[Congressional Bills 116th Congress]
[From the U.S. Government Publishing Office]
[S. 1399 Reported in Senate (RS)]

<DOC>





                                                       Calendar No. 285
116th CONGRESS
  1st Session
                                S. 1399

  To amend title VIII of the Public Health Services Act to revise and 
             extend nursing workforce development programs.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                              May 9, 2019

 Mr. Merkley (for himself, Mr. Burr, Ms. Baldwin, Mrs. Blackburn, Mr. 
 Jones, and Ms. Collins) introduced the following bill; which was read 
 twice and referred to the Committee on Health, Education, Labor, and 
                                Pensions

                            November 5, 2019

              Reported by Mr. Alexander, with an amendment
 [Strike out all after the enacting clause and insert the part printed 
                               in italic]

_______________________________________________________________________

                                 A BILL


 
  To amend title VIII of the Public Health Services Act to revise and 
             extend nursing workforce development programs.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

<DELETED>SECTION 1. SHORT TITLE.</DELETED>

<DELETED>    This Act may be cited as the ``Title VIII Nursing 
Workforce Reauthorization Act of 2019''.</DELETED>

<DELETED>SEC. 2. NURSING WORKFORCE DEVELOPMENT.</DELETED>

<DELETED>    (a) In General.--Title VIII of the Public Health Service 
Act (42 U.S.C. 296 et seq.) is amended--</DELETED>
        <DELETED>    (1) in section 801 (42 U.S.C. 296), by adding at 
        the end the following:</DELETED>
        <DELETED>    ``(18) Nurse managed health clinic.--The term 
        `nurse managed health clinic' means a nurse-practice 
        arrangement, managed by advanced practice nurses, that provides 
        primary care or wellness services to underserved or vulnerable 
        populations and that is associated with a school, college, 
        university or department of nursing, federally qualified health 
        center, or independent nonprofit health or social services 
        agency.'';</DELETED>
        <DELETED>    (2) in section 802(c) (42 U.S.C. 296a(c)), by 
        inserting ``, and how such project aligns with the goals in 
        section 806(a)'' before the period in the second 
        sentence;</DELETED>
        <DELETED>    (3) in section 803(b) (42 U.S.C. 296b(b)), by 
        adding at the end the following: ``Such Federal funds are 
        intended to supplement, not supplant, existing non-Federal 
        expenditures for such activities.'';</DELETED>
        <DELETED>    (4) in section 806 (42 U.S.C. 296e)--</DELETED>
                <DELETED>    (A) in subsection (a), by striking ``as 
                needed to'' and all that follows and inserting the 
                following: ``as needed to address national nursing 
                needs, including--</DELETED>
        <DELETED>    ``(1) addressing challenges, including through 
        supporting training and education of nursing students, related 
        to the distribution of the nursing workforce and existing or 
        projected nursing workforce shortages in geographic areas that 
        have been identified as having, or that are projected to have, 
        a nursing shortage;</DELETED>
        <DELETED>    ``(2) increasing access to and the quality of 
        health care services, including by supporting the training of 
        professional registered nurses, advanced practice registered 
        nurses, and advanced education nurses within community based 
        settings and in a variety of health delivery system settings; 
        or</DELETED>
        <DELETED>    ``(3) addressing the strategic goals and 
        priorities identified by the Secretary and that are in 
        accordance with this title.</DELETED>
<DELETED>Contracts may be entered into under this title with public or 
private entities as determined necessary by the Secretary.'';</DELETED>
                <DELETED>    (B) in subsection (b)(2), by striking ``a 
                demonstration'' and all that follows and inserting the 
                following: ``the reporting of data and information 
                demonstrating that satisfactory progress has been made 
                by the program or project in meeting the performance 
                outcome standards (as described in section 802) of such 
                program or project.'';</DELETED>
                <DELETED>    (C) in subsection (e)(2), by inserting ``, 
                and have relevant expertise and experience'' before the 
                period at the end of the first sentence; and</DELETED>
                <DELETED>    (D) by adding at the end the 
                following:</DELETED>
<DELETED>    ``(i) Biennial Report on Nursing Workforce Program 
Improvements.--Not later than September 30, 2020, and biennially 
thereafter, the Secretary shall submit to the Committee on Health, 
Education, Labor, and Pensions of the Senate and the Committee on 
Energy and Commerce of the House of Representatives, a report that 
contains an assessment of the programs and activities of the Department 
of Health and Human Services related to enhancing the nursing 
workforce, including the extent to which programs and activities under 
this title meet the identified goals and performance measures developed 
for the respective programs and activities, and the extent to which the 
Department coordinates with other Federal departments with programs 
designed to improve the nursing workforce.'';</DELETED>
        <DELETED>    (5) in section 811 (42 U.S.C. 296j)--</DELETED>
                <DELETED>    (A) in subsection (b)--</DELETED>
                        <DELETED>    (i) by striking ``Master's'' and 
                        inserting ``graduate''; and</DELETED>
                        <DELETED>    (ii) by inserting ``clinical nurse 
                        leaders,'' after ``nurse 
                        administrators,'';</DELETED>
                <DELETED>    (B) by redesignating subsections (f) and 
                (g) as subsections (g) and (h), respectively; 
                and</DELETED>
                <DELETED>    (C) by inserting after subsection (e), the 
                following:</DELETED>
<DELETED>    ``(f) Authorized Clinical Nurse Specialist Programs.--
Clinical nurse specialist programs eligible for support under this 
section are education programs that--</DELETED>
        <DELETED>    ``(1) provide registered nurses with full-time 
        clinical nurse specialist education; and</DELETED>
        <DELETED>    ``(2) have as their objective the education of 
        clinical nurse specialists who will, upon completion of such a 
        program, be qualified to effectively provide care through the 
        wellness and illness continuum to inpatients and outpatients 
        experiencing acute and chronic illness.'';</DELETED>
        <DELETED>    (6) in section 831 (42 U.S.C. 296p)--</DELETED>
                <DELETED>    (A) in the section heading, by striking 
                ``and quality grants'' and inserting ``quality, and 
                retention grants'';</DELETED>
                <DELETED>    (B) in subsection (b)(2), by striking 
                ``other high-risk groups such as the elderly, 
                individuals with HIV/AIDS, substance abusers, the 
                homeless, and victims'' and inserting ``high risk 
                groups, such as the elderly, individuals with HIV/AIDS, 
                individuals with mental health or substance use 
                disorders, individuals who are homeless, and 
                survivors'';</DELETED>
                <DELETED>    (C) in subsection (c)(1)--</DELETED>
                        <DELETED>    (i) in subparagraph (A)--
                        </DELETED>
                                <DELETED>    (I) by striking 
                                ``advancement for nursing personnel'' 
                                and inserting the following: 
                                ``advancement for--</DELETED>
                        <DELETED>    ``(i) nursing'';</DELETED>
                                <DELETED>    (II) by striking 
                                ``professional nurses, advanced 
                                education nurses, licensed practical 
                                nurses, certified nurse assistants, and 
                                home health aides'' and inserting 
                                ``professional registered nurses, 
                                advanced practice registered nurses, 
                                and nurses with graduate nursing 
                                education''; and</DELETED>
                                <DELETED>    (III) by adding at the end 
                                the following:</DELETED>
                        <DELETED>    ``(ii) individuals including 
                        licensed practical nurses, licensed vocational 
                        nurses, certified nurse assistants, home health 
                        aides, diploma degree or associate degree 
                        nurses, to become registered nurses with 
                        baccalaureate degrees or nurses with graduate 
                        nursing education;'';</DELETED>
                        <DELETED>    (ii) in subparagraph (B), by 
                        striking the period and inserting ``; and''; 
                        and</DELETED>
                        <DELETED>    (iii) by adding at the end the 
                        following:</DELETED>
                <DELETED>    ``(C) developing and implementing 
                internships, accredited fellowships, and accredited 
                residency programs in collaboration with one or more 
                accredited schools of nursing, to encourage the 
                mentoring and development of specialties.'';</DELETED>
                <DELETED>    (D) by striking subsection (e);</DELETED>
                <DELETED>    (E) by redesignating subsection (f) 
                through (h), as subsections (e) through (g), 
                respectively;</DELETED>
                <DELETED>    (F) in subsection (e) (as so 
                redesignated), by striking ``The Secretary shall submit 
                to the Congress before the end of each fiscal year'' 
                and inserting ``As part of the report on nursing 
                workforce programs described in section 806(i), the 
                Secretary shall include'';</DELETED>
                <DELETED>    (G) in subsection (f) (as so 
                redesignated), by striking ``a school of nursing, as 
                defined in section 801(2),,'' and inserting ``an 
                accredited school of nursing, as defined in section 
                801(2), a health care facility, including federally 
                qualified health centers or nurse-managed health 
                clinics, or a partnership of such a school and 
                facility''; and</DELETED>
                <DELETED>    (H) in subsection (g) (as so 
                redesignated), by striking ``2010 through 2014'' and 
                inserting ``2020 through 2024'';</DELETED>
        <DELETED>    (7) by striking section 831A (42 U.S.C. 296p-
        1);</DELETED>
        <DELETED>    (8) in section 846 (42 U.S.C. 297n)--</DELETED>
                <DELETED>    (A) by striking the last sentence of 
                subsection (a);</DELETED>
                <DELETED>    (B) in subsection (b)(1), by striking ``he 
                began such practice'' and inserting ``the individual 
                began such practice''; and</DELETED>
                <DELETED>    (C) in subsection (i)(I), by striking 
                ``2003 through 2007'' and inserting ``2020 through 
                2024'';</DELETED>
        <DELETED>    (9) in section 846A(f) (42 U.S.C. 247n-1(f)), by 
        striking ``2010 through 2014'' and inserting ``2020 through 
        2024'';</DELETED>
        <DELETED>    (10) in section 847(g) (42 U.S.C. 297o(g)), by 
        striking ``such sums as may be necessary for each of fiscal 
        years 2010 through 2014'' and inserting ``$115,635,000 for each 
        of fiscal years 2020 through 2024'';</DELETED>
        <DELETED>    (11) in section 851 (42 U.S.C. 297t)--</DELETED>
                <DELETED>    (A) in subsection (b)(1)(A)(iv), by 
                striking ``and nurse anesthetists'' and inserting 
                ``nurse anesthetists, and clinical nurse 
                specialists'';</DELETED>
                <DELETED>    (B) in subsection (d)(3)--</DELETED>
                        <DELETED>    (i) by striking ``3 years after 
                        the date of enactment of this section'' and 
                        inserting ``2 years after the date of enactment 
                        of the Title VIII Nursing Workforce 
                        Reauthorization Act'';</DELETED>
                        <DELETED>    (ii) by striking ``Labor and Human 
                        Resources'' and inserting ``Health, Education, 
                        Labor, and Pensions''; and</DELETED>
                        <DELETED>    (iii) by inserting ``Energy and'' 
                        before ``Commerce''; and</DELETED>
                <DELETED>    (C) in subsection (g), by striking ``under 
                this title'' and inserting ``for carrying out parts B, 
                C, and D'';</DELETED>
        <DELETED>    (12) in section 865(e) (42 U.S.C. 298(e)), by 
        striking ``2014'' and inserting ``2024''; and</DELETED>
        <DELETED>    (13) in section 871 (42 U.S.C. 298d), by striking 
        ``$338,000,000 for fiscal year 2010, and such sums as may be 
        necessary for each of the fiscal years 2011 through 2016'' and 
        inserting ``$133,837,000 for each of fiscal years 2020 through 
        2024''.</DELETED>
<DELETED>    (b) Evaluation and Report on Nurse Loan Repayment 
Programs.--</DELETED>
        <DELETED>    (1) Evaluation.--The Comptroller General shall 
        conduct an evaluation of the nurse loan repayment programs 
        administered by the Health Resources and Services 
        Administration. Such evaluation shall include--</DELETED>
                <DELETED>    (A) the manner in which payments are made 
                under such programs;</DELETED>
                <DELETED>    (B) the existing oversight functions 
                necessary to ensure the proper use of such programs, 
                including payments made as part of such 
                programs;</DELETED>
                <DELETED>    (C) the identification of gaps, if any, in 
                oversight functions; and</DELETED>
                <DELETED>    (D) information on the number of nurses 
                assigned to facilities pursuant to such programs, 
                including the type of facility to which nurses are 
                assigned and the impact of modifying the eligibility 
                requirements for programs under section 846 of the 
                Public Health Service Act (42 U.S.C. 297n), such as the 
                impact on entities to which nurses had previously been 
                assigned prior to fiscal year 2019 (such as federally 
                qualified health centers and facilities affiliated with 
                the Indian Health Service).</DELETED>
        <DELETED>    (2) Report.--Not later than 18 months after the 
        enactment of this Act, the Comptroller General shall submit to 
        the Committee on Health, Education, Labor, and Pensions of the 
        Senate and the Committee on Energy and Commerce of the House of 
        Representatives a report on the evaluation under paragraph (1), 
        which may include recommendations to improve relevant nursing 
        workforce loan repayment programs.</DELETED>

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Title VIII Nursing Workforce 
Reauthorization Act of 2019''.

SEC. 2. NURSING WORKFORCE DEVELOPMENT.

    (a) In General.--Title VIII of the Public Health Service Act (42 
U.S.C. 296 et seq.) is amended--
            (1) in section 801 (42 U.S.C. 296), by adding at the end 
        the following:
            ``(18) Nurse managed health clinic.--The term `nurse 
        managed health clinic' means a nurse-practice arrangement, 
        managed by advanced practice nurses, that provides primary care 
        or wellness services to underserved or vulnerable populations 
        and that is associated with a school, college, university or 
        department of nursing, federally qualified health center, or 
        independent nonprofit health or social services agency.'';
            (2) in section 802(c) (42 U.S.C. 296a(c)), by inserting ``, 
        and how such project aligns with the goals in section 806(a)'' 
        before the period in the second sentence;
            (3) in section 803(b) (42 U.S.C. 296b(b)), by adding at the 
        end the following: ``Such Federal funds are intended to 
        supplement, not supplant, existing non-Federal expenditures for 
        such activities.'';
            (4) in section 806 (42 U.S.C. 296e)--
                    (A) in subsection (a), by striking ``as needed to'' 
                and all that follows and inserting the following: ``as 
                needed to address national nursing needs, including--
            ``(1) addressing challenges, including through supporting 
        training and education of nursing students, related to the 
        distribution of the nursing workforce and existing or projected 
        nursing workforce shortages in geographic areas that have been 
        identified as having, or that are projected to have, a nursing 
        shortage;
            ``(2) increasing access to and the quality of health care 
        services, including by supporting the training of professional 
        registered nurses, advanced practice registered nurses, and 
        advanced education nurses within community based settings and 
        in a variety of health delivery system settings; or
            ``(3) addressing the strategic goals and priorities 
        identified by the Secretary and that are in accordance with 
        this title.
Contracts may be entered into under this title with public or private 
entities as determined necessary by the Secretary.'';
                    (B) in subsection (b)(2), by striking ``a 
                demonstration'' and all that follows and inserting the 
                following: ``the reporting of data and information 
                demonstrating that satisfactory progress has been made 
                by the program or project in meeting the performance 
                outcome standards (as described in section 802) of such 
                program or project.'';
                    (C) in subsection (e)(2), by inserting ``, and have 
                relevant expertise and experience'' before the period 
                at the end of the first sentence; and
                    (D) by adding at the end the following:
    ``(i) Biennial Report on Nursing Workforce Program Improvements.--
Not later than September 30, 2020, and biennially thereafter, the 
Secretary shall submit to the Committee on Health, Education, Labor, 
and Pensions of the Senate and the Committee on Energy and Commerce of 
the House of Representatives, a report that contains an assessment of 
the programs and activities of the Department of Health and Human 
Services related to enhancing the nursing workforce, including the 
extent to which programs and activities under this title meet the 
identified goals and performance measures developed for the respective 
programs and activities, and the extent to which the Department 
coordinates with other Federal departments regarding programs designed 
to improve the nursing workforce.'';
            (5) in section 811 (42 U.S.C. 296j)--
                    (A) in subsection (b)--
                            (i) by striking ``Master's'' and inserting 
                        ``graduate''; and
                            (ii) by inserting ``clinical nurse 
                        leaders,'' after ``nurse administrators,'';
                    (B) by redesignating subsections (f) and (g) as 
                subsections (g) and (h), respectively; and
                    (C) by inserting after subsection (e), the 
                following:
    ``(f) Authorized Clinical Nurse Specialist Programs.--Clinical 
nurse specialist programs eligible for support under this section are 
education programs that--
            ``(1) provide registered nurses with full-time clinical 
        nurse specialist education; and
            ``(2) have as their objective the education of clinical 
        nurse specialists who will, upon completion of such a program, 
        be qualified to effectively provide care through the wellness 
        and illness continuum to inpatients and outpatients 
        experiencing acute and chronic illness.''; and
            (6) in section 831 (42 U.S.C. 296p)--
                    (A) in the section heading, by striking ``and 
                quality grants'' and inserting ``quality, and retention 
                grants'';
                    (B) in subsection (b)(2), by striking ``other high-
                risk groups such as the elderly, individuals with HIV/
                AIDS, substance abusers, the homeless, and victims'' 
                and inserting ``high risk groups, such as the elderly, 
                individuals with HIV/AIDS, individuals with mental 
                health or substance use disorders, individuals who are 
                homeless, and survivors'';
                    (C) in subsection (c)(1)--
                            (i) in subparagraph (A)--
                                    (I) by striking ``advancement for 
                                nursing personnel'' and inserting the 
                                following: ``advancement for--
                            ``(i) nursing'';
                                    (II) by striking ``professional 
                                nurses, advanced education nurses, 
                                licensed practical nurses, certified 
                                nurse assistants, and home health 
                                aides'' and inserting ``professional 
                                registered nurses, advanced practice 
                                registered nurses, and nurses with 
                                graduate nursing education''; and
                                    (III) by adding at the end the 
                                following:
                            ``(ii) individuals including licensed 
                        practical nurses, licensed vocational nurses, 
                        certified nurse assistants, home health aides, 
                        diploma degree or associate degree nurses, and 
                        other health professionals, such as health 
                        aides or community health practitioners 
                        certified under the Community Health Aide 
                        Program of the Indian Health Service, to become 
                        registered nurses with baccalaureate degrees or 
                        nurses with graduate nursing education;'';
                            (ii) in subparagraph (B), by striking the 
                        period and inserting ``; and''; and
                            (iii) by adding at the end the following:
                    ``(C) developing and implementing internships, 
                accredited fellowships, and accredited residency 
                programs in collaboration with one or more accredited 
                schools of nursing, to encourage the mentoring and 
                development of specialties.'';
                    (D) by striking subsection (e);
                    (E) by redesignating subsection (f) through (h), as 
                subsections (e) through (g), respectively;
                    (F) in subsection (e) (as so redesignated), by 
                striking ``The Secretary shall submit to the Congress 
                before the end of each fiscal year'' and inserting ``As 
                part of the report on nursing workforce programs 
                described in section 806(i), the Secretary shall 
                include'';
                    (G) in subsection (f) (as so redesignated), by 
                striking ``a school of nursing, as defined in section 
                801(2),,'' and inserting ``an accredited school of 
                nursing, as defined in section 801(2), a health care 
                facility, including federally qualified health centers 
                or nurse-managed health clinics, or a partnership of 
                such a school and facility''; and
                    (H) in subsection (g) (as so redesignated), by 
                striking ``2010 through 2014'' and inserting ``2020 
                through 2024'';
            (7) by striking section 831A (42 U.S.C. 296p-1);
            (8) in section 846 (42 U.S.C. 297n)--
                    (A) by striking the last sentence of subsection 
                (a);
                    (B) in subsection (b)(1), by striking ``he began 
                such practice'' and inserting ``the individual began 
                such practice''; and
                    (C) in subsection (i)(I), by striking ``2003 
                through 2007'' and inserting ``2020 through 2024'';
            (9) in section 846A(f) (42 U.S.C. 247n-1(f)), by striking 
        ``2010 through 2014'' and inserting ``2020 through 2024'';
            (10) in section 847(g) (42 U.S.C. 297o(g)), by striking 
        ``such sums as may be necessary for each of fiscal years 2010 
        through 2014'' and inserting ``$115,635,000 for each of fiscal 
        years 2020 through 2024'';
            (11) in section 851 (42 U.S.C. 297t)--
                    (A) in subsection (b)(1)(A)(iv), by striking ``and 
                nurse anesthetists'' and inserting ``nurse 
                anesthetists, and clinical nurse specialists'';
                    (B) in subsection (d)(3)--
                            (i) by striking ``3 years after the date of 
                        enactment of this section'' and inserting ``2 
                        years after the date of enactment of the Title 
                        VIII Nursing Reauthorization Act'';
                            (ii) by striking ``Labor and Human 
                        Resources'' and inserting ``Health, Education, 
                        Labor, and Pensions''; and
                            (iii) by inserting ``Energy and'' before 
                        ``Commerce''; and
                    (C) in subsection (g), by striking ``under this 
                title'' and inserting ``for carrying out parts B, C, 
                and D'';
            (12) by striking sections 861 and 862 (42 U.S.C. 297w and 
        297x);
            (13) in section 865(e) (42 U.S.C. 298(e)), by striking 
        ``2014'' and inserting ``2024''; and
            (14) in section 871 (42 U.S.C. 298d), by striking 
        ``$338,000,000 for fiscal year 2010, and such sums as may be 
        necessary for each of the fiscal years 2011 through 2016'' and 
        inserting ``$133,837,000 for each of fiscal years 2020 through 
        2024''.
    (b) Evaluation and Report on Nurse Loan Repayment Programs.--
            (1) Evaluation.--The Comptroller General shall conduct an 
        evaluation of the nurse loan repayment programs administered by 
        the Health Resources and Services Administration. Such 
        evaluation shall include--
                    (A) the manner in which payments are made under 
                such programs;
                    (B) the existing oversight functions necessary to 
                ensure the proper use of such programs, including 
                payments made as part of such programs;
                    (C) the identification of gaps, if any, in 
                oversight functions; and
                    (D) information on the number of nurses assigned to 
                facilities pursuant to such programs, including the 
                type of facility to which nurses are assigned and the 
                impact of modifying the eligibility requirements for 
                programs under section 846 of the Public Health Service 
                Act (42 U.S.C. 297n), such as the impact on entities to 
                which nurses had previously been assigned prior to 
                fiscal year 2019 (such as federally qualified health 
                centers and facilities affiliated with the Indian 
                Health Service).
            (2) Report.--Not later than 18 months after the enactment 
        of this Act, the Comptroller General shall submit to the 
        Committee on Health, Education, Labor, and Pensions of the 
        Senate and the Committee on Energy and Commerce of the House of 
        Representatives, a report on the evaluation under paragraph 
        (1), which may include recommendations to improve relevant 
        nursing workforce loan repayment programs.
                                                       Calendar No. 285

116th CONGRESS

  1st Session

                                S. 1399

_______________________________________________________________________

                                 A BILL

  To amend title VIII of the Public Health Services Act to revise and 
             extend nursing workforce development programs.

_______________________________________________________________________

                            November 5, 2019

                       Reported with an amendment