House Report 116-265 - PATHWAYS TO HEALTH CAREERS ACT

[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.