[Congressional Bills 107th Congress]
[From the U.S. Government Publishing Office]
[S. 1387 Introduced in Senate (IS)]







107th CONGRESS
  1st Session
                                S. 1387

  To conduct a demonstration program to show that physician shortage, 
recruitment, and retention problems may be ameliorated in rural States 
  by developing a comprehensive program that will result in statewide 
          physician population growth, and for other purposes.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                             August 3, 2001

     Mr. Bingaman (for himself, Mr. Domenici, and Mr. Rockefeller) 
introduced the following bill; which was read twice and referred to the 
                          Committee on Finance

_______________________________________________________________________

                                 A BILL


 
  To conduct a demonstration program to show that physician shortage, 
recruitment, and retention problems may be ameliorated in rural States 
  by developing a comprehensive program that will result in statewide 
          physician population growth, and for other purposes.

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

SECTION 1. SHORT TITLE; TABLE OF CONTENTS.

    (a) Short Title.--This Act may be cited as the ``Rural States 
Physician Recruitment and Retention Demonstration Act of 2001''.
    (b) Table of Contents.--The table of contents of this Act is as 
follows:

Sec. 1. Short title; table of contents.
Sec. 2. Definitions.
Sec. 3. Rural States Physician Recruitment and Retention Demonstration 
                            Program.
Sec. 4. Establishment of the Health Professions Database.
Sec. 5. Evaluation and reports.
Sec. 6. Contracting flexibility.

SEC. 2. DEFINITIONS.

    In this Act:
            (1) COGME.--The term ``COGME'' means the Council on 
        Graduate Medical Education established under section 762 of the 
        Public Health Service Act (42 U.S.C. 294o).
            (2) Demonstration program.--The term ``demonstration 
        program'' means the Rural States Physician Recruitment and 
        Retention Demonstration Program established by the Secretary 
        under section 3(a).
            (3) Demonstration states.--The term ``demonstration 
        States'' means each State identified by the Secretary, based 
        upon data from the most recent year for which data are 
        available--
                    (A) that has an uninsured population above 16 
                percent (as determined by the Bureau of the Census);
                    (B) for which the sum of the number of individuals 
                who are entitled to benefits under the medicare program 
                and the number of individuals who are eligible for 
                medical assistance under the medicaid program under 
                title XIX of the Social Security Act (42 U.S.C. 1396 et 
                seq.) equals or exceeds 20 percent of the total 
                population of the State (as determined by the Centers 
                for Medicare & Medicaid Services); and
                    (C) that has an estimated number of individuals in 
                the State without access to a primary care provider of 
                at least 17 percent (as published in ``HRSA's Bureau of 
                Primary Health Care: BPHC State Profiles'').
            (4) Eligible residency or fellowship graduate.--The term 
        ``eligible residency or fellowship graduate'' means a graduate 
        of an approved medical residency training program (as defined 
        in section 1886(h)(5)(A) of the Social Security Act (42 U.S.C. 
        1395ww(h)(5)(A))) in a shortage physician specialty.
            (5) Health professions database.--The term ``Health 
        Professions Database'' means the database established under 
        section 4(a).
            (6) Medicare program.--The term ``medicare program'' means 
        the health benefits program under title XVIII of the Social 
        Security Act (42 U.S.C. 1395 et seq.).
            (7) MedPAC.--The term ``MedPAC'' means the Medicare Payment 
        Advisory Commission established under section 1805 of the 
        Social Security Act (42 U.S.C. 1395b-6).
            (8) Secretary.--The term ``Secretary'' means the Secretary 
        of Health and Human Services.
            (9) Shortage physician specialty.--The term ``shortage 
        physician specialty'' means a medical or surgical specialty 
        identified in a demonstration State by the Secretary based on--
                    (A) an analysis and comparison of national data and 
                demonstration State data; and
                    (B) recommendations from appropriate Federal, 
                State, and private commissions, centers, councils, 
                medical and surgical physician specialty boards, and 
                medical societies or associations involved in physician 
                workforce, education and training, and payment issues.

SEC. 3. RURAL STATES PHYSICIAN RECRUITMENT AND RETENTION DEMONSTRATION 
              PROGRAM.

    (a) Establishment.--
            (1) In general.--The Secretary shall establish a Rural 
        States Physician Recruitment and Retention Demonstration 
        Program for the purpose of ameliorating physician shortage, 
        recruitment, and retention problems in rural States in 
        accordance with the requirements of this section.
            (2) Consultation.--For purposes of establishing the 
        demonstration program, the Secretary shall consult with--
                    (A) COGME;
                    (B) MedPAC;
                    (C) a representative of each demonstration State 
                medical society or association;
                    (D) the health workforce planning and physician 
                training authority of each demonstration State; and
                    (E) any other entity described in section 2(9)(B).
    (b) Duration.--The Secretary shall conduct the demonstration 
program for a period of 10 years.
    (c) Conduct of Program.--
            (1) Funding of additional residency and fellowship 
        positions.--
                    (A) In general.--As part of the demonstration 
                program, the Secretary (acting through the 
                Administrator of the Centers for Medicare & Medicaid 
                Services) shall--
                            (i) notwithstanding section 1886(h)(4)(F) 
                        of the Social Security Act (42 U.S.C. 
                        1395ww(h)(4)(F)) increase, by up to 50 percent 
                        of the total number of residency and fellowship 
                        positions approved at each medical residency 
                        training program in each demonstration State, 
                        the number of residency and fellowship 
                        positions in each shortage physician specialty; 
                        and
                            (ii) subject to subparagraph (C), provide 
                        funding under subsections (d)(5)(B) and (h) of 
                        section 1886 of the Social Security Act (42 
                        U.S.C. 1395ww) for each position added under 
                        clause (i).
                    (B) Establishment of additional positions.--
                            (i) Identification.--The Secretary shall 
                        identify each additional residency and 
                        fellowship position created as a result of the 
                        application of subparagraph (A).
                            (ii) Negotiation and consultation.--The 
                        Secretary shall negotiate and consult with 
                        representatives of each approved medical 
                        residency training program in a demonstration 
                        State at which a position identified under 
                        clause (i) is created for purposes of 
                        supporting such position.
                    (C) Contracts with sponsoring institutions.--
                            (i) In general.--The Secretary shall 
                        condition the availability of funding for each 
                        residency and fellowship position identified 
                        under subparagraph (B)(i) on the execution of a 
                        contract containing such provisions as the 
                        Secretary determines are appropriate, including 
                        the provision described in clause (ii) by each 
                        sponsoring institution.
                            (ii) Provision described.--
                                    (I) In general.--Except as provided 
                                in subclause (II), the provision 
                                described in this clause is a provision 
                                that provides that, during the 
                                residency or fellowship, the resident 
                                or fellow shall spend not less than 10 
                                percent of the training time providing 
                                specialty services to underserved and 
                                rural community populations other than 
                                an underserved population of the 
                                sponsoring institution.
                                    (II) Exceptions.--The Secretary, in 
                                consultation with COGME, shall identify 
                                shortage physician specialties and 
                                subspecialties for which the 
                                application of the provision described 
                                in subclause (I) would be inappropriate 
                                and the Secretary may waive the 
                                requirement under clause (i) that such 
                                provision be included in the contract 
                                of a resident or fellow with such a 
                                specialty or subspecialty.
                    (D) Limitations.--
                            (i) Period of payment.--The Secretary may 
                        not fund any residency or fellowship position 
                        identified under subparagraph (B)(i) for a 
                        period of more than 5 years.
                            (ii) Reassessment of need.--The Secretary 
                        shall reassess the status of the shortage 
                        physician specialty in the demonstration State 
                        prior to entering into any contract under 
                        subparagraph (C) after the date that is 5 years 
                        after the date on which the Secretary 
                        establishes the demonstration program.
            (2) Loan repayment and forgiveness program.--
                    (A) In general.--As part of the demonstration 
                program, the Secretary (acting through the 
                Administrator of the Health Resources and Services 
                Administration) shall establish a loan repayment and 
                forgiveness program, through the holder of the loan, 
                under which the Secretary assumes the obligation to 
                repay a qualified loan amount for an educational loan 
                of an eligible residency or fellowship graduate--
                            (i) for whom the Secretary has approved an 
                        application submitted under subparagraph (D); 
                        and
                            (ii) with whom the Secretary has entered 
                        into a contract under subparagraph (C).
                    (B) Qualified loan amount.--
                            (i) In general.--Subject to clause (ii), 
                        the Secretary shall repay the lesser of--
                                    (I) 25 percent of the loan 
                                obligation of a graduate on a loan that 
                                is outstanding during the period that 
                                the eligible residency or fellowship 
                                graduate practices in the area 
                                designated by the contract entered into 
                                under subparagraph (C); or
                                    (II) $25,000 per graduate per year 
                                of such obligation during such period.
                            (ii) Limitation.--The aggregate amount 
                        under this subparagraph may not exceed $125,000 
                        for any graduate and the Secretary may not 
                        repay or forgive more than 30 loans per year in 
                        each demonstration State under this paragraph.
                    (C) Contracts with residents and fellows.--
                            (i) In general.--Each eligible residency or 
                        fellowship graduate desiring repayment of a 
                        loan under this paragraph shall execute a 
                        contract containing the provisions described in 
                        clause (ii).
                            (ii) Provisions.--The provisions described 
                        in this clause are provisions that require the 
                        eligible residency or fellowship graduate--
                                    (I) to practice in a health 
                                professional shortage area of a 
                                demonstration State during the period 
                                in which a loan is being repaid or 
                                forgiven under this section; and
                                    (II) to provide health services 
                                relating to the shortage physician 
                                specialty of the graduate that was 
                                funded with the loan being repaid or 
                                forgiven under this section during such 
                                period.
                    (D) Application.--
                            (i) In general.--Each eligible residency or 
                        fellowship graduate desiring repayment of a 
                        loan under this paragraph shall submit an 
                        application to the Secretary at such time, in 
                        such manner, and accompanied by such 
                        information as the Secretary may reasonably 
                        require.
                            (ii) Reassessment of need.--The Secretary 
                        shall reassess the shortage physician specialty 
                        in the demonstration State prior to accepting 
                        an application for repayment of any loan under 
                        this paragraph after the date that is 5 years 
                        after the date on which the demonstration 
                        program is established.
                    (E) Construction.--Nothing in the section shall be 
                construed to authorize any refunding of any repayment 
                of a loan.
                    (F) Prevention of double benefits.--No borrower 
                may, for the same service, receive a benefit under both 
                this paragraph and any loan repayment or forgiveness 
                program under title VII of the Public Health Service 
                Act (42 U.S.C. 292 et seq.).
    (d) Waiver of Medicare Requirements.--The Secretary is authorized 
to waive any requirement of the medicare program, or approve equivalent 
or alternative ways of meeting such a requirement, if such waiver is 
necessary to carry out the demonstration program, including the waiver 
of any limitation on the amount of payment or number of residents under 
section 1886 of the Social Security Act (42 U.S.C. 1395ww).
    (e) Appropriations.--
            (1) Funding of additional residency and fellowship 
        positions.--Any expenditures resulting from the establishment 
        of the funding of additional residency and fellowship positions 
        under subsection (c)(1) shall be made from the Federal Hospital 
        Insurance Trust Fund under section 1817 of the Social Security 
        Act (42 U.S.C. 1395i).
            (2) Loan repayment and forgiveness program.--There are 
        authorized to be appropriated such sums as may be necessary to 
        carry out the loan repayment and forgiveness program 
        established under subsection (c)(2).

SEC. 4. ESTABLISHMENT OF THE HEALTH PROFESSIONS DATABASE.

    (a) Establishment of the Health Professions Database.--
            (1) In general.--Not later than 7 months after the date of 
        enactment of this Act, the Secretary (acting through the 
        Administrator of the Health Resources and Services 
        Administration) shall establish a State-specific health 
        professions database to track health professionals in each 
        demonstration State with respect to specialty certifications, 
        practice characteristics, professional licensure, practice 
        types, locations, education, and training, as well as 
        obligations under the demonstration program as a result of the 
        execution of a contract under paragraph (1)(C) or (2)(C) of 
        section 3(c).
            (2) Data sources.--In establishing the Health Professions 
        Database, the Secretary shall use the latest available data 
        from existing health workforce files, including the AMA Master 
        File, State databases, specialty medical society data sources 
        and information, and such other data points as may be 
        recommended by COGME, MedPAC, the National Center for Workforce 
        Information and Analysis, or the medical society of the 
        respective demonstration State.
    (b) Availability.--
            (1) During the program.--During the demonstration program, 
        data from the Health Professions Database shall be made 
        available to the Secretary, each demonstration State, and the 
        public for the purposes of--
                    (A) developing a baseline with respect to a State's 
                health professions workforce and to track changes in a 
                demonstration State's health professions workforce;
                    (B) tracking direct and indirect graduate medical 
                education payments to hospitals;
                    (C) tracking the forgiveness and repayment of loans 
                for educating physicians; and
                    (D) tracking commitments by physicians under the 
                demonstration program.
            (2) Following the program.--Following the termination of 
        the demonstration program, a demonstration State may elect to 
        maintain the Health Professions Database for such State at its 
        expense.
    (c) Authorization of Appropriations.--There are authorized to be 
appropriated such sums as may be necessary for the purpose of carrying 
out this section.

SEC. 5. EVALUATION AND REPORTS.

    (a) Evaluation.--
            (1) In general.--COGME and MedPAC shall jointly conduct a 
        comprehensive evaluation of the demonstration program.
            (2) Matters evaluated.--The evaluation conducted under 
        paragraph (1) shall include an analysis of the effectiveness of 
        the funding of additional residency and fellowship positions 
        and the loan repayment and forgiveness program on physician 
        recruitment, retention, and specialty mix in each demonstration 
        State.
    (b) Progress Reports.--
            (1) COGME.--Not later than 1 year after the date on which 
        the Secretary establishes the demonstration program, 5 years 
        after such date, and 10 years after such date, COGME shall 
        submit a report on the progress of the demonstration program to 
        the Secretary and Congress.
            (2) MedPAC.--MedPAC shall submit biennial reports on the 
        progress of the demonstration program to the Secretary and 
        Congress.
    (c) Final Report.--Not later than 1 year after the date on which 
the demonstration program terminates, COGME and MedPAC shall submit a 
final report to the President, Congress, and the Secretary which shall 
contain a detailed statement of the findings and conclusions of COGME 
and MedPAC, together with such recommendations for legislation and 
administrative actions as COGME and MedPAC consider appropriate.
    (d) Authorization of Appropriations.--There are authorized to be 
appropriated to COGME such sums as may be necessary for the purpose of 
carrying out this section.

SEC. 6. CONTRACTING FLEXIBILITY.

    For purposes of conducting the demonstration program and 
establishing and administering the Health Professions Database, the 
Secretary may procure temporary and intermittent services under section 
3109(b) of title 5, United States Code.
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