I 
110TH CONGRESS 
2D SESSION 
H. R. 7302 
To amend the Public Health Service Act with respect to health professions 
education, and for other purposes. 
IN THE HOUSE OF REPRESENTATIVES 
NOVEMBER 20, 2008 
Ms. DEGETTE introduced the following bill; which was referred to the 
Committee on Energy and Commerce 
A BILL 
To amend the Public Health Service Act with respect to 
health professions education, and for other purposes. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Health Professions and 
Primary Care Reinvestment Act’’. 
SEC. 2. TABLE OF CONTENTS; REFERENCES IN ACT. 
(a) TABLE OF CONTENTS.—The table of contents for 
this Act is as follows: 
Sec. 1. Short title. 
Sec. 2. Table of contents; references in Act. 
Sec. 3. Federally supported student loan funds. 
Sec. 4. Centers of excellence. 
Sec. 5. Health professions training for diversity. 
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Sec. 6. Training in family medicine, general internal medicine, general pediat-
rics, and physician assistantship; community health needs as-
sessments; primary care training institutes. 
Sec. 7. Training in general and pediatric dentistry; loan repayments. 
Sec. 8. Interdisciplinary, community-based linkages. 
Sec. 9. Geriatrics education and training. 
Sec. 10. Training in graduate psychology education. 
Sec. 11. Health professions workforce information and analysis. 
Sec. 12. Health workforce information, evaluation, and assessment. 
Sec. 13. Funding for dental public health and preventive medicine. 
Sec. 14. Academic health departments grant program. 
Sec. 15. Definitions. 
(b) REFERENCES IN ACT.—Except as otherwise spec-
ified, amendments made by this Act to a section or other 
provision of law are amendments to such section or other 
provision of the Public Health Service Act (42 U.S.C. 201 
et seq.). 
SEC. 3. FEDERALLY SUPPORTED STUDENT LOAN FUNDS. 
(a) PURPOSE.—Subpart II of title VII (42 U.S.C. 
292q et seq.) is amended by inserting after the subpart 
heading the following: 
‘‘SEC. 720A. PURPOSE. 
‘‘The purpose of this subpart is to improve the sup-
ply, distribution, diversity, and quality of health profes-
sionals in the healthcare workforce by— 
‘‘(1) making health professionals more acces-
sible to low-income, underserved, uninsured, minor-
ity, health disparity, and rural populations; 
‘‘(2) improving the training of primary care 
physicians, dentists, physician assistants, behavioral 
and mental health professionals, public health pro-
fessionals, and other health professionals; and 
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‘‘(3) training faculty educators in the health 
professions.’’. 
(b) LOAN PROVISIONS.—Section 722 (42 U.S.C. 
292r) is amended by striking subsection (e) and inserting 
the following: 
‘‘(e) RATE OF INTEREST.—Such loans shall bear in-
terest, on the unpaid balance of the loan, computed only 
for periods for which the loan is repayable, at the rate 
of 2 percent less than the applicable rate of interest de-
scribed in section 427A(l)(1) of the Higher Education Act 
of 1965 (20 U.S.C. 1077a(l)(1)) per year.’’. 
(c) MEDICAL
SCHOOLS
AND
PRIMARY
HEALTH 
CARE.—Section 723 (42 U.S.C. 292s) is amended— 
(1) in subsection (a)— 
(A) in paragraph (1), by striking subpara-
graph (B) and inserting the following: 
‘‘(B) to practice in such care for 10 years 
(including residency training in primary health 
care) or through the date on which the loan is 
repaid in full, whichever occurs first.’’; and 
(B) by striking paragraph (3) and insert-
ing the following: 
‘‘(3) NONCOMPLIANCE
BY
STUDENT.—Each 
agreement entered into with a student pursuant to 
paragraph (1) shall provide that, if the student fails 
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to comply with such agreement, the loan involved 
will begin to accrue interest at a rate of 2 percent 
per year greater than the rate at which the student 
would pay if compliant in such year.’’; and 
(2) by adding at the end the following: 
‘‘(d) SENSE OF CONGRESS.—It is the sense of Con-
gress that funds repaid under the loan program under this 
section should not be transferred to the Treasury of the 
United States or otherwise used for any other purpose 
other than to carry out this section.’’. 
(d) STUDENT LOAN GUIDELINES.—The Secretary of 
Health and Human Services shall not require parental fi-
nancial information from a student to determine financial 
need under section 723 of the Public Health Service Act 
(42 U.S.C. 292s) and the determination of need for such 
information shall be at the discretion of applicable school 
loan officer. The Secretary shall amend guidelines issued 
by the Health Resources and Services Administration in 
accordance with the preceding sentence. 
SEC. 4. CENTERS OF EXCELLENCE. 
Section 736 of the Public Health Service Act (42 
U.S.C. 293) is amended— 
(1) by striking subsection (a) and inserting the 
following: 
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‘‘(a) IN GENERAL.—The Secretary shall make grants 
to, and enter into contracts with, public and nonprofit pri-
vate health or educational entities, including designated 
health professions schools described in subsection (c), for 
the purpose of assisting the entities in supporting pro-
grams of excellence in health professions education for 
underrepresented minorities in health professions.’’; 
(2) by striking subsection (b) and inserting the 
following: 
‘‘(b) REQUIRED USE
OF FUNDS.—The Secretary 
may not make a grant under subsection (a) unless the des-
ignated health professions school agrees, subject to sub-
section (c)(1)(C), to use the funds awarded under the 
grant to— 
‘‘(1) develop a large competitive applicant pool 
through linkages with institutions of higher edu-
cation, local school districts, and other community- 
based entities and establish an education pipeline for 
health professions careers; 
‘‘(2) establish, strengthen, or expand programs 
to enhance the academic performance of underrep-
resented minority in health professions students at-
tending the school; 
‘‘(3) improve the capacity of such school to 
train, recruit, and retain underrepresented minority 
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faculty members including the payment of such sti-
pends and fellowships as the Secretary may deter-
mine appropriate; 
‘‘(4) carry out activities to improve the informa-
tion resources, clinical education, curricula, and cul-
tural and linguistic competence of the graduates of 
the school, as it relates to minority health issues; 
‘‘(5) facilitate faculty and student research on 
health issues particularly affecting racial and ethnic 
minority groups, including research on issues relat-
ing to the delivery of culturally competent healthcare 
(as defined in section 270); 
‘‘(6) establish and implement a program to 
train students of the school in providing health serv-
ices to racial and ethnic minority individuals through 
training provided to such students at community- 
based health facilities that— 
‘‘(A) provide such health services; and 
‘‘(B) are located at a site remote from the 
main site of the teaching facilities of the school; 
‘‘(7) provide stipends as the Secretary deter-
mines appropriate, in amounts as the Secretary de-
termines appropriate; and 
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‘‘(8) conduct accountability and other reporting 
activities, as required by the Secretary in subsection 
(i).’’; 
(3) in subsection (c)— 
(A) by amending paragraph (1) to read as 
follows: 
‘‘(1) DESIGNATED SCHOOLS.— 
‘‘(A) IN GENERAL.—The designated health 
professions schools referred to in subsection (a) 
are such schools that meet each of the condi-
tions specified in subparagraphs (B) and (C), 
and that— 
‘‘(i) meet each of the conditions speci-
fied in paragraph (2)(A); 
‘‘(ii) meet each of the conditions spec-
ified in paragraph (3); 
‘‘(iii) meet each of the conditions 
specified in paragraph (4); or 
‘‘(iv) meet each of the conditions spec-
ified in paragraph (5). 
‘‘(B) GENERAL CONDITIONS.—The condi-
tions specified in this subparagraph are that a 
designated health professions school— 
‘‘(i) has a significant number of 
underrepresented minority in health pro-
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fessions students enrolled in the school, in-
cluding individuals accepted for enrollment 
in the school; 
‘‘(ii) has been effective in assisting 
such students of the school to complete the 
program of education and receive the de-
gree involved; 
‘‘(iii) has been effective in recruiting 
such students to enroll in and graduate 
from the school, including providing schol-
arships and other financial assistance to 
such students and encouraging such stu-
dents from all levels of the educational 
pipeline to pursue health professions ca-
reers; and 
‘‘(iv) has made significant recruitment 
efforts to increase the number of underrep-
resented minority in health professions in-
dividuals serving in faculty or administra-
tive positions at the school. 
‘‘(C) CONSORTIUM.—The condition speci-
fied in this subparagraph is that, in accordance 
with subsection (e)(1), the designated health 
profession school involved has with other health 
profession schools (designated or otherwise) 
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formed a consortium to carry out the purposes 
described in subsection (b) at the schools of the 
consortium. 
‘‘(D) 
APPLICATION
OF
CRITERIA
TO 
OTHER PROGRAMS.—In the case of any criteria 
established by the Secretary for purposes of de-
termining whether schools meet the conditions 
described in subparagraph (B), this section may 
not, with respect to racial and ethnic minority 
groups, be construed to authorize, require, or 
prohibit the use of such criteria in any program 
other than the program established in this sec-
tion.’’; 
(B) by amending paragraph (2) to read as 
follows: 
‘‘(2) CENTERS
OF
EXCELLENCE
AT
CERTAIN 
HISTORICALLY
BLACK
COLLEGES
AND
UNIVER-
SITIES.— 
‘‘(A) CONDITIONS.—The conditions speci-
fied in this subparagraph are that a designated 
health professions school is a school described 
in section 799B(1). 
‘‘(B) USE OF GRANT.—In addition to the 
purposes described in subsection (b), a grant 
under subsection (a) to a designated health pro-
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‘‘(i) the school will establish an ar-
rangement with 1 or more public or non-
profit private institutions of higher edu-
cation, including schools of nursing, whose 
enrollment of students has traditionally in-
cluded a significant number of Native 
Americans, the purpose of which arrange-
ment will be to carry out a program— 
‘‘(I) to identify Native American 
students, from the institutions of 
higher education referred to in clause 
(i), who are interested in health pro-
fessions careers; and 
‘‘(II) to facilitate the educational 
preparation of such students to enter 
the 
designated 
health 
professions 
school; and 
‘‘(ii) the designated health professions 
school will make efforts to recruit Native 
American students, including students who 
have participated in the undergraduate 
program carried out under arrangements 
established by the school pursuant to 
clause (i) and will assist Native American 
students regarding the completion of the 
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educational requirements for a degree from 
the designated health professions school. 
‘‘(5) OTHER CENTERS OF EXCELLENCE.—The 
conditions specified in this paragraph are— 
‘‘(A) with respect to other centers of excel-
lence, the conditions described in clauses (i) 
through (iv) of paragraph (1)(B); and 
‘‘(B) that the health professions school in-
volved has an enrollment of underrepresented 
minorities in health professions significantly 
above the national average for such enrollments 
of health professions schools.’’; and 
(4) by striking subsection (h) and inserting the 
following: 
‘‘(h) FORMULA FOR ALLOCATIONS.— 
‘‘(1) ALLOCATIONS.—Based on the amount ap-
propriated under subsection (i) for a fiscal year, the 
following subparagraphs shall apply as appropriate: 
‘‘(A) IN GENERAL.—If the amounts appro-
priated under subsection (i) for a fiscal year are 
$24,000,000 or less— 
‘‘(i) the Secretary shall make available 
$12,000,000 for grants under subsection 
(a) to health professions schools that meet 
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the conditions described in subsection 
(c)(2)(A); and 
‘‘(ii) and available after grants are 
made with funds under clause (i), the Sec-
retary shall make available— 
‘‘(I) 60 percent of such amount 
for grants under subsection (a) to 
health professions schools that meet 
the conditions described in paragraph 
(3) or (4) of subsection (c) (including 
meeting the conditions under sub-
section (e)); and 
‘‘(II) 40 percent of such amount 
for grants under subsection (a) to 
health professions schools that meet 
the conditions described in subsection 
(c)(5). 
‘‘(B) 
FUNDING
IN
EXCESS
OF 
$24,000,000.—If amounts appropriated under 
subsection 
(i) 
for 
a 
fiscal 
year 
exceed 
$24,000,000 but are less than $30,000,000— 
‘‘(i) 
percent 
of 
such 
excess 
amounts shall be made available for grants 
under subsection (a) to health professions 
schools that meet the requirements de-
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scribed in paragraph (3) or (4) of sub-
section (c) (including meeting conditions 
pursuant to subsection (e)); and 
‘‘(ii) 20 percent of such excess 
amount shall be made available for grants 
under subsection (a) to health professions 
schools that meet the conditions described 
in subsection (c)(5). 
‘‘(C) 
FUNDING
IN
EXCESS
OF 
$30,000,000.—If amounts appropriated under 
subsection 
(i) 
for 
a 
fiscal 
year 
exceed 
$30,000,000 but are less than $40,000,000, the 
Secretary shall make available— 
‘‘(i) not less than $12,000,000 for 
grants under subsection (a) to health pro-
fessions schools that meet the conditions 
described in subsection (c)(2)(A); 
‘‘(ii) not less than $12,000,000 for 
grants under subsection (a) to health pro-
fessions schools that meet the conditions 
described in paragraph (3) or (4) of sub-
section (c) (including meeting conditions 
pursuant to subsection (e)); 
‘‘(iii) not less than $6,000,000 for 
grants under subsection (a) to health pro-
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fessions schools that meet the conditions 
described in subsection (c)(5); and 
‘‘(iv) after grants are made with 
funds under clauses (i) through (iii), any 
remaining excess amount for grants under 
subsection (a) to health professions schools 
that meet the conditions described in para-
graph (2)(A), (3), (4), or (5) of subsection 
(c). 
‘‘(D) 
FUNDING
IN
EXCESS
OF 
$40,000,000.—If amounts appropriated under 
subsection (i) for a fiscal year are $40,000,000 
or more, the Secretary shall make available— 
‘‘(i) not less than $16,000,000 for 
grants under subsection (a) to health pro-
fessions schools that meet the conditions 
described in subsection (c)(2)(A); 
‘‘(ii) not less than $16,000,000 for 
grants under subsection (a) to health pro-
fessions schools that meet the conditions 
described in paragraph (3) or (4) of sub-
section (c) (including meeting conditions 
pursuant to subsection (e)); 
‘‘(iii) not less than $8,000,000 for 
grants under subsection (a) to health pro-
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fessions schools that meet the conditions 
described in subsection (c)(5); and 
‘‘(iv) after grants are made with 
funds under clauses (i) through (iii), any 
remaining funds for grants under sub-
section (a) to health professions schools 
that meet the conditions described in para-
graph (2)(A), (3), (4), or (5) of subsection 
(c). 
‘‘(2) NO
LIMITATION.—Nothing in this sub-
section shall be construed as limiting the centers of 
excellence referred to in this section to the des-
ignated amount, or to preclude such entities from 
competing for grants under this section. 
‘‘(3) MAINTENANCE OF EFFORT.— 
‘‘(A) IN GENERAL.—With respect to activi-
ties for which a grant made under this part are 
authorized to be expended, the Secretary may 
not make such a grant to a center of excellence 
for any fiscal year unless the center agrees to 
maintain expenditures of non-Federal amounts 
for such activities at a level that is not less 
than the level of such expenditures maintained 
by the center for the fiscal year preceding the 
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fiscal year for which the school receives such a 
grant. 
‘‘(B) USE OF FEDERAL FUNDS.—With re-
spect to any Federal amounts received by a cen-
ter of excellence and available for carrying out 
activities for which a grant under this part is 
authorized to be expended, the center shall, be-
fore expending the grant, expend the Federal 
amounts obtained from sources other than the 
grant, unless given prior approval from the Sec-
retary. 
‘‘(i) AUTHORIZATION OF APPROPRIATIONS.—There 
are authorized to be appropriated to carry out this sec-
tion— 
‘‘(1) $50,000,000 for each of the fiscal years 
2009 through 2013; and 
‘‘(2) and such sums as are necessary for each 
subsequent fiscal year.’’. 
SEC. 5. HEALTH PROFESSIONS TRAINING FOR DIVERSITY. 
(a) LOAN REPAYMENTS AND FELLOWSHIPS REGARD-
ING FACULTY POSITIONS.—Section 738(a)(1) (42 U.S.C. 
293b(a)(1)) is amended by striking ‘‘$20,000 of the prin-
cipal and interest of the educational loans of such individ-
uals.’’ and inserting ‘‘$30,000 of the principal and interest 
of the educational loans of such individuals. With respect 
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to such an individual who enters into a new contract under 
the preceding sentence with the Secretary after 2009, the 
amount paid by the Federal Government pursuant to such 
contract shall be increased by the percentage increase in 
the gross domestic product since the beginning of the pre-
vious year.’’. 
(b) SCHOLARSHIPS
FOR
DISADVANTAGED
STU-
DENTS.—Section 740(a) (42 U.S.C. 293d(a)) is amended 
by striking ‘‘$37,000,000’’ and all that follows through 
‘‘2002’’ and inserting ‘‘$51,000,000 for fiscal year 2008, 
and such sums as may be necessary for each of the fiscal 
years 2009 through 2013’’. 
(c) REAUTHORIZATION FOR LOAN REPAYMENTS AND 
FELLOWSHIPS REGARDING FACULTY POSITIONS.—Sec-
tion 740(b) (42 U.S.C. 293d(b)) is amended by striking 
‘‘appropriated’’ and all that follows through the period at 
the end and inserting ‘‘appropriated, $5,000,000 for each 
of the fiscal years 2009 through 2013. For fiscal year 
2014 and each subsequent fiscal year, there is authorized 
to be appropriated the amount authorized for the pre-
ceding fiscal year increased by the percentage increase in 
the gross domestic product during such preceding fiscal 
year.’’. 
(d) REAUTHORIZATION FOR EDUCATIONAL ASSIST-
ANCE IN THE HEALTH PROFESSIONS REGARDING INDI-
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VIDUALS FROM A DISADVANTAGED BACKGROUND.—Sec-
tion 740(c) of the Public Health Service Act (42 U.S.C. 
293d(c)) is amended by striking the first sentence and in-
serting the following: ‘‘For the purpose of grants and con-
tracts under section 739(a)(1), there is authorized to be 
appropriated $60,000,000 for fiscal year 2009 and such 
sums as may be necessary for each of the fiscal years 2010 
through 2013.’’ 
SEC. 6. TRAINING IN FAMILY MEDICINE, GENERAL INTER-
NAL MEDICINE, GENERAL PEDIATRICS, AND 
PHYSICIAN 
ASSISTANTSHIP; 
COMMUNITY 
HEALTH 
NEEDS 
ASSESSMENTS; 
PRIMARY 
CARE TRAINING INSTITUTES. 
Part C of title VII (42 U.S.C. 293k et seq.) is amend-
ed by striking section 747 and inserting the following: 
‘‘SEC. 747. PRIMARY CARE TRAINING AND ENHANCEMENT. 
‘‘(a) SUPPORT
AND DEVELOPMENT
OF PRIMARY 
CARE TRAINING PROGRAMS.— 
‘‘(1) IN GENERAL.—The Secretary may make 
grants to, or enter into contracts with, an accredited 
public or nonprofit private hospital, school of medi-
cine or osteopathic medicine, academically affiliated 
physician assistant training program, or a public or 
private nonprofit entity which the Secretary has de-
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termined is capable of carrying out such grant or 
contract— 
‘‘(A) to plan, develop, operate, or partici-
pate in an accredited professional training pro-
gram, including an accredited residency or in-
ternship program in the field of family medi-
cine, general internal medicine, or general pedi-
atrics for medical students, interns, residents, 
or practicing physicians as defined by the Sec-
retary; 
‘‘(B) to provide need-based financial assist-
ance in the form of traineeships and fellowships 
to medical students, interns, residents, prac-
ticing physicians, or other medical personnel, 
who are participants in any such program, and 
who plan to specialize or work in the practice 
of family medicine, general internal medicine, or 
general pediatrics; 
‘‘(C) to plan, develop, and operate a pro-
gram for the training of physicians who plan to 
teach in family medicine, general internal medi-
cine, or general pediatrics training programs; 
‘‘(D) to plan, develop, and operate a pro-
gram for the training of physicians teaching in 
community-based settings; 
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‘‘(E) to provide financial assistance in the 
form of traineeships and fellowships to physi-
cians who are participants in any such pro-
grams and who plan to teach or conduct re-
search in a family medicine, general internal 
medicine, or general pediatrics training pro-
gram; 
‘‘(F) to plan, develop, and operate a physi-
cian assistant education program, and for the 
training of individuals who will teach in pro-
grams to provide such training; 
‘‘(G) to plan, develop, and operate an 
interdisciplinary training program that includes 
at least 1 of the following which demonstrates 
a team approach to care and may demonstrate 
a patient-centered medical home model: 
‘‘(i) A program designed to teach 
trainees the skills to provide interdiscipli-
nary patient care through collaboration 
among various professionals, including 
those trained in geriatrics, physician as-
sistants, nurse practitioners, pharmacists, 
or social workers. 
‘‘(ii) A program developed in collabo-
ration with dental students or residency 
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training programs to improve integration 
and access to dental care. 
‘‘(iii) A program developed in collabo-
ration with psychologists and other behav-
ioral and mental health professionals to in-
tegrate mental and behavioral health and 
primary health care; and 
‘‘(H) to plan, develop and operate joint de-
gree programs to provide interdisciplinary grad-
uate training in public health and other health 
professions to provide training in environmental 
health, infectious disease control, disease pre-
vention and health promotion, epidemiological 
studies and injury control. 
‘‘(2) DURATION OF AWARDS.—The period dur-
ing which payments are made to an entity from an 
award of a grant or contract under this subsection 
shall be 5 years. 
‘‘(b) CAPACITY BUILDING IN PRIMARY CARE.— 
‘‘(1) IN GENERAL.—The Secretary may make 
grants to or enter into contracts with accredited 
schools of medicine or osteopathic medicine to estab-
lish, maintain, or improve academic units (which 
may be departments, divisions, or other units) or 
programs that improve clinical teaching and re-
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search in family medicine, general internal medicine, 
or general pediatrics. 
‘‘(2) PREFERENCE IN MAKING AWARDS UNDER 
THIS
SUBSECTION.—In making awards of grants 
and contracts under paragraph (1), the Secretary 
shall give preference to any qualified applicant for 
such an award that agrees to expend the award for 
the purpose of— 
‘‘(A) establishing academic units or pro-
grams in family medicine; or 
‘‘(B) substantially expanding such units or 
programs. 
‘‘(3) PRIORITY IN MAKING AWARDS.—In mak-
ing awards of grants and contracts under paragraph 
(1), the Secretary shall give priority to any qualified 
applicant for such an award that proposes— 
‘‘(A) a collaborative project between aca-
demic administrative units of primary care; and 
‘‘(B) innovative approaches to clinical 
teaching using models of primary care, such as 
the patient centered medical home, team man-
agement of chronic disease, and interdiscipli-
nary integrated models of health care that in-
corporate transitions in health care settings and 
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integration physical and mental health provi-
sion. 
‘‘(4) DURATION OF AWARDS.—The period dur-
ing which payments are made to an entity from an 
award of a grant or contract under this subsection 
shall be 5 years. 
‘‘(c) COMMUNITY HEALTH NEEDS ASSESSMENT.— 
‘‘(1) IN GENERAL.—The Secretary may award 
grants or enter into contracts with eligible entities to 
conduct community health needs assessments as de-
scribed by this subsection. 
‘‘(2) ELIGIBLE ENTITY.—For purposes of this 
subsection, the term ‘eligible entity’ means an entity 
described in section 799(b). 
‘‘(3) APPLICATION.—To receive a grant under 
this section, an eligible entity shall submit to the 
Secretary an application at such time, in such man-
ner, and containing such information as the Sec-
retary may require. 
‘‘(4) CONTENT.—A community health needs as-
sessment shall— 
‘‘(A) identify community needs for a health 
care workforce and collaborative programs and 
partnerships to address the needs; 
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‘‘(B) identify barriers to health care in un-
derserved areas, health disparity populations, or 
regions experiencing significant changes in the 
cultural and linguistic demographics of their 
populations, including border communities; and 
‘‘(C) provide assurance that the entity or 
entities conducting such assessment will assess 
how to— 
‘‘(i) link community organizations and 
academic health centers to address commu-
nity health workforce training needs; 
‘‘(ii) support development of a work-
force reflective of the cultural, linguistic, 
racial, and ethnic makeup of the popu-
lation involved; 
‘‘(iii) address the barriers identified in 
subparagraph (B), with an emphasis on 
community based participatory research 
which includes local communities and pre-
pares members of the identified popu-
lations to participate in improving health 
care in these communities; 
‘‘(iv) enhance the development of the 
workforce practicing in primary care; 
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‘‘(v) enhance the development of the 
workforce serving underserved areas and 
health disparity populations; 
‘‘(vi) build capacity and develop com-
petency within the health care delivery and 
public health systems; and 
‘‘(vii) be responsive to national and 
local health issues impacting the work-
force, such as problems specific to children, 
emerging chronic diseases, an aging popu-
lation, infectious diseases, mental health or 
substance related disorders, or bioterrorism 
by employing such approaches as health 
promotion, health literacy, pharmaceutical 
case management, interdisciplinary inte-
grated models of health care that include 
both physical and mental health, cultural 
and linguistic competency, or approaches 
that reduce health disparities. 
‘‘(5) TERM AND AMOUNT OF AWARD.—A grant 
awarded under this subsection shall be— 
‘‘(A) for a term of 2 years; and 
‘‘(B) in an amount of $150,000 for each 
year of the 2-year term. 
‘‘(d) PRIMARY CARE TRAINING INSTITUTES.— 
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‘‘(1) PURPOSE.—The purpose of the Primary 
Care Training Institute program established under 
this subsection is to— 
‘‘(A) prepare and train primary care pro-
viders by enhancing and coordinating multiple 
aims within academic health centers in order to 
lead to improving patient care delivered to 
health disparity populations and reduce health 
disparities; 
‘‘(B) enhance the status of primary care 
within undergraduate and graduate medical 
education through influencing priorities in prac-
tice, education, and research; 
‘‘(C) develop innovative approaches to pri-
mary care education and scholarship by trans-
forming and integrating health care systems 
through interdisciplinary, team-based, and col-
laborative models that may demonstrate im-
proved quality or lower costs; and 
‘‘(D) create economies of scale through 
academic and community collaborations by ena-
bling academic infrastructure support for mul-
tiple community programs. 
‘‘(2) ESTABLISHMENT.—Grants or contracts 
awarded under this subsection shall establish new 
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centers for primary care education and research 
within academic units of family medicine, general in-
ternal medicine, or general pediatrics within aca-
demic health centers. Such new centers shall be 
known as Primary Care Training Institutes (referred 
to in this section as ‘PCTIs’). 
‘‘(3) AUTHORITY
TO
AWARD
GRANTS.—The 
Secretary may make grants to or enter into con-
tracts with eligible entities to develop and implement 
PCTIs in accordance with this subsection. 
‘‘(4) ELIGIBLE ENTITY.—For purposes of this 
subsection, the term ‘eligible entity’ means a pri-
mary care (including family medicine, general inter-
nal medicine, and general pediatrics) academic ad-
ministrative unit. 
‘‘(5) APPLICATION; REQUIREMENT FOR NEEDS 
ASSESSMENT.—An eligible entity desiring a grant 
under this subsection shall submit to the Secretary 
an application at such time, in such manner, and 
containing— 
‘‘(A)(i) a community health needs assess-
ment conducted by such eligible entity through 
a grant awarded under subsection (c); or 
‘‘(ii) a community health needs assessment 
conducted by such entity through other means 
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and that meets the requirements of subsection 
(c); and 
‘‘(B) such information as the Secretary 
may require. 
‘‘(6) FUNCTIONS.—An eligible entity shall use 
amounts awarded under a grant under this sub-
section to carry out the purpose described in para-
graph (1), through— 
‘‘(A) establishment of a PCTI to improve 
primary care training and practice, to improve 
recruitment of underrepresented minority stu-
dents into primary care careers, and to improve 
the number and percentage of trained profes-
sionals serving in underserved areas and health 
disparity populations; and 
‘‘(B) the establishment of infrastructure to 
support the PCTI including development of, 
and training in— 
‘‘(i) curriculum designs; 
‘‘(ii) education evaluation tools; 
‘‘(iii) online interactive educational 
curricula; 
‘‘(iv) community-based and population 
research study designs; 
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‘‘(v) applied behavioral science and 
psychology educational programs; 
‘‘(vi) clinical epidemiology; 
‘‘(vii) models for teaching caring for 
older adults; 
‘‘(viii) models for health services deliv-
ery; 
‘‘(ix) public health and preventive 
medicine; and 
‘‘(x) models for teaching cultural com-
petency and health literacy. 
‘‘(7) REQUIREMENTS.— 
‘‘(A) REQUIRED ACTIVITIES.—Each eligi-
ble entity that establishes a PCTI under this 
subsection shall, through such PCTI— 
‘‘(i) collaborate across disciplines in-
cluding family medicine, general internal 
medicine, general pediatrics, or with dis-
ciplines such as physician assistants and 
those certified in geriatrics or gerontology, 
general dentistry, behavioral and mental 
health, or public health; 
‘‘(ii) establish and maintain formal 
partnerships with area health education 
centers, Federally qualified health centers, 
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rural health clinics, hospital and nonhos-
pital-based teaching clinics, Geriatric Edu-
cation Centers, Geriatric Research Edu-
cation and Clinical Centers, or other facili-
ties focused on social and health needs of 
older adults or other underserved areas, 
health disparity populations, and other vul-
nerable populations, such as older adults, 
homeless individuals, victims of abuse or 
trauma, individuals with mental health or 
substance-related disorders, and individ-
uals with HIV/AIDS; 
‘‘(iii) create new models of teaching 
and evaluating patient care based on the 
patient centered medical home model, 
interdisciplinary 
integrated 
models 
of 
health care that incorporate both physical 
and mental health, drug therapy manage-
ment, or other new models of effective pa-
tient care utilizing a team or collaborative 
approach; 
‘‘(iv) conduct research and education 
that improves or is relevant to community 
practice and that is carried out in commu-
nity or primary care settings, and that 
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may address such issues as environmental 
health, infectious disease control, disease 
prevention, health promotion, and injury 
control; 
‘‘(v) increase the number of trainees 
and faculty from underrepresented minor-
ity groups, and from rural disadvantaged 
backgrounds; and 
‘‘(vi) address the changing national, 
regional, and local health care needs and 
priorities as identified in the community 
health needs assessment submitted by such 
eligible entity in the application under this 
subsection. 
‘‘(B) VOLUNTARY ACTIVITIES.—Each eligi-
ble entity that establishes a PCTI under this 
subsection may, through such PCTI, integrate 
programs along the educational continuum, in-
cluding high school and college pipeline pro-
grams, predoctoral education in primary care, 
primary care residency training, faculty devel-
opment, fellowship programs, and primary care 
research infrastructure programs and inter-
disciplinary joint degree programs in graduate 
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public health training and other health profes-
sions. 
‘‘(8) TERM AND AMOUNT OF AWARD.—A grant 
awarded under this subsection shall be— 
‘‘(A) for a term of 5 years; and 
‘‘(B) in an amount of $750,000 for each 
year of the 5-year term. 
‘‘(e) PRIORITIES IN MAKING AWARDS.—With respect 
to the training provided for under this section, the Sec-
retary shall give priority in awarding grants or contracts 
to the following: 
‘‘(1) Qualified applicants that have a record of 
training individuals who are from underrepresented 
minority groups or from a rural or disadvantaged 
background. 
‘‘(2) Qualified applicants that establish formal 
relationships with Federally qualified health centers, 
rural health centers, or accredited teaching facilities 
located in underserved areas or serve health dis-
parity populations, and that conduct training of stu-
dents, residents, fellows, or faculty at the center or 
facility. 
‘‘(3) Qualified applicants that conduct teaching 
programs targeting vulnerable populations such as 
older adults, homeless individuals, victims of abuse 
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or trauma, individuals with mental health or sub-
stance-related disorders, and individuals with HIV/ 
AIDS. 
‘‘(4) Qualified applicants that include edu-
cational activities in care of older adults. 
‘‘(5) Qualified applicants that conduct teaching 
programs in an interdiscliplinary setting dem-
onstrating a team or collaborative approach to care. 
‘‘(6) Qualified applicants that include edu-
cational activities in cultural competency and health 
literacy. 
‘‘(f) PREFERENCE IN MAKING AWARDS UNDER THIS 
SECTION.—In making awards of grants or contracts 
under this section, the Secretary shall give preference to 
any qualified applicant that— 
‘‘(1) has a high rate for placing graduates in 
practice settings having the principle focus of serv-
ing underserved areas or health disparity popu-
lations; 
‘‘(2) during the 2-year period preceding the fis-
cal year for which such an award is sought, has 
achieved a significant increase in the rate of placing 
graduates in such settings; or 
‘‘(3) have a record of training the greatest per-
centage of providers, or that have demonstrated sig-
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nificant improvements in the percentage of pro-
viders, who enter and remain in primary care prac-
tice. 
‘‘(g) APPLICATION.—An eligible entity desiring a 
grant under this section shall submit to the Secretary an 
application at such time, in such manner, and containing 
such information as the Secretary may require. 
‘‘(h) DUTIES OF SECRETARY.—The Secretary shall, 
in carrying out this section and section 748— 
‘‘(1) require collaboration— 
‘‘(A) among the pertinent workforce pro-
grams within this title and the Department of 
Health and Human Services; and 
‘‘(B) among such pertinent programs ad-
ministered by the Department of Labor and the 
Department of Education; 
‘‘(2) use and adequately support existing pro-
grams to address new Departmental initiatives, as 
appropriate; 
‘‘(3) take into consideration capabilities of ex-
isting programs before creating separate or parallel 
programs; and 
‘‘(4) evaluate and publicly report on the effec-
tiveness of such programs on an annual basis. 
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‘‘(i) RURAL BACKGROUND DEFINED.—For purposes 
of this section, the term ‘rural background’ means, with 
respect to an individual, having grown up, lived a substan-
tial portion of such individual’s life, or attended high 
school in a federally designated rural or nonmetropolitan 
area. 
‘‘(j) AUTHORIZATION OF APPROPRIATIONS.— 
‘‘(1) TRAINING PROGRAMS.—There is author-
ized to be appropriated to carry out subsections (a) 
and (b), $125,000,000 for each of the fiscal years 
2009 through 2014, of which 15 percent of the 
amount appropriated in each such fiscal year shall 
be allocated to physician assistant training programs 
as described under subsection (a)(1)(F), which pre-
pare students for practice in primary care settings. 
‘‘(2) COMMUNITY
HEALTH
NEEDS
ASSESS-
MENTS.—There is authorized to be appropriated to 
carry out subsection (c)— 
‘‘(A) $1,800,000 for fiscal year 2009; and 
‘‘(B) $3,600,000 for each of the fiscal 
years 2010 through 2013. 
‘‘(3) PRIMARY CARE TRAINING INSTITUTES.— 
There is authorized to be appropriated to carry out 
subsection (d)— 
‘‘(A) $6,000,000 for fiscal year 2009; 
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‘‘(B) $12,000,000 for fiscal year 2010; 
‘‘(C) $18,000,000 for fiscal year 2011; 
‘‘(D) $24,000,000 for fiscal year 2012; 
and 
‘‘(E) $30,000,000 for fiscal year 2013. 
‘‘(4) CARRYOVER FUNDS.—An entity that re-
ceives an award under this section may carry over 
funds from 1 fiscal year to another without obtain-
ing approval from the Secretary. In no case may any 
funds be carried over pursuant to the preceding sen-
tence for more than 3 years, and in the case of a 
community health needs assessment under sub-
section (c), for more than 1 year.’’. 
SEC. 7. TRAINING IN GENERAL AND PEDIATRIC DEN-
TISTRY; LOAN REPAYMENTS. 
(a) TRAINING IN GENERAL AND PEDIATRIC DEN-
TISTRY.—Part C of Title VII (42 U.S.C. 293k et seq.) 
is amended by— 
(1) redesignating section 748 as section 749; 
and 
(2) inserting after section 747 the following: 
‘‘SEC. 748. TRAINING IN GENERAL AND PEDIATRIC DEN-
TISTRY. 
‘‘(a) SUPPORT
AND DEVELOPMENT
OF DENTAL 
TRAINING PROGRAMS.— 
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‘‘(1) IN GENERAL.—The Secretary may make 
grants to, or enter into contracts with, a school of 
dentistry, public or nonprofit private hospital, or a 
public or private nonprofit entity which the Sec-
retary has determined is capable of carrying out 
such grant or contract— 
‘‘(A) to plan, develop, and operate, or par-
ticipate in, an approved professional training 
program in the field of general dentistry, or pe-
diatric dentistry for dental students, residents, 
or practicing dentists, that emphasizes training 
for general dentistry or pediatric dentistry; 
‘‘(B) to provide financial assistance to den-
tal students, residents, and practicing dentists 
who are in need thereof, who are participants in 
any such program, and who plan to work in the 
practice of general or pediatric dentistry; 
‘‘(C) to plan, develop, and operate a pro-
gram for the training of dentists who plan to 
teach in general or pediatric dentistry; and 
‘‘(D) to provide financial assistance in the 
form of traineeships and fellowships to dentists 
who plan to teach or are teaching in general or 
pediatric dentistry. 
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‘‘(2) ELIGIBLE ENTITY.—For purposes of this 
subsection, entities eligible for such grants or con-
tracts in general or pediatric dentistry shall include 
entities that have programs in dental schools, or ap-
proved residency or advanced education programs in 
the practice of general or pediatric dentistry. 
‘‘(b) ACADEMIC ADMINISTRATIVE UNITS.— 
‘‘(1) IN GENERAL.—The Secretary may make 
grants to or enter into contracts with schools of den-
tistry to meet the costs of projects to establish, 
maintain, or improve academic administrative units 
(which may be departments, divisions, or other 
units) to provide clinical instruction in general or pe-
diatric dentistry. 
‘‘(2) PRIORITY IN MAKING AWARDS.—In mak-
ing awards of grants and contracts under paragraph 
(1), the Secretary shall give priority to any qualified 
applicant for such an award that proposes a collabo-
rative project between departments of primary care 
medicine and departments of general and pediatric 
dentistry. 
‘‘(3) PREFERENCE
IN
MAKING
AWARDS.—In 
making awards of grants and contracts under para-
graph (1), the Secretary shall give preference to any 
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qualified applicant for such an award that agrees to 
expend the award for the purpose of— 
‘‘(A) establishing an academic administra-
tive unit for programs in general or pediatric 
dentistry; and 
‘‘(B) substantially expanding the programs 
of such a unit. 
‘‘(c) PRIORITIES IN MAKING AWARDS UNDER THIS 
SECTION.—With respect to training provided for under 
this section, the Secretary shall give priority in awarding 
grants or contracts to the following: 
‘‘(1) Qualified applicants that have a record of 
training the greatest percentage of providers, or that 
have demonstrated significant improvements in the 
percentage of providers, who enter and remain in 
general or pediatric dentistry. 
‘‘(2) Qualified applicants that have a record of 
training individuals who are from a rural or dis-
advantaged background, or from underrepresented 
minorities. 
‘‘(3) Qualified applicants that establish formal 
relationships with Federally qualified health centers, 
rural health centers, or accredited teaching facilities 
and that conduct training of students, residents, fel-
lows, or faculty at the center or facility. 
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‘‘(4) Qualified applicants that conduct teaching 
programs targeting vulnerable populations such as 
older adults, homeless individuals, victims of abuse 
or trauma, individuals with mental health or sub-
stance-related disorders, and individuals with HIV/ 
AIDS. 
‘‘(5) Qualified applicants that include edu-
cational activities in cultural competency and health 
literacy. 
‘‘(d) PREFERENCE IN MAKING AWARDS.—In making 
awards of grants or contracts under this section, the Sec-
retary shall give preference to any qualified applicant 
that— 
‘‘(1) has a high rate for placing graduates in 
practice settings having the principal focus of serv-
ing in underserved areas or health disparity popu-
lations; or 
‘‘(2) during the 2-year period before the fiscal 
year for which such an award is sought, has 
achieved a significant increase in the rate of placing 
graduates in such settings. 
‘‘(e) APPLICATION.—An eligible entity desiring a 
grant under this section shall submit to the Secretary an 
application at such time, in such manner, and containing 
such information as the Secretary may require. 
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‘‘(f) DURATION
OF AWARD.—The period during 
which payments are made to an entity from an award of 
a grant or contract under subsection (a) shall be 5 years. 
The provision of such payments shall be subject to annual 
approval by the Secretary of the payments and subject to 
the availability of appropriations for the fiscal year in-
volved to make the payments. 
‘‘(g) FUNDING.—For the purpose of carrying out 
subsections (a) and (b), there is authorized to be appro-
priated $20,000,000 for each of the fiscal years 2009 
through 2013. 
‘‘(h) CARRYOVER FUNDS.—An entity that receives an 
award under this section may carry over funds from 1 fis-
cal year to another without obtaining approval from the 
Secretary. In no case may any funds be carried over pur-
suant to the preceding sentence for more than 3 years.’’. 
(b) LOAN
REPAYMENTS
FOR
DENTAL
PROFES-
SIONALS.— 
(1) IN GENERAL.—Section 738(a) (42 U.S.C. 
293b(a)) is amended by inserting at the end the fol-
lowing: 
‘‘(7) PRIORITY FOR DENTAL PROFESSIONALS.— 
In entering into contracts under this subsection, the 
Secretary shall give priority to individuals who— 
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‘‘(A) are teaching or doing research in an 
academic dental setting in general or pediatric 
dentistry; 
‘‘(B) have a degree in dentistry; 
‘‘(C) are enrolled in an approved graduate 
training program in dentistry; or 
‘‘(D) are enrolled as full-time students— 
‘‘(i) in an accredited (as determined 
by the Secretary) school of dentistry; and 
‘‘(ii) in the final year of a course of 
a study or program, offered by such insti-
tution and approved by the Secretary, lead-
ing to a degree from such a school.’’. 
(2) AUTHORIZATION
OF
APPROPRIATIONS.— 
Section 740(b) (42 U.S.C. 293d(b)) is amended by 
adding at the end the following: ‘‘In addition to any 
amounts authorized under this subsection, there is 
authorized to be appropriated to enter into contracts 
under section 738(a) with individuals described in 
section 738(a)(7), $500,000 for fiscal year 2009, 
$1,000,000 for fiscal year 2010, $1,500,000 for fis-
cal year 2011, and $2,000,000 for each of the fiscal 
years 2012 and 2013.’’. 
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SEC. 8. INTERDISCIPLINARY, COMMUNITY-BASED LINK-
AGES. 
(a) AREA HEALTH EDUCATION CENTERS.—Section 
751 (42 U.S.C. 294a) is amended to read as follows: 
‘‘SEC. 751. AREA HEALTH EDUCATION CENTERS. 
‘‘(a) DEFINITIONS; ESTABLISHMENT OF AWARDS.— 
‘‘(1) DEFINITIONS.—In this section: 
‘‘(A) AREA
HEALTH
EDUCATION
CEN-
TER.—The terms ‘area health education center’ 
or ‘center’ mean a public or nonprofit private 
organization that has a cooperative agreement 
or contract in effect with an entity that has re-
ceived an award under subsection (b) or (c), 
satisfies the requirements in subsection (d)(1), 
and has as one of its principal functions the op-
eration of an area health education center. Ap-
propriate organizations may include hospitals, 
health organizations with accredited primary 
care training programs, accredited physician as-
sistant educational programs associated with a 
college or university, and universities or colleges 
not operating a school of medicine or osteo-
pathic medicine. 
‘‘(B) AREA HEALTH EDUCATION CENTER 
PROGRAM.—The terms ‘area health education 
center program’ or ‘program’ mean cooperative 
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program consisting of an entity that has re-
ceived an award under subsection (b) or (c) for 
the purpose of planning, developing, operating, 
and evaluating an area health education center 
program and one or more area health education 
centers, which carries out the required activities 
described in subsection (b)(4) or (c)(4), satisfies 
the program requirements in this section, and 
has as one of its principal functions identifying 
and implementing strategies and activities that 
address health care workforce needs in its serv-
ice area. 
‘‘(C) RURAL BACKGROUND.—For purposes 
of this section, the term ‘rural background’ 
means, with respect to an individual, having 
grown up, lived a substantial portion of such in-
dividual’s life, or attended high school in a fed-
erally designated rural or nonmetropolitan area. 
‘‘(2) ESTABLISHMENT.—The Secretary shall 
make awards in accordance with this section. 
‘‘(b) INFRASTRUCTURE DEVELOPMENT AWARD.— 
‘‘(1) IN GENERAL.—The Secretary shall make 
awards to eligible entities to enable such entities to 
initiate health care workforce educational programs 
or to continue to carry out comparable programs 
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that are operating at the time the award is made by 
planning, developing, operating, and evaluating of an 
area health education center program. 
‘‘(2) ELIGIBLE ENTITY.—For purposes of this 
subsection, an ‘eligible entity’ means a school of 
medicine or osteopathic medicine, an incorporated 
consortium of such schools, or the parent institu-
tions of such a school. With respect to a State in 
which no area health education center program is in 
operation, the Secretary may award a grant or con-
tract under paragraph (1) to a school of nursing. 
‘‘(3) APPLICATION.—An eligible entity desiring 
to receive an award under this subsection shall sub-
mit to the Secretary an application at such time, in 
such manner, and containing such information as 
the Secretary may require. 
‘‘(4) USE OF FUNDS.— 
‘‘(A) REQUIRED ACTIVITIES.—An eligible 
entity shall use amounts awarded under a grant 
under paragraph (1) to carry out the following 
activities: 
‘‘(i) Develop and implement strategies 
to recruit individuals from underrep-
resented minority populations or from dis-
advantaged or rural backgrounds into 
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health professions, and support such indi-
viduals in attaining such careers. 
‘‘(ii) Develop and implement strate-
gies to foster and provide community-based 
training and education to individuals seek-
ing careers in health professions within un-
derserved areas for the purpose of devel-
oping and maintaining a diverse health 
care workforce that is prepared to deliver 
high-quality care, with an emphasis on pri-
mary care, in underserved areas or for 
health disparity populations, in collabora-
tion with other Federal and State health 
care workforce development programs, and 
in health care safety net sites. 
‘‘(iii) Prepare individuals to more ef-
fectively provide health services to under-
served areas and health disparity popu-
lations through field placements or precep-
torships in conjunction with community- 
based organizations, accredited primary 
care residency training programs, Feder-
ally qualified health centers, rural health 
clinics, public health departments, or other 
appropriate facilities. 
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‘‘(iv) Conduct and participate in inter-
disciplinary training that involves physi-
cians, physician assistants, nurse practi-
tioners, nurse midwives, dentists, psycholo-
gists, pharmacists, public health, or other 
health professionals, as practicable. 
‘‘(v) Deliver or facilitate continuing 
education and information dissemination 
programs for health care professionals, 
with an emphasis on individuals providing 
care in underserved areas and for health 
disparity populations. 
‘‘(vi) Propose and implement effective 
program and outcomes measurement and 
evaluation strategies. 
‘‘(B) INNOVATIVE
OPPORTUNITIES.—An 
eligible entity may use amounts awarded under 
a grant under paragraph (1) to carry out any 
of the following activities: 
‘‘(i) Develop and implement innovative 
curricula in collaboration with community- 
based accredited primary care residency 
training 
programs, 
Federally 
qualified 
health centers, rural health clinics, behav-
ioral and mental health facilities, public 
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health departments, or other appropriate 
facilities, with the goal of increasing the 
number of primary care physicians and 
other primary care providers prepared to 
serve in underserved areas and health dis-
parity populations. 
‘‘(ii) 
Coordinate 
community-based 
participatory 
research 
with 
academic 
health centers, and facilitate rapid flow 
and dissemination of evidence-based health 
care information, research results, and best 
practices to improve quality, efficiency, and 
effectiveness of health care and health care 
systems within community settings. 
‘‘(iii) Develop and implement other 
strategies to address identified workforce 
needs and increase and enhance the health 
care workforce in the area served by the 
area health education center program. 
‘‘(c) POINT OF SERVICE MAINTENANCE AND EN-
HANCEMENT AWARD.— 
‘‘(1) IN GENERAL.—The Secretary shall make 
awards to eligible entities to maintain and improve 
the effectiveness and capabilities of an existing area 
health education center program, and make other 
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‘‘(I) evaluates and reports to the Sec-
retary, in collaboration with the area health 
education center program of which the center is 
a part, concerning the effectiveness of the cen-
ter on an annual basis. 
‘‘(e) DUTIES OF THE SECRETARY.—In carrying out 
this section, the Secretary shall— 
‘‘(1) require collaboration— 
‘‘(A) among the pertinent workforce pro-
grams under this title and the Department of 
Health and Human Services; and 
‘‘(B) among such pertinent programs ad-
ministered by the Department of Labor and the 
Department of Education; 
‘‘(2) use and adequately support existing pro-
grams to address new initiatives of the Department 
of Health and Human Services, as appropriate; 
‘‘(3) take into consideration capabilities of ex-
isting programs prior to establishing separate or 
parallel programs; and 
‘‘(4) evaluate and publicly report on the effec-
tiveness of such programs on an annual basis. 
‘‘(f) MATCHING FUNDS.—With respect to the costs 
of operating a program through a grant under this section, 
to be eligible for financial assistance under this section, 
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