[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.

                          ____________________