I 

111TH CONGRESS 

1ST SESSION H. R. 2930 

To enhance the primary care workforce through modifications to the medical 

residency training programs and use of qualified teaching health centers 

and through State primary care scholarship and loan repayment programs. 

IN THE HOUSE OF REPRESENTATIVES 

JUNE 17, 2009 

Mr. SARBANES (for himself and Mr. BRALEY of Iowa) 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 enhance the primary care workforce through modifications to the medical residency training programs and 

use of qualified teaching health centers and through 

State primary care scholarship and loan repayment programs. 

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 ‘‘Primary Care Training 

5 Enhancement Act’’. 


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1 TITLE I—MEDICAL RESIDENCY 

2 TRAINING PROGRAMS IN 

3 QUALIFIED TEACHING 

4 HEALTH CENTERS 

5 SEC. 101. AUTHORIZING PAYMENTS FOR GRADUATE MED6 ICAL EDUCATION COSTS TO QUALIFIED 

7 TEACHING HEALTH CENTERS. 

8 (a) PAYMENTS FOR DIRECT GRADUATE MEDICAL

9 EDUCATION COSTS.—Section 1886(h) of the Social Secu10 rity Act (42 U.S.C. 1395ww(h)) is amended by adding at 

11 the end the following new paragraphs: 

12 ‘‘(8) QUALIFIED TEACHING HEALTH CEN13 TERS.— 

14 ‘‘(A) IN GENERAL.—The Secretary may 

15 approve qualified teaching health centers to re16 ceive payments as determined under subpara17 graph (C). 

18 ‘‘(B) REDISTRIBUTION OF UNUSED RESI19 DENCY POSITIONS.— 

20 ‘‘(i) REDUCTION IN LIMIT BASED ON

21 UNUSED POSITIONS.— 

22 ‘‘(I) IN GENERAL.—Except as 

23 provided in subclause (II), the Sec24 retary shall reduce the otherwise ap25 plicable resident limit (as defined in 


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1 paragraph (7)(C)(ii)) for a hospital 

2 that the Secretary determines had 

3 residency positions that were unused 

4 for all 3 of the most recent cost re5 porting periods of such hospital end6 ing prior to the date of enactment of 

7 this paragraph by an amount that is 

8 equal to the number of such unused 

9 residency positions. 

10 ‘‘(II) EXCEPTION FOR RURAL

11 HOSPITALS AND CERTAIN OTHER HOS12 PITALS.—Subclause (I) shall not 

13 apply to a hospital— 

14 ‘‘(aa) located in a rural area 

15 (as defined in subsection 

16 (d)(2)(D) in the matter following 

17 clause (ii)); 

18 ‘‘(bb) that has participated 

19 in a voluntary reduction plan 

20 under paragraph (6); or 

21 ‘‘(cc) that has participated 

22 in a demonstration project ap23 proved as of October 31, 2003, 

24 under the authority of section 

25 402 of Public Law 90–248. 


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1 ‘‘(ii) REDISTRIBUTION.—The Sec2 retary shall redistribute the unused resi3 dency positions as determined under clause 

4 (i) to qualified teaching health centers. 

5 ‘‘(C) DETERMINING RESIDENT PAYMENT

6 AMOUNT.—The resident payment amount for 

7 each teaching health center shall be determined 

8 according to paragraph (3) except that— 

9 ‘‘(i) the resident payment amount 

10 shall not be set lower than the national av11 erage per resident amount adjusting for lo12 cality as determined in paragraph (2)(E); 

13 and 

14 ‘‘(ii) the resident payment amount 

15 shall be determined using the medicare pa16 tient load (as defined in paragraph (3)(C)) 

17 of the hospital with which the teaching 

18 health center has contracted, and the resi19 dent payment amount of a teaching health 

20 center that has contracted with more than 

21 one hospital shall be determined based on 

22 the medicare patient load of the hospital in 

23 which residents spend the greatest propor24 tion of their training. 


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1 ‘‘(D) QUALIFIED TEACHING HEALTH CEN2 TER DEFINED.—In this paragraph, the term 

3 ‘qualified teaching health center’ means a com4 munity-based, ambulatory care patient care cen5 ter that— 

6 ‘‘(i) operates an approved medical 

7 residency training program; and 

8 ‘‘(ii) contracts with at least one hos9 pital for residency training purposes with 

10 the following conditions: 

11 ‘‘(I) The teaching health center 

12 shall incur the cost of the resident’s 

13 salary and fringe benefits while the 

14 resident is training at the hospital 

15 site. 

16 ‘‘(II) The teaching health center 

17 shall compensate the hospital for su18 pervisory teaching activities and indi19 rect costs as determined appropriate 

20 by the two contracting bodies. 

21 ‘‘(III) The FTE resident amount 

22 of the teaching health center shall not 

23 affect the FTE resident amount or 

24 resident limit of the contracting hos25 pital. 


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1 ‘‘(9) PRIMARY CARE MAINTENANCE LEVEL.— 

2 ‘‘(A) IN GENERAL.—A hospital receiving 

3 payments for graduate medical education under 

4 this subsection must maintain the number of 

5 primary care residents that is equal to the aver6 age number of primary care residents for the 3 

7 most recent 12-month cost reporting periods of 

8 such hospital ending prior to the date of enact9 ment of this paragraph, except that— 

10 ‘‘(i) in the case of a hospital unable to 

11 fill its primary care resident positions, 

12 such positions shall not be converted to 

13 non-primary care positions; and 

14 ‘‘(ii) in the case of a hospital awarded 

15 additional primary care resident positions, 

16 such hospital must maintain the number of 

17 primary care residents that is equal to the 

18 average number of primary care residents 

19 for the 3 most recent 12-month cost re20 porting periods of such hospital plus the 

21 number of newly awarded positions. 

22 ‘‘(B) PRIMARY CARE RESIDENT DE23 FINED.—In this paragraph, the term ‘primary 

24 care resident’ has the meaning given the term 

25 in paragraph (5)(H).’’. 


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1 (b) PAYMENTS FOR INDIRECT GRADUATE MEDICAL

2 EDUCATION COSTS.—Section 1886(d)(5)(B) of the Social 

3 Security Act (42 U.S.C. 1395ww(d)(5)(B)) is amended by 

4 adding at the end the following new clauses: 

5 ‘‘(x) PAYMENTS TO QUALIFIED

6 TEACHING HEALTH CENTERS.—For quali7 fied teaching health centers (as defined in 

8 subsection (h)(8)(D)), indirect costs of 

9 medical education shall be determined ac10 cording to clause (i), except that— 

11 ‘‘(I) payments shall be distrib12 uted directly to teaching health cen13 ters on a quarterly basis; and 

14 ‘‘(II) payments shall be deter15 mined based on the average ratio in 

16 the contracting hospital (as described 

17 in subsection (h)(8)(D)(ii)) of full18 time equivalent interns and residents 

19 to beds in the 3-month cost reporting 

20 period immediately preceeding the 

21 payment date. 

22 ‘‘(xi) PRIMARY CARE MAINTENANCE

23 LEVEL.— 

24 ‘‘(I) IN GENERAL.—A hospital 

25 receiving additional payments under 


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1 this subparagraph shall maintain the 

2 number of primary care residents that 

3 is equal to the average number of pri4 mary care residents for the 3 most re5 cent 12-month cost reporting periods 

6 of such hospital ending prior to the 

7 date of enactment of this paragraph, 

8 except that— 

9 ‘‘(aa) in the case of a hos10 pital unable to fill its primary 

11 care resident positions, those po12 sitions shall not be converted to 

13 non-primary care positions; and 

14 ‘‘(bb) in the case of a hos15 pital awarded additional primary 

16 care resident positions, that hos17 pital shall maintain the number 

18 of primary care residents that is 

19 equal to the average number of 

20 primary care residents for the 3 

21 most recent 12-month cost re22 porting periods of such hospital 

23 plus the number of newly award24 ed positions. 


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1 ‘‘(II) PRIMARY CARE RESIDENT

2 DEFINED.—In this clause, the term 

3 ‘primary care resident’ has the mean4 ing given the term in subsection 

5 (h)(5)(H).’’. 

6 SEC. 102. GRANT PROGRAM FOR MEDICAL RESIDENCY 

7 TRAINING PROGRAMS IN QUALIFIED TEACH8 ING HEALTH CENTERS. 

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

10 (42 U.S.C. 293k et seq.) is amended by adding after sec11 tion 748 the following: 

12 ‘‘SEC. 749. GRANT PROGRAM FOR MEDICAL RESIDENCY 

13 TRAINING PROGRAMS IN QUALIFIED TEACH14 ING HEALTH CENTERS. 

15 ‘‘(a) ESTABLISHMENT.—The Secretary shall make 

16 grants— 

17 ‘‘(1) to qualified teaching health centers to es18 tablish new accredited medical residency training 

19 programs or to expand existing medical residency 

20 training programs; and 

21 ‘‘(2) to public or private nonprofit organizations 

22 to provide technical support to qualified teaching 

23 health centers to establish medical residency training 

24 programs. 

25 ‘‘(b) USE OF FUNDS.— 


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1 ‘‘(1) A grant received under subsection (a)(1) 

2 shall be used for the following: 

3 ‘‘(A) Curriculum development. 

4 ‘‘(B) Facilities expansion. 

5 ‘‘(C) Equipment acquisition. 

6 ‘‘(D) Recruitment, training, and retention 

7 of residents and faculty. 

8 ‘‘(E) Accreditation by the Accreditation 

9 Council for Graduate Medical Education 

10 (ACGME) or the American Osteopathic Asso11 ciation (AOA). 

12 ‘‘(F) Faculty and resident salaries. 

13 ‘‘(2) A grant received under subsection (a)(2) 

14 shall be used for the following: 

15 ‘‘(A) Materials development. 

16 ‘‘(B) Staff salaries. 

17 ‘‘(C) Travel expenses. 

18 ‘‘(D) Administrative costs. 

19 ‘‘(c) LIMITATION.—Not more than 25 percent of 

20 funds made available to carry out this section shall be used 

21 for technical support grants under subsection (a)(2). 

22 ‘‘(d) QUALIFIED TEACHING HEALTH CENTER DE23 FINED.—In this section, the term ‘qualified teaching 

24 health center’ has the meaning given the term in section 


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1 1886(h)(8)(D) of the Social Security Act (42 U.S.C. 

2 1395ww(h)(8)(D)). 

3 ‘‘(e) AUTHORIZATION OF APPROPRIATIONS.—There 

4 are authorized to be appropriated to carry out this section 

5 such sums as may be necessary.’’. 

6 SEC. 103. EXPANDING THE NATIONAL HEALTH SERVICE 

7 CORPS TO ALLOW SERVICE IN A TEACHING 

8 CAPACITY. 

9 Section 338C(a) of the Public Health Service Act (42 

10 U.S.C. 254m(a)) is amended to read as follows: 

11 ‘‘(a) SERVICE IN FULL-TIME CLINICAL PRACTICE.— 

12 Except as provided in section 338D (42 U.S.C. 254n), 

13 each individual who has entered into a written contract 

14 with the Secretary under section 338A or 338B (42 

15 U.S.C. 254l or 254l–1) shall provide service in the full16 time clinical practice of such individual’s profession as a 

17 member of the Corps for the period of obligated service 

18 provided in such contract. For the purpose of calculating 

19 time spent in full-time clinical practice under this subpara20 graph, up to 30 percent of time spent teaching by a mem21 ber of the Corps may be counted toward his or her service 

22 obligation.’’. 


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1 TITLE II—STATE PRIMARY CARE 

2 SCHOLARSHIP AND LOAN RE3 PAYMENT PROGRAMS 

4 SEC. 201. ESTABLISHMENT. 

5 (a) ESTABLISHMENT.—State Primary Care Scholar6 ship and Loan Repayment Program; Part C of title VII 

7 (42 U.S.C. 293k et seq.) should be amended to do the 

8 following: 

9 (1) SUPPORT AND DEVELOPMENT OF STATE

10 PRIMARY CARE SCHOLARSHIP AND REPAYMENT PRO11 GRAMS.— 

12 (A) GENERAL.—Secretary to make grants 

13 to states for the purpose of— 

14 (i) entering into contracts with ac15 credited public or nonprofit private hos16 pitals, schools of medicine or osteopathic 

17 medicine, academically affiliated physician 

18 assistant training program, academically 

19 affiliate nursing program, or a public or 

20 private nonprofit entity which the States 

21 have determined are capable of carrying 

22 out such grants or contracts; 

23 (ii) planning, developing, operating, or 

24 participating in an accredited professional 

25 training program, including an accredited 


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1 residency or internship program in the 

2 field of family medicine, general internal 

3 medicine, general pediatrics, or geriatrics 

4 for medical students, interns, residents, or 

5 practicing physicians as defined by the 

6 Secretary; 

7 (iii) creating scholarship programs for 

8 Matching Federal funds to states to estab9 lish or expand current Primary Care 

10 Scholarship and Loan Repayment Pro11 grams, allowing states to target scholar12 ships to medical schools and loan repay13 ments to training institutions which adopt 

14 pro-primary care policies (admission poli15 cies or curriculums) and require subse16 quent service within the State; and 

17 (iv) to empower states with the ability 

18 to provide need-based financial assistance 

19 in the form of scholarships, traineeships 

20 and fellowships to medical students, in21 terns, residents, practicing physicians, or 

22 other medical personnel, who are partici23 pants in any such program, and who plan 

24 to specialize or work in the practice of 


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1 family medicine, general internal medicine, 

2 general pediatrics, or geriatrics. 

3 SEC. 202. INNOVATIVE PRIMARY CARE TRAINING MODELS/ 

4 INSTITUTES. 

5 (a) PRIMARY CARE TRAINING INSTITUTES.— 

6 (1) PURPOSE.—The purpose of the Primary 

7 Care Training Institute program is to— 

8 (A) prepare and train primary care pro9 viders by enhancing and coordinating multiple 

10 aims within academic health centers in order to 

11 lead to improving patient care delivered to 

12 health disparity populations and reduce health 

13 disparities; 

14 (B) enhance the status of primary care 

15 within undergraduate and graduate medical 

16 education through influencing priorities in prac17 tice, education, and research; 

18 (C) develop innovative approaches to pri19 mary care education and scholarship by trans20 forming and integrating health care systems 

21 through interdisciplinary, team-based, and col22 laborative models, such as teaching health cen23 ters, that may demonstrate improved quality or 

24 lower costs; 


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1 (D) create economies of scale through aca2 demic and community collaborations by ena3 bling academic infrastructure support for mul4 tiple community programs; and 

5 (E) support innovative quality primary 

6 care workforce development models including 

7 those geared towards removing barriers to mili8 tary health personnel entry into the healthcare 

9 workforce, particularly for service in identifiable 

10 health shortage areas. 

11 (2) ESTABLISHMENT.—Grants or contracts 

12 awarded under this subsection shall establish new 

13 centers for primary care education and research 

14 within academic units of family medicine, general in15 ternal medicine, general pediatrics, or geriatrics 

16 within academic health centers. Such new centers 

17 shall be known as Primary Care Training Institutes 

18 (referred to in this section as ‘‘PCTIs’’). 

19 (3) AUTHORITY TO AWARD GRANTS.—The Sec20 retary may make grants to or enter into contracts 

21 with eligible entities to develop and implement 

22 PCTIs in accordance with this subsection. 

23 (A) In all cases, priority will be given to 

24 grant applicants within high-need geographic 

25 areas, as determined by State Workforce CounVerDate Nov 24 2008 02:04 Jun 19, 2009 Jkt 079200 PO 00000 Frm 00015 Fmt 6652 Sfmt 6201 E:\BILLS\H2930.IH H2930

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1 cils and the National Workforce Advisory 

2 Board, and to applications demonstrating 

3 multi-disciplinary partnerships. 

4 (B) Priority will be given to grant appli5 cants within high-need geographic areas, as de6 termined by the relevant Federal agency or pro7 gram. 

8 (b) SISTER SCHOOL PROGRAM.—Grants to promote 

9 pairing health professions schools with undergraduate or 

10 primary/secondary schools to establish pipeline health pro11 fessions programs. Part C of title VII (42 U.S.C. 293k 

12 et seq.) should be amended to do the following: 

13 (1) Direct the Secretary to provide grants to 

14 promote the pairing of accredited health professions 

15 schools with undergraduate or secondary schools to 

16 establish a pipeline to health professions program. 

17 (Area to address minority health workforce edu18 cation; health disparities; research shows that where 

19 partnerships developed—with local high schools, 

20 etc.) 

Æ 


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