I 

111TH CONGRESS 

1ST SESSION H. R. 3109 

To improve access to health care services in rural, frontier, and urban underserved areas in the United States by addressing the supply of health 

professionals and the distribution of health professionals to areas of 

need. 

IN THE HOUSE OF REPRESENTATIVES 

JUNE 26, 2009 

Mr. TEAGUE (for himself, Mr. GENE GREEN of Texas, Mr. SPACE, and Mr. 

GONZALEZ) introduced the following bill; which was referred to the Committee on Energy and Commerce, and in addition to the Committees on 

Ways and Means, Veterans’ Affairs, Education and Labor, Armed Services, and Natural Resources, 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 improve access to health care services in rural, frontier, 

and urban underserved areas in the United States by 

addressing the supply of health professionals and the 

distribution of health professionals to areas of need. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 


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1 SECTION 1. SHORT TITLE; TABLE OF CONTENTS. 

2 (a) SHORT TITLE.—This Act may be cited as the 

3 ‘‘Health Access and Health Professions Supply Act of 

4 2009’’ or ‘‘HAHPSA 2009’’. 

5 (b) TABLE OF CONTENTS.—The table of contents of 

6 this Act is as follows: 

Sec. 1. Short title; table of contents. 

Sec. 2. Findings. 

TITLE I—AMENDMENTS TO THE SOCIAL SECURITY ACT 

Subtitle A—Workforce Improvements 

Sec. 101. National health care workforce commission. 

Sec. 102. State health workforce centers program. 

Sec. 103. Improvements to payments for graduate medical education under 

medicare. 

Sec. 104. Distribution of resident trainees in an emergency. 

Sec. 105. Authority to include costs of training of psychologists in payments to 

hospitals for approved educational activities under Medicare. 

Subtitle B—Geriatric Assessments and Chronic Care Management and 

Coordination Services Under the Medicare Program 

Sec. 111. Medicare coverage of geriatric assessments. 

Sec. 112. Medicare coverage of chronic care management and coordination services. 

Sec. 113. Outreach activities regarding geriatric assessments and chronic care 

management and coordination services under the Medicare program. 

Sec. 114. Utilization of telehealth services to furnish geriatric assessments and 

chronic care management and coordination services under the 

Medicare program. 

Sec. 115. Study and report on geriatric assessments and chronic care management and coordination services under the Medicare program. 

Sec. 116. Rule of construction. 

TITLE II—AMENDMENTS TO THE PUBLIC HEALTH SERVICE ACT 

Sec. 201. Expansion of National Health Service Corps programs. 

Sec. 202. National health service corps scholarship program for medical, dental, 

physician assistant, pharmacy, behavioral and mental health, 

public health, and nursing students in the United States public 

health sciences track in affiliated schools. 

Sec. 203. Federal medical facility grant program and program assessments. 

Sec. 204. Health professions training loan program. 

Sec. 205. United States Public Health Sciences Track. 

Sec. 206. Medical education debt reimbursement for physicians of the Veterans 

Health Administration. 


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Sec. 207. Promoting education and training of psychologists to provide mental 

and behavioral health services to underserved populations. 

TITLE III—HEALTH PROFESSIONAL TRAINING PIPELINE 

PARTNERSHIPS PROGRAM 

Sec. 301. Grants to prepare students for careers in health care. 

1 SEC. 2. FINDINGS. 

2 (a) FINDINGS RELATED TO HEALTH CARE ACCESS

3 IN RURAL, FRONTIER, AND URBAN UNDERSERVED

4 AREAS OF THE UNITED STATES.—Congress finds the fol5 lowing: 

6 (1) The United States does not have a cohesive 

7 or coordinated approach to addressing health work8 force shortages and problems with reliable access to 

9 quality, affordable health care. 

10 (2) There are 50,000,000 citizens of the United 

11 States living in areas that are designated under sec12 tion 332(a)(1)(A) of the Public Health Service Act 

13 as health professional shortage areas. 

14 (3) The population of the United States will 

15 grow by 25,000,000 each decade. 

16 (4) The number of individuals over 65 years of 

17 age in the United States will double between 2000 

18 and 2030, with such individuals accounting for 20 

19 percent of the total population of the United States 

20 in 2030. 

21 (5) Individuals over 65 years of age have twice 

22 as many doctor visits as those individuals under 65 


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1 years of age, resulting in an increase in the demand 

2 for physicians, physician assistants, pharmacists be3 havioral and mental health professionals, nurses, 

4 and dentists. 

5 (6) The rates of chronic diseases (such as dia6 betes) are increasing in the population of the United 

7 States. 

8 (7) There are 47,000,000 citizens of the United 

9 States who do not have health insurance, and over 

10 130,000,000 individuals within the United States 

11 who do not have dental insurance. Those individuals 

12 who are uninsured have limited access to health 

13 care. 

14 (8) Academic health centers, Federal medical 

15 facilities, and teaching hospitals provide a substan16 tial percentage of safety net services in the United 

17 States to uninsured and underinsured populations 

18 and to those individuals who have 1 or more chronic 

19 diseases. Such centers, facilities, and teaching hos20 pitals provide those safety net services while concur21 rently providing for the training of health profes22 sionals. 

23 (9) The pipeline for the education of health pro24 fessionals— 

25 (A) begins and often ends in urban areas; 


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1 (B) does not reliably include Federal sup2 port for nonphysician training; 

3 (C) does not incorporate modern training 

4 venues and techniques, including community5 based ambulatory sites; and 

6 (D) discourages interdisciplinary, team, 

7 and care coordination models as a result of re8 strictive regulations. 

9 (10) Health reform must include measures to 

10 transform the health delivery system to assure ac11 cess, quality, and efficiency by utilizing contem12 porary models and venues of care. 

13 (11) Reform of the health delivery system will 

14 require modernization of the training of health pro15 fessionals to ensure that health professionals— 

16 (A) practice in integrated teams in a vari17 ety of delivery venues (including inpatient and 

18 ambulatory settings and long-term care facili19 ties) to utilize decision support and health in20 formation systems; 

21 (B) deliver patient-centered care; 

22 (C) practice evidence-based health care; 

23 (D) learn performance-based compensation 

24 systems, comparative effectiveness, and costs of 

25 care across the spectrum; and 


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1 (E) deliver culturally appropriate, person2 alized care. 

3 (b) FINDINGS RELATED TO ACCESS TO ORAL

4 HEALTH.—Congress finds the following: 

5 (1) Dental care is the number 1 unmet health 

6 care need in children, and is 1 of the top 5 unmet 

7 health care needs in adults. 

8 (2) Over 130,000,000 citizens of the United 

9 States are without dental insurance. 

10 (3) Over 45,000,000 citizens of the United 

11 States live in areas that are designated under sec12 tion 332(a)(1)(A) of the Public Health Service Act 

13 as dental health professional shortage areas. 

14 (4) Rural counties have less than half the num15 ber of dentists per capita compared to large metro16 politan areas (29 versus 62 for population of 

17 100,000). 

18 (5) In 2006, over 9,000 dentists were needed in 

19 such dental health professional shortage areas. 

20 (6) Between 27 and 29 percent of children and 

21 adults in the United States have untreated cavities. 

22 (7) The number of dental school graduates in 

23 the United States decreased by 20 percent between 

24 1982 and 2003 and the average age of practicing 

25 dentists in the United States is 49. 


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1 (8) There were over 400 dental faculty vacan2 cies in the school year beginning in 2006. 

3 (9) In 2007, the average debt of a dental stu4 dent at graduation was $172,627. 

5 (c) FINDINGS RELATED TO PHYSICIAN SHORTAGES, 

6 EDUCATION, AND DISTRIBUTION.—Congress finds the fol7 lowing: 

8 (1) By 2020, physician shortages are forecasted 

9 to be in the range of 55,000 to 200,000. 

10 (2) Although 21 percent of the population of 

11 the United States lives in rural areas, only 10 per12 cent of physicians work in rural areas and, for every 

13 1 physician who goes into practice in regions with a 

14 low supply of physicians, 4 physicians go into prac15 tice in regions with a high supply of physicians. 

16 (3) According to a 2004 report by Green et al. 

17 for the Robert Graham Center of the American 

18 Academy of Family Physicians, the number of appli19 cants from rural areas accepted to medical school 

20 has decreased by 40 percent in the last 20 years 

21 while the number of such applications has remained 

22 the same. 

23 (4) In order to respond to forecasted shortages, 

24 experts have recommended an increase between 15 


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1 and 30 percent in class size at medical schools over 

2 the next 10 years. 

3 (5) There are 55,000,000 citizens of the United 

4 States who lack adequate access to primary health 

5 care because of shortages of primary care providers 

6 in their communities. 

7 (6) The number of graduates from medical 

8 school in the United States who choose to practice 

9 family medicine has plummeted 50 percent in less 

10 than 10 years. Without congressional intervention, 

11 such decline will likely continue, and access to care 

12 in underserved areas will rapidly deteriorate. Family 

13 physicians represent 58 percent of the rural physi14 cian workforce, 70 percent of non-Federal physicians 

15 in whole-county health professional shortage areas, 

16 and 78 percent of primary care physician full-time 

17 equivalents in the National Health Service Corps. 

18 (7) Current trends indicate that fewer resident 

19 trainees from pediatric and internal medicine 

20 residencies pursue generalist practice at graduation. 

21 (8) Funding for medical education which is pro22 vided through direct Graduate Medical Education 

23 (GME) and Indirect Medical Education (IME) 

24 under the Medicare program is not transparent or 

25 accountable, nor is it aligned to the types of health 


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1 professionals most needed or to the areas in which 

2 health professionals are most needed. 

3 (9) Physician supply varies 200 percent across 

4 regions and there is no relationship between regional 

5 physician supply and health needs. 

6 (10) The Council on Graduate Medical Edu7 cation’s 18th Report (issued in 2007), entitled ‘‘New 

8 Paradigms for Physician Training for Improving Ac9 cess to Health Care’’, and 19th Report (issued in 

10 2007), entitled ‘‘Enhancing Flexibility in Graduate 

11 Medical Education’’, each call for changes to address 

12 the healthcare needs of the United States by remov13 ing barriers to expanding and more appropriately 

14 training the physician workforce. 

15 (d) FINDINGS RELATED TO NURSING SHORTAGES, 

16 EDUCATION, AND DISTRIBUTION.—Congress finds the fol17 lowing: 

18 (1) By 2020, nursing shortages are forecast to 

19 be in the range of 300,000 to 1,000,000 and the 

20 Bureau of Labor Statistics of the Department of 

21 Labor estimates that more than 1,200,000 new and 

22 replacement registered nurses will be needed by 

23 2014. 

24 (2) Nurse vacancy rates are currently 8 percent 

25 or greater in hospitals and community health centers 


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1 receiving assistance under section 330 of the Public 

2 Health Service Act, and for nursing faculty posi3 tions. 

4 (3) Surveys indicate that 40 percent of nurses 

5 in hospitals are dissatisfied with their work and, of 

6 nurses who graduate and go into nursing, 50 per7 cent leave their first employer within 2 years. 

8 (4) Nursing baccalaureate and graduate pro9 grams rejected more than 40,000 qualified nursing 

10 school applicants in 2006, with faculty shortages 

11 identified by such programs as a major reason for 

12 turning away qualified applicants. 

13 (5) More than 70 percent of nursing schools 

14 cited faculty shortages as the primary reason for not 

15 accepting all qualified applicants into entry-level 

16 nursing programs. 

17 (6) The nursing faculty workforce is aging and 

18 retiring and, by 2019, approximately 75 percent of 

19 the nursing faculty workforce is expected to retire. 

20 (7) The average age of nurses in the United 

21 States is 49 and the average age of an associate pro22 fessor nurse faculty member in the United States is 

23 56. 

24 (8) Geriatric patients receiving care from 

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1 admitted to hospitals or transferred from skilled 

2 nursing facilities and nursing facilities to hospitals. 

3 (e) FINDINGS RELATED TO PUBLIC HEALTH WORK4 FORCE SHORTAGES.—Congress finds the following: 

5 (1) The United States has an estimated 50,000 

6 fewer public health workers than it did 20 years ago 

7 while the population has grown by approximately 22 

8 percent. 

9 (2) Government public health departments are 

10 facing significant workforce shortages that could be 

11 exacerbated through retirements. 

12 (3) Twenty percent of the average State health 

13 agency’s workforce will be eligible to retire within 3 

14 years, and by 2012, over 50 percent of some State 

15 health agency workforces will be eligible to retire. 

16 (4) Approximately 20 percent of local health de17 partment employees will be eligible for retirement by 

18 2010. 

19 (5) The average age of new hires in State 

20 health agencies is 40. 

21 (6) Four out of 5 current public health workers 

22 have not had formal training for their specific job 

23 functions. 

24 (f) FINDINGS RELATED TO PHYSICIAN ASSISTANT

25 SHORTAGES.—Congress finds the following: 


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1 (1) The purpose of the physician assistant pro2 fession is to extend the ability of physicians to pro3 vide primary care services, particularly in rural and 

4 other medically underserved communities. 

5 (2) Physician assistants always practice medi6 cine as a team with their supervising physicians, 

7 however, supervising physicians need not be phys8 ically present when physician assistants provide 

9 medical care. 

10 (3) Physician assistants are legally regulated in 

11 all States, the District of Columbia, and Guam. All 

12 States, the District of Columbia, and Guam author13 ize physicians to delegate prescriptive authority to 

14 physician assistants. 

15 (4) In 2007, physician assistants made approxi16 mately 245,000,000 patient visits and prescribed or 

17 recommended approximately 303,000,000 medica18 tions. 

19 (5) The National Association of Community 

20 Health Centers, the George Washington University, 

21 and the Robert Graham Center for Policy Studies in 

22 Family Medicine and Primary Care found that while 

23 the number of patients who seek care at community 

24 health centers has increased, the number of primary 

25 care providers, including physician assistants, has 


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1 not. The report estimates a need for 15,500 primary 

2 health care providers to provide care at community 

3 health centers. 

4 (g) FINDINGS RELATED TO MENTAL HEALTH PRO5 FESSIONAL SHORTAGES.—Congress finds the following: 

6 (1) The National Institute of Mental Health es7 timates that 26.2 percent of citizens of the United 

8 States ages 18 and older suffer from a diagnosable 

9 mental disorder. Approximately 20 percent of chil10 dren in the United States have diagnosable mental 

11 disorders with at least mild functional impairment. 

12 (2) The Health Resources and Services Admin13 istration reports that there are 3,059 mental health 

14 professional shortage areas within the United States 

15 with 77,000,000 people living in those areas. More 

16 than 5,000 additional mental health professionals 

17 are needed to meet demand. 

18 (3) According to the Department of Health and 

19 Human Services, minority representation is lacking 

20 in the mental health workforce. Although 12 percent 

21 of the population of the United States is African22 American, only 2 percent of psychologists, 2 percent 

23 of psychiatrists, and 4 percent of social workers are 

24 African-American. Moreover, there are only 29 men25 tal health professionals who are Hispanic for every 


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1 100,000 individuals who are Hispanic in the United 

2 States, compared with 173 non-Hispanic White pro3 viders for every 100,000 individuals who are non4 Hispanic White in the United States. 

5 (h) FINDINGS RELATED TO HEALTH PROFESSIONAL

6 SHORTAGE AREAS.— 

7 (1) In 2006, the National Health Service Corps 

8 had a total of 4,200 vacant positions in health pro9 fessional shortage areas, but only 1,200 of those po10 sitions were funded. For each National Health Serv11 ice Corps award, there are 7 applicants. 

12 (2) Community health centers receiving assist13 ance under section 330 of the Public Health Service 

14 Act have expanded to serve 16,000,000 individuals 

15 in over 1,000 sites. Such community health centers 

16 have high vacancy rates for family physicians (13 

17 percent), obstetricians and gynecologists (21 per18 cent), dentists, nurses, and other health profes19 sionals. 

20 (3) The Institute of Medicine of the National 

21 Academies has recommended that medical education 

22 and public health issues be more closely aligned, es23 pecially in relation to preparedness for natural disas24 ters, pandemic, bioterrorism, and other threats to 

25 public health. 


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1 (4) The education of health professionals must 

2 be more closely aligned with health care needs in the 

3 United States, with special attention to underserved 

4 populations and areas, health disparities, the aging 

5 population, and individuals with 1 or more chronic 

6 diseases. 

7 (5) There is some duplication, and little coordi8 nation, between the Council on Graduate Medical 

9 Education (related to the physician workforce), the 

10 National Advisory Committee on Nursing Programs 

11 (related to the nursing workforce), the Advisory 

12 Committee on Training in Primary Care Medicine 

13 and Dentistry, and other advisory committees and 

14 councils. 

15 (6) The Association of Academic Health Cen16 ters calls for making the health workforce of the 

17 United States a priority domestic policy issue and 

18 creating a national health workforce planning body 

19 that engages Federal, State, public, and private 

20 stakeholders. 


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1 TITLE I—AMENDMENTS TO THE 

2 SOCIAL SECURITY ACT 

3 Subtitle A—Workforce 

4 Improvements 

5 SEC. 101. NATIONAL HEALTH CARE WORKFORCE COMMIS6 SION. 

7 (a) PURPOSE.—It is the purpose of this section to 

8 establish a National Health Care Workforce Commission 

9 that— 

10 (1) serves as a national resource for Congress, 

11 the President, States, and localities by— 

12 (A) disseminating information on current 

13 and projected health care workforce supply and 

14 demand; 

15 (B) disseminating information on health 

16 care workforce education and training capacity 

17 and instruction or delivery models and best 

18 practices; 

19 (C) recognizing efforts of Federal, State, 

20 and local partnerships to develop and offer 

21 health care career pathways of proven effective22 ness; 

23 (D) disseminating information on prom24 ising retention practices for health care profes25 sionals; 


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1 (E) communicating information on impor2 tant policies and practices that affect the re3 cruitment, education and training, and reten4 tion of the health care workforce; and 

5 (F) disseminating recommendations on the 

6 development of a fiscally sustainable integrated 

7 workforce that supports a high-quality health 

8 care delivery system that meets the needs of pa9 tients and populations; 

10 (2) communicates and coordinates with the De11 partments of Health and Human Services, Labor, 

12 and Education on related activities administered by 

13 one or more of such Departments; 

14 (3) develops and commissions evaluations of 

15 education and training activities to determine wheth16 er the demand for health care workers is being met; 

17 (4) identifies barriers to improved coordination 

18 at the Federal, State, and local levels and rec19 ommend ways to address such barriers; and 

20 (5) encourages innovations to address popu21 lation needs, constant changes in technology, and 

22 other environmental factors. 

23 (b) ESTABLISHMENT.—There is hereby established 

24 the National Health Care Workforce Commission (in this 

25 section referred to as the ‘‘Commission’’). 


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1 (c) MEMBERSHIP.— 

2 (1) NUMBER AND APPOINTMENT.—The Com3 mission shall be composed of 15 members to be ap4 pointed by the Comptroller General. 

5 (2) QUALIFICATIONS.— 

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

7 Commission shall include individuals— 

8 (i) with national recognition for their 

9 expertise in health care labor market anal10 ysis, including health care workforce anal11 ysis; health care finance and economics; 

12 health care facility management; health 

13 care plans and integrated delivery systems; 

14 health care workforce education and train15 ing; health care philanthropy; providers of 

16 health care services; and other related 

17 fields; and 

18 (ii) who will provide a combination of 

19 professional perspectives, broad geographic 

20 representation, and a balance between 

21 urban, suburban, and rural representa22 tives. 

23 (B) INCLUSION.— 


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1 (i) IN GENERAL.—The membership of 

2 the Commission shall include no less than 

3 one representative of— 

4 (I) the health care workforce and 

5 health professionals; 

6 (II) employers; 

7 (III) third-party payers; 

8 (IV) individuals skilled in the 

9 conduct and interpretation of health 

10 care services and health economics re11 search; 

12 (V) representatives of consumers; 

13 (VI) labor unions; 

14 (VII) State or local workforce in15 vestment boards; and 

16 (VIII) educational institutions 

17 (which may include elementary and 

18 secondary institutions, institutions of 

19 higher education, including 2 and 4 

20 year institutions, or registered ap21 prenticeship programs). 

22 (ii) ADDITIONAL MEMBERS.—The re23 maining membership may include addi24 tional representatives from clause (i) and 

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1 priate by the Comptroller General of the 

2 United States. 

3 (C) MAJORITY NON-PROVIDERS.—Individ4 uals who are directly involved in health profes5 sions education or practice shall not constitute 

6 a majority of the membership of the Commis7 sion. 

8 (3) TERMS.— 

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

10 of the Commission shall be for 3 years except 

11 that the Comptroller General shall designate 

12 staggered terms for the members first ap13 pointed. 

14 (B) VACANCIES.—Any member appointed 

15 to fill a vacancy occurring before the expiration 

16 of the term for which the member’s predecessor 

17 was appointed shall be appointed only for the 

18 remainder of that term. A member may serve 

19 after the expiration of that members term until 

20 a successor has taken office. A vacancy in the 

21 Commission shall be filled in the manner in 

22 which the original appointment was made. 

23 (4) COMPENSATION.—While serving on the 

24 business of the Commission (including travel time), 

25 a member of the Commission shall be entitled to 


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1 compensation at the per diem equivalent of the rate 

2 provided for level IV of the Executive Schedule 

3 under section 5315 of tile 5, United States Code, 

4 and while so serving away from home and the mem5 ber’s regular place of business, a member may be al6 lowed travel expenses, as authorized by the Chair7 man of the Commission. Physicians serving as per8 sonnel of the Commission may be provided a physi9 cian comparability allowance by the Commission in 

10 the same manner as Government physicians may be 

11 provided such an allowance by an agency under sec12 tion 5948 of title 5, United States Code, and for 

13 such purpose subsection (i) of such section shall 

14 apply to the Commission in the same manner as it 

15 applies to the Tennessee Valley Authority. For pur16 poses of pay (other than pay of members of the 

17 Commission) and employment benefits, rights, and 

18 privileges, all personnel of the Commission shall be 

19 treated as if they were employees of the United 

20 States Senate. 

21 (5) CHAIRMAN, VICE CHAIRMAN.—The members 

22 of the Commission shall elect, by a majority vote, a 

23 chairman and vice chairman of the Commission for 

24 the term of their appointment of portion remaining. 

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1 man or vice chairman’s term or upon the resignation 

2 of the chairman or vice chairman from the Commis3 sion. 

4 (6) MEETINGS.—The Commission shall meet at 

5 the call of the chairman, but no less frequently than 

6 on a quarterly basis. 

7 (d) DUTIES.— 

8 (1) REVIEW OF HEALTH CARE WORKFORCE

9 AND ANNUAL REPORTS.—In order to develop a fis10 cally sustainable integrated workforce that supports 

11 a high-quality, readily accessible health care delivery 

12 system that meets the needs of patients and popu13 lations, the Commission, in consultation with rel14 evant Federal, State, and local agencies, shall— 

15 (A) review current and projected health 

16 care workforce supply and demand, including 

17 the topics described in paragraph (2); 

18 (B) make recommendations to Congress 

19 and the Administration concerning national 

20 health care workforce priorities, goals, and poli21 cies; 

22 (C) by not later than October 1 of each 

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

24 Congress and the Administration containing the 


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1 results of such reviews and recommendations 

2 concerning related policies; and 

3 (D) by not later than April 1 of each year 

4 (beginning with 2011), submit a report to Con5 gress and the Administration containing a re6 view of, and recommendations on, at a min7 imum one high priority area as described in 

8 paragraph (3). 

9 (2) SPECIFIC TOPICS TO BE REVIEWED.—The 

10 topics described in this paragraph include— 

11 (A) current health care workforce supply 

12 and distribution, including demographics, skill 

13 sets, and demands, with projected demands 

14 during the subsequent 10 and 25 year periods; 

15 (B) health care workforce education and 

16 training capacity, including the number of stu17 dents who have completed education and train18 ing, including registered apprenticeships; the 

19 number of qualified faculty; the education and 

20 training infrastructure; and the education and 

21 training demands, with projected demands dur22 ing the subsequent 10 and 25 year periods, and 

23 including identified models of education and 

24 training delivery and best practices; 


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1 (C) the implications of new and existing 

2 Federal policies which affect the health care 

3 workforce, including Medicare and Medicaid 

4 graduate medical education policies, titles VII 

5 and VIII of the Public Health Service Act (42 

6 U.S.C. 292 et seq. and 296 et seq.), the Na7 tional Health Service Corps (with recommenda8 tions for aligning such programs with national 

9 health workforce priorities and goals), and 

10 other health care workforce programs, including 

11 those supported through the Workforce Invest12 ment Act of 1998 (29 U.S.C. 2801 et seq.), the 

13 Carl D. Perkins Career and Technical Edu14 cation Act of 2006 (20 U.S.C. 2301 et seq.), 

15 the Higher Education Act of 1965 (20 U.S.C. 

16 1001 et seq.), and any other Federal health 

17 care workforce programs; and 

18 (D) the health care workforce needs of spe19 cial populations, such as minorities, rural popu20 lations, medically underserved populations, gen21 der specific needs, and geriatric and pediatric 

22 populations with recommendations for new and 

23 existing Federal policies to meet the needs of 

24 these special populations. 

25 (3) HIGH PRIORITY AREAS.— 


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1 (A) IN GENERAL.—The initial high priority 

2 topics described in this paragraph include— 

3 (i) integrated health care workforce 

4 planning that identifies health care profes5 sional skills needed and maximizes the skill 

6 sets of health care professionals across dis7 ciplines; 

8 (ii) an analysis of the nature, scopes 

9 of practice, and demands for health care 

10 workers in the enhanced information tech11 nology and management workplace; 

12 (iii) Medicare and Medicaid graduate 

13 medical education policies and rec14 ommendations for aligning with national 

15 workforce goals; 

16 (iv) nursing workforce capacity at all 

17 levels, including education and training ca18 pacity, projected demands, and integration 

19 within the health care delivery system; 

20 (v) oral health care workforce capac21 ity, including education and training ca22 pacity, projected demands, and integration 

23 within the health care delivery system; 

24 (vi) mental and behavioral health care 

25 workforce capacity, including education 


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1 and training capacity, projected demands, 

2 and integration within the health care de3 livery system; 

4 (vii) allied health and public health 

5 care workforce capacity, including edu6 cation and training capacity, projected de7 mands, and integration within the health 

8 care delivery system; and 

9 (viii) the geographic distribution of 

10 health care providers as compared to the 

11 identified health care workforce needs of 

12 States and regions. 

13 (B) FUTURE DETERMINATIONS.—The 

14 Commission may require that additional topics 

15 be included under subparagraph (A). The ap16 propriate committees of Congress may rec17 ommend to the Commission the inclusion of 

18 other topics for health care workforce develop19 ment areas that require special attention. 

20 (4) GRANT PROGRAM.—The Commission shall 

21 oversee and report to Congress on the State Health 

22 Care Workforce Development Grants program estab23 lished in section 412. 

24 (5) STUDY.—The Commission shall study effec25 tive mechanisms for financing education and trainVerDate Nov 24 2008 01:33 Jul 02, 2009 Jkt 079200 PO 00000 Frm 00026 Fmt 6652 Sfmt 6201 E:\BILLS\H3109.IH H3109

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1 ing for careers in health care, including public health 

2 and allied health. 

3 (6) RECOMMENDATIONS.—The Commission 

4 shall submit recommendations to Congress, the De5 partment of Labor, and the Department of Health 

6 and Human Services about improving safety, health, 

7 and worker protections in the workplace for the 

8 health care workforce. 

9 (7) ASSESSMENT.—The Commission shall as10 sess and receive reports from the National Center 

11 for Health Care Workforce Analysis established 

12 under title VII of the Public Service Health Act. 

13 (e) CONSULTATION WITH FEDERAL, STATE, AND

14 LOCAL AGENCIES, CONGRESS, AND OTHER ORGANIZA15 TIONS.— 

16 (1) IN GENERAL.—The Commission shall con17 sult with Federal agencies (including the Depart18 ments of Health and Human Services, Labor, Edu19 cation, Commerce, Agriculture, Defense, and Vet20 erans Affairs and the Environmental Protections 

21 Agency), Congress, the Medicare Payment Advisory 

22 Commission, and, to the extent practicable, with 

23 State and local agencies, voluntary health care orga24 nizations professional societies, and other relevant 

25 public-private health care partnerships. 


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1 (2) OBTAINING OFFICIAL DATA.—The Commis2 sion, consistent with established privacy rules, may 

3 secure directly from any department or agency of 

4 the United States information necessary to enable 

5 the Commission to carry out this section. 

6 (3) DETAIL OF FEDERAL GOVERNMENT EM7 PLOYEES.—An employee of the Federal Government 

8 may be detailed to the Commission without reim9 bursement. The detail of such an employee shall be 

10 without interruption or loss of civil service status. 

11 (f) DIRECTOR AND STAFF; EXPERTS AND CONSULT12 ANTS.—Subject to such review as the Comptroller General 

13 of the United States determines to be necessary to ensure 

14 the efficient administration of the Commission, the Com15 mission may— 

16 (1) employ and fix the compensation of an exec17 utive director (subject to the approval of the Comp18 troller General) and such other personnel as may be 

19 necessary to carry out its duties (without regard to 

20 the provisions of title 5, United States Code, gov21 erning appointments in the competitive service); 

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

23 required in the performance of its duties from ap24 propriate Federal departments and agencies; 


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1 (3) enter into contracts or make other arrange2 ments, as may be necessary for the conduct of the 

3 work of the Commission (without regard to section 

4 3709 of the Revised Statutes (41 U.S.C. 5)); 

5 (4) make advance, progress, and other pay6 ments which relate to the work of the Commission; 

7 (5) provide transportation and subsistence for 

8 persons serving without compensation; and 

9 (6) prescribe such rules and regulations as the 

10 Commission determines to be necessary with respect 

11 to the internal organization and operation of the 

12 Commission. 

13 (g) POWERS.— 

14 (1) DATA COLLECTION.—In order to carry out 

15 its functions under this section, the Commission 

16 shall— 

17 (A) utilize existing information, both pub18 lished and unpublished, where possible, collected 

19 and assessed either by its own staff or under 

20 other arrangements made in accordance with 

21 this section, including coordination with the Bu22 reau of Labor Statistics; 

23 (B) carry out, or award grants or con24 tracts for the carrying out of, original research 


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1 and development, where existing information is 

2 inadequate, and 

3 (C) adopt procedures allowing interested 

4 parties to submit information for the Commis5 sion’s use in making reports and recommenda6 tions. 

7 (2) ACCESS OF THE GOVERNMENT ACCOUNT8 ABILITY OFFICE TO INFORMATION.—The Comp9 troller General of the United States shall have unre10 stricted access to all deliberations, records, and non11 proprietary data of the Commission, immediately 

12 upon request. 

13 (3) PERIODIC AUDIT.—The Commission shall 

14 be subject to periodic audit by a third party ap15 pointed by the Secretary. 

16 (h) AUTHORIZATION OF APPROPRIATIONS.— 

17 (1) REQUEST FOR APPROPRIATIONS.—The 

18 Commission shall submit requests for appropriations 

19 in the same manner as the Comptroller General of 

20 the United States submits requests for appropria21 tions. Amounts so appropriated for the Commission 

22 shall be separate from amounts appropriated for the 

23 Comptroller General. 


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1 (2) AUTHORIZATION.—There are authorized to 

2 be appropriated such sums as may be necessary to 

3 carry out this section. 

4 (3) GIFTS.—The Commission is authorized to 

5 accept and gifts for purposing of carrying out this 

6 section. 

7 (i) DEFINITIONS.—In this section: 

8 (1) HEALTH CARE WORKFORCE.—The term 

9 ‘‘health care workforce’’ includes all health care pro10 viders with direct patient care and support respon11 sibilities, including physicians, nurses, physician as12 sistants, pharmacists, oral healthcare professionals, 

13 allied health professionals, mental health profes14 sionals, and public health professionals. 

15 (2) HEALTH PROFESSIONALS.—The term 

16 ‘‘health professionals’’ includes— 

17 (A) dentists, dental hygienists, primary 

18 care providers, specialty physicians, nurses, 

19 nurse practitioners, physician assistants, psy20 chologists and other behavioral and mental 

21 health professionals, social workers, physical 

22 therapists, public health professionals, clinical 

23 pharmacists, allied health professionals, chiro24 practors, community health workers, school 

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1 censed complementary and alternative medicine 

2 providers, and integrative health practitioners; 

3 (B) national representatives of health pro4 fessionals; 

5 (C) representatives of schools of medicine, 

6 osteopathy, nursing, allied health, educational 

7 programs for public health professionals, behav8 ioral and mental health professionals (as so de9 fined), social workers, physical therapists, oral 

10 health care industry dentistry and dental hy11 giene, and physician assistants; 

12 (D) representatives of public and private 

13 teaching hospitals, and ambulatory health facili14 ties, including Federal medical facilities; and 

15 (E) any other health professional the 

16 Comptroller General of the United States deter17 mines appropriate. 

18 SEC. 102. STATE HEALTH WORKFORCE CENTERS PROGRAM. 

19 (a) ESTABLISHMENT.—The Secretary shall establish 

20 a demonstration program (in this section referred to as 

21 the ‘‘program’’) under which the Secretary makes grants 

22 to participating States for the operation of State Health 

23 Workforce Centers to carry out the activities described in 

24 subsection (c). 


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1 (b) PARTICIPATING STATES.—A State seeking to 

2 participate in the program shall submit an application to 

3 the Secretary containing such information and at such 

4 time as the Secretary may specify. The Secretary may only 

5 consider under the preceding sentence 1 application sub6 mitted by each State which has been certified by the Gov7 ernor or the chief executive officer of the State. 

8 (c) USE OF FUNDS.—Grants awarded under sub9 section (a) may be used to support activities designed to 

10 improve the training, deployment, and retention of critical 

11 health professionals in underserved areas and for under12 served populations, including the following: 

13 (1) Conducting assessments of key health pro14 fessional capacity and needs. Such assessments shall 

15 be conducted in a coordinated manner that provides 

16 for the nationwide collection of health professional 

17 data. 

18 (2) Convening State health professional policy19 makers to review education, education financing, 

20 regulations, and taxation and compensation policies 

21 which affect the training, deployment, and retention 

22 of health professionals. A participating State may, 

23 taking into consideration the results of such reviews, 

24 develop short-term and long-term recommendations 

25 for improving the supply, deployment, and retention 


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1 of critical health professionals in underserved areas 

2 and for underserved populations. 

3 (d) FUNDING.— 

4 (1) AUTHORIZATION OF APPROPRIATIONS.— 

5 There are authorized to be appropriated 

6 $13,750,000 to carry out this section. 

7 (2) MATCHING REQUIREMENT.—The Secretary 

8 may require a State, in order to be eligible to receive 

9 a grant under this section, to agree that, with re10 spect to the costs incurred by the State in carrying 

11 out the activities for which the grant was awarded, 

12 the State will make available (directly or through do13 nations from public or private entities) non-Federal 

14 contributions in an amount equal to a percent of 

15 Federal funds provided under the grant (as deter16 mined appropriate by the Secretary). 

17 (e) DEFINITIONS.—In this section: 

18 (1) SECRETARY.—The term ‘‘Secretary’’ means 

19 the Secretary of Health and Human Services. 

20 (2) STATE.—The term ‘‘State’’ means— 

21 (A) a State; 

22 (B) the District of Columbia; 

23 (C) the Commonwealth of Puerto Rico; 

24 and 


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1 (D) any other territory or possession of the 

2 United States. 

3 SEC. 103. IMPROVEMENTS TO PAYMENTS FOR GRADUATE 

4 MEDICAL EDUCATION UNDER MEDICARE. 

5 (a) INCREASING THE MEDICARE CAPS ON GRADUATE

6 MEDICAL EDUCATION POSITIONS.— 

7 (1) DIRECT GRADUATE MEDICAL EDUCATION.— 

8 Section 1886(h)(4)(F) of the Social Security Act (42 

9 U.S.C. 1395ww(h)(4)(F)) is amended— 

10 (A) in clause (i), by inserting ‘‘clause (iii) 

11 and’’ after ‘‘subject to’’; and 

12 (B) by adding at the end the following new 

13 clause: 

14 ‘‘(iii) INCREASE IN CAPS ON GRAD15 UATE MEDICAL EDUCATION POSITIONS FOR

16 STATES WITH A SHORTAGE OF RESI17 DENTS.— 

18 ‘‘(I) IN GENERAL.—For cost re19 porting periods beginning on or after 

20 January 1, 2011, the Secretary shall 

21 increase the otherwise applicable limit 

22 on the total number of full-time equiv23 alent residents in the field of 

24 allopathic or osteopathic medicine de25 termined under clause (i) with respect 


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1 to a qualifying hospital by an amount 

2 equal to 15 percent of the amount of 

3 the otherwise applicable limit (deter4 mined without regard to this clause). 

5 Such increase shall be phased-in 

6 equally over a period of 3 cost report7 ing periods beginning with the first 

8 cost reporting period in which the in9 crease is applied under the previous 

10 sentence to the hospital. 

11 ‘‘(II) QUALIFYING HOSPITAL.— 

12 In this clause, the term ‘qualifying 

13 hospital’ means a hospital that agrees 

14 to use the increase in the number of 

15 full-time equivalent residents under 

16 subclause (I) to support community17 based training which emphasizes un18 derserved areas and innovative train19 ing models which address community 

20 needs and reflect emerging, evolving, 

21 and contemporary models of health 

22 care delivery. A qualifying hospital 

23 shall give priority to providing such 

24 training and training models to health 

25 professionals in specialties which the 


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1 Secretary, in consultation with the 

2 Permanent National Health Work3 force Commission established under 

4 section 101(a) of the Health Access 

5 and Health Professions Supply Act of 

6 2009, determines are in high-need (in7 cluding family medicine, general sur8 gery, geriatrics, general internal medi9 cine, general surgery, and obstetrics 

10 and gynecology). 

11 ‘‘(III) INCREASE IN PAY12 MENTS.—Notwithstanding any other 

13 provision of law, in the case of full14 time equivalent residents added to a 

15 hospital’s training program as a result 

16 of such increase, the Secretary shall 

17 provide for an increase in the amounts 

18 otherwise payable under this sub19 section with respect to direct graduate 

20 medical education costs that would 

21 otherwise apply with respect to such 

22 residents by 10 percent. Such in23 creased payments shall be made to the 

24 facility in which the training is pro25 vided to such residents.’’. 


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1 (2) INDIRECT MEDICAL EDUCATION.—Section 

2 1886(d)(5)(B) of the Social Security Act (42 U.S.C. 

3 1395ww(d)(5)(B)) is amended by adding at the end 

4 the following new clause: 

5 ‘‘(x) Clause (iii) of subsection (h)(4)(F) shall 

6 apply to clause (v) in the same manner and for the 

7 same period as such clause (iii) applies to clause (i) 

8 of such subsection.’’. 

9 (b) APPLICATION OF MEDICARE GME PAYMENTS TO

10 ADDITIONAL TRAINING SITE VENUES.— 

11 (1) IN GENERAL.—The Secretary of Health and 

12 Human Services (in this subsection referred to as 

13 the ‘‘Secretary’’) shall, by regulation, provide for the 

14 use of payments for direct graduate medical edu15 cation costs under section 1886(h) of the Social Se16 curity Act (42 U.S.C. 1395ww(h)) and payments for 

17 the indirect costs of medical education under section 

18 1886(d)(5)(B) of the Social Security Act (42 U.S.C. 

19 1395ww(d)(5)(B)) to support the implementation of 

20 community-based training and innovative training 

21 models under subsections (h)(4)(F)(iii)(II) and 

22 (d)(5)(B)(x) of section 1886 of the Social Security 

23 Act (42 U.S.C. 1395ww). 

24 (2) USE OF MODEL OF CARE DELIVERY.—In 

25 promulgating regulations under paragraph (1), the 


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1 Secretary shall consider the model of care delivery of 

2 the Institute of Medicine of the National Academies. 

3 (3) CONSULTATION.—In promulgating such 

4 regulations, the Secretary shall consult with the Per5 manent National Health Workforce Commission es6 tablished under section 101(a). 

7 (c) DETERMINATION OF HOSPITAL-SPECIFIC AP8 PROVED FTE RESIDENT AMOUNTS.—Section 1886(h)(2) 

9 of the Social Security Act (42 U.S.C. 1395ww(h)(2)) is 

10 amended by adding at the end the following new subpara11 graph: 

12 ‘‘(G) FLEXIBILITY IN DETERMINATION.— 

13 ‘‘(i) IN GENERAL.—Notwithstanding 

14 the preceding provisions of this paragraph, 

15 the approved FTE resident amount for 

16 each cost reporting period beginning on or 

17 after January 1, 2011, with respect to an 

18 applicable resident shall be determined 

19 using a methodology established by the 

20 Secretary that allows flexibility for pay21 ments to be made for costs in addition to 

22 the costs of hospital-sponsored education. 

23 Such methodology shall provide that non24 teaching hospital-based entities (such as 

25 managed care organizations and public and 


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1 private healthcare consortia) that are capa2 ble of assembling all of the resources nec3 essary for effectively providing graduate 

4 medical education may receive payments 

5 for providing graduate medical education, 

6 either as the sponsor of such graduate 

7 medical education program or as an affil8 iate of such a sponsor. 

9 ‘‘(ii) APPLICABLE RESIDENT.—In this 

10 subparagraph, the term ‘applicable resi11 dent’ means a resident— 

12 ‘‘(I) in a specialty which the Sec13 retary, in consultation with the Per14 manent National Health Workforce 

15 Commission established under section 

16 101(a) of the Health Access and 

17 Health Professions Supply Act of 

18 2009, determines is in high-need; 

19 ‘‘(II) in a health professional 

20 shortage area (as defined in section 

21 332 of the Public Health Service Act); 

22 ‘‘(III) in a medically underserved 

23 community (as defined in section 

24 799B of the Public Health Service 

25 Act), or with respect to a medically 


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1 underserved population (as defined in 

2 section 330(b)(3) of the Public Health 

3 Service Act); and 

4 ‘‘(IV) in a Federal medical facil5 ity. 

6 ‘‘(iii) FEDERAL MEDICAL FACILITY.— 

7 In this subparagraph, the term ‘Federal 

8 medical facility’ means a facility for the 

9 delivery of health services, and includes— 

10 ‘‘(I) a community health center 

11 (as defined in section 330 of the Pub12 lic Health Service Act), a public 

13 health center, an outpatient medical 

14 facility, or a community mental health 

15 center; 

16 ‘‘(II) a hospital, State mental 

17 hospital, facility for long-term care, or 

18 rehabilitation facility; 

19 ‘‘(III) a migrant health center or 

20 an Indian Health Service facility; 

21 ‘‘(IV) a facility for the delivery of 

22 health services to inmates in a penal 

23 or correctional institution (under sec24 tion 323 of such Act) or a State cor25 rectional institution; 


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1 ‘‘(V) a Public Health Service 

2 medical facility (used in connection 

3 with the delivery of health services 

4 under section 320, 321, 322, 324, 

5 325, or 326 of such Act); or 

6 ‘‘(VI) any other Federal medical 

7 facility.’’. 

8 SEC. 104. DISTRIBUTION OF RESIDENT TRAINEES IN AN 

9 EMERGENCY. 

10 (a) EXCLUSION FROM 3-YEAR ROLLING AVERAGE.— 

11 Notwithstanding any other provision of law, in the case 

12 of a host hospital participating in an emergency Medicare 

13 GME affiliation agreement on or after the date of enact14 ment of this Act and training residents in excess of its 

15 cap, consistent with the rolling average provisions applica16 ble for closed programs as specified in section 

17 413.79(d)(6) of title 42, Code of Federal Regulations, the 

18 Secretary of Health and Human Services shall exclude 

19 from the 3-year rolling average FTE residents associated 

20 with displaced residents during the period in which such 

21 agreement is in effect. 

22 (b) ASSESSMENT AND REVISION OF GME POLI23 CIES.— 

24 (1) REVIEW.—The Secretary of Health and 

25 Human Services shall review policies with respect to 


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1 payments for direct graduate medical education 

2 costs under section 1886(h) of the Social Security 

3 Act (42 U.S.C. 1395ww(h)) and payments for the 

4 indirect costs of medical education under section 

5 1886(d)(5)(B) of the Social Security Act (42 U.S.C. 

6 1395ww(d)(5)(B)). 

7 (2) REVISION AND REPORT.—Not later than 

8 January 1, 2011, the Secretary shall— 

9 (A) as appropriate, revise such policies 

10 that constrain the ability of the Secretary to re11 spond to emergency situations and situations 

12 involving institutional and program closure; and 

13 (B) in the case where the Secretary deter14 mines legislative action is necessary to make 

15 such revisions, submit to Congress a report con16 taining recommendations for such legislative ac17 tion. 

18 SEC. 105. AUTHORITY TO INCLUDE COSTS OF TRAINING OF 

19 PSYCHOLOGISTS IN PAYMENTS TO HOS20 PITALS FOR APPROVED EDUCATIONAL AC21 TIVITIES UNDER MEDICARE. 

22 Effective for cost reporting periods beginning on or 

23 after the date that is 18 months after the date of enact24 ment of this Act, for purposes of payment to hospitals 

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1 cial Security Act for costs of approved educational activi2 ties (as defined in section 413.85 of title 42, Code of Fed3 eral Regulations), such approved educational activities 

4 shall include a 1-year doctoral clinical internship operated 

5 by the hospital as part of a clinical psychology training 

6 program that is provided upon completion of university 

7 course work. 

8 Subtitle B—Geriatric Assessments 

9 and Chronic Care Management 

10 and Coordination Services 

11 Under the Medicare Program 

12 SEC. 111. MEDICARE COVERAGE OF GERIATRIC ASSESS13 MENTS. 

14 (a) COVERAGE OF GERIATRIC ASSESSMENTS.— 

15 (1) IN GENERAL.—Section 1861(s)(2) of the 

16 Social Security Act (42 U.S.C. 1395x(s)(2)) is 

17 amended— 

18 (A) in subparagraph (DD), by striking 

19 ‘‘and’’ at the end; 

20 (B) in subparagraph (EE), by adding 

21 ‘‘and’’ at the end; and 

22 (C) by adding at the end the following new 

23 subparagraph: 

24 ‘‘(FF) geriatric assessments (as defined in sub25 section (hhh)(1));’’. 


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1 (2) CONFORMING AMENDMENTS.—Clauses (i) 

2 and (ii) of section 1861(s)(2)(K) of the Social Secu3 rity Act (42 U.S.C. 1395x(s)(2)(K)) are each 

4 amended by striking ‘‘subsection (ww)(1)’’ and in5 serting ‘‘subsections (ww)(1) and (hhh)(1)’’. 

6 (b) GERIATRIC ASSESSMENTS DEFINED.—Section 

7 1861 of the Social Security Act (42 U.S.C. 1395x) is 

8 amended by adding at the end the following new sub9 sections: 

10 ‘‘Geriatric Assessment 

11 ‘‘(hhh)(1) The term ‘geriatric assessment’ means 

12 each of the following: 

13 ‘‘(A) An assessment of the clinical status, func14 tional status, social and environmental functioning, 

15 and need for caregiving of a geriatric assessment eli16 gible individual (as defined in subsection (iii)). The 

17 assessment shall include a comprehensive history 

18 and physical examination and assessments of the fol19 lowing domains using standardized validated clinical 

20 tools: 

21 ‘‘(i) Comprehensive review of medications 

22 and the individual’s adherence to the medica23 tion regimen. 


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1 ‘‘(ii) Measurement of affect, cognition and 

2 executive function, mobility, balance, gait, risk 

3 of falling, and sensory function. 

4 ‘‘(iii) Social functioning, environmental 

5 needs, and caregiver resources and needs. 

6 ‘‘(iv) Any other domain determined appro7 priate by the Secretary. 

8 ‘‘(B) The development of a written care plan 

9 based on the results of the assessment under sub10 paragraph (A) (and any subsequent assessment 

11 under subparagraph (B)). The care plan shall detail 

12 identified problems, outline therapies, assign respon13 sibility for actions, and indicate whether the indi14 vidual is likely to benefit from chronic care manage15 ment and coordination services (as defined in sub16 section (jjj)(1)). If the individual is determined likely 

17 to benefit from chronic care management and co18 ordination services, the care plan shall also provide 

19 the basis for the chronic care management and co20 ordination plan to be developed by the chronic care 

21 manager pursuant to subsection (jjj). 

22 ‘‘(2) A geriatric assessment may only be conducted 

23 by— 

24 ‘‘(A) a physician; 


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1 ‘‘(B) a practitioner described in section 

2 1842(b)(18)(C)(i) under the supervision of a physi3 cian; or 

4 ‘‘(C) any other provider that meets such condi5 tions as the Secretary may specify. 

6 ‘‘(3) An individual described in subclause (A), (B), 

7 or, if applicable, (C) may provide for the furnishing of 

8 services included in the geriatric assessment by other 

9 qualified health care professionals. 

10 ‘‘(4)(A) Subject to subparagraph (B), a geriatric as11 sessment of a geriatric assessment eligible individual may 

12 not be conducted more frequently than annually. 

13 ‘‘(B) A geriatric assessment of a geriatric assessment 

14 eligible individual may be conducted more frequently than 

15 annually if the assessment is medically necessary due to 

16 a significant change in the condition of the individual. 

17 ‘‘Geriatric Assessment Eligible Individual 

18 ‘‘(iii)(1) Subject to paragraph (3), the term ‘geriatric 

19 assessment eligible individual’ means an individual identi20 fied by the Secretary as eligible for a geriatric assessment. 

21 ‘‘(2) In identifying individuals under paragraph (1), 

22 the following rules shall apply: 

23 ‘‘(A) The individual must have at least 1 of the 

24 following present: 


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1 ‘‘(i) Multiple chronic conditions that the 

2 Secretary identifies as likely to result in high 

3 expenditures under this title. In identifying 

4 such conditions, the Secretary may consider— 

5 ‘‘(I) the hierarchal condition category 

6 methodology employed for risk adjustment 

7 under part C or other comparable meth8 odologies the Secretary deems appropriate; 

9 ‘‘(II) data from the Chronic Condition 

10 Data Warehouse under section 723 of the 

11 Medicare Prescription Drug, Improvement, 

12 and Modernization Act of 2003; and 

13 ‘‘(III) indicators of geriatric syn14 dromes, such as experiencing 2 or more 

15 falls in the past year, urinary incontinence, 

16 clinically significant depression, or other 

17 such indicators that the Secretary indicates 

18 as likely to result in high expenditures 

19 under this title when they exist in com20 bination with one or more chronic condi21 tions). 

22 ‘‘(ii) Dementia, as defined in the most re23 cent Diagnostic and Statistical Manual of Men24 tal Disorders, and at least 1 other chronic con25 dition. 


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1 ‘‘(iii) Any other factor identified by the 

2 Secretary. 

3 ‘‘(B) The Secretary shall consult with physi4 cians, physician groups and organizations, other 

5 health care professional groups and organizations, 

6 organizations representing individuals with chronic 

7 conditions and older adults, and other stakeholders 

8 in identifying conditions under clauses (i) and (ii) of 

9 subparagraph (A) and any factors under subpara10 graph (A)(iii). 

11 ‘‘(3) The term ‘geriatric assessment eligible indi12 vidual’ shall not include the following individuals: 

13 ‘‘(A) An individual who is receiving hospice care 

14 under this title. 

15 ‘‘(B) An individual who is residing in a skilled 

16 nursing facility, a nursing facility (as defined in sec17 tion 1919), or any other facility identified by the 

18 Secretary. 

19 ‘‘(C) An individual medically determined to 

20 have end-stage renal disease. 

21 ‘‘(D) An individual enrolled in a Medicare Ad22 vantage plan or a plan under section 1876. 

23 ‘‘(E) An individual enrolled in a PACE pro24 gram under section 1894. 


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1 ‘‘(F) Any other categories of individuals deter2 mined appropriate by the Secretary. 

3 ‘‘(4) For purposes of this subsection, the term ‘chron4 ic condition’ means a condition, such as dementia, that 

5 lasts or is expected to last 1 year or longer, limits what 

6 an individual can do, and requires ongoing care.’’. 

7 (c) PAYMENT AND ELIMINATION OF COST-SHAR8 ING.— 

9 (1) PAYMENT AND ELIMINATION OF COINSUR10 ANCE.—Section 1833(a)(1) of the Social Security 

11 Act (42 U.S.C. 1395l(a)(1)) is amended— 

12 (A) in subparagraph (N), by inserting 

13 ‘‘other than geriatric assessments (as defined in 

14 section 1861(hhh)(1))’’ after ‘‘(as defined in 

15 section 1848(j)(3))’’; 

16 (B) by striking ‘‘and’’ before ‘‘(W)’’; and 

17 (C) by inserting before the semicolon at 

18 the end the following: ‘‘, and (X) with respect 

19 to geriatric assessments (as defined in section 

20 1861(hhh)(1)), the amount paid shall be 100 

21 percent of the lesser of the actual charge for 

22 the services or the amount determined under 

23 section 1848(o)’’. 

24 (2) PAYMENT.— 


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1 (A) IN GENERAL.—Section 1848 of the So2 cial Security Act (42 U.S.C. 1395w–4) is 

3 amended by adding at the end the following 

4 new subsection: 

5 ‘‘(p) PAYMENT FOR GERIATRIC ASSESSMENTS.— 

6 ‘‘(1) ESTABLISHMENT.— 

7 ‘‘(A) IN GENERAL.—The Secretary shall 

8 establish— 

9 ‘‘(i) a payment code (or codes) under 

10 this section for a geriatric assessment (as 

11 defined in section 1861(hhh)(1)) furnished 

12 to a geriatric assessment eligible individual 

13 (as defined in section 1861(iii)) by a physi14 cian, practitioner, or other provider de15 scribed in section 1861(hhh)(2); and 

16 ‘‘(ii) a payment amount for each such 

17 code. 

18 ‘‘(B) REQUIREMENTS.—In establishing 

19 payment amounts under subparagraph (A)(ii), 

20 the Secretary shall— 

21 ‘‘(i) take into account— 

22 ‘‘(I) the amount of work required 

23 to perform a geriatric assessment, in24 cluding the time and effort put forth 

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1 sional involved in performing the geri2 atric assessment; and 

3 ‘‘(II) all of the costs associated 

4 with the geriatric assessment, includ5 ing labor, supplies, equipment, and 

6 the costs of health information tech7 nologies and systems incurred by the 

8 physician, practitioner, or other pro9 vider (as described in section 

10 1861(hhh)(2)) in providing the assess11 ment; and 

12 ‘‘(ii) ensure that such payments do 

13 not result in a reduction in payments for 

14 office visits or other evaluation and man15 agement services that would otherwise be 

16 allowable. 

17 ‘‘(2) SEPARATE PAYMENTS FROM PAYMENTS

18 FOR CHRONIC CARE MANAGEMENT AND COORDINA19 TION SERVICES.—Payments for geriatric assess20 ments shall be made separately from payments for 

21 chronic care management and coordination services 

22 (as defined in section 1861(jjj)(1)) and other serv23 ices for which payment is made under this title.’’. 

24 (B) CONFORMING AMENDMENT.—Section 

25 1848(j)(3) of the Social Security Act (42 


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1 U.S.C. 1395w–4(j)(3)), as amended by section 

2 111(c)(2)), is amended by inserting ‘‘(2)(FF),’’ 

3 after ‘‘(2)(EE),’’. 

4 (3) ELIMINATION OF COINSURANCE IN OUT5 PATIENT HOSPITAL SETTINGS.— 

6 (A) EXCLUSION FROM OPD FEE SCHED7 ULE.—Section 1833(t)(1)(B)(iv) of the Social 

8 Security Act (42 U.S.C. 1395l(t)(1)(B)(iv)) is 

9 amended by striking ‘‘and diagnostic mammog10 raphy’’ and inserting ‘‘, diagnostic mammog11 raphy, or geriatric assessments (as defined in 

12 section 1861(hhh)(1))’’. 

13 (B) CONFORMING AMENDMENTS.—Section 

14 1833(a)(2) of the Social Security Act (42 

15 U.S.C. 1395l(a)(2)) is amended— 

16 (i) in subparagraph (F), by striking 

17 ‘‘and’’ at the end; 

18 (ii) in subparagraph (G)(ii), by strik19 ing the comma at the end and inserting ‘‘; 

20 and’’; and 

21 (iii) by inserting after subparagraph 

22 (G)(ii) the following new subparagraph: 

23 ‘‘(H) with respect to geriatric assessments 

24 (as defined in section 1861(hhh)(1)) furnished 


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1 by an outpatient department of a hospital, the 

2 amount determined under paragraph (1)(X),’’. 

3 (4) ELIMINATION OF DEDUCTIBLE.—The first 

4 sentence of section 1833(b) of the Social Security 

5 Act (42 U.S.C. 1395l(b)) is amended— 

6 (A) by striking ‘‘and’’ before ‘‘(9)’’; and 

7 (B) by inserting before the period the fol8 lowing: ‘‘, and (10) such deductible shall not 

9 apply with respect to geriatric assessments (as 

10 defined in section 1861(hhh)(1))’’. 

11 (d) FREQUENCY LIMITATION.—Section 1862(a) of 

12 the Social Security Act (42 U.S.C. 1395y(a)(1)) is amend13 ed— 

14 (1) in paragraph (1)— 

15 (A) in subparagraph (N), by striking 

16 ‘‘and’’ at the end; 

17 (B) in subparagraph (O) by striking the 

18 semicolon at the end and inserting ‘‘, and’’; and 

19 (C) by adding at the end the following new 

20 subparagraph: 

21 ‘‘(P) in the case of geriatric assessments (as de22 fined in section 1861(hhh)(1)), which are performed 

23 more frequently than is covered under such sec24 tion;’’; and 


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1 (2) in paragraph (7), by striking ‘‘or (K)’’ and 

2 inserting ‘‘(K), or (P)’’. 

3 (e) EXCEPTION TO LIMITS ON PHYSICIAN REFER4 RALS.—Section 1877(b) of the Social Security Act (42 

5 U.S.C. 1395nn(b)) is amended by adding at the end the 

6 following new paragraph: 

7 ‘‘(6) GERIATRIC ASSESSMENTS.—In the case of 

8 a designated health service, if the designated health 

9 service is a geriatric assessment (as defined in sec10 tion 1861(hhh)(1)) and furnished by a physician.’’. 

11 (f) RULEMAKING.—The Secretary of Health and 

12 Human Services shall define such terms, establish such 

13 procedures, and promulgate such regulations as the Sec14 retary determines necessary to implement the amend15 ments made by, and the provisions of, this section, includ16 ing the establishment of additional domains under sub17 section (hhh)(1)(A)(iv) of section 1861 of the Social Secu18 rity Act, as added by subsection (b). In promulgating such 

19 regulations, the Secretary shall consult with physicians, 

20 physician groups and organizations, other health care pro21 fessional groups and organizations representing individ22 uals with chronic conditions and older adults. 

23 (g) EFFECTIVE DATE.—The amendments made by 

24 this section shall apply to assessments furnished on or 

25 after January 1, 2010. 


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1 SEC. 112. MEDICARE COVERAGE OF CHRONIC CARE MAN2 AGEMENT AND COORDINATION SERVICES. 

3 (a) PART B COVERAGE OF CHRONIC CARE MANAGE4 MENT AND COORDINATION SERVICES.— 

5 (1) IN GENERAL.—Section 1861(s)(2) of the 

6 Social Security Act (42 U.S.C. 1395x(s)(2)), as 

7 amended by section 111(a)(1), is amended— 

8 (A) in subparagraph (EE), by striking 

9 ‘‘and’’ at the end; 

10 (B) in subparagraph (FF), by adding 

11 ‘‘and’’ at the end; and 

12 (C) by adding at the end the following new 

13 subparagraph: 

14 ‘‘(GG) chronic care management and coordina15 tion services (as defined in subsection (jjj));’’. 

16 (2) CONFORMING AMENDMENTS.—(A) Clauses 

17 (i) and (ii) of section 1861(s)(2)(K) of the Social Se18 curity Act (42 U.S.C. 1395x(s)(2)(K)), as amended 

19 by section 111(a)(2), are each amended by striking 

20 ‘‘subsections (ww)(1) and (hhh)(1)’’ and inserting 

21 ‘‘subsections (ww)(1), (hhh)(1), and (jjj)(1)’’. 

22 (B) Section 1862(a)(7) of the Social Security 

23 Act (42 U.S.C. 1395y(a)(7)), as amended by section 

24 111(d), is amended by striking ‘‘section 

25 1861(s)(10)’’ and inserting ‘‘paragraphs (2)(GG) 

26 and (10) of section 1861(s)’’. 


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1 (b) SERVICES DESCRIBED.—Section 1861 of the So2 cial Security Act (42 U.S.C. 1395x), as amended by sec3 tion 111(b), is amended by adding at the end the following 

4 new subsection: 

5 ‘‘Chronic Care Management and Coordination Services; 

6 Chronic Care Manager; Chronic Care Eligible Individual 

7 ‘‘(jjj)(1) The term ‘chronic care management and co8 ordination services’ means services that are furnished to 

9 a chronic care eligible individual (as defined in paragraph 

10 (3)) by, or under the supervision of, a single chronic care 

11 manager (as defined in paragraph (2)) chosen by the 

12 chronic care eligible individual, a caregiver designated by 

13 the individual in writing, or a representative authorized 

14 to make decisions on the individual’s behalf, under a plan 

15 of care prescribed by such chronic care manager for the 

16 purpose of chronic care coordination, including dementia 

17 as appropriate, which may include any of the following 

18 services: 

19 ‘‘(A) The development of an initial plan of care 

20 (based on the results of a geriatric assessment, as 

21 defined in subsection (hhh)), and subsequent appro22 priate revisions to that plan of care. 

23 ‘‘(B) The management of, and referral for, 

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1 disciplinary care conferences and management with 

2 other providers. 

3 ‘‘(C) The monitoring and management of medi4 cations. 

5 ‘‘(D) Patient education and counseling services. 

6 ‘‘(E) Family caregiver education and counseling 

7 services, including preventive care consistent with 

8 the patient’s condition. 

9 ‘‘(F) Self-management services, including 

10 health education and risk appraisal to identify be11 havioral risk factors through self-assessment. 

12 ‘‘(G) Providing access for individuals, and care13 givers or authorized representatives as appropriate, 

14 by telephone and e-mail to physicians or other ap15 propriate health care professionals, including 24- 

16 hour availability of such professionals for after hours 

17 consultation. 

18 ‘‘(H) Coordination with the principal nonprofes19 sional caregiver in the home. 

20 ‘‘(I) Managing and facilitating transitions that 

21 occur among health care professionals and across 

22 settings of care, including the following: 

23 ‘‘(i) Pursuing the treatment option elected 

24 by the individual. 


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1 ‘‘(ii) Including any advance directive exe2 cuted by the individual in the medical file of the 

3 individual. 

4 ‘‘(J) Information about pain management and 

5 palliative care. 

6 ‘‘(K) Information about, and referral to, hos7 pice care, including patient and family caregiver 

8 education and counseling about hospice care, and fa9 cilitating transition to hospice care when elected. 

10 ‘‘(L) Information about, referral to, and coordi11 nation with, community resources. 

12 ‘‘(M) Such additional services for which pay13 ment would not otherwise be made under this title 

14 that the Secretary may specify that encourage the 

15 receipt of, or improve the effectiveness of, the serv16 ices described in the preceding subparagraphs. 

17 ‘‘(2)(A) For purposes of this subsection, the term 

18 ‘chronic care manager’ means an individual or entity 

19 that— 

20 ‘‘(i) is— 

21 ‘‘(I) a physician; 

22 ‘‘(II) a practitioner described in clause (i) 

23 or (iv) of section 1842(b)(18)(C); or 

24 ‘‘(III) any other provider that meets such 

25 conditions as the Secretary may specify; 


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1 ‘‘(ii) has entered into a chronic care manage2 ment and coordination agreement with the Sec3 retary; and 

4 ‘‘(iii) is working in collaboration with, or under 

5 the supervision of, as determined by the Secretary— 

6 ‘‘(I) the physician, practitioner, or other 

7 provider who completed the geriatric assessment 

8 of the individual; or 

9 ‘‘(II) a physician, practitioner, or other 

10 provider to whom the individual’s care was 

11 transferred by the physician, practitioner, or 

12 other provider who performed the geriatric as13 sessment. 

14 ‘‘(B)(i) For purposes of subparagraph (A)(ii), each 

15 chronic care management and coordination agreement 

16 shall meet the requirements described in subparagraph 

17 (C) and shall— 

18 ‘‘(I) subject to clause (ii), be entered into for a 

19 period of 3 years and may be renewed if the Sec20 retary is satisfied that the chronic care manager 

21 continues to meet such terms and conditions as the 

22 Secretary may require; and 

23 ‘‘(II) contain such other terms and conditions 

24 as the Secretary may require. 


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1 ‘‘(ii) Each chronic care management and coordination 

2 agreement shall provide for the termination of such agree3 ment prior to such 3-year period in the case where the 

4 chronic care manager— 

5 ‘‘(I) is no longer able to provide chronic care 

6 services; or 

7 ‘‘(II) does not meet such terms and conditions 

8 as the Secretary may require. 

9 ‘‘(C)(i) Subject to clause (ii), the requirements of this 

10 subparagraph are met if the agreement requires the chron11 ic care manager to perform, or provide for the perform12 ance of, the following services: 

13 ‘‘(I) Advocating for, and providing ongoing sup14 port, oversight, and guidance with respect to the im15 plementation of a plan of care that provides an inte16 grated, coherent, and cross-disciplined plan for ongo17 ing medical care that is developed in partnership 

18 with the chronic care eligible individual and all other 

19 physicians and other care providers and agencies (in20 cluding home health agencies) providing care to the 

21 chronic care eligible individual. 

22 ‘‘(II) Using evidence-based medicine and clin23 ical decision support tools to guide decisionmaking 

24 at the point of care and on the basis of specific pa25 tient factors. 


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1 ‘‘(III) Using health information technology, in2 cluding, where appropriate, remote monitoring and 

3 patient registries, to monitor and track the health 

4 status of patients and to provide patients with en5 hanced and convenient access to health care services. 

6 ‘‘(IV) Encouraging patients to engage in the 

7 management of their own health through education 

8 and support systems. 

9 ‘‘(V) Incorporating family caregivers into the 

10 chronic care planning process. 

11 ‘‘(ii) The Secretary may modify the services required 

12 under the agreement under clause (i), including by requir13 ing different services or services in addition to those de14 scribed in subclauses (I) through (V) of such clause. 

15 ‘‘(D) The Secretary shall adopt procedures which ex16 empt providers in rural areas from providing 1 or more 

17 of the services otherwise required to be provided under 

18 subparagraph (C) or modify such requirements for such 

19 providers. In establishing such procedures, the Secretary 

20 shall ensure that such exemptions and modifications do 

21 not impact the quality of chronic care management and 

22 coordination services furnished by such providers. 

23 ‘‘(3) For purposes of this subsection, the term ‘chron24 ic care eligible individual’ means a geriatric assessment 

25 eligible individual (as defined in subsection (iii)) who has 


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1 undergone a geriatric assessment (as defined in subsection 

2 (hhh)(1)) which determined that the individual would ben3 efit from chronic care management and coordination. 

4 ‘‘(4) Chronic care management and coordination 

5 services may be furnished in the chronic care eligible indi6 vidual’s home or residence.’’. 

7 (c) PAYMENT AND ELIMINATION OF COST-SHAR8 ING.— 

9 (1) PAYMENT AND ELIMINATION OF COINSUR10 ANCE.—Section 1833(a)(1) of the Social Security 

11 Act (42 U.S.C. 1395l(a)(1)), as amended by section 

12 111(c)(1), is amended— 

13 (A) in subparagraph (N), by inserting ‘‘or 

14 chronic care management and coordination 

15 services (as defined in section 1861(jjj)(1))’’ 

16 after ‘‘other than geriatric assessments (as de17 fined in section 1861(hhh)(1))’’; 

18 (B) by striking ‘‘and’’ before ‘‘(X)’’; and 

19 (C) by inserting before the semicolon at 

20 the end the following: ‘‘, and (Y) with respect 

21 to chronic care management and coordination 

22 services (as defined in section 1861(jjj)(1)), the 

23 amount paid shall be 100 percent of the lesser 

24 of the actual charge for the services or the 

25 amount determined under section 1848(p)’’. 


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1 (2) PAYMENT.— 

2 (A) IN GENERAL.—Section 1848 of the So3 cial Security Act (42 U.S.C. 1395w–4), as 

4 amended by section 111(c)(2), is amended by 

5 adding at the end the following new subsection: 

6 ‘‘(q) PAYMENT FOR CHRONIC CARE MANAGEMENT

7 AND COORDINATION SERVICES.— 

8 ‘‘(1) ESTABLISHMENT.— 

9 ‘‘(A) IN GENERAL.—The Secretary shall 

10 establish— 

11 ‘‘(i) a payment code (or codes) under 

12 this section for chronic care management 

13 and coordination services (as defined in 

14 paragraph (1) of section 1861(jjj)) fur15 nished to a chronic care eligible individual 

16 (as defined in paragraph (3) of such sec17 tion) by a chronic care manager (as de18 fined in paragraph (2) of such section); 

19 and 

20 ‘‘(ii) a payment amount for each such 

21 code. 

22 ‘‘(B) REQUIREMENTS.—In establishing 

23 payment amounts under subparagraph (A)(ii), 

24 the Secretary shall— 

25 ‘‘(i) take into account— 


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1 ‘‘(I) the amount of work required 

2 of the chronic care manager in pro3 viding chronic care management and 

4 coordination services to eligible indi5 viduals; and 

6 ‘‘(II) all of the costs associated 

7 with providing chronic care manage8 ment and coordination services, in9 cluding labor, supplies, equipment, 

10 and the costs of health information 

11 technologies and systems incurred by 

12 the chronic care manager in providing 

13 such services; 

14 ‘‘(ii) ensure that such payments are 

15 for such services furnished during a 30-day 

16 period; and 

17 ‘‘(iii) ensure that such payments do 

18 not result in a reduction in payments for 

19 office visits or other evaluation and man20 agement services that would otherwise be 

21 allowable. 

22 ‘‘(2) SEPARATE PAYMENTS FROM PAYMENTS

23 FOR GERIATRIC ASSESSMENTS.—Payments for 

24 chronic care management and coordination services 

25 shall be made separately from payments for geriatric 


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1 assessments (as defined in section 1861(hhh)(1)) 

2 and other services for which payment is made under 

3 this title.’’. 

4 (B) CONFORMING AMENDMENT.—Section 

5 1848(j)(3) of the Social Security Act (42 

6 U.S.C. 1395w–4(j)(3)), as amended by section 

7 111(c)(2)), is amended by inserting ‘‘(2)(GG),’’ 

8 after ‘‘(2)(FF),’’. 

9 (3) ELIMINATION OF COINSURANCE IN OUT10 PATIENT HOSPITAL SETTINGS.— 

11 (A) EXCLUSION FROM OPD FEE SCHED12 ULE.—Section 1833(t)(1)(B)(iv) of the Social 

13 Security Act (42 U.S.C. 1395l(t)(1)(B)(iv)), as 

14 amended by section 111(c)(3)(A), is amended 

15 by striking ‘‘or geriatric assessments (as de16 fined in section 1861(hhh)(1))’’ and inserting 

17 ‘‘geriatric assessments (as defined in section 

18 1861(hhh)(1)), or chronic care management 

19 and coordination services (as defined in section 

20 1861(jjj)(1))’’. 

21 (B) CONFORMING AMENDMENTS.—Section 

22 1833(a)(2) of the Social Security Act (42 

23 U.S.C. 1395l(a)(2)), as amended by section 

24 111(c)(3)(B), is amended— 


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1 (i) in subparagraph (G)(ii), by strik2 ing ‘‘and’’ at the end; 

3 (ii) in subparagraph (H), by striking 

4 the comma at the end and inserting ‘‘; 

5 and’’; and 

6 (iii) by inserting after subparagraph 

7 (H) the following new subparagraph: 

8 ‘‘(I) with respect to chronic care manage9 ment and coordination services (as defined in 

10 section 1861(jjj)(1)) furnished by an outpatient 

11 department of a hospital, the amount deter12 mined under paragraph (1)(Y),’’. 

13 (4) ELIMINATION OF DEDUCTIBLE.—Paragraph 

14 (10) of section 1833(b) of the Social Security Act 

15 (42 U.S.C. 1395l(b)), as added by section 111(c)(4), 

16 is amended by inserting ‘‘or chronic care manage17 ment and coordination services (as defined in section 

18 1861(jjj)(1))’’ after ‘‘geriatric assessments (as de19 fined in section 1861(hhh)(1))’’. 

20 (d) EXCEPTION TO LIMITS ON PHYSICIAN REFER21 RALS.—Section 1877(b)(6) of the Social Security Act (42 

22 U.S.C. 1395nn(b)(6)), as amended by section 111(e), is 

23 amended to read as follows: 

24 ‘‘(6) GERIATRIC ASSESSMENTS AND CHRONIC

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1 ICES.—In the case of a designated health service, if 

2 the designated health service is— 

3 ‘‘(A) a geriatric assessment or a chronic 

4 care management and coordination service (as 

5 defined in subsections (hhh)(1) or (jjj)(1) of 

6 section 1861, respectively); and 

7 ‘‘(B) furnished by a physician.’’. 

8 (e) RULEMAKING.—The Secretary of Health and 

9 Human Services shall define such terms, establish such 

10 procedures, and promulgate such regulations as the Sec11 retary determines necessary to implement the amend12 ments made by, and the provisions of, this section. In pro13 mulgating such regulations, the Secretary shall consult 

14 with physicians, physician groups and organizations, other 

15 health care professional groups and organizations, and or16 ganizations representing individuals with chronic condi17 tions and older adults. 

18 (f) EFFECTIVE DATE.—The amendments made by 

19 this section shall apply to chronic care management and 

20 coordination services furnished on or after January 1, 

21 2010. 


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1 SEC. 113. OUTREACH ACTIVITIES REGARDING GERIATRIC 

2 ASSESSMENTS AND CHRONIC CARE MANAGE3 MENT AND COORDINATION SERVICES UNDER 

4 THE MEDICARE PROGRAM. 

5 The Secretary of Health and Human Services shall 

6 conduct outreach activities to individuals likely to be eligi7 ble to receive coverage of geriatric assessments (as defined 

8 in subsection (hhh)(1) of section 1861 of the Social Secu9 rity Act, as added by section 111) under the Medicare pro10 gram and individuals likely to be eligible to receive cov11 erage of chronic care management and coordination serv12 ices (as defined in subsection (jjj)(1) of such section 1861, 

13 as added by section 112) under the Medicare program, 

14 to inform such individuals about the availability of such 

15 benefits under the Medicare program. 

16 SEC. 114. UTILIZATION OF TELEHEALTH SERVICES TO FUR17 NISH GERIATRIC ASSESSMENTS AND CHRON18 IC CARE MANAGEMENT AND COORDINATION 

19 SERVICES UNDER THE MEDICARE PROGRAM. 

20 (a) IN GENERAL.—Section 1834(m)(4)(F) of the So21 cial Security Act (42 U.S.C. 1395m(m)(4)(F)) is amended 

22 by adding at the end the following new clause: 

23 ‘‘(iii) GERIATRIC ASSESSMENTS AND

24 CHRONIC CARE MANAGEMENT AND CO25 ORDINATION SERVICES.—The term ‘tele26 health service’ shall also include geriatric 


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1 assessments (as defined in section 

2 1861(hhh)(1)) and chronic care manage3 ment and coordination services (as defined 

4 in section 1861(jjj)).’’. 

5 (b) EFFECTIVE DATE.—The amendments made by 

6 this section shall apply to services furnished on or after 

7 January 1, 2010. 

8 SEC. 115. STUDY AND REPORT ON GERIATRIC ASSESS9 MENTS AND CHRONIC CARE MANAGEMENT 

10 AND COORDINATION SERVICES UNDER THE 

11 MEDICARE PROGRAM. 

12 (a) STUDY.—The Secretary of Health and Human 

13 Services shall enter into a contract with an entity to con14 duct a study on— 

15 (1) the effectiveness of the coverage of geriatric 

16 assessments and chronic care management and co17 ordination services, including an evaluation of the 

18 use of interdisciplinary teams in providing such serv19 ices, under the Medicare program (under the amend20 ments made by sections 3 and 4) on improving the 

21 quality of care provided to Medicare beneficiaries 

22 with chronic conditions, including dementia; and 

23 (2) the impact of such geriatric assessments 

24 and care coordination services on reducing expendi25 tures under title XVIII of the Social Security Act, 


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1 including reduced expenditures that may result 

2 from— 

3 (A) reducing preventable hospital admis4 sions; 

5 (B) more appropriate use of pharma6 ceuticals; and 

7 (C) reducing duplicate or unnecessary 

8 tests. 

9 (b) REPORT.—Not later than 3 years after the date 

10 of enactment of this Act, the entity conducting the study 

11 under subsection (a) shall submit to Congress and the Sec12 retary of Health and Human Services a report on the 

13 study, together with recommendations for such legislation 

14 or administrative action as such entity determines appro15 priate. 

16 (c) AUTHORIZATION OF APPROPRIATIONS.—There 

17 are authorized to be appropriated such sums as may be 

18 necessary to carry out this section. 

19 SEC. 116. RULE OF CONSTRUCTION. 

20 Nothing in the provisions of, or in the amendments 

21 made by, this subtitle shall be construed as requiring an 

22 individual to receive a geriatric assessment (as defined in 

23 section 1861(hhh)(1) of the Social Security Act, as added 

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1 ordination services (as defined in section 1861(jjj)(1) of 

2 such Act, as added by section 112(b)). 

3 TITLE II—AMENDMENTS TO THE 

4 PUBLIC HEALTH SERVICE ACT 

5 SEC. 201. EXPANSION OF NATIONAL HEALTH SERVICE 

6 CORPS PROGRAMS. 

7 (a) IN GENERAL.—Section 338H of the Public 

8 Health Service Act (42 U.S.C. 254q) is amended— 

9 (1) in subsection (a), by striking paragraphs 

10 (1) through (5) and inserting the following: 

11 ‘‘(1) for fiscal year 2009, $165,000,000; 

12 ‘‘(2) for fiscal year 2010, $198,000,000; 

13 ‘‘(3) for fiscal year 2011, $231,000,000; 

14 ‘‘(4) for fiscal year 2012, $264,000,000; 

15 ‘‘(5) for fiscal year 2013, $297,000,000; and 

16 ‘‘(6) for fiscal year 2014, $330,000,000.’’; and 

17 (2) by adding at the end the following: 

18 ‘‘(d) EXPANSION OF PROGRAMS.—The Secretary 

19 shall use amounts appropriated for each of fiscal years 

20 2010 through 2014 under subsection (a), that are in ex21 cess of the amount appropriated under such subsection for 

22 fiscal year 2009, to address shortages of health profes23 sionals in rural, frontier, and urban underserved areas 

24 through an expansion of the number of scholarships and 

25 loan repayments under this subpart to address health 


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1 workforce shortages in health professional shortage areas 

2 (as defined in section 332), in medically underserved com3 munities (as defined in section 799B), or with respect to 

4 medically underserved populations (as defined in section 

5 330(b)(3)).’’. 

6 (b) EXPANSION OF OTHER PROGRAMS.—The Direc7 tor of the Indian Health Service, the Secretary of Defense, 

8 and the Secretary of Veterans Affairs, shall expand exist9 ing loan repayment programs to emphasize the provision 

10 of health professions services to facilities that have health 

11 professional shortages. 

12 (c) NO TAX IMPLICATIONS.— 

13 (1) IN GENERAL.—For purposes of the Internal 

14 Revenue Code of 1986, any amount received under 

15 a health-related Federal loan repayment program by 

16 a health professional providing health-related serv17 ices in a Federal medical facility shall not be in18 cluded in the gross income of such professional. 

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

20 ‘‘Federal medical facility’’ means a facility for the 

21 delivery of health services, and includes— 

22 (A) a federally qualified health center (as 

23 defined in section 330A of the Public Health 

24 Service Act (42 U.S.C. 254c)), a public health 


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1 center, an outpatient medical facility, or a com2 munity mental health center; 

3 (B) a hospital, State mental hospital, facil4 ity for long-term care, or rehabilitation facility; 

5 (C) a migrant health center or an Indian 

6 Health Service facility; 

7 (D) a facility for the delivery of health 

8 services to inmates in a penal or correctional in9 stitution (under section 323 of such Act (42 

10 U.S.C. 250)) or a State correctional institution; 

11 (E) a Public Health Service medical facil12 ity (used in connection with the delivery of 

13 health services under section 320, 321, 322, 

14 324, 325, or 326 of such Act (42 U.S.C. 247e, 

15 248, 249, 251, 252, or 253)); 

16 (F) a nurse-managed health center; or 

17 (G) any other Federal medical facility. 

18 (d) REDUCED LOAN SUPPORT FOR PART TIME

19 PRACTITIONERS.—Section 338C of the Public Health 

20 Service Act (42 U.S.C. 254m) is amended by adding at 

21 the end the following: 

22 ‘‘(e) Notwithstanding any other provision of this sub23 part, the Secretary shall develop procedures to permit pe24 riods of obligated services to be provided on a part-time 

25 basis (not less than 1,040 hours of such service per year). 


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1 Such procedures shall prohibit an individual from holding 

2 other part-time employment while providing such part3 time obligated services. The Secretary may provide for a 

4 reduction in the loan repayments provided to individuals 

5 who provide part-time obligated services under the author6 ity provided under this subsection.’’. 

7 (e) LOAN SUPPORT FOR PARTICIPATING PRECEP8 TORS, MENTORS, AND ATTENDINGS TO SUPERVISE STU9 DENTS AND TRAINEES ON-SITE.—Section 338C of the 

10 Public Health Service Act (42 U.S.C. 254m), as amended 

11 by subsection (d), is further amended by adding at the 

12 end the following: 

13 ‘‘(f) The Secretary shall develop procedures to permit 

14 up to 20 percent of the service obligation of an individual 

15 under this section to be provided by the individual through 

16 precepting or mentoring activities, or by preparing cur17 riculum, for on-site students and trainees. The procedures 

18 developed under subsection (e) shall provide for the pro19 portional application of this subsection with respect to in20 dividual providing obligated service on a part-time basis.’’. 


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1 SEC. 202. NATIONAL HEALTH SERVICE CORPS SCHOLAR2 SHIP PROGRAM FOR MEDICAL, DENTAL, PHY3 SICIAN ASSISTANT, PHARMACY, BEHAVIORAL 

4 AND MENTAL HEALTH, PUBLIC HEALTH, AND 

5 NURSING STUDENTS IN THE UNITED STATES 

6 PUBLIC HEALTH SCIENCES TRACK IN AFFILI7 ATED SCHOOLS. 

8 (a) PROGRAM AUTHORIZED.— 

9 (1) IN GENERAL.—Subpart III of part D of 

10 title III of the Public Health Service Act (42 U.S.C. 

11 254l et seq.) is amended— 

12 (A) in the heading by inserting ‘‘, Schol13 arship Program for Medical, Dental, 

14 Physician Assistant, Pharmacy, Be15 havioral and Mental Health, Public 

16 Health, and Nursing Students in the 

17 United States Public Health Sciences 

18 Track in Affiliated Schools,’’ after 

19 ‘‘Scholarship Program’’; and 

20 (B) by inserting after section 338A the fol21 lowing: 


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1 ‘‘SEC. 338A–1. NATIONAL HEALTH SERVICE CORPS SCHOL2 ARSHIP PROGRAM FOR MEDICAL, DENTAL, 

3 PHYSICIAN ASSISTANT, PHARMACY, BEHAV4 IORAL AND MENTAL HEALTH, PUBLIC 

5 HEALTH, AND NURSING STUDENTS IN THE 

6 UNITED STATES PUBLIC HEALTH SCIENCES 

7 TRACK IN AFFILIATED SCHOOLS. 

8 ‘‘(a) ESTABLISHMENT.— 

9 ‘‘(1) IN GENERAL.—The Secretary shall estab10 lish a program to be known as the National Health 

11 Service Corps Scholarship Program for Medical, 

12 Dental, Physician Assistant, Pharmacy, Behavioral 

13 and Mental Health, Public Health, and Nursing Stu14 dents in the United States Public Health Sciences 

15 Track in Affiliated Schools (in this section referred 

16 to as the ‘U.S. Public Health Sciences Track Schol17 arship Program’) to ensure, with respect to the pro18 vision of high-needs health care services, including 

19 primary care, general dentistry, nursing, obstetrics, 

20 and geriatricians pursuant to section 331(a)(2), an 

21 adequate supply of physicians, physician assistants, 

22 pharmacists, behavioral and mental health profes23 sionals, public health professionals, dentists, and 

24 nurses. The purpose of this program is to train an 

25 additional 150 medical students, 100 dental stu26 dents, 100 physician assistant students, 100 behavVerDate Nov 24 2008 01:33 Jul 02, 2009 Jkt 079200 PO 00000 Frm 00077 Fmt 6652 Sfmt 6201 E:\BILLS\H3109.IH H3109

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1 ioral and mental health students, 100 public health 

2 students, and 250 nursing students during each 

3 year. Of the 150 scholarships awarded to the med4 ical students as described under the preceding sen5 tence, 10 shall be for training at the Uniformed 

6 Services University of the Health Sciences as mem7 bers of the Commissioned Corps of the Public 

8 Health Service. 

9 ‘‘(2) RELATIONSHIP TO NATIONAL HEALTH

10 SERVICE CORPS SCHOLARSHIP PROGRAM.—Scholar11 ships provided under this section are intended to 

12 complement, and not take the place of, scholarships 

13 provided to students enrolled in courses of study 

14 leading to a degree in medicine, osteopathic medi15 cine, dentistry, or nursing or completion of an ac16 credited physician assistant, pharmacy, public 

17 health, or behavioral and mental health educational 

18 program under the National Health Service Corps 

19 Scholarship Program authorized by section 338A. 

20 ‘‘(b) ELIGIBILITY.—To be eligible to participate in 

21 the U.S. Public Health Sciences Track Scholarship and 

22 Grants Program, an individual shall— 

23 ‘‘(1) be accepted for enrollment as a full-time 

24 student— 


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1 ‘‘(A) in an accredited (as determined by 

2 the Secretary) educational institution in a 

3 State; and 

4 ‘‘(B) in a course of study, or program, of5 fered by such institution leading to a degree in 

6 medicine, osteopathic medicine, dentistry, physi7 cian assistant, pharmacy, behavioral and mental 

8 health, public health, or nursing; 

9 ‘‘(2) be eligible for, or hold, an appointment as 

10 a commissioned officer in the Regular or Reserve 

11 Corps of the Service or be eligible for selection for 

12 civilian service in the Corps; 

13 ‘‘(3) submit an application to participate in the 

14 U.S. Public Health Sciences Track Scholarship and 

15 Grants Program; and 

16 ‘‘(4) sign and submit to the Secretary, at the 

17 time of submittal of such application, a written con18 tract to accept payment of a scholarship and to 

19 serve (in accordance with this subpart) for the appli20 cable period of obligated service in an area in which 

21 the need for public health-related services may be 

22 demonstrated.’’. 

23 (2) NO TAX IMPLICATIONS.—For purposes of 

24 the Internal Revenue Code of 1986, any amount re25 ceived under the National Health Service Corps 


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1 Scholarship Program for Medical, Dental and Nurs2 ing Students in the United States Public Health 

3 Sciences Track in Affiliated Schools under section 

4 338A–1 of the Public Health Service Act, as added 

5 by paragraph (1), by a medical student, dental stu6 dent, or nursing student shall not be included in the 

7 gross income of such student. 

8 (b) GRANTS TO INCREASE THE NUMBER OF AVAIL9 ABLE SLOTS FOR NEWLY ADMITTED MEDICAL, DENTAL, 

10 PHYSICIAN ASSISTANT, PHARMACY, BEHAVIORAL AND

11 MENTAL HEALTH, PUBLIC HEALTH, AND NURSING STU12 DENTS AND TO INCREASE PARTICIPATION IN THE U.S. 

13 PUBLIC HEALTH SCIENCES TRACK SCHOLARSHIP PRO14 GRAM.—Part C of title VII of the Public Health Service 

15 Act (42 U.S.C. 293k et seq.) is amended by adding at 

16 the end the following: 


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1 ‘‘SEC. 749. GRANTS TO INCREASE THE NUMBER OF AVAIL2 ABLE SLOTS FOR NEWLY ADMITTED MED3 ICAL, DENTAL, PHYSICIAN ASSISTANT, PHAR4 MACY, BEHAVIORAL AND MENTAL HEALTH, 

5 PUBLIC HEALTH, AND NURSING STUDENTS 

6 AND TO INCREASE PARTICIPATION IN THE 

7 U.S. PUBLIC HEALTH SCIENCES TRACK 

8 SCHOLARSHIP PROGRAM. 

9 ‘‘(a) PROGRAM AUTHORIZED.—The Secretary may 

10 make grants to medical, dental, public health, and nursing 

11 schools and physician assistant, pharmacy, and behavioral 

12 and mental health programs for the following purposes: 

13 ‘‘(1) To increase the capacity of the recipient 

14 medical, dental, public health, or nursing school or 

15 physician assistant, pharmacy, or behavioral and 

16 mental health program, to accept additional medical, 

17 dental, public health, nursing, physician assistant, 

18 pharmacy, or behavioral and mental health students 

19 each year. 

20 ‘‘(2) To develop curriculum. 

21 ‘‘(3) To acquire equipment. 

22 ‘‘(4) To recruit, train, and retain faculty. 

23 ‘‘(5) To provide assistance to students who have 

24 completed a course of study at the recipient medical, 

25 dental, public health, or nursing school or physician 

26 assistant, pharmacy, or behavioral and mental health 


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1 program during the period in which such students 

2 are completing a residency or internship program af3 filiated with the recipient institution. 

4 ‘‘(b) APPLICATION.—A medical, dental, public health, 

5 or nursing school or physician assistant, pharmacy, or be6 havioral and mental health program seeking a grant under 

7 this section shall submit an application to the Secretary 

8 at such time, in such manner, and containing such infor9 mation as the Secretary may require. 

10 ‘‘(c) DEFINITION OF MEDICAL SCHOOL.—In this sec11 tion, the term ‘medical school’ means a school of medicine 

12 or a school of osteopathic medicine.’’. 

13 SEC. 203. FEDERAL MEDICAL FACILITY GRANT PROGRAM 

14 AND PROGRAM ASSESSMENTS. 

15 (a) FEDERAL MEDICAL FACILITY GRANT PRO16 GRAM.—Title VII of the Public Health Service Act (42 

17 U.S.C. 292 et seq.) is amended— 

18 (1) by redesignating part F as part G; and 

19 (2) by inserting after part E, the following: 


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1 ‘‘PART F—START-UP EXPENSES LOAN AND GRANT 

2 PROGRAMS FOR FEDERAL MEDICAL FACILI3 TIES AND HOSPITALS STARTING HIGH 

4 NEEDS RESIDENCY PROGRAMS IN SHORT5 AGE AREAS 

6 ‘‘SEC. 781. FEDERAL MEDICAL FACILITY GRANT PROGRAM. 

7 ‘‘(a) IN GENERAL.—The Secretary shall award 

8 grants to eligible facilities to increase interdisciplinary, 

9 community-based health professions training in high-needs 

10 specialties for physicians, nurses, dentists, physician as11 sistants, pharmacy, behavioral and mental health profes12 sionals, public health professionals, and other health pro13 fessionals as determined appropriate by the Secretary, in 

14 consultation with the Permanent National Health Work15 force Commission established under section 101(a) of the 

16 Health Access and Health Professions Supply Act of 

17 2009. 

18 ‘‘(b) ELIGIBLE FACILITIES; APPLICATION.— 

19 ‘‘(1) DEFINITION OF ELIGIBLE FACILITY.—In 

20 this section, the term ‘eligible facility’— 

21 ‘‘(A) means a facility which— 

22 ‘‘(i) is located in a health professional 

23 shortage area (as defined in section 332); 

24 ‘‘(ii) is located in a medically under25 served community (as defined in section 

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1 derserved population (as defined in section 

2 330(b)(3)); 

3 ‘‘(iii) is a Federal medical facility; 

4 ‘‘(iv) is an area health education cen5 ter, a health education and training center, 

6 or a participant in the Quentin N. Burdick 

7 program for rural interdisciplinary train8 ing, that meet the requirements established 

9 by the Secretary; or 

10 ‘‘(v) is establishing new residency pro11 grams in a specialty which the Secretary, 

12 in consultation with the Permanent Na13 tional Health Workforce Commission es14 tablished under section 101(a) of the 

15 Health Access and Health Professions 

16 Supply Act of 2009, determines is in high17 need; and 

18 ‘‘(B) includes Medicare certified Federally 

19 Qualified Health Centers, community health 

20 centers, health care for the homeless centers, 

21 rural health centers, migrant health centers, In22 dian Health Service entities, urban Indian cen23 ters, health clinics and hospitals operated by 

24 the Indian Health Service, Indian tribes and 

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1 zations (as defined in section 4 of the Indian 

2 Health Care Improvement Act), and other Fed3 eral medical facilities). 

4 ‘‘(2) APPLICATION.—An eligible facility desiring 

5 a grant under subsection (a) shall submit to the Sec6 retary an application at such time, in such manner, 

7 and containing such information as the Secretary 

8 may require. 

9 ‘‘(c) USE OF FUNDS.—An eligible facility shall use 

10 amounts received under a grant under subsection (a) to 

11 promote— 

12 ‘‘(1) the training of health professionals in 

13 interdisciplinary, community-based settings that are 

14 affiliated with hospitals and other health care facili15 ties and teaching institutions; 

16 ‘‘(2) community development programs that as17 sure a diverse health professions workforce through 

18 emphasis on individuals from rural and frontier 

19 areas and underrepresented minority groups; 

20 ‘‘(3) the development of a reliable health profes21 sions pipeline that provides an emphasis on health22 related careers in schools (such as schools partici23 pating in the Health Careers Opportunities Pro24 gram) and centers of excellence, and that encourage 

25 individuals in underrepresented minorities (including 


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1 Hispanic, African-American, American Indian, and 

2 Alaska Native individuals) to pursue health profes3 sions careers; 

4 ‘‘(4) the reduction of health professional isola5 tion in rural, frontier, and urban underserved areas 

6 through the provision of continuing education, men7 toring, and precepting activities, field faculty devel8 opment, and the utilization of technology such as 

9 telehealth and electronic health records; 

10 ‘‘(5) the establishment and operation of re11 gional or statewide health advice telephone lines to 

12 reduce after-hours call responsibilities for over13 worked health professionals who provide services in 

14 remote areas that have few health professionals tak15 ing such after-hours calls; 

16 ‘‘(6) an increase in the number of professionals 

17 taking after-hours calls in hospitals and emergency 

18 departments in health professional shortage areas 

19 (as defined in section 332), in medically underserved 

20 communities (as defined in section 799B), or with 

21 respect to medically underserved populations (as de22 fined in section 330(b)(3)); 

23 ‘‘(7) the establishment and operation of relief 

24 programs that provide health professionals prac25 ticing in health professional shortage areas (as deVerDate Nov 24 2008 01:33 Jul 02, 2009 Jkt 079200 PO 00000 Frm 00086 Fmt 6652 Sfmt 6201 E:\BILLS\H3109.IH H3109

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1 fined in section 332) with patient and call coverage 

2 when such professionals are ill, are pursuing con3 tinuing education, or are taking a vacation; and 

4 ‘‘(8) the exposure of health professions resi5 dents to systems of health care that represent the 

6 contemporary American healthcare delivery program 

7 (such as ‘P4’ Prepare the Personal Physician for 

8 Practice and the ‘Health Commons’ programs). 

9 ‘‘(d) SUBGRANTS.—An eligible facility may use 

10 amounts received under a grant under this section to 

11 award subgrants to States and other entities determined 

12 appropriate by the Secretary to carry out the activities de13 scribed in subsection (c). 

14 ‘‘(e) SET ASIDE.—In awarding grants under this sec15 tion, the Secretary shall ensure that a total of $500,000 

16 is awarded annually for the activities of the National 

17 Rural Recruitment and Retention Network, or a similar 

18 entity. 

19 ‘‘(f) DEFINITION OF FEDERAL MEDICAL FACIL20 ITY.—In this section, the term ‘Federal medical facility’ 

21 means a facility for the delivery of health services, and 

22 includes— 

23 ‘‘(1) a federally qualified health center (as de24 fined in section 330A), a public health center, an 


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1 outpatient medical facility, or a community mental 

2 health center; 

3 ‘‘(2) a hospital, State mental hospital, facility 

4 for long-term care, or rehabilitation facility; 

5 ‘‘(3) a migrant health center or an Indian 

6 Health Service facility; 

7 ‘‘(4) a facility for the delivery of health services 

8 to inmates in a penal or correctional institution 

9 (under section 323) or a State correctional institu10 tion; 

11 ‘‘(5) a Public Health Service medical facility 

12 (used in connection with the delivery of health serv13 ices under section 320, 321, 322, 324, 325, or 

14 326)); or 

15 ‘‘(6) any other Federal medical facility. 

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

17 are authorized to be appropriated to carry out this section, 

18 $623,000,000 for fiscal year 2009, $666,000,000 for fis19 cal year 2010, $675,000,000 for fiscal year 2011, 

20 $700,000,000 for fiscal year 2012, and $725,000,000 for 

21 fiscal year 2013.’’. 

22 (b) ASSESSMENTS.— 

23 (1) ESTABLISHMENT.—The Secretary of Health 

24 and Human Services (referred to in this section as 

25 the ‘‘Secretary’’) shall establish program assessment 


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1 rating tools for each program funded through titles 

2 VII and VIII of the Public Health Service Act (42 

3 U.S.C. 292 and 296 et seq.). 

4 (2) CRITERIA.—The Secretary, in consultation 

5 with the Administrator of the Health Resources and 

6 Services Administration and other appropriate public 

7 and private stakeholders, shall, through negotiated 

8 rulemaking, establish criteria for the conduct of the 

9 assessments under paragraph (2). 

10 (3) ANNUAL ASSESSMENTS.—The Secretary 

11 shall annually enter into a contract with an inde12 pendent nongovernmental entity for the conduct of 

13 an assessment, using the tools established under 

14 paragraph (1) and the criteria established under 

15 paragraph (2), of not less than 20 percent, nor more 

16 than 25 percent, of the programs carried out under 

17 titles VII and VIII of the Public Health Service Act, 

18 so that every program under such titles is assessed 

19 at least once during every 5-year period. 

20 SEC. 204. HEALTH PROFESSIONS TRAINING LOAN PRO21 GRAM. 

22 Part F of title VII of the Public Health Service Act 

23 (as added by section 203) is amended by adding at the 

24 end the following 


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1 ‘‘SEC. 782. ESTABLISHMENT. 

2 ‘‘(a) IN GENERAL.—The Secretary shall establish a 

3 program under which the Secretary shall award interest4 free loans to— 

5 ‘‘(1) eligible hospitals to enable such hospitals 

6 to establish training programs in high-need special7 ties; and 

8 ‘‘(2) eligible non-hospital community-based enti9 ties to enable such entities to establish health profes10 sions training programs. 

11 ‘‘(b) ELIGIBILITY.— 

12 ‘‘(1) IN GENERAL.—To be eligible to receive a 

13 loan under subsection (a)— 

14 ‘‘(A) a hospital shall— 

15 ‘‘(i) be located in a health professional 

16 shortage area (as such term is defined in 

17 section 332); 

18 ‘‘(ii) comply with the requirements of 

19 paragraph (2); and 

20 ‘‘(iii) submit to the Secretary an ap21 plication at such time, in such manner, 

22 and containing such information as the 

23 Secretary may require; or 

24 ‘‘(B) a non-hospital community-based enti25 ty shall— 


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1 ‘‘(i) comply with the requirements of 

2 paragraph (2); and 

3 ‘‘(ii) submit to the Secretary an appli4 cation at such time, in such manner, and 

5 containing such information as the Sec6 retary may require. 

7 ‘‘(2) REQUIREMENTS.—To be eligible to receive 

8 a loan under subsection (a), a hospital or non-hos9 pital community-based entity shall— 

10 ‘‘(A) on the date on which the entity sub11 mits the loan application, not operate a resi12 dency with respect to a high-needs specialty (as 

13 determined by the Secretary in consultation 

14 with the Permanent National Health Workforce 

15 Commission established under section 101(a) of 

16 the Health Access and Health Professions Sup17 ply Act of 2009) or provide a health professions 

18 training program, as the case may be; 

19 ‘‘(B) have received appropriate preliminary 

20 accreditation from the relevant accrediting 

21 agency (American Council for Graduate Medical 

22 Education, American Osteopathic Association, 

23 or Dental, Physician Assistant, Pharmacy, Be24 havioral and Mental Health, Public Health, and 


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1 Nursing accrediting agencies), as determined by 

2 the Secretary; and 

3 ‘‘(C) execute a signed formal contract 

4 under which the hospital or entity agree to 

5 repay the loan. 

6 ‘‘(c) USE OF LOAN FUNDS.—Amounts received under 

7 a loan under subsection (a) shall be used only for— 

8 ‘‘(1) the salary and fringe benefit expenses of 

9 residents, students, trainees, and faculty, or other 

10 costs directly attributable to the residency, edu11 cational, or training program to be carried out under 

12 the loan, as specified by the Secretary; or 

13 ‘‘(2) facility construction or renovation, includ14 ing equipment purchase. 

15 ‘‘(d) PRIORITY.—In awarding loans under subsection 

16 (a), the Secretary shall give priority to applicants that are 

17 located in health professional shortage areas (as defined 

18 in section 332) or in medically underserved communities 

19 (as defined in section 799B), or that serve medically un20 derserved populations (as defined in section 330(b)(3)). 

21 ‘‘(e) LOAN PROVISIONS.— 

22 ‘‘(1) LOAN CONTRACT.—The loan contract en23 tered into under subsection (b)(2) shall contain 

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1 ments as described in such contract. Such repay2 ment shall begin on the date that is 24 months after 

3 the date on which the loan contract is executed and 

4 shall be fully repaid not later than 36 months after 

5 the date of the first payment. 

6 ‘‘(2) INTEREST.—Loans under this section shall 

7 be repaid without interest. 

8 ‘‘(f) LIMITATION.—The amount of a loan under this 

9 section with respect to each of the uses described in sub10 section (c)(1) or (c)(2) shall not exceed $2,000,000. 

11 ‘‘(g) FAILURE TO REPAY.—A hospital or non-hos12 pital community-based entity that fails to comply with the 

13 terms of a contract entered into under subsection (b)(2) 

14 shall be liable to the United States for the amount which 

15 has been paid to such hospital or entity under the con16 tract. 

17 ‘‘(h) AUTHORIZATION OF APPROPRIATIONS.—There 

18 is authorized to be appropriated, such sums as may be 

19 necessary to carry out this section.’’. 

20 SEC. 205. UNITED STATES PUBLIC HEALTH SCIENCES 

21 TRACK. 

22 Title II of the Public Health Service Act (42 U.S.C. 

23 202 et seq.) is amended by adding at the end the fol24 lowing: 


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1 ‘‘PART D—UNITED STATES PUBLIC HEALTH 

2 SCIENCES TRACK 

3 ‘‘SEC. 271. ESTABLISHMENT. 

4 ‘‘(a) UNITED STATES PUBLIC HEALTH SERVICES

5 TRACK.— 

6 ‘‘(1) IN GENERAL.—There is hereby authorized 

7 to be established a United States Public Health 

8 Sciences Track (referred to in this part as the 

9 ‘Track’), at sites to be selected by the Secretary, 

10 with authority to grant appropriate advanced de11 grees in a manner that uniquely emphasizes team12 based service, public health, epidemiology, and emer13 gency preparedness and response. It shall be so or14 ganized as to graduate not less than— 

15 ‘‘(A) 150 medical students annually; 

16 ‘‘(B) 100 dental students annually; 

17 ‘‘(C) 250 nursing students annually; 

18 ‘‘(D) 100 public health students annually; 

19 ‘‘(E) 100 behavioral and mental health 

20 professional students annually; 

21 ‘‘(F) 100 physician assistant or nurse 

22 practitioner students annually; and 

23 ‘‘(G) 50 pharmacy students annually. 

24 ‘‘(2) LOCATIONS.—The Track shall be located 

25 at existing and accredited, affiliated health profes26 sions education training programs at academic 


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1 health centers located in regions of the United 

2 States determined appropriate by the Surgeon Gen3 eral, in consultation with the Permanent National 

4 Health Workforce Commission. 

5 ‘‘(b) NUMBER OF GRADUATES.—Except as provided 

6 in subsection (a), the number of persons to be graduated 

7 from the Track shall be prescribed by the Secretary. In 

8 so prescribing the number of persons to be graduated from 

9 the Track, the Secretary shall institute actions necessary 

10 to ensure the maximum number of first-year enrollments 

11 in the Track consistent with the academic capacity of the 

12 affiliated sites and the needs of the United States for med13 ical, dental, and nursing personnel. 

14 ‘‘(c) DEVELOPMENT.—The development of the Track 

15 may be by such phases as the Secretary may prescribe 

16 subject to the requirements of subsection (a). 

17 ‘‘(d) INTEGRATED LONGITUDINAL PLAN.—The Sur18 geon General shall develop an integrated longitudinal plan 

19 for health professions continuing education throughout the 

20 continuum of health-related education, training, and prac21 tice. Training under such plan shall emphasize patient22 centered, interdisciplinary, and care coordination skills. 

23 Experience with deployment of emergency response teams 

24 shall be included during the clinical experiences. 


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1 ‘‘(e) FACULTY DEVELOPMENT.—The Surgeon Gen2 eral shall develop faculty development programs and cur3 ricula in decentralized venues of health care, to balance 

4 urban, tertiary, and inpatient venues. 

5 ‘‘SEC. 272. ADMINISTRATION. 

6 ‘‘(a) IN GENERAL.—The business of the Track shall 

7 be conducted by the Surgeon General with funds appro8 priated for and provided by the Department of Health and 

9 Human Services. The Permanent National Health Work10 force Commission shall assist the Surgeon General in an 

11 advisory capacity. 

12 ‘‘(b) FACULTY.— 

13 ‘‘(1) IN GENERAL.—The Surgeon General, after 

14 considering the recommendations of the Permanent 

15 National Health Workforce Commission, shall obtain 

16 the services of such professors, instructors, and ad17 ministrative and other employees as may be nec18 essary to operate the Track, but utilize when pos19 sible, existing affiliated health professions training 

20 institutions. Members of the faculty and staff shall 

21 be employed under salary schedules and granted re22 tirement and other related benefits prescribed by the 

23 Secretary so as to place the employees of the Track 

24 faculty on a comparable basis with the employees of 


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1 fully accredited schools of the health professions 

2 within the United States. 

3 ‘‘(2) TITLES.—The Surgeon General may con4 fer academic titles, as appropriate, upon the mem5 bers of the faculty. 

6 ‘‘(3) NONAPPLICATION OF PROVISIONS.—The 

7 limitations in section 5373 of title 5, United States 

8 Code, shall not apply to the authority of the Surgeon 

9 General under paragraph (1) to prescribe salary 

10 schedules and other related benefits. 

11 ‘‘(c) AGREEMENTS.—The Surgeon General may ne12 gotiate agreements with agencies of the Federal Govern13 ment to utilize on a reimbursable basis appropriate exist14 ing Federal medical resources located in the United States 

15 (or locations selected in accordance with section 

16 271(a)(2)). Under such agreements the facilities con17 cerned will retain their identities and basic missions. The 

18 Surgeon General may negotiate affiliation agreements 

19 with accredited universities and health professions train20 ing institutions in the United States. Such agreements 

21 may include provisions for payments for educational serv22 ices provided students participating in Department of 

23 Health and Human Services educational programs. 


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1 ‘‘(d) PROGRAMS.—The Surgeon General may estab2 lish the following educational programs for Track stu3 dents: 

4 ‘‘(1) Postdoctoral, postgraduate, and techno5 logical institutes. 

6 ‘‘(2) A graduate school of nursing. 

7 ‘‘(3) Other schools or programs that the Sur8 geon General determines necessary in order to oper9 ate the Track in a cost-effective manner. 

10 ‘‘(e) CONTINUING MEDICAL EDUCATION.—The Sur11 geon General shall establish programs in continuing med12 ical education for members of the health professions to 

13 the end that high standards of health care may be main14 tained within the United States. 

15 ‘‘(f) AUTHORITY OF THE SURGEON GENERAL.— 

16 ‘‘(1) IN GENERAL.—The Surgeon General is au17 thorized— 

18 ‘‘(A) to enter into contracts with, accept 

19 grants from, and make grants to any nonprofit 

20 entity for the purpose of carrying out coopera21 tive enterprises in medical, dental, physician as22 sistant, pharmacy, behavioral and mental 

23 health, public health, and nursing research, 

24 consultation, and education; 


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1 ‘‘(B) to enter into contracts with entities 

2 under which the Surgeon General may furnish 

3 the services of such professional, technical, or 

4 clerical personnel as may be necessary to fulfill 

5 cooperative enterprises undertaken by the 

6 Track; 

7 ‘‘(C) to accept, hold, administer, invest, 

8 and spend any gift, devise, or bequest of per9 sonal property made to the Track, including 

10 any gift, devise, or bequest for the support of 

11 an academic chair, teaching, research, or dem12 onstration project; 

13 ‘‘(D) to enter into agreements with entities 

14 that may be utilized by the Track for the pur15 pose of enhancing the activities of the Track in 

16 education, research, and technological applica17 tions of knowledge; and 

18 ‘‘(E) to accept the voluntary services of 

19 guest scholars and other persons. 

20 ‘‘(2) LIMITATION.—The Surgeon General may 

21 not enter into any contract with an entity if the con22 tract would obligate the Track to make outlays in 

23 advance of the enactment of budget authority for 

24 such outlays. 


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1 ‘‘(3) SCIENTISTS.—Scientists or other medical, 

2 dental, or nursing personnel utilized by the Track 

3 under an agreement described in paragraph (1) may 

4 be appointed to any position within the Track and 

5 may be permitted to perform such duties within the 

6 Track as the Surgeon General may approve. 

7 ‘‘(4) VOLUNTEER SERVICES.—A person who 

8 provides voluntary services under the authority of 

9 subparagraph (E) of paragraph (1) shall be consid10 ered to be an employee of the Federal Government 

11 for the purposes of chapter 81 of title 5, relating to 

12 compensation for work-related injuries, and to be an 

13 employee of the Federal Government for the pur14 poses of chapter 171 of title 28, relating to tort 

15 claims. Such a person who is not otherwise employed 

16 by the Federal Government shall not be considered 

17 to be a Federal employee for any other purpose by 

18 reason of the provision of such services. 

19 ‘‘SEC. 273. STUDENTS; SELECTION; OBLIGATION. 

20 ‘‘(a) STUDENT SELECTION.— 

21 ‘‘(1) IN GENERAL.—Medical, dental, physician 

22 assistant, pharmacy, behavioral and mental health, 

23 public health, and nursing students at the Track 

24 shall be selected under procedures prescribed by the 

25 Surgeon General. In so prescribing, the Surgeon 


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1 General shall consider the recommendations of the 

2 Permanent National Health Workforce Commission. 

3 ‘‘(2) PRIORITY.—In developing admissions pro4 cedures under paragraph (1), the Surgeon General 

5 shall ensure that such procedures give priority to ap6 plicant medical, dental, physician assistant, phar7 macy, behavioral and mental health, public health, 

8 and nursing students from rural communities and 

9 underrepresented minorities. 

10 ‘‘(b) CONTRACT AND SERVICE OBLIGATION.— 

11 ‘‘(1) CONTRACT.—Upon being admitted to the 

12 Track, a medical, dental, physician assistant, phar13 macy, behavioral and mental health, public health, 

14 or nursing student shall enter into a written con15 tract with the Surgeon General that shall contain— 

16 ‘‘(A) an agreement under which— 

17 ‘‘(i) subject to subparagraph (B), the 

18 Surgeon General agrees to provide the stu19 dent with tuition (or tuition remission) and 

20 a student stipend (described in paragraph 

21 (2)) in each school year for a period of 

22 years (not to exceed 4 school years) deter23 mined by the student, during which period 

24 the student is enrolled in the Track at an 

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1 fessions institution pursuant to an agree2 ment between the Track and such institu3 tion; and 

4 ‘‘(ii) subject to subparagraph (B), the 

5 student agrees— 

6 ‘‘(I) to accept the provision of 

7 such tuition and student stipend to 

8 the student; 

9 ‘‘(II) to maintain enrollment at 

10 the Track until the student completes 

11 the course of study involved; 

12 ‘‘(III) while enrolled in such 

13 course of study, to maintain an ac14 ceptable level of academic standing 

15 (as determined by the Surgeon Gen16 eral); 

17 ‘‘(IV) if pursuing a degree from 

18 a school of medicine or osteopathic 

19 medicine, dental, public health, or 

20 nursing school or a physician assist21 ant, pharmacy, or behavioral and 

22 mental health professional program, 

23 to complete a residency or internship 

24 in a specialty that the Surgeon Gen25 eral determines is appropriate; and 


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1 ‘‘(V) to serve for a period of time 

2 (referred to in this part as the ‘period 

3 of obligated service’) within the Com4 missioned Corps of the Public Health 

5 Service equal to 2 years for each 

6 school year during which such indi7 vidual was enrolled at the College, re8 duced as provided for in paragraph 

9 (3); 

10 ‘‘(B) a provision that any financial obliga11 tion of the United States arising out of a con12 tract entered into under this part and any obli13 gation of the student which is conditioned 

14 thereon, is contingent upon funds being appro15 priated to carry out this part; 

16 ‘‘(C) a statement of the damages to which 

17 the United States is entitled for the student’s 

18 breach of the contract; and 

19 ‘‘(D) such other statements of the rights 

20 and liabilities of the Secretary and of the indi21 vidual, not inconsistent with the provisions of 

22 this part. 

23 ‘‘(2) TUITION AND STUDENT STIPEND.— 

24 ‘‘(A) TUITION REMISSION RATES.—The 

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1 tions of the Permanent National Health Work2 force Commission established under section 

3 101(a) of the Health Access and Health Profes4 sions Supply Act of 2009, shall establish Fed5 eral tuition remission rates to be used by the 

6 Track to provide reimbursement to affiliated 

7 and other participating health professions insti8 tutions for the cost of educational services pro9 vided by such institutions to Track students. 

10 The agreement entered into by such partici11 pating institutions under paragraph (1)(A)(i) 

12 shall contain an agreement to accept as pay13 ment in full the established remission rate 

14 under this subparagraph. 

15 ‘‘(B) STIPEND.—The Surgeon General, 

16 based on the recommendations of the Perma17 nent National Health Workforce Commission, 

18 shall establish and update Federal stipend rates 

19 for payment to students under this part. 

20 ‘‘(3) REDUCTIONS IN THE PERIOD OF OBLI21 GATED SERVICE.—The period of obligated service 

22 under paragraph (1)(A)(ii)(V) shall be reduced— 

23 ‘‘(A) in the case of a student who elects to 

24 participate in a high-needs speciality residency 

25 (as determined by the Permanent National 


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1 Health Workforce Commission), by 3 months 

2 for each year of such participation (not to ex3 ceed a total of 12 months); and 

4 ‘‘(B) in the case of a student who, upon 

5 completion of their residency, elects to practice 

6 in a Federal medical facility (as defined in sec7 tion 781(e)) that is located in a health profes8 sional shortage area (as defined in section 332), 

9 by 3 months for year of full-time practice in 

10 such a facility (not to exceed a total of 12 

11 months). 

12 ‘‘(c) SECOND 2 YEARS OF SERVICE.—During the 

13 third and fourth years in which a medical, dental, physi14 cian assistant, pharmacy, behavioral and mental health, 

15 public health, or nursing student is enrolled in the Track, 

16 training should be designed to prioritize clinical rotations 

17 in Federal medical facilities in health professional short18 age areas, and emphasize a balance of hospital and com19 munity-based experiences, and training within inter20 disciplinary teams. 

21 ‘‘(d) DENTIST, PHYSICIAN ASSISTANT, PHARMACIST, 

22 BEHAVIORAL AND MENTAL HEALTH PROFESSIONAL, 

23 PUBLIC HEALTH PROFESSIONAL, AND NURSE TRAIN24 ING.—The Surgeon General shall establish provisions ap25 plicable with respect to dental, physician assistant, pharVerDate Nov 24 2008 01:33 Jul 02, 2009 Jkt 079200 PO 00000 Frm 00105 Fmt 6652 Sfmt 6201 E:\BILLS\H3109.IH H3109

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1 macy, behavioral and mental health, public health, and 

2 nursing students that are comparable to those for medical 

3 students under this section, including service obligations, 

4 tuition support, and stipend support. The Surgeon Gen5 eral shall give priority to health professions training insti6 tutions that train medical, dental, physician assistant, 

7 pharmacy, behavioral and mental health, public health, 

8 and nursing students for some significant period of time 

9 together, but at a minimum have a discrete and shared 

10 core curriculum. 

11 ‘‘(e) ELITE FEDERAL DISASTER TEAMS.—The Sur12 geon General, in consultation with the Secretary, the Di13 rector of the Centers for Disease Control and Prevention, 

14 and other appropriate military and Federal government 

15 agencies, shall develop criteria for the appointment of 

16 highly qualified Track faculty, medical, dental, physician 

17 assistant, pharmacy, behavioral and mental health, public 

18 health, and nursing students, and graduates to elite Fed19 eral disaster preparedness teams to train and to respond 

20 to public health emergencies, natural disasters, bioter21 rorism events, and other emergencies. 

22 ‘‘(f) STUDENT DROPPED FROM TRACK IN AFFILIATE

23 SCHOOL.—A medical, dental, physician assistant, phar24 macy, behavioral and mental health, public health, or 

25 nursing student who, under regulations prescribed by the 


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1 Surgeon General, is dropped from the Track in an affili2 ated school for deficiency in conduct or studies, or for 

3 other reasons, shall be liable to the United States for all 

4 tuition and stipend support provided to the student. 

5 ‘‘SEC. 274. AUTHORIZATION OF APPROPRIATIONS. 

6 ‘‘There is authorized to be appropriated to carry out 

7 this part, section 338A–1, and section 749, such sums as 

8 may be necessary.’’. 

9 SEC. 206. MEDICAL EDUCATION DEBT REIMBURSEMENT 

10 FOR PHYSICIANS OF THE VETERANS HEALTH 

11 ADMINISTRATION. 

12 (a) IN GENERAL.—The Secretary of Veterans Affairs 

13 shall carry out a program under which eligible physicians 

14 described in subsection (b) are reimbursed for the edu15 cation debt of such physicians as described in subsection 

16 (c). 

17 (b) ELIGIBLE PHYSICIANS.—An eligible physician de18 scribed in this subsection is any physician currently ap19 pointed to a physician position in the Veterans Health Ad20 ministration under section 7402(b)(1) of title 38, United 

21 States Code, who enters into an agreement with the Sec22 retary to continue serving as a physician in such position 

23 for such period of time as the Secretary shall specify in 

24 the agreement. 


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1 (c) COVERED EDUCATION DEBT.—The education 

2 debt for which an eligible physician may be reimbursed 

3 under this section is any amount paid by the physician 

4 for tuition, room and board, or expenses in obtaining the 

5 degree of doctor or medicine or of doctor of osteopathy, 

6 including any amounts of principal or interest paid by the 

7 physician under a loan, the proceeds of which were used 

8 by or on behalf of the physician for the costs of obtaining 

9 such degree. 

10 (d) FREQUENCY OF REIMBURSEMENT.—Any reim11 bursement of an eligible physician under this section shall 

12 be made in a lump sum or in installments of such fre13 quency as the Secretary shall specify the agreement of the 

14 physician as required under subsection (b). 

15 (e) LIABILITY FOR FAILURE TO COMPLETE OBLI16 GATED SERVICE.—Any eligible physician who fails to sat17 isfactorily complete the period of service agreed to by the 

18 physician under subsection (b) shall be liable to the United 

19 States in an amount determined in accordance with the 

20 provisions of section 7617(c)(1) of title 38, United States 

21 Code. 

22 (f) TREATMENT OF REIMBURSEMENT WITH OTHER

23 PAY AND BENEFIT AUTHORITIES.—Any amount of reim24 bursement payable to an eligible physician under this sec25 tion is in addition to any other pay, allowances, or benefits 


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1 that may be provided the physician under law, including 

2 any educational assistance under the Department of Vet3 erans Affairs Health Professional Educational Assistance 

4 Program under chapter 76 of title 38, United States Code. 

5 SEC. 207. PROMOTING EDUCATION AND TRAINING OF PSY6 CHOLOGISTS TO PROVIDE MENTAL AND BE7 HAVIORAL HEALTH SERVICES TO UNDER8 SERVED POPULATIONS. 

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

10 (42 U.S.C. 294n et seq.) is amended by adding at the end 

11 the following: 

12 ‘‘Subpart 3—Mental and Behavioral Health Care 

13 Workforce 

14 ‘‘SEC. 775. PROGRAM FOR GRADUATE EDUCATION AND 

15 TRAINING IN PSYCHOLOGY. 

16 ‘‘(a) IN GENERAL.—The Secretary may award 

17 grants, cooperative agreements, and contracts to accred18 ited doctoral, internship, and residency programs in psy19 chology for the development and implementation of pro20 grams to provide interdisciplinary training in integrated 

21 health care settings to students in doctoral psychology 

22 programs, including interns and residents in such pro23 grams. Any training funded by such grants, cooperative 

24 agreements, or contracts shall focus on the needs of under25 served populations. 


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1 ‘‘(b) ELIGIBILITY.—To be eligible to receive an award 

2 under this section an entity shall— 

3 ‘‘(1) provide training at or through an accred4 ited doctoral program in psychology, including an in5 ternship or residency program; and 

6 ‘‘(2) prepare and submit to the Secretary an 

7 application at such time, in such manner, and con8 taining such information as the Secretary may re9 quire. 

10 ‘‘(c) EVALUATION OF PROGRAMS.—The Secretary 

11 shall evaluate any program implemented through an 

12 award under this section in order to determine the effect 

13 of such program on increasing the number of psychologists 

14 who provide mental and behavioral health services to un15 derserved populations. 

16 ‘‘(d) DEFINITIONS.—For purposes of this section— 

17 ‘‘(1) the term ‘underserved population’ means 

18 individuals, especially older adults, children, chron19 ically ill individuals, victims of abuse or trauma, and 

20 victims of combat- or war-related stress disorders, 

21 including post-traumatic stress disorder and trau22 matic brain injury, and their families, living in an 

23 urban or rural area that has a shortage of mental 

24 or behavioral health services; and 


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1 ‘‘(2) the term ‘interdisciplinary training’ means 

2 training for graduate psychology students with 1 or 

3 more of the other health professions, including medi4 cine, nursing, dentistry, and pharmacy. 

5 ‘‘(e) AUTHORIZATION OF APPROPRIATIONS.—To 

6 carry out this section, there is authorized to be appro7 priated $10,000,000 for fiscal year 2010, $12,000,000 for 

8 fiscal year 2011, $14,000,000 for fiscal year 2012, 

9 $16,000,000 for fiscal year 2013, and $18,000,000 for fis10 cal year 2014.’’. 

11 TITLE III—HEALTH PROFES12 SIONAL TRAINING PIPELINE 

13 PARTNERSHIPS PROGRAM 

14 SEC. 301. GRANTS TO PREPARE STUDENTS FOR CAREERS 

15 IN HEALTH CARE. 

16 (a) PURPOSE.—The purpose of this section is to sup17 port the development and implementation of programs de18 signed to prepare middle school and high school students 

19 for study and careers in the healthcare field, including 

20 success in postsecondary mathematics and science pro21 grams. 

22 (b) DEFINITIONS.—In this section: 

23 (1) CHILDREN FROM LOW-INCOME FAMILIES.— 

24 The term ‘‘children from low-income families’’ 

25 means children described in section 1124(c)(1)(A) of 


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1 the Elementary and Secondary Education Act of 

2 1965 (20 U.S.C. 6333(c)(1)(A)). 

3 (2) ELIGIBLE RECIPIENTS.—The term ‘‘eligible 

4 recipient’’ means— 

5 (A) a nonprofit healthcare career pathway 

6 partnership organization; or 

7 (B) a high-need local educational agency in 

8 partnership with— 

9 (i) not less than 1 institution of high10 er education with an established health 

11 profession education program; and 

12 (ii) not less than 1 community-based, 

13 private sector healthcare provider organiza14 tion. 

15 (3) HIGH-NEED LOCAL EDUCATIONAL AGEN16 CY.—The term ‘‘high-need local educational agency’’ 

17 means a local educational agency or educational 

18 service agency— 

19 (A) that serves not fewer than 10,000 chil20 dren from low-income families; 

21 (B) for which not less than 20 percent of 

22 the children served by the agency are children 

23 from low-income families; 

24 (C) that meets the eligibility requirements 

25 for funding under the Small, Rural School 


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1 Achievement Program under section 6211(b) of 

2 the Elementary and Secondary Education Act 

3 of 1965 (20 U.S.C. 7345(b)); or 

4 (D) that meets the eligibility requirements 

5 for funding under the Rural and Low-Income 

6 School Program under section 6221(b)(1) of 

7 the Elementary and Secondary Education Act 

8 of 1965 (20 U.S.C. 7351(b)(1)). 

9 (4) NONPROFIT HEALTHCARE CAREER PATH10 WAY PARTNERSHIP ORGANIZATION.—The term 

11 ‘‘nonprofit healthcare career pathway partnership 

12 organization’’ means a nonprofit organization fo13 cused on developing career and educational pathways 

14 to healthcare professions, that shall include rep15 resentatives of— 

16 (A) the local educational agencies; 

17 (B) not less than 1 institution of higher 

18 education (as defined in section 101(a) of the 

19 Higher Education Act of 1965 (20 U.S.C. 

20 1001(a))) with an established health profession 

21 education program; and 

22 (C) not less than 1 community-based, pri23 vate sector healthcare provider organization or 

24 other healthcare industry organization. 


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1 (5) SECRETARY.—The term ‘‘Secretary’’ means 

2 the Secretary of Education. 

3 (c) GRANTS AUTHORIZED.— 

4 (1) IN GENERAL.—The Secretary is authorized 

5 to award grants, on a competitive basis, to eligible 

6 recipients to enable the recipients to develop and im7 plement programs of study to prepare middle school 

8 and high school students for postsecondary edu9 cation leading to careers in the healthcare field. 

10 (2) MINIMUM FUNDING LEVEL.—Grants shall 

11 be awarded at a minimum level of $500,000 per re12 cipient, per year. 

13 (3) RENEWABILITY.—Grants may be renewed, 

14 at the discretion of the Secretary, for not more than 

15 5 years. 

16 (d) APPLICATION.—Each eligible recipient desiring a 

17 grant under this section shall submit an application to the 

18 Secretary at such time, in such manner, and containing 

19 such information as the Secretary may require, which shall 

20 include an assurance that the recipient will meet the pro21 gram requirements described in subsection (f)(2). 

22 (e) PRIORITY.—In awarding grants under this sec23 tion, the Secretary shall give priority to— 

24 (1) applicants that include a local educational 

25 agency that is located in an area that is designated 


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1 under section 332(a)(1)(A) of the Public Health 

2 Service Act (42 U.S.C. 254e(a)(1)(A)) as a health 

3 professional shortage area; 

4 (2) applicants that include an institution of 

5 higher education that emphasizes an interdiscipli6 nary approach to health profession education; and 

7 (3) applicants whose program involves the de8 velopment of a uniquely innovative public-private 

9 partnership. 

10 (f) AUTHORIZED ACTIVITIES/USE OF FUNDS.— 

11 (1) IN GENERAL.—Each eligible recipient that 

12 receives a grant under this section shall use the 

13 grant funds to develop and implement programs of 

14 study to prepare middle school and high school stu15 dents for careers in the healthcare field that— 

16 (A) are aligned with State challenging aca17 demic content standards and State challenging 

18 student academic achievement standards; and 

19 (B) lead to high school graduation with the 

20 skills and preparation— 

21 (i) to enter postsecondary education 

22 programs of study in mathematics and 

23 science without remediation; and 

24 (ii) necessary to enter healthcare jobs 

25 directly. 


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1 (2) PROGRAM REQUIREMENTS.—A program of 

2 study described in paragraph (1) shall— 

3 (A) involve a review and identification of 

4 the content knowledge and skills students who 

5 enter institutions of higher education and the 

6 workforce need to have in order to succeed in 

7 the healthcare field; 

8 (B) promote the alignment of mathematics 

9 and science curricula and assessments in middle 

10 school and high school and facilitate learning of 

11 the required knowledge and skills identified in 

12 subparagraph (A); 

13 (C) include an outreach component to edu14 cate middle school and high school students and 

15 their parents about the full range of employ16 ment opportunities in the healthcare field, spe17 cifically in the local community; 

18 (D) include specific opportunities for youth 

19 to interact with healthcare professionals or in20 dustry representatives in the classroom, school, 

21 or community locations and how these experi22 ences will be integrated with coursework; 

23 (E) include high-quality volunteer or in24 ternship experiences, integrated with 

25 coursework; 


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1 (F) provide high-quality mentoring, coun2 seling, and career counseling support services to 

3 program participants; 

4 (G) consider the inclusion of a distance5 learning component or similar education tech6 nology that would expand opportunities for geo7 graphically isolated individuals; 

8 (H) encourage the participation of individ9 uals who are members of groups that are 

10 underrepresented in postsecondary education 

11 programs in mathematics and science; 

12 (I) encourage participants to seek work in 

13 communities experiencing acute health profes14 sional shortages; and 

15 (J) collect data, and analyze the data 

16 using measurable objectives and benchmarks, to 

17 evaluate the extent to which the program suc18 ceeded in— 

19 (i) increasing student and parent 

20 awareness of occupational opportunities in 

21 the healthcare field; 

22 (ii) improving student academic 

23 achievement in mathematics and science; 


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1 (iii) increasing the number of students 

2 entering health care professions upon grad3 uation; and 

4 (iv) increasing the number of students 

5 pursuing secondary education or training 

6 opportunities with the potential to lead to 

7 a career in the healthcare field. 

8 (3) PLANNING GRANT SET ASIDE.—Each eligi9 ble recipient that receives a grant under this section 

10 shall set aside 10 percent of the grant funds for 

11 planning and program development purposes. 

12 (g) MATCHING REQUIREMENT.—Each eligible recipi13 ent that receives a grant under this section shall provide, 

14 from the private sector, an amount equal to 40 percent 

15 of the amount of the grant, in cash or in kind, to carry 

16 out the activities supported by the grant. 

17 (h) REPORTS.— 

18 (1) ANNUAL EVALUATION.—Each eligible re19 cipient that receives a grant under this section shall 

20 collect and report to the Secretary annually such in21 formation as the Secretary may reasonably require, 

22 including— 

23 (A) the number of schools involved and 

24 student participants in the program; 


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1 (B) the race, gender, socio-economic sta2 tus, and disability status of program partici3 pants; 

4 (C) the number of program participants 

5 who successfully graduated from high school; 

6 (D) the number of program participants 

7 who reported enrollment in some form of post8 secondary education with the potential to lead 

9 to a career in the healthcare field; 

10 (E) the number of program participants 

11 who entered a paid position, either part-time or 

12 full-time, in the healthcare field following par13 ticipation in the program; and 

14 (F) the data and analysis required under 

15 subsection (f)(2)(J). 

16 (2) REPORT.—Not later than 3 years after the 

17 date of enactment of this section, the Secretary shall 

18 submit to Congress an interim report on the results 

19 of the evaluations conducted under paragraph (1). 

20 (i) AUTHORIZATION AND APPROPRIATION.— 

21 (1) IN GENERAL.—There are authorized to be 

22 appropriated $100,000,000 for each of fiscal years 

23 2009 through 2013 to carry out this section. 

24 (2) ADMINISTRATIVE COSTS.—For the costs of 

25 administering this section, including the costs of 


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1 evaluating the results of grants and submitting re2 ports to the Congress, there are authorized to be ap3 propriated such sums as may be necessary for each 

4 of fiscal years 2009 through 2013. 

Æ 


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