To amend the Public Health Service Act to establish a scholarship and loan repayment program for public health preparedness workforce development to eliminate critical public health preparedness workforce shortages in Federal, State, local, and tribal public health agencies.

March 3, 2005

Mr. HAGEL (for himself, Mr. DURBIN, Ms. CANTWELL, Mr. LAUTENBERG, and Mrs. MURRAY) introduced the following bill; which was read twice and referred to the Committee on Health, Education, Labor, and Pensions

To amend the Public Health Service Act to establish a scholarship and loan repayment program for public health preparedness workforce development to eliminate critical public health preparedness workforce shortages in Federal, State, local, and tribal public health agencies.

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

SECTION 1. SHORT TITLE.

This Act may be cited as the `Public Health Preparedness Workforce Development Act of 2005'.

SEC. 2. FINDINGS.

Congress makes the following findings:

(1) The ability of the public health system to prevent, respond to, and recover from bioterrorism or acute outbreaks of infectious diseases and other health threats and emergencies depends upon the existence of adequate numbers of well-trained public health professionals in Federal, State, local, and tribal public health departments. The public health system has an aging staff nearing retirement with no clear pipeline of highly-skilled and capable employees to fill the void. The average age of the State public health workforce is 47, 7 years older than the average age of the nation's workforce. More than 50 percent of the States cite the lack of qualified individuals or individuals willing to relocate as being a major barrier to preparedness.

(2) The National Association of State Personnel Executives reports that State governments could lose more than 30 percent of their workforce to retirement, private-sector employers, and alternative careers by 2006. The rates for State public health departments are as high as 45 percent.

(3) The ratio of public health workers to the population has dropped from 219 per 100,000 in 1980 to 158 per 100,000 in 2000.

(4) Approximately 42 percent of the current epidemiology workforce in State and territorial health departments lacks formal academic training in epidemiology.

(5) Thirteen State public health laboratories are without doctoral-level molecular scientists on staff, 23 have only one, and only 15 States have any staff redundancy at this level.

(6) Public health nurses comprise the largest segment of the public health workforce. The leaders of State public health nursing average more than 30 years service and are very close to retirement. In one State nearly 40 percent of the public health nursing workforce is eligible for retirement today.

(7) Nearly half of the Federal employees in occupations critical to United States biodefense will be eligible to retire within the next 5 years. The high number of employees nearing retirement is accompanied by alarmingly small numbers of younger employees doing biodefense work for the Federal government.

(8) The Partnership for Public Service reports that in the field of microbiology, there are four times as many employees over age 40 as under age 40 at the Centers for Disease Control and Prevention. Among employees with medical backgrounds at the Centers for Disease Control and Prevention and the Food and Drug Administration, there are more than twice as many employees over 40 years of age as under 40.

(9) Bureau of Labor Statistics data project that the demand for physicians and related occupations is expected to be 26 percent greater in 2012 than 2002, but the number of medical professionals entering the labor market has remained generally constant over the last 20 years.

SEC. 3. PUBLIC HEALTH WORKFORCE SCHOLARSHIP AND LOAN REPAYMENT PROGRAM.

Part E of title VII of the Public Health Service Act (42 U.S.C. 294n et seq.) is amended by adding at the end the following:

`Subpart 3--Public Health Workforce Scholarship and Loan Repayment Program

`SEC. 780. PUBLIC HEALTH WORKFORCE SCHOLARSHIP PROGRAM.

`(a) ESTABLISHMENT- The Secretary shall establish the Public Health Workforce Scholarship Program (referred to in this section as the `Program') to assure an adequate supply of public health professionals to eliminate critical public health preparedness workforce shortages in Federal, State, local, and tribal public health agencies.

`(b) ELIGIBILITY- To be eligible to participate in the Program, an individual shall--

`(1) be accepted for enrollment, or be enrolled, as a full-time student--

`(A) in an accredited (as determined by the Secretary) educational institution in a State or territory; and

`(B) in a course of study or program, offered by such institution and approved by the Secretary, leading to a health professions degree (graduate, undergraduate, or associate) or certificate, which may include laboratory sciences, epidemiology, environmental health, health communications, health education and behavioral sciences, information sciences, or public administration;

`(2) be a United States citizen;

`(3) submit an application to the Secretary to participate in the Program; and

`(4) sign and submit to the Secretary, at the time of the submittal of such application, a written contract (described in subsection (d)) to serve, upon the completion of the course of study or program

involved, for the applicable period of obligated service in the full-time employment of a Federal, State, local, or tribal public health agency.

`(c) DISSEMINATION OF INFORMATION-

`(1) APPLICATION AND CONTRACT FORMS- The Secretary shall disseminate application forms and contract forms to individuals desiring to participate in the Program. The Secretary shall include with such forms--

`(A) a fair summary of the rights and liabilities of an individual whose application is approved (and whose contract is accepted) by the Secretary, including in the summary a clear explanation of the damages to which the United States is entitled to recover in the case of the individual's breach of the contract; and

`(B) information relating to the service obligation and such other information as may be necessary for the individual to understand the individual's prospective participation in the Program.

`(2) INFORMATION FOR SCHOOLS- The Secretary shall distribute to health professions schools and other appropriate accredited academic institutions and relevant Federal, State, local, and tribal public health agencies, materials providing information on the Program and shall encourage such schools, institutions, and agencies to disseminate such materials to potentially eligible students.

`(3) UNDERSTANDABILITY AND TIMING- The application form, contract form, and all other information furnished by the Secretary under this section shall--

`(A) be written in a manner calculated to be understood by the average individual applying to participate in the Program; and

`(B) be made available by the Secretary on a date sufficiently early to ensure that such individuals have adequate time to carefully review and evaluate such forms and information.

`(d) CONTRACT- The written contract (referred to in this section) between the Secretary and an individual shall contain--

`(1) an agreement on the part of the Secretary that the Secretary will provide the individual with a scholarship for a period of years (not to exceed 4 academic years) during which the individual shall pursue an approved course of study or program to prepare the individual to serve in the public health workforce;

`(2) an agreement on the part of the individual that the individual will--

`(A) maintain full-time enrollment in the approved course of study or program described in subsection (b)(1) until the individual completes that course of study or program;

`(B) while enrolled in the course of study or program, maintain an acceptable level of academic standing (as determined under regulations of the Secretary by the educational institution offering such course of study or program); and

`(C) immediately upon graduation, serve in the full-time employment of a Federal, State, local, or tribal public health agency in a position related to the course of study or program for which the contract was awarded for a period of time (referred to in this section as the `period of obligated service') equal to the greater of--

`(i) 1 year for each academic year for which the individual was provided a scholarship under the Program; or

`(ii) 2 years;

`(3) an agreement by both parties as to the nature and extent of the scholarship assistance, which may include--

`(A) payment of the tuition expenses of the individual;

`(B) payment of all other reasonable educational expenses of the individual including fees, books, equipment and laboratory expenses; and

`(C) payment of a stipend of not more than $1,200 per month for each month of the academic year involved (indexed to account for increases in the Consumer Price Index); and

`(4) a provision that any financial obligation of the United States arising out of a contract entered into under this section and any obligation of the individual which is conditioned thereon, is contingent upon funds being appropriated for scholarships under this section;

`(5) a statement of the damages to which the United States is entitled for the individual's breach of the contract; and

`(6) such other statements of the rights and liabilities of the Secretary and of the individual, not inconsistent with the provisions of this section.

`(e) POSTPONING OBLIGATED SERVICE- With respect to an individual receiving a degree or certificate from a school of medicine, public health, nursing, osteopathic medicine, dentistry, veterinary medicine, optometry, podiatry, pharmacy, psychology, or social work under a scholarship under the Program, the date of the initiation of the period of obligated service may be postponed, upon the submission by the individual of a petition for such postponement and approval by the Secretary, to the date on which the individual completes an approved internship, residency, or other relevant public health preparedness advanced training program.

`(f) ADMINISTRATIVE PROVISIONS-

`(1) CONTRACTS WITH INSTITUTIONS- The Secretary may contract with an educational institution in which a participant in the Program is enrolled, for the payment to the educational institution of the amounts of tuition and other reasonable educational expenses described in subsection (d)(3).

`(2) EMPLOYMENT CEILINGS- Notwithstanding any other provision of law, individuals who have entered into written contracts with the Secretary under this section, while undergoing academic training, shall not be counted against any employment ceiling affecting the Department or any other Federal agency.

`(g) BREACH OF CONTRACT- An individual who fails to comply with the contract entered into under subsection (d) shall be subject to the same financial penalties as provided for under section 338E for breaches of scholarship contracts under sections 338A.

`SEC. 781. PUBLIC HEALTH WORKFORCE LOAN REPAYMENT PROGRAM.

`(a) ESTABLISHMENT- The Secretary shall establish the Public Health Workforce Loan Repayment Program (referred to in this section as the `Program') to assure an adequate supply of public health professionals to eliminate critical public health preparedness workforce shortages in Federal, State, local, and tribal public health agencies.

`(b) ELIGIBILITY- To be eligible to participate in the Program, an individual shall--

`(1)(A) be accepted for enrollment, or be enrolled, as a full-time or part-time student in an accredited academic educational institution in a State or territory in the final year of a course of study or program offered by that institution leading to a health professions degree or certificate, which may include a degree (graduate, undergraduate, or associate) or certificate relating to laboratory sciences, epidemiology, environmental health, health communications, health education and behavioral sciences, information sciences, or public administration; or

`(B) have graduated, within 10 years, from an accredited educational institution in a State or territory and received a health professions degree (graduate, undergraduate, or associate) or certificate, which may include a degree (graduate, undergraduate, or associate) or certificate relating to laboratory sciences, epidemiology, environmental health, health communications, health education and behavioral sciences, information sciences, or public administration;

`(2)(A) in the case of an individual described in paragraph (1)(A), have accepted employment with a Federal, State, local, or tribal public health agency, as recognized by the Secretary, to commence upon graduation; or

`(B) in the case of an individual described in paragraph (1)(B), be employed by, or have accepted employment with, a Federal, State, local, or tribal public health agency, as recognized by the Secretary;

`(3) be a United States citizen;

`(4) submit an application to the Secretary to participate in the Program; and

`(5) sign and submit to the Secretary, at the time of the submittal of such application, a written contract (described in subsection (d)) to serve for the applicable period of obligated service in the full-time employment of a Federal, State, local, or tribal public health agency.

`(c) DISSEMINATION OF INFORMATION-

`(1) APPLICATION AND CONTRACT FORMS- The Secretary shall disseminate application forms and contract forms to individuals desiring to participate in the Program. The Secretary shall include with such forms--

`(A) a fair summary of the rights and liabilities of an individual whose application is approved (and whose contract is accepted) by the Secretary, including in the summary a clear explanation of the damages to which the United States is entitled to recover in the case of the individual's breach of the contract; and

`(B) information relating to the service obligation and such other information as may be necessary for the individual to understand the individual's prospective participation in the Program.

`(2) INFORMATION FOR SCHOOLS- The Secretary shall distribute to health professions schools and other appropriate accredited academic institutions and relevant Federal, State, local, and tribal public health agencies, materials providing information on the Program and shall encourage such schools, institutions, and agencies to disseminate such materials to potentially eligible students.

`(3) UNDERSTANDABILITY AND TIMING- The application form, contract form, and all other information furnished by the Secretary under this section shall--

`(A) be written in a manner calculated to be understood by the average individual applying to participate in the Program; and

`(B) be made available by the Secretary on a date sufficiently early to ensure that such individuals have adequate time to carefully review and evaluate such forms and information.

`(d) CONTRACT- The written contract (referred to in this section) between the Secretary and an individual shall contain--

`(1) an agreement on the part of the Secretary that the Secretary will repay on behalf of the individual loans incurred by the individual in the pursuit of the relevant public health preparedness workforce educational degree or certificate in accordance with the terms of the contract;

`(2) an agreement on the part of the individual that the individual will serve, immediately upon graduation in the case of an individual described in subsection (b)(1)(A) service, or in the case of an individual described in subsection (b)(1)(B) continue to serve, in the full-time employment of a Federal, State, local, or tribal public health agency in a position related to the course of study or program for which the contract was awarded for a period of time (referred to in this section as the `period of obligated service') equal to the greater of--

`(i) 3 years; or

`(ii) such longer period of time as determined appropriate by the Secretary and the individual;

`(3) an agreement, as appropriate, on the part of the individual to relocate for the entire period of obligated service to a political jurisdiction designated by the Secretary to be a priority service area in exchange for an additional loan repayment incentive amount that does not exceed 20 percent of the individual's eligible loan repayment award per academic year such that the total of the loan repayment and the incentive amount shall not exceed 1/3 of the eligible loan balance per year;

`(4) in the case of an individual described in subsection (b)(1)(A) who is in the final year of study and who has accepted employment with a Federal, State, local, or tribal public health agency upon graduation, an agreement on the part of the individual to complete the education or training, maintain an acceptable level of academic standing (as determined by the education institution offering the course of study or training), and agree to the period of obligated service;

`(5) a provision that any financial obligation of the United States arising out of a contract entered into under this section and any obligation of the individual that is conditioned thereon, is contingent on funds being appropriated for loan repayments under this section;

`(6) a statement of the damages to which the United States is entitled, under this section for the individual's breach of the contract; and

`(7) such other statements of the rights and liabilities of the Secretary and of the individual, not inconsistent with this section.

`(e) PAYMENTS-

`(1) IN GENERAL- A loan repayment provided for an individual under a written contract under the Program shall consist of payment, in accordance with paragraph (2), on behalf of the individual of the principal, interest, and related expenses on government and commercial loans received by the individual regarding the undergraduate or graduate education of the individual (or both), which loans were made for--

`(A) tuition expenses; or

`(B) all other reasonable educational expenses, including fees, books, and laboratory expenses, incurred by the individual.

`(2) Payments for years served-

`(A) IN GENERAL- For each year of obligated service that an individual contracts to serve under subsection (d) the Secretary may pay up to $35,000 on behalf of the individual for loans described in paragraph (1). With respect to participants under the Program whose total eligible loans are less than $105,000, the Secretary shall pay an amount that does not exceed 1/3 of the eligible loan balance for each year of obligated service of the individual.

`(B) REPAYMENT SCHEDULE- Any arrangement made by the Secretary for the making of loan repayments in accordance with this subsection shall provide that any repayments for a year of obligated service shall be made no later than the end of the fiscal year in which the individual completes such year of service.

`(3) TAX LIABILITY- For the purpose of providing reimbursements for tax liability resulting from payments under paragraph (2) on behalf of an individual--

`(A) the Secretary shall, in addition to such payments, make payments to the individual in an amount not to exceed 39 percent of the total amount of loan repayments made for the taxable year involved; and

`(B) may make such additional payments as the Secretary determines to be appropriate with respect to such purpose.

`(4) PAYMENT SCHEDULE- The Secretary may enter into an agreement with the holder of any loan for which payments are made under the Program to establish a schedule for the making of such payments.

`(f) POSTPONING OBLIGATED SERVICE- With respect to an individual receiving a degree or certificate from a school of medicine, public health, nursing, osteopathic medicine, dentistry, veterinary medicine, optometry, podiatry, pharmacy, psychology, or social work, the date of the initiation of the period of obligated service may be postponed, upon the submission by the individual of a petition for such postponement and approval by the Secretary, to the date on which the individual completes an approved internship, residency, or other relevant public health preparedness advanced training program.

`(g) ADMINISTRATIVE PROVISIONS-

`(1) HIRING PRIORITY- Notwithstanding any other provision of law, Federal, State, local, and tribal public health agencies may give hiring priority to any individual who has qualified for and is willing to execute a contract to participate in the Program.

`(2) EMPLOYMENT CEILINGS- Notwithstanding any other provision of law, individuals who have entered into written contracts with the Secretary under this section, who are serving as full-time employees of a State, local, or tribal public health agency, or who are in the last year of public

health workforce academic preparation, shall not be counted against any employment ceiling affecting the Department or any other Federal agency.

`(h) BREACH OF CONTRACT- An individual who fails to comply with the contract entered into under subsection (d) shall be subject to the same financial penalties as provided for under section 338E for breaches of loan repayment contracts under section 338B.

`SEC. 782. GRANTS FOR STATE AND LOCAL PROGRAMS.

`(a) IN GENERAL- For the purpose of operating State, local, and tribal public health workforce loan repayment programs, the Secretary shall award a grant to any public health agency that receives public health preparedness cooperative agreements, or other successor cooperative agreements, from the Department of Health and Human Services.

`(b) REQUIREMENTS- A State or local loan repayment program operated with a grant under subsection (a) shall incorporate all provisions of the Public Health Workforce Loan Repayment Program under section 781, including the ability to designate priority service areas within the relevant political jurisdiction.

`(c) ADMINISTRATION- The head of the State or local office that receives a grant under subsection (a) shall be responsible for contracting and operating the loan repayment program under the grant.

`(d) RULE OF CONSTRUCTION- Nothing in this section shall be construed to obligate or limit any State, local, or tribal government entity from implementing independent or supplemental public health workforce development programs within their borders.

`SEC. 783. CATALOGUE OF FEDERAL PUBLIC HEALTH WORKFORCE EMPLOYMENT OPPORTUNITIES.

`(a) IN GENERAL- The Director of the Office of Personnel Management, in cooperation with the Secretary, shall ensure that within the Office of Personnel Management's website, there is an on-line catalogue of public health workforce employment opportunities in the Federal Government.

`(b) REQUIREMENTS- To the extent practical, the catalogue described in subsection (a) shall include--

`(1) existing and projected job openings in the Federal public health workforce; and

`(2) a general discussion of the occupations that comprise the Federal public health workforce.

`(c) INFORMATION- The Secretary shall include a copy of the catalogue, or a prominent reference to the catalogue, in--

`(1) the information for schools provided under section 780(c)(2) and 781(c)(2); and

`(2) the application forms provided under sections 780(c)(1) and 781(c)(1).

`SEC. 784. AUTHORIZATION OF APPROPRIATIONS.

`(a) SCHOLARSHIP PROGRAM- For the purpose of carrying out section 780, there is authorized to be appropriated $35,000,000 for fiscal year 2006, and such sums as may be necessary for each of fiscal years 2007 through 2011.

`(b) LOAN REPAYMENT PROGRAMS-

`(1) IN GENERAL- For the purpose of carrying out sections 781 and 782, there is authorized to be appropriated $195,000,000 for fiscal year 2006, and such sums as may be necessary for each of fiscal years 2007 through 2011.

`(2) ALLOCATION- Not less than 80 percent of the amount appropriated under paragraph (1) in each fiscal year shall be made available to carry out section 782.

`SEC. 785. SEVERABILITY.

`If any provision of this subpart, or the application of such provision to any person or circumstance, is held to be unconstitutional, the remainder of this subpart and the application of the provisions of this subpart to any person or circumstance shall not be affected thereby.'.

END