[Congressional Bills 117th Congress]
[From the U.S. Government Publishing Office]
[S. 3189 Introduced in Senate (IS)]
<DOC>
117th CONGRESS
1st Session
S. 3189
To amend title XX of the Social Security Act to provide a pathway to
health careers through health profession opportunity grants.
_______________________________________________________________________
IN THE SENATE OF THE UNITED STATES
November 4, 2021
Mr. Heinrich (for himself, Mr. Wyden, Mr. Lujan, Mr. Murphy, Mr.
Blumenthal, and Ms. Rosen) introduced the following bill; which was
read twice and referred to the Committee on Finance
_______________________________________________________________________
A BILL
To amend title XX of the Social Security Act to provide a pathway to
health careers through health profession opportunity grants.
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 ``Pathways to Health Careers Act''.
SEC. 2. PATHWAYS TO HEALTH CAREERS.
Effective October 1, 2021, title XX of the Social Security Act (42
U.S.C. 1397-1397n-13) is amended by adding at the end the following:
``Subtitle D--Career Pathways Through Health Profession Opportunity
Grants
``SEC. 2071. CAREER PATHWAYS THROUGH HEALTH PROFESSION OPPORTUNITY
GRANTS.
``(a) Application Requirements.--An eligible entity desiring a
grant under this section for a project shall submit to the Secretary an
application for the grant, that includes the following:
``(1) A description of how the applicant will use a career
pathways approach to train eligible individuals for health
professions that will put eligible individuals on a career path
to an occupation that pays well, under the project.
``(2) A description of the adult basic education and
literacy activities, work readiness activities, training
activities, and case management and career coaching services
that the applicant will use to assist eligible individuals to
gain work experience, connection to employers, and job
placement, and a description of the plan for recruiting,
hiring, and training staff to provide the case management,
mentoring, and career coaching services, under the project
directly or through local governmental, apprenticeship,
educational, or charitable institutions.
``(3) A demonstration that the applicant has experience
working with low-income populations, or a description of the
plan of the applicant to work with a partner organization that
has the experience.
``(4) A plan for providing post-employment support and
ongoing training as part of a career pathway under the project.
``(5) A description of the support services that the
applicant will provide under the project, including a plan for
how child care and transportation support services will be
guaranteed and, if the applicant will provide a cash stipend or
wage supplement, how the stipend or supplement would be
calculated and distributed.
``(6) A certification by the applicant that the project
development included--
``(A) consultation or commitment to consult with a
local workforce development board;
``(B) consideration of registered apprenticeship
and pre-apprenticeship models;
``(C) consideration of career pathway programs in
the State in which the project is to be conducted; and
``(D) a review of the State plan under section 102
or 103 of the Workforce Innovation and Opportunity Act.
``(7) A description of the availability and relevance of
recent labor market information and other pertinent evidence of
in-demand jobs or worker shortages.
``(8) A certification that the applicant will directly
provide or contract for the training services described in the
application.
``(9) A commitment by the applicant that, if the grant is
made to the applicant, the applicant will--
``(A) during the planning period for the project,
provide the Secretary with any information needed by
the Secretary to establish adequate data reporting and
administrative structure for the project;
``(B) hire a person to direct the project not later
than the end of the planning period applicable to the
project;
``(C) accept all technical assistance offered by
the Secretary with respect to the grant;
``(D) participate in peer technical assistance
conferences as are regularly scheduled by the
Secretary; and
``(E) provide all data required by the Secretary
under subsection (g).
``(b) Additional Application Element.--In considering applications
for a grant under this section, the Secretary shall require qualified
applicants to have at least 1 of the following application elements--
``(1) applications submitted by applicants to whom a grant
was made under this section or any predecessor to this section;
``(2) applications submitted by applicants who have
business and community partners in each of the following
categories:
``(A) State and local government agencies and
social service providers, including a State or local
entity that administers a State program funded under
part A of this title;
``(B) institutions of higher education,
apprenticeship programs, and local workforce
development boards; and
``(C) health care employers, health care industry
or sector partnerships, labor unions, and labor-
management partnerships;
``(3) applications that include opportunities for mentoring
or peer support, and make career coaching available, as part of
the case management plan;
``(4) applications which describe a project that will serve
a rural area in which--
``(A) the community in which the individuals to be
enrolled in the project reside is located;
``(B) the project will be conducted; or
``(C) an employer partnership that has committed to
hiring individuals who successfully complete all
activities under the project is located;
``(5) applications that include a commitment to providing
project participants with a cash stipend or wage supplement;
and
``(6) applications which have an emergency cash fund to
assist project participants financially in emergency
situations.
``(c) Grants.--
``(1) Competitive grants.--
``(A) Grant authority.--
``(i) In general.--The Secretary shall make
a grant in accordance with this paragraph to an
eligible entity whose application for the grant
is approved by the Secretary, to conduct a
project designed to train low-income
individuals for allied health professions,
health information technology, physician
assistants, nursing assistants, registered
nurse, advanced practice nurse, and other
professions considered part of a health care
career pathway model.
``(ii) Guarantee of grantees in each state
and the district of columbia.--For each grant
cycle, the Secretary shall award a grant under
this paragraph to at least 2 eligible entities
in each State that is not a territory, to the
extent there are a sufficient number of
applications that have a high likelihood of
success and that are submitted by the entities
that meet the requirements applicable with
respect to such a grant. If, for a grant cycle,
there are fewer than 2 such eligible entities
in a State that have submitted applications
with a high likelihood of success, the
Secretary shall identify qualified eligible
applicants located elsewhere, that are
otherwise approved but un-funded, and issue a
Substitution of Grant and tailored technical
assistance. In the preceding sentence, the term
`issue a Substitution of Grant' means, in a
case in which an approved grantee does not
complete its full project period, or in which
there are fewer than 2 qualified grantees per
State with a high likelihood of success,
substitute an applicant located in another
State that was approved but un-funded during
the competition for the award for the award
recipient.
``(B) Guarantee of grants for indian populations.--
The Secretary shall award a grant under this paragraph
to at least 10 eligible entities that are an Indian
tribe, a tribal organization, or a tribal college or
university, to the extent there are a sufficient number
of applications submitted by the entities that meet the
requirements applicable with respect to such a grant.
``(C) Guarantee of grantees in the territories.--
The Secretary shall award a grant under this paragraph
to at least 2 eligible entities that are located in a
territory, to the extent there are a sufficient number
of applications submitted by the entities that meet the
requirements applicable with respect to such a grant.
``(2) Grant cycle.--The grant cycle under this section
shall be not less than 5 years, with a planning period of not
more than the first 12 months of the grant cycle. During the
planning period, the amount of the grant shall be in such
lesser amount as the Secretary determines appropriate.
``(d) Use of Grant.--
``(1) In general.--An entity to which a grant is made under
this section shall use the grant in accordance with the
approved application for the grant.
``(2) Support to be provided.--
``(A) Required support.--A project for which a
grant is made under this section shall include the
following:
``(i) An assessment for adult basic skill
competency, and provision of adult basic skills
education if necessary for lower-skilled
eligible individuals to enroll in the project
and go on to enter and complete post-secondary
training, through means including the
following:
``(I) Establishing a network of
partners that offer pre-training
activities for project participants who
need to improve basic academic skills
or English language proficiency before
entering a health occupational training
career pathway program.
``(II) Offering resources to enable
project participants to continue
advancing adult basic skill proficiency
while enrolled in a career pathway
program.
``(III) Embedding adult basic skill
maintenance as part of ongoing post-
graduation career coaching and
mentoring.
``(ii) A guarantee that child care is an
available and affordable support service for
project participants through means such as the
following:
``(I) Referral to, and assistance
with, enrollment in a subsidized child
care program.
``(II) Direct payment to a child
care provider if a slot in a subsidized
child care program is not available or
reasonably accessible.
``(III) Payment of co-payments or
associated fees for child care.
``(iii) Case management plans that include
career coaching (with the option to offer
appropriate peer support and mentoring
opportunities to help develop soft skills and
social capital), which may be offered on an
ongoing basis before, during, and after initial
training as part of a career pathway model.
``(iv) A plan to provide project
participants with transportation through means
such as the following:
``(I) Referral to, and assistance
with enrollment in, a subsidized
transportation program.
``(II) If a subsidized
transportation program is not
reasonably available, direct payments
to subsidize transportation costs.
For purposes of this clause, the term
`transportation' includes public transit, or
gasoline for a personal vehicle if public
transit is not reasonably accessible or
available.
``(B) Allowed support.--The goods and services
provided under a project for which a grant is made
under this section may include the following:
``(i) A cash stipend.
``(ii) A reserve fund for financial
assistance to project participants in emergency
situations.
``(iii) Tuition, certification exam fees,
and training materials such as books, software,
uniforms, shoes, connection to the internet,
hair nets, and personal protective equipment.
``(iv) In-kind resource donations such as
interview clothing and conference attendance
fees.
``(v) Assistance with accessing and
completing high school equivalency or adult
basic education courses as necessary to achieve
success in the project and make progress toward
career goals.
``(vi) Assistance with programs and
activities, including legal assistance, deemed
necessary to address arrest or conviction
records as an employment barrier.
``(vii) Other support services as deemed
necessary for family well-being, success in the
project, and progress toward career goals.
``(3) Training.--The number of hours of training provided
to an eligible individual under a project for which a grant is
made under this section, for a recognized postsecondary
credential (including an industry-recognized credential, and a
certificate awarded by a local workforce development board),
which is awarded in recognition of attainment of measurable
technical or occupational skills necessary to gain employment
or advance within an occupation, shall be--
``(A) not less than the number of hours of training
required for certification in that level of skill by
the State in which the project is conducted; or
``(B) if there is no such requirement, such number
of hours of training as the Secretary finds is
necessary to achieve that skill level.
``(4) Inclusion of tanf recipients.--In the case of a
project for which a grant is made under this section that is
conducted in a State that has a program funded under part A of
title IV, at least 10 percent of the eligible individuals to
whom support is provided under the project shall meet the
income eligibility requirements under that State program,
without regard to whether the individuals receive benefits or
services directly under that State program.
``(5) Income limitation.--An entity to which a grant is
made under this section shall not use the grant to provide
support to a person who is not an eligible individual.
``(6) Prohibition.--An entity to which a grant is made
under this section shall not use the grant for purposes of
entertainment, except that case management and career coaching
services may include celebrations of specific career-based
milestones such as completing a semester, graduation, or job
placement.
``(e) Technical Assistance.--
``(1) In general.--The Secretary shall provide technical
assistance--
``(A) to assist eligible entities in applying for
grants under this section;
``(B) that is tailored to meet the needs of
grantees at each stage of the administration of
projects for which grants are made under this section;
``(C) that is tailored to meet the specific needs
of Indian tribes, tribal organizations, and tribal
colleges and universities;
``(D) that is tailored to meet the specific needs
of the territories;
``(E) that is tailored to meet the specific needs
of applicants, eligible entities, and grantees, in
carrying out dedicated career pathway projects pursuant
to subsections (h) and (i); and
``(F) to facilitate the exchange of information
among eligible entities regarding best practices and
promising practices used in the projects.
``(2) Continuation of peer technical assistance
conferences.--The Secretary shall continue to hold peer
technical assistance conferences for entities to which a grant
is made under this section or was made under the immediate
predecessor of this section. The preceding sentence shall not
be interpreted to require any such conference to be held in
person.
``(f) Evaluation of Dedicated Career Pathways.--
``(1) In general.--The Secretary shall, by grant, contract,
or interagency agreement, conduct rigorous and well-designed
evaluations of the dedicated career pathway projects carried
out pursuant to subsections (h) and (i).
``(2) Requirement applicable to second chance career
pathway.--In the case of a project of the type described in
subsection (i), the evaluation shall include identification of
successful activities for creating opportunities for developing
and sustaining, particularly with respect to low-income
individuals with arrest or conviction records, a health
professions workforce that has accessible entry points, that
meets high standards for education, training, certification,
and professional development, and that provides increased wages
and affordable benefits, including health care coverage, that
are responsive to the needs of the workforce.
``(3) Requirement applicable to maternal mortality career
pathway.--In the case of a project of the type described in
subsection (h), the evaluation shall include identification of
successful activities for creating opportunities for developing
and sustaining, particularly with respect to low-income
individuals and other entry-level workers, a career pathway
that has accessible entry points, that meets high standards for
education, training, certification, and professional
development, and that provides increased wages and affordable
benefits, including health care coverage, that are responsive
to the needs of the birth, pregnancy, and post-partum
workforce.
``(g) Reports.--As a condition of funding, an eligible entity
awarded a grant to conduct a project under this section shall submit
interim reports to the Secretary on the activities carried out under
the project, and, on the conclusion of the project, a final report on
the activities.
``(h) Maternal Mortality Career Pathway.--
``(1) Grant authority.--The Secretary shall award grants in
accordance with this subsection to eligible entities to conduct
career pathway projects for the purpose of providing education
for professions such as doulas, lactation consultants,
childbirth educators, infant massage therapists, newborn care
specialists, midwives, and other community health worker
professions, for individuals to enter and follow a dedicated
career pathway in the field of pregnancy, childbirth, or post-
partum services in a State that recognizes doulas or midwives
as health care providers and that provides payment for services
provided by doulas or midwives, as the case may be, under the
State plan approved under title XIX.
``(2) Duration.--A grant awarded under this subsection
shall have the same grant cycle as is provided in subsection
(c)(2), and as a condition of funding the grantee shall comply
with all data reporting requirements associated with the grant
cycle.
``(3) Application requirements.--An entity seeking a grant
under this subsection for a project shall submit to the
Secretary an application for the grant, that includes the
following:
``(A) A description of the partnerships, strategic
staff hiring decisions, tailored program activities, or
other programmatic elements of the project that are
designed to support a strong career pathway in
pregnancy, birth, or post-partum services.
``(B) A demonstration that the State in which the
project is to be conducted recognizes and permits
doulas and midwives to practice in the State.
``(C) A demonstration that the applicant has
experience working with low-income populations, or a
description of the plan of the applicant to work with a
partner that has the experience.
``(4) Support to be provided.--The recipient of a grant
under this subsection for a project shall provide required
supportive services described in subsection (d)(2)(A) to
project participants who need the services, and may expend the
funding on eligible supportive services described in subsection
(d)(2)(B).
``(i) Second Chance Career Pathway.--
``(1) Grant authority.--The Secretary shall award grants in
accordance with this subsection to eligible entities to conduct
career pathway projects for the purpose of providing education
and training for eligible individuals with arrest or conviction
records to enter and follow a career pathway in the health
professions through occupations that are expected to experience
a labor shortage or be in high demand.
``(2) Duration.--A grant awarded under this subsection
shall have the same grant cycle as is provided in subsection
(c)(2), and as a condition of funding the grantee shall comply
with all data reporting requirements associated with the grant
cycle.
``(3) Application requirements.--An entity seeking a grant
under this subsection for a project shall submit to the
Secretary an application for the grant, that includes the
following:
``(A) A demonstration that the State in which the
project is to be conducted has in effect policies or
laws that permit certain allied health and behavioral
health care credentials to be awarded to people with
certain arrest or conviction records (which policies or
laws shall include appeals processes and other
opportunities to demonstrate rehabilitation to obtain
licensure and approval to work in the proposed health
careers), and a plan described in the application which
will use a legally permitted career pathway to train
people with such a record to be trained and employed in
such a career.
``(B) A discussion of how the project or future
strategic hiring decisions will demonstrate the
experience and expertise of the project in working with
job seekers who have arrest or conviction records or
employers with experience working with people with
arrest or conviction records.
``(C) A demonstration that the applicant has
experience working with low-income populations, or a
description of the plan of the applicant to work with a
partner that has the experience.
``(D) An identification of promising innovations or
best practices that can be used to provide the
training.
``(E) A proof of concept or demonstration that the
applicant has done sufficient research on workforce
shortage or in-demand jobs for which people with
certain types of criminal records can be hired.
``(F) A plan for recruiting students who are
eligible individuals into the project.
``(G) A plan for providing post-employment support
and ongoing training as part of a career pathway under
the project.
``(4) Support to be provided.--
``(A) Required support.--A recipient of a grant
under this subsection for a project shall provide--
``(i) access to legal assistance for
project participants for the purpose of
addressing arrest or conviction records and
associated workforce barriers;
``(ii) assistance with programs and
activities deemed necessary to address arrest
or conviction records as an employment barrier;
and
``(iii) required supportive services
described in subsection (d)(2)(A) to
participants who need the services, and may
expend funds on eligible supportive services
described in subsection (d)(2)(B).
``(j) Definitions.--In this section:
``(1) Allied health profession.--The term `allied health
profession' has the meaning given in section 799B(5) of the
Public Health Service Act.
``(2) Career pathway.--The term `career pathway' has the
meaning given that term in section 3(7) of the Workforce
Innovation and Opportunity Act.
``(3) Doula.--The term `doula' means an individual who--
``(A) is certified by an organization that has been
established for not less than 5 years and that requires
the completion of continuing education to maintain the
certification, to provide non-medical advice,
information, emotional support, and physical comfort to
an individual during the individual's pregnancy,
childbirth, and post-partum period; and
``(B) maintains the certification by completing the
required continuing education.
``(4) Eligible entity.--The term `eligible entity' means
any of the following entities that demonstrates in an
application submitted under this section that the entity has
the capacity to fully develop and administer the project
described in the application:
``(A) A local workforce development board
established under section 107 of the Workforce
Innovation and Opportunity Act.
``(B) A State or territory, a political subdivision
of a State or territory, or an agency of a State,
territory, or such a political subdivision, including a
State or local entity that administers a State program
funded under part A of this title.
``(C) An Indian tribe, a tribal organization, or a
tribal college or university.
``(D) An institution of higher education (as
defined in the Higher Education Act of 1965).
``(E) A hospital (as defined in section 1861(e)).
``(F) A high-quality skilled nursing facility.
``(G) A Federally qualified health center (as
defined in section 1861(aa)(4)).
``(H) A nonprofit organization described in section
501(c)(3) of the Internal Revenue Code of 1986, a labor
organization, or an entity with shared labor-management
oversight, that has a demonstrated history of providing
health profession training to eligible individuals.
``(I) In the case of a project of the type provided
for in subsection (h) of this section, an entity
recognized by a State, Indian tribe, or tribal
organization as qualified to train doulas or midwives,
if midwives or doulas, as the case may be, are
permitted to practice in the State involved.
``(J) An opioid treatment program (as defined in
section 1861(jjj)(2)), and other high quality
comprehensive addiction care providers.
``(5) Eligible individual.--The term `eligible individual'
means an individual whose family income does not exceed 200
percent of the Federal poverty level.
``(6) Federal poverty level.--The term `Federal poverty
level' means the poverty line (as defined in section 673(2) of
the Omnibus Budget Reconciliation Act of 1981, including any
revision required by such section applicable to a family of the
size involved).
``(7) Indian tribe; tribal organization.--The terms `Indian
tribe' and `tribal organization' have the meaning given the
terms in section 4 of the Indian Self-Determination and
Education Assistance Act (25 U.S.C. 450b).
``(8) Institution of higher education.--The term
`institution of higher education' has the meaning given the
term in section 101 or 102(a)(1)(B) of the Higher Education Act
of 1965.
``(9) Territory.--The term `territory' means the
Commonwealth of Puerto Rico, the United States Virgin Islands,
Guam, the Northern Mariana Islands, and American Samoa.
``(10) Tribal college or university.--The term `tribal
college or university' has the meaning given the term in
section 316(b) of the Higher Education Act of 1965.
``(k) Funding.--In addition to amounts otherwise available, there
is appropriated to the Secretary--
``(1) $318,750,000 for grants under subsection (c)(1)(A)
for each of fiscal years 2022 through 2026;
``(2) $17,000,000 for grants under subsection (c)(1)(B) for
each of fiscal years 2022 through 2026;
``(3) $21,250,000 for grants under subsection (c)(1)(C) for
each of fiscal years 2022 through 2026;
``(4) $25,500,000 for projects conducted under subsections
(h) and (i) for each of fiscal years 2023 through 2026;
``(5) $25,500,000, plus all amounts referred to in
paragraphs (1) through (4) of this subsection that remain
unused after all grant awards are made for the fiscal year, for
each of fiscal years 2022 through 2026, for the provision of
technical assistance and administration; and
``(6) $17,000,000 for each of fiscal years 2022 through
2026 for studying the effects of the projects for which a grant
is made under this section, and for administration, for the
purpose of supporting the rigorous evaluation of the projects,
and supporting the continued study of the short-, medium-, and
long-term effects of all such projects, including the
effectiveness of new or added elements of the projects.''.
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