(1) The purpose of the physician assistant pro-
fession is to extend the ability of physicians to pro-
vide primary care services, particularly in rural and 
other medically underserved communities. 
(2) Physician assistants always practice medi-
cine as a team with their supervising physicians, 
however, supervising physicians need not be phys-
ically 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 author-
ize physicians to delegate prescriptive authority to 
physician assistants. 
(4) In 2007, physician assistants made approxi-
mately 245,000,000 patient visits and prescribed or 
recommended approximately 303,000,000 medica-
tions. 
(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 
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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 PRO-
FESSIONAL SHORTAGES.—Congress finds the following: 
(1) The National Institute of Mental Health es-
timates that 26.2 percent of citizens of the United 
States ages 18 and older suffer from a diagnosable 
mental disorder. Approximately 20 percent of chil-
dren in the United States have diagnosable mental 
disorders with at least mild functional impairment. 
(2) The Health Resources and Services Admin-
istration 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 men-
tal health professionals who are Hispanic for every 
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100,000 individuals who are Hispanic in the United 
States, compared with 173 non-Hispanic White pro-
viders 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 pro-
fessional shortage areas, but only 1,200 of those po-
sitions were funded. For each National Health Serv-
ice Corps award, there are 7 applicants. 
(2) Community health centers receiving assist-
ance 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 per-
cent), dentists, nurses, and other health profes-
sionals. 
(3) The Institute of Medicine of the National 
Academies has recommended that medical education 
and public health issues be more closely aligned, es-
pecially in relation to preparedness for natural disas-
ters, pandemic, bioterrorism, and other threats to 
public health. 
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(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 coordi-
nation, 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 Cen-
ters 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. 
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TITLE I—AMENDMENTS TO THE 
SOCIAL SECURITY ACT 
Subtitle A—Workforce 
Improvements 
SEC. 101. NATIONAL HEALTH CARE WORKFORCE COMMIS-
SION. 
(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 effective-
ness; 
(D) disseminating information on prom-
ising retention practices for health care profes-
sionals; 
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(E) communicating information on impor-
tant policies and practices that affect the re-
cruitment, education and training, and reten-
tion 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 pa-
tients and populations; 
(2) communicates and coordinates with the De-
partments 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 wheth-
er the demand for health care workers is being met; 
(4) identifies barriers to improved coordination 
at the Federal, State, and local levels and rec-
ommend ways to address such barriers; and 
(5) encourages innovations to address popu-
lation 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’’). 
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(c) MEMBERSHIP.— 
(1) NUMBER AND APPOINTMENT.—The Com-
mission shall be composed of 15 members to be ap-
pointed 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 anal-
ysis, including health care workforce anal-
ysis; health care finance and economics; 
health care facility management; health 
care plans and integrated delivery systems; 
health care workforce education and train-
ing; 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 representa-
tives. 
(B) INCLUSION.— 
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(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 re-
search; 
(V) representatives of consumers; 
(VI) labor unions; 
(VII) State or local workforce in-
vestment boards; and 
(VIII) 
educational 
institutions 
(which may include elementary and 
secondary institutions, institutions of 
higher education, including 2 and 4 
year institutions, or registered ap-
prenticeship programs). 
(ii) ADDITIONAL MEMBERS.—The re-
maining membership may include addi-
tional representatives from clause (i) and 
other individuals as determined appro-
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priate by the Comptroller General of the 
United States. 
(C) MAJORITY
NON-PROVIDERS.—Individ-
uals who are directly involved in health profes-
sions education or practice shall not constitute 
a majority of the membership of the Commis-
sion. 
(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 ap-
pointed. 
(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 
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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 mem-
ber’s regular place of business, a member may be al-
lowed travel expenses, as authorized by the Chair-
man of the Commission. Physicians serving as per-
sonnel of the Commission may be provided a physi-
cian comparability allowance by the Commission in 
the same manner as Government physicians may be 
provided such an allowance by an agency under sec-
tion 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 pur-
poses 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 chair-
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man or vice chairman’s term or upon the resignation 
of the chairman or vice chairman from the Commis-
sion. 
(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 fis-
cally sustainable integrated workforce that supports 
a high-quality, readily accessible health care delivery 
system that meets the needs of patients and popu-
lations, the Commission, in consultation with rel-
evant 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 poli-
cies; 
(C) by not later than October 1 of each 
year (beginning with 2011), submit a report to 
Congress and the Administration containing the 
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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 Con-
gress and the Administration containing a re-
view of, and recommendations on, at a min-
imum 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 stu-
dents who have completed education and train-
ing, including registered apprenticeships; the 
number of qualified faculty; the education and 
training infrastructure; and the education and 
training demands, with projected demands dur-
ing the subsequent 10 and 25 year periods, and 
including identified models of education and 
training delivery and best practices; 
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(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 Na-
tional Health Service Corps (with recommenda-
tions for aligning such programs with national 
health workforce priorities and goals), and 
other health care workforce programs, including 
those supported through the Workforce Invest-
ment Act of 1998 (29 U.S.C. 2801 et seq.), the 
Carl D. Perkins Career and Technical Edu-
cation 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 spe-
cial populations, such as minorities, rural popu-
lations, medically underserved populations, gen-
der 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.— 
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(A) IN GENERAL.—The initial high priority 
topics described in this paragraph include— 
(i) integrated health care workforce 
planning that identifies health care profes-
sional skills needed and maximizes the skill 
sets of health care professionals across dis-
ciplines; 
(ii) an analysis of the nature, scopes 
of practice, and demands for health care 
workers in the enhanced information tech-
nology and management workplace; 
(iii) Medicare and Medicaid graduate 
medical 
education 
policies 
and 
rec-
ommendations for aligning with national 
workforce goals; 
(iv) nursing workforce capacity at all 
levels, including education and training ca-
pacity, projected demands, and integration 
within the health care delivery system; 
(v) oral health care workforce capac-
ity, including education and training ca-
pacity, projected demands, and integration 
within the health care delivery system; 
(vi) mental and behavioral health care 
workforce capacity, including education 
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and training capacity, projected demands, 
and integration within the health care de-
livery system; 
(vii) allied health and public health 
care workforce capacity, including edu-
cation and training capacity, projected de-
mands, 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 ap-
propriate committees of Congress may rec-
ommend to the Commission the inclusion of 
other topics for health care workforce develop-
ment 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 estab-
lished in section 412. 
(5) STUDY.—The Commission shall study effec-
tive mechanisms for financing education and train-
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ing for careers in health care, including public health 
and allied health. 
(6) 
RECOMMENDATIONS.—The 
Commission 
shall submit recommendations to Congress, the De-
partment 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 as-
sess 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 ORGANIZA-
TIONS.— 
(1) IN GENERAL.—The Commission shall con-
sult with Federal agencies (including the Depart-
ments of Health and Human Services, Labor, Edu-
cation, Commerce, Agriculture, Defense, and Vet-
erans 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 orga-
nizations professional societies, and other relevant 
public-private health care partnerships. 
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(2) OBTAINING OFFICIAL DATA.—The Commis-
sion, 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
EM-
PLOYEES.—An employee of the Federal Government 
may be detailed to the Commission without reim-
bursement. The detail of such an employee shall be 
without interruption or loss of civil service status. 
(f) DIRECTOR AND STAFF; EXPERTS AND CONSULT-
ANTS.—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 Com-
mission may— 
(1) employ and fix the compensation of an exec-
utive director (subject to the approval of the Comp-
troller 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, gov-
erning appointments in the competitive service); 
(2) seek such assistance and support as may be 
required in the performance of its duties from ap-
propriate Federal departments and agencies; 
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(3) enter into contracts or make other arrange-
ments, 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 pay-
ments 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 pub-
lished 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 Bu-
reau of Labor Statistics; 
(B) carry out, or award grants or con-
tracts for the carrying out of, original research 
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and development, where existing information is 
inadequate, and 
(C) adopt procedures allowing interested 
parties to submit information for the Commis-
sion’s use in making reports and recommenda-
tions. 
(2) ACCESS OF THE GOVERNMENT ACCOUNT-
ABILITY
OFFICE
TO
INFORMATION.—The Comp-
troller General of the United States shall have unre-
stricted access to all deliberations, records, and non-
proprietary data of the Commission, immediately 
upon request. 
(3) PERIODIC
AUDIT.—The Commission shall 
be subject to periodic audit by a third party ap-
pointed 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 appropria-
tions. Amounts so appropriated for the Commission 
shall be separate from amounts appropriated for the 
Comptroller General. 
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(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 pro-
viders with direct patient care and support respon-
sibilities, including physicians, nurses, physician as-
sistants, pharmacists, oral healthcare professionals, 
allied health professionals, mental health profes-
sionals, 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, psy-
chologists and other behavioral and mental 
health professionals, social workers, physical 
therapists, public health professionals, clinical 
pharmacists, allied health professionals, chiro-
practors, community health workers, school 
nurses, certified nurse midwives, podiatrists, li-
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censed complementary and alternative medicine 
providers, and integrative health practitioners; 
(B) national representatives of health pro-
fessionals; 
(C) representatives of schools of medicine, 
osteopathy, nursing, allied health, educational 
programs for public health professionals, behav-
ioral and mental health professionals (as so de-
fined), social workers, physical therapists, oral 
health care industry dentistry and dental hy-
giene, and physician assistants; 
(D) representatives of public and private 
teaching hospitals, and ambulatory health facili-
ties, including Federal medical facilities; and 
(E) any other health professional the 
Comptroller General of the United States deter-
mines 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). 
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(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 sub-
mitted by each State which has been certified by the Gov-
ernor or the chief executive officer of the State. 
(c) USE OF FUNDS.—Grants awarded under sub-
section (a) may be used to support activities designed to 
improve the training, deployment, and retention of critical 
health professionals in underserved areas and for under-
served populations, including the following: 
(1) Conducting assessments of key health pro-
fessional 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 policy-
makers 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 
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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 re-
spect 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 do-
nations from public or private entities) non-Federal 
contributions in an amount equal to a percent of 
Federal funds provided under the grant (as deter-
mined 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 
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(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
GRAD-
UATE MEDICAL EDUCATION POSITIONS FOR 
STATES
WITH
A
SHORTAGE
OF
RESI-
DENTS.— 
‘‘(I) IN GENERAL.—For cost re-
porting periods beginning on or after 
January 1, 2011, the Secretary shall 
increase the otherwise applicable limit 
on the total number of full-time equiv-
alent 
residents 
in 
the 
field 
of 
allopathic or osteopathic medicine de-
termined under clause (i) with respect 
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to a qualifying hospital by an amount 
equal to 15 percent of the amount of 
the otherwise applicable limit (deter-
mined without regard to this clause). 
Such increase shall be phased-in 
equally over a period of 3 cost report-
ing periods beginning with the first 
cost reporting period in which the in-
crease 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 un-
derserved areas and innovative train-
ing 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 
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Secretary, in consultation with the 
Permanent National Health Work-
force Commission established under 
section 101(a) of the Health Access 
and Health Professions Supply Act of 
2009, determines are in high-need (in-
cluding family medicine, general sur-
gery, geriatrics, general internal medi-
cine, general surgery, and obstetrics 
and gynecology). 
‘‘(III) 
INCREASE
IN
PAY-
MENTS.—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 sub-
section with respect to direct graduate 
medical education costs that would 
otherwise apply with respect to such 
residents by 10 percent. Such in-
creased payments shall be made to the 
facility in which the training is pro-
vided to such residents.’’. 
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(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 edu-
cation costs under section 1886(h) of the Social Se-
curity 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 
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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 Per-
manent National Health Workforce Commission es-
tablished under section 101(a). 
(c) DETERMINATION
OF HOSPITAL-SPECIFIC AP-
PROVED 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 subpara-
graph: 
‘‘(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 pay-
ments to be made for costs in addition to 
the costs of hospital-sponsored education. 
Such methodology shall provide that non-
teaching hospital-based entities (such as 
managed care organizations and public and 
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private healthcare consortia) that are capa-
ble of assembling all of the resources nec-
essary 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 affil-
iate of such a sponsor. 
‘‘(ii) APPLICABLE RESIDENT.—In this 
subparagraph, the term ‘applicable resi-
dent’ means a resident— 
‘‘(I) in a specialty which the Sec-
retary, in consultation with the Per-
manent 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 
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underserved population (as defined in 
section 330(b)(3) of the Public Health 
Service Act); and 
‘‘(IV) in a Federal medical facil-
ity. 
‘‘(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 Pub-
lic 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 sec-
tion 323 of such Act) or a State cor-
rectional institution; 
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‘‘(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 enact-
ment of this Act and training residents in excess of its 
cap, consistent with the rolling average provisions applica-
ble 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 POLI-
CIES.— 
(1) REVIEW.—The Secretary of Health and 
Human Services shall review policies with respect to 
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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 re-
spond to emergency situations and situations 
involving institutional and program closure; and 
(B) in the case where the Secretary deter-
mines legislative action is necessary to make 
such revisions, submit to Congress a report con-
taining recommendations for such legislative ac-
tion. 
SEC. 105. AUTHORITY TO INCLUDE COSTS OF TRAINING OF 
PSYCHOLOGISTS 
IN 
PAYMENTS 
TO 
HOS-
PITALS FOR APPROVED EDUCATIONAL AC-
TIVITIES UNDER MEDICARE. 
Effective for cost reporting periods beginning on or 
after the date that is 18 months after the date of enact-
ment of this Act, for purposes of payment to hospitals 
under the Medicare program under title XVIII of the So-
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cial Security Act for costs of approved educational activi-
ties (as defined in section 413.85 of title 42, Code of Fed-
eral 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 ASSESS-
MENTS. 
(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 sub-
section (hhh)(1));’’. 
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(2) CONFORMING
AMENDMENTS.—Clauses (i) 
and (ii) of section 1861(s)(2)(K) of the Social Secu-
rity Act (42 U.S.C. 1395x(s)(2)(K)) are each 
amended by striking ‘‘subsection (ww)(1)’’ and in-
serting ‘‘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 sub-
sections: 
‘‘Geriatric Assessment 
‘‘(hhh)(1) The term ‘geriatric assessment’ means 
each of the following: 
‘‘(A) An assessment of the clinical status, func-
tional status, social and environmental functioning, 
and need for caregiving of a geriatric assessment eli-
gible individual (as defined in subsection (iii)). The 
assessment shall include a comprehensive history 
and physical examination and assessments of the fol-
lowing domains using standardized validated clinical 
tools: 
‘‘(i) Comprehensive review of medications 
and the individual’s adherence to the medica-
tion regimen. 
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‘‘(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 appro-
priate by the Secretary. 
‘‘(B) The development of a written care plan 
based on the results of the assessment under sub-
paragraph (A) (and any subsequent assessment 
under subparagraph (B)). The care plan shall detail 
identified problems, outline therapies, assign respon-
sibility for actions, and indicate whether the indi-
vidual is likely to benefit from chronic care manage-
ment and coordination services (as defined in sub-
section (jjj)(1)). If the individual is determined likely 
to benefit from chronic care management and co-
ordination services, the care plan shall also provide 
the basis for the chronic care management and co-
ordination 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; 
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‘‘(B) 
a 
practitioner 
described 
in 
section 
1842(b)(18)(C)(i) under the supervision of a physi-
cian; or 
‘‘(C) any other provider that meets such condi-
tions 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 as-
sessment 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 identi-
fied 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: 
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‘‘(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 meth-
odologies 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 syn-
dromes, 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 com-
bination with one or more chronic condi-
tions). 
‘‘(ii) Dementia, as defined in the most re-
cent Diagnostic and Statistical Manual of Men-
tal Disorders, and at least 1 other chronic con-
dition. 
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‘‘(iii) Any other factor identified by the 
Secretary. 
‘‘(B) The Secretary shall consult with physi-
cians, 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 subpara-
graph (A)(iii). 
‘‘(3) The term ‘geriatric assessment eligible indi-
vidual’ 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 sec-
tion 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 Ad-
vantage plan or a plan under section 1876. 
‘‘(E) An individual enrolled in a PACE pro-
gram under section 1894. 
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‘‘(F) Any other categories of individuals deter-
mined appropriate by the Secretary. 
‘‘(4) For purposes of this subsection, the term ‘chron-
ic 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-SHAR-
ING.— 
(1) PAYMENT AND ELIMINATION OF COINSUR-
ANCE.—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.— 
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(A) IN GENERAL.—Section 1848 of the So-
cial 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 physi-
cian, practitioner, or other provider de-
scribed 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, in-
cluding the time and effort put forth 
by each qualified health care profes-
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sional involved in performing the geri-
atric assessment; and 
‘‘(II) all of the costs associated 
with the geriatric assessment, includ-
ing labor, supplies, equipment, and 
the costs of health information tech-
nologies and systems incurred by the 
physician, practitioner, or other pro-
vider 
(as 
described 
in 
section 
1861(hhh)(2)) in providing the assess-
ment; and 
‘‘(ii) ensure that such payments do 
not result in a reduction in payments for 
office visits or other evaluation and man-
agement services that would otherwise be 
allowable. 
‘‘(2) SEPARATE
PAYMENTS
FROM
PAYMENTS 
FOR CHRONIC CARE MANAGEMENT AND COORDINA-
TION
SERVICES.—Payments for geriatric assess-
ments shall be made separately from payments for 
chronic care management and coordination services 
(as defined in section 1861(jjj)(1)) and other serv-
ices for which payment is made under this title.’’. 
(B) CONFORMING
AMENDMENT.—Section 
1848(j)(3) of the Social Security Act (42 
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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
OUT-
PATIENT HOSPITAL SETTINGS.— 
(A) EXCLUSION FROM OPD FEE SCHED-
ULE.—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 mammog-
raphy’’ and inserting ‘‘, diagnostic mammog-
raphy, 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 strik-
ing 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 
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