[Congressional Bills 118th Congress]
[From the U.S. Government Publishing Office]
[H.R. 4837 Introduced in House (IH)]

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118th CONGRESS
  1st Session
                                H. R. 4837

To amend the Public Health Service Act to help build a stronger health 
                            care workforce.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                             July 24, 2023

   Mr. Ruiz introduced the following bill; which was referred to the 
 Committee on Energy and Commerce, and in addition to the Committee on 
   Ways and Means, for a period to be subsequently determined by the 
  Speaker, in each case for consideration of such provisions as fall 
           within the jurisdiction of the committee concerned

_______________________________________________________________________

                                 A BILL


 
To amend the Public Health Service Act to help build a stronger health 
                            care workforce.

    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 ``Building a Health Care Workforce for 
the Future Act''.

SEC. 2. GRANTS TO STATES FOR SCHOLARSHIP PROGRAMS.

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

``SEC. 338O. GRANTS TO STATES FOR SCHOLARSHIP PROGRAMS.

    ``(a) In General.--The Secretary shall award grants to eligible 
States to enable such States to implement scholarship programs to 
ensure, with respect to the provision of health services, an adequate 
supply of physicians, dentists, behavioral and mental health 
professionals, certified nurse midwives, certified nurse practitioners, 
physician assistants, pharmacists, and other health professionals as 
determined by the Secretary.
    ``(b) Eligible States.--To be eligible to receive a grant under 
this section, a State shall submit to the Secretary an application 
containing such information as the Secretary determines necessary to 
carry out this section.
    ``(c) Eligible Participants.--To be eligible to participate in a 
scholarship program carried out with a grant received under this 
section, an individual shall--
            ``(1) be accepted for enrollment, or be enrolled, as a 
        full-time student--
                    ``(A) in an accredited (as determined by the 
                Secretary) educational institution in a State; and
                    ``(B) in a course of study or program, offered by 
                such institution and approved by the Secretary, leading 
                to a degree in medicine, dentistry, nursing, pharmacy, 
                or other health profession, or an appropriate degree 
                from a graduate program of behavioral and mental 
                health;
            ``(2) submit to the State an application to participate in 
        the program; and
            ``(3) sign and submit to the State, at the time of the 
        submission of the application under paragraph (2), a written 
        contract that requires the individual to--
                    ``(A) accept payments under the scholarship;
                    ``(B) maintain a minimum level of academic standing 
                during the period of the scholarship, as determined by 
                the Secretary;
                    ``(C) if applicable, complete an accredited 
                residency training program;
                    ``(D) become licensed in the applicant's State of 
                residence; and
                    ``(E) serve as a provider for one year in--
                            ``(i) a health professional shortage area 
                        (as defined under section 332);
                            ``(ii) a medically underserved community 
                        (as defined under section 799B); or
                            ``(iii) any other shortage area defined by 
                        the State and approved by the Secretary;
                in the applicant's State of residence for every year in 
                which the applicant received a scholarship.
    ``(d) Designation of Areas.--To be eligible to receive a grant 
under this section, a State shall adequately demonstrate to the 
Secretary that the State has designated appropriate health professional 
or specialty shortage areas.
    ``(e) Required Disclosures.--In disseminating application and 
contract forms to individuals desiring to participate in a scholarship 
program funded under this section, the State shall include with such 
forms a summary of the rights and liabilities of an individual whose 
application is approved (and whose contract is accepted), including a 
clear explanation of the damages to which the State is entitled in the 
case of the individual's breach of the contract.
    ``(f) Awarding of Contracts.--
            ``(1) In general.--A State that enters into a contract with 
        an individual under subsection (c)(3) shall, with respect to 
        the program in which the individual is enrolled, agree to pay--
                    ``(A) all tuition and costs associated with the 
                program;
                    ``(B) any other reasonable educational expenses, 
                including fees, books, and laboratory expenses, related 
                to the program; and
                    ``(C) a cost-of-living stipend in an amount to be 
                determined by the Secretary.
            ``(2) Consideration by state.--In entering into contracts 
        with individuals that meet the requirements of subsection (c), 
        the State shall consider the extent of the applicant's 
        demonstrated interest in the provision of care services in a 
        particular provider shortage area.
    ``(g) Matching Funds.--A State receiving a grant under this section 
shall, with respect to the costs of making payments on behalf of 
individuals under the scholarship program implemented by the State 
under the grant, make available (directly or through donations from 
public or private entities) non-Federal contributions in cash toward 
such costs in an amount equal to not less than $1 for each $1 of 
Federal funds provided under the grant.
    ``(h) Direct Administration by State Agency.--The scholarship 
program of any State receiving a grant under this section shall be 
administered directly by a State agency.
    ``(i) Report by Secretary.--Not later than four years after the 
date of enactment of this section, and every five years thereafter, the 
Secretary shall submit to Congress a report concerning--
            ``(1) the number of scholarships awarded under the State 
        scholarship program;
            ``(2) the number of scholarship recipients, broken down by 
        practice area, serving in the profession originally awarded a 
        scholarship for one year after the completion of the service 
        period required under subsection (c)(3)(E);
            ``(3) the number of scholarship recipients, broken down by 
        provider type, practicing in a medically underserved community 
        one year after the completion of the service period required 
        under subsection (c)(3)(E);
            ``(4) data on any changes in health professional shortage 
        areas or medically underserved communities within the State;
            ``(5) remaining gaps in such health professional shortage 
        areas or medically underserved communities;
            ``(6) the number of additional full-time physicians that 
        would be required to eliminate such health professional 
        shortage areas or medically underserved communities in the 
        State;
            ``(7) the number of individuals who received a scholarship 
        but failed to comply with the requirements of the scholarship;
            ``(8) the action taken by the State to recoup scholarship 
        funds in the case of any non-compliance; and
            ``(9) recommendations to improve the program under this 
        section.
    ``(j) Authorization of Appropriations.--There is authorized to be 
appropriated to carry out this section $20,000,000 for each of fiscal 
years 2024 through 2028. Not less than 50 percent of the amount 
appropriated for a fiscal year under this subsection shall be used to 
provide scholarships to providers who intend on pursuing careers in 
primary care.''.

SEC. 3. INCREASING MENTORING AND TRANSFORMING COMPETENCIES IN PRIMARY 
              CARE.

    Title VII of the Public Health Service Act is amended by inserting 
after section 747A (42 U.S.C. 293k-1) the following:

``SEC. 747B. DEVELOPING EFFECTIVE PRIMARY CARE MENTORS AND IMPROVING 
              MENTORSHIP OPPORTUNITIES FOR MEDICAL STUDENTS.

    ``(a) Grants To Cultivate Primary Care Mentors and Improve Primary 
Care Mentorship Opportunities for Medical Students.--The Secretary may 
award grants to eligible medical schools to assist such schools in 
developing and strengthening primary care mentorship programs and 
cultivating leaders in primary care among students.
    ``(b) Eligibility.--To be eligible to receive a grant under this 
section, an entity shall--
            ``(1) be an accredited medical school or college of 
        osteopathic medicine; and
            ``(2) submit to the Secretary an application at such time, 
        in such manner, and containing such information as the 
        Secretary may require, including an assurance that the 
        applicant will use amounts received under the grant to--
                    ``(A) establish or enhance existing mentorship 
                programs, including--
                            ``(i) incentivizing medical school faculty 
                        (through financial or other reward systems) to 
                        participate as a mentor of other primary care 
                        physician faculty members and students;
                            ``(ii) providing resources for aspiring 
                        mentors to participate in workshops or other 
                        learning experiences in which primary care 
                        physicians can learn about effective strategies 
                        in primary care mentoring;
                            ``(iii) enabling successful primary care 
                        mentors on medical school faculty to spend time 
                        at another institution where they can promote 
                        best practices in mentoring primary care 
                        leaders and students; and
                            ``(iv) developing web-based resources for 
                        mentors to interact regularly and share 
                        successful strategies; or
                    ``(B) cultivate interest and leaders in primary 
                care among students, including--
                            ``(i) offering students that identify 
                        interest in primary care upon matriculation 
                        longitudinal experiences in primary care to 
                        care for and track the health and wellness of 
                        patients throughout medical school;
                            ``(ii) arranging partnerships with private 
                        practices, insurers, schools of public health, 
                        public health departments, and community-based 
                        service projects with the goal of providing 
                        students with the opportunity to interact with 
                        primary care mentors from a variety of health 
                        care settings;
                            ``(iii) providing stipends or other forms 
                        of financial resources to students who work 
                        with designated mentors in the field of primary 
                        care in underserved urban and rural 
                        communities; and
                            ``(iv) supporting opportunities for 
                        students to engage in practice redesign or 
                        other efforts in which primary care physicians 
                        are taking a leadership role in delivery system 
                        reform.
    ``(c) Authorization of Appropriations.--There is authorized to be 
appropriated to carry out this section $20,000,000 for each of fiscal 
years 2024 through 2030.

``SEC. 747C. DEVELOPING AND PROMOTING NEW COMPETENCIES.

    ``(a) Grants To Develop and Promote New Competencies.--In order to 
foster curricular innovations to improve the education and training of 
health care providers, the Secretary shall award grants to medical and 
other health professions schools to promote priority competencies (as 
described in subsection (b)).
    ``(b) Priority Competencies.--In awarding grants under subsection 
(a), the Secretary, acting through the Advisory Committee on Training 
in Primary Care and Dentistry, shall select an annual competency to 
direct the awarding of such grants. Such annual competencies may 
include--
            ``(1) patient-centered medical homes;
            ``(2) chronic disease management;
            ``(3) integration of primary care and mental health care;
            ``(4) integration of primary care, public and population 
        health, and health promotion;
            ``(5) cultural competency;
            ``(6) domestic violence;
            ``(7) improving care in medically undeserved areas; and
            ``(8) team-based care.
    ``(c) Grant Recipients.--The Secretary may award grants under 
subsection (a) to programs that provide education or training for--
            ``(1) physicians;
            ``(2) dentists and dental hygienists;
            ``(3) physician assistants;
            ``(4) mental and behavioral health providers;
            ``(5) public and populations health professionals; or
            ``(6) pharmacists.
    ``(d) Consideration in Evaluating Grant Applications.--The 
Secretary shall give consideration to applicants that are proposing to 
partner with other medical programs, health professions programs, or 
nursing programs.
    ``(e) Grantee Reports.--Each recipient of a grant under this 
section shall, not later than 180 days after the end of the grant 
period involved, submit to the Advisory Committee, a report on the 
following (where appropriate):
            ``(1) A description of how the funding under the grant was 
        used by the grantee.
            ``(2) A description of the intended goal of such funding.
            ``(3) A description of the challenges faced by the grantee 
        in reaching the goal described in paragraph (2).
            ``(4) A description of the lessons learned by the grantee 
        related to the grant activities.
    ``(f) Recommendations of the Advisory Committee.--The Advisory 
Committee, based on the information submitted under subsection (e), 
shall annually report to the Secretary on outcomes of the activities 
carried out under grants under this section, including specific 
recommendations for scaling up innovations to promote education and 
training of health care providers in the priority competencies 
described in subsection (b).
    ``(g) Authorization of Appropriations.--There is authorized to be 
appropriated to carry out this section $10,000,000 for each of fiscal 
years 2024 through 2028.''.

SEC. 4. STUDY ON DOCUMENTATION REQUIREMENTS FOR COGNITIVE SERVICES.

    Not later than three years after the date of enactment of this Act, 
the Institute of Medicine shall conduct a study and submit a report to 
Congress concerning the documentation requirements for cognitive 
services (evaluation and management services) required under the 
Medicare and Medicaid programs under titles XVIII and XIX of the Social 
Security Act, respectively, and through private health insurers. Such 
study shall include an evaluation of--
            (1) how documentation requirements designed for paper-based 
        records should be modified for electronic records;
            (2) whether or not the documentation requirements are 
        overly burdensome on physicians and detract from patient care;
            (3) the administrative costs to physician practices of the 
        current documentation requirements;
            (4) the average amount of time required by physicians to 
        document cognitive services;
            (5) options to more appropriately compensate physicians for 
        evaluation and management of patient care without requiring 
        excessive documentation of cognitive services; and
            (6) recommendations for less burdensome alternatives or 
        changes to existing documentation requirements of cognitive 
        services.
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