The Public Health Service Act (PHSA) establishes authority for the Secretary of Health and Human Services (HHS) to develop and implement workforce programs authorized in Title VII (health and medicine) and Title VIII (nursing). These programs, administered by the Health Resources and Services Administration (HRSA), provide grants, scholarships, and loans to support institutions and individuals in developing and sustaining the health workforce.
Before passage of health care reform legislation in March 2010, appropriations authority for all Title VII and Title VIII programs had expired. Congress had nonetheless continued to appropriate funds for the programs. During the period from FY2001 through FY2010, total annual appropriations for Title VII programs fluctuated from a high of $308.4 million in FY2003 to a low of $145.1 million in FY2006. For Title VIII programs, during the period from FY2001 through FY2009, the annual appropriation increased from $83.8 million to $171.0 million. In the FY2010 appropriation, Congress boosted Title VIII funding by an additional 43% over the previous year.
For FY2009, Congress appropriated funds for Title VII and Title VIII programs through two separate enactments. The Omnibus Appropriations Act, 2009 (P.L. 111-8) provided $392.7 million in regular appropriations. The American Recovery and Reinvestment Act of 2009 (ARRA, P.L. 111-5) added a supplemental appropriation of $200 million to be obligated over two years. Of this total, $148.5 million has been applied to Title VII and Title VIII programs; remaining funds are expected to be obligated for related activities (see Appendix A).
For FY2010, Congress appropriated $498.0 million for Title VII and Title VIII programs, an increase of 26.8% over the regular FY2009 appropriations. President Barack Obama's FY2011 budget contains a request of $503.9 million for Title VII and Title VIII programs, a 1.2% increase above the regular FY2010 appropriations. The FY2011 request would provide level funding for almost all Title VII and Title VIII programs.
This report provides a history of appropriations for programs in Title VII and Title VIII of the PHSA. It includes a summary of new authorizations for these two titles, as enacted in major health reform legislation, the Patient Protection and Affordable Care Act, P.L. 111-148 (see Appendix B).
Since the mid-1950s, Congress has added numerous provisions to the Public Health Service Act (PHSA) that authorize education and training programs for various health, medical, and nursing professionals. The programs, consolidated in Title VII and Title VIII of the PHSA, provide grants, scholarships, and loans to individuals and institutions in order to increase the supply of professionals in health care, medicine, and nursing. Title VII programs support individuals who study to become primary care physicians, dentists, public health, and allied health professionals. Also, institutions that train these individuals are eligible for grants to support the development of education and training opportunities through endeavors such as multidisciplinary collaborative efforts and community partnerships. Title VIII programs support individuals in the study of nursing and enhance the ability of institutions to sustain nursing workforce programs. Major health reform legislation enacted in 2010 includes amendments to Title VII and Title VIII that add, delete or modify program authorities.
The Health Resources and Services Administration (HRSA) in the Department of Health and Human Services (HHS) administers Title VII and Title VIII programs.1 Discretionary funding for these programs is provided in the annual appropriations act for the Departments of Labor, HHS, and Education (Labor-HHS-ED). The FY2010 enacted appropriations for Title VII and Title VIII programs are $254.1 million and $243.9 million, respectively, for a total of $498.0 million.2 In addition, a portion of the supplemental funds provided through the American Recovery and Reinvestment Act of 2009 (ARRA)3 is available for FY2010.
Major provisions enacted in the Patient Protection and Affordable Care Act (PPACA)4 amended Title VII and Title VIII of the PHSA to revise existing authorities or create new ones. Implementation of the discretionary programs authorized in PPACA will depend on future appropriations actions.
After reviewing the status of authorizations for Title VII and Title VIII programs, this report summarizes the appropriations history for the period from FY2001 through FY2010, together with the FY2011 President's budget request. Table 1 provides an appropriations history for Title VII; Table 2, an appropriations history for Title VIII; and Table 3, a consolidation of program totals for Title VII and Title VIII. Appendix A provides details about plans within HRSA to distribute ARRA funds in FY2009 and FY2010 for Title VII and Title VIII programs. Appendix B summarizes the sections of PPACA that amend various sections in Title VII and Title VIII of the PHSA.
Before PPACA was enacted in March 2010, statutory authorities for Title VII and Title VIII programs had been amended numerous times since their initial passage. For Title VII, the Health Education Partnerships Act of 1998 (P.L. 105-392)5 had been the most recent reauthorizing legislation, authorizing appropriations for many programs through FY2002. The same law also extended appropriations authority for most Title VIII programs through FY2002. Subsequently, authorizations for some, but not all, Title VIII programs had been extended through FY2007 in the Nurse Reinvestment Act of 2002 (P.L. 107-205).6 In the 111th Congress, multiple provisions of PPACA added, eliminated, or revised program authorities in each of Title VII and Title VIII, including new or extended authorization of appropriations for selected programs (see Appendix B). 7
On February 1, 2010, President Barack Obama presented the FY2011 budget, requesting a total of $503.9 million for Title VII and Title VIII programs. The amount is an increase of $5.9 million (1.2%) above the $498.0 million enacted in the FY2010 appropriations for these programs. The FY2010 enacted appropriations for Title VII and Title VIII programs are $254.1 million and $243.9 million, respectively. PPACA provided no supplemental FY2010 appropriations for Title VII and Title VIII programs.8
For FY2009, Congress appropriated funds for Title VII and Title VIII programs in two separate enactments. Regular appropriations of $392.7 million were provided in the FY2009 Omnibus Appropriations Act.9 A supplemental appropriation of $200 million for health, medical, and nursing workforce programs was added by ARRA. Of that $200 million, the Secretary has allocated $148.5 million to Title VII and Title VIII programs, and $50 million for equipment to enhance the training of health professionals.10 Unlike regular appropriations, most ARRA funds are available for obligation over two fiscal years, through September 30, 2010. As shown in Appendix A, HRSA obligated about one-third ($68.2 million) of the $200 million in FY2009, leaving about two-thirds ($131.8 million) for obligation in FY2010.
President Obama's FY2011 budget request would provide a total of $260.0 million for Title VII programs, representing an increase of $5.9 million (2.3%) above the FY2010 appropriation of $254.1 million. All currently funded programs would receive level funding, except for the Workforce Information and Analysis program, which would be increased from $2.8 million to $8.8 million.
Table 1 presents Title VII appropriations for health and medical professions training programs for the period from FY2001 through FY2010, together with President Obama's FY2011 budget request.
During the period from FY2001 through FY2010, total annual appropriations for Title VII programs fluctuated significantly, from a high of $308.4 million in FY2003 to a low of $145.1 million in FY2006. Throughout much of this period, the George W. Bush Administration sought to eliminate funds for most Title VII programs, but Congress generally restored funding. Funding for several progams was eliminated starting in FY2006, including Health Education and Training Centers, Workforce Information and Analysis, and Health Administration Traineeships and Special Projects.11 However, Workforce Information and Analysis received renewed funding in FY2010.
President Obama's FY2011 budget request would provide $243.9 million for Title VIII programs, which is equal to the FY2010 enacted appropriation. The request would maintain current levels of funding for each of six authorized programs.
Table 2 presents Title VIII appropriations for nursing programs from FY2001 through FY2010, together with President Obama's FY2011 budget request. During the period from FY2001 through FY2009, appropriations for Title VIII programs increased by 104%, from $83.8 million to $171.0 million. In the FY2010 appropriation, Congress boosted Title VIII funding by an additional 43% over the FY2009 regular appropriation. The Public Service Announcements program (PHSA Sections 851 and 852) is the only program authorized in P.L. 107-205 that has received no funding.
Table 3 compiles total appropriations for Title VII and Title VIII programs for FY2001 through FY2010, and shows President Obama's FY2011 budget request. Appendix A details HRSA's planned obligations of $200 million in ARRA funding over FY2009 and FY2010. Appendix B summarizes the sections of the health care reform legislation that added, deleted or modified selected authorities in Title VII and Title VIII.
Table 1. Appropriations for Title VII, Health Professions Education Programs, FY2001 through FY2010, and the FY2011Budget Request
(in thousands of dollars)
|
Program |
FY01 |
FY02 |
FY03 |
FY04 |
FY05 |
FY06 |
FY07 |
FY08 |
FY09 |
FY09 ARRAa |
FY10 Enacted |
FY11 Pres. Request |
||
|
Training for Diversity |
||||||||||||||
|
Centers of Excellence (736b ) |
30,388 |
32,788 |
34,088 |
33,657 |
33,609 |
11,872 |
11,880 |
12,773 |
20,602 |
4,924 |
24,602 |
24,602 |
||
|
Scholarships for Disadvantaged Students (737b ) |
44,473 |
46,216 |
47,795 |
47,510 |
47,129 |
46,625 |
46,657 |
45,842 |
45,842 |
40,000 |
49,342 |
49,342 |
||
|
Faculty Loan Repayment and Minority Faculty Fellowship (738b, c ) |
1,330 |
1,330 |
1,321 |
1,313 |
1,302 |
1,288 |
1,289 |
1,266 |
1,266 |
1,200 |
1,266 |
1,266 |
||
|
Health Careers Opportunity Program (739b ) |
33,044 |
34,611 |
36,153 |
36,160 |
35,646 |
3,957 |
3,960 |
9,825 |
19,133 |
2,520 |
22,133 |
22,133 |
||
|
Subtotal, Training for Diversity |
109,235 |
114,945 |
119,357 |
118,640 |
117,686 |
63,742 |
63,786 |
69,706 |
86,843 |
48,644 |
97,343 |
97,343 |
||
|
Training/Primary Care Med/Dentistry (747, 748b ) |
91,048 |
93,002 |
92,432 |
81,917 |
88,816 |
40,823 |
48,851 |
47,998 |
48,425 |
47,600 |
54,425 |
54,425 |
||
|
Area Health Education Centers (751, 757b) |
33,125 |
33,346 |
32,946 |
29,206 |
28,971 |
28,661 |
28,681 |
28,180 |
32,540 |
0 |
33,345 |
33,345 |
||
|
Health Education and Training Centers (752, 757b ) |
4,640 |
4,400 |
4,371 |
3,851 |
3,820 |
0 |
0 |
0 |
0 |
0 |
0 |
0 |
||
|
Geriatric Programs (753, 757b ) |
12,410 |
20,400 |
27,818 |
31,805 |
31,548 |
0 |
31,548 |
30,997 |
30,997 |
0 |
33,747 |
33,747 |
||
|
Quentin N. Burdick Program/Rural Training (754, 757d ) |
5,988 |
6,996 |
6,954 |
6,125 |
6,076 |
0 |
0 |
0 |
0 |
0 |
0 |
0 |
||
|
8,422 |
9,495 |
11,922 |
11,849 |
11,753 |
3,957 |
3,960 |
8,803 |
13,890 |
0 |
22,390 |
22,390 |
|||
|
Subtotal, Interdisciplinary Community Linkages |
64,585 |
74,637 |
84,011 |
82,836 |
82,168 |
32,618 |
64,189 |
67,980 |
77,427 |
0 |
89,482 |
89,482 |
||
|
Workforce Information and Analysis (761b ) |
834 |
824 |
819 |
722 |
716 |
0 |
0 |
0 |
0 |
0 |
2,832 |
8,781 |
||
|
Public Health Workforce Development |
||||||||||||||
|
Public Health/Dental/ Medicine (765b, 766e, 767b, 768b, 770b) |
9,478 |
10,473 |
10,600 |
9,170 |
9,097 |
7,915 |
7,920 |
8,273 |
9,000 |
10,500 |
10,000 |
10,000 |
||
|
Health Admin/Trainees and Special Projects (769b) |
1,231 |
1,230 |
1,222 |
1,078 |
1,070 |
0 |
0 |
0 |
0 |
0 |
0 |
0 |
||
|
Subtotal, Public Health Workforce Development |
10,709 |
11,703 |
11,822 |
10,248 |
10,167 |
7,915 |
7,920 |
8,273 |
9,000 |
10,500 |
10,000 |
10,000 |
||
|
TOTAL, TITLE VII HEALTH PROFESSIONS |
276,411 |
295,111 |
308,441 |
294,363 |
299,553 |
145,098 |
184,746 |
193,957 |
221,695 |
106,744 |
|
|
||
Sources: HHS, HRSA Budget Justification documents, FY2003 through FY2011.
Note: PPACA = Patient Protection and Affordable Care Act of 2010
a. About three-fourths of ARRA funds were allocated for Title VII and Title VIII programs, and the remainder for other HRSA activities related to health professions. For the distribution of ARRA funds, see Appendix A.
b. For authorizations of these programs in health care reform legislation (PPACA), see Appendix B.
c. PHSA Section 738, Faculty Loan Repayment Program/Minority Faculty Fellowship Program, is the only program in Title VII that is administered by the HRSA Bureau of Clinician Recruitment and Retention; all others are administered in the HRSA Bureau of Health Professions.
d. The Quentin N. Burdick Program/Rural Training authority is currently administered and funded through the Indian Health Service of HHS.
e. This section is not modified by PPACA.
Table 2. Appropriations for Title VIII, Nursing Workforce Development Programs, FY2001 through FY2010, and the FY2011 Budget Request
(in thousands of dollars)
Program |
FY01 |
FY02 |
FY03 |
FY04 |
FY05 |
FY06 |
FY07 |
FY08 |
FY09 |
FY09 |
FY10 Enacted |
FY11 Pres. Request |
|
|
Advanced Education Nursing (811)b |
59,045 |
60,018 |
50,174 |
58,636 |
58,160 |
57,021 |
57,061 |
61,875 |
64,438 |
|
64,438 |
64,438 |
|
|
Nursing Workforce Diversity (821)b |
4,573 |
6,172 |
9,935 |
16,402 |
16,270 |
16,096 |
16,107 |
15,826 |
16,107 |
|
16,107 |
16,107 |
|
|
12,790 |
16,283 |
26,825 |
31,769 |
36,468 |
37,266 |
37,291 |
36,640 |
37,291 |
|
39,896 |
39,896 |
||
|
7,279 |
10,235 |
19,870 |
26,736 |
31,482 |
31,034 |
31,055 |
30,512 |
37,128 |
|
93,864 |
93,864 |
||
|
Nurse Faculty Loan Program ( 846A)c |
NA |
NA |
2,980 |
4,870 |
4,831 |
4,770 |
4,773 |
7,860 |
11,500 |
|
25,000 |
25,000 |
|
|
Comprehensive Geriatric Education (855)c |
NA |
NA |
2,980 |
3,478 |
3,450 |
3,389 |
3,392 |
3,333 |
4,567 |
|
4,567 |
4,567 |
|
|
TOTAL, TITLE VIII |
83,787 |
92,708 |
112,764 |
141,891 |
150,661 |
149,576 |
149,679 |
156,046 |
171,031 |
|
243,872 |
243,872 |
Sources: HHS, HRSA Budget Justification documents, FY2003 through FY2011.
Note: NA = Not Applicable; PPACA = Patient Protection and Affordable Care Act of 2010
a. About three-fourths of ARRA funds were allocated for Title VII and Title VIII programs, and the remainder for other HRSA activities related to health professions. For the distribution of ARRA funds, see Appendix A.
b. These programs were authorized in the Health Education Partnerships Act of 1998 (P.L. 105-392) through the end of FY2002. For authorizations of these programs in health care reform legislation (or PPACA), see Appendix B.
c. These programs were authorized or reauthorized in the Nurse Reinvestment Act of 2002 (P.L. 107-205); authorizations expired at the end of FY2007. For authorizations of these programs in PPACA, see Appendix B. Additional programs authorized in P.L. 107-205 that remain unfunded are Section 851, Public Service Announcements, and Section 852, State and Local Public Service Announcements.
d. PHSA Section 846, Loan Repayments/Scholarships, is the only program in Title VIII that is administered by the HRSA Bureau of Clinician Recruitment and Retention; all others are administered in the HRSA Bureau of Health Professions.
Table 3. Total Appropriations for Title VII and Title VIII Programs, FY2001 through FY2010, and the FY2011 Budget Request
(in thousands of dollars)
|
Programs |
FY01 |
FY02 |
FY03 |
FY04 |
FY05 |
FY06 |
FY07 |
FY08 |
FY09 |
FY09 ARRAa |
FY10 Enacted |
FY11 Pres. Request |
||||||||||||
|
Title VII, Health Professions Education |
|
|
|
|
|
|
|
|
|
|
|
|
||||||||||||
|
Title VIII, Nursing Workforce Development |
|
|
|
|
|
|
|
|
|
|
|
|
||||||||||||
|
TOTAL, TITLE VII AND TITLE VIII |
|
|
|
|
|
|
|
|
|
|
|
|
a. About three-fourths of ARRA funds were allocated for Title VII and Title VIII programs, and the remainder for other HRSA activities related to health professions. For the distribution of ARRA funds, see Appendix A.
Appendix A. Allocation of Stimulus Funds Appropriated for HRSA Health Professions Programs in the American Recovery and Reinvestment Act of 2009 (P.L. 111-5)
Table A-1. Allocation of Stimulus Funds Appropriated for HRSA Health Professions Programs in the American Recovery and Reinvestment Act of 2009
(in thousands of dollars)
|
Programs |
Total Allocation from ARRA 2009 Appropriation |
Planned Obligations |
|||||
|
FY2009 |
FY2010 |
||||||
|
Health and Medicince |
|||||||
|
Centers of Excellence (736) |
|
|
|
||||
|
Scholarships for Disadvantaged Students (737) |
|
|
|
||||
|
Faculty Loan Repayment (738) |
|
|
|
||||
|
Health Careers Opportunity Program (739) |
|
|
|
||||
|
Training in Primary Care Medicine and Dentistry (747, 748) |
|
|
|
||||
|
Public Health/Dental/Medicine, Total |
|
|
|
||||
|
(Public Health Traineeships (767, 770) (non-add) |
|
|
|
||||
|
(Preventive Medicine; Dental Public Health (768, 770) (non-add) |
|
|
|
||||
|
Subtotal Title VII |
|
|
|
||||
|
Nursing |
|
|
|
||||
|
Nursing Workforce Diversity (821) |
|
|
|
||||
|
Loan Repayments/Scholarships (846) |
|
|
|
||||
|
Nurse Faculty Loan (846A) |
|
|
|
||||
|
Subtotal Title VIII |
|
|
|
||||
|
SUBTOTAL HEALTH PROFESSIONS |
|
|
|
||||
|
EQUIPMENTa |
|
|
|
||||
|
LICENSURE PORTABILITYb |
|
|
|
||||
|
TOTAL |
|
|
|
||||
Appendix B. Sections of Patient Protection and Affordable Care Act (PPACA) that Amend Authorities in Title VII and Title VIII of the Public Health Service Act (PHSA)
Table B-1. PPACA Sections Amending Title VII
|
Section and Topic in PPACA, As Amended |
Section Created or Amended in the Public Health Service Act (PHSA) |
Previous or Related PHSA Section(s) |
|
Sec. 4305. Advancing Research and Treatment for Pain Care Management |
This section adds a new PHSA Sec. 759, Program for Education and Training in Pain Care, to Title VII, Part D, authorizing the Secretary to establish a program to train health professionals in pain care. The Secretary is authorized to fund health professions schools, hospices, and other entities for the development and implementation of education and training programs for health care professionals in pain care. For each of FY2010 through FY2012, SSAN are authorized to be appropriated with amounts remaining available until expended. |
Not applicable |
|
Sec. 5101. National Health Care Workforce Commission |
This section, as amended by Sec. 10501(a) of PPACA, establishes a National Health Care Workforce Commission to serve as a national resource that focuses on evaluating and meeting the need for health care workers. The Commission is composed of 15 members appointed by the U.S. Comptroller General. The Commission is required to review health care workforce supply and demand and make recommendations on national priorities and policies as well as review and make recommendations on one or more additional specified high priority topics and submit annual reports on both activities to Congress and the Administration beginning in 2011. The Commission also is required to (1) review implementation progress reports and report on the state health care workforce development grants program; (2) study effective mechanisms for financing education and training for careers in health care; (3) make recommendations about improving health care workers' safety, health, and protections in the workplace; and (4) assess reports from the National Center for Health Care Workforce Analysis (NCHWA). There are authorized to be appropriated SSAN to carry out this section. |
Not applicable |
|
Sec. 5102. State Health Care Workforce Development Grants |
This section establishes a competitive health care workforce development grants program for the purpose of enabling state partnerships to plan and implement activities leading to comprehensive health care workforce development strategies at the state and local levels. HRSA is responsible for administering the program, in consultation with the Commission; providing technical assistance to grantees; and reporting performance information to the Commission. For planning grants, this section authorizes to be appropriated $8 million for FY2010, and SSAN for each subsequent fiscal year. For implementation grants, it authorizes to be appropriated $150 million for FY2010, and SSAN for each subsequent fiscal year. |
Not applicable |
|
Sec. 5103. Health Care Workforce Assessment |
This section amends PHSA Sec. 761, Health Professions Workforce Information and Analysis, requiring the Secretary to (1) establish a National Center for Health Care Workforce Analysis; (2) establish State and Regional Centers for Health; and (3) increase grant amounts for longitudinal evaluations of specified individuals who have received education, training, or financial assistance from programs under PHSA Title VII. This section authorizes the following appropriations for each of FY2010 through FY2014: (1) $7.5 million for the National Center; (2) $4.5 million for State and Regional Centers; and (3) SSAN for grants for longitudinal evaluations. It amends PHSA Sec. 791, Preferences and Required Information in Certain Programs, to establish preferences for grant awards to an applicant that uses longitudinal evaluations, and refers such reports to a national workforce database. The section amends PHSA Sec. 791 by adding new language requiring the Secretary to give preference in awarding grants or contracts under Secs. 747 and 750 to any qualified applicant that utilizes a longitudinal evaluation and reports data from such system to a national workforce database. It also amends Secs. 748, 756, and 762 to include additional duties regarding performance measures and guidelines for longitudinal evaluations for the Advisory Committee on Training in Primary Care Medicine and Dentistry; the Advisory Committee on Interdisciplinary, Community-based Linkages; and the Advisory Council on Graduate Medical Education. |
747, 748, 750, 756, 761, 762, 791 |
|
Sec. 5201. Federally Supported Student Loan Funds |
This section amends PHSA Sec. 723(a), Medical Schools and Primary Health Care, to require medical students who receive loan funds to practice in primary care for 10 years or until the loan is repaid, whichever comes first. (This section contains no authorization to appropriate funding.) |
723 |
|
Sec. 5203. Health Care Workforce Loan Repayment Programs (Pediatric Specialty Loan Repayment Program) |
This section creates a new PHSA Sec. 775, Investment in Tomorrow's Pediatric Health Care Workforce, requiring the Secretary to establish and implement a pediatric specialty loan repayment program. Eligible individuals must agree to work full-time for not less than two years in a pediatric medical specialty, in pediatric surgery, or in child and adolescent mental and behavioral health care (which could include substance abuse prevention and treatment). There are authorized to be appropriated (1) $30 million for each of FY2010 through FY2014 for loan repayments for pediatric medical specialists and pediatric surgical specialists; and (2) $20 million for each of FY2010 through FY2013 for loan repayments for child and adolescent mental and behavioral health professionals. |
747 |
|
Sec. 5204. Public Health Workforce Loan Repayment Program |
This section creates a new PHSA Sec. 776, Public Health Workforce Loan Repayment Program, requiring the Secretary, depending on appropriations, to establish a Public Health Workforce Loan Repayment Program in which individuals must agree to work in a federal, state, local, or tribal public health agency or applicable fellowship after graduation. The section authorizes to be appropriated $195 million for FY2010, and SSAN for each of FY2011 through FY2015. |
Not applicable |
|
Sec. 5206. Public Health Workforce Grants for State and Local Programs |
This section creates a new PHSA Sec. 777, Training for Mid-Career Public and Allied Health Professionals, authorizing the Secretary to make awards to educational entities to establish scholarly programs for mid-career professionals in public and allied health fields. Additionally, this section amends PHSA Sec. 765, General Provisions, to add public health workforce loan repayment programs to the list of the allowable activities for public health workforce development grants. The section authorizes the appropriation of $60 million for FY2010, and SSAN for each of FY2011 through FY2015. Appropriated funds would have to be evenly divided between programs for public health professionals and those for allied health professionals. |
765-770 |
|
Sec. 5301. Primary Care Training and Enhancement |
This section strikes the existing PHSA Sec. 747, Family Medicine, General Internal Medicine, General Pediatrics, General Dentistry, Pediatric Dentistry, and Physician Assistants, and replaces it with a new PHSA Sec. 747, Primary Care Training and Enhancement, authorizing the Secretary to award grants or enter into contracts for a variety of activities. Those activities are to include capacity building and the support of training programs in primary care—defined for this purpose as family medicine, general internal medicine, or general pediatrics. The section authorizes to be appropriated $125 million for FY2010, and SSAN for each of FY2011 through FY2014; it requires that 15% of the amount appropriated in each fiscal year be allocated to physician assistant training programs specializing in primary care. For purposes of carrying out programs that integrate academic administrative units, this section authorizes to be appropriated an additional $750,000 for each of FY2010 through FY2014. |
747 |
|
Sec. 5302. Training Opportunities for Direct Care Workers |
This section adds a new PHSA Sec. 747A, Training Opportunities for Direct Care Workers, which requires the Secretary to establish a grant program to provide new training opportunities for direct care workers employed in specified long-term care settings. This section authorizes to be appropriated $10 million for the period FY2011 through FY2013. |
Not applicable |
|
Sec. 5303. Training in General, Pediatric, and Public Health Dentistry |
This section redesignates PHSA Sec. 748, Advisory Committee on Training in Primary Care Medicine and Dentistry, as amended by Sec. 5103 of PPACA, as PHSA Sec. 749 and inserts a new PHSA Sec. 748, Training in General, Pediatric, and Public Health Dentistry. Sec. 748 authorizes the Secretary to make grants or enter into contracts with specified entities to support training, provide financial assistance, and fund projects for dental students, dental residents, dental hygienists, practicing dentists, or dental faculty in the fields of general dentistry, pediatric dentistry, or public health dentistry. Sec. 748 also establishes a faculty loan repayment program under which individuals agree to serve full-time as faculty members in one of the specified dental fields. The section authorizes to be appropriated $30 million for FY2010, and SSAN for each of FY2011 through FY2015. |
747, 766, 748 |
|
Sec. 5305(a) and (b). Geriatric Education and Training |
Subsection 5305(a) amends PHSA Sec. 753, Education and Training Relating to Geriatrics, by adding two new subsections. The first subsection requires the Secretary to award grants or contracts for geriatric workforce development fellowship and training programs to qualified entities that operate a Geriatric Education Center (GEC). This section authorizes to be appropriated $10.8 million for the period FY2011 through FY2014. The second new subsection creates incentive grants or contracts for certain qualified health professionals entering the field of geriatrics, long-term care, and chronic care management. This section authorizes to be appropriated $10 million for the geriatric training program for the period FY2011 through FY2013. Subsection 5305(b) further amends PHSA Sec. 753 by expanding eligibility for geriatric academic career awards to qualified faculty at any accredited health professions school, as determined by the Secretary. Entities receiving an award must meet specified targets and use award funds to supplement and not supplant funds otherwise available to the GEC. This section also amends a nursing program which is authorized in Title VIII (see Table B-2in this appendix). |
753 |
|
Sec. 5306. Mental and Behavioral Health Education and Training Grants |
This section amends PHSA Title VII, Part D by deleting PHSA Sec. 757, which authorized appropriations for multiple sections in Part D through FY2002 (most sections are provided with their own authorizations through PPACA). This section also redesignates PHSA Sec. 756, Advisory Committee on Interdisciplinary, Community-Based Linkages (as amended by Sec. 5103 of PPACA), as Sec. 757, and adds a new PHSA Sec. 756, Mental and Behavioral Health Education and Training Grants. The new section authorizes the Secretary to award grants to (1) eligible institutions of higher education to support the recruitment and education of students in social work programs, interdisciplinary psychology training programs, and internships or other field placement programs related to child and adolescent mental health; and (2) state licensed mental health organizations to train paraprofessional child and adolescent mental health workers. For FY2010 through FY2013, the section authorizes to be appropriated $8 million for training in social work, $12 million for training in graduate psychology, $10 million for training in professional child and adolescent mental health, and $5 million for training in paraprofessional child and adolescent work. |
756, 757 |
|
Sec. 5307. Cultural Competency, Prevention, and Public Health and Individuals with Disabilities Training |
This section amends PHSA Sec. 741, Grants for Health Professions Education, requiring the Secretary to support the development and evaluation of research, demonstration projects, and model curricula for use in health professions schools and continuing education programs for providing training in cultural competency, prevention, public health proficiency, reducing health disparities, and aptitude for working with individuals with disabilities. There are authorized to be appropriated SSAN for each of FY2010 through FY2015. |
741 |
|
Sec. 5314. Fellowship Training in Public Health |
This section adds a new PHSA Sec. 778, Fellowship Training in Applied Public Health Epidemiology, Public Health Laboratory Science, Public Health Informatics, and Expansion of the Epidemic Intelligence Service, authorizing the Secretary to expand existing CDC public health training fellowships in epidemiology, laboratory science, and informatics; the Epidemic Intelligence Service (EIS); and other training programs that meet similar objectives. The section authorizes to be appropriated for each of FY2010 through FY2013, $24.5 million for EIS fellowships, and $5 million each for epidemiology, laboratory, and informatics fellowships. |
765-770 |
|
Sec. 5401. Centers of Excellence |
This section amends PHSA Sec. 736, Centers of Excellence (COE), by modifying the funding formula to add an additional set of specifications for allocating funds among the various types of COEs when the appropriation is $40 million or more. It authorizes to be appropriated $50 million for each of FY2010 through FY2015, and SSAN for each subsequent year. |
736 |
|
Sec. 5402. Health Care Professionals Training for Diversity |
This section amends PHSA Sec. 738(a), Loan Repayments and Fellowships Regarding Faculty Positions, by increasing the annual limit on the loan repayment amount from $20,000 to $30,000. In addition, the section amends PHSA Sec. 740 by authorizing the following appropriations: (1) for PHSA Sec. 737, Scholarships for Disadvantaged Students, $51 million for FY2010, and SSAN for each of FY2011 through FY2014; (2) for PHSA Sec. 738, Loan Repayments and Fellowships Regarding Faculty Positions, $5 million for each of FY2010 through FY2014; and (3) for PHSA Sec. 739, Educational Assistance in the Health Professions Regarding Individuals from Disadvantaged Backgrounds, $60 million for FY2010, and SSAN for each of FY2011 through FY2014. |
737, 738, 739, 740 |
|
Sec. 5403 Interdisciplinary, Community-Based Linkages |
This section amends PHSA Sec. 751, Area Health Education Centers, replacing the existing provisions with new language. The new section expands the current AHEC program and requires the Secretary to award (1) infrastructure development grants to medical and nursing schools to plan, develop, and operate AHEC programs; and (2) point-of-service maintenance and enhancement grants to maintain and improve the effectiveness of existing AHEC programs. It authorizes to be appropriated $125 million for each of FY2010 through FY2014. In addition, the section replaces the existing PHSA Sec. 752, Health Education and Training Centers, with a new PHSA Sec. 752, Continuing Educational Support for Health Professionals Serving in Underserved Communities, requiring the Secretary to award grants to health professions schools, academic health centers, and state or local governments, among others, to fund innovative activities to enhance education through distance learning, continuing education, collaborative conferences, and telehealth, with a focus on primary care. This section authorizes to be appropriated $5 million for each of FY2010 through FY2014, and SSAN for each subsequent fiscal year. |
751, 752 |
|
Sec. 5508. Increasing Teaching Capacity |
Subsection 5508(a) adds at the end of PHSA Title VII, Part C a new PHSA Sec. 749A, Teaching Health Centers Development Grants, authorizing the Secretary to award grants to teaching health centers (THCs) to establish newly accredited or expanded eligible primary care residency programs. There are authorized to be appropriated $25 million for FY2010, $50 million for FY2011, $50 million for FY2012, and SSAN for each fiscal year thereafter. No more than $5 million annually may be used for technical assistance program grants. [In addition, Section 5508 makes an amendment to the PHSA Title III: Subsection 5508(c) amends PHSA Title III, Part D by adding a new Subpart XI, Support of Graduate Medical Education in Qualified Teaching Health Centers, and, within this subpart, creates a new PHSA Sec. 340H, Program of Payments to Teaching Health Centers that Operate Graduate Medical Education Programs. The new section requires the Secretary to make payments for direct and indirect costs to qualified THCs for expansion of existing or establishment of new approved graduate medical residency training programs. To carry out the section, SSAN are appropriated, not to exceed $230 million, for the period FY2011 through FY2015.] |
747 |
|
Sec. 10501(d). Physician Assistant Education |
This section amends PHSA Sec. 738(a), Loan Repayments and Fellowships Regarding Faculty Positions, by adding schools offering physician assistant education programs to the list of specified health professions schools. |
738 |
|
Sec. 10501(l). Rural Physician Training Grants |
This section adds a new PHSA Sec. 749B, Rural Physician Training Grants, requiring the Secretary, acting through HRSA, to award grants to medical schools to recruit and provide focused training and experiences to students likely to practice medicine in underserved rural communities. It authorizes to be appropriated $4 million for each of FY2010 through FY2013. |
754 |
|
Sec. 10501(m)(1). Preventive Medicine and Public Health Training Grants |
This subsection replaces the existing PHSA Sec. 768, Preventive Medicine/Dental Public Health, with new language that establishes the Preventive Medicine and Public Health Training Grant Program, requiring the Secretary to award grants or contracts for preventive medicine residency training. |
768 |
|
Sec. 10501(m)(2). Reauthorization of Appropriations for Public Health Workforce Programs |
This subsection amends PHSA Sec. 770(a), which authorizes appropriations for PHSA Secs. 765-769. It authorizes to be appropriated $43 million for FY2011, and SSAN for each of FY2012 through FY2015. |
770 |
Note: Implementation of the discretionary programs authorized in PPACA will depend on future appropriations actions. SSAN = Such Sums As Necessary.
Source: Compiled by CRS, from PPACA (P.L. 111-148) enacted on March 23, 2010.
Table B-2. PPACA Sections Amending Title VIII
|
Section and Topic in PPACA, as Amended |
Section Created or Amended in the PHSA |
Previous or Related PHSA Sections |
|
Sec. 5202. Nursing Student Loan Program |
This section amends PHSA Sec. 836, Loan Provisions, by (1) increasing the annual maximum amount of loan funds a recipient can receive during FY2010 and FY2011 from $2,500 to $3,300; (2) increasing the final two-year amounts from $4,000 to $5,200 per year; and (3) increasing the total loan amount from $13,000 to $17,000. The section provides, for loans made after FY2011, for a cost-of attendance increase for the yearly and aggregate amounts. The section also amends applicable dates to require that financial need be a criterion for receiving a loan after 2000. Additionally, it provides for partial loan cancellation for loan recipients working as full-time nurses in public or nonprofit settings who received loan funds before September 29, 1995. This section authorizes no funds. |
836 |
|
Sec. 5305(c). Geriatric Education and Training |
This subsection amends PHSA Sec. 855, Comprehensive Geriatric Education, to include new language establishing traineeships for individuals who are preparing for advanced degrees in geriatric nursing or other nursing areas that specialize in elder care. It authorizes to be appropriated SSAN for each of FY2010 through FY2014. Subsequently, Sec. 855 is redesignated as PHSA Sec. 865 by Sec. 5310 of PPACA. |
855 |
|
Sec. 5307. Cultural Competency, Prevention, and Public Health and Individuals with Disabilities Training |
In addition to amending PHSA Sec. 741, this section amends PHSA Sec. 807, Grants For Health Professions Education, to create a program for the nursing workforce that is parallel to the one authorized under Sec. 741 (as amended) and to require coordination with that program. To carry out Sec. 807, SSAN are authorized to be appropriated for each of FY2010 through FY2015. |
807 |
|
Sec. 5308. Advanced Nursing Education Grants |
This section amends PHSA Sec. 811, Advanced Education Nursing Grants, to establish separate authorizations for the support of nurse practitioner and nurse midwifery programs. It also inserts new language establishing expanded grant eligibility criteria for nurse midwifery programs. The section deletes the prohibition on obligating more than 10% of the traineeships for individuals in doctoral programs. |
811 |
|
Sec. 5309. Nurse Education, Practice, and Retention Grants |
This section amends PHSA Sec. 831, Nurse Education, Practice, and Retention Grants, by renaming the grant program as, Nurse Education, Practice, and Quality Grants. It also deletes the provision's support for internship and residency programs to encourage mentoring and the development of specialties within nursing. The section restates certain specified grant priority activities, and redefines nursing schools to have the same meaning as the term in Sec. 801(2). The section authorizes to be appropriated SSAN for each of FY2010 through FY2014. Additionally, the section adds a new PHSA Sec. 831A, Nurse Retention Grants, authorizing the Secretary to provide funding to eligible entities for nurse retention and promotion ("career ladder") programs. The section authorizes to be appropriated SSAN to carry out grant programs in this section for each of FY2010 through FY2012. |
831 |
|
Sec. 5310. Loan Repayment and Scholarship Program |
This section amends PHSA Sec. 846, Loan Repayment and Scholarship Programs, by expanding eligibility for the nursing student loan repayment and scholarship program to individuals who agree to serve as nurse faculty at an accredited school of nursing for two years or more. This section also contains several technical and conforming amendments for PHSA Title VIII, including redesignating PHSA Sec. 841, Funding, as PHSA Sec. 871, Authorization of Appropriations, and PHSA Sec. 855, Comprehensive Geriatric Education, as PHSA Sec. 865. |
810, 835, 836, 838, 839, 840, 841, 842, 845, 846 851, 852, 855 |
|
Sec. 5311. Nurse Faculty Loan Program |
This section amends PHSA Sec. 846A by renaming the Nurse Faculty Loan Program as the School of Nursing Student Loan Fund. It adds the requirement that loan fund agreements must be made with accredited schools of nursing. The section also increases the annual loan limit from $30,000 to $35,500 for FY2010 and FY2011. This section authorizes to be appropriated SSAN for each of FY2010 through FY2014. Additionally, the section creates a new PHSA Sec. 847 authorizing the Secretary, acting through HRSA, to enter into an agreement with eligible individuals for the repayment of qualified education loans for the purpose of increasing the number of qualified nursing faculty. There is authorized to be appropriated SSAN for each of FY2010 through FY2014. |
846A |
|
Sec. 5312. Authorization of Appropriations for Parts B Through D of Title VIII |
This section amends PHSA Sec. 871, Authorization of Appropriations (as redesignated by Sec. 5310 of PPACA), by authorizing to be appropriated $338 million in FY2010 for Title VIII Parts B, C, and D (i.e., Secs. 811, 821, and 831), and SSAN for each of FY2011 through FY2016. |
871 |
|
Sec. 5404. Workforce Diversity Grants |
This section amends PHSA Sec. 821, Workforce Diversity Grants, by expanding the allowable uses of diversity grants to include stipends for (1) diploma or associated degree nurses to enter a bridge or degree completion program, (2) student scholarships or stipends for accelerated nursing degree programs, and (3) advanced education preparation. In lieu of the previous consultation requirements, it requires the Secretary to take into account the recommendations of the National Advisory Council on Nurse Education and Practice and consult with nursing associations including the National Coalition of Ethnic Minority Nurse Associations and other appropriate organizations. Appropriations authority is established in PHSA Sec. 871. |
821 |
Note: Implementation of the discretionary programs authorized in PPACA will depend on future appropriations actions. SSAN = Such Sums As Necessary.
Source: Compiled by CRS, from PPACA (P.L. 111-148) enacted on March 23, 2010.
| 1. |
Detailed program information is available from HRSA's Bureau of Health Professions, at http://bhpr.hrsa.gov/. |
| 2. |
P.L. 111-117, the Consolidated Appropriations Act, 2010, was signed into law on December 16, 2009. Funding for Title VII and Title VIII is found in Division D—Departments of Labor, Health and Human Services, and Education, and Related Agencies Appropriations Act, 2010. |
| 3. |
P.L. 111-5 was signed into law on February 17, 2009. |
| 4. |
P.L. 111-148 was signed into law on March 23, 2010. The Health Care and Education Reconciliation Act of 2010 (HCERA, P.L. 111-152), signed into law on March 30, 2010, amended certain provisions in PPACA. However, none of these amendments affected authorities in Title VII and Title VIII. |
| 5. |
Signed into law on November 13, 1998. |
| 6. |
Signed into law on August 1, 2002. |
| 7. |
For a detailed summary of these provisions in the health reform legislation, see CRS Report R41278, Public Health, Workforce, Quality, and Related Provisions in the Patient Protection and Affordable Care Act (PPACA), coordinated by [author name scrubbed] and [author name scrubbed]. |
| 8. |
However, PPACA provided supplements for FY2010 to some other health workforce programs. |
| 9. |
P.L. 111-8 was signed into law on March 11, 2009. |
| 10. |
The remaining $1.5 million has been allocated to programs for telehealth licensure, which are authorized in Section 330L of the PHSA. For more details, see CRS Report R40181, Selected Health Funding in the American Recovery and Reinvestment Act of 2009, coordinated by [author name scrubbed]. |
| 11. |
The Quentin Burdick Program for Rural Interdisciplinary Training is currently administered and funded through the Indian Health Service. |