[Congressional Bills 107th Congress]
[From the U.S. Government Publishing Office]
[S. 1864 Engrossed in Senate (ES)]

  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
107th CONGRESS
  1st Session
                                S. 1864

_______________________________________________________________________

                                 AN ACT


 
 To amend the Public Health Service Act to establish a Nurse Corps and 
 recruitment and retention strategies to address the nursing shortage, 
                        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 ``Nurse Reinvestment Act''.

SEC. 2. AMENDMENT TO THE PUBLIC HEALTH SERVICE ACT.

    Title VIII of the Public Health Service Act (42 U.S.C. 296 et seq.) 
is amended--
            (1) in section 846(a)(3), by inserting ``in a nursing home, 
        in a hospice, in a home health agency, in a nurse-managed 
        health center, in a public health department,'' after ``in a 
        public hospital,'';
            (2) in section 801, by adding at the end the following:
            ``(9) Health care facility.--The term `health care 
        facility' means an Indian Health service health center, a 
        Native Hawaiian health center, a hospital, a migrant health 
        center, a community health center, a Federally qualified health 
        center, a nurse-managed health center, a rural health clinic, a 
        nursing home, a home health care agency, a hospice, a public 
        health clinic, a long-term care facility, a skilled nursing 
        facility, or any other public, nonprofit, or private facility 
        designated by the Secretary.''; and
            (3) by adding at the end the following:

       ``PART H--NATIONAL NURSE SERVICE CORPS SCHOLARSHIP PROGRAM

``SEC. 851. NATIONAL NURSE SERVICE CORPS SCHOLARSHIP PROGRAM.

    ``(a) Program Authorized.--The Secretary shall establish a National 
Nurse Service Corps Scholarship program (referred to in this section as 
the `program') that provides scholarships to individuals seeking 
nursing education in exchange for service by such individuals in 
critical nursing shortage areas or facilities.
    ``(b) Preference.--In awarding scholarships under this section, the 
Secretary shall give preference to applicants with the greatest 
financial need, applicants who agree to serve in health care facilities 
experiencing nursing shortages in medically underserved areas, 
applicants currently working in a health care facility who agree to 
serve the period of obligated service at such facility, minority nurse 
applicants, and applicants with an interest in a practice area of 
nursing that has unmet needs.
    ``(c) Requirements.--To be eligible to participate in the program, 
an individual must--
            ``(1) be accepted for enrollment, or be enrolled, in an 
        accredited school of nursing, on a full- or part-time basis, to 
        take courses leading to a collegiate or associate degree in 
        nursing, or a diploma in nursing;
            ``(2) submit an application to participate in the program; 
        and
            ``(3) enter into an agreement with the Secretary, at the 
        time of submittal of such application, to--
                    ``(A) accept the conditions of the scholarship and 
                remain enrolled in a school of nursing;
                    ``(B) maintain an acceptable level of academic 
                standing;
                    ``(C) maintain enrollment in a course of study 
                until the individual completes the course of study; and
                    ``(D) serve as a nurse for a period of not less 
                than 2 years in a critical nursing shortage area or 
                facility, or the individual may complete such required 
                period of service on a part-time basis subject to--
                            ``(i) an agreement entered into by the 
                        facility and the individual which is approved 
                        by the Secretary; and
                            ``(ii) the individual agrees in writing 
                        that the period of obligated service will be 
                        extended so that the aggregate amount of less 
                        than full-time service performed will equal the 
                        amount of service that would be performed 
                        through full-time service.
    ``(d) Rule of Construction.--In selecting individuals to 
participate in the program, the Secretary shall give preference to 
individuals serving at public or nonprofit private facilities, unless 
only a private facility is present in the geographic area that the 
Secretary determines is experiencing a nursing shortage. While giving 
priority to individuals who propose to provide service in public or 
nonprofit private facilities, the Secretary must not disregard the 
needs of areas that individuals seek to provide services in which no 
public or nonprofit private facility is operating, including rural 
areas.
    ``(e) Applications.--
            ``(1) In general.--The application forms for the programs 
        shall include--
                    ``(A) a fair summary of the rights and liabilities 
                of an individual whose application is approved by the 
                Secretary; and
                    ``(B) information respecting meeting a service 
                obligation and such other information as may be 
                necessary for the individual to understand the program.
            ``(2) Accessibility.--The application form and all other 
        information furnished by the Secretary shall be written so that 
        it may be understood by the average individual applying to 
        participate in the program. The Secretary shall make such 
        application forms, and other information available to 
        individuals desiring to participate in the program, on a date 
        sufficiently early to ensure that such individuals have 
        adequate time to carefully review and evaluate such forms and 
        information.
            ``(3) Distribution.--The Secretary shall distribute to 
        junior and senior high schools, community colleges, 
        universities, and schools of nursing materials providing 
        information on the program and shall encourage the schools to 
        disseminate the materials to students of the schools.
    ``(f) Scholarship.--
            ``(1) In general.--A scholarship provided to a student for 
        a school year under a written contract under the program shall 
        consist of--
                    ``(A) payment to, or (in accordance with paragraph 
                (2)) on behalf of the student of--
                            ``(i) the tuition of the student in such 
                        school year; and
                            ``(ii) all other reasonable educational 
                        expenses and support services, including fees, 
                        books, and laboratory expenses incurred by the 
                        student in such school year; and
                    ``(B) payment to the student of a stipend of $400 
                per month (adjusted in accordance with paragraph (3)) 
                for each month that the student is enrolled.
            ``(2) Contracts.--
                    ``(A) With a school of nursing.--The Secretary may 
                contract with a school of nursing, in which a 
                participant in the program is enrolled, for the payment 
                to the school of nursing of the amounts of tuition and 
                other reasonable educational expenses described in 
                paragraph (1)(A).
                    ``(B) With an individual.--The Secretary shall 
                prepare a written contract for the program that shall 
                be provided to any individual who is enrolled or 
                accepted for enrollment at a school of nursing and who 
                desires to participate in the program at the time that 
                an application is provided to such individual. The 
                contract described in this paragraph shall contain a 
                provision that any financial obligation of the United 
                States arising out of a contract entered into under 
                this section and any obligation of the individual which 
                is conditioned thereon, is contingent upon funds being 
                appropriated for scholarships under this section.
            ``(3) Monthly stipend.--The amount of the monthly stipend 
        for each month that a student is enrolled, specified in 
        paragraph (1)(B) and as previously adjusted (if at all) in 
        accordance with this paragraph, shall be increased by the 
        Secretary as the Secretary determines to be reasonable.
    ``(g) Breach of Agreement.--In the case of an individual who enters 
into an agreement under this section to provide service as a nurse in 
consideration for receiving a scholarship, such individual is liable to 
the Federal Government in accordance with sections 338E and 338F as 
amended in the future. If the individual begins providing less than 
full-time service but fails to begin or complete the period of 
obligated service, the methods stated in section 338E(c) for 
determining the damages for breach of the individual's written contract 
will be used after converting periods of obligated service or of 
service performed into their full-time equivalence.
    ``(h) Fund Regarding Use of Amounts Recovered for Contract 
Breach.--There is established in the Treasury of the United States a 
fund to be known as the National Nurse Service Corps Replacement Fund. 
Such fund shall be governed under section 338F.
    ``(i) Service Information.--The Secretary shall provide to an 
individual who has participated in the program and is nearing the 
conclusion of his or her service obligation, information regarding 
other opportunities for nursing in critical nursing shortage areas or 
facilities.
    ``(j) Report.--Not later than 18 months after the first loan cycle, 
and annually thereafter, the Secretary shall prepare and submit to 
Congress a report describing the program, including statements 
regarding--
            ``(1) the number of enrollees, scholarships, and grant 
        recipients by year of study;
            ``(2) the number of graduates;
            ``(3) the amount of scholarship payments made for each of 
        tuition, stipends, and other expenses;
            ``(4) which educational institution the scholar attended;
            ``(5) the number and placement location of the scholars;
            ``(6) the default rate and actions required;
            ``(7) the amount of outstanding default funds;
            ``(8) to the extent that it can be determined, the reason 
        for the default;
            ``(9) the demographics of the individuals participating in 
        the scholarship program; and
            ``(10) recommendations for future modifications of the 
        scholarship program.
    ``(k) Definitions.--In this section:
            ``(1) Community health center.--The term `community health 
        center' has the meaning given such term in section 330(a).
            ``(2) Critical nursing shortage area or facility.--
                    ``(A) In general.--The term `critical nursing 
                shortage area or facility' means--
                            ``(i) an urban or rural area that the 
                        Secretary determines is experiencing a nursing 
                        shortage;
                            ``(ii) a population that the Secretary 
                        determines has such a shortage; or
                            ``(iii) a health care facility or other 
                        public, nonprofit, or private facility that the 
                        Secretary determines has a shortage.
                    ``(B) Factors to consider.--In making a 
                determination regarding a critical nursing shortage 
                area or facility, the Secretary shall use the criteria 
                in section 846 for not more than 12 months, and after 
                such period--
                            ``(i) the ratio of available nurses to the 
                        number of individuals in the area or population 
                        group;
                            ``(ii) the demonstrated need of a health 
                        care facility or other public, nonprofit, or 
                        private facility in the area; or
                            ``(iii) the presence of innovative 
                        retention strategies utilized by eligible 
                        facilities.
            ``(3) Rural health clinic.--The term `rural health clinic' 
        has the meaning given such term in section 1861(aa)(2) of the 
        Social Security Act.
    ``(l) Authorization of Appropriations.--For the purpose of payments 
under agreements entered into under subsection (a), there are 
authorized to be appropriated $40,000,000 for fiscal year 2003 and such 
sums as may be necessary for fiscal years 2004 through 2007.

``PART I--INITIATIVES TO RECRUIT NURSES AND COMBAT THE NURSING SHORTAGE

``SEC. 855. NURSE RECRUITMENT GRANT PROGRAM.

    ``(a) Program Authorized.--The Secretary shall award grants to 
eligible entities to increase nursing education opportunities.
    ``(b) Eligible Entity.--In this section, the term `eligible entity' 
means a school of nursing, or a health care facility, or a partnership 
of such school and facility.
    ``(c) Use of Funds.--An eligible entity that receives a grant under 
subsection (a) shall use funds received from such grant to--
            ``(1) support outreach programs at primary, junior, and 
        secondary schools that inform guidance counselors and students 
        of education opportunities regarding nursing;
            ``(2) carry out special projects to increase nursing 
        education opportunities for individuals who are from 
        disadvantaged backgrounds (including economically disadvantaged 
        backgrounds and racial and ethnic minorities underrepresented 
        among registered nurses) by providing student scholarships or 
        stipends, pre-entry preparation, or retention activities;
            ``(3) support education programs for nursing students who 
        require assistance with math, science, English, and medical 
        terminology;
            ``(4) meet the costs of dependent care and transportation 
        for individuals who are taking part in a nursing education 
        program at any level; or
            ``(5) support community-based partnerships seeking to 
        recruit nurses in rural communities and medically underserved 
        urban communities, and other communities experiencing a nursing 
        shortage.
    ``(d) 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.
    ``(e) Authorization of Appropriations.--There is authorized to be 
appropriated to carry out this section $10,000,000 for fiscal year 2003 
and such sums as may be necessary for fiscal years 2004 through 2007.

``SEC. 856. PUBLIC AWARENESS AND EDUCATION CAMPAIGN.

    ``(a) National Campaign.--
            ``(1) In general.--The Secretary shall develop and 
        administer a comprehensive national multi-media public 
        education campaign to enhance the image of the nursing 
        profession, promote diversity in the workforce, encourage 
        individuals to enter the nursing profession, and encourage 
        career development for individuals in the nursing profession.
            ``(2) Authorization of appropriations.--There is authorized 
        to be appropriated to carry out this subsection $4,000,000 for 
        fiscal year 2003 and such sums as may be necessary for fiscal 
        years 2004 through 2007.
    ``(b) State Campaigns.--
            ``(1) In general.--The Secretary shall award grants to 
        eligible entities to establish the multi-media campaigns 
        described in subsection (a) at a State level.
            ``(2) Definitions.--
                    ``(A) Eligible entity.--The term `eligible entity' 
                means a professional State nursing association, State 
                health care provider association, school of nursing, 
                and any other entity that provides similar services or 
                serves a like function.
                    ``(B) State health care provider association.--The 
                term `State health care provider association' means a 
                professional association of hospitals, nursing homes, 
                home health care agencies, hospices, consortia of said 
                associations, or other such entities deemed eligible by 
                the Secretary.
            ``(3) Limitation.--An eligible entity that receives a grant 
        under this subsection shall not use funds received through such 
        grant to advertise particular employment opportunities or 
        recruit members or affiliates of such entity.
            ``(4) Application.--Each eligible entity that desires a 
        grant under this subsection shall submit an application to the 
        Secretary at such time, in such manner, and containing such 
        information as the Secretary may reasonably require.
            ``(5) Equitable broadcasting.--The campaigns described in 
        paragraph (1) shall be broadcast in such a manner as to inform 
        diverse populations throughout the State of nursing 
        opportunities, including rural populations.
    ``(c) Authorization of Appropriations.--There is authorized to be 
appropriated to carry out this section $4,000,000 for fiscal year 2003 
and such sums as may be necessary for fiscal years 2004 through 2007.

        ``PART J--INITIATIVES TO STRENGTHEN THE NURSE WORKFORCE

``SEC. 857. GRANTS FOR CAREER LADDER PROGRAMS.

    ``(a) Program Authorized.--The Secretary shall award grants to 
eligible entities to assist individuals and develop programs to assist 
individuals in obtaining education and training required to enter the 
nursing profession and advance within such profession.
    ``(b) Definition.--The term `eligible entity' means a school of 
nursing or a health care facility, or a partnership of such school and 
facility.
    ``(c) Use of Funds.--An eligible entity that receives a grant under 
subsection (a) shall use such funds received through such grant to--
            ``(1) establish student scholarships or stipends for nurse 
        professionals, licensed practical nurses, certified nurse 
        assistants, and home health aides who enroll in entry level 
        nursing programs, advanced practice nursing degree programs, 
        RN/Master nursing degree programs, doctoral nursing programs, 
        nurse administrator programs, and training programs focused on 
        specific technology use or disease management;
            ``(2) provide career counseling to individuals seeking to 
        advance within the nursing profession;
            ``(3) provide employees of the facility advanced training 
        and education at the school of nursing or health care facility;
            ``(4) establish or expand nursing practice arrangements in 
        noninstitutional settings to demonstrate methods to improve 
        access to primary health care in medically underserved 
        communities; and
            ``(5) develop programs, including distance learning 
        programs in coordination with the Office for the Advancement of 
        Telehealth, to facilitate educational advancement for 
        individuals with existing degrees or health care training.
    ``(d) Application.--An eligible entity seeking a grant under 
subsection (a) shall submit an application to the Secretary at such 
time, in such a manner, and containing such information as the 
Secretary may reasonably require.
    ``(e) Authorization of Appropriations.--There is authorized to be 
appropriated to carry out this section $20,000,000 for fiscal year 2003 
and such sums as may be necessary for fiscal years 2004 through 2007.

``SEC. 858. AREA HEALTH EDUCATION CENTERS PROGRAM.

    ``(a) Program Authorized.--The Secretary shall award grants to area 
health education centers to contract with schools of nursing to expand 
the operation of area health education centers under section 751 to 
work in communities to develop models of excellence for school nurses, 
public health nurses, perinatal outreach nurses, and other community-
based nurses, or to expand any junior and senior high school mentoring 
programs to include a nurse mentoring program.
    ``(b) Authorization of Appropriations.--There is authorized to be 
appropriated to carry out this section $5,000,000 for fiscal year 2003 
and such sums as may be necessary for fiscal years 2004 through 2007.

``SEC. 859. GRANTS FOR NURSE TRAINING IN LONG-TERM CARE FOR THE 
              ELDERLY.

    ``(a) Program Authorized.--The Secretary shall award grants to 
eligible entities to develop and incorporate gerontology curriculum and 
competencies and to encourage individuals to enter the nursing 
profession with a focus on providing long-term care for the elderly.
    ``(b) Eligible Entity.--The term `eligible entity' means a--
            ``(1) school of nursing;
            ``(2) health care facility; or
            ``(3) partnership of paragraphs (1) and (2).
    ``(c) 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 
        long-term care for the elderly;
            ``(2) develop stand alone courses in gerontological nursing 
        to support concentrations, minors, and majors in the 
        discipline;
            ``(3) train faculty members in gerontological nursing; or
            ``(4) provide continuing education in gerontological 
        nursing.
    ``(d) 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.
    ``(e) Definitions.--For the purposes of this section, the term 
`health care facility' means a hospital, nursing home, home health care 
agency, hospice, skilled nursing facility, long-term care facility, or 
any other facility designated by the Secretary.
    ``(f) Authorization of Appropriations.--There is authorized to be 
appropriated to carry out this section $12,000,000 for fiscal year 2003 
and such sums as may be necessary for fiscal years 2004 through 2007.

``SEC. 860. GRANTS FOR INTERNSHIP AND RESIDENCY PROGRAMS.

    ``(a) Program Authorized.--The Secretary shall award grants to an 
eligible entity to develop internship and residency programs that 
encourage mentoring and the development of specialties.
    ``(b) Definition.--The term `eligible entity' means a partnership 
of a school of nursing and health care facility.
    ``(c) Use of Funds.--An eligible entity that receives a grant under 
subsection (a) shall use such funds received through such grant to--
            ``(1) develop internship and residency programs and 
        curriculum and training programs for graduates of a nursing 
        program;
            ``(2) provide support for faculty and mentors; and
            ``(3) provide support for nurses participating in 
        internship and residency programs on both a full-time and part-
        time basis.
    ``(d) Application.--An eligible entity seeking a grant under 
subsection (a) shall submit an application to the Secretary at such 
time, in such a manner, and containing such information as the 
Secretary may reasonably require.
    ``(e) Authorization of Appropriations.--There is authorized to be 
appropriated to carry out this section $10,000,000 for fiscal year 2003 
and such sums as may be necessary for fiscal years 2004 through 2007.

``SEC. 861. DEVELOPING RETENTION STRATEGIES AND BEST PRACTICES IN 
              NURSING STAFF MANAGEMENT.

    ``(a) Program Authorized.--The Secretary shall award grants to 
eligible entities to carry out and evaluate demonstrations of models 
and best practices in nursing care and develop innovative strategies or 
approaches for retention of professional nurses.
    ``(b) Definitions.--In this section:
            ``(1) Eligible entity.--The term `eligible entity' means--
                    ``(A) a partnership or coalition containing a 
                health care facility and a school of nursing;
                    ``(B) a partnership or coalition containing a 
                health care facility and another organization with 
                expertise in outcome and cost-effectiveness 
                measurement; or
                    ``(C) containing a health care facility 
                demonstrating proficiency in outcomes and cost-
                effectiveness measurement, and receipt of accreditation 
                by an accepted organization shall constitute evidence 
                of such proficiency.
            ``(2) Nurse leadership.--The term `nurse leadership' 
        includes nurse executives, nurse administrators, and nurse 
        managers.
            ``(3) Professional nurse.--The term `professional nurse' 
        means a registered nurse who holds a valid and unrestricted 
        license to practice nursing in a State.
    ``(c) Distribution of Grants.--Grants awarded under this section 
shall be distributed among a variety of geographic regions and among a 
range of different types and sizes of health care facilities.
    ``(d) Duration of grants.--Grants awarded under this section shall 
be awarded for a period not greater than 2 years (and may be renewable 
only once).
    ``(e) Allocation.--The Secretary shall determine the amount of a 
grant awarded under this section to the nursing services of the health 
care facility based on the number of staffed beds as follows, and if 
the Secretary deems appropriate these amounts may be adjusted:
            ``(1) A maximum of $200,000 for a facility with less than 
        100 staffed beds.
            ``(2) A maximum of $400,000 for a facility with less than 
        400 staffed beds.
            ``(3) A maximum of $600,000 for a facility with 400 or more 
        staffed beds.
    ``(f) Priority criteria.--The Secretary shall give priority in 
awarding grants under this section to health care facilities that have 
not previously received a grant under this section, and in the case of 
a grant renewal, the Secretary shall give priority to grant recipients 
who have demonstrated outcome improvements or have been designated as a 
magnet hospital by the American Nurses Credentialing Center.
    ``(g) Use of Funds.--An eligible entity that receives a grant under 
subsection (a) shall use such grant funds to do one or more of the 
following:
            ``(1) Improve the quality of the health care facility work 
        environment, including improving communication and 
        collaboration among health care professionals.
            ``(2) Initiate or maintain aggressive nurse retention 
        programs, including other initiatives as deemed appropriate by 
        the nurse retention committee at the health care facility.
            ``(3) Reduce workplace injuries.
            ``(4) Reduce rates of nursing sensitive patient outcomes.
            ``(5) Provide high quality evaluations of the cost-
        effectiveness and patient-outcomes of best practices, to assist 
        health care facility decision-makers in determining appropriate 
        nurse retention strategies.
            ``(6) Promote continuing nursing education and career 
        development.
    ``(h) Application.--
            ``(1) In general.--An eligible entity desiring a grant 
        under subsection (a) shall submit an application to the 
        Secretary at such time, and in such manner, and containing such 
        information as the Secretary may reasonably require.
            ``(2) Contents.--The application submitted under paragraph 
        (1) shall include a description of--
                    ``(A) the project or projects proposed to be 
                carried out with grant funds;
                    ``(B) the means by which to evaluate the project 
                with respect to its cost-effectiveness and outcomes as 
                they relate to staff turnover, workplace injuries, and 
                patient care outcomes that are sensitive to nursing 
                care; and
                    ``(C) the system of patient outcomes measurement, 
                which shall be described by the nurse leadership and 
                professional nurses of the health care facility and 
                shall be sensitive to nursing care and shall evaluate 
                the specific needs of the patients served by the health 
                care facility and the educational needs of the nursing 
                staff at such facility to meet the needs of the 
                patients, and the health care facility must allocate 
                sufficient funds to carry out the system;
                    ``(D) the health care facility's organizational and 
                clinical decision-making processes that incorporate the 
                input of the nursing staff, including the development 
                of a nurse retention committee, the inclusion of nurse 
                executive participation in senior level management of 
                the health care facility, and a nurse residency 
                training program for new graduate nurses entering the 
                workforce on a full-time basis, or nurses returning to 
                work at a health care facility on a full-time basis 
                after an absence of not less than 3 years without 
                working in the nursing field.
    ``(i) Authorization of Appropriations.--There is to be authorized 
to be appropriated to carry out this section $10,000,000 for fiscal 
year 2003 and such sums as may be necessary for fiscal years 2004 
through 2007.

``SEC. 862. FAST-TRACK FACULTY LOAN PROGRAM.

    ``(a) In General.--In the case of any individual--
            ``(1) who has received a collegiate or associate degree in 
        nursing (or an equivalent degree), a diploma in nursing, or a 
        graduate degree in nursing;
            ``(2) who obtained 1 or more loans related to nursing 
        training costs for a masters or a doctoral degree;
            ``(3) who is capable, in the opinion of the public or 
        nonprofit private school of nursing in which the student is 
        accepted for enrollment or enrolled, of maintaining good 
        standing in such course of study; and
            ``(4) who enters into a written agreement with the 
        Secretary to teach at an accredited school of nursing for each 
        year of assistance after the masters or doctoral degree has 
        been obtained or two years (whichever is greater), or may 
        complete such required period of service on a part-time basis 
        subject to--
                    ``(A) an agreement entered into by the accredited 
                school of nursing and individual which is approved by 
                the Secretary; and
                    ``(B) the individual agrees in writing that the 
                required period of service will be extended so that the 
                aggregate amount of less than full-time service 
                performed will equal the amount of service that would 
                be performed through full-time service,
the Secretary shall make payments in accordance with subsection (c) of 
this section, for and on behalf of that individual, on the principal of 
and interest on any loan of that individual provided under this section 
which is outstanding on the date the individual begins the service 
specified in the agreement described in paragraph (4) of this 
subsection. Assistance provided under this section for a part-time 
masters degree program shall be provided for not more than 6 years and 
for a part-time doctoral degree program for not more than 7 years.
    ``(b) Terms of Agreement.--The agreement described in paragraph (4) 
of subsection (a) shall also provide that the total of the loans for 
any academic year made pursuant to an agreement under subsection (a) 
may not exceed $35,000 (indexed for inflation) in the case of any 
student.
    ``(c) Manner of Payments.--For each year of service, the Secretary 
shall in equal installments pay 85 percent of the principal of, and 
interest on the loans for an individual pursuant to an agreement under 
subsection (a)(4).
    ``(d) Payment by Due Date.-- Notwithstanding the requirement of 
completion of service specified in subsection (c) of this section, the 
Secretary shall, on or before the due date thereof, pay any loan or 
loan installment which may fall due within the period of service for 
which the borrower may receive payments under this subsection, upon the 
declaration of such borrower, at such times and in such manner as the 
Secretary may prescribe (and supported by such other evidence as the 
Secretary may reasonably require), that the borrower is then serving as 
described by subsection (a)(4) of this section, and that the borrower 
will continue to so serve for the period required (in the absence of 
this subsection) to entitle the borrower to have made the payments 
provided by this subsection for such period, except that not more than 
85 percent of the principal of any such loan shall be paid pursuant to 
this subsection.
    ``(e) Breach of Agreement.--The Secretary may make payments under 
subsection (a) of this section on behalf of an individual only if the 
agreement under such subsection provides that section 860(c) of this 
title is applicable to the individual. The Secretary may declare an 
individual in breach of the agreement if an individual fails to 
complete the year of service for which the payment was made.
    ``(f) Preferences Regarding Participants.--In entering into 
agreements under subsection (a) of this section, the Secretary shall 
give preference to qualified applicants with the greatest financial 
need.
    ``(g) Breach of Agreement.--
            ``(1) In general.--In the case of any program under this 
        section under which an individual makes an agreement to teach 
        at an accredited school of nursing for a period of time in 
        accordance with such program in consideration of receiving an 
        award of Federal funds regarding education as a nurse 
        (including an award for the repayment of loans), the following 
        applies if the agreement provides that this subsection is 
        applicable: the individual is liable to the Federal Government 
        for the amount of such award (including amounts provided for 
        expenses related to such attendance), and for interest on such 
        amount at the maximum legal prevailing rate, if the individual 
        fails to teach at an accredited school of nursing in accordance 
        with the program under this section for the period of time 
        applicable under the program.
            ``(2) Waiver or suspension of liability.--In the case of an 
        individual making an agreement for purposes of paragraph (1), 
        the Secretary shall provide for the waiver or suspension of 
        liability under such subsection if compliance by the individual 
        with the agreements involved is impossible, or would involve 
        extreme hardship to the individual and if enforcement of the 
        agreements with respect to the individual would be 
        unconscionable.
            ``(3) Date certain for recovery.--Subject to paragraph (2), 
        any amount that the Federal Government is entitled to recover 
        under paragraph (1) shall be paid to the United States not 
        later than the expiration of the 3-year period beginning on the 
        date the United States becomes so entitled.
            ``(4) Availability.--Amounts recovered under paragraph (1) 
        with respect to a program under this section shall be available 
        for the purposes of such program, and shall remain available 
        for such purposes until expended.
    ``(h) Authorization of Appropriations.--For the purpose of payments 
under agreements entered into under subsection (a) of this section, 
there are authorized to be appropriated $10,000,000 for fiscal year 
2003, and such sums as may be necessary for fiscal years 2004 through 
2007.

``SEC. 863. STIPEND AND SCHOLARSHIP PROGRAM.

    ``(a) Program Authorized.--
            ``(1) In general.--The Secretary shall establish a 
        scholarship and stipend program to encourage individuals to 
        seek a masters degree or a doctoral degree at a school of 
        nursing.
            ``(2) Limitation.--Assistance provided under paragraph (1) 
        for a part-time masters degree program shall be provided for 
        not more than 6 years and for a part-time doctoral degree 
        program not more than 7 years.
    ``(b) Eligibility.--To be eligible to receive a scholarship or 
stipend under this section, an individual shall--
            ``(1) submit an application to the Secretary at such time, 
        in such manner, and containing such information as the 
        Secretary may reasonably require;
            ``(2) be accepted for enrollment, or be enrolled, in an 
        accredited school of nursing, on a full- or part-time basis to 
        take courses leading to a masters degree or doctoral degree;
            ``(3) enter into an agreement with the Secretary, at the 
        time of submittal of such application, to--
                    ``(A) accept the conditions of the scholarship and 
                remain enrolled in a school of nursing;
                    ``(B) maintain an acceptable level of academic 
                standing; and
                    ``(C) maintain enrollment in a course of study 
                until the individual completes the course of study; and
            ``(4) teach at an accredited school of nursing for 1 year 
        for each year of assistance with a course load determined by 
        the school of nursing where the teaching will take place, and 
        the individual may complete such required period of service on 
        a part-time basis subject to--
                    ``(A) an agreement entered into by the facility and 
                the individual which is approved by the Secretary; and
                    ``(B) the individual agrees in writing that the 
                period of obligated service will be extended so that 
                the aggregate amount of less than full-time service 
                will equal the amount of service that would be 
                performed through full-time service.
    ``(c) Application.--The Secretary shall disseminate application 
forms to individuals and in such forms, include--
            ``(1) a summary of the rights and liabilities of an 
        individual whose application is approved by the Secretary; and
            ``(2) information respecting meeting the service obligation 
        described in subsection (b)(4).
    ``(d) Scholarship.--
            ``(1) In general.--A scholarship provided to a student for 
        a school year under a written contract under the program shall 
        consist of--
                    ``(A) payment to, or (in accordance with paragraph 
                (2)) on behalf of the student of--
                            ``(i) the tuition of the student in such 
                        school year; and
                            ``(ii) all other reasonable educational 
                        expenses and support services, including fees, 
                        books, and laboratory expenses incurred by the 
                        student in such school year; and
                    ``(B) payment to the student of a stipend of $400 
                per month (adjusted in accordance with paragraph (3)) 
                for each month that the student is enrolled.
            ``(2) Contracts.--
                    ``(A) With a school of nursing.--The Secretary may 
                contract with a school of nursing, in which a 
                participant in the program is enrolled, for the payment 
                to the school of nursing of the amounts of tuition and 
                other reasonable educational expenses described in 
                paragraph (1)(A).
                    ``(B) With an individual.--The Secretary shall 
                prepare a written contract for the program that shall 
                be provided to any individual who is enrolled or 
                accepted for enrollment at a school of nursing and who 
                desires to participate in the program at the time that 
                an application is provided to such individual. The 
                contract described in this paragraph shall contain a 
                provision that any financial obligation of the United 
                States arising out of a contract entered into under 
                this section and any obligation of the individual which 
                is conditioned thereon, is contingent upon funds being 
                appropriated for scholarships under this section.
            ``(3) Monthly stipend.--The amount of the monthly stipend 
        for each month that a student is enrolled, specified in 
        paragraph (1)(B) and as previously adjusted (if at all) in 
        accordance with this paragraph, shall be increased by the 
        Secretary as the Secretary determines to be reasonable.
    ``(e) Breach of Agreement.--In the case of an individual who enters 
into an agreement under this section to provide service as a nurse in 
consideration for receiving a scholarship, such individual is liable to 
the Federal Government in accordance with sections 338E and 338F as 
amended in the future. If the individual begins providing less than 
full-time service but fails to begin or complete the period of 
obligated service, the methods stated in section 338E(c) for 
determining the damages for breech of the individual's written contract 
will be used after converting periods of obligated service or of 
service performed into their full-time equivalence.
    ``(f) Authorization of Appropriations.--There are authorized to be 
appropriated to carry out this section $10,000,000 for fiscal year 2003 
and such sums as may be necessary for fiscal years 2004 through 2007.

                     ``PART K--NATIONAL COMMISSION

``SEC. 865. NATIONAL COMMISSION.

    ``(a) In General.--There is established a commission known as the 
National Commission on the Recruitment and Retention of Nurses 
(referred to in this section as the `Commission').
    ``(b) Duties.--The Commission shall meet at least 4 times and study 
and make innovative and creative recommendations in the following 
areas, and shall widely disseminate its findings, including to the 
appropriate committees of Congress regarding--
            ``(1) strategies necessary to address the nursing shortage 
        in the long term;
            ``(2) best practices in the recruitment and retention of 
        nurses and the impact on patients and staff of employing 
        participatory, collaborative, and patient-centered models of 
        nursing care, which shall include the examination of--
                    ``(A) reasons behind low nurse vacancy rates and 
                turnover in the workplace;
                    ``(B) practices that are not effective in 
                recruiting and retaining nurses and why;
                    ``(C) how successful recruitment and retention 
                practices work, why they are successful and how health 
                care facilities with lower than average retention rates 
                can improve their working conditions to improve their 
                retention rates, including an examination of hospitals 
                and other health care facilities with higher than 
                average retention rates, and the role of different 
                stakeholders in the workplace, such as nurses, doctors, 
                other health professionals and employees, and 
                management at all levels;
                    ``(D) factors that influence career satisfaction 
                for nurses;
                    ``(E) to what extent successful recruitment and 
                retention practices are unique to a particular 
                situation or applicable across the field; and
                    ``(F) the effectiveness of best practices for 
                recruitment and retention for different populations of 
                nurses, such as nurses who choose nursing as a second 
                career, nurses from various racial and ethnic groups, 
                male and female nurses, and nurses with varying ages 
                and experience levels;
            ``(3) the facilitation of career advancement within the 
        nursing profession;
            ``(4) attracting middle and high school students into 
        nursing careers; and
            ``(5) attracting individuals who may pursue nursing careers 
        after they have pursued other careers.
    ``(c) Consultation.--In carrying out the duties described in 
subsection (b), the Commission shall consult with the Health Resources 
and Services Administration's Bureau of Health Professions, the 
American Nurses Credentialing Center's Magnet Nursing Services 
Recognition Program, the National Advisory Council on Nurse Education 
and Practice, the National Institute of Nursing Research, and other 
appropriate resources that may provide information or other assistance.
    ``(d) Membership.--Not later than 12 months after the date of 
enactment of this section, the Comptroller General shall appoint 21 
members of the Commission (taking into account rural and urban areas, 
geographic diversity, racial and ethnic diversity, and relevant 
experience) of whom--
            ``(1) 8 shall be nurses with different levels of education, 
        and a significant portion of whom shall be currently practicing 
        nurses;
            ``(2) 6 shall be representatives (with various management 
        experiences) of employers such as hospitals, long term care 
        facilities, and home health agencies;
            ``(3) 1 shall be a representative of schools of nursing;
            ``(4) 1 shall be a representative of primary and secondary 
        schools;
            ``(5) 1 shall be a representative from the Departments of 
        Health and Human Services, Education, Labor, and Veterans 
        Affairs; and
            ``(6) 1 shall be a physician.
    ``(e) Chairs.--The Secretary of the Department of Health and Human 
Services and the Secretary of Labor shall jointly chair the Commission.
    ``(f) Subcommittees.--The Chairs shall have the authority to create 
subcommittees as they determine is necessary.
    ``(g) Staff.--The Chairs shall provide any staff that the 
Commission shall require.
    ``(h) Quorum.--Eleven members of the Commission shall constitute a 
quorum.
    ``(i) Vacancies.--Any vacancy in the Commission shall not affect 
the powers of the Commission, but shall be filled in the same manner as 
the original appointment and shall be made not later than 30 days after 
the date on which the Commission is given notice of such vacancy.
    ``(j) Compensation.--Members of the Commission shall receive no 
additional compensation by reason of their service to the Commission. 
Each member shall be allowed travel expenses, including per diem in 
lieu of subsistence, at rates authorized for employees of agencies 
under subchapter I of chapter 57 of title 5, United States Code, while 
away from their homes or regular places of business in the performance 
of services for the Commission.
    ``(k) Report.--Not later than 24 months after the date of enactment 
of this section, the Commission shall prepare and submit to Congress 
and widely disseminate in the health care field, a report that makes 
the recommendations described in subsection (b).
    ``(l) Sunset.--This section shall be effective for 24 months from 
the date of enactment of this section.
    ``(m) Authorization of Appropriations.--There are authorized to be 
appropriated to carry out this section $750,000 for fiscal year 2002 
for use in fiscal years 2002 and 2003.''.

            Passed the Senate December 20 (legislative day, December 
      18), 2001.

            Attest:

                                                             Secretary.
107th CONGRESS

  1st Session

                                S. 1864

_______________________________________________________________________

                                 AN ACT

 To amend the Public Health Service Act to establish a Nurse Corps and 
 recruitment and retention strategies to address the nursing shortage, 
                        and for other purposes.