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[Congressional Bills 111th Congress]
[From the U.S. Government Publishing Office]
[H.R. 1946 Introduced in House (IH)]

111th CONGRESS
  1st Session
                                H. R. 1946

  To amend the Public Health Service Act to address health workforce 
                               shortages.

_______________________________________________________________________

                    IN THE HOUSE OF REPRESENTATIVES

                             April 2, 2009

 Mr. Pascrell (for himself, Mr. Moran of Kansas, and Ms. Kilpatrick of 
  Michigan) introduced the following bill; which was referred to the 
                    Committee on Energy and Commerce

_______________________________________________________________________

                                 A BILL

 
  To amend the Public Health Service Act to address health workforce 
                               shortages.

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

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Health Workforce Investment Act of 
2009''.

SEC. 2. FINDINGS; PURPOSES.

    (a) Findings.--The Congress finds as follows:
            (1) The United States is facing shortages in a wide range 
        of health workforce professions, including among specialists 
        and subspecialists.
            (2) By 2020, the United States will face shortages of as 
        many as 1,000,000 nurses, 55,000 physicians, 140,000 family 
        physicians, 157,000 pharmacists, and 2,500,000 allied health 
        professionals.
            (3) The long-term care workforce is plagued by rising 
        vacancy and turnover rates.
            (4) These shortages will be exacerbated by the growth in 
        the number and proportion of older adults in America.
            (5) Data on health workforce supply and demand are limited.
            (6) Many health workforce professions are inappropriately 
        distributed, with some areas experiencing chronic shortages of 
        a wide range of health professionals.
            (7) The diversity of the health workforce continually fails 
        to mirror the diversity of the United States population.
            (8) A 2008 report entitled ``Out of Order, Out of Time'' 
        from the Association of Academic Health Centers found that 
        Federal health workforce policy and infrastructure has been 
        dysfunctional, decentralized, and piecemeal with little 
        integration and harmonization.
            (9) Nearly every State has initiated action to address 
        health workforce shortages without comprehensive planning and 
        leadership from the Federal Government to address the full 
        spectrum of health workforce professions and issues.
            (10) Over the last 5 years, Federal investment in health 
        workforce programs has fallen by more than 20 percent.
    (b) Purposes.--The purposes of this Act are to--
            (1) ensure access to health services for all individuals, 
        particularly those with low incomes or limited access to health 
        services, through an adequate health workforce;
            (2) comprehensively and regularly gather data, provide 
        projections, and conduct research on the supply, demand, 
        distribution, diversity, and development of the health 
        workforce, including information on specific specialties and 
        subspecialties;
            (3) coordinate the current patchwork of health workforce 
        programs through a comprehensive Federal framework;
            (4) improve the supply, distribution, diversity, and 
        development of the health workforce, including specialties and 
        subspecialties, through the creation of comprehensive national 
        and related State-specific health workforce goals and 
        objectives related to current and emerging issues related to 
        the overall health workforce; and
            (5) provide States with national leadership, 
        accountability, and flexibility to address specific health 
        workforce needs.

SEC. 3. NATIONAL HEALTH WORKFORCE ADVISORY COUNCIL.

    Section 762 of the Public Health Service Act (42 U.S.C. 294o) is 
amended to read as follows:

``SEC. 762. NATIONAL HEALTH WORKFORCE ADVISORY COUNCIL.

    ``(a) Establishment.--There is established the National Health 
Workforce Advisory Council.
    ``(b) Duties.--The Council shall--
            ``(1) make recommendations to the Secretary of Health and 
        Human Services, the Secretary of Labor, the Secretary of 
        Education, the Secretary of Veterans Affairs, the Committee on 
        Health, Education, Labor, and Pensions of the Senate, the 
        Committee on Finance of the Senate, the Committee on Energy and 
        Commerce of the House of Representatives, and the Committee on 
        Ways and Means of the House of Representatives with respect 
        to--
                    ``(A) the supply and distribution of the health 
                workforce in the United States;
                    ``(B) current and future shortages or excesses of 
                health workforce professionals, including specialists 
                and subspecialists;
                    ``(C) issues relating to foreign medical school 
                graduates and graduates of foreign schools of nursing;
                    ``(D) appropriate Federal policies with respect to 
                the matters specified in subparagraphs (A), (B), and 
                (C), including--
                            ``(i) policies concerning changes in the 
                        financing of undergraduate and graduate medical 
                        education programs; and
                            ``(ii) changes in the types of medical 
                        education training in career, technical, and 
                        postsecondary education, including graduate 
                        medical education programs;
                    ``(E) appropriate efforts to be carried out by 
                hospitals and career, technical, and postsecondary 
                education programs, including schools of medicine, 
                schools of osteopathic medicine, schools of public 
                health, schools of allied health, and accrediting 
                bodies, with respect to the matters specified in 
                subparagraphs (A), (B), and (C), including efforts for 
                changes in undergraduate and graduate medical education 
                programs;
                    ``(F) deficiencies in, and needs for improvements 
                in, existing databases concerning the supply and 
                distribution of, and career, technical, and 
                postsecondary education training programs for, health 
                workforce professionals in the United States and steps 
                that should be taken to eliminate those deficiencies;
                    ``(G) factors in the health care environment which 
                may impact decisions of practitioners in selecting 
                certain specialty areas, including malpractice 
                insurance costs, on-call time, and income levels;
                    ``(H) incentives to encourage primary care practice 
                in underserved areas; and
                    ``(I) appropriate levels or percentages of funds 
                under section 781 (relating to health workforce 
                investment grants) for specific professions based on 
                evolving health workforce needs, including whether the 
                percentage of funds reserved for nursing programs under 
                section 781(c)(2) remains appropriate; and
            ``(2) encourage entities providing graduate medical 
        education to conduct activities to voluntarily achieve the 
        recommendations of the Council under paragraph (1)(E).
    ``(c) Composition.--The Council shall be composed of--
            ``(1) the Assistant Secretary for Health (or the Assistant 
        Secretary's designee);
            ``(2) the Administrator of the Centers for Medicare & 
        Medicaid Services;
            ``(3) the official designated by the Secretary to 
        administer section 781 (relating to health workforce investment 
        grants);
            ``(4) the Chief Medical Director of the Department of 
        Veterans Affairs;
            ``(5) 15 members appointed by the Secretary to include 
        representatives of practicing health and public health 
        workforce professionals, national and specialty health 
        profession organizations, foreign medical graduates, and health 
        workforce student associations;
            ``(6) 10 members appointed by the Secretary to include 
        representatives of schools of medicine and osteopathic 
        medicine, schools of nursing, allied health schools, other 
        health workforce training programs, and public and private 
        teaching hospitals;
            ``(7) 4 members appointed by the Secretary to include 
        representatives of health insurers, business, and labor;
            ``(8) the Assistant Secretary for the Employment and 
        Training Administration of the Department of Labor (or the 
        Assistant Secretary's designee); and
            ``(9) the Secretary of Education (or the Secretary's 
        designee).
    ``(d) Terms of Appointed Members.--
            ``(1) In general; staggered rotation.--Members of the 
        Council appointed under paragraphs (5), (6), and (7) of 
        subsection (b) shall be appointed for a term of 4 years, except 
        that the term of office of the members first appointed shall 
        expire, as designated by the Secretary at the time of 
        appointment, as follows: 8 at the end of 1 year, 7 at the end 
        of 2 years, 7 at the end of 3 years, and 7 at the end of 4 
        years.
            ``(2) Date certain for appointment.--The Secretary shall 
        appoint the first members to the Council under paragraphs (5), 
        (6), and (7) of subsection (b) within 60 days after the date of 
        the enactment of the Health Workforce Investment Act of 2009.
    ``(e) Chair.--The Council shall elect one of its members as 
Chairman of the Council.
    ``(f) Cooperation.--The Council shall carry out this section in 
cooperation with the Council on Graduate Medical Education established 
by section 762, the National Advisory Council on the National Health 
Service Corps established by section 337, the Advisory Committee on 
Training in Primary Care Medicine and Dentistry established pursuant to 
section 748, the Advisory Committee on Interdisciplinary, Community-
Based Linkages established pursuant to section 756, and the National 
Advisory Council on Nurse Education and Practice established pursuant 
to section 845.
    ``(g) Quorum.--Eighteen members of the Council shall constitute a 
quorum, but a lesser number may hold hearings.
    ``(h) Vacancies.--Any vacancy in the Council shall not affect its 
power to function.
    ``(i) Compensation.--Each member of the Council who is not 
otherwise employed by the United States Government shall receive 
compensation at a rate equal to the daily rate prescribed for GS-18 
under the General Schedule under section 5332 of title 5, United States 
Code, for each day, including traveltime, such member is engaged in the 
actual performance of duties as a member of the Council. A member of 
the Council who is an officer or employee of the United States 
Government shall serve without additional compensation. All members of 
the Council shall be reimbursed for travel, subsistence, and other 
necessary expenses incurred by them in the performance of their duties.
    ``(j) Certain Authorities and Duties.--
            ``(1) Authorities.--In order to carry out the provisions of 
        this section--
                    ``(A) the Council is authorized to collect such 
                information, hold such hearings, and sit and act at 
                such times and places, either as a whole or by 
                subcommittee, and request the attendance and testimony 
                of such witnesses and the production of such books, 
                records, correspondence, memoranda, papers, and 
                documents as the Council or such subcommittee may 
                consider available; and
                    ``(B) the Council is authorized to request the 
                cooperation and assistance of Federal departments, 
                agencies, and instrumentalities, and such departments, 
                agencies, and instrumentalities are authorized to 
                provide such cooperation and assistance.
            ``(2) Coordination of activities.--The Council shall 
        coordinate its activities with the activities of the Secretary 
        under section 792. The Secretary shall, in cooperation with the 
        Council and pursuant to the recommendations of the Council, 
        take such steps as are practicable to eliminate deficiencies in 
        the data base established under section 792 and shall make 
        available in reports such comprehensive data sets as are 
        developed pursuant to this section.
    ``(k) Reports.--Not later than 2 years after the date of the 
enactment of the Health Workforce Investment Act of 2009, and annually 
thereafter, the Council shall submit a report to each official and 
committee listed in the matter preceding subparagraph (A) in subsection 
(b)(1) containing--
            ``(1) a description of the Council's actions during the 
        period for which the report is made; and
            ``(2) each of the recommendations required by subsection 
        (b).
    ``(l) Definitions.--In this section:
            ``(1) The term `Council' means the National Health 
        Workforce Advisory Council established by subsection (a).
            ``(2) The term `health workforce' has the meaning given to 
        such term in section 781.
            ``(3) The term `Secretary' means the Secretary of Health 
        and Human Services unless otherwise specified.
    ``(m) Authorization of Appropriations.--To carry out this section, 
there are authorized to be appropriated such sums as may be necessary 
for each of fiscal years 2009 through 2013.''.

SEC. 4. NATIONAL CENTER FOR HEALTH WORKFORCE INFORMATION AND ANALYSIS.

    Section 792 of the Public Health Service Act (42 U.S.C. 295k) is 
amended to read as follows:

``SEC. 792. NATIONAL CENTER FOR HEALTH WORKFORCE INFORMATION AND 
              ANALYSIS.

    ``(a) Establishment.--There is established in the Department of 
Health and Human Services the National Center for Health Workforce 
Information and Analysis (in this section referred to as the `Center'), 
which shall be under the direction of a director who shall conduct and 
support statistical and epidemiological activities for the purpose of 
assessing and improving the supply, distribution, diversity, and 
development of the health workforce in the United States.
    ``(b) Certain Authorities and Requirements.--In carrying out 
subsection (a), the Secretary, acting through the Director of the 
Center, shall--
            ``(1) regularly collect statistics on--
                    ``(A) the supply and projected demand, along with 
                projected shortages and surpluses, of the health 
                workforce by health profession, specialty, and 
                geographic location;
                    ``(B) the diversity of the health workforce by 
                health profession, specialty, and geographic location; 
                and
                    ``(C) the supply and projected demand, along with 
                projected shortages and surpluses, of the health 
                workforce serving minority groups by health profession, 
                specialty, and geographic location;
            ``(2) establish a uniform health workforce data reporting 
        system, which may include a system of unique identifiers for 
        various provider groups;
            ``(3) undertake and support (by grant or contract) 
        research, demonstrations, and evaluations respecting new or 
        improved methods for obtaining current data on the matters 
        referred to in paragraph (1);
            ``(4) undertake and support (by grant or contract) 
        research, demonstrations, and evaluations on the matters 
        referred to in paragraph (1); and
            ``(5) coordinate efforts with the National Center for 
        Health Statistics and the Bureau of Labor Statistics.
    ``(c) Grants and Contracts.--The Secretary may make grants and 
enter into contracts with States (or an appropriate nonprofit private 
entity in any State) for carrying out the activities referred to in 
paragraphs (1) through (3). The Secretary shall determine the amount 
and scope of any such grant or contract. To be eligible for any such 
grant or contract, a State or entity shall submit an application in 
such form and manner and containing such information as the Secretary 
may require. Such application shall include reasonable assurances, 
satisfactory to the Secretary, that--
            ``(1) such State or entity will establish a program of 
        mandatory annual registration of the health workforce personnel 
        who reside or practice in such State and of health institutions 
        licensed by such State, which registration shall include such 
        information as the Secretary may determine to be appropriate;
            ``(2) such State or entity will collect and report to the 
        Secretary such information in such form and manner as the 
        Secretary may prescribe; and
            ``(3) such State or entity will comply with the 
        requirements of subsection (e).
    ``(d) Report to Congress.--The Secretary shall submit to the 
Congress not later than October 1, 2010, and biennially thereafter, a 
comprehensive report regarding the status of the health workforce 
according to profession, including a report regarding the analytic and 
descriptive studies conducted under this section.
    ``(e) Requirements Regarding Personal Data.--
            ``(1) In general.--The Secretary and each program entity 
        shall in securing and maintaining any record of individually 
        identifiable personal data (hereinafter in this subsection 
        referred to as `personal data') for purposes of this section--
                    ``(A) inform any individual who is asked to supply 
                personal data whether he is legally required, or may 
                refuse, to supply such data and inform him of any 
                specific consequences, known to the Secretary or 
                program entity, as the case may be, of providing or not 
                providing such data;
                    ``(B) upon request, inform any individual if he is 
                the subject of personal data secured or maintained by 
                the Secretary or program entity, as the case may be, 
                and make the data available to him in a form 
                comprehensible to him;
                    ``(C) assure that no use is made of personal data 
                which use is not within the purposes of this section 
                unless an informed consent has been obtained from the 
                individual who is the subject of such data; and
                    ``(D) upon request, inform any individual of the 
                use being made of personal data respecting such 
                individual and of the identity of the individuals and 
                entities which will use the data and their relationship 
                to the programs under this section.
            ``(2) Consent as precondition to disclosure.--Any entity 
        which maintains a record of personal data and which receives a 
        request from the Secretary or a program entity for such data 
        for purposes of this section shall not transfer any such data 
        to the Secretary or to a program entity unless the individual 
        whose personal data is to be so transferred gives an informed 
        consent for such transfer.
            ``(3) Disclosure by secretary.--
                    ``(A) Notwithstanding any other provision of law, 
                personal data collected by the Secretary or any program 
                entity under this section may not be made available or 
                disclosed by the Secretary or any program entity to any 
                person other than the individual who is the subject of 
                such data unless (i) such person requires such data for 
                purposes of this section, or (ii) in response to a 
                demand for such data made by means of compulsory legal 
                process. Any individual who is the subject of personal 
                data made available or disclosed under clause (ii) 
                shall be notified of the demand for such data.
                    ``(B) Subject to all applicable laws regarding 
                confidentiality, only the data collected by the 
                Secretary under this section which is not personal data 
                shall be made available to bona fide researchers and 
                policy analysts (including the Congress) for the 
                purposes of assisting in the conduct of studies 
                respecting health professions personnel.
            ``(4) Definition.--For purposes of this subsection, the 
        term `program entity' means any public or private entity which 
        collects, compiles, or analyzes health professions data under a 
        grant, contract, or other arrangement with the Secretary under 
        this section.
    ``(f) Technical Assistance.--The Secretary shall provide technical 
assistance to the States and political subdivisions thereof in the 
development of systems (including model laws) concerning 
confidentiality and comparability of data collected pursuant to this 
section.
    ``(g) Data on Health Workforce Personnel.--In carrying out 
subsection (b), the Secretary may make grants, or enter into contracts 
and cooperative agreements with, and provide technical assistance to, a 
nonprofit entity in order to establish a uniform health workforce data 
reporting system to collect, compile, and analyze data on health 
workforce personnel.
    ``(h) Definition.--In this section, the term `health workforce' has 
the meaning given to such term in section 781.
    ``(i) Authorization of Appropriations.--To carry out this section, 
there are authorized to be appropriated such sums as may be necessary 
for each of fiscal years 2009 through 2013.''.

SEC. 5. HEALTH WORKFORCE INVESTMENT GRANTS.

    Title VII of the Public Health Service Act (42 U.S.C. 292 et seq.) 
is amended--
            (1) by redesignating part F as part G; and
            (2) by inserting after section 770 the following:

              ``PART F--HEALTH WORKFORCE INVESTMENT GRANTS

``SEC. 781. HEALTH WORKFORCE INVESTMENT GRANTS.

    ``(a) Formula Grants to States.--
            ``(1) In general.--For the purposes described in paragraph 
        (2), the Secretary shall make an allotment each fiscal year for 
        each State in an amount determined in accordance with 
        subsection (d). The Secretary shall make a grant to the State 
        of the allotment made for the State for the fiscal year if the 
        State submits to the Secretary an application in accordance 
        with subsection (b).
            ``(2) Purposes of grants.--A funding agreement for a grant 
        under paragraph (1) is that the State involved will expend the 
        grant for the purposes of--
                    ``(A) ensuring access to health services for all 
                individuals, particularly those with low incomes or 
                limited access to health services, through an adequate 
                health workforce;
                    ``(B) improving the supply, distribution, 
                diversity, and development of the health workforce, 
                taking into consideration the supply, distribution, and 
                diversity of health workforce profession specialties 
                and subspecialties;
                    ``(C) creating State-specific health workforce 
                goals and objectives consistent with health status 
                goals and national health workforce objectives 
                developed under subsection (h); and
                    ``(D) during the first 12-month period funded 
                through the grant, establishing or designating a State 
                health workforce planning entity to establish statewide 
                processes for State health workforce planning, State 
                health workforce data collection, policy 
                recommendations, and State resource allocations.
            ``(3) Purposes of national program.--The Secretary shall 
        carry out this section in a manner designed--
                    ``(A) to identify innovations in approaches to 
                improving the supply, distribution, diversity, and 
                development of the health workforce, taking into 
                consideration specialties and subspecialties;
                    ``(B) to develop national goals and objectives for 
                improving the supply, distribution, diversity, and 
                development of the health workforce, including 
                specialties and subspecialties; and
                    ``(C) to develop and expand programs designed to 
                ensure access to health workforce professionals for an 
                aging population.
    ``(b) Application for Grant.--For purposes of subsection (a)(1), an 
application for a grant is in accordance with this subsection if each 
of the following is met:
            ``(1) Use of funds.--The application includes each funding 
        agreement required by this section, including an assurance that 
        all funds received through the grant will be used for the 
        purposes described in subsection (a)(2).
            ``(2) Statewide needs assessment.--The application includes 
        a statewide needs assessment that--
                    ``(A) will be updated not less than every 5 years; 
                and
                    ``(B) identifies--
                            ``(i) long-term State-specific health 
                        workforce goals and objectives consistent with 
                        health status goals and national health 
                        workforce objectives developed under subsection 
                        (h); and
                            ``(ii) projected needs related to the 
                        supply, distribution, diversity, and 
                        development of the State health workforce.
            ``(3) Annual plans.--The application includes a plan to 
        meet the goals and objectives, and address the needs, 
        identified under the statewide needs assessment described in 
        paragraph (2), and such plan--
                    ``(A) will be updated on an annual basis; and
                    ``(B) includes strategies related to--
                            ``(i) collaboration between--
                                    ``(I) State departments of labor, 
                                health, education, higher education, 
                                veterans affairs, environment, and 
                                professional licensure; and
                                    ``(II) State health workforce 
                                investment boards;
                            ``(ii) State data collection;
                            ``(iii) State Medicaid and Medicare 
                        policies; and
                            ``(iv) State health professions licensure 
                        and regulation.
            ``(4) Description of funding use.--The application includes 
        a description of how funds received through the grant will be 
        used--
                    ``(A) in accordance with subparagraphs (A) and (B) 
                of subsection (a)(2), to ensure access to health 
                services for all individuals and to improve the supply, 
                distribution, diversity, and development of the health 
                workforce, such as through programs related to--
                            ``(i) health workforce training and 
                        education capacity;
                            ``(ii) the health care safety net 
                        workforce, including health centers under 
                        section 330;
                            ``(iii) provider cultural competency;
                            ``(iv) health workforce diversity;
                            ``(v) health workforce pipeline 
                        development;
                            ``(vi) health workforce retention;
                            ``(vii) health workforce faculty 
                        recruitment;
                            ``(viii) health workforce faculty 
                        retention;
                            ``(ix) health workforce career ladders;
                            ``(x) public awareness; and
                            ``(xi) health workforce scholarship and 
                        loan repayment programs;
                    ``(B) to create State-specific health workforce 
                goals and objectives in accordance with subsection 
                (a)(2)(C) and to develop annual plans in accordance 
                with paragraph (3) of this subsection to meet such 
                goals and objectives; and
                    ``(C) during the first 12-month period funded 
                through the grant, to establish or designate in 
                accordance with subsection (a)(2)(D) a State health 
                workforce planning entity to establish statewide 
                processes for State health workforce planning, State 
                health workforce data collection, policy 
                recommendations, and State resource allocations.
            ``(5) Development of application.--The application--
                    ``(A) is developed by or in consultation with the 
                State agency that will be responsible for administering 
                the program; and
                    ``(B) is made publicly available during its 
                development or after its submission to the Secretary in 
                order to facilitate public comment.
    ``(c) Additional Grant Requirements.--
            ``(1) Restrictions on use of grants.--A funding agreement 
        for a grant under subsection (a)(1) is that the State involved 
        will not use the grant--
                    ``(A) to provide health services (other than health 
                services provided as part of a health training 
                program);
                    ``(B) to make payments to for-profit schools; or
                    ``(C) to provide matching funds to satisfy a 
                condition for the receipt of other Federal funds.
            ``(2) Nursing programs.--A funding agreement for a grant 
        under subsection (a)(1) is that the State involved will expend 
        at least 25 percent of the funds received through the grant for 
        programs related to nursing (including registered nurses and 
        licensed practical nurses) and advanced practice nursing 
        (including nurse practitioners, certified registered nurse 
        anesthetists, certified nurse midwives, clinical nurse 
        specialists, doctorates of nursing practice, and clinical nurse 
        leaders).
            ``(3) Administration and evaluation.--A funding agreement 
        for a grant under subsection (a)(1) is that the State involved 
        will expend not more than 10 percent of the funds received 
        through the grant on administration and evaluation.
            ``(4) State agency.--A funding agreement for a grant under 
        subsection (a)(1) is that the State involved will designate a 
        lead State agency to administer the grant, including by--
                    ``(A) coordinating State activities under the grant 
                with State administration of Medicaid and Medicare, 
                including policies related to reimbursement and 
                graduate medical education payments; and
                    ``(B) coordinating State activities under the grant 
                with related activities of other Federal grantees 
                within the State, including State workforce boards, 
                community health center grantees, and recipients of 
                grants from the Substance and Mental Health Services 
                Administration and the Health Resources and Services 
                Administration.
            ``(5) Annual reports.--
                    ``(A) In general.--A funding agreement for a grant 
                under subsection (a)(1) is that the State involved will 
                submit annual reports to the Secretary--
                            ``(i) detailing activities carried out 
                        through the grant in a standardized manner that 
                        enables the Secretary to evaluate the 
                        activities and compare performance relative to 
                        other States; and
                            ``(ii) describing the extent to which the 
                        State has met its long-term State-specific 
                        health workforce goals and objectives 
                        identified pursuant to subsection (b)(2)(B)(i).
                    ``(B) Contents.--Each report under subparagraph (A) 
                must include--
                            ``(i) information on the status of the 
                        State's health workforce by profession, 
                        specialty, and geographic location, including 
                        such information on--
                                    ``(I) the supply of the State's 
                                health workforce, including with 
                                respect to primary care providers, 
                                nurses, long-term care workers, 
                                dentists, and allied health 
                                professionals; and
                                    ``(II) the diversity of the State's 
                                health workforce;
                            ``(ii) a description of each program funded 
                        through this section during the previous fiscal 
                        year; and
                            ``(iii) a description of efforts to 
                        coordinate the State departments responsible 
                        for administering Medicaid and Medicare funds, 
                        education and labor programs, the health care 
                        safety net, veterans programs, environmental 
                        programs, and medical licensing.
            ``(6) Audits.--A funding agreement for a grant under 
        subsection (a)(1) is that the State involved will provide for 
        audits of expenditures of grant funds.
    ``(d) Determination of Amount of Allotment.--
            ``(1) In general.--The Secretary shall determine the amount 
        of the allotment to each State under this section for a fiscal 
        year based on a formula.
            ``(2) Development of formula.--The formula referred to in 
        paragraph (1) shall be determined by the Secretary by 
        regulation, taking into consideration the following criteria:
                    ``(A) Existing shortages and deficiencies in health 
                workforce distribution.
                    ``(B) Rural, urban, and frontier areas.
                    ``(C) Community health centers.
                    ``(D) The number of medical, nursing, and allied 
                health professions schools in each State.
    ``(e) Federal Program Administration.--
            ``(1) Delegation within hhs.--The Secretary shall designate 
        an identifiable administrative unit of the Department of Health 
        and Human Services with expertise in health workforce issues to 
        be responsible for administering the program under this 
        section, including the following:
                    ``(A) Coordinating activities under this section 
                with related activities of the Department of Health and 
                Human Services, the Department of Defense, the 
                Department of Education, the Department of Labor, the 
                Department of Veterans Affairs, and any other relevant 
                Federal departments or agencies.
                    ``(B) Disseminating health workforce information 
                and best practices to States.
                    ``(C) Providing technical assistance to grant 
                recipients under this section.
                    ``(D) Submitting reports to Congress under 
                paragraph (2).
            ``(2) Annual reports.--The Secretary shall submit annual 
        reports to the Congress on the following:
                    ``(A) The amount of each allotment and grant to a 
                State under this section.
                    ``(B) Significant State projects funded through 
                this section and their performance.
                    ``(C) Significant innovations funded through this 
                section and their outcomes.
                    ``(D) Highlights with respect to the status of the 
                Nation's health workforce, including--
                            ``(i) significant changes in supply by 
                        profession, specialty, and geographic location, 
                        including with respect to primary care 
                        providers, nurses, long-term care workers, 
                        dentists, and allied health professionals; and
                            ``(ii) significant changes in diversity by 
                        profession, specialty, and geographic location.
            ``(3) Additional authorities.--In carrying out this 
        section, the Secretary may--
                    ``(A) allow States receiving grants to work 
                together in regional authorities;
                    ``(B) impose matching fund requirements as a 
                condition on receipt of a grant; and
                    ``(C) allow States to use grant funds for planning 
                and infrastructure development.
    ``(f) Rule of Construction.--Subject to the purposes described in 
subsection (a)(2), nothing in this section shall be construed to 
prohibit a State from making funds received under this section 
available to other entities, including entities receiving funds under 
other provisions of this title or title VIII.
    ``(g) Federal Research and Projects.--
            ``(1) In general.--The Secretary may make grants to, or 
        enter into contracts or jointly financed cooperative agreements 
        with, public or nonprofit institutions of higher education and 
        public or nonprofit private agencies and organizations engaged 
        in research to identify best practices and innovative 
        approaches to improving the supply, distribution, diversity, 
        and development of the health workforce, taking into 
        consideration the supply, distribution, diversity, and 
        development of health workforce profession specialties and 
        subspecialties.
            ``(2) Technical assistance.--The Secretary shall 
        incorporate the best practices and innovative approaches 
        identified under paragraph (1) into any technical assistance 
        provided to grant recipients under this section.
            ``(3) Coordination.--The Secretary shall carry out this 
        subsection in coordination with the activities of the National 
        Center for Health Workforce Information and Analysis, including 
        any research, demonstrations, and evaluations under section 
        792(b)(4).
    ``(h) National Health Workforce Objectives.--The Secretary, based 
on information and analysis of the National Center for Health Workforce 
Information and Analysis and the findings and recommendations of the 
National Health Workforce Advisory Council, shall develop national 
health workforce objectives to be used for purposes of subsections 
(a)(2)(C) and (b)(2)(B)(i).
    ``(i) Definitions.--In this section:
            ``(1) The term `diversity' includes racial, ethnic, 
        language ability, and gender diversity.
            ``(2) The term `health workforce' includes physicians, 
        nurses (including registered nurses and licensed practical 
        nurses), advance practice nurses (including nurse 
        practitioners, certified registered nurse anesthetists, 
        certified nurse midwives, clinical nurse specialists, 
        doctorates of nursing practice, and clinical nurse leaders), 
        dentists, physician assistants, chiropractors, podiatrists, 
        optometrists and opticians, pharmacists, mental health 
        providers (including psychologists and clinical social 
        workers), allied health professionals (including physical 
        therapists, occupational therapists, speech-language 
        pathologists, audiologists, respiratory therapists, 
        technicians, technologists, emergency medical technicians, 
        paramedics, medical and clinical laboratory technologists and 
        technicians, medical records and health information 
        technicians, nuclear medicine technologists, radiologic 
        technologists, dieticians, and nutritionists), auxiliary health 
        professionals (including home health aides, certified nursing 
        assistants, nursing aides, orderlies, and attendants), public 
        health workforce professionals, and any other providers 
        determined by the Secretary for purposes of this section to be 
        part of the health workforce.
            ``(3) The term `National Center for Health Workforce 
        Information and Analysis' means the National Center for Health 
        Workforce Information and Analysis established under section 
        792.
            ``(4) The term `National Health Workforce Advisory Council' 
        means the National Health Workforce Advisory Council 
        established under section 762.
    ``(j) Funding.--
            ``(1) Authorization of appropriations.--To carry out this 
        section, there are authorized to be appropriated such sums as 
        may be necessary for each of fiscal years 2009 through 2013.
            ``(2) Reservation.--Of the amount of funds appropriated to 
        carry out this section for a fiscal year, the Secretary shall 
        reserve 5 percent of such amount to carry out subsection 
        (g).''.
                                 <all>
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