II 

Calendar No. 242 

118TH CONGRESS 

1ST SESSION S. 2840 

To improve access to and the quality of primary health care, expand the 

health workforce, and for other purposes. 

IN THE SENATE OF THE UNITED STATES 

SEPTEMBER 19, 2023 

Mr. SANDERS (for himself and Mr. MARSHALL) introduced the following bill; 

which was read twice and referred to the Committee on Health, Education, Labor, and Pensions 

NOVEMBER 8, 2023 

Reported by Mr. SANDERS, with an amendment 

[Strike out all after the enacting clause and insert the part printed in italic] 

A BILL 

To improve access to and the quality of primary health 

care, expand the health workforce, 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 ‘‘Bipartisan Primary Care and Health Workforce Act’’. 


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1 (b) TABLE OF CONTENTS.—The table of contents for 

2 this Act is as follows: 

Sec. 1. Short title; table of contents. 

TITLE I—EXTENSION FOR COMMUNITY HEALTH CENTERS, THE 

NATIONAL HEALTH SERVICE CORPS, AND TEACHING HEALTH 

CENTERS THAT OPERATE GME PROGRAMS 

Sec. 101. Programs of payments to teaching health centers that operate graduate medical education programs. 

Sec. 102. Community health centers. 

Sec. 103. National Health Service Corps. 

Sec. 104. GAO report. 

Sec. 105. OIG report. 

Sec. 106. Application of provisions. 

TITLE II—SUPPORTING THE HEALTH CARE WORKFORCE 

Sec. 201. Rural residency planning and development program. 

Sec. 202. Primary care training and enhancement program. 

Sec. 203. Telehealth technology-enabled learning program. 

Sec. 204. Expanding the number of primary care doctors. 

Sec. 205. Nurse education, practice, quality, and retention grants. 

Sec. 206. Nurse faculty loan program. 

Sec. 207. Nurse faculty demonstration program. 

Sec. 208. Nurse corps scholarship and loan repayment program. 

Sec. 209. Grants for primary care nurse residency training programs. 

Sec. 210. State oral health workforce improvement grant program. 

Sec. 211. Oral health training programs. 

Sec. 212. Allied health professionals. 

Sec. 213. Budgetary treatment. 

TITLE III—REDUCING HEALTH CARE COSTS FOR PATIENTS 

Sec. 301. Banning anticompetitive terms in facility and insurance contracts 

that limit access to higher quality, lower cost care. 

Sec. 302. Honest billing requirements applicable to providers. 

Sec. 303. Banning facility fees for certain services. 

Sec. 304. Prevention and Public Health Fund. 


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1 TITLE I—EXTENSION FOR COM2 MUNITY HEALTH CENTERS, 

3 THE NATIONAL HEALTH 

4 SERVICE CORPS, AND TEACH5 ING HEALTH CENTERS THAT 

6 OPERATE GME PROGRAMS 

7 SEC. 101. PROGRAMS OF PAYMENTS TO TEACHING HEALTH 

8 CENTERS THAT OPERATE GRADUATE MED9 ICAL EDUCATION PROGRAMS. 

10 (a) FUNDING.—Section 340H(g)(1) of the Public 

11 Health Service Act (42 U.S.C. 256h(g)(1)) is amended— 

12 (1) by striking ‘‘such sums as may be nec13 essary, not to exceed’’; 

14 (2) by striking ‘‘2017, and’’ and inserting 

15 ‘‘2017,’’; and 

16 (3) by inserting ‘‘and $300,000,000 for each of 

17 fiscal years 2024 through 2028,’’ after ‘‘2023,’’. 

18 (b) PER RESIDENT AMOUNT.—Section 340H(a)(2) 

19 of the Public Health Service Act (42 U.S.C. 256h(a)(2)) 

20 is amended by adding at the end the following: ‘‘Beginning 

21 in fiscal year 2024, in accordance with paragraph (1), but 

22 notwithstanding the capped amount referenced in sub23 sections (b)(2) and (d)(2), the qualified teaching health 

24 center per resident amount for a fiscal year shall be not 

25 less than such amount for the previous fiscal year.’’. 


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1 (c) AMOUNT OF PAYMENTS.—Section 340H of the 

2 Public Health Service Act (42 U.S.C. 256h) is amended— 

3 (1) in subsection (b)(2)— 

4 (A) in subparagraph (A), by striking 

5 ‘‘amount of funds appropriated under sub6 section (g) for such payments for that fiscal 

7 year’’ and inserting ‘‘total amount of funds 

8 available under subsection (g) and any amounts 

9 recouped under subsection (f)’’; and 

10 (B) in subparagraph (B), by striking ‘‘ap11 propriated in a fiscal year under subsection 

12 (g)’’ and inserting ‘‘available under subsection 

13 (g) and any amounts recouped under subsection 

14 (f)’’; and 

15 (2) in subsection (d)(2)(B), by striking 

16 ‘‘amount appropriated for such expenses as deter17 mined in subsection (g)’’ and inserting ‘‘total 

18 amount of funds available under subsection (g) and 

19 any amounts recouped under subsection (f)’’. 

20 (d) PRIORITY PAYMENTS.—Section 340H(a)(3) of 

21 Public Health Service Act (42 U.S.C. 256h(a)(3)) is 

22 amended— 

23 (1) in subparagraph (A), by striking ‘‘; or’’ and 

24 inserting a semicolon; 


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1 (2) in subparagraph (B), by striking the period 

2 and inserting ‘‘; or’’; and 

3 (3) by adding at the end the following: 

4 ‘‘(C) are located in a State that does not 

5 already have a qualified teaching health center 

6 receiving funding under this section.’’. 

7 (e) REPORTING REQUIREMENTS.—Section 

8 340H(h)(1) of the Public Health Service Act (42 U.S.C. 

9 256h(h)(1)) is amended— 

10 (1) by redesignating subparagraph (H) as sub11 paragraph (I); and 

12 (2) by inserting after subparagraph (G) the fol13 lowing: 

14 ‘‘(H) Of the number of residents described 

15 in paragraph (4) who completed their residency 

16 training, the number practicing primary care 

17 (meaning any of the areas of practice listed in 

18 the definition of a primary care residency pro19 gram in section 749A) 5 years following com20 pletion of such training.’’. 

21 (f) GUIDANCE.—The Secretary shall update guidance 

22 and relevant information regarding States described in 

23 subparagraph (C) of section 340H(a)(3) of the Public 

24 Health Service Act (42 U.S.C. 256h(a)(3)), as amended 

25 by subsection (d), and make available model templates to 


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1 assist health centers in such States to establish a teaching 

2 health center. 

3 SEC. 102. COMMUNITY HEALTH CENTERS. 

4 (a) COMMUNITY HEALTH CENTER FUND.—Section 

5 10503 of the Patient Protection and Affordable Care Act 

6 (42 U.S.C. 254b–2) is amended— 

7 (1) in subsection (b)(1)(F)— 

8 (A) by striking ‘‘2018 and’’ and inserting 

9 ‘‘2018,’’; and 

10 (B) by inserting before the semicolon the 

11 following: ‘‘, and $5,800,000,000 for each of 

12 fiscal years 2024 through 2026’’; and 

13 (2) by adding at the end the following: 

14 ‘‘(f) PRIORITY USE OF FUNDS.—For fiscal years 

15 2024 through 2026, with respect to $1,800,000,000 of the 

16 amount appropriated under subsection (b)(1)(F), the Sec17 retary shall prioritize awards to entities for purposes of— 

18 ‘‘(1) increasing the number of low-income pa19 tients not enrolled in a group health plan or group 

20 or individual health insurance coverage who are 

21 served by health centers, including through Health 

22 Center Program New Access Points described in sec23 tion 330(e)(6) of the Public Health Service Act, in24 cluding school-based service sites; 


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1 ‘‘(2) increasing the required primary health 

2 services described in paragraph (1)(A)(i) of section 

3 330(b) of the Public Health Service Act and addi4 tional health services (as defined in paragraph (2) of 

5 such section) offered by health centers; and 

6 ‘‘(3) increasing patient case management, ena7 bling services, and education services, as described 

8 in clauses (iii) through (v) of section 330(b)(1)(A) of 

9 the Public Health Service Act.’’. 

10 (b) AUTHORIZATION OF APPROPRIATIONS.—Section 

11 330(r)(1) of the Public Health Service Act (42 U.S.C. 

12 254b(r)(1)) is amended— 

13 (1) in subparagraph (G), by striking ‘‘fiscal 

14 year 2016, and each subsequent fiscal year’’ and in15 serting ‘‘each of fiscal years 2016 through 2023’’; 

16 and 

17 (2) by adding at the end the following: 

18 ‘‘(H) For each of fiscal years 2024 

19 through 2026, $2,200,000,000. 

20 ‘‘(I) For fiscal year 2027, and each subse21 quent fiscal year, the amount appropriated for 

22 the preceding fiscal year adjusted by the prod23 uct of— 


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1 ‘‘(i) one plus the average percentage 

2 increase in costs incurred per patient 

3 served; and 

4 ‘‘(ii) one plus the average percentage 

5 increase in the total number of patients 

6 served.’’. 

7 (c) ALLOCATION OF FUNDS.—Section 10503 of the 

8 Patient Protection and Affordable Care Act (42 U.S.C. 

9 254b–2), as amended by subsection (a), is further amend10 ed by adding at the end the following: 

11 ‘‘(g) ALLOCATION OF FUNDS.—For each of fiscal 

12 years 2024 through 2026, of the amounts appropriated 

13 under subsection (b)(1)(F) for a fiscal year, the Secretary 

14 shall use— 

15 ‘‘(1) at least $245,000,000 for awards to sup16 port health centers in each State that are receiving 

17 awards under section 330 of the Public Health Serv18 ice Act in extending operating hours, in an amount 

19 determined pursuant to a formula and eligibility cri20 teria developed by the Secretary, for the purposes of 

21 increasing access to services; 

22 ‘‘(2) at least $55,000,000 for awards under this 

23 section for health centers to expand school-based 

24 services and establish new school-based service sites; 

25 and 


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1 ‘‘(3) such sums as may be necessary for pur2 poses of increasing the amount awarded pursuant to 

3 grants or cooperative agreements under section 330 

4 of the Public Health Service Act so that each recipi5 ent of such an award receives— 

6 ‘‘(A) for fiscal year 2024, at least 15 per7 cent more than such recipient received for fiscal 

8 year 2023; and 

9 ‘‘(B) for each of fiscal years 2025 and 

10 2026, the amount received in the previous year 

11 adjusted by— 

12 ‘‘(i) the percent increase in the med13 ical component of the consumer price index 

14 for the most recent 12-month period for 

15 which applicable data is available; plus 

16 ‘‘(ii) one percent.’’. 

17 (d) CAPITAL FUNDING.—Section 10503(c) of the Pa18 tient Protection and Affordable Care Act (42 U.S.C. 

19 254b–2(c)) is amended— 

20 (1) in the subsection heading, by inserting ‘‘, 

21 CAPITAL FUNDING’’ after ‘‘CONSTRUCTION’’; 

22 (2) by striking ‘‘There is’’ and inserting the fol23 lowing: 

24 ‘‘(1) CONSTRUCTION.—There is’’; and 

25 (3) by adding at the end the following: 


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1 ‘‘(2) CAPITAL FUNDING.—For the alteration, 

2 renovation, construction, equipment, and other cap3 ital costs of health centers that receive funding 

4 under section 330 of the Public Health Service Act 

5 (42 U.S.C. 254b), in addition to amounts otherwise 

6 made available for such purpose, there is appro7 priated to the Secretary of Health and Human Serv8 ices, out of amounts in the Treasury not otherwise 

9 appropriated, $3,000,000,000 for fiscal year 2024, 

10 to remain available until September 30, 2026. In 

11 awarding amounts appropriated under this para12 graph, the Secretary shall prioritize awards related 

13 to increasing access to dental and behavioral health 

14 services.’’. 

15 (e) STRATEGIC PLAN TO IMPROVE HEALTH OUT16 COMES THROUGH NUTRITION.— 

17 (1) IN GENERAL.—Not later than one year 

18 after the date of enactment of this Act, the Sec19 retary of Health and Human Services, in consulta20 tion with the Secretary of Agriculture, shall submit 

21 to the Committee on Health, Education, Labor, and 

22 Pensions of the Senate and the Committee on En23 ergy and Commerce of the House of Representatives 

24 a 5-year strategic plan to improve health outcomes 

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1 tient populations with severe, complex chronic condi2 tions and one or more diet-related conditions. 

3 (2) REPORT.—In carrying out paragraph (1), 

4 the Secretary of Health and Human Services shall— 

5 (A) conduct an evaluation of previous and 

6 current federally-funded efforts of the Depart7 ment of Health and Human Services to improve 

8 patient outcomes through nutrition interven9 tions, such as medically tailored meals and nu10 trition counseling; and 

11 (B) include in the strategic report rec12 ommendations for— 

13 (i) reducing the financial impact of 

14 obesity and preventable chronic conditions 

15 resulting from obesity; 

16 (ii) empowering federally-funded com17 munity health centers, rural health clinics, 

18 and other relevant federally-funded facili19 ties to provide produce prescriptions, medi20 cally tailored groceries, and medically tai21 lored meals; 

22 (iii) promoting long-term adoption of 

23 improved nutrition habits, including 

24 through increased culinary education and 

25 consumer nutrition aligned with the most 


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1 recent Dietary Guidelines for Americans 

2 published under section 301 of the Na3 tional Nutrition Monitoring and Related 

4 Research Act of 1990 (7 U.S.C. 5341) and 

5 incorporating behavioral modeling or other 

6 novel methods across Federal programs; 

7 (iv) developing performance and qual8 ity metrics related to the delivery of 

9 produce prescriptions, medically tailored 

10 groceries, and medically tailored meals 

11 across relevant Federal payers to aid in re12 imbursement strategies; 

13 (v) developing payment models for 

14 novel obesity care therapies for the treat15 ment of diabetes that include behavioral 

16 and nutritional and dietary services and 

17 education; 

18 (vi) improving coordination of care 

19 and integrating nutrition services and re20 sources within federally-funded community 

21 health centers, rural health clinics, and 

22 other federally-funded primary care facili23 ties; 


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1 (vii) bolstering partnerships with 

2 State and local governments and non3 governmental organizations; and 

4 (viii) addressing geographic disparities 

5 in access to nutrition services and re6 sources. 

7 (f) REQUIRED PRIMARY HEALTH SERVICES.— 

8 (1) IN GENERAL.—Section 330 of the Public 

9 Health Service Act (42 U.S.C. 254b) is amended— 

10 (A) in subsection (b)(1)(A)— 

11 (i) in clause (i)— 

12 (I) in subclause (IV), by striking 

13 ‘‘; and’’ and inserting a semicolon; 

14 (II) in subclause (V), by adding 

15 ‘‘and’’ after the semicolon; and 

16 (III) by adding at the end the 

17 following: 

18 ‘‘(VI) appropriate nutritional and 

19 dietary services;’’; 

20 (ii) in clause (ii), by inserting ‘‘and 

21 nutrition services’’ after ‘‘mental health 

22 services’’; and 

23 (iii) in clause (iii), by inserting ‘‘nutri24 tional,’’ after ‘‘educational,’’; and 


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1 (B) in subsection (d)(1)(A), by inserting 

2 ‘‘or one or more diet-related conditions’’ before 

3 the semicolon. 

4 (2) IMPLEMENTATION OF NEW REQUIRED PRI5 MARY HEALTH SERVICE.—Paragraph (4) of section 

6 330(e) of the Public Health Service Act (42 U.S.C. 

7 254b(e)) is amended to read as follows: 

8 ‘‘(4) LIMITATION.—Not more than 2 grants 

9 may be made under paragraph (1)(B) for the same 

10 entity, except that such limitation shall not apply for 

11 the period of 2 years beginning on the date of enact12 ment of the Bipartisan Primary Care and Health 

13 Workforce Act, in any case where the only basis 

14 upon which paragraph (1)(B) applies to a health 

15 center is that the health center is not in noncompli16 ance with the requirements under subsection 

17 (b)(1)(A)(i)(VI) to provide appropriate nutritional 

18 and dietary services.’’. 

19 (g) INCREASE THE USE OF PROVIDER TOOLS TO IM20 PROVE HEALTH OUTCOMES.—Not later than one year 

21 after the date of enactment of this Act, the Secretary of 

22 Health and Human Services, in consultation with the Sec23 retary of Agriculture, shall submit to Congress a report 

24 that includes— 


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1 (1) recommendations for States to support the 

2 coordination of federally-funded nutrition programs 

3 and services provided by health care professionals in 

4 community health centers; and 

5 (2) data on the number of individuals enrolled 

6 in federally-subsidized health insurance coverage 

7 who are also enrolled in or eligible for federally-sub8 sidized nutrition and food programs. 

9 SEC. 103. NATIONAL HEALTH SERVICE CORPS. 

10 Section 10503(b)(2) of the Patient Protection and 

11 Affordable Care Act (42 U.S.C. 254b–2(b)(2)) is amend12 ed— 

13 (1) in subparagraph (G), by striking ‘‘; and’’ 

14 and inserting a semicolon; 

15 (2) in subparagraph (H), by striking the period 

16 and inserting ‘‘; and’’; and 

17 (3) by adding at the end the following: 

18 ‘‘(I) $950,000,000 for each of fiscal years 

19 2024 through 2026.’’. 

20 SEC. 104. GAO REPORT. 

21 (a) IN GENERAL.—Not later than one year after the 

22 date of enactment of this Act, the Comptroller General 

23 of the United States shall submit to the Committee on 

24 Health, Education, Labor, and Pensions of the Senate and 

25 the Committee on Energy and Commerce of the House 


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1 of Representatives a report assessing the effectiveness of 

2 the National Health Service Corps (referred to in this sec3 tion as the ‘‘NHSC’’) at attracting health care profes4 sionals to health professional shortage areas designated 

5 under section 332 of the Public Health Service Act (42 

6 U.S.C. 254e) (referred to in this section as ‘‘HPSAs’’), 

7 such as by— 

8 (1) assessing the metrics used by the Health 

9 Resources and Services Administration in evaluating 

10 the program; 

11 (2) comparing the retention rates of NHSC 

12 participants in the HPSAs where they completed 

13 their period of obligated service to the retention rate 

14 of non-NHSC participants in the corresponding 

15 HPSAs; 

16 (3) comparing the retention rates of NHSC 

17 participants in the HPSAs where they completed 

18 their period of obligated service to the retention 

19 rates of NHSC participants in HPSAs other than 

20 those where they completed their period of obligated 

21 service; 

22 (4) identifying factors that influence a NHSC 

23 participant’s decision to practice in a HPSA other 

24 than the HPSA where they completed their period of 

25 obligated service; 


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1 (5) identifying factors other than participation 

2 in the National Health Service Corps Scholarship 

3 and Loan Repayment Programs that attract health 

4 care professionals to a HPSA; 

5 (6) assessing the impact the NHSC has on 

6 wages for health care professionals in a HPSA; and 

7 (7) comparing the distribution of NHSC par8 ticipants across HPSAs, including a comparison of 

9 rural versus non-rural HPSAs. 

10 (b) DEFINITION.—In this section, the term ‘‘NHSC 

11 participant’’ means a National Health Service Corps mem12 ber participating in the National Health Service Corps 

13 Scholarship or Loan Repayment Program under subpart 

14 III of part D of title III of the Public Health Service Act 

15 (42 U.S.C. 254l et seq.). 

16 SEC. 105. OIG REPORT. 

17 Not later than 2 years after the date of enactment 

18 of this Act, the Inspector General of the Department of 

19 Health and Human Services shall submit to Congress a 

20 report on integrity efforts of the Health Resources and 

21 Services Administration with respect to programs carried 

22 out by the Health Resources and Services Administration. 

23 Such report shall include an assessment of— 

24 (1) the ways in which the Administrator of the 

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1 ferred to in this section as the ‘‘Administrator’’) de2 termines reasonable efforts are continuously made to 

3 establish and maintain collaborative relationships 

4 with health care providers; 

5 (2) the ways in which the Administrator en6 sures quality and continuity of care for underserved 

7 areas; and 

8 (3) the extent to which the Administrator vali9 dates the financial responsibility of and use of grant 

10 funding by community health centers. 

11 SEC. 106. APPLICATION OF PROVISIONS. 

12 (a) IN GENERAL.—Amounts appropriated pursuant 

13 to the amendments made by this title shall be subject to 

14 the requirements contained in Public Law 117–328 for 

15 funds for programs authorized under sections 330 through 

16 340 of the Public Health Service Act (42 U.S.C. 254b 

17 through 256). 

18 (b) CONFORMING AMENDMENT.—Paragraph (4) of 

19 section 3014(h) of title 18, United States Code, ‘‘and sec20 tion 301(d) of division BB of the Consolidated Appropria21 tions Act, 2021.’’ and inserting ‘‘section 301(d) of division 

22 BB of the Consolidated Appropriations Act, 2021, and 

23 section 106(a) of the Bipartisan Primary Care and Health 

24 Workforce Act’’. 


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1 TITLE II—SUPPORTING THE 

2 HEALTH CARE WORKFORCE 

3 SEC. 201. RURAL RESIDENCY PLANNING AND DEVELOP4 MENT PROGRAM. 

5 Title III of the Public Health Service Act (42 U.S.C. 

6 241 et seq.) is amended by inserting after section 330A– 

7 2 the following: 

8 ‘‘SEC. 330A–3. RURAL RESIDENCY PLANNING AND DEVELOP9 MENT PROGRAM AND RURAL RESIDENCY 

10 PLANNING AND DEVELOPMENT TECHNICAL 

11 ASSISTANCE PROGRAM. 

12 ‘‘(a) DEFINITION OF RURAL RESIDENCY PRO13 GRAM.—In this section, the term ‘rural residency pro14 gram’ means a physician residency program, including a 

15 rural track program, accredited by the Accreditation 

16 Council for Graduate Medical Education (or a similar 

17 body) that— 

18 ‘‘(1) trains residents in rural areas (as defined 

19 by the Secretary) for more than 50 percent of the 

20 total time of their residency; and 

21 ‘‘(2) primarily focuses on producing physicians 

22 who will practice in rural areas, as defined by the 

23 Secretary. 

24 ‘‘(b) RURAL RESIDENCY PLANNING AND DEVELOP25 MENT PROGRAM.— 


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1 ‘‘(1) DEFINITION OF ELIGIBLE ENTITY.—In 

2 this subsection, the term ‘eligible entity’— 

3 ‘‘(A) means— 

4 ‘‘(i) a domestic public or private non5 profit or for-profit entity; 

6 ‘‘(ii) an Indian Tribe, Tribal health 

7 program, Tribal organization, or Urban In8 dian organization (as such terms are de9 fined in section 4 of the Indian Health 

10 Care Improvement Act); or 

11 ‘‘(iii) a Native Hawaiian Health orga12 nization as defined in section 12 of the Na13 tive Hawaiian Health Care Improvement; 

14 and 

15 ‘‘(B) may include faith-based or commu16 nity-based organizations, rural hospitals, rural 

17 community-based ambulatory patient care cen18 ters (including rural health clinics), health cen19 ters operated by a Native Hawaiian Health or20 ganization (defined as described in subpara21 graph (A)(iii)), an Indian Tribe, a Tribal health 

22 program, a Tribal organization, or an Urban 

23 Indian organization (defined as described in 

24 subparagraph (A)(ii)), graduate medical edu25 cation consortiums (including institutions of 


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1 higher education, such as schools of allopathic 

2 medicine, schools of osteopathic medicine, or 

3 historically Black colleges or universities (as de4 fined by the term ‘part B institution’ in section 

5 322 of the Higher Education Act of 1965 or 

6 described in section 326(e)(1) of the Higher 

7 Education Act of 1965) or other minority-serv8 ing institutions (as described in section 371(a) 

9 of the Higher Education Act of 1965), or other 

10 organizations as determined appropriate by the 

11 Secretary. 

12 ‘‘(2) GRANTS.— 

13 ‘‘(A) IN GENERAL.—The Secretary may 

14 award grants to eligible entities to create new 

15 rural residency programs (including adding new 

16 rural training sites to existing rural track pro17 grams). 

18 ‘‘(B) FUNDING.—Grants awarded under 

19 this subsection may be fully funded at the time 

20 of the award. 

21 ‘‘(C) TERM.—The term of a grant under 

22 this subsection shall be 4 years and may be ex23 tended at the discretion of the Secretary. 

24 ‘‘(3) APPLICATIONS.— 


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1 ‘‘(A) IN GENERAL.—To be eligible to re2 ceive a grant under this subsection, an eligible 

3 entity shall prepare and submit to the Secretary 

4 an application at such time, in such manner, 

5 and containing such information as the Sec6 retary may require, including a description of 

7 the pathway of the rural residency program as 

8 described in subparagraph (B). 

9 ‘‘(B) PATHWAY.—A pathway of a rural 

10 residency program supported under this sub11 section shall be for— 

12 ‘‘(i) general primary care and high13 need specialty care, including family medi14 cine, internal medicine, preventive medi15 cine, psychiatry, or general surgery; 

16 ‘‘(ii) maternal health and obstetrics, 

17 which may be obstetrics and gynecology or 

18 family medicine with enhanced obstetrical 

19 training; or 

20 ‘‘(iii) any other pathway as deter21 mined appropriate by the Secretary. 

22 ‘‘(c) RURAL RESIDENCY PLANNING AND DEVELOP23 MENT TECHNICAL ASSISTANCE.— 

24 ‘‘(1) DEFINITION OF ELIGIBLE ENTITY.—In 

25 this subsection, the term ‘eligible entity’ means— 


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1 ‘‘(A) a domestic public or private nonprofit 

2 or for-profit entity; or 

3 ‘‘(B) an Indian Tribe or Tribal organiza4 tion (as such terms are defined in section 4 of 

5 the Indian Health Care Improvement Act). 

6 ‘‘(2) GRANTS.— 

7 ‘‘(A) IN GENERAL.—The Secretary may 

8 award grants to eligible entities to provide tech9 nical assistance to awardees of and potential 

10 applicants of the program described in sub11 section (b). 

12 ‘‘(B) FUNDING.—Grants awarded under 

13 this subsection may be fully funded at the time 

14 of the award. 

15 ‘‘(C) TERM.—The term of a grant under 

16 this subsection shall be 4 years and may be ex17 tended at the discretion of the Secretary. 

18 ‘‘(3) APPLICATIONS.—To be eligible to receive a 

19 grant under this subsection, an eligible entity shall 

20 prepare and submit to the Secretary an application 

21 at such time, in such manner, and containing such 

22 information as the Secretary may require. 

23 ‘‘(d) AUTHORIZATION OF APPROPRIATIONS.—There 

24 is authorized to be appropriated to carry out this section 

25 $13,000,000 for fiscal year 2024, $13,500,00 for fiscal 


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1 year 2025, and $14,000,000 for fiscal year 2026, to re2 main available until expended.’’. 

3 SEC. 202. PRIMARY CARE TRAINING AND ENHANCEMENT 

4 PROGRAM. 

5 Section 747(c)(1) of the Public Health Service Act 

6 (42 U.S.C. 293k(c)(1)) is amended— 

7 (1) by striking ‘‘$48,924,000 for each of fiscal 

8 years 2021 through 2025’’ and inserting 

9 ‘‘$49,250,000 for fiscal year 2024, $49,500,000 for 

10 fiscal year 2025, and $50,000,000 for fiscal year 

11 2026’’; and 

12 (2) by striking ‘‘subsection (b)(1)(B)’’ and in13 serting ‘‘subsections (b)(1)(B) and (c)’’. 

14 SEC. 203. TELEHEALTH TECHNOLOGY-ENABLED LEARNING 

15 PROGRAM. 

16 Section 330N(k) of the Public Health Service Act (42 

17 U.S.C. 254c–20(k)) is amended by striking ‘‘2026’’ and 

18 inserting ‘‘2025, and $11,000,000 for each of fiscal years 

19 2026 through 2028, to remain available until expended’’. 

20 SEC. 204. EXPANDING THE NUMBER OF PRIMARY CARE 

21 DOCTORS. 

22 Section 747 of the Public Health Service Act (42 

23 U.S.C. 293k), as amended by section 202, is further 

24 amended— 


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1 (1) by redesignating subsection (c) as sub2 section (d); and 

3 (2) by inserting after subsection (b) the fol4 lowing: 

5 ‘‘(c) EXPANDING THE NUMBER OF PRIMARY CARE

6 DOCTORS.— 

7 ‘‘(1) IN GENERAL.—The Secretary shall award 

8 grants to eligible medical schools described in para9 graph (2) for the purpose of graduating more physi10 cians who will practice a primary care discipline. 

11 Funds awarded under this subsection may be used 

12 for costs associated with faculty, construction and 

13 capital improvements, clinical support, research sup14 port, student supports, and any other costs, as de15 termined by the Secretary. 

16 ‘‘(2) ELIGIBILITY.—To be eligible to receive a 

17 grant under this subsection, a medical school shall— 

18 ‘‘(A) be a nonprofit school of medicine or 

19 osteopathic medicine that is accredited by a na20 tionally recognized accrediting agency or asso21 ciation; and 

22 ‘‘(B) demonstrate in the grant application 

23 of the medical school— 

24 ‘‘(i) that not less than 33 percent of 

25 graduates from the medical school enter 


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1 primary care and are, as of the date of the 

2 application, practicing primary care, as 

3 calculated by dividing— 

4 ‘‘(I) the number of physicians 

5 who graduated during such time pe6 riod as is specified by the Secretary 

7 who are practicing primary care; by 

8 ‘‘(II) the total number of physi9 cians who graduated during such time 

10 period; and 

11 ‘‘(ii) a plan to expand the number of 

12 graduates of the medical school who are 

13 practicing primary care; and 

14 ‘‘(iii) a commitment to use grant 

15 funds to supplement, not supplant, such 

16 school’s investment in primary care med17 ical education. 

18 ‘‘(3) EXPANDING THE NUMBER OF MINORITY

19 PRIMARY CARE DOCTORS.—Of the amounts appro20 priated under paragraph (6)(C), the Secretary shall 

21 awards not less than 20 percent to eligible medical 

22 schools described in paragraph (2) that are histori23 cally Black colleges and universities (as defined by 

24 the term ‘part B institution’ in section 322 of the 

25 Higher Education Act of 1965 (20 U.S.C. 1061) or 


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1 described in section 326(e)(1) of such Act (20 

2 U.S.C. 1063b(e)(1))) or other minority-serving insti3 tutions (as described in section 371(a) of the Higher 

4 Education Act of 1965 (20 U.S.C. 1067q(a))). 

5 ‘‘(4) GRANT AMOUNTS; GEOGRAPHIC DISTRIBU6 TION.— 

7 ‘‘(A) GRANT AMOUNTS.—The Secretary 

8 shall determine the amount of each grant 

9 awarded under this subsection, which shall be 

10 based on the scope of the plan submitted by the 

11 medical school under paragraph (2)(B)(ii), and 

12 other appropriate factors. 

13 ‘‘(B) GEOGRAPHIC DISTRIBUTION.—In 

14 awarding grants under this subsection, the Sec15 retary shall ensure, to the greatest extent prac16 ticable, that such grants are equitably distrib17 uted among the geographic regions of the 

18 United States. 

19 ‘‘(5) PRIMARY CARE.—In this subsection, the 

20 term ‘primary care’ means health care services re21 lated to family medicine, internal medicine, pediat22 rics, obstetrics, gynecology, geriatrics, or psychiatry. 

23 ‘‘(6) ACCOUNT TO ADDRESS THE PRIMARY

24 CARE PHYSICIAN SHORTAGE.— 


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1 ‘‘(A) ESTABLISHMENT OF ACCOUNT.— 

2 There is established in the Treasury an ac3 count, to be known as the ‘Account to Address 

4 the Primary Care Physician Shortage’ (referred 

5 to in this subsection as the ‘Account’), for pur6 poses of carrying out this subsection. 

7 ‘‘(B) TRANSFER OF DIRECT SPENDING.— 

8 ‘‘(i) IN GENERAL.—The Secretary of 

9 the Treasury shall transfer, from the gen10 eral fund of the Treasury, to the Account 

11 $300,000,000 for fiscal year 2024. 

12 ‘‘(ii) AMOUNTS DEPOSITED.—Any 

13 amounts transferred under clause (i) shall 

14 remain unavailable in the Account until 

15 such amounts are appropriated pursuant 

16 to subparagraph (C). 

17 ‘‘(C) APPROPRIATIONS.— 

18 ‘‘(i) AUTHORIZATION OF APPROPRIA19 TIONS.—For the period of fiscal years 

20 2024 through 2026, there is authorized to 

21 be appropriated from the Account to the 

22 Secretary, for the purpose of carrying out 

23 the activities under this subsection, an 

24 amount not to exceed the total amount 


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1 transferred to the Account under subpara2 graph (B)(i). 

3 ‘‘(ii) OFFSETTING FUTURE APPRO4 PRIATIONS.—For fiscal years 2024 

5 through 2026, for any discretionary appro6 priation under the heading ‘Account to Ad7 dress the Primary Care Physician Short8 age’ provided to the Secretary pursuant to 

9 the authorization of appropriations under 

10 clause (i) for the purpose of carrying out 

11 this subsection, the total amount of such 

12 appropriations for the applicable fiscal year 

13 (not to exceed the total amount remaining 

14 in the Account) shall be subtracted from 

15 the estimate of discretionary budget au16 thority and the resulting outlays for any 

17 estimate under the Congressional Budget 

18 and Impoundment Control Act of 1974 or 

19 the Balanced Budget and Emergency Def20 icit Control Act of 1985, and the amount 

21 transferred to the Account shall be reduced 

22 by the same amount. 

23 ‘‘(7) ANNUAL REPORTS.—Not later than Octo24 ber 1 of fiscal years 2025 through 2027, the Sec25 retary shall submit to the Committee on Health, 


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1 Education, Labor, and Pensions and the Committee 

2 on Appropriations of the Senate and the Committee 

3 on Energy and Commerce and the Committee on 

4 Appropriations of the House of Representatives, a 

5 report including a description of any use of funds 

6 provided pursuant to the authorization of appropria7 tions under paragraph (6)(C). 

8 ‘‘(8) LIMITATIONS.—Notwithstanding any 

9 transfer authority authorized by this subsection or 

10 any appropriations Act, any funds made available 

11 pursuant to the authorization of appropriations 

12 under paragraph (6)(C) may not be used for any 

13 purpose other than the program established under 

14 paragraph (1). 

15 ‘‘(9) SUNSET.—Amounts remaining unappropri16 ated in the Account under this subsection shall be 

17 transferred back to the general fund of the Treasury 

18 on October 1, 2026.’’. 

19 SEC. 205. NURSE EDUCATION, PRACTICE, QUALITY, AND RE20 TENTION GRANTS. 

21 (a) REAUTHORIZATION.—Section 831 of the Public 

22 Health Service Act (42 U.S.C. 296p) is amended by add23 ing at the end the following: 

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

25 carry out this section (other than subsection (e)), in addiVerDate Sep 11 2014 22:48 Nov 08, 2023 Jkt 049200 PO 00000 Frm 00030 Fmt 6652 Sfmt 6401 E:\BILLS\S2840.RS S2840

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1 tion to amounts made available under section 871(a), 

2 there are authorized to be appropriated $59,413,000 for 

3 each of fiscal years 2024 through 2026, to remain avail4 able until expended.’’. 

5 (b) EXPANDING ASSOCIATE DEGREE NURSING PRO6 GRAMS.—Section 831 of the Public Health Service Act (42 

7 U.S.C. 296p), as amended by subsection (a), is further 

8 amended— 

9 (1) by redesignating subsections (e) through (g) 

10 as subsections (f) through (h), respectively; and 

11 (2) by inserting after subsection (d) the fol12 lowing: 

13 ‘‘(e) SUPPLEMENTAL APPROPRIATIONS EXPANDING

14 ASSOCIATE DEGREE NURSING PROGRAMS.— 

15 ‘‘(1) AUTHORIZATION.—The Secretary shall 

16 award grants to institutions of higher education (as 

17 defined in section 101 of the Higher Education Act 

18 of 1965) offering an accredited registered nursing 

19 program at the associate degree level for the purpose 

20 of expanding the number of students enrolled in 

21 each such program. 

22 ‘‘(2) USE OF FUNDS.—A recipient of a grant 

23 under this subsection shall use the grant funds to 

24 expand the number of students enrolled in the re25 cipient’s accredited registered nursing program, 


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1 which may include increasing nurse faculty and 

2 nurse faculty salaries, expanding the number of 

3 qualified preceptors at clinical rotations sites, pro4 viding direct support for students, supporting part5 nerships with health facilities for clinical training, 

6 purchasing and training faculty to use distance 

7 learning technologies and simulation equipment, al8 teration, renovation, construction, equipment, and 

9 other capital improvement costs, and other projects 

10 determined appropriate by the Secretary. 

11 ‘‘(3) DETERMINATION OF NUMBER OF STU12 DENTS AND APPLICATION.—Each institution of 

13 higher education that offers a program described in 

14 paragraph (1) that desires to receive a grant under 

15 this subsection shall— 

16 ‘‘(A) provide documentation from the last 

17 4 academic years, or number of academic years 

18 the program has been accredited if less than 4, 

19 demonstrating the average percentage of indi20 viduals who graduated from the nursing degree 

21 program with an associate degree within 150 

22 percent of the expected completion time des23 ignated for the program; and 

24 ‘‘(B) submit an application to the Sec25 retary at such time, in such manner, and acVerDate Sep 11 2014 22:48 Nov 08, 2023 Jkt 049200 PO 00000 Frm 00032 Fmt 6652 Sfmt 6401 E:\BILLS\S2840.RS S2840

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1 companied by such information as the Secretary 

2 may require, including the average percent of 

3 individuals determined under subparagraph (A). 

4 ‘‘(4) DEFINITION.—For purposes of this sub5 section, the term ‘health facility’ means an Indian 

6 health service center, a Native Hawaiian health cen7 ter, a Federally qualified health center, a rural 

8 health clinic, a nursing home, a home health agency, 

9 a hospice program, a public health clinic, a State or 

10 local department of public health, a skilled nursing 

11 facility, or an ambulatory surgical center. 

12 ‘‘(5) ACCOUNT TO ADDRESS THE NURSING

13 WORKFORCE SHORTAGE.— 

14 ‘‘(A) ESTABLISHMENT OF ACCOUNT.— 

15 There is established in the Treasury an ac16 count, to be known as the ‘Account to Address 

17 the Nursing Workforce Shortage’ (referred to in 

18 this subsection as the ‘Account’), for purposes 

19 of carrying out this subsection, in addition to 

20 amounts otherwise made available, including 

21 under section 871(a). 

22 ‘‘(B) TRANSFER OF DIRECT SPENDING.— 

23 ‘‘(i) IN GENERAL.—The Secretary of 

24 the Treasury shall transfer, from the gen25 eral fund of the Treasury, to the Account 


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1 $240,000,000 for each of fiscal years 2024 

2 through 2028. 

3 ‘‘(ii) AMOUNTS DEPOSITED.—Any 

4 amounts transferred under clause (i) shall 

5 remain unavailable in the Account until 

6 such amounts are appropriated pursuant 

7 to subparagraph (C). 

8 ‘‘(C) APPROPRIATIONS.— 

9 ‘‘(i) AUTHORIZATION OF APPROPRIA10 TIONS.—For each of fiscal years 2024 

11 through 2028, there is authorized to be ap12 propriated from the Account to the Sec13 retary, for the purpose of carrying out the 

14 activities under this subsection, in addition 

15 to amounts otherwise made available for 

16 such purpose, an amount not to exceed the 

17 total amount transferred to the Account 

18 under subparagraph (B)(i). 

19 ‘‘(ii) OFFSETTING FUTURE APPRO20 PRIATIONS.—For any of fiscal years 2024 

21 through 2028, for any discretionary appro22 priation under the heading ‘Account to Ad23 dress the Nursing Workforce Shortage’ 

24 provided to the Secretary pursuant to the 

25 authorization of appropriations under 


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1 clause (i) for an additional amount for car2 rying out this subsection, the total amount 

3 of such appropriations for the applicable 

4 fiscal year (not to exceed the total amount 

5 remaining in the Account) shall be sub6 tracted from the estimate of discretionary 

7 budget authority and the resulting outlays 

8 for any estimate under the Congressional 

9 Budget and Impoundment Control Act of 

10 1974 or the Balanced Budget and Emer11 gency Deficit Control Act of 1985, and the 

12 amount transferred to the Account shall be 

13 reduced by the same amount. 

14 ‘‘(6) ANNUAL REPORTS.—Not later than Octo15 ber 1 of fiscal years 2025 through 2029, the Sec16 retary shall submit to the Committee on Health, 

17 Education, Labor, and Pensions and the Committee 

18 on Appropriations of the Senate and the Committee 

19 on Energy and Commerce and the Committee on 

20 Appropriations of the House of Representatives, a 

21 report including a description of any use of funds 

22 provided pursuant to the authorization of appropria23 tions under paragraph (5)(C). 

24 ‘‘(7) LIMITATIONS.—Notwithstanding any 

25 transfer authority authorized by this subsection or 


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1 any appropriations Act, any funds made available 

2 pursuant to the authorization of appropriations 

3 under paragraph (5)(C) may not be used for any 

4 purpose other than the program established under 

5 paragraph (1). 

6 ‘‘(8) SUNSET.—Amounts remaining unappropri7 ated in the Account under this subsection shall be 

8 transferred back to the general fund of the Treasury 

9 on October 1, 2028.’’. 

10 SEC. 206. NURSE FACULTY LOAN PROGRAM. 

11 Section 846A of the Public Health Service Act (42 

12 U.S.C. 297n–1), as amended by section 207, is amended 

13 by inserting after subsection (b) the following: 

14 ‘‘(c) FUNDING.— 

15 ‘‘(1) AUTHORIZATION OF APPROPRIATIONS.— 

16 ‘‘(A) IN GENERAL.—To carry out this sec17 tion (other than subsection (d)), in addition to 

18 amounts otherwise made available, including 

19 under section 871(b) and paragraph (2), there 

20 are authorized to be appropriated $28,500,000 

21 for each of fiscal years 2024 through 2026, to 

22 remain available until expended. 

23 ‘‘(2) ACCOUNT TO ADDRESS THE NURSE FAC24 ULTY WORKFORCE SHORTAGE.— 


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1 ‘‘(A) ESTABLISHMENT OF ACCOUNT.— 

2 There is established in the Treasury an ac3 count, to be known as the ‘Account to Address 

4 the Nurse Faculty Shortage’ (referred to in this 

5 paragraph as the ‘Account’), for purposes of 

6 carrying out this section (other than subsection 

7 (d)) in addition to amounts otherwise made 

8 available, including under section 871(b) and 

9 paragraph (1). 

10 ‘‘(B) TRANSFER OF DIRECT SPENDING.— 

11 ‘‘(i) IN GENERAL.—The Secretary of 

12 the Treasury shall transfer, from the gen13 eral fund of the Treasury, to the Account 

14 $57,000,000 for each of fiscal years 2024 

15 through 2026. 

16 ‘‘(ii) AMOUNTS DEPOSITED.—Any 

17 amounts transferred under clause (i) shall 

18 remain unavailable in the Account until 

19 such amounts are appropriated pursuant 

20 to subparagraph (C). 

21 ‘‘(C) APPROPRIATIONS.— 

22 ‘‘(i) AUTHORIZATION OF APPROPRIA23 TIONS.—For each of fiscal years 2024 

24 through 2026, there is authorized to be ap25 propriated from the Account to the SecVerDate Sep 11 2014 22:48 Nov 08, 2023 Jkt 049200 PO 00000 Frm 00037 Fmt 6652 Sfmt 6401 E:\BILLS\S2840.RS S2840

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1 retary, for the purpose of carrying out the 

2 activities under this section, in addition to 

3 amounts otherwise made available for such 

4 purpose, an amount not to exceed the total 

5 amount transferred to the Account under 

6 subparagraph (B)(i). 

7 ‘‘(ii) OFFSETTING FUTURE APPRO8 PRIATIONS.—For any of fiscal years 2024 

9 through 2026, for any discretionary appro10 priation under the heading ‘Account to Ad11 dress the Nurse Faculty Shortage’ pro12 vided to the Secretary pursuant to the au13 thorization of appropriations under clause 

14 (i) for an additional amount for carrying 

15 out this section, the total amount of such 

16 appropriations for the applicable fiscal year 

17 (not to exceed the total amount remaining 

18 in the Account) shall be subtracted from 

19 the estimate of discretionary budget au20 thority and the resulting outlays for any 

21 estimate under the Congressional Budget 

22 and Impoundment Control Act of 1974 or 

23 the Balanced Budget and Emergency Def24 icit Control Act of 1985, and the amount 


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1 transferred to the Account shall be reduced 

2 by the same amount. 

3 ‘‘(D) ANNUAL REPORTS.—Not later than 

4 October 1 of fiscal years 2025 through 2027, 

5 the Secretary shall submit to the Committee on 

6 Health, Education, Labor, and Pensions and 

7 the Committee on Appropriations of the Senate 

8 and the Committee on Energy and Commerce 

9 and the Committee on Appropriations of the 

10 House of Representatives, a report including a 

11 description of any use of funds provided pursu12 ant to the authorization of appropriations under 

13 subparagraph (C). 

14 ‘‘(E) LIMITATIONS.—Notwithstanding any 

15 transfer authority authorized by this paragraph 

16 or any appropriations Act, any funds made 

17 available pursuant to the authorization of ap18 propriations under subparagraph (C) may not 

19 be used for any purpose other than the program 

20 under this section. 

21 ‘‘(F) SUNSET.—Amounts remaining unap22 propriated in the Account under this paragraph 

23 shall be transferred back to the general fund of 

24 the Treasury on October 1, 2026.’’. 


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1 SEC. 207. NURSE FACULTY DEMONSTRATION PROGRAM. 

2 Section 846A of the Public Health Service Act (42 

3 U.S.C. 297n–1) is amended— 

4 (1) by amending subsection (a) to read as fol5 lows: 

6 ‘‘(a) IN GENERAL.—To increase the number of quali7 fied nursing faculty, the Secretary may— 

8 ‘‘(1) enter into an agreement with any accred9 ited school of nursing for the establishment and op10 eration of a student loan fund in accordance with 

11 subsection (b); and 

12 ‘‘(2) award nurse faculty grants in accordance 

13 with subsection (d).’’; 

14 (2) in subsection (b)— 

15 (A) by redesignating subparagraphs (A) 

16 through (D) of paragraph (2) as clauses (i) 

17 through (iv), respectively, and adjusting the 

18 margins accordingly; 

19 (B) by redesignating paragraphs (1) 

20 through (5) as subparagraphs (A) through (E), 

21 respectively, and adjusting the margins accord22 ingly; 

23 (C) in subparagraph (C), as so redesig24 nated, by striking ‘‘subsection (c)’’ and insert25 ing ‘‘paragraph (2)’’; and 


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1 (D) by striking ‘‘(b) AGREEMENTS—Each 

2 agreement entered into under subsection (a) 

3 shall—’’ and inserting the following: 

4 ‘‘(b) SCHOOL OF NURSING STUDENT LOAN FUND.— 

5 ‘‘(1) IN GENERAL.—Each agreement entered 

6 into under subsection (a)(1) shall—’’; 

7 (3) in subsection (c)— 

8 (A) by striking ‘‘subsection (a)’’ each place 

9 it appears and inserting ‘‘subsection (a)(1)’’; 

10 (B) in paragraph (3), by redesignating 

11 subparagraphs (A) and (B) as clauses (i) and 

12 (ii), respectively, and adjusting the margins ac13 cordingly; 

14 (C) in paragraph (6), by redesignating 

15 subparagraphs (A) and (B) as clauses (i) and 

16 (ii), respectively, and adjusting the margins ac17 cordingly; 

18 (D) by redesignating paragraphs (1) 

19 through (6) as subparagraphs (A) through (F), 

20 respectively, and adjusting the margins accord21 ingly; and 

22 (E) in subparagraph (F)(ii), as so redesig23 nated, by striking ‘‘subsection (e)’’ and insert24 ing ‘‘paragraph (4)’’; 


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1 (4) in subsection (e), by striking ‘‘subsection 

2 (c)(6)(B)’’ and inserting ‘‘paragraph (2)(F)(ii)’’; 

3 (5) by redesignating subsections (c) through (e) 

4 (before application of the amendment made by sec5 tion 206) as paragraphs (2) through (4), respec6 tively, and adjusting the margins accordingly; and 

7 (6) by adding after subsection (c), as added by 

8 section 206, the following: 

9 ‘‘(d) NURSE FACULTY DEMONSTRATION PRO10 GRAM.— 

11 ‘‘(1) IN GENERAL.—The Secretary shall estab12 lish and carry out a demonstration program de13 scribed in subsection (a)(2) under which eligible 

14 schools of nursing receive a grant for purposes of 

15 supplementing the salaries of eligible nursing faculty 

16 members to enhance recruitment and retention of 

17 nursing faculty members. 

18 ‘‘(2) ELIGIBLE ENTITIES.—To be eligible to re19 ceive a grant under this subsection, an entity shall— 

20 ‘‘(A) be an accredited school of nursing; 

21 and 

22 ‘‘(B) submit an application to the Sec23 retary, at such time, in such manner, and con24 taining such information as the Secretary may 

25 require, including— 


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1 ‘‘(i)(I) to the extent such information 

2 is available to the school of nursing, the 

3 salary history of nursing faculty at such 

4 school who previously were nurses in clin5 ical practice, for the most recent 3-year pe6 riod ending on the date of application, ad7 justed for inflation as appropriate and bro8 ken down by credentials, experience, and 

9 levels of education of such nurses; or 

10 ‘‘(II) if the information described in 

11 subclause (I) is not available, information 

12 on the average local salary of nurses in 

13 clinical practice, adjusted for inflation as 

14 appropriate and broken down by creden15 tials, experience, and levels of education of 

16 the individual nurses, in accordance with 

17 such requirements as the Secretary may 

18 specify; 

19 ‘‘(ii) an attestation of the average 

20 nursing faculty salary at the school of 

21 nursing during the most recent 3-year pe22 riod prior to the date of application, ad23 justed for inflation, as appropriate, broken 

24 down by credentials, experience, and levels 

25 of education of such faculty members; 


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1 ‘‘(iii) the number of nursing faculty 

2 member vacancies at the entity at the time 

3 of application, and the entity’s projection 

4 of such vacancies over the ensuing 5-year 

5 period; and 

6 ‘‘(iv) a description of the entity’s 

7 plans to identify funding sources to 

8 sustainably continue, after the 2-year 

9 grant period, the salary available to the eli10 gible nursing faculty member pursuant to 

11 the program under this subsection during 

12 such grant program and to retain eligible 

13 nursing faculty members after the end of 

14 the grant period. 

15 ‘‘(3) AWARDS.—A grant awarded under this 

16 subsection, with respect to supporting eligible nurs17 ing faculty members, shall— 

18 ‘‘(A) be awarded to the school of nursing 

19 to supplement the salaries of eligible faculty 

20 members at the school of nursing, annually, for 

21 up to a 2-year period, in an amount equal to, 

22 for each eligible nursing faculty member at the 

23 eligible entity during the grant period, the dif24 ference between— 


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1 ‘‘(i) the average salary of nurses in 

2 clinical practice submitted under subclause 

3 (I) or (II) of paragraph (2)(B)(i); and 

4 ‘‘(ii) the greater of— 

5 ‘‘(I) the salary for the eligible 

6 nursing faculty member at the school 

7 of nursing; or 

8 ‘‘(II) the average nursing faculty 

9 salary submitted under paragraph 

10 (2)(B)(ii) for faculty members with 

11 the same or similar credentials and 

12 level of education; 

13 ‘‘(B) notwithstanding section 803(a), be 

14 used in its entirety to supplement the eligible 

15 faculty member’s salary; and 

16 ‘‘(C) be conditioned upon the school of 

17 nursing maintaining, for each year in which the 

18 award is made as described in subparagraph 

19 (A), a salary for such faculty member at a level 

20 that is not less than the greater of the amount 

21 under subclause (I) or (II) of subparagraph 

22 (A)(ii). 

23 ‘‘(4) PRIORITY.—In awarding grants under this 

24 subsection, the Secretary shall ensure the equitable 

25 geographic distribution of awards, and shall give priVerDate Sep 11 2014 22:48 Nov 08, 2023 Jkt 049200 PO 00000 Frm 00045 Fmt 6652 Sfmt 6401 E:\BILLS\S2840.RS S2840

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1 ority to applications from schools of nursing that 

2 demonstrate— 

3 ‘‘(A) the greatest need for such grant, 

4 which may be based upon the financial cir5 cumstances of the school of nursing, eligible 

6 nurse faculty members, the planned number of 

7 students to be trained or admitted off a wait 

8 list; 

9 ‘‘(B) training or partnerships to serve vul10 nerable patient populations, such as through 

11 the location or activity of a school in a health 

12 professional shortage area (as defined in section 

13 332); 

14 ‘‘(C) recruitment and retention of faculty 

15 from underrepresented populations; or 

16 ‘‘(D) other particular need for such grant, 

17 including public institutions of higher education 

18 that offer 4-year degrees but at which the pre19 dominant degree awarded is an associate de20 gree. 

21 ‘‘(5) RULE OF CONSTRUCTION.—Nothing in 

22 this subsection precludes a school of nursing or an 

23 eligible nursing faculty member receiving an award 

24 under this section from obtaining or receiving any 

25 other form of Federal support or funding. 


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1 ‘‘(6) REPORT.—Not later than 3 years after the 

2 date of enactment of the Bipartisan Primary Care 

3 and Health Workforce Act, the Secretary shall sub4 mit to the Committee on Finance and the Com5 mittee on Health, Education, Labor, and Pensions 

6 of the Senate and the Committee on Ways and 

7 Means and the Committee on Energy and Commerce 

8 of the House of Representatives, a report that evalu9 ates the program established under this subsection, 

10 including— 

11 ‘‘(A) the impact of such program on re12 cruitment and retention rates of nursing fac13 ulty, as available, and specifically for each fac14 ulty member participating in the program; and 

15 ‘‘(B) recommendations and considerations 

16 for Congress on continuing the program under 

17 this subsection. 

18 ‘‘(7) DEFINITIONS.—In this subsection: 

19 ‘‘(A) ELIGIBLE NURSING FACULTY MEM20 BER.—The term ‘eligible nursing faculty mem21 ber’ means a nursing faculty member who— 

22 ‘‘(i) was hired by a school of nursing 

23 within the 2-year period preceding the sub24 mission of an application under paragraph 


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1 (2), or a prospective nursing faculty mem2 ber; 

3 ‘‘(ii) is currently employed at the 

4 school of nursing and who demonstrates 

5 the need for such support; 

6 ‘‘(iii) previously worked as a nurse in 

7 clinical practice or as a nurse faculty mem8 ber at another school of nursing; or 

9 ‘‘(iv) may work on a part-time basis 

10 as a nursing faculty member, for whom 

11 such award amounts described in para12 graph (3) shall be prorated relative to the 

13 amount of time participating in part-time 

14 teaching. 

15 ‘‘(B) INFLATION.—The term ‘inflation’ 

16 means the Consumer Price Index for all urban 

17 consumers (all items; U.S. city average). 

18 ‘‘(8) AUTHORIZATION OF APPROPRIATIONS.— 

19 To carry out this subsection, in addition to amounts 

20 otherwise available, including under section 871(b), 

21 there is authorized to be appropriated $15,000,000 

22 for each of fiscal years 2024 and 2025.’’. 


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1 SEC. 208. NURSE CORPS SCHOLARSHIP AND LOAN REPAY2 MENT PROGRAM. 

3 Section 846 of the Public Health Service Act (42 

4 U.S.C. 297n) is amended by adding at the end the fol5 lowing: 

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

7 carry out this section, in addition to amounts otherwise 

8 made available, including under section 871(b), there are 

9 authorized to be appropriated $93,600,000 for fiscal year 

10 2024, $94,600,000 for fiscal year 2025, and $95,600,000 

11 for fiscal year 2026, to remain available until expended.’’. 

12 SEC. 209. GRANTS FOR PRIMARY CARE NURSE RESIDENCY 

13 TRAINING PROGRAMS. 

14 Section 5316 of the Patient Protection and Afford15 able Care Act (42 U.S.C. 296j–1) is amended— 

16 (1) in the section heading, by striking ‘‘DEM17 ONSTRATION’’; 

18 (2) in subsection (a), by striking ‘‘demonstra19 tion’’; 

20 (3) in subsection (d)— 

21 (A) in paragraph (1)(B), by striking ‘‘and’’ 

22 at the end; 

23 (B) by redesignating paragraph (2) as 

24 paragraph (3); and 

25 (C) by inserting after paragraph (1) the 

26 following: 


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1 ‘‘(2)(A) in the case of an entity that does not 

2 have an established residency program for nurse 

3 practitioners at the time of the application, dem4 onstrate plans to establish a new residency program 

5 for nurse practitioners; or 

6 ‘‘(B) in the case of an entity that has an estab7 lished residency program for nurse practitioners at 

8 the time of the application, demonstrate plans to use 

9 the grant under this section to offer not fewer than 

10 4 additional residency positions for new nurse prac11 titioners to participate in such program; and’’; and 

12 (4) in subsection (i), by striking ‘‘such sums as 

13 may be necessary for each of fiscal years 2011 

14 through 2014’’ and inserting ‘‘$30,000,000 for each 

15 of fiscal years 2024 through 2026’’. 

16 SEC. 210. STATE ORAL HEALTH WORKFORCE IMPROVE17 MENT GRANT PROGRAM. 

18 Subsection (f) of section 340G of the Public Health 

19 Service Act (42 U.S.C. 256g) is amended by striking 

20 ‘‘$13,903,000 for each of fiscal years 2019 through 2023’’ 

21 and inserting ‘‘$15,200,000 for fiscal year 2024, 

22 $15,500,000 for fiscal year 2025, and $15,800,000 for fis23 cal year 2026, to remain available until expended’’. 


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1 SEC. 211. ORAL HEALTH TRAINING PROGRAMS. 

2 Subsection (f) of section 748 of the Public Health 

3 Service Act (42 U.S.C. 293k–2) is amended to read as 

4 follows: 

5 ‘‘(f) AUTHORIZATION OF APPROPRIATIONS.— 

6 ‘‘(1) IN GENERAL.—To carry out this section, 

7 there is authorized to be appropriated $28,500,000 

8 for fiscal year 2026, to remain available until ex9 pended. 

10 ‘‘(2) GEOGRAPHIC DISTRIBUTION.—In awarding 

11 grants under this section, the Secretary shall ensure, 

12 to the greatest extent practicable, that such grants 

13 are equitably distributed among the geographical re14 gions of the United States.’’. 

15 SEC. 212. ALLIED HEALTH PROFESSIONALS. 

16 (a) SUPPORTING DUAL OR CONCURRENT ENROLL17 MENT IN THE ALLIED HEALTH PROJECTS PROGRAM.— 

18 Section 755(b)(1) of the Public Health Service Act (42 

19 U.S.C. 294e(b)(1)) is amended— 

20 (1) in subparagraph (B), by striking ‘‘to indi21 viduals who have baccalaureate degrees in health-re22 lated sciences’’; 

23 (2) in the flush text at the end of subparagraph 

24 (I), by striking ‘‘; and’’ and inserting a semicolon; 

25 (3) in subparagraph (J), by striking the period 

26 and inserting ‘‘; and’’; and 


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1 (4) by adding at the end the following: 

2 ‘‘(K) those that establish or support a dual 

3 or concurrent enrollment program (as defined 

4 in section 8101 of the Elementary and Sec5 ondary Education Act of 1965) if the dual or 

6 concurrent enrollment program— 

7 ‘‘(i) provides outreach on allied health 

8 careers requiring an industry-recognized 

9 credential, a certificate, or an associate de10 gree, to all high schools served by the local 

11 educational agency that is a partner in the 

12 partnership offering the dual or concurrent 

13 enrollment program; 

14 ‘‘(ii) provides information to high 

15 school students about the training require16 ments and expected salary of allied health 

17 professions; and 

18 ‘‘(iii) provides academic and financial 

19 aid counseling to students who participate 

20 in the dual or concurrent enrollment pro21 gram.’’. 

22 (b) SUPPORTING DUAL OR CONCURRENT ENROLL23 MENT IN THE HEALTH CAREERS OPPORTUNITY PRO24 GRAM.—Section 739(a)(2) of the Public Health Service 

25 Act (42 U.S.C. 293c(a)(2)) is amended— 


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1 (1) in subparagraph (H), by striking ‘‘and’’ 

2 after the semicolon; 

3 (2) in subparagraph (I), by striking the period 

4 at the end and inserting ‘‘; and’’; and 

5 (3) by adding at the end the following: 

6 ‘‘(J) providing academic and financial aid 

7 counseling to support participation in a dual or 

8 concurrent enrollment program (as defined in 

9 section 8101 of the Elementary and Secondary 

10 Education Act of 1965) that leads to an indus11 try-recognized credential, a certificate, or an as12 sociate degree in the health professions or aca13 demic credits that can be transferred, as indi14 cated through an articulation agreement be15 tween 2 or more community colleges or univer16 sities, to obtain an industry-recognized creden17 tial, a certificate, or a degree in the health pro18 fessions.’’. 

19 (c) HEALTH CARE WORKFORCE INNOVATION PRO20 GRAM.—Section 755(b) of the Public Health Service Act 

21 (42 U.S.C. 294e(b)) is amended by adding at the end the 

22 following: 

23 ‘‘(5)(A) Supporting and developing new innova24 tive, community-driven approaches for the education 

25 and training of allied health professionals, including 


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1 those described in subparagraph (F)(i), with an em2 phasis on expanding the supply of such professionals 

3 located in, and meeting the needs of, underserved 

4 communities and rural areas. Grants under this 

5 paragraph shall be awarded through a new program 

6 (referred to as the ‘Health Care Workforce Innova7 tion Program’ or in this paragraph as the ‘Pro8 gram’). 

9 ‘‘(B) To be eligible to receive a grant under the 

10 Program an entity shall— 

11 ‘‘(i) be a Federally qualified health center 

12 (as defined in section 1905(l)(2)(B) of the So13 cial Security Act), a State-level association or 

14 other consortium that represents and is com15 prised of Federally qualified health centers, or 

16 a certified rural health clinic that meets the re17 quirements of section 334; and 

18 ‘‘(ii) submit to the Secretary an application 

19 that, at a minimum, contains— 

20 ‘‘(I) a description of how all trainees 

21 will be trained in accredited training pro22 grams either directly or through partner23 ships with public or nonprofit private enti24 ties; 


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1 ‘‘(II) a description of the community2 driven health care workforce innovation 

3 model to be carried out under the grant, 

4 including the specific professions to be 

5 funded; 

6 ‘‘(III) the geographic service area that 

7 will be served, including quantitative data, 

8 if available, showing that such particular 

9 area faces a shortage of health profes10 sionals and lacks access to health care; 

11 ‘‘(IV) a description of the benefits 

12 provided to each health care professional 

13 trained under the proposed model during 

14 the education and training phase; 

15 ‘‘(V) a description of the experience 

16 that the applicant has in the recruitment, 

17 retention, and promotion of the well-being 

18 of workers and volunteers; 

19 ‘‘(VI) a description of how the fund20 ing awarded under the Program will sup21 plement rather than supplant existing 

22 funding; 

23 ‘‘(VII) a description of the scalability 

24 and replicability of the community-driven 

25 approach to be funded under the Program; 


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1 ‘‘(VIII) a description of the infra2 structure, outreach and communication 

3 plan and other program support costs re4 quired to operationalize the proposed 

5 model; and 

6 ‘‘(IX) any other information, as the 

7 Secretary determines appropriate. 

8 ‘‘(C)(i) An entity shall use amounts received 

9 under a grant awarded under the Program to carry 

10 out the innovative, community-driven model de11 scribed in the application under subparagraph (B). 

12 Such amounts may be used for launching new or ex13 panding existing innovative health care professional 

14 partnerships, including the following specific uses: 

15 ‘‘(I) Establishing or expanding a partner16 ship between an eligible entity and 1 or more 

17 high schools, accredited public or nonprofit pri18 vate vocational-technical schools, accredited 

19 public or nonprofit private 2-year colleges, area 

20 health education centers, and entities with clin21 ical settings for the provision of education and 

22 training opportunities not available at the 

23 grantee’s facilities. 

24 ‘‘(II) Providing education and training 

25 programs to improve allied health professionals’ 


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1 readiness in settings that serve underserved 

2 communities and rural areas; encouraging stu3 dents from underserved and disadvantaged 

4 backgrounds and former patients to consider 

5 careers in health care, and better reflecting and 

6 meeting community needs; providing education 

7 and training programs for individuals to work 

8 in patient-centered, team-based, community9 driven health care models that include integra10 tion with other clinical practitioners and train11 ing in cultural and linguistic competence; pro12 viding pre-apprenticeship and apprenticeship 

13 programs for health care technical, support, 

14 and entry-level occupations, particularly for 

15 those enrolled in dual or concurrent enrollment 

16 programs; building a preceptorship training-to17 practice model for medical, behavioral health, 

18 oral health, and public health disciplines in an 

19 integrated, community-driven setting; providing 

20 and expanding internships, career ladders, and 

21 development opportunities for health care pro22 fessionals, including new and existing staff; or 

23 investing in training equipment, supplies, and 

24 limited renovations or retrofitting of training 


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1 space needed for grantees to carry out their 

2 particular model. 

3 ‘‘(ii) Amounts received under a grant awarded 

4 under the Program shall not be used to support con5 struction costs or to supplant funding from existing 

6 programs that support the applicant’s health work7 force. 

8 ‘‘(iii) Models funded under the Program shall 

9 be for a duration of at least 3 years. 

10 ‘‘(D) In awarding grants under the Program, 

11 the Secretary may give priority to applicants that 

12 will use grant funds to support workforce innovation 

13 models that increase the number of individuals from 

14 underserved and disadvantaged backgrounds work15 ing in such health care professions, improve access 

16 to health care (including medical, behavioral health 

17 and oral health) in underserved communities, or 

18 demonstrate that the model can be replicated in 

19 other underserved communities in a cost-efficient 

20 and effective manner to achieve the purposes of the 

21 Program. 

22 ‘‘(E) An entity that receives a grant under the 

23 Program shall provide periodic reports to the Sec24 retary detailing the findings and outcomes of the in25 novative, community-driven model carried out under 


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1 the grant. Such reports shall contain information in 

2 a manner and at such times as determined appro3 priate by the Secretary. 

4 ‘‘(F) In this paragraph: 

5 ‘‘(i) The term ‘allied health care profes6 sional’ includes individuals who provide clinical 

7 support services, including medical assistants, 

8 dental assistants, dental hygienists, pharmacy 

9 technicians, physical therapists and health care 

10 interpreters; individuals providing non-clinical 

11 support, such as billing and coding profes12 sionals and health information technology pro13 fessionals; dieticians; medical technologists; 

14 emergency medical technicians; community 

15 health workers; public health personnel; and 

16 peer support workers. 

17 ‘‘(ii) The term ‘rural area’ has the mean18 ing given such term by the Administrator of the 

19 Health Resources and Services Administration. 

20 ‘‘(iii) The term ‘underserved communities’ 

21 means areas, population groups, and facilities 

22 designated as health professional shortage areas 

23 under section 332, medically underserved areas 

24 as defined under section 330I(a)), or medically 


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1 underserved populations as defined under sec2 tion 330(b)(3). 

3 ‘‘(G)(i) There are authorized to be appropriated 

4 $100,000,000 for each of fiscal years 2024 through 

5 2026, to carry out this section, to remain available 

6 until expended. 

7 ‘‘(ii) A grant provided under the Program shall 

8 not exceed $2,500,000 for a grant period.’’. 

9 SEC. 213. BUDGETARY TREATMENT. 

10 (a) STATUTORY PAYGO SCORECARDS.—The budg11 etary effects of section 302 (including the amendments 

12 made by such section), up to $1,671,000,000, shall not 

13 be entered on either PAYGO scorecard maintained pursu14 ant to section 4(d) of the Statutory Pay As-You-Go Act 

15 of 2010 (2 U.S.C. 933(d)). 

16 (b) SENATE PAYGO SCORECARDS.—The budgetary 

17 effects of section 302 (including the amendments made by 

18 such section), up to $1,671,000,000, shall not be entered 

19 on any PAYGO scorecard maintained for purposes of sec20 tion 4106 of H. Con. Res. 71 (115th Congress). 

21 (c) RESERVATION OF SAVINGS.—None of the funds 

22 in the Account to Address the Primary Care Physician 

23 Shortage (established under section 747(c)(6) of the Pub24 lic Health Service Act, as amended by section 204), the 

25 Account to Address the Nursing Workforce Shortage (esVerDate Sep 11 2014 22:48 Nov 08, 2023 Jkt 049200 PO 00000 Frm 00060 Fmt 6652 Sfmt 6401 E:\BILLS\S2840.RS S2840

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1 tablished under section 831(e)(5) of the Public Health 

2 Service Act, as amended by section 205), or the Account 

3 to Address the Nurse Faculty Shortage (established under 

4 section 846A(c)(2) of the Public Health Service Act, as 

5 amended by section 206) shall be made available except 

6 to the extent provided in advance in appropriations Acts, 

7 and legislation or an Act that rescinds or reduces amounts 

8 in such accounts shall not be estimated as a reduction in 

9 direct spending under the Congressional Budget and Im10 poundment Control Act of 1974 or the Balanced Budget 

11 and Emergency Deficit Control Act of 1985. 

12 TITLE III—REDUCING HEALTH 

13 CARE COSTS FOR PATIENTS 

14 SEC. 301. BANNING ANTICOMPETITIVE TERMS IN FACILITY 

15 AND INSURANCE CONTRACTS THAT LIMIT AC16 CESS TO HIGHER QUALITY, LOWER COST 

17 CARE. 

18 (a) IN GENERAL.— 

19 (1) PUBLIC HEALTH SERVICE ACT.—Section 

20 2799A–9 of the Public Health Service Act (42 

21 U.S.C. 300gg–119) is amended— 

22 (A) by adding at the end the following: 

23 ‘‘(b) PROTECTING HEALTH PLANS NETWORK DE24 SIGN FLEXIBILITY.— 


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1 ‘‘(1) IN GENERAL.—A group health plan or a 

2 health insurance issuer offering group or individual 

3 health insurance coverage shall not enter into an 

4 agreement with a provider, network or association of 

5 providers, or other service provider offering access to 

6 a network of service providers if such agreement, di7 rectly or indirectly— 

8 ‘‘(A) restricts the group health plan or 

9 health insurance issuer from— 

10 ‘‘(i) directing or steering enrollees to 

11 other health care providers; or 

12 ‘‘(ii) offering incentives to encourage 

13 enrollees to utilize specific health care pro14 viders; 

15 ‘‘(B) requires the group health plan or 

16 health insurance issuer to enter into any addi17 tional contract with an affiliate of the provider 

18 as a condition of entering into a contract with 

19 such provider; 

20 ‘‘(C) requires the group health plan or 

21 health insurance issuer to agree to payment 

22 rates or other terms for any affiliate not party 

23 to the contract of the provider involved; or 

24 ‘‘(D) restricts other group health plans or 

25 health insurance issuers not party to the conVerDate Sep 11 2014 22:48 Nov 08, 2023 Jkt 049200 PO 00000 Frm 00062 Fmt 6652 Sfmt 6401 E:\BILLS\S2840.RS S2840

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1 tract from paying a lower rate for items or 

2 services than the contracting plan or issuer 

3 pays for such items or services. 

4 ‘‘(2) ADDITIONAL REQUIREMENT FOR SELF-IN5 SURED PLANS.—A self-insured group health plan 

6 shall not enter into an agreement with a provider, 

7 network or association of providers, third-party ad8 ministrator, or other service provider offering access 

9 to a network of providers if such agreement directly 

10 or indirectly requires the group health plan to cer11 tify, attest, or otherwise confirm in writing that the 

12 group health plan is bound by restrictive contracting 

13 terms between the service provider and a third-party 

14 administrator that the group health plan is not 

15 party to, without a disclosure that such terms exist. 

16 ‘‘(3) EXCEPTION FOR PLANS AND ISSUERS.— 

17 Paragraph (1)(A) shall not apply to a group health 

18 plan or health insurance issuer offering group or in19 dividual health insurance coverage with respect to— 

20 ‘‘(A) a health maintenance organization 

21 (as defined in section 2791(b)(3)), if such 

22 health maintenance organization operates pri23 marily through exclusive contracts with multi24 specialty physician groups, nor to any arrangeVerDate Sep 11 2014 22:48 Nov 08, 2023 Jkt 049200 PO 00000 Frm 00063 Fmt 6652 Sfmt 6401 E:\BILLS\S2840.RS S2840

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1 ment between such a health maintenance orga2 nization and its affiliates; or 

3 ‘‘(B) a value-based network arrangement, 

4 such as an exclusive provider network, account5 able care organization, center of excellence, a 

6 provider sponsored health insurance issuer that 

7 operates primarily through aligned multi-spe8 cialty physician group practices or integrated 

9 health systems, or such other similar network 

10 arrangements as determined by the Secretary 

11 through rulemaking. 

12 ‘‘(4) ATTESTATION.—A group health plan or 

13 health insurance issuer offering group or individual 

14 health insurance coverage shall annually submit to, 

15 as applicable, the applicable authority described in 

16 section 2723 or the Secretary of Labor or the Sec17 retary of the Treasury, an attestation that such plan 

18 or issuer is in compliance with the requirements of 

19 this subsection. 

20 ‘‘(5) RULE OF CONSTRUCTION.—Nothing in 

21 this subsection shall be construed to limit network 

22 design or cost or quality initiatives by a group health 

23 plan or health insurance issuer, including account24 able care organizations, exclusive provider organiza25 tions, networks that tier providers by cost or quality 


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1 or steer enrollees to centers of excellence, or other 

2 pay-for-performance programs. 

3 ‘‘(6) COMPLIANCE WITH RESPECT TO ANTI4 TRUST LAWS.—Compliance with this subsection does 

5 not constitute compliance with the antitrust laws, as 

6 defined in subsection (a) of the first section of the 

7 Clayton Act (15 U.S.C. 12(a)). 

8 ‘‘(7) GRANDFATHERING.—An applicable State 

9 authority may make a determination that the prohi10 bitions under paragraph (1) (with respect to condi11 tions that would direct or steer to, or offer incentives 

12 to encourage enrollees to use, other health care pro13 viders) will not apply in the State with respect to 

14 any specified agreement that is executed before the 

15 date of enactment of the Bipartisan Primary Care 

16 and Health Workforce Act, for a maximum length of 

17 nonapplicability of up to 10 years from the date of 

18 execution of the contract if the applicable State au19 thority determines that the contract is unlikely to 

20 significantly lessen competition. With respect to a 

21 specified agreement for which an applicable State 

22 authority has made a determination under the pre23 ceding sentence an applicable State authority may 

24 determine whether renewal of the contract, within 

25 the applicable 10-year period, is allowed.’’; and 


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1 (B) by redesignating paragraph (5) of sub2 section (a) as subsection (c), adjusting the mar3 gin of such subsection accordingly, and trans4 ferring such subsection (c) to appear after sub5 section (b), as added by subparagraph (A). 

6 (2) EMPLOYEE RETIREMENT INCOME SECURITY

7 ACT OF 1974.—Section 724 of the Employee Retire8 ment Income Security Act of 1974 (29 U.S.C. 

9 1185m) is amended— 

10 (A) by adding at the end the following: 

11 ‘‘(b) PROTECTING HEALTH PLANS NETWORK DE12 SIGN FLEXIBILITY.— 

13 ‘‘(1) IN GENERAL.—A group health plan or a 

14 health insurance issuer offering group health insur15 ance coverage shall not enter into an agreement with 

16 a provider, network or association of providers, or 

17 other service provider offering access to a network of 

18 service providers if such agreement, directly or indi19 rectly— 

20 ‘‘(A) restricts the group health plan or 

21 health insurance issuer from— 

22 ‘‘(i) directing or steering enrollees to 

23 other health care providers; or 


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1 ‘‘(ii) offering incentives to encourage 

2 enrollees to utilize specific health care pro3 viders; 

4 ‘‘(B) requires the group health plan or 

5 health insurance issuer to enter into any addi6 tional contract with an affiliate of the provider 

7 as a condition of entering into a contract with 

8 such provider; 

9 ‘‘(C) requires the group health plan or 

10 health insurance issuer to agree to payment 

11 rates or other terms for any affiliate not party 

12 to the contract of the provider involved; or 

13 ‘‘(D) restricts other group health plans or 

14 health insurance issuers not party to the con15 tract from paying a lower rate for items or 

16 services than the contracting plan or issuer 

17 pays for such items or services. 

18 ‘‘(2) ADDITIONAL REQUIREMENT FOR SELF-IN19 SURED PLANS.—A self-insured group health plan 

20 shall not enter into an agreement with a provider, 

21 network or association of providers, third-party ad22 ministrator, or other service provider offering access 

23 to a network of providers if such agreement directly 

24 or indirectly requires the group health plan to cer25 tify, attest, or otherwise confirm in writing that the 


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1 group health plan is bound by restrictive contracting 

2 terms between the service provider and a third-party 

3 administrator that the group health plan is not 

4 party to, without a disclosure that such terms exist. 

5 ‘‘(3) EXCEPTION FOR PLANS AND ISSUERS.— 

6 Paragraph (1)(A) shall not apply to a group health 

7 plan or health insurance issuer offering group health 

8 insurance coverage with respect to— 

9 ‘‘(A) a health maintenance organization 

10 (as defined in section 733(b)(3)), if such health 

11 maintenance organization operates primarily 

12 through exclusive contracts with multi-specialty 

13 physician groups, nor to any arrangement be14 tween such a health maintenance organization 

15 and its affiliates; or 

16 ‘‘(B) a value-based network arrangement, 

17 such as an exclusive provider network, account18 able care organization, center of excellence, a 

19 provider sponsored health insurance issuer that 

20 operates primarily through aligned multi-spe21 cialty physician group practices or integrated 

22 health systems, or such other similar network 

23 arrangements as determined by the Secretary 

24 through rulemaking. 


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1 ‘‘(4) ATTESTATION.—A group health plan or 

2 health insurance issuer offering group health insur3 ance coverage shall annually submit to, as applica4 ble, the applicable authority described in section 

5 2723 of the Public Health Service Act or the Sec6 retary of Labor or the Secretary of the Treasury, an 

7 attestation that such plan or issuer is in compliance 

8 with the requirements of this subsection. 

9 ‘‘(5) RULE OF CONSTRUCTION.—Nothing in 

10 this subsection shall be construed to limit network 

11 design or cost or quality initiatives by a group health 

12 plan or health insurance issuer, including account13 able care organizations, exclusive provider organiza14 tions, networks that tier providers by cost or quality 

15 or steer enrollees to centers of excellence, or other 

16 pay-for-performance programs. 

17 ‘‘(6) COMPLIANCE WITH RESPECT TO ANTI18 TRUST LAWS.—Compliance with this subsection does 

19 not constitute compliance with the antitrust laws, as 

20 defined in subsection (a) of the first section of the 

21 Clayton Act (15 U.S.C. 12(a)). 

22 ‘‘(7) GRANDFATHERING.—An applicable State 

23 authority may make a determination that the prohi24 bitions under paragraph (1) (with respect to condi25 tions that would direct or steer to, or offer incentives 


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1 to encourage enrollees to use, other health care pro2 viders) will not apply in the State with respect to 

3 any specified agreement that is executed before the 

4 date of enactment of the Bipartisan Primary Care 

5 and Health Workforce Act, for a maximum length of 

6 nonapplicability of up to 10 years from the date of 

7 execution of the contract if the applicable State au8 thority determines that the contract is unlikely to 

9 significantly lessen competition. With respect to a 

10 specified agreement for which an applicable State 

11 authority has made a determination under the pre12 ceding sentence an applicable State authority may 

13 determine whether renewal of the contract, within 

14 the applicable 10-year period, is allowed.’’; and 

15 (B) by redesignating paragraph (4) of sub16 section (a) as subsection (c), adjusting the mar17 gin of such subsection accordingly, and trans18 ferring such subsection (c) to appear after sub19 section (b), as added by subparagraph (A). 

20 (3) INTERNAL REVENUE CODE OF 1986.—Sec21 tion 9824 of the Internal Revenue Code of 1986 is 

22 amended— 

23 (A) by adding at the end the following: 

24 ‘‘(b) PROTECTING HEALTH PLANS NETWORK DE25 SIGN FLEXIBILITY.— 


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1 ‘‘(1) IN GENERAL.—A group health plan shall 

2 not enter into an agreement with a provider, net3 work or association of providers, or other service 

4 provider offering access to a network of service pro5 viders if such agreement, directly or indirectly— 

6 ‘‘(A) restricts the group health plan 

7 from— 

8 ‘‘(i) directing or steering enrollees to 

9 other health care providers; or 

10 ‘‘(ii) offering incentives to encourage 

11 enrollees to utilize specific health care pro12 viders; 

13 ‘‘(B) requires the group health plan to 

14 enter into any additional contract with an affil15 iate of the provider as a condition of entering 

16 into a contract with such provider; 

17 ‘‘(C) requires the group health plan to 

18 agree to payment rates or other terms for any 

19 affiliate not party to the contract of the pro20 vider involved; or 

21 ‘‘(D) restricts other group health plans not 

22 party to the contract from paying a lower rate 

23 for items or services than the contracting plan 

24 pays for such items or services. 


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1 ‘‘(2) ADDITIONAL REQUIREMENT FOR SELF-IN2 SURED PLANS.—A self-insured group health plan 

3 shall not enter into an agreement with a provider, 

4 network or association of providers, third-party ad5 ministrator, or other service provider offering access 

6 to a network of providers if such agreement directly 

7 or indirectly requires the group health plan to cer8 tify, attest, or otherwise confirm in writing that the 

9 group health plan is bound by restrictive contracting 

10 terms between the service provider and a third-party 

11 administrator that the group health plan is not 

12 party to, without a disclosure that such terms exist. 

13 ‘‘(3) EXCEPTION FOR CERTAIN PLANS.—Para14 graph (1)(A) shall not apply to a group health plan 

15 with respect to— 

16 ‘‘(A) a health maintenance organization 

17 (as defined in section 9832(b)(3)), if such 

18 health maintenance organization operates pri19 marily through exclusive contracts with multi20 specialty physician groups, nor to any arrange21 ment between such a health maintenance orga22 nization and its affiliates; or 

23 ‘‘(B) a value-based network arrangement, 

24 such as an exclusive provider network, account25 able care organization, center of excellence, a 


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1 provider sponsored health insurance issuer that 

2 operates primarily through aligned multi-spe3 cialty physician group practices or integrated 

4 health systems, or such other similar network 

5 arrangements as determined by the Secretary 

6 through rulemaking. 

7 ‘‘(4) ATTESTATION.—A group health plan shall 

8 annually submit to, as applicable, the applicable au9 thority described in section 2723 of the Public 

10 Health Service Act or the Secretary of Labor or the 

11 Secretary of the Treasury, an attestation that such 

12 plan is in compliance with the requirements of this 

13 subsection. 

14 ‘‘(5) RULE OF CONSTRUCTION.—Nothing in 

15 this subsection shall be construed to limit network 

16 design or cost or quality initiatives by a group health 

17 plan, including accountable care organizations, ex18 clusive provider organizations, networks that tier 

19 providers by cost or quality or steer enrollees to cen20 ters of excellence, or other pay-for-performance pro21 grams. 

22 ‘‘(6) COMPLIANCE WITH RESPECT TO ANTI23 TRUST LAWS.—Compliance with this subsection does 

24 not constitute compliance with the antitrust laws, as 


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1 defined in subsection (a) of the first section of the 

2 Clayton Act (15 U.S.C. 12(a)). 

3 ‘‘(7) GRANDFATHERING.—An applicable State 

4 authority may make a determination that the prohi5 bitions under paragraph (1) (with respect to condi6 tions that would direct or steer to, or offer incentives 

7 to encourage enrollees to use, other health care pro8 viders) will not apply in the State with respect to 

9 any specified agreement that is executed before the 

10 date of enactment of the Bipartisan Primary Care 

11 and Health Workforce Act, for a maximum length of 

12 nonapplicability of up to 10 years from the date of 

13 execution of the contract if the applicable State au14 thority determines that the contract is unlikely to 

15 significantly lessen competition. With respect to a 

16 specified agreement for which an applicable State 

17 authority has made a determination under the pre18 ceding sentence an applicable State authority may 

19 determine whether renewal of the contract, within 

20 the applicable 10-year period, is allowed.’’; and 

21 (B) by redesignating paragraph (4) of sub22 section (a) as subsection (c), adjusting the mar23 gin of such subsection accordingly, and trans24 ferring such subsection (c) to appear after sub25 section (b), as added by subparagraph (A). 


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1 (b) REGULATIONS.—Not later than 1 year after the 

2 date of enactment of this Act, the Secretary of Health and 

3 Human Services, the Secretary of Labor, and the Sec4 retary of the Treasury, jointly, shall promulgate regula5 tions to carry out section 2799A–9(b) of the Public Health 

6 Service Act, section 724(b) of the Employee Retirement 

7 Income Security Act of 1974, and section 9824(b) of the 

8 Internal Revenue Code of 1986, as added by subsection 

9 (a). 

10 (c) EFFECTIVE DATE.—Subsection (b) of section 

11 2799A–9 of the Public Health Service Act, subsection (b) 

12 of section 724 of the Employee Retirement Income Secu13 rity Act of 1974, and subsection (b) of section 9824 of 

14 the Internal Revenue Code of 1986 (as added by para15 graphs (1), (2), and (3), respectively, of subsection (a)) 

16 shall apply with respect to any contract entered into on 

17 or after the date that is 18 months after the date of enact18 ment of this Act. With respect to an applicable contract 

19 that is in effect on the date of enactment of this Act, such 

20 subsection (b) shall apply on the earlier of the date of re21 newal of such contract or 3 years after such date of enact22 ment. 


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1 SEC. 302. HONEST BILLING REQUIREMENTS APPLICABLE 

2 TO PROVIDERS. 

3 (a) GROUP HEALTH PLAN AND HEALTH INSURANCE

4 ISSUER REQUIREMENTS.— 

5 (1) PUBLIC HEALTH SERVICE ACT.—Part D of 

6 title XXVII of the Public Health Service Act (42 

7 U.S.C. 300gg–111 et seq.) is amended by adding at 

8 the end the following: 

9 ‘‘SEC. 2799A–11. HONEST BILLING REQUIREMENTS APPLICA10 BLE TO PLANS AND ISSUERS. 

11 ‘‘A group health plan or health insurance issuer offer12 ing group or individual health insurance coverage may not 

13 pay a claim for items and services furnished on or after 

14 January 1, 2026, to an individual at an off-campus out15 patient department of a provider (as defined in section 

16 2799B–10(b))) submitted by a health care provider or fa17 cility unless such claim submitted by such provider or fa18 cility includes a separate unique health identifier for the 

19 department where items and services were furnished, in 

20 accordance with section 2799B–10.’’. 

21 (2) EMPLOYEE RETIREMENT INCOME SECURITY

22 ACT OF 1974.— 

23 (A) IN GENERAL.—Subpart B of part 7 of 

24 subtitle B of title I of the Employee Retirement 

25 Income Security Act of 1974 (29 U.S.C. 1185 


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1 et seq.) is amended by adding at the end the 

2 following: 

3 ‘‘SEC. 726. HONEST BILLING REQUIREMENTS APPLICABLE 

4 TO PLANS AND ISSUERS. 

5 ‘‘A group health plan or health insurance issuer offer6 ing group health insurance coverage may not pay a claim 

7 for items and services furnished on or after January 1, 

8 2026, to an individual at an off-campus outpatient depart9 ment of a provider (as defined in section 2799B–10(b)) 

10 of the Public Health Service Act) submitted by a health 

11 care provider or facility unless such claim submitted by 

12 such provider or facility includes a separate unique health 

13 identifier for the department where items and services 

14 were furnished, in accordance with section 2799B–10 of 

15 such Act.’’. 

16 (B) CLERICAL AMENDMENT.—The table of 

17 contents in section 1 of the Employee Retire18 ment Income Security Act of 1974 (29 U.S.C. 

19 1001 et seq.) is amended by inserting after the 

20 item relating to section 725 the following new 

21 item: 

‘‘Sec. 726. Honest billing requirements applicable to plans and issuers.’’. 

22 (3) INTERNAL REVENUE CODE OF 1986.— 

23 (A) IN GENERAL.—Subchapter B of chap24 ter 100 of the Internal Revenue Code of 1986 

25 is amended by adding at the end the following: 


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1 ‘‘SEC. 9826. HONEST BILLING REQUIREMENTS APPLICABLE 

2 TO PLANS. 

3 ‘‘A group health plan may not pay a claim for items 

4 and services furnished on or after January 1, 2026, to 

5 an individual at an off-campus outpatient department of 

6 a provider (as defined in section 2799B–10(b)) of the 

7 Public Health Service Act) submitted by a health care pro8 vider or facility unless such claim submitted by such pro9 vider or facility includes a separate unique health identi10 fier for the department where items and services were fur11 nished, in accordance with section 2799B–10 of such 

12 Act.’’. 

13 (B) CLERICAL AMENDMENT.—The table of 

14 sections for subchapter B of chapter 100 of the 

15 Internal Revenue Code of 1986 is amended by 

16 adding at the end the following new item: 

‘‘Sec. 9826. Honest billing requirements applicable to plans.’’. 

17 (b) REQUIRING A SEPARATE IDENTIFICATION NUM18 BER AND AN ATTESTATION FOR EACH OFF-CAMPUS OUT19 PATIENT DEPARTMENT OF A PROVIDER.— 

20 (1) IN GENERAL.—Part E of title XXVII of the 

21 Public Health Service Act (42 U.S.C. 300gg–131 et 

22 seq.) is amended by adding at the end the following: 


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1 ‘‘SEC. 2799B–10. HONEST BILLING REQUIREMENTS APPLI2 CABLE TO PROVIDERS. 

3 ‘‘(a) REQUIREMENTS RELATING TO UNIQUE

4 HEALTH IDENTIFIERS.—For items and services fur5 nished, on or after January 1, 2026, at an off-campus out6 patient department of a provider to a participant, bene7 ficiary, or enrollee with benefits under a group health plan 

8 or group or individual health insurance coverage offered 

9 by a health insurance issuer, a health care provider or fa10 cility may not submit a claim to the group health plan 

11 or health insurance issuer, bill the participant, beneficiary, 

12 or enrollee, or hold liable the participant, beneficiary, or 

13 enrollee, unless— 

14 ‘‘(1) such provider or facility obtains a separate 

15 unique health identifier established for such depart16 ment pursuant to section 1173(b) of the Social Se17 curity Act; and 

18 ‘‘(2) such items and services are billed using 

19 the separate unique health identifier established for 

20 such department pursuant to paragraph (1). 

21 ‘‘(b) OFF-CAMPUS OUTPATIENT DEPARTMENT OF A

22 PROVIDER.—The term ‘off-campus outpatient department 

23 of a provider’ means a department of a provider (as de24 fined in section 413.65(a)(2) of title 42 of the Code of 

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1 ment of the Bipartisan Primary Care and Health Work2 force Act) that is not located— 

3 ‘‘(1) on the campus (as defined in such section 

4 413.65(a)(2)) of such provider; or 

5 ‘‘(2) within the distance (described in such defi6 nition of campus) from a remote location of a hos7 pital (as defined in such section 413.65(a)(2)). 

8 ‘‘(c) PROCESS FOR REPORTING SUSPECTED VIOLA9 TIONS.—The Secretary shall establish a process under 

10 which a suspected violation of this section may be reported 

11 to such Secretary. 

12 ‘‘(d) PENALTIES.—The Secretary may assess a civil 

13 monetary penalty against a hospital for a violation under 

14 this section in an amount— 

15 ‘‘(1) in the case of a hospital with not more 

16 than 30 beds (as determined under section 

17 180.90(c)(2)(ii)(D) of title 45, Code of Federal Reg18 ulations, as in effect on the date of the enactment 

19 of the Bipartisan Primary Care and Health Work20 force Act (or any successor regulations)), not to ex21 ceed $300 per day that the violation is ongoing, as 

22 determined by the Secretary; and 

23 ‘‘(2) in the case of a hospital with more than 

24 30 beds (as so determined), not to exceed $5,500 


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1 per day that the violation is ongoing, as determined 

2 by the Secretary.’’. 

3 (2) CONFORMING AMENDMENT.—Section 

4 2799B–4(a)(1) of the Public Health Service Act (42 

5 U.S.C. 300gg–134(a)(1)) is amended by inserting 

6 ‘‘(other than section 2799B–10)’’ after ‘‘this part’’. 

7 SEC. 303. BANNING FACILITY FEES FOR CERTAIN SERV8 ICES. 

9 Part E of title XXVII of the Public Health Service 

10 Act (42 U.S.C. 300gg–131 et seq.), as amended by section 

11 302(b), is further amended by adding at the end the fol12 lowing: 

13 ‘‘SEC. 2799B–11. BANNING FACILITY FEES FOR CERTAIN 

14 SERVICES. 

15 ‘‘(a) IN GENERAL.—With respect to applicable items 

16 and services furnished to an individual on or after January 

17 1, 2026, a health care provider or facility may not charge 

18 a facility fee (regardless of how the fee is labeled) to a 

19 group health plan, a health insurance issuer offering 

20 group or individual health insurance coverage, a partici21 pant, beneficiary, or enrollee in such a plan or coverage, 

22 or an individual patient who is not covered by a group 

23 health plan, health insurance coverage, or a Federal health 

24 care program (as defined in section 1128(f) of the Social 

25 Security Act). 


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1 ‘‘(b) APPLICABLE ITEMS AND SERVICES.—In this 

2 section, the term ‘applicable items and services’ means— 

3 ‘‘(1) evaluation and management services de4 scribed in section 1833(cc)(1)(B)(i) of the Social Se5 curity Act; 

6 ‘‘(2) outpatient behavioral health services (not 

7 including partial hospitalizations, intensive out8 patient program services, and other services not 

9 typically provided in an office setting (as the Sec10 retary may determine)); and 

11 ‘‘(3) any items and services (including the items 

12 and services described in paragraphs (1) and (2)) 

13 furnished via telehealth.’’. 

14 SEC. 304. PREVENTION AND PUBLIC HEALTH FUND. 

15 Section 4002(b) of the Patient Protection and Af16 fordable Care Act (42 U.S.C. 300u–11(b)) is amended by 

17 striking paragraphs (8) through (10) and inserting the fol18 lowing: 

19 ‘‘(8) for each of fiscal years 2026 and 2027, 

20 $1,425,000,000; 

21 ‘‘(9) for each of fiscal years 2028 and 2029, 

22 $1,495,000,000; 

23 ‘‘(10) for fiscal year 2030, $1,680,000,000; and 

24 ‘‘(11) for fiscal year 2031 and each fiscal year 

25 thereafter, $2,000,000,000.’’. 


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1 SECTION 1. SHORT TITLE; TABLE OF CONTENTS. 

2 (a) SHORT TITLE.—This Act may be cited as the ‘‘Bi3 partisan Primary Care and Health Workforce Act’’. 

4 (b) TABLE OF CONTENTS.—The table of contents for 

5 this Act is as follows: 

Sec. 1. Short title; table of contents. 

TITLE I—EXTENSION FOR COMMUNITY HEALTH CENTERS, THE NATIONAL HEALTH SERVICE CORPS, AND TEACHING HEALTH CENTERS THAT OPERATE GME PROGRAMS 

Sec. 101. Programs of payments to teaching health centers that operate graduate 

medical education programs. 

Sec. 102. Community health centers. 

Sec. 103. National Health Service Corps. 

Sec. 104. GAO report. 

Sec. 105. OIG report. 

Sec. 106. Application of provisions. 

TITLE II—SUPPORTING THE HEALTH CARE WORKFORCE 

Sec. 201. Rural residency planning and development program. 

Sec. 202. Primary care training and enhancement program. 

Sec. 203. Telehealth technology-enabled learning program. 

Sec. 204. Nurse education, practice, quality, and retention grants and contracts. 

Sec. 205. Nurse faculty loan program. 

Sec. 206. Nurse faculty demonstration program. 

Sec. 207. Nurse corps scholarship and loan repayment program. 

Sec. 208. Grants for primary care nurse residency training programs. 

Sec. 209. State oral health workforce improvement grant program. 

Sec. 210. Oral health training programs. 

Sec. 211. Allied health professionals. 

Sec. 212. Review of and report on programs supporting the nursing workforce. 

Sec. 213. Report on impacts to community health centers. 

TITLE III—REDUCING HEALTH CARE COSTS FOR PATIENTS 

Sec. 301. Banning anticompetitive terms in facility and insurance contracts that 

limit access to higher quality, lower cost care. 

Sec. 302. Honest billing requirements applicable to providers. 

Sec. 303. Banning facility fees for certain services. 

Sec. 304. Prevention and Public Health Fund. 

Sec. 305. Price transparency requirements. 

Sec. 306. Publication of list of hospitals. 


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1 TITLE I—EXTENSION FOR COM2 MUNITY HEALTH CENTERS, 

3 THE NATIONAL HEALTH 

4 SERVICE CORPS, AND TEACH5 ING HEALTH CENTERS THAT 

6 OPERATE GME PROGRAMS 

7 SEC. 101. PROGRAMS OF PAYMENTS TO TEACHING HEALTH 

8 CENTERS THAT OPERATE GRADUATE MED9 ICAL EDUCATION PROGRAMS. 

10 (a) FUNDING.—Section 340H(g)(1) of the Public 

11 Health Service Act (42 U.S.C. 256h(g)(1)) is amended— 

12 (1) by striking ‘‘such sums as may be necessary, 

13 not to exceed’’; 

14 (2) by striking ‘‘2017, and’’ and inserting 

15 ‘‘2017,’’; and 

16 (3) by inserting ‘‘and $300,000,000 for each of 

17 fiscal years 2024 through 2028,’’ after ‘‘2023,’’. 

18 (b) PER RESIDENT AMOUNT.—Section 340H(a)(2) of 

19 the Public Health Service Act (42 U.S.C. 256h(a)(2)) is 

20 amended by adding at the end the following: ‘‘Beginning 

21 in fiscal year 2024, in accordance with paragraph (1), but 

22 notwithstanding the capped amount referenced in sub23 sections (b)(2) and (d)(2), the qualified teaching health cen24 ter per resident amount for a fiscal year shall be not less 


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1 than $10,000 more than the qualified teaching health center 

2 per resident amount for the prior fiscal year.’’. 

3 (c) AMOUNT OF PAYMENTS.—Section 340H of the Pub4 lic Health Service Act (42 U.S.C. 256h) is amended— 

5 (1) in subsection (b)(2)— 

6 (A) in subparagraph (A), by striking 

7 ‘‘amount of funds appropriated under subsection 

8 (g) for such payments for that fiscal year’’ and 

9 inserting ‘‘total amount of funds available under 

10 subsection (g) and any amounts recouped under 

11 subsection (f)’’; and 

12 (B) in subparagraph (B), by striking ‘‘ap13 propriated in a fiscal year under subsection (g)’’ 

14 and inserting ‘‘available under subsection (g) 

15 and any amounts recouped under subsection (f)’’; 

16 and 

17 (2) in subsection (d)(2)(B), by striking ‘‘amount 

18 appropriated for such expenses as determined in sub19 section (g)’’ and inserting ‘‘total amount of funds 

20 available under subsection (g) and any amounts re21 couped under subsection (f)’’. 

22 (d) PRIORITY PAYMENTS.—Section 340H(a)(3) of 

23 Public Health Service Act (42 U.S.C. 256h(a)(3)) is amend24 ed— 


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1 (1) in subparagraph (A), by striking ‘‘; or’’ and 

2 inserting a semicolon; 

3 (2) in subparagraph (B), by striking the period 

4 and inserting ‘‘; or’’; and 

5 (3) by adding at the end the following: 

6 ‘‘(C) are located in a State that does not al7 ready have a qualified teaching health center re8 ceiving funding under this section.’’. 

9 (e) REPORTING REQUIREMENTS.—Section 340H(h)(1) 

10 of the Public Health Service Act (42 U.S.C. 256h(h)(1)) is 

11 amended— 

12 (1) by redesignating subparagraph (H) as sub13 paragraph (I); and 

14 (2) by inserting after subparagraph (G) the fol15 lowing: 

16 ‘‘(H) Of the number of residents described 

17 in paragraph (4) who completed their residency 

18 training, the number practicing primary care 

19 (meaning any of the areas of practice listed in 

20 the definition of a primary care residency pro21 gram in section 749A) 5 years following comple22 tion of such training.’’. 

23 (f) GUIDANCE.—The Secretary shall update guidance 

24 and relevant information regarding States described in sub25 paragraph (C) of section 340H(a)(3) of the Public Health 


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1 Service Act (42 U.S.C. 256h(a)(3)), as amended by sub2 section (d), and make available model templates to assist 

3 health centers in such States in establishing a teaching 

4 health center. 

5 SEC. 102. COMMUNITY HEALTH CENTERS. 

6 (a) COMMUNITY HEALTH CENTER FUND.—Section 

7 10503 of the Patient Protection and Affordable Care Act 

8 (42 U.S.C. 254b–2) is amended— 

9 (1) in subsection (b)(1)(F)— 

10 (A) by striking ‘‘2018 and’’ and inserting 

11 ‘‘2018,’’; and 

12 (B) by inserting before the semicolon the fol13 lowing: ‘‘, and $5,800,000,000 for each of fiscal 

14 years 2024 through 2026’’; and 

15 (2) by adding at the end the following: 

16 ‘‘(f) PRIORITY USE OF FUNDS.—For fiscal years 2024 

17 through 2026, with respect to $1,800,000,000 of the amount 

18 appropriated under subsection (b)(1)(F), the Secretary shall 

19 prioritize awards to entities for purposes of— 

20 ‘‘(1) increasing the number of low-income pa21 tients not enrolled in a group health plan or group 

22 or individual health insurance coverage who are 

23 served by health centers, including through Health 

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1 tion 330(e)(6) of the Public Health Service Act, in2 cluding school-based service sites; 

3 ‘‘(2) increasing the required primary health serv4 ices described in paragraph (1)(A)(i) of section 330(b) 

5 of the Public Health Service Act and additional 

6 health services (as defined in paragraph (2) of such 

7 section) offered by health centers; and 

8 ‘‘(3) increasing patient case management, ena9 bling services, and education services, as described in 

10 clauses (iii) through (v) of section 330(b)(1)(A) of the 

11 Public Health Service Act.’’. 

12 (b) AUTHORIZATION OF APPROPRIATIONS.—Section 

13 330(r)(1) of the Public Health Service Act (42 U.S.C. 

14 254b(r)(1)) is amended— 

15 (1) in subparagraph (G), by striking ‘‘fiscal year 

16 2016, and each subsequent fiscal year’’ and inserting 

17 ‘‘each of fiscal years 2016 through 2023’’; and 

18 (2) by adding at the end the following: 

19 ‘‘(H) For each of fiscal years 2024 through 

20 2026, $2,200,000,000. 

21 ‘‘(I) For fiscal year 2027, and each subse22 quent fiscal year, the amount appropriated for 

23 the preceding fiscal year adjusted by the product 

24 of— 


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1 ‘‘(i) one plus the average percentage 

2 increase in costs incurred per patient 

3 served; and 

4 ‘‘(ii) one plus the average percentage 

5 increase in the total number of patients 

6 served.’’. 

7 (c) ALLOCATION OF FUNDS.—Section 10503 of the Pa8 tient Protection and Affordable Care Act (42 U.S.C. 254b– 

9 2), as amended by subsection (a), is further amended by 

10 adding at the end the following: 

11 ‘‘(g) ALLOCATION OF FUNDS.—For each of fiscal years 

12 2024 through 2026, of the amounts appropriated under sub13 section (b)(1)(F) for a fiscal year, the Secretary shall use— 

14 ‘‘(1) at least $245,000,000 for awards to support 

15 health centers in each State that are receiving awards 

16 under section 330 of the Public Health Service Act in 

17 extending operating hours, in an amount determined 

18 pursuant to a formula and eligibility criteria devel19 oped by the Secretary, for the purposes of increasing 

20 access to services; 

21 ‘‘(2) at least $55,000,000 for awards under this 

22 section for health centers to expand school-based serv23 ices and establish new school-based service sites; and 

24 ‘‘(3) such sums as may be necessary for purposes 

25 of increasing the amount awarded pursuant to grants 


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1 or cooperative agreements under section 330 of the 

2 Public Health Service Act so that each recipient of 

3 such an award receives— 

4 ‘‘(A) for fiscal year 2024, at least 15 per5 cent more than such recipient received for fiscal 

6 year 2023; and 

7 ‘‘(B) for each of fiscal years 2025 and 2026, 

8 the amount received in the previous year ad9 justed by— 

10 ‘‘(i) the percent increase in the medical 

11 component of the consumer price index for 

12 the most recent 12-month period for which 

13 applicable data is available; plus 

14 ‘‘(ii) one percent.’’. 

15 (d) CAPITAL FUNDING.—Section 10503(c) of the Pa16 tient Protection and Affordable Care Act (42 U.S.C. 254b– 

17 2(c)) is amended— 

18 (1) in the subsection heading, by inserting ‘‘; 

19 CAPITAL FUNDING’’ after ‘‘CONSTRUCTION’’; 

20 (2) by striking ‘‘There is’’ and inserting the fol21 lowing: 

22 ‘‘(1) CONSTRUCTION.—There is’’; and 

23 (3) by adding at the end the following: 

24 ‘‘(2) CAPITAL FUNDING.—For the alteration, ren25 ovation, construction, equipment, and other capital 


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1 costs of health centers that receive funding under sec2 tion 330 of the Public Health Service Act (42 U.S.C. 

3 254b), in addition to amounts otherwise made avail4 able for such purpose, there is appropriated to the 

5 Secretary of Health and Human Services, out of 

6 amounts in the Treasury not otherwise appropriated, 

7 $3,000,000,000 for fiscal year 2024, to remain avail8 able until September 30, 2026. In awarding amounts 

9 appropriated under this paragraph, the Secretary 

10 shall prioritize awards related to increasing access to 

11 dental and behavioral health services.’’. 

12 (e) STRATEGIC PLAN TO IMPROVE HEALTH OUT13 COMES THROUGH NUTRITION.— 

14 (1) IN GENERAL.—Not later than one year after 

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

16 Health and Human Services, in consultation with the 

17 Secretary of Agriculture, shall submit to the Com18 mittee on Health, Education, Labor, and Pensions of 

19 the Senate and the Committee on Energy and Com20 merce of the House of Representatives a 5-year stra21 tegic plan to improve health outcomes through nutri22 tion for low-income or uninsured patient populations 

23 with severe, complex chronic conditions and one or 

24 more diet-related conditions. 


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1 (2) REPORT.—In carrying out paragraph (1), 

2 the Secretary of Health and Human Services shall— 

3 (A) conduct an evaluation of previous and 

4 current federally funded efforts of the Depart5 ment of Health and Human Services to improve 

6 patient outcomes through nutrition interven7 tions, such as medically tailored meals and nu8 trition counseling; and 

9 (B) include in the strategic report rec10 ommendations for— 

11 (i) reducing the financial impact of 

12 obesity and preventable chronic conditions 

13 resulting from obesity; 

14 (ii) empowering federally funded com15 munity health centers, rural health clinics, 

16 and other relevant federally funded facilities 

17 to provide produce prescriptions, medically18 tailored groceries, and medically-tailored 

19 meals; 

20 (iii) promoting long-term adoption of 

21 improved nutrition habits, including 

22 through increased culinary education and 

23 consumer nutrition aligned with the most 

24 recent Dietary Guidelines for Americans 

25 published under section 301 of the National 


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1 Nutrition Monitoring and Related Research 

2 Act of 1990 (7 U.S.C. 5341) and incor3 porating behavioral modeling or other novel 

4 methods across Federal programs; 

5 (iv) developing performance and qual6 ity metrics related to the delivery of produce 

7 prescriptions, medically tailored groceries, 

8 and medically-tailored meals across relevant 

9 Federal payers to aid in reimbursement 

10 strategies; 

11 (v) developing payment models for 

12 novel obesity care therapies for the treat13 ment of diabetes that include behavioral 

14 and nutritional and dietary services and 

15 education; 

16 (vi) improving coordination of care 

17 and integrating nutrition services and re18 sources within federally funded community 

19 health centers, rural health clinics, and 

20 other federally funded primary care facili21 ties; 

22 (vii) bolstering partnerships with State 

23 and local governments and nongovern24 mental organizations; and 


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1 (viii) addressing geographic disparities 

2 in access to nutrition services and resources. 

3 (f) REQUIRED PRIMARY HEALTH SERVICES.— 

4 (1) IN GENERAL.—Section 330 of the Public 

5 Health Service Act (42 U.S.C. 254b) is amended— 

6 (A) in subsection (b)(1)(A)— 

7 (i) in clause (i)— 

8 (I) in subclause (IV), by striking 

9 ‘‘; and’’ and inserting a semicolon; and 

10 (II) by adding at the end the fol11 lowing: 

12 ‘‘(VI) appropriate nutritional and 

13 dietary services; and 

14 ‘‘(VII) appropriate behavioral and 

15 mental health and substance use dis16 order services;’’; 

17 (ii) in clause (ii)— 

18 (I) by striking ‘‘substance use dis19 order and mental health services’’ and 

20 inserting ‘‘behavioral and mental 

21 health and substance use disorder serv22 ices and nutrition services’’; and 

23 (II) by inserting ‘‘, including such 

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1 ioral health clinics’’ before the semi2 colon; and 

3 (iii) in clause (iii), by inserting ‘‘nu4 tritional,’’ after ‘‘educational,’’; 

5 (B) in subsection (b)(2)— 

6 (i) by striking subparagraph (A); and 

7 (ii) by redesignating subparagraphs 

8 (B) through (D) as subparagraphs (A) 

9 through (C), respectively; and 

10 (C) in subsection (d)(1)(A), by inserting ‘‘or 

11 one or more diet-related conditions’’ before the 

12 semicolon. 

13 (2) IMPLEMENTATION OF NEW REQUIRED PRI14 MARY HEALTH SERVICE.—Paragraph (4) of section 

15 330(e) of the Public Health Service Act (42 U.S.C. 

16 254b(e)) is amended to read as follows: 

17 ‘‘(4) LIMITATION.—Not more than 2 grants may 

18 be made under paragraph (1)(B) for the same entity, 

19 except that such limitation shall not apply for the pe20 riod of 2 years beginning on the date of enactment of 

21 the Bipartisan Primary Care and Health Workforce 

22 Act, in any case where the only basis upon which 

23 paragraph (1)(B) applies to a health center is that 

24 the health center is not in noncompliance with the re25 quirements under subclauses (VI) and (VII) of subVerDate Sep 11 2014 22:48 Nov 08, 2023 Jkt 049200 PO 00000 Frm 00095 Fmt 6652 Sfmt 6203 E:\BILLS\S2840.RS S2840

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1 section (b)(1)(A)(i) to provide appropriate nutritional 

2 disorder providers, including for health centers, cer3 tified community behavioral health centers, and other 

4 community care settings.’’. 

5 (g) INCREASE THE USE OF PROVIDER TOOLS TO IM6 PROVE HEALTH OUTCOMES.—Not later than one year after 

7 the date of enactment of this Act, the Secretary of Health 

8 and Human Services, in consultation with the Secretary 

9 of Agriculture, shall submit to Congress a report that in10 cludes— 

11 (1) recommendations for States on how to sup12 port the coordination of federally funded nutrition 

13 programs and services provided by health care profes14 sionals in community health centers; and 

15 (2) data on the number of individuals enrolled 

16 in federally subsidized health insurance coverage who 

17 are also enrolled in or eligible for federally subsidized 

18 nutrition and food programs. 

19 SEC. 103. NATIONAL HEALTH SERVICE CORPS. 

20 Section 10503(b)(2) of the Patient Protection and Af21 fordable Care Act (42 U.S.C. 254b–2(b)(2)) is amended— 

22 (1) in subparagraph (G), by striking ‘‘; and’’ 

23 and inserting a semicolon; 

24 (2) in subparagraph (H), by striking the period 

25 and inserting ‘‘; and’’; and 


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1 (3) by adding at the end the following: 

2 ‘‘(I) $950,000,000 for each of fiscal years 

3 2024 through 2026.’’. 

4 SEC. 104. GAO REPORT. 

5 (a) IN GENERAL.—Not later than one year after the 

6 date of enactment of this Act, the Comptroller General of 

7 the United States shall submit to the Committee on Health, 

8 Education, Labor, and Pensions of the Senate and the Com9 mittee on Energy and Commerce of the House of Represent10 atives a report assessing the effectiveness of the National 

11 Health Service Corps (referred to in this section as the 

12 ‘‘NHSC’’) in attracting health care professionals to health 

13 professional shortage areas designated under section 332 of 

14 the Public Health Service Act (42 U.S.C. 254e) (referred 

15 to in this section as ‘‘HPSAs’’), such as by— 

16 (1) assessing the metrics used by the Health Re17 sources and Services Administration in evaluating 

18 the program; 

19 (2) comparing the retention rates of NHSC par20 ticipants in the HPSAs where they completed their 

21 period of obligated service to the retention rates of 

22 non-NHSC participants in the corresponding HPSAs; 

23 (3) comparing the retention rates of NHSC par24 ticipants in the HPSAs where they completed their 

25 period of obligated service to the retention rates of 


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1 NHSC participants in HPSAs other than those where 

2 they completed their period of obligated service; 

3 (4) identifying factors that influence an NHSC 

4 participant’s decision to practice in an HPSA other 

5 than the HPSA where they completed their period of 

6 obligated service; 

7 (5) identifying factors other than participation 

8 in the National Health Service Corps Scholarship 

9 and Loan Repayment Programs that attract health 

10 care professionals to practice in a HPSA; 

11 (6) assessing the impact the NHSC has on wages 

12 for health care professionals in an HPSA; and 

13 (7) comparing the distribution of NHSC partici14 pants across HPSAs, including a comparison of rural 

15 versus non-rural HPSAs. 

16 (b) DEFINITION.—In this section, the term ‘‘NHSC 

17 participant’’ means a National Health Service Corps mem18 ber participating in the National Health Service Corps 

19 Scholarship or Loan Repayment Program under subpart 

20 III of part D of title III of the Public Health Service Act 

21 (42 U.S.C. 254l et seq.). 

22 SEC. 105. OIG REPORT. 

23 Not later than 2 years after the date of enactment of 

24 this Act, the Inspector General of the Department of Health 

25 and Human Services shall submit to Congress a report on 


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1 integrity efforts of the Health Resources and Services Ad2 ministration with respect to programs carried out by the 

3 Health Resources and Services Administration. Such report 

4 shall include an assessment of— 

5 (1) the ways in which the Administrator of the 

6 Health Resources and Services Administration (re7 ferred to in this section as the ‘‘Administrator’’) de8 termines reasonable efforts are continuously made to 

9 establish and maintain collaborative relationships 

10 with health care providers; 

11 (2) the ways in which the Administrator ensures 

12 quality and continuity of care for underserved areas; 

13 and 

14 (3) the extent to which the Administrator vali15 dates the financial responsibility of and use of grant 

16 funding by community health centers. 

17 SEC. 106. APPLICATION OF PROVISIONS. 

18 (a) IN GENERAL.—Amounts appropriated pursuant to 

19 the amendments made by this title shall be subject to the 

20 requirements contained in Public Law 117–328 for funds 

21 for programs authorized under sections 330 through 340 of 

22 the Public Health Service Act (42 U.S.C. 254b through 

23 256). 

24 (b) CONFORMING AMENDMENT.—Paragraph (4) of sec25 tion 3014(h) of title 18, United States Code, is amended 


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1 by striking ‘‘and section 301(d) of division BB of the Con2 solidated Appropriations Act, 2021.’’ and inserting ‘‘section 

3 301(d) of division BB of the Consolidated Appropriations 

4 Act, 2021, and section 106(a) of the Bipartisan Primary 

5 Care and Health Workforce Act’’. 

6 TITLE II—SUPPORTING THE 

7 HEALTH CARE WORKFORCE 

8 SEC. 201. RURAL RESIDENCY PLANNING AND DEVELOP9 MENT PROGRAM. 

10 Title III of the Public Health Service Act (42 U.S.C. 

11 241 et seq.) is amended by inserting after section 330A– 

12 2 the following: 

13 ‘‘SEC. 330A–3. RURAL RESIDENCY PLANNING AND DEVELOP14 MENT PROGRAM AND RURAL RESIDENCY 

15 PLANNING AND DEVELOPMENT TECHNICAL 

16 ASSISTANCE PROGRAM. 

17 ‘‘(a) DEFINITION OF RURAL RESIDENCY PROGRAM.— 

18 In this section, the term ‘rural residency program’ means 

19 a physician residency program, including a rural track 

20 program, accredited by the Accreditation Council for Grad21 uate Medical Education (or a similar body) that— 

22 ‘‘(1) trains residents in rural areas (as defined 

23 by the Secretary) for more than 50 percent of the total 

24 time of their residency; and 


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1 ‘‘(2) primarily focuses on producing physicians 

2 who will practice in rural areas, as defined by the 

3 Secretary. 

4 ‘‘(b) RURAL RESIDENCY PLANNING AND DEVELOP5 MENT PROGRAM.— 

6 ‘‘(1) DEFINITION OF ELIGIBLE ENTITY.—In this 

7 subsection, the term ‘eligible entity’— 

8 ‘‘(A) means— 

9 ‘‘(i) a domestic public or private non10 profit or for-profit entity; 

11 ‘‘(ii) an Indian Tribe, Tribal health 

12 program, Tribal organization, or Urban In13 dian organization (as such terms are de14 fined in section 4 of the Indian Health Care 

15 Improvement Act); or 

16 ‘‘(iii) a Native Hawaiian Health orga17 nization as defined in section 12 of the Na18 tive Hawaiian Health Care Improvement 

19 Act; and 

20 ‘‘(B) may include faith-based or commu21 nity-based organizations, rural hospitals, rural 

22 community-based ambulatory patient care cen23 ters (including rural health clinics), health cen24 ters operated by a Native Hawaiian Health or25 ganization (defined as described in subparaVerDate Sep 11 2014 22:48 Nov 08, 2023 Jkt 049200 PO 00000 Frm 00101 Fmt 6652 Sfmt 6203 E:\BILLS\S2840.RS S2840

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1 graph (A)(iii)), an Indian Tribe, a Tribal health 

2 program, a Tribal organization, or an Urban 

3 Indian organization (defined as described in 

4 subparagraph (A)(ii)), graduate medical edu5 cation consortiums (including institutions of 

6 higher education, such as schools of allopathic 

7 medicine, schools of osteopathic medicine, or his8 torically Black colleges or universities (as defined 

9 by the term ‘part B institution’ in section 322 

10 of the Higher Education Act of 1965 or described 

11 in section 326(e)(1) of the Higher Education Act 

12 of 1965) or other minority-serving institutions 

13 (as described in section 371(a) of the Higher 

14 Education Act of 1965)), or other organizations 

15 as determined appropriate by the Secretary. 

16 ‘‘(2) GRANTS.— 

17 ‘‘(A) IN GENERAL.—The Secretary may 

18 award grants to eligible entities to create new 

19 rural residency programs (including adding new 

20 rural training sites to existing rural track pro21 grams). 

22 ‘‘(B) FUNDING.—Grants awarded under 

23 this subsection may be fully funded at the time 

24 of the award. 


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1 ‘‘(C) TERM.—The term of a grant under 

2 this subsection shall be 4 years and may be ex3 tended at the discretion of the Secretary. 

4 ‘‘(3) APPLICATIONS.— 

5 ‘‘(A) IN GENERAL.—To be eligible to receive 

6 a grant under this subsection, an eligible entity 

7 shall prepare and submit to the Secretary an ap8 plication at such time, in such manner, and con9 taining such information as the Secretary may 

10 require, including a description of the pathway 

11 of the rural residency program as described in 

12 subparagraph (B). 

13 ‘‘(B) PATHWAY.—A pathway of a rural 

14 residency program supported under this sub15 section shall be for— 

16 ‘‘(i) general primary care and high17 need specialty care, including family medi18 cine, internal medicine, preventive medi19 cine, psychiatry, or general surgery; 

20 ‘‘(ii) maternal health and obstetrics, 

21 which may be obstetrics and gynecology or 

22 family medicine with enhanced obstetrical 

23 training; or 

24 ‘‘(iii) any other pathway as deter25 mined appropriate by the Secretary. 


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1 ‘‘(c) RURAL RESIDENCY PLANNING AND DEVELOP2 MENT TECHNICAL ASSISTANCE.— 

3 ‘‘(1) DEFINITION OF ELIGIBLE ENTITY.—In this 

4 subsection, the term ‘eligible entity’ means— 

5 ‘‘(A) a domestic public or private nonprofit 

6 or for-profit entity; or 

7 ‘‘(B) an Indian Tribe or Tribal organiza8 tion (as such terms are defined in section 4 of 

9 the Indian Health Care Improvement Act). 

10 ‘‘(2) GRANTS.— 

11 ‘‘(A) IN GENERAL.—The Secretary may 

12 award grants to eligible entities to provide tech13 nical assistance to awardees of and potential ap14 plicants of the program described in subsection 

15 (b). 

16 ‘‘(B) FUNDING.—Grants awarded under 

17 this subsection may be fully funded at the time 

18 of the award. 

19 ‘‘(C) TERM.—The term of a grant under 

20 this subsection shall be 4 years and may be ex21 tended at the discretion of the Secretary. 

22 ‘‘(3) APPLICATIONS.—To be eligible to receive a 

23 grant under this subsection, an eligible entity shall 

24 prepare and submit to the Secretary an application 


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1 at such time, in such manner, and containing such 

2 information as the Secretary may require. 

3 ‘‘(d) AUTHORIZATION OF APPROPRIATIONS.—There is 

4 authorized to be appropriated to carry out this section 

5 $13,000,000 for fiscal year 2024, $13,500,00 for fiscal year 

6 2025, and $14,000,000 for fiscal year 2026, to remain 

7 available until expended.’’. 

8 SEC. 202. PRIMARY CARE TRAINING AND ENHANCEMENT 

9 PROGRAM. 

10 Section 747(c)(1) of the Public Health Service Act (42 

11 U.S.C. 293k(c)(1)) is amended by striking ‘‘$48,924,000 for 

12 each of fiscal years 2021 through 2025’’ and inserting 

13 ‘‘$49,250,000 for fiscal year 2024, $49,500,000 for fiscal 

14 year 2025, and $50,000,000 for fiscal year 2026’’. 

15 SEC. 203. TELEHEALTH TECHNOLOGY-ENABLED LEARNING 

16 PROGRAM. 

17 Section 330N(k) of the Public Health Service Act (42 

18 U.S.C. 254c–20(k)) is amended by striking ‘‘2026’’ and in19 serting ‘‘2025, and $11,000,000 for each of fiscal years 2026 

20 through 2028, to remain available until expended’’. 

21 SEC. 204. NURSE EDUCATION, PRACTICE, QUALITY, AND RE22 TENTION GRANTS AND CONTRACTS. 

23 Section 831 of the Public Health Service Act (42 

24 U.S.C. 296p) is amended by adding at the end the fol25 lowing: 


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1 ‘‘(g) PILOT PROGRAM.— 

2 ‘‘(1) IN GENERAL.—The Secretary shall establish 

3 a 2-year pilot program under which the Secretary 

4 may award grants to, and enter into contracts with, 

5 schools of nursing offering associate degrees that oth6 erwise meet the criteria for receiving a grant or con7 tract under this section, for the purpose of promoting 

8 career advancement for individuals, including li9 censed practical nurses, licensed vocational nurses, 

10 certified nurse assistants, home health aides, and 

11 other health professionals, such as health aides or 

12 community health practitioners certified under the 

13 Community Health Aide Program of the Indian 

14 Health Service under section 119 of the Indian 

15 Health Care Improvement Act, by supporting such 

16 individuals in becoming registered nurses with asso17 ciate degrees. 

18 ‘‘(2) CRITERIA; REQUIREMENTS.—With respect 

19 to grants and contracts awarded under this sub20 section, the Secretary shall use the same criteria (ex21 cept as otherwise provided in paragraph (1)) as 

22 apply to other grants and contracts awarded under 

23 this section, and entities receiving such grants or con24 tracts shall be subject to the same requirements (ex25 cept as otherwise provided in paragraph (1)) as 


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1 apply to other grant and contract recipients under 

2 this section. 

3 ‘‘(3) AUTHORIZATION OF APPROPRIATIONS.—To 

4 carry out this subsection, there are authorized to be 

5 appropriated such sums as may be necessary for the 

6 period of fiscal years 2024 and 2025.’’. 

7 SEC. 205. NURSE FACULTY LOAN PROGRAM. 

8 Section 846A of the Public Health Service Act (42 

9 U.S.C. 297n–1), as amended by section 206, is amended 

10 by inserting after subsection (b) the following: 

11 ‘‘(c) AUTHORIZATION OF APPROPRIATIONS.—To carry 

12 out this section (other than subsection (d)), in addition to 

13 amounts otherwise made available, including under section 

14 871(b), there are authorized to be appropriated $28,500,000 

15 for each of fiscal years 2024 through 2026, to remain avail16 able until expended.’’. 

17 SEC. 206. NURSE FACULTY DEMONSTRATION PROGRAM. 

18 Section 846A of the Public Health Service Act (42 

19 U.S.C. 297n–1) is amended— 

20 (1) by amending subsection (a) to read as fol21 lows: 

22 ‘‘(a) IN GENERAL.—To increase the number of quali23 fied nursing faculty, the Secretary may— 

24 ‘‘(1) enter into an agreement with any accredited 

25 school of nursing for the establishment and operation 


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1 of a student loan fund in accordance with subsection 

2 (b); and 

3 ‘‘(2) award nurse faculty grants in accordance 

4 with subsection (d).’’; 

5 (2) in subsection (b)— 

6 (A) by redesignating subparagraphs (A) 

7 through (D) of paragraph (2) as clauses (i) 

8 through (iv), respectively, and adjusting the 

9 margins accordingly; 

10 (B) by redesignating paragraphs (1) 

11 through (5) as subparagraphs (A) through (E), 

12 respectively, and adjusting the margins accord13 ingly; 

14 (C) in subparagraph (C), as so redesig15 nated, by striking ‘‘subsection (c)’’ and inserting 

16 ‘‘paragraph (2)’’; and 

17 (D) by striking ‘‘(b) AGREEMENTS—Each 

18 agreement entered into under subsection (a) 

19 shall—’’ and inserting the following: 

20 ‘‘(b) SCHOOL OF NURSING STUDENT LOAN FUND.— 

21 ‘‘(1) IN GENERAL.—Each agreement entered into 

22 under subsection (a)(1) shall—’’; 

23 (3) in subsection (c)— 

24 (A) by striking ‘‘subsection (a)’’ each place 

25 it appears and inserting ‘‘subsection (a)(1)’’; 


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1 (B) in paragraph (3), by redesignating sub2 paragraphs (A) and (B) as clauses (i) and (ii), 

3 respectively, and adjusting the margins accord4 ingly; 

5 (C) in paragraph (6), by redesignating sub6 paragraphs (A) and (B) as clauses (i) and (ii), 

7 respectively, and adjusting the margins accord8 ingly; 

9 (D) by redesignating paragraphs (1) 

10 through (6) as subparagraphs (A) through (F), 

11 respectively, and adjusting the margins accord12 ingly; and 

13 (E) in subparagraph (F)(ii), as so redesig14 nated, by striking ‘‘subsection (e)’’ and inserting 

15 ‘‘paragraph (4)’’; 

16 (4) in subsection (e), by striking ‘‘subsection 

17 (c)(6)(B)’’ and inserting ‘‘paragraph (2)(F)(ii)’’; 

18 (5) by redesignating subsections (c) through (e) 

19 (before application of the amendment made by section 

20 206) as paragraphs (2) through (4), respectively, and 

21 adjusting the margins accordingly; and 

22 (6) by adding after subsection (c), as added by 

23 section 205, the following: 

24 ‘‘(d) NURSE FACULTY DEMONSTRATION PROGRAM.— 


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

2 and carry out a demonstration program described in 

3 subsection (a)(2) under which eligible schools of nurs4 ing receive a grant for purposes of supplementing the 

5 salaries of eligible nursing faculty members to en6 hance recruitment and retention of nursing faculty 

7 members. 

8 ‘‘(2) ELIGIBLE ENTITIES.—To be eligible to re9 ceive a grant under this subsection, an entity shall— 

10 ‘‘(A) be an accredited school of nursing; and 

11 ‘‘(B) submit an application to the Sec12 retary, at such time, in such manner, and con13 taining such information as the Secretary may 

14 require, including— 

15 ‘‘(i)(I) to the extent such information 

16 is available to the school of nursing, the sal17 ary history of nursing faculty at such school 

18 who previously were nurses in clinical prac19 tice, for the most recent 3-year period end20 ing on the date of application, adjusted for 

21 inflation as appropriate and broken down 

22 by credentials, experience, and levels of edu23 cation of such nurses; or 

24 ‘‘(II) if the information described in 

25 subclause (I) is not available, information 


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1 on the average local salary of nurses in 

2 clinical practice, adjusted for inflation as 

3 appropriate and broken down by creden4 tials, experience, and levels of education of 

5 the individual nurses, in accordance with 

6 such requirements as the Secretary may 

7 specify; 

8 ‘‘(ii) an attestation of the average 

9 nursing faculty salary at the school of nurs10 ing during the most recent 3-year period 

11 prior to the date of application, adjusted for 

12 inflation, as appropriate, broken down by 

13 credentials, experience, and levels of edu14 cation of such faculty members; 

15 ‘‘(iii) the number of nursing faculty 

16 member vacancies at the entity at the time 

17 of application, and the entity’s projection of 

18 such vacancies over the ensuing 5-year pe19 riod; and 

20 ‘‘(iv) a description of the entity’s plans 

21 to identify funding sources to sustainably 

22 continue, after the 2-year grant period, the 

23 salary available to the eligible nursing fac24 ulty member pursuant to the program 

25 under this subsection during such grant 


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1 program and to retain eligible nursing fac2 ulty members after the end of the grant pe3 riod. 

4 ‘‘(3) AWARDS.—A grant awarded under this sub5 section, with respect to supporting eligible nursing 

6 faculty members, shall— 

7 ‘‘(A) be awarded to the school of nursing to 

8 supplement the salaries of eligible faculty mem9 bers at the school of nursing, annually, for up to 

10 a 2-year period, in an amount equal to, for each 

11 eligible nursing faculty member at the eligible 

12 entity during the grant period, the difference be13 tween— 

14 ‘‘(i) the average salary of nurses in 

15 clinical practice, as submitted under sub16 clause (I) or (II) of paragraph (2)(B)(i); 

17 and 

18 ‘‘(ii) the greater of— 

19 ‘‘(I) the salary for the eligible 

20 nursing faculty member at the school of 

21 nursing; or 

22 ‘‘(II) the average nursing faculty 

23 salary submitted under paragraph 

24 (2)(B)(ii) for faculty members with the 


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1 same or similar credentials and level of 

2 education; 

3 ‘‘(B) notwithstanding section 803(a), be 

4 used in its entirety to supplement the eligible 

5 faculty member’s salary; and 

6 ‘‘(C) be conditioned upon the school of nurs7 ing maintaining, for each year in which the 

8 award is made as described in subparagraph 

9 (A), a salary for such faculty member at a level 

10 that is not less than the greater of the amount 

11 under subclause (I) or (II) of subparagraph 

12 (A)(ii). 

13 ‘‘(4) PRIORITY.—In awarding grants under this 

14 subsection, the Secretary shall ensure the equitable ge15 ographic distribution of awards, and shall give pri16 ority to applications from schools of nursing that 

17 demonstrate— 

18 ‘‘(A) the greatest need for such grant, which 

19 may be based upon the financial circumstances 

20 of the school of nursing, the number of eligible 

21 nurse faculty members, and the planned number 

22 of students to be trained or admitted off a wait 

23 list; 

24 ‘‘(B) training or partnerships to serve vul25 nerable patient populations, such as through the 


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1 location or activity of a school in a health pro2 fessional shortage area (as defined in section 

3 332); 

4 ‘‘(C) recruitment and retention of faculty 

5 from underrepresented populations; or 

6 ‘‘(D) other particular need for such grant, 

7 including public institutions of higher education 

8 that offer 4-year degrees but at which the pre9 dominant degree awarded is an associate degree. 

10 ‘‘(5) RULE OF CONSTRUCTION.—Nothing in this 

11 subsection precludes a school of nursing or an eligible 

12 nursing faculty member receiving an award under 

13 this section from obtaining or receiving any other 

14 form of Federal support or funding. 

15 ‘‘(6) REPORT.—Not later than 3 years after the 

16 date of enactment of the Bipartisan Primary Care 

17 and Health Workforce Act, the Secretary shall submit 

18 to the Committee on Finance and the Committee on 

19 Health, Education, Labor, and Pensions of the Senate 

20 and the Committee on Ways and Means and the Com21 mittee on Energy and Commerce of the House of Rep22 resentatives, a report that evaluates the program es23 tablished under this subsection, including— 

24 ‘‘(A) the impact of such program on recruit25 ment and retention rates of nursing faculty, as 


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1 available, and specifically for each faculty mem2 ber participating in the program; and 

3 ‘‘(B) recommendations and considerations 

4 for Congress on continuing the program under 

5 this subsection. 

6 ‘‘(7) DEFINITIONS.—In this subsection: 

7 ‘‘(A) ELIGIBLE NURSING FACULTY MEM8 BER.—The term ‘eligible nursing faculty mem9 ber’ means a nursing faculty member who— 

10 ‘‘(i) was hired by a school of nursing 

11 within the 2-year period preceding the sub12 mission of an application under paragraph 

13 (2), or a prospective nursing faculty mem14 ber; 

15 ‘‘(ii) is currently employed at the 

16 school of nursing and who demonstrates the 

17 need for such support; 

18 ‘‘(iii) previously worked as a nurse in 

19 clinical practice or as a nurse faculty mem20 ber at another school of nursing; or 

21 ‘‘(iv) may work on a part-time basis 

22 as a nursing faculty member, for whom 

23 such award amounts described in para24 graph (3) shall be prorated relative to the 


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1 amount of time participating in part-time 

2 teaching. 

3 ‘‘(B) INFLATION.—The term ‘inflation’ 

4 means the Consumer Price Index for all urban 

5 consumers (all items; U.S. city average). 

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

7 carry out this subsection, in addition to amounts oth8 erwise available, including under section 871(b), there 

9 is authorized to be appropriated $15,000,000 for each 

10 of fiscal years 2024 and 2025.’’. 

11 SEC. 207. NURSE CORPS SCHOLARSHIP AND LOAN REPAY12 MENT PROGRAM. 

13 Section 846 of the Public Health Service Act (42 

14 U.S.C. 297n) is amended by adding at the end the fol15 lowing: 

16 ‘‘(j) AUTHORIZATION OF APPROPRIATIONS.—To carry 

17 out this section, in addition to amounts otherwise made 

18 available, including under section 871(b), there are author19 ized to be appropriated $93,600,000 for fiscal year 2024, 

20 $94,600,000 for fiscal year 2025, and $95,600,000 for fiscal 

21 year 2026, to remain available until expended.’’. 

22 SEC. 208. GRANTS FOR PRIMARY CARE NURSE RESIDENCY 

23 TRAINING PROGRAMS. 

24 Section 5316 of the Patient Protection and Affordable 

25 Care Act (42 U.S.C. 296j–1) is amended— 


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1 (1) in the section heading, by striking ‘‘DEM2 ONSTRATION’’; 

3 (2) in subsection (a), by striking ‘‘demonstra4 tion’’; 

5 (3) in subsection (d)— 

6 (A) in paragraph (1)(B), by striking ‘‘and’’ 

7 at the end; 

8 (B) by redesignating paragraph (2) as 

9 paragraph (3); and 

10 (C) by inserting after paragraph (1) the fol11 lowing: 

12 ‘‘(2)(A) in the case of an entity that does not 

13 have an established residency program for nurse prac14 titioners at the time of the application, demonstrate 

15 plans to establish a new residency program for nurse 

16 practitioners; or 

17 ‘‘(B) in the case of an entity that has an estab18 lished residency program for nurse practitioners at 

19 the time of the application, demonstrate plans to use 

20 the grant under this section to offer not fewer than 4 

21 additional residency positions for new nurse practi22 tioners to participate in such program; and’’; and 

23 (4) in subsection (i), by striking ‘‘such sums as 

24 may be necessary for each of fiscal years 2011 through 


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1 2014’’ and inserting ‘‘$30,000,000 for each of fiscal 

2 years 2024 through 2026’’. 

3 SEC. 209. STATE ORAL HEALTH WORKFORCE IMPROVEMENT 

4 GRANT PROGRAM. 

5 Subsection (f) of section 340G of the Public Health 

6 Service Act (42 U.S.C. 256g) is amended by striking 

7 ‘‘$13,903,000 for each of fiscal years 2019 through 2023’’ 

8 and inserting ‘‘$15,200,000 for fiscal year 2024, 

9 $15,500,000 for fiscal year 2025, and $15,800,000 for fiscal 

10 year 2026, to remain available until expended’’. 

11 SEC. 210. ORAL HEALTH TRAINING PROGRAMS. 

12 Subsection (f) of section 748 of the Public Health Serv13 ice Act (42 U.S.C. 293k–2) is amended to read as follows: 

14 ‘‘(f) AUTHORIZATION OF APPROPRIATIONS.— 

15 ‘‘(1) IN GENERAL.—To carry out this section, 

16 there is authorized to be appropriated $28,500,000 for 

17 fiscal year 2026, to remain available until expended. 

18 ‘‘(2) GEOGRAPHIC DISTRIBUTION.—In awarding 

19 grants under this section, the Secretary shall ensure, 

20 to the greatest extent practicable, that such grants are 

21 equitably distributed among the geographical regions 

22 of the United States.’’. 

23 SEC. 211. ALLIED HEALTH PROFESSIONALS. 

24 (a) SUPPORTING DUAL OR CONCURRENT ENROLLMENT

25 IN THE ALLIED HEALTH PROJECTS PROGRAM.—Section 


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1 755(b)(1) of the Public Health Service Act (42 U.S.C. 

2 294e(b)(1)) is amended— 

3 (1) in subparagraph (B), by striking ‘‘to indi4 viduals who have baccalaureate degrees in health-re5 lated sciences’’; 

6 (2) in the flush text at the end of subparagraph 

7 (I), by striking ‘‘; and’’ and inserting a semicolon; 

8 (3) in subparagraph (J), by striking the period 

9 and inserting ‘‘; and’’; and 

10 (4) by adding at the end the following: 

11 ‘‘(K) those that establish or support a dual 

12 or concurrent enrollment program (as defined in 

13 section 8101 of the Elementary and Secondary 

14 Education Act of 1965) if the dual or concurrent 

15 enrollment program— 

16 ‘‘(i) provides outreach on allied health 

17 careers requiring an industry-recognized 

18 credential, a certificate, or an associate de19 gree, to all high schools served by the local 

20 educational agency that is a partner in the 

21 partnership offering the dual or concurrent 

22 enrollment program; 

23 ‘‘(ii) provides information to high 

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1 ments and expected salary of allied health 

2 professionals; and 

3 ‘‘(iii) provides academic and financial 

4 aid counseling to students who participate 

5 in the dual or concurrent enrollment pro6 gram.’’. 

7 (b) SUPPORTING DUAL OR CONCURRENT ENROLLMENT

8 IN THE HEALTH CAREERS OPPORTUNITY PROGRAM.—Sec9 tion 739(a)(2) of the Public Health Service Act (42 U.S.C. 

10 293c(a)(2)) is amended— 

11 (1) in subparagraph (H), by striking ‘‘and’’ 

12 after the semicolon; 

13 (2) in subparagraph (I), by striking the period 

14 at the end and inserting ‘‘; and’’; and 

15 (3) by adding at the end the following: 

16 ‘‘(J) providing academic and financial aid 

17 counseling to support participation in a dual or 

18 concurrent enrollment program (as defined in 

19 section 8101 of the Elementary and Secondary 

20 Education Act of 1965) that leads to an indus21 try-recognized credential, a certificate, or an as22 sociate degree in the health professions or aca23 demic credits that can be transferred, as indi24 cated through an articulation agreement between 

25 2 or more community colleges or universities, to 


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1 obtain an industry-recognized credential, a cer2 tificate, or a degree in the health professions.’’. 

3 (c) HEALTH CARE WORKFORCE INNOVATION PRO4 GRAM.—Section 755(b) of the Public Health Service Act (42 

5 U.S.C. 294e(b)) is amended by adding at the end the fol6 lowing: 

7 ‘‘(5)(A) Supporting and developing new innova8 tive, community-driven approaches for the education 

9 and training of allied health professionals, including 

10 those described in subparagraph (F)(i), with an em11 phasis on expanding the supply of such professionals 

12 located in, and meeting the needs of, underserved com13 munities and rural areas. Grants under this para14 graph shall be awarded through a new program (re15 ferred to as the ‘Health Care Workforce Innovation 

16 Program’ or in this paragraph as the ‘Program’). 

17 ‘‘(B) To be eligible to receive a grant under the 

18 Program an entity shall— 

19 ‘‘(i) be a Federally qualified health center 

20 (as defined in section 1905(l)(2)(B) of the Social 

21 Security Act), a State-level association or other 

22 consortium that represents and is comprised of 

23 Federally qualified health centers, or a certified 

24 rural health clinic that meets the requirements of 

25 section 334; and 


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1 ‘‘(ii) submit to the Secretary an application 

2 that, at a minimum, contains— 

3 ‘‘(I) a description of how all trainees 

4 will be trained in accredited training pro5 grams either directly or through partner6 ships with public or nonprofit private enti7 ties; 

8 ‘‘(II) a description of the community9 driven health care workforce innovation 

10 model to be carried out under the grant, in11 cluding the specific professions to be funded; 

12 ‘‘(III) the geographic service area that 

13 will be served, including quantitative data, 

14 if available, showing that such particular 

15 area faces a shortage of health professionals 

16 and lacks access to health care; 

17 ‘‘(IV) a description of the benefits pro18 vided to each health care professional 

19 trained under the proposed model during 

20 the education and training phase; 

21 ‘‘(V) a description of the experience 

22 that the applicant has in the recruitment, 

23 retention, and promotion of the well-being 

24 of workers and volunteers; 


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1 ‘‘(VI) a description of how the funding 

2 awarded under the Program will supple3 ment rather than supplant existing funding; 

4 ‘‘(VII) a description of the scalability 

5 and replicability of the community-driven 

6 approach to be funded under the Program; 

7 ‘‘(VIII) a description of the infrastruc8 ture, outreach and communication plan, 

9 and other program support costs required to 

10 operationalize the proposed model; and 

11 ‘‘(IX) any other information, as the 

12 Secretary determines appropriate. 

13 ‘‘(C)(i) An entity shall use amounts received 

14 under a grant awarded under the Program to carry 

15 out the innovative, community-driven model described 

16 in the application under subparagraph (B). Such 

17 amounts may be used for launching new, or expand18 ing existing, innovative health care professional part19 nerships, including the following specific uses: 

20 ‘‘(I) Establishing or expanding a partner21 ship between an eligible entity and 1 or more 

22 high schools, accredited public or nonprofit pri23 vate vocational-technical schools, accredited pub24 lic or nonprofit private 2-year colleges, area 

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1 ical settings for the provision of education and 

2 training opportunities not available at the 

3 grantee’s facilities. 

4 ‘‘(II) Providing education and training 

5 programs to improve allied health professionals’ 

6 readiness in settings that serve underserved com7 munities and rural areas; encouraging students 

8 from underserved and disadvantaged back9 grounds and former patients to consider careers 

10 in health care, and better reflecting and meeting 

11 community needs; providing education and 

12 training programs for individuals to work in 

13 patient-centered, team-based, community-driven 

14 health care models that include integration with 

15 other clinical practitioners and training in cul16 tural and linguistic competence; providing pre17 apprenticeship and apprenticeship programs for 

18 health care technical, support, and entry-level oc19 cupations, particularly for those enrolled in dual 

20 or concurrent enrollment programs; building a 

21 preceptorship training-to-practice model for med22 ical, behavioral health, oral health, and public 

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1 nities for health care professionals, including 

2 new and existing staff; or investing in training 

3 equipment, supplies, and limited renovations or 

4 retrofitting of training space needed for grantees 

5 to carry out their particular model. 

6 ‘‘(ii) Amounts received under a grant awarded 

7 under the Program shall not be used to support con8 struction costs or to supplant funding from existing 

9 programs that support the applicant’s health work10 force. 

11 ‘‘(iii) Funding of models under the Program 

12 shall be for a duration of at least 3 years. 

13 ‘‘(D) In awarding grants under the Program, the 

14 Secretary may give priority to applicants that will 

15 use grant funds to support workforce innovation mod16 els that increase the number of individuals from un17 derserved and disadvantaged backgrounds working in 

18 such health care professions, improve access to health 

19 care (including medical, behavioral health and oral 

20 health) in underserved communities, or demonstrate 

21 that the model can be replicated in other underserved 

22 communities in a cost-efficient and effective manner 

23 to achieve the purposes of the Program. 

24 ‘‘(E) An entity that receives a grant under the 

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1 retary detailing the findings and outcomes of the in2 novative, community-driven model carried out under 

3 the grant. Such reports shall contain information in 

4 a manner and at such times as determined appro5 priate by the Secretary. 

6 ‘‘(F) In this paragraph: 

7 ‘‘(i) The term ‘allied health care profes8 sional’ includes individuals who provide clinical 

9 support services, including medical assistants, 

10 dental assistants, dental hygienists, pharmacy 

11 technicians, physical therapists, and health care 

12 interpreters; individuals providing non-clinical 

13 support, such as billing and coding professionals 

14 and health information technology professionals; 

15 dieticians; medical technologists; emergency med16 ical technicians; community health workers; pub17 lic health personnel; and peer support workers. 

18 ‘‘(ii) The term ‘rural area’ has the meaning 

19 given such term by the Administrator of the 

20 Health Resources and Services Administration. 

21 ‘‘(iii) The term ‘underserved communities’ 

22 means areas, population groups, and facilities 

23 designated as health professional shortage areas 

24 under section 332, medically underserved areas 

25 as defined under section 330I(a), or medically 


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1 underserved populations as defined under section 

2 330(b)(3). 

3 ‘‘(G)(i) There are authorized to be appropriated 

4 $100,000,000 for each of fiscal years 2024 through 

5 2026, to carry out this section, to remain available 

6 until expended. 

7 ‘‘(ii) A grant provided under the Program shall 

8 not exceed $2,500,000 for a grant period.’’. 

9 SEC. 212. REVIEW OF AND REPORT ON PROGRAMS SUP10 PORTING THE NURSING WORKFORCE. 

11 The Secretary of Health and Human Services and the 

12 Secretary of Labor, jointly, shall— 

13 (1) conduct a review of all grant programs car14 ried out by the Department of Health and Human 

15 Services or by the Department of Labor that support 

16 the nurse workforce; and 

17 (2) not later than 1 year after the date of enact18 ment of this Act, submit to Congress a report on the 

19 review under paragraph (1) that includes rec20 ommendations for changes to such grant programs to 

21 improve upon the goals of— 

22 (A) increasing nurse faculty, particularly 

23 in underserved areas; 


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1 (B) providing pathways for nurses who 

2 have more than 10 years of clinical experience to 

3 become faculty at schools of nursing; and 

4 (C) encouraging and increasing the nursing 

5 pipeline through pathways for licensed practical 

6 nurses to become registered nurses. 

7 SEC. 213. REPORT ON IMPACTS TO COMMUNITY HEALTH 

8 CENTERS. 

9 Not later than 5 years after the date of enactment of 

10 this Act, the Secretary of Health and Human Services, act11 ing through the Assistant Secretary for Planning and Eval12 uation, shall submit to Congress a report on the impacts 

13 of this title, including the amendments made by this title, 

14 on community health centers. Such report shall consider— 

15 (1) current and projected savings or cost impact 

16 on the Medicare program under title XVIII of the So17 cial Security Act (42 U.S.C. 1395 et seq.), the Med18 icaid program under title XIX of such Act (42 U.S.C. 

19 1396 et seq.), and the Children’s Health Insurance 

20 Program under title XXI of such Act (42 U.S.C. 

21 1397aa et seq.); 

22 (2) current and projected changes in access to 

23 health care, health outcomes, health literacy, and ac24 cess to social care services; 


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1 (3) current and projected changes in wait and 

2 travel times to access primary care services; and 

3 (4) contributions to the economies of the commu4 nities served by community health centers, including 

5 employment opportunities. 

6 TITLE III—REDUCING HEALTH 

7 CARE COSTS FOR PATIENTS 

8 SEC. 301. BANNING ANTICOMPETITIVE TERMS IN FACILITY 

9 AND INSURANCE CONTRACTS THAT LIMIT AC10 CESS TO HIGHER QUALITY, LOWER COST 

11 CARE. 

12 (a) IN GENERAL.— 

13 (1) PUBLIC HEALTH SERVICE ACT.—Section 

14 2799A–9 of the Public Health Service Act (42 U.S.C. 

15 300gg–119) is amended— 

16 (A) by adding at the end the following: 

17 ‘‘(b) PROTECTING HEALTH PLANS NETWORK DESIGN

18 FLEXIBILITY.— 

19 ‘‘(1) IN GENERAL.—A group health plan or a 

20 health insurance issuer offering group or individual 

21 health insurance coverage shall not enter into an 

22 agreement with a provider, network or association of 

23 providers, or other service provider offering access to 

24 a network of service providers if such agreement, di25 rectly or indirectly— 


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1 ‘‘(A) restricts the group health plan or 

2 health insurance issuer from— 

3 ‘‘(i) directing or steering enrollees to 

4 other health care providers; or 

5 ‘‘(ii) offering incentives to encourage 

6 enrollees to utilize specific health care pro7 viders; 

8 ‘‘(B) requires the group health plan or 

9 health insurance issuer to enter into any addi10 tional contract with an affiliate of the provider 

11 as a condition of entering into a contract with 

12 such provider; 

13 ‘‘(C) requires the group health plan or 

14 health insurance issuer to agree to payment rates 

15 or other terms for any affiliate not party to the 

16 contract of the provider involved; or 

17 ‘‘(D) restricts other group health plans or 

18 health insurance issuers not party to the contract 

19 from paying a lower rate for items or services 

20 than the contracting plan or issuer pays for such 

21 items or services. 

22 ‘‘(2) ADDITIONAL REQUIREMENT FOR SELF-IN23 SURED PLANS.—A self-insured group health plan 

24 shall not enter into an agreement with a provider, 

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1 ministrator, or other service provider offering access 

2 to a network of providers if such agreement directly 

3 or indirectly requires the group health plan to certify, 

4 attest, or otherwise confirm in writing that the group 

5 health plan is bound by restrictive contracting terms 

6 between the service provider and a third-party ad7 ministrator that the group health plan is not party 

8 to, without a disclosure that such terms exist. 

9 ‘‘(3) EXCEPTION FOR PLANS AND ISSUERS.— 

10 Paragraph (1)(A) shall not apply to a group health 

11 plan or health insurance issuer offering group or in12 dividual health insurance coverage with respect to— 

13 ‘‘(A) a health maintenance organization (as 

14 defined in section 2791(b)(3)), if such health 

15 maintenance organization operates primarily 

16 through exclusive contracts with multi-specialty 

17 physician groups, nor to any arrangement be18 tween such a health maintenance organization 

19 and its affiliates; or 

20 ‘‘(B) a value-based network arrangement, 

21 such as an exclusive provider network, account22 able care organization, center of excellence, a 

23 provider sponsored health insurance issuer that 

24 operates primarily through aligned multi-spe25 cialty physician group practices or integrated 


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1 health systems, or such other similar network ar2 rangements as determined by the Secretary 

3 through rulemaking. 

4 ‘‘(4) ATTESTATION.—A group health plan or 

5 health insurance issuer offering group or individual 

6 health insurance coverage shall annually submit to, 

7 as applicable, the applicable authority described in 

8 section 2723 or the Secretary of Labor or the Sec9 retary of the Treasury, an attestation that such plan 

10 or issuer is in compliance with the requirements of 

11 this subsection. 

12 ‘‘(5) RULE OF CONSTRUCTION.—Nothing in this 

13 subsection shall be construed to limit network design 

14 or cost or quality initiatives by a group health plan 

15 or health insurance issuer, including accountable care 

16 organizations, exclusive provider organizations, net17 works that tier providers by cost or quality or steer 

18 enrollees to centers of excellence, or other pay-for-per19 formance programs. 

20 ‘‘(6) COMPLIANCE WITH RESPECT TO ANTITRUST

21 LAWS.—Compliance with this subsection does not con22 stitute compliance with the antitrust laws, as defined 

23 in subsection (a) of the first section of the Clayton Act 

24 (15 U.S.C. 12(a)). 


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1 ‘‘(7) GRANDFATHERING.—An applicable State 

2 authority may make a determination that the prohi3 bitions under paragraph (1) (with respect to condi4 tions that would direct or steer enrollees to, or offer 

5 incentives to encourage enrollees to use, other health 

6 care providers) will not apply in the State with re7 spect to any specified agreement that is executed be8 fore the date of enactment of the Bipartisan Primary 

9 Care and Health Workforce Act, for a maximum 

10 length of nonapplicability of up to 10 years from the 

11 date of execution of the contract if the applicable 

12 State authority determines that the contract is un13 likely to significantly lessen competition. With respect 

14 to a specified agreement for which an applicable State 

15 authority has made a determination under the pre16 ceding sentence, an applicable State authority may 

17 determine whether renewal of the contract, within the 

18 applicable 10-year period, is allowed.’’; and 

19 (B) by redesignating paragraph (5) of sub20 section (a) as subsection (c), adjusting the mar21 gin of such subsection accordingly, and transfer22 ring such subsection (c) to appear after sub23 section (b), as added by subparagraph (A). 

24 (2) EMPLOYEE RETIREMENT INCOME SECURITY

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1 ment Income Security Act of 1974 (29 U.S.C. 1185m) 

2 is amended— 

3 (A) by adding at the end the following: 

4 ‘‘(b) PROTECTING HEALTH PLANS NETWORK DESIGN

5 FLEXIBILITY.— 

6 ‘‘(1) IN GENERAL.—A group health plan or a 

7 health insurance issuer offering group health insur8 ance coverage shall not enter into an agreement with 

9 a provider, network or association of providers, or 

10 other service provider offering access to a network of 

11 service providers if such agreement, directly or indi12 rectly— 

13 ‘‘(A) restricts the group health plan or 

14 health insurance issuer from— 

15 ‘‘(i) directing or steering enrollees to 

16 other health care providers; or 

17 ‘‘(ii) offering incentives to encourage 

18 enrollees to utilize specific health care pro19 viders; 

20 ‘‘(B) requires the group health plan or 

21 health insurance issuer to enter into any addi22 tional contract with an affiliate of the provider 

23 as a condition of entering into a contract with 

24 such provider; 


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1 ‘‘(C) requires the group health plan or 

2 health insurance issuer to agree to payment rates 

3 or other terms for any affiliate not party to the 

4 contract of the provider involved; or 

5 ‘‘(D) restricts other group health plans or 

6 health insurance issuers not party to the contract 

7 from paying a lower rate for items or services 

8 than the contracting plan or issuer pays for such 

9 items or services. 

10 ‘‘(2) ADDITIONAL REQUIREMENT FOR SELF-IN11 SURED PLANS.—A self-insured group health plan 

12 shall not enter into an agreement with a provider, 

13 network or association of providers, third-party ad14 ministrator, or other service provider offering access 

15 to a network of providers if such agreement directly 

16 or indirectly requires the group health plan to certify, 

17 attest, or otherwise confirm in writing that the group 

18 health plan is bound by restrictive contracting terms 

19 between the service provider and a third-party ad20 ministrator that the group health plan is not party 

21 to, without a disclosure that such terms exist. 

22 ‘‘(3) EXCEPTION FOR PLANS AND ISSUERS.— 

23 Paragraph (1)(A) shall not apply to a group health 

24 plan or health insurance issuer offering group health 

25 insurance coverage with respect to— 


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1 ‘‘(A) a health maintenance organization (as 

2 defined in section 733(b)(3)), if such health 

3 maintenance organization operates primarily 

4 through exclusive contracts with multi-specialty 

5 physician groups, nor to any arrangement be6 tween such a health maintenance organization 

7 and its affiliates; or 

8 ‘‘(B) a value-based network arrangement, 

9 such as an exclusive provider network, account10 able care organization, center of excellence, a 

11 provider sponsored health insurance issuer that 

12 operates primarily through aligned multi-spe13 cialty physician group practices or integrated 

14 health systems, or such other similar network ar15 rangements as determined by the Secretary 

16 through rulemaking. 

17 ‘‘(4) ATTESTATION.—A group health plan or 

18 health insurance issuer offering group health insur19 ance coverage shall annually submit to, as applicable, 

20 the applicable authority described in section 2723 of 

21 the Public Health Service Act or the Secretary of 

22 Labor or the Secretary of the Treasury, an attestation 

23 that such plan or issuer is in compliance with the re24 quirements of this subsection. 


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1 ‘‘(5) RULE OF CONSTRUCTION.—Nothing in this 

2 subsection shall be construed to limit network design 

3 or cost or quality initiatives by a group health plan 

4 or health insurance issuer, including accountable care 

5 organizations, exclusive provider organizations, net6 works that tier providers by cost or quality or steer 

7 enrollees to centers of excellence, or other pay-for-per8 formance programs. 

9 ‘‘(6) COMPLIANCE WITH RESPECT TO ANTITRUST

10 LAWS.—Compliance with this subsection does not con11 stitute compliance with the antitrust laws, as defined 

12 in subsection (a) of the first section of the Clayton Act 

13 (15 U.S.C. 12(a)). 

14 ‘‘(7) GRANDFATHERING.—An applicable State 

15 authority may make a determination that the prohi16 bitions under paragraph (1) (with respect to condi17 tions that would direct or steer enrollees to, or offer 

18 incentives to encourage enrollees to use, other health 

19 care providers) will not apply in the State with re20 spect to any specified agreement that is executed be21 fore the date of enactment of the Bipartisan Primary 

22 Care and Health Workforce Act, for a maximum 

23 length of nonapplicability of up to 10 years from the 

24 date of execution of the contract if the applicable 

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1 likely to significantly lessen competition. With respect 

2 to a specified agreement for which an applicable State 

3 authority has made a determination under the pre4 ceding sentence, an applicable State authority may 

5 determine whether renewal of the contract, within the 

6 applicable 10-year period, is allowed.’’; and 

7 (B) by redesignating paragraph (4) of sub8 section (a) as subsection (c), adjusting the mar9 gin of such subsection accordingly, and transfer10 ring such subsection (c) to appear after sub11 section (b), as added by subparagraph (A). 

12 (3) INTERNAL REVENUE CODE OF 1986.—Section 

13 9824 of the Internal Revenue Code of 1986 is amend14 ed— 

15 (A) by adding at the end the following: 

16 ‘‘(b) PROTECTING HEALTH PLANS NETWORK DESIGN

17 FLEXIBILITY.— 

18 ‘‘(1) IN GENERAL.—A group health plan shall 

19 not enter into an agreement with a provider, network 

20 or association of providers, or other service provider 

21 offering access to a network of service providers if 

22 such agreement, directly or indirectly— 

23 ‘‘(A) restricts the group health plan from— 

24 ‘‘(i) directing or steering enrollees to 

25 other health care providers; or 


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1 ‘‘(ii) offering incentives to encourage 

2 enrollees to utilize specific health care pro3 viders; 

4 ‘‘(B) requires the group health plan to enter 

5 into any additional contract with an affiliate of 

6 the provider as a condition of entering into a 

7 contract with such provider; 

8 ‘‘(C) requires the group health plan to agree 

9 to payment rates or other terms for any affiliate 

10 not party to the contract of the provider in11 volved; or 

12 ‘‘(D) restricts other group health plans not 

13 party to the contract from paying a lower rate 

14 for items or services than the contracting plan 

15 pays for such items or services. 

16 ‘‘(2) ADDITIONAL REQUIREMENT FOR SELF-IN17 SURED PLANS.—A self-insured group health plan 

18 shall not enter into an agreement with a provider, 

19 network or association of providers, third-party ad20 ministrator, or other service provider offering access 

21 to a network of providers if such agreement directly 

22 or indirectly requires the group health plan to certify, 

23 attest, or otherwise confirm in writing that the group 

24 health plan is bound by restrictive contracting terms 

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1 ministrator that the group health plan is not party 

2 to, without a disclosure that such terms exist. 

3 ‘‘(3) EXCEPTION FOR CERTAIN PLANS.—Para4 graph (1)(A) shall not apply to a group health plan 

5 with respect to— 

6 ‘‘(A) a health maintenance organization (as 

7 defined in section 9832(b)(3)), if such health 

8 maintenance organization operates primarily 

9 through exclusive contracts with multi-specialty 

10 physician groups, nor to any arrangement be11 tween such a health maintenance organization 

12 and its affiliates; or 

13 ‘‘(B) a value-based network arrangement, 

14 such as an exclusive provider network, account15 able care organization, center of excellence, a 

16 provider sponsored health insurance issuer that 

17 operates primarily through aligned multi-spe18 cialty physician group practices or integrated 

19 health systems, or such other similar network ar20 rangements as determined by the Secretary 

21 through rulemaking. 

22 ‘‘(4) ATTESTATION.—A group health plan shall 

23 annually submit to, as applicable, the applicable au24 thority described in section 2723 of the Public Health 

25 Service Act or the Secretary of Labor or the Secretary 


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1 of the Treasury, an attestation that such plan is in 

2 compliance with the requirements of this subsection. 

3 ‘‘(5) RULE OF CONSTRUCTION.—Nothing in this 

4 subsection shall be construed to limit network design 

5 or cost or quality initiatives by a group health plan, 

6 including accountable care organizations, exclusive 

7 provider organizations, networks that tier providers 

8 by cost or quality or steer enrollees to centers of excel9 lence, or other pay-for-performance programs. 

10 ‘‘(6) COMPLIANCE WITH RESPECT TO ANTITRUST

11 LAWS.—Compliance with this subsection does not con12 stitute compliance with the antitrust laws, as defined 

13 in subsection (a) of the first section of the Clayton Act 

14 (15 U.S.C. 12(a)). 

15 ‘‘(7) GRANDFATHERING.—An applicable State 

16 authority may make a determination that the prohi17 bitions under paragraph (1) (with respect to condi18 tions that would direct or steer enrollees to, or offer 

19 incentives to encourage enrollees to use, other health 

20 care providers) will not apply in the State with re21 spect to any specified agreement that is executed be22 fore the date of enactment of the Bipartisan Primary 

23 Care and Health Workforce Act, for a maximum 

24 length of nonapplicability of up to 10 years from the 

25 date of execution of the contract if the applicable 


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1 State authority determines that the contract is un2 likely to significantly lessen competition. With respect 

3 to a specified agreement for which an applicable State 

4 authority has made a determination under the pre5 ceding sentence, an applicable State authority may 

6 determine whether renewal of the contract, within the 

7 applicable 10-year period, is allowed.’’; and 

8 (B) by redesignating paragraph (4) of sub9 section (a) as subsection (c), adjusting the mar10 gin of such subsection accordingly, and transfer11 ring such subsection (c) to appear after sub12 section (b), as added by subparagraph (A). 

13 (b) REGULATIONS.—Not later than 1 year after the 

14 date of enactment of this Act, the Secretary of Health and 

15 Human Services, the Secretary of Labor, and the Secretary 

16 of the Treasury, jointly, shall promulgate regulations to 

17 carry out section 2799A–9(b) of the Public Health Service 

18 Act, section 724(b) of the Employee Retirement Income Se19 curity Act of 1974, and section 9824(b) of the Internal Rev20 enue Code of 1986, as added by subsection (a). 

21 (c) EFFECTIVE DATE.—Subsection (b) of section 

22 2799A–9 of the Public Health Service Act, subsection (b) 

23 of section 724 of the Employee Retirement Income Security 

24 Act of 1974, and subsection (b) of section 9824 of the Inter25 nal Revenue Code of 1986 (as added by paragraphs (1), 


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1 (2), and (3), respectively, of subsection (a)) shall apply with 

2 respect to any contract entered into on or after the date 

3 that is 18 months after the date of enactment of this Act. 

4 With respect to an applicable contract that is in effect on 

5 the date of enactment of this Act, such subsection (b) shall 

6 apply on the earlier of the date of renewal of such contract 

7 or 3 years after such date of enactment. 

8 SEC. 302. HONEST BILLING REQUIREMENTS APPLICABLE 

9 TO PROVIDERS. 

10 (a) GROUP HEALTH PLAN AND HEALTH INSURANCE

11 ISSUER REQUIREMENTS.— 

12 (1) PUBLIC HEALTH SERVICE ACT.—Part D of 

13 title XXVII of the Public Health Service Act (42 

14 U.S.C. 300gg–111 et seq.) is amended by adding at 

15 the end the following: 

16 ‘‘SEC. 2799A–11. HONEST BILLING REQUIREMENTS APPLICA17 BLE TO PLANS AND ISSUERS. 

18 ‘‘A group health plan or health insurance issuer offer19 ing group or individual health insurance coverage may not 

20 pay a claim for items and services furnished on or after 

21 January 1, 2026, to an individual at an off-campus out22 patient department of a provider (as defined in section 

23 2799B–10(b)) submitted by a health care provider or facil24 ity unless such claim submitted by such provider or facility 

25 includes a separate unique health identifier for the departVerDate Sep 11 2014 22:48 Nov 08, 2023 Jkt 049200 PO 00000 Frm 00143 Fmt 6652 Sfmt 6203 E:\BILLS\S2840.RS S2840

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1 ment where items and services were furnished, in accord2 ance with section 2799B–10.’’. 

3 (2) EMPLOYEE RETIREMENT INCOME SECURITY

4 ACT OF 1974.— 

5 (A) IN GENERAL.—Subpart B of part 7 of 

6 subtitle B of title I of the Employee Retirement 

7 Income Security Act of 1974 (29 U.S.C. 1185 et 

8 seq.) is amended by adding at the end the fol9 lowing: 

10 ‘‘SEC. 726. HONEST BILLING REQUIREMENTS APPLICABLE 

11 TO PLANS AND ISSUERS. 

12 ‘‘A group health plan or health insurance issuer offer13 ing group health insurance coverage may not pay a claim 

14 for items and services furnished on or after January 1, 

15 2026, to an individual at an off-campus outpatient depart16 ment of a provider (as defined in section 2799B–10(b) of 

17 the Public Health Service Act) submitted by a health care 

18 provider or facility unless such claim submitted by such 

19 provider or facility includes a separate unique health iden20 tifier for the department where items and services were fur21 nished, in accordance with section 2799B–10 of such Act.’’. 

22 (B) CLERICAL AMENDMENT.—The table of 

23 contents in section 1 of the Employee Retirement 

24 Income Security Act of 1974 (29 U.S.C. 1001 et 


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1 seq.) is amended by inserting after the item re2 lating to section 725 the following new item: 

‘‘Sec. 726. Honest billing requirements applicable to plans and issuers.’’. 

3 (3) INTERNAL REVENUE CODE OF 1986.— 

4 (A) IN GENERAL.—Subchapter B of chapter 

5 100 of the Internal Revenue Code of 1986 is 

6 amended by adding at the end the following: 

7 ‘‘SEC. 9826. HONEST BILLING REQUIREMENTS APPLICABLE 

8 TO PLANS. 

9 ‘‘A group health plan may not pay a claim for items 

10 and services furnished on or after January 1, 2026, to an 

11 individual at an off-campus outpatient department of a 

12 provider (as defined in section 2799B–10(b) of the Public 

13 Health Service Act) submitted by a health care provider 

14 or facility unless such claim submitted by such provider or 

15 facility includes a separate unique health identifier for the 

16 department where items and services were furnished, in ac17 cordance with section 2799B–10 of such Act.’’. 

18 (B) CLERICAL AMENDMENT.—The table of 

19 sections for subchapter B of chapter 100 of the 

20 Internal Revenue Code of 1986 is amended by 

21 adding at the end the following new item: 

‘‘Sec. 9826. Honest billing requirements applicable to plans.’’. 

22 (b) REQUIRING A SEPARATE IDENTIFICATION NUMBER

23 AND AN ATTESTATION FOR EACH OFF-CAMPUS OUT24 PATIENT DEPARTMENT OF A PROVIDER.— 


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1 (1) IN GENERAL.—Part E of title XXVII of the 

2 Public Health Service Act (42 U.S.C. 300gg–131 et 

3 seq.) is amended by adding at the end the following: 

4 ‘‘SEC. 2799B–10. HONEST BILLING REQUIREMENTS APPLICA5 BLE TO PROVIDERS. 

6 ‘‘(a) REQUIREMENTS RELATING TO UNIQUE HEALTH

7 IDENTIFIERS.—For items and services furnished, on or 

8 after January 1, 2026, at an off-campus outpatient depart9 ment of a provider to a participant, beneficiary, or enrollee 

10 with benefits under a group health plan or group or indi11 vidual health insurance coverage offered by a health insur12 ance issuer, a health care provider or facility may not sub13 mit a claim to the group health plan or health insurance 

14 issuer, bill the participant, beneficiary, or enrollee, or hold 

15 liable the participant, beneficiary, or enrollee, unless— 

16 ‘‘(1) such provider or facility obtains a separate 

17 unique health identifier established for such depart18 ment pursuant to section 1173(b) of the Social Secu19 rity Act; and 

20 ‘‘(2) such items and services are billed using the 

21 separate unique health identifier established for such 

22 department pursuant to paragraph (1). 

23 ‘‘(b) OFF-CAMPUS OUTPATIENT DEPARTMENT OF A

24 PROVIDER.—The term ‘off-campus outpatient department 

25 of a provider’ means a department of a provider (as defined 


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1 in section 413.65(a)(2) of title 42 of the Code of Federal 

2 Regulations, as in effect on the date of the enactment of 

3 the Bipartisan Primary Care and Health Workforce Act) 

4 that is not located— 

5 ‘‘(1) on the campus (as defined in such section 

6 413.65(a)(2)) of such provider; or 

7 ‘‘(2) within the distance described in such defini8 tion of campus from a remote location of a hospital 

9 (as defined in such section 413.65(a)(2)). 

10 ‘‘(c) PROCESS FOR REPORTING SUSPECTED VIOLA11 TIONS.—The Secretary shall establish a process under which 

12 a suspected violation of this section may be reported to such 

13 Secretary. 

14 ‘‘(d) PENALTIES.—The Secretary may assess a civil 

15 monetary penalty against a hospital for a violation under 

16 this section in an amount— 

17 ‘‘(1) in the case of a hospital with not more than 

18 30 beds (as determined under section 

19 180.90(c)(2)(ii)(D) of title 45, Code of Federal Regu20 lations, as in effect on the date of the enactment of 

21 the Bipartisan Primary Care and Health Workforce 

22 Act (or any successor regulations), not to exceed $300 

23 per day that the violation is ongoing, as determined 

24 by the Secretary; and 


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1 ‘‘(2) in the case of a hospital with more than 30 

2 beds (as so determined), not to exceed $5,500 per day 

3 that the violation is ongoing, as determined by the 

4 Secretary.’’. 

5 (2) CONFORMING AMENDMENT.—Section 2799B– 

6 4(a)(1) of the Public Health Service Act (42 U.S.C. 

7 300gg–134(a)(1)) is amended by inserting ‘‘(other 

8 than section 2799B–10)’’ after ‘‘this part’’. 

9 SEC. 303. BANNING FACILITY FEES FOR CERTAIN SERVICES. 

10 Part E of title XXVII of the Public Health Service Act 

11 (42 U.S.C. 300gg–131 et seq.), as amended by section 

12 302(b), is further amended by adding at the end the fol13 lowing: 

14 ‘‘SEC. 2799B–11. BANNING FACILITY FEES FOR CERTAIN 

15 SERVICES. 

16 ‘‘(a) IN GENERAL.—With respect to applicable items 

17 and services furnished to an individual on or after January 

18 1, 2026, a health care provider or facility may not charge 

19 a facility fee (regardless of how the fee is labeled) to a group 

20 health plan, a health insurance issuer offering group or in21 dividual health insurance coverage, a participant, bene22 ficiary, or enrollee in such a plan or coverage, or an indi23 vidual patient who is not covered by a group health plan, 

24 health insurance coverage, or a Federal health care program 

25 (as defined in section 1128(f) of the Social Security Act). 


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1 ‘‘(b) APPLICABLE ITEMS AND SERVICES.—In this sec2 tion, the term ‘applicable items and services’ means— 

3 ‘‘(1) evaluation and management services de4 scribed in section 1833(cc)(1)(B)(i) of the Social Se5 curity Act; 

6 ‘‘(2) outpatient behavioral health services (not 

7 including partial hospitalizations, intensive out8 patient program services, and other services not typi9 cally provided in an office setting (as the Secretary 

10 may determine)); and 

11 ‘‘(3) any items and services (including the items 

12 and services described in paragraphs (1) and (2)) fur13 nished via telehealth.’’. 

14 SEC. 304. PREVENTION AND PUBLIC HEALTH FUND. 

15 Section 4002(b) of the Patient Protection and Afford16 able Care Act (42 U.S.C. 300u–11(b)) is amended by strik17 ing paragraphs (8) through (10) and inserting the fol18 lowing: 

19 ‘‘(8) for each of fiscal years 2026 and 2027, 

20 $1,425,000,000; 

21 ‘‘(9) for each of fiscal years 2028 and 2029, 

22 $1,495,000,000; 

23 ‘‘(10) for fiscal year 2030, $1,680,000,000; and 

24 ‘‘(11) for fiscal year 2031 and each fiscal year 

25 thereafter, $2,000,000,000.’’. 


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1 SEC. 305. PRICE TRANSPARENCY REQUIREMENTS. 

2 (a) HOSPITALS.—Section 2718(e) of the Public Health 

3 Service Act (42 U.S.C. 300gg–18(e)) is amended— 

4 (1) by striking ‘‘Each hospital’’ and inserting 

5 the following: 

6 ‘‘(1) IN GENERAL.—Each hospital’’; 

7 (2) by inserting ‘‘, in plain language without 

8 subscription and free of charge, in a consumer-friend9 ly, machine-readable format,’’ after ‘‘a list’’; and 

10 (3) by adding at the end the following: ‘‘Each 

11 hospital shall include in its list of standard charges, 

12 along with such additional information as the Sec13 retary may require with respect to such charges for 

14 purposes of promoting public awareness of hospital 

15 pricing in advance of receiving a hospital item or 

16 service, as applicable, the following: 

17 ‘‘(A) A description of each item or service 

18 provided by the hospital. 

19 ‘‘(B) The gross charge. 

20 ‘‘(C) Any payer-specific negotiated charge 

21 clearly associated with the name of the third22 party payer and plan. 

23 ‘‘(D) The de-identified minimum negotiated 

24 charge. 

25 ‘‘(E) The de-identified maximum negotiated 

26 charge. 


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1 ‘‘(F) The discounted cash price. 

2 ‘‘(G) Any code used by the hospital for pur3 poses of accounting or billing, including Current 

4 Procedural Terminology (CPT) code, the 

5 Healthcare Common Procedure Coding System 

6 (HCPCS) code, the Diagnosis Related Group 

7 (DRG), the National Drug Code (NDC), or other 

8 common payer identifier. 

9 ‘‘(2) DELIVERY METHODS AND USE.— 

10 ‘‘(A) IN GENERAL.—Each hospital shall 

11 make public the standard charges described in 

12 paragraph (1) for as many of the 70 Centers for 

13 Medicaid & Medicare Services-specified 

14 shoppable services that are provided by the hos15 pital, and as many additional hospital-selected 

16 shoppable services as may be necessary for a 

17 combined total of at least 300 shoppable services, 

18 including the rate at which a hospital provides 

19 and bills for that shoppable service. If a hospital 

20 does not provide 300 shoppable services in ac21 cordance with the previous sentence, the hospital 

22 shall make public the information specified 

23 under paragraph (1) for as many shoppable 

24 services as it provides. 


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1 ‘‘(B) DETERMINATION BY CMS.—A hospital 

2 shall be deemed by the Centers for Medicare & 

3 Medicaid Services to meet the requirements of 

4 subparagraph (A) if the hospital maintains an 

5 internet-based price estimator tool that meets the 

6 following requirements: 

7 ‘‘(i) The tool provides estimates for as 

8 many of the 70 specified shoppable services 

9 that are provided by the hospital, and as 

10 many additional hospital-selected shoppable 

11 services as may be necessary for a combined 

12 total of at least 300 shoppable services. 

13 ‘‘(ii) The tool allows health care con14 sumers to, at the time they use the tool, ob15 tain an estimate of the amount they will be 

16 obligated to pay the hospital for the 

17 shoppable service. 

18 ‘‘(iii) The tool is prominently dis19 played on the hospital’s website and easily 

20 accessible to the public, without subscrip21 tion, fee, or having to submit personal iden22 tifying information (PII), and searchable 

23 by service description, billing code, and 

24 payer. 


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1 ‘‘(3) DEFINITIONS.—Notwithstanding any other 

2 provision of law, for the purpose of paragraphs (1) 

3 and (2): 

4 ‘‘(A) DE-IDENTIFIED MAXIMUM NEGOTIATED

5 CHARGE.—The term ‘de-identified maximum ne6 gotiated charge’ means the highest charge that a 

7 hospital has negotiated with all third-party pay8 ers for an item or service. 

9 ‘‘(B) DE-IDENTIFIED MINIMUM NEGOTIATED

10 CHARGE.—The term ‘de-identified minimum ne11 gotiated charge’ means the lowest charge that a 

12 hospital has negotiated with all third-party pay13 ers for an item or service. 

14 ‘‘(C) DISCOUNTED CASH PRICE.—The term 

15 ‘discounted cash price’ means the charge that ap16 plies to an individual who pays cash, or cash 

17 equivalent, for a hospital item or service. Hos18 pitals that do not offer self-pay discounts may 

19 display the hospital’s undiscounted gross charges 

20 as found in the hospital chargemaster. 

21 ‘‘(D) GROSS CHARGE.—The term ‘gross 

22 charge’ means the charge for an individual item 

23 or service that is reflected on a hospital’s 

24 chargemaster, absent any discounts. 


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1 ‘‘(E) PAYER-SPECIFIC NEGOTIATED

2 CHARGE.—The term ‘payer-specific negotiated 

3 charge’ means the charge that a hospital has ne4 gotiated with a third-party payer for an item or 

5 service. 

6 ‘‘(F) SHOPPABLE SERVICE.—The term 

7 ‘shoppable service’ means a service that can be 

8 scheduled by a health care consumer in advance. 

9 ‘‘(G) STANDARD CHARGES.—The term 

10 ‘standard charges’ means the regular rate estab11 lished by the hospital for an item or service, in12 cluding both individual items and services and 

13 service packages, provided to a specific group of 

14 paying patients, including the gross charge, the 

15 payer-specific negotiated charge, the discounted 

16 cash price, the de-identified minimum negotiated 

17 charge, the de-identified maximum negotiated 

18 charge, and other rates determined by the Sec19 retary. 

20 ‘‘(H) THIRD-PARTY PAYER.—The term 

21 ‘third-party payer’ means an entity that is, by 

22 statute, contract, or agreement, legally respon23 sible for payment of a claim for a health care 

24 item or service. 


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1 ‘‘(4) ENFORCEMENT.—In addition to any other 

2 enforcement actions or penalties that may apply 

3 under subsection (b)(3) or another provision of law, 

4 a hospital that fails to provide the information re5 quired by this subsection and has not completed a 

6 corrective action plan to comply with the require7 ments of such subsection shall be subject to a civil 

8 monetary penalty of an amount not to exceed $300 

9 per day that the violation is ongoing as determined 

10 by the Secretary. Such penalty shall be imposed and 

11 collected in the same manner as civil money penalties 

12 under subsection (a) of section 1128A of the Social 

13 Security Act are imposed and collected.’’. 

14 (b) TRANSPARENCY IN COVERAGE.—Section 1311(e)(3) 

15 of the Patient Protection and Affordable Care Act (42 

16 U.S.C. 18031(e)(3)) is amended— 

17 (1) in subparagraph (A)— 

18 (A) by redesignating clause (ix) as clause 

19 (xii); and 

20 (B) by inserting after clause (viii) the fol21 lowing: 

22 ‘‘(ix) In-network provider rates for cov23 ered items and services. 


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1 ‘‘(x) Out-of-network allowed amounts 

2 and billed charges for covered items and 

3 services. 

4 ‘‘(xi) Negotiated rates and historical 

5 net prices for covered prescription drugs.’’; 

6 (2) in subparagraph (B)— 

7 (A) in the heading, by striking ‘‘USE’’ and 

8 inserting ‘‘DELIVERY METHODS AND USE’’; 

9 (B) by inserting ‘‘and subparagraph (C)’’ 

10 after ‘‘subparagraph (A)’’; 

11 (C) by inserting ‘‘, as applicable’’ after 

12 ‘‘English proficiency’’; and 

13 (D) by inserting after the second sentence, 

14 the following: ‘‘The Secretary shall establish 

15 standards for the methods and formats for dis16 closing information to individuals. At a min17 imum, these standards shall include the fol18 lowing: 

19 ‘‘(i) An internet-based self-service tool 

20 to provide information to an individual in 

21 plain language, without subscription and 

22 free of charge, in a machine-readable for23 mat, through a self-service tool on an inter24 net website that provides real-time responses 

25 based on cost-sharing information that is 


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1 accurate at the time of the request that al2 lows, at a minimum, users to— 

3 ‘‘(I) search for cost-sharing infor4 mation for a covered item or service 

5 provided by a specific in-network pro6 vider or by all in-network providers; 

7 ‘‘(II) search for an out-of-network 

8 allowed amount, percentage of billed 

9 charges, or other rate that provides a 

10 reasonably accurate estimate of the 

11 amount an insurer will pay for a cov12 ered item or service provided by out-of13 network providers; and 

14 ‘‘(III) refine and reorder search 

15 results based on geographic proximity 

16 of in-network providers, and the 

17 amount of the individual’s cost-sharing 

18 liability for the covered item or service, 

19 to the extent the search for cost-sharing 

20 information for covered items or serv21 ices returns multiple results. 

22 ‘‘(ii) In paper form at the request of 

23 the individual that includes no fewer than 

24 20 providers per request with respect to 

25 which cost-sharing information for covered 


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1 items and services is provided, and discloses 

2 the applicable provider, per-request limit to 

3 the individual, mailed to the individual not 

4 later than 2 business days after receiving 

5 an individual’s request.’’; 

6 (3) in subparagraph (C)— 

7 (A) in the first sentence— 

8 (i) by striking ‘‘The Exchange’’ and 

9 inserting the following: 

10 ‘‘(i) IN GENERAL.—The Exchange’’; 

11 (ii) by inserting ‘‘or out-of-network 

12 provider’’ after ‘‘item or service by a par13 ticipating provider’’; and 

14 (iii) by striking the period and insert15 ing the following: ‘‘the following informa16 tion: 

17 ‘‘(i) An estimate of an individual’s 

18 cost-sharing liability for a requested covered 

19 item or service furnished by a provider, 

20 which shall reflect any cost-sharing reduc21 tions the individual would receive. 

22 ‘‘(ii) A description of the accumulated 

23 amounts. 


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1 ‘‘(iii) The in-network rate, including 

2 negotiated rates and underlying fee schedule 

3 rates. 

4 ‘‘(iv) The out-of-network allowed 

5 amount or any other rate that provides a 

6 more accurate estimate of an amount an 

7 issuer will pay, including the percent reim8 bursed by insurers to out-of-network pro9 viders, for the requested covered item or 

10 service furnished by an out-of-network pro11 vider. 

12 ‘‘(v) A list of the items and services in13 cluded in bundled payment arrangements 

14 for which cost-sharing information is being 

15 disclosed. 

16 ‘‘(vi) A notification that coverage of a 

17 specific item or service is subject to a pre18 requisite, if applicable. 

19 ‘‘(vii) A notice that includes the fol20 lowing information: 

21 ‘‘(I) A statement that out-of-net22 work providers may bill individuals 

23 for the difference, including the balance 

24 billing, between a provider’s billed 

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1 lected from the insurer in the form of 

2 a copayment or coinsurance amount 

3 and the cost-sharing information. 

4 ‘‘(II) A statement that the actual 

5 charges for an individual’s covered 

6 item or service may be different from 

7 an estimate of cost-sharing liability de8 pending on the actual items or services 

9 the individual receives at the point of 

10 care. 

11 ‘‘(III) A statement that the esti12 mate of cost-sharing liability for a cov13 ered item or service is not a guarantee 

14 that benefits will be provided for that 

15 item or service. 

16 ‘‘(IV) A statement disclosing 

17 whether the plan counts copayment as18 sistance and other third-party pay19 ments in the calculation of the individ20 ual’s deductible and out-of-pocket max21 imum. 

22 ‘‘(V) For items and services that 

23 are recommended preventive services 

24 under section 2713 of the Public 

25 Health Service Act, a statement that 


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1 an in-network item or service may not 

2 be subject to cost-sharing if it is billed 

3 as a preventive service and the insurer 

4 cannot determine whether the request is 

5 for a preventive or non-preventive item 

6 or service. 

7 ‘‘(VI) Any additional informa8 tion, including other disclaimers, that 

9 the insurer determines is appropriate, 

10 provided the additional information 

11 does not conflict with the information 

12 required to be provided by this sub13 section.’’; 

14 (B) by striking the second sentence; and 

15 (C) by adding at the end the following: 

16 ‘‘(ii) DEFINITIONS.—Notwithstanding 

17 any other provision of law, for the purpose 

18 of subparagraphs (A), (B), and (C): 

19 ‘‘(I) ACCUMULATED AMOUNTS.— 

20 The term ‘accumulated amounts’ 

21 means the amount of financial respon22 sibility an individual has incurred at 

23 the time a request for cost-sharing in24 formation is made, with respect to a 

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1 cluding any expense that counts to2 ward a deductible or out-of-pocket 

3 limit, but excluding any expense that 

4 does not count toward a deductible or 

5 out-of-pocket limit. To the extent an 

6 insurer imposes a cumulative treat7 ment limitation on a particular cov8 ered item or service independent of in9 dividual medical necessity determina10 tions, the amount that has accrued to11 ward the limit on the item or service. 

12 ‘‘(II) HISTORICAL NET PRICE.— 

13 The term ‘historical net price’ means 

14 the retrospective average amount an 

15 insurer paid for a prescription drug, 

16 inclusive of any reasonably allocated 

17 rebates, discounts, chargebacks, fees, 

18 and any additional price concessions 

19 received by the insurer with respect to 

20 the prescription drug. The allocation 

21 shall be determined by dollar value for 

22 non-product specific and product-spe23 cific rebates, discounts, chargebacks, 

24 fees, and other price concessions to the 

25 extent that the total amount of any 


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1 such price concession is known to the 

2 insurer at the time of publication of 

3 the historical net price. 

4 ‘‘(III) NEGOTIATED RATE.—The 

5 term ‘negotiated rate’ means the 

6 amount a plan or issuer has contrac7 tually agreed to pay for a covered item 

8 or service, whether directly or indi9 rectly through a third-party adminis10 trator or pharmacy benefit manager, to 

11 an in-network provider, including an 

12 in-network pharmacy or other pre13 scription drug dispenser, for covered 

14 items or services. 

15 ‘‘(IV) OUT-OF-NETWORK ALLOWED

16 AMOUNT.—The term ‘out-of-network al17 lowed amount’ means the maximum 

18 amount an insurer will pay for a cov19 ered item or service furnished by an 

20 out-of-network provider. 

21 ‘‘(V) OUT-OF-NETWORK LIMIT.— 

22 The term ‘out-of-network limit’ means 

23 the maximum amount that an indi24 vidual is required to pay during a cov25 erage period for his or her share of the 


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1 costs of covered items and services 

2 under his or her plan or coverage, in3 cluding for self-only and other than 

4 self-only coverage, as applicable. 

5 ‘‘(VI) UNDERLYING FEE SCHED6 ULE RATE.—The term ‘underlying fee 

7 schedule rate’ means the rate for an 

8 item or service that a plan or issuer 

9 uses to determine a participant’s, bene10 ficiary’s, or enrollee’s cost-sharing li11 ability with respect to a particular 

12 provider or providers, when the rate is 

13 different from the negotiated rate.’’; 

14 (4) in subparagraph (D), by striking ‘‘subpara15 graph (A)’’ and inserting ‘‘subparagraphs (A), (B), 

16 and (C)’’; and 

17 (5) by adding at the end the following: 

18 ‘‘(E) APPLICATION OF PARAGRAPH.—In ad19 dition to qualified health plans (and plans seek20 ing certification as qualified health plans), this 

21 paragraph (as amended by the Bipartisan Pri22 mary Care and Health Workforce Act) shall 

23 apply to group health plans (including self-in24 sured and fully insured plans) and health insurVerDate Sep 11 2014 22:48 Nov 08, 2023 Jkt 049200 PO 00000 Frm 00164 Fmt 6652 Sfmt 6203 E:\BILLS\S2840.RS S2840

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1 ance coverage (as such terms are defined in sec2 tion 2791 of the Public Health Service Act).’’. 

3 SEC. 306. PUBLICATION OF LIST OF HOSPITALS. 

4 (a) LIST OF HOSPITALS.—Beginning not later than 

5 90 days after the date of enactment of this Act, the Sec6 retary of Health and Human Services (referred to in this 

7 section as the ‘‘Secretary’’) shall establish and maintain a 

8 publicly available list, on the website of the Centers for 

9 Medicare & Medicaid Services, of each hospital that— 

10 (1) is not in compliance with the hospital price 

11 transparency rule implementing section 2718(e) of the 

12 Public Health Service Act (42 U.S.C. 300gg–18(e)), 

13 and that, with respect to such noncompliance— 

14 (A) has been issued a civil monetary pen15 alty; 

16 (B) has received a warning notice; or 

17 (C) has received a request for a corrective 

18 action plan; or 

19 (2) has received any written communication 

20 from the Secretary regarding potential noncompliance 

21 with such hospital price transparency rule. 

22 (b) FOIA REQUESTS.—Any penalty, notice, request, 

23 or other communication described in subsection (a) shall 

24 be subject to public disclosure, in full and without redac25 tion, under section 552 of title 5, United States Code, notVerDate Sep 11 2014 22:48 Nov 08, 2023 Jkt 049200 PO 00000 Frm 00165 Fmt 6652 Sfmt 6203 E:\BILLS\S2840.RS S2840

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1 withstanding any exemptions or exclusions otherwise avail2 able under such section 552. 

3 (c) REPORT TO CONGRESS.—Not later than 1 year 

4 after the date of enactment of this Act and each year there5 after, the Secretary shall submit to Congress, and make pub6 licly available, a report that contains information regard7 ing complaints of alleged violations of law with respect to, 

8 and enforcement activities by the Secretary under, the hos9 pital price transparency rule implementing section 2718(e) 

10 of the Public Health Service Act (42 U.S.C. 300gg–18(e)). 

11 Such report shall be made available to the public on the 

12 website of the Centers for Medicare & Medicaid Services. 

13 (d) GAO REPORT.—Not later than 1 year after the 

14 date of enactment of this Act, the Comptroller General of 

15 the United States shall submit to the Committee on Health, 

16 Education, Labor, and Pensions of the Senate and the Com17 mittee on Ways and Means and the Committee on Energy 

18 and Commerce of the House of Representatives a report on 

19 compliance and enforcement of the hospital price trans20 parency rule implementing section 2718(e) of the Public 

21 Health Service Act (42 U.S.C. 300gg–18(e)). The report 

22 shall include recommendations related to— 

23 (1) improving price transparency for patients, 

24 employers, and the public; 


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1 (2) the revocation or suspension of tax-exempt 

2 status under section 501(c)(3) of the Internal Revenue 

3 Code of 1986 for noncompliant hospitals; and 

4 (3) increased civil monetary penalty amounts to 

5 ensure compliance. 

6 (e) RULEMAKING.—Not later than 180 days after the 

7 report described in subsection (d) is published, the Sec8 retary, in consultation with the Secretary of the Treasury, 

9 shall issue a proposed rule based on the recommendations 

10 of the Comptroller General of the United States under sub11 section (d), including the recommendations described in 

12 paragraphs (2) and (3) of such subsection. 


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Calendar No. 242 

118TH CONGRESS 

1ST SESSION S. 2840 

A BILL 

To improve access to and the quality of primary 

other purposes. health care, expand the health workforce, and for 

NOVEMBER 8, 2023 

Reported with an amendment 


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