,,ii #aaith ,,congress #ast ,session ,s4 #bied ,,in ,,the ,,senate ,,of ,,the ,,united ,,states ,september #cj1 #bjbe,mr4 ,sanders 7for himself and ,mr4 ,merkley7 introduced the following bill2 which was read twice and referred to the ,committee on ,health1 ,education1 ,labor1 and ,pensions ,a ,,bill ,to establish grant programs for health professional schools1 and for other purposes4 #a4 ,short title ,this ,act may be cited as the ,health ,care ,workforce ,expansion ,act of #bjbe4 #b4 ,grant programs for health professional schools 7a7 ,,med1 ,,dental1 and ,,nurse ,grants ,part ,a of title ,,iv of the ,higher ,education ,act of #aife 7#bj ,u4,s4,c4 #ajgj7 is amended by adding at the end the following3 #aa ,,med ,grants #dbj,s4 ,definitions ,for the purposes of this subpart3 7#a7 ,eligible institution ,the term eligible institution means an institution of higher education1 as defined in section #aja1 that is a school of medicine or school of osteopathic medicine as defined in section #gii;,b of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #biep74 7#b7 ,medical school candidate ,the term medical school candidate means a student in attendance at an eligible institution pursuing a professional doctor of medicine or doctor of osteopathic medicine degree4 #dbj,t4 ,program established 7a7 ,program authority 7#a7 ,payments required ,the ,secretary shall pay to each eligible institution such sums as may be necessary to pay to each medical school candidate who files an application and agreement in accordance with section #dbj,u1 and who qualifies under such section1 a ,,med ,grant in the amount of tuition and required fees for each year during which that medical school candidate is in attendance at the institution4 7#b7 ,references ,grants made under paragraph 7#a7 shall be known as ,,med ,grants4 7b7 ,payment methodology 7#a7 ,prepayment ,not less than #he percent of any funds provided to an eligible institution under subsection 7a7 shall be advanced to the eligible institution prior to the start of each payment period and shall be based upon an amount requested by the institution as needed to pay medical school candidates until such time as the ,secretary determines and publishes in the ,federal ,register with an opportunity for comment1 an alternative payment system that provides payments to institutions in an accurate and timely manner1 except that this sentence shall not be construed to limit the authority of the ,secretary to place an institution on a reimbursement system of payment4 7#b7 ,direct payment ,nothing in this section shall be interpreted to prohibit the ,secretary from paying directly to medical school candidates1 in advance of the beginning of the academic term1 an amount for which medical school candidates are eligible1 in cases where the eligible institution elects not to participate in the disbursement system required by paragraph 7#a74 7c7 ,no exceeding cost ,the amount of a grant awarded under this subpart1 in combination with ,federal assistance1 shall not exceed the cost of attendance 7as defined in section #dgb7 at the eligible institution at which that medical school candidate is in attendance4 7d7 ,period of eligibility for grants ,the period during which a medical school candidate may receive a ,,med grant under this subpart shall be the period required for the completion of the professional medical degree being pursued by the medical school candidate at the eligible institution at which the medical school candidate is in attendance1 except that the period during which a medical school candidate may receive a ,,med ,grant under this subpart shall not exceed #h years4 #dbj,u4 ,application2 award 7a7 ,application2 award 7#a7 ,application ,the ,secretary shall periodically set dates by which medical school candidates shall file applications for grants under this subpart4 ,each medical school candidate desiring a grant under this subpart for any year shall file an application containing such information as is necessary to demonstrate that the medical school candidate-- 7,a7 is an eligible student for purposes of section #dhd2 7,b7 has completed a ,,fafsa2 7,c7 would like to receive a ,,med grant2 and 7,d7 understands and agrees to the terms and conditions of the agreement to serve described in subparagraph 7b74 7#b7 ,award ,the ,secretary shall award a ,,med grant to each eligible medical school candidate who meets the requirements described in paragraph 7#a7 for each year that the application under such paragraph is submitted and such requirements are met4 7b7 ,agreements ,to serve ,each application under subsection 7a7 shall contain or be accompanied by an agreement by the applicant that-- 7#a7 the applicant will-- 7,a7 practice primary care1 as defined in section #ahhf of the ,social ,security ,act 7#db ,u4,s4,c4 #acieww71 as a physician for at least #aj years after their related training is completed 7including residency or fellowship programs7 within #ae years after completing the degree for which the applicant received a ,,med ,grant under this subpart or such related training 7referred to in this section as the service obligation window72 and 7,b7 annually submit an employment certification1 for each year of service1 showing that the requirement under subparagraph 7,a7 is being met2 7#b7 in the event that the applicant is determined to have failed or refused to carry out such service obligation1 a specified amount of any ,,med ,grants received by such applicant will be treated as a loan and collected from the applicant in accordance with subsection 7c7 and the regulations thereunder2 and 7#c7 contains1 or is accompanied by1 a plain-language disclosure form developed by the ,secretary that clearly describes the nature of the ,,med ,grant award1 the service obligation1 and the loan repayment requirements that are the consequence of the failure to complete the service obligation4 7c7 ,repayment for failure ,to complete service 7#a7 ,in general ,in the event that any recipient of a grant under this subpart fails or refuses to comply with the service obligation in the agreement under subsection 7b71 a specified amount as described in paragraph 7#c7 of the ,,med ,grants received by such recipient shall1 upon a determination of such a failure or refusal in such service obligation1 be converted to a ,federal ,direct ,unsubsidized ,stafford ,loan under part ,d of title ,,iv1 and shall be subject to repayment1 in accordance with paragraph 7#b74 7#b7 ,interest and repayment ,amounts that are converted to a ,direct ,unsubsidized ,stafford ,loan under paragraph 7#a7 shall accrue interest at the rate applicable to such ,direct ,unsubsidized ,stafford ,loans for borrowers as of the date of conversion1 and the recipient shall be eligible for the same repayment plans and borrower protections with respect to such converted loans as that recipient would otherwise be eligible for with respect to a ,federal ,direct ,unsubsidized ,stafford ,loan under part ,d of title ,,iv for a borrower that is disbursed on the same date4 7#c7 ,specified amount to be repaid 7,a7 #e years or less ,if a ,,med ,grant recipient has completed #e years or less of required service1 the lesser of-- 7i7 the total amount of ,,med grants received by the recipient2 or 7ii7 #ej1jjj4 7,b7 ,greater than #e years and less than #aj years ,if a ,,med ,grant recipient has completed more than #e years of required service but less than #aj years of required service1 the lesser of-- 7i7 the total amount of ,,med grants received by the recipient2 or 7ii7 #be1jjj4 7,c7 ,cap ,the amount of ,,med ,grants that is converted to a loan and required to be repaid under this subsection shall not exceed #ej1jjj4 7#d7 ,reconsideration of conversion decisions 7,a7 ,request to reconsider ,in any case where the ,secretary has determined that a recipient of a grant under this subpart has failed or refused to comply with the service obligation in the agreement under subsection 7b7 and has converted the grant into a ,federal ,direct ,unsubsidized ,stafford ,loan under part ,d in accordance with paragraph 7#a71 7including cases where such loans have been fully or partially paid71 the recipient may request that the ,secretary reconsider such initial determination and may submit additional information to demonstrate satisfaction of the service obligation4 ,upon receipt of such a request1 the ,secretary shall reconsider the determination in accordance with this paragraph not later than #ij days after the date that such request was received4 7,b7 ,reconsideration ,if1 in reconsidering an initial determination under subparagraph 7,a7 7including cases where such loans were fully or partially paid71 the ,secretary determines that the reason for such determination was the recipient's failure to timely submit a certification required under subsection 7b77#a77;,b71 an error or processing delay by the ,secretary1 a change to the fields considered eligible for fulfillment of the service obligation 7as described in subsection 7b77#a77;,a771 a recipient having previously requested to have the ,,med ,grant converted to a loan1 or another valid reason determined by the ,secretary1 and that the recipient has1 as of the date of the reconsideration1 demonstrated that the recipient did meet1 or is meeting the service obligation in the agreement under subsection 7b71 the ,secretary shall-- 7i7 discharge the ,federal ,direct ,unsubsidized ,stafford ,loan under part ,d1 and reinstate the recipient's grant under this subpart2 7ii7 discharge any interest or fees that may have accumulated during the period that the grant was converted to a ,federal ,direct ,unsubsidized ,stafford ,loan under part ,d2 7iii7 if the recipient has other loans under part ,d1 apply any payments made for the ,federal ,direct ,unsubsidized ,stafford ,loan under part ,d during such period to those other loans under part ,d2 7iv7 if the recipient does not have other loans under part ,d1 reimburse the recipient for any amounts paid on the ,federal ,direct ,unsubsidized ,stafford ,loan under part ,d during such period2 7v7 request that consumer reporting agencies remove any negative credit reporting due to the conversion of the ,,med ,grant to a loan2 and 7vi7 use the additional information provided under subparagraph 7,a7 to determine the progress the recipient has made in meeting the service obligation4 7,c7 ,extension of time to complete service obligation ,in the case of a recipient whose ,,med ,grant was reinstated in accordance with subparagraph 7,b71 the ,secretary shall1 upon such reinstatement-- 7i7 extend the time remaining for the recipient to fulfill the service obligation described in subsection 7b77#a7 to a period of time equal to-- 7,i7 #aj years2 minus 7,,ii7 the number of years that the recipient completed service as a physician in primary care prior to the reconversion of the loan to a ,,med ,grant under subparagraph 7,b71 including any years of qualifying service completed during the period when the ,,med ,grant was in loan status2 and 7ii7 treat any years of service described in subclause 7,,ii7 of clause 7i7 as years that count toward the individual's service obligation 7regardless of whether the ,,med ,grant funds were in grant or loan status7 if that time otherwise meets the requirements of this section4 7d7 ,additional administrative provisions 7#a7 ,extenuating circumstances ,the ,secretary shall establish1 by regulation1 categories of extenuating circumstances under which a recipient of a grant under this subpart who is unable to fulfill all or part of the recipient's service obligation may be excused from fulfilling that portion of the service obligation4 7#b7 ,communication with recipients ,the ,secretary shall notify ,,med grant recipients not less than twice per calendar year regarding how to submit the employment certification under subsection 7b77#a77;,b7 and the recommendations and requirements for submitting that certification under paragraph 7#c74 7#c7 ,submission of employment certification 7,a7 ,recommended submissions 7i7 ,in ,general ,the ,secretary shall notify ,,med ,grant recipients that the ,department recommends that ,,med ,grant recipients submit the employment certification described in subsection 7b77#a77;,b7 as soon as practicable after the completion of each year of service4 7ii7 ,form ,the ,secretary shall provide a standardized annual certification form for use under this section and allow electronic submission by the recipient or employer4 7,b7 ,required submission ,a ,,med ,grant recipient shall be required to submit to the ,department employment certification within the timeframe that would allow that individual to complete their service obligation before the end of the service obligation window4 7,c7 ,notification ,the ,secretary shall notify ,,med ,grant recipients of the required submission deadlines described in this paragraph4 7,d7 ,adjustment of deadline ,the ,secretary shall adjust the submission deadline described in subparagraph 7,b7 to account for a service obligation window extension4 7,e7 ,alternative to certification ,the ,secretary shall provide an alternative to the certification of employment described in subsection 7b77#a77;,b7 for recipients who cannot obtain such required certification of employment because the recipient can demonstrate the employer is no longer in existence or the employer refuses to cooperate4 #dbj,v4 ,program period and funding ,beginning on ,july #a1 #bjbf1 there shall be available to the ,secretary to carry out this subpart1 from funds not otherwise appropriated1 such sums as may be necessary to provide ,,med ,grants in accordance with this subpart to each eligible applicant4 #ab ,,dental ,grants #dbj,w4 ,definitions ,for the purposes of this subpart3 7#a7 ,eligible institution ,the term eligible institution means an institution of higher education1 as defined in section #aja1 that is a school of dentistry as defined in section #gii;,b of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #biep74 7#b7 ,dental school candidate ,the term dental school candidate means a student in attendance at an eligible institution pursuing a professional dental degree4 7#c7 ,rural area ,the term rural area has the meaning given that term in section #hfa7;b77#b74 #dbj,x4 ,program established 7a7 ,program authority 7#a7 ,payments required ,the ,secretary shall pay to each eligible institution such sums as may be necessary to pay to each dental school candidate who files an application and agreement in accordance with section #dbj,y1 and who qualifies under such section1 a ,,dental ,grant in the amount of tuition and required fees for each year during which that dental school candidate is in attendance at the institution4 7#b7 ,references ,grants made under paragraph 7#a7 shall be known as ,,dental ,grants4 7b7 ,payment methodology 7#a7 ,prepayment ,not less than #he percent of any funds provided to an eligible institution under subsection 7a7 shall be advanced to the eligible institution prior to the start of each payment period and shall be based upon an amount requested by the institution as needed to pay dental school candidates until such time as the ,secretary determines and publishes in the ,federal ,register with an opportunity for comment1 an alternative payment system that provides payments to institutions in an accurate and timely manner1 except that this sentence shall not be construed to limit the authority of the ,secretary to place an institution on a reimbursement system of payment4 7#b7 ,direct payment ,nothing in this section shall be interpreted to prohibit the ,secretary from paying directly to dental school candidates1 in advance of the beginning of the academic term1 an amount for which dental school candidates are eligible1 in cases where the eligible institution elects not to participate in the disbursement system required by paragraph 7#a74 7c7 ,no exceeding cost ,the amount of a grant awarded under this subpart1 in combination with ,federal assistance1 shall not exceed the cost of attendance 7as defined in section #dgb7 at the eligible institution at which that dental school candidate is in attendance4 7d7 ,period of eligibility for grants ,the period during which a dental school candidate may receive a ,,dental grant under this subpart shall be the period required for the completion of the professional dental degree being pursued by the dental school candidate at the eligible institution at which the dental school candidate is in attendance1 except that the period during which a dental school candidate may receive a ,,dental ,grant under this subpart shall not exceed #h years4 #dbj,y4 ,application2 award 7a7 ,application2 award 7#a7 ,application ,the ,secretary shall periodically set dates by which dental school candidates shall file applications for grants under this subpart4 ,each dental school candidate desiring a grant under this subpart for any year shall file an application containing such information as is necessary to demonstrate that the dental school candidate-- 7,a7 is an eligible student for purposes of section #dhd2 7,b7 has completed a ,,fafsa2 7,c7 would like to receive a ,,dental grant2 and 7,d7 understands and agrees to the terms and conditions of the agreement to serve described in subparagraph 7b74 7#b7 ,award ,the ,secretary shall award a ,,dental grant to each eligible dental school candidate who meets the requirements described in paragraph 7#a7 for each year that the application under such paragraph is submitted and such requirements are met4 7b7 ,agreements ,to serve ,each application under subsection 7a7 shall contain or be accompanied by an agreement by the applicant that-- 7#a7 the applicant will-- 7,a7 practice general dental care in a rural area1 with the option for service to be completed cumulatively across eligible sites and locations1 for at least #aj years after their related training is completed 7including a residency or fellowship program7 within #ae years after completing the degree and such related training for which the applicant received a ,,dental ,grant under this subpart 7referred to in this section as the service obligation window72 and 7,b7 annually submit an employment certification1 for each year of service1 showing that the requirement under subparagraph 7,a7 is being met2 7#b7 in the event that the applicant is determined to have failed or refused to carry out such service obligation1 the specified amount of any ,,dental ,grants received by such applicant will be treated as a loan and collected from the applicant in accordance with subsection 7c7 and the regulations thereunder2 and 7#c7 contains1 or is accompanied by1 a plain-language disclosure form developed by the ,secretary that clearly describes the nature of the ,,dental ,grant award1 the service obligation1 and the loan repayment requirements that are the consequence of the failure to complete the service obligation4 7c7 ,repayment for failure ,to complete service 7#a7 ,in general ,in the event that any recipient of a grant under this subpart fails or refuses to comply with the service obligation in the agreement under subsection 7b71 a specified amount as described in paragraph 7#c7 of the ,,dental ,grants received by such recipient shall1 upon a determination of such a failure or refusal in such service obligation1 be converted to a ,federal ,direct ,unsubsidized ,stafford ,loan under part ,d of title ,,iv1 and shall be subject to repayment1 in accordance with paragraph 7#b74 7#b7 ,interest and repayment ,amounts that are converted to a ,direct ,unsubsidized ,stafford ,loan under paragraph 7#a7 shall accrue interest at the rate applicable to such ,direct ,unsubsidized ,stafford ,loans for borrowers as of the date of conversion1 and the recipient shall be eligible for the same repayment plans and borrower protections with respect to such converted loans as that recipient would otherwise be eligible for with respect to a ,federal ,direct ,unsubsidized ,stafford ,loan under part ,d of title ,,iv for a borrower that is disbursed on the same date4 7#c7 ,specified amount to be repaid 7,a7 #e years or less ,if a ,,dental ,grant recipient has completed #e years or less of required service1 the specified amount to be repaid is the lesser of-- 7i7 the total amount of ,,dental ,grants received by the recipient2 or 7ii7 #ej1jjj4 7,b7 ,greater than #e years and less than #aj years ,if a ,,dental ,grant recipient has completed more than #e years of required service but less than #aj years of required service1 the specified amount to be repaid is the lesser of-- 7i7 the total amount of ,,dental ,grants received by the recipient2 or 7ii7 #be1jjj4 7,c7 ,cap ,the amount of ,,dental ,grants that is converted to a loan and required to be repaid under this subsection shall not exceed #ej1jjj4 7#d7 ,reconsideration of conversion decisions 7,a7 ,request to reconsider ,in any case where the ,secretary has determined that a recipient of a grant under this subpart has failed or refused to comply with the service obligation in the agreement under subsection 7b7 and has converted the grant into a ,federal ,direct ,unsubsidized ,stafford ,loan under part ,d in accordance with paragraph 7#a71 7including cases where such loans have been fully or partially paid71 the recipient may request that the ,secretary reconsider such initial determination and may submit additional information to demonstrate satisfaction of the service obligation4 ,upon receipt of such a request1 the ,secretary shall reconsider the determination in accordance with this paragraph not later than #ij days after the date that such request was received4 7,b7 ,reconsideration ,if1 in reconsidering an initial determination under subparagraph 7,a7 7including cases where such loans were fully or partially paid71 the ,secretary determines that the reason for such determination was the recipient's failure to timely submit a certification required under subsection 7b77#a77;,b71 an error or processing delay by the ,secretary1 a change to the fields considered eligible for fulfillment of the service obligation 7as described in subsection 7b77#a77;,a771 a recipient having previously requested to have the ,,dental ,grant converted to a loan1 or another valid reason determined by the ,secretary1 and that the recipient has1 as of the date of the reconsideration1 demonstrated that the recipient did meet1 or is meeting the service obligation in the agreement under subsection 7b71 the ,secretary shall-- 7i7 discharge the ,federal ,direct ,unsubsidized ,stafford ,loan under part ,d1 and reinstate the recipient's grant under this subpart2 7ii7 discharge any interest or fees that may have accumulated during the period that the grant was converted to a ,federal ,direct ,unsubsidized ,stafford ,loan under part ,d2 7iii7 if the recipient has other loans under part ,d1 apply any payments made for the ,federal ,direct ,unsubsidized ,stafford ,loan under part ,d during such period to those other loans under part ,d2 7iv7 if the recipient does not have other loans under part ,d1 reimburse the recipient for any amounts paid on the ,federal ,direct ,unsubsidized ,stafford ,loan under part ,d during such period2 7v7 request that consumer reporting agencies remove any negative credit reporting due to the conversion of the ,,dental ,grant to a loan2 and 7vi7 use the additional information provided under subparagraph 7,a7 to determine the progress the recipient has made in meeting the service obligation4 7,c7 ,extension of time to complete service obligation ,in the case of a recipient whose ,,dental ,grant was reinstated in accordance with subparagraph 7,b71 the ,secretary shall1 upon such reinstatement-- 7i7 extend the time remaining for the recipient to fulfill the service obligation described in subsection 7b77#a7 to a period of time equal to-- 7,i7 #aj years2 minus 7,,ii7 the number of years that the recipient completed required service in general dentistry in a rural area prior to the reconversion of the loan to a ,,dental ,grant under subparagraph 7,b71 including any years of qualifying service completed during the period when the ,,dental ,grant was in loan status2 and 7ii7 treat any years of service described in subclause 7,,ii7 of clause 7i7 as years that count toward the individual's service obligation 7regardless of whether the ,,dental ,grant funds were in grant or loan status7 if that time otherwise meets the requirements of this section4 7d7 ,additional administrative provisions 7#a7 ,extenuating circumstances ,the ,secretary shall establish1 by regulation1 categories of extenuating circumstances under which a recipient of a grant under this subpart who is unable to fulfill all or part of the recipient's service obligation may be excused from fulfilling that portion of the service obligation4 7#b7 ,communication with recipients ,the ,secretary shall notify ,,dental grant recipients not less than twice per calendar year regarding how to submit the employment certification under subsection 7b77#a77;,b7 and the recommendations and requirements for submitting that certification under paragraph 7#c74 7#c7 ,submission of employment certification 7,a7 ,recommended submissions 7i7 ,in ,general ,the ,secretary shall notify ,,dental ,grant recipients that the ,department recommends that ,,dental ,grant recipients submit the employment certification described in subsection 7b77#a77;,b7 as soon as practicable after the completion of each year of service4 7ii7 ,form ,the ,secretary shall provide a standardized annual certification form for use under this section and allow electronic submission by the recipient or employer4 7,b7 ,required submission ,a ,,dental ,grant recipient shall be required to submit to the ,department employment certification within the timeframe that would allow that individual to complete their service obligation before the end of the service obligation window4 7,c7 ,notification ,the ,secretary shall notify ,,dental ,grant recipients of the required submission deadlines described in this paragraph4 7,d7 ,adjustment of deadline ,the ,secretary shall adjust the submission deadline described in subparagraph 7,b7 to account for a service obligation window extension4 7,e7 ,alternative to certification ,the ,secretary shall provide an alternative to the certification of employment described in subsection 7b77#a77;,b7 for recipients who cannot obtain such required certification of employment because the recipient can demonstrate the employer is no longer in existence or the employer refuses to cooperate4 #dbj,z4 ,program period and funding ,beginning on ,july #a1 #bjbf1 there shall be available to the ,secretary to carry out this subpart1 from funds not otherwise appropriated1 such sums as may be necessary to provide ,,dental ,grants in accordance with this subpart to each eligible applicant4 #ac ,,nurse ,grants #dbj;,,aa4 ,definitions ,for the purposes of this subpart3 7#a7 ,eligible institution ,the term eligible institution means an accredited school of nursing1 as defined in section #hja of the of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bif71 at an institution of higher education1 as defined in section #aja4 7#b7 ,nursing student ,the term nursing student means a student in attendance at an eligible institution4 #dbj;,,bb4 ,program established 7a7 ,program authority 7#a7 ,payments required ,the ,secretary shall pay to each eligible institution such sums as may be necessary to pay to each nursing student who files an application and agreement in accordance with section #dbj;,,cc1 and who qualifies under such section1 a ,,nurse ,grant in the amount of tuition and required fees for each year during which that nursing student is in attendance at the institution4 7#b7 ,references ,grants made under paragraph 7#a7 shall be known as ,,nurse ,grants4 7b7 ,payment methodology 7#a7 ,prepayment ,not less than #he percent of any funds provided to an eligible institution under subsection 7a7 shall be advanced to the eligible institution prior to the start of each payment period and shall be based upon an amount requested by the institution as needed to pay nursing students until such time as the ,secretary determines and publishes in the ,federal ,register with an opportunity for comment1 an alternative payment system that provides payments to institutions in an accurate and timely manner1 except that this sentence shall not be construed to limit the authority of the ,secretary to place an institution on a reimbursement system of payment4 7#b7 ,direct payment ,nothing in this section shall be interpreted to prohibit the ,secretary from paying directly to nursing students1 in advance of the beginning of the academic term1 an amount for which nursing students are eligible1 in cases where the eligible institution elects not to participate in the disbursement system required by paragraph 7#a74 7c7 ,no exceeding cost ,the amount of a grant awarded under this subpart1 in combination with ,federal assistance1 shall not exceed the cost of attendance 7as defined in section #dgb7 at the eligible institution at which that nursing student is in attendance4 7d7 ,period of eligibility for grants ,the period during which a nursing student may receive a ,,nurse grant under this subpart shall be the period required for the completion of the professional nursing degree being pursued by the nursing student at the eligible institution at which the nursing student is in attendance1 except that the period during which a nursing student may receive a ,,nurse ,grant under this subpart shall not exceed #h years4 #dbj;,,cc4 ,application2 award 7a7 ,application ,the ,secretary shall periodically set dates by which nursing students shall file applications for grants under this subpart4 ,each nursing student desiring a grant under this subpart for any year shall file an application containing such information as is necessary to demonstrate that the nursing student-- 7#a7 is an eligible student for purposes of section #dhd2 7#b7 has completed a ,,fafsa2 and 7#c7 would like to receive a ,,nurse grant4 7b7 ,award ,the ,secretary shall award a ,,nurse grant to each nursing student who meets the requirements described in subsection 7a7 for each year that the application under such subsection is submitted and such requirements are met4 #dbj;,,dd4 ,program period and funding ,beginning on ,july #a1 #bjbf1 there shall be available to the ,secretary to carry out this subpart1 from funds not otherwise appropriated1 such sums as may be necessary to provide ,,nurse ,grants in accordance with this subpart to each eligible applicant4 4 7b7 ,increasing enrollment at health professions schools ,part ,e of title ,,vii of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bidn et seq47 is amended by adding at the end the following3 #d ,increasing enrollment at health professions schools #ggi4 ,grant program to increase enrollment at health professions schools 7a7 ,schools of medicine and schools of osteopathic medicine 7#a7 ,in general ,the ,secretary shall award grants to eligible schools of medicine and schools of osteopathic medicine to assist such schools in expanding student enrollment4 7#b7 ,eligibility ,to be eligible to receive a grant under this section1 a school of medicine or school of osteopathic medicine shall submit an application to the ,secretary at such time1 in such manner1 and containing such information as the ,secretary may require1 including a plan to increase enrollment in the school by at least-- 7,a7 #ej percent by year #b of the grant2 and 7,b7 an additional #ej percent by year #d of the grant4 7#c7 ,use of funds ,a school of medicine or school of osteopathic medicine that receives a grant under this section shall use the funds awarded through such grant for activities that include-- 7,a7 enhancing enrollment and retention of students at such school using evidence-based practices1 with a priority for students from disadvantaged backgrounds 7including racial or ethnic groups underrepresented in the physician workforce71 individuals from rural and underserved areas1 low-income individuals1 individuals with a disability1 and first generation college students 7as defined in section #djb;,a7h77#c7 of the ,higher ,education ,act of #aife71 including through mentorship programs1 providing tools and programming for underrepresented students1 and addressing other student needs2 7,b7 retaining current faculty and clinical preceptors1 and recruiting and hiring new faculty and clinical preceptors1 including by increasing wages and providing loan repayment1 with an emphasis on faculty and clinical preceptors from racial or ethnic groups who are underrepresented in the physician workforce2 7,c7 partnering with a health care facility1 community health center1 or other facility that provides health care in order to provide educational opportunities for the purpose of establishing or expanding clinical education1 with emphasis on community-based clinical education2 7,d7 modernizing infrastructure at such school1 including audiovisual or other equipment1 simulation and augmented reality resources1 telehealth technologies1 and virtual and physical laboratories2 7,e7 creating1 supporting1 or modernizing educational programs and curriculum1 including rural and community-based clinical education1 at such school2 or 7,f7 other activities that the ,secretary determines further the development1 improvement1 and expansion of schools of medicine and schools of osteopathic medicine4 7b7 ,schools of nursing 7#a7 ,in general ,the ,secretary shall award grants to eligible schools of nursing to assist such schools in expanding student enrollment4 7#b7 ,eligibility ,to be eligible to receive a grant under this section1 a school of nursing shall submit an application to the ,secretary at such time1 in such manner1 and containing such information as the ,secretary may require1 including a plan to increase enrollment in the school by at least-- 7,a7 #cj percent by year #b of the grant2 and 7,b7 an additional #cj percent by year #d of the grant4 7#c7 ,use of funds ,a school of nursing that receives a grant under this section shall use the funds awarded through such grant for activities that include-- 7,a7 enhancing enrollment and retention of students at such school using evidence-based practices1 with a priority for students from disadvantaged backgrounds 7including racial or ethnic groups underrepresented in the nursing workforce71 students who identify as an underrepresented sex in the nursing workforce1 individuals from rural and underserved areas1 low-income individuals1 individuals with a disability1 and first generation college students 7as defined in section #djb;,a7h77#c7 of the ,higher ,education ,act of #aife71 including through mentorship programs1 providing tools and programming for underrepresented students1 and addressing other student needs2 7,b7 retaining current faculty and clinical preceptors1 and recruiting and hiring new faculty and clinical preceptors1 including by increasing wages and providing loan repayment1 with an emphasis on faculty and clinical preceptors from racial or ethnic groups who are underrepresented in the nursing workforce2 7,c7 partnering with a health care facility1 nurse-managed health clinic1 community health center1 or other facility that provides health care in order to provide educational opportunities for the purpose of establishing or expanding clinical education1 with emphasis on community-based clinical education2 7,d7 modernizing infrastructure at such school1 including audiovisual or other equipment1 simulation and augmented reality resources1 telehealth technologies1 and virtual and physical laboratories2 7,e7 creating1 supporting1 or modernizing educational programs and curriculum1 including rural and community-based clinical education1 at such school2 7,f7 enhancing and expanding nursing programs that prepare nurse researchers and scientists2 7,g7 establishing nurse-led intradisciplinary and interprofessional educational partnerships2 7,h7 supporting registered nurses in baccalaureate degree programs or advanced degree programs described in section #haa7;b71 with a goal of becoming nurse faculty and clinical preceptors2 or 7,i7 other activities that the ,secretary determines further the development1 improvement1 and expansion of schools of nursing4 7#d7 ,definition ,in this section1 the term school of nursing has the meaning given such term in section #hja7b74 7c7 ,schools of dentistry 7#a7 ,in general ,the ,secretary shall award grants to eligible schools of dentistry to assist such schools in expanding student enrollment4 7#b7 ,eligibility ,to be eligible to receive a grant under this section1 a school of dentistry shall submit an application to the ,secretary at such time1 in such manner1 and containing such information as the ,secretary may require1 including a plan to increase enrollment in the school by at least-- 7,a7 #bj percent by year #b of the grant2 and 7,b7 an additional #bj percent by year #d of the grant4 7#c7 ,use of funds ,a school of dentistry that receives a grant under this section shall use the funds awarded through such grant for activities that include-- 7,a7 enhancing enrollment and retention of students at such school using evidence-based practices1 with a priority for students from disadvantaged backgrounds 7including racial or ethnic groups underrepresented in the dental workforce71 individuals from rural and underserved areas1 low-income individuals1 individuals with a disability1 and first generation college students 7as defined in section #djb;,a7h77#c7 of the ,higher ,education ,act of #aife71 including through mentorship programs1 providing tools and programming for underrepresented students1 and addressing other student needs2 7,b7 retaining current faculty and clinical preceptors1 and recruiting and hiring new faculty and clinical preceptors1 including by increasing wages and providing loan repayment1 with an emphasis on faculty and clinical preceptors from racial or ethnic groups who are underrepresented in the dentistry workforce2 7,c7 partnering with a dental clinic1 community health center1 or other facility1 including a school-based dental clinic1 that provides dental care in order to provide educational opportunities for the purpose of establishing or expanding clinical education1 with emphasis on community-based clinical education2 7,d7 modernizing infrastructure at such school1 including audiovisual or other equipment1 simulation and augmented reality resources1 telehealth technologies1 and virtual and physical laboratories2 7,e7 creating1 supporting1 or modernizing educational programs and curriculum1 including rural and community-based clinical education1 at such school2 or 7,f7 other activities that the ,secretary determines further the development1 improvement1 and expansion of schools of dentistry4 7d7 ,grant amounts2 grant period ,each grant awarded under this section shall be in an amount determined by the ,secretary1 and for a period of #aj years4 7e7 ,reporting ,each recipient of a grant under this section shall submit to the ,secretary an annual report that describes-- 7#a7 the number of students enrolled during the year preceding the date of the report2 7#b7 the percentage by which such enrollment for such year has increased or decreased1 as compared to enrollment for the year preceding such year2 7#c7 the number of new faculty and clinical preceptors that were hired during such year2 and 7#d7 in the case of a recipient of a grant under subsection 7c71 with respect to graduates of the applicable school of dentistry-- 7,a7 the number who are practicing dentistry in a rural community2 7,b7 the number who are enrolled as a participating provider under a ,state plan under title ,,xix of the ,social ,security ,act or under a waiver of such a plan2 7,c7 the rates of passage of the ,integrated ,national ,board ,dental ,examination1 and of any exam or process by which a dentist obtains a license to practice dentistry2 and 7,d7 the rates at which such graduates are practicing dentistry #c and #e years after graduation4 7f7 ,authorization of appropriations ,there are authorized to be appropriated1 for the period of fiscal years #bjbf through #bjce-- 7#a7 #b1hjj1jjj1jjj for purposes of carrying out subsection 7a72 7#b7 #a1ihj1jjj1jjj for purposes of carrying out subsection 7b72 and 7#c7 #fae1jjj1jjj for purposes of carrying out subsection 7c74 4 #c4 ,program of payments to teaching health centers that operate graduate medical education programs ,section #cdj;,h of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bef;h7 is amended-- 7#a7 in subsection 7c77#b77;,b71 by adding at the end the following3 ,notwithstanding any other provision of this section1 the ,secretary shall update such per resident amount for each such qualified teaching health center such that such amount for fiscal year #bjbf is not less than #agj1jjj1 and such amount for fiscal year #bjbg and each fiscal year thereafter is not less than the sum of the amount determined for the previous fiscal year plus #aj1jjj42 and 7#b7 in subsection 7g77#a7-- 7,a7 in subparagraph 7,e71 by striking 2 and and inserting a semicolon2 7,b7 in subparagraph 7,f71 by striking the period and inserting a semicolon2 and 7,c7 by adding at the end the following3 7,g7 #hib1ejj1jjj for fiscal year #bjbf2 7,h7 #a1hij1jjj1jjj for fiscal year #bjbg2 7,i7 #b1iib1ejj1jjj for fiscal year #bjbh2 7,j7 #c1aej1jjj1jjj for fiscal year #bjbi2 7,k7 #c1cjg1ejj1jjj for fiscal year #bjcj2 7,l7 #c1dfe1jjj1jjj for fiscal year #bjca2 7,m7 #c1fbb1ejj1jjj for fiscal year #bjcb2 7,n7 #c1ghj1jjj1jjj for fiscal year #bjcc2 7,o7 #c1icg1ejj1jjj for fiscal year #bjcd2 and 7,p7 #d1jie1jjj1jjj for fiscal year #bjce4 4 #d4 ,distribution of additional ,medicare ,,gme residency positions 7a7 ,distribution 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 and 7#aj7 and inserting 7#aj71 and 7#aa72 7,b7 in paragraph 7#d77;,h77i71 by striking and 7#aj7 and inserting 7#aj71 and 7#aa72 and 7,c7 by adding at the end the following new paragraph3 7#aa7 ,distribution of additional residency positions in psychiatry and psychiatry subspecialties and primary care 7,a7 ,additional residency positions 7i7 ,in general ,for each of fiscal years #bjbg through #bjcf and for each succeeding fiscal year until the aggregate number of full-time equivalent residency positions distributed under this paragraph is equal to the aggregate number of such positions made available 7as specified in clause 7ii77,i771 the ,secretary shall1 subject to the succeeding provisions of this paragraph1 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 effective beginning ,july #a of the fiscal year of the increase4 7ii7 ,number available for distribution 7,i7 ,total number available ,the aggregate number of such positions made available under this paragraph shall be equal to #ej1bbj4 7,,ii7 ,annual limit ,the aggregate number of such positions so made available shall not exceed #e1jbb for a fiscal year4 7iii7 ,distribution for psychiatry or psychiatry subspecialty residencies2 primary care residencies ,for each of fiscal years #bjbg through #bjcf1 of the positions made available under this paragraph-- 7,i7 at least #ae percent shall be distributed for a psychiatry or psychiatry subspecialty residency 7as defined in subparagraph 7,f772 7,,ii7 at least #cj percent shall be distributed for a primary care residency 7as defined in such subparagraph72 and 7iv7 ,timing ,the ,secretary shall notify hospitals of the number of positions distributed to the hospital under this paragraph as a result of an increase in the otherwise applicable resident limit by ,january #ca of the fiscal year of the increase4 ,such increase shall be effective beginning ,july #a of such fiscal year4 7,b7 ,considerations in distribution ,in determining for which qualifying hospitals an increase in the otherwise applicable resident limit is provided under subparagraph 7,a71 the ,secretary shall take into account the demonstrated likelihood of the hospital filling the positions made available under this paragraph within the first #e training years beginning after the date the increase would be effective1 as determined by the ,secretary4 7,c7 ,requirements 7i7 ,prohibition on distribution to hospitals without an increase agreement ,no increase in the otherwise applicable resident limit of a hospital may be made under this paragraph unless such hospital agrees to increase the total number of full-time equivalent residency positions under the approved medical residency training program of such hospital by the number of such positions made available by such increase under this paragraph4 7ii7 ,requirement for hospitals to expand programs ,if a hospital that receives an increase in the otherwise applicable resident limit under this paragraph would be eligible for an adjustment to the otherwise applicable resident limit for participation in a new medical residency training program under section #dac4gi7;e77#c7 of title #db1 ,code of ,federal ,regulations 7or any successor regulation71 the hospital shall ensure that any positions made available under this paragraph are used to expand an existing program of the hospital and not for participation in a new medical residency training program4 7,d7 ,application of per resident amounts for nonprimary care ,with respect to additional residency positions in a hospital attributable to the increase provided under this paragraph1 the approved ,,fte per resident amounts are deemed to be equal to the hospital per resident amounts for nonprimary care computed under paragraph 7#b77;,d7 for that hospital4 7,e7 ,permitting facilities to apply aggregation rules ,the ,secretary shall permit hospitals receiving additional residency positions attributable to the increase provided under this paragraph to1 beginning in the fifth year after the effective date of such increase1 apply such positions to the limitation amount under paragraph 7#d77;,f7 that may be aggregated pursuant to paragraph 7#d77;,h7 among members of the same affiliated group4 7,f7 ,definitions ,in this paragraph3 7i7 ,otherwise applicable resident limit ,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 for the hospital determined without regard to this paragraph1 but taking into account paragraphs 7#g77;,a71 7#g77;,b71 7#h77;,a71 7#h77;,b71 7#i77;,a71 and 7#aj77;,a74 7ii7 ,primary care residency ,the term primary care residency means a residency in a program described in paragraph 7#e77;,h74 7iii7 ,psychiatry or psychiatry subspecialty residency ,the term psychiatry or psychiatry subspecialty residency has the meaning given that term in paragraph 7#aj77;,f74 7iv7 ,reference resident level ,the term reference resident level means1 with respect to a hospital1 the resident level for the most recent cost reporting period of the hospital ending on or before the date of enactment of this paragraph1 for which a cost report has been settled 7or1 if not1 submitted 7subject to audit771 as determined by the ,secretary4 7v7 ,resident level ,the term resident level has the meaning given such term in paragraph 7#g77;,c77i74 4 7#b7 ,,ime ,section #ahhf7;d77#e77;,b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acieww7d77#e77;,b77 is amended-- 7,a7 in clause 7v71 in the third sentence1 by striking and 7h77#aj7 and inserting 7h77#aj71 and 7h77#aa72 and 7,b7 by adding at the end the following new clause3 7xiii7 ,for discharges occurring on or after ,july #a1 #bjbg1 insofar as an additional payment amount under this subparagraph is attributable to resident positions distributed to a hospital under subsection 7h77#aa71 the indirect teaching adjustment factor shall be computed in the same manner as provided under clause 7ii7 with respect to such resident positions4 4 7#c7 ,prohibition on judicial review ,section #ahhf7;h77#g77;,e7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acieww7h77#g77;,e77 is amended by inserting paragraph 7#aa71 after paragraph 7#aj714 #e4 ,rural relocation grant program ,subpart #b of part ,e of title ,,vii of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bie et seq47 is amended by adding at the end the following3 #ggh;,a4 ,rural relocation grant program 7a7 ,in general ,the ,secretary shall award grants to eligible physicians1 nurses1 and dentists for purposes of assisting such individuals in relocating to a rural area in which the individual intends to practice medicine1 nursing1 or dentistry1 as applicable4 7b7 ,eligibility ,to be eligible to receive a grant under this section1 a physician1 nurse1 or dentist shall-- 7#a7 be licensed to practice medicine1 nursing1 or dentistry1 as applicable1 in the ,state in which the rural area to which the individual is relocating is located2 7#b7 prior to such relocation1 be practicing in an area that is not a rural area2 7#c7 upon such relocation1 have a permanent position in the area to which the individual is relocating and intend to practice in such area for not fewer than #c years2 and 7#d7 submit an application to the ,secretary at such time1 in such manner1 and containing such information as the ,secretary may require4 7c7 ,grant amounts2 use of funds2 repayment 7#a7 ,in general ,a grant awarded under this section shall be in an amount determined by the ,secretary1 not to exceed #bj1jjj4 7#b7 ,use of funds ,an individual receiving a grant under this section may use such grant for eligible life and relocation expenses1 as determined by the ,secretary4 7#c7 ,repayment ,if an individual receiving a grant under this section leaves the area described in subsection 7b77#c7 before the expiration of the #c-year period described in such subsection1 such individual shall repay to the ,secretary an amount equal to #ej percent of the amount of the grant4 7d7 ,authorization of appropriations ,to carry out this section1 there is authorized to be appropriated #a1hjj1jjj1jjj for the period of fiscal years #bjbf through #bjce4 4