Health Access and Health Professions Supply Act of 2009
HAHPSA 2009
Be it enacted by the Senate and House of Representatives of the United States of America in Congress assembled,
1.
SHORT TITLE; TABLE OF CONTENTS
(a)
This Act may be cited as the Health Access and Health Professions Supply Act of 2009
or HAHPSA 2009
.
(b)
The table of contents of this Act is as follows:
Sec. 1. Short title; table of contents.
Sec. 2. Findings.
TITLE I—AMENDMENTS TO THE SOCIAL SECURITY ACT
Subtitle A—Workforce Improvements
Sec. 101. National health care workforce commission.
Sec. 102. State health workforce centers program.
Sec. 103. Improvements to payments for graduate medical education under medicare.
Sec. 104. Distribution of resident trainees in an emergency.
Sec. 105. Authority to include costs of training of psychologists in payments to hospitals for approved educational activities under Medicare.
Subtitle B—Geriatric Assessments and Chronic Care Management and Coordination Services Under the Medicare Program
Sec. 111. Medicare coverage of geriatric assessments.
Sec. 112. Medicare coverage of chronic care management and coordination services.
Sec. 113. Outreach activities regarding geriatric assessments and chronic care management and coordination services under the Medicare program.
Sec. 114. Utilization of telehealth services to furnish geriatric assessments and chronic care management and coordination services under the Medicare program.
Sec. 115. Study and report on geriatric assessments and chronic care management and coordination services under the Medicare program.
Sec. 116. Rule of construction.
TITLE II—AMENDMENTS TO THE PUBLIC HEALTH SERVICE ACT
Sec. 201. Expansion of National Health Service Corps programs.
Sec. 202. National health service corps scholarship program for medical, dental, physician assistant, pharmacy, behavioral and mental health, public health, and nursing students in the United States public health sciences track in affiliated schools.
Sec. 203. Federal medical facility grant program and program assessments.
Sec. 204. Health professions training loan program.
Sec. 205. United States Public Health Sciences Track.
Sec. 206. Medical education debt reimbursement for physicians of the Veterans Health Administration.
Sec. 207. Promoting education and training of psychologists to provide mental and behavioral health services to underserved populations.
TITLE III—HEALTH PROFESSIONAL TRAINING PIPELINE PARTNERSHIPS PROGRAM
Sec. 301. Grants to prepare students for careers in health care.
2.
(a)
Findings Related to Health Care Access in Rural, Frontier, and Urban Underserved Areas of the United States
Congress finds the following:
(1)
The United States does not have a cohesive or coordinated approach to addressing health workforce shortages and problems with reliable access to quality, affordable health care.
(2)
There are 50,000,000 citizens of the United States living in areas that are designated under section 332(a)(1)(A) of the Public Health Service Act as health professional shortage areas.
(3)
The population of the United States will grow by 25,000,000 each decade.
(4)
The number of individuals over 65 years of age in the United States will double between 2000 and 2030, with such individuals accounting for 20 percent of the total population of the United States in 2030.
(5)
Individuals over 65 years of age have twice as many doctor visits as those individuals under 65 years of age, resulting in an increase in the demand for physicians, physician assistants, pharmacists behavioral and mental health professionals, nurses, and dentists.
(6)
The rates of chronic diseases (such as diabetes) are increasing in the population of the United States.
(7)
There are 47,000,000 citizens of the United States who do not have health insurance, and over 130,000,000 individuals within the United States who do not have dental insurance. Those individuals who are uninsured have limited access to health care.
(8)
Academic health centers, Federal medical facilities, and teaching hospitals provide a substantial percentage of safety net services in the United States to uninsured and underinsured populations and to those individuals who have 1 or more chronic diseases. Such centers, facilities, and teaching hospitals provide those safety net services while concurrently providing for the training of health professionals.
(9)
The pipeline for the education of health professionals—
(A)
begins and often ends in urban areas;
(B)
does not reliably include Federal support for nonphysician training;
(C)
does not incorporate modern training venues and techniques, including community-based ambulatory sites; and
(D)
discourages interdisciplinary, team, and care coordination models as a result of restrictive regulations.
(10)
Health reform must include measures to transform the health delivery system to assure access, quality, and efficiency by utilizing contemporary models and venues of care.
(11)
Reform of the health delivery system will require modernization of the training of health professionals to ensure that health professionals—
(A)
practice in integrated teams in a variety of delivery venues (including inpatient and ambulatory settings and long-term care facilities) to utilize decision support and health information systems;
(B)
deliver patient-centered care;
(C)
practice evidence-based health care;
(D)
learn performance-based compensation systems, comparative effectiveness, and costs of care across the spectrum; and
(E)
deliver culturally appropriate, personalized care.
(b)
Findings Related to Access to Oral Health
Congress finds the following:
(1)
Dental care is the number 1 unmet health care need in children, and is 1 of the top 5 unmet health care needs in adults.
(2)
Over 130,000,000 citizens of the United States are without dental insurance.
(3)
Over 45,000,000 citizens of the United States live in areas that are designated under section 332(a)(1)(A) of the Public Health Service Act as dental health professional shortage areas.
(4)
Rural counties have less than half the number of dentists per capita compared to large metropolitan areas (29 versus 62 for population of 100,000).
(5)
In 2006, over 9,000 dentists were needed in such dental health professional shortage areas.
(6)
Between 27 and 29 percent of children and adults in the United States have untreated cavities.
(7)
The number of dental school graduates in the United States decreased by 20 percent between 1982 and 2003 and the average age of practicing dentists in the United States is 49.
(8)
There were over 400 dental faculty vacancies in the school year beginning in 2006.
(9)
In 2007, the average debt of a dental student at graduation was $172,627.
(c)
Findings Related to Physician Shortages, Education, and Distribution
Congress finds the following:
(1)
By 2020, physician shortages are forecasted to be in the range of 55,000 to 200,000.
(2)
Although 21 percent of the population of the United States lives in rural areas, only 10 percent of physicians work in rural areas and, for every 1 physician who goes into practice in regions with a low supply of physicians, 4 physicians go into practice in regions with a high supply of physicians.
(3)
According to a 2004 report by Green et al. for the Robert Graham Center of the American Academy of Family Physicians, the number of applicants from rural areas accepted to medical school has decreased by 40 percent in the last 20 years while the number of such applications has remained the same.
(4)
In order to respond to forecasted shortages, experts have recommended an increase between 15 and 30 percent in class size at medical schools over the next 10 years.
(5)
There are 55,000,000 citizens of the United States who lack adequate access to primary health care because of shortages of primary care providers in their communities.
(6)
The number of graduates from medical school in the United States who choose to practice family medicine has plummeted 50 percent in less than 10 years. Without congressional intervention, such decline will likely continue, and access to care in underserved areas will rapidly deteriorate. Family physicians represent 58 percent of the rural physician workforce, 70 percent of non-Federal physicians in whole-county health professional shortage areas, and 78 percent of primary care physician full-time equivalents in the National Health Service Corps.
(7)
Current trends indicate that fewer resident trainees from pediatric and internal medicine residencies pursue generalist practice at graduation.
(8)
Funding for medical education which is provided through direct Graduate Medical Education (GME) and Indirect Medical Education (IME) under the Medicare program is not transparent or accountable, nor is it aligned to the types of health professionals most needed or to the areas in which health professionals are most needed.
(9)
Physician supply varies 200 percent across regions and there is no relationship between regional physician supply and health needs.
(10)
The Council on Graduate Medical Education’s 18th Report (issued in 2007), entitled New Paradigms for Physician Training for Improving Access to Health Care
, and 19th Report (issued in 2007), entitled Enhancing Flexibility in Graduate Medical Education
, each call for changes to address the healthcare needs of the United States by removing barriers to expanding and more appropriately training the physician workforce.
(d)
Findings Related to Nursing Shortages, Education, and Distribution
Congress finds the following:
(1)
By 2020, nursing shortages are forecast to be in the range of 300,000 to 1,000,000 and the Bureau of Labor Statistics of the Department of Labor estimates that more than 1,200,000 new and replacement registered nurses will be needed by 2014.
(2)
Nurse vacancy rates are currently 8 percent or greater in hospitals and community health centers receiving assistance under section 330 of the Public Health Service Act, and for nursing faculty positions.
(3)
Surveys indicate that 40 percent of nurses in hospitals are dissatisfied with their work and, of nurses who graduate and go into nursing, 50 percent leave their first employer within 2 years.
(4)
Nursing baccalaureate and graduate programs rejected more than 40,000 qualified nursing school applicants in 2006, with faculty shortages identified by such programs as a major reason for turning away qualified applicants.
(5)
More than 70 percent of nursing schools cited faculty shortages as the primary reason for not accepting all qualified applicants into entry-level nursing programs.
(6)
The nursing faculty workforce is aging and retiring and, by 2019, approximately 75 percent of the nursing faculty workforce is expected to retire.
(7)
The average age of nurses in the United States is 49 and the average age of an associate professor nurse faculty member in the United States is 56.
(8)
Geriatric patients receiving care from nurses trained in geriatrics are less frequently readmitted to hospitals or transferred from skilled nursing facilities and nursing facilities to hospitals.
(e)
Findings Related to Public Health Workforce Shortages
Congress finds the following:
(1)
The United States has an estimated 50,000 fewer public health workers than it did 20 years ago while the population has grown by approximately 22 percent.
(2)
Government public health departments are facing significant workforce shortages that could be exacerbated through retirements.
(3)
Twenty percent of the average State health agency’s workforce will be eligible to retire within 3 years, and by 2012, over 50 percent of some State health agency workforces will be eligible to retire.
(4)
Approximately 20 percent of local health department employees will be eligible for retirement by 2010.
(5)
The average age of new hires in State health agencies is 40.
(6)
Four out of 5 current public health workers have not had formal training for their specific job functions.
(f)
Findings Related to Physician Assistant Shortages
Congress finds the following:
(1)
The purpose of the physician assistant profession is to extend the ability of physicians to provide primary care services, particularly in rural and other medically underserved communities.
(2)
Physician assistants always practice medicine as a team with their supervising physicians, however, supervising physicians need not be physically present when physician assistants provide medical care.
(3)
Physician assistants are legally regulated in all States, the District of Columbia, and Guam. All States, the District of Columbia, and Guam authorize physicians to delegate prescriptive authority to physician assistants.
(4)
In 2007, physician assistants made approximately 245,000,000 patient visits and prescribed or recommended approximately 303,000,000 medications.
(5)
The National Association of Community Health Centers, the George Washington University, and the Robert Graham Center for Policy Studies in Family Medicine and Primary Care found that while the number of patients who seek care at community health centers has increased, the number of primary care providers, including physician assistants, has not. The report estimates a need for 15,500 primary health care providers to provide care at community health centers.
(g)
Findings Related to Mental Health Professional Shortages
Congress finds the following:
(1)
The National Institute of Mental Health estimates that 26.2 percent of citizens of the United States ages 18 and older suffer from a diagnosable mental disorder. Approximately 20 percent of children in the United States have diagnosable mental disorders with at least mild functional impairment.
(2)
The Health Resources and Services Administration reports that there are 3,059 mental health professional shortage areas within the United States with 77,000,000 people living in those areas. More than 5,000 additional mental health professionals are needed to meet demand.
(3)
According to the Department of Health and Human Services, minority representation is lacking in the mental health workforce. Although 12 percent of the population of the United States is African-American, only 2 percent of psychologists, 2 percent of psychiatrists, and 4 percent of social workers are African-American. Moreover, there are only 29 mental health professionals who are Hispanic for every 100,000 individuals who are Hispanic in the United States, compared with 173 non-Hispanic White providers for every 100,000 individuals who are non-Hispanic White in the United States.
(h)
Findings Related to Health Professional Shortage Areas
(1)
In 2006, the National Health Service Corps had a total of 4,200 vacant positions in health professional shortage areas, but only 1,200 of those positions were funded. For each National Health Service Corps award, there are 7 applicants.
(2)
Community health centers receiving assistance under section 330 of the Public Health Service Act have expanded to serve 16,000,000 individuals in over 1,000 sites. Such community health centers have high vacancy rates for family physicians (13 percent), obstetricians and gynecologists (21 percent), dentists, nurses, and other health professionals.
(3)
The Institute of Medicine of the National Academies has recommended that medical education and public health issues be more closely aligned, especially in relation to preparedness for natural disasters, pandemic, bioterrorism, and other threats to public health.
(4)
The education of health professionals must be more closely aligned with health care needs in the United States, with special attention to underserved populations and areas, health disparities, the aging population, and individuals with 1 or more chronic diseases.
(5)
There is some duplication, and little coordination, between the Council on Graduate Medical Education (related to the physician workforce), the National Advisory Committee on Nursing Programs (related to the nursing workforce), the Advisory Committee on Training in Primary Care Medicine and Dentistry, and other advisory committees and councils.
(6)
The Association of Academic Health Centers calls for making the health workforce of the United States a priority domestic policy issue and creating a national health workforce planning body that engages Federal, State, public, and private stakeholders.
<enum>I</enum>
<header>AMENDMENTS TO THE SOCIAL SECURITY ACT</header>
<subtitle id="PBB93BAB8B5774D5E86ED9A3D29B1BA26">
<enum>A</enum>
<header>Workforce Improvements</header>
<section id="P55E41DEE5B8B4045AD73F5E1F22DF085">
<enum>101.</enum>
<header>NATIONAL HEALTH CARE WORKFORCE COMMISSION</header>
<subsection id="P93B63EE2F85C4678A925C9086DC7A8A3">
<enum>(a)</enum>
<header>Purpose</header>
<text>It is the purpose of this section to establish a National Health Care Workforce Commission that—</text>
<paragraph id="P2185FC0F2017441BB2CD5CF7F9A64094">
<enum>(1)</enum>
<text>serves as a national resource for Congress, the President, States, and localities by—</text>
<subparagraph id="P6612A76FC83546D58AE95CF88BF9CBCD">
<enum>(A)</enum>
<text>disseminating information on current and projected health care workforce supply and demand;</text>
</subparagraph>
<subparagraph id="P3533693A3FD242F2A54868EFA26C5ACF">
<enum>(B)</enum>
<text>disseminating information on health care workforce education and training capacity and instruction or delivery models and best practices;</text>
</subparagraph>
<subparagraph id="PBD2BB3B64B55445D8EE6D3AABF0A95AC">
<enum>(C)</enum>
<text>recognizing efforts of Federal, State, and local partnerships to develop and offer health care career pathways of proven effectiveness;</text>
</subparagraph>
<subparagraph id="P97D076D439B24A79B31A957DFDE98C6A">
<enum>(D)</enum>
<text>disseminating information on promising retention practices for health care professionals;</text>
</subparagraph>
<subparagraph id="P5986FF2E38ED49C3A0A86CA237665D2A">
<enum>(E)</enum>
<text>communicating information on important policies and practices that affect the recruitment, education and training, and retention of the health care workforce; and</text>
</subparagraph>
<subparagraph id="P57663AE5DB804CA884DDBF1E8F58D488">
<enum>(F)</enum>
<text>disseminating recommendations on the development of a fiscally sustainable integrated workforce that supports a high-quality health care delivery system that meets the needs of patients and populations;</text>
</subparagraph>
</paragraph>
<paragraph id="PB025DA39B3C048C7903C4695CDB4D431">
<enum>(2)</enum>
<text>communicates and coordinates with the Departments of Health and Human Services, Labor, and Education on related activities administered by one or more of such Departments;</text>
</paragraph>
<paragraph id="PD322C9B79B8F471285FA689382B269FC">
<enum>(3)</enum>
<text>develops and commissions evaluations of education and training activities to determine whether the demand for health care workers is being met;</text>
</paragraph>
<paragraph id="P9E98B8E2FC414F559AF6E653A1752A39">
<enum>(4)</enum>
<text>identifies barriers to improved coordination at the Federal, State, and local levels and recommend ways to address such barriers; and</text>
</paragraph>
<paragraph id="P26F99F2001644FCDAAA030D430CBEF9F">
<enum>(5)</enum>
<text>encourages innovations to address population needs, constant changes in technology, and other environmental factors.</text>
</paragraph>
</subsection>
<subsection id="P5AB69207319243958DC5B1B280584297">
<enum>(b)</enum>
<header>Establishment</header>
<text>There is hereby established the National Health Care Workforce Commission (in this section referred to as the <quote>Commission</quote>).</text>
</subsection>
<subsection id="P2D23EE4EF43747088B60F050E23146F2">
<enum>(c)</enum>
<header>Membership</header>
<paragraph id="PC80CE3E9EB93437DB6569E18A37C96DA">
<enum>(1)</enum>
<header>Number and appointment</header>
<text>The Commission shall be composed of 15 members to be appointed by the Comptroller General.</text>
</paragraph>
<paragraph id="PD2BDB4E08F7A4FA998B597B68B009013">
<enum>(2)</enum>
<header>Qualifications</header>
<subparagraph id="PAB0FCB54E25047518709DE31683E382D">
<enum>(A)</enum>
<header>In general</header>
<text>The membership of the Commission shall include individuals—</text>
<clause id="P59ACD92065F245428291F6B2AB3028FA">
<enum>(i)</enum>
<text>with national recognition for their expertise in health care labor market analysis, including health care workforce analysis; health care finance and economics; health care facility management; health care plans and integrated delivery systems; health care workforce education and training; health care philanthropy; providers of health care services; and other related fields; and</text>
</clause>
<clause id="P5CA35FD17C6346E6B75CFB7A10F1E184">
<enum>(ii)</enum>
<text>who will provide a combination of professional perspectives, broad geographic representation, and a balance between urban, suburban, and rural representatives.</text>
</clause>
</subparagraph>
<subparagraph id="P893F8EF3330241B19D97B8A84B189FC6">
<enum>(B)</enum>
<header>Inclusion</header>
<clause id="P2E62B02E0C684E4CA447627437967FF6">
<enum>(i)</enum>
<header>In general</header>
<text>The membership of the Commission shall include no less than one representative of—</text>
<subclause id="P992A4370F7C24A15A1A8E56530509D4F">
<enum>(I)</enum>
<text>the health care workforce and health professionals;</text>
</subclause>
<subclause id="PD4A8CF77006B4A678E36138D2C844547">
<enum>(II)</enum>
<text>employers;</text>
</subclause>
<subclause id="P37AF41AD3FDD4284A35710ECDF5BC9E2">
<enum>(III)</enum>
<text>third-party payers;</text>
</subclause>
<subclause id="PEC6332365BF2403881CD1D75E7D752C4">
<enum>(IV)</enum>
<text>individuals skilled in the conduct and interpretation of health care services and health economics research;</text>
</subclause>
<subclause id="PB95B16858867412B955475B53F9047C9">
<enum>(V)</enum>
<text>representatives of consumers;</text>
</subclause>
<subclause id="PBF7D2FB060A24A889B7AF6CE0B2244D9">
<enum>(VI)</enum>
<text>labor unions;</text>
</subclause>
<subclause id="PBBE2A84DBF744458B56B13F274C9CD71">
<enum>(VII)</enum>
<text>State or local workforce investment boards; and</text>
</subclause>
<subclause id="P8A7DEEBC0217424D93FC2BD9319D2A3E">
<enum>(VIII)</enum>
<text>educational institutions (which may include elementary and secondary institutions, institutions of higher education, including 2 and 4 year institutions, or registered apprenticeship programs).</text>
</subclause>
</clause>
<clause id="PEE388F88E2CB48AF8683FDD3AADB904F">
<enum>(ii)</enum>
<header>Additional members</header>
<text>The remaining membership may include additional representatives from clause (i) and other individuals as determined appropriate by the Comptroller General of the United States.</text>
</clause>
</subparagraph>
<subparagraph id="P344ECBC37A2541EFB994C3A8799DD3B6">
<enum>(C)</enum>
<header>Majority non-providers</header>
<text>Individuals who are directly involved in health professions education or practice shall not constitute a majority of the membership of the Commission.</text>
</subparagraph>
</paragraph>
<paragraph id="PE358DAA554434A84A8E80B80DF3939D4">
<enum>(3)</enum>
<header>Terms</header>
<subparagraph id="PFD3B0AD3F9C5400B9610F03B3708A240">
<enum>(A)</enum>
<header>In general</header>
<text>The terms of members of the Commission shall be for 3 years except that the Comptroller General shall designate staggered terms for the members first appointed.</text>
</subparagraph>
<subparagraph id="P5C68543DCC6546FFB3BE03BF575F1084">
<enum>(B)</enum>
<header>Vacancies</header>
<text>Any member appointed to fill a vacancy occurring before the expiration of the term for which the member’s predecessor was appointed shall be appointed only for the remainder of that term. A member may serve after the expiration of that members term until a successor has taken office. A vacancy in the Commission shall be filled in the manner in which the original appointment was made.</text>
</subparagraph>
</paragraph>
<paragraph id="PE7C6E256970D4178B05479D198B139E9">
<enum>(4)</enum>
<header>Compensation</header>
<text>While serving on the business of the Commission (including travel time), a member of the Commission shall be entitled to compensation at the per diem equivalent of the rate provided for level IV of the Executive Schedule under section 5315 of tile 5, United States Code, and while so serving away from home and the member’s regular place of business, a member may be allowed travel expenses, as authorized by the Chairman of the Commission. Physicians serving as personnel of the Commission may be provided a physician comparability allowance by the Commission in the same manner as Government physicians may be provided such an allowance by an agency under section <usc-ref title="5" section="5948">5948</usc-ref> of title 5, United States Code, and for such purpose subsection (i) of such section shall apply to the Commission in the same manner as it applies to the Tennessee Valley Authority. For purposes of pay (other than pay of members of the Commission) and employment benefits, rights, and privileges, all personnel of the Commission shall be treated as if they were employees of the United States Senate.</text>
</paragraph>
<paragraph id="P802F3515764B457E8F28049917A0E347">
<enum>(5)</enum>
<header>Chairman, vice chairman</header>
<text>The members of the Commission shall elect, by a majority vote, a chairman and vice chairman of the Commission for the term of their appointment of portion remaining. Such elections shall occur at the end of any chairman or vice chairman’s term or upon the resignation of the chairman or vice chairman from the Commission.</text>
</paragraph>
<paragraph id="PD85CFF4A52BE4886B53E7C000AE5DC7D">
<enum>(6)</enum>
<header>Meetings</header>
<text>The Commission shall meet at the call of the chairman, but no less frequently than on a quarterly basis.</text>
</paragraph>
</subsection>
<subsection id="PA53D1ECB8CED44DBA4462C578E529F22">
<enum>(d)</enum>
<header>Duties</header>
<paragraph id="P8AD72B7AD2904E4A97E551E6825695AA">
<enum>(1)</enum>
<header>Review of health care workforce and annual reports</header>
<text>In order to develop a fiscally sustainable integrated workforce that supports a high-quality, readily accessible health care delivery system that meets the needs of patients and populations, the Commission, in consultation with relevant Federal, State, and local agencies, shall—</text>
<subparagraph id="P77A4646119FB49AEBD1E9FED480C1413">
<enum>(A)</enum>
<text>review current and projected health care workforce supply and demand, including the topics described in paragraph (2);</text>
</subparagraph>
<subparagraph id="P03E5ACED3BB14502B944D1233FA00288">
<enum>(B)</enum>
<text>make recommendations to Congress and the Administration concerning national health care workforce priorities, goals, and policies;</text>
</subparagraph>
<subparagraph id="P43D2E4C090354520925699BD37E61E90">
<enum>(C)</enum>
<text>by not later than October 1 of each year (beginning with 2011), submit a report to Congress and the Administration containing the results of such reviews and recommendations concerning related policies; and</text>
</subparagraph>
<subparagraph id="PB3B3F9F5851E4AD0BB4A078C70D5930C">
<enum>(D)</enum>
<text>by not later than April 1 of each year (beginning with 2011), submit a report to Congress and the Administration containing a review of, and recommendations on, at a minimum one high priority area as described in paragraph (3).</text>
</subparagraph>
</paragraph>
<paragraph id="P1B89E8821C6043CEB434F606D2E564E4">
<enum>(2)</enum>
<header>Specific topics to be reviewed</header>
<text>The topics described in this paragraph include—</text>
<subparagraph id="PD819187CBC0F49DE9B0FD9374F45C0AF">
<enum>(A)</enum>
<text>current health care workforce supply and distribution, including demographics, skill sets, and demands, with projected demands during the subsequent 10 and 25 year periods;</text>
</subparagraph>
<subparagraph id="P5D58BC47186B4E868844A0342EDA570F">
<enum>(B)</enum>
<text>health care workforce education and training capacity, including the number of students who have completed education and training, including registered apprenticeships; the number of qualified faculty; the education and training infrastructure; and the education and training demands, with projected demands during the subsequent 10 and 25 year periods, and including identified models of education and training delivery and best practices;</text>
</subparagraph>
<subparagraph id="P75407B656EFE4A7AA140A33961D3D4F3">
<enum>(C)</enum>
<text>the implications of new and existing Federal policies which affect the health care workforce, including Medicare and Medicaid graduate medical education policies, titles VII and VIII of the <act-ref scope="public" congress="78" type="chapter" number="373" session="2">Public Health Service Act</act-ref> (<usc-ref title="42" section="292">42 U.S.C. 292</usc-ref> et seq. and 296 et seq.), the National Health Service Corps (with recommendations for aligning such programs with national health workforce priorities and goals), and other health care workforce programs, including those supported through the <act-ref scope="public" congress="105" type="law" number="220" session="2">Workforce Investment Act of 1998</act-ref> (<usc-ref title="29" section="2801">29 U.S.C. 2801</usc-ref> et seq.), the Carl D. Perkins Career and Technical Education Act of 2006 (<usc-ref title="20" section="2301">20 U.S.C. 2301</usc-ref> et seq.), the <act-ref scope="public" congress="89" type="law" number="329" session="1">Higher Education Act of 1965</act-ref> (<usc-ref title="20" section="1001">20 U.S.C. 1001</usc-ref> et seq.), and any other Federal health care workforce programs; and</text>
</subparagraph>
<subparagraph id="PC326702078164D07A76DBC714119CDCD">
<enum>(D)</enum>
<text>the health care workforce needs of special populations, such as minorities, rural populations, medically underserved populations, gender specific needs, and geriatric and pediatric populations with recommendations for new and existing Federal policies to meet the needs of these special populations.</text>
</subparagraph>
</paragraph>
<paragraph id="P725CFAF1FDD74492A39725E74B477186">
<enum>(3)</enum>
<header>High priority areas</header>
<subparagraph id="P469645B2C28E4C5385F1C5CA0A3AB890">
<enum>(A)</enum>
<header>In general</header>
<text>The initial high priority topics described in this paragraph include—</text>
<clause id="P7E1DBEDD9DC44305B27BE5EBCD7E2D93">
<enum>(i)</enum>
<text>integrated health care workforce planning that identifies health care professional skills needed and maximizes the skill sets of health care professionals across disciplines;</text>
</clause>
<clause id="PFF6474CCB45B4380B693ED5EAAE5FD25">
<enum>(ii)</enum>
<text>an analysis of the nature, scopes of practice, and demands for health care workers in the enhanced information technology and management workplace;</text>
</clause>
<clause id="P0B4A0AA785E74DF69271533849C2E3EE">
<enum>(iii)</enum>
<text>Medicare and Medicaid graduate medical education policies and recommendations for aligning with national workforce goals;</text>
</clause>
<clause id="P9A3523839B6E4CBEB1E895EB400AC557">
<enum>(iv)</enum>
<text>nursing workforce capacity at all levels, including education and training capacity, projected demands, and integration within the health care delivery system;</text>
</clause>
<clause id="P7DC215FE2A794217915572A3C80406F4">
<enum>(v)</enum>
<text>oral health care workforce capacity, including education and training capacity, projected demands, and integration within the health care delivery system;</text>
</clause>
<clause id="PBB550C104CE743C0A3D7FBBC95F27C11">
<enum>(vi)</enum>
<text>mental and behavioral health care workforce capacity, including education and training capacity, projected demands, and integration within the health care delivery system;</text>
</clause>
<clause id="P200A558FBDC94B81AB3DD267C910C7AC">
<enum>(vii)</enum>
<text>allied health and public health care workforce capacity, including education and training capacity, projected demands, and integration within the health care delivery system; and</text>
</clause>
<clause id="PD1F61C47B38C4C6B8435E825E1FE5AF5">
<enum>(viii)</enum>
<text>the geographic distribution of health care providers as compared to the identified health care workforce needs of States and regions.</text>
</clause>
</subparagraph>
<subparagraph id="PF11E929496FD4ADC9BBEE278AC40605D">
<enum>(B)</enum>
<header>Future determinations</header>
<text>The Commission may require that additional topics be included under subparagraph (A). The appropriate committees of Congress may recommend to the Commission the inclusion of other topics for health care workforce development areas that require special attention.</text>
</subparagraph>
</paragraph>
<paragraph id="P4E4898D233154EA0A0AE80F0D2893D16">
<enum>(4)</enum>
<header>Grant program</header>
<text>The Commission shall oversee and report to Congress on the State Health Care Workforce Development Grants program established in section 412.</text>
</paragraph>
<paragraph id="P56D5CBCB96C1481886003F955A80CB16">
<enum>(5)</enum>
<header>Study</header>
<text>The Commission shall study effective mechanisms for financing education and training for careers in health care, including public health and allied health.</text>
</paragraph>
<paragraph id="P20919C95F78F4A9495C4B9BA9D22F281">
<enum>(6)</enum>
<header>Recommendations</header>
<text>The Commission shall submit recommendations to Congress, the Department of Labor, and the Department of Health and Human Services about improving safety, health, and worker protections in the workplace for the health care workforce.</text>
</paragraph>
<paragraph id="P660398B79EE7400A89AC8E5A4FCAA83D">
<enum>(7)</enum>
<header>Assessment</header>
<text>The Commission shall assess and receive reports from the National Center for Health Care Workforce Analysis established under title VII of the Public Service Health Act.</text>
</paragraph>
</subsection>
<subsection id="P886C6EB3545A492E9383802A7B25CD14">
<enum>(e)</enum>
<header>Consultation With Federal, State, and Local Agencies, Congress, and Other Organizations</header>
<paragraph id="P3ACDB5256E9C450D87FF4F50A3B6262F">
<enum>(1)</enum>
<header>In general</header>
<text>The Commission shall consult with Federal agencies (including the Departments of Health and Human Services, Labor, Education, Commerce, Agriculture, Defense, and Veterans Affairs and the Environmental Protections Agency), Congress, the Medicare Payment Advisory Commission, and, to the extent practicable, with State and local agencies, voluntary health care organizations professional societies, and other relevant public-private health care partnerships.</text>
</paragraph>
<paragraph id="P85505B1E2BBB4EED9483CC2BF4790431">
<enum>(2)</enum>
<header>Obtaining official data</header>
<text>The Commission, consistent with established privacy rules, may secure directly from any department or agency of the United States information necessary to enable the Commission to carry out this section.</text>
</paragraph>
<paragraph id="PA855A5DECDFD42C1A414D5B43F3304F7">
<enum>(3)</enum>
<header>Detail of federal government employees</header>
<text>An employee of the Federal Government may be detailed to the Commission without reimbursement. The detail of such an employee shall be without interruption or loss of civil service status.</text>
</paragraph>
</subsection>
<subsection id="P426E09F9D6924281AF64BFCD7C14C355">
<enum>(f)</enum>
<header>Director and Staff; Experts and Consultants</header>
<text>Subject to such review as the Comptroller General of the United States determines to be necessary to ensure the efficient administration of the Commission, the Commission may—</text>
<paragraph id="P814E0ADCDB70471CA68C34AC9A53C1C1">
<enum>(1)</enum>
<text>employ and fix the compensation of an executive director (subject to the approval of the Comptroller General) and such other personnel as may be necessary to carry out its duties (without regard to the provisions of title 5, United States Code, governing appointments in the competitive service);</text>
</paragraph>
<paragraph id="PC553DDCE95214AE59ED360AD35593656">
<enum>(2)</enum>
<text>seek such assistance and support as may be required in the performance of its duties from appropriate Federal departments and agencies;</text>
</paragraph>
<paragraph id="PDA2C182D625546E4B20C92E4D10359FC">
<enum>(3)</enum>
<text>enter into contracts or make other arrangements, as may be necessary for the conduct of the work of the Commission (without regard to section 3709 of the Revised Statutes (<usc-ref title="41" section="5">41 U.S.C. 5</usc-ref>));</text>
</paragraph>
<paragraph id="P4F6F12BA57B04EABB8E7FBAF97FBF103">
<enum>(4)</enum>
<text>make advance, progress, and other payments which relate to the work of the Commission;</text>
</paragraph>
<paragraph id="P6969A0DA73104CA2AA236001A07B7B1B">
<enum>(5)</enum>
<text>provide transportation and subsistence for persons serving without compensation; and</text>
</paragraph>
<paragraph id="PADA764DBC22142529859576BA70E9C04">
<enum>(6)</enum>
<text>prescribe such rules and regulations as the Commission determines to be necessary with respect to the internal organization and operation of the Commission.</text>
</paragraph>
</subsection>
<subsection id="P988AC6775D364EC2A816C16108529947">
<enum>(g)</enum>
<header>Powers</header>
<paragraph id="PD9F3F556A0E545A699ACCE753AF54516">
<enum>(1)</enum>
<header>Data collection</header>
<text>In order to carry out its functions under this section, the Commission shall—</text>
<subparagraph id="P36AA5C8F995B451E9C7271353E6801E3">
<enum>(A)</enum>
<text>utilize existing information, both published and unpublished, where possible, collected and assessed either by its own staff or under other arrangements made in accordance with this section, including coordination with the Bureau of Labor Statistics;</text>
</subparagraph>
<subparagraph id="PA0046CB1CEF04BAD80DB2C94808ED2C2">
<enum>(B)</enum>
<text>carry out, or award grants or contracts for the carrying out of, original research and development, where existing information is inadequate, and</text>
</subparagraph>
<subparagraph id="PC22A23F32C3F4C529A470FA644B7A83A">
<enum>(C)</enum>
<text>adopt procedures allowing interested parties to submit information for the Commission’s use in making reports and recommendations.</text>
</subparagraph>
</paragraph>
<paragraph id="P093C31DF495840758EC42E71E4BB0ACC">
<enum>(2)</enum>
<header>Access of the government accountability office to information</header>
<text>The Comptroller General of the United States shall have unrestricted access to all deliberations, records, and nonproprietary data of the Commission, immediately upon request.</text>
</paragraph>
<paragraph id="P28A7667FE0824D3D8C063AFCD3BA7D82">
<enum>(3)</enum>
<header>Periodic audit</header>
<text>The Commission shall be subject to periodic audit by a third party appointed by the Secretary.</text>
</paragraph>
</subsection>
<subsection id="PEA4DFC700D1F4E98AD205BADB975BB08">
<enum>(h)</enum>
<header>Authorization of Appropriations</header>
<paragraph id="PACDB5C417819474EBE66CF3CB9DC74FA">
<enum>(1)</enum>
<header>Request for appropriations</header>
<text>The Commission shall submit requests for appropriations in the same manner as the Comptroller General of the United States submits requests for appropriations. Amounts so appropriated for the Commission shall be separate from amounts appropriated for the Comptroller General.</text>
</paragraph>
<paragraph id="P51E43A2F84524A5D8CF2F0DF3AA10205">
<enum>(2)</enum>
<header>Authorization</header>
<text>There are authorized to be appropriated such sums as may be necessary to carry out this section.</text>
</paragraph>
<paragraph id="P23754822336F47178B520459DCF962C9">
<enum>(3)</enum>
<header>Gifts</header>
<text>The Commission is authorized to accept and gifts for purposing of carrying out this section.</text>
</paragraph>
</subsection>
<subsection id="P0551325673724F298209F86FE5A1B4FB">
<enum>(i)</enum>
<header>Definitions</header>
<text>In this section:</text>
<paragraph id="P37A24BD1E6D04265A896BB14C251DDFA">
<enum>(1)</enum>
<header>Health care workforce</header>
<text>The term <quote>health care workforce</quote> includes all health care providers with direct patient care and support responsibilities, including physicians, nurses, physician assistants, pharmacists, oral healthcare professionals, allied health professionals, mental health professionals, and public health professionals.</text>
</paragraph>
<paragraph id="P1591B92F42AA4D438F5367148ADE9686">
<enum>(2)</enum>
<header>Health professionals</header>
<text>The term <quote>health professionals</quote> includes—</text>
<subparagraph id="PDE52A3F68E25485087DB267A34015797">
<enum>(A)</enum>
<text>dentists, dental hygienists, primary care providers, specialty physicians, nurses, nurse practitioners, physician assistants, psychologists and other behavioral and mental health professionals, social workers, physical therapists, public health professionals, clinical pharmacists, allied health professionals, chiropractors, community health workers, school nurses, certified nurse midwives, podiatrists, licensed complementary and alternative medicine providers, and integrative health practitioners;</text>
</subparagraph>
<subparagraph id="P3C77EC0F0DED41478513B2CD021109A8">
<enum>(B)</enum>
<text>national representatives of health professionals;</text>
</subparagraph>
<subparagraph id="P929D5D2981B44DE2B89967A64500B075">
<enum>(C)</enum>
<text>representatives of schools of medicine, osteopathy, nursing, allied health, educational programs for public health professionals, behavioral and mental health professionals (as so defined), social workers, physical therapists, oral health care industry dentistry and dental hygiene, and physician assistants;</text>
</subparagraph>
<subparagraph id="P2408758DCA8640C8812E4CF0C3584D4A">
<enum>(D)</enum>
<text>representatives of public and private teaching hospitals, and ambulatory health facilities, including Federal medical facilities; and</text>
</subparagraph>
<subparagraph id="P28FDDCFE7B5C47868F4CC891FCE64BCF">
<enum>(E)</enum>
<text>any other health professional the Comptroller General of the United States determines appropriate.</text>
</subparagraph>
</paragraph>
</subsection>
</section>
<section id="P9C4A2B095F7B488193246DD76E3C18A1">
<enum>102.</enum>
<header>STATE HEALTH WORKFORCE CENTERS PROGRAM</header>
<subsection id="P883C28F462F64D4886755E976B83A84A">
<enum>(a)</enum>
<header>Establishment</header>
<text>The Secretary shall establish a demonstration program (in this section referred to as the <quote>program</quote>) under which the Secretary makes grants to participating States for the operation of State Health Workforce Centers to carry out the activities described in subsection (c).</text>
</subsection>
<subsection id="P9EC2FF8C3AF240469968066B9440C56B">
<enum>(b)</enum>
<header>Participating States</header>
<text>A State seeking to participate in the program shall submit an application to the Secretary containing such information and at such time as the Secretary may specify. The Secretary may only consider under the preceding sentence 1 application submitted by each State which has been certified by the Governor or the chief executive officer of the State.</text>
</subsection>
<subsection id="P7D1142FA9CB846DDA7D0A705D86F0DEC">
<enum>(c)</enum>
<header>Use of Funds</header>
<text>Grants awarded under subsection (a) may be used to support activities designed to improve the training, deployment, and retention of critical health professionals in underserved areas and for underserved populations, including the following:</text>
<paragraph id="P8B415A936FD946A890A0692D61A459FA">
<enum>(1)</enum>
<text>Conducting assessments of key health professional capacity and needs. Such assessments shall be conducted in a coordinated manner that provides for the nationwide collection of health professional data.</text>
</paragraph>
<paragraph id="P73B1BC1D5E4B4E898B7B7BB8FAEF2C51">
<enum>(2)</enum>
<text>Convening State health professional policymakers to review education, education financing, regulations, and taxation and compensation policies which affect the training, deployment, and retention of health professionals. A participating State may, taking into consideration the results of such reviews, develop short-term and long-term recommendations for improving the supply, deployment, and retention of critical health professionals in underserved areas and for underserved populations.</text>
</paragraph>
</subsection>
<subsection id="PBF3540759C974458860B346FAF6901BE">
<enum>(d)</enum>
<header>Funding</header>
<paragraph id="PAF8080FD0063438FAF31586ECF6DCF06">
<enum>(1)</enum>
<header>Authorization of appropriations</header>
<text>There are authorized to be appropriated $13,750,000 to carry out this section.</text>
</paragraph>
<paragraph id="PD72BA06CD4C9402D914AA82B2633FA54">
<enum>(2)</enum>
<header>Matching requirement</header>
<text>The Secretary may require a State, in order to be eligible to receive a grant under this section, to agree that, with respect to the costs incurred by the State in carrying out the activities for which the grant was awarded, the State will make available (directly or through donations from public or private entities) non-Federal contributions in an amount equal to a percent of Federal funds provided under the grant (as determined appropriate by the Secretary).</text>
</paragraph>
</subsection>
<subsection id="P9FA4A7AE507743EE8D2D70D6E64F4E57">
<enum>(e)</enum>
<header>Definitions</header>
<text>In this section:</text>
<paragraph id="P81E24E653B474CF397B2A150D6B94722">
<enum>(1)</enum>
<header>Secretary</header>
<text>The term <quote>Secretary</quote> means the Secretary of Health and Human Services.</text>
</paragraph>
<paragraph id="PD62FB411D45247DAA48FBF88430CEC64">
<enum>(2)</enum>
<header>State</header>
<text>The term <quote>State</quote> means—</text>
<subparagraph id="P90BD0F72B22943E696D991D451176253">
<enum>(A)</enum>
<text>a State;</text>
</subparagraph>
<subparagraph id="P82B0159066B948E6BE5D8AEAFEECEFAB">
<enum>(B)</enum>
<text>the District of Columbia;</text>
</subparagraph>
<subparagraph id="PD68845BCFE33424DA211595892A1BDA4">
<enum>(C)</enum>
<text>the Commonwealth of Puerto Rico; and</text>
</subparagraph>
<subparagraph id="P21793AEFD5D244A2BF93AFDBF92414C4">
<enum>(D)</enum>
<text>any other territory or possession of the United States.</text>
</subparagraph>
</paragraph>
</subsection>
</section>
<section id="P2873F6358A7A42EE9B8F0FA823E5A55D">
<enum>103.</enum>
<header>IMPROVEMENTS TO PAYMENTS FOR GRADUATE MEDICAL EDUCATION UNDER MEDICARE</header>
<subsection id="P7A8390D06CAB4921B2A2AE16ACD4E103">
<enum>(a)</enum>
<header>Increasing the Medicare Caps on Graduate Medical Education Positions</header>
<paragraph id="PE2D2127D878E4BB3B5498D9BA2C767BA">
<enum>(1)</enum>
<header>Direct graduate medical education</header>
<text>Section 1886(h)(4)(F) of the <act-ref scope="public" congress="74" type="chapter" number="531" session="1">Social Security Act</act-ref> (<usc-ref title="42" section="1395ww" provision="(h)(4)(F)">42 U.S.C. 1395ww(h)(4)(F)</usc-ref>) is amended—</text>
<subparagraph id="P5B09AEDC10D14339B60C90A4169D4505">
<enum>(A)</enum>
<text>in clause (i), by inserting <quote>clause (iii) and</quote> after <quote>subject to</quote>; and</text>
</subparagraph>
<subparagraph id="P0580FFE34AC442DE93B1B9573C51BFD3">
<enum>(B)</enum>
<text>by adding at the end the following new clause:</text>
<quoted-block id="PD45CAB615EDD49C28AEFC0887ACB316D">
<clause id="PBE267AC2A78B4C2AB9B5E3BEA092BE19">
<enum>(iii)</enum>
<header>Increase in caps on graduate medical education positions for states with a shortage of residents</header>
<subclause id="P7CFE3E3FCC97433FB1284F7E2DFB184F">
<enum>(I)</enum>
<header>In general</header>
<text>For cost reporting periods beginning on or after January 1, 2011, the Secretary shall increase the otherwise applicable limit on the total number of full-time equivalent residents in the field of allopathic or osteopathic medicine determined under clause (i) with respect to a qualifying hospital by an amount equal to 15 percent of the amount of the otherwise applicable limit (determined without regard to this clause). Such increase shall be phased-in equally over a period of 3 cost reporting periods beginning with the first cost reporting period in which the increase is applied under the previous sentence to the hospital.</text>
</subclause>
<subclause id="PABE53136305E4B4C92CC794F1859884C">
<enum>(II)</enum>
<header>Qualifying hospital</header>
<text>In this clause, the term <quote>qualifying hospital</quote> means a hospital that agrees to use the increase in the number of full-time equivalent residents under subclause (I) to support community-based training which emphasizes underserved areas and innovative training models which address community needs and reflect emerging, evolving, and contemporary models of health care delivery. A qualifying hospital shall give priority to providing such training and training models to health professionals in specialties which the Secretary, in consultation with the Permanent National Health Workforce Commission established under section 101(a) of the Health Access and Health Professions Supply Act of 2009, determines are in high-need (including family medicine, general surgery, geriatrics, general internal medicine, general surgery, and obstetrics and gynecology).</text>
</subclause>
<subclause id="P13B3599C96C24CED96A3B2F0BBBBD706">
<enum>(III)</enum>
<header>Increase in payments</header>
<text>Notwithstanding any other provision of law, in the case of full-time equivalent residents added to a hospital’s training program as a result of such increase, the Secretary shall provide for an increase in the amounts otherwise payable under this subsection with respect to direct graduate medical education costs that would otherwise apply with respect to such residents by 10 percent. Such increased payments shall be made to the facility in which the training is provided to such residents.</text>
</subclause>
</clause>
<after-quoted-block>.</after-quoted-block>
</quoted-block>
</subparagraph>
</paragraph>
<paragraph id="PF623D16B2137487996D1B671ECD233FA">
<enum>(2)</enum>
<header>Indirect medical education</header>
<text>Section 1886(d)(5)(B) of the <act-ref scope="public" congress="74" type="chapter" number="531" session="1">Social Security Act</act-ref> (<usc-ref title="42" section="1395ww" provision="(d)(5)(B)">42 U.S.C. 1395ww(d)(5)(B)</usc-ref>) is amended by adding at the end the following new clause:</text>
<quoted-block id="P066E0D83A2A04E4BB451A41C23B4421F">
<clause indent="paragraph" id="P9794E8327C0444299826CF7D23AF1413">
<enum>(x)</enum>
<text>Clause (iii) of subsection (h)(4)(F) shall apply to clause (v) in the same manner and for the same period as such clause (iii) applies to clause (i) of such subsection.</text>
</clause>
<after-quoted-block>.</after-quoted-block>
</quoted-block>
</paragraph>
</subsection>
<subsection id="P9BA807AFF75B45B59670964180E91B7F">
<enum>(b)</enum>
<header>Application of Medicare GME Payments to Additional Training Site Venues</header>
<paragraph id="PB9A6F7CE87744967B0B3371538E6D88E">
<enum>(1)</enum>
<header>In general</header>
<text>The Secretary of Health and Human Services (in this subsection referred to as the <quote>Secretary</quote>) shall, by regulation, provide for the use of payments for direct graduate medical education costs under section 1886(h) of the <act-ref scope="public" congress="74" type="chapter" number="531" session="1">Social Security Act</act-ref> (<usc-ref title="42" section="1395ww" provision="(h)">42 U.S.C. 1395ww(h)</usc-ref>) and payments for the indirect costs of medical education under section 1886(d)(5)(B) of the <act-ref scope="public" congress="74" type="chapter" number="531" session="1">Social Security Act</act-ref> (<usc-ref title="42" section="1395ww" provision="(d)(5)(B)">42 U.S.C. 1395ww(d)(5)(B)</usc-ref>) to support the implementation of community-based training and innovative training models under subsections (h)(4)(F)(iii)(II) and (d)(5)(B)(x) of section 1886 of the <act-ref scope="public" congress="74" type="chapter" number="531" session="1">Social Security Act</act-ref> (<usc-ref title="42" section="1395ww">42 U.S.C. 1395ww</usc-ref>).</text>
</paragraph>
<paragraph id="P42EAB138E89248E299DC54551B45E959">
<enum>(2)</enum>
<header>Use of model of care delivery</header>
<text>In promulgating regulations under paragraph (1), the Secretary shall consider the model of care delivery of the Institute of Medicine of the National Academies.</text>
</paragraph>
<paragraph id="P17CAAFB548F5411989CD600301E85E27">
<enum>(3)</enum>
<header>Consultation</header>
<text>In promulgating such regulations, the Secretary shall consult with the Permanent National Health Workforce Commission established under section 101(a).</text>
</paragraph>
</subsection>
<subsection id="P0FF148E8FC8040B7BF6E5AB4B6B9FAE9">
<enum>(c)</enum>
<header>Determination of Hospital-specific Approved FTE Resident Amounts</header>
<text>Section 1886(h)(2) of the <act-ref scope="public" congress="74" type="chapter" number="531" session="1">Social Security Act</act-ref> (<usc-ref title="42" section="1395ww" provision="(h)(2)">42 U.S.C. 1395ww(h)(2)</usc-ref>) is amended by adding at the end the following new subparagraph:</text>
<quoted-block id="PB16861A39DEF46C99623436359693972">
<subparagraph id="P6EB6C3AF553D45C18846C94F2006DCAB">
<enum>(G)</enum>
<header>Flexibility in determination</header>
<clause id="P1965D52579E6416C9CD2662062BEED73">
<enum>(i)</enum>
<header>In general</header>
<text>Notwithstanding the preceding provisions of this paragraph, the approved FTE resident amount for each cost reporting period beginning on or after January 1, 2011, with respect to an applicable resident shall be determined using a methodology established by the Secretary that allows flexibility for payments to be made for costs in addition to the costs of hospital-sponsored education. Such methodology shall provide that nonteaching hospital-based entities (such as managed care organizations and public and private healthcare consortia) that are capable of assembling all of the resources necessary for effectively providing graduate medical education may receive payments for providing graduate medical education, either as the sponsor of such graduate medical education program or as an affiliate of such a sponsor.</text>
</clause>
<clause id="PB8045BAC717E4FAD9C887501D80E0362">
<enum>(ii)</enum>
<header>Applicable resident</header>
<text>In this subparagraph, the term <quote>applicable resident</quote> means a resident—</text>
<subclause id="PC7D5F43ACC104D4C974B48E591140967">
<enum>(I)</enum>
<text>in a specialty which the Secretary, in consultation with the Permanent National Health Workforce Commission established under section 101(a) of the Health Access and Health Professions Supply Act of 2009, determines is in high-need;</text>
</subclause>
<subclause id="PC1476A47A8B64981B504F759671E5767">
<enum>(II)</enum>
<text>in a health professional shortage area (as defined in section 332 of the <act-ref scope="public" congress="78" type="chapter" number="373" session="2">Public Health Service Act</act-ref>);</text>
</subclause>
<subclause id="P56244A490F674994907463D919A1B32F">
<enum>(III)</enum>
<text>in a medically underserved community (as defined in section 799B of the <act-ref scope="public" congress="78" type="chapter" number="373" session="2">Public Health Service Act</act-ref>), or with respect to a medically underserved population (as defined in section 330(b)(3) of the <act-ref scope="public" congress="78" type="chapter" number="373" session="2">Public Health Service Act</act-ref>); and</text>
</subclause>
<subclause id="P0A2EF10D656F484E84A27B1BAE77030E">
<enum>(IV)</enum>
<text>in a Federal medical facility.</text>
</subclause>
</clause>
<clause id="P3AC8934014E54F87B6099FCC84A961C8">
<enum>(iii)</enum>
<header>Federal medical facility</header>
<text>In this subparagraph, the term <quote>Federal medical facility</quote> means a facility for the delivery of health services, and includes—</text>
<subclause id="P310D0CC155E9437996D3BA6AB0B36F4E">
<enum>(I)</enum>
<text>a community health center (as defined in section 330 of the <act-ref scope="public" congress="78" type="chapter" number="373" session="2">Public Health Service Act</act-ref>), a public health center, an outpatient medical facility, or a community mental health center;</text>
</subclause>
<subclause id="P61DE5B5A891A4237881AE61942A36161">
<enum>(II)</enum>
<text>a hospital, State mental hospital, facility for long-term care, or rehabilitation facility;</text>
</subclause>
<subclause id="PC55992BE7BA345519F221A93C6512B45">
<enum>(III)</enum>
<text>a migrant health center or an Indian Health Service facility;</text>
</subclause>
<subclause id="P03BED59E310A41CB8E2B6F889427AA28">
<enum>(IV)</enum>
<text>a facility for the delivery of health services to inmates in a penal or correctional institution (under section 323 of such Act) or a State correctional institution;</text>
</subclause>
<subclause id="P3F15A225F4294542BD4454D4A16D684D">
<enum>(V)</enum>
<text>a Public Health Service medical facility (used in connection with the delivery of health services under section 320, 321, 322, 324, 325, or 326 of such Act); or</text>
</subclause>
<subclause id="PE93CE2033ED64289B223982D36868426">
<enum>(VI)</enum>
<text>any other Federal medical facility.</text>
</subclause>
</clause>
</subparagraph>
<after-quoted-block>.</after-quoted-block>
</quoted-block>
</subsection>
</section>
<section id="P5B18B9A8113245BBAC5EA52F790F070C">
<enum>104.</enum>
<header>DISTRIBUTION OF RESIDENT TRAINEES IN AN EMERGENCY</header>
<subsection id="P67F46D0220D048E7A920C4D43F1C5E8F">
<enum>(a)</enum>
<header>Exclusion From 3-year Rolling Average</header>
<text>Notwithstanding any other provision of law, in the case of a host hospital participating in an emergency Medicare GME affiliation agreement on or after the date of enactment of this Act and training residents in excess of its cap, consistent with the rolling average provisions applicable for closed programs as specified in section 413.79(d)(6) of title 42, Code of Federal Regulations, the Secretary of Health and Human Services shall exclude from the 3-year rolling average FTE residents associated with displaced residents during the period in which such agreement is in effect.</text>
</subsection>
<subsection id="P2DA613A9FABE40D89A0EEEEBC134D962">
<enum>(b)</enum>
<header>Assessment and Revision of GME Policies</header>
<paragraph id="PC5E65C4B0B1F46F8BBCF24F150B49261">
<enum>(1)</enum>
<header>Review</header>
<text>The Secretary of Health and Human Services shall review policies with respect to payments for direct graduate medical education costs under section 1886(h) of the <act-ref scope="public" congress="74" type="chapter" number="531" session="1">Social Security Act</act-ref> (<usc-ref title="42" section="1395ww" provision="(h)">42 U.S.C. 1395ww(h)</usc-ref>) and payments for the indirect costs of medical education under section 1886(d)(5)(B) of the <act-ref scope="public" congress="74" type="chapter" number="531" session="1">Social Security Act</act-ref> (<usc-ref title="42" section="1395ww" provision="(d)(5)(B)">42 U.S.C. 1395ww(d)(5)(B)</usc-ref>).</text>
</paragraph>
<paragraph id="P4D0A1233815F4ABCB2B53DD153739C82">
<enum>(2)</enum>
<header>Revision and report</header>
<text>Not later than January 1, 2011, the Secretary shall—</text>
<subparagraph id="PC631E21248154A1A846F047187C3D5DD">
<enum>(A)</enum>
<text>as appropriate, revise such policies that constrain the ability of the Secretary to respond to emergency situations and situations involving institutional and program closure; and</text>
</subparagraph>
<subparagraph id="P30A086CA77F9466E898B0C5BE48935FB">
<enum>(B)</enum>
<text>in the case where the Secretary determines legislative action is necessary to make such revisions, submit to Congress a report containing recommendations for such legislative action.</text>
</subparagraph>
</paragraph>
</subsection>
</section>
<section id="PF0F20BB579D748DABBBF405A7FDB610B">
<enum>105.</enum>
<header>AUTHORITY TO INCLUDE COSTS OF TRAINING OF PSYCHOLOGISTS IN PAYMENTS TO HOSPITALS FOR APPROVED EDUCATIONAL ACTIVITIES UNDER MEDICARE</header>
<text display-inline="no-display-inline">Effective for cost reporting periods beginning on or after the date that is 18 months after the date of enactment of this Act, for purposes of payment to hospitals under the Medicare program under title XVIII of the <act-ref scope="public" congress="74" type="chapter" number="531" session="1">Social Security Act</act-ref> for costs of approved educational activities (as defined in section 413.85 of title 42, Code of Federal Regulations), such approved educational activities shall include a 1-year doctoral clinical internship operated by the hospital as part of a clinical psychology training program that is provided upon completion of university course work.</text>
</section>
</subtitle>
<subtitle id="P8B673C103E4941BAAF20E742DB789A1D">
<enum>B</enum>
<header>Geriatric Assessments and Chronic Care Management and Coordination Services Under the Medicare Program</header>
<section id="P206F00C38DA1402791658EFB8BDFF5D3">
<enum>111.</enum>
<header>MEDICARE COVERAGE OF GERIATRIC ASSESSMENTS</header>
<subsection id="P52E9E111F46046B3AC6AB54F5C96EE08">
<enum>(a)</enum>
<header>Coverage of Geriatric Assessments</header>
<paragraph id="P73C8688EEC0F4293BF819DEAC2296236">
<enum>(1)</enum>
<header>In general</header>
<text>Section 1861(s)(2) of the <act-ref scope="public" congress="74" type="chapter" number="531" session="1">Social Security Act</act-ref> (<usc-ref title="42" section="1395x" provision="(s)(2)">42 U.S.C. 1395x(s)(2)</usc-ref>) is amended—</text>
<subparagraph id="PADC1329530054C0C84B884FA8B1C20D0">
<enum>(A)</enum>
<text>in subparagraph (DD), by striking <quote>and</quote> at the end;</text>
</subparagraph>
<subparagraph id="P7783027276E84C868D5C9AE8F6F0E92A">
<enum>(B)</enum>
<text>in subparagraph (EE), by adding <quote>and</quote> at the end; and</text>
</subparagraph>
<subparagraph id="P0F3959E1F7BF403F9117FD698681B2F4">
<enum>(C)</enum>
<text>by adding at the end the following new subparagraph:</text>
<quoted-block id="PDA7656B9B42144598E8602F9A4F9EE26">
<subitem indent="paragraph" id="P936C0784CBB343E4930163A6E34CDB94">
<enum>(FF)</enum>
<text>geriatric assessments (as defined in subsection (hhh)(1));</text>
</subitem>
<after-quoted-block>.</after-quoted-block>
</quoted-block>
</subparagraph>
</paragraph>
<paragraph id="PEA047C72CFDD4DE2BC0197B297E9E656">
<enum>(2)</enum>
<header>Conforming amendments</header>
<text>Clauses (i) and (ii) of section 1861(s)(2)(K) of the <act-ref scope="public" congress="74" type="chapter" number="531" session="1">Social Security Act</act-ref> (<usc-ref title="42" section="1395x" provision="(s)(2)(K)">42 U.S.C. 1395x(s)(2)(K)</usc-ref>) are each amended by striking <quote>subsection (ww)(1)</quote> and inserting <quote>subsections (ww)(1) and (hhh)(1)</quote>.</text>
</paragraph>
</subsection>
<subsection id="PF432DC43967A4D5BA698AAE8A2FB65E6">
<enum>(b)</enum>
<header>Geriatric Assessments Defined</header>
<text>Section 1861 of the <act-ref scope="public" congress="74" type="chapter" number="531" session="1">Social Security Act</act-ref> (<usc-ref title="42" section="1395x">42 U.S.C. 1395x</usc-ref>) is amended by adding at the end the following new subsections:</text>
<quoted-block style="traditional" id="P23BC832F5F3641FE9523C4C7528DE684">
<item indent="subsection" id="PD2095B248A85423BA9C83A0FD4B691DD">
<enum>(hhh)</enum>
<header>Geriatric Assessment</header>
<subitem display-inline="yes-display-inline" id="PAA5F070A2E8C4A38811CF5B71EE27B09">
<enum>(1)</enum>
<text>The term <quote>geriatric assessment</quote> means each of the following:</text>
</subitem>
</item>
<subparagraph indent="paragraph" id="P992D660B23244C3B838F6BA4E67AB045">
<enum>(A)</enum>
<text>An assessment of the clinical status, functional status, social and environmental functioning, and need for caregiving of a geriatric assessment eligible individual (as defined in subsection (iii)). The assessment shall include a comprehensive history and physical examination and assessments of the following domains using standardized validated clinical tools:</text>
<clause indent="subparagraph" id="PB26DE101C7394CA193B92FD093FBFAB0">
<enum>(i)</enum>
<text>Comprehensive review of medications and the individual’s adherence to the medication regimen.</text>
</clause>
<clause indent="subparagraph" id="P49BDA03280EF4A52B6B3421D8D46C407">
<enum>(ii)</enum>
<text>Measurement of affect, cognition and executive function, mobility, balance, gait, risk of falling, and sensory function.</text>
</clause>
<clause indent="subparagraph" id="PEC9112CE686143719F1938A9FDAAED21">
<enum>(iii)</enum>
<text>Social functioning, environmental needs, and caregiver resources and needs.</text>
</clause>
<clause indent="subparagraph" id="PDC98F3C7B31D445AA0CC89607A0D6C7F">
<enum>(iv)</enum>
<text>Any other domain determined appropriate by the Secretary.</text>
</clause>
</subparagraph>
<subparagraph indent="paragraph" id="P4106EED2753A439984FEB93A15035C9F">
<enum>(B)</enum>
<text>The development of a written care plan based on the results of the assessment under subparagraph (A) (and any subsequent assessment under subparagraph (B)). The care plan shall detail identified problems, outline therapies, assign responsibility for actions, and indicate whether the individual is likely to benefit from chronic care management and coordination services (as defined in subsection (jjj)(1)). If the individual is determined likely to benefit from chronic care management and coordination services, the care plan shall also provide the basis for the chronic care management and coordination plan to be developed by the chronic care manager pursuant to subsection (jjj).</text>
</subparagraph>
<paragraph indent="subsection" id="PB029C2E0F29D4E62BCB2E546AB99115C">
<enum>(2)</enum>
<text>A geriatric assessment may only be conducted by—</text>
<subparagraph indent="paragraph" id="PE44859A3562D4A91A3CA75FC671DADD1">
<enum>(A)</enum>
<text>a physician;</text>
</subparagraph>
<subparagraph indent="paragraph" id="PADD0E42EBE6A40C484EECC076A06E06B">
<enum>(B)</enum>
<text>a practitioner described in section 1842(b)(18)(C)(i) under the supervision of a physician; or</text>
</subparagraph>
<subparagraph indent="paragraph" id="PEAE3D27B4DEC4826B6A3D817D5B48A78">
<enum>(C)</enum>
<text>any other provider that meets such conditions as the Secretary may specify.</text>
</subparagraph>
</paragraph>
<paragraph indent="subsection" id="PF965242A33624A85A283C8FECDA09ADD">
<enum>(3)</enum>
<text>An individual described in subclause (A), (B), or, if applicable, (C) may provide for the furnishing of services included in the geriatric assessment by other qualified health care professionals.</text>
</paragraph>
<paragraph indent="subsection" id="P8768C64382B549BE90739716D6EA9393">
<enum>(4)</enum>
<subparagraph display-inline="yes-display-inline" id="P713C69A7D0184D268F81CB3EA1C6A096">
<enum>(A)</enum>
<text>Subject to subparagraph (B), a geriatric assessment of a geriatric assessment eligible individual may not be conducted more frequently than annually.</text>
</subparagraph>
<subparagraph indent="subsection" id="P7B597484C8A74073813C9E223CC683E3">
<enum>(B)</enum>
<text>A geriatric assessment of a geriatric assessment eligible individual may be conducted more frequently than annually if the assessment is medically necessary due to a significant change in the condition of the individual.</text>
<clause indent="subsection" id="PB91018C7693E4575A153F7E947003417">
<enum>(iii)</enum>
<header>Geriatric Assessment Eligible Individual</header>
<subclause display-inline="yes-display-inline" id="P859F30A1208243F8AC922A1AB4238F19">
<enum>(1)</enum>
<text>Subject to paragraph (3), the term <quote>geriatric assessment eligible individual</quote> means an individual identified by the Secretary as eligible for a geriatric assessment.</text>
</subclause>
</clause>
</subparagraph>
</paragraph>
<paragraph indent="subsection" id="PF58F97559DDA4E4B8E7D07EFD89A8442">
<enum>(2)</enum>
<text>In identifying individuals under paragraph (1), the following rules shall apply:</text>
<subparagraph indent="paragraph" id="P34E435FF87A549E4905AD1E65DDE125C">
<enum>(A)</enum>
<text>The individual must have at least 1 of the following present:</text>
<clause indent="subparagraph" id="PC503E1ED88934A758695A01D0BD994B8">
<enum>(i)</enum>
<text>Multiple chronic conditions that the Secretary identifies as likely to result in high expenditures under this title. In identifying such conditions, the Secretary may consider—</text>
<subclause indent="clause" id="PD7CF1B9C699249578980488143119022">
<enum>(I)</enum>
<text>the hierarchal condition category methodology employed for risk adjustment under part C or other comparable methodologies the Secretary deems appropriate;</text>
</subclause>
<subclause indent="clause" id="P23E81666F6F349589407AD461FD25931">
<enum>(II)</enum>
<text>data from the Chronic Condition Data Warehouse under section 723 of the <act-ref scope="public" congress="108" type="law" number="173" session="1">Medicare Prescription Drug, Improvement, and Modernization Act of 2003</act-ref>; and</text>
</subclause>
<subclause indent="clause" id="P2D57FAC9A2A9446B954682843D778789">
<enum>(III)</enum>
<text>indicators of geriatric syndromes, such as experiencing 2 or more falls in the past year, urinary incontinence, clinically significant depression, or other such indicators that the Secretary indicates as likely to result in high expenditures under this title when they exist in combination with one or more chronic conditions).</text>
</subclause>
</clause>
<clause indent="subparagraph" id="P8BCF06A98763425FA111B5F5FEAEA720">
<enum>(ii)</enum>
<text>Dementia, as defined in the most recent Diagnostic and Statistical Manual of Mental Disorders, and at least 1 other chronic condition.</text>
</clause>
<clause indent="subparagraph" id="P5F977B0C28F54F03BC95310B09B4E4F4">
<enum>(iii)</enum>
<text>Any other factor identified by the Secretary.</text>
</clause>
</subparagraph>
<subparagraph indent="paragraph" id="PDC1902E82FF94F11929D72F224271EFF">
<enum>(B)</enum>
<text>The Secretary shall consult with physicians, physician groups and organizations, other health care professional groups and organizations, organizations representing individuals with chronic conditions and older adults, and other stakeholders in identifying conditions under clauses (i) and (ii) of subparagraph (A) and any factors under subparagraph (A)(iii).</text>
</subparagraph>
</paragraph>
<paragraph indent="subsection" id="P921927CA05954AD9AAAED144A3A00F13">
<enum>(3)</enum>
<text>The term <quote>geriatric assessment eligible individual</quote> shall not include the following individuals:</text>
<subparagraph indent="paragraph" id="PACFB99DC81AC4B48A825BDABA72CB044">
<enum>(A)</enum>
<text>An individual who is receiving hospice care under this title.</text>
</subparagraph>
<subparagraph indent="paragraph" id="PD3BA28B658DE416886D0FDFD0507A869">
<enum>(B)</enum>
<text>An individual who is residing in a skilled nursing facility, a nursing facility (as defined in section 1919), or any other facility identified by the Secretary.</text>
</subparagraph>
<subparagraph indent="paragraph" id="P0A3121B9DDB34AD29ABD8AC642CE6632">
<enum>(C)</enum>
<text>An individual medically determined to have end-stage renal disease.</text>
</subparagraph>
<subparagraph indent="paragraph" id="P818809BC0D984A4ABD0DAC0206CCDD6A">
<enum>(D)</enum>
<text>An individual enrolled in a Medicare Advantage plan or a plan under section 1876.</text>
</subparagraph>
<subparagraph indent="paragraph" id="PBD70B47DBFF548AA89C2225175408242">
<enum>(E)</enum>
<text>An individual enrolled in a PACE program under section 1894.</text>
</subparagraph>
<subparagraph indent="paragraph" id="PF1ACA764C8B444AA97357B56BCDB8C47">
<enum>(F)</enum>
<text>Any other categories of individuals determined appropriate by the Secretary.</text>
</subparagraph>
</paragraph>
<paragraph indent="subsection" id="P524F2CA58E66466E83A5D4D1DD279990">
<enum>(4)</enum>
<text>For purposes of this subsection, the term <quote>chronic condition</quote> means a condition, such as dementia, that lasts or is expected to last 1 year or longer, limits what an individual can do, and requires ongoing care.</text>
</paragraph>
<after-quoted-block>.</after-quoted-block>
</quoted-block>
</subsection>
<subsection id="PC6653C049DF14A1E881476197806E620">
<enum>(c)</enum>
<header>Payment and Elimination of Cost-Sharing</header>
<paragraph id="P88A319F32EE14753892D0418AB177D86">
<enum>(1)</enum>
<header>Payment and elimination of coinsurance</header>
<text>Section 1833(a)(1) of the <act-ref scope="public" congress="74" type="chapter" number="531" session="1">Social Security Act</act-ref> (<usc-ref title="42" section="1395l" provision="(a)(1)">42 U.S.C. 1395l(a)(1)</usc-ref>) is amended—</text>
<subparagraph id="PC64BE741DDD048059FC02A177BF3E380">
<enum>(A)</enum>
<text>in subparagraph (N), by inserting <quote>other than geriatric assessments (as defined in section 1861(hhh)(1))</quote> after <quote>(as defined in section 1848(j)(3))</quote>;</text>
</subparagraph>
<subparagraph id="PA7607DB5B83D4D4D928DD42612248D72">
<enum>(B)</enum>
<text>by striking <quote>and</quote> before <quote>(W)</quote>; and</text>
</subparagraph>
<subparagraph id="P431B53EBFB41431EA2A2A011BCEE1E80">
<enum>(C)</enum>
<text>by inserting before the semicolon at the end the following: <quote>, and (X) with respect to geriatric assessments (as defined in section 1861(hhh)(1)), the amount paid shall be 100 percent of the lesser of the actual charge for the services or the amount determined under section 1848(o)</quote>.</text>
</subparagraph>
</paragraph>
<paragraph id="PD6D4DB8E18ED4DC197DD2135A0147919">
<enum>(2)</enum>
<header>Payment</header>
<subparagraph id="P95CAEC1182374882B1A29F83963A46AB">
<enum>(A)</enum>
<header>In general</header>
<text>Section 1848 of the <act-ref scope="public" congress="74" type="chapter" number="531" session="1">Social Security Act</act-ref> (<usc-ref title="42" section="1395w-4">42 U.S.C. 1395w-4</usc-ref>) is amended by adding at the end the following new subsection:</text>
<quoted-block id="P5ADB70A9706B4E3293F4A3ABFCB96882">
<subsection id="PA7C4CAA47C0041EAACCC815CA7BE7803">
<enum>(p)</enum>
<header>Payment for Geriatric Assessments</header>
<paragraph id="P3A6076558CAE4488B058B24F263D0119">
<enum>(1)</enum>
<header>Establishment</header>
<subparagraph id="P9B36F541A4AA418D957F3E204DC2C07E">
<enum>(A)</enum>
<header>In general</header>
<text>The Secretary shall establish—</text>
<clause id="PFD88BA3D93EC4CD9AC5A5FFCCCFD409A">
<enum>(i)</enum>
<text>a payment code (or codes) under this section for a geriatric assessment (as defined in section 1861(hhh)(1)) furnished to a geriatric assessment eligible individual (as defined in section 1861(iii)) by a physician, practitioner, or other provider described in section 1861(hhh)(2); and</text>
</clause>
<clause id="P0FB80B42BB954A4AB24357A2B24E2227">
<enum>(ii)</enum>
<text>a payment amount for each such code.</text>
</clause>
</subparagraph>
<subparagraph id="P7476884E27D44826860AC61828C7BCDB">
<enum>(B)</enum>
<header>Requirements</header>
<text>In establishing payment amounts under subparagraph (A)(ii), the Secretary shall—</text>
<clause id="P059D0C5D811E461A87A0A71C11BE3016">
<enum>(i)</enum>
<text>take into account—</text>
<subclause id="P1074F59E9A13440285D90640D0CF68B4">
<enum>(I)</enum>
<text>the amount of work required to perform a geriatric assessment, including the time and effort put forth by each qualified health care professional involved in performing the geriatric assessment; and</text>
</subclause>
<subclause id="PAAE02A8AAC9F4AFDAB436AB032D37811">
<enum>(II)</enum>
<text>all of the costs associated with the geriatric assessment, including labor, supplies, equipment, and the costs of health information technologies and systems incurred by the physician, practitioner, or other provider (as described in section 1861(hhh)(2)) in providing the assessment; and</text>
</subclause>
</clause>
<clause id="P42209A567BDB4240B5F35A5B2EB6E087">
<enum>(ii)</enum>
<text>ensure that such payments do not result in a reduction in payments for office visits or other evaluation and management services that would otherwise be allowable.</text>
</clause>
</subparagraph>
</paragraph>
<paragraph id="P5EFC8289AA854ECDB49AA7B35FBBEEE8">
<enum>(2)</enum>
<header>Separate payments from payments for chronic care management and coordination services</header>
<text>Payments for geriatric assessments shall be made separately from payments for chronic care management and coordination services (as defined in section 1861(jjj)(1)) and other services for which payment is made under this title.</text>
</paragraph>
</subsection>
<after-quoted-block>.</after-quoted-block>
</quoted-block>
</subparagraph>
<subparagraph id="PBD968D244869497B9033B971753AAE18">
<enum>(B)</enum>
<header>Conforming amendment</header>
<text>Section 1848(j)(3) of the <act-ref scope="public" congress="74" type="chapter" number="531" session="1">Social Security Act</act-ref> (<usc-ref title="42" section="1395w-4" provision="(j)(3)">42 U.S.C. 1395w-4(j)(3)</usc-ref>), as amended by section 111(c)(2)), is amended by inserting <quote>(2)(FF),</quote> after <quote>(2)(EE),</quote>.</text>
</subparagraph>
</paragraph>
<paragraph id="P7E9FFAA4FB49432780A8E329EDC0A51A">
<enum>(3)</enum>
<header>Elimination of coinsurance in outpatient hospital settings</header>
<subparagraph id="PE305E525F9C84AF0B100BF9E2345E0D9">
<enum>(A)</enum>
<header>Exclusion from opd fee schedule</header>
<text>Section 1833(t)(1)(B)(iv) of the <act-ref scope="public" congress="74" type="chapter" number="531" session="1">Social Security Act</act-ref> (<usc-ref title="42" section="1395l" provision="(t)(1)(B)(iv)">42 U.S.C. 1395l(t)(1)(B)(iv)</usc-ref>) is amended by striking <quote>and diagnostic mammography</quote> and inserting <quote>, diagnostic mammography, or geriatric assessments (as defined in section 1861(hhh)(1))</quote>.</text>
</subparagraph>
<subparagraph id="PA0E8210FE376426DABDBF673C3C25AD1">
<enum>(B)</enum>
<header>Conforming amendments</header>
<text>Section 1833(a)(2) of the <act-ref scope="public" congress="74" type="chapter" number="531" session="1">Social Security Act</act-ref> (<usc-ref title="42" section="1395l" provision="(a)(2)">42 U.S.C. 1395l(a)(2)</usc-ref>) is amended—</text>
<clause id="P20CA1C7E4D9F4CC0AE871E8277E7B4A6">
<enum>(i)</enum>
<text>in subparagraph (F), by striking <quote>and</quote> at the end;</text>
</clause>
<clause id="PEEB432B73E7A458782B342613421B5D5">
<enum>(ii)</enum>
<text>in subparagraph (G)(ii), by striking the comma at the end and inserting <quote>; and</quote>; and</text>
</clause>
<clause id="PCBBA9B9B2975484688E726A38F6AE861">
<enum>(iii)</enum>
<text>by inserting after subparagraph (G)(ii) the following new subparagraph:</text>
<quoted-block id="P2A81F2AEDFF84470B8508CEDD9AA280F">
<subparagraph id="P223DFAD2169346218CA40B26FF2354E2">
<enum>(H)</enum>
<text>with respect to geriatric assessments (as defined in section 1861(hhh)(1)) furnished by an outpatient department of a hospital, the amount determined under paragraph (1)(X),</text>
</subparagraph>
<after-quoted-block>.</after-quoted-block>
</quoted-block>
</clause>
</subparagraph>
</paragraph>
<paragraph id="P79471DF4A1324507A0EE66127D92D78E">
<enum>(4)</enum>
<header>Elimination of deductible</header>
<text>The first sentence of section 1833(b) of the <act-ref scope="public" congress="74" type="chapter" number="531" session="1">Social Security Act</act-ref> (<usc-ref title="42" section="1395l" provision="(b)">42 U.S.C. 1395l(b)</usc-ref>) is amended—</text>
<subparagraph id="PB6AA013B8C6F441B8427670C3CE97DB4">
<enum>(A)</enum>
<text>by striking <quote>and</quote> before <quote>(9)</quote>; and</text>
</subparagraph>
<subparagraph id="PD95071CBE79F467BA2BCA2EEFD3E9E16">
<enum>(B)</enum>
<text>by inserting before the period the following: <quote>, and (10) such deductible shall not apply with respect to geriatric assessments (as defined in section 1861(hhh)(1))</quote>.</text>
</subparagraph>
</paragraph>
</subsection>
<subsection id="P0D1468734DEA4F1DBD00150E374F668C">
<enum>(d)</enum>
<header>Frequency Limitation</header>
<text>Section 1862(a) of the <act-ref scope="public" congress="74" type="chapter" number="531" session="1">Social Security Act</act-ref> (<usc-ref title="42" section="1395y" provision="(a)(1)">42 U.S.C. 1395y(a)(1)</usc-ref>) is amended—</text>
<paragraph id="PC516E5A9D33840B6B3EFA90C0A8684F8">
<enum>(1)</enum>
<text>in paragraph (1)—</text>
<subparagraph id="PFF478B965CF646E380151E7F1B840665">
<enum>(A)</enum>
<text>in subparagraph (N), by striking <quote>and</quote> at the end;</text>
</subparagraph>
<subparagraph id="P59CFCB362B8A4D13AF062F88255CD1AB">
<enum>(B)</enum>
<text>in subparagraph (O) by striking the semicolon at the end and inserting <quote>, and</quote>; and</text>
</subparagraph>
<subparagraph id="PA53B20D054F048B891A693412B4F66DB">
<enum>(C)</enum>
<text>by adding at the end the following new subparagraph:</text>
<quoted-block id="P992EE3BDF3FF441E883C960E4365450E">
<subparagraph indent="paragraph" id="PDD8E5FC284DA4976AE580BDF0C650D5D">
<enum>(P)</enum>
<text>in the case of geriatric assessments (as defined in section 1861(hhh)(1)), which are performed more frequently than is covered under such section;</text>
</subparagraph>
<after-quoted-block>; and</after-quoted-block>
</quoted-block>
</subparagraph>
</paragraph>
<paragraph id="PB39C0DE3807F40319D7B6E59FB68ED27">
<enum>(2)</enum>
<text>in paragraph (7), by striking <quote>or (K)</quote> and inserting <quote>(K), or (P)</quote>.</text>
</paragraph>
</subsection>
<subsection id="P8CD18316717149A9BC5C9E9419520A60">
<enum>(e)</enum>
<header>Exception to Limits on Physician Referrals</header>
<text>Section 1877(b) of the <act-ref scope="public" congress="74" type="chapter" number="531" session="1">Social Security Act</act-ref> (<usc-ref title="42" section="1395nn" provision="(b)">42 U.S.C. 1395nn(b)</usc-ref>) is amended by adding at the end the following new paragraph:</text>
<quoted-block id="PFDD128529BA64DB9B7A7D070DCCCF4D8">
<paragraph id="PCC0DCF99ED6D4963BD02E636F72777E4">
<enum>(6)</enum>
<header>Geriatric assessments</header>
<text>In the case of a designated health service, if the designated health service is a geriatric assessment (as defined in section 1861(hhh)(1)) and furnished by a physician.</text>
</paragraph>
<after-quoted-block>.</after-quoted-block>
</quoted-block>
</subsection>
<subsection id="P271DF9D659924F689F3AE4E0374D6595">
<enum>(f)</enum>
<header>Rulemaking</header>
<text>The Secretary of Health and Human Services shall define such terms, establish such procedures, and promulgate such regulations as the Secretary determines necessary to implement the amendments made by, and the provisions of, this section, including the establishment of additional domains under subsection (hhh)(1)(A)(iv) of section 1861 of the <act-ref scope="public" congress="74" type="chapter" number="531" session="1">Social Security Act</act-ref>, as added by subsection (b). In promulgating such regulations, the Secretary shall consult with physicians, physician groups and organizations, other health care professional groups and organizations representing individuals with chronic conditions and older adults.</text>
</subsection>
<subsection id="PC9A08EB1E6054B9C885A0A01CD5A0189">
<enum>(g)</enum>
<header>Effective Date</header>
<text>The amendments made by this section shall apply to assessments furnished on or after January 1, 2010.</text>
</subsection>
</section>
<section id="PE62E96E4B1E44958A104FE8F7B3EB40D">
<enum>112.</enum>
<header>MEDICARE COVERAGE OF CHRONIC CARE MANAGEMENT AND COORDINATION SERVICES</header>
<subsection id="P40AF99D958984A98B38A06ED644A5028">
<enum>(a)</enum>
<header>Part <enum-in-header>B</enum-in-header> Coverage of Chronic Care Management and Coordination Services</header>
<paragraph id="P443E5D0EDEF142B5B2B2AB6EF5592081">
<enum>(1)</enum>
<header>In general</header>
<text>Section 1861(s)(2) of the <act-ref scope="public" congress="74" type="chapter" number="531" session="1">Social Security Act</act-ref> (<usc-ref title="42" section="1395x" provision="(s)(2)">42 U.S.C. 1395x(s)(2)</usc-ref>), as amended by section 111(a)(1), is amended—</text>
<subparagraph id="PDF75E7FFBF6A4A27B71AF1344DBDF2BA">
<enum>(A)</enum>
<text>in subparagraph (EE), by striking <quote>and</quote> at the end;</text>
</subparagraph>
<subparagraph id="P26FA18B33AF34662BDA690E73D354AF5">
<enum>(B)</enum>
<text>in subparagraph (FF), by adding <quote>and</quote> at the end; and</text>
</subparagraph>
<subparagraph id="PC333A8A03E064119AFF48601AD456E60">
<enum>(C)</enum>
<text>by adding at the end the following new subparagraph:</text>
<quoted-block id="PC8F68EF02E834361BA4C6031BB551936">
<subitem indent="paragraph" id="PA788A96B06A14030BA1641FE6C0827CE">
<enum>(GG)</enum>
<text>chronic care management and coordination services (as defined in subsection (jjj));</text>
</subitem>
<after-quoted-block>.</after-quoted-block>
</quoted-block>
</subparagraph>
</paragraph>
<paragraph id="PC03D2199C0D744CC80BE549F464AA993">
<enum>(2)</enum>
<header>Conforming amendments</header>
<subparagraph display-inline="yes-display-inline" id="P94A4122AA8B24CFBA15E14155BD8013E">
<enum>(A)</enum>
<text>Clauses (i) and (ii) of section 1861(s)(2)(K) of the <act-ref scope="public" congress="74" type="chapter" number="531" session="1">Social Security Act</act-ref> (<usc-ref title="42" section="1395x" provision="(s)(2)(K)">42 U.S.C. 1395x(s)(2)(K)</usc-ref>), as amended by section 111(a)(2), are each amended by striking <quote>subsections (ww)(1) and (hhh)(1)</quote> and inserting <quote>subsections (ww)(1), (hhh)(1), and (jjj)(1)</quote>.</text>
</subparagraph>
<subparagraph indent="paragraph" id="P5ADFF1D6D407409C80EE7A1118CC6EC4">
<enum>(B)</enum>
<text>Section 1862(a)(7) of the <act-ref scope="public" congress="74" type="chapter" number="531" session="1">Social Security Act</act-ref> (<usc-ref title="42" section="1395y" provision="(a)(7)">42 U.S.C. 1395y(a)(7)</usc-ref>), as amended by section 111(d), is amended by striking <quote>section 1861(s)(10)</quote> and inserting <quote>paragraphs (2)(GG) and (10) of section 1861(s)</quote>.</text>
</subparagraph>
</paragraph>
</subsection>
<subsection id="P937608BD25054E7D8EA81341DDE0C847">
<enum>(b)</enum>
<header>Services Described</header>
<text>Section 1861 of the <act-ref scope="public" congress="74" type="chapter" number="531" session="1">Social Security Act</act-ref> (<usc-ref title="42" section="1395x">42 U.S.C. 1395x</usc-ref>), as amended by section 111(b), is amended by adding at the end the following new subsection:</text>
<quoted-block style="traditional" id="PEB45DA0CD214415CAA093CD0E7CC8DC3">
<subsection id="PE3BFB06733B740749BBCF8F8F5DD52E5">
<enum>(jjj)</enum>
<header>Chronic Care Management and Coordination Services; Chronic Care Manager; Chronic Care Eligible Individual</header>
<paragraph display-inline="yes-display-inline" id="P7248AED28FBE46C09871CE5998AAFE6B">
<enum>(1)</enum>
<text>The term <quote>chronic care management and coordination services</quote> means services that are furnished to a chronic care eligible individual (as defined in paragraph (3)) by, or under the supervision of, a single chronic care manager (as defined in paragraph (2)) chosen by the chronic care eligible individual, a caregiver designated by the individual in writing, or a representative authorized to make decisions on the individual’s behalf, under a plan of care prescribed by such chronic care manager for the purpose of chronic care coordination, including dementia as appropriate, which may include any of the following services:</text>
<subparagraph indent="paragraph" id="P2CF7520EEF63475CB49CE2A274B6A623">
<enum>(A)</enum>
<text>The development of an initial plan of care (based on the results of a geriatric assessment, as defined in subsection (hhh)), and subsequent appropriate revisions to that plan of care.</text>
</subparagraph>
<subparagraph indent="paragraph" id="P3AD34AA3965F493DAE80DDEECE406940">
<enum>(B)</enum>
<text>The management of, and referral for, medical and other health services, including interdisciplinary care conferences and management with other providers.</text>
</subparagraph>
<subparagraph indent="paragraph" id="P4C8EAA43BC3D4823A45451E2BFB676C4">
<enum>(C)</enum>
<text>The monitoring and management of medications.</text>
</subparagraph>
<subparagraph indent="paragraph" id="PD103D93AA0014C89BD264C17F5849445">
<enum>(D)</enum>
<text>Patient education and counseling services.</text>
</subparagraph>
<subparagraph indent="paragraph" id="P1CEB9F3ED51744A3B6B84AAFD753DB10">
<enum>(E)</enum>
<text>Family caregiver education and counseling services, including preventive care consistent with the patient’s condition.</text>
</subparagraph>
<subparagraph indent="paragraph" id="P26676BB1CAD54E9DA15509BBDCD6947F">
<enum>(F)</enum>
<text>Self-management services, including health education and risk appraisal to identify behavioral risk factors through self-assessment.</text>
</subparagraph>
<subparagraph indent="paragraph" id="P4C1B2C77C2AE42E298FC73BC02933214">
<enum>(G)</enum>
<text>Providing access for individuals, and caregivers or authorized representatives as appropriate, by telephone and e-mail to physicians or other appropriate health care professionals, including 24-hour availability of such professionals for after hours consultation.</text>
</subparagraph>
<subparagraph indent="paragraph" id="P45F24E51B79D4554834B418DEA7D44DF">
<enum>(H)</enum>
<text>Coordination with the principal nonprofessional caregiver in the home.</text>
</subparagraph>
<subparagraph indent="paragraph" id="P72A6774DC58B45B6A02018871C736FD9">
<enum>(I)</enum>
<text>Managing and facilitating transitions that occur among health care professionals and across settings of care, including the following:</text>
<clause indent="subparagraph" id="P4252E6D95B3541938A5515C422116122">
<enum>(i)</enum>
<text>Pursuing the treatment option elected by the individual.</text>
</clause>
<clause indent="subparagraph" id="PE3D710C5648842208F77A66B040E0C04">
<enum>(ii)</enum>
<text>Including any advance directive executed by the individual in the medical file of the individual.</text>
</clause>
</subparagraph>
<subparagraph indent="paragraph" id="P958988F21773450C969AA019D9E9729A">
<enum>(J)</enum>
<text>Information about pain management and palliative care.</text>
</subparagraph>
<subparagraph indent="paragraph" id="PEA395AD834BA4A5D8398A629D9BC69A3">
<enum>(K)</enum>
<text>Information about, and referral to, hospice care, including patient and family caregiver education and counseling about hospice care, and facilitating transition to hospice care when elected.</text>
</subparagraph>
<subparagraph indent="paragraph" id="P1F97F93810D841409A94BF19890E386B">
<enum>(L)</enum>
<text>Information about, referral to, and coordination with, community resources.</text>
</subparagraph>
<subparagraph indent="paragraph" id="PDC9EB3B210AE438A8DB6ECCD9E6DB9EE">
<enum>(M)</enum>
<text>Such additional services for which payment would not otherwise be made under this title that the Secretary may specify that encourage the receipt of, or improve the effectiveness of, the services described in the preceding subparagraphs.</text>
</subparagraph>
</paragraph>
<paragraph indent="subsection" id="PC2667C5847954D329B015A1333A171AC">
<enum>(2)</enum>
<subparagraph display-inline="yes-display-inline" id="PB82D6A25D76648FAA6C321299308A299">
<enum>(A)</enum>
<text>For purposes of this subsection, the term <quote>chronic care manager</quote> means an individual or entity that—</text>
<clause indent="paragraph" id="P73E7F5E9C4DB473FA36616D4FCD69ABB">
<enum>(i)</enum>
<text>is—</text>
<subclause indent="subparagraph" id="P71C720AEA01C45FBBC3748E6C1105756">
<enum>(I)</enum>
<text>a physician;</text>
</subclause>
<subclause indent="subparagraph" id="P7CBD0F3A4E2A4D0086F03857A8C1A237">
<enum>(II)</enum>
<text>a practitioner described in clause (i) or (iv) of section 1842(b)(18)(C); or</text>
</subclause>
<subclause indent="subparagraph" id="P5E4520C395A04B1290572172D98615E1">
<enum>(III)</enum>
<text>any other provider that meets such conditions as the Secretary may specify;</text>
</subclause>
</clause>
<clause indent="paragraph" id="P32DC2FED2A694AE1A106F2000CE6AD6E">
<enum>(ii)</enum>
<text>has entered into a chronic care management and coordination agreement with the Secretary; and</text>
</clause>
<clause indent="paragraph" id="P67B8BCFF37DB4F8CB6F3F76D3D5CA1FA">
<enum>(iii)</enum>
<text>is working in collaboration with, or under the supervision of, as determined by the Secretary—</text>
<subclause indent="subparagraph" id="P421F4278E9174686AC7548B63AC0C249">
<enum>(I)</enum>
<text>the physician, practitioner, or other provider who completed the geriatric assessment of the individual; or</text>
</subclause>
<subclause indent="subparagraph" id="P32164CB60AFC4BD8A1BF862C6F484E60">
<enum>(II)</enum>
<text>a physician, practitioner, or other provider to whom the individual’s care was transferred by the physician, practitioner, or other provider who performed the geriatric assessment.</text>
</subclause>
</clause>
</subparagraph>
<subparagraph indent="subsection" id="P70FED501F87A41018408FB4F9B85D206">
<enum>(B)</enum>
<clause display-inline="yes-display-inline" id="P01562F699AB44CEA8E84D3DAC239789C">
<enum>(i)</enum>
<text>For purposes of subparagraph (A)(ii), each chronic care management and coordination agreement shall meet the requirements described in subparagraph (C) and shall—</text>
<subclause indent="paragraph" id="PF8176CE59C774FBAA98483118910A93D">
<enum>(I)</enum>
<text>subject to clause (ii), be entered into for a period of 3 years and may be renewed if the Secretary is satisfied that the chronic care manager continues to meet such terms and conditions as the Secretary may require; and</text>
</subclause>
<subclause indent="paragraph" id="P6E95FF81221946378DC2A5E435B1B3DA">
<enum>(II)</enum>
<text>contain such other terms and conditions as the Secretary may require.</text>
</subclause>
</clause>
<clause indent="subsection" id="P1774E1A4B94D4715B6E284A1B45BAD54">
<enum>(ii)</enum>
<text>Each chronic care management and coordination agreement shall provide for the termination of such agreement prior to such 3-year period in the case where the chronic care manager—</text>
<subclause indent="paragraph" id="P439C6D8824564859A505AD308CD3227F">
<enum>(I)</enum>
<text>is no longer able to provide chronic care services; or</text>
</subclause>
<subclause indent="paragraph" id="P0951DBC2C61F494DBD3E20E4063A57E4">
<enum>(II)</enum>
<text>does not meet such terms and conditions as the Secretary may require.</text>
</subclause>
</clause>
</subparagraph>
<subparagraph indent="subsection" id="PDFE76C21D81D4B7192CF1E73FED342B6">
<enum>(C)</enum>
<clause display-inline="yes-display-inline" id="P34E07E1C779C4CA28C36C92398BB6757">
<enum>(i)</enum>
<text>Subject to clause (ii), the requirements of this subparagraph are met if the agreement requires the chronic care manager to perform, or provide for the performance of, the following services:</text>
<subclause indent="paragraph" id="P2D22CB81DD4443BDA2F89A245FE675E6">
<enum>(I)</enum>
<text>Advocating for, and providing ongoing support, oversight, and guidance with respect to the implementation of a plan of care that provides an integrated, coherent, and cross-disciplined plan for ongoing medical care that is developed in partnership with the chronic care eligible individual and all other physicians and other care providers and agencies (including home health agencies) providing care to the chronic care eligible individual.</text>
</subclause>
<subclause indent="paragraph" id="PE2D42A26E06D424D8F86C0F2D865081F">
<enum>(II)</enum>
<text>Using evidence-based medicine and clinical decision support tools to guide decisionmaking at the point of care and on the basis of specific patient factors.</text>
</subclause>
<subclause indent="paragraph" id="P1154D946D38C4B13B50E5C21E33F8376">
<enum>(III)</enum>
<text>Using health information technology, including, where appropriate, remote monitoring and patient registries, to monitor and track the health status of patients and to provide patients with enhanced and convenient access to health care services.</text>
</subclause>
<subclause indent="paragraph" id="P00FC5D20F89A41EDA94377EEC7C19C9D">
<enum>(IV)</enum>
<text>Encouraging patients to engage in the management of their own health through education and support systems.</text>
</subclause>
<subclause indent="paragraph" id="P05C53B9AF79D452B9A1EA057CD064CF0">
<enum>(V)</enum>
<text>Incorporating family caregivers into the chronic care planning process.</text>
</subclause>
</clause>
<clause indent="subsection" id="PA16CAD6DE0C54C818EFD7268E295980C">
<enum>(ii)</enum>
<text>The Secretary may modify the services required under the agreement under clause (i), including by requiring different services or services in addition to those described in subclauses (I) through (V) of such clause.</text>
</clause>
</subparagraph>
<subparagraph indent="subsection" id="PECBD40565BBC4B548C64DDCFA2DF2387">
<enum>(D)</enum>
<text>The Secretary shall adopt procedures which exempt providers in rural areas from providing 1 or more of the services otherwise required to be provided under subparagraph (C) or modify such requirements for such providers. In establishing such procedures, the Secretary shall ensure that such exemptions and modifications do not impact the quality of chronic care management and coordination services furnished by such providers.</text>
</subparagraph>
</paragraph>
<paragraph indent="subsection" id="P94E979A50BFA45BE82915A5D5480F9E6">
<enum>(3)</enum>
<text>For purposes of this subsection, the term <quote>chronic care eligible individual</quote> means a geriatric assessment eligible individual (as defined in subsection (iii)) who has undergone a geriatric assessment (as defined in subsection (hhh)(1)) which determined that the individual would benefit from chronic care management and coordination.</text>
</paragraph>
<paragraph indent="subsection" id="P0CC1B73427884E798BC263A45604478F">
<enum>(4)</enum>
<text>Chronic care management and coordination services may be furnished in the chronic care eligible individual’s home or residence.</text>
</paragraph>
</subsection>
<after-quoted-block>.</after-quoted-block>
</quoted-block>
</subsection>
<subsection id="P309EEB0AEA494898B062980374012979">
<enum>(c)</enum>
<header>Payment and Elimination of Cost-Sharing</header>
<paragraph id="P0B1DDC13DD184B9084EA884D845826AD">
<enum>(1)</enum>
<header>Payment and elimination of coinsurance</header>
<text>Section 1833(a)(1) of the <act-ref scope="public" congress="74" type="chapter" number="531" session="1">Social Security Act</act-ref> (<usc-ref title="42" section="1395l" provision="(a)(1)">42 U.S.C. 1395l(a)(1)</usc-ref>), as amended by section 111(c)(1), is amended—</text>
<subparagraph id="P4F052565E19E456C9E9BF9E2CE0934C5">
<enum>(A)</enum>
<text>in subparagraph (N), by inserting <quote>or chronic care management and coordination services (as defined in section 1861(jjj)(1))</quote> after <quote>other than geriatric assessments (as defined in section 1861(hhh)(1))</quote>;</text>
</subparagraph>
<subparagraph id="P68E86159C6DF4F8C8DC0A9E74A4238DE">
<enum>(B)</enum>
<text>by striking <quote>and</quote> before <quote>(X)</quote>; and</text>
</subparagraph>
<subparagraph id="PD1A1EC202450453BAED498BD5B04BB10">
<enum>(C)</enum>
<text>by inserting before the semicolon at the end the following: <quote>, and (Y) with respect to chronic care management and coordination services (as defined in section 1861(jjj)(1)), the amount paid shall be 100 percent of the lesser of the actual charge for the services or the amount determined under section 1848(p)</quote>.</text>
</subparagraph>
</paragraph>
<paragraph id="PB727C1F278574DF1A19124B7F0EFD1F6">
<enum>(2)</enum>
<header>Payment</header>
<subparagraph id="PEBE63DE1C4EF4343A080DA17572B098A">
<enum>(A)</enum>
<header>In general</header>
<text>Section 1848 of the <act-ref scope="public" congress="74" type="chapter" number="531" session="1">Social Security Act</act-ref> (<usc-ref title="42" section="1395w-4">42 U.S.C. 1395w-4</usc-ref>), as amended by section 111(c)(2), is amended by adding at the end the following new subsection:</text>
<quoted-block id="P32CD84AEB6A84BAD9B543FEF6DBBF45D">
<subsection id="PFBCA5CE544314E6EB15205874705264D">
<enum>(q)</enum>
<header>Payment for Chronic Care Management and Coordination Services</header>
<paragraph id="P3DFCBE8D0493486FB18AB0CD70CFD998">
<enum>(1)</enum>
<header>Establishment</header>
<subparagraph id="P4C8A90DA7EAC459EAD5D9907D32AA587">
<enum>(A)</enum>
<header>In general</header>
<text>The Secretary shall establish—</text>
<clause id="PBED6004008C24219A055E2BDBAB025A3">
<enum>(i)</enum>
<text>a payment code (or codes) under this section for chronic care management and coordination services (as defined in paragraph (1) of section 1861(jjj)) furnished to a chronic care eligible individual (as defined in paragraph (3) of such section) by a chronic care manager (as defined in paragraph (2) of such section); and</text>
</clause>
<clause id="P123064228E2940148A3DB96AE0B00D0F">
<enum>(ii)</enum>
<text>a payment amount for each such code.</text>
</clause>
</subparagraph>
<subparagraph id="PC4E40DA652C54558B6B73FBA210250B2">
<enum>(B)</enum>
<header>Requirements</header>
<text>In establishing payment amounts under subparagraph (A)(ii), the Secretary shall—</text>
<clause id="P53E38EE0B3B64D2FB93E60F853400E47">
<enum>(i)</enum>
<text>take into account—</text>
<subclause id="P99BE445F24C34982B00F4448A893EA28">
<enum>(I)</enum>
<text>the amount of work required of the chronic care manager in providing chronic care management and coordination services to eligible individuals; and</text>
</subclause>
<subclause id="P6A8C79E519F644699FE916BB07D6A056">
<enum>(II)</enum>
<text>all of the costs associated with providing chronic care management and coordination services, including labor, supplies, equipment, and the costs of health information technologies and systems incurred by the chronic care manager in providing such services;</text>
</subclause>
</clause>
<clause id="PC61FCE6B2B9242F489596C2901F55CDA">
<enum>(ii)</enum>
<text>ensure that such payments are for such services furnished during a 30-day period; and</text>
</clause>
<clause id="PBFBCECEE31F94EB0BC400A7D39D53CF4">
<enum>(iii)</enum>
<text>ensure that such payments do not result in a reduction in payments for office visits or other evaluation and management services that would otherwise be allowable.</text>
</clause>
</subparagraph>
</paragraph>
<paragraph id="P9A21D4BBC0B348B680D4F3E238283035">
<enum>(2)</enum>
<header>Separate payments from payments for geriatric assessments</header>
<text>Payments for chronic care management and coordination services shall be made separately from payments for geriatric assessments (as defined in section 1861(hhh)(1)) and other services for which payment is made under this title.</text>
</paragraph>
</subsection>
<after-quoted-block>.</after-quoted-block>
</quoted-block>
</subparagraph>
<subparagraph id="P60DE1790AEF54BCDB53DCD09ECBEF03E">
<enum>(B)</enum>
<header>Conforming amendment</header>
<text>Section 1848(j)(3) of the <act-ref scope="public" congress="74" type="chapter" number="531" session="1">Social Security Act</act-ref> (<usc-ref title="42" section="1395w-4" provision="(j)(3)">42 U.S.C. 1395w-4(j)(3)</usc-ref>), as amended by section 111(c)(2)), is amended by inserting <quote>(2)(GG),</quote> after <quote>(2)(FF),</quote>.</text>
</subparagraph>
</paragraph>
<paragraph id="P3BE9D02EE30A4CC5B5FE6CB8D18B3079">
<enum>(3)</enum>
<header>Elimination of coinsurance in outpatient hospital settings</header>
<subparagraph id="P496768BED05E4943AF6A86BB70068BBF">
<enum>(A)</enum>
<header>Exclusion from opd fee schedule</header>
<text>Section 1833(t)(1)(B)(iv) of the <act-ref scope="public" congress="74" type="chapter" number="531" session="1">Social Security Act</act-ref> (<usc-ref title="42" section="1395l" provision="(t)(1)(B)(iv)">42 U.S.C. 1395l(t)(1)(B)(iv)</usc-ref>), as amended by section 111(c)(3)(A), is amended by striking <quote>or geriatric assessments (as defined in section 1861(hhh)(1))</quote> and inserting <quote>geriatric assessments (as defined in section 1861(hhh)(1)), or chronic care management and coordination services (as defined in section 1861(jjj)(1))</quote>.</text>
</subparagraph>
<subparagraph id="P988AC9EAB55F49B7859F2D516C3A39C9">
<enum>(B)</enum>
<header>Conforming amendments</header>
<text>Section 1833(a)(2) of the <act-ref scope="public" congress="74" type="chapter" number="531" session="1">Social Security Act</act-ref> (<usc-ref title="42" section="1395l" provision="(a)(2)">42 U.S.C. 1395l(a)(2)</usc-ref>), as amended by section 111(c)(3)(B), is amended—</text>
<clause id="PBF7F01D895B64FCA927B890A437A34E3">
<enum>(i)</enum>
<text>in subparagraph (G)(ii), by striking <quote>and</quote> at the end;</text>
</clause>
<clause id="PDACD8D3D88EC4EF0A6A7F6C91273FC63">
<enum>(ii)</enum>
<text>in subparagraph (H), by striking the comma at the end and inserting <quote>; and</quote>; and</text>
</clause>
<clause id="P2532A6185C5447228BDF536A7908981F">
<enum>(iii)</enum>
<text>by inserting after subparagraph (H) the following new subparagraph:</text>
<quoted-block id="P1E90E5BA757E412F8EE843B54AB70EF7">
<subparagraph id="PAF5CC35BA1A3437D8CDF3A109A7100B3">
<enum>(I)</enum>
<text>with respect to chronic care management and coordination services (as defined in section 1861(jjj)(1)) furnished by an outpatient department of a hospital, the amount determined under paragraph (1)(Y),</text>
</subparagraph>
<after-quoted-block>.</after-quoted-block>
</quoted-block>
</clause>
</subparagraph>
</paragraph>
<paragraph id="P7F8BD65D136A49FEB04C12B5ED05B6A4">
<enum>(4)</enum>
<header>Elimination of deductible</header>
<text>Paragraph (10) of section 1833(b) of the <act-ref scope="public" congress="74" type="chapter" number="531" session="1">Social Security Act</act-ref> (<usc-ref title="42" section="1395l" provision="(b)">42 U.S.C. 1395l(b)</usc-ref>), as added by section 111(c)(4), is amended by inserting <quote>or chronic care management and coordination services (as defined in section 1861(jjj)(1))</quote> after <quote>geriatric assessments (as defined in section 1861(hhh)(1))</quote>.</text>
</paragraph>
</subsection>
<subsection id="PF429F9374FAE47C093239F2C34AB53CC">
<enum>(d)</enum>
<header>Exception to Limits on Physician Referrals</header>
<text>Section 1877(b)(6) of the <act-ref scope="public" congress="74" type="chapter" number="531" session="1">Social Security Act</act-ref> (<usc-ref title="42" section="1395nn" provision="(b)(6)">42 U.S.C. 1395nn(b)(6)</usc-ref>), as amended by section 111(e), is amended to read as follows:</text>
<quoted-block id="PFA4DF576DD38447A9CB99718A16717AC">
<paragraph id="P0CE08CF1DE2B4E5E912906AFCDB822E3">
<enum>(6)</enum>
<header>Geriatric assessments and chronic care management and coordination services</header>
<text>In the case of a designated health service, if the designated health service is—</text>
<subparagraph id="PB375FCB308CA465CB207489D87045AF3">
<enum>(A)</enum>
<text>a geriatric assessment or a chronic care management and coordination service (as defined in subsections (hhh)(1) or (jjj)(1) of section 1861, respectively); and</text>
</subparagraph>
<subparagraph id="P453F1B64D62F48298F8AB693AE1179FD">
<enum>(B)</enum>
<text>furnished by a physician.</text>
</subparagraph>
</paragraph>
<after-quoted-block>.</after-quoted-block>
</quoted-block>
</subsection>
<subsection id="PECB8AFCDB1954FD7AD266E24B5D2157C">
<enum>(e)</enum>
<header>Rulemaking</header>
<text>The Secretary of Health and Human Services shall define such terms, establish such procedures, and promulgate such regulations as the Secretary determines necessary to implement the amendments made by, and the provisions of, this section. In promulgating such regulations, the Secretary shall consult with physicians, physician groups and organizations, other health care professional groups and organizations, and organizations representing individuals with chronic conditions and older adults.</text>
</subsection>
<subsection id="PA6761E7CC7684A50866A06681FC98517">
<enum>(f)</enum>
<header>Effective Date</header>
<text>The amendments made by this section shall apply to chronic care management and coordination services furnished on or after January 1, 2010.</text>
</subsection>
</section>
<section id="PB2BD3DAB76374726920A056CAA205283">
<enum>113.</enum>
<header>OUTREACH ACTIVITIES REGARDING GERIATRIC ASSESSMENTS AND CHRONIC CARE MANAGEMENT AND COORDINATION SERVICES UNDER THE MEDICARE PROGRAM</header>
<text display-inline="no-display-inline">The Secretary of Health and Human Services shall conduct outreach activities to individuals likely to be eligible to receive coverage of geriatric assessments (as defined in subsection (hhh)(1) of section 1861 of the <act-ref scope="public" congress="74" type="chapter" number="531" session="1">Social Security Act</act-ref>, as added by section 111) under the Medicare program and individuals likely to be eligible to receive coverage of chronic care management and coordination services (as defined in subsection (jjj)(1) of such section 1861, as added by section 112) under the Medicare program, to inform such individuals about the availability of such benefits under the Medicare program.</text>
</section>
<section id="P61F710781096458CA5B80D1915E8BB06">
<enum>114.</enum>
<header>UTILIZATION OF TELEHEALTH SERVICES TO FURNISH GERIATRIC ASSESSMENTS AND CHRONIC CARE MANAGEMENT AND COORDINATION SERVICES UNDER THE MEDICARE PROGRAM</header>
<subsection id="P3480ADBCC12D482DBBF3918550B006F5">
<enum>(a)</enum>
<header>In General</header>
<text>Section 1834(m)(4)(F) of the <act-ref scope="public" congress="74" type="chapter" number="531" session="1">Social Security Act</act-ref> (<usc-ref title="42" section="1395m" provision="(m)(4)(F)">42 U.S.C. 1395m(m)(4)(F)</usc-ref>) is amended by adding at the end the following new clause:</text>
<quoted-block id="PDFC151238C414F4BB923B5CCB7992219">
<clause id="P8A2D92850CDD4B1687F332084526AD4F">
<enum>(iii)</enum>
<header>Geriatric assessments and chronic care management and coordination services</header>
<text>The term <quote>telehealth service</quote> shall also include geriatric assessments (as defined in section 1861(hhh)(1)) and chronic care management and coordination services (as defined in section 1861(jjj)).</text>
</clause>
<after-quoted-block>.</after-quoted-block>
</quoted-block>
</subsection>
<subsection id="P20C2298A655F47CF83DA866D9A2EB429">
<enum>(b)</enum>
<header>Effective Date</header>
<text>The amendments made by this section shall apply to services furnished on or after January 1, 2010.</text>
</subsection>
</section>
<section id="P0E1A4C26601543FDB70AA0DCC38C9D39">
<enum>115.</enum>
<header>STUDY AND REPORT ON GERIATRIC ASSESSMENTS AND CHRONIC CARE MANAGEMENT AND COORDINATION SERVICES UNDER THE MEDICARE PROGRAM</header>
<subsection id="P4C6EF4DBE27B44CA87701BE55D8C80BE">
<enum>(a)</enum>
<header>Study</header>
<text>The Secretary of Health and Human Services shall enter into a contract with an entity to conduct a study on—</text>
<paragraph id="P2A023F32B84346A1B744736A03F3C1C4">
<enum>(1)</enum>
<text>the effectiveness of the coverage of geriatric assessments and chronic care management and coordination services, including an evaluation of the use of interdisciplinary teams in providing such services, under the Medicare program (under the amendments made by sections 3 and 4) on improving the quality of care provided to Medicare beneficiaries with chronic conditions, including dementia; and</text>
</paragraph>
<paragraph id="PA44DDF3FC4C84E258478E5E08FCB25A0">
<enum>(2)</enum>
<text>the impact of such geriatric assessments and care coordination services on reducing expenditures under title XVIII of the <act-ref scope="public" congress="74" type="chapter" number="531" session="1">Social Security Act</act-ref>, including reduced expenditures that may result from—</text>
<subparagraph id="P2724F3E319A941A09DF8C887488E510B">
<enum>(A)</enum>
<text>reducing preventable hospital admissions;</text>
</subparagraph>
<subparagraph id="P4DF5FD267D264F47A18348487926F2AB">
<enum>(B)</enum>
<text>more appropriate use of pharmaceuticals; and</text>
</subparagraph>
<subparagraph id="P2C9F43B9D18648A88F7903F8C9323EA4">
<enum>(C)</enum>
<text>reducing duplicate or unnecessary tests.</text>
</subparagraph>
</paragraph>
</subsection>
<subsection id="P2E75C6D603714A4EB9B6E9FF61672386">
<enum>(b)</enum>
<header>Report</header>
<text>Not later than 3 years after the date of enactment of this Act, the entity conducting the study under subsection (a) shall submit to Congress and the Secretary of Health and Human Services a report on the study, together with recommendations for such legislation or administrative action as such entity determines appropriate.</text>
</subsection>
<subsection id="P680349FA10904C2792FFC72729CCFC72">
<enum>(c)</enum>
<header>Authorization of Appropriations</header>
<text>There are authorized to be appropriated such sums as may be necessary to carry out this section.</text>
</subsection>
</section>
<section id="P750911D1AC394E99BFCB0E3CD1A5BC7A">
<enum>116.</enum>
<header>RULE OF CONSTRUCTION</header>
<text display-inline="no-display-inline">Nothing in the provisions of, or in the amendments made by, this subtitle shall be construed as requiring an individual to receive a geriatric assessment (as defined in section 1861(hhh)(1) of the <act-ref scope="public" congress="74" type="chapter" number="531" session="1">Social Security Act</act-ref>, as added by section 111(b)) or chronic care management and coordination services (as defined in section 1861(jjj)(1) of such Act, as added by section 112(b)).</text>
</section>
</subtitle>
<enum>II</enum>
<header>AMENDMENTS TO THE PUBLIC HEALTH SERVICE ACT</header>
<section id="PB9E7842CD53C4CFEA74D5FD7DA88E7AC">
<enum>201.</enum>
<header>EXPANSION OF NATIONAL HEALTH SERVICE CORPS PROGRAMS</header>
<subsection id="P476C03153A704B3F97664F1B001488B9">
<enum>(a)</enum>
<header>In General</header>
<text>Section 338H of the <act-ref scope="public" congress="78" type="chapter" number="373" session="2">Public Health Service Act</act-ref> (<usc-ref title="42" section="254q">42 U.S.C. 254q</usc-ref>) is amended—</text>
<paragraph id="PA344B59A80C24C38A2B57F0BC4589899">
<enum>(1)</enum>
<text>in subsection (a), by striking paragraphs (1) through (5) and inserting the following:</text>
<quoted-block id="P73998076748A425EB6266671B0018629">
<paragraph id="P02671DAF94754B1ABB3632739EFF159A">
<enum>(1)</enum>
<text>for fiscal year 2009, $165,000,000;</text>
</paragraph>
<paragraph id="P9A8D9BAEFA46460797BF5CD2EE7116AA">
<enum>(2)</enum>
<text>for fiscal year 2010, $198,000,000;</text>
</paragraph>
<paragraph id="P395FCFF816804F11BC3006C35BAAD21C">
<enum>(3)</enum>
<text>for fiscal year 2011, $231,000,000;</text>
</paragraph>
<paragraph id="P250FE00939634C52A8D8A9C37494DE5F">
<enum>(4)</enum>
<text>for fiscal year 2012, $264,000,000;</text>
</paragraph>
<paragraph id="P060C188A37294680B1E85B84FA7A3539">
<enum>(5)</enum>
<text>for fiscal year 2013, $297,000,000; and</text>
</paragraph>
<paragraph id="P8A4816B81FF34A42A9D1226165F0B6E7">
<enum>(6)</enum>
<text>for fiscal year 2014, $330,000,000.</text>
</paragraph>
<after-quoted-block>; and</after-quoted-block>
</quoted-block>
</paragraph>
<paragraph id="P11177060D5404056A5C5A26431B047D4">
<enum>(2)</enum>
<text>by adding at the end the following:</text>
<quoted-block id="P25BA35A81DD242278E1BA27044F7EA65">
<subsection id="P8588E1F59F4E4E2DA87A5136245362D6">
<enum>(d)</enum>
<header>Expansion of Programs</header>
<text>The Secretary shall use amounts appropriated for each of fiscal years 2010 through 2014 under subsection (a), that are in excess of the amount appropriated under such subsection for fiscal year 2009, to address shortages of health professionals in rural, frontier, and urban underserved areas through an expansion of the number of scholarships and loan repayments under this subpart to address health workforce shortages in health professional shortage areas (as defined in section 332), in medically underserved communities (as defined in section 799B), or with respect to medically underserved populations (as defined in section 330(b)(3)).</text>
</subsection>
<after-quoted-block>.</after-quoted-block>
</quoted-block>
</paragraph>
</subsection>
<subsection id="PB0EB8DDED8D14530BB004548C721CBA4">
<enum>(b)</enum>
<header>Expansion of Other Programs</header>
<text>The Director of the Indian Health Service, the Secretary of Defense, and the Secretary of Veterans Affairs, shall expand existing loan repayment programs to emphasize the provision of health professions services to facilities that have health professional shortages.</text>
</subsection>
<subsection id="P915C50304A60491AA7D8BA1B90DA367D">
<enum>(c)</enum>
<header>No Tax Implications</header>
<paragraph id="PA20099F847E0446292498C812B58008F">
<enum>(1)</enum>
<header>In general</header>
<text>For purposes of the Internal Revenue Code of 1986, any amount received under a health-related Federal loan repayment program by a health professional providing health-related services in a Federal medical facility shall not be included in the gross income of such professional.</text>
</paragraph>
<paragraph id="P62C61766E3A846FFBAB24B8237D97F6D">
<enum>(2)</enum>
<header>Definition</header>
<text>In this subsection, the term <quote>Federal medical facility</quote> means a facility for the delivery of health services, and includes—</text>
<subparagraph id="P1F63A0388397441C98CDD746F325B94B">
<enum>(A)</enum>
<text>a federally qualified health center (as defined in section 330A of the <act-ref scope="public" congress="78" type="chapter" number="373" session="2">Public Health Service Act</act-ref> (<usc-ref title="42" section="254c">42 U.S.C. 254c</usc-ref>)), a public health center, an outpatient medical facility, or a community mental health center;</text>
</subparagraph>
<subparagraph id="P5FB963EC580841F4A3768F5CD52158F2">
<enum>(B)</enum>
<text>a hospital, State mental hospital, facility for long-term care, or rehabilitation facility;</text>
</subparagraph>
<subparagraph id="P71ACD5C4872346C49299A64F18071F4D">
<enum>(C)</enum>
<text>a migrant health center or an Indian Health Service facility;</text>
</subparagraph>
<subparagraph id="PFC86F198277E45A09AB5C6B3A6870600">
<enum>(D)</enum>
<text>a facility for the delivery of health services to inmates in a penal or correctional institution (under section 323 of such Act (<usc-ref title="42" section="250">42 U.S.C. 250</usc-ref>)) or a State correctional institution;</text>
</subparagraph>
<subparagraph id="P3798433932214522A6F21A418B71291C">
<enum>(E)</enum>
<text>a Public Health Service medical facility (used in connection with the delivery of health services under section 320, 321, 322, 324, 325, or 326 of such Act (<usc-ref title="42" section="247e">42 U.S.C. 247e</usc-ref>, <usc-ref title="42" section="248">248</usc-ref>, <usc-ref title="42" section="249">249</usc-ref>, <usc-ref title="42" section="251">251</usc-ref>, <usc-ref title="42" section="252">252</usc-ref>, or <usc-ref title="42" section="253">253</usc-ref>));</text>
</subparagraph>
<subparagraph id="PE3C05B9F315841DDA92D67E4B62FF569">
<enum>(F)</enum>
<text>a nurse-managed health center; or</text>
</subparagraph>
<subparagraph id="PCFD6ABF4651040DAACAC35843F25DC75">
<enum>(G)</enum>
<text>any other Federal medical facility.</text>
</subparagraph>
</paragraph>
</subsection>
<subsection id="P05E2A40F90064C8FB95B69EA95DBEB81">
<enum>(d)</enum>
<header>Reduced Loan Support for Part Time Practitioners</header>
<text>Section 338C of the <act-ref scope="public" congress="78" type="chapter" number="373" session="2">Public Health Service Act</act-ref> (<usc-ref title="42" section="254m">42 U.S.C. 254m</usc-ref>) is amended by adding at the end the following:</text>
<quoted-block id="PC7EC38F9F1204DA1A1A1A6E5D04D58D5">
<subsection id="P00F009A05FD0401DAA70BCEB9FC8355A">
<enum>(e)</enum>
<text>Notwithstanding any other provision of this subpart, the Secretary shall develop procedures to permit periods of obligated services to be provided on a part-time basis (not less than 1,040 hours of such service per year). Such procedures shall prohibit an individual from holding other part-time employment while providing such part-time obligated services. The Secretary may provide for a reduction in the loan repayments provided to individuals who provide part-time obligated services under the authority provided under this subsection.</text>
</subsection>
<after-quoted-block>.</after-quoted-block>
</quoted-block>
</subsection>
<subsection id="P08D465A34BF04476922FF37B0D21C99F">
<enum>(e)</enum>
<header>Loan Support for Participating Preceptors, Mentors, and Attendings To Supervise Students and Trainees On-site</header>
<text>Section 338C of the <act-ref scope="public" congress="78" type="chapter" number="373" session="2">Public Health Service Act</act-ref> (<usc-ref title="42" section="254m">42 U.S.C. 254m</usc-ref>), as amended by subsection (d), is further amended by adding at the end the following:</text>
<quoted-block id="P17D2DA2B9E4546B1A042DD890CD2056B">
<subsection id="P9370F5FB2FD049AB9EEE02C0AADB6709">
<enum>(f)</enum>
<text>The Secretary shall develop procedures to permit up to 20 percent of the service obligation of an individual under this section to be provided by the individual through precepting or mentoring activities, or by preparing curriculum, for on-site students and trainees. The procedures developed under subsection (e) shall provide for the proportional application of this subsection with respect to individual providing obligated service on a part-time basis.</text>
</subsection>
<after-quoted-block>.</after-quoted-block>
</quoted-block>
</subsection>
</section>
<section id="PF14078579DE74AF79C68DE5779F34CF1">
<enum>202.</enum>
<header>NATIONAL HEALTH SERVICE CORPS SCHOLARSHIP PROGRAM FOR MEDICAL, DENTAL, PHYSICIAN ASSISTANT, PHARMACY, BEHAVIORAL AND MENTAL HEALTH, PUBLIC HEALTH, AND NURSING STUDENTS IN THE UNITED STATES PUBLIC HEALTH SCIENCES TRACK IN AFFILIATED SCHOOLS</header>
<subsection id="P40BBB67FB85E4911BB95A1802D8C340D">
<enum>(a)</enum>
<header>Program Authorized</header>
<paragraph id="P22208CA1E61D4ED0A0B6F911F7EFF1A0">
<enum>(1)</enum>
<header>In general</header>
<text>Subpart III of part D of title III of the <act-ref scope="public" congress="78" type="chapter" number="373" session="2">Public Health Service Act</act-ref> (<usc-ref title="42" section="254l">42 U.S.C. 254l</usc-ref> et seq.) is amended—</text>
<subparagraph id="PE9C02C00CA2E4FB984178CB0B6E76285">
<enum>(A)</enum>
<text>in the heading by inserting <quote><header-in-text>, Scholarship Program for Medical, Dental, Physician Assistant, Pharmacy, Behavioral and Mental Health, Public Health, and Nursing Students in the United States Public Health Sciences Track in Affiliated Schools,</header-in-text></quote> after <quote><header-in-text>Scholarship Program</header-in-text></quote>; and</text>
</subparagraph>
<subparagraph id="PAD664340140F4F0981620F25DEE08E17">
<enum>(B)</enum>
<text>by inserting after section 338A the following:</text>
<quoted-block id="PBCDEB4CFC0D4456D84DAB6D413406137">
<section id="P430B8060F799409B8BD119CF37BA4AE3">
<enum>338A–1.</enum>
<header>NATIONAL HEALTH SERVICE CORPS SCHOLARSHIP PROGRAM FOR MEDICAL, DENTAL, PHYSICIAN ASSISTANT, PHARMACY, BEHAVIORAL AND MENTAL HEALTH, PUBLIC HEALTH, AND NURSING STUDENTS IN THE UNITED STATES PUBLIC HEALTH SCIENCES TRACK IN AFFILIATED SCHOOLS</header>
<subsection id="PBA3BC6BC1A2441A38FDE6A27AEB723FD">
<enum>(a)</enum>
<header>Establishment</header>
<paragraph id="P693CED167B324172AE12124C1D53D41C">
<enum>(1)</enum>
<header>In general</header>
<text>The Secretary shall establish a program to be known as the National Health Service Corps Scholarship Program for Medical, Dental, Physician Assistant, Pharmacy, Behavioral and Mental Health, Public Health, and Nursing Students in the United States Public Health Sciences Track in Affiliated Schools (in this section referred to as the <quote>U.S. Public Health Sciences Track Scholarship Program</quote>) to ensure, with respect to the provision of high-needs health care services, including primary care, general dentistry, nursing, obstetrics, and geriatricians pursuant to section 331(a)(2), an adequate supply of physicians, physician assistants, pharmacists, behavioral and mental health professionals, public health professionals, dentists, and nurses. The purpose of this program is to train an additional 150 medical students, 100 dental students, 100 physician assistant students, 100 behavioral and mental health students, 100 public health students, and 250 nursing students during each year. Of the 150 scholarships awarded to the medical students as described under the preceding sentence, 10 shall be for training at the Uniformed Services University of the Health Sciences as members of the Commissioned Corps of the Public Health Service.</text>
</paragraph>
<paragraph id="P4D18A7F291BA4712ADFCD3F6CAFDA8D1">
<enum>(2)</enum>
<header>Relationship to national health service corps scholarship program</header>
<text>Scholarships provided under this section are intended to complement, and not take the place of, scholarships provided to students enrolled in courses of study leading to a degree in medicine, osteopathic medicine, dentistry, or nursing or completion of an accredited physician assistant, pharmacy, public health, or behavioral and mental health educational program under the National Health Service Corps Scholarship Program authorized by section 338A.</text>
</paragraph>
</subsection>
<subsection id="PE2CD2B4326EE42D19B870D6D3EC8F4B0">
<enum>(b)</enum>
<header>Eligibility</header>
<text>To be eligible to participate in the U.S. Public Health Sciences Track Scholarship and Grants Program, an individual shall—</text>
<paragraph id="P3ACA2A93652041CAB5086FC19E28044A">
<enum>(1)</enum>
<text>be accepted for enrollment as a full-time student—</text>
<subparagraph id="PC62949165A334A109FF8FDDE6C90057F">
<enum>(A)</enum>
<text>in an accredited (as determined by the Secretary) educational institution in a State; and</text>
</subparagraph>
<subparagraph id="P16A75DE040CD4F05AFA915160057E9D2">
<enum>(B)</enum>
<text>in a course of study, or program, offered by such institution leading to a degree in medicine, osteopathic medicine, dentistry, physician assistant, pharmacy, behavioral and mental health, public health, or nursing;</text>
</subparagraph>
</paragraph>
<paragraph id="PF5B6C41DF15E41FABC7362E0418D9054">
<enum>(2)</enum>
<text>be eligible for, or hold, an appointment as a commissioned officer in the Regular or Reserve Corps of the Service or be eligible for selection for civilian service in the Corps;</text>
</paragraph>
<paragraph id="P81ED440A45DA4E108F0F3D71F3DDBB2F">
<enum>(3)</enum>
<text>submit an application to participate in the U.S. Public Health Sciences Track Scholarship and Grants Program; and</text>
</paragraph>
<paragraph id="PB0E2D9C1F0DA4C04BA59BB68FB17CF46">
<enum>(4)</enum>
<text>sign and submit to the Secretary, at the time of submittal of such application, a written contract to accept payment of a scholarship and to serve (in accordance with this subpart) for the applicable period of obligated service in an area in which the need for public health-related services may be demonstrated.</text>
</paragraph>
</subsection>
</section>
<after-quoted-block>.</after-quoted-block>
</quoted-block>
</subparagraph>
</paragraph>
<paragraph id="P86FD86BDD61548A0B539D9B4A9B993E9">
<enum>(2)</enum>
<header>No tax implications</header>
<text>For purposes of the Internal Revenue Code of 1986, any amount received under the National Health Service Corps Scholarship Program for Medical, Dental and Nursing Students in the United States Public Health Sciences Track in Affiliated Schools under section 338A-1 of the <act-ref scope="public" congress="78" type="chapter" number="373" session="2">Public Health Service Act</act-ref>, as added by paragraph (1), by a medical student, dental student, or nursing student shall not be included in the gross income of such student.</text>
</paragraph>
</subsection>
<subsection id="PE6B149D3A8764030BB3964270573A10E">
<enum>(b)</enum>
<header>Grants To Increase the Number of Available Slots for Newly Admitted Medical, Dental, Physician Assistant, Pharmacy, Behavioral and Mental Health, Public Health, and Nursing Students and To Increase Participation in the U.S. Public Health Sciences Track Scholarship Program</header>
<text>Part C of title VII of the <act-ref scope="public" congress="78" type="chapter" number="373" session="2">Public Health Service Act</act-ref> (<usc-ref title="42" section="293k">42 U.S.C. 293k</usc-ref> et seq.) is amended by adding at the end the following:</text>
<quoted-block id="P738D48308EB7427BB8DFE612140C980C">
<section id="PB82D6A3BA9F84A38B1AD6226853E297C">
<enum>749.</enum>
<header>GRANTS TO INCREASE THE NUMBER OF AVAILABLE SLOTS FOR NEWLY ADMITTED MEDICAL, DENTAL, PHYSICIAN ASSISTANT, PHARMACY, BEHAVIORAL AND MENTAL HEALTH, PUBLIC HEALTH, AND NURSING STUDENTS AND TO INCREASE PARTICIPATION IN THE U.S. PUBLIC HEALTH SCIENCES TRACK SCHOLARSHIP PROGRAM</header>
<subsection id="P6724272FE180433895F10A132447757B">
<enum>(a)</enum>
<header>Program Authorized</header>
<text>The Secretary may make grants to medical, dental, public health, and nursing schools and physician assistant, pharmacy, and behavioral and mental health programs for the following purposes:</text>
<paragraph id="P833EB5170DE04B9489F264137674803C">
<enum>(1)</enum>
<text>To increase the capacity of the recipient medical, dental, public health, or nursing school or physician assistant, pharmacy, or behavioral and mental health program, to accept additional medical, dental, public health, nursing, physician assistant, pharmacy, or behavioral and mental health students each year.</text>
</paragraph>
<paragraph id="P85F1568B8BF843A1B948227470A4AD9A">
<enum>(2)</enum>
<text>To develop curriculum.</text>
</paragraph>
<paragraph id="P9EE4CA38AD264368910880F20A432A7D">
<enum>(3)</enum>
<text>To acquire equipment.</text>
</paragraph>
<paragraph id="PAF99749DD398466FAB1C76E4E950CC47">
<enum>(4)</enum>
<text>To recruit, train, and retain faculty.</text>
</paragraph>
<paragraph id="PE115A81E43454F2ABB53BF37794AE4EE">
<enum>(5)</enum>
<text>To provide assistance to students who have completed a course of study at the recipient medical, dental, public health, or nursing school or physician assistant, pharmacy, or behavioral and mental health program during the period in which such students are completing a residency or internship program affiliated with the recipient institution.</text>
</paragraph>
</subsection>
<subsection id="PB0339AD0B8F34A3B8F41BE9E96321346">
<enum>(b)</enum>
<header>Application</header>
<text>A medical, dental, public health, or nursing school or physician assistant, pharmacy, or behavioral and mental health program seeking a grant under this section shall submit an application to the Secretary at such time, in such manner, and containing such information as the Secretary may require.</text>
</subsection>
<subsection id="P6E2C373B4923422BA063EB06F58D08BB">
<enum>(c)</enum>
<header>Definition of Medical School</header>
<text>In this section, the term <quote>medical school</quote> means a school of medicine or a school of osteopathic medicine.</text>
</subsection>
</section>
<after-quoted-block>.</after-quoted-block>
</quoted-block>
</subsection>
</section>
<section id="P371B306CB5D34588AC201BC4AF51B28F">
<enum>203.</enum>
<header>FEDERAL MEDICAL FACILITY GRANT PROGRAM AND PROGRAM ASSESSMENTS</header>
<subsection id="P30EAF152128B45669C1E32EE145720DE">
<enum>(a)</enum>
<header>Federal Medical Facility Grant Program</header>
<text>Title VII of the <act-ref scope="public" congress="78" type="chapter" number="373" session="2">Public Health Service Act</act-ref> (<usc-ref title="42" section="292">42 U.S.C. 292</usc-ref> et seq.) is amended—</text>
<paragraph id="P707D46F2DE1D466DA7612A36A25370A9">
<enum>(1)</enum>
<text>by redesignating part F as part G; and</text>
</paragraph>
<paragraph id="PFF4575899C9C451EA1B5FE032879E463">
<enum>(2)</enum>
<text>by inserting after part E, the following:</text>
<quoted-block id="P6E79BCDC8F98427EBD8AE31C74F1EF18">
<part id="PBE7FCFBF419243BD864AE060ACE13256">
<enum>F</enum>
<header>START-UP EXPENSES LOAN AND GRANT PROGRAMS FOR FEDERAL MEDICAL FACILITIES AND HOSPITALS STARTING HIGH NEEDS RESIDENCY PROGRAMS IN SHORTAGE AREAS</header>
<section id="P318F40FD817F4EB1A27A0394BD249E9B">
<enum>781.</enum>
<header>FEDERAL MEDICAL FACILITY GRANT PROGRAM</header>
<subsection id="P4C608FA033544110987D6C154345285E">
<enum>(a)</enum>
<header>In General</header>
<text>The Secretary shall award grants to eligible facilities to increase interdisciplinary, community-based health professions training in high-needs specialties for physicians, nurses, dentists, physician assistants, pharmacy, behavioral and mental health professionals, public health professionals, and other health professionals as determined appropriate by the Secretary, in consultation with the Permanent National Health Workforce Commission established under section 101(a) of the Health Access and Health Professions Supply Act of 2009.</text>
</subsection>
<subsection id="P886C3D38F0AC488093D61B2230DE7138">
<enum>(b)</enum>
<header>Eligible Facilities; Application</header>
<paragraph id="P1B4BD30020AE4630A5D1D091E6B76E68">
<enum>(1)</enum>
<header>Definition of eligible facility</header>
<text>In this section, the term <quote>eligible facility</quote>—</text>
<subparagraph id="PDAAE6142874A4296852A8BCF0FE7D8FD">
<enum>(A)</enum>
<text>means a facility which—</text>
<clause id="P4BE1B2D1DF8F416CB40843F54DBEA9A9">
<enum>(i)</enum>
<text>is located in a health professional shortage area (as defined in section 332);</text>
</clause>
<clause id="PAE7D8AE5F0C44CA19344527B0E4DED5A">
<enum>(ii)</enum>
<text>is located in a medically underserved community (as defined in section 799B), or with respect to a medically underserved population (as defined in section 330(b)(3));</text>
</clause>
<clause id="P3C3CD570D7E54E28977FE5800D9408A5">
<enum>(iii)</enum>
<text>is a Federal medical facility;</text>
</clause>
<clause id="PB72BB68AEBF5452AAA78F7FCD62EB8D5">
<enum>(iv)</enum>
<text>is an area health education center, a health education and training center, or a participant in the Quentin N. Burdick program for rural interdisciplinary training, that meet the requirements established by the Secretary; or</text>
</clause>
<clause id="P9608A92A4241492EBC1FEA9A12199744">
<enum>(v)</enum>
<text>is establishing new residency programs in a specialty which the Secretary, in consultation with the Permanent National Health Workforce Commission established under section 101(a) of the Health Access and Health Professions Supply Act of 2009, determines is in high-need; and</text>
</clause>
</subparagraph>
<subparagraph id="P76D5B99E46CE459F826EBE2D9F83A3F8">
<enum>(B)</enum>
<text>includes Medicare certified Federally Qualified Health Centers, community health centers, health care for the homeless centers, rural health centers, migrant health centers, Indian Health Service entities, urban Indian centers, health clinics and hospitals operated by the Indian Health Service, Indian tribes and tribal organizations, and urban Indian organizations (as defined in section 4 of the <act-ref scope="public" congress="94" type="law" number="437" session="2">Indian Health Care Improvement Act</act-ref>), and other Federal medical facilities).</text>
</subparagraph>
</paragraph>
<paragraph id="P34C5098B642A43628A35BF05F9F2A577">
<enum>(2)</enum>
<header>Application</header>
<text>An eligible facility desiring a grant under subsection (a) shall submit to the Secretary an application at such time, in such manner, and containing such information as the Secretary may require.</text>
</paragraph>
</subsection>
<subsection id="P4716879580E441F8B0C108F90577695D">
<enum>(c)</enum>
<header>Use of Funds</header>
<text>An eligible facility shall use amounts received under a grant under subsection (a) to promote—</text>
<paragraph id="P679DB375FA0E4F21B486E1689FBB6256">
<enum>(1)</enum>
<text>the training of health professionals in interdisciplinary, community-based settings that are affiliated with hospitals and other health care facilities and teaching institutions;</text>
</paragraph>
<paragraph id="PBF63C8A959474944BA32AF57CF23CC0F">
<enum>(2)</enum>
<text>community development programs that assure a diverse health professions workforce through emphasis on individuals from rural and frontier areas and underrepresented minority groups;</text>
</paragraph>
<paragraph id="PC67F65EEE01C46AD8B40DC53BB3FF1AC">
<enum>(3)</enum>
<text>the development of a reliable health professions pipeline that provides an emphasis on health-related careers in schools (such as schools participating in the Health Careers Opportunities Program) and centers of excellence, and that encourage individuals in underrepresented minorities (including Hispanic, African-American, American Indian, and Alaska Native individuals) to pursue health professions careers;</text>
</paragraph>
<paragraph id="P916DF8227CCF4F0FBA1EDEF14D0CDF70">
<enum>(4)</enum>
<text>the reduction of health professional isolation in rural, frontier, and urban underserved areas through the provision of continuing education, mentoring, and precepting activities, field faculty development, and the utilization of technology such as telehealth and electronic health records;</text>
</paragraph>
<paragraph id="P446E463D29E24C6889B489DE8F235B27">
<enum>(5)</enum>
<text>the establishment and operation of regional or statewide health advice telephone lines to reduce after-hours call responsibilities for overworked health professionals who provide services in remote areas that have few health professionals taking such after-hours calls;</text>
</paragraph>
<paragraph id="P17549D481645449EA21F91CBCCAEC815">
<enum>(6)</enum>
<text>an increase in the number of professionals taking after-hours calls in hospitals and emergency departments in health professional shortage areas (as defined in section 332), in medically underserved communities (as defined in section 799B), or with respect to medically underserved populations (as defined in section 330(b)(3));</text>
</paragraph>
<paragraph id="P5A447A3EDDDD4F5D8B3A31F2E4DC58CB">
<enum>(7)</enum>
<text>the establishment and operation of relief programs that provide health professionals practicing in health professional shortage areas (as defined in section 332) with patient and call coverage when such professionals are ill, are pursuing continuing education, or are taking a vacation; and</text>
</paragraph>
<paragraph id="P5486A3666EA34CEBBF240334D7EB676E">
<enum>(8)</enum>
<text>the exposure of health professions residents to systems of health care that represent the contemporary American healthcare delivery program (such as <quote>P4</quote> Prepare the Personal Physician for Practice and the <quote>Health Commons</quote> programs).</text>
</paragraph>
</subsection>
<subsection id="P3B13805B993E4D918024015A59FCFFA7">
<enum>(d)</enum>
<header>Subgrants</header>
<text>An eligible facility may use amounts received under a grant under this section to award subgrants to States and other entities determined appropriate by the Secretary to carry out the activities described in subsection (c).</text>
</subsection>
<subsection id="P136307E4D1214E3186BC92CF56E9C74F">
<enum>(e)</enum>
<header>Set Aside</header>
<text>In awarding grants under this section, the Secretary shall ensure that a total of $500,000 is awarded annually for the activities of the National Rural Recruitment and Retention Network, or a similar entity.</text>
</subsection>
<subsection id="P4ACC74ADC7954704BD1F726F235C4574">
<enum>(f)</enum>
<header>Definition of Federal Medical Facility</header>
<text>In this section, the term <quote>Federal medical facility</quote> means a facility for the delivery of health services, and includes—</text>
<paragraph id="P397A06D1441E4A95BD6FD46E235A7E79">
<enum>(1)</enum>
<text>a federally qualified health center (as defined in section 330A), a public health center, an outpatient medical facility, or a community mental health center;</text>
</paragraph>
<paragraph id="P9FAA8A0760174A8DBC2682A265048E82">
<enum>(2)</enum>
<text>a hospital, State mental hospital, facility for long-term care, or rehabilitation facility;</text>
</paragraph>
<paragraph id="PC399614EE2844BA688509909F00D450B">
<enum>(3)</enum>
<text>a migrant health center or an Indian Health Service facility;</text>
</paragraph>
<paragraph id="P614B001ED7244F259CE26D43F7E63A49">
<enum>(4)</enum>
<text>a facility for the delivery of health services to inmates in a penal or correctional institution (under section 323) or a State correctional institution;</text>
</paragraph>
<paragraph id="P405DA37F5E1D44E895EC57990827C649">
<enum>(5)</enum>
<text>a Public Health Service medical facility (used in connection with the delivery of health services under section 320, 321, 322, 324, 325, or 326)); or</text>
</paragraph>
<paragraph id="P2E6AF29C155346A69D34B66DC3D5776C">
<enum>(6)</enum>
<text>any other Federal medical facility.</text>
</paragraph>
</subsection>
<subsection id="PCD887D51BCCE4297A29B709071325A4E">
<enum>(g)</enum>
<header>Authorization of Appropriations</header>
<text>There are authorized to be appropriated to carry out this section, $623,000,000 for fiscal year 2009, $666,000,000 for fiscal year 2010, $675,000,000 for fiscal year 2011, $700,000,000 for fiscal year 2012, and $725,000,000 for fiscal year 2013.</text>
</subsection>
</section>
</part>
<after-quoted-block>.</after-quoted-block>
</quoted-block>
</paragraph>
</subsection>
<subsection id="P06AB37FF8078458A94BE425A1BA2E9F4">
<enum>(b)</enum>
<header>Assessments</header>
<paragraph id="P1301FD0E356343D2ADAEB721291DC22F">
<enum>(1)</enum>
<header>Establishment</header>
<text>The Secretary of Health and Human Services (referred to in this section as the <quote>Secretary</quote>) shall establish program assessment rating tools for each program funded through titles VII and VIII of the <act-ref scope="public" congress="78" type="chapter" number="373" session="2">Public Health Service Act</act-ref> (<usc-ref title="42" section="292">42 U.S.C. 292</usc-ref> and 296 et seq.).</text>
</paragraph>
<paragraph id="P0044F4843E11448DA47ACB17CD63F3F2">
<enum>(2)</enum>
<header>Criteria</header>
<text>The Secretary, in consultation with the Administrator of the Health Resources and Services Administration and other appropriate public and private stakeholders, shall, through negotiated rulemaking, establish criteria for the conduct of the assessments under paragraph (2).</text>
</paragraph>
<paragraph id="P8DEA0EEE408B4B6186BF192CA31377D9">
<enum>(3)</enum>
<header>Annual assessments</header>
<text>The Secretary shall annually enter into a contract with an independent nongovernmental entity for the conduct of an assessment, using the tools established under paragraph (1) and the criteria established under paragraph (2), of not less than 20 percent, nor more than 25 percent, of the programs carried out under titles VII and VIII of the <act-ref scope="public" congress="78" type="chapter" number="373" session="2">Public Health Service Act</act-ref>, so that every program under such titles is assessed at least once during every 5-year period.</text>
</paragraph>
</subsection>
</section>
<section id="P3A164BC2BD754C428D453818B621E2B2">
<enum>204.</enum>
<header>HEALTH PROFESSIONS TRAINING LOAN PROGRAM</header>
<text display-inline="no-display-inline">Part F of title VII of the <act-ref scope="public" congress="78" type="chapter" number="373" session="2">Public Health Service Act</act-ref> (as added by section 203) is amended by adding at the end the following</text>
<quoted-block id="P51075B08D0D8493483DDDBDEB7ED5A50">
<section id="P1D11F17AA7E14810A91795A2C682DBB3">
<enum>782.</enum>
<header>ESTABLISHMENT</header>
<subsection id="P083EBF4D6D7B4A33913715813A6F9D53">
<enum>(a)</enum>
<header>In General</header>
<text>The Secretary shall establish a program under which the Secretary shall award interest-free loans to—</text>
<paragraph id="P847D1A430A284224B1989913C65B4B8C">
<enum>(1)</enum>
<text>eligible hospitals to enable such hospitals to establish training programs in high-need specialties; and</text>
</paragraph>
<paragraph id="PF9A29A7745764F0BA1BC8FDD2157799B">
<enum>(2)</enum>
<text>eligible non-hospital community-based entities to enable such entities to establish health professions training programs.</text>
</paragraph>
</subsection>
<subsection id="PD1ACC13E50B741C18CE6C36A513D7AFD">
<enum>(b)</enum>
<header>Eligibility</header>
<paragraph id="P6FEEC3CC5AA2490C8827E53BC247FA6B">
<enum>(1)</enum>
<header>In general</header>
<text>To be eligible to receive a loan under subsection (a)—</text>
<subparagraph id="P092B62F788DE45F397C9639350219DD3">
<enum>(A)</enum>
<text>a hospital shall—</text>
<clause id="P15809E64E8EB474B8D541E0DFED5AB88">
<enum>(i)</enum>
<text>be located in a health professional shortage area (as such term is defined in section 332);</text>
</clause>
<clause id="P526A17934BF6482CA1AD0702A5D03A5B">
<enum>(ii)</enum>
<text>comply with the requirements of paragraph (2); and</text>
</clause>
<clause id="P507AF5BBE3FB4206AA17BD443E7FD35C">
<enum>(iii)</enum>
<text>submit to the Secretary an application at such time, in such manner, and containing such information as the Secretary may require; or</text>
</clause>
</subparagraph>
<subparagraph id="PDCD0CB8FC53D41B9AE5F656138318492">
<enum>(B)</enum>
<text>a non-hospital community-based entity shall—</text>
<clause id="P37E03D6C8E9D43CF93CB31E8C170BE80">
<enum>(i)</enum>
<text>comply with the requirements of paragraph (2); and</text>
</clause>
<clause id="P8BF05EF4AA314BBA820BB7B45805A718">
<enum>(ii)</enum>
<text>submit to the Secretary an application at such time, in such manner, and containing such information as the Secretary may require.</text>
</clause>
</subparagraph>
</paragraph>
<paragraph id="PB127C79B55654F3EB64382FCF95CAE2E">
<enum>(2)</enum>
<header>Requirements</header>
<text>To be eligible to receive a loan under subsection (a), a hospital or non-hospital community-based entity shall—</text>
<subparagraph id="P37800A9A60E54311ACCAABC6E52DB45A">
<enum>(A)</enum>
<text>on the date on which the entity submits the loan application, not operate a residency with respect to a high-needs specialty (as determined by the Secretary in consultation with the Permanent National Health Workforce Commission established under section 101(a) of the Health Access and Health Professions Supply Act of 2009) or provide a health professions training program, as the case may be;</text>
</subparagraph>
<subparagraph id="P86A4CB921B4D436D80D7B422687127B9">
<enum>(B)</enum>
<text>have received appropriate preliminary accreditation from the relevant accrediting agency (American Council for Graduate Medical Education, American Osteopathic Association, or Dental, Physician Assistant, Pharmacy, Behavioral and Mental Health, Public Health, and Nursing accrediting agencies), as determined by the Secretary; and</text>
</subparagraph>
<subparagraph id="P754D9E89800843D286A5C2061EB25BF6">
<enum>(C)</enum>
<text>execute a signed formal contract under which the hospital or entity agree to repay the loan.</text>
</subparagraph>
</paragraph>
</subsection>
<subsection id="PB46A83216AF44CDCA8C63D72150B0F77">
<enum>(c)</enum>
<header>Use of Loan Funds</header>
<text>Amounts received under a loan under subsection (a) shall be used only for—</text>
<paragraph id="PFAF70308F8F947E394CE424FA7ABA7A0">
<enum>(1)</enum>
<text>the salary and fringe benefit expenses of residents, students, trainees, and faculty, or other costs directly attributable to the residency, educational, or training program to be carried out under the loan, as specified by the Secretary; or</text>
</paragraph>
<paragraph id="P0CA3718377F14A52B7F413BA102C6C7D">
<enum>(2)</enum>
<text>facility construction or renovation, including equipment purchase.</text>
</paragraph>
</subsection>
<subsection id="P75A363D3730241849641335343F1B6FA">
<enum>(d)</enum>
<header>Priority</header>
<text>In awarding loans under subsection (a), the Secretary shall give priority to applicants that are located in health professional shortage areas (as defined in section 332) or in medically underserved communities (as defined in section 799B), or that serve medically underserved populations (as defined in section 330(b)(3)).</text>
</subsection>
<subsection id="PCFE965160A0C4AC7AC1FCA3CE99E3DA9">
<enum>(e)</enum>
<header>Loan Provisions</header>
<paragraph id="P1AE84633421C492AB207261A04EFC1F4">
<enum>(1)</enum>
<header>Loan contract</header>
<text>The loan contract entered into under subsection (b)(2) shall contain terms that provide for the repayment of the loan, including the number and amount of installment payments as described in such contract. Such repayment shall begin on the date that is 24 months after the date on which the loan contract is executed and shall be fully repaid not later than 36 months after the date of the first payment.</text>
</paragraph>
<paragraph id="P9617297BF3D74575AD85DEC1B68DD383">
<enum>(2)</enum>
<header>Interest</header>
<text>Loans under this section shall be repaid without interest.</text>
</paragraph>
</subsection>
<subsection id="PD9E7B5A47B654D8483D91DB629858D11">
<enum>(f)</enum>
<header>Limitation</header>
<text>The amount of a loan under this section with respect to each of the uses described in subsection (c)(1) or (c)(2) shall not exceed $2,000,000.</text>
</subsection>
<subsection id="PC20FF6FA1B5C4EA6BCCDD2E2F2331505">
<enum>(g)</enum>
<header>Failure To Repay</header>
<text>A hospital or non-hospital community-based entity that fails to comply with the terms of a contract entered into under subsection (b)(2) shall be liable to the United States for the amount which has been paid to such hospital or entity under the contract.</text>
</subsection>
<subsection id="P98C79773BFD647E08BAD667C3BCC2956">
<enum>(h)</enum>
<header>Authorization of Appropriations</header>
<text>There is authorized to be appropriated, such sums as may be necessary to carry out this section.</text>
</subsection>
</section>
<after-quoted-block>.</after-quoted-block>
</quoted-block>
</section>
<section id="P79E1E6612ECF43109C4BA2993EDCA021">
<enum>205.</enum>
<header>UNITED STATES PUBLIC HEALTH SCIENCES TRACK</header>
<text display-inline="no-display-inline">Title II of the <act-ref scope="public" congress="78" type="chapter" number="373" session="2">Public Health Service Act</act-ref> (<usc-ref title="42" section="202">42 U.S.C. 202</usc-ref> et seq.) is amended by adding at the end the following:</text>
<quoted-block id="P1734EA2620CC43D489EF992B5CFC527E">
<part id="PCD131957B81549DDAB66F0A82A58CF40">
<enum>D</enum>
<header>UNITED STATES PUBLIC HEALTH SCIENCES TRACK</header>
<section id="PBEBA5E13C4DA43E18F3DFED6D1623245">
<enum>271.</enum>
<header>ESTABLISHMENT</header>
<subsection id="P5EC84C031D3A4C34BA542A85063C137C">
<enum>(a)</enum>
<header>United States Public Health Services Track</header>
<paragraph id="P45ECA7C5348544969CAA84EFCBCAE955">
<enum>(1)</enum>
<header>In general</header>
<text>There is hereby authorized to be established a United States Public Health Sciences Track (referred to in this part as the <quote>Track</quote>), at sites to be selected by the Secretary, with authority to grant appropriate advanced degrees in a manner that uniquely emphasizes team-based service, public health, epidemiology, and emergency preparedness and response. It shall be so organized as to graduate not less than—</text>
<subparagraph id="P4BAD844612FF455E8000DAC3BD1C4C70">
<enum>(A)</enum>
<text>150 medical students annually;</text>
</subparagraph>
<subparagraph id="P9665AD4D0B9F4C26AF9EE26CA9F78346">
<enum>(B)</enum>
<text>100 dental students annually;</text>
</subparagraph>
<subparagraph id="PC48ADFD676E24A9B9223531C25A4C530">
<enum>(C)</enum>
<text>250 nursing students annually;</text>
</subparagraph>
<subparagraph id="PDB8F48E9FEAD489FB21C5D9A9C2E3C75">
<enum>(D)</enum>
<text>100 public health students annually;</text>
</subparagraph>
<subparagraph id="PA16C421B1C534C2C8E349C89CDACD1EF">
<enum>(E)</enum>
<text>100 behavioral and mental health professional students annually;</text>
</subparagraph>
<subparagraph id="PD340E64B44D444CC954FDDC3949521DB">
<enum>(F)</enum>
<text>100 physician assistant or nurse practitioner students annually; and</text>
</subparagraph>
<subparagraph id="PE6D92930F19E4E31AEC5B27FA5C67702">
<enum>(G)</enum>
<text>50 pharmacy students annually.</text>
</subparagraph>
</paragraph>
<paragraph id="P61D6D8BB5F7A4D7F964F0903A9E7921B">
<enum>(2)</enum>
<header>Locations</header>
<text>The Track shall be located at existing and accredited, affiliated health professions education training programs at academic health centers located in regions of the United States determined appropriate by the Surgeon General, in consultation with the Permanent National Health Workforce Commission.</text>
</paragraph>
</subsection>
<subsection id="PB905F7E4E26C442989309E9766F4EC10">
<enum>(b)</enum>
<header>Number of Graduates</header>
<text>Except as provided in subsection (a), the number of persons to be graduated from the Track shall be prescribed by the Secretary. In so prescribing the number of persons to be graduated from the Track, the Secretary shall institute actions necessary to ensure the maximum number of first-year enrollments in the Track consistent with the academic capacity of the affiliated sites and the needs of the United States for medical, dental, and nursing personnel.</text>
</subsection>
<subsection id="PEF772C12DBAF4866BB5A3EDFA4F148B4">
<enum>(c)</enum>
<header>Development</header>
<text>The development of the Track may be by such phases as the Secretary may prescribe subject to the requirements of subsection (a).</text>
</subsection>
<subsection id="PDE4270FF3E884EDDB6960435F9B4E1BE">
<enum>(d)</enum>
<header>Integrated Longitudinal Plan</header>
<text>The Surgeon General shall develop an integrated longitudinal plan for health professions continuing education throughout the continuum of health-related education, training, and practice. Training under such plan shall emphasize patient-centered, interdisciplinary, and care coordination skills. Experience with deployment of emergency response teams shall be included during the clinical experiences.</text>
</subsection>
<subsection id="P4F6E7D1D37084078BC4BA3B2171C6E95">
<enum>(e)</enum>
<header>Faculty Development</header>
<text>The Surgeon General shall develop faculty development programs and curricula in decentralized venues of health care, to balance urban, tertiary, and inpatient venues.</text>
</subsection>
</section>
<section id="PF2549C351DCE444F9F0E6C3DB5EB1C7C">
<enum>272.</enum>
<header>ADMINISTRATION</header>
<subsection id="PCF713366DF1B4E8295419D83C837B366">
<enum>(a)</enum>
<header>In General</header>
<text>The business of the Track shall be conducted by the Surgeon General with funds appropriated for and provided by the Department of Health and Human Services. The Permanent National Health Workforce Commission shall assist the Surgeon General in an advisory capacity.</text>
</subsection>
<subsection id="P10B4E4C8F455463498B83CDE09DF980E">
<enum>(b)</enum>
<header>Faculty</header>
<paragraph id="PEDFB24B28F7345EB92EA724A69B9F84C">
<enum>(1)</enum>
<header>In general</header>
<text>The Surgeon General, after considering the recommendations of the Permanent National Health Workforce Commission, shall obtain the services of such professors, instructors, and administrative and other employees as may be necessary to operate the Track, but utilize when possible, existing affiliated health professions training institutions. Members of the faculty and staff shall be employed under salary schedules and granted retirement and other related benefits prescribed by the Secretary so as to place the employees of the Track faculty on a comparable basis with the employees of fully accredited schools of the health professions within the United States.</text>
</paragraph>
<paragraph id="P05E99DDCD6E441E4A094F1320D3AAD2E">
<enum>(2)</enum>
<header>Titles</header>
<text>The Surgeon General may confer academic titles, as appropriate, upon the members of the faculty.</text>
</paragraph>
<paragraph id="P09514DC7AFA843799E78A0697BEDE61B">
<enum>(3)</enum>
<header>Nonapplication of provisions</header>
<text>The limitations in section <usc-ref title="5" section="5373">5373</usc-ref> of title 5, United States Code, shall not apply to the authority of the Surgeon General under paragraph (1) to prescribe salary schedules and other related benefits.</text>
</paragraph>
</subsection>
<subsection id="P0602528C60C44AA79FDAB19E660D36E1">
<enum>(c)</enum>
<header>Agreements</header>
<text>The Surgeon General may negotiate agreements with agencies of the Federal Government to utilize on a reimbursable basis appropriate existing Federal medical resources located in the United States (or locations selected in accordance with section 271(a)(2)). Under such agreements the facilities concerned will retain their identities and basic missions. The Surgeon General may negotiate affiliation agreements with accredited universities and health professions training institutions in the United States. Such agreements may include provisions for payments for educational services provided students participating in Department of Health and Human Services educational programs.</text>
</subsection>
<subsection id="PDE636CC0373446DF90B17ADDB42E8487">
<enum>(d)</enum>
<header>Programs</header>
<text>The Surgeon General may establish the following educational programs for Track students:</text>
<paragraph id="P4BEF11D5BA8242AAACE7658B30A8B0ED">
<enum>(1)</enum>
<text>Postdoctoral, postgraduate, and technological institutes.</text>
</paragraph>
<paragraph id="P8636024EC4A644658A062D0F324D51E1">
<enum>(2)</enum>
<text>A graduate school of nursing.</text>
</paragraph>
<paragraph id="P66604DC3024341C79DD453858FA209D7">
<enum>(3)</enum>
<text>Other schools or programs that the Surgeon General determines necessary in order to operate the Track in a cost-effective manner.</text>
</paragraph>
</subsection>
<subsection id="P248678ED862F4C82A2EB64198CB3860E">
<enum>(e)</enum>
<header>Continuing Medical Education</header>
<text>The Surgeon General shall establish programs in continuing medical education for members of the health professions to the end that high standards of health care may be maintained within the United States.</text>
</subsection>
<subsection id="P822250E0D5A04B5A88CEB79F5D0638C1">
<enum>(f)</enum>
<header>Authority of the Surgeon General</header>
<paragraph id="PD2B35BC11FB64A2BA9C95585BC64C814">
<enum>(1)</enum>
<header>In general</header>
<text>The Surgeon General is authorized—</text>
<subparagraph id="P6916D5F6CBBF425DB3995B64C2ECD18F">
<enum>(A)</enum>
<text>to enter into contracts with, accept grants from, and make grants to any nonprofit entity for the purpose of carrying out cooperative enterprises in medical, dental, physician assistant, pharmacy, behavioral and mental health, public health, and nursing research, consultation, and education;</text>
</subparagraph>
<subparagraph id="PF1584FFBB023429AAE4EE4FACF0190D8">
<enum>(B)</enum>
<text>to enter into contracts with entities under which the Surgeon General may furnish the services of such professional, technical, or clerical personnel as may be necessary to fulfill cooperative enterprises undertaken by the Track;</text>
</subparagraph>
<subparagraph id="P42871A6F57A440358A3CD9930CD7AED6">
<enum>(C)</enum>
<text>to accept, hold, administer, invest, and spend any gift, devise, or bequest of personal property made to the Track, including any gift, devise, or bequest for the support of an academic chair, teaching, research, or demonstration project;</text>
</subparagraph>
<subparagraph id="P9D5D5789E29147368B23D908EA523C67">
<enum>(D)</enum>
<text>to enter into agreements with entities that may be utilized by the Track for the purpose of enhancing the activities of the Track in education, research, and technological applications of knowledge; and</text>
</subparagraph>
<subparagraph id="P5484ED20A5514C4BAFE4488333564508">
<enum>(E)</enum>
<text>to accept the voluntary services of guest scholars and other persons.</text>
</subparagraph>
</paragraph>
<paragraph id="P9CE38E1F86B14B7381AAAFFBCA073A81">
<enum>(2)</enum>
<header>Limitation</header>
<text>The Surgeon General may not enter into any contract with an entity if the contract would obligate the Track to make outlays in advance of the enactment of budget authority for such outlays.</text>
</paragraph>
<paragraph id="P1B7FE10115384BB0BB70E30C4CB868D6">
<enum>(3)</enum>
<header>Scientists</header>
<text>Scientists or other medical, dental, or nursing personnel utilized by the Track under an agreement described in paragraph (1) may be appointed to any position within the Track and may be permitted to perform such duties within the Track as the Surgeon General may approve.</text>
</paragraph>
<paragraph id="PC9C826651A0D42C9AD12F03FABCC6B80">
<enum>(4)</enum>
<header>Volunteer services</header>
<text>A person who provides voluntary services under the authority of subparagraph (E) of paragraph (1) shall be considered to be an employee of the Federal Government for the purposes of chapter 81 of title 5, relating to compensation for work-related injuries, and to be an employee of the Federal Government for the purposes of chapter 171 of title 28, relating to tort claims. Such a person who is not otherwise employed by the Federal Government shall not be considered to be a Federal employee for any other purpose by reason of the provision of such services.</text>
</paragraph>
</subsection>
</section>
<section id="P0126482D587144B3ACAEF756642EBA7E">
<enum>273.</enum>
<header>STUDENTS; SELECTION; OBLIGATION</header>
<subsection id="P117F525A0336473FACFE9AC7A85EC254">
<enum>(a)</enum>
<header>Student Selection</header>
<paragraph id="P048177AFB8A44A2599ABD2D453E9827D">
<enum>(1)</enum>
<header>In general</header>
<text>Medical, dental, physician assistant, pharmacy, behavioral and mental health, public health, and nursing students at the Track shall be selected under procedures prescribed by the Surgeon General. In so prescribing, the Surgeon General shall consider the recommendations of the Permanent National Health Workforce Commission.</text>
</paragraph>
<paragraph id="PE430E3DCEABE4C479B7A4F4B39CF2523">
<enum>(2)</enum>
<header>Priority</header>
<text>In developing admissions procedures under paragraph (1), the Surgeon General shall ensure that such procedures give priority to applicant medical, dental, physician assistant, pharmacy, behavioral and mental health, public health, and nursing students from rural communities and underrepresented minorities.</text>
</paragraph>
</subsection>
<subsection id="P5D43CE9DB5F64302B8E8C8D8583C54D5">
<enum>(b)</enum>
<header>Contract and Service Obligation</header>
<paragraph id="P4F4558A7840F43BBA9212A9ABB41E664">
<enum>(1)</enum>
<header>Contract</header>
<text>Upon being admitted to the Track, a medical, dental, physician assistant, pharmacy, behavioral and mental health, public health, or nursing student shall enter into a written contract with the Surgeon General that shall contain—</text>
<subparagraph id="PCB081710408A47F1A4C62AEE8B871CB0">
<enum>(A)</enum>
<text>an agreement under which—</text>
<clause id="P1CE95F0C37CE48CEB8D30D19A315B6B9">
<enum>(i)</enum>
<text>subject to subparagraph (B), the Surgeon General agrees to provide the student with tuition (or tuition remission) and a student stipend (described in paragraph (2)) in each school year for a period of years (not to exceed 4 school years) determined by the student, during which period the student is enrolled in the Track at an affiliated or other participating health professions institution pursuant to an agreement between the Track and such institution; and</text>
</clause>
<clause id="PB659D275A9A8449FB967FCED53D4BA5B">
<enum>(ii)</enum>
<text>subject to subparagraph (B), the student agrees—</text>
<subclause id="PFAC983CBD148456C8741A0F31E601D33">
<enum>(I)</enum>
<text>to accept the provision of such tuition and student stipend to the student;</text>
</subclause>
<subclause id="P9F2CF5A2C1FB41DF8F74243FEC173C11">
<enum>(II)</enum>
<text>to maintain enrollment at the Track until the student completes the course of study involved;</text>
</subclause>
<subclause id="PAA440EC3AEC744E1928EBB369844A792">
<enum>(III)</enum>
<text>while enrolled in such course of study, to maintain an acceptable level of academic standing (as determined by the Surgeon General);</text>
</subclause>
<subclause id="P961139723DA04A469201A4D6011D1834">
<enum>(IV)</enum>
<text>if pursuing a degree from a school of medicine or osteopathic medicine, dental, public health, or nursing school or a physician assistant, pharmacy, or behavioral and mental health professional program, to complete a residency or internship in a specialty that the Surgeon General determines is appropriate; and</text>
</subclause>
<subclause id="PDD74AE7198FE49F6A2A9CD6B8138BAB9">
<enum>(V)</enum>
<text>to serve for a period of time (referred to in this part as the <quote>period of obligated service</quote>) within the Commissioned Corps of the Public Health Service equal to 2 years for each school year during which such individual was enrolled at the College, reduced as provided for in paragraph (3);</text>
</subclause>
</clause>
</subparagraph>
<subparagraph id="P2CE320D061AB4822A72EECF9AE12885F">
<enum>(B)</enum>
<text>a provision that any financial obligation of the United States arising out of a contract entered into under this part and any obligation of the student which is conditioned thereon, is contingent upon funds being appropriated to carry out this part;</text>
</subparagraph>
<subparagraph id="PACA7BA691CA5460398727EFE11139FEB">
<enum>(C)</enum>
<text>a statement of the damages to which the United States is entitled for the student’s breach of the contract; and</text>
</subparagraph>
<subparagraph id="PEAA8AD77F8054E89B550DF3A2076AA33">
<enum>(D)</enum>
<text>such other statements of the rights and liabilities of the Secretary and of the individual, not inconsistent with the provisions of this part.</text>
</subparagraph>
</paragraph>
<paragraph id="PF2BCDD3B0A194EE1B8280884EA1D6A82">
<enum>(2)</enum>
<header>Tuition and student stipend</header>
<subparagraph id="P44E95C4327604354AF0010297547F56E">
<enum>(A)</enum>
<header>Tuition remission rates</header>
<text>The Surgeon General, based on the recommendations of the Permanent National Health Workforce Commission established under section 101(a) of the Health Access and Health Professions Supply Act of 2009, shall establish Federal tuition remission rates to be used by the Track to provide reimbursement to affiliated and other participating health professions institutions for the cost of educational services provided by such institutions to Track students. The agreement entered into by such participating institutions under paragraph (1)(A)(i) shall contain an agreement to accept as payment in full the established remission rate under this subparagraph.</text>
</subparagraph>
<subparagraph id="P989FF6F295CA45C6B53BD5009FEE5A1F">
<enum>(B)</enum>
<header>Stipend</header>
<text>The Surgeon General, based on the recommendations of the Permanent National Health Workforce Commission, shall establish and update Federal stipend rates for payment to students under this part.</text>
</subparagraph>
</paragraph>
<paragraph id="PCE4739AF3356440EAB7AC28808CBE1EE">
<enum>(3)</enum>
<header>Reductions in the period of obligated service</header>
<text>The period of obligated service under paragraph (1)(A)(ii)(V) shall be reduced—</text>
<subparagraph id="P9B27B2607E2C4FC8B2D419A471685B56">
<enum>(A)</enum>
<text>in the case of a student who elects to participate in a high-needs speciality residency (as determined by the Permanent National Health Workforce Commission), by 3 months for each year of such participation (not to exceed a total of 12 months); and</text>
</subparagraph>
<subparagraph id="PA45C21C0C6324A37B2EE62A5478D8ED2">
<enum>(B)</enum>
<text>in the case of a student who, upon completion of their residency, elects to practice in a Federal medical facility (as defined in section 781(e)) that is located in a health professional shortage area (as defined in section 332), by 3 months for year of full-time practice in such a facility (not to exceed a total of 12 months).</text>
</subparagraph>
</paragraph>
</subsection>
<subsection id="P1E91BCEBA0C14DCF87DC8D1BFB130D87">
<enum>(c)</enum>
<text>Second 2 Years of Service.—During the third and fourth years in which a medical, dental, physician assistant, pharmacy, behavioral and mental health, public health, or nursing student is enrolled in the Track, training should be designed to prioritize clinical rotations in Federal medical facilities in health professional shortage areas, and emphasize a balance of hospital and community-based experiences, and training within interdisciplinary teams.</text>
</subsection>
<subsection id="P2EB74272CB45421FA22C95C6BCFAB521">
<enum>(d)</enum>
<header>Dentist, Physician Assistant, Pharmacist, Behavioral and Mental Health Professional, Public Health Professional, and Nurse Training</header>
<text>The Surgeon General shall establish provisions applicable with respect to dental, physician assistant, pharmacy, behavioral and mental health, public health, and nursing students that are comparable to those for medical students under this section, including service obligations, tuition support, and stipend support. The Surgeon General shall give priority to health professions training institutions that train medical, dental, physician assistant, pharmacy, behavioral and mental health, public health, and nursing students for some significant period of time together, but at a minimum have a discrete and shared core curriculum.</text>
</subsection>
<subsection id="PE1226EC8BBE144A58E9AA415F17F1AE7">
<enum>(e)</enum>
<header>Elite Federal Disaster Teams</header>
<text>The Surgeon General, in consultation with the Secretary, the Director of the Centers for Disease Control and Prevention, and other appropriate military and Federal government agencies, shall develop criteria for the appointment of highly qualified Track faculty, medical, dental, physician assistant, pharmacy, behavioral and mental health, public health, and nursing students, and graduates to elite Federal disaster preparedness teams to train and to respond to public health emergencies, natural disasters, bioterrorism events, and other emergencies.</text>
</subsection>
<subsection id="PB6D9ADA094054EC5B8C633CF8E4EB5AD">
<enum>(f)</enum>
<header>Student Dropped From Track in Affiliate School</header>
<text>A medical, dental, physician assistant, pharmacy, behavioral and mental health, public health, or nursing student who, under regulations prescribed by the Surgeon General, is dropped from the Track in an affiliated school for deficiency in conduct or studies, or for other reasons, shall be liable to the United States for all tuition and stipend support provided to the student.</text>
</subsection>
</section>
<section id="PD32BBE6606DE4857A8D2D65A0F52D188">
<enum>274.</enum>
<header>AUTHORIZATION OF APPROPRIATIONS</header>
<text display-inline="no-display-inline">There is authorized to be appropriated to carry out this part, section 338A-1, and section 749, such sums as may be necessary.</text>
</section>
</part>
<after-quoted-block>.</after-quoted-block>
</quoted-block>
</section>
<section id="PB71325EFFF734184B84DF59D08455469">
<enum>206.</enum>
<header>MEDICAL EDUCATION DEBT REIMBURSEMENT FOR PHYSICIANS OF THE VETERANS HEALTH ADMINISTRATION</header>
<subsection id="PDFB8526807D14A15830164F181A45682">
<enum>(a)</enum>
<header>In General</header>
<text>The Secretary of Veterans Affairs shall carry out a program under which eligible physicians described in subsection (b) are reimbursed for the education debt of such physicians as described in subsection (c).</text>
</subsection>
<subsection id="P26539402707C4A889FC1D17054461569">
<enum>(b)</enum>
<header>Eligible Physicians</header>
<text>An eligible physician described in this subsection is any physician currently appointed to a physician position in the Veterans Health Administration under section <usc-ref title="38" section="7402" provision="(b)(1)">7402(b)(1)</usc-ref> of title 38, United States Code, who enters into an agreement with the Secretary to continue serving as a physician in such position for such period of time as the Secretary shall specify in the agreement.</text>
</subsection>
<subsection id="PF47F1A0443924E6EAEDB146C5621C807">
<enum>(c)</enum>
<header>Covered Education Debt</header>
<text>The education debt for which an eligible physician may be reimbursed under this section is any amount paid by the physician for tuition, room and board, or expenses in obtaining the degree of doctor or medicine or of doctor of osteopathy, including any amounts of principal or interest paid by the physician under a loan, the proceeds of which were used by or on behalf of the physician for the costs of obtaining such degree.</text>
</subsection>
<subsection id="PEF8DEE44EFD049C9987832FEF4D879BC">
<enum>(d)</enum>
<header>Frequency of Reimbursement</header>
<text>Any reimbursement of an eligible physician under this section shall be made in a lump sum or in installments of such frequency as the Secretary shall specify the agreement of the physician as required under subsection (b).</text>
</subsection>
<subsection id="P893A2F6769474D4D943E6D015511D14D">
<enum>(e)</enum>
<header>Liability for Failure To Complete Obligated Service</header>
<text>Any eligible physician who fails to satisfactorily complete the period of service agreed to by the physician under subsection (b) shall be liable to the United States in an amount determined in accordance with the provisions of section <usc-ref title="38" section="7617" provision="(c)(1)">7617(c)(1)</usc-ref> of title 38, United States Code.</text>
</subsection>
<subsection id="P79573B0003804917B1DCF60E0C91CAC3">
<enum>(f)</enum>
<header>Treatment of Reimbursement With Other Pay and Benefit Authorities</header>
<text>Any amount of reimbursement payable to an eligible physician under this section is in addition to any other pay, allowances, or benefits that may be provided the physician under law, including any educational assistance under the Department of Veterans Affairs Health Professional Educational Assistance Program under chapter 76 of title 38, United States Code.</text>
</subsection>
</section>
<section id="PB9255C0EFA65466EA0F461FDC5293045">
<enum>207.</enum>
<header>PROMOTING EDUCATION AND TRAINING OF PSYCHOLOGISTS TO PROVIDE MENTAL AND BEHAVIORAL HEALTH SERVICES TO UNDERSERVED POPULATIONS</header>
<text display-inline="no-display-inline">Part E of title VII of the <act-ref scope="public" congress="78" type="chapter" number="373" session="2">Public Health Service Act</act-ref> (<usc-ref title="42" section="294n">42 U.S.C. 294n</usc-ref> et seq.) is amended by adding at the end the following:</text>
<quoted-block id="PB78A02FDE59F4E279D47C358E4CCF220">
<subpart id="P657D0D5139054234B9BBFC23622D72D6">
<enum>3</enum>
<header>Mental and Behavioral Health Care Workforce</header>
<section id="P28BB010AED7A41E6A31E40026D346C59">
<enum>775.</enum>
<header>PROGRAM FOR GRADUATE EDUCATION AND TRAINING IN PSYCHOLOGY</header>
<subsection id="P51F3434107F746B99E5F45A2D54D4EF2">
<enum>(a)</enum>
<header>In General</header>
<text>The Secretary may award grants, cooperative agreements, and contracts to accredited doctoral, internship, and residency programs in psychology for the development and implementation of programs to provide interdisciplinary training in integrated health care settings to students in doctoral psychology programs, including interns and residents in such programs. Any training funded by such grants, cooperative agreements, or contracts shall focus on the needs of underserved populations.</text>
</subsection>
<subsection id="P429FB9A7E12F49BFB60947560EA55889">
<enum>(b)</enum>
<header>Eligibility</header>
<text>To be eligible to receive an award under this section an entity shall—</text>
<paragraph id="PDEE86B094C344C42BE2315B3C2977B03">
<enum>(1)</enum>
<text>provide training at or through an accredited doctoral program in psychology, including an internship or residency program; and</text>
</paragraph>
<paragraph id="P58EC71B2EBB84A7E87464078BC7DCEAF">
<enum>(2)</enum>
<text>prepare and submit to the Secretary an application at such time, in such manner, and containing such information as the Secretary may require.</text>
</paragraph>
</subsection>
<subsection id="P24FDDB724AC34CFA8A84E678C6F3D125">
<enum>(c)</enum>
<header>Evaluation of Programs</header>
<text>The Secretary shall evaluate any program implemented through an award under this section in order to determine the effect of such program on increasing the number of psychologists who provide mental and behavioral health services to underserved populations.</text>
</subsection>
<subsection id="PD04656AC60FA44A692B8EC576B5C61CF">
<enum>(d)</enum>
<header>Definitions</header>
<text>For purposes of this section—</text>
<paragraph id="P082DF19EE16D4D91A1ED163666A20F51">
<enum>(1)</enum>
<text>the term <quote>underserved population</quote> means individuals, especially older adults, children, chronically ill individuals, victims of abuse or trauma, and victims of combat- or war-related stress disorders, including post-traumatic stress disorder and traumatic brain injury, and their families, living in an urban or rural area that has a shortage of mental or behavioral health services; and</text>
</paragraph>
<paragraph id="P4C5B8D61D86C42AE8DC048597AC7B188">
<enum>(2)</enum>
<text>the term <quote>interdisciplinary training</quote> means training for graduate psychology students with 1 or more of the other health professions, including medicine, nursing, dentistry, and pharmacy.</text>
</paragraph>
</subsection>
<subsection id="P5F20675BF60A4D658B49AEC1901807B1">
<enum>(e)</enum>
<header>Authorization of Appropriations</header>
<text>To carry out this section, there is authorized to be appropriated $10,000,000 for fiscal year 2010, $12,000,000 for fiscal year 2011, $14,000,000 for fiscal year 2012, $16,000,000 for fiscal year 2013, and $18,000,000 for fiscal year 2014.</text>
</subsection>
</section>
</subpart>
<after-quoted-block>.</after-quoted-block>
</quoted-block>
</section>
<enum>III</enum>
<header>HEALTH PROFESSIONAL TRAINING PIPELINE PARTNERSHIPS PROGRAM</header>
<section id="PC15C3729FFCF4645B8B4F8EB5FBBCF98">
<enum>301.</enum>
<header>GRANTS TO PREPARE STUDENTS FOR CAREERS IN HEALTH CARE</header>
<subsection id="P4D1A76FE10844CAFB318BBD70706DD97">
<enum>(a)</enum>
<header>Purpose</header>
<text>The purpose of this section is to support the development and implementation of programs designed to prepare middle school and high school students for study and careers in the healthcare field, including success in postsecondary mathematics and science programs.</text>
</subsection>
<subsection id="PD0205AD4D2A548789FF4184059994F8E">
<enum>(b)</enum>
<header>Definitions</header>
<text>In this section:</text>
<paragraph id="PE32E45E3B0EF4340ACE41598592C00FF">
<enum>(1)</enum>
<header>Children from low-income families</header>
<text>The term <quote>children from low-income families</quote> means children described in section 1124(c)(1)(A) of the <act-ref scope="public" congress="89" type="law" number="10" session="1">Elementary and Secondary Education Act of 1965</act-ref> (<usc-ref title="20" section="6333" provision="(c)(1)(A)">20 U.S.C. 6333(c)(1)(A)</usc-ref>).</text>
</paragraph>
<paragraph id="P6FF8DFC545A64B89BC7A2DF004A90DEE">
<enum>(2)</enum>
<header>Eligible recipients</header>
<text>The term <quote>eligible recipient</quote> means—</text>
<subparagraph id="PC457B9C4756848C6A1F80EA727EC7871">
<enum>(A)</enum>
<text>a nonprofit healthcare career pathway partnership organization; or</text>
</subparagraph>
<subparagraph id="P7FA6B02D31B04CC09850902353EC7B05">
<enum>(B)</enum>
<text>a high-need local educational agency in partnership with—</text>
<clause id="PA3530AA4B922475892EDABD4E292A8FC">
<enum>(i)</enum>
<text>not less than 1 institution of higher education with an established health profession education program; and</text>
</clause>
<clause id="PD1A1D4F29179451B8904EBAB5491A1BA">
<enum>(ii)</enum>
<text>not less than 1 community-based, private sector healthcare provider organization.</text>
</clause>
</subparagraph>
</paragraph>
<paragraph id="P93158935343E417B93B4C014C2FE6E0D">
<enum>(3)</enum>
<header>High-need local educational agency</header>
<text>The term <quote>high-need local educational agency</quote> means a local educational agency or educational service agency—</text>
<subparagraph id="PC38EA99E965E45B1B0D8737C0FD36489">
<enum>(A)</enum>
<text>that serves not fewer than 10,000 children from low-income families;</text>
</subparagraph>
<subparagraph id="PA6418CFABF2D4545A4A411FCF4C4FED0">
<enum>(B)</enum>
<text>for which not less than 20 percent of the children served by the agency are children from low-income families;</text>
</subparagraph>
<subparagraph id="PEA1A1A6517B143B2B0DEEC660A8632CF">
<enum>(C)</enum>
<text>that meets the eligibility requirements for funding under the Small, Rural School Achievement Program under section 6211(b) of the <act-ref scope="public" congress="89" type="law" number="10" session="1">Elementary and Secondary Education Act of 1965</act-ref> (<usc-ref title="20" section="7345" provision="(b)">20 U.S.C. 7345(b)</usc-ref>); or</text>
</subparagraph>
<subparagraph id="PAB16107CBFA44D268FD07E365B061FF6">
<enum>(D)</enum>
<text>that meets the eligibility requirements for funding under the Rural and Low-Income School Program under section 6221(b)(1) of the <act-ref scope="public" congress="89" type="law" number="10" session="1">Elementary and Secondary Education Act of 1965</act-ref> (<usc-ref title="20" section="7351" provision="(b)(1)">20 U.S.C. 7351(b)(1)</usc-ref>).</text>
</subparagraph>
</paragraph>
<paragraph id="P1C68576DA8F04FA7BFE924D9F263B8DF">
<enum>(4)</enum>
<header>Nonprofit healthcare career pathway partnership organization</header>
<text>The term <quote>nonprofit healthcare career pathway partnership organization</quote> means a nonprofit organization focused on developing career and educational pathways to healthcare professions, that shall include representatives of—</text>
<subparagraph id="P98D83BDD333F45E3ACA6FEAE59B3E248">
<enum>(A)</enum>
<text>the local educational agencies;</text>
</subparagraph>
<subparagraph id="P7CCCEDE07E384F2096ABD31F5279CB89">
<enum>(B)</enum>
<text>not less than 1 institution of higher education (as defined in section 101(a) of the <act-ref scope="public" congress="89" type="law" number="329" session="1">Higher Education Act of 1965</act-ref> (<usc-ref title="20" section="1001" provision="(a)">20 U.S.C. 1001(a)</usc-ref>)) with an established health profession education program; and</text>
</subparagraph>
<subparagraph id="PA4AD09BF9F0141F1A88E45436E25C9E8">
<enum>(C)</enum>
<text>not less than 1 community-based, private sector healthcare provider organization or other healthcare industry organization.</text>
</subparagraph>
</paragraph>
<paragraph id="P6B1EFE594F6A46B4B80959FD48372BA8">
<enum>(5)</enum>
<header>Secretary</header>
<text>The term <quote>Secretary</quote> means the Secretary of Education.</text>
</paragraph>
</subsection>
<subsection id="PAC568FBABAA044D68407AC43A13A4564">
<enum>(c)</enum>
<header>Grants Authorized</header>
<paragraph id="P3ACD122D69D044838E7E18B659293A89">
<enum>(1)</enum>
<header>In general</header>
<text>The Secretary is authorized to award grants, on a competitive basis, to eligible recipients to enable the recipients to develop and implement programs of study to prepare middle school and high school students for postsecondary education leading to careers in the healthcare field.</text>
</paragraph>
<paragraph id="P0BFEA81FDE564CEDB3365B1B975EC968">
<enum>(2)</enum>
<header>Minimum funding level</header>
<text>Grants shall be awarded at a minimum level of $500,000 per recipient, per year.</text>
</paragraph>
<paragraph id="P52F4F5A18E284A96B3B31B4A81B908E4">
<enum>(3)</enum>
<header>Renewability</header>
<text>Grants may be renewed, at the discretion of the Secretary, for not more than 5 years.</text>
</paragraph>
</subsection>
<subsection id="P5AB79C3303284B358E8C07205BCBDBD8">
<enum>(d)</enum>
<header>Application</header>
<text>Each eligible recipient desiring a grant under this section shall submit an application to the Secretary at such time, in such manner, and containing such information as the Secretary may require, which shall include an assurance that the recipient will meet the program requirements described in subsection (f)(2).</text>
</subsection>
<subsection id="PF6B07D2248924868860EEC8520060105">
<enum>(e)</enum>
<header>Priority</header>
<text>In awarding grants under this section, the Secretary shall give priority to—</text>
<paragraph id="PA8AEAB8C4B3A4F5E9A8B5B1BBF4AB2B9">
<enum>(1)</enum>
<text>applicants that include a local educational agency that is located in an area that is designated under section 332(a)(1)(A) of the <act-ref scope="public" congress="78" type="chapter" number="373" session="2">Public Health Service Act</act-ref> (<usc-ref title="42" section="254e" provision="(a)(1)(A)">42 U.S.C. 254e(a)(1)(A)</usc-ref>) as a health professional shortage area;</text>
</paragraph>
<paragraph id="P0E97F86E2C0E463BBEA986C42776B8A2">
<enum>(2)</enum>
<text>applicants that include an institution of higher education that emphasizes an interdisciplinary approach to health profession education; and</text>
</paragraph>
<paragraph id="P79F5B1928D154C279DE512134D6C6774">
<enum>(3)</enum>
<text>applicants whose program involves the development of a uniquely innovative public-private partnership.</text>
</paragraph>
</subsection>
<subsection id="PA42FA02029EB48F3A34833A8BF8DBC0E">
<enum>(f)</enum>
<header>Authorized Activities/use of Funds</header>
<paragraph id="PF71D815185CD40FFABC832A3DA7A2AAE">
<enum>(1)</enum>
<header>In general</header>
<text>Each eligible recipient that receives a grant under this section shall use the grant funds to develop and implement programs of study to prepare middle school and high school students for careers in the healthcare field that—</text>
<subparagraph id="PB5CD9832A26D4BC4BF05D4913C03EBAE">
<enum>(A)</enum>
<text>are aligned with State challenging academic content standards and State challenging student academic achievement standards; and</text>
</subparagraph>
<subparagraph id="P696CA07F08CE448B884E40815722F3EC">
<enum>(B)</enum>
<text>lead to high school graduation with the skills and preparation—</text>
<clause id="P410CCB9D19F24742A0B8A73C485988FA">
<enum>(i)</enum>
<text>to enter postsecondary education programs of study in mathematics and science without remediation; and</text>
</clause>
<clause id="PEDEE1A25D1424744A76AB34CC35396DA">
<enum>(ii)</enum>
<text>necessary to enter healthcare jobs directly.</text>
</clause>
</subparagraph>
</paragraph>
<paragraph id="PE9AD33BD426041FC953AD91B0F9F1AC2">
<enum>(2)</enum>
<header>Program requirements</header>
<text>A program of study described in paragraph (1) shall—</text>
<subparagraph id="PB17B04372EC94234B2A1994FBF111A1F">
<enum>(A)</enum>
<text>involve a review and identification of the content knowledge and skills students who enter institutions of higher education and the workforce need to have in order to succeed in the healthcare field;</text>
</subparagraph>
<subparagraph id="P7899945654C84285BC342B353815825E">
<enum>(B)</enum>
<text>promote the alignment of mathematics and science curricula and assessments in middle school and high school and facilitate learning of the required knowledge and skills identified in subparagraph (A);</text>
</subparagraph>
<subparagraph id="P2FA30386B81741659CE74ED16CC2C3BE">
<enum>(C)</enum>
<text>include an outreach component to educate middle school and high school students and their parents about the full range of employment opportunities in the healthcare field, specifically in the local community;</text>
</subparagraph>
<subparagraph id="P69F42431110E41ECB9845DE4E9956D27">
<enum>(D)</enum>
<text>include specific opportunities for youth to interact with healthcare professionals or industry representatives in the classroom, school, or community locations and how these experiences will be integrated with coursework;</text>
</subparagraph>
<subparagraph id="P374E71917FDE407B85F48CB86B218388">
<enum>(E)</enum>
<text>include high-quality volunteer or internship experiences, integrated with coursework;</text>
</subparagraph>
<subparagraph id="P284CD865264C435AA989FB3CBDF9C3F2">
<enum>(F)</enum>
<text>provide high-quality mentoring, counseling, and career counseling support services to program participants;</text>
</subparagraph>
<subparagraph id="PBBEE2833F51F42AB950FA035AB2ED8DA">
<enum>(G)</enum>
<text>consider the inclusion of a distance-learning component or similar education technology that would expand opportunities for geographically isolated individuals;</text>
</subparagraph>
<subparagraph id="PD0DD2617DD244B0590128DE74EF7CF05">
<enum>(H)</enum>
<text>encourage the participation of individuals who are members of groups that are underrepresented in postsecondary education programs in mathematics and science;</text>
</subparagraph>
<subparagraph id="P8AA3642686174EB298C17ED0F57C769F">
<enum>(I)</enum>
<text>encourage participants to seek work in communities experiencing acute health professional shortages; and</text>
</subparagraph>
<subparagraph id="PF3D59B5D6675430E8A11BF6850FE2660">
<enum>(J)</enum>
<text>collect data, and analyze the data using measurable objectives and benchmarks, to evaluate the extent to which the program succeeded in—</text>
<clause id="P65717E5897CF4A3891EAF135C3ABF11D">
<enum>(i)</enum>
<text>increasing student and parent awareness of occupational opportunities in the healthcare field;</text>
</clause>
<clause id="P031BFADA4283443E977B9A78C5ABA7DB">
<enum>(ii)</enum>
<text>improving student academic achievement in mathematics and science;</text>
</clause>
<clause id="P440087B0D1DA4521A5138D796421F3EC">
<enum>(iii)</enum>
<text>increasing the number of students entering health care professions upon graduation; and</text>
</clause>
<clause id="P97CE9908AE4C48E8A7846D8140EA3AB1">
<enum>(iv)</enum>
<text>increasing the number of students pursuing secondary education or training opportunities with the potential to lead to a career in the healthcare field.</text>
</clause>
</subparagraph>
</paragraph>
<paragraph id="P7F0EA8A355144534A542C7110F80E397">
<enum>(3)</enum>
<header>Planning grant set aside</header>
<text>Each eligible recipient that receives a grant under this section shall set aside 10 percent of the grant funds for planning and program development purposes.</text>
</paragraph>
</subsection>
<subsection id="P01918BEA2D4D4BA5A86F3D7CF49E0CCE">
<enum>(g)</enum>
<header>Matching Requirement</header>
<text>Each eligible recipient that receives a grant under this section shall provide, from the private sector, an amount equal to 40 percent of the amount of the grant, in cash or in kind, to carry out the activities supported by the grant.</text>
</subsection>
<subsection id="PC9F2A7F521B84A66BA337C0A7E473A92">
<enum>(h)</enum>
<header>Reports</header>
<paragraph id="P69737DEC242B437C9D5CE712F644DE9B">
<enum>(1)</enum>
<header>Annual evaluation</header>
<text>Each eligible recipient that receives a grant under this section shall collect and report to the Secretary annually such information as the Secretary may reasonably require, including—</text>
<subparagraph id="P5A31329BFAEC4307B756DEA850B75DA8">
<enum>(A)</enum>
<text>the number of schools involved and student participants in the program;</text>
</subparagraph>
<subparagraph id="P4CC5A7E4372E4B6DAF885AA24166E693">
<enum>(B)</enum>
<text>the race, gender, socio-economic status, and disability status of program participants;</text>
</subparagraph>
<subparagraph id="P0B2532F31786431B85FDFFC79F775DFC">
<enum>(C)</enum>
<text>the number of program participants who successfully graduated from high school;</text>
</subparagraph>
<subparagraph id="PB507984D553843D2B8656F985C93EF05">
<enum>(D)</enum>
<text>the number of program participants who reported enrollment in some form of postsecondary education with the potential to lead to a career in the healthcare field;</text>
</subparagraph>
<subparagraph id="P3A8801E150C647E8B27DDF22BA279DEF">
<enum>(E)</enum>
<text>the number of program participants who entered a paid position, either part-time or full-time, in the healthcare field following participation in the program; and</text>
</subparagraph>
<subparagraph id="PB87ABB3FB1054FA1870BB893D4B9A989">
<enum>(F)</enum>
<text>the data and analysis required under subsection (f)(2)(J).</text>
</subparagraph>
</paragraph>
<paragraph id="P09266D8994DB41F281347A620AEBC9A8">
<enum>(2)</enum>
<header>Report</header>
<text>Not later than 3 years after the date of enactment of this section, the Secretary shall submit to Congress an interim report on the results of the evaluations conducted under paragraph (1).</text>
</paragraph>
</subsection>
<subsection id="PE0E17383CCAA4F58B5CCFA4305729CA6">
<enum>(i)</enum>
<header>Authorization and Appropriation</header>
<paragraph id="PA11923482CFD49BAAFA9ECF4E8449D3C">
<enum>(1)</enum>
<header>In general</header>
<text>There are authorized to be appropriated $100,000,000 for each of fiscal years 2009 through 2013 to carry out this section.</text>
</paragraph>
<paragraph id="PEDB862CA926244DAB0B2B1DFC56E1F85">
<enum>(2)</enum>
<header>Administrative costs</header>
<text>For the costs of administering this section, including the costs of evaluating the results of grants and submitting reports to the Congress, there are authorized to be appropriated such sums as may be necessary for each of fiscal years 2009 through 2013.</text>
</paragraph>
</subsection>
</section>