[Congressional Bills 111th Congress]
[From the U.S. Government Publishing Office]
[H.R. 2930 Introduced in House (IH)]

111th CONGRESS
  1st Session
                                H. R. 2930

  To enhance the primary care workforce through modifications to the 
   medical residency training programs and use of qualified teaching 
  health centers and through State primary care scholarship and loan 
                          repayment programs.


_______________________________________________________________________


                    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, and in addition to the Committee on Ways and Means, for a 
 period to be subsequently determined by the Speaker, in each case for 
consideration of such provisions as fall within the jurisdiction of the 
                          committee concerned

_______________________________________________________________________

                                 A BILL


 
  To enhance the primary care workforce through modifications to the 
   medical residency training programs and use of qualified teaching 
  health centers and through State primary care scholarship and loan 
                          repayment programs.

    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 ``Primary Care Training Enhancement 
Act''.

  TITLE I--MEDICAL RESIDENCY TRAINING PROGRAMS IN QUALIFIED TEACHING 
                             HEALTH CENTERS

SEC. 101. AUTHORIZING PAYMENTS FOR GRADUATE MEDICAL EDUCATION COSTS TO 
              QUALIFIED TEACHING HEALTH CENTERS.

    (a) Payments for Direct Graduate Medical Education Costs.--Section 
1886(h) of the Social Security Act (42 U.S.C. 1395ww(h)) is amended by 
adding at the end the following new paragraphs:
            ``(8) Qualified teaching health centers.--
                    ``(A) In general.--The Secretary may approve 
                qualified teaching health centers to receive payments 
                as determined under subparagraph (C).
                    ``(B) Redistribution of unused residency 
                positions.--
                            ``(i) Reduction in limit based on unused 
                        positions.--
                                    ``(I) In general.--Except as 
                                provided in subclause (II), the 
                                Secretary shall reduce the otherwise 
                                applicable resident limit (as defined 
                                in paragraph (7)(C)(ii)) for a hospital 
                                that the Secretary determines had 
                                residency positions that were unused 
                                for all 3 of the most recent cost 
                                reporting periods of such hospital 
                                ending prior to the date of enactment 
                                of this paragraph by an amount that is 
                                equal to the number of such unused 
                                residency positions.
                                    ``(II) Exception for rural 
                                hospitals and certain other 
                                hospitals.--Subclause (I) shall not 
                                apply to a hospital--
                                            ``(aa) located in a rural 
                                        area (as defined in subsection 
                                        (d)(2)(D) in the matter 
                                        following clause (ii));
                                            ``(bb) that has 
                                        participated in a voluntary 
                                        reduction plan under paragraph 
                                        (6); or
                                            ``(cc) that has 
                                        participated in a demonstration 
                                        project approved as of October 
                                        31, 2003, under the authority 
                                        of section 402 of Public Law 
                                        90-248.
                            ``(ii) Redistribution.--The Secretary shall 
                        redistribute the unused residency positions as 
                        determined under clause (i) to qualified 
                        teaching health centers.
                    ``(C) Determining resident payment amount.--The 
                resident payment amount for each teaching health center 
                shall be determined according to paragraph (3) except 
                that--
                            ``(i) the resident payment amount shall not 
                        be set lower than the national average per 
                        resident amount adjusting for locality as 
                        determined in paragraph (2)(E); and
                            ``(ii) the resident payment amount shall be 
                        determined using the medicare patient load (as 
                        defined in paragraph (3)(C)) of the hospital 
                        with which the teaching health center has 
                        contracted, and the resident payment amount of 
                        a teaching health center that has contracted 
                        with more than one hospital shall be determined 
                        based on the medicare patient load of the 
                        hospital in which residents spend the greatest 
                        proportion of their training.
                    ``(D) Qualified teaching health center defined.--In 
                this paragraph, the term `qualified teaching health 
                center' means a community-based, ambulatory care 
                patient care center that--
                            ``(i) operates an approved medical 
                        residency training program; and
                            ``(ii) contracts with at least one hospital 
                        for residency training purposes with the 
                        following conditions:
                                    ``(I) The teaching health center 
                                shall incur the cost of the resident's 
                                salary and fringe benefits while the 
                                resident is training at the hospital 
                                site.
                                    ``(II) The teaching health center 
                                shall compensate the hospital for 
                                supervisory teaching activities and 
                                indirect costs as determined 
                                appropriate by the two contracting 
                                bodies.
                                    ``(III) The FTE resident amount of 
                                the teaching health center shall not 
                                affect the FTE resident amount or 
                                resident limit of the contracting 
                                hospital.
            ``(9) Primary care maintenance level.--
                    ``(A) In general.--A hospital receiving payments 
                for graduate medical education under this subsection 
                must maintain the number of primary care residents that 
                is equal to the average number of primary care 
                residents for the 3 most recent 12-month cost reporting 
                periods of such hospital ending prior to the date of 
                enactment of this paragraph, except that--
                            ``(i) in the case of a hospital unable to 
                        fill its primary care resident positions, such 
                        positions shall not be converted to non-primary 
                        care positions; and
                            ``(ii) in the case of a hospital awarded 
                        additional primary care resident positions, 
                        such hospital must maintain the number of 
                        primary care residents that is equal to the 
                        average number of primary care residents for 
                        the 3 most recent 12-month cost reporting 
                        periods of such hospital plus the number of 
                        newly awarded positions.
                    ``(B) Primary care resident defined.--In this 
                paragraph, the term `primary care resident' has the 
                meaning given the term in paragraph (5)(H).''.
    (b) Payments for Indirect Graduate Medical Education Costs.--
Section 1886(d)(5)(B) of the Social Security Act (42 U.S.C. 
1395ww(d)(5)(B)) is amended by adding at the end the following new 
clauses:
                            ``(x) Payments to qualified teaching health 
                        centers.--For qualified teaching health centers 
                        (as defined in subsection (h)(8)(D)), indirect 
                        costs of medical education shall be determined 
                        according to clause (i), except that--
                                    ``(I) payments shall be distributed 
                                directly to teaching health centers on 
                                a quarterly basis; and
                                    ``(II) payments shall be determined 
                                based on the average ratio in the 
                                contracting hospital (as described in 
                                subsection (h)(8)(D)(ii)) of full-time 
                                equivalent interns and residents to 
                                beds in the 3-month cost reporting 
                                period immediately preceeding the 
                                payment date.
                            ``(xi) Primary care maintenance level.--
                                    ``(I) In general.--A hospital 
                                receiving additional payments under 
                                this subparagraph shall maintain the 
                                number of primary care residents that 
                                is equal to the average number of 
                                primary care residents for the 3 most 
                                recent 12-month cost reporting periods 
                                of such hospital ending prior to the 
                                date of enactment of this paragraph, 
                                except that--
                                            ``(aa) in the case of a 
                                        hospital unable to fill its 
                                        primary care resident 
                                        positions, those positions 
                                        shall not be converted to non-
                                        primary care positions; and
                                            ``(bb) in the case of a 
                                        hospital awarded additional 
                                        primary care resident 
                                        positions, that hospital shall 
                                        maintain the number of primary 
                                        care residents that is equal to 
                                        the average number of primary 
                                        care residents for the 3 most 
                                        recent 12-month cost reporting 
                                        periods of such hospital plus 
                                        the number of newly awarded 
                                        positions.
                                    ``(II) Primary care resident 
                                defined.--In this clause, the term 
                                `primary care resident' has the meaning 
                                given the term in subsection 
                                (h)(5)(H).''.

SEC. 102. GRANT PROGRAM FOR MEDICAL RESIDENCY TRAINING PROGRAMS IN 
              QUALIFIED TEACHING HEALTH CENTERS.

    Part C of title VII of the Public Health Service Act (42 U.S.C. 
293k et seq.) is amended by adding after section 748 the following:

``SEC. 749. GRANT PROGRAM FOR MEDICAL RESIDENCY TRAINING PROGRAMS IN 
              QUALIFIED TEACHING HEALTH CENTERS.

    ``(a) Establishment.--The Secretary shall make grants--
            ``(1) to qualified teaching health centers to establish new 
        accredited medical residency training programs or to expand 
        existing medical residency training programs; and
            ``(2) to public or private nonprofit organizations to 
        provide technical support to qualified teaching health centers 
        to establish medical residency training programs.
    ``(b) Use of Funds.--
            ``(1) A grant received under subsection (a)(1) shall be 
        used for the following:
                    ``(A) Curriculum development.
                    ``(B) Facilities expansion.
                    ``(C) Equipment acquisition.
                    ``(D) Recruitment, training, and retention of 
                residents and faculty.
                    ``(E) Accreditation by the Accreditation Council 
                for Graduate Medical Education (ACGME) or the American 
                Osteopathic Association (AOA).
                    ``(F) Faculty and resident salaries.
            ``(2) A grant received under subsection (a)(2) shall be 
        used for the following:
                    ``(A) Materials development.
                    ``(B) Staff salaries.
                    ``(C) Travel expenses.
                    ``(D) Administrative costs.
    ``(c) Limitation.--Not more than 25 percent of funds made available 
to carry out this section shall be used for technical support grants 
under subsection (a)(2).
    ``(d) Qualified Teaching Health Center Defined.--In this section, 
the term `qualified teaching health center' has the meaning given the 
term in section 1886(h)(8)(D) of the Social Security Act (42 U.S.C. 
1395ww(h)(8)(D)).
    ``(e) Authorization of Appropriations.--There are authorized to be 
appropriated to carry out this section such sums as may be 
necessary.''.

SEC. 103. EXPANDING THE NATIONAL HEALTH SERVICE CORPS TO ALLOW SERVICE 
              IN A TEACHING CAPACITY.

    Section 338C(a) of the Public Health Service Act (42 U.S.C. 
254m(a)) is amended to read as follows:
    ``(a) Service in Full-Time Clinical Practice.--Except as provided 
in section 338D (42 U.S.C. 254n), each individual who has entered into 
a written contract with the Secretary under section 338A or 338B (42 
U.S.C. 254l or 254l-1) shall provide service in the full-time clinical 
practice of such individual's profession as a member of the Corps for 
the period of obligated service provided in such contract. For the 
purpose of calculating time spent in full-time clinical practice under 
this subparagraph, up to 30 percent of time spent teaching by a member 
of the Corps may be counted toward his or her service obligation.''.

  TITLE II--STATE PRIMARY CARE SCHOLARSHIP AND LOAN REPAYMENT PROGRAMS

SEC. 201. ESTABLISHMENT.

    (a) Establishment.--State Primary Care Scholarship and Loan 
Repayment Program; Part C of title VII (42 U.S.C. 293k et seq.) should 
be amended to do the following:
            (1) Support and development of state primary care 
        scholarship and repayment programs.--
                    (A) General.--Secretary to make grants to states 
                for the purpose of--
                            (i) entering into contracts with accredited 
                        public or nonprofit private hospitals, schools 
                        of medicine or osteopathic medicine, 
                        academically affiliated physician assistant 
                        training program, academically affiliate 
                        nursing program, or a public or private 
                        nonprofit entity which the States have 
                        determined are capable of carrying out such 
                        grants or contracts;
                            (ii) planning, developing, operating, or 
                        participating in an accredited professional 
                        training program, including an accredited 
                        residency or internship program in the field of 
                        family medicine, general internal medicine, 
                        general pediatrics, or geriatrics for medical 
                        students, interns, residents, or practicing 
                        physicians as defined by the Secretary;
                            (iii) creating scholarship programs for 
                        Matching Federal funds to states to establish 
                        or expand current Primary Care Scholarship and 
                        Loan Repayment Programs, allowing states to 
                        target scholarships to medical schools and loan 
                        repayments to training institutions which adopt 
                        pro-primary care policies (admission policies 
                        or curriculums) and require subsequent service 
                        within the State; and
                            (iv) to empower states with the ability to 
                        provide need-based financial assistance in the 
                        form of scholarships, 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, general pediatrics, 
                        or geriatrics.

SEC. 202. INNOVATIVE PRIMARY CARE TRAINING MODELS/INSTITUTES.

    (a) Primary Care Training Institutes.--
            (1) Purpose.--The purpose of the Primary Care Training 
        Institute program 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, such as teaching health centers, that may 
                demonstrate improved quality or lower costs;
                    (D) create economies of scale through academic and 
                community collaborations by enabling academic 
                infrastructure support for multiple community programs; 
                and
                    (E) support innovative quality primary care 
                workforce development models including those geared 
                towards removing barriers to military health personnel 
                entry into the healthcare workforce, particularly for 
                service in identifiable health shortage areas.
            (2) Establishment.--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, general pediatrics, or 
        geriatrics 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 grants.--The Secretary may make 
        grants to or enter into contracts with eligible entities to 
        develop and implement PCTIs in accordance with this subsection.
                    (A) In all cases, priority will be given to grant 
                applicants within high-need geographic areas, as 
                determined by State Workforce Councils and the National 
                Workforce Advisory Board, and to applications 
                demonstrating multi-disciplinary partnerships.
                    (B) Priority will be given to grant applicants 
                within high-need geographic areas, as determined by the 
                relevant Federal agency or program.
    (b) Sister School Program.--Grants to promote pairing health 
professions schools with undergraduate or primary/secondary schools to 
establish pipeline health professions programs. Part C of title VII (42 
U.S.C. 293k et seq.) should be amended to do the following:
            (1) Direct the Secretary to provide grants to promote the 
        pairing of accredited health professions schools with 
        undergraduate or secondary schools to establish a pipeline to 
        health professions program. (Area to address minority health 
        workforce education; health disparities; research shows that 
        where partnerships developed--with local high schools, etc.)
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