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

Page 1006 TITLE 42—THE PUBLIC HEALTH AND WELFARE § 292s 1 See References in Text note below. nate the period within which suit may be filed, a judgment may be enforced, or an offset, gar- nishment, or other action may be initiated or taken by a school that has an agreement with the Secretary pursuant to section 292q of this title that is seeking the repayment of the amount due from a borrower on a loan made under this subpart after the default of the bor- rower on such loan. (July 1, 1944, ch. 373, title VII, § 722, as added Pub. L. 102–408, title I, § 102, Oct. 13, 1992, 106 Stat. 2012; amended Pub. L. 103–43, title XX, § 2014(b), June 10, 1993, 107 Stat. 215; Pub. L. 105–392, title I, § 134(a), (b)(1), Nov. 13, 1998, 112 Stat. 3577, 3578; Pub. L. 117–103, div. R, § 104(2), Mar. 15, 2022, 136 Stat. 821.) Editorial Notes REFERENCES IN TEXT The Peace Corps Act, referred to in subsec. (c)(1)(B), is Pub. L. 87–293, Sept. 22, 1961, 75 Stat. 612, which is classified principally to chapter 34 (§ 2501 et seq.) of Title 22, Foreign Relations and Intercourse. For com- plete classification of this Act to the Code, see Short Title note set out under section 2501 of Title 22 and Ta- bles. PRIOR PROVISIONS A prior section 722 of act July 1, 1944, was classified to section 293b of this title prior to the general revision of this subchapter by Pub. L. 102–408. AMENDMENTS 2022—Subsec. (b). Pub. L. 117–103 substituted ‘‘to a student who is in need’’ for ‘‘to a student— ‘‘(1) who is in need’’ and struck out par. (2) which read as follows: ‘‘who, if required under section 3802 of title 50 to present himself for and submit to registration under such section, has presented himself and submitted to registration under such section.’’ 1998—Subsec. (a)(1). Pub. L. 105–392, § 134(a)(1), sub- stituted ‘‘the cost of attendance (including tuition, other reasonable educational expenses, and reasonable living costs) for that year at the educational institu- tion attended by the student (as determined by such educational institution).’’ for ‘‘the sum of— ‘‘(A) the cost of tuition for such year at such school, and ‘‘(B) $2,500.’’ Subsec. (a)(2). Pub. L. 105–392, § 134(a)(2), substituted ‘‘the amount of the loan may, in the case of the third or fourth year of a student at a school of medicine or osteopathic medicine, be increased to the extent nec- essary’’ for ‘‘the amount $2,500 may, in the case of the third or fourth year of a student at school of medicine or osteopathic medicine, be increased to the extent necessary (including such $2,500)’’. Subsec. (c). Pub. L. 105–392, § 134(a)(3), in heading, sub- stituted ‘‘repayment’’ for ‘‘ten-year’’ and, in introduc- tory provisions, substituted ‘‘period of not less than 10 years nor more than 25 years, at the discretion of the institution, which begins’’ for ‘‘ten-year period which begins’’ and ‘‘such period’’ for ‘‘such ten-year period’’. Subsec. (j). Pub. L. 105–392, § 134(a)(4), substituted ‘‘$40’’ for ‘‘$15’’. Subsec. (m). Pub. L. 105–392, § 134(b)(1), added subsec. (m). 1993—Subsec. (a). Pub. L. 103–43, § 2014(b)(1), amended heading and text of subsec. (a) generally. Prior to amendment, text read as follows: ‘‘Loans from a stu- dent loan fund (established under an agreement with a school under section 292q of this title) may not exceed for any student for each school year (or its equivalent) the sum of— ‘‘(1) the cost of tuition for such year at such school, and ‘‘(2) $2,500.’’ Subsec. (b)(2), (3). Pub. L. 103–43, § 2014(b)(2), redesig- nated par. (3) as (2) and struck out former par. (2), which read as follows: ‘‘who, if pursuing a full-time course of study at the school leading to a degree of doc- tor of medicine or doctor of osteopathy, is of excep- tional financial need (as defined by regulations of the Secretary); and’’. Statutory Notes and Related Subsidiaries EFFECTIVE DATE OF 1998 AMENDMENT Pub. L. 105–392, title I, § 134(b)(2), Nov. 13, 1998, 112 Stat. 3578, provided that: ‘‘The amendment made by paragraph (1) [amending this section] shall be effective with respect to actions pending on or after the date of enactment of this Act [Nov. 13, 1998].’’ § 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 by schools of medicine or osteopathic medicine, each agree- ment 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 para- graph (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 that is made from amounts appropriated under section 292t(f) 1 of this title (in this section re- ferred to as an ‘‘exempt Federal capital contribution’’); or (II) a school contribution made under section 292q of this title pursuant to such a Federal capital contribution (in this sec- tion referred to as an ‘‘exempt school con- tribution’’). (B) A Federal capital contribution under sec- tion 292q of this title 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 may not be construed as being an exempt school contribution if the contribution was Page 1007 TITLE 42—THE PUBLIC HEALTH AND WELFARE § 292s 2 So in original. The semicolon probably should be a comma. made pursuant to a Federal capital contribu- tion 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 agree- ment, 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 indi- vidual under an agreement made under para- graph (1) as a student, the Secretary shall pro- vide for the partial or total waiver or suspen- sion of the obligation whenever compliance by the individual is impossible, or would involve extreme hardship to the individual, and if en- forcement of the obligation with respect to the individual would be unconscionable. (B) For purposes of subparagraph (A), the ob- ligation 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 volun- tarily or involuntarily; and (ii) the individual does not, after such ter- mination, resume attendance at the school or begin attendance at any other school of medicine or osteopathic medicine. (C) If an individual resumes or begins at- tendance for purposes of subparagraph (B), the obligation of the individual under the agree- ment 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 ob- ligation of a student to repay, in accordance with section 292r of this title, loans from stu- dent loan funds under section 292q of this title. (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 by schools of medicine or osteopathic medicine, each agree- ment 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; 2 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 condi- tions described in paragraph (2) with respect to graduates of the school whose date of grad- uation from the school occurred approxi- mately 4 years before the end of the 1-year pe- riod involved. (2) Description of conditions With respect to graduates described in para- graph (1) (in this paragraph referred to as ‘‘designated graduates’’), the conditions re- ferred 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 des- ignated graduates of the school meet such criterion, and such percentage is not less than 5 percentage points above the percent- age of such graduates meeting such criterion for the preceding 1-year period. (C) In the case of schools of medicine or os- teopathic medicine with student loans funds under section 292q of this title, the school in- volved 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 pe- riod complied with such paragraph and shall in writing inform the school of the determina- tion. 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 with a school of medicine or osteopathic medicine shall provide that, if the school fails to com- ply 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 para- graph (3) of the determination of the Sec- retary regarding such period. (ii) Any amount that a school is required to pay under clause (i) may be paid from the stu- dent loan fund of the school under section 292q of this title. (B) For purposes of subparagraph (A), the amount applicable for a school, subject to sub- paragraph (C), is— (i) for the 1-year period ending June 30, 1997, an amount equal to 10 percent of the in- come received during such period by the stu- dent loan fund of the school under section 292q of this title; (ii) for the 1-year period ending June 30, 1998, an amount equal to 20 percent of the in- come received during such period by the stu- dent 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 pur- poses of subparagraph (B), the Secretary shall exclude any income derived from exempt con- tributions. Payments made to the Secretary under subparagraph (A) may not be made with Page 1008 TITLE 42—THE PUBLIC HEALTH AND WELFARE § 292s 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 Fed- eral capital contributions to student loan funds under section 292q of this title of schools that are in compliance with paragraph (1). (B) A Federal capital contribution under sec- tion 292q of this title 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 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 sub- section. Each such report shall include statis- tics concerning the current training or prac- tice status of all graduates of such school whose date of graduation from the school oc- curred 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 ex- empt school contributions. (2) The term ‘‘exempt Federal capital con- tribution’’ means a Federal capital contribu- tion described in subclause (I) of subsection (a)(2)(A)(ii). (3) The term ‘‘exempt school contribution’’ means a school contribution described in sub- clause (II) of subsection (a)(2)(A)(ii). (4) The term ‘‘income’’, with respect to a student fund under section 292q of this title, 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 os- teopathic 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. (July 1, 1944, ch. 373, title VII, § 723, as added Pub. L. 102–408, title I, § 102, Oct. 13, 1992, 106 Stat. 2015; amended Pub. L. 103–43, title XX, § 2014(c), June 10, 1993, 107 Stat. 216; Pub. L. 105–392, title I, § 131, Nov. 13, 1998, 112 Stat. 3574; Pub. L. 111–148, title V, § 5201(a), Mar. 23, 2010, 124 Stat. 606.) Editorial Notes REFERENCES IN TEXT Section 292t(f) of this title, referred to in subsec. (a)(2)(A)(ii)(I), contained provisions in par. (1) relating to appropriation of funds for Federal capital contribu- tions to student loan funds, prior to repeal by Pub. L. 105–392, title I, § 132(b), Nov. 13, 1998, 112 Stat. 3575, eff. Oct. 1, 2002. PRIOR PROVISIONS A prior section 723 of act July 1, 1944, was classified to section 293c of this title prior to the general revision of this subchapter by Pub. L. 102–408. AMENDMENTS 2010—Subsec. (a)(1)(B). Pub. L. 111–148, § 5201(a)(1)(A), added subpar. (B) and struck out former subpar. (B) which read as follows: ‘‘to practice in such care through the date on which the loan is repaid in full.’’ Subsec. (a)(3). Pub. L. 111–148, § 5201(a)(1)(B), added par. (3) and struck out former par. (3). Prior to amend- ment, text read as follows: ‘‘Each agreement entered into with a student pursuant to paragraph (1) shall pro- vide that, if the student fails to comply with such agreement, the loan involved will begin to accrue inter- est at a rate of 18 percent per year beginning on the date of such noncompliance.’’ Subsec. (d). Pub. L. 111–148, § 5201(a)(2), added subsec. (d). 1998—Subsec. (a)(3). Pub. L. 105–392, § 131(b), reenacted heading without change and amended text of par. (3) generally. Prior to amendment, text read as follows: ‘‘Each agreement entered into with a student pursuant to paragraph (1) shall provide that, if the student fails to comply with the agreement— ‘‘(A) the balance due on the loan involved will be immediately recomputed from the date of issuance at an interest rate of 12 percent per year, compounded annually; and ‘‘(B) the recomputed balance will be paid not later than the expiration of the 3-year period beginning on the date on which the student fails to comply with the agreement.’’ Subsec. (b)(1). Pub. L. 105–392, § 131(a), substituted ‘‘4 years before’’ for ‘‘3 years before’’. Subsecs. (c), (d). Pub. L. 105–392, § 131(c), redesignated subsec. (d) as (c) and struck out heading and text of subsec. (c). Text read as follows: ‘‘The Secretary shall each fiscal year submit to the Committee on Energy and Commerce of the House of Representatives, and the Committee on Labor and Human Resources of the Sen- ate, a report regarding the administration of this sec- tion, including the extent of compliance with the re- quirements of this section, during the preceding fiscal year.’’ 1993—Subsec. (a)(4). Pub. L. 103–43, § 2014(c)(1), added par. (4). Subsec. (b)(1). Pub. L. 103–43, § 2014(c)(2)(A), sub- stituted ‘‘1997;’’ for ‘‘1994,’’ and ‘‘3 years before’’ for ‘‘4 years before’’. Subsec. (b)(2)(B). Pub. L. 103–43, § 2014(c)(2)(B), sub- stituted ‘‘25 percent’’ for ‘‘15 percent’’. Subsec. (b)(4)(B). Pub. L. 103–43, § 2014(c)(2)(C), sub- stituted ‘‘1997’’ for ‘‘1994’’ in cl. (i) and ‘‘1998’’ for ‘‘1995’’ in cl. (ii). Statutory Notes and Related Subsidiaries STUDENT LOAN GUIDELINES Pub. L. 111–148, title V, § 5201(b), Mar. 23, 2010, 124 Stat. 607, provided that: ‘‘The Secretary of Health and Human Services shall not require parental financial in- formation for an independent student to determine fi- nancial need under section 723 of the Public Health Service Act (42 U.S.C. 292s) and the determination of need for such information shall be at the discretion of applicable school loan officer. The Secretary shall amend guidelines issued by the Health Resources and Page 1009 TITLE 42—THE PUBLIC HEALTH AND WELFARE § 292t Services Administration in accordance with the pre- ceding sentence.’’ § 292t. Individuals from disadvantaged back- grounds (a) Fund agreements regarding certain amounts With respect to amounts appropriated under subsection (f), each agreement entered into under section 292q of this title with a school shall provide (in addition to the provisions re- quired in subsection (b) of such section) that— (1) any Federal capital contribution made to the student loan fund of the school from such amounts, together with the school contribu- tion appropriate under subsection (b)(2)(B) of such section to the amount of the Federal cap- ital contribution, will be utilized only for the purpose of— (A) making loans to individuals from dis- advantaged backgrounds; and (B) the costs of the collection of the loans and interest on the loans; and (2) collections of principal and interest on loans made pursuant to paragraph (1), and any other earnings of the student loan fund attrib- utable to amounts that are in the fund pursu- ant to such paragraph, will be utilized only for the purpose described in such paragraph. (b) Minimum qualifications for schools The Secretary may not make a Federal capital contribution for purposes of subsection (a) for a fiscal year unless the health professions school involved— (1) is carrying out a program for recruiting and retaining students from disadvantaged backgrounds, including racial and ethnic mi- norities; and (2) is carrying out a program for recruiting and retaining minority faculty. (c) Certain agreements regarding education of students; date certain for compliance The Secretary may not make a Federal capital contribution for purposes of subsection (a) for a fiscal year unless the health professions school involved agrees— (1) to ensure that adequate instruction re- garding minority health issues is provided for in the curricula of the school; (2) with respect to health clinics providing services to a significant number of individuals who are from disadvantaged backgrounds, in- cluding members of minority groups, to enter into arrangements with 1 or more such clinics for the purpose of providing students of the school with experience in providing clinical services to such individuals; (3) with respect to public or nonprofit pri- vate secondary educational institutions and undergraduate institutions of higher edu- cation, to enter into arrangements with 1 or more such institutions for the purpose of car- rying out programs regarding the educational preparation of disadvantaged students, includ- ing minority students, to enter the health pro- fessions and regarding the recruitment of such individuals into the health professions; (4) to establish a mentor program for assist- ing disadvantaged students, including minor- ity students, regarding the completion of the educational requirements for degrees from the school; (5) to be carrying out each of the activities specified in any of paragraphs (1) through (4) by not later than 1 year after the date on which the first Federal capital contribution is made to the school for purposes of subsection (a); and (6) to continue carrying out such activities, and the activities specified in paragraphs (1) and (2) of subsection (b), throughout the period during which the student loan fund established pursuant to section 292q(b) of this title is in operation. (d) Availability of other amounts With respect to Federal capital contributions to student loan funds under agreements under section 292q(b) of this title, any such contribu- tions made before October 1, 1990, together with the school contributions appropriate under para- graph (2)(B) of such section to the amount of the Federal capital contributions, may be utilized for the purpose of making loans to individuals from disadvantaged backgrounds, subject to sec- tion 292s(a)(2)(B) of this title. (e) ‘‘Disadvantaged’’ defined For purposes of this section, the term ‘‘dis- advantaged’’, with respect to an individual, shall be defined by the Secretary. (f) Authorization of appropriations (1) Repealed. Pub. L. 105–392, title I, § 132(b), Nov. 13, 1998, 112 Stat. 3575 (2) Special consideration for certain schools In making Federal capital contributions to student loan funds for purposes of subsection (a), the Secretary shall give special consider- ation to health professions schools that have enrollments of underrepresented minorities above the national average for health profes- sions schools. (July 1, 1944, ch. 373, title VII, § 724, as added Pub. L. 102–408, title I, § 102, Oct. 13, 1992, 106 Stat. 2018; amended Pub. L. 105–392, title I, § 132, Nov. 13, 1998, 112 Stat. 3575.) Editorial Notes PRIOR PROVISIONS A prior section 724 of act July 1, 1944, was classified to section 293d of this title prior to the general revision of this subchapter by Pub. L. 102–408. AMENDMENTS 1998—Subsec. (f)(1). Pub. L. 105–392, § 132(b), struck out heading and text of par. (1). Text read as follows: ‘‘With respect to making Federal capital contributions to stu- dent loan funds for purposes of subsection (a) of this section, there is authorized to be appropriated for such contributions $8,000,000 for each of the fiscal years 1998 through 2002.’’ Pub. L. 105–392, § 132(a), substituted ‘‘$8,000,000 for each of the fiscal years 1998 through 2002’’ for ‘‘$15,000,000 for fiscal year 1993’’. Statutory Notes and Related Subsidiaries EFFECTIVE DATE OF 1998 AMENDMENT Pub. L. 105–392, title I, § 132(b), Nov. 13, 1998, 112 Stat. 3575, provided that the repeal of subsec. (f)(1) of this section is effective Oct. 1, 2002.