[Congressional Bills 107th Congress]
[From the U.S. Government Publishing Office]
[H.R. 3487 Enrolled Bill (ENR)]
H.R.3487
One Hundred Seventh Congress
of the
United States of America
AT THE SECOND SESSION
Begun and held at the City of Washington on Wednesday,
the twenty-third day of January, two thousand and two
An Act
To amend the Public Health Service Act with respect to health
professions programs regarding the field of nursing.
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 ``Nurse Reinvestment Act''.
SEC. 2. TABLE OF CONTENTS.
The table of contents for this Act is as follows:
Sec. 1. Short title.
Sec. 2. Table of contents.
TITLE I--NURSE RECRUITMENT
Sec. 101. Definitions.
Sec. 102. Public service announcements regarding the nursing profession.
Sec. 103. National Nurse Service Corps.
TITLE II--NURSE RETENTION
Sec. 201. Building career ladders and retaining quality nurses.
Sec. 202. Comprehensive geriatric education.
Sec. 203. Nurse faculty loan program.
Sec. 204. Reports by General Accounting Office.
TITLE I--NURSE RECRUITMENT
SEC. 101. DEFINITIONS.
Section 801 of the Public Health Service Act (42 U.S.C. 296) is
amended by adding at the end the following:
``(9) Ambulatory surgical center.--The term `ambulatory
surgical center' has the meaning applicable to such term under
title XVIII of the Social Security Act.
``(10) Federally qualified health center.--The term `Federally
qualified health center' has the meaning given such term under
section 1861(aa)(4) of the Social Security Act.
``(11) Health care facility.--The term `health care facility'
means an Indian Health Service health center, a Native Hawaiian
health center, a hospital, a Federally qualified health center, a
rural health clinic, a nursing home, a home health agency, a
hospice program, a public health clinic, a State or local
department of public health, a skilled nursing facility, an
ambulatory surgical center, or any other facility designated by the
Secretary.
``(12) Home health agency.--The term `home health agency' has
the meaning given such term in section 1861(o) of the Social
Security Act.
``(13) Hospice program.--The term `hospice program' has the
meaning given such term in section 1861(dd)(2) of the Social
Security Act.
``(14) Rural health clinic.--The term `rural health clinic' has
the meaning given such term in section 1861(aa)(2) of the Social
Security Act.
``(15) Skilled nursing facility.--The term `skilled nursing
facility' has the meaning given such term in section 1819(a) of the
Social Security Act.''.
SEC. 102. PUBLIC SERVICE ANNOUNCEMENTS REGARDING THE NURSING
PROFESSION.
Title VIII of the Public Health Service Act (42 U.S.C. 296 et seq.)
is amended by adding at the end the following:
``PART H--PUBLIC SERVICE ANNOUNCEMENTS
``SEC. 851. PUBLIC SERVICE ANNOUNCEMENTS.
``(a) In General.--The Secretary shall develop and issue public
service announcements that advertise and promote the nursing
profession, highlight the advantages and rewards of nursing, and
encourage individuals to enter the nursing profession.
``(b) Method.--The public service announcements described in
subsection (a) shall be broadcast through appropriate media outlets,
including television or radio, in a manner intended to reach as wide
and diverse an audience as possible.
``(c) Authorization of Appropriations.--There are authorized to be
appropriated to carry out this section such sums as may be necessary
for each of fiscal years 2003 through 2007.
``SEC. 852. STATE AND LOCAL PUBLIC SERVICE ANNOUNCEMENTS.
``(a) In General.--The Secretary may award grants to eligible
entities to support State and local advertising campaigns through
appropriate media outlets to promote the nursing profession, highlight
the advantages and rewards of nursing, and encourage individuals from
disadvantaged backgrounds to enter the nursing profession.
``(b) Use of Funds.--An eligible entity that receives a grant under
subsection (a) shall use funds received through such grant to acquire
local television and radio time, place advertisements in local
newspapers, or post information on billboards or on the Internet in a
manner intended to reach as wide and diverse an audience as possible,
in order to--
``(1) advertise and promote the nursing profession;
``(2) promote nursing education programs;
``(3) inform the public of financial assistance regarding such
education programs;
``(4) highlight individuals in the community who are practicing
nursing in order to recruit new nurses; or
``(5) provide any other information to recruit individuals for
the nursing profession.
``(c) Limitation.--An eligible entity that receives a grant under
subsection (a) shall not use funds received through such grant to
advertise particular employment opportunities.
``(d) Authorization of Appropriations.--There are authorized to be
appropriated to carry out this section such sums as may be necessary
for each of fiscal years 2003 through 2007.''.
SEC. 103. NATIONAL NURSE SERVICE CORPS.
(a) Loan Repayment Program.--Section 846(a) of the Public Health
Service Act (42 U.S.C. 297n(a)) is amended--
(1) in paragraph (3), by striking ``in an Indian Health Service
health center'' and all that follows to the semicolon and inserting
``at a health care facility with a critical shortage of nurses'';
and
(2) by adding at the end the following: ``After fiscal year
2007, the Secretary may not, pursuant to any agreement entered into
under this subsection, assign a nurse to any private entity unless
that entity is nonprofit.''.
(b) Establishment of Scholarship Program.--Section 846 of the
Public Health Service Act (42 U.S.C. 297n) is amended--
(1) in the heading for the section, by striking ``loan
repayment program'' and inserting ``loan repayment and scholarship
programs'';
(2) by redesignating subsections (d), (f), (g), and (h) as
subsections (f), (h), (i), and (g), respectively;
(3) by transferring subsections (f) and (g) (as so
redesignated) from their current placements, by inserting
subsection (f) after subsection (e), and by inserting subsection
(g) after subsection (f) (as so inserted); and
(4) by inserting after subsection (c) the following subsection:
``(d) Scholarship Program.--
``(1) In general.--The Secretary shall (for fiscal years 2003
and 2004) and may (for fiscal years thereafter) carry out a program
of entering into contracts with eligible individuals under which
such individuals agree to serve as nurses for a period of not less
than 2 years at a health care facility with a critical shortage of
nurses, in consideration of the Federal Government agreeing to
provide to the individuals scholarships for attendance at schools
of nursing.
``(2) Eligible individuals.--In this subsection, the term
`eligible individual' means an individual who is enrolled or
accepted for enrollment as a full-time or part-time student in a
school of nursing.
``(3) Service requirement.--
``(A) In general.--The Secretary may not enter into a
contract with an eligible individual under this subsection
unless the individual agrees to serve as a nurse at a health
care facility with a critical shortage of nurses for a period
of full-time service of not less than 2 years, or for a period
of part-time service in accordance with subparagraph (B).
``(B) Part-time service.--An individual may complete the
period of service described in subparagraph (A) on a part-time
basis if the individual has a written agreement that--
``(i) is entered into by the facility and the
individual and is approved by the Secretary; and
``(ii) provides that the period of obligated service
will be extended so that the aggregate amount of service
performed will equal the amount of service that would be
performed through a period of full-time service of not less
than 2 years.
``(4) Applicability of certain provisions.--The provisions of
subpart III of part D of title III shall, except as inconsistent
with this section, apply to the program established in paragraph
(1) in the same manner and to the same extent as such provisions
apply to the National Health Service Corps Scholarship Program
established in such subpart.''.
(c) Preference.--Section 846(e) of the Public Health Service Act
(42 U.S.C. 297n(e)) is amended by striking ``under subsection (a)'' and
all that follows through the period and inserting ``under subsection
(a) or (d), the Secretary shall give preference to qualified applicants
with the greatest financial need.''.
(d) Reports.--Subsection (h) of section 846 of the Public Health
Service Act (42 U.S.C. 297n) (as redesignated by subsection (b)(2)) is
amended to read as follows:
``(h) Reports.--Not later than 18 months after the date of
enactment of the Nurse Reinvestment Act, and annually thereafter, the
Secretary shall prepare and submit to the Congress a report describing
the programs carried out under this section, including statements
regarding--
``(1) the number of enrollees, scholarships, loan repayments,
and grant recipients;
``(2) the number of graduates;
``(3) the amount of scholarship payments and loan repayments
made;
``(4) which educational institution the recipients attended;
``(5) the number and placement location of the scholarship and
loan repayment recipients at health care facilities with a critical
shortage of nurses;
``(6) the default rate and actions required;
``(7) the amount of outstanding default funds of both the
scholarship and loan repayment programs;
``(8) to the extent that it can be determined, the reason for
the default;
``(9) the demographics of the individuals participating in the
scholarship and loan repayment programs;
``(10) justification for the allocation of funds between the
scholarship and loan repayment programs; and
``(11) an evaluation of the overall costs and benefits of the
programs.''.
(e) Funding.--Subsection (i) of section 846 of the Public Health
Service Act (42 U.S.C. 297n) (as redesignated by subsection (b)(2)) is
amended to read as follows:
``(i) Funding.--
``(1) Authorization of appropriations.--For the purpose of
payments under agreements entered into under subsection (a) or (d),
there are authorized to be appropriated such sums as may be
necessary for each of fiscal years 2003 through 2007.
``(2) Allocations.--Of the amounts appropriated under paragraph
(1), the Secretary may, as determined appropriate by the Secretary,
allocate amounts between the program under subsection (a) and the
program under subsection (d).''.
TITLE II--NURSE RETENTION
SEC. 201. BUILDING CAREER LADDERS AND RETAINING QUALITY NURSES.
Section 831 of the Public Health Service Act (42 U.S.C. 296p) is
amended to read as follows:
``SEC. 831. NURSE EDUCATION, PRACTICE, AND RETENTION GRANTS.
``(a) Education Priority Areas.--The Secretary may award grants to
or enter into contracts with eligible entities for--
``(1) expanding the enrollment in baccalaureate nursing
programs;
``(2) developing and implementing internship and residency
programs to encourage mentoring and the development of specialties;
or
``(3) providing education in new technologies, including
distance learning methodologies.
``(b) Practice Priority Areas.--The Secretary may award grants to
or enter into contracts with eligible entities for--
``(1) establishing or expanding nursing practice arrangements
in noninstitutional settings to demonstrate methods to improve
access to primary health care in medically underserved communities;
``(2) providing care for underserved populations and other
high-risk groups such as the elderly, individuals with HIV/AIDS,
substance abusers, the homeless, and victims of domestic violence;
``(3) providing managed care, quality improvement, and other
skills needed to practice in existing and emerging organized health
care systems; or
``(4) developing cultural competencies among nurses.
``(c) Retention Priority Areas.--The Secretary may award grants to
and enter into contracts with eligible entities to enhance the nursing
workforce by initiating and maintaining nurse retention programs
pursuant to paragraph (1) or (2).
``(1) Grants for career ladder programs.--The Secretary may
award grants to and enter into contracts with eligible entities for
programs--
``(A) to promote career advancement for nursing personnel
in a variety of training settings, cross training or specialty
training among diverse population groups, and the advancement
of individuals including to become professional nurses,
advanced education nurses, licensed practical nurses, certified
nurse assistants, and home health aides; and
``(B) to assist individuals in obtaining education and
training required to enter the nursing profession and advance
within such profession, such as by providing career counseling
and mentoring.
``(2) Enhancing patient care delivery systems.--
``(A) Grants.--The Secretary may award grants to eligible
entities to improve the retention of nurses and enhance patient
care that is directly related to nursing activities by
enhancing collaboration and communication among nurses and
other health care professionals, and by promoting nurse
involvement in the organizational and clinical decisionmaking
processes of a health care facility.
``(B) Preference.--In making awards of grants under this
paragraph, the Secretary shall give a preference to applicants
that have not previously received an award under this
paragraph.
``(C) Continuation of an award.--The Secretary shall make
continuation of any award under this paragraph beyond the
second year of such award contingent on the recipient of such
award having demonstrated to the Secretary measurable and
substantive improvement in nurse retention or patient care.
``(d) Other Priority Areas.--The Secretary may award grants to or
enter into contracts with eligible entities to address other areas that
are of high priority to nurse education, practice, and retention, as
determined by the Secretary.
``(e) Preference.--For purposes of any amount of funds appropriated
to carry out this section for fiscal year 2003, 2004, or 2005 that is
in excess of the amount of funds appropriated to carry out this section
for fiscal year 2002, the Secretary shall give preference to awarding
grants or entering into contracts under subsections (a)(2) and (c).
``(f) Report.--The Secretary shall submit to the Congress before
the end of each fiscal year a report on the grants awarded and the
contracts entered into under this section. Each such report shall
identify the overall number of such grants and contracts and provide an
explanation of why each such grant or contract will meet the priority
need of the nursing workforce.
``(g) Eligible Entity.--For purposes of this section, the term
`eligible entity' includes a school of nursing, a health care facility,
or a partnership of such a school and facility.
``(h) Authorization of Appropriations.--There are authorized to be
appropriated to carry out this section such sums as may be necessary
for each of fiscal years 2003 through 2007.''.
SEC. 202. COMPREHENSIVE GERIATRIC EDUCATION.
(a) Comprehensive Geriatric Education.--Title VIII of the Public
Health Service Act (42 U.S.C. 296 et seq.) (as amended by section 102)
is amended by adding at the end the following:
``PART I--COMPREHENSIVE GERIATRIC EDUCATION
``SEC. 855. COMPREHENSIVE GERIATRIC EDUCATION.
``(a) Program Authorized.--The Secretary shall award grants to
eligible entities to develop and implement, in coordination with
programs under section 753, programs and initiatives to train and
educate individuals in providing geriatric care for the elderly.
``(b) Use of Funds.--An eligible entity that receives a grant under
subsection (a) shall use funds under such grant to--
``(1) provide training to individuals who will provide
geriatric care for the elderly;
``(2) develop and disseminate curricula relating to the
treatment of the health problems of elderly individuals;
``(3) train faculty members in geriatrics; or
``(4) provide continuing education to individuals who provide
geriatric care.
``(c) Application.--An eligible entity desiring a grant under
subsection (a) shall submit an application to the Secretary at such
time, in such manner, and containing such information as the Secretary
may reasonably require.
``(d) Eligible Entity.--For purposes of this section, the term
`eligible entity' includes a school of nursing, a health care facility,
a program leading to certification as a certified nurse assistant, a
partnership of such a school and facility, or a partnership of such a
program and facility.
``(e) Authorization of Appropriations.--There are authorized to be
appropriated to carry out this section such sums as may be necessary
for each of fiscal years 2003 through 2007.''.
(b) Technical Amendment.--Section 753(a)(1) of the Public Health
Service Act (42 U.S.C. 294c) is amended by striking ``, and section
853(2),'' and inserting ``, and section 801(2),''.
SEC. 203. NURSE FACULTY LOAN PROGRAM.
Part E of title VIII of the Public Health Service Act (42 U.S.C.
297a et seq.) is amended by inserting after section 846 the following:
``nurse faculty loan program
``Sec. 846A. (a) Establishment.--The Secretary, acting through the
Administrator of the Health Resources and Services Administration, may
enter into an agreement with any school of nursing for the
establishment and operation of a student loan fund in accordance with
this section, to increase the number of qualified nursing faculty.
``(b) Agreements.--Each agreement entered into under subsection (a)
shall--
``(1) provide for the establishment of a student loan fund by
the school involved;
``(2) provide for deposit in the fund of--
``(A) the Federal capital contributions to the fund;
``(B) an amount equal to not less than one-ninth of such
Federal capital contributions, contributed by such school;
``(C) collections of principal and interest on loans made
from the fund; and
``(D) any other earnings of the fund;
``(3) provide that the fund will be used only for loans to
students of the school in accordance with subsection (c) and for
costs of collection of such loans and interest thereon;
``(4) provide that loans may be made from such fund only to
students pursuing a full-time course of study or, at the discretion
of the Secretary, a part-time course of study in an advanced degree
program described in section 811(b); and
``(5) contain such other provisions as are necessary to protect
the financial interests of the United States.
``(c) Loan Provisions.--Loans from any student loan fund
established by a school pursuant to an agreement under subsection (a)
shall be made to an individual on such terms and conditions as the
school may determine, except that--
``(1) such terms and conditions are subject to any conditions,
limitations, and requirements prescribed by the Secretary;
``(2) in the case of any individual, the total of the loans for
any academic year made by schools of nursing from loan funds
established pursuant to agreements under subsection (a) may not
exceed $30,000, plus any amount determined by the Secretary on an
annual basis to reflect inflation;
``(3) an amount up to 85 percent of any such loan (plus
interest thereon) shall be canceled by the school as follows:
``(A) upon completion by the individual of each of the
first, second, and third year of full-time employment, required
by the loan agreement entered into under this subsection, as a
faculty member in a school of nursing, the school shall cancel
20 percent of the principle of, and the interest on, the amount
of such loan unpaid on the first day of such employment; and
``(B) upon completion by the individual of the fourth year
of full-time employment, required by the loan agreement entered
into under this subsection, as a faculty member in a school of
nursing, the school shall cancel 25 percent of the principle
of, and the interest on, the amount of such loan unpaid on the
first day of such employment;
``(4) such a loan may be used to pay the cost of tuition, fees,
books, laboratory expenses, and other reasonable education
expenses;
``(5) such a loan shall be repayable in equal or graduated
periodic installments (with the right of the borrower to accelerate
repayment) over the 10-year period that begins 9 months after the
individual ceases to pursue a course of study at a school of
nursing; and
``(6) such a loan shall--
``(A) beginning on the date that is 3 months after the
individual ceases to pursue a course of study at a school of
nursing, bear interest on the unpaid balance of the loan at the
rate of 3 percent per annum; or
``(B) subject to subsection (e), if the school of nursing
determines that the individual will not complete such course of
study or serve as a faculty member as required under the loan
agreement under this subsection, bear interest on the unpaid
balance of the loan at the prevailing market rate.
``(d) Payment of Proportionate Share.--Where all or any part of a
loan, or interest, is canceled under this section, the Secretary shall
pay to the school an amount equal to the school's proportionate share
of the canceled portion, as determined by the Secretary.
``(e) Review by Secretary.--At the request of the individual
involved, the Secretary may review any determination by a school of
nursing under subsection (c)(6)(B).
``(f) Authorization of Appropriations.--There are authorized to be
appropriated to carry out this section such sums as may be necessary
for each of fiscal years 2003 through 2007.''.
SEC. 204. REPORTS BY GENERAL ACCOUNTING OFFICE.
(a) National Variations.--Not later than 4 years after the date of
the enactment of this Act, the Comptroller General of the United States
shall conduct a survey to determine national variations in the nursing
shortage at hospitals, nursing homes, and other health care providers,
and submit a report, including recommendations, to the Congress on
Federal remedies to ease nursing shortages. The Comptroller General
shall submit to the Congress this report describing the findings
relating to ownership status and associated remedies.
(b) Hiring Differences Among Certain Private Entities.--The
Comptroller General of the United States shall conduct a study to
determine differences in the hiring of nurses by nonprofit private
entities as compared to the hiring of nurses by private entities that
are not nonprofit. In carrying out the study, the Comptroller General
shall determine the effect of the inclusion of private entities that
are not nonprofit in the program under section 846 of the Public Health
Service Act. Not later than 4 years after the date of the enactment of
this Act, the Comptroller General shall submit to the Congress a report
describing the findings of the study.
(c) Nursing Scholarships.--The Comptroller General of the United
States shall conduct an evaluation of whether the program carried out
under section 846(d) of the Public Health Service Act has demonstrably
increased the number of applicants to schools of nursing and, not later
than 4 years after the date of the enactment of this Act, submit a
report to the Congress on the results of such evaluation.
Speaker of the House of Representatives.
Vice President of the United States and
President of the Senate.