nou MEALTH MANPOVIER ACT OF 1974 As Passed In The House, December 12, 1974 HIGHLIGHT SUMMARY Except as otherwise indicated, extensions are for three years, through FY 1977. : TITLE I ~ GENERAL PROVISIONS Research Facilities ‘Authorities repealed except to preserve recapture provisions. } Guidelines for Training of Physician Assistants, etc. Secretary required to prescribe guidelines to be met by training programs for physician assistants, nurse practitioners, and expanded duty. dental auxiliaries, by March 1, 1975, after consultation with professional organizations. Guidelines must require minimum course of study of one academic year and minimum enrollment of 25 students. National Advisory Council on Health Professions Education Groups to be represented on Council spelled out in greater detail than in existing law. t Records _and Audits Fach grant or or contract recipient to keep such records as Secretary may prescribe, and provide for annual audit of records or books. Scholar- ship and traineeship recipients exempted. *Welepation The Secretary may delegate the authority to administer any program authorized by this title to the administrator of a central or regional office or offices in the Department of Health, Education, and Welfare, except that the authority (1) to review, and prepare comments on the merit of, any application for a grant or contract under any program authorized by this title for purposes of presenting such application to the National Advisory Council on Health Professions Education, or (2) to make such grant or enter into such a contract, shall not be further delegated to any officer in any regional office or offices. TLIILE II - ASSISTANCE FOR CONSTRUCTION Construction Grants. Authority extended. Conditions for grants essentially the same, except that single maximum Federal share of 80% of costs would replace existing different maximums for different types of projects. In considering applications for grants for teaching facilities for training of physicians, Secretary to give special consideration to projects in States having no such facilities. Such acniaee to be entitled to 80% matching unless Secretary determines grant fcr such portion of costs not needed. Construction Loans and Interest Subsidies futhorities extended. Loan puarancee provision amended to allow Federal government to pay 100% cf defaults on principal and interast. “PLELE TLE - STUDENL ASSTSTANCH Student Loans | Authority extended. Eligibility brozdened to include students at schools of public health. Masxchaum loen raised to cost of tuition plus $2,500 per academic year. Interest rate raised to ? perceat. Provision for loan repayment for service in shortage areas made retroactive for NUS Corps members, officers in cd PHS Commissioned Corps, or civilian employees of Pils. Student loan revolving * a * * . . fund repealed except to allow honoring of existing obligations. Loans to U.S. Students in Foreign Medical Schools Authority repealed. — Scholarships (UPAA). : a Existing health professions scholarship program and Physician Shortage Area Scholarship program to be phased out. rships our. fan Shortape Area Schola program to be phas Scholarships to U.S. Students in Foreign Medical Schools 2 pet 2 . Authority repealed. Traineeships to Students in Schools of Public Health Provides separate authority for traineeships for Students in schools of pubiie health. (For trainees s to students in institutions other than schools of public health, see title VI below.) ' Len diye National Health Service Corps Authority extended and amended. Appropriation aithorizations of $25 million for FY 1975, $36 million for FY 1976, and $45 million for FY 1977. National Health Service Corps Scholarships Authority extended and amended. Eligibility for scholarships to include NOD and nursing students and, if needed by Corps or other unit of PHS, students in schools of podiatry, optometry, pharmacy, OF public health, graduate prom grams in health administration, and other health-related specialties as determined by Secretary. Hay include physicien assistant, expanded function dentel auxiliary, or nurse practitioner students. Recipients obligated to serve not less than 1 year for every year of training or 2 years. — Service to be performed in NHS Corps or indian Health Service, specified other Federal service, other medical facility designated by Secretary as having priority need for health personnel, oc other PHEW service, in that crder; or, alterna- tively, service may be performed in private practice of profession in an area in which is Loceted a medically underserved population designated under Sec. 329¢b). Individuals failing to complete service ebligations liable to repay twice the amount paid to or on behalf of him under the scholarship program, pius interest, within 3 years. Appropriations authorizations of $80 million for FY 1976 and $120 million for FY 1977 (FY 1975 authorization of $40 million enacted in P.-L. 93-4385). TITLE IV - GRANTS FOR HEALTH PROFESSIONS SCHOOLS = — 6 ariel ntmemnnntinmmnt etre Payments authorized for schools of MODVOPP and public health based on full-time enrollment only. Includes capitation for PA and expanded function dental auxiliary students (not nurse practitioner students). Separate appropriation authorizations for HOD, PA's and expanded func- tion dental auxiliaries, PH, V, and OPP. In addition, "such sums as- necessary!’ authorized to be appropriated in FYs 75-77 for continuation of grants based on "enrollment bonus students" so designated prior to June 30, 1974. Amount of Capitation MOD - $2,100 per full-time student 650 per full-time physician assistant or expanded function dental auxiliary student *MOD ~ $2,000 per full-time student in FY 77 PH - 1,500 per full-time student | : Vo- 1,500 per full-time student Oo - 700 per full-time student Ph. - 700 per full-time student (in last 4 years, if program longer than 4 years) *Po -~- 1,500 per full-time student Eligibility for Capitation Grants All schools required to maintain first-year enrollment of the previous year and maintain non~Federal expenditures at level at least as great as amount in preceding fiscal year (formerly average of last three years). All schools must give assurance that in year following award of grant and in each year thereafter in which grant is received, school will enter into legally enforceable agreement with each student enrolled under which student agrees to repay, following graduation, the amount of capitation paid on his behalf, in a number of annual installments equal to number of years of capitation support given. However, no installment payable if individual is serving (i) as a member of the NHS Corps in area which is located a medically underserved population, (ii) as a member of the indian Wealth Service, or (iii) in accordance with an agreement to ful- fill NHS Corps Scholarship service obligation through private practice in an area in which is located a medically underserved population. *Capitation requirements to take effect in academic year 1976-1977. Medical, osteopathic, and dental schools would be required also to (a) expand first-year. enrollment over 1973-74 base year or offer a program for the training of physician assistants or expanded funetion dental auxiliaries and (b) effective for FY 1976 grants, have an approved AHEC-type plan to train students (including PA and EFDA students) in part in areas geo- graphically remote from main campus. Waiver of enrollment increase requirement authorized if compliance impossible without lowering quality of education. Schools of public health would be required also to expand first-year enrollment over 1973-74 base year. Waiver authorized as for MOD schools. Schools of veterinary medicine would be required also to expand first-year enrollment over 1973-74 base year or enroll at least 20% of students from States without accredited school. No waiver provision. Schools of optometry would be required also to expand first-year enroll- ment over 1973-74 base year. Waiver authorized as for MOD schools. Schools of pharmacy would be required also to expand first-year enroll- ment improvement, or operation of at least two of three types of phar- macy teaching programs. No waiver provision. Schools of podiatry would be required also to expand first-year enrollment over 1973-74 base year or enroll at least 40% of students from States without accredited school. No waiver provision. Special Projects Existing broad authority replaced by limited authority for aid to disadvantaged students (See under Title V below). Start-up and Conversion Grants Authorities extended and amended to make schools of veterinary medicine, optometry, pharmacy, podiatry, and public health eligible for start-up grants (now only MOD schools eligible). ' Financial Distress Grants Authority extended and amended to add schools of public health to list of eligible schools. Standard Recording and Reporting of Tinancial Information | All schools receiving capitation, start-up, or financial distress grants to be required to use standard procedures for recording and reporting financial information, to enable Secretary to determine costs of education. #&mercency Medical Services Training (existing Sec. 776) ; Authority extended for three years at $7 million per year authorization level. TITLE V - SPECIAL PROJECT GRANTS AND CONTRACTS © Training in Family Medicine and General Practice of Dentistry . Family medicine training authority (existing Sec. 767). extended and. © amended to add authority for grants to dental schools or accredited postgraduate dental training institutions for residency programs in general practice of dentistry. *Also grants to MO schools to establish and maintain academic instruction units in family medicine authorized at $10, $15, and $20 million for FY 75-77. , Aid to Disadvantaged Students . Authorizes grants and contracts to health professions schools and other public or private nonprofit health or educational entities to assist stu- dents from disadvantaged backgrounds. No specific authority for stipends to students. ‘To qualify for assistance, schools required to enroll in first-year class a number of students from disadvantaged backgrounds at least equal to the lesser of (a) 5% of preceding year's first-year students or (b) ten. *Authorization level increased to $40 million per year, FY 75-77. Area Health Education Centers ; Existing Section 774(a) HMEIA authority substantially amended to (1) provide aid for AHEC projects only, (2) limit eligibility to educational entities in which at least three degree or diploma granting health pro- fessions education programs (of which one is a medical or osteopathic ‘school) agree to affiliate, (3) modify the purposes of the authority, adding a new purpose relaaed to health education of the public, (4) require applicants to accomplish each (rather than one or more) of the - listed purposes, and (5) spell out a detailed list of requirements for projects, covering such matters as designation of geographic boundaries, listing of manpower needs, minimum amounts of training to be provided in centers, faculty, types of training to be provided, and coordination with related programs, among others. Secretary re- quired to assess program of grants under their authority and submit a report to Congress on the assessment by January 1, 1977. - (Note: Existing Section 774(b) authority replaced by authority for special projects to aid disadvantaged students, described above.) Project Grants and Contracts for OPP Schools ; Separate authority would be provided for grants and contracts to schools of optometry, pharmacy, and podiatry providing for closer association of OPP and other health professions training, and, in the case of pharmacy, projects to expand or improve specific types of pharmacy teaching programs. *Also. added two additional purposes for which schools of optometry could — receive special project grants and contracts: 1. planning, developing, and operating residency training programs in special optometric services or in meeting the optometric needs of special populations, or - 2. planning, developing, and operating educational programs which provide training in the early detection and diagnosis of health problems which are accompanied by visual or ocular symptoms. Posteraduate Training of Physicians and Dentists (existing Sec. 768) Authority (never funded since enactment of 1971) repealed. Health Professions Teacher Training (existing Sec. 769) Authority (not funded since FY 73) repealed. - &Computer Technology Health Care Demonstrations (existing Sec. 769A) Authority extended for three years at $3 million per year authorization level. ‘*Training of U.S. Graduates of Foreign Medical Schools Authority to make grants to allow U.S. graduates of foreign medical schools to enter U.S. schools with advanced standing. Authorizations of $2 million, $3 million, and $4 million, FY 75-77. TITLE VI ~ PUBLIC AND ALLIED HEALTH PERSONNEL Public Health Training . o, Secs. 306 (public health traineeships) and 309 (public health training “project grants and formula-type grants to schools of public health) repealed, and replaced as follows: . =