SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Student-to-School Nurse Ratio 
Improvement Act of 2013''.

SEC. 2. FINDINGS.

    The Congress finds the following:
            (1) The American Academy of Pediatrics emphasizes the 
        crucial role of school nurses in the seamless provision of 
        comprehensive health services to children and youth, as well as 
        in the development of a coordinated school health program.
            (2) The school nurse functions as a leader and the 
        coordinator of the school health services team, facilitating 
        access to a medical home for each child and supporting academic 
        achievement.
            (3) School nurses promote wellness and disease prevention 
        to improve health outcomes for our Nation's children. In 
        addition, school nurses perform early intervention services 
        such as periodic assessments for vision, hearing, and dental 
        problems, in an effort to remove barriers to learning.
            (4) Recent national data indicates 45 percent of public 
        schools have a school nurse all day, every day, while another 
        30 percent of schools have a school nurse who works part time 
        in one or more schools.
            (5) The American Nurses Association has reported that when 
        there is no registered nurse on the school premises, the 
        responsibility to administer the necessary medications and 
        treatments, and appropriate monitoring of the children falls on 
        the shoulders of administrators, educators, and staff who are 
        ill-prepared to perform these tasks.
            (6) Statistics from the National Center for Educational 
        Statistics indicate that of the 52,000,000 students who 
        currently spend their day in schools, 15 to 18 percent of 
        children and adolescents have a chronic health condition.
            (7) A recent study indicated that from 2002 to 2008, the 
        percentage of children in special education with health 
        impairments, due to chronic or acute health problems, increased 
        60 percent. School nurses use their specialized knowledge, 
        assessment skills, and judgment to manage children's 
        increasingly complex medical conditions and chronic health 
        illnesses.
            (8) Among adolescents aged 12 to 19 years old, the 
        prevalence of pre-diabetes and diabetes increased from 9 
        percent to 23 percent between 1999 and 2008. More than 30 
        percent of children aged 2 to 19 years old are obese or 
        overweight (&gt;85th percentile). In 2008, more than 10 million 
        children in the United States had asthma. The prevalence of 
        food allergies among children under the age of 18 increased 19 
        percent from 1997 to 2007.
            (9) According to the American Academy of Pediatrics, 
        students today face increased social and emotional issues, 
        which enhance the need for preventive services and 
        interventions for acute and chronic health issues. School 
        nurses are actively engaged members of school-based mental 
        health teams and spend nearly 32 percent of their time 
        providing mental health services, including universal and 
        targeted interventions, screenings to identify early warning 
        signs and referrals to medical providers, and crisis planning.
            (10) In 2011, the Bureau of the Census reported 9.7 percent 
        of children under the age of 19, which equals 7.6 million 
        children under the age of 19, were without health insurance. 
        Data shows that uninsured children achieve lower educational 
        outcomes than those with health coverage. Children who cannot 
        afford to see a medical provider miss more days of school, 
        experience increased severity of illness, and suffer from 
        disparities in health.
            (11) More than 1.6 million children experience homelessness 
        each year in the United States. Homeless children develop 
        increased rates of acute and chronic health conditions, and the 
        stress of their living situation can negatively affect their 
        development and ability to learn. As a result, schools have 
        become the primary access to health care for many children and 
        adolescents. School nurses serve on the frontlines as a safety 
        net for the Nation's most vulnerable children.
            (12) Communicable and infectious diseases account for 
        millions of school days lost each year. Data illustrate that 
        when students have access to a registered nurse in school, 
        immunization rates increase.
            (13) A 2011 study showed that a school nurse in the 
        building saves principals, teachers, and clerical staff a 
        considerable amount of time that they would have spent 
        addressing health concerns of students, including saving 
        principals almost an hour a day; saving teachers almost 20 
        minutes a day; and saving clerical staff more than 45 minutes a 
        day. This would amount to a savings of about 13 hours per day 
        in the aggregate for such school personnel.
            (14) Using a formula-based approach, taking into 
        consideration the overall health acuity of the student body and 
        the workload of school nurses, for determining a balanced 
        student-to-school nurse ratio offers a reasonable means for 
        achieving better student outcomes.

SEC. 3. REDUCING STUDENT-TO-SCHOOL NURSE RATIOS.

    (a) Demonstration Grants.--
            (1) In general.--The Secretary of Education, in 
        consultation with the Secretary of Health and Human Services 
        and the Director of the Centers for Disease Control and 
        Prevention, may make demonstration grants to eligible local 
        educational agencies for the purpose of reducing the student-
        to-school nurse ratio in public elementary schools and 
        secondary schools.
            (2) Application.--To receive a grant under this section, an 
        eligible local educational agency shall submit to the Secretary 
        of Education an application at such time, in such manner, and 
        containing such information as the Secretary may require, which 
        shall include information with respect to the current ratios of 
        students-to-school nurses, student health acuity levels, and 
        workloads of school nurses in each of the public elementary 
        schools and secondary schools served by the agency.
            (3) Priority.--In awarding grants under this section, the 
        Secretary of Education shall give priority to applications 
        submitted by high-need local educational agencies that 
        demonstrate the greatest need for new or additional nursing 
        services among students in the public elementary secondary and 
        secondary schools served by the agency.
            (4) Matching funds.--The Secretary of Education may require 
        recipients of grants under this section to provide matching 
        funds from non-Federal sources, and shall permit the recipients 
        to match funds in whole or in part with in-kind contributions.
    (b) Report.--Not later than 24 months after the date on which a 
grant is first made to a local educational agency under this section, 
the Secretary of Education shall submit to the Congress a report on the 
results of the demonstration grant program carried out under this 
section, including an evaluation--
            (1) of the effectiveness of the program in reducing the 
        student-to-school nurse ratios described in subsection (a)(1); 
        and
            (2) of the impact of any resulting enhanced health of 
        students on learning, such as academic achievement, attendance, 
        and classroom time.
    (c) Definitions.--For purposes of this section:
            (1) ESEA terms.--The terms ``elementary school'', ``local 
        educational agency'', ``poverty line'', and ``secondary 
        school'' have the meanings given to those terms in section 9101 
        of the Elementary and Secondary Education Act of 1965 (20 
        U.S.C. 7801).
            (2) Acuity.--The term ``acuity'', when used with respect to 
        a level, means the level of a patient's sickness, such as a 
        chronic condition, which influences the need for nursing care.
            (3) Workload.--The term ``workload'', when used with 
        respect to a nurse, means the amount of time the nurse takes to 
        provide care and complete the other tasks for which the nurse 
        may be responsible.
            (4) Eligible local educational agency.--The term ``eligible 
        local educational agency'' means a local educational agency in 
        which the student-to-school nurse ratio in each public 
        elementary and secondary school served by the agency is 750 or 
        more students to 1 school nurse.
            (5) High-need local educational agency.--The term ``high-
        need local educational agency'' means a local educational 
        agency--
                    (A) that serves not fewer than 10,000 children from 
                families with incomes below the poverty line; or
                    (B) for which not less than 20 percent of the 
                children served by the agency are from families with 
                incomes below the poverty line.
            (6) Nurse.--The term ``nurse'' means a licensed nurse, as 
        defined under State law.
    (d) Authorization of Appropriations.--There are authorized to be 
appropriated such sums as may be necessary to carry out this section 
for each of the fiscal years 2014 through 2018.
Student-to-School Nurse Ratio Improvement Act of 2013 - Authorizes the Secretary of Education to make matching demonstration grants to local educational agencies (LEAs) in which the student-to-school nurse ratio in each of their public elementary and secondary schools is 750 or more students to every school nurse for the purpose of reducing such ratio. Gives grant priority to LEAs: (1) for which not fewer than 10,000 or not less than 20% of the children served are from families with incomes below the poverty line, and (2) that demonstrate the greatest need for new or additional nursing services for their students.
Student-to-School Nurse Ratio Improvement Act of 2013