[Congressional Record Volume 171, Number 214 (Thursday, December 18, 2025)]
[Senate]
[Page S8934]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

  SA 4130. Ms. KLOBUCHAR submitted an amendment intended to be proposed 
by her to the bill H.R. 4016, making appropriations for the Department 
of Defense for the fiscal year ending September 30, 2026, and for other 
purposes; which was ordered to lie on the table; as follows:

       At the appropriate place, insert the following:

     SEC. __. ADJUSTING ALLOWABLE DIRECT AND INDIRECT COSTS FOR 
                   NURSING AND ALLIED HEALTH EDUCATION PROGRAMS.

       (a) In General.--Section 1861(v)(1) of the Social Security 
     Act (42 U.S.C. 1395x(v)(1)) is amended by adding at the end 
     the following new subparagraph:
       ``(X)(i) In determining such reasonable costs for nursing 
     and allied health education furnished by a hospital, 
     beginning with respect to cost reporting periods beginning on 
     or after the date of the enactment of this subparagraph, the 
     Secretary shall include as reasonable costs all direct and 
     indirect costs incurred by a hospital participating in a 
     nursing and allied health education program licensed by State 
     law or accredited by a national or regional professional 
     organization, including costs that--
       ``(I) were directly incurred by the hospital;
       ``(II) were allocated to the hospital by a related entity 
     holding the applicable State license or accreditation by a 
     national or regional professional organization;
       ``(III) were associated with the training or advanced 
     clinical training of a program participant at the hospital or 
     at a related entity;
       ``(IV) were associated with contracts to provide for 
     faculty for the program when such faculty are employed by an 
     educational institution that is not a related entity; or
       ``(V) were associated with shared services, such as shared 
     payroll and administrative services, to support the operation 
     of an approved nursing or allied health education program, 
     provided by an educational institution or a clinical site 
     that is a related entity.
       ``(ii) For purposes of clause (i), the term `related 
     entity' means, with respect to a hospital, any entity that is 
     related by common ownership or control to--
       ``(I) the hospital itself; or
       ``(II) an entity--
       ``(aa) in which the hospital (or another entity that is a 
     related entity with respect to the hospital) is the sole 
     corporate member;
       ``(bb) that is the sole corporate member of the hospital;
       ``(cc) that is part of the same legal entity as the 
     hospital; or
       ``(dd) that shares a board with the hospital.''.
       (b) Allowing Health Systems and Hospital-Based Schools To 
     Provide Clinical Training and Support.--Not later than 120 
     days after the date of the enactment of this section, the 
     Secretary of Health and Human Services shall issue such rules 
     as are necessary to carry out the amendments made by 
     subsection (a).
       (c) Prohibiting Recoupment of Certain Costs Under 
     Medicare.--
       (1) In general.--Beginning on the date of the enactment of 
     this section, the Secretary of Health and Human Services may 
     not recoup or reduce payments made to a hospital under part A 
     of title XVIII of the Social Security Act (42 U.S.C. 1395c et 
     seq.) for costs related to an approved nursing or allied 
     health education program that are included on the Medicare 
     cost report for such hospital if such costs would be 
     allowable after the amendments made by subsection (a) take 
     effect.
       (2) Refund of amounts recouped.--If, during the 6-year 
     period ending on the date of the enactment of this section, 
     the Secretary recouped or reduced payments made to a hospital 
     under such part A for costs described in paragraph (1), the 
     Secretary shall refund to the hospital the amount so recouped 
     or reduced.
                                 ______