§293j. Area health education center programs

(a) Authority for provision of financial assistance

(1) Assistance for planning, development, and operation of programs

(A) The Secretary shall provide financial assistance to schools of medicine and osteopathic medicine for the planning, development, and operation of area health education center programs.

(B)(i) Subject to clause (ii), the period during which payments are made from an award under subparagraph (A) may not exceed 12 years. The provision of the payments shall be subject to annual approval by the Secretary of the payments and subject to the availability of appropriations for the fiscal year involved to make the payments. The preceding sentence may not be construed as establishing a limitation on the number of awards under such subparagraph that may be made to the school involved.

(ii) In the case of an area health education center planned, developed, or operated with an award under subparagraph (A), the period during which the award is expended for the center may not exceed 6 years.

(2) Assistance for certain projects of existing programs

(A) The Secretary shall provide financial assistance to schools of medicine and osteopathic medicine-

(i) which have previously received Federal financial assistance for an area health education center program under section 802 of the Health Professions Educational Assistance Act of 1976 in fiscal year 1979 or under paragraph (1), or

(ii) which are receiving assistance under paragraph (1),

to carry out projects described in subparagraph (B) through area health education centers for which Federal financial assistance was provided under paragraph (1) and which are no longer eligible to receive such assistance.

(B) Projects for which assistance may be provided under subparagraph (A) are-

(i) projects to improve the distribution, supply, quality, utilization, and efficiency of health personnel in the health services delivery system;

(ii) projects to encourage the regionalization of educational responsibilities of the health professions schools; and

(iii) projects designed to prepare, through preceptorships and other programs, individuals subject to a service obligation under the National Health Service Corps Scholarship Program to effectively provide health services in health professional shortage areas.

(C) In the case of the requirement established in section 3804(e)(1) of part 57 of title 42, Code of Federal Regulations (42 CFR 57.3804(e)(1)) (relating to the location of area health education centers), the Secretary shall waive such requirement with respect to an area health education center having, at the time of initial application for financial assistance under this section or under a previous authorizing law, an operating program supported by both appropriations of a State legislature and local resources.

(3) Assistance for operation of model programs

(A) In the case of any school of medicine or osteopathic medicine that is operating an area health education center program and that is not receiving financial assistance under paragraph (1), the Secretary may provide financial assistance to the school for the costs of operating the program, and for carrying out activities described in subparagraph (E), if the school makes the agreements described in subparagraphs (B) through (D).

(B)(i) For purposes of subparagraph (A), the agreement described in this subparagraph for a school is that, with respect to the costs of operating the area health education center program of the school, the school will make available (directly or through donations from public or private entities) non-Federal contributions in cash toward such costs in an amount that is not less than 50 percent of such costs.

(ii) Amounts provided by the Federal Government may not be included in determining the amount of non-Federal contributions in cash made for purposes of the requirement established in clause (i).

(C) For purposes of subparagraph (A), the agreement described in this subparagraph for a school is that, in operating the area health education program of the school, the school will-

(i) coordinate the activities of the program with the activities of any office of rural health established by the State or States in which the program is operating;

(ii) conduct health professions education and training activities consistent with national and State priorities in the area served by the program in coordination with the National Health Service Corps, entities receiving funds under section 254b or 254c of this title, and public health departments; and

(iii) cooperate with any entities that are in operation in the area served by the program and that receive Federal or State funds to carry out activities regarding the recruitment and retention of health care providers.

(D) For purposes of subparagraph (A), the agreement described in this subparagraph for a school is that, with respect to the costs of operating the area health education center program of the school, the school will maintain expenditures of non-Federal amounts for such costs at a level that is not less than the level of such expenditures maintained by the school for the fiscal year preceding the first fiscal year for which the school receives an award under subparagraph (A).

(E) A school may expend not more than 10 percent of an award under subparagraph (A) for demonstration projects for any or all of the following purposes:

(i) The establishment of computer-based information programs or telecommunication networks that will link health science centers and service delivery sites.

(ii) The provision of disease specific educational programs for health providers and students in areas of concern to the United States.

(iii) The development of information dissemination models to make available new information and technologies emerging from biological research centers to the practicing medical community.

(iv) The institution of new minority recruitment and retention programs, targeted to improved service delivery in areas the program determines to be medically underserved.

(v) The establishment of programs to place physicians from health manpower shortage areas into similar areas to encourage retention of physicians and to provide flexibility to States in filling positions in health professional shortage areas.

(vi) The establishment or improvement of education and training programs for State emergency medical systems.

(vii) The establishment of programs to train health care providers in the identification and referral of cases of domestic violence.

(F) The aggregate amount of awards provided under subparagraph (A) to schools in a State for a fiscal year may not exceed the lesser of-

(i) $2,000,000; and

(ii) an amount equal to the product of $250,000 and the aggregate number of area health education centers operated in the State by the schools.

(b) Structure of programs

(1) In general

An area health education center program shall be a cooperative program of one or more medical (M.D. and D.O.) schools and one or more nonprofit private or public area health education centers.

(2) Certain requirements

With respect to an area health education center program, a school may not receive an award under paragraph (1) of subsection (a) of this section for operational expenses, or an award under paragraph (2) or (3) of such subsection, unless the program-

(A) maintains preceptorship educational experiences for health science students;

(B) maintains community-based primary care residency programs or is affiliated with such programs;

(C) maintains continuing education programs for health professionals or coordinates with such programs;

(D) maintains learning resource and dissemination systems for information identification and retrieval;

(E) has agreements with community-based organizations for the delivery of education and training in the health professions;

(F) is involved in the training of health professionals (including nurses and allied health professionals), except to the extent inconsistent with the law of the State in which the training is conducted; and

(G) carries out recruitment programs for the health science professions, or programs for health-career awareness, among minority and other elementary or secondary students from areas the program has determined to be medically underserved.

(c) Requirements for schools

Each medical (M.D. and D.O.) school participating in an area health education center program shall-

(1) provide for the active participation in such program by individuals who are associated with the administration of the school and each of the departments (or specialties if the school has no such departments) of internal medicine, pediatrics, obstetrics and gynecology, surgery, psychiatry, and family medicine;

(2) provide that no less than 10 percent of all undergraduate medical (M.D. and D.O.) clinical education of the school will be conducted in an area health education center and at locations under the sponsorship of such center;

(3) be responsible for, or conduct, a program for the training of physician assistants (as defined in section 295p of this title) or nurse practitioners (as defined under section 296m of this title) which gives special consideration to the enrollment of individuals from, or intending to practice in, the area served by the area health education center of the program; and

(4) provide for the active participation of at least 2 schools or programs of other health professions (including a school of dentistry and a graduate program of mental health practice if there are ones affiliated with the university with which the school of medicine or osteopathic medicine is affiliated) in the educational program conducted in the area served by the area health education center.

The requirement of paragraph (3) shall not apply to a medical (M.D. and D.O.) school participating in an area health education center program if another such school participating in the same program meets the requirement of that paragraph.

(d) Requirements for centers

(1) Service area

Each area health education center shall specifically designate a geographic area in which it will serve, or shall specifically designate a medically underserved population it will serve (such area or population with respect to such center in this section referred to as "the area served by the center"), which area or population is in a location remote from the main site of the teaching facilities of the school or schools which participate in the program with such center.

(2) Other requirements

Each area health education center shall-

(A) provide for or conduct training in health education services, including education in nutrition evaluation and counseling, in the area served by the center;

(B) assess the health manpower needs of the area served by the center and assist in the planning and development of training programs to meet such needs;

(C) provide for or conduct a rotating osteopathic internship or a medical residency training program in family medicine, general internal medicine, or general pediatrics in which no fewer than four individuals are enrolled in first-year positions in such program;

(D) provide opportunities for continuing medical education (including education in disease prevention) to all physicians and other health professionals (including allied health personnel) practicing within the area served by the center;

(E) provide continuing medical education and other educational support services to the National Health Service Corps members serving within the area served by the center;

(F) conduct interdisciplinary training and practice involving physicians and other health personnel including, where practicable, physician assistants, nurse practitioners, and nurse midwives;

(G) arrange and support educational opportunities for medical and other students at health facilities, ambulatory care centers, and health agencies throughout the area served by the center; and

(H) have an advisory board of which at least 75 percent of the members shall be individuals, including both health service providers and consumers, from the area served by the center.

Any area health education center which is participating in an area health education center program in which another center has a medical residency training program described in subparagraph (C) need not provide for or conduct such a medical residency training program.

(e) Certain provisions regarding funding

(1) Programs

Subject to paragraph (2), in providing financial assistance under this section to a school, the Secretary shall assure that-

(A) at least 75 percent of the total funds provided to the school are expended by an area health education center program in the area health education centers, and that the school enters into an agreement with each of such centers for purposes of specifying the allocation of such 75 percent;

(B) with respect to the operating costs of the area health education program of the school, non-Federal contributions for such costs are made in an amount that is not less than 25 percent of such costs; and

(C) no award provides funds solely for the planning or development of such a program for a period exceeding two years.

The Secretary may vest in entities which have received financial assistance under section 802 of the Health Professions Educational Assistance Act of 1976, section 295f–4 of this title as in effect before October 1, 1977, or under subsection (a) of this section for area health education centers programs title to any property acquired on behalf of the United States by that entity (or furnished to that entity by the United States) under that award.

(2) Centers

With respect to the period during which an area health education center is planned, developed or operated pursuant to an award under subsection (a)(1) of this section, not more than 55 percent of the total amounts expended for the center in any fifth or sixth year of such period may be provided by the Secretary, subject to paragraph (3).

(3) Applicability of provision regarding centers

Paragraph (2) shall apply only in the case of an area health education center program for which the initial award under subsection (a)(1) of this section is provided on or after October 13, 1992.

(f) Health education and training centers

(1) In general

The Secretary shall provide financial assistance to schools of medicine and osteopathic medicine 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 health services in the State of Florida or (in the United States) 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) Arrangements with other entities

The Secretary may not provide financial assistance 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) Service area

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) Advisory group; operational plan

The Secretary may not provide financial assistance 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) Certain activities

The Secretary may not provide financial assistance under paragraph (1) unless the applicant for such assistance agrees-

(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 less 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;

(H) to make available technical assistance in the service area in the aspects of health care organization, financing and delivery; and

(I) in the case of any school of public health located in the service area of the health education and training center operated with the assistance, to permit any such school to participate in the program of the center if the school makes a request to so participate.

(6) Allocation of funds by centers

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 osteopathic medicine 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 osteopathic medicine will obtain from nongovernmental sources the amount of the total operating funds for such program which are not provided by the Secretary;

(C) no award 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 award 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) Definitions

For purposes of this subsection:

(A) The term "border health education and training center" means an entity that is a recipient of an award 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 an award under paragraph (1).

(C) The term "service area" means, with respect to a health education and training center, the geographic area designated for the center under paragraph (3).

(8) Allocation of funds by Secretary

(A) Of the amounts appropriated pursuant to subsection (i)(2) of this section 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, in the State of Florida and 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.

(g) Definitions

For purposes of this section:

(1) The term "area health education center program" means a program which is organized as provided in subsection (b) of this section and under which the participating medical (M.D. and D.O.) schools and the area health education centers meet the requirements of subsections (c) and (d) of this section.

(2) The term "award" means an award of financial assistance.

(3) The term "financial assistance" means a grant, cooperative agreement, or contract.

(h) Criteria and standards

The Secretary shall establish standards and criteria for the requirements of this section.

(i) Authorization of appropriations

(1) Area health education center programs

(A) For the purpose of carrying out this section other than subsection (f) of this section, there is authorized to be appropriated $25,000,000 for each of the fiscal years 1993 through 1995.

(B) Of the amounts appropriated under paragraph (1) for a fiscal year, the Secretary may not obligate more than 20 percent for awards under subsection (a)(2) of this section.

(C) Of the amounts appropriated under paragraph (1) for fiscal year 1993, the Secretary shall obligate for awards under subsection (a)(3) of this section such amounts as are appropriated in excess of $19,200,000. Of the amounts appropriated under paragraph (1) for each of the fiscal years 1994 and 1995, the Secretary shall obligate for such awards such amounts as are appropriated in excess of $18,700,000.

(2) Health education and training centers

For the purpose of carrying out subsection (f) of this section, there is authorized to be appropriated $5,000,000 for each of the fiscal years 1993 through 1995.

(July 1, 1944, ch. 373, title VII, §746, as added Oct. 13, 1992, Pub. L. 102–408, title I, §102, 106 Stat. 2034 ; amended Oct. 27, 1992, Pub. L. 102–531, title III, §313(a)(2), 106 Stat. 3507 ; June 10, 1993, Pub. L. 103–43, title XX, §2008(i)(3), 107 Stat. 213 .)

References in Text

Section 802 of the Health Professions Educational Assistance Act of 1976, referred to in subsecs. (a)(2)(A)(i) and (e)(1), is section 802 of Pub. L. 94–484, as amended, which was set out as a note under section 295g–1 of this title prior to the general revision of this subchapter by section 102 of Pub. L. 102–408.

Section 295f–4 of this title, referred to in subsec. (e)(1), was repealed by Pub. L. 94–484, title V, §502, Oct. 12, 1976, 90 Stat. 2293 , effective with respect to fiscal years beginning after Sept. 30, 1977.

Prior Provisions

A prior section 746 of act July 1, 1944, was classified to section 294q–2 of this title prior to the general revision of this subchapter by Pub. L. 102–408.

Amendments

1993-Subsec. (i)(1). Pub. L. 103–43 amended par. (1) to read as if the amendment by Pub. L. 103–531, §313(a)(2)(B), had not been enacted. See 1992 Amendment note below.

1992-Subsec. (a)(2)(A). Pub. L. 102–531, §313(a)(2)(A)(ii), realigned margin of concluding provisions.

Subsec. (a)(2)(A)(i). Pub. L. 102–531, §313(a)(2)(A)(i), substituted "Health Professions" for "Health Professionals".

Subsec. (i)(1). Pub. L. 102–531, §313(a)(2)(B), realigned margins of subpars. (A) to (C).

Effective Date of 1992 Amendment

Amendment by Pub. L. 102–531 effective immediately after enactment of Pub. L. 102–408, see section 313(c) of Pub. L. 102–531, set out as a note under section 292y of this title.