's participation in such
  program.
  `(e) CONTENTS OF CONTRACTS- The written contract (referred to in this
  section) between the Secretary and an individual shall contain--
  `(1) an agreement that--
  `(A) subject to paragraph (3), the Secretary agrees to pay on behalf of
  the individual, loans in accordance with subsection (f);
  `(B) subject to paragraph (3), the individual agrees to accept an offer
  of any school described in subsection (a)(3)--
  `(i) at which individuals as described in subsection (a)(2)(A) constitute
  not less than 50 percent of the total number of individuals enrolled at
  the school; and
  `(ii) that offers the applicant a full-time faculty appointment at the
  school for not less than 2 years;
  `(2) an agreement by the applicant--
  `(A) to accept loan payments on behalf of the applicant;
  `(B) to maintain enrollment in a course of study or training described
  in subsection (a) until the individual completes the course of study
  or training;
  `(C) that while enrolled in such course of study or training, the applicant
  shall maintain an acceptable level of academic standing (as determined
  under regulations of the Secretary by the educational institution offering
  such course of study or training);
  `(D) to serve for a time period (hereinafter in this section referred
  to as the `period of obligated service') equal to 2 years or such longer
  period as the individual may agree to, as a faculty member as described
  in paragraph (1)(B);
  `(E) to complete the requirements established by such school for a degree
  from the school; and
  `(F) that, with respect to any violation by the applicant of an agreement
  entered into pursuant to this subsection, to pay such liquidated damages
  for such violation as the Secretary may by regulation prescribe.
  `(3) a provision permitting the Secretary to extend for such longer
  additional periods, as the individual may agree to, the period of obligated
  service agreed to by the individual under paragraph (2)(D);
  `(4) a provision that any financial obligation of the United States arising
  out of a contract entered into under this subpart and any obligation of
  the individual that is conditioned thereon, is contingent on funds being
  appropriated for loan repayments under this subpart;
  `(5) a statement of the damages to which the United States is entitled to
  for the individual's breach of the contract; and
  `(6) such other statements of the rights and liabilities of the Secretary
  and of the individual, not inconsistent with this subpart.
  `(f) Payments-
  `(1) IN GENERAL- A loan repayment provided for an individual under a written
  contract under the program shall consist of payment, in accordance with
  paragraph (2), on behalf of the individual of the principal, interest,
  and related expenses on government and commercial loans received by the
  individual for--
  `(A) tuition expenses;
  `(B) all other reasonable educational expenses, including fees, books,
  and laboratory expenses, incurred by the individual; or
  `(C) reasonable living expenses as determined by the Secretary.
  `(2) Payments for years served-
  `(A) IN GENERAL- Except as provided in subparagraph (B) and paragraph (3),
  for each year for which an individual accepts, pursuant to subsection
  (d)(2)(D), an offer to serve as a member of the faculty of a school
  described in subsection (a)(3), the Secretary may, subject to paragraph
  (2), pay not more than $10,000 on behalf of the individual for loans
  described in such subsection.
  `(B) REPAYMENT SCHEDULE- Any arrangement made by the Secretary for the
  making of loan repayments in accordance with this subsection shall provide
  that any repayments for a year of obligated service shall be made no later
  than the end of the fiscal year in which the individual completes such
  year of service.
  `(C) MAXIMUM AMOUNT OF PAYMENTS- Payments made on behalf of an individual
  pursuant to subparagraph (A) shall not exceed $40,000.
  `(3) TAX LIABILITY- In addition to payments made under paragraph (2), in
  any case in which payments on behalf of an individual under the program
  result in an increase in Federal, State, or local income tax liability for
  such individual, the Secretary may, on the request of such individual,
  make payments to such individual in a reasonable amount, as determined
  by the Secretary, to reimburse such individual for all or part of the
  increased tax liability of the individual.
  `(4) PAYMENT SCHEDULE- The Secretary may enter into an agreement with
  the holder of any loan for which payments are made under the program to
  establish a schedule for the making of such payments.
  `(g) EMPLOYMENT CEILING- Notwithstanding any other provision of law,
  individuals who have entered into written contracts with the Secretary
  under this section, while undergoing academic or other training, shall
  not be counted against any employment ceiling affecting the Department.
  `(h) Termination, Waiver, or Suspension of Obligation-
  `(1) TERMINATION- Any obligation of an individual under a contract entered
  into under this section for service or payment of damages shall be terminated
  on the death of the individual.
  `(2) WAIVER OR SUSPENSION- The Secretary shall by regulation provide for
  the partial or total waiver or suspension of any obligation of service or
  payment by an individual under a contract entered into under this section
  whenever compliance by the individual is impossible or would involve
  extreme hardship to the individual and if enforcement of such obligation
  with respect to any individual would be unconscionable.
  `(3) BANKRUPTCY- Any debt that is a loan insured under this section may
  be released by a discharge in bankruptcy under any chapter of title 11,
  United States Code, only if such discharge is granted--
  `(A) after the expiration of the 5-year period beginning on the date that
  payment of such debt is first required; and
  `(B) on a finding by the Bankruptcy Court that the nondischarge of such
  debt would be unconscionable.
  `(i) REPORTS- The Secretary shall, not later than March 1 of each year,
  prepare and submit to the appropriate Committees of Congress a report
  specifying--
  `(1) the number of individuals receiving loan payments under the program;
  `(2) the educational institution at which such individuals are receiving
  their training;
  `(3) the number of applications filed under this section in the school
  year beginning in such year and in prior school years; and
  `(4) the amount of loan payments made in the year reported on.
  `(j) AUTHORIZATION OF APPROPRIATIONS- There are authorized to be appropriated
  to carry out this section $3,000,000 for each of the fiscal years 1990
  through 1992.'.
TITLE III--COORDINATION OF FEDERAL EXPENDITURES FOR HEALTH PROGRAMS OF TRUST
TERRITORIES OF THE PACIFIC ISLANDS
SEC. 301. PACIFIC BASIN HEALTH SERVICES COUNCIL.
  (a) ESTABLISHMENT- The Secretary of Health and Human Services (hereafter
  in this title referred to as the `Secretary') shall establish a public or
  private nonprofit entity to be known as the `Pacific Basin Health Services
  Council' (hereafter in this title referred to as the `Council').
  (b) DEFINITION- As used in this title, the term `Pacific Basin' means the
  Federated States of Micronesia, the Republic of BeLau, the Republic of
  the Marshall Islands, the Commonwealth of the Northern Mariana Islands,
  Guam, and American Samoa.
  (c) DUTIES- The Council shall--
  (1) monitor the need for health services and health professions development
  in the Pacific Basin; and
  (2) establish priorities for the expenditure of public health funds in
  the Pacific Basin.
  (d) MEMBERS- The Council shall consist of no more than 16 members, and
  shall include--
  (1) the deans of the Schools of Medicine, Nursing, Social Work, and Public
  Health of the University of Hawaii;
  (2) the Chancellor of the University of Hawaii Community College system;
  (3) the Directors of the Health Departments for the State of Hawaii and
  the Federated States of Micronesia, the Republic of Belau, the Republic
  of the Marshall Islands, the Commonwealth of the Northern Mariana Islands,
  Guam, and American Samoa;
  (4) the President of the Rehabilitation Hospital of the Pacific in the
  State of Hawaii;
  (5) additional members that the Governor of the State of Hawaii shall
  appoint to ensure that the public health expertise of the Pacific Basin
  is appropriately represented; and
  (6) such additional ex officio members as the Secretary determines
  appropriate.
  (e) Use of Funds-
  (1) FIRST PRIORITY- The Council shall give first priority in expending
  the funds referred to in subsection (h) to continuing the Pacific Basin
  medical officer training program in effect on March 1, 1989, on Pohnpei.
  (2) ADDITIONAL PROJECTS- The Council may expend the remaining funds in
  subsection (h) to--
  (A) establish nurse practitioner or nurse clinical specialist training
  programs;
  (B) provide technical training of new auxiliary health workers including
  environmental sanitation aides, social work assistants, community and
  hospital nurse assistants, and allied health technicians;
  (C) upgrade the training of currently employed health personnel in
  special areas of need, including management, social services, and the
  establishment of continuing education programs for any of the traditional
  health professionals;
  (D) establish and support appropriate health promotion and disease
  prevention efforts;
  (E) develop a long-term plan for meeting the health professions needs,
  and to collect and analyze relevant statistical information on which to
  develop and regularly update such plan; and
  (F) provide innovative health professions training initiatives (including
  scholarships) targeted toward ensuring that residents of the Pacific
  Basin attend and graduate from recognized health professional programs in
  medicine, dentistry, nursing, optometry, pharmacy, podiatry, public health,
  psychology, social work, and allied health, that includes--
  (i) support for upgrading the quality and depth of the preventative health
  professions educational programs within the Pacific Basin; and
  (ii) residency training in public health, primary care and preventive
  medicine for National Health Service Corps officers assigned to the
  Pacific Basin.
  (f) AUTHORIZATION TO SUBCONTRACT- In order to comply with the duties of
  the Council described subsection (c), the Council may enter into contracts
  with various educational and service delivery institutions with relevant
  expertise.
  (g) REPORT- The Council, in consultation with the Secretary, shall annually
  prepare and submit to the appropriate Committees of Congress a report
  describing the expenditure of the funds authorized to be appropriated under
  subsection (h) and any programmatic recommendations that the Secretary
  may have.
  (h) Authorization of Appropriation-
  (1) IN GENERAL- There is authorized to be appropriated to carry out this
  title $20,000,000 for each of the fiscal years 1990 through 1993.
  (2) LIMITATION- No more than 10 percent of the funds appropriated under
  this subsection shall be used for administrative expenses of the Council.
Disadvantaged Minority Health Improvement Act of 1989

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