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[Congressional Bills 108th Congress]
[From the U.S. Government Publishing Office]
[S. 2613 Introduced in Senate (IS)]

108th CONGRESS
  2d Session
                                S. 2613

 To amend the Public Health Service Act to establish a scholarship and 
    loan repayment program for public health preparedness workforce 
development to eliminate critical public health preparedness workforce 
     shortages in Federal, State, and local public health agencies.

_______________________________________________________________________

                   IN THE SENATE OF THE UNITED STATES

                              July 7, 2004

 Mr. Hagel (for himself and 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 a scholarship and 
    loan repayment program for public health preparedness workforce 
development to eliminate critical public health preparedness workforce 
     shortages in Federal, State, and local public health agencies.

    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 Preparedness Workforce 
Development Act of 2004''.

SEC. 2. FINDINGS.

    Congress makes the following findings:
            (1) The ability of the public health system to prevent, 
        respond to, and recover from bioterrorism or acute outbreaks of 
        infectious diseases and other health threats and emergencies 
        depends upon the existence of adequate numbers of well-trained 
        public health professionals in Federal, State, and local public 
        health departments. The public health system has an aging staff 
        nearing retirement with no clear pipeline of highly-skilled and 
        capable employees to fill the void. The average age of the 
        State public health workforce is 47, 7 years older than the 
        average age of the nation's workforce. More than 50 percent of 
        the States cite the lack of qualified individuals or 
        individuals willing to relocate as being a major barrier to 
        preparedness.
            (2) The National Association of State Personnel Executives 
        reports that State governments could lose more than 30 percent 
        of their workforce to retirement, private-sector employers, and 
        alternative careers by 2006. The rates for State public health 
        departments are as high as 45 percent.
            (3) 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.
            (4) Approximately 42 percent of the current epidemiology 
        workforce in State and territorial health departments lacks 
        formal academic training in epidemiology.
            (5) Thirteen State public health laboratories are without 
        doctoral-level molecular scientists on staff, 23 have only one, 
        and only 15 States have any staff redundancy at this level.
            (6) Public health nurses comprise the largest segment of 
        the public health workforce. The leaders of State public health 
        nursing average more than 30 years service and are very close 
        to retirement. In one State nearly 40 percent of the public 
        health nursing workforce is eligible for retirement today.

SEC. 3. PUBLIC HEALTH WORKFORCE SCHOLARSHIP AND LOAN REPAYMENT PROGRAM.

    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 Scholarship and Loan Repayment 
                                Program

``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 preparedness 
workforce shortages in Federal, State, and local public health 
agencies.
    ``(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 laboratory sciences, epidemiology, 
                environmental health, health communications, 
                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 
        submittal 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, or local 
public health agency.
    ``(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, 
        and local 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 (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 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 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, or local 
                public health agency 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); and
            ``(4) 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 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 preparedness 
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.

``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 preparedness 
workforce shortages in Federal, State, and local public health 
agencies.
    ``(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 
        laboratory sciences, epidemiology, environmental health, health 
        communications, 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 laboratory sciences, epidemiology, environmental health, 
        health communications, 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, or local public health agency, 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, or local governmental public health agency, 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 
        submittal 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, or 
        local public health agency.
    ``(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, 
        and local 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 (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 
        preparedness 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, or local public health agency 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) 3 years; or
                            ``(ii) 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, or local public 
        health agency 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 preparedness advanced training program.
    ``(g) Administrative Provisions.--
            ``(1) Hiring priority.--Notwithstanding any other provision 
        of law, Federal, State, and local public health agencies 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 or local public 
        health agency, 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.

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

    ``(a) In General.--For the purpose of operating State and local 
public health workforce loan repayment programs, 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 or local government entity 
from implementing independent or supplemental public health workforce 
development programs within their borders.

``SEC. 783. AUTHORIZATION OF APPROPRIATIONS.

    ``(a) Scholarship Program.--For the purpose of carrying out section 
780, there is authorized to be appropriated $35,000,000 for fiscal year 
2004, and such sums as may be necessary for each of fiscal years 2005 
through 2009.
    ``(b) Loan Repayment Programs.--
            ``(1) In general.--For the purpose of carrying out sections 
        781 and 782, there is authorized to be appropriated 
        $195,000,000 for fiscal year 2004, and such sums as may be 
        necessary for each of fiscal years 2005 through 2009.
            ``(2) Allocation.--Not less than 80 percent of the amount 
        appropriated under paragraph (1) in each fiscal year shall be 
        made available to carry out section 782.

``SEC. 784. SEVERABILITY.

    ``If any provision of this subpart, or the application of such 
provision to any person or circumstance, is held to be 
unconstitutional, the remainder of this subpart and the application of 
the provisions of this subpart to any person or circumstance shall not 
be affected thereby.''.
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