I 
110TH CONGRESS 
1ST SESSION H. R. 2584 
To amend the Public Health Service Act to alleviate critical shortages of 
physicians in the fields of family practice, internal medicine, pediatrics, 
emergency medicine, general surgery, and obstetrics-gynecology, and for 
other purposes. 
IN THE HOUSE OF REPRESENTATIVES 
JUNE 6, 2007 
Mr. BURGESS (for himself and Mr. CUELLAR) introduced the following bill; 
which was referred to the Committee on Energy and Commerce, and in 
addition to the Committee on Ways and Means, for a period to be subse-
quently determined by the Speaker, in each case for consideration of such 
provisions as fall within the jurisdiction of the committee concerned 
A BILL 
To amend the Public Health Service Act to alleviate critical 
shortages of physicians in the fields of family practice, 
internal medicine, pediatrics, emergency medicine, gen-
eral surgery, and obstetrics-gynecology, 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 ‘‘High-Need Physician 
Workforce Incentives Act of 2007’’. 
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SEC. 2. HIGH-NEED PHYSICIAN SPECIALTY WORKFORCE IN-
CENTIVES. 
Page E of title VII of the Public Health Service Act 
(42 U.S.C. 294n et seq.) is amended by adding at the end 
the following: 
‘‘Subpart 3—High-Need Physician Specialty 
Workforce Incentives 
‘‘SEC. 775. SCHOLARSHIP PROGRAM. 
‘‘(a) PURPOSE.—The purpose of this section is to al-
leviate critical shortages of physicians in the fields of fam-
ily practice, internal medicine, pediatrics, emergency medi-
cine, general surgery, and obstetrics-gynecology. 
‘‘(b) GRANTS.—The Secretary, acting through the 
Administrator of the Health Resources and Services Ad-
ministration, shall make grants to critical shortage health 
facilities to carry out a scholarship program described in 
this section. 
‘‘(c) SCHOLARSHIPS.—A health facility receiving a 
grant under this section shall use the grant to enter into 
contracts with eligible individuals under which— 
‘‘(1) the facility agrees to provide the individual 
with a scholarship for each school year (not to ex-
ceed 4 school years) in which the individual is en-
rolled as a full-time student in a school of medicine 
or a school of osteopathic medicine; and 
‘‘(2) the individual agrees— 
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‘‘(A) to maintain an acceptable level of 
academic standing; 
‘‘(B) to complete a residency in the field of 
family practice, internal medicine, pediatrics, 
emergency medicine, general surgery, or obstet-
rics-gynecology; and 
‘‘(C) after completing the residency, to 
serve as a physician at such facility in such 
field for a time period equal to the greater of— 
‘‘(i) one year for each school year for 
which the individual was provided a schol-
arship under this section; or 
‘‘(ii) two years. 
‘‘(d) AMOUNT OF SCHOLARSHIP.— 
‘‘(1) IN
GENERAL.—The amount paid by a 
health facility to an individual through a scholarship 
under this section shall not exceed $30,000 for any 
school year. 
‘‘(2) CONSIDERATIONS.—In determining the 
amount of a scholarship to be provided to an indi-
vidual under this section, a health facility may take 
into consideration the individual’s financial need, ge-
ographic differences, and educational costs. 
‘‘(3) EXCLUSION
FROM
GROSS
INCOME.—For 
purposes of the Internal Revenue Code of 1986, 
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gross income shall not include any amount received 
as a scholarship under this section. 
‘‘(e) APPLICATION OF CERTAIN PROVISIONS.—The 
provisions of subpart III of part D of title III shall, except 
as inconsistent with this section, apply to the program es-
tablished under this section in the same manner and to 
the same extent as such provisions apply to the National 
Health Service Corps Scholarship Program established in 
such subpart. 
‘‘(f) DEFINITIONS.—In this subsection: 
‘‘(1) The term ‘critical shortage health facility’ 
means a public or private nonprofit health facility 
that does not serve a health professional shortage 
area (as such term is defined in section 332), but 
has a critical shortage of physicians (as determined 
by the Secretary) in the field of family practice, in-
ternal medicine, pediatrics, emergency medicine, 
general surgery, or obstetrics-gynecology. 
‘‘(2) The term ‘eligible individual’ means an in-
dividual who is enrolled or accepted for enrollment 
as a full-time student in an accredited school of 
medicine or school of osteopathic medicine. 
‘‘(g) AUTHORIZATION
OF
APPROPRIATIONS.—To 
carry out this section, there is authorized to be appro-
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priated $5,000,000 for each of fiscal years 2008 through 
2012. 
‘‘SEC. 776. LOAN REPAYMENT PROGRAM. 
‘‘(a) PURPOSE.—The purpose of this section is to al-
leviate critical shortages of physicians in the fields of fam-
ily practice, internal medicine, pediatrics, emergency medi-
cine, general surgery, and obstetrics-gynecology. 
‘‘(b) LOANS.—The Secretary, acting through the Ad-
ministrator of the Health Resources and Services Admin-
istration, shall establish a program of entering into con-
tracts with eligible individuals under which— 
‘‘(1) the individual agrees to serve— 
‘‘(A) as a physician in the field of family 
practice, internal medicine, pediatrics, emer-
gency medicine, general surgery, or obstetrics- 
gynecology; and 
‘‘(B) in an area that is not a health profes-
sional shortage area (as such term is defined in 
section 332), but has a critical shortage of phy-
sicians (as determined by the Secretary) in such 
field; and 
‘‘(2) the Secretary agrees to pay, for each year 
of such service, not more than $35,000 of the prin-
cipal and interest of the undergraduate or graduate 
educational loans of the individual. 
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‘‘(c) SERVICE REQUIREMENT.—A contract entered 
into under this section shall allow the individual receiving 
the loan repayment to satisfy the service requirement de-
scribed in subsection (b)(1) through employment in a solo 
or group practice, a clinic, a public or private nonprofit 
hospital, or any other appropriate health care entity. 
‘‘(d) APPLICATION OF CERTAIN PROVISIONS.—The 
provisions of subpart III of part D of title III shall, except 
as inconsistent with this section, apply to the program es-
tablished in this section to the same extent and in the 
same manner as such provisions apply to the National 
Health Service Corps Loan Repayment Program estab-
lished in such subpart. 
‘‘(e) DEFINITION.—In this section, the term ‘eligible 
individual’ means an individual with a degree in medicine 
or osteopathic medicine. 
‘‘(f) AUTHORIZATION
OF
APPROPRIATIONS.—To 
carry out this section, there is authorized to be appro-
priated $5,000,000 for each of fiscal years 2008 through 
2012. 
‘‘SEC. 777. PRIMARY CARE PHYSICIAN RETENTION AND 
MEDICAL HOME ENHANCEMENT GRANTS. 
‘‘(a) GRANTS.—The Secretary, acting through the 
Administrator of the Health Resources and Services Ad-
ministration, shall make grants to States to provide care 
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management fees to physicians in medically underserved 
communities to support the provision of targeted, acces-
sible, continuous, coordinated, and patient-centered care 
through a qualified medical home. 
‘‘(b) QUALIFIED MEDICAL HOMES.— 
‘‘(1) IN GENERAL.—In this section, the term 
‘qualified medical home’ means a physician-directed 
practice that is certified as a qualified medical home 
in accordance with this subsection. 
‘‘(2) ACTIONS BY SECRETARY.—Not later than 
90 days after the date of the enactment of this sub-
part, the Secretary shall— 
‘‘(A) designate one or more objective exter-
nal private-sector entities to certify physician- 
directed practices as qualified medical homes; 
and 
‘‘(B) issue requirements for such certifi-
cation. 
‘‘(3) REQUIREMENTS.—The requirements re-
ferred to in paragraph (2)(B) shall set forth a cer-
tification process whereby— 
‘‘(A) a physician-directed practice, in con-
sultation with the State where the practice is 
located, submits an application on a voluntary 
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basis to an entity designated by the Secretary 
under paragraph (2)(A); and 
‘‘(B) the entity certifies the practice as a 
qualified medical home if the practice dem-
onstrates that the practice has capabilities to 
achieve improvements in the management and 
coordination of care of patients described in 
paragraph (4) by incorporating attributes of the 
care management model described in paragraph 
(5). 
‘‘(4) ELIGIBLE
PATIENTS.—The patients re-
ferred to in paragraph (3)(B)— 
‘‘(A) are patients determined by the State 
involved under criteria developed by the Sec-
retary to be underserved, special needs, or high 
risk patients; and 
‘‘(B) shall include individuals who— 
‘‘(i) are eligible for medical assistance 
under title XIX of the Social Security Act; 
‘‘(ii) are eligible for child health as-
sistance under title XXI of the Social Se-
curity Act; or 
‘‘(iii) otherwise lack health insurance. 
‘‘(5) CARE
MANAGEMENT
MODEL.—The care 
management model referred to in paragraph (3)(B) 
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is a model that uses health information technology 
and other physician-practice innovations to improve 
the management and coordination of patient care. 
Such a model includes the following conditions: 
‘‘(A) Physicians advocate for their patients 
to support the attainment of optimal, patient- 
centered outcomes that are defined by a care 
planning process driven by a partnership be-
tween physicians, patients, and the patient’s 
family. 
‘‘(B) Evidence-based medicine and clinical 
decision-support tools guide decision making. 
‘‘(C) Physicians in the practice accept ac-
countability for continuous quality improvement 
through voluntary engagement in performance 
measurement and improvement. 
‘‘(D) Patients actively participate in deci-
sionmaking; patients take personal responsi-
bility for their own health through diet and life-
style changes; and feedback is sought to ensure 
that patients’ expectations are being met. 
‘‘(E) Information technology is utilized ap-
propriately to support optimal patient care, per-
formance measurement, patient education, and 
enhanced communication. 
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‘‘(F) Patients and families participate in 
quality improvement activities at the practice 
level. 
‘‘(c) AMOUNT OF CARE MANAGEMENT FEE.— 
‘‘(1) IN GENERAL.—As a condition on the re-
ceipt of a grant under this section, a State shall 
agree to determine the amount of each care manage-
ment fee provided through the grant in accordance 
with the guidance issued by the Secretary under 
paragraph (2). 
‘‘(2) GUIDANCE.—Not later than 90 days after 
the date of the enactment of this Act, the Secretary 
shall issue guidance for determining the amount of 
a care management fee to be provided through a 
grant under this section. Such guidance shall take 
into account the costs of implementation, additional 
time by participating physicians, and training associ-
ated with compliance with this section. Such guid-
ance shall include— 
‘‘(A) recognition of the value of physician 
and clinical staff work associated with patient 
care that falls outside the face-to-face visit, 
such as the time and effort spent on educating 
family caregivers and arranging appropriate fol-
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low-up services with other health care profes-
sionals, such as nurse educators; 
‘‘(B) recognition of expenses that the 
qualified medical home will incur to acquire and 
utilize health information technology, such as 
clinical decision support tools, patient registries, 
and electronic medical records; 
‘‘(C) additional performance-based reim-
bursement payments based on reporting on evi-
dence-based quality, cost of care, and patient 
experience measures; 
‘‘(D) reimbursement for separately identifi-
able e-mail and telephonic consultations, either 
as separately-billable services or as part of a 
global management fee; 
‘‘(E) recognition of the specific cir-
cumstances and expenses associated with physi-
cian practices of fewer that 5 full-time employ-
ees in implementing the attributes of a qualified 
medical home and care management model de-
scribed in subsection (b); and 
‘‘(F) recognition and sharing of savings 
that may result from a qualified medical home. 
‘‘(d) APPLICATION.—A State seeking a grant under 
this section shall submit an application to the Secretary 
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at such time, in such manner, and containing such infor-
mation as the Secretary may require. Each such applica-
tion shall describe the methodologies to be used by the 
State to determine the amount of care managements fees 
to be provided through the grant. 
‘‘(e) AUTHORIZATION
OF
APPROPRIATIONS.—To 
carry out this section, there is authorized to be appro-
priated $10,000,000 for each of fiscal years 2008 through 
2012. 
‘‘SEC. 778. COMPREHENSIVE GERIATRIC TRAINING GRANTS. 
‘‘(a) GRANTS.—The Secretary, acting through the 
Administrator of the Health Resources and Services Ad-
ministration, shall make grants to board-certified entities 
to establish or expand geriatric fellowship programs de-
scribed in subsection (b). 
‘‘(b) GERIATRIC FELLOWSHIP PROGRAMS.—A geri-
atric fellowship program funded through a grant under 
this section shall provide 1-year fellowships to train physi-
cians practicing in rural areas or in the field of family 
practice, internal medicine, emergency medicine, general 
surgery, or obstetrics-gynecology, at any time during their 
careers, in geriatric medicine. 
‘‘(c) AMOUNT.—As a condition on the receipt of a 
grant under this section, an entity shall agree to expend 
not more than $50,000 of the grant per fellow. 
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‘‘(d) PREFERENCE.—In awarding grants under this 
section, the Secretary shall give preference to entities 
seeking to establish or expand a fellowship program in a 
rural area, a suburban area, or a medically underserved 
community. 
‘‘(e) AUTHORIZATION
OF
APPROPRIATIONS.—To 
carry out this section, there is authorized to be appro-
priated $1,000,000 for each of fiscal years 2008 through 
2012. 
‘‘SEC. 779. REPORTS TO CONGRESS. 
‘‘Not later than 1 year after the date of the enact-
ment of the High-Need Physician Workforce Incentives 
Act of 2007, and annually thereafter, the Secretary shall 
submit a report to the Congress— 
‘‘(1) identifying the number of grants and loans 
made under this section during the preceding 12- 
month period; and 
‘‘(2) describing the results achieved through 
such grants and loans, including the extent to which 
such grants and loans met the needs of the physi-
cian workforce in rural areas and in the fields of 
family practice, internal medicine, pediatrics, emer-
gency medicine, general surgery, and obstetrics-gyn-
ecology.’’. 
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SEC. 3. EXEMPTION FROM GROSS INCOME FOR CERTAIN 
COMPENSATION PAID TO PHYSICIANS BY 
LOCAL 
GOVERNMENTS 
FOR 
SERVICE 
IN 
MEDICALLY UNDERSERVED AREAS. 
(a) IN GENERAL.—Part III of subchapter B of chap-
ter 1 of the Internal Revenue Code of 1986 (relating to 
items specifically excluded from gross income) is amended 
by adding at the end the following new section: 
‘‘SEC. 139B. CERTAIN COMPENSATION PAID TO PHYSICIANS 
BY LOCAL GOVERNMENTS FOR SERVICE IN 
MEDICALLY UNDERSERVED AREAS. 
‘‘(a) IN GENERAL.—Gross income does not include 
compensation received by a physician (as defined in sec-
tion 1861(r) of the Social Security Act) from a local gov-
ernment (as defined in section 1393(a)(5)) for qualified 
medical service. 
‘‘(b) QUALIFIED MEDICAL SERVICE.—For purposes 
of this section, the term ‘qualified medical service’ means 
medical care described in section 213(d)(1)(A) which is 
performed— 
‘‘(1) in a medically underserved community (as 
defined in section 799B(6) of the Public Health 
Service Act), and 
‘‘(2) under a contract with the local government 
referred to in subsection (a) for the performance of 
such services for a period of not less than 4 years. 
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‘‘(c) NO EXEMPTION FROM EMPLOYMENT TAXES.— 
Compensation shall not fail to be taken into account as 
wages under any provision of subtitle C solely because 
such compensation is excluded from gross income under 
this section.’’. 
(b) CLERICAL AMENDMENT.—The table of sections 
for part III of subchapter B of chapter 1 of such Code 
is amended by inserting after the item relating to section 
139A the following new item: 
‘‘Sec. 139B. Certain compensation paid to physicians by local governments for 
service in medically underserved areas.’’. 
(c) EFFECTIVE DATE.—The amendments made by 
this section shall apply to taxable years beginning after 
the date of the enactment of this Act. 
Æ 
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