[Congressional Bills 117th Congress]
[From the U.S. Government Publishing Office]
[S. 3189 Introduced in Senate (IS)]

<DOC>






117th CONGRESS
  1st Session
                                S. 3189

 To amend title XX of the Social Security Act to provide a pathway to 
      health careers through health profession opportunity grants.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                            November 4, 2021

   Mr. Heinrich (for himself, Mr. Wyden, Mr. Lujan, Mr. Murphy, Mr. 
  Blumenthal, and Ms. Rosen) introduced the following bill; which was 
          read twice and referred to the Committee on Finance

_______________________________________________________________________

                                 A BILL


 
 To amend title XX of the Social Security Act to provide a pathway to 
      health careers through health profession opportunity grants.

    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 ``Pathways to Health Careers Act''.

SEC. 2. PATHWAYS TO HEALTH CAREERS.

    Effective October 1, 2021, title XX of the Social Security Act (42 
U.S.C. 1397-1397n-13) is amended by adding at the end the following:

  ``Subtitle D--Career Pathways Through Health Profession Opportunity 
                                 Grants

``SEC. 2071. CAREER PATHWAYS THROUGH HEALTH PROFESSION OPPORTUNITY 
              GRANTS.

    ``(a) Application Requirements.--An eligible entity desiring a 
grant under this section for a project shall submit to the Secretary an 
application for the grant, that includes the following:
            ``(1) A description of how the applicant will use a career 
        pathways approach to train eligible individuals for health 
        professions that will put eligible individuals on a career path 
        to an occupation that pays well, under the project.
            ``(2) A description of the adult basic education and 
        literacy activities, work readiness activities, training 
        activities, and case management and career coaching services 
        that the applicant will use to assist eligible individuals to 
        gain work experience, connection to employers, and job 
        placement, and a description of the plan for recruiting, 
        hiring, and training staff to provide the case management, 
        mentoring, and career coaching services, under the project 
        directly or through local governmental, apprenticeship, 
        educational, or charitable institutions.
            ``(3) A demonstration that the applicant has experience 
        working with low-income populations, or a description of the 
        plan of the applicant to work with a partner organization that 
        has the experience.
            ``(4) A plan for providing post-employment support and 
        ongoing training as part of a career pathway under the project.
            ``(5) A description of the support services that the 
        applicant will provide under the project, including a plan for 
        how child care and transportation support services will be 
        guaranteed and, if the applicant will provide a cash stipend or 
        wage supplement, how the stipend or supplement would be 
        calculated and distributed.
            ``(6) A certification by the applicant that the project 
        development included--
                    ``(A) consultation or commitment to consult with a 
                local workforce development board;
                    ``(B) consideration of registered apprenticeship 
                and pre-apprenticeship models;
                    ``(C) consideration of career pathway programs in 
                the State in which the project is to be conducted; and
                    ``(D) a review of the State plan under section 102 
                or 103 of the Workforce Innovation and Opportunity Act.
            ``(7) A description of the availability and relevance of 
        recent labor market information and other pertinent evidence of 
        in-demand jobs or worker shortages.
            ``(8) A certification that the applicant will directly 
        provide or contract for the training services described in the 
        application.
            ``(9) A commitment by the applicant that, if the grant is 
        made to the applicant, the applicant will--
                    ``(A) during the planning period for the project, 
                provide the Secretary with any information needed by 
                the Secretary to establish adequate data reporting and 
                administrative structure for the project;
                    ``(B) hire a person to direct the project not later 
                than the end of the planning period applicable to the 
                project;
                    ``(C) accept all technical assistance offered by 
                the Secretary with respect to the grant;
                    ``(D) participate in peer technical assistance 
                conferences as are regularly scheduled by the 
                Secretary; and
                    ``(E) provide all data required by the Secretary 
                under subsection (g).
    ``(b) Additional Application Element.--In considering applications 
for a grant under this section, the Secretary shall require qualified 
applicants to have at least 1 of the following application elements--
            ``(1) applications submitted by applicants to whom a grant 
        was made under this section or any predecessor to this section;
            ``(2) applications submitted by applicants who have 
        business and community partners in each of the following 
        categories:
                    ``(A) State and local government agencies and 
                social service providers, including a State or local 
                entity that administers a State program funded under 
                part A of this title;
                    ``(B) institutions of higher education, 
                apprenticeship programs, and local workforce 
                development boards; and
                    ``(C) health care employers, health care industry 
                or sector partnerships, labor unions, and labor-
                management partnerships;
            ``(3) applications that include opportunities for mentoring 
        or peer support, and make career coaching available, as part of 
        the case management plan;
            ``(4) applications which describe a project that will serve 
        a rural area in which--
                    ``(A) the community in which the individuals to be 
                enrolled in the project reside is located;
                    ``(B) the project will be conducted; or
                    ``(C) an employer partnership that has committed to 
                hiring individuals who successfully complete all 
                activities under the project is located;
            ``(5) applications that include a commitment to providing 
        project participants with a cash stipend or wage supplement; 
        and
            ``(6) applications which have an emergency cash fund to 
        assist project participants financially in emergency 
        situations.
    ``(c) Grants.--
            ``(1) Competitive grants.--
                    ``(A) Grant authority.--
                            ``(i) In general.--The Secretary shall make 
                        a grant in accordance with this paragraph to an 
                        eligible entity whose application for the grant 
                        is approved by the Secretary, to conduct a 
                        project designed to train low-income 
                        individuals for allied health professions, 
                        health information technology, physician 
                        assistants, nursing assistants, registered 
                        nurse, advanced practice nurse, and other 
                        professions considered part of a health care 
                        career pathway model.
                            ``(ii) Guarantee of grantees in each state 
                        and the district of columbia.--For each grant 
                        cycle, the Secretary shall award a grant under 
                        this paragraph to at least 2 eligible entities 
                        in each State that is not a territory, to the 
                        extent there are a sufficient number of 
                        applications that have a high likelihood of 
                        success and that are submitted by the entities 
                        that meet the requirements applicable with 
                        respect to such a grant. If, for a grant cycle, 
                        there are fewer than 2 such eligible entities 
                        in a State that have submitted applications 
                        with a high likelihood of success, the 
                        Secretary shall identify qualified eligible 
                        applicants located elsewhere, that are 
                        otherwise approved but un-funded, and issue a 
                        Substitution of Grant and tailored technical 
                        assistance. In the preceding sentence, the term 
                        `issue a Substitution of Grant' means, in a 
                        case in which an approved grantee does not 
                        complete its full project period, or in which 
                        there are fewer than 2 qualified grantees per 
                        State with a high likelihood of success, 
                        substitute an applicant located in another 
                        State that was approved but un-funded during 
                        the competition for the award for the award 
                        recipient.
                    ``(B) Guarantee of grants for indian populations.--
                The Secretary shall award a grant under this paragraph 
                to at least 10 eligible entities that are an Indian 
                tribe, a tribal organization, or a tribal college or 
                university, to the extent there are a sufficient number 
                of applications submitted by the entities that meet the 
                requirements applicable with respect to such a grant.
                    ``(C) Guarantee of grantees in the territories.--
                The Secretary shall award a grant under this paragraph 
                to at least 2 eligible entities that are located in a 
                territory, to the extent there are a sufficient number 
                of applications submitted by the entities that meet the 
                requirements applicable with respect to such a grant.
            ``(2) Grant cycle.--The grant cycle under this section 
        shall be not less than 5 years, with a planning period of not 
        more than the first 12 months of the grant cycle. During the 
        planning period, the amount of the grant shall be in such 
        lesser amount as the Secretary determines appropriate.
    ``(d) Use of Grant.--
            ``(1) In general.--An entity to which a grant is made under 
        this section shall use the grant in accordance with the 
        approved application for the grant.
            ``(2) Support to be provided.--
                    ``(A) Required support.--A project for which a 
                grant is made under this section shall include the 
                following:
                            ``(i) An assessment for adult basic skill 
                        competency, and provision of adult basic skills 
                        education if necessary for lower-skilled 
                        eligible individuals to enroll in the project 
                        and go on to enter and complete post-secondary 
                        training, through means including the 
                        following:
                                    ``(I) Establishing a network of 
                                partners that offer pre-training 
                                activities for project participants who 
                                need to improve basic academic skills 
                                or English language proficiency before 
                                entering a health occupational training 
                                career pathway program.
                                    ``(II) Offering resources to enable 
                                project participants to continue 
                                advancing adult basic skill proficiency 
                                while enrolled in a career pathway 
                                program.
                                    ``(III) Embedding adult basic skill 
                                maintenance as part of ongoing post-
                                graduation career coaching and 
                                mentoring.
                            ``(ii) A guarantee that child care is an 
                        available and affordable support service for 
                        project participants through means such as the 
                        following:
                                    ``(I) Referral to, and assistance 
                                with, enrollment in a subsidized child 
                                care program.
                                    ``(II) Direct payment to a child 
                                care provider if a slot in a subsidized 
                                child care program is not available or 
                                reasonably accessible.
                                    ``(III) Payment of co-payments or 
                                associated fees for child care.
                            ``(iii) Case management plans that include 
                        career coaching (with the option to offer 
                        appropriate peer support and mentoring 
                        opportunities to help develop soft skills and 
                        social capital), which may be offered on an 
                        ongoing basis before, during, and after initial 
                        training as part of a career pathway model.
                            ``(iv) A plan to provide project 
                        participants with transportation through means 
                        such as the following:
                                    ``(I) Referral to, and assistance 
                                with enrollment in, a subsidized 
                                transportation program.
                                    ``(II) If a subsidized 
                                transportation program is not 
                                reasonably available, direct payments 
                                to subsidize transportation costs.
                        For purposes of this clause, the term 
                        `transportation' includes public transit, or 
                        gasoline for a personal vehicle if public 
                        transit is not reasonably accessible or 
                        available.
                    ``(B) Allowed support.--The goods and services 
                provided under a project for which a grant is made 
                under this section may include the following:
                            ``(i) A cash stipend.
                            ``(ii) A reserve fund for financial 
                        assistance to project participants in emergency 
                        situations.
                            ``(iii) Tuition, certification exam fees, 
                        and training materials such as books, software, 
                        uniforms, shoes, connection to the internet, 
                        hair nets, and personal protective equipment.
                            ``(iv) In-kind resource donations such as 
                        interview clothing and conference attendance 
                        fees.
                            ``(v) Assistance with accessing and 
                        completing high school equivalency or adult 
                        basic education courses as necessary to achieve 
                        success in the project and make progress toward 
                        career goals.
                            ``(vi) Assistance with programs and 
                        activities, including legal assistance, deemed 
                        necessary to address arrest or conviction 
                        records as an employment barrier.
                            ``(vii) Other support services as deemed 
                        necessary for family well-being, success in the 
                        project, and progress toward career goals.
            ``(3) Training.--The number of hours of training provided 
        to an eligible individual under a project for which a grant is 
        made under this section, for a recognized postsecondary 
        credential (including an industry-recognized credential, and a 
        certificate awarded by a local workforce development board), 
        which is awarded in recognition of attainment of measurable 
        technical or occupational skills necessary to gain employment 
        or advance within an occupation, shall be--
                    ``(A) not less than the number of hours of training 
                required for certification in that level of skill by 
                the State in which the project is conducted; or
                    ``(B) if there is no such requirement, such number 
                of hours of training as the Secretary finds is 
                necessary to achieve that skill level.
            ``(4) Inclusion of tanf recipients.--In the case of a 
        project for which a grant is made under this section that is 
        conducted in a State that has a program funded under part A of 
        title IV, at least 10 percent of the eligible individuals to 
        whom support is provided under the project shall meet the 
        income eligibility requirements under that State program, 
        without regard to whether the individuals receive benefits or 
        services directly under that State program.
            ``(5) Income limitation.--An entity to which a grant is 
        made under this section shall not use the grant to provide 
        support to a person who is not an eligible individual.
            ``(6) Prohibition.--An entity to which a grant is made 
        under this section shall not use the grant for purposes of 
        entertainment, except that case management and career coaching 
        services may include celebrations of specific career-based 
        milestones such as completing a semester, graduation, or job 
        placement.
    ``(e) Technical Assistance.--
            ``(1) In general.--The Secretary shall provide technical 
        assistance--
                    ``(A) to assist eligible entities in applying for 
                grants under this section;
                    ``(B) that is tailored to meet the needs of 
                grantees at each stage of the administration of 
                projects for which grants are made under this section;
                    ``(C) that is tailored to meet the specific needs 
                of Indian tribes, tribal organizations, and tribal 
                colleges and universities;
                    ``(D) that is tailored to meet the specific needs 
                of the territories;
                    ``(E) that is tailored to meet the specific needs 
                of applicants, eligible entities, and grantees, in 
                carrying out dedicated career pathway projects pursuant 
                to subsections (h) and (i); and
                    ``(F) to facilitate the exchange of information 
                among eligible entities regarding best practices and 
                promising practices used in the projects.
            ``(2) Continuation of peer technical assistance 
        conferences.--The Secretary shall continue to hold peer 
        technical assistance conferences for entities to which a grant 
        is made under this section or was made under the immediate 
        predecessor of this section. The preceding sentence shall not 
        be interpreted to require any such conference to be held in 
        person.
    ``(f) Evaluation of Dedicated Career Pathways.--
            ``(1) In general.--The Secretary shall, by grant, contract, 
        or interagency agreement, conduct rigorous and well-designed 
        evaluations of the dedicated career pathway projects carried 
        out pursuant to subsections (h) and (i).
            ``(2) Requirement applicable to second chance career 
        pathway.--In the case of a project of the type described in 
        subsection (i), the evaluation shall include identification of 
        successful activities for creating opportunities for developing 
        and sustaining, particularly with respect to low-income 
        individuals with arrest or conviction records, a health 
        professions workforce that has accessible entry points, that 
        meets high standards for education, training, certification, 
        and professional development, and that provides increased wages 
        and affordable benefits, including health care coverage, that 
        are responsive to the needs of the workforce.
            ``(3) Requirement applicable to maternal mortality career 
        pathway.--In the case of a project of the type described in 
        subsection (h), the evaluation shall include identification of 
        successful activities for creating opportunities for developing 
        and sustaining, particularly with respect to low-income 
        individuals and other entry-level workers, a career pathway 
        that has accessible entry points, that meets high standards for 
        education, training, certification, and professional 
        development, and that provides increased wages and affordable 
        benefits, including health care coverage, that are responsive 
        to the needs of the birth, pregnancy, and post-partum 
        workforce.
    ``(g) Reports.--As a condition of funding, an eligible entity 
awarded a grant to conduct a project under this section shall submit 
interim reports to the Secretary on the activities carried out under 
the project, and, on the conclusion of the project, a final report on 
the activities.
    ``(h) Maternal Mortality Career Pathway.--
            ``(1) Grant authority.--The Secretary shall award grants in 
        accordance with this subsection to eligible entities to conduct 
        career pathway projects for the purpose of providing education 
        for professions such as doulas, lactation consultants, 
        childbirth educators, infant massage therapists, newborn care 
        specialists, midwives, and other community health worker 
        professions, for individuals to enter and follow a dedicated 
        career pathway in the field of pregnancy, childbirth, or post-
        partum services in a State that recognizes doulas or midwives 
        as health care providers and that provides payment for services 
        provided by doulas or midwives, as the case may be, under the 
        State plan approved under title XIX.
            ``(2) Duration.--A grant awarded under this subsection 
        shall have the same grant cycle as is provided in subsection 
        (c)(2), and as a condition of funding the grantee shall comply 
        with all data reporting requirements associated with the grant 
        cycle.
            ``(3) Application requirements.--An entity seeking a grant 
        under this subsection for a project shall submit to the 
        Secretary an application for the grant, that includes the 
        following:
                    ``(A) A description of the partnerships, strategic 
                staff hiring decisions, tailored program activities, or 
                other programmatic elements of the project that are 
                designed to support a strong career pathway in 
                pregnancy, birth, or post-partum services.
                    ``(B) A demonstration that the State in which the 
                project is to be conducted recognizes and permits 
                doulas and midwives to practice in the State.
                    ``(C) A demonstration that the applicant has 
                experience working with low-income populations, or a 
                description of the plan of the applicant to work with a 
                partner that has the experience.
            ``(4) Support to be provided.--The recipient of a grant 
        under this subsection for a project shall provide required 
        supportive services described in subsection (d)(2)(A) to 
        project participants who need the services, and may expend the 
        funding on eligible supportive services described in subsection 
        (d)(2)(B).
    ``(i) Second Chance Career Pathway.--
            ``(1) Grant authority.--The Secretary shall award grants in 
        accordance with this subsection to eligible entities to conduct 
        career pathway projects for the purpose of providing education 
        and training for eligible individuals with arrest or conviction 
        records to enter and follow a career pathway in the health 
        professions through occupations that are expected to experience 
        a labor shortage or be in high demand.
            ``(2) Duration.--A grant awarded under this subsection 
        shall have the same grant cycle as is provided in subsection 
        (c)(2), and as a condition of funding the grantee shall comply 
        with all data reporting requirements associated with the grant 
        cycle.
            ``(3) Application requirements.--An entity seeking a grant 
        under this subsection for a project shall submit to the 
        Secretary an application for the grant, that includes the 
        following:
                    ``(A) A demonstration that the State in which the 
                project is to be conducted has in effect policies or 
                laws that permit certain allied health and behavioral 
                health care credentials to be awarded to people with 
                certain arrest or conviction records (which policies or 
                laws shall include appeals processes and other 
                opportunities to demonstrate rehabilitation to obtain 
                licensure and approval to work in the proposed health 
                careers), and a plan described in the application which 
                will use a legally permitted career pathway to train 
                people with such a record to be trained and employed in 
                such a career.
                    ``(B) A discussion of how the project or future 
                strategic hiring decisions will demonstrate the 
                experience and expertise of the project in working with 
                job seekers who have arrest or conviction records or 
                employers with experience working with people with 
                arrest or conviction records.
                    ``(C) A demonstration that the applicant has 
                experience working with low-income populations, or a 
                description of the plan of the applicant to work with a 
                partner that has the experience.
                    ``(D) An identification of promising innovations or 
                best practices that can be used to provide the 
                training.
                    ``(E) A proof of concept or demonstration that the 
                applicant has done sufficient research on workforce 
                shortage or in-demand jobs for which people with 
                certain types of criminal records can be hired.
                    ``(F) A plan for recruiting students who are 
                eligible individuals into the project.
                    ``(G) A plan for providing post-employment support 
                and ongoing training as part of a career pathway under 
                the project.
            ``(4) Support to be provided.--
                    ``(A) Required support.--A recipient of a grant 
                under this subsection for a project shall provide--
                            ``(i) access to legal assistance for 
                        project participants for the purpose of 
                        addressing arrest or conviction records and 
                        associated workforce barriers;
                            ``(ii) assistance with programs and 
                        activities deemed necessary to address arrest 
                        or conviction records as an employment barrier; 
                        and
                            ``(iii) required supportive services 
                        described in subsection (d)(2)(A) to 
                        participants who need the services, and may 
                        expend funds on eligible supportive services 
                        described in subsection (d)(2)(B).
    ``(j) Definitions.--In this section:
            ``(1) Allied health profession.--The term `allied health 
        profession' has the meaning given in section 799B(5) of the 
        Public Health Service Act.
            ``(2) Career pathway.--The term `career pathway' has the 
        meaning given that term in section 3(7) of the Workforce 
        Innovation and Opportunity Act.
            ``(3) Doula.--The term `doula' means an individual who--
                    ``(A) is certified by an organization that has been 
                established for not less than 5 years and that requires 
                the completion of continuing education to maintain the 
                certification, to provide non-medical advice, 
                information, emotional support, and physical comfort to 
                an individual during the individual's pregnancy, 
                childbirth, and post-partum period; and
                    ``(B) maintains the certification by completing the 
                required continuing education.
            ``(4) Eligible entity.--The term `eligible entity' means 
        any of the following entities that demonstrates in an 
        application submitted under this section that the entity has 
        the capacity to fully develop and administer the project 
        described in the application:
                    ``(A) A local workforce development board 
                established under section 107 of the Workforce 
                Innovation and Opportunity Act.
                    ``(B) A State or territory, a political subdivision 
                of a State or territory, or an agency of a State, 
                territory, or such a political subdivision, including a 
                State or local entity that administers a State program 
                funded under part A of this title.
                    ``(C) An Indian tribe, a tribal organization, or a 
                tribal college or university.
                    ``(D) An institution of higher education (as 
                defined in the Higher Education Act of 1965).
                    ``(E) A hospital (as defined in section 1861(e)).
                    ``(F) A high-quality skilled nursing facility.
                    ``(G) A Federally qualified health center (as 
                defined in section 1861(aa)(4)).
                    ``(H) A nonprofit organization described in section 
                501(c)(3) of the Internal Revenue Code of 1986, a labor 
                organization, or an entity with shared labor-management 
                oversight, that has a demonstrated history of providing 
                health profession training to eligible individuals.
                    ``(I) In the case of a project of the type provided 
                for in subsection (h) of this section, an entity 
                recognized by a State, Indian tribe, or tribal 
                organization as qualified to train doulas or midwives, 
                if midwives or doulas, as the case may be, are 
                permitted to practice in the State involved.
                    ``(J) An opioid treatment program (as defined in 
                section 1861(jjj)(2)), and other high quality 
                comprehensive addiction care providers.
            ``(5) Eligible individual.--The term `eligible individual' 
        means an individual whose family income does not exceed 200 
        percent of the Federal poverty level.
            ``(6) Federal poverty level.--The term `Federal poverty 
        level' means the poverty line (as defined in section 673(2) of 
        the Omnibus Budget Reconciliation Act of 1981, including any 
        revision required by such section applicable to a family of the 
        size involved).
            ``(7) Indian tribe; tribal organization.--The terms `Indian 
        tribe' and `tribal organization' have the meaning given the 
        terms in section 4 of the Indian Self-Determination and 
        Education Assistance Act (25 U.S.C. 450b).
            ``(8) Institution of higher education.--The term 
        `institution of higher education' has the meaning given the 
        term in section 101 or 102(a)(1)(B) of the Higher Education Act 
        of 1965.
            ``(9) Territory.--The term `territory' means the 
        Commonwealth of Puerto Rico, the United States Virgin Islands, 
        Guam, the Northern Mariana Islands, and American Samoa.
            ``(10) Tribal college or university.--The term `tribal 
        college or university' has the meaning given the term in 
        section 316(b) of the Higher Education Act of 1965.
    ``(k) Funding.--In addition to amounts otherwise available, there 
is appropriated to the Secretary--
            ``(1) $318,750,000 for grants under subsection (c)(1)(A) 
        for each of fiscal years 2022 through 2026;
            ``(2) $17,000,000 for grants under subsection (c)(1)(B) for 
        each of fiscal years 2022 through 2026;
            ``(3) $21,250,000 for grants under subsection (c)(1)(C) for 
        each of fiscal years 2022 through 2026;
            ``(4) $25,500,000 for projects conducted under subsections 
        (h) and (i) for each of fiscal years 2023 through 2026;
            ``(5) $25,500,000, plus all amounts referred to in 
        paragraphs (1) through (4) of this subsection that remain 
        unused after all grant awards are made for the fiscal year, for 
        each of fiscal years 2022 through 2026, for the provision of 
        technical assistance and administration; and
            ``(6) $17,000,000 for each of fiscal years 2022 through 
        2026 for studying the effects of the projects for which a grant 
        is made under this section, and for administration, for the 
        purpose of supporting the rigorous evaluation of the projects, 
        and supporting the continued study of the short-, medium-, and 
        long-term effects of all such projects, including the 
        effectiveness of new or added elements of the projects.''.
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