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1976/10/12 HR5546 Health Professions Educational Assistance Act of 1976 (2)
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1976/10/12 HR5546 Health Professions Educational Assistance Act of 1976 (2)
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The original documents are located in Box 63, folder "10/12/76 HR5546 Health Professions
Educational Assistance Act of 1976 (2)" of the White House Records Office: Legislation
Case Files at the Gerald R. Ford Presidential Library.
Copyright Notice
The copyright law of the United States (Title 17, United States Code) governs the making of
photocopies or other reproductions of copyrighted material. Gerald R. Ford donated to the United
States of America his copyrights in all of his unpublished writings in National Archives collections.
Works prepared by U.S. Government employees as part of their official duties are in the public
domain. The copyrights to materials written by other individuals or organizations are presumed to
remain with them. If you think any of the information displayed in the PDF is subject to a valid
copyright claim, please contact the Gerald R. Ford Presidential Library.
Exact duplicates within this folder were not digitized.
Digitized from Box 63 of the White House Records Office Legislation Case Files
at the Gerald R. Ford Presidential Library
94TH CONGRESS
1st Session
}
{
REPORT
HOUSE OF REPRESENTATIVES
No. 94-266
HEALTH MANPOWER ACT OF 1975
REPORT
BY THE
COMMITTEE ON INTERSTATE AND
FOREIGN COMMERCE
Together With
OPPOSING, SEPARATE, AND
SUPPLEMENTAL VIEWS
[To accompany H.R. 5546]
JUNE 7, 1975.-Committed to the Committee of the Whole House
on the State of the Union and ordered to be printed
U.S. GOVERNMENT PRINTING OFFICE
52-595 0
WASHINGTON : 1975
This lengthy publication was not digitized. Please contact the Gerald R. Ford
Presidential Library or the government documents department of a local library to
obtain a copy of this item.
Calendar No. 843
94TH CONGRESS
SENATE
REPORT
2d Session
No. 94-887
HEALTH PROFESSIONS EDUCATIONAL ASSISTANCE
ACT OF 1976
MAY 14, 1976.-Ordered to be printed
Filed under authority of the order of the Senate May 13, 1976
Mr. KENNEDY, from the Committee on Labor and Public Welfare,
submitted the following
REPORT
together with
SUPPLEMENTAL VIEWS
[To accompany S. 3239]
The Committee on Labor and Public Welfare, to which was re-
ferred the bill (S. 3239) to amend the Public Health Service Act to
revise and extend the programs of assistance under title VII for train-
ing in the health professions, to revise the National Health Service
Corps program, and for other purposes, having considered the same,
reports favorably thereon with an amendment in the nature of a
substitute and recommends that the bill (as amended) do pass.
CONTENTS
Page
1. Legislative history
2
II. Program accomplishments
19
III. Committee hearings
30
IV. Need for legislation
34
1. Geographic maldistribution
36
2. Specialty maldistribution
48
3. Foreign medical graduates
61
4. Licensure
69
5. Occupational health
85
V. Administration proposal
91
VI. Comparative summary
97
VII. Description of the committee's bill
174
VIII. Special committee concerns
193
IX. Committee views
194
X. Radiation health and safety
260
XI. Cost estimates
279
XII. Votes in committee
286
XIII. Section-by-section analysis
287
XIV. Changes in existing law
330
XV. Supplemental views
497
71-093 0
This lengthy publication was not digitized. Please contact the Gerald R. Ford
Presidential Library or the government documents department of a local library to
obtain a copy of this item.
94TH CONGRESS
}
HOUSE OF REPRESENTATIVES
REPORT
2d Session
No. 94-1612
HEALTH PROFESSIONS EDUCATIONAL ASSISTANCE
ACT OF 1976
SEPTEMBER 17, 1976.-Ordered to be printed
Mr. STAGGERS, from the committee of conference,
submitted the following
CONFERENCE REPORT
[To accompany H.R. 5546]
The committee of conference on the disagreeing votes of the two
Houses on the amendment of the Senate to the bill (H.R. 5546) to
amend the Public Health Service Act to revise and extend the pro-
grams of assistance under title VII for training in the health and
allied health professions, to revise the National Health Service Corps
program, and the National Health Service Corps scholarship training
program, and for other purposes, having met, after full and free con-
ference, have agreed to recommend and do recommend to their respec-
tive Houses as follows:
That the House recede from its disagreement to the amendment of
the Senate and agree to the same with an amendment as follows:
In lieu of the matter proposed to be inserted by the Senate amend-
ment insert the following:
SHORT TITLE: REFERENCE TO ACT
SECTION 1. (a) This Act may be cited as the "Health Professions
Educational Assistance Act of 1976".
(b) Except as otherwise specifically provided, whenever in this Act
an amendment or repeal is expressed in terms of an amendment to, or
repeal of, a section or other provision, the reference shall be considered
to be made to a section or other provision of the Public Health Service
Act.
FINDINGS AND DECLARATION OF POLICY
SEC. 2. (a) The Congress finds and declares that-
(1) the availability of high quality health care to all Americans
is a national goal;
(2) the availability of high quality health care is, to a substan-
tial extent, dependent upon-
2
3
(4) the availability of qualified health professions per-
(c) Section 720 (relating to grants for construction of teaching fa-
sonel; and
cilities) is amended (1) by striking out "and" after "1973," and (2)
(B) the availability of adequate numbers of physicians
by striking out "for the fiscal year ending June 30, 1974" and inserting
engaged in the delivery of primary care, including family
in lieu thereof "each for the fiscal years ending June 30, 1974, June
practice, general internal medicine, and general pediatrics,
30, 1975, and June 30, 1976, and $103,000,000 for the fiscal year ending
and in the various specialties, but numbers which do not ex-
September 30, 1977".
ceed the need for physicians in such specialties;
(d) Section 729 (relating to loan guarantees and interest subsidies)
(3) there are many areas in the United States which are unable
is amended-
to attract adequate numbers of health professions personnel to
(1) by striking "June 30, 1974" in subsections (a) and (b) and
meet their health care needs; and
inserting in lieu thereof "September 30, 1977"; and
(4) physician specialization has resulted in inadequate num-
(2) by inserting after "1974" in subsection (e) the following:
bers of physicians engaged in the delivery of primary care.
or in any of the next three fiscal years".
(b) The Congress further finds and declares that-
(e) Section 742 (relating to health professions student loans) is
(1) health professions personnel are a national health resource
amended (1) by striking out "and" after "1975," the first time it oc-
and the Federal government shares the responsibility of assuring
curs, and (2) by inserting after "1976" the following: ", and $39,-
that such qualified personnel are available to meet the health care
100,000 for the fiscal year ending September 30, 1977".
needs of the American people;
(f) Section 747 (d) (relating to loans for students in foreign medi-
(2) it is therefore appropriate to provide support for the edu-
cal schools) is amended by striking out "two" and inserting in lieu
cation and training of such personnel; and
thereof "four".
(3) at the same time it is appropriate to provide such support
(g) The section 767 entitled "GRANTS FOR TRAINING, TRAINEESHIPS,
in a manner which will assure the availability of health profes-
AND FELLOWSHIPS IN FAMILY MEDICINE" is amended (1) by striking out
sions personnel to all of the American people.
"and" after "1973,", and (2) by striking out "for the fiscal year ending
(c) The Congress further finds and declares that there is no longer
June 30, 1974" and inserting in lieu thereof "each for the fiscal years
an insufficient number of physicians and surgeons in the United States
ending June 30, 1974, June 30, 1975, and June 30, 1976, and $39,000,000
and that there is no further need for the admission of alien physicians
for the fiscal year ending September 30, 1977".
and surgeons under the Immigration and Nationality Act.
(h) The section 768 entitled "GRANTS FOR SUPPORT OF POST-GRADUATE
TRAINING PROGRAMS FOR PHYSICIANS AND DENTISTS" is amended-
TITLE I-EXTENSION OF CURRENT AUTHORITIES
(1) by striking out "for the fiscal year ending June 30, 1974"
THROUGH FISCAL YEAR 1977
in subsection (a) and inserting in lieu thereof "each for the fiscal
years ending June 30, 1974, June 30, 1975, and June 30, 1976"; and
EXTENSION
(2) by inserting "or in the next two fiscal years" after "1974,"
in subsection (3) (3) (B).
SEC. 101. (a) (1) Section 312(a) (relating to traineeships for pro-
(i) Section 769 (relating to grants for training for health pro-
fessional public health personnel) is amended (A) by striking out
fessions teaching personnel) is amended by striking out "for the fiscal
"and" after "1973,", and (B) by striking out "for the fiscal year end-
year ending June 30, 1974" and inserting in lieu thereof "each for the
ing June 30, 1974" and inserting in lieu thereof "each for the fiscal
fiscal years ending June 30, 1974, June 30 1975, and June 30, 1976".
years ending June 30, 1974, June 30, 1975, and June 30, 1976, and $9,-
(j) Section 769A (relating to grants for computer technology) is
900,000 for the fiscal year ending September 30, 1977".
amended by striking out "for the fiscal year ending June 30, 1974"
(2) Section 313 (a) (relating to project grants for graduate train-
and inserting in lieu thereof "each for the fiscal years ending June 30,
ing in public health) is amended (4) by striking out "and" after
1974, June 30, 1975, June 30, 1976, and September 30, 1977".
"1973,", and (B) by striking out "for the fiscal year ending June 30,
(k) (1) Paragragh (1) of section 770(j) (relating to capitation
1974" and inserting in lieu thereof "each for the fiscal years ending
grants) is amended (4) by striking out "and" after "1973", and (B)
June 30, 1974, June 30, 1975, and June 30, 1976, and $6,000,000 for the
by striking out "for the fiscal year ending June 30, 197.4" and inserting
fiscal year ending September 1977".
in lieu thereof "each for the fiscal years ending June 30, 1974, June 30,
(3) Section 313(c) is amended (A) by striking out "and" after
1975, and June 30, 1976, and $133,700,000 for the fiscal year ending
"1973,", and (B) by striking out "for the fiscal year ending June 30,
September 30, 1977".
1974" and inserting in lieu thereof "each for the fiscal years ending
(2) Paragraph (2) of such section is amended (A) by striking
June 30, 1974, June 30, 1975, and June 30, 1976, and $6,400,000 for the
out "and" after "1973,", and (B) by striking out "for the fiscal year
fiscal year ending September 30, 1977".
ending June 30, 1974" and inserting in lieu thereof "each for the fiscal
(b) Section 329(h) (relating to the National Health Service Corps)
years ending June 30, 1974, June 30, 1975, and June 30, 1976, and
is amended (1) by striking out "and" after "1975;", and (2) by strik-
$29,300,000 for the fiscal year ending September 30, 1977".
ing out "1976" and inserting in lieu thereof "1976; and $34,000,000 for
(l) Section 771 (a) (6) (relating to start-up assistance) is amended
the fiscal year ending September 30, 1977".
(1) by striking out "two fiscal years" and inserting in lieu thereof
5
4
"four fiscal years, and not to exceed $5,100,000 for the fiscal year ending
(3) Section 793 (relating to traineeships for advanced training)
September 30, 1977", (2) by striking out "July 1, 1974" in subsection
is amended (A) by striking out "and" after "1973,", and (B) by
(b) (2) and inserting in lieu thereof "October 1, 1977", and (3) by
striking out "for the fiscal year ending June 30, 1974" and inserting
striking out "June 30, 1975" in such subsection and inserting in lieu
in lieu therof "each for the fiscal years ending June 30, 1974, June 30,
1975, and June 30, 1976, and $3,900,000 for the fiscal year ending Sep-
thereof "September 30, 1978".
(m) Section 772 (d) (relating to special project grants and con-
tember 30, 1977".
tracts) is amended (1) by striking out "and" after "1973,", and (2) by
(4) Section 794A (3) (relating to assistance for recruitment) is
striking out "for the fiscal year ending June 30, 1974" and inserting
amended (A) by striking out "and" after "1973;", and (B) by striking
in lieu thereof "each for the fiscal years ending June 30, 1974, June
out "for the fiscal year ending June 30, 1974" and inserting in lieu
30, 1975, and June 30, 1976, and $40,852,000 for the fiscal year ending
thereof "each for the fiscal years ending June 30, 1974, June 30,
1975, and June 30, 1976, and $109,000 for the fiscal year ending Sep-
September 30, 1977".
(1) by striking out "and" after "1973,", and (2) by striking out "for
(n) Section (relating to financial distress grants) is amended
tember 30, 1977".
(t) Section 225(i) (relating to Public Health and National Health
the fiscal year ending June 30, 1974" the first time it appears and in-
Service Corps scholarships) is amended (1) by striking out "and"
serting in lieu thereof "each for the fiscal years ending June 30, 1974,
after "1974,", and (2) by striking out "for the fiscal year ending June
June 30, 1975, and June 30, 1976, and $5,400,000 for the fiscal year end-
30, 1975" and inserting in lieu thereof "each for the fiscal years end-
ing June 30, 1975, and June 30, 1976, and $40,000,000 for the fiscal year
ing September 30, 1977".
amended (1) by striking out "and" after "1973,", and (2) by striking
(o) Section 774(e) (relating to education initiative awards) is
ending September 30, 1977".
out "for the fiscal year ending June 30, 1974" and inserting in lieu
TITLE II-GENERAL PROVISIONS
thereof "each for the fiscal years ending June 30, 1974, June 30, 1975,
and June 30, 1976, and $41,170,000 for the fiscal year ending September
NEW GENERAL PROVISIONS
30, 1977".
(p) Section 780 (relating to scholarship grants) is amended (1) by
SEC. 201. (a) Sections 701 through 711 are repealed.
striking out "the next fiscal year" in subsection (b) and inserting in
(b) The following section is inserted in part A of title VII:
lieu thereof "the next three fiscal years", (2) by striking out "1974" in
such subsection and subsection (c) (1) (B) and inserting in lieu thereof
"LIMITATION ON USE OF APPROPRIATIONS
"1976", (3) by striking out in subsections (b) and (c) (1) (B) "June
30, 1975" and inserting in lieu thereof "September 30, 1977" and (4)
"Sec. 700. (a) Notwithstanding any other provision of law, with
by striking out "two" in subsection (c) (1) (A) and inserting in lieu
respect to any fiscal year beginning after September 30, 1977, no funds
appropriated for such fiscal year may be made available for obligation
thereof "four".
is amended (1) by striking "two" in subsection (e) (1) and inserting in
(q) The section 785 entitled "SCHOLARSHIP GRANTS FOR STUDY abroad"
or expenditure for the purposes of carrying out any provision of this
title if the sum of the amounts appropriated for such fiscal year for
lieu thereof "four", (2) by striking out "June 30, 1975" in subsection
scholarships under subpart IV of part C of title VII (relating to Na-
(e) (2) and inserting in lieu thereof September 30, 1977", and (3) by
tional Health Service Corps scholarships) and for the purpose of mak-
striking out in such subsection "1974" and inserting in lieu thereof
ing grants under section 758 (relating to disadvantaged student schol-
arships) is less than the lesser of-
"1976". (r) Section 786 (relating to physician shortage area scholarships)
(1) the sum of the amounts authorized to be appropriated for
is amended (1) by striking out "June 30, 1975" in the second sentence
such fiscal year under such subpart and section, or
and inserting in lieu thereof "September 30, 1977", and (2) by striking
"(2) 50 percent of the sum of the amounts appropriated for
out "1974" in that sentence and inserting in lieu thereof "1976".
such fiscal year under this title.
(8) (1) Section 792(b) (relating to special improvement grants) is
"(b) Subsection (a) shall not apply with respect to a fiscal year
amended (A) by striking out "and" after "1973,", and (B) by striking
if less than 75 percent of the sum of the amounts authorized to be ap-
out "for the fiscal year ending June 30, 1974" and inserting in lieu
propriated for such fiscal year under paragraphs (1), (2), and (3) of
thereof "each for the fiscal years ending June 30, 1974, June 30,
section 770 (e) (relating to capitation grants for medical, osteopathic,
1975, and June 30, 1976, and $11,400,000 for the fiscal year ending
and dental schools) is appropriated for such fiscal year under such
paragraphs.".
September 30, 1977".
(2) Section 792(c) (1) (relating to special projects) is amended
(c) Sections 724, 725, 799, and 799A are transferred to part A, in-
(A) by striking out "and" after "1973,", and (B) by striking out "for
serted after section 700 (added by subsection (b)), and redesignated
the fiscal year ending June 30, 1974" and inserting in lieu thereof
as sections 701, 702, 703, and 704, respectively.
"each for the fiscal years ending June 30, 1974, June 30, 1975, and
(d) (1) The heading for part A of title VII is amended to read as
June 30, 1976, and $15,400,000 for the fiscal year ending September 30,
follows:
1977".
6
7
"PART A-GENERAL PROVISIONS
(10) The term 'Department' means the Department of Health,
Education, and Welfare.
(2) The heading for part H of title VII is repealed.
(11) The term 'medical residency training program' means a
(e) Section 701 (as 80 redesignated) is amended-
program which trains graduates of schools of medicine and
(1) by striking out "As used in this part and parts o, E, and
schools of osteopathy in a medical specialty recognized by the
F- and inserting in lieu thereof "For purposes of this title
Liaison Committee for Specialty Boards established jointly by the
(2) by inserting "or an equivalent degree" after "degree in
American Board of Medical Specialties and the Council on Medi-
public health" in paragraph (4); and
cal Education of the American Medical Association and which
(3) by adding at the end the following new paragraphs:
provides the graduate education required by the specialty board
(7) (A) The term 'program for the training of physician
(recognized by such Liaison Committee) for certification in such
assistants' means an educational program which (i) has as its
specialty. Such term does not include a residency training pro-
objective the education of individuals who will, upon completion
gram in an osteopathic hospital.".
of their studies in the program, be qualified to effectively provide
health care under the supervision of a physician and (ii) meets
ADVISORY COUNCIL
regulations prescribed by the Secretary in accordance with sub-
paragraph (B).
SEC. 202. (a) (1) The second sentence of subsection (a) of section 702
"(B) After consultation with appropriate professional orga-
(as 80 redesignated) is amended to read as follows: "Of the appointed
nizations, the Secretary shall (within 180 days after the date of
members of the Council (1) twelve shall be representatives of the
enactment of this paragraph) prescribe regulations for programs
health professions schools assisted under programs authorized by this
for the training of physician assistants. Such regulations shall,
title, including at least six persons experienced in university adminis-
as a minimum, require that such a program-
tration and at least four representatives, of schools of veterinary medi-
"(i) extend for at least one academic year and consist of-
cine, optometry, pharmacy, podiatry, and public health, and entities
(I) supervised clinical practice, and
which may receive a grant under section 791, (2) two shall be full-
(II) at least four months (in the aggregate) of class-
time students enrolled in health professions schools, and (3) six shall
room instruction,
be members of the general public.".
directed toward preparing students to deliver health
(2) Section 702 (as 80 redesignated) is amended by adding at the
care; and
end thereof the following new subsection:
"(ii) have an enrollment of not less than eight students.
"(d) Section 14 of the Federal Advisory Committee Act shall not
"(8) (4) The term 'program for the training of expanded
apply with respect to the Council.".
function dental auxiliaries' means an educational program which
(3) The amendment made by paragraph (1) with respect to com-
(i) has as its objective the education of individuals who will, upon
positions of the National Advisory Counoil on Health Professions
completion of an accredited program of studies, be qualified to
Education shall apply with respect to appointments made to the Coun-
assist in the provision of dental care under the supervision of a
cil after October 1, 1976, and the Secretary of Health, Education, and
dentist and (ii) meets regulations prescribed by the Secretary
Welfare shall make appointments to the Council after such date in a
in accordance with subparagraph (B).
manner which will bring about, at the earliest feasible time, the Council
(B) After consultation with appropriate professional orga-
composition prescribed by the amendment.
nizations, the Secretary shall (within 180 days after the date of
(b) (1) Section 702 (as 80 redesignated) is amended by striking out
enactment of this paragraph) prescribe regulations for programs
"E, and F" in subsection (a) and inserting in lieu thereof "E, F,
for the training of expanded function dental auxiliaries. Such
and G".
regulations shall, as a minimum, require that such a program-
(2) Section 702 (as 30 redesignated) is amended by striking out
"(i) extend for at least one academic year and consist of-
"parts A and G" in subsections (b) and (c) and inserting in lieu
"(I) supervised clinical practice, and
thereof "subpart II of part G".
(II) at least four months (in the aggregate) of class-
room instruction,
ADVANCE FUNDING AUTHORITY
directed toward preparing students to deliver dental care;
and
SEC. 203. Section 703 (as so redesignated) is amended to read as
"(ii) have an enrollment of not less than eight students.
follows:
"ADVANCE FUNDING
"(9) The term 'State' includes, in addition to the several States,
only the District of Columbia, the Commonwealth of Puerto Rico,
"Sec. 703. (a) An appropriation under an authorization of appro-
the Commonwealth of the Northern Mariana Islands, the Virgin
priations for grants or contracts under this title for any fiscal year may
Islands, Guam, American Samoa, and the Trust Territory of the
be made at any time before that fiscal year and may be included in an
Pacific Islands.
Act making an appropriation under such authorization for another
8
9
fiscal year; but no funds may be made available from any appropria-
"(2) The Secretary and the Comptroller General of the United
tion under such authorization for obligation for such grants or
States, or any of their duly authorized representatives shall have the
contracts before the fiscal year for which such appropriation is
authority to carry out the purposes of this subsection.
authorized.
"(b) Subsection (a) shall not apply with respect to grants under
"CONTRACTS
section 770 (relating to capitation).
"Sec. 706. Contracts authorized by this title may be entered into
RECORDS AND AUDITS, CONTRACTS
without regard to section 3648 and 3709 of the Revised Statutes (31
U.S.C. 529, 41 U.S.C. 5)
SEC. 204. Part A of title VII is amended by adding after section 70.4
(as 30 redesignated) the following new sections:
DELEGATION OF AUTHORITY
"RECORDS AND AUDITS
Sec. 205. Part A of title VII is amended by adding after section 706
(added by section 204) the following new section:
"Sec. 705. (a) Each entity which receives a grant, loan, loan guaran-
tee, or interest subsidy or which enters into a contract with the Secre-
"DELEGATION
tary under this title, shall establish and maintain such records as the
Secretary shall by regulation or order require. Such records shall in-
"Sec. 707. The Secretary may delegate the authority to admin-
clude, among other things, records which completely disclose the
ister any program authorized by this title to the administrator of a
amount and disposition of the total amount of funds received by such
central or regional office or offices of the Department, except that the
entity, the total cost of any project or undertaking for which funds
authority-
were received, and the total amount of that portion of the total cost
(1) to review, and prepare comments on the merit of, any ap-
of any project or undertaking received by or allocated to such entity
plication for a grant or contract under any such program for pur-
from other sources, and such other records as will facilitate an audit
poses of presenting such application to the National Advisory
conducted in accordance with generally accepted auditing standards.
Council on Health Professions Education, and
"(b) Each entity which received a grant or entered into a contract
"(2) to make such a grant or enter into such a contract,
under this title shall have an annual financial audit of any books, ac-
shall not be delegated to any administrator of, or officer in, a regional
counts, financial records, files, and other papers and property which
office or offices of the Department.".
relate to the disposition or use of any funds received under such grant
or contract and such other funds received by or allocated to any project
HEALTH PROFESSIONS DATA
or undertaking for which any funds received under this Act were used,
and any other funds received under this Act. Each such entity shall be
SEC. 206. Part A of title VII is amended by adding after section 707
responsible for providing and paying for such audit. For purposes of
(added by section 205) the following new section:
assuring accurate, current, and complete disclosure of the disposition
or use of the funds received, each such audit shall be conducted by and
"HEALTH PROFESSIONS DATA
certified to be accurate by an independent certified public accountant
utilizing generally accepted auditing standards. A report of each
"SEC. 708. (a) The Secretary shall establish a program, including a
such audit shall be filed with the Secretary at such time and in such
uniform health professions data reporting system, to collect,
manner as he may require.
compile, and analyze data on health professions personnel which shall
"(c) The Secretary may specify, by regulation, the form and man-
initially include data respecting all physicians and dentists in the
ner in which such records, required by subsection (a), shall be estab-
United States and its territories and possessions. The Secretary is are-
lished and maintained.
thorized to expand the program to include, whenever he determines it
"(d) A student recipient of a scholarship, traineeship, loan, or
necessary, the collection, compilation, and analysis of data respecting
loan guarantee under this title shall not be required to establish or
pharmacists, optometrists, podiatrists, veterinarians, public health per-
maintain the records required under subsection (a) or provide for an
sonnel, audiologists, speech pathologists, health care administration
audit required under subsection (b).
personnel, nurses, allied health personnel. medical technologists, and
(e) (1) Each entity which is required to establish and maintain rec-
any other health personnel in States designated by the Secretary to
ords or to provide for an audit under this section shall make such
be included in the program. Such data shall include data respecting
books, documents, papers, and records available to the Secretary or the
the training, licensure status (including permanent, temporary, par-
Comptroller General of the United States, or any of their duly au-
tial, limited, or institutional), place or places of practice, professional
thorized representatives, for examination, copying, or mechanical re-
specialty, practice characteristics, place and date of birth, sex, and
production on or off the premises of such entity upon a reasonable
socioeconomic background of health professions personnel and such
request therefor.
other demographic information regarding health professions person-
nel as the Secretary may require.
10
11
"(b) (1) In carrying out subsection (a), the Secretary shall collect
'(O) assure that no use is made of personal data which is not
available information from appropriate local, State, and Federal
within the purposes of this section unless an informed consent
agencies and other appropriate sources.
has been obtained from the individual who is the subject of
"(2) The Secretary shall conduct or enter into contracts for the
such data; and
conduct of analytic and descriptive studies of the health professions,
"(D) upon requèst, inform any individual of the use being
including evaluations and projections of the supply of, and require-
made of personal data respecting such individual and of the
ments for, the health professions by specialty and geographic location.
identity of the individuals and entities which will use the data
"(3) The Secretary is authorized to make grants and to enter into
and their relationship to the programs under this section.
contracts with States (or an appropriate nonprofit private entity in
(2) Any entity which maintains a record of personal data and
any State) for the purpose of participating in the program estab-
which receives a request from the Secretary or a program entity for
lished under subsection (a). The Secretary shall determine the amount
such data for purposes of this section shall not transfer any such data
and scope of any such grant or contract. To be eligible for a grant
to the Secretary or to a program entity unless the individual whose
or contract under this paragraph a State or entity shall submit an
personal data is to be 80 transferred gives an informed consent for
application in such form and manner and containing such information
such transfer.
as the Secretary shall require. Such application shall include reason-
(3) (A) Notwithstanding any other provision of law, personal
able assurances, satisfactory to the Secretary, that-
data collected by the Secretary or any program entity under this
(A) such State (or nonprofit entity within a State) will estab-
section may not be made available or disclosed by the Secretary or
lish a program of mandatory annual registration of the health
any program entity to any person other than the individual who is the
professions personnel described in subsection (a) who reside or
subject of such data unless (i) such person requires such data for
practice in such State and of health institutions licensed by such
purposes of this section, or (ii) in response to a demand for such
State, which registration shall include such information as the
data made by means of compulsory legal process. Any individual who
Secretary shall determine to be appropriate;
is the subject of personal data made available or disclosed under clause
(B) such State or entity shall collect such information and
(ii) shall be notified of the demand for such data.
report it to the Secretary in such form and manner as the Secre-
(B) Subject to all applicable laws regarding confidentiality, only
the data collected by the Secretary under this section which is not
tary shall prescribe; and
(C) such State or entity shall comply with the requirements of
personal data shall be made available to bona fide researchers and
subsection (e).
policy analysts (including the Congress) for the purposes of assist-
ing in the conduct of studies respecting health professions personnel.
"(c) For purposes of providing the Secretary with information
(4) For purposes of this subsection, the term 'program entity'
under this section, each school which receives financial support under
means any public or private entity which collects, compiles, or analyzes
section 770 shall annually report to the ,Secretary information, de-
health professions data under a grant, contract, or other arrangement
termined to be appropriate by the Secretary, respecting the students
with the Secretary under this section.
who attend such school. The Secretary may collect such additional
"(f) In carrying out his responsibilities under this section, the Sec-
data respecting students of the health professions as he determines to
be appropriate.
retary shall not be subject to the provisions of chapter 35 of title 44,
United States Code.
(d) The Secretary shall assemble and submit to the President
"(g) The Secretary shall provide technical asistance to the States
and Congress not later than September 1 of each year a report on
and political subdivisions thereof in the development of systems (in-
the status of health professions personnel in the United States, which
cluding model laws) concerning confidentiality and comparability
report shall include a description and analysis of the data collected
pursuant to this section. Such report may be included as part of the
of data collected pursuant to this section.".
report made under section 308(a) (2) (C).
SHARED SCHEDULE RESIDENCIES
'(e) (1) The Secretary and each program entity shall in securing
and maintaining any record of individually identifiable personal data
SEC. 207. Part A of title VII is amended by adding after section
(hereinafter in this subsection referred to as 'personal data') for
708 (added by section 206) the following new section:
purposes of this section-
(A) inform any individual who is asked to supply personal
"SHARED SCHEDULE RESIDENCY TRAINING POSITIONS
data whether he is legally required, or may refuse, to supply
such data and inform him of any specific consequences, known
"Sec. 709. (a) Any entity which-
to the Secretary or program entity as the case may be, of pro-
"(1) maintains a medical residency training program in family
viding or not providing such data;
practice, general internal medicine, general pediatrics, or general
(B) upon request, inform any individual if he is the sub-
obstetrics and gynecology, and
ject of personal data secured or maintained by the Secretary
"(2) receives any Federal assistance,
or program entity, as the case may be, and make the data avail-
shall establish or restructure and maintain, to the maximum extent
able to him in a form comprehensive to him;
12
13
feasible, a reasonable number of physician training positions in such
fiscal year ending September 30, 1977, for an affiliated clinical facility
program as shared schedule positions.
for the establishment or expansion of a regional health professions
'(b) The Secretary shall report to Congress not later than Janu-
program may be filed by any public or other nonprofit agency if the
ary 1, 1979, on entities' compliance with subsection (a) and shall
application is approved by the school of veterinary medicine, optome-
include in such report recommendations for legislation to ensure com-
try, podiatry, or pharmacy with which the facility is affiliated. Only
pliance with such subsection.
that portion of the project to construct such a facility which the
"(c) For purposes of subsection (a), the term 'shared schedule posi-
Secretary determines to be reasonably attributable to the need of
tion' means a physician training position in a medical residency train-
regional health professions program for the facility for teaching pur-
ing program which is shared by two individuals and in which each
poses shall be regarded as the project with respect to which payments
individual-
may be made under section 722.
"(1) engages in at least two-thirds but not more than three-
(2) In considering applications for grants under subsection (a) for
fourths of the total training prescribed for such position,
the fiscal year ending September 30, 1977, the Secretary shall give
"(2) receives for each year in such position an amount of
special consideration to applications for facilities for the establishment
credit for certification in the medical specialty for which the
or expansion of regional health professions programs.
position provides training which is equal to the amount of train-
"(3) For the purposes of this subsection, the term 'regional health
ing engaged in in such year,
professions program' refers to an interstate program (4) in which a
(3) receives at least one-half of the salary for such position,
State with an existing degree-granting school sets up a cooperative
and
program with another State (or other States) which does not have
"(4) receives all applicable employee benefits.".
such a school, and (B) which provides for (i) a shared curriculum
between two or more schools, or (ii) a single campus which is cooper-
PAYMENT UNDER GRANTS
atively financed and controlled by two or more States.".
SEC. 208. Part A of title VII is amended by adding after section 709
GRANT AUTHORITY; AUTHORIZATIONS
(added by section 207) the following new section:
SEC. 302. Section 720 is amended to read as follows:
"PAYMENT UNDER GRANTS
"SEC. 710. Grants made under this title (except under section 770)
"GRANT AUTHORITY; AUTHORIZATIONS OF APPROPRIATIONS
may be paid in advance or by way of reimbursement, at such intervals
"Sec. 720. (a) (1) The Secretary may make grants to assist in the
and on such conditions as the Secretary may find necessary and with
construction of teaching facilities for the training of physicians, den-
appropriate adjustments on account of overpayments or underpay-
tists, pharmacists, optometrists, podiatrists, veterinarians, and pro-
ments previously made.".
fessional public health personnel.
(2) (4) The Secretary may make grants to public and nonprofit
PAYMENT FOR TUITION AND OTHER EDUCATIONAL EXPENSES
private entities to assist in the construction of ambulatory, primary
SEC. 209. Part A of title VII is amended by adding after section 710
care teaching facilities for the training of physicians and dentists.
(added by section 208) the following new section:
"(B) For purposes of this section, the term 'ambulatory, primary
care teaching facilities' means areas dedicated for the training of
"PAYMENT FOR TUITION AND OTHER EDUCATIONAL COSTS
students in the diagnosis and treatment of ambulatory patients and
primarily in the specialties of family practice, general pediatrics,
"Sec. 711. The Secretary shall by regulation establish criteria for
general internal medicine, general dentistry, and pedodontics. Such
determining allowable increases in tuition and other educational costs
areas may include examination rooms, clinical laboratories, libraries,
for which he shall be responsible for payment under any provision of
classrooms, offices, and other areas for clinical or research purposes
this title after the date of enactment of the Health Professions Educa-
necessary for, and appropriate to, the conduct of comprehensive am-
tional Assistance Act of 1976.".
bulatory, primary care training of physicians and dentists in such
specialties.
TITLE III-ASSISTANCE FOR CONSTRUCTION OF
"(b) For payments under grants under this part there is authorized
TEACHING FACILITIES
to be appropriated $40,000,000 for the fiscal year ending September
30, 1978, $40,000,000 for the fiscal year ending September 30, 1979,
REGIONAL HEALTH PROFESSIONS PROGRAMS
and $40,000,000 for the fiscal year ending September 30, 1980. Of the
sums appropriated under this subsection for any fiscal year 50 per-
SEC. 301. Section 721 is amended by adding after subsection (e)
the following new subsection:
cent of such sums shall be obligated for grants under subsection (a)
"(f) (1) An application for a grant under subsection (a) for the
(2)
15
14
GRANT AMOUNTS
APPLICATIONS
SEC. 303. (a) (1) Section 721 (b) (1) is amended by inserting "under
SEC. 304. (a) Subsection (a) of section 722 is amended to read as
section 720(a) (1)" after "for a grant".
follows:
(2) Section 721 (b) (2) is amended by inserting "for a grant under
(a) (1) The amount of any grant under section 720 (1) for
section 720 (1)" after "an application" the first time it appears.
construction of a project shall be such amount as the ,Secretary deter-
(3) Sections 721 (b) (3) and 721 (c) are each amended by striking
mines to be appropriate after obtaining advice of the Council, except
out "grant under this part" and inserting in lieu thereof "grant under
that no grant for any project may exceed 80 percent of the necessary
section 720(a) (1)".
costs of construction, as determined by the Secretary of such project.
(4) Section 721 (d) is amended by inserting "under section 720
"(2) The amount of any grant under section 720 (2) for con-
(1) after "for grants".
struction of a facility shall be such amount as the Secretary determines
(5) Section 721 is amended by inserting "for a grant under
to be appropriate, except that no grant for any facility may exceed
section 720(a) (1)" after "of applications".
the lesser of-
(b) Section 721 is amended by adding after subsection (f) (added
(A) 50 percent of the total cost of such facility, or
by section 301) the following new subsection:
(B) $1,000,000.".
(g) (1) A grant under section 720(a) (2) may be made only if the
(b) (1) Subsection (d) of section 722 is amended by striking out
application therefor is approved by the ,Secretary upon his deter-
"under this part" and inserting in lieu thereof "under section 720
mination that—
(a) (1)"
(A) the applicant meets the eligibility conditions set forth
(2) Subsection (d) of section 722 is amended by striking out (with-
in section 720(a) (2);
in the meaning of part A of this title)".
"(B) the application contains or is supported by reasonable
RECAPTURE
assurances that (i) the facility is intended to be used for pur-
purposes for which the application has been made, (ii) sufficient
Sec. 305. Section 723 is amended-
funds will be available to meet the non-Federal share of the cost
(1) by striking out "paid under this part" and inserting in
of constructing the facility, and (iii) sufficient funds will be
lieu thereof "under a grant under section 720 (1)",
available, when construction is completed, for effective use of the
(2) by inserting "(a)" before "If",
facility for the training for which it is being constructed;
(3) by redesignating paragraphs (a), (3), and (c) as para-
'(O) the plans and specifications are in accordance with regu-
graphs (1), (2); and (3), respectively, and
lations relating to minimum standards of construction and equip-
(4) by adding at the end the following:
ment:
'(D) the application contains or is supported by adequate as-
(b) If, within 20 years after completion of any construction for
which funds have been paid under a grant under section 720 (2)-
surance that any laborer or mechanic employed by a contractor
(1) the applicant or other owner of the facility shall cease
or subcontractors in the performance of work on the construction
to be a public or nonprofit entity;
of the facility will be paid wages at rates not less than those pre-
"(2) the facility shall cease to be used for the training pur-
vailing on similar construction in the locality as determined by
poses for which such funds were provided, unless the Secretary
the ,Secretary of Labor in accordance with the Act of March 3,
determines, in accordance with regulations which he shall pro-
1931 (40 U.S.C. 276a-276a-5, known as the Davis-Bacon Act).
mulgate, that there is a significant public purpose and good
The Secretary of Labor shall have with respect to the labor standards
cause for releasing the applicant or other owner from the obliga-
specified in subparagraph (D) the authority and functions set forth in
tion to do so; or
Reorganization Plan Numbered 14 of 1950 (15 F.R. 3176; 5 U.S.C.
"(3) the facility is used for sectarian instruction or as a place
Appendix) and section 2 of the Act of June 13, 1934 (40 U.S.C.
276c).
for religious worship,
the United States shall be entitled to recover from the applicant or
'(2) In making grants under this section 720(a) (2) the Secretary
shall give special consideration to entities which have been awarded
other owner of the facility the amount bearing the same ratio to the
then value (as determined by agreement of the parties or by action
grants or received contracts under section 781, 784, or 786 (relating to
brought in the United States district court for the district in which
area health education centers, general internal medicine and general
pediatrics, and family medicine and general practice of dentistry).
such facility is situated) of the facility, as the amount of the Federal
(c) Subsection (e) of section 721 is amended by adding at the end
participation bore to the cost of construction of such facility.".
the following new sentence: "In considering applications submitted
LOAN GUARANTEES AND INTEREST SUBSIDIES
for a grant under section (1) for the cost of construction of
teaching facilities for the training of physicians, the Secretary shall
SEC. 306. (a) Subsections (a) and (b) of section 729 are each
give special consideration to projects in States which have no such
amended by striking out "September 30, 1977" and inserting in lieu
facilities.".
thereof "September 30, 1980".
16
17
(3) The second sentence of section 729(e) is amended by striking
(b) Section 726 is repealed.
out "and" after "June 30, 1973," and by striking out the period at the
(c) Section 727 (a) is amended by striking out "institutions" each
end thereof and inserting in lieu thereof a comma and the following:
time it appears and inserting in lieu thereof "entities".
$2,000,000 in the fiscal year ending September 30, 1978, $3,000,000 in
(d) Sections 727, 728, and 729 are redesignated as sections 724, 725,
the fiscal year ending September 30, 1979, and $3,000,000 in the fiscal
and 726, respectively.
year ending September 30, 1980.".
(c) The third sentence of section 729 is amended to read as fol-
TITLE IV-STUDENT ASSISTANCE; NATIONAL HEALTH
lows: "No such loan guarantee may, except under special circum-
SERVICE CORPS
stances and under such conditions as are prescribed by regulations, ap-
ply to any amount which, when added to any grant under this part or
INSURED LOANS TO STUDENTS
any other law of the United States, exceeds 90 percent of the cost
of the construction of the project.".
SEC. 401. (a) Effective October 1, 1976, subpart II of part C of title
(d) Subsections (a) and (b) of section 729 are each amended by
VII is repealed.
inserting "or the Federal Financing Bank" after "non-Federal lender".
(b) Effective October 1, 1977, part C of title VII is amended by-
(1) amending the heading for part o to read as follows:
EFFECTIVE DATE
"PART C-STUDENT ASSISTANCE";
SEC. 307. (a) The amendments made by sections 302 through 305
shall apply with respect to grants made under part B of title VII of
(2) redesignating subpart I of such part as subpart II, and by
the Public Health Service Act from appropriations under section 720
amending the heading for such subpart to read as follows:
of such Act for fiscal years beginning after September 30, 1977.
(b) The amendment made by section 306 (c) shall apply with re-
"Subpart II-Student Loans"; and
spect to loans guaranteed under section 729(a) of the Public Health
Service Act redesignated section 726 by section 308(d) of this
(3) inserting immediately below the heading to such part the
Act) after September 30, 1977.
following new subpart:
"Subpart I-Federal Program of Insured Loans to Graduate Students
TECHNICAL AND CONFORMING AMENDMENTS
in Health Professions Schools
SEC. 308. (a) Section 721 (c) is amended-
(1) by striking out "section 770(f) of this Act" in paragraph
"STATEMENT OF PURPOSE AND APPROPRIATIONS AUTHORIZED
(2) and inserting in lieu thereof "section 771";
(2) by striking out the sentence at the end of paragraph (2);
"Sec. 727. (a) The purpose of this subpart is to enable the Secre-
(3) by striking out paragraph (5) and redesignating para-
tary to provide a Federal program of student loan insurance for
graphs (6) and (7) as paragraphs (5) and (6), respectively;
students in eligible institutions.
(4) by striking out "and" at the end of paragraph (5) (as 80
(b) For the purpose of carrying out this subpart there are
redesignated), by striking out the period at the end of paragraph
authorized to be appropriated (1) for the fiscal year ending Septem-
(6) (as 80 designated) and inserting in lieu thereof "; and", and
ber 30, 1978, to the student loan insurance fund (established by section
by inserting after paragraph (6) the following:
734) the sum of $1,500,000 and of such further sums, if any, as may be-
"(7) the application contains or is supported by adequate as-
come necessary for the adequacy of student loan insurance fund and
surance that any laborer or mechanic employed by a contractor or
for the purpose of administering this subpart; and (2) for fiscal years
subcontractors in the performance of work on the construction of
thereafter such sums as may be necessary for the purpose of adminis-
the facility will be paid wages at rates not less than those prevail-
tering this subpart. Sums appropriated under this subsection shall re-
ing on similiar construction in the locality as determined by the
main available until expended.
Secretary of Labor in accordance with the Act of March 3, 1931
(40 U.S.C. 276a-276a-5, known as the Davis-Bacon Act).
"SCOPE AND DURATION OF FEDERAL LOAN INSURANCE PROGRAM
The Secretary of Labor shall have with respect to the labor standards
"Sec. 728. (a) The total principal amount of new loans made
specified in paragraph (7) the authority and functions set forth in
and installments paid pursuant to lines of credit (as defined in section
Reorganization Plan Numbered 14 of 1950 (15 F.R. 3176; 5 U.S.C. Ap-
737), to students covered by Federal loan insurance under this sub-
pendix) and section 2 of the Act of June 13, 1934 (40 U.S.C. 276c) ,";
and
part shall not exceed $500,000,000 for the fiscal year ending Septem-
ber 30, 1978; $510,000,000 for the fiscal year ending September 30,
(5) by striking out "725" in the last sentence and inserting in
1979; and $520,000,000 for the fiscal year ending September 30, 1980.
lieu thereof "702".
Thereafter, Federal loan insurance pursuant to this subpart may
76-510 76 2
18
19
be granted only for loans made (or for loan installments paid pursuant
to lines of credit) to enable students, who have obtained prior loans
"(C) is pursuing a full-time course of study at an eligible
insured under this subpart, to continue or complete their educational
institution;
'(D) in the case of a student in a school of medicine, oste-
program; but no insurance may be granted for any loan made or in-
opathy, or dentistry, has been authorized by the institution
stallment paid after September 30, 1982.
'(b) The Secretary may, if necessary to assure an equitable distribu-
in accordance with section 739 (3) (2) to receive a loan under
this subpart;
tion of the benefits of this subpart, assign, within the maximum
"(E) has agreed that all funds received under such loan
amounts specified in subsection (a), Federal loan insurance quotas
shall be used solely for tuition and other reasonable educa-
applicable to eligible lenders, or to States or areas, and may from time
tional expenses, including fees, books, and laboratory ex-
to time reassign unused portions of these quotas.
penses, incurred by such student;
"LIMITATIONS ON INDIVIDUAL FEDERALLY INSURED LOANS AND ON FEDERAL
"(F) for the school year for which such loan is made,
receives no funds from a loan insured under a Federal, State,
LOAN INSURANCE
or nonprofit program provided or assisted under part B of
"Sec. 729. (a) The total of the loans made to a student in any
title IV of the Higher Education Act of 1965; and
academic year or its equivalent (as determined by the Secretary)
"(G) in the case of a pharmacy student, has satisfactorily
which may be covered by Federal loan insurance under this subpart
completed three years of training; and
may not exceed $10,000 in the case of a student enrolled in a school
"(2) evidenced by a note or other written agreement which-
of medicine, osteopathy, dentistry, veterinary medicine, optometry,
(4) is made without security and without endorsement,
podiatry, or public health, and $7,500 in the case of a student enrolled
except that if the borrower is a minor and such note or other
in a school of pharmacy. The aggregate insured unpaid principal
written agreement executed by him would not, under the ap-
amount for all such insured loans made to any student shall not at
plicable law, create a binding obligation, an endorsement may
any. time exceed $50,000 in the case of a student enrolled in a school
be required;
of medicine, osteopathy, dentistry, veterinary medicine, optometry,
"(B) provides for repayment (except as provided in sub-
podiatry, or public health, and $37 ,500 in the case of a student enrolled
section (c)) of the principal amount of the loan in install-
in a school of pharmacy. The annual insurable limit per student shall
ments over a period of not less than 10 years (unless sooner
not be exceeded by a line of credit under which actual payments by
repaid) nor more than 15, years beginning not earlier than 9
the lender to the borrower will not be made in any years in excess
months after the date on which the student completes his
of the annual limit.
internship or residency training, and not later than the earlier
"(3) The insurance liability on any loan insured by the Secretary
of 12 months after such date or of 3 years after the date he
under this subpart shall be 100 percent of the unpaid balance of
ceases to carry, at an eligible institution, the normal full-time
the principal amount of the loan plus interest. The full faith and
academic workload as determined by the institution, except
credit of the United States is pledged to the payment of all amounts
(i) as provided in clause (C) below, (ii) that the period of
which may be required to be paid under the provisions of section
the loan may not exceed 23 years from the date of execution
733 or 738.
of the note or written agreement evidencing it, and (iii) that
"SOURCES OF FUNDS
the note or other written instrument may contain such pro-
visions relating to repayment in the event of default in the
"Sec. 730. Loans made by eligible lenders in accordance with
payment of interest or in the payment of the cost of insurance
this subpart shall be insurable by the Secretary whether made from
premiums, or other default by the borrower, as may be au-
funds fully owned by the lender or from funds held by the lender
thorized by regulations of the Secretary in effect at the time
in a trust or similar capacity and available for such loans.
the loan is made;
'(C) provides that periodic installments of principal need
"ELIGIBILTY OF STUDENT BORROWERS AND TERMS OF FEDERALLY INSURED
not be paid, but interest shall accrue and be paid, during any
STUDENT LOANS
period (i) during which the borrower is pursuing a full-time
course of study at an eligible institution, (ii) not in excess of
"SEC. 731. (a) A loan by an eligible lender shall be insurable by the
three years during which the borrower is a participant in an
Secretary under the provisions of this subpart only if
accredited internship or residency program, (iii) not in ex-
(1) made to a student who
cess of three years, during which the borrower 28 a member
"(A) has been accepted for enrollment at an eligible
of the Armed Forces of the United States, (iv) not in excess
institution;
of three years during which the borrower is in service as a
(B) is in good standing at an eligible institution as deter-
volunteer under the Peace Corps Act, or (v) not in excess of
mined by the institution;
three years, during which the borrower is a member of the
National Health Service Corps, (vi) not in excess of three
20
21
years during which the borrower is in service as a full-time
"(3) An application submitted pursuant to subsection (a) (1) shall
volunteer under title I of the Domestic Volunteer Serv-
contain (A) an agreement by the applicant to pay, in accordance with
ice Act of 1973, and any such period shall not be included
regulations, the premiums fixed by the Secretary pursuant to subsec-
in determining the 15-year period or the 23-year period pro-
tion (c), and (B) an agreement by the applicant that if the loan is
vided in clause (B) above;
covered by insurance the applicant will submit such supplementary
'(D) provides for interest on the unpaid principal balance
reports and statements during the effective period of the loan agree-
of the loan at a yearly rate, not exceeding the applicable maxi-
ment, upon such forms, at such times, and containing such information
mum rate prescribed and defined by the Secretary (within
as the Secretary may prescribe by or pursuant to regulation.
the limits set forth in subsection (b)) on a national, regional,
(b) (1) In lieu of requiring a separate insurance application and
or other appropriate basis, which interest shall be com-
issuing a separate certificate of insurance for each student loan made
pounded semiannually and payable in installments over the
by an eligible lender as provided in subsection (a), the Secretary
period of the loan;
may, in accordance with regulations consistent with section 728, is-
"(E) entitles the student borrower to accelerate without
sue to any eligible lender applying therefor a certificate of compre-
penalty repayment of the whole or any part of the loan; and
hensive insurance coverage which shall, without further action by the
'(F) contains such other terms and conditions consistent
Secretary, insure all insurable loans made by that lender, on or after
with the provisions of this subpart and with the regula-
the date of the certificate and before a specified cutoff date, within the
tions issued by the Secretary pursuant to this subpart, as
limits of an aggregate maximum amount stated in the certificate.
may be agreed upon by the parties to such loan, including, if
Such regulations may provide for conditioning such insurance, with
agreed upon, a provision requiring the borrower to pay to
respect to any loan, upon compliance by the lender with such require-
the lender, in addition to principal and interest, amounts
ments (to be stated or incorporated by reference in the certificate) as
equal to the insurance premiums payable by the lender to
in the Secretary's judgment will best achieve the purpose of this sub-
the Secretary with respect to such loan.
section while protecting the financial interest of the United States and
"(b) No maximum rate of interest prescribed and defined by the
promoting the objectives of this part, including (but not limited to)
Secretary for the purpose of clause (2) (d) of subsection (a) may
provisions as to the reporting of such loans and information relevant
exceed loan. 10 percent per annum on the unpaid principal balance of the
thereto to the Secretary and as to the payment of initial and other
premiums and the effect of default therein, and including provision
"(c) The total of the payments by a borrower during any year of
for confirmation by the Secretary from time to time (through endorse-
any repayment period with respect to the aggregate amount of all
ment of the certificate) of the coverage of specific new loans by such
loans to that borrower which are insured under this subpart, shall
certificate, which confirmation shall be incontestable by the Secretary
not be less than the annual interest on the outstanding principal.
in the absence of fraud or misrepresentation of fact or patent error.
"CERTIFICATE OF FEDERAL LOAN INSURANCE-EFFECTIVE DATE OF
"(2) If the holder of a certificate of comprehensive insurance cov-
erage issued under this subsection grants to a student, a line of credit
INSURANCE
extending beyond the cutoff date specified in that certificate, loans or
"SEC. 732. (a) (1) If, upon application by an eligible lender, made
payments thereon made by the holder after that date pursuant to the
upon such form, containing such information, and supported by such
line of credit shall not be deemed to be included in the coverage of that
evidence as the Secretary may require, and otherwise in conformity
certificate except as may be specifically provided therein; but, subject
with this section, the ,Secretary finds that the applicant has made a
to the limitations of section 728, the Secretary may, in accordance
loan to an eligible student which is insurable under the provisions of
with regulations, make commitments to insure such future loans or
this subpart, he may issue to the applicant a certificate of insurance
payments, and such commitments may be honored either as provided
covering the loan and setting forth the amount and terms of the
in subsection (a) or by inclusion of such insurance in comprehensive
insurance.
coverage under this subsection for the period or periods in which such
"(2) Insurance evidenced by a certificate of insurance pursuant to
future loans or payments are made.
subsection (a) (1) shall become effective upon the date of issuance of
"(c) The Secretary shall, pursuant to regulations, charge for insur-
the certificate, except that the Secretary is authorized, in accordance
ance on each loan under this subpart a premium in an amount not to
with regulations, to issue commitments with respect to proposed loans,
exceed 2 percent per year of the unpaid principal amount of such loan
or with respect to lines (or proposed lines) of credit, submitted by
(excluding interest added to principal), payable in advance, at such
eligible lenders, and in that event, upon compliance with subsection
times and in such manner as may be prescribed by the Secretary. Such
(a) (1) by the lender, the certificate of insurance may be issued effec-
regulations may provide that such premium shall not be payable, or if
tive as of the date when any loan, or any payment by the lender pur-
paid shall be refundable, with respect to any period after default in
suant to a line of credit, to be covered by such insurance was made.
the payment of principal or interest or after the borrower has died or
Such insurance shall cease to be effective upon 60 days' default by the
become totally and permanently disabled, if (1) notice of such default
lender in the payment of any installment of the premiums payable
or other event has been duly given, and (2) requests for payment of
pursuant to subsection (c).
the loss insured against has been made or the Secretary has made such
payment on his own motion pursuant to section 733 (a).
22
23
"(d) The rights of an eligible lender arising under insurance evi-
further Federal insurance on loans granted pursuant to this subpart
denced by a certificate of insurance issued to it under this section may
until he is satisfied that its failure has ceased and finds that there is
be assigned as security by such lender only to another eligible lender,
reasonable assurance that the lender will in the future exercise neces-
and subject to regulation by the Secretary.
sary care and diligence or comply with such requirements, as the case
"(e) The consolidation of the obligations of two or more federally
may be.
insured loans obtained by a student borrower in any fiscal year into a
"(e) A8 used in this section-
single obligation evidenced by a single instrument of indebtedness
(1) the term 'insurance beneficiary' means the insured or its
shall not affect the insurance by the United States. If the loans thus
authorized assignee in accordance with section 732 (d) ;
consolidated are covered by separate certificates of insurance issued
"(2) the term 'amount of the loss' means, with respect to a loan,
under subsection (a), the Secretary may upon surrender of the origi-
the unpaid balance of the principal amount and interest on such
nal certificates issue a new certificate of insurance in accordance with
loan; and
that subsection upon the consolidated obligation. If the loans thus con-
"(3) the term 'default' includes only such defaults as have
solidated are covered by a single comprehensive certificate issued un-
existed for (4) 120 days in the case of a loan which is repayable in
der subsection (b), the Secretary may amend that certificate
monthly installments, or (B) 180 days in the case of a loan which
accordingly.
is repayable in less frequent installments.
'(f) The Secretary may, after notice and opportunity for a hear-
"DEFAULT OF STUDENT UNDER FEDERAL LOAN INSURANCE PROGRAM
ing, cause to be reduced Federal reimbursements or payments for
health services under any Federal law to borrowers who are practicing
"SEC. 733. (a) Upon default by the student borrower on any loan
their professions and have defaulted on their loans insured under this
covered by Federal loan insurance pursuant to this subpart, and after
subpart in amounts up to the remaining balance of such loans.
a substantial collection effort (including, if appropriate, commence-
(g) A debt which is a loan insured under the authority of this
ment of a suit) as determined under regulations of the Secretary, the
subpart may be released by a discharge in bankruptcy under the
insurance beneficiary shall promptly notify the Secretary and the
Bankruptcy Act only if such discharge is granted after the expiration
Secretary shall, if requested (at that time or after further collection
of the five-year period beginning on the first date, as specified in sec-
efforts) by the beneficiary, or may on his own motion, if the insurance
tion 731 (2) (B), when repayment of such loan is required.
is still in effect, pay to the beneficiary the amount of the loss sustained
by the insured upon that loan as 800n as that amount has been
"STUDENT LOAN INSURANCE FUND
determined.
"(b) Upon payment by the Secretary of the amount of the loss
"Sec. 734. (a) There is hereby established a student loan insurance
pursuant to subsection (a), the United States shall be subrogated for
fund (hereinafter in this section referred to as the 'fund') which shall
all of the rights of the holder of the obligation upon the insured loan
be available without fiscal year limitation to the Secretary for making
and shall be entitled to an assignment of the note or other evidence
payments in connection with the default of loans insured by him under
of the insured loan by the insurance beneficiary. If the net recovery
this subpart. All amounts received by the Secretary as premium
made by the ,Secretary on a loan after deduction of the cost of that
charges for insurance and as receipts, earnings, or proceeds derived
recovery (including reasonable administrative costs) exceeds the
from any claim or other assets acquired by the ,Secretary in connection
amount of the loss, the excess shall be paid over to the insured.
with his operations under this subpart, and any other moneys, prop-
"(c) Nothing in this section or in this subpart shall be construed
erty, or assets derived by the Secretary from his operations in connec-
to preclude any forbearance for the benefit of the student borrower
tion with this section, shall be deposited in the fund. All payments in
which may be agreed upon by the parties to the insured loan and
connection with the default of loans insured by the ,Secretary under
approved by the Secretary or to preclude forbearance by the Secre-
this subpart shall be paid from the fund. Moneys in the fund not
tary in the enforcement of the insured obligation after payment on
needed for current operations under this section may be invested in
that insurance.
bonds or other obligations guaranteed as to principal and interest by
"(d) Nothing in this section or in this subpart shall be construed
the United States.
to excuse the holder of a federally insured loan from exercising
"(b) If at any time the moneys in the fund are insufficient to make
reasonable care and diligence in the making of loans under the pro-
payments in connection with the default of any loan insured by the
visions of this subpart and from exercising a substantial effort in the
Secretary under this subpart, the Secretary is authorized to issue to
collection of loans under the provisions of this subpart. If the Secre-
the Secretary of the Treasury notes or other obligations in such forms
tary, after reasonable notice and opportunity for hearing to an eligible
and denominations, bearing such maturities, and subject to such terms
lender, finds that the lender has failed to exercise such case and
and conditions as may be prescribed by the Secretary with the ap-
diligence, to exercise such substantial efforts, to make the reports and
proval of the Secretary of the Treasury. Such notes or other obliga-
statements required under section 733(a) (3), or to pay the required
tions shall bear interest at a rate determined by the Secretary of the
Federal loan insurance premiums, he shall disqualify that lender for
Treasury, taking into consideration the current average market yield
24
25
on outstanding marketable obligations of the United States of com-
(5) enforce, pay, compromise, waive, or release any right,
parable maturities during the month preceding the issuance of the
title, claim, lien, or demand, however acquired, including any
notes or other obligations. The ,Secretary of the Treasury shall pur-
chase any notes and other obligations issued hereunder and for that
(3) The ,Secretary shall, with respect to the financial operations
equity or any right or redemption.
purpose he is authorized to use as a public debt transaction the pro-
arising by reason of this subpart-
ceeds from the sale of any securities issued under the Second Liberty
Bond Act, as amended, and the purposes for which securities may be
vided for wholly owned Government corporations by the Govern-
(1) prepare annually and submit a budget program as pro-
issued under that Act, as amended, are extended to include any pur-
ment Corporation Control Act; and
chase of such notes and obligations. The Secretary of the Treasury
(2) maintain with respect to insurance under this subpart an
may at any time sell any of the notes or other obligations acquired by
borrower under which the Secretary agrees to assume the obligation
(c) (1) The Secretary may enter into a written agreement with
integral set of accounts.
him under this subsection. All redemptions, purchases, and sales by
the Secretary of the Treasury of such notes or other obligations shall
be treated as public debt transactions of the United States. Sums bor-
a of paying an amount, not to exceed $10,000 in any 12-month period,
rowed under this subsection shall be deposited in the fund and redemp-
toward the principal and interest due on any loan made to the borrower
tion of such notes and obligations shall be made by the Secretary from
and insured under this subpart and the borrower agrees to serve,
such fund.
either as a member of the National Health Service Corps or in private
"POWERS AND RESPONSIBILITIES
practice pursuant to section 723 (as determined by the Secretary), which in a
health manpower shortage area (designated under section 332)
"Sec. 735. (a) In the performance of, and with respect to, the
is described in subparagraphs (4) and (B) of section (2) for
functions, powers, and duties vested in him by this subpart, the
a continuous period of (A) not less than 12 months for each 12-month
Secretary may-
period the ,Secretary assumes such obligation under the agreement, or
"(1) prescribe such regulations as may be necessary to carry
(B) 24 months, whichever is greater.
out the purposes of this subpart;
ual, who has entered into a written contract under paragraph (1), for in
(2) Except as provided in paragraphs (3) and (4), if an individ-
"(2) sue and be sued in any district court of the United States,
and such district courts shall have jurisdiction of civil actions
any reason breaches his contract obligations with respect to serving
arising under this subpart without regard to the amount in con-
a health manpower shortage area for the period specified in the agree-
troversy, and action instituted under this subsection by or against
ment, the United States shall be entitled to recover damages from such
the Secretary shall survive notwithstanding any change in the
individual in an amount equal to three times the amount paid by the
person occupying the office of Secretary or any vacancy in that
Secretary under the agreement to or on behalf of such individual.
office. No attachment, injunction, garnishment, or other similar
Any amount of damages which the United States is entitled to recover
process, mesne or final, shall be issued against the Secretary or
under this paragraph shall be paid to the United States not later than
property under his control, and nothing herein shall be construed
one year after the date of the breach of such contract obligations.
to except litigation arising out of activities under this sub-
part from the application of sections 517 and 547 of title 28 of
from an individual under paragraph (2) upon the death of the
(3) The United States shall not be entitled to recover any damages
the United States code;
"(3) include in any contract for Federal loan insurance such
individual. "(4) The Secretary shall by regulation provide for the waiver or
terms, conditions, and convenants relating to repayment of prin-
suspension of payment of any or all of the damages to which the
cipal and payment of interest, relating to his obligations and
United States is entitled under paragraph (2) whenever the Secretary
rights and to those of eligible lenders, and borrowers in case of
determines that compliance by an individual with the agreement which
default, and relating to such other matters as the Secretary deter-
was breached is impossible or would involve extreme hardship to the
mines to be necessary to assure that the purposes of this sub-
individual and that recovery of such damages with respect to the
part will be achieved; and any term, condition, and covenant
individual would be unconscionable.
made pursuant to this clause or any other provisions of this
subpart may be modified by the Secretary if he determines
"PARTICIPATION BY FEDERAL CREDIT UNIONS IN FEDERAL, STATE, AND
that modification is necessary to protect the financial interest
PRIVATE STUDENT LOAN INSURANCE PROGRAMS
of the United States:
"(4) subject to the specific limitations in the subpart, con-
"SEC. 736. Notwithstanding any other provision of law, Federal
sent to the modification, with respect to rate of interest, time
credit unions shall, pursuant to regulations of the Director of the Bu-
of payment of any installment of principal and interest or any
reau of Federal Credit Unions, have power to make insured loans to
portion thereof, or any other provision of any note or other in-
eligible students in accordance with the provisions of this subpart
strument evidencing a loan which has been insured by him under
relating to Federal insured loans.
this subpart; and
26
27
"DEFINITIONS
financial aid wth respect to funds obtained from a student who
"Sec. 737. A8 used in this subpart:
has received a loan insured under this subpart; and
"(1) The term 'eligible institution' means, with respect to a fiscal
"(3) the limitation, suspension, or termination of the eligi-
year, a school of medicine, osteopathy, dentistry, optometry, phar-
bility under this subpart of any otherwise eligible institution,
macy, podiatry, veterinary medicine, and public health within the
whenever the Secretary has determined, after notice and afford-
United States that is receiving, or the Secretary determines is eligible
ing an opportunity for hearing, that such institution has vio-
to receive, a grant under section 770 of this Act.
lated or failed to carry out any regulation prescribed under this
"(2) The term 'school of medicine, osteopathy, or dentistry, optom-
subpart".
etry, pharmacy, podiatry, veterinary medicine, and public health'
"(b) The Secretary shall by regulation-
means any school legally authorized within a State to train members
(1) require an eligible institution to record, and make avail-
bodies of the professions indicated and accredited by a recognized body
able to a lender and to the Secretary upon request, the name,
approved for such purpose by the Commissioner of Education, or
address, postgraduate destination, and other reasonable identify-
except that a new school which (by reason of no, or an insufficient,
ing information for each student of such institution who has a
period of operation) is not, at the time of application for insurance
loan insured under this subpart; and
for a loan under this subpart, eligible for accreditation by such
"(2) in the case of an eligible institution which is a school of
this recognized body or bodies, shall be deemed accredited for of a
medicine, osteopathy, or dentistry, require such institution to
part if the Commissioner of Education finds, after consultation purposes
establish procedures to insure that no more than 50 percent of
with the appropriate accreditation body or bodies, that there is
the students in each class in the institution are authorized to have
sonable assurance that the school will meet the accreditation standards rea-
loans insured under this subpart.".
of such body or bodies prior to the beginning of the academic
such following school. the normal graduation date of the first entering class year in
STUDENT LOAN AGREEMENTS
"(3) The term 'eligible lender' means an eligible institution,
SEC. 402. Section 740 is amended—
agency or instrumentality of a State, a financial or credit institution an
(1) by striking out "of Health, Education, and Welfare" in
(including an insurance company) which is subject to examination
subsection (a);
a and supervision by an agency of the United States or of any State, or
(2) by striking out ", except as provided in section 746," in
pension fund approved by the Secretary for this purpose.
paragraphs (2) and (3) of subsection (b);
"(4) The term line of credit' means an arrangement or
(3) by striking out and that while the agreement remains in
the between the lender and the borrower whereby a loan is paid agreement out by
effect" and all that follows through "National Defense Education
lender lender to the borrower in annual installments, or whereby the
Act of 1958; and" in subsection (b) (4) and inserting in lieu there-
in subsequent years.
agrees to make, in addition to the initial loan, additional loans
of a semicolon;
(4) by redesignating paragraph (5) of subsection (3) as para-
graph (6), and inserting after paragraph (4) of such subsection
"REPAYMENT BY THE SECRETARY OF LOANS OF DECEASED OR DISABLED
the following new paragraph; and
BORROWERS
"(5) provide that the school shall advise, in writing, each appli-
cant for a loan from the student loan fund of the provisions of
becomes permanently and totally disabled (as determined in accord- or
"Sec. 738. If a student borrower who has received a loan dies
section 741 under which outstanding loans from the student loan
fund may be paid (in whole or in part) by the Secretary; and".
the borrower's liability on the loan by repaying the amount owed on
the ance with regulations of the Secretary), the Secretary shall discharge
LOAN PROVISIONS
loan from the fund established under section 734.
SEC. 403. (a) Subsection (a) of section 741 is amended to read as
"ELIGIBILITY OF INSTITUTIONS
follows:
"(a) Loans from a student loan fund (established under an agree-
necessary to provide for
the Secretary is authorized to prescribe such regulations as subpart, may be
"SEC. 739. (a) Notwithstanding any other provision of this
ment with a school under section 740) may not exceed for any student
for each school year (or its equivalent) the sum of-
"(1) the cost of tuition for such year at such school, and
funds obtained from a student who has received a loan insured any
"(1) a fiscal audit of an eligible institution with regard to
"(2) $2,500.".
(b) Subsection (e) of section 741 is amended by striking out "3
under this subpart;
per centum" and inserting in lieu thereof "ry percent".
"(2) the establishment of reasonable standards of financial
(c) The amendments made by subsections (a) and (3) shall apply
responsibility and appropriate institutional capability for the ad-
with respect to loans made after September 30, 1977, from student
ministration by an eligible institution of a program of student
loan funds established under section 740 of the Public Health Service
Act.
28
29
(d) Subsection (f) (1) (B) of section 741 is amended to read as
for the purpose of meeting his responsibilities respecting participa-
follows:
tions in obligations acquired under section 744 of such Act. The Secre-
"(B) who obtained one or more loans from a loan fund estab-
tary shall continue to deposit in such fund all amounts received by
lished under this subpart; and".
him as interest payments or repayments of principal on loans under
(e) In the case of any individual who, on or after November 18,
such section 744. If at any time the ,Secretary determines the moneys
1971, and before the date of enactment of this Act, met the require-
in the fund exceed the present and any reasonable prospective future
ments of subparagraphs (4) and (B) of section 741(f) (1) of the
requirements of such fund, such excess may be transferred to the gen-
Public Health Service Act and who practiced his profession in an
eral fund of the Treasury.
area described in subparagraph (C) of such section (as in effect be-
(c) There are authorized to be appropriated without fiscal year
fore the date of the enactment of this Act) while a member of the
limitation such sums as may be necessary to enable the Secretary to
National Health Service Corps or as an officer of the Regular or Re-
make payments under agreements entered into under section 744(b)
serve Corps of the Public Health Service or as a civilian employee of
of the Public Health Service Act before September 30, 1977.
the Public Health Service, the individual shall, for purposes of section
(d) Section 742(b) is amended (1) by striking out and for loans
741(f) of such Act, be deemed to have entered into the agreement re-
pursuant to section 744" in paragraph (1), and (2) by striking out
quired by such subparagraph (C) with respect to that practice if such
"whether as Federal capital contributions or as loans to schools under
individual makes application to the Secretary, not later than Janu-
section 744" in paragraph (3).
ary 1, 1977, for payment by the Secretary under section 741(f) (2) of
(e) Section 743 (3) is amended by striking out (other than 30 much
such Act.
of such fund as relates to payments from the revolving fund estab-
(f) A student in a school of medicine or osteopathy who will
lished by section 744(d))".
graduate from such school after June 30, 1979, shall be eligible to re-
ceive a loan under section 741 of the Public Health Service Act after
REVISION OF NATIONAL HEALTH SERVICE CORPS PROGRAM
October 1, 1977 only if such student is of exceptional financial need
(as defined by regulations of the Secretary).
SEC. 407. (a) Part C of title III is amended by inserting immedi-
ately below the heading for such part the following:
AUTHORIZATION OF APPROPRIATIONS
"Subpart I-General Provisions".
SEC. 404. Effective October 1, 1977, subsection (a) of section 742 is
(3) Title III is amended-
amended to read as follows:
(1) by striking out section 329;
"(a) For the purpose of making Federal capital contributions into
(2) by redesignating sections 331 and 332 as sections 339 and
the student loan funds of schools which have established such funds
340, respectively; and
under section 740, there are authorized to be appropriated $26,000,000
(3) by inserting immediately after section 330 the following
for the fiscal year ending September 30, 1978, $27,000,000 for the fiscal
new subpart:
year ending September 30, 1979, and $28,000,000 for the fiscal year end-
"Subpart II-National Health Service Corps Program
ing September 30, 1980. For the fiscal year ending September 30, 1981,
and each of the two succeeding fiscal years, there are authorized to be
"NATIONAL HEALTH SERVICE CORPS
appropriated to the Secretary such sums as may be necessary to en-
able students who have received a loan under this part for any aca-
"Sec. 331. (a) There is established, within the Service, the National
demic year ending before October 1, 1981, to continue or complete their
Health Service Corps (hereinafter in this subpart referred to as the
education.".
'Corps') which (1) shall consist of such officers of the Regular and
DISTRIBUTION OF ASSETS
Reserve Corps of the Service and such civilian personnel as the Sec-
retary may designate (such officers and personnel hereinafter in this
SEC. 405. Section 743 is amended by striking out "June 30, 1977"
subpart referred to as 'Corps members') and (2) shall be utilized by
and "September 30, 1977" each place they occur and inserting in lieu
the ,Secretary to improve the delivery of health services in health man-
thereof "September 30, 1983" and "December 31, 1983", respectively.
power shortage areas as defined in section 332 (a).
"(b) The Secretary shall conduct at schools of medicine, osteopa-
LOANS TO SCHOOLS AND TECHNICAL AND CONFORMING AMENDMENTS
thy, dentistry, and, as appropriate, nursing and other schools of the
health professions and at entities which train allied health personnel,
Sec. 406. (a) (1) Sections 744 and 746 are repealed.
recruiting programs for the Corps and the Scholarship Program.
(2) Section 745 is redesignated as section 744.
"(c) The Secretary may reimburse applicants for positions in
(b) The health professions education fund created within the
the Corps for actual and reasonable expenses incurred in traveling to
Treasury by section 744(d) (1) of the Public Health Service Act shall
and from their places of residence to the health manpower shortage
remain available to the Secretary of Health, Education, and Welfare
area (designated under section 332) in which they would be assigned
30
31
for the purpose of evaluating such area with regard to being assigned
"(g) The administrative unit which administers section 770-
in such area. The Secretary shall not reimburse an applicant for more
(1) shall participate in the development of regulations, guide-
than one such trip.
lines, funding priorities, and application forms, and
(d) (1) The Secretary may, under regulations promulgated by
'(2) shall be consulted by, and may make recommendations to,
the Secretary, adjust the monthly pay of each member of the Corps
the Secretary in the review of applications and proposals for, and
who is directly engaged in the delivery of health services in a health
the awarding of, grants and contracts,
manpower shortage area as follows:
"(A) During the first 36 months in which such a member is 80
with respect to the Corps.
engaged in the delivery of health services, his monthly pay shall
"(h) For the purposes of this subpart:
(1) The term 'Department' means the Department of Health,
be increased by an amount (not to exceed $1,000) which when
added to the member's monthly pay and allowance will provide a
Education, and Welfare.
(2) The term 'Scholarship Program' means the National
monthly income competitive with the average monthly income
from a practice of an individual who is a member of the profes-
Health Service Corps Scholarship Program established under
section 751.
sion of the Corps member, who has equivalent training, and who
has been in practice for a period equivalent to the period during
(3) The term 'State' includes, in addition to the several States,
which the Corps member has been in practice.
only the District of Columbia, the Commonwealth of Puerto Rico,
"(B) During the period beginning upon the expiration of the
the Commonwealth of the Northern [ariana Islands. the Virgin
36 months referred to in subparagraph (4) and ending with the
Islands, Guam, American Samoa, and the Trust Territory of
month in which the member's monthly pay and allowances is equal
the Pacific Islands.
to or exceeds the monthly income he received for the last of such
"DESIGNATION OF HEALTH MANPOWER SHORTAGE AREAS
36 months, the member shall receive in addition to his monthly
pay and allowances an amount which when added to such monthly
"SEC. 332. (α) (1) For purposes of this subpart the term 'health man-
pay and allowances equals the monthly income he received for
power shortage area' means (4) an area in an urban or rural area
such last month.
(which need not conform to the geographic boundaries of a political
"(C) For each month in which a member is directly engaged
subdivision and which is a rational area for the delivery of health
in the delivery of health services in a health manpower short-
services) which the Secretary determines has a health manpower
age area in accordance with an agreement with the Secretary
shortage, (B) a population group which the Secretary determines
entered into under section 741(f) (1) (σ), under which the Sec-
has such a shortage, or (C) a public or nonprofit private medical facil-
retary is obligated to make payments in accordance with section
ity or other public facility which the Secretary determines has such a
741(f) (2), the amount of any monthly increase under subpara-
shortage.
graph (A) or (B) with respect to such member shall be de-
(2) For purposes of this subsection, the term 'medical facility'
creased by an amount equal to one-twelfth of the amount which
means a facility for the delivery of health services and includes-
the Secretary is obligated to pay upon the completion of the year
'(A) a hospital, State mental hospital, public health center,
of practice in which such month occurs.
outpatient medical facility, rehabilitation facility, facility for
For purposes of subparagraphs (A) and (B), the term 'monthly pay'
long-term care, community mental health center, migrant health
includes special pay received under chapter 5 of title 37 of the United
center, community health center;
States Code.
(B) such a facility of a State correctional institution or of
'(2) In the case of a member of the Corps who is directly engaged in
the Indian Health Service;
the delivery of health services in a health manpower shortage area in
"(O) such a facility used in connection with the delivery of
accordance with a service obligation incurred under the Scholarship
health services under section 321 (relating to hospitals), 322 (re-
Program, the adjustment in pay authorized by paragraph (1) may be
lating to care and treatment of seamen and others), 323 (relating
made for such a member only upon satisfactory completion of such
to care and treatment of Federal prisoners), 32.4 (relating to ex-
service obligation, and the first 36 months of such member's being so en-
amination and treatment of certain Federal employees), 325 (re-
gaged in the delivery of health services shall, for purposes of para-
lating to examination of aliens), or 326 (relating to services to
graph (1) (A), be deemed to begin upon such satisfactory completion.
certain Federal employees), or part D of title III (relating to
(e) Corps members assigned under section 333 to provide health
services for persons with Hansen's disease); and
services in health manpower shortage areas shall not be counted against
'(D) α Federal medical facility.
any employment ceiling affecting the Department.
(b) The Secretary shall establish by regulation, promulgated not
(f) Sections 214 and 216 shall not apply to commissioned officers in
later than May 1, 1977, criteria for the designation of areas, popula-
the Regular or Reserve Corps of the Service who are members of the
tion groups, medical facilities, and other public facilities, in the States,
National Health Service Corps and who have participated in the
as health manpower shortage areas. In establishing such criteria, the
Scholarship Program.
Secretary shall take into consideration the following:
32
33
"(1) The ratio of available health manpower to number of in-
"(B) the State health planning and development agency of the
dividends in an area or population group, or served by a medical
State (designated under section 1521) if such area, population
tion. facility or other public facility under consideration for designa-
group, medical facility, or other public facility is within a health
service area for which no health systems agency has been des-
"(2) Indicators of a need, notwithstanding the supply of health
ignated; and
manpower, for health services for the individuals in an area or
'(4) appropriate public or nonprofit private entities which are
population group or served by a medical facility or other public
located or which have a demonstrated interest in the area 80
facility under consideration for designation, with special consid-
designated.
eration to indicators of-
"(g) Any person may recommend to the Secretary the designation
(A) infant mortality,
(B) access to health services, and
of an area, population group, medical facility, or other public facility
"(0) health status.
as a health manpower shortage area.
"(h) The ,Secretary shall conduct such information programs in
"(3) The percentage of physicians serving an area, population
areas, among population groups, and in medical facilities and other
group, medical facility, or other public facility under considera-
public facilities designated under this section as health manpower
tion for designation who are employed by hospitals and who are
shortage areas as may be necessary to inform public and nonprofit
graduates of foreign medical schools.
"(c) In determining whether to make a designation, the Secretary
private entities which are located or have a demonstrated interest in
shall take into consideration the following:
such areas of the assistance available under this title by virtue of the
"(1) (A) The recommendations of each health systems agency
designation of such areas.
(designated under section 1515) for a health service area which in-
"ASSIGNMENT OF CORPS PERSONNEL
cludes all or any part of the area, population group, medical fa-
cility, or other public facility under consideration for designation.
"SEC. 333. (a) (1) The Secretary may assign members of the Corps
'(B) The recommendations of the State health planning and
to provide, under regulations promulgated by the Secretary, health
development agency (designated under section 1521) if such area,
services in or to a health manpower shortage area during the assign-
population group, medical facility, or other public facility is with-
ment period (specified in the agreement described in section 334) only
in a health service area for which no health systems agency has
if-
been designated.
"(A) a public or nonprofit private entity, which is located or
"(2) The recommendations of the Governor of each State in
has a demonstrated interest in such area makes application to the
which the area, population group, medical facility, or other public
Secretary for such assignment;
facility located. under consideration for designation is in whole or part
(B) such application has been approved by the Secretary;
"(C) an agreement has been entered into between the entity
(d) In accordance with the criteria established under subsection
which has applied and the Secretary, in accordance with section
(3) and the considerations listed in subsection (c), the Secretary shall
334; and
designate, not later than November 1, 1977, health manpower shortage
(D) in the case of an application made by an entity which has
areas in the States, publish the names of the areas, population groups,
previously been assigned a Corps member for a health manpower
medical facilities, and other public facilities 80 designated, and at least
shortage area under an agreement (entered into under section 334)
annually review and, as necessary, revise such designations.
which has expired, the Secretary has (i) conducted an evaluation
"(e) Prior to the designation of a public facility, including a Fed-
of the continued need for health manpower for the area, the use
eral medical facility, as a health manpower shortage area, the Secre-
of Corps members previously assigned to the area, community
tary shall give written notice of such proposed designation to the chief
support for the assignment of Corps members to the area, the
administrative officer of such facility and request comments within 30
area's efforts to secure health manpower for the area, and fiscal
days with respect to such designation.
management by the entity with respect to Corps members pre-
(f) The Secretary shall give written notice of the designation of a
viously assigned and (ii) on the basis of such evaluation has deter-
health manpower shortage area, not later than 60 days from the date
mined that-
of such designation, to-
"(I) there is a continued need for health manpower for the
"(1) the Governor of each State in which the area, popula-
area;
tion group, medical facility, or other public facility 80 designated
"(II) there has been appropriate and efficient use of Corps
is in whole or part located;
members previously assigned to the entity for the area;
"(2) (A) each health systems agency (designated under section
(III) there is general community support for the assign-
1515) for a health service area which includes all or any part of
ment of Corps members to the entity;
the area, population group, medical facility, or other public facil-
'(IV) the area has made continued efforts to secure health
ity 80 designated; or
manpower for the area; and
76-510 76 3
35
34
characteristics which are characteristics which increase the probability
(V) there has been sound fiscal management, including
of the member's remaining to serve the area upon completion of his
efficient collection of fee-for-service, third-party, and other
assignment period.
appropriate funds, by the entity with respect to Corps mem-
(f) (1) The Secretary shall provide technical assistance to a public
bers previously assigned to such entity.
or nonprofit private entity which is located or has a demonstrated in-
"(2) Corps members may be assigned to a Federal health care
terest in a health manpower shortage area which entity desires to make
facility, but only upon the request of the head of the department br
an application under this section for assignment of a Corps member
agency of which such facility is a part.
to such area.
"(b) The ,Secretary may not approve an application under this sec-
(2) The Secretary shall provide, to public and nonprofit private
tion for assignment of a Corps member to a health manpower shortage
entities which are located or have a demonstrated interest in a health
area unless the Secretary has afforded-
manpower shortage area to which area a Corps member has been as-
"(1) each health systems agency (designated under section
signed, technical assistance to assist in the retention of such member
1515) for a health service area which includes all or part of the
in such area after the completion of such member's assignment to the
area in which the area, population group, medical facility, or
area.
other public facility 80 designated is located, and
"(3) The Secretary shall provide, to health manpower shortage areas
(2) if there is a part of such area, population group, medical
to which no Corps member has been assigned, (A) technical assistance
facility, or other public facility located within a health service
to assist in the recruitment of health manpower for such areas, and
area for which no health systems agency has been designated, the
(B) current information on public and private programs which pro-
State health planning and development agency (designated under
vide assistance in the securing of health manpower.
section 1521) of the State in which such part is located,
"(g) The Secretary shall conduct, or enter into contracts for the
an opportunity to review the application and submit to the Secretary
conduct of studies of the methods of assignments of Corps members
its comments respecting the need for, and proposed use of, the Corps
to health manpower shortage areas. Such studies shall include studies
member requested in the application.
of-
"(c) In considering, and giving approval to, applications made
"(1) the characteristics of physicians, dentists, and other health
shall- under this section for the assignment of Corps members, the Secretary
professionals who are more likely to remain in practice in health
manpower shortage areas;
"(1) give priority to an application which provides for the
(2) the characteristics, including utilization and reimburse-
assignment of Corps members to an area, population group, medi-
ment patterns, of areas which have been able to retain health
cal facility, or other public facility with the greatest health man-
manpower personnel; and
power shortage, as determined under criteria established under
(3) the appropriate conditions for the assignment and use of
section 332(b);
nurse practitioners, physician's assistants, and expanded function
(2) give special consideration to an application which pro-
dental auxiliaries in health manpower shortage areas.
vides for the use of physician assistants, nurse practitioners, or
"(h) Notwithstanding any other law, any member of the Corps
expanded function dental auxiliaries;
licensed to practice medicine, osteopathy, or dentistry in any State
" (3) take into consideration the willingness of individuals in
shall, while serving in the Corps, be allowed to practice such profes-
the area or population group, or at the medical facility or other
sion in any State.
public facility, and of the appropriate governmental agencies or
"COST SHARING
health entities, to assist and cooperate with the Corps in provid-
ing effective health services; and
"SEC. 334. (a) The Secretary shall require, as a condition to the
(4) take into consideration comments of medical, osteopathic,
approval of an application under section 333, that the entity which
dental, or other health professional societies serving the area,
submitted the application enter into an agreement for a specific as-
population group, medical facility, or other public facility, or, if
signment period (not to exceed 4 years) with the Secretary under
no such societies exist, comments of medical, dental, or other
which-
health professions serving the area, population group, medical
"(1) the entity shall be responsible for charging in accordance
facility, or other public facility.
with subsection (d) for health services provided by Corps mem-
(d) The Secretary shall assign Corps members to entities in health
bers assigned to the entity;
manpower shortage areas without regard to the ability of the in-
"(2) the entity shall take such action as may be reasonable for
dividuals in such areas population groups, medical facilities, or other
the collection of payments for such health services, including, if
public facilities to pay for such services.
a Federal agency, an agency of a State or local government, or
'(e) In making the assignment of a Corps member to an entity in
other third party would be responsible for all or part of the cost
a health manpower shortage area which has had an application ap-
of such health services if it had not been provided by Corps mem-
proved under this section, the Secretary shall seek to assign to an
bers under this subpart, the collection, on a fee-for-service or other
area a Corps member who has (and whose spouse, if any, has) those
37
36
basis, from such agency or third party, the portion of such cost
entity submitted an application or to recruit and retain health man-
for which it would be 80 responsible (and in determining the
power to provide health services for such individuals.
amount of such cost which such agency or third party would be
member under this subpart shall be charged for such services on a fee-
"(d) Any person who receives health services provided by a Corps
responsible, the health services provided by Corps members shall
be considered as being provided by private practitioners);
"(3) the entity shall pay to the United States, as prescribed
suant to regulations. Such rate shall be computed in such a way as to
for-service or other basis, at a rate approved by the Secretary, pur-
by the Secretary in each calendar quarter (or other period as may
permit the recovery of the value of such services, except that if such
be specified in the agreement) during which any Corps member
person is determined under regulations of the Secretary to be unable
to pay such charge, the Secretary shall provide for the furnishing of
is assigned to such entity, the sum of-
"(A) the portion of the salary (including amounts paid
such services at a reduced rate or without charge.
"(e) Funds received by the Secretary under an agreement entered
in accordance with section 331(d)) and allowances of any
into under this section shall be deposited in the Treasury as miscel-
Corps member received by such member during such calendar
laneous receipts and shall be disregarded in determining the amounts
quarter (or other period) while such member was assigned to
of appropriations to be requested and the amounts to be made avail-
such entity;
able from appropriations made under section 338 to carry out this
"(B) for any Corps member assigned to such entity, an
amount which bears the same ratio to the amount paid under
subpart.
the Scholarship Program to or on the behalf of such Corps
"PROVISION OF HEALTH SERVICES BY CORPS MEMBERS
member as the number of days of obligated service provided
by such member during such quarter (or other period) bears
"Sec. 335. (a) In providing health services in a health manpower
to the number of days in his period of obligated service under
shortage area, Corps members shall utilize the techniques, facilities,
such program; and
and organizational froms most appropriate for the area, population
"(0) if such entity received a loan under section 335 (c),
group, medical facility, or other public facility, and shall, to the maxi-
an amount which bears the same ratio to the amount of such
mum extent feasible, provide such services (1) to all individuals in
loan as the number of days in such quarter (or other period)
such health manpower shortage area regardless of their ability to pay
during which any Corps members were assigned to the entity
for the services, and (2) in connection with (A) direct health services
bears to the number of days in the assignment period after
programs carried out by the Service, (B) any other direct health serv-
such entity received such loan; and
ices program carried out by the Service, (B) any other direct health
"(4) the entity shall prepare and submit to the Secretary an
services program carried out in whole or in part with Federal financial
annual report, in such form and manner, as the Secretary may
assistance, or (C) any other health services activity which is in fur-
require.
therance of the purposes of this subpart.
(3) (1) The Secretary may waive in whole or in part the applica-
"(b) (1) Notwithstanding any other provision of law, the Sec-
tion of the requirement of subsection (a) (3) for an entity if he deter-
ments as he determines necessary to enable Corps members to utilize
retary may (A) to the maximum extent feasible make such arrange-
mines that the entity is financially unable to meet such requirement or
if he determines that compliance with such requirement would unrea-
the health facilities in or serving the health manpower shortage area
sonably limit the ability of the entity to provide for the adequate sup-
in providing health services; (B) make such arrangements as he
port of the provision of health services by Corps members.
determines are necessary for the use of equipment and supplies of the
"(2) The Secretary may waive in whole or in part the applica-
Service and for the lease or acquisition of other equipment and sup-
tion of the requirement of subsection (a) (3) for any entity, which is
plies; and (C) secure the permanent, or temporary services of physi-
located in a health manpower shortage area in which a significant per-
cians, dentists, nurses, administrators, and other health personnel. If
centage of the individuals are elderly, living in poverty, or have other
there are no health facilities in or serving such area, the Secretary may
characteristics which indicate an inability to repay, in whole or in
arrange to have Corps members provide health services in the nearest
part, the amounts required in subsection (a) (3).
health facilities of the Service or may lease or otherwise provide facil-
(3) In the event that the Secretary grants a waiver under para-
ities in or serving such area for the provision of health services.
graph (1) or (2), the entity shall be required to use the total amount of
"(2) If the individuals in or served by a health manpower shortage
funds collected by such entity in accordance with subsection (a) (2)
area are being served (as determined under regulations of the Secre-
for the improvement of the capability of such entity to deliver health
tary) by a hospital or other health care delivery facility of the Service,
services to the individuals in the health manpower shortage area.
the Secretary may, in addition to such other arrangements as he may
"(c) The excess (if any) of the amount of funds collected by an
make under paragraph (1), arrange for the utilization of such hospital
entity in accordance with subsection (a) (2) over the amount paid to
or facility by Corps members in providing health services, but only to
the United States in accordance with subsection (a) (3) shall be used
the extent that such utilization will not impair the delivery of health
by the entity to expand and improve the provision of health services to
services and treatment through such hospital or facility to individuals
the individuals in the health manpower shortage area for which the
38
39
who are entitled to health services and treatment through such hos-
"(3) the number and types of Corps members assigned in such
pital or facility.
year to health manpower shortage areas, the number and types
"(c) The Secretary may make one loan to any entity with an ap-
of additional Corps members which the Secretary estimates will
proved application under section 333 to assist such entity in meeting
be assigned to such areas in the subsequent year, and the need for
the costs of (1) establishing medical, dental, or other health profes-
additional members for the Corps;
sion practices, including the development of medical practice man-
"(4) the recruitment efforts engaged in for the Corps in such
agement systems; (2) acquiring equipment for use in providing health
year and the number of qualified individuals who applied for
services; (3) renovating buildings to establish health facilities; and
service in the Corps in such year;
(4) establishing appropriate continuing education programs. No loan
"(5) the number of patients seen and the number of patient
may be made under this subsection unless an application therefor is
visits recorded during such year with respect to each health man-
submitted to, and approved by, the Secretary. The amount of any loan
power shortage area to which a Corps member was assigned dur-
shall be determined by the Secretary, except that no loan may exceed
ing such year;
$50,000.
"(6) the number of Corps members who elected, and the num-
"(d) Upon the expiration of the assignment of all Corps members
ber of Corps members who did not elect, to continue to provide
to a health manpower shortage area, the ,Secretary may (notwithstand-
health services in health manpower shortage areas after termina-
ing any other provision of law) sell to any appropriate local entity
tion of their service in the Corps and the reasons (as reported to
equipment and other property of the United States utilized by such
the Secretary) of members who did not elect for their not making
members in providing health services. Sales made under this subsec-
such election;
tion shall be made at the fair market value (as determined by the
"(7) the results of evaluations and determinations made under
Secretary) of the equipment or such other property; except that the
section (1) (D) during such year; and
,Secretary may make such sales for a lesser value to an appropriate
"(8) the amount charged during such year for health services
local entity, if he determines that the entity is financially unable to
provided by Corps members, the amount which was collected
pay the full market value.
in such year by entities in accordance with agreements under sec-
"(e) (1) (A) It shall be unlawful for any hospital to deny an author-
tion 334, and the amount which was paid to the Secretary in such
ized physician or dentist member of the Corps admitting privileges,
year under such agreements.
when such Corps member otherwise meets the professional qualifica-
tions established by the hospital for granting such privileges and
"NATIONAL ADVISORY COUNCIL
agrees to abide by the published bylaws of the hospital and the pub-
lished bylaws, rules, and regulations of its medical staff.
"Sec. 337. (a) There is established a council to be known as the
"(B) Any hospital which is found by the Secretary, after notice
National Advisory Council on the National Health Service Corps
and an opportunity for a hearing on the record, to have violated this
(hereinafter in this section referred to as the 'Council'). The Council
subsection shall upon such finding cease to receive and to be eligible to
shall be composed of fifteen members appointed by the Secretary as
receive any Federal funds under this Act or under titles XVIII or
follows:
XIX of the Social Security Act.
"(1) Four members shall be appointed from the general public
"(2) For purposes of this subsection, the term 'hospital' includes a
to represent the consumers of health care, at least two of whom
State or local public hospital, a private profit hospital, a private non-
shall be individuals who are residents of, members of, or served by
profit hospital, a general or special hospital, and any other type of
Corps members assigned to, a health manpower shortage area.
hospital (excluding a hospital owned or operated by an agency of the
"(2) Three members shall be appointed from medical, dental,
Federal Government), and any related facilities.
and other health professions.
"(3) One member shall be appointed from a State health plan-
"ANNUAL REPORTS
ning and development agency (designated under section 1521),
one member shall be appointed from a Statewide Health Co-
"SEC. 336. The Secretary shall submit an annual report to Congress
ordinating Council (designated under section 1524), and one
on May 1 of each year, and shall include in such report with respect
member shall be appointed from a health systems agency (desig-
to the previous calendar year-
nated under section 1515).
(1) the number, identity, and priority of all health manpower
"(4) Three members shall be appointed from the Service, at
shortage areas designated in such year and the number of health
least two of whom shall be members of the Corps directly engaged
manpower shortage areas which the Secretary estimates will be
in the provision of health services in a health manpower shortage
designated in the subsequent year;
area.
"(2) the number of applications filed under section 333 in such
"(5) Two members shall be appointed from the National Coun-
year for assignment of Corps members and the action taken on
cil on Health Planning and Development (established under sec-
each such application;
tion 1503).
40
41
No individual who is a provider of health care (as defined in section
shortage area (as defined by section 332 of such Act (as 30 added)) and
1531 (3)) may be appointed as a member of the Council under para-
(ii) have had an application approved under section 333 of such Act
graph (1), (3), or (5). The Council shall consult with, advise, and
(as 80 added) for the assignment of Corps personnel unless, as deter-
make recommendations to, the Secretary with respect to his responsi-
mined under subparagraph (B) of this paragraph, the assignment
bilities in carrying out this subpart, and shall review and comment
period applicable to such area (within the meaning of section 334 (as
upon regulations promulgated by the Secretary under this subpart.
80 added)) has expired.
"(b) (1) Members of the Council shall be appointed for a term of
(B) The assignment period (within the meaning of such section
three years, except that any member appointed to fill a vacancy oc-
334) applicable to an area described in subparagraph (A) of this
curring prior to the expiration of the term for which the member's
paragraph shall be considered to have begun on the date Corps person-
predecessor was appointed shall be appointed for the remainder of
nel were first assigned to such area under section 329 of such Act (as in
such term. No member shall be removed, except for cause. Members
effect on September 30, 1977).
may be reappointed to the Council.
(σ) In the case of any physician or dentist member of the Corps
"(2) Members of the Council (other than members who are officers
who was providing health care and services on September 30, 1977,
or employees of the United States), while attending meetings or con-
under an assignment made under section 329 (b) of such Act (as in
ferences thereof or otherwise serving on the business of the Council,
effect on September 30, 1977), the number of the months during which
shall be entitled to receive for each day (including traveltime) in
such member provided such care and sevices before October 1, 1977,
which they are 80 serving the daily equivalent of the annual rate of
shall be counted in determining the application of the additional pay
basic pay in effect for grade GS-18 of the General Schedule; and while
provisions of section 331 (d) of such Act (as added by subsection (3)
80 serving away from their homes or regular places of business all
of this section) to such number.
members may be allowed travel expènses, including per diem in
(3) The amendment made by subsection (b) which changed the
lieu of subsistence, as authorized by section 5703(b) of title 5 of the
name of the Advisory Council established under section 329 of the
intermittently. United States Code for persons in the Government Service employed
Public Health Service Act (and placed the authority for the Advisory
Council in section 337 of such Act (as added by such amendment))
"(c) Section 14 of the Federal Advisory Committee Act shall not
shall not be construed as requiring the establishment of a new Advis-
apply with respect to the Council.
ory Council under such section 337; and the amendment made by such
subsection with respect to the composition of such Advisory Council
"AUTHORIZATION OF APPROPRIATION
shall apply with respect to appointments made to the Advisory Coun-
cil after October 1, 1977, and the Secretary of Health, Education, and
"Sec. 338. (a) To carry out the purposes of this subpart, there are
Welfare shall make appointments to the Advisory Council after such
authorized to be appropriated $47,000,000 for the fiscal year ending
date in a manner which will bring about, at the earliest feasible time,
September 30, 1978; $57,000,000 for the fiscal year ending September
the Advisory Council composition prescribed by the amendment.
30, 1979; and $70,000,000 for the fiscal year ending September 30, 1980.
(d) (1) Section 7.41 (f) (1) (C) is amended by striking out all that
"(b) An appropriation under an authorization under subsection (a)
follows after "in a State" and inserting in lieu thereof "in a health
for any fiscal year may be made at any time before that fiscal year and
manpower shortage area designated under section 332;".
may be included in an Act making an appropriation under an authori-
(2) The amendment made by paragraph (1) shall apply with
zation under subsection (a) for another fiscal year; but no funds may
respect to agreements entered into under section (f) of the Public
be made available from any appropriation under such authorization
Health Service Act after September 30, 1977.
for obligation under this subpart before the fiscal year for which such
appropriation is authorized.".
SCHOLARSHIPS AND PUBLIC HEALTH TRAINEESHIPS
(c) (1) The amendment made by subsections (a) and (b) shall apply
only with respect to fiscal years beginning after September 30, 1977,
SEC. 408. (a) Effective October 1, 1977, part o of title VII is
except that the Secretary of Health, Education, and Welfare shall
amended by adding at the end thereof the following new subpart:
carry out the activities dscribed in section 332 of the Public Health
Service Act (as added by such amendment) after the date of enact-
"Subpart III-Traineeships for Students in Schools of Public Health
ment of this Act.
and Other Graduate Programs
(2) (A) Any area for which a designation under section 329 (b) of
the Public Health Service Act (as in effect on September 30, 1977)
"TRAINEESHIPS FOR STUDENTS IN SCHOOLS OF PUBLIC HEALTH
was in effect on such date and in which National Health Service Corps
personnel were, on such date, providing, under an assignment made
"Sec. 748. (a) The Secretary may make grants to accredited
under such section (as 80 in effect), health care and services for persons
schools of public health for traineeships to train students enrolled in
residing in such area shall, effective October 1, 1977, be considered
such schools.
under subpart II of part 0 of title III of such Act (as added by sub-
(3) (1) No grant for traineeships may be made under subsection
section (b) of this section) to (i) be designated a health manpower
(a) unless an application therefor has been submitted to, and approved
43
42
"(2) Traineeships awarded under grants made under subsection (α)
by, the Secretary. Such application shall be in such form, be submitted
shall provide for such stipends and allowances (including travel and
in such manner, and contain such information, as the Secretary by
subsistence expenses and dependency allowances) for the trainees as
regulation may prescribe. Traineeships under such a grant shall be
the Secretary may deem necessary.
awarded in accordance with such regulations as the Secretary shall
"(3) In awarding traineeships under this section, each applicant
Secretary. prescribe. The amount of any such grant shall be determined by the
shall assure to the satisfaction of the Secretary that at least 80 per-
cent of the funds received under this section shall до to individuals
"(2) Traineeships awarded under grants made under subsection (a)
who (A) have previously received a postbaccalaureate degree, or (B)
shall provide for such stipends and allowances (including travel and
have three years work experience in health services.
subsistence expenses and dependency allowances) for the trainees as
"(C) For payments under grants under subsection (a), there are
the ,Secretary may deem necessary.
authorized to be appropriated $2,500,000 for the fiscal year ending
"(3) In awarding traineeships under this section, each applicant
September 30, 1978; $2,500,000 for the fiscal year ending September
shall assure to the satisfaction of the Secretary that at least the per-
30, 1979; and $2,500,000 for the fiscal year ending September 30, 1980.".
cent specified in paragraph (4) of the funds received under this sec-
(b) (1) Effective October 1, 1977, section 225 is repealed and part 0
tion shall go to individuals who
of title VII (as amended by subsection (a)) is amended by adding
(A) (i) have previously received a postbaccalaureate degree,
after subpart III the following new subpart:
or
and '(ii) have three years work experience in health services;
"Subpart IV-National Health Service Corps Scholarships
"(B) are pursuing a course of study in-
"NATIONAL HEALTH SERVICE CORPS SCHOLARSHIP PROGRAM
(i) biostatistics or epidemiology,
(ii) health administration, health planning, or health
"SEC. 751. (a) The Secretary shall establish the National Health
policy analysis and planning,
Service Corps Scholarship Program (hereinafter in this subpart re-
(iii) environmental or occupational health, or
ferred to as the 'Scholarship Program") to assure an adequate supply
(iv) dietetics or nutrition.
of trained physicians, dentists, and nurses for the National Health
"(4) The percent referred to in paragraph (3) is-
Service Corps (hereinafter in this subpart referred to as the 'Corps')
"(A) 45 percent for grants made for the fiscal year ending
and, if needed by the Corps, podiatrists, optometrists, pharmacists,
September 30, 1978,
graduates of schools of veterinary medicine, graduates of schools of
(B) 55 percent for grants made for the fiscal year ending
public health, graduates of programs in health administration, grad-
September 30, 1979, and
uates of programs for the training of physician assistants, expanded
(0) 65 percent for grants made for the fiscal year ending
function dental auxiliaries, and nurse practitioners (as defined in
September 30, 1980, and in succeeding fiscal years.
section 822), and other health professionals.
"(c). For payments under grants under subsection (a), there
"(b) To be eligible to participate in the Scholarship Program, an
are authorized to be appropriated $7.500,000 for the fiscal year ending
individual must-
September 30, 1978; $8,000,000 for the fiscal year ending September
"(1) be accepted for enrollment, or be enrolled, as a full-time
30, 1979; and $9,000,000 for the fiscal year ending September 30, 1980.
student (4) in an accredited (as determined by the Secretary)
educational institution in a State and (B) in a course of study
"TRAINEESHIPS FOR STUDENTS IN OTHER GRADUATE PROGRAMS
or program, offered by such institution and approved by the
"Sec. 749. (a) The Secretary may make grants to public or nonprofit
Secretary, leading to a degree in medicine, osteopathy, dentistry,
private educational entities. including graduate schools of social work
or other health profession;
but excluding schools of public health, which offer a program in health
"(2) be eligible for, or hold, an appointment as a commissioned
administration, hospital administration, or health policy analysis and
officer in the Regular or Reserve Corps of the Service or be eligible
planning, which program is accredited by a body or bodies approved
for selection for civilian service in the Corps;
for such purpose, by the Commissioner of Education and which meets
(3) submit an application to participate in the Scholarship
such other quality standards as the Secretary by regulation may pre-
Program; and
scribe, for traineeships to train students enrolled in such a program.
"(4) sign and submit to the Secretary, at the time of submittal
"(b) (1) No grant for traineeships may be made under subsection
of such application, a written contract (described in subsection
(a) unless an application therefor has been submitted to, and approved
(f)) to accept payment of a scholarship and to serve (in accord-
by, the Secretary. Such application shall be in such form, be sub-
ance with this subpart) for the applicable period of obligated
mitted in such manner, and contain such information, as the ,Secretary
service in a health manpower shortage area.
by regulation may prescribe. Traineeships under such a grant shall be
"(c)- In disseminating application forms and contract forms to in-
awarded in accordance with such regulations as the Secretary shall
dividuals desiring to participate in the Scholarship Program, the Sec-
prescribe. Secretary. The amount of any such grant shall be determined by the
retary shall include with such forms-
44
45
"(1) a fair summary of the rights and liabilities of an indi-
the Corps (or for equivalent service as otherwise provided
vidual whose application is approved (and whose contract is
in this subpart), and
accepted) by the Secretary, including in the summary a clear
"(B) subject to paragraph (2), the individual agrees-
explanation of the damages to which the United States is entitled
"(i) to accept provision of such a scholarship to the
under section 754 in the case of the individual's breach of the con-
individual;
tract; and
(ii) to maintain enrollment in a course of study
(2) such other information as may be necessary for the indi-
described in subsection (b) (1) (B) until the individual
vidual to understand the individual's prospective participation
completes the course of study;
in the Scholarship Program and service in the Corps.
"(iii) while enrolled in such course of study, to main-
The application form, contract form, and all other information fur-
tain an acceptable level of academic standing (as deter-
nished by the Secretary under this subpart shall be written in a manner
mined under regulations of the Secretary, by the
calculated to be understood by the average individual applying to
educational, institution offering such course of study);
participate in the Scholarship Program. The Secretary shall make
and
such application forms, contract forms, and other information avail-
'(iv) to serve for a time period (hereinafter in the
able to individuals desiring to participate in the Scholarship Program
subpart referred to as the 'period of obligated service')
on a date sufficiently early to insure that such individuals have
equal to-
adequate time to carefully review and evaluate such forms and
"(I) one year for each school year for which the
information.
individual was provided a scholarship under the
"(d) In determining which applications under the Scholarship Pro-
Scholarship Program, or
gram to approve (and which contracts to accept), the Secretary shall
"(II) two years,
give priority-
whichever is greater, in a health manpower shortage area
"(1) first, to applications made (and contracts submitted) by
(designated under section 332) to which he is assigned by
individuals who have previously received scholarships under the
the ,Secretary as a member of the Corps, or as otherwise
Scholarship Program or under section 758; and
provided in this subpart;
"(2) second, to applications made (and contracts submitted)-
"(2) a provision that any financial obligation of the United
(A) in the school year ending in the fiscal year beginning
States arising out of a contract entered into under this subpart
October 1, 1977, by individuals who are entering their first
and any obligation of the individual which is conditioned thereon,
or second year of study in a course of study or program de-
is contingent upon funds being appropriated to carry out the
scribed in subsection (b) (1) (B) in such school year; and
purposes of this subpart and subpart II of part C for title III;
"(B) in each school year thereafter, by individuals who
"(3) a statement of the damages to which the United States
are entering their first year of study, in a course of study or
is entitled, under section 754, for the individual's breach of the
program described in subsection (3) (1) (B) in such school
contract; and
year.
"(4) such other statements of the rights and liabilities of the
"(e) (1) An individual becomes a participant in the Scholarship
Secretary and of the individual, not inconsistent with the provi-
Program only upon the Secretary's approval of the individual's appli-
sions of this subpart.
cation submitted under subsection (b) (3) and the Secretary's accept-
(g) (1) A scholarship, provided to a student for a school year
ance of the contract submitted by the individual under subsection
under a written contract under the Scholarship Program or under
(3) (4).
section 758 (relating to the disadvantaged student scholarship pro-
(2) The Secretary shall provide written notice to an individual
gram), shall consist of-
promptly upon the Secretary's approving, under paragraph (1), of
(4) payment to, or (in accordance with paragraph (2)) on
the individual's participation in the Scholarship Program.
behalf of, the student of the amount (except as provided in sec-
"(f) The written contract (referred to in this subpart) between
tion 711) of-
the Secretary and an individal shall contain-
"(i) the tuition of the student in such school year; and
"(1) an agreement that—
"(ii) all other reasonable educational expenses, including
"(A) subject to paragraph (2), the Secretary agrees (i)
fees, books, and laboratory expenses, incurred by the student
to provide the individual with a scholarship (described in
in such school year; and
subsection (g)) in each such school year or years (not to
"(B) payment to the student of a stipend of $400 per month
exceed four school years), during which the individual is
(adjusted in accordance with paragraph (3)) for each of the
pursuing a course of study described in subsection (b) (1) (B),
12 consecutive months beginning with the first month of such
as shall be determined by the individual, and (ii) to accept
school year.
(subject to the availability of appropriated funds for carry-
"(2) The Secretary may contract with an educational instituton,
ing out subpart II of part 0 of title III) the individual into
in which a participant in the Scholarship Program is enrolled, for
46
47
the payment to the educational institution of the amounts of tuition
such notice sufficient information regarding the advantages and dis-
and other reasonable educational expenses described in paragraph
(1) (A). Payment to such an educational institution may be made
advantages to each alternative to enable an individual to make a deci-
sion on an formed basis.
529). without regard to section 3648 of the Revised Statutes (31 U.S.C.
(2) To be eligible to provide obligated service as a commissioned
officer in the Service, an individual shall notify the Secretary, not
(3) The amount of the monthly stipend, specified in paragraph
later than 30 days before the date the individual is required to begin
(1) (B) and as previously adjusted (if at all) in accordance with this
the period of such obligated service, of the individual's desire to pro-
paragraph, shall be increased by the Secretary for each school year
vide such service as such an officer.
ending in a fiscal year beginning after September 30, 1978, by an
"(3) If an individual who has notified the Secretary under para-
amount (rounded to the next highest multiple of $1) equal to the
graph (2) qualifies for an appointment as such an officer, the Secre-
amount of such stipend multiplied by the overall percentage (as set
tary shall promptly appoint the individual as a commissioned officer
forth in the report transmitted to the Congress under section 5303 of
of the Regular or Reserve Corps and of the Service and shall desig-
title 5, United States Code) of the adjustment (if such adjustment
nate the individual as a member of the Corps. If an individual who
is an increase in the rates of pay under the General Schedule made
has notified the Secretary under paragraph (3) does not 80 qualify,
effective in the fiscal year in which such school year ends.
the Secretary shall promptly appoint such individual in accordance
"(h) Notwithstanding any other provision of law, individuals who
with paragraph (4).
have entered into written contracts with the Secretary under this sec-
"(4) Except as provided in paragraph (3) and in section 753, the
tion, while undergoing academic training, shall not be counted against
Secretary shall appoint each individual, as soon as possible after the
any employment ceiling affecting the Department.
date described in paragraph (5), to serve in the full-time clinical prac-
(i) The Secretary shall report to Congress on December 1 of each
tice of his profession as a civilian member of the Corps.
year-
'(5) (A) With respect to an individual receiving a degree from a
"(1) the number, and type of health profession training, of
school of. medicine, osteopathy, or dentistry, the date referred to in
students receiving scholarships under the Scholarship Program;
paragraph (4) shall be the date upon which the individual completes
(2) the educational institutions at which such students are
the training required for such degree, except that the Secretary shall,
receiving their training;
at the request of such individual, defer such date until the end of the
"(3) the number of applications filed under this section in the
period of time (not to exceed three years) required for the individual
school year beginning in such year and in prior school years; and
to complete an internship, residency, or other advanced clinical train-
"(4) the amount of tuition paid in the aggregate and at each
ing. No such period of internship, residency, or other advanced clini-
educational institution for the school year beginning in such year
cal training shall be counted toward satisfying a period of obligated
and for prior school years.
service under this subpart.
'(j) The administrative unit which administers section 770 shall-
"(B) With respect to an individual receiving a degree other than
(1) participate in the development of regulations, funding
from a school of medicine, osteopathy, or dentistry, the date referred
priorities, and application forms, and
to in paragraph (4) shall be the date upon which the individual com-
(2) be consulted by, and may make recommendations to, the
pletes his academic training leading to such degree.
grants, Secretary in the review of applications for scholarships and
"(0) An individual shall be considered to have begun serving a
period of obligated service-
with respect to the Scholarship Program.
(1) on the date such individual is appointed as an officer in a
Regular or Reserve Corps of the service or as a member of the
"OBLIGATED SERVICE
Corps, or
(2) in the case of an individual who has entered into an agree-
"Sec. 752. (a) Except as provided in section 753, each individual
ment with the Secretary under section 753, on the date specified in
who has entered into a written contract with the Secretary under sec-
such agreement,
tion 751, shall provide service in the full-time clinical practice of such
whichever is earlier.
obligated services provided in such contract.
individual's profession as a member of the Corps for the period of
"(d) The Secretary shall assign individuals performing obligated
service in accordance with a written contract under the Scholarship
"(b) (1) The Secretary shall notify each individual required to
Program to health manpower shortage areas in accordance with sub-
provide service under the Scholarship Program, not later than 60 days
part II of part C of title III. If the Secretary determines that there
before the date such individual is required to begin the period of such
is no need in a health manpower shortage area (designated under sec-
obligated service, of the opportunity of such individual to serve in
tion 332) for a member of the profession under which an individual is
the full-time clinical practice of his profession either as a commis-
obligated to provide service under a written contract, the Secretary may
sioned officer in either the Regular or Reserve Corps of the Service
detail such individual to serve his period of obligated service as a full-
or as a civilian member of the Corps. The Secretary shall include in
time member of such profession in such unit of the Department as the
Secretary may determine.
48
49
"(e) Notwithstanding any other provision of this title, if the Sec-
For purposes of paragraph (1) (A), the Secretary shall by regulation
retary determines that an individual who is or has been a participant
prescribe the method for determining a person's ability to pay a charge
in the Program demonstrates exceptional promise for medical re-
for health services and the method of determining the amount (if
search, the Secretary may permit such individual to perform his serv-
any) to be charged such person based on such ability.
ice obligation under the National Research Service Award program
established under section 472.
"BREACH OF SCHOLARSHIP CONTRACT
"PRIVATE PRACTICE
"SEC. 754. (a) An individual who has entered into a written contract
with the Secretary under section 751 and who fails to accept payment,
"SEC. 753. (a) The Secretary shall release an individual from all
or instructs the educational institution in which he is enrolled not to
or part of his service obligation under section 752 if the individual
applies for such a release under this section and enters into a written
accept payment, in whole or in part of a scholarship under such con-
tract, shall, in addition to any service or other obligation or liability
agreement with the Secretary under which the individual agrees to
under the contract, be liable to the United States for the amount of
engage for a period equal to the remaining period of his service obli-
gation in the full-time private clinical practice (including service as
$1,500 as liquidated damages.
a salaried employee in an entity directly providing health services)
'(b) An individual who has entered into a written contract with the
of his health profession-
Secretary under section 751 and who
"(1) in the case of an individual who is performing obligated
"(1) fails to maintain an acceptable level of academic stand-
service as a member of the Corps in a health manpower shortage
ing in the educational institution in which he is enrolled (such
area on the date of his application for such a release, in the health
level determined by the educational institution under regula-
manpower shortage area in which such individual is serving on
tions of the Secretary),
such date; or
"(2) is dismissed from such educational institution for disci-
"(2) in the case of any other individual, in a health manpower
plinary reasons; or
shortage area (designated under section 332) which (A) has a
"(3) voluntarily terminates the training in such an educational
priority for the assignment of Corps members under section
institution for which he is provided a scholarship under such con-
333 (c), and (B) has a sufficient financial base to sustain such
tract, before the completion of such training,
private practice and to provide the individual with income of not
in lieu of any service obligation arising under such contract shall be
less than the income of members of the Corps.
liable to the United States for the amount which has been paid to him,
shall release the individual from his service obligation under this sub-
In the case of an individual described in paragraph (1), the Secretary
or on his behalf, under the contract.
"(c) If an individual breaches his written contract by failing (for
section only if the ,Secretary determines that the area in which the
any reason) either to begin such individual's service обнас: in in ac-
paragraph (2).
individual is serving meets the requirement of subparagraph (B) of
cordance with section 752 or 753 or to complete such service obligation,
the United States shall be entitled to recover from the individual an
"(b) The written agreement described in subsection (a) shall-
amount determined in accordance with the formula
individual pursuant to the agreement-
"(1) provide that during the period of private practice by an
"(A) any person who receives health services provided by
A=34(t)
the individual in connection with such practice will be
charged for such services at the usual and customary rate
in which 'A' is the amount the United States is entitled to recover,
prevaiting in the area in which such services are provided,
'Φ' is the sum of the amount paid under this subpart to or on behalf
except that if such person is unable to pay such charge, such
of the individual and the interest on such amount which would be
fee; and
person shall be charged at a reduced rate or not charged any
payable if at the time it was paid it was a loan bearing interest at
the maximum legal prevailing rate, as determined by the Treasurer of
(B) the individual in providing health services in connec-
the United States; "t" is the total number of months in the individual's
tion with such practice shall not discriminate against any
period of obligated service and '8' is the number of months of such
person on the basis of such person's ability to pay for such
period served by him in accordance with section 752 or a written agree-
services or because payment for the health services provided
ment under section 753. Any amount of damages which the United
to such person will be made under the insurance program
States is entitled to recover under this subsection shall, within the
established under part A or B of title XVIII of the Social
one year period beginning on the date of the breach of the written
Security Act or under a State plan for medical assistance
contract, be paid to the United States.
approved under title XIX of such Act; and
"(d) (1) Any obligation of an individual under the Scholarship
"(2) contain such additional provisions as the Secretary may
Program (or a contract thereunder) for service or payment of damages
require to carry out the purposes of this section.
shall be canceled upon the death of the individual.
76-510 O.- 76 4
51
50
"(2) The Secretary shall by regulation provide for the waiver or
in accordance with the agreement under such subsection and has not
of giving such notice, such individual is not practicing his profession
suspension of any obligation of service or payment by an individual
under the Scholarship Program (or a contract thereunder) whenever
provided assurances satisfactory to the Secretary that he will not
knowingly violate such agreement again, the United States shall be
compliance by the individual is impossible or would involve extreme
entitled to recover from such individual an amount determined under
hardship to the individual and if enforcement of such obligation with
section 753 (c), except that in applying the formula contained in such
respect to any individual would be unconscionable.
section, 'Φ' shall be the sum of the amount of the grant made under
(3) Any obligation of an individual under the scholarship (or a
subsection (a) to such individual and the interest on such amount
contract thereunder) for payment of damages may be released by a
which would be payable if at the time it was paid it was a loan bearing
discharge in bankruptcy under the Bankruptcy Act only if such dis-
interest at the maximum legal prevailing rate, 't' shall be the number
charge is granted after the expiration of the five-year period beginning
of months that such individual agreed to practice his profession under
on the first date, as specified in section 731 (a) (2) (B), when payment
such agreement, and '8' shall be the number of months that such
of such damages is required.
individual practices his profession in accordance with such agreement.
"SPECIAL GRANTS FOR FORMER CORPS MEMBERS TO ENTER PRIVATE PRACTICE
"AUTHORIZATION OF APPROPRIATIONS
"SEC. 755. (a) The Secretary may make one grant to an individual
"SEC. 756. (a) There are authorized to be appropriated for scholar-
(other than an individual who has entered into an agreement under
ships under this subpart $75,000,000 for the fiscal year ending Septem-
section 753)-
ber 30, 1978, $140,000,000 for the fiscal year ending September 30,
"(1) who has completed his period of obligated service in the
1979, and $200,000,000 for the fiscal year ending September 30, 1980.
Corps, and
For the fiscal year ending September 30, 1981, and for each subsequent
"(2) who has agreed in writing-
fiscal year, there are authorized to be appropriated such sums as may
"(A) to engage in the private full-time clinical practice
be necessary to continue to make scholarship awards to students who
of his profession in a health manpower shortage area (desig-
have entered into written contracts under the Scholarship Program
nated under section 332 and described in paragraphs (1)
before October 1, 1980.
and (2) of section for a period (beginning not later
(3) Of the sums appropriated under this section (1) 90 percent
than one year after the date he completed his period of obli-
shall be obligated for scholarships for medical, osteopathic, and dental
gated service in the Corps) of not less than one year;
students, and (2) 10 percent of such 90 percent shall be obligated for
"(B) to conduct such practice in accordance with the pro-
scholarships for dental students.".
visions of section 753 (3) (1) and
(2) (A) Except as provided in subparagraph (B), the amendment
"(O) to such additional conditions as the Secretary may
made by paragraph (1) of this subsection shall apply with respect to
require to carry out the purposes of this section;
scholarships awarded under the National Health Service Corps Schol-
to assist such individual in meeting the costs of beginning the practice
arship Program from appropriations for such Program for fiscal years
of such individual's profession in accordance with such agreement,
beginning after September 30, 1977.
including the costs of acquiring equipment and renovating facilities
(B) The provisions of section (1) of the Public Health Serv-
for use in providing health services, and of hiring nurses and other
ice Act (as in effect on September 30, 1977) prescribing the financial
personnel to assist in providing health services. Such grant may not
obligation of a participant in the National Health Service Corps
be used for the purchase or construction of any building.
Scholarship Program who fails to complete an active duty service ob-
"(b) The amount of the grant under subsection (a) to an individual
ligation incurred under that Program shall apply to any individual
shall be-
who received a scholarship under such Program for any school year
"(1) $12,500, if the individual agrees to practice his profession
ending before September 30, 1977, irrespective of whether such indi-
in accordance with the agreement for a period of at least one year,
vidual received such a scholarship after that date, unless such individ-
but less than two years; or
ual agrees to meet his active duty service obligation (or the remaining
"(2) $25,000 if the individual agrees to practice his profession
part thereof) through the private practice of his profession under an
in accordance with the agreement for a period of at least two
agreement entered into under section 753 of the Public Health Service
years.
Act (as added by this subsection), in which case the provisions of sec-
(c) The Secretary may not make a grant under this section unless
tion 75.4 of such Act (as added by this subsection) shall apply to such
an application therefor has been submitted to, and approved by, the
individual if he violates such agreement.
Secretary.
(σ) Periods of internship or residency served before September 30,
"(d) If the Secretary determines that an individual has breached
1976, in a facility of the National Health Service Corps or other fa-
a written agreement entered into under subsection (a), he shall, as
cility of the Public Health Service in accordance with an agreement
soon as practicable after making such determination, notify the
entered into under section 225 (b) of the Public Health Service Act
individual of such determination. If within 120 days after the date
52
53
Service Corps Scholarship Program as revised by this subsection.
obligation incurred under the Public Health and National Health
(as in effect before that date) shall be creditable in satisfying a service
SCHOLARSHIPS
(c) Effective October 1, 1977, part 0 of title VII (as amended by
SEC. 409. (a) Effective October 1, 1976, subparts I, II, and III of
following new subpart:
subsections (a) and (b)) is amended by adding after subpart IV the
part F of title VII are repealed.
(b) The Secretary of Health, Education, and Welfare during the
period beginning October 1, 1976, and ending September 30, 1979,
"Subpart V-Other Scholarships
may (1) make grants under section 780 of the Public Health Service
Act (as in effect before the date of the enactment of this Act) to public
"SCHOLARSHIPS FOR FIRST-YEAR STUDENTS OF EXCEPTIONAL FINANCIAL NEED
and nonprofit private schools of medicine, osteopathy, dentistry, veter-
inary medicine, optometry, podiatry, and pharmacy to enable such
"Sec. 758. (a) The Secretary shall make grants to a public
schools to continue making payments under scholarship awards to
profit school of medicine, osteopathy, dentistry, optometry, pharmacy, or non-
individuals enrolled and in good standing as full-time students who
podiatry, or veterinary medicine which is accredited as provided in
initially received such awards out of grants made to the schools under
section to 721 (b) (1) (B), for scholarships to be awarded by the school
such section 780 for fiscal years ending before October 1, 1976, and (2)
who full-time students thereof who are of exceptional financial need, and
make scholarship grants under section 784 of such Act (as in effect
ending in the fiscal year in which such grant is made.
are in their first year of study at such school in the school year
before the date of the enactment of this Act) to individuals enrolled
and in good standing as'medical students who initially received such
rollment subsection (a) only to individuals who have been accepted by it for
(b) (1) Scholarships may be awarded by a school from grant under
grants before October 1, 1976.
"(2) A scholarship awarded to a student for a school under
as full-time students in their first year of study at such school. en-
TITLE V-GRANTS FOR HEALTH PROFESSIONS
in section 751 (g).
a grant made under subsection (a) shall be the scholarship year described
SCHOOLS
means, with respect to a student of a school other than a school of
"(3) For purposes of this section, the term 'first year of study'
GRANT AMOUNTS; AUTHORIZATIONS
school. pharmacy, the student's first year of postbaccalaureate study at such
SEC. 501. (a) Section is amended to read as follows:
(a) GRANT COMPUTATION.-The Secretary shall make annual grants
"(c) The Secretary shall distribute grants under this section
to schools of medicine, osteopathy, dentistry, public health, veterinary
all schools of the health professions, but shall give priority in among dis-
medicine, optometry, pharmacy, and podiatry for the support of the
dentistry. tributing such grants to schools of medicine, osteopathy, and
education programs of such schools. The amount of the annual grant
to each such school with an approved application shall be computed
"(d) For the purpose of making grants under this section, there is
for each fiscal year as follows:
authorized to be appropriated $16,000,000 for the fiscal
"(1) Each school of medicine, osteopathy, and dentistry shall
30, 1979, and $18,000,000 for the fiscal year ending September 30, 1980.
September 30, 1978, $17,000,000 for the fiscal year ending year September ending
receive-
"(A) for the fiscal year ending September 30, 1978, $2,000
for each full-time student enrolled in such school in the school
"LISTER HILL SCHOLARSHIP PROGRAM
year beginning in such fiscal year,
"(B) for the fiscal year ending September 30, 1979, $2,050
"Sec. 759. (a) The Secretary annually shall make grants to at least
for each full-time student enrolled in such school in the school
10 individuals (to be known as Lister Hill scholars) for scholarships
year beginning in such fiscal year, and
of up to four years of medical school if such individuals agree to enter
(C) for the fiscal year ending September 30, 1980, $2,100
area in accordance with this section. Grants made under this section
into the family practice of medicine in a health manpower shortage
for each full-time student enrolled in such school in the school
year beginning in such fiscal year.
shall be made only from funds appropriated under subsection (b).
(2) (A) Each school of public health shall receive for the fiscal
"(b) There are authorized to be appropriated to carry out the
year ending September 30, 1978, and for each of the next two fiscal
1977, $160,000 for the fiscal year ending September 30, 1978, $240,000 30,
poses of this section $80,000 for the fiscal year ending September pur-
years an amount equal to the product of-
(i) $1,400, and
for the fiscal year ending September 30, 1979, and $320,000 for the
"(ii) the sum of (I) the number of full-time students en-
fiscal year ending September 30, 1980. For the fiscal year ending Sep-
rolled in such school in the school year beginning in such fiscal
tember 30, 1981 and for each succeeding fiscal year, there are authorized
year, and (II) the number of full-time equivalents of part-
to be appropriated such sums as may be necessary to continue to make
time students, determined pursuant to subparagraph (B),
such grants to students who (prior to October 1, 1980) have received
for such school for such school year.
such a grant under this section during such succeeding fiscal year.".
(B) For purposes of subparagraph (A) the number of full-
time equivalents of part-time students for a school of public health
for any school year is a number equal to-
54
55
"(i) the total number of credit hours of instruction in such
year for which part-time students of such school, who are
a school on the basis of estimates, on the basis of the number of
pursuing a course of study leading to a graduate degree in
students who in an earlier year were enrolled in a school or in a
public health or an equivalent degree, have enrolled, divided
partioular year-class, or on such other basis as he deems appropri-
by
ate for making such determination, and shall include methods of
"(ii) the greater of (I) the number of credit hours of in-
making such determination when a school or a year-class was not
struction which a full-time student of such school was required
in existence in an earlier year at a school.
to take in such year, or (II) 9,
"(2) For purposes of this section, the term 'full-time students'
rounded to the next highest whole number.
(whether such term is used by itself or in connection with a par-
(3) For the fiscal year ending September 30, 1978, and for
ticular year-class) means students pursuing a full-time course of
each of the next two fiscal years, each school of veterinary medi-
study leading to a degree of doctor of medicine, doctor of dentistry
cine shall receive $1,450 for each full-time student enrolled in such
or an equivalent degree, doctor of osteopathy, bachelor or master
school in the school year beginning in such fiscal year.
of science in pharmacy or an equivalent degree, doctor of optom-
"(4) For the fiscal year ending September 30, 1978, and for
etry or an equivalent degree, doctor of veterinary medioine or an
each of the next two fiscal years, each school of optometry shall
equivalent degree, or doctor of podiatry or an equivalent degree
receive $765 for each full-time student enrolled in such school in
or to a graduate degree in public health or equivalent degree. In
the school year beginning in such fiscal year.
the case of a training program of a school designed to permit the
(5) For the fiscal year ending September 30, 1978, and for
students enrolled in such program to complete, within six years
each of the next two fiscal years, each school of pharmacy (other
after completing secondary school, the requirements for degree of
than a school of pharmacy with a course of study of more than
doctor of medicine, doctor of dentistry or an equivalent degree, or
four years) shall receive $695 for each full-time student enrolled
doctor of osteopathy, the term 'full-time students' shall only in-
in such school in the school year beginning in such fiscal year.
clude students enrolled on a full-time basis in the last four years
Each school of pharmacy with a course of study of more than four
of such program and for purposes of section 771, students en-
years shall receive $695 for each full-time student enrolled in the
rolled in the first of the last four years of such program shall be
last four years of such school. For purposes of section 771, a
considered as first-year students.".
student enrolled in the first year of the last four years of such
(3) Subsection (i) of section 770 is amended (A) by inserting
school shall be considered a first-year student.
public health" after "dentistry", (B) by striking out "and (b)", and
"(6) For the fiscal year ending September 30, 1978, and for
(C) redesignated as subsection (d).
each of the next two fiscal years, each school of podiatry shall
(4) Subsection (j) of section 770 is redesignated as subsection (e)
receive $965 for each full-time student enrolled in such school in
and is amended to read as follows:
the school year beginning in such fiscal year.".
"(e) AUTHORIZATIONS OF APPROPRIATIONS.--
(3) Subsection (3) of section 770 is amended to read as follows:
"(1) There are authorized to be appropriated $124,182,000 for
(b) APPORTIONMENT OF APPROPRIATIONS.-Notwithstanding subsec-
the fiscal year ending September 30, 1978, $131,683,800 for the
tion (α), if the aggregate of the amounts of the grants to be made in
fiscal year ending September 30, 1979, and $139,400,100 for the
accordance with such subsection for any fiscal year to schools of medi-
fiscal year ending September 30, 1980, for payments under grants
cine, osteopathy, dentistry, public health, veterinary medicine, optom-
under this section to schools of medicine.
etry, pharmacy, or podiatry with approved applications exceeds the
"(2) There are authorized to be appropriated $8,680,000 for the
total of the amounts appropriated under subsection (f) for such
fiscal year ending September 30, 1978, $9,337,750 for the fiscal
grants, the amount of a school's grant with respect to which such excess
year ending September 30, 1979, and $10,159,800 for the fiscal
exists shall for such fiscal year be an amount which bears the same ratio
year ending September 30, 1980, for payments under grants under
to the amount determined for the school under such subsection as the
this section for schools of osteopathy.
total of the amounts appropriated for that year under subsection (f)
(3) There are authorized to be appropriated $45,798,000 for
for grants to schools of the same category as such school bears to the
the fiscal year ending September 30, 1978, $45,409,550 for the fiscal
amount required to make grants in accordance with such subsection to
year ending September 30, 1979, and $46,909,800 for the fiscal year
each of the schools of that category with approved applications.".
ending September 30, 1980, for payments under grants under this
(c) (1) Subsections (c), (d), (e), (f), and (g) of section 770 are
section for schools of dentistry.
repealed.
"(4) There are authorized to be appropriated $7,166,600 for the
(2) Subsection (h) of section 770 is (A) redesignated as subsec-
fiscal year ending September 30, 1978, $7,296,800 for the fiscal
tion (c), and (B) is amended to read as follows:
year ending September 30, 1979, and $7,411,600 for the fiscal
"(C) ENROLLMENT DETERMINATIONS.-
year ending September 30, 1980, for payments under grants under
"(1) For purposes of this section, regulations of the Secretary
this section to schools of public health.
shall include provisions relating to the determination of the num-
(5) There are authorized to be appropriated $10,219,600 for
ber of students enrolled in a school or in a particular year-class in
the fiscal year ending September 30,1978, $10,548,750 for the fiscal
year ending September 30, 1979, and $10,705,350 for the fiscal
56
57
year ending September 30, 1980, for payments under grants under
ber 30, 1977, unless the application for the grant contains, or is sup-
this section to schools of veterinary medicine.
ported by, assurances satisfactory to the ,Secretary that-
(6) There are authorized to be appropriated $3,204,585 for the
(1) the first-year enrollment of full-time students in the
fiscal year ending September 30, 1978, $3,272,670 for the fiscal
school in the school year beginning in the fiscal year in which the
year ending September 30, 1979, and $3,366,000 for the fiscal
grant applied for is to be made will not be less than the first-year
year ending September 30, 1980, for payments under grants under
enrollment of such students in the school in the preceding school
this section to schools of optometry.
year; and
(7) There are authorized to be appropriated $16,989,970 for
"(2) the applicant will expend in carrying out its functions as
the fiscal year ending September 30, 1978, $17,110,205 for the
a school of medicine, osteopathy, dentistry, public health, veteri-
fiscal year ending September 30, 1979, and $17,368,050 for the
nary medicine, optometry, pharmacy, or podiatry, as the case
fiscal year ending September 30, 1980, for payments under grants
may be, during the fiscal year for which such grant is sought, an
under this section to schools of pharmacy.
amount of funds (other than funds for construction as determined
(8) There are authorized to be appropriated $2,267,750 for the
by the Secretary) from non-Federal sources which is at least as
fiscal year ending September 30, 1978, $2,270,645 for the fiscal
great as the amount of funds expended by such applicant for
year ending September 30, 1979, and $2,285,120 for the fiscal year
such purpose (excluding expenditures of a nonrecurring nature)
ending September 30, 1980, for payments under grants under this
in the fiscal year preceding the fiscal year for which such grant
section to schools of podiatry.".
is sought.
(d) For the fiscal year ending September 30, 1978, and for each of
"(b) (1) MEDICAL SCHOOLS.-To be eligible for a grant under sec-
the next two fiscal years, there are authorized to be appropriated
tion 770 each school of medicine shall, in addition to the requirements
such sums as may be necessary to continue to make annual grants to
of subsection (a), meet the applicable requirements of paragraphs (2)
schools of medicine, osteopathy, dentistry, veterinary medicine, optom-
and (3).
etry, pharmacy, and podiatry under section 770(a) of the Public
"(2) (A) (i) Unless, as determined under subparagraph (B), the
Health Service Act (as in effect on September 30, 1977) based on the
number of filled first year positions on July 15, 1977, in direct or
number of enrollment bonus students (determined in accordance with
affiliated medical residency training programs in primary care is at
subsections (d) and (c) of section 770 of such Act (as so in effect))
least 35 percent of the number of filled first year positions on that
enrolled in such schools who were first-year students in such schools
date in all direct or affiliated medical residency training programs,
for school years ending before September 30, 1977, except that the
to be eligible for a grant under section 770 for the fiscal year ending
amount of any grant made to such a school from sums appropriated
September 30, 1978, a school of medicine shall have on July 15, 1978,
under this subsection may not exceed the amount of the grant the
at least 35 percent of its filled first year positions, as determined under
school received in the fiscal year ending September 30, 1977, based on
subparagraph (B), and (3), in its direct or affiliated medical resi-
the number of such students enrolled in it.
dency training programs in first year positions in such programs in
(e) Effective October 1, 1977, the heading for part E of title VII
primary care.
is amended to read as follows:
"(ii) Unless, as determined under subparagraph (B), the number
of fiited first year positions on July 15, 1978, in direct or affiliated
"PART E.-GRANTS To IMPROVE THE QUALITY OF SCHOOLS OF MEDI-
medical residency training programs in primary care is at least 40
CINE, OSTEOPATHY, DENTISTRY, PUBLIC HEALTH, VETERINARY MED-
percent of the number of filled first year positions on that date in all
ICINE, OPTOMETRY, PHARMACY, AND PODIATRY".
direct or affiliated medical residency training programs, to be eligible
(f) The amendments made by subsections (a), (b), and (c) shall
for a grant under section 770 for the fiscal year ending September 30,
apply with respect to appropriations under section 770 of the Public
1979, a school of medicine shall have on July 15, 1979, at least 40 per-
Health Service Act, and grants under that section, for fiscal years
cent of its filled first year positions, as determined under subparagraph
beginning after September 30, 1977.
(B), and (b), in its direct or affiliated medical residency training pro-
grams in first year positions in such programs in primary care.
GRANT REQUIREMENTS
(iii) Unless, as determined under subparagraph (B), the number
of filled first year positions on July 15 of any year (beginning with
SEC. 502. Effective with respect to fiscal years beginning after Sep-
1979) in direct or affiliated medical residency training programs in
tember 30, 1977, part E of title VII is amended (1) by striking out
primary care is at least 50 percent of the number of filled first year
sections 771, 772, 773, 774, and 776, and (2) by adding after section
positions on that date all direct or affiliated. medical residency train-
770 the following new section:
ing programs, to be eligible for a grant under section 770 for the
fiscal year ending on September 30 of the following year, a school of
"ELIGIBILITY FOR CAPITATION GRANTS
medicine shall have on July 15 of such following year at least 50 per-
cent of its filled first year positions, as determined under subpara-
"SEC. 771. (a) IN GENERAL.-The ,Secretary shall not make a grant
graphs (C) and (D), in its direct or affiliated medical residency train-
under section 770 to any school in a fiscal year beginning after Septem-
ing programs in first year positions in such programs in primary
care.
58
59
(B) The Secretary shall determine what percent of all the positions
(F) For purposes of this paragraph:
filled, as of July 15, 1977, and July 15 of each subsequent year, in
"(i) The term 'direct or affiliated medical residency training pro-
all direct or affiliated medical residency training programs are filled
gram' means a medical residency training program with which a
positions in such programs in primary care. In determining the num-
school of medicine is affiliated or has a similar arrangement (including
ber of such positions on July 15, 1978, or on July 15 of a subsequent
any arrangement which provides for any interchange of medical resv-
year, the Secretary shall deduct from such number a number equal to
dents, students, or faculty between the school and such program, the
the number of individuals who were in a first year position in any
offering of any faculty position at such school to any individual on the
direct or affiliated medical residency training program in primary
staff of such entity who has any responsibility for such program, or
care as of July 15 of the previous year and who on the date for which
the provision or receipt by such school of any funds for such pro-
the determination is to be made were not in any direct or affiliated
gram), as determined under. regulations of the Secretary, or which is
medical residency training program in primary care. Each determina-
primarity conducted in facilities owned by a school of medicine.
tion under this subparagraph shall, not later than 45 days after the
(ii) The term 'primary care' means general internal medicine,
date for which the determination is made, be published in the Federal
family medicine, or general pediatrics.
Register and reported in writing to each school of medicine in the
"(3) (A) To be eligible for a grant under section 770 a school of
States and to the Committee on Interstate and Foreign Commerce of
medicine shall, in its application for such grant, give assurances satis-
the House of Representatives and to the Committee on Labor and
factory to the Secretary that, except as provided in subparagraph (C),
Public Welfare of the Senate.
the school will reserve positions in the school year beginning immedi-
"(C) In determining if a school of medicine meets an applicable.
ately before the fiscal year for which such grant is applied for for
requirement of clause (i), (ii), or (iii) of subparagraph (4) for a
students described in subparagraph (B).
fiscal year, the number of filled first year positions in direct or affiliated
"(B) No later than August 15, 1977, and August 15 of each of the
medical residency training programs of such school in primary care
next two years, the Secretary shall identify the citizens of the United
on July 15 in such fiscal year shall be reduced by the number of indi-
States who, before September 15, 1976, were enrolled in a school of
viduals who were in a first year position in a direct or affiliated medi-
medicine not in a State and who by the date of the identification is
cal residency training program of such school in primary care on
made under this subparagraph-
July 15 in the previous fiscal year and who on July 15 in the fiscal year
"(i) successfully completed at least two years in such school of
to which the requirement applies are not in a direct or affiliated medi-
medicine, and
cal residency training program of such school in primary care. Each
(ii) successfully completed part I of the National Board of
determination, with respect to a school, under this subparagraph shall,
Medical Examiners' examination (or any successor to such
not later than 45 days after the date on which the determination is
examination).
made, be reported in writing to such school and to the Committee on
The Secretary shall equitably apportion a number of positions ade-
Interstate and Foreign Commerce of the House of Representatives
quate to fill the needs of students described in subparagraph (B)
and to the Committee on Labor and Public Welfare of the Senate.
among the schools of medicine in the States.
'(D) The percent of filled first year positions which a school is
"(C) A school of medicine shall not be required to enroll a student
required to have on a date under subparagraph (A), in order to be
described in subparagraph (B) if
eligible for a grant under section 770, shall be waived by the Secretary
"(i) the individual does not meet, as determined under guide-
if he determines (i) that such school has made a good faith effort to
lines established by the Secretary by regulation, the entrance
comply with such percent requirement, and (ii) the school has at least
requirements of the school (other than requirements related to
98 percent of such percent of its positions filled on such date.
academic qualifications or to place of residence), or
(E) The Secretary shall not make any grant under section 770
(ii) enrollment of such individual will, as determined by the
to a school of medicine for any fiscal year if the Secretary, after pro-
Secretary after consultation with the appropriate accreditation
viding notice and opportunity for a hearing, determines that in the
body, result in the school's not meeting the accreditation standards
preceding fiscal year such school-
of such body.
"(i) terminated or failed to renew an affiliation with a medical
"(D) The Secretary may waive the requirements of this paragraph
residency training program for the purpose of meeting the re-
upon a finding that, because of the inadequate size of the population
quirements of this paragraph, and
served by the hospital or clinical facility in which such school con-
(ii) after such a termination or failure to renew, provided
ducts its clinical training, compliance by such school with such assur-
support for such medical residency training program (including
ances will prevent such school from providing high quality clinical
any interchange of medical residents, students, or faculty between
training for the students added by the application of this paragraph
the school and such program, the offering of any faculty position
to such school.
at such school to any individual on the staff of such entity who
"(c) SCHOOLS OF OSTEOPATHY.-(1) To be eligible for a grant under
has any responsibility for such program, or the provision or re-
section 770 for a fiscal year beginning after September 30, 1977, a
ceipt by such school of any funds for such program).
school of osteopathy shall, in addition to the requirements of subsection
60
61
(a), submit to the Secretary and have approved by him before the
grant applied for is made, a plan to train full-time students in ambu-
such school in the school year beginning in the fiscal year ending Sep-
latory care settings in the school year beginning in the fiscal year for
tember 30, 1976-
which the grant is made and in each school year thereafter beginning
"(A) by 10 percent of such number if such number was not more
in a fiscal year for which such a grant is made and either in areas
than 100, or
geographically remote from the main site of the teaching facilities of
"(B) by 5 percent of such number, or 10 students, whichever
the applicant (or any other school of osteopathy which has joined with
is greater, if such number was more than 100.
the applicant in the submission of the plan) areas in which medically
"(4) (A) A school of dentistry shall submit to the Secretary and
underserved population reside.
have approved by him before the grant applied for is made, a plan
(2) ore than one applicant may join in the submission of a plan
to train full-time students in ambulatory care settings in the school
described in paragraph (1). No plan may be approved by the Sec-
year beginning in the fiscal year for which the grant is made and in
retary unless-
each school year thereafter beginning in a fiscal year for which such a
(A) the application for a grant under section 770 of each
grant is made and in areas geographically remote from the main site
school which has joined in the submission of the plan contains
of the teaching facilities of the applicant (or any other school of den-
or is supported by assurances satisfactory to the Secretary that
tistry which has joined with the applicant in the submission of the
all of the full-time students who will graduate from such school
plan) or in areas in which medically underserved populations reside.
will upon graduation have received, in an area geographically
"(B) More than one applicant may join in the submission of a plan
remote from the main site of the training facilities of such school,
described in subparagraph (4). No plan may be approved by the
at least 6 weeks (at last 3 of which shall be consecutive of clini-
Secretary unless-
cal training or in areas in which medically underserved popula-
(i) the application for a grant under section 770 of each school
tions reside;
which has joined in the submission of the plan contains or is
"(B) the plan contains a list of the areas where the training
supported by assurances satisfactory to the ,Secretary that all
under such plan is to be conducted, a detailed description of the
of the full-time students who will graduate from such school will
type and amount of training to be given in such areas, and pro-
upon graduation have received, in an area geographically remote
vision for periodic review by experts in osteopathic education of
from the main site of the training facilities of such school, at least
the desirability of providing training in such areas and of the
6 weeks (in the aggregate) of clinical training;
quality of training rendered in such areas;
"(ii) the plan contains a list of the areas where the train-
"(C) the plan contains a specific program for the appointing, as
ing under such plan is to be conducted, a detailed description
members of the faculty of the school or schools submitting the
of the type and amount of training to be given in such areas, and
plan, of practicing physicians to serve as instructors in the train-
provision for periodic review by experts in dental education of
ing program in such areas; and
the desirability of providing training in such areas and of the
(D) the plan contains a plan for frequent counseling and con-
quality of training rendered in such areas;
sultation between the faculty of the school or schools at the main
(iii) the plan contains a specific program for. the hiring, as
site of their training facilities and the instructors in the training
members of the faculty of the school or schools submitting the
program in such areas.
plan, of practicing dentists to serve as instructors in the train-
"(d) SCHOOLS OF DENTISTRY.-(1) To be eligible for a grant under
ing program in such areas; and
section 770 for a fiscal year beginning after September 30, 1977, a
(iv) the plan contains a plan for frequent counseling and
school of dentistry shall, in addition to the requirements of sub-
consultation between the faculty of the school or schools at the
section (a), meet the requirements of paragraph (2) and of subpara-
main site of their training facilities and the instructors in the
graphs (A) or (B) of paragraph (3).
training program in such areas.
"(2) In the school year beginning in the fiscal year ending Septem-
"(e) SCHOOLS OF PUBLIC HEALTH.-(1) To be eligible for a grant un-
ber 30, 1978, and in each school year thereafter beginning in a fiscal
der section 770 for a fiscal year beginning after September 30, 1977, a
year for which a grant under section 770 is applied for, at least 70
school of public health shall, in addition to the requirements of sub-
percent of a school of dentistry's filled positions in dental specialty
section (a), maintain an enrollment of full-time, first-lear students,
programs which are in excess of the number of filled positions in its
for the school year beginning in the fiscal year ending September 30,
programs in the school year beginning in the fiscal year ending Sep-
1978, and for each school year thereafter beginning in a fiscal year for
tember 30, 1977, shall be positions in dental specialty programs in
which a grant under section 770 is applied for, which exceeds the num-
general dentistry or pedodontics.
ber of full-time, first-year students enrolled in such school in the school
"(3) A school of dentistry shall maintain an enrollment of full-time
year beginning in. the fiscal year ending September 30, 1976-
first-year students, for the school year beginning in the fiscal year
(A) by 5 percent of such number if such number was not more
ending September 30, 1978, and for each school year thereafter begin-
than 100, or
ning in a fiscal year for which a grant under section 770 is applied for,
"(B) by 2.5 percent of such number, or 5 students, whichever
which exceeds the number of full-time first-year students enrolled in
is greater, if such number was more than 100.
"(2) The Secretary may waive (in whole or in part) application
62
63
to a school of public health the requirement of paragraph (1) if the
Secretary determines, after receiving the written recommendation
of full-time students in such school will be comprised of students
of the appropriate accreditation body or bodies (as defined in section
who are residents of States in which there are no accredited schools
721 (b) (1)) that compliance by such school with such requirement will
of optometry.
prevent it from maintaining its accreditation.
(h) SCHOOLS OF PODIATRY.-(1) To be eligible for a grant under
"(f) SCHOOLS OF VETERINARY MEDICINE.-(1) To be eligible for a
section 770 for a fiscal year beginning after September 30, 1977, a
grant under section 770 for a fiscal year beginning after September 30,
school of podiatry shall, in addition to the requirements of subsection
1977, a school of veterinary medicine shall, in addition to the require-
(a), meet the requirements of paragraph (2) or (3).
ments of subsection (a), meet the requirements of paragraph (2) and
(2) A school of podiatry shall maintain an enrollment of full-time,
paragraph (3) or (4).
first-year students, for the school year beginning in the fiscal year
(2) An application of a school of veterinary medicine for a grant
ending September 30, 1978, and for each school year thereafter begin-
under section 770 shall contain or be supported by assurances satisfac-
ning in a fiscal year for which a grant under section 770 is applied for,
tory to the Secretary that the clinical training of the school shall em-
which exceeds the number of full-time, first-year students enrolled in
phasize predominantly care to food-producing animals or to fibre-pro-
such school in the school year beginning in the fiscal year ending
ducing animals, or to both types of animals.
September 30, 1976-
"(3) A school of veterinary medicine shall maintain an enrollment
(4) by 5 persent of such number if such number was not
of full-time, first-year students, for the school year beginning in the
more than 100, or
fiscal year ending September 30, 1978, and for each school year there-
"(B) by 2.5 percent of such number, or 5 students, whichever
after beginning in a fiscal year for which a grant under section 770 is
is greater, if such number was more than 100.
applied for, which exceeds the number of full-time, first-year students
"(3) An application of a school of podiatry shall contain or be
enrolled in such school in the school year beginning in the fiscal year
supported by assurances satisfactory to the Secretary that for the
ending September 30, 1976-
school year beginning in the fiscal year for which a grant is made
(A) by 5 percent of such number if such number was not more
under section 770 at least 40 percent of the enrollment of full-time,
than 100, or
first-year students in such school will be comprised of students who
'(B) by 2.5 percent of such number, or 5 students, whichever
are residents of States in which there are no accredited schools of
is greater, if such number was more than 100.
"(4) An application of a school of veterinary medicine shall con-
podiatry. "(i) SCHOOLS OF PHARMACY.-To be eligible for a grant under sec-
tain or be supported by assurances satisfactory to the Secretary that
tion 770 for a fiscal year beginning after September 30, 1977, a
for the school year beginning in the fiscal year for which a grant is
school of pharmacy's application for such a grant shall, in addition
made under section 770 at least 30 percent of the enrollment of full-
to the assurances required by subsection (a), contain or be supported
time, first-year students in such school will be comprised of students
by assurances that each student who is enrolled in the school will
who are residents of States in which there are no accredited schools of
before graduation undergo a training program in clinical pharmacy,
veterinary medicine.
which shall include (1) an inpatient and outpatient clerkship experi-
"(g) SCHOOLS OF OPTOMETRY.-(1) To be eligible for a grant under
ence in a hospital, extended care facility, or other clinical setting,
section 770 for a fiscal year beginning after September 30, 1977, a school
(2) interaction with physicians and other health professionals; (3)
of optometry shall, in addition to the requirements of subsection (a),
training in the counseling of patients with regard to the appropriate
meet the requirement of paragraph (2) or (3).
use and reactions to drugs; and (4) training in drug information re-
(2) A school of optometry shall maintain an enrollment of full-
trieval and analysis in the context of actual patient problems.".
time, first-year students, for the school year beginning in the fiscal year
ending September 30, 1978, and for each school year thereafter begin-
TECHNICAL AND CONFORMING AMENDMENTS
ning in a fiscal year for which a grant under section 770 is applied for,
which exceeds the number of full-time, first-year students enrolled in
SEC. 503. (a) Section 775 is redesignated section 772 and is
such school in the school year beginning in the fiscal year ending
amended-
September 30, 1976-
(1) by striking out "section 770, 771, 772, or 773" each place it
(A) by 5 percent of such number if such number was not more
occurs and inserting in lieu thereof "section 770",
than 100, or
(2) by inserting ", public health" after "dentistry" in subsec-
"(B) by 2.5 percent of such number, or 5 students, whichever
tion (b),
is greater, if such number was more than 100.
(3) by striking out "this part" in subsection (c) and inserting
(3) An application of a school of optometry shall contain or be
in lieu thereof "section 770",
supported by assurances satisfactory to the Secretary that for the
(4) by striking out "section 770, 771, or 773" in subsection (d)
school year ending in the fiscal year for which a grant is made under
(1) and inserting in lieu thereof "section 771", and
section 770 at least 25 percent (or 50 percent if the applicant is a
(5) by amending subsection (d) (3) to read as follows:
nonprofit private school of optometry) of the first year enrollment
(3) provides for such fiscal control and accounting pro-
cedures and reports, including the use of such standard proce-
64
dures for the recording and reporting of financial informa-
(2) by striking out "or" immediately before "(ii)";
tion, as the Secretary may prescribe, and access to the
(3) by inserting immediately before "shall be eligible" in the
records of the applicant, as the Secretary may require to
first sentence the following: "or (iii) who came to the United
enable him to determine the costs to the applicant of its
States or acquired such status in order to receive graduate medi-
program for the education or training of students.".
cal education or training,"; and
(3) Sections 312 and 313 are repealed.
(4) by inserting except in the case of an alien described in
(c) The amendments made by this section shall take effect Octo-
clause (iii)," immediately after "provided further, That".
ber 1, 1977.
(d) Section 212 of such Act (8 U.S.C.1182) is amended by inserting
at the end thereof the following new subsection:
TITLE VI-FOREIGN MEDICAL GRADUATES
"(j) (1) The additional requirements referred to in section 101 (a)
(15) (J) for an alien who is coming to the United States under a pro-
LIMITATION ON IMMIGRATION OF FOREIGN MEDICAL GRADUATES
gram under which he will receive graduate medical education or
training are:
SEC. 601. (a) Section 212(a) of the Immigration and Nationality
(4) A school of medicine or of one of the other health pro-
Act (8 U.S.C. 1182(a)) is amended by (1) striking out the period at
fessions, which is accredited by a body or bodies approved for the
the end thereof and inserting a semicolon in lieu thereof, and (2) by
purpose by the Commissioner of Education, has agreed in writing
adding at the end thereof the following new paragraph:
to provide the graduate medical education or training under the
(32) Aliens who are graduates of a medical school and are coming
program for which the alien is coming to the United States or
to the United States principally to perform services as members of
to assume responsibility for arranging for the provision thereof
the medical profession, except such aliens who have passed parts I and
by an appropriate public or nonprofit private institution or
II of the National Board of Medical Examiners Examination (or
agency, except that, in the case of such an agreement by a school
equivalent examination as determined by the Secretary of Health,
of medicine, any one or more of its affiliated hospitals which are
Education, and Welfare) and who are competent in oral and written
to participate in the provision of the graduate medical education
English. The exclusion of aliens under this paragraph shall apply
or training must join in the agreement;
to special immigrants defined in section 101 (a) (27) (4) (other than
"(B) Before making such agreement, the accredited school has
the parents, spouses, or children of United States citizens or of aliens
been satisfied that the alien has passed parts I and II of the Na-
lawfully admitted for permanent residence), to nonpreference im-
tional Board of Medical Examiners Examination (or equivalent
migrant aliens described in section 203 (8), and to preference im-
examination as determined by the Secretary of Health, Education,
migrant aliens described in section 203(a) (3) and (6).".
and Welfare), has competency in oral and written English, will
(b) Section 101 (a) (15) of the Immigration and Nationality Act
be able to adapt to the educational and cultural environment in
(15)) is amended as follows:
which he will be receiving his education or training, and has ade-
(1) Subparagraph (H) (i) is amended by inserting before the
quate prior education and training to participate satisfactorily in
semicolon and who, in the case of a graduate of a medical school
the program for which he is coming to the United States;
coming to the United States to perform services as a member of
"(0) The alien has made a commitment to return to the coun-
the medical profession, is coming pursuant to an invitation from
try of his nationality or last residence upon completion of his
a public or nonprofit private educational or research institution
education or training for which he is coming to the United States
or agency in the United States to teach or conduct research, or
(including any extension of the duration thereof under subpara-
both, at or for such institution or agency".
graph (D)), and the government of the country of his nationality
(2) Subparagraph (H) (ii) is amended by inserting before the
or last residence has provided a written assurance, satisfactory
semicolon." but this clause shall not apply to graduates of medical
to the Secretary of Health, Education, and Welfare, that upon
schools coming to the United States to perform services as mem-
such completion and return he will be appointed to a position in
bers of the medical profession".
which he will fully utilize the skills acquired in such education or
(3) Subparagraph (H) (iii) is amended by inserting before the
training in the government of that country or in an educational or
semicolon other than to receive graduate medical education or
other appropriate institution or agency in that country; and
training".
'(D) The duration of the alien's participation in the program
(4) Subparagraph (J) is amended by inserting "and who, if
for which he is coming to the United States is limited to not more
he 28 coming to the United States to participate in a program under
than 2 years, except that such duration may be extended for one
which he will receive graduate medical education or training, also
year at the request of the government of his nationality or last
meets the requirements of section 212(j)" before and the alien
residence, if (i) such government provides a written assurance,
spouse".
satisfactory to the Secretary of Health, Education, and Welfare,
(c) Section 212 of such Act (8 U.S.C. 1182(e)) is amended-
that the alien will, at the end of such extension, be appointed to a
(1) by striking out "whose (i)" and inserting in lieu thereof
position in which he will fully utilize the skills acquired in such
"(i) whose";
76-510 76 5
66
67
education or training in the government of that country or in an
(d) for such fiscal year divided by the number of educational entities
educational or other appropriate institution or agency in that
which have applications for grants for such fiscal year approved under
country, and (ii) the accredited school providing or arranging for
subsection (c).
the provision of his education or training agrees in writing to such
(c) (1) No grant may be made under subsection (a) unless an
extension, and (iii) such extension is for the purpose of continuing
application therefor has been submitted to the Secretary before such
the alien's education or training under the program for which he
time as he shall by regulation prescribe and has been approved by the
came to the United States.
Secretary. Such application shall be in such form, and submitted in
"(2) (A) Except as provided in subparagraph (B), the require-
such manner, as the Secretary shall by regulation prescribe.
ments of subparagraphs (A) through (D) of paragraph (1) shall not
(2) The Secretary may not approve an application submitted under
apply between the effective date of this subsection and December 31,
paragraph (1) unless-
1980, to any alien who seeks to come to the United States to participate
"(A) such application-
in an accredited program of graduate medical education or training
(i) contains assurances satisfactory to the ,Secretary that
if there would be a substantial disruption in the health services pro-
in the school year (as defined in regulations of the Secretary)
vided in such program because such alien was not permitted, because
ending in the fiscal year for which the applicant receives a
of his failure to meet such requirements, to enter the United States to
grant under subsection (a) that-
participate in such program.
"(I) at least 25 individuals will complete the graduate
"(B) In the administration of this subsection, the Attorney General
educational programs of the entity for which such appli-
shall take such action as may be necessary to ensure that the total
cation is submitted; and
number of aliens participating (at any time) in programs described in
(II) such entity shall expend or obligate at least
subparagraph (A) does not, because of the exemption provided by
$100,000 in funds from non-Federal sources to conduct
such subparagraph, exceed the total number of aliens participating in
such programs;
such programs on the effective date of this subsection.".
"(ii) contains assurances satisfactory to the Secretary that
(C) Section 101 (a) of the Immigration and Nationality Act (8
such entity shall maintain a first-year enrollment of full-
U.S.C. 1101 (a)) is amended by adding the following at the end
time students in the programs, for the school year ending
thereof:
in the fiscal year ending September 30, 1978, and for each
"(41) The term 'graduates of medical school means aliens who have
school year thereafter ending in a fiscal year for which a
graduated from a medical school or who have qualified to practice
grant under this section is applied for, which exceeds the
medicine in a foreign state.".
number of full-time, first year students enrolled in such pro-
(f) The amendments made by this section shall take effect ninety
grams in the school year ending in the fiscal year ending Sep-
days after the date of enactment of this section.
tember 30, 1976-
"(I) by 5 percent of such number if such number was
TITLE VII-PUBLIC AND ALLIED HEALTH PERSONNEL
not more than 100, or
"(II) by 2.5 percent of such number, or 5 students,
PUBLIC AND ALLIED HEALTH PERSONNEL
whichever is greater, if such number was more than 100;
and
SEC. 701. (a) Effective October 1, 1977, part G of title VII is
amended to read as follows:
"(iii) contains such other information as the Secretary
may by regulation prescribe; and
"PART G- PROGRAMS FOR PERSONNEL IN HEALTH ADMINISTRATION AND
'(B) the program for which such application was submitted
IN ALLIED HEALTH
has been accredited for the training of individuals for health ad-
ministration, hospital administration, or health planning by a
"SUBPART I-PUBLIC HEALTH PERSONNEL
recognized body or bodies approved for such purpose by the
Commissioner of Education and meet such other quality standards
"GRANTS FOR GRADUATE PROGRAMS IN HEALTH ADMINISTRATION
as the Secretary shall by regulation prescribe.
'(3) The Secretary may waive (in whole or in part) the require-
"Sec. 791. (a) From funds appropriated under subsection (d), the
ments of paragraph (2) with respect to any school upon written
Secretary shall make annual grants to public or nonprofit private
notification by the appropriate accreditation body or bodies that com-
educational entities (including schools of social work and excluding
pliance with the assurances required by such paragraph will prevent
accredited schools of public health) to support the graduate educa-
tional programs of such entities in health administration, hospital ad-
bodies. such school from meeting the accreditation standards of such body or
ministration, and health planning.
The Secretary may not approve or disapprove such an application
"(b) The amount of the grant for any fiscal year under subsection
except after consultation with the National Advisory Council on
(a) to an educational entity with an application approved under sub-
Health Professions Education.
section (c) shall be equal to the amount appropriated under subsection
68
69
"(d) There are authorized to be appropriated for payments under
grants under this section $3,250,000 for the fiscal year ending Septem-
(hereinafter in this subsection referred to as 'personal data') for
ber 30, 1978, $3,500,000 for the fiscal year ending September 30, 1979,
purposes of this section-
and $3,750,000 for the fiscal year ending September 30, 1980.
"(A) inform any individual who is asked to supply personal
data whether he is legally required, or may refuse, to supply
"SPECIAL PROJECTS FOR ACCREDITED SCHOOLS OF PUBLIC HEALTH AND
such data and inform him of any specific consequences, known
GRADUATE PROGRAMS IN HEALTH ADMINISTRATION
to the Secretary or program entity as the case may be, of pro-
viding or not providing such data;
"Sec. 792. (a) The Secretary may make grants to assist accredited
(B) upon request, inform any individual if he is the sub-
schools of public health in meeting the costs of special projects to
ject of personal data secured or maintained by the Secretary
develop new programs or to expand existing programs in-
or program entity as the case may be and make the data avail-
(1) biostatistics or epidemiology,
able to him in a form comprehensible to him;
(2) health administration, health planning or health policy
'(C) assure that no use is made of personal data which is not
analysis and planning,
within the purposes of this section unless an informed consent
(3) environmental or occupational health, or
has been obtained from the individual who is the subject of such
"(4) dietetics and nutrition.
data; and
"(b) (1) The Secretary may make grants to assist those public or
"(D) upon request, inform any individual of the use being
non-profit educational entities (including graduate schools of social
made of personal data respecting such individual and of the iden-
work) which have accredited programs in accordance with paragraph
tity of the individuals and entities which will use the data and
(2) in meeting the costs of special projects to develop new programs
their relationship to the program under this section.
or to expand existing programs in-
"(2) Any entity which maintains a record of personal data and
(4) biostatistics or epidemiology,
which receives a request from the Secretary or a program entity to
'(B) health administration, health planning or health policy
use such data for purposes of this section shall not transfer any such
analysis and planning,
data to the Secretary or to a program entity unless the individual
(O) environmental or occupational health, or
whose personal data is to be 80 transferred gives an informed consent
"(D) dietetics and nutrition.
for such transfer.
"(2) For purposes of this section, an accredited program is a gradu-
(3) (A) Notwithstanding any other provision of law, personal
ate program accredited for the training of individuals in health ad-
data collected by the Secretary or any program entity for purposes of
ministration, health planning, or health policy analysis and planning
this section may not be made available or disclosed by the Secretary or
by a recognized body or bodies approved by the Commissioner of
any program entity to any person other than the individual who is the
Education and meets such other quality standards as the Secretary
subject of such data unless (i) such person requires such data for
may by regulation prescribe.
purposes of this section, or (ii) in response to a demand for such
"(c) There are authorized for the purpose of making payments pur-
data made by means of compulsory legal process. Any individual who
suant to grants under this section $5,000,000 for the fiscal year ending
is the subject of personal data made available or disclosed under clause
September 30, 1978; $5,500,000 for the fiscal year ending September 30,
(ii) shall be notified of the demand for such data.
1979; and $6,000,000 for the fiscal year ending September 30, 1980.
(B) Subject to all applicable laws regarding confidentiality, only
the data collected by the ,Secretary under this section which is not
"STATISTICS AND ANNUAL REPORT
personal data shall be made available to bona fide researchers and
policy analysts (including the Congress) for the purposes of assist-
"SEC. 793. (a) The Secretary shall, in coordination with the National
ing in the conduct of studies respecting health professions personnel.
Center for Health Statistics (established under section 306), con-
(4) For purposes of this subsection, the term 'program entity'
tinuously develop, publish, and disseminate on a nationwide basis
means any public or private entity which collects, compiles, or analyzes
statistics and other information respecting public and community
health professions data under an arrangement with the Secretary for
health personnel, including-
purposes of this section.
(1) detailed descriptions of the various types of activities in
"(c) The Secretary shall submit annually to the Committee on Inter-
which public and community health personnel are engaged,
state and Foreign Commerce of the House of Representatives and to
"(2) the current and anticipated needs for the various types
of public and community health personnel, and
on- the Committee on Labor and Public Welfare of the Senate a report
(3) the number. employment, geographic locations, salaries,
"(1) the statistics and other information developed pursuant
and surpluses and shortages of public and community health per-
to subsection (a), and
sonnel, the educational and licensure requirements for the various
"(2) the activities conducted under this subpart, including an
types of such personnel, and the cost of training such personnel.
evaluation of such activities.
'(b) (1) The Secretary and each program entity shall in securing
Such report shall contain such recommendations for legislation as the
and maintaining any record of individually identifiable personal data
Secretary determines is needed to improve the programs authorized
under this subpart. The Office of Management and Budget may review
70
71
such report before its submission to Congress, but the Office may not
purpose by the Commissioner of Education, or which is in a
revise the report or delay its submission beyond the date prescribed
junior college which is accredited by the regional accrediting
for its submission and may submit to Congress its comments respecting
agency for the region in which it is located or there is satis-
such report. The first report under this subsection shall be submitted
factory assurance afforded by such accrediting agency to the
not later than December 1, 1978.
,Secretary that reasonable progress is being made toward ac-
(d) For purposes of this section, the term 'public and community
creditation by such junior college,
health personnel' means individuals who are engaged in-
except that an applicant for a grant under this subpart which does
(1) the planning, development, monitoring, or management of
not at the time of application meet the requirement of clause (B)
health care or health care institutions, organizations, or systems,
shall be deemed to meet such requirement if the Secretary finds
(2) research on health care development and the collection and
there is reasonable assurance that the unit will meet the require-
analysis of health statistics, data on the health of population
ment of clause (B) prior to the beginning of the academic year
groups, and any other health data,
following the normal graduation date of the first entering class
(3) the development and improvement of individual and
in such unit.
community knowledge of health (including environmental health
(3) The term "nonprofit" as applied to any training center for
and preventive medicine) and the health care system, or
allied health professions means such a training center which is
"(4) the planning and development of a healthful environ-
an entity, or 28 owned and operated by an entity, no part of the
ment and control of environmental health hazards.
net earnings of which inures or may lawfully inure, to the benefit
of any private shareholder or individual; and as applied to any
"SUBPART II-ALLIED HEALTH PERSONNEL
entity means an entity no part of the net earnings of which inures
or may lawfully inure to the benefit of any private shareholder
"DEFINITIONS
or individual.
"PROJECT GRANTS AND CONTRACTS
"Sec. 795. For purposes of this subpart:
"(1) the term 'allied health personnel means individuals with
"Sec. 796. (a) The Secretary shall make grants and enter into con-
training and responsibilities for (A) supporting, complementing,
tracts with eligible entities to assist them in meeting the costs of plan-
or supplementing the professional functions of physicians, den-
ning, developing, demonstrating, operating, and evaluating projects
tists, and other health professionals in the delivery of health care
relating to:
to patients, or (B) assisting environmental engineers and other
(1) Establishment of regional or State systems for the coordi-
personnel in environmental health control and preventive medi-
nation and management of education and training at various
cine activities.
levels for allied health personnel and nurses within and among
"(2) The term 'training center for allied health professions'
educational institutions and their clinical affiliates for the pur-
means a junior college, college, or university-
pose of assuring that allied health and nurse manpower needs of
"(A) which provides, or can provide, programs of educa-
such region or State are substantially met.
tion leading to a baccalaureate or associate degree or to the
"(2) Establishment of new roles and functions for allied health
equivalent of either or to a higher degree in the medical tech-
personnel and methods for increasing the efficiency of health
nology, optometric technology, dental hygiene, or any of such
manpower through more effective utilization of allied health per-
other of the allied health professions curriculums as are
sonnel in various practice settings.
specified by regulations, or which, if in a junior college pro-
"(3) Establishment of new or improved methods of creden-
vides a program (i) leading to an associate or an equivalent
tialing allied health personnel, including techniques for appro-
degree, (ii) of education in optometric technology, dental
priate recognition (through equivalency and proficiency testing
hygiene, or curriculums as are specified by regulation, and
or otherwise) of previously acquired training or experience, de-
(iii) acceptable for full credit toward a baccalaureate or
veloped in coordination with the Secretary's program under sec-
equivalent degree in the allied health professions or designed
tion 1123 of the Social Security Act.
to prepare the student to work as a technician in a health
"(4) Establishment of methods of recruitment, training, and
occupation specified by regulations of the Secretary,
retraining of allied health personnel.
(B) which provides training for not less than a total of
(5) Establishment of meaningful career ladders and programs
twenty persons in such curriculums,
of advancement for practicing allied health personnel.
"(C) which, if in a college or university which does not
(6) Establishment of continuing education programs for prac-
include a teaching hospital or in a junior college, is affiliated
ticing allied health personnel.
(to the extent and in the manner determined in accordance
"(b) (1) No grant may be made or contract entered into under sub-
with regulations) with such a hospital, and
section (a) unless an application therefor has been submitted to, and
(D) which is (or is in a college or university, which is)
approved by, the Secretary. Such application shall be in such form,
accredited by a recognized body or bodies approved for such
submitted in such manner, and contain such information, as the Sec-
retary shall by regulation prescribe.
73
72
grants to and enter into contracts with schools of allied health, State
"(2) The amount of any grant under subsection (a) shall be de-
and local educational agencies, and other public or private nonprofit
termined by the Secretary.
entities to assist in meeting the costs described in paragraph (2).
"(c) (1) For purposes of subsection (a), the term 'eligible entities'
'(2) A grant or contract under paragraph (1) may be used by the
means entities which are-
health or educational entity to meet the costs of-
"(A) schools, universities, or other educational entities which
"(A) identifying, recruiting, and selecting such individuals
provide for allied health personnel education and training and
with a potential for education or training in the allied health
which meet such standards as the Secretary may by regulation
professions;
prescribe;
(B) facilitating the entry of those individuals into such an
"(B) States, political subdivisions of States, or regional and
entity;
other public bodies representing States or political subdivisions of
"(O) providing counseling or other services designed to assist
States or both; or
those individuals to complete successfully their education at such
"(O) entities which have a working arrangement (meeting such
an entity;
requirements as the Secretary may by regulation prescribe) with
"(D) providing, for a period prior to the entry of those in-
an entity described in subparagraph (A).
dividuals into the regular course of education of such an entity,
"(d) (1) For the purpose of making payments under grants and con-
preliminary. education designed to assist them to complete suc-
tracts under subsection (α), there are authorized to be appropriated
cessfully such regular course of education at such an entity, or
$22,000,000 for the fiscal year ending September 30, 1978; $24,000,000
referring such individuals to institutions providing such pre-
for the fiscal year ending September 30, 1979; and $26,000,000 for the
liminary education; and
fiscal year ending September 30, 1980.
"(E) publicizing existing sources of financial aid available to
'(2) In each fiscal year for which funds are authorized to be appro-
persons enrolled in the education program of such an entity or
priated under this subsection, not less than 50 percent of the funds ap-
who are undertaking training necessary to qualify them to enroll
propriated shall be reserved for award to training centers for allied
in such a program.
health professions.
"(b) (1) No grant may be made or contract entered into under sub-
section (a) unless an application therefor has been submitted to, and
"TRAINEESHIPS FOR ADVANCED TRAINING OF ALLIED HEALTH PERSONNEL
approved by, the Secretary. Such application shall be in such form,
"Sec. 797. (a) The Secretary may make grants to public and non-
submitted in such manner, and contain such information, as the Secre-
profit private entities for traineeships provided by such entities for
lary shall by regulation prescribe.
the advanced training of allied health personnel to teach in training
(2) The amount of any grant under subsection (a) shall be deter-
programs for such personnel or to serve in administrative or super-
mined by the Secretary.
visory positions.
"(c) For payments under grants and contracts under subsection
(b) (1) No grant may be made under subsection (a) unless an ap-
(a) there are authorized to be appropriated $1,000,000 for fiscal year
plication therefor has been submitted to and approved by the Secre-
ending September 30, 1978, $1,000,000 for fiscal year ending Septem-
tary. Such application shall be in such form, submitted in such man-
ber 30, 1979, and $1,000,000 for fiscal year ending September 30, 1980.".
ner, and contain such information as the Secretary shall by regulation
STUDIES AND STATISTICAL REPORT ON ALLIED HEALTH PERSONNEL
prescribe.
"(2) Payments under such grants shall be limited to such amounts
SEC. 702. (a) The Secretary of Health, Education, and Welfare
as the Secretary finds necessary to cover the cost of tuition and fees of,
shall conduct and complete, not later than two years after the date of
and stipends and allowances (including travel and subsistence expenses
enactment of this Act, studies-
and dependency allowances) for, the trainees.
(1) to identify the various types of allied health personnel and
(c) For the purposes of making payments under grants under sub-
the activities in which such personnel are engaged and the vari-
section (a), there are authorized to be appropriated $4,500,000 for the
ous training programs currently offered for allied health per-
fiscal year ending September 30, 1978; $5,000,000 for the fiscal year
sonnel;
ending September 30, 1979; and $5,500,000 for the fiscal year ending
(2) to establish classifications of allied health personnel on the
September 30, 1980.
basis of their activities, responsibilities, and training;
(3) using appropriate methodologies, to determine the cost of
"EDUCATIONAL ASSISTANCE TO DISADVANTAGED INDIVIDUALS IN ALLIED
HEALTH TRAINING
educating and training allied health personnel in each such classi-
fication; and
"SEC. 798. (a) (1) For the purpose of assisting individuals who, due
(4) to identify the classifications in which there are a critical
to socioeconomic factors, are financially or otherwise disadvantaged
shortage of such personnel and the training programs which
(including individuals who are veterans of the Armed Forces with
should be assisted to meet that shortage.
military training or experience in the health field) to undertake educa-
(b) In addition, the Secretary shall, in coordination with the Na-
tion to enter the allied health professions, the Secretary may make
tional Center for Health Statistics (established under section 306 of
74
75
the Public Health Service Act), develop, publish, and disseminate
professions data under an arrangement with the Secretary for purposes
on a nationwide basis a report containing statistics and other informa-
of this section.
tion respecting allied health personnel, including-
(d) The Secretary shall submit, not later than two years after the
(1) detailed descriptions of the various types of such personnel
date of enactment of this Act, to the Committee on Interstate and
and the activities in which such personnel are engaged,
Foreign Commerce of the House of Representatives and to the Com-
(2) the current and anticipated needs for the various types of
mittee on Labor and Public Welfare of the Senate-
such health personnel, and
(1) a report on the results of the studies conducted under sub-
(3) the number, employment, geographic locations, salaries,
section (a);
and surpluses and shortages of such personnel.
(2) the report developed under subsection (b), and
(c) (1) The Secretary and each program entity shall in securing
(3) a report on, including an evaluation of, activities conducted
and maintaining any record of individually identifiable personal data
under subpart II of part G of title VII of the Public Health
(hereinafter in this subsection referred to as 'personal data') for pur-
Service Act (relating to allied health personnel).
poses of this section-
The report described in paragraph (3) shall contain such recommen-
(4) inform any individual who is asked to supply personal
dations for legislation as the Secretary determines is needed to im-
data whether he is legally required, or may refuse, to supply
prove the programs authorized under such subpart. The Office of
such data and inform him of any specific consequences, known
M anagement and Budget may review such report before its submis-
to the Secretary or program entity as the case may be, of pro-
sion to Congress, but the Office may not revise the report or delay
viding or not providing such data;
its submission beyond the date prescribed for its submission and may
(B) upon request, inform any individual if he is the sub-
submit to Congress its comments respecting such report.
ject of personal data secured or maintained by the Secretary
(e) For the purposes of this section, the term "allied health per-
or program entity, as the case may be, and make the data avail-
sonnel" means individuals with training and responsibilities for (1)
able to him in a form comprehensible to him;
supporting, complementing, or supplementing the professional func-
(σ) assure that no use is made of personal data which is not
tions of physicians, dentists, and other health professionals in the
within the purposes of this section unless an informed consent
delivery of health care to patients, or (2) assisting environmental engi-
has been obtained from the individual who is the subject of such
neers and other personnel in environmental health control and pre-
data; and
ventive medicine activities.
(D) upon request, inform any individual of the use being made
of personal data respecting such individual and of the identity
TITLE VIII-SPECIAL PROJECTS
of the individuals and entities which will use the data and their
relationship to the studies made or information collected under
GRANTS AND CONTRACTS
this section.
(2) Any entity which maintains a record of personal data and which
SEC. 801. Effective October 1, 1976, part F of title VII is amended
receives a request from the Secretary or a program entity for data
to read as follows:
for purposes of this section shall not transfer any such data to the
Secretary or to a program entity unless the individual whose personal
"PART F-GRANTS AND CONTRACTS FOR PROGRAMS AND PROJECTS
data is to be 80 transferred gives an informed consent for such transfer.
(3) (4) Notwithstanding any other provision of law, personal data
"PROJECT GRANTS FOR ESTABLISHMENT OF DEPARTMENTS OF FAMILY MEDICINE
collected by the Secretary or any program entity for purposes of this
section may not be made available or disclosed by the Secretary or any
"Sec. 780. (a) The Secretary may make grants to schools of medi-
program entity to any person other than the individual who is the
cine and osteopathy to meet the costs of projects to establish and
subject of such data unless (i) such person requires such data for pur-
maintain academic administrative units (which may be departments,
poses of this section, or (ii) in response to a demand for such data made
divisions, or other units) to provide clinical instruction in family
medicine.
by means of compulsory legal process. Any individual who is the sub-
ject of personal data made available or disclosed under clause (ii) shall
(b) The Secretary may not approve an application for a grant
be notified of the demand for such data.
under subsection (a) unless such application contains-
(B) Subject to all applicable laws regarding confidentiality, only
"(1) assurances satisfactory to the Secretary that the academic
the data collected by the Secretary under this section which is not
administrative unit with respect to which the application is
personal data shall be made available to bona fide researchers and
made will (A) be comparable to academic administrative units
policy analysts (including the Congress) for the purposes of assist-
for other major clinical specialties offered by the applicant, (B)
ing in the conduct of studies respecting health professions personnel.
be responsible for directing an amount of the curriculum for each
(4) For purposes of this subsection, the term "program entity" means
member of the student body engaged in an education program
any public or private entity which collects, compiles, or analyzes health
leading to the awarding of the degree of doctor of medioine or
doctor of osteopathy. which amount is determined by the Secre-
76
77
tary to be comparable to the amount of curriculum required for
designate the medically underserved population it will serve (such area
other major clinical specialties in the school, (C) have a number
or population with respect to such center in this section referred to as
of full-time faculty which is determined by the Secretary to be
'the area served by the center').
sufficient to conduct the instruction required by clause (B) and
(2) Each area health education center shall-
to be comparable to the number of faculty assigned to other major
"(A) provide for or conduct training in health education serv-
clinical specialties in the school, and (D) have control over a
ices, including education in nutrition evaluation and counseling,
three-year approved or provisionally approved medical residency
in the area served by the center;
training program in family practice or its equivalent as deter-
"(B) assess the health manpower needs of the area served by
mined by the ,Secretary which shall have the capacity to enroll a
the center and assist in the planning and development of training
total of no less than twelve interns or residents per year; and
programs to meet such needs;
"(2) such other information as the Secretary shall by regula-
"(0) provide for or conduct a medical residency training pro-
tion prescribe.
gram in family medicine or general internal medicine and in
(c) There are authorized to be appropriated $10,000,000 for the
which no fewer than six individuals are enrolled in first-year
fiscal year ending September 30, 1978, $15,000,000 for the fiscal year
positions in such program;
ending September 30, 1979, and $20,000,000 for the fiscal year ending
(D) provide opportunities for continuing medical education
September 30, 1980, for payments under grants under subsection (a).
(including education in disease prevention) to all physicians and
other health professionals (including allied health personnel)
"AREA HEALTH EDUCATION CENTERS
practicing within the area served by the center;
"(E) provide continuing medical education and other support
"Sec. 781. (a) For the purpose of improving the distribution, sup-
services to the National Health Service Corps members serving
ply, quality, utilization, and efficiency of health personnel in the
within the area served by the center;
health services delivery system and for the purpose of encouraging
'(F) encourage the utilization of nurse practitioners and physi-
the regionalization of educational responsibilities of the health pro-
cian assistants within the area served by the center and the
fessions schools, the Secretary may enter into contracts for projects
recruitment of individuals for training in such professions at the
to assist in the planning, development, and implementation of area
participating medical or osteopathic schools;
health education center programs.
'(G) arrange and support educational opportunities for medi-
"(b) An area health education center program shall be a coopera-
cal and other students at health facilities, ambulatory care centers,
tive program of one or more medical or osteopathic schools and one
and health agencies throughout the area served by the center;
or more nonprofit private or public area health education centers.
and
"(c) Each medical or osteopathic school participating in an area
(H) have an advisory board of which at least 75 percent of
health education center shall-
the members shall be individuals, including both health service
"(1) provide for the active participation in such program by
providers and consumers, from the area served by the center.
individuals who are associated with the administration of the
Any health education center which is participating in an area health
school, each of the departments (or specialties if the school has
education center program in which another center has a medical
no such departments) of internal medicine, pediatrics, obstetrics
residency training program described in subparagraph (σ) need not
and gynecology, surgery, psychiatry, and family medicine;
"(2) provide that no less than 10 percent of all undergraduate
provide for or conduct such a medical residency training program.
medical or osteopathic clinical education of the school will be
"(e) The Secretary is authorized to enter into contracts with medical
and osteopathic schools, which have cooperative arrangements with
conducted in an area health education center and at locations
area health education centers, for the planning, development, and
under the sponsorship of such center;
"(3) be responsible for, or conduct, a nurse practitioner or
operation of area health education center programs. In making con-
tracts under this section the Secretary shall assure that-
physician assistant training program which gives special con-
(1) 75 percent of the total funds provided to any school shall
sideration to the enrollment of individuals from, or intending
be expended by an area health education program in the area
to practice in, the area served by the area health education center
of the program; and
served by the centers;
"(2) not more than 75 percent of the total operating funds of
"(4) provide for the active participation of at least 2 other
the program in any year shall be provided by the Secretary; and
health science disciplines (including a school of dentistry if there
(3) no contract shall provide funds solely for the planning or
is one affiliated with the university with which the school of
development of such program for α period of longer than two
medicine or osteopathy is affiliated) in the educational program
conducted in the area served by the area health education center.
years.
"(f) For the purpose of this section the term 'area health education
"(d) (1) Each area health education center shall specifically desig-
center program' means a program which is organized and operated in
nate the geographic area in which it will serve, or shall specifically
78
79
a manner described in subsection (3) and which is capable, as deter-
"PROGRAMS FOR PHYSICIAN ASSISTANTS, EXPANDED FUNCTION DENTAL
mined by the Secretary, of performing each of the functions described
AUXILIARIES AND DENTAL TEAM PRACTICE
in subsection (d) (2). The ,Secretary shall, by regulation, establish
standards and criteria for the requirements of such subsections.
"Sec. 783. (a) The Secretary may make grants to and enter into
"(g) There are authorized to be appropriated to carry out the pro-
contracts with public or nonprofit private schools of medicine, osteop-
visions of this section $20,000,000 for the fiscal year ending Septem-
athy, dentistry and other public or nonprofit private entities to meet
ber 30, 1978, $30,000,000 for the fiscal year ending September 30, 1979,
the costs of projects to-
and $40,000,000 for the fiscal year ending September 30, 1980.
'(A) plan, develop, and operate or maintain programs for the
training of physician assistants (as defined in section 701 (7))
"EDUCATION OF RETURNING UNITED STATES STUDENTS FROM FOREIGN
"(B) plan, develop, and operate or maintain programs for the
MEDICAL SCHOOLS
training of expanded function dental auxiliaries (as defined in
section 701 (8)) and
"Sec. 782. (a) The Secretary may make grants to schools of medi-
"(O) plan, develop, and operate or maintain a program to
cine and osteopathy in the United States to plan, develop, and operate
train dental students in the organization and management of
programs-
multiple auxiliary dental team practice (T.E.A.M.) in accord-
"(1) to train United States citizens who have been enrolled in
ance with regulations of the Secretary.
medioal schools in foreign countries before the date of enactment
"(b) No grant or contract may be made under subsection (a)
of the Health Professions Education Assistance Act of 1976 to en-
unless the application therefor contains or is supported by assurances
able them to meet the requirements for enrolling in schools of
satisfactory to the Secretary that the school or entity receiving the
medicine or osteopathy in the United States as full-time students
grant or contract, has appropriate mechanisms for placing graduates
with advanced standing; or
of the training program, with respect to which the application is sub-
"(2) to train United States citizens who have transferred from
mitted, in positions for which they have been trained.
medical schools in foreign countries in which they were enrolled
"(0) The Secretary shall assure that the making of grants and en-
before the date of enactment of the Health Professions Educa-
tering into contracts under this section shall be integrated with the
tional Assistance Act of 1976, and who have enrolled in schools of
making of grants and entering into contracts under section 830.
medicine or osteopathy in the United States as full-time students
'(d) The costs for which a grant or contract under this section may
with advanced standing.
be made include costs of preparation of faculty members respecting
The costs for which a grant under this subsection may be made may
programs for the training of physician assistants and expanded func-
include the costs of identifying deficiencies in the medical school edu-
tion dental auxiliaries.
cation of the United States citizens who have been enrolled in foreign
"(e) For payments under grants and contracts under this section,
medical schools, the development of materials and methodology for
there is authorized to be appropriated $25,000,000 for the fiscal year
correcting such deficiencies, and specialized training designed to pre-
ending September 30, 1978, $30,000,000 for the fiscal year ending Sep-
pare such United States citizens for enrollment in schools of medicine
tember 30, 1979, and $35,000,000 for the fiscal year ending Septem-
or osteopathy in the United States as full-time students with advanced
ber 30, 1980.
standing.
"(3) More than one school of medicine or osteopathy may join in the
"GRANTS FOR TRAINING, TRAINEESHIPS, AND FELLOWSHIPS IN GENERAL
submission of an application for a grant under subsection (a).
INTERNAL MEDICINE AND GENERAL PEDIATRICS
"(o) Any school of medicine or osteopathy which receives a grant
under this subsection in the fiscal year ending September 30, 1978, shall
"SEC. 784. (a) The Secretary may make grants to and enter into
submit to the Secretary before June 30, 1979, a report on the deficien-
contracts with schools of medicine and osteopathy to meet the costs of
cies (if any) identified by the school in the foreign medical education
projects-
of the students trained by such school under the program for which
"(1) to plan, develop, and operate an approved medical resi-
such grant was made. The Secretary shall compile the reports sub-
dency training program in internal medicine or pediatrics, which
mitted under the preceding sentence, and before September 30, 1979
emphasize the training of residents for practice of general internal
submit to the Congress his analysis and evaluation of the information
medicine or general pediatrics (as defined by the Secretary in
contained in such reports.
regulations),
"(d) There are authorized to be appropriated for the purposes of
(2) which provide financial assistance (in the form of train-
this section $2,000,000 for the fiscal year ending September 30, 1977,
eeships and fellowships) to residents who are participants in any
$2,000,000 for the fiscal year ending September 30, 1978, $3,000,000 for
such program, and who plan to specialize or work in the practice
the fiscal year ending September 30, 1979, and $4,000,000 for the fiscal
of general internal medicine or general pediatrics.
year ending September 30, 1980.
"(b) There are authorized to be appropriated to carry out the pro-
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81
visions of this section $10,000,000 for the fiscal year ending Septem-
ber 30, 1977, $15,000,000 for the fiscal year ending September 30, 1978,
"(b) To the extent feasible, the Secretary shall approve, in accord-
$20,000,000 for the fiscal year ending September 30, 1979, and
ance with the requirements of subsection (a), at least 10 such cen-
$25,000,000 for the fiscal year ending September 30, 1980.
ters and at least one of which shall be located in each region of the
Department of Health, Education, and elfare.
"OOCUPATIONAL HEALTH TRAINING AND EDUCATION CENTERS
(c) For the purpose of making grants to carry out this section,
"Sec. 785. (a) (1) The Secretary shall, by grants, assist public or
there are authorized to be appropriated $5,000,000 for the fiscal
private nonprofit colleges or universities, to establish, operate, and ad-
year ending September 30, 1977, $5,000,000 for the fiscal year ending
minister occupational health training and education centers through
September 30, 1978, $8,000,000 for the fiscal year ending September 30,
9179, and $10,000,000 for the fiscal year ending September 30, 1980.
cooperative arrangements between schools of medicine and schools of
public health (or other qualified departments or schools within such
"FAMILY MEDICINE AND GENERAL PRACTICE OF DENTISTRY
colleges or universities which are qualified to participate in carrying
out activities set forth in this section).
"SEC. 786. (a) The Secretary may make grants to, or enter into con-
"(2) To be eligible for a grant under this section, the applicant
tracts with, any public or nonprofit hospital, school of medicine of
must demonstrate to the Secretary that it has or will have available
osteopathy, or to or with a public or private nonprofit entity (which
full-time faculty members with training and experience in the field
the Secretary has determined is capable of carrying out such grant
of occupational health and support from other faculty members
or contract)-
trained in the occupational health sciences and other relevant disci-
"(1) to plan, develop, and operate, or participate in, an ap-
plines and medical and public health specialties and that it will sub-
proved professional training program (including a continuing
stantially carry out activities including, but not limited to-
education program or an approved residency or internship pro-
(4) the establishment and operation of a new graduate train-
gram) in the field of family medicine for medical and osteopathic
ing program, or where appropriate, the substantial expansion of
students, interns (including interns in internships in osteopathic
an health; existing graduate training program in the field of occupational
medicine), residents, or practicing physicians;
"(2) to provide financial assistance (in the form of trainee-
"(B) the development of curricula and operation of con-
ships and fellowships) to medical and osteopathic students, interns
tinuing education for physicians, nurses, and industrial hy-
(including interns in internships in osteopathic medicine), resi-
gienists, and other professionals, practicing full- or part-time in
dents, practicing physicians, or other medical personnel, who are
the field of occupational health in order to upgrade their pro-
in need thereof, who are participants in any such program, and
ficiency in delivering such services;
who plan to specialize or work in the practice of family medicine;
"(C) the establishment and operation of projects designed
"(3) to plan, develop, and operate a program for the train-
to increase admissions to and enrollment in occupational health
ing of physicians who plan to teach in family medicine training
programs of individuals who by virtue of their background and
programs; and
interests are likely to engage in the delivery of occupational
"(4) to provide financial assistance (in the form of traineeships
health services;
and fellowships) to physicians who are participants in any such
students; "(D) the establishment of traineeships for industrial hygiene
program and who plan to teach in a family medicine training
program.
"(E) the establishment and operation of medical residencies
"(b) The Secretary may make grants to any public or nonprofit
in the field of occupational health at a level of financial support
private school of dentistry or accredited postgraduate dental training
comparable to that provided to such individuals for residencies
institution-
in other medical specialties;
"(1) to plan, develop, and operate an approved residency pro-
"(F) the establishment and operation of traineeships in the
gram in the general practice of dentistry; and
field of occupational health for medical students, residents, nurs-
"(2) to provide financial assistance (in the form of traineeships
disciplines; ing students, nurses, physicians, sanitarians, and other relevant
and fellowships) to residents in such a program who are in need
of financial assistance and who plan to specialize in the practice
"(G) the establishment and operation of short-term trainee-
of general dentistry.
ships for continuing education in the field of occupational health
"(c) Not less than 10 percent of the amount appropriated to make
for any of the health profession disciplines dealing with prob-
grants under this section shall be made available for grants under
lems of occupational health; and
subsection (b).
"(H) the appointment of full-time staff for the center, who
"(d) There are authorized to be appropriated to make grants
have training, experience and demonstrated capacity for leader-
under this section $40,000,000 for the fiscal year ending September 30,
ship in the field of occupational health.
1978, $45,000,000 for the fiscal year ending September 30, 1979, and
$50,000,000 for the fiscal year ending September 30, 1980.
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83
"EDUCATIONAL ASSISTANCE TO INDIVIDUALS FROM DISADVANTAGED
BACKGROUNDS
"(D) The Secretary shall determine the amount of any grant under
this subsection; but no such grant to any school may exceed-
"Sec. 787. (a) (1) For the purpose of assisting individuals from
"(A) in the case of the year preceding the first year in which
disadvantaged backgrounds, as determined in accordance with criteria
such school has students enrolled, an amount equal to the product
prescribed by the Secretary, to undertake education to enter a health
of $10,000 and the number of full-time students which the Secre-
profession, the Secretary may make grants to and enter into contracts
tary estimates will enroll in such school in such first year;
with schools of medicine, osteopathy, public health, dentistry,
(B) in the case of the first year in which such school has stu-
veterinary medicine, optometry, pharmacy, and podiatry and other
dents enrolled, an amount equal to the product of $7,500 and the
public or private nonprofit health or educational entities to assist in
number of full-time students enrolled in such school in such year;
meeting the costs described in paragraph (2).
"(0) in the case of the second year in which such school has
"(2) A grant or contract under paragraph (1) may be used by the
students enrolled, an amount equal to the product of $5,000 and
health or educational entity to meet the cost of-
the number of full-time students enrolled in such school in such
(A) identifying, recruiting, and selecting individuals from
year;
disadvantaged backgrounds, as 80 determined, for education and
"(D) in the case of the third year in which such school has stu-
training in the health professions,
dents enrolled, an amount equal to the product of $2,500 and the
(B) facilitating the entry of those individuals into such a
number of full-time students enrolled in such school in such year.
school,
Estimates by the Secretary under this subsection of the number of
(C) providing counseling or other services designed to assist
full-time students enrolled in a school may be made on the basis of
those individuals to complete successfully their education at
assurances provided by the school.
such a school,
(3) A grant may not be made under this subsection unless an ap-
"(D) providing, for a period prior to the entry of those in-
plication for such grant is submitted, and approved by the ,Secretary.
dividuals into the regular course of education of such a school,
The Secretary shall give priority to applications which provide for
preliminary education designed to assist them to complete suc-
projects which-
cessfully such regular course of education at such a school, or re-
(4) assist in the planning, development, or initial operation
ferring such individuals to institutions providing such pre-
of a new school of medicine, osteopathy, or dentistry (i) which
liminary education, and
will conduct exceptionally innovative programs for training
'(E) publicizing existing sources of financial aid available to
students in ambulatory primary care in cooperation with accred-
persons enrolled in the education program of such a school or who
ited psychiatric practitioners or program, as appropriate, or
are undertaking training necessary to qualify them to enroll in
(ii) which will have as a major objective the provision of train-
such a program.
ing opportunities for individuals from disadvantaged back-
"(b) There are authorized to be appropriated $20,000,000 for the
grounds;
fiscal year ending September 30, 1978, $20,000,000 for the fiscal year
(B) assist in the planning, development, expansion, or initial
ending September 30, 1979, and $20,000,000 for the fiscal year ending
operation of a regional health profession school granting a degree
September 30, 1980, for payments under grants and contracts under
in one or more of the following professions: medicine, osteopathy,
subsection (a).
dentistry, veterinary medicine, optometry, podiatry, or public
health; or
"PROJECT GRANT AUTHORITY FOR START-UP ASSISTANCE, FINANCIAL DISTRESS
"(C) the Secretary determines will meet a national or regional
INTERDISCIPLINARY TRAINING, AND CURRICULUM DEVELOPMENT
need for members of the profession to be trained in the new
"Sec. 788. (a) (1) In the case of any new school of medicine, osteo-
school for which the application is submitted.
pathy, dentistry, public health, veterinary medicine, optometry,
"(4) The Secretary shall give special consideration to each applica-
pharmacy, or podiatry which begins instruction after July 1, 1974,
tion of a school for a grant under this subsection-
the ,Secretary may, after taking into account-
(A) which application contains or is reasonably supported
"(A) the ability of such school to use a grant under this sub-
by assurances, that, because of the use that the school will make
section to (i) accelerate the date it will begin instruction, or (ii)
of existing facilities (including Federal medical or dental facili-
increase the number of students in its entering class, and
ties), it will be able to accelerate the date on which it will begin
"(B) the other resources available to such school,
its teaching program;
make a grant to such school for each year such school is a new school
'(B) which school will be located in a health manpower short-
(as determined under paragraph (5)). No school may receive a grant
age area (designated under section 332) ; or
under this subsection unless the Secretary estimates that the number
"(C) which school is a school of medicine or osteopathy which
will be located in a State which has no other such school.
of full-time students enrolled in its first school year of operation will
exceed twenty-three.
"(5) For purposes of this subsection, any school of medicine, osteop-
athy, dentistry, public health, veterinary medicine, optometry, phar-
84
85
macy, or podiatry shall be considered a new school for any year if such
shall give special emphasis to a description of the results of the cost
year is the year preceding the first year in which such school has stu-
analysis study carried out under paragraph (2) (B) and the opera-
dents enrolled, such first year, and the next two years.
tional, managerial, and financial reforms instituted under paragraph
(3) (1) The Secretary may make grants to and enter into contracts
(2) (C).
with, schools of medicine, osteopathy, dentistry, veterinary medicine,
(c) The Secretary may make grants to any health profession,
optometry, pharmacy, podiatry, or public health for the purposes of
allied health profession, or nurse training institution, or to any other
assisting in-
public or nonprofit private entity for the encouragement of the devel-
(4) (i) meeting the costs of operation of any school of medi-
opment of programs for cooperative interdisciplinary training among
cine, osteopathy, dentistry, veterinary medicine, optometry, phar-
schools of medicine, osteopathy, dentistry, veterinary medicine, optom-
macy, podiatry, and public health if they are in serious financial
etry, pharmacy, podiatry, nursing, public health, and allied health,
distress, or
emphasizing-
(ii) meeting accreditation requirements, if they have special
'(1) the use of the team approach to the delivery of health
need to be assisted in meeting such requirements, and
services,
"(B) carrying out appropriate operational, managerial, and
"(2) the training of physician assistants and extenders and
financial reforms on the basis of information obtained in com-
nurse practitioners with physicians and expanded function dental
information. prehensive cost analysis study or on the basis of other relevant
auxiliaries with dentists, and
"(3) the training of physicians, dentists, nurses, and other
"(2) Any grant under this subsection may be made upon such terms
health professionals in the organization, management, and effec-
and conditions as the Secretary determines to be reasonable and neces-
tive utilization of such extenders, practitioners, and auxiliaries.
sary, including requirements that the school agree-
"(d) The Secretary may make grants and enter into contracts with
"(A) to disclose any financial information or data deemed by
any health profession, allied health profession, or nurse training
the Secretary to be necessary to determine the sources or causes
institution, or any other public or nonprofit private entity for projects
of that school's financial distress,
and programs such as-
(B) to conduct a comprehensive cost analysis study in coopera-
(1) speech pathology, audiology, bioanalysis, and medical
tion with the Secretary, and
technology;
"(C) to carry out appropriate operational, managerial, and
(2) establishing humanism in health care centers;
financial reforms (as the Secretary may require), including the
(3) biomedical combined educational programs;
securing of increased financial support from State or local govern-
"(4) cooperative human behavior and psychiatry in medical
mental units or the increasing of tuition on the basis of informa-
and dental education and practice;
tion obtained in the course of a comprehensive cost analysis study
(5) bilingual health clinical training centers;
or on the basis of other relevant information.
(6) curriculum development in schools of optometry, phar-
"(3) An application for a grant under this subsection must contain
macy and podiatry;
or be supported by assurances satisfactory to the Secretary that the
(7) social work in health care;
applicant will expend in carrying out its function of a school of medi-
(8) health manpower development;
cine, osteopathy, dentistry, veterinary medicine, optometry, pharmacy,
" (9) environmental health education and preventive medicine;
podiatry, or public health as the case may be, during the fiscal year for
" (10) the special medical problems related to women;
which such grant is sought an amount of funds (other than funds for
" (11) the development or expansion of regional health pro-
construction, as determined by the Secretary) from non-Federal
fessions schools;
sources which is at least as great as the average amount of funds ex-
(12) training of citizens of the United States from foreign
pended by such applicant for such training in the preceding two
health professions schools to enable them to enroll in residency
years.
programs in the United States;
"(4) In the case of a school which has received a grant under this
(13) psychology training programs;
subsection in the immediately preceding fiscal year, the amount
" (14) ethical implications of biomedical research;
granted to that school under this section in any fiscal year may not
" (15) establishment of dietetic residencies;
exceed 75 percent of the amount granted to that school under this sub-
" (16) regional systems of continuing education;
section in that immediately preceding fiscal year.
(17) computer technology;
"(5) The Secretary may provide to any school eligible for a grant
(18) training of professional standards review organization
under this subsection technical assistance to enable the school to con-
staff;
duct a comprehensive cost analysis study of its operations, to identify
(19) training of health professionals in human nutrition and
operational inefficiencies, or to develop or carry out appropriate opera-
its application to health.
tional, managerial, and financial reforms.
(20) health manpower development for the Trust Territories
(6) The Secretary shall prepare and submit on or before September
and incorporated Trust Territories of the United States; and
30, 1978, a report on the administration of this subsection. Such report
86
87
(21) training in the diagnosis, treatment, and prevention of
aged. the diseases and related medical and behavioral problems of the
cation as the accrediting body for schools of medicine respecting
approval of the application.
"(e) (1) There are authorized to be appropriated to carry out the
(3) No institution or facility may receive more than one grant
provisions of this section (other than the provisions of subsections
under this subsection. For payment under grants under this subsection,
(f) and (g)) $25,000,000 for the fiscal year ending September 30, 1978,
there is authorized to be appropriated $1,500,000 for the fiscal year
$25,000,000 for the fiscal year ending September 30, 1979, and $25,000,-
ending September 30, 1977 and $1,500,000 for the fiscal year ending
000 for the fiscal year ending September 30, 1980.
September 30, 1978.
'(2) From the sums authorized to be appropriated under paragraph
(4) Upon graduation of the second class from each school of medi-
(1) not more than-
cine for which a grant was made under this subsection, the Secretary
"(A) $5,000,000 may be obligated or expended for the pur-
shall report to the Congress on the ability of the school of medicine to
poses of subsection (a), and
improve access to health care for residents of the geographical regions
(B) $5,000,000 may be obligated or expended for the purposes
in which the clinical training programs of the school are located.
poses of subsection (b).
(f) (1) The Secretary may make grants to any school of medicine
"GENERAL PROVISIONS
to meet the planning costs for projects for the training of students,
enrolled in the last two years of such school, in facilities-
"SEC. 789. Except as otherwise provided in this part:
"(4) which are other than the principal teaching facilities of
"(1) No grant may be made or contract entered into under this part
the school receiving the grant and which are existing Federal
unless an application therefor has been submitted to, and approved
health care facilities or are other public or private health care
by, the Secretary. Such application shall be in such form, submitted
facilities; and
in such manner, and contain such information, as the Secretary shall
"(B) which are located in a health manpower shortage area.
by regulation prescribe. The Secretary may not approve or disap-
No grant may be made under this paragraph with respect to any project
prove any application for a grant or contract under this part except
unless before the fiscal year for which the grant is to be made the
after consultation with the National Advisory Council on Health Pro-
project has received at least $100,000 from non-Federal sources and
fessions Education.
has been approved by the legislature of the State in which it is located.
(2) Payments by recipients of grants or contracts under this part
"(2) For payments under grants under paragraph (1), there are
for (A) traineeships shall be limited to such amounts as the Secre-
authorized to be appropriated $400,000 for the fiscal year ending Sep-
tary finds necessary to cover the cost of tuition and fees of, and sti-
tember 30, 1977.
pends and allowances (including travel and subsistence expenses and
"(g) (1) The Secretary may make grants to public and nonprofit
dependency allowances) for the trainees; and (B) fellowships shall
private institutions of higher education and hospitals and other health
be limited to such amounts as the Secretary finds necessary to cover
care delivery facilities which are engaged in the development of new
the cost of advanced study by, and stipends and allowances (including
schools of medicine to assist such institutions and facilities in meeting
travel and subsistence expenses and dependency allowances) for, the
the costs of employing faculty, acquiring equipment, and taking such
fellows.
other action related to the initial operation of a school of medicine as
(3) The amount of any grant or contract under this part shall be
may be necessary for the proposed schools to meet the eligibility re-
determined by the Secretary. Contracts may be entered into under this
quirements for a grant under subsection (a) of this section.
part without regard to sections 3648 and 3709 of the Revised Statutes
"(2) No application for a grant under paragraph (1) may be ap-
(31 U.S.C. 529; 41 U.S.C.5)
proved by the Secretary unless the application contains or is supported
by assurances satisfactory to the ,Secretary that-
TRANSITIONAL PROVISIONS AND REPORTS ON AREA HEALTH EDUCATIONAL
"(A) with the assistance provided under the grant applied for
CENTERS
the applicant will be able to accelerate the date on which the school
SEC. 802. (a) For the fiscal year ending September 30, 1978, and
its teaching program,
of medicine being developed by the applicant will be able to begin
for the next fiscal year there are authorized to be appropriated such
(B) there is a reasonable indication of non-Federal financial
sums as may be necessary to continue payments to entities under con-
tracts entered into under section 774 of the Public Health Service Act
resources for development and operation of such school, and
"(O) the school of medicine will emphasize training programs
(as in effect on September 30, 1977) for projects for area health edu-
in family medicine and will improve access to health care for resi-
cation centers, except that no payment shall be made to an entity
dents of the geographical regions in which such training pro-
under such a contract in the fiscal year ending September 30, 1979,
grams are located.
unless the entity provides assurances satisfactory to the Secretary
The ,Secretary may not approve or disapprove an application unless he
that not later than September 30, 1979, the project for which the pay-
has consulted with the body recognized by the Commissioner of Edu-
ment is to be made will be a project described in subsection (a) of
section 781 of such Act (as added by this Act) and the entity and
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89
its application will meet the requirements of subsections (c), and
(d) of such section. Such payments may only be made from such
$20,000,000 for the fiscal year ending September 30, 1977, and.
sums for the periods and amounts specified in such contracts.
$25,000,000 for the fiscal year ending September 30, 1978.".
(3)~After October 1, 1978, the Secretary of Health, Education,
and Welfare shall assess the program of contracts under section 781
HEALTH PLANNING
of the Public Health Service Act (as 80 added) to determine the effect
Sec. 902. (a) Section 1512 (3) (3) (c) (ii) (I) is amended by inserting
of the projects funded under such contracts on the distribution of
"optometrists," after "nurses,".
health manpower and on the access to and the quality of health care
(b) Section 1531(3) (4) is amended by inserting "optometrist,"
in the areas in which such projects are located. Not later than Septem-
after "podiatrist,".
ber 30, 1979, the Secretary shall submit to the Congress a report on
(c) The amendments made by subsections (a) and (b) shall take
the assessment conducted under this subsection.
effect on the date of enactment of this Act.
TITLE IX-MISCELLANEOUS
STUDY RELATING TO CHIROPRACTIC HEALTH PROFESSIONS
NURSE TRAINEESHIPS
SEC. 903. (a) (1) The Secretary shall arrange for the conduct of a
study or studies to determine the national average annual per student
SEC. 901. (a) The second sentence of section 830(b) is amended to
educational cost of providing education programs which lead to a
read as follows: "In making grants for traineeships under this section,
degree of doctor of chiropractics.
the Secretary shall give special consideration to applications-
(2) Such study shall be completed and an interim report thereby
Sec. 901. Section 830 is amended-
submitted not later than March 30, 1978, and a finat report not later
(1) by striking out in subsection (a) "There are authorized"
than January 1, 1979, to the Secretary, the Committee on Labor and
and all that follows through "1978," and inserting in lieu thereof
Public Welfare of the Senate, and the Committee on Interstate and
"(1) The Secretary may make grants to public or private non-
Foreign Commerce of the House of Representatives.
profit institutions";
(3) Such study shall develop methodologies for ascertaining the
(2) by redesignating paragraphs (1), (2), (3), and (4) of
average annual cost of chiropractic education, and the factors that
subsection (a) as subparagraphs (A), (B), (0), and (D),
affect any variation among schools with respect to their average annual
(3) by striking out subsection (b) and inserting in lieu thereof
per student educational costs. The study shall employ the most recent
the following:
data available from the chiropractic schools in the United States at
"(2) In making grants for traineeships under this subsection, the
the time of the study.
Secretary shall give special consideration to applications for trainee-
(4) The study shall also determine the current demand for chiro-
ship programs (4) for the training of nurse practitioners who will
practic services throughout the United States and shall develop
practice in health manpower shortage areas (designated under section
methodologies for determining if current supply of chiropractors is
332), and (B) for traineeship programs which conform to guidelines
sufficient to meet this demand.
established by the Secretary under section 822 (a) (2) (B).";
(5) The study shall include an analysis of the current costs of chiro-
(4) by striking out "section" in subsection (c) and inserting in
practic services by type of service and shall include an analysis of
lieu thereof "subsection";
such costs over the past five years.
(5) by redesignating subsection (c) as paragraph (3); and
(b) The Secretary shall enter into an agreement with an appro-
(6) by adding at the end thereof the following:
priate nonprofit group or association to conduct such a study under
"(b) (1) The ,Secretary may make grants and enter into contracts
an arrangement which reimburses for actual expenses incurred by
with schools of nursing, medicine, and public health, public or non-
such group or association in conducting such a study. Such expenses
profit private hospitals, and other nonprofit entities to establish and
will be paid by the Secretary.
operate traineeship programs to train nurse practitioners who are resi-
(c) The provisions of this section shall take effect on the date of
332). dents of a health manpower shortage area (designated under section
enactment of this Act.
"(2) Traineeships funded under this subsection shall include 100
STUDIES OF TRAINING IN BILINGUAL AND BICULTURAL AWARENESS AND OF
percent of the costs of tuition, reasonable living and moving expenses
ADMISSIONS EXAMINATIONS OF PERSONS FROM POPULATION GROUPS OF
(including stipends), books, fees, and necessary transportation.
LIMITED ENGLISH SPEAKING ABIILTY
(3) A traineeship funded under this subsection shall not be
awarded unless the recipient enters into a commitment with the Sec-
Sec. 904. (a) The Secretary of Health, Education, and Welfare
retary to practice as a nurse practitioner in a health manpower short-
shall conduct, or arrange for the conduct of, a study of the adequacy of
age area (designated under section 332).
the efforts of health professions schools which provide training in
"(c) There are authorized to be appropriated for the purposes of
facilities which serve populations of limited English-speaking ability
this section $15,000,000 for the fiscal year ending June 30, 1976,
(1) in recruiting and training individuals who are competent in the
76-510 0- 76 6
91
90
graphic area necessary to provide adequate medical care, including
predominant language (other than English) spoken by such popula-
such care in hospitals, nursing homes, and other health care institu-
tions, and (2) in conducting programs to increase the awareness of
tions, in such area.
such individuals of the cultural sensitivities of such populations.
(c) The Secretary of Health, Education, and elfare shall develop
(b) The Secretary of Health, Education, and Welfare shall con-
such data after consultation with such medical or other associations as
duct, or arrange for the conduct of, a study or studies to determine the
may be necessary.
effectiveness of health training institution admissions examinations in
evaluating accurately the potential and ability of the student applicant
And the Senate agree to the same.
from a population group of limited English-speaking abilty to partici-
HARLEY O. STAGGERS,
pate in and successfully complete the educational program. Such study
PAUL G. ROGERS,
or studies shall particularly consider the extent of any cultural bias in
DAVID E. SATTERFIELD,
admissions examinations utilized by such institutions.
RICHARD PREYER,
(c) Within one year of the date of enactment of this Act the Secre-
JAMES W. SYMINGTON,
tary shall report to the Congress the findings made in the studies
JAMES H. SCHEUER,
conducted pursuant to subsections (a) and (3), recommendations for
HENRY A. WAXMAN,
administrative action and legislation, and the steps taken to carry out
JAMES J. FLORIO,
such action.
CHARLES J. CARNEY,
DEFINITION OF STATE
ANDREW MAGUIRE,
Sec. 905. (a) Section 2(f) is amended to read as follows:
SAMUEL L. DEVINE,
'(f) Except as provided in sections 314(g) (4) (B), 317(h) (2),
TIM LEE CARTER,
318(c) (1), 331 (h) (3), 355 (5), 361 (d), 701 (9), 1002 (c), 1201(2), 1410
JAMES T. BROYHILL,
(13), 1531(1), and 1633(1), the term 'State' includes, in addition to
EDWARD R. MADIGAN,
the several States, only the District of Columbia, Guam, the Common-
Managers on the Part of the House.
wealth of Puerto Rico, the Commonwealth of the Northern Mariana
EDWARD KENNEDY,
Islands, and the Virgin Islands."
H. A. WILLIAMS,
(3) (1) Section 361 (d) is amended by adding at the end thereof
GAYLORD NELSON,
the following: "For purposes of this subsection, the term 'State' in-
THOMAS F. EAGLETON,
cludes, in addition to the several States, only the District of Colum-
ALAN CRANSTON,
bia.".
CLAIBORNE PELL,
(2) Section 1410 is amended by adding paragraph (12) the
WILLIAM D. HATHAWAY,
following new paragraph:
JOHN A. DURKIN,
"(13) The term 'State' includes, in addition to the several
RICHARD S. SCHWEIKER,
States, only the District of Columbia, the Commonwealth of
J. K. JAVITS,
Puerto Rico, the Commonwealth of the Northern Mariana I8-
J. GLENN BEALL, Jr.,
lands, the Virgin Islands, Guam, American Samoa, and the
ROBERT TAFT, Jr.,
Trust Territory of the Pacific Islands.".
ROBERT T. STAFFORD,
(3) Sections 314(g) (4) (B), 317 (2), (5), 1002(c), 1201 (2),
PAUL LAXALT,
and 1633 (1) are amended by inserting "The Commonwealth of the
Managers on the Part of the Senate.
Northern Mariana Islands," immediately after "Puerto Rico," in each
such section.
(4) Section 318 (1) is amended by inserting "The Commonwealth
of the Northern Mariana Islands," immediately after "American
Samoa,".
LABOR CERTIFICATION
SEC. 906. (a) The Secretary of Health, Education, and W elfare shall
(not later than one year after the date of the enactment of this Act)
develop sufficient data to enable the ,Secretary of Labor to make equi-
table determinations with regard to applications for labor certification
by graduates of foreign medical schools.
(3) The data required under subsection (a) shall include the num-
ber of physicians (by specialty and by percent of population) in a geo-
JOINT EXPLANATORY STATEMENT OF THE COMMITTEE
OF CONFERENCE
The managers on the part of the House and Senate at the conference
on the disagreeing votes of the two Houses on the amendment of the
Senate to the bill (H.R. 3546) to amend the Public Health Service
Act to revise and extend the programs of assistance under title VII of
such act for training in the health and allied health professions, to
revise the National Health Service Corps program and the National
Health Service Corps scholarship training program, and for other
purposes, submit the following joint statement to the House and the
Senate in explanation of the effect of the action agreed upon by the
managers and recommended in the accompanying conference report:
The Senate amendment struck out all of the House bill after the enact-
ing clause and inserted a substitute text. The House recedes from its
disagreement to the amendment of the Senate with an amendment
which is a substitute for the House bill and the Senate amendment.
The principal differences between the House bill, the Senate amend-
ment, and the substitute agreed to in conference are noted below.
SHORT TITLE
The House bill provided that the act was to be cited as the "Health
Manpower Act of 1975".
The Senate amendment provided that the act was to be cited as the
"Health Professions Educational Assistance Act of 1976".
The conference substitute conforms to the Senate amendment.
EXTENSION OF EXISTING AUTHORITIES
The House bill extended, without substantive revision, existing au-
thorities relating to health manpower through fiscal year 1975 at the
fiscal year 1974 authorization levels.
The Senate amendment extended most existing authorities through
fiscal year 1977, and made substantive revisions through such fiscal
year in the authorities for construction of teaching facilities. It ex-
tended the existing authority for loans and scholarships to United
States students enrolled in foreign medical schools through fiscal
year 1980. It also extended, with substantive revisions, the existing
authority for grants for training in family medicine through fiscal
year 1980. Under the Senate amendment, the fiscal year 1976 authori-
zations reflected the higher of the fiscal year 1975 appropriation and
the fiscal year 1975 budget request. The fiscal 1977 levels reflected the
higher of the fiscal year 1976 appropriations times 1.072 (the cost
of living increment, as determined by the Senate Budget Committee)
and the fiscal year 1977 budget request.
The conference substitute provides for an extension of existing pro-
grams through fiscal year 1976 at the fiscal year 1974 authorization
(93)
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95
levels. It includes the line-item authorizations for fiscal year 1977
provided by the Senate amendment, and makes substantive revisions
The House bill contained no comparable provision.
for fiscal year 1977 in the existing construction authority. As noted
In lieu of the provisions of the Senate amendment, the conference
substitute authorizes the award of special project grants, described
below, the substantive revisions with respect to grants for traineeships
and fellowships in family medicine are made applicable beginning in
below, for the development of programs of interdisciplinary health
fiscal year 1978. Finally, under the conference substitute, the programs
personnel training.
of loans and scholarships for United States citizens studying abroad
PRESERVATION OF ACADEMIC FREEDOM
are extended only through fiscal year 1976.
The Senate amendment included a provision whereby it was ex-
TRAINING IN BILINGUAL AND BICULTURAL AWARENESS AND STUDY OF
pressly declared to be the intent of Congress to supersede any laws
ADMISSIONS EXAMINATIONS
of States or political subdivisions insofar as they prevent training
authorized under the Public Health Service Act.
The Senate amendment required that any entity seeking assistance
under the Public Health Service Act which provides training in
The House bill contained no comparable provision.
facilities providing health services to an area where a substantial
The conference substitute does not include the Senate provision.
portion of individuals served is of limited English-speaking ability
ADVISORY COUNCIL
shall include in its application for assistance assurances that it will
(1) place special emphasis on the recruitment and training of per-
The House bill amended the provisions of existing law with respect
sonnel who are competent in the predominant language other than
to the composition of the National Advisory Council on Health Pro-
English spoken by such individuals and (2) plan and operate projects
fessions Education to require that, of the appointed members of the
to increase the awareness of their trainees of the cultural sensitivities of
council, twelve shall be representatives of health professions schools,
such individuals. The Senate amendment also required the Secretary to
two shall be full-time students enrolled in such schools, and six shall be
arrange for the conduct of a study to determine the effectiveness of the
members of the general public.
admissions examinations of health training institutions in evaluating
The Senate amendment contained no comparable provision.
the potential and ability of applicants from population groups of
The conference substitute conforms to the provisions of the House
limited English-speaking ability to participate in and successfully
bill except that of the twelve representatives of health professions
complete the educational program of the institution.
schools, at least four are to be representatives of schools of veterinary
The House bill contained no comparable provisions.
medicine, optometry, podiatry, pharmacy and public health.
Under the conference substitute, the Secretary is required to arrange
The conferees view the efficient implementation of the various pro-
for the conduct of two studies: the first to determine the effectiveness
grams for grants authorized by the conference substitute as a top
of admissions examinations in evaluating the potential of applicants
priority of the National Advisory Council. In this regard, the con-
from population groups of limited English-speaking ability and the
ferees fully expect that each of the programs will be administered
second to determine the adequacy of efforts by health training insti-
expeditiously and in a way that will insure that only quality pro-
tutions which provide training in facilities serving populations with
grams which have passed the rigors of scientific review will be ap-
limited English-speaking ability to recruit and train health personnel
proved. It is, therefore, the intent of the conferees that sufficient
who are bilingual and to conduct programs to increase the awareness
advisory committees be established as complements to the Advisory
of those trainees of the cultural sensitivities of population groups with
Council in order that grant applications may be evaluated in a timely
limited English-speaking ability. The conferees agreed that if the
manner with appropriate advice and recommendations prepared for
findings of either study indicate a need for legislation, they will give
final action by the National Advisory Council. It is intended that
serious consideration to remedial legislation without awaiting expira-
separate advisory committees be established SO that they represent the
tion and reconsideration of renew the authorities in the conference re-
disciplines of (1) medicine and osteopathy, (2) dentistry, and (3) vet-
port. The conference substitute also provides special project grant
erinary medicine, optometry, pharmacy, podiatry, and public health.
authority, described below, designed to encourage the recruitment and
The conferees feel strongly that review of grants by experts in the
training of bilingual personnel and the establishment of programs to
discipline which is the subject of the grant application is necessary if
increase awareness of cultural sensitivities.
sufficient technical expertise is to be available to insure that each
application receives thorough review. by qualified persons.
INTERDISCIPLINARY HEALTH PERSONNEL TRAINING
Both the House bill and the Senate amendment included provisions
The Senate amendment required that, in providing assistance under
which prohibited the Secretary from delegating to regional offices his
the Public Health Service Act to any entity for the training of health
authority to (1) review and prepare comments upon the merit of any
personnel, the Secretary take affirmative steps to encourage the de-
grant or contract under any health manpower program for the pur-
velopment of programs for cooperative interdisciplinary training
poses of presenting such application to the National Advisory Coun-
among the various health professions.
cil on Health Professions Education, and (2) to make such a grant or
contract.
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97
The conferees made their intention clear that this provision
cludes only the making of comments on such applications for purposes pre-
other educational costs for which he would be responsible for pay-
of presenting them to the Advisory Council, and does not constitute a
ment under the Public Health Service Act.
applications. blanket prohibition of regional office comment on grant or contract
The House bill contained no comparable provision.
The conference substitute adopts the provision of the Senate amend-
HEALTH PROFESSIONS DATA
ment except that the determination is limited to tuition and other ed-
ucational costs for which the Secretary is responsible for payment
The Senate amendment contained a provision requiring the Secre-
under title VII of the Public Health Service Act.
tary to establish a program to collect, compile, and analyze data on
health professions personnel (including data respecting their train-
ACCREDITATION OF NONAFFILIATED RESIDENCIES
characteristics, place and date of birth, sex, and socioeconomic back-
ing, licensure status, place of practice, professional specialty, practice
Under the Senate amendment the Commissioner of Education was
ground). It authorized the Secretary, in the collection of such data,
directed not to recognize any entity for the purposes of accrediting
studies of the health professions as well as to make grants and enter
to enter into contracts for the conduct of analytic and descriptive
graduate medical education, or to revoke recognition, in the case
where he has recognized such an entity for such purposes, where the
into contracts with States (or appropriate nonprofit private entities
entity has either accredited or proposed to accredit a graduate medical
within States) for the purpose of establishing a uniform health
residency training program in a hospital which is not contractually
fessions data reporting system. Further, the Senate amendment pro- re-
affiliated with an accredited school of medicine or osteopathy.
quired any school receiving institutional support under the bill to
The House bill contained no comparable provision.
make reports annually to the Secretary respecting students which
The conference substitute does not contain the Senate provision.
to attend the such school. The Senate amendment required an annual report
However, as described in more detail below, the conference agree-
Congress and to the President on the status of health professions
ment does contain broad authorities to enable the Secretary to deter-
personnel in the United States. Finally, the Senate amendment
mine whether a medical residency training program is, in fact,
vided for the confidentiality of personal data secured for the purposes pro-
affiliated with a school of medicine for purposes of determining com-
described above.
pliance with eligibility requirements for capitation support. More-
The House bill contained no comparable provisions.
over, the conference report contains a requirement that, if the
Secretary determines that a school of medicine has disaffiliated with a
amendment with technical amendments.
The conference substitute includes the provisions of the Senate
medical residency training program for the purpose of compli-
ance with such requirements but continued to provide training sup-
SHARED SCHEDULE RESIDENCIES
port for such a program, he is to deny such school capitation support.
The Senate amendment required that any entity which maintains
SOLDIERS' AND SAILORS' CIVIL RELIEF ACT
eral a post-graduate physician training position in family practice,
internal medicine, general pediatrics, or general obstetrics gen- and
The House bill contained a provision which equated active service
gynecology and which receives financial support under title VII of the
of commissioned officers of the Public Health Service with active
Public Health Service Act shall, in the fiscal year in which it received
service in the armed forces of the United States for the purpose of
such financial assistance, establish a reasonable number of such
rights, privileges. immunities, and benefits under the Soldiers' and
tions as "shared schedule positions." "Shared schedule positions" posi-
Sailors' Civil Relief Act of 1940.
but individuals in which each individual (1) engages in at least two-thirds
defined as a post-graduate training position which is shared by was two
The Senate amendment contained no comparable provision.
The conference agreement contains no such provision since the con-
not more than three-fourths of the total training for such position,
ferees noted that the provision was included in Public Law 94-278,
(2) receives for each year in such position an amount of credit for
enacted after the passage of the House bill.
for the trainee was engaged, (3) receives one-half of the salary
in certification which in the medical specialty equal to the amount of training
ASSISTANCE FOR CONSTRUCTION OF TEACHING FACILITIES
The such position, and (4) receives all applicable employee benefits.
House amendment contained no comparable provision.
The House bill continued the existing program of assistance for
The conference substitute conforms to the Senate amendment,
construction of teaching facilities with the following revisions: (1)
cept tions that is the requirement to maintain shared schedule residency posi- ex-
it added facilities for the training of professional public health per-
applicable to all entities that receive Federal assistance.
sonnel as entities eligible for such assistance; (2) it required that
grants for construction projects for teaching facilities for the training
PAYMENT FOR INCREASES IN RESPONSIBLE TUITION FOR WHICH THE SECRETARY Is
of physicians located in a State which has no such facilities shall
cover 80 percent of the construction costs unless the Secretary deter-
mines that such percent is not needed; (3) it required that, in consider-
establish criteria for determining allowable increases in tuition and
The Senate amendment required the Secretary, by regulation, to
ing grant applications for the cost of construction of teaching facilities
for the training of physicians, the Secretary give special consideration
to projects in States which have no such facilities and (4) it author-
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99
ized $25 million per year for fiscal years 1976, 1977, 1978 for the con-
AUTHORIZATIONS OF APPROPRIATIONS FOR LOAN GUARANTEES
struction program.
AND INTEREST SUBSIDIES
The Senate amendment extended the existing program through
fiscal year 1977 with revisions which authorized (1) that, for such
The House bill continued the existing program authorizing loan
fiscal year, an application for the construction of a clinical facility
guarantees and interest subsidies to assist nonprofit private entities to
affiliated with a school of veterinary medicine, optometry, podiatry,
carry out approved construction projects for teaching facilities, and
or pharmacy, which has as its purpose the establishment or expansion
authorized appropriations of $2 million for fiscal year 1976, $3 mil-
of a regional health professions school may be filed by any public or
lion for fiscal year 1977, and $3 million for fiscal year 1978 for the
other nonprofit agency if the application is approved by the school
with which the facility is to be affiliated and that, in connection with
program. The Senate amendment also continued the loan guarantee and inter-
such an application, (2) that only that portion of the project which the
est subsidy program, with authorizations of $3 million for each of
Secretary determines to be reasonably attributable to the need of the
fiscal years 1978, 1979, and 1980.
regional health professions school for teaching facilities shall be re-
The conference substitute authorizes $2 million for fiscal year 1978,
garded as the project with respect to which the application is sub-
$3 million for fiscal year 1979, and $3 million for fiscal year 1980 for
mitted and (3) that, in considering applications for grants under the
the program.
construction authority, the Secretary afford special consideration to
REVISIONS OF STUDENT LOAN PROGRAM
applications for facilities for the establishment or expansion of re-
gional health professions schools.
Both bills contained extensions and revisions of the existing pro-
In addition, the Senate amendment repealed the existing construc-
gram authorizing the Secretary to assist schools of the health profes-
tion authority beginning in fiscal year 1978 and replaced such author-
sions in establishing student loan funds for the purpose of making
ity with authority to make grants (not to exceed the lesser of $1 mil-
loans to students in such schools.
lion or 50 percent of costs) to public and nonprofit private entities
Under the House bill, the following appropriations were authorized
to assist in the construction of ambulatory, primary care teaching
for Federal capital contributions to student loan funds: $30 million
facilities for the training of physicians and dentists. The Senate
for each of fiscal years 1976, 1977, and 1978.
amendment authorized $80 million for fiscal year 1978 and $40 million
Under the Senate amendment, the following appropriations for
for fiscal year 1979 for this purpose.
Federal capital contributions to student loan funds were authorized
Under the conference substitute, the existing program is continued
$22 million for fiscal year 1978, $24 million for fiscal year 1979, and $26
through fiscal year 1980 with the following revisions: (1) the con-
million for fiscal year 1980. Further, the Senate amendment made the
ference substitute adopts the provisions of the Senate amendment with
following revisions in the program: (1) it repealed the prohibition
respect to regional health professions schools and makes such au-
against health professions students receiving both a health professions
thority effective only during fiscal year 1977, (2) the amendment of
student loan and a national defense education loan; (2) it required
the House bill to existing authority which added facilities of schools
that no student of medicine or osteopathy who would graduate that
of public health as eligible entities and the authority of the Senate
June 30, 1978 would be eligible to receive a health professions student
amendment with respect to construction of ambulatory primary care
loan after October 1, 1976 unless such student were of exceptional
teaching facilities for the training of physicians and dentists are added
financial need; and (3) it limited the existing loan forgiveness provi-
to the existing authority, and (3) authorizations of $40 million per
sions to allow repayment only of health professions student loans
year for fiscal years 1978, 1979, and 1980 are provided with the stipula-
through service in a shortage area.
tion that 50 percent of sums appropriated shall be obligated for grants
The conference substitute conforms to the Senate amendment except
for the construction of teaching facilities and the remaining 50 percent
that (1) it prohibits assistance to any medical or osteopathic student
primary care teaching facilities.
shall be obligated for grants for the construction of ambulatory,
who will graduate after June 30, 1979 unless such student is of excep-
tional financial need, and (2) it authorizes the following appropria-
During their deliberations with respect to the construction author-
tions for Federal contributions to student loan funds: $26 million for
ity, the conferees expressed interest in the concept of establishing "twi-
fiscal year 1978, $27 million for fiscal year 1979, and $28 million for
light medical schools" whereby, in effect, two separate student bodies
fiscal year 1980.
could attend one medical school at the same time through utilization
LISTER HILL SCHOLARSHIPS
of the school's facilities during evening hours. The conferees direct
the Secretary of Health, Education, and Welfare to conduct a study
The Senate amendment established a program whereby up to ten
of this concept and to submit a report of his findings with respect to
Lister Hill scholarships each year would be awarded to medical
its feasibility to the appropriate House and Senate committees within
students who agree to enter into the family practice of medicine in
six months of the date of enactment of the conference report.
health manpower shortage areas and authorized appropriations for
such program as follows: $80,000 for fiscal year 1977, $160,000 for
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101
fiscal year 1978, $240,000 for fiscal year 1979, and $320,000 for fiscal
year 1980.
DESIGNATION OF MEDICALLY UNDERSERVED POPULATIONS OR HEALTH
The House bill contained no comparable provision.
MANPOWER SHORTAGE AREAS
The conference substitute conforms to the Senate provision, with
technical amendments.
Under the House bill, the population of an urban or rural area which
the Secretary determined to have a critical health manpower shortage
or a population group determined by the Secretary to have such a
X
REVISIONS TO NATIONAL HEALTH SERVICE CORPS PROGRAM
shortage was to be designated as a "medical underserved population"
and, thus, eligible for service from a National Health Service Corps
ADMINISTRATIVE PROVISIONS
assignee.
The House bill retained the provisions of existing law which require
The Senate amendment, using the term "health manpower shortage
the Secretary to conduct recruiting programs for the National Health
area", defined such an area as (1) an area in an urban or rural area
Service Corps at health professions schools, authorize the Secretary to
which the Secretary determines has a health manpower shortage, (2) a
reimburse applicants for positions in the Corps for expenses incurred
population group which the Secretary determines has such a shortage
in making one trip to an area in which they would be assigned, and
or (3) a public or nonprofit private medical facility or other public
provide that personnel of the Corps engaged in the provision of health
facility (including a Federal facility) which the Secretary determines
services. to underserved populations shall not be counted against
has such a shortage.
employment ceilings affecting the Department of Health, Education,
The conference substitute adopts the provisions of the Senate
and Welfare.
amendment, except that it adds a definition of the term "medical fa-
The Senate amendment did not contain the provisions described
cility".
above. The Senate amendment did require that the identifiable ad-
ministrative unit within the Department of Health, Education, and
REVIEW OF APPLICATIONS FOR ASSIGNMENT OF CORPS PERSONNEL
Welfare which administers programs relating to construction, capita-
tion grants, and grants for family medicine programs concur in ad-
Under the House bill, the Secretary could not approve an applica-
ministrative actions, prior to the issuance thereof, with respect to the
tion for the assignment of a National Health Service Corps member
National Health Service Corps Program and the National Health
to an area unless he had afforded each health systems agency for a
Service Corps Scholarship Program.
health service area which includes any or part of the area in which the
Under the conference substitute, the three administrative provisions
population for which the application is submitted resides (or, if there
contained in the House bill are adopted. In addition, the conference
is part of such area within a health service area for which no health
substitute provides that the administrative unit within the Depart-
systems agency has been designated, the State health planning and
development agency of the State in which such part is located) is af-
ment of Health, Education, and Welfare which administers the pro-
gram relating to capitation grants shall participate in the development
forded an opportunity to review the application and submit comments
of administrative actions, prior to their issuance, with respect to the
respecting the need for and proposed use of the Corps personnel
requested.
Program. National Health Service Corps Program and the Scholarship
The Senate amendment contained no comparable provision.
The conference substitute includes the provisions of the House bill
ADJUSTMENT OF PAY
except that health systems agencies (and where appropriate State
Under the House bill, the Secretary was authorized to adjust the
health planning and development agencies) are afforded 90 days to
monthly pay of each National Health Service Corps physician and
review and comment upon applications.
dentist engaged directly in the delivery of health services, following
the termination of any obligatory service incurred as a result of
PARTICIPATION OF MEDICAL AND OTHER HEALTH PROFESSIONS SOCIETIES
NHSC scholarship support, by an amount not to exceed $1,000 per
IN ASSIGNMENT OF CORPS PERSONNEL
month so that such pay would be competitive with that of members
of their professions with equivalent training and time experience.
The House bill required the certification of a State or district medi-
Upon expiration of the thirty-six month period, such bonus support
cal, osteopathic, dental, or other appropriate health society for a des-
would continue only to the extent necessary to make the National
ignated area to certify to the Secretary that assignment of Corps per-
Health Service Corps member's monthly pay equal to the income he
sonnel is needed for the area prior to the assignment of a National
received for the last month of the thirty-six month period.
Health Service Corps member. The House bill provided for a waiver
The Senate amendment contained no comparable provision.
of this requirement if the Secretary determined that certification had
The conference substitute includes the House provision, except that
clearly been arbitrarily and capriciously withheld.
it Corps. is made applicable to all members of the National Health Service
The Senate amendment required that, in considering an application
for assignment, the Secretary take into consideration comments from
medical, osteopathic, dental or other health professions societies or
individuals in such professions serving the appropriate area.
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103
The conference substitute directs the Secretary to take into consider-
ation the comments of such societies or individuals prior to making an
loan to an entity that was financially unable to meet the full cost
assignment of a National Health Service Corps member to a designated
a of providing facilities. The amount of any such grant could facilities, not ex-
area.
ceed $15,000 or 50 percent of the cost of providing such
WAIVER OF COST SHARING PROVISIONS
whichever is less.
The conference substitute conforms to the House bill except that
Both bills provided authority for the Secretary to waive require-
ments that an entity to which a National Health Service Corps mem-
which (1) authorized as one of the purposes for a loan the renovation exceed
the term "grant" is changed to "loan" (2) the Senate provision of
ber has been assigned pay to the United States an amount equal to
buildings is included and (3) the amount of the loan may not
the assignee's salary, any scholarship support he might have received
$50,000.
under the National Health Service Corps Scholarship Program, and
any amount payed to the entity by the Secretary in order that the
DENIAL OF HOSPITAL PRIVILEGES TO NATIONAL HEALTH
entity could prepare for the arrival of the National Health Service
SERVICE CORPS MEMBERS
Corps member.
Under the House bill the Secretary was authorized to waive, in
The Senate amendment contained a provision, not included in the
whole or in part, such repayment requirements if he determines that
House bill, making it unlawful for any hospital to deny admitting
compliance would unduly limit the ability of the entity to maintain
privileges to a physician or dentist member of the National Health
the quality of the services it provided.
Service Corps when such member otherwise meets the professional the
Under the Senate amendment, the Secretary's determination was to
qualifications established by the hospital and agrees to abide amend- by
be with respect to the ability of the entity to provide for the support
bylaws of the hospital and medical staff. Further, the Senate to
of the provision of health services by Corps members. In addition, the
Senate amendment exempted from the repayment requirement en-
have violated this requirement shall cease to receive and be eligible to
ment provided that any hospital which is found by the Secretary
tities located in a health manpower shortage area in which a signif-
receive federal funds under the Public Health Service Act, and shall
icant percentage of the residents were elderly, living in poverty, or
be liable to the United States for civil penalty of $10,000.
had other characteristics which would indicate an inability to repay
The conference substitute includes the Senate provision.
the required amount.
Under the conference substitute, the Secretary is authorized to waive,
ADVISORY COUNCIL
in whole or in part, the repayment requirement if he finds that the
The House bill repealed the provisions of existing law which estab-
requirement would unreasonably limit the ability of the entity to pro-
lish the National Advisory Council on Health Manpower Shortage
vide for the adequate support of the provision of health services by
Areas and established in its place a council to be known as the National
Corps members. In addition, the Secretary is authorized, but not re-
quired, to grant such a waiver to an entity located in an area in which
Advisory Council on the National Health Service Corps.
The Senate bill repealed the authority for the National Advisory
a significant percentage of the residents of the area are elderly, living
in poverty, or have other characteristics bearing upon ability to repay.
Council on Health Manpower Shortage Areas.
The conference substitute conforms to the provisions of the House
bill.
LOANS AND GRANTS TO ENTITIES TO WHICH NATIONAL HEALTH SERVICE
AUTHORIZATION OF APPROPRIATIONS FOR THE NATIONAL
CORPS PERSONNEL WILL BE ASSIGNED
HEALTH SERVICE CORPS PROGRAM
The House bill authorized the Secretary to make single grants, not-
The House bill authorized appropriations as follows for the Schol-
in excess of $25,000, to entities to which National Health Service
Corps personnel had been assigned for the purpose of establishing
arship Program $30 million for fiscal year 1976, $36 million for fiscal
medical practice management systems, acquiring equipment, and estab-
year 1977, $45 million for fiscal year 1978.
The Senate amendment authorized the following appropriations
lishing continuing education programs for National Health Service
Corps personnel. As noted above, the amount of such grants was
for the program $47 million for fiscal year 1978, $57 million for fiscal
required to be repayed by the entity, although the repayment require-
year 1979, and $70 million for fiscal year 1980.
ment could be waived in whole or in part.
The conference substitute conforms to the Senate amendment.
The conferees intend that persons who volunteer for the National
The Senate amendment authorized the Secretary to make one loan,
without interest, to any entity to which a National Health Service
Health Service Corps should be given greater. consideration in match-
Corps member has been assigned for purposes comparable to those for
ing their preferences for assignment among all health manpower
which the House bill authorized grants except that such a loan could
shortage areas than persons who acquire an obligation to serve in such
also be utilized for the renovation of buildings. No such loan could
areas because of receipt of scholarship support.
The conferees further intend that scholarship recipients should be
exceed $75,000, and repayment could be waived. In addition, the Sen-
ate amendment authorized the Secretary to make one grant in lieu of
assigned to areas of greatest need. In determining assignments, the
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105
Secretary should establish groupings of areas of greatest need and
individual who has previously received such a scholarship or who had
authorize limited assignment choices for scholarship recipients among
received a scholarship for persons of exceptional financial need, and
such groupings.
thereafter priority to individuals who will be entering their first year
of school, and, finally, special consideration to individuals who reside
REVISIONS IN THE NATIONAL HEALTH SERVICE CORPS
in designated medically underserved areas.
SCHOLARSHIP PROGRAM
The House bill contained no comparable provision.
Under the conference substitute, the Secretary is required to give
PERIOD OF OBLIGATED SERVICE
priority in acceptance of applicants for participation in the program
The House bill required each applicant for participation in the
individuals who have previously participated in the Scholarship
(1) for the academic year which begins September, 1978, first Pro- to
National Health Service Corps Scholarship Program to agree to pro-
or who have received scholarships under the program for stu-
vide one year of service for each academic year of training for which
gram dents of exceptional financial need, and, secondly to individuals who
a scholarship was received, or two years of service, whichever is
will be entering their first or second year of training at an accredited
greater.
health professions school; and (2) for each academic year which
The Senate amendment required each participant in the program
begins September, 1979 and thereafter, first to individuals who have have
to serve for a period equal to one year of such service for each year
previously participated in the Scholarship Program or who and
for which the scholarship was received, but required each applicant to
received scholarships for persons of exceptional financial need
accept no less than two years of scholarship support.
secondly to those individuals entering their first year of training at an
The conference agreement conforms to the House provision.
accredited health professions school.
APPLICATION, PROVISIONS OF OFFER, AND CONTRACT
AMOUNT OF SCHOLARSHIP
The Senate amendment required that, to be eligible for acceptance
The House bill provided that a National Health Service Corps
in the National Health Service Corps Program, an individual must
scholarship was to consist of (1) an amount equal to the basic pay
submit an application for acceptance in the program and enter into a
and allowances of a commissioned officer of the Public Health Service
written contract with the Secretary.
on active duty in pay grade O-1 with less than two years of service
In addition, the Senate amendment contained a provision requiring
and (2) payment of the tuition expenses of the participant and all
the Secretary to transmit an offer to each person whose application for
other reasonable educational expenses.
participation in the Scholarship Program had been approved. The
The Senate amendment provided that the scholarship of a partici-
offer was required to include (1) a copy of the approval, (2) necessary
pant in the National Health Service Corps Scholarship Program was for
forms, (3) a summary of the rights and liabilities of the individual
to consist of (1) a stipend of $400.00 per month (with a provision
upon acceptance of the scholarship, and (4) a copy of the contract to
annual increase of a percentage equal to the percentage of the
be entered into by the individual. The contract was required to contain
increase an in the salaries of Federal employees) and (2) tuition and all
(1) an agreement whereby the Secretary agrees to provide the individ-
other reasonable educational expenses.
ual with scholarships for a specified number of years and the individ-
The conference agreement adopts the provisions of the Senate
ual agrees to accept such scholarships and serve for the period of
amendment.
obligated service in an area to which he is assigned by the Secretary,
DEFERRAL OF OBLIGATED SERVICE
(2) a provision that any financial obligation of the United States and
of the student is contingent upon sufficient funds being appropriated
The House bill provided that the Secretary shall, at the request of
to carry out such obligation, (3) provisions for liquidated damages,
of obligated service for the time required for the participant to com-
participants in the NHSC Scholarship Program, defer the beginning
(4) applicable administrative and judicial procedures, and (5) other
significant matters affecting the rights and liabilities of the parties.
plete internship, residency, or other advanced clinical training.
The House bill contained no comparable provision.
Under the Senate amendment, the Secretary was authorized but not
The conference substitute combines the provisions of the Senate
required, to defer the beginning of obligated service for such persons
amendment into one provision whereby the application for acceptance
into the program includes the provisions of the offer and a copy of the
dency, or other advanced clinical training, except that such period
for a period required for a participant to complete internship, resi-
contract which must be signed by the applicant prior to acceptance
could not exceed three years. Under the Senate amendment, the Sec-
into the program.
retary was to give priority in granting a deferral to participants who in
requested such deferral for the purpose of completing such training
PRIORITY AND AWARD OF SCHOLARSHIPS
a medically underserved area, or for the purpose of receiving training
in family medicine, general internal medicine, general pediatrics, and
The Senate amendment required that, in awarding National Health
Service Corps scholarships, the Secretary give initial priority to an
general obstetrics and gynecology.
76-510 76 7
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107
The conference substitute conforms to the House provision except
The Senate amendment permitted but did not require the Secretary
that the period of deferral may not exceed three years.
to release such an individual, conditioned upon the existence of a suffi-
cient financial base in the area in which the individual intended to
REPORTS
practice his profession. It contained no provision authorizing the
award of a grant to such an individual.
The Senate amendment required each member of the National
Under the conference substitute the Secretary is required to release
Health Service Corps during his period of obligatory service and each
from his service obligation a member of the National Health Service
individual released from his service requirement as a member of the
Corps who agrees to enter into the private practice of his profession
Corps to serve in private practice to file a report with the Secretary
in a health manpower shortage area which has a sufficient financial
each year which shall include his activities over the previous year.
base to sustain such practice. The conference substitute contains no
The House bill contained no comparable provision.
provision with respect to the award of a grant to such an individual.
The conference report does not contain the Senate provision. How-
ever, the conferees do not intend that this action be construed as
GOOD MEDICAL PRACTICE REQUIREMENTS
prohibiting reasonable requests for information from such individuals
by the Secretary.
The Senate amendment required that agreements entered into be-
tween the Secretary and persons released from obligated service in
RELEASE TO ENGAGE IN RESEARCH
order to enter private practice contain provisions in order to assure
that the medical practice of such person will be in accordance with the
The Senate amendment contained a provision, not included in the
requirements of good medical practice in effect for Corps members,
House bill, which authorized the Secretary, if he determines that a
including requirements relating to medical records systems, profes-
participant in the National Health Service Corps Program demon-
sional coverage arrangements, and hours of practice.
strates exceptional promise for medical research, to permit such in-
The House bill contained no comparable provision.
dividual to perform his service obligation under the requirements of
The conference substitute does not contain this provision. However,
the National Research Service Award program obligation established
the conferees noted that this action does not preclude the establishment
under section of the Public Health Service Act.
of reasonable regulations by the Secretary to insure that persons re-
The conference substitute conforms to the Senate provision, except
leased for purposes of private practice engage in the full time clinical
that the Secretary may permit such individuals to perform their service
obligation through participation in the National Research Service
practice of their profession and that such practice be of high quality.
Award program.
GRANTS FOR PERSONS WHO HAVE COMPLETED OBLIGATED SERVICE
The conferees intend that the Secretary would use his authority to
release such individuals who demonstrate extraordinary promise re-
The House bill contained a provision authorizing grants to persons
specting biomedical research, given the fact that the principal pur-
who have completed their service obligation and who agree to engage
pose of awarding National Health Service Corps scholarships is to
in the private practice of their profession in a medically underserved
provide health services to medically underserved areas and not simply
area to assist such persons in meeting the costs of beginning the prac-
to provide financial support for health professions students. It is the
tice of their professions. The authorized amount of such grant was
intent of the conferees that, in his annual report to the Congress with
$12,500 if the individual agreed to practice his profession for a period
respect to the Scholarship Program, the Secretary report as to the
of at least one but not less than two years; such amount was to be
number of individuals released from their service obligations under
$25,000 if such individual agreed to practice his profession for a period
the Program during the previous year.
of at least two years.
The Senate amendment contained no comparable provision.
RELEASE FROM OBLIGATION TO ENTER PRIVATE PRACTICE
The conference substitute includes the House provision.
Both bills contained provisions authorizing the release of persons
RECOVERY OF DAMAGES UPON DEFAULT
from their service obligation in order to enter the private clinical
practice of their profession in a health manpower shortage area.
The House bill contained a provision which entitled the United
Under the House bill, the Secretary was required to release such an
States to recover from a person failing to begin or complete his service
individual from his service obligation and was authorized to make one
obligation an amount equal to two times the amount paid under the
grant to any such individual who has agreed to extend the period of
scholarship training program, plus interest at the maximum prevailing
practice under such agreement by a period of not less than one year
legal rate, within a three year period beginning on the date the United
to assist in the costs of beginning the practice of his profession. The
States becomes entitled to recover such amounts. Repayment was to
amount of the grant was authorized to be $12,500 if the individual
be in accordance with a formula designed to encourage participants
agreed to practice his profession for a period of at least one year but
not to fulfill only a portion of their service obligations.
less than two years; such amount was to be $25,000 if the individual
The Senate amendment contained a comparable provision, except
agreed to practice his profession for a period of at least two years.
that repayment was to be at an amount equal to three times the amount
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109
paid under the scholarship training program plus interest, repayable
within 60 days of the period in which the United States becomes en-
$233 million for fiscal year 1980. The Senate amendment further re-
titled to recover the amount.
quired that not less than $68 million for fiscal year 1978, $120 million
Under the conference substitute, the amount the United States is
for fiscal year 1979, and $190 million for fiscal year 1980 be used for
entitled to recover is an amount equal to three times the amount paid
scholarships for medical and osteopathic students and that not less
under the scholarship training program, plus interest, payable within
than $12 million for fiscal year 1978, $24 million for fiscal year 1979,
one year from the date of the breach of the contract entered into be-
and $36 million for fiscal year 1980 be used for scholarships for dental
tween the United States and the individual.
students.
Under the conference substitute, the following appropriations are
TERMINATION OF STUDIES
authorized for the National Health Service Corps Scholarship Pro-
gram : $75 million for fiscal year 1978 $140 million for fiscal year 1979,
The House bill provided that when a participant in the scholarship
and $200 million for fiscal year 1980. In addition, under the conference
program is dismissed for failure to meet academic standing require-
substitute, not less than 90 percent of funds appropriated in any of the
ments or for disciplinary reasons or voluntarily terminates academic
above fiscal years must be for the purpose of awarding scholarships
training, he shall be liable for repayment to the government for an
for medical, osteopathic, or dental students, of which 10 percent must
amount equal to the scholarship which he received.
be reserved for dental students. Finally, the conference substitute in-
Under the Senate amendment, the obligation of such individual
cludes the House provision which required that sums appropriated for
would be cancelled without prejudice, although if the individual subse-
any fiscal year shall remain available for obligation for the succeeding
quently received a health professions degree, the obligation which had
fiscal year.
been cancelled would be reinstated.
X
FUNDING PRIORITY
The conference substitute conforms to the House bill.
Under the Senate amendment, funds appropriated under the au-
LIQUIDATED DAMAGES
thorization of appropriations for National Health Service Corps
scholarships and scholarships for students of exceptional financial
The Senate amendment contained a provision providing that any
need could not be less than 50 percent of the funds appropriated for
individual who entered into a written contract to accept a National
capitation grants to schools of medicine, osteopathy, and dentistry.
Health Service Corps scholarship and who failed to enroll as a first
The House bill contained no comparable provision.
year student shall be liable to the United States for the sum of $1,500
Under the conference substitute, if 75 percent or more of the sum
in liquidated damages. Further, it provided that whenever an individ-
of the amounts authorized to be appropriated for such fiscal year for
ual submitted an application for a National Service Corps scholarship,
the purpose of making capitation grants to schools of medicine, osteop-
agreed in writing to accept the scholarship, enrolled as a student in
athy and dentistry is appropriated for any fiscal year, no funds ap-
a school of the health professions and failed to accept such scholarship,
propriated for such fiscal year may be obligated or expended for the
if offered, such individual would be liable to the United States for the
purpose of carrying out any provisions of title VII of the Public
sum of $1,500 in liquidated damages.
Health Service Act unless the amounts appropriated for National
The House bill contained no comparable provision.
Health Service Corps Scholarships and scholarships for students of
The conference substitute does not contain the provisions of the
exceptional financial need are less than the lesser of (1) the amounts
Senate amendment with respect to failure to enroll as a first year stu-
authorized to be appropriated for such fiscal year for such programs
dent. It does, however, contain the provisions with respect to the liabil-
or (2) 50 percent of the total amount appropriated for such fiscal year
ity of an individual who enrolls in a health professions school and fails
under title VII of the Public Health Service Act.
to accept a scholarship after agreeing in writing to do so.
X
REVISION OF SCHOLARSHIP AUTHORITY
AUTHORIZATION OF APPROPRIATIONS FOR NATIONAL HEALTH SERVICE CORPS
SCHOLARSHIP PROGRAM
Under the House bill, the existing authority for grants to schools
for the provision of scholarship awards to students was repealed, and
The House bill authorized the following appropriations to carry out
appropriations were authorized only for the purpose of making pay-
the National Health Service Corps Scholarship Program $40 million
ments to students who had received such awards from grants made
for fiscal year 1976, $80 million for fiscal year 1977, and $120 million
to schools prior to fiscal year 1975.
for fiscal year 1978. Further, the House amendment required that
Under the Senate amendment, the existing scholarship authority
sums appropriated under the authority for National Health Service
was repealed and replaced by authority for grants to public or non-
Corps scholarships for any fiscal year must remain available for
profit private schools of medicine, osteopathy, dentistry, optometry,
obligation in the succeeding fiscal year.
pharmacy, podiatry, and veterinary medicine for scholarships to be
Under the Senate amendment, the following appropriations were au-
awarded to students who are of exceptional financial need and who
thorized for the National Health Service Corps Scholarship Program
are in their first year of study at such schools. Scholarships were to
$85 million for fiscal year 1978, $150 million for fiscal year 1979, and
consist of a stipend of $400 per month, tuition, and all other reasonable
educational expenses. Authorizations of $16 million for fiscal year
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111
1978, $17 million for fiscal year 1979, and $18 million for fiscal year
1980 were provided for such purpose.
agreement, he is required to pay damages in an amount equal to three
Under the conference substitute, both the provisions of the House
times the amount paid by the Secretary under the agreement to him
bill and the Senate amendment are adopted with technical changes.
or on his behalf.
The conferees were particularly concerned that schools not use the
GUARANTEED STUDENT LOANS
guaranteed student loan program as a substitute for the capitation
program. Thus, the conference substitute provides that only the stu-
The Senate amendment contained provisions which would estab-
dents of schools that are in compliance with the capitation conditions
lish a new program of Federally insured loans for students enrolled in
for receipt of capitation support are eligible for participation in the
health professions schools, modeled on the program established by the
program.
Higher Education Act but with substantially increased ceilings on the
In the view of the conferees, the new guaranteed loan program will
amounts that could be borrowed by health professions students. Stu-
be of material assistance to health professions schools by providing
dents in schools of medicine, osteopathy, dentistry, veterinary medi-
private sources of income for students to meet the ever rising costs of
cine, podiatry, optometry, and public health were authorized to bor-
education. This program should be of particular value to those institu-
row up to $10,000 a year with a total loan limit per student of $50,000.
tions which receive relatively little public support and, consequently,
Students in schools of pharmacy were permitted to borrow up to
are obliged to charge high tuition fees. Thus, the conferees expect that,
$7500 a year with a total loan limit per student of $37,500. The Senate
in the administration of the program, the Secretary will pay particu-
amendment provided for principal payments on such loans to be de-
lar attention to the needs of high tuition schools.
ferred while the borrower was in school, and during a period not to
Finally, the conferees noted that the guaranteed student loan pro-
exceed three years, while in training as an intern or resident or while
gram offers the Secretary a source of personnel for service in under-
serving in the Armed Forces, the Peace Corps, or under the Domestic
served areas in addition to persons who are under obligation due to
Volunteer Services Act of 1973, but required that interest payments
receipt of National Health Service Corps scholarships. Although bor-
be made during the period of deferral. It limited the amounts of new
rowers under the program are not entitled to repay their loans through
loans that could be insured in each of the fiscal years covered by the
service as a matter of right, the Secretary is authorized to enter into
legislation to $500 million during fiscal year 1978, $510 million during
agreements with them to discharge their loan obligations in return for
fiscal year 1979, and $520 million during fiscal year 1980, and it pro-
service under terms and conditions identical to those of the NHSC
vided that not more than 50 percent of the students in any class of a
program. In all likelihood. most of the loans insured under this pro-
medical, dental, or osteopathic school were authorized to obtain such
gram will be repaid in the normal course; however, there may be cir-
insured loans. In addition, the Senate amendment authorized the mar-
cumstances under which the Secretary seeks to obtain additional per-
keting of such loans in the secondary market established by the Stu-
sonnel for service in underserved areas. This program enables the
dent Marketing Association, permitted institutions to use capitation
Secretary to obtain such personnel by contracting with borrowers for
such service.
payments to subsidize the interest costs of students holding such in-
sured loans, and authorized the Secretary to permit borrowèrs under
The conferees stress that provision is made to limit the possibility
the program to discharge their loan obligation after graduation by
of avoidance of repayment by restricting borrowers under the program
providing service in a medically underserved area either as a member
from discharging their obligation through bankruptcy for a period of
of the National Health Service Corps or in private practice in such an
five years after repayment commences and, further, by authorizing
area.
denial of reimbursement under any Federal program to providers who
The House bill contained no comparable provision.
have defaulted on loan obligations incurred under the program.
The conference substitute includes the provisions of the Senate
amendment with the following changes:
TRAINEESHIPS FOR STUDENTS IN SCHOOLS OF PUBLIC HEALTH AND
(1) Health professions schools participating in the program may do
OTHER GRADUATE PROGRAMS
SO only if they meet the conditions prescribed by the conference report
The House bill contained two provisions which authorized trainee-
respecting eligibilitv for capitation.
ship support for students in schools of public health and other gradu-
(2) The schools themselves are designated as eligible lenders, unlike
ate programs in health. The first provision authorized appropriations
the provision of the Senate amendment which excluded such institu-
tions as being lenders.
of $6 million for each of fiscal years 1976, 1977, and 1978 for grants to
schools of public health for traineeships to train students enrolled
(3) Lenders are required to make substantial efforts at collecting on
in such schools. The second provision authorized appropriations of
loans insured under the program before the Federal government may
$2.5 million for each of fiscal years 1976, 1977, and 1978 for grants to
pay the amount owed under the guarantee.
public or nonprofit private entities (except schools of public health)
(4) In the event that the Secretary enters into an agreement with a
borrower for payment of a portion of a loan obligation in return for
training students in graduate educational programs in health adminis-
tration, hospital administration, health planning, environmental
service and the borrower breaches his contract obligation under such
health, and preventive medicine for traineeships to train public and
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113
community health personnel for which the Secretary determines there
HOUSE BILL
is unusual need.
The Senate amendment combined the two authorities into one au-
Under the House bill, schools of medicine, osteopathy, and dentistry
thority for traineeships. Under the Senate provision, the Secretary
were eligible for institutional support of $2100 per full time student
was authorized to make grants to accredited schools of public health
for fiscal year 1975, $2100 per full time student for fiscal year 1976,
and to public or nonprofit private educational entities (including
and $2000 per full time student for fiscal year 1977.
schools of social work) which have accredited programs in health
The House bill provided that a school of medicine, osteopathy,
administration, hospital administration, and health planning for
or dentistry was not eligible for capitation support unless one of the
traineeships to train students in such schools and programs. It pro-
vided that eighty percent of the traineeships were to be awarded to
following three conditions were met:
(1) That for the second school year beginning after the fiscal
individuals who either had a postbaccalaureate degree or had worked
in which the grant was to be made the first year enrollment
for three years in health services, and were pursuing courses of study
year of such school would be increased over the 1975 enrollment level
in biostatistics, epidemiology, health administration, health planning,
by 10 percent if the enrollment in fiscal year 1975 was under 100
health policy analysis and planning, environmental health, occupa-
students, or by 5 percent or 10 students, whichever is greater,
tional health, dietetics, or nutrition. The Senate amendment author-
if such year's enrollment was over 100 and maintained for each
ized appropriations of $10 million for fiscal year 1978, $11 million
for fiscal year 1979, and $12 million for fiscal year 1980 for such
school year thereafter;
traineeships.
year in which the grant was to be made and the third year enroll-
(2) That for the second school year beginning after the fiscal
The conference substitute provides for two separate traineeship pro-
ment of such school would be increased over the 1975 enrollment
grams, one for students in accredited schools of public health and one
level by 10 percent if the enrollment in fiscal year 1975 was under
for students in accredited programs of health administration, hospital
100 students, or by 5 percent or 10 students, whichever is greater,
administration, and health planning. With respect to traineeships to
if such year's enrollment was over 100 and maintained for each
students in accredited schools of public health, 45% of the awards in
fiscal year 1978, 55% in fiscal year 1979, and 65% in fiscal year 1980
school year thereafter; or
dents in ambulatory care settings in areas geographically remote
(3) That such school would have approved a plan to train stu-
are to be reserved for awards to the individuals eligible under the
Senate amendment. Eighty percent of the awards for students in
from the main site of teaching facilities of the school. Under this
accredited programs of health administration, hospital administration,
and health planning are earmarked for individuals who either have a
option, a minimum of 50 percent of graduating students were re-
in such areas; if 60 percent of the students were to receive such
quired to receive at least six weeks of training (in the aggregate)
postbaccalaureate degree or three years of work experience in health.
The conference substitute authorizes appropriations of $7.5 million for
training, the required period was shortened to five weeks; if 75
fiscal year 1978. $8 million for fiscal year 1979, and $9 million for fiscal
percent of the students were to receive such training, the required
year 1980 for traineeship awards for students in schools of public
health, and $2.5 million for each of fiscal years 1978, 1979, and 1980 for
period was shortened to four weeks.
traineeship awards to students enrolled in graduate programs of
SENATE AMENDMENT
health administration, hospital administration, and health planning.
The conferees recognize that the report contains several references
Under the Senate amendment, capitation support for schools of
regarding accreditation of schools of public health and programs in
medicine, osteopathy, and dentistry was established at $1800 per stu-
health administration, hospital administration, and health planning.
dent for fiscal year 1978, $1900 per student for fiscal year 1979, and
These references are in no way intended to imply that any changes in
$2000 per student for fiscal year 1980.
policy or direction with respect to HEW's Office of Education respect-
The Senate amendment required the following as conditions for
ing the recognition it chooses to grant regarding accreditation are
receipt of capitation support by schools of medicine, osteopathy and
necessary.
dentistry:
CAPITATION GRANTS FOR SCHOOLS OF MEDICINE, OSTEOPATHY AND
Schools of Medicine and Osteopathy
DENTISTRY AND ELIGIBILITY FOR SUCH GRANTS
Each such school would be required to provide assurances that an
established number of positions available to students enrolled in such
Under both the House bill and the Senate amendment, schools of
school would be reserved for students (excluding fourth-year stu-
medicine, osteopathy, and dentistry were eligible for Federal institu-
dents) who had applied for and agreed in writing to accept National
tional support based on a formula of a statutory amount of money
Health Service Corps scholarships. The required number in academic
times the number of full time students enrolled in such schools (and
1977-78 would be 25 percent of the number of first year students
thus termed "capitation" support). Both the House bill and the Senate
year enrolled in the preceding academic year; in 1978-79, 30 percent of
amendment required that certain conditions be met by such schools
such number; and in 1979-80, 35 percent of such number. Further,
in order that they be eligible for capitation support.
the Senate amendment provided that these school-by-school require-
ments would not apply if "assured national goals" were "substantially
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114
met". "Assured national goals" meant that the national average of
Third, dental schools would be required to provide assurances that
full-time first year students submitting applications for National
at least 70 percent of filled positions in dental specialty programs in
excess of academic year 1976-77 levels would be in either general den-
Health Service Corps scholarships and entering into written contracts
constituted at least the following percentages: 25 percent in academic
tistry or pedodontics.
year 1977-78; 30 percent in 1978-79; and 35 percent in 1979-80. "Sub-
CONFERENCE SUBSTITUTE
stantially met" was defined to mean either that 92.5 percent of funds
authorized to be appropriated for National Health Service Corps
Under the conference substitute, the following appropriations are
scholarships for medical and osteopathic students had been obligated,
authorized for capitation grants to schools of medicine, osteopathy
or that at least 92.5 percent of the assured national goal for each
and dentistry $2000 per full time student for fiscal year 1978; $2050
academic year had been met.
per full time student for fiscal year 1979; and $2100 per full time stu-
In addition, each school of medicine would have been required to
have the following percentages of all of its filled residency positions
dent for fiscal year 1980.
The requirements of the conference substitute with respect to eligi-
(including both direct and affiliated positions) in the specialties of
bility for capitation support are modifications of the provisions of the
family practice, general internal medicine, general pediatrics, and gen-
House bill with respect to enrollment increases and of the Senate
eral obstetrics and gynecology 42 percent in academic year 1977-78;
amendment with respect to requirements for percentages of residency
47 percent in 1978-79; and 57 percent in academic year 1979-80; with
training programs in primary care. The requirements of the Senate
not more than 7 percent each year attributable to residencies in gen-
amendment with respect to the reservation of certain percentages of
eral obstetrics and gynecology (calculated on a school-by-school
positions in schools for students who apply for and agree to accept
basis). Further, in applying these requirements, the Secretary was
National Health Service Corps scholarships are not included in the
required to seek to assure that calculated in the national aggregate
conference substitute; however, due to the provisions of the confer-
for each academic year there were an appropriate percentage of resi-
ence substitute with respect to funding priorities for National Health
dencies in psychiatry.
Service Corps scholarships, (described above) the intention of the
Schools of Dentistry
Senate amendment-to insure that adequate numbers of students re-
Under the Senate amendment, schools of dentistry were required to
ceive scholarships in return for an agreement to practice their profes-
meet the following conditions:
sions in medically underserved areas-will, in the opinion of the con-
First, each such school would be required to provide assurances that
ferees, be fulfilled.
an established number of positions available to students enrolled in
The conference substitute provides as follows:
such school would be reserved for students (excluding fourth year stu-
Requirements for Schools of Medicine
dents) who applied for and agreed to accept National Health Service
Requirements for Primary Care Residency Positions: Unless, on
Corps scholarships. The number was to be a percentage of first year
July 15, 1977, the number of filled first. year residency positions
positions to be determined by the Secretary (which could not be more
in primary care (defined as family medicine, general internal medi-
than 20 percent, but not less than 10 percent). This school-by-school
cine and general pediatrics) is at least 35% of the total number of
requirement would not apply if the national average of full-time first
first year filled positions on that date in all direct or affiliated medical
year students who applied for and agreed to accept National Health
residency training programs, then in order for a school of medicine
Service Corps scholarships was equal to or exceeded the percentage
to be eligible for capitation grants for the fiscal year 1978, it must
established by the Secretary or if 92.5 percent of the funds authorized
have, on July 15, 1978, at least 35% of its filled first year positions in
to be appropriated for such scholarships for dental students were
its direct or affiliated medical residency training programs in primary
obligated. The percentage of first year positions which was to consti-
tute the requirements under the Senate amendment was to be deter-
care. Unless, on July 15, 1978, the number of filled first year residency
mined by the Secretary in cooperation with appropriate national
positions in primary care is at least 40% of the total number of filled
dental organizations.
first year filled positions, then in order for a medical school to be
Second, each dental school would be required either (1) to develop
eligible for a capitation grant for fiscal year 1979, it must have on
a program to train dental students in the organization and manage-
July 15, 1979, 40% of its filled first year residency positions in its
ment of multiple auxiliary dental team practices in accordance with
direct or affiliated medical residency training programs in primary
regulations of the Secretary, or (2) to increase (beginning in academic
year 1977-78) the number of first year students above 1976-77 levels by
care. Unless, on July 15, 1979, at least 50% of all filled first year medical
10 percent if such level was 100 or less, or by 5 percent or 10 students,
residency positions are in primary care, then in order for a medical
whichever is greater, if such level was more than 100. Further, the
school to be eligible for capitation support for fiscal year 1980, it must
Secretary was authorized to waive either of these requirements in cases
have July 15, 1980, at least 50% of its filled first year positions, in its
in which dental schools would face the loss of accreditation due to com-
direct or affiliated medical residency training programs in primary
pliance with such requirements.
care.
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117
Under the conference substitute, the Secretary is required to deter-
medical education in foreign medical schools if such persons intend to
mine what percent of all first year filled positions as of July 15, 1977
practice medicine in the United States. Rather, it is intended to remedy
and July 15 of each succeeding in direct or affiliated medical residency
an unfortunate situation which currently exists. In the view of the
training programs are filled positions in primary care. In making his
conferees, the current situation, in which thousands of U.S. citizens
determination each year, the Secretary is to deduct from the number of
are presently enrolled in foreign medical schools where, in most cases,
filled first year positions in primary care, a number equal to the number
the education they are receiving is not of the quality provided by U.S.
of individuals who were in a first year filled position in primary care
medical schools and is being taught in a language other than English,
in the previous year and who are, at the time the Secretary makes his
is a situation which deserves the immediate attention of the Depart-
determination, not in a residency training program in primary care.
ment of Health, Education, and Welfare, the American Medical Asso-
Each such determination is required to be published in the Federal
ciation, and the Association of American Medical Colleges. The con-
Register not later than 45 days after the determination is made and
ferees believe that it is in the best interests of the U.S. health care
reported in writing to each school of medicine in the United States
system to permit those U.S. citizens who have successfully completed
and to the appropriate committees of the Congress. The Secretary may,
two years of medical education in a foreign medical school and who
in instances in which a school is required to have a specified percentage
have passed Part I of the National Board of Medical Examiners' Ex-
in primary care positions, determine that such requirement is met if
amination to complete their education in U.S. medical schools. The
(1) he determines that a school has made good faith efforts to meet the
conferees intend that this provision not be extended beyond the life
requirement and that at least 98 percent of the required percentage has
of the conference report and that individuals planning a career in
been met. In addition, the conference substitute provides that the Secre-
medicine become cognizant of this fact.
tary may not make a capitation grant to a school of medicine for any
Although the conference substitute does not include the provisions
fiscal year if in the preceding year such school terminated or failed to
of the Senate amendment with respect to emphasis on residencies in
renew an affiliation with a medical residency training program for the
psychiatry and obstetrics and gynecology, the conferees do not intend
purpose of meeting the requirements for eligibility for capitation
that this action be construed as prohibiting the development of appro-
grants relating to residency positions continued to provide training
priate numbers of such residencies to meet national needs.
support for such a residency training program.
Requirements to Enroll Students from Foreign Medical Schools:
Schools of Osteopathy
In order for a school of medicine to be eligible for capitation sup-
The requirements of the conference substitute with respect to receipt
port, it must in its application for such support provide assurances
of capitation support by schools of osteopathy build upon the remote
satisfactory to the Secretary that it will participate in a national
site training requirements of the House bill. Under the conference sub-
program whereby it will reserve positions in the school year beginning
stitute, in order for a school of osteopathy to be eligible for capitation
immediately before the fiscal year for which the grant is applied for
support for fiscal years 1978, 1979, or 1980 such school must submit to
students who were enrolled in a school of medicine outside of the
the Secretary and have approved a plan to train full time students in
United States prior to the enactment of the conference report which
ambulatory care settings in the school year beginning in the fiscal year
students (1) are citizens of the United States, (2) successfully com-
for which the grant was made and in each school year thereafter be-
pleted at least two years in such a school of medicine. (3) successfully
ginning in a fiscal year for which a grant is made. Such training must
completed Part I of the National Board of Medical Examiners exami-
be in an area geographically remote from the main site of the teaching
nation (or its equivalent) and (4) have applied to the Secretary for
facilities of the applicant (or any other school of osteopathy which is
assignment to a school of medicine in the United States. The Secretary
joined with the applicant in the submission of the plan or areas in
is required to apportion equitably among the schools of medicine in the
which medically underserved populations reside. This provision au-
United States the number of positions for individuals eligible for ad-
thorizes more than one school of osteopathy to join in the submission of
mission under this provision and must report to the schools not later
the plan. It requires that no plan may be approved unless (1) each
than 15 days after the identification is made of such individuals;
school which joins in the submission of the plan submits assurances
schools of medicine are not required to enroll an individual apportioned
that all of the full time students who graduated from the school will
to it if such individual does not meet the school's entrance requirements
upon graduation have received, in such areas, at least six weeks (of
(other than requirements with respect to academic standing or place
which as least three weeks must be consecutive) of clinical training,
of residence) or, if enrollment of such individual will, as determined
(2) the plan contains a list of the areas where the training is to be
by the Secretary after consultation with the appropriate accreditation
conducted, a detailed description of the type and amount of training
body, result in the school's not meeting the accreditation standards of
to be given in the areas, and provision for periodic review by experts
such body. In addition, if the Secretary determines that there is an
in osteopathic education of the desirability of providing training in
inadequate population in the area served by the medical school hospital
such areas and the quality of training rendered in such areas, (3) the
to provide an adequate patient load so quality clinical training can be
plan contains a specific program for the hiring, as members of faculty
provided to students in the medical schools.
of the school or schools submitting the plan, of practicing physicians
It is not the conferees' intent, in including this requirement, either
to serve as instructors in the training program in such areas, and
to encourage or condone the practice of U.S. citizens receiving their
(4) the plan contains a plan for frequent counseling and consultation
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119
between the faculty of the school or schools at the main site of their
authorized to waive such requirement if he determined that such school
training facilities and the instructors in the training program in such
could not increase its first year enrollment without lowering the quality
areas.
of education provided in the school.
Schools of Dentistry
SENATE AMENDMENT
The conference substitute provides that no school of dentistry will
be eligible to receive capitation support for fiscal years 1978, 1979,
Under the Senate amendment, capitation support for schools of
or 1980 unless the following requirements are met.
public health was established at $1225 per student equivalent for fiscal
First, in the school year beginning in fiscal year 1978 and in each
year 1978, $1300 per student equivalent for fiscal year 1979, and $1375
school year ending in the fiscal year for which a capitation grant
per student equivalent for fiscal year 1980.
is applied for, at least 70 percent of such school's filled positions in
The Senate amendment's requirements for eligibility for capitation
dental specialty programs which are in excess of the number of filled
support were comparable to the requirements of the House bill, except
positions in its program in the school year beginning in fiscal year 1977
that the enrollment increase was to be by 5 percent of the number of
must be in general dentistry or pedodontics.
students enrolled in the preceding school year if such number was not
Second, a school of dentistry must either increase its enrollment
more than 100, or by 2.5 percent of such number or five students,
during fiscal year 1978 or submit and have approved a plan for remote
whichever was greater, if such number was not more than 100.
site training of its students. The enrollment increase must be a per-
centage of the number of full time students enrolled in the school in
CONFERENCE SUBSTITUTE
the school year beginning in fiscal year 1977. The increase must be by 10
percent of the academic year 1976-77 enrollment if the enrollment was
Under the conference substitute, appropriations of $1,400 per student
not more than 100 or 5 percent of such number (or 10 students) which-
equivalent are authorized for each of fiscal years 1978, 1979, and 1980
ever is greater if such number was more than 100. Requirements with
for capitation grants for schools of public health.
respect to remote site training are identical to those described above
The requirements of the conference substitute with respect to eli-
with respect to schools of osteopathy except that the requirement to
gibility for capitation grants conform to the Senate amendment.
provide at least three consecutive weeks of training is not included.
However the conferees anticipate that this requirement could and
CAPITATION GRANTS FOR SCHOOLS OF VETERINARY MEDICINE
should be met in most instances. It is the intention of the conferees
that, to the maximum extent feasible, remote site training should be
Under both the House bill and the Senate amendment, schools of
conducted in areas which are in need of dentists. The conferees antici-
veterinary medicine were eligible for capitation support. Both the
pate that the Secretary would use as a guideline counties (or equivalent
House bill and the Senate amendment required that certain condi-
political units) in which the dental to population ratio is 1 to 2,000 or
tions be met by such schools in order that they be eligible for capita-
more and that the area be an area in which training support in general
tion support.
dental practice and pedodontics is available.
HOUSE BILL
CAPITATION GRANTS FOR SCHOOLS OF PUBLIC HEALTH
Under the House bill, schools of veterinary medicine were eligible
for capitation grants of $1,500 per year for each full time student
Under both the House bill and the Senate amendment, schools of
for each of fiscal years 1976, 1977, and 1978.
public health were eligible for capitation support. Both the House
The House bill required that one of two conditions were required
bill and the Senate amendment required that certain conditions be
to be met in order for a school of veterinary medicine to be eligible
met by such schools in order that they be eligible for capitation
for capitation support. First, the number of full time students enrolled
support.
in the second school year beginning after the close of the fiscal year in
HOUSE BILL
which the capitation grant was to be made and for each school year
thereafter was required to exceed the number of such students enrolled
Under the House bill, schools of public health were eligible for
in the school year which began during fiscal year 1975 by 10 percent of
capitation grants of $1,500 per student equivalent for fiscal years 1976,
such number if the number was not more than 100, or by 5 percent of
1977, and 1978.
such number, or 10 students, whichever was greater, if such number
The House bill required that no school of public health would be
was more than 100. Alternatively, such schools would be required to
eligible for capitation support unless it agreed that the number of
submit assurances to the Secretary that at least 20 percent of the first
full time students enrolled in the second school year beginning after
year enrollment of full time students in such school would, for the sec-
the close of the fiscal year in which the capitation grant was to be
ond school year beginning after the close of the fiscal year in which the
made and for each school year thereafter would exceed the number of
grant applied for was to be made and in each school year thereafter
such students enrolled in the school year which began during fiscal
beginning in a fiscal year in which the grant was to be made, be com-
year 1975 by 10 percent of such number if the number was not more
prised of students who were residents of States in which there were no
than 100, or by 5 percent of such number, or 10 students, whichever
accredited schools of veterinary medicine.
was greater, if such number was more than 100. The Secretary was
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121
SENATE AMENDMENT
Under the House bill, one of two conditions was required to be met
in order for a school of optometry to be eligible for capitation. First,
Under the Senate amendment, capitation support for schools of
the number of full time students enrolled in the second school year
veterinary medicine was established at $1,350 per full time student for
fiscal year 1978, $1,425 per full time student for fiscal year 1979, and
beginning after the close of the fiscal year in which the capitation
$1,500 per full time student for fiscal year 1980.
grant was to be made and for each school year thereafter was required
to exceed the number of such students enrolled in the school year which
The Senate amendment contained requirements with respect to eligi-
bility for capitation support comparable to those of the House bill, ex-
began during fiscal year 1975 by 10 percent of such number if the
number was not more than 100, or by 5 percent of such number, or 10
cept that the enrollment increase requirement was to be by 5 percent
students, whichever was greater, if such number was more than 100.
of the number of students of the preceding school year if such number
Alternatively, such schools would be required to submit assurances to
was not more than 100 or by 2.5 percent of such number, or 5 students,
the Secretary that at least 25 percent of the first year enrollment of
whichever was greater, if such number was more than 100, and that at
full time students in such school (or, in the case of a private school,
least 40 percent of the first year enrollment of full time students must
50 percent of such enrollment) would, for the second school year be-
be comprised of students who are residents of States in which there are
ginning after the close of the fiscal year in which the grant applied
no accredited schools of veterinary medicine. In addition, the Senate
for was to be made and in each school year thereafter beginning in a
amendment required that each school of veterinary medicine, in order
fiscal year in which the grant was to be made, be comprised of students
to be eligible for capitation support, provide assurances to the Secre-
who were residents of States in which there were no accredited schools
tary that the clinical training provided by such school emphasize pre-
of optometry.
dominantly care to food producing animals or to fiber producing
SENATE AMENDMENT
animals or to both types of animals. Further, the Senate amendment
authorized the Secretary to waive requirements with respect to increas-
Under the Senate amendment, capitation support for schools of
ing enrollment or enrollment of students from States in which there
optometry was established at $775 per student for fiscal year 1978,
are no accredited schools of veterinary medicine (or both such require-
$830 per student for fiscal year 1979, and $885 per student for fiscal
ments) if he determined, after receiving the written recommendation
year 1980.
of the appropriate accreditation body, that compliance by such school
The Senate amendment contained requirements with respect to
would prevent it from maintaining its accreditation.
eligibility for capitation support comparable to those of the House
bill, except that the enrollment increase requirement was to be by 5
CONFERENCE SUBSTITUTE
percent of the number of students of the preceding school year if such
Under the conference substitute, $1,450 per full time student is
number were less than 100, or 2.5 percent of such number or 5 students,
authorized for fiscal years 1978, 1979, and 1980 for capitation grants
whichever was greater, if such number was more than 100.
for schools of veterinary medicine.
Further, the Senate amendment authorized the Secretary to waive
The requirements of the conference substitute with respect to eligi-
requirements with respect to increasing enrollment if he determined,
bility for capitation support conform to the Senate amendment,
after receiving the written recommendation of the appropriate accredi-
except that (1) the requirement with respect to enrollment of students
tation body, that compliance by such school would prevent it from
from States which have no accredited schools of veterinary medicine
maintaining its accreditation.
is that 30 percent of the first year enrollment of such schools be com-
prised of such students and (2) that the Secretary is not authorized to
CONFERENCE SUBSTITUTE
waive either requirement.
Under the conference substitute. $765 per full time student is author-
ized for each of fiscal years 1978, 1979, and 1980 for capitation grants
CAPITATION GRANTS FOR SCHOOLS OF OPTOMETRY
for schools of optometry.
Under both the House bill and the Senate amendment schools of
The requirements of the conference substitute with respect to eligi-
optometry were eligible for capitation support. Both the House bill
bility for receipt of capitation support conform to the Senate
and the Senate amendment required that certain conditions be met by
amendment, except that the conference substitute does not provide
such schools in order that they be eligible for capitation support.
for a waiver of the requirements.
CAPITATION GRANTS FOR SCHOOLS OF PODIATRY
HOUSE BILL
Under the House bill, schools of optometry were eligible for capita-
Under both the House bill and the Senate amendment schools of
tion grants of $700 per full time student for fiscal years 1976, 1977
podiatry were eligible for capitation support. Both the House bill
and 1978.
and the Senate amendment required that certain conditions be met
by such schools in order that they be eligible for capitation support.
76-510 76 8
122
123
HOUSE BILL
CAPITATION GRANTS FOR SCHOOLS OF PHARMACY
Under the House bill, schools of podiatry were eligible for capita-
Under both the House bill and the Senate amendment schools of
tion grants of $1,100 per full time student for each of fiscal years 1976,
pharmacy were eligible for capitation support. Both the House bill
1977, and 1978.
and the Senate amendment required that certain conditions be met
Under the House bill, one of two conditions was required to be
by such schools in order that they be eligible for capitation support.
met in order for a school of podiatry to be eligible for capitation.
First, the number of full time students enrolled in the second school
HOUSE BILL
year beginning after the close of the fiscal year in which the capita-
tion grant was to be made and for each school year thereafter was
Under the House bill, schools of pharmacy were eligible for capi-
required to exceed the number of such students enrolled in the school
tation grants of $700 per full time student for each of fiscal years 1975,
year which began during fiscal year 1975 by 10 percent of such
1976, and 1977.
number if the number was not more than 100, or by 5 percent of such
Under the House bill, one of two conditions was required to be
number, or 10 students, whichever was greater, if such number was
met in order for a school of pharmacy to be eligible for capitation.
more than 100. Alternatively, such schools would be required to sub-
First, the number of full time students enrolled in the second school
mit assurances to the Secretary that at least 40 percent of the first
year beginning after the close of the fiscal year in which the capitation
year enrollment of full time students in such school would, for the
grant was to be made and for each school year thereafter was re-
second school year beginning after the close of the fiscal year in
quired to exceed the number of such students enrolled in the school
which the grant applied for was to be made and in each school year
year which began during fiscal year 1975 by 10 percent of such num-
thereafter beginning in a fiscal year in which the grant was to be
ber if the number was not more than 100, or by 5 percent of such
made, be comprised of students who were residents of States in which
number, of 10 students, whichever was greater, if such number was
there were no accredited schools of podiatry.
more than 100. Alternatively, such schools would be required to have
a plan approved by the Secretary for the establishment, expansion,
SENATE AMENDMENT
improvement, or operation of at least two of the following programs:
(1) a program to teach pharmacy in a hospital, extended care facility,
Under the Senate amendment, capitation support for schools of
or other clinical setting; (2) a program of training in clinical phar-
podiatry was established at $775 per full time student for fiscal year
macology; or (3) a program to train pharmacists to assist physicians
1978, $830 per full time student for fiscal year 1979, and $885 per
and patients on the appropriate use of and reaction to drugs.
full time student for fiscal year 1980.
The Senate amendment contained requirements with respect to
SENATE AMENDMENT
eligibility for capitation support comparable to those of the House
bill, except that the enrollment increase requirement was to be by
Under the Senate amendment, capitation support for schools of
5 percent of the number of students of the preceding school year if
pharmacy was established at $650 per full time student for fiscal year
such number was not more than 100 or by 2.5 percent of such number,
1978, $690 per full time student for fiscal year 1979, and $730 per full
or 5 students, whichever was greater, if such number was more
time student for fiscal year 1980.
than 100.
The requirements of the Senate amendment with respect to eligibil-
Further, the Senate amendment authorized the Secretary to waive
ity for capitation support were that each such school must provide
requirements with respect to increasing enrollment if he determined,
each student with a training program in clinical pharmacy which
after receiving the written recommendation of the appropriate ac-
includes one clinically trained full-time faculty member for every
creditation body, that compliance by such school would prevent it
fifteen students in the last year of the program; inpatient and out-
from maintaining its accreditation.
patient clinical pharmacy clerkship experience, and training in drug
information retrieval and analysis in the context of actual patient
CONFERENCE SUBSTITUTE
problems.
CONFERENCE SUBSTITUTE
Under the conference substitute, $965 per full time student is
authorized for each of fiscal years 1978, 1979, and 1980 for capitation
Under the conference substitute, $695 per full time student is au-
grants for schools of podiatry.
thorized for each of fiscal years 1978, 1979, and 1980 for capitation
The requirements of the conference substitute with respect to
grants for schools of pharmacy.
eligibility for receipt of capitation support conform to the Senate
The requirements of the conference substitute with respect to eligi-
amendment except that the conference substitute does not provide for
bility for receipt of capitation grants are that each student enrolled in
a waiver of the requirements.
such school must undergo a training program in clinical pharmacy
which shall include inpatient and outpatient clinical pharmacy clerk-
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125
ship experience in a hospital, extended care facility, or other clinical
program maintains a first year enrollment of full time students in such
setting; interaction with physicians and other health professionals;
program for the school year ending in fiscal year 1978 and for each
training in the counseling of patients on the appropriate use or and
school year thereafter ending in a fiscal year in which a grant is ap-
reactions to drugs, training in drug information retrieval and analysis
plied for exceeds the number of such students enrolled in such program
in the context of actual patient problems.
ending in fiscal year 1977 by 5 percent of such number if such number
was not more than 100 or by 2.5 percent of such number, or 5 students,
REQUIREMENTS THAT STUDENTS IN HEALTH PROFESSIONS SCHOOLS
whichever is greater, if such number was more than 100. Provision for
REPAY CAPITATION GRANTS RECEIVED BY SUCH SCHOOLS
waiver if accreditation status is threatened is included in the con-
ference substitute. Finally, under the conference substitute, the follow-
The House bill contained a provision which required that, as a
ing appropriations are authorized for institutional grants for graduate
condition for receipt of capitation support, each school of the
programs in health $3.25 million for fiscal year 1978, $3.5 million for
health professions enter into agreements with each of its students to
fiscal year 1979, and $3.75 million for fiscal year 1980.
repay, beginning two years after such student graduates or completes
postgraduate clinical training, the amount of capitation grants paid
SPECIAL PROJECT GRANTS AND CONTRACTS
on his behalf, in annual installments equal to the number of such
grants. It provided for forgiveness of one annual installment for each
Both the House bill and the Senate amendment authorized funds
year of service in the National Health Service Corps or Indian Health
for special project grants and contracts. The House bill provided
Service, in private practice for a designated medically underserved
detailed authority for ten programs with discrete line item authoriza-
population, or in military service.
tions of appropriations for each program. The Senate amendment,
The Senate amendment contained no comparable provision.
with a few exceptions, combined all special project authorities into
The conference substitute does not include the provision of the
a single line item authorization of appropriations with priority for
House bill.
certain purposes.
HOUSE BILL
INSTITUTIONAL GRANTS FOR GRADUATE PROGRAMS IN HEALTH
The House bill provided for a line item authorization of appropria-
Both bills contained provisions providing new authority for the
tions for each of the following programs at the specified funding
Secretary to make annual grants to public or nonprofit private educa-
level and repealed all other existing special project authority:
tional entities (except schools of public health) to support the gradu-
1. Revised and extended the existing program of start-up assistance
ate programs in health of such entities.
and authorized $10 million for each of fiscal years 1976, 1977, and
Under the House bill, grants were to be for the purpose of support-
1978 for the program.
ing the graduate educational programs of such entities in health
2. Extended the existing authority for financial distress awards,
administration, hospital administration, health planning, environ-
included schools of public health as entities eligible to receive such
mental health and preventive medicine. In addition, the House bill
awards, and authorized $5 million for each of fiscal years 1976, 1977,
required that the Secretary could not approve an application for
and 1978 for such purpose.
assistance to such entities unless they provided assurances to the Sec-
3. Extended the existing program of support for family medicine
retary that they would increase overall enrollment, as well as increase
residency programs, added authority for the support of residency
enrollment in programs for the training of needed types of health
programs in the general practice of dentistry and authorized $40
personnel (as determined by the Secretary). The House bill author-
million for each of fiscal years 1976, 1977, and 1978 for the program.
ized the following appropriations for such grants: $3 million for fiscal
4. Extended the existing program of grants for computer tech-
year 1976, $3.5 million for fiscal year 1977, and $4 million for fiscal
nology health care demonstration programs and authorized $3 million
year 1978.
for each of fiscal years 1976, 1977 and 1978 for the program.
Under the Senate amendment, funds were authorized to support
5. Extended the existing program of support for emergency medical
graduate educational programs in health administration, hospital
services training, added authority for support of postgraduate physi-
administration, and health planning. The Senate bill contained no pro-
cian training. and authorized $10 million for each of fiscal years 1976,
visions with respect to requirements for increases in enrollment. The
1977, and 1978, of which one-third of the monies appropriated was to
Senate amendment authorized the following appropriations for such
be obligated for postgraduate physician training program support.
programs: $3 million for fiscal year 1977, $3.25 million for fiscal year
6. Added specific authority for the following two programs which
1978, $3.5 million for fiscal year 1979, and $3.75 million for fiscal year
had previously been funded under the general authority entitled
1980.
"Health Manpower Educational Initiative Awards":
Under the conference substitute, grants for graduate programs in
(a) Area Health Education Centers at $15 million for fiscal year
health are to be for the purpose of supporting programs in health ad-
1976, $20 million for fiscal year 1977, and $25 million for fiscal year
ministration, hospital administration, and health planning. In addi-
1978; and
tion, an application for assistance may not be approved unless the
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127
(b) Training of physician assistants and expanded function dental
auxiliaries at $25 million for fiscal year 1976, $30 million for fiscal
21. Implications of advances in biomedical research.
year 1977, and $35 million for fiscal year 1978.
22. Dietetic residencies.
7. Added new authority for the establishment and support of family
23. Regional systems of continuing education.
medicine departments in schools of medicine and osteopathy and
24. Health manpower development in the Trust Territories.
authorized $10 million for fiscal year 1976, $15 million for fiscal year
25. Problems of the Aged.
1977, and $20 million for fiscal year 1978 for such purposes.
The Senate amendment authorized $110 million for fiscal year 1978,
8. Added new authority to award grants to schools of medicine and
$120 million for fiscal year 1979, and $130 million for fiscal year 1980
osteopathy to train U.S. citizens who had been enrolled in foreign
for such programs, and required that, of funds appropriated in each
medical schools prior to July 1, 1975, to enable such individuals to
fiscal year, not less than 50 percent were to be obligated for the pur-
enroll in U.S. schools and to encourage such schools to enroll such in-
poses of (a) programs for physician assistants and expanded function
dividuals with advanced standing, and authorized $2 million for fiscal
dental auxiliaries, (b) start-up grants, (c) area health education cen-
year 1976, $3 million for fiscal year 1977, and $4 million for fiscal year
ter programs, and (d) financial distress.
1978 for such awards.
In addition, the Senate amendment contained provisions which:
9. Added new authority to award grants and enter into contracts
(1) Extended the program of support for family medicine resi-
with schools of optometry, pharmacy, and podiatry for specified spe-
dencies, and authorized $40 million for fiscal year 1978, $45 million
cial projects and authorized $5 million for each of fiscal years 1976,
for fiscal year 1979, and $50 million for fiscal year 1980 for such
1977, and 1978 for such purposes.
program;
(2) Added new authority to award grants to assist public or private
nonprofit colleges or universities in the establishment, operation, and
SENATE AMENDMENT
administration of occupational health training and education centers
The Senate amendment contained a broad, general special project
and authorized $5 million for each of fiscal years 1977 and 1978, $8
grant authority which specified, in detail, twenty-three purposes
million for fiscal year 1979, and $10 million for fiscal year 1980 for
which could be funded by special project grants and contracts. It
such purpose.
authorized the Secretary to make grants and enter into contracts with
(3) Added new authority for special project grants to accredited
public or nonprofit private hospitals, schools of medicine, osteopathy,
schools of public health, and public or nonprofit private educational
and dentistry, graduate schools of psychology and social work, and
entities (including graduate schools of social work) which have ac-
other public or nonprofit private entities for special projects for the
credited programs of health administration, health planning, or
following purposes:
health policy analysis and planning, and authorized $5 million for
1. Programs for physician assistants and expanded function dental
fiscal year 1978, $5.5 million for fiscal year 1979, and $6 million for
auxiliaries.
fiscal year 1980 for such program.
2. Start-up grants.
(4) Added new authority for grants to public or nonprofit private
3. Area Health Education Center programs.
agencies, institutions, or organizations which can demonstrate the
4. Financial distress.
ability to assist in carrying out a program to select and train effective
5. Grants for training, traineeships, and fellowships in general in-
lay staff of professional standards review organizations and author-
ternal medicine and general pediatrics.
ized $2.5 million for each of fiscal years 1978, 1979, and 1980 for such
6. Human behavior and psychiatry in medical and dental practice.
purposes.
7. Speech pathology, audiology, bioanalysis and medical technology.
(5) Added new general authority (under section 301 of the Public
8. Humanism in health care.
Health Service Act) to award grants to universities, hospitals,
9. Biomedical educational programs.
laboratories, and other public or private institutions for such projects
10. Education of United States citizens returning from foreign med-
as are recommended by the National Environmental Health Sciences
ical schools.
Council for institutional support for manpower development
11. Grants for bilingual health clinical training centers.
programs.
12. Project grants and contracts for schools of optometry, pharmacy,
CONFERENCE SUBSTITUTE
and podiatry.
13. Grants to schools of social work in health care.
The conference substitute provides for a line-item authorization for
14. Health manpower development grants and contracts.
each of the following programs at the specified funding level:
15. Environmental health education grants.
(1) It continues the program of assistance for family medicine
16. Problems relating to women.
residency programs, adds authority for support of general dentistry
17. Regional health professions schools.
residency programs, and authorizes $45 million for fiscal year 1978,
18. Primary dental care development.
$45 million for fiscal year 1979, and $50 million for fiscal year 1980
19. United States citizens trained abroad.
for such purposes, of which not less than ten percent of funds appro-
20. Psychology training programs.
priated must be obligated for support of general dentistry residency
programs;
129
128
(13) psychology training programs,
(2) It adds new authority to make grants to schools of medicine
(14) ethical implications of biomedical research,
and osteopathy to meet the costs of projects to establish and maintain
academic administrative units to provide instruction in family medi-
(15) establishment of dietetic residencies,
cine, and authorizes $10 million for fiscal year 1978, $15 million for
(16) regional systems of continuing education,
fiscal year 1979, and $20 million for fiscal year 1980 for such purposes.
(17) computer technology,
(3) It adds specific authority for the support of area health educa-
(18) training of professional standards review organiza-
tion center programs and authorizes $20 million for fiscal year 1978,
tion staff, and
$30 million for fiscal year 1979, and $40 million for fiscal year 1980 for
(19) training of health professionals in human nutrition
and its application to health.
such purposes.
The conference substitute authorizes $25 million for each of fiscal
(4) It adds new authority to award grants to schools of medicine
and osteopathy to train U.S. citizens who had been enrolled in foreign
years 1978, 1979, and 1980 for such purposes of which not more than
$5 million of the funds appropriated in each fiscal year may be obli-
medical schools prior to the date of enactment to enable such indi-
viduals to enroll in U.S. medical schools, or to encourage such schools
gated for startup assistance and not more than $5 million may be
to enroll such individuals, and authorizes $2 million for each of fiscal
obligated for financial distress awards.
years 1977 and 1978, $3 million for fiscal year 1979, and $4 million for
(9) It adds new authority for special project grants to accredited
fiscal year 1980 for such purposes.
schools of public health, and public or nonprofit private educational
(5) It adds specific authority to support programs for the training
entities (including schools of social work) which have accredited pro-
of physician assistants and expanded function dental auxiliaries and
grams of health administration, health planning, or health policy anal-
to support training in the TEAM approach to the delivery of dental
ysis and planning, and authorizes $5 million for fiscal year 1978, $5.5
care, and authorizes $25 million for fiscal year 1978, $30 million for
million for fiscal year 1979, and $6 million for the fiscal year 1980 for
fiscal year 1979, and $35 million for fiscal year 1980 for such purposes.
such purposes.
(6) It adds new authority to support general internal medicine and
As noted above, many of the provisions of the Senate amendment
general pediatric residency programs and authorizes $10 million for
which provided detailed authority for a variety of special project
fiscal year 1977, $15 million for fiscal year 1978, $20 million for fiscal
grant programs are included in the conference substitute, but are
year 1979, and $25 million for fiscal year 1980 for such purposes.
mentioned only briefly as examples of projects which may be funded
(7) It adds new authority for grant support for the establishment,
under broad, general authority. The conferees intend that, if applica-
tions are submitted under this broad authority for the specific pro-
operation, and administration of occupational health training and
education centers, and authorizes $5 million for each of fiscal years
grams derived from the provisions of the Senate amendment, they be
considered under the detailed terms and conditions as required in the
1977 and 1978, $8 million for fiscal year 1979, and $10 million for fiscal
provisions of the Senate amendment and the legislative history re-
year 1980 for such purpose.
(8) It adds a new general authority for the following purposes:
specting such programs set forth in Senate Report 94-887.
The conferees believe that the TEAM approach to the delivery of
(a) start-up assistance,
dental services is one which increases the capacity of the current
(b) financial distress,
(c) interdisciplinary training, and
dental system to increase the productivity and thereby obviate the
necessity for producing more dentists. The TEAM concept is based on
(d) projects and programs such as-
(1) speech pathology, audiology, bioanalysis, and medi-
increasing efficiency and productivity through incorporation of man-
cal technology,
agement philosophies and utilization of expanded function auxiliaries.
(2) establishing humanism in health care centers,
Basic to achieving these efficiencies is the necessity for dental students
to work with auxiliaries, in a clinical environment, who are perform-
(3) biomedical combined educational programs,
(4) cooperative human behavior and psychiatry in medi-
ing expanded functions; without the clinical experience and the abil-
cal and dental education and practice,
ity to work with expanded function dental auxiliaries, the productivity
increases will not be realized. It is therefore the intent of the con-
(5) bilingual health clinical training centers,
(6) curriculum development in school of optometry, phar-
ferees that any school applying for special project support to institute
macy, and podiatry.
a TEAM program must demonstrate a capacity for clinical training
(7) social work in health care,
and insure that expanded function dental auxiliaries are participants
(8) health manpower development,
in the training program. Research demonstrates that in order to in-
(9) environmental health education and preventive
crease the productivity of the TEAM to a meaningful degree, it is
medicine,
imperative that the EFDA's pack, carve, and finish amalgams.
(10) the special medical problems related to women,
The conferees are impressed with the potential that preventive den-
(11) the development or expansion of regional health pro-
tal care has on preventing dental disease and thereby greatly lessening
fessions schools,
the cost of dental care to the public. It is therefore intended that the
(12) training of citizens of the United States from foreign
dental TEAM program include at least one dental hygienist and the
medical schools to enable them to enroll in residency pro-
clinical experience incorporate the provision of preventive care.
grams in the United States,
130
131
In addition, the conferees recognize that virtually all of the expertise
allied health professions. The provisions of the House bill and the
with respect to the special training needed for top management and
Senate amendment were comparable except that
data handling in Professional Standards Review Organizations exists
(1) The House bill authorized the award of project grants and con-
among those who are working in a PSRO. Thus, the conferees intend
tracts to public and nonprofit private entities while the Senate amend-
that, if the Secretary awards a grant or contract for the training of
ment defined entities eligible for receipt of project grants and con-
Professional Standards Review Organization personnel, that such
tracts as schools, universities, other educational entities, States, political
grant or contract stipulate that training be conducted by or through
subdivisions of States, or regional and other public bodies represent-
organizations of PSROs and those with experience working in a
ing States or political subdivisions, and any entity which has a work-
PSRO.
ing relationship with such entities. The conference substitute conforms
It is also the expressed intent of the conferees that the Secretary of
to the provisions of the Senate amendment.
HEW establish coordinating mechanisms which will insure that the
(2) The House bill provided that project support could be for the
training and education functions of the National Institute of Occupa-
purposes of coordination of training programs for allied health per-
tional Safety and Health and the National Institute of Environmental
sonnel with other educational institutions and for State and regional
Health Science will be coordinated with the development and opera-
coordination and monitoring of education and training of allied health
tion of the Occupational Health Training and Education Centers pro-
personnel. The Senate amendment authorized project grant support
gram authorized by the conference report.
for such purposes for the training of nurses, as well as allied health
The conferees recognize that the provisions of the new authority for
personnel. The conference substitute conforms to the Senate provision.
Area Health Education Center programs are such that many existing
(3) The House bill provided that one of the purposes for which
area health education centers are not in compliance with them. In the
project grants and contracts could be awarded was the support of edu-
view of the conferees, these centers have been given sufficient time
cational programs leading to a degree in the various fields within the
under the provisions of the conference report to meet the new require-
allied health professions and the expansion or establishment of new
ments. It may be, however, that in the case of the AHEC program
educational programs in the allied health professions for which the
located in Nex Mexico, the principal thrust of the program-the train-
Secretary determined there was a critical national need. The Senate
ing of Indian people in health professions-can not be continued under
amendment contained no comparable provision, and the conference
the new provisions. If this becomes the case, then it is the intent of
substitute contains no comparable provision.
the conferees that the Secretary afford special consideration to the
(4) One of the purposes for which project grants and contracts
funding of the program under other provisions of law.
could be awarded under the House amendment was for continuing
education programs for practicing allied health personnel. The Senate
PROVISIONS WITH RESPECT TO TRAINING IN ALLIED HEALTH
amendment contained no comparable provision. The conference substi-
tute includes the provision of the House amendment.
Both the House bill and the Senate amendment contained provisions
(5) Under the House bill, $20 million for each of fiscal years 1976,
authorizing support of project grants and contracts and traineeships
1977, and 1978, was authorized for the purpose of making payments
with respect to schools and students of the allied health professions.
under grants and contracts for projects relating to allied health. The
Senate amendment contained the following authorizations $27.2 mil-
DEFINITION
lion for fiscal year 1978, $30 million for fiscal year 1979, and $32.5
million for fiscal year 1980. Under the conference substitute, the follow-
Under the House bill, the term "allied health personnel" was defined
ing authorizations of appropriations are provided for project grants
as individuals responsible for (1) supporting, complementing, or sup-
and contracts for projects relating to allied health: $22 million for
plementing the professional activities of physicians, dentists, and other
fiscal year 1978, $24 million for fiscal year 1979, and $26 million for
health professionals in the delivery of health care to patients, or (2)
fiscal year 1980.
assisting environmental engineers and other personnel in environ-
(6) The Senate amendment required that not less than 50 percent
mental health control and preventive medicine activities.
of funds appropriated for projects in the allied health professions
The definition of "allied health personnel" in the Senate amendment
be reserved for awards to training centers for allied health professions.
was identical to that of the House amendment except that it did not
The House bill contained no comparable provision, and the conference
include reference to assistance to environmental engineers and other
substitute conforms to the provision of the Senate amendment.
personnel in environmental health control and preventive medicine
activities.
TRAINEESHIPS FOR ADVANCED TRAINING OF ALLIED HEALTH PERSONNEL
The conference substitute conforms to the provisions of the House
bill.
Both the House bill and the Senate amendment contained provi-
PROJECT GRANTS AND CONTRACTS
sions authorizing the Secretary to make grants for traineeships for
the advanced training of allied health personnel. The provisions of the
Both the House bill and the Senate amendment authorized the
House bill and the Senate amendment respecting such traineeships
award of project grants and contracts with respect to training in the
132
133
were identical except that the House bill authorized $6 million per
Secretary to arrange for the conduct of a study to determine the
year for fiscal years 1976, 1977, and 1978 for such purposes and the
national average per student educational cost of providing education
Senate amendment authorized $4.5 million for fiscal year 1978, $5
programs which lead to a degree of Doctor of Chiropractics, and rec-
million for fiscal year 1979, and $5.5 million for fiscal year 1980 for
ommendations concerning how the Federal government can utilize
such purposes.
educational cost per student data to determine the amount of capi-
The conference substitute conforms to the provisions of the Senate
tation grants which might be provided under the Public Health Serv-
amendment.
ice Act.
Under the conference substitute, the following studies and reports
GRANTS FOR EDUCATIONAL ASSISTANCE TO DISADVANTAGED INDIVIDUALS
are mandated: (1) the provision of the House bill with respect to
IN ALLIED HEALTH TRAINING
public health personnel, (2) a study of data and characteristics with
Both the House bill and the Senate amendment authorized the Sec-
respect to allied health personnel, combining the requirements of the
two studies of allied health personnel contained in the House bill,
retary to make grants to and enter into contracts with State and local
(3) the provision of the Senate amendment with respect to chiroprac-
educational entities and other public or private nonprofit entities for
tic education, except that the report to the Congress is not to contain
the recruitment and training of such persons in the allied health
information concerning how the Federal government can utilize costs
professions.
Under the House bill, $1 million per year was authorized for fiscal
per student to determine the amount of capitation grants which might
be provided under the Public Health Service Act.
years 1976, 1977, and 1978 for such purposes.
Under the Senate amendment, the following appropriations were
NATIONAL COUNCIL ON POSTGRADUATE PHYSICIAN TRAINING
authorized for such purposes: $1.1 million for fiscal year 1978, $1.2
million for fiscal year 1979, and $1.3 million for fiscal year 1980.
The Senate amendment provided for the establishment of a Na-
The conference substitute conforms to the House bill.
tional Council on Postgraduate Physician Training consisting of vari-
ous officers of the Federal government and members of the public.
STUDIES AND REPORTS
Duties of the council included the making of studies and other activi-
ties (and the making of recommendations to the Secretary of Health,
The House bill required the following studies and reports:
Education and Welfare) with respect to distribution and goals for the
(1) A continuous compilation of statistics, and an annual report
distribution of postgraduate physician training positions among the
to the Congress, of information respecting activities, needs and other
various medical specialties, the development of working relationships
characteristics with respect to public health personnel.
with specialty organizations with respect to number and location of
(2) A continuous study, and an annual report to the Congress, with
specialists, assessment of the need for financial support for postgradu-
respect to descriptions of anticipated need for, and the number, em-
ate physician training, and assessment of the service needs of hospitals
ployment, geographic locations, salaries, and surpluses and shortages
and other health institutions for graduate physician trainees, an assess-
of allied health personnel.
ment of the educational components of postgraduate physician train-
(3) A study of the current distribution of physicians by specialty,
ing programs, and an assessment of the impact of practice in the
a projection of the expected distribution of physicians by specialty
United States by graduates of foreign medical schools. Not later than
and subspecialty, an examination of the various methods for estimat-
6 months after the completion of the study by the National Council,
ing the optimal distribution of physicians and the development of a
the Secretary was to report to the Congress on the status of specialty
methodology to establish such distribution.
and geographic maldistribution of postgraduate physician training
(4) A report describing the allied health personnel program sup-
programs, any changes in the goals recommended by the National
ported by the Secretary and a requirement that assistance be pro-
Council, and any authority the Secretary may require to implement
vided only to programs which meet quality standards.
such goals.
(5) Studies with respect to the types of allied health personnel
The House bill contained no comparable provision.
and the activities in which they are engaged, classifications of allied
The conference substitute does not include the Senate provision.
health personnel, methodologies to determine the cost of educating
and training allied health personnel, and an identification of the class-
STANDARDS FOR LICENSURE, RELICENSURE AND CONTINUING
ifications in which there is a critical shortage of allied health
EDUCATION
personnel.
(6) A study of funding alternatives to Federal and State sup-
The Senate amendment required the Secretary, in consultation with
port which may be developed to meet the costs of training within
appropriate professional organizations, to develop and establish
schools of medicine, osteopathy, dentistry, veterinary medicine, optom-
model standards for State licensure of physicians and dentists, prepare
etry, podiatry, and pharmacy.
appropriate examinations for the licensing and procedures for the re-
The Senate amendment contained no comparable provisions. How-
licensing of physicians and dentists, and develop appropriate stand-
ever, the Senate amendment contained a provision requiring the
ards for continuing educational programs for physicians and dentists.
134
135
Standards were to include a level of satisfactory performance
The House bill contained no comparable provision.
on examinations, the demonstration of written and spoken proficiency
The conference substitute does not contain the Senate provision.
in the English language, and completion of a specific number of hours
However, the protection of patients from unnecessary radiation expo-
of continuing education. In addition, under the Senate amendment,
sure in the provision of radiologic services is a matter of considerable
the Secretary was authorized to make grants to State agencies to
concern to the conferees. The general public's exposure to radiation in
assist States planning, developing, or operating systems for licensure
medicine and dentistry amounts to over 90 percent of all human expo-
and relicensure of physicians and dentists which would meet the stand-
sure to man-made ionizing radiation. Testimony before the House
ards established by the Secretary. Authorizations of $3 million for
Committee on Interstate and Foreign Commerce and the Senate Com-
fiscal year 1978, $4 million for fiscal year 1979, and $5 million for fiscal
mittee on Labor and Public Welfare indicates that such patient ex-
year 1980 were provided for such grants.
posure can be significantly reduced without impairing the provision
The House bill contained no comparable provision.
of radiologic services, such as X-ray examinations, which are essential
The conference substitute does not contain the Senate provision.
to effective medical and dental services.
Concern for the public health implications of present practices has
AMENDMENTS TO NURSE TRAINING AcT WITH RESPECT TO NURSE
spurred no less than seven national bodies between 1966 and 1974
PRACTITIONERS
to recommend that the qualifications of the operators of radiologic
equipment be upgraded. In response, eight States have enacted legisla-
The Senate amendment contained a provision which would amend
tion and four other States have been judged by their Attorney Gen-
the Nurse Training Act with respect to nurse traineeships to (1) re-
erals to possess sufficient authority to require the mandatory licensure
quire the Secretary, in awarding such traineeships to give special con-
of radiologic technologists.
sideration to programs for the training of nurse practitioners who will
In the judgment of the conferees the programs of the Department
practice in health manpower shortage areas and (2) to authorize the
of Health, Education, and Welfare to promote model legislation to
Secretary to make grants and enter into contracts with schools of nurs-
encourage State licensure of radiologic technologists have been inade-
ing, medicine, and public health, hospitals, and other nonprofit entities
quate, compared to the potential risks associated with unnecessary
to establish traineeship programs to train nurse practitioners who are
radiation exposure of consumer-patients. Thus, the conferees expect
residents of urban or rural health manpower shortage areas.
the Secretary to intensify his efforts with respect to offering encourage-
The House bill contained no comparable provision.
ment and assistance to States to upgrade their standards with respect
The conference substitute conforms to the provisions of the Senate
to the provision of radiologic services.
amendment.
AMENDMENTS TO THE IMMIGRATION AND NATIONALITY Act
INCLUSION OF OPTOMETRISTS AS PROVIDERS UNDER HEALTH PLANNING
AUTHORITY
The Senate amendment contained provisions which amended the
Immigration and Nationality Act with respect to the eligibility of
The Senate amendment contained a provision which (1) specifically
alien physicians to immigrate into the United States. These provisions
included optometrists as providers of health care eligible to be ap-
rendered such aliens ineligible for preference priorities under section
pointed to the governing bodies of health systems agencies under sec-
203 (a) (3) and (6) of such Act (relating to preferences for persons
tion 1512 of the Public Health Service Act and (2) included optom-
of exceptional ability in the sciences or the arts and to persons capable
etrists within the definition of "provider of health care" under section
of performing labor for which a shortage exists in the United States)
1531 of such Act.
and for the nonpreference category, unless such aliens have passed
The House bill contained no comparable provision.
Parts I and II of the National Board of Medical Examiners Examina-
The conference substitute includes the provisions of the Senate
tion (or an equivalent examination) and are competent in the English
amendment.
language. In addition, the Senate amendment added new provisions
RADIATION HEALTH AND SAFETY
to such Act which required that in order for an alien physician to
The Senate amendment contained a provision which required the
enter the United States on an exchange visitor visa, (a so-called "J-
Secretary to develop criteria for minimum standards for accreditation
visa"), he must (a) participate in a program sponsored by a United
of educational institutions for the training of radiologic technologists
States school of medicine or other recognized educational institution,
(b) have passed parts I or II of the National Board of Medical Ex-
and for use in the accreditation of educational institutions conducting
programs for the training of medical and dental practitioners, dental
aminers Examination or an equivalent examination, and (c) make
hygienists, and dental assistants. In addition, the Secretary was re-
a commitment to return to the country of his origin upon completion
quired to develop and issue to the States criteria and minimum stand-
of his education in the United States. In addition, such alien physician
ards for licensure of radiologic technologists. If such standards for
may not participate in an educational program in the United States
accreditation of institutions or licensure of personnel were not met by
for more than two years (with provision for extension of this period
States within two years, standards developed by the Secretary were
for an additional year). Until December 31, 1980, these additional
to become standards to be applied within such States.
requirements with respect to the J-visa program would not preclude
136
participation by aliens in an accredited program of graduate training
in a medical facility where such program would otherwise be sub-
stantially disrupted.
The House amendment contained no comparable provision.
The conference substitute includes the Senate provisions, with
technical amendments, including an amendment requiring the Secre-
tary of Health, Education, and Welfare to develop sufficient data to
enable the Secretary of Labor to make equitable determinations with
regard to applications for labor certification by graduates of foreign
medical schools.
The conferees recognize that successful legal challenges have been
made to Department of Labor determinations under section 212
(a) (14) of the Immigration and Nationality Act. As a result, future
case-by-case determinations should be supported by data and informa-
tion relating to the availability of physicians, and the conferees
expect the Department of Health, Education, and Welfare to provide
the necessary assistance in accumulating such data.
HARLEY O. STAGGERS,
PAUL G. ROGERS,
DAVID E. SATTERFIELD,
RICHARD PREYER,
JAMES W. SYMINGTON,
JAMES H. SCHEUER,
HENRY A. Waxman,
JAMES J. FLORIO,
CHARLES J. CARNEY,
ANDREW MAGUIRE,
SAMUEL L. DEVINE,
TIM LEE CARTER,
JAMES T. BROYHILL,
EDWARD R. MADIGAN,
Managers on the Part of the House.
EDWARD KENNEDY,
H. A. WILLIAMS,
GAYLORD NELSON,
THOMAS F. EAGLETON,
ALAN CRANSTON,
CLAIBORNE PELL,
WILLIAM D. HATHAWAY,
JOHN A. DURKIN,
RICHARD S. SCHWEIKER,
J. K. JAVITS,
J. GLENN BEALL, Jr.,
ROBERT TAFT, Jr.,
ROBERT T. STAFFORD,
PAUL LAXALT,
Managers on the Part of the Senate.