1.This Act may be cited as the
Primary Care Training Enhancement
Act
.
<enum>I</enum><header>Medical Residency
Training Programs in Qualified Teaching Health Centers</header>
<section id="HCF9AD422C6FC4FB5BE1EEFE0F1AA4CCA"><enum>101.</enum><header>Authorizing
payments for graduate medical education costs to qualified teaching health
centers</header>
<subsection display-inline="no-display-inline" id="H17AC13B1EB474960B61B81C8E100A934"><enum>(a)</enum><header>Payments for
direct graduate medical education costs</header><text display-inline="yes-display-inline">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:</text>
<quoted-block id="HAD259DB15B47484BBDDB5D2799C6EB8B">
<paragraph id="H84C4DC002B8048D28BF979DD04F9C924"><enum>(8)</enum><header>Qualified
teaching health centers</header>
<subparagraph display-inline="no-display-inline" id="H6F2300D27669435E918EDE1C61B09050"><enum>(A)</enum><header>In
general</header><text display-inline="yes-display-inline">The Secretary may
approve qualified teaching health centers to receive payments as determined
under subparagraph (C).</text>
</subparagraph><subparagraph id="H082A40AA55C4420481C57F0000114497"><enum>(B)</enum><header>Redistribution
of unused residency positions</header>
<clause id="H3556B249C706445E8C827FA5C8385B55"><enum>(i)</enum><header>Reduction in
limit based on unused positions</header>
<subclause id="H8BF6AF6E8AE04DA4BD778900A7D5C8BC"><enum>(I)</enum><header>In
general</header><text>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.</text>
</subclause><subclause id="HFC56CE8A3DDE4ADA923EE392A6A9A627"><enum>(II)</enum><header>Exception for
rural hospitals and certain other hospitals</header><text>Subclause (I) shall
not apply to a hospital—</text>
<item id="H923616649C0746EC8D30DB61E124AF6E"><enum>(aa)</enum><text>located in a
rural area (as defined in subsection (d)(2)(D) in the matter following clause
(ii));</text>
</item><item id="H5B0F63F8D9544438AE8C7D002DA64DEF"><enum>(bb)</enum><text>that has
participated in a voluntary reduction plan under paragraph (6); or</text>
</item><item id="H6DB0D7E48F974CCFAAFDB614474B003B"><enum>(cc)</enum><text>that has
participated in a demonstration project approved as of October 31, 2003, under
the authority of section 402 of Public Law 90–248.</text>
</item></subclause></clause><clause id="H937DC977400A4D73A99D48A69C582535"><enum>(ii)</enum><header>Redistribution</header><text display-inline="yes-display-inline">The Secretary shall redistribute the unused
residency positions as determined under clause (i) to qualified teaching health
centers.</text>
</clause></subparagraph><subparagraph display-inline="no-display-inline" id="HBEE7962A4AE6446D9E543B097239CB11"><enum>(C)</enum><header>Determining
resident payment amount</header><text display-inline="yes-display-inline">The
resident payment amount for each teaching health center shall be determined
according to paragraph (3) except that—</text>
<clause id="H6E43DFB6FAFA41FFA809FF3FDDE0206"><enum>(i)</enum><text display-inline="yes-display-inline">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</text>
</clause><clause id="H85942DC5B97B4857A4BC962987BD6E5C"><enum>(ii)</enum><text display-inline="yes-display-inline">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.</text>
</clause></subparagraph><subparagraph display-inline="no-display-inline" id="H9690A43633F94D1782933B7967F31498"><enum>(D)</enum><header>Qualified
teaching health center defined</header><text>In this paragraph, the term
<term>qualified teaching health center</term> means a community-based,
ambulatory care patient care center that—</text>
<clause id="H1E012FBA92D24B1C9B78D6D97861366B"><enum>(i)</enum><text>operates an
approved medical residency training program; and</text>
</clause><clause id="H5735274C80AA408894BFC37800DEF330"><enum>(ii)</enum><text display-inline="yes-display-inline">contracts with at least one hospital for
residency training purposes with the following conditions:</text>
<subclause id="HF8A0B2A9F9B3429EB1835C312885746B"><enum>(I)</enum><text>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.</text>
</subclause><subclause id="HD1B8270D8EFA4D43AA56E06F5EDC7F67"><enum>(II)</enum><text display-inline="yes-display-inline">The teaching health center shall compensate
the hospital for supervisory teaching activities and indirect costs as
determined appropriate by the two contracting bodies.</text>
</subclause><subclause id="H5CEDC9D6266F49D3A8521C00D614570"><enum>(III)</enum><text>The FTE resident
amount of the teaching health center shall not affect the FTE resident amount
or resident limit of the contracting hospital.</text>
</subclause></clause></subparagraph></paragraph><paragraph id="H77296875825E48FAB119408B9D046490"><enum>(9)</enum><header>Primary care
maintenance level</header>
<subparagraph id="H5A04EDBD7C944B5A86C0440037CA17C9"><enum>(A)</enum><header>In
general</header><text>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—</text>
<clause id="H1A6801220554452AB8CC73A8D9B3E23D"><enum>(i)</enum><text>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</text>
</clause><clause id="H06B8CAD011AB4459B7F72BBC9E21FC53"><enum>(ii)</enum><text display-inline="yes-display-inline">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.</text>
</clause></subparagraph><subparagraph id="HA913AB5A3C4D45C9A12B8BDDD3DEF36"><enum>(B)</enum><header>Primary care
resident defined</header><text>In this paragraph, the term <term>primary care
resident</term> has the meaning given the term in paragraph
(5)(H).</text>
</subparagraph></paragraph><after-quoted-block>.</after-quoted-block></quoted-block>
</subsection><subsection id="H4E5BA82299FA42809912EFF22FEFBB9"><enum>(b)</enum><header>Payments for
indirect graduate medical education costs</header><text>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:</text>
<quoted-block display-inline="no-display-inline" id="HD148594017F94E00A59D4BB54C0E1AA" style="OLC">
<clause id="HC257B5EA8F4446F482F787E4558285B2"><enum>(x)</enum><header>Payments to
qualified teaching health centers</header><text>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—</text>
<subclause id="HB1287701E9A8439D00E52F9600A0C56C"><enum>(I)</enum><text>payments shall be
distributed directly to teaching health centers on a quarterly basis;
and</text>
</subclause><subclause id="H9AB1F941E8CF4532AF8100E2D62EE538"><enum>(II)</enum><text display-inline="yes-display-inline">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.</text>
</subclause></clause><clause id="HA5D018EE8D494FBD9D26F6B8D88FC04D"><enum>(xi)</enum><header>Primary care
maintenance level</header>
<subclause id="HD5380A48B36143FEA83784644E88026C"><enum>(I)</enum><header>In
general</header><text display-inline="yes-display-inline">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—</text>
<item id="HAFCEEBF891D84BB88047CF813E3E4DB8"><enum>(aa)</enum><text>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</text>
</item><item id="HE66E06BC865649AF80413D9723065499"><enum>(bb)</enum><text display-inline="yes-display-inline">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.</text>
</item></subclause><subclause id="H8C7F57A14EDC49388FED8300C62015CA"><enum>(II)</enum><header>Primary care
resident defined</header><text>In this clause, the term <term>primary care
resident</term> has the meaning given the term in subsection
(h)(5)(H).</text>
</subclause></clause><after-quoted-block>.</after-quoted-block></quoted-block>
</subsection></section><section id="H098E7C1270A74C7B98E459575160E19C"><enum>102.</enum><header>Grant program
for medical residency training programs in qualified teaching health
centers</header><text display-inline="no-display-inline">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:</text>
<quoted-block id="H2E25952E8FAB4A12B71EBDE3E29EBBE1">
<section display-inline="no-display-inline" id="HDC3158E5776047599213A47641FD23EB" section-type="subsequent-section"><enum>749.</enum><header>Grant program for
medical residency training programs in qualified teaching health
centers</header>
<subsection id="H564D6146991F4F6C94335948C13449AB"><enum>(a)</enum><header>Establishment</header><text>The
Secretary shall make grants—</text>
<paragraph id="H9F423454577440C0BE71697E66F829F"><enum>(1)</enum><text>to qualified
teaching health centers to establish new accredited medical residency training
programs or to expand existing medical residency training programs; and</text>
</paragraph><paragraph id="H4FCFE8A724774E409F41F9F00028CFB"><enum>(2)</enum><text>to public or
private nonprofit organizations to provide technical support to qualified
teaching health centers to establish medical residency training
programs.</text>
</paragraph></subsection><subsection id="H2D279F567FF64E6E842C3EEE7501644F"><enum>(b)</enum><header>Use of
funds</header>
<paragraph id="HEFE7CFB454D2448BB2B38DE6DDDA836E"><enum>(1)</enum><text display-inline="yes-display-inline">A grant received under subsection (a)(1)
shall be used for the following:</text>
<subparagraph id="H95B19F80B052439E9BC392B2ED3BA566"><enum>(A)</enum><text>Curriculum
development.</text>
</subparagraph><subparagraph id="H02016805D49144E100B170FB4444A100"><enum>(B)</enum><text>Facilities
expansion.</text>
</subparagraph><subparagraph id="HDF7992E10E9B47D6BE02EC9F09B25BEC"><enum>(C)</enum><text>Equipment
acquisition.</text>
</subparagraph><subparagraph id="HE3673D44AC93438D90027CE200F32294"><enum>(D)</enum><text>Recruitment,
training, and retention of residents and faculty.</text>
</subparagraph><subparagraph id="H97D6127083B1452A8F174F9FDCB70971"><enum>(E)</enum><text>Accreditation by
the Accreditation Council for Graduate Medical Education (ACGME) or the
American Osteopathic Association (AOA).</text>
</subparagraph><subparagraph id="HF7680B0085F54E51BA7F4C5EAAF8200"><enum>(F)</enum><text>Faculty and
resident salaries.</text>
</subparagraph></paragraph><paragraph id="H971C94E896264CD9BA64CD1787023193"><enum>(2)</enum><text>A grant received
under subsection (a)(2) shall be used for the following:</text>
<subparagraph id="H07CAD81D743F4F0CA52300A4D059D3F2"><enum>(A)</enum><text>Materials
development.</text>
</subparagraph><subparagraph id="H53FB3B496E804524BB58A0AB3B6D74D1"><enum>(B)</enum><text>Staff
salaries.</text>
</subparagraph><subparagraph id="HBB869A27424E41FFA4F8CC9D19C6D47E"><enum>(C)</enum><text>Travel
expenses.</text>
</subparagraph><subparagraph id="H4D760CBF766145A1BA871E965F37A91B"><enum>(D)</enum><text>Administrative
costs.</text>
</subparagraph></paragraph></subsection><subsection id="H5FF9CD63308D49C0819337580033F58C"><enum>(c)</enum><header>Limitation</header><text>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).</text>
</subsection><subsection id="H605FF852127F4C58B531BABB089458E9"><enum>(d)</enum><header>Qualified
teaching health center defined</header><text display-inline="yes-display-inline">In this section, the term <term>qualified
teaching health center</term> 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)).</text>
</subsection><subsection id="H6DB186651BC042608504EFE842DBD092"><enum>(e)</enum><header>Authorization of
appropriations</header><text>There are authorized to be appropriated to carry
out this section such sums as may be
necessary.</text>
</subsection></section><after-quoted-block>.</after-quoted-block></quoted-block>
</section><section id="H683E782EF6A34E50A90033753B6E57F5"><enum>103.</enum><header>Expanding the
National Health Service Corps to allow service in a teaching
capacity</header><text display-inline="no-display-inline">Section 338C(a) of
the Public Health Service Act (42 U.S.C. 254m(a)) is amended to read as
follows:</text>
<quoted-block id="H2888E4B22DE244C6AB60D25CA034FFA0">
<subsection id="HB01246BB285B4AE991407E00FD4407AB"><enum>(a)</enum><header>Service in
full-time clinical practice</header><text display-inline="yes-display-inline">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.</text>
</subsection><after-quoted-block>.</after-quoted-block></quoted-block>
</section><enum>II</enum><header>State Primary
Care Scholarship and Loan Repayment Programs</header>
<section commented="no" id="H9E52947C106A42BCB0FB8485D9FA285C"><enum>201.</enum><header>Establishment</header>
<subsection commented="no" display-inline="no-display-inline" id="HC8189BC93D0143CAB4BB86E3FA796706"><enum>(a)</enum><header>Establishment</header><text>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:</text>
<paragraph commented="no" id="H79F00BBEA76B41E1B3F1B02FAB7E52E"><enum>(1)</enum><header>Support and
Development of State Primary Care Scholarship and Repayment Programs</header>
<subparagraph commented="no" id="H9E8AC271A5614115867DD41DF54B521B"><enum>(A)</enum><header>General</header><text>Secretary
to make grants to states for the purpose of—</text>
<clause commented="no" id="H3CC0E4404A394EF5A6E8DC502B671907"><enum>(i)</enum><text>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;</text>
</clause><clause commented="no" id="H90A2E6B6726A444CB168D7E4640B4DA"><enum>(ii)</enum><text>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;</text>
</clause><clause commented="no" id="HF02BCFD254BE47459D1154DDD160E936"><enum>(iii)</enum><text>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</text>
</clause><clause commented="no" id="H4DAD9C93264947CAA311DA91DFC2BCCB"><enum>(iv)</enum><text>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.</text>
</clause></subparagraph></paragraph></subsection></section><section commented="no" id="HB4A5A9AFB97643C68EA007E3487E17F"><enum>202.</enum><header>Innovative
Primary Care Training Models/Institutes</header>
<subsection commented="no" id="H5EA2CF742B5E44899BD3CC66F537E464"><enum>(a)</enum><header>Primary Care
Training Institutes</header>
<paragraph commented="no" id="H9544FB715EE04139A4CFC48CBD00AD3F"><enum>(1)</enum><header>Purpose</header><text>The
purpose of the Primary Care Training Institute program is to—</text>
<subparagraph commented="no" id="HA6D541FA9DF94F0392E1F2A523002E9E"><enum>(A)</enum><text>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;</text>
</subparagraph><subparagraph commented="no" id="HEB69F3382DC24C09B0CEF37E6912FDA5"><enum>(B)</enum><text>enhance the status
of primary care within undergraduate and graduate medical education through
influencing priorities in practice, education, and research;</text>
</subparagraph><subparagraph commented="no" id="H06EA654C2EBE4764B8B3ECDAB7FF07E"><enum>(C)</enum><text>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;</text>
</subparagraph><subparagraph commented="no" id="H5906F126C5374BD38E639728E4C9671"><enum>(D)</enum><text>create economies of
scale through academic and community collaborations by enabling academic
infrastructure support for multiple community programs; and</text>
</subparagraph><subparagraph commented="no" id="H4A8D96758A7F4A1E89DCB215A75B611E"><enum>(E)</enum><text>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.</text>
</subparagraph></paragraph><paragraph commented="no" id="H589B81F09B22476E83CC66F59D526CA"><enum>(2)</enum><header>Establishment</header><text>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 <quote>PCTIs</quote>).</text>
</paragraph><paragraph commented="no" id="H1B75A150155243B7985B43D22E85123B"><enum>(3)</enum><header>Authority to
award grants</header><text>The Secretary may make grants to or enter into
contracts with eligible entities to develop and implement PCTIs in accordance
with this subsection.</text>
<subparagraph commented="no" id="H946889A577224717BCB8E026615DCF41"><enum>(A)</enum><text>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.</text>
</subparagraph><subparagraph commented="no" id="H0355697868DA403CAA51729C53E652CC"><enum>(B)</enum><text>Priority will be
given to grant applicants within high-need geographic areas, as determined by
the relevant Federal agency or program.</text>
</subparagraph></paragraph></subsection><subsection commented="no" id="HF201ED9262B74A9DAB751621866C0078"><enum>(b)</enum><header>Sister School
Program</header><text>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:</text>
<paragraph commented="no" id="HF000D03048BB4265891D6C47FD00009D"><enum>(1)</enum><text display-inline="yes-display-inline">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.)</text>
</paragraph></subsection></section>