[107th Congress Public Law 205]
[From the U.S. Government Printing Office]


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[DOCID: f:publ205.107]


[[Page 116 STAT. 811]]

Public Law 107-205
107th Congress

                                 An Act


 
     To amend the Public Health Service Act with respect to health 
          professions programs regarding the field of nursing.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress <<NOTE: Nurse Reinvestment 
Act.>> assembled,

SECTION 1. <<NOTE: 42 USC 201 note.>> 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.

[[Page 116 STAT. 812]]

            ``(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 <<NOTE: 42 USC 297w.>> 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 <<NOTE: 42 USC 
            297x.>> 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.''.

[[Page 116 STAT. 813]]

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) <<NOTE: Contracts.>> 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

[[Page 116 STAT. 814]]

        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) <<NOTE: Deadline.>>  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).''.

[[Page 116 STAT. 815]]

                        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

[[Page 116 STAT. 816]]

                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) <<NOTE: Deadline.>>  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 <<NOTE: Grants. 42 USC 298.>> 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.

[[Page 116 STAT. 817]]

    ``(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

[[Page 116 STAT. 818]]

        (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

[[Page 116 STAT. 819]]

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.

    Approved August 1, 2002.

LEGISLATIVE HISTORY--H.R. 3487:
---------------------------------------------------------------------------

CONGRESSIONAL RECORD:
                                                        Vol. 147 (2001):
                                    Dec. 19, 20, considered and passed 
                                        House.
                                                        Vol. 148 (2002):
                                    July 22, considered and passed 
                                        Senate, amended. House concurred 
                                        in Senate amendment.

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