[Congressional Record Volume 150, Number 103 (Thursday, July 22, 2004)]
[Senate]
[Pages S8714-S8720]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. BINGAMAN:
  S. 2739. A bill to improve the training and retention of health 
professionals under titles VII and VIII of the Public Health Service 
Act, and for other purposes; to the Committee on Health, Education, 
Labor, and Pensions.
  Mr. BINGAMAN. Health care continues to be among the fastest growing 
sectors of the U.S. economy. From 1970 to 2002, the health care 
consumption doubled from 7 to 14 percent of the U.S. Gross Domestic 
Product (GDP). Employment in health occupations is projected to 
increase from 11 million in 2000 to 14 million by 2010. In that same 
period, the growth rate for new job creation in health care occupations 
is expected to be 29 percent more than double the growth projected for 
non-health occupations. Over 5.3 million people will be needed to fill 
these health-related positions. However, as a nation, we are not 
educating and training sufficient numbers of healthcare workers and 
providers, and therefore failing the American people.
  There are two ways in which we are failing our citizens. The first is 
an over-reliance on foreign healthcare workers. Instead of committing 
ourselves to training and educating Americans, we are importing large 
numbers of foreigners to meet our public health needs. For example, 25 
percent of all physicians in the U.S. are immigrants, as are 16 percent 
of all laboratory technicians. Although these foreign workers are 
filling an important void, and are both qualified and competent, 
thousands of qualified Americans wishing to pursue an education in 
healthcare fields are turned down every year. It's time we stop 
importing our skilled workers and start investing in the expansion of a 
skilled workforce in our own country. In fact, given the recent 
economic downturn, and the high level of unemployment in our country, 
preparing Americans to work in an expanding job market such as 
healthcare is the right thing to do.
  The second way in which we are failing the American people is by not 
educating and training sufficient numbers of racial and ethnic 
minorities to work in the healthcare system. The racial/ethnic 
composition of the U.S. healthcare workforce does not reflect that of 
the general population. For example, while Blacks, Hispanics, and 
Native Americans represented 26 percent of the general population in 
2002, they only represented 6 percent of physicians.
  A recent study of New Mexico healthcare professionals concluded that 
88 percent of physicians are non-Hispanic Whites, while only 6.5 
percent are Hispanic. Overall, ethnic/racial minorities are 
inadequately represented in all healthcare professions in New Mexico. 
Additionally, in my State, 21 percent of Internal Medicine Specialists 
are international medical school graduates, and so are 15 percent of 
primary care physicians.
  A recent Institute of Medicine (IOM) study described compelling 
evidence for the need to increase diversity within the health 
workforce. Diversity ensures access to healthcare for underserved 
populations and greater patient satisfaction. Many segments of the U.S. 
population, particularly minority groups, reside in medically 
underserved areas. Black and Hispanic health workers are more likely to 
provide healthcare to Black and Hispanic patients, to serve poor, 
uninsured, or Medicaid-insured patients, and to locate their practices 
in underserved

[[Page S8715]]

areas. Furthermore, racial/ethnic minority patients are more satisfied 
with their providers when they are of the same racial/ethnic group.
  It is time we invest in our healthcare workforce; in our people; in 
our future. That is why I am introducing the ``Investing in America's 
Future Act of 2004'' today. This bill has several components aimed at 
improving and expanding education and training for healthcare workers.
  This bill will provide incentives for Americans to seek and complete 
high-quality allied health education and training. It will also expand 
the Health Career Opportunities Program, which is aimed at enhancing 
the academic skills of students from disadvantaged backgrounds and 
supporting them in successfully entering and graduating from health 
professions training programs. It creates programs of excellence in 
health professions education for underrepresented minorities, and a 
health professions student loan fund for low-income and racial/ethnic 
minority students. Finally, this bill also establishes a Health Work 
Advisory Commission, charged with creating a national vision to serve 
as a map for investing in the health workforce.
  We must ensure that qualified Americans who wish to enter the health 
workforce are able to do so, and we must support the training and 
education of the generations of Americans to come. In doing so, not 
only will we help more Americans hold good jobs, but we will also 
provide better healthcare to underserved and disadvantaged groups.
  Mr. President, I ask unanimous consent that the text of this bill be 
in the Record.
  There being two objection, the bill was ordered to be printed in the 
Record, as follows:

                                S. 2739

       Be it enacted by the Senate and House of Representatives of 
     the United States of America in Congress assembled,

     SECTION 1. SHORT TITLE; TABLE OF CONTENTS.

       (a) Short Title.--This Act may be cited as the ``Investing 
     in America's Future Act of 2004''.
       (b) Table of Contents.--The table of contents of this Act 
     is as follows:

Sec. 1. Short title; table of contents.

                         TITLE I--ALLIED HEALTH

Sec. 101. Findings.
Sec. 102. Purposes.
Sec. 103. Amendments to Public Health Service Act.

             TITLE II--HEALTH WORKFORCE ADVISORY COMMISSION

Sec. 201. Health Workforce Advisory Commission.

      TITLE III--PHYSICIAN DEMONSTRATION PROJECTS IN RURAL STATES

Sec. 301. Definitions.
Sec. 302. Rural States physician recruitment and retention 
              demonstration program.
Sec. 303. Establishment of the health professions database.
Sec. 304. Evaluation and reports.
Sec. 305. Contracting flexibility.

              TITLE IV--HEALTH CAREERS OPPORTUNITY PROGRAM

Sec. 401. Purpose.
Sec. 402. Authorization of appropriations.

  TITLE V--PROGRAM OF EXCELLENCE IN HEALTH PROFESSIONS EDUCATION FOR 
                      UNDERREPRESENTED MINORITIES

Sec. 501. Purpose.
Sec. 502. Authorization of appropriation.

   TITLE VI--HEALTH PROFESSIONS STUDENT LOAN FUND; AUTHORIZATIONS OF 
    APPROPRIATIONS REGARDING STUDENTS FROM DISADVANTAGED BACKGROUNDS

Sec. 601. Student loans.
Sec. 602. National Health Service Corps; recruitment and fellowships 
              for individuals from disadvantaged backgrounds.

                  TITLE VII--MISCELLANEOUS PROVISIONS

Sec. 703. Study by the Institute of Medicine.

                         TITLE I--ALLIED HEALTH

     SEC. 101. FINDINGS.

       Congress makes the following findings:
       (1) The Bureau of the Census [and other reports] highlight 
     the increased demand for acute and chronic health care 
     services among both the general population and a rapidly 
     [growing aging portion of the population].
       (2) The calls for reduction in medical errors, increased 
     patient safety, and increased quality of care have resulted 
     in an amplified call for allied health professionals to 
     provide health care services.
       (3) Several allied health professions are characterized by 
     workforce shortages, declining enrollments in allied health 
     education programs, or a combination of both factors, and 
     hospital officials have reported vacancy rates in positions 
     occupied by allied health professionals.
       (4) Many allied health education programs are facing 
     significant economic pressure that could force their closure 
     due to an insufficient number of students.

     SEC. 102. PURPOSES.

       The purpose of this title is to ensure that the United 
     States health care industry will have a supply of allied 
     health professionals needed to support the Nation's health 
     care system in this decade and beyond by--
       (1) providing incentives for members of the United States 
     population to seek and complete high-quality allied health 
     education and training; and
       (2) providing additional funding to ensure that such 
     education and training can be provided to allied health 
     students.

     SEC. 103. AMENDMENTS TO PUBLIC HEALTH SERVICE ACT.

       (a) In General.--Part E of title VII of the Public Health 
     Service Act (42 U.S.C. 294n et seq.) is amended by adding at 
     the end the following:

                ``Subpart 3--Allied Health Professionals

     ``SEC. 775. DEFINITIONS.

       ``In this subpart:
       ``(1) Allied health education program.--The term `allied 
     health education program' means any education program at an 
     accredited institution of higher education leading to a 
     certificate, an associate's degree, a bachelor's degree, or a 
     post baccalaureate degree in an allied health profession.
       ``(2) Allied health profession.--The term `allied health 
     profession' means any profession practiced by an individual 
     in his or her capacity as an allied health professional.
       ``(3) Elementary school; secondary school.--The terms 
     `elementary school' and `secondary school' have the meanings 
     give to those terms in section 9101 of the Elementary and 
     Secondary Education Act of 1965 (20 U.S.C. 7801).
       ``(4) Institution of higher education.--The term 
     `institution of higher education' has the meaning given to 
     that term in section 101 of the Higher Education Act of 1965 
     (20 U.S.C. 1001).

     ``SEC. 775A. PUBLIC SERVICE ANNOUNCEMENTS.

       ``The Secretary shall develop and issue public service 
     announcements that advertise and promote the allied health 
     professions, highlight the advantages and rewards of the 
     allied health professions, and encourage individuals from 
     disadvantaged communities and backgrounds to enter the allied 
     health professions.

     ``SEC. 775B. STATE AND LOCAL PUBLIC SERVICE ANNOUNCEMENTS.

       ``(a) In General.--The Secretary shall award grants to 
     eligible entities to support State and local advertising 
     campaigns through appropriate media outlets to promote the 
     allied health professions, highlight the advantages and 
     rewards of the allied health professions, and encourage 
     individuals from disadvantaged communities and backgrounds to 
     enter the allied health professions.
       ``(b) Eligible Entity.--In this section, the term `eligible 
     entity' means an entity that is--
       ``(1) a professional, national, or State allied health 
     association;
       ``(2) a State health care provider; or
       ``(3) an association of entities that are each a health 
     care facility, an allied health education program, [or an 
     entity that provides similar services or serves a like 
     function].

     ``SEC. 775C. ALLIED HEALTH RECRUITMENT GRANT PROGRAM.

       ``(a) Program Authorized.--The Secretary shall award grants 
     to eligible entities to increase allied health professions 
     education opportunities.
       ``(b) Eligible Entity.--In this section, the term `eligible 
     entity' means an entity that is--
       ``(1) a professional, national, or State allied health 
     association;
       ``(2) a State health care provider; or
       ``(3) an association of entities that are each a health 
     care facility, an allied health education program, [or an 
     entity that provides similar services or serves a like 
     function].
       ``(c) Use of Funds.--An eligible entity that receives a 
     grant under this section shall use funds received under such 
     grant to--
       ``(1) support outreach programs at elementary schools and 
     secondary schools that inform guidance counselors and 
     students of education opportunities regarding the allied 
     health professions;
       ``(2) carry out special projects to increase allied health 
     professions education opportunities for individuals who are 
     from disadvantaged backgrounds (including racial and ethnic 
     minorities underrepresented in the allied health professions) 
     by providing student scholarships or stipends, pre-entry 
     preparation, and retention activities;
       ``(3) provide assistance to public and nonprofit private 
     educational institutions to support remedial education 
     programs for allied health professions students who require 
     assistance with math, science, English, and medical 
     terminology;
       ``(4) meet the costs of child care and transportation for 
     individuals who are taking part in an allied health education 
     program; or
       ``(5) support community-based partnerships seeking to 
     recruit allied health professionals in rural communities, 
     urban medically underserved communities, and other 
     communities experiencing an allied health professions 
     shortage.

     ``SEC. 775D. GRANTS FOR HEALTH CAREER ACADEMIES.

       ``(a) In General.--The Secretary shall award grants to 
     eligible entities for the purpose of assisting such entities 
     in collaborating to carry out programs that form education 
     pipelines to facilitate the entry of

[[Page S8716]]

     students of secondary schools, especially underrepresented 
     racial and ethnic minorities, into careers in the allied 
     health professions.
       ``(b) Eligible Entity.--In this section, the term `eligible 
     entity' means an institution that offers an allied health 
     education program, a health care facility, or a secondary 
     school.

     ``SEC. 775E. ALLIED HEALTH PROFESSION, PRACTICE, AND 
                   RETENTION GRANTS.

       ``(a) Education Priority Areas.--The Secretary may award 
     grants to or enter into contracts with eligible entities 
     for--
       ``(1) expanding the enrollment in allied health profession 
     education programs, especially by underrepresented racial and 
     ethnic minority students; and
       ``(2) providing allied health education through new 
     technologies and methods, including distance learning 
     methodologies.
       ``(b) Practice Priority Areas.--The Secretary may award 
     grants to or enter into contracts with eligible entities 
     for--
       ``(1) establishing or expanding allied health professions 
     practice arrangements in noninstitutional settings to 
     demonstrate methods to improve access to primary health care 
     in rural areas and other medically underserved communities;
       ``(2) providing care for underserved populations and other 
     high-risk groups such as the elderly, individuals with HIV/
     AIDS, substance abusers, the homeless, and victims of 
     domestic violence;
       ``(3) providing managed care, information management, 
     quality improvement, and other skills needed to practice in 
     existing and emerging organized health care systems; or
       ``(4) developing generational and cultural competencies 
     among allied health professionals.
       ``(c) Retention Priority Areas.--
       ``(1) In general.--The Secretary may award grants to and 
     enter into contracts with eligible entities to enhance the 
     allied health professions workforce by initiating and 
     maintaining allied health retention programs pursuant to 
     paragraph (2) or (3).
       ``(2) Grants for career ladder programs.--The Secretary may 
     award grants to and enter into contracts with eligible 
     entities for programs--
       ``(A) to promote career advancement for allied health 
     professionals in a variety of training settings, cross 
     training or specialty training among diverse population 
     groups, and the advancement of individuals; and
       ``(B) to assist individuals in obtaining education and 
     training required to enter the allied health professions and 
     advance within such professions, such as by providing career 
     counseling and mentoring.
       ``(3) Enhancing patient care delivery systems.--
       ``(A) Grants.--The Secretary may award grants to eligible 
     entities to improve the retention of allied health 
     professionals and enhance patient care that is directly 
     related to allied health activities by enhancing 
     collaboration and communication among allied health 
     professionals and other health care professionals, and by 
     promoting the involvement of allied health professionals in 
     the organizational and clinical decisionmaking processes of a 
     health care facility.
       ``(B) Preference.--In making awards of grants under this 
     paragraph, the Secretary shall give preference to applicants 
     that have not previously received an award under this 
     paragraph and to applicants from rural, underserved areas.
       ``(C) Continuation of an award.--The Secretary shall make 
     continuation of any award under this paragraph beyond the 
     second year of such award contingent on the recipient of such 
     award having demonstrated to the Secretary measurable and 
     substantive improvement in allied health professional 
     retention or patient care.
       ``(d) Eligible Entity.--In this section, the term `eligible 
     entity' means a health care facility, or any partnership or 
     coalition including a health care facility or an allied 
     health education program.

     ``SEC. 775F. DEVELOPING MODELS AND BEST PRACTICES PROGRAM.

       ``(a) Models and Best Practices.--
       ``(1) Grants.--The Secretary shall award grants to eligible 
     entities to enable such entities to carry out demonstrations 
     of models and best practices in allied health for the purpose 
     of developing innovative strategies or approaches for the 
     retention of allied health professionals.
       ``(2) Distribution of grants.--The Secretary shall ensure 
     the distribution of grants under this subsection to a range 
     of types and sizes of facilities, including facilities 
     located in rural, urban, and suburban areas and a variety of 
     geographic regions.
       ``(3) Use of fund.--The Secretary may not make a grant to 
     an eligible entity under this subsection unless the entity 
     agrees to use funds received under the grant to carry out 
     demonstrations of models and best practices in allied health 
     for the purpose of--
       ``(A) promoting retention and satisfaction of allied health 
     professionals;
       ``(B) promoting opportunities for allied health 
     professionals to pursue education, career advancement, and 
     organizational recognition; and
       ``(C) developing continuing education programs that 
     instruct allied health professionals on how to use emerging 
     medical technologies and how to address current and future 
     health care needs.
       ``(b) Models of Excellence.--The Secretary shall award 
     grants to [area health education centers] to enable such 
     centers to enter into contracts with allied health education 
     programs--
       ``(1) to expand the operation of area health education 
     centers to work in communities to develop models of 
     excellence for allied health professionals; or
       ``(2) to expand any junior or senior secondary school 
     mentoring programs to include an allied health professions 
     mentoring program.
       ``(c) Definition.--In this section the term `eligible 
     entity' means a health care facility, or any partnership or 
     coalition containing a health care facility and an allied 
     health education program.

     ``SEC. 775G. ALLIED HEALTH FACULTY LOAN PROGRAM.

       ``(a) Establishment.--The Secretary, acting through the 
     Administrator of the Health Resources and Services 
     Administration, may enter into an agreement with any 
     institution of higher education offering an allied health 
     education program for the establishment and operation of a 
     faculty loan fund in accordance with this section, to 
     increase the number of qualified allied health faculty.
       ``(b) Agreements.--Each agreement entered into under this 
     section shall--
       ``(1) provide for the establishment of a loan fund by the 
     institution involved;
       ``(2) provide for deposit in the fund of--
       ``(A) the Federal capital contributions to the fund;
       ``(B) an amount equal to not less than one-ninth of such 
     Federal capital contributions, contributed by such 
     institution;
       ``(C) collections of principal and interest on loans made 
     from the fund; and
       ``(D) any other earnings of the fund;
       ``(3) provide that the fund will be used only for loans to 
     faculty of allied health education programs in accordance 
     with subsection (c) and for the costs of collection of such 
     loans and interest thereon;
       ``(4) provide that loans may be made from such fund only to 
     faculty pursuing a full-time course of study or, at the 
     discretion of the Secretary, a part-time course of study in 
     an advanced degree program; and
       ``(5) contain such other provisions as are necessary to 
     protect the financial interests of the United States.
       ``(c) Loan Provisions.--Loans from any faculty loan fund 
     established by an institution pursuant to an agreement under 
     this section shall be made to an individual on such terms and 
     conditions as the institution may determine, except that--
       ``(1) such terms and conditions are subject to any 
     conditions, limitations, and requirements prescribed by the 
     Secretary;
       ``(2) in the case of any individual, the total of the loans 
     for any academic year made by an institution from loan funds 
     established pursuant to agreements under this section may not 
     exceed $30,000, plus any amount determined by the Secretary 
     on an annual basis to reflect inflation;
       ``(3) an amount up to 85 percent of any such loan (plus 
     interest thereon) shall be canceled by the institution as 
     follows--
       ``(A) upon completion by the individual of each of the 
     first, second, and third year of full-time employment 
     required by the loan agreement entered into under this 
     section, as a faculty member in an allied health education 
     program, the institution shall cancel __ percent of the 
     principal of, and the interest on, the amount of such loan 
     unpaid on the first day of such employment; and
       ``(B) upon completion by the individual of the fourth year 
     of full-time employment, required by the loan agreement 
     entered into under this section, as a faculty member in an 
     allied health education program, the school shall cancel 25 
     percent of the principal of, and the interest on, the amount 
     of such loan unpaid on the first day of such employment;
       ``(4) such a loan may be used to pay the cost of tuition, 
     fees, books, laboratory expenses, and other reasonable 
     education expenses;
       ``(5) such a loan shall be repayable in equal or graduated 
     periodic installments (with the right of the borrower to 
     accelerate repayment) over the 10-year period that begins 9 
     months after the individual ceases to pursue a course of 
     study in an allied health education program; and
       ``(6) such a loan shall--
       ``(A) beginning on the date that is 3 months after the 
     individual ceases to pursue a course of study in an allied 
     health education program, bear interest on the unpaid balance 
     of the loan at the rate of 3 percent per annum; or
       ``(B) subject to subsection (e), if the institution 
     determines that the individual will not complete such course 
     of study or serve as a faculty member as required under the 
     loan agreement under this subsection, bear interest on the 
     unpaid balance of the loan at the prevailing market rate.
       ``(d) Payment of Proportionate Share.--Where all or any 
     part of a loan, or interest, is canceled under this section, 
     the Secretary shall pay to the institution and amount equal 
     to the school's proportionate share of the canceled portion, 
     as determined by the Secretary.
       ``(e) Review by Secretary.--At the request of the 
     individual involved, the Secretary may review any 
     determination by an institution under this section.

     ``SEC. 775H. SCHOLARSHIP PROGRAM FOR SERVICE IN RURAL AND 
                   OTHER MEDICALLY UNDER-SERVED AREAS.

       ``(a) Scholarship Program.--
       ``(1) In general.--The Secretary shall carry out a program 
     of entering into contracts with eligible individuals under 
     which such individuals agree to serve as allied

[[Page S8717]]

     health professionals for a period of not less than 2 years at 
     a health care facility with a critical shortage of allied 
     health professionals in consideration of the Federal 
     Government agreeing to provide to the individuals 
     scholarships for attendance in an allied health education 
     program.
       ``(2) Eligible individuals.--In this subsection, the term 
     `eligible individual' means an individual who is enrolled or 
     accepted for enrollment as a full-time or part-time student 
     in an allied health education program.
       ``(3) Service requirement.--
       ``(A) In general.--The Secretary may not enter into a 
     contract with an eligible individual under this section 
     unless the individual agrees to serve as an allied health 
     professional at a health care facility with a critical 
     shortage of allied health professionals for a period of full-
     time service of not less than 2 years, or for a period of 
     part-time service in accordance with subparagraph (B).
       ``(B) Part-time service.--An individual may complete the 
     period of service described in subparagraph (A) on a part-
     time basis if the individual has a written agreement that--
       ``(i) is entered into by the health care facility involved 
     and the individual and is approved by the Secretary; and
       ``(ii) provides that the period of obligated service will 
     be extended so that the aggregate amount of service performed 
     will equal the amount of service that would be performed 
     through a period of full-time service of not less than 2 
     years.
       ``(4) Preference.--In awarding scholarships under this 
     section, the Secretary shall give a preference to applicants 
     with the greatest financial need, applicants currently 
     working in a health care facility who agree to serve the 
     period of obligated service at such facility, minority allied 
     health applicants, and applicants with an interest in a 
     practice area of allied health that has unmet needs.
       ``(b) Reports.--Not later than 18 months after the date of 
     enactment of this subpart and annually thereafter, the 
     Secretary shall prepare and submit to Congress a report 
     describing the programs carried out under this section, 
     including statements regarding--
       ``(1) the number of enrollees by specialty or discipline, 
     scholarships, and grant recipients;
       ``(2) the number of graduates;
       ``(3) the amount of scholarship payments made;
       ``(4) which educational institutions the recipients 
     attended;
       ``(5) the number and placement location of the scholarship 
     recipients at health care facilities with a critical shortage 
     of allied health professionals;
       ``(6) the default rate and actions required;
       ``(7) the amount of outstanding default funds of the 
     scholarship program;
       ``(8) to the extent that it can be determined, the reason 
     for the default;
       ``(9) the demographics of the individuals participating in 
     the scholarship program; and
       ``(10) an evaluation of the overall costs and benefits of 
     the program.

     ``SEC. 775I. GRANTS FOR CLINICAL EDUCATION, INTERNSHIP, 
                   RESIDENCY PROGRAMS, AND CONTINUING EDUCATION.

       ``(a) Program Authorized.--The Secretary shall award grants 
     to eligible entities to develop allied health clinical 
     education, internship, residency, and continuing education 
     programs described in subsection (b).
       ``(b) Use of Funds.--The Secretary may not award a grant to 
     an eligible entity under this section unless the entity 
     agrees to use the grant to develop clinical education, 
     internship, residency, and continuing education programs for 
     graduates of allied health education programs. Each such 
     clinical education, internship, residency, or continuing 
     education program shall--
       ``(1) provide support for allied health education program 
     faculty and mentors;
       ``(2) provide support for allied health professionals 
     participating on a full-time or a part-time basis; and
       ``(3) encourage the development of specialties.
       ``(c) Eligible Entity.--In this section, the term `eligible 
     entity' means a partnership of an allied health education 
     program and a health care facility.

     ``SEC. 775J. GRANTS FOR PARTNERSHIPS.

       ``(a) In General.--The Secretary shall award grants to 
     eligible entities to enable such entities to form 
     partnerships to carry out the activities described in this 
     section.
       ``(b) Use of Funds.--An eligible entity that receives a 
     grant under this section shall use amounts received under the 
     grant to--
       ``(1) provide employees of the health care facility 
     involved advanced training and education in an allied health 
     education program;
       ``(2) establish or expand allied health practice 
     arrangements in noninstitutional settings to demonstrate 
     methods to improve access to health care in rural and other 
     medically underserved communities;
       ``(3) purchase distance learning technology to extend 
     general education and training programs to rural areas, and 
     to extend specialty education and training programs to all 
     areas; and
       ``(4) establish or expand mentoring, clinical education, 
     and internship programs for training in specialty care areas.
       ``(c) Eligible Entity.--In this section, the term `eligible 
     entity' means a partnership of an allied health education 
     program and a health care facility formed to carry out the 
     activities described in this section.

     ``SEC. 775K. ALLIED HEALTH WORKFORCE DATA COLLECTION AND 
                   ANALYSIS.

       ``The Secretary, in conjunction with allied health 
     professional associations, shall develop a system for 
     collecting and analyzing allied health workforce data 
     gathered by the Bureau of Labor Statistics, the Health 
     Resources and Services Administration, the Department of 
     Health and Human Services, the Department of Veterans 
     Affairs, the Center for Medicare & Medicaid Services, the 
     Department of Defense, allied health professional 
     associations, and regional centers for health workforce 
     studies for the purpose of--
       ``(1) determining educational pipeline and practitioner 
     shortages; and
       ``(2) projecting future needs for such a workforce.

     ``SEC. 775L. REPORTS BY GOVERNMENT ACCOUNTABILITY OFFICE.

       ``The Comptroller General of the United States shall 
     conduct an evaluation of whether the activities carried out 
     under this subpart have demonstrably increased the number of 
     applicants to allied health education programs. Not later 
     than 4 years after the date of the enactment of this subpart, 
     the Comptroller General shall submit a report to the Congress 
     on the results of such evaluation.

     ``SEC. 775M. AUTHORIZATION OF APPROPRIATIONS.

       ``There are authorized to be appropriated to carry out this 
     subpart, such sums as may be necessary for fiscal years 2005 
     through 2009.''.
       (b) Centers of Excellence.--Subparagraph (A) of section 
     736(g)(1) of the Public Health Service Act (42 U.S.C. 
     293(g)(1)) is amended by inserting ``a school of allied 
     health,'' after ``a school of pharmacy,''.

             TITLE II--HEALTH WORKFORCE ADVISORY COMMISSION

     SEC. 201. HEALTH WORKFORCE ADVISORY COMMISSION.

       (a) Establishment.--The Comptroller General of the United 
     States (referred to in this title as the ``Comptroller 
     General'') shall establish a commission to be known as the 
     Health Workforce Advisory Commission (referred to in this 
     title as the ``Commission'').
       (b) Membership.--
       (1) In general.--The Commission shall be composed of 18 
     members to be appointed by the Comptroller General not later 
     than 90 days after the date of enactment of this Act, and an 
     ex-officio member who shall serve as the Director of the 
     Commission.
       (2) Qualifications.--In appointing members to the 
     Commission under paragraph (1), the Comptroller General shall 
     ensure that--
       (A) the Commission includes individuals with national 
     recognition for their expertise in health care workforce 
     issues, including workforce forecasting, undergraduate and 
     graduate training, economics, health care and health care 
     systems financing, public health policy, and other fields;
       (B) the members are geographically representative of the 
     United States and maintain a balance between urban and rural 
     representatives;
       (C) the members include a representative from the 
     commissioned corps of the Public Health Service;
       (D) the members represent the spectrum of professions in 
     the current and future healthcare workforce, including 
     physicians, nurses, and other health professionals and 
     personnel, and are skilled in the conduct and interpretation 
     of health workforce measurement, monitoring and analysis, 
     health services, economics, and other workforce related 
     research and technology assessment;
       (E) at least 25 percent of the members who are health care 
     providers are from rural areas; and
       (F) a majority of the members are individuals who are not 
     currently primarily involved in the provision or management 
     of health professions education and training programs.
       (3) Terms and vacancies.--
       (A) Terms.--The term of service of the members of the 
     Commission shall be for 3 years, except that the Comptroller 
     General shall designate staggered terms for members initially 
     appointed under paragraph (1).
       (B) Vacancies.--Any member of the Commission who is 
     appointed to fill a vacancy on the Commission that occurs 
     before the expiration of the term for which the member's 
     predecessor was appointed shall be appointed only for the 
     remainder of that term.
       (4) Chairperson.--
       (A) Designation.--The Comptroller General shall designate a 
     member of the Commission, at the time of the appointment of 
     such member--
       (i) to serve as the Chairperson of the Commission; and
       (ii) to serve as the Vice Chairperson of the Commission.
       (B) Term.--A member of the Commission shall serve as the 
     Chairperson or Vice Chairperson of the Commission under 
     subparagraph (A) for the term of such member.
       (C) Vacancy.--In the case of a vacancy in the 
     Chairpersonship or Vice Chairpersonship, the Comptroller 
     General shall designate another member to serve for the 
     remainder of the vacant member's term.
       (c) Duties.--The Commission shall--
       (1) review the health workforce policies implemented--
       (A) under titles XVIII and XIX of the Social Security Act 
     (42 U.S.C. 1395, 1396 et seq.);
       (B) under titles VII and VIII of the Public Health Service 
     Act (42 U.S.C. 292, 296 et seq.);

[[Page S8718]]

       (C) by the National Institutes of Health;
       (D) by the Department of Health and Human Services;
       (E) by the Department of Veterans Affairs; and
       (F) by other departments and agencies as appropriate;
       (2) analyze and make recommendations to improve the methods 
     used to measure and monitor the health workforce and the 
     relationship between the number and make up of such personnel 
     and the access of individuals to appropriate health care;
       (3) review the impact of health workforce policies and 
     other factors on the ability of the health care system to 
     provide optimal medical and health care services;
       (4) analyze and make recommendations pertaining to Federal 
     incentives (financial, regulatory, and otherwise) and Federal 
     programs that are in place to promote the education of an 
     appropriate number and mix of health professionals to provide 
     access to appropriate health care in the United States;
       (5) analyze and make recommendations about the appropriate 
     supply and distribution of physicians, nurses, and other 
     health professionals and personnel to achieve a health care 
     system that is safe, effective, patient centered, timely, 
     equitable, and efficient;
       (6) analyze the role and global implications of 
     internationally trained physicians, nurses, and other health 
     professionals and personnel in the United States health 
     workforce;
       (7) analyze and make recommendations about achieving 
     appropriate diversity in the United States health workforce;
       (8) conduct public meetings to discuss health workforce 
     policy issues and help formulate recommendations for Congress 
     and the Secretary of Health and Human Services;
       (9) in the course of meetings conducted under paragraph 
     (8), consider the results of staff research, presentations by 
     policy experts, and comments from interested parties;
       (10) make recommendations to Congress concerning health 
     workforce policy issues;
       (11) not later than April 15, 2005, and each April 15 
     thereafter, submit a report to Congress containing the 
     results of the reviews conducted under this subsection and 
     the recommendations developed under this subsection;
       (12) periodically, as determined appropriate by the 
     Commission, submit reports to Congress concerning specific 
     issues that the Commission determines are of high importance; 
     and
       (13) carry out any other activities determined appropriate 
     by the Secretary of Health and Human Services.
       (d) Ongoing Duties Concerning Reports and Reviews.--
       (1) Commenting on reports.--
       (A) Submission to commission.--The Secretary of Health and 
     Human Services shall transmit to the Commission a copy of 
     each report that is submitted by the Secretary to Congress if 
     such report is required by law and relates to health 
     workforce policy.
       (B) Review.--The Commission shall review a report 
     transmitted under subparagraph (A) and, not later than 6 
     months after the date on which the report is transmitted, 
     submit to the appropriate committees of Congress written 
     comments concerning such report. Such comments may include 
     such recommendations as the Commission determines 
     appropriate.
       (2) Agenda and additional reviews.--
       (A) In general.--The Commission shall consult periodically 
     with the chairman and ranking members of the appropriate 
     committees of Congress concerning the agenda and progress of 
     the Commission.
       (B) Additional reviews.--The Commission may from time to 
     time conduct additional reviews and submit additional reports 
     to the appropriate committees of Congress on topics relating 
     to Federal health workforce-related programs and as may be 
     requested by the chairman and ranking members of such 
     committees.
       (3) Availability of reports.--The Commission shall transmit 
     to the Secretary of Health and Human Services a copy of each 
     report submitted by the Commission under this section and 
     shall make such reports available to the public.
       (e) Powers of the Commission.--
       (1) General powers.--Subject to such review as the 
     Comptroller General determines to be necessary to ensure the 
     efficient administration of the Commission, the Commission 
     may--
       (A) employ and fix the compensation of the Executive 
     Director and such other personnel as may be necessary to 
     carry out its duties;
       (B) seek such assistance and support as may be required in 
     the performance of its duties from appropriate Federal 
     departments and agencies;
       (C) enter into contracts or make other arrangements as may 
     be necessary for the conduct of the work of the Commission;
       (D) make advance, progress, and other payments that relate 
     to the work of the Commission;
       (E) provide transportation and subsistence for personnel 
     who are serving without compensation; and
       (F) prescribe such rules and regulations at the Commission 
     determines necessary with respect to the internal 
     organization and operation of the Commission.
       (2) Information.--To carry out its duties under this 
     section, the Commission--
       (A) shall have unrestricted access to all deliberations, 
     records, and nonproprietary data maintained by the Government 
     Accountability Office;
       (B) may secure directly from any department or agency of 
     the United States information necessary to enable the 
     Commission to carry out its duties under this section, on a 
     schedule that is agreed upon between the Chairperson and the 
     head of the department or agency involved;
       (C) shall utilize existing information (published and 
     unpublished) collected and assessed either by the staff of 
     the Commission or under other arrangements;
       (D) may conduct, or award grants or contracts for the 
     conduct of, original research and experimentation where 
     information available under subparagraphs (A) and (B) is 
     inadequate;
       (E) may adopt procedures to permit any interested party to 
     submit information to be used by the Commission in making 
     reports and recommendations under this section; and
       (F) may carry out other activities determined appropriate 
     by the Commission.
       (f) Administrative Provisions.--
       (1) Compensation.--While serving on the business of the 
     Commission a member of the Commission shall be entitled to 
     compensation at the per diem equivalent of the rate provided 
     for under level IV of the Executive Schedule under title 5, 
     United States Code.
       (2) Meetings.--The Commission shall meet at the call of the 
     Chairperson.
       (3) Executive director and staff.--The Comptroller General 
     shall appoint an individual to serve as the interim Executive 
     Director of the Commission until the members of the 
     Commission are able to select a permanent Executive Director 
     under subsection (e)(1)(A).
       (4) Ethical disclosure.--The Comptroller General shall 
     establish a system for public disclosure by members of the 
     Commission of financial and other potential conflicts of 
     interest relating to such members.
       (5) Audits.--The Commission shall be subject to periodic 
     audit by the Comptroller General.
       (g) Funding.--
       (1) Requests.--The Commission shall submit requests for 
     appropriations in the same manner as the Comptroller General 
     submits such requests. Amounts appropriated for the 
     Commission shall be separate from amounts appropriated for 
     the Comptroller General.
       (2) Authorization of appropriations.--There are authorized 
     to be appropriated to carry out this section, $6,000,000 for 
     fiscal year 2005, and such sums as may be necessary for each 
     subsequent fiscal year, of which--
       (A) 80 percent of such appropriated amount shall be made 
     available from the Federal Hospital Insurance Trust Fund 
     under section 1817 of the Social Security Act (42 U.S.C. 
     1395i); and
       (B) 20 percent of such appropriated amount shall be made 
     available from amounts appropriated to carry out title XIX of 
     such Act (42 U.S.C. 1396 et seq.).
       (h) Definition.--In this title, the term ``appropriate 
     committees of Congress'' means the Committee on Finance of 
     the Senate and the Committee on Ways and Means of the House 
     of Representatives.

      TITLE III--PHYSICIAN DEMONSTRATION PROJECTS IN RURAL STATES

     SEC. 301. DEFINITIONS.

       In this title:
       (1) COGME.--The term ``COGME'' means the Council on 
     Graduate Medical Education established under section 762 of 
     the Public Health Service Act (42 U.S.C. 294o).
       (2) Demonstration program.--The term ``demonstration 
     program'' means the Rural States Physician Recruitment and 
     Retention Demonstration Program established by the Secretary 
     under section 302(a).
       (3) Demonstration states.--The term ``demonstration 
     States'' means each State identified by the Secretary, based 
     upon data from the most recent year for which data are 
     available--
       (A) that has an uninsured population above 16 percent (as 
     determined by the Bureau of the Census);
       (B) for which the sum of the number of individuals who are 
     entitled to benefits under the medicare program under title 
     XVIII of the Social Security Act (42 U.S.C. 1395 et seq.) and 
     the number of individuals who are eligible for medical 
     assistance under the medicaid program under title XIX of such 
     Act (42 U.S.C. 1396 et seq.) equals or exceeds 20 percent of 
     the total population of the State (as determined by the 
     Centers for Medicare & Medicaid Services); and
       (C) that has an estimated number of individuals in the 
     State without access to a primary care provider of at least 
     17 percent (as published in ``HRSA's Bureau of Primary Health 
     Care: BPHC State Profiles'').
       (4) Eligible residency or fellowship graduate.--The term 
     ``eligible residency or fellowship graduate'' means a 
     graduate of an approved medical residency training program 
     (as defined in section 1886(h)(5)(A) of the Social Security 
     Act (42 U.S.C. 1395ww(h)(5)(A))) in a shortage physician 
     specialty.
       (5) Health professions database.--The term ``Health 
     Professions Database'' means the database established under 
     section 303(a).
       (6) Medicare program.--The term ``medicare program'' means 
     the health benefits program under title XVIII of the Social 
     Security Act (42 U.S.C. 1395 et seq.).
       (7) MedPAC.--The term ``MedPAC'' means the Medicare Payment 
     Advisory Commission established under section 1805 of the 
     Social Security Act (42 U.S.C. 1395b-6).
       (8) Secretary.--The term ``Secretary'' means the Secretary 
     of Health and Human Services.

[[Page S8719]]

       (9) Shortage physician specialty.--The term ``shortage 
     physician specialty'' means a medical or surgical specialty 
     identified in a demonstration State by the Secretary based 
     on--
       (A) an analysis and comparison of national data and 
     demonstration State data; and
       (B) recommendations from appropriate Federal, State, and 
     private commissions, centers, councils, medical and surgical 
     physician specialty boards, and medical societies or 
     associations involved in physician workforce, education and 
     training, and payment issues.

     SEC. 302. RURAL STATES PHYSICIAN RECRUITMENT AND RETENTION 
                   DEMONSTRATION PROGRAM.

       (a) Establishment.--
       (1) In general.--The Secretary shall establish a Rural 
     States Physician Recruitment and Retention Demonstration 
     Program for the purpose of ameliorating physician shortage, 
     recruitment, and retention problems in rural States in 
     accordance with the requirements of this section.
       (2) Consultation.--For purposes of establishing the 
     demonstration program, the Secretary shall consult with--
       (A) COGME;
       (B) MedPAC;
       (C) a representative of each demonstration State medical 
     society or association;
       (D) the health workforce planning and physician training 
     authority of each demonstration State; and
       (E) any other entity described in section 301(9)(B).
       (b) Duration.--The Secretary shall conduct the 
     demonstration program for a period of 10 years.
       (c) Conduct of Program.--
       (1) Funding of additional residency and fellowship 
     positions.--
       (A) In general.--As part of the demonstration program, the 
     Secretary (acting through the Administrator of the Centers 
     for Medicare & Medicaid Services) shall--
       (i) notwithstanding section 1886(h)(4)(F) of the Social 
     Security Act (42 U.S.C. 1395ww(h)(4)(F)) increase, by up to 
     50 percent of the total number of residency and fellowship 
     positions approved at each medical residency training program 
     in each demonstration State, the number of residency and 
     fellowship positions in each shortage physician specialty; 
     and
       (ii) subject to subparagraph (C), provide funding under 
     subsections (d)(5)(B) and (h) of section 1886 of the Social 
     Security Act (42 U.S.C. 1395ww) for each position added under 
     clause (i).
       (B) Establishment of additional positions.--
       (i) Identification.--The Secretary shall identify each 
     additional residency and fellowship position created as a 
     result of the application of subparagraph (A).
       (ii) Negotiation and consultation.--The Secretary shall 
     negotiate and consult with representatives of each approved 
     medical residency training program in a demonstration State 
     at which a position identified under clause (i) is created 
     for purposes of supporting such position.
       (C) Contracts with sponsoring institutions.--
       (i) In general.--The Secretary shall condition the 
     availability of funding for each residency and fellowship 
     position identified under subparagraph (B)(i) on the 
     execution of a contract containing such provisions as the 
     Secretary determines are appropriate, including the provision 
     described in clause (ii) by each sponsoring institution.
       (ii) Provision described.--

       (I) In general.--Except as provided in subclause (II), the 
     provision described in this clause is a provision that 
     provides that, during the residency or fellowship, the 
     resident or fellow shall spend not less than 10 percent of 
     the training time providing specialty services to underserved 
     and rural community populations other than an underserved 
     population of the sponsoring institution.
       (II) Exceptions.--The Secretary, in consultation with 
     COGME, shall identify shortage physician specialties and 
     subspecialties for which the application of the provision 
     described in subclause (I) would be inappropriate and the 
     Secretary may waive the requirement under clause (i) that 
     such provision be included in the contract of a resident or 
     fellow with such a specialty or subspecialty.

       (D) Limitations.--
       (i) Period of payment.--The Secretary may not fund any 
     residency or fellowship position identified under 
     subparagraph (B)(i) for a period of more than 5 years.
       (ii) Reassessment of need.--The Secretary shall reassess 
     the status of the shortage physician specialty in the 
     demonstration State prior to entering into any contract under 
     subparagraph (C) after the date that is 5 years after the 
     date on which the Secretary establishes the demonstration 
     program.
       (2) Loan repayment and forgiveness program.--
       (A) In general.--As part of the demonstration program, the 
     Secretary (acting through the Administrator of the Health 
     Resources and Services Administration) shall establish a loan 
     repayment and forgiveness program, through the holder of the 
     loan, under which the Secretary assumes the obligation to 
     repay a qualified loan amount for an educational loan of an 
     eligible residency or fellowship graduate--
       (i) for whom the Secretary has approved an application 
     submitted under subparagraph (D); and
       (ii) with whom the Secretary has entered into a contract 
     under subparagraph (C).
       (B) Qualified loan amount.--
       (i) In general.--Subject to clause (ii), the Secretary 
     shall repay the lesser of--

       (I) 25 percent of the loan obligation of a graduate on a 
     loan that is outstanding during the period that the eligible 
     residency or fellowship graduate practices in the area 
     designated by the contract entered into under subparagraph 
     (C); or
       (II) $25,000 per graduate per year of such obligation 
     during such period.

       (ii) Limitation.--The aggregate amount under this 
     subparagraph may not exceed $125,000 for any graduate and the 
     Secretary may not repay or forgive more than 30 loans per 
     year in each demonstration State under this paragraph.
       (C) Contracts with residents and fellows.--
       (i) In general.--Each eligible residency or fellowship 
     graduate desiring repayment of a loan under this paragraph 
     shall execute a contract containing the provisions described 
     in clause (ii).
       (ii) Provisions.--The provisions described in this clause 
     are provisions that require the eligible residency or 
     fellowship graduate--

       (I) to practice in a health professional shortage area of a 
     demonstration State during the period in which a loan is 
     being repaid or forgiven under this section; and
       (II) to provide health services relating to the shortage 
     physician specialty of the graduate that was funded with the 
     loan being repaid or forgiven under this section during such 
     period.

       (D) Application.--
       (i) In general.--Each eligible residency or fellowship 
     graduate desiring repayment of a loan under this paragraph 
     shall submit an application to the Secretary at such time, in 
     such manner, and accompanied by such information as the 
     Secretary may reasonably require.
       (ii) Reassessment of need.--The Secretary shall reassess 
     the shortage physician specialty in the demonstration State 
     prior to accepting an application for repayment of any loan 
     under this paragraph after the date that is 5 years after the 
     date on which the demonstration program is established.
       (E) Construction.--Nothing in the section shall be 
     construed to authorize any refunding of any repayment of a 
     loan.
       (F) Prevention of double benefits.--No borrower may, for 
     the same service, receive a benefit under both this paragraph 
     and any loan repayment or forgiveness program under title VII 
     of the Public Health Service Act (42 U.S.C. 292 et seq.).
       (d) Waiver of Medicare Requirements.--The Secretary is 
     authorized to waive any requirement of the medicare program, 
     or approve equivalent or alternative ways of meeting such a 
     requirement, if such waiver is necessary to carry out the 
     demonstration program, including the waiver of any limitation 
     on the amount of payment or number of residents under section 
     1886 of the Social Security Act (42 U.S.C. 1395ww).
       (e) Appropriations.--
       (1) Funding of additional residency and fellowship 
     positions.--Any expenditures resulting from the establishment 
     of the funding of additional residency and fellowship 
     positions under subsection (c)(1) shall be made from the 
     Federal Hospital Insurance Trust Fund under section 1817 of 
     the Social Security Act (42 U.S.C. 1395i).
       (2) Loan repayment and forgiveness program.--There are 
     authorized to be appropriated such sums as may be necessary 
     to carry out the loan repayment and forgiveness program 
     established under subsection (c)(2).

     SEC. 303. ESTABLISHMENT OF THE HEALTH PROFESSIONS DATABASE.

       (a) Establishment of the Health Professions Database.--
       (1) In general.--Not later than 7 months after the date of 
     enactment of this Act, the Secretary (acting through the 
     Administrator of the Health Resources and Services 
     Administration) shall establish a State-specific health 
     professions database to track health professionals in each 
     demonstration State with respect to specialty certifications, 
     practice characteristics, professional licensure, practice 
     types, locations, education, and training, as well as 
     obligations under the demonstration program as a result of 
     the execution of a contract under paragraph (1)(C) or (2)(C) 
     of section 302(c).
       (2) Data sources.--In establishing the Health Professions 
     Database, the Secretary shall use the latest available data 
     from existing health workforce files, including the American 
     Medical Association Master File, State databases, specialty 
     medical society data sources and information, and such other 
     data points as may be recommended by COGME, MedPAC, the 
     National Center for Workforce Information and Analysis, or 
     the medical society of the respective demonstration State.
       (b) Availability.--
       (1) During the program.--During the demonstration program, 
     data from the Health Professions Database shall be made 
     available to the Secretary, each demonstration State, and the 
     public for the purposes of--
       (A) developing a baseline with respect to a State's health 
     professions workforce and to track changes in a demonstration 
     State's health professions workforce;
       (B) tracking direct and indirect graduate medical education 
     payments to hospitals;
       (C) tracking the forgiveness and repayment of loans for 
     educating physicians; and

[[Page S8720]]

       (D) tracking commitments by physicians under the 
     demonstration program.
       (2) Following the program.--Following the termination of 
     the demonstration program, a demonstration State may elect to 
     maintain the Health Professions Database for such State at 
     its expense.
       (c) Authorization of Appropriations.--There are authorized 
     to be appropriated such sums as may be necessary for the 
     purpose of carrying out this section.

     SEC. 304. EVALUATION AND REPORTS.

       (a) Evaluation.--
       (1) In general.--COGME and MedPAC shall jointly conduct a 
     comprehensive evaluation of the demonstration program.
       (2) Matters evaluated.--The evaluation conducted under 
     paragraph (1) shall include an analysis of the effectiveness 
     of the funding of additional residency and fellowship 
     positions and the loan repayment and forgiveness program on 
     physician recruitment, retention, and specialty mix in each 
     demonstration State.
       (b) Progress Reports.--
       (1) COGME.--Not later than 1 year after the date on which 
     the Secretary establishes the demonstration program, 5 years 
     after such date, and 10 years after such date, COGME shall 
     submit a report on the progress of the demonstration program 
     to the Secretary and Congress.
       (2) MedPAC.--MedPAC shall submit biennial reports on the 
     progress of the demonstration program to the Secretary and 
     Congress.
       (c) Final Report.--Not later than 1 year after the date on 
     which the demonstration program terminates, COGME and MedPAC 
     shall submit a final report to the President, Congress, and 
     the Secretary which shall contain a detailed statement of the 
     findings and conclusions of COGME and MedPAC, together with 
     such recommendations for legislation and administrative 
     actions as COGME and MedPAC consider appropriate.
       (d) Authorization of Appropriations.--There are authorized 
     to be appropriated to COGME such sums as may be necessary for 
     the purpose of carrying out this section.

     SEC. 305. CONTRACTING FLEXIBILITY.

       For purposes of conducting the demonstration program and 
     establishing and administering the Health Professions 
     Database, the Secretary may procure temporary and 
     intermittent services under section 3109(b) of title 5, 
     United States Code.

              TITLE IV--HEALTH CAREERS OPPORTUNITY PROGRAM

     SEC. 401. PURPOSE.

       It is the purpose of this title to diversify the healthcare 
     workforce by increasing the number of individuals from 
     disadvantaged backgrounds in the health and allied health 
     professions by enhancing the academic skills of students from 
     disadvantaged backgrounds and supporting them in successfully 
     completing, entering, and graduating from health professions 
     training programs.

     SEC. 402. AUTHORIZATION OF APPROPRIATIONS.

       Section 740(c) of the Public Health Service Act (42 U.S.C. 
     293d(c)) is amended by striking ``$29,400,000'' and all that 
     follows through ``2002'' and inserting ``$50,000,000 for 
     fiscal year 2005, and such sums as may be necessary for each 
     of fiscal years 2006 through 2010''.

  TITLE V--PROGRAM OF EXCELLENCE IN HEALTH PROFESSIONS EDUCATION FOR 
                      UNDERREPRESENTED MINORITIES

     SEC. 501. PURPOSE.

       It is the purpose of this title to diversify the healthcare 
     workforce by supporting programs of excellence in designated 
     health professions schools that demonstrate a commitment to 
     underrepresented minority populations with a focus on 
     minority health issues, cultural and linguistic competence, 
     and eliminating health disparities.

     SEC. 502. AUTHORIZATION OF APPROPRIATION.

       Section 736(h)(1) of the Public Health Service Act (42 
     U.S.C. 293(h)(1)) is amended to read as follows:
       ``(1) Authorization of appropriations.--For the purpose of 
     making grants under subsection (a), there are authorized to 
     be appropriated $50,000,000 for fiscal year 2005, and such 
     sums as may be necessary for each of the fiscal years 2006 
     through 2010.''.

   TITLE VI--HEALTH PROFESSIONS STUDENT LOAN FUND; AUTHORIZATIONS OF 
    APPROPRIATIONS REGARDING STUDENTS FROM DISADVANTAGED BACKGROUNDS

     SEC. 601. STUDENT LOANS.

       Section 724(f) of the Public Health Service Act (42 U.S.C. 
     292t(f)) is amended by inserting before paragraph (2), the 
     following:
       ``(1) In general.--With respect to making Federal capital 
     contributions to student loan funds for purposes of 
     subsection (a), there are authorized to be appropriated 
     $35,000,000 for fiscal year 2005, and such sums as may be 
     necessary for each of the fiscal years 2006 through 2010.''.

     SEC. 602. NATIONAL HEALTH SERVICE CORPS; RECRUITMENT AND 
                   FELLOWSHIPS FOR INDIVIDUALS FROM DISADVANTAGED 
                   BACKGROUNDS.

       (a) In General.--Section 331(b) of the Public Health 
     Service Act (42 U.S.C. 254d(b)) is amended by adding at the 
     end the following:
       ``(3) The Secretary shall ensure that the individuals with 
     respect to whom activities under paragraphs (1) and (2) are 
     carried out include individuals from disadvantaged 
     backgrounds, including activities carried out to provide 
     health professions students with information on the 
     Scholarship and Repayment Programs.''.
       (b) Assignment of Corps Personnel.--Section 333(a) of the 
     Public Health Service Act (42 U.S.C. 254f(a)) is amended by 
     adding at the end the following:
       ``(4) In assigning Corps personnel under this section, the 
     Secretary shall give preference to applicants who request 
     assignment to a federally qualified health center (as defined 
     in section 1905(1)(2)(B) of the Social Security Act) or to a 
     provider organization that has a majority of patients who are 
     minorities or individuals from low-income families (families 
     with a family income that is less than 200 percent of the 
     Official Poverty Line).''.

                  TITLE VII--MISCELLANEOUS PROVISIONS

     SEC. 703. STUDY BY THE INSTITUTE OF MEDICINE.

       (a) Contract.--Not later than 90 days after the date of 
     enactment of this Act, the Secretary of Health and Human 
     Services shall enter into a contract with the Institute of 
     Medicine for the conduct of a study and the preparation of a 
     report on the role of United States medical schools in 
     meeting the physician needs of the United States.
       (b) Requirements.--In conducting the study under the 
     contract under subsection (a), the Institute of Medicine 
     shall--
       (1) examine the supply structure of United States 
     undergraduate medical education and make recommendations 
     concerning the advisability of expanding, enhancing, or 
     modifying such structure to achieve a higher degree of self-
     sufficiency and equity in such medical education and to 
     position medical schools for the future demands generated by 
     the growing population of the United States; and
       (2) examine the role of United States medical schools in 
     reducing racial and ethnic disparities in medical education 
     opportunities and in population health outcomes as well as in 
     reducing the drain on the medical education systems of other 
     countries.
       (c) Report.--The contract under subsection (a) shall 
     require the Institute of Medicine to submit a report to the 
     Secretary of Health and Human Services on the results of the 
     study not later than 12 months after the date on which the 
     contract is entered into. The Secretary shall submit such 
     report to the Committee on Health, Education, Labor, and 
     Pensions of the Senate and the Committee on Commerce of the 
     House of Representatives.
                                 ______