No official summary available for this bill.
[Congressional Bills 119th Congress]
[From the U.S. Government Publishing Office]
[S. 2954 Introduced in Senate (IS)]
<DOC>
119th CONGRESS
1st Session
S. 2954
To establish grant programs for health professional schools, and for
other purposes.
_______________________________________________________________________
IN THE SENATE OF THE UNITED STATES
September 30, 2025
Mr. Sanders (for himself and Mr. Merkley) introduced the following
bill; which was read twice and referred to the Committee on Health,
Education, Labor, and Pensions
_______________________________________________________________________
A BILL
To establish grant programs for health professional schools, and for
other purposes.
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 ``Health Care Workforce Expansion Act
of 2025''.
SEC. 2. GRANT PROGRAMS FOR HEALTH PROFESSIONAL SCHOOLS.
(a) MED, DENTAL, and NURSE Grants.--Part A of title IV of the
Higher Education Act of 1965 (20 U.S.C. 1070) is amended by adding at
the end the following:
``Subpart 11--MED Grants
``SEC. 420S. DEFINITIONS.
``For the purposes of this subpart:
``(1) Eligible institution.--The term `eligible
institution' means an institution of higher education, as
defined in section 101, that is a school of medicine or school
of osteopathic medicine as defined in section 799B of the
Public Health Service Act (42 U.S.C. 295p).
``(2) Medical school candidate.--The term `medical school
candidate' means a student in attendance at an eligible
institution pursuing a professional doctor of medicine or
doctor of osteopathic medicine degree.
``SEC. 420T. PROGRAM ESTABLISHED.
``(a) Program Authority.--
``(1) Payments required.--The Secretary shall pay to each
eligible institution such sums as may be necessary to pay to
each medical school candidate who files an application and
agreement in accordance with section 420U, and who qualifies
under such section, a MED Grant in the amount of tuition and
required fees for each year during which that medical school
candidate is in attendance at the institution.
``(2) References.--Grants made under paragraph (1) shall be
known as `MED Grants'.
``(b) Payment Methodology.--
``(1) Prepayment.--Not less than 85 percent of any funds
provided to an eligible institution under subsection (a) shall
be advanced to the eligible institution prior to the start of
each payment period and shall be based upon an amount requested
by the institution as needed to pay medical school candidates
until such time as the Secretary determines and publishes in
the Federal Register with an opportunity for comment, an
alternative payment system that provides payments to
institutions in an accurate and timely manner, except that this
sentence shall not be construed to limit the authority of the
Secretary to place an institution on a reimbursement system of
payment.
``(2) Direct payment.--Nothing in this section shall be
interpreted to prohibit the Secretary from paying directly to
medical school candidates, in advance of the beginning of the
academic term, an amount for which medical school candidates
are eligible, in cases where the eligible institution elects
not to participate in the disbursement system required by
paragraph (1).
``(c) No Exceeding Cost.--The amount of a grant awarded under this
subpart, in combination with Federal assistance, shall not exceed the
cost of attendance (as defined in section 472) at the eligible
institution at which that medical school candidate is in attendance.
``(d) Period of Eligibility for Grants.--The period during which a
medical school candidate may receive a MED grant under this subpart
shall be the period required for the completion of the professional
medical degree being pursued by the medical school candidate at the
eligible institution at which the medical school candidate is in
attendance, except that the period during which a medical school
candidate may receive a MED Grant under this subpart shall not exceed 8
years.
``SEC. 420U. APPLICATION; AWARD.
``(a) Application; Award.--
``(1) Application.--The Secretary shall periodically set
dates by which medical school candidates shall file
applications for grants under this subpart. Each medical school
candidate desiring a grant under this subpart for any year
shall file an application containing such information as is
necessary to demonstrate that the medical school candidate--
``(A) is an eligible student for purposes of
section 484;
``(B) has completed a FAFSA;
``(C) would like to receive a MED grant; and
``(D) understands and agrees to the terms and
conditions of the agreement to serve described in
subparagraph (b).
``(2) Award.--The Secretary shall award a MED grant to each
eligible medical school candidate who meets the requirements
described in paragraph (1) for each year that the application
under such paragraph is submitted and such requirements are
met.
``(b) Agreements To Serve.--Each application under subsection (a)
shall contain or be accompanied by an agreement by the applicant that--
``(1) the applicant will--
``(A) practice primary care, as defined in section
1886 of the Social Security Act (42 U.S.C. 1395ww), as
a physician for at least 10 years after their related
training is completed (including residency or
fellowship programs) within 15 years after completing
the degree for which the applicant received a MED Grant
under this subpart or such related training (referred
to in this section as the `service obligation window');
and
``(B) annually submit an employment certification,
for each year of service, showing that the requirement
under subparagraph (A) is being met;
``(2) in the event that the applicant is determined to have
failed or refused to carry out such service obligation, a
specified amount of any MED Grants received by such applicant
will be treated as a loan and collected from the applicant in
accordance with subsection (c) and the regulations thereunder;
and
``(3) contains, or is accompanied by, a plain-language
disclosure form developed by the Secretary that clearly
describes the nature of the MED Grant award, the service
obligation, and the loan repayment requirements that are the
consequence of the failure to complete the service obligation.
``(c) Repayment for Failure To Complete Service.--
``(1) In general.--In the event that any recipient of a
grant under this subpart fails or refuses to comply with the
service obligation in the agreement under subsection (b), a
specified amount as described in paragraph (3) of the MED
Grants received by such recipient shall, upon a determination
of such a failure or refusal in such service obligation, be
converted to a Federal Direct Unsubsidized Stafford Loan under
part D of title IV, and shall be subject to repayment, in
accordance with paragraph (2).
``(2) Interest and repayment.--Amounts that are converted
to a Direct Unsubsidized Stafford Loan under paragraph (1)
shall accrue interest at the rate applicable to such Direct
Unsubsidized Stafford Loans for borrowers as of the date of
conversion, and the recipient shall be eligible for the same
repayment plans and borrower protections with respect to such
converted loans as that recipient would otherwise be eligible
for with respect to a Federal Direct Unsubsidized Stafford Loan
under part D of title IV for a borrower that is disbursed on
the same date.
``(3) Specified amount to be repaid.--
``(A) 5 years or less.--If a MED Grant recipient
has completed 5 years or less of required service, the
lesser of--
``(i) the total amount of MED grants
received by the recipient; or
``(ii) $50,000.
``(B) Greater than 5 years and less than 10
years.--If a MED Grant recipient has completed more
than 5 years of required service but less than 10 years
of required service, the lesser of--
``(i) the total amount of MED grants
received by the recipient; or
``(ii) $25,000.
``(C) Cap.--The amount of MED Grants that is
converted to a loan and required to be repaid under
this subsection shall not exceed $50,000.
``(4) Reconsideration of conversion decisions.--
``(A) Request to reconsider.--In any case where the
Secretary has determined that a recipient of a grant
under this subpart has failed or refused to comply with
the service obligation in the agreement under
subsection (b) and has converted the grant into a
Federal Direct Unsubsidized Stafford Loan under part D
in accordance with paragraph (1), (including cases
where such loans have been fully or partially paid),
the recipient may request that the Secretary reconsider
such initial determination and may submit additional
information to demonstrate satisfaction of the service
obligation. Upon receipt of such a request, the
Secretary shall reconsider the determination in
accordance with this paragraph not later than 90 days
after the date that such request was received.
``(B) Reconsideration.--If, in reconsidering an
initial determination under subparagraph (A) (including
cases where such loans were fully or partially paid),
the Secretary determines that the reason for such
determination was the recipient's failure to timely
submit a certification required under subsection
(b)(1)(B), an error or processing delay by the
Secretary, a change to the fields considered eligible
for fulfillment of the service obligation (as described
in subsection (b)(1)(A)), a recipient having previously
requested to have the MED Grant converted to a loan, or
another valid reason determined by the Secretary, and
that the recipient has, as of the date of the
reconsideration, demonstrated that the recipient did
meet, or is meeting the service obligation in the
agreement under subsection (b), the Secretary shall--
``(i) discharge the Federal Direct
Unsubsidized Stafford Loan under part D, and
reinstate the recipient's grant under this
subpart;
``(ii) discharge any interest or fees that
may have accumulated during the period that the
grant was converted to a Federal Direct
Unsubsidized Stafford Loan under part D;
``(iii) if the recipient has other loans
under part D, apply any payments made for the
Federal Direct Unsubsidized Stafford Loan under
part D during such period to those other loans
under part D;
``(iv) if the recipient does not have other
loans under part D, reimburse the recipient for
any amounts paid on the Federal Direct
Unsubsidized Stafford Loan under part D during
such period;
``(v) request that consumer reporting
agencies remove any negative credit reporting
due to the conversion of the MED Grant to a
loan; and
``(vi) use the additional information
provided under subparagraph (A) to determine
the progress the recipient has made in meeting
the service obligation.
``(C) Extension of time to complete service
obligation.--In the case of a recipient whose MED Grant
was reinstated in accordance with subparagraph (B), the
Secretary shall, upon such reinstatement--
``(i) extend the time remaining for the
recipient to fulfill the service obligation
described in subsection (b)(1) to a period of
time equal to--
``(I) 10 years; minus
``(II) the number of years that the
recipient completed service as a
physician in primary care prior to the
reconversion of the loan to a MED Grant
under subparagraph (B), including any
years of qualifying service completed
during the period when the MED Grant
was in loan status; and
``(ii) treat any years of service described
in subclause (II) of clause (i) as years that
count toward the individual's service
obligation (regardless of whether the MED Grant
funds were in grant or loan status) if that
time otherwise meets the requirements of this
section.
``(d) Additional Administrative Provisions.--
``(1) Extenuating circumstances.--The Secretary shall
establish, by regulation, categories of extenuating
circumstances under which a recipient of a grant under this
subpart who is unable to fulfill all or part of the recipient's
service obligation may be excused from fulfilling that portion
of the service obligation.
``(2) Communication with recipients.--The Secretary shall
notify MED grant recipients not less than twice per calendar
year regarding how to submit the employment certification under
subsection (b)(1)(B) and the recommendations and requirements
for submitting that certification under paragraph (3).
``(3) Submission of employment certification.--
``(A) Recommended submissions.--
``(i) In general.--The Secretary shall
notify MED Grant recipients that the Department
recommends that MED Grant recipients submit the
employment certification described in
subsection (b)(1)(B) as soon as practicable
after the completion of each year of service.
``(ii) Form.--The Secretary shall provide a
standardized annual certification form for use
under this section and allow electronic
submission by the recipient or employer.
``(B) Required submission.--A MED Grant recipient
shall be required to submit to the Department
employment certification within the timeframe that
would allow that individual to complete their service
obligation before the end of the service obligation
window.
``(C) Notification.--The Secretary shall notify MED
Grant recipients of the required submission deadlines
described in this paragraph.
``(D) Adjustment of deadline.--The Secretary shall
adjust the submission deadline described in
subparagraph (B) to account for a service obligation
window extension.
``(E) Alternative to certification.--The Secretary
shall provide an alternative to the certification of
employment described in subsection (b)(1)(B) for
recipients who cannot obtain such required
certification of employment because the recipient can
demonstrate the employer is no longer in existence or
the employer refuses to cooperate.
``SEC. 420V. PROGRAM PERIOD AND FUNDING.
``Beginning on July 1, 2026, there shall be available to the
Secretary to carry out this subpart, from funds not otherwise
appropriated, such sums as may be necessary to provide MED Grants in
accordance with this subpart to each eligible applicant.
``Subpart 12--DENTAL Grants
``SEC. 420W. DEFINITIONS.
``For the purposes of this subpart:
``(1) Eligible institution.--The term `eligible
institution' means an institution of higher education, as
defined in section 101, that is a school of dentistry as
defined in section 799B of the Public Health Service Act (42
U.S.C. 295p).
``(2) Dental school candidate.--The term `dental school
candidate' means a student in attendance at an eligible
institution pursuing a professional dental degree.
``(3) Rural area.--The term rural area has the meaning
given that term in section 861(b)(2).
``SEC. 420X. PROGRAM ESTABLISHED.
``(a) Program Authority.--
``(1) Payments required.--The Secretary shall pay to each
eligible institution such sums as may be necessary to pay to
each dental school candidate who files an application and
agreement in accordance with section 420Y, and who qualifies
under such section, a DENTAL Grant in the amount of tuition and
required fees for each year during which that dental school
candidate is in attendance at the institution.
``(2) References.--Grants made under paragraph (1) shall be
known as `DENTAL Grants'.
``(b) Payment Methodology.--
``(1) Prepayment.--Not less than 85 percent of any funds
provided to an eligible institution under subsection (a) shall
be advanced to the eligible institution prior to the start of
each payment period and shall be based upon an amount requested
by the institution as needed to pay dental school candidates
until such time as the Secretary determines and publishes in
the Federal Register with an opportunity for comment, an
alternative payment system that provides payments to
institutions in an accurate and timely manner, except that this
sentence shall not be construed to limit the authority of the
Secretary to place an institution on a reimbursement system of
payment.
``(2) Direct payment.--Nothing in this section shall be
interpreted to prohibit the Secretary from paying directly to
dental school candidates, in advance of the beginning of the
academic term, an amount for which dental school candidates are
eligible, in cases where the eligible institution elects not to
participate in the disbursement system required by paragraph
(1).
``(c) No Exceeding Cost.--The amount of a grant awarded under this
subpart, in combination with Federal assistance, shall not exceed the
cost of attendance (as defined in section 472) at the eligible
institution at which that dental school candidate is in attendance.
``(d) Period of Eligibility for Grants.--The period during which a
dental school candidate may receive a DENTAL grant under this subpart
shall be the period required for the completion of the professional
dental degree being pursued by the dental school candidate at the
eligible institution at which the dental school candidate is in
attendance, except that the period during which a dental school
candidate may receive a DENTAL Grant under this subpart shall not
exceed 8 years.
``SEC. 420Y. APPLICATION; AWARD.
``(a) Application; Award.--
``(1) Application.--The Secretary shall periodically set
dates by which dental school candidates shall file applications
for grants under this subpart. Each dental school candidate
desiring a grant under this subpart for any year shall file an
application containing such information as is necessary to
demonstrate that the dental school candidate--
``(A) is an eligible student for purposes of
section 484;
``(B) has completed a FAFSA;
``(C) would like to receive a DENTAL grant; and
``(D) understands and agrees to the terms and
conditions of the agreement to serve described in
subparagraph (b).
``(2) Award.--The Secretary shall award a DENTAL grant to
each eligible dental school candidate who meets the
requirements described in paragraph (1) for each year that the
application under such paragraph is submitted and such
requirements are met.
``(b) Agreements To Serve.--Each application under subsection (a)
shall contain or be accompanied by an agreement by the applicant that--
``(1) the applicant will--
``(A) practice general dental care in a rural area,
with the option for service to be completed
cumulatively across eligible sites and locations, for
at least 10 years after their related training is
completed (including a residency or fellowship program)
within 15 years after completing the degree and such
related training for which the applicant received a
DENTAL Grant under this subpart (referred to in this
section as the `service obligation window'); and
``(B) annually submit an employment certification,
for each year of service, showing that the requirement
under subparagraph (A) is being met;
``(2) in the event that the applicant is determined to have
failed or refused to carry out such service obligation, the
specified amount of any DENTAL Grants received by such
applicant will be treated as a loan and collected from the
applicant in accordance with subsection (c) and the regulations
thereunder; and
``(3) contains, or is accompanied by, a plain-language
disclosure form developed by the Secretary that clearly
describes the nature of the DENTAL Grant award, the service
obligation, and the loan repayment requirements that are the
consequence of the failure to complete the service obligation.
``(c) Repayment for Failure To Complete Service.--
``(1) In general.--In the event that any recipient of a
grant under this subpart fails or refuses to comply with the
service obligation in the agreement under subsection (b), a
specified amount as described in paragraph (3) of the DENTAL
Grants received by such recipient shall, upon a determination
of such a failure or refusal in such service obligation, be
converted to a Federal Direct Unsubsidized Stafford Loan under
part D of title IV, and shall be subject to repayment, in
accordance with paragraph (2).
``(2) Interest and repayment.--Amounts that are converted
to a Direct Unsubsidized Stafford Loan under paragraph (1)
shall accrue interest at the rate applicable to such Direct
Unsubsidized Stafford Loans for borrowers as of the date of
conversion, and the recipient shall be eligible for the same
repayment plans and borrower protections with respect to such
converted loans as that recipient would otherwise be eligible
for with respect to a Federal Direct Unsubsidized Stafford Loan
under part D of title IV for a borrower that is disbursed on
the same date.
``(3) Specified amount to be repaid.--
``(A) 5 years or less.--If a DENTAL Grant recipient
has completed 5 years or less of required service, the
specified amount to be repaid is the lesser of--
``(i) the total amount of DENTAL Grants
received by the recipient; or
``(ii) $50,000.
``(B) Greater than 5 years and less than 10
years.--If a DENTAL Grant recipient has completed more
than 5 years of required service but less than 10 years
of required service, the specified amount to be repaid
is the lesser of--
``(i) the total amount of DENTAL Grants
received by the recipient; or
``(ii) $25,000.
``(C) Cap.--The amount of DENTAL Grants that is
converted to a loan and required to be repaid under
this subsection shall not exceed $50,000.
``(4) Reconsideration of conversion decisions.--
``(A) Request to reconsider.--In any case where the
Secretary has determined that a recipient of a grant
under this subpart has failed or refused to comply with
the service obligation in the agreement under
subsection (b) and has converted the grant into a
Federal Direct Unsubsidized Stafford Loan under part D
in accordance with paragraph (1), (including cases
where such loans have been fully or partially paid),
the recipient may request that the Secretary reconsider
such initial determination and may submit additional
information to demonstrate satisfaction of the service
obligation. Upon receipt of such a request, the
Secretary shall reconsider the determination in
accordance with this paragraph not later than 90 days
after the date that such request was received.
``(B) Reconsideration.--If, in reconsidering an
initial determination under subparagraph (A) (including
cases where such loans were fully or partially paid),
the Secretary determines that the reason for such
determination was the recipient's failure to timely
submit a certification required under subsection
(b)(1)(B), an error or processing delay by the
Secretary, a change to the fields considered eligible
for fulfillment of the service obligation (as described
in subsection (b)(1)(A)), a recipient having previously
requested to have the DENTAL Grant converted to a loan,
or another valid reason determined by the Secretary,
and that the recipient has, as of the date of the
reconsideration, demonstrated that the recipient did
meet, or is meeting the service obligation in the
agreement under subsection (b), the Secretary shall--
``(i) discharge the Federal Direct
Unsubsidized Stafford Loan under part D, and
reinstate the recipient's grant under this
subpart;
``(ii) discharge any interest or fees that
may have accumulated during the period that the
grant was converted to a Federal Direct
Unsubsidized Stafford Loan under part D;
``(iii) if the recipient has other loans
under part D, apply any payments made for the
Federal Direct Unsubsidized Stafford Loan under
part D during such period to those other loans
under part D;
``(iv) if the recipient does not have other
loans under part D, reimburse the recipient for
any amounts paid on the Federal Direct
Unsubsidized Stafford Loan under part D during
such period;
``(v) request that consumer reporting
agencies remove any negative credit reporting
due to the conversion of the DENTAL Grant to a
loan; and
``(vi) use the additional information
provided under subparagraph (A) to determine
the progress the recipient has made in meeting
the service obligation.
``(C) Extension of time to complete service
obligation.--In the case of a recipient whose DENTAL
Grant was reinstated in accordance with subparagraph
(B), the Secretary shall, upon such reinstatement--
``(i) extend the time remaining for the
recipient to fulfill the service obligation
described in subsection (b)(1) to a period of
time equal to--
``(I) 10 years; minus
``(II) the number of years that the
recipient completed required service in
general dentistry in a rural area prior
to the reconversion of the loan to a
DENTAL Grant under subparagraph (B),
including any years of qualifying
service completed during the period
when the DENTAL Grant was in loan
status; and
``(ii) treat any years of service described
in subclause (II) of clause (i) as years that
count toward the individual's service
obligation (regardless of whether the DENTAL
Grant funds were in grant or loan status) if
that time otherwise meets the requirements of
this section.
``(d) Additional Administrative Provisions.--
``(1) Extenuating circumstances.--The Secretary shall
establish, by regulation, categories of extenuating
circumstances under which a recipient of a grant under this
subpart who is unable to fulfill all or part of the recipient's
service obligation may be excused from fulfilling that portion
of the service obligation.
``(2) Communication with recipients.--The Secretary shall
notify DENTAL grant recipients not less than twice per calendar
year regarding how to submit the employment certification under
subsection (b)(1)(B) and the recommendations and requirements
for submitting that certification under paragraph (3).
``(3) Submission of employment certification.--
``(A) Recommended submissions.--
``(i) In general.--The Secretary shall
notify DENTAL Grant recipients that the
Department recommends that DENTAL Grant
recipients submit the employment certification
described in subsection (b)(1)(B) as soon as
practicable after the completion of each year
of service.
``(ii) Form.--The Secretary shall provide a
standardized annual certification form for use
under this section and allow electronic
submission by the recipient or employer.
``(B) Required submission.--A DENTAL Grant
recipient shall be required to submit to the Department
employment certification within the timeframe that
would allow that individual to complete their service
obligation before the end of the service obligation
window.
``(C) Notification.--The Secretary shall notify
DENTAL Grant recipients of the required submission
deadlines described in this paragraph.
``(D) Adjustment of deadline.--The Secretary shall
adjust the submission deadline described in
subparagraph (B) to account for a service obligation
window extension.
``(E) Alternative to certification.--The Secretary
shall provide an alternative to the certification of
employment described in subsection (b)(1)(B) for
recipients who cannot obtain such required
certification of employment because the recipient can
demonstrate the employer is no longer in existence or
the employer refuses to cooperate.
``SEC. 420Z. PROGRAM PERIOD AND FUNDING.
``Beginning on July 1, 2026, there shall be available to the
Secretary to carry out this subpart, from funds not otherwise
appropriated, such sums as may be necessary to provide DENTAL Grants in
accordance with this subpart to each eligible applicant.
``Subpart 13--NURSE Grants
``SEC. 420AA. DEFINITIONS.
``For the purposes of this subpart:
``(1) Eligible institution.--The term `eligible
institution' means an accredited school of nursing, as defined
in section 801 of the of the Public Health Service Act (42
U.S.C. 296), at an institution of higher education, as defined
in section 101.
``(2) Nursing student.--The term `nursing student' means a
student in attendance at an eligible institution.
``SEC. 420BB. PROGRAM ESTABLISHED.
``(a) Program Authority.--
``(1) Payments required.--The Secretary shall pay to each
eligible institution such sums as may be necessary to pay to
each nursing student who files an application and agreement in
accordance with section 420CC, and who qualifies under such
section, a NURSE Grant in the amount of tuition and required
fees for each year during which that nursing student is in
attendance at the institution.
``(2) References.--Grants made under paragraph (1) shall be
known as `NURSE Grants'.
``(b) Payment Methodology.--
``(1) Prepayment.--Not less than 85 percent of any funds
provided to an eligible institution under subsection (a) shall
be advanced to the eligible institution prior to the start of
each payment period and shall be based upon an amount requested
by the institution as needed to pay nursing students until such
time as the Secretary determines and publishes in the Federal
Register with an opportunity for comment, an alternative
payment system that provides payments to institutions in an
accurate and timely manner, except that this sentence shall not
be construed to limit the authority of the Secretary to place
an institution on a reimbursement system of payment.
``(2) Direct payment.--Nothing in this section shall be
interpreted to prohibit the Secretary from paying directly to
nursing students, in advance of the beginning of the academic
term, an amount for which nursing students are eligible, in
cases where the eligible institution elects not to participate
in the disbursement system required by paragraph (1).
``(c) No Exceeding Cost.--The amount of a grant awarded under this
subpart, in combination with Federal assistance, shall not exceed the
cost of attendance (as defined in section 472) at the eligible
institution at which that nursing student is in attendance.
``(d) Period of Eligibility for Grants.--The period during which a
nursing student may receive a NURSE grant under this subpart shall be
the period required for the completion of the professional nursing
degree being pursued by the nursing student at the eligible institution
at which the nursing student is in attendance, except that the period
during which a nursing student may receive a NURSE Grant under this
subpart shall not exceed 8 years.
``SEC. 420CC. APPLICATION; AWARD.
``(a) Application.--The Secretary shall periodically set dates by
which nursing students shall file applications for grants under this
subpart. Each nursing student desiring a grant under this subpart for
any year shall file an application containing such information as is
necessary to demonstrate that the nursing student--
``(1) is an eligible student for purposes of section 484;
``(2) has completed a FAFSA; and
``(3) would like to receive a NURSE grant.
``(b) Award.--The Secretary shall award a NURSE grant to each
nursing student who meets the requirements described in subsection (a)
for each year that the application under such subsection is submitted
and such requirements are met.
``SEC. 420DD. PROGRAM PERIOD AND FUNDING.
``Beginning on July 1, 2026, there shall be available to the
Secretary to carry out this subpart, from funds not otherwise
appropriated, such sums as may be necessary to provide NURSE Grants in
accordance with this subpart to each eligible applicant.''.
(b) Increasing Enrollment at Health Professions Schools.--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 4--Increasing Enrollment at Health Professions Schools
``SEC. 779. GRANT PROGRAM TO INCREASE ENROLLMENT AT HEALTH PROFESSIONS
SCHOOLS.
``(a) Schools of Medicine and Schools of Osteopathic Medicine.--
``(1) In general.--The Secretary shall award grants to
eligible schools of medicine and schools of osteopathic
medicine to assist such schools in expanding student
enrollment.
``(2) Eligibility.--To be eligible to receive a grant under
this section, a school of medicine or school of osteopathic
medicine shall submit an application to the Secretary at such
time, in such manner, and containing such information as the
Secretary may require, including a plan to increase enrollment
in the school by at least--
``(A) 50 percent by year 2 of the grant; and
``(B) an additional 50 percent by year 4 of the
grant.
``(3) Use of funds.--A school of medicine or school of
osteopathic medicine that receives a grant under this section
shall use the funds awarded through such grant for activities
that include--
``(A) enhancing enrollment and retention of
students at such school using evidence-based practices,
with a priority for students from disadvantaged
backgrounds (including racial or ethnic groups
underrepresented in the physician workforce),
individuals from rural and underserved areas, low-
income individuals, individuals with a disability, and
first generation college students (as defined in
section 402A(h)(3) of the Higher Education Act of
1965), including through mentorship programs, providing
tools and programming for underrepresented students,
and addressing other student needs;
``(B) retaining current faculty and clinical
preceptors, and recruiting and hiring new faculty and
clinical preceptors, including by increasing wages and
providing loan repayment, with an emphasis on faculty
and clinical preceptors from racial or ethnic groups
who are underrepresented in the physician workforce;
``(C) partnering with a health care facility,
community health center, or other facility that
provides health care in order to provide educational
opportunities for the purpose of establishing or
expanding clinical education, with emphasis on
community-based clinical education;
``(D) modernizing infrastructure at such school,
including audiovisual or other equipment, simulation
and augmented reality resources, telehealth
technologies, and virtual and physical laboratories;
``(E) creating, supporting, or modernizing
educational programs and curriculum, including rural
and community-based clinical education, at such school;
or
``(F) other activities that the Secretary
determines further the development, improvement, and
expansion of schools of medicine and schools of
osteopathic medicine.
``(b) Schools of Nursing.--
``(1) In general.--The Secretary shall award grants to
eligible schools of nursing to assist such schools in expanding
student enrollment.
``(2) Eligibility.--To be eligible to receive a grant under
this section, a school of nursing shall submit an application
to the Secretary at such time, in such manner, and containing
such information as the Secretary may require, including a plan
to increase enrollment in the school by at least--
``(A) 30 percent by year 2 of the grant; and
``(B) an additional 30 percent by year 4 of the
grant.
``(3) Use of funds.--A school of nursing that receives a
grant under this section shall use the funds awarded through
such grant for activities that include--
``(A) enhancing enrollment and retention of
students at such school using evidence-based practices,
with a priority for students from disadvantaged
backgrounds (including racial or ethnic groups
underrepresented in the nursing workforce), students
who identify as an underrepresented sex in the nursing
workforce, individuals from rural and underserved
areas, low-income individuals, individuals with a
disability, and first generation college students (as
defined in section 402A(h)(3) of the Higher Education
Act of 1965), including through mentorship programs,
providing tools and programming for underrepresented
students, and addressing other student needs;
``(B) retaining current faculty and clinical
preceptors, and recruiting and hiring new faculty and
clinical preceptors, including by increasing wages and
providing loan repayment, with an emphasis on faculty
and clinical preceptors from racial or ethnic groups
who are underrepresented in the nursing workforce;
``(C) partnering with a health care facility,
nurse-managed health clinic, community health center,
or other facility that provides health care in order to
provide educational opportunities for the purpose of
establishing or expanding clinical education, with
emphasis on community-based clinical education;
``(D) modernizing infrastructure at such school,
including audiovisual or other equipment, simulation
and augmented reality resources, telehealth
technologies, and virtual and physical laboratories;
``(E) creating, supporting, or modernizing
educational programs and curriculum, including rural
and community-based clinical education, at such school;
``(F) enhancing and expanding nursing programs that
prepare nurse researchers and scientists;
``(G) establishing nurse-led intradisciplinary and
interprofessional educational partnerships;
``(H) supporting registered nurses in baccalaureate
degree programs or advanced degree programs described
in section 811(b), with a goal of becoming nurse
faculty and clinical preceptors; or
``(I) other activities that the Secretary
determines further the development, improvement, and
expansion of schools of nursing.
``(4) Definition.--In this section, the term `school of
nursing' has the meaning given such term in section 801(2).
``(c) Schools of Dentistry.--
``(1) In general.--The Secretary shall award grants to
eligible schools of dentistry to assist such schools in
expanding student enrollment.
``(2) Eligibility.--To be eligible to receive a grant under
this section, a school of dentistry shall submit an application
to the Secretary at such time, in such manner, and containing
such information as the Secretary may require, including a plan
to increase enrollment in the school by at least--
``(A) 20 percent by year 2 of the grant; and
``(B) an additional 20 percent by year 4 of the
grant.
``(3) Use of funds.--A school of dentistry that receives a
grant under this section shall use the funds awarded through
such grant for activities that include--
``(A) enhancing enrollment and retention of
students at such school using evidence-based practices,
with a priority for students from disadvantaged
backgrounds (including racial or ethnic groups
underrepresented in the dental workforce), individuals
from rural and underserved areas, low-income
individuals, individuals with a disability, and first
generation college students (as defined in section
402A(h)(3) of the Higher Education Act of 1965),
including through mentorship programs, providing tools
and programming for underrepresented students, and
addressing other student needs;
``(B) retaining current faculty and clinical
preceptors, and recruiting and hiring new faculty and
clinical preceptors, including by increasing wages and
providing loan repayment, with an emphasis on faculty
and clinical preceptors from racial or ethnic groups
who are underrepresented in the dentistry workforce;
``(C) partnering with a dental clinic, community
health center, or other facility, including a school-
based dental clinic, that provides dental care in order
to provide educational opportunities for the purpose of
establishing or expanding clinical education, with
emphasis on community-based clinical education;
``(D) modernizing infrastructure at such school,
including audiovisual or other equipment, simulation
and augmented reality resources, telehealth
technologies, and virtual and physical laboratories;
``(E) creating, supporting, or modernizing
educational programs and curriculum, including rural
and community-based clinical education, at such school;
or
``(F) other activities that the Secretary
determines further the development, improvement, and
expansion of schools of dentistry.
``(d) Grant Amounts; Grant Period.--Each grant awarded under this
section shall be in an amount determined by the Secretary, and for a
period of 10 years.
``(e) Reporting.--Each recipient of a grant under this section
shall submit to the Secretary an annual report that describes--
``(1) the number of students enrolled during the year
preceding the date of the report;
``(2) the percentage by which such enrollment for such year
has increased or decreased, as compared to enrollment for the
year preceding such year;
``(3) the number of new faculty and clinical preceptors
that were hired during such year; and
``(4) in the case of a recipient of a grant under
subsection (c), with respect to graduates of the applicable
school of dentistry--
``(A) the number who are practicing dentistry in a
rural community;
``(B) the number who are enrolled as a
participating provider under a State plan under title
XIX of the Social Security Act or under a waiver of
such a plan;
``(C) the rates of passage of the Integrated
National Board Dental Examination, and of any exam or
process by which a dentist obtains a license to
practice dentistry; and
``(D) the rates at which such graduates are
practicing dentistry 3 and 5 years after graduation.
``(f) Authorization of Appropriations.--There are authorized to be
appropriated, for the period of fiscal years 2026 through 2035--
``(1) $2,800,000,000 for purposes of carrying out
subsection (a);
``(2) $1,980,000,000 for purposes of carrying out
subsection (b); and
``(3) $615,000,000 for purposes of carrying out subsection
(c).''.
SEC. 3. PROGRAM OF PAYMENTS TO TEACHING HEALTH CENTERS THAT OPERATE
GRADUATE MEDICAL EDUCATION PROGRAMS.
Section 340H of the Public Health Service Act (42 U.S.C. 256h) is
amended--
(1) in subsection (c)(2)(B), by adding at the end the
following: ``Notwithstanding any other provision of this
section, the Secretary shall update such per resident amount
for each such qualified teaching health center such that such
amount for fiscal year 2026 is not less than $170,000, and such
amount for fiscal year 2027 and each fiscal year thereafter is
not less than the sum of the amount determined for the previous
fiscal year plus $10,000.''; and
(2) in subsection (g)(1)--
(A) in subparagraph (E), by striking ``; and'' and
inserting a semicolon;
(B) in subparagraph (F), by striking the period and
inserting a semicolon; and
(C) by adding at the end the following:
``(G) $892,500,000 for fiscal year 2026;
``(H) $1,890,000,000 for fiscal year 2027;
``(I) $2,992,500,000 for fiscal year 2028;
``(J) $3,150,000,000 for fiscal year 2029;
``(K) $3,307,500,000 for fiscal year 2030;
``(L) $3,465,000,000 for fiscal year 2031;
``(M) $3,622,500,000 for fiscal year 2032;
``(N) $3,780,000,000 for fiscal year 2033;
``(O) $3,937,500,000 for fiscal year 2034; and
``(P) $4,095,000,000 for fiscal year 2035.''.
SEC. 4. DISTRIBUTION OF ADDITIONAL MEDICARE GME RESIDENCY POSITIONS.
(a) Distribution.--
(1) In general.--Section 1886(h) of the Social Security Act
(42 U.S.C. 1395ww(h)) is amended--
(A) in paragraph (4)(F)(i), by striking ``and
(10)'' and inserting ``(10), and (11)'';
(B) in paragraph (4)(H)(i), by striking ``and
(10)'' and inserting ``(10), and (11)''; and
(C) by adding at the end the following new
paragraph:
``(11) Distribution of additional residency positions in
psychiatry and psychiatry subspecialties and primary care.--
``(A) Additional residency positions.--
``(i) In general.--For each of fiscal years
2027 through 2036 and for each succeeding
fiscal year until the aggregate number of full-
time equivalent residency positions distributed
under this paragraph is equal to the aggregate
number of such positions made available (as
specified in clause (ii)(I)), the Secretary
shall, subject to the succeeding provisions of
this paragraph, increase the otherwise
applicable resident limit for each qualifying
hospital that submits a timely application
under this subparagraph by such number as the
Secretary may approve effective beginning July
1 of the fiscal year of the increase.
``(ii) Number available for distribution.--
``(I) Total number available.--The
aggregate number of such positions made
available under this paragraph shall be
equal to 50,220.
``(II) Annual limit.--The aggregate
number of such positions so made
available shall not exceed 5,022 for a
fiscal year.
``(iii) Distribution for psychiatry or
psychiatry subspecialty residencies; primary
care residencies.--For each of fiscal years
2027 through 2036, of the positions made
available under this paragraph--
``(I) at least 15 percent shall be
distributed for a psychiatry or
psychiatry subspecialty residency (as
defined in subparagraph (F));
``(II) at least 30 percent shall be
distributed for a primary care
residency (as defined in such
subparagraph); and
``(iv) Timing.--The Secretary shall notify
hospitals of the number of positions
distributed to the hospital under this
paragraph as a result of an increase in the
otherwise applicable resident limit by January
31 of the fiscal year of the increase. Such
increase shall be effective beginning July 1 of
such fiscal year.
``(B) Considerations in distribution.--In
determining for which qualifying hospitals an increase
in the otherwise applicable resident limit is provided
under subparagraph (A), the Secretary shall take into
account the demonstrated likelihood of the hospital
filling the positions made available under this
paragraph within the first 5 training years beginning
after the date the increase would be effective, as
determined by the Secretary.
``(C) Requirements.--
``(i) Prohibition on distribution to
hospitals without an increase agreement.--No
increase in the otherwise applicable resident
limit of a hospital may be made under this
paragraph unless such hospital agrees to
increase the total number of full-time
equivalent residency positions under the
approved medical residency training program of
such hospital by the number of such positions
made available by such increase under this
paragraph.
``(ii) Requirement for hospitals to expand
programs.--If a hospital that receives an
increase in the otherwise applicable resident
limit under this paragraph would be eligible
for an adjustment to the otherwise applicable
resident limit for participation in a new
medical residency training program under
section 413.79(e)(3) of title 42, Code of
Federal Regulations (or any successor
regulation), the hospital shall ensure that any
positions made available under this paragraph
are used to expand an existing program of the
hospital and not for participation in a new
medical residency training program.
``(D) Application of per resident amounts for
nonprimary care.--With respect to additional residency
positions in a hospital attributable to the increase
provided under this paragraph, the approved FTE per
resident amounts are deemed to be equal to the hospital
per resident amounts for nonprimary care computed under
paragraph (2)(D) for that hospital.
``(E) Permitting facilities to apply aggregation
rules.--The Secretary shall permit hospitals receiving
additional residency positions attributable to the
increase provided under this paragraph to, beginning in
the fifth year after the effective date of such
increase, apply such positions to the limitation amount
under paragraph (4)(F) that may be aggregated pursuant
to paragraph (4)(H) among members of the same
affiliated group.
``(F) Definitions.--In this paragraph:
``(i) Otherwise applicable resident
limit.--The term `otherwise applicable resident
limit' means, with respect to a hospital, the
limit otherwise applicable under subparagraphs
(F)(i) and (H) of paragraph (4) on the resident
level for the hospital determined without
regard to this paragraph, but taking into
account paragraphs (7)(A), (7)(B), (8)(A),
(8)(B), (9)(A), and (10)(A).
``(ii) Primary care residency.--The term
`primary care residency' means a residency in a
program described in paragraph (5)(H).
``(iii) Psychiatry or psychiatry
subspecialty residency.--The term `psychiatry
or psychiatry subspecialty residency' has the
meaning given that term in paragraph (10)(F).
``(iv) Reference resident level.--The term
`reference resident level' means, with respect
to a hospital, the resident level for the most
recent cost reporting period of the hospital
ending on or before the date of enactment of
this paragraph, for which a cost report has
been settled (or, if not, submitted (subject to
audit)), as determined by the Secretary.
``(v) Resident level.--The term `resident
level' has the meaning given such term in
paragraph (7)(C)(i).''.
(2) IME.--Section 1886(d)(5)(B) of the Social Security Act
(42 U.S.C. 1395ww(d)(5)(B)) is amended--
(A) in clause (v), in the third sentence, by
striking ``and (h)(10)'' and inserting ``(h)(10), and
(h)(11)''; and
(B) by adding at the end the following new clause:
``(xiii) For discharges occurring on or
after July 1, 2027, insofar as an additional
payment amount under this subparagraph is
attributable to resident positions distributed
to a hospital under subsection (h)(11), the
indirect teaching adjustment factor shall be
computed in the same manner as provided under
clause (ii) with respect to such resident
positions.''.
(3) Prohibition on judicial review.--Section 1886(h)(7)(E)
of the Social Security Act (42 U.S.C. 1395ww(h)(7)(E)) is
amended by inserting ``paragraph (11),'' after ``paragraph
(10),''.
SEC. 5. RURAL RELOCATION GRANT PROGRAM.
Subpart 2 of part E of title VII of the Public Health Service Act
(42 U.S.C. 295 et seq.) is amended by adding at the end the following:
``SEC. 778A. RURAL RELOCATION GRANT PROGRAM.
``(a) In General.--The Secretary shall award grants to eligible
physicians, nurses, and dentists for purposes of assisting such
individuals in relocating to a rural area in which the individual
intends to practice medicine, nursing, or dentistry, as applicable.
``(b) Eligibility.--To be eligible to receive a grant under this
section, a physician, nurse, or dentist shall--
``(1) be licensed to practice medicine, nursing, or
dentistry, as applicable, in the State in which the rural area
to which the individual is relocating is located;
``(2) prior to such relocation, be practicing in an area
that is not a rural area;
``(3) upon such relocation, have a permanent position in
the area to which the individual is relocating and intend to
practice in such area for not fewer than 3 years; and
``(4) submit an application to the Secretary at such time,
in such manner, and containing such information as the
Secretary may require.
``(c) Grant Amounts; Use of Funds; Repayment.--
``(1) In general.--A grant awarded under this section shall
be in an amount determined by the Secretary, not to exceed
$20,000.
``(2) Use of funds.--An individual receiving a grant under
this section may use such grant for eligible life and
relocation expenses, as determined by the Secretary.
``(3) Repayment.--If an individual receiving a grant under
this section leaves the area described in subsection (b)(3)
before the expiration of the 3-year period described in such
subsection, such individual shall repay to the Secretary an
amount equal to 50 percent of the amount of the grant.
``(d) Authorization of Appropriations.--To carry out this section,
there is authorized to be appropriated $1,800,000,000 for the period of
fiscal years 2026 through 2035.''.
<all>
Introduced in Senate
Read twice and referred to the Committee on Health, Education, Labor, and Pensions.
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