H.R. 3200/Division C/Title II/Subtitle A/Part 2

PART 2 — PROMOTION OF PRIMARY CARE AND DENTISTRY

Sec. 2211. Frontline Health Providers.

Part D of title III (42 U.S.C. 254b et seq.) is amended by adding at the end the following:

``SUBPART XI—HEALTH PROFESSIONAL NEEDS AREAS

``SEC. 340H. IN GENERAL.

``(a) Program.—The Secretary, acting through the Administrator of the Health Resources and Services Administration, shall establish a program, to be known as the Frontline Health Providers Loan Repayment Program, to address unmet health care needs in health professional needs areas through loan repayments under section 340I.

``(b) Designation of health professional needs areas.—

``(1) In general.—In this subpart, the term ‘health professional needs area’ means an area, population, or facility that is designated by the Secretary in accordance with paragraph (2).

``(2) Designation.—To be designated by the Secretary as a health professional needs area under this subpart:

``(A) In the case of an area, the area must be a rational area for the delivery of health services.

``(B) The area, population, or facility must have, in one or more health disciplines, specialties, or subspecialties for the population served, as determined by the Secretary—

``(i) insufficient capacity of health professionals; or

``(ii) high needs for health services.

``(C) With respect to the delivery of primary health services, the area, population, or facility must not include a health professional shortage area (as designated under section 332), except that the area, population, or facility may include such a health professional shortage area to which no member of the National Health Service Corps is currently assigned.

``(c) Eligibility.—To be eligible to participate in the Program, an individual shall—

``(1) hold a degree in a course of study or program (approved by the Secretary) from a school defined in section 799B(1)(A) (other than a school of public health);

``(2) hold a degree in a course of study or program (approved by the Secretary) from a school or program defined in subparagraph (C), (D), or (E)(4) of section 799B(1), as designated by the Secretary;

``(3) be enrolled as a full-time student—

``(A) in a school or program defined in subparagraph (C), (D), or (E)(4) of section 799B(1), as designated by the Secretary, or a school described in paragraph (1); and

``(B) in the final year of a course of study or program, offered by such school or program and approved by the Secretary, leading to a degree in a discipline referred to in subparagraph (A) (other than a graduate degree in public health), (C), (D), or (E)(4) of section 799B(1);

``(4) be a practitioner described in section 1842(b)(18)(C) or 1848(k)(3)(B)(iii) or (iv) of the Social Security Act; or

``(5) be a practitioner in the field of respiratory therapy, medical technology, or radiologic technology.

``(d) Definition.—In this subpart, the term ‘primary health services’ has the meaning given to such term in section 331(a)(3)(D).

``SEC. 340I. LOAN REPAYMENTS.

``(a) Loan repayments.—The Secretary, acting through the Administrator of the Health Resources and Services Administration, shall enter into contracts with individuals under which—

``(1) the individual agrees—

``(A) to serve as a full-time primary health services provider or as a full-time or part-time provider of other health services for a period of time equal to 2 years or such longer period as the individual may agree to;

``(B) to serve in a health professional needs area in a health discipline, specialty, or a subspecialty for which the area, population, or facility is designated as a health professional needs area under section 340H; and

``(C) in the case of an individual described in subsection 340H(c)(3) who is in the final year of study and who has accepted employment as primary health services provider or provider of other health services in accordance with subparagraphs (A) and (B), to complete the education or training and maintain an acceptable level of academic standing (as determined by the educational institution offering the course of study or training); and

``(2) the Secretary agrees to pay, for each year of such service, an amount on the principal and interest of the undergraduate or graduate educational loans (or both) of the individual that is not more than 50 percent of the average award made under the National Health Service Corps Loan Repayment Program under subpart III in that year.

``(b) Practice setting.—A contract entered into under this section shall allow the individual receiving the loan repayment to satisfy the service requirement described in subsection (a)(1) through employment in a solo or group practice, a clinic, an accredited public or private nonprofit hospital, or any other health care entity, as deemed appropriate by the Secretary.

``(c) Application of certain provisions.—The provisions of subpart III of part D shall, except as inconsistent with this section, apply to the loan repayment program under this subpart in the same manner and to the same extent as such provisions apply to the National Health Service Corps Loan Repayment Program established under section 338B.

``(d) Insufficient number of applicants.—If there are an insufficient number of applicants for loan repayments under this section to obligate all appropriated funds, the Secretary shall transfer the unobligated funds to the National Health Service Corps for the purpose of—

``(1) recruitment of sufficient applicants for the National Health Service Corps for the following year; or

``(2) making additional loan repayments under section 338B if there is an excess number of qualified applicants for loan repayments under such section.

``SEC. 340J. REPORT.

``The Secretary shall submit to the Congress an annual report on the program carried out under this subpart.

``SEC. 340K. ALLOCATION.

``Of the amount of funds obligated under this subpart each fiscal year for loan repayments—

``(1) 90 percent shall be for physicians and other health professionals providing primary health services; and

``(2) 10 percent shall be for health professionals not described in paragraph (1).´´.

Sec. 2212. Primary Care Student Loan Funds.

(a) Loan Provisions.—

Section 722 (42 U.S.C. 292r) is amended by striking subsection (e) and inserting the following:

``(e) Rate of interest.—Such loans shall bear interest, on the unpaid balance of the loan, computed only for periods for which the loan is repayable, at the rate of 2 percentage points less than the applicable rate of interest described in section 427A(l)(1) of the Higher Education Act of 1965 per year.´´.

(b) Medical Schools and Primary Health Care.—

Subsection (a) of section 723 (42 U.S.C. 292s) is amended—

(1) in paragraph (1), by striking subparagraph (B) and inserting the following:

``(B) to practice in such care for 10 years (including residency training in primary health care) or through the date on which the loan is repaid in full, whichever occurs first.´´; and

(2) by striking paragraph (3) and inserting the following:

``(3) Noncompliance by student.—If an individual fails to comply with an agreement entered into pursuant to paragraph (1), such agreement shall provide that the total interest to be paid on the loan, over the course of the loan period, shall equal the total amount of interest that would have been incurred by the individual if, from the outset of the loan, the loan was repayable at the rate of interest described in section 427A(l)(1) of the Higher Education Act of 1965 per year instead of the rate of interest described in section 722(e).´´.

(c) Student Loan Guidelines.—

(1) In general.—

Section 735 (42 U.S.C. 292y) is amended—

(A) by redesignating subsection (f) as subsection (g); and

(B) by inserting after subsection (e) the following:

``(f) Determination of financial need.—The Secretary—

``(1) may require, or authorize a school or other entity to require, the submission of financial information to determine the financial resources available to any individual seeking assistance under this subpart; and

``(2) shall take into account the extent to which such individual is financially independent in determining whether to require or authorize the submission of such information regarding such individual’s family members.´´.

(2) Revised guidelines.—

The Secretary of Health and Human Services shall—

(A) strike the second sentence of section 57.206(b) of title 42, Code of Federal Regulations; and

(B) make such other revisions to guidelines and regulations in effect as of the date of the enactment of this Act as may be necessary for consistency with the amendments made by paragraph (1).

Sec. 2213. Training in Family Medicine, General Internal Medicine, General Pediatrics, Geriatrics, and Physician Assistantship.

Section 747 (42 U.S.C. 293k) is amended—

(1) by amending the section heading to read as follows: ``Primary care training and enhancement´´;

(2) by redesignating subsection (e) as subsection (f); and

(3) by striking subsections (a) through (d) and inserting the following:

``(a) Program.—The Secretary shall establish a primary care training and capacity building program consisting of awarding grants and contracts under subsections (b) and (c).

``(b) Support and development of primary care training programs.—

``(1) In general.—The Secretary shall make grants to, or enter into contracts with, eligible entities—

``(A) to plan, develop, operate, or participate in an accredited professional training program, including an accredited residency or internship program, in the field of family medicine, general internal medicine, general pediatrics, or geriatrics for medical students, interns, residents, or practicing physicians;

``(B) to provide financial assistance in the form of traineeships and fellowships to medical students, interns, residents, or practicing physicians, who are participants in any such program, and who plan to specialize or work in family medicine, general internal medicine, general pediatrics, or geriatrics;

``(C) to plan, develop, operate, or participate in an accredited program for the training of physicians who plan to teach in family medicine, general internal medicine, general pediatrics, or geriatrics training programs including in community-based settings;

``(D) to provide financial assistance in the form of traineeships and fellowships to practicing physicians who are participants in any such programs and who plan to teach in a family medicine, general internal medicine, general pediatrics, or geriatrics training program; and

``(E) to plan, develop, operate, or participate in an accredited program for physician assistant education, and for the training of individuals who plan to teach in programs to provide such training.

``(2) Eligibility.—To be eligible for a grant or contract under paragraph (1), an entity shall be—

``(A) an accredited school of medicine or osteopathic medicine, public or nonprofit private hospital, or physician assistant training program;

``(B) a public or private nonprofit entity; or

``(C) a consortium of 2 or more entities described in subparagraphs (A) and (B).

``(c) Capacity building in primary care.—

``(1) In general.—The Secretary shall make grants to or enter into contracts with eligible entities to establish, maintain, or improve—

``(A) academic administrative units (including departments, divisions, or other appropriate units) in the specialties of family medicine, general internal medicine, general pediatrics, or geriatrics; or

``(B) programs that improve clinical teaching in such specialties.

``(2) Eligibility.—To be eligible for a grant or contract under paragraph (1), an entity shall be an accredited school of medicine or osteopathic medicine.

``(d) Preference.—In awarding grants or contracts under this section, the Secretary shall give preference to entities that have a demonstrated record of the following:

``(1) Training the greatest percentage, or significantly improving the percentage, of health care professionals who provide primary care.

``(2) Training individuals who are from underrepresented minority groups or disadvantaged backgrounds.

``(3) A high rate of placing graduates in practice settings having the principal focus of serving in underserved areas or populations experiencing health disparities (including serving patients eligible for medical assistance under title XIX of the Social Security Act or for child health assistance under title XXI of such Act or those with special health care needs).

``(4) Supporting teaching programs that address the health care needs of vulnerable populations.

``(e) Report.—The Secretary shall submit to the Congress an annual report on the program carried out under this section.

``(f) Definition.—In this section, the term ‘health disparities’ has the meaning given the term in section 3171.´´.

Sec. 2214. Training of Medical Residents in Community-based Settings.

Title VII (42 U.S.C. 292 et seq.) is amended—

(1) by redesignating section 748 as 749A; and

(2) by inserting after section 747 the following:

``SEC. 748. Training of medical residents in community-based settings.

``(a) Program.—The Secretary shall establish a program for the training of medical residents in community-based settings consisting of awarding grants or contracts under this section.

``(b) Development and operation of community-Based programs.—The Secretary shall make grants to, or enter into contracts with, eligible entities—

``(1) to plan and develop a new primary care residency training program, which may include—

``(A) planning and developing curricula;

``(B) recruiting and training residents and faculty; and

``(C) other activities designated to result in accreditation of such a program; or

``(2) to operate or participate in an established primary care residency training program, which may include—

``(A) planning and developing curricula;

``(B) recruitment and training of residents; and

``(C) retention of faculty.

``(c) Eligible entity.—To be eligible to receive a grant or contract under subsection (b), an entity shall—

``(1) be designated as a recipient of payment for the direct costs of medical education under section 1886(k) of the Social Security Act;

``(2) be designated as an approved teaching health center under section 1502(d) of the America’s Affordable Health Choices Act of 2009 and continuing to participate in the demonstration project under such section; or

``(3) be an applicant for designation described in paragraph (1) or (2) and have demonstrated to the Secretary appropriate involvement of an accredited teaching hospital to carry out the inpatient responsibilities associated with a primary care residency training program.

``(d) Preferences.—In awarding grants and contracts under paragraph (1) or (2) of subsection (b), the Secretary shall give preference to entities that—

``(1) support teaching programs that address the health care needs of vulnerable populations; or

``(2) are a Federally qualified health center (as defined in section 1861(aa)(4) of the Social Security Act) or a rural health clinic (as defined in section 1861(aa)(2) of such Act).

``(e) Additional preferences for established programs.—In awarding grants and contracts under subsection (b)(2), the Secretary shall give preference to entities that have a demonstrated record of training—

``(1) a high or significantly improved percentage of health care professionals who provide primary care;

``(2) individuals who are from underrepresented minority groups or disadvantaged backgrounds; or

``(3) individuals who practice in settings having the principal focus of serving underserved areas or populations experiencing health disparities (including serving patients eligible for medical assistance under title XIX of the Social Security Act or for child health assistance under title XXI of such Act or those with special health care needs).

``(f) Period of awards.—

``(1) In general.—The period of a grant or contract under this section—

``(A) shall not exceed 2 years for awards under subsection (b)(1); and

``(B) shall not exceed 5 years for awards under subsection (b)(2).

``(2) Special rules.—

``(A) An award of a grant or contract under subsection (b)(1) shall not be renewed.

``(B) The period of a grant or contract awarded to an entity under subsection (b)(2) shall not overlap with the period of any grant or contact awarded to the same entity under subsection (b)(1).

``(g) Report.—The Secretary shall submit to the Congress an annual report on the program carried out under this section.

``(h) Definitions.—In this section:

``(1) Primary care residency training program.—The term ‘primary care residency training program’ means an approved medical residency training program described in section 1886(h)(5)(A) of the Social Security Act that is—

``(A) in the case of entities seeking awards under subsection (b)(1), actively applying to be accredited by the Accreditation Council for Graduate Medical Education; or

``(B) in the case of entities seeking awards under subsection (b)(2), so accredited.

``(2) Health disparities.—The term ‘health disparities’ has the meaning given the term in section 3171.´´.

Sec. 2215. Training for General, Pediatric, and Public Health Dentists and Dental Hygienists.

Title VII (42 U.S.C. 292 et seq.) is amended—

(1) in section 791(a)(1), by striking ``747 and 750´´ and inserting ``747, 749, and 750´´; and

(2) by inserting after section 748, as added, the following:

``SEC. 749. Training for general, pediatric, and public health dentists and dental hygienists.

``(a) Program.—The Secretary shall establish a dental medicine training program consisting of awarding grants and contracts under this section.

``(b) Support and development of dental training programs.—The Secretary shall make grants to, or enter into contracts with, eligible entities—

``(1) to plan, develop, operate, or participate in an accredited professional training program for oral health professionals;

``(2) to provide financial assistance to oral health professionals who are in need thereof, who are participants in any such program, and who plan to work in general, pediatric, or public health dentistry, or dental hygiene;

``(3) to plan, develop, operate, or participate in a program for the training of oral health professionals who plan to teach in general, pediatric, or public health dentistry, or dental hygiene;

``(4) to provide financial assistance in the form of traineeships and fellowships to oral health professionals who plan to teach in general, pediatric, or public health dentistry or dental hygiene;

``(5) to establish, maintain, or improve—

``(A) academic administrative units (including departments, divisions, or other appropriate units) in the specialties of general, pediatric, or public health dentistry; or

``(B) programs that improve clinical teaching in such specialties;

``(6) to plan, develop, operate, or participate in predoctoral and postdoctoral training in general, pediatric, or public health dentistry programs, or training for dental hygienists;

``(7) to plan, develop, operate, or participate in a loan repayment program for full-time faculty in a program of general, pediatric, or public health dentistry; and

``(8) to provide technical assistance to pediatric dental training programs in developing and implementing instruction regarding the oral health status, dental care needs, and risk-based clinical disease management of all pediatric populations with an emphasis on underserved children.

``(c) Eligibility.—To be eligible for a grant or contract under subsection (a), an entity shall be—

``(1) an accredited school of dentistry, training program in dental hygiene, or public or nonprofit private hospital;

``(2) a training program in dental hygiene at an accredited institution of higher education;

``(3) a public or private nonprofit entity; or

``(4) a consortium of—

``(A) 2 or more of the entities described in paragraphs (1) through (3); and

``(B) an accredited school of public health.

``(d) Preference.—In awarding grants or contracts under this section, the Secretary shall give preference to entities that have a demonstrated record of the following:

``(1) Training the greatest percentage, or significantly improving the percentage, of oral health professionals who practice general, pediatric, or public health dentistry.

``(2) Training individuals who are from underrepresented minority groups or disadvantaged backgrounds.

``(3) A high rate of placing graduates in practice settings having the principal focus of serving in underserved areas or populations experiencing health disparities (including serving patients eligible for medical assistance under title XIX of the Social Security Act or for child health assistance under title XXI of such Act or those with special health care needs).

``(4) Supporting teaching programs that address the dental needs of vulnerable populations.

``(5) Providing instruction regarding the oral health status, dental care needs, and risk-based clinical disease management of all pediatric populations with an emphasis on underserved children.

``(e) Report.—The Secretary shall submit to the Congress an annual report on the program carried out under this section.

``(f) Definition.—In this section:

``(1) The term ‘health disparities’ has the meaning given the term in section 3171.

``(2) The term ‘oral health professional’ means an individual training or practicing—

``(A) in general dentistry, pediatric dentistry, public health dentistry, or dental hygiene; or

``(B) another dental medicine specialty, as deemed appropriate by the Secretary.´´.

Sec. 2216. Authorization of Appropriations.

(a) In General.—

Part F of title VII (42 U.S.C. 295j et seq.) is amended by adding at the end the following:

``SEC. 799C. Funding through Public Health Investment Fund.

``(a) Promotion of primary care and dentistry.—For the purpose of carrying out subpart XI of part D of title III and sections 723, 747, 748, and 749, in addition to any other amounts authorized to be appropriated for such purpose, there is authorized to be appropriated, out of any monies in the Public Health Investment Fund, the following:

``(1) $240,000,000 for fiscal year 2010.

``(2) $253,000,000 for fiscal year 2011.

``(3) $265,000,000 for fiscal year 2012.

``(4) $278,000,000 for fiscal year 2013.

``(5) $292,000,000 for fiscal year 2014.

``(6) $307,000,000 for fiscal year 2015.

``(7) $322,000,000 for fiscal year 2016.

``(8) $338,000,000 for fiscal year 2017.

``(9) $355,000,000 for fiscal year 2018.

``(10) $373,000,000 for fiscal year 2019.´´.

(b) Existing Authorizations of Appropriations.—

(1) Section 735.—

Paragraph (1) of section 735(g), as so redesignated, is amended by inserting ``and such sums as may be necessary for subsequent years through fiscal year 2019´´ before the period at the end.

(2) Section 747.—

Subsection (f), as so redesignated, of section 747 (42 U.S.C. 293k) is amended by striking ``2002´´ and inserting ``2019´´.