[Congressional Bills 116th Congress]
[From the U.S. Government Publishing Office]
[H.R. 2781 Introduced in House (IH)]

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116th CONGRESS
  1st Session
                                H. R. 2781

  To amend title VII of the Public Health Service Act to reauthorize 
certain programs relating to the health professions workforce, and for 
                            other purposes.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                              May 16, 2019

 Ms. Schakowsky (for herself and Mr. Burgess) introduced the following 
    bill; which was referred to the Committee on Energy and Commerce

_______________________________________________________________________

                                 A BILL


 
  To amend title VII of the Public Health Service Act to reauthorize 
certain programs relating to the health professions workforce, 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 ``Educating Medical Professionals and 
Optimizing Workforce Efficiency and Readiness for Health Act of 2019'' 
or the ``EMPOWER for Health Act of 2019''.

SEC. 2. REAUTHORIZATION OF HEALTH PROFESSIONS WORKFORCE PROGRAMS.

    (a) Centers of Excellence.--Subsection (i) of section 736 of the 
Public Health Service Act (42 U.S.C. 293) is amended to read as 
follows:
    ``(i) Authorization of Appropriations.--To carry out this section, 
there is authorized to be appropriated $24,897,000 for each of fiscal 
years 2020 through 2024.''.
    (b) Health Professions Training for Diversity.--Section 740 of the 
Public Health Service Act (42 U.S.C. 293d) is amended--
            (1) in subsection (a), by striking ``$51,000,000 for fiscal 
        year 2010, and such sums as may be necessary for each of the 
        fiscal years 2011 through 2014'' and inserting ``$51,419,000 
        for each of fiscal years 2020 through 2024'';
            (2) in subsection (b), by striking ``$5,000,000 for each of 
        the fiscal years 2010 through 2014'' and inserting ``$1,250,000 
        for each of fiscal years 2020 through 2024''; and
            (3) in subsection (c), by striking ``$60,000,000 for fiscal 
        year 2010 and such sums as may be necessary for each of the 
        fiscal years 2011 through 2014'' and inserting ``$14,899,000 
        for each of fiscal years 2020 through 2024''.
    (c) Primary Care Training and Enhancement.--Section 747(c)(1) of 
the Public Health Service Act (42 U.S.C. 293k(c)(1)) is amended by 
striking ``$125,000,000 for fiscal year 2010, and such sums as may be 
necessary for each of fiscal years 2011 through 2014'' and inserting 
``$51,371,000 for each of fiscal years 2020 through 2024''.
    (d) Training in General, Pediatric, and Public Health Dentistry.--
Section 748(f) of the Public Health Service Act (42 U.S.C. 293k-2(f)) 
is amended by striking ``$30,000,000 for fiscal year 2010 and such sums 
as may be necessary for each of fiscal years 2011 through 2015'' and 
inserting ``$42,707,000 for each of fiscal years 2020 through 2024''.
    (e) 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 
``$125,000,000 for each of the fiscal years 2010 through 2014'' and 
inserting ``$42,075,000 for each of fiscal years 2020 through 2024''.
    (f) National Center for Healthcare Workforce Analysis.--
            (1) In general.--Section 761(e)(1)(A) of the Public Health 
        Service Act (42 U.S.C. 294n(e)(1)(A)) is amended by striking 
        ``$7,500,000 for each of fiscal years 2010 through 2014'' and 
        inserting ``$5,947,000 for each of fiscal years 2020 through 
        2024''.
            (2) Technical correction.--Section 761(e)(2) of the Public 
        Health Service Act (42 U.S.C. 294n(e)(2)) is amended by 
        striking ``subsection (a)'' and inserting ``paragraph (1)''.
    (g) Public Health Workforce.--Section 770(a) of the Public Health 
Service Act (42 U.S.C. 295e(a)) is amended by striking ``$43,000,000 
for fiscal year 2011, and such sums as may be necessary for each of the 
fiscal years 2012 through 2015'' and inserting ``$17,850,000 for each 
of fiscal years 2020 through 2024''.

SEC. 3. 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 Programs.--
            ``(1) In general.--The Secretary shall award grants or 
        contracts 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 geriatrics workforce enhancement 
        program 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 should 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. Areas of 
        programmatic focus may include the following:
                    ``(A) Transforming clinical training environments 
                to integrated geriatrics and primary care delivery 
                systems to ensure trainees are well prepared to 
                practice in and lead in such systems.
                    ``(B) 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 with 
                cultural and linguistic competency.
                    ``(C) Creating and delivering community-based 
                programs that will provide older adults and their 
                families and caregivers with the knowledge and skills 
                to improve health outcomes and the quality of care for 
                such adults.
                    ``(D) Providing Alzheimer's disease and related 
                dementias (ADRD) education to the families and 
                caregivers of older adults, direct care workers, health 
                professions students, faculty, and providers.
            ``(3) Duration.--The Secretary shall award grants and 
        contracts under paragraph (1) for a period not to exceed five 
        years.
            ``(4) Application.--To be eligible to receive a grant or 
        contract 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) Equitable geographic distribution.--The Secretary may 
        award grants and contracts under paragraph (1) in a manner 
        which will equitably distribute such grants among the various 
        regions of the United States.
            ``(6) Qualifications.--In awarding grants and contracts 
        under paragraph (2), the Secretary shall consider programs 
        that--
                    ``(A) have the goal of improving and providing 
                comprehensive coordinated care of older adults, 
                including medical, dental, and psychosocial needs;
                    ``(B) demonstrate coordination with other 
                programmatic efforts funded under this program or other 
                public or private entities;
                    ``(C) support the training and retraining of 
                faculty, preceptors, primary care providers, and 
                providers in other specialties to increase their 
                knowledge of geriatrics and gerontology;
                    ``(D) provide clinical experiences across care 
                settings, including ambulatory care, hospitals, post-
                acute care, nursing homes, federally qualified health 
                centers, and home and community-based services;
                    ``(E) emphasize education and engagement of family 
                caregivers on disease self-management, medication 
                management, and stress reduction strategies;
                    ``(F) provide training to the health care workforce 
                on disease self-management, motivational interviewing, 
                medication management, and stress reduction strategies;
                    ``(G) provide training to the health care workforce 
                on social determinants of health in order to better 
                address the geriatric health care needs of diverse 
                populations with cultural and linguistic competency;
                    ``(H) integrate geriatrics competencies and 
                interprofessional collaborative practice into health 
                care education and training curricula for residents, 
                fellows, and students;
                    ``(I) substantially benefit rural or underserved 
                populations of older adults or conduct outreach to 
                communities that have a shortage of geriatric workforce 
                professionals;
                    ``(J) integrate behavioral health competencies into 
                primary care practice, especially with respect to elder 
                abuse, pain management, and advance care planning; or
                    ``(K) offer short-term intensive courses that--
                            ``(i) focus on geriatrics, gerontology, 
                        chronic care management, and long-term care 
                        that provide supplemental training for faculty 
                        members in medical schools and other health 
                        professions schools or graduate programs in 
                        psychology, pharmacy, nursing, social work, 
                        dentistry, public health, allied health, or 
                        other health disciplines, as approved by the 
                        Secretary; and
                            ``(ii) are open to current faculty, and 
                        appropriately credentialed volunteer faculty 
                        and practitioners, to upgrade their knowledge 
                        and clinical skills for the care of older 
                        adults and adults with functional and cognitive 
                        limitations and to enhance their 
                        interdisciplinary teaching skills.
            ``(7) Priority.--In awarding grants under paragraph (1), 
        particularly with respect to awarding, in fiscal year 2020, any 
        amount appropriated for such fiscal year for purposes of 
        carrying out this subsection that is in excess of the amount 
        appropriated for the most previous fiscal year for which 
        appropriations were made for such purposes, the Secretary may 
        give priority to entities that operate--
                    ``(A) in communities that have a shortage of 
                geriatric workforce professionals; and
                    ``(B) in States in which no entity has previously 
                received an award under such paragraph (including as in 
                effect before the date of enactment of the Educating 
                Medical Professionals and Optimizing Workforce 
                Efficiency and Readiness for Health Act of 2019).
            ``(8) 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.
            ``(9) Reporting.--
                    ``(A) Reports from entities.--Each entity awarded a 
                grant under paragraph (1) shall submit an annual report 
                to the Secretary on 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 such other factors 
                as the Secretary may require.
                    ``(B) Reports to congress.--
                            ``(i) Annual report.--At the end of each 
                        fiscal year in which the Secretary awards 
                        grants under this subsection, the Secretary 
                        shall submit to Congress a report that provides 
                        a summary of the financial and programmatic 
                        performance of such grants, which may include 
                        factors such as--
                                    ``(I) the number of trainees;
                                    ``(II) the number of professions 
                                and disciplines;
                                    ``(III) the number of partnerships 
                                with health care delivery sites;
                                    ``(IV) the number of faculty and 
                                practicing professionals who 
                                participated in continuing education 
                                programs; and
                                    ``(V) other factors that assess the 
                                impact of the program under this 
                                subsection on the health status of 
                                older adults, the 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.
    ``(b) Geriatric Academic Career Awards.--
            ``(1) Establishment of program.--The Secretary shall 
        establish a program to award grants, to be known as 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 accredited school of allopathic 
                        medicine, osteopathic medicine, nursing, social 
                        work, psychology, dentistry, pharmacy, or 
                        allied health; or
                            ``(ii) another type of accredited health 
                        professions school or graduate program deemed 
                        by the Secretary to be eligible under this 
                        subsection.
                    ``(B) Eligible individual.--
                            ``(i) In general.--For purposes of this 
                        subsection, the term `eligible individual' 
                        means an individual who--
                                    ``(I) has a junior, nontenured, 
                                faculty appointment at an accredited 
                                school of allopathic medicine, 
                                osteopathic medicine, nursing, social 
                                work, psychology, dentistry, pharmacy, 
                                or allied health or at another type of 
                                accredited health professions school or 
                                graduate program described in 
                                subparagraph (A)(ii);
                                    ``(II)(aa) is board certified or 
                                board eligible in internal medicine, 
                                family practice, psychiatry, or 
                                licensed dentistry, or has completed 
                                the training required for the 
                                individual's discipline; and
                                    ``(bb) is employed at an eligible 
                                entity; or
                                    ``(III) has completed an approved 
                                fellowship program in geriatrics or 
                                gerontology, or has completed specialty 
                                training in geriatrics or gerontology 
                                as required for the individual's 
                                discipline and any additional 
                                geriatrics or gerontology training as 
                                required by the Secretary.
                            ``(ii) Special rule.--If during the period 
                        of an award under this subsection respecting an 
                        eligible individual, the individual is promoted 
                        to associate professor and thereby no longer 
                        meets the criteria of clause (i)(I), the 
                        individual may continue to be treated as an 
                        eligible individual through the term of the 
                        award.
            ``(3) Limitations.--An eligible entity may not receive an 
        award under paragraph (1) on behalf of an eligible individual 
        unless the eligible entity--
                    ``(A) submits to the Secretary an application, at 
                such time, in such manner, and containing such 
                information as the Secretary may require, and the 
                Secretary approves such application;
                    ``(B) provides, in such form and manner as the 
                Secretary may require, assurances that the eligible 
                individual on whose behalf an application was submitted 
                under subparagraph (A) will meet the service 
                requirement described in paragraph (8); and
                    ``(C) provides, in such form and manner as the 
                Secretary may require, assurances that such 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 75 percent of the total time of such individual 
                on teaching and developing skills in interprofessional 
                education in geriatrics.
            ``(4) Requirements.--In awarding grants under this 
        subsection, the Secretary--
                    ``(A) shall give priority to eligible entities that 
                apply on behalf of eligible individuals who are on the 
                faculty of institutions that integrate geriatrics 
                education, training, and best practices into academic 
                program criteria;
                    ``(B) may give priority to eligible entities that 
                operate a geriatrics workforce enhancement program 
                under subsection (a);
                    ``(C) shall ensure that grants are equitably 
                distributed across the various geographical regions of 
                the United States, including rural and underserved 
                areas;
                    ``(D) shall pay particular attention to geriatrics 
                health care workforce needs among underserved 
                populations, diverse communities, and rural areas;
                    ``(E) may not require an eligible individual, or an 
                eligible entity applying on behalf of an eligible 
                individual, to be a recipient of a grant or contract 
                under this part; and
                    ``(F) shall pay the full amount of the award to the 
                eligible entity.
            ``(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 by such individual.
            ``(6) Amount and term.--
                    ``(A) Amount.--The amount of an award under this 
                subsection for eligible individuals who are physicians 
                shall equal $100,000 for fiscal year 2020, adjusted for 
                subsequent fiscal years to reflect the increase in the 
                Consumer Price Index. The Secretary shall determine the 
                amount of an award under this subsection for 
                individuals who are not physicians.
                    ``(B) Term.--The term of any award made under this 
                subsection shall not exceed 5 years.
            ``(7) Service requirement.--An eligible individual on whose 
        behalf an application was submitted and approved under 
        paragraph (3)(A) shall provide training in clinical geriatrics 
        or gerontology, including the training of interprofessional 
        teams of health care professionals.
    ``(c) Authorization of Appropriations.--To carry out this section, 
there is authorized to be appropriated $51,000,000 for each of fiscal 
years 2020 through 2024. Notwithstanding the preceding sentence, no 
funds shall be made available to carry out subsection (b) for a fiscal 
year unless the amount made available to carry out this section for 
such fiscal year is more than the amount made available to carry out 
this section for fiscal year 2017.''.

SEC. 4. INVESTMENT IN TOMORROW'S PEDIATRIC HEALTH CARE WORKFORCE.

    Section 775 of the Public Health Service Act (42 U.S.C. 295f) is 
amended to read as follows:

``SEC. 775. INVESTMENT IN TOMORROW'S PEDIATRIC HEALTH CARE WORKFORCE.

    ``(a) In General.--The Secretary shall establish and carry out a 
program of entering into pediatric specialty loan repayment agreements 
with qualified health professionals under which--
            ``(1) the qualified health professional agrees to a period 
        of not less than 2 years of obligated service during which the 
        professional will--
                    ``(A) participate in an accredited pediatric 
                medical subspecialty, pediatric surgical specialty, or 
                child and adolescent mental and behavioral health 
                residency or fellowship; or
                    ``(B) be employed full-time in providing pediatric 
                medical subspecialty care, pediatric surgical specialty 
                care, or child and adolescent mental and behavioral 
                health care, including substance use disorder 
                prevention and treatment services, in an area with--
                            ``(i) a shortage of health care 
                        professionals practicing in the pediatric 
                        medical subspecialty, the pediatric surgical 
                        specialty, or child and adolescent mental and 
                        behavioral health, as applicable; and
                            ``(ii) a sufficient pediatric population, 
                        as determined by the Secretary, to support the 
                        addition of a practitioner in the pediatric 
                        medical subspecialty, the pediatric surgical 
                        specialty, or child and adolescent mental and 
                        behavioral health, as applicable; and
            ``(2) the Secretary agrees to make payments on the 
        principal and interest of undergraduate, graduate, or graduate 
        medical education loans of the qualified health professional of 
        not more than $35,000 a year for each year of agreed upon 
        service under paragraph (1) for a period of not more than 3 
        years.
    ``(b) Eligibility Requirements.--
            ``(1) Pediatric medical specialists and pediatric surgical 
        specialists.--For purposes of loan repayment agreements under 
        this section with respect to pediatric medical subspecialty and 
        pediatric surgical specialty practitioners, the term `qualified 
        health professional' means a licensed physician who--
                    ``(A) is entering or receiving training in an 
                accredited pediatric medical subspecialty or pediatric 
                surgical subspecialty residency or fellowship; or
                    ``(B) has completed (but not prior to the end of 
                the calendar year in which this section is enacted) the 
                training described in clause (i).
            ``(2) Child and adolescent mental and behavioral health.--
        For purposes of loan repayment agreements under this section 
        with respect to child and adolescent mental and behavioral 
        health care, the term `qualified health professional' means a 
        health care professional who--
                    ``(A) has received specialized training or clinical 
                experience in child and adolescent mental health in 
                psychiatry, psychology, school psychology, behavioral 
                pediatrics, psychiatric nursing, social work, school 
                social work, substance use disorder prevention and 
                treatment, marriage and family therapy, school 
                counseling, or professional counseling;
                    ``(B) has a license or certification in a State to 
                practice allopathic medicine, osteopathic medicine, 
                psychology, school psychology, psychiatric nursing, 
                social work, school social work, marriage and family 
                therapy, school counseling, or professional counseling; 
                or
                    ``(C) is a mental health service professional who 
                has completed (but not before the end of the calendar 
                year in which this section is enacted) specialized 
                training or clinical experience in child and adolescent 
                mental health described in clause (i).
            ``(3) Additional eligibility requirements.--The Secretary 
        may not enter into a loan repayment agreement under this 
        section with a qualified health professional unless--
                    ``(A) the professional agrees to work in, or for a 
                provider serving, a medically underserved area, or to 
                serve a medically underserved population;
                    ``(B) the professional is a United States citizen 
                or a permanent legal United States resident; and
                    ``(C) if the professional is enrolled in a graduate 
                program, the program is accredited, and the 
                professional has an acceptable level of academic 
                standing (as determined by the Secretary).
    ``(c) Priority.--In entering into loan repayment agreements under 
this section, the Secretary shall give priority to applicants who--
            ``(1) are or will be working in a school or other pre-
        kindergarten, elementary, or secondary education setting;
            ``(2) have familiarity with evidence-based methods and 
        cultural and linguistic competence in health care services; and
            ``(3) demonstrate financial need.
    ``(d) Authorization of Appropriations.--There are authorized to be 
appropriated for each of fiscal years 2020 through 2024--
            ``(1) $30,000,000 to carry out this section with respect to 
        loan repayment agreements with qualified health professionals 
        described in subsection (b)(1); and
            ``(2) $20,000,000 to carry out this section with respect to 
        loan repayment agreements with respect to qualified health 
        professionals described in subsection (b)(2).''.
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