[Congressional Bills 110th Congress]
[From the U.S. Government Publishing Office]
[H.R. 7065 Introduced in House (IH)]
110th CONGRESS
2d Session
H. R. 7065
To amend the Public Health Service Act to address health workforce
shortages.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
September 25, 2008
Mr. Pascrell (for himself, Mr. Moran of Kansas, Mr. McGovern, and Mrs.
Capps) introduced the following bill; which was referred to the
Committee on Energy and Commerce
_______________________________________________________________________
A BILL
To amend the Public Health Service Act to address health workforce
shortages.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Health Workforce Investment Act of
2008''.
SEC. 2. FINDINGS.
The Congress finds as follows:
(1) The United States is facing shortages in a wide range
of health workforce professions, including among specialists
and subspecialists.
(2) By 2020, the United States will face shortages of as
many as 1,000,000 nurses, 55,000 physicians, 140,000 family
physicians, 157,000 pharmacists, and 2,500,000 allied health
professionals.
(3) The long-term care workforce is plagued by rising
vacancy and turnover rates.
(4) These shortages will be exacerbated by the growth in
the number and proportion of older adults in America.
(5) Data on health workforce supply and demand are limited.
(6) Many health workforce professions are inappropriately
distributed, with some areas experiencing chronic shortages of
a wide range of health professionals.
(7) The diversity of the health workforce continually fails
to mirror the diversity of the United States population.
(8) A 2008 report entitled ``Out of Order, Out of Time''
from the Association of Academic Health Centers found that
Federal health workforce policy and infrastructure has been
dysfunctional, decentralized, and piecemeal with little
integration and harmonization.
(9) Nearly every State has initiated action to address
health workforce shortages without comprehensive planning and
leadership from the Federal Government to address the full
spectrum of health workforce professions and issues.
(10) Over the last 5 years, Federal investment in health
workforce programs has fallen by more than 20 percent.
SEC. 3. NATIONAL HEALTH WORKFORCE ADVISORY COUNCIL.
Section 762 of the Public Health Service Act (42 U.S.C. 294o) is
amended to read as follows:
``SEC. 762. NATIONAL HEALTH WORKFORCE ADVISORY COUNCIL.
``(a) Establishment.--There is established the National Health
Workforce Advisory Council.
``(b) Duties.--The Council shall--
``(1) make recommendations to the Secretary of Health and
Human Services, the Secretary of Labor, the Secretary of
Education, the Secretary of Veterans Affairs, the Committee on
Health, Education, Labor, and Pensions of the Senate, the
Committee on Finance of the Senate, the Committee on Energy and
Commerce of the House of Representatives, and the Committee on
Ways and Means of the House of Representatives with respect
to--
``(A) the supply and distribution of the health
workforce in the United States;
``(B) current and future shortages or excesses of
health workforce professionals, including specialists
and subspecialists;
``(C) issues relating to foreign medical school
graduates and graduates of foreign schools of nursing;
``(D) appropriate Federal policies with respect to
the matters specified in subparagraphs (A), (B), and
(C), including policies concerning changes in the
financing of undergraduate and graduate medical
education programs and changes in the types of medical
education training in graduate medical education
programs;
``(E) appropriate efforts to be carried out by
hospitals, schools of medicine, schools of osteopathic
medicine, and accrediting bodies with respect to the
matters specified in subparagraphs (A), (B), and (C),
including efforts for changes in undergraduate and
graduate medical education programs; and
``(F) deficiencies in, and needs for improvements
in, existing databases concerning the supply and
distribution of, and postgraduate training programs
for, health workforce professionals in the United
States and steps that should be taken to eliminate
those deficiencies; and
``(2) encourage entities providing graduate medical
education to conduct activities to voluntarily achieve the
recommendations of the Council under paragraph (1)(E).
``(c) Composition.--The Council shall be composed of--
``(1) the Assistant Secretary for Health (or the Assistant
Secretary's designee);
``(2) the Administrator of the Centers for Medicare &
Medicaid Services;
``(3) the Chief Medical Director of the Department of
Veterans Affairs;
``(4) 15 members appointed by the Secretary to include
representatives of practicing health workforce professionals,
national and specialty health profession organizations, foreign
medical graduates, and health workforce student associations;
``(5) 10 members appointed by the Secretary to include
representatives of schools of medicine and osteopathic
medicine, schools of nursing, allied health schools, other
health workforce training programs, and public and private
teaching hospitals;
``(6) 4 members appointed by the Secretary to include
representatives of health insurers, business, and labor;
``(7) the official at the Department of Labor responsible
for administering grants under the Workforce Investment Act of
1998 targeted at the health sector; and
``(8) the Secretary of Education (or the Secretary's
designee).
``(d) Terms of Appointed Members.--
``(1) In general; staggered rotation.--Members of the
Council appointed under paragraphs (4), (5), and (6) of
subsection (b) shall be appointed for a term of 4 years, except
that the term of office of the members first appointed shall
expire, as designated by the Secretary at the time of
appointment, as follows: 8 at the end of 1 year, 7 at the end
of 2 years, 7 at the end of 3 years, and 7 at the end of 4
years.
``(2) Date certain for appointment.--The Secretary shall
appoint the first members to the Council under paragraphs (4),
(5), and (6) of subsection (b) within 60 days after the date of
the enactment of the Health Workforce Investment Act of 2008.
``(e) Chair.--The Council shall elect one of its members as
Chairman of the Council.
``(f) Cooperation.--The Council shall carry out this section in
cooperation with the Council on Graduate Medical Education established
by section 762, the National Advisory Council on the National Health
Service Corps established by section 337, the Advisory Committee on
Training in Primary Care Medicine and Dentistry established pursuant to
section 748, the Advisory Committee on Interdisciplinary, Community-
Based Linkages established pursuant to section 756, and the National
Advisory Council on Nurse Education and Practice established pursuant
to section 845.
``(g) Quorum.--Eighteen members of the Council shall constitute a
quorum, but a lesser number may hold hearings.
``(h) Vacancies.--Any vacancy in the Council shall not affect its
power to function.
``(i) Compensation.--Each member of the Council who is not
otherwise employed by the United States Government shall receive
compensation at a rate equal to the daily rate prescribed for GS-18
under the General Schedule under section 5332 of title 5, United States
Code, for each day, including traveltime, such member is engaged in the
actual performance of duties as a member of the Council. A member of
the Council who is an officer or employee of the United States
Government shall serve without additional compensation. All members of
the Council shall be reimbursed for travel, subsistence, and other
necessary expenses incurred by them in the performance of their duties.
``(j) Certain Authorities and Duties.--
``(1) Authorities.--In order to carry out the provisions of
this section, the Council is authorized to--
``(A) collect such information, hold such hearings,
and sit and act at such times and places, either as a
whole or by subcommittee, and request the attendance
and testimony of such witnesses and the production of
such books, records, correspondence, memoranda, papers,
and documents as the Council or such subcommittee may
consider available; and
``(B) request the cooperation and assistance of
Federal departments, agencies, and instrumentalities,
and such departments, agencies, and instrumentalities
are authorized to provide such cooperation and
assistance.
``(2) Coordination of activities.--The Council shall
coordinate its activities with the activities of the Secretary
under section 792. The Secretary shall, in cooperation with the
Council and pursuant to the recommendations of the Council,
take such steps as are practicable to eliminate deficiencies in
the data base established under section 792 and shall make
available in reports such comprehensive data sets as are
developed pursuant to this section.
``(k) Reports.--Not later than 2 years after the date of the
enactment of the Health Workforce Investment Act of 2008, and annually
thereafter, the Council shall submit a report to official and committee
listed in the matter preceding subparagraph (A) in subsection (b)(1)
containing--
``(1) a description of the Council's actions during the
period for which the report is made; and
``(2) each of the recommendations required by subsection
(b).
``(l) Definitions.--In this section:
``(1) The term `Council' means the National Health
Workforce Advisory Council established by subsection (a).
``(2) The term `health workforce' has the meaning given to
such term in section 781.
``(3) The term `Secretary' means the Secretary of Health
and Human Services unless otherwise specified.
``(m) Authorization of Appropriations.--To carry out this section,
there are authorized to be appropriated such sums as may be necessary
for each of fiscal years 2009 through 2013.''.
SEC. 4. NATIONAL CENTER FOR HEALTH WORKFORCE INFORMATION AND ANALYSIS.
(a) Technical Corrections.--Section 792 of the Public Health
Service Act (42 U.S.C. 295k) is amended by redesignating subsections
(d), (e), (g), and (h) as subsections (c), (d), (e), and (f),
respectively.
(b) Center.--Section 792 of the Public Health Service Act (42
U.S.C. 295k) is amended--
(1) in the section heading, by striking ``health
professions data'' and inserting ``national center for health
workforce information and analysis'';
(2) by redesignating subsections (d), (e), and (f), as so
redesignated, as subsections (e), (f), and (g), respectively;
(3) by striking subsections (a), (b), and (c), as so
redesignated, and inserting the following:
``(a) Establishment.--There is established in the Department of
Health and Human Services the National Center for Health Workforce
Information and Analysis (in this section referred to as the `Center'),
which shall be under the direction of a director who shall conduct and
support statistical and epidemiological activities for the purpose of
assessing and improving the supply, distribution, diversity, and
development of the health workforce in the United States.
``(b) Certain Authorities and Requirements.--In carrying out
subsection (a), the Secretary, acting through the Director of the
Center--
``(1) shall regularly collect statistics on--
``(A) the supply and projected demand, along with
projected shortages and surpluses, of the health
workforce by health profession, specialty, and
geographic location;
``(B) the diversity of the health workforce by
health profession, specialty, and geographic location;
and
``(C) the supply and projected demand, along with
projected shortages and surpluses, of the health
workforce serving minority groups by health profession,
specialty, and geographic location;
``(2) shall establish a uniform health workforce data
reporting system;
``(3) shall undertake and support (by grant or contract)
research, demonstrations, and evaluations respecting new or
improved methods for obtaining current data on the matters
referred to in paragraph (1); and
``(4) may undertake and support (by grant or contract)
research, demonstrations, and evaluations on the matters
referred to in paragraph (1).
``(c) Grants and Contracts.--The Secretary may make grants and
enter into contracts with States (or an appropriate nonprofit private
entity in any State) for carrying out the matters referred to in
paragraph (1). The Secretary shall determine the amount and scope of
any such grant or contract. To be eligible for any such grant or
contract, a State or entity shall submit an application in such form
and manner and containing such information as the Secretary may
require. Such application shall include reasonable assurances,
satisfactory to the Secretary, that--
``(1) such State or entity will establish a program of
mandatory annual registration of the health workforce personnel
who reside or practice in such State and of health institutions
licensed by such State, which registration shall include such
information as the Secretary may determine to be appropriate;
``(2) such State or entity will collect and report to the
Secretary such information in such form and manner as the
Secretary may prescribe; and
``(3) such State or entity will comply with the
requirements of subsection (e).
``(d) Report to Congress.--The Secretary shall submit to the
Congress not later than October 1, 2010, and biennially thereafter, a
comprehensive report regarding the status of the health workforce
according to profession, including a report regarding the analytic and
descriptive studies conducted under this section.'';
(4) by amending subsection (g), as redesignated by
paragraph (2), to read as follows:
``(f) Data on Allied Health Workforce Personnel.--In carrying out
subsection (b), the Secretary may make grants, or enter into contracts
and cooperative agreements with, and provide technical assistance to, a
nonprofit entity in order to establish a uniform allied health
workforce data reporting system to collect, compile, and analyze data
on allied health workforce personnel.''; and
(5) by adding at the end the following:
``(g) Definition.--In this section, the term `health workforce' has
the meaning given to such term in section 781.
``(h) Authorization of Appropriations.--To carry out this section,
there are authorized to be appropriated such sums as may be necessary
for each of fiscal years 2009 through 2013.''.
SEC. 5. HEALTH WORKFORCE INVESTMENT GRANTS.
Title VII of the Public Health Service Act (42 U.S.C. 292 et seq)
is amended--
(1) by redesignating part F as part G; and
(2) by inserting after section 770 the following:
``PART F--HEALTH WORKFORCE INVESTMENT GRANTS
``SEC. 781. HEALTH WORKFORCE INVESTMENT GRANTS.
``(a) Formula Grants to States.--
``(1) In general.--For the purposes described in paragraph
(2), the Secretary shall make an allotment each fiscal year for
each State in an amount determined in accordance with
subsection (d). The Secretary shall make a grant to the State
of the allotment made for the State for the fiscal year if the
State submits to the Secretary an application in accordance
with subsection (b).
``(2) Purposes of grants.--A funding agreement for a grant
under paragraph (1) is that the State involved will expend the
grant for the purposes of--
``(A) ensuring access to health services for all
individuals, particularly those with low incomes or
limited access to health services;
``(B) improving the supply, distribution,
diversity, and development of the health workforce,
taking into consideration the supply, distribution, and
diversity of health workforce profession specialties
and subspecialties; and
``(C) creating State-specific health workforce
goals and objectives consistent with health status
goals and national health workforce objectives
developed under subsection (h).
``(3) Purposes of national program.--The Secretary shall
carry out this section in a manner designed--
``(A) to identify innovations in approaches to
improving the supply, distribution, diversity, and
development of the health workforce, taking into
consideration specialties and subspecialties;
``(B) to develop national goals and objectives for
improving the supply, distribution, diversity, and
development of the health workforce, including
specialties and subspecialties; and
``(C) to develop and expand programs designed to
ensure access to health workforce professionals for an
aging population.
``(b) Application for Grant.--For purposes of subsection (a)(1), an
application for a grant is in accordance with this subsection if each
of the following is met:
``(1) Use of funds.--The application includes each funding
agreement required by this section, including an assurance that
all funds received through the grant will be used for the
purposes described in subsection (a)(2).
``(2) Statewide needs assessment.--The application includes
a statewide needs assessment that--
``(A) will be updated not less than every 5 years;
and
``(B) identifies--
``(i) long-term State-specific health
workforce goals and objectives consistent with
health status goals and national health
workforce objectives developed under subsection
(h); and
``(ii) projected needs related to the
supply, distribution, diversity, and
development of the State health workforce.
``(3) Annual plans.--The application includes a plan to
meet the goals and objectives, and address the needs,
identified under the statewide needs assessment described in
paragraph (2), and such plan--
``(A) will be updated on an annual basis; and
``(B) includes strategies related to--
``(i) collaboration between the State
departments of labor, health, education, higher
education, and professional licensure and State
health workforce investment boards;
``(ii) State data collection;
``(iii) State Medicaid and Medicare
policies; and
``(iv) State health professions licensure
and regulation.
``(4) Description of funding use.--The application includes
a description of how funds received through the grant will be
used--
``(A) in accordance with subparagraphs (A) and (B)
of subsection (a)(1), to ensure access to health
services for all individuals and to improve the supply,
distribution, diversity, and development of the health
workforce, such as through programs related to--
``(i) health workforce training and
education capacity;
``(ii) the health care safety net
workforce;
``(iii) provider cultural competency;
``(iv) health workforce diversity;
``(v) health workforce pipeline
development;
``(vi) health workforce retention;
``(vii) health workforce faculty
recruitment;
``(viii) health workforce faculty
retention;
``(ix) health workforce career ladders;
``(x) public awareness; and
``(xi) health workforce scholarship and
loan repayment programs; and
``(B) to create State-specific health workforce
goals and objectives in accordance with subsection
(a)(1)(C) and to develop annual plans in accordance
with paragraph (3) of this subsection to meet such
goals and objectives.
``(5) Development of application.--The application--
``(A) is developed by or in consultation with the
State agency that will be responsible for administering
the program; and
``(B) is made publicly available during its
development or after its submission to the Secretary in
order to facilitate public comment.
``(c) Additional Grant Requirements.--
``(1) Restrictions on use of grants.--A funding agreement
for a grant under subsection (a)(1) is that the State involved
will not use the grant--
``(A) to provide health services;
``(B) to make payments to for-profit schools; or
``(C) to provide matching funds to satisfy a
condition for the receipt of other Federal funds.
``(2) Nursing programs.--A funding agreement for a grant
under subsection (a)(1) is that the State involved will expend
at least 25 percent of the funds received through the grant for
programs related to nursing.
``(3) Administration.--A funding agreement for a grant
under subsection (a)(1) is that the State involved will expend
not more than 10 percent of the funds received through the
grant on administration.
``(4) State agency.--A funding agreement for a grant under
subsection (a)(1) is that the State involved will designate a
lead State agency to administer the grant, including by--
``(A) coordinating State activities under the grant
with State administration of Medicaid and Medicare,
including policies related to reimbursement and
graduate medical education payments; and
``(B) coordinating State activities under the grant
with related activities of other Federal grantees
within the State, including State health workforce
board and community health center grantees.
``(5) Annual reports.--
``(A) In general.--A funding agreement for a grant
under subsection (a)(1) is that the State involved will
submit annual reports to the Secretary--
``(i) detailing activities carried out
through the grant in a standardized manner that
enables the Secretary to evaluate the
activities and compare performance relative to
other States; and
``(ii) describing the extent to which the
State has met its long-term State-specific
health workforce goals and objectives
identified pursuant to subsection (b)(2)(B)(i).
``(B) Contents.--Each report under subparagraph (A)
must include--
``(i) information on the status of the
State's health workforce by profession,
specialty, and geographic location, including
such information on--
``(I) the supply of the State's
health workforce, including with
respect to primary care providers,
nurses, long-term care workers,
dentists, and allied health
professionals; and
``(II) the diversity of the State's
health workforce;
``(ii) a description of each program funded
through this section during the previous fiscal
year; and
``(iii) a description of efforts to
coordinate the State departments responsible
for administering Medicaid and Medicare funds,
education and labor programs, the health care
safety net, and medical licensing.
``(6) Audits.--A funding agreement for a grant under
subsection (a)(1) is that the State involved will provide for
audits of expenditures of grant funds.
``(d) Determination of Amount of Allotment.--
``(1) In general.--The Secretary shall determine the amount
of the allotment to each State under this section for a fiscal
year based on a formula.
``(2) Development of formula.--The formula referred to in
paragraph (1) shall be determined by the Secretary by
regulation, taking into consideration the following criteria:
``(A) Existing shortages and deficiencies in health
workforce distribution.
``(B) Rural, urban, and frontier areas.
``(C) Community health centers.
``(D) The number of medical, nursing, and allied
health professions schools in each State.
``(e) Federal Program Administration.--
``(1) Delegation within hhs.--The Secretary shall designate
an identifiable administrative unit of the Department of Health
and Human Services with expertise in health workforce issues to
be responsible for administering the program under this
section, including the following:
``(A) Coordinating activities under this section
with related activities of the Department of Health and
Human Services, the Department of Defense, the
Department of Education, the Department of Labor, the
Department of Veterans Affairs, and any other relevant
Federal departments or agencies.
``(B) Disseminating health workforce information
and best practices to States.
``(C) Providing technical assistance to grant
recipients under this section.
``(D) Submitting reports to Congress under
paragraph (2).
``(2) Annual reports.--The Secretary shall submit annual
reports to the Congress on the following:
``(A) The amount of each allotment and grant to a
State under this section.
``(B) Significant State projects funded through
this section and their performance.
``(C) Significant innovations funded through this
section and their outcomes.
``(D) Highlights with respect to the status of the
Nation's health workforce, including--
``(i) significant changes in supply by
profession, specialty, and geographic location,
including with respect to primary care
providers, nurses, long-term care workers,
dentists, and allied health professionals; and
``(ii) significant changes in diversity by
profession, specialty, and geographic location.
``(3) Additional authorities.--In carrying out this
section, the Secretary may--
``(A) allow States receiving grants to work
together in regional authorities;
``(B) impose matching fund requirements as a
condition on receipt of a grant; and
``(C) allow States to use grant funds for planning
and infrastructure development.
``(f) Rule of Construction.--Subject to the purposes described in
subsection (a)(2), nothing in this section shall be construed to
prohibit a State from making funds received under this section
available to other entities, including entities receiving funds under
other provisions of this title or title VIII.
``(g) Federal Research and Projects.--
``(1) In general.--The Secretary may make grants to, or
enter into contracts or jointly financed cooperative agreements
with, public or nonprofit institutions of higher education and
public or nonprofit private agencies and organizations engaged
in research to identify best practices and innovative
approaches to improving the supply, distribution, diversity,
and development of the health workforce, taking into
consideration the supply, distribution, diversity, and
development of health workforce profession specialties and
subspecialties.
``(2) Technical assistance.--The Secretary shall
incorporate the best practices and innovative approaches
identified under paragraph (1) into any technical assistance
provided to grant recipients under this section.
``(3) Coordination.--The Secretary shall carry out this
subsection in coordination with the activities of the National
Center for Health Workforce Information and Analysis, including
any research, demonstrations, and evaluations under section
792(b)(4).
``(h) National Health Workforce Objectives.--The Secretary, based
on information and analysis of the National Center for Health Workforce
Information and Analysis and the findings and recommendations of the
National Health Workforce Advisory Council, shall develop national
health workforce objectives to be used for purposes of subsections
(a)(2)(C) and (b)(2)(B)(i).
``(i) Definitions.--In this section:
``(1) The term `diversity' includes racial, ethnic,
language ability, and gender diversity.
``(2) The term `health workforce' includes physicians,
nurses (including registered nurses and licensed practical
nurses), advance practice nurses (including nurse
practitioners, certified registered nurse anesthetists,
certified nurse midwives, clinical nurse specialists,
doctorates of nursing practice, and clinical nurse leaders),
dentists, physician assistants, chiropractors, podiatrists,
optometrists and opticians, pharmacists, mental health
providers (including psychologists and clinical social
workers), allied health professionals (including physical
therapists, occupational therapists, speech-language
pathologists, audiologists, respiratory therapists,
technicians, technologists, emergency medical technicians,
paramedics, medical and clinical laboratory technologists and
technicians, medical records and health information
technicians, nuclear medicine technologists, radiologic
technologists, dieticians, and nutritionists), auxiliary health
professionals (including home health aides, certified nursing
assistants, nursing aides, orderlies, and attendants), and any
other providers determined by the Secretary for purposes of
this section to be part of the health workforce.
``(3) The term `National Center for Health Workforce
Information and Analysis' means the National Center for Health
Workforce Information and Analysis established under section
792.
``(4) The term `National Health Workforce Advisory Council'
means the National Health Workforce Advisory Council
established under section 762.
``(j) Funding.--
``(1) Authorization of appropriations.--To carry out this
section, there are authorized to be appropriated such sums as
may be necessary for each of fiscal years 2009 through 2013.
``(2) Reservation.--Of the amount of funds appropriated to
carry out this section for a fiscal year, the Secretary shall
reserve 5 percent of such amount to carry out subsection
(g).''.
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