IIB 
110TH CONGRESS 
2D SESSION 
H. R. 2583 
IN THE SENATE OF THE UNITED STATES 
SEPTEMBER 25 (legislative day, SEPTEMBER 17), 2008 
Received 
OCTOBER 2 (legislative day, SEPTEMBER 17), 2008 
Read twice and referred to the Committee on Health, Education, Labor, and 
Pensions 
AN ACT 
To amend title VII of the Public Health Service Act to 
establish a loan program for eligible hospitals to establish 
residency training programs. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
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SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Physician Workforce 
Enhancement Act of 2008’’. 
SEC. 2. HOSPITAL RESIDENCY LOAN PROGRAM. 
Subpart 2 of part E of title VII of the Public Health 
Service Act is amended by adding at the end the following 
new section: 
‘‘SEC. 771. HOSPITAL RESIDENCY LOAN PROGRAM. 
‘‘(a) ESTABLISHMENT.—Not later than October 1, 
2010, the Secretary, acting through the Administrator of 
the Health Resources and Services Administration, shall 
establish a hospital residency loan program that provides 
loans to eligible hospitals to establish a residency training 
program. 
‘‘(b) APPLICATION.—No loan may be provided under 
this section to an eligible hospital except pursuant to an 
application that is submitted and approved in a time, man-
ner, and form specified by the Administrator of the Health 
Resources and Services Administration. A loan under this 
section shall be on such terms and conditions and meet 
such requirements as the Administrator determines appro-
priate, in accordance with the provisions of this section. 
‘‘(c) 
ELIGIBILITY; 
PREFERENCE
FOR
RURAL 
AREAS.— 
‘‘(1) ELIGIBLE HOSPITAL DEFINED.—For pur-
poses of this section, an ‘eligible hospital’ means, 
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with respect to a loan under this section, a public or 
non-profit hospital that, as of the date of the sub-
mission of an application under subsection (b), 
meets, to the satisfaction of the Administrator of the 
Health Resources and Services Administration, each 
of the following criteria: 
‘‘(A) The hospital does not operate a resi-
dency training program and has not previously 
operated such a program. 
‘‘(B) The hospital has secured initial ac-
creditation by the American Council for Grad-
uate Medical Education or the American Osteo-
pathic Association. 
‘‘(C) The hospital provides assurances to 
the satisfaction of the Administrator of the 
Health Resources and Services Administration 
that such loan shall be used, consistent with 
subsection (d), only for the purposes of estab-
lishing and conducting an allopathic or osteo-
pathic physician residency training program in 
at least one of the following, or a combination 
of the following: 
‘‘(i) Family medicine. 
‘‘(ii) Internal medicine. 
‘‘(iii) Obstetrics or gynecology. 
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‘‘(iv) Behavioral or Mental health. 
‘‘(v) Pediatrics. 
‘‘(D) The hospital enters into an agree-
ment with the Administrator that certifies the 
hospital will provide for the repayment of the 
loan in accordance with subsection (e). 
‘‘(2) PREFERENCE
FOR
RURAL
AREAS.—In 
making loans under this section, the Administrator 
of the Health Resources and Services Administration 
shall create guidelines that give preference to rural 
areas 
(as 
such 
term 
is 
defined 
in 
section 
1886(d)(2)(D) of the Social Security Act). 
‘‘(d) PERMISSIBLE USES OF LOAN FUNDS.—A loan 
provided under this section shall be used, with respect to 
a residency training program, only for costs directly at-
tributable to the residency training program, except as 
otherwise provided by the Administrator of the Health Re-
sources and Services Administration. 
‘‘(e) REPAYMENT OF LOANS.— 
‘‘(1) REPAYMENT
PLANS.—For purposes of 
subsection (c)(1)(D), a repayment plan for an eligi-
ble hospital is in accordance with this subsection if 
it provides for the repayment of the loan amount in 
installments, in accordance with a schedule that is 
agreed to by the Administrator of the Health Re-
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sources and Services Administration and the hospital 
and that is in accordance with paragraphs (2), (3), 
and (4). 
‘‘(2) COMMENCEMENT
OF
REPAYMENT.—Re-
payment by an eligible hospital of a loan under this 
section shall commence not later than the date that 
is 18 months after the date on which the loan 
amount is disbursed to such hospital. 
‘‘(3) REPAYMENT PERIOD.—A loan made under 
this section shall be fully repaid not later than the 
date that is 24 months after the date on which the 
repayment is required to commence. 
‘‘(4) LOAN PAYABLE IN FULL IF RESIDENCY 
TRAINING PROGRAM CANCELED.—In the case that 
an eligible hospital borrows a loan under this sec-
tion, with respect to a residency training program, 
and terminates such program before the date on 
which such loan has been fully repaid in accordance 
with a plan under paragraph (1), such loan shall be 
payable by the hospital not later than 45 days after 
the date of such termination. 
‘‘(f) NO INTEREST CHARGED.—The Administrator of 
the Health Resources and Services Administration may 
not charge or collect interest on any loan made under this 
section. 
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‘‘(g) LIMITATION ON TOTAL AMOUNT OF LOAN.— 
The cumulative annual dollar amount of a loan made to 
an eligible hospital under this section may not exceed 
$250,000. 
‘‘(h) PENALTIES.—The Administrator of the Health 
Resources and Services Administration shall establish pen-
alties to which an eligible hospital receiving a loan under 
this section would be subject if such hospital is in violation 
of any of the criteria described in subsection (c)(1). Such 
penalties shall include the charge or collection of interest, 
at a rate to be determined by the Administrator of the 
Health Resources and Services Administration. Except as 
otherwise provided, penalties collected under this sub-
section shall be paid to the Administrator of the Health 
Resources and Services Administration and shall, subject 
to appropriation Acts, be available until expended for the 
purpose of enforcing the provisions of this section. 
‘‘(i) REPORTS.—Not later than January 1, 2012, and 
annually thereafter (before January 2, 2014), the Admin-
istrator of the Health Resources and Services Administra-
tion shall submit to Congress a report on the efficacy of 
the program under this section in increasing the number 
of residents practicing in each medical specialty described 
in subsection (c)(1)(C) during such year and the extent 
to which the program resulted in an increase in the num-
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ber of available practitioners in each of such medical spe-
cialties that serve medically underserved populations. 
‘‘(j) FUNDING.— 
‘‘(1) AUTHORIZATION
OF
APPROPRIATIONS.— 
For the purpose of providing amounts for loans 
under this section, there are authorized to be appro-
priated such sums as may be necessary to provide— 
‘‘(A) $8,000,000 in loans for fiscal year 
2010; 
‘‘(B) $8,400,000 in loans for fiscal year 
2011; 
‘‘(C) $8,820,000 in loans for fiscal year 
2012; 
‘‘(D) $9,261,000 in loans for fiscal year 
2013; and 
‘‘(E) $9,724,050 in loans for fiscal year 
2014. 
‘‘(2) 
AVAILABILITY.—Amounts 
appropriated 
under paragraph (1) shall remain available until ex-
pended. 
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‘‘(k) TERMINATION OF PROGRAM.—No loan may be 
made under this section after December 31, 2013.’’. 
Passed the House of Representatives September 23, 
2008. 
Attest: 
LORRAINE C. MILLER, 
Clerk. 
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