II

106TH CONGRESS

2D SESSION S. 3176

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

developing a comprehensive program that will result in statewide physician population growth.

IN THE SENATE OF THE UNITED STATES

OCTOBER 6 (legislative day, SEPTEMBER 22), 2000

Mr. BINGAMAN (for himself, Mr. DOMENICI, and Mr. CONRAD) introduced the

following bill; which was read twice and referred to the Committee on Finance

A BILL

To conduct a demonstration program to show that physician

shortage, recruitment, and retention problems may be

ameliorated in rural States by developing a comprehensive program that will result in statewide physician population growth.

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

3 SECTION 1. SHORT TITLE; TABLE OF CONTENTS.

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

5 ‘‘Rural States Physician Recruitment and Retention Dem6 onstration Act of 2000’’.
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1 (b) TABLE OF CONTENTS.—The table of contents of

2 this Act is as follows:

Sec. 1. Short title; table of contents.

Sec. 2. Definitions.

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

Sec. 4. Establishment of the Health Professions Database.

Sec. 5. Evaluation and reports.

Sec. 6. Contracting flexibility.

3 SEC. 2. DEFINITIONS.

4 In this Act:

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

6 Council on Graduate Medical Education established

7 under section 762 of the Public Health Service Act

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

9 (2) DEMONSTRATION PROGRAM.—The term

10 ‘‘demonstration program’’ means the Rural States

11 Physician Recruitment and Retention Demonstration

12 Program established by the Secretary under section

13 3(a).

14 (3) DEMONSTRATION STATES.—The term

15 ‘‘demonstration States’’ means the 2 States selected

16 by the Secretary that, based upon 1998 data,

17 have—

18 (A) an uninsured population above 20 per19 cent (as determined by the Bureau of the Cen20 sus);

21 (B) a population eligible for medical assist22 ance under the medicaid program under title
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1 XIX of the Social Security Act (42 U.S.C. 1396

2 et seq.) above 17 percent (as determined by the

3 Health Care Financing Administration);

4 (C) an unemployment rate above 4.8 per5 cent (as determined by the Bureau of Labor

6 Statistics);

7 (D) an average per capita income below

8 $21,200 (as determined by the Bureau of Eco9 nomic Analysis); and

10 (E) a geographic practice cost indices com11 ponent of the reimbursement rate for physicians

12 under the medicare program that is below the

13 national average (as determined by the Health

14 Care Financing Administration).

15 (4) ELIGIBLE RESIDENCY OR FELLOWSHIP

16 GRADUATE.—The term ‘‘eligible residency or fellow17 ship graduate’’ means a graduate of an approved

18 medical residency training program (as defined in

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

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

21 specialty.

22 (5) HEALTH PROFESSIONS DATABASE.—The

23 term ‘‘Health Professions Database’’ means the

24 database established under section 4(a).
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1 (6) MEDICARE PROGRAM.—The term ‘‘medicare

2 program’’ means the health benefits program under

3 title XVIII of the Social Security Act (42 U.S.C.

4 1395 et seq.).

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

6 the Medicare Payment Advisory Commission estab7 lished under section 1805 of the Social Security Act

8 (42 U.S.C. 1395b–6).

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

10 the Secretary of Health and Human Services.

11 (9) SHORTAGE PHYSICIAN SPECIALTIES.—The

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

13 or surgical specialty identified in a demonstration

14 State by the Secretary based on—

15 (A) an analysis and comparison of Na16 tional data and demonstration State data; and

17 (B) recommendations from appropriate

18 Federal, State, and private commissions, cen19 ters, councils, medical and surgical physician

20 specialty boards, and medical societies or asso21 ciations involved in physician workforce, edu22 cation and training, and payment issues.

23 SEC. 3. RURAL STATES PHYSICIAN RECRUITMENT AND RE24 TENTION DEMONSTRATION PROGRAM.

25 (a) ESTABLISHMENT.—
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1 (1) IN GENERAL.—The Secretary shall establish

2 a Rural States Physician Recruitment and Retention

3 Demonstration Program for the purpose of amelio4 rating physician shortage, recruitment, and retention

5 problems in rural States in accordance with the re6 quirements of this section.

7 (2) CONSULTATION.—For purposes of estab8 lishing the demonstration program, the Secretary

9 shall consult with—

10 (A) COGME;

11 (B) MedPAC;

12 (C) a representative of each demonstration

13 State medical society or association;

14 (D) the health workforce planning and

15 physician training authority of each demonstra16 tion State; and

17 (E) any other entity described in section

18 2(9)(B).

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

20 demonstration program for a period of 10 years.

21 (c) CONDUCT OF PROGRAM.—

22 (1) FUNDING OF ADDITIONAL RESIDENCY AND

23 FELLOWSHIP POSITIONS.—

24 (A) IN GENERAL.—As part of the dem25 onstration program, the Secretary (acting
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1 through the Administrator of the Health Care

2 Financing Administration) shall—

3 (i) waive any limitation under section

4 1886 of the Social Security Act (42 U.S.C.

5 1395ww) with respect to the number of

6 residency and fellowship positions;

7 (ii) increase by up to 15 percent of

8 the total number residency and fellowship

9 positions approved at each medical resi10 dency training program in each demonstra11 tion State the number of residency and fel12 lowships in each shortage physician spe13 cialty; and

14 (iii) subject to subparagraph (C), pro15 vide funding for such additional positions

16 under subsections (d)(5)(B) and (h) of sec17 tion 1886 of the Social Security Act (42

18 U.S.C. 1395ww).

19 (B) ESTABLISHMENT OF ADDITIONAL PO20 SITIONS.—

21 (i) IDENTIFICATION.—The Secretary

22 shall identify each additional residency and

23 fellowship position created as a result of

24 the application of subparagraph (A).
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1 (ii) NEGOTIATION AND CONSULTA2 TION.—The Secretary shall negotiate and

3 consult with representatives of each ap4 proved medical residency training program

5 in a demonstration State at which a posi6 tion identified under clause (i) is created

7 for purposes of supporting such position.

8 (C) CONTRACTS WITH RESIDENTS AND

9 FELLOWS.—

10 (i) IN GENERAL.—The Secretary shall

11 condition the availability of funding for

12 each residency and fellowship position

13 identified under subparagraph (B)(i) on

14 the execution of a contract containing the

15 provisions described in clause (ii) by each

16 individual accepting such a residency or

17 fellowship position.

18 (ii) PROVISIONS DESCRIBED.—The

19 provisions described in this clause provide

20 that, upon completion of the residency or

21 fellowship, the individual completing such

22 residency or fellowship will practice in the

23 demonstration State in which such resi24 dency or fellowship was completed that is

25 designated by the contract for 1 year for
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1 each year of training under the residency

2 or fellowship in the demonstration State.

3 (iii) CONSTRUCTION.—The period

4 that the individual practices in the area

5 designated by the contract shall be in addi6 tion to any period that such individual

7 practices in an area designated under a

8 contract executed pursuant to paragraph

9 (2)(C).

10 (D) LIMITATIONS.—

11 (i) PERIOD OF PAYMENT.—The Sec12 retary may not fund any residency of fel13 lowship position identified under subpara14 graph (B)(i) for a period of more than 5

15 years.

16 (ii) PHASE-OUT OF PROGRAM.—The

17 Secretary may not enter into any contract

18 under subparagraph (C) after the date

19 that is 5 years after the date on which the

20 Secretary establishes the demonstration

21 program.

22 (2) LOAN REPAYMENT AND FORGIVENESS PRO23 GRAM.—

24 (A) IN GENERAL.—As part of the dem25 onstration program, the Secretary (acting
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1 through the Administrator of Health Resources

2 and Services Administration) shall establish a

3 loan repayment and forgiveness program,

4 through the holder of the loan, under which the

5 Secretary assumes the obligation to repay a

6 qualified loan amount for an educational loan of

7 an eligible residency or fellowship graduate—

8 (i) for which the Secretary has ap9 proved an application submitted under

10 subparagraph (D); and

11 (ii) with which the Secretary has en12 tered into a contract under subparagraph

13 (C).

14 (B) QUALIFIED LOAN AMOUNT.—

15 (i) IN GENERAL.—Subject to clause

16 (ii), the Secretary shall repay not more

17 than $25,000 per graduate per year of the

18 loan obligation on a loan that is out19 standing during the period that the eligible

20 residency or fellowship graduate practices

21 in the area designated by the contract en22 tered into under subparagraph (C).

23 (ii) LIMITATION.—The aggregate

24 amount under this subparagraph shall not

25 exceed $125,000 for any graduate and the
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1 Secretary may not repay or forgive more

2 than 30 loans per year in each demonstra3 tion State under this paragraph.

4 (C) CONTRACTS WITH RESIDENTS AND

5 FELLOWS.—

6 (i) IN GENERAL.—Each eligible resi7 dency or fellowship graduate desiring re8 payment of a loan under this paragraph

9 shall execute a contract containing the pro10 visions described in clause (ii).

11 (ii) PROVISIONS.—The provisions de12 scribed in this clause are provisions that

13 require the eligible residency or fellowship

14 graduate to practice in a demonstration

15 State during the period in which a loan is

16 being repaid or forgiven under this section.

17 (D) APPLICATION.—

18 (i) IN GENERAL.—Each eligible resi19 dency or fellowship graduate desiring re20 payment of a loan under this paragraph

21 shall submit an application to the Sec22 retary at such time, in such manner, and

23 accompanied by such information as the

24 Secretary may reasonably require.
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1 (ii) PHASE-OUT OF LOAN REPAYMENT

2 AND FORGIVENESS PROGRAM.—The Sec3 retary may not accept an application for

4 repayment of any loan under this para5 graph after the date that is 5 years after

6 the date on which the demonstration pro7 gram is established.

8 (E) CONSTRUCTION.—Nothing in the sec9 tion shall be construed to authorize any refund10 ing of any repayment of a loan.

11 (F) PREVENTION OF DOUBLE BENE12 FITS.—No borrower may, for the same service,

13 receive a benefit under both this paragraph and

14 any loan repayment or forgiveness program

15 under title VII of the Public Health Service Act

16 (42 U.S.C. 292 et seq.).

17 (d) WAIVER OF MEDICARE REQUIREMENTS.—The

18 Secretary is authorized to waive any requirement of the

19 medicare program, or approve equivalent or alternative

20 ways of meeting such a requirement, if such waiver is nec21 essary to carry out the demonstration program, including

22 the waiver of any limitation on the amount of payment

23 or number of residents under section 1886 of the Social

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

25 (e) APPROPRIATIONS.—
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1 (1) FUNDING OF ADDITIONAL RESIDENCY AND

2 FELLOWSHIP POSITIONS.—Any expenditures result3 ing from the establishment of the funding of addi4 tional residency and fellowship positions under sub5 section (c)(1) shall be made from the Federal Hos6 pital Insurance Trust Fund under section 1817 of

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

8 (2) LOAN REPAYMENT AND FORGIVENESS PRO9 GRAM.—There are authorized to be appropriated

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

11 repayment and forgiveness program established

12 under subsection (c)(2).

13 SEC. 4. ESTABLISHMENT OF THE HEALTH PROFESSIONS

14 DATABASE.

15 (a) ESTABLISHMENT OF THE HEALTH PROFESSIONS

16 DATABASE.—

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

18 after the date of enactment of this Act, the Sec19 retary (acting through the Administrator of Health

20 Resources and Services Administration) shall estab21 lish a State-specific health professions database to

22 track health professionals in each demonstration

23 State with respect to specialty certifications, practice

24 characteristics, professional licensure, practice types,

25 locations, education, training, as well as obligations
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1 under the demonstration program as a result of the

2 execution of a contract under paragraph (1)(C) or

3 (2)(C) of section 3(c).

4 (2) DATA SOURCES.—In establishing the

5 Health Professions Database, the Secretary shall use

6 the latest available data from existing health work7 force files, including the AMA Master File, State

8 databases, specialty medical society data sources and

9 information, and such other data points as may be

10 recommended by COGME, MedPAC, the National

11 Center for Workforce Information and Analysis, or

12 the medical society of the respective demonstration

13 State.

14 (b) AVAILABILITY.—

15 (1) DURING THE PROGRAM.—During the dem16 onstration program, data from the Health Profes17 sions Database shall be made available to the Sec18 retary, each demonstration State, and the public for

19 the purposes of—

20 (A) developing a baseline and to track

21 changes in a demonstration State’s health pro22 fessions workforce;

23 (B) tracking direct and indirect graduate

24 medical education payments to hospitals;
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1 (C) tracking the forgiveness and repay2 ment of loans for educating physicians; and

3 (D) tracking commitments by physicians

4 under the demonstration program.

5 (2) FOLLOWING THE PROGRAM.—Following the

6 termination of the demonstration program, a dem7 onstration State may elect to maintain the Health

8 Professions Database for such State at its expense.

9 (c) AUTHORIZATION OF APPROPRIATIONS.—There

10 are authorized to be appropriated such sums as may be

11 necessary for the purpose of carrying out this section.

12 SEC. 5. EVALUATION AND REPORTS.

13 (a) EVALUATION.—

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

15 jointly conduct a comprehensive evaluation of the

16 demonstration program established under section 3.

17 (2) MATTERS EVALUATED.—The evaluation

18 conducted under paragraph (1) shall include an

19 analysis of the effectiveness of the funding of addi20 tional residency and fellowship positions and the

21 loan repayment and forgiveness program on physi22 cian recruitment, retention, and specialty mix in

23 each demonstration State.

24 (b) PROGRESS REPORTS.—
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1 (1) COGME.—COGME shall submit a report

2 on the progress of the demonstration program to the

3 Secretary and Congress 1 year after the date on

4 which the Secretary establishes the demonstration

5 program, 5 years after such date, and 10 years after

6 such date.

7 (2) MEDPAC.—MedPAC shall submit biennial

8 reports on the progress of the demonstration pro9 gram to the Secretary and Congress.

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

11 date on which the demonstration program terminates,

12 COGME and MedPAC shall submit a final report to the

13 President, Congress, and the Secretary which shall contain

14 a detailed statement of the findings and conclusions of

15 COGME and MedPAC, together with such recommenda16 tions for such legislation and administrative actions as

17 COGME and MedPAC consider appropriate.

18 (d) AUTHORIZATION OF APPROPRIATIONS.—There

19 are authorized to be appropriated to COGME such sums

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

21 section.

22 SEC. 6. CONTRACTING FLEXIBILITY.

23 For purposes of conducting the demonstration pro24 gram and establishing and administering the Health Pro25 fessions Database, the Secretary may procure temporary
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1 and intermittent services under section 3109(b) of title 5,

2 United States Code.

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