I 

111TH CONGRESS 

1ST SESSION H. R. 2929 

To enhance the primary care workforce through the establishment of a National Health Workforce Advisory Board and the provision of workforce 

data and analysis. 

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 

A BILL 

To enhance the primary care workforce through the establishment of a National Health Workforce Advisory Board 

and the provision of workforce data and analysis. 

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 ‘‘Health Care Workforce 

5 Incentive Act of 2009’’. 


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1 TITLE I—NATIONAL HEALTH 

2 WORKFORCE ADVISORY BOARD 

3 SEC. 101. ESTABLISHMENT. 

4 There is established an independent National Health 

5 Workforce Advisory Board (in this title referred to as the 

6 ‘‘Advisory Board’’) to advise Congress on issues affecting 

7 the health care workforce, consistent with this title. 

8 SEC. 102. PURPOSE. 

9 (a) IN GENERAL.—The purpose of the Advisory 

10 Board is to improve the supply, distribution, diversity, and 

11 quality of health professionals in the health care workforce 

12 by— 

13 (1) examining the impact of policies on work14 force and workforce shortages from a multijuris15 dictional perspective, including the Department of 

16 Labor, Department of Health and Human Services, 

17 the Department of Veterans Affairs, and the De18 partment of Defense; 

19 (2) developing innovative solutions to increase 

20 the short-term supply of the health care workforce, 

21 including a plan to rapidly deploy health care profes22 sionals in the field; 

23 (3) coming up with a national plan for increas24 ing the long-term supply and structure of the health 

25 care workforce; 


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1 (4) making health care professionals more ac2 cessible to the general population, especially low-in3 come, underserved, uninsured, minority, those expe4 riencing health disparities, and rural populations; 

5 (5) improving the training of primary care phy6 sicians, nurses, dentists, physician assistants, behav7 ioral and mental health professionals, public health 

8 professionals, and other health professionals; 

9 (6) training faculty educators in the health pro10 fessions; and 

11 (7) utilizing data from a variety of sources, in12 cluding the Health Resources and Services Adminis13 tration, the Centers for Medicare & Medicaid Serv14 ices, and State Councils that report to the National 

15 Workforce Data Center of the Health Resources and 

16 Services Administration. 

17 (b) DUTIES.— 

18 (1) REVIEW OF HEALTH CARE WORKFORCE

19 AND ANNUAL REPORTS.—With the goal of devel20 oping a fiscally sustainable integrated workforce 

21 which supports high-quality health care delivery sys22 tem that meets the needs of patients and popu23 lations, the Advisory Board shall— 


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1 (A) review health care workforce and pro2 jected workforce needs, including the topics de3 scribed in paragraph (2); 

4 (B) make recommendations to Congress 

5 concerning national workforce priorities, goals, 

6 and policies; 

7 (C) examine and develop innovative short8 term and long-term solutions for rapid training 

9 and deployment of personnel into the health 

10 care workforce; 

11 (D) not later than 6 months after its cre12 ation, the Board shall develop short-term solu13 tions for rapid training and deployment of per14 sonnel into the workforce, submit to Congress a 

15 report on such solutions; 

16 (E) by not later than January 31 of each 

17 year (beginning with 2011), submit a report to 

18 Congress containing the results of such reviews 

19 and its recommendations concerning related 

20 policies; and 

21 (F) by not later than April 1 of each year 

22 (beginning with 2011), submit a report to Con23 gress containing a review of and recommenda24 tions on at minimum one high priority area as 

25 described in paragraph (3). 


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1 (2) SPECIFIC TOPICS TO BE REVIEWED.— 

2 (A) Current health care workforce demo3 graphics, skill sets, and needs, with projected 

4 needs over the following 10- and 25-year peri5 ods. 

6 (B) Health care workforce training capac7 ity, including number of students trained, num8 ber of qualified faculty, training infrastructure 

9 and training needs, with projected needs over 

10 the following 10- and 25-year periods. 

11 (C) The implications of new and existing 

12 Federal policies which affect the workforce, in13 cluding but not limited to Medicare and Med14 icaid GME policies, title VII and title VIII of 

15 the Public Health Service Act, and the National 

16 Health Service Corps with recommendations for 

17 aligning these programs with national health 

18 workforce priorities and goals. 

19 (D) Health care workforce needs of special 

20 populations, such as minorities, rural popu21 lations, underserved populations, and geriatric 

22 and pediatric populations with recommenda23 tions for new and existing Federal policies to 

24 meet the needs of these special populations. 


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1 (3) HIGH PRIORITY TOPICS.—High priority top2 ics are health care workforce areas which require 

3 special attention. The topics may be determined by 

4 the Advisory Board or assigned by appropriate com5 mittees of Congress. Initial high priority topics in6 clude— 

7 (A) integrated workforce planning maxi8 mizing the skill sets of health care professionals 

9 across disciplines; 

10 (B) integrated workforce planning for 

11 short-term and rapid deployment into the 

12 health care workforce; 

13 (C) analysis of the nature, scopes of prac14 tice, and demands for health workers in the en15 hanced information technology and manage16 ment work place; 

17 (D) Medicare and Medicaid graduate med18 ical education policies and recommendations for 

19 aligning with national workforce goals; 

20 (E) nursing workforce capacity at all levels 

21 of nurse training, training capacity, projected 

22 needs, and integration within the health care 

23 system; 


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1 (F) dental workforce capacity, training ca2 pacity, projected needs, and integration within 

3 the health care system; and 

4 (G) mental health workforce capacity, 

5 training capacity and projected needs. 

6 (4) AGENDA AND ADDITIONAL REVIEWS.—The 

7 Advisory Board shall consult periodically with the 

8 chairmen and ranking minority members of the ap9 propriate committees of Congress regarding the Ad10 visory Board’s agenda, progress towards achieving 

11 this agenda and requests for high priority topics. 

12 SEC. 103. MEMBERSHIP AND RELATED PROVISIONS. 

13 (a) MEMBERSHIP.— 

14 (1) NUMBER AND APPOINTMENT.—The Advi15 sory Board shall be composed of 15 members ap16 pointed by the Comptroller General. 

17 (2) QUALIFICATIONS.— 

18 (A) IN GENERAL.—The membership of the 

19 Advisory Board shall include individuals with 

20 national recognition for their expertise in the 

21 provision of health services, health care work22 force analysis, health care finance and econom23 ics, health facility management, health plans 

24 and integrated delivery systems, higher edu25 cation, health care philanthropy, and other reVerDate Nov 24 2008 21:18 Jun 26, 2009 Jkt 079200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\H2929.IH H2929

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1 lated fields, who will provide a mix of profes2 sional perspectives, broad geographic represen3 tation, and a balance between urban and rural 

4 representatives. 

5 (B) INCLUSION.—The membership of the 

6 Advisory Board shall include (but not be limited 

7 to) health professionals, employers, third-party 

8 payers, individuals skilled in the conduct and 

9 interpretation of health services and health eco10 nomics research. Such membership shall also 

11 include representatives of consumers. 

12 (C) MAJORITY NON-PROVIDERS.—Individ13 uals who are directly involved in health profes14 sions education or practice shall not constitute 

15 a majority of the membership of the Advisory 

16 Board. 

17 (D) ETHICAL DISCLOSURE.—The Comp18 troller General shall establish a system for pub19 lic disclosure by members of the Advisory 

20 Board of financial and other potential conflicts 

21 of interest relating to such members. 

22 (3) TERMS.— 

23 (A) IN GENERAL.—The terms of members 

24 of the Advisory Board shall be for 3 years ex25 cept that the Comptroller General shall desVerDate Nov 24 2008 21:18 Jun 26, 2009 Jkt 079200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\H2929.IH H2929

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1 ignate staggered terms for the members first 

2 appointed. 

3 (B) VACANCIES.—Any member appointed 

4 to fill a vacancy occurring before the expiration 

5 of the term for which the member’s predecessor 

6 was appointed shall be appointed only for the 

7 remainder of that term. A member may serve 

8 after the expiration of that member’s term until 

9 a successor has taken office. A vacancy in the 

10 Advisory Board shall be filled in the manner in 

11 which the original appointment was made. 

12 (4) COMPENSATION.—While serving on the 

13 business of the Advisory Board (including travel 

14 time), a member of the Advisory Board shall be enti15 tled to compensation at the per diem equivalent of 

16 the rate provided for level IV of the Executive 

17 Schedule under section 5315 of title 5, United 

18 States Code; and while so serving away from home 

19 and the member’s regular place of business, a mem20 ber may be allowed travel expenses, as authorized by 

21 the Chairman of the Advisory Board. Physicians 

22 serving as personnel of the Advisory Board may be 

23 provided a physician comparability allowance by the 

24 Advisory Board in the same manner as Government 

25 physicians may be provided such an allowance by an 


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1 agency under section 5948 of title 5, United States 

2 Code, and for such purpose subsection (i) of such 

3 section shall apply to the Advisory Board in the 

4 same manner as it applies to the Tennessee Valley 

5 Authority. For purposes of pay (other than pay of 

6 members of the Advisory Board) and employment 

7 benefits, rights, and privileges, all personnel of the 

8 Advisory Board shall be treated as if they were em9 ployees of the United States Senate. 

10 (5) CHAIRMAN; VICE CHAIRMAN.—The Advisory 

11 Board members shall elect by a majority vote the 

12 Advisory Board chairman and vice chairman for the 

13 term of their appointment of portion remaining. 

14 Elections shall occur at the end of any chairman or 

15 vice chairman’s term or should a Advisory Board 

16 member leave the Advisory Board for any reason. 

17 (6) MEETINGS.—The Advisory Board shall 

18 meet at the call of the Chairman. 

19 (b) DIRECTOR AND STAFF; EXPERTS AND CONSULT20 ANTS.—Subject to such review as the Comptroller General 

21 deems necessary to assure the efficient administration of 

22 the Advisory Board, the Advisory Board may— 

23 (1) employ and fix the compensation of an Ex24 ecutive Director (subject to the approval of the 

25 Comptroller General) and such other personnel as 


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1 may be necessary to carry out its duties (without re2 gard to the provisions of title 5, United States Code, 

3 governing appointments in the competitive service); 

4 (2) seek such assistance and support as may be 

5 required in the performance of its duties from ap6 propriate Federal departments and agencies; 

7 (3) enter into contracts or make other arrange8 ments, as may be necessary for the conduct of the 

9 work of the Advisory Board (without regard to sec10 tion 3709 of the Revised Statutes (41 U.S.C. 5)); 

11 (4) make advance, progress, and other pay12 ments which relate to the work of the Advisory 

13 Board; 

14 (5) provide transportation and subsistence for 

15 persons serving without compensation; and 

16 (6) prescribe such rules and regulations as it 

17 deems necessary with respect to the internal organi18 zation and operation of the Advisory Board. 

19 (c) POWERS.— 

20 (1) OBTAINING OFFICIAL DATA.—The Advisory 

21 Board may secure directly from any department or 

22 agency of the United States information necessary 

23 to enable it to carry out this section. Upon request 

24 of the Chairman, the head of that department or 


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1 agency shall furnish that information to the Advi2 sory Board on an agreed upon schedule. 

3 (2) DATA COLLECTION.—In order to carry out 

4 its functions, the Advisory Board shall— 

5 (A) utilize existing information, both pub6 lished and unpublished, where possible, collected 

7 and assessed either by its own staff or under 

8 other arrangements made in accordance with 

9 this section; 

10 (B) carry out, or award grants or con11 tracts for, original research and experimen12 tation, where existing information is inad13 equate; and 

14 (C) adopt procedures allowing any inter15 ested party to submit information for the Advi16 sory Board’s use in making reports and rec17 ommendations. 

18 (3) ACCESS OF GAO TO INFORMATION.—The 

19 Comptroller General shall have unrestricted access 

20 to all deliberations, records, and nonproprietary data 

21 of the Advisory Board, immediately upon request. 

22 (4) PERIODIC AUDIT.—The Advisory Board 

23 shall be subject to periodic audit by the Comptroller 

24 General. 


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1 (d) COOPERATION.—The Advisory Board shall carry 

2 out its duties in cooperation with the Council on Graduate 

3 Medical Education established under section 762 of the 

4 Public Health Service Act (42 U.S.C. 294o), the National 

5 Advisory Council on the National Health Service Corps 

6 established by section 337 of such Act (42 U.S.C. 254j), 

7 the Advisory Committee on Training in Primary Care 

8 Medicine and Dentistry established pursuant to section 

9 748 of such Act (42 U.S.C. 2931), the Advisory Com10 mittee on Interdisciplinary, Community-Based Linkages 

11 established pursuant to section 756 of such Act (42 U.S.C. 

12 294f), and the National Advisory Council on Nurse Edu13 cation and Practice established pursuant to section 845 

14 of such Act (42 U.S.C. 297t). 

15 (e) AUTHORIZATION OF APPROPRIATIONS.— 

16 (1) REQUEST FOR APPROPRIATIONS.—The Ad17 visory Board shall submit requests for appropria18 tions in the same manner as the Comptroller Gen19 eral submits requests for appropriations, but 

20 amounts appropriated for the Advisory Board shall 

21 be separate from amounts appropriated for the 

22 Comptroller General. 

23 (2) AUTHORIZATION.—There are authorized to 

24 be appropriated such sums as may be necessary to 

25 carry out the provisions of this section. 


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1 (f) HEALTH CARE WORKFORCE DEFINITION.—In 

2 this section, the term ‘‘health care workforce’’ includes all 

3 health care providers with direct patient care and support 

4 responsibilities, including physicians, nurses, physician as5 sistants, pharmacists, dentists, allied health professionals, 

6 mental health professionals, and public health profes7 sionals. 

8 TITLE II—WORKFORCE DATA 

9 AND ANALYSIS 

10 SEC. 201. CENTER FOR WORKFORCE DATA AND ANALYSIS. 

11 (a) ESTABLISHMENT.—There is established a Na12 tional Center for Workforce Data and Analysis in the De13 partment of Health and Human Services. 

14 (b) DUTIES.—Such Center shall comprehensively and 

15 regularly gather data, provide projections, and conduct re16 search on the supply, demand, distribution, diversity, and 

17 development of the health care workforce, including infor18 mation on specific disciplines, specialties, and subspecial19 ties. 

20 (c) AUTHORITY.—Such Center is authorized to ac21 cept applications for and administer grants for the pur22 pose of establishing State and Regional Health Workforce 

23 Councils under section 202. 


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1 SEC. 202. STATE AND REGIONAL HEALTH WORKFORCE 

2 COUNCILS. 

3 (a) ESTABLISHMENT.—The Secretary of Health and 

4 Human Services, through the National Center for Work5 force Data and Analysis, shall establish a competitive 

6 State Health Workforce Shortage grants program (in this 

7 section referred to as the ‘‘Grant Program’’) under which, 

8 for the purposes described, the Secretary may make for9 mula grants or an allotment of funds to States. 

10 (b) PURPOSES.—The purpose of the Grant Program 

11 is to harmonize health workforce needs and medical edu12 cation through incorporating local and regional perspec13 tives through the organization of State and regional health 

14 workforce councils to— 

15 (1) ensure access to health services for all indi16 viduals, particularly those with low incomes or lim17 ited access to health services, through an adequate 

18 health care workforce; 

19 (2) improve the supply, distribution, diversity, 

20 and development of the health care workforce, tak21 ing into consideration the supply, distribution, and 

22 diversity of health care workforce profession special23 ties and subspecialties in a manner consistent 

24 with— 

25 (A) determining high-need geographic 

26 areas; 


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1 (B) determining high-priority specialties; 

2 and 

3 (C) determining the optimal mix and num4 bers of primary care physicians per population 

5 and as a percentage of the total health care 

6 workforce; 

7 (3) create State-specific health care workforce 

8 goals and objectives that are consistent with and 

9 aligned to health status goals and national health 

10 care workforce objectives developed under the Na11 tional Health Workforce Advisory Board under title 

12 I; and 

13 (4) during the first 12-month period funded 

14 through grants provided under this section, establish 

15 or designate a State health care workforce planning 

16 entity to establish statewide processes for State 

17 health care workforce planning, State health work18 force data collection, policy recommendations, and 

19 State resource allocations. 

20 (c) APPLICATION FOR GRANT.—For the purpose of 

21 this subsection, a grant is in accordance if the following 

22 is met: 

23 (1) USE OF FUNDS.—For the purposes de24 scribed in subsection (b), State and Regional Health 


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1 Workforce Councils may use grant funds under this 

2 section to— 

3 (A) collect and analyze State and regional 

4 health workforce supply, distribution, diversity, 

5 demand and training capacity data, following 

6 any data collection and reporting standards set 

7 by the National Health Workforce Advisory 

8 Board; 

9 (B) determine critical State/regional level 

10 health workforce needs, including identifying— 

11 (i) high-priority specialties and dis12 ciplines, which may be region specific; and 

13 (ii) high-need geographic areas; 

14 (C) establish State/regional health work15 force goals and recommendations to coordinate 

16 with national level goals set by the National 

17 Health Workforce Advisory Board; 

18 (D) devise short- and long-term plans and 

19 initiatives for meeting State/regional health 

20 workforce goals; 

21 (E) devise State/regional level plans that 

22 set specific targets for increasing primary care 

23 capacity, including training and retaining more 

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1 sistants, and other members of the allied health 

2 workforce; and 

3 (F) make recommendations to the National 

4 Health Workforce Advisory Board on the re5 alignment of graduate medical education under 

6 title XVIII of the Social Security Act to meet 

7 State/regional health workforce goals, includ8 ing— 

9 (i) recommendations for GME funding 

10 cap modifications; and 

11 (ii) proposals for alternative funding 

12 and distribution frameworks aligned with 

13 State/regional health workforce goals. 

14 (2) STATE/REGION WIDE HEALTH WORKFORCE

15 ASSESSMENT.—The application includes a plan for a 

16 state/region wide health workforce assessment 

17 that— 

18 (A) will be updated not less than every 5 

19 years; 

20 (B) identifies— 

21 (i) current and future State and re22 gional health workforce supply, distribu23 tion, diversity, demand and training capac24 ity; 


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1 (ii) projected needs related to the sup2 ply, distribution, diversity and development 

3 of the State/regional health workforce; and 

4 (iii) short- and long-term State/region 

5 specific health workforce goals and objec6 tives consistent with health status goals 

7 and national health workforce objectives 

8 developed under section (103) of previous 

9 title. 

10 (3) ANNUAL REPORTS.—The application in11 cludes a plan for annual reports submitted to HRSA 

12 and to the National Health Workforce Advisory 

13 Board to include an annually updated plan to meet 

14 the goals and objectives and address the needs iden15 tified under the State/Region wide health workforce 

16 assessment described in paragraph (1), and such 

17 plan includes strategies related to— 

18 (A) collaboration between— 

19 (i) State departments of labor, health, 

20 education, higher education, veterans af21 fairs, environment, and professional licen22 sure; and 

23 (ii) State health workforce investment 

24 boards; 

25 (B) State data collection; 


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1 (C) State Medicare and Medicaid policies; 

2 and 

3 (D) State health professions licensure and 

4 regulation. 

5 (4) DESCRIPTION OF FUNDING USE.—The ap6 plication includes a description of how funds received 

7 through the grant will be used— 

8 (A) in accordance with subparagraphs (1) 

9 and (2) of subsection (b), to ensure access to 

10 health services for all individuals and to im11 prove the supply, distribution, diversity, and de12 velopment of the health workforce, such as 

13 through programs related to— 

14 (i) health workforce training and edu15 cation capacity; 

16 (ii) the health care safety net work17 force, including health centers under sec18 tion 330; 

19 (iii) provider cultural competency; 

20 (iv) health workforce diversity; 

21 (v) health workforce pipeline develop22 ment; 

23 (vi) health workforce retention; 

24 (vii) health workforce faculty recruit25 ment; 


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1 (viii) health workforce faculty reten2 tion; 

3 (ix) health workforce career ladders; 

4 (x) public awareness; and 

5 (xi) health workforce scholarship and 

6 loan repayment programs; 

7 (B) to create State-specific health work8 force goals and objectives in accordance with 

9 subsection (b)(3) and to develop annual plans 

10 in accordance with subsection (b)(4) to meet 

11 such goals and objectives; and 

12 (C) during the first 12-month period fund13 ed through the grant, to establish or designate 

14 in accordance with subsection (a)(2)(D) a State 

15 health workforce planning entity to establish 

16 statewide processes for State health workforce 

17 planning, State health workforce data collec18 tion, policy recommendations, and State re19 source allocations. 

20 (5) DEVELOPMENT OF APPLICATION.—The ap21 plication— 

22 (A) is developed by or in consultation with 

23 the State agency that will be responsible for ad24 ministering the program; and 


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1 (B) is made publicly available during its 

2 development or after its submission to the Sec3 retary in order to facilitate public comment. 

4 (d) ADDITIONAL DUTIES AND AUTHORITIES.—A 

5 State and Regional Health Workforce Council funded 

6 through a grant under this section shall— 

7 (1) submit analyses and recommendations to 

8 the Advisory Board under title I, at least on an an9 nual basis; 

10 (2) have the authority to allocate any future in11 creases in State graduate medical education caps 

12 under title XVIII of the Social Security Act, con13 sistent with section 203 and the amendments made 

14 by title III; and 

15 (3) shall be eligible to apply for the authority 

16 to administer direct graduate medical education 

17 funds under title XVIII of such Act at the State 

18 level in order to achieve flexibility in direct graduate 

19 medical education placements to meet State health 

20 needs. 

21 (e) DETERMINATION OF AMOUNT OF ALLOTMENT.— 

22 (1) IN GENERAL.—The Secretary shall deter23 mine the amount of the allotment to each State 

24 under this section for a fiscal year based on a for25 mula. 


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1 (2) DEVELOPMENT OF FORMULA.—The formula 

2 referred to in paragraph (1) shall be determined by 

3 the Secretary by regulation, taking into consider4 ation the following criteria: 

5 (A) Existing shortages and deficiencies in 

6 health workforce distribution. 

7 (B) Rural, urban, and frontier areas. 

8 (C) Community health centers. 

9 (D) The number of medical, nursing, and 

10 allied health professions schools in each State. 

11 (f) REPORTS.—A State and Regional Health Work12 force Council funded through a grant under this section 

13 shall submit data to the National Health Workforce Advi14 sory Board under title I and the National Workforce Data 

15 Center established under section 201 on an annual basis 

16 for purposes of consideration and incorporation into the 

17 recommendations made by the National Health Workforce 

18 Advisory Board. 

Æ 


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