1.Short title; table of
contents
(a)This Act may be cited
as the Health Access and Health
Professions Supply Act of 2009
or HAHPSA
2009
.
(b)The table of contents of this Act is as follows:
Sec. 1. Short title; table of contents.
Sec. 2. Findings.
Title I—Amendments to the Social Security Act
Subtitle A—Workforce Improvements
Sec. 101. National health care workforce
commission.
Sec. 102. State health workforce centers program.
Sec. 103. Improvements to payments for graduate medical
education under medicare.
Sec. 104. Distribution of resident trainees in an
emergency.
Sec. 105. Authority to include costs of training of
psychologists in payments to hospitals for approved educational activities
under Medicare.
Subtitle B—Geriatric Assessments and Chronic Care Management
and Coordination Services Under the Medicare Program
Sec. 111. Medicare coverage of geriatric
assessments.
Sec. 112. Medicare coverage of chronic care management and
coordination services.
Sec. 113. Outreach activities regarding geriatric assessments
and chronic care management and coordination services under the Medicare
program.
Sec. 114. Utilization of telehealth services to furnish
geriatric assessments and chronic care management and coordination services
under the Medicare program.
Sec. 115. Study and report on geriatric assessments and chronic
care management and coordination services under the Medicare
program.
Sec. 116. Rule of construction.
Title II—Amendments to the Public Health Service Act
Sec. 201. Expansion of National Health Service Corps
programs.
Sec. 202. National health service corps scholarship program for
medical, dental, physician assistant, pharmacy, behavioral and mental health,
public health, and nursing students in the United States public health sciences
track in affiliated schools.
Sec. 203. Federal medical facility grant program and program
assessments.
Sec. 204. Health professions training loan program.
Sec. 205. United States Public Health Sciences
Track.
Sec. 206. Medical education debt reimbursement for physicians
of the Veterans Health Administration.
Sec. 207. Promoting education and training of psychologists to
provide mental and behavioral health services to underserved
populations.
Title III—Health professional training pipeline partnerships
program
Sec. 301. Grants to prepare students for careers in health
care.
2.
(a)Findings related
to health care access in rural, frontier, and urban underserved areas of the
United StatesCongress finds
the following:
(1)The United States
does not have a cohesive or coordinated approach to addressing health workforce
shortages and problems with reliable access to quality, affordable health
care.
(2)There are
50,000,000 citizens of the United States living in areas that are designated
under section 332(a)(1)(A) of the Public Health Service Act as health
professional shortage areas.
(3)The population of
the United States will grow by 25,000,000 each decade.
(4)The number of
individuals over 65 years of age in the United States will double between 2000
and 2030, with such individuals accounting for 20 percent of the total
population of the United States in 2030.
(5)Individuals over
65 years of age have twice as many doctor visits as those individuals under 65
years of age, resulting in an increase in the demand for physicians, physician
assistants, pharmacists behavioral and mental health professionals, nurses, and
dentists.
(6)The rates of
chronic diseases (such as diabetes) are increasing in the population of the
United States.
(7)There are
47,000,000 citizens of the United States who do not have health insurance, and
over 130,000,000 individuals within the United States who do not have dental
insurance. Those individuals who are uninsured have limited access to health
care.
(8)Academic health
centers, Federal medical facilities, and teaching hospitals provide a
substantial percentage of safety net services in the United States to uninsured
and underinsured populations and to those individuals who have 1 or more
chronic diseases. Such centers, facilities, and teaching hospitals provide
those safety net services while concurrently providing for the training of
health professionals.
(9)The pipeline for
the education of health professionals—
(A)begins and often
ends in urban areas;
(B)does not reliably
include Federal support for nonphysician training;
(C)does not
incorporate modern training venues and techniques, including community-based
ambulatory sites; and
(D)discourages
interdisciplinary, team, and care coordination models as a result of
restrictive regulations.
(10)Health reform
must include measures to transform the health delivery system to assure access,
quality, and efficiency by utilizing contemporary models and venues of
care.
(11)Reform of the
health delivery system will require modernization of the training of health
professionals to ensure that health professionals—
(A)practice in
integrated teams in a variety of delivery venues (including inpatient and
ambulatory settings and long-term care facilities) to utilize decision support
and health information systems;
(B)deliver
patient-centered care;
(C)practice
evidence-based health care;
(D)learn
performance-based compensation systems, comparative effectiveness, and costs of
care across the spectrum; and
(E)deliver culturally
appropriate, personalized care.
(b)Findings related
to access to oral healthCongress finds the following:
(1)Dental care is the
number 1 unmet health care need in children, and is 1 of the top 5 unmet health
care needs in adults.
(2)Over 130,000,000
citizens of the United States are without dental insurance.
(3)Over 45,000,000
citizens of the United States live in areas that are designated under section
332(a)(1)(A) of the Public Health Service Act as dental health professional
shortage areas.
(4)Rural counties
have less than half the number of dentists per capita compared to large
metropolitan areas (29 versus 62 for population of 100,000).
(5)In 2006, over
9,000 dentists were needed in such dental health professional shortage
areas.
(6)Between 27 and 29
percent of children and adults in the United States have untreated
cavities.
(7)The number of
dental school graduates in the United States decreased by 20 percent between
1982 and 2003 and the average age of practicing dentists in the United States
is 49.
(8)There were over
400 dental faculty vacancies in the school year beginning in 2006.
(9)In 2007, the
average debt of a dental student at graduation was $172,627.
(c)Findings related
to physician shortages, education, and distributionCongress
finds the following:
(1)By 2020, physician
shortages are forecasted to be in the range of 55,000 to 200,000.
(2)Although 21
percent of the population of the United States lives in rural areas, only 10
percent of physicians work in rural areas and, for every 1 physician who goes
into practice in regions with a low supply of physicians, 4 physicians go into
practice in regions with a high supply of physicians.
(3)According to a
2004 report by Green et al. for the Robert Graham Center of the American
Academy of Family Physicians, the number of applicants from rural areas
accepted to medical school has decreased by 40 percent in the last 20 years
while the number of such applications has remained the same.
(4)In order to
respond to forecasted shortages, experts have recommended an increase between
15 and 30 percent in class size at medical schools over the next 10
years.
(5)There are
55,000,000 citizens of the United States who lack adequate access to primary
health care because of shortages of primary care providers in their
communities.
(6)The number of
graduates from medical school in the United States who choose to practice
family medicine has plummeted 50 percent in less than 10 years. Without
congressional intervention, such decline will likely continue, and access to
care in underserved areas will rapidly deteriorate. Family physicians represent
58 percent of the rural physician workforce, 70 percent of non-Federal
physicians in whole-county health professional shortage areas, and 78 percent
of primary care physician full-time equivalents in the National Health Service
Corps.
(7)Current trends
indicate that fewer resident trainees from pediatric and internal medicine
residencies pursue generalist practice at graduation.
(8)Funding for
medical education which is provided through direct Graduate Medical Education
(GME) and Indirect Medical Education (IME) under the Medicare program is not
transparent or accountable, nor is it aligned to the types of health
professionals most needed or to the areas in which health professionals are
most needed.
(9)Physician supply
varies 200 percent across regions and there is no relationship between regional
physician supply and health needs.
(10)The Council on
Graduate Medical Education’s 18th Report (issued in 2007), entitled New
Paradigms for Physician Training for Improving Access to Health Care
,
and 19th Report (issued in 2007), entitled Enhancing Flexibility in
Graduate Medical Education
, each call for changes to address the
healthcare needs of the United States by removing barriers to expanding and
more appropriately training the physician workforce.
(d)Findings related
to nursing shortages, education, and distributionCongress finds
the following:
(1)By 2020, nursing
shortages are forecast to be in the range of 300,000 to 1,000,000 and the
Bureau of Labor Statistics of the Department of Labor estimates that more than
1,200,000 new and replacement registered nurses will be needed by 2014.
(2)Nurse vacancy
rates are currently 8 percent or greater in hospitals and community health
centers receiving assistance under section 330 of the Public Health Service
Act, and for nursing faculty positions.
(3)Surveys indicate
that 40 percent of nurses in hospitals are dissatisfied with their work and, of
nurses who graduate and go into nursing, 50 percent leave their first employer
within 2 years.
(4)Nursing
baccalaureate and graduate programs rejected more than 40,000 qualified nursing
school applicants in 2006, with faculty shortages identified by such programs
as a major reason for turning away qualified applicants.
(5)More than 70
percent of nursing schools cited faculty shortages as the primary reason for
not accepting all qualified applicants into entry-level nursing
programs.
(6)The nursing
faculty workforce is aging and retiring and, by 2019, approximately 75 percent
of the nursing faculty workforce is expected to retire.
(7)The average age of
nurses in the United States is 49 and the average age of an associate professor
nurse faculty member in the United States is 56.
(8)Geriatric patients
receiving care from nurses trained in geriatrics are less frequently readmitted
to hospitals or transferred from skilled nursing facilities and nursing
facilities to hospitals.
(e)Findings related
to public health workforce shortagesCongress finds the
following:
(1)The United States
has an estimated 50,000 fewer public health workers than it did 20 years ago
while the population has grown by approximately 22 percent.
(2)Government public
health departments are facing significant workforce shortages that could be
exacerbated through retirements.
(3)Twenty percent of
the average State health agency’s workforce will be eligible to retire within 3
years, and by 2012, over 50 percent of some State health agency workforces will
be eligible to retire.
(4)Approximately 20
percent of local health department employees will be eligible for retirement by
2010.
(5)The average age of
new hires in State health agencies is 40.
(6)Four out of 5
current public health workers have not had formal training for their specific
job functions.
(f)Findings related
to physician assistant shortagesCongress finds the
following:
(1)The purpose of the
physician assistant profession is to extend the ability of physicians to
provide primary care services, particularly in rural and other medically
underserved communities.
(2)Physician
assistants always practice medicine as a team with their supervising
physicians, however, supervising physicians need not be physically present when
physician assistants provide medical care.
(3)Physician
assistants are legally regulated in all States, the District of Columbia, and
Guam. All States, the District of Columbia, and Guam authorize physicians to
delegate prescriptive authority to physician assistants.
(4)In 2007, physician
assistants made approximately 245,000,000 patient visits and prescribed or
recommended approximately 303,000,000 medications.
(5)The National
Association of Community Health Centers, the George Washington University, and
the Robert Graham Center for Policy Studies in Family Medicine and Primary Care
found that while the number of patients who seek care at community health
centers has increased, the number of primary care providers, including
physician assistants, has not. The report estimates a need for 15,500 primary
health care providers to provide care at community health centers.
(g)Findings related
to mental health professional shortagesCongress finds the
following:
(1)The National
Institute of Mental Health estimates that 26.2 percent of citizens of the
United States ages 18 and older suffer from a diagnosable mental disorder.
Approximately 20 percent of children in the United States have diagnosable
mental disorders with at least mild functional impairment.
(2)The Health
Resources and Services Administration reports that there are 3,059 mental
health professional shortage areas within the United States with 77,000,000
people living in those areas. More than 5,000 additional mental health
professionals are needed to meet demand.
(3)According to the
Department of Health and Human Services, minority representation is lacking in
the mental health workforce. Although 12 percent of the population of the
United States is African-American, only 2 percent of psychologists, 2 percent
of psychiatrists, and 4 percent of social workers are African-American.
Moreover, there are only 29 mental health professionals who are Hispanic for
every 100,000 individuals who are Hispanic in the United States, compared with
173 non-Hispanic White providers for every 100,000 individuals who are
non-Hispanic White in the United States.
(h)Findings related
to health professional shortage areas
(1)In 2006, the
National Health Service Corps had a total of 4,200 vacant positions in health
professional shortage areas, but only 1,200 of those positions were funded. For
each National Health Service Corps award, there are 7 applicants.
(2)Community health
centers receiving assistance under section 330 of the Public Health Service Act
have expanded to serve 16,000,000 individuals in over 1,000 sites. Such
community health centers have high vacancy rates for family physicians (13
percent), obstetricians and gynecologists (21 percent), dentists, nurses, and
other health professionals.
(3)The Institute of
Medicine of the National Academies has recommended that medical education and
public health issues be more closely aligned, especially in relation to
preparedness for natural disasters, pandemic, bioterrorism, and other threats
to public health.
(4)The education of
health professionals must be more closely aligned with health care needs in the
United States, with special attention to underserved populations and areas,
health disparities, the aging population, and individuals with 1 or more
chronic diseases.
(5)There is some
duplication, and little coordination, between the Council on Graduate Medical
Education (related to the physician workforce), the National Advisory Committee
on Nursing Programs (related to the nursing workforce), the Advisory Committee
on Training in Primary Care Medicine and Dentistry, and other advisory
committees and councils.
(6)The Association of
Academic Health Centers calls for making the health workforce of the United
States a priority domestic policy issue and creating a national health
workforce planning body that engages Federal, State, public, and private
stakeholders.
<enum>I</enum><header>Amendments to the
Social Security Act</header>
<subtitle id="H66822CF2124F488F83467F2780F3DF16"><enum>A</enum><header>Workforce
Improvements</header>
<section id="H34907558C63648A59920B266FE242934"><enum>101.</enum><header>National health
care workforce commission</header>
<subsection id="HB5BC1A8504CF46C4843040486EF51B6B"><enum>(a)</enum><header>Purpose</header><text>It
is the purpose of this section to establish a National Health Care Workforce
Commission that—</text>
<paragraph id="H9BD51FFB0CD64FA1B8F0BDFB2B4C0BCC"><enum>(1)</enum><text>serves as a
national resource for Congress, the President, States, and localities
by—</text>
<subparagraph id="HA7D400102F4642DB8136E6A24E88FA79"><enum>(A)</enum><text>disseminating
information on current and projected health care workforce supply and
demand;</text>
</subparagraph><subparagraph id="HFCE59135E60740829DA3FF1A47089F25"><enum>(B)</enum><text>disseminating
information on health care workforce education and training capacity and
instruction or delivery models and best practices;</text>
</subparagraph><subparagraph id="H456A0E45C32143C2852DE4A68D10E52D"><enum>(C)</enum><text>recognizing
efforts of Federal, State, and local partnerships to develop and offer health
care career pathways of proven effectiveness;</text>
</subparagraph><subparagraph id="HC50FCA3D06D142B6BEA4304D10BEE5FC"><enum>(D)</enum><text>disseminating
information on promising retention practices for health care
professionals;</text>
</subparagraph><subparagraph id="HDFD0C3C04E4940ACAFF0433797A94BD4"><enum>(E)</enum><text>communicating
information on important policies and practices that affect the recruitment,
education and training, and retention of the health care workforce; and</text>
</subparagraph><subparagraph id="H177ED26B3990485FAC3063F0940AE1D8"><enum>(F)</enum><text>disseminating
recommendations on the development of a fiscally sustainable integrated
workforce that supports a high-quality health care delivery system that meets
the needs of patients and populations;</text>
</subparagraph></paragraph><paragraph id="H7714B1DBD3DC4C0998418BB62B921BA9"><enum>(2)</enum><text>communicates and
coordinates with the Departments of Health and Human Services, Labor, and
Education on related activities administered by one or more of such
Departments;</text>
</paragraph><paragraph id="H2584EF0CB6DC4BB183358479D3FFA8BA"><enum>(3)</enum><text>develops and
commissions evaluations of education and training activities to determine
whether the demand for health care workers is being met;</text>
</paragraph><paragraph id="H05DAF36292624A7ABEC4A32E2ADA2CA0"><enum>(4)</enum><text>identifies
barriers to improved coordination at the Federal, State, and local levels and
recommend ways to address such barriers; and</text>
</paragraph><paragraph id="H1542D3A121B74F5CA8326737F2D388A4"><enum>(5)</enum><text>encourages
innovations to address population needs, constant changes in technology, and
other environmental factors.</text>
</paragraph></subsection><subsection id="H09A178D1F1C14C2B8C02CE395401B111"><enum>(b)</enum><header>Establishment</header><text>There
is hereby established the National Health Care Workforce Commission (in this
section referred to as the <quote>Commission</quote>).</text>
</subsection><subsection id="H25C02B56ACE94B9290D487BAF51CC5C9"><enum>(c)</enum><header>Membership</header>
<paragraph id="H40E1695AA9FA46A09D988845F494E9B6"><enum>(1)</enum><header>Number and
appointment</header><text>The Commission shall be composed of 15 members to be
appointed by the Comptroller General.</text>
</paragraph><paragraph id="H8CD6636C102747C8931D1CDAC19DD5CC"><enum>(2)</enum><header>Qualifications</header>
<subparagraph id="HCB54F18630AD4E13A6BE656541510A2E"><enum>(A)</enum><header>In
general</header><text>The membership of the Commission shall include
individuals—</text>
<clause id="H8DDA4ED47BEF4C198ED5BAAA1C454DCC"><enum>(i)</enum><text>with
national recognition for their expertise in health care labor market analysis,
including health care workforce analysis; health care finance and economics;
health care facility management; health care plans and integrated delivery
systems; health care workforce education and training; health care
philanthropy; providers of health care services; and other related fields;
and</text>
</clause><clause id="HFDF5306D8B2A425B823DD9D6A85B7DC3"><enum>(ii)</enum><text>who
will provide a combination of professional perspectives, broad geographic
representation, and a balance between urban, suburban, and rural
representatives.</text>
</clause></subparagraph><subparagraph id="HCB812666D78749D39F3CDAE3C55F04A8"><enum>(B)</enum><header>Inclusion</header>
<clause id="H65099E1DC56B4E049E37B3F0AD5EA956"><enum>(i)</enum><header>In
general</header><text>The membership of the Commission shall include no less
than one representative of—</text>
<subclause id="H3D46852D0C34480193A8E91A5C380A1A"><enum>(I)</enum><text>the health care
workforce and health professionals;</text>
</subclause><subclause id="H6EB4ECB30F814446807A6736742A7B93"><enum>(II)</enum><text>employers;</text>
</subclause><subclause id="H4E724BC89D4D473CAB4C105C5AED7A76"><enum>(III)</enum><text>third-party
payers;</text>
</subclause><subclause id="H613DBABE6867449A953417B562214FAF"><enum>(IV)</enum><text>individuals
skilled in the conduct and interpretation of health care services and health
economics research;</text>
</subclause><subclause id="H45DA977691BE475C9C84146E3F62D60F"><enum>(V)</enum><text>representatives of
consumers;</text>
</subclause><subclause id="HAFA89A27B95045C3847F7C900A0244EE"><enum>(VI)</enum><text>labor
unions;</text>
</subclause><subclause id="H1F5616CC231843D2B04514320AEE088A"><enum>(VII)</enum><text>State or local
workforce investment boards; and</text>
</subclause><subclause id="H3F64D808A525490B85736457D76EEBC6"><enum>(VIII)</enum><text>educational
institutions (which may include elementary and secondary institutions,
institutions of higher education, including 2 and 4 year institutions, or
registered apprenticeship programs).</text>
</subclause></clause><clause id="HCA1EA0A40F024BCC8F61592495E32BA0"><enum>(ii)</enum><header>Additional
members</header><text>The remaining membership may include additional
representatives from clause (i) and other individuals as determined appropriate
by the Comptroller General of the United States.</text>
</clause></subparagraph><subparagraph id="HBEEC79F8B4EB47DCA40E5D9ED5556B23"><enum>(C)</enum><header>Majority
non-providers</header><text>Individuals who are directly involved in health
professions education or practice shall not constitute a majority of the
membership of the Commission.</text>
</subparagraph></paragraph><paragraph id="HA23A89AE131E48F6A787C06D93243B5E"><enum>(3)</enum><header>Terms</header>
<subparagraph id="H52E72EE252E24283940AF0212A001DBF"><enum>(A)</enum><header>In
general</header><text>The terms of members of the Commission shall be for 3
years except that the Comptroller General shall designate staggered terms for
the members first appointed.</text>
</subparagraph><subparagraph id="H9659B5CE85AB4087BCC5D723D4540A43"><enum>(B)</enum><header>Vacancies</header><text>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
members term until a successor has taken office. A vacancy in the Commission
shall be filled in the manner in which the original appointment was
made.</text>
</subparagraph></paragraph><paragraph id="H71761A5A5C5B4DD5A798D0265412F5E9"><enum>(4)</enum><header>Compensation</header><text>While
serving on the business of the Commission (including travel time), a member of
the Commission 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
tile 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 Commission. Physicians serving as personnel
of the Commission may be provided a physician comparability allowance by the
Commission 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 Commission
in the same manner as it applies to the Tennessee Valley Authority. For
purposes of pay (other than pay of members of the Commission) and employment
benefits, rights, and privileges, all personnel of the Commission shall be
treated as if they were employees of the United States Senate.</text>
</paragraph><paragraph id="H2B8689BBF23E49388426D70F725DCECE"><enum>(5)</enum><header>Chairman, vice
chairman</header><text>The members of the Commission shall elect, by a majority
vote, a chairman and vice chairman of the Commission for the term of their
appointment of portion remaining. Such elections shall occur at the end of any
chairman or vice chairman’s term or upon the resignation of the chairman or
vice chairman from the Commission.</text>
</paragraph><paragraph id="HF76C720D52DE4F71B302121AC4489FE8"><enum>(6)</enum><header>Meetings</header><text>The
Commission shall meet at the call of the chairman, but no less frequently than
on a quarterly basis.</text>
</paragraph></subsection><subsection id="H5766A0487BCC42AD8572750BB3C05E1D"><enum>(d)</enum><header>Duties</header>
<paragraph id="HA8AA167032B345ECBBC2838A40994EF8"><enum>(1)</enum><header>Review of health
care workforce and annual reports</header><text>In order to develop a fiscally
sustainable integrated workforce that supports a high-quality, readily
accessible health care delivery system that meets the needs of patients and
populations, the Commission, in consultation with relevant Federal, State, and
local agencies, shall—</text>
<subparagraph id="H265F2EDC5DF64273BD13CE320D012761"><enum>(A)</enum><text>review current and
projected health care workforce supply and demand, including the topics
described in paragraph (2);</text>
</subparagraph><subparagraph id="HB0A001B004804738802782B974B54912"><enum>(B)</enum><text>make
recommendations to Congress and the Administration concerning national health
care workforce priorities, goals, and policies;</text>
</subparagraph><subparagraph id="HD96C53C9C4B04A9F9E4060DDC7CBDA23"><enum>(C)</enum><text>by not later than
October 1 of each year (beginning with 2011), submit a report to Congress and
the Administration containing the results of such reviews and recommendations
concerning related policies; and</text>
</subparagraph><subparagraph id="H5474AC10E2A74740BB4FAE8E11E34835"><enum>(D)</enum><text>by not later than
April 1 of each year (beginning with 2011), submit a report to Congress and the
Administration containing a review of, and recommendations on, at a minimum one
high priority area as described in paragraph (3).</text>
</subparagraph></paragraph><paragraph id="H1E104750BECE4AE983B0694724084FAA"><enum>(2)</enum><header>Specific topics
to be reviewed</header><text>The topics described in this paragraph
include—</text>
<subparagraph id="H78E2E961DD174DE38C7A975402CF9956"><enum>(A)</enum><text>current health
care workforce supply and distribution, including demographics, skill sets, and
demands, with projected demands during the subsequent 10 and 25 year
periods;</text>
</subparagraph><subparagraph id="HB1506772805D4DB6B158951DD8E54516"><enum>(B)</enum><text>health care
workforce education and training capacity, including the number of students who
have completed education and training, including registered apprenticeships;
the number of qualified faculty; the education and training infrastructure; and
the education and training demands, with projected demands during the
subsequent 10 and 25 year periods, and including identified models of education
and training delivery and best practices;</text>
</subparagraph><subparagraph id="HB72A3857406049F0B55FB8FDF6AFA0BA"><enum>(C)</enum><text>the implications
of new and existing Federal policies which affect the health care workforce,
including Medicare and Medicaid graduate medical education policies, titles VII
and VIII of the Public Health Service Act (42 U.S.C. 292 et seq. and 296 et
seq.), the National Health Service Corps (with recommendations for aligning
such programs with national health workforce priorities and goals), and other
health care workforce programs, including those supported through the Workforce
Investment Act of 1998 (29 U.S.C. 2801 et seq.), the Carl D. Perkins Career and
Technical Education Act of 2006 (20 U.S.C. 2301 et seq.), the Higher Education
Act of 1965 (20 U.S.C. 1001 et seq.), and any other Federal health care
workforce programs; and</text>
</subparagraph><subparagraph id="H2E7FA9B5FBDE442F9762918F8D4AE163"><enum>(D)</enum><text>the health care
workforce needs of special populations, such as minorities, rural populations,
medically underserved populations, gender specific needs, and geriatric and
pediatric populations with recommendations for new and existing Federal
policies to meet the needs of these special populations.</text>
</subparagraph></paragraph><paragraph id="H8B9A95367BF948218CD7F27C0DF57284"><enum>(3)</enum><header>High priority
areas</header>
<subparagraph id="H99CFE52166714F6FB59B6CCFDD8496CC"><enum>(A)</enum><header>In
general</header><text>The initial high priority topics described in this
paragraph include—</text>
<clause id="H29462D69DDF24CBCA0FB2C6E7038806E"><enum>(i)</enum><text>integrated health
care workforce planning that identifies health care professional skills needed
and maximizes the skill sets of health care professionals across
disciplines;</text>
</clause><clause id="H4DBE40F41EBB48229B786225E0772F0D"><enum>(ii)</enum><text>an
analysis of the nature, scopes of practice, and demands for health care workers
in the enhanced information technology and management workplace;</text>
</clause><clause id="HA8BE594BE46548099A0A23BE0B275288"><enum>(iii)</enum><text>Medicare and
Medicaid graduate medical education policies and recommendations for aligning
with national workforce goals;</text>
</clause><clause id="HBA85A69C72C641889DBA31C5F80AAFC8"><enum>(iv)</enum><text>nursing workforce
capacity at all levels, including education and training capacity, projected
demands, and integration within the health care delivery system;</text>
</clause><clause id="HCC25451C6C2D484DBF09093AAC559970"><enum>(v)</enum><text>oral
health care workforce capacity, including education and training capacity,
projected demands, and integration within the health care delivery
system;</text>
</clause><clause id="H5D496F660AA842D8BB8D9A7A83008970"><enum>(vi)</enum><text>mental and
behavioral health care workforce capacity, including education and training
capacity, projected demands, and integration within the health care delivery
system;</text>
</clause><clause id="H6EA2C1FA2AD74A19A430C2D70E40FF26"><enum>(vii)</enum><text>allied health
and public health care workforce capacity, including education and training
capacity, projected demands, and integration within the health care delivery
system; and</text>
</clause><clause id="HD7C13766AA9A4BE88FC0941C68D04B68"><enum>(viii)</enum><text>the geographic
distribution of health care providers as compared to the identified health care
workforce needs of States and regions.</text>
</clause></subparagraph><subparagraph id="HA39F32755FD84C4DB9317C172C2A43A8"><enum>(B)</enum><header>Future
determinations</header><text>The Commission may require that additional topics
be included under subparagraph (A). The appropriate committees of Congress may
recommend to the Commission the inclusion of other topics for health care
workforce development areas that require special attention.</text>
</subparagraph></paragraph><paragraph id="HF3BE060F97FF417D98C4EE4262A44060"><enum>(4)</enum><header>Grant
program</header><text>The Commission shall oversee and report to Congress on
the State Health Care Workforce Development Grants program established in
section 412.</text>
</paragraph><paragraph id="HA13333B06BEF4015A92F157CA3CD66D8"><enum>(5)</enum><header>Study</header><text>The
Commission shall study effective mechanisms for financing education and
training for careers in health care, including public health and allied
health.</text>
</paragraph><paragraph id="HCA308BAD57364013B7D5F692B6F80CB4"><enum>(6)</enum><header>Recommendations</header><text>The
Commission shall submit recommendations to Congress, the Department of Labor,
and the Department of Health and Human Services about improving safety, health,
and worker protections in the workplace for the health care workforce.</text>
</paragraph><paragraph commented="no" id="HDA97C799A253424EA08B7DE8FD79464F"><enum>(7)</enum><header>Assessment</header><text>The
Commission shall assess and receive reports from the National Center for Health
Care Workforce Analysis established under title VII of the Public Service
Health Act.</text>
</paragraph></subsection><subsection id="HC657EEB571F3493EACFD4C5696672E3F"><enum>(e)</enum><header>Consultation
with Federal, State, and local agencies, congress, and other
organizations</header>
<paragraph id="HA7974D3C78BB4A08A44FEFF4ABBD0A46"><enum>(1)</enum><header>In
general</header><text>The Commission shall consult with Federal agencies
(including the Departments of Health and Human Services, Labor, Education,
Commerce, Agriculture, Defense, and Veterans Affairs and the Environmental
Protections Agency), Congress, the Medicare Payment Advisory Commission, and,
to the extent practicable, with State and local agencies, voluntary health care
organizations professional societies, and other relevant public-private health
care partnerships.</text>
</paragraph><paragraph id="H9812DEF2CC3E4A77BF2A26DACBC333D1"><enum>(2)</enum><header>Obtaining
official data</header><text>The Commission, consistent with established privacy
rules, may secure directly from any department or agency of the United States
information necessary to enable the Commission to carry out this
section.</text>
</paragraph><paragraph id="H6F99DA2986FA4A92B4CF2E6ED86BCE79"><enum>(3)</enum><header>Detail of
Federal Government employees</header><text>An employee of the Federal
Government may be detailed to the Commission without reimbursement. The detail
of such an employee shall be without interruption or loss of civil service
status.</text>
</paragraph></subsection><subsection id="HD51B822C1D2C49AC99E7470A8461F487"><enum>(f)</enum><header>Director and
staff; experts and consultants</header><text>Subject to such review as the
Comptroller General of the United States determines to be necessary to ensure
the efficient administration of the Commission, the Commission may—</text>
<paragraph id="HF0C74F6644784FCB8F24C05690EDCE12"><enum>(1)</enum><text>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);</text>
</paragraph><paragraph id="HB77EF8CFBC2C4801A6466371973D8AD6"><enum>(2)</enum><text>seek such
assistance and support as may be required in the performance of its duties from
appropriate Federal departments and agencies;</text>
</paragraph><paragraph id="H61CE83C61B084E47B5D216C1509DD9B7"><enum>(3)</enum><text>enter into
contracts or make other arrangements, as may be necessary for the conduct of
the work of the Commission (without regard to section 3709 of the Revised
Statutes (41 U.S.C. 5));</text>
</paragraph><paragraph id="HA2CBD4657B97490C9F36FBBAD12328A9"><enum>(4)</enum><text>make advance,
progress, and other payments which relate to the work of the Commission;</text>
</paragraph><paragraph id="HB549EF6C4ABF4DAE8FD119CCB5CCFA44"><enum>(5)</enum><text>provide
transportation and subsistence for persons serving without compensation;
and</text>
</paragraph><paragraph id="H5355607D27BB422E9F958EE2A7C0113B"><enum>(6)</enum><text>prescribe such
rules and regulations as the Commission determines to be necessary with respect
to the internal organization and operation of the Commission.</text>
</paragraph></subsection><subsection id="H39018E8B29B7424E9805D8FFD36072CB"><enum>(g)</enum><header>Powers</header>
<paragraph id="HFABD1390CC9043028EB2D2B7458D33A4"><enum>(1)</enum><header>Data
collection</header><text>In order to carry out its functions under this
section, the Commission shall—</text>
<subparagraph id="H6B3982DB195C4DC0B46D29C2481EC9D5"><enum>(A)</enum><text>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, including coordination with the Bureau of Labor
Statistics;</text>
</subparagraph><subparagraph id="HE1DA673D0A2E40369B673235222B7234"><enum>(B)</enum><text>carry out, or
award grants or contracts for the carrying out of, original research and
development, where existing information is inadequate, and</text>
</subparagraph><subparagraph id="H5EE381D1632C45EFB4DDC11DD3C03A36"><enum>(C)</enum><text>adopt procedures
allowing interested parties to submit information for the Commission’s use in
making reports and recommendations.</text>
</subparagraph></paragraph><paragraph id="HF6FDD8982F274AE1BB7C30EA0DAD1EB7"><enum>(2)</enum><header>Access of the
government accountability office to information</header><text>The Comptroller
General of the United States shall have unrestricted access to all
deliberations, records, and nonproprietary data of the Commission, immediately
upon request.</text>
</paragraph><paragraph id="H07AE173FB64B4A03A581E0B5494CA839"><enum>(3)</enum><header>Periodic
audit</header><text>The Commission shall be subject to periodic audit by a
third party appointed by the Secretary.</text>
</paragraph></subsection><subsection id="H972843BA605242CE890EDD4425592A80"><enum>(h)</enum><header>Authorization of
appropriations</header>
<paragraph id="H0D0B5B22C73F4BD6B955BB58C45094E5"><enum>(1)</enum><header>Request for
appropriations</header><text>The Commission shall submit requests for
appropriations in the same manner as the Comptroller General of the United
States submits requests for appropriations. Amounts so appropriated for the
Commission shall be separate from amounts appropriated for the Comptroller
General.</text>
</paragraph><paragraph id="H00B24E85E8D644199494C78B1E804DE5"><enum>(2)</enum><header>Authorization</header><text>There
are authorized to be appropriated such sums as may be necessary to carry out
this section.</text>
</paragraph><paragraph id="H8730D03DD7484D96A5592A0A2E7BFF40"><enum>(3)</enum><header>Gifts</header><text>The
Commission is authorized to accept and gifts for purposing of carrying out this
section.</text>
</paragraph></subsection><subsection id="HDCDF2D1D65234734AE7FC251144E51B7"><enum>(i)</enum><header>Definitions</header><text>In
this section:</text>
<paragraph id="HC5A6B79C45124102B59EEBA4E710EFF1"><enum>(1)</enum><header>Health care
workforce</header><text>The term <term>health care workforce</term> includes
all health care providers with direct patient care and support
responsibilities, including physicians, nurses, physician assistants,
pharmacists, oral healthcare professionals, allied health professionals, mental
health professionals, and public health professionals.</text>
</paragraph><paragraph id="H54783FF2B1DB4FFBB337795824D471D4"><enum>(2)</enum><header>Health
professionals</header><text>The term <term>health professionals</term>
includes—</text>
<subparagraph id="HC6825E5584554D16A5343D98824F7F8A"><enum>(A)</enum><text>dentists, dental
hygienists, primary care providers, specialty physicians, nurses, nurse
practitioners, physician assistants, psychologists and other behavioral and
mental health professionals, social workers, physical therapists, public health
professionals, clinical pharmacists, allied health professionals,
chiropractors, community health workers, school nurses, certified nurse
midwives, podiatrists, licensed complementary and alternative medicine
providers, and integrative health practitioners;</text>
</subparagraph><subparagraph id="H67BAA5057B754B74A0E5E89A8BF0E29C"><enum>(B)</enum><text>national
representatives of health professionals;</text>
</subparagraph><subparagraph id="H293A829B21CB400D94832C11D89EA2BE"><enum>(C)</enum><text>representatives of
schools of medicine, osteopathy, nursing, allied health, educational programs
for public health professionals, behavioral and mental health professionals (as
so defined), social workers, physical therapists, oral health care industry
dentistry and dental hygiene, and physician assistants;</text>
</subparagraph><subparagraph id="H18BC1D5F0CF4448E8B4BE51F2F63A863"><enum>(D)</enum><text>representatives of
public and private teaching hospitals, and ambulatory health facilities,
including Federal medical facilities; and</text>
</subparagraph><subparagraph id="HED03ED735E2D4B668F11313FF0AAF26F"><enum>(E)</enum><text>any other health
professional the Comptroller General of the United States determines
appropriate.</text>
</subparagraph></paragraph></subsection></section><section commented="no" display-inline="no-display-inline" id="HC394615A7482464CB1A6391681E29EB2"><enum>102.</enum><header>State health
workforce centers program</header>
<subsection commented="no" display-inline="no-display-inline" id="H0FE56261D1374C9D86785104338AEC28"><enum>(a)</enum><header>Establishment</header><text>The
Secretary shall establish a demonstration program (in this section referred to
as the <quote>program</quote>) under which the Secretary makes grants to
participating States for the operation of State Health Workforce Centers to
carry out the activities described in subsection (c).</text>
</subsection><subsection id="H31A5CB07E9A44D23BF2CD357B26172AF"><enum>(b)</enum><header>Participating
states</header><text>A State seeking to participate in the program shall submit
an application to the Secretary containing such information and at such time as
the Secretary may specify. The Secretary may only consider under the preceding
sentence 1 application submitted by each State which has been certified by the
Governor or the chief executive officer of the State.</text>
</subsection><subsection id="H93AF2FA7F8694DE2860815BF7228DF74"><enum>(c)</enum><header>Use of
funds</header><text>Grants awarded under subsection (a) may be used to support
activities designed to improve the training, deployment, and retention of
critical health professionals in underserved areas and for underserved
populations, including the following:</text>
<paragraph id="HCDBFF6B99BB1491E92BF296DCA751B81"><enum>(1)</enum><text>Conducting
assessments of key health professional capacity and needs. Such assessments
shall be conducted in a coordinated manner that provides for the nationwide
collection of health professional data.</text>
</paragraph><paragraph id="H5754830475094070B909C11381E31892"><enum>(2)</enum><text>Convening State
health professional policymakers to review education, education financing,
regulations, and taxation and compensation policies which affect the training,
deployment, and retention of health professionals. A participating State may,
taking into consideration the results of such reviews, develop short-term and
long-term recommendations for improving the supply, deployment, and retention
of critical health professionals in underserved areas and for underserved
populations.</text>
</paragraph></subsection><subsection id="H9575A4F858D14164BFA515E748A4C94C"><enum>(d)</enum><header>Funding</header>
<paragraph id="H830DEA05A9FF4B6D9CC03DD18AC0A00B"><enum>(1)</enum><header>Authorization of
appropriations</header><text>There are authorized to be appropriated
$13,750,000 to carry out this section.</text>
</paragraph><paragraph id="H93C516582CF8451EB641E9E9B9FCF549"><enum>(2)</enum><header>Matching
requirement</header><text>The Secretary may require a State, in order to be
eligible to receive a grant under this section, to agree that, with respect to
the costs incurred by the State in carrying out the activities for which the
grant was awarded, the State will make available (directly or through donations
from public or private entities) non-Federal contributions in an amount equal
to a percent of Federal funds provided under the grant (as determined
appropriate by the Secretary).</text>
</paragraph></subsection><subsection id="H7CBA6B92F7884568AA3920D3B5A897E4"><enum>(e)</enum><header>Definitions</header><text>In
this section:</text>
<paragraph id="H3F081E849D8944B4AB2B2599A00BEDBF"><enum>(1)</enum><header>Secretary</header><text>The
term <term>Secretary</term> means the Secretary of Health and Human
Services.</text>
</paragraph><paragraph id="H6B58274CF3514478AA9278CE2FEAD258"><enum>(2)</enum><header>State</header><text>The
term <term>State</term> means—</text>
<subparagraph id="HC3B2CA6FDA57412DB2DFDA03B86D4EB0"><enum>(A)</enum><text>a State;</text>
</subparagraph><subparagraph id="HF273989E3C204AECA83B834C0E4AE054"><enum>(B)</enum><text>the District of
Columbia;</text>
</subparagraph><subparagraph id="H99487C06048D4BAEAF9F06807292B090"><enum>(C)</enum><text>the Commonwealth
of Puerto Rico; and</text>
</subparagraph><subparagraph id="H80BB145125024282804B7A75F01BB539"><enum>(D)</enum><text>any other
territory or possession of the United States.</text>
</subparagraph></paragraph></subsection></section><section id="H691ACEDABDFC40BBA794C507EBCDF918"><enum>103.</enum><header>Improvements to
payments for graduate medical education under medicare</header>
<subsection id="HCDB55511309E4301977E3D59FBE9F3CA"><enum>(a)</enum><header>Increasing the
Medicare caps on graduate medical education positions</header>
<paragraph id="H2156C605F4A642619EF480FF30B5B525"><enum>(1)</enum><header>Direct Graduate
Medical Education</header><text>Section 1886(h)(4)(F) of the Social Security
Act (42 U.S.C. 1395ww(h)(4)(F)) is amended—</text>
<subparagraph id="HEE544601117740A687AA7003FBF8393F"><enum>(A)</enum><text>in clause (i), by
inserting <quote>clause (iii) and</quote> after <quote>subject to</quote>;
and</text>
</subparagraph><subparagraph id="H468C4C673A1D4D449863CB940F43F0A7"><enum>(B)</enum><text>by adding at the
end the following new clause:</text>
<quoted-block id="H7F4F8691A92146B48761E06ABE43CBF4" style="OLC">
<clause id="H140F27FC6FE54D4F95E0B0F881262E41"><enum>(iii)</enum><header>Increase in
caps on graduate medical education positions for states with a shortage of
residents</header>
<subclause id="HABDFE10520F543CD8F7346888720823B"><enum>(I)</enum><header>In
general</header><text>For cost reporting periods beginning on or after January
1, 2011, the Secretary shall increase the otherwise applicable limit on the
total number of full-time equivalent residents in the field of allopathic or
osteopathic medicine determined under clause (i) with respect to a qualifying
hospital by an amount equal to 15 percent of the amount of the otherwise
applicable limit (determined without regard to this clause). Such increase
shall be phased-in equally over a period of 3 cost reporting periods beginning
with the first cost reporting period in which the increase is applied under the
previous sentence to the hospital.</text>
</subclause><subclause commented="no" id="HDCDB7084496E4ACDB35B2E2AA17B93E7"><enum>(II)</enum><header>Qualifying
hospital</header><text>In this clause, the term <term>qualifying
hospital</term> means a hospital that agrees to use the increase in the number
of full-time equivalent residents under subclause (I) to support
community-based training which emphasizes underserved areas and innovative
training models which address community needs and reflect emerging, evolving,
and contemporary models of health care delivery. A qualifying hospital shall
give priority to providing such training and training models to health
professionals in specialties which the Secretary, in consultation with the
Permanent National Health Workforce Commission established under section 101(a)
of the <short-title>Health Access and Health Professions
Supply Act of 2009</short-title>, determines are in high-need (including family
medicine, general surgery, geriatrics, general internal medicine, general
surgery, and obstetrics and gynecology).</text>
</subclause><subclause commented="no" id="H4BECC49BCFAD451A8DE2DE6B2E7F524A"><enum>(III)</enum><header>Increase in
payments</header><text>Notwithstanding any other provision of law, in the case
of full-time equivalent residents added to a hospital's training program as a
result of such increase, the Secretary shall provide for an increase in the
amounts otherwise payable under this subsection with respect to direct graduate
medical education costs that would otherwise apply with respect to such
residents by 10 percent. Such increased payments shall be made to the facility
in which the training is provided to such
residents.</text>
</subclause></clause><after-quoted-block>.</after-quoted-block></quoted-block>
</subparagraph></paragraph><paragraph id="HE91EBFF7200E4D48BD0E088C4CBBABD9"><enum>(2)</enum><header>Indirect Medical
Education</header><text>Section 1886(d)(5)(B) of the
<act-name parsable-cite="SSA">Social Security Act</act-name> (42 U.S.C.
1395ww(d)(5)(B)) is amended by adding at the end the following new
clause:</text>
<quoted-block act-name="Social Security Act" id="H8FB254527814488485A8118022A0C0FD" style="OLC">
<clause id="HF6D7E13B26294D18A1E2A2FF58A48AB2" indent="up2"><enum>(x)</enum><text>Clause (iii) of subsection (h)(4)(F)
shall apply to clause (v) in the same manner and for the same period as such
clause (iii) applies to clause (i) of such
subsection.</text>
</clause><after-quoted-block>.</after-quoted-block></quoted-block>
</paragraph></subsection><subsection id="H53336D2A44D14714B8C9545A15A5C4BD"><enum>(b)</enum><header>Application of
Medicare GME payments to additional training site venues</header>
<paragraph id="HD444C661ACF142F3982C7F1B7F8B9198"><enum>(1)</enum><header>In
general</header><text>The Secretary of Health and Human Services (in this
subsection referred to as the <quote>Secretary</quote>) shall, by regulation,
provide for the use of payments for direct graduate medical education costs
under section 1886(h) of the Social Security Act (42 U.S.C. 1395ww(h)) and
payments for the indirect costs of medical education under section
1886(d)(5)(B) of the Social Security Act (42 U.S.C. 1395ww(d)(5)(B)) to support
the implementation of community-based training and innovative training models
under subsections (h)(4)(F)(iii)(II) and (d)(5)(B)(x) of section 1886 of the
Social Security Act (42 U.S.C. 1395ww).</text>
</paragraph><paragraph id="H4F6226335D4A4C77A776F1F39D293317"><enum>(2)</enum><header>Use of model of
care delivery</header><text>In promulgating regulations under paragraph (1),
the Secretary shall consider the model of care delivery of the Institute of
Medicine of the National Academies.</text>
</paragraph><paragraph id="HB6D6587EFAA04460A603F234A04E14C8"><enum>(3)</enum><header>Consultation</header><text>In
promulgating such regulations, the Secretary shall consult with the Permanent
National Health Workforce Commission established under section 101(a).</text>
</paragraph></subsection><subsection id="HD1F10A285B7D4BE4B09F9847EF4EE87D"><enum>(c)</enum><header>Determination of
hospital-specific approved FTE resident amounts</header><text>Section
1886(h)(2) of the Social Security Act (42 U.S.C. 1395ww(h)(2)) is amended by
adding at the end the following new subparagraph:</text>
<quoted-block display-inline="no-display-inline" id="H93EFB552287C4E829365B953CDFA0FE9" style="OLC">
<subparagraph id="HB66284B4E10547B498965851D8608DC4"><enum>(G)</enum><header>Flexibility in
determination</header>
<clause id="H25029749C55346948EE2E4CBA32656BB"><enum>(i)</enum><header>In
general</header><text>Notwithstanding the preceding provisions of this
paragraph, the approved FTE resident amount for each cost reporting period
beginning on or after January 1, 2011, with respect to an applicable resident
shall be determined using a methodology established by the Secretary that
allows flexibility for payments to be made for costs in addition to the costs
of hospital-sponsored education. Such methodology shall provide that
nonteaching hospital-based entities (such as managed care organizations and
public and private healthcare consortia) that are capable of assembling all of
the resources necessary for effectively providing graduate medical education
may receive payments for providing graduate medical education, either as the
sponsor of such graduate medical education program or as an affiliate of such a
sponsor.</text>
</clause><clause id="HB8AD58B32CC341DB8BE1B21939AE64F2"><enum>(ii)</enum><header>Applicable
resident</header><text>In this subparagraph, the term <term>applicable
resident</term> means a resident—</text>
<subclause id="HD7C04E1846E94649822347AD3301C1D1"><enum>(I)</enum><text>in a specialty
which the Secretary, in consultation with the Permanent National Health
Workforce Commission established under section 101(a) of the
<short-title>Health Access and Health Professions Supply
Act of 2009</short-title>, determines is in high-need;</text>
</subclause><subclause id="HED7076D529794A768BE799B4B3CDD176"><enum>(II)</enum><text>in a health
professional shortage area (as defined in section 332 of the Public Health
Service Act);</text>
</subclause><subclause id="H91342B34F1DF43049B388968DB428246"><enum>(III)</enum><text>in a medically
underserved community (as defined in section 799B of the Public Health Service
Act), or with respect to a medically underserved population (as defined in
section 330(b)(3) of the Public Health Service Act); and</text>
</subclause><subclause id="HE14C2DD189BF4D55948A5736BC7C8D0A"><enum>(IV)</enum><text>in a Federal
medical facility.</text>
</subclause></clause><clause id="H66FCDF49C31C426295CCE11D9D8654CD"><enum>(iii)</enum><header>Federal
medical facility</header><text>In this subparagraph, the term <term>Federal
medical facility</term> means a facility for the delivery of health services,
and includes—</text>
<subclause id="HC55267CF5EF54C4AB4DDE87CF1E75233"><enum>(I)</enum><text>a community health
center (as defined in section 330 of the Public Health Service Act), a public
health center, an outpatient medical facility, or a community mental health
center;</text>
</subclause><subclause id="H0E57525C77354700880B168B06696C90"><enum>(II)</enum><text>a hospital, State
mental hospital, facility for long-term care, or rehabilitation
facility;</text>
</subclause><subclause id="HD2B1A7DDF7D34076B77ECCF8C3CB9B85"><enum>(III)</enum><text>a migrant health
center or an Indian Health Service facility;</text>
</subclause><subclause id="HA1F7E9A70D124A109B80EEC16FD8616A"><enum>(IV)</enum><text>a facility for
the delivery of health services to inmates in a penal or correctional
institution (under section 323 of such Act) or a State correctional
institution;</text>
</subclause><subclause id="HD5BD22E069B44373AF9B2CE9D320C7B5"><enum>(V)</enum><text>a Public Health
Service medical facility (used in connection with the delivery of health
services under section 320, 321, 322, 324, 325, or 326 of such Act); or</text>
</subclause><subclause commented="no" display-inline="no-display-inline" id="H445157D7965F44B3855587D60BA6DF3E"><enum>(VI)</enum><text>any other Federal
medical
facility.</text>
</subclause></clause></subparagraph><after-quoted-block>.</after-quoted-block></quoted-block>
</subsection></section><section id="HECDC709C09C94DAABDC1547E19087E4A"><enum>104.</enum><header>Distribution of
resident trainees in an emergency</header>
<subsection id="HD64C6786D7BB437E9C437F67E35C4320"><enum>(a)</enum><header>Exclusion from
3-year rolling average</header><text display-inline="yes-display-inline">Notwithstanding any other provision of law,
in the case of a host hospital participating in an emergency Medicare GME
affiliation agreement on or after the date of enactment of this Act and
training residents in excess of its cap, consistent with the rolling average
provisions applicable for closed programs as specified in section 413.79(d)(6)
of title 42, Code of Federal Regulations, the Secretary of Health and Human
Services shall exclude from the 3-year rolling average FTE residents associated
with displaced residents during the period in which such agreement is in
effect.</text>
</subsection><subsection id="H6FAC4BF0F2D743349F85351CE9156010"><enum>(b)</enum><header>Assessment and
revision of GME policies</header>
<paragraph id="HBAB240D3F5D34C36AAC2859DED42CF42"><enum>(1)</enum><header>Review</header><text display-inline="yes-display-inline">The Secretary of Health and Human Services
shall review policies with respect to payments for direct graduate medical
education costs under section 1886(h) of the Social Security Act (42 U.S.C.
1395ww(h)) and payments for the indirect costs of medical education under
section 1886(d)(5)(B) of the Social Security Act (42 U.S.C.
1395ww(d)(5)(B)).</text>
</paragraph><paragraph id="HBFAABD338E75401DB96E2749AA01E838"><enum>(2)</enum><header>Revision and
report</header><text display-inline="yes-display-inline">Not later than January
1, 2011, the Secretary shall—</text>
<subparagraph id="H2F51C422A25247789112C6FE05362855"><enum>(A)</enum><text display-inline="yes-display-inline">as appropriate, revise such policies that
constrain the ability of the Secretary to respond to emergency situations and
situations involving institutional and program closure; and</text>
</subparagraph><subparagraph id="H949BBC5802FC441BA3AE6DBD8F97DE31"><enum>(B)</enum><text>in the case where
the Secretary determines legislative action is necessary to make such
revisions, submit to Congress a report containing recommendations for such
legislative action.</text>
</subparagraph></paragraph></subsection></section><section id="H136ED80432594D3F8474AC8F9C38E6CD"><enum>105.</enum><header>Authority to
include costs of training of psychologists in payments to hospitals for
approved educational activities under Medicare</header><text display-inline="no-display-inline">Effective for cost reporting periods
beginning on or after the date that is 18 months after the date of enactment of
this Act, for purposes of payment to hospitals under the Medicare program under
title XVIII of the Social Security Act for costs of approved educational
activities (as defined in section 413.85 of title 42, Code of Federal
Regulations), such approved educational activities shall include a 1-year
doctoral clinical internship operated by the hospital as part of a clinical
psychology training program that is provided upon completion of university
course work.</text>
</section></subtitle><subtitle commented="no" id="H6036BC45C5214EDD8D341897458D0D57"><enum>B</enum><header>Geriatric
Assessments and Chronic Care Management and Coordination Services Under the
Medicare Program</header>
<section commented="no" id="H1503B5B9D332439A8DB0CAE8269829D8"><enum>111.</enum><header>Medicare
coverage of geriatric assessments</header>
<subsection commented="no" id="H2A5D6EDD7A564A5399C22F099DC949EE"><enum>(a)</enum><header>Coverage of
geriatric assessments</header>
<paragraph commented="no" id="H31F9D759C3D94225A0DA506F5C817425"><enum>(1)</enum><header>In
general</header><text>Section 1861(s)(2) of the <act-name parsable-cite="SSA">Social Security Act</act-name> (42 U.S.C. 1395x(s)(2)) is
amended—</text>
<subparagraph commented="no" id="HC7A4D88AF19A4D769B947BAEC28112B9"><enum>(A)</enum><text>in subparagraph
(DD), by striking <quote>and</quote> at the end;</text>
</subparagraph><subparagraph commented="no" id="H73A1DCEC23A04F069955784D41046048"><enum>(B)</enum><text>in subparagraph
(EE), by adding <quote>and</quote> at the end; and</text>
</subparagraph><subparagraph commented="no" id="HD81419C09D9D4A349D72BD28B4117885"><enum>(C)</enum><text>by adding at the
end the following new subparagraph:</text>
<quoted-block id="H5D65C1545F8B45559F4ACB9083F6830D" style="OLC">
<subitem commented="no" id="H7233C235CD164AC1AC5E72F04265E505" indent="up5"><enum>(FF)</enum><text>geriatric assessments (as defined in
subsection
(hhh)(1));</text>
</subitem><after-quoted-block>.</after-quoted-block></quoted-block>
</subparagraph></paragraph><paragraph commented="no" id="H898C983394BA45C5A9EB3CD5501C313B"><enum>(2)</enum><header>Conforming
amendments</header><text>Clauses (i) and (ii) of section 1861(s)(2)(K) of the
<act-name parsable-cite="SSA">Social Security Act</act-name> (42 U.S.C.
1395x(s)(2)(K)) are each amended by striking <quote>subsection (ww)(1)</quote>
and inserting <quote>subsections (ww)(1) and (hhh)(1)</quote>.</text>
</paragraph></subsection><subsection commented="no" id="H73AF53FEC257421DB17FF08ED866285C"><enum>(b)</enum><header>Geriatric
Assessments Defined</header><text>Section 1861 of the
<act-name parsable-cite="SSA">Social Security Act</act-name> (42 U.S.C. 1395x)
is amended by adding at the end the following new subsections:</text>
<quoted-block act-name="" id="HD09349C859F5431592841A982210EA34" other-style="archaic" style="other"><subsection commented="no" id="HDE22B340A97B4CCD8716CA210BB8B55D"><enum>(hhh)</enum><header>Geriatric
Assessment</header><paragraph commented="no" display-inline="yes-display-inline" id="H0B669E101982411CB35020BD358EAE05"><enum>(1)</enum><text>The term <term>geriatric
assessment</term> means each of the following:</text>
<subparagraph commented="no" id="H2D4C1B8B4DBC4401966C01FC687EC3FB" indent="up1"><enum>(A)</enum><text>An assessment of the clinical status,
functional status, social and environmental functioning, and need for
caregiving of a geriatric assessment eligible individual (as defined in
subsection (iii)). The assessment shall include a comprehensive history and
physical examination and assessments of the following domains using
standardized validated clinical tools:</text>
<clause commented="no" id="H4D1780C841DD40D3A0155F0C7070D56B"><enum>(i)</enum><text>Comprehensive review of medications
and the individual's adherence to the medication regimen.</text>
</clause><clause commented="no" id="HD373756F84A44162AEEA301C2B89281F"><enum>(ii)</enum><text>Measurement of affect, cognition
and executive function, mobility, balance, gait, risk of falling, and sensory
function.</text>
</clause><clause commented="no" id="H25BA4ABA0B8B4A3D99A56A31EF5E712F"><enum>(iii)</enum><text>Social functioning, environmental
needs, and caregiver resources and needs.</text>
</clause><clause commented="no" id="H2179B10E9888495EAE8128062EB50D22"><enum>(iv)</enum><text>Any other domain determined
appropriate by the Secretary.</text>
</clause></subparagraph><subparagraph commented="no" id="HC75FC090FF9B4E15AC6FFFCCC1556EB1" indent="up1"><enum>(B)</enum><text>The development of a written care plan
based on the results of the assessment under subparagraph (A) (and any
subsequent assessment under subparagraph (B)). The care plan shall detail
identified problems, outline therapies, assign responsibility for actions, and
indicate whether the individual is likely to benefit from chronic care
management and coordination services (as defined in subsection (jjj)(1)). If
the individual is determined likely to benefit from chronic care management and
coordination services, the care plan shall also provide the basis for the
chronic care management and coordination plan to be developed by the chronic
care manager pursuant to subsection (jjj).</text>
</subparagraph></paragraph><paragraph commented="no" id="H89C80356935445A79CB721312BC6731F" indent="up1"><enum>(2)</enum><text>A geriatric assessment may only be
conducted by—</text>
<subparagraph commented="no" id="H525B17323043412EA4DEBE6F68DC561C"><enum>(A)</enum><text>a physician;</text>
</subparagraph><subparagraph commented="no" id="HCD9191D9EA8640E89BA95EA0B5AFDFF9"><enum>(B)</enum><text>a practitioner described in section
1842(b)(18)(C)(i) under the supervision of a physician; or</text>
</subparagraph><subparagraph commented="no" id="H663AF3245BDE484A8A3EEE1260C7836E"><enum>(C)</enum><text>any other provider that meets such
conditions as the Secretary may specify.</text>
</subparagraph></paragraph><paragraph commented="no" id="H014F9B6D5FF444F797307AA4E844F686" indent="up1"><enum>(3)</enum><text>An individual described in subclause
(A), (B), or, if applicable, (C) may provide for the furnishing of services
included in the geriatric assessment by other qualified health care
professionals.</text>
</paragraph><paragraph commented="no" id="H42650F8933384FD9BB51771694FB8FEA" indent="up1"><enum>(4)</enum><subparagraph commented="no" display-inline="yes-display-inline" id="H7F0018F7A3744774A38A4C9E081D8B7A"><enum>(A)</enum><text>Subject to subparagraph
(B), a geriatric assessment of a geriatric assessment eligible individual may
not be conducted more frequently than annually.</text>
</subparagraph><subparagraph commented="no" id="H7770AD5707DE4CDDBBC74598C018AB95" indent="up1"><enum>(B)</enum><text>A geriatric assessment of a geriatric
assessment eligible individual may be conducted more frequently than annually
if the assessment is medically necessary due to a significant change in the
condition of the individual.</text>
</subparagraph></paragraph></subsection><subsection commented="no" id="H92E9589B1A8D433896A9A2DD00593522"><enum>(iii)</enum><header>Geriatric Assessment Eligible
Individual</header><paragraph commented="no" display-inline="yes-display-inline" id="H1B54EB3A004B426CAC0C9F0BE8678FDF"><enum>(1)</enum><text>Subject to paragraph
(3), the term <term>geriatric assessment eligible individual</term> means an
individual identified by the Secretary as eligible for a geriatric
assessment.</text>
</paragraph><paragraph commented="no" id="H04CF5FF67B264F5A865EEFEC10F15D99" indent="up1"><enum>(2)</enum><text>In identifying individuals under
paragraph (1), the following rules shall apply:</text>
<subparagraph commented="no" id="HF8ECF03F588D46CABA07BB7262978802"><enum>(A)</enum><text>The individual must have at least 1 of
the following present:</text>
<clause commented="no" id="HFC2DDBE6F90A4DC6A4158464A22C2175"><enum>(i)</enum><text>Multiple chronic conditions that
the Secretary identifies as likely to result in high expenditures under this
title. In identifying such conditions, the Secretary may consider—</text>
<subclause commented="no" id="H2E1BC2E6B7854A6AA5297FB3FA9C1D2A"><enum>(I)</enum><text>the hierarchal condition category
methodology employed for risk adjustment under part C or other comparable
methodologies the Secretary deems appropriate;</text>
</subclause><subclause commented="no" id="HCA2391FE981A41BBBB2A833F67A6E439"><enum>(II)</enum><text>data from the Chronic Condition Data
Warehouse under section 723 of the Medicare Prescription Drug, Improvement, and
Modernization Act of 2003; and</text>
</subclause><subclause commented="no" id="H94DAC726B792411892C7FD746EFE29FB"><enum>(III)</enum><text>indicators of geriatric syndromes, such
as experiencing 2 or more falls in the past year, urinary incontinence,
clinically significant depression, or other such indicators that the Secretary
indicates as likely to result in high expenditures under this title when they
exist in combination with one or more chronic conditions).</text>
</subclause></clause><clause commented="no" id="HFE16CFF21C5B4C1EBDDDD915366814C0"><enum>(ii)</enum><text>Dementia, as defined in the most
recent Diagnostic and Statistical Manual of Mental Disorders, and at least 1
other chronic condition.</text>
</clause><clause commented="no" id="H8B3E571C6F314A79A8FB6E6C225BCFEA"><enum>(iii)</enum><text>Any other factor identified by
the Secretary.</text>
</clause></subparagraph><subparagraph commented="no" id="HC40A74802F0D4243B890F2ADBB755C1E"><enum>(B)</enum><text>The Secretary shall consult with
physicians, physician groups and organizations, other health care professional
groups and organizations, organizations representing individuals with chronic
conditions and older adults, and other stakeholders in identifying conditions
under clauses (i) and (ii) of subparagraph (A) and any factors under
subparagraph (A)(iii).</text>
</subparagraph></paragraph><paragraph commented="no" id="H82EE63335BFD48C8AFE89D65D6751964" indent="up1"><enum>(3)</enum><text>The term <term>geriatric assessment
eligible individual</term> shall not include the following individuals:</text>
<subparagraph commented="no" id="H17EF51CA383D4AC29A5F7E53C3C877E7"><enum>(A)</enum><text>An individual who is receiving hospice
care under this title.</text>
</subparagraph><subparagraph commented="no" id="HAA8EC92296D945D3B231406C5650745F"><enum>(B)</enum><text>An individual who is residing in a
skilled nursing facility, a nursing facility (as defined in section 1919), or
any other facility identified by the Secretary.</text>
</subparagraph><subparagraph commented="no" id="H47C1ACCC2C8F44268D54A3EE2DE5F987"><enum>(C)</enum><text>An individual medically determined to
have end-stage renal disease.</text>
</subparagraph><subparagraph commented="no" id="H24300C9EC94B4140B019D38BAB6C123B"><enum>(D)</enum><text>An individual enrolled in a Medicare
Advantage plan or a plan under section 1876.</text>
</subparagraph><subparagraph commented="no" id="H90E3AF806AA84138BF072471779E4C09"><enum>(E)</enum><text>An individual enrolled in a PACE
program under section 1894.</text>
</subparagraph><subparagraph commented="no" id="HA6C6C1D232B74DF1903A17FC2D50FE2C"><enum>(F)</enum><text>Any other categories of individuals
determined appropriate by the Secretary.</text>
</subparagraph></paragraph><paragraph commented="no" display-inline="no-display-inline" id="HE067A9815978413DBCD22B6F313ADE59" indent="up1"><enum>(4)</enum><text display-inline="yes-display-inline">For purposes of this subsection, the term
<term>chronic condition</term> means a condition, such as dementia, that lasts
or is expected to last 1 year or longer, limits what an individual can do, and
requires ongoing
care.</text>
</paragraph></subsection><after-quoted-block>.</after-quoted-block></quoted-block>
</subsection><subsection commented="no" id="HA7BDCCC22A96470BBDF6BD289E51A5D0"><enum>(c)</enum><header>Payment and
Elimination of Cost-Sharing</header>
<paragraph commented="no" id="HC4FEA98C2C6749DD884711819213EBC4"><enum>(1)</enum><header>Payment and
elimination of coinsurance</header><text>Section 1833(a)(1) of the
<act-name parsable-cite="SSA">Social Security Act</act-name> (42 U.S.C.
1395l(a)(1)) is amended—</text>
<subparagraph commented="no" id="H709DD4F110FB402281EF2E55845C9DD0"><enum>(A)</enum><text>in subparagraph
(N), by inserting <quote>other than geriatric assessments (as defined in
section 1861(hhh)(1))</quote> after <quote>(as defined in section
1848(j)(3))</quote>;</text>
</subparagraph><subparagraph commented="no" id="HB6AA1B6B63F34799897D047ACAFA2F90"><enum>(B)</enum><text>by striking
<quote>and</quote> before <quote>(W)</quote>; and</text>
</subparagraph><subparagraph commented="no" id="H77F5525948B944BEB99FBAA1AFA820F2"><enum>(C)</enum><text>by inserting
before the semicolon at the end the following: <quote>, and (X) with respect to
geriatric assessments (as defined in section 1861(hhh)(1)), the amount paid
shall be 100 percent of the lesser of the actual charge for the services or the
amount determined under section 1848(o)</quote>.</text>
</subparagraph></paragraph><paragraph commented="no" id="H41DB56509A494B5095C8B3341D8F4B6A"><enum>(2)</enum><header>Payment</header>
<subparagraph commented="no" id="H239279C9A020472198F66B4AC65BD8AB"><enum>(A)</enum><header>In
general</header><text>Section 1848 of the <act-name parsable-cite="SSA">Social
Security Act</act-name> (42 U.S.C. 1395w–4) is amended by adding at the end the
following new subsection:</text>
<quoted-block display-inline="no-display-inline" id="H0250ECEF36824D44AFE2F8CD46722B25" style="OLC">
<subsection commented="no" id="HFB39608B23984CFB820AFC19AFAC78C1"><enum>(p)</enum><header>Payment for
geriatric assessments</header>
<paragraph commented="no" id="HCD4977D43DAE47D78F65456AEC88258D"><enum>(1)</enum><header>Establishment</header>
<subparagraph commented="no" id="HACF35A4BA2D944E6B25094E12E515C0B"><enum>(A)</enum><header>In
general</header><text>The Secretary shall establish—</text>
<clause commented="no" id="H371D1B860AC444EEB88F8B87B2C06CE2"><enum>(i)</enum><text>a payment code (or
codes) under this section for a geriatric assessment (as defined in section
1861(hhh)(1)) furnished to a geriatric assessment eligible individual (as
defined in section 1861(iii)) by a physician, practitioner, or other provider
described in section 1861(hhh)(2); and</text>
</clause><clause commented="no" id="H1B97461FD55343498BEDFC49CB7DBD5B"><enum>(ii)</enum><text>a payment amount
for each such code.</text>
</clause></subparagraph><subparagraph commented="no" id="H2E6A1613349F4E269CD64AA0D114D9A0"><enum>(B)</enum><header>Requirements</header><text>In
establishing payment amounts under subparagraph (A)(ii), the Secretary
shall—</text>
<clause commented="no" id="H0AA2A932A3554DBBAD2DDB255375613F"><enum>(i)</enum><text>take into
account—</text>
<subclause commented="no" id="H1EF7DE2CE9D64A379964AB4563045E91"><enum>(I)</enum><text>the amount of work
required to perform a geriatric assessment, including the time and effort put
forth by each qualified health care professional involved in performing the
geriatric assessment; and</text>
</subclause><subclause commented="no" id="HE0B43DDFA4F94C0A8E3CB4C108CF20F4"><enum>(II)</enum><text>all of the costs
associated with the geriatric assessment, including labor, supplies, equipment,
and the costs of health information technologies and systems incurred by the
physician, practitioner, or other provider (as described in section
1861(hhh)(2)) in providing the assessment; and</text>
</subclause></clause><clause commented="no" id="HEBB680ABD0114E609FF8916A32117480"><enum>(ii)</enum><text>ensure that such
payments do not result in a reduction in payments for office visits or other
evaluation and management services that would otherwise be allowable.</text>
</clause></subparagraph></paragraph><paragraph commented="no" id="H961D849F442A4102A29BD29F1CD1A612"><enum>(2)</enum><header>Separate
payments from payments for chronic care management and coordination
services</header><text>Payments for geriatric assessments shall be made
separately from payments for chronic care management and coordination services
(as defined in section 1861(jjj)(1)) and other services for which payment is
made under this
title.</text>
</paragraph></subsection><after-quoted-block>.</after-quoted-block></quoted-block>
</subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="HE83A60CE70E246E3BA5DC0EFD1E5CAAC"><enum>(B)</enum><header>Conforming
amendment</header><text>Section 1848(j)(3) of the <act-name parsable-cite="SSA">Social Security Act</act-name> (42 U.S.C. 1395w–4(j)(3)),
as amended by section 111(c)(2)), is amended by inserting
<quote>(2)(FF),</quote> after <quote>(2)(EE),</quote>.</text>
</subparagraph></paragraph><paragraph commented="no" id="H1595790FD72D4B1F88039E5445C95B39"><enum>(3)</enum><header>Elimination of
coinsurance in outpatient hospital settings</header>
<subparagraph commented="no" id="H5EAC124FF085464BAD024481424F5768"><enum>(A)</enum><header>Exclusion from
OPD fee schedule</header><text>Section 1833(t)(1)(B)(iv) of the
<act-name parsable-cite="SSA">Social Security Act</act-name> (42 U.S.C.
1395l(t)(1)(B)(iv)) is amended by striking <quote>and diagnostic
mammography</quote> and inserting <quote>, diagnostic mammography, or geriatric
assessments (as defined in section 1861(hhh)(1))</quote>.</text>
</subparagraph><subparagraph commented="no" id="H7F0869A428F34028B4794E9D4FCC930C"><enum>(B)</enum><header>Conforming
amendments</header><text>Section 1833(a)(2) of the
<act-name parsable-cite="SSA">Social Security Act</act-name> (42 U.S.C.
1395l(a)(2)) is amended—</text>
<clause commented="no" id="HEA5067D6E6F34DF092431A7A6F336C45"><enum>(i)</enum><text>in subparagraph
(F), by striking <quote>and</quote> at the end;</text>
</clause><clause commented="no" id="H00A59F5E555E4B6BB42A132F0F682B78"><enum>(ii)</enum><text>in subparagraph
(G)(ii), by striking the comma at the end and inserting <quote>; and</quote>;
and</text>
</clause><clause commented="no" id="H398FC11387784F318B051DF71779A08D"><enum>(iii)</enum><text>by inserting
after subparagraph (G)(ii) the following new subparagraph:</text>
<quoted-block id="H2792214A42A24422A95E2CD84A01177A" style="OLC">
<subparagraph commented="no" id="HDD817EC241344D81896884AF6C63CA66"><enum>(H)</enum><text>with respect to
geriatric assessments (as defined in section 1861(hhh)(1)) furnished by an
outpatient department of a hospital, the amount determined under paragraph
(1)(X),</text>
</subparagraph><after-quoted-block>.</after-quoted-block></quoted-block>
</clause></subparagraph></paragraph><paragraph commented="no" id="HB4DB24C70EF04444B61B61E32EA8507B"><enum>(4)</enum><header>Elimination of
deductible</header><text>The first sentence of section 1833(b) of the
<act-name parsable-cite="SSA">Social Security Act</act-name> (42 U.S.C.
1395l(b)) is amended—</text>
<subparagraph commented="no" id="H38FB5A4EF2CD4C919271A0155CECD4E8"><enum>(A)</enum><text>by striking
<quote>and</quote> before <quote>(9)</quote>; and</text>
</subparagraph><subparagraph commented="no" id="HE6ED548B77F1410495B78CFBB2D6A7CF"><enum>(B)</enum><text>by inserting
before the period the following: <quote>, and (10) such deductible shall not
apply with respect to geriatric assessments (as defined in section
1861(hhh)(1))</quote>.</text>
</subparagraph></paragraph></subsection><subsection commented="no" id="HB2C6AA3687E8438687775A6DBDEFD90D"><enum>(d)</enum><header>Frequency
Limitation</header><text>Section 1862(a) of the <act-name parsable-cite="SSA">Social Security Act</act-name> (42 U.S.C. 1395y(a)(1)) is
amended—</text>
<paragraph commented="no" id="H8F663421607747A394326D6649445208"><enum>(1)</enum><text>in paragraph
(1)—</text>
<subparagraph commented="no" id="H1A3C3C62F50B44F088F98E983DB3A40F"><enum>(A)</enum><text>in subparagraph
(N), by striking <quote>and</quote> at the end;</text>
</subparagraph><subparagraph commented="no" id="H2E65F3E0A7654C32AADBC04C4E6B5EAE"><enum>(B)</enum><text>in subparagraph
(O) by striking the semicolon at the end and inserting <quote>, and</quote>;
and</text>
</subparagraph><subparagraph commented="no" id="H2730B1BE9F6B44BB961E60608CC568F9"><enum>(C)</enum><text>by adding at the
end the following new subparagraph:</text>
<quoted-block id="H9DED3BDA498B4E7E923DB604001A9142" style="OLC">
<subparagraph commented="no" id="H7EEDAF98408C4BE9B43A9EE7B2E23D16" indent="up1"><enum>(P)</enum><text>in the case of geriatric assessments
(as defined in section 1861(hhh)(1)), which are performed more frequently than
is covered under such section;</text>
</subparagraph><after-quoted-block>;
and</after-quoted-block></quoted-block>
</subparagraph></paragraph><paragraph commented="no" id="HA3CF658731174AA7967A873C00571C09"><enum>(2)</enum><text>in paragraph (7),
by striking <quote>or (K)</quote> and inserting <quote>(K), or
(P)</quote>.</text>
</paragraph></subsection><subsection commented="no" id="HF49EDE7501FC4440AC5C44268A055E97"><enum>(e)</enum><header>Exception to
Limits on Physician Referrals</header><text>Section 1877(b) of the
<act-name parsable-cite="SSA">Social Security Act</act-name> (42 U.S.C.
1395nn(b)) is amended by adding at the end the following new paragraph:</text>
<quoted-block act-name="Social Security Act" id="H2AD53978050640DC9B54930A24331290" style="OLC">
<paragraph commented="no" id="HBD1EF615E16F40FEBD5040AEC3AB284D"><enum>(6)</enum><header>Geriatric
assessments</header><text>In the case of a designated health service, if the
designated health service is a geriatric assessment (as defined in section
1861(hhh)(1)) and furnished by a
physician.</text>
</paragraph><after-quoted-block>.</after-quoted-block></quoted-block>
</subsection><subsection commented="no" id="H4A3F818848604E86B5884279E593D710"><enum>(f)</enum><header>Rulemaking</header><text>The
Secretary of Health and Human Services shall define such terms, establish such
procedures, and promulgate such regulations as the Secretary determines
necessary to implement the amendments made by, and the provisions of, this
section, including the establishment of additional domains under subsection
(hhh)(1)(A)(iv) of section 1861 of the Social Security Act, as added by
subsection (b). In promulgating such regulations, the Secretary shall consult
with physicians, physician groups and organizations, other health care
professional groups and organizations representing individuals with chronic
conditions and older adults.</text>
</subsection><subsection commented="no" id="H7CFDB5D842BD44DE917F5233D8EC09C2"><enum>(g)</enum><header>Effective
Date</header><text>The amendments made by this section shall apply to
assessments furnished on or after January 1, 2010.</text>
</subsection></section><section commented="no" id="HBDE9D710294B455A92145708241DE2C4"><enum>112.</enum><header>Medicare
coverage of chronic care management and coordination services</header>
<subsection commented="no" id="H49A3558279D1477A828C905114205F46"><enum>(a)</enum><header>Part
<enum-in-header>B</enum-in-header> coverage of chronic care management and
coordination services</header>
<paragraph commented="no" id="H68295968144540CEB9879812905B2657"><enum>(1)</enum><header>In
general</header><text>Section 1861(s)(2) of the <act-name parsable-cite="SSA">Social Security Act</act-name> (42 U.S.C. 1395x(s)(2)), as
amended by section 111(a)(1), is amended—</text>
<subparagraph commented="no" id="HE57F79C8200A471D9EBA9B1827A6BA4E"><enum>(A)</enum><text>in subparagraph
(EE), by striking <quote>and</quote> at the end;</text>
</subparagraph><subparagraph commented="no" id="HABC31DB581E14851BD79384B03F90761"><enum>(B)</enum><text>in subparagraph
(FF), by adding <quote>and</quote> at the end; and</text>
</subparagraph><subparagraph commented="no" id="HDDD92C42CDB6403F9D6EE12650ECB0F3"><enum>(C)</enum><text>by adding at the
end the following new subparagraph:</text>
<quoted-block id="H3C57C4A273E54422B3E567B673EA09B6" style="OLC">
<subitem commented="no" id="HB7AAE0F5493249D08311F0EA01AC81CA" indent="up5"><enum>(GG)</enum><text>chronic care management and
coordination services (as defined in subsection
(jjj));</text>
</subitem><after-quoted-block>.</after-quoted-block></quoted-block>
</subparagraph></paragraph><paragraph commented="no" id="H3A51EC4F3DD343DEBC758A6B1BF1335A"><enum>(2)</enum><header>Conforming
amendments</header><subparagraph commented="no" display-inline="yes-display-inline" id="HCA20D19C163F465ABDF4009655FD864E"><enum>(A)</enum><text>Clauses (i) and (ii) of
section 1861(s)(2)(K) of the <act-name parsable-cite="SSA">Social Security
Act</act-name> (42 U.S.C. 1395x(s)(2)(K)), as amended by section 111(a)(2), are
each amended by striking <quote>subsections (ww)(1) and (hhh)(1)</quote> and
inserting <quote>subsections (ww)(1), (hhh)(1), and (jjj)(1)</quote>.</text>
</subparagraph><subparagraph commented="no" id="H4A9A4E2DFDE64AD1AAABFB76472B73C1" indent="up1"><enum>(B)</enum><text>Section 1862(a)(7) of the
<act-name parsable-cite="SSA">Social Security Act</act-name> (42 U.S.C.
1395y(a)(7)), as amended by section 111(d), is amended by striking
<quote>section 1861(s)(10)</quote> and inserting <quote>paragraphs (2)(GG) and
(10) of section 1861(s)</quote>.</text>
</subparagraph></paragraph></subsection><subsection commented="no" id="H54F3040A788E4BE3907BC01202DD0481"><enum>(b)</enum><header>Services
Described</header><text>Section 1861 of the <act-name parsable-cite="SSA">Social Security Act</act-name> (42 U.S.C. 1395x), as
amended by section 111(b), is amended by adding at the end the following new
subsection:</text>
<quoted-block act-name="Social Security Act" id="HAD33E981766F4051B16C17A1DBC2F5EA" other-style="archaic" style="other">
<subsection commented="no" id="H3689056B85B04757A8B8945B5EA060AD"><enum>(jjj)</enum><header>Chronic Care Management and Coordination Services; Chronic
Care Manager; Chronic Care Eligible Individual</header><paragraph commented="no" display-inline="yes-display-inline" id="HDBFB5ED119C3487980C3F5BC59F72ED0"><enum>(1)</enum><text>The term <term>chronic
care management and coordination services</term> means services that are
furnished to a chronic care eligible individual (as defined in paragraph (3))
by, or under the supervision of, a single chronic care manager (as defined in
paragraph (2)) chosen by the chronic care eligible individual, a caregiver
designated by the individual in writing, or a representative authorized to make
decisions on the individual’s behalf, under a plan of care prescribed by such
chronic care manager for the purpose of chronic care coordination, including
dementia as appropriate, which may include any of the following
services:</text>
<subparagraph commented="no" id="HA0F782B7C28F41189D7F0EE43DD9A481" indent="up1"><enum>(A)</enum><text>The development of an initial plan of
care (based on the results of a geriatric assessment, as defined in subsection
(hhh)), and subsequent appropriate revisions to that plan of care.</text>
</subparagraph><subparagraph commented="no" id="H177A6BD4010C4B27863B5BD42FD8764C" indent="up1"><enum>(B)</enum><text>The management of, and referral for,
medical and other health services, including interdisciplinary care conferences
and management with other providers.</text>
</subparagraph><subparagraph commented="no" id="HC35A6AAC981D48C4A84EBB3091AF62D9" indent="up1"><enum>(C)</enum><text>The monitoring and management of
medications.</text>
</subparagraph><subparagraph commented="no" id="H04FE2FD365954A94B069E687D40D249A" indent="up1"><enum>(D)</enum><text>Patient education and counseling
services.</text>
</subparagraph><subparagraph commented="no" id="H4A01B378AC9A4B5988769B5EE2F9AC19" indent="up1"><enum>(E)</enum><text>Family caregiver education and
counseling services, including preventive care consistent with the patient's
condition.</text>
</subparagraph><subparagraph commented="no" id="HDA46E4D6F509428AB4A8008D16BCF936" indent="up1"><enum>(F)</enum><text>Self-management services, including
health education and risk appraisal to identify behavioral risk factors through
self-assessment.</text>
</subparagraph><subparagraph commented="no" id="H4EC13EA8A1954E28A1411EC57758898E" indent="up1"><enum>(G)</enum><text>Providing access for individuals, and
caregivers or authorized representatives as appropriate, by telephone and
e-mail to physicians or other appropriate health care professionals, including
24-hour availability of such professionals for after hours consultation.</text>
</subparagraph><subparagraph commented="no" id="HD5DA2D450F014B4A9EF1ADE4D6CCDE95" indent="up1"><enum>(H)</enum><text>Coordination with the principal
nonprofessional caregiver in the home.</text>
</subparagraph><subparagraph commented="no" id="H82136EFA231141C58F67026558516712" indent="up1"><enum>(I)</enum><text>Managing and facilitating transitions
that occur among health care professionals and across settings of care,
including the following:</text>
<clause commented="no" id="HCBF50FE3588548E390E4C02FA7E66F13"><enum>(i)</enum><text>Pursuing the treatment option
elected by the individual.</text>
</clause><clause commented="no" id="HA3E3CABDD0724C6C8089DD4C6CECC1A9"><enum>(ii)</enum><text>Including any advance directive
executed by the individual in the medical file of the individual.</text>
</clause></subparagraph><subparagraph commented="no" id="HA00CB16AD9E2407D9B146389F7CBAE97" indent="up1"><enum>(J)</enum><text>Information about pain management and
palliative care.</text>
</subparagraph><subparagraph commented="no" id="H876FDC9E4BE141A2B630CBA74C3393E9" indent="up1"><enum>(K)</enum><text>Information about, and referral to,
hospice care, including patient and family caregiver education and counseling
about hospice care, and facilitating transition to hospice care when
elected.</text>
</subparagraph><subparagraph commented="no" id="H484819EB23A849F9BA81F9548B242F95" indent="up1"><enum>(L)</enum><text>Information about, referral to, and
coordination with, community resources.</text>
</subparagraph><subparagraph commented="no" id="H972AB15423114E559F416AFFE577C513" indent="up1"><enum>(M)</enum><text>Such additional services for which
payment would not otherwise be made under this title that the Secretary may
specify that encourage the receipt of, or improve the effectiveness of, the
services described in the preceding subparagraphs.</text>
</subparagraph></paragraph><paragraph commented="no" id="H6EC3490968094216AE8562ACD18B03D7" indent="up1"><enum>(2)</enum><subparagraph commented="no" display-inline="yes-display-inline" id="H45E74CEE771340778A73A1B36DB35F83"><enum>(A)</enum><text>For purposes of this
subsection, the term <term>chronic care manager</term> means an individual or
entity that—</text>
<clause commented="no" id="H3E02F98FE9124CC2B96BC7709EF58FDC" indent="up1"><enum>(i)</enum><text>is—</text>
<subclause commented="no" id="H092C215B8A80408297B763556D5E3D55"><enum>(I)</enum><text>a physician;</text>
</subclause><subclause commented="no" id="H5C8A493F7A7645F6BC0B92009FCE26CB"><enum>(II)</enum><text>a practitioner described in clause
(i) or (iv) of section 1842(b)(18)(C); or</text>
</subclause><subclause commented="no" id="H914851A465DD4BEDB7E64FB6A9827FA1"><enum>(III)</enum><text>any other provider that meets
such conditions as the Secretary may specify;</text>
</subclause></clause><clause commented="no" id="H85CA859E692745DAA39C35B10DFBFF02" indent="up1"><enum>(ii)</enum><text>has entered into a chronic care
management and coordination agreement with the Secretary; and</text>
</clause><clause commented="no" id="HD635AAE9E8A04DE9AF48ED688B7CC62F" indent="up1"><enum>(iii)</enum><text>is working in collaboration with, or
under the supervision of, as determined by the Secretary—</text>
<subclause commented="no" id="H6045C7D6F7034676B893C700DB18D11A"><enum>(I)</enum><text>the physician, practitioner, or
other provider who completed the geriatric assessment of the individual;
or</text>
</subclause><subclause commented="no" id="HDBD0F43F1F7B4A04BC29D82267C27380"><enum>(II)</enum><text>a physician, practitioner, or
other provider to whom the individual’s care was transferred by the physician,
practitioner, or other provider who performed the geriatric assessment.</text>
</subclause></clause></subparagraph><subparagraph commented="no" id="H5C1D1FE5385246EFBEB2F0BC02FECA6F" indent="up1"><enum>(B)</enum><clause commented="no" display-inline="yes-display-inline" id="HBCD05431AAAA47ABA4ADBED1029A3E9D"><enum>(i)</enum><text>For purposes of
subparagraph (A)(ii), each chronic care management and coordination agreement
shall meet the requirements described in subparagraph (C) and shall—</text>
<subclause commented="no" id="H31276E166984490BAD1C1D3DA9DDE2FC" indent="up1"><enum>(I)</enum><text>subject to clause (ii), be entered
into for a period of 3 years and may be renewed if the Secretary is satisfied
that the chronic care manager continues to meet such terms and conditions as
the Secretary may require; and</text>
</subclause><subclause commented="no" id="HDC6BE8AB5070440DB64ACC2B6110EBFB" indent="up1"><enum>(II)</enum><text>contain such other terms and
conditions as the Secretary may require.</text>
</subclause></clause><clause commented="no" id="HA5A675FC4F924028991397C41A7270A9" indent="up1"><enum>(ii)</enum><text>Each chronic care management and
coordination agreement shall provide for the termination of such agreement
prior to such 3-year period in the case where the chronic care manager—</text>
<subclause commented="no" id="H84171372499E4F2A86FBF318A3FB642F"><enum>(I)</enum><text>is no longer able to provide chronic
care services; or</text>
</subclause><subclause commented="no" id="H15BD13E33614456FA799D0451736C522"><enum>(II)</enum><text>does not meet such terms and
conditions as the Secretary may require.</text>
</subclause></clause></subparagraph><subparagraph commented="no" id="HDCC23D7DFA034A8386BC422121F703D2" indent="up1"><enum>(C)</enum><clause commented="no" display-inline="yes-display-inline" id="H7A6BAA1DFB0241A6B6F8057ABF394060"><enum>(i)</enum><text>Subject to clause (ii),
the requirements of this subparagraph are met if the agreement requires the
chronic care manager to perform, or provide for the performance of, the
following services:</text>
<subclause commented="no" id="HD7478755158F4002B79342C6230DC0C9" indent="up1"><enum>(I)</enum><text>Advocating for, and providing ongoing
support, oversight, and guidance with respect to the implementation of a plan
of care that provides an integrated, coherent, and cross-disciplined plan for
ongoing medical care that is developed in partnership with the chronic care
eligible individual and all other physicians and other care providers and
agencies (including home health agencies) providing care to the chronic care
eligible individual.</text>
</subclause><subclause commented="no" id="HBABD3853E134489B845CAB0385B6DEF0" indent="up1"><enum>(II)</enum><text>Using evidence-based medicine and
clinical decision support tools to guide decisionmaking at the point of care
and on the basis of specific patient factors.</text>
</subclause><subclause commented="no" id="H6A19F4A3580345099CA619677BFB4AC5" indent="up1"><enum>(III)</enum><text>Using health information technology,
including, where appropriate, remote monitoring and patient registries, to
monitor and track the health status of patients and to provide patients with
enhanced and convenient access to health care services.</text>
</subclause><subclause commented="no" id="HDA09E7B139384695A84A7A1BF44CDA24" indent="up1"><enum>(IV)</enum><text>Encouraging patients to engage in the
management of their own health through education and support systems.</text>
</subclause><subclause commented="no" id="HE99BC2EF52274078A6DE090442367604" indent="up1"><enum>(V)</enum><text>Incorporating family caregivers into
the chronic care planning process.</text>
</subclause></clause><clause commented="no" id="HEED2E2F05E7643C981024D818CAF1164" indent="up1"><enum>(ii)</enum><text>The Secretary may modify the
services required under the agreement under clause (i), including by requiring
different services or services in addition to those described in subclauses (I)
through (V) of such clause.</text>
</clause></subparagraph><subparagraph commented="no" id="H3218DE844DFD4C8A82220D0C9FB16038" indent="up1"><enum>(D)</enum><text>The Secretary shall adopt procedures
which exempt providers in rural areas from providing 1 or more of the services
otherwise required to be provided under subparagraph (C) or modify such
requirements for such providers. In establishing such procedures, the Secretary
shall ensure that such exemptions and modifications do not impact the quality
of chronic care management and coordination services furnished by such
providers.</text>
</subparagraph></paragraph><paragraph commented="no" id="H2BADEBC044E74CBF882830D97C3844E8" indent="up1"><enum>(3)</enum><text>For purposes of this subsection, the
term <term>chronic care eligible individual</term> means a geriatric assessment
eligible individual (as defined in subsection (iii)) who has undergone a
geriatric assessment (as defined in subsection (hhh)(1)) which determined that
the individual would benefit from chronic care management and
coordination.</text>
</paragraph><paragraph commented="no" id="H2E1A04C1C1164429BD94E615A3B3D3D8" indent="up1"><enum>(4)</enum><text>Chronic care management and
coordination services may be furnished in the chronic care eligible
individual's home or
residence.</text>
</paragraph></subsection><after-quoted-block>.</after-quoted-block></quoted-block>
</subsection><subsection commented="no" id="H6337254618214211BA237FB1F84E950A"><enum>(c)</enum><header>Payment and
Elimination of Cost-Sharing</header>
<paragraph commented="no" id="HCC8EFBF65CF1498B81DC436928618F58"><enum>(1)</enum><header>Payment and
elimination of coinsurance</header><text>Section 1833(a)(1) of the
<act-name parsable-cite="SSA">Social Security Act</act-name> (42 U.S.C.
1395l(a)(1)), as amended by section 111(c)(1), is amended—</text>
<subparagraph commented="no" id="HBB62E9E73036475090EEA6762170EBAB"><enum>(A)</enum><text>in subparagraph
(N), by inserting <quote>or chronic care management and coordination services
(as defined in section 1861(jjj)(1))</quote> after <quote>other than geriatric
assessments (as defined in section 1861(hhh)(1))</quote>;</text>
</subparagraph><subparagraph commented="no" id="HB9353BCEF56B4F71A6338AA6A378ECEC"><enum>(B)</enum><text>by striking
<quote>and</quote> before <quote>(X)</quote>; and</text>
</subparagraph><subparagraph commented="no" id="H18B4B767F0394A81B79E156E117EB569"><enum>(C)</enum><text>by inserting
before the semicolon at the end the following: <quote>, and (Y) with respect to
chronic care management and coordination services (as defined in section
1861(jjj)(1)), the amount paid shall be 100 percent of the lesser of the actual
charge for the services or the amount determined under section
1848(p)</quote>.</text>
</subparagraph></paragraph><paragraph commented="no" id="H2F867B6D25D84D59BF459E3962B77449"><enum>(2)</enum><header>Payment</header>
<subparagraph commented="no" id="H7FA6AD48C2234EB49591CC4D9018D497"><enum>(A)</enum><header>In
general</header><text>Section 1848 of the <act-name parsable-cite="SSA">Social
Security Act</act-name> (42 U.S.C. 1395w–4), as amended by section 111(c)(2),
is amended by adding at the end the following new subsection:</text>
<quoted-block display-inline="no-display-inline" id="HF78D0B2D4AE548C493A559E48225BC18" style="OLC">
<subsection commented="no" id="H4119D82BB8C64CC699016DE0327AFF5B"><enum>(q)</enum><header>Payment for
chronic care management and coordination services</header>
<paragraph commented="no" id="H15A9505803CB42A898E2A3998AAB0B08"><enum>(1)</enum><header>Establishment</header>
<subparagraph commented="no" id="H21C43BF371774C9BA126501D7FA6C3A1"><enum>(A)</enum><header>In
general</header><text>The Secretary shall establish—</text>
<clause commented="no" id="H4DDC8A9DAAD44500BE7BD838D7D392F4"><enum>(i)</enum><text>a payment code (or
codes) under this section for chronic care management and coordination services
(as defined in paragraph (1) of section 1861(jjj)) furnished to a chronic care
eligible individual (as defined in paragraph (3) of such section) by a chronic
care manager (as defined in paragraph (2) of such section); and</text>
</clause><clause commented="no" id="HE550855F9622477BAAAD1C7B92671D5C"><enum>(ii)</enum><text>a payment amount
for each such code.</text>
</clause></subparagraph><subparagraph commented="no" id="HA4E4A64634C64FD89A0C6B0A01FFC493"><enum>(B)</enum><header>Requirements</header><text>In
establishing payment amounts under subparagraph (A)(ii), the Secretary
shall—</text>
<clause commented="no" id="H147F0E1875F34733B7F858EB5B4E8A4E"><enum>(i)</enum><text>take into
account—</text>
<subclause commented="no" id="H4EA3E86E50BF48FE9215CF2AC5DE6C22"><enum>(I)</enum><text>the amount of work
required of the chronic care manager in providing chronic care management and
coordination services to eligible individuals; and</text>
</subclause><subclause commented="no" id="HCFC047AB26D64AECABF0EE0DA47F6609"><enum>(II)</enum><text>all of the costs
associated with providing chronic care management and coordination services,
including labor, supplies, equipment, and the costs of health information
technologies and systems incurred by the chronic care manager in providing such
services;</text>
</subclause></clause><clause commented="no" id="H2DB3B482FB78480CA8449B1A63E5A75A"><enum>(ii)</enum><text>ensure that such
payments are for such services furnished during a 30-day period; and</text>
</clause><clause commented="no" id="H1AB2A2D0C073431089E5B3DB5F5779AD"><enum>(iii)</enum><text>ensure that such
payments do not result in a reduction in payments for office visits or other
evaluation and management services that would otherwise be allowable.</text>
</clause></subparagraph></paragraph><paragraph commented="no" id="H0B352783EBF74DC69B4C0A2F5562D54B"><enum>(2)</enum><header>Separate
payments from payments for geriatric assessments</header><text>Payments for
chronic care management and coordination services shall be made separately from
payments for geriatric assessments (as defined in section 1861(hhh)(1)) and
other services for which payment is made under this
title.</text>
</paragraph></subsection><after-quoted-block>.</after-quoted-block></quoted-block>
</subparagraph><subparagraph commented="no" id="H9915E2D4C5964306A5106FBF34EAF476"><enum>(B)</enum><header>Conforming
amendment</header><text>Section 1848(j)(3) of the <act-name parsable-cite="SSA">Social Security Act</act-name> (42 U.S.C. 1395w–4(j)(3)),
as amended by section 111(c)(2)), is amended by inserting
<quote>(2)(GG),</quote> after <quote>(2)(FF),</quote>.</text>
</subparagraph></paragraph><paragraph commented="no" id="H865E99C7B38F46B28C5604BAE7339D45"><enum>(3)</enum><header>Elimination of
coinsurance in outpatient hospital settings</header>
<subparagraph commented="no" id="HFB3A6AA0099F47F19876A438E0E9FAFC"><enum>(A)</enum><header>Exclusion from
OPD fee schedule</header><text>Section 1833(t)(1)(B)(iv) of the
<act-name parsable-cite="SSA">Social Security Act</act-name> (42 U.S.C.
1395l(t)(1)(B)(iv)), as amended by section 111(c)(3)(A), is amended by striking
<quote>or geriatric assessments (as defined in section 1861(hhh)(1))</quote>
and inserting <quote>geriatric assessments (as defined in section
1861(hhh)(1)), or chronic care management and coordination services (as defined
in section 1861(jjj)(1))</quote>.</text>
</subparagraph><subparagraph commented="no" id="H5201C1B5B321460E99E58B11C376B698"><enum>(B)</enum><header>Conforming
amendments</header><text>Section 1833(a)(2) of the
<act-name parsable-cite="SSA">Social Security Act</act-name> (42 U.S.C.
1395l(a)(2)), as amended by section 111(c)(3)(B), is amended—</text>
<clause commented="no" id="H504A79BD6045490DA3B301682F938E44"><enum>(i)</enum><text>in subparagraph
(G)(ii), by striking <quote>and</quote> at the end;</text>
</clause><clause commented="no" id="HCF0B337C4CD44A62B0E848BE65049154"><enum>(ii)</enum><text>in subparagraph
(H), by striking the comma at the end and inserting <quote>; and</quote>;
and</text>
</clause><clause commented="no" id="HE9C1331301C741A881899769F0500015"><enum>(iii)</enum><text>by inserting
after subparagraph (H) the following new subparagraph:</text>
<quoted-block id="H30DC119C206E43F9B2DF07A0ED55568A" style="OLC">
<subparagraph commented="no" id="H8DA1989070034A9C8BF57B51B3834881"><enum>(I)</enum><text>with respect to
chronic care management and coordination services (as defined in section
1861(jjj)(1)) furnished by an outpatient department of a hospital, the amount
determined under paragraph
(1)(Y),</text>
</subparagraph><after-quoted-block>.</after-quoted-block></quoted-block>
</clause></subparagraph></paragraph><paragraph commented="no" id="H7C74A8ED777F4F1E801DBCB49E960660"><enum>(4)</enum><header>Elimination of
deductible</header><text>Paragraph (10) of section 1833(b) of the
<act-name parsable-cite="SSA">Social Security Act</act-name> (42 U.S.C.
1395l(b)), as added by section 111(c)(4), is amended by inserting <quote>or
chronic care management and coordination services (as defined in section
1861(jjj)(1))</quote> after <quote>geriatric assessments (as defined in section
1861(hhh)(1))</quote>.</text>
</paragraph></subsection><subsection commented="no" id="HC42A942F95474B1EBFED8A0198662651"><enum>(d)</enum><header>Exception to
Limits on Physician Referrals</header><text>Section 1877(b)(6) of the
<act-name parsable-cite="SSA">Social Security Act</act-name> (42 U.S.C.
1395nn(b)(6)), as amended by section 111(e), is amended to read as
follows:</text>
<quoted-block act-name="Social Security Act" id="H056F8F3F3AA74FA7B44C21B0D7C51EA4" style="OLC">
<paragraph commented="no" id="H7F6CF282FBD14E31A4CE51D7594F8BAF"><enum>(6)</enum><header>Geriatric
assessments and chronic care management and coordination
services</header><text>In the case of a designated health service, if the
designated health service is—</text>
<subparagraph commented="no" id="H9F6996DD10B64EC2ABA1C7C0AAA94C2A"><enum>(A)</enum><text>a geriatric
assessment or a chronic care management and coordination service (as defined in
subsections (hhh)(1) or (jjj)(1) of section 1861, respectively); and</text>
</subparagraph><subparagraph commented="no" id="H592463593E234494A8E846B6E634C0C0"><enum>(B)</enum><text>furnished by a
physician.</text>
</subparagraph></paragraph><after-quoted-block>.</after-quoted-block></quoted-block>
</subsection><subsection commented="no" id="HD11D037802014B679D8109F616762E2F"><enum>(e)</enum><header>Rulemaking</header><text>The
Secretary of Health and Human Services shall define such terms, establish such
procedures, and promulgate such regulations as the Secretary determines
necessary to implement the amendments made by, and the provisions of, this
section. In promulgating such regulations, the Secretary shall consult with
physicians, physician groups and organizations, other health care professional
groups and organizations, and organizations representing individuals with
chronic conditions and older adults.</text>
</subsection><subsection commented="no" id="HDC8DBBDC28624898B2193225FEFE7C73"><enum>(f)</enum><header>Effective
Date</header><text>The amendments made by this section shall apply to chronic
care management and coordination services furnished on or after January 1,
2010.</text>
</subsection></section><section commented="no" id="HAB87EC67F78148DEB41EDF6C90CB8E68"><enum>113.</enum><header>Outreach
activities regarding geriatric assessments and chronic care management and
coordination services under the Medicare program</header><text display-inline="no-display-inline">The Secretary of Health and Human Services
shall conduct outreach activities to individuals likely to be eligible to
receive coverage of geriatric assessments (as defined in subsection (hhh)(1) of
section 1861 of the Social Security Act, as added by section 111) under the
Medicare program and individuals likely to be eligible to receive coverage of
chronic care management and coordination services (as defined in subsection
(jjj)(1) of such section 1861, as added by section 112) under the Medicare
program, to inform such individuals about the availability of such benefits
under the Medicare program.</text>
</section><section commented="no" id="H825E8CBCDA954E81A05A6CF74D26B624"><enum>114.</enum><header>Utilization of
telehealth services to furnish geriatric assessments and chronic care
management and coordination services under the Medicare program</header>
<subsection commented="no" id="H2F1A3441313E49C68C6D81954623852B"><enum>(a)</enum><header>In
general</header><text>Section 1834(m)(4)(F) of the Social Security Act (42
U.S.C. 1395m(m)(4)(F)) is amended by adding at the end the following new
clause:</text>
<quoted-block display-inline="no-display-inline" id="H97223EBED8BE4E889CCE1DE16098CC19" style="OLC">
<clause commented="no" id="H104CB2545A814543BE69F71439704BEA"><enum>(iii)</enum><header>Geriatric
assessments and chronic care management and coordination
services</header><text>The term <term>telehealth service</term> shall also
include geriatric assessments (as defined in section 1861(hhh)(1)) and chronic
care management and coordination services (as defined in section
1861(jjj)).</text>
</clause><after-quoted-block>.</after-quoted-block></quoted-block>
</subsection><subsection commented="no" id="H7136B2EF942A43D296105A4B58A07ADE"><enum>(b)</enum><header>Effective
Date</header><text>The amendments made by this section shall apply to services
furnished on or after January 1, 2010.</text>
</subsection></section><section commented="no" id="HEC68C8FD7AD74C59A8025A1177274C27"><enum>115.</enum><header>Study and
report on geriatric assessments and chronic care management and coordination
services under the Medicare program</header>
<subsection commented="no" id="HAC080E617F8B41D0BE732B92A955EDFF"><enum>(a)</enum><header>Study</header><text>The
Secretary of Health and Human Services shall enter into a contract with an
entity to conduct a study on—</text>
<paragraph commented="no" id="HAC8AF3D3813D4DB0AA996921CCA7EBEB"><enum>(1)</enum><text>the effectiveness
of the coverage of geriatric assessments and chronic care management and
coordination services, including an evaluation of the use of interdisciplinary
teams in providing such services, under the Medicare program (under the
amendments made by sections 3 and 4) on improving the quality of care provided
to Medicare beneficiaries with chronic conditions, including dementia;
and</text>
</paragraph><paragraph commented="no" id="H74C6248A32BD421AB4AF2011A2465267"><enum>(2)</enum><text>the impact of such
geriatric assessments and care coordination services on reducing expenditures
under title XVIII of the Social Security Act, including reduced expenditures
that may result from—</text>
<subparagraph commented="no" id="HDC95FFD8A76B45478CAF9D772F38E91C"><enum>(A)</enum><text>reducing
preventable hospital admissions;</text>
</subparagraph><subparagraph commented="no" id="H359772A8A9B047CEA668C4DC43D35E07"><enum>(B)</enum><text>more appropriate
use of pharmaceuticals; and</text>
</subparagraph><subparagraph commented="no" id="H69E1D185A7E74B44A68D2D8B08E1A6A3"><enum>(C)</enum><text>reducing duplicate
or unnecessary tests.</text>
</subparagraph></paragraph></subsection><subsection commented="no" id="H24DD0B6E4CBC42838EA58700FF68BFE8"><enum>(b)</enum><header>Report</header><text>Not
later than 3 years after the date of enactment of this Act, the entity
conducting the study under subsection (a) shall submit to Congress and the
Secretary of Health and Human Services a report on the study, together with
recommendations for such legislation or administrative action as such entity
determines appropriate.</text>
</subsection><subsection commented="no" id="HE4D593AF977D45899BF26F4CB7B00F76"><enum>(c)</enum><header>Authorization of
appropriations</header><text>There are authorized to be appropriated such sums
as may be necessary to carry out this section.</text>
</subsection></section><section commented="no" display-inline="no-display-inline" id="H329629333A414E149CF795A348E0D748"><enum>116.</enum><header>Rule of
construction</header><text display-inline="no-display-inline">Nothing in the
provisions of, or in the amendments made by, this subtitle shall be construed
as requiring an individual to receive a geriatric assessment (as defined in
section 1861(hhh)(1) of the Social Security Act, as added by section 111(b)) or
chronic care management and coordination services (as defined in section
1861(jjj)(1) of such Act, as added by section 112(b)).</text>
</section></subtitle><enum>II</enum><header>Amendments to the
Public Health Service Act</header>
<section id="HEB4127EE2DC94E9AB12092EDBE18F207"><enum>201.</enum><header>Expansion of
National Health Service Corps programs</header>
<subsection id="HBA20A94540A1428780128BF4942C8D5D"><enum>(a)</enum><header>In
general</header><text display-inline="yes-display-inline">Section 338H of the
Public Health Service Act (42 U.S.C. 254q) is amended—</text>
<paragraph id="HC51D12E65C8C49DC9D1D2C12017F00AE"><enum>(1)</enum><text display-inline="yes-display-inline">in subsection (a), by striking paragraphs
(1) through (5) and inserting the following:</text>
<quoted-block display-inline="no-display-inline" id="HB767CDF76B294422A23CB1110B6A45BD" style="OLC">
<paragraph id="HCCE1297FAA6F41759121BB2830993A38"><enum>(1)</enum><text>for fiscal year
2009, $165,000,000;</text>
</paragraph><paragraph id="H13A02207414F40F1AD2C9074C182261F"><enum>(2)</enum><text>for fiscal year
2010, $198,000,000;</text>
</paragraph><paragraph id="H311D3F1B8E4A49778B9DF63CFB49A5DC"><enum>(3)</enum><text>for fiscal year
2011, $231,000,000;</text>
</paragraph><paragraph id="H1D30E7960C3D44199A133A010D7B1DF8"><enum>(4)</enum><text>for fiscal year
2012, $264,000,000;</text>
</paragraph><paragraph id="HCB00BF1B76D6416397B309BE835DC704"><enum>(5)</enum><text>for fiscal year
2013, $297,000,000; and</text>
</paragraph><paragraph id="H66B05336DD6A468F99A68B1B0B684F2D"><enum>(6)</enum><text>for fiscal year
2014, $330,000,000.</text>
</paragraph><after-quoted-block>;
and</after-quoted-block></quoted-block>
</paragraph><paragraph id="H5C0FBC4488C14541A32A6A696C293606"><enum>(2)</enum><text>by adding at the
end the following:</text>
<quoted-block display-inline="no-display-inline" id="HB3619FAA3D1B48AAB588A5057A51A8A0" style="OLC">
<subsection id="H245DAF1DC380410B853B9CBCDABC8B3C"><enum>(d)</enum><header>Expansion of
programs</header><text>The Secretary shall use amounts appropriated for each of
fiscal years 2010 through 2014 under subsection (a), that are in excess of the
amount appropriated under such subsection for fiscal year 2009, to address
shortages of health professionals in rural, frontier, and urban underserved
areas through an expansion of the number of scholarships and loan repayments
under this subpart to address health workforce shortages in health professional
shortage areas (as defined in section 332), in medically underserved
communities (as defined in section 799B), or with respect to medically
underserved populations (as defined in section
330(b)(3)).</text>
</subsection><after-quoted-block>.</after-quoted-block></quoted-block>
</paragraph></subsection><subsection id="HFCB6697956B949C3ACD2122756119449"><enum>(b)</enum><header>Expansion of
other programs</header><text>The Director of the Indian Health Service, the
Secretary of Defense, and the Secretary of Veterans Affairs, shall expand
existing loan repayment programs to emphasize the provision of health
professions services to facilities that have health professional
shortages.</text>
</subsection><subsection id="H4BEFEC01869C4DA09460C65E4718F41B"><enum>(c)</enum><header>No tax
implications</header>
<paragraph id="H7E1E41C616BB440294399AF95AB31074"><enum>(1)</enum><header>In
general</header><text>For purposes of the Internal Revenue Code of 1986, any
amount received under a health-related Federal loan repayment program by a
health professional providing health-related services in a Federal medical
facility shall not be included in the gross income of such professional.</text>
</paragraph><paragraph id="H92AAA0AAB54F4FBA9984FE2110D70D99"><enum>(2)</enum><header>Definition</header><text>In
this subsection, the term <term>Federal medical facility</term> means a
facility for the delivery of health services, and includes—</text>
<subparagraph id="HCE95E4D586FB468EB879647DDD5303AD"><enum>(A)</enum><text>a federally
qualified health center (as defined in section 330A of the Public Health
Service Act (42 U.S.C. 254c)), a public health center, an outpatient medical
facility, or a community mental health center;</text>
</subparagraph><subparagraph id="HC9A9B78A8EEE4C549E7251F0EECBD4D1"><enum>(B)</enum><text>a hospital, State
mental hospital, facility for long-term care, or rehabilitation
facility;</text>
</subparagraph><subparagraph id="H445EEE30C05F4DE199A622A284A024FA"><enum>(C)</enum><text>a migrant health
center or an Indian Health Service facility;</text>
</subparagraph><subparagraph id="H073D1A56ACDC4629B989E0B5082C42E9"><enum>(D)</enum><text>a facility for the
delivery of health services to inmates in a penal or correctional institution
(under section 323 of such Act (42 U.S.C. 250)) or a State correctional
institution;</text>
</subparagraph><subparagraph id="H18F05F1AEFD94925B5AECB2A9DC0AD50"><enum>(E)</enum><text>a Public Health
Service medical facility (used in connection with the delivery of health
services under section 320, 321, 322, 324, 325, or 326 of such Act (42 U.S.C.
247e, 248, 249, 251, 252, or 253));</text>
</subparagraph><subparagraph id="HC4C5A72146AE4840A11AD11330458D73"><enum>(F)</enum><text>a nurse-managed
health center; or</text>
</subparagraph><subparagraph id="H00AB1ED97B7649AC81D231DA2B2C6FBD"><enum>(G)</enum><text>any other Federal
medical facility.</text>
</subparagraph></paragraph></subsection><subsection id="H71365DBEE11444F4AA7B9BFC27709CB5"><enum>(d)</enum><header>Reduced loan
support for part time practitioners</header><text>Section 338C of the Public
Health Service Act (42 U.S.C. 254m) is amended by adding at the end the
following:</text>
<quoted-block display-inline="no-display-inline" id="H69CCFC6AFDD646A7B5B424C8BE149823" style="OLC">
<subsection id="H48F0CD61B7624C4E80FB06E23C986632"><enum>(e)</enum><text>Notwithstanding
any other provision of this subpart, the Secretary shall develop procedures to
permit periods of obligated services to be provided on a part-time basis (not
less than 1,040 hours of such service per year). Such procedures shall prohibit
an individual from holding other part-time employment while providing such
part-time obligated services. The Secretary may provide for a reduction in the
loan repayments provided to individuals who provide part-time obligated
services under the authority provided under this
subsection.</text>
</subsection><after-quoted-block>.</after-quoted-block></quoted-block>
</subsection><subsection id="H735C31451DDF4B74A556243D8C365FDB"><enum>(e)</enum><header>Loan support for
participating preceptors, mentors, and attendings To supervise students and
trainees on-site</header><text>Section 338C of the Public Health Service Act
(42 U.S.C. 254m), as amended by subsection (d), is further amended by adding at
the end the following:</text>
<quoted-block display-inline="no-display-inline" id="H6E4907CFA32C4E09922D9440896506C6" style="OLC">
<subsection id="H806C43B117774F09B703A11E8AEADC74"><enum>(f)</enum><text>The Secretary
shall develop procedures to permit up to 20 percent of the service obligation
of an individual under this section to be provided by the individual through
precepting or mentoring activities, or by preparing curriculum, for on-site
students and trainees. The procedures developed under subsection (e) shall
provide for the proportional application of this subsection with respect to
individual providing obligated service on a part-time
basis.</text>
</subsection><after-quoted-block>.</after-quoted-block></quoted-block>
</subsection></section><section id="HA9B2AF342A984F618A64D867E56713AB"><enum>202.</enum><header>National health
service corps scholarship program for medical, dental, physician assistant,
pharmacy, behavioral and mental health, public health, and nursing students in
the United States public health sciences track in affiliated schools</header>
<subsection id="H45264819DA9640C494C6962EEA194F7C"><enum>(a)</enum><header>Program
authorized</header>
<paragraph id="HB51B8745FD5F468FABD60D65865CB45D"><enum>(1)</enum><header>In
general</header><text display-inline="yes-display-inline">Subpart III of part D
of title III of the Public Health Service Act (42 U.S.C. 254l et seq.) is
amended—</text>
<subparagraph id="H7FA628D94FCC48ACB2B5A6F0E13FDBD4"><enum>(A)</enum><text>in the heading by
inserting <quote><header-in-text level="subpart" style="OLC">, Scholarship
Program for Medical, Dental, Physician Assistant, Pharmacy, Behavioral and
Mental Health, Public Health, and Nursing Students in the United States Public
Health Sciences Track in Affiliated Schools,</header-in-text></quote> after
<quote><header-in-text level="subpart" style="OLC">Scholarship
Program</header-in-text></quote>; and</text>
</subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="H1146E8F370D3478F8E2C0E93963092D5"><enum>(B)</enum><text>by inserting after
section 338A the following:</text>
<quoted-block display-inline="no-display-inline" id="H1CD03FB6C00E4535AAB72C5802B6EED1" style="OLC">
<section id="HE7C7C250CE084BBDB4CA12FAD739B253"><enum>338A–1.</enum><header>National
health service corps scholarship program for medical, dental, physician
assistant, pharmacy, behavioral and mental health, public health, and nursing
students in the United States public health sciences track in affiliated
schools</header>
<subsection id="H17EE2E872B164E48A035C33593972A78"><enum>(a)</enum><header>Establishment</header>
<paragraph id="HBECA66763F034EA3A2E4F6E680787D3A"><enum>(1)</enum><header>In
general</header><text>The Secretary shall establish a program to be known as
the National Health Service Corps Scholarship Program for Medical, Dental,
Physician Assistant, Pharmacy, Behavioral and Mental Health, Public Health, and
Nursing Students in the United States Public Health Sciences Track in
Affiliated Schools (in this section referred to as the <quote>U.S. Public
Health Sciences Track Scholarship Program</quote>) to ensure, with respect to
the provision of high-needs health care services, including primary care,
general dentistry, nursing, obstetrics, and geriatricians pursuant to section
331(a)(2), an adequate supply of physicians, physician assistants, pharmacists,
behavioral and mental health professionals, public health professionals,
dentists, and nurses. The purpose of this program is to train an additional 150
medical students, 100 dental students, 100 physician assistant students, 100
behavioral and mental health students, 100 public health students, and 250
nursing students during each year. Of the 150 scholarships awarded to the
medical students as described under the preceding sentence, 10 shall be for
training at the Uniformed Services University of the Health Sciences as members
of the Commissioned Corps of the Public Health Service.</text>
</paragraph><paragraph id="H09A9EAEB394946318CBAE12DA8E1B9F7"><enum>(2)</enum><header>Relationship to
National Health Service Corps Scholarship Program</header><text>Scholarships
provided under this section are intended to complement, and not take the place
of, scholarships provided to students enrolled in courses of study leading to a
degree in medicine, osteopathic medicine, dentistry, or nursing or completion
of an accredited physician assistant, pharmacy, public health, or behavioral
and mental health educational program under the National Health Service Corps
Scholarship Program authorized by section 338A.</text>
</paragraph></subsection><subsection id="H3B6B62B74A244C3E9745291F8A82A49C"><enum>(b)</enum><header>Eligibility</header><text>To
be eligible to participate in the U.S. Public Health Sciences Track Scholarship
and Grants Program, an individual shall—</text>
<paragraph id="H811714D9FAED4ACC8ADFEBD98A272F6B"><enum>(1)</enum><text>be accepted for
enrollment as a full-time student—</text>
<subparagraph id="H644A65615B5A477988B64D25A9A09D3A"><enum>(A)</enum><text>in an accredited
(as determined by the Secretary) educational institution in a State; and</text>
</subparagraph><subparagraph id="HC6CC55EEADB44ED08706C0707CAA7D70"><enum>(B)</enum><text>in a course of
study, or program, offered by such institution leading to a degree in medicine,
osteopathic medicine, dentistry, physician assistant, pharmacy, behavioral and
mental health, public health, or nursing;</text>
</subparagraph></paragraph><paragraph id="HBCB2CD08120645A38C3C9F62DB72DE41"><enum>(2)</enum><text>be eligible for,
or hold, an appointment as a commissioned officer in the Regular or Reserve
Corps of the Service or be eligible for selection for civilian service in the
Corps;</text>
</paragraph><paragraph id="HAC83AEB976BF43C4B09611CBA8AF4F64"><enum>(3)</enum><text>submit an
application to participate in the U.S. Public Health Sciences Track Scholarship
and Grants Program; and</text>
</paragraph><paragraph id="H4FA00EA37B874C2BA5CB0B68746DEBA7"><enum>(4)</enum><text>sign and submit to
the Secretary, at the time of submittal of such application, a written contract
to accept payment of a scholarship and to serve (in accordance with this
subpart) for the applicable period of obligated service in an area in which the
need for public health-related services may be
demonstrated.</text>
</paragraph></subsection></section><after-quoted-block>.</after-quoted-block></quoted-block>
</subparagraph></paragraph><paragraph id="HB03CEC41EE5D4EE2BF9459A6F57234C4"><enum>(2)</enum><header>No tax
implications</header><text>For purposes of the Internal Revenue Code of 1986,
any amount received under the National Health Service Corps Scholarship Program
for Medical, Dental and Nursing Students in the United States Public Health
Sciences Track in Affiliated Schools under section 338A–1 of the Public Health
Service Act, as added by paragraph (1), by a medical student, dental student,
or nursing student shall not be included in the gross income of such
student.</text>
</paragraph></subsection><subsection id="H90BEEB379229435895438D2BCC76938F"><enum>(b)</enum><header>Grants To
increase the number of available slots for newly admitted medical, dental,
physician assistant, pharmacy, behavioral and mental health, public health, and
nursing students and To increase participation in the U.S. Public Health
Sciences Track Scholarship Program</header><text display-inline="yes-display-inline">Part C of title VII of the Public Health
Service Act (42 U.S.C. 293k et seq.) is amended by adding at the end the
following:</text>
<quoted-block display-inline="no-display-inline" id="H8CF057BC411E44F197A91A79CCC612F7" style="OLC">
<section id="HB1137BD4F8C74C1E92CF61F5790BE94D"><enum>749.</enum><header>Grants to
increase the number of available slots for newly admitted medical, dental,
physician assistant, pharmacy, behavioral and mental health, public health, and
nursing students and to increase participation in the u.s. public health
sciences track scholarship program</header>
<subsection id="HA15AAF83EE3A4822BDE2E4110BC51830"><enum>(a)</enum><header>Program
authorized</header><text>The Secretary may make grants to medical, dental,
public health, and nursing schools and physician assistant, pharmacy, and
behavioral and mental health programs for the following purposes:</text>
<paragraph id="H7FCA4343B1634C6D9641E0EDBFB8C1A6"><enum>(1)</enum><text>To increase the
capacity of the recipient medical, dental, public health, or nursing school or
physician assistant, pharmacy, or behavioral and mental health program, to
accept additional medical, dental, public health, nursing, physician assistant,
pharmacy, or behavioral and mental health students each year.</text>
</paragraph><paragraph id="H148A1FC391CE4546AC7B7FFBF75955EB"><enum>(2)</enum><text>To develop
curriculum.</text>
</paragraph><paragraph id="H935D5798B63E4DEA9DF5B28842B8FCB2"><enum>(3)</enum><text>To acquire
equipment.</text>
</paragraph><paragraph id="H715AF7A493554CF09F3E61BC8561DC96"><enum>(4)</enum><text>To recruit, train,
and retain faculty.</text>
</paragraph><paragraph id="H346273A6C11A4B61B5532CBF1ACD411D"><enum>(5)</enum><text>To provide
assistance to students who have completed a course of study at the recipient
medical, dental, public health, or nursing school or physician assistant,
pharmacy, or behavioral and mental health program during the period in which
such students are completing a residency or internship program affiliated with
the recipient institution.</text>
</paragraph></subsection><subsection id="HB1D0A046123648B6B9EDD6E5AA06409F"><enum>(b)</enum><header>Application</header><text>A
medical, dental, public health, or nursing school or physician assistant,
pharmacy, or behavioral and mental health program 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.</text>
</subsection><subsection id="HB685B5B79935465F94D637BE9C07650D"><enum>(c)</enum><header>Definition of
medical school</header><text>In this section, the term <term>medical
school</term> means a school of medicine or a school of osteopathic
medicine.</text>
</subsection></section><after-quoted-block>.</after-quoted-block></quoted-block>
</subsection></section><section id="HA253FC2EB11B4404B920CFB4F3639267"><enum>203.</enum><header>Federal medical
facility grant program and program assessments</header>
<subsection id="H7C30F00AE4FB4988B16A951AEA01D64E"><enum>(a)</enum><header>Federal medical
facility grant program</header><text display-inline="yes-display-inline">Title
VII of the Public Health Service Act (42 U.S.C. 292 et seq.) is amended—</text>
<paragraph id="H03ABE35F42134AFBA7ACDEBFF38B4A03"><enum>(1)</enum><text display-inline="yes-display-inline">by redesignating part F as part G;
and</text>
</paragraph><paragraph commented="no" display-inline="no-display-inline" id="H7900501879D04125995D3F44C1C5FB99"><enum>(2)</enum><text>by inserting after
part E, the following:</text>
<quoted-block display-inline="no-display-inline" id="H2B6E58F320924D6CA5B081A3F58BCF45" style="OLC">
<part id="HE0CC4DAAD12546D798A1A2546BF07572"><enum>F</enum><header>Start-up expenses
loan and grant programs for Federal medical facilities and hospitals starting
high needs residency programs in shortage areas</header>
<section id="H2C6BB2C1661446D881A38601BE2904D1"><enum>781.</enum><header>Federal medical
facility grant program</header>
<subsection id="H599F9356191F4EF28DBE8C6196D7C4C8"><enum>(a)</enum><header>In
general</header><text>The Secretary shall award grants to eligible facilities
to increase interdisciplinary, community-based health professions training in
high-needs specialties for physicians, nurses, dentists, physician assistants,
pharmacy, behavioral and mental health professionals, public health
professionals, and other health professionals as determined appropriate by the
Secretary, in consultation with the Permanent National Health Workforce
Commission established under section 101(a) of the
<short-title>Health Access and Health Professions Supply
Act of 2009</short-title>.</text>
</subsection><subsection id="H93CA1F65CC6C4CA3BCB58F3B5BAE4FA7"><enum>(b)</enum><header>Eligible
facilities; application</header>
<paragraph id="H7A75617171594C039F9754B12D7D2BE7"><enum>(1)</enum><header>Definition of
eligible facility</header><text>In this section, the term <term>eligible
facility</term>—</text>
<subparagraph id="H5E8CB2FBB5C2473EAEF37E92A5C8121E"><enum>(A)</enum><text>means a facility
which—</text>
<clause id="HB1F55F35B8864586844CFD8ED3C90642"><enum>(i)</enum><text>is
located in a health professional shortage area (as defined in section
332);</text>
</clause><clause id="H79B5C736A8844731A2660C45AD4E9695"><enum>(ii)</enum><text>is located in a
medically underserved community (as defined in section 799B), or with respect
to a medically underserved population (as defined in section 330(b)(3));</text>
</clause><clause id="HAA398EBE0A8F45B9900E6711EA874C03"><enum>(iii)</enum><text>is a Federal
medical facility;</text>
</clause><clause id="H4C94B13E55CE4F10948D5CAF84302D04"><enum>(iv)</enum><text>is an area health
education center, a health education and training center, or a participant in
the Quentin N. Burdick program for rural interdisciplinary training, that meet
the requirements established by the Secretary; or</text>
</clause><clause id="HA061884DA4AD4768BB91534468A7094D"><enum>(v)</enum><text>is
establishing new residency programs in a specialty which the Secretary, in
consultation with the Permanent National Health Workforce Commission
established under section 101(a) of the <short-title>Health Access and Health Professions Supply Act of
2009</short-title>, determines is in high-need; and</text>
</clause></subparagraph><subparagraph id="H7C3C891522134AEAA2F3EED683DF4053"><enum>(B)</enum><text>includes Medicare
certified Federally Qualified Health Centers, community health centers, health
care for the homeless centers, rural health centers, migrant health centers,
Indian Health Service entities, urban Indian centers, health clinics and
hospitals operated by the Indian Health Service, Indian tribes and tribal
organizations, and urban Indian organizations (as defined in section 4 of the
Indian Health Care Improvement Act), and other Federal medical
facilities).</text>
</subparagraph></paragraph><paragraph id="H04D6FC5831164F9E9CBFCBCE7FAF6385"><enum>(2)</enum><header>Application</header><text>An
eligible facility desiring a grant under subsection (a) shall submit to the
Secretary an application at such time, in such manner, and containing such
information as the Secretary may require.</text>
</paragraph></subsection><subsection id="H28A9E2DE20124A9689C56019EE7D6850"><enum>(c)</enum><header>Use of
funds</header><text>An eligible facility shall use amounts received under a
grant under subsection (a) to promote—</text>
<paragraph id="HA88E75E2918B47BD8635F8F00A1FE773"><enum>(1)</enum><text>the training of
health professionals in interdisciplinary, community-based settings that are
affiliated with hospitals and other health care facilities and teaching
institutions;</text>
</paragraph><paragraph id="HDD41668F55134088A2047338DE8FAC80"><enum>(2)</enum><text>community
development programs that assure a diverse health professions workforce through
emphasis on individuals from rural and frontier areas and underrepresented
minority groups;</text>
</paragraph><paragraph id="H58EDF1DEC9594F31A944B404F5F88CCB"><enum>(3)</enum><text>the development of
a reliable health professions pipeline that provides an emphasis on
health-related careers in schools (such as schools participating in the Health
Careers Opportunities Program) and centers of excellence, and that encourage
individuals in underrepresented minorities (including Hispanic,
African-American, American Indian, and Alaska Native individuals) to pursue
health professions careers;</text>
</paragraph><paragraph id="HFB4700659B39473C9F464B7167D4C53D"><enum>(4)</enum><text>the reduction of
health professional isolation in rural, frontier, and urban underserved areas
through the provision of continuing education, mentoring, and precepting
activities, field faculty development, and the utilization of technology such
as telehealth and electronic health records;</text>
</paragraph><paragraph id="HFB16E8B3510E4817A5D56C8443CB907C"><enum>(5)</enum><text>the establishment
and operation of regional or statewide health advice telephone lines to reduce
after-hours call responsibilities for overworked health professionals who
provide services in remote areas that have few health professionals taking such
after-hours calls;</text>
</paragraph><paragraph id="H6331CE0EC08D4768BC8C10F72DF1FDE9"><enum>(6)</enum><text>an increase in the
number of professionals taking after-hours calls in hospitals and emergency
departments in health professional shortage areas (as defined in section 332),
in medically underserved communities (as defined in section 799B), or with
respect to medically underserved populations (as defined in section
330(b)(3));</text>
</paragraph><paragraph id="H9B43E616BF994D3F88D6DE5C7991862F"><enum>(7)</enum><text>the establishment
and operation of relief programs that provide health professionals practicing
in health professional shortage areas (as defined in section 332) with patient
and call coverage when such professionals are ill, are pursuing continuing
education, or are taking a vacation; and</text>
</paragraph><paragraph commented="no" id="HBF9C23D976B2455B95BEDFAE9D004CC7"><enum>(8)</enum><text>the exposure of
health professions residents to systems of health care that represent the
contemporary American healthcare delivery program (such as <quote>P4</quote>
Prepare the Personal Physician for Practice and the <quote>Health
Commons</quote> programs).</text>
</paragraph></subsection><subsection id="H90ACC09876E344E5941C2A8A920F86DF"><enum>(d)</enum><header>Subgrants</header><text>An
eligible facility may use amounts received under a grant under this section to
award subgrants to States and other entities determined appropriate by the
Secretary to carry out the activities described in subsection (c).</text>
</subsection><subsection id="HF317FC12A1C2480499CD4BC0EE79EAA6"><enum>(e)</enum><header>Set
aside</header><text>In awarding grants under this section, the Secretary shall
ensure that a total of $500,000 is awarded annually for the activities of the
National Rural Recruitment and Retention Network, or a similar entity.</text>
</subsection><subsection id="H46F7DD30A4E14E3FB123BFBE19B07A92"><enum>(f)</enum><header>Definition of
Federal medical facility</header><text>In this section, the term <term>Federal
medical facility</term> means a facility for the delivery of health services,
and includes—</text>
<paragraph id="H20911675B08947B4919E792E07A15F4A"><enum>(1)</enum><text>a federally
qualified health center (as defined in section 330A), a public health center,
an outpatient medical facility, or a community mental health center;</text>
</paragraph><paragraph id="H6E8AF3AE707D41B3830E1A2E7E0C7B60"><enum>(2)</enum><text>a hospital, State
mental hospital, facility for long-term care, or rehabilitation
facility;</text>
</paragraph><paragraph id="H9DEE5310797E403EA0CCA4EF6B2363E2"><enum>(3)</enum><text>a migrant health
center or an Indian Health Service facility;</text>
</paragraph><paragraph id="H26F9F1D0E9F34BC3A06C59EF1836C872"><enum>(4)</enum><text>a facility for the
delivery of health services to inmates in a penal or correctional institution
(under section 323) or a State correctional institution;</text>
</paragraph><paragraph id="HD98A5E0599F1442F84E5F6C42104488D"><enum>(5)</enum><text>a Public Health
Service medical facility (used in connection with the delivery of health
services under section 320, 321, 322, 324, 325, or 326)); or</text>
</paragraph><paragraph id="H4DE57E660886482794993ED982BB65EA"><enum>(6)</enum><text>any other Federal
medical facility.</text>
</paragraph></subsection><subsection id="HF36868AC07B84388BDE53AE20DB8B7A4"><enum>(g)</enum><header>Authorization of
appropriations</header><text>There are authorized to be appropriated to carry
out this section, $623,000,000 for fiscal year 2009, $666,000,000 for fiscal
year 2010, $675,000,000 for fiscal year 2011, $700,000,000 for fiscal year
2012, and $725,000,000 for fiscal year
2013.</text>
</subsection></section></part><after-quoted-block>.</after-quoted-block></quoted-block>
</paragraph></subsection><subsection id="HAF5D77F96E7141EFBCE717027784C6C4"><enum>(b)</enum><header>Assessments</header>
<paragraph id="H6073F4C214614D83B1EB9575DB31011D"><enum>(1)</enum><header>Establishment</header><text>The
Secretary of Health and Human Services (referred to in this section as the
<quote>Secretary</quote>) shall establish program assessment rating tools for
each program funded through titles VII and VIII of the Public Health Service
Act (42 U.S.C. 292 and 296 et seq.).</text>
</paragraph><paragraph id="H3B97E8F605A54ED5BB13147CDED65106"><enum>(2)</enum><header>Criteria</header><text>The
Secretary, in consultation with the Administrator of the Health Resources and
Services Administration and other appropriate public and private stakeholders,
shall, through negotiated rulemaking, establish criteria for the conduct of the
assessments under paragraph (2).</text>
</paragraph><paragraph commented="no" display-inline="no-display-inline" id="H22F08E95F9DE44B1B5722BAB1896CC87"><enum>(3)</enum><header>Annual
assessments</header><text>The Secretary shall annually enter into a contract
with an independent nongovernmental entity for the conduct of an assessment,
using the tools established under paragraph (1) and the criteria established
under paragraph (2), of not less than 20 percent, nor more than 25 percent, of
the programs carried out under titles VII and VIII of the Public Health Service
Act, so that every program under such titles is assessed at least once during
every 5-year period.</text>
</paragraph></subsection></section><section id="H6097F900214D4BE9ACD39CF1AADD5D76"><enum>204.</enum><header>Health
professions training loan program</header><text display-inline="no-display-inline">Part F of title VII of the Public Health
Service Act (as added by section 203) is amended by adding at the end the
following</text>
<quoted-block display-inline="no-display-inline" id="H7E8B26DA1A0D4E1A87516CA59F7B78D7" style="OLC">
<section id="H06B0C5399CEA45CD9390EED30DC28D7C"><enum>782.</enum><header>Establishment</header>
<subsection id="H6C8DB9C75DE242509EE988C2C2968AB3"><enum>(a)</enum><header>In
general</header><text>The Secretary shall establish a program under which the
Secretary shall award interest-free loans to—</text>
<paragraph id="H1E29A062664B4B0CACAF78E270B7480A"><enum>(1)</enum><text>eligible hospitals
to enable such hospitals to establish training programs in high-need
specialties; and</text>
</paragraph><paragraph id="H2CF94B887C43462FB47DEBA4D7FA773A"><enum>(2)</enum><text>eligible
non-hospital community-based entities to enable such entities to establish
health professions training programs.</text>
</paragraph></subsection><subsection id="H950518C1230C427AB47BD40FA5A100E5"><enum>(b)</enum><header>Eligibility</header>
<paragraph id="H193E3FD61E074CC4921F13F717FA5230"><enum>(1)</enum><header>In
general</header><text>To be eligible to receive a loan under subsection
(a)—</text>
<subparagraph id="HBCBD14729E5B4C1296938384389B60B3"><enum>(A)</enum><text>a hospital
shall—</text>
<clause id="H165E7A61D8F244D09E8CE0F2BCB511A5"><enum>(i)</enum><text>be
located in a health professional shortage area (as such term is defined in
section 332);</text>
</clause><clause id="H901B7F81CA774A62875AAB6548CBCB28"><enum>(ii)</enum><text>comply with the
requirements of paragraph (2); and</text>
</clause><clause id="H96A095A01A1144D394FFDF4095CCBEC9"><enum>(iii)</enum><text>submit to the
Secretary an application at such time, in such manner, and containing such
information as the Secretary may require; or</text>
</clause></subparagraph><subparagraph id="H76A4370D5C4B480591F4C806B3083860"><enum>(B)</enum><text>a non-hospital
community-based entity shall—</text>
<clause id="H066387A9E183426CBE838183E9F38BB5"><enum>(i)</enum><text>comply with the
requirements of paragraph (2); and</text>
</clause><clause id="H0F5C0DE9C77A46DC8BE6213BE1489800"><enum>(ii)</enum><text>submit to the
Secretary an application at such time, in such manner, and containing such
information as the Secretary may require.</text>
</clause></subparagraph></paragraph><paragraph id="H449EFFC9511941908C1BA0B87F1BCC93"><enum>(2)</enum><header>Requirements</header><text>To
be eligible to receive a loan under subsection (a), a hospital or non-hospital
community-based entity shall—</text>
<subparagraph id="HCE0F6A21AAE94397A90F89F868821085"><enum>(A)</enum><text>on the date on
which the entity submits the loan application, not operate a residency with
respect to a high-needs specialty (as determined by the Secretary in
consultation with the Permanent National Health Workforce Commission
established under section 101(a) of the <short-title>Health Access and Health Professions Supply Act of
2009</short-title>) or provide a health professions training program, as the
case may be;</text>
</subparagraph><subparagraph id="H154EB16162C448719AA866CB73298ACA"><enum>(B)</enum><text>have received
appropriate preliminary accreditation from the relevant accrediting agency
(American Council for Graduate Medical Education, American Osteopathic
Association, or Dental, Physician Assistant, Pharmacy, Behavioral and Mental
Health, Public Health, and Nursing accrediting agencies), as determined by the
Secretary; and</text>
</subparagraph><subparagraph id="H9752B25A9D09471AA5909BF8A8E6DBFE"><enum>(C)</enum><text>execute a signed
formal contract under which the hospital or entity agree to repay the
loan.</text>
</subparagraph></paragraph></subsection><subsection id="H62ACF076D3CC48218E10E95735B59E64"><enum>(c)</enum><header>Use of loan
funds</header><text>Amounts received under a loan under subsection (a) shall be
used only for—</text>
<paragraph id="H0FBE15B3F4E345D7B8B0FA2AE2A4B407"><enum>(1)</enum><text>the salary and
fringe benefit expenses of residents, students, trainees, and faculty, or other
costs directly attributable to the residency, educational, or training program
to be carried out under the loan, as specified by the Secretary; or</text>
</paragraph><paragraph id="H4CEAC73D8AE0469299674723AE490662"><enum>(2)</enum><text>facility
construction or renovation, including equipment purchase.</text>
</paragraph></subsection><subsection id="H67CE72578FF7402AA2010FE4369B7BA4"><enum>(d)</enum><header>Priority</header><text>In
awarding loans under subsection (a), the Secretary shall give priority to
applicants that are located in health professional shortage areas (as defined
in section 332) or in medically underserved communities (as defined in section
799B), or that serve medically underserved populations (as defined in section
330(b)(3)).</text>
</subsection><subsection id="H4E94768369094A939FCC2400AE75E003"><enum>(e)</enum><header>Loan
provisions</header>
<paragraph id="H6309B64C96AC44409820A2B7C3929B60"><enum>(1)</enum><header>Loan
contract</header><text>The loan contract entered into under subsection (b)(2)
shall contain terms that provide for the repayment of the loan, including the
number and amount of installment payments as described in such contract. Such
repayment shall begin on the date that is 24 months after the date on which the
loan contract is executed and shall be fully repaid not later than 36 months
after the date of the first payment.</text>
</paragraph><paragraph id="H00E4DF63B87B46FB8324E8FD06E3706A"><enum>(2)</enum><header>Interest</header><text>Loans
under this section shall be repaid without interest.</text>
</paragraph></subsection><subsection id="HDE11E5D759C64760B01001DD429916EA"><enum>(f)</enum><header>Limitation</header><text>The
amount of a loan under this section with respect to each of the uses described
in subsection (c)(1) or (c)(2) shall not exceed $2,000,000.</text>
</subsection><subsection id="H4EDCA81FDAFA461FBA40AC5E0C43643F"><enum>(g)</enum><header>Failure To
repay</header><text>A hospital or non-hospital community-based entity that
fails to comply with the terms of a contract entered into under subsection
(b)(2) shall be liable to the United States for the amount which has been paid
to such hospital or entity under the contract.</text>
</subsection><subsection id="H0B07A3CAFBE3422F811F269AF85D27B8"><enum>(h)</enum><header>Authorization of
appropriations</header><text>There is authorized to be appropriated, such sums
as may be necessary to carry out this
section.</text>
</subsection></section><after-quoted-block>.</after-quoted-block></quoted-block>
</section><section id="H14E69EE1F9AB4B48890BA83F0262B476"><enum>205.</enum><header>United States
Public Health Sciences Track</header><text display-inline="no-display-inline">Title II of the Public Health Service Act
(42 U.S.C. 202 et seq.) is amended by adding at the end the following:</text>
<quoted-block display-inline="no-display-inline" id="HF31111CA136E4ED3824B696C170CE5A1" style="OLC">
<part id="H8121FCDA2D8B41CFB43DCDDC7F63C943"><enum>D</enum><header>United States
Public Health Sciences Track</header>
<section id="H26FB97B7E44D4BD69620651B9A0C19CE"><enum>271.</enum><header>Establishment</header>
<subsection id="HD55437FCEF224AA6825DFF4E50560533"><enum>(a)</enum><header>United States
Public Health Services Track</header>
<paragraph id="H76B79DD7508A4FFF973CF13760ADA999"><enum>(1)</enum><header>In
general</header><text>There is hereby authorized to be established a United
States Public Health Sciences Track (referred to in this part as the
<quote>Track</quote>), at sites to be selected by the Secretary, with authority
to grant appropriate advanced degrees in a manner that uniquely emphasizes
team-based service, public health, epidemiology, and emergency preparedness and
response. It shall be so organized as to graduate not less than—</text>
<subparagraph id="H1B193C621F6545C1B103C5608AC7900B"><enum>(A)</enum><text>150 medical
students annually;</text>
</subparagraph><subparagraph id="H9B53EB48626546C29DE9673F894FE254"><enum>(B)</enum><text>100 dental
students annually;</text>
</subparagraph><subparagraph id="HB16CFF7BE86A429FAB597C3C582ACA19"><enum>(C)</enum><text>250 nursing
students annually;</text>
</subparagraph><subparagraph id="HB00780B2732F400983782BDA54827EA4"><enum>(D)</enum><text>100 public health
students annually;</text>
</subparagraph><subparagraph id="H36F5FE3E0A3B425B91B757941B7A0470"><enum>(E)</enum><text>100 behavioral and
mental health professional students annually;</text>
</subparagraph><subparagraph id="HA02002ED19824A85911E1BBAEDCFC80B"><enum>(F)</enum><text>100 physician
assistant or nurse practitioner students annually; and</text>
</subparagraph><subparagraph id="H7F265DD55C1248A58ED40A2B0FA1BED0"><enum>(G)</enum><text>50 pharmacy
students annually.</text>
</subparagraph></paragraph><paragraph id="HD87F6F1A6131413D92800091E9CB8D6B"><enum>(2)</enum><header>Locations</header><text>The
Track shall be located at existing and accredited, affiliated health
professions education training programs at academic health centers located in
regions of the United States determined appropriate by the Surgeon General, in
consultation with the Permanent National Health Workforce Commission.</text>
</paragraph></subsection><subsection id="H1425413AA80841AAB696D72547090997"><enum>(b)</enum><header>Number of
graduates</header><text>Except as provided in subsection (a), the number of
persons to be graduated from the Track shall be prescribed by the Secretary. In
so prescribing the number of persons to be graduated from the Track, the
Secretary shall institute actions necessary to ensure the maximum number of
first-year enrollments in the Track consistent with the academic capacity of
the affiliated sites and the needs of the United States for medical, dental,
and nursing personnel.</text>
</subsection><subsection id="HC725B28797EF420C964524BCF9C76924"><enum>(c)</enum><header>Development</header><text>The
development of the Track may be by such phases as the Secretary may prescribe
subject to the requirements of subsection (a).</text>
</subsection><subsection id="H9E7A60D8A2EE4A1FB50C24536A463E5C"><enum>(d)</enum><header>Integrated
longitudinal plan</header><text>The Surgeon General shall develop an integrated
longitudinal plan for health professions continuing education throughout the
continuum of health-related education, training, and practice. Training under
such plan shall emphasize patient-centered, interdisciplinary, and care
coordination skills. Experience with deployment of emergency response teams
shall be included during the clinical experiences.</text>
</subsection><subsection id="H3DD03710D3DC49A3A283D7F2BA5B837B"><enum>(e)</enum><header>Faculty
development</header><text>The Surgeon General shall develop faculty development
programs and curricula in decentralized venues of health care, to balance
urban, tertiary, and inpatient venues.</text>
</subsection></section><section id="H59B8DF292526476884F61CAC11DC90D8"><enum>272.</enum><header>Administration</header>
<subsection id="H840DA1F819D24D53B7D95B23EF2F40D8"><enum>(a)</enum><header>In
general</header><text>The business of the Track shall be conducted by the
Surgeon General with funds appropriated for and provided by the Department of
Health and Human Services. The Permanent National Health Workforce Commission
shall assist the Surgeon General in an advisory capacity.</text>
</subsection><subsection id="HE96C0445B34F49DFB3C45EB9D51B520A"><enum>(b)</enum><header>Faculty</header>
<paragraph id="H4D61D44BC6E1450EBA8A0A89A60B2FFE"><enum>(1)</enum><header>In
general</header><text>The Surgeon General, after considering the
recommendations of the Permanent National Health Workforce Commission, shall
obtain the services of such professors, instructors, and administrative and
other employees as may be necessary to operate the Track, but utilize when
possible, existing affiliated health professions training institutions. Members
of the faculty and staff shall be employed under salary schedules and granted
retirement and other related benefits prescribed by the Secretary so as to
place the employees of the Track faculty on a comparable basis with the
employees of fully accredited schools of the health professions within the
United States.</text>
</paragraph><paragraph id="H2C9DCF73590D4722B241BFA1DF88C9E3"><enum>(2)</enum><header>Titles</header><text>The
Surgeon General may confer academic titles, as appropriate, upon the members of
the faculty.</text>
</paragraph><paragraph id="HACBB5DA991924A4BA1DDAF8A943482B9"><enum>(3)</enum><header>Nonapplication
of provisions</header><text>The limitations in section 5373 of title 5, United
States Code, shall not apply to the authority of the Surgeon General under
paragraph (1) to prescribe salary schedules and other related benefits.</text>
</paragraph></subsection><subsection id="H8BEE3633094A4A7FA1412BB43BBD2432"><enum>(c)</enum><header>Agreements</header><text>The
Surgeon General may negotiate agreements with agencies of the Federal
Government to utilize on a reimbursable basis appropriate existing Federal
medical resources located in the United States (or locations selected in
accordance with section 271(a)(2)). Under such agreements the facilities
concerned will retain their identities and basic missions. The Surgeon General
may negotiate affiliation agreements with accredited universities and health
professions training institutions in the United States. Such agreements may
include provisions for payments for educational services provided students
participating in Department of Health and Human Services educational
programs.</text>
</subsection><subsection id="H238E10CFD23B4A5E8C82B0394723F65E"><enum>(d)</enum><header>Programs</header><text>The
Surgeon General may establish the following educational programs for Track
students:</text>
<paragraph id="H1EBF2EDDFDBF468B86BA3C129E0E3C84"><enum>(1)</enum><text>Postdoctoral,
postgraduate, and technological institutes.</text>
</paragraph><paragraph id="H1DF7154DFF4046C891C7028BB5CEA5BB"><enum>(2)</enum><text>A graduate school
of nursing.</text>
</paragraph><paragraph id="H1572BE1AABED4E62926DD3D16B96B67F"><enum>(3)</enum><text>Other schools or
programs that the Surgeon General determines necessary in order to operate the
Track in a cost-effective manner.</text>
</paragraph></subsection><subsection id="HB951F385005A44C6B8F5F67AAFBBC933"><enum>(e)</enum><header>Continuing
medical education</header><text>The Surgeon General shall establish programs in
continuing medical education for members of the health professions to the end
that high standards of health care may be maintained within the United
States.</text>
</subsection><subsection id="H308FD53C4E9A4FC6B7CD078DA86EDB07"><enum>(f)</enum><header>Authority of the
Surgeon General</header>
<paragraph id="HDCCF69748F874796B8AE8BE3430BE9D8"><enum>(1)</enum><header>In
general</header><text>The Surgeon General is authorized—</text>
<subparagraph id="H28099FFE8FE44B48A964A6FB739AA509"><enum>(A)</enum><text>to enter into
contracts with, accept grants from, and make grants to any nonprofit entity for
the purpose of carrying out cooperative enterprises in medical, dental,
physician assistant, pharmacy, behavioral and mental health, public health, and
nursing research, consultation, and education;</text>
</subparagraph><subparagraph id="H3B8AB446344A4911974DCC593FDB1E9C"><enum>(B)</enum><text>to enter into
contracts with entities under which the Surgeon General may furnish the
services of such professional, technical, or clerical personnel as may be
necessary to fulfill cooperative enterprises undertaken by the Track;</text>
</subparagraph><subparagraph id="H6C54EEE7FFAF48DD9506BE3F9DAD5A7F"><enum>(C)</enum><text>to accept, hold,
administer, invest, and spend any gift, devise, or bequest of personal property
made to the Track, including any gift, devise, or bequest for the support of an
academic chair, teaching, research, or demonstration project;</text>
</subparagraph><subparagraph id="H2AB7202B7A8B48D2904A675AC6768360"><enum>(D)</enum><text>to enter into
agreements with entities that may be utilized by the Track for the purpose of
enhancing the activities of the Track in education, research, and technological
applications of knowledge; and</text>
</subparagraph><subparagraph id="HD9EC9C59A4A246BDBEB42AB5B76ED7C8"><enum>(E)</enum><text>to accept the
voluntary services of guest scholars and other persons.</text>
</subparagraph></paragraph><paragraph id="HE479DD457C8E49E2AC72B22F8D72486E"><enum>(2)</enum><header>Limitation</header><text>The
Surgeon General may not enter into any contract with an entity if the contract
would obligate the Track to make outlays in advance of the enactment of budget
authority for such outlays.</text>
</paragraph><paragraph id="HB1A0D807FEA54A298D8999D03F64F695"><enum>(3)</enum><header>Scientists</header><text>Scientists
or other medical, dental, or nursing personnel utilized by the Track under an
agreement described in paragraph (1) may be appointed to any position within
the Track and may be permitted to perform such duties within the Track as the
Surgeon General may approve.</text>
</paragraph><paragraph id="H6FEC12449B3A4C4D8843725B0BEC48C9"><enum>(4)</enum><header>Volunteer
services</header><text>A person who provides voluntary services under the
authority of subparagraph (E) of paragraph (1) shall be considered to be an
employee of the Federal Government for the purposes of chapter 81 of title 5,
relating to compensation for work-related injuries, and to be an employee of
the Federal Government for the purposes of chapter 171 of title 28, relating to
tort claims. Such a person who is not otherwise employed by the Federal
Government shall not be considered to be a Federal employee for any other
purpose by reason of the provision of such services.</text>
</paragraph></subsection></section><section id="H6D37B450E70C43F496FB7BC5E7048D58"><enum>273.</enum><header>Students;
selection; obligation</header>
<subsection id="H926AE4C6FD4B4A3DAB48870B9E9E31A8"><enum>(a)</enum><header>Student
selection</header>
<paragraph id="H46E48F433D1B4BD4969051B9F0FDED63"><enum>(1)</enum><header>In
general</header><text>Medical, dental, physician assistant, pharmacy,
behavioral and mental health, public health, and nursing students at the Track
shall be selected under procedures prescribed by the Surgeon General. In so
prescribing, the Surgeon General shall consider the recommendations of the
Permanent National Health Workforce Commission.</text>
</paragraph><paragraph id="H6C0F41C2B2DD46718B79A200A4BA5557"><enum>(2)</enum><header>Priority</header><text>In
developing admissions procedures under paragraph (1), the Surgeon General shall
ensure that such procedures give priority to applicant medical, dental,
physician assistant, pharmacy, behavioral and mental health, public health, and
nursing students from rural communities and underrepresented minorities.</text>
</paragraph></subsection><subsection id="H9CBB636BA77A46ACA3BF43166BA81331"><enum>(b)</enum><header>Contract and
service obligation</header>
<paragraph id="HB98C63EAB2464259BE33EB0974E9D869"><enum>(1)</enum><header>Contract</header><text>Upon
being admitted to the Track, a medical, dental, physician assistant, pharmacy,
behavioral and mental health, public health, or nursing student shall enter
into a written contract with the Surgeon General that shall contain—</text>
<subparagraph id="H87CA51B2EE194F38AD000AFF6FFF9AB9"><enum>(A)</enum><text>an agreement under
which—</text>
<clause id="HC8F7892F1D1C498B9BBFF5AFA714748E"><enum>(i)</enum><text>subject to
subparagraph (B), the Surgeon General agrees to provide the student with
tuition (or tuition remission) and a student stipend (described in paragraph
(2)) in each school year for a period of years (not to exceed 4 school years)
determined by the student, during which period the student is enrolled in the
Track at an affiliated or other participating health professions institution
pursuant to an agreement between the Track and such institution; and</text>
</clause><clause id="H67E55CE47FA74D1AAC7C4F53231A2B81"><enum>(ii)</enum><text>subject to
subparagraph (B), the student agrees—</text>
<subclause id="H077E27BFB25F43C88CE6C8E3C6F1AF28"><enum>(I)</enum><text>to accept the
provision of such tuition and student stipend to the student;</text>
</subclause><subclause id="HFC6D63A93EBC4C0A8D3F3BADDA4C450C"><enum>(II)</enum><text>to maintain
enrollment at the Track until the student completes the course of study
involved;</text>
</subclause><subclause id="HCA596D0F0CE54EF9894524E1D937618C"><enum>(III)</enum><text>while enrolled
in such course of study, to maintain an acceptable level of academic standing
(as determined by the Surgeon General);</text>
</subclause><subclause id="HD8DF074BDEC640F5B6CFB590908E39A5"><enum>(IV)</enum><text>if pursuing a
degree from a school of medicine or osteopathic medicine, dental, public
health, or nursing school or a physician assistant, pharmacy, or behavioral and
mental health professional program, to complete a residency or internship in a
specialty that the Surgeon General determines is appropriate; and</text>
</subclause><subclause id="HCC04EA1D74EE40C980EE977E363B8C0A"><enum>(V)</enum><text>to serve for a
period of time (referred to in this part as the <quote>period of obligated
service</quote>) within the Commissioned Corps of the Public Health Service
equal to 2 years for each school year during which such individual was enrolled
at the College, reduced as provided for in paragraph (3);</text>
</subclause></clause></subparagraph><subparagraph id="H970428680D694040AD98234F83BB98DD"><enum>(B)</enum><text>a provision that
any financial obligation of the United States arising out of a contract entered
into under this part and any obligation of the student which is conditioned
thereon, is contingent upon funds being appropriated to carry out this
part;</text>
</subparagraph><subparagraph id="H468D50A5B3B5433DB38880222C1D7DEF"><enum>(C)</enum><text>a statement of the
damages to which the United States is entitled for the student’s breach of the
contract; and</text>
</subparagraph><subparagraph id="H9626D42C2A074B95BEAF22770195ECEA"><enum>(D)</enum><text>such other
statements of the rights and liabilities of the Secretary and of the
individual, not inconsistent with the provisions of this part.</text>
</subparagraph></paragraph><paragraph id="H8892C32FB7764C23BF8E20EB23DF5B7E"><enum>(2)</enum><header>Tuition and
student stipend</header>
<subparagraph id="H93ED2B7928F641CE8D9404BBD91AAAB9"><enum>(A)</enum><header>Tuition
remission rates</header><text>The Surgeon General, based on the recommendations
of the Permanent National Health Workforce Commission established under section
101(a) of the <short-title>Health Access and Health
Professions Supply Act of 2009</short-title>, shall establish Federal tuition
remission rates to be used by the Track to provide reimbursement to affiliated
and other participating health professions institutions for the cost of
educational services provided by such institutions to Track students. The
agreement entered into by such participating institutions under paragraph
(1)(A)(i) shall contain an agreement to accept as payment in full the
established remission rate under this subparagraph.</text>
</subparagraph><subparagraph id="H5362D15A99444431A4CC9B945590AD0C"><enum>(B)</enum><header>Stipend</header><text>The
Surgeon General, based on the recommendations of the Permanent National Health
Workforce Commission, shall establish and update Federal stipend rates for
payment to students under this part.</text>
</subparagraph></paragraph><paragraph id="H581AC94A83F94510AA4C38DE257A9A79"><enum>(3)</enum><header>Reductions in
the period of obligated service</header><text>The period of obligated service
under paragraph (1)(A)(ii)(V) shall be reduced—</text>
<subparagraph id="HD57F16FD6FCD435C8AAC8AD4D6490E12"><enum>(A)</enum><text>in the case of a
student who elects to participate in a high-needs speciality residency (as
determined by the Permanent National Health Workforce Commission), by 3 months
for each year of such participation (not to exceed a total of 12 months);
and</text>
</subparagraph><subparagraph id="H6FBC63F31288465EB5640F885AD8A261"><enum>(B)</enum><text>in the case of a
student who, upon completion of their residency, elects to practice in a
Federal medical facility (as defined in section 781(e)) that is located in a
health professional shortage area (as defined in section 332), by 3 months for
year of full-time practice in such a facility (not to exceed a total of 12
months).</text>
</subparagraph></paragraph></subsection><subsection id="H39A6AEBC09F2454698293E57B44B379D"><enum>(c)</enum><header>Second 2 years
of service</header><text>During the third and fourth years in which a medical,
dental, physician assistant, pharmacy, behavioral and mental health, public
health, or nursing student is enrolled in the Track, training should be
designed to prioritize clinical rotations in Federal medical facilities in
health professional shortage areas, and emphasize a balance of hospital and
community-based experiences, and training within interdisciplinary
teams.</text>
</subsection><subsection id="H968DB2AAC41B4AAAA5B7249515864730"><enum>(d)</enum><header>Dentist,
physician assistant, pharmacist, behavioral and mental health professional,
public health professional, and nurse training</header><text>The Surgeon
General shall establish provisions applicable with respect to dental, physician
assistant, pharmacy, behavioral and mental health, public health, and nursing
students that are comparable to those for medical students under this section,
including service obligations, tuition support, and stipend support. The
Surgeon General shall give priority to health professions training institutions
that train medical, dental, physician assistant, pharmacy, behavioral and
mental health, public health, and nursing students for some significant period
of time together, but at a minimum have a discrete and shared core
curriculum.</text>
</subsection><subsection id="H755780673B9E42B69B6EF58E7C060932"><enum>(e)</enum><header>Elite Federal
disaster teams</header><text>The Surgeon General, in consultation with the
Secretary, the Director of the Centers for Disease Control and Prevention, and
other appropriate military and Federal government agencies, shall develop
criteria for the appointment of highly qualified Track faculty, medical,
dental, physician assistant, pharmacy, behavioral and mental health, public
health, and nursing students, and graduates to elite Federal disaster
preparedness teams to train and to respond to public health emergencies,
natural disasters, bioterrorism events, and other emergencies.</text>
</subsection><subsection id="HBF8456A80879444C9E7A1F09B809E85B"><enum>(f)</enum><header>Student dropped
from Track in affiliate school</header><text>A medical, dental, physician
assistant, pharmacy, behavioral and mental health, public health, or nursing
student who, under regulations prescribed by the Surgeon General, is dropped
from the Track in an affiliated school for deficiency in conduct or studies, or
for other reasons, shall be liable to the United States for all tuition and
stipend support provided to the student.</text>
</subsection></section><section id="HFA2442B319DC40CFBD997FC73A1BC0E4"><enum>274.</enum><header>Authorization
of appropriations</header><text display-inline="no-display-inline">There is
authorized to be appropriated to carry out this part, section 338A–1, and
section 749, such sums as may be
necessary.</text>
</section></part><after-quoted-block>.</after-quoted-block></quoted-block>
</section><section id="HC5F22E5080B74D7E834BFC21D31E5423"><enum>206.</enum><header>Medical
education debt reimbursement for physicians of the Veterans Health
Administration</header>
<subsection id="H6EAD9B0FA66F41FE8F696503083B76B1"><enum>(a)</enum><header>In
general</header><text>The Secretary of Veterans Affairs shall carry out a
program under which eligible physicians described in subsection (b) are
reimbursed for the education debt of such physicians as described in subsection
(c).</text>
</subsection><subsection id="H28C92B5EA1494770A1E84F647895A542"><enum>(b)</enum><header>Eligible
physicians</header><text>An eligible physician described in this subsection is
any physician currently appointed to a physician position in the Veterans
Health Administration under section 7402(b)(1) of title 38, United States Code,
who enters into an agreement with the Secretary to continue serving as a
physician in such position for such period of time as the Secretary shall
specify in the agreement.</text>
</subsection><subsection id="H4AE5117467F14A138A7A757C38311EF5"><enum>(c)</enum><header>Covered
education debt</header><text>The education debt for which an eligible physician
may be reimbursed under this section is any amount paid by the physician for
tuition, room and board, or expenses in obtaining the degree of doctor or
medicine or of doctor of osteopathy, including any amounts of principal or
interest paid by the physician under a loan, the proceeds of which were used by
or on behalf of the physician for the costs of obtaining such degree.</text>
</subsection><subsection id="H84EE888164414F0F94467FFE488CB388"><enum>(d)</enum><header>Frequency of
reimbursement</header><text>Any reimbursement of an eligible physician under
this section shall be made in a lump sum or in installments of such frequency
as the Secretary shall specify the agreement of the physician as required under
subsection (b).</text>
</subsection><subsection id="H800F1D4EDF264D9B9F575A9484ACB8B3"><enum>(e)</enum><header>Liability for
failure To complete obligated service</header><text>Any eligible physician who
fails to satisfactorily complete the period of service agreed to by the
physician under subsection (b) shall be liable to the United States in an
amount determined in accordance with the provisions of section 7617(c)(1) of
title 38, United States Code.</text>
</subsection><subsection commented="no" display-inline="no-display-inline" id="H04A31D5E126D456F9B69CA29F5E6DD0D"><enum>(f)</enum><header>Treatment of
reimbursement with other pay and benefit authorities</header><text>Any amount
of reimbursement payable to an eligible physician under this section is in
addition to any other pay, allowances, or benefits that may be provided the
physician under law, including any educational assistance under the Department
of Veterans Affairs Health Professional Educational Assistance Program under
chapter 76 of title 38, United States Code.</text>
</subsection></section><section commented="no" id="H9C4CEED809BE40E5B9A12900E0BFA534"><enum>207.</enum><header>Promoting
education and training of psychologists to provide mental and behavioral health
services to underserved populations</header><text display-inline="no-display-inline">Part E of title VII of the Public Health
Service Act (42 U.S.C. 294n et seq.) is amended by adding at the end the
following:</text>
<quoted-block display-inline="no-display-inline" id="H1A0FACF5A328420A9461C217EB105A2E" style="OLC">
<subpart commented="no" id="H45407E07952F43C3AF287F03F0EAA61A"><enum>3</enum><header>Mental and
Behavioral Health Care Workforce</header>
<section commented="no" id="HAA0938F0BA084CB98B454C770B370FE0"><enum>775.</enum><header>Program for
graduate education and training in psychology</header>
<subsection commented="no" id="H8E40CB4E07CB45C2BE5077593ECA387A"><enum>(a)</enum><header>In
General</header><text>The Secretary may award grants, cooperative agreements,
and contracts to accredited doctoral, internship, and residency programs in
psychology for the development and implementation of programs to provide
interdisciplinary training in integrated health care settings to students in
doctoral psychology programs, including interns and residents in such programs.
Any training funded by such grants, cooperative agreements, or contracts shall
focus on the needs of underserved populations.</text>
</subsection><subsection commented="no" id="H305C026B34A54031BD21E905B5AB8E99"><enum>(b)</enum><header>Eligibility</header><text>To
be eligible to receive an award under this section an entity shall—</text>
<paragraph commented="no" id="H4EEECA6A486B48448BD903E4E2159413"><enum>(1)</enum><text>provide training
at or through an accredited doctoral program in psychology, including an
internship or residency program; and</text>
</paragraph><paragraph commented="no" id="HDC698EF2E5484BA38043042A69FED03C"><enum>(2)</enum><text>prepare and submit
to the Secretary an application at such time, in such manner, and containing
such information as the Secretary may require.</text>
</paragraph></subsection><subsection commented="no" id="H5102F1FE9BFB4F12BD92FA5716D5CA27"><enum>(c)</enum><header>Evaluation of
Programs</header><text>The Secretary shall evaluate any program implemented
through an award under this section in order to determine the effect of such
program on increasing the number of psychologists who provide mental and
behavioral health services to underserved populations.</text>
</subsection><subsection commented="no" id="HECFD9C8DD5804716B36B58EB93D1680A"><enum>(d)</enum><header>Definitions</header><text>For
purposes of this section—</text>
<paragraph commented="no" id="HCF34EA20362C4E178C7C0F0C66658CA7"><enum>(1)</enum><text>the term
<quote>underserved population</quote> means individuals, especially older
adults, children, chronically ill individuals, victims of abuse or trauma, and
victims of combat- or war-related stress disorders, including post-traumatic
stress disorder and traumatic brain injury, and their families, living in an
urban or rural area that has a shortage of mental or behavioral health
services; and</text>
</paragraph><paragraph commented="no" id="H8D9F9CB3A524450F844D658C8B71F1CE"><enum>(2)</enum><text>the term
<quote>interdisciplinary training</quote> means training for graduate
psychology students with 1 or more of the other health professions, including
medicine, nursing, dentistry, and pharmacy.</text>
</paragraph></subsection><subsection commented="no" id="HCCBE69355C5444278170FB412C2541BE"><enum>(e)</enum><header>Authorization of
Appropriations</header><text>To carry out this section, there is authorized to
be appropriated $10,000,000 for fiscal year 2010, $12,000,000 for fiscal year
2011, $14,000,000 for fiscal year 2012, $16,000,000 for fiscal year 2013, and
$18,000,000 for fiscal year
2014.</text>
</subsection></section></subpart><after-quoted-block>.</after-quoted-block></quoted-block>
</section><enum>III</enum><header>Health
professional training pipeline partnerships program</header>
<section id="H52CC7715D8BB4E61A2524E0DFB2AA787"><enum>301.</enum><header>Grants to
prepare students for careers in health care</header>
<subsection id="H4F520870D88E45E4BAD0904E93E3398C"><enum>(a)</enum><header>Purpose</header><text>The
purpose of this section is to support the development and implementation of
programs designed to prepare middle school and high school students for study
and careers in the healthcare field, including success in postsecondary
mathematics and science programs.</text>
</subsection><subsection id="H53921B3905B245A2B271436339A20AB9"><enum>(b)</enum><header>Definitions</header><text>In
this section:</text>
<paragraph id="H9C24553FEB684FFCB1BBE6D877FDD90B"><enum>(1)</enum><header>Children from
low-income families</header><text>The term <term>children from low-income
families</term> means children described in section 1124(c)(1)(A) of the
Elementary and Secondary Education Act of 1965 (20 U.S.C.
6333(c)(1)(A)).</text>
</paragraph><paragraph id="HF3F77730ECBB4F038E54B5ACBC157E55"><enum>(2)</enum><header>Eligible
recipients</header><text>The term <term>eligible recipient</term> means—</text>
<subparagraph id="H38851EB4BE47411CB340CE9050DD3303"><enum>(A)</enum><text>a nonprofit
healthcare career pathway partnership organization; or</text>
</subparagraph><subparagraph id="HEB7AD0AB563A46F9AE4A405966FF1674"><enum>(B)</enum><text>a high-need local
educational agency in partnership with—</text>
<clause id="HC4D6B8596EEB48CC88C00EEADA87346C"><enum>(i)</enum><text>not
less than 1 institution of higher education with an established health
profession education program; and</text>
</clause><clause id="HAF90FCC34BE742549CCAC7C1BEAE152F"><enum>(ii)</enum><text>not
less than 1 community-based, private sector healthcare provider
organization.</text>
</clause></subparagraph></paragraph><paragraph id="HBE28C47D9F7040AC8AC3D01197D1506C"><enum>(3)</enum><header>High-need local
educational agency</header><text>The term <term>high-need local educational
agency</term> means a local educational agency or educational service
agency—</text>
<subparagraph id="H263ABCE5FCD940E6BEE2D00A454FCB78"><enum>(A)</enum><text>that serves not
fewer than 10,000 children from low-income families;</text>
</subparagraph><subparagraph id="HE365E6D109A5454BB9ACEA5E0C8E142B"><enum>(B)</enum><text>for which not less
than 20 percent of the children served by the agency are children from
low-income families;</text>
</subparagraph><subparagraph id="H7848BE56E4E2443996D4C11682AD9103"><enum>(C)</enum><text>that meets the
eligibility requirements for funding under the Small, Rural School Achievement
Program under section 6211(b) of the Elementary and Secondary Education Act of
1965 (20 U.S.C. 7345(b)); or</text>
</subparagraph><subparagraph id="H428EB4503DB4455A939FCA843B2AB2A0"><enum>(D)</enum><text>that meets the
eligibility requirements for funding under the Rural and Low-Income School
Program under section 6221(b)(1) of the Elementary and Secondary Education Act
of 1965 (20 U.S.C. 7351(b)(1)).</text>
</subparagraph></paragraph><paragraph id="H555F845C3BFB4444B326E12F733376CB"><enum>(4)</enum><header>Nonprofit
healthcare career pathway partnership organization</header><text>The term
<term>nonprofit healthcare career pathway partnership organization</term> means
a nonprofit organization focused on developing career and educational pathways
to healthcare professions, that shall include representatives of—</text>
<subparagraph id="HEA2A4F539D98488C81ECCAFF9BAEC3A3"><enum>(A)</enum><text>the local
educational agencies;</text>
</subparagraph><subparagraph id="H9A1CA167ED164949840E13738315769C"><enum>(B)</enum><text>not less than 1
institution of higher education (as defined in section 101(a) of the Higher
Education Act of 1965 (20 U.S.C. 1001(a))) with an established health
profession education program; and</text>
</subparagraph><subparagraph id="H86674789DDD9468ABDC23EAC80251D17"><enum>(C)</enum><text>not less than 1
community-based, private sector healthcare provider organization or other
healthcare industry organization.</text>
</subparagraph></paragraph><paragraph id="H28A354CB5595407DAE07B21A4DE69EDA"><enum>(5)</enum><header>Secretary</header><text>The
term <term>Secretary</term> means the Secretary of Education.</text>
</paragraph></subsection><subsection id="H99B5CD1BCE3B4878965A1C7D71DAD722"><enum>(c)</enum><header>Grants
authorized</header>
<paragraph id="HC71E911C05F24959951304C8B9B01112"><enum>(1)</enum><header>In
general</header><text>The Secretary is authorized to award grants, on a
competitive basis, to eligible recipients to enable the recipients to develop
and implement programs of study to prepare middle school and high school
students for postsecondary education leading to careers in the healthcare
field.</text>
</paragraph><paragraph id="H046C27D328874DD7B776D1ECAFB04233"><enum>(2)</enum><header>Minimum funding
level</header><text>Grants shall be awarded at a minimum level of $500,000 per
recipient, per year.</text>
</paragraph><paragraph id="HE560C2B66ABC48218A3E3FEFD4E68DBF"><enum>(3)</enum><header>Renewability</header><text>Grants
may be renewed, at the discretion of the Secretary, for not more than 5
years.</text>
</paragraph></subsection><subsection id="H8E545B41F0324219B4E64794D2E4AB6B"><enum>(d)</enum><header>Application</header><text>Each
eligible recipient desiring 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, which shall include an assurance that
the recipient will meet the program requirements described in subsection
(f)(2).</text>
</subsection><subsection id="H02B585CC4AC142419F34087A16E94B3A"><enum>(e)</enum><header>Priority</header><text>In
awarding grants under this section, the Secretary shall give priority
to—</text>
<paragraph id="H89E987D1862542E8903CC0A420CA5387"><enum>(1)</enum><text>applicants that
include a local educational agency that is located in an area that is
designated under section 332(a)(1)(A) of the Public Health Service Act (42
U.S.C. 254e(a)(1)(A)) as a health professional shortage area;</text>
</paragraph><paragraph id="H9CC1CCA6B61A4C43B5B0C219A562DA4F"><enum>(2)</enum><text>applicants that
include an institution of higher education that emphasizes an interdisciplinary
approach to health profession education; and</text>
</paragraph><paragraph id="H422CBEC01D254F39BE483D188FAB1A1A"><enum>(3)</enum><text>applicants whose
program involves the development of a uniquely innovative public-private
partnership.</text>
</paragraph></subsection><subsection id="HAF4ED62391FA4F13A66944A57EDD851F"><enum>(f)</enum><header>Authorized
activities/use of funds</header>
<paragraph id="H1521382E9F8140F4BD4B6CE23C84E989"><enum>(1)</enum><header>In
general</header><text>Each eligible recipient that receives a grant under this
section shall use the grant funds to develop and implement programs of study to
prepare middle school and high school students for careers in the healthcare
field that—</text>
<subparagraph id="HD35351E575CA440C9F167090FC0DFA39"><enum>(A)</enum><text>are aligned with
State challenging academic content standards and State challenging student
academic achievement standards; and</text>
</subparagraph><subparagraph id="H5AEC715FB218426C82A05301680AB881"><enum>(B)</enum><text>lead to high
school graduation with the skills and preparation—</text>
<clause id="H5FCFAA32E2304374BFAF230F4998C1B1"><enum>(i)</enum><text>to
enter postsecondary education programs of study in mathematics and science
without remediation; and</text>
</clause><clause id="H1C2D07E8F49B47258F3ED323F93FABAD"><enum>(ii)</enum><text>necessary to
enter healthcare jobs directly.</text>
</clause></subparagraph></paragraph><paragraph id="H4F1CF6F3D8E74A38A83A7886C4BD3252"><enum>(2)</enum><header>Program
requirements</header><text>A program of study described in paragraph (1)
shall—</text>
<subparagraph id="HB94F58C9EFA44CEAB686BDDE549F1C63"><enum>(A)</enum><text>involve a review
and identification of the content knowledge and skills students who enter
institutions of higher education and the workforce need to have in order to
succeed in the healthcare field;</text>
</subparagraph><subparagraph id="H69EEF2D8DE0A45B4B5D388A38A049352"><enum>(B)</enum><text>promote the
alignment of mathematics and science curricula and assessments in middle school
and high school and facilitate learning of the required knowledge and skills
identified in subparagraph (A);</text>
</subparagraph><subparagraph id="H0130703F6ACE462386C71E92F37F8A29"><enum>(C)</enum><text>include an
outreach component to educate middle school and high school students and their
parents about the full range of employment opportunities in the healthcare
field, specifically in the local community;</text>
</subparagraph><subparagraph id="HE83EF51469F04F8AA9BA24C654C88C42"><enum>(D)</enum><text>include specific
opportunities for youth to interact with healthcare professionals or industry
representatives in the classroom, school, or community locations and how these
experiences will be integrated with coursework;</text>
</subparagraph><subparagraph id="HCDACEFBF78A9406C8D2C0693B26C2967"><enum>(E)</enum><text>include
high-quality volunteer or internship experiences, integrated with
coursework;</text>
</subparagraph><subparagraph id="H1F82E1B649E04DFFB5D5E521035C7856"><enum>(F)</enum><text>provide
high-quality mentoring, counseling, and career counseling support services to
program participants;</text>
</subparagraph><subparagraph id="H41440585C8354015831CEA1294388132"><enum>(G)</enum><text>consider the
inclusion of a distance-learning component or similar education technology that
would expand opportunities for geographically isolated individuals;</text>
</subparagraph><subparagraph id="H485E941AA00E48F782E65302470D5E78"><enum>(H)</enum><text>encourage the
participation of individuals who are members of groups that are
underrepresented in postsecondary education programs in mathematics and
science;</text>
</subparagraph><subparagraph id="H076464C62067419883080D983B4797E1"><enum>(I)</enum><text>encourage
participants to seek work in communities experiencing acute health professional
shortages; and</text>
</subparagraph><subparagraph id="HC81345FFC2854F68907F482895F85D6A"><enum>(J)</enum><text>collect data, and
analyze the data using measurable objectives and benchmarks, to evaluate the
extent to which the program succeeded in—</text>
<clause id="H21E53F6978D948E1842EB25B1ECD9AF2"><enum>(i)</enum><text>increasing student
and parent awareness of occupational opportunities in the healthcare
field;</text>
</clause><clause id="H57F9FB2C1CEE4E3591189571C374F359"><enum>(ii)</enum><text>improving student
academic achievement in mathematics and science;</text>
</clause><clause id="H154477F81E7D407DB580747802F861F0"><enum>(iii)</enum><text>increasing the
number of students entering health care professions upon graduation; and</text>
</clause><clause id="H134FA70D67B74D6085901092C48A0277"><enum>(iv)</enum><text>increasing the
number of students pursuing secondary education or training opportunities with
the potential to lead to a career in the healthcare field.</text>
</clause></subparagraph></paragraph><paragraph id="H77905343F7F643FDAF5CAB498C0253FE"><enum>(3)</enum><header>Planning grant
set aside</header><text>Each eligible recipient that receives a grant under
this section shall set aside 10 percent of the grant funds for planning and
program development purposes.</text>
</paragraph></subsection><subsection id="H83D21E0C32F343BD9F8161BCD148D53C"><enum>(g)</enum><header>Matching
requirement</header><text>Each eligible recipient that receives a grant under
this section shall provide, from the private sector, an amount equal to 40
percent of the amount of the grant, in cash or in kind, to carry out the
activities supported by the grant.</text>
</subsection><subsection id="HE3224CDF5BA749B2948C858359433A65"><enum>(h)</enum><header>Reports</header>
<paragraph id="H7D6B880508E24A84BC4E1918D6A190C1"><enum>(1)</enum><header>Annual
evaluation</header><text>Each eligible recipient that receives a grant under
this section shall collect and report to the Secretary annually such
information as the Secretary may reasonably require, including—</text>
<subparagraph id="H81AB97BF71A740F88A5DFEEAC5DC5AB0"><enum>(A)</enum><text>the number of
schools involved and student participants in the program;</text>
</subparagraph><subparagraph id="H7C51D2B02D2D4B11A14C8192865C2B10"><enum>(B)</enum><text>the race, gender,
socio-economic status, and disability status of program participants;</text>
</subparagraph><subparagraph id="HC0C341050248405B8EAEEBEFA6382C2C"><enum>(C)</enum><text>the number of
program participants who successfully graduated from high school;</text>
</subparagraph><subparagraph id="H15EE193739844196AED7AF89C5E369B5"><enum>(D)</enum><text>the number of
program participants who reported enrollment in some form of postsecondary
education with the potential to lead to a career in the healthcare
field;</text>
</subparagraph><subparagraph id="H7BFC288DB70A46F99EEDCBF671AB063B"><enum>(E)</enum><text>the number of
program participants who entered a paid position, either part-time or
full-time, in the healthcare field following participation in the program;
and</text>
</subparagraph><subparagraph id="H44788FBDB37744639DFDC9716C913C19"><enum>(F)</enum><text>the data and
analysis required under subsection (f)(2)(J).</text>
</subparagraph></paragraph><paragraph id="H390633362F204999A2F420BB217DB6ED"><enum>(2)</enum><header>Report</header><text>Not
later than 3 years after the date of enactment of this section, the Secretary
shall submit to Congress an interim report on the results of the evaluations
conducted under paragraph (1).</text>
</paragraph></subsection><subsection id="HFE43856E51AE4DFDA91153639D4D03BC"><enum>(i)</enum><header>Authorization
and appropriation</header>
<paragraph id="H82FBFCAE74FD4EFFA69B56359C4458F5"><enum>(1)</enum><header>In
general</header><text>There are authorized to be appropriated $100,000,000 for
each of fiscal years 2009 through 2013 to carry out this section.</text>
</paragraph><paragraph commented="no" display-inline="no-display-inline" id="HB6884A7F05EF4BB1B774EB709B56CE6C"><enum>(2)</enum><header>Administrative
costs</header><text>For the costs of administering this section, including the
costs of evaluating the results of grants and submitting reports to the
Congress, there are authorized to be appropriated such sums as may be necessary
for each of fiscal years 2009 through 2013.</text>
</paragraph></subsection></section>