Health Security Act
Title III
TITLE III_PUBLIC HEALTH INITIATIVES


table of contents of title


Subtitle A_Workforce Priorities Under Federal Payments
Part 1_Institutional Costs of Graduate Medical Education; Workforce Priorities
SUBPART A_NATIONAL COUNCIL REGARDING WORKFORCE PRIORITIES
Sec._3001._National Council on Graduate Medical Education.
SUBPART B_AUTHORIZED POSITIONS IN SPECIALTY TRAINING
Sec._3011._Cooperation of approved physician training programs.
Sec._3012._Annual authorization of number of specialty positions; requirements regarding primary health care.
Sec._3013._Allocations among specialities and programs.
SUBPART C_INSTITUTIONAL COSTS OF GRADUATE MEDICAL EDUCATION
Sec._3031._Federal formula payments to approved physician training programs.
Sec._3032._Application for payments.
Sec._3033._Availability of funds for payments; annual amount of payments.
Sec._3034._Additional funding provisions.
SUBPART D_GENERAL PROVISIONS
Sec._3041._Definitions.
SUBPART E_TRANSITIONAL PROVISIONS
Sec._3051._Transitional payments to institutions.
Part 2_Related Programs
Sec._3061._Additional funding for certain workforce programs.
Sec._3062._Programs of the Secretary of Health and Human Services.
Sec._3063._Programs of the Secretary of Labor.
Sec._3064._National Institute for Health Care Workforce Development.
Subtitle B_Academic Health Centers
Part 1_Formula Payments
Sec._3101._Federal formula payments to academic health centers.
Sec._3102._Request for payments.
Sec._3103._Availability of funds for payments; annual amount of payments.
Sec._3104._Additional funding provisions.
Part 2_Access of Patients to Academic Health Centers
Sec._3131._Contracts for ensuring access to centers.
Sec._3132._Discretionary grants regarding access to centers.
Subtitle C_Health Research Initiatives
Part 1_Programs for Certain Agencies
Sec._3201._Biomedical and behavioral research on health promotion and disease prevention.
Sec._3202._Health services research.
Part 2_Funding for Programs
Sec._3211._Authorizations regarding Public Health Service Initiatives Fund.
Subtitle D_Core Functions of Public Health Programs; National Initiatives Regarding Preventive Health
Part 1_Funding
Sec._3301._Authorizations regarding Public Health Service Initiatives Fund.
Part 2_Core Functions of Public Health Programs
Sec._3311._Purposes.
Sec._3312._Grants to States for core health functions.
Sec._3313._Submission of information.
Sec._3314._Reports.
Sec._3315._Application for grant.
Sec._3316._General provisions.
Sec._3317._Allocations for certain activities.
Sec._3318._Definitions.
Part 3_National Initiatives Regarding Health Promotion and Disease Prevention
Sec._3331._Grants for national prevention initiatives.
Sec._3332._Priorities.
Sec._3333._Submission of information.
Sec._3334._Application for grant.
Subtitle E_Health Services for Medically Underserved Populations
Part 1_Community and Migrant Health Centers
Sec._3401._Authorizations regarding Public Health Service Initiatives Fund.
Sec._3402._Use of funds.
Part 2_Initiatives for Access to Health Care
SUBPART A_PURPOSES; FUNDING
Sec._3411._Purposes.
Sec._3412._Authorizations regarding Public Health Service Initiatives Fund.
SUBPART B_DEVELOPMENT OF QUALIFIED COMMUNITY HEALTH PLANS AND PRACTICE NETWORKS
Sec._3421._Grants and contracts for development of plans and networks.
Sec._3422._Preferences in making awards of assistance.
Sec._3423._Certain uses of awards.
Sec._3424._Accessibility of services.
Sec._3425._Additional agreements.
Sec._3426._Submission of certain information.
Sec._3427._Reports; audits.
Sec._3428._Application for assistance.
Sec._3429._General provisions.
SUBPART C_CAPITAL COST OF DEVELOPMENT OF QUALIFIED COMMUNITY HEALTH PLANS AND PRACTICE NETWORKS
Sec._3441._Loans and loan guarantees regarding plans and networks.
Sec._3442._Certain requirements.
Sec._3443._Defaults; right of recovery.
Sec._3444._Provisions regarding construction or expansion of facilities.
Sec._3445._Application for assistance.
Sec._3446._Administration of programs.
SUBPART D_ENABLING SERVICES
Sec._3461._Grants and contracts for enabling services.
Sec._3462._Authorizations regarding Public Health Service Initiatives Fund.
Part 3_National Health Service Corps
Sec._3471._Authorizations regarding Public Health Service Initiatives Fund.
Sec._3472._Allocation for participation of nurses in scholarship and loan repayment programs.
Part 4_Payments to Hospitals Serving Vulnerable Populations
Sec._3481._Payments to hospitals.
Sec._3482._Identification of eligible hospitals.
Sec._3483._Amount of payments.
Sec._3484._Base year.
Subtitle F_Mental Health; Substance Abuse
Part 1_Financial Assistance
Sec._3501._Authorizations regarding Public Health Service Initiatives Fund.
Sec._3502._Supplemental formula grants for States regarding activities under part B of title XIX of Public Health Service Act.
Sec._3503._Capital costs of development of certain centers and clinics.
Part 2_Authorities Regarding Participating States
SUBPART A_Reports
Sec._3511._Report on integration of mental health systems.
SUBPART B_Pilot Program
Sec._3521._Pilot program.
Subtitle G_Comprehensive School Health Education; School-Related Health Services
Part 1_General Provisions
Sec._3601._Purposes.
Sec._3602._Definitions.
Part 2_School Health Education; General Provisions
Sec._3611._Authorizations regarding Public Health Service Initiatives Fund.
Sec._3612._Waivers of statutory and regulatory requirements.
Part 3_School Health Education; Grants to States
SUBPART A_PLANNING GRANTS FOR STATES
Sec._3621._Application for grant.
Sec._3622._Approval of Secretary.
Sec._3623._Amount of grant.
Sec._3624._Authorized activities.
SUBPART B_IMPLEMENTATION GRANTS FOR STATES
Sec._3631._Application for grant.
Sec._3632._Selection of grantees.
Sec._3633._Amount of grant.
Sec._3634._Authorized activities; limitation on administrative costs.
Sec._3635._Subgrants to local educational agencies.
SUBPART C_STATE AND LOCAL REPORTS
Sec._3641._State and local reports.
Part 4_School Health Education; Grants to Certain Local Educational Agencies
SUBPART A_ELIGIBILITY
Sec._3651._Substantial need of area served by agency.
SUBPART B_PLANNING GRANTS FOR LOCAL EDUCATION AGENCIES
Sec._3661._Application for grant.
Sec._3662._Selection of grantees.
Sec._3663._Amount of grant.
Sec._3664._Authorized activities.
SUBPART C_IMPLEMENTATION GRANTS FOR LOCAL EDUCATIONAL AGENCIES
Sec._3671._Application for grant.
Sec._3672._Selection of grantees.
Sec._3673._Amount of grant.
Sec._3674._Authorized activities.
Sec._3675._Reports.
Part 5_School-Related Health Services
SUBPART A_DEVELOPMENT AND OPERATION OF PROJECTS
Sec._3681._Authorizations regarding Public Health Service Initiatives Fund.
Sec._3682._Eligibility for development and operation grants.
Sec._3683._Preferences.
Sec._3684._Grants for development of projects.
Sec._3685._Grants for operation of projects.
Sec._3686._Federal administrative costs.
SUBPART B_CAPITAL COSTS OF DEVELOPING PROJECTS
Sec._3691._Loans and loan guarantees regarding projects.
Sec._3692._Funding.
Subtitle H_Public Health Service Initiative
Sec._3701._Public Health Service Initiative.
Subtitle I_Coordination With Cobra Continuation Coverage
Sec._3801._Public Health Service Act; coordination with COBRA continuation coverage.


Title III, Subtitle A

Subtitle A_Workforce Priorities Under Federal Payments
PART 1_INSTITUTIONAL COSTS OF GRADUATE MEDICAL EDUCATION; WORKFORCE PRIORITIES
Subpart A_National Council Regarding Workforce Priorities
SEC. 3001. NATIONAL COUNCIL ON GRADUATE MEDICAL EDUCATION.
__(a) In General._There is established within the Department of Health and Human Services a council to be known as the National Council on Graduate Medical Education.
__(b) Duties._The Secretary shall carry out subpart B acting through the National Council.
__(c) Composition._
__(1) In general._The membership of the National Council shall include individuals who are appointed to the Council from among individuals who are not officers or employees of the United States. Such individuals shall be appointed by the Secretary, and shall include individuals from each of the following categories:
__(A) Consumers of health care services.
__(B) Physicians who are faculty members of medical schools.
__(C) Physicians in private practice who are not physicians described in subparagraph (B).
__(D) Officers or employees of regional and corporate health alliances.
__(E) Officers or employees of health care plans that participate in such alliances.
__(F) Such other individuals as the Secretary determines to be appropriate.
__(2) Ex officio members; other federal officers or employees._The membership of the National Council shall include individuals designated by the Secretary to serve as members of the Council from among Federal officers or employees who are appointed by the President, or by the Secretary or other Federal officers who are appointed by the President with the advice and consent of the Senate.
__(d) Chair._The Secretary shall, from among members of the National Council appointed under subsection (a)(1), designate an individual to serve as the Chair of the Council.
__(e) Definitions._For purposes of this subtitle:
__(1) The term ``medical school'' means a school of medicine (as defined in section 799 of the Public Health Service Act) or a school of osteopathic medicine (as defined in such section).
__(2) The term ``National Council'' means the council established in subsection (a).
Subpart B_Authorized Positions in Specialty Training
SEC. 3011. COOPERATION OF APPROVED PHYSICIAN TRAINING PROGRAMS.
__(a) In General._With respect to an approved physician training program in a medical specialty, a funding agreement for payments under section 3031 for a calendar year is that the program will ensure that the number of individuals enrolled in the program in the subsequent academic year is in accordance with this subpart.
__(b) Definitions._
__(1) Approved program._
__(A) For purposes of this subtitle, the term ``approved physician training program'', with respect to the medical speciality involved, means a residency or other postgraduate program that trains physicians and meets the following conditions:
__(i) Participation in the program may be counted toward certification in the medical specialty.
__(ii) The program is accredited by the Accreditation Council on Graduate Medical Education, or approved by the Council on Postgraduate Training of the American Osteopathic Association.
__(B) For purposes of this subtitle, the term ``approved physician training program'' includes any postgraduate program described in subparagraph (A) that provides health services in an ambulatory setting, without regard to whether the program provides inpatient hospital services.
__(2) Eligible program; subpart definition._For purposes of this subpart, the term ``eligible program'', with respect to an academic year, means an approved physician training program that receives payments under subpart C for the calendar year in which the academic year begins.
__(3) Other definitions._For purposes of this subtitle:
__(A)(i) The term ``academic year'' means the 1-year period beginning on July 1. The academic year beginning July 1, 1993, is academic year 1993-94.
__(ii) With respect to the funding agreement described in subsection (a), the term ``subsequent academic year'' means the academic year beginning July 1 of the calendar year for which payments are to be made under the agreement.
__(B) The term ``funding agreement'', with respect to payments under section 3031 to an approved physician training program, means that the Secretary may make the payments only if the program makes the agreement involved.
__(C) The term ``medical specialty'' includes subspecialties.
SEC. 3012. ANNUAL AUTHORIZATION OF NUMBER OF SPECIALTY POSITIONS; REQUIREMENTS REGARDING PRIMARY HEALTH CARE.
__(a) Annual Authorization of Number of Positions._In the case of each medical specialty, the National Council shall designate for each academic year the number of individuals nationwide who under section 3011 are authorized to be enrolled in eligible programs. The preceding sentence is subject to subsection (c)(2).
__(b) Primary Health Care._
__(1) In general._Subject to paragraph (2), in carrying out subsection (a) for an academic year, the National Council shall ensure that, of the class of training participants entering eligible programs for academic year 2002-03 or any subsequent academic year, the percentage of such class that completes eligible programs in primary health care is not less than 55 percent (without regard to the academic year in which the members of the class complete the programs).
__(2) Rule of construction._The requirement of paragraph (1) regarding a percentage applies in the aggregate to training participants entering eligible programs for the academic year involved, and not individually to any eligible program.
__(c) Designations Regarding 3-Year Periods._
__(1) Designation periods._For each medical specialty, the National Council shall make the annual designations under subsection (a) for periods of 3 academic years.
__(2) Initial period._The first designation period established by the National Council after the date of the enactment of this Act shall be the academic years 1998-99 through 2000-01.
__(d) Certain Considerations in Designating Annual Numbers._
__(1) In general._Factors considered by the National Council in designating the annual number of specialty positions for an academic year for a medical specialty shall include the extent to which there is a need for additional practitioners in the speciality, as indicated by the following:
__(A) The incidence and prevalence (in the general population and in various other populations) of the diseases, disorders, or other health conditions with which the specialty is concerned.
__(B) The number of physicians who will be practicing in the specialty in the academic year.
__(C) The number of physicians who will be practicing in the specialty at the end of the 5-year period beginning on the first day of the academic year.
__(2) Recommendations of private organizations._In designating the annual number of specialty positions for an academic year for a medical specialty, the National Council shall consider the recommendations of organizations representing physicians in the specialty and the recommendations of organizations representing consumers of the services of such physicians.
__(3) Minimum total of respective annual numbers._
__(A) Subject to subparagraph (B), for academic year 2003-04 and subsequent academic years, the National Council shall ensure that the total of the respective annual numbers designated under subsection (a) for an academic year is a total that_
__(i) bears a relationship to the number of individuals who graduated from medical schools in the United States in the preceding academic year; and
__(ii) is consistent with the purposes of this subpart.
__(B) For each of the academic years 2003-04 through 2007-08, the total determined under subparagraph (A) shall be reduced by a percentage determined by the National Council.
__(e) Definitions._For purposes of this subtitle:
__(1) The term ``annual number of specialty positions'', with respect to a medical specialty, means the number designated by the National Council under subsection (a) for eligible programs for the academic year involved.
__(2) The term ``designation period'' means a 3-year period under subsection (c)(1) for which designations under subsection (a) are made by the National Council.
__(3) The term ``primary health care'' means the following medical specialties: Family medicine, general internal medicine, general pediatrics, and obstetrics and gynecology.
__(4) The term ``specialty position'', with respect to a medical specialty, means a position (designated under subsection (a)) as one of the individuals who may be a training participant in an eligible program.
__(5) The term ``training participant'' means an individual who is enrolled in an approved physician training program.
SEC. 3013. ALLOCATIONS AMONG SPECIALITIES AND PROGRAMS.
__(a) In General._For each academic year, the National Council shall for each medical specialty make allocations among eligible programs of the annual number of specialty positions that the Council has designated for such year.  The preceding sentence is subject to subsection (b)(3).
__(b) Allocations Regarding 3-Year Period._
__(1) In general._For each medical specialty, the National Council shall make the annual allocations under subsection (a) for periods of 3 academic years.
__(2) Advance notice to programs._With respect to the first academic year of an allocation period established by the National Council, the National Council shall, not later than July 1 of the preceding academic year, notify each eligible program of the allocations made for the program for each of the academic years of the period. 
__(3) Initial period._The first allocation period established by the National Council after the date of the enactment of this Act shall be the academic years 1998-99 through 2000-01.
__(c) Certain Considerations._
__(1) Geographic areas; quality of residency programs._In making allocations under subsection (a) for eligible programs of the various geographic areas, the National Council shall include among the factors considered the historical distribution among the areas of approved physician training programs, and the quality of each of the programs.
__(2) Underrepresentation of minority groups._In making an allocation under subsection (a) for an eligible program, the National Council shall include among the factors considered the following:
__(A) The extent to which the population of training participants in the program includes training participants who are members of racial or ethnic minority groups.
__(B) With respect to a racial or ethnic group represented among the training participants, the extent to which the group is underrepresented in the field of medicine generally and in the various medical specialities.
__(3) Recommendations of private organizations._In making allocations under subsection (a) for eligible programs, the National Council shall consider the recommendations of organizations representing physicians in the medical specialties and the recommendations of organizations representing consumers of the services of such physicians.
__(d) Definitions._For purposes of this subtitle, the term ``allocation period'' means a 3-year period under subsection (b)(1) for which allocations under subsection (a) are made by the National Council.
Subpart C_Institutional Costs of Graduate Medical Education
SEC. 3031. FEDERAL FORMULA PAYMENTS TO APPROVED PHYSICIAN TRAINING PROGRAMS.
__(a) In General._
__(1) Formula payments._Subject to paragraph (2), in the case of any approved physician training program that submits to the Secretary an application for a calendar year in accordance with section 3032, the Secretary shall make payments for such year to the program for the purpose specified in subsection (b). The Secretary shall make the payments in an amount determined in accordance with section 3033, and may administer the payments as a contract, grant, or cooperative agreement.
__(2) Applicable years._Payments under paragraph (1) may not be made before calendar year 1998, except that the Secretary may make such payments before such year to eligible programs in any State that has become a participating State under title I.
__(b) Payments for Operation of Approved Physician Training Programs._The purpose of payments under subsection (a) is to assist an eligible program with the costs of operation. A funding agreement for such payments is that the program will expend the payments only for such purpose.
__(c) Eligible Program; Subpart Definition._For purposes of this subpart, the term ``eligible program'', with respect to the calendar year involved, means an approved physician training program that submits to the Secretary an application for such year in accordance with section 3032.
SEC. 3032. APPLICATION FOR PAYMENTS.
__(a) In General._For purposes of section 3031, an application for payments under such section is in accordance with this section if_
__(1) the approved physician training program involved submits the application not later than the date specified by the Secretary;
__(2) the condition described in subsection (b) is met with respect to the program;
__(3) the application contains each funding agreement described in this part and the application provides assurances of compliance with such agreements that are satisfactory to the Secretary; and
__(4) 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 part.
__(b) Certain Conditions._An approved physician training program meets the condition described in this subsection for receiving payments under section 3031 for a calendar year if the institution within which the program operates agrees that such payments will be made by the Secretary directly to the program (and such agreement is included in the application under subsection (a)), and the Secretary shall ensure that such institution is permitted to participate as a provider in a regional or corporate alliance health plan during such year only if each of the approved physician training programs of the institution meets the requirements for receiving payments under such section for such year.
SEC. 3033. AVAILABILITY OF FUNDS FOR PAYMENTS; ANNUAL AMOUNT OF PAYMENTS.
__(a) Determination by Secretary of Funds Available for Payments._
__(1) Annual health professions workforce account._Subject to paragraph (2) and section 3034, the Secretary shall determine for each calendar year the amount to be made available for the purpose of making payments under section 3031 (and under section 3051, as applicable) for the year. In determining such amount, the Secretary shall consider the amount necessary for making payments in the amounts determined under subsection (b) (and the amounts necessary for making payments in the amounts determined under section 3051(e) for institutions, in the case of calendar years 1998 through 2001).
__(2) Limitation._The amount determined by the Secretary for a calendar year under paragraph (1) may not exceed the following amount, as applicable to the calendar year:
__(A) In the case of calendar year 1996, $3,200,000,000.
__(B) In the case of calendar year 1997, $3,500,000,000.
__(C) In the case of calendar year 1998, $4,800,000,000.
__(D) In the case of each of the calendar years 1999 and 2000, $5,800,000,000.
__(E) In the case of each subsequent calendar year, the amount specified in subparagraph (D) increased by the product of such amount and the general health care inflation factor for such year (as defined in subsection (c)).
__(b) Amount of Payments for Individual Eligible Programs._
__(1) In general._Subject to the annual health professions workforce account determined by the Secretary under subsection (a) for the calendar year involved, the amount of payments required in section 3031 to be made to an eligible program for the calendar year is an amount equal to the product of_
__(A) the number of full-time equivalent training participants in the program; and
__(B) the national average of the costs of such programs in training an individual, as determined by consideration of the following factors (and as adjusted under paragraph (2)(B)):
__(i) The national average salary of training participants.
__(ii) The national average costs of such programs in providing for faculty supervision of training participants and for related activities.
__(2) Additional provisions regarding national average cost._
__(A) The Secretary shall in accordance with paragraph (1)(B) determine, for academic year 1992-93, an amount equal to the national average described in such paragraph with respect to training an individual. The national average applicable under such paragraph for a calendar year is, subject to subparagraph (B), the amount determined under the preceding sentence increased by an amount necessary to offset the effects of health care inflation occurring since academic year 1992-93, as determined through use of the general health care inflation factors for such years (or if there is no such factor for a calendar year, the consumer price index for the year).
__(B) The national average determined under subparagraph (A) and applicable to a calendar year shall, in the case of the eligible program involved, be adjusted by a factor to reflect regional differences in the applicable wage and wage-related costs.
__(c) Definitions._For purposes of this subtitle:
__(1) The term ``annual health professions workforce account'', with respect to a calendar year, means the amount determined under subsection (a) for such year.
__(2) The term ``consumer price index'' has the meaning given such term in section 1902.
__(3) The term ``general health care inflation factor'', with respect to a year, has the meaning given such term in section 6001(a)(3) for such year.
SEC. 3034. ADDITIONAL FUNDING PROVISIONS.
__(a) Sources of Funds for Annual Health Professions Workforce Account._The annual health professions workforce account under section 3033(a) for a calendar year shall be derived from the sources specified in subsection (b).
__(b) Contributions From Medicare Trust Funds, Regional Alliances, and Corporate Alliances._For purposes of subsection (a), the sources specified in this subsection for a calendar year are the following:
__(1) Transfers made by the Secretary under section 4051.
__(2) Payments made by regional alliances under section 1353 and transferred in an amount equal to the aggregate regional alliance portion determined under subsection (c)(2)(A).
__(3) The transfer made under section (d)(1).
__(c) Contributions From Regional and Corporate Alliances._
__(1) Determination of aggregate regional and corporate alliance amount._For purposes regarding the provision of funds for the annual health professions workforce account for a calendar year, the Secretary shall determine an aggregate regional and corporate alliance amount, which amount is to be paid by such alliances pursuant to paragraphs (2) and (3) of subsection (b), respectively, and which amount shall be equal to the difference between_ 
__(A) the annual health professions workforce account for such year; and
__(B) the amount transferred under section 4051 for the year.
__(2) Allocation of amount among regional and corporate alliances._With respect to the aggregate regional and corporate alliance amount determined under paragraph (1) for a calendar year_
__(A) the aggregate regional alliance portion of such amount is the product of such amount and the percentage constituted by the ratio of the total plan payments of regional alliances to the combined total plan payments of regional alliances and corporate alliances; and
__(B) the aggregate corporate alliance portion of such amount is the product of such amount and the percentage constituted by the ratio of the total plan payments of corporate alliances to such combined total plan payments.
__(d) Compliance Regarding Corporate Alliances._
__(1) In general._Effective January 15 of each calendar year, there is hereby transferred to the Secretary, out of any money in the Treasury not otherwise appropriated, an amount equal to the aggregate corporate alliance portion determined under subsection (c)(2)(B) for such year.
__(2) Manner of compliance._The payment by corporate alliances of the tax imposed under section 3461 of the Internal Revenue Code of 1986 (as added by section 7121 of this Act), together with the transfer made in paragraph (1) for the calendar year involved, is deemed to be the payment required pursuant to subsection (c)(1) for corporate alliances for such year.
__(e) Definitions._For purposes of this subtitle, the term ``plan payments'' with respect to a regional or corporate alliance, means the amount paid to health plans by the alliance.
Subpart D_General Provisions
SEC. 3041. DEFINITIONS.
__For purposes of this subtitle:
__(1) The term ``academic year'' has the meaning given such term in section 3011(b).
__(2) The term ``allocation period'' has the meaning given such term in section 3013(d).
__(3) The term ``annual health professions workforce account'' has the meaning given such term in section 3033(c).
__(4) The term ``annual number of specialty positions'' has the meaning given such term in section 3012(e).
__(5) The term ``approved physician training program'' has the meaning given such term in section 3011(b).
__(6) The term ``consumer price index'' has the meaning given such term in section 3033(c).
__(7) The term ``designation period'' has the meaning given such term in section 3012(e).
__(8) The term ``eligible program'' has the meaning given such term in section 3011(b), in the case of subpart B; and has the meaning given such term in section 3031(c), in the case of subpart C.
__(9) The term ``funding agreement'' has the meaning given such term in section 3011(b).
__(10) The term ``general health care inflation factor'' has the meaning given such term in section 3033(c).
__(11) The term ``medical school'' has the meaning given such term in section 3001(e).
__(12) The term ``medical specialty'' has the meaning given such term in section 3011(b).
__(13) The term ``National Council'' has the meaning given such term in section 3001(e).
__(14) The term ``plan payments'' has the meaning given such term in section 3034(e).
__(15) The term ``primary health care'' has the meaning given such term in section 3012(e).
__(16) The term ``specialty position'' has the meaning given such term in section 3012(e).
__(17) The term ``training participant'' has the meaning given such term in section 3012(e).
Subpart E_Transitional Provisions
SEC. 3051. TRANSITIONAL PAYMENTS TO INSTITUTIONS.
__(a) Payments Regarding Effects of Subpart B Allocations._
__(1) In general._For each of the calendar years 1998 through 2001, in the case of any eligible institution that submits to the Secretary an application for the year involved in accordance with subsection (d), the Secretary shall make payments for such year to the institution for the purpose specified in subsection (c). The Secretary shall make the payments in an amount determined in accordance with subsection (e), and may administer the payments as a contract, grant, or cooperative agreement.
__(2) Applicable years._Payments under paragraph (1) may not be made before calendar year 1998, except that the Secretary may make such payments before such year to eligible institutions in any State that has become a participating State under title I.
__(b) Eligible Institution._For purposes of this section, the term ``eligible institution'', with respect to a calendar year, means an institution_
__(1) in which there are one or more programs that_
__(A) are approved physician training programs; and
__(B) are receiving payments under section 3031 for such year; and
__(2) whose number of speciality positions (in the medical specialities with respect to which such payments are made) is below the number of such positions at the institution for academic year 1993-94 as a result of allocations under subpart B.
__(c) Purpose of Payments._The purpose of payments under subsection (a) is to assist an eligible institution with the costs of operation. A funding agreement for such payments is that the institution will expend the payments only for such purpose.
__(d) Application for Payments._For purposes of subsection (a), an application for payments under such subsection is in accordance with this subsection if the institution involved submits the application not later than the date specified by the Secretary; the institution has cooperated with the approved physician training programs of the institution in meeting the condition described in section 3032(b); the application contains each funding agreement described in this section and provides assurances of compliance with such agreements satisfactory 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.
__(e) Amount of Payments._
__(1) In general._Subject to the annual health professions workforce account determined by the Secretary under section 3033(a) for the calendar year involved, the amount of payments required in subsection (a) to be made to an eligible institution for the calendar year is the product of the amount determined under paragraph (2) and the applicable percentage specified in paragraph (3).
__(2) Number of specialty positions lost; national average salary._For purposes of paragraph (1), the amount determined under this paragraph for an eligible institution for the calendar year involved is the product of_
__(A) an amount equal to the number of full-time equivalent specialty positions lost; and
__(B) the national average salary of training participants.
__(3) Applicable percentage._For purposes of paragraph (1), the applicable percentage for a calendar year is the following, as applicable to such year:
__(A) For calendar year 1998, 100 percent.
__(B) For calendar year 1999, 75 percent.
__(C) For calendar year 2000, 50 percent.
__(D) For calendar year 2001, 25 percent.
__(4) Determination of specialty positions lost._
__(A) For purposes of this section, the number of specialty positions lost, with respect to a calendar year, is the difference between_
__(i) the number of specialty positions described in subparagraph (B) that are estimated for the institution involved for the academic year beginning in such calendar year; and
__(ii) the number of such specialty positions at the institution for academic year 1993-94.
__(B) For purposes of subparagraph (A), the specialty positions described in this subparagraph are specialty positions in the medical specialities with respect to which payments under section 3031 are made to programs of the institution involved.
__(5) Additional provision regarding national average salary._
__(A) The Secretary shall determine, for academic year 1992-93, an amount equal to the national average described in paragraph (2)(B). The national average applicable under such paragraph for a calendar year is, subject to subparagraph (B), the amount determined under the preceding sentence increased by an amount necessary to offset the effects of health care inflation occurring since academic year 1992-93, as determined through use of the general health care inflation factors for such years (or if there is no such factor for a year, the consumer price index for the year).
__(B) The national average determined under subparagraph (A) and applicable to a calendar year shall, in the case of the eligible institution involved, be adjusted by a factor to reflect regional differences in the applicable wage and wage-related costs.
PART 2_RELATED PROGRAMS
SEC. 3061. ADDITIONAL FUNDING FOR CERTAIN WORKFORCE PROGRAMS.
__(a) In General._For purpose of carrying out the programs described in sections 3062 and 3063, there is authorized to be appropriated  $200,000,000 for fiscal year 1994 and each subsequent fiscal year (in addition to amounts that may otherwise be authorized to be appropriated for carrying out the programs).
__(b) Allocations._With respect to the amount appropriated under subsection (a) for a fiscal year, the Secretary of Health and Human Services and the Secretary of Labor shall enter into an agreement specifying the aggregate portion of such amount to be made available for the programs described in section 3062 and the aggregate portion to be made available for the programs described in section 3063.
SEC. 3062. PROGRAMS OF THE SECRETARY OF HEALTH AND HUMAN SERVICES.
__(a) In General._The programs described in this section and carried out with amounts made available under section 3061 shall be carried out by the Secretary of Health and Human Services.
__(b) Primary Care Physician and Physician Assistant Training._For purposes of section 3061, the programs described in this section include programs to support projects to train additional numbers of primary care physicians and physician assistants, including projects to enhance community-based generalist training for medical students, residents, and practicing physicians; to retrain mid-career physicians previously certified in a nonprimary care medical specialty; to expand the supply of physicians with special training to serve in rural and inner-city medically underserved areas; to support expansion of service-linked educational networks that train a range of primary care providers in community settings; to provide for training in managed care, cost-effective practice management, and continuous quality improvement; and to develop additional information on primary care workforce issues as required to meet future needs in health care.
__(b) Training of Underrepresented Minorities and Disadvantaged Persons._For purposes of section 3061, the programs described in this section include a program to support projects to increase the number of underrepresented minority and disadvantaged persons in medicine, osteopathy, dentistry, nursing, public health, and other health professions, including projects to provide continuing financial assistance for such persons entering health professions training programs; to increase support for recruitment and retention of such persons in the health professions; to maintain efforts to foster interest in health careers among such persons at the preprofessional level; and to increase the number of minority health professions faculty.
__(c) Nurse Training._For purposes of section 3061, the programs described in this section include the following:
__(1) A program to support projects to support midlevel provider training and address priority nursing workforce needs, including projects to train additional nurse practitioners and nurse midwives; to support baccalaureate-level nurse training programs providing preparation for careers in teaching, community health service, and specialized clinical care; to train additional nurse clinicians and nurse anesthetists; to support interdisciplinary school-based community nursing programs; and to promote research on nursing workforce issues.
__(2) A program to develop and encourage the adoption of model professional practice statutes for advanced practice nurses and physician assistants, and to otherwise support efforts to remove inappropriate barriers to practice by such nurses and such physician assistants.
__(d) Other Programs._For purposes of section 3061, the programs described in this section include a program to train health professionals and administrators in managed care, cost-effective practice management, continuous quality improvement practices, and provision of culturally sensitive care.
__(e) Relationship to Existing Programs._This section may be carried out through programs established in title VII or VIII of the Public Health Service Act, as appropriate and as consistent with the purposes of such programs.
SEC. 3063. PROGRAMS OF THE SECRETARY OF LABOR.
__(a) In General._The programs described in this section and carried out with amounts made available under section 3061 shall be carried out by the Secretary of Labor (in this section referred to as the ``Secretary'').
__(b) Retraining Programs; Advanced Career Positions; Job Banks._
__(1) In general._For purposes of section 3061, the programs described in this section are the following:
__(A) A program to retrain administrative and clerical workers for positions as technicians, nurses, and physician assistants.
__(B) A demonstration program to assist workers in health care institutions in obtaining advanced career positions.
__(C) A program to support development of health-worker job banks in local employment services agencies.
__(D) A program for skills upgrading, occupational retraining, and quality improvement.
__(E) A program to facilitate the comprehensive workforce adjustment initiative.
__(2) Use of funds._Amounts made available under section 3061 for carrying out this section may be expended for program support, faculty development, trainee support, workforce analysis, and dissemination of information, as necessary to produce required performance outcomes, and for establishing and operating the Institute authorized in section 3064.
__(c) Certain Requirements for Programs._In carrying out the programs described in subsection (b), the Secretary shall, with respect to the organizations and employment positions involved, provide for the following:
__(1) Explicit, clearly defined skill requirements developed for all the positions and projections of the number of openings for each position.
__(2) Opportunities for internal career movement.
__(3) Opportunities to work while training or completing and educational program.
__(4) Evaluation and dissemination.
__(5) Training opportunities in several forms, as appropriate.
__(d) Administrative Requirements._In carrying out the programs described in subsection (b), the Secretary shall, with respect to the organizations and employment positions involved, provide for the following:
__(1) Implementation and administration jointly by management and employees and their representatives.
__(2) Discussion with employees as to training needs for career advancement.
__(3) Commitment to a policy of internal hirings and promotion.
__(4) Provision of support services.
__(5) Consultations with employers and with organized labor.
SEC. 3064. NATIONAL INSTITUTE FOR HEALTH CARE WORKFORCE DEVELOPMENT.
__(a) Establishment of Institute._The Secretary of Health and Human Services and the Secretary of Labor may jointly establish an office to be known as the National Institute for Health Care Workforce Development. The subsequent provisions of this section apply to any such Institute.
__(b) Director._The Institute shall be headed by a director, who shall be appointed jointly by the Secretaries.
__(c) Duties._
__(1) In general._The Director of the Institute shall make recommendations to the Secretaries regarding_
__(A) the supply of health care workers needed for the system of regional and corporate alliance health plans established under title I; and
__(B) the impact of such system on health care workers and the needs of such workers with respect to the system, including needs regarding education, training, and other matters relating to career development.
__(2) Administration of programs regarding retraining, advanced career positions, and job banks._The Secretary of Labor may carry out section 3063 acting through the Director of the Institute.
__(d) Advisory Board._
__(1) In general._The Secretaries shall establish an advisory board to assist in the develop of recommendations under subsection (c).
__(2) Composition._The Advisory Board shall be composed of_
__(A) the Secretary of Labor;
__(B) the Secretary of Health and Human Services;
__(C) representatives of health care workers in organized labor;
__(D) representatives of health care institutions;
__(E) representatives of health care education organizations;
__(F) representatives of consumer organizations; and
__(G) such other individuals as the Secretaries determine to be appropriate.
__(e) Staff, Quarters, and Other Assistance._The Secretaries shall provide the Institute and the Advisory Board with such staff, quarters, and other administrative assistance as may be necessary for the Institute and the Advisory Board to carry out this section.
__(f) Definitions._For purposes of this section:
__(1) The term ``Advisory Board'' means the advisory board established under subsection (c).
__(2) The term ``Institute'' means an Institute established under subsection (a).
__(3) The term ``Secretaries'' means the Secretary of Health and Human Services and the Secretary of Labor.
__(g) Sunset._Effective upon the end of calendar year 2000, this section is repealed.

Title III, Subtitle B

Subtitle B_Academic Health Centers
PART 1_FORMULA PAYMENTS
SEC. 3101. FEDERAL FORMULA PAYMENTS TO ACADEMIC HEALTH CENTERS.
__(a) In General._
__(1) Formula payments._In the case of any academic health center that submits to the Secretary a written request for a calendar year in accordance with section 3102, the Secretary shall make payments for such year to the center for the purpose specified in subsection (b). The Secretary shall make the payments in an amount determined in accordance with section 3103, and shall administer the payments as a contract, grant, or cooperative agreement.
__(2) Applicable years._Payments under paragraph (1) may not be made before calendar year 1998, except that the Secretary may make such payments before such year to eligible programs in any State that has become a participating State under title I.
__(b) Payments for Costs Attributable to Academic Nature of Centers._The purpose of payments under subsection (a) is to assist academic health centers with costs that are not routinely incurred by other entities in providing health services, but are incurred by such centers in providing health services by virtue of the academic nature of such centers.
__(c) Academic Health Centers._For purposes of this subtitle, the term ``academic health center'' means an entity that operates a teaching hospital that carries out an approved physician training program (as defined in section 3011(b)).
SEC. 3102. REQUEST FOR PAYMENTS.
_(a) In General._For purposes of section 3101, a written request for payments under such section is in accordance with this section if the academic health center involved submits the request not later than the date specified by the Secretary; the request is accompanied by each funding agreement described in this part; and the request 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 part.
__(b) Continued Status as Academic Health Center._A funding agreement for payments under section 3101 is that the entity involved will maintain status as an academic health center. For purposes of this subtitle, the term ``funding agreement'', with respect to payments under section 3101 to an entity, means that the Secretary may make the payments only if the entity makes the agreement involved.
SEC. 3103. AVAILABILITY OF FUNDS FOR PAYMENTS; ANNUAL AMOUNT OF PAYMENTS.
__(a) Determination by Secretary of Funds Available for Payments._
__(1) Annual academic health center account._Subject to paragraph (2) and section 3104, the Secretary shall determine for each calendar year the amount to be made available for the purpose of making payments under section 3101 for the year to eligible centers. In determining such amount, the Secretary shall consider the need of eligible centers for assistance with the costs described in section 3101(b).
__(2) Limitation._The amount determined by the Secretary for a calendar year under paragraph (1) may not exceed the following amount, as applicable to the calendar year:
__(A) In the case of calendar year 1996, $3,100,000,000.
__(B) In the case of each of the calendar years 1997 and 1998, $3,200,000,000.
__(C) In the case of calendar year 1999, $3,700,000,000.
__(D) In the case of calendar year 2000, $3,800,000,000.
__(E) In the case of each subsequent calendar year, the amount specified in subparagraph (C) increased by the product of such amount and the general health care inflation factor (as defined in subsection (c)).
__(b) Amount of Payments for Individual Eligible Centers._The amount of payments required in section 3101 to be made to an eligible center for a calendar year is an amount equal to the product of_
__(1) the annual academic health center account determined by the Secretary under subsection (a) for the calendar year; and
__(2) the percentage constituted by the ratio of_
__(A) an amount equal to product of_
__(i) the portion of the gross receipts of the center for the preceding calendar year that was derived from providing services to patients (both inpatients and outpatients); and
__(ii) the indirect teaching adjustment factor determined under section 1886(d)(5)(B)(ii) of the Social Security Act (as in effect before January 1, 1998) and applicable to patients discharged from the center in such preceding year (or, in the case of patients discharged from the center on or after January 1, 1998, applicable to patients discharged in calendar year 1997); to
__(B) the sum of the respective amounts determined under subparagraph (A) for eligible centers.
__(c) Report Regarding Modifications in Formula._Not later than July 1, 1996, the Secretary shall submit to the Congress a report containing any recommendations of the Secretary regarding policies for allocating amounts under subsection (a) among eligible centers.
__(d) Definition._For purposes of this subtitle:
__(1) The term ``eligible center'', with respect to the calendar year involved, means an academic health center that submits to the Secretary a written request for such year in accordance with section 3102.
__(2) The term ``annual academic health center account'', with respect to a calendar year, means the amount determined under subsection (a) for such year.
__(2) The term ``general health care inflation factor'', with respect to a year, has the meaning given such term in section 6001(a)(3) for such year.
SEC. 3104. ADDITIONAL FUNDING PROVISIONS.
__(a) Sources of Funds for Annual Academic Health Center._The annual academic health center account under section 3103(a) for a calendar year shall be derived from the sources specified in subsection (b).
__(b) Contributions From Medicare Trust Funds, Regional Alliances, and Corporate Alliances._For purposes of subsection (a), the sources specified in this subsection for a calendar year are the following:
__(1) Transfers made by the Secretary under section 4052.
__(2) Payments made by regional alliances under section 1353 and transferred in an amount equal to the aggregate regional alliance portion determined under subsection (c)(2)(A).
__(3) The transfer made under section (d)(1).
__(c) Contributions From Regional and Corporate Alliances._
__(1) Determination of aggregate regional and corporate alliance amount._For purposes regarding the provision of funds for the annual academic health center account for a calendar year, the Secretary shall determine an aggregate regional and corporate alliance amount, which amount is to be paid by such alliances pursuant to paragraphs (2) and (3) of subsection (b), respectively, and which amount shall be equal to the difference between_ 
__(A) the annual academic health center account for such year; and
__(B) the amount transferred under section 4052 for the year.
__(2) Allocation of amount among regional and corporate alliances._With respect to the aggregate regional and corporate alliance amount determined under paragraph (1) for a calendar year_
__(A) the aggregate regional alliance portion of such amount is the product of such amount and the percentage constituted by the ratio of the total plan payments of regional alliances to the combined total plan payments of regional alliances and corporate alliances; and
__(B) the aggregate corporate alliance portion of such amount is the product of such amount and the percentage constituted by the ratio of the total plan payments of corporate alliances to such combined total plan payments.
__(d) Compliance Regarding Corporate Alliances._
__(1) In general._Effective January 15 of each calendar year, there is hereby transferred to the Secretary, out of any money in the Treasury not otherwise appropriated, an amount equal to the aggregate corporate alliance portion determined under subsection (c)(2)(B) for such year.
__(2) Manner of compliance._The payment by corporate alliances of the tax imposed under section 3461 of the Internal Revenue Code of 1986 (as added by section 7121 of this Act), together with the transfer made in paragraph (1) for the calendar year involved, is deemed to be the payment required pursuant to subsection (c)(1) for corporate alliances for such year..
__(e) Definitions._For purposes of this subtitle, the term ``plan payments'' with respect to a regional or corporate alliance, means the amount paid to health plans by the alliance.
PART 2_ACCESS OF PATIENTS TO ACADEMIC HEALTH CENTERS
SEC. 3131. CONTRACTS FOR ENSURING ACCESS TO CENTERS.
__(a) Contracts With Health Plans._Regional and corporate health alliances under this Act shall ensure that, in accordance with subsection (b), the health plans of the alliances enter into sufficient contracts with eligible centers to ensure that enrollees in regional or corporate alliance health plans, as appropriate, receive the specialized treatment expertise of such centers, subject to such exceptions as the Secretary may provide.
__(b) Utilization of Specialized Treatment Expertise of Centers._Contracts under subsection (a) between eligible centers and health plans are in accordance with this subsection if the contracts provide that, with respect to health conditions within the specialized treatment expertise of the centers, health plans will refer medical cases involving such conditions to the centers.
__(c) Specialized Treatment Expertise._For purposes of this subtitle, the term ``specialized treatment expertise'', with respect to treatment of a health condition by an academic health center, means expertise in treating rare diseases, treating unusually severe conditions, and providing other specialized health care.
SEC. 3132. DISCRETIONARY GRANTS REGARDING ACCESS TO CENTERS.
__(a) Rural Information and Referral Systems._The Secretary may make grants to eligible centers for the establishment and operation of information and referral systems to provide the services of such centers to rural regional and corporate health alliance health plans.
__(b) Other Purposes Regarding Urban and Rural Areas._The Secretary may make grants to eligible centers to carry out activities (other than activities carried out under subsection (a)) for the purpose of providing the services of eligible centers to residents of rural or urban communities who otherwise would not have adequate access to such services.

Title III, Subtitle C

Subtitle C_Health Research Initiatives
PART 1_PROGRAMS FOR CERTAIN AGENCIES
SEC. 3201. BIOMEDICAL AND BEHAVIORAL RESEARCH ON HEALTH PROMOTION AND DISEASE PREVENTION.
__Section 402(f) of the Public Health Service Act (42 U.S.C. 282(f)), as amended by section 201 of Public Law 103-43 (107 Stat. 144), is amended_
__(1) in paragraph (3), by redesignating subparagraphs (A) and (B) as clauses (i) and (ii), respectively;
__(2) by redesignating paragraphs (1) through (3) as subparagraphs (A) through (C);
__(3) by inserting ``(1)'' after ``(f)''; and
__(4) by adding at the end the following paragraph:
__``(2)(A) The Director of NIH, in collaboration with the Associate Director for Prevention and with the heads of the agencies of the National Institutes of Health, shall ensure that such Institutes conduct and support biomedical and behavioral research on promoting health and preventing diseases, disorders, and other health conditions (including Alzheimer's disease, breast cancer, heart disease, and stroke).
__``(B) In carrying out subparagraph (A), the Director of NIH shall give priority to conducting and supporting research on child and adolescent health (including birth defects), chronic and recurrent health conditions, reproductive health, mental health, elderly health, substance abuse, infectious diseases, health and wellness promotion, and environmental health, and to resource development related to such research.''.
SEC. 3202. HEALTH SERVICES RESEARCH.
__Section 902 of the Public Health Service Act (42 U.S.C. 299a), as amended by section 2(b) of Public Law 102-410 (106 Stat. 2094), is amended by adding at the end the following subsection:
__``(f) Research on Health Care Reform._
__``(1) In general._In carrying out section 901(b), the Administrator shall conduct and support research on the reform of the health care system of the United States, as directed by the National Board.
__``(2) Priorities._In carrying out paragraph (1), the Administrator shall give priority to the following:
__``(A) Conducting and supporting research on the appropriateness and effectiveness of alternative clinical strategies; the quality and outcomes of care; and administrative simplification.
__``(B) Conducting and supporting research on consumer choice and information resources; the effects of health care reform on health delivery systems; workplace injury and illness prevention; methods for risk adjustment; factors influencing access to health care for underserved populations; and primary care.
__``(C) The development of clinical practice guidelines consistent with section 913, the dissemination of such guidelines consistent with section 903, and the assessment of the effectiveness of such guidelines.''.
PART 2_FUNDING FOR PROGRAMS
SEC. 3211. AUTHORIZATIONS REGARDING PUBLIC HEALTH SERVICE INITIATIVES FUND.
__(a) Biomedical and Behavioral Research on Health Promotion and Disease Prevention._For the purpose of carrying out activities pursuant to the amendments made by section 3201, there are authorized to be appropriated from the Public Health Service Initiatives Fund (established in section 3701) $400,000,000 for fiscal year 1995, and $500,000,000 for each of the fiscal years 1996 through 2000.
__(b) Health Services Research._For the purpose of carrying out activities pursuant to the amendments made by section 3202, there are authorized to be appropriated from the Public Health Service Initiatives Fund $150,000,000 for fiscal year 1995, $400,000,000 for fiscal year 1996, $500,000,000 for fiscal year 1997, and $600,000,000 for each of the fiscal years 1998 through 2000.
__(c) Relation to Other Funds._The authorizations of appropriations established in subsections (a) and (b) are in addition to any other authorizations of appropriations that are available for the purposes described in such subsections.

Title III, Subtitle D

Subtitle D_Core Functions of Public Health Programs; National Initiatives Regarding Preventive Health
PART 1_FUNDING
SEC. 3301. AUTHORIZATIONS REGARDING PUBLIC HEALTH SERVICE INITIATIVES FUND.
__(a) Core Functions of Public Health Programs._For the purpose of carrying out part 2, there are authorized to be appropriated from the Public Health Service Initiatives Fund (established in section 3701) $12,000,000 for fiscal year 1995, $325,000,000 for fiscal year 1996, $450,000,000 for fiscal year 1997, $550,000,000 for fiscal year 1998, $650,000,000 for fiscal year 1999, and $750,000,000 for fiscal year 2000.
__(b) National Initiatives Regarding Health Promotion and Disease Prevention._For the purpose of carrying out part 3, there are authorized to be appropriated from the Public Health Service Initiatives Fund (established in section 3701) $175,000,000 for fiscal year 1996, and $200,000,000 for each of the fiscal years 1997 through 2000.
__(c) Relation to Other Funds._The authorizations of appropriations established in subsections (a) and (b) are in addition to any other authorizations of appropriations that are available for the purposes described in such subsections.
PART 2_CORE FUNCTIONS OF PUBLIC HEALTH PROGRAMS
SEC. 3311. PURPOSES.
__Subject to the subsequent provisions of this subtitle, the purposes of this part are to strengthen the capacity of State and local public health agencies to carry out the following functions:
__(1) To monitor and protect the health of communities against communicable diseases and exposure to toxic environmental pollutants, occupational hazards, harmful products, and poor quality health care.
__(2) To identify and control outbreaks of infectious disease and patterns of chronic disease and injury.
__(3) To inform and educate health care consumers and providers about their roles in preventing and controlling disease and the appropriate use of medical services.
__(4) To develop and test new prevention and public health control interventions.
SEC. 3312. GRANTS TO STATES FOR CORE HEALTH FUNCTIONS.
__(a) In General._The Secretary may make grants to States for the purpose of carrying out one or more of the functions described in subsection (b).
__(b) Core Functions of Public Health Programs._For purposes of subsection (a), the functions described in this subsection are, subject to subsection to subsection (c), as follows:
__(1) Data collection, activities related to population health measurement and outcomes monitoring, including the regular collection and analysis of public health data, vital statistics, and personal health services data and analysis for planning and needs assessment purposes of data collected from health plans through the information system under title V of this Act.  
__(2) Activities to protect the environment and to assure the safety of housing, workplaces, food and water, including the following activities: 
__(A) Monitoring the overall public health quality and safety of communities.  
__(B) Assessing exposure to high lead levels and water contamination.  
__(C) Monitoring sewage and solid waste disposal, radiation exposure, radon exposure, and noise levels.
__(D) Abatement of lead-related hazards.
__(E) Assuring recreation and worker safety.
__(F) Enforcing public health safety and sanitary codes.
__(G) Other activities relating to promoting the public health of communities.
__(3) Investigation and control of adverse health conditions, including improvements in emergency treatment preparedness, cooperative activities to reduce violence levels in communities, activities to control the outbreak of disease, exposure related conditions and other threats to the health status of individuals. 
__(4) Public information and education programs to reduce risks to health such as use of tobacco, alcohol and other drugs, sexual activities that increase the risk to HIV transmission and sexually transmitted diseases, poor diet, physical inactivity, and low childhood immunization levels.   
__(5) Accountability and quality assurance activities, including monitoring the quality of personal health services furnished by health plans and providers of medical and health services in a manner consistent with the overall quality of care monitoring activities undertaken under title V, and monitoring communities' overall access to health services.  
__(6) Provision of public health laboratory services to complement private clinical laboratory services and that screen for diseases and conditions such as metabolic diseases in newborns, provide toxicology assessments of blood lead levels and other environmental toxins, diagnose sexually transmitted diseases, tuberculosis and other diseases requiring partner notification, test for infectious and food-borne diseases, and monitor the safety of water and food supplies.  
__(7) Training and education to assure provision of care by all health professionals, with special emphasis placed on the training of public health professions including epidemiologists, biostatisticians, health educators, public health administrators, sanitarians and laboratory technicians.  
__(8) Leadership, policy development and administration activities, including needs assessment, the setting of public health standards, the development of community public health policies, and the development of community public health coalitions.
__(c) Restrictions on Use of Grant._
__ (1) In general._A funding agreement for a grant under subsection (a) for a State is that the grant will not be expended_
__(A) to provide inpatient services;
__(B) to make cash payments to intended recipients of health services;
__(C) to purchase or improve land, purchase, construct, or permanently improve (other than minor remodeling) any building or other facility, or purchase major medical equipment;  
__(D) to satisfy any requirement for the expenditure of non-Federal funds as a condition for the receipt of Federal funds; or  
__(E) to provide financial assistance to any entity other than a public or nonprofit private entity.  
__(2) Limitation on administrative expenses._A funding agreement for a grant under subsection (a) is that the State involved will not expend more than 10 percent of the grant for administrative expenses with respect to the grant.
__(d) Maintenance of Effort._A funding agreement for a grant under subsection (a) is that the State involved will maintain expenditures of non-Federal amounts for core health functions at a level that is not less than the level of such expenditures maintained by the State for the fiscal year preceding the first fiscal year for which the State receives such a grant.
SEC. 3313. SUBMISSION OF INFORMATION.
__The Secretary may make a grant under section 3312 only if the State involved submits to the Secretary the following information:
__(1) A description of existing deficiencies in the State's public health system (at the State level and the local level), using standards of sufficiency developed by the Secretary.
__(2) A description of health status measures to be improved within the State (at the State level and the local level) through expanded public health functions.
__(3) Measurable outcomes and process objectives for improving health status and core health functions for which the grant is to be expended.
__(4) Information regarding each such function, which_ 
__(A) identifies the amount of State and local funding expended on each such function for the fiscal year preceding the fiscal year for which the grant is sought; and  
__(B) provides a detailed description of how additional Federal funding will improve each such function by both the State and local public health  agencies.
__(5) A description of the core health functions to be carried out at the local level, and a specification for each such function of_
__(A) the communities in which the function will be carried out; and
__(B) the amount of the grant to be expended for the function in each community so specified.
SEC. 3314. REPORTS.
__A funding agreement for a grant under section 3312 is that the States involved will, not later than the date specified by the Secretary, submit to the Secretary a report describing_
__(1) the purposes for which the grant was expended; and
__(2) describing the extent of progress made by the State in achieving measurable outcomes and process objectives described in section 3313(3).
SEC. 3315. APPLICATION FOR GRANT.
__The Secretary may make a grant under section 3312 only if an application for the grant is submitted to the Secretary, the application contains each agreement described in this part, the application contains the information required in section 3314, 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 part.
SEC. 3316. GENERAL PROVISIONS.
__(a) Uniform Data Sets._The Secretary, in consultation with the States, shall develop uniform sets of data for the purpose of monitoring the core health functions carried out with grants under section 3312.
__(b) Duration of Grant._The period during which payments are made to a State from a grant under section 3312 may not exceed 5 years. The provision of such payments shall be subject to annual approval by the Secretary of the payments. This subsection may not be construed as establishing a limitation on the number of grants under such section that may be made to the State.
SEC. 3317. ALLOCATIONS FOR CERTAIN ACTIVITIES.
__Of the amounts made available under section 3301 for a fiscal year for carrying out this part, the Secretary may reserve not more than 5 percent for carrying out the following activities:
__(1) Technical assistance with respect to planning, development, and operation of core health functions carried out under section 3312, including provision of biostatistical and epidemiological expertise and provision of laboratory expertise.
__(2) Development and operation of a national information network among State and local health agencies.
__(3) Program monitoring and evaluation of core health functions carried out under section 3312.
__(4) Development of a unified electronic reporting mechanism to improve the efficiency of administrative management requirements regarding the provision of Federal grants to State public health agencies.
SEC. 3318. DEFINITIONS.
__For purposes of this part:
__(1) The term ``funding agreement'', with respect to a grant under section 3312 to a State, means that the Secretary may make the grant only if the State makes the agreement involved.
__(2) The term ``core health functions'', with respect to a State, means the functions described in section 3312(b).
PART 3_NATIONAL INITIATIVES REGARDING HEALTH PROMOTION AND DISEASE PREVENTION
SEC. 3331. GRANTS FOR NATIONAL PREVENTION INITIATIVES.
__(a) In General._The Secretary may make grants to entities described in subsection (b) for the purpose of carrying out projects to develop and implement innovative community-based strategies to provide for health promotion and disease prevention activities for which there is a significant need, as identified under section 1701 of the Public Health Service Act.
__(b) Eligible Entities._The entities referred to in subsection (a) are agencies of State or local government, private nonprofit organizations (including research institutions), and coalitions that link two or more of these groups.
__(c) Certain Activities._The Secretary shall ensure that projects carried out under subsection (a)_
__(1) reflect approaches that take into account the special needs and concerns of the affected populations;
__(2) are targeted to the most needy and vulnerable population groups and geographic areas of the Nation;
__(3) examine links between various high priority preventable health problems and the potential community-based remedial actions; and 
__(4) establish or strengthen the links between the activities of agencies engaged in public health activities with those of health alliances, health care providers, and other entities involved in the personal health care delivery system described in title I.
SEC. 3332. PRIORITIES.
__(a) Establishment._
__(1) Annual statement._After consultation with the advisory board established in section 3335, the Secretary shall for each fiscal year develop a statement of proposed priorities for grants under section 3331 for the fiscal year.
__(2) Allocations among priorities._With respect to the amounts available under section 3301 for the fiscal year for carrying out this part, each statement under paragraph (1) for a fiscal year shall include a specification of the percentage of the amount to be devoted to projects addressing each of the proposed priorities established in the statement.
__(3) Process for establishing priorities._Not later than January 1 of each fiscal year, the Secretary shall publish a statement under paragraph (1) in the Federal Register.  A period of 60 days shall be allowed for the submission of public comments and suggestions concerning the proposed priorities.  After analyzing and considering comments on the proposed priorities, the Secretary shall publish in the Federal Register final priorities (and associated reservations of funds) for approval of projects for the following fiscal year.
__(b) Applicability to Making of Grants._
__(1) In general._Subject to paragraph (3), the Secretary may make grants under section 3331 for projects that the Secretary determines_
__(A) are consistent with the applicable final statement of priorities and otherwise meets the objectives described in subsection (a); and
__(B) will assist in meeting a health need or concern of a population served by a health plan or health alliance established under title I.
__(2) Special consideration for certain projects._In making grants under section 3331, the Secretary shall, subject to paragraph (3), give special consideration to applicants that will carry out projects that, in addition to being consistent with the applicable published priorities under subsection (a) and otherwise meeting the requirements of this part, have the potential for replication in other communities.
SEC. 3333. SUBMISSION OF INFORMATION.
__The Secretary may make a grant under section 3331 only if the applicant involved submits to the Secretary the following information:
__(1) A description of the activities to be conducted, and the manner in which the activities are expected to contribute to meeting one or more of the priority health needs specified under section 3332 for the fiscal year for which the grant is initially sought.
__(2) A description of the total amount of Federal funding requested, the geographic area and populations to be served, and the evaluation procedures to be followed.
__(3) Such other information as the Secretary determines to be appropriate.
SEC. 3334. APPLICATION FOR GRANT.
__The Secretary may make a grant under section 3331 only if an application for the grant is submitted to the Secretary, the application contains each agreement described in this part, the application contains the information required in section 3333, 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 part.

Title III, Subtitle E

Subtitle E_Health Services for Medically Underserved Populations
PART 1_COMMUNITY AND MIGRANT HEALTH CENTERS
SEC. 3401. AUTHORIZATIONS REGARDING PUBLIC HEALTH SERVICE INITIATIVES FUND.
__(a) Grants to Community and Migrant Health Centers._The Secretary shall make grants in accordance with this part to migrant health centers and community health centers.
__(b) Authorization of Appropriations._For the purpose of carrying out subsection (a), there are authorized to be appropriated from the Public Health Service Initiatives Fund (established in section 3701) $100,000,000 for each of the fiscal years 1995 through 2000.
__(c) Relation to Other Funds._The authorizations of appropriations established in subsection (b) for the purpose described in such subsection are in addition to any other authorizations of appropriations that are available for such purpose.
__(d) Definitions._For purposes of this subtitle, the terms ``migrant health center'' and ``community health center'' have the meanings given such terms in sections 329(a)(1) and 330(a) of the Public Health Service Act, respectively.
SEC. 3402. USE OF FUNDS.
__(a) Development, Operation, and Other Purposes Regarding Centers._Subject to subsection (b), grants under section 3401 to migrant health centers and community health centers may be made only in accordance with the conditions upon which grants are made under sections 329 and 330 of the Public Health Service Act, respectively.
__(b) Required Financial Reserves._The Secretary may authorize migrant health centers and community health centers to expend a grant under section 3401 to establish and maintain the financial reserves required under title I for providers of health services.
PART 2_INITIATIVES FOR ACCESS TO HEALTH CARE
Subpart A_Purposes; Funding
SEC. 3411. PURPOSES.
__Subject to the provisions of subparts B through D, the purposes of this part are as follows:
__(1) To improve access to health services for urban and rural medically-underserved populations through a program of flexible grants, contracts, and loans.
__(2) To facilitate transition to a system in which medically-underserved populations have an adequate choice of community-oriented providers and health plans.
__(3) To promote the development of community practice networks and community health plans that integrate health professionals and health care organizations supported through public funding with other providers in medically underserved areas.
__(4) To support linkages between providers of health care for medically-underserved populations and regional and corporate alliance health plans.
__(5) To expand the capacity of community practice networks and community health plans in underserved areas by increasing the number of practice sites and by renovating and converting substandard inpatient and outpatient facilities.
__(6) To link providers in underserved areas with each other and with regional health care institutions and academic health centers through information systems and telecommunications.
__(7) To support activities that enable medically underserved populations to gain access to the health care system and use it effectively.
SEC. 3412. AUTHORIZATIONS REGARDING PUBLIC HEALTH SERVICE INITIATIVES FUND.
__(a) Development of Qualified Community Health Plans and Practice Groups._For the purpose of carrying out subparts B and C, there are authorized to be appropriated from the Public Health Service Initiatives Fund (established in section 3701) $200,000,000 for fiscal year 1995, $500,000,000 for fiscal year 1996, $600,000,000 for fiscal year 1997, $700,000,000 for fiscal year 1998, $500,000,000 for fiscal year 1999, and $200,000,000 for fiscal year 2000.
__(b) Relation to Other Funds._The authorizations of appropriations established in subsection (a) are in addition to any other authorizations of appropriations that are available for the purpose described in such subsection.
__(c) Relationship to Program Regarding School-Related Health Services._This section is subject to section 3692.
Subpart B_Development of Qualified Community Health Plans and Practice Networks
SEC. 3421. GRANTS AND CONTRACTS FOR DEVELOPMENT OF PLANS AND NETWORKS.
__(a) In General._The Secretary may make grants to and enter into contracts with consortia of public or private health care providers for the development of qualified community health plans and qualified community practice networks. For purposes of this subtitle, the term ``qualified community health group'' means such a health plan or such a practice network.
__(b) Qualified Community Health Plans._For purposes of this subtitle, the term ``qualified community health plan'' means a health plan that meets the following conditions:
__(1) The health plan is a public or nonprofit private entity whose principal purpose is, with respect to the items and services included in the comprehensive benefit package under title I, to provide each of such items and services in one or more health professional shortage areas or to provide such items and services to a significant number of individuals who are members of a medically underserved population.
__(2) The health plan is a participant in one or more health alliances.
__(3) Two or more of the categories specified in subsection (d) are represented among the entities providing health services through the health plan.
__(c) Qualified Community Practice Networks._For purposes of this subtitle, the term ``qualified community practice network'' means a consortium of health care providers meeting the following conditions:
__(1) The consortium is a public or nonprofit private entity whose principal purpose is the purpose described in subsection (b)(1).
__(2) The consortium has an agreement with one or more health plans that are participating in one or more health alliances.
__(3) The participation of health care providers in the consortium is governed by a written agreement to which each of the participating providers is a party.
__(4) Two or more of the categories described in subsection (d) are represented among the entities participating in the consortium.
__(d) Relevant Categories of Entities._For purposes of subsections (b)(3) and (c)(4), the categories described in this subsection are the following categories of entities:
__(1) Physicians, other health professionals, or health care institutions that provide health services in one or more health professional shortage areas or provide such services to a significant number of individuals who are members of a medically underserved population, and that do not provide health services under any of the programs specified in paragraphs (2) through (7) or as employees of public entities.
__(2) Entities providing health services under grants under sections 329 and 330 of the Public Health Service Act.
__(3) Entities providing health services under grants under sections 340 and 340A of such Act.
__(4) Entities providing health services under grants under section 1001 or title XXIII of such Act.
__(5) Entities providing health services under title V of the Social Security Act.
__(6) Entities providing health services through rural health clinics and other federally qualified health centers.
__(7) Entities providing health services in urban areas through programs under title V of the Indian Health Care Improvement Act, and entities providing outpatient health services through programs under the Indian Self-Determination Act.
__(8) Programs providing personal health services and operating through State or local public health agencies.
__(e) Rule of Construction._The consortia to which the Secretary may make an award of financial assistance under subsection (a) for the development of qualified community practice networks include any health plan that participates in one or more health alliances, without regard to whether the health plan is a qualified community health plan.
__(f) Service Area._In making an award of financial assistance under subsection (a), the Secretary shall designate the geographic area with respect to which the qualified community health group involved is to provide health services. A funding agreement for such an award is that the qualified community health group involved will provide such services in the area so designated.
__(g) Definitions._For purposes of this subtitle:
__(1) The term ``health professional shortage areas'' means health professional shortage areas designated under section 332 of the Public Health Service Act.
__(2) The term ``medically underserved population'' means a medically underserved population designated under section 330 of the Public Health Service Act.
__(3) The term ``rural health clinic'' has the meaning given such term in section 1861(aa)(2) of the Social Security Act.
__(4) The term ``federally qualified health centers'' has the meaning given such term in section 1861(aa)(4) of the Social Security Act.
__(5) The term ``service area'', with respect to a qualified community health group, means the geographic area designated under subsection (g).
__(6) The term ``funding agreement'', with respect to an award of financial assistance under this section, means that the Secretary may make the award only if the applicant for the award makes the agreement involved.
__(7) The term ``financial assistance'', with respect to awards under subsection (a), means a grant or contract.
SEC. 3422. PREFERENCES IN MAKING AWARDS OF ASSISTANCE.
__In making awards of financial assistance under section 3421, the Secretary shall give preference to applicants in accordance with the following:
__(1) The Secretary shall give preference if 3 or more of the categories described in subsection (d) of such section will be represented in the qualified community health group involved (pursuant to subsection (b)(3) or (c)(4), as the case may be).
__(2) Of applicants receiving preference under paragraph (1), the Secretary shall give a greater degree of preference according to the extent to which a greater number of categories are represented.
__(3) Of applicants receiving preference under paragraph (1), the Secretary shall give a greater degree of preference if one of the categories represented is the category described in subsection (d)(1) of such section.
SEC. 3423. CERTAIN USES OF AWARDS.
__(a) In General._Subject to subsection (b), the purposes for which an award of financial assistance under section 3421 may be expended in developing a qualified community health group include the following:
__(1) Planning such group, including entering into contracts between the recipient of the award and health care providers who are to participate in the group.
__(2) Recruitment, compensation, and training of health professionals and administrative staff.
__(3) Acquisition, expansion, modernization, and conversion of facilities, including for purposes of providing for sites at which health services are to be provided through such group.
__(4) Acquisition and development of information systems (exclusive of systems that the Secretary determines are information highways).
__(5) Such other expenditures as the Secretary determines to be appropriate. 
__(b) Twenty-year Obligation Regarding Significant Capital Expenditures; Right of Recovery._
__(1) In general._With respect to a facility for which substantial capital costs are to paid from an award of financial assistance under section 3421, the Secretary may make the award only if the applicant involved agrees that the applicant will be liable to the United States for the amount of the award expended for such costs, together with an amount representing interest, if at any time during the 20-period beginning on the date of completion of the activities involved, the facility_
__(A) ceases to be a facility utilized by a qualified community health group, or by another public or nonprofit private entity that provides health services in one or more health professional shortage areas or that provides such services to a significant number of individuals who are members of a medically underserved population; or
__(B) is sold or transferred to any entity other than an entity that is_
__(i) a qualified community health group or other entity described in subparagraph (A); and
__(ii) approved by the Secretary as a purchaser or transferee regarding the facility.
__(2) Subordination; waivers._The Secretary may subordinate or waive the right of recovery under paragraph (1), and any other Federal interest that may be derived by virtue of an award of financial assistance under section 3421 from which substantial capital costs are to paid from an award, if the Secretary determines that subordination or waiver will further the objectives of this part.
SEC. 3424. ACCESSIBILITY OF SERVICES.
__(a) Services for Certain Individuals._A funding agreement for an award of financial assistance under section 3421 is that the qualified community health group involved will ensure that the services of the group will be accessible directly or through formal contractual arrangements with its participating providers regardless of whether individuals who seek care from the applicant are eligible persons under title I.  
__(b) Use of Third-Party Payors._A funding agreement for an award of financial assistance under section 3421 is that the qualified community health group involved will ensure that the health care providers of the group are all approved by the Secretary as providers under title XVIII of the Social Security Act and by the appropriate State agency as providers under title XIX of the Social Security Act, and the applicant has made or will make every reasonable effort to collect appropriate reimbursement for its costs in providing health services to individuals who are entitled to health benefits under title I of this Act, insurance benefits under title XVIII of the Social Security Act,  medical assistance under a State plan approved under title XIX of the Social Security Act, or to assistance for medical expenses under any other public assistance program or private health insurance program.
__(c) Schedule of Fees._A funding agreement for an award of financial assistance under section 3421 is that the qualified community health group involved will_
__(1) prepare a schedule of fees or payments for the provision of health services not covered by title I that is consistent with locally prevailing rates or charges and designed to cover its reasonable costs of operation and has prepared a corresponding schedule of discounts to be applied to the payment of such fees or payments (or payments of cost sharing amounts owed in the case of covered benefits) which discounts are applied on the basis of the patient's ability to pay; and
__(2) make every reasonable effort to secure from patients payment in accordance with such schedules, and to collect reimbursement for services to persons entitled to public or private insurance benefits or other medical assistance on the basis of full fees without application of discounts, except that the applicant will ensure that no person is denied service based on the person's inability to pay therefor.
__(d) Barriers Within Service Area._A funding agreement for an award of financial assistance under section 3421 is that the qualified community health group involved will ensure that the following conditions are met:
__(1) In the service area of the group, the group will ensure that_
__(A) the services of the group are accessible to all residents; and
__(B) to the maximum extent possible, barriers to access to the services of the group are eliminated, including barriers resulting from the area's physical characteristics, its residential patterns, its economic, social and cultural groupings, and available  transportation.
__(2) The group will periodically conduct reviews within the service area of the group to determine whether the conditions described in paragraph (1) are being met.
__(e) Limited Ability to Speak English Language._A funding agreement for an award of financial assistance under section 3421 is that, if the service area of the qualified community health group involved serves a substantial number of individuals who have a limited ability to speak the English language, the applicant will_
__(1) maintain arrangements responsive to the needs of such individuals for providing services to the extent practicable in the language and cultural context most appropriate to such individuals; and 
__(2) maintain a sufficient number of staff members who are fluent in both English and the languages spoken by such individuals, and will ensure that the responsibilities of the employees include providing guidance and assistance to such individuals and to other staff members of the group.
SEC. 3425. ADDITIONAL AGREEMENTS.
__(a) Required Services._A funding agreement for an award of financial assistance under section 3421 is that the qualified community health group involved will provide enabling services (as defined in section 3461(g)) and all of the items and services identified by the Secretary in rules regarding qualified community health plans and practice networks.
__(b) Quality Control System._A funding agreement for an award of financial assistance under section 3421 is that the qualified community health group involved will maintain a community-oriented, patient responsive, quality control system under which the group, in accordance with regulations prescribed by the Secretary_
__(1) conducts an ongoing quality assurance program for the health services delivered by participating provider entities; 
__(2) maintains a continuous community health status improvement process; and 
__(3) maintains a system for development, compilation, evaluation and reporting of information to the public regarding the costs of operation, service utilization patterns, availability, accessibility and acceptability of services, developments in the health status of the populations served, uniform health and clinical performance measures and financial performance of the network or plan.
__(c) Use of Existing Resources._A funding agreement for an award of financial assistance under section 3421 is that the applicant will, in developing the qualified community health group involved, utilize existing resources to the maximum extent practicable.
SEC. 3426. SUBMISSION OF CERTAIN INFORMATION.
__(a) Assessment of Need._The Secretary may make an award of financial assistance under section 3421 only if the applicant involved submits to the Secretary an assessment of the need that the medically underserved population or populations proposed to be served by the applicant have for health services and for enabling services (as defined in section 3461(g)).
__(b) Description of Intended Expenditures; Related Information._The Secretary may make an award of financial assistance under section 3421 only if the applicant involved submits to the Secretary the following information:
__(1) A description of how the applicant will design the proposed quality community health plan or practice network (including the service sites involved) for such populations based on the assessment of need.  
__(2) A description of efforts to secure, within the proposed service area of such health plan or practice network (including the service sites involved), financial and professional assistance and support for the project.
__(3) Evidence of significant community involvement in the initiation, development and ongoing operation of the project.
SEC. 3427. REPORTS; AUDITS.
__A funding agreement for an award of financial assistance under section 3421 is that the applicant involved will_
__(1) provide such reports and information on activities carried out under this section in a manner and form required by the Secretary; and
__(2) provide an annual organization-wide audit that meets applicable standards of the Secretary.
SEC. 3428. APPLICATION FOR ASSISTANCE.
__The Secretary may make an award of financial assistance under section 3421 only if an application for the award is submitted to the Secretary, the application contains each funding agreement described in this subpart, the application contains the information required in section 3426, 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 subpart.
SEC. 3429. GENERAL PROVISIONS.
__(a) Limitation on Number of Awards._The Secretary may not make more than two awards of financial assistance under section 3421 for the same project.
__(b) Amount._The amount of any award of financial assistance under section 3421 for any project shall be determined by the Secretary.
Subpart C_Capital Cost of Development of Qualified Community Health Plans and Practice Networks
SEC. 3441. LOANS AND LOAN GUARANTEES REGARDING PLANS AND NETWORKS.
__(a) In General._The Secretary may make loans to, and guarantee the payment of principal and interest to Federal and non-Federal lenders on behalf of, public and private entities for the capital costs of developing qualified community health groups (as defined in section 3421(a)).
__(b) Preferences; Accessibility of Services; Certain Other Provisions._The provisions of subpart B apply to loans and loan guarantees under subsection (a) to the same extent and in the same manner as such provisions apply to awards of grants and contracts under section 3421.
__(c) Use of Assistance._
__(1) In general._With respect to the development of qualified community health groups, the capital costs for which loans made pursuant to subsection (a) may be expended are, subject to paragraphs (2) and (3), the following:
__(A) The acquisition, modernization, expansion or construction of facilities, or the conversion of unneeded hospital facilities to facilities that will assure or enhance the provision and accessibility of health care and enabling services to medically underserved populations.
__(B) The purchase of major equipment, including equipment necessary for the support of external and internal information systems.
__(C) The establishment of reserves required for furnishing services on a prepaid basis.
__(D) Such other capital costs as the Secretary may determine are necessary to achieve the objectives of this section.
__(2) Priorities regarding use of funds._In providing loans or loan guarantees under subsection (a) for an entity, the Secretary shall give priority to authorizing the use of amounts for projects for the renovation and modernization of medical facilities necessary to prevent or eliminate safety hazards, avoid noncompliance with licensure or accreditation standards, or projects to replace obsolete facilities.
__(3) Limitation._The Secretary may authorize the use of amounts under subsection (a) for the construction of new buildings only if the Secretary determines that appropriate facilities are not available through acquiring, modernizing, expanding or converting existing buildings, or that construction new buildings will cost less.
__(d) Amount of assistance._The principal amount of loans or loan guarantees under subsection (a) may, when added to any other assistance under this section, cover up to 100 percent of the costs involved.
SEC. 3442. CERTAIN REQUIREMENTS.
__(a) Loans._
__(1) In general._The Secretary may approve a loan under section 3441 only if_
__(A) the Secretary is reasonably satisfied that the applicant for the project for which the loan would be made will be able to make payments of principal and interest thereon when due; and  
__(B) the applicant provides the Secretary with reasonable assurances that there will be available to it such additional funds as may be necessary to complete the project or undertaking with respect to which such loan is requested.
__(2) Terms and conditions._Any loan made under section 3441 shall meet such terms and conditions (including provisions for recovery in case of default) as the Secretary determines to be necessary to carry out the purposes of such section while adequately  protecting the financial interests of the United States. Terms and conditions for such loans shall include provisions regarding the following:
__(A) Security.
__(B) Maturity date. 
__(C) Amount and frequency  of installments.
__(D) Rate of interest, which shall be at a rate comparable to the rate of interest prevailing on the date the loan is made.
__(b) Loan Guarantees._The Secretary may not approve a loan guarantee under section 3441 unless the Secretary determines that the terms, conditions, security (if any), schedule and amount of repayments with respect to the loan are sufficient to protect the financial interests of the United States and are otherwise reasonable. Such loan guarantees shall be subject to such further terms and conditions as the  Secretary determines to be necessary to ensure that the purposes of this section will be achieved.
__(c) Use of Existing Resources._The Secretary may provide a loan or loan guarantee under section 3441 only if the applicant involved agrees that, in developing the qualified community health group involved, the applicant will utilize existing resources to the maximum extent practicable.
SEC. 3443. DEFAULTS; RIGHT OF RECOVERY.
__(a) Defaults._
__(1) In general._The Secretary may take such action as may be necessary to prevent a default on loans or loan guarantees under section 3441, including the waiver of regulatory conditions, deferral of loan payments, renegotiation of loans, and the expenditure of funds for technical and consultative assistance, for the temporary payment of the interest and principal on such a loan, and for other purposes.  
__(2) Foreclosure._The Secretary may take such action, consistent with State law respecting foreclosure procedures, as the Secretary deems appropriate to protect the interest of the United States in the event of a default on a loan made pursuant to section 3441, including selling real property pledged as security for such a loan or loan guarantee and for a reasonable period of time taking possession of, holding, and using real property pledged as security for such a loan or  loan guarantee.
__(3) Waivers._The Secretary may, for good cause, but with due regard to the financial interests of the United States, waive any right of recovery which the Secretary has by reasons of the failure of a borrower to make payments of principal of and interest on a loan made pursuant to section 3441, except that if such loan is sold and guaranteed, any such waiver shall have no effect upon the Secretary's guarantee of timely payment of principal and interest.
__(b) Twenty-year Obligation; Right of Recovery._
__(1) In general._With respect to a facility for which a loan is to be made pursuant to section 3441, the Secretary may provide the loan or loan guarantee only if the applicant involved agrees that the applicant will be liable to the United States for the amount of the loan or loan guarantee, together with an amount representing interest, if at any time during the 20-period beginning on the date of completion of the activities involved, the facility_
__(A) ceases to be a facility utilized by a qualified community health group, or by another public or nonprofit private entity that provides health services in one or more health professional shortage areas or that provides such services to a significant number of individuals who are members of a medically underserved population; or
__(B) is sold or transferred to any entity other than an entity that is_
__(i) a qualified community health group or other entity described in subparagraph (A); and
__(ii) approved by the Secretary as a purchaser or transferee regarding the facility.
__(2) Subordination; waivers._The Secretary may subordinate or waive the right of recovery under paragraph (1), and any other Federal interest that may be derived by virtue of a loan or loan guarantee under subsection (a), if the Secretary determines that subordination or waiver will further the objectives of this part.
SEC. 3444. PROVISIONS REGARDING CONSTRUCTION OR EXPANSION OF FACILITIES.
__(a) Submission of Information._In the case of a project for construction, conversion, expansion or modernization of a facility, the Secretary may provide loans or loan guarantees under section 3441 only if the applicant submits to the Secretary the following:
__(1) A description of the site.
__(2) Plans and specifications which meet requirements prescribed by the Secretary.
__(3) Information reasonably demonstrating that title to such site is vested in one or more of the entities filing the application (unless the agreement described in subsection (b)(1) is made).
__(4) A specification of the type of assistance being requested under section 3441.
__(b) Agreements._In the case of a project for construction, conversion, expansion or modernization of a facility, the Secretary may provide loans or loan guarantees under section 3441 only if the applicant makes the following agreements:
__(1) Title to such site will be vested in one or more of the entities filing the application (unless the assurance described in subsection (a)(3) has been submitted under such subsection).
__(2) Adequate financial support will be available for completion of the project and for its maintenance and operation when completed.
__(3) All laborers and mechanics employed by contractors or subcontractors in the performance of work on a project will be paid wages at rates not less than those prevailing on similar construction in the locality as determined by the Secretary of Labor in accordance with the Act of March  3, 1931 (40 U.S.C. 276a et seq; commonly known as the Davis-Bacon Act), and the Secretary of Labor shall have with respect to such labor standards the authority and functions set forth in Reorganization Plan Numbered 14 of 1950 (15 FR 3176; 5 U.S.C. Appendix) and section 276c of title 40.
__(4) The facility will be made available to all persons seeking service regardless of their ability to pay.  
SEC. 3445. APPLICATION FOR ASSISTANCE.
__The Secretary may provide loans or loan guarantees under section 3441 only if an application for such assistance is submitted to the Secretary, the application contains each agreement described in this subpart, the application contains the information required in section 3444(a), 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 subpart.
SEC. 3446. ADMINISTRATION OF PROGRAMS.
__This subpart, and any other program of the Secretary that provides loans or loan guarantees, shall be carried out by a centralized loan unit established within the Department of Health and Human Services.
Subpart D_Enabling Services
SEC. 3461. GRANTS AND CONTRACTS FOR ENABLING SERVICES.
__(a) In General._
__(1) Grants and contracts._The Secretary may make grants to and enter into contracts with entities described in paragraph (2) to assist such entities in providing the services described in subsection (b) for the purpose of increasing the capacity of individuals to utilize the items and services included in the comprehensive benefits package under title I.
__(2) Relevant entities._For purposes of paragraph (1), the entities described in this paragraph are qualified community health groups (as defined in section 3421(a)), and other public or nonprofit private entities, that_
__(A) provide health services in one or more health professional shortage areas or that provide such services to a significant number of individuals who are members of a medically underserved population; and
__(B) are experienced in providing services to increase the capacity of individuals to utilize health services.
__(b) Enabling Services._The services referred to in subsection (a)(1) are transportation, community and patient outreach, patient education, translation services, and such other services as the Secretary determines to be appropriate in carrying out the purpose described in such subsection.
__(c) Certain Requirements Regarding Project Area._The Secretary may make an award of a grant or contract under subsection (a) only if the applicant involved_
__(1) submits to the Secretary_
__(A) information demonstrating that the medically underserved populations in the community to be served under the award have a need for enabling services; and
__(B) a proposed budget for providing such services; and
__(2) the applicant for the award agrees that the residents of the community will be significantly involved in the project carried out with the award.
__(d) Imposition of Fees._The Secretary may make an award of a grant or contract under subsection (a) only if the applicant involved agrees that, in the project carried out under such subsection, enabling services will be provided without charge to the recipients of the services.
__(e) Use of Existing Resources._The Secretary may make an award of a grant or contract under subsection (a) only if the applicant involved agrees that, in carrying out the project under such subsection, the applicant will utilize existing resources to the maximum extent practicable.
__(f) Application for Awards of Assistance._The Secretary may make an award of a grant or contract under subsection (a) only if an application for the award is submitted to the Secretary, the application contains each agreement described in this subpart, the application contains the information required in subsection (d)(1), 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 subpart.
__(g) Definition._For purposes of this section, the term ``enabling services'' means services described in subsection (b) that are provided for the purpose described in subsection (a)(1).
SEC. 3462. AUTHORIZATIONS REGARDING PUBLIC HEALTH SERVICE INITIATIVES FUND.
__(a) Enabling Services._For the purpose of carrying out section 3461, there are authorized to be appropriated from the Public Health Service Initiatives Fund (established in section 3701) $200,000,000 for fiscal year 1996, $300,000,000 for each of the fiscal years 1997 through 1999, and $100,000,000 for fiscal year 2000.
__(b) Relation to Other Funds._The authorizations of appropriations established in subsection (a) are in addition to any other authorizations of appropriations that are available for the purpose described in such subsection.
PART 3_NATIONAL HEALTH SERVICE CORPS
SEC. 3471. AUTHORIZATIONS REGARDING PUBLIC HEALTH SERVICE INITIATIVES FUND.
__(a) Additional Funding; General Corps Program; Allocations Regarding Nurses._For the purpose of carrying out subpart II of part D of title III of the Public Health Service Act, and for the purpose of carrying out section 3472, there are authorized to be appropriated from the Public Health Service Initiatives Fund (established in section 3701) $50,000,000 for fiscal year 1995, $100,000,000 for fiscal year 1996, and $200,000,000 for each of the fiscal years 1997 through 2000.
__(b) Relation to Other Funds._The authorizations of appropriations established in subsection (a) are in addition to any other authorizations of appropriations that are available for the purpose described in such subsection.
__(c) Availability of Funds._An appropriation under this section for any fiscal year may be made at any time before that fiscal year and may be included in an Act making an appropriation under an authorization under subsection (a) for another fiscal year; but no funds may be made available from any appropriation under this section for obligation under sections 331 through 335, section 336A, and section 337 before the fiscal year involved.
SEC. 3472. ALLOCATION FOR PARTICIPATION OF NURSES IN SCHOLARSHIP AND LOAN REPAYMENT PROGRAMS.
__Of the amounts appropriated under section 3471, the Secretary shall reserve such amounts as may be necessary to ensure that, of the aggregate number of individuals who are participants in the Scholarship Program under section 338A of the Public Health Service Act, or in the Loan Repayment Program under section 338B of such Act, the total number who are being educated as nurses or are serving as nurses, respectively, is increased to 20 percent.
PART 4_PAYMENTS TO HOSPITALS SERVING VULNERABLE POPULATIONS
SEC. 3481. PAYMENTS TO HOSPITALS.
__(a) Entitlement Status._The Secretary shall make payments in accordance with this part to eligible hospitals described in section 3482. The preceding sentence_
__(1) is an entitlement in the Secretary on behalf of such eligible hospitals (but is not an entitlement in the State in which any such hospital is located or in any individual receiving services from any such hospital); and
__(2) constitutes budget authority in advance of appropriations Acts and represents the obligation of the Federal Government to provide funding for such payments in the amounts, and for the fiscal years, specified in subsection (b).
__(b) Amount of Entitlement._
__(1) In general._For purposes of subsection (a)(2), the amounts and fiscal years specified in this subsection are (in the aggregate for all eligible hospitals) $800,000,000 for the fiscal year in which the general effective date occurs and for each subsequent fiscal year.
__(2) Special rule for years before general effective date._
__(A) In general._For any fiscal year that begins prior to the general effective date, the amount specified in this subsection for purposes of subsection (a)(2) shall be equal to the aggregate DSH percentage of the amount otherwise determined under paragraph (1).
__(B) Aggregate DSH percentage defined._In subparagraph (A), the ``aggregate DSH percentage'' for a year is the amount (expressed as a percentage) equal to_
__(i) the total amount of payment made by the Secretary under section 1903(a) of the Social Security Act during the base year with respect to payment adjustments made under section 1923(c) of such Act for hospitals in the States in which eligible hospitals for the year are located; divided by 
__(ii) the total amount of payment made by the Secretary under section 1903(a) of such Act during the base year with respect to payment adjustments made under section 1923(c) of such Act for hospitals in all States.
__(c) Period of Payment._An eligible hospital shall receive a payment under this section for a period of 5 years, without regard to the year for which the hospital first receives a payment.
__(d) Payments Made on Quarterly Basis._Payments to an eligible hospital under this section for a year shall be made on a quarterly basis during the year.
SEC. 3482. IDENTIFICATION OF ELIGIBLE HOSPITALS.
__(a) Hospitals in Participating States._In order to be an eligible hospital under this part, a hospital must be located in a State that is a participating State under this Act, except that an eligible hospital remains eligible to receive a payment under this part notwithstanding that, during the 5-year period for which the payment is to be made, the State in which it is located no longer meets the requirements for participating States under this Act.
__(b) State Identification._In accordance with the criteria described in subsection (c) and such procedures as the Secretary may require, each State shall identify the hospitals in the State that meet such criteria and provide the Secretary with a list of such hospitals.
__(c) Criteria for Eligibility._A hospital meets the criteria described in this subsection if the hospital's low-income utilization rate for the base year under section 1923(b)(3) of the Social Security Act (as such section is in effect on the day before the date of the enactment of this Act) is not less than 25 percent.
SEC. 3483. AMOUNT OF PAYMENTS.
__(a) Distribution of Allocation for Low-Income Assistance._
__(1) Allocation from total amount._Of the total amount available for payments under this section in a year, 75 percent shall be allocated to hospitals for low-income assistance in accordance with this subsection.
__(2) Determination of hospital payment amount._The amount of payment to an eligible hospital from the allocation made under paragraph (1) during a year shall be the equal to the hospital's low-income