,,ii #aai? ,,congress #a/ ,session ,s4 #bied ,,9 ,,! ,,s5ate ,,( ,,! ,,unit$ ,,/ates ,septemb] #cj1 #bjbe,mr4 ,s&]s 7= himself & ,mr4 ,m]kley7 introduc$ ! foll[+ bill2 :i* 0 read twice & ref]r$ to ! ,committee on ,heal?1 ,education1 ,labor1 & ,p5sions ,a ,,bill ,to e/abli% grant programs = heal? pr(essional s*ools1 & = o!r purposes4 #a4 ,%ort title ,?is ,act may be cit$ z ! ,heal? ,c>e ,work=ce ,expansion ,act ( #bjbe4 #b4 ,grant programs = heal? pr(essional s*ools 7a7 ,,m$1 ,,d5tal1 & ,,nurse ,grants ,"p ,a ( title ,,iv ( ! ,high] ,education ,act ( #aife 7#bj ,u4,s4,c4 #ajgj7 is am5d$ by add+ at ! end ! foll[+3 #aa ,,m$ ,grants #dbj,s4 ,def9itions ,= ! purposes ( ?is subp>t3 7#a7 ,eligible in/itution ,! t]m eligible in/itution means an in/itution ( high] education1 z def9$ 9 section #aja1 t is a s*ool ( m$ic9e or s*ool ( o/eopa?ic m$ic9e z def9$ 9 section #gii;,b ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #biep74 7#b7 ,m$ical s*ool c&idate ,! t]m m$ical s*ool c&idate means a /ud5t 9 att5dance at an eligible in/itution pursu+ a pr(essional doctor ( m$ic9e or doctor ( o/eopa?ic m$ic9e degree4 #dbj,t4 ,program e/abli%$ 7a7 ,program au?ority 7#a7 ,paym5ts requir$ ,! ,secret>y %all pay to ea* eligible in/itution su* sums z may be necess>y to pay to ea* m$ical s*ool c&idate :o files an application & agreem5t 9 accordance ) section #dbj,u1 & :o qualifies "u su* section1 a ,,m$ ,grant 9 ! am\nt ( tuition & requir$ fees = ea* ye> dur+ :i* t m$ical s*ool c&idate is 9 att5dance at ! in/itution4 7#b7 ,ref]5ces ,grants made "u p>agraph 7#a7 %all be kn[n z ,,m$ ,grants4 7b7 ,paym5t me?odology 7#a7 ,prepaym5t ,n less ?an #he p]c5t ( any funds provid$ to an eligible in/itution "u subsection 7a7 %all be advanc$ to ! eligible in/itution prior to ! />t ( ea* paym5t p]iod & %all be bas$ ^u an am\nt reque/$ by ! in/itution z ne$$ to pay m$ical s*ool c&idates until su* "t z ! ,secret>y det]m9es & publi%es 9 ! ,f$]al ,regi/] ) an opportunity = comm5t1 an alt]native paym5t sy/em t provides paym5ts to in/itutions 9 an accurate & timely mann]1 except t ?is s5t5ce %all n be con/ru$ to limit ! au?ority ( ! ,secret>y to place an in/itution on a reimbursem5t sy/em ( paym5t4 7#b7 ,direct paym5t ,no?+ 9 ?is section %all be int]pret$ to prohibit ! ,secret>y f pay+ directly to m$ical s*ool c&idates1 9 advance ( ! beg9n+ ( ! academic t]m1 an am\nt = :i* m$ical s*ool c&idates are eligible1 9 cases :]e ! eligible in/itution elects n to p>ticipate 9 ! disbursem5t sy/em requir$ by p>agraph 7#a74 7c7 ,no exce$+ co/ ,! am\nt ( a grant aw>d$ "u ?is subp>t1 9 comb9ation ) ,f$]al assi/ance1 %all n exce$ ! co/ ( att5dance 7z def9$ 9 section #dgb7 at ! eligible in/itution at :i* t m$ical s*ool c&idate is 9 att5dance4 7d7 ,p]iod ( eligibility = grants ,! p]iod dur+ :i* a m$ical s*ool c&idate may receive a ,,m$ grant "u ?is subp>t %all be ! p]iod requir$ = ! completion ( ! pr(essional m$ical degree be+ pursu$ by ! m$ical s*ool c&idate at ! eligible in/itution at :i* ! m$ical s*ool c&idate is 9 att5dance1 except t ! p]iod dur+ :i* a m$ical s*ool c&idate may receive a ,,m$ ,grant "u ?is subp>t %all n exce$ #h ye>s4 #dbj,u4 ,application2 aw>d 7a7 ,application2 aw>d 7#a7 ,application ,! ,secret>y %all p]iodically set dates by :i* m$ical s*ool c&idates %all file applications = grants "u ?is subp>t4 ,ea* m$ical s*ool c&idate desir+ a grant "u ?is subp>t = any ye> %all file an application conta9+ su* in=mation z is necess>y to demon/rate t ! m$ical s*ool c&idate-- 7,a7 is an eligible /ud5t = purposes ( section #dhd2 7,b7 has complet$ a ,,fafsa2 7,c7 w\ld l to receive a ,,m$ grant2 & 7,d7 und]/&s & agrees to ! t]ms & conditions ( ! agreem5t to s]ve describ$ 9 subp>agraph 7b74 7#b7 ,aw>d ,! ,secret>y %all aw>d a ,,m$ grant to ea* eligible m$ical s*ool c&idate :o meets ! requirem5ts describ$ 9 p>agraph 7#a7 = ea* ye> t ! application "u su* p>agraph is submitt$ & su* requirem5ts are met4 7b7 ,agreem5ts ,to s]ve ,ea* application "u subsection 7a7 %all conta9 or be accompani$ by an agreem5t by ! applicant t-- 7#a7 ! applicant w-- 7,a7 practice prim>y c>e1 z def9$ 9 section #ahhf ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acieww71 z a physician = at lea/ #aj ye>s aft] _! relat$ tra9+ is complet$ 7includ+ resid5cy or fell[%ip programs7 )9 #ae ye>s aft] complet+ ! degree = :i* ! applicant receiv$ a ,,m$ ,grant "u ?is subp>t or su* relat$ tra9+ 7ref]r$ to 9 ?is section z ! s]vice obligation w9d[72 & 7,b7 annually submit an employm5t c]tification1 = ea* ye> ( s]vice1 %[+ t ! requirem5t "u subp>agraph 7,a7 is be+ met2 7#b7 9 ! ev5t t ! applicant is det]m9$ to h fail$ or refus$ to c>ry out su* s]vice obligation1 a specifi$ am\nt ( any ,,m$ ,grants receiv$ by su* applicant w be treat$ z a loan & collect$ f ! applicant 9 accordance ) subsection 7c7 & ! regulations !reund]2 & 7#c7 conta9s1 or is accompani$ by1 a pla9-language disclosure =m develop$ by ! ,secret>y t cle>ly describes ! nature ( ! ,,m$ ,grant aw>d1 ! s]vice obligation1 & ! loan repaym5t requirem5ts t are ! consequ5ce ( ! failure to complete ! s]vice obligation4 7c7 ,repaym5t = failure ,to complete s]vice 7#a7 ,9 g5]al ,9 ! ev5t t any recipi5t ( a grant "u ?is subp>t fails or refuses to comply ) ! s]vice obligation 9 ! agreem5t "u subsection 7b71 a specifi$ am\nt z describ$ 9 p>agraph 7#c7 ( ! ,,m$ ,grants receiv$ by su* recipi5t %all1 ^u a det]m9ation ( su* a failure or refusal 9 su* s]vice obligation1 be conv]t$ to a ,f$]al ,direct ,unsubsidiz$ ,/af=d ,loan "u "p ,d ( title ,,iv1 & %all be subject to repaym5t1 9 accordance ) p>agraph 7#b74 7#b7 ,int]e/ & repaym5t ,am\nts t are conv]t$ to a ,direct ,unsubsidiz$ ,/af=d ,loan "u p>agraph 7#a7 %all accrue int]e/ at ! rate applicable to su* ,direct ,unsubsidiz$ ,/af=d ,loans = borr[]s z ( ! date ( conv]sion1 & ! recipi5t %all be eligible = ! same repaym5t plans & borr[] protections ) respect to su* conv]t$ loans z t recipi5t w\ld o!rwise be eligible = ) respect to a ,f$]al ,direct ,unsubsidiz$ ,/af=d ,loan "u "p ,d ( title ,,iv = a borr[] t is disburs$ on ! same date4 7#c7 ,specifi$ am\nt to be repaid 7,a7 #e ye>s or less ,if a ,,m$ ,grant recipi5t has complet$ #e ye>s or less ( requir$ s]vice1 ! less] (-- 7i7 ! total am\nt ( ,,m$ grants receiv$ by ! recipi5t2 or 7ii7 #ej1jjj4 7,b7 ,great] ?an #e ye>s & less ?an #aj ye>s ,if a ,,m$ ,grant recipi5t has complet$ m ?an #e ye>s ( requir$ s]vice b less ?an #aj ye>s ( requir$ s]vice1 ! less] (-- 7i7 ! total am\nt ( ,,m$ grants receiv$ by ! recipi5t2 or 7ii7 #be1jjj4 7,c7 ,cap ,! am\nt ( ,,m$ ,grants t is conv]t$ to a loan & requir$ to be repaid "u ?is subsection %all n exce$ #ej1jjj4 7#d7 ,reconsid]ation ( conv]sion decisions 7,a7 ,reque/ to reconsid] ,9 any case :]e ! ,secret>y has det]m9$ t a recipi5t ( a grant "u ?is subp>t has fail$ or refus$ to comply ) ! s]vice obligation 9 ! agreem5t "u subsection 7b7 & has conv]t$ ! grant into a ,f$]al ,direct ,unsubsidiz$ ,/af=d ,loan "u "p ,d 9 accordance ) p>agraph 7#a71 7includ+ cases :]e su* loans h be5 fully or p>tially paid71 ! recipi5t may reque/ t ! ,secret>y reconsid] su* initial det]m9ation & may submit additional in=mation to demon/rate satisfaction ( ! s]vice obligation4 ,^u receipt ( su* a reque/1 ! ,secret>y %all reconsid] ! det]m9ation 9 accordance ) ?is p>agraph n lat] ?an #ij days aft] ! date t su* reque/ 0 receiv$4 7,b7 ,reconsid]ation ,if1 9 reconsid]+ an initial det]m9ation "u subp>agraph 7,a7 7includ+ cases :]e su* loans 7 fully or p>tially paid71 ! ,secret>y det]m9es t ! reason = su* det]m9ation 0 ! recipi5t's failure to timely submit a c]tification requir$ "u subsection 7b77#a77;,b71 an error or process+ delay by ! ,secret>y1 a *ange to ! fields consid]$ eligible = fulfillm5t ( ! s]vice obligation 7z describ$ 9 subsection 7b77#a77;,a771 a recipi5t hav+ previ\sly reque/$ to h ! ,,m$ ,grant conv]t$ to a loan1 or ano!r valid reason det]m9$ by ! ,secret>y1 & t ! recipi5t has1 z ( ! date ( ! reconsid]ation1 demon/rat$ t ! recipi5t did meet1 or is meet+ ! s]vice obligation 9 ! agreem5t "u subsection 7b71 ! ,secret>y %all-- 7i7 dis*>ge ! ,f$]al ,direct ,unsubsidiz$ ,/af=d ,loan "u "p ,d1 & re9/ate ! recipi5t's grant "u ?is subp>t2 7ii7 dis*>ge any int]e/ or fees t may h accumulat$ dur+ ! p]iod t ! grant 0 conv]t$ to a ,f$]al ,direct ,unsubsidiz$ ,/af=d ,loan "u "p ,d2 7iii7 if ! recipi5t has o!r loans "u "p ,d1 apply any paym5ts made = ! ,f$]al ,direct ,unsubsidiz$ ,/af=d ,loan "u "p ,d dur+ su* p]iod to ^? o!r loans "u "p ,d2 7iv7 if ! recipi5t does n h o!r loans "u "p ,d1 reimburse ! recipi5t = any am\nts paid on ! ,f$]al ,direct ,unsubsidiz$ ,/af=d ,loan "u "p ,d dur+ su* p]iod2 7v7 reque/ t consum] report+ ag5cies remove any negative cr$it report+ due to ! conv]sion ( ! ,,m$ ,grant to a loan2 & 7vi7 use ! additional in=mation provid$ "u subp>agraph 7,a7 to det]m9e ! progress ! recipi5t has made 9 meet+ ! s]vice obligation4 7,c7 ,ext5sion ( "t to complete s]vice obligation ,9 ! case ( a recipi5t ^: ,,m$ ,grant 0 re9/at$ 9 accordance ) subp>agraph 7,b71 ! ,secret>y %all1 ^u su* re9/atem5t-- 7i7 ext5d ! "t rema9+ = ! recipi5t to fulfill ! s]vice obligation describ$ 9 subsection 7b77#a7 to a p]iod ( "t equal to-- 7,i7 #aj ye>s2 m9us 7,,ii7 ! numb] ( ye>s t ! recipi5t complet$ s]vice z a physician 9 prim>y c>e prior to ! reconv]sion ( ! loan to a ,,m$ ,grant "u subp>agraph 7,b71 includ+ any ye>s ( qualify+ s]vice complet$ dur+ ! p]iod :5 ! ,,m$ ,grant 0 9 loan /atus2 & 7ii7 treat any ye>s ( s]vice describ$ 9 subclause 7,,ii7 ( clause 7i7 z ye>s t c\nt t[>d ! individual's s]vice obligation 7reg>dless ( :e!r ! ,,m$ ,grant funds 7 9 grant or loan /atus7 if t "t o!rwise meets ! requirem5ts ( ?is section4 7d7 ,additional adm9i/rative provisions 7#a7 ,ext5uat+ circum/ances ,! ,secret>y %all e/abli%1 by regulation1 categories ( ext5uat+ circum/ances "u :i* a recipi5t ( a grant "u ?is subp>t :o is unable to fulfill all or "p ( ! recipi5t's s]vice obligation may be excus$ f fulfill+ t portion ( ! s]vice obligation4 7#b7 ,communication ) recipi5ts ,! ,secret>y %all notify ,,m$ grant recipi5ts n less ?an twice p] cal5d> ye> reg>d+ h[ to submit ! employm5t c]tification "u subsection 7b77#a77;,b7 & ! recomm5dations & requirem5ts = submitt+ t c]tification "u p>agraph 7#c74 7#c7 ,submission ( employm5t c]tification 7,a7 ,recomm5d$ submissions 7i7 ,9 ,g5]al ,! ,secret>y %all notify ,,m$ ,grant recipi5ts t ! ,dep>tm5t recomm5ds t ,,m$ ,grant recipi5ts submit ! employm5t c]tification describ$ 9 subsection 7b77#a77;,b7 z soon z practicable aft] ! completion ( ea* ye> ( s]vice4 7ii7 ,=m ,! ,secret>y %all provide a /&>diz$ annual c]tification =m = use "u ?is section & all[ electronic submission by ! recipi5t or employ]4 7,b7 ,requir$ submission ,a ,,m$ ,grant recipi5t %all be requir$ to submit to ! ,dep>tm5t employm5t c]tification )9 ! timeframe t w\ld all[ t individual to complete _! s]vice obligation be=e ! end ( ! s]vice obligation w9d[4 7,c7 ,notification ,! ,secret>y %all notify ,,m$ ,grant recipi5ts ( ! requir$ submission deadl9es describ$ 9 ?is p>agraph4 7,d7 ,adju/m5t ( deadl9e ,! ,secret>y %all adju/ ! submission deadl9e describ$ 9 subp>agraph 7,b7 to acc\nt = a s]vice obligation w9d[ ext5sion4 7,e7 ,alt]native to c]tification ,! ,secret>y %all provide an alt]native to ! c]tification ( employm5t describ$ 9 subsection 7b77#a77;,b7 = recipi5ts :o _c obta9 su* requir$ c]tification ( employm5t because ! recipi5t c demon/rate ! employ] is no long] 9 exi/5ce or ! employ] refuses to coop]ate4 #dbj,v4 ,program p]iod & fund+ ,beg9n+ on ,july #a1 #bjbf1 !re %all be available to ! ,secret>y to c>ry out ?is subp>t1 f funds n o!rwise appropriat$1 su* sums z may be necess>y to provide ,,m$ ,grants 9 accordance ) ?is subp>t to ea* eligible applicant4 #ab ,,d5tal ,grants #dbj,w4 ,def9itions ,= ! purposes ( ?is subp>t3 7#a7 ,eligible in/itution ,! t]m eligible in/itution means an in/itution ( high] education1 z def9$ 9 section #aja1 t is a s*ool ( d5ti/ry z def9$ 9 section #gii;,b ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #biep74 7#b7 ,d5tal s*ool c&idate ,! t]m d5tal s*ool c&idate means a /ud5t 9 att5dance at an eligible in/itution pursu+ a pr(essional d5tal degree4 7#c7 ,rural area ,! t]m rural area has ! mean+ giv5 t t]m 9 section #hfa7;b77#b74 #dbj,x4 ,program e/abli%$ 7a7 ,program au?ority 7#a7 ,paym5ts requir$ ,! ,secret>y %all pay to ea* eligible in/itution su* sums z may be necess>y to pay to ea* d5tal s*ool c&idate :o files an application & agreem5t 9 accordance ) section #dbj,y1 & :o qualifies "u su* section1 a ,,d5tal ,grant 9 ! am\nt ( tuition & requir$ fees = ea* ye> dur+ :i* t d5tal s*ool c&idate is 9 att5dance at ! in/itution4 7#b7 ,ref]5ces ,grants made "u p>agraph 7#a7 %all be kn[n z ,,d5tal ,grants4 7b7 ,paym5t me?odology 7#a7 ,prepaym5t ,n less ?an #he p]c5t ( any funds provid$ to an eligible in/itution "u subsection 7a7 %all be advanc$ to ! eligible in/itution prior to ! />t ( ea* paym5t p]iod & %all be bas$ ^u an am\nt reque/$ by ! in/itution z ne$$ to pay d5tal s*ool c&idates until su* "t z ! ,secret>y det]m9es & publi%es 9 ! ,f$]al ,regi/] ) an opportunity = comm5t1 an alt]native paym5t sy/em t provides paym5ts to in/itutions 9 an accurate & timely mann]1 except t ?is s5t5ce %all n be con/ru$ to limit ! au?ority ( ! ,secret>y to place an in/itution on a reimbursem5t sy/em ( paym5t4 7#b7 ,direct paym5t ,no?+ 9 ?is section %all be int]pret$ to prohibit ! ,secret>y f pay+ directly to d5tal s*ool c&idates1 9 advance ( ! beg9n+ ( ! academic t]m1 an am\nt = :i* d5tal s*ool c&idates are eligible1 9 cases :]e ! eligible in/itution elects n to p>ticipate 9 ! disbursem5t sy/em requir$ by p>agraph 7#a74 7c7 ,no exce$+ co/ ,! am\nt ( a grant aw>d$ "u ?is subp>t1 9 comb9ation ) ,f$]al assi/ance1 %all n exce$ ! co/ ( att5dance 7z def9$ 9 section #dgb7 at ! eligible in/itution at :i* t d5tal s*ool c&idate is 9 att5dance4 7d7 ,p]iod ( eligibility = grants ,! p]iod dur+ :i* a d5tal s*ool c&idate may receive a ,,d5tal grant "u ?is subp>t %all be ! p]iod requir$ = ! completion ( ! pr(essional d5tal degree be+ pursu$ by ! d5tal s*ool c&idate at ! eligible in/itution at :i* ! d5tal s*ool c&idate is 9 att5dance1 except t ! p]iod dur+ :i* a d5tal s*ool c&idate may receive a ,,d5tal ,grant "u ?is subp>t %all n exce$ #h ye>s4 #dbj,y4 ,application2 aw>d 7a7 ,application2 aw>d 7#a7 ,application ,! ,secret>y %all p]iodically set dates by :i* d5tal s*ool c&idates %all file applications = grants "u ?is subp>t4 ,ea* d5tal s*ool c&idate desir+ a grant "u ?is subp>t = any ye> %all file an application conta9+ su* in=mation z is necess>y to demon/rate t ! d5tal s*ool c&idate-- 7,a7 is an eligible /ud5t = purposes ( section #dhd2 7,b7 has complet$ a ,,fafsa2 7,c7 w\ld l to receive a ,,d5tal grant2 & 7,d7 und]/&s & agrees to ! t]ms & conditions ( ! agreem5t to s]ve describ$ 9 subp>agraph 7b74 7#b7 ,aw>d ,! ,secret>y %all aw>d a ,,d5tal grant to ea* eligible d5tal s*ool c&idate :o meets ! requirem5ts describ$ 9 p>agraph 7#a7 = ea* ye> t ! application "u su* p>agraph is submitt$ & su* requirem5ts are met4 7b7 ,agreem5ts ,to s]ve ,ea* application "u subsection 7a7 %all conta9 or be accompani$ by an agreem5t by ! applicant t-- 7#a7 ! applicant w-- 7,a7 practice g5]al d5tal c>e 9 a rural area1 ) ! option = s]vice to be complet$ cumulatively across eligible sites & locations1 = at lea/ #aj ye>s aft] _! relat$ tra9+ is complet$ 7includ+ a resid5cy or fell[%ip program7 )9 #ae ye>s aft] complet+ ! degree & su* relat$ tra9+ = :i* ! applicant receiv$ a ,,d5tal ,grant "u ?is subp>t 7ref]r$ to 9 ?is section z ! s]vice obligation w9d[72 & 7,b7 annually submit an employm5t c]tification1 = ea* ye> ( s]vice1 %[+ t ! requirem5t "u subp>agraph 7,a7 is be+ met2 7#b7 9 ! ev5t t ! applicant is det]m9$ to h fail$ or refus$ to c>ry out su* s]vice obligation1 ! specifi$ am\nt ( any ,,d5tal ,grants receiv$ by su* applicant w be treat$ z a loan & collect$ f ! applicant 9 accordance ) subsection 7c7 & ! regulations !reund]2 & 7#c7 conta9s1 or is accompani$ by1 a pla9-language disclosure =m develop$ by ! ,secret>y t cle>ly describes ! nature ( ! ,,d5tal ,grant aw>d1 ! s]vice obligation1 & ! loan repaym5t requirem5ts t are ! consequ5ce ( ! failure to complete ! s]vice obligation4 7c7 ,repaym5t = failure ,to complete s]vice 7#a7 ,9 g5]al ,9 ! ev5t t any recipi5t ( a grant "u ?is subp>t fails or refuses to comply ) ! s]vice obligation 9 ! agreem5t "u subsection 7b71 a specifi$ am\nt z describ$ 9 p>agraph 7#c7 ( ! ,,d5tal ,grants receiv$ by su* recipi5t %all1 ^u a det]m9ation ( su* a failure or refusal 9 su* s]vice obligation1 be conv]t$ to a ,f$]al ,direct ,unsubsidiz$ ,/af=d ,loan "u "p ,d ( title ,,iv1 & %all be subject to repaym5t1 9 accordance ) p>agraph 7#b74 7#b7 ,int]e/ & repaym5t ,am\nts t are conv]t$ to a ,direct ,unsubsidiz$ ,/af=d ,loan "u p>agraph 7#a7 %all accrue int]e/ at ! rate applicable to su* ,direct ,unsubsidiz$ ,/af=d ,loans = borr[]s z ( ! date ( conv]sion1 & ! recipi5t %all be eligible = ! same repaym5t plans & borr[] protections ) respect to su* conv]t$ loans z t recipi5t w\ld o!rwise be eligible = ) respect to a ,f$]al ,direct ,unsubsidiz$ ,/af=d ,loan "u "p ,d ( title ,,iv = a borr[] t is disburs$ on ! same date4 7#c7 ,specifi$ am\nt to be repaid 7,a7 #e ye>s or less ,if a ,,d5tal ,grant recipi5t has complet$ #e ye>s or less ( requir$ s]vice1 ! specifi$ am\nt to be repaid is ! less] (-- 7i7 ! total am\nt ( ,,d5tal ,grants receiv$ by ! recipi5t2 or 7ii7 #ej1jjj4 7,b7 ,great] ?an #e ye>s & less ?an #aj ye>s ,if a ,,d5tal ,grant recipi5t has complet$ m ?an #e ye>s ( requir$ s]vice b less ?an #aj ye>s ( requir$ s]vice1 ! specifi$ am\nt to be repaid is ! less] (-- 7i7 ! total am\nt ( ,,d5tal ,grants receiv$ by ! recipi5t2 or 7ii7 #be1jjj4 7,c7 ,cap ,! am\nt ( ,,d5tal ,grants t is conv]t$ to a loan & requir$ to be repaid "u ?is subsection %all n exce$ #ej1jjj4 7#d7 ,reconsid]ation ( conv]sion decisions 7,a7 ,reque/ to reconsid] ,9 any case :]e ! ,secret>y has det]m9$ t a recipi5t ( a grant "u ?is subp>t has fail$ or refus$ to comply ) ! s]vice obligation 9 ! agreem5t "u subsection 7b7 & has conv]t$ ! grant into a ,f$]al ,direct ,unsubsidiz$ ,/af=d ,loan "u "p ,d 9 accordance ) p>agraph 7#a71 7includ+ cases :]e su* loans h be5 fully or p>tially paid71 ! recipi5t may reque/ t ! ,secret>y reconsid] su* initial det]m9ation & may submit additional in=mation to demon/rate satisfaction ( ! s]vice obligation4 ,^u receipt ( su* a reque/1 ! ,secret>y %all reconsid] ! det]m9ation 9 accordance ) ?is p>agraph n lat] ?an #ij days aft] ! date t su* reque/ 0 receiv$4 7,b7 ,reconsid]ation ,if1 9 reconsid]+ an initial det]m9ation "u subp>agraph 7,a7 7includ+ cases :]e su* loans 7 fully or p>tially paid71 ! ,secret>y det]m9es t ! reason = su* det]m9ation 0 ! recipi5t's failure to timely submit a c]tification requir$ "u subsection 7b77#a77;,b71 an error or process+ delay by ! ,secret>y1 a *ange to ! fields consid]$ eligible = fulfillm5t ( ! s]vice obligation 7z describ$ 9 subsection 7b77#a77;,a771 a recipi5t hav+ previ\sly reque/$ to h ! ,,d5tal ,grant conv]t$ to a loan1 or ano!r valid reason det]m9$ by ! ,secret>y1 & t ! recipi5t has1 z ( ! date ( ! reconsid]ation1 demon/rat$ t ! recipi5t did meet1 or is meet+ ! s]vice obligation 9 ! agreem5t "u subsection 7b71 ! ,secret>y %all-- 7i7 dis*>ge ! ,f$]al ,direct ,unsubsidiz$ ,/af=d ,loan "u "p ,d1 & re9/ate ! recipi5t's grant "u ?is subp>t2 7ii7 dis*>ge any int]e/ or fees t may h accumulat$ dur+ ! p]iod t ! grant 0 conv]t$ to a ,f$]al ,direct ,unsubsidiz$ ,/af=d ,loan "u "p ,d2 7iii7 if ! recipi5t has o!r loans "u "p ,d1 apply any paym5ts made = ! ,f$]al ,direct ,unsubsidiz$ ,/af=d ,loan "u "p ,d dur+ su* p]iod to ^? o!r loans "u "p ,d2 7iv7 if ! recipi5t does n h o!r loans "u "p ,d1 reimburse ! recipi5t = any am\nts paid on ! ,f$]al ,direct ,unsubsidiz$ ,/af=d ,loan "u "p ,d dur+ su* p]iod2 7v7 reque/ t consum] report+ ag5cies remove any negative cr$it report+ due to ! conv]sion ( ! ,,d5tal ,grant to a loan2 & 7vi7 use ! additional in=mation provid$ "u subp>agraph 7,a7 to det]m9e ! progress ! recipi5t has made 9 meet+ ! s]vice obligation4 7,c7 ,ext5sion ( "t to complete s]vice obligation ,9 ! case ( a recipi5t ^: ,,d5tal ,grant 0 re9/at$ 9 accordance ) subp>agraph 7,b71 ! ,secret>y %all1 ^u su* re9/atem5t-- 7i7 ext5d ! "t rema9+ = ! recipi5t to fulfill ! s]vice obligation describ$ 9 subsection 7b77#a7 to a p]iod ( "t equal to-- 7,i7 #aj ye>s2 m9us 7,,ii7 ! numb] ( ye>s t ! recipi5t complet$ requir$ s]vice 9 g5]al d5ti/ry 9 a rural area prior to ! reconv]sion ( ! loan to a ,,d5tal ,grant "u subp>agraph 7,b71 includ+ any ye>s ( qualify+ s]vice complet$ dur+ ! p]iod :5 ! ,,d5tal ,grant 0 9 loan /atus2 & 7ii7 treat any ye>s ( s]vice describ$ 9 subclause 7,,ii7 ( clause 7i7 z ye>s t c\nt t[>d ! individual's s]vice obligation 7reg>dless ( :e!r ! ,,d5tal ,grant funds 7 9 grant or loan /atus7 if t "t o!rwise meets ! requirem5ts ( ?is section4 7d7 ,additional adm9i/rative provisions 7#a7 ,ext5uat+ circum/ances ,! ,secret>y %all e/abli%1 by regulation1 categories ( ext5uat+ circum/ances "u :i* a recipi5t ( a grant "u ?is subp>t :o is unable to fulfill all or "p ( ! recipi5t's s]vice obligation may be excus$ f fulfill+ t portion ( ! s]vice obligation4 7#b7 ,communication ) recipi5ts ,! ,secret>y %all notify ,,d5tal grant recipi5ts n less ?an twice p] cal5d> ye> reg>d+ h[ to submit ! employm5t c]tification "u subsection 7b77#a77;,b7 & ! recomm5dations & requirem5ts = submitt+ t c]tification "u p>agraph 7#c74 7#c7 ,submission ( employm5t c]tification 7,a7 ,recomm5d$ submissions 7i7 ,9 ,g5]al ,! ,secret>y %all notify ,,d5tal ,grant recipi5ts t ! ,dep>tm5t recomm5ds t ,,d5tal ,grant recipi5ts submit ! employm5t c]tification describ$ 9 subsection 7b77#a77;,b7 z soon z practicable aft] ! completion ( ea* ye> ( s]vice4 7ii7 ,=m ,! ,secret>y %all provide a /&>diz$ annual c]tification =m = use "u ?is section & all[ electronic submission by ! recipi5t or employ]4 7,b7 ,requir$ submission ,a ,,d5tal ,grant recipi5t %all be requir$ to submit to ! ,dep>tm5t employm5t c]tification )9 ! timeframe t w\ld all[ t individual to complete _! s]vice obligation be=e ! end ( ! s]vice obligation w9d[4 7,c7 ,notification ,! ,secret>y %all notify ,,d5tal ,grant recipi5ts ( ! requir$ submission deadl9es describ$ 9 ?is p>agraph4 7,d7 ,adju/m5t ( deadl9e ,! ,secret>y %all adju/ ! submission deadl9e describ$ 9 subp>agraph 7,b7 to acc\nt = a s]vice obligation w9d[ ext5sion4 7,e7 ,alt]native to c]tification ,! ,secret>y %all provide an alt]native to ! c]tification ( employm5t describ$ 9 subsection 7b77#a77;,b7 = recipi5ts :o _c obta9 su* requir$ c]tification ( employm5t because ! recipi5t c demon/rate ! employ] is no long] 9 exi/5ce or ! employ] refuses to coop]ate4 #dbj,z4 ,program p]iod & fund+ ,beg9n+ on ,july #a1 #bjbf1 !re %all be available to ! ,secret>y to c>ry out ?is subp>t1 f funds n o!rwise appropriat$1 su* sums z may be necess>y to provide ,,d5tal ,grants 9 accordance ) ?is subp>t to ea* eligible applicant4 #ac ,,nurse ,grants #dbj;,,aa4 ,def9itions ,= ! purposes ( ?is subp>t3 7#a7 ,eligible in/itution ,! t]m eligible in/itution means an accr$it$ s*ool ( nurs+1 z def9$ 9 section #hja ( ! ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #bif71 at an in/itution ( high] education1 z def9$ 9 section #aja4 7#b7 ,nurs+ /ud5t ,! t]m nurs+ /ud5t means a /ud5t 9 att5dance at an eligible in/itution4 #dbj;,,bb4 ,program e/abli%$ 7a7 ,program au?ority 7#a7 ,paym5ts requir$ ,! ,secret>y %all pay to ea* eligible in/itution su* sums z may be necess>y to pay to ea* nurs+ /ud5t :o files an application & agreem5t 9 accordance ) section #dbj;,,cc1 & :o qualifies "u su* section1 a ,,nurse ,grant 9 ! am\nt ( tuition & requir$ fees = ea* ye> dur+ :i* t nurs+ /ud5t is 9 att5dance at ! in/itution4 7#b7 ,ref]5ces ,grants made "u p>agraph 7#a7 %all be kn[n z ,,nurse ,grants4 7b7 ,paym5t me?odology 7#a7 ,prepaym5t ,n less ?an #he p]c5t ( any funds provid$ to an eligible in/itution "u subsection 7a7 %all be advanc$ to ! eligible in/itution prior to ! />t ( ea* paym5t p]iod & %all be bas$ ^u an am\nt reque/$ by ! in/itution z ne$$ to pay nurs+ /ud5ts until su* "t z ! ,secret>y det]m9es & publi%es 9 ! ,f$]al ,regi/] ) an opportunity = comm5t1 an alt]native paym5t sy/em t provides paym5ts to in/itutions 9 an accurate & timely mann]1 except t ?is s5t5ce %all n be con/ru$ to limit ! au?ority ( ! ,secret>y to place an in/itution on a reimbursem5t sy/em ( paym5t4 7#b7 ,direct paym5t ,no?+ 9 ?is section %all be int]pret$ to prohibit ! ,secret>y f pay+ directly to nurs+ /ud5ts1 9 advance ( ! beg9n+ ( ! academic t]m1 an am\nt = :i* nurs+ /ud5ts are eligible1 9 cases :]e ! eligible in/itution elects n to p>ticipate 9 ! disbursem5t sy/em requir$ by p>agraph 7#a74 7c7 ,no exce$+ co/ ,! am\nt ( a grant aw>d$ "u ?is subp>t1 9 comb9ation ) ,f$]al assi/ance1 %all n exce$ ! co/ ( att5dance 7z def9$ 9 section #dgb7 at ! eligible in/itution at :i* t nurs+ /ud5t is 9 att5dance4 7d7 ,p]iod ( eligibility = grants ,! p]iod dur+ :i* a nurs+ /ud5t may receive a ,,nurse grant "u ?is subp>t %all be ! p]iod requir$ = ! completion ( ! pr(essional nurs+ degree be+ pursu$ by ! nurs+ /ud5t at ! eligible in/itution at :i* ! nurs+ /ud5t is 9 att5dance1 except t ! p]iod dur+ :i* a nurs+ /ud5t may receive a ,,nurse ,grant "u ?is subp>t %all n exce$ #h ye>s4 #dbj;,,cc4 ,application2 aw>d 7a7 ,application ,! ,secret>y %all p]iodically set dates by :i* nurs+ /ud5ts %all file applications = grants "u ?is subp>t4 ,ea* nurs+ /ud5t desir+ a grant "u ?is subp>t = any ye> %all file an application conta9+ su* in=mation z is necess>y to demon/rate t ! nurs+ /ud5t-- 7#a7 is an eligible /ud5t = purposes ( section #dhd2 7#b7 has complet$ a ,,fafsa2 & 7#c7 w\ld l to receive a ,,nurse grant4 7b7 ,aw>d ,! ,secret>y %all aw>d a ,,nurse grant to ea* nurs+ /ud5t :o meets ! requirem5ts describ$ 9 subsection 7a7 = ea* ye> t ! application "u su* subsection is submitt$ & su* requirem5ts are met4 #dbj;,,dd4 ,program p]iod & fund+ ,beg9n+ on ,july #a1 #bjbf1 !re %all be available to ! ,secret>y to c>ry out ?is subp>t1 f funds n o!rwise appropriat$1 su* sums z may be necess>y to provide ,,nurse ,grants 9 accordance ) ?is subp>t to ea* eligible applicant4 4 7b7 ,increas+ enrollm5t at heal? pr(essions s*ools ,"p ,e ( title ,,vii ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #bidn et seq47 is am5d$ by add+ at ! end ! foll[+3 #d ,increas+ enrollm5t at heal? pr(essions s*ools #ggi4 ,grant program to increase enrollm5t at heal? pr(essions s*ools 7a7 ,s*ools ( m$ic9e & s*ools ( o/eopa?ic m$ic9e 7#a7 ,9 g5]al ,! ,secret>y %all aw>d grants to eligible s*ools ( m$ic9e & s*ools ( o/eopa?ic m$ic9e to assi/ su* s*ools 9 exp&+ /ud5t enrollm5t4 7#b7 ,eligibility ,to be eligible to receive a grant "u ?is section1 a s*ool ( m$ic9e or s*ool ( o/eopa?ic m$ic9e %all submit an application to ! ,secret>y at su* "t1 9 su* mann]1 & conta9+ su* in=mation z ! ,secret>y may require1 includ+ a plan to increase enrollm5t 9 ! s*ool by at lea/-- 7,a7 #ej p]c5t by ye> #b ( ! grant2 & 7,b7 an additional #ej p]c5t by ye> #d ( ! grant4 7#c7 ,use ( funds ,a s*ool ( m$ic9e or s*ool ( o/eopa?ic m$ic9e t receives a grant "u ?is section %all use ! funds aw>d$ ?r\gh su* grant = activities t include-- 7,a7 enhanc+ enrollm5t & ret5tion ( /ud5ts at su* s*ool us+ evid5ce-bas$ practices1 ) a priority = /ud5ts f disadvantag$ backgr\nds 7includ+ racial or e?nic gr\ps und]repres5t$ 9 ! physician work=ce71 individuals f rural & und]s]v$ areas1 l[-income individuals1 individuals ) a disability1 & fir/ g5]ation college /ud5ts 7z def9$ 9 section #djb;,a7h77#c7 ( ! ,high] ,education ,act ( #aife71 includ+ ?r\gh m5tor%ip programs1 provid+ tools & programm+ = und]repres5t$ /ud5ts1 & address+ o!r /ud5t ne$s2 7,b7 reta9+ curr5t faculty & cl9ical preceptors1 & recruit+ & hir+ new faculty & cl9ical preceptors1 includ+ by increas+ wages & provid+ loan repaym5t1 ) an emphasis on faculty & cl9ical preceptors f racial or e?nic gr\ps :o are und]repres5t$ 9 ! physician work=ce2 7,c7 p>tn]+ ) a heal? c>e facility1 community heal? c5t]1 or o!r facility t provides heal? c>e 9 ord] to provide educational opportunities = ! purpose ( e/abli%+ or exp&+ cl9ical education1 ) emphasis on community-bas$ cl9ical education2 7,d7 mod]niz+ infra/ructure at su* s*ool1 includ+ audiovisual or o!r equipm5t1 simulation & augm5t$ reality res\rces1 teleheal? te*nologies1 & virtual & physical laboratories2 7,e7 creat+1 support+1 or mod]niz+ educational programs & curriculum1 includ+ rural & community-bas$ cl9ical education1 at su* s*ool2 or 7,f7 o!r activities t ! ,secret>y det]m9es fur!r ! developm5t1 improvem5t1 & expansion ( s*ools ( m$ic9e & s*ools ( o/eopa?ic m$ic9e4 7b7 ,s*ools ( nurs+ 7#a7 ,9 g5]al ,! ,secret>y %all aw>d grants to eligible s*ools ( nurs+ to assi/ su* s*ools 9 exp&+ /ud5t enrollm5t4 7#b7 ,eligibility ,to be eligible to receive a grant "u ?is section1 a s*ool ( nurs+ %all submit an application to ! ,secret>y at su* "t1 9 su* mann]1 & conta9+ su* in=mation z ! ,secret>y may require1 includ+ a plan to increase enrollm5t 9 ! s*ool by at lea/-- 7,a7 #cj p]c5t by ye> #b ( ! grant2 & 7,b7 an additional #cj p]c5t by ye> #d ( ! grant4 7#c7 ,use ( funds ,a s*ool ( nurs+ t receives a grant "u ?is section %all use ! funds aw>d$ ?r\gh su* grant = activities t include-- 7,a7 enhanc+ enrollm5t & ret5tion ( /ud5ts at su* s*ool us+ evid5ce-bas$ practices1 ) a priority = /ud5ts f disadvantag$ backgr\nds 7includ+ racial or e?nic gr\ps und]repres5t$ 9 ! nurs+ work=ce71 /ud5ts :o id5tify z an und]repres5t$ sex 9 ! nurs+ work=ce1 individuals f rural & und]s]v$ areas1 l[-income individuals1 individuals ) a disability1 & fir/ g5]ation college /ud5ts 7z def9$ 9 section #djb;,a7h77#c7 ( ! ,high] ,education ,act ( #aife71 includ+ ?r\gh m5tor%ip programs1 provid+ tools & programm+ = und]repres5t$ /ud5ts1 & address+ o!r /ud5t ne$s2 7,b7 reta9+ curr5t faculty & cl9ical preceptors1 & recruit+ & hir+ new faculty & cl9ical preceptors1 includ+ by increas+ wages & provid+ loan repaym5t1 ) an emphasis on faculty & cl9ical preceptors f racial or e?nic gr\ps :o are und]repres5t$ 9 ! nurs+ work=ce2 7,c7 p>tn]+ ) a heal? c>e facility1 nurse-manag$ heal? cl9ic1 community heal? c5t]1 or o!r facility t provides heal? c>e 9 ord] to provide educational opportunities = ! purpose ( e/abli%+ or exp&+ cl9ical education1 ) emphasis on community-bas$ cl9ical education2 7,d7 mod]niz+ infra/ructure at su* s*ool1 includ+ audiovisual or o!r equipm5t1 simulation & augm5t$ reality res\rces1 teleheal? te*nologies1 & virtual & physical laboratories2 7,e7 creat+1 support+1 or mod]niz+ educational programs & curriculum1 includ+ rural & community-bas$ cl9ical education1 at su* s*ool2 7,f7 enhanc+ & exp&+ nurs+ programs t prep>e nurse rese>*]s & sci5ti/s2 7,g7 e/abli%+ nurse-l$ intradiscipl9>y & int]pr(essional educational p>tn]%ips2 7,h7 support+ regi/]$ nurses 9 baccalaureate degree programs or advanc$ degree programs describ$ 9 section #haa7;b71 ) a goal ( becom+ nurse faculty & cl9ical preceptors2 or 7,i7 o!r activities t ! ,secret>y det]m9es fur!r ! developm5t1 improvem5t1 & expansion ( s*ools ( nurs+4 7#d7 ,def9ition ,9 ?is section1 ! t]m s*ool ( nurs+ has ! mean+ giv5 su* t]m 9 section #hja7b74 7c7 ,s*ools ( d5ti/ry 7#a7 ,9 g5]al ,! ,secret>y %all aw>d grants to eligible s*ools ( d5ti/ry to assi/ su* s*ools 9 exp&+ /ud5t enrollm5t4 7#b7 ,eligibility ,to be eligible to receive a grant "u ?is section1 a s*ool ( d5ti/ry %all submit an application to ! ,secret>y at su* "t1 9 su* mann]1 & conta9+ su* in=mation z ! ,secret>y may require1 includ+ a plan to increase enrollm5t 9 ! s*ool by at lea/-- 7,a7 #bj p]c5t by ye> #b ( ! grant2 & 7,b7 an additional #bj p]c5t by ye> #d ( ! grant4 7#c7 ,use ( funds ,a s*ool ( d5ti/ry t receives a grant "u ?is section %all use ! funds aw>d$ ?r\gh su* grant = activities t include-- 7,a7 enhanc+ enrollm5t & ret5tion ( /ud5ts at su* s*ool us+ evid5ce-bas$ practices1 ) a priority = /ud5ts f disadvantag$ backgr\nds 7includ+ racial or e?nic gr\ps und]repres5t$ 9 ! d5tal work=ce71 individuals f rural & und]s]v$ areas1 l[-income individuals1 individuals ) a disability1 & fir/ g5]ation college /ud5ts 7z def9$ 9 section #djb;,a7h77#c7 ( ! ,high] ,education ,act ( #aife71 includ+ ?r\gh m5tor%ip programs1 provid+ tools & programm+ = und]repres5t$ /ud5ts1 & address+ o!r /ud5t ne$s2 7,b7 reta9+ curr5t faculty & cl9ical preceptors1 & recruit+ & hir+ new faculty & cl9ical preceptors1 includ+ by increas+ wages & provid+ loan repaym5t1 ) an emphasis on faculty & cl9ical preceptors f racial or e?nic gr\ps :o are und]repres5t$ 9 ! d5ti/ry work=ce2 7,c7 p>tn]+ ) a d5tal cl9ic1 community heal? c5t]1 or o!r facility1 includ+ a s*ool-bas$ d5tal cl9ic1 t provides d5tal c>e 9 ord] to provide educational opportunities = ! purpose ( e/abli%+ or exp&+ cl9ical education1 ) emphasis on community-bas$ cl9ical education2 7,d7 mod]niz+ infra/ructure at su* s*ool1 includ+ audiovisual or o!r equipm5t1 simulation & augm5t$ reality res\rces1 teleheal? te*nologies1 & virtual & physical laboratories2 7,e7 creat+1 support+1 or mod]niz+ educational programs & curriculum1 includ+ rural & community-bas$ cl9ical education1 at su* s*ool2 or 7,f7 o!r activities t ! ,secret>y det]m9es fur!r ! developm5t1 improvem5t1 & expansion ( s*ools ( d5ti/ry4 7d7 ,grant am\nts2 grant p]iod ,ea* grant aw>d$ "u ?is section %all be 9 an am\nt det]m9$ by ! ,secret>y1 & = a p]iod ( #aj ye>s4 7e7 ,report+ ,ea* recipi5t ( a grant "u ?is section %all submit to ! ,secret>y an annual report t describes-- 7#a7 ! numb] ( /ud5ts enroll$ dur+ ! ye> prec$+ ! date ( ! report2 7#b7 ! p]c5tage by :i* su* enrollm5t = su* ye> has increas$ or decreas$1 z comp>$ to enrollm5t = ! ye> prec$+ su* ye>2 7#c7 ! numb] ( new faculty & cl9ical preceptors t 7 hir$ dur+ su* ye>2 & 7#d7 9 ! case ( a recipi5t ( a grant "u subsection 7c71 ) respect to graduates ( ! applicable s*ool ( d5ti/ry-- 7,a7 ! numb] :o are practic+ d5ti/ry 9 a rural community2 7,b7 ! numb] :o are enroll$ z a p>ticipat+ provid] "u a ,/ate plan "u title ,,xix ( ! ,social ,security ,act or "u a waiv] ( su* a plan2 7,c7 ! rates ( passage ( ! ,integrat$ ,national ,bo>d ,d5tal ,exam9ation1 & ( any exam or process by :i* a d5ti/ obta9s a lic5se to practice d5ti/ry2 & 7,d7 ! rates at :i* su* graduates are practic+ d5ti/ry #c & #e ye>s aft] graduation4 7f7 ,au?orization ( appropriations ,!re are au?oriz$ to be appropriat$1 = ! p]iod ( fiscal ye>s #bjbf ?r\gh #bjce-- 7#a7 #b1hjj1jjj1jjj = purposes ( c>ry+ out subsection 7a72 7#b7 #a1ihj1jjj1jjj = purposes ( c>ry+ out subsection 7b72 & 7#c7 #fae1jjj1jjj = purposes ( c>ry+ out subsection 7c74 4 #c4 ,program ( paym5ts to tea*+ heal? c5t]s t op]ate graduate m$ical education programs ,section #cdj;,h ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #bef;h7 is am5d$-- 7#a7 9 subsection 7c77#b77;,b71 by add+ at ! end ! foll[+3 ,not)/&+ any o!r provision ( ?is section1 ! ,secret>y %all update su* p] resid5t am\nt = ea* su* qualifi$ tea*+ heal? c5t] su* t su* am\nt = fiscal ye> #bjbf is n less ?an #agj1jjj1 & su* am\nt = fiscal ye> #bjbg & ea* fiscal ye> !reaft] is n less ?an ! sum ( ! am\nt det]m9$ = ! previ\s fiscal ye> plus #aj1jjj42 & 7#b7 9 subsection 7g77#a7-- 7,a7 9 subp>agraph 7,e71 by /rik+ 2 & & ins]t+ a semicolon2 7,b7 9 subp>agraph 7,f71 by /rik+ ! p]iod & ins]t+ a semicolon2 & 7,c7 by add+ at ! end ! foll[+3 7,g7 #hib1ejj1jjj = fiscal ye> #bjbf2 7,h7 #a1hij1jjj1jjj = fiscal ye> #bjbg2 7,i7 #b1iib1ejj1jjj = fiscal ye> #bjbh2 7,j7 #c1aej1jjj1jjj = fiscal ye> #bjbi2 7,k7 #c1cjg1ejj1jjj = fiscal ye> #bjcj2 7,l7 #c1dfe1jjj1jjj = fiscal ye> #bjca2 7,m7 #c1fbb1ejj1jjj = fiscal ye> #bjcb2 7,n7 #c1ghj1jjj1jjj = fiscal ye> #bjcc2 7,o7 #c1icg1ejj1jjj = fiscal ye> #bjcd2 & 7,p7 #d1jie1jjj1jjj = fiscal ye> #bjce4 4 #d4 ,di/ribution ( additional ,m$ic>e ,,gme resid5cy positions 7a7 ,di/ribution 7#a7 ,9 g5]al ,section #ahhf7;h7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acieww7h77 is am5d$-- 7,a7 9 p>agraph 7#d77;,f77i71 by /rik+ & 7#aj7 & ins]t+ 7#aj71 & 7#aa72 7,b7 9 p>agraph 7#d77;,h77i71 by /rik+ & 7#aj7 & ins]t+ 7#aj71 & 7#aa72 & 7,c7 by add+ at ! end ! foll[+ new p>agraph3 7#aa7 ,di/ribution ( additional resid5cy positions 9 psy*iatry & psy*iatry subspecialties & prim>y c>e 7,a7 ,additional resid5cy positions 7i7 ,9 g5]al ,= ea* ( fiscal ye>s #bjbg ?r\gh #bjcf & = ea* succe$+ fiscal ye> until ! aggregate numb] ( full-"t equival5t resid5cy positions di/ribut$ "u ?is p>agraph is equal to ! aggregate numb] ( su* positions made available 7z specifi$ 9 clause 7ii77,i771 ! ,secret>y %all1 subject to ! succe$+ provisions ( ?is p>agraph1 increase ! o!rwise applicable resid5t limit = ea* qualify+ hospital t submits a timely application "u ?is subp>agraph by su* numb] z ! ,secret>y may approve effective beg9n+ ,july #a ( ! fiscal ye> ( ! increase4 7ii7 ,numb] available = di/ribution 7,i7 ,total numb] available ,! aggregate numb] ( su* positions made available "u ?is p>agraph %all be equal to #ej1bbj4 7,,ii7 ,annual limit ,! aggregate numb] ( su* positions s made available %all n exce$ #e1jbb = a fiscal ye>4 7iii7 ,di/ribution = psy*iatry or psy*iatry subspecialty resid5cies2 prim>y c>e resid5cies ,= ea* ( fiscal ye>s #bjbg ?r\gh #bjcf1 ( ! positions made available "u ?is p>agraph-- 7,i7 at lea/ #ae p]c5t %all be di/ribut$ = a psy*iatry or psy*iatry subspecialty resid5cy 7z def9$ 9 subp>agraph 7,f772 7,,ii7 at lea/ #cj p]c5t %all be di/ribut$ = a prim>y c>e resid5cy 7z def9$ 9 su* subp>agraph72 & 7iv7 ,tim+ ,! ,secret>y %all notify hospitals ( ! numb] ( positions di/ribut$ to ! hospital "u ?is p>agraph z a result ( an increase 9 ! o!rwise applicable resid5t limit by ,janu>y #ca ( ! fiscal ye> ( ! increase4 ,su* increase %all be effective beg9n+ ,july #a ( su* fiscal ye>4 7,b7 ,consid]ations 9 di/ribution ,9 det]m9+ = :i* qualify+ hospitals an increase 9 ! o!rwise applicable resid5t limit is provid$ "u subp>agraph 7,a71 ! ,secret>y %all take into acc\nt ! demon/rat$ likelihood ( ! hospital fill+ ! positions made available "u ?is p>agraph )9 ! fir/ #e tra9+ ye>s beg9n+ aft] ! date ! increase w\ld be effective1 z det]m9$ by ! ,secret>y4 7,c7 ,requirem5ts 7i7 ,prohibition on di/ribution to hospitals )\t an increase agreem5t ,no increase 9 ! o!rwise applicable resid5t limit ( a hospital may be made "u ?is p>agraph unless su* hospital agrees to increase ! total numb] ( full-"t equival5t resid5cy positions "u ! approv$ m$ical resid5cy tra9+ program ( su* hospital by ! numb] ( su* positions made available by su* increase "u ?is p>agraph4 7ii7 ,requirem5t = hospitals to exp& programs ,if a hospital t receives an increase 9 ! o!rwise applicable resid5t limit "u ?is p>agraph w\ld be eligible = an adju/m5t to ! o!rwise applicable resid5t limit = p>ticipation 9 a new m$ical resid5cy tra9+ program "u section #dac4gi7;e77#c7 ( title #db1 ,code ( ,f$]al ,regulations 7or any successor regulation71 ! hospital %all ensure t any positions made available "u ?is p>agraph are us$ to exp& an exi/+ program ( ! hospital & n = p>ticipation 9 a new m$ical resid5cy tra9+ program4 7,d7 ,application ( p] resid5t am\nts = nonprim>y c>e ,) respect to additional resid5cy positions 9 a hospital attributable to ! increase provid$ "u ?is p>agraph1 ! approv$ ,,fte p] resid5t am\nts are deem$ to be equal to ! hospital p] resid5t am\nts = nonprim>y c>e comput$ "u p>agraph 7#b77;,d7 = t hospital4 7,e7 ,p]mitt+ facilities to apply aggregation rules ,! ,secret>y %all p]mit hospitals receiv+ additional resid5cy positions attributable to ! increase provid$ "u ?is p>agraph to1 beg9n+ 9 ! fif? ye> aft] ! effective date ( su* increase1 apply su* positions to ! limitation am\nt "u p>agraph 7#d77;,f7 t may be aggregat$ pursuant to p>agraph 7#d77;,h7 among memb]s ( ! same affiliat$ gr\p4 7,f7 ,def9itions ,9 ?is p>agraph3 7i7 ,o!rwise applicable resid5t limit ,! t]m o!rwise applicable resid5t limit means1 ) respect to a hospital1 ! limit o!rwise applicable "u subp>agraphs 7,f77i7 & 7,h7 ( p>agraph 7#d7 on ! resid5t level = ! hospital det]m9$ )\t reg>d to ?is p>agraph1 b tak+ into acc\nt p>agraphs 7#g77;,a71 7#g77;,b71 7#h77;,a71 7#h77;,b71 7#i77;,a71 & 7#aj77;,a74 7ii7 ,prim>y c>e resid5cy ,! t]m prim>y c>e resid5cy means a resid5cy 9 a program describ$ 9 p>agraph 7#e77;,h74 7iii7 ,psy*iatry or psy*iatry subspecialty resid5cy ,! t]m psy*iatry or psy*iatry subspecialty resid5cy has ! mean+ giv5 t t]m 9 p>agraph 7#aj77;,f74 7iv7 ,ref]5ce resid5t level ,! t]m ref]5ce resid5t level means1 ) respect to a hospital1 ! resid5t level = ! mo/ rec5t co/ report+ p]iod ( ! hospital end+ on or be=e ! date ( enactm5t ( ?is p>agraph1 = :i* a co/ report has be5 settl$ 7or1 if n1 submitt$ 7subject to audit771 z det]m9$ by ! ,secret>y4 7v7 ,resid5t level ,! t]m resid5t level has ! mean+ giv5 su* t]m 9 p>agraph 7#g77;,c77i74 4 7#b7 ,,ime ,section #ahhf7;d77#e77;,b7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acieww7d77#e77;,b77 is am5d$-- 7,a7 9 clause 7v71 9 ! ?ird s5t5ce1 by /rik+ & 7h77#aj7 & ins]t+ 7h77#aj71 & 7h77#aa72 & 7,b7 by add+ at ! end ! foll[+ new clause3 7xiii7 ,= dis*>ges occurr+ on or aft] ,july #a1 #bjbg1 ins(> z an additional paym5t am\nt "u ?is subp>agraph is attributable to resid5t positions di/ribut$ to a hospital "u subsection 7h77#aa71 ! indirect tea*+ adju/m5t factor %all be comput$ 9 ! same mann] z provid$ "u clause 7ii7 ) respect to su* resid5t positions4 4 7#c7 ,prohibition on judicial review ,section #ahhf7;h77#g77;,e7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acieww7h77#g77;,e77 is am5d$ by ins]t+ p>agraph 7#aa71 aft] p>agraph 7#aj714 #e4 ,rural relocation grant program ,subp>t #b ( "p ,e ( title ,,vii ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #bie et seq47 is am5d$ by add+ at ! end ! foll[+3 #ggh;,a4 ,rural relocation grant program 7a7 ,9 g5]al ,! ,secret>y %all aw>d grants to eligible physicians1 nurses1 & d5ti/s = purposes ( assi/+ su* individuals 9 relocat+ to a rural area 9 :i* ! individual int5ds to practice m$ic9e1 nurs+1 or d5ti/ry1 z applicable4 7b7 ,eligibility ,to be eligible to receive a grant "u ?is section1 a physician1 nurse1 or d5ti/ %all-- 7#a7 be lic5s$ to practice m$ic9e1 nurs+1 or d5ti/ry1 z applicable1 9 ! ,/ate 9 :i* ! rural area to :i* ! individual is relocat+ is locat$2 7#b7 prior to su* relocation1 be practic+ 9 an area t is n a rural area2 7#c7 ^u su* relocation1 h a p]man5t position 9 ! area to :i* ! individual is relocat+ & int5d to practice 9 su* area = n few] ?an #c ye>s2 & 7#d7 submit an application to ! ,secret>y at su* "t1 9 su* mann]1 & conta9+ su* in=mation z ! ,secret>y may require4 7c7 ,grant am\nts2 use ( funds2 repaym5t 7#a7 ,9 g5]al ,a grant aw>d$ "u ?is section %all be 9 an am\nt det]m9$ by ! ,secret>y1 n to exce$ #bj1jjj4 7#b7 ,use ( funds ,an individual receiv+ a grant "u ?is section may use su* grant = eligible life & relocation exp5ses1 z det]m9$ by ! ,secret>y4 7#c7 ,repaym5t ,if an individual receiv+ a grant "u ?is section leaves ! area describ$ 9 subsection 7b77#c7 be=e ! expiration ( ! #c-ye> p]iod describ$ 9 su* subsection1 su* individual %all repay to ! ,secret>y an am\nt equal to #ej p]c5t ( ! am\nt ( ! grant4 7d7 ,au?orization ( appropriations ,to c>ry out ?is section1 !re is au?oriz$ to be appropriat$ #a1hjj1jjj1jjj = ! p]iod ( fiscal ye>s #bjbf ?r\gh #bjce4 4