Health Professions Training Assistance, Nurse Education, National Health Service Corps, Health Maintenance Organizations, and Primary Health Care Amendments of 1984

(Conference report filed in House, H. Rept. 98-1143)

Public Health Service Act Amendments of 1984 - Title I: Health Professions Training Assistance - Part A: Authorization of Appropriations - Amends title VII (Health Research and Teaching Facilities and Training of Professional Health Personnel) of the Public Health Service Act to authorize FY 1985 through 1987 appropriations for: (1) Federal student loan insurance (extends eligible loan insurance through FY 1990); (2) student loans (extends the loan fund distribution of assets through 1990); (3) scholarships for students of exceptional financial need; (4) departments of family medicine; (5) area health education centers; (6) physician assistants; (7) internal medicine and pediatrics; (8) family medicine and general dentistry; (9) educational assistance to persons from disadvantaged backgrounds; (10) curriculum development and faculty training; (11) advanced financial distress assistance; (12) graduate programs in health administration; (13) traineeships for students in other graduate programs; (14) public health traineeships; and (15) training in preventive medicine.

Part B: Program Revisions - Includes chiropractic schools and graduate programs in clinical psychology in the health professions student loan program.

Requires the Secretary to prescribe regulations for physician assistant training by May 1,1985. Includes colleges and institutions providing additional training in a science related to health care as schools of allied health. States that allied health professionals include individuals with degrees in a science related to health care.

Changes the composition of the National Advisory Council on Health Professions Education to require that at least one member be a representative of schools of public health.

Prohibits health education assistance loans from being made to students in violation of the draft registration laws.

Eliminates semiannual interest compounding of health professions student loans.

Limits the deferral of interest and principal payments on such loans to a maximum of four years of internship or residency (with an additional two years for fellowship training or other related health study).

Prohibits a total repayment period of more than 33 years. Increases the insurance premium ceiling from two to four percent. Requires such premiums to be collected at the time the loan is made.

Makes students in schools of allied health eligible for student loans.

Makes chiropractic schools, public health schools, and schools offering graduate clinical psychology programs eligible for health professions student loans. States that doctoral level pharmacy students are eligible for such loans.

Prohibits such loans to students who are in violation of the draft registration laws.

Sets aside at least one-half of such loan funds beginning in FY 1985 for disadvantaged students. Limits Federal contributions to chiropractic schools to four percent of total student loan appropriations in any fiscal year.

Requires deferral of such loan repayments by persons who leave school to engage for up to two years in an activity directly related to the health profession for which the person is preparing.

Repeals the provision requiring the Secretary to reimburse a school for its capital contribution for the loans of a borrower who died or became disabled. Permits schools to assess charges to cover insurance against cancellation of repayment liability because of death or disability. Requires a late charge of up to six percent on installments paid more than 60 days late.

Authorizes Federal assistance, including civil suits, in collecting a defaulted loan if the school has complied with related Federal collection requirements.

Makes returned loan funds available for reallotment.

Requires schools to make specified loan information available to the students.

Sets forth provisions for a school to appeal the Secretary's termination of a loan agreement.

Provides that scholarships for first year students of exceptional financial need shall include tuition, other reasonable educational expenses, and an annually adjusted stipend. States that the total scholarship award shall not exceed attendance costs.

Authorizes capitation grant appropriations for FY 1985 through 1987. Limits such grants to schools of public health. Sets forth revised eligibility provisions, including using 1983 as the base year and calculating enrollment based on full-time and full-time equivalent students.

Requires that family medicine, internal medicine, and pediatrics grant priority be given to applicants that demonstrate a committment to such disciplines in their medical education training programs.

Requires (presently authorizes) the Secretary to obligate specified area health education funds for certain existing health personnel and health delivery improvement projects.

Authorizes the Secretary to make grants for approved advanced educational programs in the general practice of dentistry. Obligates at least seven and one-half percent of training appropriations for such purposes.

Authorizes the Secretary to make grants to chiropractic schools to provide educational assistance to individuals from disadvantaged backgrounds. Permits such funds to be used for public and nonprofit private schools that offer graduate programs in clinical psychology.

Authorizes conversion and curriculum grants to be used for schools that provide the first or last two years of education leading to the degree of doctor of medicine or osteopathy. Permits schools in existence as of September 30, 1984, to use such grants for construction and equipment purchases.

Sets forth revised special project authorities including: (1) health promotion and disease prevention; (2) curriculum development in health policy and policy analysis; (3) curriculum development in clinical nutrition; and (4) curriculum and program development in applying the social and behavioral sciences to the study of health care.

Requires obligation of at least 75 percent of such project appropriations for grants to and contracts with institutions of allied health, health professions, and nurse training. Subjects such grants to peer review.

Authorizes such grants to veterinary schools for: (1) large animal care and research; (2) curriculum development and training in the care of animals used in research, and alternatives to such use; and (3) providing such animal care.

Increases advanced financial distress assistance support from five to six years.

Exempts graduate health administration programs with 45 percent minority enrollment from the 25 graduating students requirement for purposes of grant eligibility (permits such programs to graduate 20 students).

Repeals provisions of such Act referring to certain expired programs.

Requires the Secretary to study financial disincentives to graduates of health professions schools affecting the specialty of practice chosen by such graduates or their decision to practice in an area which lacks an adequate number of health care professionals. Directs the Secretary to make recommendations for legislation and administrative action to correct any disincentive identified.

Directs the Secretary, in cooperation with the Director of Selective Service, to conduct a study to determine if health professions schools are acting in compliance with the Selective Service Act. Requires a report to Congress within one year.

Title II: Nurse Education - Amends the Public Health Service Act to authorize FY 1985 through 1987 appropriations for the nursing special projects program. Authorizes additional projects that demonstrate: (1) clinical nurse education programs combining educational curricula and clinical practice in health care delivery organizations, including acute care, long-term care, and ambulatory care facilities; (2) methods to improve access to nursing services in noninstitutional settings through support of nursing practice arrangements in communities; or (3) methods to encourage nursing graduates to practice in health manpower shortage areas. Authorizes FY 1985 through 1987 appropriations for such additional projects.

Revises the advanced nurse training program to authorize grants and contracts that lead to masters' and doctoral degrees and which prepare professional nurses to serve as nurse educators, administrators, consultants, researchers, or to serve in clinical nurse specialties. Authorizes FY 1985 through 1987 appropriations.

Makes nurse midwives eligible for nurse training grants. Repeals authority for grants and contracts for faculty preparation. Authorizes FY 1985 through 1987 appropriations.

Extends the authority for traineeships for training nurse anesthetists to cover the cost of improving existing programs. Provides financial assistance to nurse anesthetist faculty members for advanced education relevant to their teaching function. Authorizes FY 1985 through 1987 appropriations, of which not more than 20 percent of the amounts appropriated in any fiscal year may be used for advanced faculty education grants.

Revises the nursing student loan allocation formula to provides that if total requests exceed available appropriations, a school's allotment shall be the smaller of: (1) the amount requested by such school; or (2) an amount which bears the same ratio to the total appropriations as the number of full-time students in such school compared to the estimated number of students in all nursing schools. Requires returned loan funds to be allocated to nursing schools, with priority given to those schools which established student loan funds after September 30, 1975.

Requires schools terminated from such program to return any loan funds within 90 days of termination.

Repeals specified nursing school construction and capitation grant provisions.

Revises recovery of construction payments provisions to: (1) require the owner or transferor to provide the Secretary with written notice of sale or transfer; (2) set forth the recovery formula; and (3) permit the Secretary to waive recovery rights.

Title III: National Health Service Corps - Amends title III (General Powers and Duties of Public Health Service) of the Public Health Service Act to authorize FY 1985 through 1987 appropriations for: (1) National Health Service Corps Program; and (2) new and continuing (contracts entered into before October 1, 1987) National Health Service Corps scholarships. Authorizes 350, 400, and 425 new scholarships in FY 1985 through 1987, respectively.

Prohibits the Secretary from removing the designation of a geographic area as health manpower shortage area without an opportunity for public comment.

Provides with regard to scholarhip-obligated service deferrals for advanced clinical training that the Secretary: (1) shall grant such deferrals upon request for contracts entered into prior to October 1, 1984; (2) may do so for contracts entered into after such date; and (3) shall not count such periods of advanced training toward satisfying the service obligation.

Requires action to be taken to assure that the conditions of any written agreement concerning National Health Service Corps scholarships are adhered to.

Revises special private practice assistance provisions to: (1) limit such assistance to loans (presently grants and loans); (2) extend the minimum obligated service period from one to two years; and (3) apply such provisions to obligated- and unobligated-service National Health Service Corps members.

Requires the Secretary to submit to the appropriate congressional committees by October 1, 1985, a FY 1988 through 1991 personnel plan for the Corps.

Authorizes the Secretary to provide technical assistance to assist States in carrying out health manpower shortage data collection and public information activities. Authorizes FY 1985 through 1988 appropriations.

Title IV: Health Maintenance Organizations - Amends title XIII (Health Maintenance Organizations) of the Public Health Service Act to repeal provisions providing support for health maintenance organization (HMO) feasibility surveys, planning, and development.

Limits loan and loan guarantees for initial operating costs to HMOs receiving such assistance in FY 1981 through 1984.

Repeals loan and loan guarantee provisions for ambulatory care facility construction and acquisition.

Repeals provisions providing for: (1) health systems agency review; (2) periodic compliance demonstration; and (3) specified financial disclosure reporting requirements.

Requires annual (currently quarterly) updates of State HMO law digests.

Restricts the Secretary's authority to borrow from the Treasury to meet loan guarantee fund obligations to those guarantees issued before October 1, 1984.

Authorizes FY 1985 through 1988 appropriations for: (1) training and technical assistance; and (2) loan fund obligations.

Provides for the inclusion of organ transplants not currently required to be included in basic health services if the Secretary: (1) publishes the proposed requirement in the Federal Register; (2) provides an opportunity for public comment; (3) publishes a final determination in the Federal Register; and (4) provides HMOs with a reasonable opportunity to comply with such new requirement.

Title V: Primary Health Care Services - Amends the Public Health Service Act to direct the Secretary to prescribe criteria for determining the specific shortages of personal health services of an area or population group. Permits designation of underserved populations not meeting such criteria if recommended by appropriate State or local officials based on unusual local conditions. Prohibits the Secretary from designating a medically underserved population in a State, or terminating an existing designation, without prior consultation with appropriate State officials or organizations.

Authorizes the Secretary to enter into memoranda of agreement with States to permit them to: (1) analyze the need for primary health services for medically underserved populations; (2) assist in planning and developing new community health centers (CHCs); (3) review CHC program plans and budgets; (4) assist CHCs in developing clinical practices and fiscal and administrative systems; and (5) share relevant information.

Authorizes CHC appropriations for FY 1985 through 1988. Limits expenditures for prepaid CHC services and "non-criteria" medically underserved populations.

Replaces the existing primary care block authority with a program of State grants for primary care research, demonstration, and services. Authorizes FY 1985 through 1988 appropriations for: (1) improving access to and delivery of primary health services for medically underserved populations; and (2) reducing costly inpatient and long-term care services, and reducing the incidence of preventable illnesses and premature death.

Allocates funds on the basis of the ratio of low-income people residing in a State to the total number of low-income people in all States. Sets forth minimum State and territorial allotments. Provides for direct allotments to Indian tribes or tribal organizations.

Permits the carryover of unobligated funds not in excess of 20 percent of a State's total allocation.

Authorizes grants to be used for: (1) providing medically underserved populations with primary health services; and (2) research and evaluations of alternative reimbursement systems, new methods of providing services and retaining health professionals, and medical cost reductions. Requires at least 80 percent of allocated funds to be used to provide primary health services.

Sets forth application provisions.

Authorizes FY 1985 through 1988 appropriations for migrant health centers. Permits such grants to be used to repay Farmers Home Administration loans.

Title VI: Miscellaneous Provisions - Directs the Secretary to undertake a set of related studies regarding health care consumer information and report to the appropriate congressional committees by October 1, 1985.

Authorizes the Secretary, acting through the Director of the Centers for Disease Control, to make grants to States for plague control. Authorizes FY 1985 through 1987 appropriations.

Expresses the sense of Congress that the problem of rising health care costs can be reduced if those engaged in health care professions do everything possible to hold down costs by considering appropriate options to institutionalized health services.

Directs the Secretary to conduct a study of the delivery of health care services to the homeless and report to the appropriate congressional committees by March 31,1986. Requires such study to evaluate: (1) whether eligibility requirements prevent the homeless from receiving health care services; and (2) the efficiency of such health care services.

Directs the Secretary to designate a specified Regional Primate Research Center for experimental medicine and surgery in primates.