
From the U.S. Code Online via GPO Access
[wais.access.gpo.gov]
[Laws in effect as of January 23, 2000]
[Document not affected by Public Laws enacted between
  January 23, 2000 and December 4, 2001]
[CITE: 42USC254t]

 
                 TITLE 42--THE PUBLIC HEALTH AND WELFARE
 
                    CHAPTER 6A--PUBLIC HEALTH SERVICE
 
                SUBCHAPTER II--GENERAL POWERS AND DUTIES
 
                       Part D--Primary Health Care
 
       subpart iii--scholarship program and loan repayment program
 
Sec. 254t. Demonstration grants to States for community 
        scholarship programs
        

(a) In general

    The Secretary, acting through the Administrator of the Health 
Resources and Services Administration, may make grants to States for the 
purpose of carrying out demonstration programs to increase the 
availability of primary health care in urban and rural health manpower 
shortage areas through assisting community organizations of such areas 
in educating individuals to serve as health professionals in such areas.

(b) Certain requirements for States

                     (1) Minimum qualifications

        The Secretary may not make a grant under subsection (a) of this 
    section unless the State involved will, under any provision of this 
    chapter other than subsection (a) of this section, receive 1 or more 
    grants, cooperative agreements, or contracts for the fiscal year for 
    which the State is applying pursuant to subsection (h) of this 
    section to receive a grant under subsection (a) of this section.

                    (2) Administration of program

        The Secretary may not make a grant under subsection (a) of this 
    section unless the State involved agrees that the program carried 
    out by the State with the grant will be administered directly by a 
    single State agency.

(c) Grants by States to community organizations for provision of 
        scholarship contracts

    The Secretary may not make a grant under subsection (a) of this 
section unless the State involved agrees, subject to subsections (d) and 
(e) of this section, to carry out the purpose described in subsection 
(a) of this section only through operating a program in which the State 
makes grants to community organizations located in health manpower \1\ 
shortage areas in order to assist the organizations with the costs of 
entering into contracts under which--
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    \1\ So in original. Probably should be ``professional''.
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        (1) the community organizations agree to provide scholarships to 
    individuals for attendance at health professions schools; and
        (2) the individuals agree to provide, in the health manpower 
    shortage areas in which the community organizations are located, 
    primary health care for--
            (A) a number of years equal to the number of years for which 
        the scholarships are provided, or for a period of 2 years, 
        whichever period is greater; or
            (B) such greater period of time as the individuals and the 
        community organizations may agree.

(d) Requirement of State and local matching funds

                           (1) In general

        With respect to the costs of providing any scholarship pursuant 
    to subsection (c) of this section, the Secretary may not make a 
    grant under subsection (a) of this section unless the State involved 
    agrees that--
            (A) 40 percent of the costs of the scholarship will be paid 
        from the grant made under subsection (a) of this section to the 
        State; and
            (B) 60 percent of such costs will be paid from non-Federal 
        contributions made in cash by both the State and the community 
        organization through which the scholarship is provided, subject 
        to--
                (i) the State making available through such 
            contributions not less than 15 percent, nor more than 25 
            percent, of such costs; and
                (ii) the community organization making available through 
            such contributions not less than 35 percent, nor more than 
            45 percent, of such costs.

      (2) Determination of amount of non-Federal contributions

        The Secretary may not make a grant under subsection (a) of this 
    section unless the State involved agrees that, in determining the 
    amount of non-Federal contributions that have been provided in cash 
    for purposes of paragraph (1), the State will not include any 
    amounts provided by the Federal Government to the State or community 
    organization involved, or to any other entity.

                        (3) Use of donations

        Non-Federal contributions required in paragraph (1) may be 
    provided directly by the State and community organization involved, 
    and may be provided through donations from public and private 
    entities.

(e) Specifications regarding scholarship contract

    The Secretary may not make a grant under subsection (a) of this 
section unless the State involved agrees that the State will make a 
grant to a community organization for a contract described in subsection 
(c) of this section only if--
        (1) the individual who is to receive the scholarship under the 
    contract is a resident of the health manpower shortage area in which 
    the community organization is located;
        (2) the individual is enrolled or accepted for enrollment as a 
    full-time student in a health professions school that is approved by 
    the Secretary for purposes of this section;
        (3) the individual agrees to maintain an acceptable level of 
    academic standing at the school (as determined by the school in 
    accordance with regulations issued by the Secretary for purposes of 
    section 254l(f)(1)(B)(iii) of this title);
        (4) the individual and the community organization agree that the 
    scholarship provided pursuant to the contract--
            (A) will be expended only for--
                (i) tuition expenses, other reasonable educational 
            expenses, and reasonable living expenses incurred in 
            attendance at the school; and
                (ii) payment to the individual of a monthly stipend of 
            not more than the amount authorized for purposes of section 
            254l(g)(1)(B) of this title; and

            (B) will not, for any year of such attendance for which the 
        scholarship is provided, be in an amount exceeding the total 
        amount required for the year for the purposes authorized in 
        subparagraph (A);

        (5) the individual agrees to meet the educational and licensure 
    requirements necessary to be a physician, certified nurse 
    practitioner, certified nurse midwife, or physician assistant; and
        (6) the individual agrees that, in providing primary health care 
    pursuant to the scholarship, the individual--
            (A) will not, in the case of an individual seeking such 
        care, discriminate against the individual on the basis of the 
        ability of the individual to pay for such care or on the basis 
        that payment for such care will be made pursuant to the program 
        established in title XVIII of the Social Security Act [42 U.S.C. 
        1395 et seq.] or pursuant to the program established in title 
        XIX of such Act [42 U.S.C. 1396 et seq.]; and
            (B) will accept assignment under section 1842(b)(3)(B)(ii) 
        of the Social Security Act [42 U.S.C. 1395u(b)(3)(B)(ii)] for 
        all services for which payment may be made under part B of title 
        XVIII of such Act [42 U.S.C. 1395j et seq.], and will enter into 
        an appropriate agreement with the State agency that administers 
        the State plan for medical assistance under title XIX of such 
        Act to provide service to individuals entitled to medical 
        assistance under the plan.

(f) Reports to Secretary

    The Secretary may not make a grant under subsection (a) of this 
section unless the State involved agrees--
        (1) for each fiscal year for which such a grant is received by 
    the State, to submit to the Secretary a report--
            (A) identifying the community organizations providing 
        scholarships pursuant to subsection (c) of this section and the 
        health manpower shortage areas in which the organizations are 
        located;
            (B) providing the names of individuals receiving the 
        scholarships, the health professions in which the individuals 
        will engage pursuant to the scholarships, the number of years of 
        service the individuals are obligated to provide pursuant to the 
        scholarships, and the extent of compliance with the contracts 
        under subsection (c) of this section on the part of the 
        individuals and the community organizations; and
            (C) providing such information as the Secretary may 
        determine to be necessary for carrying out this section; and

        (2) to submit each such report not later than January 10 of the 
    fiscal year immediately following the fiscal year for which the 
    report is prepared.

(g) Estimates regarding allocations between urban and rural areas

    The Secretary may not make a grant under subsection (a) of this 
section unless the State involved submits to the Secretary, as part of 
the application required in subsection (h) of this section, an estimate 
of the amount of the grant that will be expended regarding the provision 
of primary health care in urban health manpower shortage areas of the 
State, and an estimate of the amount of the grant that will be expended 
regarding the provision of such care in rural health manpower shortage 
areas of the State.

(h) Requirement of application

    The Secretary may not make a grant under subsection (a) of this 
section unless an application for the grant is submitted to the 
Secretary and the application is in such form, is made in such manner, 
and contains such agreements, assurances, and information as the 
Secretary determines to be necessary to carry out this section.

(i) Noncompliance

                           (1) In general

        The Secretary may not make payments under subsection (a) of this 
    section to a State for any fiscal year subsequent to the first 
    fiscal year of such payments unless the Secretary determines that, 
    for the immediately preceding fiscal year, the State has complied 
    with each of the agreements made by the State under this section.

       (2) Reduction in grant relative to number of breached 
                                  contracts

        (A) Before making a grant under subsection (a) of this section 
    to a State for a fiscal year, the Secretary shall determine the 
    number of contracts provided under subsection (c) of this section 
    with respect to which there has been an initial breach by the 
    community organizations or individuals involved during the fiscal 
    year preceding the fiscal year for which the State is applying to 
    receive the grant.
        (B) In the case of a State with 1 or more initial breaches for 
    purposes of subparagraph (A), the Secretary shall reduce the amount 
    of a grant under subsection (a) of this section to the State for the 
    fiscal year involved by an amount equal to the sum of--
            (i) an amount equal to the expenditures of Federal funds 
        made regarding the contracts involved; and
            (ii) an amount representing interest on the amount of such 
        expenditures, determined with respect to each contract on the 
        basis of the maximum legal rate prevailing for loans made during 
        the time amounts were paid under the contract, as determined by 
        the Treasurer of the United States.

        (C) If a State is not receiving a grant under subsection (a) of 
    this section for a fiscal year for which a reduction under 
    subparagraph (B) would have been made in the event that the State 
    had received such a grant, the Secretary shall reduce the amount of 
    payments due to the State under other grants, cooperative 
    agreements, or contracts under this chapter by the amount specified 
    in such subparagraph.
        (D) With respect to contracts provided under subsection (c) of 
    this section, the Secretary may carry out this paragraph on the 
    basis of information submitted by the States involved, or on the 
    basis of information collected through such other means as the 
    Secretary determines to be appropriate.

(j) Reports to Congress

                           (1) In general

        Each fiscal year the Secretary shall submit to the Committee on 
    Energy and Commerce of the House of Representatives, and to the 
    Committee on Labor and Human Resources of the Senate, a report 
    summarizing information received by the Secretary under subsection 
    (f) of this section for the preceding fiscal year.

                       (2) Date for submission

        With respect to a fiscal year, the report required in paragraph 
    (1) shall be submitted for purposes of such paragraph by not later 
    than the date on which the report required in section 254l(i) of 
    this title is required to be submitted for purposes of such section.

(k) Definitions

    For purposes of this section:

                     (1) Community organization

        The term ``community organization'' means a public or nonprofit 
    private entity.

                       (2) Primary health care

        The term ``primary health care'' means health services regarding 
    family medicine, internal medicine, pediatrics, or obstetrics and 
    gynecology, that are provided by physicians, certified nurse 
    practitioners, certified nurse midwives, or physician assistants.

                              (3) State

        The term ``State'' means each of the several States and the 
    District of Columbia.

(l) Funding

                 (1) Authorization of appropriations

        For the purpose of making grants under subsection (a) of this 
    section, there are authorized to be appropriated $5,000,000 for 
    fiscal year 1991, $10,000,000 for fiscal year 1992, and such sums as 
    may be necessary for fiscal year 1993.

                          (2) Availability

        Amounts appropriated under paragraph (1) shall remain available 
    until expended.

                   (3) Allocations for rural areas

        (A) In carrying out subsection (a) of this section, the 
    Secretary shall, to the extent practicable, ensure that not less 
    than 50 percent of the amounts appropriated under paragraph (1) are, 
    in the aggregate, expended for making grants pursuant to subsection 
    (c) of this section to community organizations that are located in 
    rural health manpower shortage areas.
        (B) Subparagraph (A) may not be construed to prohibit the 
    Secretary from making grants under subsection (a) of this section to 
    States in which no rural health manpower shortage areas are located.
        (C) With respect to any fiscal year for which the Secretary is 
    unable to comply with subparagraph (A), the Secretary shall, not 
    later than April 1 of the subsequent fiscal year, submit to the 
    Committee on Energy and Commerce of the House of Representatives, 
    and to the Committee on Labor and Human Resources of the Senate, a 
    report stating the fact of such noncompliance and an explanation of 
    the reasons underlying such noncompliance.

(July 1, 1944, ch. 373, title III, Sec. 338L, as added Pub. L. 101-527, 
Sec. 8, Nov. 6, 1990, 104 Stat. 2328.)

                       References in Text

    The Social Security Act, referred to in subsec. (e)(6), is act Aug. 
14, 1935, ch. 531, 49 Stat. 620, as amended. Titles XVIII and XIX of the 
Act are classified generally to subchapters XVIII (Sec. 1395 et seq.) 
and XIX (Sec. 1396 et seq.), respectively, of chapter 7 of this title. 
Part B of title XVIII of the Act is classified generally to part B 
(Sec. 1395j et seq.) of subchapter XVIII of chapter 7 of this title. For 
complete classification of this Act to the Code, see section 1305 of 
this title and Tables.

                         Change of Name

    Committee on Energy and Commerce of House of Representatives treated 
as referring to Committee on Commerce of House of Representatives by 
section 1(a) of Pub. L. 104-14, set out as a note preceding section 21 
of Title 2, The Congress.
