[Congressional Bills 116th Congress]
[From the U.S. Government Publishing Office]
[S. 299 Introduced in Senate (IS)]

<DOC>






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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