69–006 

114TH CONGRESS REPORT " ! HOUSE OF REPRESENTATIVES 2d Session 114–803 

TITLE VIII NURSING WORKFORCE REAUTHORIZATION 

ACT OF 2016 

NOVEMBER 14, 2016.—Committed to the Committee of the Whole House on the 

State of the Union and ordered to be printed 

Mr. UPTON, from the Committee on Energy and Commerce, 

submitted the following 

R E P O R T 

[To accompany H.R. 2713] 

The Committee on Energy and Commerce, to whom was referred 

the bill (H.R. 2713) 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 

Purpose and Summary ............................................................................................ 2 

Background and Need for Legislation .................................................................... 2 

Hearings ................................................................................................................... 3 

Committee Consideration ........................................................................................ 3 

Committee Votes ...................................................................................................... 3 

Committee Oversight Findings ............................................................................... 3 

Statement of General Performance Goals and Objectives .................................... 3 

New Budget Authority, Entitlement Authority, and Tax Expenditures ............. 4 

Earmark, Limited Tax Benefits, and Limited Tariff Benefits ............................. 4 

Committee Cost Estimate ....................................................................................... 4 

Congressional Budget Office Estimate ................................................................... 4 

Federal Mandates Statement ................................................................................. 4 

Duplication of Federal Programs ............................................................................ 4 

Disclosure of Directed Rule Makings ..................................................................... 4 

Advisory Committee Statement .............................................................................. 4 

Applicability to Legislative Branch ........................................................................ 5 

Section-by-Section Analysis of the Legislation ...................................................... 5 

Changes in Existing Law Made by the Bill, as Reported ..................................... 5 

The amendment is as follows: 

Strike all after the enacting clause and insert the following: 


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SECTION 1. SHORT TITLE. 

This Act may be cited as the ‘‘Title VIII Nursing Workforce Reauthorization Act 

of 2016’’. 

SEC. 2. SUPPORTING CLINICAL NURSE SPECIALISTS. 

(a) ADVANCED EDUCATION NURSING GRANTS.—Section 811 of the Public Health 

Service Act (42 U.S.C. 296j) is amended— 

(1) in subsection (b), by inserting ‘‘clinical nurse leaders,’’ before ‘‘or public 

health nurses’’; 

(2) by redesignating subsections (f) and (g) as subsections (g) and (h), respectively; and 

(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 to inpatients and outpatients experiencing acute and chronic illness.’’. 

(b) DEFINITION OF NURSE-MANAGED HEALTH CLINIC.—Section 801 of the Public 

Health Service Act (42 U.S.C. 296) is amended by adding at the end the following: 

‘‘(18) NURSE-MANAGED HEALTH CLINIC.—The term ‘nurse-managed health clinic’ has the meaning given to such term in section 330A–1.’’. 

(c) NATIONAL ADVISORY COUNCIL ON NURSE EDUCATION AND PRACTICE.—Section 

851(b)(1)(A)(iv) of the Public Health Service Act (42 U.S.C. 297t(b)(1)(A)(iv)) is 

amended by striking ‘‘and nurse anesthetists’’ and inserting ‘‘nurse anesthetists, and 

clinical nurse specialists’’. 

SEC. 3. REAUTHORIZATION OF FUNDING FOR NURSING PROGRAMS. 

(a) IN GENERAL.—Title VIII of the Public Health Service Act (42 U.S.C. 296 et 

seq.) is amended— 

(1) in subsection (i)(1) of section 846 (42 U.S.C. 297n; loan repayment and 

scholarship programs), by striking ‘‘such sums as may be necessary for each of 

fiscal years 2003 through 2007’’ and inserting ‘‘$83,135,000 for each of fiscal 

years 2017 through 2021’’; 

(2) in subsection (f) of section 846A (42 U.S.C. 297n–1; nurse faculty loan program), by striking ‘‘such sums as may be necessary for each of fiscal years 2010 

through 2014’’ and inserting ‘‘$26,500,000 for each of fiscal years 2017 through 

2021’’; 

(3) in subsection (e) of section 865 (42 U.S.C. 298; comprehensive geriatric 

education), by striking ‘‘such sums as may be necessary for each of fiscal years 

2010 through 2014’’ and inserting ‘‘$38,737,000 for each of fiscal years 2017 

through 2021’’; and 

(4) in section 871 (42 U.S.C. 298d; funding for carrying out parts B, C, and 

D), by striking ‘‘$338,000,000 for fiscal year 2010, and such sums as may be 

necessary for each of the fiscal years 2011 through 2016’’ and inserting 

‘‘$119,837,000 for each of fiscal years 2017 through 2021’’. 

(b) CONFORMING CHANGES.— 

(1) Section 831 of the Public Health Service Act (42 U.S.C. 296p) is amended— 

(A) in subsection (g), by striking ‘‘,,’’ and inserting ‘‘,’’; and 

(B) by striking subsection (h). 

(2) Section 831A of the Public Health Service Act (42 U.S.C. 296p–1) is 

amended by striking subsection (g). 

PURPOSE AND SUMMARY

H.R. 2713 was introduced on June 10, 2015, by Rep. Lois Capps 

(D–CA) and Rep. David Joyce (R–OH). H.R. 2713 supports advanced education nursing grants and specifically reauthorizes loan 

repayment and scholarship programs, a nurse faculty loan program, and a comprehensive geriatric education program. 

BACKGROUND AND NEED FOR LEGISLATION

The nursing workforce plays a critical role in ensuring that all 

Americans get the health care services they need. For example, 

they care for patients in hospitals and serve as primary care proVerDate Sep 11 2014 05:24 Nov 17, 2016 Jkt 069006 PO 00000 Frm 00002 Fmt 6659 Sfmt 6602 E:\HR\OC\HR803.XXX HR803

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viders in health care clinics. Additionally, nursing continues to 

evolve to include new roles and functions. In recent years, advanced practice registered nurses have begun serving as clinical 

nurse specialists in addition to serving as nurse practitioners, 

nurse midwives, and nurse anesthetists. Despite their importance 

to the health care system, there are projected shortages that will 

leave too many patients without the nursing care services that they 

need. H.R. 2713 will help to increase and strengthen the nursing 

workforce in order to keep pace with the evolving roles that nurses 

play in the U.S. health care system. 

HEARINGS

The Subcommittee on Health held a hearing on H.R. 2713 on December 9, 2015. The hearing was entitled ‘‘Examining Legislation 

to Improve Health Care and Treatment’’ and witnesses included 

the following: 

• Chad Asplund, Director, Athletic Medicine and Head Team 

Physician, Georgia Southern University; 

• Ovidio Bermudez, Chief Clinical Officer and Medical Director of Child and Adolescent Services, Eating Recovery Center; 

• Ginger Breedlove, President, American College of Nurse 

Midwives; 

• Anthony Gregg, Professor and Chief, Division of MaternalFetal Medicine, University of Florida Department of Obstetrics 

and Gynecology; 

• Jonathan Reiner, Director, Cardiac Catheterization Laboratory, George Washington University Hospital; and 

• Deborah Trautman, President and CEO, American Association of Colleges of Nursing. 

COMMITTEE CONSIDERATION

On December 9, 2015, the Subcommittee on Health met in open 

markup session and forwarded H.R. 2713 to the full Committee, as 

amended, by a voice vote. 

On September 20 and 21, 2016, the full Committee on Energy 

and Commerce met in open markup session and ordered H.R. 2713 

reported to the House, as amended, by a voice vote. 

COMMITTEE VOTES

Clause 3(b) of rule XIII of the Rules of the House of Representatives requires the Committee to list the record votes on the motion 

to report legislation and amendments thereto. There were no 

record votes taken in connection with ordering H.R. 2713 reported. 

COMMITTEE OVERSIGHT FINDINGS

Pursuant to clause 3(c)(1) of rule XIII of the Rules of the House 

of Representatives, the Committee has not held hearings on this 

legislation. 

STATEMENT OF GENERAL PERFORMANCE GOALS AND OBJECTIVES

This legislation supports advanced education nursing grants and 

specifically reauthorizes loan repayment and scholarship programs, 


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a nurse faculty loan program, and a comprehensive geriatric education program. 

NEW BUDGET AUTHORITY, ENTITLEMENT AUTHORITY, AND TAX

EXPENDITURES

In compliance with clause 3(c)(2) of rule XIII of the Rules of the 

House of Representatives, the Committee finds that H.R. 2713, 

would result in no new or increased budget authority, entitlement 

authority, or tax expenditures or revenues. 

EARMARK, LIMITED TAX BENEFITS, AND LIMITED TARIFF BENEFITS

In compliance with clause 9(e), 9(f), and 9(g) of rule XXI of the 

Rules of the House of Representatives, the Committee finds that 

H.R. 2713 contains no earmarks, limited tax benefits, or limited 

tariff benefits. 

COMMITTEE COST ESTIMATE

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. At the time this report was filed, the estimate was not available. 

CONGRESSIONAL BUDGET OFFICE ESTIMATE

At the time this report was filed, the cost estimate prepared by 

the Director of the Congressional Budget Office pursuant to section 

402 of the Congressional Budget Act of 1974 was not available. 

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. 

DUPLICATION OF FEDERAL PROGRAMS

No provision of H.R. 2713 establishes or reauthorizes a program 

of the Federal Government known to be duplicative of another Federal program, a program that was included in any report from the 

Government Accountability Office to Congress pursuant to section 

21 of Public Law 111–139, or a program related to a program identified in the most recent Catalog of Federal Domestic Assistance. 

DISCLOSURE OF DIRECTED RULE MAKINGS

The Committee estimates that enacting H.R. 2713 specifically directs to be completed no rule making within the meaning of 5 

U.S.C. 551. 

ADVISORY COMMITTEE STATEMENT

No advisory committees within the meaning of section 5(b) of the 

Federal Advisory Committee Act were created by this legislation. 


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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. 

SECTION-BY-SECTION ANALYSIS OF THE LEGISLATION

Section 1. Short title 

Section 1 provides that the Act may be cited as the ‘‘Title VIII 

Nursing Workforce Reauthorization Act of 2016’’. 

Section 2. Supporting clinical nurse specialists 

Section 2 updates various definitions in Title VIII. 

Section 3. Reauthorization of funding for nursing programs 

Section 3 reauthorizes funding for nursing programs at the fiscal 

year 2016 appropriated level. 

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. 801. DEFINITIONS. 

As used in this title: 

(1) ELIGIBLE ENTITIES.—The term ‘‘eligible entities’’ means 

schools of nursing, nursing centers, academic health centers, 

State or local governments, and other public or private nonprofit entities determined appropriate by the Secretary that 

submit to the Secretary an application in accordance with section 802. 

(2) SCHOOL OF NURSING.—The term ‘‘school of nursing’’ 

means an accredited (as defined in paragraph 6) collegiate, associate degree, or diploma school of nursing in a State where 

graduates are— 

(A) authorized to sit for the National Council Licensure 

EXamination-Registered Nurse (NCLEX–RN); or 

(B) licensed registered nurses who will receive a graduate or equivalent degree or training to become an advanced education nurse as defined by section 811(b). 


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(3) COLLEGIATE SCHOOL OF NURSING.—The term ‘‘collegiate 

school of nursing’’ means a department, division, or other administrative unit in a college or university which provides primarily or exclusively a program of education in professional 

nursing and related subjects leading to the degree of bachelor 

of arts, bachelor of science, bachelor of nursing, or to an equivalent degree, or to a graduate degree in nursing, or to an 

equivalent degree, and including advanced training related to 

such program of education provided by such school, but only if 

such program, or such unit, college or university is accredited. 

(4) ASSOCIATE DEGREE SCHOOL OF NURSING.—The term ‘‘associate degree school of nursing’’ means a department, division, 

or other administrative unit in a junior college, community college, college, or university which provides primarily or exclusively a two-year program of education in professional nursing 

and allied subjects leading to an associate degree in nursing or 

to an equivalent degree, but only if such program, or such unit, 

college, or university is accredited. 

(5) DIPLOMA SCHOOL OF NURSING.—The term ‘‘diploma school 

of nursing’’ means a school affiliated with a hospital or university, or an independent school, which provides primarily or exclusively a program of education in professional nursing and 

allied subjects leading to a diploma or to equivalent indicia 

that such program has been satisfactorily completed, but only 

if such program, or such affiliated school or such hospital or 

university or such independent school is accredited. 

(6) ACCREDITED.— (A) IN GENERAL.—Except as provided in subparagraph 

(B), the term ‘‘accredited’’ when applied to any program of 

nurse education means a program accredited by a recognized body or bodies, or by a State agency, approved for 

such purpose by the Secretary of Education and when applied to a hospital, school, college, or university (or a unit 

thereof) means a hospital, school, college, or university (or 

a unit thereof) which is accredited by a recognized body or 

bodies, or by a State agency, approved for such purpose by 

the Secretary of Education. For the purpose of this paragraph, the Secretary of Education shall publish a list of 

recognized accrediting bodies, and of State agencies, which 

the Secretary of Education determines to be reliable authority as to the quality of education offered. 

(B) NEW PROGRAMS.—A new program of nursing that, by 

reason of an insufficient period of operation, is not, at the 

time of the submission of an application for a grant or contract under this title, eligible for accreditation by such a 

recognized body or bodies or State agency, shall be deemed 

accredited for purposes of this title if the Secretary of Education finds, after consultation with the appropriate accreditation body or bodies, that there is reasonable assurance that the program will meet the accreditation standards of such body or bodies prior to the beginning of the 

academic year following the normal graduation date of students of the first entering class in such a program. 

(7) NONPROFIT.—The term ‘‘nonprofit’’ as applied to any 

school, agency, organization, or institution means one which is 


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a corporation or association, or is owned and operated by one 

or more corporations or associations, no part of the net earnings of which inures, or may lawfully inure, to the benefit of 

any private shareholder or individual. 

(8) STATE.—The term ‘‘State’’ means a State, the Commonwealth of Puerto Rico, the District of Columbia, the Commonwealth of the Northern Mariana Islands, Guam, American 

Samoa, the Virgin Islands, or the Trust Territory of the Pacific 

Islands. 

(9) AMBULATORY SURGICAL CENTER.—The term ‘‘ambulatory 

surgical center’’ has the meaning applicable to such term under 

title XVIII of the Social Security Act. 

(10) FEDERALLY QUALIFIED HEALTH CENTER.—The term ‘‘Federally qualified health center’’ has the meaning given such 

term under section 1861(aa)(4) of the Social Security Act. 

(11) HEALTH CARE FACILITY.—The term ‘‘health care facility’’ 

means an Indian Health Service health center, a Native Hawaiian health center, a hospital, a Federally qualified health 

center, a rural health clinic, a nursing home, a home health 

agency, a hospice program, a public health clinic, a State or 

local department of public health, a skilled nursing facility, an 

ambulatory surgical center, or any other facility designated by 

the Secretary. 

(12) HOME HEALTH AGENCY.—The term ‘‘home health agency’’ 

has the meaning given such term in section 1861(o) of the Social Security Act. 

(13) HOSPICE PROGRAM.—The term ‘‘hospice program’’ has 

the meaning given such term in section 1861(dd)(2) of the Social Security Act. 

(14) RURAL HEALTH CLINIC.—The term ‘‘rural health clinic’’ 

has the meaning given such term in section 1861(aa)(2) of the 

Social Security Act. 

(15) SKILLED NURSING FACILITY.—The term ‘‘skilled nursing 

facility’’ has the meaning given such term in section 1819(a) of 

the Social Security Act. 

(16) ACCELERATED NURSING DEGREE PROGRAM.—The term 

‘‘accelerated nursing degree program’’ means a program of education in professional nursing offered by an accredited school 

of nursing in which an individual holding a bachelors degree 

in another discipline receives a BSN or MSN degree in an accelerated time frame as determined by the accredited school of 

nursing. 

(17) BRIDGE OR DEGREE COMPLETION PROGRAM.—The term 

‘‘bridge or degree completion program’’ means a program of 

education in professional nursing offered by an accredited 

school of nursing, as defined in paragraph (2), that leads to a 

baccalaureate degree in nursing. Such programs may include, 

Registered Nurse (RN) to Bachelor’s of Science of Nursing 

(BSN) programs, RN to MSN (Master of Science of Nursing) 

programs, or BSN to Doctoral programs. 

(18) NURSE-MANAGED HEALTH CLINIC.—The term ‘‘nurse-managed health clinic’’ has the meaning given to such term in section 330A–1. 

* * * * * * * 


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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 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, longterm 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 to inpatients and outpatients experiencing acute and chronic illness. 


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ø(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. 

ø(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. 

* * * * * * * 

PART D—STRENGTHENING CAPACITY FOR 

BASIC NURSE EDUCATION AND PRACTICE 

SEC. 831. NURSE EDUCATION, PRACTICE, AND QUALITY 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; 

(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 


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specialty training among diverse population groups, and 

the advancement of individuals including to become professional nurses, advanced education nurses, licensed practical nurses, certified nurse assistants, and home health 

aides; and 

(B) to assist individuals in obtaining education and 

training required to enter the nursing profession and advance within such profession, such as by providing career 

counseling and mentoring. 

(2) ENHANCING PATIENT CARE DELIVERY SYSTEMS.— (A) GRANTS.—The Secretary may award grants to eligible entities to improve the retention of nurses and enhance 

patient care that is directly related to nursing activities by 

enhancing collaboration and communication among nurses 

and other health care professionals, and by promoting 

nurse involvement in the organizational and clinical decisionmaking processes of a health care facility. 

(B) PREFERENCE.—In making awards of grants under 

this paragraph, the Secretary shall give a preference to applicants that have not previously received an award under 

this paragraph. 

(C) CONTINUATION OF AN AWARD.—The Secretary shall 

make continuation of any award under this paragraph beyond the second year of such award contingent on the recipient of such award having demonstrated to the Secretary measurable and substantive improvement in nurse 

retention or patient care. 

(d) OTHER PRIORITY AREAS.—The Secretary may award grants to 

or enter into contracts with eligible entities to address other areas 

that are of high priority to nurse education, practice, and retention, 

as determined by the Secretary. 

(e) PREFERENCE.—For purposes of any amount of funds appropriated to carry out this section for fiscal year 2003, 2004, or 2005 

that is in excess of the amount of funds appropriated to carry out 

this section for fiscal year 2002, the Secretary shall give preference 

to awarding grants or entering into contracts under subsections 

(a)(2) and (c). 

(f) REPORT.—The Secretary shall submit to the Congress before 

the end of each fiscal year a report on the grants awarded and the 

contracts entered into under this section. Each such report shall 

identify the overall number of such grants and contracts and provide an explanation of why each such grant or contract will meet 

the priority need of the nursing workforce. 

(g) ELIGIBLE ENTITY.—For purposes of this section, the term ‘‘eligible entity’’ includes a school of nursing, as defined in section 

801(2)ø,,¿, a health care facility, or a partnership of such a school 

and facility. 

ø(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 2010 through 2014.¿ 

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). 


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(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. 

ø(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 

* * * * * * * 


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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. 

(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 


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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 

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ance), 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— 

(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; 


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(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 øsuch sums as 

may be necessary for each of fiscal years 2003 through 2007¿ 

$83,135,000 for each of fiscal years 2017 through 2021. (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; 


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(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 øsuch sums as may be 

necessary for each of fiscal years 2010 through 2014¿ $26,500,000 

for each of fiscal years 2017 through 2021. 

* * * * * * * 


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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, øand 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— 


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(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. 

(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 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 


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the provisions of such Act do not conflict with the requirements of 

this section. 

* * * * * * * 

PART H—COMPREHENSIVE GERIATRIC 

EDUCATION 

SEC. 865. COMPREHENSIVE GERIATRIC EDUCATION. 

(a) PROGRAM AUTHORIZED.—The Secretary shall award grants to 

eligible entities to develop and implement, in coordination with 

programs under section 753, programs and initiatives to train and 

educate individuals in providing geriatric care for the elderly. 

(b) USE OF FUNDS.—An eligible entity that receives a grant 

under subsection (a) shall use funds under such grant to— 

(1) provide training to individuals who will provide geriatric 

care for the elderly; 

(2) develop and disseminate curricula relating to the treatment of the health problems of elderly individuals; 

(3) train faculty members in geriatrics; 

(4) provide continuing education to individuals who provide 

geriatric care; or 

(5) establish traineeships for individuals who are preparing 

for advanced education nursing degrees in geriatric nursing, 

long-term care, gero-psychiatric nursing or other nursing areas 

that specialize in the care of the elderly population. 

(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 øsuch sums as may be 

necessary for each of fiscal years 2010 through 2014¿ $38,737,000 

for each of fiscal years 2017 through 2021. 

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 ø$338,000,000 

for fiscal year 2010, and such sums as may be necessary for each 

of the fiscal years 2011 through 2016¿ $119,837,000 for each of fiscal years 2017 through 2021. 

* * * * * * * 

Æ 


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