HB 157 — An Act providing for grant awards to entities in rural counties and designated medically underserved areas to pay for the education debt of practitioners employed at the entity.

PRINTER'S NO.   99

                   THE GENERAL ASSEMBLY OF PENNSYLVANIA



                       HOUSE BILL
                       No. 157
                                              Session of
                                                2025

     INTRODUCED BY RAPP, FRANKEL, TWARDZIK, SANCHEZ, ZIMMERMAN,
        VENKAT, HOWARD, KHAN, CUTLER, GREINER, HILL-EVANS, FREEMAN,
        PICKETT AND WEBSTER, JANUARY 14, 2025

     REFERRED TO COMMITTEE ON HEALTH, JANUARY 14, 2025


                                   AN ACT
 1   Providing for grant awards to entities in rural counties and
 2      designated medically underserved areas to pay for the
 3      education debt of practitioners employed at the entity.
 4      The General Assembly of the Commonwealth of Pennsylvania
 5   hereby enacts as follows:
 6   Section 1.   Short title.
 7      This act shall be known and may be cited as the Rural Health
 8   Care Grant Program Act.
 9   Section 2.   Legislative intent.
10      It is the intent of the General Assembly through this
11   legislation to:
12          (1)   Allow entities in designated medically underserved
13      areas and rural areas to have an opportunity to recruit and
14      retain high quality practitioners.
15          (2)   Have more practitioners available to practice in
16      designated medically underserved areas and rural areas.
17          (3)   Give patients in designated medically underserved
18      areas and rural areas more access to practitioners.
 1             (4)   Prevent the possible closure of entities in
 2      designated medically underserved areas and rural areas due to
 3      practitioner shortages.
 4   Section 3.      Definitions.
 5      The following words and phrases when used in this act shall
 6   have the meanings given to them in this section unless the
 7   context clearly indicates otherwise:
 8      "Birth center."      As defined in section 802.1 of the act of
 9   July 19, 1979 (P.L.130, No.48), known as the Health Care
10   Facilities Act.
11      "Department."      The Department of Health of the Commonwealth.
12      "Designated medically underserved area."      The term shall mean
13   the same as defined under section 1301 of the act of December 2,
14   1992 (P.L.741, No.113), known as the Children's Health Care Act.
15      "Education debt."      Debt incurred for professional schooling
16   to practice as a practitioner in this Commonwealth.
17      "Entity."      A birth center, a federally qualified health
18   center, a rural health clinic or a hospital.
19      "Federally qualified health center."      As defined in 42 U.S.C.
20   § 1396d(l)(2)(B) (relating to definitions). The term includes a
21   federally qualified health center look-alike.
22      "Full-time."      A practitioner who works on average more than
23   30 hours per week or more than 130 hours per month.
24      "Grant."      A sum of money that is awarded to an entity by the
25   department under this act.
26      "Hospital."      A general acute care or specialty hospital
27   located in a designated medically underserved area or rural
28   county.
29      "Licensed practical nurse."      An individual licensed to
30   practice practical nursing under the act of March 2, 1956 (1955

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 1   P.L.1211, No.376), known as the Practical Nurse Law.
 2      "Midwife or nurse-midwife."       As defined in section 2 of the
 3   act of December 20, 1985 (P.L.457, No.112), known as the Medical
 4   Practice Act of 1985.
 5      "Nurse."     A licensed practical nurse or registered nurse.
 6      "Physician."     Either:
 7            (1)   as defined in section 2 of the act of October 5,
 8      1978 (P.L.1109, No.261), known as the Osteopathic Medical
 9      Practice Act; or
10            (2)   as defined in section 2 of the Medical Practice Act
11      of 1985.
12      "Practitioner."     A physician, nurse or midwife or nurse-
13   midwife.
14      "Program."     The Rural Health Care Grant Program established
15   under section 4.
16      "Registered nurse."     An individual licensed to practice
17   professional nursing under the act of May 22, 1951 (P.L.317,
18   No.69), known as The Professional Nursing Law.
19      "Rural county."     A county within this Commonwealth where the
20   population density is less than 284 persons per square mile as
21   defined by the Center for Rural Pennsylvania.
22      "Rural health clinic."       As defined in 42 U.S.C. § 1395x(aa)
23   (2) (relating to definitions) and certified by Medicare.
24   Section 4.     Establishment.
25      The Rural Health Care Grant Program is established in the
26   department to be administered by the department.
27   Section 5.     Use of money.
28      (a)     Duty of department.--The department shall distribute
29   grants to an entity in accordance with this act from money
30   appropriated for the program by the General Assembly.

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 1      (b)   Distribution by entity.--An entity shall use the grant
 2   awarded under subsection (a) to pay for the education debt of
 3   practitioners that the entity employs according to the
 4   following:
 5            (1)   An entity shall pay the applicable creditor or
 6      designated person of the education debt on behalf of the
 7      practitioner.
 8            (2)   Within 30 days after disbursement of money to the
 9      applicable creditor or designated person, an entity shall
10      report to the department the following:
11                  (i)    The date the payment was sent to the applicable
12            creditor or designated person.
13                  (ii)    The amount of the payment.
14                  (iii)    The name and address of the applicable
15            creditor or designated person.
16                  (iv)    The names of the practitioners whose education
17            debt was paid by the entity with the grant.
18      (c)   Receipt.--A written or electronic receipt of payment of
19   education debt shall be issued to a practitioner employed by the
20   entity whose education debt was paid by a grant under this act.
21   Section 6.     Grant awards.
22      (a)   Criteria for grant from department.--The department
23   shall award a grant to an entity that is located in a designated
24   medically underserved area or rural county. Priority shall be
25   given to independent entities not owned by, managed by or
26   affiliated with any health care system, a legally separate
27   health care provider or other entity.
28      (b)   Limitation of awards.--
29            (1)   The department may not award more than $250,000 to
30      an entity in one calendar year.

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 1            (2)   The amount distributed to a practitioner may not
 2      exceed the amount owed in education debt.
 3      (c)   Entity award.--An entity shall distribute the grant to
 4   one or more chosen practitioners who are employed by the entity.
 5   In order to receive a payment of education debt, a practitioner
 6   must:
 7            (1)   Work a minimum of three years for the entity that
 8      distributed the grant to pay for education debt.
 9            (2)   Be licensed to practice as a practitioner in this
10      Commonwealth under the applicable licensing board of the
11      Department of State.
12            (3)   Begin work within six months of accepting a position
13      with the entity paying for the education debt.
14            (4)   Be employed as a full-time practitioner for the
15      entity providing the grant.
16   Section 7.     Entity application for a grant.
17      (a)   Requirements.--Applications shall:
18            (1)   Be submitted by an entity to the department in a
19      manner the department deems appropriate.
20            (2)   Be available electronically.
21            (3)   Include documentation as deemed necessary by the
22      department.
23      (b)   Certification.--An entity shall certify in good faith
24   that the information provided in the application and all
25   supporting documents and forms are true and accurate in all
26   material aspects. An entity, or an authorized representative of
27   the entity, that knowingly makes a false statement to obtain a
28   grant shall be subject to 18 Pa.C.S. § 4904 (relating to unsworn
29   falsification to authorities).
30   Section 8.     Review of application.

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 1      (a)   Selection.--The department shall select an appropriate
 2   number of entities to receive a grant under this act each
 3   calendar year, dependent upon the amount of money appropriated
 4   for the program by the General Assembly.
 5      (b)   Approval or disapproval.--No later than 60 days after an
 6   entity's submission or resubmission of an application, the
 7   department shall approve or deny the application for a grant.
 8   The department shall provide a notice to the entity that:
 9            (1)   the application for a grant is approved for an
10      amount determined by the department; or
11            (2)   the application for a grant is denied. The
12      department shall provide its reasons for denial of the
13      application. The entity may resubmit its application based
14      upon the department's reasons for denying the application.
15   Section 9.     Grant agreements.
16      Upon approval of an application under section 8, the
17   department shall enter into a grant agreement with the entity to
18   award a grant under this act. The grant agreement shall explain
19   the terms and conditions of the grant, including the applicable
20   laws of this Commonwealth and all reporting requirements. The
21   department, an entity and any other party, as deemed necessary
22   by the department, may enter into the grant agreement via
23   electronic signature.
24   Section 10.    Disbursement of grants.
25      The following shall apply to the disbursement of grants:
26            (1)   The department shall determine the number of grants
27      to be awarded with the money appropriated by the General
28      Assembly.
29            (2)   For approved grants, the department shall award a
30      grant to an entity in increments of $10,000 up to the limit

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 1      under section 6(b)(1). The department may award a grant of
 2      less than $10,000 if the department determines that a
 3      decrease is necessary to preserve adequate funding for more
 4      grants.
 5            (3)   An entity shall report to the department the initial
 6      date of employment for each practitioner who receives payment
 7      of education debt and the date of departure from employment
 8      for each practitioner, if applicable.
 9            (4)   The department shall begin disbursement of grant
10      money to an entity within 90 days after the approval of an
11      entity's application.
12   Section 11.    Reports.
13      (a)   Content.--No later than December 31 of each year, the
14   department shall publish a report on the department's publicly
15   accessible Internet website that contains the following
16   information:
17            (1)   The number of grants awarded under this act.
18            (2)   The number of practitioners who received a payment
19      of their education debt.
20            (3)   The license type and practice area of each
21      practitioner, as applicable.
22            (4)   The name and address of each entity that received a
23      grant under this act.
24            (5)   The amount of each grant awarded.
25            (6)   The total amount of the appropriation distributed
26      each calendar year.
27            (7)   An aggregate total for each designated medically
28      underserved area or rural county where a practitioner awarded
29      grant money is employed by an entity.
30      (b)   Confidentiality.--The name, address and other personal

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 1   information of a practitioner who received a payment of
 2   education debt from an entity may not be listed on the
 3   department's publicly accessible Internet website and may not be
 4   considered accessible under the act of February 14, 2008 (P.L.6,
 5   No.3), known as the Right-to-Know Law.
 6      (c)   Submission.--The department shall submit the report
 7   under subsection (a) to the following:
 8            (1)   The chair and minority chair of the Appropriations
 9      Committee of the Senate.
10            (2)   The chair and minority chair of the Appropriations
11      Committee of the House of Representatives.
12            (3)   The chair and minority chair of the Health and Human
13      Services Committee of the Senate.
14            (4)   The chair and minority chair of the Health Committee
15      of the House of Representatives.
16      (d)   Final report.--After disbursement of all money
17   appropriated for the program, the department shall publish a
18   final report with the information listed under this section
19   within six months.
20   Section 12.    Tax applicability.
21      Grants awarded under this act may not be considered taxable
22   income to an entity or practitioner under the act of March 4,
23   1971 (P.L.6, No.2), known as the Tax Reform Code of 1971.
24   Section 13.    Compliance.
25      (a)   Reimbursement for noncompliance.--The department shall
26   determine compliance with the requirements of this act. If an
27   entity or practitioner fails to comply with the requirements of
28   this act, the entity or practitioner shall reimburse the
29   Commonwealth for the amount of the grant received or awarded
30   based on the period of noncompliance, including interest

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 1   accrued, as determined by the department based on a
 2   determination of which party violated this act. The department,
 3   entity and practitioner shall make every effort to resolve
 4   conflicts in order to prevent a breach of the program
 5   requirements established by the department.
 6      (b)   Agreement between entity and practitioner.--An entity
 7   that receives a grant under this act may require a practitioner
 8   awarded money to enter into an agreement established by the
 9   entity and determine compliance, including the timing of
10   disbursement of the grant money, as appropriate to facilitate
11   the purposes and intent of this act and subject to the
12   requirements of this act.
13   Section 14.   Effective date.
14      This act shall take effect in 120 days.




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