CHANGES TO INDIAN HEALTH SERVICE LOAN REPAYMENT PROGRAM.

SEC. 106. CHANGES TO INDIAN HEALTH SERVICE LOAN REPAYMENT PROGRAM. (a) Eligibility Requirements.— Section 108 of the Act (25 U.S.C. 1616a(b)) is amended— (1) in subsection (a)(1), by striking out “physicians,” and all that follows through “professionals” and inserting in lieu thereof “health professionals”; and (2) in subsection (b)— (A) in paragraph (1)(A)— (i) by amending clause (i) to read as follows: “(i) in a course of study or program in an accredited institution, as determined by the Secretary, within any State and be scheduled to complete such course of study in the same year such individual applies to participate in such program; or”; and (ii) in clause (ii), by striking out “medicine” and all that follows through “health profession” and inserting in lieu thereof the following: “a health profession”; (B) in paragraph (1)(B)— (i) by inserting “and” at the end of clause (i), by striking out clause (ii), and by redesignating clause (iii) as clause (ii); (ii) in clause (i), by striking out “medicine, osteopathy, dentistry, or other health profession” and inserting in lieu thereof the following: “a health profession”; and (iii) in clause (ii) (as redesignated by clause (i) of this subparagraph), by striking out “medicine, osteopathy, dentistry, or other health profession” and 106 STAT. 4536inserting in lieu thereof the following: “a health profession”; and (C) in paragraph (2), by inserting “and” at the end of subparagraph (D), by striking out paragraphs (3) and (4), and by inserting after paragraph (2) the following: “(3) submit to the Secretary an application for a contract described in subsection (f).”. (b) Priority.—Section 108(d) of the Act (25 U.S.C. 1616a(d)) is amended— (1) in paragraph (1), by striking out “The” and inserting “Consistent with paragraph (3), the”; and (2) by adding at the end the following new paragraph: “(3) (A) Subject to subparagraph (B), of the total amounts appropriated for each of the fiscal years 1993, 1994, and 1995 for loan repayment contracts under this section, the Secretary shall provide that— “(i) not less than 25 percent be provided to applicants who are nurses, nurse practitioners, or nurse midwives; and “(ii) not less than 10 percent be provided to applicants who are mental health professionals (other than applicants described in clause (i)). “(B) The requirements specified in clause (i) or clause (ii) of subparagraph (A) shall not apply if the Secretary does not receive the number of applications from the individuals described in clause (i) or clause (ii), respectively, necessary to meet such requirements.”. (c) Becoming a Participant.—Paragraph (1) of section 108(e) (25 U.S.C. 1616a(e)) is amended to read as follows: “(1) An individual becomes a participant in the Loan Repayment Program only upon the Secretary and the individual entering into a written contract described in subsection (f).”. (d) Extension of Obligated Service.—Paragraph (2)(A) of section 108(e) (25 U.S.C. 1616a(e)) is amended by inserting before the semicolon the following: “, including extensions resulting in an aggregate period of obligated service in excess of 4 years”. (e) Clarification Regarding Undergraduate Loans.—Paragraph (1) of section 108(g) (25 U.S.C. 1616a(g)) is amended in the matter preceding subparagraph (A) by striking out “loans received by the individual for—” and inserting in lieu thereof “loans received by the individual regarding the undergraduate or graduate education of the individual (or both), which loans were made for—”. (f) Payment.—Section 108(g)(2)(A) (25 U.S.C. 1616a(g)(2)(A)) is amended to read as follows: “(2) (A) For each year of obligated service that an individual contracts to serve under subsection (f) the Secretary may pay up to $35,000 (or an amount equal to the amount specified in section 338B(g)(2)(A) of the Public Health Service Act) on behalf of the individual for loans described in paragraph (1). In making a determination of the amount to pay for a year of such service by an individual, the Secretary shall consider the extent to which each such determination— “(i) affects the ability of the Secretary to maximize the number of contracts that can be provided under the Loan Repayment Program from the amounts appropriated for such contracts; 106 STAT. 4537 “(ii) provides an incentive to serve in Indian health programs with the greatest shortages of health professionals; and “(iii) provides an incentive with respect to the health professional involved remaining in an Indian health program with such a health professional shortage, and continuing to provide primary health services, after the completion of the period of obligated service under the Loan Repayment Program.”. (g) Tax Liability.— (1) Paragraph (3) of section 108(g) (25 U.S.C. 1616a(g)(3)) is amended to read as follows: “(3) For the purpose of providing reimbursements for tax liability resulting from payments under paragraph (2) on behalf of an individual, the Secretary— “(A) in addition to such payments, may make payments to the individual in an amount not less than 20 percent and not more than 39 percent of the total amount of loan repayments made for the taxable year involved; and “(B) may make such additional payments as the Secretary determines to be appropriate with respect to such purpose.”. (2) The amendment made by paragraph (1) shall apply only with respect to contracts under section 108 of the Indian Health Care Improvement Act entered into on or after the date of enactment of this Act. (h) Staffing Needs.—Section 108(k) (25 U.S.C. 1616a(k)) is amended to read as follows: “(k) The Secretary, in assigning individuals to serve in Indian health programs pursuant to contracts entered into under this section, shall— “(1) ensure that the staffing needs of Indian health programs administered by an Indian tribe or tribal or health organization receive consideration on an equal basis with programs that are administered directly by the Service; and “(2) give priority to assigning individuals to Indian health programs that have a need for health professionals to provide health care services as a result of individuals having breached contracts entered into under this section.”. (i) Annual Report.—Subsection (n) of section 108 is amended to read as follows: “(n) The Secretary shall submit to the President, for inclusion in each report required to be submitted to the Congress under section 801, a report concerning the previous fiscal year which sets forth— “(1) the health professional positions maintained by the Service or by tribal or Indian organizations for which recruitment or retention is difficult; “(2) the number of Loan Repayment Program applications filed with respect to each type of health profession; “(3) the number of contracts described in subsection (f) that are entered into with respect to each health profession; “(4) the amount of loan payments made under this section, in total and by health profession; “(5) the number of scholarship grants that are provided under section 104 with respect to each health profession; “(6) the amount of scholarship grants provided under section 104, in total and by health profession; “(7) the number of providers of health care that will be needed by Indian health programs, by location and profession, 106 STAT. 4538during the three fiscal years beginning after the date the report is filed; and “(8) the measures the Secretary plans to take to fill the health professional positions maintained by the Service or by tribes or tribal or Indian organizations for which recruitment or retention is difficult.”.