[Congressional Bills 118th Congress]
[From the U.S. Government Publishing Office]
[S. 1586 Introduced in Senate (IS)]

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118th CONGRESS
  1st Session
                                S. 1586

To amend title XVIII of the Social Security Act to establish a national 
                   graduate nurse education program.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                              May 11, 2023

 Ms. Stabenow (for herself, Mr. Casey, and Ms. Hassan) introduced the 
 following bill; which was read twice and referred to the Committee on 
                                Finance

_______________________________________________________________________

                                 A BILL


 
To amend title XVIII of the Social Security Act to establish a national 
                   graduate nurse education program.

    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 ``Educating Future Nurses Act''.

SEC. 2. NATIONAL GRADUATE NURSE EDUCATION PROGRAM.

    Title XVIII of the Social Security Act (42 U.S.C. 1395 et seq.) is 
amended by inserting after section 1866G the following new section:

``SEC. 1866H. NATIONAL GRADUATE NURSE EDUCATION PROGRAM.

    ``(a) In General.--
            ``(1) Establishment.--
                    ``(A) In general.--The Secretary shall establish a 
                national graduate nurse education program under this 
                title under which an eligible hospital may receive 
                payment for the hospital's reasonable costs (described 
                in paragraph (2)) for the provision of qualified 
                clinical education to advanced practice registered 
                nurses.
                    ``(B) Written agreements.--Eligible hospitals 
                participating in the program shall enter into written 
                agreements pursuant to subsection (b)(1) in order to 
                reimburse the eligible partners of the hospital the 
                share of the costs attributable to each partner.
            ``(2) Costs described.--
                    ``(A) In general.--Subject to subparagraph (B), the 
                costs described in this paragraph are the reasonable 
                costs (as described in section 1861(v)) of each 
                eligible hospital for the clinical education costs (as 
                determined by the Secretary) that are attributable to 
                providing advanced practice registered nurses with 
                qualified clinical education.
                    ``(B) Limitation.--With respect to a year, the 
                amount reimbursed under subparagraph (A) may not exceed 
                the amount of costs described in subparagraph (A) that 
                are attributable to an increase in the number of 
                advanced practice registered nurses enrolled in an 
                accredited school of nursing that provides qualified 
                clinical education during the year and for which the 
                hospital is being reimbursed under the program, as 
                compared to the average number of advanced practice 
                registered nurses who graduated in each year during the 
                period beginning on January 1, 2021, and ending on 
                December 31, 2022 (as determined by the Secretary) from 
                the graduate nursing education program operated by the 
                applicable school of nursing that is an eligible 
                partner of the hospital for purposes of the program.
            ``(3) Establishment of regions.--
                    ``(A) In general.--The Secretary shall establish 
                regions for Graduate Nurse Education Hubs described in 
                subsection (b) under the program based on hospital 
                referral regions.
                    ``(B) Limitations.--
                            ``(i) One hub per region.--Only one 
                        Graduate Nurse Education Hub may participate in 
                        the program with respect to each region 
                        established by the Secretary under subparagraph 
                        (A).
                            ``(ii) Eligible hospitals and eligible 
                        partners.--An eligible hospital or eligible 
                        partner may only participate in one Graduate 
                        Nurse Education Hub under the program.
            ``(4) Supplement not supplant.--Payments under this section 
        in any given year shall supplement, not supplant, other Federal 
        funds that have been made available in the year for advanced 
        practice registered nurse clinical education or training.
            ``(5) Waiver authority.--The Secretary may waive such 
        requirements of title XI and this title as may be necessary to 
        carry out the program.
            ``(6) Administration.--Chapter 35 of title 44, United 
        States Code, shall not apply to the implementation of this 
        section.
    ``(b) Requirements.--No payment shall be made under this section to 
an eligible hospital unless such hospital meets the following 
requirements:
            ``(1) The hospital has in effect a written agreement with 
        the eligible partners of the hospital. Such written agreement 
        shall describe, at a minimum--
                    ``(A) the obligations of the eligible partners with 
                respect to the provision of qualified clinical 
                education; and
                    ``(B) the obligation of the eligible hospital to 
                reimburse such eligible partners (in a timely manner) 
                for the costs of such qualified clinical education that 
                are attributable to such partner.
            ``(2) The hospital demonstrates to the Secretary that it is 
        leading a Graduate Nurse Education (GNE) Hub which has 
        established and will maintain the following in order to provide 
        qualified clinical education to advanced practice registered 
        nurses:
                    ``(A) Partnerships with one or more--
                            ``(i) applicable schools of nursing;
                            ``(ii) hospitals or health systems in a 
                        regional area; and
                            ``(iii) applicable non-hospital community-
                        based care settings.
                    ``(B) A governance structure that includes one or 
                more applicable schools of nursing in the leadership 
                and an oversight process that is developed and approved 
                by the hospital, participating applicable schools of 
                nursing, and other hub partners, in accordance with 
                requirements established by the Secretary.
                    ``(C) A process for timely reimbursement of 
                eligible partners for the costs of such qualified 
                clinical education that are attributable to such 
                partner.
                    ``(D) An adequate system for coordination of 
                clinical education sites and preceptors.
                    ``(E) A process for taking into consideration 
                local, State, and regional workforce needs to 
                facilitate innovation and value-based delivery of 
                health care.
    ``(c) Payments.--
            ``(1) Per-student rate.--The amount of payment under this 
        section to an eligible hospital shall for each year of the 
        program shall be equal to the applicable per-student rate (as 
        defined in paragraph (2)) multiplied by the total number of 
        advanced practice registered nurses receiving qualified 
        clinical education through the eligible hospital under the 
        program.
            ``(2) Applicable per-student rate.--The applicable per-
        student rate, with respect to an eligible hospital, is--
                    ``(A) for the first year of the program, a per-
                student rate determined by the Secretary based on data 
                from the Graduate Nurse Education Demonstration 
                established under section 5509 of the Patient 
                Protection and Affordable Care Act (Public Law 111-
                148), increased or decreased by the percentage change 
                in the consumer price index for all urban consumers 
                (all items; United States city average) from the last 
                year of the Graduate Nurse Education Demonstration 
                established under section 5509 for which such data is 
                available to the June preceding such first year of the 
                program under this section; and
                    ``(B) for a subsequent year, the amount determined 
                under this paragraph for the preceding year, increased 
                or decreased by the percentage change in the consumer 
                price index for all urban consumers (all items; United 
                States city average) for the 12-month period ending 
                with June of the previous year.
    ``(d) Annual Reporting Required .--
            ``(1) Reduction in payment for failure to report.--
                    ``(A) In general.--The amount payable under this 
                section to an eligible hospital shall be reduced by 25 
                percent if the Secretary determines that--
                            ``(i) the hospital has failed to provide 
                        the Secretary the report required under 
                        paragraph (2) for the year; or
                            ``(ii) such report fails to provide the 
                        information required under any subparagraph of 
                        such paragraph.
                    ``(B) Notice and opportunity to provide missing 
                information.--Before imposing a reduction under 
                subparagraph (A) on the basis of a hospital's failure 
                to provide information described in subparagraph 
                (A)(ii), the Secretary shall provide notice to the 
                hospital of such failure and the Secretary's intention 
                to impose such reduction and shall provide the hospital 
                with the opportunity to provide the required 
                information within a period of 30 days beginning on the 
                date of such notice. If the hospital provides such 
                information within such period, no reduction shall be 
                made under subparagraph (A) on the basis of the 
                previous failure to provide such information.
                    ``(C) Limitation.--In the case where the amount 
                payable under this section to an eligible hospital is 
                reduced pursuant to subparagraph (A), the eligible 
                hospital may not make any corresponding reductions in 
                payment to eligible partners.
            ``(2) Annual report.--The report required under this 
        paragraph for an eligible hospital for a year is a report that 
        includes (in a form and manner specified by the Secretary) the 
        following information for the academic year completed 
        immediately prior to such year:
                    ``(A) The types of qualified clinical education 
                provided to advanced practice registered nurses under 
                the program.
                    ``(B) The type and number of academic or practice 
                partnerships established as a result of working 
                together in a Graduate Nurse Education (GNE) Hub.
                    ``(C) The number of advanced practice registered 
                nurse students receiving qualified clinical education 
                through the eligible hospital under the program.
                    ``(D) Any changes in qualified clinical education 
                made during such academic year (except that the first 
                report submitted by the eligible hospital under this 
                paragraph shall be for such changes since the first 
                year in which the hospital received payment under this 
                section), including--
                            ``(i) changes in curricula, clinical 
                        education experiences, and types of clinical 
                        education, and benefits that have resulted from 
                        such changes; and
                            ``(ii) changes for purposes of measuring 
                        and improving the quality and safety of patient 
                        care.
                    ``(E) The numbers of advanced practice registered 
                nurses who graduated from their program at the end of 
                such academic year and care for individuals within the 
                borders of the service area of the hospital or within 
                the borders of the State in which the hospital is 
                located.
                    ``(F) The number of patients treated by advanced 
                practice registered nurses under the program.
                    ``(G) The number of visits by patients treated by 
                such advanced practice registered nurses.
                    ``(H) Of the number of advanced practice registered 
                nurses who graduated from their program at the end of 
                such academic year, the number and percentage of such 
                advanced practice registered nurses who entered 
                practice at a health care facility--
                            ``(i) primarily serving a health 
                        professional shortage area with a designation 
                        in effect under section 332 of the Public 
                        Health Service Act or a medically underserved 
                        community (as defined in section 799B of such 
                        Act); or
                            ``(ii) located in a rural area (as defined 
                        in section 1886(d)(2)(D)).
                    ``(I) Other information as deemed appropriate by 
                the Secretary.
            ``(3) Report to congress.--Not later than 2 years after the 
        date of the enactment of this section, the Secretary shall 
        submit to Congress a report--
                    ``(A) summarizing the information submitted in 
                reports to the Secretary under paragraph (2);
                    ``(B) describing the results of the program carried 
                out under this section; and
                    ``(C) making recommendations for improvements to 
                the program.
    ``(e) Funding.--For purposes of carrying the program under this 
section, the Secretary shall provide for the transfer, from the Federal 
Hospital Insurance Trust Fund under section 1817 and the Federal 
Supplementary Medical Insurance Trust Fund under section 1841, in such 
proportion as the Secretary determines appropriate, of such sums as the 
Secretary determines necessary, to the Centers for Medicare & Medicaid 
Services Program Management Account.
    ``(f) Definitions.--In this section:
            ``(1) Advanced practice registered nurse.--The term 
        `advanced practice registered nurse' includes the following:
                    ``(A) A clinical nurse specialist (as defined in 
                subsection (aa)(5) of section 1861.
                    ``(B) A nurse practitioner (as defined in such 
                subsection).
                    ``(C) A certified registered nurse anesthetist (as 
                defined in subsection (bb)(2) of such section).
                    ``(D) A certified nurse-midwife (as defined in 
                subsection (gg)(2) of such section).
            ``(2) Applicable non-hospital community-based care 
        setting.--The term `applicable non-hospital community-based 
        care setting' means a non-hospital community-based care setting 
        which has entered into a written agreement (as described in 
        subsection (b)(1)) with the eligible hospital participating in 
        the program. Such settings include Federally qualified health 
        centers, rural health clinics, nurse managed clinics, 
        ambulatory practices (including retail clinics), accountable 
        care organizations, physician or practitioner offices, schools, 
        nursing homes, hospice programs, long-term care facilities, 
        home health agencies, and other non-hospital settings as 
        determined appropriate by the Secretary.
            ``(3) Applicable school of nursing.--The term `applicable 
        school of nursing' means an accredited school of nursing (as 
        defined in section 801 of the Public Health Service Act) which 
        has entered into a written agreement (as described in 
        subsection (b)(1)) with the eligible hospital participating in 
        the program.
            ``(4) Program.--The term `program' means the graduate nurse 
        education program established under subsection (a).
            ``(5) Eligible hospital.--The term `eligible hospital' 
        means a hospital (as defined in subsection (e) of section 1861) 
        or a critical access hospital (as defined in subsection (mm)(1) 
        of such section) that has a written agreement in place with--
                    ``(A) 1 or more applicable schools of nursing; and
                    ``(B) 2 or more applicable non-hospital community-
                based care settings.
            ``(6) Eligible partners.--The term `eligible partners' 
        includes the following:
                    ``(A) An applicable school of nursing.
                    ``(B) A hospital or health system in a regional 
                area.
                    ``(C) An applicable non-hospital community-based 
                care setting.
            ``(7) Qualified clinical education.--
                    ``(A) In general.--The term `qualified clinical 
                education' means education--
                            ``(i) that provides an advanced practice 
                        registered nurse with the clinical skills 
                        necessary to provide primary care, preventive 
                        care, transitional care, acute care, chronic 
                        care management, and other services appropriate 
                        for individuals entitled to, or enrolled for, 
                        benefits under part A, or enrolled under part 
                        B; and
                            ``(ii) subject to subparagraph (B), at 
                        least half of which is provided in a non-
                        hospital community-based care setting.
                    ``(B) Waiver of requirement half of qualified 
                education be provided in non-hospital community-based 
                care setting in certain areas.--The Secretary may waive 
                the requirement under subparagraph (A)(ii) with respect 
                to eligible hospitals located in rural or medically 
                underserved areas.''.
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