Strengthening Our Rural Health Workforce Act of 2019

II 116TH CONGRESS 1ST SESSION S. 2902 To enhance the rural health workforce, and for other purposes. IN THE SENATE OF THE UNITED STATES NOVEMBER 20, 2019 Ms. SMITH (for herself and Mr. BARRASSO) introduced the following bill; which was read twice and referred to the Committee on Health, Edu- cation, Labor, and Pensions A BILL To enhance the rural health workforce, 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 ‘‘Strengthening Our 4 Rural Health Workforce Act of 2019’’. 5 VerDate Sep 11 2014 01:45 Nov 26, 2019 Jkt 099200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\S2902.IS S2902 pamtmann on DSKBC07HB2PROD with BILLS 2 •S 2902 IS TITLE I—SUPPORTING PRIMARY 1 CARE WORKFORCE 2 SEC. 101. REAUTHORIZATION OF PRIMARY CARE TRAINING 3 AND ENHANCEMENT PROGRAM. 4 Section 747 of the Public Health Service Act (42 5 U.S.C. 293k) is amended— 6 (1) in subsection (a), by adding at the end the 7 following: 8 ‘‘(3) PRIORITIES IN MAKING AWARDS.— 9 ‘‘(A) IN GENERAL.—In awarding grants or 10 contracts under paragraph (1), the Secretary 11 shall give priority to qualified applicants that 12 train residents in rural and Tribal training lo- 13 cations for equal to or greater than 50 percent 14 of training time. 15 ‘‘(B) RURAL TRAINING LOCATION.—In this 16 paragraph, the term ‘rural training location’ 17 means a location in which training occurs that, 18 based on the 2010 census or any subsequent 19 census adjustment, meets one or more of the 20 following criteria: 21 ‘‘(i) The training occurs in a location 22 that is a rural area (as defined in section 23 1886(d)(2)(D) of the Social Security Act). 24 VerDate Sep 11 2014 01:45 Nov 26, 2019 Jkt 099200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\S2902.IS S2902 pamtmann on DSKBC07HB2PROD with BILLS 3 •S 2902 IS ‘‘(ii) The training occurs on an Indian 1 reservation, public domain Indian allot- 2 ment, former Indian reservation in Okla- 3 homa, or land held by an incorporated Na- 4 tive group, regional corporation, or village 5 corporation under the provisions of the 6 Alaska Native Claims Settlement Act. 7 ‘‘(iii) The training occurs in a location 8 that has a rural-urban commuting area 9 code equal to or greater than 4.0. 10 ‘‘(iv) The training occurs in a location 11 that is within 10 miles of a sole community 12 hospital (as defined in subsection 13 (d)(5)(D)(iii)).’’; and 14 (2) in subsection (c)— 15 (A) in paragraph (1), by striking 16 ‘‘$125,000,000’’ and all that follows through 17 the period at the end and inserting 18 ‘‘$125,000,000 for fiscal year 2020, and such 19 sums as may be necessary for each of fiscal 20 years 2021 through 2024.’’; and 21 (B) in paragraph (3), by striking ‘‘2010 22 through 2014’’ and inserting ‘‘2020 through 23 2024’’. 24 VerDate Sep 11 2014 01:45 Nov 26, 2019 Jkt 099200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\S2902.IS S2902 pamtmann on DSKBC07HB2PROD with BILLS 4 •S 2902 IS SEC. 102. REAUTHORIZATION OF AREA HEALTH EDU- 1 CATION CENTERS. 2 Section 751(j)(1) of the Public Health Service Act 3 (42 U.S.C. 294a(j)(1)) is amended by striking 4 ‘‘$125,000,000 for each of the fiscal years 2010 through 5 2014’’ and inserting ‘‘$125,000,000 for each of fiscal 6 years 2020 through 2024’’. 7 TITLE II—RURAL HEALTH CARE 8 WORKFORCE COMMISSION 9 SEC. 201. RURAL HEALTH CARE WORKFORCE COMMISSION. 10 (a) PURPOSE.—It is the purpose of this section to 11 establish a National Rural Health Care Workforce Com- 12 mission that develops short- and long-term solutions to ad- 13 dress the systemic workforce shortages in rural and fron- 14 tier localities, and— 15 (1) communicates and coordinates with the De- 16 partment of Health and Human Services (including 17 the Indian Health Service), the Department of Agri- 18 culture, the Department of Labor, The Department 19 of Veterans Affairs, the Department of Homeland 20 Security, the Department of Education, the Depart- 21 ment of the Interior, and any Federal advisory com- 22 mittees determined appropriate by the Secretary of 23 Health and Human Services, on related activities 24 administered by one or more of such Departments 25 and committees; 26 VerDate Sep 11 2014 01:45 Nov 26, 2019 Jkt 099200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\S2902.IS S2902 pamtmann on DSKBC07HB2PROD with BILLS 5 •S 2902 IS (2) develops and commissions evaluations of 1 education and training activities needed to address 2 shortages in geographically diverse rural and Indian 3 Tribal communities; 4 (3) identifies legislative, administrative, and 5 other barriers to addressing shortages and improving 6 coordination at the Federal, State, Tribal, and local 7 levels and recommend ways to address such barriers; 8 (4) encourages the development and implemen- 9 tation of strategies to address rural, Tribal, and 10 frontier population needs; and 11 (5) identifies innovative models used to improve 12 access to and quality of care in underserved rural 13 areas with shortages. 14 (b) ESTABLISHMENT.—There is hereby established 15 the National Workforce Commission on Rural and Fron- 16 tier Health Care (referred to in this section as the ‘‘Com- 17 mission’’). 18 (c) MEMBERSHIP.— 19 (1) NUMBER AND APPOINTMENT.—The Com- 20 mission shall be composed of not less than 9 mem- 21 bers to be appointed by the Comptroller General, 22 without regard to section 5 of the Federal Advisory 23 Committee Act (5 U.S.C. App.), and shall consult 24 with the Administrator of the Health Resources and 25 VerDate Sep 11 2014 01:45 Nov 26, 2019 Jkt 099200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\S2902.IS S2902 pamtmann on DSKBC07HB2PROD with BILLS 6 •S 2902 IS Services Administration (referred to in this section 1 as the ‘‘Administrator’’). 2 (2) QUALIFICATIONS.— 3 (A) IN GENERAL.—The membership of the 4 Commission shall include a diverse composite of 5 individuals— 6 (i) who are— 7 (I) leaders of rural, Tribal, and 8 frontier health care workforce edu- 9 cation or training programs or rural 10 training tracks; 11 (II) nationally recognized for 12 their expertise in— 13 (aa) rural, Tribal, or fron- 14 tier health care labor market 15 analysis; 16 (bb) rural, Tribal, or fron- 17 tier health care facility manage- 18 ment; 19 (cc) rural health integrated 20 delivery systems; 21 (dd) providing rural, Tribal, 22 and frontier health care services; 23 VerDate Sep 11 2014 01:45 Nov 26, 2019 Jkt 099200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\S2902.IS S2902 pamtmann on DSKBC07HB2PROD with BILLS 7 •S 2902 IS (ee) rural, Tribal, and fron- 1 tier health care needs, trends, 2 and disparities; 3 (ff) rural, Tribal, and fron- 4 tier behavioral health; or 5 (gg) rural, Tribal, and fron- 6 tier health workforce shortages; 7 (III) rural health workforce re- 8 cruitment and retention experts; and 9 (IV) relevant professional asso- 10 ciation members; and 11 (ii) who will provide a combination of 12 professional perspectives, and broad geo- 13 graphic representation of rural and fron- 14 tier communities. 15 (B) ETHICAL DISCLOSURE.—The Adminis- 16 trator shall establish a system for public disclo- 17 sure by the Commission of financial and other 18 potential conflicts of interest relating to the 19 members of the Commission. Such members 20 shall be treated as employees of Congress for 21 purposes of applying title I of the Ethics in 22 Government Act of 1978. Such members shall 23 not be treated as special government employees 24 under title 18, United States Code. 25 VerDate Sep 11 2014 01:45 Nov 26, 2019 Jkt 099200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\S2902.IS S2902 pamtmann on DSKBC07HB2PROD with BILLS 8 •S 2902 IS (3) TERMS.— 1 (A) IN GENERAL.—The terms of members 2 of the Commission shall be for 3 years except 3 that the Comptroller General shall designate 4 staggered terms for the members first ap- 5 pointed. 6 (B) VACANCIES.—Any member appointed 7 to fill a vacancy occurring before the expiration 8 of the term for which the member’s predecessor 9 was appointed shall be appointed only for the 10 remainder of that term. A member may serve 11 after the expiration of that member’s term until 12 a successor has taken office. 13 (4) COMPENSATION.—While serving on the 14 business of the Commission (including travel time), 15 a member of the Commission shall be entitled to 16 compensation at the per diem equivalent of the rate 17 provided for level IV of the Executive Schedule 18 under section 5315 of title 5, United States Code, 19 and while so serving away from home and the mem- 20 ber’s regular place of business, a member may be al- 21 lowed travel expenses, as authorized by the Chair- 22 man of the Commission. 23 (5) CHAIRMAN, VICE CHAIRMAN.—The Comp- 24 troller General shall designate a member of the 25 VerDate Sep 11 2014 01:45 Nov 26, 2019 Jkt 099200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\S2902.IS S2902 pamtmann on DSKBC07HB2PROD with BILLS 9 •S 2902 IS Commission, at the time of appointment of the mem- 1 ber, as Chairman and a member as Vice Chairman 2 for that term of appointment, except that in the case 3 of vacancy of the chairmanship or vice chairman- 4 ship, the Comptroller General may designate another 5 member for the remainder of that member’s term. 6 (6) MEETINGS.—The Commission shall meet at 7 the call of the chairman, but no less frequently than 8 on a biannual basis. 9 (d) DUTIES.— 10 (1) IDENTIFY NEEDS AND BARRIERS.—The 11 Commission shall— 12 (A) identify administrative, regulatory, and 13 statutory barriers that prevent maximum utili- 14 zation of current rural and Tribal health work- 15 force programs with a special focus on Tribal 16 and frontier workforce programs; and 17 (B) identify population health needs and 18 trends, health disparities, and minority popu- 19 lation health needs in rural, Tribal, and frontier 20 localities. 21 (2) RECOMMEND SOLUTIONS TO BARRIERS.— 22 The Commission shall— 23 (A) recognize the efforts of Federal, State, 24 Tribal, and local partnerships to support ca- 25 VerDate Sep 11 2014 01:45 Nov 26, 2019 Jkt 099200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\S2902.IS S2902 pamtmann on DSKBC07HB2PROD with BILLS 10 •S 2902 IS reers in the provision of health care services in 1 rural areas; 2 (B) explore and report on nontraditional 3 care settings and delivery of care; 4 (C) disseminate information to rural health 5 care administrators on promising retention 6 practices for rural, Tribal, and frontier health 7 care professionals; and 8 (D) recommend solutions to Federal ad- 9 ministrative, regulatory, and statutory barriers 10 that impact the recruitment, education and 11 training, and retention of the rural, Tribal, and 12 frontier health care workforce. 13 (3) SPECIFIC TOPICS TO BE REVIEWED.—In 14 carrying out this subsection, the Commission shall 15 review— 16 (A) current rural, Tribal, and frontier 17 health care workforce supply and distribution, 18 including demographics, skill sets, public health 19 expertise, and demands, with projected de- 20 mands during the subsequent 10- and 25-year 21 periods; 22 (B) rural, Tribal, and frontier health care 23 workforce education and training capacity, in- 24 cluding the— 25 VerDate Sep 11 2014 01:45 Nov 26, 2019 Jkt 099200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6201 E:\BILLS\S2902.IS S2902 pamtmann on DSKBC07HB2PROD with BILLS 11 •S 2902 IS (i) number of students who have com- 1 pleted education and training, including 2 registered apprenticeships; 3 (ii) number of qualified faculty; 4 (iii) the education and training infra- 5 structure; and 6 (iv) the education and training de- 7 mands, with projected demands during the 8 subsequent 10- and 25-year periods; 9 (C) the impact of the rural and Tribal hos- 10 pital and rural hospital unit closures on rural, 11 Tribal, and frontier communities; 12 (D) the National Health Service Corps 13 under subpart II of part D of title III of the 14 Public Health Service Act (42 U.S.C. 254d et 15 seq.), the State Loan Repayment Program 16 under section 338I of the Public Health Service 17 Act (42 U.S.C. 254q–1), the education loan, 18 scholarship, and grant programs under titles 19 VII and VIII of the Public Health Service Act 20 (42 U.S.C. 292 et seq. and 296 et seq.), as well 21 as public service loan forgiveness programs ad- 22 ministered by the Department of Education; 23 and 24 VerDate Sep 11 2014 01:45 Nov 26, 2019 Jkt 099200 PO 00000 Frm 00011 Fmt 6652 Sfmt 6201 E:\BILLS\S2902.IS S2902 pamtmann on DSKBC07HB2PROD with BILLS 12 •S 2902 IS (E) the impact of care delivery models, 1 some of which include the use of technology, 2 community health workers, and non-traditional 3 partners that leverage team-based care to im- 4 prove outcomes and address health care costs. 5 (4) HIGH PRIORITY AREAS.—In carrying out 6 this subsection, high priority should be given to— 7 (A) the education, development, recruit- 8 ment and retention of individuals— 9 (i) to fill primary care shortages of all 10 levels of licensure; 11 (ii) to undertake rural and Tribal 12 physician training tracks and programs; 13 (iii) to fill obstetric services shortages; 14 (iv) to address oral health care work- 15 force capacity at all levels; 16 (v) to address behavioral health care 17 workforce capacity at all levels; 18 (vi) to address addiction medicine 19 workforce shortages; 20 (vii) to fill the emergency medical 21 service workforce; 22 (viii) to address the workforce needs 23 of an aging population; and 24 VerDate Sep 11 2014 01:45 Nov 26, 2019 Jkt 099200 PO 00000 Frm 00012 Fmt 6652 Sfmt 6201 E:\BILLS\S2902.IS S2902 pamtmann on DSKBC07HB2PROD with BILLS 13 •S 2902 IS (ix) to serve as telehealth providers; 1 and 2 (B) the development of new rural and 3 Tribal workforce and delivery models to better 4 meet changing needs of rural communities. 5 (5) RECOMMENDATIONS.—The Commission 6 shall submit recommendations to the Committee on 7 Health, Education, Labor, and Pensions of the Sen- 8 ate and the Committee on Energy and Commerce of 9 the House of Representatives, and appropriate de- 10 partments of the Administration. 11 (6) CONSULT AND OBTAINING DATA.—The 12 Commission shall consult with and obtain necessary 13 data from all relevant Federal agencies (including 14 the Department of Health and Human Services, the 15 Department of Agriculture, the Department of 16 Labor, The Department of Veterans Affairs, the De- 17 partment of Homeland Security, the Department of 18 Education, and the Department of the Interior), 19 Congress, the Medicare Payment Advisory Commis- 20 sion, the Medicaid and CHIP Payment and Access 21 Commission, and [Text truncated for display. Full text available on Congress.gov.]