[Congressional Bills 111th Congress]
[From the U.S. Government Publishing Office]
[S. 1031 Introduced in Senate (IS)]
111th CONGRESS
1st Session
S. 1031
To amend the Public Health Service Act to establish direct care
registered nurse-to-patient staffing ratio requirements in hospitals,
and for other purposes.
_______________________________________________________________________
IN THE SENATE OF THE UNITED STATES
May 13, 2009
Mrs. Boxer introduced the following bill; which was read twice and
referred to the Committee on Health, Education, Labor, and Pensions
_______________________________________________________________________
A BILL
To amend the Public Health Service Act to establish direct care
registered nurse-to-patient staffing ratio requirements in hospitals,
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 ``National Nursing Shortage Reform and
Patient Advocacy Act''.
SEC. 2. MINIMUM DIRECT CARE REGISTERED NURSE STAFFING REQUIREMENTS.
(a) Minimum Direct Care Registered Nurse Staffing Requirements.--
The Public Health Service Act (42 U.S.C. 201 et seq.) is amended by
adding at the end the following new title:
``TITLE XXXI--MINIMUM DIRECT CARE REGISTERED NURSE STAFFING
REQUIREMENTS
``SEC. 3101. MINIMUM NURSE STAFFING REQUIREMENTS.
``(a) Staffing Plan.--
``(1) In general.--A hospital shall implement a staffing
plan that--
``(A) provides adequate, appropriate, and quality
delivery of health care services and protects patient
safety; and
``(B) is consistent with the requirements of this
title.
``(2) Effective dates.--
``(A) Implementation of staffing plan.--Subject to
subparagraph (B), the requirements under paragraph (1)
shall take effect not later than 1 year after the date
of enactment of this title.
``(B) Application of minimum direct care registered
nurse-to-patient ratios.--The requirements under
subsection (b) shall take effect as soon as
practicable, as determined by the Secretary, but not
later than 2 years after the date of enactment of this
title, or in the case of a hospital in a rural area (as
defined in section 1886(d)(2)(D) of the Social Security
Act), not later than 4 years after the date of
enactment of this title.
``(b) Minimum Direct Care Registered Nurse-to-Patient Ratios.--
``(1) In general.--Except as otherwise provided in this
section, a hospital's staffing plan shall provide that, at all
times during each shift within a unit of the hospital, a direct
care registered nurse shall be assigned to not more than the
following number of patients in that unit, subject to paragraph
(4):
``(A) 1 patient in trauma emergency units.
``(B) 1 patient in operating room units, provided
that a minimum of 1 additional person serves as a scrub
assistant in such unit.
``(C) 2 patients in critical care units, including
neonatal intensive care units, emergency critical care
and intensive care units, labor and delivery units,
coronary care units, acute respiratory care units,
postanesthesia units, and burn units.
``(D) 3 patients in emergency room units, stepdown
units, pediatrics units, telemetry units, and combined
labor, delivery, and postpartum units.
``(E) 4 patients in antepartum units, intermediate
care nursery units, psychiatric units, and other
specialty care units.
``(F) 5 patients in medical-surgical units,
rehabilitation units, and skilled nursing units.
``(G) 8 patients in well-baby nursery units and
postpartum (4 couplets) units.
``(2) Similar units with different names.--The Secretary
may apply minimum direct care registered nurse-to-patient
ratios established in paragraph (1) to a type of hospital unit
not referred to in such paragraph if such other unit performs a
function similar to the function performed by the unit referred
to in such paragraph.
``(3) Restrictions.--
``(A) Prohibition against averaging.--A hospital
shall not average the number of patients and the total
number of direct care registered nurses assigned to
patients in a hospital unit during any 1 shift or over
any period of time for purposes of meeting the
requirements under this subsection.
``(B) Prohibition against imposition of mandatory
overtime requirements.--A hospital shall not impose
mandatory overtime requirements to meet the hospital
unit direct care registered nurse-to-patient ratios
required under this subsection.
``(C) Relief during routine absences.--A hospital
shall ensure that only a direct care registered nurse
may relieve another direct care registered nurse during
breaks, meals, and other routine, expected absences
from a hospital unit.
``(D) Prohibition against imposition of lay-offs.--
A hospital shall not impose lay-offs of licensed
vocational or practical nurses, licensed psychiatric
technicians, certified nursing assistants, or other
ancillary staff to meet the hospital unit direct care
registered nurse-to-patient ratios required under this
subsection.
``(4) Adjustment of ratios.--
``(A) In general.--If necessary to protect patient
safety, the Secretary may prescribe regulations that--
``(i) increase minimum direct care
registered nurse-to-patient ratios under this
subsection to further limit the number of
patients that may be assigned to each direct
care nurse; or
``(ii) add minimum direct care registered
nurse-to-patient ratios for units not referred
to in paragraphs (1) and (2).
``(B) Consultation.--Such regulations shall be
prescribed after consultation with affected hospitals
and registered nurses.
``(5) No preemption of certain state-imposed ratios.--
Nothing in this title shall preempt State standards that the
Secretary determines to be at least equivalent to Federal
requirements for a staffing plan established under this title.
Minimum direct care registered nurse-to-patient ratios
established under this subsection shall not preempt State
requirements that the Secretary determines are at least
equivalent to Federal requirements for a staffing plan
established under this title.
``(6) Exemption in emergencies.--The requirements
established under this subsection shall not apply during a
declared state of emergency if a hospital is requested or
expected to provide an exceptional level of emergency or other
medical services.
``(c) Development and Reevaluation of Staffing Plan.--
``(1) Considerations in development of plan.--In developing
the staffing plan, a hospital shall provide for direct care
registered nurse-to-patient ratios above the minimum direct
care registered nurse-to-patient ratios required under
subsection (b) if appropriate based upon consideration of the
following factors:
``(A) The number of patients and acuity level of
patients as determined by the application of an acuity
system (as defined in section 3107(1)), on a shift-by-
shift basis.
``(B) The anticipated admissions, discharges, and
transfers of patients during each shift that impacts
direct patient care.
``(C) Specialized experience required of direct
care registered nurses on a particular unit.
``(D) Staffing levels and services provided by
other health care personnel in meeting direct patient
care needs not required by a direct care registered
nurse.
``(E) The level of technology available that
affects the delivery of direct patient care.
``(F) The level of familiarity with hospital
practices, policies, and procedures by temporary agency
direct care registered nurses used during a shift.
``(G) Obstacles to efficiency in the delivery of
patient care presented by physical layout.
``(2) Documentation of staffing.--A hospital shall specify
the system used to document actual staffing in each unit for
each shift.
``(3) Annual reevaluation of plan and acuity system.--
``(A) In general.--A hospital shall annually
evaluate--
``(i) its staffing plan in each unit in
relation to actual patient care requirements;
and
``(ii) the accuracy of its acuity system.
``(B) Update.--A hospital shall update its staffing
plan and acuity system to the extent appropriate based
on such evaluation.
``(4) Transparency.--
``(A) In general.--Any acuity-based patient
classification system adopted by a hospital under this
section shall be transparent in all respects, including
disclosure of detailed documentation of the methodology
used to predict nursing staffing, identifying each
factor, assumption, and value used in applying such
methodology.
``(B) Public availability.--The Secretary shall
establish procedures to provide that the documentation
submitted under subsection (e) is available for public
inspection in its entirety.
``(5) Registered nurse participation.--A staffing plan of a
hospital shall be developed and subsequent reevaluations shall
be conducted under this subsection on the basis of input from
direct care registered nurses at the hospital or, where such
nurses are represented through collective bargaining, from the
applicable recognized or certified collective bargaining
representative of such nurses. Nothing in this title shall be
construed to permit conduct prohibited under the National Labor
Relations Act or under the Federal Labor Relations Act.
``(d) Acuity Tool.--
``(1) In general.--Not later than 2 years after the date of
enactment of the National Nursing Shortage Reform and Patient
Advocacy Act, the Secretary shall develop a national acuity
tool that provides a method for establishing nurse staffing
requirements above the hospital unit direct care registered
nurse-to-patient ratios required under subsection (b).
``(2) Implementation.--Each hospital shall adopt and
implement the national acuity tool described in paragraph (1),
and provide staffing based on such tool. Any additional direct
care registered nursing staffing above the hospital unit direct
care registered nurse-to-patient ratios described in subsection
(b) shall be assigned in a manner determined by such national
acuity tool.
``(e) Submission of Plan to Secretary.--A hospital shall submit to
the Secretary its staffing plan required under subsection (a)(1) and
any annual updates under subsection (c)(3)(B).
``SEC. 3102. POSTING, RECORDS, AND AUDITS.
``(a) Posting Requirements.--In each unit, a hospital shall post a
uniform notice in a form specified by the Secretary in regulation
that--
``(1) explains requirements imposed under section 3101;
``(2) includes actual direct care registered nurse-to-
patient ratios during each shift; and
``(3) is visible, conspicuous, and accessible to staff,
patients, and the public.
``(b) Records.--
``(1) Maintenance of records.--Each hospital shall maintain
accurate records of actual direct care registered nurse-to-
patient ratios in each unit for each shift for no less than 2
years. Such records shall include--
``(A) the number of patients in each unit;
``(B) the identity and duty hours of each direct
care registered nurse assigned to each patient in each
unit in each shift; and
``(C) a copy of each notice posted under subsection
(a).
``(2) Availability of records.--Each hospital shall make
its records maintained under paragraph (1) available to--
``(A) the Secretary;
``(B) registered nurses and their collective
bargaining representatives (if any); and
``(C) the public under regulations established by
the Secretary, or in the case of a federally operated
hospital, under section 552 of title 5, United States
Code (commonly known as the `Freedom of Information
Act').
``(c) Audits.--The Secretary shall conduct periodic audits to
ensure--
``(1) implementation of the staffing plan in accordance
with this title; and
``(2) accuracy in records maintained under this section.
``SEC. 3103. MINIMUM DIRECT CARE LICENSED PRACTICAL NURSE STAFFING
REQUIREMENTS.
``(a) Establishment.--A hospital's staffing plan shall comply with
minimum direct care licensed practical nurse staffing requirements that
the Secretary establishes for units in hospitals. Such staffing
requirements shall be established not later than 18 months after the
date of enactment of this title, and shall be based on the study
conducted under subsection (b).
``(b) Study.--Not later than 1 year after the date of enactment of
this title, the Secretary, acting through the Director of the Agency
for Healthcare Research and Quality, shall complete a study of licensed
practical nurse staffing and its effects on patient care in hospitals.
The Director may contract with a qualified entity or organization to
carry out such study under this paragraph. The Director shall consult
with licensed practical nurses and organizations representing licensed
practical nurses regarding the design and conduct of the study.
``(c) Application of Registered Nurse Provisions to Licensed
Practical Nurse Staffing Requirements.--Paragraphs (2), (4), (5)(A),
and (6) of section 3101(b), section 3101(c), and section 3102 shall
apply to the establishment and application of direct care licensed
practical nurse staffing requirements under this section in the same
manner that they apply to the establishment and application of direct
care registered nurse-to-patient ratios under sections 3101 and 3102.
``(d) Effective Date.--The requirements of this section shall take
effect as soon as practicable, as determined by the Secretary, but not
later than 2 years after the date of enactment of this title, or in the
case of a hospital in a rural area (as defined in section 1886(d)(2)(D)
of the Social Security Act), not later than 4 years after the date of
enactment of this title.
``SEC. 3104. FEDERAL ASSISTANCE FOR THE PURCHASE OF SAFE PATIENT
HANDLING EQUIPMENT.
``(a) In General.--The Secretary shall establish a grant program to
provide financial assistance to cover some or all of the costs of
purchasing safe patient handling equipment required by the Federal safe
patient handling standard, developed under section 3 of the National
Nursing Shortage Reform and Patient Advocacy Act, for health care
facilities, such as hospitals, nursing facilities, and outpatient
facilities, that--
``(1) require such equipment in order to comply with the
standards established under section 3 of the National Nursing
Shortage Reform and Patient Advocacy Act; and
``(2) demonstrate the financial inability to otherwise
afford the purchase of such equipment.
``(b) Application.--A health care facility desiring a grant under
this section shall submit to the Secretary an application--
``(1) in such form and manner as the Secretary shall
specify; and
``(2) demonstrating true financial need, according to a
standard established by the Secretary.
``(c) Authorization of Appropriations.--There are authorized to be
appropriated to be used for grant awards under this section $50,000,000
for fiscal year 2010, which shall remain available until expended.
``SEC. 3105. WHISTLEBLOWER AND PATIENT PROTECTIONS.
``(a) Recognition of Duty and Right of Nurses To Advocate in the
Exclusive Interest of the Patient.--A nurse shall have the right to act
as the patient's advocate, as circumstances require, by--
``(1) initiating action to improve health care or to change
decisions or activities which, in the professional judgment of
the nurse, are against the interests and wishes of the patient;
and
``(2) giving the patient an opportunity to make informed
decisions about health care before it is provided.
``(b) Refusal of Assignment.--A nurse may refuse to accept an
assignment as a nurse in a hospital if--
``(1) the assignment would violate section 3101 or 3103; or
``(2) the nurse is not prepared by education, training, or
experience to fulfill the assignment without compromising the
safety of any patient or jeopardizing the license of the nurse.
``(c) Retaliation for Refusal of Assignment Barred.--
``(1) No discharge, discrimination, or retaliation.--No
hospital shall discharge, discriminate, or retaliate in any
manner with respect to any aspect of employment (as defined in
section 3107(5)), including discharge, promotion, compensation,
or terms, conditions, or privileges of employment against a
nurse based on the nurse's refusal of a work assignment under
subsection (b).
``(2) No filing of complaint.--No hospital shall file a
complaint or a report against a nurse with the appropriate
State professional disciplinary agency because of the nurse's
refusal of a work assignment described in subsection (b).
``(d) Cause of Action.--Any nurse who has been discharged,
discriminated against, or retaliated against in violation of subsection
(c)(1) or against whom a complaint has been filed in violation of
subsection (c)(2) may bring a cause of action in a United States
district court. A nurse who prevails on the cause of action shall be
entitled to one or more of the following:
``(1) Reinstatement.
``(2) Reimbursement of lost wages, compensation, and
benefits.
``(3) Attorneys' fees.
``(4) Court costs.
``(5) Other damages.
``(e) Complaint to Secretary.--
``(1) In general.--A nurse, patient, or other individual
may file a complaint with the Secretary against a hospital that
violates the provisions of this title. For any complaint filed,
the Secretary shall--
``(A) receive and investigate the complaint;
``(B) determine whether a violation of this title
as alleged in the complaint has occurred; and
``(C) if such a violation has occurred, issue an
order that the complaining nurse or individual shall
not suffer any retaliation described in subsection (c)
or subsection (g).
``(f) Toll-Free Telephone Number.--
``(1) In general.--The Secretary shall provide for the
establishment of a toll-free telephone hotline to provide
information regarding the requirements under section 3101 and
to receive reports of violations of such section.
``(2) Notice to patients.--A hospital shall provide each
patient admitted to the hospital for inpatient care with the
hotline described in paragraph (1), and shall give notice to
each patient that such hotline may be used to report inadequate
staffing or care.
``(g) Protection for Reporting.--
``(1) Prohibition on retaliation or discrimination.--A
hospital shall not discriminate or retaliate in any manner
against any patient, employee, or contract employee of the
hospital, or any other individual, on the basis that such
individual, in good faith, individually or in conjunction with
another person or persons, has presented a grievance or
complaint, or has initiated or cooperated in any investigation
or proceeding of any governmental entity, regulatory agency, or
private accreditation body, made a civil claim or demand, or
filed an action relating to the care, services, or conditions
of the hospital or of any affiliated or related facilities.
``(2) Good faith defined.--For purposes of this subsection,
an individual shall be deemed to be acting in good faith if the
individual reasonably believes--
``(A) the information reported or disclosed is
true; and
``(B) a violation of this title has occurred or may
occur.
``(h) Prohibition on Interference With Rights.--
``(1) Exercise of rights.--It shall be unlawful for any
hospital to--
``(A) interfere with, restrain, or deny the
exercise, or attempt to exercise, by any person of any
right provided or protected under this title; or
``(B) coerce or intimidate any person regarding the
exercise or attempt to exercise such right.
``(2) Opposition to unlawful policies or practices.--It
shall be unlawful for any hospital to discriminate or retaliate
against any person for opposing any hospital policy, practice,
or actions which are alleged to violate, breach, or fail to
comply with any provision of this title.
``(3) Prohibition on interference with protected
communications.--A hospital (or an individual representing a
hospital) shall not make, adopt, or enforce any rule,
regulation, policy, or practice which in any manner directly or
indirectly prohibits, impedes, or discourages a direct care
registered nurse from, or intimidates, coerces, or induces a
direct care registered nurse regarding, engaging in free speech
activities or disclosing information as provided under this
title.
``(4) Prohibition on interference with collective action.--
A hospital (or an individual representing a hospital) shall not
in any way interfere with the rights of nurses to organize,
bargain collectively, and engage in concerted activity under
section 7 of the National Labor Relations Act (29 U.S.C. 157).
``(i) Notice.--A hospital shall post in an appropriate location in
each unit a conspicuous notice in a form specified by the Secretary
that--
``(1) explains the rights of nurses, patients, and other
individuals under this section;
``(2) includes a statement that a nurse, patient, or other
individual may file a complaint with the Secretary against a
hospital that violates the provisions of this title; and
``(3) provides instructions on how to file a complaint
under paragraph (2).
``(j) Effective Dates.--
``(1) Refusal; retaliation; cause of action.--
``(A) In general.--Subsections (b) through (d)
shall apply to refusals occurring on or after the
effective date of the provision to which the refusal
relates.
``(B) Exception.--Subsection (b)(2) shall not apply
to refusals in any hospital before the requirements of
section 3101(a) apply to that hospital.
``(2) Protections for reporting.--Subsection (g)(1) shall
apply to actions occurring on or after the effective date of
the provision to which the violation relates, except that such
subsection shall apply to initiation, cooperation, or
participation in an investigation or proceeding on or after the
date of enactment of this title.
``(3) Notice.--Subsection (i) shall take effect 18 months
after the date of enactment of this title.
``SEC. 3106. ENFORCEMENT.
``(a) In General.--The Secretary shall enforce the requirements and
prohibitions of this title in accordance with this section.
``(b) Procedures for Receiving and Investigating Complaints.--The
Secretary shall establish procedures under which--
``(1) any person may file a complaint alleging that a
hospital has violated a requirement or a prohibition of this
title; and
``(2) such complaints shall be investigated by the
Secretary.
``(c) Remedies.--If the Secretary determines that a hospital has
violated a requirement of this title, the Secretary--
``(1) shall require the facility to establish a corrective
action plan to prevent the recurrence of such violation; and
``(2) may impose civil money penalties, as described in
subsection (d).
``(d) Civil Penalties.--
``(1) In general.--In addition to any other penalties
prescribed by law, the Secretary may impose civil penalties as
follows:
``(A) Hospital liability.--The Secretary may impose
on a hospital found to be in violation of this title, a
civil money penalty of not more than $25,000 for each
knowing violation of a requirement of this title,
except that the Secretary shall impose a civil money
penalty of more than $25,000 for each such violation in
the case of a participating hospital that the Secretary
determines has a pattern or practice of such violations
(with the amount of such additional penalties being
determined in accordance with a schedule or methodology
specified in regulations).
``(B) Individual liability.--The Secretary may
impose on an individual who--
``(i) is employed by a hospital found by
the Secretary to have violated a requirement of
this title; and
``(ii) willfully violates this title,
a civil money penalty of not more than $20,000 for each
such violation.
``(2) Procedures.--The provisions of section 1128A of the
Social Security Act (other than subsections (a) and (b)) shall
apply to a civil money penalty under this paragraph in the same
manner as such provisions apply to a penalty or proceeding
under such section 1128A.
``(e) Public Notice of Violations.--
``(1) Internet website.--The Secretary shall publish on the
Internet website of the Department of Health and Human Services
the names of participating hospitals on which civil money
penalties have been imposed under this subsection, the
violation for which such penalty was imposed, and such
additional information as the Secretary determines appropriate.
``(2) Change of ownership.--With respect to a participating
hospital that had a change in ownership, as determined by the
Secretary, penalties imposed on the hospital while under
previous ownership shall no longer be published by the
Secretary of such Internet website after the 1-year period
beginning on the date of change in ownership.
``(f) Offset.--Funds collected by the Secretary under this
paragraph shall be used to offset the costs of enforcing this title.
``SEC. 3107. DEFINITIONS.
``For purposes of this title:
``(1) Acuity system.--The term `acuity system' means an
established measurement tool that--
``(A) predicts nursing care requirements for
individual patients based on severity of patient
illness, need for specialized equipment and technology,
intensity of nursing interventions required, and the
complexity of clinical nursing judgment needed to
design, implement, and evaluate the patient's nursing
care plan;
``(B) details the amount of nursing care needed,
both in number of nurses and in skill mix of nursing
personnel required, on a daily basis, for each patient
in a nursing department or unit;
``(C) takes into consideration the patient care
services provided not only by registered nurses but
also by direct care licensed practical nurses and other
health care personnel; and
``(D) is stated in terms that can be readily used
and understood by nurses.
``(2) Direct care licensed practical nurse.--The term
`direct care licensed practical nurse' means an individual who
has been granted a license by at least 1 State to practice as a
licensed practical nurse or a licensed vocational nurse and who
provides bedside care for 1 or more patients.
``(3) Nurse.--The term `nurse' means any direct care
registered nurse or direct care licensed practical nurse (as
the case may be), regardless of whether or not the nurse is an
employee.
``(4) Direct care registered nurse.--The term `direct care
registered nurse' means an individual who has been granted a
license by at least 1 State to practice as a registered nurse
and who provides bedside care for 1 or more patients.
``(5) Employment.--The term `employment' includes the
provision of services under a contract or other arrangement.
``(6) Hospital.--The term `hospital' has the meaning given
that term in section 1861(e) of the Social Security Act and
includes a long-term care hospital, as defined in section
1861(ccc) of such Act.
``(7) Staffing plan.--The term `staffing plan' means a
staffing plan required under section 3101.
``(8) Declared state of emergency.--The term `declared
state of emergency' means a state of emergency that is an
unpredictable or unavoidable occurrence at an unscheduled or
unpredictable interval, relating to health care delivery and
requiring immediate medical interventions and care, that has
been declared by the Federal Government or the head of the
appropriate State or local governmental agency having authority
to declare that the State, county, municipality, or locality is
in a state of emergency, but such term does not include a state
of emergency that results from a labor dispute in the health
care industry or consistent understaffing.
``SEC. 3108. RULE OF CONSTRUCTION.
``Nothing in this title shall be construed to authorize disclosure
of private and confidential patient information, except in the case
where such disclosure is otherwise required by law, compelled by proper
legal process, consented to by the patient, provided in confidence to
regulatory or accreditation agencies or other government entities for
investigatory purposes, or provided pursuant to formal or informal
complaints of unlawful or improper practices for purposes of achieving
corrective and remedial action.''.
(b) Recommendations to Congress.--Not later than 1 year after the
date of enactment of this Act, the Secretary of Health and Human
Services shall submit to Congress a report containing recommendations
for ensuring that sufficient numbers of nurses are available to meet
the requirements imposed by title XXXI of the Public Health Service
Act, as added by subsection (a).
SEC. 3. FEDERAL SAFE PATIENT HANDLING STANDARD.
(a) In General.--Not later than 1 year after the date of enactment
of this Act, the Secretary of Labor, acting through the Director of
Occupational Safety and Health Administration, shall establish a
Federal Safe Patient Handling Standard, consistent with section 6 of
the Occupational Safety and Health Act of 1970 (29 U.S.C. 655) to
prevent musculoskeletal disorders for direct care registered nurses and
other health care providers working in health care facilities.
(b) Development of Standard.--In developing the standard under
subsection (a), the Secretary shall solicit input from direct care
registered nurses and organizations representing direct care registered
nurses in implementing the standard.
(c) Requirements.--The standard promulgated under subsection (a)
shall include--
(1) a zero lift policy;
(2) a musculoskeletal injury prevention plan, which shall
include hazard identification and risk assessments in relation
to patient care duties and patient handling;
(3) a program to identify problems and solutions regarding
safe patient handling;
(4) a system to report, track, and analyze trends in
injuries, as well as make injury data available to the public;
(5) training for staff, including interactive classroom-
based and hands-on training by a knowledgeable person or staff,
on safe patient handling policies, equipment, and devices at
least on an annual basis, which shall include training on
hazard identification, assessment, and control of
musculoskeletal hazards in patient care areas; and
(6) annual evaluations of safe patient handling efforts, as
well as new technology, handling procedures, and engineering
controls.
(d) Compliance With the Standard.--The Secretary of Labor shall
require--
(1) all health care facilities to comply with the standard
developed under subsection (a); and
(2) health care facilities to purchase, use, and maintain
safe lift mechanical devices.
(e) Safe Patient Handling Plan.--In accordance with the standard
developed under subsection (a), and not later than 180 days after such
standard is published, health care facilities shall develop and
implement a safe patient handling plan that--
(1) provides adequate, appropriate, and quality delivery of
health care services that protects patient safety and prevents
musculoskeletal disorders for direct care registered nurses and
other health care providers;
(2) is consistent with the requirements of the Federal Safe
Patient Handling Standard;
(3) provides for input by direct care registered nurses and
organizations representing direct care registered nurses in
implementing the plan; and
(4) ensures that safe lifting mechanical devices shall only
be used by direct care registered nurses and other health care
providers.
(f) Definitions.--In this section--
(1) the term ``lift team'' means employees of a hospital
who are specially trained to handle patient lifts, repositions,
and transfers using patient transfer devices or lifting devices
as appropriate for the specific patient, based on a needs
assessment of the individual hospital employer; and
(2) the term ``zero lift policy'' means replacing
unassisted manual lifting, repositioning, and transferring of
patients with the use of patient transfer devices, lifting
devices, and lift teams. Such term does not require the use of
patient transfer or lifting devices when the lift, reposition,
and transfer needs assessment indicates it is safe for the
patient and the employee to use manual lifting, repositioning,
and transferring techniques.
SEC. 4. PAYMENT ADJUSTMENT FOR HOSPITALS UNDER THE MEDICARE PROGRAM
BASED ON ADDITIONAL COSTS OF COMPLYING WITH CERTAIN
REQUIREMENTS.
Section 1886 of the Social Security Act (42 U.S.C. 1395ww), as
amended by section 4102 of the HITECH Act (Public Law 111-5), is
amended by adding at the end the following new subsection:
``(o) Adjustment Based on Additional Costs of Complying With
Certain Requirements.--
``(1) In general.--With respect to inpatient hospital
services furnished by a subsection (d) hospital during a fiscal
year (beginning with fiscal year 2010), in addition to the
amount otherwise paid under this section, there shall also be
paid to the subsection (d) hospital, from the Federal Hospital
Insurance Trust Fund established under section 1817, an amount
equal to the applicable amount specified in paragraph (2) for
the subsection (d) hospital for the fiscal year.
``(2) Applicable amount.--The applicable amount specified
in this paragraph for a subsection (d) hospital for a fiscal
year is equal to the quotient of--
``(A) the total amount of additional costs incurred
by the hospital in providing inpatient hospital
services to beneficiaries during the fiscal year that
are attributable to compliance with the requirements
under sections 3101, 3102, and 3103 of the Public
Health Services Act (as estimated by the Secretary,
taking into account recommendations contained in the
report under paragraph (3)); and
``(B) the total number of discharges during the
fiscal year (as estimated by the Secretary).
``(3) Medicare payment advisory commission report.--Not
later than 2 years after the date of the enactment of this
subsection, the Medicare Payment Advisory Commission shall
submit to Congress and the Secretary a report containing an
estimate of the total costs to and savings for subsection (d)
hospitals during a fiscal year that are attributable to
compliance with the requirements under sections 3101, 3102, and
3103 of the Public Health Service Act, including
recommendations regarding the adjustment in payments to such
hospitals under this subsection, together with recommendations
for such legislation and administrative action as the
Commission determines appropriate.''.
SEC. 5. ENFORCEMENT OF REQUIREMENTS THROUGH FEDERAL PROGRAMS.
(a) Medicare Program.--Section 1866(a)(1) of the Social Security
Act (42 U.S.C. 1395cc(a)(1)) is amended--
(1) by striking ``and'' at the end of subparagraph (U);
(2) by striking the period at the end of subparagraph (V)
and inserting ``, and''; and
(3) by inserting after subparagraph (V) the following:
``(W) in the case of a hospital, to be subject to the
provisions of title XXXI of the Public Health Service Act.''.
(b) Medicaid Program.--The first sentence of section 1902(a) of the
Social Security Act (42 U.S.C. 1396(a)), as amended by section
5006(e)(2)(A) of Division B of the American Recovery and Reinvestment
Act of 2009 (Public Law 111-5), is amended--
(1) by striking ``and'' at the end of paragraph (72);
(2) by striking the period at the end of paragraph (73) and
inserting ``; and''; and
(3) by inserting after paragraph (73) the following new
paragraph:
``(74) provide that any hospital receiving payments under
such plan shall be subject to the provisions of title XXXI of
the Public Health Service Act.''.
SEC. 6. REGISTERED NURSE WORKFORCE INITIATIVE.
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 J--REGISTERED NURSE WORKFORCE INITIATIVE
``SEC. 860. REGISTERED NURSE WORKFORCE INITIATIVE.
``(a) Establishment.--The Secretary, acting through the
Administrator of the Health Resources and Services Administration,
shall carry out a Registered Nurse Workforce Initiative (referred to in
this part as the `RNWI') to ensure that there is an adequate number of
registered nurses and to reduce critical workforce shortages in
hospitals.
``(b) Purposes.--The purposes of the RNWI are to--
``(1) achieve short-term mitigation and remedy of the
nationwide nursing shortage; and
``(2) establish and maintain the necessary educational
system foundations and institutional involvement to ensure
sufficient labor supply and labor market stability essential to
ensuring safe and competent hospital nursing care on an ongoing
basis.
``(c) Duration.--The RNWI is established as a 5-year program for
the purpose of adding new registered nurses to the workforce, and may
be extended beyond the initial 5-year period, if the Secretary
determines appropriate.
``SEC. 861. EDUCATIONAL ASSISTANCE BENEFITS.
``(a) Grants for Associate and Baccalaureate Degree Programs.--
``(1) Basic educational assistance benefits.--To address
the critical shortage of direct care registered nurses, the
Secretary shall establish a nursing educational assistance
grant program for eligible individuals who are accepted to, or
are enrolled in, associate and baccalaureate degrees in nursing
programs, based on such individuals' financial need, as
determined by the Secretary.
``(2) Supplemental educational assistance benefit.--
``(A) Benefits.--Each individual awarded a grant
under this subsection shall receive--
``(i) nursing educational assistance to
help meet, in part, the annual expenses of
enrolling in and attending an associate or a
baccalaureate degree in nursing program; and
``(ii) a monthly living stipend to help
meet the individual's basic living expenses.
``(B) Grant amounts.--The Secretary shall determine
the amounts awarded under subparagraph (A) for each
fiscal year, based upon the cost of living and the cost
of attending a nursing program for such fiscal year.
``(3) Eligibility.--An individual desiring a grant under
this subsection shall--
``(A) be an individual who has been accepted to an
accredited nursing education program;
``(B) provide assurances that such individual will
work for a health care provider that is eligible to
receive national health service corps professionals for
a period of not less than 3 years, in a setting that
the Secretary determines appropriate; and
``(C) submit to the Secretary an application at
such time, in such manner, and containing such
information as the Secretary may require.
``(b) Grants for Advance Degrees in Nursing.--
``(1) In general.--To address the critical shortage of
nurse educators holding master's or doctoral degrees in
nursing, as well as the lack of master's and doctoral nursing
students, the Secretary shall establish a program to award
grants to eligible individuals to assist such individuals in
pursuing graduate nursing degrees.
``(2) Eligible individuals.--An individual desiring a grant
under this section shall--
``(A) hold an unencumbered license as a registered
nurse;
``(B) be accepted into an accredited master's or
doctorate degree program in nursing;
``(C) provide assurances that such individual will
work as a nurse educator at an accredited nursing
program for a period of 5 years after graduating from
an accredited graduate degree program in nursing; and
``(D) submit to the Secretary an application at
such time, in such manner, and containing such
information as the Secretary may require.
``(c) Repayment Obligation.--A recipient of a grant under this
section who fails to meet the requirements of the grant, as described
in this section or as specified by the Secretary, shall repay the
Secretary all amounts received through such grant, with interest.
``SEC. 862. PRECEPTORSHIP AND MENTORSHIP DEMONSTRATION PROJECTS.
``(a) In General.--The Secretary shall award grants to eligible
entities for the purpose of conducting 5-year nursing preceptorship and
mentorship demonstration projects, designed to address nurse workforce
shortages and improve patient care by providing additional support to
nurses entering the workforce to promote the retention of nurses in the
workforce.
``(b) Eligible Entities.--An entity desiring a grant under this
section shall--
``(1) be a hospital; and
``(2) submit an application to the Secretary at such time,
in such manner, and containing such information as the
Secretary may require.
``(c) Priority.--In awarding grants under this section, the
Secretary shall give priority to hospitals that have a critical
shortage of nurses, as determined by the Secretary.
``(d) Preceptorship Program.--
``(1) In general.--The preceptorship program shall
provide--
``(A) a period of practical experience and training
for nursing students, by providing clinical supervision
by a direct care registered nurse expert or specialist
in a particular field; or
``(B) a period of orientation for newly-graduated
or newly hired direct care registered nurses.
``(2) Purpose.--The purpose of the preceptorship program is
to establish a period of practical and clinical experiences and
training for nursing students, newly hired nurses and recent
graduates of a direct care degree program for registered
nurses.
``(e) Mentorship Program.--
``(1) In general.--The mentorship program shall match newly
hired direct care registered nurses (referred to in this
subsection as the `mentees') with experienced direct care
registered nurses, who shall serve as advocates and role models
and help the mentees grow professionally, feel supported, and
adapt to the culture of the acute care hospital. Mentors shall
provide personal and career support in the workplace.
``(2) Purpose.--The purpose of the mentorship program is to
assist new or transitional direct care registered nurses to
succeed in making their own contributions to the care of
patients and to the nursing profession.
``(f) Report.--Each recipient of a grant under this section, at the
end of such recipient's 5-year demonstration project, shall submit to
the Secretary a report containing an evaluation of the effect of the
demonstration project on nurse retention and patient care in the
hospital for which such grant was awarded.
``SEC. 863. AUTHORIZATION OF APPROPRIATIONS.
``To carry out this part, there are authorized to be appropriated
such funds as may be necessary for fiscal years 2010 through 2014.''.
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