[Congressional Bills 111th Congress]
[From the U.S. Government Publishing Office]
[S. 790 Introduced in Senate (IS)]

111th CONGRESS
  1st Session
                                 S. 790

To improve access to health care services in rural, frontier, and urban 
  underserved areas in the United States by addressing the supply of 
 health professionals and the distribution of health professionals to 
                             areas of need.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                             April 2, 2009

 Mr. Bingaman (for himself, Mr. Casey, Mr. Kohl, and Mr. Udall of New 
    Mexico) introduced the following bill; which was read twice and 
                  referred to the Committee on Finance

_______________________________________________________________________

                                 A BILL


 
To improve access to health care services in rural, frontier, and urban 
  underserved areas in the United States by addressing the supply of 
 health professionals and the distribution of health professionals to 
                             areas of need.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE; TABLE OF CONTENTS.

    (a) Short Title.--This Act may be cited as the ``Health Access and 
Health Professions Supply Act of 2009'' or ``HAHPSA 2009''.
    (b) Table of Contents.--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

Sec. 101. Permanent National Health Workforce Commission.
Sec. 102. State health workforce centers program.
Sec. 103. Medicare medical home service and training pilot program.
Sec. 104. Improvements to payments for graduate medical education under 
                            medicare.
Sec. 105. Distribution of resident trainees in an emergency.
Sec. 106. Authority to include costs of training of psychologists in 
                            payments to hospitals for approved 
                            educational activities under Medicare.
         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.
 TITLE III--HEALTH PROFESSIONAL TRAINING PIPELINE PARTNERSHIPS PROGRAM

Sec. 301. Grants to prepare students for careers in health care.

SEC. 2. FINDINGS.

    (a) Findings Related to Health Care Access in Rural, Frontier, and 
Urban Underserved Areas of the United States.--Congress 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 Health.--Congress 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 
Distribution.--Congress 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 
Distribution.--Congress 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 Shortages.--
Congress 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) 4 out of 5 current public health workers have not had 
        formal training for their specific job functions.
    (f) Findings Related to Physician Assistant Shortages.--Congress 
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 Shortages.--
Congress 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.

             TITLE I--AMENDMENTS TO THE SOCIAL SECURITY ACT

SEC. 101. PERMANENT NATIONAL HEALTH WORKFORCE COMMISSION.

    (a) Establishment.--There is hereby established the Permanent 
National Health Workforce Commission (in this section referred to as 
the ``Commission'').
    (b) Duties.--
            (1) Review of federal policies and annual reports.--
                    (A) Review.--The Commission shall review Federal 
                policies with respect to the training, financing, and 
                distribution of the health professional workforce, 
                particularly with respect to such workforce in rural, 
                frontier, and urban underserved areas, including the 
                specific topics described in paragraph (2). Such review 
                shall include a comprehensive analysis and reporting 
                of--
                            (i) the most recent COHPPERDDUST Annual 
                        Report;
                            (ii) the number of medical students and 
                        residents, physician assistant students, 
                        pharmacy students and residents, behavioral and 
                        mental health students and residents, dental 
                        students and residents, nursing students and 
                        advance practice nursing trainees, and other 
                        health professionals in need of training, the 
                        rates of payment for such training; and the 
                        methodologies for funding such training;
                            (iii) how to align 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)) with other Federal and 
                        State subsidies and payments for health 
                        professions education with desired outcomes for 
                        the health professional workforce;
                            (iv) whether Federal medical facilities 
                        should be permitted to train health 
                        professionals with support paid directly by the 
                        entity sponsoring the health professional;
                            (v) whether the establishment of 
                        transparent, accountable Federal payment 
                        policies for training health professionals 
                        would ensure that the types of health 
                        professionals trained and the distribution of 
                        such health professionals would meet the health 
                        care needs of the population of the United 
                        States;
                            (vi) the feasibility of establishing a 
                        National Health Professions Education Trust 
                        Fund to ensure an open and fair system of 
                        Federal, State, and private support for 
                        providing education for health professionals; 
                        and
                            (vii) any other issues related to such 
                        Federal policies as the Commission determines 
                        appropriate.
                    (B) COHPPERDDUST annual reports.--Not later than 
                each of January 1 of each year (beginning with 2012) 
                the Commission shall submit to the Secretary and to 
                Congress a report containing--
                            (i) the results of the review conducted 
                        under subparagraph (A); and
                            (ii) recommendations--
                                    (I) with respect to the Health 
                                Professions Pipeline, Education, 
                                Research, Diversity & Distribution to 
                                Underserved Areas Utilizing Service/
                                Training Models; and
                                    (II) for such legislation or 
                                administrative action, including 
                                regulations, as the Commission 
                                determines appropriate.
            (2) Specific topics described.--
                    (A) Payments for health professions education.--
                Specifically, the Commission shall review, with respect 
                to the training, financing, and distribution of the 
                health professional workforce, the following:
                            (i) The regular update, revision, and 
                        standardization of hospital-specific and 
                        sponsoring institution-specific base-period per 
                        resident amounts and cost reporting periods for 
                        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)).
                            (ii) The feasibility of the Secretary, 
                        subject to review by the Commission, granting a 
                        waiver under the Medicare program, such as the 
                        waiver granted to the Utah Medical Education 
                        Commission, which would allow States 
                        flexibility to utilize funding under titles 
                        XVIII, XIX, and XXI of the Social Security Act 
                        for direct graduate medical education and 
                        indirect graduate medical education to support 
                        coordinated and comprehensive health workforce 
                        training innovations.
                            (iii) Replacement of the current 
                        methodology for making payments for such direct 
                        graduate medical education costs and such 
                        indirect costs of medical education with a 
                        workforce adjustment payment, based on a 
                        Sustainable Growth Rate formula or a 
                        prospective payment system, under which--
                                    (I) payments would be made directly 
                                to the sponsoring institution where 
                                such education is provided; and
                                    (II) payments would be separated to 
                                reflect the costs to the professional 
                                and facility components of such 
                                education.
                            (iv) The establishment of standards for the 
                        financing of education for health professionals 
                        who are not physicians.
                            (v) The expansion of the definition, for 
                        purposes of making payments for health 
                        professions education (including such direct 
                        graduate medical education costs and such 
                        indirect costs of medical education), of the 
                        term ``sponsoring institution'', which 
                        traditionally has been a teaching hospital or 
                        medical school, to include 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 the training and education required 
                        to address healthcare access, quality, and 
                        costs and to meet workforce needs.
                            (vi) The provision of health professions 
                        education by nonteaching hospital-based 
                        entities (including rural health clinics (as 
                        defined in subsection (aa)(2) of section 1861 
                        of the Social Security Act (42 U.S.C. 1395x)), 
                        community health centers (as defined in section 
                        330 of the Public Health Service Act (42 U.S.C. 
                        254b)), and Federally qualified health centers 
                        (as defined in subsection (aa)(4) of such 
                        section 1861) that are not sponsoring 
                        institutions (as defined under clause (v)) as 
                        affiliates of the sponsoring institution for 
                        purposes of providing more limited, but highly 
                        valuable clinical training.
                            (vii) The establishment of incentives to 
                        promote interdisciplinary, team-based, and care 
                        coordination-based education of health 
                        professionals, including incentives to 
                        encourage the development of health information 
                        technology (such as a repository of consumer 
                        health status information in computer 
                        processable form) which can be used for 
                        diagnosis, management, and treatment and 
                        includes price and cost information.
                            (viii) Adjustment to the Medicare caps on 
                        graduate medical education positions to 
                        increase the number of primary care residents, 
                        general dentistry residents, geriatric 
                        fellowship trainees, and other health 
                        professionals trained in Federal medical 
                        facilities.
                            (ix) The development of pay-for-performance 
                        methodologies for payments for health 
                        professions education (including such direct 
                        graduate medical education costs, payments for 
                        such indirect costs of medical education, and 
                        disproportionate share payments under section 
                        1886(d)(5)(F) of the Social Security Act (42 
                        U.S.C. 1395ww(d)(5)(F))) to--
                                    (I) increase payments to sponsoring 
                                institutions and the affiliates of such 
                                institutions that achieve desired 
                                outcomes; and
                                    (II) reduce payments to such 
                                institutions and such affiliates that 
                                do not perform.
                            (x) The correlation between Federal 
                        policies with respect to the training, 
                        financing, and distribution of the health 
                        professional workforce and specific evidence-
                        based, measurable, and comparative outcomes 
                        across sponsoring institutions and the 
                        affiliates of such institutions.
                            (xi) Disproportionate share payments under 
                        section 1886(d)(5)(F) of the Social Security 
                        Act (42 U.S.C. 1395ww(d)(5)(F)) made to service 
                        and training institutions that provide safety 
                        net access, community-based outreach programs, 
                        measurable and transparent community benefit, 
                        and planned financial assistance to low-income 
                        patients, Medicare beneficiaries, and 
                        underinsured (including uninsured) individuals 
                        in rural, frontier, and urban underserved 
                        areas.
                            (xii) The establishment of a workforce 
                        adjustment payment under the Medicare program 
                        under title XVIII of the Social Security Act, 
                        the Medicaid program under title XIX of such 
                        Act, the State Children's Health Insurance 
                        Program under title XXI of such Act, and other 
                        publicly funded health insurance programs to 
                        support training programs for health 
                        professionals in Federal medical facilities, 
                        under which such workforce adjustment payment 
                        would be made directly to the sponsoring 
                        institution. Such payment would, as the 
                        Secretary determines appropriate, in 
                        consultation with the Commission, replace or 
                        supplement the provisions under clause (iii).
                    (B) Data collection and review.--Specifically, the 
                Commission shall review, with respect to the adequacy, 
                supply, and distribution of undergraduate and graduate 
                education programs for health professionals, the 
                following:
                            (i) Available data on the adequacy, supply, 
                        and distribution of such education programs for 
                        physicians, physician assistants, nurses, 
                        dentists, psychologists, pharmacists, 
                        behavioral and mental health professionals (as 
                        defined in section 331(a)(3)(E)(i) of the 
                        Public Health Service Act (42 U.S.C. 
                        254d(a)(3)(E)(i)), public health professionals, 
                        and other health professionals, including data 
                        collected under the State Health Workforce 
                        Centers Program established under section 102.
                            (ii) Processes for improving the collection 
                        of data on health professionals, including the 
                        collection of more consistent, independent, and 
                        comprehensive data from entities (such as State 
                        licensure boards) to inform health professions 
                        workforce issues. In conducting such review, 
                        the Commission shall determine the costs of 
                        implementing such data collection.
            (3) Conduct of hearings.--
                    (A) In general.--The Commission shall conduct 
                hearings on health professions education to assess 
                performance, identify barriers, speed approval of 
                innovative programs, improve flexibility, and reduce 
                bureaucratic obstacles balancing hospital training 
                while emphasizing sustained affiliation agreements with 
                community-based, interdisciplinary, team, and care 
                management methodologies and education designed to 
                improve quality and efficiency of patient care across 
                the care delivery system.
                    (B) Testimony.--In conducting hearings under 
                subparagraph (A), the Commission shall solicit 
                testimony from the Accreditation Council for Graduate 
                Medical Education, Residency Review Committees, and 
                other appropriate organizations that accredit education 
                programs for health professionals.
                    (C) Information from federal agencies.--
                            (i) In general.--The Commission may secure 
                        directly from a Federal agency such information 
                        as the Commission considers necessary to carry 
                        out this section.
                            (ii) Provision of information.--The head of 
                        the agency shall provide the information to the 
                        Commission at the request of the Chairperson of 
                        the Commission.
            (4) Reducing health professional isolation and building 
        community health professional training infrastructure.--
                    (A) Identification of programs.--The Commission 
                shall identify programs to reduce health professional 
                isolation and build community health professional 
                training infrastructure in rural, frontier, and urban 
                underserved areas through continuing education 
                (including continuing education utilizing information 
                technology, such as telehealth and health information 
                technology), mentoring, and precepting activities.
                    (B) Analysis.--The Commission shall examine--
                            (i) whether the establishment of regional 
                        or statewide Health Advice Lines would reduce 
                        after-hours calls responsibilities for 
                        overworked health professionals in remote sites 
                        with few health professionals available to 
                        fulfill such responsibilities;
                            (ii) what support should be given to health 
                        professionals fulfilling such 
                        responsibilities--
                                    (I) in hospitals and emergency 
                                departments in areas designated under 
                                section 332 of the Public Health 
                                Service Act as health professional 
                                shortage areas;
                                    (II) under practice relief programs 
                                that allow health professionals 
                                practicing in such areas to have their 
                                practice and calls covered when they 
                                are ill, pursuing continuing education, 
                                or taking a vacation; and
                                    (III) with respect to field faculty 
                                development to become supervisors, 
                                mentors, and preceptors for health 
                                professional students and trainees;
                            (iii) support structures (such as Area 
                        Health Education Centers) for health 
                        professionals; and
                            (iv) whether the establishment of Rural 
                        Health Education Offices, based on the model of 
                        agricultural extension offices, would--
                                    (I) help build community health 
                                professional service and training 
                                capacity; and
                                    (II) spur local economic 
                                development.
            (5) Development of guiding principles and accountability 
        standards.--The Commission shall develop guiding principles and 
        accountability standards for Federal, State, and private sector 
        education of health professionals. Such guidelines shall be 
        crafted to assure that the Federal investment in the education 
        of health professionals is a public good, regardless of whether 
        a portion of such education is funded by other sources.
            (6) Identification of state and regional health professions 
        education commissions.--The Commission shall identify State and 
        regional Health Professions Education Centers. The Commission 
        shall enter into agreements with such Centers under which the 
        Centers shall provide data and reports to the Commission to 
        provide a balanced and adequate assessment of the entire 
        Nation's healthcare workforce.
    (c) Secretarial Responsibilities.--Not later than 18 months after 
the date of enactment of this Act, the Secretary shall, in consultation 
with the Commission, and through negotiated rulemaking, promulgate 
regulations to address the matters reviewed under clauses (i) through 
(vii) of subsection (b)(1)(A), as the Secretary determines appropriate 
to address access and health professional shortages and needs 
identified by the Commission with respect to titles XVIII, XIX, and XXI 
of the Social Security Act.
    (d) Membership.--
            (1) Number of appointment.--The Commission shall be 
        composed of 20 members appointed by the Comptroller General of 
        the United States.
            (2) Qualifications.--The membership of the Commission shall 
        include representatives of--
                    (A) dentists and dental hygienists who practice in 
                urban underserved and rural areas;
                    (B) primary care providers who practice in urban 
                underserved and rural areas;
                    (C) nurses and physician assistants who practice in 
                urban underserved and rural areas;
                    (D) psychologists and other behavioral and mental 
                health professionals (as defined in section 
                331(a)(3)(E)(i) of the Public Health Service Act (42 
                U.S.C. 254d(a)(3)(E)(i)) who practice in urban 
                underserved and rural areas;
                    (E) public health professionals;
                    (F) clinical pharmacists who practice in a Federal 
                market or are sole-community providers;
                    (G) national and specialty physician and nursing 
                organizations;
                    (H) schools of medicine, osteopathy, and nursing, 
                educational programs for public health professionals, 
                behavioral and mental health professionals (as so 
                defined), and physician assistants, public and private 
                teaching hospitals, and ambulatory health facilities, 
                including Federal medical facilities;
                    (I) health insurers;
                    (J) business;
                    (K) labor; and
                    (L) any other health professional organization or 
                practice site the Comptroller General determines 
                appropriate.
    (e) Staff.--
            (1) In general.--The Comptroller General of the United 
        States shall provide for the appointment of an executive 
        director, deputy director, and such other additional personnel 
        as are necessary to enable the Commission to perform the duties 
        of the Commission.
            (2) Compensation.--
                    (A) In general.--Except as provided in subparagraph 
                (B), the Comptroller General of the United States may 
                fix the compensation of the executive director, deputy 
                director, and other personnel without regard to the 
                provisions of chapter 51 and subchapter III of chapter 
                53 of title 5, United States Code, relating to 
                classification of positions and General Schedule pay 
                rates.
                    (B) Maximum rate of pay.--The rate of pay for the 
                executive director, deputy director, and other 
                personnel shall not exceed the rate payable for level V 
                of the Executive Schedule under section 5316 of title 
                5, United States Code.
            (3) Detail of federal government employees.--
                    (A) In general.--An employee of the Federal 
                Government may be detailed to the Commission without 
                reimbursement.
                    (B) Civil service status.--The detail of the 
                employee shall be without interruption or loss of civil 
                service status or privilege.
            (4) Procurement of temporary and intermittent services.--
        The Commission may procure temporary and intermittent services 
        in accordance with section 3109(b) of title 5, United States 
        Code, at rates for individuals that do not exceed the daily 
        equivalent of the annual rate of basic pay prescribed for level 
        V of the Executive Schedule under section 5316 of that title.
    (f) Powers.--
            (1) Hearings.--The Commission may hold such hearings, meet 
        and act at such times and places, take such testimony, and 
        receive such evidence as the Commission considers advisable to 
        carry out this section.
            (2) Information from federal agencies.--
                    (A) In general.--The Commission may secure directly 
                from a Federal agency such information as the 
                Commission considers necessary to carry out this 
                section.
                    (B) Provision of information.--On request of the 
                Chairperson of the Commission, the head of the agency 
                shall provide the information to the Commission.
            (3) Postal services.--The Commission may use the United 
        States mails in the same manner and under the same conditions 
        as other agencies of the Federal Government.
            (4) Gifts.--The Commission may accept, use, and dispose of 
        gifts or donations of services or property.
    (g) Status as Permanent Commission.--Section 14 of the Federal 
Advisory Committee Act (5 U.S.C. App.) shall not apply to the 
Commission.
    (h) Definitions.--In this section:
            (1) COHPPERDDUST annual report.--The term ``COHPPERDDUST 
        Annual Report'' means the annual report submitted by the 
        Commission under subsection (b)(1)(B).
            (2) Federal medical facility.--The term ``Federal medical 
        facility'' means a facility for the delivery of health 
        services, and includes--
                    (A) a Federally qualified health center (as defined 
                in section 1861(aa)(4) of the Social Security Act (42 
                U.S.C. 1395x(aa)(4)), a public health center, an 
                outpatient medical facility, or a community mental 
                health center;
                    (B) a hospital, State mental hospital, facility for 
                long-term care, or rehabilitation facility;
                    (C) a migrant health center or an Indian Health 
                Service facility;
                    (D) 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;
                    (E) 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));
                    (F) a nurse-managed health center; or
                    (G) any other Federal medical facility.
            (3) Secretary.--The term ``Secretary'' means the Secretary 
        of Health and Human Services.

SEC. 102. STATE HEALTH WORKFORCE CENTERS PROGRAM.

    (a) Establishment.--The Secretary shall establish a demonstration 
program (in this section referred to as the ``program'') 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).
    (b) Participating States.--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.
    (c) Use of Funds.--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:
            (1) 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.
            (2) 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.
    (d) Funding.--
            (1) Authorization of appropriations.--There are authorized 
        to be appropriated $13,750,000 to carry out this section.
            (2) Matching requirement.--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).
    (e) Definitions.--In this section:
            (1) Secretary.--The term ``Secretary'' means the Secretary 
        of Health and Human Services.
            (2) State.--The term ``State'' means--
                    (A) a State;
                    (B) the District of Columbia;
                    (C) the Commonwealth of Puerto Rico; and
                    (D) any other territory or possession of the United 
                States.

SEC. 103. MEDICARE MEDICAL HOME SERVICE AND TRAINING PILOT PROGRAM.

    (a) Expansion of Medicare Medical Home Demonstration Project.--
            (1) In general.--The Secretary of Health and Human Services 
        (in this section referred to as the ``Secretary'') shall expand 
        the Medicare medical home demonstration project under section 
        204 of Division B of the Tax Relief and Health Care Act of 2006 
        (Public Law 109-432; 120 Stat. 2987) by adding a Medicare 
        medical home service and training pilot program (in this 
        section referred to as the ``pilot program'') to redesign the 
        methodologies for payments to primary care providers for 
        coordinating the care of applicable Medicare beneficiaries. 
        Such pilot program shall be in addition to, and run 
        concurrently with, the Medicare medical home demonstration 
        program. Except for any modifications under this section, the 
        Secretary shall carry out the pilot program under similar terms 
        and conditions as the Medicare medical home demonstration 
        program.
            (2) Applicable medicare beneficiaries defined.--In this 
        section, the term ``applicable Medicare beneficiary'' means an 
        individual who--
                    (A) is entitled to, or enrolled for, benefits under 
                part A of title XVIII of the Social Security Act, or is 
                enrolled under part B of such title;
                    (B) has 1 or more chronic illnesses (such as 
                diabetes, hypertension, chronic obstructive pulmonary 
                disease, asthma, congestive heart failure, end stage 
                liver disease, and end stage renal disease); and
                    (C) is in the top 2 quartiles of cost under the 
                Medicare program under such title (as determined based 
                on Medicare claims data for the most recent 2 years for 
                which data is available).
    (b) Details.--
            (1) Duration; scope.--The pilot program shall operate 
        during the period beginning on January 1, 2011, and ending on 
        December 31, 2014, and shall include not more than 1,000 
        medical home primary care providers.
            (2) Implementation.--
                    (A) In general.--The Secretary may implement the 
                pilot program--
                            (i) under title XVIII of the Social 
                        Security Act; or
                            (ii) subject to subparagraph (B), under a 
                        combination of such title and other public or 
                        private programs or organizations.
                    (B) Special rule.--In the case where the Secretary 
                implements the pilot program under a combination of 
                title XVIII of the Social Security Act and other public 
                or private programs or organizations, the Secretary 
                shall establish procedures to ensure that any funding 
                made available under such title for the pilot program 
                is only used to furnish items and services to Medicare 
                beneficiaries.
            (3) Participation of primary care providers.--
                    (A) In general.--In no case shall participation in 
                the pilot program be limited to primary care providers 
                in those States participating in the Medicare medical 
                home demonstration project under section 204 of 
                Division B of the Tax Relief and Health Care Act of 
                2006 (Public Law 109-432; 120 Stat. 2987). Any primary 
                care provider in the United States that meets the 
                requirements and definitions under this section and, if 
                applicable, such section 204, shall be eligible to 
                participate in the pilot program. In selecting primary 
                care providers to participate in the pilot program, the 
                Secretary shall give preference to sites where clinical 
                services and health professional education are provided 
                concurrently, taking into consideration priorities of 
                the Permanent National Health Workforce Commission 
                established under section 101 of the Health Access and 
                Health Professions Supply Act of 2009.
                    (B) Definition of primary care providers.--In this 
                section, the term ``primary care provider'' means--
                            (i) a personal physician (as defined in 
                        subsection (c)(1) of section 204 of Division B 
                        of the Tax Relief and Health Care Act of 2006 
                        (Public Law 109-432; 120 Stat. 2987), except 
                        that, in applying such definition under this 
                        section, the requirements described in 
                        subsection (c)(2)(B) of such section 204 shall 
                        specify that the staff and resources of the 
                        physician may include a team of health 
                        professionals (such as nurse practitioners, 
                        clinical nurse specialists, certified nurse 
                        midwives, psychologists and other behavioral 
                        and mental health professionals (as defined in 
                        section 331(a)(3)(E)(i) of the Public Health 
                        Service Act (42 U.S.C. 254d(a)(3)(E)(i)), 
                        physician assistants, and other primary care 
                        providers that meet requirements established by 
                        the Secretary)); and
                            (ii) any other primary care provider (such 
                        as a nurse practitioner or a physician 
                        assistant) that is subject to State licensure 
                        laws and the requirements of the Secretary.
                    (C) Limitation on number of primary care providers 
                participating in the pilot program who are not personal 
                physicians.--The Secretary shall ensure that the total 
                number of independently practicing primary care 
                providers who are not personal physicians participating 
                in the pilot program reflects the percentage of such 
                primary care providers in the United States (as 
                determined by the Secretary), not to exceed 10 percent 
                of the total number of primary care providers 
                participating in the pilot program.
            (4) Services performed.--A primary care provider shall 
        perform or provide for the performance of at least the services 
        described in subsection (c)(3) of such section 204 under the 
        pilot program.
    (c) Care Coordination Fee Payment Methodology.--Under the pilot 
program, the Secretary shall provide for payment under section 1848 of 
the Social Security Act (42 U.S.C. 1395w-4) of a per member per month 
care coordination fee to primary care providers for the care of 
eligible Medicare beneficiaries participating in the pilot program. The 
Secretary shall appoint a committee to make recommendations about the 
design and implementation of a methodology for payment of the per 
member per month care coordination fee.
    (d) Provision of Data and Technical Assistance.--The Secretary 
shall provide--
            (1) data to primary care providers participating in the 
        pilot program; and
            (2) technical assistance to such primary care providers 
        that do not meet the criteria for the highest tier of the pilot 
        program (as defined by the Secretary).
    (e) Reports by the Secretary.--
            (1) Interim report.--Not later than January 1, 2013, the 
        Secretary shall submit to Congress an interim report on the 
        pilot program.
            (2) Final report.--Not later than January 1, 2014, the 
        Secretary shall submit to Congress a final report on the pilot 
        program. Such report shall include outcome measures reported by 
        the Secretary under the pilot program, including at least the 
        following:
                    (A) The total costs to the Medicare program per 
                eligible Medicare beneficiary participating in the 
                pilot program.
                    (B) The performance of primary care providers 
                participating in the pilot program with regard to--
                            (i) quality measures developed by the 
                        Secretary; and
                            (ii) patient safety indicators developed by 
                        the Secretary.
                    (C) The experience of eligible Medicare 
                beneficiaries and primary care providers participating 
                in the pilot program.
                    (D) An assessment of savings to the Medicare 
                program per eligible Medicare beneficiary participating 
                in the pilot program that are a result of such 
                participation, as compared to traditional Medicare fee-
                for-service payment methodologies.
    (f) GAO Assessment and Report.--
            (1) Assessment.--The Comptroller General of the United 
        States shall, at the completion of the pilot program, provide 
        for an overall assessment of the efficacy of the pilot program.
            (2) Report.--Not later than January 1, 2014, the 
        Comptroller General shall submit to Congress a report 
        containing the results of the assessment under paragraph (1).

SEC. 104. IMPROVEMENTS TO PAYMENTS FOR GRADUATE MEDICAL EDUCATION UNDER 
              MEDICARE.

    (a) Increasing the Medicare Caps on Graduate Medical Education 
Positions.--
            (1) Direct graduate medical education.--Section 
        1886(h)(4)(F) of the Social Security Act (42 U.S.C. 
        1395ww(h)(4)(F)) is amended--
                    (A) in clause (i), by inserting ``clause (iii) 
                and'' after ``subject to''; and
                    (B) by adding at the end the following new clause:
                            ``(iii) Increase in caps on graduate 
                        medical education positions for states with a 
                        shortage of residents.--
                                    ``(I) In general.--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.
                                    ``(II) Qualifying hospital.--In 
                                this clause, the term `qualifying 
                                hospital' 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 Health Access and Health 
                                Professions Supply Act of 2009, 
                                determines are in high-need (including 
                                family medicine, general surgery, 
                                geriatrics, general internal medicine, 
                                general surgery, and obstetrics and 
                                gynecology).
                                    ``(III) Increase in payments.--
                                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.''.
            (2) Indirect medical education.--Section 1886(d)(5)(B) of 
        the Social Security Act (42 U.S.C. 1395ww(d)(5)(B)) is amended 
        by adding at the end the following new clause:
            ``(x) 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.''.
    (b) Application of Medicare GME Payments to Additional Training 
Site Venues.--
            (1) In general.--The Secretary of Health and Human Services 
        (in this subsection referred to as the ``Secretary'') 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).
            (2) Use of model of care delivery.--In promulgating 
        regulations under paragraph (1), the Secretary shall consider 
        the model of care delivery of the Institute of Medicine of the 
        National Academies.
            (3) Consultation.--In promulgating such regulations, the 
        Secretary shall consult with the Permanent National Health 
        Workforce Commission established under section 101(a).
    (c) Determination of Hospital-Specific Approved FTE Resident 
Amounts.--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:
                    ``(G) Flexibility in determination.--
                            ``(i) In general.--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.
                            ``(ii) Applicable resident.--In this 
                        subparagraph, the term `applicable resident' 
                        means a resident--
                                    ``(I) in a specialty which the 
                                Secretary, in consultation with the 
                                Permanent National Health Workforce 
                                Commission established under section 
                                101(a) of the Health Access and Health 
                                Professions Supply Act of 2009, 
                                determines is in high-need;
                                    ``(II) in a health professional 
                                shortage area (as defined in section 
                                332 of the Public Health Service Act);
                                    ``(III) 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
                                    ``(IV) in a Federal medical 
                                facility.
                            ``(iii) Federal medical facility.--In this 
                        subparagraph, the term `Federal medical 
                        facility' means a facility for the delivery of 
                        health services, and includes--
                                    ``(I) 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;
                                    ``(II) a hospital, State mental 
                                hospital, facility for long-term care, 
                                or rehabilitation facility;
                                    ``(III) a migrant health center or 
                                an Indian Health Service facility;
                                    ``(IV) 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;
                                    ``(V) 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
                                    ``(VI) any other Federal medical 
                                facility.''.

SEC. 105. DISTRIBUTION OF RESIDENT TRAINEES IN AN EMERGENCY.

    (a) Exclusion From 3-Year Rolling Average.--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.
    (b) Assessment and Revision of GME Policies.--
            (1) Review.--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)).
            (2) Revision and report.--Not later than January 1, 2011, 
        the Secretary shall--
                    (A) 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
                    (B) 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.

SEC. 106. AUTHORITY TO INCLUDE COSTS OF TRAINING OF PSYCHOLOGISTS IN 
              PAYMENTS TO HOSPITALS FOR APPROVED EDUCATIONAL ACTIVITIES 
              UNDER MEDICARE.

    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.

         TITLE II--AMENDMENTS TO THE PUBLIC HEALTH SERVICE ACT

SEC. 201. EXPANSION OF NATIONAL HEALTH SERVICE CORPS PROGRAMS.

    (a) In General.--Section 338H of the Public Health Service Act (42 
U.S.C. 254q) is amended--
            (1) in subsection (a), by striking paragraphs (1) through 
        (5) and inserting the following:
            ``(1) for fiscal year 2009, $165,000,000;
            ``(2) for fiscal year 2010, $198,000,000;
            ``(3) for fiscal year 2011, $231,000,000;
            ``(4) for fiscal year 2012, $264,000,000;
            ``(5) for fiscal year 2013, $297,000,000; and
            ``(6) for fiscal year 2014, $330,000,000.''; and
            (2) by adding at the end the following:
    ``(d) Expansion of Programs.--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)).''.
    (b) Expansion of Other Programs.--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.
    (c) No Tax Implications.--
            (1) In general.--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.
            (2) Definition.--In this subsection, the term ``Federal 
        medical facility'' means a facility for the delivery of health 
        services, and includes--
                    (A) 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;
                    (B) a hospital, State mental hospital, facility for 
                long-term care, or rehabilitation facility;
                    (C) a migrant health center or an Indian Health 
                Service facility;
                    (D) 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;
                    (E) 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));
                    (F) a nurse-managed health center; or
                    (G) any other Federal medical facility.
    (d) Reduced Loan Support for Part Time Practitioners.--Section 338C 
of the Public Health Service Act (42 U.S.C. 254m) is amended by adding 
at the end the following:
    ``(e) 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.''.
    (e) Loan Support for Participating Preceptors, Mentors, and 
Attendings To Supervise Students and Trainees On-Site.--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:
    ``(f) 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.''.

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.

    (a) Program Authorized.--
            (1) In general.--Subpart III of part D of title III of the 
        Public Health Service Act (42 U.S.C. 254l et seq.) is amended--
                    (A) in the heading by inserting ``, 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,'' after 
                ``Scholarship Program''; and
                    (B) by inserting after section 338A the following:

``SEC. 338A-1. 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.

    ``(a) Establishment.--
            ``(1) In general.--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 `U.S. 
        Public Health Sciences Track Scholarship Program) 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.
            ``(2) Relationship to national health service corps 
        scholarship program.--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.
    ``(b) Eligibility.--To be eligible to participate in the U.S. 
Public Health Sciences Track Scholarship and Grants Program, an 
individual shall--
            ``(1) be accepted for enrollment as a full-time student--
                    ``(A) in an accredited (as determined by the 
                Secretary) educational institution in a State; and
                    ``(B) 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;
            ``(2) 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;
            ``(3) submit an application to participate in the U.S. 
        Public Health Sciences Track Scholarship and Grants Program; 
        and
            ``(4) 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.''.
            (2) No tax implications.--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.
    (b) 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.--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:

``SEC. 749. 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.

    ``(a) Program Authorized.--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:
            ``(1) 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.
            ``(2) To develop curriculum.
            ``(3) To acquire equipment.
            ``(4) To recruit, train, and retain faculty.
            ``(5) 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.
    ``(b) Application.--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.
    ``(c) Definition of Medical School.--In this section, the term 
`medical school' means a school of medicine or a school of osteopathic 
medicine.''.

SEC. 203. FEDERAL MEDICAL FACILITY GRANT PROGRAM AND PROGRAM 
              ASSESSMENTS.

    (a) Federal Medical Facility Grant Program.--Title VII of the 
Public Health Service Act (42 U.S.C. 292 et seq.) is amended--
            (1) by redesignating part F as part G; and
            (2) by inserting after part E, the following:

``PART F--START-UP EXPENSES LOAN AND GRANT PROGRAMS FOR FEDERAL MEDICAL 
  FACILITIES AND HOSPITALS STARTING HIGH NEEDS RESIDENCY PROGRAMS IN 
                             SHORTAGE AREAS

``SEC. 781. FEDERAL MEDICAL FACILITY GRANT PROGRAM.

    ``(a) In General.--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 Health Access and Health 
Professions Supply Act of 2009.
    ``(b) Eligible Facilities; Application.--
            ``(1) Definition of eligible facility.--In this section, 
        the term `eligible facility'--
                    ``(A) means a facility which--
                            ``(i) is located in a health professional 
                        shortage area (as defined in section 332);
                            ``(ii) 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));
                            ``(iii) is a Federal medical facility;
                            ``(iv) 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
                            ``(v) 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 Health Access and Health 
                        Professions Supply Act of 2009, determines is 
                        in high-need; and
                    ``(B) 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).
            ``(2) Application.--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.
    ``(c) Use of Funds.--An eligible facility shall use amounts 
received under a grant under subsection (a) to promote--
            ``(1) the training of health professionals in 
        interdisciplinary, community-based settings that are affiliated 
        with hospitals and other health care facilities and teaching 
        institutions;
            ``(2) community development programs that assure a diverse 
        health professions workforce through emphasis on individuals 
        from rural and frontier areas and underrepresented minority 
        groups;
            ``(3) 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;
            ``(4) 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;
            ``(5) 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;
            ``(6) 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));
            ``(7) 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
            ``(8) the exposure of health professions residents to 
        systems of health care that represent the contemporary American 
        healthcare delivery program (such as `P4' Prepare the Personal 
        Physician for Practice and the `Health Commons' programs).
    ``(d) Subgrants.--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).
    ``(e) Set Aside.--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.
    ``(f) Definition of Federal Medical Facility.--In this section, the 
term `Federal medical facility' means a facility for the delivery of 
health services, and includes--
            ``(1) a federally qualified health center (as defined in 
        section 330A), a public health center, an outpatient medical 
        facility, or a community mental health center;
            ``(2) a hospital, State mental hospital, facility for long-
        term care, or rehabilitation facility;
            ``(3) a migrant health center or an Indian Health Service 
        facility;
            ``(4) a facility for the delivery of health services to 
        inmates in a penal or correctional institution (under section 
        323) or a State correctional institution;
            ``(5) 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
            ``(6) any other Federal medical facility.
    ``(g) Authorization of Appropriations.--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.''.
    (b) Assessments.--
            (1) Establishment.--The Secretary of Health and Human 
        Services (referred to in this section as the ``Secretary'') 
        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.).
            (2) Criteria.--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).
            (3) Annual assessments.--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.

SEC. 204. HEALTH PROFESSIONS TRAINING LOAN PROGRAM.

    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:

``SEC. 782. ESTABLISHMENT.

    ``(a) In General.--The Secretary shall establish a program under 
which the Secretary shall award interest-free loans to--
            ``(1) eligible hospitals to enable such hospitals to 
        establish training programs in high-need specialties; and
            ``(2) eligible non-hospital community-based entities to 
        enable such entities to establish health professions training 
        programs.
    ``(b) Eligibility.--
            ``(1) In general.--To be eligible to receive a loan under 
        subsection (a)--
                    ``(A) a hospital shall--
                            ``(i) be located in a health professional 
                        shortage area (as such term is defined in 
                        section 332);
                            ``(ii) comply with the requirements of 
                        paragraph (2); and
                            ``(iii) submit to the Secretary an 
                        application at such time, in such manner, and 
                        containing such information as the Secretary 
                        may require; or
                    ``(B) a non-hospital community-based entity shall--
                            ``(i) comply with the requirements of 
                        paragraph (2); and
                            ``(ii) submit to the Secretary an 
                        application at such time, in such manner, and 
                        containing such information as the Secretary 
                        may require.
            ``(2) Requirements.--To be eligible to receive a loan under 
        subsection (a), a hospital or non-hospital community-based 
        entity shall--
                    ``(A) 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 Health Access and Health Professions 
                Supply Act of 2009) or provide a health professions 
                training program, as the case may be;
                    ``(B) 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
                    ``(C) execute a signed formal contract under which 
                the hospital or entity agree to repay the loan.
    ``(c) Use of Loan Funds.--Amounts received under a loan under 
subsection (a) shall be used only for--
            ``(1) 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
            ``(2) facility construction or renovation, including 
        equipment purchase.
    ``(d) Priority.--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)).
    ``(e) Loan Provisions.--
            ``(1) Loan contract.--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.
            ``(2) Interest.--Loans under this section shall be repaid 
        without interest.
    ``(f) Limitation.--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.
    ``(g) Failure To Repay.--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.
    ``(h) Authorization of Appropriations.--There is authorized to be 
appropriated, such sums as may be necessary to carry out this 
section.''.

SEC. 205. UNITED STATES PUBLIC HEALTH SCIENCES TRACK.

    Title II of the Public Health Service Act (42 U.S.C. 202 et seq.) 
is amended by adding at the end the following:

          ``PART D--UNITED STATES PUBLIC HEALTH SCIENCES TRACK

``SEC. 271. ESTABLISHMENT.

    ``(a) United States Public Health Services Track.--
            ``(1) In general.--There is hereby authorized to be 
        established a United States Public Health Sciences Track 
        (referred to in this part as the `Track'), 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--
                    ``(A) 150 medical students annually;
                    ``(B) 100 dental students annually;
                    ``(C) 250 nursing students annually;
                    ``(D) 100 public health students annually;
                    ``(E) 100 behavioral and mental health professional 
                students annually;
                    ``(F) 100 physician assistant or nurse practitioner 
                students annually; and
                    ``(G) 50 pharmacy students annually.
            ``(2) Locations.--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.
    ``(b) Number of Graduates.--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.
    ``(c) Development.--The development of the Track may be by such 
phases as the Secretary may prescribe subject to the requirements of 
subsection (a).
    ``(d) Integrated Longitudinal Plan.--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.
    ``(e) Faculty Development.--The Surgeon General shall develop 
faculty development programs and curricula in decentralized venues of 
health care, to balance urban, tertiary, and inpatient venues.

``SEC. 272. ADMINISTRATION.

    ``(a) In General.--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.
    ``(b) Faculty.--
            ``(1) In general.--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.
            ``(2) Titles.--The Surgeon General may confer academic 
        titles, as appropriate, upon the members of the faculty.
            ``(3) Nonapplication of provisions.--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.
    ``(c) Agreements.--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.
    ``(d) Programs.--The Surgeon General may establish the following 
educational programs for Track students:
            ``(1) Postdoctoral, postgraduate, and technological 
        institutes.
            ``(2) A graduate school of nursing.
            ``(3) Other schools or programs that the Surgeon General 
        determines necessary in order to operate the Track in a cost-
        effective manner.
    ``(e) Continuing Medical Education.--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.
    ``(f) Authority of the Surgeon General.--
            ``(1) In general.--The Surgeon General is authorized--
                    ``(A) 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;
                    ``(B) 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;
                    ``(C) 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;
                    ``(D) 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
                    ``(E) to accept the voluntary services of guest 
                scholars and other persons.
            ``(2) Limitation.--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.
            ``(3) Scientists.--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.
            ``(4) Volunteer services.--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.

``SEC. 273. STUDENTS; SELECTION; OBLIGATION.

    ``(a) Student Selection.--
            ``(1) In general.--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.
            ``(2) Priority.--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.
    ``(b) Contract and Service Obligation.--
            ``(1) Contract.--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--
                    ``(A) an agreement under which--
                            ``(i) 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
                            ``(ii) subject to subparagraph (B), the 
                        student agrees--
                                    ``(I) to accept the provision of 
                                such tuition and student stipend to the 
                                student;
                                    ``(II) to maintain enrollment at 
                                the Track until the student completes 
                                the course of study involved;
                                    ``(III) while enrolled in such 
                                course of study, to maintain an 
                                acceptable level of academic standing 
                                (as determined by the Surgeon General);
                                    ``(IV) 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
                                    ``(V) to serve for a period of time 
                                (referred to in this part as the 
                                `period of obligated service') 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);
                    ``(B) 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;
                    ``(C) a statement of the damages to which the 
                United States is entitled for the student's breach of 
                the contract; and
                    ``(D) such other statements of the rights and 
                liabilities of the Secretary and of the individual, not 
                inconsistent with the provisions of this part.
            ``(2) Tuition and student stipend.--
                    ``(A) Tuition remission rates.--The Surgeon 
                General, based on the recommendations of the Permanent 
                National Health Workforce Commission established under 
                section 101(a) of the Health Access and Health 
                Professions Supply Act of 2009, 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.
                    ``(B) Stipend.--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.
            ``(3) Reductions in the period of obligated service.--The 
        period of obligated service under paragraph (1)(A)(ii)(V) shall 
        be reduced--
                    ``(A) 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
                    ``(B) 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).
    ``(c) Second 2 Years of Service.--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.
    ``(d) Dentist, Physician Assistant, Pharmacist, Behavioral and 
Mental Health Professional, Public Health Professional, and Nurse 
Training.--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.
    ``(e) Elite Federal Disaster Teams.--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.
    ``(f) Student Dropped From Track in Affiliate School.--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.

``SEC. 274. AUTHORIZATION OF APPROPRIATIONS.

    ``There is authorized to be appropriated to carry out this part, 
section 338A-1, and section 749, such sums as may be necessary.''.

SEC. 206. MEDICAL EDUCATION DEBT REIMBURSEMENT FOR PHYSICIANS OF THE 
              VETERANS HEALTH ADMINISTRATION.

    (a) In General.--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).
    (b) Eligible Physicians.--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.
    (c) Covered Education Debt.--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.
    (d) Frequency of Reimbursement.--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).
    (e) Liability for Failure to Complete Obligated Service.--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.
    (f) Treatment of Reimbursement With Other Pay and Benefit 
Authorities.--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.

 TITLE III--HEALTH PROFESSIONAL TRAINING PIPELINE PARTNERSHIPS PROGRAM

SEC. 301. GRANTS TO PREPARE STUDENTS FOR CAREERS IN HEALTH CARE.

    (a) Purpose.--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.
    (b) Definitions.--In this section:
            (1) Children from low-income families.--The term ``children 
        from low-income families'' 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)).
            (2) Eligible recipients.--The term ``eligible recipient'' 
        means--
                    (A) a nonprofit healthcare career pathway 
                partnership organization; or
                    (B) a high-need local educational agency in 
                partnership with--
                            (i) not less than 1 institution of higher 
                        education with an established health profession 
                        education program; and
                            (ii) not less than 1 community-based, 
                        private sector healthcare provider 
                        organization.
            (3) High-need local educational agency.--The term ``high-
        need local educational agency'' means a local educational 
        agency or educational service agency--
                    (A) that serves not fewer than 10,000 children from 
                low-income families;
                    (B) for which not less than 20 percent of the 
                children served by the agency are children from low-
                income families;
                    (C) 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
                    (D) 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)).
            (4) Nonprofit healthcare career pathway partnership 
        organization.--The term ``nonprofit healthcare career pathway 
        partnership organization'' means a nonprofit organization 
        focused on developing career and educational pathways to 
        healthcare professions, that shall include representatives of--
                    (A) the local educational agencies;
                    (B) 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
                    (C) not less than 1 community-based, private sector 
                healthcare provider organization or other healthcare 
                industry organization.
            (5) Secretary.--The term ``Secretary'' means the Secretary 
        of Education.
    (c) Grants Authorized.--
            (1) In general.--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.
            (2) Minimum funding level.--Grants shall be awarded at a 
        minimum level of $500,000 per recipient, per year.
            (3) Renewability.--Grants may be renewed, at the discretion 
        of the Secretary, for not more than 5 years.
    (d) Application.--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).
    (e) Priority.--In awarding grants under this section, the Secretary 
shall give priority to--
            (1) 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;
            (2) applicants that include an institution of higher 
        education that emphasizes an interdisciplinary approach to 
        health profession education; and
            (3) applicants whose program involves the development of a 
        uniquely innovative public-private partnership.
    (f) Authorized Activities/Use of Funds.--
            (1) In general.--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--
                    (A) are aligned with State challenging academic 
                content standards and State challenging student 
                academic achievement standards; and
                    (B) lead to high school graduation with the skills 
                and preparation--
                            (i) to enter postsecondary education 
                        programs of study in mathematics and science 
                        without remediation; and
                            (ii) necessary to enter healthcare jobs 
                        directly.
            (2) Program requirements.--A program of study described in 
        paragraph (1) shall--
                    (A) 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;
                    (B) 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);
                    (C) 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;
                    (D) 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;
                    (E) include high-quality volunteer or internship 
                experiences, integrated with coursework;
                    (F) provide high-quality mentoring, counseling, and 
                career counseling support services to program 
                participants;
                    (G) consider the inclusion of a distance-learning 
                component or similar education technology that would 
                expand opportunities for geographically isolated 
                individuals;
                    (H) encourage the participation of individuals who 
                are members of groups that are underrepresented in 
                postsecondary education programs in mathematics and 
                science;
                    (I) encourage participants to seek work in 
                communities experiencing acute health professional 
                shortages; and
                    (J) collect data, and analyze the data using 
                measurable objectives and benchmarks, to evaluate the 
                extent to which the program succeeded in--
                            (i) increasing student and parent awareness 
                        of occupational opportunities in the healthcare 
                        field;
                            (ii) improving student academic achievement 
                        in mathematics and science;
                            (iii) increasing the number of students 
                        entering health care professions upon 
                        graduation; and
                            (iv) increasing the number of students 
                        pursuing secondary education or training 
                        opportunities with the potential to lead to a 
                        career in the healthcare field.
            (3) Planning grant set aside.--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.
    (g) Matching Requirement.--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.
    (h) Reports.--
            (1) Annual evaluation.--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--
                    (A) the number of schools involved and student 
                participants in the program;
                    (B) the race, gender, socio-economic status, and 
                disability status of program participants;
                    (C) the number of program participants who 
                successfully graduated from high school;
                    (D) 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;
                    (E) 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
                    (F) the data and analysis required under subsection 
                (f)(2)(J).
            (2) Report.--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).
    (i) Authorization and Appropriation.--
            (1) In general.--There are authorized to be appropriated 
        $100,000,000 for each of fiscal years 2009 through 2013 to 
        carry out this section.
            (2) Administrative costs.--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.
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