1.This Act may be cited as
the Health Professions and Primary
Care Reinvestment Act
.
2.Table of
contents; references in Act
(a)The table of contents for this Act is as follows:
Sec. 1. Short
title.
Sec. 2. Table of contents; references in Act.
Sec. 3. Federally supported student loan funds.
Sec. 4. Centers of excellence.
Sec. 5. Health professions training for diversity.
Sec. 6. Training in family medicine, general internal medicine,
general pediatrics, and physician assistantship; community health needs
assessments; primary care training institutes.
Sec. 7. Training in general and pediatric dentistry; loan
repayments.
Sec. 8. Interdisciplinary, community-based
linkages.
Sec. 9. Geriatrics education and training.
Sec. 10. Training in graduate psychology education.
Sec. 11. Health professions workforce information and
analysis.
Sec. 12. Health workforce information, evaluation, and
assessment.
Sec. 13. Funding for dental public health and preventive
medicine.
Sec. 14. Academic health departments grant program.
Sec. 15. Definitions.
(b)Except as otherwise specified, amendments made by this Act to
a section or other provision of law are amendments to such section or other
provision of the Public Health Service Act (42 U.S.C. 201 et seq.).
3.Federally
supported student loan funds
(a)Subpart
II of title VII (42 U.S.C. 292q et seq.) is amended by inserting after the
subpart heading the following:
720A.The purpose of this subpart is to improve
the supply, distribution, diversity, and quality of health professionals in the
healthcare workforce by—
(1)making health
professionals more accessible to low-income, underserved, uninsured, minority,
health disparity, and rural populations;
(2)improving the
training of primary care physicians, dentists, physician assistants, behavioral
and mental health professionals, public health professionals, and other health
professionals; and
(3)training faculty
educators in the health
professions.
.
(b)Section 722 (42 U.S.C. 292r) is amended by striking
subsection (e) and inserting the following:
(e)Such loans shall bear interest, on the unpaid balance of
the loan, computed only for periods for which the loan is repayable, at the
rate of 2 percent less than the applicable rate of interest described in
section 427A(l)(1) of the Higher Education Act of 1965 (20 U.S.C. 1077a(l)(1))
per
year.
.
(c)Medical schools
and primary health careSection 723 (42 U.S.C. 292s) is
amended—
(1)in subsection
(a)—
(A)in paragraph (1),
by striking subparagraph (B) and inserting the following:
(B)to practice in
such care for 10 years (including residency training in primary health care) or
through the date on which the loan is repaid in full, whichever occurs
first.
;
and
(B)by striking
paragraph (3) and inserting the following:
(3)Each agreement entered into with a student pursuant to
paragraph (1) shall provide that, if the student fails to comply with such
agreement, the loan involved will begin to accrue interest at a rate of 2
percent per year greater than the rate at which the student would pay if
compliant in such year.
;
and
(2)by adding at the
end the following:
(d)It is the sense of Congress that funds repaid under the
loan program under this section should not be transferred to the Treasury of
the United States or otherwise used for any other purpose other than to carry
out this
section.
.
(d)The Secretary of Health and Human Services shall not
require parental financial information from a student to determine financial
need under section 723 of the Public Health Service Act (42 U.S.C. 292s) and
the determination of need for such information shall be at the discretion of
applicable school loan officer. The Secretary shall amend guidelines issued by
the Health Resources and Services Administration in accordance with the
preceding sentence.
4.Section 736 of the
Public Health Service Act (42 U.S.C. 293) is amended—
(1)by striking
subsection (a) and inserting the following:
(a)The Secretary shall make grants to, and enter into
contracts with, public and nonprofit private health or educational entities,
including designated health professions schools described in subsection (c),
for the purpose of assisting the entities in supporting programs of excellence
in health professions education for underrepresented minorities in health
professions.
;
(2)by striking
subsection (b) and inserting the following:
(b)The Secretary may not make a grant under subsection (a)
unless the designated health professions school agrees, subject to subsection
(c)(1)(C), to use the funds awarded under the grant to—
(1)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)establish,
strengthen, or expand programs to enhance the academic performance of
underrepresented minority in health professions students attending the
school;
(3)improve the
capacity of such school to train, recruit, and retain underrepresented minority
faculty members including the payment of such stipends and fellowships as the
Secretary may determine appropriate;
(4)carry out
activities to improve the information resources, clinical education, curricula,
and cultural and linguistic competence of the graduates of the school, as it
relates to minority health issues;
(5)facilitate
faculty and student research on health issues particularly affecting racial and
ethnic minority groups, including research on issues relating to the delivery
of culturally competent healthcare (as defined in section 270);
(6)establish and
implement a program to train students of the school in providing health
services to racial and ethnic 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;
(7)provide stipends
as the Secretary determines appropriate, in amounts as the Secretary determines
appropriate; and
(8)conduct
accountability and other reporting activities, as required by the Secretary in
subsection
(i).
;
(3)in subsection
(c)—
(A)by amending
paragraph (1) to read as follows:
(1)
(A)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)The conditions specified in this subparagraph are that
a designated health professions school—
(i)has a significant
number of underrepresented minority in health professions students enrolled in
the school, including individuals accepted for enrollment in the school;
(ii)has been
effective in assisting such students of the school to complete the program of
education and receive the degree involved;
(iii)has been
effective in recruiting such students to enroll in and graduate from the
school, including providing scholarships and other financial assistance to such
students and encouraging such 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 underrepresented
minority in health professions individuals serving in faculty or administrative
positions at the school.
(C)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 programsIn 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 minority groups, be construed to authorize,
require, or prohibit the use of such criteria in any program other than the
program established in this
section.
;
(B)by amending
paragraph (2) to read as follows:
(2)Centers of
excellence at certain historically black colleges and universities
(A)The
conditions specified in this subparagraph are that a designated health
professions school is a school described in section 799B(1).
(B)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 underrepresented minority individuals; and
(ii)to provide
improved access to the library and informational resources of the
school.
(C)The
requirements of paragraph (1)(C) shall not apply to a historically black
college or university that receives funding under this paragraph or paragraph
(5).
;
and
(C)by amending
paragraphs (3) through (5) to read as follows:
(3)Hispanic
centers of excellenceThe 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) of this
section, that the school will, in carrying out the duties described in
subsection (b) of this section, 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) of this
section, 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 excellenceSubject 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) of this
section, that the school will, in carrying out the duties described in
subsection (b) of this section, 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) of this
section, 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 excellenceThe 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 underrepresented minorities in
health professions significantly above the national average for such
enrollments of health professions
schools.
;
and
(4)by striking
subsection (h) and inserting the following:
(h)
(1)Based
on the amount appropriated under subsection (i) for a fiscal year, the
following subparagraphs shall apply as appropriate:
(A)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 $24,000,000If 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 $30,000,000If 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 $40,000,000If 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)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)
(A)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)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 appropriationsThere are authorized to be appropriated to
carry out this section—
(1)$50,000,000 for
each of the fiscal years 2009 through 2013; and
(2)and such sums as
are necessary for each subsequent fiscal
year.
.
5.Health
professions training for diversity
(a)Loan repayments
and fellowships regarding faculty positionsSection 738(a)(1) (42
U.S.C. 293b(a)(1)) is amended by striking $20,000 of the principal and
interest of the educational loans of such individuals.
and inserting
$30,000 of the principal and interest of the educational loans of such
individuals. With respect to such an individual who enters into a new contract
under the preceding sentence with the Secretary after 2009, the amount paid by
the Federal Government pursuant to such contract shall be increased by the
percentage increase in the gross domestic product since the beginning of the
previous year.
.
(b)Scholarships
for disadvantaged studentsSection 740(a) (42 U.S.C. 293d(a)) is
amended by striking $37,000,000
and all that follows through
‘‘2002’’ and inserting $51,000,000 for fiscal year 2008, and such sums
as may be necessary for each of the fiscal years 2009 through
2013
.
(c)Reauthorization
for loan repayments and fellowships regarding faculty
positionsSection 740(b) (42 U.S.C. 293d(b)) is amended by
striking appropriated
and all that follows through the period at
the end and inserting appropriated, $5,000,000 for each of the fiscal
years 2009 through 2013. For fiscal year 2014 and each subsequent fiscal year,
there is authorized to be appropriated the amount authorized for the preceding
fiscal year increased by the percentage increase in the gross domestic product
during such preceding fiscal year.
.
(d)Reauthorization
for educational assistance in the health professions regarding individuals from
a disadvantaged backgroundSection 740(c) of the Public Health
Service Act (42 U.S.C. 293d(c)) is amended by striking the first sentence and
inserting the following: For the purpose of grants and contracts under
section 739(a)(1), there is authorized to be appropriated $60,000,000 for
fiscal year 2009 and such sums as may be necessary for each of the fiscal years
2010 through 2013.
6.Training in
family medicine, general internal medicine, general pediatrics, and physician
assistantship; community health needs assessments; primary care training
institutesPart C of title VII
(42 U.S.C. 293k et seq.) is amended by striking section 747 and inserting the
following:
747.Primary care
training and enhancement
(a)Support and
development of primary care training programs
(1)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 family medicine, general internal medicine, or
general pediatrics;
(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 an interdisciplinary training program that includes at least 1 of
the following which demonstrates a team approach to care and may demonstrate a
patient-centered medical home model:
(i)A
program designed to teach trainees the skills to provide interdisciplinary
patient care through collaboration among various professionals, including those
trained in geriatrics, physician assistants, nurse practitioners, pharmacists,
or social workers.
(ii)A program
developed in collaboration with dental students or residency training programs
to improve integration and access to dental care.
(iii)A program
developed in collaboration with psychologists and other behavioral and mental
health professionals to integrate mental and behavioral health and primary
health care; and
(H)to plan, develop
and operate joint degree programs to provide interdisciplinary 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)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)The Secretary may make grants to or enter into contracts
with accredited schools of medicine or osteopathic medicine to establish,
maintain, or improve academic units (which may be departments, divisions, or
other units) or programs that improve clinical teaching and research in family
medicine, general internal medicine, or general pediatrics.
(2)Preference in
making awards under this subsectionIn 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 family medicine; or
(B)substantially
expanding such units or programs.
(3)Priority in
making awardsIn making awards of grants and contracts under
paragraph (1), the Secretary shall give priority to any qualified applicant for
such an award that proposes—
(A)a collaborative
project between academic administrative units of primary care; and
(B)innovative
approaches to clinical teaching using models of primary care, such as the
patient centered medical home, team management of chronic disease, and
interdisciplinary integrated models of health care that incorporate transitions
in health care settings and integration physical and mental health
provision.
(4)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)Community
health needs assessment
(1)The Secretary may award grants or enter into contracts
with eligible entities to conduct community health needs assessments as
described by this subsection.
(2)For purposes of this subsection, the term eligible
entity means an entity described in section 799(b).
(3)To
receive a grant under this section, an eligible entity shall submit to the
Secretary an application at such time, in such manner, and containing such
information as the Secretary may require.
(4)A
community health needs assessment shall—
(A)identify
community needs for a health care workforce and collaborative programs and
partnerships to address the needs;
(B)identify barriers
to health care in underserved areas, health disparity populations, or regions
experiencing significant changes in the cultural and linguistic demographics of
their populations, including border communities; and
(C)provide assurance
that the entity or entities conducting such assessment will assess how
to—
(i)link community
organizations and academic health centers to address community health workforce
training needs;
(ii)support
development of a workforce reflective of the cultural, linguistic, racial, and
ethnic makeup of the population involved;
(iii)address the
barriers identified in subparagraph (B), with an emphasis on community based
participatory research which includes local communities and prepares members of
the identified populations to participate in improving health care in these
communities;
(iv)enhance the
development of the workforce practicing in primary care;
(v)enhance the
development of the workforce serving underserved areas and health disparity
populations;
(vi)build capacity
and develop competency within the health care delivery and public health
systems; and
(vii)be responsive
to national and local health issues impacting the workforce, such as problems
specific to children, emerging chronic diseases, an aging population,
infectious diseases, mental health or substance related disorders, or
bioterrorism by employing such approaches as health promotion, health literacy,
pharmaceutical case management, interdisciplinary integrated models of health
care that include both physical and mental health, cultural and linguistic
competency, or approaches that reduce health disparities.
(5)A grant awarded under this subsection shall be—
(A)for a term of 2
years; and
(B)in an amount of
$150,000 for each year of the 2-year term.
(d)Primary care
training institutes
(1)The
purpose of the Primary Care Training Institute program established under this
subsection is to—
(A)prepare and train
primary care providers by enhancing and coordinating multiple aims within
academic health centers in order to lead to improving patient care delivered to
health disparity populations and reduce health disparities;
(B)enhance the
status of primary care within undergraduate and graduate medical education
through influencing priorities in practice, education, and research;
(C)develop
innovative approaches to primary care education and scholarship by transforming
and integrating health care systems through interdisciplinary, team-based, and
collaborative models that may demonstrate improved quality or lower costs;
and
(D)create economies
of scale through academic and community collaborations by enabling academic
infrastructure support for multiple community programs.
(2)Grants
or contracts awarded under this subsection shall establish new centers for
primary care education and research within academic units of family medicine,
general internal medicine, or general pediatrics within academic health
centers. Such new centers shall be known as Primary Care Training Institutes
(referred to in this section as PCTIs).
(3)Authority to
award grantsThe Secretary may make grants to or enter into
contracts with eligible entities to develop and implement PCTIs in accordance
with this subsection.
(4)For purposes of this subsection, the term eligible
entity means a primary care (including family medicine, general internal
medicine, and general pediatrics) academic administrative unit.
(5)Application;
requirement for needs assessmentAn eligible entity desiring a
grant under this subsection shall submit to the Secretary an application at
such time, in such manner, and containing—
(A)(i)a community health
needs assessment conducted by such eligible entity through a grant awarded
under subsection (c); or
(ii)a community health needs
assessment conducted by such entity through other means and that meets the
requirements of subsection (c); and
(B)such information
as the Secretary may require.
(6)An
eligible entity shall use amounts awarded under a grant under this subsection
to carry out the purpose described in paragraph (1), through—
(A)establishment of
a PCTI to improve primary care training and practice, to improve recruitment of
underrepresented minority students into primary care careers, and to improve
the number and percentage of trained professionals serving in underserved areas
and health disparity populations; and
(B)the establishment
of infrastructure to support the PCTI including development of, and training
in—
(i)curriculum
designs;
(ii)education
evaluation tools;
(iii)online
interactive educational curricula;
(iv)community-based
and population research study designs;
(v)applied
behavioral science and psychology educational programs;
(vi)clinical
epidemiology;
(vii)models for
teaching caring for older adults;
(viii)models for
health services delivery;
(ix)public health
and preventive medicine; and
(x)models for
teaching cultural competency and health literacy.
(7)
(A)Each eligible entity that establishes a PCTI under
this subsection shall, through such PCTI—
(i)collaborate
across disciplines including family medicine, general internal medicine,
general pediatrics, or with disciplines such as physician assistants and those
certified in geriatrics or gerontology, general dentistry, behavioral and
mental health, or public health;
(ii)establish and
maintain formal partnerships with area health education centers, Federally
qualified health centers, rural health clinics, hospital and nonhospital-based
teaching clinics, Geriatric Education Centers, Geriatric Research Education and
Clinical Centers, or other facilities focused on social and health needs of
older adults or other underserved areas, health disparity populations, and
other vulnerable populations, such as older adults, homeless individuals,
victims of abuse or trauma, individuals with mental health or substance-related
disorders, and individuals with HIV/AIDS;
(iii)create new
models of teaching and evaluating patient care based on the patient centered
medical home model, interdisciplinary integrated models of health care that
incorporate both physical and mental health, drug therapy management, or other
new models of effective patient care utilizing a team or collaborative
approach;
(iv)conduct research
and education that improves or is relevant to community practice and that is
carried out in community or primary care settings, and that may address such
issues as environmental health, infectious disease control, disease prevention,
health promotion, and injury control;
(v)increase the
number of trainees and faculty from underrepresented minority groups, and from
rural disadvantaged backgrounds; and
(vi)address the
changing national, regional, and local health care needs and priorities as
identified in the community health needs assessment submitted by such eligible
entity in the application under this subsection.
(B)Each eligible entity that establishes a PCTI under
this subsection may, through such PCTI, integrate programs along the
educational continuum, including high school and college pipeline programs,
predoctoral education in primary care, primary care residency training, faculty
development, fellowship programs, and primary care research infrastructure
programs and interdisciplinary joint degree programs in graduate public health
training and other health professions.
(8)A grant awarded under this subsection shall be—
(A)for a term of 5
years; and
(B)in an amount of
$750,000 for each year of the 5-year term.
(e)Priorities in
Making AwardsWith respect to the training provided for under
this section, the Secretary shall give priority in awarding grants or contracts
to the following:
(1)Qualified
applicants that have a record of training individuals who are from
underrepresented minority groups or from a rural or disadvantaged
background.
(2)Qualified
applicants that establish formal relationships with Federally qualified health
centers, rural health centers, or accredited teaching facilities located in
underserved areas or serve health disparity populations, and that conduct
training of students, residents, fellows, or faculty at the center or
facility.
(3)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, and individuals with
HIV/AIDS.
(4)Qualified
applicants that include educational activities in care of older adults.
(5)Qualified
applicants that conduct teaching programs in an interdiscliplinary setting
demonstrating a team or collaborative approach to care.
(6)Qualified
applicants that include educational activities in cultural competency and
health literacy.
(f)Preference in
making awards under this sectionIn making awards of grants or
contracts under this section, the Secretary shall give preference to any
qualified applicant that—
(1)has a high rate
for placing graduates in practice settings having the principle focus of
serving underserved areas or health disparity populations;
(2)during the 2-year
period preceding the fiscal year for which such an award is sought, has
achieved a significant increase in the rate of placing graduates in such
settings; or
(3)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 primary care practice.
(g)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.
(h)The Secretary shall, in carrying out this section and
section 748—
(1)require
collaboration—
(A)among the
pertinent workforce programs within this title and the Department of Health and
Human Services; and
(B)among such
pertinent programs administered by the Department of Labor and the Department
of Education;
(2)use and
adequately support existing programs to address new Departmental initiatives,
as appropriate;
(3)take into
consideration capabilities of existing programs before creating separate or
parallel programs; and
(4)evaluate and
publicly report on the effectiveness of such programs on an annual
basis.
(i)For purposes of this section, the term
rural background means, with respect to an individual, having
grown up, lived a substantial portion of such individual's life, or attended
high school in a federally designated rural or nonmetropolitan area.
(j)Authorization
of appropriations
(1)There is authorized to be appropriated to carry out
subsections (a) and (b), $125,000,000 for each of the fiscal years 2009 through
2014, of which 15 percent of the amount appropriated in each such fiscal year
shall be allocated to physician assistant training programs as described under
subsection (a)(1)(F), which prepare students for practice in primary care
settings.
(2)Community
health needs assessmentsThere is authorized to be appropriated
to carry out subsection (c)—
(A)$1,800,000 for
fiscal year 2009; and
(B)$3,600,000 for
each of the fiscal years 2010 through 2013.
(3)Primary care
training institutesThere is authorized to be appropriated to
carry out subsection (d)—
(A)$6,000,000 for
fiscal year 2009;
(B)$12,000,000 for
fiscal year 2010;
(C)$18,000,000 for
fiscal year 2011;
(D)$24,000,000 for
fiscal year 2012; and
(E)$30,000,000 for
fiscal year 2013.
(4)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, and in the case of a community health
needs assessment under subsection (c), for more than 1
year.
.
7.Training in
general and pediatric dentistry; loan repayments
(a)Training in
general and pediatric dentistryPart C of Title VII (42 U.S.C. 293k et
seq.) is amended by—
(1)redesignating section 748 as section 749;
and
(2)inserting after
section 747 the following:
748.Training in
General and Pediatric Dentistry
(a)Support and
development of dental training programs
(1)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, or pediatric dentistry for dental students,
residents, or practicing dentists, that emphasizes training for general
dentistry or pediatric dentistry;
(B)to provide
financial assistance to dental students, residents, and practicing dentists who
are in need thereof, who are participants in any such program, and who plan to
work in the practice of general or pediatric dentistry;
(C)to plan, develop,
and operate a program for the training of dentists who plan to teach in general
or pediatric dentistry; and
(D)to provide
financial assistance in the form of traineeships and fellowships to dentists
who plan to teach or are teaching in general or pediatric dentistry.
(2)For purposes of this subsection, entities eligible for
such grants or contracts in general or pediatric dentistry shall include
entities that have programs in dental schools, or approved residency or
advanced education programs in the practice of general or pediatric
dentistry.
(b)Academic
administrative units
(1)The Secretary may make grants to or enter into contracts
with schools of dentistry to meet the costs of projects to establish, maintain,
or improve academic administrative units (which may be departments, divisions,
or other units) to provide clinical instruction in general or pediatric
dentistry.
(2)Priority in
making awardsIn making awards of grants and contracts under
paragraph (1), the Secretary shall give priority to any qualified applicant for
such an award that proposes a collaborative project between departments of
primary care medicine and departments of general and pediatric
dentistry.
(3)Preference in
making awardsIn 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 an
academic administrative unit for programs in general or pediatric dentistry;
and
(B)substantially
expanding the programs of such a unit.
(c)Priorities in
making awards under this sectionWith 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 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 or pediatric dentistry.
(2)Qualified
applicants that have a record of training individuals who are from a rural or
disadvantaged background, or from underrepresented minorities.
(3)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.
(4)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, and individuals with
HIV/AIDS.
(5)Qualified
applicants that include educational activities in cultural competency and
health literacy.
(d)Preference in
making awardsIn making awards of grants or contracts under this
section, the Secretary shall give preference to any qualified applicant
that—
(1)has a high rate
for placing graduates in practice settings having the principal focus of
serving in underserved areas or health disparity populations; or
(2)during the 2-year
period before the fiscal year for which such an award is sought, has achieved a
significant increase in the rate of placing graduates in such settings.
(e)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.
(f)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 of the payments and subject to the
availability of appropriations for the fiscal year involved to make the
payments.
(g)For the purpose of carrying out subsections
(a) and (b), there is authorized to be appropriated $20,000,000 for each of the
fiscal years 2009 through 2013.
(h)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.
.
(b)Loan repayments
for dental professionals
(1)Section 738(a) (42 U.S.C. 293b(a)) is amended by
inserting at the end the following:
(7)Priority for
dental professionalsIn entering into contracts under this
subsection, the Secretary shall give priority to individuals who—
(A)are teaching or
doing research in an academic dental setting in general or pediatric
dentistry;
(B)have a degree in
dentistry;
(C)are enrolled in
an approved graduate training program in dentistry; or
(D)are enrolled as full-time students—
(i)in an accredited
(as determined by the Secretary) school of dentistry; and
(ii)in the final
year of a course of a study or program, offered by such institution and
approved by the Secretary, leading to a degree from such a
school.
.
(2)Authorization
of appropriationsSection 740(b) (42 U.S.C. 293d(b)) is amended
by adding at the end the following: In addition to any amounts
authorized under this subsection, there is authorized to be appropriated to
enter into contracts under section 738(a) with individuals described in section
738(a)(7), $500,000 for fiscal year 2009, $1,000,000 for fiscal year 2010,
$1,500,000 for fiscal year 2011, and $2,000,000 for each of the fiscal years
2012 and 2013.
.
8.Interdisciplinary,
community-based linkages
(a)Area health
education centersSection 751 (42 U.S.C. 294a) is amended to read
as follows:
751.Area health
education centers
(a)Definitions;
Establishment of awards
(1)In
this section:
(A)Area health
education centerThe terms area health education
center or center mean a public or nonprofit private
organization that has a cooperative agreement or contract in effect with an
entity that has received an award under subsection (b) or (c), satisfies the
requirements in subsection (d)(1), and has as one of its principal functions
the operation of an area health education center. Appropriate organizations may
include hospitals, health organizations with accredited primary care training
programs, accredited physician assistant educational programs associated with a
college or university, and universities or colleges not operating a school of
medicine or osteopathic medicine.
(B)Area health
education center programThe terms area health education
center program or program mean cooperative program
consisting of an entity that has received an award under subsection (b) or (c)
for the purpose of planning, developing, operating, and evaluating an area
health education center program and one or more area health education centers,
which carries out the required activities described in subsection (b)(4) or
(c)(4), satisfies the program requirements in this section, and has as one of
its principal functions identifying and implementing strategies and activities
that address health care workforce needs in its service area.
(C)For purposes of this section, the term rural
background means, with respect to an individual, having grown up, lived
a substantial portion of such individual's life, or attended high school in a
federally designated rural or nonmetropolitan area.
(2)The
Secretary shall make awards in accordance with this section.
(b)Infrastructure
development award
(1)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 of an area
health education center program.
(2)For purposes of this subsection, an 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
paragraph (1) to a school of nursing.
(3)An
eligible entity desiring to receive an award under this subsection shall submit
to the Secretary an application at such time, in such manner, and containing
such information as the Secretary may require.
(4)
(A)An eligible entity shall use amounts awarded under a
grant under paragraph (1) to carry out the following activities:
(i)Develop and
implement strategies to recruit individuals from underrepresented minority
populations or from disadvantaged or rural backgrounds into health professions,
and support such individuals in attaining such careers.
(ii)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, and in health care safety net sites.
(iii)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.
(iv)Conduct and
participate in interdisciplinary training that involves physicians, physician
assistants, nurse practitioners, nurse midwives, dentists, psychologists,
pharmacists, public health, or other health professionals, as
practicable.
(v)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.
(vi)Propose and
implement effective program and outcomes measurement and evaluation
strategies.
(B)An eligible entity may use amounts awarded under a
grant under paragraph (1) to carry out any of the following activities:
(i)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.
(ii)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.
(iii)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.
(c)Point of
service maintenance and enhancement award
(1)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 program.
(2)For purposes of this subsection, the term eligible
entity means an entity that has received funds under this section (as
this section was in effect on the day before the date of enactment of the
Health Professions and Primary Care
Reinvestment Act), is operating an area health education center
program, including area health education centers, and has a center or centers
that are no longer eligible to receive financial assistance under subsection
(b).
(3)An
eligible entity desiring to receive an award under this subsection shall submit
to the Secretary an application at such time, in such manner, and containing
such information as the Secretary may require.
(4)
(A)An eligible entity shall use amounts awarded under a
grant under paragraph (1) to carry out the following activities:
(i)Develop and
implement strategies to recruit individuals from underrepresented minority
groups, underserved areas, or with rural backgrounds into health care careers,
and support such individuals in attaining such careers.
(ii)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 and to health disparity
populations, in collaboration with other Federal and State health care
workforce development programs, and in health care safety net sites.
(iii)Prepare
individuals to more effectively provide health services to underserved areas or
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, behavioral and mental health facilities, public health departments, or
other appropriate facilities.
(iv)Conduct and
participate in interdisciplinary training that involves physicians, physician
assistants, nurse practitioners, nurse midwives, dentists, psychologists,
pharmacists, public health, or other health professionals, as
practicable.
(v)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.
(vi)Propose and
implement effective program and outcomes measurement and evaluation
strategies.
(B)An eligible entity shall use amounts awarded under
a grant under paragraph (1) to carry out at least 1 of the following
activities:
(i)Develop
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.
(ii)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.
(iii)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)
(1)Area health
education center programIn 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 places at least 10 percent of its students in training sites affiliated
with an area health education center that is 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 (c) does not distribute such funding to a
center that is eligible to receive funding under subsection (b).
(2)Area health
education centerThe 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;
(G)has a
community-based governing or advisory board that reflects the diversity of the
communities involved;
(H)addresses changes
in local community health and demographics identified in—
(i)a
community health needs assessment that was conducted by the area health
education center through a grant awarded under section 748(a); or
(ii)a community
health needs assessment that was conducted by such center through other means
and that meets the requirements of section 748(a); and
(I)evaluates and
reports to the Secretary, in collaboration with the area health education
center program of which the center is a part, concerning the effectiveness of
the center on an annual basis.
(e)In carrying out this section, the Secretary
shall—
(1)require
collaboration—
(A)among the
pertinent workforce programs under this title and the Department of Health and
Human Services; and
(B)among such
pertinent programs administered by the Department of Labor and the Department
of Education;
(2)use and
adequately support existing programs to address new initiatives of the
Department of Health and Human Services, as appropriate;
(3)take into
consideration capabilities of existing programs prior to establishing separate
or parallel programs; and
(4)evaluate and
publicly report on the effectiveness of such programs on an annual
basis.
(f)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 (b).
(g)Not
less than 75 percent of the total amount provided to an area health education
center program under subsection (b) or (c) 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
(b).
(h)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 (l)(2) is maintained.
(i)
(1)Except as provided in paragraph (2), the period during
which payments may be made under an award under subsection (b) 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)The
periods described in paragraph (1) shall not apply to programs receiving point
of service maintenance and enhancement awards under subsection (c) to maintain
existing centers and activities.
(j)Inapplicability
of provisionNotwithstanding any other provision of this title,
section 791(a) shall not apply to an area health education center funded under
this section.
(k)Authorization
of appropriations
(1)There is authorized to be appropriated to carry out this
section $125,000,000 for each of the fiscal years 2009 through 2013.
(2)Of
the amounts appropriated for a fiscal year under subparagraph (A)—
(A)not more than 35
percent shall be used for awards under subsection (b);
(B)not less than 60
percent shall be used for awards under subsection (c);
(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)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.
(l)It is the sense of the Congress that every
State have an area health education center program in effect under this
section.
.
(b)Continuing
educational support for health professionals serving in underserved
communitiesPart D of title VII (42 U.S.C. 294 et seq.) is
amended by striking section 752 and inserting the following:
752.Continuing
educational support for health professionals serving in underserved
communities
(a)The Secretary shall make grants to, and enter into
contracts with, eligible entities to improve health care, increase retention,
increase representation of minority faculty members, enhance the practice
environment, and provide information dissemination and educational support to
reduce professional isolation through the timely dissemination of research
findings using relevant resources.
(b)For purposes of this section, the term eligible
entity means an entity described in section 799(b).
(c)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.
(d)An eligible entity shall use amounts awarded under a grant
or contract under this section to provide innovative supportive activities to
enhance education through distance learning, continuing educational activities,
collaborative conferences, and electronic and telelearning activities, with
preference for primary care, including physician assistants, general and
pediatric dental providers, psychologists, and other mental health providers,
and physicians teaching in federally designated underserved areas.
(e)There
is authorized to be appropriated to carry out this section $5,000,000 for each
of the fiscal years 2009 through 2014, and such sums as may be necessary for
each subsequent fiscal
year.
.
9.Geriatrics
education and training
(a)Geriatric
education centersSection 753(a) (42 U.S.C. 294c(a)) is
amended—
(1)in paragraph (1),
by striking in paragraphs (1), (3), or (4) of section 799B, and section
801(2),
and inserting in paragraph (1), (3), or (4) of section
799B and section 801(2), health paraprofessional programs, community health
worker programs, and programs for informal caregivers,
;
(2)in paragraph
(2)—
(A)in subparagraph
(A), by inserting allied health professionals, community health workers,
and informal caregivers
after health
professionals
;
(B)in subparagraph
(D), by inserting allied health professionals, community health workers,
and informal caregivers
after health professionals
;
and
(C)in subparagraph
(E), by striking and senior centers
and inserting or
senior centers
; and
(3)by adding at the
end the following:
(3)The term of any award made under this subsection shall not
exceed 5 years.
(4)Data
collections and reporting
(A)Each entity that receives an award under this subsection
shall submit to the National Health Workforce Analysis Center established under
section 761, standardized and specific workforce data, as determined by the
Secretary and in a form and manner specified by the Secretary.
(B)Annual report
to CongressSuch National Health Workforce Analysis Center shall,
on an annual basis, submit to Congress and the Secretary a report the describes
the information received by such Center under subparagraph (A) during the
previous
year.
.
(b)Geriatric
training regarding physicians, dentists, and the health
professionsSection 753(b) (42 U.S.C. 294c(b)) is amended—
(1)in the subsection
heading, by striking Physicians and Dentists
and inserting
Physicians, Dentists, and
the Health Professions
; and
(2)by striking
paragraph (1) and inserting the following:
(1)The Secretary may make grants to, and enter into
contracts with, schools of medicine, schools of osteopathic medicine, academic
dental institutions, teaching hospitals, physician assistant education
programs, graduate medical or dental education programs, and graduate programs
in behavioral or mental health, for the purpose of providing support (including
internships, residencies, traineeships, and fellowships) for geriatric training
projects to train physicians, physician assistants, dentists, and behavioral
and mental health professionals who plan to teach geriatric medicine, geriatric
behavioral or mental health, or geriatric
dentistry.
.
(c)Geriatric
Academic Career AwardsSection 753(c) (42 U.S.C. 294c(c)) is
amended by striking paragraph (1) through paragraph (3) and inserting the
following:
(1)The Secretary shall establish a program to provide
Geriatric Academic Career Awards to eligible entities to promote the career
development of individuals as academic geriatricians or gerontologists.
(2)
(A)For purposes of this section, the term eligible
entity means an entity described in section 799(b).
(B)Awards to
individuals from eligible entitiesAn eligible entity shall
provide funding to an individual through a grant received under this section
only if such individual—
(i)is board
certified or board eligible in internal medicine, family medicine, or
psychiatry, or is a certified and licensed nurse, pharmacist, psychologist,
social worker, or physician assistant, employed by an approved school;
(ii)has completed an
approved internship or fellowship program in geriatrics; and
(iii)has a junior or
midlevel faculty appointment at an accredited (as determined by the Secretary)
school of medicine or osteopathic medicine, physician assistant education
program, or graduate program in behavioral or mental health.
(3)No
Award under paragraph (1) may be made to an eligible entity unless the
entity—
(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; and
(B)provides, in such
form and manner as the Secretary may require, assurances that the entity will
provide funding only to individuals associated with such entity that will meet
the service requirement described in paragraph
(5).
.
(d)Authorization
of appropriationsSection 753 is (42 U.S.C. 294c) is amended by
adding at the end the following:
(d)Authorization
of appropriationsThere is authorized to be appropriated to carry
out this section $50,000,000 for each of the fiscal years 2009 through
2013.
.
(e)
(1)Rural
interdisciplinary trainingTitle VII (42 U.S.C. 292 et seq.) is
amended by striking section 754.
(2)Allied health
and other disciplinesSection
755 (42 U.S.C. 294e) is amended—
(A)in subsection (a) by striking may
make
and inserting shall make
;
(B)in subsection
(b)(1)—
(i)in subparagraph
(H), by striking the semicolon at the end and inserting ;
and
;
(ii)in subparagraph
(I) by striking necessary; and
and inserting a period;
and
(iii)striking
subparagraph (J); and
(C)by adding at the
end the following:
(c)Authorization
of appropriationsThere is authorized to be appropriated to carry
out this section $12,000,000 for each of the fiscal years 2009 through
2013.
.
10.Training in
graduate psychology education
(a)Part D of title VII (42 U.S.C. 294 et seq.) is amended
by—
(1)striking section
757;
(2)redesignating
section 756 as section 757; and
(3)inserting after
section 755 the following:
756.Training in
graduate psychology education
(a)The Secretary may award grants, cooperative agreements
and contracts to accredited graduate programs of psychology including public or
nonprofit private hospitals for the development and implementation of
interdisciplinary training of psychology graduate students for providing
behavioral and mental health services. Such training shall focus on the needs
of vulnerable groups such as older adults and children, individuals with mental
health or substance-related disorders, victims of abuse or trauma and of combat
stress disorders such as posttraumatic stress disorder and traumatic brain
injuries, homeless individuals, chronically ill persons, and their
families.
(b)Training under subsection (a) may be provided through
accredited graduate programs of psychology including public or nonprofit
private hospitals and such other sites as the Secretary determines to be
appropriate.
(c)The Secretary shall directly or through grants or
contracts provide for the evaluation of programs implemented under subsection
(a) in order to determine the effect of such programs on increasing the number
of psychologists who provide behavioral and mental health services to
identified underserved areas or health disparity populations.
(d)Authorization
of appropriationThere is authorized to be appropriated to carry
out this section $10,000,000 for each of the fiscal years 2009 through
2013.
.
(b)Section 757(b)(2),
as redesignated by subsection (a), is amended by striking sections
751(a)(1)(A), 751(a)(1)(B), 753(b), 754(3)(A), and 755(b)
and inserting
sections 751(b), 753(b), and 755(b)
.
11.Health
professions workforce information and analysis
(a)Section 761 (42
U.S.C. 294n) is amended—
(1)by redesignating subsection (c) as
subsection (e);
(2)by striking
subsection (b) and inserting the following:
(b)National Center
for Health Workforce Analysis
(1)The
Secretary shall establish the National Center for Health Workforce Analysis
within the Department of Health and Human Services. The Secretary shall appoint
a Director in consultation with the Advisory Committee on Health Workforce
Information, Evaluation, and Assessment established under section 764 (in this
section referred to as the Committee
).
(2)The National Center for Health Workforce Analysis
shall—
(A)carry out the
duties of the Secretary under section 792(a); and
(B)collect, analyze,
and report data regarding workforce issues, as determined appropriate by the
Committee in coordination with the Regional Centers designated under subsection
(c).
(3)The
National Center for Health Workforce Analysis shall—
(A)describe and
evaluate the effectiveness of the programs under this part, and under other
sections of this title determined relevant by the Committee, including
evaluating and reporting on workforce diversity, distribution in underserved
areas and for health disparity populations, primary care capacity and other
needs, including the establishment of benchmarks for such programs;
(B)use grantee data
and data collected from regional workforce analysis centers designated under
subsection (c) in conjunction with National DataNet to regularly evaluate
program performance through—
(i)comparing
benchmarks;
(ii)assessing the
effectiveness of programs in meeting the specified goals of this title;
and
(iii)tracking
recognized subspecialties of the physician and dentistry workforce and
nonphysician providers including physician assistants, advance practice nurses,
psychologists, pharmacists, public health workers, and other professionals as
appropriate by measuring and reporting on changes in workforce production and
distribution, and population health;
(C)produce and
report to the relevant committees of Congress an estimate of the supply and
need for physicians, nurses, dentists, psychologists, pharmacists, and other
health professionals, as directed by the Committee, that—
(i)uses the best
available methods for estimating supply and needs;
(ii)provides that
any models or statistical software be subject to review and made available to
the public; and
(iii)is routinely
(such as biennially) compiled and reported for physicians alternating with
other professions;
(D)maintain uniform
data sets in coordination with, and responsive to, the regional centers
designated under subsection (c) that—
(i)can be used to
estimate State and county supply and needs of physicians, nurses, dentists, and
other health professionals;
(ii)can be used to
develop in the identification of health professional shortage areas and
medically underserved areas; and
(iii)shall be
updated and made available to the public via the Internet or other electronic
means; and
(E)collaborate with
agencies in the Department of Health and Human Services, the Department of
Labor, and the Department of Education in data collection and maintenance of
uniform data sets as determined appropriate by the Secretary and the
Committee.
(4)On
biennial basis, the Director shall submit to the relevant Congressional
committees a report on the activities, information gathered, and findings of
the Center during the previous 2-year period.
(c)Regional
Centers for workforce analysis
(1)The
Secretary shall designate 6 to 10 entities described in paragraph (2) as
regional workforce analysis centers.
(2)An
entity described in this paragraph shall be a public health or health
professions school, an academic health center, or other appropriate public or
private nonprofit entity or partnerships of such entities determined by the
Secretary to be capable of carrying out the functions described in paragraph
(3).
(3)An
entity designated under this subsection shall—
(A)function
cooperatively with the national and other regional centers to—
(i)collect data on
programs carried out under this part, and under other sections of this title
determined relevant by the Committee, in a consistent manner;
(ii)develop and
maintain standardized approaches toward reporting conformity across regional
centers;
(iii)collaborate
with the National Center for Health Workforce Analysis, the Committee, and
other regional centers, on the development and distribution of regional and
national studies and reports to a wide audience, including policymakers;
(iv)coordinate with
identified local and regional sources of health professionals workforce data,
such as State workforce commissions, for reporting to national level;
and
(v)develop program
evaluations and assessments, as described in subsection (b);
(B)serve as a
regional resource for monitoring the impact of policies and programs on the
healthcare workforce, including—
(i)developing and
maintaining a nongovernment analytic and research infrastructure related to the
purposes described in subsection (b); and
(ii)working with
States and State agencies, including State primary care offices and State
workforce commissions, to identify areas that qualify as shortage designations
and supporting the development of such shortage designation requests;
and
(C)provide technical
assistance to local and regional entities on data collection and analysis
related to healthcare workforce issues, including—
(i)supporting
studies that lead to understanding the impact of a diverse workforce on health
outcomes, both descriptive and analytic;
(ii)supporting
studies that lead to understanding the impact of the primary care workforce on
health outcomes, both descriptive and analytic; and
(iii)supporting
studies that lead to understanding the impact of geographic distribution on
health outcomes, both descriptive and analytic; and
(D)initiate and
conduct research on high-priority health workforce questions, in accordance
with subparagraph (A).
(4)Grants or
contracts to conduct research
(A)The Secretary shall award grants or contracts to regional
centers for workforce analysis for the conduct of research on high-priority
workforce questions described in paragraph (3)(D), including—
(i)national studies
on emerging issues;
(ii)State health
workforce profiles; and
(iii)future health
workforce issues and trends.
(B)The period during which payments are made to an entity from
an award of a grant or contract under this paragraph shall not exceed 3
years.
(C)Dissemination
of informationAmounts awarded under this paragraph shall include
amounts necessary for the dissemination of reports produced pursuant to the
award.
(d)Grants To
assess and monitor the supply and need of health professionals
(1)The Secretary shall award grants to, and enter into
contracts with, eligible entities for the purpose of monitoring the supply,
need for, and diversity and distribution of, physicians, psychologists,
dentists, physician assistants, and other health professionals as determined
by, and based on health workforce needs assessments provided by the National
Center for Health Workforce Analysis under subsection (b).
(2)For purposes of this subsection, the term eligible
entity means an entity described in section 799(b) and regional centers
for health workforce analysis under subsection (c).
(3)To
be eligible for a grant or contract under paragraph (1), an entity shall submit
to the Secretary an application at such time, in such manner, and containing
such information as the Secretary may require.
(4)An entity shall use amounts awarded under a grant or
contract under this subsection to collaborate with the National and regional
centers under subsections (b) and (c) to conduct research on workforce issues,
as determined by the Director of the National Center for Health Workforce
Analysis in consultation with the Committee. Such research shall
include—
(A)collecting,
analyzing, and reporting data pertinent to State and regional workforce issues
that may contribute to the national understanding of workforce supply and
need;
(B)setting up and
monitoring data sets appropriate to specific workforce supply and need;
and
(C)other projects as
deemed appropriate by such Director and
Committee.
;
and
(3)in subsection (e)
(as so redesignated)—
(A)by striking
paragraph (1) and inserting the following:
(1)
(A)National center
for workforce analysisThere are authorized to be appropriated to
carry out subsection (b) (to fund the National Center for Workforce Analysis),
$1,000,000 for each of the fiscal years 2009 through 2013, and such sums as may
be necessary for each fiscal year thereafter.
(B)There are authorized to be appropriated $4,500,000 to
carry out subsection (c) (to fund each of the regional centers), an amount not
to exceed $750,000 for each of the centers for each of the fiscal years 2009
through 2013, and such sums as may be necessary for each fiscal year
thereafter.
(C)Awards to
conduct researchThere are authorized to be appropriated to carry
out subsection (c)(4), $2,000,000 for each of the fiscal years 2009 through
2013. Any amount appropriated pursuant to the preceding sentence shall be in
addition to any amount appropriated pursuant to subparagraph (B).
(D)Awards to
assess and monitor the supply and need of health
professionalsThere are authorized to be appropriated to carry
out subsection (d), $1,000,000 for each of the fiscal years 2009 through 2013,
and such sums as may be necessary for each fiscal year thereafter.
(E)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.
;
and
(B)in paragraph (2),
by striking subsection (a)
and inserting paragraph
(1)
.
(b)Not later than 180 days after the date of enactment of
this Act, all of the functions and authorities carried out by the National
Center for Health Workforce Analysis of the Health Resources and Services
Administration as in effect on the day before the date of enactment of this Act
shall be transferred to the National Center for Health Workforce Analysis
established under section 761(b) of the Public Health Service Act (as amended
by subsection (a)).
12.Health
workforce information, evaluation, and assessment
(a)Health
professional workforce information and analysisSubpart 1 of part E of title VII (42 U.S.C.
294n et seq.) is amended by adding at the end the following:
764.Health
workforce information, evaluation, and assessment
(a)The Secretary shall establish an advisory committee to
be known as the Advisory Committee on Health Workforce Information, Evaluation,
and Assessment (referred to in this section as the Advisory
Committee
).
(b)
(1)The Secretary shall determine the appropriate number of
individuals to serve on the Advisory Committee, which shall include—
(A)the Director of
Health Resources and Services Administration (or his or her designee);
(B)the Director of
the National Health Service Corps (or his or her designee);
(C)a director of an
area health education center program or area health education center under
section 751;
(D)the chairperson
of the Accreditation Council on Graduate Medical Education;
(E)the Director of
the National Center for Healthcare Workforce Analysis;
(F)the Chair of the
National Advisory Council on Nurse Education and Practice;
(G)at least 1
representative of—
(i)the Department of
Labor;
(ii)the Department
of Education;
(iii)the Advisory
Committee on Training in Primary Care Medicine and Dentistry;
(iv)a regional
workforce analysis center designated under section 761(c); and
(v)a
State-level primary care organization; and
(H)one
representative from each of the practicing clinical professions described in
paragraph (2).
(2)Practicing
clinical professionsThe practicing clinical professions
described in this paragraph include—
(A)one of each of
the physician specialties representing primary care including family medicine,
pediatrics, general internal medicine, and general geriatrics;
(B)physician
assistants;
(C)general or
pediatric dental professionals;
(D)psychology
professionals;
(E)nursing
professionals;
(F)pharmacy
professionals;
(G)public health
professionals; and
(H)preventive
medicine physicians.
(3)In
providing for the membership of the Advisory Committee, the Secretary shall
ensure that—
(A)the members
adequately represent urban and federally designated rural and nonmetropolitan
areas from throughout the Nation and that there is at least 1 clinical
professional representing a rural and an urban Federally qualified health
center;
(B)the members
adequately represent underrepresented populations in the health professions;
and
(C)the members are
selected based on competence, interest, and knowledge of the mission and
professions involved.
(4)The Secretary shall make the initial appointment
under this section of members to the Advisory Committee in consultation with
the Comptroller General of the United States.
(5)The
chairperson of the Advisory Committee shall be selected by a vote of the
members of the Committee.
(6)
(A)Except as provided in subparagraph (B), each member of
the Advisory Committee shall be appointed for a period of 3 years.
(B)Of the members first appointed to the Advisory Committee
under paragraph (4)—
(i)1/3
shall be appointed for a period of 1 year;
(ii)1/3
shall be appointed for a period of 2 years; and
(iii)1/3
shall be appointed for a period of 3 years.
(c)The
Advisory Committee shall carry out the following activities:
(1)Make
recommendations regarding the classifications of the health care workforce in
collaboration with the Department of Labor to ensure the consistency of data
collection, and update these recommendations at least every 5 years.
(2)Make
recommendations regarding standardized methodology and procedures to enumerate
the health care workforce, and update these recommendations at least every 5
years.
(3)Direct that
adequate data be collected to evaluate the impact on the distribution and
deployment of the health care workforce in settings such as Federally qualified
health centers, the National Health Service Corps, and to underserved areas or
populations.
(4)(A)Make recommendations
regarding standardized measures and procedures for reporting, including
reporting with respect to—
(i)student entry and retention in the
health professions, with focus on primary care fields and general
dentistry;
(ii)increasing the diversity of the
health professional population;
(iii)improving the distribution of
health professionals in the United States;
(iv)strengthening the public health
and health care delivery infrastructure;
(v)providing access to care relative
to workforce distribution;
(vi)improving the quality of health
care through education, training, and collaboration with appropriate entities
to identify and define excellence in health services delivery which is
efficient, effective, evidence-based, and timely and may include—
(I)community-based quality improvement and
best practices networks;
(II)community-based participatory research
networks;
(III)continuing professional education
programs; and
(IV)distance learning technologies and
methodologies;
(vii)practice improvement through the
implementation of new systems of care, such as health information technology,
chronic care models, interdisciplinary and collaborative care, cultural
competency, and health literacy and other models; and
(viii)assessing the link between the
pipeline programs and staffing of health professional shortage areas, medically
underserved areas, and the National Health Service Corps as well as other
Federal safety net programs.
(B)Update the recommendations under
subparagraph (A) at least every 5 years.
(5)Define successful
performance outcome measures within programs under this title.
(6)Define processes
by which funding recipients will collaborate with regional workforce analysis
centers under section 761(c) to collect and share data with other such centers
for further analysis.
(7)Other duties as
deemed appropriate by the Secretary in consultation with the Committee.
(d)Working groups
and subcommitteesThe Advisory Committee may establish working
groups or other subcommittees to carry out functions determined to be
appropriate by the Advisory Committee and the Chairman and meet separately for
these purposes.
(e)The
full Advisory Committee shall meet at least 3 times annually.
(f)The
Advisory Committee shall not be terminated prior to the later of—
(1)the date that is
5 years after the date of enactment of this section; or
(2)the date on which
funding is not made available for the Advisory Committee.
(g)The
Federal Advisory Committee Act (5 U.S.C. App.) shall apply to the Advisory
Committee under this section only to the extent that the provisions of such Act
do not conflict with the requirements of this
section.
.
(b)Public health
workforce general provisionsSection 765 (42 U.S.C. 295) is
amended—
(1)in subsection
(b)(1)(A), by striking or dental public health
and inserting
dental public health, or behavioral and mental health
;
and
(2)in subsection
(d)—
(A)in paragraph
(5)(A)—
(i)by
inserting internship and
after new
;
(ii)by
inserting internship and
after existing
;
(iii)by striking
and dental public health, that
and inserting , dental
public health, and behavioral and mental health, that
; and
(iv)by
striking and dental public health; and
and inserting ,
dental public health, and behavioral and mental health; and
;
(B)in paragraph
(5)(B), by inserting internship and
after assistance
to
; and
(C)in paragraph (6),
by inserting behavioral and mental health,
after public
health dentistry,
13.Funding for
dental public health and preventive medicineSection 768 (42 U.S.C. 295c) is amended by
adding at the end the following:
(c)Authorization
of appropriationsThere is authorized to be appropriated—
(1)for dental public
health programs carried out under this section—
(A)$1,000,000 for
each of the fiscal years 2009 through 2013; and
(B)such sums as may
be necessary for each fiscal year thereafter; and
(2)for public health
(other than dental public health) and preventive medicine programs carried out
under this section—
(A)$16,000,000 for
each of the fiscal years 2009 through 2013; and
(B)such sums as may
be necessary for each fiscal year
thereafter.
.
14.Academic health
departments grant programSubpart 2 of part E (42 U.S.C. 295 et seq.)
is amended by adding at the end the following:
771.Academic
health departments grant program
(a)
(1)In order to improve the training of public health
students, the Secretary, acting in conjunction with the Director of the Centers
for Disease Control and Prevention and in consultation with the Association of
Schools of Public Health, shall carry out the Academic Health Departments grant
program (referred to in this section as the Program
) under which
the Secretary shall award competitive grants, of not more than $250,000 each,
to eligible partnerships to establish Academic Health Departments.
(2)Academic health
departmentFor purposes of this section, the term Academic
Health Department means a program administered by an eligible
partnership that provides for collaboration between the academic and practice
aspects of public health. The purpose of such a department is to increase the
number of graduates in public health who work in State and local health
departments, increase the relevance of the curriculum in schools and programs
of public health to health department practice, and to increase the use of
academic theories, knowledge, and methodologies in the work of health
departments.
(b)For
purposes of this section, an eligible partnership is a partnership, with
respect to establishing an Academic Health Department, consisting of—
(1)a State or local
public health department; and
(2)an accredited
school of public health or an accredited public health degree program.
(c)An eligible partnership described in subsection (b) may use
funds provided under a grant made under subsection (a) for the following
purposes, with respect to an Academic Health Department:
(1)To conduct
training needs assessment surveys.
(2)To provide for
curriculum development.
(3)To provide for
training and academic instruction.
(4)To conduct
leadership seminars.
(5)To facilitate
appropriate staff of the State or local health department participating in the
eligible partnership to teach with the school of public health or public health
degree program participating in such partnership.
(6)To facilitate
faculty and students of the school of public health or public health degree
program participating in the eligible partnership to work in the health
department participating in such partnership.
(7)To provide for a
project coordinator.
(8)To provide for
subgrants to organizations to conduct activities consistent with the goals of
the Program.
(9)Other appropriate
activities specified by the Secretary to recruit public health students to full
time employment in a health department after graduation.
(d)
(1)Grant recipient
reports to the SecretaryEach recipient of a grant awarded under
subsection (a) shall submit to the Secretary a report for each year for which
the recipient received such a grant on the results and outcomes of the
activities funded by such grant during such year.
(2)For the 3-year period beginning on the date of the
establishment of the Program, and for each subsequent 3-year period in which
the Program is in existence, the Secretary shall submit to Congress a report on
the results and outcomes of the Program during such 3-year period, including
the number of Academic Health Departments funded by grants under the Program,
the number of students trained through grants under the Program, and the number
of trainees participating in such Academic Health Departments who remain in
public health professions.
(3)Not later than the date that is 5 years after the date of
the establishment of the Program, the Secretary shall submit to Congress a
report that examines the results and outcomes of the Program and recommends the
extent to which the Program should be continued.
(e)Authorization
of appropriationsThere is authorized to be appropriated to carry
out this section, $4,000,000 for each of the fiscal years 2009 through
2013.
.
15.Section 799B (42 U.S.C. 295p) is
amended—
(1)by striking paragraph (3) and inserting the
following:
(3)Physician
assistant education programThe term physician assistant
education program means an educational program in a public or private
institution in a State that—
(A)has as its
objective the education of individuals who, upon completion of their studies in
the program, be qualified to provide primary care medical services with the
supervision of a physician; and
(B)is accredited by
the Accreditation Review Commission on Education for the Physician
Assistant.
;
and
(2)by adding at the end the following:
(12)Federally
qualified health centerThe term Federally qualified health
center has the meaning given that term in section 1861(aa) of the Social
Security Act.
(13)The term rural health clinic has the meaning
given that term in section 1861(aa) of the Social Security Act.
(14)The term culturally competency—
(A)with respect to
health-related services, means the ability to provide healthcare tailored to
meet the social, cultural, and linguistic needs of patients from diverse
backgrounds; and
(B)when used to
describe education or training, means education or training designed to prepare
those receiving the education or training to provide health-related services
tailored to meet the social, cultural, and linguistic needs of patients from
diverse backgrounds.
(15)Health
disparity populationThe term health disparity
population has the meaning given such term in section 903(d)(1).
(16)The term health literacy means the degree
to which an individual has the capacity to obtain, communicate, process, and
understand health information (including the register and language in which the
information is provided) and services in order to make appropriate health
decisions.
(17)The
term Indian has the meaning given such term in section 4 of the
Indian Health Care Improvement Act (25 U.S.C. 1603).
(18)The term minority group has the meaning given
the term racial and ethnic minority group in section
1707.
.