SPARC Act
Bill: S.4330 | Sponsor: Sen. Rosen, Jacky (D-NV)
Policy area: Health

Summary:
Specialty Physicians Advancing Rural Care Act or the SPARC Act
This bill establishes student loan repayment programs to support the provision of specialty medical care in rural areas.
The Health Resources and Services Administration (HRSA) must carry out such a program for certain specialty medicine physicians who provide care in rural communities with shortages of such physicians. Physicians must agree to a period of obligated service and, for each year of such service, HRSA must pay one-sixth of the principal payment and interest on eligible loans up to a maximum cap of $250,000. Additionally, HRSA may carry out a similar loan repayment program for nonphysician specialty health care providers.

To amend the Public Health Service Act to authorize a loan repayment 
 program to encourage specialty medicine physicians to serve in rural 
 communities experiencing a shortage of specialty medicine physicians, 
                        and for other purposes.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Specialty Physicians Advancing Rural 
Care Act'' or the ``SPARC Act''.

SEC. 2. FINDINGS.

    Congress finds the following:
            (1) According to a June 2021 study by the Association of 
        American Medical Colleges, titled ``The Complexities of 
        Physician Supply and Demand: Projections From 2019 to 2034'', 
        the projected demand for physicians continues to exceed 
        projected supply, with a projected shortage of between 37,800 
        and 124,000 physicians by 2034. Further, the study projects a 
        shortage of between 21,000 and 77,100 nonprimary care 
        physicians by 2034.
            (2) A July 25, 2019, article, titled ``Implications of an 
        Aging Rural Physician Workforce'', published in the New England 
        Journal of Medicine, estimates that the size of the workforce 
        held relatively steady at about 12 physicians per 10,000 
        population in rural areas from 2000 to 2017, but such workforce 
        is forecast to decrease by 23 percent by 2030.
            (3) According to the report by the Association of American 
        Medical Colleges, titled ``Medical Student Education: Debt, 
        Costs, and Loan Repayment Fact Card for the Class of 2020'', 
        the percentage of medical school graduates with education debt 
        is 73 percent and the average education debt amount for a 
        medical school graduate is $207,003. Medical school debt 
        accounts for 70 percent of overall student loan debt, and the 
        median stipend for a medical graduate's first year after 
        earning a medical degree is $58,305.

SEC. 3. SPECIALTY MEDICAL PRACTITIONERS WORKFORCE IN RURAL COMMUNITIES.

    Title VII of the Public Health Service Act (42 U.S.C. 292 et seq.) 
is amended--
            (1) by redesignating part G (42 U.S.C. 795j et seq.) as 
        part H; and
            (2) by inserting after part F (42 U.S.C. 295h) the 
        following new part:

      ``PART G--SPECIALTY MEDICINE WORKFORCE IN RURAL COMMUNITIES

``SEC. 782. LOAN REPAYMENT PROGRAM.

    ``(a) In General.--
            ``(1) Program for specialty medicine physicians.--The 
        Secretary, acting through the Administrator of the Health 
        Resources and Services Administration, shall carry out a 
        program under which--
                    ``(A) the Secretary enters into agreements with 
                specialty medicine physicians to make payments in 
                accordance with subsection (b) on the principal of and 
                interest on any eligible loans described in subsection 
                (c); and
                    ``(B) the specialty medicine physicians each agree 
                to complete a period of obligated service described in 
                subsection (d) as a specialty medicine physician in the 
                United States in a rural community experiencing a 
                shortage of specialty medicine physicians.
            ``(2) Program for non-physician specialty health care 
        providers.--The Secretary, acting through the Administrator of 
        the Health Resources and Services Administration, may carry out 
        a program under which--
                    ``(A) the Secretary enters into agreements with 
                non-physician specialty health care providers to make 
                payments in accordance with subsection (b) on the 
                principal of and interest on any eligible loans 
                described in subsection (c); and
                    ``(B) the non-physician specialty health care 
                providers each agree to complete a period of obligated 
                service described in subsection (d) as a non-physician 
                specialty health care provider in the United States in 
                a rural community experiencing a shortage of such 
                providers.
    ``(b) Payments.--For each year of obligated service by a specialty 
medicine physician pursuant to an agreement under subsection (a)(1) or 
by a non-physician specialty health care provider pursuant to an 
agreement under subsection (a)(2), the Secretary shall make a payment 
to such physician or provider as follows:
            ``(1) Service in shortage area.--The Secretary shall pay--
                    ``(A) for each year of obligated service by a 
                specialty medicine physician or non-physician specialty 
                health care provider pursuant to an agreement under 
                paragraph (1) or (2) of subsection (a), \1/6\ of the 
                principal of and interest on each eligible loan of the 
                physician or provider which is outstanding on the date 
                the physician or provider began service pursuant to the 
                agreement; and
                    ``(B) for completion of the sixth and final year of 
                such service, the remainder of such principal and 
                interest.
            ``(2) Maximum amount.--The total amount of payments under 
        this section to any specialty medicine physician or non-
        physician specialty health care provider shall not exceed 
        $250,000.
    ``(c) Eligible Loans.--The loans eligible for repayment under this 
section are each of the following:
            ``(1) Any loan for education in specialty medicine or 
        specialty health care.
            ``(2) Any Federal Direct Stafford Loan, Federal Direct PLUS 
        Loan, Federal Direct Unsubsidized Stafford Loan, or Federal 
        Direct Consolidation Loan (as such terms are used in section 
        455 of the Higher Education Act of 1965).
            ``(3) Any Federal Perkins Loan under part E of title I of 
        the Higher Education Act of 1965.
            ``(4) Any other Federal loan as determined appropriate by 
        the Secretary.
    ``(d) Period of Obligated Service.--Any specialty medicine 
physician or non-physician specialty health care provider receiving 
payments under this section as required by an agreement under paragraph 
(1) or (2) of subsection (a) shall agree to a 6-year commitment to 
full-time employment, with no more than 1 year passing between any 2 
years of covered employment, as a specialty medicine physician or non-
physician specialty health care provider, as applicable, in the United 
States in a rural community experiencing a shortage of specialty 
medicine physicians or non-physician specialty health care providers, 
as applicable.
    ``(e) Ineligibility for Double Benefits.--No borrower may, for the 
same service, receive a reduction of loan obligations or a loan 
repayment under both--
            ``(1) this section; and
            ``(2) any federally supported loan forgiveness program, 
        including under section 338B, 338I, or 846 of this Act, or 
        section 428J, 428L, 455(m), or 460 of the Higher Education Act 
        of 1965.
    ``(f) Breach.--
            ``(1) Liquidated damages formula.--The Secretary may 
        establish a liquidated damages formula to be used in the event 
        of a breach of an agreement entered into under paragraph (1) or 
        (2) of subsection (a).
            ``(2) Limitation.--The failure by a specialty medicine 
        physician or a non-physician specialty health care provider to 
        complete the full period of service obligated pursuant to such 
        an agreement, taken alone, shall not constitute a breach of the 
        agreement, so long as the physician or provider completed in 
        good faith the years of service for which payments were made to 
        the physician or provider under this section.
    ``(g) Special Rules for Non-Physician Specialty Health Care 
Providers.--Non-physician specialty health care providers participating 
in the program under this section are not eligible for other Federal 
loan forgiveness programs specific to health care providers. Not more 
than 15 percent of amounts made available to carry out this section for 
a fiscal year may be allocated to awards to non-physician specialty 
health care providers.
    ``(h) Reports to Congress.--Not later than 5 years after the date 
of enactment of this section, and not less than every other year 
thereafter through fiscal year 2030, the Secretary shall report to 
Congress on--
            ``(1) the practice location of special medicine physicians 
        and non-physician specialty health care providers 
        participating, or who have participated, in the loan repayment 
        program under this section; and
            ``(2) the impact of the loan repayment program under this 
        section on the availability of specialty medicine or specialty 
        health care services in the United States in rural communities 
        experiencing a shortage of specialty medicine physicians or 
        non-physician specialty health care providers.
    ``(i) Data Updates.--The Administrator of the Health Resources and 
Services Administration shall update publicly available data on the 
supply of specialty medicine physicians and non-physician specialty 
health care providers, as appropriate.
    ``(j) Definitions.--In this section:
            ``(1) Non-physician specialty health care provider.--The 
        term `non-physician specialty health care provider' means a 
        health professional other than a physician who is licensed to 
        provide patient care other than primary care services.
            ``(2) Specialty medicine physician.--The term `specialty 
        medicine physician' means a physician practicing in--
                    ``(A) a specialty identified in the report of the 
                Health Resources and Services Administration, titled 
                `Projecting the Supply of Non-Primary Care Specialty 
                and Subspecialty Clinicians: 2010-2025';
                    ``(B) hospice and palliative medicine;
                    ``(C) geriatric medicine; or
                    ``(D) another medical specialty, if the Secretary 
                determines that there is evidence demonstrating a 
                significant shortage of providers in the medical 
                specialty and limited patient access to care.
    ``(k) Authorization of Appropriations.--To carry out this section, 
there are authorized to be appropriated such sums as may be necessary 
for fiscal years 2022 through 2031.''.
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