paragraph (7)(C)(ii)) for a hospital 
that the Secretary determines had 
residency positions that were unused 
for all 3 of the most recent cost re-
porting periods of such hospital end-
ing prior to the date of enactment of 
this paragraph by an amount that is 
equal to the number of such unused 
residency positions. 
‘‘(II) EXCEPTION
FOR
RURAL 
HOSPITALS AND CERTAIN OTHER HOS-
PITALS.—Subclause 
(I) 
shall 
not 
apply to a hospital— 
‘‘(aa) located in a rural area 
(as 
defined 
in 
subsection 
(d)(2)(D) in the matter following 
clause (ii)); 
‘‘(bb) that has participated 
in a voluntary reduction plan 
under paragraph (6); or 
‘‘(cc) that has participated 
in a demonstration project ap-
proved as of October 31, 2003, 
under the authority of section 
402 of Public Law 90–248. 
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‘‘(ii) 
REDISTRIBUTION.—The 
Sec-
retary shall redistribute the unused resi-
dency positions as determined under clause 
(i) to qualified teaching health centers. 
‘‘(C) DETERMINING
RESIDENT
PAYMENT 
AMOUNT.—The resident payment amount for 
each teaching health center shall be determined 
according to paragraph (3) except that— 
‘‘(i) the resident payment amount 
shall not be set lower than the national av-
erage per resident amount adjusting for lo-
cality as determined in paragraph (2)(E); 
and 
‘‘(ii) the resident payment amount 
shall be determined using the medicare pa-
tient load (as defined in paragraph (3)(C)) 
of the hospital with which the teaching 
health center has contracted, and the resi-
dent payment amount of a teaching health 
center that has contracted with more than 
one hospital shall be determined based on 
the medicare patient load of the hospital in 
which residents spend the greatest propor-
tion of their training. 
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‘‘(D) QUALIFIED TEACHING HEALTH CEN-
TER
DEFINED.—In this paragraph, the term 
‘qualified teaching health center’ means a com-
munity-based, ambulatory care patient care cen-
ter that— 
‘‘(i) operates an approved medical 
residency training program; and 
‘‘(ii) contracts with at least one hos-
pital for residency training purposes with 
the following conditions: 
‘‘(I) The teaching health center 
shall incur the cost of the resident’s 
salary and fringe benefits while the 
resident is training at the hospital 
site. 
‘‘(II) The teaching health center 
shall compensate the hospital for su-
pervisory teaching activities and indi-
rect costs as determined appropriate 
by the two contracting bodies. 
‘‘(III) The FTE resident amount 
of the teaching health center shall not 
affect the FTE resident amount or 
resident limit of the contracting hos-
pital. 
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‘‘(9) PRIMARY CARE MAINTENANCE LEVEL.— 
‘‘(A) IN
GENERAL.—A hospital receiving 
payments for graduate medical education under 
this subsection must maintain the number of 
primary care residents that is equal to the aver-
age number of primary care residents for the 3 
most recent 12-month cost reporting periods of 
such hospital ending prior to the date of enact-
ment of this paragraph, except that— 
‘‘(i) in the case of a hospital unable to 
fill its primary care resident positions, 
such positions shall not be converted to 
non-primary care positions; and 
‘‘(ii) in the case of a hospital awarded 
additional primary care resident positions, 
such hospital must maintain the number of 
primary care residents that is equal to the 
average number of primary care residents 
for the 3 most recent 12-month cost re-
porting periods of such hospital plus the 
number of newly awarded positions. 
‘‘(B) 
PRIMARY
CARE
RESIDENT
DE-
FINED.—In this paragraph, the term ‘primary 
care resident’ has the meaning given the term 
in paragraph (5)(H).’’. 
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(b) PAYMENTS FOR INDIRECT GRADUATE MEDICAL 
EDUCATION COSTS.—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 clauses: 
‘‘(x) 
PAYMENTS
TO
QUALIFIED 
TEACHING HEALTH CENTERS.—For quali-
fied teaching health centers (as defined in 
subsection (h)(8)(D)), indirect costs of 
medical education shall be determined ac-
cording to clause (i), except that— 
‘‘(I) payments shall be distrib-
uted directly to teaching health cen-
ters on a quarterly basis; and 
‘‘(II) payments shall be deter-
mined based on the average ratio in 
the contracting hospital (as described 
in subsection (h)(8)(D)(ii)) of full- 
time equivalent interns and residents 
to beds in the 3-month cost reporting 
period immediately preceeding the 
payment date. 
‘‘(xi) PRIMARY
CARE
MAINTENANCE 
LEVEL.— 
‘‘(I) IN
GENERAL.—A hospital 
receiving additional payments under 
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this subparagraph shall maintain the 
number of primary care residents that 
is equal to the average number of pri-
mary care residents for the 3 most re-
cent 12-month cost reporting periods 
of such hospital ending prior to the 
date of enactment of this paragraph, 
except that— 
‘‘(aa) in the case of a hos-
pital unable to fill its primary 
care resident positions, those po-
sitions shall not be converted to 
non-primary care positions; and 
‘‘(bb) in the case of a hos-
pital awarded additional primary 
care resident positions, that hos-
pital shall maintain the number 
of primary care residents that is 
equal to the average number of 
primary care residents for the 3 
most recent 12-month cost re-
porting periods of such hospital 
plus the number of newly award-
ed positions. 
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‘‘(II) PRIMARY
CARE
RESIDENT 
DEFINED.—In this clause, the term 
‘primary care resident’ has the mean-
ing given the term in subsection 
(h)(5)(H).’’. 
SEC. 102. GRANT PROGRAM FOR MEDICAL RESIDENCY 
TRAINING PROGRAMS IN QUALIFIED TEACH-
ING HEALTH CENTERS. 
Part C of title VII of the Public Health Service Act 
(42 U.S.C. 293k et seq.) is amended by adding after sec-
tion 748 the following: 
‘‘SEC. 749. GRANT PROGRAM FOR MEDICAL RESIDENCY 
TRAINING PROGRAMS IN QUALIFIED TEACH-
ING HEALTH CENTERS. 
‘‘(a) ESTABLISHMENT.—The Secretary shall make 
grants— 
‘‘(1) to qualified teaching health centers to es-
tablish new accredited medical residency training 
programs or to expand existing medical residency 
training programs; and 
‘‘(2) to public or private nonprofit organizations 
to provide technical support to qualified teaching 
health centers to establish medical residency training 
programs. 
‘‘(b) USE OF FUNDS.— 
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‘‘(1) A grant received under subsection (a)(1) 
shall be used for the following: 
‘‘(A) Curriculum development. 
‘‘(B) Facilities expansion. 
‘‘(C) Equipment acquisition. 
‘‘(D) Recruitment, training, and retention 
of residents and faculty. 
‘‘(E) Accreditation by the Accreditation 
Council 
for 
Graduate 
Medical 
Education 
(ACGME) or the American Osteopathic Asso-
ciation (AOA). 
‘‘(F) Faculty and resident salaries. 
‘‘(2) A grant received under subsection (a)(2) 
shall be used for the following: 
‘‘(A) Materials development. 
‘‘(B) Staff salaries. 
‘‘(C) Travel expenses. 
‘‘(D) Administrative costs. 
‘‘(c) LIMITATION.—Not more than 25 percent of 
funds made available to carry out this section shall be used 
for technical support grants under subsection (a)(2). 
‘‘(d) QUALIFIED TEACHING HEALTH CENTER DE-
FINED.—In this section, the term ‘qualified teaching 
health center’ has the meaning given the term in section 
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1886(h)(8)(D) of the Social Security Act (42 U.S.C. 
1395ww(h)(8)(D)). 
‘‘(e) AUTHORIZATION OF APPROPRIATIONS.—There 
are authorized to be appropriated to carry out this section 
such sums as may be necessary.’’. 
SEC. 103. EXPANDING THE NATIONAL HEALTH SERVICE 
CORPS TO ALLOW SERVICE IN A TEACHING 
CAPACITY. 
Section 338C(a) of the Public Health Service Act (42 
U.S.C. 254m(a)) is amended to read as follows: 
‘‘(a) SERVICE IN FULL-TIME CLINICAL PRACTICE.— 
Except as provided in section 338D (42 U.S.C. 254n), 
each individual who has entered into a written contract 
with the Secretary under section 338A or 338B (42 
U.S.C. 254l or 254l–1) shall provide service in the full- 
time clinical practice of such individual’s profession as a 
member of the Corps for the period of obligated service 
provided in such contract. For the purpose of calculating 
time spent in full-time clinical practice under this subpara-
graph, up to 30 percent of time spent teaching by a mem-
ber of the Corps may be counted toward his or her service 
obligation.’’. 
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TITLE II—STATE PRIMARY CARE 
SCHOLARSHIP AND LOAN RE-
PAYMENT PROGRAMS 
SEC. 201. ESTABLISHMENT. 
(a) ESTABLISHMENT.—State Primary Care Scholar-
ship and Loan Repayment Program; Part C of title VII 
(42 U.S.C. 293k et seq.) should be amended to do the 
following: 
(1) SUPPORT
AND
DEVELOPMENT
OF
STATE 
PRIMARY CARE SCHOLARSHIP AND REPAYMENT PRO-
GRAMS.— 
(A) GENERAL.—Secretary to make grants 
to states for the purpose of— 
(i) entering into contracts with ac-
credited public or nonprofit private hos-
pitals, schools of medicine or osteopathic 
medicine, academically affiliated physician 
assistant training program, academically 
affiliate nursing program, or a public or 
private nonprofit entity which the States 
have determined are capable of carrying 
out such grants or contracts; 
(ii) planning, developing, operating, or 
participating in an accredited professional 
training program, including an accredited 
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residency or internship program in the 
field of family medicine, general internal 
medicine, general pediatrics, or geriatrics 
for medical students, interns, residents, or 
practicing physicians as defined by the 
Secretary; 
(iii) creating scholarship programs for 
Matching Federal funds to states to estab-
lish or expand current Primary Care 
Scholarship and Loan Repayment Pro-
grams, allowing states to target scholar-
ships to medical schools and loan repay-
ments to training institutions which adopt 
pro-primary care policies (admission poli-
cies or curriculums) and require subse-
quent service within the State; and 
(iv) to empower states with the ability 
to provide need-based financial assistance 
in the form of scholarships, traineeships 
and fellowships to medical students, in-
terns, residents, practicing physicians, or 
other medical personnel, who are partici-
pants in any such program, and who plan 
to specialize or work in the practice of 
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family medicine, general internal medicine, 
general pediatrics, or geriatrics. 
SEC. 202. INNOVATIVE PRIMARY CARE TRAINING MODELS/ 
INSTITUTES. 
(a) PRIMARY CARE TRAINING INSTITUTES.— 
(1) PURPOSE.—The purpose of the Primary 
Care Training Institute program 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, such as teaching health cen-
ters, that may demonstrate improved quality or 
lower costs; 
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(D) create economies of scale through aca-
demic and community collaborations by ena-
bling academic infrastructure support for mul-
tiple community programs; and 
(E) support innovative quality primary 
care workforce development models including 
those geared towards removing barriers to mili-
tary health personnel entry into the healthcare 
workforce, particularly for service in identifiable 
health shortage areas. 
(2) ESTABLISHMENT.—Grants or contracts 
awarded under this subsection shall establish new 
centers for primary care education and research 
within academic units of family medicine, general in-
ternal medicine, general pediatrics, or geriatrics 
within academic 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 Sec-
retary may make grants to or enter into contracts 
with eligible entities to develop and implement 
PCTIs in accordance with this subsection. 
(A) In all cases, priority will be given to 
grant applicants within high-need geographic 
areas, as determined by State Workforce Coun-
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cils and the National Workforce Advisory 
Board, and to applications demonstrating 
multi-disciplinary partnerships. 
(B) Priority will be given to grant appli-
cants within high-need geographic areas, as de-
termined by the relevant Federal agency or pro-
gram. 
(b) SISTER SCHOOL PROGRAM.—Grants to promote 
pairing health professions schools with undergraduate or 
primary/secondary schools to establish pipeline health pro-
fessions programs. Part C of title VII (42 U.S.C. 293k 
et seq.) should be amended to do the following: 
(1) Direct the Secretary to provide grants to 
promote the pairing of accredited health professions 
schools with undergraduate or secondary schools to 
establish a pipeline to health professions program. 
(Area to address minority health workforce edu-
cation; health disparities; research shows that where 
partnerships developed—with local high schools, 
etc.) 
Æ 
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