[Congressional Bills 103th Congress]
[From the U.S. Government Publishing Office]
[H.R. 3089 Introduced in House (IH)]

103d CONGRESS
  1st Session
                                H. R. 3089

 To provide for programs and activities regarding primary health care.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                           September 15, 1993

 Mr. Klug introduced the following bill; which was referred jointly to 
 the Committees on Energy and Commerce, Ways and Means, and Education 
                               and Labor

_______________________________________________________________________

                                 A BILL


 
 To provide for programs and activities regarding primary health care.

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

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Family Medicine and Primary Care 
Research Act of 1993''.

      TITLE I--OFFICE OF FAMILY MEDICINE AND PRIMARY CARE RESEARCH

SEC. 101. ESTABLISHMENT OF OFFICE OF FAMILY MEDICINE AND PRIMARY CARE 
              RESEARCH.

    Subpart A of title IV of the Public Health Service Act (42 U.S.C. 
281 et seq.), as amended by section 209 of Public Law 103-43 (107 Stat. 
149), is amended by adding at the end the following section:

         ``office of family medicine and primary care research

    ``Sec. 404F. (a) In General.--There is established within the 
Office of the Director of NIH an office to be known as the Office on 
Family Medicine and Primary Care Research (in this section referred to 
as the `Office'), which shall be headed by a director appointed by the 
Director of NIH.
    ``(b) Duties.--
            ``(1) In general.--With respect to the field of family 
        medicine and other primary medical care disciplines, the 
        Director of the Office shall monitor and coordinate all 
        activities of the National Institutes of Health, including 
        biomedical, social, and behavioral research and activities 
        regarding training and the dissemination of health information.
            ``(2) Priorities.--In carrying out paragraph (1), the 
        Director of the Office shall give priority--
                    ``(A) to activities regarding the prevention, 
                diagnosis, and treatment of medical illness in the 
                primary medical practice setting, and during early 
                stages of the development of the disease processes; and
                    ``(B) to conducting research on the capacity of 
                physicians in the disciplines of family medicine and 
                other primary care medical specialties to provide an 
                integrated set of preventive and curative services 
                addressing the broadest scope of disease presentations.
    ``(c) Plan.--The Director of the Office shall prepare and transmit 
to the Director of NIH a plan for a national family medicine and 
primary care research program to establish, expand, intensify, and 
coordinate the activities of the Institute respecting family medicine 
and primary care research.
    ``(d) Academic Health Centers.--The Director of NIH, in 
collaboration with the Director of the Office, shall in carrying out 
subsection (a) provide for the development, modernization, and 
operation (including staffing and other operating costs such as the 
costs of patient care required for research) of new and existing 
centers for research in family care medicine and primary care.
    ``(e) Advisory Council.--The Secretary shall appoint an advisory 
council for the Office to advise, assist, consult with, and make 
recommendations to the Secretary and the Director of the Office on 
matters related to the activities carried out under this section.
    ``(f) Biennial Report.--The Director of the Office, after 
consultation with the advisory council established under subsection 
(e), shall prepare for inclusion in the biennial report made under 
section 403 a biennial report which shall consist of a description of 
the activities of the Office and program policies of the Director of 
the Office in the fiscal years respecting which the report is prepared, 
including the program required under subsection (c).''.

    TITLE II--INCENTIVES FOR RURAL PHYSICIANS REGARDING PRIMARY CARE

SEC. 201. DEDUCTION FOR MEDICAL SCHOOL EDUCATION LOAN INTEREST INCURRED 
              BY DOCTORS SERVING IN MEDICALLY UNDERSERVED RURAL AREAS.

    (a) In General.--Paragraph (1) of section 163(h) of the Internal 
Revenue Code of 1986 (relating to disallowance of deduction for 
personal interest) is amended by striking ``and'' at the end of 
subparagraph (D), by redesignating subparagraph (E) as subparagraph 
(F), and by inserting after subparagraph (D) the following new 
subparagraph:
                    ``(E) any qualified medical education loan interest 
                (within the meaning of paragraph (5)), and''.
    (b) Qualified Medical Education Loan Interest Defined.--Subsection 
(h) of section 163 of such Code is amended by redesignating paragraph 
(5) as paragraph (6) and by inserting after paragraph (4) the following 
new paragraph:
            ``(5) Qualified medical education loan interest.--
                    ``(A) In general.--The term `qualified medical 
                education loan interest' means interest--
                            ``(i) which is on a medical education loan 
                        of a physician,
                            ``(ii) which is paid or accrued by such 
                        physician, and
                            ``(iii) which accrues during the period--
                                    ``(I) such physician is providing 
                                primary care (including general 
                                internal medicine, general pediatrics, 
                                family medicine, and osteopathy), or 
                                obstetrical and gynecology services, to 
                                residents of a medically underserved 
                                rural area, and
                                    ``(II) such physician's principal 
                                place of abode is in such area.
                    ``(B) Medical education loan.--The term `medical 
                education loan' means indebtedness incurred to pay the 
                individual's--
                            ``(i) qualified tuition and related 
                        expenses (as defined in section 117(b)) 
                        incurred for the medical education of such 
                        individual, or
                            ``(ii) reasonable living expenses while 
                        away from home in order to attend an 
                        educational institution described in section 
                        170(b)(1)(A)(ii) for the medical education of 
                        such individual.
                    ``(C) Physician.--For purposes of subparagraph (A), 
                the term `physician' has the meaning given such term by 
                section 1861(r)(1) of the Social Security Act.
                    ``(D) Medically underserved rural area.--The term 
                `medically underserved rural area' means any rural area 
                which is a medically underserved area (as defined in 
                section 330(b) or 1302(7) of the Public Health Service 
                Act).''.
    (c) Effective Date.--The amendments made by this section shall 
apply to taxable years ending after the date of the enactment of this 
Act.

SEC. 202. EXTENSION OF DEFERMENTS.

    (a) Stafford Loans.--
            (1) GSL loans.--Section 428(b)(1)(M) of the Higher 
        Education Act of 1965 (20 U.S.C. 1078(b)(1)(M)) is amended--
                    (A) by striking ``or'' at the end of clause (ii);
                    (B) by inserting ``or'' after the semicolon at the 
                end of clause (iii); and
                    (C) by adding at the end thereof the following new 
                clause:
                            ``(iv) during which the borrower is serving 
                        in an internship or residency program in 
                        preparation for practice in an area of primary 
                        care (including general internal medicine, 
                        general pediatrics, family medicine, and 
                        osteopathy) or in obstetrics and gynecology;''.
            (2) FISL loans.--Section 427(a)(2)(C) of such Act (20 
        U.S.C. 1077(a)(2)(C)) is amended--
                    (A) by striking ``or'' at the end of clause (ii);
                    (B) by inserting ``or'' after the semicolon at the 
                end of clause (iii); and
                    (C) by adding at the end thereof the following new 
                clause:
                            ``(iv) during which the borrower is serving 
                        in an internship or residency program in 
                        preparation for practice in an area of primary 
                        care (including general internal medicine, 
                        general pediatrics, family medicine, and 
                        osteopathy) or in obstetrics and gynecology;''.
    (b) Perkins Loans.--Section 464(c)(2)(A) of such Act (20 U.S.C. 
1087dd(c)(2)(A)) is amended--
            (1) by striking ``or'' at the end of clause (iii);
            (2) by inserting ``or'' after the semicolon at the end of 
        clause (iv); and
            (3) by adding at the end thereof the following new clause:
                            ``(v) during which the borrower is serving 
                        in an internship or residency program in 
                        preparation for practice in an area of primary 
                        care (including general internal medicine, 
                        general pediatrics, family medicine, and 
                        osteopathy) or in obstetrics and gynecology;''.
    (c) Effective Date.--The amendments made by this section shall 
apply to on and after the date of the enactment of this Act with 
respect to loans made under the Higher Education Act of 1965 before, 
on, or after that date.

SEC. 203. CLARIFICATION OF PERMISSIBLE SUBSTITUTE BILLING ARRANGEMENTS 
              FOR PHYSICIANS' SERVICES UNDER THE MEDICARE AND MEDICAID 
              PROGRAMS.

    (a) Medicare Program.--
            (1) In general.--Clause (D) of section 1842(b)(6) of the 
        Social Security Act (42 U.S.C. 1395u(b)(6)) is amended to read 
        as follows: ``(D)(i) payment may be made to a physician for 
        physicians' services (and services incident to such services) 
        to be provided by a second physician on a reciprocal basis to 
        individuals who are patients of the first physician if (I) the 
        first physician is unavailable to provide the services, (II) 
        the services are not provided by the second physician over a 
        continuous period of longer than 60 days, and (III) the claim 
        form submitted to the carrier includes the second physician's 
        unique identifier (provided under the system established under 
        subsection (r)) and indicates that the claim meets the 
        requirements of this clause for payment to the first physician; 
        and (ii) payment may be made to a physician for physicians' 
        services (and services incident to such services) which that 
        physician pays a second physician on a per diem or other fee-
        for-time basis to provide to individuals who are patients of 
        the first physician if (I) the first physician is unavailable 
        to provide the services, (II) the services are not provided by 
        the second physician over a continuous period of longer than 90 
        days (or such longer period as the Secretary may provide), and 
        (III) the claim form submitted to the carrier includes the 
        second physician's unique identifier (provided under the system 
        established under subsection (r)) and indicates that the claim 
        meets the requirements of this clause for payment to the first 
        physician''.
            (2) Effective date.--The amendment made by paragraph (1) 
        shall apply to services furnished on or after the first day of 
        the first month beginning more than 60 days after the date of 
        the enactment of this Act.
    (b) Medicaid Program.--
            (1) In general.--Section 1902(a)(32)(C) of the Social 
        Security Act (42 U.S.C. 1396a(a)(32)(C)) is amended to read as 
        follows:
                    ``(C) payment may be made to a physician for 
                services furnished by a substitute physician under the 
                circumstances described in subparagraph (D) of section 
                1842(b)(6), except that, for purposes of this 
                subparagraph, any reference in such subparagraph to `a 
                carrier' or `the system established under subsection 
                (r)' is deemed a reference to the State (or other 
                fiscal agent under the State plan) and to the system 
                established under subsection (x) of this section, 
                respectively.''.
            (2) Effective date.--(A) The amendment made by paragraph 
        (1) shall apply to services furnished on or after the date of 
        the enactment of this Act.
            (B) Until the first day of the first calendar quarter 
        beginning more than 60 days after the date the Secretary of 
        Health and Human Services establishes the physician identifier 
        system under section 1902(x) of the Social Security Act, the 
        requirement under section 1902(a)(32)(C) of such Act that a 
        claim form submitted must include the second physician's unique 
        identifier is deemed to be satisfied if the claim form 
        identifies (in a manner specified by the Secretary of Health 
        and Human Services) the second physician.

  TITLE III--PRIMARY CARE PHYSICIANS UNDER APPROVED MEDICAL RESIDENCY 
                           TRAINING PROGRAMS

SEC. 301. DISTRIBUTION OF PRIMARY CARE PHYSICIANS UNDER APPROVED 
              MEDICAL RESIDENCY TRAINING PROGRAMS.

    (a) Establishment of 50/50 Rule as National Policy.--
            (1) In general.--The Secretary of Health and Human Services 
        shall establish a national policy providing that, after a 3-
        year transition period beginning on June 1, 1995, the number of 
        entry positions in all approved medical residency training 
        programs in a State or region for residents who begin an 
        initial residency period on or after June 1, 1998, who are not 
        primary care residents may not exceed 50 percent of the total 
        number of entry positions in all such programs in a State for 
        all residents who are medical graduates.
            (2) Waiver for certain states.--The Secretary may waive the 
        application of the general rule described in paragraph (1) to a 
        State if the Secretary finds that the application of the rule 
        to the State is not practicable.
            (3) Timetable.--
                    (A) Publication of interim final regulation.--The 
                Secretary shall publish an interim final regulation 
                carrying out the national policy referred to in 
                paragraph (1) not later than 60 days after the National 
                Health Professional Workforce Advisory Board submits 
                its recommendations to the Secretary regarding such 
                national policy pursuant to subsection (c)(2).
                    (B) Use of board's recommendations as default 
                policy.--If the Secretary does not meet the 
                requirements of subparagraph (A), the recommendations 
                of the National Health Professional Workforce Advisory 
                Board submitted to the Secretary pursuant to subsection 
                (c)(2) shall, for purposes of this section and the 
                amendments made by this section, be deemed to be the 
                national policy established by the Secretary under 
                paragraph (1) respecting the number of positions in 
                each State or region in the approved medical residency 
                training programs of the different medical specialties 
                conducted in the State.
    (b) Assuring Conformity of Medicare Payments for Medical Education 
With National Policy.--
            (1) Payment for direct medical education.--Section 
        1886(h)(5)(A) of the Social Security Act (42 U.S.C. 
        1395ww(h)(5)(A)) is amended--
                    (A) by striking ``means'' and inserting ``means, 
                with respect to a hospital,''; and
                    (B) by striking the period at the end and inserting 
                the following: ``, but only if (with respect to 
                residents who begin an initial residency period on or 
                after June 1, 1995) entry positions in each such 
                program of the hospital are in accordance with the 
                national policy established by the Secretary under 
                section 301(a) of the Family Medicine and Primary Care 
                Research Act of 1993 respecting the number of positions 
                in such program.''.
            (2) Payment for indirect medical education.--Section 
        1886(d)(5)(B) of such Act (42 U.S.C. 1395ww(d)(5)(B)) is 
        amended by adding at the end the following new clauses:
            ``(v) In determining such adjustment, the Secretary may not 
        take into account the services of any interns and residents in 
        a medical residency training program for a specialty or 
        subspecialty unless, with respect to interns and residents who 
        begin an initial residency period (as defined in subsection 
        (h)(5)(F)) on or after June 1, 1995, entry positions in each 
        such program of the hospital are in accordance with the 
        national policy established by the Secretary under section 
        301(a) of the Family Medicine and Primary Care Research Act of 
        1993 respecting the number of positions in such program.
            ``(vi) With respect to payments during each of the first 5 
        fiscal years for which clause (v) is in effect, the application 
        of such clause may not result in a reduction of the additional 
        payment amount made to the hospital under this subparagraph 
        during the fiscal year to an amount that is less than--
                    ``(I) in the case of a hospital receiving an 
                additional payment amount under subparagraph (F) during 
                the fiscal year that is computed under clause (vii)(I) 
                of such subparagraph, 95 percent of the additional 
                payment amount made to the hospital under this 
                subparagraph during the previous fiscal year; or
                    ``(II) in the case of any other hospital, 90 
                percent of the additional payment amount made to the 
                hospital under this subparagraph during the previous 
                fiscal year.''.
    (c) National Health Professional Workforce Advisory Board.--
            (1) Establishment; composition.--There is hereby 
        established the National Health Professional Workforce Advisory 
        Board (hereafter in this subsection referred to as the 
        ``Board''), to be composed of the Secretary of Health and Human 
        Services, the Secretary of Veterans' Affairs, and 7 other 
        members appointed by the President not later than 3 months 
        after the date of the enactment of this Act, of whom--
                    (A) at least 1 shall be a dean of a school of 
                medicine;
                    (B) at least 1 shall be a health care professional 
                who is not a physician;
                    (C) at least 3 shall be the program directors of 
                approved medical residency training programs in each of 
                the 3 primary care disciplines;
                    (D) at least 1 shall be the chief executive officer 
                of a hospital that operates an approved medical 
                residency training program;
                    (E) at least 1 shall be the vice-president or vice-
                chancellor for health affairs of a multi-disciplinary 
                academic health center; and
                    (F) at least 1 shall represent the general public.
            (2) Duties.--
                    (A) In general.--The Board shall--
                            (i) prepare initial recommendations 
                        regarding the national policy referred to in 
                        subsection (a)(1) regarding the distribution of 
                        entry positions in approved medical residency 
                        training programs of the different medical 
                        specialties among primary care and non-primary 
                        care residents at various sites, and submit 
                        such recommendations to the Secretary not later 
                        than 1 year after the date of the enactment of 
                        this Act;
                            (ii) submit recommendations to the 
                        Secretary regarding the supply and role of 
                        providers of primary care services who are not 
                        physicians;
                            (iii) with respect to funds available 
                        pursuant to title XVIII of the Social Security 
                        Act for direct graduate medical education for 
                        the clinical training of physicians and nurses, 
                        study the appropriateness of expending such 
                        funds to make reimbursements under such title 
                        for the clinical training in primary care of 
                        additional practitioners;
                            (iv) submit annual reports to Congress and 
                        the Secretary on the implementation of such 
                        national policy; and
                            (v) provide the Secretary with such 
                        technical and other assistance regarding such 
                        national policy as the Secretary may request.
                    (B) Criteria for recommendations.--In preparing its 
                recommendations under subparagraph (A), the Board shall 
                take into consideration--
                            (i) the quality of graduate medical 
                        residency training programs;
                            (ii) the need to maintain the operation of 
                        such programs that have demonstrated success in 
                        recruiting, retaining, and promoting minority 
                        practitioners;
                            (iii) the need to assure that the 
                        distribution of entry positions in such 
                        programs is not inequitable in relation to the 
                        States and hospitals in urban and rural areas 
                        that are qualified to offer such programs;
                            (iv) the need to assure the provision of 
                        primary care and other health care services to 
                        medically underserved communities; and
                            (v) such other criteria as the Board (in 
                        consultation with the accrediting bodies 
                        referred to in paragraph (3)) considers 
                        appropriate.
            (3) Role of accrediting bodies and certifying boards.--In 
        preparing its recommendations regarding the national policy 
        referred to in subsection (a)(1), the Board shall--
                    (A) request each accrediting body for approved 
                medical residency training programs for a specialty or 
                subspecialty, and each certification board for such 
                specialty or subspecialty, to prepare and submit a plan 
                that provides for the achievement of such national 
                policy with respect to approved medical residency 
                training programs for such specialty or subspecialty;
                    (B) analyze the extent to which the Board may adopt 
                such plans as the basis for its recommendations; and
                    (C) maintain close consultation with such bodies 
                and boards throughout the process of preparing its 
                recommendations.
            (4) Chairperson; additional duties.--The President shall 
        designate a Chairperson from among the members, who (subject to 
        the approval of the Board) may--
                    (A) employ and fix the compensation of an Executive 
                Director and such other personnel (not to exceed 25) as 
                may be necessary to carry out the Board's duties;
                    (B) seek such assistance and support as may be 
                required in the performance of the Board's duties from 
                appropriate Federal departments and agencies;
                    (C) enter into contracts or make other 
                arrangements, as may be necessary for the conduct of 
                the work of the Board (without regard to section 3709 
                of the Revised Statutes (41 U.S.C. 5));
                    (D) make advance, progress, and other payments 
                which relate to the work of the Commission;
                    (E) provide transportation and subsistence for 
                persons serving without compensation; and
                    (F) prescribe such rules and regulations as the 
                Board deems necessary with respect to its internal 
                organization and operation.
            (5) Compensation.--Members of the Board who are full-time 
        officers or employees of the United States may not receive 
        additional pay, allowances, or benefits by reason of their 
        service on the Board, but may receive travel expenses, 
        including per diem in lieu of subsistence, in accordance with 
        sections 5702 and 5703 of title 5, United States Code.
            (6) Termination.--The Board shall terminate upon the 
        expiration of the 6-year period that begins on the date of the 
        enactment of this act. Section 14(a) of the Federal Advisory 
        Committee Act (5 U.S.C. App.; relating to the termination of 
        advisory committees) shall not apply to the Board.
            (7) Conforming amendment repealing council on graduate 
        medical education.--Effective on the date of the enactment of 
        this Act, section 301 of the Health Professions Education 
        Extension Amendments of 1992 (Public Law 102-408) is repealed.
    (d) Annual Publication of Medicare Payments for Direct Graduate 
Medical Education Costs.--Not later than March of each year (beginning 
with 1994), the Secretary of Health and Human Services shall publish in 
the Federal Register a list of the total amount of payments made to 
each hospital in the United States during the previous year under 
section 1886(h) of the Social Security Act for the direct costs of 
graduate medical education.

                                 <all>

HR 3089 IH----2