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116th Congress } { Report
HOUSE OF REPRESENTATIVES
1st Session } { 116-214
======================================================================
EDUCATING MEDICAL PROFESSIONALS AND OPTIMIZING WORKFORCE EFFICIENCY AND
READINESS FOR HEALTH ACT OF 2019
_______
September 24, 2019.--Committed to the Committee of the Whole House on
the State of the Union and ordered to be printed
_______
Mr. Pallone, from the Committee on Energy and Commerce, submitted the
following
R E P O R T
[To accompany H.R. 2781]
The Committee on Energy and Commerce, to whom was referred
the bill (H.R. 2781) to amend title VII of the Public Health
Service Act to reauthorize certain programs relating to the
health professions workforce, and for other purposes, having
considered the same, report favorably thereon with an amendment
and recommend that the bill as amended do pass.
CONTENTS
Page
I. Purpose and Summary..............................................8
II. Background and Need for the Legislation..........................8
III. Committee Hearings..............................................11
IV. Committee Consideration.........................................12
V. Committee Votes.................................................12
VI. Oversight Findings..............................................12
VII. New Budget Authority, Entitlement Authority, and Tax Expenditure12
VIII.Federal Mandates Statement......................................13
IX. Statement of General Performance Goals and Objectives...........13
X. Duplication of Federal Programs.................................13
XI. Committee Cost Estimate.........................................13
XII. Earmarks, Limited Tax Benefits, and Limited Tariff Benefits.....13
XIII.Advisory Committee Statement....................................13
XIV. Applicability to Legislative Branch.............................13
XV. Section-by-Section Analysis of the Legislation..................14
XVI. Changes in Existing Law Made by the Bill, as Reported...........16
The amendment is as follows:
Strike all after the enacting clause and insert the
following:
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Educating Medical Professionals and
Optimizing Workforce Efficiency and Readiness for Health Act of 2019''
or the ``EMPOWER for Health Act of 2019''.
SEC. 2. REAUTHORIZATION OF HEALTH PROFESSIONS WORKFORCE PROGRAMS.
(a) Centers of Excellence.--Subsection (i) of section 736 of the
Public Health Service Act (42 U.S.C. 293) is amended to read as
follows:
``(i) Authorization of Appropriations.--To carry out this section,
there is authorized to be appropriated $24,897,000 for each of fiscal
years 2020 through 2024.''.
(b) Health Professions Training for Diversity.--Section 740 of the
Public Health Service Act (42 U.S.C. 293d) is amended--
(1) in subsection (a), by striking ``$51,000,000 for fiscal
year 2010, and such sums as may be necessary for each of the
fiscal years 2011 through 2014'' and inserting ``$51,419,000
for each of fiscal years 2020 through 2024'';
(2) in subsection (b), by striking ``$5,000,000 for each of
the fiscal years 2010 through 2014'' and inserting ``$1,250,000
for each of fiscal years 2020 through 2024''; and
(3) in subsection (c), by striking ``$60,000,000 for fiscal
year 2010 and such sums as may be necessary for each of the
fiscal years 2011 through 2014'' and inserting ``$20,000,000
for each of fiscal years 2020 through 2024''.
(c) Primary Care Training and Enhancement.--Section 747(c)(1) of the
Public Health Service Act (42 U.S.C. 293k(c)(1)) is amended by striking
``$125,000,000 for fiscal year 2010, and such sums as may be necessary
for each of fiscal years 2011 through 2014'' and inserting
``$51,371,000 for each of fiscal years 2020 through 2024''.
(d) Training in General, Pediatric, and Public Health Dentistry.--
Section 748(f) of the Public Health Service Act (42 U.S.C. 293k-2(f))
is amended by striking ``$30,000,000 for fiscal year 2010 and such sums
as may be necessary for each of fiscal years 2011 through 2015'' and
inserting ``$42,707,000 for each of fiscal years 2020 through 2024''.
(e) Area Health Education Centers.--Section 751(j)(1) of the Public
Health Service Act (42 U.S.C. 294a(j)(1)) is amended by striking
``$125,000,000 for each of the fiscal years 2010 through 2014'' and
inserting ``$42,075,000 for each of fiscal years 2020 through 2024''.
(f) National Center for Healthcare Workforce Analysis.--
(1) In general.--Section 761(e)(1)(A) of the Public Health
Service Act (42 U.S.C. 294n(e)(1)(A)) is amended by striking
``$7,500,000 for each of fiscal years 2010 through 2014'' and
inserting ``$5,947,000 for each of fiscal years 2020 through
2024''.
(2) Technical correction.--Section 761(e)(2) of the Public
Health Service Act (42 U.S.C. 294n(e)(2)) is amended by
striking ``subsection (a)'' and inserting ``paragraph (1)''.
(g) Public Health Workforce.--Section 770(a) of the Public Health
Service Act (42 U.S.C. 295e(a)) is amended by striking ``$43,000,000
for fiscal year 2011, and such sums as may be necessary for each of the
fiscal years 2012 through 2015'' and inserting ``$17,850,000 for each
of fiscal years 2020 through 2024''.
SEC. 3. EDUCATION AND TRAINING RELATING TO GERIATRICS.
Section 753 of the Public Health Service Act (42 U.S.C. 294c) is
amended to read as follows:
``SEC. 753. EDUCATION AND TRAINING RELATING TO GERIATRICS.
``(a) Geriatrics Workforce Enhancement Programs.--
``(1) In general.--The Secretary shall award grants or
contracts under this subsection to entities described in
paragraph (1), (3), or (4) of section 799B, section 801(2), or
section 865(d), or other health professions schools or programs
approved by the Secretary, for the establishment or operation
of geriatrics workforce enhancement programs that meet the
requirements of paragraph (2).
``(2) Requirements.--A geriatrics workforce enhancement
program meets the requirements of this paragraph if such
program supports the development of a health care workforce
that maximizes patient and family engagement and improves
health outcomes for older adults by integrating geriatrics with
primary care and other appropriate specialties. Special
emphasis should be placed on providing the primary care
workforce with the knowledge and skills to care for older
adults and collaborating with community partners to address
gaps in health care for older adults through individual,
system, community, and population level changes. Areas of
programmatic focus may include the following:
``(A) Transforming clinical training environments to
integrated geriatrics and primary care delivery systems
to ensure trainees are well prepared to practice in and
lead in such systems.
``(B) Developing providers from multiple disciplines
and specialties to work interprofessionally to assess
and address the needs and preferences of older adults
and their families and caregivers at the individual,
community, and population levels with cultural and
linguistic competency.
``(C) Creating and delivering community-based
programs that will provide older adults and their
families and caregivers with the knowledge and skills
to improve health outcomes and the quality of care for
such adults.
``(D) Providing Alzheimer's disease and related
dementias (ADRD) education to the families and
caregivers of older adults, direct care workers, health
professions students, faculty, and providers.
``(3) Duration.--The Secretary shall award grants and
contracts under paragraph (1) for a period not to exceed five
years.
``(4) Application.--To be eligible to receive a grant or
contract under paragraph (1), an entity described in such
paragraph shall submit to the Secretary an application at such
time, in such manner, and containing such information as the
Secretary may require, including the specific measures the
applicant will use to demonstrate that the project is improving
the quality of care provided to older adults in the applicant's
region, which may include--
``(A) improvements in access to care provided by a
health professional with training in geriatrics or
gerontology;
``(B) improvements in family caregiver capacity to
care for older adults;
``(C) patient outcome data demonstrating an
improvement in older adult health status or care
quality; and
``(D) reports on how the applicant will implement
specific innovations with the target audience to
improve older adults' health status or the quality of
care.
``(5) Equitable geographic distribution.--The Secretary may
award grants and contracts under paragraph (1) in a manner
which will equitably distribute such grants among the various
regions of the United States.
``(6) Qualifications.--In awarding grants and contracts under
paragraph (2), the Secretary shall consider programs that--
``(A) have the goal of improving and providing
comprehensive coordinated care of older adults,
including medical, dental, and psychosocial needs;
``(B) demonstrate coordination with other
programmatic efforts funded under this program or other
public or private entities;
``(C) support the training and retraining of faculty,
preceptors, primary care providers, and providers in
other specialties to increase their knowledge of
geriatrics and gerontology;
``(D) provide clinical experiences across care
settings, including ambulatory care, hospitals, post-
acute care, nursing homes, federally qualified health
centers, and home and community-based services;
``(E) emphasize education and engagement of family
caregivers on disease self-management, medication
management, and stress reduction strategies;
``(F) provide training to the health care workforce
on disease self-management, motivational interviewing,
medication management, and stress reduction strategies;
``(G) provide training to the health care workforce
on social determinants of health in order to better
address the geriatric health care needs of diverse
populations with cultural and linguistic competency;
``(H) integrate geriatrics competencies and
interprofessional collaborative practice into health
care education and training curricula for residents,
fellows, and students;
``(I) substantially benefit rural or underserved
populations of older adults or conduct outreach to
communities that have a shortage of geriatric workforce
professionals;
``(J) integrate behavioral health competencies into
primary care practice, especially with respect to elder
abuse, pain management, and advance care planning; or
``(K) offer short-term intensive courses that--
``(i) focus on geriatrics, gerontology,
chronic care management, and long-term care
that provide supplemental training for faculty
members in medical schools and other health
professions schools or graduate programs in
psychology, pharmacy, nursing, social work,
dentistry, public health, allied health, or
other health disciplines, as approved by the
Secretary; and
``(ii) are open to current faculty, and
appropriately credentialed volunteer faculty
and practitioners, to upgrade their knowledge
and clinical skills for the care of older
adults and adults with functional and cognitive
limitations and to enhance their
interdisciplinary teaching skills.
``(7) Priority.--In awarding grants under paragraph (1),
particularly with respect to awarding, in fiscal year 2020, any
amount appropriated for such fiscal year for purposes of
carrying out this subsection that is in excess of the amount
appropriated for the most previous fiscal year for which
appropriations were made for such purposes, the Secretary may
give priority to entities that operate--
``(A) in communities that have a shortage of
geriatric workforce professionals; and
``(B) in States in which no entity has previously
received an award under such paragraph (including as in
effect before the date of enactment of the Educating
Medical Professionals and Optimizing Workforce
Efficiency and Readiness for Health Act of 2019).
``(8) Award amounts.--Awards under paragraph (1) shall be in
an amount determined by the Secretary. Entities that submit
applications under this subsection that describe a plan for
providing geriatric education and training for home health
workers and family caregivers are eligible to receive $100,000
per year more than entities that do not include a description
of such a plan.
``(9) Reporting.--Each entity awarded a grant under paragraph
(1) shall submit an annual report to the Secretary on financial
and programmatic performance under such grant, which may
include factors such as the number of trainees, the number of
professions and disciplines, the number of partnerships with
health care delivery sites, the number of faculty and
practicing professionals who participated in continuing
education programs, and such other factors as the Secretary may
require.
``(b) Geriatric Academic Career Awards.--
``(1) Establishment of program.--The Secretary shall
establish a program to award grants, to be known as Geriatric
Academic Career Awards, to eligible entities applying on behalf
of eligible individuals to promote the career development of
such individuals as academic geriatricians or other academic
geriatrics health professionals.
``(2) Eligibility.--
``(A) Eligible entity.--For purposes of this
subsection, the term `eligible entity' means--
``(i) an accredited school of allopathic
medicine, osteopathic medicine, nursing, social
work, psychology, dentistry, pharmacy, or
allied health; or
``(ii) another type of accredited health
professions school or graduate program deemed
by the Secretary to be eligible under this
subsection.
``(B) Eligible individual.--
``(i) In general.--For purposes of this
subsection, the term `eligible individual'
means an individual who--
``(I) has a junior, nontenured,
faculty appointment at an accredited
school of allopathic medicine,
osteopathic medicine, nursing, social
work, psychology, dentistry, pharmacy,
or allied health or at another type of
accredited health professions school or
graduate program described in
subparagraph (A)(ii);
``(II)(aa) is board certified or
board eligible in internal medicine,
family practice, psychiatry, or
licensed dentistry, or has completed
the training required for the
individual's discipline; and
``(bb) is employed at an eligible
entity; or
``(III) has completed an approved
fellowship program in geriatrics or
gerontology, or has completed specialty
training in geriatrics or gerontology
as required for the individual's
discipline and any additional
geriatrics or gerontology training as
required by the Secretary.
``(ii) Special rule.--If during the period of
an award under this subsection respecting an
eligible individual, the individual is promoted
to associate professor and thereby no longer
meets the criteria of clause (i)(I), the
individual may continue to be treated as an
eligible individual through the term of the
award.
``(3) Limitations.--An eligible entity may not receive an
award under paragraph (1) on behalf of an eligible individual
unless the eligible entity--
``(A) submits to the Secretary an application, at
such time, in such manner, and containing such
information as the Secretary may require, and the
Secretary approves such application;
``(B) provides, in such form and manner as the
Secretary may require, assurances that the eligible
individual on whose behalf an application was submitted
under subparagraph (A) will meet the service
requirement described in paragraph (8); and
``(C) provides, in such form and manner as the
Secretary may require, assurances that such individual
has a full-time faculty appointment in an accredited
health professions school or graduate program and
documented commitment from such school or program to
spend 75 percent of the individual's time that is
supported by the award on teaching and developing
skills in interprofessional education in geriatrics.
``(4) Requirements.--In awarding grants under this
subsection, the Secretary--
``(A) shall give priority to eligible entities that
apply on behalf of eligible individuals who are on the
faculty of institutions that integrate geriatrics
education, training, and best practices into academic
program criteria;
``(B) may give priority to eligible entities that
operate a geriatrics workforce enhancement program
under subsection (a);
``(C) shall ensure that grants are equitably
distributed across the various geographical regions of
the United States, including rural and underserved
areas;
``(D) shall pay particular attention to geriatrics
health care workforce needs among underserved
populations, diverse communities, and rural areas;
``(E) may not require an eligible individual, or an
eligible entity applying on behalf of an eligible
individual, to be a recipient of a grant or contract
under this part; and
``(F) shall pay the full amount of the award to the
eligible entity.
``(5) Maintenance of effort.--An eligible entity receiving an
award under paragraph (1) on behalf of an eligible individual
shall provide assurances to the Secretary that funds provided
to such individual under this subsection will be used only to
supplement, not to supplant, the amount of Federal, State, and
local funds otherwise expended by such individual.
``(6) Amount and term.--
``(A) Amount.--The amount of an award under this
subsection for eligible individuals who are physicians
shall equal $100,000 for fiscal year 2020, adjusted for
subsequent fiscal years to reflect the increase in the
Consumer Price Index. The Secretary shall determine the
amount of an award under this subsection for
individuals who are not physicians.
``(B) Term.--The term of any award made under this
subsection shall not exceed 5 years.
``(7) Service requirement.--An eligible individual on whose
behalf an application was submitted and approved under
paragraph (3)(A) shall provide training in clinical geriatrics
or gerontology, including the training of interprofessional
teams of health care professionals.
``(c) Authorization of Appropriations.--To carry out this section,
there is authorized to be appropriated $51,000,000 for each of fiscal
years 2020 through 2024. Notwithstanding the preceding sentence, no
funds shall be made available to carry out subsection (b) for a fiscal
year unless the amount made available to carry out this section for
such fiscal year is more than the amount made available to carry out
this section for fiscal year 2017.''.
SEC. 4. INVESTMENT IN TOMORROW'S PEDIATRIC HEALTH CARE WORKFORCE.
Section 775 of the Public Health Service Act (42 U.S.C. 295f) is
amended to read as follows:
``SEC. 775. INVESTMENT IN TOMORROW'S PEDIATRIC HEALTH CARE WORKFORCE.
``(a) In General.--The Secretary shall establish and carry out a
program of entering into pediatric specialty loan repayment agreements
with qualified health professionals under which--
``(1) the qualified health professional agrees to a period of
not less than 2 years of obligated service during which the
professional will--
``(A) participate in an accredited pediatric medical
subspecialty, pediatric surgical specialty, child and
adolescent psychiatry subspecialty, or child and
adolescent mental and behavioral health residency or
fellowship; or
``(B) be employed full-time in providing pediatric
medical subspecialty care, pediatric surgical specialty
care, child and adolescent psychiatry subspecialty
care, or child and adolescent mental and behavioral
health care, including substance use disorder
prevention and treatment services, in an area with--
``(i) a shortage of health care professionals
practicing in the pediatric medical
subspecialty, the pediatric surgical specialty,
the child and adolescent psychiatry
subspecialty, or child and adolescent mental
and behavioral health, as applicable; and
``(ii) a sufficient pediatric population, as
determined by the Secretary, to support the
addition of a practitioner in the pediatric
medical subspecialty, the pediatric surgical
specialty, the child and adolescent psychiatry
subspecialty, or child and adolescent mental
and behavioral health, as applicable; and
``(2) the Secretary agrees to make payments on the principal
and interest of undergraduate, graduate, or graduate medical
education loans of the qualified health professional of not
more than $35,000 a year for each year of agreed upon service
under paragraph (1) for a period of not more than 3 years.
``(b) Eligibility Requirements.--
``(1) Pediatric medical specialists and pediatric surgical
specialists.--For purposes of loan repayment agreements under
this section with respect to pediatric medical subspecialty and
pediatric surgical specialty practitioners, the term `qualified
health professional' means a licensed physician who--
``(A) is entering or receiving training in an
accredited pediatric medical subspecialty or pediatric
surgical subspecialty residency or fellowship; or
``(B) has completed (but not prior to the end of the
calendar year in which the Educating Medical
Professionals and Optimizing Workforce Efficiency and
Readiness for Health Act of 2019 is enacted) the
training described in subparagraph (A).
``(2) Child and adolescent psychiatry and mental and
behavioral health.--For purposes of loan repayment agreements
under this section with respect to child and adolescent mental
and behavioral health care, the term `qualified health
professional' means a health care professional who--
``(A) has received specialized training or clinical
experience in child and adolescent mental health in
psychiatry, psychology, school psychology, or
psychiatric nursing;
``(B) has a license or certification in a State to
practice allopathic medicine, osteopathic medicine,
psychology, school psychology, or psychiatric nursing;
or
``(C) is a mental health service professional who has
completed (but not before the end of the calendar year
in which the Educating Medical Professionals and
Optimizing Workforce Efficiency and Readiness for
Health Act of 2019 is enacted) specialized training or
clinical experience in child and adolescent mental
health described in subparagraph (A).
``(3) Additional eligibility requirements.--The Secretary may
not enter into a loan repayment agreement under this section
with a qualified health professional unless--
``(A) the professional agrees to work in, or for a
provider serving, an area or community with a shortage
of eligible qualified health professionals (as defined
in paragraphs (1) and (2));
``(B) the professional is a United States citizen, a
permanent legal United States resident, or lawfully
present in the United States; and
``(C) if the professional is enrolled in a graduate
program, the program is accredited, and the
professional has an acceptable level of academic
standing (as determined by the Secretary).
``(c) Priority.--In entering into loan repayment agreements under
this section, the Secretary shall give priority to applicants who--
``(1) have familiarity with evidence-based methods and
cultural and linguistic competence in health care services; and
``(2) demonstrate financial need.
``(d) Authorization of Appropriations.--There are authorized to be
appropriated for each of fiscal years 2020 through 2024--
``(1) $30,000,000 to carry out this section with respect to
loan repayment agreements with qualified health professionals
described in subsection (b)(1); and
``(2) $20,000,000 to carry out this section with respect to
loan repayment agreements with respect to qualified health
professionals described in subsection (b)(2).''.
SEC. 5. INCREASING WORKFORCE DIVERSITY IN THE PROFESSIONS OF PHYSICAL
THERAPY, OCCUPATIONAL THERAPY, AUDIOLOGY, AND
SPEECH-LANGUAGE PATHOLOGY.
Title VII of the Public Health Service Act is amended--
(1) by redesignating part G (42 U.S.C. 295j et seq.) as part
H; and
(2) by inserting after part F (42 U.S.C. 294n et seq.) the
following new part:
``PART G--INCREASING WORKFORCE DIVERSITY IN THE PROFESSIONS OF PHYSICAL
THERAPY, OCCUPATIONAL THERAPY, AUDIOLOGY, AND SPEECH-LANGUAGE PATHOLOGY
``SEC. 783. SCHOLARSHIPS AND STIPENDS.
``(a) In General.--The Secretary may award grants and contracts to
eligible entities to increase educational opportunities in the
professions of physical therapy, occupational therapy, audiology, and
speech-language pathology for eligible individuals by--
``(1) providing student scholarships or stipends, including
for--
``(A) completion of an accelerated degree program;
``(B) completion of an associate's, bachelor's,
master's, or doctoral degree program; and
``(C) entry by a diploma or associate's degree
practitioner into a bridge or degree completion
program;
``(2) providing assistance for completion of prerequisite
courses or other preparation necessary for acceptance for
enrollment in the eligible entity; and
``(3) carrying out activities to increase the retention of
students in one or more programs in the professions of physical
therapy, occupational therapy, audiology, and speech-language
pathology.
``(b) Consideration of Recommendations.--In carrying out subsection
(a), the Secretary shall take into consideration the recommendations of
national organizations representing the professions of physical
therapy, occupational therapy, audiology, and speech-language
pathology, including the American Physical Therapy Association, the
American Occupational Therapy Association, the American Speech-
Language-Hearing Association, the American Academy of Audiology, and
the Academy of Doctors of Audiology.
``(c) Required Information and Conditions for Award Recipients.--
``(1) In general.--The Secretary may require recipients of
awards under this section to report to the Secretary concerning
the annual admission, retention, and graduation rates for
eligible individuals in programs of the recipient leading to a
degree in any of the professions of physical therapy,
occupational therapy, audiology, and speech-language pathology.
``(2) Falling rates.--If any of the rates reported by a
recipient under paragraph (1) fall below the average for such
recipient over the two years preceding the year covered by the
report, the recipient shall provide the Secretary with plans
for immediately improving such rates.
``(3) Ineligibility.--A recipient described in paragraph (2)
shall be ineligible for continued funding under this section if
the plan of the recipient fails to improve the rates within the
1-year period beginning on the date such plan is implemented.
``(d) Definitions.--In this section:
``(1) Eligible entities.--The term `eligible entity' means an
education program that--
``(A) is accredited by--
``(i) the Council on Academic Accreditation
in Audiology and Speech-Language Pathology or
the Accreditation Commission for Audiology
Education;
``(ii) the Commission on Accreditation in
Physical Therapy Education; or
``(iii) the Accreditation Council for
Occupational Therapy Education; and
``(B) is carrying out a program for recruiting and
retaining students underrepresented in the professions
of physical therapy, occupational therapy, audiology,
and speech-language pathology (including racial or
ethnic minorities, or students from disadvantaged
backgrounds).
``(2) Eligible individual.--The term `eligible individual'
means an individual who--
``(A) is a member of a class of persons who are
underrepresented in the professions of physical
therapy, occupational therapy, audiology, and speech-
language pathology (including individuals who are
racial or ethnic minorities, or are from disadvantaged
backgrounds);
``(B) has a financial need for a scholarship or
stipend; and
``(C) is enrolled (or accepted for enrollment) at an
audiology, speech-language pathology, physical therapy,
or occupational therapy program as a full-time student
at an eligible entity.
``(e) Authorization of Appropriations.--There are authorized to be
appropriated to carry out this section $5,000,000 for each of fiscal
years 2020 through 2024.''.
I. Purpose and Summary
H.R. 2781, the ``Educating Medical Professionals and
Optimizing Workforce Efficiency and Readiness for Health Act of
2019'' or the ``EMPOWER for Health Act of 2019'', was
introduced on May 16, 2019, by Reps. Jan Schakowsky (D-IL) and
Michael Burgess (R-TX) and referred to the Committee on Energy
and Commerce. H.R. 2781 would reauthorize funding at the Health
Resources and Services Administration (HRSA) for health
professions workforce, education, and training programs. The
legislation expands efforts to increase diversity, improve
geriatrics education and training, and grow the pediatric
health care workforce. The five-year reauthorization includes
annual authorizations of: $24.897 million for Centers of
Excellence; $51.419 million for Scholarships for Disadvantaged
Students; $1.25 million for Loan Repayments and Fellowships
Regarding Faculty Positions; $14.899 million for the Health
Careers Opportunity Program; $51.371 million for Primary Care
Training and Enhancement; $42.707 million for Oral Health
Training; $42,075,000 for Area Health Education Centers; $5.947
million for the National Center for Health Workforce Analysis;
$17.85 million for Public Health Workforce grants; $51 million
for Education and Training Related to Geriatrics; $30 million
for pediatric medical subspecialists and surgical specialist
loan repayment; and $20 million for child and adolescent mental
and behavioral health professionals loan repayment. The bill
also creates a new authorization of $5 million to increase
workforce diversity in the professions of physical therapy,
occupational therapy, audiology, and speech-language pathology.
II. Background and Need for Legislation
Title VII of the Public Health Service Act includes
programs administered primarily through HRSA to support and
educate the medical, dental, public health, and allied health
professional workforce through grants that flow to institutions
and directly to professionals and pre-professionals.\1\ Some
estimates have projected that the United States could
experience a shortfall of over 100,000 physicians by 2032,\2\
and Title VII workforce programs aim to reduce that shortage by
bolstering the health workforce. With the goal of improving
health and achieving health equity, many of the programs in
Title VII place a particular emphasis on ensuring the United
States has a diverse health workforce, which has been shown to
improve patient satisfaction, patient-clinician communication,
and access to care for patients belonging to minority
populations.\3\
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\1\Bernice Reyes-Akinbileje, Cong. Research Serv., R43177, Health
Workforce Programs in Title VII of the Public Health Service Act
(2013).
\2\Assoc. of American Medical Colleges, The Complexities of
Physician Supply and Demand: Projections from 2017 to 2032 4 (2019).
\3\Health Resources and Services Admin., Sex, Race, and Ethnic
Diversity of U.S. Health Occupations (2011-2015) 2-3 (2017).
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H.R. 2781 provides reauthorizations and updates for Title
VII programs, and makes modifications to the programs,
including the creation of a new workforce diversity program in
the professions of physical therapy, occupational therapy,
audiology, and speech-language pathology.
The Centers of Excellence Program provides grants to health
professions schools and other public and nonprofit health or
educational entities to focus on recruitment, training, and
retention of underrepresented minority students and faculty.\4\
In the 2017-2018 academic year, the Centers of Excellence
Program supported 168 training programs or activities, and more
than 97 percent of trainees were underrepresented minorities in
the health professions, and 69 percent were from financially
and/or educationally disadvantaged backgrounds.\5\
---------------------------------------------------------------------------
\4\Health Resources and Services Admin., Fiscal Year 2020
Justification of Estimates for Appropriations Committees 89 (2019).
\5\Id.
---------------------------------------------------------------------------
The Scholarships for Disadvantaged Students Program
provides grants to health professional and nursing schools to
be used as scholarships for students from disadvantaged
backgrounds, a majority of whom are underrepresented
minorities.\6\ In the 2017-2018 school year, 3,047 students
received scholarship amounts up to $30,000 for their health
professional and nursing educations.\7\
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\6\Id. at 92.
\7\Id.
---------------------------------------------------------------------------
The Faculty Loan Repayment Program pays up to $20,000 of
principal and interest, per year, on loans held by health
profession graduates from disadvantaged backgrounds who serve
as faculty at health professions colleges or universities for
at least two years.\8\
---------------------------------------------------------------------------
\8\Id. at 87.
---------------------------------------------------------------------------
The Health Careers Opportunity Program (HCOP) promotes
interest in health careers and avenues for young students from
economically and educationally disadvantaged backgrounds to
gain the skills needed to compete for, enter, and graduate from
health professional schools and schools for the allied health
professions.\9\ Entities eligible to receive HCOP awards
include health professional schools and other public or private
nonprofit health or educational entities, including non-
academic nonprofit entities focused on health care that have
partnered with educational entities to serve disadvantaged
students underrepresented in the health professions.
---------------------------------------------------------------------------
\9\Id. at 95.
---------------------------------------------------------------------------
The Primary Care Training and Enhancement Program
strengthens the primary care workforce by creating accredited
professional training programs in the field of family medicine,
general internal medicine, or general pediatrics. The program
includes support for the Primary Care Medicine and Dentistry
Clinician Educator Career Development Awards, which fund
innovative projects that aim to transform health delivery
systems.\10\
---------------------------------------------------------------------------
\10\Id. at 102-103.
---------------------------------------------------------------------------
Oral Health Training Programs include training for general,
pediatric, and public health dentists and dental hygiene
providers. In the 2017-2018 academic year, the program trained
9,562 dental and dental hygiene students, 495 dental residents
and fellows, and 332 dental faculty members.\11\
---------------------------------------------------------------------------
\11\Id. at 107-108.
---------------------------------------------------------------------------
Area Health Education Centers (AHEC) coordinate and enhance
education and training networks within communities, academic
institutions, and community-based organizations. The networks
support increased diversity among health professionals, spread
the health workforce throughout the country, enhance quality,
and improve care delivery in rural and underserved areas.\12\
In the 2017-2018 academic year, the AHEC program supported more
than 3,600 different types of training programs that drew the
participation of 297,169 students and residents.\13\
---------------------------------------------------------------------------
\12\Health Resources and Services Administration, National Center
for Workforce Analysis, Area Health Education Centers Program,
bhw.hrsa.gov/sites/default/files/bhw/health-workforce-analysis/program-
highlights/2018/area-health-education-centers-2018.pdf (2018).
\13\Id.
---------------------------------------------------------------------------
The National Center for Health Workforce Analysis (NCHWA)
collects and analyzes workforce data and information while
evaluating the effectiveness of workforce investments. NCHWA
models projections of future supply and demand of the health
care workforce.
Title VII also funds public health workforce development
through Public Health Training Centers (PHTC) Program and the
Preventive Medicine Residency (PMR) Program. PHTCs strengthen
the public health workforce by providing education, training,
and consultation to state, local, and tribal public health
departments. Approximately 63 percent of the most recent cohort
of training sites in the PHTC program were in underserved
communities.\14\ The PMR program provides stipends for medical
residents training in preventive medicine to defer costs of
living expenses, tuition, and fees.\15\
---------------------------------------------------------------------------
\14\Supra note 4 at 130-131.
\15\Id.
---------------------------------------------------------------------------
The Geriatrics Workforce Enhancement Program (GWEP) and
Geriatrics Academic Career Awards (GACA) program provide
training to students, faculty, providers, direct service
workers, patients, families, and lay and family caregivers to
address gaps in health care for older adults.\16\ According to
the NCHWA, by 2025, all regions in the U.S. are projected to
have a shortage of geriatricians.\17\ These programs make
important investments in the future of the geriatric workforce.
---------------------------------------------------------------------------
\16\Id. at 120-121.
\17\Health Recourses and Services Administration, National Center
for Health Workforce Analysis.
---------------------------------------------------------------------------
The Investment in Tomorrow's Pediatric Health Care
Workforce loan repayment program provides loan repayment to
health professionals in pediatric medical subspecialties,
pediatric surgical specialties, or child and adolescent mental
and behavioral health. Eligible individuals must have
familiarity with evidence-based methods and cultural and
linguistic competence health care services and demonstrate
financial need.
Members of the physical therapy, occupational therapy, and
speech-language pathology professions are predominantly white
and female.\18\ Researchers have noted that achieving greater
diversity among healthcare workforce will produce a more
culturally competent workforce, improve access to high-quality
care for the medically underserved, increase the breadth and
depth of the U.S. health research agenda, and expand the pool
of medically trained executives and policymakers ready to serve
in leadership positions in the health care system.\19\ Despite
the benefits of a more diverse workforce, health professional
education programs have struggled to diversify the pool of
health professional students and the future health care
workforce.\20\ The diversity workforce program for physical
therapists, occupational therapists, audiologists, and speech-
language pathologists, authorized by this legislation, is
modeled on the successful nursing workforce diversity grants
program in Title VIII of the Public Health Service Act\21\ and
would provide student scholarships or stipends to eligible
entities (defined as accredited education programs carrying out
a program for recruiting and retaining students
underrepresented in the processions of physical therapy,
occupational therapy, audiology, and speech-language pathology,
including racial or ethnic minorities or students from
disadvantaged backgrounds) on behalf of eligible individuals
(defined as an individual who is a member of a class of persons
who are underrepresented in the professions described above,
has a financial need for a scholarship or stipend, and is
enrolled at an audiology, speech-language pathology, physical
therapy, or occupational therapy program as a full-time student
at an eligible entity.
---------------------------------------------------------------------------
\18\Health Resources and Services Admin., Sex, Race, and Ethnic
Diversity of U.S. Health Occupations (2011-2015) Tables 1-2 (2017).
\19\Jordan J. Cohen, Barbara A. Gabriel, and Charles Terrell, The
Case for Diversity in the Health Care Workforce, Health Affairs, Vol.
21, Issue 5, at 90 (2002).
\20\See In the Nation's Compelling Interest: Ensuring Diversity in
the Health-Care Workforce (Brian D. Smedley, Adrienne Stith Butler,
Lonnie R. Bristow, eds., Institute of Medicine of the National
Academies 2004).
\21\See 42 U.S.C. Sec. 296m.
---------------------------------------------------------------------------
The diversity workforce program for physical therapists,
occupational therapists, audiologists, and speech-language
pathologists, authorized by this legislation, is modeled on the
successful nursing workforce diversity grants program in Title
VIII of the Public Health Service Act\22\ and would provide
student scholarships or stipends to eligible entities (defined
as accredited education programs carrying out a program for
recruiting and retaining students underrepresented in the
processions of physical therapy, occupational therapy,
audiology, and speech-language pathology, including racial or
ethnic minorities or students from disadvantaged backgrounds)
on behalf of eligible individuals (defined as an individual who
is a member of a class of persons who are underrepresented in
the professions described above, has a financial need for a
scholarship or stipend, and is enrolled at an audiology,
speech-language pathology, physical therapy, or occupational
therapy program as a full-time student at an eligible entity).
---------------------------------------------------------------------------
\22\See 42 U.S.C. Sec. 296m.
---------------------------------------------------------------------------
III. Committee Hearings
For the purposes of section 103(i) of H. Res. 6 of the
116th Congress, the following hearing was used to develop or
consider H.R. 2781:
The Subcommittee on Health held a hearing in the 115th
Congress entitled ``Supporting Tomorrow's Health Providers:
Examining Workforce Programs Under the Public Health Service
Act.'' Witnesses at the hearing included:
Adrian Billings, M.D., Ph.D., FAAFP, Chief Medical
Officer, Preventive Care Health Services and Associate
Professor, Department of Family and Community Medicine, Texas
Tech University Health Sciences Center-Permian Basin.
Neil S. Calman, M.D., FAAFP, President, American
Association of Teaching Health Centers, President and CEO,
Institute for Family Health, Chair, Department of Family
Medicine and Community Health, Icahn School of Medicine at
Mount Sinai.
Janice A. Knebl, D.O., M.B.A., Dallas Southwest
Osteopathic Physicians Endowed Chair and Professor in
Geriatrics, University of North Texas Health Science Center.
Juliann Sebastian, Ph.D., R.N., FAAN, Chair of the
Board of Directors, American Association of Colleges of
Nursing, Dean and Professor, College of Nursing, University of
Nebraska Medical Center.
IV. Committee Consideration
H.R. 2781, the ``Educating Medical Professionals and
Optimizing Workforce Efficiency and Readiness for Health Act of
2019'' or the ``EMPOWER for Health Act of 2019'', was
introduced on May 16, 2019, by Reps. Jan Schakowsky (D-IL) and
Michael Burgess (R-TX) and referred to the Committee on Energy
and Commerce. Subsequently, the bill was referred to the
Subcommittee on Health on May 17, 2019. The Subcommittee met in
open markup session, pursuant to notice, on July 11, 2019, for
consideration of H.R. 2781. Amendments offered by Mr. Burgess
and Mr. Rush were both agreed to by a voice vote. Subsequently,
the Subcommittee on Health agreed to a motion by Ms. Eshoo,
Chairwoman of the Subcommittee, to forward favorably H.R. 2781,
amended, to the full Committee on Energy and Commerce by a
voice vote.
On July 17, 2019, the full Committee met in open markup
session, pursuant to notice, to consider H.R. 2781, as amended
by the subcommittee. During markup of the bill, an amendment
offered by Ms. Schakowsky (D-IL) was agreed to by a voice vote.
At the conclusion of consideration of the bill, the full
Committee on Energy and Commerce agreed to a motion by Mr.
Pallone, Chairman of the Committee, to order the bill H.R. 2781
reported favorably to the House, amended, by a voice vote, a
quorum being present.
V. Committee Votes
Clause 3(b) of rule XIII of the Rules of the House of
Representatives requires the Committee to list each record vote
on the motion to report legislation and amendments thereto.
There were no recorded votes taken in connection with ordering
H.R. 2781 reported or on any amendments to the bill.
VI. Oversight Findings
Pursuant to clause 3(c)(1) of rule XIII and clause 2(b)(1)
of rule X of the Rules of the House of Representatives, the
oversight findings and recommendations of the Committee are
reflected in the descriptive portion of the report.
VII. New Budget Authority, Entitlement Authority, and Tax Expenditures
Pursuant to 3(c)(2) of rule XIII of the Rules of the House
of Representatives, the Committee adopts as its own the
estimate of new budget authority, entitlement authority, or tax
expenditures or revenues contained in the cost estimate
prepared by the Director of the Congressional Budget Office
pursuant to section 402 of the Congressional Budget Act of
1974.
The Committee has requested but not received from the
Director of the Congressional Budget Office a statement as to
whether this bill contains any new budget authority, credit
authority, or an increase or decrease in revenues or tax
expenditures.
VIII. Federal Mandates Statement
The Committee adopts as its own the estimate of Federal
mandates prepared by the Director of the Congressional Budget
Office pursuant to section 423 of the Unfunded Mandates Reform
Act.
IX. Statement of General Performance Goals and Objectives
Pursuant to clause 3(c)(4) of rule XIII, the general
performance goal or objective of this legislation is to amend
title VII of the Public Health Service Act to reauthorize
certain programs relating to the health professions workforce.
X. Duplication of Federal Programs
Pursuant to clause 3(c)(5) of rule XIII, no provision of
H.R. 2781 is known to be duplicative of another Federal
program, including any program that was included in a report to
Congress pursuant to section 21 of Public Law 111-139 or the
most recent Catalog of Federal Domestic Assistance.
XI. Committee Cost Estimate
Pursuant to clause 3(d)(1) of rule XIII, the Committee
adopts as its own the cost estimate prepared by the Director of
the Congressional Budget Office pursuant to section 402 of the
Congressional Budget Act of 1974.
XII. Earmarks, Limited Tax Benefits, and Limited Tariff Benefits
Pursuant to clause 9(e), 9(f), and 9(g) of rule XXI, the
Committee finds that H.R. 2781 contains no earmarks, limited
tax benefits, or limited tariff benefits.
XIII. Advisory Committee Statement
No advisory committees within the meaning of section 5(b)
of the Federal Advisory Committee Act were created by this
legislation.
XIV. Applicability to Legislative Branch
The Committee finds that the legislation does not relate to
the terms and conditions of employment or access to public
services or accommodations within the meaning of section
102(b)(3) of the Congressional Accountability Act.
XV. Section-by-Section Analysis of the Legislation
Section 1. Short title
Section 1 designates that the short title may be cited as
the ``Educating Medical Professionals and Optimizing Workforce
Efficiency and Readiness for Health Act of 2019'' or the
``EMPOWER for Health Act of 2019''.
Section 2. Reauthorization of health professions workforce programs
Section 2 reauthorizes funding for health professions
workforce programs for five years, through 2024, and includes
the following annual authorizations: $24,897,000 for Centers of
Excellence; $51,419,000 for scholarships for disadvantaged
students; $1,250,000 for faculty loan repayment; $20,000,000
for the Health Careers Opportunities Program; $51,371,000 for
primary care training and enhancement; $42,707,000 for training
in general, pediatric, and public health dentistry; $42,075,000
for area health education centers; $5,947,000 for the National
Center for Healthcare Workforce Analysis; and $17,850,000 for
public health workforce programs.
Section 3. Education and training related to geriatrics
Section 3 reauthorizes the Geriatrics Workforce Enhancement
Programs (GWEPs) and officially authorizes the Geriatric
Academic Career Awards (GACAs) program. GWEPs are required to
place special emphasis on providing the primary care workforce
with the knowledge and skills to care for older adults and
collaborating with community partners to address gaps in health
care for older adults through individual, system, community,
and population level changes. Priority for GWEP awards will be
given to communities that have a shortage of workforce
professionals and states in which no entity has previously
received a GWEP award. Award amounts are determined by the
Secretary, and Section 3, paragraph 8 notes that those program
applications that describe a plan for providing geriatric
education and training for home health workers and family
caregivers are eligible to receive $100,000 per year more than
entities that do not include a description of such a plan.
The GACA program would provide awards to eligible entities
(specifically accredited schools of allopathic or osteopathic
medicine, nursing, social work, psychology, dentistry,
pharmacy, allied health, or other types of accredited health
professions schools or graduate programs deemed eligible by the
Secretary), on behalf of eligible individuals (specifically: an
individual who has a junior, nontenured faculty appointment at
accredited schools of allopathic or osteopathic medicine,
nursing, social work, psychology, dentistry, pharmacy, allied
health, or other types of accredited health professions schools
or graduate programs deemed eligible by the Secretary; is board
certified or board eligible in internal medicine, family
practice, psychiatry, or licensed dentistry, or has completed
the training required for the individual's discipline and meets
other requirements). Award amounts for physicians shall be
$100,000 for fiscal year (FY) 2020, and that amount should
increase in future years to reflect the increase in the
Consumer Price Index. The Secretary can determine award amounts
for non-physicians. The term of any GACAs may not exceed five
years. Under a special rule, if during an award period an
individual is promoted to associate professor during the course
of an award, and thereby no longer meets the criteria of being
a junior nontenured faculty appointee, the individual may
continue to be treated as an eligible individual through the
full term of the award. In issuing awards, the Secretary shall
pay particular attention to geriatrics health care workforce
needs among underserved populations, diverse communities, and
rural areas, and shall ensure that grants are equitably
distributed across the various geographical regions of the
United States, including rural and underserved areas. Any funds
awarded under a GACA must only be used to supplement, and not
supplant, the amount of Federal, State, and local funds
otherwise expended by such an individual.
For both GWEPs and GACAs, $51,000,000 is authorized
annually from FY 2020 to FY 2024 to carry out the programs.
Funds for GACAs may not be made available unless the amount
made available to carry out the GACA program is more than the
amount made to carry out GWEPs and GACAs in FY 2017.
Section 4. Investment in Tomorrow's Pediatric Health Care Workforce
This section reauthorizes the Investment in Tomorrow's
Pediatric Health Care Workforce Program, which requires the
Secretary to establish and carry out a pediatric specialty loan
repayment program for qualified health professionals who agree
to serve not less than two years in which the professional
participates in an accredited pediatric subspecialty, pediatric
surgical specialty, child and adolescent psychiatry
subspecialty, or child and adolescent mental and behavioral
health residency or fellowship; or employed full-time in
providing such care in an area with a shortage of health care
professionals practicing in these specialties or subspecialties
and a sufficient pediatric population to support the addition
of a practitioner in such specialties. Under the program, the
Secretary would agree to make payments on the principal and
interest of undergraduate, graduate, or graduate medical
education loans of the qualified health professional of not
more than $35,000 per year for each year of agreed upon service
for not more than three years. This section describes an
individual's required educational and professional
qualifications relevant to each respective specialty or
subspecialty, and further requires that eligible individuals
must agree to work in or for a provider serving an area or
community with a shortage of eligible qualified health
professionals, and the professional is a United States citizen,
a permanent legal United States resident, or is lawfully
present in the United States. This section authorizes
$30,000,000 annually to carry out this program for pediatric
medical subspecialists and pediatric surgical specialists and
$20,000,000 annually to carry out this program for child and
adolescent psychiatry and behavioral health professionals. The
authorizations run from FY 2020 through FY 2024.
Section 5. Increasing workforce diversity in the professions of
physical therapy, occupational therapy, audiology, and speech-
language pathology
Section 5 creates a workforce diversity program which pays
scholarships or stipends to eligible entities on behalf of
eligible students underrepresented in the fields of physical
therapy, occupational therapy, audiology, or speech-language
pathology. This section authorizes $5,000,000 annually for FYs
2020 through 2024 for purposes of carrying out this program.
Changes in Existing Law Made by the Bill, as Reported
In compliance with clause 3(e) of rule XIII of the Rules of
the House of Representatives, changes in existing law made by
the bill, as reported, are shown as follows (existing law
proposed to be omitted is enclosed in black brackets, new
matter is printed in italic, and existing law in which no
change is proposed is shown in roman):
PUBLIC HEALTH SERVICE ACT
* * * * * * *
TITLE VII--HEALTH PROFESSIONS EDUCATION
* * * * * * *
PART B--HEALTH PROFESSIONS TRAINING FOR DIVERSITY
SEC. 736. CENTERS OF EXCELLENCE.
(a) In General.--The Secretary shall make grants to, and
enter into contracts with, designated health professions
schools described in subsection (c), and other public and
nonprofit health or educational entities, for the purpose of
assisting the schools in supporting programs of excellence in
health professions education for under-represented minority
individuals.
(b) Required Use of Funds.--The Secretary may not make a
grant under subsection (a) unless the designated health
professions school involved agrees, subject to subsection
(c)(1)(C), to expend the grant--
(1) to develop a large competitive applicant pool
through linkages with institutions of higher education,
local school districts, and other community-based
entities and establish an education pipeline for health
professions careers;
(2) to establish, strengthen, or expand programs to
enhance the academic performance of under-represented
minority students attending the school;
(3) to improve the capacity of such school to train,
recruit, and retain under-represented minority faculty
including the payment of such stipends and fellowships
as the Secretary may determine appropriate;
(4) to carry out activities to improve the
information resources, clinical education, curricula
and cultural competence of the graduates of the school,
as it relates to minority health issues;
(5) to facilitate faculty and student research on
health issues particularly affecting under-represented
minority groups, including research on issues relating
to the delivery of health care;
(6) to carry out a program to train students of the
school in providing health services to a significant
number of under-represented minority individuals
through training provided to such students at
community-based health facilities that--
(A) provide such health services; and
(B) are located at a site remote from the
main site of the teaching facilities of the
school; and
(7) to provide stipends as the Secretary determines
appropriate, in amounts as the Secretary determines
appropriate.
(c) Centers of Excellence.--
(1) Designated schools.--
(A) In general.--The designated health
professions schools referred to in subsection
(a) are such schools that meet each of the
conditions specified in subparagraphs (B) and
(C), and that--
(i) meet each of the conditions
specified in paragraph (2)(A);
(ii) meet each of the conditions
specified in paragraph (3);
(iii) meet each of the conditions
specified in paragraph (4); or
(iv) meet each of the conditions
specified in paragraph (5).
(B) General conditions.--The conditions
specified in this subparagraph are that a
designated health professions school--
(i) has a significant number of
under-represented minority individuals
enrolled in the school, including
individuals accepted for enrollment in
the school;
(ii) has been effective in assisting
under-represented minority students of
the school to complete the program of
education and receive the degree
involved;
(iii) has been effective in
recruiting under-represented minority
individuals to enroll in and graduate
from the school, including providing
scholarships and other financial
assistance to such individuals and
encouraging under-represented minority
students from all levels of the
educational pipeline to pursue health
professions careers; and
(iv) has made significant recruitment
efforts to increase the number of
under-represented minority individuals
serving in faculty or administrative
positions at the school.
(C) Consortium.--The condition specified in
this subparagraph is that, in accordance with
subsection (e)(1), the designated health
profession school involved has with other
health profession schools (designated or
otherwise) formed a consortium to carry out the
purposes described in subsection (b) at the
schools of the consortium.
(D) Application of criteria to other
programs.--In the case of any criteria
established by the Secretary for purposes of
determining whether schools meet the conditions
described in subparagraph (B), this section may
not, with respect to racial and ethnic
minorities, be construed to authorize, require,
or prohibit the use of such criteria in any
program other than the program established in
this section.
(2) Centers of excellence at certain historically
black colleges and universities.--
(A) Conditions.--The conditions specified in
this subparagraph are that a designated health
professions school--
(i) is a school described in section
799B(1); and
(ii) received a contract under
section 788B for fiscal year 1987, as
such section was in effect for such
fiscal year.
(B) Use of grant.--In addition to the
purposes described in subsection (b), a grant
under subsection (a) to a designated health
professions school meeting the conditions
described in subparagraph (A) may be expended--
(i) to develop a plan to achieve
institutional improvements, including
financial independence, to enable the
school to support programs of
excellence in health professions
education for under-represented
minority individuals; and
(ii) to provide improved access to
the library and informational resources
of the school.
(C) Exception.--The requirements of paragraph
(1)(C) shall not apply to a historically black
college or university that receives funding
under paragraphs (2) or (5).
(3) Hispanic centers of excellence.--The conditions
specified in this paragraph are that--
(A) with respect to Hispanic individuals,
each of clauses (i) through (iv) of paragraph
(1)(B) applies to the designated health
professions school involved;
(B) the school agrees, as a condition of
receiving a grant under subsection (a), that
the school will, in carrying out the duties
described in subsection (b), give priority to
carrying out the duties with respect to
Hispanic individuals; and
(C) the school agrees, as a condition of
receiving a grant under subsection (a), that--
(i) the school will establish an
arrangement with 1 or more public or
nonprofit community based Hispanic
serving organizations, or public or
nonprofit private institutions of
higher education, including schools of
nursing, whose enrollment of students
has traditionally included a
significant number of Hispanic
individuals, the purposes of which will
be to carry out a program--
(I) to identify Hispanic
students who are interested in
a career in the health
profession involved; and
(II) to facilitate the
educational preparation of such
students to enter the health
professions school; and
(ii) the school will make efforts to
recruit Hispanic students, including
students who have participated in the
undergraduate or other matriculation
program carried out under arrangements
established by the school pursuant to
clause (i)(II) and will assist Hispanic
students regarding the completion of
the educational requirements for a
degree from the school.
(4) Native american centers of excellence.--Subject
to subsection (e), the conditions specified in this
paragraph are that--
(A) with respect to Native Americans, each of
clauses (i) through (iv) of paragraph (1)(B)
applies to the designated health professions
school involved;
(B) the school agrees, as a condition of
receiving a grant under subsection (a), that
the school will, in carrying out the duties
described in subsection (b), give priority to
carrying out the duties with respect to Native
Americans; and
(C) the school agrees, as a condition of
receiving a grant under subsection (a), that--
(i) the school will establish an
arrangement with 1 or more public or
nonprofit private institutions of
higher education, including schools of
nursing, whose enrollment of students
has traditionally included a
significant number of Native Americans,
the purpose of which arrangement will
be to carry out a program--
(I) to identify Native
American students, from the
institutions of higher
education referred to in clause
(i), who are interested in
health professions careers; and
(II) to facilitate the
educational preparation of such
students to enter the
designated health professions
school; and
(ii) the designated health
professions school will make efforts to
recruit Native American students,
including students who have
participated in the undergraduate
program carried out under arrangements
established by the school pursuant to
clause (i) and will assist Native
American students regarding the
completion of the educational
requirements for a degree from the
designated health professions school.
(5) Other centers of excellence.--The conditions
specified in this paragraph are--
(A) with respect to other centers of
excellence, the conditions described in clauses
(i) through (iv) of paragraph (1)(B); and
(B) that the health professions school
involved has an enrollment of under-represented
minorities above the national average for such
enrollments of health professions schools.
(d) Designation as Center of Excellence.--
(1) In general.--Any designated health professions
school receiving a grant under subsection (a) and
meeting the conditions described in paragraph (2) or
(5) of subsection (c) shall, for purposes of this
section, be designated by the Secretary as a Center of
Excellence in Under-Represented Minority Health
Professions Education.
(2) Hispanic centers of excellence.--Any designated
health professions school receiving a grant under
subsection (a) and meeting the conditions described in
subsection (c)(3) shall, for purposes of this section,
be designated by the Secretary as a Hispanic Center of
Excellence in Health Professions Education.
(3) Native american centers of excellence.--Any
designated health professions school receiving a grant
under subsection (a) and meeting the conditions
described in subsection (c)(4) shall, for purposes of
this section, be designated by the Secretary as a
Native American Center of Excellence in Health
Professions Education. Any consortium receiving such a
grant pursuant to subsection (e) shall, for purposes of
this section, be so designated.
(e) Authority Regarding Native American Centers of
Excellence.--With respect to meeting the conditions specified
in subsection (c)(4), the Secretary may make a grant under
subsection (a) to a designated health professions school that
does not meet such conditions if--
(1) the school has formed a consortium in accordance
with subsection (d)(1); and
(2) the schools of the consortium collectively meet
such conditions, without regard to whether the schools
individually meet such conditions.
(f) Duration of Grant.--The period during which payments are
made under a grant under subsection (a) may not exceed 5 years.
Such payments shall be subject to annual approval by the
Secretary and to the availability of appropriations for the
fiscal year involved to make the payments.
(g) Definitions.--In this section:
(1) Designated health professions school.--
(A) In general.--The term ``health
professions school'' means, except as provided
in subparagraph (B), a school of medicine, a
school of osteopathic medicine, a school of
dentistry, a school of pharmacy, or a graduate
program in behavioral or mental health.
(B) Exception.--The definition established in
subparagraph (A) shall not apply to the use of
the term ``designated health professions
school'' for purposes of subsection (c)(2).
(2) Program of excellence.--The term ``program of
excellence'' means any program carried out by a
designated health professions school with a grant made
under subsection (a), if the program is for purposes
for which the school involved is authorized in
subsection (b) or (c) to expend the grant.
(3) Native americans.--The term ``Native Americans''
means American Indians, Alaskan Natives, Aleuts, and
Native Hawaiians.
(h) Formula for Allocations.--
(1) Allocations.--Based on the amount appropriated
under subsection (i) for a fiscal year, the following
subparagraphs shall apply as appropriate:
(A) In general.--If the amounts appropriated
under subsection (i) for a fiscal year are
$24,000,000 or less--
(i) the Secretary shall make
available $12,000,000 for grants under
subsection (a) to health professions
schools that meet the conditions
described in subsection (c)(2)(A); and
(ii) and available after grants are
made with funds under clause (i), the
Secretary shall make available--
(I) 60 percent of such amount
for grants under subsection (a)
to health professions schools
that meet the conditions
described in paragraph (3) or
(4) of subsection (c)
(including meeting the
conditions under subsection
(e)); and
(II) 40 percent of such
amount for grants under
subsection (a) to health
professions schools that meet
the conditions described in
subsection (c)(5).
(B) Funding in excess of $24,000,000.--If
amounts appropriated under subsection (i) for a
fiscal year exceed $24,000,000 but are less
than $30,000,000--
(i) 80 percent of such excess amounts
shall be made available for grants
under subsection (a) to health
professions schools that meet the
requirements described in paragraph (3)
or (4) of subsection (c) (including
meeting conditions pursuant to
subsection (e)); and
(ii) 20 percent of such excess amount
shall be made available for grants
under subsection (a) to health
professions schools that meet the
conditions described in subsection
(c)(5).
(C) Funding in excess of $30,000,000.--If
amounts appropriated under subsection (i) for a
fiscal year exceed $30,000,000 but are less
than $40,000,000, the Secretary shall make
available--
(i) not less than $12,000,000 for
grants under subsection (a) to health
professions schools that meet the
conditions described in subsection
(c)(2)(A);
(ii) not less than $12,000,000 for
grants under subsection (a) to health
professions schools that meet the
conditions described in paragraph (3)
or (4) of subsection (c) (including
meeting conditions pursuant to
subsection (e));
(iii) not less than $6,000,000 for
grants under subsection (a) to health
professions schools that meet the
conditions described in subsection
(c)(5); and
(iv) after grants are made with funds
under clauses (i) through (iii), any
remaining excess amount for grants
under subsection (a) to health
professions schools that meet the
conditions described in paragraph
(2)(A), (3), (4), or (5) of subsection
(c).
(D) Funding in excess of $40,000,000.--If
amounts appropriated under subsection (i) for a
fiscal year are $40,000,000 or more, the
Secretary shall make available--
(i) not less than $16,000,000 for
grants under subsection (a) to health
professions schools that meet the
conditions described in subsection
(c)(2)(A);
(ii) not less than $16,000,000 for
grants under subsection (a) to health
professions schools that meet the
conditions described in paragraph (3)
or (4) of subsection (c) (including
meeting conditions pursuant to
subsection (e));
(iii) not less than $8,000,000 for
grants under subsection (a) to health
professions schools that meet the
conditions described in subsection
(c)(5); and
(iv) after grants are made with funds
under clauses (i) through (iii), any
remaining funds for grants under
subsection (a) to health professions
schools that meet the conditions
described in paragraph (2)(A), (3),
(4), or (5) of subsection (c).
(2) No limitation.--Nothing in this subsection shall
be construed as limiting the centers of excellence
referred to in this section to the designated amount,
or to preclude such entities from competing for grants
under this section.
(3) Maintenance of effort.--
(A) In general.--With respect to activities
for which a grant made under this part are
authorized to be expended, the Secretary may
not make such a grant to a center of excellence
for any fiscal year unless the center agrees to
maintain expenditures of non-Federal amounts
for such activities at a level that is not less
than the level of such expenditures maintained
by the center for the fiscal year preceding the
fiscal year for which the school receives such
a grant.
(B) Use of federal funds.--With respect to
any Federal amounts received by a center of
excellence and available for carrying out
activities for which a grant under this part is
authorized to be expended, the center shall,
before expending the grant, expend the Federal
amounts obtained from sources other than the
grant, unless given prior approval from the
Secretary.
[(i) Authorization of Appropriations.--There are authorized
to be appropriated to carry out this section--
[(1) $50,000,000 for each of the fiscal years 2010
through 2015; and
[(2) and such sums as are necessary for each
subsequent fiscal year.]
(i) Authorization of Appropriations.--To carry out this
section, there is authorized to be appropriated $24,897,000 for
each of fiscal years 2020 through 2024.
* * * * * * *
SEC. 740. AUTHORIZATION OF APPROPRIATION.
(a) Scholarships.--There are authorized to be appropriated to
carry out section 737, [$51,000,000 for fiscal year 2010, and
such sums as may be necessary for each of the fiscal years 2011
through 2014] $51,419,000 for each of fiscal years 2020 through
2024. Of the amount appropriated in any fiscal year, the
Secretary shall ensure that not less than 16 percent shall be
distributed to schools of nursing.
(b) Loan Repayments and Fellowships.--For the purpose of
carrying out section 738, there is authorized to be
appropriated, [$5,000,000 for each of the fiscal years 2010
through 2014] $1,250,000 for each of fiscal years 2020 through
2024.
(c) Educational Assistance in Health Professions Regarding
Individuals for Disadvantaged Backgrounds.--For the purpose of
grants and contracts under section 739(a)(1), there is
authorized to be appropriated [$60,000,000 for fiscal year 2010
and such sums as may be necessary for each of the fiscal years
2011 through 2014] $20,000,000 for each of fiscal years 2020
through 2024. The Secretary may use not to exceed 20 percent of
the amount appropriated for a fiscal year under this subsection
to provide scholarships under section 739(a)(2)(F).
(d) Report.--Not later than 6 months after the date of
enactment of this part, the Secretary shall prepare and submit
to the appropriate committees of Congress a report concerning
the efforts of the Secretary to address the need for a
representative mix of individuals from historically minority
health professions schools, or from institutions or other
entities that historically or by geographic location have a
demonstrated record of training or educating underrepresented
minorities, within various health professions disciplines, on
peer review councils.
* * * * * * *
PART C--TRAINING IN FAMILY MEDICINE, GENERAL INTERNAL MEDICINE, GENERAL
PEDIATRICS, PHYSICIAN ASSISTANTS, GENERAL DENTISTRY, AND PEDIATRIC
DENTISTRY
Subpart I--Medical Training Generally
SEC. 747. PRIMARY CARE TRAINING AND ENHANCEMENT.
(a) Support and Development of Primary Care Training
Programs.--
(1) In general.--The Secretary may make grants to, or
enter into contracts with, an accredited public or
nonprofit private hospital, school of medicine or
osteopathic medicine, academically affiliated physician
assistant training program, or a public or private
nonprofit entity which the Secretary has determined is
capable of carrying out such grant or contract--
(A) to plan, develop, operate, or participate
in an accredited professional training program,
including an accredited residency or internship
program in the field of family medicine,
general internal medicine, or general
pediatrics for medical students, interns,
residents, or practicing physicians as defined
by the Secretary;
(B) to provide need-based financial
assistance in the form of traineeships and
fellowships to medical students, interns,
residents, practicing physicians, or other
medical personnel, who are participants in any
such program, and who plan to specialize or
work in the practice of the fields defined in
subparagraph (A);
(C) to plan, develop, and operate a program
for the training of physicians who plan to
teach in family medicine, general internal
medicine, or general pediatrics training
programs;
(D) to plan, develop, and operate a program
for the training of physicians teaching in
community-based settings;
(E) to provide financial assistance in the
form of traineeships and fellowships to
physicians who are participants in any such
programs and who plan to teach or conduct
research in a family medicine, general internal
medicine, or general pediatrics training
program;
(F) to plan, develop, and operate a physician
assistant education program, and for the
training of individuals who will teach in
programs to provide such training;
(G) to plan, develop, and operate a
demonstration program that provides training in
new competencies, as recommended by the
Advisory Committee on Training in Primary Care
Medicine and Dentistry and the National Health
Care Workforce Commission established in
section 5101 of the Patient Protection and
Affordable Care Act, which may include--
(i) providing training to primary
care physicians relevant to providing
care through patient-centered medical
homes (as defined by the Secretary for
purposes of this section);
(ii) developing tools and curricula
relevant to patient-centered medical
homes; and
(iii) providing continuing education
to primary care physicians relevant to
patient-centered medical homes; and
(H) to plan, develop, and operate joint
degree programs to provide interdisciplinary
and interprofessional graduate training in
public health and other health professions to
provide training in environmental health,
infectious disease control, disease prevention
and health promotion, epidemiological studies
and injury control.
(2) Duration of awards.--The period during which
payments are made to an entity from an award of a grant
or contract under this subsection shall be 5 years.
(b) Capacity Building in Primary Care.--
(1) In general.--The Secretary may make grants to or
enter into contracts with accredited schools of
medicine or osteopathic medicine to establish,
maintain, or improve--
(A) academic units or programs that improve
clinical teaching and research in fields
defined in subsection (a)(1)(A); or
(B) programs that integrate academic
administrative units in fields defined in
subsection (a)(1)(A) to enhance
interdisciplinary recruitment, training, and
faculty development.
(2) Preference in making awards under this
subsection.--In making awards of grants and contracts
under paragraph (1), the Secretary shall give
preference to any qualified applicant for such an award
that agrees to expend the award for the purpose of--
(A) establishing academic units or programs
in fields defined in subsection (a)(1)(A); or
(B) substantially expanding such units or
programs.
(3) Priorities in making awards.--In awarding grants
or contracts under paragraph (1), the Secretary shall
give priority to qualified applicants that--
(A) proposes a collaborative project between
academic administrative units of primary care;
(B) proposes innovative approaches to
clinical teaching using models of primary care,
such as the patient centered medical home, team
management of chronic disease, and
interprofessional integrated models of health
care that incorporate transitions in health
care settings and integration physical and
mental health provision;
(C) have a record of training the greatest
percentage of providers, or that have
demonstrated significant improvements in the
percentage of providers trained, who enter and
remain in primary care practice;
(D) have a record of training individuals who
are from underrepresented minority groups or
from a rural or disadvantaged background;
(E) provide training in the care of
vulnerable populations such as children, older
adults, homeless individuals, victims of abuse
or trauma, individuals with mental health or
substance-related disorders, individuals with
HIV/AIDS, and individuals with disabilities;
(F) establish formal relationships and submit
joint applications with federally qualified
health centers, rural health clinics, area
health education centers, or clinics located in
underserved areas or that serve underserved
populations;
(G) teach trainees the skills to provide
interprofessional, integrated care through
collaboration among health professionals;
(H) provide training in enhanced
communication with patients, evidence-based
practice, chronic disease management,
preventive care, health information technology,
or other competencies as recommended by the
Advisory Committee on Training in Primary Care
Medicine and Dentistry and the National Health
Care Workforce Commission established in
section 5101 of the Patient Protection and
Affordable Care Act; or
(I) provide training in cultural competency
and health literacy.
(4) Duration of awards.--The period during which
payments are made to an entity from an award of a grant
or contract under this subsection shall be 5 years.
(c) Authorization of Appropriations.--
(1) In general.--For purposes of carrying out this
section (other than subsection (b)(1)(B)), there are
authorized to be appropriated [$125,000,000 for fiscal
year 2010, and such sums as may be necessary for each
of fiscal years 2011 through 2014] $51,371,000 for each
of fiscal years 2020 through 2024.
(2) Training programs.--Fifteen percent of the amount
appropriated pursuant to paragraph (1) in each such
fiscal year shall be allocated to the physician
assistant training programs described in subsection
(a)(1)(F), which prepare students for practice in
primary care.
(3) Integrating academic administrative units.--For
purposes of carrying out subsection (b)(1)(B), there
are authorized to be appropriated $750,000 for each of
fiscal years 2010 through 2014.
* * * * * * *
SEC. 748. TRAINING IN GENERAL, PEDIATRIC, AND PUBLIC HEALTH DENTISTRY.
(a) Support and Development of Dental Training Programs.--
(1) In general.--The Secretary may make grants to, or
enter into contracts with, a school of dentistry,
public or nonprofit private hospital, or a public or
private nonprofit entity which the Secretary has
determined is capable of carrying out such grant or
contract--
(A) to plan, develop, and operate, or
participate in, an approved professional
training program in the field of general
dentistry, pediatric dentistry, or public
health dentistry for dental students,
residents, practicing dentists, dental
hygienists, or other approved primary care
dental trainees, that emphasizes training for
general, pediatric, or public health dentistry;
(B) to provide financial assistance to dental
students, residents, practicing dentists, and
dental hygiene students who are in need
thereof, who are participants in any such
program, and who plan to work in the practice
of general, pediatric, public heath dentistry,
or dental hygiene;
(C) to plan, develop, and operate a program
for the training of oral health care providers
who plan to teach in general, pediatric, public
health dentistry, or dental hygiene;
(D) to provide financial assistance in the
form of traineeships and fellowships to
dentists who plan to teach or are teaching in
general, pediatric, or public health dentistry;
(E) to meet the costs of projects to
establish, maintain, or improve dental faculty
development programs in primary care (which may
be departments, divisions or other units);
(F) to meet the costs of projects to
establish, maintain, or improve predoctoral and
postdoctoral training in primary care programs;
(G) to create a loan repayment program for
faculty in dental programs; and
(H) to provide technical assistance to
pediatric training programs in developing and
implementing instruction regarding the oral
health status, dental care needs, and risk-
based clinical disease management of all
pediatric populations with an emphasis on
underserved children.
(2) Faculty loan repayment.--
(A) In general.--A grant or contract under
subsection (a)(1)(G) may be awarded to a
program of general, pediatric, or public health
dentistry described in such subsection to plan,
develop, and operate a loan repayment program
under which--
(i) individuals agree to serve full-
time as faculty members; and
(ii) the program of general,
pediatric or public health dentistry
agrees to pay the principal and
interest on the outstanding student
loans of the individuals.
(B) Manner of payments.--With respect to the
payments described in subparagraph (A)(ii),
upon completion by an individual of each of the
first, second, third, fourth, and fifth years
of service, the program shall pay an amount
equal to 10, 15, 20, 25, and 30 percent,
respectively, of the individual's student loan
balance as calculated based on principal and
interest owed at the initiation of the
agreement.
(b) Eligible Entity.--For purposes of this subsection,
entities eligible for such grants or contracts in general,
pediatric, or public health dentistry shall include entities
that have programs in dental or dental hygiene schools, or
approved residency or advanced education programs in the
practice of general, pediatric, or public health dentistry.
Eligible entities may partner with schools of public health to
permit the education of dental students, residents, and dental
hygiene students for a master's year in public health at a
school of public health.
(c) Priorities in Making Awards.--With respect to training
provided for under this section, the Secretary shall give
priority in awarding grants or contracts to the following:
(1) Qualified applicants that propose collaborative
projects between departments of primary care medicine
and departments of general, pediatric, or public health
dentistry.
(2) Qualified applicants that have a record of
training the greatest percentage of providers, or that
have demonstrated significant improvements in the
percentage of providers, who enter and remain in
general, pediatric, or public health dentistry.
(3) Qualified applicants that have a record of
training individuals who are from a rural or
disadvantaged background, or from underrepresented
minorities.
(4) Qualified applicants that establish formal
relationships with Federally qualified health centers,
rural health centers, or accredited teaching facilities
and that conduct training of students, residents,
fellows, or faculty at the center or facility.
(5) Qualified applicants that conduct teaching
programs targeting vulnerable populations such as older
adults, homeless individuals, victims of abuse or
trauma, individuals with mental health or substance-
related disorders, individuals with disabilities, and
individuals with HIV/AIDS, and in the risk-based
clinical disease management of all populations.
(6) Qualified applicants that include educational
activities in cultural competency and health literacy.
(7) Qualified applicants that have a high rate for
placing graduates in practice settings that serve
underserved areas or health disparity populations, or
who achieve a significant increase in the rate of
placing graduates in such settings.
(8) Qualified applicants that intend to establish a
special populations oral health care education center
or training program for the didactic and clinical
education of dentists, dental health professionals, and
dental hygienists who plan to teach oral health care
for people with developmental disabilities, cognitive
impairment, complex medical problems, significant
physical limitations, and vulnerable elderly.
(d) Application.--An eligible entity desiring a grant under
this section shall submit to the Secretary an application at
such time, in such manner, and containing such information as
the Secretary may require.
(e) Duration of Award.--The period during which payments are
made to an entity from an award of a grant or contract under
subsection (a) shall be 5 years. The provision of such payments
shall be subject to annual approval by the Secretary and
subject to the availability of appropriations for the fiscal
year involved to make the payments.
(f) Authorizations of Appropriations.--For the purpose of
carrying out subsections (a) and (b), there is authorized to be
appropriated [$30,000,000 for fiscal year 2010 and such sums as
may be necessary for each of fiscal years 2011 through 2015]
$42,707,000 for each of fiscal years 2020 through 2024.
(g) Carryover Funds.--An entity that receives an award under
this section may carry over funds from 1 fiscal year to another
without obtaining approval from the Secretary. In no case may
any funds be carried over pursuant to the preceding sentence
for more than 3 years.
* * * * * * *
PART D--INTERDISCIPLINARY, COMMUNITY-BASED LINKAGES
* * * * * * *
SEC. 751. AREA HEALTH EDUCATION CENTERS.
(a) Establishment of Awards.--The Secretary shall make the
following 2 types of awards in accordance with this section:
(1) Infrastructure development award.--The Secretary
shall make awards to eligible entities to enable such
entities to initiate health care workforce educational
programs or to continue to carry out comparable
programs that are operating at the time the award is
made by planning, developing, operating, and evaluating
an area health education center program.
(2) Point of service maintenance and enhancement
award.--The Secretary shall make awards to eligible
entities to maintain and improve the effectiveness and
capabilities of an existing area health education
center program, and make other modifications to the
program that are appropriate due to changes in
demographics, needs of the populations served, or other
similar issues affecting the area health education
center program. For the purposes of this section, the
term ``Program'' refers to the area health education
center program.
(b) Eligible Entities; Application.--
(1) Eligible entities.--
(A) Infrastructure development.--For purposes
of subsection (a)(1), the term ``eligible
entity'' means a school of medicine or
osteopathic medicine, an incorporated
consortium of such schools, or the parent
institutions of such a school. With respect to
a State in which no area health education
center program is in operation, the Secretary
may award a grant or contract under subsection
(a)(1) to a school of nursing.
(B) Point of service maintenance and
enhancement.--For purposes of subsection
(a)(2), the term ``eligible entity'' means an
entity that has received funds under this
section, is operating an area health education
center program, including an area health
education center or centers, and has a center
or centers that are no longer eligible to
receive financial assistance under subsection
(a)(1).
(2) Application.--An eligible entity desiring to
receive an award under this section shall submit to the
Secretary an application at such time, in such manner,
and containing such information as the Secretary may
require.
(c) Use of Funds.--
(1) Required activities.--An eligible entity shall
use amounts awarded under a grant under subsection
(a)(1) or (a)(2) to carry out the following activities:
(A) Develop and implement strategies, in
coordination with the applicable one-stop
delivery system under section 134(c) of the
Workforce Investment Act of 1998, to recruit
individuals from underrepresented minority
populations or from disadvantaged or rural
backgrounds into health professions, and
support such individuals in attaining such
careers.
(B) Develop and implement strategies to
foster and provide community-based training and
education to individuals seeking careers in
health professions within underserved areas for
the purpose of developing and maintaining a
diverse health care workforce that is prepared
to deliver high-quality care, with an emphasis
on primary care, in underserved areas or for
health disparity populations, in collaboration
with other Federal and State health care
workforce development programs, the State
workforce agency, and local workforce
investment boards, and in health care safety
net sites.
(C) Prepare individuals to more effectively
provide health services to underserved areas
and health disparity populations through field
placements or preceptorships in conjunction
with community-based organizations, accredited
primary care residency training programs,
Federally qualified health centers, rural
health clinics, public health departments, or
other appropriate facilities.
(D) Conduct and participate in
interdisciplinary training that involves
physicians, physician assistants, nurse
practitioners, nurse midwives, dentists,
psychologists, pharmacists, optometrists,
community health workers, public and allied
health professionals, or other health
professionals, as practicable.
(E) Deliver or facilitate continuing
education and information dissemination
programs for health care professionals, with an
emphasis on individuals providing care in
underserved areas and for health disparity
populations.
(F) Propose and implement effective program
and outcomes measurement and evaluation
strategies.
(G) Establish a youth public health program
to expose and recruit high school students into
health careers, with a focus on careers in
public health.
(2) Innovative opportunities.--An eligible entity may
use amounts awarded under a grant under subsection
(a)(1) or subsection (a)(2) to carry out any of the
following activities:
(A) Develop and implement innovative
curricula in collaboration with community-based
accredited primary care residency training
programs, Federally qualified health centers,
rural health clinics, behavioral and mental
health facilities, public health departments,
or other appropriate facilities, with the goal
of increasing the number of primary care
physicians and other primary care providers
prepared to serve in underserved areas and
health disparity populations.
(B) Coordinate community-based participatory
research with academic health centers, and
facilitate rapid flow and dissemination of
evidence-based health care information,
research results, and best practices to improve
quality, efficiency, and effectiveness of
health care and health care systems within
community settings.
(C) Develop and implement other strategies to
address identified workforce needs and increase
and enhance the health care workforce in the
area served by the area health education center
program.
(d) Requirements.--
(1) Area health education center program.--In
carrying out this section, the Secretary shall ensure
the following:
(A) An entity that receives an award under
this section shall conduct at least 10 percent
of clinical education required for medical
students in community settings that are removed
from the primary teaching facility of the
contracting institution for grantees that
operate a school of medicine or osteopathic
medicine. In States in which an entity that
receives an award under this section is a
nursing school or its parent institution, the
Secretary shall alternatively ensure that--
(i) the nursing school conducts at
least 10 percent of clinical education
required for nursing students in
community settings that are remote from
the primary teaching facility of the
school; and
(ii) the entity receiving the award
maintains a written agreement with a
school of medicine or osteopathic
medicine to place students from that
school in training sites in the area
health education center program area.
(B) An entity receiving funds under
subsection (a)(2) does not distribute such
funding to a center that is eligible to receive
funding under subsection (a)(1).
(2) Area health education center.--The Secretary
shall ensure that each area health education center
program includes at least 1 area health education
center, and that each such center--
(A) is a public or private organization whose
structure, governance, and operation is
independent from the awardee and the parent
institution of the awardee;
(B) is not a school of medicine or
osteopathic medicine, the parent institution of
such a school, or a branch campus or other
subunit of a school of medicine or osteopathic
medicine or its parent institution, or a
consortium of such entities;
(C) designates an underserved area or
population to be served by the center which is
in a location removed from the main location of
the teaching facilities of the schools
participating in the program with such center
and does not duplicate, in whole or in part,
the geographic area or population served by any
other center;
(D) fosters networking and collaboration
among communities and between academic health
centers and community-based centers;
(E) serves communities with a demonstrated
need of health professionals in partnership
with academic medical centers;
(F) addresses the health care workforce needs
of the communities served in coordination with
the public workforce investment system; and
(G) has a community-based governing or
advisory board that reflects the diversity of
the communities involved.
(e) Matching Funds.--With respect to the costs of operating a
program through a grant under this section, to be eligible for
financial assistance under this section, an entity shall make
available (directly or through contributions from State, county
or municipal governments, or the private sector) recurring non-
Federal contributions in cash or in kind, toward such costs in
an amount that is equal to not less than 50 percent of such
costs. At least 25 percent of the total required non-Federal
contributions shall be in cash. An entity may apply to the
Secretary for a waiver of not more than 75 percent of the
matching fund amount required by the entity for each of the
first 3 years the entity is funded through a grant under
subsection (a)(1).
(f) Limitation.--Not less than 75 percent of the total amount
provided to an area health education center program under
subsection (a)(1) or (a)(2) shall be allocated to the area
health education centers participating in the program under
this section. To provide needed flexibility to newly funded
area health education center programs, the Secretary may waive
the requirement in the sentence for the first 2 years of a new
area health education center program funded under subsection
(a)(1).
(g) Award.--An award to an entity under this section shall be
not less than $250,000 annually per area health education
center included in the program involved. If amounts
appropriated to carry out this section are not sufficient to
comply with the preceding sentence, the Secretary may reduce
the per center amount provided for in such sentence as
necessary, provided the distribution established in subsection
(j)(2) is maintained.
(h) Project Terms.--
(1) In general.--Except as provided in paragraph (2),
the period during which payments may be made under an
award under subsection (a)(1) may not exceed--
(A) in the case of a program, 12 years; or
(B) in the case of a center within a program,
6 years.
(2) Exception.--The periods described in paragraph
(1) shall not apply to programs receiving point of
service maintenance and enhancement awards under
subsection (a)(2) to maintain existing centers and
activities.
(i) Inapplicability of Provision.--Notwithstanding any other
provision of this title, section 791(a) shall not apply to an
area health education center funded under this section.
(j) Authorization of Appropriations.--
(1) In general.--There is authorized to be
appropriated to carry out this section [$125,000,000
for each of the fiscal years 2010 through 2014]
$42,075,000 for each of fiscal years 2020 through 2024.
(2) Requirements.--Of the amounts appropriated for a
fiscal year under paragraph (1)--
(A) not more than 35 percent shall be used
for awards under subsection (a)(1);
(B) not less than 60 percent shall be used
for awards under subsection (a)(2);
(C) not more than 1 percent shall be used for
grants and contracts to implement outcomes
evaluation for the area health education
centers; and
(D) not more than 4 percent shall be used for
grants and contracts to provide technical
assistance to entities receiving awards under
this section.
(3) Carryover funds.--An entity that receives an
award under this section may carry over funds from 1
fiscal year to another without obtaining approval from
the Secretary. In no case may any funds be carried over
pursuant to the preceding sentence for more than 3
years.
(k) Sense of Congress.--It is the sense of the Congress that
every State have an area health education center program in
effect under this section.
* * * * * * *
[SEC. 753. EDUCATION AND TRAINING RELATING TO GERIATRICS.
[(a) Geriatric Education Centers.--
[(1) In general.--The Secretary shall award grants or
contracts under this section to entities described in
paragraphs (1), (3), or (4) of section 799B, and
section 801(2), for the establishment or operation of
geriatric education centers.
[(2) Requirements.--A geriatric education center is a
program that--
[(A) improves the training of health
professionals in geriatrics, including
geriatric residencies, traineeships, or
fellowships;
[(B) develops and disseminates curricula
relating to the treatment of the health
problems of elderly individuals;
[(C) supports the training and retraining of
faculty to provide instruction in geriatrics;
[(D) supports continuing education of health
professionals who provide geriatric care; and
[(E) provides students with clinical training
in geriatrics in nursing homes, chronic and
acute disease hospitals, ambulatory care
centers, and senior centers.
[(b) Geriatric Training Regarding Physicians and Dentists.--
[(1) In general.--The Secretary may make grants to,
and enter into contracts with, schools of medicine,
schools of osteopathic medicine, teaching hospitals,
and graduate medical education programs, for the
purpose of providing support (including residencies,
traineeships, and fellowships) for geriatric training
projects to train physicians, dentists and behavioral
and mental health professionals who plan to teach
geriatric medicine, geriatric behavioral or mental
health, or geriatric dentistry.
[(2) Requirements.--Each project for which a grant or
contract is made under this subsection shall--
[(A) be staffed by full-time teaching
physicians who have experience or training in
geriatric medicine or geriatric behavioral or
mental health;
[(B) be staffed, or enter into an agreement
with an institution staffed by full-time or
part-time teaching dentists who have experience
or training in geriatric dentistry;
[(C) be staffed, or enter into an agreement
with an institution staffed by full-time or
part-time teaching behavioral mental health
professionals who have experience or training
in geriatric behavioral or mental health;
[(D) be based in a graduate medical education
program in internal medicine or family medicine
or in a department of geriatrics or behavioral
or mental health;
[(E) provide training in geriatrics and
exposure to the physical and mental
disabilities of elderly individuals through a
variety of service rotations, such as geriatric
consultation services, acute care services,
dental services, geriatric behavioral or mental
health units, day and home care programs,
rehabilitation services, extended care
facilities, geriatric ambulatory care and
comprehensive evaluation units, and community
care programs for elderly individuals with
intellectual disabilities; and
[(F) provide training in geriatrics through
one or both of the training options described
in subparagraphs (A) and (B) of paragraph (3).
[(3) Training options.--The training options referred
to in subparagraph (F) of paragraph (2) shall be as
follows:
[(A) A 1-year retraining program in
geriatrics for--
[(i) physicians who are faculty
members in departments of internal
medicine, family medicine, gynecology,
geriatrics, and behavioral or mental
health at schools of medicine and
osteopathic medicine;
[(ii) dentists who are faculty
members at schools of dentistry or at
hospital departments of dentistry; and
[(iii) behavioral or mental health
professionals who are faculty members
in departments of behavioral or mental
health; and
[(B) A 2-year internal medicine or family
medicine fellowship program providing emphasis
in geriatrics, which shall be designed to
provide training in clinical geriatrics and
geriatrics research for--
[(i) physicians who have completed
graduate medical education programs in
internal medicine, family medicine,
behavioral or mental health, neurology,
gynecology, or rehabilitation medicine;
[(ii) dentists who have demonstrated
a commitment to an academic career and
who have completed postdoctoral dental
training, including postdoctoral dental
education programs or who have relevant
advanced training or experience; and
[(iii) behavioral or mental health
professionals who have completed
graduate medical education programs in
behavioral or mental health.
[(4) Definitions.--For purposes of this subsection:
[(A) The term ``graduate medical education
program'' means a program sponsored by a school
of medicine, a school of osteopathic medicine,
a hospital, or a public or private institution
that--
[(i) offers postgraduate medical
training in the specialties and
subspecialties of medicine; and
[(ii) has been accredited by the
Accreditation Council for Graduate
Medical Education or the American
Osteopathic Association through its
Committee on Postdoctoral Training.
[(B) The term ``post-doctoral dental
education program'' means a program sponsored
by a school of dentistry, a hospital, or a
public or private institution that--
[(i) offers post-doctoral training in
the specialties of dentistry, advanced
education in general dentistry, or a
dental general practice residency; and
[(ii) has been accredited by the
Commission on Dental Accreditation.
[(c) Geriatric Faculty Fellowships.--
[(1) Establishment of program.--The Secretary shall
establish a program to provide Geriatric Academic
Career Awards to eligible individuals to promote the
career development of such individuals as academic
geriatricians.
[(2) Eligible individuals.--To be eligible to receive
an Award under paragraph (1), an individual shall--
[(A) be board certified or board eligible in
internal medicine, family practice, psychiatry,
or licensed dentistry, or have completed any
required training in a discipline and employed
in an accredited health professions school that
is approved by the Secretary;
[(B) have completed an approved fellowship
program in geriatrics or have completed
specialty training in geriatrics as required by
the discipline and any addition geriatrics
training as required by the Secretary; and
[(C) have a junior (non-tenured) faculty
appointment at an accredited (as determined by
the Secretary) school of medicine, osteopathic
medicine, nursing, social work, psychology,
dentistry, pharmacy, or other allied health
disciplines in an accredited health professions
school that is approved by the Secretary.
[(3) Limitations.--No Award under paragraph (1) may
be made to an eligible individual unless the
individual--
[(A) has submitted to the Secretary an
application, at such time, in such manner, and
containing such information as the Secretary
may require, and the Secretary has approved
such application;
[(B) provides, in such form and manner as the
Secretary may require, assurances that the
individual will meet the service requirement
described in paragraph (6); and
[(C) provides, in such form and manner as the
Secretary may require, assurances that the
individual has a full-time faculty appointment
in a health professions institution and
documented commitment from such institution to
spend 75 percent of the total time of such
individual on teaching and developing skills in
interdisciplinary education in geriatrics.
[(4) Maintenance of effort.--An eligible individual
that receives an Award under paragraph (1) shall
provide assurances to the Secretary that funds provided
to the eligible individual under this subsection will
be used only to supplement, not to supplant, the amount
of Federal, State, and local funds otherwise expended
by the eligible individual.
[(5) Amount and term.--
[(A) Amount.--The amount of an Award under
this section for individuals who are physicians
shall equal $50,000 for fiscal year 1998,
adjusted for subsequent fiscal years to reflect
the increase in the Consumer Price Index. The
Secretary shall determine the amount of an
Award under this section for individuals who
are not physicians.
[(B) Term.--The term of any Award made under
this subsection shall not exceed 5 years.
[(C) Payment to institution.--The Secretary
shall make payments to institutions which
include schools of medicine, osteopathic
medicine, nursing, social work, psychology,
dentistry, and pharmacy, or other allied health
discipline in an accredited health professions
school that is approved by the Secretary.
[(6) Service requirement.--An individual who receives
an Award under this subsection shall provide training
in clinical geriatrics, including the training of
interdisciplinary teams of health care professionals.
The provision of such training shall constitute at
least 75 percent of the obligations of such individual
under the Award.
[(d) Geriatric Workforce Development.--
[(1) In general.--The Secretary shall award grants or
contracts under this subsection to entities that
operate a geriatric education center pursuant to
subsection (a)(1).
[(2) Application.--To be eligible for an award under
paragraph (1), an entity described in such paragraph
shall submit to the Secretary an application at such
time, in such manner, and containing such information
as the Secretary may require.
[(3) Use of funds.--Amounts awarded under a grant or
contract under paragraph (1) shall be used to--
[(A) carry out the fellowship program
described in paragraph (4); and
[(B) carry out 1 of the 2 activities
described in paragraph (5).
[(4) Fellowship program.--
[(A) In general.--Pursuant to paragraph (3),
a geriatric education center that receives an
award under this subsection shall use such
funds to offer short-term intensive courses
(referred to in this subsection as a
``fellowship'') that focus on geriatrics,
chronic care management, and long-term care
that provide supplemental training for faculty
members in medical schools and other health
professions schools with programs in
psychology, pharmacy, nursing, social work,
dentistry, public health, allied health, or
other health disciplines, as approved by the
Secretary. Such a fellowship shall be open to
current faculty, and appropriately credentialed
volunteer faculty and practitioners, who do not
have formal training in geriatrics, to upgrade
their knowledge and clinical skills for the
care of older adults and adults with functional
limitations and to enhance their
interdisciplinary teaching skills.
[(B) Location.--A fellowship shall be offered
either at the geriatric education center that
is sponsoring the course, in collaboration with
other geriatric education centers, or at
medical schools, schools of dentistry, schools
of nursing, schools of pharmacy, schools of
social work, graduate programs in psychology,
or allied health and other health professions
schools approved by the Secretary with which
the geriatric education centers are affiliated.
[(C) CME credit.--Participation in a
fellowship under this paragraph shall be
accepted with respect to complying with
continuing health profession education
requirements. As a condition of such
acceptance, the recipient shall agree to
subsequently provide a minimum of 18 hours of
voluntary instructional support through a
geriatric education center that is providing
clinical training to students or trainees in
long-term care settings.
[(5) Additional required activities described.--
Pursuant to paragraph (3), a geriatric education center
that receives an award under this subsection shall use
such funds to carry out 1 of the following 2
activities.
[(A) Family caregiver and direct care
provider training.--A geriatric education
center that receives an award under this
subsection shall offer at least 2 courses each
year, at no charge or nominal cost, to family
caregivers and direct care providers that are
designed to provide practical training for
supporting frail elders and individuals with
disabilities. The Secretary shall require such
Centers to work with appropriate community
partners to develop training program content
and to publicize the availability of training
courses in their service areas. All family
caregiver and direct care provider training
programs shall include instruction on the
management of psychological and behavioral
aspects of dementia, communication techniques
for working with individuals who have dementia,
and the appropriate, safe, and effective use of
medications for older adults.
[(B) Incorporation of best practices.--A
geriatric education center that receives an
award under this subsection shall develop and
include material on depression and other mental
disorders common among older adults, medication
safety issues for older adults, and management
of the psychological and behavioral aspects of
dementia and communication techniques with
individuals who have dementia in all training
courses, where appropriate.
[(6) Targets.--A geriatric education center that
receives an award under this subsection shall meet
targets approved by the Secretary for providing
geriatric training to a certain number of faculty or
practitioners during the term of the award, as well as
other parameters established by the Secretary.
[(7) Amount of award.--An award under this subsection
shall be in an amount of $150,000. Not more than 24
geriatric education centers may receive an award under
this subsection.
[(8) Maintenance of effort.--A geriatric education
center that receives an award under this subsection
shall provide assurances to the Secretary that funds
provided to the geriatric education center under this
subsection will be used only to supplement, not to
supplant, the amount of Federal, State, and local funds
otherwise expended by the geriatric education center.
[(9) Authorization of appropriations.--In addition to
any other funding available to carry out this section,
there is authorized to be appropriated to carry out
this subsection, $10,800,000 for the period of fiscal
year 2011 through 2014.
[(e) Geriatric Career Incentive Awards.--
[(1) In general.--The Secretary shall award grants or
contracts under this section to individuals described
in paragraph (2) to foster greater interest among a
variety of health professionals in entering the field
of geriatrics, long-term care, and chronic care
management.
[(2) Eligible individuals.--To be eligible to
received an award under paragraph (1), an individual
shall--
[(A) be an advanced practice nurse, a
clinical social worker, a pharmacist, or
student of psychology who is pursuing a
doctorate or other advanced degree in
geriatrics or related fields in an accredited
health professions school; and
[(B) submit to the Secretary an application
at such time, in such manner, and containing
such information as the Secretary may require.
[(3) Condition of award.--As a condition of receiving
an award under this subsection, an individual shall
agree that, following completion of the award period,
the individual will teach or practice in the field of
geriatrics, long-term care, or chronic care management
for a minimum of 5 years under guidelines set by the
Secretary.
[(4) Authorization of appropriations.--There is
authorized to be appropriated to carry out this
subsection, $10,000,000 for the period of fiscal years
2011 through 2013.]
SEC. 753. EDUCATION AND TRAINING RELATING TO GERIATRICS.
(a) Geriatrics Workforce Enhancement Programs.--
(1) In general.--The Secretary shall award grants or
contracts under this subsection to entities described
in paragraph (1), (3), or (4) of section 799B, section
801(2), or section 865(d), or other health professions
schools or programs approved by the Secretary, for the
establishment or operation of geriatrics workforce
enhancement programs that meet the requirements of
paragraph (2).
(2) Requirements.--A geriatrics workforce enhancement
program meets the requirements of this paragraph if
such program supports the development of a health care
workforce that maximizes patient and family engagement
and improves health outcomes for older adults by
integrating geriatrics with primary care and other
appropriate specialties. Special emphasis should be
placed on providing the primary care workforce with the
knowledge and skills to care for older adults and
collaborating with community partners to address gaps
in health care for older adults through individual,
system, community, and population level changes. Areas
of programmatic focus may include the following:
(A) Transforming clinical training
environments to integrated geriatrics and
primary care delivery systems to ensure
trainees are well prepared to practice in and
lead in such systems.
(B) Developing providers from multiple
disciplines and specialties to work
interprofessionally to assess and address the
needs and preferences of older adults and their
families and caregivers at the individual,
community, and population levels with cultural
and linguistic competency.
(C) Creating and delivering community-based
programs that will provide older adults and
their families and caregivers with the
knowledge and skills to improve health outcomes
and the quality of care for such adults.
(D) Providing Alzheimer's disease and related
dementias (ADRD) education to the families and
caregivers of older adults, direct care
workers, health professions students, faculty,
and providers.
(3) Duration.--The Secretary shall award grants and
contracts under paragraph (1) for a period not to
exceed five years.
(4) Application.--To be eligible to receive a grant
or contract under paragraph (1), an entity described in
such paragraph shall submit to the Secretary an
application at such time, in such manner, and
containing such information as the Secretary may
require, including the specific measures the applicant
will use to demonstrate that the project is improving
the quality of care provided to older adults in the
applicant's region, which may include--
(A) improvements in access to care provided
by a health professional with training in
geriatrics or gerontology;
(B) improvements in family caregiver capacity
to care for older adults;
(C) patient outcome data demonstrating an
improvement in older adult health status or
care quality; and
(D) reports on how the applicant will
implement specific innovations with the target
audience to improve older adults' health status
or the quality of care.
(5) Equitable geographic distribution.--The Secretary
may award grants and contracts under paragraph (1) in a
manner which will equitably distribute such grants
among the various regions of the United States.
(6) Qualifications.--In awarding grants and contracts
under paragraph (2), the Secretary shall consider
programs that--
(A) have the goal of improving and providing
comprehensive coordinated care of older adults,
including medical, dental, and psychosocial
needs;
(B) demonstrate coordination with other
programmatic efforts funded under this program
or other public or private entities;
(C) support the training and retraining of
faculty, preceptors, primary care providers,
and providers in other specialties to increase
their knowledge of geriatrics and gerontology;
(D) provide clinical experiences across care
settings, including ambulatory care, hospitals,
post-acute care, nursing homes, federally
qualified health centers, and home and
community-based services;
(E) emphasize education and engagement of
family caregivers on disease self-management,
medication management, and stress reduction
strategies;
(F) provide training to the health care
workforce on disease self-management,
motivational interviewing, medication
management, and stress reduction strategies;
(G) provide training to the health care
workforce on social determinants of health in
order to better address the geriatric health
care needs of diverse populations with cultural
and linguistic competency;
(H) integrate geriatrics competencies and
interprofessional collaborative practice into
health care education and training curricula
for residents, fellows, and students;
(I) substantially benefit rural or
underserved populations of older adults or
conduct outreach to communities that have a
shortage of geriatric workforce professionals;
(J) integrate behavioral health competencies
into primary care practice, especially with
respect to elder abuse, pain management, and
advance care planning; or
(K) offer short-term intensive courses that--
(i) focus on geriatrics, gerontology,
chronic care management, and long-term
care that provide supplemental training
for faculty members in medical schools
and other health professions schools or
graduate programs in psychology,
pharmacy, nursing, social work,
dentistry, public health, allied
health, or other health disciplines, as
approved by the Secretary; and
(ii) are open to current faculty, and
appropriately credentialed volunteer
faculty and practitioners, to upgrade
their knowledge and clinical skills for
the care of older adults and adults
with functional and cognitive
limitations and to enhance their
interdisciplinary teaching skills.
(7) Priority.--In awarding grants under paragraph
(1), particularly with respect to awarding, in fiscal
year 2020, any amount appropriated for such fiscal year
for purposes of carrying out this subsection that is in
excess of the amount appropriated for the most previous
fiscal year for which appropriations were made for such
purposes, the Secretary may give priority to entities
that operate--
(A) in communities that have a shortage of
geriatric workforce professionals; and
(B) in States in which no entity has
previously received an award under such
paragraph (including as in effect before the
date of enactment of the Educating Medical
Professionals and Optimizing Workforce
Efficiency and Readiness for Health Act of
2019).
(8) Award amounts.--Awards under paragraph (1) shall
be in an amount determined by the Secretary. Entities
that submit applications under this subsection that
describe a plan for providing geriatric education and
training for home health workers and family caregivers
are eligible to receive $100,000 per year more than
entities that do not include a description of such a
plan.
(9) Reporting.--Each entity awarded a grant under
paragraph (1) shall submit an annual report to the
Secretary on financial and programmatic performance
under such grant, which may include factors such as the
number of trainees, the number of professions and
disciplines, the number of partnerships with health
care delivery sites, the number of faculty and
practicing professionals who participated in continuing
education programs, and such other factors as the
Secretary may require.
(b) Geriatric Academic Career Awards.--
(1) Establishment of program.--The Secretary shall
establish a program to award grants, to be known as
Geriatric Academic Career Awards, to eligible entities
applying on behalf of eligible individuals to promote
the career development of such individuals as academic
geriatricians or other academic geriatrics health
professionals.
(2) Eligibility.--
(A) Eligible entity.--For purposes of this
subsection, the term ``eligible entity''
means--
(i) an accredited school of
allopathic medicine, osteopathic
medicine, nursing, social work,
psychology, dentistry, pharmacy, or
allied health; or
(ii) another type of accredited
health professions school or graduate
program deemed by the Secretary to be
eligible under this subsection.
(B) Eligible individual.--
(i) In general.--For purposes of this
subsection, the term ``eligible
individual'' means an individual who--
(I) has a junior, nontenured,
faculty appointment at an
accredited school of allopathic
medicine, osteopathic medicine,
nursing, social work,
psychology, dentistry,
pharmacy, or allied health or
at another type of accredited
health professions school or
graduate program described in
subparagraph (A)(ii);
(II)(aa) is board certified
or board eligible in internal
medicine, family practice,
psychiatry, or licensed
dentistry, or has completed the
training required for the
individual's discipline; and
(bb) is employed at an
eligible entity; or
(III) has completed an
approved fellowship program in
geriatrics or gerontology, or
has completed specialty
training in geriatrics or
gerontology as required for the
individual's discipline and any
additional geriatrics or
gerontology training as
required by the Secretary.
(ii) Special rule.--If during the
period of an award under this
subsection respecting an eligible
individual, the individual is promoted
to associate professor and thereby no
longer meets the criteria of clause
(i)(I), the individual may continue to
be treated as an eligible individual
through the term of the award.
(3) Limitations.--An eligible entity may not receive
an award under paragraph (1) on behalf of an eligible
individual unless the eligible entity--
(A) submits to the Secretary an application,
at such time, in such manner, and containing
such information as the Secretary may require,
and the Secretary approves such application;
(B) provides, in such form and manner as the
Secretary may require, assurances that the
eligible individual on whose behalf an
application was submitted under subparagraph
(A) will meet the service requirement described
in paragraph (8); and
(C) provides, in such form and manner as the
Secretary may require, assurances that such
individual has a full-time faculty appointment
in an accredited health professions school or
graduate program and documented commitment from
such school or program to spend 75 percent of
the individual's time that is supported by the
award on teaching and developing skills in
interprofessional education in geriatrics.
(4) Requirements.--In awarding grants under this
subsection, the Secretary--
(A) shall give priority to eligible entities
that apply on behalf of eligible individuals
who are on the faculty of institutions that
integrate geriatrics education, training, and
best practices into academic program criteria;
(B) may give priority to eligible entities
that operate a geriatrics workforce enhancement
program under subsection (a);
(C) shall ensure that grants are equitably
distributed across the various geographical
regions of the United States, including rural
and underserved areas;
(D) shall pay particular attention to
geriatrics health care workforce needs among
underserved populations, diverse communities,
and rural areas;
(E) may not require an eligible individual,
or an eligible entity applying on behalf of an
eligible individual, to be a recipient of a
grant or contract under this part; and
(F) shall pay the full amount of the award to
the eligible entity.
(5) Maintenance of effort.--An eligible entity
receiving an award under paragraph (1) on behalf of an
eligible individual shall provide assurances to the
Secretary that funds provided to such individual under
this subsection will be used only to supplement, not to
supplant, the amount of Federal, State, and local funds
otherwise expended by such individual.
(6) Amount and term.--
(A) Amount.--The amount of an award under
this subsection for eligible individuals who
are physicians shall equal $100,000 for fiscal
year 2020, adjusted for subsequent fiscal years
to reflect the increase in the Consumer Price
Index. The Secretary shall determine the amount
of an award under this subsection for
individuals who are not physicians.
(B) Term.--The term of any award made under
this subsection shall not exceed 5 years.
(7) Service requirement.--An eligible individual on
whose behalf an application was submitted and approved
under paragraph (3)(A) shall provide training in
clinical geriatrics or gerontology, including the
training of interprofessional teams of health care
professionals.
(c) Authorization of Appropriations.--To carry out this
section, there is authorized to be appropriated $51,000,000 for
each of fiscal years 2020 through 2024. Notwithstanding the
preceding sentence, no funds shall be made available to carry
out subsection (b) for a fiscal year unless the amount made
available to carry out this section for such fiscal year is
more than the amount made available to carry out this section
for fiscal year 2017.
* * * * * * *
PART E--HEALTH PROFESSIONS AND PUBLIC HEALTH WORKFORCE
Subpart 1--Health Professions Workforce Information and Analysis
SEC. 761. HEALTH PROFESSIONS WORKFORCE INFORMATION AND ANALYSIS.
(a) Purpose.--It is the purpose of this section to--
(1) provide for the development of information
describing the health professions workforce and the
analysis of workforce related issues; and
(2) provide necessary information for decision-making
regarding future directions in health professions and
nursing programs in response to societal and
professional needs.
(b) National Center for Health Care Workforce Analysis.--
(1) Establishment.--The Secretary shall establish the
National Center for Health Workforce Analysis (referred
to in this section as the ``National Center'').
(2) Purposes.--The National Center, in coordination
to the extent practicable with the National Health Care
Workforce Commission (established in section 5101 of
the Patient Protection and Affordable Care Act), and
relevant regional and State centers and agencies,
shall--
(A) provide for the development of
information describing and analyzing the health
care workforce and workforce related issues;
(B) carry out the activities under section
792(a);
(C) annually evaluate programs under this
title;
(D) develop and publish performance measures
and benchmarks for programs under this title;
and
(E) establish, maintain, and publicize a
national Internet registry of each grant
awarded under this title and a database to
collect data from longitudinal evaluations (as
described in subsection (d)(2)) on performance
measures (as developed under sections
749(d)(3), 757(d)(3), and 762(a)(3)).
(3) Collaboration and data sharing.--
(A) In general.--The National Center shall
collaborate with Federal agencies and relevant
professional and educational organizations or
societies for the purpose of linking data
regarding grants awarded under this title.
(B) Contracts for health workforce
analysis.--For the purpose of carrying out the
activities described in subparagraph (A), the
National Center may enter into contracts with
relevant professional and educational
organizations or societies.
(c) State and Regional Centers for Health Workforce
Analysis.--
(1) In general.--The Secretary shall award grants to,
or enter into contracts with, eligible entities for
purposes of--
(A) collecting, analyzing, and reporting data
regarding programs under this title to the
National Center and to the public; and
(B) providing technical assistance to local
and regional entities on the collection,
analysis, and reporting of data.
(2) Eligible entities.--To be eligible for a grant or
contract under this subsection, an entity shall--
(A) be a State, a State workforce investment
board, a public health or health professions
school, an academic health center, or an
appropriate public or private nonprofit entity;
and
(B) submit to the Secretary an application at
such time, in such manner, and containing such
information as the Secretary may require.
(d) Increase in Grants for Longitudinal Evaluations.--
(1) In general.--The Secretary shall increase the
amount awarded to an eligible entity under this title
for a longitudinal evaluation of individuals who have
received education, training, or financial assistance
from programs under this title.
(2) Capability.--A longitudinal evaluation shall be
capable of--
(A) studying practice patterns; and
(B) collecting and reporting data on
performance measures developed under sections
749(d)(3), 757(d)(3), and 762(a)(3).
(3) Guidelines.--A longitudinal evaluation shall
comply with guidelines issued under sections 749(d)(4),
757(d)(4), and 762(a)(4).
(4) Eligible entities.--To be eligible to obtain an
increase under this section, an entity shall be a
recipient of a grant or contract under this title.
(e) Authorization of Appropriations.--
(1) In general.--
(A) National center.--To carry out subsection
(b), there are authorized to be appropriated
[$7,500,000 for each of fiscal years 2010
through 2014] $5,947,000 for each of fiscal
years 2020 through 2024.
(B) State and regional centers.--To carry out
subsection (c), there are authorized to be
appropriated $4,500,000 for each of fiscal
years 2010 through 2014.
(C) Grants for longitudinal evaluations.--To
carry out subsection (d), there are authorized
to be appropriated such sums as may be
necessary for fiscal years 2010 through 2014.
(2) Reservation.--Of the amounts appropriated under
[subsection (a)] paragraph (1) for a fiscal year, the
Secretary shall reserve not less than $600,000 for
conducting health professions research and for carrying
out data collection and analysis in accordance with
section 792.
(3) Availability of additional funds.--Amounts
otherwise appropriated for programs or activities under
this title may be used for activities under subsection
(b) with respect to the programs or activities from
which such amounts were made available.
* * * * * * *
Subpart 2--Public Health Workforce
* * * * * * *
SEC. 770. AUTHORIZATION OF APPROPRIATIONS.
(a) In General.--For the purpose of carrying out this
subpart, there is authorized to be appropriated [$43,000,000
for fiscal year 2011, and such sums as may be necessary for
each of the fiscal years 2012 through 2015] $17,850,000 for
each of fiscal years 2020 through 2024.
(b) Limitation Regarding Certain Program.--In obligating
amounts appropriated under subsection (a), the Secretary may
not obligate more than 30 percent for carrying out section 767.
Subpart 3--Recruitment and Retention Programs
[SEC. 775. INVESTMENT IN TOMORROW'S PEDIATRIC HEALTH CARE WORKFORCE.
[(a) Establishment.--The Secretary shall establish and carry
out a pediatric specialty loan repayment program under which
the eligible individual agrees to be employed full-time for a
specified period (which shall not be less than 2 years) in
providing pediatric medical subspecialty, pediatric surgical
specialty, or child and adolescent mental and behavioral health
care, including substance abuse prevention and treatment
services.
[(b) Program Administration.--Through the program established
under this section, the Secretary shall enter into contracts
with qualified health professionals under which--
[(1) such qualified health professionals will agree
to provide pediatric medical subspecialty, pediatric
surgical specialty, or child and adolescent mental and
behavioral health care in an area with a shortage of
the specified pediatric subspecialty that has a
sufficient pediatric population to support such
pediatric subspecialty, as determined by the Secretary;
and
[(2) the Secretary agrees to make payments on the
principal and interest of undergraduate, graduate, or
graduate medical education loans of professionals
described in paragraph (1) of not more than $35,000 a
year for each year of agreed upon service under such
paragraph for a period of not more than 3 years during
the qualified health professional's--
[(A) participation in an accredited pediatric
medical subspecialty, pediatric surgical
specialty, or child and adolescent mental
health subspecialty residency or fellowship; or
[(B) employment as a pediatric medical
subspecialist, pediatric surgical specialist,
or child and adolescent mental health
professional serving an area or population
described in such paragraph.
[(c) In General.--
[(1) Eligible individuals.--
[(A) Pediatric medical specialists and
pediatric surgical specialists.--For purposes
of contracts with respect to pediatric medical
specialists and pediatric surgical specialists,
the term ``qualified health professional''
means a licensed physician who--
[(i) is entering or receiving
training in an accredited pediatric
medical subspecialty or pediatric
surgical specialty residency or
fellowship; or
[(ii) has completed (but not prior to
the end of the calendar year in which
this section is enacted) the training
described in subparagraph (B).
[(B) Child and adolescent mental and
behavioral health.--For purposes of contracts
with respect to child and adolescent mental and
behavioral health care, the term ``qualified
health professional'' means a health care
professional who--
[(i) has received specialized
training or clinical experience in
child and adolescent mental health in
psychiatry, psychology, school
psychology, behavioral pediatrics,
psychiatric nursing, social work,
school social work, substance abuse
disorder prevention and treatment,
marriage and family therapy, school
counseling, or professional counseling;
[(ii) has a license or certification
in a State to practice allopathic
medicine, osteopathic medicine,
psychology, school psychology,
psychiatric nursing, social work,
school social work, marriage and family
therapy, school counseling, or
professional counseling; or
[(iii) is a mental health service
professional who completed (but not
before the end of the calendar year in
which this section is enacted)
specialized training or clinical
experience in child and adolescent
mental health described in clause (i).
[(2) Additional eligibility requirements.--The
Secretary may not enter into a contract under this
subsection with an eligible individual unless--
[(A) the individual agrees to work in, or for
a provider serving, a health professional
shortage area or medically underserved area, or
to serve a medically underserved population;
[(B) the individual is a United States
citizen or a permanent legal United States
resident; and
[(C) if the individual is enrolled in a
graduate program, the program is accredited,
and the individual has an acceptable level of
academic standing (as determined by the
Secretary).
[(d) Priority.--In entering into contracts under this
subsection, the Secretary shall give priority to applicants
who--
[(1) are or will be working in a school or other pre-
kindergarten, elementary, or secondary education
setting;
[(2) have familiarity with evidence-based methods and
cultural and linguistic competence health care
services; and
[(3) demonstrate financial need.
[(e) Authorization of Appropriations.--There is authorized to
be appropriated $30,000,000 for each of fiscal years 2010
through 2014 to carry out subsection (c)(1)(A) and $20,000,000
for each of fiscal years 2010 through 2013 to carry out
subsection (c)(1)(B).]
SEC. 775. INVESTMENT IN TOMORROW'S PEDIATRIC HEALTH CARE WORKFORCE.
(a) In General.--The Secretary shall establish and carry out
a program of entering into pediatric specialty loan repayment
agreements with qualified health professionals under which--
(1) the qualified health professional agrees to a
period of not less than 2 years of obligated service
during which the professional will--
(A) participate in an accredited pediatric
medical subspecialty, pediatric surgical
specialty, child and adolescent psychiatry
subspecialty, or child and adolescent mental
and behavioral health residency or fellowship;
or
(B) be employed full-time in providing
pediatric medical subspecialty care, pediatric
surgical specialty care, child and adolescent
psychiatry subspecialty care, or child and
adolescent mental and behavioral health care,
including substance use disorder prevention and
treatment services, in an area with--
(i) a shortage of health care
professionals practicing in the
pediatric medical subspecialty, the
pediatric surgical specialty, the child
and adolescent psychiatry subspecialty,
or child and adolescent mental and
behavioral health, as applicable; and
(ii) a sufficient pediatric
population, as determined by the
Secretary, to support the addition of a
practitioner in the pediatric medical
subspecialty, the pediatric surgical
specialty, the child and adolescent
psychiatry subspecialty, or child and
adolescent mental and behavioral
health, as applicable; and
(2) the Secretary agrees to make payments on the
principal and interest of undergraduate, graduate, or
graduate medical education loans of the qualified
health professional of not more than $35,000 a year for
each year of agreed upon service under paragraph (1)
for a period of not more than 3 years.
(b) Eligibility Requirements.--
(1) Pediatric medical specialists and pediatric
surgical specialists.--For purposes of loan repayment
agreements under this section with respect to pediatric
medical subspecialty and pediatric surgical specialty
practitioners, the term ``qualified health
professional'' means a licensed physician who--
(A) is entering or receiving training in an
accredited pediatric medical subspecialty or
pediatric surgical subspecialty residency or
fellowship; or
(B) has completed (but not prior to the end
of the calendar year in which the Educating
Medical Professionals and Optimizing Workforce
Efficiency and Readiness for Health Act of 2019
is enacted) the training described in
subparagraph (A).
(2) Child and adolescent psychiatry and mental and
behavioral health.--For purposes of loan repayment
agreements under this section with respect to child and
adolescent mental and behavioral health care, the term
``qualified health professional'' means a health care
professional who--
(A) has received specialized training or
clinical experience in child and adolescent
mental health in psychiatry, psychology, school
psychology, or psychiatric nursing;
(B) has a license or certification in a State
to practice allopathic medicine, osteopathic
medicine, psychology, school psychology, or
psychiatric nursing; or
(C) is a mental health service professional
who has completed (but not before the end of
the calendar year in which the Educating
Medical Professionals and Optimizing Workforce
Efficiency and Readiness for Health Act of 2019
is enacted) specialized training or clinical
experience in child and adolescent mental
health described in subparagraph (A).
(3) Additional eligibility requirements.--The
Secretary may not enter into a loan repayment agreement
under this section with a qualified health professional
unless--
(A) the professional agrees to work in, or
for a provider serving, an area or community
with a shortage of eligible qualified health
professionals (as defined in paragraphs (1) and
(2));
(B) the professional is a United States
citizen, a permanent legal United States
resident, or lawfully present in the United
States; and
(C) if the professional is enrolled in a
graduate program, the program is accredited,
and the professional has an acceptable level of
academic standing (as determined by the
Secretary).
(c) Priority.--In entering into loan repayment agreements
under this section, the Secretary shall give priority to
applicants who--
(1) have familiarity with evidence-based methods and
cultural and linguistic competence in health care
services; and
(2) demonstrate financial need.
(d) Authorization of Appropriations.--There are authorized to
be appropriated for each of fiscal years 2020 through 2024--
(1) $30,000,000 to carry out this section with
respect to loan repayment agreements with qualified
health professionals described in subsection (b)(1);
and
(2) $20,000,000 to carry out this section with
respect to loan repayment agreements with respect to
qualified health professionals described in subsection
(b)(2).
* * * * * * *
PART G--INCREASING WORKFORCE DIVERSITY IN THE PROFESSIONS OF PHYSICAL
THERAPY, OCCUPATIONAL THERAPY, AUDIOLOGY, AND SPEECH-LANGUAGE PATHOLOGY
SEC. 783. SCHOLARSHIPS AND STIPENDS.
(a) In General.--The Secretary may award grants and contracts
to eligible entities to increase educational opportunities in
the professions of physical therapy, occupational therapy,
audiology, and speech-language pathology for eligible
individuals by--
(1) providing student scholarships or stipends,
including for--
(A) completion of an accelerated degree
program;
(B) completion of an associate's, bachelor's,
master's, or doctoral degree program; and
(C) entry by a diploma or associate's degree
practitioner into a bridge or degree completion
program;
(2) providing assistance for completion of
prerequisite courses or other preparation necessary for
acceptance for enrollment in the eligible entity; and
(3) carrying out activities to increase the retention
of students in one or more programs in the professions
of physical therapy, occupational therapy, audiology,
and speech-language pathology.
(b) Consideration of Recommendations.--In carrying out
subsection (a), the Secretary shall take into consideration the
recommendations of national organizations representing the
professions of physical therapy, occupational therapy,
audiology, and speech-language pathology, including the
American Physical Therapy Association, the American
Occupational Therapy Association, the American Speech-Language-
Hearing Association, the American Academy of Audiology, and the
Academy of Doctors of Audiology.
(c) Required Information and Conditions for Award
Recipients.--
(1) In general.--The Secretary may require recipients
of awards under this section to report to the Secretary
concerning the annual admission, retention, and
graduation rates for eligible individuals in programs
of the recipient leading to a degree in any of the
professions of physical therapy, occupational therapy,
audiology, and speech-language pathology.
(2) Falling rates.--If any of the rates reported by a
recipient under paragraph (1) fall below the average
for such recipient over the two years preceding the
year covered by the report, the recipient shall provide
the Secretary with plans for immediately improving such
rates.
(3) Ineligibility.--A recipient described in
paragraph (2) shall be ineligible for continued funding
under this section if the plan of the recipient fails
to improve the rates within the 1-year period beginning
on the date such plan is implemented.
(d) Definitions.--In this section:
(1) Eligible entities.--The term ``eligible entity''
means an education program that--
(A) is accredited by--
(i) the Council on Academic
Accreditation in Audiology and Speech-
Language Pathology or the Accreditation
Commission for Audiology Education;
(ii) the Commission on Accreditation
in Physical Therapy Education; or
(iii) the Accreditation Council for
Occupational Therapy Education; and
(B) is carrying out a program for recruiting
and retaining students underrepresented in the
professions of physical therapy, occupational
therapy, audiology, and speech-language
pathology (including racial or ethnic
minorities, or students from disadvantaged
backgrounds).
(2) Eligible individual.--The term ``eligible
individual'' means an individual who--
(A) is a member of a class of persons who are
underrepresented in the professions of physical
therapy, occupational therapy, audiology, and
speech-language pathology (including
individuals who are racial or ethnic
minorities, or are from disadvantaged
backgrounds);
(B) has a financial need for a scholarship or
stipend; and
(C) is enrolled (or accepted for enrollment)
at an audiology, speech-language pathology,
physical therapy, or occupational therapy
program as a full-time student at an eligible
entity.
(e) Authorization of Appropriations.--There are authorized to
be appropriated to carry out this section $5,000,000 for each
of fiscal years 2020 through 2024.
PART [G] H--GENERAL PROVISIONS
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