[Congressional Record (Bound Edition), Volume 148 (2002), Part 10]
[Senate]
[Pages 13734-13736]
[From the U.S. Government Publishing Office, www.gpo.gov]




                           TEXT OF AMENDMENTS

  SA 4312. Mr. REID (for Ms. Mikulski (for himself, Mr. Hutchinson, Mr. 
Kerry, Mr. Jeffords, Mr. Gregg, Mr. Frist, Mr. Kennedy, Ms. Collins, 
Mrs. Clinton, Mr. Roberts, Mr. Wellstone, Mr. Enzi, Mr. Biden, Mr. 
Warner, Mr. Corzine, Mr. Lugar, Mr. Leahy, Mr. Graham, Ms. Cantwell, 
Mrs. Lincoln, Mr. Baucus, Mr. Johnson, Mr. Harkin, Mr. Levin, Mr. 
Inouye, Mr. Torricelli, Mr. Domenici, Mrs. Murray, Mr. Dodd, Mr. 
Daschle, Mrs. Carnahan, Mr. Smith of Oregon, Mr. Reed, Mr. Breaux, Mr. 
Bond, Mr. Dayton, Mr. DeWine, Mr. Sarbanes, Mr. Allen, Mr. Chafee, Mr. 
Hagel, Mr. Santorum, Mr. Bayh, Mr. Rockefeller, Mr. Cleland, Mr. Smith 
of New Hampshire, and Mr. Inhofe)) proposed an amendment to the bill 
H.R. 3487, to amend the Public Health Service Act with respect to 
health professions program.

       Strike all after the enacting clause and insert the 
     following:

     SECTION 1. SHORT TITLE.

       This Act may be cited as the ``Nurse Reinvestment Act''.

     SEC. 2. TABLE OF CONTENTS.

       The table of contents for this Act is as follows:

Sec. 1. Short title.
Sec. 2. Table of contents.

                       TITLE I--NURSE RECRUITMENT

Sec. 101. Definitions.
Sec. 102. Public service announcements regarding the nursing 
              profession.
Sec. 103. National Nurse Service Corps.

                       TITLE II--NURSE RETENTION

Sec. 201. Building career ladders and retaining quality nurses.
Sec. 202. Comprehensive geriatric education.
Sec. 203. Nurse faculty loan program.
Sec. 204. Reports by General Accounting Office.

                       TITLE I--NURSE RECRUITMENT

     SEC. 101. DEFINITIONS.

       Section 801 of the Public Health Service Act (42 U.S.C. 
     296) is amended by adding at the end the following:
       ``(9) Ambulatory surgical center.--The term `ambulatory 
     surgical center' has the meaning applicable to such term 
     under title XVIII of the Social Security Act.
       ``(10) Federally qualified health center.--The term 
     `Federally qualified health center' has the meaning given 
     such term under section 1861(aa)(4) of the Social Security 
     Act.
       ``(11) Health care facility.--The term `health care 
     facility' means an Indian Health Service health center, a 
     Native Hawaiian health center, a hospital, a Federally 
     qualified health center, a rural health clinic, a nursing 
     home, a home health agency, a hospice program, a public 
     health clinic, a State or local department of public health, 
     a skilled nursing facility, an ambulatory surgical center, or 
     any other facility designated by the Secretary.
       ``(12) Home health agency.--The term `home health agency' 
     has the meaning given such term in section 1861(o) of the 
     Social Security Act.
       ``(13) Hospice program.--The term `hospice program' has the 
     meaning given such term in section 1861(dd)(2) of the Social 
     Security Act.
       ``(14) Rural health clinic.--The term `rural health clinic' 
     has the meaning given such term in section 1861(aa)(2) of the 
     Social Security Act.
       ``(15) Skilled nursing facility.--The term `skilled nursing 
     facility' has the meaning given such term in section 1819(a) 
     of the Social Security Act.''.

     SEC. 102. PUBLIC SERVICE ANNOUNCEMENTS REGARDING THE NURSING 
                   PROFESSION.

       Title VIII of the Public Health Service Act (42 U.S.C. 296 
     et seq.) is amended by adding at the end the following:

                 ``PART H--PUBLIC SERVICE ANNOUNCEMENTS

     ``SEC. 851. PUBLIC SERVICE ANNOUNCEMENTS.

       ``(a) In General.--The Secretary shall develop and issue 
     public service announcements that advertise and promote the 
     nursing profession, highlight the advantages and rewards of 
     nursing, and encourage individuals to enter the nursing 
     profession.
       ``(b) Method.--The public service announcements described 
     in subsection (a) shall be broadcast through appropriate 
     media outlets, including television or radio, in a manner 
     intended to reach as wide and diverse an audience as 
     possible.
       ``(c) Authorization of Appropriations.--There are 
     authorized to be appropriated to carry out this section such 
     sums as may be necessary for each of fiscal years 2003 
     through 2007.

     ``SEC. 852. STATE AND LOCAL PUBLIC SERVICE ANNOUNCEMENTS.

       ``(a) In General.--The Secretary may award grants to 
     eligible entities to support State and local advertising 
     campaigns through appropriate media outlets to promote the 
     nursing profession, highlight the advantages and rewards of 
     nursing, and encourage individuals from disadvantaged 
     backgrounds to enter the nursing profession.
       ``(b) Use of Funds.--An eligible entity that receives a 
     grant under subsection (a) shall use funds received through 
     such grant to acquire local television and radio time, place 
     advertisements in local newspapers, or post information on 
     billboards or on the Internet in a manner intended to reach 
     as wide and diverse an audience as possible, in order to--
       ``(1) advertise and promote the nursing profession;
       ``(2) promote nursing education programs;

[[Page 13735]]

       ``(3) inform the public of financial assistance regarding 
     such education programs;
       ``(4) highlight individuals in the community who are 
     practicing nursing in order to recruit new nurses; or
       ``(5) provide any other information to recruit individuals 
     for the nursing profession.
       ``(c) Limitation.--An eligible entity that receives a grant 
     under subsection (a) shall not use funds received through 
     such grant to advertise particular employment opportunities.
       ``(d) Authorization of Appropriations.--There are 
     authorized to be appropriated to carry out this section such 
     sums as may be necessary for each of fiscal years 2003 
     through 2007.''.

     SEC. 103. NATIONAL NURSE SERVICE CORPS.

       (a) Loan Repayment Program.--Section 846(a) of the Public 
     Health Service Act (42 U.S.C. 297n(a)) is amended--
       (1) in paragraph (3), by striking ``in an Indian Health 
     Service health center'' and all that follows to the semicolon 
     and inserting ``at a health care facility with a critical 
     shortage of nurses''; and
       (2) by adding at the end the following: ``After fiscal year 
     2007, the Secretary may not, pursuant to any agreement 
     entered into under this subsection, assign a nurse to any 
     private entity unless that entity is nonprofit.''.
       (b) Establishment of Scholarship Program.--Section 846 of 
     the Public Health Service Act (42 U.S.C. 297n) is amended--
       (1) in the heading for the section, by striking ``loan 
     repayment program'' and inserting ``loan repayment and 
     scholarship programs'';
       (2) by redesignating subsections (d), (f), (g), and (h) as 
     subsections (f), (h), (i), and (g), respectively;
       (3) by transferring subsections (f) and (g) (as so 
     redesignated) from their current placements, by inserting 
     subsection (f) after subsection (e), and by inserting 
     subsection (g) after subsection (f) (as so inserted); and
       (4) by inserting after subsection (c) the following 
     subsection:
       ``(d) Scholarship Program.--
       ``(1) In general.--The Secretary shall (for fiscal years 
     2003 and 2004) and may (for fiscal years thereafter) carry 
     out a program of entering into contracts with eligible 
     individuals under which such individuals agree to serve as 
     nurses for a period of not less than 2 years at a health care 
     facility with a critical shortage of nurses, in consideration 
     of the Federal Government agreeing to provide to the 
     individuals scholarships for attendance at schools of 
     nursing.
       ``(2) Eligible individuals.--In this subsection, the term 
     `eligible individual' means an individual who is enrolled or 
     accepted for enrollment as a full-time or part-time student 
     in a school of nursing.
       ``(3) Service requirement.--
       ``(A) In general.--The Secretary may not enter into a 
     contract with an eligible individual under this subsection 
     unless the individual agrees to serve as a nurse at a health 
     care facility with a critical shortage of nurses for a period 
     of full-time service of not less than 2 years, or for a 
     period of part-time service in accordance with subparagraph 
     (B).
       ``(B) Part-time service.--An individual may complete the 
     period of service described in subparagraph (A) on a part-
     time basis if the individual has a written agreement that--
       ``(i) is entered into by the facility and the individual 
     and is approved by the Secretary; and
       ``(ii) provides that the period of obligated service will 
     be extended so that the aggregate amount of service performed 
     will equal the amount of service that would be performed 
     through a period of full-time service of not less than 2 
     years.
       ``(4) Applicability of certain provisions.--The provisions 
     of subpart III of part D of title III shall, except as 
     inconsistent with this section, apply to the program 
     established in paragraph (1) in the same manner and to the 
     same extent as such provisions apply to the National Health 
     Service Corps Scholarship Program established in such 
     subpart.''.
       (c) Preference.--Section 846(e) of the Public Health 
     Service Act (42 U.S.C. 297n(e)) is amended by striking 
     ``under subsection (a)'' and all that follows through the 
     period and inserting ``under subsection (a) or (d), the 
     Secretary shall give preference to qualified applicants with 
     the greatest financial need.''.
       (d) Reports.--Subsection (h) of section 846 of the Public 
     Health Service Act (42 U.S.C. 297n) (as redesignated by 
     subsection (b)(2)) is amended to read as follows:
       ``(h) Reports.--Not later than 18 months after the date of 
     enactment of the Nurse Reinvestment Act, and annually 
     thereafter, the Secretary shall prepare and submit to the 
     Congress a report describing the programs carried out under 
     this section, including statements regarding--
       ``(1) the number of enrollees, scholarships, loan 
     repayments, and grant recipients;
       ``(2) the number of graduates;
       ``(3) the amount of scholarship payments and loan 
     repayments made;
       ``(4) which educational institution the recipients 
     attended;
       ``(5) the number and placement location of the scholarship 
     and loan repayment recipients at health care facilities with 
     a critical shortage of nurses;
       ``(6) the default rate and actions required;
       ``(7) the amount of outstanding default funds of both the 
     scholarship and loan repayment programs;
       ``(8) to the extent that it can be determined, the reason 
     for the default;
       ``(9) the demographics of the individuals participating in 
     the scholarship and loan repayment programs;
       ``(10) justification for the allocation of funds between 
     the scholarship and loan repayment programs; and
       ``(11) an evaluation of the overall costs and benefits of 
     the programs.''.
       (e) Funding.--Subsection (i) of section 846 of the Public 
     Health Service Act (42 U.S.C. 297n) (as redesignated by 
     subsection (b)(2)) is amended to read as follows:
       ``(i) Funding.--
       ``(1) Authorization of appropriations.--For the purpose of 
     payments under agreements entered into under subsection (a) 
     or (d), there are authorized to be appropriated such sums as 
     may be necessary for each of fiscal years 2003 through 2007.
       ``(2) Allocations.--Of the amounts appropriated under 
     paragraph (1), the Secretary may, as determined appropriate 
     by the Secretary, allocate amounts between the program under 
     subsection (a) and the program under subsection (d).''.

                       TITLE II--NURSE RETENTION

     SEC. 201. BUILDING CAREER LADDERS AND RETAINING QUALITY 
                   NURSES.

       Section 831 of the Public Health Service Act (42 U.S.C. 
     296p) is amended to read as follows:

     ``SEC. 831. NURSE EDUCATION, PRACTICE, AND RETENTION GRANTS.

       ``(a) Education Priority Areas.--The Secretary may award 
     grants to or enter into contracts with eligible entities 
     for--
       ``(1) expanding the enrollment in baccalaureate nursing 
     programs;
       ``(2) developing and implementing internship and residency 
     programs to encourage mentoring and the development of 
     specialties; or
       ``(3) providing education in new technologies, including 
     distance learning methodologies.
       ``(b) Practice Priority Areas.--The Secretary may award 
     grants to or enter into contracts with eligible entities 
     for--
       ``(1) establishing or expanding nursing practice 
     arrangements in noninstitutional settings to demonstrate 
     methods to improve access to primary health care in medically 
     underserved communities;
       ``(2) providing care for underserved populations and other 
     high-risk groups such as the elderly, individuals with HIV-
     AIDS, substance abusers, the homeless, and victims of 
     domestic violence;
       ``(3) providing managed care, quality improvement, and 
     other skills needed to practice in existing and emerging 
     organized health care systems; or
       ``(4) developing cultural competencies among nurses.
       ``(c) Retention Priority Areas.--The Secretary may award 
     grants to and enter into contracts with eligible entities to 
     enhance the nursing workforce by initiating and maintaining 
     nurse retention programs pursuant to paragraph (1) or (2).
       ``(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 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 
     nurses, advanced education nurses, licensed practical nurses, 
     certified nurse assistants, and home health aides; and
       ``(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.
       ``(2) Enhancing patient care delivery systems.--
       ``(A) Grants.--The Secretary may award grants to eligible 
     entities to improve the retention of nurses and enhance 
     patient care that is directly related to nursing activities 
     by enhancing collaboration and communication among nurses and 
     other health care professionals, and by promoting nurse 
     involvement in the organizational and clinical decisionmaking 
     processes of a health care facility.
       ``(B) Preference.--In making awards of grants under this 
     paragraph, the Secretary shall give a preference to 
     applicants that have not previously received an award under 
     this paragraph.
       ``(C) Continuation of an award.--The Secretary shall make 
     continuation of any award under this paragraph beyond the 
     second year of such award contingent on the recipient of such 
     award having demonstrated to the Secretary measurable and 
     substantive improvement in nurse retention or patient care.
       ``(d) Other Priority Areas.--The Secretary may award grants 
     to or enter into contracts with eligible entities to address 
     other areas that are of high priority to nurse education, 
     practice, and retention, as determined by the Secretary.
       ``(e) Preference.--For purposes of any amount of funds 
     appropriated to carry out

[[Page 13736]]

     this section for fiscal year 2003, 2004, or 2005 that is in 
     excess of the amount of funds appropriated to carry out this 
     section for fiscal year 2002, the Secretary shall give 
     preference to awarding grants or entering into contracts 
     under subsections (a)(2) and (c).
       ``(f) Report.--The Secretary shall submit to the Congress 
     before the end of each fiscal year a report on the grants 
     awarded and the contracts entered into under this section. 
     Each such report shall identify the overall number of such 
     grants and contracts and provide an explanation of why each 
     such grant or contract will meet the priority need of the 
     nursing workforce.
       ``(g) Eligible Entity.--For purposes of this section, the 
     term `eligible entity' includes a school of nursing, a health 
     care facility, or a partnership of such a school and 
     facility.
       ``(h) Authorization of Appropriations.--There are 
     authorized to be appropriated to carry out this section such 
     sums as may be necessary for each of fiscal years 2003 
     through 2007.''.

     SEC. 202. COMPREHENSIVE GERIATRIC EDUCATION.

       (a) Comprehensive Geriatric Education.--Title VIII of the 
     Public Health Service Act (42 U.S.C. 296 et seq.) (as amended 
     by section 102) is amended by adding at the end the 
     following:

              ``PART I--COMPREHENSIVE GERIATRIC EDUCATION

     ``SEC. 855. COMPREHENSIVE GERIATRIC EDUCATION.

       ``(a) Program Authorized.--The Secretary shall award grants 
     to eligible entities to develop and implement, in 
     coordination with programs under section 753, programs and 
     initiatives to train and educate individuals in providing 
     geriatric care for the elderly.
       ``(b) Use of Funds.--An eligible entity that receives a 
     grant under subsection (a) shall use funds under such grant 
     to--
       ``(1) provide training to individuals who will provide 
     geriatric care for the elderly;
       ``(2) develop and disseminate curricula relating to the 
     treatment of the health problems of elderly individuals;
       ``(3) train faculty members in geriatrics; or
       ``(4) provide continuing education to individuals who 
     provide geriatric care.
       ``(c) Application.--An eligible entity desiring a grant 
     under subsection (a) shall submit an application to the 
     Secretary at such time, in such manner, and containing such 
     information as the Secretary may reasonably require.
       ``(d) Eligible Entity.--For purposes of this section, the 
     term `eligible entity' includes a school of nursing, a health 
     care facility, a program leading to certification as a 
     certified nurse assistant, a partnership of such a school and 
     facility, or a partnership of such a program and facility.
       ``(e) Authorization of Appropriations.--There are 
     authorized to be appropriated to carry out this section such 
     sums as may be necessary for each of fiscal years 2003 
     through 2007.''.
       (b) Technical Amendment.--Section 753(a)(1) of the Public 
     Health Service Act (42 U.S.C. 294c) is amended by striking 
     ``, and section 853(2),'' and inserting ``, and section 
     801(2),''.

     SEC. 203. NURSE FACULTY LOAN PROGRAM.

       Part E of title VIII of the Public Health Service Act (42 
     U.S.C. 297a et seq.) is amended by inserting after section 
     846 the following:

                      ``nurse faculty loan program

       ``Sec. 846A. (a) Establishment.--The Secretary, acting 
     through the Administrator of the Health Resources and 
     Services Administration, may enter into an agreement with any 
     school of nursing for the establishment and operation of a 
     student loan fund in accordance with this section, to 
     increase the number of qualified nursing faculty.
       ``(b) Agreements.--Each agreement entered into under 
     subsection (a) shall--
       ``(1) provide for the establishment of a student loan fund 
     by the school involved;
       ``(2) provide for deposit in the fund of--
       ``(A) the Federal capital contributions to the fund;
       ``(B) an amount equal to not less than one-ninth of such 
     Federal capital contributions, contributed by such school;
       ``(C) collections of principal and interest on loans made 
     from the fund; and
       ``(D) any other earnings of the fund;
       ``(3) provide that the fund will be used only for loans to 
     students of the school in accordance with subsection (c) and 
     for costs of collection of such loans and interest thereon;
       ``(4) provide that loans may be made from such fund only to 
     students pursuing a full-time course of study or, at the 
     discretion of the Secretary, a part-time course of study in 
     an advanced degree program described in section 811(b); and
       ``(5) contain such other provisions as are necessary to 
     protect the financial interests of the United States.
       ``(c) Loan Provisions.--Loans from any student loan fund 
     established by a school pursuant to an agreement under 
     subsection (a) shall be made to an individual on such terms 
     and conditions as the school may determine, except that--
       ``(1) such terms and conditions are subject to any 
     conditions, limitations, and requirements prescribed by the 
     Secretary;
       ``(2) in the case of any individual, the total of the loans 
     for any academic year made by schools of nursing from loan 
     funds established pursuant to agreements under subsection (a) 
     may not exceed $30,000, plus any amount determined by the 
     Secretary on an annual basis to reflect inflation;
       ``(3) an amount up to 85 percent of any such loan (plus 
     interest thereon) shall be canceled by the school as follows:
       ``(A) upon completion by the individual of each of the 
     first, second, and third year of full-time employment, 
     required by the loan agreement entered into under this 
     subsection, as a faculty member in a school of nursing, the 
     school shall cancel 20 percent of the principle of, and the 
     interest on, the amount of such loan unpaid on the first day 
     of such employment; and
       ``(B) upon completion by the individual of the fourth year 
     of full-time employment, required by the loan agreement 
     entered into under this subsection, as a faculty member in a 
     school of nursing, the school shall cancel 25 percent of the 
     principle of, and the interest on, the amount of such loan 
     unpaid on the first day of such employment;
       ``(4) such a loan may be used to pay the cost of tuition, 
     fees, books, laboratory expenses, and other reasonable 
     education expenses;
       ``(5) such a loan shall be repayable in equal or graduated 
     periodic installments (with the right of the borrower to 
     accelerate repayment) over the 10-year period that begins 9 
     months after the individual ceases to pursue a course of 
     study at a school of nursing; and
       ``(6) such a loan shall--
       ``(A) beginning on the date that is 3 months after the 
     individual ceases to pursue a course of study at a school of 
     nursing, bear interest on the unpaid balance of the loan at 
     the rate of 3 percent per annum; or
       ``(B) subject to subsection (e), if the school of nursing 
     determines that the individual will not complete such course 
     of study or serve as a faculty member as required under the 
     loan agreement under this subsection, bear interest on the 
     unpaid balance of the loan at the prevailing market rate.
       ``(d) Payment of Proportionate Share.--Where all or any 
     part of a loan, or interest, is canceled under this section, 
     the Secretary shall pay to the school an amount equal to the 
     school's proportionate share of the canceled portion, as 
     determined by the Secretary.
       ``(e) Review by Secretary.--At the request of the 
     individual involved, the Secretary may review any 
     determination by a school of nursing under subsection 
     (c)(6)(B).
       ``(f) Authorization of Appropriations.--There are 
     authorized to be appropriated to carry out this section such 
     sums as may be necessary for each of fiscal years 2003 
     through 2007.''.

     SEC. 204. REPORTS BY GENERAL ACCOUNTING OFFICE.

       (a) National Variations.--Not later than 4 years after the 
     date of the enactment of this Act, the Comptroller General of 
     the United States shall conduct a survey to determine 
     national variations in the nursing shortage at hospitals, 
     nursing homes, and other health care providers, and submit a 
     report, including recommendations, to the Congress on Federal 
     remedies to ease nursing shortages. The Comptroller General 
     shall submit to the Congress this report describing the 
     findings relating to ownership status and associated 
     remedies.
       (b) Hiring Differences Among Certain Private Entities.--The 
     Comptroller General of the United States shall conduct a 
     study to determine differences in the hiring of nurses by 
     nonprofit private entities as compared to the hiring of 
     nurses by private entities that are not nonprofit. In 
     carrying out the study, the Comptroller General shall 
     determine the effect of the inclusion of private entities 
     that are not nonprofit in the program under section 846 of 
     the Public Health Service Act. Not later than 4 years after 
     the date of the enactment of this Act, the Comptroller 
     General shall submit to the Congress a report describing the 
     findings of the study.
       (c) Nursing Scholarships.--The Comptroller General of the 
     United States shall conduct an evaluation of whether the 
     program carried out under section 846(d) of the Public Health 
     Service Act has demonstrably increased the number of 
     applicants to schools of nursing and, not later than 4 years 
     after the date of the enactment of this Act, submit a report 
     to the Congress on the results of such evaluation.

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