I 

111TH CONGRESS 

1ST SESSION H. R. 3098 

To amend the Public Health Service Act to attract and retain trained health 

care professionals and direct care workers dedicated to providing quality 

care to the growing population of older Americans. 

IN THE HOUSE OF REPRESENTATIVES 

JUNE 26, 2009 

Ms. KILPATRICK of Michigan introduced the following bill; which was referred 

to the Committee on Energy and Commerce 

A BILL 

To amend the Public Health Service Act to attract and 

retain trained health care professionals and direct care 

workers dedicated to providing quality care to the growing population of older Americans. 

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 ‘‘Caring for an Aging 

5 America Act of 2009’’. 


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1 SEC. 2. GERIATRIC AND GERONTOLOGY LOAN REPAYMENT 

2 PROGRAM. 

3 Part E of title VII of the Public Health Service Act 

4 (42 U.S.C. 295 et seq.) is amended by adding at the end 

5 the following: 

6 ‘‘Subpart 3—Strengthening Recruitment and 

7 Retention for Geriatric Care Practice 

8 ‘‘SEC. 771. GERIATRIC AND GERONTOLOGY LOAN REPAY9 MENT PROGRAM. 

10 ‘‘(a) ESTABLISHMENT.—The Secretary shall estab11 lish a Geriatric and Gerontology Loan Repayment Pro12 gram within the Health Resources and Services Adminis13 tration to ensure an adequate supply of physicians, physi14 cian assistants, nurse practitioners, clinical nurse special15 ists, pharmacists, psychologists, and social workers 

16 trained in geriatrics or gerontology and to reduce critical 

17 workforce shortages in geriatric care practice. 

18 ‘‘(b) CONTRACTS.—Under the program established 

19 under subsection (a), the Secretary shall enter into con20 tracts with individuals described in subsection (d) under 

21 which the individuals agree to provide full-time clinical 

22 practice and service to older adults for a minimum of 2 

23 years. 

24 ‘‘(c) PAYMENT FOR YEARS OF SERVICE.—In consid25 eration of the Federal Government agreeing to pay, for 

26 each year of service under a contract under this section, 


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1 not more than $35,000 of the principal and interest of 

2 the educational loans of the individual involved for each 

3 of the first 2 years of service, the individual shall carry 

4 out activities in accordance with subsection (d)(4). For 

5 subsequent years, loan repayments of up to $40,000 per 

6 year for a third or fourth year of service may be made 

7 available. 

8 ‘‘(d) ELIGIBLE INDIVIDUALS.—An individual de9 scribed in this subsection is an individual— 

10 ‘‘(1) who— 

11 ‘‘(A) is a physician, including an osteo12 pathic physician, who has completed specialty 

13 training in geriatric medicine or geriatric psy14 chiatry; 

15 ‘‘(B) is a nurse practitioner or clinical 

16 nurse specialist who has completed specialty 

17 training in geriatrics or gerontology; 

18 ‘‘(C) is a pharmacist who has completed 

19 specialty training in geriatrics; 

20 ‘‘(D) is a social worker who has completed 

21 specialty training in gerontology; 

22 ‘‘(E) is a physician assistant who has com23 pleted specialty training in geriatrics; 

24 ‘‘(F) is a psychologist who has completed 

25 specialty training in gerontology; or 


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1 ‘‘(G) otherwise— 

2 ‘‘(i) has a degree in medicine, phar3 macy, osteopathic medicine, clinical or 

4 counseling psychology (doctoral degree pro5 gram), social work (master’s or doctoral 

6 degree program), or who is a certified 

7 nurse practitioner, certified clinical nurse 

8 specialist, or physician assistant; and 

9 ‘‘(ii) is enrolled in, or has successfully 

10 completed, an accredited program of spe11 cialty training in geriatric medicine, geri12 atric psychiatry, geriatric pharmacothera13 py, geropsychology, gerontological social 

14 work, gerontological nursing, or equivalent 

15 geriatric care practice (as determined by 

16 the Secretary); 

17 ‘‘(2) who has obtained an educational loan for 

18 costs associated with graduate training in medicine, 

19 pharmacy, psychology, or social work, or costs asso20 ciated with becoming a nurse practitioner, clinical 

21 nurse specialist, or physician assistant; 

22 ‘‘(3) who is appropriately licensed, without re23 striction (as determined by the Secretary), in the 

24 State in which the individual practices; 


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1 ‘‘(4) who agrees to provide clinical services to 

2 older adults for a period of not less than 2 years in 

3 a setting determined appropriate by the Secretary; 

4 and 

5 ‘‘(5) has demonstrated the capability through 

6 education or training to work with frail older adults 

7 and older adults with disabilities, including individ8 uals with dementia, urinary incontinence, and prob9 lems with balance or mobility, and raising awareness 

10 of medication issues for older adults. 

11 ‘‘(e) APPLICABILITY OF CERTAIN PROVISIONS.— 

12 With respect to the National Health Service Corps Loan 

13 Repayment Program established in subpart III of part D 

14 of title III of this Act, the provisions of such subpart shall, 

15 except as inconsistent with this section, apply to the pro16 gram established in this section in the same manner and 

17 to the same extent as such provisions apply to the Na18 tional Health Service Corps Loan Repayment Program. 

19 ‘‘(f) NATIONAL ADVISORY COUNCIL ON THE GERI20 ATRIC AND GERONTOLOGY LOAN REPAYMENT PRO21 GRAM.— 

22 ‘‘(1) ESTABLISHMENT.—The Secretary shall es23 tablish a National Advisory Council on the Geriatric 

24 and Gerontology Loan Repayment Program (re25 ferred to in this section as the ‘Council’) that shall 


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1 be composed of not to exceed 11 members to be ap2 pointed by the Secretary. 

3 ‘‘(2) DUTIES.—The Council shall consult with, 

4 advise, and make recommendations to the Secretary 

5 with respect to the Secretary’s administration of the 

6 program established under subsection (a). 

7 ‘‘(3) ADMINISTRATIVE PROVISIONS.—Members 

8 of the Council shall be appointed for a term of 3 

9 years and shall be representative of the health pro10 fessions, and professional associations, that are eligi11 ble to enter into agreements under this section. 

12 ‘‘(g) REPORTS.—Not later than 2 years after the date 

13 of the enactment of this section, and annually thereafter, 

14 the Secretary shall prepare and submit to the appropriate 

15 committees of Congress a report that describes— 

16 ‘‘(1) the program established under this section 

17 (including the number and amount of loan repay18 ments, the number and practice locations of the loan 

19 repayment recipients, the demographics of the indi20 viduals participating in the program, the default 

21 rate and actions required upon default, and to the 

22 extent that it can be determined, the reasons for 

23 such defaults); 


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1 ‘‘(2) how the program interacts with other Fed2 eral loan repayment programs for primary health 

3 care professionals; and 

4 ‘‘(3) the overall costs and benefits of the pro5 gram. 

6 ‘‘(h) DEFINITION.—In this section: 

7 ‘‘(1) GERIATRICS.—The term ‘geriatrics’ means 

8 the branch of medicine that deals with the problems 

9 and diseases of older adults and aging, including 

10 chronic conditions and geriatric syndromes such as 

11 dementia, delirium, urinary incontinence, osteoporo12 sis, falls or gait disorders, or sleep disorders. 

13 ‘‘(2) GERONTOLOGY.—The term ‘gerontology’ 

14 means the multidisciplinary study of the aging proc15 ess and individuals as they grow from middle age 

16 through later life. Such term encompasses the social, 

17 cognitive, psychological, biological and economic as18 pects of aging. 

19 ‘‘(3) SPECIALTY TRAINING.—The term ‘spe20 cialty training’ means coursework in geriatrics and 

21 gerontology and clinical training, including intern22 ships, residency programs, or fellowships, in a geri23 atric setting. 

24 ‘‘(i) AUTHORIZATION OF APPROPRIATIONS.—There is 

25 authorized to be appropriated to carry out this section, 


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1 $4,000,000 for fiscal year 2010, $9,500,000 for fiscal year 

2 2011, $16,000,000 for fiscal year 2012, $24,000,000 for 

3 fiscal year 2013, and $30,500,000 for fiscal year 2014.’’. 

4 SEC. 3. EXPANSION OF NURSING EDUCATION LOAN REPAY5 MENT PROGRAM. 

6 Section 846 of the Public Health Service Act (42 

7 U.S.C. 297n) is amended— 

8 (1) by redesignating subsection (i) as subsection 

9 (j); and 

10 (2) by inserting after subsection (h), the fol11 lowing: 

12 ‘‘(i) GERIATRIC CARE PRACTICE IN LONG-TERM

13 CARE SETTINGS.— 

14 ‘‘(1) LOAN REPAYMENTS.—In providing for 

15 loan repayments under this section, the Secretary 

16 shall ensure that eligible individuals include reg17 istered nurses who complete specialty training in 

18 geriatrics or gerontology and who elect to provide 

19 nursing services to older adults in home and commu20 nity-based or facility-based long-term care settings, 

21 or any other program determined appropriate by the 

22 Secretary. 

23 ‘‘(2) DEFINITION.—In this subsection, the term 

24 ‘specialty training’ means coursework in geriatrics 


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1 and gerontology and clinical training, including in2 ternships or fellowships, in a geriatric setting. 

3 ‘‘(3) AUTHORIZATION OF APPROPRIATIONS.— 

4 There is authorized to be appropriated to carry out 

5 this subsection, $1,500,000 for fiscal year 2010, 

6 $3,000,000 for fiscal year 2011, $5,000,000 for fis7 cal year 2012, $7,000,000 for fiscal year 2013, and 

8 $8,500,000 for fiscal year 2014.’’. 

9 SEC. 4. EXPANSION OF CAREER LADDER PROGRAMS. 

10 Section 831 of the Public Health Service Act (42 

11 U.S.C. 296p) is amended— 

12 (1) in subsection (c)(1)(A)— 

13 (A) by striking ‘‘to promote career’’ and 

14 inserting the following: ‘‘to— 

15 ‘‘(i) promote career’’; and 

16 (B) by adding at the end the following: 

17 ‘‘(ii) focus on specialty training in 

18 providing long-term care services for nurs19 ing personnel (including registered nurses, 

20 licensed practical nurses, licensed voca21 tional nurses, certified nurse assistants, 

22 home health aides, personal care attend23 ants, or any other related worker category 

24 designated by the Secretary) who provide 

25 services in home and community-based or 


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1 facility-based long-term care settings; 

2 and’’; and 

3 (2) in subsection (h), by adding at the end the 

4 following: ‘‘There is authorized to be appropriated 

5 for grants under subsection (c)(1)(A)(ii), $4,000,000 

6 for fiscal year 2010, $4,000,000 for each of fiscal 

7 years 2011 through 2013, and $3,500,000 for fiscal 

8 year 2014.’’. 

9 SEC. 5. HEALTH AND LONG-TERM CARE WORKFORCE ADVI10 SORY PANEL FOR AN AGING AMERICA. 

11 Subpart 3 of part E of title VII of the Public Health 

12 Service Act (as added by section 2) is further amended 

13 by adding at the end the following: 

14 ‘‘SEC. 772. HEALTH AND LONG-TERM CARE WORKFORCE 

15 ADVISORY PANEL FOR AN AGING AMERICA. 

16 ‘‘(a) ESTABLISHMENT.—The Secretary, in consulta17 tion with the Secretary of Labor, shall establish a Health 

18 and Long-Term Care Workforce Advisory Panel (referred 

19 to in this section as the ‘Panel’) to— 

20 ‘‘(1) examine workforce issues related to health 

21 and long-term care for the aging population; and 

22 ‘‘(2) provide advice to each such Secretary and 

23 to the appropriate committees of Congress con24 cerning workforce issues related to health and long25 term care for the aging population. 


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1 ‘‘(b) MEMBERSHIP.—The Panel shall be composed of 

2 not to exceed 20 individuals to be appointed by the Sec3 retary. 

4 ‘‘(c) DUTIES.—The Panel shall— 

5 ‘‘(1) analyze the existing geriatric health and 

6 long-term care workforce data infrastructure; 

7 ‘‘(2) make recommendations for new or addi8 tional uniform data elements across regions and 

9 States that is necessary to track supply, demand, 

10 and workforce shortages related to health and long11 term care for the aging population; 

12 ‘‘(3) conduct a research project to identify in13 centives for recruitment and retention of new popu14 lations of clinicians and providers who agree to serve 

15 vulnerable older adults in geriatric and long-term 

16 care settings and make recommendations for one or 

17 more demonstrations, including the design, imple18 mentation and evaluation of outcomes; and 

19 ‘‘(4) carry out other activities determined ap20 propriate by the Secretary. 

21 ‘‘(d) FOCUS OF RESEARCH PROJECT.—In carrying 

22 out the research project under subsection (c)(3), the Sec23 retary in consultation with the Panel shall focus on indi24 viduals who are not otherwise eligible for loan repayment 

25 incentives under this title or title VIII, such as retired 


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1 military clinicians or other retired health professionals, 

2 health care professionals seeking a mid-career change, and 

3 direct care workers in long-term care settings. To carry 

4 out such research project, the Secretary may award grants 

5 or contracts. Eligible entities shall include State or local 

6 government, health professions schools, academic health 

7 centers, and other appropriate public or private non-profit 

8 entities. 

9 ‘‘(e) ADMINISTRATIVE PROVISIONS.—Members of the 

10 Panel shall be appointed for a term of not to exceed 3 

11 years (as determined by the Secretary at the time of ap12 pointment), shall convene at least twice per year, and shall 

13 be representative of diverse public and private sector ex14 pertise and interests, including representation from the 

15 Department of Health and Human Services (including the 

16 Health Resources and Services Administration, the Agen17 cy for Healthcare Research and Quality, and the Adminis18 tration on Aging), the Department of Labor (including the 

19 Bureau of Labor Statistics, the Employment and Training 

20 Administration, and the Employment Standards Adminis21 tration), other Federal officials as the Secretary deter22 mines appropriate, academic institutions, consumer orga23 nizations, national aging advocates, health professional 

24 and paraprofessional associations, organized labor, nation25 ally recognized researchers in the area of geriatric care 


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1 and long-term care workforce issues, health care and long2 term care associations (including those representing home 

3 and community-based and facility-based settings), and pri4 vate foundations that have sponsored initiatives to expand 

5 health professionals to care for the aging population. 

6 ‘‘(f) REPORTS.—Not later than 2 years after the date 

7 of enactment of this section, and every 2 years thereafter, 

8 the Secretary, based on the advice and recommendations 

9 of the Panel, shall submit to the appropriate committees 

10 of Congress a report on the status of the health profes11 sions and long-term care workforce for the aging popu12 lation. 

13 ‘‘(g) AUTHORIZATION OF APPROPRIATIONS.—There 

14 is authorized to be appropriated to carry out this section, 

15 $1,500,000 for fiscal year 2010, and such sums as may 

16 be necessary for each of fiscal years 2011 through 2014.’’. 

Æ 


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