[Congressional Bills 107th Congress]
[From the U.S. Government Publishing Office]
[S. 706 Introduced in Senate (IS)]







107th CONGRESS
  1st Session
                                 S. 706

To amend the Social Security Act to establish programs to alleviate the 
          nursing profession shortage, and for other purposes.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                             April 5, 2001

Mr. Kerry (for himself, Mr. Jeffords, Mr. Daschle, Mrs. Hutchinson, Mr. 
Leahy, Mr. Reid, Mr. Hollings, Mr. Johnson, Mr. Schumer, Ms. Mikulski, 
 Mrs. Murray, Mr. Torricelli, Mr. Inouye, Mr. Reed, Mrs. Clinton, Mr. 
Bingaman, Mr. Harkin, Mr. Sarbanes, Mr. Lieberman, Mr. Rockefeller, Mr. 
 Kennedy, Mrs. Lincoln, and Ms. Snowe) introduced the following bill; 
     which was read twice and referred to the Committee on Finance

_______________________________________________________________________

                                 A BILL


 
To amend the Social Security Act to establish programs to alleviate the 
          nursing profession 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. EXPANSION OF NURSING TRAINING EDUCATION PAYMENTS TO QUALIFIED 
              NONHOSPITAL PROVIDERS.

    Section 1861(v)(1) of the Social Security Act (42 U.S.C. 
1395x(v)(1)) is amended by adding at the end the following new 
subparagraph:
    ``(V)(i) For portions of cost reporting periods beginning on or 
after October 1, 2001, the Secretary shall establish rules for making 
payments to qualified nonhospital providers for the reasonable costs of 
providing nursing training if such costs are incurred in the operation 
of a training program that is operated by a hospital.
    ``(ii) The rules established under clause (i) shall--
            ``(I) be similar to rules for payments to hospitals under 
        this subsection for such reasonable costs; and
            ``(II) specify the form and manner in which such payments 
        will be made and the portion of such payments that will be made 
        from each of the trust funds under this title.
    ``(iii) No payment shall be made to a qualified nonhospital 
provider under this subparagraph for such reasonable costs to the 
extent that such reasonable costs are otherwise reimbursed under this 
title or under any other Federal program.
    ``(iv) For purposes of this subparagraph, the term `qualified 
nonhospital providers' means--
            ``(I) a Federally qualified health center (as defined in 
        section 1861(aa)(4));
            ``(II) a rural health clinic (as defined in section 
        1861(aa)(2));
            ``(III) a Medicare+Choice organization under part C; and
            ``(IV) any other provider (other than a hospital) that the 
        Secretary determines to be appropriate.''.

SEC. 3. REIMBURSEMENT OF THE COSTS OF PROVIDING NURSING TRAINING 
              EDUCATION BY HOSPICE AND HOME HEALTH PROVIDERS.

    Title XVIII (42 U.S.C. 1395 et seq.) is amended by adding at the 
end the following new section:

``reimbursement of the costs of providing nursing training education by 
                   hospice and home health providers

    ``Sec. 1897. (a) Payments.--
            ``(1) In general.--The Secretary shall establish rules for 
        making payments to qualified entities for the reasonable costs 
        of providing nursing training during fiscal years 2002 through 
        2006. Subject to subsection (c), such payments shall be in 
        addition to payments otherwise made to such entities under this 
        title.
            ``(2) Rules.--The rules established under paragraph (1) 
        shall ensure that reimbursement is made for the costs of 
        training nurses to furnish items and services which are 
        specific to the qualified entity.
            ``(3) Qualified entity defined.--For purposes of this 
        section, the term `qualified entity' means--
            ``(I) a hospice program providing hospice care; and
            ``(II) a home health agency (as defined in section 
        1861(o)).
    ``(b) Maintenance of Effort.--The Secretary shall ensure that a 
qualified entity does not use amounts received under this section to 
reduce or eliminate staffing problems that the entity may have.
    ``(c) Prohibition on Double Payments.--No payment shall be made to 
a qualified entity under this section for the reasonable costs of 
providing nursing training to the extent that such costs are otherwise 
reimbursed under this title or under any other Federal program.
    ``(d) Funding.--For purposes of making payments under this section, 
there are appropriated, out of any money in the Treasury not otherwise 
appropriated, such sums as may be necessary for each of fiscal years 
2002 through 2006.''.

SEC. 4. TEMPORARY INCREASE IN FEDERAL MATCHING RATE FOR MEDICAID NURSE 
              AIDE TRAINING AND COMPETENCY EVALUATION PROGRAMS.

    Section 1903(a)(2)(B) of the Social Security Act (42 U.S.C. 
1396b(a)(2)(B)) is amended by striking ``(or, for calendar quarters 
beginning on or after July 1, 1988, and before October 1, 1990, the 
lesser of 90 percent or the Federal medical assistance percentage plus 
25 percentage points)'' and inserting ``(or, for calendar quarters 
beginning on or after October 1, 2001, and before October 1, 2006, 90 
percent)''.

SEC. 5. EXCLUSION OF CERTAIN AMOUNTS RECEIVED UNDER THE NATIONAL 
              NURSING SERVICE CORPS SCHOLARSHIP PROGRAM.

    (a) In General.--Section 117(c) (relating to the exclusion from 
gross income amounts received as a qualified scholarship) is amended--
            (1) by striking ``Subsections (a)'' and inserting the 
        following:
            ``(1) In general.--Except as provided in paragraph (2), 
        subsections (a)'', and
            (2) by adding at the end the following new paragraph:
            ``(2) Exceptions.--Paragraph (1) shall not apply to any 
        amount received by an individual under the National Nursing 
        Service Corps Scholarship program under part J of title VIII of 
        the Public Health Service Act.''.
    (b) Effective Date.--The amendments made by subsection (a) shall 
apply to amounts received in taxable years beginning after December 31, 
2001.

SEC. 6. 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,'' after ``in a public 
        hospital,''; and
            (2) by adding at the end the following:

           ``PART H--INITIATIVES TO COMBAT NURSING SHORTAGES

``SEC. 851. PUBLIC SERVICE ANNOUNCEMENTS.

    ``(a) In General.--The Secretary shall develop and issue public 
service announcements that shall advertise and promote the nursing 
profession, highlight the advantages and rewards of nursing, and 
encourage individuals from diverse communities and backgrounds to enter 
the nursing profession.
    ``(b) Method.--The public service announcements described in 
subsection (a) shall be broadcast in appropriate languages via 
appropriate media outlets, including on television or radio, in a 
manner intended to reach as wide and diverse an audience as possible.

``SEC. 852. STATE AND LOCAL PUBLIC SERVICE ANNOUNCEMENTS.

    ``(a) In General.--The Secretary shall award grants to eligible 
entities to support State and local advertising campaigns via 
appropriate media outlets to promote the nursing profession, highlight 
the advantages and rewards of nursing, and encourage individuals from 
disadvantaged communities and backgrounds to enter the nursing 
profession.
    ``(b) Definitions.--In this section:
            ``(1) Eligible entity.--The term `eligible entity' means a 
        professional State nursing association, State health care 
        provider association, accredited school of nursing, and any 
        other entity that provides similar services or serves a like 
        function.
            ``(2) 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.
    ``(c) Use of Funds.--An eligible entity that receives a grant under 
subsection (a) shall use funds received through such grant to buy local 
television and radio time, place advertisements in local newspapers, 
post information on billboards or on the Internet, or utilize other 
appropriate media outlets in order to--
            ``(1) advertise and promote the nursing profession;
            ``(2) promote nursing education programs;
            ``(3) inform the public of public assistance regarding such 
        education programs;
            ``(4) highlight individuals in the community that are 
        presently practicing nursing in order to recruit new nurses; or
            ``(5) provide any other information to recruit individuals 
        to enroll in nursing programs.
    ``(d) Method.--The campaigns described in subsection (a) shall be 
broadcast in appropriate languages on television or radio, or placed in 
newspapers as advertisements, posted on billboards or the Internet, or 
publicized via other appropriate media outlets in a manner intended to 
reach as wide and diverse an audience as possible.
    ``(e) 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.

``SEC. 853. NURSE RECRUITMENT GRANT PROGRAM.

    ``(a) Program Authorized.--The Secretary shall award grants to 
eligible entities to increase nursing education opportunities.
    ``(b) 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) provide assistance to diploma, associate degree, and 
        collegiate schools of nursing to support remedial education 
        programs for nursing students who require assistance with math, 
        science, English, and medical terminology; or
            ``(4) meet the costs of child care and transportation for 
        individuals who are taking part in a nursing education program 
        at any level.
    ``(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.

``SEC. 854. AUTHORIZATION OF APPROPRIATIONS.

    ``There is authorized to be appropriated to carry out this part, 
$20,000,000 for each of the fiscal years 2002 through 2004.

       ``PART I--INITIATIVES TO STRENGTHEN THE NURSING WORKFORCE

``SEC. 861. CAREER LADDER GRANT PROGRAM.

    ``(a) Program Authorized.--The Secretary shall award grants to 
eligible entities to assist individuals in obtaining education required 
to enter the nursing profession and advance within such profession.
    ``(b) Eligible Entity.--The term `eligible entity' means a diploma, 
associate degree, or collegiate school of nursing.
    ``(c) Use of Funds.--An eligible entity that receives a grant under 
subsection (a) shall use funds under such grant to 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's nursing degree programs, doctoral nursing 
programs, public health nursing programs, nurse educator programs, 
nurse administrator programs, and training programs focused on specific 
technology use or disease management.
    ``(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.

``SEC. 862. GRANTS FOR CURRICULUM DEVELOPMENT.

    ``(a) Program Authorized.--The Secretary shall award grants to 
eligible entities to develop and incorporate gerontology curriculum and 
competencies.
    ``(b) Eligible Entity.--The term `eligible entity' means a diploma, 
associate degree, or collegiate school of nursing.
    ``(c) Use of Funds.--An eligible entity that receives a grant under 
subsection (a) shall use funds under such grant to develop stand alone 
courses in geriatric nursing to support concentrations, minors, and 
majors in the discipline, to hire faculty who are certified in 
geriatric nursing, to train nursing faculty members in gerontology, to 
provide continuing education in gerontology for practicing nurses at 
diploma, associate degree, and baccalaureate schools of 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.

``SEC. 863. GRANTS FOR PARTNERSHIPS.

    ``(a) In General.--The Secretary shall award grants to eligible 
entities to enable such entities to form partnerships to carry out the 
activities described in subsection (d).
    ``(b) Eligible Entity.--The term `eligible entity' means an 
accredited school of nursing and a health care facility that forms a 
partnership to provide the services described in this section.
    ``(c) Health Care Facility.--The term `health care facility' means 
a hospital, nursing home, home health care agency, hospice, federally 
qualified health center, rural health clinic, or public health clinic.
    ``(d) Use of Funds.--An eligible entity that receives a grant under 
subsection (a) shall use funds received through such grant to--
            ``(1) provide employees of the facility advanced training 
        and education at the school or facility;
            ``(2) establish or expand nursing practice arrangements in 
        noninstitutional settings to demonstrate methods to improve 
        access to primary health care in medically underserved 
        communities; and
            ``(3) purchase distance learning technology to extend 
        general education and training programs to rural areas, and to 
        extend specialty education and training programs to all areas.
    ``(e) 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.

``SEC. 864. AUTHORIZATION OF APPROPRIATIONS.

    ``There is authorized to be appropriated to carry out this part, 
$20,000,000 for each of the fiscal years 2002 through 2004.

      ``PART J--NATIONAL NURSING SERVICE CORPS SCHOLARSHIP PROGRAM

``SEC. 871. NATIONAL NURSING 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 areas 
with nursing shortages.
    ``(b) Preference.--In awarding scholarships under this section, the 
Secretary shall give preference to applicants with the greatest 
financial need, and applicants who agree to serve in health facilities 
experiencing nursing shortages in medically underserved areas.
    ``(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, to take courses leading to a 
        baccalaureate 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 payment of a scholarship and remain 
                enrolled in a nursing school;
                    ``(B) maintain an acceptable level of academic 
                standing; and
                    ``(C) serve as a nurse for a period of not less 
                than 2 years in an Indian Health Service health center, 
                a Native Hawaiian health center, a public hospital, a 
                migrant health center, a community health center, a 
                rural health clinic, a nursing home, a home health 
                agency, hospice, or a public or nonprofit private 
                health facility determined by the Secretary to have a 
                critical shortage of nurses.
    ``(d) 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 
        nursing schools materials providing information on the program 
        and shall encourage the schools to disseminate the materials to 
        students of the schools.
    ``(e) 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 12 consecutive months beginning with the first 
                month of the school year.
            ``(2) Contract.--The Secretary may contract with a nursing 
        school, in which a participant in the program is enrolled, for 
        the payment to the nursing school of the amounts of tuition and 
        other reasonable educational expenses described in paragraph 
        (1)(A).
            ``(3) Monthly stipend.--The amount of the monthly stipend, 
        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.
    ``(f) Breach of Agreement.--
            ``(1) In general.--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 for the amount 
        of such scholarship, and for interest on such scholarship at 
        the maximum legal prevailing rate, if the individual--
                    ``(A) fails to maintain an acceptable level of 
                academic standing in the nursing program;
                    ``(B) is dismissed from the nursing program for 
                disciplinary reasons;
                    ``(C) voluntarily terminates the nursing program; 
                or
                    ``(D) fails to provide services in accordance with 
                the program under this section for the period of time 
                applicable under the program.
            ``(2) Waiver or suspension of liability.--The Secretary 
        shall provide for the waiver or suspension of liability under 
        this section if compliance by the individual with the agreement 
        is impossible, or would involve extreme hardship to the 
        individual, or if enforcement of the agreement 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.
    ``(g) Definitions.--In this section:
            ``(1) Community health center.--The term ``community health 
        center'' has the meaning given such term in section 330(a).
            ``(2) Rural health clinic.--The term ``rural health 
        clinic'' has the meaning given such term in section 1861(aa)(2) 
        of the Social Security Act.
    ``(h) Authorization of Appropriations.--For the purpose of payments 
under agreements entered into under subsection (a), there are 
authorized to be appropriated $65,000,000 for each of the fiscal years 
2002 through 2004.''.
                                 <all>