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[Congressional Bills 111th Congress]
[From the U.S. Government Publishing Office]
[S. 1143 Introduced in Senate (IS)]

111th CONGRESS
  1st Session
                                S. 1143

 To amend the Public Health Service Act to establish various programs 
   for the recruitment and retention of public health workers and to 
eliminate critical public health workforce shortages in Federal, State, 
      local, and tribal public health agencies and health centers.

_______________________________________________________________________

                   IN THE SENATE OF THE UNITED STATES

                              May 21, 2009

  Mr. Durbin introduced the following bill; which was read twice and 
  referred to the Committee on Health, Education, Labor, and Pensions

_______________________________________________________________________

                                 A BILL

 
 To amend the Public Health Service Act to establish various programs 
   for the recruitment and retention of public health workers and to 
eliminate critical public health workforce shortages in Federal, State, 
      local, and tribal public health agencies and health centers.

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

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Public Health Workforce Development 
Act of 2009''.

SEC. 2. FINDINGS.

    Congress makes the following findings:
            (1) The ability of the public health system to prevent, 
        respond to, and recover from bioterrorism, acute outbreaks of 
        infectious diseases, or other health threats and emergencies, 
        and to prevent and reduce chronic disease, depends upon the 
        existence of adequate numbers of well-trained public health 
        professionals in Federal, State, local, and tribal public 
        health departments and health centers.
            (2) The public health system has an aging staff nearing 
        retirement with no clear pipeline of highly-skilled and capable 
        employees to fill the void, with the average age of the State 
        public health workforce at 47 years.
            (3) Retirement rates in some State public health agencies 
        were as high as 20 percent as of June 2007, and projected to be 
        as high as 45 percent in 2009.
            (4) The ratio of public health workers to the population 
        has dropped from 219 per 100,000 in 1980 to 158 per 100,000 in 
        2000, while responsibilities of such workers have continued to 
        expand.
            (5) Public health nurses comprise the largest segment of 
        the public health workforce. A study by the Institute of 
        Medicine in 2003 identified nursing as facing one of the most 
        severe shortages of public health workers. The average age of 
        public health nurses is nearly 50 years, with the leaders of 
        State public health nursing averaging more than 30 years of 
        service. In one State nearly 40 percent of the public health 
        nursing workforce was eligible for retirement as of June 2007.
            (6) According to the Association of State and Territorial 
        Health Officials, most of the approximately 6,400 graduates 
        from accredited schools of public health took jobs in the 
        private sector in 2004. The Bureau of Labor Statistics projects 
        that there will be an increase in private sector demand for 
        highly-educated graduates in scientific fields during the 10-
        year period ending in 2017. Public health agencies will have 
        difficulty competing for those highly-skilled scientists.
            (7) As of June 2007, approximately 42 percent of the 
        epidemiology workforce in State and territorial health 
        departments lacked formal academic training in epidemiology. 
        States have reported that approximately 47 percent more 
        epidemiologists are needed to adequately prevent and control 
        avian influenza and other emerging diseases.
            (8) The Partnership for Public Service reports that in the 
        field of microbiology, there are more than 4 times as many 
        full-time permanent employees over age 40 as under age 40 at 
        the Centers for Disease Control and Prevention. Among full-time 
        permanent employees with medical backgrounds at the Centers for 
        Disease Control and Prevention and the Food and Drug 
        Administration, there are 3 times as many employees over 40 
        years of age as under 40.
            (9) More than 50 percent of States cite the lack of 
        qualified individuals or individuals willing to relocate as 
        being a major barrier to preparedness. A study conducted by the 
        Health Resources and Services Association reported difficulty 
        with recruiting more educated, skilled public health providers 
        to work in traditionally medically underserved areas, such as 
        rural populations. Public health agencies continue to face an 
        unmet need for public health workers who are bilingual and 
        culturally competent.
            (10) Lack of access to advanced education, including 
        baccalaureate nursing and graduate studies, is a significant 
        barrier to upgrading the existing public health workforce, 
        particularly in rural areas.

SEC. 3. PUBLIC HEALTH WORKFORCE RECRUITMENT AND RETENTION PROGRAMS.

    Part E of title VII of the Public Health Service Act (42 U.S.C. 
294n et seq.) is amended by adding at the end the following:

``Subpart 3--Public Health Workforce Recruitment and Retention Programs

``SEC. 780. PUBLIC HEALTH WORKFORCE SCHOLARSHIP PROGRAM.

    ``(a) Establishment.--The Secretary shall establish the Public 
Health Workforce Scholarship Program (referred to in this section as 
the `Program') to assure an adequate supply of public health 
professionals to eliminate critical public health workforce shortages 
in Federal, State, local, and tribal public health agencies and health 
centers.
    ``(b) Eligibility.--To be eligible to participate in the Program, 
an individual shall--
            ``(1) be accepted for enrollment, or be enrolled, as a 
        full-time student--
                    ``(A) in an accredited (as determined by the 
                Secretary) educational institution in a State or 
                territory; and
                    ``(B) in a course of study or program, offered by 
                such institution and approved by the Secretary, leading 
                to a health professions degree (graduate, 
                undergraduate, or associate) or certificate, which may 
                include public health, laboratory sciences, 
                epidemiology, environmental health, health 
                communications, health education and behavioral 
                sciences, information sciences, or public 
                administration;
            ``(2) be a United States citizen;
            ``(3) submit an application to the Secretary to participate 
        in the Program; and
            ``(4) sign and submit to the Secretary, at the time of the 
        submission of such application, a written contract (described 
        in subsection (d)) to serve, upon the completion of the course 
        of study or program involved, for the applicable period of 
        obligated service in the full-time employment of a Federal, 
        State, local, or tribal public health agency or a health 
        center.
    ``(c) Dissemination of Information.--
            ``(1) Application and contract forms.--The Secretary shall 
        disseminate application forms and contract forms to individuals 
        desiring to participate in the Program. The Secretary shall 
        include with such forms--
                    ``(A) a fair summary of the rights and liabilities 
                of an individual whose application is approved (and 
                whose contract is accepted) by the Secretary, including 
                in the summary a clear explanation of the damages to 
                which the United States is entitled in the case of the 
                individual's breach of the contract; and
                    ``(B) information relating to the service 
                obligation and such other information as may be 
                necessary for the individual to understand the 
                individual's prospective participation in the Program.
            ``(2) Information for schools.--The Secretary shall 
        distribute to health professions schools and other appropriate 
        accredited academic institutions and relevant Federal, State, 
        local, and tribal public health agencies, materials providing 
        information on the Program and shall encourage such schools, 
        institutions, and agencies to disseminate such materials to 
        potentially eligible students.
            ``(3) Understandability and timing.--The application form, 
        contract form, and all other information furnished by the 
        Secretary under this section shall--
                    ``(A) be written in a manner calculated to be 
                understood by the average individual applying to 
                participate in the Program; and
                    ``(B) be made available by the Secretary on a date 
                sufficiently early to ensure that such individuals have 
                adequate time to carefully review and evaluate such 
                forms and information.
    ``(d) Contract.--The written contract between the Secretary and an 
individual shall contain--
            ``(1) an agreement on the part of the Secretary that the 
        Secretary will provide the individual with a scholarship for a 
        period of years (not to exceed 4 academic years) during which 
        the individual shall pursue an approved course of study or 
        program to prepare the individual to serve in the public health 
        workforce;
            ``(2) an agreement on the part of the individual that the 
        individual will--
                    ``(A) maintain full-time enrollment in the approved 
                course of study or program described in subsection 
                (b)(1) until the individual completes that course of 
                study or program;
                    ``(B) while enrolled in the course of study or 
                program, maintain an acceptable level of academic 
                standing (as determined under regulations of the 
                Secretary by the educational institution offering such 
                course of study or program); and
                    ``(C) immediately upon graduation, serve in the 
                full-time employment of a Federal, State, local, or 
                tribal public health agency or a health center in a 
                position related to the course of study or program for 
                which the contract was awarded for a period of time 
                (referred to in this section as the `period of 
                obligated service') equal to the greater of--
                            ``(i) 1 year for each academic year for 
                        which the individual was provided a scholarship 
                        under the Program; or
                            ``(ii) 2 years;
            ``(3) an agreement by both parties as to the nature and 
        extent of the scholarship assistance, which may include--
                    ``(A) payment of the tuition expenses of the 
                individual;
                    ``(B) payment of all other reasonable educational 
                expenses of the individual including fees, books, 
                equipment, and laboratory expenses; and
                    ``(C) payment of a stipend of not more than $1,200 
                per month for each month of the academic year involved 
                (indexed to account for increases in the Consumer Price 
                Index);
            ``(4) a provision that any financial obligation of the 
        United States arising out of a contract entered into under this 
        subsection and any obligation of the individual which is 
        conditioned thereon, is contingent upon funds being 
        appropriated for scholarships under this section;
            ``(5) a statement of the damages to which the United States 
        is entitled for the individual's breach of the contract; and
            ``(6) such other statements of the rights and liabilities 
        of the Secretary and of the individual, not inconsistent with 
        the provisions of this section.
    ``(e) Postponing Obligated Service.--With respect to an individual 
receiving a degree or certificate from a school of medicine, public 
health, nursing, osteopathic medicine, dentistry, veterinary medicine, 
optometry, podiatry, pharmacy, psychology, or social work under a 
scholarship under the Program, the date of the initiation of the period 
of obligated service may be postponed, upon the submission by the 
individual of a petition for such postponement and approval by the 
Secretary, to the date on which the individual completes an approved 
internship, residency, or other relevant public health advanced 
training program.
    ``(f) Administrative Provisions.--
            ``(1) Contracts with institutions.--The Secretary may 
        contract with an educational institution in which a participant 
        in the Program is enrolled, for the payment to the educational 
        institution of the amounts of tuition and other reasonable 
        educational expenses described in subsection (d)(3).
            ``(2) Employment ceilings.--Notwithstanding any other 
        provision of law, individuals who have entered into written 
        contracts with the Secretary under this section, while 
        undergoing academic training, shall not be counted against any 
        employment ceiling affecting the Department or any other 
        Federal agency.
    ``(g) Breach of Contract.--An individual who fails to comply with 
the contract entered into under subsection (d) shall be subject to the 
same financial penalties as provided for under section 338E for 
breaches of scholarship contracts under sections 338A.
    ``(h) Authorization of Appropriations.--There are authorized to be 
appropriated to carry out this section $35,000,000 for each of the 
fiscal years 2010 through 2015.
    ``(i) Definition.--For purposes of this subpart, the term `health 
center' has the meaning given such term in section 330(a).

``SEC. 781. PUBLIC HEALTH WORKFORCE LOAN REPAYMENT PROGRAM.

    ``(a) Establishment.--The Secretary shall establish the Public 
Health Workforce Loan Repayment Program (referred to in this section as 
the `Program') to assure an adequate supply of public health 
professionals to eliminate critical public health workforce shortages 
in Federal, State, local, and tribal public health agencies and in 
health centers.
    ``(b) Eligibility.--To be eligible to participate in the Program, 
an individual shall--
            ``(1)(A) be accepted for enrollment, or be enrolled, as a 
        full-time or part-time student in an accredited academic 
        educational institution in a State or territory in the final 
        year of a course of study or program offered by that 
        institution leading to a health professions degree or 
        certificate, which may include a degree (graduate, 
        undergraduate, or associate) or certificate relating to public 
        health, laboratory sciences, epidemiology, environmental 
        health, health communications, health education and behavioral 
        sciences, information sciences, or public administration; or
            ``(B) have graduated, within 10 years, from an accredited 
        educational institution in a State or territory and received a 
        health professions degree (graduate, undergraduate, or 
        associate) or certificate, which may include a degree 
        (graduate, undergraduate, or associate) or certificate relating 
        to public health, laboratory sciences, epidemiology, 
        environmental health, health communications, health education 
        and behavioral sciences, information sciences, or public 
        administration;
            ``(2)(A) in the case of an individual described in 
        paragraph (1)(A), have accepted employment with a Federal, 
        State, local, or tribal public health agency or a health 
        center, as recognized by the Secretary, to commence upon 
        graduation; or
            ``(B) in the case of an individual described in paragraph 
        (1)(B), be employed by, or have accepted employment with, a 
        Federal, State, local, or tribal public health agency or a 
        health center, as recognized by the Secretary;
            ``(3) be a United States citizen;
            ``(4) submit an application to the Secretary to participate 
        in the Program; and
            ``(5) sign and submit to the Secretary, at the time of the 
        submission of such application, a written contract (described 
        in subsection (d)) to serve for the applicable period of 
        obligated service in the full-time employment of a Federal, 
        State, local, or tribal public health agency or a health 
        center.
    ``(c) Dissemination of Information.--
            ``(1) Application and contract forms.--The Secretary shall 
        disseminate application forms and contract forms to individuals 
        desiring to participate in the Program. The Secretary shall 
        include with such forms--
                    ``(A) a fair summary of the rights and liabilities 
                of an individual whose application is approved (and 
                whose contract is accepted) by the Secretary, including 
                in the summary a clear explanation of the damages to 
                which the United States is entitled to recover in the 
                case of the individual's breach of the contract; and
                    ``(B) information relating to the service 
                obligation and such other information as may be 
                necessary for the individual to understand the 
                individual's prospective participation in the Program.
            ``(2) Information for schools.--The Secretary shall 
        distribute to health professions schools and other appropriate 
        accredited academic institutions and relevant Federal, State, 
        local, and tribal public health agencies and health centers, 
        materials providing information on the Program and shall 
        encourage such schools, institutions, and agencies to 
        disseminate such materials to potentially eligible students.
            ``(3) Understandability and timing.--The application form, 
        contract form, and all other information furnished by the 
        Secretary under this section shall--
                    ``(A) be written in a manner calculated to be 
                understood by the average individual applying to 
                participate in the Program; and
                    ``(B) be made available by the Secretary on a date 
                sufficiently early to ensure that such individuals have 
                adequate time to carefully review and evaluate such 
                forms and information.
    ``(d) Contract.--The written contract (referred to in this section) 
between the Secretary and an individual shall contain--
            ``(1) an agreement on the part of the Secretary that the 
        Secretary will repay on behalf of the individual loans incurred 
        by the individual in the pursuit of the relevant public health 
        workforce educational degree or certificate in accordance with 
        the terms of the contract;
            ``(2) an agreement on the part of the individual that the 
        individual will serve, immediately upon graduation in the case 
        of an individual described in subsection (b)(1)(A) service, or 
        in the case of an individual described in subsection (b)(1)(B) 
        continue to serve, in the full-time employment of a Federal, 
        State, local, or tribal public health agency or health center 
        in a position related to the course of study or program for 
        which the contract was awarded for a period of time (referred 
        to in this section as the `period of obligated service') equal 
        to the greater of--
                    ``(A) 3 years; or
                    ``(B) such longer period of time as determined 
                appropriate by the Secretary and the individual;
            ``(3) an agreement, as appropriate, on the part of the 
        individual to relocate for the entire period of obligated 
        service to a political jurisdiction designated by the Secretary 
        to be a priority service area in exchange for an additional 
        loan repayment incentive amount that does not exceed 20 percent 
        of the individual's eligible loan repayment award per academic 
        year such that the total of the loan repayment and the 
        incentive amount shall not exceed \1/3\ of the eligible loan 
        balance per year;
            ``(4) in the case of an individual described in subsection 
        (b)(1)(A) who is in the final year of study and who has 
        accepted employment with a Federal, State, local, or tribal 
        public health agency or a health center upon graduation, an 
        agreement on the part of the individual to complete the 
        education or training, maintain an acceptable level of academic 
        standing (as determined by the education institution offering 
        the course of study or training), and agree to the period of 
        obligated service;
            ``(5) a provision that any financial obligation of the 
        United States arising out of a contract entered into under this 
        section and any obligation of the individual that is 
        conditioned thereon, is contingent on funds being appropriated 
        for loan repayments under this section;
            ``(6) a statement of the damages to which the United States 
        is entitled, under this section for the individual's breach of 
        the contract; and
            ``(7) such other statements of the rights and liabilities 
        of the Secretary and of the individual, not inconsistent with 
        this section.
    ``(e) Payments.--
            ``(1) In general.--A loan repayment provided for an 
        individual under a written contract under the Program shall 
        consist of payment, in accordance with paragraph (2), on behalf 
        of the individual of the principal, interest, and related 
        expenses on government and commercial loans received by the 
        individual regarding the undergraduate or graduate education of 
        the individual (or both), which loans were made for--
                    ``(A) tuition expenses; or
                    ``(B) all other reasonable educational expenses, 
                including fees, books, and laboratory expenses, 
                incurred by the individual.
            ``(2) Payments for years served.--
                    ``(A) In general.--For each year of obligated 
                service that an individual contracts to serve under 
                subsection (d) the Secretary may pay up to $35,000 on 
                behalf of the individual for loans described in 
                paragraph (1). With respect to participants under the 
                Program whose total eligible loans are less than 
                $105,000, the Secretary shall pay an amount that does 
                not exceed \1/3\ of the eligible loan balance for each 
                year of obligated service of the individual.
                    ``(B) Repayment schedule.--Any arrangement made by 
                the Secretary for the making of loan repayments in 
                accordance with this subsection shall provide that any 
                repayments for a year of obligated service shall be 
                made no later than the end of the fiscal year in which 
                the individual completes such year of service.
            ``(3) Tax liability.--For the purpose of providing 
        reimbursements for tax liability resulting from payments under 
        paragraph (2) on behalf of an individual--
                    ``(A) the Secretary shall, in addition to such 
                payments, make payments to the individual in an amount 
                not to exceed 39 percent of the total amount of loan 
                repayments made for the taxable year involved; and
                    ``(B) may make such additional payments as the 
                Secretary determines to be appropriate with respect to 
                such purpose.
            ``(4) Payment schedule.--The Secretary may enter into an 
        agreement with the holder of any loan for which payments are 
        made under the Program to establish a schedule for the making 
        of such payments.
    ``(f) Postponing Obligated Service.--With respect to an individual 
receiving a degree or certificate from a school of medicine, public 
health, nursing, osteopathic medicine, dentistry, veterinary medicine, 
optometry, podiatry, pharmacy, psychology, or social work, the date of 
the initiation of the period of obligated service may be postponed, 
upon the submission by the individual of a petition for such 
postponement and approval by the Secretary, to the date on which the 
individual completes an approved internship, residency, or other 
relevant public health advanced training program.
    ``(g) Administrative Provisions.--
            ``(1) Hiring priority.--Notwithstanding any other provision 
        of law, Federal, State, local, and tribal public health 
        agencies and health centers may give hiring priority to any 
        individual who has qualified for and is willing to execute a 
        contract to participate in the Program.
            ``(2) Employment ceilings.--Notwithstanding any other 
        provision of law, individuals who have entered into written 
        contracts with the Secretary under this section, who are 
        serving as full-time employees of a State, local, or tribal 
        public health agency or a health center, or who are in the last 
        year of public health workforce academic preparation, shall not 
        be counted against any employment ceiling affecting the 
        Department or any other Federal agency.
    ``(h) Breach of Contract.--An individual who fails to comply with 
the contract entered into under subsection (d) shall be subject to the 
same financial penalties as provided for under section 338E for 
breaches of loan repayment contracts under section 338B.
    ``(i) Authorization of Appropriations.--There are authorized to be 
appropriated to carry out this section $195,000,000 for each of the 
fiscal years 2010 through 2015.

``SEC. 782. GRANTS FOR STATE AND LOCAL PROGRAMS.

    ``(a) In General.--For the purpose of operating State, local, 
tribal, and health center public health workforce loan repayment 
programs under this subpart, the Secretary shall award a grant to any 
public health agency that receives public health preparedness 
cooperative agreements, or other successor cooperative agreements, from 
the Department of Health and Human Services.
    ``(b) Requirements.--A State or local loan repayment program 
operated with a grant under subsection (a) shall incorporate all 
provisions of the Public Health Workforce Loan Repayment Program under 
section 781, including the ability to designate priority service areas 
within the relevant political jurisdiction.
    ``(c) Administration.--The head of the State or local office that 
receives a grant under subsection (a) shall be responsible for 
contracting and operating the loan repayment program under the grant.
    ``(d) Rule of Construction.--Nothing in this section shall be 
construed to obligate or limit any State, local, or tribal government 
entity from implementing independent or supplemental public health 
workforce development programs within their borders.

``SEC. 783. TRAINING FOR MID-CAREER PUBLIC HEALTH PROFESSIONALS.

    ``(a) In General.--The Secretary may make grants to, or enter into 
contracts with, any eligible entity to award scholarships to eligible 
individuals to enroll in degree or professional training programs for 
the purpose of enabling mid-career professionals in the public health 
workforce to receive additional training in the field of public health.
    ``(b) Eligibility.--
            ``(1) Eligible entity.--The term `eligible entity' 
        indicates an accredited educational institution that offers a 
        course of study, certificate program, or professional training 
        program in infectious disease science, medicine, public health, 
        veterinary medicine, or other discipline impacting or 
        influenced by bioterrorism or emerging infectious diseases.
            ``(2) Eligible individuals.--The term `eligible 
        individuals' includes those individuals employed in public 
        health positions at the Federal, State, tribal, or local level 
        or a health center who are interested in retaining or upgrading 
        their education.
    ``(c) Authorization of Appropriations.--There are authorized to be 
appropriated to carry out this section, $30,000,000 for each of the 
fiscal years 2010 through 2015.

``SEC. 784. CATALOGUE OF FEDERAL PUBLIC HEALTH WORKFORCE EMPLOYMENT 
              OPPORTUNITIES.

    ``(a) In General.--The Director of the Office of Personnel 
Management, in cooperation with the Secretary, shall ensure that, 
included in the Internet website of the Office of Personnel Management, 
there is an online catalogue, or link to an online catalogue, of public 
health workforce employment opportunities in the Federal Government.
    ``(b) Requirements.--To the extent practicable, the catalogue 
described in subsection (a) shall include--
            ``(1) existing and projected job openings in the Federal 
        public health workforce; and
            ``(2) a general discussion of the occupations that comprise 
        the Federal public health workforce.
    ``(c) Information.--The Secretary shall include a copy of the 
catalogue described in subsection (a), or a prominent reference to the 
catalogue, in--
            ``(1) the application forms provided under section 
        780(c)(1); and
            ``(2) the information for schools provided under section 
        780(c)(2).''.
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