[Congressional Bills 118th Congress]
[From the U.S. Government Publishing Office]
[S. 2840 Introduced in Senate (IS)]
<DOC>
118th CONGRESS
1st Session
S. 2840
To improve access to and the quality of primary health care, expand the
health workforce, and for other purposes.
_______________________________________________________________________
IN THE SENATE OF THE UNITED STATES
September 19, 2023
Mr. Sanders (for himself and Mr. Marshall) introduced the following
bill; which was read twice and referred to the Committee on Health,
Education, Labor, and Pensions
_______________________________________________________________________
A BILL
To improve access to and the quality of primary health care, expand the
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; TABLE OF CONTENTS.
(a) Short Title.--This Act may be cited as the ``Bipartisan Primary
Care and Health Workforce Act''.
(b) Table of Contents.--The table of contents for this Act is as
follows:
Sec. 1. Short title; table of contents.
TITLE I--EXTENSION FOR COMMUNITY HEALTH CENTERS, THE NATIONAL HEALTH
SERVICE CORPS, AND TEACHING HEALTH CENTERS THAT OPERATE GME PROGRAMS
Sec. 101. Programs of payments to teaching health centers that operate
graduate medical education programs.
Sec. 102. Community health centers.
Sec. 103. National Health Service Corps.
Sec. 104. GAO report.
Sec. 105. OIG report.
Sec. 106. Application of provisions.
TITLE II--SUPPORTING THE HEALTH CARE WORKFORCE
Sec. 201. Rural residency planning and development program.
Sec. 202. Primary care training and enhancement program.
Sec. 203. Telehealth technology-enabled learning program.
Sec. 204. Expanding the number of primary care doctors.
Sec. 205. Nurse education, practice, quality, and retention grants.
Sec. 206. Nurse faculty loan program.
Sec. 207. Nurse faculty demonstration program.
Sec. 208. Nurse corps scholarship and loan repayment program.
Sec. 209. Grants for primary care nurse residency training programs.
Sec. 210. State oral health workforce improvement grant program.
Sec. 211. Oral health training programs.
Sec. 212. Allied health professionals.
Sec. 213. Budgetary treatment.
TITLE III--REDUCING HEALTH CARE COSTS FOR PATIENTS
Sec. 301. Banning anticompetitive terms in facility and insurance
contracts that limit access to higher
quality, lower cost care.
Sec. 302. Honest billing requirements applicable to providers.
Sec. 303. Banning facility fees for certain services.
Sec. 304. Prevention and Public Health Fund.
TITLE I--EXTENSION FOR COMMUNITY HEALTH CENTERS, THE NATIONAL HEALTH
SERVICE CORPS, AND TEACHING HEALTH CENTERS THAT OPERATE GME PROGRAMS
SEC. 101. PROGRAMS OF PAYMENTS TO TEACHING HEALTH CENTERS THAT OPERATE
GRADUATE MEDICAL EDUCATION PROGRAMS.
(a) Funding.--Section 340H(g)(1) of the Public Health Service Act
(42 U.S.C. 256h(g)(1)) is amended--
(1) by striking ``such sums as may be necessary, not to
exceed'';
(2) by striking ``2017, and'' and inserting ``2017,''; and
(3) by inserting ``and $300,000,000 for each of fiscal
years 2024 through 2028,'' after ``2023,''.
(b) Per Resident Amount.--Section 340H(a)(2) of the Public Health
Service Act (42 U.S.C. 256h(a)(2)) is amended by adding at the end the
following: ``Beginning in fiscal year 2024, in accordance with
paragraph (1), but notwithstanding the capped amount referenced in
subsections (b)(2) and (d)(2), the qualified teaching health center per
resident amount for a fiscal year shall be not less than such amount
for the previous fiscal year.''.
(c) Amount of Payments.--Section 340H of the Public Health Service
Act (42 U.S.C. 256h) is amended--
(1) in subsection (b)(2)--
(A) in subparagraph (A), by striking ``amount of
funds appropriated under subsection (g) for such
payments for that fiscal year'' and inserting ``total
amount of funds available under subsection (g) and any
amounts recouped under subsection (f)''; and
(B) in subparagraph (B), by striking ``appropriated
in a fiscal year under subsection (g)'' and inserting
``available under subsection (g) and any amounts
recouped under subsection (f)''; and
(2) in subsection (d)(2)(B), by striking ``amount
appropriated for such expenses as determined in subsection
(g)'' and inserting ``total amount of funds available under
subsection (g) and any amounts recouped under subsection (f)''.
(d) Priority Payments.--Section 340H(a)(3) of Public Health Service
Act (42 U.S.C. 256h(a)(3)) is amended--
(1) in subparagraph (A), by striking ``; or'' and inserting
a semicolon;
(2) in subparagraph (B), by striking the period and
inserting ``; or''; and
(3) by adding at the end the following:
``(C) are located in a State that does not already
have a qualified teaching health center receiving
funding under this section.''.
(e) Reporting Requirements.--Section 340H(h)(1) of the Public
Health Service Act (42 U.S.C. 256h(h)(1)) is amended--
(1) by redesignating subparagraph (H) as subparagraph (I);
and
(2) by inserting after subparagraph (G) the following:
``(H) Of the number of residents described in
paragraph (4) who completed their residency training,
the number practicing primary care (meaning any of the
areas of practice listed in the definition of a primary
care residency program in section 749A) 5 years
following completion of such training.''.
(f) Guidance.--The Secretary shall update guidance and relevant
information regarding States described in subparagraph (C) of section
340H(a)(3) of the Public Health Service Act (42 U.S.C. 256h(a)(3)), as
amended by subsection (d), and make available model templates to assist
health centers in such States to establish a teaching health center.
SEC. 102. COMMUNITY HEALTH CENTERS.
(a) Community Health Center Fund.--Section 10503 of the Patient
Protection and Affordable Care Act (42 U.S.C. 254b-2) is amended--
(1) in subsection (b)(1)(F)--
(A) by striking ``2018 and'' and inserting
``2018,''; and
(B) by inserting before the semicolon the
following: ``, and $5,800,000,000 for each of fiscal
years 2024 through 2026''; and
(2) by adding at the end the following:
``(f) Priority Use of Funds.--For fiscal years 2024 through 2026,
with respect to $1,800,000,000 of the amount appropriated under
subsection (b)(1)(F), the Secretary shall prioritize awards to entities
for purposes of--
``(1) increasing the number of low-income patients not
enrolled in a group health plan or group or individual health
insurance coverage who are served by health centers, including
through Health Center Program New Access Points described in
section 330(e)(6) of the Public Health Service Act, including
school-based service sites;
``(2) increasing the required primary health services
described in paragraph (1)(A)(i) of section 330(b) of the
Public Health Service Act and additional health services (as
defined in paragraph (2) of such section) offered by health
centers; and
``(3) increasing patient case management, enabling
services, and education services, as described in clauses (iii)
through (v) of section 330(b)(1)(A) of the Public Health
Service Act.''.
(b) Authorization of Appropriations.--Section 330(r)(1) of the
Public Health Service Act (42 U.S.C. 254b(r)(1)) is amended--
(1) in subparagraph (G), by striking ``fiscal year 2016,
and each subsequent fiscal year'' and inserting ``each of
fiscal years 2016 through 2023''; and
(2) by adding at the end the following:
``(H) For each of fiscal years 2024 through 2026,
$2,200,000,000.
``(I) For fiscal year 2027, and each subsequent
fiscal year, the amount appropriated for the preceding
fiscal year adjusted by the product of--
``(i) one plus the average percentage
increase in costs incurred per patient served;
and
``(ii) one plus the average percentage
increase in the total number of patients
served.''.
(c) Allocation of Funds.--Section 10503 of the Patient Protection
and Affordable Care Act (42 U.S.C. 254b-2), as amended by subsection
(a), is further amended by adding at the end the following:
``(g) Allocation of Funds.--For each of fiscal years 2024 through
2026, of the amounts appropriated under subsection (b)(1)(F) for a
fiscal year, the Secretary shall use--
``(1) at least $245,000,000 for awards to support health
centers in each State that are receiving awards under section
330 of the Public Health Service Act in extending operating
hours, in an amount determined pursuant to a formula and
eligibility criteria developed by the Secretary, for the
purposes of increasing access to services;
``(2) at least $55,000,000 for awards under this section
for health centers to expand school-based services and
establish new school-based service sites; and
``(3) such sums as may be necessary for purposes of
increasing the amount awarded pursuant to grants or cooperative
agreements under section 330 of the Public Health Service Act
so that each recipient of such an award receives--
``(A) for fiscal year 2024, at least 15 percent
more than such recipient received for fiscal year 2023;
and
``(B) for each of fiscal years 2025 and 2026, the
amount received in the previous year adjusted by--
``(i) the percent increase in the medical
component of the consumer price index for the
most recent 12-month period for which
applicable data is available; plus
``(ii) one percent.''.
(d) Capital Funding.--Section 10503(c) of the Patient Protection
and Affordable Care Act (42 U.S.C. 254b-2(c)) is amended--
(1) in the subsection heading, by inserting ``, Capital
Funding'' after ``Construction'';
(2) by striking ``There is'' and inserting the following:
``(1) Construction.--There is''; and
(3) by adding at the end the following:
``(2) Capital funding.--For the alteration, renovation,
construction, equipment, and other capital costs of health
centers that receive funding under section 330 of the Public
Health Service Act (42 U.S.C. 254b), in addition to amounts
otherwise made available for such purpose, there is
appropriated to the Secretary of Health and Human Services, out
of amounts in the Treasury not otherwise appropriated,
$3,000,000,000 for fiscal year 2024, to remain available until
September 30, 2026. In awarding amounts appropriated under this
paragraph, the Secretary shall prioritize awards related to
increasing access to dental and behavioral health services.''.
(e) Strategic Plan To Improve Health Outcomes Through Nutrition.--
(1) In general.--Not later than one year after the date of
enactment of this Act, the Secretary of Health and Human
Services, in consultation with the Secretary of Agriculture,
shall submit to the Committee on Health, Education, Labor, and
Pensions of the Senate and the Committee on Energy and Commerce
of the House of Representatives a 5-year strategic plan to
improve health outcomes through nutrition for low-income or
uninsured patient populations with severe, complex chronic
conditions and one or more diet-related conditions.
(2) Report.--In carrying out paragraph (1), the Secretary
of Health and Human Services shall--
(A) conduct an evaluation of previous and current
federally-funded efforts of the Department of Health
and Human Services to improve patient outcomes through
nutrition interventions, such as medically tailored
meals and nutrition counseling; and
(B) include in the strategic report recommendations
for--
(i) reducing the financial impact of
obesity and preventable chronic conditions
resulting from obesity;
(ii) empowering federally-funded community
health centers, rural health clinics, and other
relevant federally-funded facilities to provide
produce prescriptions, medically tailored
groceries, and medically tailored meals;
(iii) promoting long-term adoption of
improved nutrition habits, including through
increased culinary education and consumer
nutrition aligned with the most recent Dietary
Guidelines for Americans published under
section 301 of the National Nutrition
Monitoring and Related Research Act of 1990 (7
U.S.C. 5341) and incorporating behavioral
modeling or other novel methods across Federal
programs;
(iv) developing performance and quality
metrics related to the delivery of produce
prescriptions, medically tailored groceries,
and medically tailored meals across relevant
Federal payers to aid in reimbursement
strategies;
(v) developing payment models for novel
obesity care therapies for the treatment of
diabetes that include behavioral and
nutritional and dietary services and education;
(vi) improving coordination of care and
integrating nutrition services and resources
within federally-funded community health
centers, rural health clinics, and other
federally-funded primary care facilities;
(vii) bolstering partnerships with State
and local governments and nongovernmental
organizations; and
(viii) addressing geographic disparities in
access to nutrition services and resources.
(f) Required Primary Health Services.--
(1) In general.--Section 330 of the Public Health Service
Act (42 U.S.C. 254b) is amended--
(A) in subsection (b)(1)(A)--
(i) in clause (i)--
(I) in subclause (IV), by striking
``; and'' and inserting a semicolon;
(II) in subclause (V), by adding
``and'' after the semicolon; and
(III) by adding at the end the
following:
``(VI) appropriate nutritional and
dietary services;'';
(ii) in clause (ii), by inserting ``and
nutrition services'' after ``mental health
services''; and
(iii) in clause (iii), by inserting
``nutritional,'' after ``educational,''; and
(B) in subsection (d)(1)(A), by inserting ``or one
or more diet-related conditions'' before the semicolon.
(2) Implementation of new required primary health
service.--Paragraph (4) of section 330(e) of the Public Health
Service Act (42 U.S.C. 254b(e)) is amended to read as follows:
``(4) Limitation.--Not more than 2 grants may be made under
paragraph (1)(B) for the same entity, except that such
limitation shall not apply for the period of 2 years beginning
on the date of enactment of the Bipartisan Primary Care and
Health Workforce Act, in any case where the only basis upon
which paragraph (1)(B) applies to a health center is that the
health center is not in noncompliance with the requirements
under subsection (b)(1)(A)(i)(VI) to provide appropriate
nutritional and dietary services.''.
(g) Increase the Use of Provider Tools To Improve Health
Outcomes.--Not later than one year after the date of enactment of this
Act, the Secretary of Health and Human Services, in consultation with
the Secretary of Agriculture, shall submit to Congress a report that
includes--
(1) recommendations for States to support the coordination
of federally-funded nutrition programs and services provided by
health care professionals in community health centers; and
(2) data on the number of individuals enrolled in
federally-subsidized health insurance coverage who are also
enrolled in or eligible for federally-subsidized nutrition and
food programs.
SEC. 103. NATIONAL HEALTH SERVICE CORPS.
Section 10503(b)(2) of the Patient Protection and Affordable Care
Act (42 U.S.C. 254b-2(b)(2)) is amended--
(1) in subparagraph (G), by striking ``; and'' and
inserting a semicolon;
(2) in subparagraph (H), by striking the period and
inserting ``; and''; and
(3) by adding at the end the following:
``(I) $950,000,000 for each of fiscal years 2024
through 2026.''.
SEC. 104. GAO REPORT.
(a) In General.--Not later than one year after the date of
enactment of this Act, the Comptroller General of the United States
shall submit to the Committee on Health, Education, Labor, and Pensions
of the Senate and the Committee on Energy and Commerce of the House of
Representatives a report assessing the effectiveness of the National
Health Service Corps (referred to in this section as the ``NHSC'') at
attracting health care professionals to health professional shortage
areas designated under section 332 of the Public Health Service Act (42
U.S.C. 254e) (referred to in this section as ``HPSAs''), such as by--
(1) assessing the metrics used by the Health Resources and
Services Administration in evaluating the program;
(2) comparing the retention rates of NHSC participants in
the HPSAs where they completed their period of obligated
service to the retention rate of non-NHSC participants in the
corresponding HPSAs;
(3) comparing the retention rates of NHSC participants in
the HPSAs where they completed their period of obligated
service to the retention rates of NHSC participants in HPSAs
other than those where they completed their period of obligated
service;
(4) identifying factors that influence a NHSC participant's
decision to practice in a HPSA other than the HPSA where they
completed their period of obligated service;
(5) identifying factors other than participation in the
National Health Service Corps Scholarship and Loan Repayment
Programs that attract health care professionals to a HPSA;
(6) assessing the impact the NHSC has on wages for health
care professionals in a HPSA; and
(7) comparing the distribution of NHSC participants across
HPSAs, including a comparison of rural versus non-rural HPSAs.
(b) Definition.--In this section, the term ``NHSC participant''
means a National Health Service Corps member participating in the
National Health Service Corps Scholarship or Loan Repayment Program
under subpart III of part D of title III of the Public Health Service
Act (42 U.S.C. 254l et seq.).
SEC. 105. OIG REPORT.
Not later than 2 years after the date of enactment of this Act, the
Inspector General of the Department of Health and Human Services shall
submit to Congress a report on integrity efforts of the Health
Resources and Services Administration with respect to programs carried
out by the Health Resources and Services Administration. Such report
shall include an assessment of--
(1) the ways in which the Administrator of the Health
Resources and Services Administration (referred to in this
section as the ``Administrator'') determines reasonable efforts
are continuously made to establish and maintain collaborative
relationships with health care providers;
(2) the ways in which the Administrator ensures quality and
continuity of care for underserved areas; and
(3) the extent to which the Administrator validates the
financial responsibility of and use of grant funding by
community health centers.
SEC. 106. APPLICATION OF PROVISIONS.
(a) In General.--Amounts appropriated pursuant to the amendments
made by this title shall be subject to the requirements contained in
Public Law 117-328 for funds for programs authorized under sections 330
through 340 of the Public Health Service Act (42 U.S.C. 254b through
256).
(b) Conforming Amendment.--Paragraph (4) of section 3014(h) of
title 18, United States Code, ``and section 301(d) of division BB of
the Consolidated Appropriations Act, 2021.'' and inserting ``section
301(d) of division BB of the Consolidated Appropriations Act, 2021, and
section 106(a) of the Bipartisan Primary Care and Health Workforce
Act''.
TITLE II--SUPPORTING THE HEALTH CARE WORKFORCE
SEC. 201. RURAL RESIDENCY PLANNING AND DEVELOPMENT PROGRAM.
Title III of the Public Health Service Act (42 U.S.C. 241 et seq.)
is amended by inserting after section 330A-2 the following:
``SEC. 330A-3. RURAL RESIDENCY PLANNING AND DEVELOPMENT PROGRAM AND
RURAL RESIDENCY PLANNING AND DEVELOPMENT TECHNICAL
ASSISTANCE PROGRAM.
``(a) Definition of Rural Residency Program.--In this section, the
term `rural residency program' means a physician residency program,
including a rural track program, accredited by the Accreditation
Council for Graduate Medical Education (or a similar body) that--
``(1) trains residents in rural areas (as defined by the
Secretary) for more than 50 percent of the total time of their
residency; and
``(2) primarily focuses on producing physicians who will
practice in rural areas, as defined by the Secretary.
``(b) Rural Residency Planning and Development Program.--
``(1) Definition of eligible entity.--In this subsection,
the term `eligible entity'--
``(A) means--
``(i) a domestic public or private
nonprofit or for-profit entity;
``(ii) an Indian Tribe, Tribal health
program, Tribal organization, or Urban Indian
organization (as such terms are defined in
section 4 of the Indian Health Care Improvement
Act); or
``(iii) a Native Hawaiian Health
organization as defined in section 12 of the
Native Hawaiian Health Care Improvement; and
``(B) may include faith-based or community-based
organizations, rural hospitals, rural community-based
ambulatory patient care centers (including rural health
clinics), health centers operated by a Native Hawaiian
Health organization (defined as described in
subparagraph (A)(iii)), an Indian Tribe, a Tribal
health program, a Tribal organization, or an Urban
Indian organization (defined as described in
subparagraph (A)(ii)), graduate medical education
consortiums (including institutions of higher
education, such as schools of allopathic medicine,
schools of osteopathic medicine, or historically Black
colleges or universities (as defined by the term `part
B institution' in section 322 of the Higher Education
Act of 1965 or described in section 326(e)(1) of the
Higher Education Act of 1965) or other minority-serving
institutions (as described in section 371(a) of the
Higher Education Act of 1965), or other organizations
as determined appropriate by the Secretary.
``(2) Grants.--
``(A) In general.--The Secretary may award grants
to eligible entities to create new rural residency
programs (including adding new rural training sites to
existing rural track programs).
``(B) Funding.--Grants awarded under this
subsection may be fully funded at the time of the
award.
``(C) Term.--The term of a grant under this
subsection shall be 4 years and may be extended at the
discretion of the Secretary.
``(3) Applications.--
``(A) In general.--To be eligible to receive a
grant under this subsection, an eligible entity shall
prepare and submit to the Secretary an application at
such time, in such manner, and containing such
information as the Secretary may require, including a
description of the pathway of the rural residency
program as described in subparagraph (B).
``(B) Pathway.--A pathway of a rural residency
program supported under this subsection shall be for--
``(i) general primary care and high-need
specialty care, including family medicine,
internal medicine, preventive medicine,
psychiatry, or general surgery;
``(ii) maternal health and obstetrics,
which may be obstetrics and gynecology or
family medicine with enhanced obstetrical
training; or
``(iii) any other pathway as determined
appropriate by the Secretary.
``(c) Rural Residency Planning and Development Technical
Assistance.--
``(1) Definition of eligible entity.--In this subsection,
the term `eligible entity' means--
``(A) a domestic public or private nonprofit or
for-profit entity; or
``(B) an Indian Tribe or Tribal organization (as
such terms are defined in section 4 of the Indian
Health Care Improvement Act).
``(2) Grants.--
``(A) In general.--The Secretary may award grants
to eligible entities to provide technical assistance to
awardees of and potential applicants of the program
described in subsection (b).
``(B) Funding.--Grants awarded under this
subsection may be fully funded at the time of the
award.
``(C) Term.--The term of a grant under this
subsection shall be 4 years and may be extended at the
discretion of the Secretary.
``(3) Applications.--To be eligible to receive a grant
under this subsection, an eligible entity shall prepare and
submit to the Secretary an application at such time, in such
manner, and containing such information as the Secretary may
require.
``(d) Authorization of Appropriations.--There is authorized to be
appropriated to carry out this section $13,000,000 for fiscal year
2024, $13,500,00 for fiscal year 2025, and $14,000,000 for fiscal year
2026, to remain available until expended.''.
SEC. 202. PRIMARY CARE TRAINING AND ENHANCEMENT PROGRAM.
Section 747(c)(1) of the Public Health Service Act (42 U.S.C.
293k(c)(1)) is amended--
(1) by striking ``$48,924,000 for each of fiscal years 2021
through 2025'' and inserting ``$49,250,000 for fiscal year
2024, $49,500,000 for fiscal year 2025, and $50,000,000 for
fiscal year 2026''; and
(2) by striking ``subsection (b)(1)(B)'' and inserting
``subsections (b)(1)(B) and (c)''.
SEC. 203. TELEHEALTH TECHNOLOGY-ENABLED LEARNING PROGRAM.
Section 330N(k) of the Public Health Service Act (42 U.S.C. 254c-
20(k)) is amended by striking ``2026'' and inserting ``2025, and
$11,000,000 for each of fiscal years 2026 through 2028, to remain
available until expended''.
SEC. 204. EXPANDING THE NUMBER OF PRIMARY CARE DOCTORS.
Section 747 of the Public Health Service Act (42 U.S.C. 293k), as
amended by section 202, is further amended--
(1) by redesignating subsection (c) as subsection (d); and
(2) by inserting after subsection (b) the following:
``(c) Expanding the Number of Primary Care Doctors.--
``(1) In general.--The Secretary shall award grants to
eligible medical schools described in paragraph (2) for the
purpose of graduating more physicians who will practice a
primary care discipline. Funds awarded under this subsection
may be used for costs associated with faculty, construction and
capital improvements, clinical support, research support,
student supports, and any other costs, as determined by the
Secretary.
``(2) Eligibility.--To be eligible to receive a grant under
this subsection, a medical school shall--
``(A) be a nonprofit school of medicine or
osteopathic medicine that is accredited by a nationally
recognized accrediting agency or association; and
``(B) demonstrate in the grant application of the
medical school--
``(i) that not less than 33 percent of
graduates from the medical school enter primary
care and are, as of the date of the
application, practicing primary care, as
calculated by dividing--
``(I) the number of physicians who
graduated during such time period as is
specified by the Secretary who are
practicing primary care; by
``(II) the total number of
physicians who graduated during such
time period; and
``(ii) a plan to expand the number of
graduates of the medical school who are
practicing primary care; and
``(iii) a commitment to use grant funds to
supplement, not supplant, such school's
investment in primary care medical education.
``(3) Expanding the number of minority primary care
doctors.--Of the amounts appropriated under paragraph (6)(C),
the Secretary shall awards not less than 20 percent to eligible
medical schools described in paragraph (2) that are
historically Black colleges and universities (as defined by the
term `part B institution' in section 322 of the Higher
Education Act of 1965 (20 U.S.C. 1061) or described in section
326(e)(1) of such Act (20 U.S.C. 1063b(e)(1))) or other
minority-serving institutions (as described in section 371(a)
of the Higher Education Act of 1965 (20 U.S.C. 1067q(a))).
``(4) Grant amounts; geographic distribution.--
``(A) Grant amounts.--The Secretary shall determine
the amount of each grant awarded under this subsection,
which shall be based on the scope of the plan submitted
by the medical school under paragraph (2)(B)(ii), and
other appropriate factors.
``(B) Geographic distribution.--In awarding grants
under this subsection, the Secretary shall ensure, to
the greatest extent practicable, that such grants are
equitably distributed among the geographic regions of
the United States.
``(5) Primary care.--In this subsection, the term `primary
care' means health care services related to family medicine,
internal medicine, pediatrics, obstetrics, gynecology,
geriatrics, or psychiatry.
``(6) Account to address the primary care physician
shortage.--
``(A) Establishment of account.--There is
established in the Treasury an account, to be known as
the `Account to Address the Primary Care Physician
Shortage' (referred to in this subsection as the
`Account'), for purposes of carrying out this
subsection.
``(B) Transfer of direct spending.--
``(i) In general.--The Secretary of the
Treasury shall transfer, from the general fund
of the Treasury, to the Account $300,000,000
for fiscal year 2024.
``(ii) Amounts deposited.--Any amounts
transferred under clause (i) shall remain
unavailable in the Account until such amounts
are appropriated pursuant to subparagraph (C).
``(C) Appropriations.--
``(i) Authorization of appropriations.--For
the period of fiscal years 2024 through 2026,
there is authorized to be appropriated from the
Account to the Secretary, for the purpose of
carrying out the activities under this
subsection, an amount not to exceed the total
amount transferred to the Account under
subparagraph (B)(i).
``(ii) Offsetting future appropriations.--
For fiscal years 2024 through 2026, for any
discretionary appropriation under the heading
`Account to Address the Primary Care Physician
Shortage' provided to the Secretary pursuant to
the authorization of appropriations under
clause (i) for the purpose of carrying out this
subsection, the total amount of such
appropriations for the applicable fiscal year
(not to exceed the total amount remaining in
the Account) shall be subtracted from the
estimate of discretionary budget authority and
the resulting outlays for any estimate under
the Congressional Budget and Impoundment
Control Act of 1974 or the Balanced Budget and
Emergency Deficit Control Act of 1985, and the
amount transferred to the Account shall be
reduced by the same amount.
``(7) Annual reports.--Not later than October 1 of fiscal
years 2025 through 2027, the Secretary shall submit to the
Committee on Health, Education, Labor, and Pensions and the
Committee on Appropriations of the Senate and the Committee on
Energy and Commerce and the Committee on Appropriations of the
House of Representatives, a report including a description of
any use of funds provided pursuant to the authorization of
appropriations under paragraph (6)(C).
``(8) Limitations.--Notwithstanding any transfer authority
authorized by this subsection or any appropriations Act, any
funds made available pursuant to the authorization of
appropriations under paragraph (6)(C) may not be used for any
purpose other than the program established under paragraph (1).
``(9) Sunset.--Amounts remaining unappropriated in the
Account under this subsection shall be transferred back to the
general fund of the Treasury on October 1, 2026.''.
SEC. 205. NURSE EDUCATION, PRACTICE, QUALITY, AND RETENTION GRANTS.
(a) Reauthorization.--Section 831 of the Public Health Service Act
(42 U.S.C. 296p) is amended by adding at the end the following:
``(g) Authorization of Appropriations.--To carry out this section
(other than subsection (e)), in addition to amounts made available
under section 871(a), there are authorized to be appropriated
$59,413,000 for each of fiscal years 2024 through 2026, to remain
available until expended.''.
(b) Expanding Associate Degree Nursing Programs.--Section 831 of
the Public Health Service Act (42 U.S.C. 296p), as amended by
subsection (a), is further amended--
(1) by redesignating subsections (e) through (g) as
subsections (f) through (h), respectively; and
(2) by inserting after subsection (d) the following:
``(e) Supplemental Appropriations Expanding Associate Degree
Nursing Programs.--
``(1) Authorization.--The Secretary shall award grants to
institutions of higher education (as defined in section 101 of
the Higher Education Act of 1965) offering an accredited
registered nursing program at the associate degree level for
the purpose of expanding the number of students enrolled in
each such program.
``(2) Use of funds.--A recipient of a grant under this
subsection shall use the grant funds to expand the number of
students enrolled in the recipient's accredited registered
nursing program, which may include increasing nurse faculty and
nurse faculty salaries, expanding the number of qualified
preceptors at clinical rotations sites, providing direct
support for students, supporting partnerships with health
facilities for clinical training, purchasing and training
faculty to use distance learning technologies and simulation
equipment, alteration, renovation, construction, equipment, and
other capital improvement costs, and other projects determined
appropriate by the Secretary.
``(3) Determination of number of students and
application.--Each institution of higher education that offers
a program described in paragraph (1) that desires to receive a
grant under this subsection shall--
``(A) provide documentation from the last 4
academic years, or number of academic years the program
has been accredited if less than 4, demonstrating the
average percentage of individuals who graduated from
the nursing degree program with an associate degree
within 150 percent of the expected completion time
designated for the program; and
``(B) submit an application to the Secretary at
such time, in such manner, and accompanied by such
information as the Secretary may require, including the
average percent of individuals determined under
subparagraph (A).
``(4) Definition.--For purposes of this subsection, the
term `health facility' means an Indian health service center, a
Native Hawaiian health center, a Federally qualified health
center, a rural health clinic, a nursing home, a home health
agency, a hospice program, a public health clinic, a State or
local department of public health, a skilled nursing facility,
or an ambulatory surgical center.
``(5) Account to address the nursing workforce shortage.--
``(A) Establishment of account.--There is
established in the Treasury an account, to be known as
the `Account to Address the Nursing Workforce Shortage'
(referred to in this subsection as the `Account'), for
purposes of carrying out this subsection, in addition
to amounts otherwise made available, including under
section 871(a).
``(B) Transfer of direct spending.--
``(i) In general.--The Secretary of the
Treasury shall transfer, from the general fund
of the Treasury, to the Account $240,000,000
for each of fiscal years 2024 through 2028.
``(ii) Amounts deposited.--Any amounts
transferred under clause (i) shall remain
unavailable in the Account until such amounts
are appropriated pursuant to subparagraph (C).
``(C) Appropriations.--
``(i) Authorization of appropriations.--For
each of fiscal years 2024 through 2028, there
is authorized to be appropriated from the
Account to the Secretary, for the purpose of
carrying out the activities under this
subsection, in addition to amounts otherwise
made available for such purpose, an amount not
to exceed the total amount transferred to the
Account under subparagraph (B)(i).
``(ii) Offsetting future appropriations.--
For any of fiscal years 2024 through 2028, for
any discretionary appropriation under the
heading `Account to Address the Nursing
Workforce Shortage' provided to the Secretary
pursuant to the authorization of appropriations
under clause (i) for an additional amount for
carrying out this subsection, the total amount
of such appropriations for the applicable
fiscal year (not to exceed the total amount
remaining in the Account) shall be subtracted
from the estimate of discretionary budget
authority and the resulting outlays for any
estimate under the Congressional Budget and
Impoundment Control Act of 1974 or the Balanced
Budget and Emergency Deficit Control Act of
1985, and the amount transferred to the Account
shall be reduced by the same amount.
``(6) Annual reports.--Not later than October 1 of fiscal
years 2025 through 2029, the Secretary shall submit to the
Committee on Health, Education, Labor, and Pensions and the
Committee on Appropriations of the Senate and the Committee on
Energy and Commerce and the Committee on Appropriations of the
House of Representatives, a report including a description of
any use of funds provided pursuant to the authorization of
appropriations under paragraph (5)(C).
``(7) Limitations.--Notwithstanding any transfer authority
authorized by this subsection or any appropriations Act, any
funds made available pursuant to the authorization of
appropriations under paragraph (5)(C) may not be used for any
purpose other than the program established under paragraph (1).
``(8) Sunset.--Amounts remaining unappropriated in the
Account under this subsection shall be transferred back to the
general fund of the Treasury on October 1, 2028.''.
SEC. 206. NURSE FACULTY LOAN PROGRAM.
Section 846A of the Public Health Service Act (42 U.S.C. 297n-1),
as amended by section 207, is amended by inserting after subsection (b)
the following:
``(c) Funding.--
``(1) Authorization of appropriations.--
``(A) In general.--To carry out this section (other
than subsection (d)), in addition to amounts otherwise
made available, including under section 871(b) and
paragraph (2), there are authorized to be appropriated
$28,500,000 for each of fiscal years 2024 through 2026,
to remain available until expended.
``(2) Account to address the nurse faculty workforce
shortage.--
``(A) Establishment of account.--There is
established in the Treasury an account, to be known as
the `Account to Address the Nurse Faculty Shortage'
(referred to in this paragraph as the `Account'), for
purposes of carrying out this section (other than
subsection (d)) in addition to amounts otherwise made
available, including under section 871(b) and paragraph
(1).
``(B) Transfer of direct spending.--
``(i) In general.--The Secretary of the
Treasury shall transfer, from the general fund
of the Treasury, to the Account $57,000,000 for
each of fiscal years 2024 through 2026.
``(ii) Amounts deposited.--Any amounts
transferred under clause (i) shall remain
unavailable in the Account until such amounts
are appropriated pursuant to subparagraph (C).
``(C) Appropriations.--
``(i) Authorization of appropriations.--For
each of fiscal years 2024 through 2026, there
is authorized to be appropriated from the
Account to the Secretary, for the purpose of
carrying out the activities under this section,
in addition to amounts otherwise made available
for such purpose, an amount not to exceed the
total amount transferred to the Account under
subparagraph (B)(i).
``(ii) Offsetting future appropriations.--
For any of fiscal years 2024 through 2026, for
any discretionary appropriation under the
heading `Account to Address the Nurse Faculty
Shortage' provided to the Secretary pursuant to
the authorization of appropriations under
clause (i) for an additional amount for
carrying out this section, the total amount of
such appropriations for the applicable fiscal
year (not to exceed the total amount remaining
in the Account) shall be subtracted from the
estimate of discretionary budget authority and
the resulting outlays for any estimate under
the Congressional Budget and Impoundment
Control Act of 1974 or the Balanced Budget and
Emergency Deficit Control Act of 1985, and the
amount transferred to the Account shall be
reduced by the same amount.
``(D) Annual reports.--Not later than October 1 of
fiscal years 2025 through 2027, the Secretary shall
submit to the Committee on Health, Education, Labor,
and Pensions and the Committee on Appropriations of the
Senate and the Committee on Energy and Commerce and the
Committee on Appropriations of the House of
Representatives, a report including a description of
any use of funds provided pursuant to the authorization
of appropriations under subparagraph (C).
``(E) Limitations.--Notwithstanding any transfer
authority authorized by this paragraph or any
appropriations Act, any funds made available pursuant
to the authorization of appropriations under
subparagraph (C) may not be used for any purpose other
than the program under this section.
``(F) Sunset.--Amounts remaining unappropriated in
the Account under this paragraph shall be transferred
back to the general fund of the Treasury on October 1,
2026.''.
SEC. 207. NURSE FACULTY DEMONSTRATION PROGRAM.
Section 846A of the Public Health Service Act (42 U.S.C. 297n-1) is
amended--
(1) by amending subsection (a) to read as follows:
``(a) In General.--To increase the number of qualified nursing
faculty, the Secretary may--
``(1) enter into an agreement with any accredited school of
nursing for the establishment and operation of a student loan
fund in accordance with subsection (b); and
``(2) award nurse faculty grants in accordance with
subsection (d).'';
(2) in subsection (b)--
(A) by redesignating subparagraphs (A) through (D)
of paragraph (2) as clauses (i) through (iv),
respectively, and adjusting the margins accordingly;
(B) by redesignating paragraphs (1) through (5) as
subparagraphs (A) through (E), respectively, and
adjusting the margins accordingly;
(C) in subparagraph (C), as so redesignated, by
striking ``subsection (c)'' and inserting ``paragraph
(2)''; and
(D) by striking ``(b) Agreements--Each agreement
entered into under subsection (a) shall--'' and
inserting the following:
``(b) School of Nursing Student Loan Fund.--
``(1) In general.--Each agreement entered into under
subsection (a)(1) shall--'';
(3) in subsection (c)--
(A) by striking ``subsection (a)'' each place it
appears and inserting ``subsection (a)(1)'';
(B) in paragraph (3), by redesignating
subparagraphs (A) and (B) as clauses (i) and (ii),
respectively, and adjusting the margins accordingly;
(C) in paragraph (6), by redesignating
subparagraphs (A) and (B) as clauses (i) and (ii),
respectively, and adjusting the margins accordingly;
(D) by redesignating paragraphs (1) through (6) as
subparagraphs (A) through (F), respectively, and
adjusting the margins accordingly; and
(E) in subparagraph (F)(ii), as so redesignated, by
striking ``subsection (e)'' and inserting ``paragraph
(4)'';
(4) in subsection (e), by striking ``subsection (c)(6)(B)''
and inserting ``paragraph (2)(F)(ii)'';
(5) by redesignating subsections (c) through (e) (before
application of the amendment made by section 206) as paragraphs
(2) through (4), respectively, and adjusting the margins
accordingly; and
(6) by adding after subsection (c), as added by section
206, the following:
``(d) Nurse Faculty Demonstration Program.--
``(1) In general.--The Secretary shall establish and carry
out a demonstration program described in subsection (a)(2)
under which eligible schools of nursing receive a grant for
purposes of supplementing the salaries of eligible nursing
faculty members to enhance recruitment and retention of nursing
faculty members.
``(2) Eligible entities.--To be eligible to receive a grant
under this subsection, an entity shall--
``(A) be an accredited school of nursing; and
``(B) submit an application to the Secretary, at
such time, in such manner, and containing such
information as the Secretary may require, including--
``(i)(I) to the extent such information is
available to the school of nursing, the salary
history of nursing faculty at such school who
previously were nurses in clinical practice,
for the most recent 3-year period ending on the
date of application, adjusted for inflation as
appropriate and broken down by credentials,
experience, and levels of education of such
nurses; or
``(II) if the information described in
subclause (I) is not available, information on
the average local salary of nurses in clinical
practice, adjusted for inflation as appropriate
and broken down by credentials, experience, and
levels of education of the individual nurses,
in accordance with such requirements as the
Secretary may specify;
``(ii) an attestation of the average
nursing faculty salary at the school of nursing
during the most recent 3-year period prior to
the date of application, adjusted for
inflation, as appropriate, broken down by
credentials, experience, and levels of
education of such faculty members;
``(iii) the number of nursing faculty
member vacancies at the entity at the time of
application, and the entity's projection of
such vacancies over the ensuing 5-year period;
and
``(iv) a description of the entity's plans
to identify funding sources to sustainably
continue, after the 2-year grant period, the
salary available to the eligible nursing
faculty member pursuant to the program under
this subsection during such grant program and
to retain eligible nursing faculty members
after the end of the grant period.
``(3) Awards.--A grant awarded under this subsection, with
respect to supporting eligible nursing faculty members, shall--
``(A) be awarded to the school of nursing to
supplement the salaries of eligible faculty members at
the school of nursing, annually, for up to a 2-year
period, in an amount equal to, for each eligible
nursing faculty member at the eligible entity during
the grant period, the difference between--
``(i) the average salary of nurses in
clinical practice submitted under subclause (I)
or (II) of paragraph (2)(B)(i); and
``(ii) the greater of--
``(I) the salary for the eligible
nursing faculty member at the school of
nursing; or
``(II) the average nursing faculty
salary submitted under paragraph
(2)(B)(ii) for faculty members with the
same or similar credentials and level
of education;
``(B) notwithstanding section 803(a), be used in
its entirety to supplement the eligible faculty
member's salary; and
``(C) be conditioned upon the school of nursing
maintaining, for each year in which the award is made
as described in subparagraph (A), a salary for such
faculty member at a level that is not less than the
greater of the amount under subclause (I) or (II) of
subparagraph (A)(ii).
``(4) Priority.--In awarding grants under this subsection,
the Secretary shall ensure the equitable geographic
distribution of awards, and shall give priority to applications
from schools of nursing that demonstrate--
``(A) the greatest need for such grant, which may
be based upon the financial circumstances of the school
of nursing, eligible nurse faculty members, the planned
number of students to be trained or admitted off a wait
list;
``(B) training or partnerships to serve vulnerable
patient populations, such as through the location or
activity of a school in a health professional shortage
area (as defined in section 332);
``(C) recruitment and retention of faculty from
underrepresented populations; or
``(D) other particular need for such grant,
including public institutions of higher education that
offer 4-year degrees but at which the predominant
degree awarded is an associate degree.
``(5) Rule of construction.--Nothing in this subsection
precludes a school of nursing or an eligible nursing faculty
member receiving an award under this section from obtaining or
receiving any other form of Federal support or funding.
``(6) Report.--Not later than 3 years after the date of
enactment of the Bipartisan Primary Care and Health Workforce
Act, the Secretary shall submit to the Committee on Finance and
the Committee on Health, Education, Labor, and Pensions of the
Senate and the Committee on Ways and Means and the Committee on
Energy and Commerce of the House of Representatives, a report
that evaluates the program established under this subsection,
including--
``(A) the impact of such program on recruitment and
retention rates of nursing faculty, as available, and
specifically for each faculty member participating in
the program; and
``(B) recommendations and considerations for
Congress on continuing the program under this
subsection.
``(7) Definitions.--In this subsection:
``(A) Eligible nursing faculty member.--The term
`eligible nursing faculty member' means a nursing
faculty member who--
``(i) was hired by a school of nursing
within the 2-year period preceding the
submission of an application under paragraph
(2), or a prospective nursing faculty member;
``(ii) is currently employed at the school
of nursing and who demonstrates the need for
such support;
``(iii) previously worked as a nurse in
clinical practice or as a nurse faculty member
at another school of nursing; or
``(iv) may work on a part-time basis as a
nursing faculty member, for whom such award
amounts described in paragraph (3) shall be
prorated relative to the amount of time
participating in part-time teaching.
``(B) Inflation.--The term `inflation' means the
Consumer Price Index for all urban consumers (all
items; U.S. city average).
``(8) Authorization of appropriations.--To carry out this
subsection, in addition to amounts otherwise available,
including under section 871(b), there is authorized to be
appropriated $15,000,000 for each of fiscal years 2024 and
2025.''.
SEC. 208. NURSE CORPS SCHOLARSHIP AND LOAN REPAYMENT PROGRAM.
Section 846 of the Public Health Service Act (42 U.S.C. 297n) is
amended by adding at the end the following:
``(j) Authorization of Appropriations.--To carry out this section,
in addition to amounts otherwise made available, including under
section 871(b), there are authorized to be appropriated $93,600,000 for
fiscal year 2024, $94,600,000 for fiscal year 2025, and $95,600,000 for
fiscal year 2026, to remain available until expended.''.
SEC. 209. GRANTS FOR PRIMARY CARE NURSE RESIDENCY TRAINING PROGRAMS.
Section 5316 of the Patient Protection and Affordable Care Act (42
U.S.C. 296j-1) is amended--
(1) in the section heading, by striking ``demonstration'';
(2) in subsection (a), by striking ``demonstration'';
(3) in subsection (d)--
(A) in paragraph (1)(B), by striking ``and'' at the
end;
(B) by redesignating paragraph (2) as paragraph
(3); and
(C) by inserting after paragraph (1) the following:
``(2)(A) in the case of an entity that does not have an
established residency program for nurse practitioners at the
time of the application, demonstrate plans to establish a new
residency program for nurse practitioners; or
``(B) in the case of an entity that has an established
residency program for nurse practitioners at the time of the
application, demonstrate plans to use the grant under this
section to offer not fewer than 4 additional residency
positions for new nurse practitioners to participate in such
program; and''; and
(4) in subsection (i), by striking ``such sums as may be
necessary for each of fiscal years 2011 through 2014'' and
inserting ``$30,000,000 for each of fiscal years 2024 through
2026''.
SEC. 210. STATE ORAL HEALTH WORKFORCE IMPROVEMENT GRANT PROGRAM.
Subsection (f) of section 340G of the Public Health Service Act (42
U.S.C. 256g) is amended by striking ``$13,903,000 for each of fiscal
years 2019 through 2023'' and inserting ``$15,200,000 for fiscal year
2024, $15,500,000 for fiscal year 2025, and $15,800,000 for fiscal year
2026, to remain available until expended''.
SEC. 211. ORAL HEALTH TRAINING PROGRAMS.
Subsection (f) of section 748 of the Public Health Service Act (42
U.S.C. 293k-2) is amended to read as follows:
``(f) Authorization of Appropriations.--
``(1) In general.--To carry out this section, there is
authorized to be appropriated $28,500,000 for fiscal year 2026,
to remain available until expended.
``(2) Geographic distribution.--In awarding grants under
this section, the Secretary shall ensure, to the greatest
extent practicable, that such grants are equitably distributed
among the geographical regions of the United States.''.
SEC. 212. ALLIED HEALTH PROFESSIONALS.
(a) Supporting Dual or Concurrent Enrollment in the Allied Health
Projects Program.--Section 755(b)(1) of the Public Health Service Act
(42 U.S.C. 294e(b)(1)) is amended--
(1) in subparagraph (B), by striking ``to individuals who
have baccalaureate degrees in health-related sciences'';
(2) in the flush text at the end of subparagraph (I), by
striking ``; and'' and inserting a semicolon;
(3) in subparagraph (J), by striking the period and
inserting ``; and''; and
(4) by adding at the end the following:
``(K) those that establish or support a dual or
concurrent enrollment program (as defined in section
8101 of the Elementary and Secondary Education Act of
1965) if the dual or concurrent enrollment program--
``(i) provides outreach on allied health
careers requiring an industry-recognized
credential, a certificate, or an associate
degree, to all high schools served by the local
educational agency that is a partner in the
partnership offering the dual or concurrent
enrollment program;
``(ii) provides information to high school
students about the training requirements and
expected salary of allied health professions;
and
``(iii) provides academic and financial aid
counseling to students who participate in the
dual or concurrent enrollment program.''.
(b) Supporting Dual or Concurrent Enrollment in the Health Careers
Opportunity Program.--Section 739(a)(2) of the Public Health Service
Act (42 U.S.C. 293c(a)(2)) is amended--
(1) in subparagraph (H), by striking ``and'' after the
semicolon;
(2) in subparagraph (I), by striking the period at the end
and inserting ``; and''; and
(3) by adding at the end the following:
``(J) providing academic and financial aid
counseling to support participation in a dual or
concurrent enrollment program (as defined in section
8101 of the Elementary and Secondary Education Act of
1965) that leads to an industry-recognized credential,
a certificate, or an associate degree in the health
professions or academic credits that can be
transferred, as indicated through an articulation
agreement between 2 or more community colleges or
universities, to obtain an industry-recognized
credential, a certificate, or a degree in the health
professions.''.
(c) Health Care Workforce Innovation Program.--Section 755(b) of
the Public Health Service Act (42 U.S.C. 294e(b)) is amended by adding
at the end the following:
``(5)(A) Supporting and developing new innovative,
community-driven approaches for the education and training of
allied health professionals, including those described in
subparagraph (F)(i), with an emphasis on expanding the supply
of such professionals located in, and meeting the needs of,
underserved communities and rural areas. Grants under this
paragraph shall be awarded through a new program (referred to
as the `Health Care Workforce Innovation Program' or in this
paragraph as the `Program').
``(B) To be eligible to receive a grant under the Program
an entity shall--
``(i) be a Federally qualified health center (as
defined in section 1905(l)(2)(B) of the Social Security
Act), a State-level association or other consortium
that represents and is comprised of Federally qualified
health centers, or a certified rural health clinic that
meets the requirements of section 334; and
``(ii) submit to the Secretary an application that,
at a minimum, contains--
``(I) a description of how all trainees
will be trained in accredited training programs
either directly or through partnerships with
public or nonprofit private entities;
``(II) a description of the community-
driven health care workforce innovation model
to be carried out under the grant, including
the specific professions to be funded;
``(III) the geographic service area that
will be served, including quantitative data, if
available, showing that such particular area
faces a shortage of health professionals and
lacks access to health care;
``(IV) a description of the benefits
provided to each health care professional
trained under the proposed model during the
education and training phase;
``(V) a description of the experience that
the applicant has in the recruitment,
retention, and promotion of the well-being of
workers and volunteers;
``(VI) a description of how the funding
awarded under the Program will supplement
rather than supplant existing funding;
``(VII) a description of the scalability
and replicability of the community-driven
approach to be funded under the Program;
``(VIII) a description of the
infrastructure, outreach and communication plan
and other program support costs required to
operationalize the proposed model; and
``(IX) any other information, as the
Secretary determines appropriate.
``(C)(i) An entity shall use amounts received under a grant
awarded under the Program to carry out the innovative,
community-driven model described in the application under
subparagraph (B). Such amounts may be used for launching new or
expanding existing innovative health care professional
partnerships, including the following specific uses:
``(I) Establishing or expanding a partnership
between an eligible entity and 1 or more high schools,
accredited public or nonprofit private vocational-
technical schools, accredited public or nonprofit
private 2-year colleges, area health education centers,
and entities with clinical settings for the provision
of education and training opportunities not available
at the grantee's facilities.
``(II) Providing education and training programs to
improve allied health professionals' readiness in
settings that serve underserved communities and rural
areas; encouraging students from underserved and
disadvantaged backgrounds and former patients to
consider careers in health care, and better reflecting
and meeting community needs; providing education and
training programs for individuals to work in patient-
centered, team-based, community-driven health care
models that include integration with other clinical
practitioners and training in cultural and linguistic
competence; providing pre-apprenticeship and
apprenticeship programs for health care technical,
support, and entry-level occupations, particularly for
those enrolled in dual or concurrent enrollment
programs; building a preceptorship training-to-practice
model for medical, behavioral health, oral health, and
public health disciplines in an integrated, community-
driven setting; providing and expanding internships,
career ladders, and development opportunities for
health care professionals, including new and existing
staff; or investing in training equipment, supplies,
and limited renovations or retrofitting of training
space needed for grantees to carry out their particular
model.
``(ii) Amounts received under a grant awarded under the
Program shall not be used to support construction costs or to
supplant funding from existing programs that support the
applicant's health workforce.
``(iii) Models funded under the Program shall be for a
duration of at least 3 years.
``(D) In awarding grants under the Program, the Secretary
may give priority to applicants that will use grant funds to
support workforce innovation models that increase the number of
individuals from underserved and disadvantaged backgrounds
working in such health care professions, improve access to
health care (including medical, behavioral health and oral
health) in underserved communities, or demonstrate that the
model can be replicated in other underserved communities in a
cost-efficient and effective manner to achieve the purposes of
the Program.
``(E) An entity that receives a grant under the Program
shall provide periodic reports to the Secretary detailing the
findings and outcomes of the innovative, community-driven model
carried out under the grant. Such reports shall contain
information in a manner and at such times as determined
appropriate by the Secretary.
``(F) In this paragraph:
``(i) The term `allied health care professional'
includes individuals who provide clinical support
services, including medical assistants, dental
assistants, dental hygienists, pharmacy technicians,
physical therapists and health care interpreters;
individuals providing non-clinical support, such as
billing and coding professionals and health information
technology professionals; dieticians; medical
technologists; emergency medical technicians; community
health workers; public health personnel; and peer
support workers.
``(ii) The term `rural area' has the meaning given
such term by the Administrator of the Health Resources
and Services Administration.
``(iii) The term `underserved communities' means
areas, population groups, and facilities designated as
health professional shortage areas under section 332,
medically underserved areas as defined under section
330I(a)), or medically underserved populations as
defined under section 330(b)(3).
``(G)(i) There are authorized to be appropriated
$100,000,000 for each of fiscal years 2024 through 2026, to
carry out this section, to remain available until expended.
``(ii) A grant provided under the Program shall not exceed
$2,500,000 for a grant period.''.
SEC. 213. BUDGETARY TREATMENT.
(a) Statutory Paygo Scorecards.--The budgetary effects of section
302 (including the amendments made by such section), up to
$1,671,000,000, shall not be entered on either PAYGO scorecard
maintained pursuant to section 4(d) of the Statutory Pay As-You-Go Act
of 2010 (2 U.S.C. 933(d)).
(b) Senate Paygo Scorecards.--The budgetary effects of section 302
(including the amendments made by such section), up to $1,671,000,000,
shall not be entered on any PAYGO scorecard maintained for purposes of
section 4106 of H. Con. Res. 71 (115th Congress).
(c) Reservation of Savings.--None of the funds in the Account to
Address the Primary Care Physician Shortage (established under section
747(c)(6) of the Public Health Service Act, as amended by section 204),
the Account to Address the Nursing Workforce Shortage (established
under section 831(e)(5) of the Public Health Service Act, as amended by
section 205), or the Account to Address the Nurse Faculty Shortage
(established under section 846A(c)(2) of the Public Health Service Act,
as amended by section 206) shall be made available except to the extent
provided in advance in appropriations Acts, and legislation or an Act
that rescinds or reduces amounts in such accounts shall not be
estimated as a reduction in direct spending under the Congressional
Budget and Impoundment Control Act of 1974 or the Balanced Budget and
Emergency Deficit Control Act of 1985.
TITLE III--REDUCING HEALTH CARE COSTS FOR PATIENTS
SEC. 301. BANNING ANTICOMPETITIVE TERMS IN FACILITY AND INSURANCE
CONTRACTS THAT LIMIT ACCESS TO HIGHER QUALITY, LOWER COST
CARE.
(a) In General.--
(1) Public health service act.--Section 2799A-9 of the
Public Health Service Act (42 U.S.C. 300gg-119) is amended--
(A) by adding at the end the following:
``(b) Protecting Health Plans Network Design Flexibility.--
``(1) In general.--A group health plan or a health
insurance issuer offering group or individual health insurance
coverage shall not enter into an agreement with a provider,
network or association of providers, or other service provider
offering access to a network of service providers if such
agreement, directly or indirectly--
``(A) restricts the group health plan or health
insurance issuer from--
``(i) directing or steering enrollees to
other health care providers; or
``(ii) offering incentives to encourage
enrollees to utilize specific health care
providers;
``(B) requires the group health plan or health
insurance issuer to enter into any additional contract
with an affiliate of the provider as a condition of
entering into a contract with such provider;
``(C) requires the group health plan or health
insurance issuer to agree to payment rates or other
terms for any affiliate not party to the contract of
the provider involved; or
``(D) restricts other group health plans or health
insurance issuers not party to the contract from paying
a lower rate for items or services than the contracting
plan or issuer pays for such items or services.
``(2) Additional requirement for self-insured plans.--A
self-insured group health plan shall not enter into an
agreement with a provider, network or association of providers,
third-party administrator, or other service provider offering
access to a network of providers if such agreement directly or
indirectly requires the group health plan to certify, attest,
or otherwise confirm in writing that the group health plan is
bound by restrictive contracting terms between the service
provider and a third-party administrator that the group health
plan is not party to, without a disclosure that such terms
exist.
``(3) Exception for plans and issuers.--Paragraph (1)(A)
shall not apply to a group health plan or health insurance
issuer offering group or individual health insurance coverage
with respect to--
``(A) a health maintenance organization (as defined
in section 2791(b)(3)), if such health maintenance
organization operates primarily through exclusive
contracts with multi-specialty physician groups, nor to
any arrangement between such a health maintenance
organization and its affiliates; or
``(B) a value-based network arrangement, such as an
exclusive provider network, accountable care
organization, center of excellence, a provider
sponsored health insurance issuer that operates
primarily through aligned multi-specialty physician
group practices or integrated health systems, or such
other similar network arrangements as determined by the
Secretary through rulemaking.
``(4) Attestation.--A group health plan or health insurance
issuer offering group or individual health insurance coverage
shall annually submit to, as applicable, the applicable
authority described in section 2723 or the Secretary of Labor
or the Secretary of the Treasury, an attestation that such plan
or issuer is in compliance with the requirements of this
subsection.
``(5) Rule of construction.--Nothing in this subsection
shall be construed to limit network design or cost or quality
initiatives by a group health plan or health insurance issuer,
including accountable care organizations, exclusive provider
organizations, networks that tier providers by cost or quality
or steer enrollees to centers of excellence, or other pay-for-
performance programs.
``(6) Compliance with respect to antitrust laws.--
Compliance with this subsection does not constitute compliance
with the antitrust laws, as defined in subsection (a) of the
first section of the Clayton Act (15 U.S.C. 12(a)).
``(7) Grandfathering.--An applicable State authority may
make a determination that the prohibitions under paragraph (1)
(with respect to conditions that would direct or steer to, or
offer incentives to encourage enrollees to use, other health
care providers) will not apply in the State with respect to any
specified agreement that is executed before the date of
enactment of the Bipartisan Primary Care and Health Workforce
Act, for a maximum length of nonapplicability of up to 10 years
from the date of execution of the contract if the applicable
State authority determines that the contract is unlikely to
significantly lessen competition. With respect to a specified
agreement for which an applicable State authority has made a
determination under the preceding sentence an applicable State
authority may determine whether renewal of the contract, within
the applicable 10-year period, is allowed.''; and
(B) by redesignating paragraph (5) of subsection
(a) as subsection (c), adjusting the margin of such
subsection accordingly, and transferring such
subsection (c) to appear after subsection (b), as added
by subparagraph (A).
(2) Employee retirement income security act of 1974.--
Section 724 of the Employee Retirement Income Security Act of
1974 (29 U.S.C. 1185m) is amended--
(A) by adding at the end the following:
``(b) Protecting Health Plans Network Design Flexibility.--
``(1) In general.--A group health plan or a health
insurance issuer offering group health insurance coverage shall
not enter into an agreement with a provider, network or
association of providers, or other service provider offering
access to a network of service providers if such agreement,
directly or indirectly--
``(A) restricts the group health plan or health
insurance issuer from--
``(i) directing or steering enrollees to
other health care providers; or
``(ii) offering incentives to encourage
enrollees to utilize specific health care
providers;
``(B) requires the group health plan or health
insurance issuer to enter into any additional contract
with an affiliate of the provider as a condition of
entering into a contract with such provider;
``(C) requires the group health plan or health
insurance issuer to agree to payment rates or other
terms for any affiliate not party to the contract of
the provider involved; or
``(D) restricts other group health plans or health
insurance issuers not party to the contract from paying
a lower rate for items or services than the contracting
plan or issuer pays for such items or services.
``(2) Additional requirement for self-insured plans.--A
self-insured group health plan shall not enter into an
agreement with a provider, network or association of providers,
third-party administrator, or other service provider offering
access to a network of providers if such agreement directly or
indirectly requires the group health plan to certify, attest,
or otherwise confirm in writing that the group health plan is
bound by restrictive contracting terms between the service
provider and a third-party administrator that the group health
plan is not party to, without a disclosure that such terms
exist.
``(3) Exception for plans and issuers.--Paragraph (1)(A)
shall not apply to a group health plan or health insurance
issuer offering group health insurance coverage with respect
to--
``(A) a health maintenance organization (as defined
in section 733(b)(3)), if such health maintenance
organization operates primarily through exclusive
contracts with multi-specialty physician groups, nor to
any arrangement between such a health maintenance
organization and its affiliates; or
``(B) a value-based network arrangement, such as an
exclusive provider network, accountable care
organization, center of excellence, a provider
sponsored health insurance issuer that operates
primarily through aligned multi-specialty physician
group practices or integrated health systems, or such
other similar network arrangements as determined by the
Secretary through rulemaking.
``(4) Attestation.--A group health plan or health insurance
issuer offering group health insurance coverage shall annually
submit to, as applicable, the applicable authority described in
section 2723 of the Public Health Service Act or the Secretary
of Labor or the Secretary of the Treasury, an attestation that
such plan or issuer is in compliance with the requirements of
this subsection.
``(5) Rule of construction.--Nothing in this subsection
shall be construed to limit network design or cost or quality
initiatives by a group health plan or health insurance issuer,
including accountable care organizations, exclusive provider
organizations, networks that tier providers by cost or quality
or steer enrollees to centers of excellence, or other pay-for-
performance programs.
``(6) Compliance with respect to antitrust laws.--
Compliance with this subsection does not constitute compliance
with the antitrust laws, as defined in subsection (a) of the
first section of the Clayton Act (15 U.S.C. 12(a)).
``(7) Grandfathering.--An applicable State authority may
make a determination that the prohibitions under paragraph (1)
(with respect to conditions that would direct or steer to, or
offer incentives to encourage enrollees to use, other health
care providers) will not apply in the State with respect to any
specified agreement that is executed before the date of
enactment of the Bipartisan Primary Care and Health Workforce
Act, for a maximum length of nonapplicability of up to 10 years
from the date of execution of the contract if the applicable
State authority determines that the contract is unlikely to
significantly lessen competition. With respect to a specified
agreement for which an applicable State authority has made a
determination under the preceding sentence an applicable State
authority may determine whether renewal of the contract, within
the applicable 10-year period, is allowed.''; and
(B) by redesignating paragraph (4) of subsection
(a) as subsection (c), adjusting the margin of such
subsection accordingly, and transferring such
subsection (c) to appear after subsection (b), as added
by subparagraph (A).
(3) Internal revenue code of 1986.--Section 9824 of the
Internal Revenue Code of 1986 is amended--
(A) by adding at the end the following:
``(b) Protecting Health Plans Network Design Flexibility.--
``(1) In general.--A group health plan shall not enter into
an agreement with a provider, network or association of
providers, or other service provider offering access to a
network of service providers if such agreement, directly or
indirectly--
``(A) restricts the group health plan from--
``(i) directing or steering enrollees to
other health care providers; or
``(ii) offering incentives to encourage
enrollees to utilize specific health care
providers;
``(B) requires the group health plan to enter into
any additional contract with an affiliate of the
provider as a condition of entering into a contract
with such provider;
``(C) requires the group health plan to agree to
payment rates or other terms for any affiliate not
party to the contract of the provider involved; or
``(D) restricts other group health plans not party
to the contract from paying a lower rate for items or
services than the contracting plan pays for such items
or services.
``(2) Additional requirement for self-insured plans.--A
self-insured group health plan shall not enter into an
agreement with a provider, network or association of providers,
third-party administrator, or other service provider offering
access to a network of providers if such agreement directly or
indirectly requires the group health plan to certify, attest,
or otherwise confirm in writing that the group health plan is
bound by restrictive contracting terms between the service
provider and a third-party administrator that the group health
plan is not party to, without a disclosure that such terms
exist.
``(3) Exception for certain plans.--Paragraph (1)(A) shall
not apply to a group health plan with respect to--
``(A) a health maintenance organization (as defined
in section 9832(b)(3)), if such health maintenance
organization operates primarily through exclusive
contracts with multi-specialty physician groups, nor to
any arrangement between such a health maintenance
organization and its affiliates; or
``(B) a value-based network arrangement, such as an
exclusive provider network, accountable care
organization, center of excellence, a provider
sponsored health insurance issuer that operates
primarily through aligned multi-specialty physician
group practices or integrated health systems, or such
other similar network arrangements as determined by the
Secretary through rulemaking.
``(4) Attestation.--A group health plan shall annually
submit to, as applicable, the applicable authority described in
section 2723 of the Public Health Service Act or the Secretary
of Labor or the Secretary of the Treasury, an attestation that
such plan is in compliance with the requirements of this
subsection.
``(5) Rule of construction.--Nothing in this subsection
shall be construed to limit network design or cost or quality
initiatives by a group health plan, including accountable care
organizations, exclusive provider organizations, networks that
tier providers by cost or quality or steer enrollees to centers
of excellence, or other pay-for-performance programs.
``(6) Compliance with respect to antitrust laws.--
Compliance with this subsection does not constitute compliance
with the antitrust laws, as defined in subsection (a) of the
first section of the Clayton Act (15 U.S.C. 12(a)).
``(7) Grandfathering.--An applicable State authority may
make a determination that the prohibitions under paragraph (1)
(with respect to conditions that would direct or steer to, or
offer incentives to encourage enrollees to use, other health
care providers) will not apply in the State with respect to any
specified agreement that is executed before the date of
enactment of the Bipartisan Primary Care and Health Workforce
Act, for a maximum length of nonapplicability of up to 10 years
from the date of execution of the contract if the applicable
State authority determines that the contract is unlikely to
significantly lessen competition. With respect to a specified
agreement for which an applicable State authority has made a
determination under the preceding sentence an applicable State
authority may determine whether renewal of the contract, within
the applicable 10-year period, is allowed.''; and
(B) by redesignating paragraph (4) of subsection
(a) as subsection (c), adjusting the margin of such
subsection accordingly, and transferring such
subsection (c) to appear after subsection (b), as added
by subparagraph (A).
(b) Regulations.--Not later than 1 year after the date of enactment
of this Act, the Secretary of Health and Human Services, the Secretary
of Labor, and the Secretary of the Treasury, jointly, shall promulgate
regulations to carry out section 2799A-9(b) of the Public Health
Service Act, section 724(b) of the Employee Retirement Income Security
Act of 1974, and section 9824(b) of the Internal Revenue Code of 1986,
as added by subsection (a).
(c) Effective Date.--Subsection (b) of section 2799A-9 of the
Public Health Service Act, subsection (b) of section 724 of the
Employee Retirement Income Security Act of 1974, and subsection (b) of
section 9824 of the Internal Revenue Code of 1986 (as added by
paragraphs (1), (2), and (3), respectively, of subsection (a)) shall
apply with respect to any contract entered into on or after the date
that is 18 months after the date of enactment of this Act. With respect
to an applicable contract that is in effect on the date of enactment of
this Act, such subsection (b) shall apply on the earlier of the date of
renewal of such contract or 3 years after such date of enactment.
SEC. 302. HONEST BILLING REQUIREMENTS APPLICABLE TO PROVIDERS.
(a) Group Health Plan and Health Insurance Issuer Requirements.--
(1) Public health service act.--Part D of title XXVII of
the Public Health Service Act (42 U.S.C. 300gg-111 et seq.) is
amended by adding at the end the following:
``SEC. 2799A-11. HONEST BILLING REQUIREMENTS APPLICABLE TO PLANS AND
ISSUERS.
``A group health plan or health insurance issuer offering group or
individual health insurance coverage may not pay a claim for items and
services furnished on or after January 1, 2026, to an individual at an
off-campus outpatient department of a provider (as defined in section
2799B-10(b))) submitted by a health care provider or facility unless
such claim submitted by such provider or facility includes a separate
unique health identifier for the department where items and services
were furnished, in accordance with section 2799B-10.''.
(2) Employee retirement income security act of 1974.--
(A) In general.--Subpart B of part 7 of subtitle B
of title I of the Employee Retirement Income Security
Act of 1974 (29 U.S.C. 1185 et seq.) is amended by
adding at the end the following:
``SEC. 726. HONEST BILLING REQUIREMENTS APPLICABLE TO PLANS AND
ISSUERS.
``A group health plan or health insurance issuer offering group
health insurance coverage may not pay a claim for items and services
furnished on or after January 1, 2026, to an individual at an off-
campus outpatient department of a provider (as defined in section
2799B-10(b)) of the Public Health Service Act) submitted by a health
care provider or facility unless such claim submitted by such provider
or facility includes a separate unique health identifier for the
department where items and services were furnished, in accordance with
section 2799B-10 of such Act.''.
(B) Clerical amendment.--The table of contents in
section 1 of the Employee Retirement Income Security
Act of 1974 (29 U.S.C. 1001 et seq.) is amended by
inserting after the item relating to section 725 the
following new item:
``Sec. 726. Honest billing requirements applicable to plans and
issuers.''.
(3) Internal revenue code of 1986.--
(A) In general.--Subchapter B of chapter 100 of the
Internal Revenue Code of 1986 is amended by adding at
the end the following:
``SEC. 9826. HONEST BILLING REQUIREMENTS APPLICABLE TO PLANS.
``A group health plan may not pay a claim for items and services
furnished on or after January 1, 2026, to an individual at an off-
campus outpatient department of a provider (as defined in section
2799B-10(b)) of the Public Health Service Act) submitted by a health
care provider or facility unless such claim submitted by such provider
or facility includes a separate unique health identifier for the
department where items and services were furnished, in accordance with
section 2799B-10 of such Act.''.
(B) Clerical amendment.--The table of sections for
subchapter B of chapter 100 of the Internal Revenue
Code of 1986 is amended by adding at the end the
following new item:
``Sec. 9826. Honest billing requirements applicable to plans.''.
(b) Requiring a Separate Identification Number and an Attestation
for Each Off-Campus Outpatient Department of a Provider.--
(1) In general.--Part E of title XXVII of the Public Health
Service Act (42 U.S.C. 300gg-131 et seq.) is amended by adding
at the end the following:
``SEC. 2799B-10. HONEST BILLING REQUIREMENTS APPLICABLE TO PROVIDERS.
``(a) Requirements Relating to Unique Health Identifiers.--For
items and services furnished, on or after January 1, 2026, at an off-
campus outpatient department of a provider to a participant,
beneficiary, or enrollee with benefits under a group health plan or
group or individual health insurance coverage offered by a health
insurance issuer, a health care provider or facility may not submit a
claim to the group health plan or health insurance issuer, bill the
participant, beneficiary, or enrollee, or hold liable the participant,
beneficiary, or enrollee, unless--
``(1) such provider or facility obtains a separate unique
health identifier established for such department pursuant to
section 1173(b) of the Social Security Act; and
``(2) such items and services are billed using the separate
unique health identifier established for such department
pursuant to paragraph (1).
``(b) Off-Campus Outpatient Department of a Provider.--The term
`off-campus outpatient department of a provider' means a department of
a provider (as defined in section 413.65(a)(2) of title 42 of the Code
of Federal Regulations, as in effect on the date of the enactment of
the Bipartisan Primary Care and Health Workforce Act) that is not
located--
``(1) on the campus (as defined in such section
413.65(a)(2)) of such provider; or
``(2) within the distance (described in such definition of
campus) from a remote location of a hospital (as defined in
such section 413.65(a)(2)).
``(c) Process for Reporting Suspected Violations.--The Secretary
shall establish a process under which a suspected violation of this
section may be reported to such Secretary.
``(d) Penalties.--The Secretary may assess a civil monetary penalty
against a hospital for a violation under this section in an amount--
``(1) in the case of a hospital with not more than 30 beds
(as determined under section 180.90(c)(2)(ii)(D) of title 45,
Code of Federal Regulations, as in effect on the date of the
enactment of the Bipartisan Primary Care and Health Workforce
Act (or any successor regulations)), not to exceed $300 per day
that the violation is ongoing, as determined by the Secretary;
and
``(2) in the case of a hospital with more than 30 beds (as
so determined), not to exceed $5,500 per day that the violation
is ongoing, as determined by the Secretary.''.
(2) Conforming amendment.--Section 2799B-4(a)(1) of the
Public Health Service Act (42 U.S.C. 300gg-134(a)(1)) is
amended by inserting ``(other than section 2799B-10)'' after
``this part''.
SEC. 303. BANNING FACILITY FEES FOR CERTAIN SERVICES.
Part E of title XXVII of the Public Health Service Act (42 U.S.C.
300gg-131 et seq.), as amended by section 302(b), is further amended by
adding at the end the following:
``SEC. 2799B-11. BANNING FACILITY FEES FOR CERTAIN SERVICES.
``(a) In General.--With respect to applicable items and services
furnished to an individual on or after January 1, 2026, a health care
provider or facility may not charge a facility fee (regardless of how
the fee is labeled) to a group health plan, a health insurance issuer
offering group or individual health insurance coverage, a participant,
beneficiary, or enrollee in such a plan or coverage, or an individual
patient who is not covered by a group health plan, health insurance
coverage, or a Federal health care program (as defined in section
1128(f) of the Social Security Act).
``(b) Applicable Items and Services.--In this section, the term
`applicable items and services' means--
``(1) evaluation and management services described in
section 1833(cc)(1)(B)(i) of the Social Security Act;
``(2) outpatient behavioral health services (not including
partial hospitalizations, intensive outpatient program
services, and other services not typically provided in an
office setting (as the Secretary may determine)); and
``(3) any items and services (including the items and
services described in paragraphs (1) and (2)) furnished via
telehealth.''.
SEC. 304. PREVENTION AND PUBLIC HEALTH FUND.
Section 4002(b) of the Patient Protection and Affordable Care Act
(42 U.S.C. 300u-11(b)) is amended by striking paragraphs (8) through
(10) and inserting the following:
``(8) for each of fiscal years 2026 and 2027,
$1,425,000,000;
``(9) for each of fiscal years 2028 and 2029,
$1,495,000,000;
``(10) for fiscal year 2030, $1,680,000,000; and
``(11) for fiscal year 2031 and each fiscal year
thereafter, $2,000,000,000.''.
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