42 U.S.C. § 292s — Medical schools and primary health care

**(a) Requirements for students** (1) **In general** — Subject to the provisions of this subsection, in the case of student loan funds established under [section 292q of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section292q&num=0&edition=prelim) by schools of medicine or osteopathic medicine, each agreement entered into under such section with such a school shall provide (in addition to the provisions required in subsection (b) of such section) that the school will make a loan from such fund to a student only if the student agrees— (A) to enter and complete a residency training program in primary health care not later than 4 years after the date on which the student graduates from such school; and (B) to practice in such care for 10 years (including residency training in primary health care) or through the date on which the loan is repaid in full, whichever occurs first. (2) **Inapplicability to certain students** (A) The requirement established in paragraph (1) regarding the student loan fund of a school does not apply to a student if— (i) the first loan to the student from such fund is made before July 1, 1993; or (ii) the loan is made from— (I) a Federal capital contribution under [section 292q of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section292q&num=0&edition=prelim) that is made from amounts appropriated under section 292t(f) 11 See References in Text note below. of this title (in this section referred to as an “exempt Federal capital contribution”); or (II) a school contribution made under [section 292q of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section292q&num=0&edition=prelim) pursuant to such a Federal capital contribution (in this section referred to as an “exempt school contribution”). (B) A Federal capital contribution under [section 292q of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section292q&num=0&edition=prelim) may not be construed as being an exempt Federal capital contribution if the contribution was made from amounts appropriated before October 1, 1990. A school contribution under [section 292q of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section292q&num=0&edition=prelim) may not be construed as being an exempt school contribution if the contribution was made pursuant to a Federal capital contribution under such section that was made from amounts appropriated before such date. (3) **Noncompliance by student** — Each agreement entered into with a student pursuant to paragraph (1) shall provide that, if the student fails to comply with such agreement, the loan involved will begin to accrue interest at a rate of 2 percent per year greater than the rate at which the student would pay if compliant in such year. (4) **Waivers** (A) With respect to the obligation of an individual under an agreement made under paragraph (1) as a student, the Secretary shall provide for the partial or total waiver or suspension of the obligation whenever compliance by the individual is impossible, or would involve extreme hardship to the individual, and if enforcement of the obligation with respect to the individual would be unconscionable. (B) For purposes of subparagraph (A), the obligation of an individual shall be waived if— (i) the status of the individual as a student of the school involved is terminated before graduation from the school, whether voluntarily or involuntarily; and (ii) the individual does not, after such termination, resume attendance at the school or begin attendance at any other school of medicine or osteopathic medicine. (C) If an individual resumes or begins attendance for purposes of subparagraph (B), the obligation of the individual under the agreement under paragraph (1) shall be considered to have been suspended for the period in which the individual was not in attendance. (D) This paragraph may not be construed as authorizing the waiver or suspension of the obligation of a student to repay, in accordance with [section 292r of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section292r&num=0&edition=prelim), loans from student loan funds under [section 292q of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section292q&num=0&edition=prelim). **(b) Requirements for schools** (1) **In general** — Subject to the provisions of this subsection, in the case of student loan funds established under [section 292q of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section292q&num=0&edition=prelim) by schools of medicine or osteopathic medicine, each agreement entered into under such section with such a school shall provide (in addition to the provisions required in subsection (b) of such section) that, for the 1-year period ending on June 30, 1997; 22 So in original. The semicolon probably should be a comma. and for the 1-year period ending on June 30 of each subsequent fiscal year, the school will meet not less than 1 of the conditions described in paragraph (2) with respect to graduates of the school whose date of graduation from the school occurred approximately 4 years before the end of the 1-year period involved. (2) **Description of conditions** — With respect to graduates described in paragraph (1) (in this paragraph referred to as “designated graduates”), the conditions referred to in such paragraph for a school for a 1-year period are as follows: (A) Not less than 50 percent of designated graduates of the school meet the criterion of either being in a residency training program in primary health care, or being engaged in a practice in such care (having completed such a program). (B) Not less than 25 percent of the designated graduates of the school meet such criterion, and such percentage is not less than 5 percentage points above the percentage of such graduates meeting such criterion for the preceding 1-year period. (C) In the case of schools of medicine or osteopathic medicine with student loans funds under [section 292q of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section292q&num=0&edition=prelim), the school involved is at or above the 75th percentile of such schools whose designated graduates meet such criterion. (3) **Determinations by Secretary** — Not later than 90 days after the close of each 1-year period described in paragraph (1), the Secretary shall make a determination of whether the school involved has for such period complied with such paragraph and shall in writing inform the school of the determination. Such determination shall be made only after consideration of the report submitted to the Secretary by the school under paragraph (6). (4) **Noncompliance by school** (A) (i) Subject to subparagraph (C), each agreement under [section 292q of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section292q&num=0&edition=prelim) with a school of medicine or osteopathic medicine shall provide that, if the school fails to comply with paragraph (1) for a 1-year period under such paragraph, the school— (I) will pay to the Secretary the amount applicable under subparagraph (B) for the period; and (II) will pay such amount not later than 90 days after the school is informed under paragraph (3) of the determination of the Secretary regarding such period. (ii) Any amount that a school is required to pay under clause (i) may be paid from the student loan fund of the school under [section 292q of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section292q&num=0&edition=prelim). (B) For purposes of subparagraph (A), the amount applicable for a school, subject to subparagraph (C), is— (i) for the 1-year period ending June 30, 1997, an amount equal to 10 percent of the income received during such period by the student loan fund of the school under [section 292q of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section292q&num=0&edition=prelim); (ii) for the 1-year period ending June 30, 1998, an amount equal to 20 percent of the income received during such period by the student loan fund; and (iii) for any subsequent 1-year period under paragraph (1), an amount equal to 30 percent of the income received during such period by the student loan fund. (C) In determining the amount of income that a student loan fund has received for purposes of subparagraph (B), the Secretary shall exclude any income derived from exempt contributions. Payments made to the Secretary under subparagraph (A) may not be made with such contributions or with income derived from such contributions. (5) **Expenditure of payments** (A) Amounts paid to the Secretary under paragraph (4) shall be expended to make Federal capital contributions to student loan funds under [section 292q of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section292q&num=0&edition=prelim) of schools that are in compliance with paragraph (1). (B) A Federal capital contribution under [section 292q of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section292q&num=0&edition=prelim) may not be construed as being an exempt Federal capital contribution if the contribution is made from payments under subparagraph (A). A school contribution under such section may not be construed as being an exempt school contribution if the contribution is made pursuant to a Federal capital contribution from such payments. (6) **Reports by schools** — Each agreement under [section 292q of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section292q&num=0&edition=prelim) with a school of medicine or osteopathic medicine shall provide that the school will submit to the Secretary a report for each 1-year period under paragraph (1) that provides such information as the Secretary determines to be necessary for carrying out this subsection. Each such report shall include statistics concerning the current training or practice status of all graduates of such school whose date of graduation from the school occurred approximately 4 years before the end of the 1-year period involved. **(c) Definitions** For purposes of this section: (1) The term “exempt contributions” means exempt Federal capital contributions and exempt school contributions. (2) The term “exempt Federal capital contribution” means a Federal capital contribution described in subclause (I) of subsection (a)(2)(A)(ii). (3) The term “exempt school contribution” means a school contribution described in subclause (II) of subsection (a)(2)(A)(ii). (4) The term “income”, with respect to a student fund under [section 292q of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section292q&num=0&edition=prelim), means payments of principal and interest on any loan made from the fund, and any other earnings of the fund. (5) The term “primary health care” means family medicine, general internal medicine, general pediatrics, preventive medicine, or osteopathic general practice. **(d) Sense of Congress** It is the sense of Congress that funds repaid under the loan program under this section should not be transferred to the Treasury of the United States or otherwise used for any other purpose other than to carry out this section.