[Congressional Bills 116th Congress]
[From the U.S. Government Publishing Office]
[S. 299 Introduced in Senate (IS)]
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116th CONGRESS
1st Session
S. 299
To amend title VII of the Public Health Service Act to reauthorize
programs that support interprofessional geriatric education and
training 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
January 31, 2019
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 and
training 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 and the Geriatrics
Academic Career Award.
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 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) Program requirements.--
``(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;
``(iii) shall give priority to applicants
with programs or activities should
substantially benefit rural, underserved, or
Native American populations of older adults;
and
``(iv) may give priority to any program
that--
``(I) 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;
``(II) 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;
``(III) emphasizes integration into
existing service delivery locations and
care across settings, including primary
care clinics, medical homes, Federally
qualified health centers, ambulatory
care clinics, age-friendly health
systems, critical access hospitals,
emergency care, assisted living and
nursing facilities, and home- and
community-based services, including
senior day care;
``(IV) supports the training and
retraining of faculty, preceptors,
primary care providers, and other
direct care providers to increase their
knowledge of geriatrics and
gerontology;
``(V) emphasizes education and
engagement of family caregivers on
disease self-management, medication
management, and stress-reduction
strategies for older adults;
``(VI) 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
``(VII) 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 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 recent previous fiscal year for which
appropriations were made 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 subsection (a)(1) of
this section 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.--
``(I) Annual report.--At the end of
each 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 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.
``(II) Summary reports.--Not later
than 1 year after the completion of
each 5-year grant term under this
subsection, the Secretary shall submit
to Congress a report--
``(aa) that provides a
summary of the financial and
programmatic performance of the
funded grants and a summary of
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; and
``(bb) 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, and
the number of faculty and
practicing professionals who
participated in continuing
education program.
``(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 2020 through
2024.
``(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), an eligible entity, on behalf of
eligible individuals, shall--
``(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 (6); and
``(C) provide, in such form and manner as the
Secretary may require, documented commitment from such
school or program to spend 50 percent of the
individual's time that is supported by the award on
teaching and developing skills in interprofessional
education in geriatrics.
``(4) Equitable distribution.--In making awards under this
subsection, the Secretary shall ensure that awards are
equitably distributed, including among rural or underserved
populations across the various geographical regions of the
United States.
``(5) 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.
``(6) Service requirement.--An individual who receives an
award under this subsection shall provide training in clinical
geriatrics or gerontology, including the training of
interprofessional teams of health care professionals. The
provision of such training shall constitute at least 50 percent
of the obligations of such individual under the award.
``(7) Authorization of appropriations.--There is authorized
to be appropriated $6,000,000 for each of fiscal years 2020
through 2024 for purposes of carrying out this subsection.
``(c) Inapplicability.--Section 791(a) shall not apply with respect
to grants under subsection (a) or awards under subsection (b).''.
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