[Congressional Record Volume 144, Number 146 (Wednesday, October 14, 1998)]
[Senate]
[Page S12592]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




         HEALTH PROFESSIONS EDUCATION PARTNERSHIPS ACT OF 1998

  Mr. FRIST. Mr. President, I rise to address the Senate today on the 
passage of the Health Professions Education Partnerships Act of 1998. 
This bill reauthorizes the programs funded through Titles VII and VIII 
of the Public Health Service Act. These programs are intended to 
increase access to primary care and to improve the distribution of 
members of the health professions--physicians, dentists, pharmacists, 
nurses, and others--to underserved areas. For many years, this 
legislation has helped our nation's schools of health serve the needs 
of their communities better and prepare the health care practitioners 
of the future. This bill provides a comprehensive and flexible 
authority to support training programs for health professions and 
related community-based educational partnerships. It will improve the 
quality, diversity, and distribution of the work force.
  The Senate has worked diligently on this effort for the past four 
years. Reauthorization has been a priority since the authority expired 
for Title VII programs in 1995 and for Title VIII programs in 1994. In 
1995, Senators Kassebaum, Kennedy, and I introduced S. 555 to take the 
44 programs involved and consolidate them into six groups or clusters. 
Performance outcomes and improved data collection were added. This 
approach was used to streamline the granting process, and to allow the 
Department of Health and Human Services greater flexibility to leverage 
areas of development; and to align with community workforce needs. It 
also provided flexibility for strategic planning of the workforce 
supply, and insured that a greater percentage of program dollars would 
go directly to grantees versus federal administration.
  After this bill, S. 555, passed in the Senate but failed to pass in 
the House during the 104th Congress, I identified areas of disagreement 
and developed ways to address these obstacles. At a hearing in April 
1997, I had the opportunity to listen to concerned groups and outline 
possibilities for compromise. My staff has worked very hard to maintain 
a high level of input from constituency groups. We worked with the 
Congressional Hispanic Caucus to address their concerns. We worked to 
ensure that this bill lived up to the goal of increasing the number of 
underrepresented minorities in the health professions. We are very 
pleased that the Congressional Hispanic Caucus supports S. 1754.
  This bill enjoys broad support in the medical and public health 
community. The bill is supported by a broad range of professional 
societies for physicians, nurses, pharmacists, psychologists, dentists, 
and others.
  S. 1754 establishes a program with the flexibility to respond to 
changes in the workforce. Flexibility is built into the bill over time. 
As funding lines change, the Secretary's authority to move funds across 
program lines increases. This revision will allow programs to address 
the constantly changing health care needs of communities and respond to 
the changes in the health care delivery system.
  Since so much of the Act's flexibility is based on the discretion of 
the Secretary, we have added advisory councils to ensure that the view 
points of those providing medical services are considered. This will 
generate confidence among the grantees and encourage collaboration 
between agency officers and the programs they manage. In addition, 
these councils will report back to Congress to ensure oversight of 
these programs.
  However, flexibility alone will not result in successful targeting of 
resources. As noted by the Government Accounting Office in testimony to 
the Senate Labor Subcommittee on Public Health and Safety in April 
1997, federal efforts should be based on performance measures and 
achievement of goals. The Secretary of Health and Human Services will 
ensure that there is an annual evaluation of programs and projects 
funded through this legislation.
  It was very important to maintain the distinct and separate funding 
for nurse education--Title VIII, the ``Nursing Education and Practice 
Improvement Act of 1998.'' We wanted to increase the flexibility of the 
Department of Health and Human Services to target funding and to 
respond to the nursing workforce needs of a rapidly changing health 
care system. S. 1754 strengthens the role of the National Advisory 
Council on Nursing Education and Practice. We rewrote the duties of the 
Council so that it not only provides advice and recommendations to the 
Secretary and the Congress but also to report its findings and 
recommendations annually. In addition, S. 1754 specifies that the 
Council include representatives of advanced practice nursing groups, 
including nurse practitioners.
  The bill specifically states that authorized nurse practitioner 
programs have as their objective the education of nurses who will 
provide primary health care. For advanced practice nurse traineeships, 
the Secretary shall give special consideration to those programs that 
agree to train advanced practice nurses who will practice in health 
professional shortage areas. The amendment proposed and passed by the 
House further clarifies how funding for training for nurse midwives, 
nurse practitioners, and nurse midwives will be allocated. The 
Department of Health and Human Services, in consultation with 
individuals in the field of nursing, will develop a methodology, based 
on data, to allocate training funds. The data for this methodology will 
include the need for and distribution of services among underserved 
populations and health professional shortage areas, and the percentage 
of the population that are minorities, elderly, or below the poverty 
level. The methodology will be in place by fiscal year 2003. Until the 
methodology is developed, the funding for nurse practitioners, nurse 
midwives, and nurse anesthetists will be ``held harmless''. The House 
amendment also clarifies the use of the definition of an advanced 
practice nurse in S. 1754.
  Mr. President, this bill creates new partnerships and supports 
existing ones. It represents the best example of team work among 
interest groups, agencies and legislators. Through the goals of 
improving the distribution and quality of health professions in 
underserved areas and of simplifying the administration of existing 
programs, this bill fosters change. The Health Professions Education 
Partnerships Act of 1998 will help underserved areas meet their future 
health care needs.
  Mr. President, I am proud of our work. I would like to take this 
opportunity to specifically thank, Senators Kennedy, Jeffords, and 
Bingaman, and all their staffs for their efforts to work with us on 
this bill. I would also like to thank the interest groups which gave so 
generously of their time and support to help us address the issues 
involved. Mr. President, I especially thank Dr. Mary Moseley, Dr. Carol 
Pertowski, Dr. Debra Nichols, and Sue Ramthun of my staff for their 
dedication and hard work toward the reauthorization of these programs.

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