August 15, Congressional Requesters. Subject: Health Care Workforce: Federally Funded Training Programs in Fiscal Year 2012

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1 441 G St. N.W. Wshngton, DC August 15, 2013 Congressonl Requesters Sujet: Helth Cre Workfore: Federlly Funded Trnng s n Fsl Yer 2012 A well-trned nd dverse helth re workfore s essentl for provdng Amerns wth ess to qulty helth re serves. As prt of ensurng suffent supply of physns, nurses, dentsts, nd other dret re helth for the nton, the federl government supports helth re workfore trnng through vrous efforts. 1 These efforts nlude federl progrms tht dretly trn helth, wrd grnts or mke pyments to nsttutons trnng helth, nd provde fnnl ssstne to helth professonl students through stpends, sholrshps, lons, or lon remursement. For exmple, ttles VII nd VIII of the Pul Helth Serve At (PHSA) uthorze multple grnt nd fnnl ssstne progrms n order to nrese the supply, dversty, nd geogrph dstruton of prmry re provders nd nurses. 2 In ddton, prmrly through Medre pyments to tehng hosptls, the federl government s lso the lrgest supporter of grdute medl eduton (GME) postgrdute resdeny trnng progrms for physns nd others. More reently, the Ptent Proteton nd Affordle Cre At (PPACA) reuthorzed mny of the exstng PHSA workfore trnng progrms s well s estlshed severl new progrms med t mprovng nd dversfyng the helth re workfore. 3 To etter understnd the sope of the federl government s role n helth re workfore trnng, you sked us to provde nformton on federlly funded helth re workfore trnng progrms. Ths report dentfes federl progrms tht postseondry trnng nd eduton for dret re helth n fsl yer 2012, nludng nformton out progrm purpose, fundng, nd trgeted helth. To dentfy these federl progrms, we revewed reports y orgnztons tht hve exmned helth re workfore ssues, 4 revewed federl deprtment udgets, serhed the Ctlog of Federl Domest Assstne (CFDA), 5 revewed the Fsl Yer 2012 Budget of the Unted Sttes Government, nd revewed relevnt federl lws nd regultons. For federl deprtments dentfed s hvng t lest one helth re workfore trnng progrm, we dmnstered strutured request to dentfy ny ddtonl progrms nd otn nformton on eh progrm s purpose, uthorty, fundng olgtons, nd the numer of helth professonl 1 For the purposes of ths revew, dret re helth re those who delver lnl or rehlttve re to ptents, suh s llopth nd osteopth physns, nurses, dentsts, phrmsts, physn ssstnts, podtrsts, psyhologsts, nd physl or ouptonl therpsts U.S.C d. 3 Pu. L. No , 124 Stt. 119, (2010) s mended y the Helth Cre nd Eduton Reonlton At of 2010, Pu. L. No , 124 Stt Speflly, we revewed reports y the Congressonl Reserh Serve, the Insttute of Medne, nd the Medre Pyment Advsory Commsson. 5 The CFDA s government-wde ompendum of federl progrms tht provde ssstne or enefts to the Amern pul. Pge 1

2 trnees y progrm funds n fsl yer We lso revewed ddtonl progrm nformton from westes nd mterls, suh s udget justftons nd grnt nnounements, from genes wthn the deprtments tht dmnstered progrms. To ssess the rellty of the geny-provded nformton on fundng levels nd the numer of trnees y progrm funds, we sked offls questons out soure dt nd onduted follow-up ntervews s neessry. We determned tht the dt re suffently relle for our purposes. Our revew foused on federl progrms tht provded postseondry trnng or eduton for 7 dret re helth or the osts of suh trnng n fsl yer 2012, the most reently ompleted fsl yer t the tme of our revew, y dretly provdng or fundng one or more of the followng serves: 8 nstruton (e.g., degree progrms) or forml trnng opportuntes (e.g., nternshps) for helth professonl students; on-the-jo lnl trnng for postgrdute helth (e.g., resdenes); fnnl ssstne for helth professonl students or (e.g., stpends, sholrshps, lons, or repyment or nellton of edutonl lons); or ptent re-relted ontnung eduton for dret re helth f suh trnng ws the mn progrm serve provded. 9 We onduted ths performne udt from Mrh 2013 through August 2013 n ordne wth generlly epted government udtng stndrds. Those stndrds requre tht we pln nd perform the udt to otn suffent, pproprte evdene to provde resonle ss for our fndngs nd onlusons sed on our udt ojetves. We eleve tht the evdene otned provdes resonle ss for our fndngs sed on our udt ojetves. 6 s helth professonl trnees through rnge of serves wth dfferng osts; we therefore dd not thnk t pproprte to determne or ompre the fundng progrms provded per trnee. 7 We nluded progrms tht genes developed s dreted n sttute or ntted under the genes uthorzng legslton. A progrm s n orgnzed set of tvtes dreted towrd ommon purpose or gol tht n geny undertkes to rry out ts responsltes. GAO, A Glossry of Terms Used n the Federl Budget Proess, GAO SP (Wshngton, D.C.: Septemer 2005). For the purposes of ths report, to more ompletely desre helth re workfore trnng efforts, we ounted seprte tvtes tht were funded wthn n uthorzed progrm s ndvdul progrms when possle. Exeptons re noted n the report. 8 We exluded progrms wth prmry fous on trnng reserhers, helth dmnstrtors, or pul helth-relted professons euse they do not provde dret re to ptents; progrms tht dd not speflly trget enefts towrd dret re helth ; nd progrms foused on helth re workfore nlyss. 9 We exluded progrms f they ontnung eduton n ddton to other serves tht were otherwse unrelted to helth re workfore trnng euse t ws dffult to seprte ontnung eduton serves nd fundng from other progrm serves. Contnung eduton s forml or nforml trnng for estlshed helth n spef skll (e.g., spef proedure). Some ontnung eduton ourses wrd ontnung eduton redts needed for ertn helth to mntn lensure. Pge 2

3 Results n Bref In fsl yer 2012, we found tht four federl deprtments the Deprtment of Helth nd Humn Serves (HHS), Deprtment of Veterns Affrs (VA), Deprtment of Defense (DOD), nd Deprtment of Eduton (Eduton) dmnstered 91 progrms tht postseondry trnng or eduton speflly for dret re helth. The deprtments reported olgtng out $14.2 llon for these progrms n fsl yer 2012 wth the mjorty (78 perent) of fundng gong to progrms tht GME postgrdute resdeny trnng for physns nd ertn other helth. Bkground The U.S. helth re workfore nludes spetrum of helth requrng vryng levels of postseondry eduton nd trnng, rngng from dplom progrms to grdute degrees nd postgrdute trnng. 10 Some who delver dret helth re serves to ptents requre lnl trnng, suh s nternshps, resdenes, or fellowshps, through helth re nsttuton n ddton to ompletng grdute-level edutonl requrements efore eng elgle for full lensure. These nlude physns, ertn phrmsts, podtrsts, lnl psyhologsts, nd dentsts seekng dentl spelty. Tle 1 provdes the generl eduton levels for ommon helth tht provde dret lnl or rehlttve serves. Tle 1: Dret Cre Helth Professonls Eduton nd Trnng Helth professonl Audologst Chroprtors Dentl hygenst Dentst Medl ssstnt Nurse - dvned prte regstered nurse, whh nludes nurse prttoners, nurse mdwves, nurse nesthetsts, nd nurse spelsts Nurse - regstered nurse Nurse - lensed prtl nurse Ouptonl therpst Optometrst Phrmst Physl therpst Physn (nludng dotor of medne nd dotor of osteopthy) Physn ssstnt Podtrst Clnl psyhologst Clnl sol worker Typl eduton nd trnng Dotorl degree nd lnl externshp Dotorl or professonl degree Assote s, helor s, or mster s degree Dotorl or professonl degree nd optonl resdeny Assote s degree, dplom, or ertfte Mster s or dotorl degree Assote s or helor s degree, or dplom progrm Postseondry nondegree wrd Mster s degree Dotorl or professonl degree Dotorl or professonl degree nd optonl resdeny Mster s or dotorl degree nd optonl resdeny or fellowshp Dotorl degree nd nternshp nd or resdeny trnng wth possle fellowshp Mster s degree Dotorl degree nd resdeny Dotorl degree nd nternshp Mster s degree nd supervsed lnl experene Soure: GAO nlyss of nformton from the Bureu of Lor Sttsts nd professonl orgnztons. 10 Postseondry eduton s eduton or trnng eyond the hgh shool level. Pge 3

4 Four Deprtments Admnstered 91 s Tht Supported Helth Cre Workfore Trnng n Fsl Yer 2012 In fsl yer 2012, we found tht four federl deprtments dmnstered 91 progrms tht postseondry trnng or eduton speflly for dret re helth. All together, the four deprtments reported olgtng out $14.2 llon for helth re workfore trnng progrms n fsl yer 2012, wth HHS fundng the most progrms (69) nd hvng the lrgest perentge of totl reported fundng (82 perent). 11 Speflly, HHS reported out $11.7 llon n fundng for workfore trnng progrms n fsl yer 2012, VA reported out $1.7 llon n fundng for 12 progrms, DOD reported out $0.9 llon n fundng for 7 progrms, 12 nd Eduton reported out $2 mllon n fundng for 3 progrms n fsl yer (En. I provdes nformton on eh of the HHS-dmnstered helth re workfore trnng progrms, nludng progrm uthorty, purpose nd desrpton, trgeted helth, nd reported fundng n fsl yer 2012; en. II provdes smlr nformton on eh of the VA-dmnstered progrms; en. III provdes nformton on eh of the DOD-dmnstered progrms; nd en. IV provdes nformton on eh of the Edutondmnstered progrms.) In totl, ross ll four deprtments, the mjorty (78 perent) of federl fundng for helth re workfore trnng n fsl yer 2012 went to progrms tht GME (see fg. 1). Two progrms dmnstered y HHS s Centers for Medre & Medd Serves (CMS) Medre pyments to tehng hosptls nd other enttes for Dret Grdute Medl Eduton (DGME) nd Medre pyments to tehng hosptls for Indret Medl Eduton (IME) 13 ounted for out 66 perent of totl reported helth re workfore trnng fundng. CMS s Medd progrm lso mde pyments to tehng hosptls for GME nd the Helth Resoures nd Serves Admnstrton (HRSA), nother geny wthn HHS, dmnstered 2 progrms tht GME n settngs other thn tehng hosptls. 14 VA nd DOD lso GME n ther medl fltes; however, the fundng nformton VA provded to us ounted for resdent slres nd enefts, nd the fundng nformton provded y DOD ounted for only ertn dmnstrtve osts to operte ts GME. 11 GAO sked deprtment nd geny offls to provde olgtons, nludng those for whh expendtures hve een mde, for eh progrm n fsl yer The term olgton refers to defnte ommtment y federl geny tht retes legl llty to mke pyments mmedtely or n the future. Agenes nur olgtons, for exmple, when they wrd grnts or ontrts to prvte enttes. An expendture s the tul spendng of money y the ssune of heks, dsursement of sh, or eletron trnsfer of funds mde to lqudte federl olgton. See GAO SP. The totl reported olgtons do not nlude mounts olgted n pror yers tht were expended y grntees n fsl yer One of DOD s seven progrms represents multple lnl nd nstrutonl helth professons eduton progrms. For the purposes of ths report, we hrterzed them s sngle progrm euse DOD ould not provde onsstent progrm-level nformton. 13 For the purposes of ths revew, we onsdered Medre DGME pyments nd Medre IME pyments to e seprte progrms. Medre DGME pyments over the tehng osts of trnng resdents, suh s resdent stpends, dmnstrtve overhed, nd supervsory physn slres. Medre IME pyments support the hgher ptent re osts ssoted wth trnng resdents, suh s the orderng of more tests nd nresed use of emergng tehnologes. 14 Medd pyments for GME nd the two HRSA progrms the Chldren s Hosptls GME Pyment progrm nd the Tehng Helth Center GME Pyment progrm provded fundng for oth dret osts of resdent trnng, suh s resdent slres nd enefts, nd ndret fundng to reflet the hgher ptent re osts ssoted wth resdent eduton. Pge 4

5 Fgure 1: Proporton of Totl Reported Federl Fundng Olgted for Helth Cre Workfore Trnng y Grdute Medl Eduton (GME) nd Other s, Fsl Yer 2012 Note: Perentges do not dd to 100 euse of roundng. The remnng federl fundng for helth re workfore trnng went towrd 84 progrms tht provded fnnl ssstne to dret re helth professonl students nd, provded or nstruton or lnl trnng for dret re helth, or provded omnton of these nd other trnng support serves. Aross ll 84 progrms, trnees reeved dfferng levels of ssstne, rngng from prtpton n short-term ontnung eduton ourses to full support for tuton nd ooks nd stpend for lvng expenses. For exmple: Sxty of the 84 progrms provded fnnl ssstne to support helth or students of vryng kgrounds ether s the sole progrm serve or n onjunton wth other serves. Speflly, 18 progrms provded sholrshps for tuton nd other osts to students enrolled n helth professonl trnng progrm, nd 10 progrms provded lon remursements to helth wth vryng elglty rter. Mny of these progrms provded fnnl ssstne n exhnge for ommtment y the repent to serve or work n spef flty or loton. Other progrms tht provded fnnl ssstne nluded 4 low nterest lon progrms for vrous elgle helth professonl students, 1 lon progrm tht lso provded lon remursement, nd 27 progrms tht provded stpends or otherwse fnnlly students s they ompleted trnng. Pge 5

6 Ffty of the 84 progrms dretly provded trnng, nludng ontnung eduton trnng, to helth nd students or provded grnts to nsttutons to support suh trnng, develop trnng progrms, or omnton of serves. 15 For exmple, VA nd DOD funded nstrutonl nd lnl trnng progrms for vrety of helth n ther medl fltes. The 84 progrms trgeted vrous types of helth nd elgle ndvduls. Fortyseven of the 84 progrms trgeted support for students,, or fulty n multple helth professons, though 18 progrms exlusvely trgeted nurses, 8 progrms exlusvely trgeted physns or physn ssstnts, 6 progrms exlusvely trgeted dentsts or dentl hygensts, 4 progrms exlusvely trgeted ehvorl helth, nd 1 progrm 16 exlusvely trgeted physns nd dentsts. In ddton to trgetng ertn helth, 16 of the 84 progrms were speflly trgeted to nrese prtpton of underrepresented mnortes or fnnlly dsdvntged ndvduls n the helth re workfore. In ddton to trnng progrms tht speflly trgeted helth, we found tht Eduton dmnstered progrms tht provde generl edutonl support towrd the osts of degree-grntng progrms, ut these progrms dd not speflly trget dret re helth (en. IV provdes exmples of these ddtonl progrms). Ageny Comments nd Our Evluton We provded drft of ths report to offls from the Deprtments of Defense, Eduton, Helth nd Humn Serves, nd Veterns Affrs for ther revew nd omment. HHS nd VA provded tehnl omments, whh we norported s pproprte. The other deprtments hd no omments. As greed wth your offes, unless you pully nnoune the ontents of ths report erler, we pln no further dstruton untl 30 dys from the report dte. At tht tme, we wll send opes to the Seretry of Defense, the Seretry of Eduton, the Seretry of Helth nd Humn Serves, the Seretry of Veterns Affrs, nd other nterested prtes. In ddton, the report wll e vlle t no hrge on the GAO weste t 15 s tht ontnung eduton re dentfed n the progrm purpose nd desrpton n ens. I through IV, f pplle. 16 We nluded oth progrms tht solely trgeted dret re helth nd progrms tht trgeted dret re helth mong other f the progrm purpose or ojetves speflly dentfed dret re helth. Pge 6

7 If you or your stff hve ny questons out ths report, plese ontt me t (202) or kohnl@go.gov. Contt ponts for our Offes of Congressonl Reltons nd Pul Affrs my e found on the lst pge of ths report. GAO stff memers who mde key ontrutons to ths report nlude Mrtn T. Ghrt (Assstnt Dretor), Ree Ael, Krster Frdy, nd Jennfer Whtworth. Lnd T. Kohn Dretor, Helth Cre Enlosures 4 Pge 7

8 Lst of Requesters The Honorle Tom Courn, MD Rnkng Memer Commttee on Homelnd Seurty nd Governmentl Affrs Unted Sttes Sente The Honorle Mhel B. Enz Rnkng Memer Suommttee on Chldren nd Fmles Commttee on Helth, Eduton, Lor, nd Pensons Unted Sttes Sente The Honorle Rhrd Burr Rnkng Memer Suommttee on Prmry Helth nd Agng Commttee on Helth, Eduton, Lor, nd Pensons Unted Sttes Sente Pge 8

9 Enlosure I Deprtment of Helth nd Humn Serves (HHS) Helth Cre Workfore Trnng s Funded n Fsl Yer 2012 HHS reported olgtng out $11.7 llon for progrms tht postseondry trnng or eduton speflly for dret re helth n fsl yer Tle 2 desres eh of the 69 ndvdul progrms dmnstered y seven genes wthn HHS nd provdes nformton on the numer of trnees y eh progrm nd relted fundng olgtons n fsl yer Tle 2: Deprtment of Helth nd Humn Serves (HHS) Helth Cre Workfore Trnng s Tht Reeved Fundng n Fsl Yer (FY) 2012, y Ageny (Sttutory uthorty) Purpose nd desrpton Admnstrton for Chldren nd Fmles 1. Helth Professon Opportunty Grnts (42 U.S.C 1397g) Grnts to orgnztons, sttes, nd other enttes for the purpose of provdng eduton nd trnng to Temporry Assstne for Needy Fmles repents nd other low-nome ndvduls for ouptons n helth re felds tht py well nd re expeted to ether experene lor shortges or e n hgh demnd. Centers for Medre & Medd Serves (CMS) Medre Medre s the federlly fnned helth nsurne progrm for elderly nd ertn dsled ndvduls. Medre provdes fundng for grdute medl eduton (GME) resdeny progrms nd ertn nursng nd lled helth eduton. Trgeted helth Multple helth, suh s home helth des, nurses, nd nursng ssstnts Numer of trnees 10,327 prtpnts reeved trnng Olgtons (dollrs n mllons) $ The totl reported olgtons do not nlude mounts olgted n pror yers tht were expended y grntees n fsl yer For exmple, HHS s Helth Resoures nd Serves Admnstrton (HRSA), olgted funds n fsl yer 2010 for three yer udget perod for the Nurse Mnged Helth Clns progrm reted y the Ptent Proteton nd Affordle Cre At of 2010 (PPACA). 2 For the purposes of ths report, we onsdered seprte tvtes funded wthn n uthorzed progrm to e ndvdul progrms unless otherwse noted n the tle. Tle 2 does not nlude progrms tht were uthorzed for ut tht dd not reeve pproprtons to provde trnng serves n fsl yer For exmple, the Centers for Medre & Medd Serves (CMS) dmnstered Grdute Nurse Eduton Demonstrton, med t nresng the provson of trnng to dvned prte regstered nursng students; however, funds for the trnng spets of the progrm were not vlle untl fsl yer In ddton to the progrms n tle 2, CMS, HRSA, nd the Sustne Ause nd Mentl Helth Serves Admnstrton (SAMHSA) dentfed other progrms for whh olgtons were mde n fsl yer 2012 ut tht were outsde the sope of ths report. For exmple, HRSA dmnstered progrms med t pul helth workfore development, whh trgeted helth or provded trnng n sklls not dretly relted to ptent re. Pge 9

10 Enlosure I (Sttutory uthorty) 2. Medre Dret GME Pyments (DGME) (42 U.S.C. 1395ww(h), (k)) 3. Medre Indret Medl Eduton Pyments (IME) (42 U.S.C. 1395ww (d)(5)(b)) 4. Medre Pyments for Nursng nd Alled Helth Eduton (42 U.S.C. 1395x note; 1395x(v)(1)(A)) Purpose nd desrpton Medre pyments to tehng hosptls nd ertn ommunty-sed nsttutons to over the tehng osts, suh s resdent stpends nd supervsory physn slres, ssoted wth trnng resdents n redted resdeny progrms n llopth nd osteopth medne, s well s dentstry nd podtry. Pyments my nlude funds for trnng n nonhosptl settngs. Addtonl Medre pyments to tehng hosptls per Medre dshrge to support the hgher ptent re osts, suh s nresed use of emergng tehnologes, ssoted wth trnng resdents n redted resdeny progrms n llopth nd osteopth medne, s well s dentstry nd podtry. Pyments my nlude funds for trnng n nonhosptl settngs. Medre pyments outsde of GME pyments to hosptls tht operte pproved nursng nd lled helth eduton progrms to support Medre s shre of the osts of those progrms. To qulfy for nursng nd lled helth pyment, hosptls must operte the progrms n ther entrety. g 5. Medd Pyments for GME Medd pyments to tehng hosptls or s prt of ptton rtes under mnged re to ount for Medd s shre of GME. Helth Resoures nd Serves Admnstrton (HRSA) 6. Nurse Mnged Helth Clns (42 U.S.C ) 7. Rurl Helth Workfore Development (42 U.S.C. 254(f)) Grnts to nurse-mnged lns tht mprove ess to prmry re, enhne nursng prte y nresng the numer of lnl tehng stes for prmry re nd ommunty helth nursng students, nd develop eletron proesses for estlshng effetve ptent nd workfore dt olleton systems. Grnts to estlsh nd sustn rurl helth networks tht develop nnovtve ommunty-sed edutonl nd lnl helth trnng progrms to enourge the rerutment nd retenton of emergng helth (students nd resdents) n rurl ommuntes. Trgeted helth Physns, dentsts, nd podtrsts Physns, dentsts, nd podtrsts Nurses nd lled helth Physns, dentsts, nd podtrsts Numer of trnees 85,000 full-tme equvlent physn resdents; 3,000 dentl nd podtry resdents 77,000 full-tme equvlent physn resdents; 3,000 dentl nd podtry resdents Olgtons (dollrs n mllons) d $2, $6, f Not vlle $ f Not vlle $ Nurses (prmry re) 2,417 trnees Not pplle Physns nd other prmry re nd lled helth 1029 students; 82 physn resdents e h $3.993 j Pge 10

11 Enlosure I (Sttutory uthorty) Ntonl Helth Serve Corps (NHSC) 8. NHSC Lon Repyment (42 U.S.C. 254l-1) 9. NHSC Stte Lon Repyment (42 U.S.C. 254q-1) 10. NHSC Sholrshp (42 U.S.C. 254l) 11. NHSC Students to Serve Lon Repyment (42 U.S.C. 254l-1) 12. Ntve Hwn Helth Sholrshp (42 U.S.C. 254s, 11709) Purpose nd desrpton Provdes fnnl ssstne to rerut nd retn helth re provders to serve n nd meet the workfore needs of ommuntes desgnted s helth professonl shortge res (HPSA). The NHSC funded the followng tvtes n FY 2012 to ddress nd trget vrous spets of workfore development. We ounted eh tvty s seprte progrm. Lon repyment of up to $60,000 to prmry re medl, dentl, nd ehvorl helth provders n exhnge for 2 yers of full-tme serve or 4 yers of hlf-tme serve n n HPSA. Grnts to sttes to provde lon repyment ontrts to provders who prte n n HPSA n tht stte. The stte lon repyment serves s omplement to the NHSC nd provdes flexlty to sttes to ple provders n underserved res nd help meet ther unque prmry re workfore needs. Sholrshps to students pursung reers n prmry re, who upon ompletng ther trnng, re requred to dedte 2 to 4 yers of serve t NHSCpproved ste n hgh-need HPSA. Lon repyment of up to $120,000 to medl students n ther lst yer of shool who, upon ompleton of prmry re resdeny, must provde 3 yers of full-tme or 6 yers of hlf-tme prmry helth re serve n n NHSC-pproved ste n hgh-need HPSA. The progrm ws estlshed s plot n FY 2012 to enourge students to hoose prmry re resdeny. Sholrshps to ntve Hwn helth professonl students n exhnge for provdng serve fter grduton n medlly underserved re n the stte of Hw for mnmum of 2 yers to ddress the demnd for more helth re to delver qulty, ulturlly ompetent prmry helth serves to ntve Hwns. Trgeted helth Physns (prmry re), APRNs, physn ssstnts, dentsts, dentl hygensts, nd ehvorl helth provders Physns, nurses, physn ssstnts, dentsts, dentl hygensts, ehvorl helth provders, nd phrmsts Physns (prmry re), APRNs, physn ssstnts, nd dentsts Physns (prmry re) Multple helth, suh s physns, nurses, physn ssstnts, dentsts, ehvorl helth provders, nd phrmsts Numer of trnees 4,267 lon repyment repents 339 lon repyment repents 222 sholrshp repents 69 lon repyment repents 14 sholrshp repents Olgtons (dollrs n mllons) $ $ $ $8.830 $1.350 Pge 11

12 Enlosure I (Sttutory uthorty) 13. Chldren s Hosptls GME Pyment (42 U.S.C. 256e) 14. Grnts to Sttes to Support Orl Helth Workfore Atvtes (42 U.S.C. 256g) 15. Tehng Helth Centers GME Pyment (42 U.S.C. 256h) 16. Lons for Dsdvntged Students (42 U.S.C. 292q-292y) 17. Helth Professons Student Lons (42 U.S.C. 292q-292y) Purpose nd desrpton Pyments to freestndng hldren s hosptls tht sponsor resdeny progrms for prmry re physns nd physns wth pedtr medl nd surgl suspeltes n order to nrese the numer of those physns n the workfore. Pyments urrently nlude oth dret medl k eduton nd ndret medl eduton expenses. Grnts to sttes to develop nd mplement nnovtve progrms to ddress dentl workfore needs of desgnted dentl HPSAs. Sttes re uthorzed to use grnt funds for vrous tvtes, nludng lon forgveness nd repyment progrms for dentsts who gree to prte n dentl HPSAs; estlshment of dentl resdeny progrms; plement nd support of dentl students, dentl resdents nd dvned dentstry trnees; ontnung dentl eduton; nd estlshment of fulty rerutment progrms. Pyments to qulfed tehng helth enters ommunty-sed nsttutons tht sponsor resdeny progrms for prmry re physns nd dentsts n order to olster the prmry re workfore, nd mprove the dstruton of tht workfore nto outptent ommunty-sed re. Pyments nlude dret medl eduton nd ndret medl eduton expenses. Grnts to redted helth professons shools to provde low-nterest lons to helth professonl students from dsdvntged kgrounds enrolled n pproved helth professonl degree progrms n order to mprove rerutment nd retenton of the dsdvntged nd to nrese helth professons workfore dversty. Grnts to redted helth professons shools to provde low-nterest lons to helth professonl students n order to llevte the shortge of helth nd to ensure tht qulfed students re not dened helth professonl reer euse of lk of fnnl resoures. Trgeted helth Physns (prmry re or pedtr medl nd surgl suspelsts) Numer of trnees Olgtons (dollrs n mllons) 6,185 resdents $ Dentsts 386 trnees $ Physns (prmry re) nd dentsts (prmry re) Multple helth, suh s physns, dentsts, optometrsts, nd phrmsts Dentsts, optometrsts, phrmsts, nd podtrsts 63 resdents $ reeved lons $ ,017 reeved lons $4.261 l l Pge 12

13 Enlosure I (Sttutory uthorty) 18. Prmry Cre Lons (42 U.S.C. 292q-292y) 19. Centers of Exellene (42 U.S.C. 293) 20. Sholrshps for Dsdvntged Students (42 U.S.C. 293) 21. Fulty Lon Repyment (42 U.S.C. 293) Trgeted helth Purpose nd desrpton Grnts to medl shools to provde low-nterest Physns lons to full-tme medl students n exhnge for (prmry re) greement to trn nd prte s prmry re physns. Prtptng medl shools must meet ertn requrements regrdng prtpton of grdutes n prmry helth re prtes nd resdenes. Grnts to ertn helth professons shools to Physns, dentsts, support eduton nd trnng enhnement phrmsts, nd progrms tht nrese helth professons ehvorl helth opportuntes for underrepresented mnorty students nd fulty through tvtes, nludng: mprovng fulty development or retenton, edutonl ppelne development, developng mnorty helth urrul, provdng helth serves trnng to underrepresented mnorty ndvduls n ommunty-sed helth fltes, nd provdng stpends to students or fulty. Grnts to redted helth professons shools to Multple helth provde sholrshps to helth professonl students, suh s from dsdvntged kgrounds enrolled n hroprtors, dentsts, pproved helth professons degree progrms n nurses, physn order to nrese the dversty of the helth re ssstnts, phrmsts, workfore. physl nd ouptonl therpsts, nd podtrsts Repyment of up to $40,000 of edutonl lons to qulfed helth from dsdvntged kgrounds n exhnge for ommtment to serve s fulty t n pproved helth professons nsttuton for mnmum of 2 yers. The employng nsttuton must lso mke mthng lon pyments unless t fes undue fnnl hrdshp. Multple helth, suh s physns, podtrsts, dentsts, phrmsts, optometrsts, nurses, physn ssstnts, nd ehvorl helth Numer of trnees Olgtons (dollrs n mllons) 281 reeved lons l $ ,243 trnees (1,217 of whom reeved fnnl ssstne) 22,407 reeved sholrshps 20 lon repyment repents $ $ $1.230 Pge 13

14 Enlosure I (Sttutory uthorty) Prmry Cre Trnng nd Enhnement (42 U.S.C. 293k) 22. Adem Admnstrtve Unts n Prmry Cre 23. Physn Fulty Development n Prmry Cre 24. Pre-Dotorl Trnng n Prmry Cre 25. Physn Assstnt Trnng n Prmry Cre 26. Resdeny Trnng n Prmry Cre Purpose nd desrpton Grnts to hosptls, medl shools, demlly fflted physn ssstnt trnng progrms nd other enttes to mprove the qulty, quntty, dstruton, nd dversty of the prmry re workfore through urrulum enhnement nd trnng progrm expnson. The progrm sx tvtes n FY 2012 tht we ounted s ndvdul progrms: Funds the estlshment, mntenne, or mprovement of dem dmnstrtve unts tht provde lnl nstruton n fmly medne, generl nternl medne, generl pedtrs, or omnton of these dsplnes. Funds the plnnng, development, nd operton (nludng fnnl ssstne to trnees) of progrms tht trn physns to teh fmly medne (nludng gertrs), generl nternl medne, generl pedtrs, or omnton of these dsplnes. Funds the plnnng, development, operton, or prtpton (nludng fnnl ssstne to medl students) n predotorl progrms n fmly medne, generl nternl medne, generl pedtrs, or omnton of these dsplnes. Funds the plnnng, development, operton, nd mntenne of progrms tht trn physn ssstnts nd prepre fulty to trn physn ssstnts. The progrm lso nreses the numer of enrolled nd grduted physn ssstnts y provdng stpend support. Funds the plnnng, development, operton, or prtpton (nludng fnnl ssstne to resdents) n pproved resdeny progrms n fmly medne, generl nternl medne, generl pedtrs, or omnton of these dsplnes. The progrm lso nreses the numer of resdents trned n prmry re y provdng stpend support to resdents. Trgeted helth Physns (fmly medne, generl nternl medne, generl pedtrs, nd med-peds) Physns (fmly medne, generl nternl medne, generl pedtrs, nd med-peds) Physns (fmly medne, generl nternl medne, generl pedtrs, nd med-peds) Physn ssstnts Physns (fmly medne, generl nternl medne, generl pedtrs, nd med-peds) Numer of trnees 5,064 trnees (15 of whh reeved fnnl ssstne) 980 trnees (42 of whh reeved fnnl ssstne) 10,049 trnees (191 of whh reeved fnnl ssstne) 2,602 trnees (318 of whh reeved fnnl ssstne) 2,072 trnees (217 of whh reeved fnnl ssstne) Olgtons (dollrs n mllons) $ Pge 14

15 Enlosure I (Sttutory uthorty) 27. Interdsplnry nd Interprofessonl Jont Grdute Degree Trnng n Generl, Pedtr nd Pul Helth Dentstry (42 U.S.C. 293k-2) 28. Predotorl Trnng n Generl, Pedtr nd Pul Helth Dentstry nd Dentl Hygene 29. Postdotorl Trnng n Generl, Pedtr nd Pul Helth Dentstry nd Dentl Hygene 30. Fulty Development n Generl, Pedtr, nd Pul Helth Dentstry nd Dentl Hygene Purpose nd desrpton Funds the plnnng, development nd operton of jont degree progrms to provde nterdsplnry nd nterprofessonl grdute trnng n pul helth nd other helth professons to provde trnng n envronmentl helth, nfetous dsese ontrol, dsese preventon nd helth promoton, epdemologl studes, nd njury ontrol. Grnts to dentl or dentl hygene shools or pproved resdeny or dvned eduton progrms n the prte of generl, pedtr, or pul helth dentstry to mprove ess to nd the delvery of orl helth re serves for underserved popultons y nresng the supply of orl helth re nd enhnng orl helth re workfore eduton nd trnng. The progrm four tvtes n FY 2012 tht we ounted s ndvdul progrms: Funds the plnnng, development, operton of, nd prtpton n pproved professonl trnng progrms n generl, pedtr, or pul helth dentstry nd dentl hygene for students nd provdes fnnl ssstne to dentl or dentl hygene students. Funds the plnnng, development, operton of, nd prtpton n pproved professonl trnng progrms n generl, pedtr, or pul helth dentstry for dentl resdents, prtng dentsts, or other pproved prmry re dentl trnees; grntees my lso provde fnnl ssstne to dentl resdents or prtng dentsts. Funds the plnnng, development, nd operton of progrms for the trnng of orl helth re provders who pln to teh n generl, pedtr, nd pul helth dentstry or dentl hygene nd provdes fnnl ssstne through trneeshps nd fellowshps to dentsts who pln to teh or re tehng n generl, pedtr, or pul helth dentstry. Trgeted helth Physns (prmry re) nd physn ssstnts Dentsts (generl, pedtr, pul helth) nd dentl hygensts Dentsts (generl, pedtr, pul helth) nd dentl hygensts Dentsts (generl, pedtr, pul helth) nd dentl hygensts Numer of trnees 1,131 trnees 1,916 trnees (25 of whh reeved fnnl ssstne) 674 trnees (62 of whh reeved fnnl ssstne; 119 ontnung eduton trnees) 148 trnees (127 of whh reeved fnnl ssstne) Olgtons (dollrs n mllons) $ Pge 15

16 Enlosure I (Sttutory uthorty) 31. Dentl Fulty Lon Repyment 32. Are Helth Eduton Centers (42 U.S.C. 294) Eduton nd Trnng Reltng to Gertrs (42 U.S.C. 294) 33. Gertr Eduton Centers 34. Gertr Trnng for Physns, Dentsts, nd Behvorl nd Mentl Helth Professons 35. Gertr Adem Creer Awrds Purpose nd desrpton Funds the plnnng, development, nd operton of progrm to provde lon repyment to dentl fulty engged n generl, pedtr, nd pul helth dentstry nd dentl hygene n exhnge for ommtment to serve s full-tme fulty memers. Grnts to medl nd nursng shools to develop nd mntn re helth eduton enters (AHEC) nd progrms tht mprove the dstruton, dversty, nd supply of the prmry re helth professonl workfore tht serves medlly underserved res. AHECs provde ommunty-sed nterdsplnry eduton nd trnng for helth professonl students, ontnung eduton for, feld plements, nd helth reer rerutment nd outreh to underrepresented mnorty or dsdvntged ndvduls, nd edutonl ppelne development. Grnts to support the eduton nd trnng of helth n the needs spef to the gertr ptent populton. The progrm three tvtes n FY 2012 tht we ounted s ndvdul progrms: Funds redted helth professons shools nd grdute progrms to estlsh nd operte enters tht provde nterprofessonl gertr trnng nd eduton to helth professonl students, fulty, nd prttoners, nludng lnl trnng, fulty development, nd ontnung eduton n gertrs. Funds redted medl shools, tehng hosptls, nd GME progrms to support fellowshps nd other trnng efforts tht ssst physns, dentsts, nd ehvorl nd mentl helth who pln to teh n gertr medne. Grnts to elgle ndvduls to support, through fnnl ssstne, the reer development of junor fulty physns, nurses, sol workers, psyhologsts, dentsts, phrmsts, nd lled helth n dem gertrs who provde trnng n lnl gertrs nludng the trnng of nterprofessonl/nterdsplnry tems of helth. Trgeted helth Dentsts (generl, pedtr, pul helth) nd dentl hygensts Multple helth wth fous on prmry re Multple helth, suh s physns, nd other gertr-relted helth Physns (prmry re, psyhtrsts), dentsts, nd ehvorl helth Multple helth, suh s physns, nurses, sol workers, psyhologsts, dentsts, nd phrmsts Numer of trnees 35 reeved fnnl ssstne 648,166 trnees (245,075 of whh reeved ontnung eduton) 79,521 trnees (60,259 of whh reeved ontnung eduton) 63 reeved fnnl ssstne 66 reeved fnnl ssstne Olgtons (dollrs n mllons) $ $ Pge 16

17 Enlosure I (Sttutory uthorty) 36. Grdute Psyhology Eduton (42 U.S.C. 294e()(1)(J)) 37. Mentl nd Behvorl Helth Eduton nd Trnng Grnts (42 U.S.C. 294e-1) Advned Nursng Eduton Grnts (42 U.S.C. 296j) 38. Advned Nursng Eduton (ANE) 39. Advned Eduton Nursng Trneeshp 40. Nurse Anesthetst Trneeshp Trgeted helth Purpose nd desrpton Grnts for the plnnng, development, or operton of Psyhologsts redted grdute, dotorl, dotorl nternshp, nd dotorl psyhology resdeny progrms tht ddress ess for underserved popultons y provdng prte-sed trnng experene (nludng stpends) for psyhology students. Grnts to redted shools of sol work nd Mentl nd ehvorl dotorl psyhology to strengthen the lnl feld helth ompetenes of sol workers nd psyhologsts (psyhologsts, sol who pursue lnl serve wth hgh-need nd hghdemnd popultons. Grntee serves n nlude workers, nd others) fundng psyhology nternshps or sol work feld plements or stpends for trnees durng nternshps. Grnts to redted nurse eduton progrms to rete or expnd projets tht support the enhnement of dvned nursng eduton nd prte nd trneeshps for ndvduls n dvned nursng eduton progrms. The progrm three tvtes n FY 2012 tht we ounted s ndvdul progrms: Grnts to support dvned nursng eduton APRNs progrms for RNs preprng to eome NPs, nurse mdwves, nurse nesthetsts, nurse dmnstrtors, nd other speltes requrng dvned eduton. ANE lso nreses the numer of enrolled nd grduted prmry re NP nd nurse mdwfery students y provdng students wth fnnl ssstne, nludng stpends. Funds trneeshps whh over tuton nd other APRNs osts, for enrolled RNs to prte s prmry re provders, nursng fulty, or oth. Funds trneeshps, whh over tuton nd other APRNs osts, for RNs enrolled n nurse nesthes progrms to nrese the numer of nurse nesthetsts to tret underserved popultons. Numer of trnees 938 trnees (106 of whh reeved fnnl ssstne) m Olgtons (dollrs n mllons) $2.892 Not pplle $ ,825 trnees (368 of whh trnees reeved fnnl ssstne) 8,963 reeved fnnl ssstne 2,279 reeved fnnl ssstne m $ Pge 17

18 Enlosure I (Sttutory uthorty) 41. Nursng Workfore Dversty (42 U.S.C. 296m) Nurse Eduton, Prte, Qulty, nd Retenton Grnts (42 U.S.C. 296p- 296p-1) 42. Nurse Eduton Prte, Qulty, nd Retenton 43. Fulty Development: Integrted Tehnology nto Nursng Eduton nd Prte Inttve 44. Innovtve Nurse Eduton Tehnologes 45. Nursng Assstnt nd Home Helth Ade Trgeted helth Purpose nd desrpton Grnts to redted nursng shools nd other Nurses nd nursng enttes for stpends nd sholrshps for nursng ssstnts students from dsdvntged kgrounds, nludng rl nd ethn mnortes tht re underrepresented mong RNs. Stpends re for dplom or ssote degree nurses; student sholrshps or stpends re for elerted nursng degree progrms, pre-entry preprton, dvned eduton preprton, nd retenton tvtes. Grnts to redted nursng shools, helth re fltes, or prtnershps to ddress the needs of growng nd gng populton s demnd for nursng serves y expndng the nursng ppelne, promotng reer molty, provdng ontnung eduton nd supportng retenton. The progrm fve tvtes n FY 2012 tht we ounted s ndvdul progrms: Funds dem, serve, nd ontnung eduton Nurses, nursng projets to strengthen nd enhne the pty for ssstnts, nursng nurse eduton, prte, nd retenton through home, nd home helth tvtes nludng mplementng nternshp nd des resdeny progrms to enourge development of speltes, provdng eduton n new tehnologes, nd provdng reer ldder progrms. Funds nursng ollortves for fulty development Nurses n the use of nformton nd other tehnologes to edute students for 21st entury helth re prte. Funds nurse trnng progrms to develop nnovtve regonl pprohes to usng tehnology, nludng ompeteny-sed dstne lernng, to enhne nursng eduton. Funds nfrstruture support for the development, evluton, nd demonstrton of ompetenysed unform urrulum to trn qulfed nursng ssstnts nd home helth des to meet the growng helthre needs of the gng populton. Nurses Nursng ssstnts, nursng home, nd home helth des Numer of trnees 4,518 trnees (1,824 of whh reeved fnnl ssstne) 23,157 trnees (43 of whh reeved fnnl ssstne, 4,608 ontnung eduton trnees) Olgtons (dollrs n mllons) $ $ Pge 18

19 Enlosure I (Sttutory uthorty) 46. Interprofessonl Collortve Prte 47. Nursng Student Lons (42 U.S.C. 297) 48. Nurse Fulty Lon (42 U.S.C. 297n-1) NURSE Corps (42 U.S.C. 297n) 49. NURSE Corps Lon Repyment Purpose nd desrpton Funds projets desgned to strengthen the nursng workfore, nrese nurse retenton, promote oordnted re, mprove the qulty of ptent re, nd provde nurses wth the sklls needed to prte n exstng nd emergng orgnzed helth re systems. Grnts to redted nursng shools to provde low-nterest lons to nursng students n progrms ledng to dplom, ssote s, helor s, or grdute degree n nursng n order to llevte the shortge of nurses. Prtptng nsttutons operte ther lon progrms through revolvng ounts. Grnts to nursng shools to provde lons nd lon nellton to RNs nd nursng fulty n order to nrese the numer of qulfed nursng fulty nd ddress the nursng workfore shortge, nludng lons mde to RNs to omplete grdute eduton nd lon nellton provded to orrowers n exhnge for serve s full-tme nursng fulty. Provdes fnnl ssstne to llevte the rtl shortge of nurses nd nurse fulty nd to rerut nd retn nurses to meet the workfore needs of helth re fltes wth rtl shortges of nurses known s rtl shortge fltes (CSF). CSFs re helth re fltes loted n, desgnted s, or servng prmry medl re or mentl helth HPSA. The NURSE Corps nludes the NURSE Corps Lon Repyment s nd NURSE Corps Sholrshp. Repyment of qulfed nursng eduton lons to RNs, nludng APRNs, n exhnge for workng full-tme for 2 to 3 yers n CSF or t n redted shool or nursng. Trgeted helth Nurses, APRNs, physns, therpsts (ouptonl, physl, resprtory), physn ssstnts, phrmsts, dentsts, ehvorl helth, nursng ssstnts, nursng home, nd home helth des Nurses APRNs Nurses Numer of trnees 7,063 trnees reeved lons 2,374 trnees (2,227 of whh reeved fnnl ssstne) 1,452 lon repyment repents Olgtons (dollrs n mllons) $1.629 $ l n $ Pge 19

20 Enlosure I (Sttutory uthorty) 50. NURSE Corps Sholrshp 51. Comprehensve Gertr Eduton (42 U.S.C. 298) 52. Mternl nd Chld Helth Trnng (42 U.S.C. 701()(2)) 53. The Comtng Autsm At Trnng (42 U.S.C (e)(1)) 54. AIDS Eduton nd Trnng Centers (42 U.S.C. 300ff-111) 55. Communty Bsed Dentl Prtnershp (42 U.S.C. 300ff-111) Trgeted helth Purpose nd desrpton Sholrshps to nursng students epted or Nurses enrolled n dplom, ssote s, helor s, or grdute nursng progrm n exhnge for ommtment of 2 to 4 yers of serve n CSF upon grduton. Grnts to nursng shools, helth re fltes, or APRNs nd lled helth nurse trnng progrms for gertr urrulum development, gertr fulty development, ontnung eduton n gertrs, nd trneeshps for ndvduls who re preprng for dvned eduton nursng degrees n gertr or long-term re nursng. Grnts to pul nd prvte nonproft nsttutons Multple helth of hgher lernng to provde ledershp trnng n, suh s mternl nd hld helth. The progrm supports udologsts, physns, multple trnng tvtes, nludng sngle dsplne nurses, APRNs, trnng tvtes, nterdsplnry trnng tvtes, dentsts, psyhologsts, nd short-term trnng nttves, some of whh nd sol workers provde lnl sklls trnng nd ontnung eduton for trnees. Reported fundng s for nne spef tvtes, seven of whh provded trnng n ptentrelted sklls. o Grnts to pul nd prvte nonproft nsttutons of Multple helth hgher lernng to provde grdute lnl trnng, suh s to vrety of helth n sklls relted to udologsts, physns, utsm nd other developmentl dsltes. Reported nurses, APRNs, fundng s for two spef tvtes tht provded dentsts, psyhologsts, p trnng n ptent-relted sklls. nd sol workers Grnts to support network of enters tht ondut Multple helth trgeted, multdsplnry eduton nd trnng, suh s progrms, nludng ontnung eduton, for helth physns, physn re provders tretng people lvng wth HIV/AIDS, ssstnts, nurses, wth spel emphss on trnng mnorty lnns APRNs, dentsts, nd nd prmry re lnns servng mnorty phrmsts popultons. Grnts to dentl nd dentl hygene trnng progrms Dentsts nd dentl to trn dentl nd hygene students, dentl resdents, hygensts nd ommunty-sed dentsts to delver HIV/AIDS dentl re n ommunty settngs nd thus mprove ess to orl helth re serves for ptents wth HIV. Numer of trnees 264 sholrshp repents 7,115 trnees (6,790 of whh reeved ontnung eduton) 93,734 reeved trnng nludng ontnung eduton 139,089 reeved trnng nludng ontnung eduton Olgtons (dollrs n mllons) $ $4.484 $8.519 $ ,108 trnees $ q 3,162 trnees $3.989 Pge 20