I 

111TH CONGRESS 

2D SESSION H. R. 5889 

To amend the Public Health Service Act and title XVIII of the Social 

Security Act to increase the number of primary care physicians and 

medical residents serving health professional shortage areas, and for 

other purposes. 

IN THE HOUSE OF REPRESENTATIVES 

JULY 27, 2010 

Mr. YOUNG of Alaska 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 and title XVIII 

of the Social Security Act to increase the number of 

primary care physicians and medical residents serving 

health professional shortage areas, 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. FINDINGS. 

4 Congress finds the following: 


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1 (1) The average life expectancy in the United 

2 States has increased to 80 years of age, causing an 

3 ever-increasing demand for medical care. 

4 (2) Medical school enrollment numbers have 

5 been virtually stagnant for the last 25 years. 

6 (3) During the last 20 years, median tuition 

7 and fees at medical schools have increased by 229 

8 percent (122 percent adjusted for inflation) in pri9 vate schools and by 479 percent (256 percent ad10 justed for inflation) in public schools. 

11 (4) The Association of American Medical Col12 leges, in its Statement on the Physician Workforce, 

13 dated June, 2006, called for an increase of 1,500 

14 National Health Service Corps program awards per 

15 year to help meet the need for physicians caring for 

16 underserved populations and to help address rising 

17 medical student indebtedness. 

18 (5) The National Health Service Corps program 

19 has a proven record of supplying physicians to un20 derserved areas, and has played an important role in 

21 expanding access for underserved populations in 

22 rural and inner city communities. 

23 (6) Continued expansion of the National Health 

24 Service Corps program is strongly recommended. 


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1 (7) The growing debt incurred by graduating 

2 medical students is likely to increase the interest 

3 and willingness of graduates of United States med4 ical schools to apply for National Health Service 

5 Corps program funding and awards. 

6 (8) One-third (250,000) of active physicians are 

7 over the age of 55 and are likely to retire in the next 

8 ten years, while the population will have increased 

9 by 24 percent. These demographic changes will 

10 cause the population-to-physician ratio to peak by 

11 the year 2020. 

12 (9) In 2005, the Council on Graduate Medical 

13 Education stated in a report to Congress that there 

14 will be a shortage of not fewer than 90,000 full-time 

15 physicians by 2020. 

16 (10) A continuing decline in the number of pri17 mary care physicians will lead to increased shortages 

18 of health care access in rural America. 

19 (11) There is a declining ability to recruit 

20 qualified medical students from rural and under21 served areas, coupled with greater difficulty on the 

22 part of community health centers and other clinics 

23 to attract adequate personnel. 

24 (12) Individuals in many geographic areas, es25 pecially rural areas, lack adequate access to high 


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1 quality preventive, primary and specialty health care, 

2 contributing to significant health disparities that im3 pair America’s public health and economic produc4 tivity. 

5 (13) A collaborative process is needed between 

6 hospitals and non-hospital settings to maximize the 

7 potential of non-hospital health care training. 

8 SEC. 2. SCHOLARSHIPS FOR MEDICAL STUDENTS UNDER 

9 NATIONAL HEALTH SERVICE CORPS SCHOL10 ARSHIP PROGRAM. 

11 Section 338H of the Public Health Service Act (42 

12 U.S.C. 254q) is amended by adding at the end the fol13 lowing: 

14 ‘‘(d) SCHOLARSHIPS FOR MEDICAL STUDENTS.—For 

15 contracts for scholarships under this subpart to individ16 uals who are accepted for enrollment, or enrolled, in a 

17 course of study or program described in section 

18 338A(b)(1)(B) that leads to a degree in medicine or osteo19 pathic medicine, the Secretary shall, of the amounts ap20 propriated under subsection (a) for a fiscal year, obligate 

21 the greater of 10 percent or such amount as necessary 

22 to fund ongoing activities related to such contracts.’’. 


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1 SEC. 3. CLARIFICATION OF ELIGIBILITY FOR MEDICARE 

2 GRADUATE MEDICAL EDUCATION FUNDING 

3 OF A NONRURAL HOSPITAL THAT HAS A 

4 TRAINING PROGRAM WITH AN INTEGRATED 

5 RURAL TRACK. 

6 (a) IN GENERAL.—Section 1886(h)(4)(H) of the So7 cial Security Act (42 U.S.C. 1395ww(h)(4)(H)), as 

8 amended by section 5506(a) of the Patient Protection and 

9 Affordable Care Act (Public Law 111–148), is amended— 

10 (1) in clause (iv), by inserting ‘‘(as defined in 

11 clause (vii))’’ after ‘‘an integrated rural track’’; and 

12 (2) by adding at the end the following new 

13 clause: 

14 ‘‘(vii) DEFINITION OF ACCREDITED

15 TRAINING PROGRAM WITH AN INTEGRATED

16 RURAL TRACK.—For purposes of clause 

17 (iv), the term ‘accredited training program 

18 with an integrated rural track’ means an 

19 accredited medical residency training pro20 gram located in an urban area which offers 

21 a curriculum for all residents in the pro22 gram that includes the following character23 istics: 

24 ‘‘(I) A minimum of 3 block 

25 months of rural rotations. During 

26 such 3 block months, the resident is 


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1 in a rural area for 4 weeks or a 

2 month. 

3 ‘‘(II) A stated mission for train4 ing rural physicians. 

5 ‘‘(III) A minimum of 3 months of 

6 obstetrical training, or an equivalent 

7 longitudinal experience. 

8 ‘‘(IV) A minimum of 4 months of 

9 pediatric training that includes neo10 natal, ambulatory, inpatient, and 

11 emergency experiences through rota12 tions, or an equivalent longitudinal ex13 perience. 

14 ‘‘(V) A minimum of 2 months of 

15 emergency medicine rotations, or an 

16 equivalent longitudinal experience.’’. 

17 (b) EFFECTIVE DATE.—The amendments made by 

18 subsection (a) apply with respect to— 

19 (1) payments to hospitals under section 

20 1886(h) of the Social Security Act (42 U.S.C. 

21 1395ww(h)) for cost reporting periods beginning on 

22 or after January 1, 2011; and 

23 (2) payments to hospitals under section 

24 1886(d)(5)(B)(v) of such Act (42 U.S.C. 


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1 1395ww(d)(5)(B)(v)) for discharges occurring on or 

2 after January 1, 2011. 

Æ 


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