[Congressional Record Volume 165, Number 170 (Monday, October 28, 2019)]
[House]
[Pages H8513-H8516]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
TITLE VIII NURSING WORKFORCE REAUTHORIZATION ACT OF 2019
Ms. SCHAKOWSKY. Madam Speaker, I move to suspend the rules and pass
the bill (H.R. 728) 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. 728
Be it enacted by the Senate and House of Representatives of
the United States of America in Congress assembled,
SECTION 1. SHORT TITLE; TABLE OF CONTENTS.
(a) Short Title.--This Act may be cited as the ``Title VIII
Nursing Workforce Reauthorization Act of 2019''.
(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
[[Page H8514]]
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
$77,585,000 for each of fiscal years 2020 through 2024.''.
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
$18,037,000 for each of fiscal years 2020 through 2024.''.
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 ``$43,590,000 for
each of fiscal years 2020 through 2024''.
(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 ``$90,620,000 for each of fiscal years 2020 through
2024''.
(b) Nurse Faculty Loan Program.--Section 846A(f) of the
Public Health Service Act (42 U.S.C. 297n-1(f)) is amended by
striking ``such sums as may be necessary for each of fiscal
years 2010 through 2014'' and inserting ``$29,640,000 for
each of fiscal years 2020 through 2024''.
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 2019,
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''.
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.
(c) Eliminating Limitation on Assignment.--Section 846(a)
of the Public Health Service Act (42 U.S.C. 297n(a)) is
amended, in the matter following paragraph (3), by striking
``After fiscal year 2007,'' and all that follows through the
period at the end.
The SPEAKER pro tempore. Pursuant to the rule, the gentlewoman from
Illinois (Ms. Schakowsky) and the gentleman from Texas (Mr. Burgess)
each will control 20 minutes.
The Chair recognizes the gentlewoman from Illinois.
General Leave
Ms. SCHAKOWSKY. Madam Speaker, I ask unanimous consent that all
Members have 5 legislative days in which to revise and extend their
remarks and include extraneous materials on H.R. 728.
The SPEAKER pro tempore. Is there objection to the request of the
gentlewoman from Illinois?
There was no objection.
Ms. SCHAKOWSKY. Madam Speaker, I yield 1\1/2\ minutes to the
gentlewoman from Oregon (Ms. Bonamici).
Ms. BONAMICI. Madam Speaker, I thank the gentlewoman for yielding.
[[Page H8515]]
I rise today in support of H.R. 728, the Title VIII Nursing Workforce
Reauthorization Act and to highlight the importance of title VIII
programs, a critical lifeline for America's nursing workforce and the
patients they serve.
Demand for healthcare services provided by nurses continues to grow,
so we must expand and support these programs to maintain a highly
educated nursing workforce. Title VIII programs support more than
61,000 students in almost every State, but there are still significant
nursing shortages in northwest Oregon and across the country.
Title VIII programs increase the nursing pipeline and also create a
culturally diverse workforce to make sure that our increasingly diverse
patient population is cared for by culturally aware providers. Title
VIII programs prepare nurses to serve the most vulnerable communities
and regions, such as rural areas, that are in desperate need of
providers.
Title VIII programs also provide crucial support for our nursing
educators, greater diversity in the nursing workforce, and more
successful careers for nurses who work tirelessly on the front lines of
patient care.
Our nurses are critical to the health and well-being of our
communities. That is why I am honored to serve as a leader on the
Nursing Caucus along with several other cosponsors of this legislation,
Representatives Joyce, Davis, and Gabbard.
I thank them and the Energy and Commerce Committee for their
leadership on this bill. I look forward to our continued bipartisan
effort in advocating for the title VIII Nursing Workforce Development
programs.
Madam Speaker, I urge my colleagues to join us in supporting this
legislation.
Mr. BURGESS. Madam Speaker, I yield myself such time as I may
consume.
Madam Speaker, I support H.R. 728, the Title VIII Nursing Workforce
Reauthorization Act of 2019 which was introduced by Mr. Joyce, our
Republican lead of Ohio. This bill reauthorizes the title VIII nursing
workforce programs for fiscal years 2020 through 2024. Title VIII
programs, in addition to the title VII physician workforce programs,
have actually expired, but they have continued to receive
appropriations.
According to a Health Resource and Services Administration report on
nursing workforce projections in 2017, the future supply of and demand
for nurses will be affected by a host of factors, including population
growth, aging of the Nation's population, overall economic conditions,
expanded health insurance coverage, changes in healthcare
reimbursement, geographic location, and health workforce availability.
The demands for RNs are projected to increase by nearly 800,000 between
2014 and 2030.
Texas is projected to face a shortage of all types of nurses by 2030.
Registered nurses, nurse practitioners, certified nurse anesthetists,
and certified nurse-midwives will fall short of demand year after year
from now until 2030. This is an issue that we are facing across the
country, and H.R. 728 can help fix that.
While our appropriations process has continued to fund these
programs, without authorization there remains uncertainty regarding how
much money the program will receive each year. These programs range
from providing our advanced practice nurses with additional educational
opportunities to increasing nursing workforce diversity.
In the midst of a nursing shortage, we must ensure that our
healthcare system has the capacity to educate and retain a qualified
workforce and also allows for career advancement. This bill includes
grants for nurses of different levels of education to obtain further
education to advance within their profession. Additionally, this
legislation reauthorizes loan repayments, scholarships, and grants for
education, practice, quality, and retention. These provisions are
essential in educating and retaining a qualified nursing workforce.
Madam Speaker, I urge support of H.R. 728, and I reserve the balance
of my time.
Ms. SCHAKOWSKY. Madam Speaker, I yield myself such time as I may
consume.
I rise in great support of H.R. 728, the Nursing Workforce
Reauthorization Act introduced by Representatives Joyce, Gabbard,
Davis, Bonamici, Matsui, Castor, McKinley, and Underwood.
The title VIII nursing workforce program ensures that we have a
skilled, competent, and diverse nursing workforce, and the Nursing
Workforce Reauthorization Act will go a long way in strengthening these
programs.
This bill provides grants to nursing schools, academic health
centers, and other entities to help in training graduate-level nurse
practitioners and clinical nurse specialists, certified nurse-midwives
and certified registered nurse anesthetists and public health nurses.
The bill also reauthorizes the successful Nursing Workforce Diversity
grant program which has been shown to reduce health disparities and
improve outcomes for patients.
As our population ages we are seeing a growing demand for qualified
nursing. H.R. 728 helps us prepare for the future by training the next
generation of nurses and nurse educators.
Madam Speaker, I urge all of my colleagues to support this bill, and
I reserve the balance of my time.
{time} 1815
Mr. BURGESS. Madam Speaker, I yield 4 minutes to the gentleman from
Ohio (Mr. Joyce), who is the Republican lead on this bill.
Mr. JOYCE of Ohio. Madam Speaker, I rise today in support of H.R.
728, the Title VIII Nursing Workforce Reauthorization Act of 2019.
With 4 million registered nurses nationwide, nurses are more than
just the largest healthcare workforce in the United States. They are
the backbone of the healthcare system.
As a proud husband of a nurse and as co-chair of the Congressional
Nursing Caucus, it is easy for me to understand why nursing is the most
trusted profession in America. I can personally attest to the amount of
dedication nurses put into caring for their patients each and every
day. The bottom line is that any challenge facing our Nation's nurses
hurts the health and well-being of the American people.
Unfortunately, despite the importance of nurses to the well-being of
patients, we are facing a nursing shortage that will leave far too many
patients without the care that they need. The demand for nurses varies
State by State, but it is estimated that the national need for nurses
will increase by 28 percent by 2030. On top of that, it is reported
that roughly 10,000 baby boomers turn 65 every day--10,000 every single
day.
To meet this increased demand, Congress must address the issues
impacting nursing recruitment, education, and retention. My bill
accomplishes exactly that by reauthorizing title VIII nursing workforce
development programs.
These programs are designed to address specific needs within the
nursing workforce in America's patient population. Importantly, they
also provide targeted support for the institutions that educate nurses
for practice in rural and medically underserved communities.
By passing this legislation, Congress can ensure that those
interested in pursuing a career in nursing have access to the high-
quality education and training opportunities necessary to do so. By
passing this legislation, Congress can make a direct investment in our
Nation's health.
Before I close, I thank the American Association of Colleges of
Nursing, the American Nurses Association, and my fellow co-chairs of
the Congressional Nursing Caucus who have joined me in this effort:
Representative Tulsi Gabbard, Representative Rodney Davis, and
Representative Suzanne Bonamici.
I also thank Chairman Pallone and Ranking Member Walden, as well as
Subcommittee on Health Chair Eshoo and Ranking Member Burgess, for
recognizing the importance of this legislation and moving it through
the Committee on Energy and Commerce.
Madam Speaker, I am grateful for the overwhelming bipartisan support
this bill has received. On behalf of the Nation's nurses, I urge all of
my colleagues to support its passage.
Ms. SCHAKOWSKY. Madam Speaker, I am prepared to close with this.
Nurses are the backbone of our healthcare system. It looks like, in a
bipartisan way, everybody loves nurses. They provide frontline care in
a
[[Page H8516]]
variety of settings and often work to supervise and coordinate care for
patients. We couldn't live without them, and so we are helping them
today.
Madam Speaker, I urge the passage of this legislation with all of my
colleagues, and I yield back the balance of my time.
Mr. BURGESS. Madam Speaker, I yield myself the balance of my time.
Again, this is one of those bills that passed out of the Subcommittee
on Health last Congress, passed on the floor of the House, and, for
some reason, didn't see action over in the Senate. This year, it needs
to, for all the reasons we have heard articulated here today.
I also am obligated to mention that my district in Texas is home to
one of the largest and best nursing education programs in the country
at Texas Woman's University.
I would also be remiss if I didn't acknowledge the work done in the
last Congress by Lois Capps, who was our colleague at the time, who is
no longer in Congress, but it was always her passion to see this bill
passed.
Madam Speaker, I urge passage, and I yield back the balance of my
time.
Ms. JOHNSON of Texas. Madam Speaker, today, I rise in support of H.R.
728, the Title VIII Nursing Workforce Reauthorization Act of 2019.
As the first registered nurse elected to Congress, I know how
essential the federal nursing workforce development grant programs are
to the development of the next generation of our nursing leaders. These
Title VIII programs, administered through the Health Resources and
Services Administration, have supported the recruitment, retention, and
distribution of our nation's nursing workforce for over five decades.
Title VIII programs have supported nursing education at all levels,
from entry level preparation through graduate study. They have provided
support for institutions that educate nurses for practice in rural and
medically underserved communities, thus representing a direct
investment in our nation's health.
With the support of our House and Senate colleagues, we must continue
to elevate and strengthen our nursing workforce for the wellbeing of
our nation. I wholeheartedly urge my colleagues to support the Title
VIII Nursing Workforce Reauthorization Act of 2019.
The SPEAKER pro tempore. The question is on the motion offered by the
gentlewoman from Illinois (Ms. Schakowsky) that the House suspend the
rules and pass the bill, H.R. 728, 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.
____________________