Part C—Training in Family Medicine, General Internal Medicine, General Pediatrics, Physician Assistants, General Dentistry, and Pediatric Dentistry
subpart 1—medical training generally
§293j. Repealed. Pub. L. 105–392, title I, §102(2), Nov. 13, 1998, 112 Stat. 3537
Section, act July 1, 1944, ch. 373, title VII, §746, as added
A prior section 746 of act July 1, 1944, was classified to
§293k. Primary care training and enhancement
(a) Support and development of primary care training programs
(1) In general
The Secretary may make grants to, or enter into contracts with, an accredited public or nonprofit private hospital, school of medicine or osteopathic medicine, academically affiliated physician assistant training program, or a public or private nonprofit entity which the Secretary has determined is capable of carrying out such grant or contract—
(A) to plan, develop, operate, or participate in an accredited professional training program, including an accredited residency or internship program in the field of family medicine, general internal medicine, or general pediatrics for medical students, interns, residents, or practicing physicians as defined by the Secretary;
(B) to provide need-based financial assistance in the form of traineeships and fellowships to medical students, interns, residents, practicing physicians, or other medical personnel, who are participants in any such program, and who plan to specialize or work in the practice of the fields defined in subparagraph (A);
(C) to plan, develop, and operate a program for the training of physicians who plan to teach in family medicine, general internal medicine, or general pediatrics training programs;
(D) to plan, develop, and operate a program for the training of physicians teaching in community-based settings;
(E) to provide financial assistance in the form of traineeships and fellowships to physicians who are participants in any such programs and who plan to teach or conduct research in a family medicine, general internal medicine, or general pediatrics training program;
(F) to plan, develop, and operate a physician assistant education program, and for the training of individuals who will teach in programs to provide such training;
(G) to plan, develop, and operate a program that identifies or develops innovative models of providing care, and trains primary care physicians on such models and in new competencies, as recommended by the Advisory Committee on Training in Primary Care Medicine and Dentistry and the National Health Care Workforce Commission established in
(i) providing training to primary care physicians relevant to providing care through patient-centered medical homes (as defined by the Secretary for purposes of this section);
(ii) developing tools and curricula relevant to patient-centered medical homes; and
(iii) providing continuing education to primary care physicians relevant to patient-centered medical homes; and
(H) to plan, develop, and operate joint degree programs to provide interdisciplinary and interprofessional graduate training in public health and other health professions to provide training in environmental health, infectious disease control, disease prevention and health promotion, epidemiological studies and injury control.
(2) Duration of awards
The period during which payments are made to an entity from an award of a grant or contract under this subsection shall be 5 years.
(3) Priorities in making awards
In awarding grants or contracts under paragraph (1), the Secretary may give priority to qualified applicants that train residents in rural areas, including for Tribes or Tribal Organizations in such areas.
(b) Capacity building in primary care
(1) In general
The Secretary may make grants to or enter into contracts with accredited schools of medicine or osteopathic medicine to establish, maintain, or improve—
(A) academic units or programs that improve clinical teaching and research in fields defined in subsection (a)(1)(A); or
(B) programs that integrate academic administrative units in fields defined in subsection (a)(1)(A) to enhance interdisciplinary recruitment, training, and faculty development.
(2) Preference in making awards under this subsection
In making awards of grants and contracts under paragraph (1), the Secretary shall give preference to any qualified applicant for such an award that agrees to expend the award for the purpose of—
(A) establishing academic units or programs in fields defined in subsection (a)(1)(A); or
(B) substantially expanding such units or programs.
(3) Priorities in making awards
In awarding grants or contracts under paragraph (1), the Secretary shall give priority to qualified applicants that—
(A) proposes 1 a collaborative project between academic administrative units of primary care;
(B) proposes 1 innovative approaches to clinical teaching using models of primary care, such as the patient centered medical home, team management of chronic disease, and interprofessional integrated models of health care that incorporate transitions in health care settings and integration physical and mental health provision;
(C) have a record of training the greatest percentage of providers, or that have demonstrated significant improvements in the percentage of providers trained, who enter and remain in primary care practice;
(D) have a record of training individuals who are from underrepresented minority groups or from a rural or disadvantaged background;
(E) provide training in the care of vulnerable populations such as children, older adults, homeless individuals, victims of abuse or trauma, individuals with mental health or substance use disorders, individuals with HIV/AIDS, and individuals with disabilities;
(F) establish formal relationships and submit joint applications with federally qualified health centers, rural health clinics, area health education centers, or clinics located in underserved areas or that serve underserved populations;
(G) teach trainees the skills to provide interprofessional, integrated care through collaboration among health professionals;
(H) provide training in enhanced communication with patients, evidence-based practice, chronic disease management, preventive care, health information technology, or other competencies as recommended by the Advisory Committee on Training in Primary Care Medicine and Dentistry and the National Health Care Workforce Commission established in
(I) provide training in cultural competency and health literacy.
(4) Duration of awards
The period during which payments are made to an entity from an award of a grant or contract under this subsection shall be 5 years.
(c) Authorization of appropriations
(1) In general
For purposes of carrying out this section (other than subsection (b)(1)(B)), there are authorized to be appropriated $48,924,000 for each of fiscal years 2021 through 2025.
(2) Training programs
Fifteen percent of the amount appropriated pursuant to paragraph (1) in each such fiscal year shall be allocated to the physician assistant training programs described in subsection (a)(1)(F), which prepare students for practice in primary care.
(3) Integrating academic administrative units
For purposes of carrying out subsection (b)(1)(B), there are authorized to be appropriated $750,000 for each of fiscal years 2010 through 2014.
(July 1, 1944, ch. 373, title VII, §747, as added
Editorial Notes
Codification
Prior Provisions
A prior section 293k, act July 1, 1944, ch. 373, title VII, §747, as added
A prior section 747 of act July 1, 1944, was classified to
Another prior section 747 of act July 1, 1944, was classified to
Amendments
2020—Subsec. (a)(1)(G).
Subsec. (a)(3).
Subsec. (b)(3)(E).
Subsec. (c)(1).
1 So in original. Probably should be "propose".
§293k–1. Training opportunities for direct care workers
(a) In general
The Secretary shall award grants to eligible entities to enable such entities to provide new training opportunities for direct care workers who are employed in long-term care settings such as nursing homes (as defined in
(b) Eligibility
To be eligible to receive a grant under this section, an entity shall—
(1) be an institution of higher education (as defined in
(A) is accredited by a nationally recognized accrediting agency or association listed under
(B) has established a public-private educational partnership with a nursing home or skilled nursing facility, agency or entity providing home and community based services to individuals with disabilities, or other long-term care provider; and
(2) submit to the Secretary an application at such time, in such manner, and containing such information as the Secretary may require.
(c) Use of funds
An eligible entity shall use amounts awarded under a grant under this section to provide assistance to eligible individuals to offset the cost of tuition and required fees for enrollment in academic programs provided by such entity.
(d) Eligible individual
(1) Eligibility
To be eligible for assistance under this section, an individual shall be enrolled in courses provided by a grantee under this subsection and maintain satisfactory academic progress in such courses.
(2) Condition of assistance
As a condition of receiving assistance under this section, an individual shall agree that, following completion of the assistance period, the individual will work in the field of geriatrics, disability services, long term services and supports, or chronic care management for a minimum of 2 years under guidelines set by the Secretary.
(e) Authorization of appropriations
There is authorized to be appropriated to carry out this section, $10,000,000 for the period of fiscal years 2011 through 2013.
(July 1, 1944, ch. 373, title VII, §747A, as added
§293k–2. Training in general, pediatric, and public health dentistry
(a) Support and development of dental training programs
(1) In general
The Secretary may make grants to, or enter into contracts with, a school of dentistry, public or nonprofit private hospital, or a public or private nonprofit entity which the Secretary has determined is capable of carrying out such grant or contract—
(A) to plan, develop, and operate, or participate in, an approved professional training program in the field of general dentistry, pediatric dentistry, or public health dentistry for dental students, residents, practicing dentists, dental hygienists, or other approved primary care dental trainees, that emphasizes training for general, pediatric, or public health dentistry;
(B) to provide financial assistance to dental students, residents, practicing dentists, and dental hygiene students who are in need thereof, who are participants in any such program, and who plan to work in the practice of general, pediatric, public heath dentistry, or dental hygiene;
(C) to plan, develop, and operate a program for the training of oral health care providers who plan to teach in general, pediatric, public health dentistry, or dental hygiene;
(D) to provide financial assistance in the form of traineeships and fellowships to dentists who plan to teach or are teaching in general, pediatric, or public health dentistry;
(E) to meet the costs of projects to establish, maintain, or improve dental faculty development programs in primary care (which may be departments, divisions or other units);
(F) to meet the costs of projects to establish, maintain, or improve predoctoral and postdoctoral training in primary care programs;
(G) to create a loan repayment program for faculty in dental programs; and
(H) to provide technical assistance to pediatric training programs in developing and implementing instruction regarding the oral health status, dental care needs, and risk-based clinical disease management of all pediatric populations with an emphasis on underserved children.
(2) Faculty loan repayment
(A) In general
A grant or contract under subsection (a)(1)(G) may be awarded to a program of general, pediatric, or public health dentistry described in such subsection to plan, develop, and operate a loan repayment program under which—
(i) individuals agree to serve full-time as faculty members; and
(ii) the program of general, pediatric or public health dentistry agrees to pay the principal and interest on the outstanding student loans of the individuals.
(B) Manner of payments
With respect to the payments described in subparagraph (A)(ii), upon completion by an individual of each of the first, second, third, fourth, and fifth years of service, the program shall pay an amount equal to 10, 15, 20, 25, and 30 percent, respectively, of the individual's student loan balance as calculated based on principal and interest owed at the initiation of the agreement.
(b) Eligible entity
For purposes of this subsection, entities eligible for such grants or contracts in general, pediatric, or public health dentistry shall include entities that have programs in dental or dental hygiene schools, or approved residency or advanced education programs in the practice of general, pediatric, or public health dentistry. Eligible entities may partner with schools of public health to permit the education of dental students, residents, and dental hygiene students for a master's year in public health at a school of public health.
(c) Priorities in making awards
With respect to training provided for under this section, the Secretary shall give priority in awarding grants or contracts to the following:
(1) Qualified applicants that propose collaborative projects between departments of primary care medicine and departments of general, pediatric, or public health dentistry.
(2) Qualified applicants that have a record of training the greatest percentage of providers, or that have demonstrated significant improvements in the percentage of providers, who enter and remain in general, pediatric, or public health dentistry.
(3) Qualified applicants that have a record of training individuals who are from a rural or disadvantaged background, or from underrepresented minorities.
(4) Qualified applicants that establish formal relationships with Federally qualified health centers, rural health centers, or accredited teaching facilities and that conduct training of students, residents, fellows, or faculty at the center or facility.
(5) Qualified applicants that conduct teaching programs targeting vulnerable populations such as older adults, homeless individuals, victims of abuse or trauma, individuals with mental health or substance use disorders, individuals with disabilities, and individuals with HIV/AIDS, and in the risk-based clinical disease management of all populations.
(6) Qualified applicants that include educational activities in cultural competency and health literacy.
(7) Qualified applicants that have a high rate for placing graduates in practice settings that serve underserved areas or health disparity populations, or who achieve a significant increase in the rate of placing graduates in such settings.
(8) Qualified applicants that intend to establish a special populations oral health care education center or training program for the didactic and clinical education of dentists, dental health professionals, and dental hygienists who plan to teach oral health care for people with developmental disabilities, cognitive impairment, complex medical problems, significant physical limitations, and vulnerable elderly.
(d) Application
An eligible entity desiring a grant under this section shall submit to the Secretary an application at such time, in such manner, and containing such information as the Secretary may require.
(e) Duration of award
The period during which payments are made to an entity from an award of a grant or contract under subsection (a) shall be 5 years. The provision of such payments shall be subject to annual approval by the Secretary and subject to the availability of appropriations for the fiscal year involved to make the payments.
(f) Authorizations of appropriations
For the purpose of carrying out subsections (a) and (b), there is authorized to be appropriated $28,531,000 for each of fiscal years 2021 through 2025.
(g) Carryover funds
An entity that receives an award under this section may carry over funds from 1 fiscal year to another without obtaining approval from the Secretary. In no case may any funds be carried over pursuant to the preceding sentence for more than 3 years.
(July 1, 1944, ch. 373, title VII, §748, as added
Editorial Notes
Prior Provisions
A prior section 748 of act July 1, 1944, was renumbered section 749 and is classified to
Another prior section 748 of act July 1, 1944, was classified to
Another prior section 748 of act July 1, 1944, was classified to
Amendments
2020—Subsec. (c)(5).
Subsec. (f).
§293l. Advisory Committee on Training in Primary Care Medicine and Dentistry
(a) Establishment
The Secretary shall establish an advisory committee to be known as the Advisory Committee on Training in Primary Care Medicine and Dentistry (in this section referred to as the "Advisory Committee").
(b) Composition
(1) In general
The Secretary shall determine the appropriate number of individuals to serve on the Advisory Committee. Such individuals shall not be officers or employees of the Federal Government.
(2) Appointment
Not later than 90 days after November 13, 1998, the Secretary shall appoint the members of the Advisory Committee from among individuals who are health professionals. In making such appointments, the Secretary shall ensure a fair balance between the health professions, that at least 75 percent of the members of the Advisory Committee are health professionals, a broad geographic representation of members and a balance between urban and rural members. Members shall be appointed based on their competence, interest, and knowledge of the mission of the profession involved.
(3) Minority representation
In appointing the members of the Advisory Committee under paragraph (2), the Secretary shall ensure the adequate representation of women and minorities.
(c) Terms
(1) In general
A member of the Advisory Committee shall be appointed for a term of 3 years, except that of the members first appointed—
(A) 1/3 of such members shall serve for a term of 1 year;
(B) 1/3 of such members shall serve for a term of 2 years; and
(C) 1/3 of such members shall serve for a term of 3 years.
(2) Vacancies
(A) In general
A vacancy on the Advisory Committee shall be filled in the manner in which the original appointment was made and shall be subject to any conditions which applied with respect to the original appointment.
(B) Filling unexpired term
An individual chosen to fill a vacancy shall be appointed for the unexpired term of the member replaced.
(d) Duties
The Advisory Committee shall—
(1) provide advice and recommendations to the Secretary concerning policy and program development and other matters of significance concerning the activities under
(2) not later than 3 years after November 13, 1998, and annually thereafter, prepare and submit to the Secretary, and the Committee on Health, Education, Labor, and Pensions of the Senate, and the Committee on Energy and Commerce of the House of Representatives, a report describing the activities of the Committee, including findings and recommendations made by the Committee concerning the activities under
(3) develop, publish, and implement performance measures for programs under this part;
(4) develop and publish guidelines for longitudinal evaluations (as described in
(5) recommend appropriation levels for programs under this part.
(e) Meetings and documents
(1) Meetings
The Advisory Committee shall meet not less than 2 times each year. Such meetings shall be held jointly with other related entities established under this subchapter where appropriate.
(2) Documents
Not later than 14 days prior to the convening of a meeting under paragraph (1), the Advisory Committee shall prepare and make available an agenda of the matters to be considered by the Advisory Committee at such meeting. At any such meeting, the Advisory Council 1 shall distribute materials with respect to the issues to be addressed at the meeting. Not later than 30 days after the adjourning of such a meeting, the Advisory Committee shall prepare and make available a summary of the meeting and any actions taken by the Committee based upon the meeting.
(f) Compensation and expenses
(1) Compensation
Each member of the Advisory Committee shall be compensated at a rate equal to the daily equivalent of the annual rate of basic pay prescribed for level IV of the Executive Schedule under
(2) Expenses
The members of the Advisory Committee shall be allowed travel expenses, including per diem in lieu of subsistence, at rates authorized for employees of agencies under subchapter I of
(g) Chapter 10 of title 5
(July 1, 1944, ch. 373, title VII, §749, formerly §748, as added
Editorial Notes
Codification
November 13, 1998, referred to in subsec. (b)(2), was in the original "the date of enactment of this Act", which was translated as meaning the date of enactment of
Prior Provisions
A prior section 293l, act July 1, 1944, ch. 373, title VII, §748, as added
A prior section 749 of act July 1, 1944, was classified to
Another prior section 749 of act July 1, 1944, was classified to
Amendments
2022—Subsec. (g).
2020—Subsec. (d)(2).
2010—Subsec. (d)(3) to (5).
Statutory Notes and Related Subsidiaries
Termination of Advisory Committees
1 So in original. Probably should be "Committee".
§293l–1. Teaching health centers development grants
(a) Program authorized
The Secretary may award grants under this section to teaching health centers for the purpose of establishing new accredited or expanded primary care residency programs.
(b) Amount and duration
Grants awarded under this section shall be for a term of not more than 3 years and the maximum award may not be more than $500,000.
(c) Use of funds
Amounts provided under a grant under this section shall be used to cover the costs of—
(1) establishing or expanding a primary care residency training program described in subsection (a), including costs associated with—
(A) curriculum development;
(B) recruitment, training and retention of residents and faculty: 1
(C) accreditation by the Accreditation Council for Graduate Medical Education (ACGME), the American Dental Association (ADA), or the American Osteopathic Association (AOA); and
(D) faculty salaries during the development phase; and
(2) technical assistance provided by an eligible entity.
(d) Application
A teaching health center seeking a grant under this section shall submit an application to the Secretary at such time, in such manner, and containing such information as the Secretary may require.
(e) Preference for certain applications
In selecting recipients for grants under this section, the Secretary shall give preference to any such application that documents an existing affiliation agreement with an area health education center program as defined in
(f) Definitions
In this section:
(1) Eligible entity
The term "eligible entity" means an organization capable of providing technical assistance including an area health education center program as defined in
(2) Primary care residency program
The term "primary care residency program" means an approved graduate medical residency training program (as defined in
(3) Teaching health center
(A) In general
The term "teaching health center" means an entity that—
(i) is a community based, ambulatory patient care center; and
(ii) operates a primary care residency program.
(B) Inclusion of certain entities
Such term includes the following:
(i) A Federally qualified health center (as defined in
(ii) A community mental health center (as defined in
(iii) A rural health clinic, as defined in
(iv) A health center operated by the Indian Health Service, an Indian tribe or tribal organization, or an urban Indian organization (as defined in
(v) An entity receiving funds under subchapter VIII.
(g) Authorization of appropriations
There is authorized to be appropriated, $25,000,000 for fiscal year 2010, $50,000,000 for fiscal year 2011, $50,000,000 for fiscal year 2012, and such sums as may be necessary for each fiscal year thereafter to carry out this section. Not to exceed $5,000,000 annually may be used for technical assistance program grants.
(July 1, 1944, ch. 373, title VII, §749A, as added
1 So in original. The colon probably should be a semicolon.
subpart 2—training in underserved communities
§293m. Rural physician training grants
(a) In general
The Secretary, acting through the Administrator of the Health Resources and Services Administration, shall establish a grant program for the purposes of assisting eligible entities in recruiting students most likely to practice medicine in underserved rural communities, providing rural-focused training and experience, and increasing the number of recent allopathic and osteopathic medical school graduates who practice in underserved rural communities.
(b) Eligible entities
In order to be eligible to receive a grant under this section, an entity shall—
(1) be a school of allopathic or osteopathic medicine accredited by a nationally recognized accrediting agency or association approved by the Secretary for this purpose, or any combination or consortium of such schools; and
(2) submit an application to the Secretary that includes a certification that such entity will use amounts provided to the institution as described in subsection (d)(1).
(c) Priority
In awarding grant funds under this section, the Secretary shall give priority to eligible entities that—
(1) demonstrate a record of successfully training students, as determined by the Secretary, who practice medicine in underserved rural communities;
(2) demonstrate that an existing academic program of the eligible entity produces a high percentage, as determined by the Secretary, of graduates from such program who practice medicine in underserved rural communities;
(3) demonstrate rural community institutional partnerships, through such mechanisms as matching or contributory funding, documented in-kind services for implementation, or existence of training partners with interprofessional expertise in community health center training locations or other similar facilities; or
(4) submit, as part of the application of the entity under subsection (b), a plan for the long-term tracking of where the graduates of such entity practice medicine.
(d) Use of funds
(1) Establishment
An eligible entity receiving a grant under this section shall use the funds made available under such grant to establish, improve, or expand a rural-focused training program (referred to in this section as the "Program") meeting the requirements described in this subsection and to carry out such program.
(2) Structure of Program
An eligible entity shall—
(A) enroll no fewer than 10 students per class year into the Program; and
(B) develop criteria for admission to the Program that gives priority to students—
(i) who have originated from or lived for a period of 2 or more years in an underserved rural community; and
(ii) who express a commitment to practice medicine in an underserved rural community.
(3) Curricula
The Program shall require students to enroll in didactic coursework and clinical experience particularly applicable to medical practice in underserved rural communities, including—
(A) clinical rotations in underserved rural communities, and in applicable specialties, or other coursework or clinical experience deemed appropriate by the Secretary; and
(B) in addition to core school curricula, additional coursework or training experiences focused on medical issues prevalent in underserved rural communities.
(4) Residency placement assistance
Where available, the Program shall assist all students of the Program in obtaining clinical training experiences in locations with postgraduate programs offering residency training opportunities in underserved rural communities, or in local residency training programs that support and train physicians to practice in underserved rural communities.
(5) Program student cohort support
The Program shall provide and require all students of the Program to participate in group activities designed to further develop, maintain, and reinforce the original commitment of such students to practice in an underserved rural community.
(e) Annual reporting
An eligible entity receiving a grant under this section shall submit an annual report to the Secretary on the success of the Program, based on criteria the Secretary determines appropriate, including the residency program selection of graduating students who participated in the Program.
(f) Regulations
Not later than 60 days after March 23, 2010, the Secretary shall by regulation define "underserved rural community" for purposes of this section.
(g) Supplement not supplant
Any eligible entity receiving funds under this section shall use such funds to supplement, not supplant, any other Federal, State, and local funds that would otherwise be expended by such entity to carry out the activities described in this section.
(h) Maintenance of effort
With respect to activities for which funds awarded under this section are to be expended, the entity shall agree to maintain expenditures of non-Federal amounts for such activities at a level that is not less than the level of such expenditures maintained by the entity for the fiscal year preceding the fiscal year for which the entity receives a grant under this section.
(i) Authorization of appropriations
There are authorized to be appropriated $4,000,000 for each of the fiscal years 2010 through 2013.
(July 1, 1944, ch. 373, title VII, §749B, as added
Editorial Notes
Prior Provisions
A prior section 293m, act July 1, 1944, ch. 373, title VII, §749, as added
§§293n to 293p. Repealed. Pub. L. 105–392, title I, §102(4), Nov. 13, 1998, 112 Stat. 3539
Section 293n, act July 1, 1944, ch. 373, title VII, §750, as added
Section 293o, act July 1, 1944, ch. 373, title VII, §751, as added
Section 293p, act July 1, 1944, ch. 373, title VII, §752, as added