[Congressional Bills 111th Congress]
[From the U.S. Government Publishing Office]
[S. 1161 Introduced in Senate (IS)]

111th CONGRESS
  1st Session
                                S. 1161

    To amend the Public Health Service Act to authorize programs to 
   increase the number of nurse faculty and to increase the domestic 
    nursing and physical therapy workforce, and for other purposes.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                              June 2, 2009

 Mr. Bingaman (for himself and Mrs. Lincoln) 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 authorize programs to 
   increase the number of nurse faculty and to increase the domestic 
    nursing and physical therapy workforce, 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; FINDINGS.

    (a) Short Title.--This Act may be cited as the ``Nurse Faculty and 
Physical Therapist Education Act of 2009''.
    (b) Findings.--Congress makes the following findings:
            (1) The Nurse Reinvestment Act (Public Law 107-205) has 
        helped to support students preparing to be nurse educators. 
        Yet, nursing schools nationwide are forced to deny admission to 
        individuals seeking to become nurses and nurse educators due to 
        the lack of qualified nurse faculty.
            (2) The American Association of Colleges of Nursing 
        reported that 42,866 qualified applicants were denied admission 
        to nursing baccalaureate and graduate programs in 2006, with 
        faculty shortages identified as a major reason for turning away 
        students.
            (3) Seventy-one percent of schools have reported 
        insufficient faculty as the primary reason for not accepting 
        qualified applicants. The primary reasons for lack of faculty 
        are lack of funds to hire new faculty, inability to identify, 
        recruit and hire faculty in the competitive job market as of 
        May 2007, and lack of nursing faculty available in different 
        geographic areas.
            (4) Despite the fact that in 2006, 52.4 percent of 
        graduates of doctoral nursing programs enter education roles, 
        the 103 doctoral programs nationwide produced only 437 
        graduates, which is only an additional 6 graduates from 2005. 
        This annual graduation rate is insufficient to meet the needs 
        for nurse faculty. In keeping with other professional academic 
        disciplines, nurse faculty at colleges and universities are 
        typically doctorally prepared.
            (5) The nursing faculty workforce is aging and will be 
        retiring.
            (6) With the average retirement age of nurse faculty at 
        62.5 years of age, and the average age of doctorally prepared 
        faculty, as of May 2007, that hold the rank of professor, 
        associate professor, and assistant professor is 58.6, 55.8, and 
        51.6 years, respectively, the health care system faces 
        unprecedented workforce and health access challenges with 
        current and future shortages of deans, nurse educators, and 
        nurses.
            (7) Research by the National League of Nursing indicates 
        that by 2019 approximately 75 percent of the nursing faculty 
        population (as of May 2007) is expected to retire.
            (8) A wave of nurses will be retiring from the profession 
        in the near future. As of May 2007, the average age of a nurse 
        in the United States is 46.8 years old. The Bureau of Labor 
        Statistics estimates that more than 1,200,000 new and 
        replacement registered nurses will be needed by 2014.
            (9) By 2030, the number of adults age 65 and older is 
        expected to double to 70,000,000, accounting for 20 percent of 
        the population. As the population ages, the demand for nurses 
        and nursing faculty will increase.
            (10) Despite the need for nurses to treat an aging 
        population, few registered nurses in the United States are 
        trained in geriatrics. Less than 1 percent of practicing nurses 
        have a certification in geriatrics and 3 percent of advanced 
        practice nurses specialize in geriatrics.
            (11) Specialized training in geriatrics is needed to treat 
        older adults with multiple health conditions and improve health 
        outcomes. Approximately 80 percent of Medicare beneficiaries 
        have 1 chronic condition, more than 60 percent have 2 or more 
        chronic conditions, and at least 10 percent have coexisting 
        Alzheimer's disease or other dementias that complicate their 
        care and worsen health outcomes. Two-thirds of Medicare 
        spending is attributed to 20 percent of beneficiaries who have 
        5 or more chronic conditions. Research indicates that older 
        persons receiving care from nurses trained in geriatrics are 
        less frequently readmitted to hospitals or transferred from 
        nursing facilities to hospitals than those who did not receive 
        care from a nurse trained in geriatrics.
            (12) The Department of Labor projected that the need for 
        physical therapists would increase by 36.7 percent between 2004 
        and 2014.
            (13) The need for physical therapists is particularly acute 
        rural and urban underserved areas, which have 3 to 4 times 
        fewer physical therapists per capita than suburban areas.

                 TITLE I--GRANTS FOR NURSING EDUCATION

SEC. 101. NURSE FACULTY EDUCATION.

    Part D of title VIII of the Public Health Service Act (42 U.S.C. 
296p et seq.) is amended by adding at the end the following:

``SEC. 832. NURSE FACULTY EDUCATION.

    ``(a) Establishment.--The Secretary, acting through the Health 
Resources and Services Administration, shall establish a Nurse Faculty 
Education Program to ensure an adequate supply of nurse faculty through 
the awarding of grants to eligible entities to--
            ``(1) provide support for the hiring of new faculty, the 
        retaining of existing faculty, and the purchase of educational 
        resources;
            ``(2) provide for increasing enrollment and graduation 
        rates for students from doctoral programs; and
            ``(3) assist graduates from the entity in serving as nurse 
        faculty in schools of nursing;
    ``(b) Eligibility.--To be eligible to receive a grant under 
subsection (a), an entity shall--
            ``(1) be an accredited school of nursing that offers a 
        doctoral degree in nursing in a State or territory;
            ``(2) submit to the Secretary an application at such time, 
        in such manner, and containing such information as the 
        Secretary may require;
            ``(3) develop and implement a plan in accordance with 
        subsection (c);
            ``(4) agree to submit an annual report to the Secretary 
        that includes updated information on the doctoral program 
        involved, including information with respect to--
                    ``(A) student enrollment;
                    ``(B) student retention;
                    ``(C) graduation rates;
                    ``(D) the number of graduates employed part-time or 
                full-time in a nursing faculty position; and
                    ``(E) retention in nursing faculty positions within 
                1 year and 2 years of employment;
            ``(5) agree to permit the Secretary to make on-site 
        inspections, and to comply with the requests of the Secretary 
        for information, to determine the extent to which the school is 
        complying with the requirements of this section; and
            ``(6) meet such other requirements as determined 
        appropriate by the Secretary.
    ``(c) Use of Funds.--Not later than 1 year after the receipt of a 
grant under this section, an entity shall develop and implement a plan 
for using amounts received under this grant in a manner that 
establishes not less than 2 of the following:
            ``(1) Partnering opportunities with practice and academic 
        institutions to facilitate doctoral education and research 
        experiences that are mutually beneficial.
            ``(2) Partnering opportunities with educational 
        institutions to facilitate the hiring of graduates from the 
        entity into nurse faculty, prior to, and upon completion of the 
        program.
            ``(3) Partnering opportunities with nursing schools to 
        place students into internship programs which provide hands-on 
        opportunity to learn about the nurse faculty role.
            ``(4) Cooperative education programs among schools of 
        nursing to share use of technological resources and distance 
        learning technologies that serve rural students and underserved 
        areas.
            ``(5) Opportunities for minority and diverse student 
        populations (including aging nurses in clinical roles) 
        interested in pursuing doctoral education.
            ``(6) Pre-entry preparation opportunities including 
        programs that assist returning students in standardized test 
        preparation, use of information technology, and the statistical 
        tools necessary for program enrollment.
            ``(7) A nurse faculty mentoring program.
            ``(8) A Registered Nurse baccalaureate to Ph.D. program to 
        expedite the completion of a doctoral degree and entry to nurse 
        faculty role.
            ``(9) Career path opportunities for 2nd degree students to 
        become nurse faculty.
            ``(10) Marketing outreach activities to attract students 
        committed to becoming nurse faculty.
    ``(d) Priority.--In awarding grants under this section, the 
Secretary shall give priority to entities from States and territories 
that have a lower number of employed nurses per 100,000 population.
    ``(e) Number and Amount of Grants.--Grants under this section shall 
be awarded as follows:
            ``(1) In fiscal year 2010, the Secretary shall award 10 
        grants of $100,000 each.
            ``(2) In fiscal year 2011, the Secretary shall award an 
        additional 10 grants of $100,000 each and provide continued 
        funding for the existing grantees under paragraph (1) in the 
        amount of $100,000 each.
            ``(3) In fiscal year 2012, the Secretary shall award an 
        additional 10 grants of $100,000 each and provide continued 
        funding for the existing grantees under paragraphs (1) and (2) 
        in the amount of $100,000 each.
            ``(4) In fiscal year 2013, the Secretary shall provide 
        continued funding for each of the existing grantees under 
        paragraphs (1) through (3) in the amount of $100,000 each.
            ``(5) In fiscal year 2014, the Secretary shall provide 
        continued funding for each of the existing grantees under 
        paragraphs (1) through (3) in the amount of $100,000 each.
    ``(f) Limitations.--
            ``(1) Payment.--Payments to an entity under a grant under 
        this section shall be for a period of not to exceed 5 years.
            ``(2) Improper use of funds.--An entity that fails to use 
        amounts received under a grant under this section as provided 
        for in subsection (c) shall, at the discretion of the 
        Secretary, be required to remit to the Federal Government not 
        less than 80 percent of the amounts received under the grant.
    ``(g) Reports.--
            ``(1) Evaluation.--The Secretary shall conduct an 
        evaluation of the results of the activities carried out under 
        grants under this section.
            ``(2) Reports.--Not later than 3 years after the date of 
        the enactment of this section, the Secretary shall submit to 
        Congress an interim report on the results of the evaluation 
        conducted under paragraph (1). Not later than 6 months after 
        the end of the program under this section, the Secretary shall 
        submit to Congress a final report on the results of such 
        evaluation.
    ``(h) Study.--
            ``(1) In general.--Not later than 3 years after the date of 
        the enactment of this section, the Comptroller General of the 
        United States shall conduct a study and submit a report to 
        Congress concerning activities to increase participation in the 
        nurse educator program under the section.
            ``(2) Contents.--The report under paragraph (1) shall 
        include the following:
                    ``(A) An examination of the capacity of nursing 
                schools to meet workforce needs on a nationwide basis.
                    ``(B) An analysis and discussion of sustainability 
                options for continuing programs beyond the initial 
                funding period.
                    ``(C) An examination and understanding of the 
                doctoral degree programs that are successful in placing 
                graduates as faculty in schools of nursing.
                    ``(D) An analysis of program design under this 
                section and the impact of such design on nurse faculty 
                retention and workforce shortages.
                    ``(E) An analysis of compensation disparities 
                between nursing clinical practitioners and nurse 
                faculty and between higher education nurse faculty and 
                higher education faculty overall.
                    ``(F) Recommendations to enhance faculty retention 
                and the nursing workforce.
    ``(i) Authorization of Appropriations.--
            ``(1) In general.--For the costs of carrying out this 
        section (except the costs described in paragraph (2), there are 
        authorized to be appropriated $1,000,000 for fiscal year 2010, 
        $2,000,000 for fiscal year 2011, and $3,000,000 for each of 
        fiscal years 2012 through 2014.
            ``(2) Administrative costs.--For the costs of administering 
        this section, including the costs of evaluating the results of 
        grants and submitting reports to the Congress, there are 
        authorized to be appropriated such sums as may be necessary for 
        each of fiscal years 2010 through 2014.''.

SEC. 102. GERIATRIC ACADEMIC CAREER AWARDS FOR NURSES.

    Part I of title VIII of the Public Health Service Act (42 U.S.C. 
298 et seq.) is amended by adding at the end the following:

``SEC. 856. GERIATRIC FACULTY FELLOWSHIPS.

    ``(a) Establishment of Program.--The Secretary shall establish a 
program to provide Geriatric Academic Career Awards to eligible 
individuals to promote the career development of such individuals as 
geriatric nurse faculty.
    ``(b) Eligible Individuals.--To be eligible to receive an Award 
under subsection (a), an individual shall--
            ``(1) be a registered nurse with a doctorate degree in 
        nursing;
            ``(2)(A) have completed an approved advanced education 
        nursing program in geriatric nursing or geropsychiatric 
        nursing; or
            ``(B) have a State or professional nursing certification in 
        geriatric nursing or geropsychiatric nursing; and
            ``(3) have a faculty appointment at an accredited school of 
        nursing, school of public health, or school of medicine.
    ``(c) Application.--An eligible individual desiring to receive an 
Award under this section shall submit to the Secretary an application 
at such time, in such manner, and containing such information as the 
Secretary may require, which shall include an assurance that the 
individual will meet the service requirement described in subsection 
(d).
    ``(d) Service Requirement.--An individual who receives an Award 
under this section shall provide training in clinical geriatrics, 
including the training of interdisciplinary teams of health care 
professionals. The provision of such training shall constitute at least 
50 percent of the obligations of such individual under the Award.
    ``(e) Amount and Number.--
            ``(1) Amount.--The amount of an Award under this section 
        shall equal $75,000 annually, adjusted for inflation on the 
        basis of the Consumer Price Index. The Secretary may increase 
        the amount of an Award by not more than 25 percent, taking into 
        account the fringe benefits and other research expenses, at the 
        recipient's institutional rate.
            ``(2) Number.--The Secretary shall award up to 125 Awards 
        under this section from 2008 through 2016.
            ``(3) Regional distribution.--
                    ``(A) In general.--The Secretary shall provide 
                Awards to individuals from 5 regions in the United 
                States, of which--
                            ``(i) 2 regions shall be an urban area;
                            ``(ii) 2 regions shall be a rural area; and
                            ``(iii) 1 region shall include a State 
                        with--
                                    ``(I) a medical school that has a 
                                department of geriatrics that manages 
                                rural outreach sites and is capable of 
                                managing patients with multiple chronic 
                                conditions, 1 of which is dementia; and
                                    ``(II) a college of nursing that 
                                has a required course in geriatric 
                                nursing in the baccalaureate program.
                    ``(B) Geographic diversity.--The Secretary shall 
                ensure that the 5 regions established under 
                subparagraph (A) are located in different geographic 
                areas of the United States.
    ``(f) Term of Award.--The term of an Award made under this section 
shall be 5 years.
    ``(g) Reports.--
            ``(1) Evaluation.--
                    ``(A) In general.--The Secretary shall conduct an 
                evaluation of the results of the activities carried out 
                under the Awards established under this section.
                    ``(B) Reports to congress.--Not later than 3 years 
                after the date of the enactment of this section, the 
                Secretary shall submit to Congress an interim report on 
                the results of the evaluation conducted under this 
                paragraph. Not later than 180 days after the expiration 
                of the program under this section, the Secretary shall 
                submit to Congress a final report on the results of 
                such evaluation.
            ``(2) Content.--The evaluation under paragraph (1) shall 
        examine--
                    ``(A) the program design under this section and the 
                impact of the design on nurse faculty retention; and
                    ``(B) options for continuing the program beyond 
                fiscal year 2018.
    ``(h) Authorization of Appropriations.--
            ``(1) In general.--To fund Awards under subsection (e), 
        there are authorized to be appropriated $1,875,000 for each of 
        fiscal years 2010 through 2018.
            ``(2) Administrative costs.--To carry out this section 
        (except to fund Awards under subsection (e)), there are 
        authorized to be appropriated such sums as may be necessary for 
        each of fiscal years 2008 through 2016.
            ``(3) Separation of funds.--The Secretary shall ensure that 
        the amounts appropriated pursuant to paragraph (1) are held in 
        a separate account from the amounts appropriated pursuant to 
        paragraph (2).''.

  TITLE II--DISTANCE EDUCATION PILOT PROGRAM AND OTHER PROVISIONS TO 
          INCREASE THE NURSING AND PHYSICAL THERAPY WORKFORCE

SEC. 201. INCREASING THE DOMESTIC SUPPLY OF NURSES AND PHYSICAL 
              THERAPISTS.

    (a) Establishment of Nurse and Physical Therapists Distance 
Education Pilot Program.--
            (1) In general.--The Secretary of Health and Human Services 
        (referred to in this section as the ``Secretary''), in 
        conjunction with the Secretary of Education, shall establish a 
        Nurse and Physical Therapist Distance Education Pilot Program 
        through which grants may be awarded for the conduct of 
        activities to increase accessibility to nursing and physical 
        therapy education.
            (2) Purpose.--The purpose of the Nurse and Physical 
        Therapist Distance Education Pilot Program established under 
        paragraph (1) shall be to increase accessibility to nursing and 
        physical therapy education to--
                    (A) provide assistance to individuals in rural 
                areas who want to study nursing or physical therapy to 
                enable such individuals to receive appropriate nursing 
                education and physical therapy education;
                    (B) promote the study of nursing and physical 
                therapy at all educational levels;
                    (C) establish additional slots for nursing and 
                physical therapy students at existing accredited 
                schools of nursing and physical therapy education 
                programs; and
                    (D) establish new nursing and physical therapy 
                education programs at institutions of higher education.
            (3) Application.--To be eligible to receive a grant under 
        the Pilot Program under paragraph (1), an entity shall submit 
        to the Secretary an application at such time, in such manner, 
        and containing such information as the Secretary may require.
            (4) Authorization of appropriations.--There is authorized 
        to be appropriated such sums as may be necessary to carry out 
        this subsection.
    (b) Increasing the Domestic Supply of Nurses and Physical 
Therapists.--
            (1) In general.--Not later than January 1, 2010, the 
        Secretary, in conjunction with the Secretary of Education, 
        shall--
                    (A) submit to Congress a report concerning the 
                country of origin or professional school of origin of 
                newly licensed nurses and physical therapists in each 
                State, that shall include--
                            (i) for the most recent 3-year period for 
                        which data is available--
                                    (I) separate data relating to 
                                teachers at institutions of higher 
                                education for each related occupation 
                                who have been teaching for not more 
                                than 5 years; and
                                    (II) separate data relating to all 
                                teachers at institutions of higher 
                                education for each related occupation 
                                regardless of length of service;
                            (ii) for the most recent 3-year period for 
                        which data is available, separate data for each 
                        related occupation and for each State;
                            (iii) a separate identification of those 
                        individuals receiving their initial 
                        professional license and those individuals 
                        licensed by endorsement from another State;
                            (iv) with respect to those individuals 
                        receiving their initial professional license in 
                        each year, a description of the number of 
                        individuals who received their professional 
                        education in the United States and the number 
                        of individuals who received such education 
                        outside the United States; and
                            (v) to the extent practicable, a 
                        description, by State of residence and country 
                        of education, of the number of nurses and 
                        physical therapists who were educated in any of 
                        the 5 countries (other than the United States) 
                        from which the most nurses and physical 
                        therapists arrived;
                    (B) in consultation with the Department of Labor, 
                enter into a contract with the Institute of Medicine of 
                the National Academy of Sciences for the conduct of a 
                study and submission of a report that includes--
                            (i) a description of how the United States 
                        can balance health, education, labor, and 
                        immigration policies to meet the respective 
                        policy goals and ensure an adequate and well-
                        trained nursing and physical therapy workforce;
                            (ii) a description of the barriers to 
                        increasing the supply of nursing and physical 
                        therapy faculty, domestically trained nurses, 
                        and domestically trained physical therapists;
                            (iii) recommendations of strategies to be 
                        utilized by Federal and State governments that 
                        would be effective in removing the barriers 
                        described in clause (ii), including strategies 
                        that address barriers to advancement to become 
                        registered nurses for other health care 
                        workers, such as home health aides and nurses 
                        assistants;
                            (iv) recommendations for amendments to 
                        Federal laws that would increase the supply of 
                        nursing faculty, domestically trained nurses, 
                        and domestically trained physical therapists;
                            (v) recommendations for Federal grants, 
                        loans, and other incentives that would provide 
                        increases in nurse and physical therapist 
                        educators and training facilities, and other 
                        measures to increase the domestic education of 
                        new nurses and physical therapists;
                            (vi) an identification of the effects of 
                        nurse and physical therapist emigration on the 
                        health care systems in their countries of 
                        origin; and
                            (vii) recommendations for amendments to 
                        Federal law that would minimize the effects of 
                        health care shortages in the countries of 
                        origin from which immigrant nurses arrived; and
                    (C) collaborate with the heads of other Federal 
                agencies, as appropriate, in working with ministers of 
                health or other appropriate officials of the 5 
                countries from which the most nurses and physical 
                therapists arrived into the United States, to--
                            (i) address health worker shortages caused 
                        by emigration; and
                            (ii) ensure that there is sufficient human 
                        resource planning or other technical assistance 
                        needed to reduce further health worker 
                        shortages in such countries.
            (2) Access to data.--The Secretary shall grant the 
        Institute of Medicine access to the data described under 
        paragraph (1)(A), as such data becomes available to the 
        Secretary for use by the Institute in carrying out the 
        activities under paragraph (1)(B).
            (3) Authorization of appropriations.--There is authorized 
        to be appropriated $1,400,000 to carry out paragraph (1)(B).
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