I 

113TH CONGRESS 

2D SESSION H. R. 5458 

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

care workforce. 

IN THE HOUSE OF REPRESENTATIVES 

SEPTEMBER 11, 2014 

Mr. RUIZ (for himself and Mr. HINOJOSA) introduced the following bill; which 

was referred to the Committee on Energy and Commerce 

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. 338N. 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, and pharmacists or other health pro10 fession 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, school of pharmacy, other health profesVerDate Mar 15 2010 21:58 Sep 12, 2014 Jkt 039200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\H5458.IH H5458

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1 sion designated by the Secretary, nursing col2 lege, or an appropriate degree from a graduate 

3 program of behavioral and mental health; 

4 ‘‘(2) submit to the State, an application to par5 ticipate in the program; and 

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

7 of the submission of the application under paragraph 

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

9 to— 

10 ‘‘(A) accept payments under the scholar11 ship; 

12 ‘‘(B) maintain a minimum level of aca13 demic standing during the period of the schol14 arship, as determined by the Secretary; 

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

16 residency training program; 

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

18 State of residence; and 

19 ‘‘(E) serve as a provider for 1 year in— 

20 ‘‘(i) a health professional shortage 

21 area (as defined by the National Health 

22 Service Corps under section 332); 

23 ‘‘(ii) a medically underserved area (as 

24 defined for purposes of section 330); or 


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1 ‘‘(iii) any other shortage area defined 

2 by the State and approved by the Sec3 retary; 

4 in the applicant’s State of residence for every 

5 year in which the applicant received a scholar6 ship. 

7 ‘‘(d) DESIGNATION OF AREAS.—To be eligible to re8 ceive a grant under this section, a State shall adequately 

9 demonstrate to the Secretary that the State has des10 ignated appropriate health professions or specialty short11 age areas. 

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

13 application and contract forms to individuals desiring to 

14 participate in a scholarship program funded under this 

15 section, the State shall include with such forms a sum16 mary of the rights and liabilities of an individual whose 

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

18 including a clear explanation of the damages to which the 

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

20 the contract. 

21 ‘‘(f) AWARDING OF CONTRACTS.— 

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

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

24 shall, with respect to the program in which the indi25 vidual is enrolled, agree to pay— 


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

2 the program; 

3 ‘‘(B) any other reasonable educational ex4 penses, including fees, books, and laboratory ex5 penses, related to the program; and 

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

7 to be determined the Secretary. 

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

9 into contracts with individuals that meet the require10 ments of subsection (c), the State shall consider the 

11 extent of the applicant’s demonstrated interest in 

12 the provision of care services in a particular provider 

13 shortage area. 

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

15 under this section shall, with respect to the costs of mak16 ing payments on behalf of individuals under the scholar17 ship program implemented by the State under the grant, 

18 make available (directly or through donations from public 

19 or private entities) non-Federal contributions in cash to20 ward such costs in an amount equal to not less than $1 

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

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

23 The scholarship program of any State receiving a grant 

24 under this section shall be administered directly by a State 

25 agency. 


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1 ‘‘(i) REPORT BY SECRETARY.—Not later than 4 years 

2 after the date of enactment of this section, and every 5 

3 years thereafter, the Secretary shall submit to Congress 

4 a report concerning— 

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

6 the State scholarship program; 

7 ‘‘(2) the number of scholarship recipients, bro8 ken down by practice area, serving in the profession 

9 originally awarded a scholarship for 1 year after the 

10 completion of the service period required under sub11 section (c)(3)(E); 

12 ‘‘(3) the number of scholarship recipients, bro13 ken down by provider type, practicing in an under14 served area 1 year after the completion of the serv15 ice period required under subsection (c)(3)(E); 

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

17 shortage areas or medically underserved areas within 

18 the State; 

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

20 shortage areas or medically underserved areas; 

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 areas in the State; 


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

2 scholarship but failed to comply with its require3 ments; 

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 are authorized to be appropriated to carry out this section, 

11 $20,000,000 for each of fiscal years 2015 through 2019. 

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 Mar 15 2010 21:58 Sep 12, 2014 Jkt 039200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\H5458.IH H5458

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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 Mar 15 2010 21:58 Sep 12, 2014 Jkt 039200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\H5458.IH H5458

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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 are authorized to be appropriated to carry out this section, 

13 $20,000,000 for each of fiscal years 2015 through 2021. 

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 Mar 15 2010 21:58 Sep 12, 2014 Jkt 039200 PO 00000 Frm 00011 Fmt 6652 Sfmt 6201 E:\BILLS\H5458.IH H5458

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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.—The 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 (d), 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 are authorized to be appropriated, $10,000,000 for each 

3 of fiscal years 2015 through 2019 to carry out this sec4 tion.’’. 

5 SEC. 4. STUDY ON DOCUMENTATION REQUIREMENTS FOR 

6 COGNITIVE SERVICE. 

7 Not later than 3 years after the date of enactment 

8 of this Act, the Institute of Medicine shall conduct a study, 

9 and submit a report to Congress, concerning the docu10 mentation requirements for cognitive services (evaluation 

11 and management services) required under the Medicare 

12 and Medicaid programs under titles XVIII and XIX of 

13 the Social Security Act, and through private health insur14 ers. Such study shall include an evaluation 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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