What changed between these versions
A complete substitute amendment, v2 fundamentally restructures and expands the original bill. It shifts the reauthorization periods for health workforce programs by one fiscal year, introduces new provisions for pediatric health care workforce contracts, and adds an entirely new section dedicated to State and Regional Centers for Health Workforce Analysis, particularly focusing on the nursing workforce.
Overview
Extensive changes throughout the bill, explicitly introduced as a complete substitute amendment. · v2 fundamentally restructures the bill, shifting reauthorization timelines, refining existing program parameters, and meaningfully expanding the scope by adding a new focus on nursing workforce analysis.
v2 is a complete substitute amendment, replacing the entirety of v1's operative text. The most significant changes include a shift in the reauthorization period for all health professions workforce programs from fiscal years 2026-2030 to 2027-2031, along with some adjustments to authorized funding levels. Additionally, v2 introduces new provisions regarding breach and termination of contracts for the pediatric health care workforce program and establishes an entirely new section for State and Regional Centers for Health Workforce Analysis, with a specific emphasis on the nursing workforce. While some core program reauthorizations remain, the details and scope are substantially altered.
Major additions
This new subsection, 'Breach of Contract,' authorizes the Secretary to establish a liquidated damages formula for contracts under Section 775 and specifies that failure to complete the full period of service alone does not constitute a breach if the individual completed years of service for which payments were made in good faith.
This addition provides a clearer framework for managing service obligations and potential breaches for pediatric health care professionals, offering both a mechanism for accountability and protection for individuals who fulfill part of their commitment. It introduces new legal and financial implications for participants in the program.
This new subsection, 'Termination of Contract,' allows the Secretary to terminate a contract under Section 775 in the same manner as contracts entered into under section 338B of the Public Health Service Act.
This addition standardizes the process for contract termination, aligning it with established procedures for similar health service contracts. It provides a clear administrative pathway for ending agreements, which was not explicitly detailed in v1.
This entirely new section, 'State and Regional Centers for Health Workforce Analysis,' expands covered programs under Section 761(c)(1)(A) to include programs 'under this Act' (instead of 'this title') and adds new paragraphs (3), (4), and (5) to Section 761(c). These new paragraphs mandate that at least one grant or contract be awarded to an eligible entity focused on advancing the nursing workforce, detailing specific requirements for such entities, and outlining permissible activities for analysis, reporting, and technical assistance related to the nursing workforce.
This is a significant expansion of the bill's scope, creating a dedicated framework and funding stream for robust, evidence-based analysis and support for the nursing workforce. It aims to address nursing shortages and maldistribution by fostering collaboration, data collection, and strategy development at State and regional levels, directly impacting nursing professionals, educators, and healthcare systems.
Deletions
This provision in v1 amended Section 751(h)(1) of the Public Health Service Act, which governs Area Health Education Centers (AHEC). Specifically, it changed the maximum award periods for AHEC grants from '12 years' to '2 award cycles' in subparagraph (A) and from '6 years' to '1 award cycle' in subparagraph (B).
The deletion removes v1's proposed changes to the duration limits for AHEC grants. This means that the original, pre-v1 statutory language regarding award cycles for AHEC grants would remain in effect, or new limits would need to be established elsewhere. It removes a specific attempt to modify the funding structure for these centers.
Modifications
This modification delays the start of the reauthorization period by one year and reduces the annual funding level for programs under this section, potentially impacting the scope or number of initiatives supported.
Before
v1 reauthorized section 736(i) by striking '$23,711,000 for each of fiscal years 2021 through 2025' and inserting '$28,422,000 for each of fiscal years 2026 through 2030'.
After
v2 reauthorizes section 736(i) by striking '$23,711,000 for each of fiscal years 2021 through 2025' and inserting '$25,422,000 for each of fiscal years 2027 through 2031'.
This modification delays the start of the reauthorization period by one year for programs under this section, but maintains the same funding level as previously proposed.
Before
v1 reauthorized section 740(a) by striking '$51,470,000 for each of fiscal years 2021 through 2025' and inserting '$55,014,000 for each of fiscal years 2026 through 2030'.
After
v2 reauthorizes section 740(a) by striking '$51,470,000 for each of fiscal years 2021 through 2025' and inserting '$55,014,000 for each of fiscal years 2027 through 2031'.
This modification delays the start of the reauthorization period by one year for programs under this section, but maintains the same funding level as previously proposed.
Before
v1 reauthorized section 740(b) by striking '$1,190,000 for each of fiscal years 2021 through 2025' and inserting '$2,310,000 for each of fiscal years 2026 through 2030'.
After
v2 reauthorizes section 740(b) by striking '$1,190,000 for each of fiscal years 2021 through 2025' and inserting '$2,310,000 for each of fiscal years 2027 through 2031'.
This modification delays the start of the reauthorization period by one year for programs under this section, maintaining the funding level established in v1's proposed change.
Before
v1 reauthorized section 740(c) by striking '$15,000,000 for each of fiscal years 2021 through 2025' and inserting '$16,000,000 for each of fiscal years 2026 through 2030'.
After
v2 reauthorizes section 740(c) by striking 'fiscal years 2021 through 2025' and inserting 'fiscal years 2027 through 2031'.
This modification provides an additional year of authorization for programs under this section, extending their potential operational period.
Before
v1 reauthorized section 740(d) by striking 'September 30, 2025' and inserting 'September 30, 2030'.
After
v2 reauthorizes section 740(d) by striking 'September 30, 2025' and inserting 'September 30, 2031'.
This modification delays the start of the reauthorization period by one year for programs under this section, but maintains the same funding level as previously proposed.
Before
v1 reauthorized section 747(c)(1) by striking '$48,924,000 for each of fiscal years 2021 through 2025' and inserting '$49,924,000 for each of fiscal years 2026 through 2030'.
After
v2 reauthorizes section 747(c)(1) by striking '$48,924,000 for each of fiscal years 2021 through 2025' and inserting '$49,924,000 for each of fiscal years 2027 through 2031'.
This modification delays the start of the reauthorization period by one year but increases the annual funding level for programs under this section, potentially expanding their capacity or reach.
Before
v1 reauthorized section 748(f) by striking '$28,531,000 for each of fiscal years 2021 through 2025' and inserting '$42,673,000 for each of fiscal years 2026 through 2030'.
After
v2 reauthorizes section 748(f) by striking '$28,531,000 for each of fiscal years 2021 through 2025' and inserting '$43,673,000 for each of fiscal years 2027 through 2031'.
This modification delays the start of the reauthorization period by one year for programs under this section, but maintains the same funding level as previously proposed.
Before
v1 reauthorized section 751(j)(1) by striking '$41,250,000 for each of fiscal years 2021 through 2025' and inserting '$47,000,000 for each of fiscal years 2026 through 2030'.
After
v2 reauthorizes section 751(j)(1) by striking '$41,250,000 for each of fiscal years 2021 through 2025' and inserting '$47,000,000 for each of fiscal years 2027 through 2031'.
This modification delays the start of the reauthorization period by one year for programs under this section, but maintains the same funding level as previously proposed.
Before
v1 reauthorized section 753(d) by striking '$40,737,000 for each of fiscal years 2021 through 2025' and inserting '$48,245,000 for each of fiscal years 2026 through 2030'.
After
v2 reauthorizes section 753(d) by striking '$40,737,000 for each of fiscal years 2021 through 2025' and inserting '$48,245,000 for each of fiscal years 2027 through 2031'.
This modification delays the start of the reauthorization period by one year for programs under this section.
Before
v1 reauthorized section 761(e)(1)(A) by striking '2021 through 2025' and inserting '2026 through 2030'.
After
v2 reauthorizes section 761(e)(1)(A) by striking '2021 through 2025' and inserting '2027 through 2031'.
This modification provides an additional year of authorization for programs under this section, extending their potential operational period.
Before
v1 reauthorized section 762(i) by striking 'September 30, 2023' and inserting 'September 30, 2030'.
After
v2 reauthorizes section 762(i) by striking 'September 30, 2023' and inserting 'September 30, 2031'.
This modification delays the start of the reauthorization period by one year for programs under this section, but maintains the same funding level as previously proposed.
Before
v1 reauthorized section 770(a) by striking '$17,000,000 for each of fiscal years 2021 through 2025' and inserting '$18,000,000 for each of fiscal years 2026 through 2030'.
After
v2 reauthorizes section 770(a) by striking '$17,000,000 for each of fiscal years 2021 through 2025' and inserting '$18,000,000 for each of fiscal years 2027 through 2031'.
This modification delays the start of the reauthorization period by one year, consolidates the funding authorization for the pediatric health care workforce program, and provides greater flexibility by making the funds available until expended, rather than for specific fiscal years only.
Before
v1 reauthorized section 775(e) by striking 'is authorized to be appropriated such sums as may be necessary for each of fiscal years 2021 through 2025.' and inserting specific appropriations: '$5,000,000' for subsection (c)(1)(A) and '$5,000,000' for subsection (c)(1)(B) for fiscal years 2026 through 2030.
After
v2 reauthorizes section 775(e) by striking 'such sums as may be necessary for each of fiscal years 2021 through 2025.' and inserting 'to carry out this section $10,000,000 for each of fiscal years 2027 through 2031, to remain available until expended.'
This modification delays the start of the reauthorization period by one year for programs under this section.
Before
v1 reauthorized section 776(i) by striking '2023 through 2025' and inserting '2026 through 2030'.
After
v2 reauthorizes section 776(i) by striking '2023 through 2025' and inserting '2027 through 2031'.
This modification refines the targeting of pediatric subspecialty services, potentially broadening the definition of 'underserved' to include specific pediatric populations beyond just geographic areas, ensuring care reaches those most in need.
Before
v1 modified the service requirement for pediatric subspecialists to be 'to underserved children or in an area with a shortage of the specified pediatric subspecialty'.
After
v2 modified the service requirement for pediatric subspecialists to be 'to underserved pediatric populations, or to provide such care in an area with a shortage of the specified pediatric subspecialty'.
The deletion in v2 removes a specific descriptive clause related to the service location or population, potentially streamlining the language but also removing a direct reference to the target areas/populations for service.
Before
v1 modified the text by striking 'an area or' and inserting 'a'.
After
v2 modified the text by striking 'serving an area or population described in such paragraph'.
This modification broadens the scope of mental and behavioral health professionals eligible for the program, allowing the Secretary flexibility to include emerging or specialized disciplines, thereby potentially increasing the available workforce for underserved pediatric populations.
Before
v1 defined 'qualified health professional' in relation to child and adolescent mental and behavioral health care fields, specifically mentioning 'professional counseling'.
After
v2 expands the definition of 'qualified health professional' in child and adolescent mental and behavioral health care fields to include 'professional counseling, or such other pediatric mental or behavioral health discipline as the Secretary determines appropriate'. This change applies to both clauses (i) and (ii) of subparagraph (B).
This is a structural change to accommodate the insertion of new subsections (e), (f), and (g) in v2, ensuring proper numbering and referencing within Section 775.
Before
v1 redesignated subsection (e) (reauthorization) as subsection (f).
After
v2 redesignated subsection (e) (reauthorization) as subsection (h).
This modification imposes more stringent and specific requirements on qualified health professionals regarding their service obligations, particularly by mandating a minimum percentage of direct clinical care. This ensures a greater focus on patient care delivery while still accounting for academic responsibilities.
Before
v1 inserted a new subsection (e) 'Full-Time Service Obligations' with two paragraphs. Paragraph (1) established general requirements for full-time service consistent with practice standards, including research and teaching obligations. Paragraph (2) established requirements for fellowships or residencies consistent with accrediting body requirements.
After
v2 inserts a new subsection (e) 'Full-Time Service Obligations' with two paragraphs. Paragraph (1) is rewritten to provide more detailed requirements, including a minimum of half the required service hours per contract year for direct clinical care, and mandates consultation with organizations representing qualified pediatric health professionals and service sites. It also explicitly lists the types of qualified health professionals covered. Paragraph (2) remains similar to v1's provision for fellowships or residencies.
This modification changes the target demographic for Area Health Education Centers' (AHEC) outreach programs. v1 aimed for a broader, more flexible 'pre-collegiate' definition, while v2 specifies 'middle school and high school', potentially narrowing the interpretation but clearly defining the age groups for workforce pipeline development efforts.
Before
v1 amended Section 751(c)(1)(G) by striking 'high school' and inserting 'pre-collegiate'.
After
v2 amended Section 751(c)(1)(G) by inserting 'middle school and' before 'high school'.
Scope
Complete substitute — Changes are scattered throughout the bill, affecting multiple sections of the Public Health Service Act, including reauthorization provisions, specific program details for pediatric health care, and introducing an entirely new section for health workforce analysis. — v2 represents a meaningful change in policy direction. While it maintains the core intent of reauthorizing health workforce programs, the shift in reauthorization periods, the detailed refinements to pediatric workforce obligations, and especially the introduction of a dedicated nursing workforce analysis program, signify a more targeted and expanded policy approach. — The changes interact significantly with existing provisions. The reauthorization period shifts affect all programs under Title VII. The new contract provisions for pediatric health care professionals modify the operational aspects of that specific program. The new section on health workforce analysis creates new mandates and funding opportunities that interact with existing workforce development efforts.
Impact analysis
Health professions workforce programs under Title VII of the Public Health Service Act
Procedural change and slight adjustments in funding. The shift in fiscal years delays the next reauthorization cycle, while specific funding changes could lead to minor expansions or contractions in individual program capacities.
The reauthorization period for most programs is shifted from fiscal years 2026-2030 (as proposed in v1) to 2027-2031. Some specific funding amounts are adjusted, with one program seeing a decrease and another an increase, while others remain consistent with v1's proposed levels. The authorization for Section 775 is consolidated and made available until expended.
Pediatric health care professionals participating in Section 775 programs
Procedural change, with some expansion of eligibility and increased clarity on contractual obligations and consequences. The direct clinical care mandate could shift their professional focus.
Service obligations are clarified and made more specific, including a mandate for a minimum percentage of direct clinical care. The definition of eligible mental and behavioral health disciplines is expanded. New provisions are added for managing contract breaches and terminations, providing clearer guidelines and protections.
Area Health Education Centers (AHEC) and their outreach programs
Procedural change in outreach focus and maintenance of existing grant award cycle rules.
The target for pre-collegiate outreach is specified as 'middle school and high school' students, rather than the broader 'pre-collegiate' term in v1. Additionally, v1's proposed changes to AHEC grant award cycle limits are removed.
Nursing workforce centers, nursing professionals, and healthcare systems
Expansion of support and resources. This group gains new opportunities for funding, collaboration, and evidence-based initiatives aimed at alleviating nursing shortages and maldistribution.
An entirely new section is added to the bill, establishing a framework for State and Regional Centers for Health Workforce Analysis with a specific focus on the nursing workforce. This includes mandates for grants/contracts to entities supporting the nursing workforce, and detailed provisions for analysis, reporting, and technical assistance.