0915-0337 - Section 331 of the PHS Act - Attachment A

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241

PUBLIC HEALTH SERVICE ACT

Sec. 331

(A) State, Tribal, and local agencies responsible for
Medicaid, public health, social services, mental health, and
substance use disorder treatment and services;
(B) health care providers who serve pregnant and
postpartum women; and
(C) community-based health organizations and health
workers, including providers of home visiting services and
individuals representing communities with disproportionately high rates of maternal mortality and severe maternal
morbidity, and including those representing racial and ethnic minority populations.
(2) TERMS.—
(A) PERIOD.—A grant awarded under subsection (a)
shall be made for a period of 5 years. Any supplemental
award made to a grantee under subsection (a) may be
made for a period of less than 5 years.
(B) PRIORITIES.—In awarding grants under subsection
(a), the Secretary shall—
(i) give priority to States, Indian Tribes, and Tribal organizations that have the highest rates of maternal mortality and severe maternal morbidity relative
to other such States, Indian Tribes, or Tribal organizations, respectively; and
(ii) shall consider health disparities related to maternal mortality and severe maternal morbidity, including such disparities associated with racial and
ethnic minority populations.
(C) EVALUATION.—The Secretary shall require grantees to evaluate the outcomes of the programs supported
under the grant.
(c) AUTHORIZATION OF APPROPRIATIONS.—There are authorized
to be appropriated to carry out this section $10,000,000 for each of
fiscal years 2023 through 2027.
Subpart II—National Health Service Corps Program
NATIONAL HEALTH SERVICE CORPS

SEC. 331. ø254d¿ (a)(1) For the purpose of eliminating health
manpower 38 shortages in health professional shortage areas, there
is established, within the Service, the National Health Service
Corps, which shall consist of—
(A) such officers of the Regular and Reserve Corps of the
Service as the Secretary may designate,
(B) such civilian employees of the United States as the
Secretary may appoint, and
(C) such other individuals who are not employees of the
United States.
(2) The Corps shall be utilized by the Secretary to provide primary health services in health professional shortage areas.
(3) For purposes of this subpart and subpart III:
38 So in law. Probably should be ‘‘health professional shortages’’. See section 401 of Public Law
101–597 (104 Stat. 3035).

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(A) The term ‘‘Corps’’ means the National Health Service
Corps.
(B) The term ‘‘Corps member’’ means each of the officers,
employees, and individuals of which the Corps consists pursuant to paragraph (1).
(C) The term ‘‘health professional shortage area’’ has the
meaning given such term in section 332(a).
(D) The term ‘‘primary health services’’ means health services regarding family medicine, internal medicine, pediatrics,
obstetrics and gynecology, dentistry, or mental health, that are
provided by physicians or other health professionals.
(E)(i) The term ‘‘behavioral and mental health professionals’’ means health service psychologists, licensed clinical
social workers, licensed professional counselors, marriage and
family therapists, psychiatric nurse specialists, and psychiatrists.
(ii) The term ‘‘graduate program of behavioral and mental
health’’ means a program that trains behavioral and mental
health professionals.
(b)(1) The Secretary may conduct at schools of medicine, osteopathic medicine, dentistry, and, as appropriate, nursing and other
schools of the health professions, including schools at which graduate programs of behavioral and mental health are offered, and at
entities which train allied health personnel, recruiting programs
for the Corps, the Scholarship Program, and the Loan Repayment
Program. Such recruiting programs shall include efforts to recruit
individuals who will serve in the Corps other than pursuant to obligated service under the Scholarship or Loan Repayment Program.
(2) In the case of physicians, dentists, behavioral and mental
health professionals, certified nurse midwives, certified nurse practitioners, and physician assistants who have an interest and a commitment to providing primary health care, the Secretary may establish fellowship programs to enable such health professionals to
gain exposure to and expertise in the delivery of primary health
services in health professional shortage areas. To the maximum extent practicable, the Secretary shall ensure that any such programs
are established in conjunction with accredited residency programs,
and other training programs, regarding such health professions.
(c)(1) The Secretary may reimburse an applicant for a position
in the Corps (including an individual considering entering into a
written agreement pursuant to section 338D) for the actual and
reasonable expenses incurred in traveling to and from the applicant’s place of residence to an eligible site to which the applicant
may be assigned under section 333 for the purpose of evaluating
such site with regard to being assigned at such site. The Secretary
may establish a maximum total amount that may be paid to an individual as reimbursement for such expenses.
(2) The Secretary may also reimburse the applicant for the actual and reasonable expenses incurred for the travel of 1 family
member to accompany the applicant to such site. The Secretary
may establish a maximum total amount that may be paid to an individual as reimbursement for such expenses.
(3) In the case of an individual who has entered into a contract
for obligated service under the Scholarship Program or under the
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Loan Repayment Program, the Secretary may reimburse such individual for all or part of the actual and reasonable expenses incurred in transporting the individual, the individual’s family, and
the family’s possessions to the site of the individual’s assignment
under section 333. The Secretary may establish a maximum total
amount that may be paid to an individual as reimbursement for
such expenses.
(d)(1) The Secretary may, under regulations promulgated by
the Secretary, adjust the monthly pay of each member of the Corps
(other than a member described in subsection (a)(1)(C)) who is directly engaged in the delivery of health services in a health professional shortage area as follows:
(A) During the first 36 months in which such a member is
so engaged in the delivery of health services, his monthly pay
may be increased by an amount which when added to the
member’s monthly pay and allowances will provide a monthly
income competitive with the average monthly income from a
practice of an individual who is a member of the profession of
the Corps member, who has equivalent training, and who has
been in practice for a period equivalent to the period during
which the Corps member has been in practice.
(B) During the period beginning upon the expiration of the
36 months referred to in subparagraph (A) and ending with the
month in which the member’s monthly pay and allowances are
equal to or exceed the monthly income he received for the last
of such 36 months, the member may receive in addition to his
monthly pay and allowances an amount which when added to
such monthly pay and allowances equals the monthly income
he received for such last month.
(C) For each month in which a member is directly engaged
in the delivery of health services in a health professional shortage area in accordance with an agreement with the Secretary
entered into under section 741(f)(1)(C), under which the Secretary is obligated to make payments in accordance with section 741(f)(2), the amount of any monthly increase under subparagraph (A) or (B) with respect to such member shall be decreased by an amount equal to one-twelfth of the amount
which the Secretary is obligated to pay upon the completion of
the year of practice in which such month occurs.
For purposes of subparagraphs (A) and (B), the term ‘‘monthly pay’’
includes special pay received under chapter 5 of title 37 of the
United States Code.
(2) In the case of a member of the Corps who is directly engaged in the delivery of health services in a health professional
shortage area in accordance with a service obligation incurred
under the Scholarship Program or the Loan Repayment Program,
the adjustment in pay authorized by paragraph (1) may be made
for such a member only upon satisfactory completion of such service obligation, and the first 36 months of such member’s being so
engaged in the delivery of health services shall, for purposes of
paragraph (1)(A), be deemed to begin upon such satisfactory completion.
(3) A member of the Corps described in subparagraph (C) of
subsection (a)(1) shall when assigned to an entity under section 333
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be subject to the personnel system of such entity, except that such
member shall receive during the period of assignment the income
that the member would receive if the member was a member of the
Corps described in subparagraph (B) of such subsection.
(e) Corps members assigned under section 333 to provide
health services in health professional shortage areas shall not be
counted against any employment ceiling affecting the Department.
(f) Sections 214 and 216 shall not apply to members of the National Health Service Corps during their period of obligated service
under the Scholarship Program or the Loan Repayment Program,
except when such members are Commissioned Corps officers who
entered into a contract with Secretary under section 338A or 338B
after December 31, 2006 and when the Secretary determines that
exercising the authority provided under section 214 or 216 with respect to any such officer to would not cause unreasonable disruption to health care services provided in the community in which
such officer is providing health care services.
(g)(1) The Secretary shall, by rule, prescribe conversion provisions applicable to any individual who, within a year after completion of service as a member of the Corps described in subsection
(a)(1)(C), becomes a commissioned officer in the Regular or Reserve
Corps of the Service.
(2) The rules prescribed under paragraph (1) shall provide that
in applying the appropriate provisions of this Act which relate to
retirement, any individual who becomes such an officer shall be entitled to have credit for any period of service as a member of the
Corps described in subsection (a)(1)(C).
(h) The Secretary shall ensure that adequate staff is provided
to the Service with respect to effectively administering the program
for the Corps.
(i)(1) In carrying out subpart III, the Secretary may, in accordance with this subsection, issue waivers to individuals who have
entered into a contract for obligated service under the Scholarship
Program or the Loan Repayment Program under which the individuals are authorized to satisfy the requirement of obligated service
through providing clinical practice that is half time.
(2) A waiver described in paragraph (1) may be provided by the
Secretary only if—
(A) the entity for which the service is to be performed—
(i) has been approved under section 333A for assignment of a Corps member; and
(ii) has requested in writing assignment of a health
professional who would serve half time;
(B) the Secretary has determined that assignment of a
health professional who would serve half time would be appropriate for the area where the entity is located;
(C) a Corps member who is required to perform obligated
service has agreed in writing to be assigned for half-time service to an entity described in subparagraph (A);
(D) the entity and the Corps member agree in writing that
the Corps member will perform half-time clinical practice;
(E) the Corps member agrees in writing to fulfill all of the
service obligations under section 338C through half-time clinical practice and either—
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(i) double the period of obligated service that would
otherwise be required; or
(ii) in the case of contracts entered into under section
338B, accept a minimum service obligation of 2 years with
an award amount equal to 50 percent of the amount that
would otherwise be payable for full-time service; and
(F) the Corps member agrees in writing that if the Corps
member begins providing half-time service but fails to begin or
complete the period of obligated service, the method stated in
338E(c) for determining the damages for breach of the individual’s written contract will be used after converting periods of
obligated service or of service performed into their full-time
equivalents.
(3) In evaluating waivers issued under paragraph (1), the Secretary shall examine the effect of multidisciplinary teams.
(j) For the purposes of this subpart and subpart III:
(1) The term ‘‘Department’’ means the Department of
Health and Human Services.
(2) The term ‘‘Loan Repayment Program’’ means the National Health Service Corps Loan Repayment Program established under section 338B.
(3) The term ‘‘Scholarship Program’’ means the National
Health Service Corps Scholarship Program established under
section 338A.
(4) The term ‘‘State’’ includes, in addition to the several
States, only the District of Columbia, the Commonwealth of
Puerto Rico, the Commonwealth of the Northern Mariana Islands, the Virgin Islands, Guam, American Samoa, and the
Trust Territory of the Pacific Islands.
(5) The terms ‘‘full time’’ and ‘‘full-time’’ mean a minimum
of 40 hours per week in a clinical practice, for a minimum of
45 weeks per year.
(6) The terms ‘‘half time’’ and ‘‘half-time’’ mean a minimum of 20 hours per week (not to exceed 39 hours per week)
in a clinical practice, for a minimum of 45 weeks per year.
DESIGNATION OF HEALTH PROFESSIONAL SHORTAGE AREAS

SEC. 332. ø254e¿ (a)(1) For purposes of this subpart the term
‘‘health professional shortage area’’ means (A) an area in an urban
or rural area (which need not conform to the geographic boundaries
of a political subdivision and which is a rational area for the delivery of health services) which the Secretary determines has a health
manpower shortage, (B) a population group which the Secretary determines has such a shortage, or (C) a public or nonprofit private
medical facility or other public facility which the Secretary determines has such a shortage. All Federally qualified health centers
and rural health clinics, as defined in section 1861(aa) of the Social
Security Act (42 U.S.C. 1395x(aa)), that meet the requirements of
section 334 shall be automatically designated as having such a
shortage. The Secretary shall not remove an area from the areas
determined to be health professional shortage areas under subparagraph (A) of the preceding sentence until the Secretary has afforded interested persons and groups in such area an opportunity
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