I 

116TH CONGRESS 

2D SESSION H. R. 7470 

To amend the Public Health Service Act to help build a stronger health 

care workforce. 

IN THE HOUSE OF REPRESENTATIVES 

JULY 1, 2020 

Mr. RUIZ introduced the following bill; which was referred to the Committee 

on Energy and Commerce, and in addition to the Committee on Ways 

and Means, for a period to be subsequently determined by the Speaker, 

in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned 

A BILL 

To amend the Public Health Service Act to help build a 

stronger health care workforce. 

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

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘Building a Health Care 

5 Workforce for the Future Act’’. 

6 SEC. 2. GRANTS TO STATES FOR SCHOLARSHIP PROGRAMS. 

7 Subpart III of part D of title III of the Public Health 

8 Service Act (42 U.S.C. 254l et seq.) is amended by adding 

9 at the end the following: 


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1 ‘‘SEC. 338O. GRANTS TO STATES FOR SCHOLARSHIP PRO2 GRAMS. 

3 ‘‘(a) IN GENERAL.—The Secretary shall award 

4 grants to eligible States to enable such States to imple5 ment scholarship programs to ensure, with respect to the 

6 provision of health services, an adequate supply of physi7 cians, dentists, behavioral and mental health professionals, 

8 certified nurse midwives, certified nurse practitioners, 

9 physician assistants, pharmacists, and other health profes10 sionals as determined by the Secretary. 

11 ‘‘(b) ELIGIBLE STATES.—To be eligible to receive a 

12 grant under this section, a State shall submit to the Sec13 retary an application containing such information as the 

14 Secretary determines necessary to carry out this section. 

15 ‘‘(c) ELIGIBLE PARTICIPANTS.—To be eligible to par16 ticipate in a scholarship program carried out with a grant 

17 received under this section, an individual shall— 

18 ‘‘(1) be accepted for enrollment, or be enrolled, 

19 as a full-time student— 

20 ‘‘(A) in an accredited (as determined by 

21 the Secretary) educational institution in a 

22 State; and 

23 ‘‘(B) in a course of study or program, of24 fered by such institution and approved by the 

25 Secretary, leading to a degree in medicine, den26 tistry, nursing, pharmacy, or other health proVerDate Sep 11 2014 05:41 Jul 24, 2020 Jkt 099200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\H7470.IH H7470

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1 fession, or an appropriate degree from a grad2 uate program of behavioral and mental health; 

3 ‘‘(2) submit to the State an application to par4 ticipate in the program; and 

5 ‘‘(3) sign and submit to the State, at the time 

6 of the submission of the application under paragraph 

7 (2), a written contract that requires the individual 

8 to— 

9 ‘‘(A) accept payments under the scholar10 ship; 

11 ‘‘(B) maintain a minimum level of aca12 demic standing during the period of the schol13 arship, as determined by the Secretary; 

14 ‘‘(C) if applicable, complete an accredited 

15 residency training program; 

16 ‘‘(D) become licensed in the applicant’s 

17 State of residence; and 

18 ‘‘(E) serve as a provider for one year in— 

19 ‘‘(i) a health professional shortage 

20 area (as defined under section 332); 

21 ‘‘(ii) a medically underserved commu22 nity (as defined under section 799B); or 

23 ‘‘(iii) any other shortage area defined 

24 by the State and approved by the Sec25 retary; 


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1 in the applicant’s State of residence for every 

2 year in which the applicant received a scholar3 ship. 

4 ‘‘(d) DESIGNATION OF AREAS.—To be eligible to re5 ceive a grant under this section, a State shall adequately 

6 demonstrate to the Secretary that the State has des7 ignated appropriate health professional or specialty short8 age areas. 

9 ‘‘(e) REQUIRED DISCLOSURES.—In disseminating 

10 application and contract forms to individuals desiring to 

11 participate in a scholarship program funded under this 

12 section, the State shall include with such forms a sum13 mary of the rights and liabilities of an individual whose 

14 application is approved (and whose contract is accepted), 

15 including a clear explanation of the damages to which the 

16 State is entitled in the case of the individual’s breach of 

17 the contract. 

18 ‘‘(f) AWARDING OF CONTRACTS.— 

19 ‘‘(1) IN GENERAL.—A State that enters into a 

20 contract with an individual under subsection (c)(3) 

21 shall, with respect to the program in which the indi22 vidual is enrolled, agree to pay— 

23 ‘‘(A) all tuition and costs associated with 

24 the program; 


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1 ‘‘(B) any other reasonable educational ex2 penses, including fees, books, and laboratory ex3 penses, related to the program; and 

4 ‘‘(C) a cost-of-living stipend in an amount 

5 to be determined the Secretary. 

6 ‘‘(2) CONSIDERATION BY STATE.—In entering 

7 into contracts with individuals that meet the require8 ments of subsection (c), the State shall consider the 

9 extent of the applicant’s demonstrated interest in 

10 the provision of care services in a particular provider 

11 shortage area. 

12 ‘‘(g) MATCHING FUNDS.—A State receiving a grant 

13 under this section shall, with respect to the costs of mak14 ing payments on behalf of individuals under the scholar15 ship program implemented by the State under the grant, 

16 make available (directly or through donations from public 

17 or private entities) non-Federal contributions in cash to18 ward such costs in an amount equal to not less than $1 

19 for each $1 of Federal funds provided under the grant. 

20 ‘‘(h) DIRECT ADMINISTRATION BY STATE AGENCY.— 

21 The scholarship program of any State receiving a grant 

22 under this section shall be administered directly by a State 

23 agency. 

24 ‘‘(i) REPORT BY SECRETARY.—Not later than four 

25 years after the date of enactment of this section, and every 


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1 five years thereafter, the Secretary shall submit to Con2 gress a report concerning— 

3 ‘‘(1) the number of scholarships awarded under 

4 the State scholarship program; 

5 ‘‘(2) the number of scholarship recipients, bro6 ken down by practice area, serving in the profession 

7 originally awarded a scholarship for one year after 

8 the completion of the service period required under 

9 subsection (c)(3)(E); 

10 ‘‘(3) the number of scholarship recipients, bro11 ken down by provider type, practicing in a medically 

12 underserved community one year after the comple13 tion of the service period required under subsection 

14 (c)(3)(E); 

15 ‘‘(4) data on any changes in health professional 

16 shortage areas or medically underserved commu17 nities within the State; 

18 ‘‘(5) remaining gaps in such health professional 

19 shortage areas or medically underserved commu20 nities; 

21 ‘‘(6) the number of additional full-time physi22 cians that would be required to eliminate such 

23 health professional shortage areas or medically un24 derserved communities in the State; 


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1 ‘‘(7) the number of individuals who received a 

2 scholarship but failed to comply with the require3 ments of the scholarship; 

4 ‘‘(8) the action taken by the State to recoup 

5 scholarship funds in the case of any non-compliance; 

6 and 

7 ‘‘(9) recommendations to improve the program 

8 under this section. 

9 ‘‘(j) AUTHORIZATION OF APPROPRIATIONS.—There 

10 is authorized to be appropriated to carry out this section 

11 $20,000,000 for each of fiscal years 2021 through 2025. 

12 Not less than 50 percent of the amount appropriated for 

13 a fiscal year under this subsection shall be used to provide 

14 scholarships to providers who intend on pursuing careers 

15 in primary care.’’. 

16 SEC. 3. INCREASING MENTORING AND TRANSFORMING 

17 COMPETENCIES IN PRIMARY CARE. 

18 Title VII of the Public Health Service Act is amended 

19 by inserting after section 747A (42 U.S.C. 293k–1) the 

20 following: 

21 ‘‘SEC. 747B. DEVELOPING EFFECTIVE PRIMARY CARE MEN22 TORS AND IMPROVING MENTORSHIP OPPOR23 TUNITIES FOR MEDICAL STUDENTS. 

24 ‘‘(a) GRANTS TO CULTIVATE PRIMARY CARE MEN25 TORS AND IMPROVE PRIMARY CARE MENTORSHIP OPPORVerDate Sep 11 2014 05:41 Jul 24, 2020 Jkt 099200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\H7470.IH H7470

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1 TUNITIES FOR MEDICAL STUDENTS.—The Secretary may 

2 award grants to eligible medical schools to assist such 

3 schools in developing and strengthening primary care 

4 mentorship programs and cultivating leaders in primary 

5 care among students. 

6 ‘‘(b) ELIGIBILITY.—To be eligible to receive a grant 

7 under this section, an entity shall— 

8 ‘‘(1) be an accredited medical school or college 

9 of osteopathic medicine; and 

10 ‘‘(2) submit to the Secretary an application at 

11 such time, in such manner, and containing such in12 formation as the Secretary may require, including an 

13 assurance that the applicant will use amounts re14 ceived under the grant to— 

15 ‘‘(A) establish or enhance existing 

16 mentorship programs, including— 

17 ‘‘(i) incentivizing medical school fac18 ulty (through financial or other reward 

19 systems) to participate as a mentor of 

20 other primary care physician faculty mem21 bers and students; 

22 ‘‘(ii) providing resources for aspiring 

23 mentors to participate in workshops or 

24 other learning experiences in which priVerDate Sep 11 2014 05:41 Jul 24, 2020 Jkt 099200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\H7470.IH H7470

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1 mary care physicians can learn about effec2 tive strategies in primary care mentoring; 

3 ‘‘(iii) enabling successful primary care 

4 mentors on medical school faculty to spend 

5 time at another institution where they can 

6 promote best practices in mentoring pri7 mary care leaders and students; and 

8 ‘‘(iv) developing web-based resources 

9 for mentors to interact regularly and share 

10 successful strategies; or 

11 ‘‘(B) cultivate interest and leaders in pri12 mary care among students, including— 

13 ‘‘(i) offering students that identify in14 terest in primary care upon matriculation 

15 longitudinal experiences in primary care to 

16 care for and track the health and wellness 

17 of patients throughout medical school; 

18 ‘‘(ii) arranging partnerships with pri19 vate practices, insurers, schools of public 

20 health, public health departments, and 

21 community-based service projects with the 

22 goal of providing students with the oppor23 tunity to interact with primary care men24 tors from a variety of health care settings; 


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1 ‘‘(iii) providing stipends or other 

2 forms of financial resources to students 

3 who work with designated mentors in the 

4 field of primary care in underserved urban 

5 and rural communities; and 

6 ‘‘(iv) supporting opportunities for stu7 dents to engage in practice redesign or 

8 other efforts in which primary care physi9 cians are taking a leadership role in deliv10 ery system reform. 

11 ‘‘(c) AUTHORIZATION OF APPROPRIATIONS.—There 

12 is authorized to be appropriated to carry out this section 

13 $20,000,000 for each of fiscal years 2021 through 2027. 

14 ‘‘SEC. 747C. DEVELOPING AND PROMOTING NEW COM15 PETENCIES. 

16 ‘‘(a) GRANTS TO DEVELOP AND PROMOTE NEW

17 COMPETENCIES.—In order to foster curricular innova18 tions to improve the education and training of health care 

19 providers, the Secretary shall award grants to medical and 

20 other health professions schools to promote priority com21 petencies (as described in subsection (b)). 

22 ‘‘(b) PRIORITY COMPETENCIES.—In awarding grants 

23 under subsection (a), the Secretary, acting through the 

24 Advisory Committee on Training in Primary Care and 

25 Dentistry, shall select an annual competency to direct the 


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1 awarding of such grants. Such annual competencies may 

2 include— 

3 ‘‘(1) patient-centered medical homes; 

4 ‘‘(2) chronic disease management; 

5 ‘‘(3) integration of primary care and mental 

6 health care; 

7 ‘‘(4) integration of primary care, public and 

8 population health, and health promotion; 

9 ‘‘(5) cultural competency; 

10 ‘‘(6) domestic violence; 

11 ‘‘(7) improving care in medically undeserved 

12 areas; and 

13 ‘‘(8) team-based care. 

14 ‘‘(c) GRANT RECIPIENTS.—The Secretary may award 

15 grants under subsection (a) to programs that provide edu16 cation or training for— 

17 ‘‘(1) physicians; 

18 ‘‘(2) dentists and dental hygienists; 

19 ‘‘(3) physician assistants; 

20 ‘‘(4) mental and behavioral health providers; 

21 ‘‘(5) public and populations health profes22 sionals; or 

23 ‘‘(6) pharmacists. 

24 ‘‘(d) CONSIDERATION IN EVALUATING GRANT APPLI25 CATIONS.—The Secretary shall give consideration to appliVerDate Sep 11 2014 05:41 Jul 24, 2020 Jkt 099200 PO 00000 Frm 00011 Fmt 6652 Sfmt 6201 E:\BILLS\H7470.IH H7470

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1 cants that are proposing to partner with other medical 

2 programs, health professions programs, or nursing pro3 grams. 

4 ‘‘(e) GRANTEE REPORTS.—Each recipient of a grant 

5 under this section shall, not later than 180 days after the 

6 end of the grant period involved, submit to the Advisory 

7 Committee, a report on the following (where appropriate): 

8 ‘‘(1) A description of how the funding under 

9 the grant was used by the grantee. 

10 ‘‘(2) A description of the intended goal of such 

11 funding. 

12 ‘‘(3) A description of the challenges faced by 

13 the grantee in reaching the goal described in para14 graph (2). 

15 ‘‘(4) A description of the lessons learned by the 

16 grantee related to the grant activities. 

17 ‘‘(f) RECOMMENDATIONS OF THE ADVISORY COM18 MITTEE.—The Advisory Committee, based on the informa19 tion submitted under subsection (e), shall annually report 

20 to the Secretary on outcomes of the activities carried out 

21 under grants under this section, including specific rec22 ommendations for scaling up innovations to promote edu23 cation and training of health care providers in the priority 

24 competencies described in subsection (b). 


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1 ‘‘(g) AUTHORIZATION OF APPROPRIATIONS.—There 

2 is authorized to be appropriated to carry out this section 

3 $10,000,000 for each of fiscal years 2021 through 2025.’’. 

4 SEC. 4. STUDY ON DOCUMENTATION REQUIREMENTS FOR 

5 COGNITIVE SERVICES. 

6 Not later than three years after the date of enact7 ment of this Act, the Institute of Medicine shall conduct 

8 a study and submit a report to Congress concerning the 

9 documentation requirements for cognitive services (evalua10 tion and management services) required under the Medi11 care and Medicaid programs under titles XVIII and XIX 

12 of the Social Security Act, respectively, and through pri13 vate health insurers. Such study shall include an evalua14 tion of— 

15 (1) how documentation requirements designed 

16 for paper-based records should be modified for elec17 tronic records; 

18 (2) whether or not the documentation require19 ments are overly burdensome on physicians and de20 tract from patient care; 

21 (3) the administrative costs to physician prac22 tices of the current documentation requirements; 

23 (4) the average amount of time required by 

24 physicians to document cognitive services; 


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1 (5) options to more appropriately compensate 

2 physicians for evaluation and management of patient 

3 care without requiring excessive documentation of 

4 cognitive services; and 

5 (6) recommendations for less burdensome alter6 natives or changes to existing documentation re7 quirements of cognitive services. 

Æ 


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