,,ii #aafth ,,congress #b;d ,session ,s4 #caid ,,in ,,the ,,senate ,,of ,,the ,,united ,,states ,january #ae1 #bjbj,ms4 ,rosen 7for herself and ,ms4 ,murkowski7 introduced the following bill2 which was read twice and referred to the ,committee on ,health1 ,education1 ,labor1 and ,pensions ,a ,,bill ,to establish a program ensuring access to accredited continuing medical education for primary care physicians and other health care providers at ,federally-qualified health centers and rural health clinics1 to provide training and clinical support for primary care providers to practice at their full scope and improve access to care for patients in underserved areas4 #a4 ,short title ,this ,act may be cited as the ,improving ,access to ,health ,care in ,rural and ,underserved ,areas ,act4 #b4 ,primary care accredited continuing medical education program ,subpart #a of part ,d of title ,,iii of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bed;b et seq47 is amended by adding at the end the following3 #ccj,n4 ,primary care accredited continuing medical education program 7a7 ,in general ,the ,secretary1 acting through the ,administrator of the ,health ,resources and ,services ,administration1 shall establish a program to award not more than #ajj grants to ,federally-qualified health centers or rural health clinics1 or organizations affiliated with such clinics1 for the purpose of ensuring access to accredited continuing medical education by board-certified specialist physicians1 including family and internal medicine physicians1 with teaching or high-volume patient experience1 and other licensed medical providers who have clinical experience and are certified in accordance with regulations issued by the ,secretary1 to primary care physicians and medical providers employed by ,federally-qualified health centers or rural health clinics1 to increase the primary care providers' knowledge and capacity to practice within their full scope and increase access to care for patients in rural and underserved areas4 7b7 ,scope of training 7#a7 ,in general ,accredited continuing medical education programs offered under this section-- 7,a7 shall be designed to be flexible to meet the needs of the patients and providers served and offer a variety of schedules1 with a minimum of #a-;day training per month1 per specialty area2 7,b7 shall involve clinical practice for at least #ej percent of the training 7based on a #c-month average71 involving direct care for patients with a scheduled visit with the primary care provider1 and who could benefit from a concurrent visit with both the primary care provider and a specialist2 7,c7 shall not impose additional cost-sharing with respect to the concurrent visits described in subparagraph 7,b72 7,d7 may involve specialists and faculty who participate in the program via telemedicine for up to #ej percent of the clinical time1 not to exceed #ge percent of the total program time over a #c-month average2 and 7,e7 with respect to rural and frontier ,federally-qualified health centers or rural health clinics1 may permit a waiver of subparagraph 7,d7 7upon request to the ,health ,resources and ,services ,administration7 to permit #ajj percent telemedicine participation4 7#b7 ,training ,accredited continuing medical education programs offered under this section may provide training to primary and behavioral care physicians and health care providers on-- 7,a7 endocrinology 7including diabetes care72 7,b7 palliative care and pain management2 7,c7 dermatology2 7,d7 obstetrics and gynecology2 7,e7 pediatric primary care and pediatric subspecialties2 7,f7 gastroenterology2 7,g7 mental and behavioral health1 and substance use treatment2 7,h7 preventive care and nutrition2 7,i7 geriatric medicine2 7,j7 infectious disease2 7,k7 cardiology2 7,l7 rural health and training to improve outcomes for populations experiencing health disparities2 7,m7 wound care2 7,n7 disease management for patients with multiple comorbidities2 7,o7 health information technology2 and 7,p7 other topics1 as the ,secretary determines appropriate4 7#c7 ,participating centers or clinics 7,a7 ,in general ,to be eligible for a grant under this section a ,federally-qualified health center or rural health clinic1 or an organization affiliated with any such health clinic acting on behalf of multiple such clinics1 shall-- 7i7 submit an application to the ,secretary at such time1 in such manner1 and containing such information as the ,secretary may require2 7ii7 ensure that training under the program under the grant is provided to the physicians and primary care providers employed by such center or clinic1 as well as peer-to-peer training2 7iii7 include in the application a needs assessment describing how participation in the program under the grant will meet both patient needs and skills training needs for their primary care providers2 and 7iv7 include in the application a description of the expected patient target for how many patients would be directly served by activities under the grant and an assurance that data and reports will be provided on the number of patients served and the accrediting entity used for purposes of subsection 7c74 7,b7 ,use of grant ,a ,federally-qualified health center1 rural health clinic1 or affiliated organization receiving a grant under this section may use grant funds for-- 7i7 compensation for medical providers participating in teaching at program sessions2 7ii7 part-time administration support for the program2 7iii7 compensation for the center for the nonclinical training time of the center's primary care or behavioral health care providers2 7iv7 technology and equipment needed to facilitate clinical visits for the program2 7v7 transportation costs for medical providers participating in teaching under the program to travel to center sites if such sites are located more than #ce miles from their primary residences2 and 7vi7 other purposes related to expenses incurred in the planning and delivery of the educational program and associated clinical visits1 as the ,secretary determines appropriate4 7,c7 ,term ,a grant under this section shall be for a period of #e-years4 7,d7 ,rural areas ,the ,secretary shall ensure that at least half of the recipients of a grant under this section are eligible ,federally-qualified health centers located in a rural area or rural health clinics1 or affiliated organizations acting on behalf of such centers4 7c7 ,physician participation in program 7#a7 ,eligibility ,to be eligible to participate in an accredited continuing medical education program offered under this section1 a physician or other primary care or behavioral health care provider shall be a primary care provider-- 7,a7 who is employed by the grantee2 and 7,b7 who serves patients in a medically underserved population 7as defined in section #ccj7;b77#c774 7#b7 ,,cme credit 7,a7 ,in general ,the ,secretary shall require a grantee under this section to identify an accrediting body that the grantee will work with to certify the program under the grant in a manner that provides continuing medical education credits to providers participating in the program4 ,such certification shall include material with respect to specific skills development4 7,b7 ,reporting ,as part of the annual reporting provided under subsection 7b77#c77;,a77iv7 a grantee shall provide information to confirm the accredited continuing medical education entity used by the grantee4 ,the ,secretary may suspend grant funding if the grantee fails to provide for accredited continuing medical education within the first year of the grant4 ,such grant funding may be reinstated by the ,secretary once the grantee certifies that accredited continuing medical education is provided4 7d7 ,annual reporting ,beginning #a year after the date of enactment of the ,improving ,access to ,health ,care in ,rural and ,underserved ,areas ,act1 and every year thereafter1 the ,secretary shall submit to ,congress a report on the program under this section1 including-- 7#a7 the number of physicians who participate in the program each year and the specialties of such physicians2 7#b7 a breakdown of specialist time spent directly with patients1 with patients through telemedicine1 and with primary care providers in classroom or other non-clinical setting during the program sessions2 7#c7 a comparison of measures under the ,uniform ,data ,system of the ,health ,resources and ,services ,administration1 or similar program1 relevant to patient care improvements1 between the year prior to the implementation of the program under this section and the most recent year in the program2 7#d7 a summary of any clinical practice changes or notable improvements in patient care2 7#e7 patient referrals from health centers that participate in the program to outside specialist care1 and any patient care provided at the health center that1 prior to the program1 would have been referred to outside specialists2 7#f7 retention rates of physicians at participating health centers2 and 7#g7 satisfaction rates of physicians with the education program at participating health centers4 7e7 ,authorization of appropriations ,to carry out this section1 there are authorized to be appropriated #bj1jjj1jjj for each of fiscal years #bjbj through #bjbd4 4