[Congressional Bills 113th Congress]
[From the U.S. Government Publishing Office]
[S. 2229 Introduced in Senate (IS)]

113th CONGRESS
  2d Session
                                S. 2229

                     To expand primary care access.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                             April 9, 2014

  Mr. Sanders introduced the following bill; which was read twice and 
  referred to the Committee on Health, Education, Labor, and Pensions

_______________________________________________________________________

                                 A BILL


 
                     To expand primary care access.

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

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Expanding Primary Care Access and 
Workforce Act''.

SEC. 2. SCHOLARSHIPS AND LOAN REPAYMENT OPPORTUNITIES FOR PRIMARY CARE 
              PROVIDERS.

    (a) Funding for the National Health Service Corps.--Section 338 of 
the Public Health Service Act (42 U.S.C. 254k) is amended by adding at 
the end the following:
    ``(c) Scholarship and Loan Repayment Opportunities for Primary Care 
Providers.--
            ``(1) In general.--There is authorized to be appropriated, 
        and there is appropriated, out of any amounts in the Treasury 
        not otherwise appropriated, $4,900,000,000 for the period of 
        fiscal years 2015 through 2020, to provide for a continuation 
        and expansion of the program with respect to required primary 
        health services, as defined in section 330(b), under this 
        subpart.
            ``(2) Supplemental funding.--Amounts appropriated under 
        this subsection shall be used to supplement and not supplant 
        other amounts appropriated to carry out programs under this 
        subpart.''.
    (b) Scholarship Program and Student Loan Repayment Program.--
Section 338H of the Public Health Service Act (42 U.S.C. 254q) is 
amended by adding at the end the following:
    ``(d) Distribution of Funds.--In allocating funds made available to 
the Health Resources and Services Administration for the National 
Health Service Corps, the Secretary shall provide loan repayment awards 
to at least 6 individuals in each State and scholarships to at least 3 
individuals in each State.''.
    (c) Public Information Programs in Designated Areas.--Section 
332(h) of the Public Health Service Act (42 U.S.C. 254e(h)) is amended 
by inserting ``(directly, or by grant, contract, or cooperative 
agreement)'' after ``conduct''.
    (d) Professional Development.--Section 336(d)(1) of the Public 
Health Service Act (42 U.S.C. 254h-1(d)(1)) is amended by inserting 
``(directly, or by grant, contract, or cooperative agreement)'' after 
``shall assist''.

SEC. 3. FUNDING FOR HEALTH CENTERS.

    Section 10503(b)(1) of the Patient Protection and Affordable Care 
Act of 2010 (42 U.S.C. 254b-2) is amended--
            (1) in subparagraph (D), by striking ``and'' at the end;
            (2) in subparagraph (E), by striking ``and'' at the end; 
        and
            (3) by inserting after subparagraph (E) the following:
                    ``(F) $3,800,000,000 for fiscal year 2016;
                    ``(G) $4,300,000,000 for fiscal year 2017;
                    ``(H) $4,900,000,000 for fiscal year 2018;
                    ``(I) $5,600,000,000 for fiscal year 2019; and
                    ``(J) $6,400,000,000 for fiscal year 2020; and''.

SEC. 4. INCREASING THE PRIMARY CARE PROVIDER WORKFORCE.

    (a) Reauthorization of the Teaching Health Centers Program.--
Section 340H of the Public Health Service Act (42 U.S.C. 256h) is 
amended--
            (1) in subsection (a), by striking ``subsection (h)(2)'' 
        and inserting ``subsection (i)(2)'';
            (2) in subsection (g)--
                    (A) by striking ``such sums'' and all that follows 
                through the period at the end and inserting 
                ``$800,000,000 for the period of fiscal years 2016 
                through 2020.''; and
                    (B) by adding at the end the following: ``Any 
                amounts appropriated under this subsection for any of 
                fiscal years 2011 through 2020 and remaining unexpended 
                at the end of the fiscal year involved may be used in 
                subsequent fiscal years to carry out this section.'';
            (3) in subsection (h)(2)--
                    (A) in the paragraph heading, by adding at the end 
                the following: ``; submission to congress''; and
                    (B) by adding at the end the following:
                    ``(C) Submission to congress.--The Secretary shall 
                annually submit to Congress a report that contains a 
                compilation of the data submitted to the Secretary 
                under paragraph (1) for the year involved.'';
            (4) by redesignating subsections (h) through (j) as 
        subsections (i) through (k), respectively; and
            (5) by inserting after subsection (g), the following:
    ``(h) Limitation.--The Secretary shall establish a minimum per 
resident per year payment amount for funding of all approved teaching 
health center graduate medical education positions under this section 
that shall be not less than the per resident per year payment amount as 
of January 1, 2013, and ensure that not less than such amount is 
provided to all teaching health center graduate medical education 
programs for all approved positions.''.
    (b) Teaching Health Centers Development Grants.--Section 749A(g) of 
the Public Health Service Act (42 U.S.C. 293l-1(g)) is amended by 
striking ``each fiscal year thereafter'' and inserting ``each of fiscal 
years 2013 through 2020 and each fiscal year thereafter''.
    (c) National Health Care Workforce Commission.--Section 5101 of the 
Patient Protection and Affordable Care Act (42 U.S.C. 294q) is 
amended--
            (1) in subsection (h)--
                    (A) by striking paragraphs (1) and (2) and 
                inserting the following:
            ``(1) Appropriations.--There are authorized to be 
        appropriated, and there are appropriated, out of any monies in 
        the Treasury not otherwise appropriated, $10,000,000 for each 
        fiscal year to carry out this section.''; and
                    (B) by redesignating paragraph (3) as paragraph 
                (2); and
            (2) in subsection (d)--
                    (A) in paragraph (7), by adding at the end 
                ``Whenever feasible, Congress and the Department of 
                Health and Human Services shall recognize and implement 
                such recommendations.''; and
                    (B) by adding at the end the following:
            ``(9) Data tracking.--
                    ``(A) Data tracking mechanism.--The Commission 
                shall develop, or enter into a contract with another 
                entity to develop, a mechanism for tracking information 
                on the career paths of graduates of medical schools and 
                residency programs, as described in subparagraph (B), 
                and shall make such information publicly available.
                    ``(B) Recordkeeping.--The Commission shall collect 
                or ensure the collection of data, using the mechanism 
                developed under subparagraph (A), concerning--
                            ``(i) the specialty and subspecialty 
                        training of all graduates of medical schools 
                        receiving Federal funding; and
                            ``(ii) the professional trajectory of all 
                        graduates of medical schools receiving Federal 
                        funding for not less than 15 years after each 
                        individual graduates from medical school, 
                        including data concerning graduates who 
                        practice medicine--
                                    ``(I) in underserved areas such as 
                                health professional shortage areas (as 
                                defined by the National Health Service 
                                Corps under section 332 of the Public 
                                Health Service Act (42 U.S.C. 254e));
                                    ``(II) with medically underserved 
                                populations (as defined in section 
                                330(b)(3) of the Public Health Service 
                                Act (42 U.S.C. 254b(b)(3)));
                                    ``(III) in Federally qualified 
                                health centers (as defined in section 
                                1905(l)(2)(B) of the Social Security 
                                Act (42 U.S.C. 1396d(l)(2)(B)));
                                    ``(IV) rural health clinics (under 
                                title XVIII of the Social Security Act 
                                (42 U.S.C. 1395 et seq.));
                                    ``(V) the health care system of the 
                                Department of Veterans Affairs; and
                                    ``(VI) clinics of the Indian Health 
                                Services.''.
    (d) Reauthorization of Family Nurse Practitioner Residency Training 
Program.--Section 5316(i) of the Patient Protection and Affordable Care 
Act (42 U.S.C. 296j-1(i)) is amended by striking ``such sums'' and all 
that follows through the period at the end and inserting ``$75,000,000 
for the period of fiscal years 2015 through 2019.''.
    (e) Reauthorization of Nurse Faculty Loan Program.--Section 846A(f) 
of the Public Health Service Act (42 U.S.C. 297n-1(f)) is amended by 
striking ``2014'' and inserting ``2019''.
    (f) Reauthorization of Primary Care Residency Expansion Program.--
Section 747(c)(1) of the Public Health Service Act (42 U.S.C. 
293k(c)(1)) is amended by striking ``$125,000,000'' and all that 
follows through the period at the end and inserting ``$168,000,000 for 
the period of fiscal years 2015 through 2019.''.
    (g) Reauthorization of the Area Health Education Centers.--Section 
751(j)(1) of the Public Health Service Act (42 U.S.C. 294a(j)(1)) is 
amended by striking ``2010 through 2014'' and inserting ``2015 through 
2019''.

SEC. 5. INCREASING PAYMENT FOR PRIMARY CARE.

    (a) Requirement Concerning Consultation With Organizations or Other 
Entities.--In determining physician fees for the purpose of payments 
under the Medicare program under title XVIII of the Social Security Act 
(42 U.S.C. 1395 et seq.), the Secretary of Health and Human Services 
shall not consult with an organization or other entity representing 
physicians unless at least 50 percent of the members of such 
organization or entity, at the time of such consultation, are primary 
care physicians.
    (b) Incentive Payment Program for Primary Care Services.--Section 
1833(x)(1) of the Social Security Act (42 U.S.C. 1395l(x)(1)) is 
amended by striking ``2016'' and inserting ``2020''.
    (c) Permanent Application of Medicare Payment Rate Floor to Primary 
Care Services Furnished Under Medicaid.--
            (1) In general.--Section 1902(a)(13)(C) of the Social 
        Security Act (42 U.S.C. 1396a(a)(13)(C)) is amended by striking 
        ``and 2014'' and inserting ``or any year thereafter''.
            (2) Increased fmap.--Section 1905(dd) of the Social 
        Security Act (42 U.S.C. 1396d(dd)) is amended by striking ``and 
        before January 1, 2015,''.
            (3) Effective date.--The amendments made by this subsection 
        take effect on January 1, 2015.

SEC. 6. ACCOUNTABILITY FOR FEDERAL FUNDS AT MEDICAL SCHOOLS.

    (a) Family Medicine or Primary Care Department.--A medical school 
that receives Federal funds for any purpose shall--
            (1) maintain in such medical school a family medicine or 
        primary care department; and
            (2) require for all students at least 8 weeks of rotations 
        in family medicine or community-oriented primary care during 
        the third year of training.
    (b) Reporting on Meeting Health Care Workforce Needs.--A medical 
school that receives Federal funds for any purpose shall--
            (1) prepare an annual report--
                    (A) responding to the data with respect to such 
                medical school that is collected under section 
                5101(d)(9) of the Patient Protection and Affordable 
                Care Act (as added by section 4(c)(2)(B)); and
                    (B) detailing the actions the medical school is 
                taking to meet the health care workforce needs in the 
                school's community and across the Nation; and
            (2) submit such report to the Secretary of Health and Human 
        Services and the National Health Care Workforce Commission.

SEC. 7. INCREASING OPPORTUNITIES AND ACCOUNTABILITY FOR PRIMARY CARE 
              RESIDENCY TRAINING.

    (a) Additional Residency Positions for Training in Family 
Medicine.--
            (1) In general.--Section 1886(h) of the Social Security Act 
        (42 U.S.C. 1395ww(h)) is amended--
                    (A) in paragraph (4)(F)(i), by striking 
                ``paragraphs (7) and (8)'' and inserting ``paragraphs 
                (7), (8), and (9)'';
                    (B) in paragraph (4)(H)(i), by striking 
                ``paragraphs (7) and (8)'' and inserting ``paragraphs 
                (7), (8), and (9)'';
                    (C) in paragraph (7)(E), by inserting ``paragraph 
                (9),'' after ``paragraph (8),''; and
                    (D) by adding at the end the following new 
                paragraph:
            ``(9) Additional residency positions for training in family 
        medicine.--
                    ``(A) In general.--
                            ``(i) Distribution.--For fiscal year 2014 
                        (and succeeding fiscal years if the Secretary 
                        determines that there are additional residency 
                        positions available to distribute under 
                        subparagraph (D)), the Secretary shall increase 
                        the otherwise applicable resident limit for 
                        each qualifying hospital that submits a timely 
                        application under this subparagraph by such 
                        number as the Secretary may approve for 
                        portions of cost reporting periods occurring on 
                        or after July 1 of the fiscal year of the 
                        increase. Such additional residency positions 
                        shall be for approved medical residency 
                        training programs (as defined in paragraph 
                        (5)(A)) in family medicine.
                            ``(ii) Requirements.--Subject to clause 
                        (iii), a hospital that receives an increase in 
                        the otherwise applicable resident limit under 
                        this paragraph shall ensure, during the 5-year 
                        period beginning on the date of such increase, 
                        that--
                                    ``(I) the number of full-time 
                                equivalent residents in family medicine 
                                (as determined by the Secretary), 
                                excluding any additional positions 
                                under subclause (II), is not less than 
                                the average number of full-time 
                                equivalent residents in family medicine 
                                (as so determined) during the 3 most 
                                recent cost reporting periods ending 
                                prior to the date of enactment of this 
                                paragraph; and
                                    ``(II) 100 percent of the positions 
                                attributable to such increase are in an 
                                approved medical residency training 
                                program in family medicine (as 
                                determined by the Secretary).
                            ``(iii) Redistribution of positions if 
                        hospital no longer meets certain 
                        requirements.--In the case where the Secretary 
                        determines that a hospital described in clause 
                        (ii) does not meet either of the requirements 
                        under subclause (I) or (II) of such clause, the 
                        Secretary shall--
                                    ``(I) reduce the otherwise 
                                applicable resident limit of the 
                                hospital by the amount by which such 
                                limit was increased under this 
                                paragraph; and
                                    ``(II) provide for the distribution 
                                of positions attributable to such 
                                reduction in accordance with the 
                                requirements of this paragraph.
                    ``(B) Aggregate number of increases.--The aggregate 
                number of increases in the otherwise applicable 
                resident limit under this paragraph shall be equal to 
                2,000.
                    ``(C) Timing.--The Secretary shall notify hospitals 
                of the number of positions distributed to the hospital 
                under this paragraph as result of an increase in the 
                otherwise applicable resident limit by January 1 of the 
                fiscal year of the increase. Such increase shall be 
                effective for portions of cost reporting periods 
                beginning on or after July 1 of that fiscal year.
                    ``(D) Positions not distributed during fiscal year 
                2014.--If the number of resident full-time equivalent 
                positions distributed under this paragraph in fiscal 
                year 2014 is less than the aggregate number of 
                positions available for distribution in the fiscal year 
                under subparagraph (B), the Secretary shall conduct an 
                application and distribution process in subsequent 
                fiscal years until such time as the aggregate number of 
                positions distributed under this paragraph is equal to 
                the aggregate number under subparagraph (B).
                    ``(E) Consideration in distribution.--In 
                determining for which hospitals the increase in the 
                otherwise applicable resident limit is provided under 
                this paragraph, the Secretary shall prioritize training 
                programs with an emphasis on community-based training, 
                and shall prioritize hospitals with a demonstrated 
                likelihood of filling the positions with residents who 
                will practice in health professional shortage areas (as 
                defined by the National Health Service Corps under 
                section 332 of the Public Health Service Act (42 U.S.C. 
                254e)) or with medically underserved populations (as 
                defined in section 330(b)(3) of the Public Health 
                Service Act (42 U.S.C. 254b(b)(3))), as determined by 
                the Secretary.
                    ``(F) Definition of otherwise applicable resident 
                limit.--In this paragraph, the term `otherwise 
                applicable resident limit' means, with respect to a 
                hospital, the limit otherwise applicable under 
                subparagraphs (F)(i) and (H) of paragraph (4) on the 
                resident level (as defined in paragraph (7)(C)(i)) for 
                the hospital determined without regard to this 
                paragraph but taking into account paragraphs (7)(A), 
                (7)(B), (8)(A), and (8)(B).''.
            (2) IME.--
                    (A) In general.--Section 1886(d)(5)(B)(v) of the 
                Social Security Act (42 U.S.C. 1395ww(d)(5)(B)(v)), in 
                the second sentence, is amended by striking 
                ``subsections (h)(7) and (h)(8)'' and inserting 
                ``subsections (h)(7), (h)(8), and (h)(9)''.
                    (B) Conforming provision.--Section 1886(d)(5)(B) of 
                the Social Security Act (42 U.S.C. 1395ww(d)(5)(B)) is 
                amended--
                            (i) by redesignating clause (x), as added 
                        by section 5505(b) of the Patient Protection 
                        and Affordable Care Act (Public Law 111-148), 
                        as clause (xi) and moving such clause 4 ems to 
                        the left; and
                            (ii) by adding after clause (xi), as 
                        redesignated by subparagraph (A), the following 
                        clause:
            ``(xii) For discharges occurring on or after July 1, 2014, 
        insofar as an additional payment amount under this subparagraph 
        is attributable to resident positions distributed to a hospital 
        under subsection (h)(9), the indirect teaching adjustment 
        factor shall be computed in the same manner as provided under 
        clause (ii) with respect to such resident positions.''.
    (b) Requirements To Improve Transparency.--
            (1) In general.--Section 1886(h) of the Social Security Act 
        (42 U.S.C. 1395ww(h)), as amended by subsection (a)(1), is 
        amended by adding at the end the following new paragraph:
            ``(10) Requirements.--
                    ``(A) In general.--Notwithstanding the preceding 
                provisions of this subsection, for fiscal year 2014 and 
                subsequent fiscal years, a hospital shall not receive 
                any payments under this subsection or subsection 
                (d)(5)(B) (or any other payments under this title for 
                graduate medical education costs) in a fiscal year 
                unless the hospital complies with the following 
                requirements, as determined by the Secretary:
                            ``(i) The hospital has an approved medical 
                        residency program in--
                                    ``(I) family medicine; or
                                    ``(II) adult or all-age primary 
                                care.
                            ``(ii) Each fiscal year (beginning with 
                        fiscal year 2014), the hospital submits to the 
                        Secretary a report that contains the following 
                        information with respect to residents of the 
                        hospital:
                                    ``(I) The total amount of money 
                                generated by the residents (by 
                                residency type) in each year of their 
                                residency program.
                                    ``(II) The total amount of Federal 
                                funding provided to the hospital for 
                                training residents, by residency type, 
                                in each year of the residency program.
                                    ``(III) The average number of 
                                inpatient and outpatient encounters per 
                                year by residency type in inpatient and 
                                outpatient settings.
                                    ``(IV) A justification for the 
                                hospital's allocation of residency 
                                slots across specialties and 
                                subspecialties that is responsive to 
                                local and national health care 
                                workforce needs and recommendations put 
                                forth by the National Health Care 
                                Workforce Commission.
                                    ``(V) A detailed breakdown of how 
                                the hospital uses amounts received 
                                under this subsection and under 
                                subsection (d)(5)(B).
                    ``(B) Public availability.--Not later than 30 days 
                after receiving the report under subparagraph (A)(ii), 
                the Secretary shall post the information described in 
                subclauses (I) through (VI) of such subparagraph on the 
                Internet Website of the Centers for Medicare & Medicaid 
                Services.''.
            (2) IME.--Section 1886(d)(5)(B) of the Social Security Act 
        (42 U.S.C. 1395ww(d)(5)(B)), as amended by subsection 
        (a)(2)(B), is amended by adding at the end the following new 
        clause:
            ``(xiii) The requirements under subsection (h)(10) shall 
        apply to payments under this subparagraph in the same manner as 
        such requirements apply to payments under such subsection.''.

SEC. 8. HEALTH CARE FOR THE UNINSURED.

    A hospital or health care provider that accepts any payment under 
the Medicare program under title XVIII of the Social Security Act (42 
U.S.C. 1395 et seq.) or the Medicaid program under title XIX of the 
Social Security Act (42 U.S.C. 1396 et seq.) shall not charge an 
individual without health insurance coverage an amount for any medical 
service that exceeds the amount such hospital or health care provider 
receives under the Medicare program for such service.
                                 <all>