HR 2929 IHCommentsClose CommentsPermalink

To enhance the primary care workforce through the establishment of a National Health Workforce Advisory Board and the provision of workforce data and analysis.CommentsClose CommentsPermalink

June 17, 2009CommentsClose CommentsPermalink

Mr. SARBANES (for himself and Mr. BRALEY of Iowa) introduced the following bill; which was referred to the Committee on Energy and CommerceCommentsClose CommentsPermalink

To enhance the primary care workforce through the establishment of a National Health Workforce Advisory Board and the provision of workforce data and analysis.CommentsClose CommentsPermalink

Be it enacted by the Senate and House of Representatives of the United States of America in Congress assembled,CommentsClose CommentsPermalink

SECTION 1. SHORT TITLE.

This Act may be cited as the ‘Health Care Workforce Incentive Act of 2009’.CommentsClose CommentsPermalink

TITLE I--NATIONAL HEALTH WORKFORCE ADVISORY BOARDCommentsClose CommentsPermalink

SEC. 101. ESTABLISHMENT.

There is established an independent National Health Workforce Advisory Board (in this title referred to as the ‘Advisory Board’) to advise Congress on issues affecting the health care workforce, consistent with this title.CommentsClose CommentsPermalink

SEC. 102. PURPOSE.

(a) In General- The purpose of the Advisory Board is to improve the supply, distribution, diversity, and quality of health professionals in the health care workforce by--CommentsClose CommentsPermalink





(1) examining the impact of policies on workforce and workforce shortages from a multijurisdictional perspective, including the Department of Labor, Department of Health and Human Services, the Department of Veterans Affairs, and the Department of Defense;CommentsClose CommentsPermalink





(2) developing innovative solutions to increase the short-term supply of the health care workforce, including a plan to rapidly deploy health care professionals in the field;CommentsClose CommentsPermalink





(3) coming up with a national plan for increasing the long-term supply and structure of the health care workforce;CommentsClose CommentsPermalink





(4) making health care professionals more accessible to the general population, especially low-income, underserved, uninsured, minority, those experiencing health disparities, and rural populations;CommentsClose CommentsPermalink





(5) improving the training of primary care physicians, nurses, dentists, physician assistants, behavioral and mental health professionals, public health professionals, and other health professionals;CommentsClose CommentsPermalink





(6) training faculty educators in the health professions; andCommentsClose CommentsPermalink





(7) utilizing data from a variety of sources, including the Health Resources and Services Administration, the Centers for Medicare & Medicaid Services, and State Councils that report to the National Workforce Data Center of the Health Resources and Services Administration.CommentsClose CommentsPermalink





(b) Duties-CommentsClose CommentsPermalink





(1) REVIEW OF HEALTH CARE WORKFORCE AND ANNUAL REPORTS- With the goal of developing a fiscally sustainable integrated workforce which supports high-quality health care delivery system that meets the needs of patients and populations, the Advisory Board shall--CommentsClose CommentsPermalink





(A) review health care workforce and projected workforce needs, including the topics described in paragraph (2);CommentsClose CommentsPermalink





(B) make recommendations to Congress concerning national workforce priorities, goals, and policies;CommentsClose CommentsPermalink





(C) examine and develop innovative short-term and long-term solutions for rapid training and deployment of personnel into the health care workforce;CommentsClose CommentsPermalink





(D) not later than 6 months after its creation, the Board shall develop short-term solutions for rapid training and deployment of personnel into the workforce, submit to Congress a report on such solutions;CommentsClose CommentsPermalink





(E) by not later than January 31 of each year (beginning with 2011), submit a report to Congress containing the results of such reviews and its recommendations concerning related policies; andCommentsClose CommentsPermalink





(F) by not later than April 1 of each year (beginning with 2011), submit a report to Congress containing a review of and recommendations on at minimum one high priority area as described in paragraph (3).CommentsClose CommentsPermalink





(2) SPECIFIC TOPICS TO BE REVIEWED-CommentsClose CommentsPermalink





(A) Current health care workforce demographics, skill sets, and needs, with projected needs over the following 10- and 25-year periods.CommentsClose CommentsPermalink





(B) Health care workforce training capacity, including number of students trained, number of qualified faculty, training infrastructure and training needs, with projected needs over the following 10- and 25-year periods.CommentsClose CommentsPermalink





(C) The implications of new and existing Federal policies which affect the workforce, including but not limited to Medicare and Medicaid GME policies, title VII and title VIII of the Public Health Service Act, and the National Health Service Corps with recommendations for aligning these programs with national health workforce priorities and goals.CommentsClose CommentsPermalink





(D) Health care workforce needs of special populations, such as minorities, rural populations, underserved populations, and geriatric and pediatric populations with recommendations for new and existing Federal policies to meet the needs of these special populations.CommentsClose CommentsPermalink





(3) HIGH PRIORITY TOPICS- High priority topics are health care workforce areas which require special attention. The topics may be determined by the Advisory Board or assigned by appropriate committees of Congress. Initial high priority topics include--CommentsClose CommentsPermalink





(A) integrated workforce planning maximizing the skill sets of health care professionals across disciplines;CommentsClose CommentsPermalink





(B) integrated workforce planning for short-term and rapid deployment into the health care workforce;CommentsClose CommentsPermalink





(C) analysis of the nature, scopes of practice, and demands for health workers in the enhanced information technology and management work place;CommentsClose CommentsPermalink





(D) Medicare and Medicaid graduate medical education policies and recommendations for aligning with national workforce goals;CommentsClose CommentsPermalink





(E) nursing workforce capacity at all levels of nurse training, training capacity, projected needs, and integration within the health care system;CommentsClose CommentsPermalink





(F) dental workforce capacity, training capacity, projected needs, and integration within the health care system; andCommentsClose CommentsPermalink





(G) mental health workforce capacity, training capacity and projected needs.CommentsClose CommentsPermalink





(4) AGENDA AND ADDITIONAL REVIEWS- The Advisory Board shall consult periodically with the chairmen and ranking minority members of the appropriate committees of Congress regarding the Advisory Board’s agenda, progress towards achieving this agenda and requests for high priority topics.CommentsClose CommentsPermalink

SEC. 103. MEMBERSHIP AND RELATED PROVISIONS.

(a) Membership-CommentsClose CommentsPermalink





(1) NUMBER AND APPOINTMENT- The Advisory Board shall be composed of 15 members appointed by the Comptroller General.CommentsClose CommentsPermalink





(2) QUALIFICATIONS-CommentsClose CommentsPermalink





(A) IN GENERAL- The membership of the Advisory Board shall include individuals with national recognition for their expertise in the provision of health services, health care workforce analysis, health care finance and economics, health facility management, health plans and integrated delivery systems, higher education, health care philanthropy, and other related fields, who will provide a mix of professional perspectives, broad geographic representation, and a balance between urban and rural representatives.CommentsClose CommentsPermalink





(B) INCLUSION- The membership of the Advisory Board shall include (but not be limited to) health professionals, employers, third-party payers, individuals skilled in the conduct and interpretation of health services and health economics research. Such membership shall also include representatives of consumers.CommentsClose CommentsPermalink





(C) MAJORITY NON-PROVIDERS- Individuals who are directly involved in health professions education or practice shall not constitute a majority of the membership of the Advisory Board.CommentsClose CommentsPermalink





(D) ETHICAL DISCLOSURE- The Comptroller General shall establish a system for public disclosure by members of the Advisory Board of financial and other potential conflicts of interest relating to such members.CommentsClose CommentsPermalink





(3) TERMS-CommentsClose CommentsPermalink





(A) IN GENERAL- The terms of members of the Advisory Board shall be for 3 years except that the Comptroller General shall designate staggered terms for the members first appointed.CommentsClose CommentsPermalink





(B) VACANCIES- Any member appointed to fill a vacancy occurring before the expiration of the term for which the member’s predecessor was appointed shall be appointed only for the remainder of that term. A member may serve after the expiration of that member’s term until a successor has taken office. A vacancy in the Advisory Board shall be filled in the manner in which the original appointment was made.CommentsClose CommentsPermalink





(4) COMPENSATION- While serving on the business of the Advisory Board (including travel time), a member of the Advisory Board shall be entitled to compensation at the per diem equivalent of the rate provided for level IV of the Executive Schedule under section 5315 of title 5, United States Code; and while so serving away from home and the member’s regular place of business, a member may be allowed travel expenses, as authorized by the Chairman of the Advisory Board. Physicians serving as personnel of the Advisory Board may be provided a physician comparability allowance by the Advisory Board in the same manner as Government physicians may be provided such an allowance by an agency under section 5948 of title 5, United States Code, and for such purpose subsection (i) of such section shall apply to the Advisory Board in the same manner as it applies to the Tennessee Valley Authority. For purposes of pay (other than pay of members of the Advisory Board) and employment benefits, rights, and privileges, all personnel of the Advisory Board shall be treated as if they were employees of the United States Senate.CommentsClose CommentsPermalink





(5) CHAIRMAN; VICE CHAIRMAN- The Advisory Board members shall elect by a majority vote the Advisory Board chairman and vice chairman for the term of their appointment of portion remaining. Elections shall occur at the end of any chairman or vice chairman’s term or should a Advisory Board member leave the Advisory Board for any reason.CommentsClose CommentsPermalink





(6) MEETINGS- The Advisory Board shall meet at the call of the Chairman.CommentsClose CommentsPermalink





(b) Director and Staff; Experts and Consultants- Subject to such review as the Comptroller General deems necessary to assure the efficient administration of the Advisory Board, the Advisory Board may--CommentsClose CommentsPermalink





(1) employ and fix the compensation of an Executive Director (subject to the approval of the Comptroller General) and such other personnel as may be necessary to carry out its duties (without regard to the provisions of title 5, United States Code, governing appointments in the competitive service);CommentsClose CommentsPermalink





(2) seek such assistance and support as may be required in the performance of its duties from appropriate Federal departments and agencies;CommentsClose CommentsPermalink





(3) enter into contracts or make other arrangements, as may be necessary for the conduct of the work of the Advisory Board (without regard to section 3709 of the Revised Statutes (41 U.S.C. 5));CommentsClose CommentsPermalink





(4) make advance, progress, and other payments which relate to the work of the Advisory Board;CommentsClose CommentsPermalink





(5) provide transportation and subsistence for persons serving without compensation; andCommentsClose CommentsPermalink





(6) prescribe such rules and regulations as it deems necessary with respect to the internal organization and operation of the Advisory Board.CommentsClose CommentsPermalink





(c) Powers-CommentsClose CommentsPermalink





(1) OBTAINING OFFICIAL DATA- The Advisory Board may secure directly from any department or agency of the United States information necessary to enable it to carry out this section. Upon request of the Chairman, the head of that department or agency shall furnish that information to the Advisory Board on an agreed upon schedule.CommentsClose CommentsPermalink





(2) DATA COLLECTION- In order to carry out its functions, the Advisory Board shall--CommentsClose CommentsPermalink





(A) utilize existing information, both published and unpublished, where possible, collected and assessed either by its own staff or under other arrangements made in accordance with this section;CommentsClose CommentsPermalink





(B) carry out, or award grants or contracts for, original research and experimentation, where existing information is inadequate; andCommentsClose CommentsPermalink





(C) adopt procedures allowing any interested party to submit information for the Advisory Board’s use in making reports and recommendations.CommentsClose CommentsPermalink





(3) ACCESS OF GAO TO INFORMATION- The Comptroller General shall have unrestricted access to all deliberations, records, and nonproprietary data of the Advisory Board, immediately upon request.CommentsClose CommentsPermalink





(4) PERIODIC AUDIT- The Advisory Board shall be subject to periodic audit by the Comptroller General.CommentsClose CommentsPermalink





(d) Cooperation- The Advisory Board shall carry out its duties in cooperation with the Council on Graduate Medical Education established under section 762 of the Public Health Service Act (42 U.S.C. 294o), the National Advisory Council on the National Health Service Corps established by section 337 of such Act (42 U.S.C. 254j), the Advisory Committee on Training in Primary Care Medicine and Dentistry established pursuant to section 748 of such Act (42 U.S.C. 2931), the Advisory Committee on Interdisciplinary, Community-Based Linkages established pursuant to section 756 of such Act (42 U.S.C. 294f), and the National Advisory Council on Nurse Education and Practice established pursuant to section 845 of such Act (42 U.S.C. 297t).CommentsClose CommentsPermalink





(e) Authorization of Appropriations-CommentsClose CommentsPermalink





(1) REQUEST FOR APPROPRIATIONS- The Advisory Board shall submit requests for appropriations in the same manner as the Comptroller General submits requests for appropriations, but amounts appropriated for the Advisory Board shall be separate from amounts appropriated for the Comptroller General.CommentsClose CommentsPermalink





(2) AUTHORIZATION- There are authorized to be appropriated such sums as may be necessary to carry out the provisions of this section.CommentsClose CommentsPermalink





(f) Health Care Workforce Definition- In this section, the term ‘health care workforce’ includes all health care providers with direct patient care and support responsibilities, including physicians, nurses, physician assistants, pharmacists, dentists, allied health professionals, mental health professionals, and public health professionals.CommentsClose CommentsPermalink

TITLE II--WORKFORCE DATA AND ANALYSISCommentsClose CommentsPermalink

SEC. 201. CENTER FOR WORKFORCE DATA AND ANALYSIS.

(a) Establishment- There is established a National Center for Workforce Data and Analysis in the Department of Health and Human Services.CommentsClose CommentsPermalink





(b) Duties- Such Center shall comprehensively and regularly gather data, provide projections, and conduct research on the supply, demand, distribution, diversity, and development of the health care workforce, including information on specific disciplines, specialties, and subspecialties.CommentsClose CommentsPermalink





(c) Authority- Such Center is authorized to accept applications for and administer grants for the purpose of establishing State and Regional Health Workforce Councils under section 202.CommentsClose CommentsPermalink

SEC. 202. STATE AND REGIONAL HEALTH WORKFORCE COUNCILS.

(a) Establishment- The Secretary of Health and Human Services, through the National Center for Workforce Data and Analysis, shall establish a competitive State Health Workforce Shortage grants program (in this section referred to as the ‘Grant Program’) under which, for the purposes described, the Secretary may make formula grants or an allotment of funds to States.CommentsClose CommentsPermalink





(b) Purposes- The purpose of the Grant Program is to harmonize health workforce needs and medical education through incorporating local and regional perspectives through the organization of State and regional health workforce councils to--CommentsClose CommentsPermalink





(1) ensure access to health services for all individuals, particularly those with low incomes or limited access to health services, through an adequate health care workforce;CommentsClose CommentsPermalink





(2) improve the supply, distribution, diversity, and development of the health care workforce, taking into consideration the supply, distribution, and diversity of health care workforce profession specialties and subspecialties in a manner consistent with--CommentsClose CommentsPermalink





(A) determining high-need geographic areas;CommentsClose CommentsPermalink





(B) determining high-priority specialties; andCommentsClose CommentsPermalink





(C) determining the optimal mix and numbers of primary care physicians per population and as a percentage of the total health care workforce;CommentsClose CommentsPermalink





(3) create State-specific health care workforce goals and objectives that are consistent with and aligned to health status goals and national health care workforce objectives developed under the National Health Workforce Advisory Board under title I; andCommentsClose CommentsPermalink





(4) during the first 12-month period funded through grants provided under this section, establish or designate a State health care workforce planning entity to establish statewide processes for State health care workforce planning, State health workforce data collection, policy recommendations, and State resource allocations.CommentsClose CommentsPermalink





(c) Application for Grant- For the purpose of this subsection, a grant is in accordance if the following is met:CommentsClose CommentsPermalink





(1) USE OF FUNDS- For the purposes described in subsection (b), State and Regional Health Workforce Councils may use grant funds under this section to--CommentsClose CommentsPermalink





(A) collect and analyze State and regional health workforce supply, distribution, diversity, demand and training capacity data, following any data collection and reporting standards set by the National Health Workforce Advisory Board;CommentsClose CommentsPermalink





(B) determine critical State/regional level health workforce needs, including identifying--CommentsClose CommentsPermalink





(i) high-priority specialties and disciplines, which may be region specific; andCommentsClose CommentsPermalink





(ii) high-need geographic areas;CommentsClose CommentsPermalink





(C) establish State/regional health workforce goals and recommendations to coordinate with national level goals set by the National Health Workforce Advisory Board;CommentsClose CommentsPermalink





(D) devise short- and long-term plans and initiatives for meeting State/regional health workforce goals;CommentsClose CommentsPermalink





(E) devise State/regional level plans that set specific targets for increasing primary care capacity, including training and retaining more primary care physicians, nurses, physicians assistants, and other members of the allied health workforce; andCommentsClose CommentsPermalink





(F) make recommendations to the National Health Workforce Advisory Board on the re-alignment of graduate medical education under title XVIII of the Social Security Act to meet State/regional health workforce goals, including--CommentsClose CommentsPermalink





(i) recommendations for GME funding cap modifications; andCommentsClose CommentsPermalink





(ii) proposals for alternative funding and distribution frameworks aligned with State/regional health workforce goals.CommentsClose CommentsPermalink





(2) STATE/REGION WIDE HEALTH WORKFORCE ASSESSMENT- The application includes a plan for a state/region wide health workforce assessment that--CommentsClose CommentsPermalink





(A) will be updated not less than every 5 years;CommentsClose CommentsPermalink





(B) identifies--CommentsClose CommentsPermalink





(i) current and future State and regional health workforce supply, distribution, diversity, demand and training capacity;CommentsClose CommentsPermalink





(ii) projected needs related to the supply, distribution, diversity and development of the State/regional health workforce; andCommentsClose CommentsPermalink





(iii) short- and long-term State/region specific health workforce goals and objectives consistent with health status goals and national health workforce objectives developed under section (103) of previous title.CommentsClose CommentsPermalink





(3) ANNUAL REPORTS- The application includes a plan for annual reports submitted to HRSA and to the National Health Workforce Advisory Board to include an annually updated plan to meet the goals and objectives and address the needs identified under the State/Region wide health workforce assessment described in paragraph (1), and such plan includes strategies related to--CommentsClose CommentsPermalink





(A) collaboration between--CommentsClose CommentsPermalink





(i) State departments of labor, health, education, higher education, veterans affairs, environment, and professional licensure; andCommentsClose CommentsPermalink





(ii) State health workforce investment boards;CommentsClose CommentsPermalink





(B) State data collection;CommentsClose CommentsPermalink





(C) State Medicare and Medicaid policies; andCommentsClose CommentsPermalink





(D) State health professions licensure and regulation.CommentsClose CommentsPermalink





(4) DESCRIPTION OF FUNDING USE- The application includes a description of how funds received through the grant will be used--CommentsClose CommentsPermalink





(A) in accordance with subparagraphs (1) and (2) of subsection (b), to ensure access to health services for all individuals and to improve the supply, distribution, diversity, and development of the health workforce, such as through programs related to--CommentsClose CommentsPermalink





(i) health workforce training and education capacity;CommentsClose CommentsPermalink





(ii) the health care safety net workforce, including health centers under section 330;CommentsClose CommentsPermalink





(iii) provider cultural competency;CommentsClose CommentsPermalink





(iv) health workforce diversity;CommentsClose CommentsPermalink





(v) health workforce pipeline development;CommentsClose CommentsPermalink





(vi) health workforce retention;CommentsClose CommentsPermalink





(vii) health workforce faculty recruitment;CommentsClose CommentsPermalink





(viii) health workforce faculty retention;CommentsClose CommentsPermalink





(ix) health workforce career ladders;CommentsClose CommentsPermalink





(x) public awareness; andCommentsClose CommentsPermalink





(xi) health workforce scholarship and loan repayment programs;CommentsClose CommentsPermalink





(B) to create State-specific health workforce goals and objectives in accordance with subsection (b)(3) and to develop annual plans in accordance with subsection (b)(4) to meet such goals and objectives; andCommentsClose CommentsPermalink





(C) during the first 12-month period funded through the grant, to establish or designate in accordance with subsection (a)(2)(D) a State health workforce planning entity to establish statewide processes for State health workforce planning, State health workforce data collection, policy recommendations, and State resource allocations.CommentsClose CommentsPermalink





(5) DEVELOPMENT OF APPLICATION- The application--CommentsClose CommentsPermalink





(A) is developed by or in consultation with the State agency that will be responsible for administering the program; andCommentsClose CommentsPermalink





(B) is made publicly available during its development or after its submission to the Secretary in order to facilitate public comment.CommentsClose CommentsPermalink





(d) Additional Duties and Authorities- A State and Regional Health Workforce Council funded through a grant under this section shall--CommentsClose CommentsPermalink





(1) submit analyses and recommendations to the Advisory Board under title I, at least on an annual basis;CommentsClose CommentsPermalink





(2) have the authority to allocate any future increases in State graduate medical education caps under title XVIII of the Social Security Act, consistent with section 203 and the amendments made by title III; andCommentsClose CommentsPermalink





(3) shall be eligible to apply for the authority to administer direct graduate medical education funds under title XVIII of such Act at the State level in order to achieve flexibility in direct graduate medical education placements to meet State health needs.CommentsClose CommentsPermalink





(e) Determination of Amount of Allotment-CommentsClose CommentsPermalink





(1) IN GENERAL- The Secretary shall determine the amount of the allotment to each State under this section for a fiscal year based on a formula.CommentsClose CommentsPermalink





(2) DEVELOPMENT OF FORMULA- The formula referred to in paragraph (1) shall be determined by the Secretary by regulation, taking into consideration the following criteria:CommentsClose CommentsPermalink





(A) Existing shortages and deficiencies in health workforce distribution.CommentsClose CommentsPermalink





(B) Rural, urban, and frontier areas.CommentsClose CommentsPermalink





(C) Community health centers.CommentsClose CommentsPermalink





(D) The number of medical, nursing, and allied health professions schools in each State.CommentsClose CommentsPermalink





(f) Reports- A State and Regional Health Workforce Council funded through a grant under this section shall submit data to the National Health Workforce Advisory Board under title I and the National Workforce Data Center established under section 201 on an annual basis for purposes of consideration and incorporation into the recommendations made by the National Health Workforce Advisory Board.CommentsClose CommentsPermalink