I 

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. 

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 ‘‘Health Workforce In5 vestment Act of 2009’’. 

6 SEC. 2. FINDINGS; PURPOSES. 

7 (a) FINDINGS.—The Congress finds as follows: 

8 (1) The United States is facing shortages in a 

9 wide range of health workforce professions, including 

10 among specialists and subspecialists. 


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1 (2) By 2020, the United States will face short2 ages of as many as 1,000,000 nurses, 55,000 physi3 cians, 140,000 family physicians, 157,000 phar4 macists, and 2,500,000 allied health professionals. 

5 (3) The long-term care workforce is plagued by 

6 rising vacancy and turnover rates. 

7 (4) These shortages will be exacerbated by the 

8 growth in the number and proportion of older adults 

9 in America. 

10 (5) Data on health workforce supply and de11 mand are limited. 

12 (6) Many health workforce professions are inap13 propriately distributed, with some areas experiencing 

14 chronic shortages of a wide range of health profes15 sionals. 

16 (7) The diversity of the health workforce con17 tinually fails to mirror the diversity of the United 

18 States population. 

19 (8) A 2008 report entitled ‘‘Out of Order, Out 

20 of Time’’ from the Association of Academic Health 

21 Centers found that Federal health workforce policy 

22 and infrastructure has been dysfunctional, decentral23 ized, and piecemeal with little integration and har24 monization. 


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1 (9) Nearly every State has initiated action to 

2 address health workforce shortages without com3 prehensive planning and leadership from the Federal 

4 Government to address the full spectrum of health 

5 workforce professions and issues. 

6 (10) Over the last 5 years, Federal investment 

7 in health workforce programs has fallen by more 

8 than 20 percent. 

9 (b) PURPOSES.—The purposes of this Act are to— 

10 (1) ensure access to health services for all indi11 viduals, particularly those with low incomes or lim12 ited access to health services, through an adequate 

13 health workforce; 

14 (2) comprehensively and regularly gather data, 

15 provide projections, and conduct research on the 

16 supply, demand, distribution, diversity, and develop17 ment of the health workforce, including information 

18 on specific specialties and subspecialties; 

19 (3) coordinate the current patchwork of health 

20 workforce programs through a comprehensive Fed21 eral framework; 

22 (4) improve the supply, distribution, diversity, 

23 and development of the health workforce, including 

24 specialties and subspecialties, through the creation 

25 of comprehensive national and related State-specific 


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1 health workforce goals and objectives related to cur2 rent and emerging issues related to the overall 

3 health workforce; and 

4 (5) provide States with national leadership, ac5 countability, and flexibility to address specific health 

6 workforce needs. 

7 SEC. 3. NATIONAL HEALTH WORKFORCE ADVISORY COUN8 CIL. 

9 Section 762 of the Public Health Service Act (42 

10 U.S.C. 294o) is amended to read as follows: 

11 ‘‘SEC. 762. NATIONAL HEALTH WORKFORCE ADVISORY 

12 COUNCIL. 

13 ‘‘(a) ESTABLISHMENT.—There is established the Na14 tional Health Workforce Advisory Council. 

15 ‘‘(b) DUTIES.—The Council shall— 

16 ‘‘(1) make recommendations to the Secretary of 

17 Health and Human Services, the Secretary of Labor, 

18 the Secretary of Education, the Secretary of Vet19 erans Affairs, the Committee on Health, Education, 

20 Labor, and Pensions of the Senate, the Committee 

21 on Finance of the Senate, the Committee on Energy 

22 and Commerce of the House of Representatives, and 

23 the Committee on Ways and Means of the House of 

24 Representatives with respect to— 


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1 ‘‘(A) the supply and distribution of the 

2 health workforce in the United States; 

3 ‘‘(B) current and future shortages or ex4 cesses of health workforce professionals, includ5 ing specialists and subspecialists; 

6 ‘‘(C) issues relating to foreign medical 

7 school graduates and graduates of foreign 

8 schools of nursing; 

9 ‘‘(D) appropriate Federal policies with re10 spect to the matters specified in subparagraphs 

11 (A), (B), and (C), including— 

12 ‘‘(i) policies concerning changes in the 

13 financing of undergraduate and graduate 

14 medical education programs; and 

15 ‘‘(ii) changes in the types of medical 

16 education training in career, technical, and 

17 postsecondary education, including grad18 uate medical education programs; 

19 ‘‘(E) appropriate efforts to be carried out 

20 by hospitals and career, technical, and postsec21 ondary education programs, including schools of 

22 medicine, schools of osteopathic medicine, 

23 schools of public health, schools of allied health, 

24 and accrediting bodies, with respect to the mat25 ters specified in subparagraphs (A), (B), and 


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1 (C), including efforts for changes in under2 graduate and graduate medical education pro3 grams; 

4 ‘‘(F) deficiencies in, and needs for im5 provements in, existing databases concerning 

6 the supply and distribution of, and career, tech7 nical, and postsecondary education training pro8 grams for, health workforce professionals in the 

9 United States and steps that should be taken to 

10 eliminate those deficiencies; 

11 ‘‘(G) factors in the health care environ12 ment which may impact decisions of practi13 tioners in selecting certain specialty areas, in14 cluding malpractice insurance costs, on-call 

15 time, and income levels; 

16 ‘‘(H) incentives to encourage primary care 

17 practice in underserved areas; and 

18 ‘‘(I) appropriate levels or percentages of 

19 funds under section 781 (relating to health 

20 workforce investment grants) for specific pro21 fessions based on evolving health workforce 

22 needs, including whether the percentage of 

23 funds reserved for nursing programs under sec24 tion 781(c)(2) remains appropriate; and 


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1 ‘‘(2) encourage entities providing graduate med2 ical education to conduct activities to voluntarily 

3 achieve the recommendations of the Council under 

4 paragraph (1)(E). 

5 ‘‘(c) COMPOSITION.—The Council shall be composed 

6 of— 

7 ‘‘(1) the Assistant Secretary for Health (or the 

8 Assistant Secretary’s designee); 

9 ‘‘(2) the Administrator of the Centers for Medi10 care & Medicaid Services; 

11 ‘‘(3) the official designated by the Secretary to 

12 administer section 781 (relating to health workforce 

13 investment grants); 

14 ‘‘(4) the Chief Medical Director of the Depart15 ment of Veterans Affairs; 

16 ‘‘(5) 15 members appointed by the Secretary to 

17 include representatives of practicing health and pub18 lic health workforce professionals, national and spe19 cialty health profession organizations, foreign med20 ical graduates, and health workforce student associa21 tions; 

22 ‘‘(6) 10 members appointed by the Secretary to 

23 include representatives of schools of medicine and 

24 osteopathic medicine, schools of nursing, allied 


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1 health schools, other health workforce training pro2 grams, and public and private teaching hospitals; 

3 ‘‘(7) 4 members appointed by the Secretary to 

4 include representatives of health insurers, business, 

5 and labor; 

6 ‘‘(8) the Assistant Secretary for the Employ7 ment and Training Administration of the Depart8 ment of Labor (or the Assistant Secretary’s des9 ignee); and 

10 ‘‘(9) the Secretary of Education (or the Sec11 retary’s designee). 

12 ‘‘(d) TERMS OF APPOINTED MEMBERS.— 

13 ‘‘(1) IN GENERAL; STAGGERED ROTATION.— 

14 Members of the Council appointed under paragraphs 

15 (5), (6), and (7) of subsection (b) shall be appointed 

16 for a term of 4 years, except that the term of office 

17 of the members first appointed shall expire, as des18 ignated by the Secretary at the time of appointment, 

19 as follows: 8 at the end of 1 year, 7 at the end of 

20 2 years, 7 at the end of 3 years, and 7 at the end 

21 of 4 years. 

22 ‘‘(2) DATE CERTAIN FOR APPOINTMENT.—The 

23 Secretary shall appoint the first members to the 

24 Council under paragraphs (5), (6), and (7) of sub25 section (b) within 60 days after the date of the enVerDate Nov 24 2008 00:34 Apr 07, 2009 Jkt 079200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\H1946.IH H1946

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1 actment of the Health Workforce Investment Act of 

2 2009. 

3 ‘‘(e) CHAIR.—The Council shall elect one of its mem4 bers as Chairman of the Council. 

5 ‘‘(f) COOPERATION.—The Council shall carry out this 

6 section in cooperation with the Council on Graduate Med7 ical Education established by section 762, the National 

8 Advisory Council on the National Health Service Corps 

9 established by section 337, the Advisory Committee on 

10 Training in Primary Care Medicine and Dentistry estab11 lished pursuant to section 748, the Advisory Committee 

12 on Interdisciplinary, Community-Based Linkages estab13 lished pursuant to section 756, and the National Advisory 

14 Council on Nurse Education and Practice established pur15 suant to section 845. 

16 ‘‘(g) QUORUM.—Eighteen members of the Council 

17 shall constitute a quorum, but a lesser number may hold 

18 hearings. 

19 ‘‘(h) VACANCIES.—Any vacancy in the Council shall 

20 not affect its power to function. 

21 ‘‘(i) COMPENSATION.—Each member of the Council 

22 who is not otherwise employed by the United States Gov23 ernment shall receive compensation at a rate equal to the 

24 daily rate prescribed for GS–18 under the General Sched25 ule under section 5332 of title 5, United States Code, for 


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1 each day, including traveltime, such member is engaged 

2 in the actual performance of duties as a member of the 

3 Council. A member of the Council who is an officer or 

4 employee of the United States Government shall serve 

5 without additional compensation. All members of the 

6 Council shall be reimbursed for travel, subsistence, and 

7 other necessary expenses incurred by them in the perform8 ance of their duties. 

9 ‘‘(j) CERTAIN AUTHORITIES AND DUTIES.— 

10 ‘‘(1) AUTHORITIES.—In order to carry out the 

11 provisions of this section— 

12 ‘‘(A) the Council is authorized to collect 

13 such information, hold such hearings, and sit 

14 and act at such times and places, either as a 

15 whole or by subcommittee, and request the at16 tendance and testimony of such witnesses and 

17 the production of such books, records, cor18 respondence, memoranda, papers, and docu19 ments as the Council or such subcommittee 

20 may consider available; and 

21 ‘‘(B) the Council is authorized to request 

22 the cooperation and assistance of Federal de23 partments, agencies, and instrumentalities, and 

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1 ities are authorized to provide such cooperation 

2 and assistance. 

3 ‘‘(2) COORDINATION OF ACTIVITIES.—The 

4 Council shall coordinate its activities with the activi5 ties of the Secretary under section 792. The Sec6 retary shall, in cooperation with the Council and 

7 pursuant to the recommendations of the Council, 

8 take such steps as are practicable to eliminate defi9 ciencies in the data base established under section 

10 792 and shall make available in reports such com11 prehensive data sets as are developed pursuant to 

12 this section. 

13 ‘‘(k) REPORTS.—Not later than 2 years after the 

14 date of the enactment of the Health Workforce Investment 

15 Act of 2009, and annually thereafter, the Council shall 

16 submit a report to each official and committee listed in 

17 the matter preceding subparagraph (A) in subsection 

18 (b)(1) containing— 

19 ‘‘(1) a description of the Council’s actions dur20 ing the period for which the report is made; and 

21 ‘‘(2) each of the recommendations required by 

22 subsection (b). 

23 ‘‘(l) DEFINITIONS.—In this section: 


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1 ‘‘(1) The term ‘Council’ means the National 

2 Health Workforce Advisory Council established by 

3 subsection (a). 

4 ‘‘(2) The term ‘health workforce’ has the mean5 ing given to such term in section 781. 

6 ‘‘(3) The term ‘Secretary’ means the Secretary 

7 of Health and Human Services unless otherwise 

8 specified. 

9 ‘‘(m) AUTHORIZATION OF APPROPRIATIONS.—To 

10 carry out this section, there are authorized to be appro11 priated such sums as may be necessary for each of fiscal 

12 years 2009 through 2013.’’. 

13 SEC. 4. NATIONAL CENTER FOR HEALTH WORKFORCE IN14 FORMATION AND ANALYSIS. 

15 Section 792 of the Public Health Service Act (42 

16 U.S.C. 295k) is amended to read as follows: 

17 ‘‘SEC. 792. NATIONAL CENTER FOR HEALTH WORKFORCE 

18 INFORMATION AND ANALYSIS. 

19 ‘‘(a) ESTABLISHMENT.—There is established in the 

20 Department of Health and Human Services the National 

21 Center for Health Workforce Information and Analysis (in 

22 this section referred to as the ‘Center’), which shall be 

23 under the direction of a director who shall conduct and 

24 support statistical and epidemiological activities for the 

25 purpose of assessing and improving the supply, distribuVerDate Nov 24 2008 00:34 Apr 07, 2009 Jkt 079200 PO 00000 Frm 00012 Fmt 6652 Sfmt 6201 E:\BILLS\H1946.IH H1946

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1 tion, diversity, and development of the health workforce 

2 in the United States. 

3 ‘‘(b) CERTAIN AUTHORITIES AND REQUIREMENTS.— 

4 In carrying out subsection (a), the Secretary, acting 

5 through the Director of the Center, shall— 

6 ‘‘(1) regularly collect statistics on— 

7 ‘‘(A) the supply and projected demand, 

8 along with projected shortages and surpluses, of 

9 the health workforce by health profession, spe10 cialty, and geographic location; 

11 ‘‘(B) the diversity of the health workforce 

12 by health profession, specialty, and geographic 

13 location; and 

14 ‘‘(C) the supply and projected demand, 

15 along with projected shortages and surpluses, of 

16 the health workforce serving minority groups by 

17 health profession, specialty, and geographic lo18 cation; 

19 ‘‘(2) establish a uniform health workforce data 

20 reporting system, which may include a system of 

21 unique identifiers for various provider groups; 

22 ‘‘(3) undertake and support (by grant or con23 tract) research, demonstrations, and evaluations re24 specting new or improved methods for obtaining curVerDate Nov 24 2008 00:34 Apr 07, 2009 Jkt 079200 PO 00000 Frm 00013 Fmt 6652 Sfmt 6201 E:\BILLS\H1946.IH H1946

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1 rent data on the matters referred to in paragraph 

2 (1); 

3 ‘‘(4) undertake and support (by grant or con4 tract) research, demonstrations, and evaluations on 

5 the matters referred to in paragraph (1); and 

6 ‘‘(5) coordinate efforts with the National Center 

7 for Health Statistics and the Bureau of Labor Sta8 tistics. 

9 ‘‘(c) GRANTS AND CONTRACTS.—The Secretary may 

10 make grants and enter into contracts with States (or an 

11 appropriate nonprofit private entity in any State) for car12 rying out the activities referred to in paragraphs (1) 

13 through (3). The Secretary shall determine the amount 

14 and scope of any such grant or contract. To be eligible 

15 for any such grant or contract, a State or entity shall sub16 mit an application in such form and manner and con17 taining such information as the Secretary may require. 

18 Such application shall include reasonable assurances, sat19 isfactory to the Secretary, that— 

20 ‘‘(1) such State or entity will establish a pro21 gram of mandatory annual registration of the health 

22 workforce personnel who reside or practice in such 

23 State and of health institutions licensed by such 

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1 tion as the Secretary may determine to be appro2 priate; 

3 ‘‘(2) such State or entity will collect and report 

4 to the Secretary such information in such form and 

5 manner as the Secretary may prescribe; and 

6 ‘‘(3) such State or entity will comply with the 

7 requirements of subsection (e). 

8 ‘‘(d) REPORT TO CONGRESS.—The Secretary shall 

9 submit to the Congress not later than October 1, 2010, 

10 and biennially thereafter, a comprehensive report regard11 ing the status of the health workforce according to profes12 sion, including a report regarding the analytic and descrip13 tive studies conducted under this section. 

14 ‘‘(e) REQUIREMENTS REGARDING PERSONAL

15 DATA.— 

16 ‘‘(1) IN GENERAL.—The Secretary and each 

17 program entity shall in securing and maintaining 

18 any record of individually identifiable personal data 

19 (hereinafter in this subsection referred to as ‘per20 sonal data’) for purposes of this section— 

21 ‘‘(A) inform any individual who is asked to 

22 supply personal data whether he is legally re23 quired, or may refuse, to supply such data and 

24 inform him of any specific consequences, known 

25 to the Secretary or program entity, as the case 


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1 may be, of providing or not providing such 

2 data; 

3 ‘‘(B) upon request, inform any individual if 

4 he is the subject of personal data secured or 

5 maintained by the Secretary or program entity, 

6 as the case may be, and make the data avail7 able to him in a form comprehensible to him; 

8 ‘‘(C) assure that no use is made of per9 sonal data which use is not within the purposes 

10 of this section unless an informed consent has 

11 been obtained from the individual who is the 

12 subject of such data; and 

13 ‘‘(D) upon request, inform any individual 

14 of the use being made of personal data respect15 ing such individual and of the identity of the in16 dividuals and entities which will use the data 

17 and their relationship to the programs under 

18 this section. 

19 ‘‘(2) CONSENT AS PRECONDITION TO DISCLO20 SURE.—Any entity which maintains a record of per21 sonal data and which receives a request from the 

22 Secretary or a program entity for such data for pur23 poses of this section shall not transfer any such data 

24 to the Secretary or to a program entity unless the 


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1 individual whose personal data is to be so trans2 ferred gives an informed consent for such transfer. 

3 ‘‘(3) DISCLOSURE BY SECRETARY.— 

4 ‘‘(A) Notwithstanding any other provision 

5 of law, personal data collected by the Secretary 

6 or any program entity under this section may 

7 not be made available or disclosed by the Sec8 retary or any program entity to any person 

9 other than the individual who is the subject of 

10 such data unless (i) such person requires such 

11 data for purposes of this section, or (ii) in re12 sponse to a demand for such data made by 

13 means of compulsory legal process. Any indi14 vidual who is the subject of personal data made 

15 available or disclosed under clause (ii) shall be 

16 notified of the demand for such data. 

17 ‘‘(B) Subject to all applicable laws regard18 ing confidentiality, only the data collected by 

19 the Secretary under this section which is not 

20 personal data shall be made available to bona 

21 fide researchers and policy analysts (including 

22 the Congress) for the purposes of assisting in 

23 the conduct of studies respecting health profes24 sions personnel. 


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1 ‘‘(4) DEFINITION.—For purposes of this sub2 section, the term ‘program entity’ means any public 

3 or private entity which collects, compiles, or analyzes 

4 health professions data under a grant, contract, or 

5 other arrangement with the Secretary under this 

6 section. 

7 ‘‘(f) TECHNICAL ASSISTANCE.—The Secretary shall 

8 provide technical assistance to the States and political 

9 subdivisions thereof in the development of systems (includ10 ing model laws) concerning confidentiality and com11 parability of data collected pursuant to this section. 

12 ‘‘(g) DATA ON HEALTH WORKFORCE PERSONNEL.— 

13 In carrying out subsection (b), the Secretary may make 

14 grants, or enter into contracts and cooperative agreements 

15 with, and provide technical assistance to, a nonprofit enti16 ty in order to establish a uniform health workforce data 

17 reporting system to collect, compile, and analyze data on 

18 health workforce personnel. 

19 ‘‘(h) DEFINITION.—In this section, the term ‘health 

20 workforce’ has the meaning given to such term in section 

21 781. 

22 ‘‘(i) AUTHORIZATION OF APPROPRIATIONS.—To 

23 carry out this section, there are authorized to be appro24 priated such sums as may be necessary for each of fiscal 

25 years 2009 through 2013.’’. 


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1 SEC. 5. HEALTH WORKFORCE INVESTMENT GRANTS. 

2 Title VII of the Public Health Service Act (42 U.S.C. 

3 292 et seq.) is amended— 

4 (1) by redesignating part F as part G; and 

5 (2) by inserting after section 770 the following: 

6 ‘‘PART F—HEALTH WORKFORCE INVESTMENT 

7 GRANTS 

8 ‘‘SEC. 781. HEALTH WORKFORCE INVESTMENT GRANTS. 

9 ‘‘(a) FORMULA GRANTS TO STATES.— 

10 ‘‘(1) IN GENERAL.—For the purposes described 

11 in paragraph (2), the Secretary shall make an allot12 ment each fiscal year for each State in an amount 

13 determined in accordance with subsection (d). The 

14 Secretary shall make a grant to the State of the al15 lotment made for the State for the fiscal year if the 

16 State submits to the Secretary an application in ac17 cordance with subsection (b). 

18 ‘‘(2) PURPOSES OF GRANTS.—A funding agree19 ment for a grant under paragraph (1) is that the 

20 State involved will expend the grant for the purposes 

21 of— 

22 ‘‘(A) ensuring access to health services for 

23 all individuals, particularly those with low in24 comes or limited access to health services, 

25 through an adequate health workforce; 


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1 ‘‘(B) improving the supply, distribution, di2 versity, and development of the health work3 force, taking into consideration the supply, dis4 tribution, and diversity of health workforce pro5 fession specialties and subspecialties; 

6 ‘‘(C) creating State-specific health work7 force goals and objectives consistent with health 

8 status goals and national health workforce ob9 jectives developed under subsection (h); and 

10 ‘‘(D) during the first 12-month period 

11 funded through the grant, establishing or desig12 nating a State health workforce planning entity 

13 to establish statewide processes for State health 

14 workforce planning, State health workforce data 

15 collection, policy recommendations, and State 

16 resource allocations. 

17 ‘‘(3) PURPOSES OF NATIONAL PROGRAM.—The 

18 Secretary shall carry out this section in a manner 

19 designed— 

20 ‘‘(A) to identify innovations in approaches 

21 to improving the supply, distribution, diversity, 

22 and development of the health workforce, taking 

23 into consideration specialties and subspecialties; 

24 ‘‘(B) to develop national goals and objec25 tives for improving the supply, distribution, diVerDate Nov 24 2008 00:34 Apr 07, 2009 Jkt 079200 PO 00000 Frm 00020 Fmt 6652 Sfmt 6201 E:\BILLS\H1946.IH H1946

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1 versity, and development of the health work2 force, including specialties and subspecialties; 

3 and 

4 ‘‘(C) to develop and expand programs de5 signed to ensure access to health workforce pro6 fessionals for an aging population. 

7 ‘‘(b) APPLICATION FOR GRANT.—For purposes of 

8 subsection (a)(1), an application for a grant is in accord9 ance with this subsection if each of the following is met: 

10 ‘‘(1) USE OF FUNDS.—The application includes 

11 each funding agreement required by this section, in12 cluding an assurance that all funds received through 

13 the grant will be used for the purposes described in 

14 subsection (a)(2). 

15 ‘‘(2) STATEWIDE NEEDS ASSESSMENT.—The 

16 application includes a statewide needs assessment 

17 that— 

18 ‘‘(A) will be updated not less than every 5 

19 years; and 

20 ‘‘(B) identifies— 

21 ‘‘(i) long-term State-specific health 

22 workforce goals and objectives consistent 

23 with health status goals and national 

24 health workforce objectives developed 

25 under subsection (h); and 


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1 ‘‘(ii) projected needs related to the 

2 supply, distribution, diversity, and develop3 ment of the State health workforce. 

4 ‘‘(3) ANNUAL PLANS.—The application includes 

5 a plan to meet the goals and objectives, and address 

6 the needs, identified under the statewide needs as7 sessment described in paragraph (2), and such 

8 plan— 

9 ‘‘(A) will be updated on an annual basis; 

10 and 

11 ‘‘(B) includes strategies related to— 

12 ‘‘(i) collaboration between— 

13 ‘‘(I) State departments of labor, 

14 health, education, higher education, 

15 veterans affairs, environment, and 

16 professional licensure; and 

17 ‘‘(II) State health workforce in18 vestment boards; 

19 ‘‘(ii) State data collection; 

20 ‘‘(iii) State Medicaid and Medicare 

21 policies; and 

22 ‘‘(iv) State health professions licen23 sure and regulation. 


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1 ‘‘(4) DESCRIPTION OF FUNDING USE.—The ap2 plication includes a description of how funds received 

3 through the grant will be used— 

4 ‘‘(A) in accordance with subparagraphs (A) 

5 and (B) of subsection (a)(2), to ensure access 

6 to health services for all individuals and to im7 prove the supply, distribution, diversity, and de8 velopment of the health workforce, such as 

9 through programs related to— 

10 ‘‘(i) health workforce training and 

11 education capacity; 

12 ‘‘(ii) the health care safety net work13 force, including health centers under sec14 tion 330; 

15 ‘‘(iii) provider cultural competency; 

16 ‘‘(iv) health workforce diversity; 

17 ‘‘(v) health workforce pipeline develop18 ment; 

19 ‘‘(vi) health workforce retention; 

20 ‘‘(vii) health workforce faculty recruit21 ment; 

22 ‘‘(viii) health workforce faculty reten23 tion; 

24 ‘‘(ix) health workforce career ladders; 

25 ‘‘(x) public awareness; and 


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1 ‘‘(xi) health workforce scholarship and 

2 loan repayment programs; 

3 ‘‘(B) to create State-specific health work4 force goals and objectives in accordance with 

5 subsection (a)(2)(C) and to develop annual 

6 plans in accordance with paragraph (3) of this 

7 subsection to meet such goals and objectives; 

8 and 

9 ‘‘(C) during the first 12-month period 

10 funded through the grant, to establish or des11 ignate in accordance with subsection (a)(2)(D) 

12 a State health workforce planning entity to es13 tablish statewide processes for State health 

14 workforce planning, State health workforce data 

15 collection, policy recommendations, and State 

16 resource allocations. 

17 ‘‘(5) DEVELOPMENT OF APPLICATION.—The 

18 application— 

19 ‘‘(A) is developed by or in consultation 

20 with the State agency that will be responsible 

21 for administering the program; and 

22 ‘‘(B) is made publicly available during its 

23 development or after its submission to the Sec24 retary in order to facilitate public comment. 

25 ‘‘(c) ADDITIONAL GRANT REQUIREMENTS.— 


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1 ‘‘(1) RESTRICTIONS ON USE OF GRANTS.—A 

2 funding agreement for a grant under subsection 

3 (a)(1) is that the State involved will not use the 

4 grant— 

5 ‘‘(A) to provide health services (other than 

6 health services provided as part of a health 

7 training program); 

8 ‘‘(B) to make payments to for-profit 

9 schools; or 

10 ‘‘(C) to provide matching funds to satisfy 

11 a condition for the receipt of other Federal 

12 funds. 

13 ‘‘(2) NURSING PROGRAMS.—A funding agree14 ment for a grant under subsection (a)(1) is that the 

15 State involved will expend at least 25 percent of the 

16 funds received through the grant for programs re17 lated to nursing (including registered nurses and li18 censed practical nurses) and advanced practice nurs19 ing (including nurse practitioners, certified reg20 istered nurse anesthetists, certified nurse midwives, 

21 clinical nurse specialists, doctorates of nursing prac22 tice, and clinical nurse leaders). 

23 ‘‘(3) ADMINISTRATION AND EVALUATION.—A 

24 funding agreement for a grant under subsection 

25 (a)(1) is that the State involved will expend not 


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1 more than 10 percent of the funds received through 

2 the grant on administration and evaluation. 

3 ‘‘(4) STATE AGENCY.—A funding agreement for 

4 a grant under subsection (a)(1) is that the State in5 volved will designate a lead State agency to admin6 ister the grant, including by— 

7 ‘‘(A) coordinating State activities under 

8 the grant with State administration of Medicaid 

9 and Medicare, including policies related to reim10 bursement and graduate medical education pay11 ments; and 

12 ‘‘(B) coordinating State activities under 

13 the grant with related activities of other Fed14 eral grantees within the State, including State 

15 workforce boards, community health center 

16 grantees, and recipients of grants from the 

17 Substance and Mental Health Services Adminis18 tration and the Health Resources and Services 

19 Administration. 

20 ‘‘(5) ANNUAL REPORTS.— 

21 ‘‘(A) IN GENERAL.—A funding agreement 

22 for a grant under subsection (a)(1) is that the 

23 State involved will submit annual reports to the 

24 Secretary— 


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1 ‘‘(i) detailing activities carried out 

2 through the grant in a standardized man3 ner that enables the Secretary to evaluate 

4 the activities and compare performance rel5 ative to other States; and 

6 ‘‘(ii) describing the extent to which 

7 the State has met its long-term State-spe8 cific health workforce goals and objectives 

9 identified pursuant to subsection 

10 (b)(2)(B)(i). 

11 ‘‘(B) CONTENTS.—Each report under sub12 paragraph (A) must include— 

13 ‘‘(i) information on the status of the 

14 State’s health workforce by profession, spe15 cialty, and geographic location, including 

16 such information on— 

17 ‘‘(I) the supply of the State’s 

18 health workforce, including with re19 spect to primary care providers, 

20 nurses, long-term care workers, den21 tists, and allied health professionals; 

22 and 

23 ‘‘(II) the diversity of the State’s 

24 health workforce; 


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1 ‘‘(ii) a description of each program 

2 funded through this section during the pre3 vious fiscal year; and 

4 ‘‘(iii) a description of efforts to coordi5 nate the State departments responsible for 

6 administering Medicaid and Medicare 

7 funds, education and labor programs, the 

8 health care safety net, veterans programs, 

9 environmental programs, and medical li10 censing. 

11 ‘‘(6) AUDITS.—A funding agreement for a 

12 grant under subsection (a)(1) is that the State in13 volved will provide for audits of expenditures of 

14 grant funds. 

15 ‘‘(d) DETERMINATION OF AMOUNT OF ALLOT16 MENT.— 

17 ‘‘(1) IN GENERAL.—The Secretary shall deter18 mine the amount of the allotment to each State 

19 under this section for a fiscal year based on a for20 mula. 

21 ‘‘(2) DEVELOPMENT OF FORMULA.—The for22 mula referred to in paragraph (1) shall be deter23 mined by the Secretary by regulation, taking into 

24 consideration the following criteria: 


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1 ‘‘(A) Existing shortages and deficiencies in 

2 health workforce distribution. 

3 ‘‘(B) Rural, urban, and frontier areas. 

4 ‘‘(C) Community health centers. 

5 ‘‘(D) The number of medical, nursing, and 

6 allied health professions schools in each State. 

7 ‘‘(e) FEDERAL PROGRAM ADMINISTRATION.— 

8 ‘‘(1) DELEGATION WITHIN HHS.—The Sec9 retary shall designate an identifiable administrative 

10 unit of the Department of Health and Human Serv11 ices with expertise in health workforce issues to be 

12 responsible for administering the program under this 

13 section, including the following: 

14 ‘‘(A) Coordinating activities under this sec15 tion with related activities of the Department of 

16 Health and Human Services, the Department of 

17 Defense, the Department of Education, the De18 partment of Labor, the Department of Veterans 

19 Affairs, and any other relevant Federal depart20 ments or agencies. 

21 ‘‘(B) Disseminating health workforce infor22 mation and best practices to States. 

23 ‘‘(C) Providing technical assistance to 

24 grant recipients under this section. 


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1 ‘‘(D) Submitting reports to Congress 

2 under paragraph (2). 

3 ‘‘(2) ANNUAL REPORTS.—The Secretary shall 

4 submit annual reports to the Congress on the fol5 lowing: 

6 ‘‘(A) The amount of each allotment and 

7 grant to a State under this section. 

8 ‘‘(B) Significant State projects funded 

9 through this section and their performance. 

10 ‘‘(C) Significant innovations funded 

11 through this section and their outcomes. 

12 ‘‘(D) Highlights with respect to the status 

13 of the Nation’s health workforce, including— 

14 ‘‘(i) significant changes in supply by 

15 profession, specialty, and geographic loca16 tion, including with respect to primary care 

17 providers, nurses, long-term care workers, 

18 dentists, and allied health professionals; 

19 and 

20 ‘‘(ii) significant changes in diversity 

21 by profession, specialty, and geographic lo22 cation. 

23 ‘‘(3) ADDITIONAL AUTHORITIES.—In carrying 

24 out this section, the Secretary may— 


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1 ‘‘(A) allow States receiving grants to work 

2 together in regional authorities; 

3 ‘‘(B) impose matching fund requirements 

4 as a condition on receipt of a grant; and 

5 ‘‘(C) allow States to use grant funds for 

6 planning and infrastructure development. 

7 ‘‘(f) RULE OF CONSTRUCTION.—Subject to the pur8 poses described in subsection (a)(2), nothing in this sec9 tion shall be construed to prohibit a State from making 

10 funds received under this section available to other enti11 ties, including entities receiving funds under other provi12 sions of this title or title VIII. 

13 ‘‘(g) FEDERAL RESEARCH AND PROJECTS.— 

14 ‘‘(1) IN GENERAL.—The Secretary may make 

15 grants to, or enter into contracts or jointly financed 

16 cooperative agreements with, public or nonprofit in17 stitutions of higher education and public or non18 profit private agencies and organizations engaged in 

19 research to identify best practices and innovative ap20 proaches to improving the supply, distribution, diver21 sity, and development of the health workforce, tak22 ing into consideration the supply, distribution, diver23 sity, and development of health workforce profession 

24 specialties and subspecialties. 


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1 ‘‘(2) TECHNICAL ASSISTANCE.—The Secretary 

2 shall incorporate the best practices and innovative 

3 approaches identified under paragraph (1) into any 

4 technical assistance provided to grant recipients 

5 under this section. 

6 ‘‘(3) COORDINATION.—The Secretary shall 

7 carry out this subsection in coordination with the ac8 tivities of the National Center for Health Workforce 

9 Information and Analysis, including any research, 

10 demonstrations, and evaluations under section 

11 792(b)(4). 

12 ‘‘(h) NATIONAL HEALTH WORKFORCE OBJEC13 TIVES.—The Secretary, based on information and analysis 

14 of the National Center for Health Workforce Information 

15 and Analysis and the findings and recommendations of the 

16 National Health Workforce Advisory Council, shall de17 velop national health workforce objectives to be used for 

18 purposes of subsections (a)(2)(C) and (b)(2)(B)(i). 

19 ‘‘(i) DEFINITIONS.—In this section: 

20 ‘‘(1) The term ‘diversity’ includes racial, ethnic, 

21 language ability, and gender diversity. 

22 ‘‘(2) The term ‘health workforce’ includes phy23 sicians, nurses (including registered nurses and li24 censed practical nurses), advance practice nurses 

25 (including nurse practitioners, certified registered 


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1 nurse anesthetists, certified nurse midwives, clinical 

2 nurse specialists, doctorates of nursing practice, and 

3 clinical nurse leaders), dentists, physician assistants, 

4 chiropractors, podiatrists, optometrists and opti5 cians, pharmacists, mental health providers (includ6 ing psychologists and clinical social workers), allied 

7 health professionals (including physical therapists, 

8 occupational therapists, speech-language patholo9 gists, audiologists, respiratory therapists, techni10 cians, technologists, emergency medical technicians, 

11 paramedics, medical and clinical laboratory tech12 nologists and technicians, medical records and health 

13 information technicians, nuclear medicine tech14 nologists, radiologic technologists, dieticians, and nu15 tritionists), auxiliary health professionals (including 

16 home health aides, certified nursing assistants, nurs17 ing aides, orderlies, and attendants), public health 

18 workforce professionals, and any other providers de19 termined by the Secretary for purposes of this sec20 tion to be part of the health workforce. 

21 ‘‘(3) The term ‘National Center for Health 

22 Workforce Information and Analysis’ means the Na23 tional Center for Health Workforce Information and 

24 Analysis established under section 792. 


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1 ‘‘(4) The term ‘National Health Workforce Ad2 visory Council’ means the National Health Work3 force Advisory Council established under section 

4 762. 

5 ‘‘(j) FUNDING.— 

6 ‘‘(1) AUTHORIZATION OF APPROPRIATIONS.— 

7 To carry out this section, there are authorized to be 

8 appropriated such sums as may be necessary for 

9 each of fiscal years 2009 through 2013. 

10 ‘‘(2) RESERVATION.—Of the amount of funds 

11 appropriated to carry out this section for a fiscal 

12 year, the Secretary shall reserve 5 percent of such 

13 amount to carry out subsection (g).’’. 

Æ 


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