[Congressional Bills 116th Congress]
[From the U.S. Government Publishing Office]
[S. 3194 Introduced in Senate (IS)]

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116th CONGRESS
  2d Session
                                S. 3194

To establish a program ensuring access to accredited continuing medical 
 education for primary care physicians and other health care providers 
  at Federally-qualified health centers and rural health clinics, to 
  provide training and clinical support for primary care providers to 
practice at their full scope and improve access to care for patients in 
                           underserved areas.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                            January 15, 2020

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

_______________________________________________________________________

                                 A BILL


 
To establish a program ensuring access to accredited continuing medical 
 education for primary care physicians and other health care providers 
  at Federally-qualified health centers and rural health clinics, to 
  provide training and clinical support for primary care providers to 
practice at their full scope and improve access to care for patients in 
                           underserved areas.

    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 ``Improving Access to Health Care in 
Rural and Underserved Areas Act''.

SEC. 2. PRIMARY CARE ACCREDITED CONTINUING MEDICAL EDUCATION PROGRAM.

    Subpart 1 of part D of title III of the Public Health Service Act 
(42 U.S.C. 254b et seq.) is amended by adding at the end the following:

``SEC. 330N. PRIMARY CARE ACCREDITED CONTINUING MEDICAL EDUCATION 
              PROGRAM.

    ``(a) In General.--The Secretary, acting through the Administrator 
of the Health Resources and Services Administration, shall establish a 
program to award not more than 100 grants to Federally-qualified health 
centers or rural health clinics, or organizations affiliated with such 
clinics, for the purpose of ensuring access to accredited continuing 
medical education by board-certified specialist physicians, including 
family and internal medicine physicians, with teaching or high-volume 
patient experience, and other licensed medical providers who have 
clinical experience and are certified in accordance with regulations 
issued by the Secretary, to primary care physicians and medical 
providers employed by Federally-qualified health centers or rural 
health clinics, to increase the primary care providers' knowledge and 
capacity to practice within their full scope and increase access to 
care for patients in rural and underserved areas.
    ``(b) Scope of Training.--
            ``(1) In general.--Accredited continuing medical education 
        programs offered under this section--
                    ``(A) shall be designed to be flexible to meet the 
                needs of the patients and providers served and offer a 
                variety of schedules, with a minimum of 1-day training 
                per month, per specialty area;
                    ``(B) shall involve clinical practice for at least 
                50 percent of the training (based on a 3-month 
                average), involving direct care for patients with a 
                scheduled visit with the primary care provider, and who 
                could benefit from a concurrent visit with both the 
                primary care provider and a specialist;
                    ``(C) shall not impose additional cost-sharing with 
                respect to the concurrent visits described in 
                subparagraph (B);
                    ``(D) may involve specialists and faculty who 
                participate in the program via telemedicine for up to 
                50 percent of the clinical time, not to exceed 75 
                percent of the total program time over a 3-month 
                average; and
                    ``(E) with respect to rural and frontier Federally-
                qualified health centers or rural health clinics, may 
                permit a waiver of subparagraph (D) (upon request to 
                the Health Resources and Services Administration) to 
                permit 100 percent telemedicine participation.
            ``(2) Training.--Accredited continuing medical education 
        programs offered under this section may provide training to 
        primary and behavioral care physicians and health care 
        providers on--
                    ``(A) endocrinology (including diabetes care);
                    ``(B) palliative care and pain management;
                    ``(C) dermatology;
                    ``(D) obstetrics and gynecology;
                    ``(E) pediatric primary care and pediatric 
                subspecialties;
                    ``(F) gastroenterology;
                    ``(G) mental and behavioral health, and substance 
                use treatment;
                    ``(H) preventive care and nutrition;
                    ``(I) geriatric medicine;
                    ``(J) infectious disease;
                    ``(K) cardiology;
                    ``(L) rural health and training to improve outcomes 
                for populations experiencing health disparities;
                    ``(M) wound care;
                    ``(N) disease management for patients with multiple 
                comorbidities;
                    ``(O) health information technology; and
                    ``(P) other topics, as the Secretary determines 
                appropriate.
            ``(3) Participating centers or clinics.--
                    ``(A) In general.--To be eligible for a grant under 
                this section a Federally-qualified health center or 
                rural health clinic, or an organization affiliated with 
                any such health clinic acting on behalf of multiple 
                such clinics, shall--
                            ``(i) submit an application to the 
                        Secretary at such time, in such manner, and 
                        containing such information as the Secretary 
                        may require;
                            ``(ii) ensure that training under the 
                        program under the grant is provided to the 
                        physicians and primary care providers employed 
                        by such center or clinic, as well as peer-to-
                        peer training;
                            ``(iii) include in the application a needs 
                        assessment describing how participation in the 
                        program under the grant will meet both patient 
                        needs and skills training needs for their 
                        primary care providers; and
                            ``(iv) include in the application a 
                        description of the expected patient target for 
                        how many patients would be directly served by 
                        activities under the grant and an assurance 
                        that data and reports will be provided on the 
                        number of patients served and the accrediting 
                        entity used for purposes of subsection (c).
                    ``(B) Use of grant.--A Federally-qualified health 
                center, rural health clinic, or affiliated organization 
                receiving a grant under this section may use grant 
                funds for--
                            ``(i) compensation for medical providers 
                        participating in teaching at program sessions;
                            ``(ii) part-time administration support for 
                        the program;
                            ``(iii) compensation for the center for the 
                        nonclinical training time of the center's 
                        primary care or behavioral health care 
                        providers;
                            ``(iv) technology and equipment needed to 
                        facilitate clinical visits for the program;
                            ``(v) transportation costs for medical 
                        providers participating in teaching under the 
                        program to travel to center sites if such sites 
                        are located more than 35 miles from their 
                        primary residences; and
                            ``(vi) other purposes related to expenses 
                        incurred in the planning and delivery of the 
                        educational program and associated clinical 
                        visits, as the Secretary determines 
                        appropriate.
                    ``(C) Term.--A grant under this section shall be 
                for a period of 5-years.
                    ``(D) Rural areas.--The Secretary shall ensure that 
                at least half of the recipients of a grant under this 
                section are eligible Federally-qualified health centers 
                located in a rural area or rural health clinics, or 
                affiliated organizations acting on behalf of such 
                centers.
    ``(c) Physician Participation in Program.--
            ``(1) Eligibility.--To be eligible to participate in an 
        accredited continuing medical education program offered under 
        this section, a physician or other primary care or behavioral 
        health care provider shall be a primary care provider--
                    ``(A) who is employed by the grantee; and
                    ``(B) who serves patients in a medically 
                underserved population (as defined in section 
                330(b)(3)).
            ``(2) CME credit.--
                    ``(A) In general.--The Secretary shall require a 
                grantee under this section to identify an accrediting 
                body that the grantee will work with to certify the 
                program under the grant in a manner that provides 
                continuing medical education credits to providers 
                participating in the program. Such certification shall 
                include material with respect to specific skills 
                development.
                    ``(B) Reporting.--As part of the annual reporting 
                provided under subsection (b)(3)(A)(iv) a grantee shall 
                provide information to confirm the accredited 
                continuing medical education entity used by the 
                grantee. The Secretary may suspend grant funding if the 
                grantee fails to provide for accredited continuing 
                medical education within the first year of the grant. 
                Such grant funding may be reinstated by the Secretary 
                once the grantee certifies that accredited continuing 
                medical education is provided.
    ``(d) Annual Reporting.--Beginning 1 year after the date of 
enactment of the Improving Access to Health Care in Rural and 
Underserved Areas Act, and every year thereafter, the Secretary shall 
submit to Congress a report on the program under this section, 
including--
            ``(1) the number of physicians who participate in the 
        program each year and the specialties of such physicians;
            ``(2) a breakdown of specialist time spent directly with 
        patients, with patients through telemedicine, and with primary 
        care providers in classroom or other non-clinical setting 
        during the program sessions;
            ``(3) a comparison of measures under the Uniform Data 
        System of the Health Resources and Services Administration, or 
        similar program, relevant to patient care improvements, between 
        the year prior to the implementation of the program under this 
        section and the most recent year in the program;
            ``(4) a summary of any clinical practice changes or notable 
        improvements in patient care;
            ``(5) patient referrals from health centers that 
        participate in the program to outside specialist care, and any 
        patient care provided at the health center that, prior to the 
        program, would have been referred to outside specialists;
            ``(6) retention rates of physicians at participating health 
        centers; and
            ``(7) satisfaction rates of physicians with the education 
        program at participating health centers.
    ``(e) Authorization of Appropriations.--To carry out this section, 
there are authorized to be appropriated $20,000,000 for each of fiscal 
years 2020 through 2024.''.
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