I 111th CONGRESS 2d Session H. R. 5889 IN THE HOUSE OF REPRESENTATIVES July 27, 2010 Mr. Young of Alaska introduced the following bill; which was referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned A BILL To amend the Public Health Service Act and title XVIII of the Social Security Act to increase the number of primary care physicians and medical residents serving health professional shortage areas, and for other purposes.

1.

Findings

Congress finds the following: (1)The average life expectancy in the United States has increased to 80 years of age, causing an ever-increasing demand for medical care. (2)Medical school enrollment numbers have been virtually stagnant for the last 25 years. (3)During the last 20 years, median tuition and fees at medical schools have increased by 229 percent (122 percent adjusted for inflation) in private schools and by 479 percent (256 percent adjusted for inflation) in public schools. (4)The Association of American Medical Colleges, in its Statement on the Physician Workforce, dated June, 2006, called for an increase of 1,500 National Health Service Corps program awards per year to help meet the need for physicians caring for underserved populations and to help address rising medical student indebtedness. (5)The National Health Service Corps program has a proven record of supplying physicians to underserved areas, and has played an important role in expanding access for underserved populations in rural and inner city communities. (6)Continued expansion of the National Health Service Corps program is strongly recommended. (7)The growing debt incurred by graduating medical students is likely to increase the interest and willingness of graduates of United States medical schools to apply for National Health Service Corps program funding and awards. (8)One-third (250,000) of active physicians are over the age of 55 and are likely to retire in the next ten years, while the population will have increased by 24 percent. These demographic changes will cause the population-to-physician ratio to peak by the year 2020. (9)In 2005, the Council on Graduate Medical Education stated in a report to Congress that there will be a shortage of not fewer than 90,000 full-time physicians by 2020. (10)A continuing decline in the number of primary care physicians will lead to increased shortages of health care access in rural America. (11)There is a declining ability to recruit qualified medical students from rural and underserved areas, coupled with greater difficulty on the part of community health centers and other clinics to attract adequate personnel. (12)Individuals in many geographic areas, especially rural areas, lack adequate access to high quality preventive, primary and specialty health care, contributing to significant health disparities that impair America’s public health and economic productivity. (13)A collaborative process is needed between hospitals and non-hospital settings to maximize the potential of non-hospital health care training.

2.

Scholarships for medical students under National Health Service Corps Scholarship Program

Section 338H of the Public Health Service Act (42 U.S.C. 254q) is amended by adding at the end the following: (d)

Scholarships for medical students

For contracts for scholarships under this subpart to individuals who are accepted for enrollment, or enrolled, in a course of study or program described in section 338A(b)(1)(B) that leads to a degree in medicine or osteopathic medicine, the Secretary shall, of the amounts appropriated under subsection (a) for a fiscal year, obligate the greater of 10 percent or such amount as necessary to fund ongoing activities related to such contracts. .

3.

Clarification of eligibility for Medicare graduate medical education funding of a nonrural hospital that has a training program with an integrated rural track

(a)

In general

Section 1886(h)(4)(H) of the Social Security Act (42 U.S.C. 1395ww(h)(4)(H)), as amended by section 5506(a) of the Patient Protection and Affordable Care Act (Public Law 111–148), is amended— (1)in clause (iv), by inserting (as defined in clause (vii)) after an integrated rural track; and (2)by adding at the end the following new clause: (vii)

Definition of accredited training program with an integrated rural track

For purposes of clause (iv), the term accredited training program with an integrated rural track means an accredited medical residency training program located in an urban area which offers a curriculum for all residents in the program that includes the following characteristics: (I)A minimum of 3 block months of rural rotations. During such 3 block months, the resident is in a rural area for 4 weeks or a month. (II)A stated mission for training rural physicians. (III)A minimum of 3 months of obstetrical training, or an equivalent longitudinal experience. (IV)A minimum of 4 months of pediatric training that includes neonatal, ambulatory, inpatient, and emergency experiences through rotations, or an equivalent longitudinal experience. (V)A minimum of 2 months of emergency medicine rotations, or an equivalent longitudinal experience. . (b)

Effective date

The amendments made by subsection (a) apply with respect to— (1)payments to hospitals under section 1886(h) of the Social Security Act (42 U.S.C. 1395ww(h)) for cost reporting periods beginning on or after January 1, 2011; and (2)payments to hospitals under section 1886(d)(5)(B)(v) of such Act (42 U.S.C. 1395ww(d)(5)(B)(v)) for discharges occurring on or after January 1, 2011.