II

107TH CONGRESS

1ST SESSION S. 1387

To conduct a demonstration program to show that physician shortage, recruitment, and retention problems may be ameliorated in rural States by

developing a comprehensive program that will result in statewide physician population growth, and for other purposes.

IN THE SENATE OF THE UNITED STATES

AUGUST 3, 2001

Mr. BINGAMAN (for himself, Mr. DOMENICI, and Mr. ROCKEFELLER) introduced the following bill; which was read twice and referred to the Committee on Finance

A BILL

To conduct a demonstration program to show that physician

shortage, recruitment, and retention problems may be

ameliorated in rural States by developing a comprehensive program that will result in statewide physician population growth, 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; TABLE OF CONTENTS.

4 (a) SHORT TITLE.—This Act may be cited as the

5 ‘‘Rural States Physician Recruitment and Retention Dem6 onstration Act of 2001’’.
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1 (b) TABLE OF CONTENTS.—The table of contents of

2 this Act is as follows:

Sec. 1. Short title; table of contents.

Sec. 2. Definitions.

Sec. 3. Rural States Physician Recruitment and Retention Demonstration Program.

Sec. 4. Establishment of the Health Professions Database.

Sec. 5. Evaluation and reports.

Sec. 6. Contracting flexibility.

3 SEC. 2. DEFINITIONS.

4 In this Act:

5 (1) COGME.—The term ‘‘COGME’’ means the

6 Council on Graduate Medical Education established

7 under section 762 of the Public Health Service Act

8 (42 U.S.C. 294o).

9 (2) DEMONSTRATION PROGRAM.—The term

10 ‘‘demonstration program’’ means the Rural States

11 Physician Recruitment and Retention Demonstration

12 Program established by the Secretary under section

13 3(a).

14 (3) DEMONSTRATION STATES.—The term

15 ‘‘demonstration States’’ means each State identified

16 by the Secretary, based upon data from the most re17 cent year for which data are available—

18 (A) that has an uninsured population

19 above 16 percent (as determined by the Bureau

20 of the Census);

21 (B) for which the sum of the number of in22 dividuals who are entitled to benefits under the
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1 medicare program and the number of individ2 uals who are eligible for medical assistance

3 under the medicaid program under title XIX of

4 the Social Security Act (42 U.S.C. 1396 et

5 seq.) equals or exceeds 20 percent of the total

6 population of the State (as determined by the

7 Centers for Medicare & Medicaid Services); and

8 (C) that has an estimated number of indi9 viduals in the State without access to a primary

10 care provider of at least 17 percent (as pub11 lished in ‘‘HRSA’s Bureau of Primary Health

12 Care: BPHC State Profiles’’).

13 (4) ELIGIBLE RESIDENCY OR FELLOWSHIP

14 GRADUATE.—The term ‘‘eligible residency or fellow15 ship graduate’’ means a graduate of an approved

16 medical residency training program (as defined in

17 section 1886(h)(5)(A) of the Social Security Act (42

18 U.S.C. 1395ww(h)(5)(A))) in a shortage physician

19 specialty.

20 (5) HEALTH PROFESSIONS DATABASE.—The

21 term ‘‘Health Professions Database’’ means the

22 database established under section 4(a).

23 (6) MEDICARE PROGRAM.—The term ‘‘medicare

24 program’’ means the health benefits program under
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1 title XVIII of the Social Security Act (42 U.S.C.

2 1395 et seq.).

3 (7) MEDPAC.—The term ‘‘MedPAC’’ means

4 the Medicare Payment Advisory Commission estab5 lished under section 1805 of the Social Security Act

6 (42 U.S.C. 1395b–6).

7 (8) SECRETARY.—The term ‘‘Secretary’’ means

8 the Secretary of Health and Human Services.

9 (9) SHORTAGE PHYSICIAN SPECIALTY.—The

10 term ‘‘shortage physician specialty’’ means a medical

11 or surgical specialty identified in a demonstration

12 State by the Secretary based on—

13 (A) an analysis and comparison of national

14 data and demonstration State data; and

15 (B) recommendations from appropriate

16 Federal, State, and private commissions, cen17 ters, councils, medical and surgical physician

18 specialty boards, and medical societies or asso19 ciations involved in physician workforce, edu20 cation and training, and payment issues.

21 SEC. 3. RURAL STATES PHYSICIAN RECRUITMENT AND RE22 TENTION DEMONSTRATION PROGRAM.

23 (a) ESTABLISHMENT.—

24 (1) IN GENERAL.—The Secretary shall establish

25 a Rural States Physician Recruitment and Retention
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1 Demonstration Program for the purpose of amelio2 rating physician shortage, recruitment, and retention

3 problems in rural States in accordance with the re4 quirements of this section.

5 (2) CONSULTATION.—For purposes of estab6 lishing the demonstration program, the Secretary

7 shall consult with—

8 (A) COGME;

9 (B) MedPAC;

10 (C) a representative of each demonstration

11 State medical society or association;

12 (D) the health workforce planning and

13 physician training authority of each demonstra14 tion State; and

15 (E) any other entity described in section

16 2(9)(B).

17 (b) DURATION.—The Secretary shall conduct the

18 demonstration program for a period of 10 years.

19 (c) CONDUCT OF PROGRAM.—

20 (1) FUNDING OF ADDITIONAL RESIDENCY AND

21 FELLOWSHIP POSITIONS.—

22 (A) IN GENERAL.—As part of the dem23 onstration program, the Secretary (acting

24 through the Administrator of the Centers for

25 Medicare & Medicaid Services) shall—
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1 (i) notwithstanding section

2 1886(h)(4)(F) of the Social Security Act

3 (42 U.S.C. 1395ww(h)(4)(F)) increase, by

4 up to 50 percent of the total number of

5 residency and fellowship positions approved

6 at each medical residency training program

7 in each demonstration State, the number

8 of residency and fellowship positions in

9 each shortage physician specialty; and

10 (ii) subject to subparagraph (C), pro11 vide funding under subsections (d)(5)(B)

12 and (h) of section 1886 of the Social Secu13 rity Act (42 U.S.C. 1395ww) for each posi14 tion added under clause (i).

15 (B) ESTABLISHMENT OF ADDITIONAL PO16 SITIONS.—

17 (i) IDENTIFICATION.—The Secretary

18 shall identify each additional residency and

19 fellowship position created as a result of

20 the application of subparagraph (A).

21 (ii) NEGOTIATION AND CONSULTA22 TION.—The Secretary shall negotiate and

23 consult with representatives of each ap24 proved medical residency training program

25 in a demonstration State at which a posi-
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1 tion identified under clause (i) is created

2 for purposes of supporting such position.

3 (C) CONTRACTS WITH SPONSORING INSTI4 TUTIONS.—

5 (i) IN GENERAL.—The Secretary shall

6 condition the availability of funding for

7 each residency and fellowship position

8 identified under subparagraph (B)(i) on

9 the execution of a contract containing such

10 provisions as the Secretary determines are

11 appropriate, including the provision de12 scribed in clause (ii) by each sponsoring in13 stitution.

14 (ii) PROVISION DESCRIBED.—

15 (I) IN GENERAL.—Except as pro16 vided in subclause (II), the provision

17 described in this clause is a provision

18 that provides that, during the resi19 dency or fellowship, the resident or

20 fellow shall spend not less than 10

21 percent of the training time providing

22 specialty services to underserved and

23 rural community populations other

24 than an underserved population of the

25 sponsoring institution.
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1 (II) EXCEPTIONS.—The Sec2 retary, in consultation with COGME,

3 shall identify shortage physician spe4 cialties and subspecialties for which

5 the application of the provision de6 scribed in subclause (I) would be in7 appropriate and the Secretary may

8 waive the requirement under clause (i)

9 that such provision be included in the

10 contract of a resident or fellow with

11 such a specialty or subspecialty.

12 (D) LIMITATIONS.—

13 (i) PERIOD OF PAYMENT.—The Sec14 retary may not fund any residency or fel15 lowship position identified under subpara16 graph (B)(i) for a period of more than 5

17 years.

18 (ii) REASSESSMENT OF NEED.—The

19 Secretary shall reassess the status of the

20 shortage physician specialty in the dem21 onstration State prior to entering into any

22 contract under subparagraph (C) after the

23 date that is 5 years after the date on

24 which the Secretary establishes the dem25 onstration program.
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1 (2) LOAN REPAYMENT AND FORGIVENESS PRO2 GRAM.—

3 (A) IN GENERAL.—As part of the dem4 onstration program, the Secretary (acting

5 through the Administrator of the Health Re6 sources and Services Administration) shall es7 tablish a loan repayment and forgiveness pro8 gram, through the holder of the loan, under

9 which the Secretary assumes the obligation to

10 repay a qualified loan amount for an edu11 cational loan of an eligible residency or fellow12 ship graduate—

13 (i) for whom the Secretary has ap14 proved an application submitted under

15 subparagraph (D); and

16 (ii) with whom the Secretary has en17 tered into a contract under subparagraph

18 (C).

19 (B) QUALIFIED LOAN AMOUNT.—

20 (i) IN GENERAL.—Subject to clause

21 (ii), the Secretary shall repay the lesser

22 of—

23 (I) 25 percent of the loan obliga24 tion of a graduate on a loan that is

25 outstanding during the period that the
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1 eligible residency or fellowship grad2 uate practices in the area designated

3 by the contract entered into under

4 subparagraph (C); or

5 (II) $25,000 per graduate per

6 year of such obligation during such

7 period.

8 (ii) LIMITATION.—The aggregate

9 amount under this subparagraph may not

10 exceed $125,000 for any graduate and the

11 Secretary may not repay or forgive more

12 than 30 loans per year in each demonstra13 tion State under this paragraph.

14 (C) CONTRACTS WITH RESIDENTS AND

15 FELLOWS.—

16 (i) IN GENERAL.—Each eligible resi17 dency or fellowship graduate desiring re18 payment of a loan under this paragraph

19 shall execute a contract containing the pro20 visions described in clause (ii).

21 (ii) PROVISIONS.—The provisions de22 scribed in this clause are provisions that

23 require the eligible residency or fellowship

24 graduate—
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1 (I) to practice in a health profes2 sional shortage area of a demonstra3 tion State during the period in which

4 a loan is being repaid or forgiven

5 under this section; and

6 (II) to provide health services re7 lating to the shortage physician spe8 cialty of the graduate that was funded

9 with the loan being repaid or forgiven

10 under this section during such period.

11 (D) APPLICATION.—

12 (i) IN GENERAL.—Each eligible resi13 dency or fellowship graduate desiring re14 payment of a loan under this paragraph

15 shall submit an application to the Sec16 retary at such time, in such manner, and

17 accompanied by such information as the

18 Secretary may reasonably require.

19 (ii) REASSESSMENT OF NEED.—The

20 Secretary shall reassess the shortage physi21 cian specialty in the demonstration State

22 prior to accepting an application for repay23 ment of any loan under this paragraph

24 after the date that is 5 years after the date
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1 on which the demonstration program is es2 tablished.

3 (E) CONSTRUCTION.—Nothing in the sec4 tion shall be construed to authorize any refund5 ing of any repayment of a loan.

6 (F) PREVENTION OF DOUBLE BENE7 FITS.—No borrower may, for the same service,

8 receive a benefit under both this paragraph and

9 any loan repayment or forgiveness program

10 under title VII of the Public Health Service Act

11 (42 U.S.C. 292 et seq.).

12 (d) WAIVER OF MEDICARE REQUIREMENTS.—The

13 Secretary is authorized to waive any requirement of the

14 medicare program, or approve equivalent or alternative

15 ways of meeting such a requirement, if such waiver is nec16 essary to carry out the demonstration program, including

17 the waiver of any limitation on the amount of payment

18 or number of residents under section 1886 of the Social

19 Security Act (42 U.S.C. 1395ww).

20 (e) APPROPRIATIONS.—

21 (1) FUNDING OF ADDITIONAL RESIDENCY AND

22 FELLOWSHIP POSITIONS.—Any expenditures result23 ing from the establishment of the funding of addi24 tional residency and fellowship positions under sub25 section (c)(1) shall be made from the Federal Hos-
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1 pital Insurance Trust Fund under section 1817 of

2 the Social Security Act (42 U.S.C. 1395i).

3 (2) LOAN REPAYMENT AND FORGIVENESS PRO4 GRAM.—There are authorized to be appropriated

5 such sums as may be necessary to carry out the loan

6 repayment and forgiveness program established

7 under subsection (c)(2).

8 SEC. 4. ESTABLISHMENT OF THE HEALTH PROFESSIONS

9 DATABASE.

10 (a) ESTABLISHMENT OF THE HEALTH PROFESSIONS

11 DATABASE.—

12 (1) IN GENERAL.—Not later than 7 months

13 after the date of enactment of this Act, the Sec14 retary (acting through the Administrator of the

15 Health Resources and Services Administration) shall

16 establish a State-specific health professions database

17 to track health professionals in each demonstration

18 State with respect to specialty certifications, practice

19 characteristics, professional licensure, practice types,

20 locations, education, and training, as well as obliga21 tions under the demonstration program as a result

22 of the execution of a contract under paragraph

23 (1)(C) or (2)(C) of section 3(c).

24 (2) DATA SOURCES.—In establishing the

25 Health Professions Database, the Secretary shall use
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1 the latest available data from existing health work2 force files, including the AMA Master File, State

3 databases, specialty medical society data sources and

4 information, and such other data points as may be

5 recommended by COGME, MedPAC, the National

6 Center for Workforce Information and Analysis, or

7 the medical society of the respective demonstration

8 State.

9 (b) AVAILABILITY.—

10 (1) DURING THE PROGRAM.—During the dem11 onstration program, data from the Health Profes12 sions Database shall be made available to the Sec13 retary, each demonstration State, and the public for

14 the purposes of—

15 (A) developing a baseline with respect to a

16 State’s health professions workforce and to

17 track changes in a demonstration State’s health

18 professions workforce;

19 (B) tracking direct and indirect graduate

20 medical education payments to hospitals;

21 (C) tracking the forgiveness and repay22 ment of loans for educating physicians; and

23 (D) tracking commitments by physicians

24 under the demonstration program.
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1 (2) FOLLOWING THE PROGRAM.—Following the

2 termination of the demonstration program, a dem3 onstration State may elect to maintain the Health

4 Professions Database for such State at its expense.

5 (c) AUTHORIZATION OF APPROPRIATIONS.—There

6 are authorized to be appropriated such sums as may be

7 necessary for the purpose of carrying out this section.

8 SEC. 5. EVALUATION AND REPORTS.

9 (a) EVALUATION.—

10 (1) IN GENERAL.—COGME and MedPAC shall

11 jointly conduct a comprehensive evaluation of the

12 demonstration program.

13 (2) MATTERS EVALUATED.—The evaluation

14 conducted under paragraph (1) shall include an

15 analysis of the effectiveness of the funding of addi16 tional residency and fellowship positions and the

17 loan repayment and forgiveness program on physi18 cian recruitment, retention, and specialty mix in

19 each demonstration State.

20 (b) PROGRESS REPORTS.—

21 (1) COGME.—Not later than 1 year after the

22 date on which the Secretary establishes the dem23 onstration program, 5 years after such date, and 10

24 years after such date, COGME shall submit a report
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1 on the progress of the demonstration program to the

2 Secretary and Congress.

3 (2) MEDPAC.—MedPAC shall submit biennial

4 reports on the progress of the demonstration pro5 gram to the Secretary and Congress.

6 (c) FINAL REPORT.—Not later than 1 year after the

7 date on which the demonstration program terminates,

8 COGME and MedPAC shall submit a final report to the

9 President, Congress, and the Secretary which shall contain

10 a detailed statement of the findings and conclusions of

11 COGME and MedPAC, together with such recommenda12 tions for legislation and administrative actions as COGME

13 and MedPAC consider appropriate.

14 (d) AUTHORIZATION OF APPROPRIATIONS.—There

15 are authorized to be appropriated to COGME such sums

16 as may be necessary for the purpose of carrying out this

17 section.

18 SEC. 6. CONTRACTING FLEXIBILITY.

19 For purposes of conducting the demonstration pro20 gram and establishing and administering the Health Pro21 fessions Database, the Secretary may procure temporary

22 and intermittent services under section 3109(b) of title 5,

23 United States Code.

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