[Congressional Record Volume 151, Number 20 (Monday, February 28, 2005)]
[Senate]
[Pages S1805-S1810]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Ms. CANTWELL (for herself, Mr. Bingaman, and Mr. Lieberman):
  S. 473. A bill to amend the Public Health Service Act to promote and 
improve the allied health professions; to the Committee on Health, 
Education, Labor, and Pensions.
  Ms. CANTWELL. Mr. President, the well-being of the U.S. population 
depends to a considerable extent on having access to high quality 
health care which, in turn, requires the presence of an adequate supply 
of health care professionals. The Congress and the President recognized 
this need when we passed, and President Bush signed, the Nurse 
Reinvestment Act in the 107th Congress. Just as with nurses, we must 
also insure an adequate supply of well-prepared allied health 
professionals. That is why, today, I am introducing the Allied Health 
Reinvestment Act with my good colleagues, Senator Bingaman of New 
Mexico and Senator Lieberman of Connecticut.
  The allied health professions are many. Those recognized in the act 
include professionals in the areas of: dental hygiene, dietetics/
nutrition, emergency medical services, health information management, 
clinical laboratory sciences/medical technology, cytotechnology, 
occupational therapy, physical therapy, radiologic technology, nuclear 
medical technology, rehabilitation counseling, respiratory therapy, and 
speech-language pathology/audiology. This is not an exhaustive list, as 
the act will leave to the discretion of the Secretary of HHS additional 
professions deemed eligible.
  Today, many allied health professions are characterized by existing 
workforce shortages, declining enrollments in academic institutions, or 
a combination of both factors. The American Hospital Association, AHA, 
reports vacancy rates of 18 percent among radiology technicians, 10 
percent among laboratory technologists, 15.3 percent among imaging 
technicians, and 12.7 percent among pharmacy technicians. In addition, 
the AHA indicates that hospitals are having increasing difficulties 
recruiting these same professionals over the preceding 2-year period.
  In my own State of Washington, the Washington State Hospital 
Association reports vacancy rates of 14.3 percent among ultrasound 
technologists, 11.3 percent among radiology technicians, and 10.9 
percent among nuclear medicine technologists. These vacancy rates have 
a real effect on the hospitals in my State. When I meet with hospital 
officials back home, they always tell me how the lack of technicians 
affects patient care.
  The Bureau of Labor Statistics projected that in the period 1998-
2008, the United States would need a total of 93,000 new professionals 
in clinical laboratory science by creating 53,000 new positions and 
filling the 40,000 existing vacancies. That averages 9,000 openings per 
year for technicians, and yet academic institutions are producing only 
4,990 graduates annually. If these numbers stay constant, we will be 
short by 43,100 needed technicians in 2008.
  According to the American Hospital Association, declining enrollment 
in health education programs contributes to the critical shortages of 
health care professionals. Similarly, data from a November 2002 study 
of 90 institutions by the Association of Schools of Allied Health 
Professions, ASAHP, shows a 3-year period of decline in enrollment in 
cardiovascular perfusion technology, cytotechnology, dietetics, 
emergency medical sciences, health administration, health information 
management, medical technology, occupational therapy, rehabilitation 
counseling, respiratory therapy, and respiratory therapy technician 
programs. As an indication of a worsening situation, data from the 
2002-2003 academic year, alone, show that dental hygiene, physician 
assistant, and speech-language pathology and audiology should be added 
to this list.

  While having an adequate number of health professionals in our 
country is key to ensuring access to health care for all of us, 
certainly one of the key populations for whom a healthy supply of 
health professionals is vitally important for is our senior population.
  The U.S. Census Bureau reports that rapid growth of the population 
age 65 and over will begin in 2011 when the first of the baby boom 
generation reaches age 65 and will continue for many years. From 1900 
to 2000, the proportion of persons 65 and over tripled, going from 4.1 
percent to 12.4 percent.
  The baby-boom generation's movement into middle age, a period when 
the incidence of heart attack and stroke increases, will produce a 
higher demand for therapeutic services. Medical advances now enable 
more patients with critical problems to survive, but in order to do so 
and maintain a high quality of life, these patients may need extensive 
therapy.
  Along with the aging of the population came an increase in the number 
of Americans living with one, and often more than one, chronic 
condition. Today, it is estimated that 125 million Americans live with 
a chronic condition, and by 2020 as the population ages, that number 
will increase to an estimated 157 million, with 81 million of them 
having two or more chronic conditions. Twenty-five percent of 
individuals with chronic conditions have some type of activity 
limitations. Two-thirds of Medicare spending is for beneficiaries with 
five or more chronic conditions.
  Many individuals with chronic conditions rely on family caregivers. 
Approximately 9 million Americans provide such services, and on the 
average, they spend 24 hours a week doing so. Caregivers aged 65-74 
provide an average of 30.7 hours of care per week and individuals aged 
75 and older provide an average of 34.5 hours per week.
  Women are more likely than men to have chronic conditions, in part 
because they have longer life expectancies. These same women are 
caregivers to other chronically ill persons. In addition, 65 percent of 
caregivers are female, and of all caregivers, nearly 40 percent are 55 
years of age and older.
  Physicians report that their training does not adequately prepare 
them to care for this type of patient by providing education and 
offering effective nutritional guidance. Those aspects of care can be 
provided by allied health professionals, but many of them need better 
preparation to treat and coordinate care for patients with chronic 
conditions. While much emphasis is placed on curative forms of care, 
additional efforts must be devoted to slowing the progression of 
disease and its effects.
  One example of the effectiveness of allied health interventions may 
be illustrated by a study funded by the National Institute on Aging, 
the National Center for Medical Rehabilitation Research, and the Agency 
for Health Care Policy and Research--since renamed the Agency for 
Healthcare Research and Quality. The investigation showed that 
significant benefits resulted from a 9-month occupational therapy 
intervention intended to reduce health-related declines urban, 
multiethnic, independent-living older adults. The majority of study 
participants, 73 percent, lived alone and 26 percent reported at least 
one disability. Important health-related benefits attributable to the 
intervention continued over a 6-month interval in the absence of 
further treatment.

  The bill my colleagues and I introduce today, like the Nurse 
Reinvestment Act in the 107th Congress, is intended to provide 
incentives for individuals to seek and complete high quality allied 
health education and training. Furthermore, the bill will provide 
additional funding to ensure that such education and training can be 
provided to allied health students so that the U.S. healthcare industry 
with have a supply of allied health professionals needed to support the 
Nation's health care system in this decade and beyond.
  The bill offers allied health education, practice, and retention 
grants. Education grants will be used to expand the enrollment in 
allied health education programs, especially by underrepresented racial 
and ethnic minority students, and provide educational opportunities 
through new technologies and methods, including distance-learning. 
Practice grants are intended to establish or expand allied health 
practice arrangements in noninstitutional settings to demonstrate 
methods that will improve access to primary health care in rural areas 
and other medically underserved communities. Retention grants are 
intended to promote career advancement for allied health personnel.
  Grants will also be made available to health care facilities to 
enable them to

[[Page S1806]]

carry out demonstrations of models and best practices in allied health 
for the purpose of developing innovative strategies or approaches for 
retention of allied health professionals. These grants will be awarded 
to a variety of geographic regions, and to a range of different types 
and sizes of facilities, including facilities located in rural, urban, 
and suburban areas.
  Furthermore, this bill will give the Secretary of HHS, acting through 
the Administrator of HRSA, the authority to enter into an agreement 
with any institution that offers an eligible allied health education 
program to establish and operate a faculty loan fund to increase the 
number of qualified allied health faculty. Loans may be granted to 
faculty who are 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.
  I am especially proud of the provisions of this legislation regarding 
the National Health Service Corps program, the brain child of Senator 
Warren Magnuson of Washington. The NHSC program, of course, encourages 
students in the health professions such as doctors and dentists to 
serve in underserved areas throughout our nation in return for loan 
repayment assistance. And, like the NHSC program, this Allied Health 
Reinvestment Act will establish a scholarship program that provides 
scholarships to individuals seeking allied health education in exchange 
for service by those individuals in rural and other medically 
underserved areas with allied health personnel shortages.
  There are a number of organizations supporting this bill, and I thank 
them for that support. Among them, the list includes, but is not 
limited to:

     Washington State Hospital Association
     Health Work Force Institute (Seattle, WA)
     American Association for Respiratory Care
     American Association of Community Colleges
     American Clinical Laboratory Association
     American Dental Hygienists' Association
     American Dietetic Association
     American Health Information Management Association
     American Hospital Association
     American Physical Therapy Association
     American Society for Clinical Laboratory Science
     American Society for Clinical Pathology
     American Society of Radiologic Technologists
     Association of Academic Health Centers
     College of Health Deans
     Midwest Regional Deans Group
     Myositis Association
     National Association of EMS Educators
     National Cancer Registrars Association
     National Network of Health Career Programs in Two-Year 
         Colleges
     Northeast Regional Deans Group

  In addition to these organizations, I would also like to express my 
appreciation to the Association of Schools of Allied Health 
Professions, ASAHP, for its support of the legislation as well as its 
ongoing efforts to address the need for allied health professionals and 
allied health faculty.
  ASAHP, founded in 1967, has a membership that includes 108 
institutions of higher learning throughout the United States, as well 
as several hundred individual members. ASAHP publishes a quarterly 
journal and also conducts an annual survey of member institutions. This 
annual survey, called the ``Institutional Profile Survey,'' is used 
for, among other purposes, collecting student application and 
enrollment data. These data substantiate that there is a pressing need 
to address existing allied health workforce shortages, which have been 
further exacerbated by declines in enrollment that have occurred for 4 
straight years.
  In the survey conducted during the period September-November 2004 for 
the 2004-2005 class starting in fall 2004, the results from 90 academic 
institutions indicate that in 16 of the 20 professions studied, 
available classroom seats were not filled. For example, only 33 percent 
of enrollment capacity was reached for health information management 
programs in these schools. Given the emphasis on increasing the use of 
information technology in health care such as conversion to electronic 
patient records, that figure is disturbingly low.
  Similarly, the survey shows that enrollment levels were low in the 
following professions: rehabilitation counseling, 44 percent, emergency 
medical sciences, 66 percent, cytotechnology, 69 percent, and medical 
technology, 77 percent. Severe workforce shortages already exist in the 
two laboratory professions and emergency medical personnel will play a 
key role as first responders in dealing with any bioterrorism incident 
that might occur.
  Using data from the Institutional Profile Survey, as well as the 
General Accounting Office, U.S. Census Bureau, and other sources, ASAHP 
has compiled what I believe to be a compelling rationale in its support 
for the Allied Health Reinvestment Act that Senators Bingaman, 
Lieberman, and I introduce today. I ask unanimous consent that the text 
of this Rationale for an Allied Health Reinvestment Act from the 
Association of Schools of Allied Health Professions be printed in the 
Record.
  I ask unanimous consent that the text of the bill be printed in the 
Record.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

            Rationale for an Allied Health Reinvestment Act

       Led by the Association of Schools of Allied Health 
     Professions, a Washington-DC based organization with 108 
     colleges and universities as members, a coalition of 30 
     national organizations supports the enactment of an Allied 
     Health Reinvestment Act.
       The well-being of the U.S. population depends to a 
     considerable extent on having access to high quality health 
     care, which requires the presence of an adequate supply of 
     competently-prepared allied health professionals. Workforce, 
     demographic, and epidemiologic imperatives are the driving 
     forces behind the need to have such legislation enacted.


                        The Workforce Imperative

       Many allied health professions are characterized by 
     existing workforce shortages, declining enrollments in 
     academic institutions, or a combination of both factors. 
     Hospital officials have reported vacancy rates of 18 percent 
     among radiologic technologists and 10 percent among 
     laboratory technologists, plus they indicated more difficulty 
     in recruiting these same professionals than two years prior.
       Fitch, a leading global rating agency that provides the 
     world's credit markets with credit opinions, indicates that 
     labor expenses due to personnel shortages will continue to 
     plague hospitals and is the biggest financial concern for 
     that sector because it typically costs up to twice normal 
     equivalent wages to fill gaps with temporary agency help.
       The Bureau of Labor Statistics (BLS) projects that in the 
     period 1998-2008, a total of 93,000 positions in clinical 
     laboratory science need to be provided in the form of 
     creating 53,000 new jobs and filling 40,000 existing 
     vacancies. Of the 9,000 openings per year, academic 
     institutions are producing only 4,990 graduates annually. BLS 
     projections in 2004 show that nine of the 10 fastest growing 
     occupations are health or computer (information technology) 
     occupations.
       Accredited respiratory therapy programs in 2000 graduated 
     5,512 students--21% fewer than the 6,062 graduates in 1999. 
     In 2001, the number of graduates from these schools fell 
     another 20% to 4,437. The BLS expects employment of 
     respiratory therapists to increase faster than the average of 
     all occupations, increasing from 21% to 35% through 2010. The 
     aging population and an attendant rise in the incidence of 
     respiratory ailments, including asthma and COPD, and 
     cardiopulmonary diseases drive this demand.
       Employment growth in schools will result from expansion of 
     the school-age population and extended services for disabled 
     students. Therapists will be needed to help children with 
     disabilities prepare to enter special education programs.
       The American Hospital Association has identified declining 
     enrollment in health education programs as a factor leading 
     to critical shortages of health care professionals. That 
     assessment is buttressed by data from 90 institutions 
     belonging to the Association of Schools of Allied Health 
     Professions. The following professions were unable to reach 
     enrollment capacity over a three-year period: cardiovascular 
     perfusion technology, cytotechnology, dietetics, emergency 
     medical sciences, health administration, health information 
     management, medical technology, occupational therapy, 
     rehabilitation counseling, respiratory therapy, and 
     respiratory therapy technician.
       Given the level of anxiety over the possibility of 
     terrorist attacks occurring in this country, in a study 
     released by the General Accounting Office (GAO) on April 8, 
     2003 that focused on the nation's adequacy of preparedness 
     against bioterrorism, it was reported that shortages in 
     clinical laboratory personnel exist in state and local public 
     health departments, laboratories, and hospitals. Moreover, 
     these shortages are a major concern that is difficult to 
     remedy.
       Laboratories play a critical role in the detection and 
     diagnosis of illnesses resulting from exposure to either 
     biological or chemical agents. No therapy or prophylaxis can 
     be initiated without laboratory identification and 
     confirmation of the agent in question. Laboratories need to 
     have adequate capacity and necessary staff to test clinical 
     and environmental samples in order to identify an

[[Page S1807]]

     agent promptly so that proper treatment can be started and 
     infectious diseases prevented from spreading.
       Meanwhile, the U.S population continues to become more 
     racially and ethnically diverse. A health care workforce is 
     needed that better reflects the population they serve. 
     Practitioners must become more attuned to cultural 
     differences in order to facilitate communication and enhance 
     health care quality.


                       The Demographic Imperative

       The U.S. Census Bureau reports that rapid growth of the 
     population age 65 and over will begin in 2011 when the first 
     of the baby-boom generation reaches age 65 and will continue 
     for many years. The larger proportions of the population in 
     older age groups result in part from sustained low fertility 
     levels and from relatively larger declines in mortality at 
     older ages in the latter part of the 20th century. From 1900 
     to 2000, the proportion of persons 65 and over went from 4.1 
     percent to 12.4 percent.
       In the 20th century, the total population more than 
     tripled, while the 65 years and older population grew more 
     than tenfold, from 3.1 million in 1900 to 35.0 million in 
     2000.
       Among the older population, the cohort 85 years and over 
     increased from 122,000 in 1900 to 4.2 million in 2000. Since 
     1940, this age group increased at a more rapid rate than 65-
     to-74 year olds and 75-to-85 year olds in every decade. As a 
     proportion of the older population, the 85 and over group 
     went from being four percent of the older population to 12 
     percent between 1900 and 2000.


                     The Epidemiological Imperative

       The baby-boom generation's movement into middle age, a 
     period when the incidence of heart attack and stroke 
     increases, will produce a higher demand for therapeutic 
     services. Medical advances now enable more patients with 
     critical problems to survive. These patients may need 
     extensive therapy.
       According to Solucient, a major provider of information for 
     health care providers, profound demographic shifts over the 
     next twenty-five years will result in significant increases 
     in the demand for inpatient acute care services if current 
     utilization patterns do not change. An aging baby-boom 
     generation, increasing life expectancy, rising fertility 
     rates, and continued immigration will undoubtedly increase 
     the volume of inpatient hospitalizations and significantly 
     alter the mix of acute care services required by patients 
     over the next quarter century. Nationwide, demographic 
     changes alone could result in a 46 percent increase in acute 
     care bed demand by 2027. Total acute care admissions could 
     also increase by almost 13 million cases in the next quarter 
     century--a growth of 41 percent from the current number of 
     national admissions. Currently, the aged nationwide account 
     for about 40 percent of inpatient admissions and about 49 
     percent of beds. By 2027, they could make up a majority of 
     acute care services--51 percent of admissions and 59 percent 
     of beds.
       Along with the aging of the population came an increase in 
     the number of Americans living with one, and often more than 
     one, chronic condition. Today, it is estimated that 125 
     million Americans live with a chronic condition, and by 2020 
     as the population ages, that number will increase to an 
     estimated 157 million, with 81 million of them having two or 
     more chronic conditions. Twenty-five percent of individuals 
     with chronic conditions have some type of activity 
     limitations. Two-thirds of Medicare spending is for 
     beneficiaries with five or more chronic conditions.
       Many individuals with chronic conditions rely on family 
     caregivers. Approximately nine million Americans provide such 
     services, and on the average, they spend 24 hours a week 
     doing so. Caregivers age 65-74 provide an average of 30.7 
     hours of care per week and individuals age 75 and older 
     provide an average of 34.5 hours per week.
       Women are more likely than men to have chronic conditions, 
     in part because they have longer life expectancies. These 
     same women are caregivers to other chronically ill persons. 
     In addition, 65 percent of caregivers are female, and of all 
     caregivers, nearly 40 percent are 55 years of age and older.
       Physicians report that their training does not adequately 
     prepare them to care for this type of patient in areas such 
     as providing education and offering effective nutritional 
     guidance. Allied health professionals can provide those 
     aspects of care, but many of them need better preparation to 
     treat and coordinate care for patients with chronic 
     conditions. While much emphasis is placed on curative forms 
     of care, additional efforts must be devoted to slowing the 
     progression of disease and its effects.
                                  ____


                                 S. 473

       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 ``Allied Health Reinvestment 
     Act''.

     SEC. 2. FINDINGS AND PURPOSE.

       (a) Findings.--Congress makes the following findings:
       (1) The United States Census Bureau and other reports 
     highlight the increased demand for acute and chronic 
     healthcare 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 quality of care have resulted in an 
     amplified call for allied health professionals to provide 
     healthcare 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.
       (b) Purpose.--It is the purpose of this Act to provide 
     incentives for individuals to seek and complete high quality 
     allied health education and training and provide additional 
     funding to ensure that such education and training can be 
     provided to allied health students so that the United States 
     healthcare industry with have a supply of allied health 
     professionals needed to support the health care system of the 
     United States in this decade and beyond.

     SEC. 3. AMENDMENT TO THE PUBLIC HEALTH SERVICE ACT.

       Title VII of the Public Health Service Act (42 U.S.C. 292 
     et seq.) is amended by adding at the end the following:

                 ``PART G--ALLIED HEALTH PROFESSIONALS

     ``SEC. 799C. DEFINITIONS.

       ``In this part:
       ``(1) Allied health education program.--The term `allied 
     health education program' means any postsecondary educational 
     program offered by an institution accredited by an agency or 
     commission recognized by the Department of Education, or 
     leading to a State certificate or license or any other 
     educational program approved by the Secretary. Such term 
     includes colleges, universities, or schools of allied health 
     and equivalent entities that include programs leading to a 
     certificate, associate, baccalaureate, or graduate level 
     degree in an allied health profession.
       ``(2) Allied health professions.--The term `allied health 
     professions' includes professions in the following areas at 
     the certificate, associate, baccalaureate, or graduate level:
       ``(A) Dental hygiene.
       ``(B) Dietetics or nutrition.
       ``(C) Emergency medical services.
       ``(D) Health information management.
       ``(E) Clinical laboratory sciences and medical technology.
       ``(F) Cytotechnology.
       ``(G) Occupational therapy.
       ``(H) Physical therapy.
       ``(I) Radiologic technology.
       ``(J) Nuclear medical technology.
       ``(K) Rehabilitation counseling.
       ``(L) Respiratory therapy.
       ``(M) Speech-language pathology and audiology.
       ``(N) Any other profession determined appropriate by the 
     Secretary.
       ``(3) Health care facility.--The term `health care 
     facility' means an outpatient health care facility, hospital, 
     nursing home, home health care agency, hospice, federally 
     qualified health center, nurse managed health center, rural 
     health clinic, public health clinic, or any similar 
     healthcare facility or practice that employs allied health 
     professionals.

     ``SEC. 799C-1. PUBLIC SERVICE ANNOUNCEMENTS.

       ``The Secretary shall develop and issue public service 
     announcements that shall--
       ``(1) advertise and promote the allied health professions;
       ``(2) highlight the advantages and rewards of the allied 
     health professions; and
       ``(3) encourage individuals from diverse communities and 
     backgrounds to enter the allied health professions.

     ``SEC. 799C-2. STATE AND LOCAL PUBLIC SERVICE ANNOUNCEMENTS.

       ``(a) In General.--The Secretary shall award grants to 
     designated eligible entities to support State and local 
     advertising campaigns that are conducted through appropriate 
     media outlets (as determined by the Secretary) to--
       ``(1) promote the allied health professions;
       ``(2) highlight the advantages and rewards of the allied 
     health professions; and
       ``(3) encourage individuals from disadvantaged communities 
     and backgrounds to enter the allied health professions.
       ``(b) Eligible Entity.--To be eligible to receive a grant 
     under subsection (a), an entity shall--
       ``(1) be a professional, national, or State allied health 
     association, State health care provider, or association of 
     one or more health care facilities, allied health education 
     programs, or other entities that provides similar services or 
     serves a like function; and
       ``(2) prepare and submit to the Secretary an application at 
     such time, in such manner, and containing such information as 
     the Secretary may require.

     ``SEC. 799C-3. 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.--To be eligible to receive a grant 
     under subsection (a), an entity shall--
       ``(1) be a professional, national, or State allied health 
     association, State health care provider, or association of 
     one or more

[[Page S1808]]

     health care facilities, allied health education programs, or 
     other eligible entities that provides similar services or 
     serves a like function; and
       ``(2) prepare and submit to the Secretary an application at 
     such time, in such manner, and containing such information as 
     the Secretary may require.
       ``(c) Use of Funds.--An entity shall use amounts received 
     under a grant under subsection (a) to--
       ``(1) support outreach programs at elementary 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 
     education opportunities for individuals who are from 
     disadvantaged backgrounds (including racial and ethnic 
     minorities that are underrepresented among 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 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 at any level; and
       ``(5) support community-based partnerships seeking to 
     recruit allied health professionals in rural communities and 
     medically underserved urban communities, and other 
     communities experiencing an allied health professions 
     shortage.

     ``SEC. 799C-4. GRANTS FOR HEALTH CAREER ACADEMIES.

       ``(a) In General.--The Secretary shall award grants to 
     eligible entities to assist such entities in collaborating to 
     carry out programs that form education pipelines to 
     facilitate the entry of students of secondary educational 
     institutions, especially underrepresented racial and ethnic 
     minorities, into careers in the allied health professions.
       ``(b) Eligible Entity.--To be eligible to receive a grant 
     under subsection (a), an entity shall--
       ``(1) be an institution that offers allied health education 
     programs, a health care facility, or a secondary educational 
     institution; and
       ``(2) prepare and submit to the Secretary an application at 
     such time, in such manner, and containing such information as 
     the Secretary may require.

     ``SEC. 799C-5. ALLIED HEALTH EDUCATION, PRACTICE, AND 
                   RETENTION GRANTS.

       ``(a) Education Priority Areas.--The Secretary may award 
     grants to or enter into contracts with eligible entities to--
       ``(1) expand the enrollment of individuals in allied health 
     education programs, especially the enrollment of 
     underrepresented racial and ethnic minority students; and
       ``(2) provide 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 to--
       ``(1) establish or expand allied health practice 
     arrangements in noninstitutional settings to demonstrate 
     methods to improve access to primary health care in rural 
     areas and other medically underserved communities;
       ``(2) provide 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) provide managed care, information management, quality 
     improvement, and other skills needed to practice in existing 
     and emerging organized health care systems; or
       ``(4) develop 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 described in 
     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 
     personnel 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 the 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 to 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 allied health involvement in the organizational and 
     clinical decision-making processes of a health care facility.
       ``(B) Preference.--In making awards of grants under this 
     paragraph, the Secretary shall give preferences 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 personnel retention 
     or patient care.
       ``(d) Eligible Entity.--To be eligible to receive a grant 
     under this section, an entity shall--
       ``(1) be a health care facility, or any partnership or 
     coalition containing a health care facility or allied health 
     education program; and
       ``(2) prepare and submit to the Secretary an application at 
     such time, in such manner, and containing such information as 
     the Secretary may require.

     ``SEC. 799C-6. DEVELOPING MODELS AND BEST PRACTICES PROGRAM.

       ``(a) Authorized.--The Secretary shall award grants to 
     eligible entities to enable such entities to carry out 
     demonstration programs using models and best practices in 
     allied health for the purpose of developing innovative 
     strategies or approaches for the retention of allied health 
     professionals.
       ``(b) Eligible Entity.--To be eligible to receive a grant 
     under this section, an entity shall--
       ``(1) be a health care facility, or any partnership or 
     coalition containing a health care facility or allied health 
     education program; and
       ``(2) prepare and submit to the Secretary an application at 
     such time, in such manner, and containing such information as 
     the Secretary may require.
       ``(c) Distribution of Grants.--In awarding grants under 
     this section, the Secretary shall ensure that grantee 
     represent a variety of geographic regions and a range of 
     different types and sizes of facilities, including facilities 
     located in rural, urban, and suburban areas.
       ``(d) Use of Funds.--An entity shall use amounts received 
     under a grant under this section to carry out demonstration 
     programs of models and best practices in allied health for 
     the purpose of--
       ``(1) promoting retention and satisfaction of allied health 
     professionals;
       ``(2) promoting opportunities for allied health 
     professionals to pursue education, career advancement, and 
     organizational recognition; and
       ``(3) developing continuing education programs that 
     instruct allied health professionals in how to use emerging 
     medical technologies and how to address current and future 
     health care needs.
       ``(e) Area Health Education Centers.--The Secretary shall 
     award grants to area health education centers to enable such 
     centers to enter into contracts with allied health education 
     programs to expand the operation of area health education 
     centers to work in communities to develop models of 
     excellence for allied health professionals or to expand any 
     junior and senior high school mentoring programs to include 
     an allied health professions mentoring program.

     ``SEC. 799C-7. 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 offering an eligible allied health education 
     program for the establishment and operation of a faculty loan 
     fund in accordance with this section (referred to in this 
     section as the `loan fund'), 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 offering the allied health education program 
     involved;
       ``(2) provide for deposit in the loan fund of--
       ``(A) the Federal capital contributions to the fund;
       ``(B) an amount provided by the institution involved which 
     shall be equal to not less than one-ninth of the amount of 
     the Federal capital contribution under subparagraph (A);
       ``(C) any collections of principal and interest on loans 
     made from the fund; and
       ``(D) any other earnings of the fund;
       ``(3) provide that the loan fund will be used only for the 
     provision of loans to faculty of the allied health education 
     program in accordance with subsection (c) and for the costs 
     of the collection of such loans and the interest thereon;
       ``(4) provide that loans may be made from such fund only to 
     faculty who are 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 determined appropriate 
     by the Secretary to protect the financial interests of the 
     United States.
       ``(c) Loan Provisions.--Loans from any faculty loan fund 
     established pursuant to an agreement under this section shall 
     be made to an individual on such terms and conditions as the 
     allied health education program 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

[[Page S1809]]

     an allied health education program 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) upon completion by the individual of each of the 
     first, second, and third year of full-time employment, as 
     required under the loan agreement, as a faculty member in an 
     allied health education program, the program shall cancel 20 
     percent of the principal and interest due on the amount of 
     the unpaid portion of the loan on the first day of such 
     employment;
       ``(4) upon completion by the individual of the fourth year 
     of full-time employment, as required under the loan 
     agreement, as a faculty member in an allied health education 
     program, the program shall cancel 25 percent of the principal 
     and interest due on the amount of the unpaid portion of the 
     loan on the first day of such employment;
       ``(5) the loan may be used to pay the cost of tuition, 
     fees, books, laboratory expenses, and other reasonable 
     education expenses;
       ``(6) the 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
       ``(7) such 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 year; or
       ``(B) subject to subsection (e), if the allied health 
     education program 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 (including interest thereon) is canceled under 
     this section, the Secretary shall pay to the allied health 
     education program involved an amount equal to the program'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 allied health education program under 
     this section.

     ``SEC. 799C-8. SCHOLARSHIP PROGRAM FOR SERVICE IN RURAL AND 
                   OTHER MEDICALLY UNDERSERVED AREAS.

       ``(a) Program Authorized.--The Secretary shall establish a 
     scholarship program (referred to in this section as the 
     `program') to provide scholarships to individuals seeking 
     allied health education who agree to provide service in rural 
     and other medically underserved areas with allied health 
     personnel shortages.
       ``(b) Preference.--In awarding scholarships under this 
     section, the Secretary shall give preference to--
       ``(1) applicants who demonstrate the greatest financial 
     need;
       ``(2) applicants who agree to serve in health care 
     facilities experiencing allied health shortages in rural and 
     other medically underserved areas;
       ``(3) applicants who are currently working in a health care 
     facility who agree to serve the period of obligated service 
     at such facility;
       ``(4) minority applicants; and
       ``(5) applicants with an interest in a practice area of 
     allied health that has unmet needs.
       ``(c) Program Requirements.--
       ``(1) Contracts.--Under the program, the Secretary shall 
     enter into contracts with eligible individuals under which 
     such individuals agree to serve as allied 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 facility 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.
       ``(d) Reports.--Not later than 18 months after the date of 
     enactment of this part, and annually thereafter, the 
     Secretary shall prepare and submit to the appropriate 
     committees of Congress a report describing the program 
     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 institution 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. 799C-9. GRANTS FOR CLINICAL EDUCATION, INTERNSHIP, AND 
                   RESIDENCY PROGRAMS.

       ``(a) Program Authorized.--The Secretary shall award grants 
     to eligible entities to develop clinical education, 
     internship, and residency programs that encourage mentoring 
     and the development of specialties.
       ``(b) Eligible Entities.--To be eligible for a grant under 
     this section an entity shall--
       ``(1) be a partnership of an allied health education 
     program and a health care facility; and
       ``(2) prepare and submit to the Secretary an application at 
     such time, in such manner, and containing such information as 
     the Secretary may require.
       ``(c) Use of Funds.--An eligible entity shall use amounts 
     received under a grant under this section to--
       ``(1) develop clinical education, internship, and residency 
     programs and curriculum and training programs for graduates 
     of an allied health education program;
       ``(2) provide support for faculty and mentors; and
       ``(3) provide support for allied health professionals 
     participating in clinical education, internship, and 
     residency programs on both a full-time and part-time basis.

     ``SEC. 799C-10. 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) Eligible Entity.--To be eligible to receive a grant 
     under this section, and entity shall--
       ``(1) be a partnership between an allied health education 
     program and a health care facility; and
       ``(2) prepare and submit to the Secretary an application at 
     such time, in such manner, and containing such information as 
     the Secretary may require.
       ``(c) Use of Funds.--An eligible entity shall use amounts 
     received under a grant under this section to--
       ``(1) provide employees of the health care facility that is 
     a member of the partnership involved advanced training and 
     education in a allied health education program;
       ``(2) establish or expand allied health practice 
     arrangements in non-institutional 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.

     ``SEC. 799C-11. ALLIED HEALTH PROFESSIONS TRAINING FOR 
                   DIVERSITY.

       ``The Secretary, acting 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, other entities within 
     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 to determine educational pipeline and 
     practitioner shortages, and project future needs for such a 
     workforce.

     ``SEC. 799C-12. ALLIED HEALTH PROFESSIONS TRAINING FOR 
                   DIVERSITY.

       ``The Secretary shall include schools of allied health 
     among the health professions schools that are eligible to 
     receive grants under this part for the purpose of assisting 
     such schools in supporting Centers of Excellence in health 
     professions education for under-represented minority 
     individuals.

     ``SEC. 799C-13. REPORTS BY GENERAL ACCOUNTING OFFICE.

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

[[Page S1810]]

     ``SEC. 799C-14. AUTHORIZATION OF APPROPRIATIONS.

       ``There is authorized to be appropriated to carry out this 
     part, such sums as may be necessary for each of fiscal years 
     2006 through 2011.''.

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