[Congressional Record Volume 164, Number 123 (Monday, July 23, 2018)]
[House]
[Pages H6605-H6608]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                              {time}  1515
        TITLE VIII NURSING WORKFORCE REAUTHORIZATION ACT OF 2018

  Mr. BURGESS. Mr. Speaker, I move to suspend the rules and pass the 
bill (H.R. 959) to amend title VIII of the Public Health Service Act to 
extend advanced education nursing grants to support clinical nurse 
specialist programs, and for other purposes, as amended.
  The Clerk read the title of the bill.
  The text of the bill is as follows:

                                H.R. 959

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

[[Page H6606]]

  


     SECTION 1. SHORT TITLE; TABLE OF CONTENTS.

       (a) Short Title.--This Act may be cited as the ``Title VIII 
     Nursing Workforce Reauthorization Act of 2018''.
       (b) Table of Contents.--The table of contents of this Act 
     is as follows:

Sec. 1. Short title; table of contents.
Sec. 2. General provisions.
Sec. 3. Nurse practitioners, nurse midwives, nurse anesthetists, and 
              other advanced education nurses.
Sec. 4. Increasing nursing workforce diversity.
Sec. 5. Strengthening capacity for basic nurse education and practice.
Sec. 6. Student loans.
Sec. 7. National Advisory Council on Nurse Education and Practice.
Sec. 8. Other provisions.

     SEC. 2. GENERAL PROVISIONS.

       (a) Application.--Section 802(c) of the Public Health 
     Service Act (42 U.S.C. 296a(c)) is amended by striking 
     ``shall address relevant national nursing needs that the 
     project will meet'' and inserting ``shall address relevant 
     national nursing needs that the project will address and how 
     the project aligns with the national nursing service goals 
     referred to in section 806(a)''.
       (b) Use of Funds.--Section 803 of the Public Health Service 
     Act (42 U.S.C. 296b) is amended by adding at the end the 
     following:
       ``(c) Supplement Not Supplant.--Funds awarded as a grant 
     under this title for a project or activity shall be used to 
     supplement, not supplant, the non-Federal funds that would 
     otherwise be made available for such project or activity.''.
       (c) Generally Applicable Provisions.--Section 806 of the 
     Public Health Service Act (42 U.S.C. 296e) is amended--
       (1) in subsection (b), by amending paragraph (2) to read as 
     follows:
       ``(2) Evaluations.--The Secretary shall establish 
     procedures to ensure the annual evaluation of programs and 
     projects operated by recipients of grants under this title. 
     Such procedures shall ensure that continued funding for such 
     programs and projects will be conditioned upon the submission 
     of--
       ``(A) data 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; and
       ``(B) a detailed description of activities conducted by 
     such program or project to meet such performance outcome 
     standards.'';
       (2) in subsection (e)(2), by inserting ``, and have 
     relevant expertise and experience'' after ``who are not 
     officers or employees of the Federal Government''; and
       (3) by adding at the end the following:
       ``(i) Annual Report on Nursing Workforce Programs.--
     Annually, 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 containing 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 identified goals and performance measures 
     developed for the respective programs and activities.''.

     SEC. 3. NURSE PRACTITIONERS, NURSE MIDWIVES, NURSE 
                   ANESTHETISTS, AND OTHER ADVANCED EDUCATION 
                   NURSES.

       Section 811 of the Public Health Service Act (42 U.S.C. 
     296j) is amended--
       (1) in subsection (b)--
       (A) by striking ``R.N./Master's'' and inserting ``R.N./
     graduate''; and
       (B) by inserting ``clinical nurse leaders,'' before ``or 
     public health nurses'';
       (2) by redesignating subsections (f) and (g) as subsections 
     (g) and (h), respectively;
       (3) by inserting after subsection (e) the following new 
     subsection:
       ``(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
       (4) by adding at the end the following:
       ``(i) Authorization of Appropriations.--There are 
     authorized to be appropriated to carry out this section 
     $74,581,000 for each of fiscal years 2019 through 2023.''.

     SEC. 4. INCREASING NURSING WORKFORCE DIVERSITY.

       Section 821 of the Public Health Service Act (42 U.S.C. 
     296m) is amended by adding at the end the following:
       ``(d) Authorization of Appropriations.--There are 
     authorized to be appropriated to carry out this section 
     $17,343,000 for each of fiscal years 2019 through 2023.''.

     SEC. 5. STRENGTHENING CAPACITY FOR BASIC NURSE EDUCATION AND 
                   PRACTICE.

       (a) Nurse Education, Practice, Quality, and Retention 
     Grants.--Section 831 of the Public Health Service Act (42 
     U.S.C. 296p) is amended--
       (1) in the section heading, by striking ``and quality'' and 
     inserting ``quality, and retention'';
       (2) in subsection (b), by amending paragraph (2) to read as 
     follows:
       ``(2) providing care for underserved populations and high-
     risk groups, which may include the elderly, individuals with 
     HIV/AIDS, individuals with mental health or substance use 
     disorders, individuals who are homeless, and victims and 
     survivors of domestic violence;'';
       (3) in subsection (c), by amending paragraph (1) to read as 
     follows:
       ``(1) Grants for career ladder programs.--The Secretary may 
     award grants to and enter into contracts with eligible 
     entities for programs--
       ``(A) to promote career advancement for--
       ``(i) nursing personnel in a variety of training settings, 
     cross training or specialty training among diverse population 
     groups, and the advancement of individuals, including to 
     become professional registered nurses, advanced practice 
     registered nurses, and nurses with graduate nursing 
     education; and
       ``(ii) individuals, including licensed practical nurses, 
     licensed vocational nurses, certified nurse assistants, and 
     diploma degree or associate degree nurses, to become 
     baccalaureate-prepared registered nurses or nurses with 
     graduate nursing education;
       ``(B) to assist individuals in obtaining education and 
     training required to enter the nursing profession and advance 
     within such profession, such as by providing career 
     counseling and mentoring; and
       ``(C) to develop and implement internships, accredited 
     fellowships, and accredited residency programs in 
     collaboration with one or more accredited schools of nursing 
     to encourage mentoring and development of specialties.'';
       (4) by striking subsection (e) (relating to preference);
       (5) by redesignating subsections (f) through (h) as 
     subsections (e) and (g), respectively;
       (6) in subsection (e), as so redesignated, by striking 
     ``The Secretary shall submit to the Congress before the end 
     of each fiscal year a'' and inserting ``As part of the report 
     on nursing workforce programs described in section 806(i), 
     the Secretary shall'';
       (7) by amending subsection (f), as redesignated by 
     paragraph (5), to read as follows:
       ``(f) Definitions.--For purposes of this section:
       ``(1) Eligible entity.--The term `eligible entity' includes 
     an accredited school of nursing, a health care facility, a 
     partnership of such a school and facility, a federally 
     qualified health center, or a nurse-managed health clinic.
       ``(2) 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 
     that is associated with a school, college, university or 
     department of nursing, federally qualified health center, or 
     independent nonprofit health or social services agency.''; 
     and
       (8) in subsection (g), as redesignated by paragraph (5), by 
     striking ``such sums as may be necessary for each of fiscal 
     years 2010 through 2014'' and inserting ``$41,913,000 for 
     each of fiscal years 2019 through 2023''.
       (b) Nurse Retention Grants.--Section 831A of the Public 
     Health Service Act (42 U.S.C. 296p-1) is repealed.

     SEC. 6. STUDENT LOANS.

       (a) Loan Repayment and Scholarship Programs.--Section 846 
     of the Public Health Service Act (42 U.S.C. 297n) is 
     amended--
       (1) in subsection (b)(1), by striking ``he began such 
     practice'' and inserting ``the individual began such 
     practice'';
       (2) in subsection (d)(1), by striking ``(for fiscal years 
     2003 and 2004) and may (for fiscal years thereafter)'';
       (3) in subsection (h), in the matter preceding paragraph 
     (1), by striking ``Not later than'' through ``regarding'' and 
     inserting ``The annual report on nursing workforce programs, 
     as required by section 806(i), shall include information 
     regarding the programs carried out under this section, 
     including''; and
       (4) in subsection (i)(1), by striking ``such sums as may be 
     necessary for each of fiscal years 2003 through 2007'' and 
     inserting ``$87,135,000 for each of fiscal years 2019 through 
     2023''.
       (b) Nurse Faculty Loan Program.--Section 846A of the Public 
     Health Service Act (42 U.S.C. 297n-1) is amended by striking 
     ``such sums as may be necessary for each of fiscal years 2010 
     through 2014'' and inserting ``$28,500,000 for each of fiscal 
     years 2019 through 2023''.

     SEC. 7. NATIONAL ADVISORY COUNCIL ON NURSE EDUCATION AND 
                   PRACTICE.

       Section 851 of the Public Health Service Act (42 U.S.C. 
     297t) is amended--
       (1) in subsection (b)(1)(A)(iv), by striking ``and nurse 
     anesthetists'' and inserting ``nurse anesthetists, and 
     clinical nurse specialists'';
       (2) in subsection (d), by amending paragraph (3) to read as 
     follows:
       ``(3) not later than 2 years after the date of enactment of 
     the Title VIII Nursing Workforce Reauthorization Act of 2018, 
     and every 2 years thereafter, prepare and submit to the 
     Secretary, 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 describing 
     the activities of the Council, including findings and 
     recommendations made by the Council concerning the activities 
     under this title.''; and
       (3) in subsection (g), by striking ``under this title'' and 
     inserting ``for carrying out parts B, C, and D of this 
     title''.

[[Page H6607]]

  


     SEC. 8. OTHER PROVISIONS.

       (a) Public Service Announcements.--Part G of title VIII of 
     the Public Health Service Act (42 U.S.C. 297w et seq.) is 
     repealed.
       (b) Funding.--Part I of title VIII of the Public Health 
     Service Act (42 U.S.C. 298d) is repealed.

  The SPEAKER pro tempore. Pursuant to the rule, the gentleman from 
Texas (Mr. Burgess) and the gentleman from Texas (Mr. Gene Green) each 
will control 20 minutes.
  The Chair recognizes the gentleman from Texas (Mr. Burgess).


                             general leave

  Mr. BURGESS. Mr. Speaker, I ask unanimous consent that all Members 
have 5 legislative days to revise and extend their remarks and insert 
extraneous material in the Record on the bill.
  The SPEAKER pro tempore. Is there objection to the request of the 
gentleman from Texas?
  There was no objection.
  Mr. BURGESS. Mr. Speaker, I yield myself such time as I may consume.
  Mr. Speaker, I rise in support of H.R. 959, the Title VIII Nursing 
Workforce Reauthorization Act of 2018, which was introduced by the 
gentleman from Ohio (Mr. Joyce).
  The bill reauthorizes the title VIII Nursing Workforce Development 
Programs for fiscal years 2019 through 2023. Title VIII programs, in 
addition to the title VII physician workforce programs, expired several 
years ago, but have continued to receive appropriations. This bill 
reauthorizes title VIII programs at the fiscal year 2018 level.
  While our appropriations process has continued to fund these programs 
without a reauthorization, there remains uncertainty regarding how much 
money the programs will receive each year.
  These programs range from providing our advanced practice nurses with 
additional educational opportunities to increasing the nursing 
workforce diversity.
  The bill includes grants for nurses at different levels of education 
to obtain further education so that they can advance within the nursing 
profession. Additionally, this legislation reauthorizes loan repayment 
scholarships and grants for education, practice, quality, and 
retention. These provisions are essential in educating and retaining a 
qualified nurse workforce.
  Mr. Speaker, I urge Members to support H.R. 959, and I reserve the 
balance of my time.
  Mr. GENE GREEN of Texas. Mr. Speaker, I yield myself such time as I 
may consume.
  Mr. Speaker, I rise in support of H.R. 959, the Title VIII Nursing 
Workforce Reauthorization Act.
  I thank the main sponsor of the legislation, Representative  David 
Joyce, and original cosponsors including: Representative Doris Matsui, 
Representative Kathy Castor, and Representative Tulsi Gabbard for their 
hard work on this important legislation.
  An estimated 10,000 people are turning 65 years old in America every 
day. That trend will continue through the end of the decade. In 
addition to an aging population, the United States faces rising 
healthcare costs, prevalent chronic diseases, and the rise in substance 
abuse disorders. In order to meet this increased need for care, we need 
to grow the largest group of healthcare providers in our Nation: 
nurses.
  The title VIII programs bolster nursing education at all levels, from 
entry-level preparation through graduate study, and provides support 
for institutions that educate nurses for practice in rural and 
medically underserved communities. This program is designed to address 
specific needs within the nursing workforce and America's patient 
population.
  This legislation will reauthorize title VIII of the Public Health 
Service Act that provides Federal resources toward nursing workforce 
development programs, including the recruitment, retention, and 
advanced education of skilled nursing professionals.
  This bill extends advanced education nursing grants to support 
clinical nurse specialists, clinical nurse leaders, defines nurse-
managed health clinics, adds clinical nurse specialists to the National 
Advisory Council on Nurse Education and Practice, and reauthorizes loan 
repayments, scholarships, and grants for education, practice, quality, 
and retention.
  This bipartisan legislation passed the Energy and Commerce Committee 
on voice vote earlier this month. I ask my colleagues to join me in 
supporting this important legislation to expand and strengthen our 
American nursing workforce, and I reserve the balance of my time.
  Mr. BURGESS. Mr. Speaker, I yield such time as he may consume to the 
gentleman from Ohio (Mr. Joyce), the author of the bill.
  Mr. JOYCE of Ohio. Mr. Speaker, I rise today in support of my 
legislation, H.R. 959, the Title VIII Nursing Workforce Reauthorization 
Act of 2018.
  First, I want to thank Chairman Walden and Ranking Member Pallone for 
moving this legislation through the Energy and Commerce Committee. It 
is easy to see why nursing consistently ranks as the most trusted 
profession in America. As the husband of a nurse, and co-chair of the 
Congressional Nursing Caucus, I know the amount of dedication and 
support nurses put into their daily task of caring for every patient.
  An estimated 10,000 baby boomers are turning 65 years old every day. 
In order to meet this increased demand for care, we need to grow the 
largest group of healthcare providers: nurses.
  Despite the importance of nurses to the wellbeing of patients, we 
face a projected nursing shortage that will leave too many patients 
without the care that they need. The shortage will affect the entire 
healthcare system, so we need to do all we can to make sure that those 
individuals are interested in this valued career path and have access 
to high-quality education opportunities.
  My bill authorizes funds for loan payback programs and grants for 
advanced education, workforce diversity, and nursing recruitment 
programs. This bill will expand our Nation's trained nursing workforce 
so they can provide the highest quality care American patients need.
  Mr. Speaker, I am thankful for the incredible bipartisan support this 
bill has received on behalf of the Nation's nurses, and I urge my 
colleagues to support this important legislation.
  Mr. GENE GREEN of Texas. Mr. Speaker, I yield 2 minutes to the 
gentlewoman from Hawaii (Ms. Gabbard), who is a cosponsor of this bill.
  Ms. GABBARD. Mr. Speaker, I would like to thank my colleague, 
Congressman Joyce, who has been a great leader on these issues relating 
to our nursing workforce. I appreciate working with him as co-chair of 
the House Congressional Nursing Caucus, where we are able to bring a 
lot of these issues and challenges to life.
  We all know that nurses and caregivers are the heartbeat of our 
healthcare providers. Day in and day out, they provide lifesaving care 
with empathy, compassion, and care in the most trying and stressful 
situations. But across the country, we continue to see nursing 
workforce shortages, especially in our rural and underserved 
communities, like many in my home State of Hawaii where people on 
different islands are literally separated by a body of water sometimes 
from getting access to the care that they need.
  In the next 2 years alone, the United States is on track to face a 
shortage of nearly 200,000 nursing professionals. These shortages not 
only drive up the cost of healthcare for those most in need, but they 
actually endanger the wellbeing and care of our patients.
  As our healthcare system faces heightened and complex challenges, 
like an aging population, increase in chronic diseases, an ever-
worsening opioid epidemic, and so much more, our healthcare workers 
must have the training they need to address the needs of our 
communities.
  Reauthorizing Federal funding for vital programs that provide nurses 
with training, education, and support, will help grow our nursing 
workforce, both in my home State of Hawaii and across the country, and 
expand access to the quality care for our children, our veterans, our 
seniors, and all of our communities.
  Mr. Speaker, I urge my colleagues to support this bipartisan 
legislation, and empower our nurses and healthcare professionals to 
continue serving and caring for the people in our communities.
  Mr. GENE GREEN of Texas. Mr. Speaker, we have no further speakers, 
and I yield back the balance of my time.

[[Page H6608]]

  

  Mr. BURGESS. Mr. Speaker, I yield myself the balance of my time, and 
only to point out that this bill did pass in the previous Congress, in 
the 114th Congress, both in subcommittee and full committee, but was 
never enacted into law.
  The author of that bill in the last Congress was our colleague, Lois 
Capps, on the Energy and Commerce Committee, and I know she will be 
grateful to see that her work has finally cleared the floor of the 
House and on to the Senate, and we will be successful.
  Mr. Speaker, I yield back the balance of my time, and I urge an 
``aye'' vote.
  Mr. WALDEN. Mr. Speaker, I rise in support of H.R. 959, the Title 
VIII Nursing Workforce Reauthorization Act of 2018. I'd like to thank 
Representative David Joyce for his work on this important bill. It is 
one of four bipartisan public health bills the House will vote on 
today, each of which passed through the Energy and Commerce Committee 
unanimously at both the Health Subcommittee and our full committee.
  H.R. 959 would reauthorize nursing workforce development programs, 
which support the recruitment, retention, and advanced education of 
skilled nursing professionals. The bill extends advanced education 
nursing grants to support clinical nurse specialists and clinical nurse 
leaders, defines nurse-managed health clinics, adds clinical nurse 
specialists to the National Advisory Council on Nurse Education, and 
reauthorizes loan repayments, scholarships, and grants for education, 
practice, quality, and retention.
  In rural areas of the country, like my district in Oregon, nurses 
play an especially critical role in our health care delivery system, 
and they've told me about the importance of this legislation. That's 
why it's critical we reauthorize these programs.
  Mr. Speaker, I urge my colleagues to support this bill
  Ms. JACKSON LEE. Mr. Speaker, I rise in strong support of H.R. 959, 
the Nursing Workforce Reauthorization Act of 2018.
  It is undeniable that nurses play a critical role in our society's 
function, as they are trusted healthcare professionals who are the 
heart and soul of the healthcare system.
  H.R. 959 amends the Public Health Service Act by extending support 
for nursing workforce programs and grants through the fiscal year 2022.
  This bill will reauthorize the Title VIII nursing workforce 
development programs.
  Further, eligibility for advanced nursing education grants will be 
expanded to include education programs for clinical nurse leaders and 
all combined registered nurse and graduate degree programs.
  The Nursing Workforce Reauthorization Act bolsters nursing education 
at all levels, strengthens nursing education and funds institutions 
educating nurses to practice in rural and medically underserved 
communities.
  For nearly six decades, the nursing workforce development programs 
have helped fortify the workforce by increasing the number of students, 
faculty, and practicing nurses.
  Unfortunately, health inequities, inflated costs, and poor health 
care outcomes are intensifying because of today's shortfall of 
appropriately prepared licensed vocational/practical nurses (LVNs/
LPNs), registered nurses (RNs), advanced practice registered nurses 
(APRNs), and nurse faculty.
  This trend must be ameliorated, as the importance of nurses cannot be 
understated.
  Nurses are extremely vital components to quality healthcare and 
patient education.
  Nurses are the primary professionals delivering quality health care 
in the nation, as there are over 4.2 million Registered Nurses in 
practice today.
  Moreover, the nurse workforce is expected to continue to grow, due to 
the current technological advancements for treatments, preventive care 
needs, and the rising demand from new health reform enrollments.
  It is imperative that the nursing shortage in society be eliminated, 
as the need for qualified, experienced nurses is rising and will 
continue to do so.
  Insufficient federal investments in nursing education, training, and 
the overall workforce will only be a detriment to our nation's quality 
of healthcare.
  H.R. 959 ensures that nursing workforce development programs will 
continue to address the specific needs of the nursing and nurse faculty 
workforce as well as patients in our communities.
  By modernizing the current nursing workforce development programs, 
through technical training and further financial funding, nurses will 
be able to fulfill the needs of their patients at the highest level.
  Further funding and training for nurses at all levels ensures that 
all types and levels of nurses have concrete training and are able to 
deliver high quality healthcare.
  I urge my colleagues to join me in supporting H.R. 959, which will 
strengthen the future of nursing and the health of the nation.
  The SPEAKER pro tempore. The question is on the motion offered by the 
gentleman from Texas (Mr. Burgess) that the House suspend the rules and 
pass the bill, H.R. 959, as amended.
  The question was taken; and (two-thirds being in the affirmative) the 
rules were suspended and the bill, as amended, was passed.
  A motion to reconsider was laid on the table.

                          ____________________