[Congressional Bills 115th Congress]
[From the U.S. Government Publishing Office]
[S. 2888 Introduced in Senate (IS)]

<DOC>






115th CONGRESS
  2d Session
                                S. 2888

  To amend Title VII of the Public Health Service Act to reauthorize 
programs that support interprofessional geriatric education, training, 
    and advance research to develop a geriatric-capable workforce, 
  improving health outcomes for a growing and diverse aging American 
         population and their families, and for other purposes.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                              May 21, 2018

Ms. Collins (for herself and Mr. Casey) introduced the following bill; 
     which was read twice and referred to the Committee on Health, 
                     Education, Labor, and Pensions

_______________________________________________________________________

                                 A BILL


 
  To amend Title VII of the Public Health Service Act to reauthorize 
programs that support interprofessional geriatric education, training, 
    and advance research to develop a geriatric-capable workforce, 
  improving health outcomes for a growing and diverse aging American 
         population and their families, and for other purposes.

    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 ``Geriatrics Workforce Improvement 
Act''.

SEC. 2. FINDINGS.

    Congress finds the following:
            (1) In 2016, 46,000,000 adults age 65 or older lived in the 
        United States, and this number is expected to double to over 
        98,000,000 by 2060. Three out of four older adults are expected 
        to have multiple chronic conditions, which increases the 
        complexity of care needed and increases medical expenditures.
            (2) Thirty percent of older adults in the United States, 
        about 14,000,000 individuals, are projected to need specialized 
        geriatric care by 2030. That care will require at least 20,000 
        geriatricians and even more geriatric-trained health 
        professionals. There are nearly 1,000,000 physicians in the 
        United States, less than 7,300 of whom are board-certified 
        geriatricians. There are 3,600,000 nurses in the United States, 
        of whom, less than 1 percent are registered nurses certified in 
        geriatrics and less than 3 percent are advanced practice nurses 
        certified in geriatrics. There are similarly few professionals 
        certified in geriatrics among professionals in social work, 
        pharmacy, psychiatry, and the allied health disciplines.
            (3) Health professionals trained in geriatrics understand 
        the unique health needs and complex care challenges associated 
        with aging. Outcomes associated with interprofessional 
        geriatric teams include improved health-related quality of 
        life, fewer emergency room visits, fewer hospital admissions 
        and, in the case of hospitalization, shorter length of stay and 
        lower costs per admission.
            (4) Two federally funded initiatives have historically 
        aimed to reduce the widening gap between the numbers of older 
        adults and health professionals trained in geriatrics: The 
        Geriatrics Workforce Enhancement Program (referred to in this 
        section as ``GWEP'') and the Geriatrics Academic Career Award 
        (referred to in this section as ``GACA'').

SEC. 3. PURPOSE.

    It is the purpose of this Act to develop the next generation of 
geriatric scientists and innovators, improving health outcomes and care 
delivery for older adults. Together, the Geriatrics Workforce 
Enhancement Program and the Geriatrics Academic Career Award develop a 
workforce capable of providing complex, high-quality care that improves 
health outcomes and saves valuable resources by reducing unnecessary 
costs for a growing and diverse aging population.

SEC. 4. EDUCATION AND TRAINING RELATING TO GERIATRICS.

    Section 753 of the Public Health Service Act (42 U.S.C. 294c) is 
amended to read as follows:

``SEC. 753. EDUCATION AND TRAINING RELATING TO GERIATRICS.

    ``(a) Geriatrics Workforce Enhancement Program.--
            ``(1) In general.--The Secretary shall award grants under 
        this subsection to entities described in paragraph (1), (3), or 
        (4) of section 799B, section 801(2), or section 865(d), or 
        other health professions, schools, or programs approved by the 
        Secretary, for the establishment or operation of Geriatrics 
        Workforce Enhancement Programs that meet the requirements of 
        paragraph (2).
            ``(2) Requirements.--
                    ``(A) In general.--A Geriatrics Workforce 
                Enhancement Program (referred to in this section as 
                `GWEP') meets the requirements of this paragraph if 
                such program supports the development of a health care 
                workforce that maximizes patient and family engagement 
                and improves health outcomes for older adults by 
                integrating geriatrics with primary care and other 
                appropriate specialties. Special emphasis shall be 
                placed on providing the primary care workforce with the 
                knowledge and skills to care for older adults and 
                collaborating with community partners to address gaps 
                in health care for older adults through individual-, 
                system-, community-, and population-level changes.
                    ``(B) Programmatic focus.--Areas of programmatic 
                focus for a program meeting the requirements of this 
                paragraph may include the following:
                            ``(i) Transforming clinical training 
                        environments into integrated geriatrics and 
                        primary care delivery systems to ensure 
                        trainees are well prepared to practice in and 
                        lead such systems.
                            ``(ii) Developing providers from multiple 
                        disciplines and specialties to work 
                        interprofessionally to assess and address the 
                        needs and preferences of older adults and their 
                        families and caregivers at the individual, 
                        community, and population levels.
                            ``(iii) Creating and delivering community-
                        based programs that will provide older adults 
                        and their families and caregivers with 
                        education and training to improve health 
                        outcomes and the quality of care for such 
                        adults.
                            ``(iv) Providing education on Alzheimer's 
                        disease and related dementias to families and 
                        caregivers of older adults, direct care 
                        workers, and health professions students, 
                        faculty, and providers.
            ``(3) Duration.--The Secretary shall award grants under 
        paragraph (1) for a period not to exceed 5 years.
            ``(4) Applications.--To be eligible to receive a grant 
        under paragraph (1), an entity described in such paragraph 
        shall submit to the Secretary an application at such time, in 
        such manner, and containing such information as the Secretary 
        may require, including the specific measures the applicant will 
        use to demonstrate that the project is improving the quality of 
        care provided to older adults in the applicant's region, which 
        may include--
                    ``(A) improvements in access to care provided by a 
                health professional with training in geriatrics or 
                gerontology;
                    ``(B) improvements in family caregiver capacity to 
                care for older adults;
                    ``(C) patient outcome data demonstrating an 
                improvement in older adult health status or care 
                quality; and
                    ``(D) reports on how the applicant will implement 
                specific innovations with the target audience to 
                improve older adults health status or the quality of 
                care.
            ``(5) Priority.--
                    ``(A) In general.--In awarding grants under 
                paragraph (1), the Secretary--
                            ``(i) shall ensure an equitable geographic 
                        distribution of grant recipients based on State 
                        and regional aging demographics;
                            ``(ii) shall give priority to programs that 
                        demonstrate coordination with other 
                        programmatic efforts funded under this program 
                        or other public or private entities; and
                            ``(iii) may give priority to any program 
                        that--
                                    ``(I) substantially benefits rural, 
                                underserved, or Native American 
                                populations of older adults;
                                    ``(II) integrates geriatrics and 
                                gerontology into primary care practice, 
                                especially with respect to medical, 
                                dental, and psychosocial care, elder 
                                abuse, pain management, and advance 
                                care planning;
                                    ``(III) offers courses to infuse 
                                core geriatric principles of care into 
                                other specialties across care settings, 
                                including practicing clinical 
                                specialists, health care 
                                administrators, faculty without 
                                backgrounds in geriatrics, students 
                                from all health professions, as 
                                approved by the Secretary, to improve 
                                knowledge and clinical skills for the 
                                care of older adults;
                                    ``(IV) emphasizes integration into 
                                existing service delivery locations and 
                                care across settings, including primary 
                                care clinics, medical homes, Federally-
                                qualified health centers, ambulatory 
                                care clinics, inpatient hospitals, 
                                emergency care, assisted living and 
                                nursing facilities, and home- and 
                                community-based services, including 
                                senior day care, in order to increase 
                                innovation and reduce redundancy across 
                                GWEPs;
                                    ``(V) supports the training and 
                                retraining of faculty, preceptors, 
                                primary care providers, and other 
                                direct care providers to increase their 
                                knowledge of geriatrics and 
                                gerontology;
                                    ``(VI) emphasizes education and 
                                engagement of family caregivers on 
                                disease self-management, medication 
                                management, and stress-reduction 
                                strategies for older adults;
                                    ``(VII) provides training to the 
                                health care workforce on disease self-
                                management, medication management, 
                                stress-reduction strategies, and social 
                                determinants of health in older adults; 
                                or
                                    ``(VIII) proposes to conduct 
                                outreach to communities that have a 
                                shortage of geriatric workforce 
                                professionals.
                    ``(B) Special consideration.--In awarding grants 
                under paragraph (1), particularly with respect to 
                awarding, in fiscal year 2019, any amount appropriated 
                for such fiscal year for purposes of carrying out this 
                subsection that is in excess of the amount appropriated 
                for fiscal year 2018 for such purposes, the Secretary 
                shall give special consideration to entities that 
                operate--
                            ``(i) in communities that have a shortage 
                        of geriatric workforce professionals; and
                            ``(ii) in States in which no entity has 
                        previously received an award under such 
                        paragraph (including under section 753(a)(1) as 
                        in effect before the date of enactment of the 
                        Geriatrics Workforce Improvement Act).
            ``(6) Award amounts.--Awards under paragraph (1) shall be 
        in an amount determined by the Secretary. Entities that submit 
        applications under this subsection that describe a plan for 
        providing geriatric education and training for home health 
        workers and family caregivers are eligible to receive $100,000 
        per year more than entities that do not include a description 
        of such a plan.
            ``(7) Reporting.--
                    ``(A) Reports from entities.--Each entity awarded a 
                grant under paragraph (1) shall submit an annual report 
                to the Secretary on the financial and programmatic 
                performance under such grant, which may include factors 
                such as the number of trainees, the number of 
                professions and disciplines, the number of partnerships 
                with health care delivery sites, the number of faculty 
                and practicing professionals who participated in 
                continuing education programs, and other factors, as 
                the Secretary may require.
                    ``(B) Reports to congress.--
                            ``(i) In general.--Not later than 5 years 
                        after the date of enactment of the Geriatrics 
                        Workforce Improvement Act, the Secretary shall 
                        submit to Congress a report that provides a 
                        summary of the financial and programmatic 
                        performance of the funded grants, which may 
                        include factors such as the number trainees, 
                        the number of professions and disciplines, the 
                        number of partnerships with health care 
                        delivery sites, the number of faculty and 
                        practicing professionals who participated in 
                        continuing education programs, and other 
                        factors that assess the impact of the program 
                        under this subsection on the health status of 
                        older adults, quality of care for older adults, 
                        and the knowledge and skills of the Nation's 
                        health care workforce to care for older adults.
                            ``(ii) Public availability.--The Secretary 
                        shall make each report submitted under clause 
                        (i), and supporting data publicly available in 
                        an accessible format on the internet website of 
                        the Health Resources and Services 
                        Administration.
            ``(8) Authorization of appropriations.--For purposes of 
        carrying out this subsection, in addition to any other funding 
        available for such purpose, there is authorized to be 
        appropriated $45,000,000 for each of fiscal years 2019 through 
        2023.
    ``(b) Geriatric Academic Career Awards.--
            ``(1) Establishment of program.--The Secretary shall 
        establish a program to provide geriatric academic career awards 
        to eligible entities applying on behalf of eligible individuals 
        to promote the career development of such individuals as 
        academic geriatricians or other academic geriatrics health 
        professionals.
            ``(2) Eligibility.--
                    ``(A) Eligible entity.--For purposes of this 
                subsection, the term `eligible entity' means--
                            ``(i) an entity described in paragraph (1), 
                        (3), or (4) of section 799B or section 801(2); 
                        or
                            ``(ii) another accredited health 
                        professions school or graduate program approved 
                        by the Secretary.
                    ``(B) Eligible individual.--For purposes of this 
                subsection, the term `eligible individual' means an 
                individual who--
                            ``(i)(I) is board certified or board 
                        eligible in internal medicine, family practice, 
                        psychiatry, or licensed dentistry, or has 
                        completed required training in a discipline and 
                        is employed in an accredited health professions 
                        school or graduate program that is approved by 
                        the Secretary; or
                            ``(II) has completed an approved fellowship 
                        program in geriatrics or gerontology, or has 
                        completed specialty training in geriatrics or 
                        gerontology as required by the discipline and 
                        any additional geriatrics or gerontology 
                        training as required by the Secretary; and
                            ``(ii) has a junior, nontenured, faculty 
                        appointment at an accredited health professions 
                        school or graduate program in geriatrics or a 
                        geriatrics health profession such as 
                        psychology, pharmacy, nursing, social work, 
                        dentistry, public health, allied health, health 
                        care administration, or another health 
                        discipline, as determined by the Secretary.
            ``(3) Application requirements.--In order to receive an 
        award under paragraph (1), the eligible entity shall, on behalf 
        of eligible individuals--
                    ``(A) submit to the Secretary or a designee an 
                application, at such time, in such manner, and 
                containing such information as the Secretary may 
                require;
                    ``(B) provide, in such form and manner as the 
                Secretary may require, assurances that the eligible 
                individual on whose behalf an application was submitted 
                will meet the service requirement described in 
                paragraph (7); and
                    ``(C) provide, in such form and manner as the 
                Secretary may require, assurances that such eligible 
                individual has a full-time faculty appointment in an 
                accredited health professions school or graduate 
                program and documented commitment from such school or 
                program to spend 50 percent of the total time of such 
                individual on teaching and developing skills in 
                interdisciplinary education in geriatrics.
            ``(4) Requirements.--In awarding grants under this 
        subsection, the Secretary--
                    ``(A) shall give priority to eligible entities who 
                have not received an award under subsection (a)(1) 
                (including as such subsection was in effect prior to 
                the date of enactment of the Geriatrics Workforce 
                Improvement Act) and who establish a mentoring plan to 
                support the integration of geriatrics education, 
                training, and best practices into academic program 
                criteria; and
                    ``(B) shall ensure that grants are equitably 
                distributed, including among rural or underserved 
                populations across the various geographical regions of 
                the United States.
            ``(5) Maintenance of effort.--An eligible entity receiving 
        an award under paragraph (1) on behalf of an eligible 
        individual shall provide assurances to the Secretary that funds 
        provided to such individual under this subsection will be used 
        only to supplement, not to supplant, the amount of Federal, 
        State, and local funds otherwise expended on behalf of the 
        professional development, with respect to geriatrics, of such 
        individual.
            ``(6) Amount and duration.--
                    ``(A) Amount.--The amount of an award under this 
                subsection for an eligible individual for each fiscal 
                year of such award shall be the lesser of--
                            ``(i) 50 percent of the eligible 
                        individual's annual full-time salary for such 
                        fiscal year; or
                            ``(ii) $90,000.
                    ``(B) Duration.--The Secretary shall make awards 
                under paragraph (1) for a period not to exceed 5 years.
                    ``(C) Payment to institution.--The Secretary shall 
                make payments to institutions which include schools of 
                medicine, osteopathic medicine, nursing, social work, 
                psychology, dentistry, and pharmacy, or other allied 
                health discipline in an accredited health professions 
                school or graduate program that is approved by the 
                Secretary.
            ``(7) Service requirement.--At the end of an award period, 
        an eligible individual on whose behalf an application was 
        submitted and approved under paragraph (3) shall continue to 
        teach geriatrics to geriatric health professionals in their 
        faculty role, or continue to provide training in clinical 
        geriatrics or gerontology, including the training of 
        interdisciplinary teams of health care professionals, for a 
        period of time that is equivalent to the duration of the award.
            ``(8) Authorization of appropriations.--There is authorized 
        to be appropriated $6,000,000 for each of fiscal years 2019 
        through 2023 for purposes of carrying out this subsection.''.
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