[House Report 116-216]
[From the U.S. Government Publishing Office]
116th Congress } { Report
HOUSE OF REPRESENTATIVES
1st Session } { 116-216
======================================================================
TITLE VIII NURSING WORKFORCE REAUTHORIZATION ACT OF 2019
_______
September 24, 2019.--Committed to the Committee of the Whole House on
the State of the Union and ordered to be printed
_______
Mr. Pallone, from the Committee on Energy and Commerce,
submitted the following
R E P O R T
[To accompany H.R. 728]
The Committee on Energy and Commerce, to whom was referred
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, having considered the same, report favorably thereon
with an amendment and recommend that the bill as amended do
pass.
CONTENTS
Page
I. Purpose and Summary.............................................4
II. Background and Need for the Legislation.........................4
III. Committee Hearings..............................................6
IV. Committee Consideration.........................................7
V. Committee Votes.................................................7
VI. Oversight Findings..............................................7
VII. New Budget Authority, Entitlement Authority, and Tax Expenditure7
VIII Federal Mandates Statement......................................7
.
IX. Statement of General Performance Goals and Objectives...........8
X. Duplication of Federal Programs.................................8
XI. Committee Cost Estimate.........................................8
XII. Earmarks, Limited Tax Benefits, and Limited Tariff Benefits.....8
XIII Advisory Committee Statement....................................8
.
XIV. Applicability to Legislative Branch.............................8
XV. Section-by-Section Analysis of the Legislation..................8
XVI. Changes in Existing Law Made by the Bill, as Reported...........9
The amendment is as follows:
Strike all after the enacting clause and insert the
following:
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 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.
I. Purpose and Summary
H.R. 728, the ``Title VIII Nursing Workforce
Reauthorization Act of 2019'', was introduced on January 23,
2019, by Reps. David Joyce (R-OH), Doris Matsui (D-CA), Rodney
Davis (R-IL), Kathy Castor (D-FL), David McKinley (R-WV), Tulsi
Gabbard (D-HI), Suzanne Bonamici (D-OR), and Lauren Underwood
(D-IL) and referred to the Committee on Energy and Commerce.
H.R. 728 would reauthorize funding at the Health Resources and
Services Administration (HRSA) for nursing workforce,
education, and training programs. The five-year reauthorization
includes annual authorizations of: $77,585,000 for advanced
education nursing grants; $18,037,000 for nursing workforce
diversity programs; $43,590,000 for nurse education, practice,
and quality grants; $90,620,000 for Nurse Corps loan repayment
and scholarship programs; and $29,640,000 for the nurse faculty
loan repayment program. The bill also recognizes the role of
clinical nurse specialist programs and makes technical changes
to existing nurse workforce programs to recognize diversity in
the nursing profession and nurses practicing in a variety of
settings.
II. Background and Need for Legislation
Nurses provide frontline care in a variety of settings and
often work to supervise and coordinate care for patients. The
Bureau of Labor Statistics projects that an additional 203,700
nurses will be needed every year to meet demand, filling newly
created positions, and replacing retiring nurses.\1\ While
there is a growth in enrollment at nursing schools, enrollment
is not growing fast enough to meet the projected demand for
nurses.\2\ Title VIII of the Public Health Service Act (PHSA)
includes programs administered by HRSA to support and educate
nursing students and professionals through targeted grant
programs.
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\1\Elka Torpey, Bureau of Labor Statistics, Employment Outlook for
Bachelor's-Level Occupations, www.bls.gov/careeroutlook/2018/article/
bachelors-degree-outlook.htm#Healthcare%20and %20science (2018).
\2\American Assn. of Colleges of Nursing, Fact Sheet: Nursing
Shortage, www.aacnnursing.org/Portals/42/News/Factsheets/Nursing-
Shortage-Factsheet.pdf (2019).
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H.R. 728 reauthorizes and updates Title VIII programs that
will help to bolster the recruitment, training, and support for
nursing students and professionals. In addition, H.R. 728
includes provisions that recognize clinical nurse specialist
programs and the need for diversity in the nursing profession,
and improved access to nurses in rural and underserved areas.
Advanced Nursing Education Programs include Advanced
Nursing Workforce Education (ANEW) grants, the Advanced Nursing
Education Nurse Practitioner Residency (ANE-NPR) program, the
Advanced Nursing Education for Sexual Assault Nurse Examiners
(ANE-SANE) program, and the Nurse Anesthetist Traineeships
(NAT) Program. ANEW grants prepare primary care advanced
practice registered nursing (APRN) students to practice in
rural and underserved settings through academic and clinical
training.\3\ The ANE-NPR program funds 12-month nurse
practitioner (NP) residency programs to help primary care NPs
transition to community-based settings.\4\ The ANE-SANE program
funds grants to support partnerships that will recruit, train,
and retain nurses to conduct sexual assault forensic
examinations.\5\ Nurse Anesthetist Traineeships provide
clinical training in medically underserved communities and/or
primary care settings during the academic year.\6\
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\3\Health Resources and Services Admin., Fiscal Year 2020
Justification of Estimates for Appropriations Committees 135 (2019).
\4\Id. at 136.
\5\Id.
\6\Id.
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The nursing profession is predominantly white and
female.\7\ To help alleviate health disparities, observers have
long promoted increasing the diversity of the nursing
workforce.\8\ In addition to reducing disparities, researchers
have noted that achieving greater diversity among health care
workforce will produce a more culturally competent workforce,
improve access to high-quality care for the medically
underserved, increase the breadth and depth of the U.S. health
research agenda, and expand the pool of medically trained
executives and policymakers ready to serve in leadership
positions in the healthcare system.\9\ Despite the benefits of
a more diverse workforce, health professional schools including
nursing schools, have struggled to diversify the pool of health
professional students and the future healthcare workforce.\10\
The Nursing Workforce Diversity Program supports the goal of
diversifying the nursing student pool by providing stipends,
scholarships, and a variety of pre-entry preparation, advanced
education preparation, and retention activities for individuals
from disadvantaged backgrounds, including racial and ethnic
minorities who are underrepresented among registered nurses
(RNs).\11\
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\7\See Nat'l Forum of State Nursing Workforce Centers, 2017
National Nursing Workforce Study, www.ncsbn.org/workforce.htm (2018)
(reporting that 9.1% of registered nurses (RNs) were male, and 19.2%
were minorities).
\8\Ernest Grant, We Can All Help Increase Diversity in Nursing,
Modern Healthcare, May 9, 2019, www.modernhealthcare.com/opinion-
editorial/commentary-we-can-all-help-increase-diversity-nursing.
\9\Jordan J. Cohen, Barbara A. Gabriel, and Charles Terrell, The
Case for Diversity in the Health Care Workforce, Health Affairs, Vol.
21, Issue 5, at 90 (2002).
\10\Jordan J. Cohen, Barbara A. Gabriel, and Charles Terrell, The
Case for Diversity in the Health Care Workforce, Health Affairs, Vol.
21, Issue 5, at 90 (2002).
\11\Supra note 3 at 139.
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Nurse Education, Practice, Quality, and Retention programs
aim to increase the number of Bachelor of Science in Nursing
students who receive clinical experience and training in
medically underserved and rural communities, with the goal of
increasing the number of students who choose to work in those
settings upon graduation.\12\ These programs include the
Behavioral Health Integration Program, the Registered Nurses in
Primary Care Training Program, and the Veteran Registered
Nurses in Primary Care Training Program.
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\12\Id. at 143.
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The Nurse Corps aims to support nurses and nursing students
working in communities with inadequate access to care and
limited access to behavioral health services by funding
scholarships or educational loan repayment.\13\ In exchange for
a scholarship or loan repayment, Nurse Corps members serve in
Critical Shortage Facilities in health professional shortage
areas and medically underserved communities.\14\
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\13\Id. at 150.
\14\Id.
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To promote continued growth of nursing workforce, the Nurse
Faculty Loan Program awards funds to nursing schools that
provide student loans to graduate-level nursing students who
are interested in serving as faculty. After graduating, loan
recipients are eligible to have up to 85 percent of loan
principal and interest canceled in exchange for serving as
full-time faculty at an accredited school of nursing.\15\
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\15\Id. at 147.
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III. Committee Hearings
For the purposes of section 103(i) of H. Res. 6 of the
116th Congress, the following hearing was used to develop or
consider H.R. 728:
The Subcommittee on Health held a legislative hearing in
the 115th Congress entitled ``Supporting Tomorrow's Health
Providers: Examining Workforce Programs Under the Public Health
Service Act.'' Witnesses at the hearing included:
Adrian Billings, M.D., Ph.D., FAAFP, Chief Medical
Officer, Preventive Care Health Services and Associate
Professor, Department of Family and Community Medicine, Texas
Tech University Health Sciences Center-Permian Basin;
Neil S. Calman, M.D., FAAFP, President, American
Association of Teaching Health Centers, President and CEO,
Institute for Family Health, Chair, Department of Family
Medicine and Community Health, Icahn School of Medicine at
Mount Sinai;
Janice A. Knebl, D.O., M.B.A., Dallas Southwest
Osteopathic Physicians Endowed Chair and Professor in
Geriatrics, University of North Texas Health Science Center;
Juliann Sebastian, Ph.D., R.N., FAAN, Chair of the
Board of Directors, American Association of Colleges of
Nursing, Dean and Professor, College of Nursing, University of
Nebraska Medical Center.
IV. Committee Consideration
H.R. 728, the ``Title VIII Nursing Workforce
Reauthorization Act of 2019'', was introduced on January 23,
2019, by Reps. David Joyce (R-OH), Doris Matsui (D-CA), Rodney
Davis (R-IL), Kathy Castor (D-FL), David McKinley (R-WV), Tulsi
Gabbard (D-HI), Suzanne Bonamici (D-OR), and Lauren Underwood
(D-IL) and referred to the Committee on Energy and Commerce.
Subsequently, the bill was referred to the Subcommittee on
Health on January 25, 2019. The Subcommittee met in open markup
session, pursuant to notice, on July 11, 2019, for
consideration of H.R. 728. An amendment offered by Ms. Matsui
was agreed to by a voice vote. Subsequently, the Subcommittee
on Health agreed to a motion by Ms. Eshoo, Chairwoman of the
Subcommittee, to forward favorably H.R. 728, amended, to the
full Committee on Energy and Commerce by a voice vote.
On July 17, 2019, the full Committee met in open markup
session, pursuant to notice, to consider H.R. 728, as amended
by the subcommittee. During consideration of the bill, no
amendments were offered. Subsequently, the full Committee on
Energy and Commerce agreed to a motion by Mr. Pallone, Chairman
of the Committee, to order the bill H.R. 728 reported favorably
to the House, as amended, by a voice vote, a quorum being
present.
V. Committee Votes
Clause 3(b) of rule XIII of the Rules of the House of
Representatives requires the Committee to list each record vote
on the motion to report legislation and amendments thereto.
There were no recorded votes taken in connection with ordering
H.R. 728 reported or on any amendments to the bill.
VI. Oversight Findings
Pursuant to clause 3(c)(1) of rule XIII and clause 2(b)(1)
of rule X of the Rules of the House of Representatives, the
oversight findings and recommendations of the Committee are
reflected in the descriptive portion of the report.
VII. New Budget Authority, Entitlement Authority, and Tax Expenditures
Pursuant to 3(c)(2) of rule XIII of the Rules of the House
of Representatives, the Committee adopts as its own the
estimate of new budget authority, entitlement authority, or tax
expenditures or revenues contained in the cost estimate
prepared by the Director of the Congressional Budget Office
pursuant to section 402 of the Congressional Budget Act of
1974.
The Committee has requested but not received from the
Director of the Congressional Budget Office a statement as to
whether this bill contains any new budget authority, credit
authority, or an increase or decrease in revenues or tax
expenditures.
VIII. Federal Mandates Statement
The Committee adopts as its own the estimate of Federal
mandates prepared by the Director of the Congressional Budget
Office pursuant to section 423 of the Unfunded Mandates Reform
Act.
IX. Statement of General Performance Goals and Objectives
Pursuant to clause 3(c)(4) of rule XIII, the general
performance goal or objective of this legislation is to extend
advanced education nursing grants to support clinical nurse
specialist programs and to support a robust and diverse nursing
workforce.
X. Duplication of Federal Programs
Pursuant to clause 3(c)(5) of rule XIII, no provision of
H.R. 728 is known to be duplicative of another Federal program,
including any program that was included in a report to Congress
pursuant to section 21 of Public Law 111-139 or the most recent
Catalog of Federal Domestic Assistance.
XI. Committee Cost Estimate
Pursuant to clause 3(d)(1) of rule XIII, the Committee
adopts as its own the cost estimate prepared by the Director of
the Congressional Budget Office pursuant to section 402 of the
Congressional Budget Act of 1974.
XII. Earmarks, Limited Tax Benefits, and Limited Tariff Benefits
Pursuant to clause 9(e), 9(f), and 9(g) of rule XXI, the
Committee finds that H.R. 728 contains no earmarks, limited tax
benefits, or limited tariff benefits.
XIII. Advisory Committee Statement
No advisory committees within the meaning of section 5(b)
of the Federal Advisory Committee Act were created by this
legislation.
XIV. Applicability to Legislative Branch
The Committee finds that the legislation does not relate to
the terms and conditions of employment or access to public
services or accommodations within the meaning of section
102(b)(3) of the Congressional Accountability Act.
XV. Section-by-Section Analysis of the Legislation
Section 1. Short title
Section 1 designates that the short title may be cited as
the ``Title VIII Nursing Workforce Reauthorization Act of
2019'' and lists a table of contents.
Section 2. General provisions
Section 2 states general provisions. These include an
amendment to general application language which would require
that all applications submitted for grants under Title VIII
programs ``shall address relevant national nursing needs that
the project will address and how the project aligns with . . .
national nursing service goals.'' Additionally, there is a
requirement that funds awarded for grants under Title VIII
should only be used to supplement, not supplant non-Federal
funds otherwise available for projects. Furthermore, this
section requires the Secretary to annually evaluate programs
and projects operated by grantees and would require an annual
report on nursing workforce programs.
Section 3. Nurse practitioners, nurse midwives, nurse anesthetists, and
other advanced education nurses
Section 3 makes technical changes to Advance Nursing
Education Programs and includes authorized clinical nurse
specialist programs as an eligible program for support. Section
3 provides an annual authorization of $77,585,000 for Advanced
Nursing Education Programs each fiscal year 2020 through 2024.
Section 4. Increasing nursing workforce diversity
Section 4 provides an annual authorization of $18,037,000
each fiscal year 2020 through 2024 for the Nursing Workforce
Diversity Program.
Section 5. Strengthening capacity for basic nurse education and
practice
Section 5 incorporates existing nurse retention programs,
including career ladder programs, into the same section of the
PHSA which provides nurse education, practice, and quality
grants.\16\ Section 5 provides an annual authorization of
$43,590,000 each fiscal year 2020 through 2024 for nurse
education, practice, quality, and retention grants.
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\16\42 U.S.C. 296p.
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Section 6. Student loans
Section 6 provides annual authorizations of $90,620,000 for
the Nurse Corps student loan repayment and scholarship program
and $29,640,000 for the nurse faculty loan repayment program.
Authorizations would be for each fiscal year 2020 through 2024.
This section also makes technical changes within the Nurse
Corps program.
Section 7. National Advisory Council on Nurse Education and Practice
Section 7 ensures clinical nurse specialists may be
included on the National Advisory Council on Nurse Education
and Practice and requires the National Advisory Council to
issue a report on its activities every two years.
Section 8. Other provisions
Section 8 repeals the requirement that the Secretary
develop and issue public service announcements that advertise
and promote the nursing profession and makes a technical change
to reflect specific authorizations made for each program under
Title VIII. This section also ensures that Nurse Corps members
may serve in a wider variety of health care settings.
XVI. Changes in Existing Law Made by the Bill, as Reported
In compliance with clause 3(e) of rule XIII of the Rules of
the House of Representatives, changes in existing law made by
the bill, as reported, are shown as follows (existing law
proposed to be omitted is enclosed in black brackets, new
matter is printed in italic, and existing law in which no
change is proposed is shown in roman):
PUBLIC HEALTH SERVICE ACT
* * * * * * *
TITLE VIII--NURSING WORKFORCE DEVELOPMENT
PART A--GENERAL PROVISIONS
* * * * * * *
SEC. 802. APPLICATION.
(a) In General.--To be eligible to receive a grant or
contract under this title, an eligible entity shall prepare and
submit to the Secretary an application that meets the
requirements of this section, at such time, in such manner, and
containing such information as the Secretary may require.
(b) Plan.--An application submitted under this section shall
contain the plan of the applicant for carrying out a project
with amounts received under this title. Such plan shall be
consistent with relevant Federal, State, or regional program
plans.
(c) Performance Outcome Standards.--An application submitted
under this section shall contain a specification by the
applicant entity of performance outcome standards that the
project to be funded under the grant or contract will be
measured against. Such standards [shall address relevant
national nursing needs that the project will meet] 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). The recipient of a
grant or contract under this section shall meet the standards
set forth in the grant or contract application.
(d) Linkages.--An application submitted under this section
shall contain a description of the linkages with relevant
educational and health care entities, including training
programs for other health professionals as appropriate, that
the project to be funded under the grant or contract will
establish.
SEC. 803. USE OF FUNDS.
(a) In General.--Amounts provided under a grant or contract
awarded under this title may be used for training program
development and support, faculty development, model
demonstrations, trainee support including tuition, books,
program fees and reasonable living expenses during the period
of training, technical assistance, workforce analysis, and
dissemination of information, as appropriate to meet recognized
nursing objectives, in accordance with this title.
(b) Maintenance of Effort.--With respect to activities for
which a grant awarded under this title is to be expended, the
entity shall agree to maintain expenditures of non-Federal
amounts for such activities at a level that is not less than
the level of such expenditures maintained by the entity for the
fiscal year preceding the fiscal year for which the entity
receives such a grant.
(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.
* * * * * * *
SEC. 806. GENERALLY APPLICABLE PROVISIONS.
(a) Awarding of Grants and Contracts.--The Secretary shall
ensure that grants and contracts under this title are awarded
on a competitive basis, as appropriate, to carry out innovative
demonstration projects or provide for strategic workforce
supplementation activities as needed to meet national nursing
service goals and in accordance with this title. Contracts may
be entered into under this title with public or private
entities as determined necessary by the Secretary.
(b) Information Requirements.--
(1) In general.--Recipients of grants and contracts
under this title shall meet information requirements as
specified by the Secretary.
[(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 a demonstration that satisfactory
progress has been made by the program or project in
meeting the objectives of the program or project.]
(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.
(c) Training Programs.--Training programs conducted with
amounts received under this title shall meet applicable
accreditation and quality standards.
(d) Duration of Assistance.--
(1) In general.--Subject to paragraph (2), in the
case of an award to an entity of a grant, cooperative
agreement, or contract under this title, the period
during which payments are made to the entity under the
award may not exceed 5 years. The provision of payments
under the award shall be subject to annual approval by
the Secretary of the payments and subject to the
availability of appropriations for the fiscal year
involved to make the payments. This paragraph may not
be construed as limiting the number of awards under the
program involved that may be made to the entity.
(2) Limitation.--In the case of an award to an entity
of a grant, cooperative agreement, or contract under
this title, paragraph (1) shall apply only to the
extent not inconsistent with any other provision of
this title that relates to the period during which
payments may be made under the award.
(e) Peer Review Regarding Certain Programs.--
(1) In general.--Each application for a grant under
this title, except advanced nurse traineeship grants
under section 811(a)(2), shall be submitted to a peer
review group for an evaluation of the merits of the
proposals made in the application. The Secretary may
not approve such an application unless a peer review
group has recommended the application for approval.
(2) Composition.--Each peer review group under this
subsection shall be composed principally of individuals
who are not officers or employees of the Federal
Government, and have relevant expertise and experience
. In providing for the establishment of peer review
groups and procedures, the Secretary shall, except as
otherwise provided, ensure sex, racial, ethnic, and
geographic representation among the membership of such
groups.
(3) Administration.--This subsection shall be carried
out by the Secretary acting through the Administrator
of the Health Resources and Services Administration.
(f) Analytic Activities.--The Secretary shall ensure that--
(1) cross-cutting workforce analytical activities are
carried out as part of the workforce information and
analysis activities under this title; and
(2) discipline-specific workforce information is
developed and analytical activities are carried out as
part of--
(A) the advanced education nursing activities
under part B;
(B) the workforce diversity activities under
part C; and
(C) basic nursing education and practice
activities under part D.
(g) State and Regional Priorities.--Activities under grants
or contracts under this title shall, to the extent practicable,
be consistent with related Federal, State, or regional nursing
professions program plans and priorities.
(h) Filing of Applications.--
(1) In general.--Applications for grants or contracts
under this title may be submitted by health professions
schools, schools of nursing, academic health centers,
State or local governments, or other appropriate public
or private nonprofit entities as determined appropriate
by the Secretary in accordance with this title.
(2) For-profit entities.--Notwithstanding paragraph
(1), a for-profit entity may be eligible for a grant or
contract under this title as determined appropriate by
the Secretary.
(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.
* * * * * * *
PART B--NURSE PRACTITIONERS, NURSE MIDWIVES, NURSE ANESTHETISTS, AND
OTHER ADVANCED EDUCATION NURSES
SEC. 811. ADVANCED EDUCATION NURSING GRANTS.
(a) In General.--The Secretary may award grants to and enter
into contracts with eligible entities to meet the costs of--
(1) projects that support the enhancement of advanced
nursing education and practice; and
(2) traineeships for individuals in advanced nursing
education programs.
(b) Definition of Advanced Education Nurses.--For purposes of
this section, the term ``advanced education nurses'' means
individuals trained in advanced degree programs including
individuals in combined [R.N./Master's] R.N./graduate degree
programs, post-nursing master's certificate programs, or, in
the case of nurse midwives, in certificate programs in
existence on the date that is one day prior to the date of
enactment of this section, to serve as nurse practitioners,
clinical nurse specialists, nurse midwives, nurse anesthetists,
nurse educators, nurse administrators, clinical nurse leaders,
or public health nurses, or in other nurse specialties
determined by the Secretary to require advanced education.
(c) Authorized Nurse Practitioner.--Nurse practitioner
programs eligible for support under this section are
educational programs for registered nurses (irrespective of the
type of school of nursing in which the nurses received their
training) that--
(1) meet guidelines prescribed by the Secretary; and
(2) have as their objective the education of nurses
who will upon completion of their studies in such
programs, be qualified to effectively provide primary
health care, including primary health care in homes and
in ambulatory care facilities, long-term care
facilities, acute care, and other health care settings.
(d) Authorized Nurse-midwifery Programs.--Midwifery programs
that are eligible for support under this section are
educational programs that--
(1) have as their objective the education of
midwives; and
(2) are accredited by the American College of Nurse-
Midwives Accreditation Commission for Midwifery
Education.
(e) Authorized Nurse Anesthesia Programs.--Nurse anesthesia
programs eligible for support under this section are education
programs that--
(1) provide registered nurses with full-time
anesthetist education; and
(2) are accredited by the Council on Accreditation of
Nurse Anesthesia Educational Programs.
(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.
[(f)] (g) Other Authorized Educational Programs.--The
Secretary shall prescribe guidelines as appropriate for other
advanced nurse education programs eligible for support under
this section.
[(g)] (h) Traineeships.--
(1) In general.--The Secretary may not award a grant
to an applicant under subsection (a) unless the
applicant involved agrees that traineeships provided
with the grant will only pay all or part of the costs
of--
(A) the tuition, books, and fees of the
program of advanced nurse education with
respect to which the traineeship is provided;
and
(B) the reasonable living expenses of the
individual during the period for which the
traineeship is provided.
(2) Special consideration.--In making awards of
grants and contracts under subsection (a)(2), the
Secretary shall give special consideration to an
eligible entity that agrees to expend the award to
train advanced education nurses who will practice in
health professional shortage areas designated under
section 332.
(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.
PART C--INCREASING NURSING WORKFORCE DIVERSITY
SEC. 821. WORKFORCE DIVERSITY GRANTS.
(a) In General.--
(1) Authority.--The Secretary may award grants to and
enter into contracts with eligible entities to meet the
costs of special projects to increase nursing education
opportunities for individuals who are from
disadvantaged backgrounds (including racial and ethnic
minorities underrepresented among registered nurses) by
providing student scholarships or stipends, stipends
for diploma or associate degree nurses to enter a
bridge or degree completion program, student
scholarships or stipends for accelerated nursing degree
programs, pre-entry preparation, advanced education
preparation, and retention activities.
(b) Guidance.--In carrying out subsection (a), the Secretary
shall take into consideration the recommendations of the
National Advisory Council on Nurse Education and Practice and
consult with nursing associations including the National
Coalition of Ethnic Minority Nurse Associations, American
Nurses Association, the National League for Nursing, the
American Association of Colleges of Nursing, the National Black
Nurses Association, the National Association of Hispanic
Nurses, the Association of Asian American and Pacific Islander
Nurses, the Native American Indian and Alaskan Nurses
Association, and the National Council of State Boards of
Nursing, and other organizations determined appropriate by the
Secretary.
(c) Required Information and Conditions for Award
Recipients.--
(1) In general.--Recipients of awards under this
section may be required, where requested, to report to
the Secretary concerning the annual admission,
retention, and graduation rates for individuals from
disadvantaged backgrounds and ethnic and racial
minorities in the school or schools involved in the
projects.
(2) Falling rates.--If any of the rates reported
under paragraph (1) fall below the average of the two
previous years, the grant or contract recipient shall
provide the Secretary with plans for immediately
improving such rates.
(3) Ineligibility.--A recipient described in
paragraph (2) shall be ineligible for continued funding
under this section if the plan of the recipient fails
to improve the rates within the 1-year period beginning
on the date such plan is implemented.
(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.
PART D--STRENGTHENING CAPACITY FOR BASIC NURSE EDUCATION AND PRACTICE
SEC. 831. NURSE EDUCATION, PRACTICE, [AND QUALITY] QUALITY, 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; or
(2) 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;]
(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) providing coordinated care, 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.]
(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.
(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 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)] (e) Report.-- [The Secretary shall submit to the
Congress before the end of each fiscal year a] As part of the
report on nursing workforce programs described in section
806(i), the Secretary shall 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, as defined in
section 801(2),, a health care facility, or a partnership of
such a school and facility.]
(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.
[(h)] (g) 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 2010 through
2014] $43,590,000 for each of fiscal years 2020 through 2024.
[SEC. 831A. NURSE RETENTION GRANTS.
[(a) 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 subsection (b) or (c).
[(b) Grants for Career Ladder Program.--The Secretary may
award grants to, and enter into contracts with, eligible
entities for programs--
[(1) to promote career advancement for individuals
including licensed practical nurses, licensed
vocational nurses, certified nurse assistants, home
health aides, diploma degree or associate degree
nurses, to become baccalaureate prepared registered
nurses or advanced education nurses in order to meet
the needs of the registered nurse workforce;
[(2) developing and implementing internships and
residency programs in collaboration with an accredited
school of nursing, as defined by section 801(2), to
encourage mentoring and the development of specialties;
or
[(3) to assist individuals in obtaining education and
training required to enter the nursing profession and
advance within such profession.
[(c) Enhancing Patient Care Delivery Systems.--
[(1) 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 decision-making
processes of a health care facility.
[(2) Priority.--In making awards of grants under this
subsection, the Secretary shall give preference to
applicants that have not previously received an award
under this subsection (or section 831(c) as such
section existed on the day before the date of enactment
of this section).
[(3) Continuation of an award.--The Secretary shall
make continuation of any award under this subsection
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 retention, as
determined by the Secretary.
[(e) 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.
[(f) Eligible Entity.--For purposes of this section, the term
``eligible entity'' includes an accredited school of nursing,
as defined by section 801(2), a health care facility, or a
partnership of such a school and facility.
[(g) 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 2010 through 2012.]
PART E--STUDENT LOANS
* * * * * * *
loan repayment and scholarship programs
Sec. 846. (a) In General.--In the case of any individual--
(1) who has received a baccalaureate or associate
degree in nursing (or an equivalent degree), a diploma
in nursing, or a graduate degree in nursing;
(2) who obtained (A) one or more loans from a loan
fund established under subpart II, or (B) any other
educational loan for nurse training costs; and
(3) who enters into an agreement with the Secretary
to serve as nurse for a period of not less than two
years at a health care facility with a critical
shortage of nurses, or in a accredited school of
nursing, as defined by section 801(2), as nurse
faculty;
the Secretary shall make payments in accordance with subsection
(b), for and on behalf of that individual, on the principal of
and interest on any loan of that individual described in
paragraph (2) of this subsection which is outstanding on the
date the individual begins the service specified in the
agreement described in paragraph (3) of this subsection. [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) Manner of Payments.--The payments described in subsection
(a) shall be made by the Secretary as follows:
(1) Upon completion by the individual for whom the
payments are to be made of the first year of the
service specified in the agreement entered into with
the Secretary under subsection (a), the Secretary shall
pay 30 percent of the principal of, and the interest on
each loan of such individual described in subsection
(a)(2) which is outstanding on the date [he began such
practice] the individual began such practice.
(2) Upon completion by that individual of the second
year of such service, the Secretary shall pay another
30 percent of the principal of, and the interest on
each such loan.
(3) Upon completion by that individual of a third
year of such service, the Secretary shall pay another
25 percent of the principal of, and the interest on
each such loan.
(c) Payment by Due Date.--Notwithstanding the requirement of
completion of practice specified in subsection (b), the
Secretary shall, on or before the due date thereof, pay any
loan or loan installment which may fall due within the period
of service for which the borrower may receive payments under
this subsection, upon the declaration of such borrower, at such
times and in such manner as the Secretary may prescribe (and
supported by such other evidence as the Secretary may
reasonably require), that the borrower is then serving as
described by subsection (a)(3), and that the borrower will
continue to so serve for the period required (in the absence of
this subsection) to entitle the borrower to have made the
payments provided by this subsection for such period; except
that not more than 85 percent of the principal of any such loan
shall be paid pursuant to this 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.
(e) Preferences Regarding Participants.--In entering into
agreements under subsection (a) or (d), the Secretary shall
give preference to qualified applicants with the greatest
financial need.
(f) Breach of Agreement.--The Secretary may make payments
under subsection (a) on behalf of an individual only if the
agreement under such subsection provides that section 860(c) is
applicable to the individual.
(g) Breach of Agreement.--
(1) In general.--In the case of any program under
this section under which an individual makes an
agreement to provide health services for a period of
time in accordance with such program in consideration
of receiving an award of Federal funds regarding
education as a nurse (including an award for the
repayment of loans), the following applies if the
agreement provides that this subsection is applicable:
(A) In the case of a program under this
section that makes an award of Federal funds
for attending an accredited program of nursing
(in this section referred to as a ``nursing
program''), the individual is liable to the
Federal Government for the amount of such award
(including amounts provided for expenses
related to such attendance), and for interest
on such amount at the maximum legal prevailing
rate, if the individual--
(i) fails to maintain an acceptable
level of academic standing in the
nursing program (as indicated by the
program in accordance with requirements
established by the Secretary);
(ii) is dismissed from the nursing
program for disciplinary reasons; or
(iii) voluntarily terminates the
nursing program.
(B) The individual is liable to the Federal
Government for the amount of such award
(including amounts provided for expenses
related to such attendance), and for interest
on such amount at the maximum legal prevailing
rate, if the individual fails to provide health
services in accordance with the program under
this section for the period of time applicable
under the program.
(2) Waiver or suspension of liability.--In the case
of an individual or health facility making an agreement
for purposes of paragraph (1), the Secretary shall
provide for the waiver or suspension of liability under
such subsection if compliance by the individual or the
health facility, as the case may be, with the
agreements involved is impossible, or would involve
extreme hardship to the individual or facility, and if
enforcement of the agreements with respect to the
individual or facility would be unconscionable.
(3) Date certain for recovery.--Subject to paragraph
(2), any amount that the Federal Government is entitled
to recover under paragraph (1) shall be paid to the
United States not later than the expiration of the 3-
year period beginning on the date the United States
becomes so entitled.
(4) Availability.--Amounts recovered under paragraph
(1) with respect to a program under this section shall
be available for the purposes of such program, and
shall remain available for such purposes until
expended.
(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] 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--
(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.
(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] $90,620,000 for each of
fiscal years 2020 through 2024.
(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).
nurse faculty loan program
Sec. 846A. (a) School of Nursing Student Loan Fund.--The
Secretary, acting through the Administrator of the Health
Resources and Services Administration, may enter into an
agreement with any accredited 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 $35,500, during
fiscal years 2010 and 2011 fiscal years (after fiscal
year 2011, such amounts shall be adjusted to provide
for a cost-of-attendance increase for the yearly loan
rate and the aggregate loan;
(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 an accredited 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 an
accredited 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 2010 through 2014]
$29,640,000 for each of fiscal years 2020 through 2024 .
* * * * * * *
PART F--NATIONAL ADVISORY COUNCIL ON NURSE EDUCATION AND PRACTICE
SEC. 851. NATIONAL ADVISORY COUNCIL ON NURSE EDUCATION AND PRACTICE.
(a) Establishment.--The Secretary shall establish an advisory
council to be known as the National Advisory Council on Nurse
Education and Practice (in this section referred to as the
``Advisory Council'').
(b) Composition.--
(1) In general.--The Advisory Council shall be
composed of--
(A) not less than 21, nor more than 23
individuals, who are not officers or employees
of the Federal Government, appointed by the
Secretary without regard to the Federal civil
service laws, of which--
(i) 2 shall be selected from full-
time students enrolled in schools of
nursing;
(ii) 2 shall be selected from the
general public;
(iii) 2 shall be selected from
practicing professional nurses; and
(iv) 9 shall be selected from among
the leading authorities in the various
fields of nursing, higher, secondary
education, and associate degree schools
of nursing, and from representatives of
advanced education nursing groups (such
as nurse practitioners, nurse midwives,
[and nurse anesthetists] nurse
anesthetists, and clinical nurse
specialists ), hospitals, and other
institutions and organizations which
provide nursing services; and
(B) the Secretary (or the delegate of the
Secretary (who shall be an ex officio member
and shall serve as the Chairperson)).
(2) Appointment.--Not later than 90 days after the
date of enactment of this Act, the Secretary shall
appoint the members of the Advisory Council and each
such member shall serve a 4 year term. In making such
appointments, the Secretary shall ensure a fair balance
between the nursing professions, a broad geographic
representation of members and a balance between urban
and rural members. Members shall be appointed based on
their competence, interest, and knowledge of the
mission of the profession involved. A majority of the
members shall be nurses.
(3) Minority representation.--In appointing the
members of the Advisory Council under paragraph (1),
the Secretary shall ensure the adequate representation
of minorities.
(c) Vacancies.--
(1) In general.--A vacancy on the Advisory Council
shall be filled in the manner in which the original
appointment was made and shall be subject to any
conditions which applied with respect to the original
appointment.
(2) Filling unexpired term.--An individual chosen to
fill a vacancy shall be appointed for the unexpired
term of the member replaced.
(d) Duties.--The Advisory Council shall--
(1) provide advice and recommendations to the
Secretary and Congress concerning policy matters
arising in the administration of this title, including
the range of issues relating to the nurse workforce,
education, and practice improvement;
(2) provide advice to the Secretary and Congress in
the preparation of general regulations and with respect
to policy matters arising in the administration of this
title, including the range of issues relating to nurse
supply, education and practice improvement; and
[(3) not later than 3 years after the date of
enactment of this section, and annually thereafter,
prepare and submit to the Secretary, the Committee on
Labor and Human Resources of the Senate, and the
Committee on 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.]
(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.
(e) Meetings and Documents.--
(1) Meetings.--The Advisory Council shall meet not
less than 2 times each year. Such meetings shall be
held jointly with other related entities established
under this title where appropriate.
(2) Documents.--Not later than 14 days prior to the
convening of a meeting under paragraph (1), the
Advisory Council shall prepare and make available an
agenda of the matters to be considered by the Advisory
Council at such meeting. At any such meeting, the
Advisory Council shall distribute materials with
respect to the issues to be addressed at the meeting.
Not later than 30 days after the adjourning of such a
meeting, the Advisory Council shall prepare and make
available a summary of the meeting and any actions
taken by the Council based upon the meeting.
(f) Compensation and Expenses.--
(1) Compensation.--Each member of the Advisory
Council shall be compensated at a rate equal to the
daily equivalent of the annual rate of basic pay
prescribed for level IV of the Executive Schedule under
section 5315 of title 5, United States Code, for each
day (including travel time) during which such member is
engaged in the performance of the duties of the
Council. All members of the Council who are officers or
employees of the United States shall serve without
compensation in addition to that received for their
services as officers or employees of the United States.
(2) Expenses.--The members of the Advisory Council
shall be allowed travel expenses, including per diem in
lieu of subsistence, at rates authorized for employees
of agencies under subchapter I of chapter 57 of title
5, United States Code, while away from their homes or
regular places of business in the performance of
services for the Council.
(g) Funding.--Amounts appropriated [under this title] for
carrying out parts B, C, and D of this title may be utilized by
the Secretary to support the nurse education and practice
activities of the Council.
(h) FACA.--The Federal Advisory Committee Act shall apply to
the Advisory Committee under this section only to the extent
that the provisions of such Act do not conflict with the
requirements of this section.
[PART G--PUBLIC SERVICE ANNOUNCEMENTS
[SEC. 861. 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. 862. 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;
[(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.]
* * * * * * *
[PART I--FUNDING
[SEC. 871. AUTHORIZATION OF APPROPRIATIONS.
[For the purpose of carrying out parts B, C, and D (subject
to section 851(g)), there are authorized to be appropriated
$338,000,000 for fiscal year 2010, and such sums as may be
necessary for each of the fiscal years 2011 through 2016.]
* * * * * * *
[all]