INTERDISCIPLINARY, COMMUNITY-BASED LINKAGES

SEC. 103. INTERDISCIPLINARY, COMMUNITY-BASED LINKAGES Part D of title VII of the Public Health Service Act (42 U.S.C. 294 et seq.) is amended to read as follows: “PART D— INTERDISCIPLINARY, COMMUNITY-BASED LINKAGES “SEC. 750. GENERAL PROVISIONS. “(a) Collaboration.— To be eligible to receive assistance under this part, an academic institution shall use such assistance in collaboration with 2 or more disciplines. “(b) Activities.— An entity shall use assistance under this part to carry out innovative demonstration projects for strategic workforce supplementation activities as needed to meet national goals for interdisciplinary, community-based linkages. Such assistance may be used consistent with this part— “(1) to develop and support training programs; “(2) for faculty development; “(3) for model demonstration programs; “(4) for the provision of stipends for fellowship trainees; “(5) to provide technical assistance; and “(6) for other activities that will produce outcomes consistent with the purposes of this part. “SEC. 751. AREA HEALTH EDUCATION CENTERS. “(a) Authority for Provision of Financial Assistance.— “(1) Assistance for planning, development, and operation of programs.— “(A) In general.— The Secretary shall award grants to and enter into contracts with schools of medicine and osteopathic medicine, and incorporated consortia made up of such schools, or the parent institutions of such schools, for projects for the planning, development and operation of area health education center programs that— “(i) improve the recruitment, distribution, supply, quality and efficiency of personnel providing health services in underserved rural and urban areas and personnel providing health services to populations having demonstrated serious unmet health care needs; “(ii) increase the number of primary care physicians and other primary care providers who provide services in underserved areas through the offering of an educational continuum of health career recruitment through clinical education concerning underserved areas in a comprehensive health workforce strategy; “(iii) carry out recruitment and health career awareness programs to recruit individuals from underserved areas and under-represented populations, including minority and other elementary or secondary students, into the health professions; 112 STAT. 3542 “(iv) prepare individuals to more effectively provide health services to underserved areas or underserved populations through field placements, preceptorships, the conduct of or support of community-based primary care residency programs, and agreements with community-based organizations such as community health centers, migrant health centers, Indian health centers, public health departments and others; “(v) conduct health professions education and training activities for students of health professions schools and medical residents; “(vi) conduct at least 10 percent of medical student required clinical education at sites remote to the primary teaching facility of the contracting institution; and “(vii) provide information dissemination and educational support to reduce professional isolation, increase retention, enhance the practice environment, and improve health care through the timely dissemination of research findings using relevant resources. “(B) Other eligible entities.— With respect to a State in which no area health education center program is in operation, the Secretary may award a grant or contract under subparagraph (A) to a school of nursing. “(C) Project terms.— “(i) In general.— Except as provided in clause (ii), the period during which payments may be made under an award under subparagraph (A) may not exceed— “(I) in the case of a project, 12 years or “(II) in the case of a center within a project, 6 years. “(ii) Exception.— The periods described in clause (i) shall not apply to projects that have completed the initial period of Federal funding under this section and that desire to compete for model awards under paragraph (2)(A). “(2) Assistance for operation of model programs.— “(A) In general.— In the case of any entity described in paragraph (1)(A) that— “(i) has previously received funds under this section; “(ii) is operating an area health education center program; and “(iii) is no longer receiving financial assistance under paragraph (1); the Secretary may provide financial assistance to such entity to pay the costs of operating and carrying out the requirements of the program as described in paragraph (1). “(B) Matching requirement.— With respect to the costs of operating a model program under subparagraph (A), an entity, to be eligible for financial assistance under subparagraph (A), shall make available (directly or through contributions from State, county or municipal governments, or the private sector) recurring non-Federal contributions 112 STAT. 3543in cash toward such costs in an amount that is equal to not less than 50 percent of such costs. “(C) Limitation.— The aggregate amount of awards provided under subparagraph (A) to entities in a State for a fiscal year may not exceed the lesser of— “(i) $2,000,000; or “(ii) an amount equal to the product of $250,000 and the aggregate number of area health education centers operated in the State by such entities. “(b) Requirements for Centers.— “(1) General requirement.— Each area health education center that receives funds under this section shall encourage the regionalization of health professions schools through the establishment of partnerships with community-based organizations. “(2) Service area.— Each area health education center that receives funds under this section shall specifically designate a geographic area or medically underserved population to be served by the center. Such area or population shall be in a location removed from the main location of the teaching facilities of the schools participating in the program with such center. “(3) Other requirements.— Each area health education center that receives funds under this section shall— “(A) assess the health personnel needs of the area to be served by the center and assist in the planning and development of training programs to meet such needs; “(B) arrange and support rotations for students and residents in family medicine, general internal medicine or general pediatrics, with at least one center in each program being affiliated with or conducting a rotating osteopathic internship or medical residency training program in family medicine (including geriatrics), general internal medicine (including geriatrics), or general pediatrics in which no fewer than 4 individuals are enrolled in first-year positions; “(C) conduct and participate in interdisciplinary training that involves physicians and other health personnel including, where practicable, public health professionals, physician assistants, nurse practitioners, nurse midwives, and behavioral and mental health providers; and “(D) have an advisory board, at least 75 percent of the members of which shall be individuals, including both health service providers and consumers, from the area served by the center. “(c) Certain Provisions Regarding Funding.— “(1) Allocation to center.— Not less than 75 percent of the total amount of Federal funds provided to an entity under this section shall be allocated by an area health education center program to the area health education center. Such entity shall enter into an agreement with each center for purposes of specifying the allocation of such 75 percent of funds. “(2) Operating costs.— With respect to the operating costs of the area health education center program of an entity receiving funds under this section, the entity shall make available 112 STAT. 3544(directly or through contributions from State, county or municipal governments, or the private sector) non-Federal contributions in cash toward such costs in an amount that is equal to not less than 50 percent of such costs, except that the Secretary may grant a waiver for up to 75 percent of the amount of the required non-Federal match in the first 3 years in which an entity receives funds under this section. “SEC. 752. HEALTH EDUCATION AND TRAINING CENTERS. “(a) In General.— To be eligible for funds under this section, a health education training center shall be an entity otherwise eligible for funds under section 751 that— “(1) addresses the persistent and severe unmet health care needs in States along the border between the United States and Mexico and in the State of Florida, and in other urban and rural areas with populations with serious unmet healthcare needs; “(2) establishes an advisory board comprised of health service providers, educators and consumers from the service area; “(3) conducts training and education programs for health professions students in these areas; “(4) conducts training in health education services, including training to prepare community health workers; and “(5) supports health professionals (including nursing) practicing in the area through educational and other services. “(b) Allocation of Funds.— The Secretary shall make available 50 percent of the amounts appropriated for each fiscal year under section 752 for the establishment or operation of health education training centers through projects in States along the border between the United States and Mexico and in the State of Florida. “SEC. 753. EDUCATION AND TRAINING RELATING TO GERIATRICS. “(a) Geriatric Education Centers.— “(1) In general.— The Secretary shall award grants or contracts under this section to entities described in paragraphs(1), (3), or (4) of section 799B, and section 853(2), for the establishment or operation of geriatric education centers. “(2) Requirements.— A geriatric education center is a program that— “(A) improves the training of health professionals in geriatrics, including geriatric residencies, traineeships, or fellowships; “(B) develops and disseminates curricula relating to the treatment of the health problems of elderly individuals; “(C) supports the training and retraining of faculty to provide instruction in geriatrics; “(D) supports continuing education of health professionals who provide geriatric care; and “(E) provides students with clinical training in geriatrics in nursing homes, chronic and acute disease hospitals, ambulatory care centers, and senior centers. “(b) Geriatric Training Regarding Physicians and Dentists.— “(1) In general.— The Secretary may make grants to, and enter into contracts with, schools of medicine, schools of osteopathic medicine, teaching hospitals, and graduate medical education programs, for the purpose of providing support (including 112 STAT. 3545residencies, traineeships, and fellowships) for geriatric training projects to train physicians, dentists and behavioral and mental health professionals who plan to teach geriatric medicine, geriatric behavioral or mental health, or geriatric dentistry. “(2) Requirements.— Each project for which a grant or contract is made under this subsection shall— “(A) be staffed by full-time teaching physicians who have experience or training in geriatric medicine or geriatric behavioral or mental health; “(B) be staffed, or enter into an agreement with an institution staffed by full-time or part-time teaching dentists who have experience or training in geriatric dentistry; “(C) be staffed, or enter into an agreement with an institution staffed by full-time or part-time teaching behavioral mental health professionals who have experience or training in geriatric behavioral or mental health; “(D) be based in a graduate medical education program in internal medicine or family medicine or in a department of geriatrics or behavioral or mental health; “(E) provide training in geriatrics and exposure to the physical and mental disabilities of elderly individuals through a variety of service rotations, such as geriatric consultation services, acute care services, dental services, geriatric behavioral or mental health units, day and home care programs, rehabilitation services, extended care facilities, geriatric ambulatory care and comprehensive evaluation units, and community care programs for elderly mentally retarded individuals; and “(F) provide training in geriatrics through one or both of the training options described in subparagraphs (A) and (B) of paragraph (3). “(3) Training options.— The training options referred to in subparagraph (F) of paragraph (2) shall be as follows: “(A) A 1-year retraining program in geriatrics for— “(i) physicians who are faculty members in departments of internal medicine, family medicine, gynecology, geriatrics, and behavioral or mental health at schools of medicine and osteopathic medicine; “(ii) dentists who are faculty members at schools of dentistry or at hospital departments of dentistry; and “(iii) behavioral or mental health professionals who are faculty members in departments of behavioral or mental health; and “(B) A 2-year internal medicine or family medicine fellowship program providing emphasis in geriatrics, which shall be designed to provide training in clinical geriatrics and geriatrics research for— “(i) physicians who have completed graduate medical education programs in internal medicine, family medicine, behavioral or mental health, neurology, gynecology, or rehabilitation medicine; “(ii) dentists who have demonstrated a commitment to an academic career and who have completed post-doctoral dental training, including post-doctoral dental education programs or who have relevant advanced training or experience; and 112 STAT. 3546 “(iii) behavioral or mental health professionals who have completed graduate medical education programs in behavioral or mental health. “(4) Definitions.— For purposes of this subsection: “(A) The term ‘graduate medical education program’ means a program sponsored by a school of medicine, a school of osteopathic medicine, a hospital, or a public or private institution that— “(i) offers post graduate medical training in the specialties and subspecialties of medicine; and “(ii) has been accredited by the Accreditation Council for Graduate Medical Education or the American Osteopathic Association through its Committee on Postdoctoral Training. “(B) The term ‘post-doctoral dental education program’ means a program sponsored by a school of dentistry, a hospital, or a public or private institution that— “(i) offers post-doctoral training in the specialties of dentistry, advanced education in general dentistry, or a dental general practice residency; and “(ii) has been accredited by the Commission on Dental Accreditation. “(c) Geriatric Faculty Fellowships.— “(1) Establishment of program.— The Secretary shall establish a program to provide Geriatric Academic Career Awards to eligible individuals to promote the career development of such individuals as academic geriatricians. “(2) Eligible individuals.— To be eligible to receive an Award under paragraph (1), an individual shall— “(A) be board certified or board eligible in internal medicine, family practice, or psychiatry; “(B) have completed an approved fellowship program in geriatrics; and “(C) have a junior faculty appointment at an accredited (as determined by the Secretary) school of medicine or osteopathic medicine. “(3) Limitations.— No Award under paragraph (1) may be made to an eligible individual unless the individual— “(A) has submitted to the Secretary an application, at such time, in such manner, and containing such information as the Secretary may require, and the Secretary has approved such application; and “(B) provides, in such form and manner as the Secretary may require, assurances that the individual will meet the service requirement described in subsection (e). “(4) Amount and term.— “(A) Amount.— The amount of an Award under this section shall equal $50,000 for fiscal year 1998, adjusted for subsequent fiscal years to reflect the increase in the Consumer Price Index. “(B) Term.— The term of any Award made under this subsection shall not exceed 5 years. “(5) Service requirement.— An individual who receives an Award under this subsection shall provide training in clinical geriatrics, including the training of interdisciplinary teams of health care professionals. The provision of such training shall 112 STAT. 3547constitute at least 75 percent of the obligations of such individual under the Award. “SEC. 754. QUENTIN N. BURDICK PROGRAM FOR RURAL. INTERDISCIPLINARY TRAINING. “(a) Grants.— The Secretary may make grants or contracts under this section to help entities fund authorized activities under an application approved under subsection (c). “(b) Use of Amounts.— “(1) In general.— Amounts provided under subsection (a) shall be used by the recipients to fund interdisciplinary training projects designed to— “(A) use new and innovative methods to train health care practitioners to provide services in rural areas; “(B) demonstrate and evaluate innovative interdisciplinary methods and models designed to provide access to cost-effective comprehensive health care; “(C) deliver health care services to individuals residing in rural areas; “(D) enhance the amount of relevant research conducted concerning health care issues in rural areas; and “(E) increase the recruitment and retention of health care practitioners from rural areas and make rural practice a more attractive career choice for health care practitioners. “(2) Methods.— A recipient of funds under subsection (a) may use various methods in carrying out the projects described in paragraph (1), including— “(A) the distribution of stipends to students of eligible applicants; “(B) the establishment of a post-doctoral fellowship program; “(C) the training of faculty in the economic and logistical problems confronting rural health care delivery systems; or “(D) the purchase or rental of transportation and telecommunication equipment where the need for such equipment due to unique characteristics of the rural area is demonstrated by the recipient. “(3) Administration.— “(A) In general.— An applicant shall not use more than 10 percent of the funds made available to such applicant under subsection (a) for administrative expenses. “(B) Training.— Not more than 10 percent of the individuals receiving training with funds made available to an applicant under subsection (a) shall be trained as doctors of medicine or doctors of osteopathy. “(C) Limitation.— An institution that receives a grant under this section shall use amounts received under such grant to supplement, not supplant, amounts made available by such institution for activities of the type described in subsection (b)(1) in the fiscal year preceding the year for which the grant is received. “(c) Applications.— Applications submitted for assistance under this section shall— “(1) be jointly submitted by at least two eligible applicants with the express purpose of assisting individuals in academic 112 STAT. 3548institutions in establishing long-term collaborative relationships with health care providers in rural areas; and “(2) designate a rural health care agency or agencies for clinical treatment or training, including hospitals, community health centers, migrant health centers, rural health clinics, community behavioral and mental health centers, long-term care facilities, Native Hawaiian health centers, or facilities operated by the Indian Health Service or an Indian tribe or tribal organization or Indian organization under a contract with the Indian Health Service under the Indian Self-Determination Act. “(d) Definitions.— For the purposes of this section, the term ‘rural’ means geographic areas that are located outside of standard metropolitan statistical areas. “SEC. 755. ALLIED HEALTH AND OTHER DISCIPLINES. “(a) In General.— The Secretary may make grants or contracts under this section to help entities fund activities of the type described in subsection (b). “(b) Activities.— Activities of the type described in this subsection include the following: “(1) Assisting entities in meeting the costs associated with expanding or establishing programs that will increase the number of individuals trained in allied health professions. Programs and activities funded under this paragraph may include— “(A) those that expand enrollments in allied health professions with the greatest shortages or whose services are most needed by the elderly; “(B) those that provide rapid transition training programs in allied health fields to individuals who have baccalaureate degrees in health-related sciences; “(C) those that establish community-based allied health training programs that link academic centers to rural clinical settings; “(D) those that provide career advancement training for practicing allied health professionals; “(E) those that expand or establish clinical training sites for allied health professionals in medically underserved or rural communities in order to increase the number of individuals trained; “(F) those that develop curriculum that will emphasize knowledge and practice in the areas of prevention and health promotion, geriatrics, long-term care, home health and hospice care, and ethics; “(G) those that expand or establish interdisciplinary training programs that promote the effectiveness of allied health practitioners in geriatric assessment and the rehabilitation of the elderly; “(H) those that expand or establish demonstration centers to emphasize innovative models to link allied health clinical practice, education, and research; “(I) those that provide financial assistance (in the form of traineeships) to students who are participants in any such program; and “(i) who plan to pursue a career in an allied health field that has a demonstrated personnel shortage; and 112 STAT. 3549 “(ii) who agree upon completion of the training program to practice in a medically underserved community; that shall be utilized to assist in the payment of all or part of the costs associated with tuition, fees and such other stipends as the Secretary may consider necessary; and “(J) those to meet the costs of projects to plan, develop, and operate or maintain graduate programs in behavioral and mental health practice. “(2) Planning and implementing projects in preventive and primary care training for podiatric physicians in approved or provisionally approved residency programs that shall provide financial assistance in the form of traineeships to residents who participate in such projects and who plan to specialize in primary care. “(3) Carrying out demonstration projects in which chiropractors and physicians collaborate to identify and provide effective treatment for spinal and lower-back conditions. “SEC. 756. ADVISORY COMMITTEE ON INTERDISCIPLINARY, COMMUNITY-BASED LINKAGES. “(a) Establishment.— The Secretary shall establish an advisory committee to be known as the Advisory Committee on Interdisciplinary, Community-Based Linkages (in this section referred to as the ‘Advisory Committee’). “(b) Composition.— “(1) In general.— The Secretary shall determine the appropriate number of individuals to serve on the Advisory Committee. Such individuals shall not be officers or employees of the Federal Government. “(2) Appointment.— Not later than 90 days after the date of enactment of this Act, the Secretary shall appoint the members of the Advisory Committee from among individuals who are health professionals from schools of the types described in sections 751(a)(1)(A), 751(a)(1)(B), 753(b), 754(3)(A), and 755(b). In making such appointments, the Secretary shall ensure a fair balance between the health professions, that at least 75 percent of the members of the Advisory Committee are health professionals, a broad geographic representation of members and a balance between urban and rural members. Members shall be appointed based on their competence, interest, and knowledge of the mission of the profession involved. “(3) Minority representation.— In appointing the members of the Advisory Committee under paragraph (2), the Secretary shall ensure the adequate representation of women and minorities. “(c) Terms.— “(1) In general.— A member of the Advisory Committee shall be appointed for a term of 3 years, except that of the members first appointed— “(A) ⅓ of the members shall serve for a term of 1 year; “(B) ⅓ of the members shall serve for a term of 2 years; and 112 STAT. 3550 “(C) ⅓ of the members shall serve for a term of 3 years. “(2) Vacancies.— “(A) In general.— A vacancy on the Advisory Committee shall be filled in the manner in which the original appointment was made and shall be subject to any conditions which applied with respect to the original appointment. “(B) Filling unexpired term.— An individual chosen to fill a vacancy shall be appointed for the unexpired term of the member replaced. “(d) Duties.— The Advisory Committee shall— “(1) provide advice and recommendations to the Secretary concerning policy and program development and other matters of significance concerning the activities under this part; and “(2) not later than 3 years after the date of enactment of this section, and annually thereafter, prepare and submit to the Secretary, and the Committee on Labor and Human Resources of the Senate, and the Committee on Commerce of the House of Representatives, a report describing the activities of the Committee, including findings and recommendations made by the Committee concerning the activities under this part. “(e) Meetings and Documents.— “(1) Meetings.— The Advisory Committee shall meet not less than 3 times each year. Such meetings shall be held jointly with other related entities established under this title where appropriate. “(2) Documents.— Not later than 14 days prior to the convening of a meeting under paragraph (1), the Advisory Committee shall prepare and make available an agenda of the matters to be considered by the Advisory Committee at such meeting. At any such meeting, the Advisory Council shall distribute materials with respect to the issues to be addressed at the meeting. Not later than 30 days after the adjourning of such a meeting, the Advisory Committee shall prepare and make available a summary of the meeting and any actions taken by the Committee based upon the meeting. “(f) Compensation and Expenses.— “(1) Compensation.— Each member of the Advisory Committee shall be compensated at a rate equal to the daily equivalent of the annual rate of basic pay prescribed for level IV of the Executive Schedule under section 5315 of title 5, United States Code, for each day (including travel time) during which such member is engaged in the performance of the duties of the Committee. “(2) Expenses.— The members of the Advisory Committee shall be allowed travel expenses, including per diem in lieu of subsistence, at rates authorized for employees of agencies under subchapter I of chapter 57 of title 5, United States Code, while away from their homes or regular places of business in the performance of services for the Committee. “(g) FACA.— The Federal Advisory Committee Act shall apply to the Advisory Committee under this section only to the extent that the provisions of such Act do not conflict with the requirements of this section. 112 STAT. 3551 “SEC. 757. AUTHORIZATION OF APPROPRIATIONS. “(a) In General.— There are authorized to be appropriated to carry out this part, $55,600,000 for fiscal year 1998, and such sums as may be necessary for each of the fiscal years 1999 through 2002. “(b) Allocation.— “(1) In general.— Of the amounts appropriated under subsection (a) for a fiscal year, the Secretary shall make available— “(A) not less than $28,587,000 for awards of grants and contracts under section 751; “(B) not less than $3,765,000 for awards of grants and contracts under section 752, of which not less than 50 percent of such amount shall be made available for centers described in subsection (a)(1) of such section; and “(C) not less than $22,631,000 for awards of grants and contracts under sections 753, 754, and 755. “(2) Ratable reduction.— If amounts appropriated under subsection (a) for any fiscal year are less than the amount required to comply with paragraph (1), the Secretary shall ratably reduce the amount to be made available under each of subparagraphs (A) through (C) of such paragraph accordingly. “(3) Increase in amounts.— If amounts appropriated for a fiscal year under subsection (a) exceed the amount authorized under such subsection for such fiscal year, the Secretary may increase the amount to be made available for programs and activities under this part without regard to the amounts specified in each of subparagraphs (A) through (C) of paragraph(2). “(c) Obligation of Certain Amounts.— “(1) Area health education center programs.— Of the amounts made available under subsection (b)(1)(A) for each fiscal year, the Secretary may obligate for awards under section 751(a)(2)— “(A) not less than 23 percent of such amounts in fiscal year 1998; “(B) not less than 30 percent of such amounts in fiscal year 1999; “(C) not less than 35 percent of such amounts in fiscal year 2000; “(D) not less than 40 percent of such amounts in fiscal year 2001; and “(E) not less than 45 percent of such amounts in fiscal year 2002. “(2) Sense of congress.— It is the sense of the Congress that— “(A) every State have an area health education center program in effect under this section; and “(B) the ratio of Federal funding for the model program under section 751(a)(2) should increase over time and that Federal funding for other awards under this section shall decrease so that the national program will become entirely comprised of programs that are funded at least 50 percent by State and local partners.”.