Antecedentes del estudio

Sec. 5001. Purpose.

The stated purpose of Title V of the Act is to improve access to and the delivery of health care services for all individuals, particularly low income, underserved, uninsured,

minority, health disparity, and rural populations by gathering and assessing data on the healthcare workforce; increasing workforce supply; enhancing workforce education and training; and supporting the existing workforce.

Sec. 5002. Definitions.

Provides definitions for a variety of terms for purposes of Title V.

Subtitle B Innovation in the Health care Workforce

Sec. 5101. National Health Care Workforce Commission (as modified by Sec. 10501).

Establishes a National Health Care Workforce Commission to serve as a resource for Congress, the President, and localities; coordinate activities of the Departments of HHS, Labor, Veterans Affairs, Homeland Security, and Education; develop and evaluate education and training activities; identify barriers to improved federal, state and local coordination and recommend ways to address barriers; and encourage innovations. The Commission is to be composed of 15 members (each serving 3 year terms – staggered at the start) appointed by the Comptroller General. The initial appointments must be made by September 30, 2010. Membership must include no less than one representative of certain categories, including: the health care workforce and health

professions; employers (including small business and self-employed individuals); third- party payers; experts in health care services and health economics research; consumer representatives; labor unions; state or local workforce investment boards; and

educational institutions. Individuals in health professions education or practice may not form the majority. The Commission chairman and vice-chairman will be appointed by the Comptroller General.

The Commission is required to annually submit two reports to Congress – one starting no later than April 1, 2011 to include a review of at least one high priority area, and the other starting no later than October 1, 2011, to include a review of current and projected workforce supply and demand and recommendations on workforce goals, priorities and policies. The Commission is also required to report to Congress on the state health care workforce development grants established by sec. 5102.

Initial high priority topic areas include: workforce planning that maximizes the skill sets of health professionals across disciplines; workforce demands for the enhanced

information technology workplace; how to align Medicare and Medicaid graduate medical education policies with national workforce goals; ways to eliminate barriers to entering and staying in primary care; education and training capacity and projected demands for professionals in nursing, oral health, mental health, allied and public health, and emergency medicine; and the geographic distribution of providers compared to state and regional needs.

Specific topics to be included in the annual workforce review include workforce supply and distribution with projected demands for the subsequent 10 and 25 year periods; workforce education and training capacity with projected demands for the subsequent 10 and 25 year periods; education loan and grant programs; implications of new and

existing federal policies affecting the workforce; workforce needs of special populations with recommendations on meeting the needs; and recommendations on creating or revising national loan repayment and scholarship programs to require low-income medical students to serve in their home underserved communities.

The Commission is also directed to study effective mechanisms for financing education and training for careers in health care, and make recommendations to Congress and the Departments of Labor and HHS on improving safety, health and worker protections for the health care workforce.

Sec. 5102. State health care workforce development grants.

Competitive planning and implementation grants are created for the purpose of enabling State partnerships to complete comprehensive planning and to carry out activities

leading to coherent and comprehensive health care workforce development strategies at the state and local levels. Grants will support innovative approaches to increase the number of skilled health care workers such as health care career pathways for young people and adults.

HRSA will administer the grants in consultation with the National Health Care Workforce Commission created under sec. 5101.

Planning grants of up to $150,000 will be available for a one year term. An eligible entity is a state workforce investment board, if membership includes at least one

representative from each of the following: health care employer; labor organization; public 2-year institution of higher education; public 4-year institution of higher education;

the recognized state federation of labor; the state public secondary education agency; the state P-16 or P-20 council, if one exists; and a philanthropic organization engaged in health workforce activities. State grantees are required to provide at least a 15% match in cash or in-kind. Grantees must: analyze labor market data in order to create health care career pathways; identify high demand pathways; identify public and private resources for recruitment, education, and retention; describe skill standards for various credentials and licensure; identify federal and state rules that are barriers to developing a comprehensive workforce strategy and a plan to resolve those barriers; and participate in evaluation and reporting activities (states must report to the Administration within 1 year). The Administration must submit a report to Congress on the planning grant program.

Implementation grants will be competitively awarded to state partnerships for 2-year periods (a 3rd _{year is possible for high performing grantees). An eligible grantee will} have received and completed the requirements of a planning grant and submitted an application with the information described in the Act. At least 60% of grant funds may be reserved by the state partnerships to competitively award grants for workforce

development activities. The Act does not specify a maximum grant amount. State grantees are required to provide at least a 25% match in cash or in-kind. Grantees must: convene regional leadership to engage in workforce development planning; take steps to reduce barriers to a comprehensive and coherent strategy; develop a

preliminary statewide strategy; convene partnership members on a regular basis; assist leaders at the regional level to form partnerships; collect and assess data on

benchmarks; and participate in the Administration’s evaluation and reporting activities (an annual report is required).

Authorizes appropriations of $8 million and $150 million, respectively, for planning and implementation grants during FY 2010 and such sums as may be necessary for subsequent years.

Sec. 5103. Health care workforce assessment.

Establishes the National Center for Health Workforce Analysis (i.e., codifies the existing national center); mandates that the Secretary award grants to, or enter into contracts with, state or other appropriate entities for state and regional workforce data collection and analysis; and increases funding for longitudinal evaluations of individuals

participating in federal workforce programs. Authorizes $7.5 million for each of fiscal years 2010-1014 for the National Center; $4.5 million for each of fiscal years 2010-2014 for state and regional centers; and such sums as may be necessary for longitudinal evaluations.

Sec. 5104. Interagency Task Force to Assess and Improve Access to health Care in the State of Alaska (added by Sec. 10501).

Establishes a task force to assess access to health care and develop a strategy for the Federal government to improve delivery of health care to Federal health program beneficiaries in Alaska.

Subtitle C—Increasing the Supply of the Health Care Workforce Sec. 5201. Federally supported student loan funds.

Changes the requirement to practice in primary care as a condition for student loans to the lesser of 10 years or until the loan is repaid; changes the interest rate on

noncompliance to a rate of 2% per year greater than the rate the student would pay if compliant. Specifies that the Secretary may not require parental financial information to determine financial need for an independent student.

Sec. 5202. Nursing student loan program.

Increases the cap on loan amounts under the Nursing Student Loan program as follows: the annual cap is increased from $2,500 to $3,300; the annual cap for each of the final two academic years is increased to from $4,000 to $5,200; and the aggregate cap for all years under the program is increased to from $13,000 to $17,000. Beginning with fiscal year 2012, the Secretary shall adjust all the caps to reflect increases in the cost-of- attendance. Requires loans made to students enrolling after June 30, 2000 (instead of 1986), to be based on financial need and updates the loan cancellation policy to apply to students receiving loans before September 29, 1995 (instead of 1979).

Sec. 5203. Health care workforce loan repayment programs.

Establishes a loan repayment program for pediatric subspecialists and providers of mental and behavioral health services to children and adolescents. Qualified

professionals (U.S. citizens or legal U.S. residents) must agree to be employed for a specified period of at least 2 years in a Health Professional Shortage Area or Medically Underserved Area, or to serve a Medically Underserved Population. The Secretary will make payments on the principal and interest of each individual’s medical education loans of up to $35,000 a year for each year of agreed upon service, up to 3 years. Authorizes $30,000,000 for each fiscal year 2010-2014 for pediatric subspecialists, and $20,000,000 for each of fiscal years 2010-2013 for child and adolescent mental and behavioral health professionals.

Sec. 5204. Public health workforce recruitment and retention programs.

Establishes a loan repayment program for public health students and workers. The Secretary will pay up to $35,000 per year or, if less, 1/3 of the eligible loan balance, for each year of obligated service in exchange for working at least 3 years at a federal, state, local, or tribal public health agency. Authorizes $195 million for FY2010 and such sums as may be necessary for FY2011-2015.

Sec. 5205. Allied health workforce recruitment and retention programs.

Offers loan repayment to allied health professionals employed at public health agencies or in settings providing health care to patients, including acute care facilities, ambulatory care facilities, residences, and other settings located in Health Professional Shortage Areas, Medically Underserved Areas, or serving Medically Underserved Populations.

Sec. 5206. Grants for state and local programs.

Authorizes the Secretary to make grants to, or contract with, educational institutions to award scholarships to mid-career public and allied health professionals employed in public and allied health positions at the federal, state, tribal, or local level so they may receive additional training in public or allied health fields. Authorizes $60 million for FY2010 and such sums as necessary for FY2011-2015. Allocates 50% of appropriated funds to mid-career public health professionals and 50% to mid-career allied health professionals.

Sec. 5207. Funding for National Health Service Corps.

Increases and extends the authorization of appropriations for the National Health

million for FY2011; $535 million for FY 2012; $691 million for FY 2013; $893 million for FY2014; and $1.154 billion for FY 2015 (amounts are rounded). For subsequent years the Act provides for a formula-driven increase above the immediate prior year’s

appropriated amount which takes into account the average percentage increase in the cost of health professions education and the change in the number of individuals residing in Health Professions Shortage Areas.

Sec. 5208. Nurse-managed health clinics.

Establishes a new mandatory grant program to pay for the cost of operation of nurse- managed health clinics (NMHC). The NMHC must be associated with a nursing school or department, FQHC, or an independent nonprofit social service agency. To be eligible the NMHC must assure that: nurses are the major providers of services and that at least one nurse holds an executive management position; the NMHC will provide primary care to patients without regard to income of insurance status throughout the grant period; and the NMHC will establish a community advisory committee not later than 90 days after receiving the grant. Authorizes $50 million for FY2010 and for FY 2011- 2014, such sums as may be necessary.

Sec. 5209. Elimination of cap on commissioned corps.

Eliminates the existing cap (2,800) on the number of Commissioned Corps members.

Sec. 5210. Establishing a Ready Reserve Corps.

Establishes a Ready Reserve Corps in addition to the Regular Corps within the

Commissioned Corps for service in times of national emergency. Ready Reserve Corps members may be called to active duty by the Surgeon General to respond to national emergencies and public health crises; fill critical public health positions left vacant by members of the Regular Corps who have been called to duty elsewhere; and be assigned to isolated, hardship, and medically underserved communities to improve access to health services. Authorizes $12.5 million for each of FY2010-2014.

Subtitle D Enhancing Health Care Workforce Education and Training Sec. 5301. Training in family medicine, general internal medicine, general

pediatrics, and physician assistantship.

Authorizes the Secretary to make 5-year grants or enter into contracts with capable entities to plan, develop and operate training programs in primary care; provide financial assistance to trainees and faculty; enhance faculty development in primary care and physician assistant programs; and develop and operate a demonstration program which may include training relevant to patient-centered medical homes. Preference is to be given to programs that establish or expand academic units in the stated primary care fields. The Act also includes a list of priorities for awarding grants or contracts. Authorizes $125 million for FY2010 and such sums as necessary for FY2011-2014. Allocates 15% of appropriated funds to the physician assistant training programs. Also authorizes $750 thousand for each of FY2010-2014 for programs that integrate

academic units.

Sec. 5302. Training opportunities for direct care workers.

Mandates the Secretary to award grants to entities (educational institutions in

partnership with long-term care providers) to provide new training opportunities for direct care workers in long-term care settings. Funds are to be used to provide assistance to workers to offset the costs of tuition and fees. To receive assistance, workers must

maintain satisfactory academic progress and agree to work in a long-term care field for at least 2 years after completion. Authorizes $10 million in funding for the period FY2011-2013.

Sec. 5303. Training in general, pediatric, and public health dentistry.

Authorizes the Secretary to make 5-year awards (grants or contracts) to capable entities to develop and support dental training programs, including pediatric programs. Funds may be used for primary care dental training; training providers who plan to teach; pre- doctoral and post-doctoral training, faculty development, dental faculty loan repayment, and provision of financial assistance to practitioners and students in need. Specifies details for loan repayment. Provides a list of priorities for making awards. Authorizes $30 million for FY2010 and such sums as necessary for FY2011-2015. Allows award funds to be carried over from year to year for up to 3 years.

Sec. 5304. Alternative dental health care providers demonstration project.

Authorizes the Secretary to award grants to 15 eligible entities to establish

demonstration training programs for alternative dental health care providers to increase access to dental health care services in rural, tribal, and underserved communities. Demonstrations are to begin within 2 years of enactment and terminate no later than 7 years after enactment. Each grant shall be at least $4 million for the 5-year period. Authorizes such sums as necessary.

Sec. 5305. Geriatric education and training; career awards; comprehensive geriatric education.

Requires the Secretary to award grants of $150,000 to not more than 24 geriatric education centers to offer a fellowship program with short-term intensive courses on geriatrics, chronic care management, and long-term care for medical school faculty and other health professions schools. In addition the grantee must either offer family

caregiver and direct care provider training (at no or nominal cost to enrollees) or develop best practice materials on mental disorders, medication safety, and management of dementia among older adults. Authorizes $10.8 million for the period FY2011-2014. Also mandates the Secretary to award grants to advanced practice nurses, clinical social workers, pharmacists, or psychology students who are pursuing a doctorate or other advanced degree in geriatrics who agree to teach or practice in the field of geriatrics, long-term care, or chronic care management for a minimum of 5 years. Authorizes $10 million for the period FY2011-2013.

Expands scope of individuals eligible for geriatric academic career awards to include health professionals with junior faculty appointments in accredited health professions schools. Individuals must commit to spend 75% of total faculty time teaching

interdisciplinary education in geriatrics.

Expands the Comprehensive Geriatric Education grant program to award grants to educational institutions that establish traineeships for individuals who are preparing for advanced education nursing degrees in geriatric nursing, long-term care, gero-

psychiatric nursing, or other nursing areas that specialize in care of the elderly. Authorizes such sums as necessary for FY2010-2014.

Sec. 5306. Mental and behavioral health education and training grants. Authorizes the Secretary to awards grants to schools of higher education for the

development, expansion, or enhancement of training programs in social work, graduate psychology, professional training in child and adolescent mental health, and preservice or in-service training to paraprofessionals in child and adolescent mental health. At least 4 of the grants for social work education must be awarded to historically black colleges or minority-serving institutions. Provides a list of priorities for grant awards. Authorizes for FY 2010-2013: $8 million for social work training; $12 million for graduate psychology training; $10 million for training in professional child and adolescent mental health and $5 million for training in paraprofessional child and adolescent work.

Sec. 5307. Cultural competency, prevention, and public health and individuals with disabilities training.

Reauthorizes and expands programs to support the development, evaluation, and dissemination of research, demonstration projects, and model curricula for cultural competency, prevention, public health proficiency, reducing health disparities, and aptitude for working with individuals with disabilities training for use in health professions schools and continuing education programs. Authorizes such sums as necessary for FY2010-2015.

Sec. 5308. Advanced nursing education grants.

Specifies requirements for midwifery education programs eligible for grants under the Advanced Education Nursing grant program, including requiring accreditation by the American College of Nurse-Midwives Accreditation Commission for Midwifery Education. Eliminates the cap on the number of traineeships for individuals in doctorate programs.

Sec. 5309. Nurse education, practice, and retention grants.

Revises the Nurse Education, Practice, and Retention Grant program. Specifies a focus on quality and on coordinated care.

Authorizes two new grant programs to accredited nursing schools or health facilities specifically for nurse retention: one to promote career advancement among nurses and the other for enhanced collaboration and communication among nurses and other health care professionals. Priority in the latter program is given to applicants who have not previously received an award. Authorizes such sums as may be necessary in each of FY2010-2012.

Sec. 5310. Loan repayment and scholarship program.

Extends the Nurse Loan Repayment and Scholarship Programs to provide loan

repayment for full- or part-time nursing school students who agree to serve a minimum two years as faculty members at an accredited school of nursing.

Sec. 5311. Nurse faculty loan program.

Increases the annual cap on loan amounts under the Nursing Faculty Loan program to $35,500 (from $30,000) in FY 2010 and FY2011, and substitutes an adjustment to reflect cost-of-attendance instead of the adjustment for inflation for subsequent years. Requires