To amend the Public Health Service Act and title XVIII of the Social Security Act to increase the number of primary care physicians and medical residents serving health professional shortage areas, and for other purposes.

Summary: Amends the Public Health Service Act to require the Secretary of Health and Human Services (HHS) to obligate, for scholarships for individuals who are accepted or enrolled in a course of study or program that leads to a degree in medicine or osteopathic medicine, the greater of : (1) 10% of amounts appropriated for the National Health Service Corps; or (2) the amount necessary to fund such scholarships activities.

Amends title XVIIII (Medicare) of the Social Security Act to require nonrural hospitals operating training programs in rural areas to include rural and emergency medicine rotations and obstetrical and pediatric training in such programs for purposes of payments for direct graduate medical education costs.

SECTION 1. FINDINGS.

    Congress finds the following:
            (1) The average life expectancy in the United States has 
        increased to 80 years of age, causing an ever-increasing demand 
        for medical care.
            (2) Medical school enrollment numbers have been virtually 
        stagnant for the last 25 years.
            (3) During the last 20 years, median tuition and fees at 
        medical schools have increased by 229 percent (122 percent 
        adjusted for inflation) in private schools and by 479 percent 
        (256 percent adjusted for inflation) in public schools.
            (4) The Association of American Medical Colleges, in its 
        Statement on the Physician Workforce, dated June, 2006, called 
        for an increase of 1,500 National Health Service Corps program 
        awards per year to help meet the need for physicians caring for 
        underserved populations and to help address rising medical 
        student indebtedness.
            (5) The National Health Service Corps program has a proven 
        record of supplying physicians to underserved areas, and has 
        played an important role in expanding access for underserved 
        populations in rural and inner city communities.
            (6) Continued expansion of the National Health Service 
        Corps program is strongly recommended.
            (7) The growing debt incurred by graduating medical 
        students is likely to increase the interest and willingness of 
        graduates of United States medical schools to apply for 
        National Health Service Corps program funding and awards.
            (8) One-third (250,000) of active physicians are over the 
        age of 55 and are likely to retire in the next ten years, while 
        the population will have increased by 24 percent. These 
        demographic changes will cause the population-to-physician 
        ratio to peak by the year 2020.
            (9) In 2005, the Council on Graduate Medical Education 
        stated in a report to Congress that there will be a shortage of 
        not fewer than 90,000 full-time physicians by 2020.
            (10) A continuing decline in the number of primary care 
        physicians will lead to increased shortages of health care 
        access in rural America.
            (11) There is a declining ability to recruit qualified 
        medical students from rural and underserved areas, coupled with 
        greater difficulty on the part of community health centers and 
        other clinics to attract adequate personnel.
            (12) Individuals in many geographic areas, especially rural 
        areas, lack adequate access to high quality preventive, primary 
        and specialty health care, contributing to significant health 
        disparities that impair America's public health and economic 
        productivity.
            (13) A collaborative process is needed between hospitals 
        and non-hospital settings to maximize the potential of non-
        hospital health care training.

SEC. 2. SCHOLARSHIPS FOR MEDICAL STUDENTS UNDER NATIONAL HEALTH SERVICE 
              CORPS SCHOLARSHIP PROGRAM.

    Section 338H of the Public Health Service Act (42 U.S.C. 254q) is 
amended by adding at the end the following:
    ``(d) Scholarships for Medical Students.--For contracts for 
scholarships under this subpart to individuals who are accepted for 
enrollment, or enrolled, in a course of study or program described in 
section 338A(b)(1)(B) that leads to a degree in medicine or osteopathic 
medicine, the Secretary shall, of the amounts appropriated under 
subsection (a) for a fiscal year, obligate the greater of 10 percent or 
such amount as necessary to fund ongoing activities related to such 
contracts.''.

SEC. 3. CLARIFICATION OF ELIGIBILITY FOR MEDICARE GRADUATE MEDICAL 
              EDUCATION FUNDING OF A NONRURAL HOSPITAL THAT HAS A 
              TRAINING PROGRAM WITH AN INTEGRATED RURAL TRACK.

    (a) In General.--Section 1886(h)(4)(H) of the Social Security Act 
(42 U.S.C. 1395ww(h)(4)(H)), as amended by section 5506(a) of the 
Patient Protection and Affordable Care Act (Public Law 111-148), is 
amended--
            (1) in clause (iv), by inserting ``(as defined in clause 
        (vii))'' after ``an integrated rural track''; and
            (2) by adding at the end the following new clause:
                            ``(vii) Definition of accredited training 
                        program with an integrated rural track.--For 
                        purposes of clause (iv), the term `accredited 
                        training program with an integrated rural 
                        track' means an accredited medical residency 
                        training program located in an urban area which 
                        offers a curriculum for all residents in the 
                        program that includes the following 
                        characteristics:
                                    ``(I) A minimum of 3 block months 
                                of rural rotations. During such 3 block 
                                months, the resident is in a rural area 
                                for 4 weeks or a month.
                                    ``(II) A stated mission for 
                                training rural physicians.
                                    ``(III) A minimum of 3 months of 
                                obstetrical training, or an equivalent 
                                longitudinal experience.
                                    ``(IV) A minimum of 4 months of 
                                pediatric training that includes 
                                neonatal, ambulatory, inpatient, and 
                                emergency experiences through 
                                rotations, or an equivalent 
                                longitudinal experience.
                                    ``(V) A minimum of 2 months of 
                                emergency medicine rotations, or an 
                                equivalent longitudinal experience.''.
    (b) Effective Date.--The amendments made by subsection (a) apply 
with respect to--
            (1) payments to hospitals under section 1886(h) of the 
        Social Security Act (42 U.S.C. 1395ww(h)) for cost reporting 
        periods beginning on or after January 1, 2011; and
            (2) payments to hospitals under section 1886(d)(5)(B)(v) of 
        such Act (42 U.S.C. 1395ww(d)(5)(B)(v)) for discharges 
        occurring on or after January 1, 2011.