II 111th CONGRESS 1st Session S. 1720 IN THE SENATE OF THE UNITED STATES September 25, 2009 Mr. Reed (for himself and Mr. Leahy) introduced the following bill; which was read twice and referred to the Committee on Health, Education, Labor, and Pensions A BILL To amend title VII of the Public Health Service Act to provide improved training and primary care.
1.
Short title
This Act may be cited as the Health Professions and Primary Care Reinvestment Act.
2.
Education and training for delivery system reform
(a)
Medical home training
Section 747(a) of the Public Health Service Act (42 U.S.C. 293k(a)) is amended— (1)in paragraph (5), by striking and at the end; (2)in paragraph (6), by striking the period and inserting ; and; and (3)by inserting after paragraph (6) the following: (7)to plan, develop, and operate a demonstration program that provides training in new competencies, as recommended by the Advisory Committee on Training in Primary Care Medicine and Dentistry, which may include— (A)providing training to primary care providers relevant to providing care through patient-centered medical homes (as defined by the Secretary for purposes of this paragraph, taking into account the criteria of the National Committee for Quality Assurance and other certifying entities); (B)developing tools and curricula relevant to patient-centered medical homes; and (C)providing continuing education relevant to patient-centered medical homes. . (b)
Priorities of delivery system reform
Section 747 of the Public Health Service Act (42 U.S.C. 293k) is amended by striking subsection (c) and inserting the following: (c)
Priorities in making awards
In awarding grants or contracts under this section, the Secretary shall give priority to qualified applicants that— (1)have a record of training the greatest percentage of providers, or that have demonstrated significant improvements in the percentage of providers trained, who enter and remain in primary care practice; (2)have a record of training individuals who are from underrepresented minority groups or from a rural or disadvantaged background; (3)provide training in the care of vulnerable populations such as children, older adults, homeless individuals, victims of abuse or trauma, individuals with mental health or substance-related disorders, individuals with HIV/AIDS, and individuals with disabilities; (4)establish formal relationships and submit joint applications with federally qualified health centers, rural health clinics, area health education centers, or clinics located in underserved areas or that serve underserved populations; (5)provide training in interdisciplinary, integrated care through collaboration among health professionals, including physician assistants, nurse practitioners, pharmacists, dentists, geriatricians, and mental and behavioral health professionals; (6)provide training in enhanced communication with patients, evidence-based practice, chronic disease management, preventive care, health information technology, or other competencies as recommended by the Advisory Committee on Training in Primary Care Medicine and Dentistry; or (7)provide training in cultural competency and health literacy. . (c)
Other amendments
Section 747 of the Public Health Service Act (42 U.S.C. 293k) is amended— (1)in subsection (d)— (A)by striking subsection (a) may not exceed and inserting this section shall be; and (B)by striking the second sentence; and (2)by striking subsection (e) and inserting the following: (e)
Authorization of appropriations
For purposes of carrying out this section, there are authorized to be appropriated $125,000,000 for each of fiscal years 2010 through 2014. Fifteen percent of the amount appropriated in each such fiscal year shall be allocated to the physician assistant training programs described in subsection (a)(5), which prepare students for practice in primary care. .
3.
Health workforce information and analysis
(a)
In general
Section 761 of the Public Health Service Act (42 U.S.C. 294m) is amended— (1)by redesignating subsection (c) as subsection (e); (2)by striking subsection (b) and inserting the following: (b)
National Center for Health Workforce Analysis
(1)
Establishment
The Secretary shall establish the National Center for Health Workforce Analysis (referred to in this section as the “National Center”) within the Department of Health and Human Services. (2)
Purposes
The purposes of the National Center are to— (A)carry out the activities under section 792(a); and (B)collect, analyze, and report data related to health workforce issues in coordination with the State and Regional Centers for Health Workforce Analysis described in subsection (c) (referred to in this section as the “State and Regional Centers”). (3)
Functions
The National Center shall— (A)annually evaluate the effectiveness of programs under this title, based on data reported by recipients of contracts or grants under this title, data collected from the State and Regional Centers described in subsection (c), and analyses conducted under paragraph (4); (B)develop and publish benchmarks for performance for programs under this title; (C)regularly produce and report to the relevant committees of Congress estimates of the supply, demand, and distribution of health professionals, such as physicians, dentists, nurses, physician assistants, pharmacists, mental and behavioral health professionals, public health workers, and long-term care workers, as appropriate; (D)establish, maintain, and make publicly available through the Internet a national health workforce database to collect data from— (i)longitudinal tracking systems (as defined in section 761(d)(2)) on performance measures (as developed under sections 748(d)(3), 756(d)(3), and 762(a)(3)); and (ii)the State and Regional Centers described in subsection (c); (E)establish and maintain a registry of each grant awarded under this title, including data on the project director, the institution, the type and year of the award, and the residency, fellowship, or internship program, as appropriate; and (F)biennially submit to the relevant committees of Congress a report on the activities of the National Center during the previous 2-year period. (4)
Collaboration and data sharing
(A)
In general
The National Center shall collaborate with Federal agencies, health professions education organizations, health professions organizations, and professional medical societies for the purpose of linking data regarding grants awarded under this title with 1 or more of the following: (i)Data maintained by the Centers for Medicare & Medicaid Services. (ii)Data on participation in the National Health Service Corps. (iii)Data sets maintained by health professions education organizations, health professions organizations, or professional medical societies. (iv)Other data sets, as the Secretary determines appropriate. (B)
Contracts for health workforce analysis
For the purpose of carrying out the activities described in subparagraph (A), the National Center may enter into contracts with health professions education organizations, health professions organizations, or professional medical societies. (c)
State and Regional Centers for Health Workforce Analysis
(1)
In general
The Secretary shall award grants to, or enter into contracts with, eligible entities for purposes of— (A)collecting, analyzing, and reporting to the National Center data regarding programs under this title and data related to health workforce issues; (B)conducting, broadly disseminating, and making publicly available through the Internet research and reports on State, regional, and national health workforce issues, including research on the supply, demand, and distribution of health professionals; (C)evaluating the effectiveness of programs under this title and other policies related to health workforce issues; and (D)providing technical assistance to local and regional entities on the collection, analysis, and reporting of data related to health workforce issues. (2)
Eligible entities
To be eligible for a grant or contract under this subsection, an entity shall— (A)be a State, a State workforce commission, a public health or health professions school, an academic health center, or an appropriate public or private nonprofit entity or a partnership of such entities; and (B)submit to the Secretary an application at such time, in such manner, and containing such information as the Secretary may require. (d)
Increase in Grants for Longitudinal Tracking Systems
(1)
In general
The Secretary shall increase the amount of a grant or contract awarded to an eligible entity under this title for the establishment and maintenance of a longitudinal tracking system. . (2)
Definition
(A)
In general
For purposes of paragraph (1), the term longitudinal tracking system means a system that tracks students, residents, fellows, interns, or faculty who have received education, training, or financial assistance from programs under this title over a period of not less than 5 years, as specified by the Secretary. (B)
Capability
A longitudinal tracking system shall be capable of— (i)tracking participation in the National Health Service Corps, practice in federally qualified health centers, practice in health professional shortage areas and medically underserved areas, and practice in primary care; and (ii)collecting and reporting data on performance measures developed under sections 748(d)(3), 756(d)(3), and 762(a)(3). (C)
Guidelines
A longitudinal tracking system shall comply with guidelines issued under sections 748(d)(4), 756(d)(4), and 762(a)(4). (3)
Eligible entities
To be eligible to obtain an increase under this section, an entity shall be a recipient of a grant or contract under this title and have not previously received an increase under this section. ; and (3)in subsection (e), as so redesignated— (A)by striking paragraph (1) and inserting the following: (1)
In general
(A)
National Center for Health Workforce Analysis
To carry out subsection (b), there are authorized to be appropriated $1,000,000 for each of fiscal years 2010 through 2014, and such sums as may be necessary for each subsequent fiscal year. (B)
State and Regional Centers
To carry out subsection (c), there are authorized to be appropriated $4,500,000 for each of fiscal years 2010 through 2014, and such sums as may be necessary for each subsequent fiscal year. (C)
Grants for longitudinal tracking systems
To carry out subsection (d), there are authorized to be appropriated such sums as may be necessary for fiscal years 2010 through 2014. (D)
Carryover funds
An entity that receives an award under this section may carry over funds from 1 fiscal year to another without obtaining approval from the Secretary. In no case may any funds be carried over pursuant to the preceding sentence for more than 3 years. ; and (B)in paragraph (2), by striking subsection (a) and inserting paragraph (1). (b)
Transfer of functions
Not later than 180 days after the date of enactment of this Act, all of the functions, authorities, and resources of the National Center for Health Workforce Analysis of the Health Resources and Services Administration, as in effect on the date before the date of enactment of this Act, shall be transferred to the National Center for Health Workforce Analysis established under section 761 of the Public Health Service Act, as amended by subsection (a). (c)
Preference for use of Longitudinal Tracking Systems
Section 791(a)(1) of the Public Health Service Act (42 U.S.C. 295j(a)(1)) is amended— (1)in subparagraph (A), by striking or at the end; (2)in subparagraph (B), by striking the period and inserting ; or; and (3)by adding at the end the following: (C)utilizes a longitudinal tracking system (as defined in section 761(d)(2)) and reports data from such system to the national workforce database (as established under section 761(b)(3)(D)). . (d)
Performance Measures; Guidelines for Longitudinal Tracking Systems
(1)
Advisory Committee on Training in Primary Care Medicine and Dentistry
Section 748(d) of the Public Health Service Act (42 U.S.C. 293l(d)) is amended— (A)in paragraph (1), by striking and at the end; (B)in paragraph (2), by striking the period and inserting a semicolon; and (C)by adding at the end the following: (3)not later than 3 years after the date of enactment of the Health Professions and Primary Care Reinvestment Act, develop, publish, and implement performance measures, which shall be quantitative to the extent possible, for programs under this part; (4)develop and publish guidelines for longitudinal tracking systems (as defined in section 761(d)(2)) for programs under this part; and (5)recommend appropriation levels for programs under this part. . (2)
Advisory Committee on Interdisciplinary, Community-Based Linkages
Section 756(d) of the Public Health Service Act (42 U.S.C. 294f(d)) is amended— (A)in paragraph (1), by striking and at the end; (B)in paragraph (2), by striking the period and inserting a semicolon; and (C)by adding at the end the following: (3)not later than 3 years after the date of enactment of the Health Professions and Primary Care Reinvestment Act, develop, publish, and implement performance measures, which shall be quantitative to the extent possible, for programs under this part; (4)develop and publish guidelines for longitudinal tracking systems (as defined in section 761(d)(2)) for programs under this part; and (5)recommend appropriation levels for programs under this part. . (3)
Advisory Council on Graduate Medical Education
Section 762(a) of the Public Health Service Act (42 U.S.C. 294o(a)) is amended— (A)in paragraph (1), by striking and at the end; (B)in paragraph (2), by striking the period and inserting a semicolon; and (C)by adding at the end the following: (3)not later than 3 years after the date of enactment of the Health Professions and Primary Care Reinvestment Act, develop, publish, and implement performance measures, which shall be quantitative to the extent possible, for programs under this title, except for programs under part C or D; (4)develop and publish guidelines for longitudinal tracking systems (as defined in section 761(d)(2)) for programs under this title, except for programs under part C or D; and (5)recommend appropriation levels for programs under this title, except for programs under part C or D. .