Geriatrics Workforce Improvement Act

II 116TH CONGRESS 1ST SESSION S. 299 To amend title VII of the Public Health Service Act to reauthorize programs that support interprofessional geriatric education and training 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 JANUARY 31, 2019 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 geri- atric education and training to develop a geriatric-capa- ble workforce, improving health outcomes for a growing and diverse aging American population and their fami- lies, and for other purposes. Be it enacted by the Senate and House of Representa- 1 tives of the United States of America in Congress assembled, 2 SECTION 1. SHORT TITLE. 3 This Act may be cited as the ‘‘Geriatrics Workforce 4 Improvement Act’’. 5 VerDate Sep 11 2014 04:24 Feb 08, 2019 Jkt 089200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\S299.IS S299 kjohnson on DSK79L0C42 with BILLS 2 •S 299 IS SEC. 2. FINDINGS. 1 Congress finds the following: 2 (1) In 2016, 46,000,000 adults age 65 or older 3 lived in the United States, and this number is ex- 4 pected to double to over 98,000,000 by 2060. Three 5 out of four older adults are expected to have mul- 6 tiple chronic conditions, which increases the com- 7 plexity of care needed and increases medical expend- 8 itures. 9 (2) Thirty percent of older adults in the United 10 States, about 14,000,000 individuals, are projected 11 to need specialized geriatric care by 2030. That care 12 will require at least 20,000 geriatricians and even 13 more geriatric-trained health professionals. There 14 are nearly 1,000,000 physicians in the United 15 States, less than 7,300 of whom are board-certified 16 geriatricians. There are 3,600,000 nurses in the 17 United States, of whom, less than 1 percent are reg- 18 istered nurses certified in geriatrics and less than 3 19 percent are advanced practice nurses certified in ger- 20 iatrics. There are similarly few professionals cer- 21 tified in geriatrics among professionals in social 22 work, pharmacy, psychiatry, and the allied health 23 disciplines. 24 (3) Health professionals trained in geriatrics 25 understand the unique health needs and complex 26 VerDate Sep 11 2014 04:24 Feb 08, 2019 Jkt 089200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\S299.IS S299 kjohnson on DSK79L0C42 with BILLS 3 •S 299 IS care challenges associated with aging. Outcomes as- 1 sociated with interprofessional geriatric teams in- 2 clude improved health-related quality of life, fewer 3 emergency room visits, fewer hospital admissions 4 and, in the case of hospitalization, shorter length of 5 stay and lower costs per admission. 6 (4) Two federally funded initiatives have his- 7 torically aimed to reduce the widening gap between 8 the numbers of older adults and health professionals 9 trained in geriatrics: The Geriatrics Workforce En- 10 hancement Program and the Geriatrics Academic 11 Career Award. 12 SEC. 3. PURPOSE. 13 It is the purpose of this Act to develop the next gen- 14 eration of geriatric scientists and innovators, improving 15 health outcomes and care delivery for older adults. To- 16 gether, the Geriatrics Workforce Enhancement Program 17 and the Geriatrics Academic Career Award develop a 18 workforce capable of providing complex, high-quality care 19 that improves health outcomes and saves valuable re- 20 sources by reducing unnecessary costs for a growing and 21 diverse aging population. 22 VerDate Sep 11 2014 04:24 Feb 08, 2019 Jkt 089200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\S299.IS S299 kjohnson on DSK79L0C42 with BILLS 4 •S 299 IS SEC. 4. EDUCATION AND TRAINING RELATING TO GERI- 1 ATRICS. 2 Section 753 of the Public Health Service Act (42 3 U.S.C. 294c) is amended to read as follows: 4 ‘‘SEC. 753. EDUCATION AND TRAINING RELATING TO GERI- 5 ATRICS. 6 ‘‘(a) GERIATRICS WORKFORCE ENHANCEMENT PRO- 7 GRAM.— 8 ‘‘(1) IN GENERAL.—The Secretary shall award 9 grants under this subsection to entities described in 10 paragraph (1), (3), or (4) of section 799B, section 11 801(2), or section 865(d), or other health profes- 12 sions schools or programs approved by the Sec- 13 retary, for the establishment or operation of Geri- 14 atrics Workforce Enhancement Programs that meet 15 the requirements of paragraph (2). 16 ‘‘(2) REQUIREMENTS.— 17 ‘‘(A) IN GENERAL.—A Geriatrics Work- 18 force Enhancement Program meets the require- 19 ments of this paragraph if such program sup- 20 ports the development of a health care work- 21 force that maximizes patient and family engage- 22 ment and improves health outcomes for older 23 adults by integrating geriatrics with primary 24 care and other appropriate specialties. Special 25 emphasis shall be placed on providing the pri- 26 VerDate Sep 11 2014 04:24 Feb 08, 2019 Jkt 089200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\S299.IS S299 kjohnson on DSK79L0C42 with BILLS 5 •S 299 IS mary care workforce with the knowledge and 1 skills to care for older adults and collaborating 2 with community partners to address gaps in 3 health care for older adults through individual- 4 , system-, community-, and population-level 5 changes. 6 ‘‘(B) PROGRAMMATIC FOCUS.—Areas of 7 programmatic focus for a program meeting the 8 requirements of this paragraph may include the 9 following: 10 ‘‘(i) Transforming clinical training en- 11 vironments into integrated geriatrics and 12 primary care delivery systems to ensure 13 trainees are well prepared to practice in 14 and lead such systems. 15 ‘‘(ii) Developing providers from mul- 16 tiple disciplines and specialties to work 17 interprofessionally to assess and address 18 the needs and preferences of older adults 19 and their families and caregivers at the in- 20 dividual, community, and population levels. 21 ‘‘(iii) Creating and delivering commu- 22 nity-based programs that will provide older 23 adults and their families and caregivers 24 with education and training to improve 25 VerDate Sep 11 2014 04:24 Feb 08, 2019 Jkt 089200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\S299.IS S299 kjohnson on DSK79L0C42 with BILLS 6 •S 299 IS health outcomes and the quality of care for 1 such adults. 2 ‘‘(iv) Providing education on Alz- 3 heimer’s disease and related dementias to 4 families and caregivers of older adults, di- 5 rect care workers, and health professions 6 students, faculty, and providers. 7 ‘‘(3) DURATION.—The Secretary shall award 8 grants under paragraph (1) for a period not to ex- 9 ceed 5 years. 10 ‘‘(4) APPLICATIONS.—To be eligible to receive a 11 grant under paragraph (1), an entity described in 12 such paragraph shall submit to the Secretary an ap- 13 plication at such time, in such manner, and con- 14 taining such information as the Secretary may re- 15 quire, including the specific measures the applicant 16 will use to demonstrate that the project is improving 17 the quality of care provided to older adults in the 18 applicant’s region, which may include— 19 ‘‘(A) improvements in access to care pro- 20 vided by a health professional with training in 21 geriatrics or gerontology; 22 ‘‘(B) improvements in family caregiver ca- 23 pacity to care for older adults; 24 VerDate Sep 11 2014 04:24 Feb 08, 2019 Jkt 089200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\S299.IS S299 kjohnson on DSK79L0C42 with BILLS 7 •S 299 IS ‘‘(C) patient outcome data demonstrating 1 an improvement in older adult health status or 2 care quality; and 3 ‘‘(D) reports on how the applicant will im- 4 plement specific innovations with the target au- 5 dience to improve older adults health status or 6 the quality of care. 7 ‘‘(5) PROGRAM REQUIREMENTS.— 8 ‘‘(A) IN GENERAL.—In awarding grants 9 under paragraph (1), the Secretary— 10 ‘‘(i) shall ensure an equitable geo- 11 graphic distribution of grant recipients 12 based on State and regional aging demo- 13 graphics; 14 ‘‘(ii) shall give priority to programs 15 that demonstrate coordination with other 16 programmatic efforts funded under this 17 program or other public or private entities; 18 ‘‘(iii) shall give priority to applicants 19 with programs or activities should substan- 20 tially benefit rural, underserved, or Native 21 American populations of older adults; and 22 ‘‘(iv) may give priority to any pro- 23 gram that— 24 VerDate Sep 11 2014 04:24 Feb 08, 2019 Jkt 089200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\S299.IS S299 kjohnson on DSK79L0C42 with BILLS 8 •S 299 IS ‘‘(I) integrates geriatrics and ger- 1 ontology into primary care practice, 2 especially with respect to medical, 3 dental, and psychosocial care, elder 4 abuse, pain management, and advance 5 care planning; 6 ‘‘(II) offers courses to infuse core 7 geriatric principles of care into other 8 specialties across care settings, includ- 9 ing practicing clinical specialists, 10 health care administrators, faculty 11 without backgrounds in geriatrics, 12 students from all health professions, 13 as approved by the Secretary, to im- 14 prove knowledge and clinical skills for 15 the care of older adults; 16 ‘‘(III) emphasizes integration 17 into existing service delivery locations 18 and care across settings, including 19 primary care clinics, medical homes, 20 Federally qualified health centers, am- 21 bulatory care clinics, age-friendly 22 health systems, critical access hos- 23 pitals, emergency care, assisted living 24 and nursing facilities, and home- and 25 VerDate Sep 11 2014 04:24 Feb 08, 2019 Jkt 089200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\S299.IS S299 kjohnson on DSK79L0C42 with BILLS 9 •S 299 IS community-based services, including 1 senior day care; 2 ‘‘(IV) supports the training and 3 retraining of faculty, preceptors, pri- 4 mary care providers, and other direct 5 care providers to increase their knowl- 6 edge of geriatrics and gerontology; 7 ‘‘(V) emphasizes education and 8 engagement of family caregivers on 9 disease self-management, medication 10 management, and stress-reduction 11 strategies for older adults; 12 ‘‘(VI) provides training to the 13 health care workforce on disease self- 14 management, medication manage- 15 ment, stress-reduction strategies, and 16 social determinants of health in older 17 adults; or 18 ‘‘(VII) proposes to conduct out- 19 reach to communities that have a 20 shortage of geriatric workforce profes- 21 sionals. 22 ‘‘(B) SPECIAL CONSIDERATION.—In 23 awarding grants under paragraph (1), particu- 24 larly with respect to awarding, in fiscal year 25 VerDate Sep 11 2014 04:24 Feb 08, 2019 Jkt 089200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\S299.IS S299 kjohnson on DSK79L0C42 with BILLS 10 •S 299 IS 2020, any amount appropriated for such fiscal 1 year for purposes of carrying out this sub- 2 section that is in excess of the amount appro- 3 priated for the most recent previous fiscal year 4 for which appropriations were made such pur- 5 poses, the Secretary shall give special consider- 6 ation to entities that operate— 7 ‘‘(i) in communities that have a short- 8 age of geriatric workforce professionals; 9 and 10 ‘‘(ii) in States in which no entity has 11 previously received an award under such 12 paragraph (including under subsection 13 (a)(1) of this section as in effect before the 14 date of enactment of the Geriatrics Work- 15 force Improvement Act). 16 ‘‘(6) AWARD AMOUNTS.—Awards under para- 17 graph (1) shall be in an amount determined by the 18 Secretary. Entities that submit applications under 19 this subsection that describe a plan for providing 20 geriatric education and training for home health 21 workers and family caregivers are eligible to receive 22 $100,000 per year more than entities that do not in- 23 clude a description of such a plan. 24 ‘‘(7) REPORTING.— 25 VerDate Sep 11 2014 04:24 Feb 08, 2019 Jkt 089200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6201 E:\BILLS\S299.IS S299 kjohnson on DSK79L0C42 with BILLS 11 •S 299 IS ‘‘(A) REPORTS FROM ENTITIES.—Each en- 1 tity awarded a grant under paragraph (1) shall 2 submit an annual report to the Secretary on the 3 financial and programmatic performance under 4 such grant, which may include factors such as 5 the number of trainees, the number of profes- 6 sions and disciplines, the number of partner- 7 ships with health care delivery sites, the num- 8 ber of faculty and practicing professionals who 9 participated in continuing education programs, 10 and other factors, as the Secretary may require. 11 ‘‘(B) REPORTS TO CONGRESS.— 12 ‘‘(i) IN GENERAL.— 13 ‘‘(I) ANNUAL REPORT.—At the 14 end of each year in which the Sec- 15 retary awards grants under this sub- 16 section, the Secretary shall submit to 17 Congress a report that provides a 18 summary of the financial and pro- 19 grammatic performance of such 20 grants, which may include factors 21 such as the number trainees, the 22 number of professions and disciplines, 23 the number of partnerships with 24 health care delivery sites, the number 25 VerDate Sep 11 2014 04:24 Feb 08, 2019 Jkt 089200 PO 00000 Frm 00011 Fmt 6652 Sfmt 6201 E:\BILLS\S299.IS S299 kjohnson on DSK79L0C42 with BILLS 12 •S 299 IS of faculty and practicing professionals 1 who participated in continuing edu- 2 cation programs, and other factors 3 that assess the impact of the program 4 under this subsection on the health 5 status of older adults. 6 ‘‘(II) SUMMARY REPORTS.—Not 7 later than 1 year after the completion 8 of each 5-year grant term under this 9 subsection, the Secretary shall submit 10 to Congress a report— 11 ‘‘(aa) that provides a sum- 12 mary of the financial and pro- 13 grammatic performance of the 14 funded grants and a summary of 15 other factors that assess the im- 16 pact of the program under this 17 subsection on the health status of 18 older adults, quality of care for 19 older adults, and the knowledge 20 and skills of the Nation’s health 21 care workforce to care for older 22 adults; and 23 ‘‘(bb) which may include 24 factors such as the number of 25 VerDate Sep 11 2014 04:24 Feb 08, 2019 Jkt 089200 PO 00000 Frm 00012 Fmt 6652 Sfmt 6201 E:\BILLS\S299.IS S299 kjohnson on DSK79L0C42 with BILLS 13 •S 299 IS trainees, the number of profes- 1 sions and disciplines, the number 2 of partnerships with health care 3 delivery sites, and the number of 4 faculty and practicing profes- 5 sionals who participated in con- 6 tinuing education program. 7 ‘‘(ii) PUBLIC AVAILABILITY.—The 8 Secretary shall make each report sub- 9 mitted under clause (i), and supportin [Text truncated for display. 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