II
110th CONGRESS
1st Session
S. 896
IN THE SENATE OF THE UNITED STATES
March 15, 2007
Ms. Murkowski (for herself, Mr. Schumer, Mr. Stevens, and Mr. Sanders) introduced the following bill; which was read twice and referred to the Committee on Health, Education, Labor, and Pensions
A BILL
To amend the Public Health Service Act and the Social Security Act to increase the number of primary care physicians and medical residents serving health professional shortage areas, and for other purposes.
Short title
This Act may be cited as the
Physician Shortage Elimination Act of
2007
.
Findings
Congress finds the following:
The average life expectancy in the United States has increased to 80 years of age, causing an ever-increasing demand for medical care.
Medical school enrollment numbers have been virtually stagnant for the last 25 years.
During the last 20 years, median tuition and fees at medical schools have increased by 229 percent (122 percent adjusted for inflation) in private schools and by 479 percent (256 percent adjusted for inflation) in public schools.
The Association of American Medical Colleges, in its Statement on the Physician Workforce, dated June, 2006, called for an increase of 1,500 National Health Service Corps program awards per year to help meet the need for physicians caring for underserved populations and to help address rising medical student indebtedness.
The National Health Service Corps program has a proven record of supplying physicians to underserved areas, and has played an important role in expanding access for underserved populations in rural and inner city communities.
Continued expansion of the National Health Service Corps program is strongly recommended.
The growing debt incurred by graduating medical students is likely to increase the interest and willingness of graduates of United States medical schools to apply for National Health Service Corps program funding and awards.
One-third (250,000) of active physicians are over the age of 55 and are likely to retire in the next ten years, while the population will have increased by 24 percent. These demographic changes will cause the population-to-physician ratio to peak by the year 2020.
In 2005, the Council on Graduate Medical Education stated in a report to Congress that there will be a shortage of not fewer than 90,000 full-time physicians by 2020.
A decrease in Federal spending to carry out programs authorized by title VII of the Public Health Service Act threatens the viability of programs used to solve the problem of inadequate access to health care.
A continuing decline in the number of primary care physicians will lead to increased shortages of health care access in rural America.
There is a declining ability to recruit qualified medical students from rural and underserved areas, coupled with greater difficulty on the part of community health centers and other clinics to attract adequate personnel.
Individuals in many geographic areas, especially rural areas, lack adequate access to high quality preventive, primary and specialty health care, contributing to significant health disparities that impair America’s public health and economic productivity.
Barriers to adequate access most acutely affect community-based health care safety-net providers, including Community and Migrant Health Centers, Native American health centers, Rural Health Clinics, Critical Access Hospitals, public health departments, and their patients.
Area Health Education Centers and Health Education Training Centers provide a national network of community-based and governed entities, linked to community resources and academic centers, that provide an infrastructure to facilitate and implement partnerships and programs that successfully address each of these barriers, respond to the health needs of underserved communities and populations, and use educational interventions to reduce health disparities.
A collaborative process is needed between hospitals and non-hospital settings to maximize the potential of non-hospital health care training.
Amendments to the Public Health Service Act
Reauthorization of National Health Service Corps Scholarship Program and Loan Repayment Program
Reauthorization of appropriations
Section
338H(a) of the Public Health Service Act (42 U.S.C. 254q(a)) is amended by
striking $146,250,000
and all that follows through the period
and inserting $300,000,000 for each of fiscal years 2008 through
2012.
.
Scholarships for medical students
Section 338H of such Act is further amended by adding at the end the following:
Scholarships for medical students
For contracts for scholarships under this subpart to individuals who are accepted for enrollment, or enrolled, in a course of study or program described in section 338A(b)(1)(B) that leads to a degree in medicine or osteopathic medicine, the Secretary shall, of the amounts appropriated under subsection (a) for a fiscal year, obligate the greater of 10 percent or such amount as necessary to fund ongoing activities related to such contracts.
.
Reauthorization of certain programs providing grants for health professions training for diversity
Grants for centers of excellence
Section 736(h)(1) of the Public Health
Service Act (42
U.S.C. 293(h)(1)) is amended by striking
$26,000,000
and all that follows through 2002
and
inserting $33,610,000 for each of fiscal years 2008 through
2012
.
Educational assistance for individuals from disadvantaged backgrounds
Section
740(c) of such Act (42 U.S.C. 293d(c)) is amended by
striking $29,400,000
and all that follows through the period and
inserting $35,650,000 for each of fiscal years 2008 through
2012.
.
Expansion of residency training programs and primary care services offered by community health centers
Part C of title VII of the Public Health Service Act (42 U.S.C. 293k et seq.) is amended—
by adding before section 747 the following:
In general
; and
by adding after section 748 the following:
Additional programs
Grants to expand medical residency training programs at community health centers
Program authorized
The Secretary may make grants to community health centers—
to establish, at the centers, new or alternative-campus accredited medical residency training programs affiliated with a hospital or other health care facility; or
to fund new residency positions within existing accredited medical residency training programs at the centers and their affiliated partners.
Use of funds
Amounts from a grant under this section shall be used to cover the costs of establishing or expanding a medical residency training program described in subsection (a), including costs associated with—
curriculum development;
equipment acquisition;
recruitment, training, and retention of residents and faculty; and
residency stipends.
Applications
A community health center 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.
Preference
In selecting recipients for a grant under this section, the Secretary shall give preference to funding medical residency training programs focusing on primary health care.
Definition
In this section:
The term accredited, as applied to a new or alternative-campus medical residency training program, means a program that is accredited by a recognized body or bodies approved for such purpose by the Accreditation Council for Graduate Medical Education, except that a new medical residency training program that, by reason of an insufficient period of operation, is not eligible for accreditation on or before the date of submission of an application under subsection (c) shall be deemed accredited if the Accreditation Council for Graduate Medical Education finds, after consultation with the appropriate accreditation body or bodies, that there is reasonable assurance that the program will meet the accreditation standards of such body or bodies prior to the date of graduation of the first entering class in that program.
The term community health center means a health center as defined in section 330.
Grants to improve delivery of primary care services in community health centers
Primary care access grants
Program authorized
The Secretary, acting through the Administrator of the Health Resources and Services Administration, may make grants to community health centers for the purpose of increasing the number of medical service providers associated with such centers.
Grants
A recipient of a grant under this subsection shall be eligible to receive such grants for a total of 5 fiscal years.
Use of funds
A recipient of a grant under this subsection shall use amounts from the grant for one or more of the following activities:
To recruit residents for medical residency training programs at the community health center.
To establish a multi-community physician mentoring program to encourage upper level residents to remain in the State in which the community health center and medical residency training program are located.
To enter into contracts for technical assistance for the purpose of recruiting or retaining primary health care staff.
To enter into contracts for technical assistance in preparing contracts with local providers of primary health care to provide services for medically underserved communities.
Application
A community health center seeking a grant under this subsection shall submit an application to the Secretary at such time, in such manner, and containing such information as the Secretary may require.
Grants for primary care facility capital expenditures
Program authorized
The Secretary, acting through the Administrator of the Health Resources and Services Administration, may make grants to community health centers for the purpose of increasing primary health care capabilities through the construction, expansion, or renovation of facilities.
Grants
A recipient of a grant under this subsection shall be eligible to receive such grants for a total of 5 fiscal years.
Use of funds
A recipient of a grant under this subsection shall use amounts from the grant for one or more of the following activities:
To acquire or lease facilities.
To construct new facilities.
To repair or modernize existing facilities.
To purchase or lease medical equipment.
Definition
The term community health center means a health center as defined in section 330.
Authorization of appropriations
There is authorized to be appropriated $200,000,000 for fiscal year 2008 and such sums as may be necessary for each fiscal year thereafter to carry out this subpart.
.
Interdisciplinary, community-based programs
Area health education centers
Section 751(a) of the Public Health Service Act (42 U.S.C. 294a(a)) is amended—
in paragraph (1)(A)—
in
clause (i), by inserting at the end before the semicolon the following:
, with an emphasis on such personnel who focus on primary
care
;
by redesignating clauses (ii) through (vii) as clauses (iii) through (viii), respectively; and
by inserting after clause (i) the following:
foster and provide community-based training and education for health professions students in underserved communities and among underserved populations, including but not limited to the National Health Service Corps, community and migrant health centers, rural health clinics, critical access hospitals, tribal health clinics, and public health departments;
; and
by adding at the end the following:
Point of service enhancement grants
In general
The Secretary may award grants to entities receiving an award under paragraph (1) or (2) to improve the effectiveness of the programs operated by such entities or to enable the entities to respond to changes affecting such entities arising since the date of the receipt of the award under paragraph (1) or (2).
Application
To receive an award under this paragraph, an entity described under subparagraph (A) shall submit to the Secretary an application at such time, in such manner, and containing such information as the Secretary may require, including an explanation of the changes affecting such entity arising since the date of the receipt by the entity of the award under paragraph (1) or (2), such as changes in the demographics of the area served, the needs of the population served, and the situations encountered by such population and such entity.
.
Authorization of appropriations
Section 757 of the Public Health Service Act (42 U.S.C. 294g) is amended—
in subsection
(a), by striking $55,600,000
and all that follows through
2002
and inserting $125,000,000 for fiscal year 2008 and
such sums as may be necessary for each of fiscal years 2009 through
2012
;
by striking subsection (b) and inserting the following:
Allocation
In general
Of the amounts appropriated under subsection (a) that the Secretary makes available for each fiscal year to carry out section 751, the Secretary shall obligate—
for awards under paragraph (1) of section 751(a), not more than 25 percent of such amounts in each fiscal year; and
for awards under paragraphs (2) and (3) of section 751(a), not less than 60 percent of such amounts in each fiscal year.
; and
in subsection (c), by—
striking the subsection designation and heading and inserting the following:
Sense of the Congress
It is the sense of the Congress that—
.
striking paragraph (1); and
in paragraph (2), by—
striking the
paragraph designation and all that follows through Congress
that—
; and
redesignating subparagraphs (A) and (B) as paragraphs (1) and (2) and indenting appropriately.
Amendments to the Social Security Act
Clarification of congressional intent regarding the counting of residents in a nonhospital setting
D–GME
Section
1886(h)(4)(E) of the Social Security Act (42 U.S.C. 1395ww(h)(4)(E)) is amended
by adding at the end the following new sentences: For purposes of the
preceding sentence, the term all, or substantially all, of the costs for
the training program means the stipends and benefits provided to the
resident and other amounts, if any, as determined by the hospital and the
entity operating the nonhospital setting. The hospital is not required to pay
the entity any amounts other than those determined by the hospital and the
entity in order for the hospital to be considered to have incurred all, or
substantially all, of the costs for the training program in that
setting.
.
IME
Section
1886(d)(5)(B)(iv) of the Social Security Act (42 U.S.C. 1395ww(d)(5)(B)(iv)) is
amended by adding at the end the following new sentences: For purposes
of the preceding sentence, the term all, or substantially all, of the
costs for the training program means the stipends and benefits provided
to the resident and other amounts, if any, as determined by the hospital and
the entity operating the nonhospital setting. The hospital is not required to
pay the entity any amounts other than those determined by the hospital and the
entity in order for the hospital to be considered to have incurred all, or
substantially all, of the costs for the training program in that
setting.
.
Effective Date
The amendments made by this subsection shall take effect on January 1, 2008.
Clarification of eligibility of a nonrural hospital that has a training program with an integrated rural track
In general
Section 1886(h)(4)(H) of the Social Security Act (42 U.S.C. 1395ww(h)(4)(H)) is amended—
in clause (iv),
by inserting (as defined in clause (v))
after an
integrated rural track
; and
by adding at the end the following new clause:
Definition of accredited training program with an integrated rural track
For
purposes of clause (iv), the term accredited training program with an
integrated rural track
means an accredited medical residency training
program located in an urban area which offers a curriculum for all residents in
the program that includes the following characteristics:
A minimum of 3 block months of rural rotations. During such 3 block months, the resident is in a rural area for 4 weeks or a month.
A stated mission for training rural physicians.
A minimum of 3 months of obstetrical training, or an equivalent longitudinal experience.
A minimum of 4 months of pediatric training that includes neonatal, ambulatory, inpatient, and emergency experiences through rotations, or an equivalent longitudinal experience.
A minimum of 2 months of emergency medicine rotations, or an equivalent longitudinal experience.
.
Effective date
The amendments made by this subsection apply with respect to—
payments to hospitals under section 1886(h) of the Social Security Act (42 U.S.C. 1395ww(h)) for cost reporting periods beginning on or after January 1, 2008; and
payments to hospitals under section 1886(d)(5)(B)(v) of such Act (42 U.S.C. 1395ww(d)(5)(B)(v)) for discharges occurring on or after January 1, 2008.