Title: Strengthening Our Rural Health Workforce Act of 2019
Policy area: Health

Summary:
Strengthening Our Rural Health Workforce Act of 2019
This bill reauthorizes through FY2024 the Primary Care Training and Enhancement program and the Area Health Education Centers program; it also establishes a National Rural Health Care Workforce Commission.

[Congressional Bills 116th Congress]
[From the U.S. Government Publishing Office]
[S. 2902 Introduced in Senate (IS)]

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116th CONGRESS
  1st Session
                                S. 2902

     To enhance the rural health workforce, and for other purposes.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                           November 20, 2019

Ms. Smith (for herself and Mr. Barrasso) introduced the following bill; 
     which was read twice and referred to the Committee on Health, 
                     Education, Labor, and Pensions

_______________________________________________________________________

                                 A BILL


 
     To enhance the rural health workforce, 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 ``Strengthening Our Rural Health 
Workforce Act of 2019''.

               TITLE I--SUPPORTING PRIMARY CARE WORKFORCE

SEC. 101. REAUTHORIZATION OF PRIMARY CARE TRAINING AND ENHANCEMENT 
              PROGRAM.

    Section 747 of the Public Health Service Act (42 U.S.C. 293k) is 
amended--
            (1) in subsection (a), by adding at the end the following:
            ``(3) Priorities in making awards.--
                    ``(A) In general.--In awarding grants or contracts 
                under paragraph (1), the Secretary shall give priority 
                to qualified applicants that train residents in rural 
                and Tribal training locations for equal to or greater 
                than 50 percent of training time.
                    ``(B) Rural training location.--In this paragraph, 
                the term `rural training location' means a location in 
                which training occurs that, based on the 2010 census or 
                any subsequent census adjustment, meets one or more of 
                the following criteria:
                            ``(i) The training occurs in a location 
                        that is a rural area (as defined in section 
                        1886(d)(2)(D) of the Social Security Act).
                            ``(ii) The training occurs on an Indian 
                        reservation, public domain Indian allotment, 
                        former Indian reservation in Oklahoma, or land 
                        held by an incorporated Native group, regional 
                        corporation, or village corporation under the 
                        provisions of the Alaska Native Claims 
                        Settlement Act.
                            ``(iii) The training occurs in a location 
                        that has a rural-urban commuting area code 
                        equal to or greater than 4.0.
                            ``(iv) The training occurs in a location 
                        that is within 10 miles of a sole community 
                        hospital (as defined in subsection 
                        (d)(5)(D)(iii)).''; and
            (2) in subsection (c)--
                    (A) in paragraph (1), by striking ``$125,000,000'' 
                and all that follows through the period at the end and 
                inserting ``$125,000,000 for fiscal year 2020, and such 
                sums as may be necessary for each of fiscal years 2021 
                through 2024.''; and
                    (B) in paragraph (3), by striking ``2010 through 
                2014'' and inserting ``2020 through 2024''.

SEC. 102. REAUTHORIZATION OF AREA HEALTH EDUCATION CENTERS.

    Section 751(j)(1) of the Public Health Service Act (42 U.S.C. 
294a(j)(1)) is amended by striking ``$125,000,000 for each of the 
fiscal years 2010 through 2014'' and inserting ``$125,000,000 for each 
of fiscal years 2020 through 2024''.

            TITLE II--RURAL HEALTH CARE WORKFORCE COMMISSION

SEC. 201. RURAL HEALTH CARE WORKFORCE COMMISSION.

    (a) Purpose.--It is the purpose of this section to establish a 
National Rural Health Care Workforce Commission that develops short- 
and long-term solutions to address the systemic workforce shortages in 
rural and frontier localities, and--
            (1) communicates and coordinates with the Department of 
        Health and Human Services (including the Indian Health 
        Service), the Department of Agriculture, the Department of 
        Labor, The Department of Veterans Affairs, the Department of 
        Homeland Security, the Department of Education, the Department 
        of the Interior, and any Federal advisory committees determined 
        appropriate by the Secretary of Health and Human Services, on 
        related activities administered by one or more of such 
        Departments and committees;
            (2) develops and commissions evaluations of education and 
        training activities needed to address shortages in 
        geographically diverse rural and Indian Tribal communities;
            (3) identifies legislative, administrative, and other 
        barriers to addressing shortages and improving coordination at 
        the Federal, State, Tribal, and local levels and recommend ways 
        to address such barriers;
            (4) encourages the development and implementation of 
        strategies to address rural, Tribal, and frontier population 
        needs; and
            (5) identifies innovative models used to improve access to 
        and quality of care in underserved rural areas with shortages.
    (b) Establishment.--There is hereby established the National 
Workforce Commission on Rural and Frontier Health Care (referred to in 
this section as the ``Commission'').
    (c) Membership.--
            (1) Number and appointment.--The Commission shall be 
        composed of not less than 9 members to be appointed by the 
        Comptroller General, without regard to section 5 of the Federal 
        Advisory Committee Act (5 U.S.C. App.), and shall consult with 
        the Administrator of the Health Resources and Services 
        Administration (referred to in this section as the 
        ``Administrator'').
            (2) Qualifications.--
                    (A) In general.--The membership of the Commission 
                shall include a diverse composite of individuals--
                            (i) who are--
                                    (I) leaders of rural, Tribal, and 
                                frontier health care workforce 
                                education or training programs or rural 
                                training tracks;
                                    (II) nationally recognized for 
                                their expertise in--
                                            (aa) rural, Tribal, or 
                                        frontier health care labor 
                                        market analysis;
                                            (bb) rural, Tribal, or 
                                        frontier health care facility 
                                        management;
                                            (cc) rural health 
                                        integrated delivery systems;
                                            (dd) providing rural, 
                                        Tribal, and frontier health 
                                        care services;
                                            (ee) rural, Tribal, and 
                                        frontier health care needs, 
                                        trends, and disparities;
                                            (ff) rural, Tribal, and 
                                        frontier behavioral health; or
                                            (gg) rural, Tribal, and 
                                        frontier health workforce 
                                        shortages;
                                    (III) rural health workforce 
                                recruitment and retention experts; and
                                    (IV) relevant professional 
                                association members; and
                            (ii) who will provide a combination of 
                        professional perspectives, and broad geographic 
                        representation of rural and frontier 
                        communities.
                    (B) Ethical disclosure.--The Administrator shall 
                establish a system for public disclosure by the 
                Commission of financial and other potential conflicts 
                of interest relating to the members of the Commission. 
                Such members shall be treated as employees of Congress 
                for purposes of applying title I of the Ethics in 
                Government Act of 1978. Such members shall not be 
                treated as special government employees under title 18, 
                United States Code.
            (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 appointed.
                    (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 member's term 
                until a successor has taken office.
            (4) Compensation.--While serving on the business of the 
        Commission (including travel time), a member of the Commission 
        shall be entitled to compensation at the per diem equivalent of 
        the rate provided for level IV of the Executive Schedule under 
        section 5315 of title 5, United States Code, and while so 
        serving away from home and the member's regular place of 
        business, a member may be allowed travel expenses, as 
        authorized by the Chairman of the Commission.
            (5) Chairman, vice chairman.--The Comptroller General shall 
        designate a member of the Commission, at the time of 
        appointment of the member, as Chairman and a member as Vice 
        Chairman for that term of appointment, except that in the case 
        of vacancy of the chairmanship or vice chairmanship, the 
        Comptroller General may designate another member for the 
        remainder of that member's term.
            (6) Meetings.--The Commission shall meet at the call of the 
        chairman, but no less frequently than on a biannual basis.
    (d) Duties.--
            (1) Identify needs and barriers.--The Commission shall--
                    (A) identify administrative, regulatory, and 
                statutory barriers that prevent maximum utilization of 
                current rural and Tribal health workforce programs with 
                a special focus on Tribal and frontier workforce 
                programs; and
                    (B) identify population health needs and trends, 
                health disparities, and minority population health 
                needs in rural, Tribal, and frontier localities.
            (2) Recommend solutions to barriers.--The Commission 
        shall--
                    (A) recognize the efforts of Federal, State, 
                Tribal, and local partnerships to support careers in 
                the provision of health care services in rural areas;
                    (B) explore and report on nontraditional care 
                settings and delivery of care;
                    (C) disseminate information to rural health care 
                administrators on promising retention practices for 
                rural, Tribal, and frontier health care professionals; 
                and
                    (D) recommend solutions to Federal administrative, 
                regulatory, and statutory barriers that impact the 
                recruitment, education and training, and retention of 
                the rural, Tribal, and frontier health care workforce.
            (3) Specific topics to be reviewed.--In carrying out this 
        subsection, the Commission shall review--
                    (A) current rural, Tribal, and frontier health care 
                workforce supply and distribution, including 
                demographics, skill sets, public health expertise, and 
                demands, with projected demands during the subsequent 
                10- and 25-year periods;
                    (B) rural, Tribal, and frontier health care 
                workforce education and training capacity, including 
                the--
                            (i) number of students who have completed 
                        education and training, including registered 
                        apprenticeships;
                            (ii) number of qualified faculty;
                            (iii) the education and training 
                        infrastructure; and
                            (iv) the education and training demands, 
                        with projected demands during the subsequent 
                        10- and 25-year periods;
                    (C) the impact of the rural and Tribal hospital and 
                rural hospital unit closures on rural, Tribal, and 
                frontier communities;
                    (D) the National Health Service Corps under subpart 
                II of part D of title III of the Public Health Service 
                Act (42 U.S.C. 254d et seq.), the State Loan Repayment 
                Program under section 338I of the Public Health Service 
                Act (42 U.S.C. 254q-1), the education loan, 
                scholarship, and grant programs under titles VII and 
                VIII of the Public Health Service Act (42 U.S.C. 292 et 
                seq. and 296 et seq.), as well as public service loan 
                forgiveness programs administered by the Department of 
                Education; and
                    (E) the impact of care delivery models, some of 
                which include the use of technology, community health 
                workers, and non-traditional partners that leverage 
                team-based care to improve outcomes and address health 
                care costs.
            (4) High priority areas.--In carrying out this subsection, 
        high priority should be given to--
                    (A) the education, development, recruitment and 
                retention of individuals--
                            (i) to fill primary care shortages of all 
                        levels of licensure;
                            (ii) to undertake rural and Tribal 
                        physician training tracks and programs;
                            (iii) to fill obstetric services shortages;
                            (iv) to address oral health care workforce 
                        capacity at all levels;
                            (v) to address behavioral health care 
                        workforce capacity at all levels;
                            (vi) to address addiction medicine 
                        workforce shortages;
                            (vii) to fill the emergency medical service 
                        workforce;
                            (viii) to address the workforce needs of an 
                        aging population; and
                            (ix) to serve as telehealth providers; and
                    (B) the development of new rural and Tribal 
                workforce and delivery models to better meet changing 
                needs of rural communities.
            (5) Recommendations.--The Commission shall submit 
        recommendations to the Committee on Health, Education, Labor, 
        and Pensions of the Senate and the Committee on Energy and 
        Commerce of the House of Representatives, and appropriate 
        departments of the Administration.
            (6) Consult and obtaining data.--The Commission shall 
        consult with and obtain necessary data from all relevant 
        Federal agencies (including the Department of Health and Human 
        Services, the Department of Agriculture, the Department of 
        Labor, The Department of Veterans Affairs, the Department of 
        Homeland Security, the Department of Education, and the 
        Department of the Interior), Congress, the Medicare Payment 
        Advisory Commission, the Medicaid and CHIP Payment and Access 
        Commission, and, to the extent practicable, State and local 
        agencies, voluntary health care organizations, professional 
        societies, and other relevant public-private health care 
        partnerships.
            (7) Detail of federal government employees.--An employee of 
        the Federal Government may be detailed to the Commission 
        without reimbursement. The detail of such an employee shall be 
        without interruption or loss of civil service status.
            (8) Data collection.--In order to carry out its functions 
        under this section, the Commission shall--
                    (A) utilize existing information, both published 
                and unpublished, where possible, including in 
                coordination with the Bureau of Labor Statistics;
                    (B) carry out, or award grants or contracts for the 
                carrying out of, original research and development, 
                where existing information is inadequate, and
                    (C) adopt procedures allowing interested parties to 
                submit information for the Commission's use in making 
                reports and recommendations.
    (e) State Health Care Workforce Development Grants.--
            (1) Establishment.--The Secretary of Health and Human 
        Services (referred to in this subsection as the ``Secretary''), 
        acting through the Administrator of the Health Resources and 
        Services Administration, shall establish a competitive health 
        care workforce development grant program (referred to in this 
        subsection as the ``program'') to award grants to accomplish 
        the objectives described in paragraph (4).
            (2) Eligibility.--The Secretary, acting through the 
        Administrator of the Federal Office of Rural Health Policy, 
        shall determine eligibility criteria for grants under this 
        subsection.
            (3) Fiscal and administrative agent.--The Health Resources 
        and Services Administration of the Department of Health and 
        Human Services shall be the fiscal and administrative agent for 
        grants awarded under this subsection. Such Administration is 
        authorized to carry out the program, in consultation with the 
        Commission, which shall review reports on the development, 
        implementation, and evaluation activities under the grant 
        program, including--
                    (A) administering the grants;
                    (B) providing technical assistance to grantees; and
                    (C) reporting performance information to the 
                Commission.
            (4) Grants.--The Secretary, acting through the 
        Administrator of Rural Health Policy, shall award grants under 
        the program for a period to be determined by the Secretary--
                    (A) to enable grantees to develop a comprehensive 
                plan to address workforce shortages in rural areas;
                    (B) to implement the recommendations of the 
                Commission;
                    (C) to carry out activities leading to 
                comprehensive rural and Tribal health care workforce 
                development strategies, including public health 
                workforce development, at the State and local levels; 
                and
                    (D) in a manner that ensures such grants supplement 
                rather than supplant the efforts of grantees to address 
                rural health workforce challenges.
    (f) Authorization of Appropriations.--
            (1) Authorization.--There are authorized to be appropriated 
        such sums as may be necessary to carry out this section.
            (2) Set aside.--The Secretary shall set aside 5 percent of 
        amounts appropriated under this subsection for direct grants to 
        Indian Tribes (as such term is defined in section 4 of the 
        Indian Health Care Improvement Act (25 U.S.C. 1603)) and Tribal 
        organizations (as such term is defined in section 4 of the 
        Indian Self-Determination and Education Assistance Act (25 
        U.S.C. 450b)).
            (3) Gifts and services.--The Commission may not accept 
        gifts, bequeaths, or donations of property, but may accept and 
        use donations of services for purposes of carrying out this 
        section.
    (g) Definitions.--
            (1) Health care workforce.--In this section, the term 
        ``health care workforce'' has the meaning given such term in 
        section 5101(i)(1) of the Patient Protection and Affordable 
        Care Act (42 U.S.C. 294q).
            (2) Tribal.--In this section, the term ``Tribal'' has the 
        same meaning given such term in section 4 of the Indian Health 
        Care Improvement Act (25 U.S.C. 1603).
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