[House Report 116-265]
[From the U.S. Government Publishing Office]


116th Congress }                                             { Report
                        HOUSE OF REPRESENTATIVES
 1st Session   }                                             { 116-265

======================================================================



 
                     PATHWAYS TO HEALTH CAREERS ACT

                                _______
                                

October 29, 2019.--Committed to the Committee of the Whole House on the 
              State of the Union and ordered to be printed

                                _______
                                

Mr. Neal, from the Committee on Ways and Means, submitted the following

                              R E P O R T

                             together with

                            DISSENTING VIEWS

                        [To accompany H.R. 3398]

      [Including cost estimate of the Congressional Budget Office]

    The Committee on Ways and Means, to whom was referred the 
bill (H.R. 3398) to provide low-income individuals with 
opportunities to enter and follow a career pathway in the 
health professions, to extend and expand demonstration 
projects, and for other purposes, having considered the same, 
report favorably thereon with an amendment and recommend that 
the bill as amended do pass.

                                CONTENTS

                                                                   Page
I. Summary and Background........................................     9
    A. Purpose and Summary.......................................     9
    B. Background and Need for Legislation.......................    10
    C. Legislative History.......................................    11
II. Explanation of the Bill......................................    13
    A. The Pathways to Health Careers Act........................    13
III. Votes of the Committee......................................    19
IV. Budget Effects of the Bill...................................    21
    A. Committee Estimate of Budgetary Effects...................    21
    B. Statement Regarding New Budget Authority..................    21
    C. Cost Estimate Prepared by the Congressional Budget Office.    21
V. Other Matters To Be Discussed Under the Rules of the House....    23
    A. Committee Oversight Findings and Recommendations..........    23
    B. Statement of General Performance Goals and Objectives.....    23
    C. Information Relating to Unfunded Mandates.................    23
    D. Congressional Earmarks, Limited Tax Benefits, and Limited 
      Tariff Benefits............................................    24
    E. Duplication of Federal Programs...........................    24
    F. Hearings..................................................    24
VI. Changes in Existing Law Made by the Bill, as Reported........    24

    The amendment is as follows:
  Strike all after the enacting clause and insert the 
following:

SECTION 1. SHORT TITLE.

  This Act may be cited as the ``Pathways to Health Careers Act''.

SEC. 2. EXTENSION THROUGH FISCAL YEAR 2020 OF FUNDING FOR DEMONSTRATION 
                    PROJECTS TO ADDRESS HEALTH PROFESSIONS WORKFORCE 
                    NEEDS.

  (a) In General.--Section 2008(c)(1) of the Social Security Act (42 
U.S.C. 1397g(c)(1)) is amended by striking ``2019.'' and inserting 
``2020, and to provide technical assistance and cover administrative 
costs associated with implementing the successor to this section 
$15,000,000 for fiscal year 2020.''.
  (b) Availability of Other Funds.--Upon the date of the enactment of 
this section--
          (1) amounts expended pursuant to section 1501 of division B 
        of Public Law 116-59, or any other prior law making amounts 
        available for fiscal year 2020 for activities authorized by 
        section 2008 of the Social Security Act, shall be charged to 
        the appropriation made by subsection (c)(1) of such section 
        2008 for fiscal year 2020 (not including the amount for 
        technical assistance and administrative costs); and
          (2) if such enactment occurs on or before November 21, 2019, 
        the availability of funds appropriated in, and the authority 
        provided under, such section 1501 shall terminate.

SEC. 3. CAREER PATHWAYS THROUGH HEALTH PROFESSION OPPORTUNITY GRANTS.

  Effective October 1, 2020, section 2008 of the Social Security Act 
(42 U.S.C. 1397g) is amended to read as follows:

``SEC. 2008. CAREER PATHWAYS THROUGH HEALTH PROFESSION OPPORTUNITY 
                    GRANTS.

  ``(a) Application Requirements.--An eligible entity desiring a grant 
under this section for a project shall submit to the Secretary an 
application for the grant, that includes the following:
          ``(1) A description of how the applicant will use a career 
        pathways approach to train eligible individuals for health 
        professions that pay well or will put eligible individuals on a 
        career path to an occupation that pays well, under the project.
          ``(2) A description of the adult basic education and literacy 
        activities, work readiness activities, training activities, and 
        case management and career coaching services that the applicant 
        will use to assist eligible individuals to gain work 
        experience, connection to employers, and job placement, and a 
        description of the plan for recruiting, hiring, and training 
        staff to provide the case management, mentoring, and career 
        coaching services, under the project directly or through local 
        governmental, apprenticeship, educational, or charitable 
        institutions.
          ``(3) In the case of an application for a grant under this 
        section for a demonstration project described in subsection 
        (c)(2)(B)(i)(I)--
                  ``(A) a demonstration that the State in which the 
                demonstration project is to be conducted has in effect 
                policies or laws that permit certain allied health and 
                behavioral health care credentials to be awarded to 
                people with certain arrest or conviction records (which 
                policies or laws shall include appeals processes, 
                waivers, certificates, and other opportunities to 
                demonstrate rehabilitation to obtain credentials, 
                licensure, and approval to work in the proposed health 
                careers), and a plan described in the application that 
                will use a career pathway to assist participants with 
                such a record in acquiring credentials, licensing, and 
                employment in the specified careers;
                  ``(B) a discussion of how the project or future 
                strategic hiring decisions will demonstrate the 
                experience and expertise of the project in working with 
                job seekers who have arrest or conviction records or 
                employers with experience working with people with 
                arrest or conviction records;
                  ``(C) an identification of promising innovations or 
                best practices that can be used to provide the 
                training;
                  ``(D) a proof of concept or demonstration that the 
                applicant has done sufficient research on workforce 
                shortage or in-demand jobs for which people with 
                certain types of arrest or conviction records can be 
                hired;
                  ``(E) a plan for recruiting students who are eligible 
                individuals into the project; and
                  ``(F) a plan for providing post-employment support 
                and ongoing training as part of a career pathway under 
                the project.
          ``(4) In the case of an application for a grant under this 
        section for a demonstration project described in subsection 
        (c)(2)(B)(i)(II)--
                  ``(A) a description of the partnerships, strategic 
                staff hiring decisions, tailored program activities, or 
                other programmatic elements of the project, such as 
                training plans for doulas and other community health 
                workers and training plans for midwives and other 
                allied health professions, that are designed to support 
                a career pathway in pregnancy, birth, or post-partum 
                services; and
                  ``(B) a demonstration that the State in which the 
                demonstration project is to be conducted recognizes 
                doulas or midwives, as the case may be.
          ``(5) A demonstration that the applicant has experience 
        working with low-income populations, or a description of the 
        plan of the applicant to work with a partner organization that 
        has the experience.
          ``(6) A plan for providing post-employment support and 
        ongoing training as part of a career pathway under the project.
          ``(7) A description of the support services that the 
        applicant will provide under the project, including a plan for 
        how child care and transportation support services will be 
        guaranteed and, if the applicant will provide a cash stipend or 
        wage supplement, how the stipend or supplement would be 
        calculated and distributed.
          ``(8) A certification by the applicant that the project 
        development included--
                  ``(A) consultation with a local workforce development 
                board established under section 107 of the Workforce 
                Innovation and Opportunity Act;
                  ``(B) consideration of apprenticeship and pre-
                apprenticeship models registered under the Act of 
                August 16, 1937 (also known as the `National 
                Apprenticeship Act');
                  ``(C) consideration of career pathway programs in the 
                State in which the project is to be conducted; and
                  ``(D) a review of the State plan under section 102 or 
                103 of the Workforce Innovation and Opportunity Act.
          ``(9) A description of the availability and relevance of 
        recent labor market information and other pertinent evidence of 
        in-demand jobs or worker shortages.
          ``(10) A certification that the applicant will directly 
        provide or contract for the training services described in the 
        application.
          ``(11) A commitment by the applicant that, if the grant is 
        made to the applicant, the applicant will--
                  ``(A) during the planning period for the project, 
                provide the Secretary with any information needed by 
                the Secretary to establish adequate data reporting and 
                administrative structure for the project;
                  ``(B) hire a person to direct the project not later 
                than the end of the planning period applicable to the 
                project;
                  ``(C) accept all technical assistance offered by the 
                Secretary with respect to the grant;
                  ``(D) participate in such in-person grantee 
                conferences as are regularly scheduled by the 
                Secretary;
                  ``(E) provide all data required by the Secretary 
                under subsection (g); and
                  ``(F) notify the local disabled veterans' outreach 
                program specialists under section 4103A of title 38, 
                United States Code, and the local veterans' employment 
                representatives under section 4104 of such title, of 
                the grantee's outreach plan for advertising training 
                opportunities to potential participants in the project.
  ``(b) Preferences in Considering Applications.--In considering 
applications for a grant under this section, the Secretary shall give 
preference to--
          ``(1) applications submitted by applicants to whom a grant 
        was made under this section or any predecessor to this section;
          ``(2) applications submitted by applicants who have business 
        and community partners in each of the following categories:
                  ``(A) State and local government agencies and social 
                service providers, including a State or local entity 
                that administers a State program funded under part A of 
                this title;
                  ``(B) institutions of higher education, 
                apprenticeship programs, and local workforce 
                development boards established under section 107 of the 
                Workforce Innovation and Opportunity Act; and
                  ``(C) health care employers, health care industry or 
                sector partnerships, labor unions, and labor-management 
                partnerships;
          ``(3) applications that include opportunities for mentoring 
        or peer support, and make career coaching available, as part of 
        the case management plan;
          ``(4) applications which describe a project that will serve a 
        rural area in which--
                  ``(A) the community in which the individuals to be 
                enrolled in the project reside is located;
                  ``(B) the project will be conducted; or
                  ``(C) an employer partnership that has committed to 
                hiring individuals who successfully complete all 
                activities under the project is located;
          ``(5) applications that include a commitment to providing 
        project participants with a cash stipend or wage supplement; 
        and
          ``(6) applications which have an emergency cash fund to 
        assist project participants financially in emergency 
        situations.
  ``(c) Grants.--
          ``(1) Competitive grants.--
                  ``(A) Grant authority.--
                          ``(i) In general.--The Secretary, in 
                        consultation with the Secretary of Labor and 
                        the Secretary of Education, may make a grant in 
                        accordance with this paragraph to an eligible 
                        entity whose application for the grant is 
                        approved by the Secretary, to conduct a project 
                        designed to train low-income individuals for 
                        allied health professions, health information 
                        technology, physicians assistants, nursing 
                        assistants, registered nurse, advanced practice 
                        nurse, and other professions considered part of 
                        a health care career pathway model.
                          ``(ii) Guarantee of grantees in each state 
                        and the district of columbia.--For each grant 
                        cycle, the Secretary shall award a grant under 
                        this paragraph to at least 2 eligible entities 
                        in each State that is not a territory, to the 
                        extent there are a sufficient number of 
                        applications submitted by the entities that 
                        meet the requirements applicable with respect 
                        to such a grant. If, for a grant cycle, there 
                        are fewer than 2 such eligible entities in a 
                        State, the Secretary shall include that 
                        information in the report required by 
                        subsection (g)(2) that covers the fiscal year.
                  ``(B) Guarantee of grants for indian populations.--
                From the amount reserved under subsection (i)(2)(B) for 
                each fiscal year, the Secretary shall award a grant 
                under this paragraph to at least 10 eligible entities 
                that are an Indian tribe, a tribal organization, or a 
                tribal college or university, to the extent there are a 
                sufficient number of applications submitted by the 
                entities that meet the requirements applicable with 
                respect to such a grant.
                  ``(C) Guarantee of grantees in the territories.--From 
                the amount reserved under subsection (i)(2)(C) for each 
                fiscal year, the Secretary shall award a grant under 
                this paragraph to at least 2 eligible entities that are 
                located in a territory, to the extent there are a 
                sufficient number of applications submitted by the 
                entities that meet the requirements applicable with 
                respect to such a grant.
          ``(2) Grants for demonstration projects.--
                  ``(A) Grant authority.--The Secretary, in 
                consultation with the Secretary of Labor and the 
                Secretary of Education (and, with respect to 
                demonstration projects of the type described in 
                subparagraph (B)(i)(I), the Attorney General) shall 
                make a grant in accordance with this subsection to an 
                eligible entity whose application for the grant is 
                approved by the Secretary, to conduct a demonstration 
                project that meets the requirements of subparagraph 
                (B).
                  ``(B) Requirements.--The requirements of this 
                subparagraph are the following:
                          ``(i) Type of project.--The demonstration 
                        project shall be of 1 of the following types:
                                  ``(I) Individuals with arrest or 
                                conviction records demonstration.--The 
                                demonstration project shall be of a 
                                type designed to provide education and 
                                training for eligible individuals with 
                                arrest or conviction records to enter 
                                and follow a career pathway in the 
                                health professions through occupations 
                                that pay well and are expected to 
                                experience a labor shortage or be in 
                                high demand.
                                  ``(II) Pregnancy and childbirth 
                                career pathway demonstration.--The 
                                demonstration project shall be of a 
                                type designed to provide education and 
                                training for eligible individuals to 
                                enter and follow a career pathway in 
                                the field of pregnancy, childbirth, or 
                                post-partum, in a State that recognizes 
                                doulas or midwives and that provides 
                                payment for services provided by doulas 
                                or midwives, as the case may be, under 
                                private or public health insurance 
                                plans.
                          ``(ii) Duration.--The demonstration project 
                        shall be conducted for not less than 5 years.
                  ``(C) Minimum allocation of funds for each type of 
                demonstration project.--
                          ``(i) Individuals with arrest or conviction 
                        records demonstrations.--Not less than 25 
                        percent of the amounts made available for 
                        grants under this paragraph shall be used to 
                        make grants for demonstration projects of the 
                        type described in subparagraph (B)(i)(I).
                          ``(ii) Pregnancy and childbirth career 
                        pathway demonstrations.--Not less than 25 
                        percent of the amounts made available for 
                        grants under this paragraph shall be used to 
                        make grants for demonstration projects of the 
                        type described in subparagraph (B)(i)(II).
          ``(3) Grant cycle.--The grant cycle under this section shall 
        be not less than 5 years, with a planning period of not more 
        than the 1st 12 months of the grant cycle. During the planning 
        period, the amount of the grant shall be in such lesser amount 
        as the Secretary determines appropriate.
  ``(d) Use of Grant.--
          ``(1) In general.--An entity to which a grant is made under 
        this section shall use the grant in accordance with the 
        approved application for the grant.
          ``(2) Support to be provided.--
                  ``(A) Required support.--A project for which a grant 
                is made under this section shall include the following:
                          ``(i) An assessment for adult basic skill 
                        competency, and provision of adult basic skills 
                        education if necessary for lower-skilled 
                        eligible individuals to enroll in the project 
                        and go on to enter and complete post-secondary 
                        training, through means including the 
                        following:
                                  ``(I) Establishing a network of 
                                partners that offer pre-training 
                                activities for project participants who 
                                need to improve basic academic skills 
                                or English language proficiency before 
                                entering a health occupational training 
                                career pathway program.
                                  ``(II) Offering resources to enable 
                                project participants to continue 
                                advancing adult basic skill proficiency 
                                while enrolled in a career pathway 
                                program.
                                  ``(III) Embedding adult basic skill 
                                maintenance as part of ongoing post-
                                graduation career coaching and 
                                mentoring.
                          ``(ii) A guarantee that child care is an 
                        available and affordable support service for 
                        project participants through means such as the 
                        following;
                                  ``(I) Referral to, and assistance 
                                with, enrollment in a subsidized child 
                                care program.
                                  ``(II) Direct payment to a child care 
                                provider if a slot in a subsidized 
                                child care program is not available or 
                                reasonably accessible.
                                  ``(III) Payment of co-payments or 
                                associated fees for child care.
                          ``(iii) Case management plans that include 
                        career coaching (with the option to offer 
                        appropriate peer support and mentoring 
                        opportunities to help develop soft skills and 
                        social capital), which may be offered on an 
                        ongoing basis before, during, and after initial 
                        training as part of a career pathway model.
                          ``(iv) A plan to provide project participants 
                        with transportation through means such as the 
                        following:
                                  ``(I) Referral to, and assistance 
                                with enrollment in, a subsidized 
                                transportation program.
                                  ``(II) If a subsidized transportation 
                                program is not reasonably available, 
                                direct payments to subsidize 
                                transportation costs.
                        For purposes of this clause, the term 
                        `transportation' includes public transit, or 
                        gasoline for a personal vehicle if public 
                        transit is not reasonably accessible or 
                        available.
                          ``(v) In the case of a demonstration project 
                        of the type described in subsection 
                        (c)(2)(B)(i)(I), access to legal assistance for 
                        project participants for the purpose of 
                        addressing arrest or conviction records and 
                        associated workforce barriers.
                  ``(B) Allowed support.--The goods and services 
                provided under a project for which a grant is made 
                under this section may include the following:
                          ``(i) A cash stipend that is at least 
                        monthly.
                          ``(ii) A reserve fund for financial 
                        assistance to project participants in emergency 
                        situations.
                          ``(iii) Tuition, and training materials such 
                        as books, software, uniforms, shoes, and hair 
                        nets.
                          ``(iv) In-kind resource donations such as 
                        interview clothing and conference attendance 
                        fees.
                          ``(v) Assistance with accessing and 
                        completing high school equivalency or adult 
                        basic education courses as necessary to achieve 
                        success in the project and make progress toward 
                        career goals.
                          ``(vi) Assistance with programs and 
                        activities, including legal assistance, deemed 
                        necessary to address arrest or conviction 
                        records as an employment barrier.
                          ``(vii) Other support services as deemed 
                        necessary for family well-being, success in the 
                        project, and progress toward career goals.
                  ``(C) Treatment of support for purposes of means-
                tested programs.--Any goods or services provided to an 
                eligible individual participating in a project for 
                which a grant is made under this section shall not be 
                considered income, and shall not be taken into account 
                for purposes of determining the eligibility of the 
                individual for, or amount of benefits to be provided to 
                the individual, under any means-tested program.
          ``(3) Training.--The number of hours of training provided to 
        an eligible individual under a project for which a grant is 
        made under this section, for a recognized postsecondary 
        credential, including an industry-recognized credential, which 
        is awarded in recognition of attainment of measurable technical 
        or occupational skills necessary to gain employment or advance 
        within an occupation (including a certificate awarded by a 
        local workforce development board established under section 107 
        of the Workforce Innovation and Opportunity Act), shall be--
                  ``(A) not less than the number of hours of training 
                required for certification in that level of skill by 
                the State in which the project is conducted; or
                  ``(B) if there is no such requirement, such number of 
                hours of training as the Secretary finds is necessary 
                to achieve that skill level.
          ``(4) Income limitation.--An entity to which a grant is made 
        under this section shall not use the grant to provide support 
        to a person who is not an eligible individual.
          ``(5) Inclusion of tanf recipients.--In the case of a project 
        for which a grant is made under this section that is conducted 
        in a State that has a program funded under part A of title IV, 
        at least 10 percent of the eligible individuals to whom support 
        is provided under the project shall meet the income eligibility 
        requirements under that State program, without regard to 
        whether the individuals receive benefits or services directly 
        under that State program.
          ``(6) Prohibition.--An entity to which a grant is made under 
        this section shall not use the grant for purposes of 
        entertainment, except that case management and career coaching 
        services may include celebrations of specific career-based 
        milestones such as completing a semester, graduation, or job 
        placement.
  ``(e) Technical Assistance.--
          ``(1) In general.--The Secretary shall provide technical 
        assistance--
                  ``(A) to assist eligible entities in applying for 
                grants under this section;
                  ``(B) that is tailored to meet the needs of grantees 
                at each stage of the administration of projects for 
                which grants are made under this section;
                  ``(C) that is tailored to meet the specific needs of 
                Indian tribes, tribal organizations, and tribal 
                colleges and universities;
                  ``(D) that is tailored to meet the specific needs of 
                the territories;
                  ``(E) that is tailored to meet the specific needs of 
                eligible entities in carrying out demonstration 
                projects for which a grant is made under this section; 
                and
                  ``(F) to facilitate the exchange of information among 
                eligible entities regarding best practices and 
                promising practices used in the projects.
          ``(2) Continuation of peer technical assistance 
        conferences.--The Secretary shall continue to hold peer 
        technical assistance conferences for entities to which a grant 
        is made under this section or was made under the immediate 
        predecessor of this section.
  ``(f) Evaluation of Demonstration Projects.--
          ``(1) In general.--The Secretary shall, by grant, contract, 
        or interagency agreement, conduct rigorous and well-designed 
        evaluations of the demonstration projects for which a grant is 
        made under this section.
          ``(2) Requirement applicable to individuals with arrest or 
        conviction records demonstration.--In the case of a project of 
        the type described in subsection (c)(2)(B)(i)(I), the 
        evaluation shall include identification of successful 
        activities for creating opportunities for developing and 
        sustaining, particularly with respect to low-income individuals 
        with arrest or conviction records, a health professions 
        workforce that has accessible entry points, that meets high 
        standards for education, training, certification, and 
        professional development, and that provides increased wages and 
        affordable benefits, including health care coverage, that are 
        responsive to the needs of the workforce.
          ``(3) Requirement applicable to pregnancy and childbirth 
        career pathway demonstration.--In the case of a project of the 
        type described in subsection (c)(2)(B)(i)(II), the evaluation 
        shall include identification of successful activities for 
        creating opportunities for developing and sustaining, 
        particularly with respect to low-income individuals and other 
        entry-level workers, a career pathway that has accessible entry 
        points, that meets high standards for education, training, 
        certification, and professional development, and that provides 
        increased wages and affordable benefits, including health care 
        coverage, that are responsive to the needs of the birth, 
        pregnancy, and post-partum workforce.
          ``(4) Rule of interpretation.--Evaluations conducted pursuant 
        to this subsection may include a randomized controlled trial, 
        but this subsection shall not be interpreted to require an 
        evaluation to include such a trial.
  ``(g) Reports.--
          ``(1) To the secretary.--An eligible entity awarded a grant 
        to conduct a project under this section shall submit interim 
        reports to the Secretary on the activities carried out under 
        the project, and, on the conclusion of the project, a final 
        report on the activities. Each such report shall include data 
        on participant outcomes related to earnings, employment in 
        health professions, graduation rate, graduation timeliness, 
        credential attainment, participant demographics, and other data 
        specified by the Secretary.
          ``(2) To the congress.--During each Congress, the Secretary 
        shall submit to the Committee on Ways and Means of the House of 
        Representatives and the Committee on Finance of the Senate a 
        report--
                  ``(A) on the demographics of the participants in the 
                projects for which a grant is made under this section;
                  ``(B) on the rate of which project participants 
                completed all activities under the projects;
                  ``(C) on the employment credentials acquired by 
                project participants;
                  ``(D) on the employment of project participants on 
                completion of activities under the projects, and the 
                earnings of project participants at entry into 
                employment;
                  ``(E) on best practices and promising practices used 
                in the projects;
                  ``(F) on the nature of any technical assistance 
                provided to grantees under this section;
                  ``(G) on, with respect to the period since the period 
                covered in the most recent prior report submitted under 
                this paragraph--
                          ``(i) the number of applications submitted 
                        under this section, with a separate statement 
                        of the number of applications referred to in 
                        subsection (b)(5);
                          ``(ii) the number of applications that were 
                        approved, with a separate statement of the 
                        number of such applications referred to in 
                        subsection (b)(5); and
                          ``(iii) a description of how grants were made 
                        in any case described in the last sentence of 
                        subsection (c)(1)(A)(ii); and
                  ``(H) that includes an assessment of the 
                effectiveness of the projects with respect to 
                addressing health professions workforce shortages or 
                in-demand jobs.
  ``(h) Definitions.--In this section:
          ``(1) Allied health profession.--The term `allied health 
        profession' has the meaning given in section 799B(5) of the 
        Public Health Service Act.
          ``(2) Career pathway.--The term `career pathway' has the 
        meaning given that term in section 3(7) of the Workforce 
        Innovation and Opportunity Act.
          ``(3) Doula.--The term `doula' means an individual who--
                  ``(A) is certified by an organization that has been 
                established for not less than 5 years and that requires 
                the completion of continuing education to maintain the 
                certification, to provide non-medical advice, 
                information, emotional support, and physical comfort to 
                an individual during the individual's pregnancy, 
                childbirth, and post-partum period; and
                  ``(B) maintains the certification by completing the 
                required continuing education.
          ``(4) Eligible entity.--The term `eligible entity' means any 
        of the following entities that demonstrates in an application 
        submitted under this section that the entity has the capacity 
        to fully develop and administer the project described in the 
        application:
                  ``(A) A local workforce development board established 
                under section 107 of the Workforce Innovation and 
                Opportunity Act.
                  ``(B) A State or territory, a political subdivision 
                of a State or territory, or an agency of a State, 
                territory, or such a political subdivision, including a 
                State or local entity that administers a State program 
                funded under part A of this title.
                  ``(C) An Indian tribe, a tribal organization, or a 
                tribal college or university.
                  ``(D) An institution of higher education (as defined 
                in the Higher Education Act of 1965).
                  ``(E) A hospital (as defined in section 1861(e)).
                  ``(F) A high-quality skilled nursing facility (as 
                defined in section 1819(a)).
                  ``(G) A Federally qualified health center (as defined 
                in section 1861(aa)(4)).
                  ``(H) A nonprofit organization described in section 
                501(c)(3) of the Internal Revenue Code of 1986, a labor 
                organization, or an entity with shared labor-management 
                oversight, that has a demonstrated history of providing 
                health profession training to eligible individuals.
                  ``(I) In the case of a demonstration project of the 
                type provided for in subsection (c)(2)(B)(i)(II) of 
                this section, an entity recognized by a State, Indian 
                tribe, or tribal organization as qualified to train 
                doulas or midwives, if midwives or doulas, as the case 
                may be, are permitted to practice in the State 
                involved.
                  ``(J) An opioid treatment program (as defined in 
                section 1861(jjj)(2)), and other high quality 
                comprehensive addiction care providers.
          ``(5) Eligible individual.--The term `eligible individual' 
        means an individual whose family income does not exceed 200 
        percent of the Federal poverty level.
          ``(6) Federal poverty level.--The term `Federal poverty 
        level' means the poverty line (as defined in section 673(2) of 
        the Omnibus Budget Reconciliation Act of 1981, including any 
        revision required by such section applicable to a family of the 
        size involved).
          ``(7) High-quality skilled nursing facility.--The term `high-
        quality skilled nursing facility' means a facility (as defined 
        in section 1819(a)) that has at least a 5-star rating for 
        staffing to participate based on the data from section 
        1819(i)(1)(A)(i) and not have an immediate jeopardy violation 
        as described in section 1819(h)(1)(A) within the preceding 3 
        years.
          ``(8) Indian tribe; tribal organization.--The terms `Indian 
        tribe' and `tribal organization' have the meaning given the 
        terms in section 4 of the Indian Self-Determination and 
        Education Assistance Act (25 U.S.C. 450b).
          ``(9) Institution of higher education.--The term `institution 
        of higher education' has the meaning given the term in section 
        101 or 102(a)(1)(B) of the Higher Education Act of 1965.
          ``(10) Territory.--The term `territory' means the 
        Commonwealth of Puerto Rico, the United States Virgin Islands, 
        Guam, the Northern Mariana Islands, and American Samoa.
          ``(11) Tribal college or university.--The term `tribal 
        college or university' has the meaning given the term in 
        section 316(b) of the Higher Education Act of 1965.
  ``(i) Funding.--
          ``(1) In general.--Out of any funds in the Treasury of the 
        United States not otherwise appropriated, there are 
        appropriated to the Secretary to carry out this section 
        $425,000,000 for each of fiscal years 2021 through 2025.
          ``(2) Allocation of funds.--Of the amount appropriated for a 
        fiscal year under paragraph (1) of this subsection--
                  ``(A) 75 percent shall be available for grants under 
                subsection (c)(1)(A);
                  ``(B) 4 percent shall be reserved for grants under 
                subsection (c)(1)(B);
                  ``(C) 5 percent shall be reserved for grants under 
                subsection (c)(1)(C);
                  ``(D) 6 percent shall be available for demonstration 
                project grants under subsection (c)(2);
                  ``(E) 6 percent, plus all amounts referred to in 
                subparagraphs (A) through (D) of this paragraph that 
                remain unused after all grant awards are made for the 
                fiscal year, shall be available for the provision of 
                technical assistance and associated staffing; and
                  ``(F) 4 percent shall be available for studying the 
                effects of the demonstration and non-demonstration 
                projects for which a grant is made under this section, 
                and for associated staffing, for the purpose of 
                supporting the rigorous evaluation of the demonstration 
                projects, and supporting the continued study of the 
                short-, medium-, and long-term effects of all such 
                projects, including the effectiveness of new or added 
                elements of the non-demonstration projects.
  ``(j) Nonapplicability of Preceding Sections of This Subtitle.--
          ``(1) In general.--Except as provided in paragraph (2), the 
        preceding sections of this subtitle shall not apply to a grant 
        awarded under this section.
          ``(2) Exception for certain limitations on use of grants.--
        Section 2005(a) (other than paragraphs (2), (3), (5), (6), and 
        (8)) shall apply to a grant awarded under this section to the 
        same extent and in the same manner as such section applies to 
        payments to States under this subtitle.''.

                       I. SUMMARY AND BACKGROUND


                         A. Purpose and Summary

    H.R. 3398, the Pathways to Health Careers Act as amended 
and ordered favorably reported by the Committee on Ways and 
Means on October 22, 2019, reauthorizes and expands Health 
Profession Opportunity Grant (HPOG) demonstration projects and 
makes funding available to support additional competitive HPOG 
grants in states, tribal communities, and U.S. territories 
through 2025.
    H.R. 3398 was introduced by Subcommittee on Worker and 
Family Support Chairman Danny K. Davis (D-IL) and incorporates 
through amendment to section 2008 of the Social Security Act a 
number of bills previously introduced as standalone measures. 
New subsection (a) of section 2008 of the Social Security Act, 
is based on H.R. 3338, the Essential Skills and Child Care for 
Health Professions Act, introduced by Rep. Judy Chu (D-CA); 
H.R. 3336, the Demonstrating that Empowerment Makes 
Opportunities (DEMO) Act, introduced by Rep. Danny Davis (D-
IL); H.R. 3344, the Opportunities to Support Mothers and 
Deliver Children Act, introduced by Rep. Gwen Moore (D-WI); 
H.R. 3756, the Pre-Apprenticeship Promotion Act, introduced by 
Rep. Don Beyer (D-VA); and H.R. 3337, the Labor Market Response 
Act, introduced by Rep. Brendan Boyle (D-PA).
    The bill also incorporates, as new subsection (b) of 
section 2008 of the Social Security Act, H.R. 3345, the Making 
Opportunities Reachable for Everyone (MORE) Act, introduced by 
Rep. Stephanie Murphy (D-FL); H.R. 3339, the Mentoring and 
Supporting Families Act, introduced by Rep. Dwight Evans (D-
PA); and H.R. 3347, the Rural Health Training Opportunities 
Act, introduced by Rep. Terri Sewell (D-AL).
    New subsection (c) is based on H.R. 3340, the Tribal 
Healthcare Careers Act, introduced by Rep. Jimmy Gomez (D-CA); 
H.R. 3335, the Territory Health Revitalization Act, introduced 
by Rep. Richard Neal (D-MA) and Rep. Jenniffer Gonzales-Colon 
(R-PR); and H.R. 3823, the Promoting Health Careers in 
Community and Technical Colleges Act, introduced by Rep. Lloyd 
Doggett (D-TX).
    New subsection (e) is based on H.R. 3343, the Technical 
Assistance for Health Grants Act, introduced by Rep. Dan Kildee 
(D-MI).
    New subsection (f) incorporates H.R. 3767, the Impacts and 
Outcomes for Health Career Training Act, introduced by Rep. 
Brad Schneider (D-IL).
    New subsection (g) incorporates H.R. 3346, the Health 
Opportunities to Promote Equity Act, introduced by Rep. Bill 
Pascrell (D-NJ).
    New subsection (h) incorporates H.R. 3342, the Health 
Providers Training Act, introduced by Rep. Steven Horsford (D-
NV) and H.R. 3341, the Opioid Treatment Providers Act, 
introduced by Rep. Brian Higgins (D-NY).

                 B. Background and Need for Legislation

    The Bureau of Labor Statistics projects that the number of 
health sector jobs will grow three times faster than the 
economy as a whole over the next decade, and three of the six 
fastest growing occupations are allied health worker jobs.\1\As 
our population ages, there is a greater need for allied health 
workers to care for our seniors. Advances in medicine mean that 
more people are living longer while managing chronic illnesses, 
also increasing the demand for allied health workers. It is not 
only a shortage of doctors--there is also a shortage of nurses, 
nursing assistants, paramedics, home health aides, 
phlebotomists, X-ray technicians, and more. This healthcare 
professional shortage is a problem that will only get worse.
---------------------------------------------------------------------------
    \1\Health Affairs Blog: Health Care Jobs Projected To Continue To 
Grow Far Faster Than Jobs In The General Economy, May 9, 2018.
---------------------------------------------------------------------------
    The current Health Profession Opportunity Grant (HPOG) 
program is a time-limited demonstration grant program testing a 
career pathways approach to job training for in-demand or 
worker shortage health professions. The HPOG model is intended 
to grow the pool of available workers by addressing barriers 
that may have prevented participants from taking advantage of 
traditional training programs. HPOG creates a training lattice 
to meet workers where they are and provide a meaningful and 
supportive pathway to a career as they work and earn 
credentials from progressively higher-level trainings. HPOG 
programs are means tested, and the training includes a mix of 
support services including child care, transportation, tuition 
and other financial assistance, career coaching, and job 
placement.\2\
---------------------------------------------------------------------------
    \2\Section 2008 of the Social Security Act [42 USC Section 1397g].
---------------------------------------------------------------------------
    The Administration for Children and Families at the U.S. 
Department of Health and Human Services (HHS) has administered 
the HPOG demonstration since 2010, and has awarded two rounds 
of five-year grants (HPOG 1.0 and 2.0), each evaluated in 
randomized controlled trials. The evaluations found strong 
positive outcomes associated with educational progress, 
employment outcomes, and earned income.\3\ HHS is conducting 
follow-up evaluations of the HPOG 1.0 cohort to determine 
medium-term employment outcomes.
---------------------------------------------------------------------------
    \3\Pamela Loprest, Alan Werner, and Nathan Sick (2017). Measuring 
Career Progress in the Health Profession Opportunity Grants (HPOG) 1.0 
Program, OPRE Report #2017-111, Washington, DC: Office of Planning, 
Research, and Evaluation, Administration for Children and Families, 
U.S. Department of Health and Human Services.
---------------------------------------------------------------------------
    Current demonstration grantees include institutions of 
higher education, workforce development boards, state agencies, 
tribal organizations, or community-based organizations. Second-
round grantees (HPOG 2.0) are currently entering the 5th year 
of a five-year grant award. Under current law, funding for the 
demonstration grants will expire on November 21, 2019, which is 
10 months before the demonstration projects will be 
completed.\4\
---------------------------------------------------------------------------
    \4\P.L. 116-59.
---------------------------------------------------------------------------
    In the demonstration projects, HPOG participants were 
predominantly low-income, single, working mothers of color, 48 
percent of whom have a high school education or less.\5\ 
Traditional training programs often exclude these groups, or do 
not support their success, due to the lack of supportive 
services,\6\ whereas HPOG is expressly designed to support 
their success. In a June 14 Committee hearing, Congressman 
Dwight Evans testified:
---------------------------------------------------------------------------
    \5\Pamela Loprest and Nathan Sick. (2019). Health Profession 
Opportunity Grants 2.0: Year Three Annual Report (2017-18), OPRE Report 
# 2019-64. Washington, DC: Office of Planning, Research, and 
Evaluation, Administration for Children and Families, U.S. Department 
of Health and Human Services.
    \6\Institute for Women's Policy Research (2017). Getting to the 
Finish Line: The Availability and Impact of Supportive Services in the 
Workforce Development System. IWPR Report #C453. Washington, DC.

          They (HPOGs) also help diversify the health 
        professions, which can lead to reducing disparities in 
        health outcomes. . . The mentorship and career coaching 
        components of the program are especially critical in 
        helping individuals overcome their barriers. I have 
        always been an outspoken supporter of mentoring. Not 
        all of us grow up in the same communities, come from 
        the same backgrounds, and are taught the same things 
        through our upbringing. Mentoring is key to bridging 
        the gaps we have in and across our communities, 
        strengthening bonds, and ensuring that people can grow 
        to reach their full potential, no matter where they 
        come from.\7\
---------------------------------------------------------------------------
    \7\Member Day Hearing: Hearings before the Committee on Ways and 
Means, House of Representatives, 116th Congress (June 4, 2019) https://
waysandmeans.house.gov/sites/democrats.waysandmeans.house.gov/files/
documents/Transcript_2.pdf

    Early evaluations of HPOG 1.0 suggested that the programs 
succeeded in supporting participants in meeting their career 
goals: participation in an HPOG program not only increased 
training completion rates, but also the likelihood of being 
employed in a health profession upon graduation.\8\ 
Furthermore, of those who gained health care employment, over 
15 percent received a wage increase right away.\9\ The majority 
of HPOG 1.0 participants were ``nontraditional'' postsecondary 
education students: the average student age was 32 years old, 
and most were single women raising one or more children. Nearly 
half of HPOG 1.0 participants were already employed upon 
enrollment in HPOG training but needed jobs that would move 
them out of poverty.\10\ These findings are illustrative of the 
ways in which HPOG is providing opportunities for hardworking 
families not only to meet their career goals but also to 
support their family economic mobility goals.
---------------------------------------------------------------------------
    \8\Peck, Laura R., Alan Werner, Eleanor Harvill, Daniel Litwok, 
Shawn Moulton, Alyssa Rulf Fountain, and Gretchen Locke. (2018). Health 
Profession Opportunity Grants (HPOG 1.0) Impact Study Interim Report: 
Program Implementation and Short-Term Impacts, OPRE Report 2018-16a. 
Washington, DC: Office of Planning, Research, and Evaluation, 
Administration for Children and Families, U.S. Department of Health and 
Human Services.
    \9\Walton, Douglas, Eleanor L. Harvill, and Laura R. Peck (2019). 
Which Program Characteristics Are Linked to Program Impacts? Lessons 
from the HPOG 1.0 Evaluation. OPRE Report 201951, Washington, DC: 
Office of Planning, Research, and Evaluation, Administration for 
Children and Families, U.S. Department of Health and Human Services.
    \10\Peck, Laura R., Alan Werner, Eleanor Harvill, Daniel Litwok, 
Shawn Moulton, Alyssa Rulf Fountain, and Gretchen Locke. (2018). Health 
Profession Opportunity Grants (HPOG 1.0) Impact Study Interim Report: 
Program Implementation and Short-Term Impacts, OPRE Report 2018-16a. 
Washington, DC: Office of Planning, Research, and Evaluation, 
Administration for Children and Families, U.S. Department of Health and 
Human Services.
---------------------------------------------------------------------------
    HPOG 2.0 is scheduled to run from FY2015-FY2020 and is 
building upon the lessons from the first HPOG 1.0 demonstration 
round. In just the first three years of HPOG 2.0, federally 
funded evaluations found very high training retention rates (88 
percent), high rates of acquiring certifications or credentials 
(67 percent) and high rates of employment and progression in 
health fields (three fifths started a health care job or were 
promoted within a health care job, and one fourth made career 
progress beyond getting a first job, within just the first 
three years).\11\ HPOG 2.0 grantees also had high rates of 
success with participants with very low initial levels of 
education; of those who needed basic skills training, 92 
percent completed or are still enrolled in training, and more 
than three-fourths moved on to health profession training.\12\
---------------------------------------------------------------------------
    \11\Pamela Loprest and Nathan Sick. (2019). Health Profession 
Opportunity Grants 2.0: Year Three Annual Report (2017-18), OPRE Report 
# 2019-64. Washington, DC: Office of Planning, Research, and 
Evaluation, Administration for Children and Families, U.S. Department 
of Health and Human Services.
    \12\Pamela Loprest and Nathan Sick. (2019). Health Profession 
Opportunity Grants 2.0: Year Three Annual Report (2017-18), OPRE Report 
# 2019-64. Washington, DC: Office of Planning, Research, and 
Evaluation, Administration for Children and Families, U.S. Department 
of Health and Human Services.
---------------------------------------------------------------------------
    The demonstration projects have shown that HPOG can be part 
of the solution to workforce shortages. In a letter to the 
Committee, Steady H. Moono, the President of SUNY Schenectady 
Community College, an HPOG demonstration grantee, noted:

          The HPOG program is critical to connecting our 
        employers with talent that may have been overlooked in 
        the past but is not necessarily any less successful 
        than any other trained individual. As our region's 
        unemployment rate continues to decline, our healthcare 
        providers struggle to find qualified and trained 
        applicants to fill critical positions.\13\
---------------------------------------------------------------------------
    \13\Letter from Steady H. Moono to Chairman Richard E. Neal and 
Ranking Member Kevin Brady, August 7, 2019.

    HPOG demonstrations have also been effective in rural 
areas, which struggle to find qualified workers. As the Central 
Community College HPOG grantee in rural Nebraska said, ``This 
HPOG program is a win-win for participants and employers. It 
opens doors to stable healthcare careers while producing well 
trained applicants who are ready to fill critical job 
openings.''\14\
---------------------------------------------------------------------------
    \14\HPOG Promising Practice: Central Community College, Employment 
Strategies, published on the Administration for Children and Families 
website July 1, 2019.
---------------------------------------------------------------------------
    Legislation is needed to avoid terminating the current 
demonstration projects prematurely, and to allow HHS to 
continue following the HPOG 1.0 and HPOG 2.0 cohorts, to 
determine long-term employment outcomes.
    Legislation is also needed to make this research-tested 
approach available to more workers and communities. Because it 
is structured as a demonstration project, there are currently 
only 32 HPOG programs serving approximately 15,000 individuals. 
Communities across the United States, including tribal 
communities and the U.S. Territories, could benefit from 
locally-administered grants using this proven and effective 
model to help workers and address the health worker shortage. 
We also can further build on our research investment by testing 
variations of this proven model for other career pathways and 
beneficiary populations and continuing to follow current and 
future HPOG beneficiaries and refine the model.

                         C. Legislative History


                               BACKGROUND

    H.R. 3398, the Pathways to Health Careers Act, was 
introduced on June 21, 2019, by Congressman Danny K. Davis, and 
was referred to the Committee on Ways and Means.

                           COMMITTEE HEARINGS

    On March 7, 2019 the Ways and Means Subcommittee on Worker 
and Family Support held a hearing entitled ``Leveling the 
Playing Field for Working Families: Challenges and 
Opportunities'' which focused on ways to better support workers 
and their families. Members and witnesses discussed the 
critical role of child care, as well as the bundling of 
training and work supports.
    On May 16, 2019 the Ways and Means Committee held a hearing 
entitled ``Overcoming Racial Disparities and Social 
Determinants in the Maternal Mortality Crisis,'' in which 
Members and witnesses discussed the need to increase the supply 
of diverse, well-trained pregnancy and birth healthcare 
workers.
    On June 4, 2019 the Ways and Means Committee held a Member 
Day hearing, at which Congressman Dwight Evans testified in 
support of building on HPOG success and his bill, H.R. 3339, 
the Mentoring and Supporting Families Act, which is fully 
incorporated within H.R. 3398.
    On June 11, 2019 the Ways and Means Subcommittee on Worker 
and Family Support held a hearing entitled ``Celebrating 
Fathers and Families: Federal Support for Responsible 
Fatherhood,'' in which Members and witnesses discussed 
effective approaches to helping incarcerated individuals and 
those with arrest or conviction records to enter, reenter, and 
stay in the workforce.

                            COMMITTEE ACTION

    The Committee on Ways and Means marked up H.R. 3398, the 
Pathways to Health Careers Act on October 22, 2019. The bill, 
as amended, was ordered favorably reported to the House of 
Representatives (with a quorum being present) by a vote of 24 
yeas and 16 nays.

                      II. EXPLANATION OF THE BILL


                 A. The Pathways to Health Careers Act


                              CURRENT LAW

    Under section 2008 of the Social Security Act, the U.S. 
Department of Health and Human Services, in consultation with 
the U.S. Department of Education, is authorized to use up to 
$85 million per year to award demonstration grants to states, 
federally recognized Indian tribes or tribal organizations, 
institutions of higher education, local workforce development 
boards, apprenticeship programs, or community-based 
organizations, for the purpose of providing low-income 
individuals, including recipients of Temporary Assistance for 
Needy Families cash benefits, with the training and support 
needed to enter and advance in health professions.
    The funding authorization expires on November 22, 2019.\15\
---------------------------------------------------------------------------
    \15\Section 2008 of the Social Security Act.
---------------------------------------------------------------------------

                           REASONS FOR CHANGE

    The Committee believes that after 10 years of rigorously 
evaluating Health Profession Opportunity Grant (HPOG) 
demonstration projects, we have identified an approach that is 
effective in moving low-income parents, even those with 
barriers to work, into health professions which are in-demand 
or experiencing worker shortages. Given the number of Americans 
in need of better jobs and the growing shortage of qualified 
health workers in many communities and for many specific types 
of needed health care, the Committee seeks to ensure that the 
proven HPOG model can be made available and accessible to 
Americans seeking opportunities in all 50 states, the District 
of Columbia, the U.S. Territories, and in tribal communities. 
The Committee also seeks to continue to refine this effective 
approach and test it with additional populations that might 
benefit.

                       EXPLANATION OF PROVISIONS

Sec. 1. Short title

    This section provides the bill title, ``Pathways to Health 
Careers Act''.

Sec. 2. Extension through fiscal year 2020 of funding for demonstration 
        projects to address health professions workforce needs

    This section extends existing Health Profession Opportunity 
Grant (HPOG) policy and funding until September 30, 2020, to 
finish the current demonstration grant cycle. It also provides 
an additional $15 million for fiscal year 2020 for technical 
assistance and administrative costs associated with 
implementing the HPOG grants outlined in the rest of the bill.

Sec. 3. Career pathways through health profession opportunity grants

    This section revises section 2008 of the Social Security 
Act to provide for HPOG competitive grants, beginning in FY 
2021, in all 50 states, the District of Columbia, U.S. 
territories, and tribal communities, and to authorize specific 
new demonstration grants.
    If there are sufficient qualified applicants for 
competitive grants, the Secretary is required to award at least 
two grants in each state and the District of Columbia; at least 
10 grants to federally recognized Indian tribes, tribal 
organizations, or tribal colleges or universities; and at least 
two grants to applicants in U.S. territories. The Secretary has 
discretion to not award grants, if there are not enough 
qualified applicants, but must report to Congress on the reason 
grants were not made. The Committee does not consider grants to 
federally recognized Indian tribes, tribal organizations, and 
tribal colleges and universities geographically located within 
states to fulfill the two per state requirement.
    This section also authorizes two new HPOG demonstration 
projects: a project to test the HPOG approach for individuals 
with arrest or conviction records, and a project to test the 
HPOG approach for a pregnancy and birth career pathway.
    The following description reflects the new subsections of 
section 2008 of the Social Security Act as modified by H.R. 
3398.
            Subsection (a). Application requirements
    This subsection describes grant requirements applicable to 
all grants (competitive and demonstration) and also outlines 
additional requirements which apply only to specific 
demonstration projects.
    The subsection requires all grant applications to include a 
career pathways approach, as well as plans to address 
participant basic skills and work readiness, provide training 
for in-demand or shortage health professions, case management 
and career coaching, and job placement and post-employment 
support.
    Applicants for both types of grants must certify that they 
will provide access to child care and transportation for 
participants, if needed, have experience working with low-
income populations, have considered apprenticeship models, and 
base their approach on labor market data which shows job 
shortages or the availability of in-demand jobs. Grantees are 
required to review their state's workforce development plan and 
consult with their local workforce development board, but they 
do not need to receive approval from them to submit the 
application. Further, if a stipend is a part of the applicant's 
model, they must also include a plan for calculating and 
distributing the living expenses stipend.
    The applicant is required to provide a certification, all 
data requested by the Secretary of HHS, and ensure a Director 
is in place for the project by the end of the planning period.
    Subsection (a) also includes the following additional grant 
requirements which apply only to specific demonstration 
projects. They include the following:
    Arrest or Conviction Record demonstration projects must 
sufficiently research and understand local laws and 
restrictions to ensure that state and local laws provide a way 
for people with arrest or conviction records to receive 
credentials and licenses needed for the career, including 
provisions in law that allow people with disqualifying 
convictions to appeal, obtain waivers or certificates, or 
produce evidence of rehabilitation that provide relief from 
statutory barriers. State laws that include discretionary 
denials of certifications and licensure based solely, or in 
part, on criminal history for healthcare occupations should not 
preclude applicants from competition if applicants can provide 
information regarding the opportunities in state licensure and 
certification processes to provide mitigating and 
rehabilitative evidence to document a realistic pathway to the 
specified career. Applications should include a commitment from 
stakeholder partners to work toward fair hiring practices that 
follow Title VII of the Civil Rights Act of 1964 and should 
tailor their proposed program to meet the needs of the 
community. For the purposes of this demonstration, public 
prisons and juvenile justice systems could be considered 
appropriate state agency partners. Qualified applicants for 
this demonstration must also have project staff with experience 
working with individuals who have arrest or conviction records, 
or, working with employers with experience working with people 
with arrest or conviction records, as well as a plan for 
participant recruitment.
    Pregnancy and Birth demonstration projects must have 
partnerships and a program design that will support a career 
pathway in pregnancy, birth, or post-partum services and 
conduct the demonstration in a jurisdiction where state and 
local laws recognize doulas and midwives. Grantees should train 
for a variety of credentials and roles within the pregnancy, 
birth, and post-partum field, which does not require nor 
presume that such roles require a Registered Nursing degree nor 
a Bachelor-prepared credential. The definition of ``allied 
health'' as included in the definitions subsection of the bill 
is intended to include nurse midwives in addition to other 
midwives that are not nurses and that are not bachelor-
prepared, as well as other professions that are considered part 
of the pregnancy and birth and post-partum career pathway, 
including, but not limited to, lactation support specialists 
and community health workers. The Committee intends all HPOG 
program graduates under this new demonstration project to meet 
the rigorous training requirements for standard industry-
recognized credentials, while also recognizing tribal 
sovereignty and cultural and religious doula and midwife 
practices in tribal communities. This demonstration is not 
excluded from Congressional expectation that HPOG program 
graduates, including those in the doula and midwife field, are 
employed in states and settings where they may bill their 
services to public and/or private health insurances.
            Subsection (b). Preferences in considering applications
    This subsection gives preference in awarding competitive 
grants to applicants who were prior HPOG grantees: applicants 
who partner with employers, state and local government 
agencies, labor organizations, and education and training 
providers (including workforce development boards, 
apprenticeship programs, and institutions of higher education); 
applicants that provide career coaching, mentoring, and peer 
support; applicants that serve rural areas; and applicants that 
plan to provide a stipend for living expenses, or have a 
reserve fund to help participants with emergencies that might 
otherwise force them to drop out of training.
            Subsection (c). Grants
    This subsection authorizes the Secretary of HHS, in 
consultation with the Secretary of Labor and the Secretary of 
Education (and, in the case of Arrest or Conviction Record 
demonstrations, the Attorney General) to award HPOG grants, 
guarantees each demonstration project at least 25 percent of 
funds provided for HPOG demonstration projects, and specifies a 
grant cycle of not less than five years, where the first year 
may be a planning period with a reduced funding amount 
determined by the HHS Secretary, who also has overall 
discretion in determining grant size. It is the Committee's 
expectation that the Secretary will continue to delegate this 
responsibility to the Office of Family Assistance, which will 
work with the Office of Planning, Research, and Evaluation 
within the Administration of Children and Families.
            Subsection (d). Use of grant
    Subsection (d) describes services and supports that are 
required under all grants, and also supports that are allowed, 
but not required to be provided, and how those supports 
interact with other benefit programs. It also sets beneficiary 
eligibility criteria.
    Support services that are required to be available in all 
HPOG-grant-funded programs if needed, include basic skills 
assessment and basic skills education (if necessary); 
guaranteed access to child care, either via referral, partial 
subsidy, or direct support; case management plans that include 
career coaching, with the option to offer appropriate peer 
support and mentoring opportunities to develop soft skills and 
social capital; and ensuring access to transportation 
(including public transit or gas for a personal vehicle). 
Transportation subsidies are not limited to a specific mode, as 
modes of transportation may evolve and change over time. For 
the demonstration for individuals with arrest or conviction 
records, grantees are required to facilitate access to legal 
assistance for participants, for the purpose of addressing 
arrest or conviction records and associated workforce barriers 
and increasing the accessibility of specific career pathways, 
including assisting individuals with certificates, waiver and 
licensing applications, sealing or expungement of arrest and 
conviction records, or other relevant legal services. All 
grantees are also required to provide at least the number of 
hours of training required for certification in the state in 
which the project is conducted, or, if there is no requirement, 
a number of hours set by HHS.
    Supports that are allowable but not required uses of grant 
funding include: a stipend for living expenses that is at least 
monthly; a reserve fund to provide financial assistance to 
participants in emergency situations; tuition and training 
materials such as uniforms, shoes, and hair nets; in-kind 
resource donations such as interview clothing and conference 
attendance fees; costs related to basic education or a high 
school equivalency education; legal assistance or other support 
necessary to address arrest or conviction record barriers to 
work and facilitate entrance into career pathways; and other 
support services as deemed necessary for family wellbeing, 
success in the project, and progress toward career goals.
    This subsection specifies that HPOG services do not count 
as income for the purposes of other federal benefits which use 
a means test for eligibility.
    Grantees are only allowed to serve individuals who are low-
income at the time of enrollment, but the Committee expects 
that many individuals will increase their income as they 
progress along a career pathway in the program and will remain 
eligible for services for the duration of the program. Grantees 
are also required to ensure that at least 10 percent of 
individuals served by their grant meet the income eligibility 
requirements of the state TANF program upon enrollment in the 
HPOG program, or are non-custodial parents of children who meet 
the state program eligibility requirements at the time of 
enrollment in the HPOG program.
    This subsection also prohibits the use of grant funds for 
entertainment, but provides a limited exception for career 
coaching and case management services that include family-
oriented celebrations of specific career milestones attained by 
participants.
            Subsection (e). Technical assistance
    This subsection requires the Secretary of HHS to provide 
technical assistance to grantees and potential grantees to 
assist in applying for grants, operating grants, and reporting 
data or evaluating grants. The subsection requires HHS to 
provide assistance tailored to meet the specific needs of 
Indian tribes, tribal organizations, tribal colleges and 
universities, U.S. territories, and demonstration project 
grantees. It also requires HHS to continue holding an annual 
technical assistance conference to facilitate exchange of 
information regarding best practices and promising practices 
among current and former grantees. The technical assistance 
services will assist in continuing to refine the effectiveness 
of the HPOG approach, test variations on the model, and 
encouraged continued innovation, so will be coordinated with 
evaluation services, as HHS works with new demonstration 
projects and continues to study impacts and outcomes of ongoing 
HPOG programs no longer participating in randomized controlled 
trials.
            Subsection (f). Evaluation of demonstration projects
    This subsection requires HHS to conduct rigorous and well-
designed evaluations of the demonstration projects, by grant, 
contract, or interagency agreement, and specifies that the 
evaluation does not have to be a randomized controlled trial. 
It also provides for ongoing research on long-term effects of 
past HPOG demonstrations. These evaluations should include 
study of the impact of cash stipends, regardless of the size or 
frequency of the stipend.
            Subsection (g). Reports
    This subsection requires grantees to report data on 
participant outcomes related to earnings, employment in health 
professions, graduate rate, graduation timeliness, credential 
attainment, participant demographics, and other data specified 
by the Secretary of HHS.
    The subsection also requires HHS to submit a once-per-
Congress report to the House Committee on Ways and Means and 
the Senate Finance Committee on characteristics of and outcomes 
for participants served by the awarded projects, best practices 
and promising practices, and technical assistance provided to 
grantees, as well as an assessment of the effectiveness of the 
projects in addressing health professions workforce shortages 
or in-demand jobs. The report must include a separate statement 
summarizing the number of rural applicants and rural awards, 
and, if the agency was not able to award the required number of 
grants to states, territories, and tribal communities, the 
reason why not.
            Subsection (h). Definitions
    This subsection describes entities eligible for grants and 
provides other definitions of terms used in the Act. Entities 
eligible for grants include local workforce development boards; 
states, county, and local governments or agencies; Indian 
tribes, tribal organizations, and tribal colleges and 
universities; hospitals; high-quality skilled nursing 
facilities; federally-qualified health centers; non-profits, 
labor organizations, and labor-management partnerships; and 
addiction treatment providers which the Secretary determined 
were high quality and provided comprehensive addiction 
treatment. Inclusion on the eligible entity list does not 
entitle any applicant to a grant. The Secretary has discretion 
to determine whether any individual entity is fully equipped to 
be a primary grantee of this supportive job training program.
            Subsection (i). Funding
    This subsection provides $425 million for each of fiscal 
years 2021 through 2025. Of those amounts, 75 percent is for 
general competitive grants, 4 percent is reserved for grants to 
tribes, tribal organizations, tribal colleges and universities, 
5 percent is reserved for grants to territories, 6 percent is 
reserved for demonstration projects, 6 percent plus any unspent 
funds from the other reservations is reserved for technical 
assistance, and 4 percent is reserved for evaluations and 
associated staffing.
            Subsection (j). Non-applicability of preceding section of 
                    this subtitle
    This subsection specifies that some uses of funding which 
are otherwise prohibited for states within Subtitle A of Title 
XX are allowable in the HPOG program.

                      III. VOTES OF THE COMMITTEE

    In compliance with clause 3(b) of rule XIII of the House of 
Representatives, the following statement is made concerning the 
vote of the Committee on Ways and Means during the markup 
consideration of H.R. 3398, the ``Pathways to Health Careers 
Act of 2019'' on October 22, 2019.
    A roll call vote was conducted on the following amendments 
to the Chairman's Amendment in the Nature of a Substitute.
    An amendment to the amendment in the nature of a substitute 
offered by Mr. Smith (NE) was ruled nongermane. Mr. Smith moved 
to appeal the ruling of the Chair and Mr. Thompson moved to 
table the appeal. Mr. Thompson's motion to table the appeal of 
the ruling of the chair was agreed to by a vote of 24 yeas to 
15 nays. The vote was as follows.

----------------------------------------------------------------------------------------------------------------
          Representative             Yea      Nay     Present      Representative      Yea      Nay     Present
----------------------------------------------------------------------------------------------------------------
Mr. Neal.........................       X   .......  .........  Mr. Brady..........  .......       X   .........
Mr. Lewis........................       X   .......  .........  Mr. Nunes..........  .......  .......  .........
Mr. Doggett......................       X   .......  .........  Mr. Buchanan.......  .......       X   .........
Mr. Thompson.....................       X   .......  .........  Mr. Smith..........  .......       X   .........
Mr. Larson.......................       X   .......  .........  Mr. Marchant.......  .......       X   .........
Mr. Blumenauer...................       X   .......  .........  Mr. Reed...........  .......  .......  .........
Mr. Kind.........................       X   .......  .........  Mr. Kelly..........  .......       X   .........
Mr. Pascrell.....................       X   .......  .........  Mr. Holding........  .......       X   .........
Mr. Davis........................       X   .......  .........  Mr. Smith..........  .......       X   .........
Ms. Sanchez......................       X   .......  .........  Mr. Rice...........  .......       X   .........
Mr. Higgins......................       X   .......  .........  Mr. Schweikert.....  .......       X   .........
Ms. Sewell.......................  .......  .......  .........  Ms. Walorski.......  .......       X   .........
Ms. Delbene......................       X   .......  .........  Mr. Lahood (IL)....  .......       X   .........
Ms. Chu (CA).....................       X   .......  .........  Mr. Wenstrup.......  .......       X   .........
Ms. Moore........................       X   .......  .........  Mr. Arrington......  .......       X   .........
Mr. Kildee.......................       X   .......  .........  Mr. Ferguson.......  .......       X   .........
Mr. Boyle........................       X   .......  .........  Mr. Estes..........  .......       X   .........
Mr. Beyer........................       X   .......  .........
Mr. Evans........................       X   .......  .........
Mr. Schneider....................       X   .......  .........
Mr. Suozzi.......................       X   .......  .........
Mr. Panetta......................       X   .......  .........
Ms. Murphy.......................       X   .......  .........
Mr. Gomez........................       X   .......  .........
Mr. Horsford.....................       X   .......  .........
----------------------------------------------------------------------------------------------------------------

    An amendment to the amendment in the nature of a substitute 
that would dedicate funding above $85 million per year to ``pay 
for outcomes'' financing structures was offered by Ms. 
Walorski. The amendment was defeated by a roll call vote of 24 
nays to 16 yeas. The vote was as follows.

----------------------------------------------------------------------------------------------------------------
          Representative             Yea      Nay     Present      Representative      Yea      Nay     Present
----------------------------------------------------------------------------------------------------------------
Mr. Neal.........................  .......       X   .........  Mr. Brady..........       X   .......  .........
Mr. Lewis........................  .......       X   .........  Mr. Nunes..........  .......  .......  .........
Mr. Doggett......................  .......       X   .........  Mr. Buchanan.......       X   .......  .........
Mr. Thompson.....................  .......       X   .........  Mr. Smith..........       X   .......  .........
Mr. Larson.......................  .......       X   .........  Mr. Marchant.......       X   .......  .........
Mr. Blumenauer...................  .......       X   .........  Mr. Reed...........       X   .......  .........
Mr. Kind.........................  .......       X   .........  Mr. Kelly..........       X   .......  .........
Mr. Pascrell.....................  .......       X   .........  Mr. Holding........       X   .......  .........
Mr. Davis........................  .......       X   .........  Mr. Smith..........       X   .......  .........
Ms. Sanchez......................  .......       X   .........  Mr. Rice...........       X   .......  .........
Mr. Higgins......................  .......       X   .........  Mr. Schweikert.....       X   .......  .........
Ms. Sewell.......................  .......  .......  .........  Ms. Walorski.......       X   .......  .........
Ms. Delbene......................  .......       X   .........  Mr. Lahood (IL)....       X   .......  .........
Ms. Chu (CA).....................  .......       X   .........  Mr. Wenstrup.......       X   .......  .........
Ms. Moore........................  .......       X   .........  Mr. Arrington......       X   .......  .........
Mr. Kildee.......................  .......       X   .........  Mr. Ferguson.......       X   .......  .........
Mr. Boyle........................  .......       X   .........
Mr. Estes........................       X   .......  .........
Mr. Beyer........................  .......       X   .........
Mr. Evans........................  .......       X   .........
Mr. Schneider....................  .......       X   .........
Mr. Suozzi.......................  .......       X   .........
Mr. Panetta......................  .......       X   .........
Ms. Murphy.......................  .......       X   .........
Mr. Gomez........................  .......       X   .........
Mr.Horsford......................  .......       X   .........
----------------------------------------------------------------------------------------------------------------

    An amendment to the amendment in the nature of a substitute 
that would give priority to grants that include direct 
involvement of employers in the development of training and 
grants that use earn and learn models was offered by Mr. 
LaHood. The amendment was defeated by a roll call vote of 24 
nays to 16 yeas. The vote was as follows.

----------------------------------------------------------------------------------------------------------------
          Representative             Yea      Nay     Present      Representative      Yea      Nay     Present
----------------------------------------------------------------------------------------------------------------
Mr. Neal.........................  .......       X   .........  Mr. Brady..........       X   .......  .........
Mr. Lewis........................  .......       X   .........  Mr. Nunes..........  .......  .......  .........
Mr. Doggett......................  .......       X   .........  Mr. Buchanan.......       X   .......  .........
Mr. Thompson.....................  .......       X   .........  Mr. Smith..........       X   .......  .........
Mr. Larson.......................  .......       X   .........  Mr. Marchant.......       X   .......  .........
Mr. Blumenauer...................  .......       X   .........  Mr. Reed...........       X   .......  .........
Mr. Kind.........................  .......       X   .........  Mr. Kelly..........       X   .......  .........
Mr. Pascrell.....................  .......       X   .........  Mr. Holding........       X   .......  .........
Mr. Davis........................  .......       X   .........  Mr. Smith..........       X   .......  .........
Ms. Sanchez......................  .......       X   .........  Mr. Rice...........       X   .......  .........
Mr. Higgins......................  .......       X   .........  Mr. Schweikert.....       X   .......  .........
Ms. Sewell.......................  .......  .......  .........  Ms. Walorski.......       X   .......  .........
Ms. Delbene......................  .......       X   .........  Mr. Lahood (IL)....       X   .......  .........
Ms. Chu (CA).....................  .......       X   .........  Mr. Wenstrup.......       X   .......  .........
Ms. Moore........................  .......       X   .........  Mr. Arrington......       X   .......  .........
Mr. Kildee.......................  .......       X   .........  Mr. Ferguson.......       X   .......  .........
Mr. Boyle........................  .......       X   .........  Mr. Estes..........       X   .......  .........
Mr. Beyer........................  .......       X   .........
Mr. Evans........................  .......       X   .........
Mr. Schneider....................  .......       X   .........
Mr. Suozzi.......................  .......       X   .........
Mr. Panetta......................  .......       X   .........
Ms. Murphy.......................  .......       X   .........
Mr. Gomez........................  .......       X   .........
Mr. Horsford.....................  .......       X   .........
----------------------------------------------------------------------------------------------------------------

    The amendment in the nature of a substitute to H.R. 3398 
was adopted by voice vote (with a quorum being present).
    The bill, H.R. 3398, was ordered favorably reported to the 
House of Representatives as amended, by a roll call vote of 24 
yeas to 16 nays. The vote was as follows:

----------------------------------------------------------------------------------------------------------------
          Representative             Yea      Nay     Present      Representative      Yea      Nay     Present
----------------------------------------------------------------------------------------------------------------
Mr. Neal.........................       X   .......  .........  Mr. Brady..........  .......       X   .........
Mr. Lewis........................       X   .......  .........  Mr. Nunes..........  .......  .......  .........
Mr. Doggett......................       X   .......  .........  Mr. Buchanan.......  .......       X   .........
Mr. Thompson.....................       X   .......  .........  Mr. Smith..........  .......       X   .........
Mr. Larson.......................       X   .......  .........  Mr. Marchant.......  .......       X   .........
Mr. Blumenauer...................       X   .......  .........  Mr. Reed...........  .......       X   .........
Mr. Kind.........................       X   .......  .........  Mr. Kelly..........  .......       X   .........
Mr. Pascrell.....................       X   .......  .........  Mr. Holding........  .......       X   .........
Mr. Davis........................       X   .......  .........  Mr. Smith..........  .......       X   .........
Ms. Sanchez......................       X   .......  .........  Mr. Rice...........  .......       X   .........
Mr. Higgins......................       X   .......  .........  Mr. Schweikert.....  .......       X   .........
Ms. Sewell.......................  .......  .......  .........  Ms. Walorski.......  .......       X   .........
Ms. Delbene......................       X   .......  .........  Mr. Lahood (IL)....  .......       X   .........
Ms. Chu (CA).....................       X   .......  .........  Mr. Wenstrup.......  .......       X   .........
Ms. Moore........................       X   .......  .........  Mr. Arrington......  .......       X   .........
Mr. Kildee.......................       X   .......  .........  Mr. Ferguson.......  .......       X   .........
Mr. Boyle........................       X   .......  .........  Mr. Estes..........  .......       X   .........
Mr. Beyer........................       X   .......  .........
Mr. Evans........................       X   .......  .........
Mr. Schneider....................       X   .......  .........
Mr. Suozzi.......................       X   .......  .........
Mr. Panetta......................       X   .......  .........
Ms. Murphy.......................       X   .......  .........
Mr. Gomez........................       X   .......  .........
Mr. Horsford.....................       X   .......  .........
----------------------------------------------------------------------------------------------------------------

                     IV. BUDGET EFFECTS OF THE BILL


               A. Committee Estimate of Budgetary Effects

    In compliance with clause 3(d) of rule XIII of the Rules of 
the House of Representatives, the following statement is made 
concerning the effects on the budget of the bill, H.R. 3398, as 
reported. The Committee agrees with the estimate prepared by 
the Congressional Budget Office (CBO), which is included below.

              B. Statement Regarding New Budget Authority

    In compliance with clause 3(c)(2) of rule XIII of the Rules 
of the House of Representatives, the Committee states that the 
bill provides new budget authority, as described in the 
estimate from the Congressional Budget Office. The Committee 
states further that the bill involves no new or increased tax 
expenditures.

      C. Cost Estimate Prepared by the Congressional Budget Office

    In compliance with clause 3(c)(3) of rule XIII of the Rules 
of the House of Representatives, requiring a cost estimate 
prepared by the CBO, the following statement by CBO is 
provided.

                                    U.S. Congress, 
                               Congressional Budget Office,
                                  Washington, DC, October 25, 2019.
Hon. Richard Neal,
Chairman, Committee on Ways and Means,
House of Representatives, Washington, DC.
    Dear Mr. Chairman: The Congressional Budget Office has 
prepared the enclosed cost estimate for H.R. 3398, the Pathways 
to Health Careers Act.
    If you wish further details on this estimate, we will be 
pleased to provide them. The CBO staff contact is Jennifer 
Gray.
            Sincerely,
                                         Phillip L. Swagel,
                                                          Director.
    Enclosure.

    
    

    H.R. 3398 would reauthorize and amend the Health Profession 
Opportunity Grants (HPOG) program and would provide $100 
million in 2020--$85 million for the grant program and $15 
million for administrative costs and technical assistance 
related to the expansion of the program. Beginning in 2021, the 
bill would expand the program and would provide $425 million 
for each year from 2021 through 2025. The expanded program 
would provide grants to:
           Train low-income individuals for careers in 
        the health professions,
           Create demonstration projects to train 
        individuals for careers in the pregnancy, childbirth, 
        or postpartum fields, and
           Create demonstration projects to provide 
        education and training in the health professions for 
        individuals with arrest or conviction records.
    For this estimate, CBO assumes that H.R. 3398 will be 
enacted around the end of 2019. Section 1501 of the Continuing 
Appropriations Act, 2020, and Health Extenders Act of 2019 
(Public Law 116-59) reauthorized HPOG through November 21, 
2019, which CBO estimated would provide $12 million in 2020. 
Thus, CBO estimates that in 2020, enacting H.R. 3398 would 
increase budget authority by $73 million for the grant 
program--$85 million in the bill minus the $12 million already 
provided--and $15 million for administrative expenses. (The 
bill specifies that amounts provided for HPOG in any prior act 
be charged to the appropriation in H.R. 3398.)
    Estimated outlays for the program in 2020 are based on 
historical spending patterns and are net of the outlays CBO 
estimated for section 1501 of P.L. 116-59. Beginning in 2021, 
CBO expects that the rate of spending would slow relative to 
historical spending patterns because of the program expansion. 
CBO estimates that enacting the bill would cost $2.2 billion 
over the 2020-2029 period. The costs of the legislation fall 
within budget function 500 (education, training, employment, 
and social services.)
    The Statutory Pay-As-You-Go Act of 2010 establishes budget-
reporting and enforcement procedures for legislation affecting 
direct spending or revenues. The net changes in outlays that 
are subject to those pay-as-you-go procedures are shown in 
Table 1.

                                      TABLE 1.--CBO'S ESTIMATE OF THE STATUTORY PAY-AS-YOU-GO EFFECTS OF H.R. 3398
--------------------------------------------------------------------------------------------------------------------------------------------------------
                                                                                         By fiscal year, millions of dollars--
                                                             -------------------------------------------------------------------------------------------
                                                               2020   2021   2022   2023   2024   2025   2026   2027   2028   2029  2020-2024  2020-2029
--------------------------------------------------------------------------------------------------------------------------------------------------------
Estimated Budget Authority..................................     88    425    425    425    425    425      0      0      0      0     1,788      2,213
Estimated Outlays...........................................      2     57    169    298    374    417    412    285    136     51       900      2,201
--------------------------------------------------------------------------------------------------------------------------------------------------------

    CBO estimates that enacting H.R. 3398 would not increase 
on-budget deficits by more than $5 billion in any of the four 
consecutive 10-year periods beginning in 2030.
    The CBO staff contact for this estimate is Jennifer Gray. 
The estimate was reviewed by H. Samuel Papenfuss, Deputy 
Assistant Director for Budget Analysis.

     V. OTHER MATTERS TO BE DISCUSSED UNDER THE RULES OF THE HOUSE


          A. Committee Oversight Findings and Recommendations

    With respect to clause 3(c)(1) of rule XIII and clause 
2(b)(1) of rule X of the Rules of the House of Representatives, 
the Committee made findings and recommendations that are 
reflected in this report.

        B. Statement of General Performance Goals and Objectives

    With respect to clause 3(c)(4) of rule XIII of the Rules of 
the House of Representatives, the Committee advises that the 
objective of the bill is to improve employment outcomes for 
low-income people while also increasing the size of the trained 
healthcare workforce in targeted communities. The legislation 
requires grantees to report participant outcomes related to 
earnings, employment in health professions, graduation rate and 
timeliness, and credential attainment to the Secretary of 
Health and Human Services, and requires the Secretary to report 
those and other outcomes to the Committee on Ways and Means and 
the Senate Finance Committee once per Congress.

              C. Information Relating to Unfunded Mandates

    This information is provided in accordance with Sec.423 of 
the Unfunded Mandates Reform Act of 1995 (Pub. L. No. 104-4).
    The Committee has determined that the bill does not contain 
Federal mandates on the private sector. The Committee has 
determined that the bill does not impose a Federal 
intergovernmental mandate on State, local, or tribal 
governments.

  D. Congressional Earmarks, Limited Tax Benefits, and Limited Tariff 
                                Benefits

    With respect to clause 9 of rule XXI of the Rules of the 
House of Representatives, the Committee has carefully reviewed 
the provisions of the bill, and states that the provisions of 
the bill do not contain any congressional earmarks, limited tax 
benefits, or limited tariff benefits within the meaning of the 
rule.

                   E. Duplication of Federal Programs

    With respect to clause 3(c)(5) of rule XIII of the Rules of 
the House of Representatives, the Committee states that the 
bill does not duplicate any other federal program.

                              F. Hearings

    In compliance with Sec.103(i) of H.Res. 6 (116th Congress) 
the following hearings were used to develop or consider H.R. 
3398: ``Leveling the Playing Field for Working Families: 
Challenges and Opportunities,'' held March 7, 2019; 
``Overcoming Racial Disparities and Social Determinants in the 
Maternal Mortality Crisis,'' held May 16, 2019; ``Member Day,'' 
held June 4, 2019; ``Celebrating Fathers and Families: Federal 
Support for Responsible Fatherhood,'' held June 11, 2019; and 
described in the legislative history section.

       VI. CHANGES IN EXISTING LAW MADE BY THE BILL, AS REPORTED

    In compliance with clause 3(e)(1)(B) of rule XIII of the 
Rules of the House of Representatives, changes in existing law 
proposed by the bill, as reported, are shown as follows 
(existing law proposed to be omitted is enclosed in black 
brackets, new matter is printed in italics, existing law in 
which no change is proposed is shown in roman):

         Changes in Existing Law Made by the Bill, as Reported

  In compliance with clause 3(e) of rule XIII of the Rules of 
the House of Representatives, changes in existing law made by 
the bill, as reported, are shown as follows (existing law 
proposed to be omitted is enclosed in black brackets, new 
matter is printed in italic, and existing law in which no 
change is proposed is shown in roman):

                          SOCIAL SECURITY ACT

   TITLE XX--BLOCK GRANTS AND PROGRAMS FOR SOCIAL SERVICES AND ELDER 
JUSTICE

           *       *       *       *       *       *       *


Subtitle A--Block Grants to States for Social Services

           *       *       *       *       *       *       *


SEC. 2008. DEMONSTRATION PROJECTS TO ADDRESS HEALTH PROFESSIONS 
                    WORKFORCE NEEDS.

  (a) Demonstration Projects To Provide Low-Income Individuals 
With Opportunities for Education, Training, and Career 
Advancement To Address Health Professions Workforce Needs.--
          (1) Authority to award grants.--The Secretary, in 
        consultation with the Secretary of Labor, shall award 
        grants to eligible entities to conduct demonstration 
        projects that are designed to provide eligible 
        individuals with the opportunity to obtain education 
        and training for occupations in the health care field 
        that pay well and are expected to either experience 
        labor shortages or be in high demand.
          (2) Requirements.--
                  (A) Aid and supportive services.--
                          (i) In general.--A demonstration 
                        project conducted by an eligible entity 
                        awarded a grant under this section 
                        shall, if appropriate, provide eligible 
                        individuals participating in the 
                        project with financial aid, child care, 
                        case management, and other supportive 
                        services.
                          (ii) Treatment.--Any aid, services, 
                        or incentives provided to an eligible 
                        beneficiary participating in a 
                        demonstration project under this 
                        section shall not be considered income, 
                        and shall not be taken into account for 
                        purposes of determining the 
                        individual's eligibility for, or amount 
                        of, benefits under any means-tested 
                        program.
                  (B) Consultation and coordination.--An 
                eligible entity applying for a grant to carry 
                out a demonstration project under this section 
                shall demonstrate in the application that the 
                entity has consulted with the State agency 
                responsible for administering the State TANF 
                program, the local workforce investment board 
                in the area in which the project is to be 
                conducted (unless the applicant is such board), 
                the State workforce development board 
                established under section 101 of the Workforce 
                Innovation and Opportunity Act, and the State 
                Apprenticeship Agency recognized under the Act 
                of August 16, 1937 (commonly known as the 
                ``National Apprenticeship Act'') (or if no 
                agency has been recognized in the State, the 
                Office of Apprenticeship of the Department of 
                Labor) and that the project will be carried out 
                in coordination with such entities.
                  (C) Assurance of opportunities for indian 
                populations.--The Secretary shall award at 
                least 3 grants under this subsection to an 
                eligible entity that is an Indian tribe, tribal 
                organization, or Tribal College or University.
          (3) Reports and evaluation.--
                  (A) Eligible entities.--An eligible entity 
                awarded a grant to conduct a demonstration 
                project under this subsection shall submit 
                interim reports to the Secretary on the 
                activities carried out under the project and a 
                final report on such activities upon the 
                conclusion of the entities' participation in 
                the project. Such reports shall include 
                assessments of the effectiveness of such 
                activities with respect to improving outcomes 
                for the eligible individuals participating in 
                the project and with respect to addressing 
                health professions workforce needs in the areas 
                in which the project is conducted.
                  (B) Evaluation.--The Secretary shall, by 
                grant, contract, or interagency agreement, 
                evaluate the demonstration projects conducted 
                under this subsection. Such evaluation shall 
                include identification of successful activities 
                for creating opportunities for developing and 
                sustaining, particularly with respect to low-
                income individuals and other entry-level 
                workers, a health professions workforce that 
                has accessible entry points, that meets high 
                standards for education, training, 
                certification, and professional development, 
                and that provides increased wages and 
                affordable benefits, including health care 
                coverage, that are responsive to the 
                workforce's needs.
                  (C) Report to congress.--The Secretary shall 
                submit interim reports and, based on the 
                evaluation conducted under subparagraph (B), a 
                final report to Congress on the demonstration 
                projects conducted under this subsection.
          (4) Definitions.--In this subsection:
                  (A) Eligible entity.--The term ``eligible 
                entity'' means a State, an Indian tribe or 
                tribal organization, an institution of higher 
                education, a local workforce development board 
                established under section 107 of the Workforce 
                Innovation and Opportunity Act, a sponsor of an 
                apprenticeship program registered under the 
                National Apprenticeship Act or a community-
                based organization.
                  (B) Eligible individual.--
                          (i) In general.--The term ``eligible 
                        individual'' means a individual 
                        receiving assistance under the State 
                        TANF program.
                          (ii) Other low-income individuals.--
                        Such term may include other low-income 
                        individuals described by the eligible 
                        entity in its application for a grant 
                        under this section.
                  (C) Indian tribe; tribal organization.--The 
                terms ``Indian tribe'' and ``tribal 
                organization'' have the meaning given such 
                terms in section 4 of the Indian Self-
                Determination and Education Assistance Act (25 
                U.S.C. 450b).
                  (D) Institution of higher education.--The 
                term ``institution of higher education'' has 
                the meaning given that term in section 101 of 
                the Higher Education Act of 1965 (20 U.S.C. 
                1001).
                  (E) State.--The term ``State'' means each of 
                the 50 States, the District of Columbia, the 
                Commonwealth of Puerto Rico, the United States 
                Virgin Islands, Guam, and American Samoa.
                  (F) State tanf program.--The term ``State 
                TANF program'' means the temporary assistance 
                for needy families program funded under part A 
                of title IV.
                  (G) Tribal college or university.--The term 
                ``Tribal College or University'' has the 
                meaning given that term in section 316(b) of 
                the Higher Education Act of 1965 (20 U.S.C. 
                1059c(b)).
  (b) Demonstration Project To Develop Training and 
Certification Programs for Personal or Home Care Aides.--
          (1) Authority to award grants.--Not later than 18 
        months after the date of enactment of this section, the 
        Secretary shall award grants to eligible entities that 
        are States to conduct demonstration projects for 
        purposes of developing core training competencies and 
        certification programs for personal or home care aides. 
        The Secretary shall--
                  (A) evaluate the efficacy of the core 
                training competencies described in paragraph 
                (3)(A) for newly hired personal or home care 
                aides and the methods used by States to 
                implement such core training competencies in 
                accordance with the issues specified in 
                paragraph (3)(B); and
                  (B) ensure that the number of hours of 
                training provided by States under the 
                demonstration project with respect to such core 
                training competencies are not less than the 
                number of hours of training required under any 
                applicable State or Federal law or regulation.
          (2) Duration.--A demonstration project shall be 
        conducted under this subsection for not less than 3 
        years.
          (3) Core training competencies for personal or home 
        care aides.--
                  (A) In general.--The core training 
                competencies for personal or home care aides 
                described in this subparagraph include 
                competencies with respect to the following 
                areas:
                          (i) The role of the personal or home 
                        care aide (including differences 
                        between a personal or home care aide 
                        employed by an agency and a personal or 
                        home care aide employed directly by the 
                        health care consumer or an independent 
                        provider).
                          (ii) Consumer rights, ethics, and 
                        confidentiality (including the role of 
                        proxy decision-makers in the case where 
                        a health care consumer has impaired 
                        decision-making capacity).
                          (iii) Communication, cultural and 
                        linguistic competence and sensitivity, 
                        problem solving, behavior management, 
                        and relationship skills.
                          (iv) Personal care skills.
                          (v) Health care support.
                          (vi) Nutritional support.
                          (vii) Infection control.
                          (viii) Safety and emergency training.
                          (ix) Training specific to an 
                        individual consumer's needs (including 
                        older individuals, younger individuals 
                        with disabilities, individuals with 
                        developmental disabilities, individuals 
                        with dementia, and individuals with 
                        mental and behavioral health needs).
                          (x) Self-Care.
                  (B) Implementation.--The implementation 
                issues specified in this subparagraph include 
                the following:
                          (i) The length of the training.
                          (ii) The appropriate trainer to 
                        student ratio.
                          (iii) The amount of instruction time 
                        spent in the classroom as compared to 
                        on-site in the home or a facility.
                          (iv) Trainer qualifications.
                          (v) Content for a ``hands-on'' and 
                        written certification exam.
                          (vi) Continuing education 
                        requirements.
          (4) Application and selection criteria.--
                  (A) In general.--
                          (i) Number of states.--The Secretary 
                        shall enter into agreements with not 
                        more than 6 States to conduct 
                        demonstration projects under this 
                        subsection.
                          (ii) Requirements for states.--An 
                        agreement entered into under clause (i) 
                        shall require that a participating 
                        State--
                                  (I) implement the core 
                                training competencies described 
                                in paragraph (3)(A); and
                                  (II) develop written 
                                materials and protocols for 
                                such core training 
                                competencies, including the 
                                development of a certification 
                                test for personal or home care 
                                aides who have completed such 
                                training competencies.
                          (iii) Consultation and collaboration 
                        with community and vocational 
                        colleges.--The Secretary shall 
                        encourage participating States to 
                        consult with community and vocational 
                        colleges regarding the development of 
                        curricula to implement the project with 
                        respect to activities, as applicable, 
                        which may include consideration of such 
                        colleges as partners in such 
                        implementation.
                  (B) Application and eligibility.--A State 
                seeking to participate in the project shall--
                          (i) submit an application to the 
                        Secretary containing such information 
                        and at such time as the Secretary may 
                        specify;
                          (ii) meet the selection criteria 
                        established under subparagraph (C); and
                          (iii) meet such additional criteria 
                        as the Secretary may specify.
                  (C) Selection criteria.--In selecting States 
                to participate in the program, the Secretary 
                shall establish criteria to ensure (if 
                applicable with respect to the activities 
                involved)--
                          (i) geographic and demographic 
                        diversity;
                          (ii) that participating States offer 
                        medical assistance for personal care 
                        services under the State Medicaid plan;
                          (iii) that the existing training 
                        standards for personal or home care 
                        aides in each participating State--
                                  (I) are different from such 
                                standards in the other 
                                participating States; and
                                  (II) are different from the 
                                core training competencies 
                                described in paragraph (3)(A);
                          (iv) that participating States do not 
                        reduce the number of hours of training 
                        required under applicable State law or 
                        regulation after being selected to 
                        participate in the project; and
                          (v) that participating States recruit 
                        a minimum number of eligible health and 
                        long-term care providers to participate 
                        in the project.
                  (D) Technical assistance.--The Secretary 
                shall provide technical assistance to States in 
                developing written materials and protocols for 
                such core training competencies.
          (5) Evaluation and report.--
                  (A) Evaluation.--The Secretary shall develop 
                an experimental or control group testing 
                protocol in consultation with an independent 
                evaluation contractor selected by the 
                Secretary. Such contractor shall evaluate--
                          (i) the impact of core training 
                        competencies described in paragraph 
                        (3)(A), including curricula developed 
                        to implement such core training 
                        competencies, for personal or home care 
                        aides within each participating State 
                        on job satisfaction, mastery of job 
                        skills, beneficiary and family 
                        caregiver satisfaction with services, 
                        and additional measures determined by 
                        the Secretary in consultation with the 
                        expert panel;
                          (ii) the impact of providing such 
                        core training competencies on the 
                        existing training infrastructure and 
                        resources of States; and
                          (iii) whether a minimum number of 
                        hours of initial training should be 
                        required for personal or home care 
                        aides and, if so, what minimum number 
                        of hours should be required.
                  (B) Reports.--
                          (i) Report on initial 
                        implementation.--Not later than 2 years 
                        after the date of enactment of this 
                        section, the Secretary shall submit to 
                        Congress a report on the initial 
                        implementation of activities conducted 
                        under the demonstration project, 
                        including any available results of the 
                        evaluation conducted under subparagraph 
                        (A) with respect to such activities, 
                        together with such recommendations for 
                        legislation or administrative action as 
                        the Secretary determines appropriate.
                          (ii) Final report.--Not later than 1 
                        year after the completion of the 
                        demonstration project, the Secretary 
                        shall submit to Congress a report 
                        containing the results of the 
                        evaluation conducted under subparagraph 
                        (A), together with such recommendations 
                        for legislation or administrative 
                        action as the Secretary determines 
                        appropriate.
          (6) Definitions.--In this subsection:
                  (A) Eligible health and long-term care 
                provider.--The term ``eligible health and long-
                term care provider'' means a personal or home 
                care agency (including personal or home care 
                public authorities), a nursing home, a home 
                health agency (as defined in section 1861(o)), 
                or any other health care provider the Secretary 
                determines appropriate which--
                          (i) is licensed or authorized to 
                        provide services in a participating 
                        State; and
                          (ii) receives payment for services 
                        under title XIX.
                  (B) Personal care services.--The term 
                ``personal care services'' has the meaning 
                given such term for purposes of title XIX.
                  (C) Personal or home care aide.--The term 
                ``personal or home care aide'' means an 
                individual who helps individuals who are 
                elderly, disabled, ill, or mentally disabled 
                (including an individual with Alzheimer's 
                disease or other dementia) to live in their own 
                home or a residential care facility (such as a 
                nursing home, assisted living facility, or any 
                other facility the Secretary determines 
                appropriate) by providing routine personal care 
                services and other appropriate services to the 
                individual.
                  (D) State.--The term ``State'' has the 
                meaning given that term for purposes of title 
                XIX.
  (c) Funding.--
          (1) In general.--Subject to paragraph (2), out of any 
        funds in the Treasury not otherwise appropriated, there 
        are appropriated to the Secretary to carry out 
        subsections (a) and (b), $85,000,000 for each of fiscal 
        years 2010 through [2019.] 2020, and to provide 
        technical assistance and cover administrative costs 
        associated with implementing the successor to this 
        section $15,000,000 for fiscal year 2020.
          (2) Training and certification programs for personal 
        and home care aides.--With respect to the demonstration 
        projects under subsection (b), the Secretary shall use 
        $5,000,000 of the amount appropriated under paragraph 
        (1) for each of fiscal years 2010 through 2012 to carry 
        out such projects. No funds appropriated under 
        paragraph (1) shall be used to carry out demonstration 
        projects under subsection (b) after fiscal year 2012.
  (d) Nonapplication.--
          (1) In general.--Except as provided in paragraph (2), 
        the preceding sections of this title shall not apply to 
        grant awarded under this section.
          (2) Limitations on use of grants.--Section 2005(a) 
        (other than paragraph (6)) shall apply to a grant 
        awarded under this section to the same extent and in 
        the same manner as such section applies to payments to 
        States under this title.

  [Effective on date of enactment, section 2(a) of H.R. 3398 
provides for an amendment to section 2008(c)(1) of the Social 
Security Act (shown above). Effective October 1, 2020, section 
3 of H.R. 3398 further amends section 2008 of the Social 
Security Act (as so amended by such section 2(a)) to read as 
follows.]

[SEC. 2008. DEMONSTRATION PROJECTS TO ADDRESS HEALTH PROFESSIONS 
                    WORKFORCE NEEDS.

  [(a) Demonstration Projects To Provide Low-Income Individuals 
With Opportunities for Education, Training, and Career 
Advancement To Address Health Professions Workforce Needs.--
          [(1) Authority to award grants.--The Secretary, in 
        consultation with the Secretary of Labor, shall award 
        grants to eligible entities to conduct demonstration 
        projects that are designed to provide eligible 
        individuals with the opportunity to obtain education 
        and training for occupations in the health care field 
        that pay well and are expected to either experience 
        labor shortages or be in high demand.
          [(2) Requirements.--
                  [(A) Aid and supportive services.--
                          [(i) In general.--A demonstration 
                        project conducted by an eligible entity 
                        awarded a grant under this section 
                        shall, if appropriate, provide eligible 
                        individuals participating in the 
                        project with financial aid, child care, 
                        case management, and other supportive 
                        services.
                          [(ii) Treatment.--Any aid, services, 
                        or incentives provided to an eligible 
                        beneficiary participating in a 
                        demonstration project under this 
                        section shall not be considered income, 
                        and shall not be taken into account for 
                        purposes of determining the 
                        individual's eligibility for, or amount 
                        of, benefits under any means-tested 
                        program.
                  [(B) Consultation and coordination.--An 
                eligible entity applying for a grant to carry 
                out a demonstration project under this section 
                shall demonstrate in the application that the 
                entity has consulted with the State agency 
                responsible for administering the State TANF 
                program, the local workforce investment board 
                in the area in which the project is to be 
                conducted (unless the applicant is such board), 
                the State workforce development board 
                established under section 101 of the Workforce 
                Innovation and Opportunity Act, and the State 
                Apprenticeship Agency recognized under the Act 
                of August 16, 1937 (commonly known as the 
                ``National Apprenticeship Act'') (or if no 
                agency has been recognized in the State, the 
                Office of Apprenticeship of the Department of 
                Labor) and that the project will be carried out 
                in coordination with such entities.
                  [(C) Assurance of opportunities for indian 
                populations.--The Secretary shall award at 
                least 3 grants under this subsection to an 
                eligible entity that is an Indian tribe, tribal 
                organization, or Tribal College or University.
          [(3) Reports and evaluation.--
                  [(A) Eligible entities.--An eligible entity 
                awarded a grant to conduct a demonstration 
                project under this subsection shall submit 
                interim reports to the Secretary on the 
                activities carried out under the project and a 
                final report on such activities upon the 
                conclusion of the entities' participation in 
                the project. Such reports shall include 
                assessments of the effectiveness of such 
                activities with respect to improving outcomes 
                for the eligible individuals participating in 
                the project and with respect to addressing 
                health professions workforce needs in the areas 
                in which the project is conducted.
                  [(B) Evaluation.--The Secretary shall, by 
                grant, contract, or interagency agreement, 
                evaluate the demonstration projects conducted 
                under this subsection. Such evaluation shall 
                include identification of successful activities 
                for creating opportunities for developing and 
                sustaining, particularly with respect to low-
                income individuals and other entry-level 
                workers, a health professions workforce that 
                has accessible entry points, that meets high 
                standards for education, training, 
                certification, and professional development, 
                and that provides increased wages and 
                affordable benefits, including health care 
                coverage, that are responsive to the 
                workforce's needs.
                  [(C) Report to congress.--The Secretary shall 
                submit interim reports and, based on the 
                evaluation conducted under subparagraph (B), a 
                final report to Congress on the demonstration 
                projects conducted under this subsection.
          [(4) Definitions.--In this subsection:
                  [(A) Eligible entity.--The term ``eligible 
                entity'' means a State, an Indian tribe or 
                tribal organization, an institution of higher 
                education, a local workforce development board 
                established under section 107 of the Workforce 
                Innovation and Opportunity Act, a sponsor of an 
                apprenticeship program registered under the 
                National Apprenticeship Act or a community-
                based organization.
                  [(B) Eligible individual.--
                          [(i) In general.--The term ``eligible 
                        individual'' means a individual 
                        receiving assistance under the State 
                        TANF program.
                          [(ii) Other low-income individuals.--
                        Such term may include other low-income 
                        individuals described by the eligible 
                        entity in its application for a grant 
                        under this section.
                  [(C) Indian tribe; tribal organization.--The 
                terms ``Indian tribe'' and ``tribal 
                organization'' have the meaning given such 
                terms in section 4 of the Indian Self-
                Determination and Education Assistance Act (25 
                U.S.C. 450b).
                  [(D) Institution of higher education.--The 
                term ``institution of higher education'' has 
                the meaning given that term in section 101 of 
                the Higher Education Act of 1965 (20 U.S.C. 
                1001).
                  [(E) State.--The term ``State'' means each of 
                the 50 States, the District of Columbia, the 
                Commonwealth of Puerto Rico, the United States 
                Virgin Islands, Guam, and American Samoa.
                  [(F) State tanf program.--The term ``State 
                TANF program'' means the temporary assistance 
                for needy families program funded under part A 
                of title IV.
                  [(G) Tribal college or university.--The term 
                ``Tribal College or University'' has the 
                meaning given that term in section 316(b) of 
                the Higher Education Act of 1965 (20 U.S.C. 
                1059c(b)).
  [(b) Demonstration Project To Develop Training and 
Certification Programs for Personal or Home Care Aides.--
          [(1) Authority to award grants.--Not later than 18 
        months after the date of enactment of this section, the 
        Secretary shall award grants to eligible entities that 
        are States to conduct demonstration projects for 
        purposes of developing core training competencies and 
        certification programs for personal or home care aides. 
        The Secretary shall--
                  [(A) evaluate the efficacy of the core 
                training competencies described in paragraph 
                (3)(A) for newly hired personal or home care 
                aides and the methods used by States to 
                implement such core training competencies in 
                accordance with the issues specified in 
                paragraph (3)(B); and
                  [(B) ensure that the number of hours of 
                training provided by States under the 
                demonstration project with respect to such core 
                training competencies are not less than the 
                number of hours of training required under any 
                applicable State or Federal law or regulation.
          [(2) Duration.--A demonstration project shall be 
        conducted under this subsection for not less than 3 
        years.
          [(3) Core training competencies for personal or home 
        care aides.--
                  [(A) In general.--The core training 
                competencies for personal or home care aides 
                described in this subparagraph include 
                competencies with respect to the following 
                areas:
                          [(i) The role of the personal or home 
                        care aide (including differences 
                        between a personal or home care aide 
                        employed by an agency and a personal or 
                        home care aide employed directly by the 
                        health care consumer or an independent 
                        provider).
                          [(ii) Consumer rights, ethics, and 
                        confidentiality (including the role of 
                        proxy decision-makers in the case where 
                        a health care consumer has impaired 
                        decision-making capacity).
                          [(iii) Communication, cultural and 
                        linguistic competence and sensitivity, 
                        problem solving, behavior management, 
                        and relationship skills.
                          [(iv) Personal care skills.
                          [(v) Health care support.
                          [(vi) Nutritional support.
                          [(vii) Infection control.
                          [(viii) Safety and emergency 
                        training.
                          [(ix) Training specific to an 
                        individual consumer's needs (including 
                        older individuals, younger individuals 
                        with disabilities, individuals with 
                        developmental disabilities, individuals 
                        with dementia, and individuals with 
                        mental and behavioral health needs).
                          [(x) Self-Care.
                  [(B) Implementation.--The implementation 
                issues specified in this subparagraph include 
                the following:
                          [(i) The length of the training.
                          [(ii) The appropriate trainer to 
                        student ratio.
                          [(iii) The amount of instruction time 
                        spent in the classroom as compared to 
                        on-site in the home or a facility.
                          [(iv) Trainer qualifications.
                          [(v) Content for a ``hands-on'' and 
                        written certification exam.
                          [(vi) Continuing education 
                        requirements.
          [(4) Application and selection criteria.--
                  [(A) In general.--
                          [(i) Number of states.--The Secretary 
                        shall enter into agreements with not 
                        more than 6 States to conduct 
                        demonstration projects under this 
                        subsection.
                          [(ii) Requirements for states.--An 
                        agreement entered into under clause (i) 
                        shall require that a participating 
                        State--
                                  [(I) implement the core 
                                training competencies described 
                                in paragraph (3)(A); and
                                  [(II) develop written 
                                materials and protocols for 
                                such core training 
                                competencies, including the 
                                development of a certification 
                                test for personal or home care 
                                aides who have completed such 
                                training competencies.
                          [(iii) Consultation and collaboration 
                        with community and vocational 
                        colleges.--The Secretary shall 
                        encourage participating States to 
                        consult with community and vocational 
                        colleges regarding the development of 
                        curricula to implement the project with 
                        respect to activities, as applicable, 
                        which may include consideration of such 
                        colleges as partners in such 
                        implementation.
                  [(B) Application and eligibility.--A State 
                seeking to participate in the project shall--
                          [(i) submit an application to the 
                        Secretary containing such information 
                        and at such time as the Secretary may 
                        specify;
                          [(ii) meet the selection criteria 
                        established under subparagraph (C); and
                          [(iii) meet such additional criteria 
                        as the Secretary may specify.
                  [(C) Selection criteria.--In selecting States 
                to participate in the program, the Secretary 
                shall establish criteria to ensure (if 
                applicable with respect to the activities 
                involved)--
                          [(i) geographic and demographic 
                        diversity;
                          [(ii) that participating States offer 
                        medical assistance for personal care 
                        services under the State Medicaid plan;
                          [(iii) that the existing training 
                        standards for personal or home care 
                        aides in each participating State--
                                  [(I) are different from such 
                                standards in the other 
                                participating States; and
                                  [(II) are different from the 
                                core training competencies 
                                described in paragraph (3)(A);
                          [(iv) that participating States do 
                        not reduce the number of hours of 
                        training required under applicable 
                        State law or regulation after being 
                        selected to participate in the project; 
                        and
                          [(v) that participating States 
                        recruit a minimum number of eligible 
                        health and long-term care providers to 
                        participate in the project.
                  [(D) Technical assistance.--The Secretary 
                shall provide technical assistance to States in 
                developing written materials and protocols for 
                such core training competencies.
          [(5) Evaluation and report.--
                  [(A) Evaluation.--The Secretary shall develop 
                an experimental or control group testing 
                protocol in consultation with an independent 
                evaluation contractor selected by the 
                Secretary. Such contractor shall evaluate--
                          [(i) the impact of core training 
                        competencies described in paragraph 
                        (3)(A), including curricula developed 
                        to implement such core training 
                        competencies, for personal or home care 
                        aides within each participating State 
                        on job satisfaction, mastery of job 
                        skills, beneficiary and family 
                        caregiver satisfaction with services, 
                        and additional measures determined by 
                        the Secretary in consultation with the 
                        expert panel;
                          [(ii) the impact of providing such 
                        core training competencies on the 
                        existing training infrastructure and 
                        resources of States; and
                          [(iii) whether a minimum number of 
                        hours of initial training should be 
                        required for personal or home care 
                        aides and, if so, what minimum number 
                        of hours should be required.
                  [(B) Reports.--
                          [(i) Report on initial 
                        implementation.--Not later than 2 years 
                        after the date of enactment of this 
                        section, the Secretary shall submit to 
                        Congress a report on the initial 
                        implementation of activities conducted 
                        under the demonstration project, 
                        including any available results of the 
                        evaluation conducted under subparagraph 
                        (A) with respect to such activities, 
                        together with such recommendations for 
                        legislation or administrative action as 
                        the Secretary determines appropriate.
                          [(ii) Final report.--Not later than 1 
                        year after the completion of the 
                        demonstration project, the Secretary 
                        shall submit to Congress a report 
                        containing the results of the 
                        evaluation conducted under subparagraph 
                        (A), together with such recommendations 
                        for legislation or administrative 
                        action as the Secretary determines 
                        appropriate.
          [(6) Definitions.--In this subsection:
                  [(A) Eligible health and long-term care 
                provider.--The term ``eligible health and long-
                term care provider'' means a personal or home 
                care agency (including personal or home care 
                public authorities), a nursing home, a home 
                health agency (as defined in section 1861(o)), 
                or any other health care provider the Secretary 
                determines appropriate which--
                          [(i) is licensed or authorized to 
                        provide services in a participating 
                        State; and
                          [(ii) receives payment for services 
                        under title XIX.
                  [(B) Personal care services.--The term 
                ``personal care services'' has the meaning 
                given such term for purposes of title XIX.
                  [(C) Personal or home care aide.--The term 
                ``personal or home care aide'' means an 
                individual who helps individuals who are 
                elderly, disabled, ill, or mentally disabled 
                (including an individual with Alzheimer's 
                disease or other dementia) to live in their own 
                home or a residential care facility (such as a 
                nursing home, assisted living facility, or any 
                other facility the Secretary determines 
                appropriate) by providing routine personal care 
                services and other appropriate services to the 
                individual.
                  [(D) State.--The term ``State'' has the 
                meaning given that term for purposes of title 
                XIX.
  [(c) Funding.--
          [(1) In general.--Subject to paragraph (2), out of 
        any funds in the Treasury not otherwise appropriated, 
        there are appropriated to the Secretary to carry out 
        subsections (a) and (b), $85,000,000 for each of fiscal 
        years 2010 through 2020, and to provide technical 
        assistance and cover administrative costs associated 
        with implementing the successor to this section 
        $15,000,000 for fiscal year 2020.
          [(2) Training and certification programs for personal 
        and home care aides.--With respect to the demonstration 
        projects under subsection (b), the Secretary shall use 
        $5,000,000 of the amount appropriated under paragraph 
        (1) for each of fiscal years 2010 through 2012 to carry 
        out such projects. No funds appropriated under 
        paragraph (1) shall be used to carry out demonstration 
        projects under subsection (b) after fiscal year 2012.
  [(d) Nonapplication.--
          [(1) In general.--Except as provided in paragraph 
        (2), the preceding sections of this title shall not 
        apply to grant awarded under this section.
          [(2) Limitations on use of grants.--Section 2005(a) 
        (other than paragraph (6)) shall apply to a grant 
        awarded under this section to the same extent and in 
        the same manner as such section applies to payments to 
        States under this title.]

SEC. 2008. CAREER PATHWAYS THROUGH HEALTH PROFESSION OPPORTUNITY 
                    GRANTS.

  (a) Application Requirements.--An eligible entity desiring a 
grant under this section for a project shall submit to the 
Secretary an application for the grant, that includes the 
following:
          (1) A description of how the applicant will use a 
        career pathways approach to train eligible individuals 
        for health professions that pay well or will put 
        eligible individuals on a career path to an occupation 
        that pays well, under the project.
          (2) A description of the adult basic education and 
        literacy activities, work readiness activities, 
        training activities, and case management and career 
        coaching services that the applicant will use to assist 
        eligible individuals to gain work experience, 
        connection to employers, and job placement, and a 
        description of the plan for recruiting, hiring, and 
        training staff to provide the case management, 
        mentoring, and career coaching services, under the 
        project directly or through local governmental, 
        apprenticeship, educational, or charitable 
        institutions.
          (3) In the case of an application for a grant under 
        this section for a demonstration project described in 
        subsection (c)(2)(B)(i)(I)--
                  (A) a demonstration that the State in which 
                the demonstration project is to be conducted 
                has in effect policies or laws that permit 
                certain allied health and behavioral health 
                care credentials to be awarded to people with 
                certain arrest or conviction records (which 
                policies or laws shall include appeals 
                processes, waivers, certificates, and other 
                opportunities to demonstrate rehabilitation to 
                obtain credentials, licensure, and approval to 
                work in the proposed health careers), and a 
                plan described in the application that will use 
                a career pathway to assist participants with 
                such a record in acquiring credentials, 
                licensing, and employment in the specified 
                careers;
                  (B) a discussion of how the project or future 
                strategic hiring decisions will demonstrate the 
                experience and expertise of the project in 
                working with job seekers who have arrest or 
                conviction records or employers with experience 
                working with people with arrest or conviction 
                records;
                  (C) an identification of promising 
                innovations or best practices that can be used 
                to provide the training;
                  (D) a proof of concept or demonstration that 
                the applicant has done sufficient research on 
                workforce shortage or in-demand jobs for which 
                people with certain types of arrest or 
                conviction records can be hired;
                  (E) a plan for recruiting students who are 
                eligible individuals into the project; and
                  (F) a plan for providing post-employment 
                support and ongoing training as part of a 
                career pathway under the project.
          (4) In the case of an application for a grant under 
        this section for a demonstration project described in 
        subsection (c)(2)(B)(i)(II)--
                  (A) a description of the partnerships, 
                strategic staff hiring decisions, tailored 
                program activities, or other programmatic 
                elements of the project, such as training plans 
                for doulas and other community health workers 
                and training plans for midwives and other 
                allied health professions, that are designed to 
                support a career pathway in pregnancy, birth, 
                or post-partum services; and
                  (B) a demonstration that the State in which 
                the demonstration project is to be conducted 
                recognizes doulas or midwives, as the case may 
                be.
          (5) A demonstration that the applicant has experience 
        working with low-income populations, or a description 
        of the plan of the applicant to work with a partner 
        organization that has the experience.
          (6) A plan for providing post-employment support and 
        ongoing training as part of a career pathway under the 
        project.
          (7) A description of the support services that the 
        applicant will provide under the project, including a 
        plan for how child care and transportation support 
        services will be guaranteed and, if the applicant will 
        provide a cash stipend or wage supplement, how the 
        stipend or supplement would be calculated and 
        distributed.
          (8) A certification by the applicant that the project 
        development included--
                  (A) consultation with a local workforce 
                development board established under section 107 
                of the Workforce Innovation and Opportunity 
                Act;
                  (B) consideration of apprenticeship and pre-
                apprenticeship models registered under the Act 
                of August 16, 1937 (also known as the 
                ``National Apprenticeship Act'');
                  (C) consideration of career pathway programs 
                in the State in which the project is to be 
                conducted; and
                  (D) a review of the State plan under section 
                102 or 103 of the Workforce Innovation and 
                Opportunity Act.
          (9) A description of the availability and relevance 
        of recent labor market information and other pertinent 
        evidence of in-demand jobs or worker shortages.
          (10) A certification that the applicant will directly 
        provide or contract for the training services described 
        in the application.
          (11) A commitment by the applicant that, if the grant 
        is made to the applicant, the applicant will--
                  (A) during the planning period for the 
                project, provide the Secretary with any 
                information needed by the Secretary to 
                establish adequate data reporting and 
                administrative structure for the project;
                  (B) hire a person to direct the project not 
                later than the end of the planning period 
                applicable to the project;
                  (C) accept all technical assistance offered 
                by the Secretary with respect to the grant;
                  (D) participate in such in-person grantee 
                conferences as are regularly scheduled by the 
                Secretary;
                  (E) provide all data required by the 
                Secretary under subsection (g); and
                  (F) notify the local disabled veterans' 
                outreach program specialists under section 
                4103A of title 38, United States Code, and the 
                local veterans' employment representatives 
                under section 4104 of such title, of the 
                grantee's outreach plan for advertising 
                training opportunities to potential 
                participants in the project.
  (b) Preferences in Considering Applications.--In considering 
applications for a grant under this section, the Secretary 
shall give preference to--
          (1) applications submitted by applicants to whom a 
        grant was made under this section or any predecessor to 
        this section;
          (2) applications submitted by applicants who have 
        business and community partners in each of the 
        following categories:
                  (A) State and local government agencies and 
                social service providers, including a State or 
                local entity that administers a State program 
                funded under part A of this title;
                  (B) institutions of higher education, 
                apprenticeship programs, and local workforce 
                development boards established under section 
                107 of the Workforce Innovation and Opportunity 
                Act; and
                  (C) health care employers, health care 
                industry or sector partnerships, labor unions, 
                and labor-management partnerships;
          (3) applications that include opportunities for 
        mentoring or peer support, and make career coaching 
        available, as part of the case management plan;
          (4) applications which describe a project that will 
        serve a rural area in which--
                  (A) the community in which the individuals to 
                be enrolled in the project reside is located;
                  (B) the project will be conducted; or
                  (C) an employer partnership that has 
                committed to hiring individuals who 
                successfully complete all activities under the 
                project is located;
          (5) applications that include a commitment to 
        providing project participants with a cash stipend or 
        wage supplement; and
          (6) applications which have an emergency cash fund to 
        assist project participants financially in emergency 
        situations.
  (c) Grants.--
          (1) Competitive grants.--
                  (A) Grant authority.--
                          (i) In general.--The Secretary, in 
                        consultation with the Secretary of 
                        Labor and the Secretary of Education, 
                        may make a grant in accordance with 
                        this paragraph to an eligible entity 
                        whose application for the grant is 
                        approved by the Secretary, to conduct a 
                        project designed to train low-income 
                        individuals for allied health 
                        professions, health information 
                        technology, physicians assistants, 
                        nursing assistants, registered nurse, 
                        advanced practice nurse, and other 
                        professions considered part of a health 
                        care career pathway model.
                          (ii) Guarantee of grantees in each 
                        state and the district of columbia.--
                        For each grant cycle, the Secretary 
                        shall award a grant under this 
                        paragraph to at least 2 eligible 
                        entities in each State that is not a 
                        territory, to the extent there are a 
                        sufficient number of applications 
                        submitted by the entities that meet the 
                        requirements applicable with respect to 
                        such a grant. If, for a grant cycle, 
                        there are fewer than 2 such eligible 
                        entities in a State, the Secretary 
                        shall include that information in the 
                        report required by subsection (g)(2) 
                        that covers the fiscal year.
                  (B) Guarantee of grants for indian 
                populations.--From the amount reserved under 
                subsection (i)(2)(B) for each fiscal year, the 
                Secretary shall award a grant under this 
                paragraph to at least 10 eligible entities that 
                are an Indian tribe, a tribal organization, or 
                a tribal college or university, to the extent 
                there are a sufficient number of applications 
                submitted by the entities that meet the 
                requirements applicable with respect to such a 
                grant.
                  (C) Guarantee of grantees in the 
                territories.--From the amount reserved under 
                subsection (i)(2)(C) for each fiscal year, the 
                Secretary shall award a grant under this 
                paragraph to at least 2 eligible entities that 
                are located in a territory, to the extent there 
                are a sufficient number of applications 
                submitted by the entities that meet the 
                requirements applicable with respect to such a 
                grant.
          (2) Grants for demonstration projects.--
                  (A) Grant authority.--The Secretary, in 
                consultation with the Secretary of Labor and 
                the Secretary of Education (and, with respect 
                to demonstration projects of the type described 
                in subparagraph (B)(i)(I), the Attorney 
                General) shall make a grant in accordance with 
                this subsection to an eligible entity whose 
                application for the grant is approved by the 
                Secretary, to conduct a demonstration project 
                that meets the requirements of subparagraph 
                (B).
                  (B) Requirements.--The requirements of this 
                subparagraph are the following:
                          (i) Type of project.--The 
                        demonstration project shall be of 1 of 
                        the following types:
                                  (I) Individuals with arrest 
                                or conviction records 
                                demonstration.--The 
                                demonstration project shall be 
                                of a type designed to provide 
                                education and training for 
                                eligible individuals with 
                                arrest or conviction records to 
                                enter and follow a career 
                                pathway in the health 
                                professions through occupations 
                                that pay well and are expected 
                                to experience a labor shortage 
                                or be in high demand.
                                  (II) Pregnancy and childbirth 
                                career pathway demonstration.--
                                The demonstration project shall 
                                be of a type designed to 
                                provide education and training 
                                for eligible individuals to 
                                enter and follow a career 
                                pathway in the field of 
                                pregnancy, childbirth, or post-
                                partum, in a State that 
                                recognizes doulas or midwives 
                                and that provides payment for 
                                services provided by doulas or 
                                midwives, as the case may be, 
                                under private or public health 
                                insurance plans.
                          (ii) Duration.--The demonstration 
                        project shall be conducted for not less 
                        than 5 years.
                  (C) Minimum allocation of funds for each type 
                of demonstration project.--
                          (i) Individuals with arrest or 
                        conviction records demonstrations.--Not 
                        less than 25 percent of the amounts 
                        made available for grants under this 
                        paragraph shall be used to make grants 
                        for demonstration projects of the type 
                        described in subparagraph (B)(i)(I).
                          (ii) Pregnancy and childbirth career 
                        pathway demonstrations.--Not less than 
                        25 percent of the amounts made 
                        available for grants under this 
                        paragraph shall be used to make grants 
                        for demonstration projects of the type 
                        described in subparagraph (B)(i)(II).
          (3) Grant cycle.--The grant cycle under this section 
        shall be not less than 5 years, with a planning period 
        of not more than the 1st 12 months of the grant cycle. 
        During the planning period, the amount of the grant 
        shall be in such lesser amount as the Secretary 
        determines appropriate.
  (d) Use of Grant.--
          (1) In general.--An entity to which a grant is made 
        under this section shall use the grant in accordance 
        with the approved application for the grant.
          (2) Support to be provided.--
                  (A) Required support.--A project for which a 
                grant is made under this section shall include 
                the following:
                          (i) An assessment for adult basic 
                        skill competency, and provision of 
                        adult basic skills education if 
                        necessary for lower-skilled eligible 
                        individuals to enroll in the project 
                        and go on to enter and complete post-
                        secondary training, through means 
                        including the following:
                                  (I) Establishing a network of 
                                partners that offer pre-
                                training activities for project 
                                participants who need to 
                                improve basic academic skills 
                                or English language proficiency 
                                before entering a health 
                                occupational training career 
                                pathway program.
                                  (II) Offering resources to 
                                enable project participants to 
                                continue advancing adult basic 
                                skill proficiency while 
                                enrolled in a career pathway 
                                program.
                                  (III) Embedding adult basic 
                                skill maintenance as part of 
                                ongoing post-graduation career 
                                coaching and mentoring.
                          (ii) A guarantee that child care is 
                        an available and affordable support 
                        service for project participants 
                        through means such as the following;
                                  (I) Referral to, and 
                                assistance with, enrollment in 
                                a subsidized child care 
                                program.
                                  (II) Direct payment to a 
                                child care provider if a slot 
                                in a subsidized child care 
                                program is not available or 
                                reasonably accessible.
                                  (III) Payment of co-payments 
                                or associated fees for child 
                                care.
                          (iii) Case management plans that 
                        include career coaching (with the 
                        option to offer appropriate peer 
                        support and mentoring opportunities to 
                        help develop soft skills and social 
                        capital), which may be offered on an 
                        ongoing basis before, during, and after 
                        initial training as part of a career 
                        pathway model.
                          (iv) A plan to provide project 
                        participants with transportation 
                        through means such as the following:
                                  (I) Referral to, and 
                                assistance with enrollment in, 
                                a subsidized transportation 
                                program.
                                  (II) If a subsidized 
                                transportation program is not 
                                reasonably available, direct 
                                payments to subsidize 
                                transportation costs.
                        For purposes of this clause, the term 
                        ``transportation'' includes public 
                        transit, or gasoline for a personal 
                        vehicle if public transit is not 
                        reasonably accessible or available.
                          (v) In the case of a demonstration 
                        project of the type described in 
                        subsection (c)(2)(B)(i)(I), access to 
                        legal assistance for project 
                        participants for the purpose of 
                        addressing arrest or conviction records 
                        and associated workforce barriers.
                  (B) Allowed support.--The goods and services 
                provided under a project for which a grant is 
                made under this section may include the 
                following:
                          (i) A cash stipend that is at least 
                        monthly.
                          (ii) A reserve fund for financial 
                        assistance to project participants in 
                        emergency situations.
                          (iii) Tuition, and training materials 
                        such as books, software, uniforms, 
                        shoes, and hair nets.
                          (iv) In-kind resource donations such 
                        as interview clothing and conference 
                        attendance fees.
                          (v) Assistance with accessing and 
                        completing high school equivalency or 
                        adult basic education courses as 
                        necessary to achieve success in the 
                        project and make progress toward career 
                        goals.
                          (vi) Assistance with programs and 
                        activities, including legal assistance, 
                        deemed necessary to address arrest or 
                        conviction records as an employment 
                        barrier.
                          (vii) Other support services as 
                        deemed necessary for family well-being, 
                        success in the project, and progress 
                        toward career goals.
                  (C) Treatment of support for purposes of 
                means-tested programs.--Any goods or services 
                provided to an eligible individual 
                participating in a project for which a grant is 
                made under this section shall not be considered 
                income, and shall not be taken into account for 
                purposes of determining the eligibility of the 
                individual for, or amount of benefits to be 
                provided to the individual, under any means-
                tested program.
          (3) Training.--The number of hours of training 
        provided to an eligible individual under a project for 
        which a grant is made under this section, for a 
        recognized postsecondary credential, including an 
        industry-recognized credential, which is awarded in 
        recognition of attainment of measurable technical or 
        occupational skills necessary to gain employment or 
        advance within an occupation (including a certificate 
        awarded by a local workforce development board 
        established under section 107 of the Workforce 
        Innovation and Opportunity Act), shall be--
                  (A) not less than the number of hours of 
                training required for certification in that 
                level of skill by the State in which the 
                project is conducted; or
                  (B) if there is no such requirement, such 
                number of hours of training as the Secretary 
                finds is necessary to achieve that skill level.
          (4) Income limitation.--An entity to which a grant is 
        made under this section shall not use the grant to 
        provide support to a person who is not an eligible 
        individual.
          (5) Inclusion of tanf recipients.--In the case of a 
        project for which a grant is made under this section 
        that is conducted in a State that has a program funded 
        under part A of title IV, at least 10 percent of the 
        eligible individuals to whom support is provided under 
        the project shall meet the income eligibility 
        requirements under that State program, without regard 
        to whether the individuals receive benefits or services 
        directly under that State program.
          (6) Prohibition.--An entity to which a grant is made 
        under this section shall not use the grant for purposes 
        of entertainment, except that case management and 
        career coaching services may include celebrations of 
        specific career-based milestones such as completing a 
        semester, graduation, or job placement.
  (e) Technical Assistance.--
          (1) In general.--The Secretary shall provide 
        technical assistance--
                  (A) to assist eligible entities in applying 
                for grants under this section;
                  (B) that is tailored to meet the needs of 
                grantees at each stage of the administration of 
                projects for which grants are made under this 
                section;
                  (C) that is tailored to meet the specific 
                needs of Indian tribes, tribal organizations, 
                and tribal colleges and universities;
                  (D) that is tailored to meet the specific 
                needs of the territories;
                  (E) that is tailored to meet the specific 
                needs of eligible entities in carrying out 
                demonstration projects for which a grant is 
                made under this section; and
                  (F) to facilitate the exchange of information 
                among eligible entities regarding best 
                practices and promising practices used in the 
                projects.
          (2) Continuation of peer technical assistance 
        conferences.--The Secretary shall continue to hold peer 
        technical assistance conferences for entities to which 
        a grant is made under this section or was made under 
        the immediate predecessor of this section.
  (f) Evaluation of Demonstration Projects.--
          (1) In general.--The Secretary shall, by grant, 
        contract, or interagency agreement, conduct rigorous 
        and well-designed evaluations of the demonstration 
        projects for which a grant is made under this section.
          (2) Requirement applicable to individuals with arrest 
        or conviction records demonstration.--In the case of a 
        project of the type described in subsection 
        (c)(2)(B)(i)(I), the evaluation shall include 
        identification of successful activities for creating 
        opportunities for developing and sustaining, 
        particularly with respect to low-income individuals 
        with arrest or conviction records, a health professions 
        workforce that has accessible entry points, that meets 
        high standards for education, training, certification, 
        and professional development, and that provides 
        increased wages and affordable benefits, including 
        health care coverage, that are responsive to the needs 
        of the workforce.
          (3) Requirement applicable to pregnancy and 
        childbirth career pathway demonstration.--In the case 
        of a project of the type described in subsection 
        (c)(2)(B)(i)(II), the evaluation shall include 
        identification of successful activities for creating 
        opportunities for developing and sustaining, 
        particularly with respect to low-income individuals and 
        other entry-level workers, a career pathway that has 
        accessible entry points, that meets high standards for 
        education, training, certification, and professional 
        development, and that provides increased wages and 
        affordable benefits, including health care coverage, 
        that are responsive to the needs of the birth, 
        pregnancy, and post-partum workforce.
          (4) Rule of interpretation.--Evaluations conducted 
        pursuant to this subsection may include a randomized 
        controlled trial, but this subsection shall not be 
        interpreted to require an evaluation to include such a 
        trial.
  (g) Reports.--
          (1) To the secretary.--An eligible entity awarded a 
        grant to conduct a project under this section shall 
        submit interim reports to the Secretary on the 
        activities carried out under the project, and, on the 
        conclusion of the project, a final report on the 
        activities. Each such report shall include data on 
        participant outcomes related to earnings, employment in 
        health professions, graduation rate, graduation 
        timeliness, credential attainment, participant 
        demographics, and other data specified by the 
        Secretary.
          (2) To the congress.--During each Congress, the 
        Secretary shall submit to the Committee on Ways and 
        Means of the House of Representatives and the Committee 
        on Finance of the Senate a report--
                  (A) on the demographics of the participants 
                in the projects for which a grant is made under 
                this section;
                  (B) on the rate of which project participants 
                completed all activities under the projects;
                  (C) on the employment credentials acquired by 
                project participants;
                  (D) on the employment of project participants 
                on completion of activities under the projects, 
                and the earnings of project participants at 
                entry into employment;
                  (E) on best practices and promising practices 
                used in the projects;
                  (F) on the nature of any technical assistance 
                provided to grantees under this section;
                  (G) on, with respect to the period since the 
                period covered in the most recent prior report 
                submitted under this paragraph--
                          (i) the number of applications 
                        submitted under this section, with a 
                        separate statement of the number of 
                        applications referred to in subsection 
                        (b)(5);
                          (ii) the number of applications that 
                        were approved, with a separate 
                        statement of the number of such 
                        applications referred to in subsection 
                        (b)(5); and
                          (iii) a description of how grants 
                        were made in any case described in the 
                        last sentence of subsection 
                        (c)(1)(A)(ii); and
                  (H) that includes an assessment of the 
                effectiveness of the projects with respect to 
                addressing health professions workforce 
                shortages or in-demand jobs.
  (h) Definitions.--In this section:
          (1) Allied health profession.--The term ``allied 
        health profession'' has the meaning given in section 
        799B(5) of the Public Health Service Act.
          (2) Career pathway.--The term ``career pathway'' has 
        the meaning given that term in section 3(7) of the 
        Workforce Innovation and Opportunity Act.
          (3) Doula.--The term ``doula'' means an individual 
        who--
                  (A) is certified by an organization that has 
                been established for not less than 5 years and 
                that requires the completion of continuing 
                education to maintain the certification, to 
                provide non-medical advice, information, 
                emotional support, and physical comfort to an 
                individual during the individual's pregnancy, 
                childbirth, and post-partum period; and
                  (B) maintains the certification by completing 
                the required continuing education.
          (4) Eligible entity.--The term ``eligible entity'' 
        means any of the following entities that demonstrates 
        in an application submitted under this section that the 
        entity has the capacity to fully develop and administer 
        the project described in the application:
                  (A) A local workforce development board 
                established under section 107 of the Workforce 
                Innovation and Opportunity Act.
                  (B) A State or territory, a political 
                subdivision of a State or territory, or an 
                agency of a State, territory, or such a 
                political subdivision, including a State or 
                local entity that administers a State program 
                funded under part A of this title.
                  (C) An Indian tribe, a tribal organization, 
                or a tribal college or university.
                  (D) An institution of higher education (as 
                defined in the Higher Education Act of 1965).
                  (E) A hospital (as defined in section 
                1861(e)).
                  (F) A high-quality skilled nursing facility 
                (as defined in section 1819(a)).
                  (G) A Federally qualified health center (as 
                defined in section 1861(aa)(4)).
                  (H) A nonprofit organization described in 
                section 501(c)(3) of the Internal Revenue Code 
                of 1986, a labor organization, or an entity 
                with shared labor-management oversight, that 
                has a demonstrated history of providing health 
                profession training to eligible individuals.
                  (I) In the case of a demonstration project of 
                the type provided for in subsection 
                (c)(2)(B)(i)(II) of this section, an entity 
                recognized by a State, Indian tribe, or tribal 
                organization as qualified to train doulas or 
                midwives, if midwives or doulas, as the case 
                may be, are permitted to practice in the State 
                involved.
                  (J) An opioid treatment program (as defined 
                in section 1861(jjj)(2)), and other high 
                quality comprehensive addiction care providers.
          (5) Eligible individual.--The term ``eligible 
        individual'' means an individual whose family income 
        does not exceed 200 percent of the Federal poverty 
        level.
          (6) Federal poverty level.--The term ``Federal 
        poverty level'' means the poverty line (as defined in 
        section 673(2) of the Omnibus Budget Reconciliation Act 
        of 1981, including any revision required by such 
        section applicable to a family of the size involved).
          (7) High-quality skilled nursing facility.--The term 
        ``high-quality skilled nursing facility'' means a 
        facility (as defined in section 1819(a)) that has at 
        least a 5-star rating for staffing to participate based 
        on the data from section 1819(i)(1)(A)(i) and not have 
        an immediate jeopardy violation as described in section 
        1819(h)(1)(A) within the preceding 3 years.
          (8) Indian tribe; tribal organization.--The terms 
        ``Indian tribe'' and ``tribal organization'' have the 
        meaning given the terms in section 4 of the Indian 
        Self-Determination and Education Assistance Act (25 
        U.S.C. 450b).
          (9) Institution of higher education.--The term 
        ``institution of higher education'' has the meaning 
        given the term in section 101 or 102(a)(1)(B) of the 
        Higher Education Act of 1965.
          (10) Territory.--The term ``territory'' means the 
        Commonwealth of Puerto Rico, the United States Virgin 
        Islands, Guam, the Northern Mariana Islands, and 
        American Samoa.
          (11) Tribal college or university.--The term ``tribal 
        college or university'' has the meaning given the term 
        in section 316(b) of the Higher Education Act of 1965.
  (i) Funding.--
          (1) In general.--Out of any funds in the Treasury of 
        the United States not otherwise appropriated, there are 
        appropriated to the Secretary to carry out this section 
        $425,000,000 for each of fiscal years 2021 through 
        2025.
          (2) Allocation of funds.--Of the amount appropriated 
        for a fiscal year under paragraph (1) of this 
        subsection--
                  (A) 75 percent shall be available for grants 
                under subsection (c)(1)(A);
                  (B) 4 percent shall be reserved for grants 
                under subsection (c)(1)(B);
                  (C) 5 percent shall be reserved for grants 
                under subsection (c)(1)(C);
                  (D) 6 percent shall be available for 
                demonstration project grants under subsection 
                (c)(2);
                  (E) 6 percent, plus all amounts referred to 
                in subparagraphs (A) through (D) of this 
                paragraph that remain unused after all grant 
                awards are made for the fiscal year, shall be 
                available for the provision of technical 
                assistance and associated staffing; and
                  (F) 4 percent shall be available for studying 
                the effects of the demonstration and non-
                demonstration projects for which a grant is 
                made under this section, and for associated 
                staffing, for the purpose of supporting the 
                rigorous evaluation of the demonstration 
                projects, and supporting the continued study of 
                the short-, medium-, and long-term effects of 
                all such projects, including the effectiveness 
                of new or added elements of the non-
                demonstration projects.
  (j) Nonapplicability of Preceding Sections of This 
Subtitle.--
          (1) In general.--Except as provided in paragraph (2), 
        the preceding sections of this subtitle shall not apply 
        to a grant awarded under this section.
          (2) Exception for certain limitations on use of 
        grants.--Section 2005(a) (other than paragraphs (2), 
        (3), (5), (6), and (8)) shall apply to a grant awarded 
        under this section to the same extent and in the same 
        manner as such section applies to payments to States 
        under this subtitle.

           *       *       *       *       *       *       *


                            DISSENTING VIEWS

    Committee Republicans oppose Worker and Family Support 
Chairman Davis' bill, H.R. 3398, the Pathway to Health Careers 
Act of 2019.
    The fact is we do not know if this program works yet 
because evaluations of the Health Profession Opportunity Grants 
(HPOG) program's effectiveness have not been completed. The 
Department of Health and Human Services (HHS) study of the 
first round of HPOG grants evaluated 42 programs and found no 
significant impact on overall employment and only a small 
impact on earnings. The results from a 36-month study are 
expected in late 2019 or early 2020, and the Committee should 
wait to see what those reveal before extending the program for 
a long period--and especially before adding more money and 
growing this program to several times its current size.
    In 2019, the Federal government ran 47 different employment 
and training programs spread across 15 government agencies. 
Collectively, those programs spend $18.9 billion per year to 
help Americans get the skills they need to obtain good jobs and 
move up the economic ladder. The Council of Economic Advisors 
recently issued a report assessing the evidence and performance 
of Federal employment and training programs. The report found 
that, ``with the exception of the Registered Apprenticeship 
program, government job training programs appear to be largely 
ineffective and fail to produce sufficient benefits for workers 
to justify the costs.'' Especially knowing the poor track 
record of the dozens of other government job training programs, 
there should be convincing evidence that the HPOG program 
actually works before expanding spending on it by 500 percent.
    Instead, the Committee should focus on reforming the $16.7 
billion dollar a year Temporary Assistance for Needy Families 
Program (TANF), which also helps low-income people go to work. 
There is bipartisan agreement that TANF needs immediate 
improvement to better assist low-income families in going to 
work. Both the TANF and HPOG programs expire on November 22nd. 
The HPOG program (at $85 million per year) spends just a small 
fraction of what TANF does (about $16.7 billion just in federal 
funds, and close to $30 billion counting state spending). 
Unfortunately, this Committee has not held a hearing or markup 
this Congress on proposals to reauthorize TANF. That is despite 
the fact Working on TANF would be a much better use of the 
Committee's time and resources. The Committee should focus on 
fixing TANF by advancing the JOBS for Success Act that 
Republican leader Kevin Brady introduced and this Committee 
approved in 2018. That approach would refocus the TANF program 
on helping far more people successfully enter work and move up 
the economic ladder.
    The Committee should continue to work to promote evidence-
based policy making to be good stewards of taxpayer funds. But 
there is no sound justification for significantly expanding 
spending on this program--and notably before it has proven it 
is achieving results. H.R. 3398 would spend more in 2021 
through 2024 ($1.7 billion) than in the past 10 years of the 
HPOG program. That's irresponsible. We recently exceeded $22 
trillion in debt and our nation faces a serious spending 
problem. That certainly will not be helped by growing the HPOG 
program to multiple times its current size--which is just one 
of the many ways our colleagues want to rapidly increase 
federal spending.
    In the 115th Congress, we heard countless times from our 
colleagues on the other side of the aisle complain about bills 
not going through regular order. Yet neither this bill, which 
adds $2.2 billion to the debt without a spending offset, nor 
the expansion of the HPOG program therein, have received one 
hearing before the Committee.
    Committee Republicans call on the Democratic leadership to 
allow this Committee to work in a bipartisan manner to develop 
a long-term extension to TANF that focuses giving families and 
individuals the tools they need so they can prepare for, find, 
and keep a good job.
                                   Kevin Brady,
                                           Republican Leader, Committee 
                                               on Ways and Means.
                                   Jackie Walorski,
                                           Worker and Family Support, 
                                               Republican Leader.