AREA HEALTH EDUCATION CENTERS.

SEC. 608. AREA HEALTH EDUCATION CENTERS. (a) Minimum Number of Individuals in Certain Internships.—Section 781(d)(2)(c) (42 U.S.C. 295g-l(d)(2)(c) is amended by striking “six” and inserting “four”. (b) Authorization of Appropriations for General Program of Area Health Education Centers.—(1) Section 781(a) (42 U.S.C. 295g-l(a)) is amended by adding at the end of paragraph (2) the following new subparagraph: “(C) In the case of the requirement that an area health education center be neither a school of medicine or osteopathy, the parent institution of such a school, nor a branch campus or other subunit of a school of medicine or osteopathy or its parent institution, or a consortium of such entities, to be eligible to enter into a contract under this section, the Secretary shall waive such requirement with respect to an area health education center having, at the time of initial application to enter into such contract under this section or a previous authorizing law, an operating program supported by both appropriations of a State legislature and local resources.”. (2) Section 781(d)(2)(F) is amended by striking out “and nurse practitioners” and inserting in lieu thereof “, nurse practitioners, and nurse midwives”. 102 STAT. 3128 (3) Section 781(h) (as redesignated by subsection (c)(1) of this section) is amended in the first sentence— (A) by striking “There are authorized” and all that follows through “this section” and inserting the following: “For the purpose of carrying out this section other than subsection (0, there are authorized to be appropriated”; and (B) by striking “and” after “1987,” and inserting before the period the following: “, $18,700,000 for the fiscal year 1989, and $20,000,000 for each of the fiscal years 1990 and 1991”. (c) Health Education and Training Centers.—Section 781 (42 U.S.C. 295g-l) is amended— (1) by redesignating subsections (f) and (g) as subsections (g) and (h), respectively; and (2) by adding after subsection (e) the following new subsection: “(f)(1) The Secretary shall enter into contracts with schools of medicine and osteopathy for the purpose of planning, developing, establishing, maintaining, and operating health education and training centers— “(A) to improve the supply, distribution, quality, and efficiency of personnel providing (in the United States) health services along the border between the United States and Mexico; “(B) to improve the supply, distribution, quality, and efficiency of personnel providing, in other urban and rural areas (including frontier areas) of the United States, health services to any population group, including Hispanic individuals, that has demonstrated serious unmet health care needs; and “(C) to encourage health promotion and disease prevention through public education in the areas described. “(2) The Secretary may not enter into a contract under paragraph (1) unless the applicant for such assistance agrees, in carrying out the purpose described in such paragraph, to enter into arrangements with one or more public or nonprofit private entities in the State that have expertise in providing health education to the public. “(3) The Secretary shall, after consultation with health education and training centers, designate the geographic area in which each such center will carry out the purpose described in paragraph (1). The service area of such a center shall be located entirely within the State in which the center is located. Each border health education and training center shall be located in a county (or other political subdivision) of the State in close proximity to the border between the United States and Mexico. “(4) The Secretary may not enter into a contract under paragraph (1) unless the applicant for such assistance agrees— “(A) to establish an advisory group comprised of health service providers, educators and consumers from the service area and of faculty from participating schools; “(B) after consultation with such advisory group, to develop a plan for carrying out the purpose described in paragraph (1) in the service area; “(C) to enter into contracts, as needed, with other institutions or entities to carry out such plan; and “(D) to be responsible for the evaluation of the program. “(5) The Secretary may not make a grant or enter into a contract under paragraph (1) unless the applicant for such assistance agrees— 102 STAT. 3129 “(A) to evaluate the specific service needs for health care personnel in the service area; “(B) to assist in the planning, development, and conduct of training programs to meet the needs identified pursuant to subparagraph (A); “(C) to conduct or support not leas than one training and education program for physicians and one program for nurses for at least a portion of the clinical training of such students; “(D) to conduct or support training in health education services, including training to prepare community health workers to implement health education programs in communities, health departments, health clinics, and public schools that are located in the service area; “(E) to conduct or support continuing medical education programs for physicians and other health professionals (including allied health personnel) practicing in the service area; “(F) to support health career educational opportunities designed to provide students residing in the service area with counseling, education, and training in the health professions; “(G) with respect to border health education and training centers, to assist in coordinating its activities and programs carried out pursuant to paragraph (1)(a) with any similar programs and activities carried out in Mexico along the border between the United States and Mexico; and “(H) to make available technical assistance in the service area in the aspects of health care organization, financing and delivery. “(6) In carrying out this subsection, the Secretary shall ensure that— “(A) not less than 75 percent of the total funds provided to a school or schools of medicine or osteopathy will be expended in the development and operation of the health education and training center in the service area of such program; “(B) to the maximum extent feasible, the school of medicine or osteopathy will obtain from nongovernmental sources the amount of the total operating funds for such program which are not provided by the Secretary; “(C) no grant or contract shall provide funds solely for the planning or development of a health education and training center program for a period in excess of two years; “(D) not more than 10 percent of the annual budget of each program may be utilized for the renovation and equipping of clinical teaching sites; and “(E) no grant or contract shall provide funds to be used outside the United States except as the Secretary may prescribe for travel and communications purposes related to the conduct of a border health education and training center. “(7) For purposes of this subsection: “(A) The term ‘border health education and training center’ means an entity that is a recipient of a contract under paragraph (1) and that is carrying out (or will carry out) the purpose described in subparagraph (a) of such paragraph. “(B) The term ‘health education and training center’ means an entity that is a recipient of a contract under paragraph (1). “(C) The term ‘service area’ means, with reaped to a health education and training center, the geographic area designated for the center under paragraph (3). 102 STAT. 3130 “(8)(A) Of the amounts appropriated pursuant to subsection (h)(2) for a fiscal year, the Secretary shall make available 50 percent for allocations each fiscal year for applications approved by the Secretary for border health education and training centers. The amount of the allocation for each such center shall be determined in accordance with subparagraph (B). “(B) The amount of an allocation under subparagraph (a) for a fiscal year shall be determined in accordance with a formula prescribed by the Secretary, which formula shall be based— “(i) with respect to the service area of the border health education and training center involved, on the low-income population, including Hispanic individuals, along the border between the United States and Mexico and the growth rate of such population; “(ii) on the need of such population for additional personnel to provide health care services along such border; and “(iii) on the most current information concerning mortality and morbidity and other indicators of health status for such population.”. (d) Authorization of Appropriations for Health Education and Training Centers.—Section 781(h) (as redesignated by subsection (c)(1) of this section) is amended by inserting “(1)” after the subsection designation and by adding at the end the following new paragraph: “(2) For the purpose of carrying out subsection (f), there are authorized to be appropriated $4,000,000 for fiscal year 1989, $8,000,000 for fiscal year 1990, and $12,000,000 for fiscal year 1991.”.