I 

111TH CONGRESS 

1ST SESSION H. R. 4409 

To amend the Public Health Service Act to authorize a program for the 

training of medical residents in community-based settings. 

IN THE HOUSE OF REPRESENTATIVES 

DECEMBER 19, 2009 

Mr. GENE GREEN of Texas (for himself and Mr. SARBANES) introduced the 

following bill; which was referred to the Committee on Energy and Commerce 

A BILL 

To amend the Public Health Service Act to authorize a 

program for the training of medical residents in community-based settings. 

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 ‘‘Community-Based 

5 Residency Training Act of 2009’’. 

6 SEC. 2. TRAINING OF MEDICAL RESIDENTS IN COMMUNITY7 BASED SETTINGS. 

8 Part C of title VII of the Public Health Service Act 

9 (42 U.S.C. 293k et seq.) is amended by adding at the end 

10 the following: 


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1 ‘‘SEC. 749. TRAINING OF MEDICAL RESIDENTS IN COMMU2 NITY-BASED SETTINGS. 

3 ‘‘(a) PROGRAM.—The Secretary shall establish a pro4 gram for the training of medical residents in community5 based settings consisting of awarding grants and contracts 

6 under this section. 

7 ‘‘(b) DEVELOPMENT AND OPERATION OF COMMU8 NITY-BASED PROGRAMS.—The Secretary shall make 

9 grants to, or enter into contracts with, eligible entities— 

10 ‘‘(1) to plan and develop a new primary care 

11 residency training program, which may include— 

12 ‘‘(A) planning and developing curricula; 

13 ‘‘(B) recruiting and training residents and 

14 faculty; and 

15 ‘‘(C) other activities designated to result in 

16 accreditation of such a program; or 

17 ‘‘(2) to operate or participate in an established 

18 primary care residency training program, which may 

19 include— 

20 ‘‘(A) planning and developing curricula; 

21 ‘‘(B) recruitment and training of residents; 

22 and 

23 ‘‘(C) retention of faculty. 

24 ‘‘(c) ELIGIBLE ENTITY.—To be eligible to receive a 

25 grant or contract under subsection (b), an entity must be 

26 designated as eligible to receive payment for the direct 


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1 costs of medical education under section 1886(k) of the 

2 Social Security Act. 

3 ‘‘(d) PREFERENCES.—In awarding grants and con4 tracts under paragraph (1) or (2) of subsection (b), the 

5 Secretary shall give preference to entities that— 

6 ‘‘(1) support teaching programs that address 

7 the health care needs of vulnerable populations; or 

8 ‘‘(2) are a Federally qualified health center (as 

9 defined in section 1861(aa)(4) of the Social Security 

10 Act) or a rural health clinic (as defined in section 

11 1861(aa)(2) of such Act). 

12 ‘‘(e) ADDITIONAL PREFERENCES FOR ESTABLISHED

13 PROGRAMS.—In awarding grants and contracts under 

14 subsection (b)(2), the Secretary shall give preference to 

15 entities that have a demonstrated record of training— 

16 ‘‘(1) a high or significantly improved percentage 

17 of health professionals who provide primary care; 

18 ‘‘(2) individuals who are from disadvantaged 

19 backgrounds (including racial and ethnic minorities 

20 underrepresented among primary care professionals); 

21 or 

22 ‘‘(3) individuals who practice in settings having 

23 the principal focus of serving underserved areas or 

24 populations experiencing health disparities (including 

25 serving patients eligible for medical assistance under 


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1 title XIX of the Social Security Act or for child 

2 health assistance under title XXI of such Act or 

3 those with special health care needs). 

4 ‘‘(f) PERIOD OF AWARDS.— 

5 ‘‘(1) IN GENERAL.—The period of a grant or 

6 contract under this section— 

7 ‘‘(A) shall not exceed 3 years for awards 

8 under subsection (b)(1); and 

9 ‘‘(B) shall not exceed 5 years for awards 

10 under subsection (b)(2). 

11 ‘‘(2) SPECIAL RULES.— 

12 ‘‘(A) An award of a grant or contract 

13 under subsection (b)(1) shall not be renewed. 

14 ‘‘(B) The period of a grant or contract 

15 awarded to an entity under subsection (b)(2) 

16 shall not overlap with the period of any grant 

17 or contact awarded to the same entity under 

18 subsection (b)(1). 

19 ‘‘(g) REPORT.—The Secretary shall submit to the 

20 Congress an annual report on the program carried out 

21 under this section. 

22 ‘‘(h) DEFINITIONS.—In this section: 

23 ‘‘(1) HEALTH DISPARITIES.—The term ‘health 

24 disparities’ includes health and health care dispari25 ties and means population-specific differences in the 


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1 presence of disease, health outcomes, or access to 

2 health care. For purposes of the preceding sentence, 

3 a population may be delineated by race, ethnicity, 

4 primary language, sex, sexual orientation, gender 

5 identity, disability, socioeconomic status, or rural, 

6 urban, or other geographic setting, and any other 

7 population or subpopulation determined by the Sec8 retary to experience significant gaps in disease, 

9 health outcomes, or access to health care. 

10 ‘‘(2) PRIMARY CARE RESIDENT.—The term ‘pri11 mary care resident’ has the meaning given the term 

12 in section 1886(h)(5)(H) of the Social Security Act. 

13 ‘‘(3) PRIMARY CARE RESIDENCY TRAINING PRO14 GRAM.—The term ‘primary care residency training 

15 program’ means a program that— 

16 ‘‘(A) is an approved medical residency 

17 training program described in section 

18 1886(h)(5)(A) of the Social Security Act for 

19 primary care residents; and 

20 ‘‘(B) in the case of entities seeking awards 

21 under subsection (b)(2), is accredited, or oper22 ates in partnership with a program that is ac23 credited, by the Accreditation Council for Grad24 uate Medical Education or the American Osteo25 pathic Association. 


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

2 carry out this section, there are authorized to be appro3 priated the following: 

4 ‘‘(1) $40,800,000 for fiscal year 2011. 

5 ‘‘(2) $43,010,000 for fiscal year 2012. 

6 ‘‘(3) $45,050,000 for fiscal year 2013. 

7 ‘‘(4) $47,260,000 for fiscal year 2014. 

8 ‘‘(5) $49,640,000 for fiscal year 2015.’’. 

Æ 


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