PUBLIC HEALTH SERVICE
AND RESOURCE AMENDMENTS

BHPr-2001/01
9/21/99

HEALTH RESOURCES AND SERVICES ADMINISTRATION
FISCAL YEAR 2001 DHHS LEGISLATIVE PROPOSAL

National Advisory Council Term of Student Members

Reduce the current student member term from four years to two years.

Current Law: Section 845 of the Public Health Service Act, as amended by Public Law 105-392, establishes membership terms for the National Advisory Council on Nurse Education and Practice (NACNEP). Subsection (b)(2) defines the appointment by the Secretary of the members of the Advisory Council with each member to serve for 4 years. Subsection (b)(1) requires that 2 of the members be selected from full-time students enrolled in schools of nursing.

Proposal: Revise Section 845(b)(2) of the Public Health Service Act by including specific reference to a 2 year length of term for students appointed to the NACNEP.

Rationale: The current amended Public Health Service Act delineates the membership and terms of its members to the NACNEP for a four year term. This is a change from the previous legislation which specifically defined the student term to be one year with a renewal option. The proposal to decrease the term for the student members from four (4) years to two (2) years takes into consideration the length of nursing education in various nursing programs and the trends in enrollment. Under the current legislation, a student may complete course work, graduate and join the work force after having served only one or two years of the four year term, negating their original student status on the Council.

The proposed change would enable a student to serve a 2 year term while completing the education requirements for the program in which he or she is enrolled.

Effect on Beneficiaries: None.

Cost: None.

BHPr-1998/22
12/7/98

HEALTH RESOURCES AND SERVICES ADMINISTRATION
FISCAL YEAR 2001 DHHS LEGISLATIVE PROPOSAL

Collecting Unpaid Loans

Allow a School, Lender, Holder, or the Secretary to Garnish an Individual's Disposable Pay to Collect Amounts Owed Under Student Loan Programs.

Current Law: Section 488A of the Higher Education Act allows a guaranty agency, or the Secretary of Education, in the case of loans made, insured, or guaranteed under Title IV of the Act that are held by the Secretary, to garnish up to 10 percent of the disposable pay of an individual to collect amounts owed by the individual. No comparable authority exists for garnishment of an individual's disposable pay to collect amounts owed under loan programs authorized by Titles VII or VIII of the PHS Act, including the Health Education Assistance Loan (HEAL) program, the Health Professions Student Loan (HPSL) program, the Primary Care Loan (PCL) program, the Loans for Disadvantaged Students (LDS) program, and the Nursing Student Loan (NSL) program.

Proposal: Allow a school, lender, holder, or the Secretary to garnish up to 15 percent of an individual's disposable pay to collect amounts owed under Title VII or VIII student loan programs.

Rationale: In states where institutions have the authority to garnish the pay of state employees or other individuals to collect on defaulted student loans, this device has proved effective as a collection tool.

Use of wage garnishment to collect Federally funded and insured Title VII and VIII health professions and nursing student loans has been hampered by varying state laws governing wage garnishment. For example, four states prohibit wage garnishment. Numerous other states place enough restrictions on garnishment to make the process virtually useless as a collection tool.

Since Title VII and VIII borrowers often live in states other than the state where they attended school, relevant schools, lenders, and holders may be further impeded in the use of wage garnishment by the need to learn the legal intricacies and variations of each state's garnishment laws before employing this means of requiring individuals to repay loans.

Section 488A of the Higher Education Act already enables a guaranty agency or the Secretary of Education to garnish up to 10 percent of the disposable pay of an individual to collect amounts owed for a student loan guaranteed by the Department of Education--although representatives of the lending community have advised that a 15 percent limit would be more cost effective. This level is also consistent with Federal garnishment rates.

The proposed amendment to allow a school, lender, holder, or the Secretary to garnish up to 15 percent of the disposable pay of an individual to collect amounts due under Title VII or VIII student loan programs would eliminate problems associated with differing state laws and assure that collectors of Federal and federally-insured loans have the ability to use garnishment consistently and effectively as a collection tool.

Allowing garnishment of an individual's pay for purposes of loan repayment would expedite repayment of education loans. In the case of the school-based HPSL, PCL, LDS, and NSL loan programs, which operate largely on a revolving fund basis, amounts repaid by previously delinquent borrowers would be available for additional loans to new borrowers.

While the proposed amendment would provide for a uniform garnishment procedure in place of varied State provisions, it is not anticipated that this would have significant implications for the roles, rights, or responsibilities of the states.

Cost: None.

Effective Date: Upon enactment; would apply to new and existing borrowers.

HHS-2000/06
3/22/99

DEPARTMENT OF HEALTH AND HUMAN SERVICES
FISCAL YEAR 2001 DHHS LEGISLATIVE PROPOSAL

Expand Fellowship Authority to Include Research Managers

Expand the Current PHS Fellowship Authority to Permit the Appointment of Scientists to Manage and Oversee Research Investigations and Studies

Current Law: Section 207(g) of the Public Health Service Act states: “In accordance with regulations, individual scientists, other than commissioned officers of the Service, may be designated by the Surgeon General to receive fellowships, appointed for duty without regard to the civil-service laws and compensated without regard to the Classification Act of 1923, as amended, and may be assigned for studies or investigations either in this country or abroad during the terms of their fellowships.”

Proposal: Revise the cited fellowship authority to clarify that HHS scientists appointed under these authorities may engage in the management and oversight of research programs.

Rationale: For over 50 years, Section 207(g), and its predecessor sections, have been a primary means of bringing scientists to HHS to carry out research studies and investigations. They are very flexible authorities, allowing HHS to place scientists, from developing post-doctoral scientists to established researchers, by matching them with assignments that best fit their scientific training and interests and the needs of the Department. This enables HHS to quickly address changes in research priorities and program needs without committing long-term resources. However, the statute does not currently permit scientists to be assigned to the highest positions directly related to the management and oversight of research studies and investigations for which advanced scientific and research training and experience of the individuals are a prerequisite. An HHS priority is the need to recruit and appoint strong, widely known and respected high level scientific leaders to engage in the management and oversight of research investigations and studies for time-limited but renewable terms. Existing authorities, such as the Senior Executive Service, are not flexible enough to permit the Department to recruit some of the leading scientists in the world. Amendment to Sections 207(g) is needed to clarify that scientists appointed under these authorities may engage in research studies and investigations as well as the management and oversight of research studies, investigations and programs. This amendment would permit the appointment of distinguished research leaders to high level positions responsible for the management and oversight of internal and extramural research studies, investigations and programs.

This proposal will have no impact on the roles, rights and responsibilities of states, local governments, or tribal governments.

Cost: The authority if approved would be used sparingly. The Department estimates that the additional cost will not exceed $500,000 per year.

Effective Date: Upon enactment.

Recommended Language: “In accordance with regulations, individual scientists, other than commissioned officers of the Service, may be appointed for duty in the Service by the Secretary without regard to the civil service laws and compensated without regard to the Classification Act of 1923, as amended, may hold their appointments under conditions prescribed therein, and may be assigned for the conduct or oversight and management of internal and extramural studies, investigations, and programs either in this country or abroad during the terms of their appointments.

OMH-2000/01
4/12/99

OFFICE OF MINORITY HEALTH
FISCAL YEAR 2001 DHHS LEGISLATIVE PROPOSAL

Revising Reporting Deadline

Current Law: Title II of Public Law 105-392, the “Health Professions Education Partnerships Act of 1998", amends Title XVII of the Public Health Service (PHS) Act to revise and extend the statutory authority for the Office of Minority Health (OMH). The changes include a new report to Congress describing the minority health activities carried out by OMH during the preceding 2 fiscal years and evaluating the extent to which such activities have been effective in improving the health of racial and ethnic minority groups. The report is also required to include the biennial reports prepared by other PHS agencies summarizing their respective minority health activities. The statute requires that the OMH report be forwarded to the Congress on February 1; the same date the biennial report of PHS agencies are to be forwarded to OMH.

Proposal: Amend Section 1707 (f)(2) of the PHS Act by striking “February 1, 1999" and substituting October 15, 2000. This change will allow OMH sufficient time to review and incorporate the biennial reports of PHS agencies before forwarding a consolidated report to the Congress.

Rationale: Under current law, both Section 201(f)(1) (OMH Report to Congress) and Section 201(f)(2) (PHS agency reports to OMH) have the same deadline – i.e., not later than February 1, 1999 and biennially thereafter. Since the OMH Reports to Congress are to reflect consideration of information provided by the agencies, the deadlines need to be made sequential. For the 1999 Report, OMH requested, via letter of the House and Senate authorizing committees, and was granted, an extension of its statutory deadline to submit the consolidated report. However, this is not an appropriate process for handling future reports.

This request would change the deadline by which PHS agencies must submit their information so that it would precede by 3½ months the deadline for OMH’s Report to Congress for 2001 and subsequent years. This technical amendment would remedy the current anomaly and allow appropriate sequencing for development and incorporation of agency reports into the OMH Report to Congress on Minority Health.

Costs: None

Personnel Requirements: None

Effective Date: Upon enactment

OPA-2000/02
12/14/98

OFFICE OF PUBLIC HEALTH AND SCIENCE
FISCAL YEAR 2001 DHHS LEGISLATIVE PROPOSAL

Adolescent Family Life

Reauthorize Title XX Adolescent Family Life Research and Demonstration Program for Five Years.

Current Law: Title XX of the Public Health Service Act was established in 1981 by P.L. 98-35. Although the authorizing legislation expired in 1985, the program has been operating under authority provided in the annual appropriations process. The AFL program funds three types of activities:

(1) Adolescent pregnancy prevention (abstinence education services) demonstration projects;

(2) Care (health, education, and social services delivery) demonstration projects for pregnant and parenting adolescents; and

(3) Research projects.

Funding for prevention projects is limited to one-third of the total demonstration grant funding available. Both prevention and care projects are required to charge fees for services based on ability to pay.

Proposal: Reauthorize Title XX of the Public Health Service Act for five years

Rationale: Numerous Federal and private programs already exist which provide care services to pregnant and parenting adolescents. There is a great deal of consensus that providing medical, educational and social services results in improved outcomes for both adolescent mothers and their infants -- and evaluations of these programs bear this out. Strategies to prevent adolescent pregnancy, however, are far from agreed upon. There is an urgent need to further implement and evaluate those strategies that have shown the most promise.

There are still gaps in our knowledge about providing care services to pregnant and parenting adolescents. For example, there are unanswered questions about what combinations of services work best for specific population groups, as well as the most effective ways of delivering these services. It is reasonable to continue support for these programs. There are, however, more unanswered questions and more work to be done in the area of prevention. The suggested new language will provide the program with the ability to fund a larger number of prevention projects in a given funding cycle than is now possible.

Authorization Level: Such Sums As Necessary

Effective Date: Upon enactment.

Additional Information

Recent Program History:

In FY 1995, the Department's budget proposed shifting AFL program funds to support a new Office of Adolescent Health, previously authorized by Congress but never funded. However, report language in the 1995 appropriations bill directed the Department to continue funding for AFL. The FY 1997 Omnibus Appropriation provided $6.6 million in increased funding over the previous year for a total of $14.2 million for AFL. It also requires that $9.01 million of these funds be used for new prevention grants utilizing the abstinence education definition contained in section 912 of the P.L. 104-193, Personal Responsibility and Work Opportunity Act of the 1996 (this provision created a new $50 million abstinence-only education program through the Maternal and Child Health Block Grant Program which is to start in FY 1998).

OSG-2000/02
3/25/99

DEPARTMENT OF HEALTH AND HUMAN SERVICES
OFFICE OF THE SURGEON GENERAL
FISCAL YEAR 2001 DHHS LEGISLATIVE PROPOSAL

Prohibition Against Discharge in Bankruptcy

Prohibit a Debt Incurred for Failure to Complete an Active Duty Obligation to be Discharged through Bankruptcy Proceedings.

Current Law: Pursuant to 42 U.S.C. 218a(b), Public Health Service officers incur a substantial monetary penalty if they fail to complete an active duty obligation incurred for participation in PHS-supported training. A number of individuals have sought to discharge their monetary debt through bankruptcy proceedings because the current law does not bar discharge of the debt is this manner.

Proposal: Bar discharge of a training-incurred debt for a period five years after the debt is incurred and then only if the bankruptcy court finds that non-discharge of the obligation would be unconscionable.

Rationale: This proposal mirrors a provision in the National Health Service Corps law [42 U.S.C. 254o(d)(3)(A)] which bars discharge in bankruptcy of debts incurred for failure to complete a service obligation incurred pursuant to participation in the National Health Service Corps scholarship program. The proposal would increase the incentive for officers to complete their obligated service and would make it less difficult for PHS to collect money owed because of unfulfilled service obligations.

Federalism Impact: None

Cost: None

Personnel Requirements: None

Effective Date: Upon enactment

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