I 
111TH CONGRESS 
2D SESSION 
H. R. 5889 
To amend the Public Health Service Act and title XVIII of the Social 
Security Act to increase the number of primary care physicians and 
medical residents serving health professional shortage areas, and for 
other purposes. 
IN THE HOUSE OF REPRESENTATIVES 
JULY 27, 2010 
Mr. YOUNG of Alaska introduced the following bill; which was referred to the 
Committee on Energy and Commerce, and in addition to the Committee 
on Ways and Means, 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 amend the Public Health Service Act and title XVIII 
of the Social Security Act to increase the number of 
primary care physicians and medical residents serving 
health professional shortage areas, and for other pur-
poses. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. FINDINGS. 
Congress finds the following: 
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(1) The average life expectancy in the United 
States has increased to 80 years of age, causing an 
ever-increasing demand for medical care. 
(2) Medical school enrollment numbers have 
been virtually stagnant for the last 25 years. 
(3) During the last 20 years, median tuition 
and fees at medical schools have increased by 229 
percent (122 percent adjusted for inflation) in pri-
vate schools and by 479 percent (256 percent ad-
justed for inflation) in public schools. 
(4) The Association of American Medical Col-
leges, in its Statement on the Physician Workforce, 
dated June, 2006, called for an increase of 1,500 
National Health Service Corps program awards per 
year to help meet the need for physicians caring for 
underserved populations and to help address rising 
medical student indebtedness. 
(5) The National Health Service Corps program 
has a proven record of supplying physicians to un-
derserved areas, and has played an important role in 
expanding access for underserved populations in 
rural and inner city communities. 
(6) Continued expansion of the National Health 
Service Corps program is strongly recommended. 
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(7) The growing debt incurred by graduating 
medical students is likely to increase the interest 
and willingness of graduates of United States med-
ical schools to apply for National Health Service 
Corps program funding and awards. 
(8) One-third (250,000) of active physicians are 
over the age of 55 and are likely to retire in the next 
ten years, while the population will have increased 
by 24 percent. These demographic changes will 
cause the population-to-physician ratio to peak by 
the year 2020. 
(9) In 2005, the Council on Graduate Medical 
Education stated in a report to Congress that there 
will be a shortage of not fewer than 90,000 full-time 
physicians by 2020. 
(10) A continuing decline in the number of pri-
mary care physicians will lead to increased shortages 
of health care access in rural America. 
(11) There is a declining ability to recruit 
qualified medical students from rural and under-
served areas, coupled with greater difficulty on the 
part of community health centers and other clinics 
to attract adequate personnel. 
(12) Individuals in many geographic areas, es-
pecially rural areas, lack adequate access to high 
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quality preventive, primary and specialty health care, 
contributing to significant health disparities that im-
pair America’s public health and economic produc-
tivity. 
(13) A collaborative process is needed between 
hospitals and non-hospital settings to maximize the 
potential of non-hospital health care training. 
SEC. 2. SCHOLARSHIPS FOR MEDICAL STUDENTS UNDER 
NATIONAL HEALTH SERVICE CORPS SCHOL-
ARSHIP PROGRAM. 
Section 338H of the Public Health Service Act (42 
U.S.C. 254q) is amended by adding at the end the fol-
lowing: 
‘‘(d) SCHOLARSHIPS FOR MEDICAL STUDENTS.—For 
contracts for scholarships under this subpart to individ-
uals who are accepted for enrollment, or enrolled, in a 
course of study or program described in section 
338A(b)(1)(B) that leads to a degree in medicine or osteo-
pathic medicine, the Secretary shall, of the amounts ap-
propriated under subsection (a) for a fiscal year, obligate 
the greater of 10 percent or such amount as necessary 
to fund ongoing activities related to such contracts.’’. 
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SEC. 3. CLARIFICATION OF ELIGIBILITY FOR MEDICARE 
GRADUATE MEDICAL EDUCATION FUNDING 
OF A NONRURAL HOSPITAL THAT HAS A 
TRAINING PROGRAM WITH AN INTEGRATED 
RURAL TRACK. 
(a) IN GENERAL.—Section 1886(h)(4)(H) of the So-
cial Security Act (42 U.S.C. 1395ww(h)(4)(H)), as 
amended by section 5506(a) of the Patient Protection and 
Affordable Care Act (Public Law 111–148), is amended— 
(1) in clause (iv), by inserting ‘‘(as defined in 
clause (vii))’’ after ‘‘an integrated rural track’’; and 
(2) by adding at the end the following new 
clause: 
‘‘(vii) DEFINITION
OF
ACCREDITED 
TRAINING PROGRAM WITH AN INTEGRATED 
RURAL
TRACK.—For purposes of clause 
(iv), the term ‘accredited training program 
with an integrated rural track’ means an 
accredited medical residency training pro-
gram located in an urban area which offers 
a curriculum for all residents in the pro-
gram that includes the following character-
istics: 
‘‘(I) A minimum of 3 block 
months of rural rotations. During 
such 3 block months, the resident is 
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in a rural area for 4 weeks or a 
month. 
‘‘(II) A stated mission for train-
ing rural physicians. 
‘‘(III) A minimum of 3 months of 
obstetrical training, or an equivalent 
longitudinal experience. 
‘‘(IV) A minimum of 4 months of 
pediatric training that includes neo-
natal, 
ambulatory, 
inpatient, 
and 
emergency experiences through rota-
tions, or an equivalent longitudinal ex-
perience. 
‘‘(V) A minimum of 2 months of 
emergency medicine rotations, or an 
equivalent longitudinal experience.’’. 
(b) EFFECTIVE DATE.—The amendments made by 
subsection (a) apply with respect to— 
(1) payments to hospitals under section 
1886(h) of the Social Security Act (42 U.S.C. 
1395ww(h)) for cost reporting periods beginning on 
or after January 1, 2011; and 
(2) payments to hospitals under section 
1886(d)(5)(B)(v) 
of 
such 
Act 
(42 
U.S.C. 
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1395ww(d)(5)(B)(v)) for discharges occurring on or 
after January 1, 2011. 
Æ 
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