[Congressional Bills 110th Congress]
[From the U.S. Government Publishing Office]
[S. 896 Introduced in Senate (IS)]

110th CONGRESS
  1st Session
                                 S. 896

 To amend the Public Health Service Act and the Social Security Act to 
 increase the number of primary care physicians and medical residents 
  serving health professional shortage areas, and for other purposes.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                             March 15, 2007

Ms. Murkowski (for herself, Mr. Schumer, Mr. Stevens, and Mr. Sanders) 
introduced the following bill; which was read twice and referred to the 
          Committee on Health, Education, Labor, and Pensions

_______________________________________________________________________

                                 A BILL


 
 To amend the Public Health Service Act and the Social Security Act to 
 increase the number of primary care physicians and medical residents 
  serving health professional shortage areas, and for other purposes.

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

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Physician Shortage Elimination Act 
of 2007''.

SEC. 2. FINDINGS.

    Congress finds the following:
            (1) The average life expectancy in the United States has 
        increased to 80 years of age, causing an ever-increasing demand 
        for medical care.
            (2) Medical school enrollment numbers have been virtually 
        stagnant for the last 25 years.
            (3) During the last 20 years, median tuition and fees at 
        medical schools have increased by 229 percent (122 percent 
        adjusted for inflation) in private schools and by 479 percent 
        (256 percent adjusted for inflation) in public schools.
            (4) The Association of American Medical Colleges, in its 
        Statement on the Physician Workforce, dated June, 2006, called 
        for an increase of 1,500 National Health Service Corps program 
        awards per year to help meet the need for physicians caring for 
        underserved populations and to help address rising medical 
        student indebtedness.
            (5) The National Health Service Corps program has a proven 
        record of supplying physicians to underserved areas, and has 
        played an important role in expanding access for underserved 
        populations in rural and inner city communities.
            (6) Continued expansion of the National Health Service 
        Corps program is strongly recommended.
            (7) The growing debt incurred by graduating medical 
        students is likely to increase the interest and willingness of 
        graduates of United States medical schools to apply for 
        National Health Service Corps program funding and awards.
            (8) One-third (250,000) of active physicians are over the 
        age of 55 and are likely to retire in the next ten years, while 
        the population will have increased by 24 percent. These 
        demographic changes will cause the population-to-physician 
        ratio to peak by the year 2020.
            (9) In 2005, the Council on Graduate Medical Education 
        stated in a report to Congress that there will be a shortage of 
        not fewer than 90,000 full-time physicians by 2020.
            (10) A decrease in Federal spending to carry out programs 
        authorized by title VII of the Public Health Service Act 
        threatens the viability of programs used to solve the problem 
        of inadequate access to health care.
            (11) A continuing decline in the number of primary care 
        physicians will lead to increased shortages of health care 
        access in rural America.
            (12) There is a declining ability to recruit qualified 
        medical students from rural and underserved areas, coupled with 
        greater difficulty on the part of community health centers and 
        other clinics to attract adequate personnel.
            (13) Individuals in many geographic areas, especially rural 
        areas, lack adequate access to high quality preventive, primary 
        and specialty health care, contributing to significant health 
        disparities that impair America's public health and economic 
        productivity.
            (14) Barriers to adequate access most acutely affect 
        community-based health care safety-net providers, including 
        Community and Migrant Health Centers, Native American health 
        centers, Rural Health Clinics, Critical Access Hospitals, 
        public health departments, and their patients.
            (15) Area Health Education Centers and Health Education 
        Training Centers provide a national network of community-based 
        and governed entities, linked to community resources and 
        academic centers, that provide an infrastructure to facilitate 
        and implement partnerships and programs that successfully 
        address each of these barriers, respond to the health needs of 
        underserved communities and populations, and use educational 
        interventions to reduce health disparities.
            (16) A collaborative process is needed between hospitals 
        and non-hospital settings to maximize the potential of non-
        hospital health care training.

SEC. 3. AMENDMENTS TO THE PUBLIC HEALTH SERVICE ACT.

    (a) Reauthorization of National Health Service Corps Scholarship 
Program and Loan Repayment Program.--
            (1) Reauthorization of appropriations.--Section 338H(a) of 
        the Public Health Service Act (42 U.S.C. 254q(a)) is amended by 
        striking ``$146,250,000'' and all that follows through the 
        period and inserting ``$300,000,000 for each of fiscal years 
        2008 through 2012.''.
            (2) Scholarships for medical students.--Section 338H of 
        such Act is further amended by adding at the end the following:
    ``(d) Scholarships for Medical Students.--For contracts for 
scholarships under this subpart to individuals who are accepted for 
enrollment, or enrolled, in a course of study or program described in 
section 338A(b)(1)(B) that leads to a degree in medicine or osteopathic 
medicine, the Secretary shall, of the amounts appropriated under 
subsection (a) for a fiscal year, obligate the greater of 10 percent or 
such amount as necessary to fund ongoing activities related to such 
contracts.''.
    (b) Reauthorization of Certain Programs Providing Grants for Health 
Professions Training for Diversity.--
            (1) Grants for centers of excellence.--Section 736(h)(1) of 
        the Public Health Service Act (42 U.S.C. 293(h)(1)) is amended 
        by striking ``$26,000,000'' and all that follows through 
        ``2002'' and inserting ``$33,610,000 for each of fiscal years 
        2008 through 2012''.
            (2) Educational assistance for individuals from 
        disadvantaged backgrounds.--Section 740(c) of such Act (42 
        U.S.C. 293d(c)) is amended by striking ``$29,400,000'' and all 
        that follows through the period and inserting ``$35,650,000 for 
        each of fiscal years 2008 through 2012.''.
    (c) Expansion of Residency Training Programs and Primary Care 
Services Offered by Community Health Centers.--Part C of title VII of 
the Public Health Service Act (42 U.S.C. 293k et seq.) is amended--
            (1) by adding before section 747 the following:

                     ``Subpart I--In General''; and

            (2) by adding after section 748 the following:

                   ``Subpart II--Additional Programs

``SEC. 749. GRANTS TO EXPAND MEDICAL RESIDENCY TRAINING PROGRAMS AT 
              COMMUNITY HEALTH CENTERS.

    ``(a) Program Authorized.--The Secretary may make grants to 
community health centers--
            ``(1) to establish, at the centers, new or alternative-
        campus accredited medical residency training programs 
        affiliated with a hospital or other health care facility; or
            ``(2) to fund new residency positions within existing 
        accredited medical residency training programs at the centers 
        and their affiliated partners.
    ``(b) Use of Funds.--Amounts from a grant under this section shall 
be used to cover the costs of establishing or expanding a medical 
residency training program described in subsection (a), including costs 
associated with--
            ``(1) curriculum development;
            ``(2) equipment acquisition;
            ``(3) recruitment, training, and retention of residents and 
        faculty; and
            ``(4) residency stipends.
    ``(c) Applications.--A community health center seeking a grant 
under this section shall submit an application to the Secretary at such 
time, in such manner, and containing such information as the Secretary 
may require.
    ``(d) Preference.--In selecting recipients for a grant under this 
section, the Secretary shall give preference to funding medical 
residency training programs focusing on primary health care.
    ``(e) Definition.--In this section:
            ``(1) The term `accredited', as applied to a new or 
        alternative-campus medical residency training program, means a 
        program that is accredited by a recognized body or bodies 
        approved for such purpose by the Accreditation Council for 
        Graduate Medical Education, except that a new medical residency 
        training program that, by reason of an insufficient period of 
        operation, is not eligible for accreditation on or before the 
        date of submission of an application under subsection (c) shall 
        be deemed accredited if the Accreditation Council for Graduate 
        Medical Education finds, after consultation with the 
        appropriate accreditation body or bodies, that there is 
        reasonable assurance that the program will meet the 
        accreditation standards of such body or bodies prior to the 
        date of graduation of the first entering class in that program.
            ``(2) The term `community health center' means a health 
        center as defined in section 330.

``SEC. 749A. GRANTS TO IMPROVE DELIVERY OF PRIMARY CARE SERVICES IN 
              COMMUNITY HEALTH CENTERS.

    ``(a) Primary Care Access Grants.--
            ``(1) Program authorized.--The Secretary, acting through 
        the Administrator of the Health Resources and Services 
        Administration, may make grants to community health centers for 
        the purpose of increasing the number of medical service 
        providers associated with such centers.
            ``(2) Grants.--A recipient of a grant under this subsection 
        shall be eligible to receive such grants for a total of 5 
        fiscal years.
            ``(3) Use of funds.--A recipient of a grant under this 
        subsection shall use amounts from the grant for one or more of 
        the following activities:
                    ``(A) To recruit residents for medical residency 
                training programs at the community health center.
                    ``(B) To establish a multi-community physician 
                mentoring program to encourage upper level residents to 
                remain in the State in which the community health 
                center and medical residency training program are 
                located.
                    ``(C) To enter into contracts for technical 
                assistance for the purpose of recruiting or retaining 
                primary health care staff.
                    ``(D) To enter into contracts for technical 
                assistance in preparing contracts with local providers 
                of primary health care to provide services for 
                medically underserved communities.
            ``(4) Application.--A community health center seeking a 
        grant under this subsection shall submit an application to the 
        Secretary at such time, in such manner, and containing such 
        information as the Secretary may require.
    ``(b) Grants for Primary Care Facility Capital Expenditures.--
            ``(1) Program authorized.--The Secretary, acting through 
        the Administrator of the Health Resources and Services 
        Administration, may make grants to community health centers for 
        the purpose of increasing primary health care capabilities 
        through the construction, expansion, or renovation of 
        facilities.
            ``(2) Grants.--A recipient of a grant under this subsection 
        shall be eligible to receive such grants for a total of 5 
        fiscal years.
            ``(3) Use of funds.--A recipient of a grant under this 
        subsection shall use amounts from the grant for one or more of 
        the following activities:
                    ``(A) To acquire or lease facilities.
                    ``(B) To construct new facilities.
                    ``(C) To repair or modernize existing facilities.
                    ``(D) To purchase or lease medical equipment.
    ``(c) Definition.--The term `community health center' means a 
health center as defined in section 330.

``SEC. 749B. AUTHORIZATION OF APPROPRIATIONS.

    ``There is authorized to be appropriated $200,000,000 for fiscal 
year 2008 and such sums as may be necessary for each fiscal year 
thereafter to carry out this subpart.''.
    (d) Interdisciplinary, Community-Based Programs.--
            (1) Area health education centers.--Section 751(a) of the 
        Public Health Service Act (42 U.S.C. 294a(a)) is amended--
                    (A) in paragraph (1)(A)--
                            (i) in clause (i), by inserting at the end 
                        before the semicolon the following: ``, with an 
                        emphasis on such personnel who focus on primary 
                        care'';
                            (ii) by redesignating clauses (ii) through 
                        (vii) as clauses (iii) through (viii), 
                        respectively; and
                            (iii) by inserting after clause (i) the 
                        following:
                            ``(ii) foster and provide community-based 
                        training and education for health professions 
                        students in underserved communities and among 
                        underserved populations, including but not 
                        limited to the National Health Service Corps, 
                        community and migrant health centers, rural 
                        health clinics, critical access hospitals, 
                        tribal health clinics, and public health 
                        departments;''; and
                    (B) by adding at the end the following:
            ``(3) Point of service enhancement grants.--
                    ``(A) In general.--The Secretary may award grants 
                to entities receiving an award under paragraph (1) or 
                (2) to improve the effectiveness of the programs 
                operated by such entities or to enable the entities to 
                respond to changes affecting such entities arising 
                since the date of the receipt of the award under 
                paragraph (1) or (2).
                    ``(B) Application.--To receive an award under this 
                paragraph, an entity described under subparagraph (A) 
                shall submit to the Secretary an application at such 
                time, in such manner, and containing such information 
                as the Secretary may require, including an explanation 
                of the changes affecting such entity arising since the 
                date of the receipt by the entity of the award under 
                paragraph (1) or (2), such as changes in the 
                demographics of the area served, the needs of the 
                population served, and the situations encountered by 
                such population and such entity.''.
            (2) Authorization of appropriations.--Section 757 of the 
        Public Health Service Act (42 U.S.C. 294g) is amended--
                    (A) in subsection (a), by striking ``$55,600,000'' 
                and all that follows through ``2002'' and inserting 
                ``$125,000,000 for fiscal year 2008 and such sums as 
                may be necessary for each of fiscal years 2009 through 
                2012'';
                    (B) by striking subsection (b) and inserting the 
                following:
    ``(b) Allocation.--
            ``(1) In general.--Of the amounts appropriated under 
        subsection (a) that the Secretary makes available for each 
        fiscal year to carry out section 751, the Secretary shall 
        obligate--
                    ``(A) for awards under paragraph (1) of section 
                751(a), not more than 25 percent of such amounts in 
                each fiscal year; and
                    ``(B) for awards under paragraphs (2) and (3) of 
                section 751(a), not less than 60 percent of such 
                amounts in each fiscal year.''; and
                    (C) in subsection (c), by--
                            (i) striking the subsection designation and 
                        heading and inserting the following:
    ``(c) Sense of the Congress.--It is the sense of the Congress 
that--''.
                            (ii) striking paragraph (1); and
                            (iii) in paragraph (2), by--
                                    (I) striking the paragraph 
                                designation and all that follows 
                                through ``Congress that--''; and
                                    (II) redesignating subparagraphs 
                                (A) and (B) as paragraphs (1) and (2) 
                                and indenting appropriately.

SEC. 4. AMENDMENTS TO THE SOCIAL SECURITY ACT.

    (a) Clarification of Congressional Intent Regarding the Counting of 
Residents in a Nonhospital Setting.--
            (1) D-gme.--Section 1886(h)(4)(E) of the Social Security 
        Act (42 U.S.C. 1395ww(h)(4)(E)) is amended by adding at the end 
        the following new sentences: ``For purposes of the preceding 
        sentence, the term `all, or substantially all, of the costs for 
        the training program' means the stipends and benefits provided 
        to the resident and other amounts, if any, as determined by the 
        hospital and the entity operating the nonhospital setting. The 
        hospital is not required to pay the entity any amounts other 
        than those determined by the hospital and the entity in order 
        for the hospital to be considered to have incurred all, or 
        substantially all, of the costs for the training program in 
        that setting.''.
            (2) IME.--Section 1886(d)(5)(B)(iv) of the Social Security 
        Act (42 U.S.C. 1395ww(d)(5)(B)(iv)) is amended by adding at the 
        end the following new sentences: ``For purposes of the 
        preceding sentence, the term `all, or substantially all, of the 
        costs for the training program' means the stipends and benefits 
        provided to the resident and other amounts, if any, as 
        determined by the hospital and the entity operating the 
        nonhospital setting. The hospital is not required to pay the 
        entity any amounts other than those determined by the hospital 
        and the entity in order for the hospital to be considered to 
        have incurred all, or substantially all, of the costs for the 
        training program in that setting.''.
            (3) Effective date.--The amendments made by this subsection 
        shall take effect on January 1, 2008.
    (b) Clarification of Eligibility of a Nonrural Hospital That Has a 
Training Program With an Integrated Rural Track.--
            (1) In general.--Section 1886(h)(4)(H) of the Social 
        Security Act (42 U.S.C. 1395ww(h)(4)(H)) is amended--
                    (A) in clause (iv), by inserting ``(as defined in 
                clause (v))'' after ``an integrated rural track''; and
                    (B) by adding at the end the following new clause:
                            ``(v) Definition of accredited training 
                        program with an integrated rural track.--For 
                        purposes of clause (iv), the term `accredited 
                        training program with an integrated rural 
                        track' means an accredited medical residency 
                        training program located in an urban area which 
                        offers a curriculum for all residents in the 
                        program that includes the following 
                        characteristics:
                                    ``(I) A minimum of 3 block months 
                                of rural rotations. During such 3 block 
                                months, the resident is in a rural area 
                                for 4 weeks or a month.
                                    ``(II) A stated mission for 
                                training rural physicians.
                                    ``(III) A minimum of 3 months of 
                                obstetrical training, or an equivalent 
                                longitudinal experience.
                                    ``(IV) A minimum of 4 months of 
                                pediatric training that includes 
                                neonatal, ambulatory, inpatient, and 
                                emergency experiences through 
                                rotations, or an equivalent 
                                longitudinal experience.
                                    ``(V) A minimum of 2 months of 
                                emergency medicine rotations, or an 
                                equivalent longitudinal experience.''.
            (2) Effective date.--The amendments made by this subsection 
        apply with respect to--
                    (A) payments to hospitals under section 1886(h) of 
                the Social Security Act (42 U.S.C. 1395ww(h)) for cost 
                reporting periods beginning on or after January 1, 
                2008; and
                    (B) payments to hospitals under section 
                1886(d)(5)(B)(v) of such Act (42 U.S.C. 
                1395ww(d)(5)(B)(v)) for discharges occurring on or 
                after January 1, 2008.
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