I 

110TH CONGRESS 

1ST SESSION H. R. 2584 

To amend the Public Health Service Act to alleviate critical shortages of 

physicians in the fields of family practice, internal medicine, pediatrics, 

emergency medicine, general surgery, and obstetrics-gynecology, and for 

other purposes. 

IN THE HOUSE OF REPRESENTATIVES 

JUNE 6, 2007 

Mr. BURGESS (for himself and Mr. CUELLAR) introduced the following bill; 

which was referred to the Committee on Energy and Commerce, and in 

addition to the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such 

provisions as fall within the jurisdiction of the committee concerned 

A BILL 

To amend the Public Health Service Act to alleviate critical 

shortages of physicians in the fields of family practice, 

internal medicine, pediatrics, emergency medicine, general surgery, and obstetrics-gynecology, and for other 

purposes. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘High-Need Physician 

5 Workforce Incentives Act of 2007’’. 


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1 SEC. 2. HIGH-NEED PHYSICIAN SPECIALTY WORKFORCE IN2 CENTIVES. 

3 Page E of title VII of the Public Health Service Act 

4 (42 U.S.C. 294n et seq.) is amended by adding at the end 

5 the following: 

6 ‘‘Subpart 3—High-Need Physician Specialty 

7 Workforce Incentives 

8 ‘‘SEC. 775. SCHOLARSHIP PROGRAM. 

9 ‘‘(a) PURPOSE.—The purpose of this section is to al10 leviate critical shortages of physicians in the fields of fam11 ily practice, internal medicine, pediatrics, emergency medi12 cine, general surgery, and obstetrics-gynecology. 

13 ‘‘(b) GRANTS.—The Secretary, acting through the 

14 Administrator of the Health Resources and Services Ad15 ministration, shall make grants to critical shortage health 

16 facilities to carry out a scholarship program described in 

17 this section. 

18 ‘‘(c) SCHOLARSHIPS.—A health facility receiving a 

19 grant under this section shall use the grant to enter into 

20 contracts with eligible individuals under which— 

21 ‘‘(1) the facility agrees to provide the individual 

22 with a scholarship for each school year (not to ex23 ceed 4 school years) in which the individual is en24 rolled as a full-time student in a school of medicine 

25 or a school of osteopathic medicine; and 

26 ‘‘(2) the individual agrees— 


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1 ‘‘(A) to maintain an acceptable level of 

2 academic standing; 

3 ‘‘(B) to complete a residency in the field of 

4 family practice, internal medicine, pediatrics, 

5 emergency medicine, general surgery, or obstet6 rics-gynecology; and 

7 ‘‘(C) after completing the residency, to 

8 serve as a physician at such facility in such 

9 field for a time period equal to the greater of— 

10 ‘‘(i) one year for each school year for 

11 which the individual was provided a schol12 arship under this section; or 

13 ‘‘(ii) two years. 

14 ‘‘(d) AMOUNT OF SCHOLARSHIP.— 

15 ‘‘(1) IN GENERAL.—The amount paid by a 

16 health facility to an individual through a scholarship 

17 under this section shall not exceed $30,000 for any 

18 school year. 

19 ‘‘(2) CONSIDERATIONS.—In determining the 

20 amount of a scholarship to be provided to an indi21 vidual under this section, a health facility may take 

22 into consideration the individual’s financial need, ge23 ographic differences, and educational costs. 

24 ‘‘(3) EXCLUSION FROM GROSS INCOME.—For 

25 purposes of the Internal Revenue Code of 1986, 


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1 gross income shall not include any amount received 

2 as a scholarship under this section. 

3 ‘‘(e) APPLICATION OF CERTAIN PROVISIONS.—The 

4 provisions of subpart III of part D of title III shall, except 

5 as inconsistent with this section, apply to the program es6 tablished under this section in the same manner and to 

7 the same extent as such provisions apply to the National 

8 Health Service Corps Scholarship Program established in 

9 such subpart. 

10 ‘‘(f) DEFINITIONS.—In this subsection: 

11 ‘‘(1) The term ‘critical shortage health facility’ 

12 means a public or private nonprofit health facility 

13 that does not serve a health professional shortage 

14 area (as such term is defined in section 332), but 

15 has a critical shortage of physicians (as determined 

16 by the Secretary) in the field of family practice, in17 ternal medicine, pediatrics, emergency medicine, 

18 general surgery, or obstetrics-gynecology. 

19 ‘‘(2) The term ‘eligible individual’ means an in20 dividual who is enrolled or accepted for enrollment 

21 as a full-time student in an accredited school of 

22 medicine or school of osteopathic medicine. 

23 ‘‘(g) AUTHORIZATION OF APPROPRIATIONS.—To 

24 carry out this section, there is authorized to be approVerDate Aug 31 2005 21:34 Jun 08, 2007 Jkt 059200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\H2584.IH H2584

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1 priated $5,000,000 for each of fiscal years 2008 through 

2 2012. 

3 ‘‘SEC. 776. LOAN REPAYMENT PROGRAM. 

4 ‘‘(a) PURPOSE.—The purpose of this section is to al5 leviate critical shortages of physicians in the fields of fam6 ily practice, internal medicine, pediatrics, emergency medi7 cine, general surgery, and obstetrics-gynecology. 

8 ‘‘(b) LOANS.—The Secretary, acting through the Ad9 ministrator of the Health Resources and Services Admin10 istration, shall establish a program of entering into con11 tracts with eligible individuals under which— 

12 ‘‘(1) the individual agrees to serve— 

13 ‘‘(A) as a physician in the field of family 

14 practice, internal medicine, pediatrics, emer15 gency medicine, general surgery, or obstetrics16 gynecology; and 

17 ‘‘(B) in an area that is not a health profes18 sional shortage area (as such term is defined in 

19 section 332), but has a critical shortage of phy20 sicians (as determined by the Secretary) in such 

21 field; and 

22 ‘‘(2) the Secretary agrees to pay, for each year 

23 of such service, not more than $35,000 of the prin24 cipal and interest of the undergraduate or graduate 

25 educational loans of the individual. 


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1 ‘‘(c) SERVICE REQUIREMENT.—A contract entered 

2 into under this section shall allow the individual receiving 

3 the loan repayment to satisfy the service requirement de4 scribed in subsection (b)(1) through employment in a solo 

5 or group practice, a clinic, a public or private nonprofit 

6 hospital, or any other appropriate health care entity. 

7 ‘‘(d) APPLICATION OF CERTAIN PROVISIONS.—The 

8 provisions of subpart III of part D of title III shall, except 

9 as inconsistent with this section, apply to the program es10 tablished in this section to the same extent and in the 

11 same manner as such provisions apply to the National 

12 Health Service Corps Loan Repayment Program estab13 lished in such subpart. 

14 ‘‘(e) DEFINITION.—In this section, the term ‘eligible 

15 individual’ means an individual with a degree in medicine 

16 or osteopathic medicine. 

17 ‘‘(f) AUTHORIZATION OF APPROPRIATIONS.—To 

18 carry out this section, there is authorized to be appro19 priated $5,000,000 for each of fiscal years 2008 through 

20 2012. 

21 ‘‘SEC. 777. PRIMARY CARE PHYSICIAN RETENTION AND 

22 MEDICAL HOME ENHANCEMENT GRANTS. 

23 ‘‘(a) GRANTS.—The Secretary, acting through the 

24 Administrator of the Health Resources and Services Ad25 ministration, shall make grants to States to provide care 


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1 management fees to physicians in medically underserved 

2 communities to support the provision of targeted, acces3 sible, continuous, coordinated, and patient-centered care 

4 through a qualified medical home. 

5 ‘‘(b) QUALIFIED MEDICAL HOMES.— 

6 ‘‘(1) IN GENERAL.—In this section, the term 

7 ‘qualified medical home’ means a physician-directed 

8 practice that is certified as a qualified medical home 

9 in accordance with this subsection. 

10 ‘‘(2) ACTIONS BY SECRETARY.—Not later than 

11 90 days after the date of the enactment of this sub12 part, the Secretary shall— 

13 ‘‘(A) designate one or more objective exter14 nal private-sector entities to certify physician15 directed practices as qualified medical homes; 

16 and 

17 ‘‘(B) issue requirements for such certifi18 cation. 

19 ‘‘(3) REQUIREMENTS.—The requirements re20 ferred to in paragraph (2)(B) shall set forth a cer21 tification process whereby— 

22 ‘‘(A) a physician-directed practice, in con23 sultation with the State where the practice is 

24 located, submits an application on a voluntary 


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1 basis to an entity designated by the Secretary 

2 under paragraph (2)(A); and 

3 ‘‘(B) the entity certifies the practice as a 

4 qualified medical home if the practice dem5 onstrates that the practice has capabilities to 

6 achieve improvements in the management and 

7 coordination of care of patients described in 

8 paragraph (4) by incorporating attributes of the 

9 care management model described in paragraph 

10 (5). 

11 ‘‘(4) ELIGIBLE PATIENTS.—The patients re12 ferred to in paragraph (3)(B)— 

13 ‘‘(A) are patients determined by the State 

14 involved under criteria developed by the Sec15 retary to be underserved, special needs, or high 

16 risk patients; and 

17 ‘‘(B) shall include individuals who— 

18 ‘‘(i) are eligible for medical assistance 

19 under title XIX of the Social Security Act; 

20 ‘‘(ii) are eligible for child health as21 sistance under title XXI of the Social Se22 curity Act; or 

23 ‘‘(iii) otherwise lack health insurance. 

24 ‘‘(5) CARE MANAGEMENT MODEL.—The care 

25 management model referred to in paragraph (3)(B) 


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1 is a model that uses health information technology 

2 and other physician-practice innovations to improve 

3 the management and coordination of patient care. 

4 Such a model includes the following conditions: 

5 ‘‘(A) Physicians advocate for their patients 

6 to support the attainment of optimal, patient7 centered outcomes that are defined by a care 

8 planning process driven by a partnership be9 tween physicians, patients, and the patient’s 

10 family. 

11 ‘‘(B) Evidence-based medicine and clinical 

12 decision-support tools guide decision making. 

13 ‘‘(C) Physicians in the practice accept ac14 countability for continuous quality improvement 

15 through voluntary engagement in performance 

16 measurement and improvement. 

17 ‘‘(D) Patients actively participate in deci18 sionmaking; patients take personal responsi19 bility for their own health through diet and life20 style changes; and feedback is sought to ensure 

21 that patients’ expectations are being met. 

22 ‘‘(E) Information technology is utilized ap23 propriately to support optimal patient care, per24 formance measurement, patient education, and 

25 enhanced communication. 


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1 ‘‘(F) Patients and families participate in 

2 quality improvement activities at the practice 

3 level. 

4 ‘‘(c) AMOUNT OF CARE MANAGEMENT FEE.— 

5 ‘‘(1) IN GENERAL.—As a condition on the re6 ceipt of a grant under this section, a State shall 

7 agree to determine the amount of each care manage8 ment fee provided through the grant in accordance 

9 with the guidance issued by the Secretary under 

10 paragraph (2). 

11 ‘‘(2) GUIDANCE.—Not later than 90 days after 

12 the date of the enactment of this Act, the Secretary 

13 shall issue guidance for determining the amount of 

14 a care management fee to be provided through a 

15 grant under this section. Such guidance shall take 

16 into account the costs of implementation, additional 

17 time by participating physicians, and training associ18 ated with compliance with this section. Such guid19 ance shall include— 

20 ‘‘(A) recognition of the value of physician 

21 and clinical staff work associated with patient 

22 care that falls outside the face-to-face visit, 

23 such as the time and effort spent on educating 

24 family caregivers and arranging appropriate folVerDate Aug 31 2005 21:34 Jun 08, 2007 Jkt 059200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6201 E:\BILLS\H2584.IH H2584

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1 low-up services with other health care profes2 sionals, such as nurse educators; 

3 ‘‘(B) recognition of expenses that the 

4 qualified medical home will incur to acquire and 

5 utilize health information technology, such as 

6 clinical decision support tools, patient registries, 

7 and electronic medical records; 

8 ‘‘(C) additional performance-based reim9 bursement payments based on reporting on evi10 dence-based quality, cost of care, and patient 

11 experience measures; 

12 ‘‘(D) reimbursement for separately identifi13 able e-mail and telephonic consultations, either 

14 as separately-billable services or as part of a 

15 global management fee; 

16 ‘‘(E) recognition of the specific cir17 cumstances and expenses associated with physi18 cian practices of fewer that 5 full-time employ19 ees in implementing the attributes of a qualified 

20 medical home and care management model de21 scribed in subsection (b); and 

22 ‘‘(F) recognition and sharing of savings 

23 that may result from a qualified medical home. 

24 ‘‘(d) APPLICATION.—A State seeking a grant under 

25 this section shall submit an application to the Secretary 


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1 at such time, in such manner, and containing such infor2 mation as the Secretary may require. Each such applica3 tion shall describe the methodologies to be used by the 

4 State to determine the amount of care managements fees 

5 to be provided through the grant. 

6 ‘‘(e) AUTHORIZATION OF APPROPRIATIONS.—To 

7 carry out this section, there is authorized to be appro8 priated $10,000,000 for each of fiscal years 2008 through 

9 2012. 

10 ‘‘SEC. 778. COMPREHENSIVE GERIATRIC TRAINING GRANTS. 

11 ‘‘(a) GRANTS.—The Secretary, acting through the 

12 Administrator of the Health Resources and Services Ad13 ministration, shall make grants to board-certified entities 

14 to establish or expand geriatric fellowship programs de15 scribed in subsection (b). 

16 ‘‘(b) GERIATRIC FELLOWSHIP PROGRAMS.—A geri17 atric fellowship program funded through a grant under 

18 this section shall provide 1-year fellowships to train physi19 cians practicing in rural areas or in the field of family 

20 practice, internal medicine, emergency medicine, general 

21 surgery, or obstetrics-gynecology, at any time during their 

22 careers, in geriatric medicine. 

23 ‘‘(c) AMOUNT.—As a condition on the receipt of a 

24 grant under this section, an entity shall agree to expend 

25 not more than $50,000 of the grant per fellow. 


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1 ‘‘(d) PREFERENCE.—In awarding grants under this 

2 section, the Secretary shall give preference to entities 

3 seeking to establish or expand a fellowship program in a 

4 rural area, a suburban area, or a medically underserved 

5 community. 

6 ‘‘(e) AUTHORIZATION OF APPROPRIATIONS.—To 

7 carry out this section, there is authorized to be appro8 priated $1,000,000 for each of fiscal years 2008 through 

9 2012. 

10 ‘‘SEC. 779. REPORTS TO CONGRESS. 

11 ‘‘Not later than 1 year after the date of the enact12 ment of the High-Need Physician Workforce Incentives 

13 Act of 2007, and annually thereafter, the Secretary shall 

14 submit a report to the Congress— 

15 ‘‘(1) identifying the number of grants and loans 

16 made under this section during the preceding 12- 

17 month period; and 

18 ‘‘(2) describing the results achieved through 

19 such grants and loans, including the extent to which 

20 such grants and loans met the needs of the physi21 cian workforce in rural areas and in the fields of 

22 family practice, internal medicine, pediatrics, emer23 gency medicine, general surgery, and obstetrics-gyn24 ecology.’’. 


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1 SEC. 3. EXEMPTION FROM GROSS INCOME FOR CERTAIN 

2 COMPENSATION PAID TO PHYSICIANS BY 

3 LOCAL GOVERNMENTS FOR SERVICE IN 

4 MEDICALLY UNDERSERVED AREAS. 

5 (a) IN GENERAL.—Part III of subchapter B of chap6 ter 1 of the Internal Revenue Code of 1986 (relating to 

7 items specifically excluded from gross income) is amended 

8 by adding at the end the following new section: 

9 ‘‘SEC. 139B. CERTAIN COMPENSATION PAID TO PHYSICIANS 

10 BY LOCAL GOVERNMENTS FOR SERVICE IN 

11 MEDICALLY UNDERSERVED AREAS. 

12 ‘‘(a) IN GENERAL.—Gross income does not include 

13 compensation received by a physician (as defined in sec14 tion 1861(r) of the Social Security Act) from a local gov15 ernment (as defined in section 1393(a)(5)) for qualified 

16 medical service. 

17 ‘‘(b) QUALIFIED MEDICAL SERVICE.—For purposes 

18 of this section, the term ‘qualified medical service’ means 

19 medical care described in section 213(d)(1)(A) which is 

20 performed— 

21 ‘‘(1) in a medically underserved community (as 

22 defined in section 799B(6) of the Public Health 

23 Service Act), and 

24 ‘‘(2) under a contract with the local government 

25 referred to in subsection (a) for the performance of 

26 such services for a period of not less than 4 years. 


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1 ‘‘(c) NO EXEMPTION FROM EMPLOYMENT TAXES.— 

2 Compensation shall not fail to be taken into account as 

3 wages under any provision of subtitle C solely because 

4 such compensation is excluded from gross income under 

5 this section.’’. 

6 (b) CLERICAL AMENDMENT.—The table of sections 

7 for part III of subchapter B of chapter 1 of such Code 

8 is amended by inserting after the item relating to section 

9 139A the following new item: 

‘‘Sec. 139B. Certain compensation paid to physicians by local governments for 

service in medically underserved areas.’’. 

10 (c) EFFECTIVE DATE.—The amendments made by 

11 this section shall apply to taxable years beginning after 

12 the date of the enactment of this Act. 

Æ 


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