[Congressional Bills 115th Congress]
[From the U.S. Government Publishing Office]
[S. 2888 Introduced in Senate (IS)]
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115th CONGRESS
2d Session
S. 2888
To amend Title VII of the Public Health Service Act to reauthorize
programs that support interprofessional geriatric education, training,
and advance research to develop a geriatric-capable workforce,
improving health outcomes for a growing and diverse aging American
population and their families, and for other purposes.
_______________________________________________________________________
IN THE SENATE OF THE UNITED STATES
May 21, 2018
Ms. Collins (for herself and Mr. Casey) introduced the following bill;
which was read twice and referred to the Committee on Health,
Education, Labor, and Pensions
_______________________________________________________________________
A BILL
To amend Title VII of the Public Health Service Act to reauthorize
programs that support interprofessional geriatric education, training,
and advance research to develop a geriatric-capable workforce,
improving health outcomes for a growing and diverse aging American
population and their families, and for other purposes.
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 ``Geriatrics Workforce Improvement
Act''.
SEC. 2. FINDINGS.
Congress finds the following:
(1) In 2016, 46,000,000 adults age 65 or older lived in the
United States, and this number is expected to double to over
98,000,000 by 2060. Three out of four older adults are expected
to have multiple chronic conditions, which increases the
complexity of care needed and increases medical expenditures.
(2) Thirty percent of older adults in the United States,
about 14,000,000 individuals, are projected to need specialized
geriatric care by 2030. That care will require at least 20,000
geriatricians and even more geriatric-trained health
professionals. There are nearly 1,000,000 physicians in the
United States, less than 7,300 of whom are board-certified
geriatricians. There are 3,600,000 nurses in the United States,
of whom, less than 1 percent are registered nurses certified in
geriatrics and less than 3 percent are advanced practice nurses
certified in geriatrics. There are similarly few professionals
certified in geriatrics among professionals in social work,
pharmacy, psychiatry, and the allied health disciplines.
(3) Health professionals trained in geriatrics understand
the unique health needs and complex care challenges associated
with aging. Outcomes associated with interprofessional
geriatric teams include improved health-related quality of
life, fewer emergency room visits, fewer hospital admissions
and, in the case of hospitalization, shorter length of stay and
lower costs per admission.
(4) Two federally funded initiatives have historically
aimed to reduce the widening gap between the numbers of older
adults and health professionals trained in geriatrics: The
Geriatrics Workforce Enhancement Program (referred to in this
section as ``GWEP'') and the Geriatrics Academic Career Award
(referred to in this section as ``GACA'').
SEC. 3. PURPOSE.
It is the purpose of this Act to develop the next generation of
geriatric scientists and innovators, improving health outcomes and care
delivery for older adults. Together, the Geriatrics Workforce
Enhancement Program and the Geriatrics Academic Career Award develop a
workforce capable of providing complex, high-quality care that improves
health outcomes and saves valuable resources by reducing unnecessary
costs for a growing and diverse aging population.
SEC. 4. EDUCATION AND TRAINING RELATING TO GERIATRICS.
Section 753 of the Public Health Service Act (42 U.S.C. 294c) is
amended to read as follows:
``SEC. 753. EDUCATION AND TRAINING RELATING TO GERIATRICS.
``(a) Geriatrics Workforce Enhancement Program.--
``(1) In general.--The Secretary shall award grants under
this subsection to entities described in paragraph (1), (3), or
(4) of section 799B, section 801(2), or section 865(d), or
other health professions, schools, or programs approved by the
Secretary, for the establishment or operation of Geriatrics
Workforce Enhancement Programs that meet the requirements of
paragraph (2).
``(2) Requirements.--
``(A) In general.--A Geriatrics Workforce
Enhancement Program (referred to in this section as
`GWEP') meets the requirements of this paragraph if
such program supports the development of a health care
workforce that maximizes patient and family engagement
and improves health outcomes for older adults by
integrating geriatrics with primary care and other
appropriate specialties. Special emphasis shall be
placed on providing the primary care workforce with the
knowledge and skills to care for older adults and
collaborating with community partners to address gaps
in health care for older adults through individual-,
system-, community-, and population-level changes.
``(B) Programmatic focus.--Areas of programmatic
focus for a program meeting the requirements of this
paragraph may include the following:
``(i) Transforming clinical training
environments into integrated geriatrics and
primary care delivery systems to ensure
trainees are well prepared to practice in and
lead such systems.
``(ii) Developing providers from multiple
disciplines and specialties to work
interprofessionally to assess and address the
needs and preferences of older adults and their
families and caregivers at the individual,
community, and population levels.
``(iii) Creating and delivering community-
based programs that will provide older adults
and their families and caregivers with
education and training to improve health
outcomes and the quality of care for such
adults.
``(iv) Providing education on Alzheimer's
disease and related dementias to families and
caregivers of older adults, direct care
workers, and health professions students,
faculty, and providers.
``(3) Duration.--The Secretary shall award grants under
paragraph (1) for a period not to exceed 5 years.
``(4) Applications.--To be eligible to receive a grant
under paragraph (1), an entity described in such paragraph
shall submit to the Secretary an application at such time, in
such manner, and containing such information as the Secretary
may require, including the specific measures the applicant will
use to demonstrate that the project is improving the quality of
care provided to older adults in the applicant's region, which
may include--
``(A) improvements in access to care provided by a
health professional with training in geriatrics or
gerontology;
``(B) improvements in family caregiver capacity to
care for older adults;
``(C) patient outcome data demonstrating an
improvement in older adult health status or care
quality; and
``(D) reports on how the applicant will implement
specific innovations with the target audience to
improve older adults health status or the quality of
care.
``(5) Priority.--
``(A) In general.--In awarding grants under
paragraph (1), the Secretary--
``(i) shall ensure an equitable geographic
distribution of grant recipients based on State
and regional aging demographics;
``(ii) shall give priority to programs that
demonstrate coordination with other
programmatic efforts funded under this program
or other public or private entities; and
``(iii) may give priority to any program
that--
``(I) substantially benefits rural,
underserved, or Native American
populations of older adults;
``(II) integrates geriatrics and
gerontology into primary care practice,
especially with respect to medical,
dental, and psychosocial care, elder
abuse, pain management, and advance
care planning;
``(III) offers courses to infuse
core geriatric principles of care into
other specialties across care settings,
including practicing clinical
specialists, health care
administrators, faculty without
backgrounds in geriatrics, students
from all health professions, as
approved by the Secretary, to improve
knowledge and clinical skills for the
care of older adults;
``(IV) emphasizes integration into
existing service delivery locations and
care across settings, including primary
care clinics, medical homes, Federally-
qualified health centers, ambulatory
care clinics, inpatient hospitals,
emergency care, assisted living and
nursing facilities, and home- and
community-based services, including
senior day care, in order to increase
innovation and reduce redundancy across
GWEPs;
``(V) supports the training and
retraining of faculty, preceptors,
primary care providers, and other
direct care providers to increase their
knowledge of geriatrics and
gerontology;
``(VI) emphasizes education and
engagement of family caregivers on
disease self-management, medication
management, and stress-reduction
strategies for older adults;
``(VII) provides training to the
health care workforce on disease self-
management, medication management,
stress-reduction strategies, and social
determinants of health in older adults;
or
``(VIII) proposes to conduct
outreach to communities that have a
shortage of geriatric workforce
professionals.
``(B) Special consideration.--In awarding grants
under paragraph (1), particularly with respect to
awarding, in fiscal year 2019, any amount appropriated
for such fiscal year for purposes of carrying out this
subsection that is in excess of the amount appropriated
for fiscal year 2018 for such purposes, the Secretary
shall give special consideration to entities that
operate--
``(i) in communities that have a shortage
of geriatric workforce professionals; and
``(ii) in States in which no entity has
previously received an award under such
paragraph (including under section 753(a)(1) as
in effect before the date of enactment of the
Geriatrics Workforce Improvement Act).
``(6) Award amounts.--Awards under paragraph (1) shall be
in an amount determined by the Secretary. Entities that submit
applications under this subsection that describe a plan for
providing geriatric education and training for home health
workers and family caregivers are eligible to receive $100,000
per year more than entities that do not include a description
of such a plan.
``(7) Reporting.--
``(A) Reports from entities.--Each entity awarded a
grant under paragraph (1) shall submit an annual report
to the Secretary on the financial and programmatic
performance under such grant, which may include factors
such as the number of trainees, the number of
professions and disciplines, the number of partnerships
with health care delivery sites, the number of faculty
and practicing professionals who participated in
continuing education programs, and other factors, as
the Secretary may require.
``(B) Reports to congress.--
``(i) In general.--Not later than 5 years
after the date of enactment of the Geriatrics
Workforce Improvement Act, the Secretary shall
submit to Congress a report that provides a
summary of the financial and programmatic
performance of the funded grants, which may
include factors such as the number trainees,
the number of professions and disciplines, the
number of partnerships with health care
delivery sites, the number of faculty and
practicing professionals who participated in
continuing education programs, and other
factors that assess the impact of the program
under this subsection on the health status of
older adults, quality of care for older adults,
and the knowledge and skills of the Nation's
health care workforce to care for older adults.
``(ii) Public availability.--The Secretary
shall make each report submitted under clause
(i), and supporting data publicly available in
an accessible format on the internet website of
the Health Resources and Services
Administration.
``(8) Authorization of appropriations.--For purposes of
carrying out this subsection, in addition to any other funding
available for such purpose, there is authorized to be
appropriated $45,000,000 for each of fiscal years 2019 through
2023.
``(b) Geriatric Academic Career Awards.--
``(1) Establishment of program.--The Secretary shall
establish a program to provide geriatric academic career awards
to eligible entities applying on behalf of eligible individuals
to promote the career development of such individuals as
academic geriatricians or other academic geriatrics health
professionals.
``(2) Eligibility.--
``(A) Eligible entity.--For purposes of this
subsection, the term `eligible entity' means--
``(i) an entity described in paragraph (1),
(3), or (4) of section 799B or section 801(2);
or
``(ii) another accredited health
professions school or graduate program approved
by the Secretary.
``(B) Eligible individual.--For purposes of this
subsection, the term `eligible individual' means an
individual who--
``(i)(I) is board certified or board
eligible in internal medicine, family practice,
psychiatry, or licensed dentistry, or has
completed required training in a discipline and
is employed in an accredited health professions
school or graduate program that is approved by
the Secretary; or
``(II) has completed an approved fellowship
program in geriatrics or gerontology, or has
completed specialty training in geriatrics or
gerontology as required by the discipline and
any additional geriatrics or gerontology
training as required by the Secretary; and
``(ii) has a junior, nontenured, faculty
appointment at an accredited health professions
school or graduate program in geriatrics or a
geriatrics health profession such as
psychology, pharmacy, nursing, social work,
dentistry, public health, allied health, health
care administration, or another health
discipline, as determined by the Secretary.
``(3) Application requirements.--In order to receive an
award under paragraph (1), the eligible entity shall, on behalf
of eligible individuals--
``(A) submit to the Secretary or a designee an
application, at such time, in such manner, and
containing such information as the Secretary may
require;
``(B) provide, in such form and manner as the
Secretary may require, assurances that the eligible
individual on whose behalf an application was submitted
will meet the service requirement described in
paragraph (7); and
``(C) provide, in such form and manner as the
Secretary may require, assurances that such eligible
individual has a full-time faculty appointment in an
accredited health professions school or graduate
program and documented commitment from such school or
program to spend 50 percent of the total time of such
individual on teaching and developing skills in
interdisciplinary education in geriatrics.
``(4) Requirements.--In awarding grants under this
subsection, the Secretary--
``(A) shall give priority to eligible entities who
have not received an award under subsection (a)(1)
(including as such subsection was in effect prior to
the date of enactment of the Geriatrics Workforce
Improvement Act) and who establish a mentoring plan to
support the integration of geriatrics education,
training, and best practices into academic program
criteria; and
``(B) shall ensure that grants are equitably
distributed, including among rural or underserved
populations across the various geographical regions of
the United States.
``(5) Maintenance of effort.--An eligible entity receiving
an award under paragraph (1) on behalf of an eligible
individual shall provide assurances to the Secretary that funds
provided to such individual under this subsection will be used
only to supplement, not to supplant, the amount of Federal,
State, and local funds otherwise expended on behalf of the
professional development, with respect to geriatrics, of such
individual.
``(6) Amount and duration.--
``(A) Amount.--The amount of an award under this
subsection for an eligible individual for each fiscal
year of such award shall be the lesser of--
``(i) 50 percent of the eligible
individual's annual full-time salary for such
fiscal year; or
``(ii) $90,000.
``(B) Duration.--The Secretary shall make awards
under paragraph (1) for a period not to exceed 5 years.
``(C) Payment to institution.--The Secretary shall
make payments to institutions which include schools of
medicine, osteopathic medicine, nursing, social work,
psychology, dentistry, and pharmacy, or other allied
health discipline in an accredited health professions
school or graduate program that is approved by the
Secretary.
``(7) Service requirement.--At the end of an award period,
an eligible individual on whose behalf an application was
submitted and approved under paragraph (3) shall continue to
teach geriatrics to geriatric health professionals in their
faculty role, or continue to provide training in clinical
geriatrics or gerontology, including the training of
interdisciplinary teams of health care professionals, for a
period of time that is equivalent to the duration of the award.
``(8) Authorization of appropriations.--There is authorized
to be appropriated $6,000,000 for each of fiscal years 2019
through 2023 for purposes of carrying out this subsection.''.
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