Improving Access to Health Care in Rural and Underserved Areas Act

II 116TH CONGRESS 2D SESSION S. 3194 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 JANUARY 15, 2020 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 03:31 Jan 16, 2020 Jkt 099200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\S3194.IS S3194 pamtmann on DSKBC07HB2PROD with BILLS 2 •S 3194 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. 330N. 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 03:31 Jan 16, 2020 Jkt 099200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\S3194.IS S3194 pamtmann on DSKBC07HB2PROD with BILLS 3 •S 3194 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); 20 ‘‘(D) may involve specialists and faculty 21 who participate in the program via telemedicine 22 for up to 50 percent of the clinical time, not to 23 exceed 75 percent of the total program time 24 over a 3-month average; and 25 VerDate Sep 11 2014 03:31 Jan 16, 2020 Jkt 099200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\S3194.IS S3194 pamtmann on DSKBC07HB2PROD with BILLS 4 •S 3194 IS ‘‘(E) with respect to rural and frontier 1 Federally-qualified health centers or rural 2 health clinics, may permit a waiver of subpara- 3 graph (D) (upon request to the Health Re- 4 sources and Services Administration) to permit 5 100 percent telemedicine participation. 6 ‘‘(2) TRAINING.—Accredited continuing medical 7 education programs offered under this section may 8 provide training to primary and behavioral care phy- 9 sicians and health care providers on— 10 ‘‘(A) endocrinology (including diabetes 11 care); 12 ‘‘(B) palliative care and pain management; 13 ‘‘(C) dermatology; 14 ‘‘(D) obstetrics and gynecology; 15 ‘‘(E) pediatric primary care and pediatric 16 subspecialties; 17 ‘‘(F) gastroenterology; 18 ‘‘(G) mental and behavioral health, and 19 substance use treatment; 20 ‘‘(H) preventive care and nutrition; 21 ‘‘(I) geriatric medicine; 22 ‘‘(J) infectious disease; 23 ‘‘(K) cardiology; 24 VerDate Sep 11 2014 03:31 Jan 16, 2020 Jkt 099200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\S3194.IS S3194 pamtmann on DSKBC07HB2PROD with BILLS 5 •S 3194 IS ‘‘(L) rural health and training to improve 1 outcomes for populations experiencing health 2 disparities; 3 ‘‘(M) wound care; 4 ‘‘(N) disease management for patients with 5 multiple comorbidities; 6 ‘‘(O) health information technology; and 7 ‘‘(P) other topics, as the Secretary deter- 8 mines appropriate. 9 ‘‘(3) PARTICIPATING CENTERS OR CLINICS.— 10 ‘‘(A) IN GENERAL.—To be eligible for a 11 grant under this section a Federally-qualified 12 health center or rural health clinic, or an orga- 13 nization affiliated with any such health clinic 14 acting on behalf of multiple such clinics, shall— 15 ‘‘(i) submit an application to the Sec- 16 retary at such time, in such manner, and 17 containing such information as the Sec- 18 retary may require; 19 ‘‘(ii) ensure that training under the 20 program under the grant is provided to the 21 physicians and primary care providers em- 22 ployed by such center or clinic, as well as 23 peer-to-peer training; 24 VerDate Sep 11 2014 03:31 Jan 16, 2020 Jkt 099200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\S3194.IS S3194 pamtmann on DSKBC07HB2PROD with BILLS 6 •S 3194 IS ‘‘(iii) include in the application a 1 needs assessment describing how participa- 2 tion in the program under the grant will 3 meet both patient needs and skills training 4 needs for their primary care providers; and 5 ‘‘(iv) include in the application a de- 6 scription of the expected patient target for 7 how many patients would be directly 8 served by activities under the grant and an 9 assurance that data and reports will be 10 provided on the number of patients served 11 and the accrediting entity used for pur- 12 poses of subsection (c). 13 ‘‘(B) USE OF GRANT.—A Federally-quali- 14 fied health center, rural health clinic, or affili- 15 ated organization receiving a grant under this 16 section may use grant funds for— 17 ‘‘(i) compensation for medical pro- 18 viders participating in teaching at program 19 sessions; 20 ‘‘(ii) part-time administration support 21 for the program; 22 ‘‘(iii) compensation for the center for 23 the nonclinical training time of the center’s 24 VerDate Sep 11 2014 03:31 Jan 16, 2020 Jkt 099200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\S3194.IS S3194 pamtmann on DSKBC07HB2PROD with BILLS 7 •S 3194 IS primary care or behavioral health care pro- 1 viders; 2 ‘‘(iv) technology and equipment need- 3 ed to facilitate clinical visits for the pro- 4 gram; 5 ‘‘(v) transportation costs for medical 6 providers participating in teaching under 7 the program to travel to center sites if 8 such sites are located more than 35 miles 9 from their primary residences; and 10 ‘‘(vi) other purposes related to ex- 11 penses incurred in the planning and deliv- 12 ery of the educational program and associ- 13 ated clinical visits, as the Secretary deter- 14 mines appropriate. 15 ‘‘(C) TERM.—A grant under this section 16 shall be for a period of 5-years. 17 ‘‘(D) RURAL AREAS.—The Secretary shall 18 ensure that at least half of the recipients of a 19 grant under this section are eligible Federally- 20 qualified health centers located in a rural area 21 or rural health clinics, or affiliated organiza- 22 tions acting on behalf of such centers. 23 ‘‘(c) PHYSICIAN PARTICIPATION IN PROGRAM.— 24 VerDate Sep 11 2014 03:31 Jan 16, 2020 Jkt 099200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\S3194.IS S3194 pamtmann on DSKBC07HB2PROD with BILLS 8 •S 3194 IS ‘‘(1) ELIGIBILITY.—To be eligible to participate 1 in an accredited continuing medical education pro- 2 gram offered under this section, a physician or other 3 primary care or behavioral health care provider shall 4 be a primary care provider— 5 ‘‘(A) who is employed by the grantee; and 6 ‘‘(B) who serves patients in a medically 7 underserved population (as defined in section 8 330(b)(3)). 9 ‘‘(2) CME CREDIT.— 10 ‘‘(A) IN GENERAL.—The Secretary shall 11 require a grantee under this section to identify 12 an accrediting body that the grantee will work 13 with to certify the program under the grant in 14 a manner that provides continuing medical edu- 15 cation credits to providers participating in the 16 program. Such certification shall include mate- 17 rial with respect to specific skills development. 18 ‘‘(B) REPORTING.—As part of the annual 19 reporting provided under subsection 20 (b)(3)(A)(iv) a grantee shall provide informa- 21 tion to confirm the accredited continuing med- 22 ical education entity used by the grantee. The 23 Secretary may suspend grant funding if the 24 grantee fails to provide for accredited con- 25 VerDate Sep 11 2014 03:31 Jan 16, 2020 Jkt 099200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\S3194.IS S3194 pamtmann on DSKBC07HB2PROD with BILLS 9 •S 3194 IS tinuing medical education within the first year 1 of the grant. Such grant funding may be rein- 2 stated by the Secretary once the grantee cer- 3 tifies that accredited continuing medical edu- 4 cation is provided. 5 ‘‘(d) ANNUAL REPORTING.—Beginning 1 year after 6 the date of enactment of the Improving Access to Health 7 Care in Rural and Underserved Areas Act, and every year 8 thereafter, the Secretary shall submit to Congress a report 9 on the program under this section, including— 10 ‘‘(1) the number of physicians who participate 11 in the program each year and the specialties of such 12 physicians; 13 ‘‘(2) a breakdown of specialist time spent di- 14 rectly with patients, with patients through telemedi- 15 cine, and with primary care providers in classroom 16 or other non-clinical setting during the program ses- 17 sions; 18 ‘‘(3) a comparison of measures under the Uni- 19 form Data System of the Health Resources and 20 Services Administration, or similar program, rel- 21 evant to patient care improvements, between the 22 year prior to the implementation of the program 23 under this section and the most recent year in the 24 program; 25 VerDate Sep 11 2014 03:31 Jan 16, 2020 Jkt 099200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\S3194.IS S3194 pamtmann on DSKBC07HB2PROD with BILLS 10 •S 3194 IS ‘‘(4) a summary of any clinical practice changes 1 or notable improvements in patient care; 2 ‘‘(5) patient referrals from health centers that 3 participate in the program to outside specialist care, 4 and any patient care provided at the health center 5 that, prior to the program, would have been referred 6 to outside specialists; 7 ‘‘(6) retention rates of physicians at partici- 8 pating health centers; and 9 ‘‘(7) satisfaction rates of physicians with the 10 education program at participating health centers. 11 ‘‘(e) AUTHORIZATION OF APPROPRIATIONS.—To 12 carry out this section, there are authorized to be appro- 13 priated $20,000,000 for each of fiscal years 2020 through 14 2024.’’. 15 Æ VerDate Sep 11 2014 03:31 Jan 16, 2020 Jkt 099200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6301 E:\BILLS\S3194.IS S3194 pamtmann on DSKBC07HB2PROD with BILLS