[Congressional Bills 111th Congress]
[From the U.S. Government Publishing Office]
[H.R. 2929 Introduced in House (IH)]

111th CONGRESS
  1st Session
                                H. R. 2929

 To enhance the primary care workforce through the establishment of a 
National Health Workforce Advisory Board and the provision of workforce 
                           data and analysis.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                             June 17, 2009

   Mr. Sarbanes (for himself and Mr. Braley of Iowa) introduced the 
   following bill; which was referred to the Committee on Energy and 
                                Commerce

_______________________________________________________________________

                                 A BILL


 
 To enhance the primary care workforce through the establishment of a 
National Health Workforce Advisory Board and the provision of workforce 
                           data and analysis.

    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 ``Health Care Workforce Incentive Act 
of 2009''.

           TITLE I--NATIONAL HEALTH WORKFORCE ADVISORY BOARD

SEC. 101. ESTABLISHMENT.

    There is established an independent National Health Workforce 
Advisory Board (in this title referred to as the ``Advisory Board'') to 
advise Congress on issues affecting the health care workforce, 
consistent with this title.

SEC. 102. PURPOSE.

    (a) In General.--The purpose of the Advisory Board is to improve 
the supply, distribution, diversity, and quality of health 
professionals in the health care workforce by--
            (1) examining the impact of policies on workforce and 
        workforce shortages from a multijurisdictional perspective, 
        including the Department of Labor, Department of Health and 
        Human Services, the Department of Veterans Affairs, and the 
        Department of Defense;
            (2) developing innovative solutions to increase the short-
        term supply of the health care workforce, including a plan to 
        rapidly deploy health care professionals in the field;
            (3) coming up with a national plan for increasing the long-
        term supply and structure of the health care workforce;
            (4) making health care professionals more accessible to the 
        general population, especially low-income, underserved, 
        uninsured, minority, those experiencing health disparities, and 
        rural populations;
            (5) improving the training of primary care physicians, 
        nurses, dentists, physician assistants, behavioral and mental 
        health professionals, public health professionals, and other 
        health professionals;
            (6) training faculty educators in the health professions; 
        and
            (7) utilizing data from a variety of sources, including the 
        Health Resources and Services Administration, the Centers for 
        Medicare & Medicaid Services, and State Councils that report to 
        the National Workforce Data Center of the Health Resources and 
        Services Administration.
    (b) Duties.--
            (1) Review of health care workforce and annual reports.--
        With the goal of developing a fiscally sustainable integrated 
        workforce which supports high-quality health care delivery 
        system that meets the needs of patients and populations, the 
        Advisory Board shall--
                    (A) review health care workforce and projected 
                workforce needs, including the topics described in 
                paragraph (2);
                    (B) make recommendations to Congress concerning 
                national workforce priorities, goals, and policies;
                    (C) examine and develop innovative short-term and 
                long-term solutions for rapid training and deployment 
                of personnel into the health care workforce;
                    (D) not later than 6 months after its creation, the 
                Board shall develop short-term solutions for rapid 
                training and deployment of personnel into the 
                workforce, submit to Congress a report on such 
                solutions;
                    (E) by not later than January 31 of each year 
                (beginning with 2011), submit a report to Congress 
                containing the results of such reviews and its 
                recommendations concerning related policies; and
                    (F) by not later than April 1 of each year 
                (beginning with 2011), submit a report to Congress 
                containing a review of and recommendations on at 
                minimum one high priority area as described in 
                paragraph (3).
            (2) Specific topics to be reviewed.--
                    (A) Current health care workforce demographics, 
                skill sets, and needs, with projected needs over the 
                following 10- and 25-year periods.
                    (B) Health care workforce training capacity, 
                including number of students trained, number of 
                qualified faculty, training infrastructure and training 
                needs, with projected needs over the following 10- and 
                25-year periods.
                    (C) The implications of new and existing Federal 
                policies which affect the workforce, including but not 
                limited to Medicare and Medicaid GME policies, title 
                VII and title VIII of the Public Health Service Act, 
                and the National Health Service Corps with 
                recommendations for aligning these programs with 
                national health workforce priorities and goals.
                    (D) Health care workforce needs of special 
                populations, such as minorities, rural populations, 
                underserved populations, and geriatric and pediatric 
                populations with recommendations for new and existing 
                Federal policies to meet the needs of these special 
                populations.
            (3) High priority topics.--High priority topics are health 
        care workforce areas which require special attention. The 
        topics may be determined by the Advisory Board or assigned by 
        appropriate committees of Congress. Initial high priority 
        topics include--
                    (A) integrated workforce planning maximizing the 
                skill sets of health care professionals across 
                disciplines;
                    (B) integrated workforce planning for short-term 
                and rapid deployment into the health care workforce;
                    (C) analysis of the nature, scopes of practice, and 
                demands for health workers in the enhanced information 
                technology and management work place;
                    (D) Medicare and Medicaid graduate medical 
                education policies and recommendations for aligning 
                with national workforce goals;
                    (E) nursing workforce capacity at all levels of 
                nurse training, training capacity, projected needs, and 
                integration within the health care system;
                    (F) dental workforce capacity, training capacity, 
                projected needs, and integration within the health care 
                system; and
                    (G) mental health workforce capacity, training 
                capacity and projected needs.
            (4) Agenda and additional reviews.--The Advisory Board 
        shall consult periodically with the chairmen and ranking 
        minority members of the appropriate committees of Congress 
        regarding the Advisory Board's agenda, progress towards 
        achieving this agenda and requests for high priority topics.

SEC. 103. MEMBERSHIP AND RELATED PROVISIONS.

    (a) Membership.--
            (1) Number and appointment.--The Advisory Board shall be 
        composed of 15 members appointed by the Comptroller General.
            (2) Qualifications.--
                    (A) In general.--The membership of the Advisory 
                Board shall include individuals with national 
                recognition for their expertise in the provision of 
                health services, health care workforce analysis, health 
                care finance and economics, health facility management, 
                health plans and integrated delivery systems, higher 
                education, health care philanthropy, and other related 
                fields, who will provide a mix of professional 
                perspectives, broad geographic representation, and a 
                balance between urban and rural representatives.
                    (B) Inclusion.--The membership of the Advisory 
                Board shall include (but not be limited to) health 
                professionals, employers, third-party payers, 
                individuals skilled in the conduct and interpretation 
                of health services and health economics research. Such 
                membership shall also include representatives of 
                consumers.
                    (C) Majority non-providers.--Individuals who are 
                directly involved in health professions education or 
                practice shall not constitute a majority of the 
                membership of the Advisory Board.
                    (D) Ethical disclosure.--The Comptroller General 
                shall establish a system for public disclosure by 
                members of the Advisory Board of financial and other 
                potential conflicts of interest relating to such 
                members.
            (3) Terms.--
                    (A) In general.--The terms of members of the 
                Advisory Board shall be for 3 years except that the 
                Comptroller General shall designate staggered terms for 
                the members first appointed.
                    (B) Vacancies.--Any member appointed to fill a 
                vacancy occurring before the expiration of the term for 
                which the member's predecessor was appointed shall be 
                appointed only for the remainder of that term. A member 
                may serve after the expiration of that member's term 
                until a successor has taken office. A vacancy in the 
                Advisory Board shall be filled in the manner in which 
                the original appointment was made.
            (4) Compensation.--While serving on the business of the 
        Advisory Board (including travel time), a member of the 
        Advisory Board shall be entitled to compensation at the per 
        diem equivalent of the rate provided for level IV of the 
        Executive Schedule under section 5315 of title 5, United States 
        Code; and while so serving away from home and the member's 
        regular place of business, a member may be allowed travel 
        expenses, as authorized by the Chairman of the Advisory Board. 
        Physicians serving as personnel of the Advisory Board may be 
        provided a physician comparability allowance by the Advisory 
        Board in the same manner as Government physicians may be 
        provided such an allowance by an agency under section 5948 of 
        title 5, United States Code, and for such purpose subsection 
        (i) of such section shall apply to the Advisory Board in the 
        same manner as it applies to the Tennessee Valley Authority. 
        For purposes of pay (other than pay of members of the Advisory 
        Board) and employment benefits, rights, and privileges, all 
        personnel of the Advisory Board shall be treated as if they 
        were employees of the United States Senate.
            (5) Chairman; vice chairman.--The Advisory Board members 
        shall elect by a majority vote the Advisory Board chairman and 
        vice chairman for the term of their appointment of portion 
        remaining. Elections shall occur at the end of any chairman or 
        vice chairman's term or should a Advisory Board member leave 
        the Advisory Board for any reason.
            (6) Meetings.--The Advisory Board shall meet at the call of 
        the Chairman.
    (b) Director and Staff; Experts and Consultants.--Subject to such 
review as the Comptroller General deems necessary to assure the 
efficient administration of the Advisory Board, the Advisory Board 
may--
            (1) employ and fix the compensation of an Executive 
        Director (subject to the approval of the Comptroller General) 
        and such other personnel as may be necessary to carry out its 
        duties (without regard to the provisions of title 5, United 
        States Code, governing appointments in the competitive 
        service);
            (2) seek such assistance and support as may be required in 
        the performance of its duties from appropriate Federal 
        departments and agencies;
            (3) enter into contracts or make other arrangements, as may 
        be necessary for the conduct of the work of the Advisory Board 
        (without regard to section 3709 of the Revised Statutes (41 
        U.S.C. 5));
            (4) make advance, progress, and other payments which relate 
        to the work of the Advisory Board;
            (5) provide transportation and subsistence for persons 
        serving without compensation; and
            (6) prescribe such rules and regulations as it deems 
        necessary with respect to the internal organization and 
        operation of the Advisory Board.
    (c) Powers.--
            (1) Obtaining official data.--The Advisory Board may secure 
        directly from any department or agency of the United States 
        information necessary to enable it to carry out this section. 
        Upon request of the Chairman, the head of that department or 
        agency shall furnish that information to the Advisory Board on 
        an agreed upon schedule.
            (2) Data collection.--In order to carry out its functions, 
        the Advisory Board shall--
                    (A) utilize existing information, both published 
                and unpublished, where possible, collected and assessed 
                either by its own staff or under other arrangements 
                made in accordance with this section;
                    (B) carry out, or award grants or contracts for, 
                original research and experimentation, where existing 
                information is inadequate; and
                    (C) adopt procedures allowing any interested party 
                to submit information for the Advisory Board's use in 
                making reports and recommendations.
            (3) Access of gao to information.--The Comptroller General 
        shall have unrestricted access to all deliberations, records, 
        and nonproprietary data of the Advisory Board, immediately upon 
        request.
            (4) Periodic audit.--The Advisory Board shall be subject to 
        periodic audit by the Comptroller General.
    (d) Cooperation.--The Advisory Board shall carry out its duties in 
cooperation with the Council on Graduate Medical Education established 
under section 762 of the Public Health Service Act (42 U.S.C. 294o), 
the National Advisory Council on the National Health Service Corps 
established by section 337 of such Act (42 U.S.C. 254j), the Advisory 
Committee on Training in Primary Care Medicine and Dentistry 
established pursuant to section 748 of such Act (42 U.S.C. 2931), the 
Advisory Committee on Interdisciplinary, Community-Based Linkages 
established pursuant to section 756 of such Act (42 U.S.C. 294f), and 
the National Advisory Council on Nurse Education and Practice 
established pursuant to section 845 of such Act (42 U.S.C. 297t).
    (e) Authorization of Appropriations.--
            (1) Request for appropriations.--The Advisory Board shall 
        submit requests for appropriations in the same manner as the 
        Comptroller General submits requests for appropriations, but 
        amounts appropriated for the Advisory Board shall be separate 
        from amounts appropriated for the Comptroller General.
            (2) Authorization.--There are authorized to be appropriated 
        such sums as may be necessary to carry out the provisions of 
        this section.
    (f) Health Care Workforce Definition.--In this section, the term 
``health care workforce'' includes all health care providers with 
direct patient care and support responsibilities, including physicians, 
nurses, physician assistants, pharmacists, dentists, allied health 
professionals, mental health professionals, and public health 
professionals.

                 TITLE II--WORKFORCE DATA AND ANALYSIS

SEC. 201. CENTER FOR WORKFORCE DATA AND ANALYSIS.

    (a) Establishment.--There is established a National Center for 
Workforce Data and Analysis in the Department of Health and Human 
Services.
    (b) Duties.--Such Center shall comprehensively and regularly gather 
data, provide projections, and conduct research on the supply, demand, 
distribution, diversity, and development of the health care workforce, 
including information on specific disciplines, specialties, and 
subspecialties.
    (c) Authority.--Such Center is authorized to accept applications 
for and administer grants for the purpose of establishing State and 
Regional Health Workforce Councils under section 202.

SEC. 202. STATE AND REGIONAL HEALTH WORKFORCE COUNCILS.

    (a) Establishment.--The Secretary of Health and Human Services, 
through the National Center for Workforce Data and Analysis, shall 
establish a competitive State Health Workforce Shortage grants program 
(in this section referred to as the ``Grant Program'') under which, for 
the purposes described, the Secretary may make formula grants or an 
allotment of funds to States.
    (b) Purposes.--The purpose of the Grant Program is to harmonize 
health workforce needs and medical education through incorporating 
local and regional perspectives through the organization of State and 
regional health workforce councils to--
            (1) ensure access to health services for all individuals, 
        particularly those with low incomes or limited access to health 
        services, through an adequate health care workforce;
            (2) improve the supply, distribution, diversity, and 
        development of the health care workforce, taking into 
        consideration the supply, distribution, and diversity of health 
        care workforce profession specialties and subspecialties in a 
        manner consistent with--
                    (A) determining high-need geographic areas;
                    (B) determining high-priority specialties; and
                    (C) determining the optimal mix and numbers of 
                primary care physicians per population and as a 
                percentage of the total health care workforce;
            (3) create State-specific health care workforce goals and 
        objectives that are consistent with and aligned to health 
        status goals and national health care workforce objectives 
        developed under the National Health Workforce Advisory Board 
        under title I; and
            (4) during the first 12-month period funded through grants 
        provided under this section, establish or designate a State 
        health care workforce planning entity to establish statewide 
        processes for State health care workforce planning, State 
        health workforce data collection, policy recommendations, and 
        State resource allocations.
    (c) Application for Grant.--For the purpose of this subsection, a 
grant is in accordance if the following is met:
            (1) Use of funds.--For the purposes described in subsection 
        (b), State and Regional Health Workforce Councils may use grant 
        funds under this section to--
                    (A) collect and analyze State and regional health 
                workforce supply, distribution, diversity, demand and 
                training capacity data, following any data collection 
                and reporting standards set by the National Health 
                Workforce Advisory Board;
                    (B) determine critical State/regional level health 
                workforce needs, including identifying--
                            (i) high-priority specialties and 
                        disciplines, which may be region specific; and
                            (ii) high-need geographic areas;
                    (C) establish State/regional health workforce goals 
                and recommendations to coordinate with national level 
                goals set by the National Health Workforce Advisory 
                Board;
                    (D) devise short- and long-term plans and 
                initiatives for meeting State/regional health workforce 
                goals;
                    (E) devise State/regional level plans that set 
                specific targets for increasing primary care capacity, 
                including training and retaining more primary care 
                physicians, nurses, physicians assistants, and other 
                members of the allied health workforce; and
                    (F) make recommendations to the National Health 
                Workforce Advisory Board on the re-alignment of 
                graduate medical education under title XVIII of the 
                Social Security Act to meet State/regional health 
                workforce goals, including--
                            (i) recommendations for GME funding cap 
                        modifications; and
                            (ii) proposals for alternative funding and 
                        distribution frameworks aligned with State/
                        regional health workforce goals.
            (2) State/region wide health workforce assessment.--The 
        application includes a plan for a state/region wide health 
        workforce assessment that--
                    (A) will be updated not less than every 5 years;
                    (B) identifies--
                            (i) current and future State and regional 
                        health workforce supply, distribution, 
                        diversity, demand and training capacity;
                            (ii) projected needs related to the supply, 
                        distribution, diversity and development of the 
                        State/regional health workforce; and
                            (iii) short- and long-term State/region 
                        specific health workforce goals and objectives 
                        consistent with health status goals and 
                        national health workforce objectives developed 
                        under section (103) of previous title.
            (3) Annual reports.--The application includes a plan for 
        annual reports submitted to HRSA and to the National Health 
        Workforce Advisory Board to include an annually updated plan to 
        meet the goals and objectives and address the needs identified 
        under the State/Region wide health workforce assessment 
        described in paragraph (1), and such plan includes strategies 
        related to--
                    (A) collaboration between--
                            (i) State departments of labor, health, 
                        education, higher education, veterans affairs, 
                        environment, and professional licensure; and
                            (ii) State health workforce investment 
                        boards;
                    (B) State data collection;
                    (C) State Medicare and Medicaid policies; and
                    (D) State health professions licensure and 
                regulation.
            (4) Description of funding use.--The application includes a 
        description of how funds received through the grant will be 
        used--
                    (A) in accordance with subparagraphs (1) and (2) of 
                subsection (b), to ensure access to health services for 
                all individuals and to improve the supply, 
                distribution, diversity, and development of the health 
                workforce, such as through programs related to--
                            (i) health workforce training and education 
                        capacity;
                            (ii) the health care safety net workforce, 
                        including health centers under section 330;
                            (iii) provider cultural competency;
                            (iv) health workforce diversity;
                            (v) health workforce pipeline development;
                            (vi) health workforce retention;
                            (vii) health workforce faculty recruitment;
                            (viii) health workforce faculty retention;
                            (ix) health workforce career ladders;
                            (x) public awareness; and
                            (xi) health workforce scholarship and loan 
                        repayment programs;
                    (B) to create State-specific health workforce goals 
                and objectives in accordance with subsection (b)(3) and 
                to develop annual plans in accordance with subsection 
                (b)(4) to meet such goals and objectives; and
                    (C) during the first 12-month period funded through 
                the grant, to establish or designate in accordance with 
                subsection (a)(2)(D) a State health workforce planning 
                entity to establish statewide processes for State 
                health workforce planning, State health workforce data 
                collection, policy recommendations, and State resource 
                allocations.
            (5) Development of application.--The application--
                    (A) is developed by or in consultation with the 
                State agency that will be responsible for administering 
                the program; and
                    (B) is made publicly available during its 
                development or after its submission to the Secretary in 
                order to facilitate public comment.
    (d) Additional Duties and Authorities.--A State and Regional Health 
Workforce Council funded through a grant under this section shall--
            (1) submit analyses and recommendations to the Advisory 
        Board under title I, at least on an annual basis;
            (2) have the authority to allocate any future increases in 
        State graduate medical education caps under title XVIII of the 
        Social Security Act, consistent with section 203 and the 
        amendments made by title III; and
            (3) shall be eligible to apply for the authority to 
        administer direct graduate medical education funds under title 
        XVIII of such Act at the State level in order to achieve 
        flexibility in direct graduate medical education placements to 
        meet State health needs.
    (e) Determination of Amount of Allotment.--
            (1) In general.--The Secretary shall determine the amount 
        of the allotment to each State under this section for a fiscal 
        year based on a formula.
            (2) Development of formula.--The formula referred to in 
        paragraph (1) shall be determined by the Secretary by 
        regulation, taking into consideration the following criteria:
                    (A) Existing shortages and deficiencies in health 
                workforce distribution.
                    (B) Rural, urban, and frontier areas.
                    (C) Community health centers.
                    (D) The number of medical, nursing, and allied 
                health professions schools in each State.
    (f) Reports.--A State and Regional Health Workforce Council funded 
through a grant under this section shall submit data to the National 
Health Workforce Advisory Board under title I and the National 
Workforce Data Center established under section 201 on an annual basis 
for purposes of consideration and incorporation into the 
recommendations made by the National Health Workforce Advisory Board.
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