Improving Access to Health Care in Rural and Underserved Areas Act

II 117TH CONGRESS 1ST SESSION S. 201 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 clinics, 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 areas. IN THE SENATE OF THE UNITED STATES FEBRUARY 3, 2021 Ms. ROSEN (for herself and Ms. MURKOWSKI) introduced the following bill; which was read twice and referred to the Committee on Health, Edu- cation, Labor, and Pensions A BILL To establish a program ensuring access to accredited con- tinuing medical education for primary care physicians and other health care providers at Federally-qualified health centers and rural health clinics, to provide train- ing and clinical support for primary care providers to practice at their full scope and improve access to care for patients in underserved areas. Be it enacted by the Senate and House of Representa- 1 tives of the United States of America in Congress assembled, 2 VerDate Sep 11 2014 05:29 Feb 17, 2021 Jkt 019200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\S201.IS S201 kjohnson on DSK79L0C42PROD with BILLS 2 •S 201 IS SECTION 1. SHORT TITLE. 1 This Act may be cited as the ‘‘Improving Access to 2 Health Care in Rural and Underserved Areas Act’’. 3 SEC. 2. PRIMARY CARE ACCREDITED CONTINUING MED- 4 ICAL EDUCATION PROGRAM. 5 Subpart 1 of part D of title III of the Public Health 6 Service Act (42 U.S.C. 254b et seq.) is amended by adding 7 at the end the following: 8 ‘‘SEC. 330O. PRIMARY CARE ACCREDITED CONTINUING 9 MEDICAL EDUCATION PROGRAM. 10 ‘‘(a) IN GENERAL.—The Secretary, acting through 11 the Administrator of the Health Resources and Services 12 Administration, shall establish a program to award not 13 more than 100 grants to Federally-qualified health centers 14 or rural health clinics, or organizations affiliated with such 15 clinics, for the purpose of ensuring access to accredited 16 continuing medical education by board-certified specialist 17 physicians, including family and internal medicine physi- 18 cians, with teaching or high-volume patient experience, 19 and other licensed medical providers who have clinical ex- 20 perience and are certified in accordance with regulations 21 issued by the Secretary, to primary care physicians and 22 medical providers employed by Federally-qualified health 23 centers or rural health clinics, to increase the primary care 24 providers’ knowledge and capacity to practice within their 25 VerDate Sep 11 2014 05:29 Feb 17, 2021 Jkt 019200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\S201.IS S201 kjohnson on DSK79L0C42PROD with BILLS 3 •S 201 IS full scope and increase access to care for patients in rural 1 and underserved areas. 2 ‘‘(b) SCOPE OF TRAINING.— 3 ‘‘(1) IN GENERAL.—Accredited continuing med- 4 ical education programs offered under this section— 5 ‘‘(A) shall be designed to be flexible to 6 meet the needs of the patients and providers 7 served and offer a variety of schedules, with a 8 minimum of 1-day training per month, per spe- 9 cialty area; 10 ‘‘(B) shall involve clinical practice for at 11 least 50 percent of the training (based on a 3- 12 month average), involving direct care for pa- 13 tients with a scheduled visit with the primary 14 care provider, and who could benefit from a 15 concurrent visit with both the primary care pro- 16 vider and a specialist; 17 ‘‘(C) shall not impose additional cost-shar- 18 ing with respect to the concurrent visits de- 19 scribed in subparagraph (B); and 20 ‘‘(D) may involve specialists and faculty 21 who participate in the program via telemedicine, 22 as the program determines appropriate. 23 ‘‘(2) TRAINING.—Accredited continuing medical 24 education programs offered under this section may 25 VerDate Sep 11 2014 05:29 Feb 17, 2021 Jkt 019200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\S201.IS S201 kjohnson on DSK79L0C42PROD with BILLS 4 •S 201 IS provide training to primary and behavioral care phy- 1 sicians and health care providers on— 2 ‘‘(A) endocrinology (including diabetes 3 care); 4 ‘‘(B) palliative care and pain management; 5 ‘‘(C) dermatology; 6 ‘‘(D) obstetrics and gynecology; 7 ‘‘(E) pediatric primary care and pediatric 8 subspecialties; 9 ‘‘(F) gastroenterology; 10 ‘‘(G) mental and behavioral health, and 11 substance use treatment; 12 ‘‘(H) preventive care and nutrition; 13 ‘‘(I) geriatric medicine; 14 ‘‘(J) infectious disease; 15 ‘‘(K) cardiology; 16 ‘‘(L) rural health and training to improve 17 outcomes for populations experiencing health 18 disparities; 19 ‘‘(M) wound care; 20 ‘‘(N) disease management for patients with 21 multiple comorbidities; 22 ‘‘(O) health information technology; and 23 ‘‘(P) other topics, as the Secretary deter- 24 mines appropriate. 25 VerDate Sep 11 2014 05:29 Feb 17, 2021 Jkt 019200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\S201.IS S201 kjohnson on DSK79L0C42PROD with BILLS 5 •S 201 IS ‘‘(3) PARTICIPATING CENTERS OR CLINICS.— 1 ‘‘(A) IN GENERAL.—To be eligible for a 2 grant under this section a Federally-qualified 3 health center or rural health clinic, or an orga- 4 nization affiliated with any such health clinic 5 acting on behalf of multiple such clinics, shall— 6 ‘‘(i) submit an application to the Sec- 7 retary at such time, in such manner, and 8 containing such information as the Sec- 9 retary may require; 10 ‘‘(ii) ensure that training under the 11 program under the grant is provided to the 12 physicians and primary care providers em- 13 ployed by such center or clinic, as well as 14 peer-to-peer training; 15 ‘‘(iii) include in the application a 16 needs assessment describing how participa- 17 tion in the program under the grant will 18 meet both patient needs and skills training 19 needs for their primary care providers; and 20 ‘‘(iv) include in the application a de- 21 scription of the expected patient target for 22 how many patients would be directly 23 served by activities under the grant and an 24 assurance that data and reports will be 25 VerDate Sep 11 2014 05:29 Feb 17, 2021 Jkt 019200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\S201.IS S201 kjohnson on DSK79L0C42PROD with BILLS 6 •S 201 IS provided annually on the number of pa- 1 tients served and the accrediting entity 2 used for purposes of subsection (c)(2)(B). 3 ‘‘(B) USE OF GRANT.—A Federally-quali- 4 fied health center, rural health clinic, or affili- 5 ated organization receiving a grant under this 6 section may use grant funds for— 7 ‘‘(i) compensation for medical pro- 8 viders participating in teaching at program 9 sessions; 10 ‘‘(ii) part-time administration support 11 for the program; 12 ‘‘(iii) compensation for the center for 13 the nonclinical training time of the center’s 14 primary care or behavioral health care pro- 15 viders; 16 ‘‘(iv) technology and equipment need- 17 ed to facilitate clinical visits for the pro- 18 gram; 19 ‘‘(v) transportation costs for medical 20 providers participating in teaching under 21 the program to travel to center sites if 22 such sites are located more than 35 miles 23 from their primary residences and their 24 participation is in-person; and 25 VerDate Sep 11 2014 05:29 Feb 17, 2021 Jkt 019200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\S201.IS S201 kjohnson on DSK79L0C42PROD with BILLS 7 •S 201 IS ‘‘(vi) other purposes related to ex- 1 penses incurred in the planning and deliv- 2 ery of the educational program and associ- 3 ated clinical visits, as the Secretary deter- 4 mines appropriate. 5 ‘‘(C) TERM.—A grant under this section 6 shall be for a period of 5-years. 7 ‘‘(D) RURAL AREAS.—The Secretary shall 8 ensure that at least half of the recipients of a 9 grant under this section are eligible Federally- 10 qualified health centers located in a rural area 11 or rural health clinics, or affiliated organiza- 12 tions acting on behalf of such centers. 13 ‘‘(c) PHYSICIAN PARTICIPATION IN PROGRAM.— 14 ‘‘(1) ELIGIBILITY.—To be eligible to participate 15 in an accredited continuing medical education pro- 16 gram offered under this section, a physician or other 17 primary care or behavioral health care provider shall 18 be a primary care provider— 19 ‘‘(A) who is employed by the grantee; and 20 ‘‘(B) who serves patients in a medically 21 underserved population (as defined in section 22 330(b)(3)). 23 ‘‘(2) CME CREDIT.— 24 VerDate Sep 11 2014 05:29 Feb 17, 2021 Jkt 019200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\S201.IS S201 kjohnson on DSK79L0C42PROD with BILLS 8 •S 201 IS ‘‘(A) IN GENERAL.—The Secretary shall 1 require a grantee under this section to identify 2 an accrediting body that the grantee will work 3 with to certify the program under the grant in 4 a manner that provides continuing medical edu- 5 cation credits to providers participating in the 6 program. Such certification shall include mate- 7 rial with respect to specific skills development. 8 ‘‘(B) REPORTING.—As part of the annual 9 reporting under subsection (b)(3)(A)(iv) a 10 grantee shall provide to the Secretary informa- 11 tion to confirm the accredited continuing med- 12 ical education entity used by the grantee. 13 ‘‘(C) SUSPENSION OF FUNDING FOR NON- 14 COMPLIANCE.—The Secretary may suspend 15 grant funding if the grantee fails to provide for 16 accredited continuing medical education within 17 the first year of the grant. Such grant funding 18 may be reinstated by the Secretary once the 19 grantee certifies that accredited continuing 20 medical education is provided. 21 ‘‘(d) ANNUAL REPORTING.—Beginning 1 year after 22 the date of enactment of the Improving Access to Health 23 Care in Rural and Underserved Areas Act, and every year 24 VerDate Sep 11 2014 05:29 Feb 17, 2021 Jkt 019200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\S201.IS S201 kjohnson on DSK79L0C42PROD with BILLS 9 •S 201 IS thereafter, the Secretary shall submit to Congress a report 1 on the program under this section, including— 2 ‘‘(1) the number of physicians who participate 3 in the program each year and the specialties of such 4 physicians; 5 ‘‘(2) a breakdown of specialist time spent di- 6 rectly with patients, with patients through telemedi- 7 cine, and with primary care providers in classroom 8 or other non-clinical setting during the program ses- 9 sions; 10 ‘‘(3) a comparison of measures under the Uni- 11 form Data System of the Health Resources and 12 Services Administration, or similar program, rel- 13 evant to patient care improvements, between the 14 year prior to the implementation of the program 15 under this section and the most recent year in the 16 program; 17 ‘‘(4) a summary of any clinical practice changes 18 or notable improvements in patient care; 19 ‘‘(5) patient referrals from health centers that 20 participate in the program to outside specialist care, 21 and any patient care provided at the health center 22 that, prior to the program, would have been referred 23 to outside specialists; 24 VerDate Sep 11 2014 05:29 Feb 17, 2021 Jkt 019200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\S201.IS S201 kjohnson on DSK79L0C42PROD with BILLS 10 •S 201 IS ‘‘(6) retention rates of physicians at partici- 1 pating health centers; and 2 ‘‘(7) satisfaction rates of physicians with the 3 education program at participating health centers. 4 ‘‘(e) AUTHORIZATION OF APPROPRIATIONS.—To 5 carry out this section, there are authorized to be appro- 6 priated $20,000,000 for each of fiscal years 2021 through 7 2025.’’. 8 Æ VerDate Sep 11 2014 05:29 Feb 17, 2021 Jkt 019200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6301 E:\BILLS\S201.IS S201 kjohnson on DSK79L0C42PROD with BILLS