I 
111TH CONGRESS 
1ST SESSION H. R. 4409 
To amend the Public Health Service Act to authorize a program for the 
training of medical residents in community-based settings. 
IN THE HOUSE OF REPRESENTATIVES 
DECEMBER 19, 2009 
Mr. GENE GREEN of Texas (for himself and Mr. SARBANES) introduced the 
following bill; which was referred to the Committee on Energy and Commerce 
A BILL 
To amend the Public Health Service Act to authorize a 
program for the training of medical residents in commu-
nity-based settings. 
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 ‘‘Community-Based 
Residency Training Act of 2009’’. 
SEC. 2. TRAINING OF MEDICAL RESIDENTS IN COMMUNITY- 
BASED SETTINGS. 
Part C of title VII of the Public Health Service Act 
(42 U.S.C. 293k et seq.) is amended by adding at the end 
the following: 
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‘‘SEC. 749. TRAINING OF MEDICAL RESIDENTS IN COMMU-
NITY-BASED SETTINGS. 
‘‘(a) PROGRAM.—The Secretary shall establish a pro-
gram for the training of medical residents in community- 
based settings consisting of awarding grants and contracts 
under this section. 
‘‘(b) DEVELOPMENT AND OPERATION OF COMMU-
NITY-BASED
PROGRAMS.—The Secretary shall make 
grants to, or enter into contracts with, eligible entities— 
‘‘(1) to plan and develop a new primary care 
residency training program, which may include— 
‘‘(A) planning and developing curricula; 
‘‘(B) recruiting and training residents and 
faculty; and 
‘‘(C) other activities designated to result in 
accreditation of such a program; or 
‘‘(2) to operate or participate in an established 
primary care residency training program, which may 
include— 
‘‘(A) planning and developing curricula; 
‘‘(B) recruitment and training of residents; 
and 
‘‘(C) retention of faculty. 
‘‘(c) ELIGIBLE ENTITY.—To be eligible to receive a 
grant or contract under subsection (b), an entity must be 
designated as eligible to receive payment for the direct 
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costs of medical education under section 1886(k) of the 
Social Security Act. 
‘‘(d) PREFERENCES.—In awarding grants and con-
tracts under paragraph (1) or (2) of subsection (b), the 
Secretary shall give preference to entities that— 
‘‘(1) support teaching programs that address 
the health care needs of vulnerable populations; or 
‘‘(2) are a Federally qualified health center (as 
defined in section 1861(aa)(4) of the Social Security 
Act) or a rural health clinic (as defined in section 
1861(aa)(2) of such Act). 
‘‘(e) ADDITIONAL PREFERENCES FOR ESTABLISHED 
PROGRAMS.—In awarding grants and contracts under 
subsection (b)(2), the Secretary shall give preference to 
entities that have a demonstrated record of training— 
‘‘(1) a high or significantly improved percentage 
of health professionals who provide primary care; 
‘‘(2) individuals who are from disadvantaged 
backgrounds (including racial and ethnic minorities 
underrepresented among primary care professionals); 
or 
‘‘(3) individuals who practice in settings having 
the principal focus of serving underserved areas or 
populations experiencing health disparities (including 
serving patients eligible for medical assistance under 
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title XIX of the Social Security Act or for child 
health assistance under title XXI of such Act or 
those with special health care needs). 
‘‘(f) PERIOD OF AWARDS.— 
‘‘(1) IN GENERAL.—The period of a grant or 
contract under this section— 
‘‘(A) shall not exceed 3 years for awards 
under subsection (b)(1); and 
‘‘(B) shall not exceed 5 years for awards 
under subsection (b)(2). 
‘‘(2) SPECIAL RULES.— 
‘‘(A) An award of a grant or contract 
under subsection (b)(1) shall not be renewed. 
‘‘(B) The period of a grant or contract 
awarded to an entity under subsection (b)(2) 
shall not overlap with the period of any grant 
or contact awarded to the same entity under 
subsection (b)(1). 
‘‘(g) REPORT.—The Secretary shall submit to the 
Congress an annual report on the program carried out 
under this section. 
‘‘(h) DEFINITIONS.—In this section: 
‘‘(1) HEALTH DISPARITIES.—The term ‘health 
disparities’ includes health and health care dispari-
ties and means population-specific differences in the 
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presence of disease, health outcomes, or access to 
health care. For purposes of the preceding sentence, 
a population may be delineated by race, ethnicity, 
primary language, sex, sexual orientation, gender 
identity, disability, socioeconomic status, or rural, 
urban, or other geographic setting, and any other 
population or subpopulation determined by the Sec-
retary to experience significant gaps in disease, 
health outcomes, or access to health care. 
‘‘(2) PRIMARY CARE RESIDENT.—The term ‘pri-
mary care resident’ has the meaning given the term 
in section 1886(h)(5)(H) of the Social Security Act. 
‘‘(3) PRIMARY CARE RESIDENCY TRAINING PRO-
GRAM.—The term ‘primary care residency training 
program’ means a program that— 
‘‘(A) is an approved medical residency 
training 
program 
described 
in 
section 
1886(h)(5)(A) of the Social Security Act for 
primary care residents; and 
‘‘(B) in the case of entities seeking awards 
under subsection (b)(2), is accredited, or oper-
ates in partnership with a program that is ac-
credited, by the Accreditation Council for Grad-
uate Medical Education or the American Osteo-
pathic Association. 
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‘‘(i) AUTHORIZATION
OF
APPROPRIATIONS.—To 
carry out this section, there are authorized to be appro-
priated the following: 
‘‘(1) $40,800,000 for fiscal year 2011. 
‘‘(2) $43,010,000 for fiscal year 2012. 
‘‘(3) $45,050,000 for fiscal year 2013. 
‘‘(4) $47,260,000 for fiscal year 2014. 
‘‘(5) $49,640,000 for fiscal year 2015.’’. 
Æ 
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