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[Congressional Bills 111th Congress]
[From the U.S. Government Publishing Office]
[H.R. 3109 Introduced in House (IH)]

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.

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

SECTION 1. SHORT TITLE; TABLE OF CONTENTS.

    (a) Short Title.--This Act may be cited as the ``Health Access and 
Health Professions Supply Act of 2009'' or ``HAHPSA 2009''.
    (b) Table of Contents.--The table of contents of 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.
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.

SEC. 2. FINDINGS.

    (a) Findings Related to Health Care Access in Rural, Frontier, and 
Urban Underserved Areas of the United States.--Congress finds the 
following:
            (1) The United States does not have a cohesive or 
        coordinated approach to addressing health workforce shortages 
        and problems with reliable access to quality, affordable health 
        care.
            (2) There are 50,000,000 citizens of the United States 
        living in areas that are designated under section 332(a)(1)(A) 
        of the Public Health Service Act as health professional 
        shortage areas.
            (3) The population of the United States will grow by 
        25,000,000 each decade.
            (4) The number of individuals over 65 years of age in the 
        United States will double between 2000 and 2030, with such 
        individuals accounting for 20 percent of the total population 
        of the United States in 2030.
            (5) Individuals over 65 years of age have twice as many 
        doctor visits as those individuals under 65 years of age, 
        resulting in an increase in the demand for physicians, 
        physician assistants, pharmacists behavioral and mental health 
        professionals, nurses, and dentists.
            (6) The rates of chronic diseases (such as diabetes) are 
        increasing in the population of the United States.
            (7) There are 47,000,000 citizens of the United States who 
        do not have health insurance, and over 130,000,000 individuals 
        within the United States who do not have dental insurance. 
        Those individuals who are uninsured have limited access to 
        health care.
            (8) Academic health centers, Federal medical facilities, 
        and teaching hospitals provide a substantial percentage of 
        safety net services in the United States to uninsured and 
        underinsured populations and to those individuals who have 1 or 
        more chronic diseases. Such centers, facilities, and teaching 
        hospitals provide those safety net services while concurrently 
        providing for the training of health professionals.
            (9) The pipeline for the education of health 
        professionals--
                    (A) begins and often ends in urban areas;
                    (B) does not reliably include Federal support for 
                nonphysician training;
                    (C) does not incorporate modern training venues and 
                techniques, including community-based ambulatory sites; 
                and
                    (D) discourages interdisciplinary, team, and care 
                coordination models as a result of restrictive 
                regulations.
            (10) Health reform must include measures to transform the 
        health delivery system to assure access, quality, and 
        efficiency by utilizing contemporary models and venues of care.
            (11) Reform of the health delivery system will require 
        modernization of the training of health professionals to ensure 
        that health professionals--
                    (A) practice in integrated teams in a variety of 
                delivery venues (including inpatient and ambulatory 
                settings and long-term care facilities) to utilize 
                decision support and health information systems;
                    (B) deliver patient-centered care;
                    (C) practice evidence-based health care;
                    (D) learn performance-based compensation systems, 
                comparative effectiveness, and costs of care across the 
                spectrum; and
                    (E) deliver culturally appropriate, personalized 
                care.
    (b) Findings Related to Access to Oral Health.--Congress finds the 
following:
            (1) Dental care is the number 1 unmet health care need in 
        children, and is 1 of the top 5 unmet health care needs in 
        adults.
            (2) Over 130,000,000 citizens of the United States are 
        without dental insurance.
            (3) Over 45,000,000 citizens of the United States live in 
        areas that are designated under section 332(a)(1)(A) of the 
        Public Health Service Act as dental health professional 
        shortage areas.
            (4) Rural counties have less than half the number of 
        dentists per capita compared to large metropolitan areas (29 
        versus 62 for population of 100,000).
            (5) In 2006, over 9,000 dentists were needed in such dental 
        health professional shortage areas.
            (6) Between 27 and 29 percent of children and adults in the 
        United States have untreated cavities.
            (7) The number of dental school graduates in the United 
        States decreased by 20 percent between 1982 and 2003 and the 
        average age of practicing dentists in the United States is 49.
            (8) There were over 400 dental faculty vacancies in the 
        school year beginning in 2006.
            (9) In 2007, the average debt of a dental student at 
        graduation was $172,627.
    (c) Findings Related to Physician Shortages, Education, and 
Distribution.--Congress finds the following:
            (1) By 2020, physician shortages are forecasted to be in 
        the range of 55,000 to 200,000.
            (2) Although 21 percent of the population of the United 
        States lives in rural areas, only 10 percent of physicians work 
        in rural areas and, for every 1 physician who goes into 
        practice in regions with a low supply of physicians, 4 
        physicians go into practice in regions with a high supply of 
        physicians.
            (3) According to a 2004 report by Green et al. for the 
        Robert Graham Center of the American Academy of Family 
        Physicians, the number of applicants from rural areas accepted 
        to medical school has decreased by 40 percent in the last 20 
        years while the number of such applications has remained the 
        same.
            (4) In order to respond to forecasted shortages, experts 
        have recommended an increase between 15 and 30 percent in class 
        size at medical schools over the next 10 years.
            (5) There are 55,000,000 citizens of the United States who 
        lack adequate access to primary health care because of 
        shortages of primary care providers in their communities.
            (6) The number of graduates from medical school in the 
        United States who choose to practice family medicine has 
        plummeted 50 percent in less than 10 years. Without 
        congressional intervention, such decline will likely continue, 
        and access to care in underserved areas will rapidly 
        deteriorate. Family physicians represent 58 percent of the 
        rural physician workforce, 70 percent of non-Federal physicians 
        in whole-county health professional shortage areas, and 78 
        percent of primary care physician full-time equivalents in the 
        National Health Service Corps.
            (7) Current trends indicate that fewer resident trainees 
        from pediatric and internal medicine residencies pursue 
        generalist practice at graduation.
            (8) Funding for medical education which is provided through 
        direct Graduate Medical Education (GME) and Indirect Medical 
        Education (IME) under the Medicare program is not transparent 
        or accountable, nor is it aligned to the types of health 
        professionals most needed or to the areas in which health 
        professionals are most needed.
            (9) Physician supply varies 200 percent across regions and 
        there is no relationship between regional physician supply and 
        health needs.
            (10) The Council on Graduate Medical Education's 18th 
        Report (issued in 2007), entitled ``New Paradigms for Physician 
        Training for Improving Access to Health Care'', and 19th Report 
        (issued in 2007), entitled ``Enhancing Flexibility in Graduate 
        Medical Education'', each call for changes to address the 
        healthcare needs of the United States by removing barriers to 
        expanding and more appropriately training the physician 
        workforce.
    (d) Findings Related to Nursing Shortages, Education, and 
Distribution.--Congress finds the following:
            (1) By 2020, nursing shortages are forecast to be in the 
        range of 300,000 to 1,000,000 and the Bureau of Labor 
        Statistics of the Department of Labor estimates that more than 
        1,200,000 new and replacement registered nurses will be needed 
        by 2014.
            (2) Nurse vacancy rates are currently 8 percent or greater 
        in hospitals and community health centers receiving assistance 
        under section 330 of the Public Health Service Act, and for 
        nursing faculty positions.
            (3) Surveys indicate that 40 percent of nurses in hospitals 
        are dissatisfied with their work and, of nurses who graduate 
        and go into nursing, 50 percent leave their first employer 
        within 2 years.
            (4) Nursing baccalaureate and graduate programs rejected 
        more than 40,000 qualified nursing school applicants in 2006, 
        with faculty shortages identified by such programs as a major 
        reason for turning away qualified applicants.
            (5) More than 70 percent of nursing schools cited faculty 
        shortages as the primary reason for not accepting all qualified 
        applicants into entry-level nursing programs.
            (6) The nursing faculty workforce is aging and retiring 
        and, by 2019, approximately 75 percent of the nursing faculty 
        workforce is expected to retire.
            (7) The average age of nurses in the United States is 49 
        and the average age of an associate professor nurse faculty 
        member in the United States is 56.
            (8) Geriatric patients receiving care from nurses trained 
        in geriatrics are less frequently readmitted to hospitals or 
        transferred from skilled nursing facilities and nursing 
        facilities to hospitals.
    (e) Findings Related to Public Health Workforce Shortages.--
Congress finds the following:
            (1) The United States has an estimated 50,000 fewer public 
        health workers than it did 20 years ago while the population 
        has grown by approximately 22 percent.
            (2) Government public health departments are facing 
        significant workforce shortages that could be exacerbated 
        through retirements.
            (3) Twenty percent of the average State health agency's 
        workforce will be eligible to retire within 3 years, and by 
        2012, over 50 percent of some State health agency workforces 
        will be eligible to retire.
            (4) Approximately 20 percent of local health department 
        employees will be eligible for retirement by 2010.
            (5) The average age of new hires in State health agencies 
        is 40.
            (6) Four out of 5 current public health workers have not 
        had formal training for their specific job functions.
    (f) Findings Related to Physician Assistant Shortages.--Congress 
finds the following:
            (1) The purpose of the physician assistant profession is to 
        extend the ability of physicians to provide primary care 
        services, particularly in rural and other medically underserved 
        communities.
            (2) Physician assistants always practice medicine as a team 
        with their supervising physicians, however, supervising 
        physicians need not be physically present when physician 
        assistants provide medical care.
            (3) Physician assistants are legally regulated in all 
        States, the District of Columbia, and Guam. All States, the 
        District of Columbia, and Guam authorize physicians to delegate 
        prescriptive authority to physician assistants.
            (4) In 2007, physician assistants made approximately 
        245,000,000 patient visits and prescribed or recommended 
        approximately 303,000,000 medications.
            (5) The National Association of Community Health Centers, 
        the George Washington University, and the Robert Graham Center 
        for Policy Studies in Family Medicine and Primary Care found 
        that while the number of patients who seek care at community 
        health centers has increased, the number of primary care 
        providers, including physician assistants, has not. The report 
        estimates a need for 15,500 primary health care providers to 
        provide care at community health centers.
    (g) Findings Related to Mental Health Professional Shortages.--
Congress finds the following:
            (1) The National Institute of Mental Health estimates that 
        26.2 percent of citizens of the United States ages 18 and older 
        suffer from a diagnosable mental disorder. Approximately 20 
        percent of children in the United States have diagnosable 
        mental disorders with at least mild functional impairment.
            (2) The Health Resources and Services Administration 
        reports that there are 3,059 mental health professional 
        shortage areas within the United States with 77,000,000 people 
        living in those areas. More than 5,000 additional mental health 
        professionals are needed to meet demand.
            (3) According to the Department of Health and Human 
        Services, minority representation is lacking in the mental 
        health workforce. Although 12 percent of the population of the 
        United States is African-American, only 2 percent of 
        psychologists, 2 percent of psychiatrists, and 4 percent of 
        social workers are African-American. Moreover, there are only 
        29 mental health professionals who are Hispanic for every 
        100,000 individuals who are Hispanic in the United States, 
        compared with 173 non-Hispanic White providers for every 
        100,000 individuals who are non-Hispanic White in the United 
        States.
    (h) Findings Related to Health Professional Shortage Areas.--
            (1) In 2006, the National Health Service Corps had a total 
        of 4,200 vacant positions in health professional shortage 
        areas, but only 1,200 of those positions were funded. For each 
        National Health Service Corps award, there are 7 applicants.
            (2) Community health centers receiving assistance under 
        section 330 of the Public Health Service Act have expanded to 
        serve 16,000,000 individuals in over 1,000 sites. Such 
        community health centers have high vacancy rates for family 
        physicians (13 percent), obstetricians and gynecologists (21 
        percent), dentists, nurses, and other health professionals.
            (3) The Institute of Medicine of the National Academies has 
        recommended that medical education and public health issues be 
        more closely aligned, especially in relation to preparedness 
        for natural disasters, pandemic, bioterrorism, and other 
        threats to public health.
            (4) The education of health professionals must be more 
        closely aligned with health care needs in the United States, 
        with special attention to underserved populations and areas, 
        health disparities, the aging population, and individuals with 
        1 or more chronic diseases.
            (5) There is some duplication, and little coordination, 
        between the Council on Graduate Medical Education (related to 
        the physician workforce), the National Advisory Committee on 
        Nursing Programs (related to the nursing workforce), the 
        Advisory Committee on Training in Primary Care Medicine and 
        Dentistry, and other advisory committees and councils.
            (6) The Association of Academic Health Centers calls for 
        making the health workforce of the United States a priority 
        domestic policy issue and creating a national health workforce 
        planning body that engages Federal, State, public, and private 
        stakeholders.

             TITLE I--AMENDMENTS TO THE SOCIAL SECURITY ACT

                   Subtitle A--Workforce Improvements

SEC. 101. NATIONAL HEALTH CARE WORKFORCE COMMISSION.

    (a) Purpose.--It is the purpose of this section to establish a 
National Health Care Workforce Commission that--
            (1) serves as a national resource for Congress, the 
        President, States, and localities by--
                    (A) disseminating information on current and 
                projected health care workforce supply and demand;
                    (B) disseminating information on health care 
                workforce education and training capacity and 
                instruction or delivery models and best practices;
                    (C) recognizing efforts of Federal, State, and 
                local partnerships to develop and offer health care 
                career pathways of proven effectiveness;
                    (D) disseminating information on promising 
                retention practices for health care professionals;
                    (E) communicating information on important policies 
                and practices that affect the recruitment, education 
                and training, and retention of the health care 
                workforce; and
                    (F) disseminating recommendations on the 
                development of a fiscally sustainable integrated 
                workforce that supports a high-quality health care 
                delivery system that meets the needs of patients and 
                populations;
            (2) communicates and coordinates with the Departments of 
        Health and Human Services, Labor, and Education on related 
        activities administered by one or more of such Departments;
            (3) develops and commissions evaluations of education and 
        training activities to determine whether the demand for health 
        care workers is being met;
            (4) identifies barriers to improved coordination at the 
        Federal, State, and local levels and recommend ways to address 
        such barriers; and
            (5) encourages innovations to address population needs, 
        constant changes in technology, and other environmental 
        factors.
    (b) Establishment.--There is hereby established the National Health 
Care Workforce Commission (in this section referred to as the 
``Commission'').
    (c) Membership.--
            (1) Number and appointment.--The Commission shall be 
        composed of 15 members to be appointed by the Comptroller 
        General.
            (2) Qualifications.--
                    (A) In general.--The membership of the Commission 
                shall include individuals--
                            (i) with national recognition for their 
                        expertise in health care labor market analysis, 
                        including health care workforce analysis; 
                        health care finance and economics; health care 
                        facility management; health care plans and 
                        integrated delivery systems; health care 
                        workforce education and training; health care 
                        philanthropy; providers of health care 
                        services; and other related fields; and
                            (ii) who will provide a combination of 
                        professional perspectives, broad geographic 
                        representation, and a balance between urban, 
                        suburban, and rural representatives.
                    (B) Inclusion.--
                            (i) In general.--The membership of the 
                        Commission shall include no less than one 
                        representative of--
                                    (I) the health care workforce and 
                                health professionals;
                                    (II) employers;
                                    (III) third-party payers;
                                    (IV) individuals skilled in the 
                                conduct and interpretation of health 
                                care services and health economics 
                                research;
                                    (V) representatives of consumers;
                                    (VI) labor unions;
                                    (VII) State or local workforce 
                                investment boards; and
                                    (VIII) educational institutions 
                                (which may include elementary and 
                                secondary institutions, institutions of 
                                higher education, including 2 and 4 
                                year institutions, or registered 
                                apprenticeship programs).
                            (ii) Additional members.--The remaining 
                        membership may include additional 
                        representatives from clause (i) and other 
                        individuals as determined appropriate by the 
                        Comptroller General of the United States.
                    (C) Majority non-providers.--Individuals who are 
                directly involved in health professions education or 
                practice shall not constitute a majority of the 
                membership of the Commission.
            (3) Terms.--
                    (A) In general.--The terms of members of the 
                Commission shall be for 3 years except that the 
                Comptroller General shall designate staggered terms for 
                the members first appointed.
                    (B) Vacancies.--Any member appointed to fill a 
                vacancy occurring before the expiration of the term for 
                which the member's predecessor was appointed shall be 
                appointed only for the remainder of that term. A member 
                may serve after the expiration of that members term 
                until a successor has taken office. A vacancy in the 
                Commission shall be filled in the manner in which the 
                original appointment was made.
            (4) Compensation.--While serving on the business of the 
        Commission (including travel time), a member of the Commission 
        shall be entitled to compensation at the per diem equivalent of 
        the rate provided for level IV of the Executive Schedule under 
        section 5315 of tile 5, United States Code, and while so 
        serving away from home and the member's regular place of 
        business, a member may be allowed travel expenses, as 
        authorized by the Chairman of the Commission. Physicians 
        serving as personnel of the Commission may be provided a 
        physician comparability allowance by the Commission in the same 
        manner as Government physicians may be provided such an 
        allowance by an agency under section 5948 of title 5, United 
        States Code, and for such purpose subsection (i) of such 
        section shall apply to the Commission in the same manner as it 
        applies to the Tennessee Valley Authority. For purposes of pay 
        (other than pay of members of the Commission) and employment 
        benefits, rights, and privileges, all personnel of the 
        Commission shall be treated as if they were employees of the 
        United States Senate.
            (5) Chairman, vice chairman.--The members of the Commission 
        shall elect, by a majority vote, a chairman and vice chairman 
        of the Commission for the term of their appointment of portion 
        remaining. Such elections shall occur at the end of any 
        chairman or vice chairman's term or upon the resignation of the 
        chairman or vice chairman from the Commission.
            (6) Meetings.--The Commission shall meet at the call of the 
        chairman, but no less frequently than on a quarterly basis.
    (d) Duties.--
            (1) Review of health care workforce and annual reports.--In 
        order to develop a fiscally sustainable integrated workforce 
        that supports a high-quality, readily accessible health care 
        delivery system that meets the needs of patients and 
        populations, the Commission, in consultation with relevant 
        Federal, State, and local agencies, shall--
                    (A) review current and projected health care 
                workforce supply and demand, including the topics 
                described in paragraph (2);
                    (B) make recommendations to Congress and the 
                Administration concerning national health care 
                workforce priorities, goals, and policies;
                    (C) by not later than October 1 of each year 
                (beginning with 2011), submit a report to Congress and 
                the Administration containing the results of such 
                reviews and recommendations concerning related 
                policies; and
                    (D) by not later than April 1 of each year 
                (beginning with 2011), submit a report to Congress and 
                the Administration containing a review of, and 
                recommendations on, at a minimum one high priority area 
                as described in paragraph (3).
            (2) Specific topics to be reviewed.--The topics described 
        in this paragraph include--
                    (A) current health care workforce supply and 
                distribution, including demographics, skill sets, and 
                demands, with projected demands during the subsequent 
                10 and 25 year periods;
                    (B) health care workforce education and training 
                capacity, including the number of students who have 
                completed education and training, including registered 
                apprenticeships; the number of qualified faculty; the 
                education and training infrastructure; and the 
                education and training demands, with projected demands 
                during the subsequent 10 and 25 year periods, and 
                including identified models of education and training 
                delivery and best practices;
                    (C) the implications of new and existing Federal 
                policies which affect the health care workforce, 
                including Medicare and Medicaid graduate medical 
                education policies, titles VII and VIII of the Public 
                Health Service Act (42 U.S.C. 292 et seq. and 296 et 
                seq.), the National Health Service Corps (with 
                recommendations for aligning such programs with 
                national health workforce priorities and goals), and 
                other health care workforce programs, including those 
                supported through the Workforce Investment Act of 1998 
                (29 U.S.C. 2801 et seq.), the Carl D. Perkins Career 
                and Technical Education Act of 2006 (20 U.S.C. 2301 et 
                seq.), the Higher Education Act of 1965 (20 U.S.C. 1001 
                et seq.), and any other Federal health care workforce 
                programs; and
                    (D) the health care workforce needs of special 
                populations, such as minorities, rural populations, 
                medically underserved populations, gender specific 
                needs, and geriatric and pediatric populations with 
                recommendations for new and existing Federal policies 
                to meet the needs of these special populations.
            (3) High priority areas.--
                    (A) In general.--The initial high priority topics 
                described in this paragraph include--
                            (i) integrated health care workforce 
                        planning that identifies health care 
                        professional skills needed and maximizes the 
                        skill sets of health care professionals across 
                        disciplines;
                            (ii) an analysis of the nature, scopes of 
                        practice, and demands for health care workers 
                        in the enhanced information technology and 
                        management workplace;
                            (iii) Medicare and Medicaid graduate 
                        medical education policies and recommendations 
                        for aligning with national workforce goals;
                            (iv) nursing workforce capacity at all 
                        levels, including education and training 
                        capacity, projected demands, and integration 
                        within the health care delivery system;
                            (v) oral health care workforce capacity, 
                        including education and training capacity, 
                        projected demands, and integration within the 
                        health care delivery system;
                            (vi) mental and behavioral health care 
                        workforce capacity, including education and 
                        training capacity, projected demands, and 
                        integration within the health care delivery 
                        system;
                            (vii) allied health and public health care 
                        workforce capacity, including education and 
                        training capacity, projected demands, and 
                        integration within the health care delivery 
                        system; and
                            (viii) the geographic distribution of 
                        health care providers as compared to the 
                        identified health care workforce needs of 
                        States and regions.
                    (B) Future determinations.--The Commission may 
                require that additional topics be included under 
                subparagraph (A). The appropriate committees of 
                Congress may recommend to the Commission the inclusion 
                of other topics for health care workforce development 
                areas that require special attention.
            (4) Grant program.--The Commission shall oversee and report 
        to Congress on the State Health Care Workforce Development 
        Grants program established in section 412.
            (5) Study.--The Commission shall study effective mechanisms 
        for financing education and training for careers in health 
        care, including public health and allied health.
            (6) Recommendations.--The Commission shall submit 
        recommendations to Congress, the Department of Labor, and the 
        Department of Health and Human Services about improving safety, 
        health, and worker protections in the workplace for the health 
        care workforce.
            (7) Assessment.--The Commission shall assess and receive 
        reports from the National Center for Health Care Workforce 
        Analysis established under title VII of the Public Service 
        Health Act.
    (e) Consultation With Federal, State, and Local Agencies, Congress, 
and Other Organizations.--
            (1) In general.--The Commission shall consult with Federal 
        agencies (including the Departments of Health and Human 
        Services, Labor, Education, Commerce, Agriculture, Defense, and 
        Veterans Affairs and the Environmental Protections Agency), 
        Congress, the Medicare Payment Advisory Commission, and, to the 
        extent practicable, with State and local agencies, voluntary 
        health care organizations professional societies, and other 
        relevant public-private health care partnerships.
            (2) Obtaining official data.--The Commission, consistent 
        with established privacy rules, may secure directly from any 
        department or agency of the United States information necessary 
        to enable the Commission to carry out this section.
            (3) Detail of federal government employees.--An employee of 
        the Federal Government may be detailed to the Commission 
        without reimbursement. The detail of such an employee shall be 
        without interruption or loss of civil service status.
    (f) Director and Staff; Experts and Consultants.--Subject to such 
review as the Comptroller General of the United States determines to be 
necessary to ensure the efficient administration of the Commission, the 
Commission may--
            (1) employ and fix the compensation of an executive 
        director (subject to the approval of the Comptroller General) 
        and such other personnel as may be necessary to carry out its 
        duties (without regard to the provisions of title 5, United 
        States Code, governing appointments in the competitive 
        service);
            (2) seek such assistance and support as may be required in 
        the performance of its duties from appropriate Federal 
        departments and agencies;
            (3) enter into contracts or make other arrangements, as may 
        be necessary for the conduct of the work of the Commission 
        (without regard to section 3709 of the Revised Statutes (41 
        U.S.C. 5));
            (4) make advance, progress, and other payments which relate 
        to the work of the Commission;
            (5) provide transportation and subsistence for persons 
        serving without compensation; and
            (6) prescribe such rules and regulations as the Commission 
        determines to be necessary with respect to the internal 
        organization and operation of the Commission.
    (g) Powers.--
            (1) Data collection.--In order to carry out its functions 
        under this section, the Commission shall--
                    (A) utilize existing information, both published 
                and unpublished, where possible, collected and assessed 
                either by its own staff or under other arrangements 
                made in accordance with this section, including 
                coordination with the Bureau of Labor Statistics;
                    (B) carry out, or award grants or contracts for the 
                carrying out of, original research and development, 
                where existing information is inadequate, and
                    (C) adopt procedures allowing interested parties to 
                submit information for the Commission's use in making 
                reports and recommendations.
            (2) Access of the government accountability office to 
        information.--The Comptroller General of the United States 
        shall have unrestricted access to all deliberations, records, 
        and nonproprietary data of the Commission, immediately upon 
        request.
            (3) Periodic audit.--The Commission shall be subject to 
        periodic audit by a third party appointed by the Secretary.
    (h) Authorization of Appropriations.--
            (1) Request for appropriations.--The Commission shall 
        submit requests for appropriations in the same manner as the 
        Comptroller General of the United States submits requests for 
        appropriations. Amounts so appropriated for the Commission 
        shall be separate from amounts appropriated for the Comptroller 
        General.
            (2) Authorization.--There are authorized to be appropriated 
        such sums as may be necessary to carry out this section.
            (3) Gifts.--The Commission is authorized to accept and 
        gifts for purposing of carrying out this section.
    (i) Definitions.--In this section:
            (1) Health care workforce.--The term ``health care 
        workforce'' includes all health care providers with direct 
        patient care and support responsibilities, including 
        physicians, nurses, physician assistants, pharmacists, oral 
        healthcare professionals, allied health professionals, mental 
        health professionals, and public health professionals.
            (2) Health professionals.--The term ``health 
        professionals'' includes--
                    (A) dentists, dental hygienists, primary care 
                providers, specialty physicians, nurses, nurse 
                practitioners, physician assistants, psychologists and 
                other behavioral and mental health professionals, 
                social workers, physical therapists, public health 
                professionals, clinical pharmacists, allied health 
                professionals, chiropractors, community health workers, 
                school nurses, certified nurse midwives, podiatrists, 
                licensed complementary and alternative medicine 
                providers, and integrative health practitioners;
                    (B) national representatives of health 
                professionals;
                    (C) representatives of schools of medicine, 
                osteopathy, nursing, allied health, educational 
                programs for public health professionals, behavioral 
                and mental health professionals (as so defined), social 
                workers, physical therapists, oral health care industry 
                dentistry and dental hygiene, and physician assistants;
                    (D) representatives of public and private teaching 
                hospitals, and ambulatory health facilities, including 
                Federal medical facilities; and
                    (E) any other health professional the Comptroller 
                General of the United States determines appropriate.

SEC. 102. STATE HEALTH WORKFORCE CENTERS PROGRAM.

    (a) Establishment.--The Secretary shall establish a demonstration 
program (in this section referred to as the ``program'') under which 
the Secretary makes grants to participating States for the operation of 
State Health Workforce Centers to carry out the activities described in 
subsection (c).
    (b) Participating States.--A State seeking to participate in the 
program shall submit an application to the Secretary containing such 
information and at such time as the Secretary may specify. The 
Secretary may only consider under the preceding sentence 1 application 
submitted by each State which has been certified by the Governor or the 
chief executive officer of the State.
    (c) Use of Funds.--Grants awarded under subsection (a) may be used 
to support activities designed to improve the training, deployment, and 
retention of critical health professionals in underserved areas and for 
underserved populations, including the following:
            (1) Conducting assessments of key health professional 
        capacity and needs. Such assessments shall be conducted in a 
        coordinated manner that provides for the nationwide collection 
        of health professional data.
            (2) Convening State health professional policymakers to 
        review education, education financing, regulations, and 
        taxation and compensation policies which affect the training, 
        deployment, and retention of health professionals. A 
        participating State may, taking into consideration the results 
        of such reviews, develop short-term and long-term 
        recommendations for improving the supply, deployment, and 
        retention of critical health professionals in underserved areas 
        and for underserved populations.
    (d) Funding.--
            (1) Authorization of appropriations.--There are authorized 
        to be appropriated $13,750,000 to carry out this section.
            (2) Matching requirement.--The Secretary may require a 
        State, in order to be eligible to receive a grant under this 
        section, to agree that, with respect to the costs incurred by 
        the State in carrying out the activities for which the grant 
        was awarded, the State will make available (directly or through 
        donations from public or private entities) non-Federal 
        contributions in an amount equal to a percent of Federal funds 
        provided under the grant (as determined appropriate by the 
        Secretary).
    (e) Definitions.--In this section:
            (1) Secretary.--The term ``Secretary'' means the Secretary 
        of Health and Human Services.
            (2) State.--The term ``State'' means--
                    (A) a State;
                    (B) the District of Columbia;
                    (C) the Commonwealth of Puerto Rico; and
                    (D) any other territory or possession of the United 
                States.

SEC. 103. IMPROVEMENTS TO PAYMENTS FOR GRADUATE MEDICAL EDUCATION UNDER 
              MEDICARE.

    (a) Increasing the Medicare Caps on Graduate Medical Education 
Positions.--
            (1) Direct graduate medical education.--Section 
        1886(h)(4)(F) of the Social Security Act (42 U.S.C. 
        1395ww(h)(4)(F)) is amended--
                    (A) in clause (i), by inserting ``clause (iii) 
                and'' after ``subject to''; and
                    (B) by adding at the end the following new clause:
                            ``(iii) Increase in caps on graduate 
                        medical education positions for states with a 
                        shortage of residents.--
                                    ``(I) In general.--For cost 
                                reporting periods beginning on or after 
                                January 1, 2011, the Secretary shall 
                                increase the otherwise applicable limit 
                                on the total number of full-time 
                                equivalent residents in the field of 
                                allopathic or osteopathic medicine 
                                determined under clause (i) with 
                                respect to a qualifying hospital by an 
                                amount equal to 15 percent of the 
                                amount of the otherwise applicable 
                                limit (determined without regard to 
                                this clause). Such increase shall be 
                                phased-in equally over a period of 3 
                                cost reporting periods beginning with 
                                the first cost reporting period in 
                                which the increase is applied under the 
                                previous sentence to the hospital.
                                    ``(II) Qualifying hospital.--In 
                                this clause, the term `qualifying 
                                hospital' means a hospital that agrees 
                                to use the increase in the number of 
                                full-time equivalent residents under 
                                subclause (I) to support community-
                                based training which emphasizes 
                                underserved areas and innovative 
                                training models which address community 
                                needs and reflect emerging, evolving, 
                                and contemporary models of health care 
                                delivery. A qualifying hospital shall 
                                give priority to providing such 
                                training and training models to health 
                                professionals in specialties which the 
                                Secretary, in consultation with the 
                                Permanent National Health Workforce 
                                Commission established under section 
                                101(a) of the Health Access and Health 
                                Professions Supply Act of 2009, 
                                determines are in high-need (including 
                                family medicine, general surgery, 
                                geriatrics, general internal medicine, 
                                general surgery, and obstetrics and 
                                gynecology).
                                    ``(III) Increase in payments.--
                                Notwithstanding any other provision of 
                                law, in the case of full-time 
                                equivalent residents added to a 
                                hospital's training program as a result 
                                of such increase, the Secretary shall 
                                provide for an increase in the amounts 
                                otherwise payable under this subsection 
                                with respect to direct graduate medical 
                                education costs that would otherwise 
                                apply with respect to such residents by 
                                10 percent. Such increased payments 
                                shall be made to the facility in which 
                                the training is provided to such 
                                residents.''.
            (2) Indirect medical education.--Section 1886(d)(5)(B) of 
        the Social Security Act (42 U.S.C. 1395ww(d)(5)(B)) is amended 
        by adding at the end the following new clause:
            ``(x) Clause (iii) of subsection (h)(4)(F) shall apply to 
        clause (v) in the same manner and for the same period as such 
        clause (iii) applies to clause (i) of such subsection.''.
    (b) Application of Medicare GME Payments to Additional Training 
Site Venues.--
            (1) In general.--The Secretary of Health and Human Services 
        (in this subsection referred to as the ``Secretary'') shall, by 
        regulation, provide for the use of payments for direct graduate 
        medical education costs under section 1886(h) of the Social 
        Security Act (42 U.S.C. 1395ww(h)) and payments for the 
        indirect costs of medical education under section 1886(d)(5)(B) 
        of the Social Security Act (42 U.S.C. 1395ww(d)(5)(B)) to 
        support the implementation of community-based training and 
        innovative training models under subsections (h)(4)(F)(iii)(II) 
        and (d)(5)(B)(x) of section 1886 of the Social Security Act (42 
        U.S.C. 1395ww).
            (2) Use of model of care delivery.--In promulgating 
        regulations under paragraph (1), the Secretary shall consider 
        the model of care delivery of the Institute of Medicine of the 
        National Academies.
            (3) Consultation.--In promulgating such regulations, the 
        Secretary shall consult with the Permanent National Health 
        Workforce Commission established under section 101(a).
    (c) Determination of Hospital-specific Approved FTE Resident 
Amounts.--Section 1886(h)(2) of the Social Security Act (42 U.S.C. 
1395ww(h)(2)) is amended by adding at the end the following new 
subparagraph:
                    ``(G) Flexibility in determination.--
                            ``(i) In general.--Notwithstanding the 
                        preceding provisions of this paragraph, the 
                        approved FTE resident amount for each cost 
                        reporting period beginning on or after January 
                        1, 2011, with respect to an applicable resident 
                        shall be determined using a methodology 
                        established by the Secretary that allows 
                        flexibility for payments to be made for costs 
                        in addition to the costs of hospital-sponsored 
                        education. Such methodology shall provide that 
                        nonteaching hospital-based entities (such as 
                        managed care organizations and public and 
                        private healthcare consortia) that are capable 
                        of assembling all of the resources necessary 
                        for effectively providing graduate medical 
                        education may receive payments for providing 
                        graduate medical education, either as the 
                        sponsor of such graduate medical education 
                        program or as an affiliate of such a sponsor.
                            ``(ii) Applicable resident.--In this 
                        subparagraph, the term `applicable resident' 
                        means a resident--
                                    ``(I) in a specialty which the 
                                Secretary, in consultation with the 
                                Permanent National Health Workforce 
                                Commission established under section 
                                101(a) of the Health Access and Health 
                                Professions Supply Act of 2009, 
                                determines is in high-need;
                                    ``(II) in a health professional 
                                shortage area (as defined in section 
                                332 of the Public Health Service Act);
                                    ``(III) in a medically underserved 
                                community (as defined in section 799B 
                                of the Public Health Service Act), or 
                                with respect to a medically underserved 
                                population (as defined in section 
                                330(b)(3) of the Public Health Service 
                                Act); and
                                    ``(IV) in a Federal medical 
                                facility.
                            ``(iii) Federal medical facility.--In this 
                        subparagraph, the term `Federal medical 
                        facility' means a facility for the delivery of 
                        health services, and includes--
                                    ``(I) a community health center (as 
                                defined in section 330 of the Public 
                                Health Service Act), a public health 
                                center, an outpatient medical facility, 
                                or a community mental health center;
                                    ``(II) a hospital, State mental 
                                hospital, facility for long-term care, 
                                or rehabilitation facility;
                                    ``(III) a migrant health center or 
                                an Indian Health Service facility;
                                    ``(IV) a facility for the delivery 
                                of health services to inmates in a 
                                penal or correctional institution 
                                (under section 323 of such Act) or a 
                                State correctional institution;
                                    ``(V) a Public Health Service 
                                medical facility (used in connection 
                                with the delivery of health services 
                                under section 320, 321, 322, 324, 325, 
                                or 326 of such Act); or
                                    ``(VI) any other Federal medical 
                                facility.''.

SEC. 104. DISTRIBUTION OF RESIDENT TRAINEES IN AN EMERGENCY.

    (a) Exclusion From 3-year Rolling Average.--Notwithstanding any 
other provision of law, in the case of a host hospital participating in 
an emergency Medicare GME affiliation agreement on or after the date of 
enactment of this Act and training residents in excess of its cap, 
consistent with the rolling average provisions applicable for closed 
programs as specified in section 413.79(d)(6) of title 42, Code of 
Federal Regulations, the Secretary of Health and Human Services shall 
exclude from the 3-year rolling average FTE residents associated with 
displaced residents during the period in which such agreement is in 
effect.
    (b) Assessment and Revision of GME Policies.--
            (1) Review.--The Secretary of Health and Human Services 
        shall review policies with respect to payments for direct 
        graduate medical education costs under section 1886(h) of the 
        Social Security Act (42 U.S.C. 1395ww(h)) and payments for the 
        indirect costs of medical education under section 1886(d)(5)(B) 
        of the Social Security Act (42 U.S.C. 1395ww(d)(5)(B)).
            (2) Revision and report.--Not later than January 1, 2011, 
        the Secretary shall--
                    (A) as appropriate, revise such policies that 
                constrain the ability of the Secretary to respond to 
                emergency situations and situations involving 
                institutional and program closure; and
                    (B) in the case where the Secretary determines 
                legislative action is necessary to make such revisions, 
                submit to Congress a report containing recommendations 
                for such legislative action.

SEC. 105. AUTHORITY TO INCLUDE COSTS OF TRAINING OF PSYCHOLOGISTS IN 
              PAYMENTS TO HOSPITALS FOR APPROVED EDUCATIONAL ACTIVITIES 
              UNDER MEDICARE.

    Effective for cost reporting periods beginning on or after the date 
that is 18 months after the date of enactment of this Act, for purposes 
of payment to hospitals under the Medicare program under title XVIII of 
the Social Security Act for costs of approved educational activities 
(as defined in section 413.85 of title 42, Code of Federal 
Regulations), such approved educational activities shall include a 1-
year doctoral clinical internship operated by the hospital as part of a 
clinical psychology training program that is provided upon completion 
of university course work.

   Subtitle B--Geriatric Assessments and Chronic Care Management and 
            Coordination Services Under the Medicare Program

SEC. 111. MEDICARE COVERAGE OF GERIATRIC ASSESSMENTS.

    (a) Coverage of Geriatric Assessments.--
            (1) In general.--Section 1861(s)(2) of the Social Security 
        Act (42 U.S.C. 1395x(s)(2)) is amended--
                    (A) in subparagraph (DD), by striking ``and'' at 
                the end;
                    (B) in subparagraph (EE), by adding ``and'' at the 
                end; and
                    (C) by adding at the end the following new 
                subparagraph:
            ``(FF) geriatric assessments (as defined in subsection 
        (hhh)(1));''.
            (2) Conforming amendments.--Clauses (i) and (ii) of section 
        1861(s)(2)(K) of the Social Security Act (42 U.S.C. 
        1395x(s)(2)(K)) are each amended by striking ``subsection 
        (ww)(1)'' and inserting ``subsections (ww)(1) and (hhh)(1)''.
    (b) Geriatric Assessments Defined.--Section 1861 of the Social 
Security Act (42 U.S.C. 1395x) is amended by adding at the end the 
following new subsections:

                         ``Geriatric Assessment

    ``(hhh)(1) The term `geriatric assessment' means each of the 
following:
            ``(A) An assessment of the clinical status, functional 
        status, social and environmental functioning, and need for 
        caregiving of a geriatric assessment eligible individual (as 
        defined in subsection (iii)). The assessment shall include a 
        comprehensive history and physical examination and assessments 
        of the following domains using standardized validated clinical 
        tools:
                    ``(i) Comprehensive review of medications and the 
                individual's adherence to the medication regimen.
                    ``(ii) Measurement of affect, cognition and 
                executive function, mobility, balance, gait, risk of 
                falling, and sensory function.
                    ``(iii) Social functioning, environmental needs, 
                and caregiver resources and needs.
                    ``(iv) Any other domain determined appropriate by 
                the Secretary.
            ``(B) The development of a written care plan based on the 
        results of the assessment under subparagraph (A) (and any 
        subsequent assessment under subparagraph (B)). The care plan 
        shall detail identified problems, outline therapies, assign 
        responsibility for actions, and indicate whether the individual 
        is likely to benefit from chronic care management and 
        coordination services (as defined in subsection (jjj)(1)). If 
        the individual is determined likely to benefit from chronic 
        care management and coordination services, the care plan shall 
        also provide the basis for the chronic care management and 
        coordination plan to be developed by the chronic care manager 
        pursuant to subsection (jjj).
    ``(2) A geriatric assessment may only be conducted by--
            ``(A) a physician;
            ``(B) a practitioner described in section 1842(b)(18)(C)(i) 
        under the supervision of a physician; or
            ``(C) any other provider that meets such conditions as the 
        Secretary may specify.
    ``(3) An individual described in subclause (A), (B), or, if 
applicable, (C) may provide for the furnishing of services included in 
the geriatric assessment by other qualified health care professionals.
    ``(4)(A) Subject to subparagraph (B), a geriatric assessment of a 
geriatric assessment eligible individual may not be conducted more 
frequently than annually.
    ``(B) A geriatric assessment of a geriatric assessment eligible 
individual may be conducted more frequently than annually if the 
assessment is medically necessary due to a significant change in the 
condition of the individual.

               ``Geriatric Assessment Eligible Individual

    ``(iii)(1) Subject to paragraph (3), the term `geriatric assessment 
eligible individual' means an individual identified by the Secretary as 
eligible for a geriatric assessment.
    ``(2) In identifying individuals under paragraph (1), the following 
rules shall apply:
            ``(A) The individual must have at least 1 of the following 
        present:
                    ``(i) Multiple chronic conditions that the 
                Secretary identifies as likely to result in high 
                expenditures under this title. In identifying such 
                conditions, the Secretary may consider--
                            ``(I) the hierarchal condition category 
                        methodology employed for risk adjustment under 
                        part C or other comparable methodologies the 
                        Secretary deems appropriate;
                            ``(II) data from the Chronic Condition Data 
                        Warehouse under section 723 of the Medicare 
                        Prescription Drug, Improvement, and 
                        Modernization Act of 2003; and
                            ``(III) indicators of geriatric syndromes, 
                        such as experiencing 2 or more falls in the 
                        past year, urinary incontinence, clinically 
                        significant depression, or other such 
                        indicators that the Secretary indicates as 
                        likely to result in high expenditures under 
                        this title when they exist in combination with 
                        one or more chronic conditions).
                    ``(ii) Dementia, as defined in the most recent 
                Diagnostic and Statistical Manual of Mental Disorders, 
                and at least 1 other chronic condition.
                    ``(iii) Any other factor identified by the 
                Secretary.
            ``(B) The Secretary shall consult with physicians, 
        physician groups and organizations, other health care 
        professional groups and organizations, organizations 
        representing individuals with chronic conditions and older 
        adults, and other stakeholders in identifying conditions under 
        clauses (i) and (ii) of subparagraph (A) and any factors under 
        subparagraph (A)(iii).
    ``(3) The term `geriatric assessment eligible individual' shall not 
include the following individuals:
            ``(A) An individual who is receiving hospice care under 
        this title.
            ``(B) An individual who is residing in a skilled nursing 
        facility, a nursing facility (as defined in section 1919), or 
        any other facility identified by the Secretary.
            ``(C) An individual medically determined to have end-stage 
        renal disease.
            ``(D) An individual enrolled in a Medicare Advantage plan 
        or a plan under section 1876.
            ``(E) An individual enrolled in a PACE program under 
        section 1894.
            ``(F) Any other categories of individuals determined 
        appropriate by the Secretary.
    ``(4) For purposes of this subsection, the term `chronic condition' 
means a condition, such as dementia, that lasts or is expected to last 
1 year or longer, limits what an individual can do, and requires 
ongoing care.''.
    (c) Payment and Elimination of Cost-Sharing.--
            (1) Payment and elimination of coinsurance.--Section 
        1833(a)(1) of the Social Security Act (42 U.S.C. 1395l(a)(1)) 
        is amended--
                    (A) in subparagraph (N), by inserting ``other than 
                geriatric assessments (as defined in section 
                1861(hhh)(1))'' after ``(as defined in section 
                1848(j)(3))'';
                    (B) by striking ``and'' before ``(W)''; and
                    (C) by inserting before the semicolon at the end 
                the following: ``, and (X) with respect to geriatric 
                assessments (as defined in section 1861(hhh)(1)), the 
                amount paid shall be 100 percent of the lesser of the 
                actual charge for the services or the amount determined 
                under section 1848(o)''.
            (2) Payment.--
                    (A) In general.--Section 1848 of the Social 
                Security Act (42 U.S.C. 1395w-4) is amended by adding 
                at the end the following new subsection:
    ``(p) Payment for Geriatric Assessments.--
            ``(1) Establishment.--
                    ``(A) In general.--The Secretary shall establish--
                            ``(i) a payment code (or codes) under this 
                        section for a geriatric assessment (as defined 
                        in section 1861(hhh)(1)) furnished to a 
                        geriatric assessment eligible individual (as 
                        defined in section 1861(iii)) by a physician, 
                        practitioner, or other provider described in 
                        section 1861(hhh)(2); and
                            ``(ii) a payment amount for each such code.
                    ``(B) Requirements.--In establishing payment 
                amounts under subparagraph (A)(ii), the Secretary 
                shall--
                            ``(i) take into account--
                                    ``(I) the amount of work required 
                                to perform a geriatric assessment, 
                                including the time and effort put forth 
                                by each qualified health care 
                                professional involved in performing the 
                                geriatric assessment; and
                                    ``(II) all of the costs associated 
                                with the geriatric assessment, 
                                including labor, supplies, equipment, 
                                and the costs of health information 
                                technologies and systems incurred by 
                                the physician, practitioner, or other 
                                provider (as described in section 
                                1861(hhh)(2)) in providing the 
                                assessment; and
                            ``(ii) ensure that such payments do not 
                        result in a reduction in payments for office 
                        visits or other evaluation and management 
                        services that would otherwise be allowable.
            ``(2) Separate payments from payments for chronic care 
        management and coordination services.--Payments for geriatric 
        assessments shall be made separately from payments for chronic 
        care management and coordination services (as defined in 
        section 1861(jjj)(1)) and other services for which payment is 
        made under this title.''.
                    (B) Conforming amendment.--Section 1848(j)(3) of 
                the Social Security Act (42 U.S.C. 1395w-4(j)(3)), as 
                amended by section 111(c)(2)), is amended by inserting 
                ``(2)(FF),'' after ``(2)(EE),''.
            (3) Elimination of coinsurance in outpatient hospital 
        settings.--
                    (A) Exclusion from opd fee schedule.--Section 
                1833(t)(1)(B)(iv) of the Social Security Act (42 U.S.C. 
                1395l(t)(1)(B)(iv)) is amended by striking ``and 
                diagnostic mammography'' and inserting ``, diagnostic 
                mammography, or geriatric assessments (as defined in 
                section 1861(hhh)(1))''.
                    (B) Conforming amendments.--Section 1833(a)(2) of 
                the Social Security Act (42 U.S.C. 1395l(a)(2)) is 
                amended--
                            (i) in subparagraph (F), by striking 
                        ``and'' at the end;
                            (ii) in subparagraph (G)(ii), by striking 
                        the comma at the end and inserting ``; and''; 
                        and
                            (iii) by inserting after subparagraph 
                        (G)(ii) the following new subparagraph:
                    ``(H) with respect to geriatric assessments (as 
                defined in section 1861(hhh)(1)) furnished by an 
                outpatient department of a hospital, the amount 
                determined under paragraph (1)(X),''.
            (4) Elimination of deductible.--The first sentence of 
        section 1833(b) of the Social Security Act (42 U.S.C. 1395l(b)) 
        is amended--
                    (A) by striking ``and'' before ``(9)''; and
                    (B) by inserting before the period the following: 
                ``, and (10) such deductible shall not apply with 
                respect to geriatric assessments (as defined in section 
                1861(hhh)(1))''.
    (d) Frequency Limitation.--Section 1862(a) of the Social Security 
Act (42 U.S.C. 1395y(a)(1)) is amended--
            (1) in paragraph (1)--
                    (A) in subparagraph (N), by striking ``and'' at the 
                end;
                    (B) in subparagraph (O) by striking the semicolon 
                at the end and inserting ``, and''; and
                    (C) by adding at the end the following new 
                subparagraph:
            ``(P) in the case of geriatric assessments (as defined in 
        section 1861(hhh)(1)), which are performed more frequently than 
        is covered under such section;''; and
            (2) in paragraph (7), by striking ``or (K)'' and inserting 
        ``(K), or (P)''.
    (e) Exception to Limits on Physician Referrals.--Section 1877(b) of 
the Social Security Act (42 U.S.C. 1395nn(b)) is amended by adding at 
the end the following new paragraph:
            ``(6) Geriatric assessments.--In the case of a designated 
        health service, if the designated health service is a geriatric 
        assessment (as defined in section 1861(hhh)(1)) and furnished 
        by a physician.''.
    (f) Rulemaking.--The Secretary of Health and Human Services shall 
define such terms, establish such procedures, and promulgate such 
regulations as the Secretary determines necessary to implement the 
amendments made by, and the provisions of, this section, including the 
establishment of additional domains under subsection (hhh)(1)(A)(iv) of 
section 1861 of the Social Security Act, as added by subsection (b). In 
promulgating such regulations, the Secretary shall consult with 
physicians, physician groups and organizations, other health care 
professional groups and organizations representing individuals with 
chronic conditions and older adults.
    (g) Effective Date.--The amendments made by this section shall 
apply to assessments furnished on or after January 1, 2010.

SEC. 112. MEDICARE COVERAGE OF CHRONIC CARE MANAGEMENT AND COORDINATION 
              SERVICES.

    (a) Part B Coverage of Chronic Care Management and Coordination 
Services.--
            (1) In general.--Section 1861(s)(2) of the Social Security 
        Act (42 U.S.C. 1395x(s)(2)), as amended by section 111(a)(1), 
        is amended--
                    (A) in subparagraph (EE), by striking ``and'' at 
                the end;
                    (B) in subparagraph (FF), by adding ``and'' at the 
                end; and
                    (C) by adding at the end the following new 
                subparagraph:
            ``(GG) chronic care management and coordination services 
        (as defined in subsection (jjj));''.
            (2) Conforming amendments.--(A) Clauses (i) and (ii) of 
        section 1861(s)(2)(K) of the Social Security Act (42 U.S.C. 
        1395x(s)(2)(K)), as amended by section 111(a)(2), are each 
        amended by striking ``subsections (ww)(1) and (hhh)(1)'' and 
        inserting ``subsections (ww)(1), (hhh)(1), and (jjj)(1)''.
            (B) Section 1862(a)(7) of the Social Security Act (42 
        U.S.C. 1395y(a)(7)), as amended by section 111(d), is amended 
        by striking ``section 1861(s)(10)'' and inserting ``paragraphs 
        (2)(GG) and (10) of section 1861(s)''.
    (b) Services Described.--Section 1861 of the Social Security Act 
(42 U.S.C. 1395x), as amended by section 111(b), is amended by adding 
at the end the following new subsection:

   ``Chronic Care Management and Coordination Services; Chronic Care 
               Manager; Chronic Care Eligible Individual

    ``(jjj)(1) The term `chronic care management and coordination 
services' means services that are furnished to a chronic care eligible 
individual (as defined in paragraph (3)) by, or under the supervision 
of, a single chronic care manager (as defined in paragraph (2)) chosen 
by the chronic care eligible individual, a caregiver designated by the 
individual in writing, or a representative authorized to make decisions 
on the individual's behalf, under a plan of care prescribed by such 
chronic care manager for the purpose of chronic care coordination, 
including dementia as appropriate, which may include any of the 
following services:
            ``(A) The development of an initial plan of care (based on 
        the results of a geriatric assessment, as defined in subsection 
        (hhh)), and subsequent appropriate revisions to that plan of 
        care.
            ``(B) The management of, and referral for, medical and 
        other health services, including interdisciplinary care 
        conferences and management with other providers.
            ``(C) The monitoring and management of medications.
            ``(D) Patient education and counseling services.
            ``(E) Family caregiver education and counseling services, 
        including preventive care consistent with the patient's 
        condition.
            ``(F) Self-management services, including health education 
        and risk appraisal to identify behavioral risk factors through 
        self-assessment.
            ``(G) Providing access for individuals, and caregivers or 
        authorized representatives as appropriate, by telephone and e-
        mail to physicians or other appropriate health care 
        professionals, including 24-hour availability of such 
        professionals for after hours consultation.
            ``(H) Coordination with the principal nonprofessional 
        caregiver in the home.
            ``(I) Managing and facilitating transitions that occur 
        among health care professionals and across settings of care, 
        including the following:
                    ``(i) Pursuing the treatment option elected by the 
                individual.
                    ``(ii) Including any advance directive executed by 
                the individual in the medical file of the individual.
            ``(J) Information about pain management and palliative 
        care.
            ``(K) Information about, and referral to, hospice care, 
        including patient and family caregiver education and counseling 
        about hospice care, and facilitating transition to hospice care 
        when elected.
            ``(L) Information about, referral to, and coordination 
        with, community resources.
            ``(M) Such additional services for which payment would not 
        otherwise be made under this title that the Secretary may 
        specify that encourage the receipt of, or improve the 
        effectiveness of, the services described in the preceding 
        subparagraphs.
    ``(2)(A) For purposes of this subsection, the term `chronic care 
manager' means an individual or entity that--
            ``(i) is--
                    ``(I) a physician;
                    ``(II) a practitioner described in clause (i) or 
                (iv) of section 1842(b)(18)(C); or
                    ``(III) any other provider that meets such 
                conditions as the Secretary may specify;
            ``(ii) has entered into a chronic care management and 
        coordination agreement with the Secretary; and
            ``(iii) is working in collaboration with, or under the 
        supervision of, as determined by the Secretary--
                    ``(I) the physician, practitioner, or other 
                provider who completed the geriatric assessment of the 
                individual; or
                    ``(II) a physician, practitioner, or other provider 
                to whom the individual's care was transferred by the 
                physician, practitioner, or other provider who 
                performed the geriatric assessment.
    ``(B)(i) For purposes of subparagraph (A)(ii), each chronic care 
management and coordination agreement shall meet the requirements 
described in subparagraph (C) and shall--
            ``(I) subject to clause (ii), be entered into for a period 
        of 3 years and may be renewed if the Secretary is satisfied 
        that the chronic care manager continues to meet such terms and 
        conditions as the Secretary may require; and
            ``(II) contain such other terms and conditions as the 
        Secretary may require.
    ``(ii) Each chronic care management and coordination agreement 
shall provide for the termination of such agreement prior to such 3-
year period in the case where the chronic care manager--
            ``(I) is no longer able to provide chronic care services; 
        or
            ``(II) does not meet such terms and conditions as the 
        Secretary may require.
    ``(C)(i) Subject to clause (ii), the requirements of this 
subparagraph are met if the agreement requires the chronic care manager 
to perform, or provide for the performance of, the following services:
            ``(I) Advocating for, and providing ongoing support, 
        oversight, and guidance with respect to the implementation of a 
        plan of care that provides an integrated, coherent, and cross-
        disciplined plan for ongoing medical care that is developed in 
        partnership with the chronic care eligible individual and all 
        other physicians and other care providers and agencies 
        (including home health agencies) providing care to the chronic 
        care eligible individual.
            ``(II) Using evidence-based medicine and clinical decision 
        support tools to guide decisionmaking at the point of care and 
        on the basis of specific patient factors.
            ``(III) Using health information technology, including, 
        where appropriate, remote monitoring and patient registries, to 
        monitor and track the health status of patients and to provide 
        patients with enhanced and convenient access to health care 
        services.
            ``(IV) Encouraging patients to engage in the management of 
        their own health through education and support systems.
            ``(V) Incorporating family caregivers into the chronic care 
        planning process.
    ``(ii) The Secretary may modify the services required under the 
agreement under clause (i), including by requiring different services 
or services in addition to those described in subclauses (I) through 
(V) of such clause.
    ``(D) The Secretary shall adopt procedures which exempt providers 
in rural areas from providing 1 or more of the services otherwise 
required to be provided under subparagraph (C) or modify such 
requirements for such providers. In establishing such procedures, the 
Secretary shall ensure that such exemptions and modifications do not 
impact the quality of chronic care management and coordination services 
furnished by such providers.
    ``(3) For purposes of this subsection, the term `chronic care 
eligible individual' means a geriatric assessment eligible individual 
(as defined in subsection (iii)) who has undergone a geriatric 
assessment (as defined in subsection (hhh)(1)) which determined that 
the individual would benefit from chronic care management and 
coordination.
    ``(4) Chronic care management and coordination services may be 
furnished in the chronic care eligible individual's home or 
residence.''.
    (c) Payment and Elimination of Cost-Sharing.--
            (1) Payment and elimination of coinsurance.--Section 
        1833(a)(1) of the Social Security Act (42 U.S.C. 1395l(a)(1)), 
        as amended by section 111(c)(1), is amended--
                    (A) in subparagraph (N), by inserting ``or chronic 
                care management and coordination services (as defined 
                in section 1861(jjj)(1))'' after ``other than geriatric 
                assessments (as defined in section 1861(hhh)(1))'';
                    (B) by striking ``and'' before ``(X)''; and
                    (C) by inserting before the semicolon at the end 
                the following: ``, and (Y) with respect to chronic care 
                management and coordination services (as defined in 
                section 1861(jjj)(1)), the amount paid shall be 100 
                percent of the lesser of the actual charge for the 
                services or the amount determined under section 
                1848(p)''.
            (2) Payment.--
                    (A) In general.--Section 1848 of the Social 
                Security Act (42 U.S.C. 1395w-4), as amended by section 
                111(c)(2), is amended by adding at the end the 
                following new subsection:
    ``(q) Payment for Chronic Care Management and Coordination 
Services.--
            ``(1) Establishment.--
                    ``(A) In general.--The Secretary shall establish--
                            ``(i) a payment code (or codes) under this 
                        section for chronic care management and 
                        coordination services (as defined in paragraph 
                        (1) of section 1861(jjj)) furnished to a 
                        chronic care eligible individual (as defined in 
                        paragraph (3) of such section) by a chronic 
                        care manager (as defined in paragraph (2) of 
                        such section); and
                            ``(ii) a payment amount for each such code.
                    ``(B) Requirements.--In establishing payment 
                amounts under subparagraph (A)(ii), the Secretary 
                shall--
                            ``(i) take into account--
                                    ``(I) the amount of work required 
                                of the chronic care manager in 
                                providing chronic care management and 
                                coordination services to eligible 
                                individuals; and
                                    ``(II) all of the costs associated 
                                with providing chronic care management 
                                and coordination services, including 
                                labor, supplies, equipment, and the 
                                costs of health information 
                                technologies and systems incurred by 
                                the chronic care manager in providing 
                                such services;
                            ``(ii) ensure that such payments are for 
                        such services furnished during a 30-day period; 
                        and
                            ``(iii) ensure that such payments do not 
                        result in a reduction in payments for office 
                        visits or other evaluation and management 
                        services that would otherwise be allowable.
            ``(2) Separate payments from payments for geriatric 
        assessments.--Payments for chronic care management and 
        coordination services shall be made separately from payments 
        for geriatric assessments (as defined in section 1861(hhh)(1)) 
        and other services for which payment is made under this 
        title.''.
                    (B) Conforming amendment.--Section 1848(j)(3) of 
                the Social Security Act (42 U.S.C. 1395w-4(j)(3)), as 
                amended by section 111(c)(2)), is amended by inserting 
                ``(2)(GG),'' after ``(2)(FF),''.
            (3) Elimination of coinsurance in outpatient hospital 
        settings.--
                    (A) Exclusion from opd fee schedule.--Section 
                1833(t)(1)(B)(iv) of the Social Security Act (42 U.S.C. 
                1395l(t)(1)(B)(iv)), as amended by section 
                111(c)(3)(A), is amended by striking ``or geriatric 
                assessments (as defined in section 1861(hhh)(1))'' and 
                inserting ``geriatric assessments (as defined in 
                section 1861(hhh)(1)), or chronic care management and 
                coordination services (as defined in section 
                1861(jjj)(1))''.
                    (B) Conforming amendments.--Section 1833(a)(2) of 
                the Social Security Act (42 U.S.C. 1395l(a)(2)), as 
                amended by section 111(c)(3)(B), is amended--
                            (i) in subparagraph (G)(ii), by striking 
                        ``and'' at the end;
                            (ii) in subparagraph (H), by striking the 
                        comma at the end and inserting ``; and''; and
                            (iii) by inserting after subparagraph (H) 
                        the following new subparagraph:
                    ``(I) with respect to chronic care management and 
                coordination services (as defined in section 
                1861(jjj)(1)) furnished by an outpatient department of 
                a hospital, the amount determined under paragraph 
                (1)(Y),''.
            (4) Elimination of deductible.--Paragraph (10) of section 
        1833(b) of the Social Security Act (42 U.S.C. 1395l(b)), as 
        added by section 111(c)(4), is amended by inserting ``or 
        chronic care management and coordination services (as defined 
        in section 1861(jjj)(1))'' after ``geriatric assessments (as 
        defined in section 1861(hhh)(1))''.
    (d) Exception to Limits on Physician Referrals.--Section 1877(b)(6) 
of the Social Security Act (42 U.S.C. 1395nn(b)(6)), as amended by 
section 111(e), is amended to read as follows:
            ``(6) Geriatric assessments and chronic care management and 
        coordination services.--In the case of a designated health 
        service, if the designated health service is--
                    ``(A) a geriatric assessment or a chronic care 
                management and coordination service (as defined in 
                subsections (hhh)(1) or (jjj)(1) of section 1861, 
                respectively); and
                    ``(B) furnished by a physician.''.
    (e) Rulemaking.--The Secretary of Health and Human Services shall 
define such terms, establish such procedures, and promulgate such 
regulations as the Secretary determines necessary to implement the 
amendments made by, and the provisions of, this section. In 
promulgating such regulations, the Secretary shall consult with 
physicians, physician groups and organizations, other health care 
professional groups and organizations, and organizations representing 
individuals with chronic conditions and older adults.
    (f) Effective Date.--The amendments made by this section shall 
apply to chronic care management and coordination services furnished on 
or after January 1, 2010.

SEC. 113. OUTREACH ACTIVITIES REGARDING GERIATRIC ASSESSMENTS AND 
              CHRONIC CARE MANAGEMENT AND COORDINATION SERVICES UNDER 
              THE MEDICARE PROGRAM.

    The Secretary of Health and Human Services shall conduct outreach 
activities to individuals likely to be eligible to receive coverage of 
geriatric assessments (as defined in subsection (hhh)(1) of section 
1861 of the Social Security Act, as added by section 111) under the 
Medicare program and individuals likely to be eligible to receive 
coverage of chronic care management and coordination services (as 
defined in subsection (jjj)(1) of such section 1861, as added by 
section 112) under the Medicare program, to inform such individuals 
about the availability of such benefits 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.

    (a) In General.--Section 1834(m)(4)(F) of the Social Security Act 
(42 U.S.C. 1395m(m)(4)(F)) is amended by adding at the end the 
following new clause:
                            ``(iii) Geriatric assessments and chronic 
                        care management and coordination services.--The 
                        term `telehealth service' shall also include 
                        geriatric assessments (as defined in section 
                        1861(hhh)(1)) and chronic care management and 
                        coordination services (as defined in section 
                        1861(jjj)).''.
    (b) Effective Date.--The amendments made by this section shall 
apply to services furnished on or after January 1, 2010.

SEC. 115. STUDY AND REPORT ON GERIATRIC ASSESSMENTS AND CHRONIC CARE 
              MANAGEMENT AND COORDINATION SERVICES UNDER THE MEDICARE 
              PROGRAM.

    (a) Study.--The Secretary of Health and Human Services shall enter 
into a contract with an entity to conduct a study on--
            (1) the effectiveness of the coverage of geriatric 
        assessments and chronic care management and coordination 
        services, including an evaluation of the use of 
        interdisciplinary teams in providing such services, under the 
        Medicare program (under the amendments made by sections 3 and 
        4) on improving the quality of care provided to Medicare 
        beneficiaries with chronic conditions, including dementia; and
            (2) the impact of such geriatric assessments and care 
        coordination services on reducing expenditures under title 
        XVIII of the Social Security Act, including reduced 
        expenditures that may result from--
                    (A) reducing preventable hospital admissions;
                    (B) more appropriate use of pharmaceuticals; and
                    (C) reducing duplicate or unnecessary tests.
    (b) Report.--Not later than 3 years after the date of enactment of 
this Act, the entity conducting the study under subsection (a) shall 
submit to Congress and the Secretary of Health and Human Services a 
report on the study, together with recommendations for such legislation 
or administrative action as such entity determines appropriate.
    (c) Authorization of Appropriations.--There are authorized to be 
appropriated such sums as may be necessary to carry out this section.

SEC. 116. RULE OF CONSTRUCTION.

    Nothing in the provisions of, or in the amendments made by, this 
subtitle shall be construed as requiring an individual to receive a 
geriatric assessment (as defined in section 1861(hhh)(1) of the Social 
Security Act, as added by section 111(b)) or chronic care management 
and coordination services (as defined in section 1861(jjj)(1) of such 
Act, as added by section 112(b)).

         TITLE II--AMENDMENTS TO THE PUBLIC HEALTH SERVICE ACT

SEC. 201. EXPANSION OF NATIONAL HEALTH SERVICE CORPS PROGRAMS.

    (a) In General.--Section 338H of the Public Health Service Act (42 
U.S.C. 254q) is amended--
            (1) in subsection (a), by striking paragraphs (1) through 
        (5) and inserting the following:
            ``(1) for fiscal year 2009, $165,000,000;
            ``(2) for fiscal year 2010, $198,000,000;
            ``(3) for fiscal year 2011, $231,000,000;
            ``(4) for fiscal year 2012, $264,000,000;
            ``(5) for fiscal year 2013, $297,000,000; and
            ``(6) for fiscal year 2014, $330,000,000.''; and
            (2) by adding at the end the following:
    ``(d) Expansion of Programs.--The Secretary shall use amounts 
appropriated for each of fiscal years 2010 through 2014 under 
subsection (a), that are in excess of the amount appropriated under 
such subsection for fiscal year 2009, to address shortages of health 
professionals in rural, frontier, and urban underserved areas through 
an expansion of the number of scholarships and loan repayments under 
this subpart to address health workforce shortages in health 
professional shortage areas (as defined in section 332), in medically 
underserved communities (as defined in section 799B), or with respect 
to medically underserved populations (as defined in section 
330(b)(3)).''.
    (b) Expansion of Other Programs.--The Director of the Indian Health 
Service, the Secretary of Defense, and the Secretary of Veterans 
Affairs, shall expand existing loan repayment programs to emphasize the 
provision of health professions services to facilities that have health 
professional shortages.
    (c) No Tax Implications.--
            (1) In general.--For purposes of the Internal Revenue Code 
        of 1986, any amount received under a health-related Federal 
        loan repayment program by a health professional providing 
        health-related services in a Federal medical facility shall not 
        be included in the gross income of such professional.
            (2) Definition.--In this subsection, the term ``Federal 
        medical facility'' means a facility for the delivery of health 
        services, and includes--
                    (A) a federally qualified health center (as defined 
                in section 330A of the Public Health Service Act (42 
                U.S.C. 254c)), a public health center, an outpatient 
                medical facility, or a community mental health center;
                    (B) a hospital, State mental hospital, facility for 
                long-term care, or rehabilitation facility;
                    (C) a migrant health center or an Indian Health 
                Service facility;
                    (D) a facility for the delivery of health services 
                to inmates in a penal or correctional institution 
                (under section 323 of such Act (42 U.S.C. 250)) or a 
                State correctional institution;
                    (E) a Public Health Service medical facility (used 
                in connection with the delivery of health services 
                under section 320, 321, 322, 324, 325, or 326 of such 
                Act (42 U.S.C. 247e, 248, 249, 251, 252, or 253));
                    (F) a nurse-managed health center; or
                    (G) any other Federal medical facility.
    (d) Reduced Loan Support for Part Time Practitioners.--Section 338C 
of the Public Health Service Act (42 U.S.C. 254m) is amended by adding 
at the end the following:
    ``(e) Notwithstanding any other provision of this subpart, the 
Secretary shall develop procedures to permit periods of obligated 
services to be provided on a part-time basis (not less than 1,040 hours 
of such service per year). Such procedures shall prohibit an individual 
from holding other part-time employment while providing such part-time 
obligated services. The Secretary may provide for a reduction in the 
loan repayments provided to individuals who provide part-time obligated 
services under the authority provided under this subsection.''.
    (e) Loan Support for Participating Preceptors, Mentors, and 
Attendings To Supervise Students and Trainees On-site.--Section 338C of 
the Public Health Service Act (42 U.S.C. 254m), as amended by 
subsection (d), is further amended by adding at the end the following:
    ``(f) The Secretary shall develop procedures to permit up to 20 
percent of the service obligation of an individual under this section 
to be provided by the individual through precepting or mentoring 
activities, or by preparing curriculum, for on-site students and 
trainees. The procedures developed under subsection (e) shall provide 
for the proportional application of this subsection with respect to 
individual providing obligated service on a part-time basis.''.

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.

    (a) Program Authorized.--
            (1) In general.--Subpart III of part D of title III of the 
        Public Health Service Act (42 U.S.C. 254l et seq.) is amended--
                    (A) in the heading by inserting ``, 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,'' after 
                ``Scholarship Program''; and
                    (B) by inserting after section 338A the following:

``SEC. 338A-1. 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.

    ``(a) Establishment.--
            ``(1) In general.--The Secretary shall establish a program 
        to be known as the 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 (in this section referred to as the `U.S. 
        Public Health Sciences Track Scholarship Program') to ensure, 
        with respect to the provision of high-needs health care 
        services, including primary care, general dentistry, nursing, 
        obstetrics, and geriatricians pursuant to section 331(a)(2), an 
        adequate supply of physicians, physician assistants, 
        pharmacists, behavioral and mental health professionals, public 
        health professionals, dentists, and nurses. The purpose of this 
        program is to train an additional 150 medical students, 100 
        dental students, 100 physician assistant students, 100 
        behavioral and mental health students, 100 public health 
        students, and 250 nursing students during each year. Of the 150 
        scholarships awarded to the medical students as described under 
        the preceding sentence, 10 shall be for training at the 
        Uniformed Services University of the Health Sciences as members 
        of the Commissioned Corps of the Public Health Service.
            ``(2) Relationship to national health service corps 
        scholarship program.--Scholarships provided under this section 
        are intended to complement, and not take the place of, 
        scholarships provided to students enrolled in courses of study 
        leading to a degree in medicine, osteopathic medicine, 
        dentistry, or nursing or completion of an accredited physician 
        assistant, pharmacy, public health, or behavioral and mental 
        health educational program under the National Health Service 
        Corps Scholarship Program authorized by section 338A.
    ``(b) Eligibility.--To be eligible to participate in the U.S. 
Public Health Sciences Track Scholarship and Grants Program, an 
individual shall--
            ``(1) be accepted for enrollment as a full-time student--
                    ``(A) in an accredited (as determined by the 
                Secretary) educational institution in a State; and
                    ``(B) in a course of study, or program, offered by 
                such institution leading to a degree in medicine, 
                osteopathic medicine, dentistry, physician assistant, 
                pharmacy, behavioral and mental health, public health, 
                or nursing;
            ``(2) be eligible for, or hold, an appointment as a 
        commissioned officer in the Regular or Reserve Corps of the 
        Service or be eligible for selection for civilian service in 
        the Corps;
            ``(3) submit an application to participate in the U.S. 
        Public Health Sciences Track Scholarship and Grants Program; 
        and
            ``(4) sign and submit to the Secretary, at the time of 
        submittal of such application, a written contract to accept 
        payment of a scholarship and to serve (in accordance with this 
        subpart) for the applicable period of obligated service in an 
        area in which the need for public health-related services may 
        be demonstrated.''.
            (2) No tax implications.--For purposes of the Internal 
        Revenue Code of 1986, any amount received under the National 
        Health Service Corps Scholarship Program for Medical, Dental 
        and Nursing Students in the United States Public Health 
        Sciences Track in Affiliated Schools under section 338A-1 of 
        the Public Health Service Act, as added by paragraph (1), by a 
        medical student, dental student, or nursing student shall not 
        be included in the gross income of such student.
    (b) Grants To Increase the Number of Available Slots for Newly 
Admitted Medical, Dental, Physician Assistant, Pharmacy, Behavioral and 
Mental Health, Public Health, and Nursing Students and To Increase 
Participation in the U.S. Public Health Sciences Track Scholarship 
Program.--Part C of title VII of the Public Health Service Act (42 
U.S.C. 293k et seq.) is amended by adding at the end the following:

``SEC. 749. GRANTS TO INCREASE THE NUMBER OF AVAILABLE SLOTS FOR NEWLY 
              ADMITTED MEDICAL, DENTAL, PHYSICIAN ASSISTANT, PHARMACY, 
              BEHAVIORAL AND MENTAL HEALTH, PUBLIC HEALTH, AND NURSING 
              STUDENTS AND TO INCREASE PARTICIPATION IN THE U.S. PUBLIC 
              HEALTH SCIENCES TRACK SCHOLARSHIP PROGRAM.

    ``(a) Program Authorized.--The Secretary may make grants to 
medical, dental, public health, and nursing schools and physician 
assistant, pharmacy, and behavioral and mental health programs for the 
following purposes:
            ``(1) To increase the capacity of the recipient medical, 
        dental, public health, or nursing school or physician 
        assistant, pharmacy, or behavioral and mental health program, 
        to accept additional medical, dental, public health, nursing, 
        physician assistant, pharmacy, or behavioral and mental health 
        students each year.
            ``(2) To develop curriculum.
            ``(3) To acquire equipment.
            ``(4) To recruit, train, and retain faculty.
            ``(5) To provide assistance to students who have completed 
        a course of study at the recipient medical, dental, public 
        health, or nursing school or physician assistant, pharmacy, or 
        behavioral and mental health program during the period in which 
        such students are completing a residency or internship program 
        affiliated with the recipient institution.
    ``(b) Application.--A medical, dental, public health, or nursing 
school or physician assistant, pharmacy, or behavioral and mental 
health program seeking a grant under this section shall submit an 
application to the Secretary at such time, in such manner, and 
containing such information as the Secretary may require.
    ``(c) Definition of Medical School.--In this section, the term 
`medical school' means a school of medicine or a school of osteopathic 
medicine.''.

SEC. 203. FEDERAL MEDICAL FACILITY GRANT PROGRAM AND PROGRAM 
              ASSESSMENTS.

    (a) Federal Medical Facility Grant Program.--Title VII of the 
Public Health Service Act (42 U.S.C. 292 et seq.) is amended--
            (1) by redesignating part F as part G; and
            (2) by inserting after part E, the following:

``PART F--START-UP EXPENSES LOAN AND GRANT PROGRAMS FOR FEDERAL MEDICAL 
  FACILITIES AND HOSPITALS STARTING HIGH NEEDS RESIDENCY PROGRAMS IN 
                             SHORTAGE AREAS

``SEC. 781. FEDERAL MEDICAL FACILITY GRANT PROGRAM.

    ``(a) In General.--The Secretary shall award grants to eligible 
facilities to increase interdisciplinary, community-based health 
professions training in high-needs specialties for physicians, nurses, 
dentists, physician assistants, pharmacy, behavioral and mental health 
professionals, public health professionals, and other health 
professionals as determined appropriate by the Secretary, in 
consultation with the Permanent National Health Workforce Commission 
established under section 101(a) of the Health Access and Health 
Professions Supply Act of 2009.
    ``(b) Eligible Facilities; Application.--
            ``(1) Definition of eligible facility.--In this section, 
        the term `eligible facility'--
                    ``(A) means a facility which--
                            ``(i) is located in a health professional 
                        shortage area (as defined in section 332);
                            ``(ii) is located in a medically 
                        underserved community (as defined in section 
                        799B), or with respect to a medically 
                        underserved population (as defined in section 
                        330(b)(3));
                            ``(iii) is a Federal medical facility;
                            ``(iv) is an area health education center, 
                        a health education and training center, or a 
                        participant in the Quentin N. Burdick program 
                        for rural interdisciplinary training, that meet 
                        the requirements established by the Secretary; 
                        or
                            ``(v) is establishing new residency 
                        programs in a specialty which the Secretary, in 
                        consultation with the Permanent National Health 
                        Workforce Commission established under section 
                        101(a) of the Health Access and Health 
                        Professions Supply Act of 2009, determines is 
                        in high-need; and
                    ``(B) includes Medicare certified Federally 
                Qualified Health Centers, community health centers, 
                health care for the homeless centers, rural health 
                centers, migrant health centers, Indian Health Service 
                entities, urban Indian centers, health clinics and 
                hospitals operated by the Indian Health Service, Indian 
                tribes and tribal organizations, and urban Indian 
                organizations (as defined in section 4 of the Indian 
                Health Care Improvement Act), and other Federal medical 
                facilities).
            ``(2) Application.--An eligible facility desiring a grant 
        under subsection (a) shall submit to the Secretary an 
        application at such time, in such manner, and containing such 
        information as the Secretary may require.
    ``(c) Use of Funds.--An eligible facility shall use amounts 
received under a grant under subsection (a) to promote--
            ``(1) the training of health professionals in 
        interdisciplinary, community-based settings that are affiliated 
        with hospitals and other health care facilities and teaching 
        institutions;
            ``(2) community development programs that assure a diverse 
        health professions workforce through emphasis on individuals 
        from rural and frontier areas and underrepresented minority 
        groups;
            ``(3) the development of a reliable health professions 
        pipeline that provides an emphasis on health-related careers in 
        schools (such as schools participating in the Health Careers 
        Opportunities Program) and centers of excellence, and that 
        encourage individuals in underrepresented minorities (including 
        Hispanic, African-American, American Indian, and Alaska Native 
        individuals) to pursue health professions careers;
            ``(4) the reduction of health professional isolation in 
        rural, frontier, and urban underserved areas through the 
        provision of continuing education, mentoring, and precepting 
        activities, field faculty development, and the utilization of 
        technology such as telehealth and electronic health records;
            ``(5) the establishment and operation of regional or 
        statewide health advice telephone lines to reduce after-hours 
        call responsibilities for overworked health professionals who 
        provide services in remote areas that have few health 
        professionals taking such after-hours calls;
            ``(6) an increase in the number of professionals taking 
        after-hours calls in hospitals and emergency departments in 
        health professional shortage areas (as defined in section 332), 
        in medically underserved communities (as defined in section 
        799B), or with respect to medically underserved populations (as 
        defined in section 330(b)(3));
            ``(7) the establishment and operation of relief programs 
        that provide health professionals practicing in health 
        professional shortage areas (as defined in section 332) with 
        patient and call coverage when such professionals are ill, are 
        pursuing continuing education, or are taking a vacation; and
            ``(8) the exposure of health professions residents to 
        systems of health care that represent the contemporary American 
        healthcare delivery program (such as `P4' Prepare the Personal 
        Physician for Practice and the `Health Commons' programs).
    ``(d) Subgrants.--An eligible facility may use amounts received 
under a grant under this section to award subgrants to States and other 
entities determined appropriate by the Secretary to carry out the 
activities described in subsection (c).
    ``(e) Set Aside.--In awarding grants under this section, the 
Secretary shall ensure that a total of $500,000 is awarded annually for 
the activities of the National Rural Recruitment and Retention Network, 
or a similar entity.
    ``(f) Definition of Federal Medical Facility.--In this section, the 
term `Federal medical facility' means a facility for the delivery of 
health services, and includes--
            ``(1) a federally qualified health center (as defined in 
        section 330A), a public health center, an outpatient medical 
        facility, or a community mental health center;
            ``(2) a hospital, State mental hospital, facility for long-
        term care, or rehabilitation facility;
            ``(3) a migrant health center or an Indian Health Service 
        facility;
            ``(4) a facility for the delivery of health services to 
        inmates in a penal or correctional institution (under section 
        323) or a State correctional institution;
            ``(5) a Public Health Service medical facility (used in 
        connection with the delivery of health services under section 
        320, 321, 322, 324, 325, or 326)); or
            ``(6) any other Federal medical facility.
    ``(g) Authorization of Appropriations.--There are authorized to be 
appropriated to carry out this section, $623,000,000 for fiscal year 
2009, $666,000,000 for fiscal year 2010, $675,000,000 for fiscal year 
2011, $700,000,000 for fiscal year 2012, and $725,000,000 for fiscal 
year 2013.''.
    (b) Assessments.--
            (1) Establishment.--The Secretary of Health and Human 
        Services (referred to in this section as the ``Secretary'') 
        shall establish program assessment rating tools for each 
        program funded through titles VII and VIII of the Public Health 
        Service Act (42 U.S.C. 292 and 296 et seq.).
            (2) Criteria.--The Secretary, in consultation with the 
        Administrator of the Health Resources and Services 
        Administration and other appropriate public and private 
        stakeholders, shall, through negotiated rulemaking, establish 
        criteria for the conduct of the assessments under paragraph 
        (2).
            (3) Annual assessments.--The Secretary shall annually enter 
        into a contract with an independent nongovernmental entity for 
        the conduct of an assessment, using the tools established under 
        paragraph (1) and the criteria established under paragraph (2), 
        of not less than 20 percent, nor more than 25 percent, of the 
        programs carried out under titles VII and VIII of the Public 
        Health Service Act, so that every program under such titles is 
        assessed at least once during every 5-year period.

SEC. 204. HEALTH PROFESSIONS TRAINING LOAN PROGRAM.

    Part F of title VII of the Public Health Service Act (as added by 
section 203) is amended by adding at the end the following

``SEC. 782. ESTABLISHMENT.

    ``(a) In General.--The Secretary shall establish a program under 
which the Secretary shall award interest-free loans to--
            ``(1) eligible hospitals to enable such hospitals to 
        establish training programs in high-need specialties; and
            ``(2) eligible non-hospital community-based entities to 
        enable such entities to establish health professions training 
        programs.
    ``(b) Eligibility.--
            ``(1) In general.--To be eligible to receive a loan under 
        subsection (a)--
                    ``(A) a hospital shall--
                            ``(i) be located in a health professional 
                        shortage area (as such term is defined in 
                        section 332);
                            ``(ii) comply with the requirements of 
                        paragraph (2); and
                            ``(iii) submit to the Secretary an 
                        application at such time, in such manner, and 
                        containing such information as the Secretary 
                        may require; or
                    ``(B) a non-hospital community-based entity shall--
                            ``(i) comply with the requirements of 
                        paragraph (2); and
                            ``(ii) submit to the Secretary an 
                        application at such time, in such manner, and 
                        containing such information as the Secretary 
                        may require.
            ``(2) Requirements.--To be eligible to receive a loan under 
        subsection (a), a hospital or non-hospital community-based 
        entity shall--
                    ``(A) on the date on which the entity submits the 
                loan application, not operate a residency with respect 
                to a high-needs specialty (as determined by the 
                Secretary in consultation with the Permanent National 
                Health Workforce Commission established under section 
                101(a) of the Health Access and Health Professions 
                Supply Act of 2009) or provide a health professions 
                training program, as the case may be;
                    ``(B) have received appropriate preliminary 
                accreditation from the relevant accrediting agency 
                (American Council for Graduate Medical Education, 
                American Osteopathic Association, or Dental, Physician 
                Assistant, Pharmacy, Behavioral and Mental Health, 
                Public Health, and Nursing accrediting agencies), as 
                determined by the Secretary; and
                    ``(C) execute a signed formal contract under which 
                the hospital or entity agree to repay the loan.
    ``(c) Use of Loan Funds.--Amounts received under a loan under 
subsection (a) shall be used only for--
            ``(1) the salary and fringe benefit expenses of residents, 
        students, trainees, and faculty, or other costs directly 
        attributable to the residency, educational, or training program 
        to be carried out under the loan, as specified by the 
        Secretary; or
            ``(2) facility construction or renovation, including 
        equipment purchase.
    ``(d) Priority.--In awarding loans under subsection (a), the 
Secretary shall give priority to applicants that are located in health 
professional shortage areas (as defined in section 332) or in medically 
underserved communities (as defined in section 799B), or that serve 
medically underserved populations (as defined in section 330(b)(3)).
    ``(e) Loan Provisions.--
            ``(1) Loan contract.--The loan contract entered into under 
        subsection (b)(2) shall contain terms that provide for the 
        repayment of the loan, including the number and amount of 
        installment payments as described in such contract. Such 
        repayment shall begin on the date that is 24 months after the 
        date on which the loan contract is executed and shall be fully 
        repaid not later than 36 months after the date of the first 
        payment.
            ``(2) Interest.--Loans under this section shall be repaid 
        without interest.
    ``(f) Limitation.--The amount of a loan under this section with 
respect to each of the uses described in subsection (c)(1) or (c)(2) 
shall not exceed $2,000,000.
    ``(g) Failure To Repay.--A hospital or non-hospital community-based 
entity that fails to comply with the terms of a contract entered into 
under subsection (b)(2) shall be liable to the United States for the 
amount which has been paid to such hospital or entity under the 
contract.
    ``(h) Authorization of Appropriations.--There is authorized to be 
appropriated, such sums as may be necessary to carry out this 
section.''.

SEC. 205. UNITED STATES PUBLIC HEALTH SCIENCES TRACK.

    Title II of the Public Health Service Act (42 U.S.C. 202 et seq.) 
is amended by adding at the end the following:

          ``PART D--UNITED STATES PUBLIC HEALTH SCIENCES TRACK

``SEC. 271. ESTABLISHMENT.

    ``(a) United States Public Health Services Track.--
            ``(1) In general.--There is hereby authorized to be 
        established a United States Public Health Sciences Track 
        (referred to in this part as the `Track'), at sites to be 
        selected by the Secretary, with authority to grant appropriate 
        advanced degrees in a manner that uniquely emphasizes team-
        based service, public health, epidemiology, and emergency 
        preparedness and response. It shall be so organized as to 
        graduate not less than--
                    ``(A) 150 medical students annually;
                    ``(B) 100 dental students annually;
                    ``(C) 250 nursing students annually;
                    ``(D) 100 public health students annually;
                    ``(E) 100 behavioral and mental health professional 
                students annually;
                    ``(F) 100 physician assistant or nurse practitioner 
                students annually; and
                    ``(G) 50 pharmacy students annually.
            ``(2) Locations.--The Track shall be located at existing 
        and accredited, affiliated health professions education 
        training programs at academic health centers located in regions 
        of the United States determined appropriate by the Surgeon 
        General, in consultation with the Permanent National Health 
        Workforce Commission.
    ``(b) Number of Graduates.--Except as provided in subsection (a), 
the number of persons to be graduated from the Track shall be 
prescribed by the Secretary. In so prescribing the number of persons to 
be graduated from the Track, the Secretary shall institute actions 
necessary to ensure the maximum number of first-year enrollments in the 
Track consistent with the academic capacity of the affiliated sites and 
the needs of the United States for medical, dental, and nursing 
personnel.
    ``(c) Development.--The development of the Track may be by such 
phases as the Secretary may prescribe subject to the requirements of 
subsection (a).
    ``(d) Integrated Longitudinal Plan.--The Surgeon General shall 
develop an integrated longitudinal plan for health professions 
continuing education throughout the continuum of health-related 
education, training, and practice. Training under such plan shall 
emphasize patient-centered, interdisciplinary, and care coordination 
skills. Experience with deployment of emergency response teams shall be 
included during the clinical experiences.
    ``(e) Faculty Development.--The Surgeon General shall develop 
faculty development programs and curricula in decentralized venues of 
health care, to balance urban, tertiary, and inpatient venues.

``SEC. 272. ADMINISTRATION.

    ``(a) In General.--The business of the Track shall be conducted by 
the Surgeon General with funds appropriated for and provided by the 
Department of Health and Human Services. The Permanent National Health 
Workforce Commission shall assist the Surgeon General in an advisory 
capacity.
    ``(b) Faculty.--
            ``(1) In general.--The Surgeon General, after considering 
        the recommendations of the Permanent National Health Workforce 
        Commission, shall obtain the services of such professors, 
        instructors, and administrative and other employees as may be 
        necessary to operate the Track, but utilize when possible, 
        existing affiliated health professions training institutions. 
        Members of the faculty and staff shall be employed under salary 
        schedules and granted retirement and other related benefits 
        prescribed by the Secretary so as to place the employees of the 
        Track faculty on a comparable basis with the employees of fully 
        accredited schools of the health professions within the United 
        States.
            ``(2) Titles.--The Surgeon General may confer academic 
        titles, as appropriate, upon the members of the faculty.
            ``(3) Nonapplication of provisions.--The limitations in 
        section 5373 of title 5, United States Code, shall not apply to 
        the authority of the Surgeon General under paragraph (1) to 
        prescribe salary schedules and other related benefits.
    ``(c) Agreements.--The Surgeon General may negotiate agreements 
with agencies of the Federal Government to utilize on a reimbursable 
basis appropriate existing Federal medical resources located in the 
United States (or locations selected in accordance with section 
271(a)(2)). Under such agreements the facilities concerned will retain 
their identities and basic missions. The Surgeon General may negotiate 
affiliation agreements with accredited universities and health 
professions training institutions in the United States. Such agreements 
may include provisions for payments for educational services provided 
students participating in Department of Health and Human Services 
educational programs.
    ``(d) Programs.--The Surgeon General may establish the following 
educational programs for Track students:
            ``(1) Postdoctoral, postgraduate, and technological 
        institutes.
            ``(2) A graduate school of nursing.
            ``(3) Other schools or programs that the Surgeon General 
        determines necessary in order to operate the Track in a cost-
        effective manner.
    ``(e) Continuing Medical Education.--The Surgeon General shall 
establish programs in continuing medical education for members of the 
health professions to the end that high standards of health care may be 
maintained within the United States.
    ``(f) Authority of the Surgeon General.--
            ``(1) In general.--The Surgeon General is authorized--
                    ``(A) to enter into contracts with, accept grants 
                from, and make grants to any nonprofit entity for the 
                purpose of carrying out cooperative enterprises in 
                medical, dental, physician assistant, pharmacy, 
                behavioral and mental health, public health, and 
                nursing research, consultation, and education;
                    ``(B) to enter into contracts with entities under 
                which the Surgeon General may furnish the services of 
                such professional, technical, or clerical personnel as 
                may be necessary to fulfill cooperative enterprises 
                undertaken by the Track;
                    ``(C) to accept, hold, administer, invest, and 
                spend any gift, devise, or bequest of personal property 
                made to the Track, including any gift, devise, or 
                bequest for the support of an academic chair, teaching, 
                research, or demonstration project;
                    ``(D) to enter into agreements with entities that 
                may be utilized by the Track for the purpose of 
                enhancing the activities of the Track in education, 
                research, and technological applications of knowledge; 
                and
                    ``(E) to accept the voluntary services of guest 
                scholars and other persons.
            ``(2) Limitation.--The Surgeon General may not enter into 
        any contract with an entity if the contract would obligate the 
        Track to make outlays in advance of the enactment of budget 
        authority for such outlays.
            ``(3) Scientists.--Scientists or other medical, dental, or 
        nursing personnel utilized by the Track under an agreement 
        described in paragraph (1) may be appointed to any position 
        within the Track and may be permitted to perform such duties 
        within the Track as the Surgeon General may approve.
            ``(4) Volunteer services.--A person who provides voluntary 
        services under the authority of subparagraph (E) of paragraph 
        (1) shall be considered to be an employee of the Federal 
        Government for the purposes of chapter 81 of title 5, relating 
        to compensation for work-related injuries, and to be an 
        employee of the Federal Government for the purposes of chapter 
        171 of title 28, relating to tort claims. Such a person who is 
        not otherwise employed by the Federal Government shall not be 
        considered to be a Federal employee for any other purpose by 
        reason of the provision of such services.

``SEC. 273. STUDENTS; SELECTION; OBLIGATION.

    ``(a) Student Selection.--
            ``(1) In general.--Medical, dental, physician assistant, 
        pharmacy, behavioral and mental health, public health, and 
        nursing students at the Track shall be selected under 
        procedures prescribed by the Surgeon General. In so 
        prescribing, the Surgeon General shall consider the 
        recommendations of the Permanent National Health Workforce 
        Commission.
            ``(2) Priority.--In developing admissions procedures under 
        paragraph (1), the Surgeon General shall ensure that such 
        procedures give priority to applicant medical, dental, 
        physician assistant, pharmacy, behavioral and mental health, 
        public health, and nursing students from rural communities and 
        underrepresented minorities.
    ``(b) Contract and Service Obligation.--
            ``(1) Contract.--Upon being admitted to the Track, a 
        medical, dental, physician assistant, pharmacy, behavioral and 
        mental health, public health, or nursing student shall enter 
        into a written contract with the Surgeon General that shall 
        contain--
                    ``(A) an agreement under which--
                            ``(i) subject to subparagraph (B), the 
                        Surgeon General agrees to provide the student 
                        with tuition (or tuition remission) and a 
                        student stipend (described in paragraph (2)) in 
                        each school year for a period of years (not to 
                        exceed 4 school years) determined by the 
                        student, during which period the student is 
                        enrolled in the Track at an affiliated or other 
                        participating health professions institution 
                        pursuant to an agreement between the Track and 
                        such institution; and
                            ``(ii) subject to subparagraph (B), the 
                        student agrees--
                                    ``(I) to accept the provision of 
                                such tuition and student stipend to the 
                                student;
                                    ``(II) to maintain enrollment at 
                                the Track until the student completes 
                                the course of study involved;
                                    ``(III) while enrolled in such 
                                course of study, to maintain an 
                                acceptable level of academic standing 
                                (as determined by the Surgeon General);
                                    ``(IV) if pursuing a degree from a 
                                school of medicine or osteopathic 
                                medicine, dental, public health, or 
                                nursing school or a physician 
                                assistant, pharmacy, or behavioral and 
                                mental health professional program, to 
                                complete a residency or internship in a 
                                specialty that the Surgeon General 
                                determines is appropriate; and
                                    ``(V) to serve for a period of time 
                                (referred to in this part as the 
                                `period of obligated service') within 
                                the Commissioned Corps of the Public 
                                Health Service equal to 2 years for 
                                each school year during which such 
                                individual was enrolled at the College, 
                                reduced as provided for in paragraph 
                                (3);
                    ``(B) a provision that any financial obligation of 
                the United States arising out of a contract entered 
                into under this part and any obligation of the student 
                which is conditioned thereon, is contingent upon funds 
                being appropriated to carry out this part;
                    ``(C) a statement of the damages to which the 
                United States is entitled for the student's breach of 
                the contract; and
                    ``(D) such other statements of the rights and 
                liabilities of the Secretary and of the individual, not 
                inconsistent with the provisions of this part.
            ``(2) Tuition and student stipend.--
                    ``(A) Tuition remission rates.--The Surgeon 
                General, based on the recommendations of the Permanent 
                National Health Workforce Commission established under 
                section 101(a) of the Health Access and Health 
                Professions Supply Act of 2009, shall establish Federal 
                tuition remission rates to be used by the Track to 
                provide reimbursement to affiliated and other 
                participating health professions institutions for the 
                cost of educational services provided by such 
                institutions to Track students. The agreement entered 
                into by such participating institutions under paragraph 
                (1)(A)(i) shall contain an agreement to accept as 
                payment in full the established remission rate under 
                this subparagraph.
                    ``(B) Stipend.--The Surgeon General, based on the 
                recommendations of the Permanent National Health 
                Workforce Commission, shall establish and update 
                Federal stipend rates for payment to students under 
                this part.
            ``(3) Reductions in the period of obligated service.--The 
        period of obligated service under paragraph (1)(A)(ii)(V) shall 
        be reduced--
                    ``(A) in the case of a student who elects to 
                participate in a high-needs speciality residency (as 
                determined by the Permanent National Health Workforce 
                Commission), by 3 months for each year of such 
                participation (not to exceed a total of 12 months); and
                    ``(B) in the case of a student who, upon completion 
                of their residency, elects to practice in a Federal 
                medical facility (as defined in section 781(e)) that is 
                located in a health professional shortage area (as 
                defined in section 332), by 3 months for year of full-
                time practice in such a facility (not to exceed a total 
                of 12 months).
    ``(c) Second 2 Years of Service.--During the third and fourth years 
in which a medical, dental, physician assistant, pharmacy, behavioral 
and mental health, public health, or nursing student is enrolled in the 
Track, training should be designed to prioritize clinical rotations in 
Federal medical facilities in health professional shortage areas, and 
emphasize a balance of hospital and community-based experiences, and 
training within interdisciplinary teams.
    ``(d) Dentist, Physician Assistant, Pharmacist, Behavioral and 
Mental Health Professional, Public Health Professional, and Nurse 
Training.--The Surgeon General shall establish provisions applicable 
with respect to dental, physician assistant, pharmacy, behavioral and 
mental health, public health, and nursing students that are comparable 
to those for medical students under this section, including service 
obligations, tuition support, and stipend support. The Surgeon General 
shall give priority to health professions training institutions that 
train medical, dental, physician assistant, pharmacy, behavioral and 
mental health, public health, and nursing students for some significant 
period of time together, but at a minimum have a discrete and shared 
core curriculum.
    ``(e) Elite Federal Disaster Teams.--The Surgeon General, in 
consultation with the Secretary, the Director of the Centers for 
Disease Control and Prevention, and other appropriate military and 
Federal government agencies, shall develop criteria for the appointment 
of highly qualified Track faculty, medical, dental, physician 
assistant, pharmacy, behavioral and mental health, public health, and 
nursing students, and graduates to elite Federal disaster preparedness 
teams to train and to respond to public health emergencies, natural 
disasters, bioterrorism events, and other emergencies.
    ``(f) Student Dropped From Track in Affiliate School.--A medical, 
dental, physician assistant, pharmacy, behavioral and mental health, 
public health, or nursing student who, under regulations prescribed by 
the Surgeon General, is dropped from the Track in an affiliated school 
for deficiency in conduct or studies, or for other reasons, shall be 
liable to the United States for all tuition and stipend support 
provided to the student.

``SEC. 274. AUTHORIZATION OF APPROPRIATIONS.

    ``There is authorized to be appropriated to carry out this part, 
section 338A-1, and section 749, such sums as may be necessary.''.

SEC. 206. MEDICAL EDUCATION DEBT REIMBURSEMENT FOR PHYSICIANS OF THE 
              VETERANS HEALTH ADMINISTRATION.

    (a) In General.--The Secretary of Veterans Affairs shall carry out 
a program under which eligible physicians described in subsection (b) 
are reimbursed for the education debt of such physicians as described 
in subsection (c).
    (b) Eligible Physicians.--An eligible physician described in this 
subsection is any physician currently appointed to a physician position 
in the Veterans Health Administration under section 7402(b)(1) of title 
38, United States Code, who enters into an agreement with the Secretary 
to continue serving as a physician in such position for such period of 
time as the Secretary shall specify in the agreement.
    (c) Covered Education Debt.--The education debt for which an 
eligible physician may be reimbursed under this section is any amount 
paid by the physician for tuition, room and board, or expenses in 
obtaining the degree of doctor or medicine or of doctor of osteopathy, 
including any amounts of principal or interest paid by the physician 
under a loan, the proceeds of which were used by or on behalf of the 
physician for the costs of obtaining such degree.
    (d) Frequency of Reimbursement.--Any reimbursement of an eligible 
physician under this section shall be made in a lump sum or in 
installments of such frequency as the Secretary shall specify the 
agreement of the physician as required under subsection (b).
    (e) Liability for Failure To Complete Obligated Service.--Any 
eligible physician who fails to satisfactorily complete the period of 
service agreed to by the physician under subsection (b) shall be liable 
to the United States in an amount determined in accordance with the 
provisions of section 7617(c)(1) of title 38, United States Code.
    (f) Treatment of Reimbursement With Other Pay and Benefit 
Authorities.--Any amount of reimbursement payable to an eligible 
physician under this section is in addition to any other pay, 
allowances, or benefits that may be provided the physician under law, 
including any educational assistance under the Department of Veterans 
Affairs Health Professional Educational Assistance Program under 
chapter 76 of title 38, United States Code.

SEC. 207. PROMOTING EDUCATION AND TRAINING OF PSYCHOLOGISTS TO PROVIDE 
              MENTAL AND BEHAVIORAL HEALTH SERVICES TO UNDERSERVED 
              POPULATIONS.

    Part E of title VII of the Public Health Service Act (42 U.S.C. 
294n et seq.) is amended by adding at the end the following:

        ``Subpart 3--Mental and Behavioral Health Care Workforce

``SEC. 775. PROGRAM FOR GRADUATE EDUCATION AND TRAINING IN PSYCHOLOGY.

    ``(a) In General.--The Secretary may award grants, cooperative 
agreements, and contracts to accredited doctoral, internship, and 
residency programs in psychology for the development and implementation 
of programs to provide interdisciplinary training in integrated health 
care settings to students in doctoral psychology programs, including 
interns and residents in such programs. Any training funded by such 
grants, cooperative agreements, or contracts shall focus on the needs 
of underserved populations.
    ``(b) Eligibility.--To be eligible to receive an award under this 
section an entity shall--
            ``(1) provide training at or through an accredited doctoral 
        program in psychology, including an internship or residency 
        program; and
            ``(2) prepare and submit to the Secretary an application at 
        such time, in such manner, and containing such information as 
        the Secretary may require.
    ``(c) Evaluation of Programs.--The Secretary shall evaluate any 
program implemented through an award under this section in order to 
determine the effect of such program on increasing the number of 
psychologists who provide mental and behavioral health services to 
underserved populations.
    ``(d) Definitions.--For purposes of this section--
            ``(1) the term `underserved population' means individuals, 
        especially older adults, children, chronically ill individuals, 
        victims of abuse or trauma, and victims of combat- or war-
        related stress disorders, including post-traumatic stress 
        disorder and traumatic brain injury, and their families, living 
        in an urban or rural area that has a shortage of mental or 
        behavioral health services; and
            ``(2) the term `interdisciplinary training' means training 
        for graduate psychology students with 1 or more of the other 
        health professions, including medicine, nursing, dentistry, and 
        pharmacy.
    ``(e) Authorization of Appropriations.--To carry out this section, 
there is authorized to be appropriated $10,000,000 for fiscal year 
2010, $12,000,000 for fiscal year 2011, $14,000,000 for fiscal year 
2012, $16,000,000 for fiscal year 2013, and $18,000,000 for fiscal year 
2014.''.

 TITLE III--HEALTH PROFESSIONAL TRAINING PIPELINE PARTNERSHIPS PROGRAM

SEC. 301. GRANTS TO PREPARE STUDENTS FOR CAREERS IN HEALTH CARE.

    (a) Purpose.--The purpose of this section is to support the 
development and implementation of programs designed to prepare middle 
school and high school students for study and careers in the healthcare 
field, including success in postsecondary mathematics and science 
programs.
    (b) Definitions.--In this section:
            (1) Children from low-income families.--The term ``children 
        from low-income families'' means children described in section 
        1124(c)(1)(A) of the Elementary and Secondary Education Act of 
        1965 (20 U.S.C. 6333(c)(1)(A)).
            (2) Eligible recipients.--The term ``eligible recipient'' 
        means--
                    (A) a nonprofit healthcare career pathway 
                partnership organization; or
                    (B) a high-need local educational agency in 
                partnership with--
                            (i) not less than 1 institution of higher 
                        education with an established health profession 
                        education program; and
                            (ii) not less than 1 community-based, 
                        private sector healthcare provider 
                        organization.
            (3) High-need local educational agency.--The term ``high-
        need local educational agency'' means a local educational 
        agency or educational service agency--
                    (A) that serves not fewer than 10,000 children from 
                low-income families;
                    (B) for which not less than 20 percent of the 
                children served by the agency are children from low-
                income families;
                    (C) that meets the eligibility requirements for 
                funding under the Small, Rural School Achievement 
                Program under section 6211(b) of the Elementary and 
                Secondary Education Act of 1965 (20 U.S.C. 7345(b)); or
                    (D) that meets the eligibility requirements for 
                funding under the Rural and Low-Income School Program 
                under section 6221(b)(1) of the Elementary and 
                Secondary Education Act of 1965 (20 U.S.C. 7351(b)(1)).
            (4) Nonprofit healthcare career pathway partnership 
        organization.--The term ``nonprofit healthcare career pathway 
        partnership organization'' means a nonprofit organization 
        focused on developing career and educational pathways to 
        healthcare professions, that shall include representatives of--
                    (A) the local educational agencies;
                    (B) not less than 1 institution of higher education 
                (as defined in section 101(a) of the Higher Education 
                Act of 1965 (20 U.S.C. 1001(a))) with an established 
                health profession education program; and
                    (C) not less than 1 community-based, private sector 
                healthcare provider organization or other healthcare 
                industry organization.
            (5) Secretary.--The term ``Secretary'' means the Secretary 
        of Education.
    (c) Grants Authorized.--
            (1) In general.--The Secretary is authorized to award 
        grants, on a competitive basis, to eligible recipients to 
        enable the recipients to develop and implement programs of 
        study to prepare middle school and high school students for 
        postsecondary education leading to careers in the healthcare 
        field.
            (2) Minimum funding level.--Grants shall be awarded at a 
        minimum level of $500,000 per recipient, per year.
            (3) Renewability.--Grants may be renewed, at the discretion 
        of the Secretary, for not more than 5 years.
    (d) Application.--Each eligible recipient desiring a grant under 
this section shall submit an application to the Secretary at such time, 
in such manner, and containing such information as the Secretary may 
require, which shall include an assurance that the recipient will meet 
the program requirements described in subsection (f)(2).
    (e) Priority.--In awarding grants under this section, the Secretary 
shall give priority to--
            (1) applicants that include a local educational agency that 
        is located in an area that is designated under section 
        332(a)(1)(A) of the Public Health Service Act (42 U.S.C. 
        254e(a)(1)(A)) as a health professional shortage area;
            (2) applicants that include an institution of higher 
        education that emphasizes an interdisciplinary approach to 
        health profession education; and
            (3) applicants whose program involves the development of a 
        uniquely innovative public-private partnership.
    (f) Authorized Activities/use of Funds.--
            (1) In general.--Each eligible recipient that receives a 
        grant under this section shall use the grant funds to develop 
        and implement programs of study to prepare middle school and 
        high school students for careers in the healthcare field that--
                    (A) are aligned with State challenging academic 
                content standards and State challenging student 
                academic achievement standards; and
                    (B) lead to high school graduation with the skills 
                and preparation--
                            (i) to enter postsecondary education 
                        programs of study in mathematics and science 
                        without remediation; and
                            (ii) necessary to enter healthcare jobs 
                        directly.
            (2) Program requirements.--A program of study described in 
        paragraph (1) shall--
                    (A) involve a review and identification of the 
                content knowledge and skills students who enter 
                institutions of higher education and the workforce need 
                to have in order to succeed in the healthcare field;
                    (B) promote the alignment of mathematics and 
                science curricula and assessments in middle school and 
                high school and facilitate learning of the required 
                knowledge and skills identified in subparagraph (A);
                    (C) include an outreach component to educate middle 
                school and high school students and their parents about 
                the full range of employment opportunities in the 
                healthcare field, specifically in the local community;
                    (D) include specific opportunities for youth to 
                interact with healthcare professionals or industry 
                representatives in the classroom, school, or community 
                locations and how these experiences will be integrated 
                with coursework;
                    (E) include high-quality volunteer or internship 
                experiences, integrated with coursework;
                    (F) provide high-quality mentoring, counseling, and 
                career counseling support services to program 
                participants;
                    (G) consider the inclusion of a distance-learning 
                component or similar education technology that would 
                expand opportunities for geographically isolated 
                individuals;
                    (H) encourage the participation of individuals who 
                are members of groups that are underrepresented in 
                postsecondary education programs in mathematics and 
                science;
                    (I) encourage participants to seek work in 
                communities experiencing acute health professional 
                shortages; and
                    (J) collect data, and analyze the data using 
                measurable objectives and benchmarks, to evaluate the 
                extent to which the program succeeded in--
                            (i) increasing student and parent awareness 
                        of occupational opportunities in the healthcare 
                        field;
                            (ii) improving student academic achievement 
                        in mathematics and science;
                            (iii) increasing the number of students 
                        entering health care professions upon 
                        graduation; and
                            (iv) increasing the number of students 
                        pursuing secondary education or training 
                        opportunities with the potential to lead to a 
                        career in the healthcare field.
            (3) Planning grant set aside.--Each eligible recipient that 
        receives a grant under this section shall set aside 10 percent 
        of the grant funds for planning and program development 
        purposes.
    (g) Matching Requirement.--Each eligible recipient that receives a 
grant under this section shall provide, from the private sector, an 
amount equal to 40 percent of the amount of the grant, in cash or in 
kind, to carry out the activities supported by the grant.
    (h) Reports.--
            (1) Annual evaluation.--Each eligible recipient that 
        receives a grant under this section shall collect and report to 
        the Secretary annually such information as the Secretary may 
        reasonably require, including--
                    (A) the number of schools involved and student 
                participants in the program;
                    (B) the race, gender, socio-economic status, and 
                disability status of program participants;
                    (C) the number of program participants who 
                successfully graduated from high school;
                    (D) the number of program participants who reported 
                enrollment in some form of postsecondary education with 
                the potential to lead to a career in the healthcare 
                field;
                    (E) the number of program participants who entered 
                a paid position, either part-time or full-time, in the 
                healthcare field following participation in the 
                program; and
                    (F) the data and analysis required under subsection 
                (f)(2)(J).
            (2) Report.--Not later than 3 years after the date of 
        enactment of this section, the Secretary shall submit to 
        Congress an interim report on the results of the evaluations 
        conducted under paragraph (1).
    (i) Authorization and Appropriation.--
            (1) In general.--There are authorized to be appropriated 
        $100,000,000 for each of fiscal years 2009 through 2013 to 
        carry out this section.
            (2) Administrative costs.--For the costs of administering 
        this section, including the costs of evaluating the results of 
        grants and submitting reports to the Congress, there are 
        authorized to be appropriated such sums as may be necessary for 
        each of fiscal years 2009 through 2013.
                                 <all>
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