,,ii #aacth ,,congress #b;d ,session ,s4 #bbbi ,,in ,,the ,,senate ,,of ,,the ,,united ,,states ,april #i1 #bjad ,mr4 ,sanders introduced the following bill2 which was read twice and referred to the ,committee on ,health1 ,education1 ,labor1 and ,pensions ,a ,,bill ,to expand primary care access4 #a4 ,short title ,this ,act may be cited as the ,expanding ,primary ,care ,access and ,workforce ,act4 #b4 ,scholarships and ,loan ,repayment ,opportunities for ,primary ,care ,providers 7a7 ,funding for the ,national ,health ,service ,corps ,section #cch of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bedk7 is amended by adding at the end the following3 7c7 ,scholarship and loan repayment opportunities for primary care providers 7#a7 ,in general ,there is authorized to be appropriated1 and there is appropriated1 out of any amounts in the ,treasury not otherwise appropriated1 #d1ijj1jjj1jjj for the period of fiscal years #bjae through #bjbj1 to provide for a continuation and expansion of the program with respect to required primary health services1 as defined in section #ccj7;b71 under this subpart4 7#b7 ,supplemental funding ,amounts appropriated under this subsection shall be used to supplement and not supplant other amounts appropriated to carry out programs under this subpart4 4 7b7 ,scholarship program and student loan repayment program ,section #cch;,h of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bedq7 is amended by adding at the end the following3 7d7 ,distribution of funds ,in allocating funds made available to the ,health ,resources and ,services ,administration for the ,national ,health ,service ,corps1 the ,secretary shall provide loan repayment awards to at least #f individuals in each ,state and scholarships to at least #c individuals in each ,state4 4 7c7 ,public information programs in designated areas ,section #ccb7;h7 of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bed;e7h77 is amended by inserting 7directly1 or by grant1 contract1 or cooperative agreement7 after conduct4 7d7 ,professional development ,section #ccf7;d77#a7 of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bed;h-#a7;d77#a77 is amended by inserting 7directly1 or by grant1 contract1 or cooperative agreement7 after shall assist4 #c4 ,funding for health centers ,section #ajejc7;b77#a7 of the ,patient ,protection and ,affordable ,care ,act of #bjaj 7#db ,u4,s4,c4 #bed;b-#b7 is amended-- 7#a7 in subparagraph 7,d71 by striking and at the end2 7#b7 in subparagraph 7,e71 by striking and at the end2 and 7#c7 by inserting after subparagraph 7,e7 the following3 7,f7 #c1hjj1jjj1jjj for fiscal year #bjaf2 7,g7 #d1cjj1jjj1jjj for fiscal year #bjag2 7,h7 #d1ijj1jjj1jjj for fiscal year #bjah2 7,i7 #e1fjj1jjj1jjj for fiscal year #bjai2 and 7,j7 #f1djj1jjj1jjj for fiscal year #bjbj2 and 4 #d4 ,increasing the ,primary ,care ,provider ,workforce 7a7 ,reauthorization of the teaching health centers program ,section #cdj;,h of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bef;h7 is amended-- 7#a7 in subsection 7a71 by striking subsection 7h77#b7 and inserting subsection 7i77#b72 7#b7 in subsection 7g7-- 7,a7 by striking such sums and all that follows through the period at the end and inserting #hjj1jjj1jjj for the period of fiscal years #bjaf through #bjbj42 and 7,b7 by adding at the end the following3 ,any amounts appropriated under this subsection for any of fiscal years #bjaa through #bjbj and remaining unexpended at the end of the fiscal year involved may be used in subsequent fiscal years to carry out this section42 7#c7 in subsection 7h77#b7-- 7,a7 in the paragraph heading1 by adding at the end the following3 2 submission to ,congress2 and 7,b7 by adding at the end the following3 7,c7 ,submission to ,congress ,the ,secretary shall annually submit to ,congress a report that contains a compilation of the data submitted to the ,secretary under paragraph 7#a7 for the year involved4 2 7#d7 by redesignating subsections 7h7 through 7j7 as subsections 7i7 through 7k71 respectively2 and 7#e7 by inserting after subsection 7g71 the following3 7h7 ,limitation ,the ,secretary shall establish a minimum per resident per year payment amount for funding of all approved teaching health center graduate medical education positions under this section that shall be not less than the per resident per year payment amount as of ,january #a1 #bjac1 and ensure that not less than such amount is provided to all teaching health center graduate medical education programs for all approved positions4 4 7b7 ,teaching health centers development grants ,section #gdi;,a7g7 of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bicl-#a7;g77 is amended by striking each fiscal year thereafter and inserting each of fiscal years #bjac through #bjbj and each fiscal year thereafter4 7c7 ,national ,health ,care ,workforce ,commission ,section #eaja of the ,patient ,protection and ,affordable ,care ,act 7#db ,u4,s4,c4 #bidq7 is amended-- 7#a7 in subsection 7h7-- 7,a7 by striking paragraphs 7#a7 and 7#b7 and inserting the following3 7#a7 ,appropriations ,there are authorized to be appropriated1 and there are appropriated1 out of any monies in the ,treasury not otherwise appropriated1 #aj1jjj1jjj for each fiscal year to carry out this section4 2 and 7,b7 by redesignating paragraph 7#c7 as paragraph 7#b72 and 7#b7 in subsection 7d7-- 7,a7 in paragraph 7#g71 by adding at the end ,whenever feasible1 ,congress and the ,department of ,health and ,human ,services shall recognize and implement such recommendations42 and 7,b7 by adding at the end the following3 7#i7 ,data tracking 7,a7 ,data tracking mechanism ,the ,commission shall develop1 or enter into a contract with another entity to develop1 a mechanism for tracking information on the career paths of graduates of medical schools and residency programs1 as described in subparagraph 7,b71 and shall make such information publicly available4 7,b7 ,recordkeeping ,the ,commission shall collect or ensure the collection of data1 using the mechanism developed under subparagraph 7,a71 concerning-- 7i7 the specialty and subspecialty training of all graduates of medical schools receiving ,federal funding2 and 7ii7 the professional trajectory of all graduates of medical schools receiving ,federal funding for not less than #ae years after each individual graduates from medical school1 including data concerning graduates who practice medicine-- 7,i7 in underserved areas such as health professional shortage areas 7as defined by the ,national ,health ,service ,corps under section #ccb of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bed;e772 7,,ii7 with medically underserved populations 7as defined in section #ccj7;b77#c7 of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bed;b7b77#c7772 7,,iii7 in ,federally qualified health centers 7as defined in section #aije7l77#b77;,b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;d7l77#b77;,b7772 7,,iv7 rural health clinics 7under title ,,xviii of the ,social ,security ,act 7#db ,u4,s4,c4 #acie et seq4772 7,v7 the health care system of the ,department of ,veterans ,affairs2 and 7,,vi7 clinics of the ,indian ,health ,services4 4 7d7 ,reauthorization of family nurse practitioner residency training program ,section #ecaf7;i7 of the ,patient ,protection and ,affordable ,care ,act 7#db ,u4,s4,c4 #bif;j-#a7;i77 is amended by striking such sums and all that follows through the period at the end and inserting #ge1jjj1jjj for the period of fiscal years #bjae through #bjai44 7e7 ,reauthorization of nurse faculty loan program ,section #hdf;,a7f7 of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bign-#a7;f77 is amended by striking #bjad and inserting #bjai4 7f7 ,reauthorization of primary care residency expansion program ,section #gdg7;c77#a7 of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bick7c77#a77 is amended by striking #abe1jjj1jjj and all that follows through the period at the end and inserting #afh1jjj1jjj for the period of fiscal years #bjae through #bjai44 7g7 ,reauthorization of the area health education centers ,section #gea7;j77#a7 of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bid;a7j77#a77 is amended by striking #bjaj through #bjad and inserting #bjae through #bjai4 #e4 ,increasing payment for primary care 7a7 ,requirement concerning consultation with organizations or other entities ,in determining physician fees for the purpose of payments under the ,medicare program under title ,,xviii of the ,social ,security ,act 7#db ,u4,s4,c4 #acie et seq471 the ,secretary of ,health and ,human ,services shall not consult with an organization or other entity representing physicians unless at least #ej percent of the members of such organization or entity1 at the time of such consultation1 are primary care physicians4 7b7 ,incentive payment program for primary care services ,section #ahcc7x77#a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciel7x77#a77 is amended by striking #bjaf and inserting #bjbj4 7c7 ,permanent application of ,medicare payment rate floor to primary care services furnished under ,medicaid 7#a7 ,in general ,section #aijb7;a77#ac77;,c7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;a7a77#ac77;,c77 is amended by striking and #bjad and inserting or any year thereafter4 7#b7 ,increased ,,fmap ,section #aije7;dd7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;d7dd77 is amended by striking and before ,january #a1 #bjae14 7#c7 ,effective date ,the amendments made by this subsection take effect on ,january #a1 #bjae4 #f4 ,accountability for ,federal funds at medical schools 7a7 ,family medicine or primary care department ,a medical school that receives ,federal funds for any purpose shall-- 7#a7 maintain in such medical school a family medicine or primary care department2 and 7#b7 require for all students at least #h weeks of rotations in family medicine or community-oriented primary care during the third year of training4 7b7 ,reporting on meeting health care workforce needs ,a medical school that receives ,federal funds for any purpose shall-- 7#a7 prepare an annual report-- 7,a7 responding to the data with respect to such medical school that is collected under section #eaja7;d77#i7 of the ,patient ,protection and ,affordable ,care ,act 7as added by section #d7;c77#b77;,b772 and 7,b7 detailing the actions the medical school is taking to meet the health care workforce needs in the school's community and across the ,nation2 and 7#b7 submit such report to the ,secretary of ,health and ,human ,services and the ,national ,health ,care ,workforce ,commission4 #g4 ,increasing opportunities and accountability for primary care residency training 7a7 ,additional residency positions for training in family medicine 7#a7 ,in general ,section #ahhf7;h7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acieww7h77 is amended-- 7,a7 in paragraph 7#d77;,f77i71 by striking paragraphs 7#g7 and 7#h7 and inserting paragraphs 7#g71 7#h71 and 7#i72 7,b7 in paragraph 7#d77;,h77i71 by striking paragraphs 7#g7 and 7#h7 and inserting paragraphs 7#g71 7#h71 and 7#i72 7,c7 in paragraph 7#g77;,e71 by inserting paragraph 7#i71 after paragraph 7#h712 and 7,d7 by adding at the end the following new paragraph3 7#i7 ,additional residency positions for training in family medicine 7,a7 ,in general 7i7 ,distribution ,for fiscal year #bjad 7and succeeding fiscal years if the ,secretary determines that there are additional residency positions available to distribute under subparagraph 7,d771 the ,secretary shall increase the otherwise applicable resident limit for each qualifying hospital that submits a timely application under this subparagraph by such number as the ,secretary may approve for portions of cost reporting periods occurring on or after ,july #a of the fiscal year of the increase4 ,such additional residency positions shall be for approved medical residency training programs 7as defined in paragraph 7#e77;,a77 in family medicine4 7ii7 ,requirements ,subject to clause 7iii71 a hospital that receives an increase in the otherwise applicable resident limit under this paragraph shall ensure1 during the #e-year period beginning on the date of such increase1 that-- 7,i7 the number of full-time equivalent residents in family medicine 7as determined by the ,secretary71 excluding any additional positions under subclause 7,,ii71 is not less than the average number of full-time equivalent residents in family medicine 7as so determined7 during the #c most recent cost reporting periods ending prior to the date of enactment of this paragraph2 and 7,,ii7 #ajj percent of the positions attributable to such increase are in an approved medical residency training program in family medicine 7as determined by the ,secretary74 7iii7 ,redistribution of positions if hospital no longer meets certain requirements ,in the case where the ,secretary determines that a hospital described in clause 7ii7 does not meet either of the requirements under subclause 7,i7 or 7,,ii7 of such clause1 the ,secretary shall-- 7,i7 reduce the otherwise applicable resident limit of the hospital by the amount by which such limit was increased under this paragraph2 and 7,,ii7 provide for the distribution of positions attributable to such reduction in accordance with the requirements of this paragraph4 7,b7 ,aggregate number of increases ,the aggregate number of increases in the otherwise applicable resident limit under this paragraph shall be equal to #b1jjj4 7,c7 ,timing ,the ,secretary shall notify hospitals of the number of positions distributed to the hospital under this paragraph as result of an increase in the otherwise applicable resident limit by ,january #a of the fiscal year of the increase4 ,such increase shall be effective for portions of cost reporting periods beginning on or after ,july #a of that fiscal year4 7,d7 ,positions not distributed during fiscal year #bjad ,if the number of resident full-time equivalent positions distributed under this paragraph in fiscal year #bjad is less than the aggregate number of positions available for distribution in the fiscal year under subparagraph 7,b71 the ,secretary shall conduct an application and distribution process in subsequent fiscal years until such time as the aggregate number of positions distributed under this paragraph is equal to the aggregate number under subparagraph 7,b74 7,e7 ,consideration in distribution ,in determining for which hospitals the increase in the otherwise applicable resident limit is provided under this paragraph1 the ,secretary shall prioritize training programs with an emphasis on community-based training1 and shall prioritize hospitals with a demonstrated likelihood of filling the positions with residents who will practice in health professional shortage areas 7as defined by the ,national ,health ,service ,corps under section #ccb of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bed;e77 or with medically underserved populations 7as defined in section #ccj7;b77#c7 of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bed;b7b77#c7771 as determined by the ,secretary4 7,f7 ,definition of otherwise applicable resident limit ,in this paragraph1 the term otherwise applicable resident limit means1 with respect to a hospital1 the limit otherwise applicable under subparagraphs 7,f77i7 and 7,h7 of paragraph 7#d7 on the resident level 7as defined in paragraph 7#g77;,c77i77 for the hospital determined without regard to this paragraph but taking into account paragraphs 7#g77;,a71 7#g77;,b71 7#h77;,a71 and 7#h77;,b74 4 7#b7 ,,ime 7,a7 ,in general ,section #ahhf7;d77#e77;,b77v7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acieww7d77#e77;,b77v771 in the second sentence1 is amended by striking subsections 7h77#g7 and 7h77#h7 and inserting subsections 7h77#g71 7h77#h71 and 7h77#i74 7,b7 ,conforming provision ,section #ahhf7;d77#e77;,b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acieww7d77#e77;,b77 is amended-- 7i7 by redesignating clause 7x71 as added by section #eeje7;b7 of the ,patient ,protection and ,affordable ,care ,act 7,public ,law #aaa-adh71 as clause 7xi7 and moving such clause #d ems to the left2 and 7ii7 by adding after clause 7xi71 as redesignated by subparagraph 7,a71 the following clause3 7xii7 ,for discharges occurring on or after ,july #a1 #bjad1 insofar as an additional payment amount under this subparagraph is attributable to resident positions distributed to a hospital under subsection 7h77#i71 the indirect teaching adjustment factor shall be computed in the same manner as provided under clause 7ii7 with respect to such resident positions4 4 7b7 ,requirements ,to improve transparency 7#a7 ,in general ,section #ahhf7;h7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acieww7h771 as amended by subsection 7a77#a71 is amended by adding at the end the following new paragraph3 7#aj7 ,requirements 7,a7 ,in general ,notwithstanding the preceding provisions of this subsection1 for fiscal year #bjad and subsequent fiscal years1 a hospital shall not receive any payments under this subsection or subsection 7d77#e77;,b7 7or any other payments under this title for graduate medical education costs7 in a fiscal year unless the hospital complies with the following requirements1 as determined by the ,secretary3 7i7 ,the hospital has an approved medical residency program in-- 7,i7 family medicine2 or 7,,ii7 adult or all-age primary care4 7ii7 ,each fiscal year 7beginning with fiscal year #bjad71 the hospital submits to the ,secretary a report that contains the following information with respect to residents of the hospital3 7,i7 ,the total amount of money generated by the residents 7by residency type7 in each year of their residency program4 7,,ii7 ,the total amount of ,federal funding provided to the hospital for training residents1 by residency type1 in each year of the residency program4 7,,iii7 ,the average number of inpatient and outpatient encounters per year by residency type in inpatient and outpatient settings4 7,,iv7 ,a justification for the hospital's allocation of residency slots across specialties and subspecialties that is responsive to local and national health care workforce needs and recommendations put forth by the ,national ,health ,care ,workforce ,commission4 7,v7 ,a detailed breakdown of how the hospital uses amounts received under this subsection and under subsection 7d77#e77;,b74 7,b7 ,public availability ,not later than #cj days after receiving the report under subparagraph 7,a77ii71 the ,secretary shall post the information described in subclauses 7,i7 through 7,,vi7 of such subparagraph on the ,internet ,website of the ,centers for ,medicare ,medicaid ,services4 4 7#b7 ,,ime ,section #ahhf7;d77#e77;,b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acieww7d77#e77;,b771 as amended by subsection 7a77#b77;,b71 is amended by adding at the end the following new clause3 7xiii7 ,the requirements under subsection 7h77#aj7 shall apply to payments under this subparagraph in the same manner as such requirements apply to payments under such subsection4 4 #h4 ,health care for the uninsured ,a hospital or health care provider that accepts any payment under the ,medicare program under title ,,xviii of the ,social ,security ,act 7#db ,u4,s4,c4 #acie et seq47 or the ,medicaid program under title ,,xix of the ,social ,security ,act 7#db ,u4,s4,c4 #acif et seq47 shall not charge an individual without health insurance coverage an amount for any medical service that exceeds the amount such hospital or health care provider receives under the ,medicare program for such service4