```

[House Report 114-803]
[From the U.S. Government Publishing Office]

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:

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 providers 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 Maternal-Fetal 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, 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.

                  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).
          (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 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.

           *       *       *       *       *       *       *

 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, long-term care 
        facilities, acute care, and other health care settings.
  (d) Authorized Nurse-midwifery Programs.--Midwifery programs 
that are eligible for support under this section are 
educational programs that--
          (1) have as their objective the education of 
        midwives; and
          (2) are accredited by the American College of Nurse-
        Midwives Accreditation Commission for Midwifery 
        Education.
  (e) Authorized Nurse Anesthesia Programs.--Nurse anesthesia 
programs eligible for support under this section are education 
programs that--
          (1) provide registered nurses with full-time 
        anesthetist education; and
          (2) are accredited by the Council on Accreditation of 
        Nurse Anesthesia Educational Programs.
  (f) Authorized Clinical Nurse Specialist Programs.--Clinical 
nurse specialist programs eligible for support under this 
section are education programs that--
          (1) provide registered nurses with full-time clinical 
        nurse specialist education; and
          (2) have as their objective the education of clinical 
        nurse specialists who will upon completion of such a 
        program be qualified to effectively provide care to 
        inpatients and outpatients experiencing acute and 
        chronic illness.
  [(f)] (g) Other Authorized Educational Programs.--The 
Secretary shall prescribe guidelines as appropriate for other 
advanced nurse education programs eligible for support under 
this section.
  [(g)] (h) Traineeships.--
          (1) In general.--The Secretary may not award a grant 
        to an applicant under subsection (a) unless the 
        applicant involved agrees that traineeships provided 
        with the grant will only pay all or part of the costs 
        of--
                  (A) the tuition, books, and fees of the 
                program of advanced nurse education with 
                respect to which the traineeship is provided; 
                and
                  (B) the reasonable living expenses of the 
                individual during the period for which the 
                traineeship is provided.
          (2) Special consideration.--In making awards of 
        grants and contracts under subsection (a)(2), the 
        Secretary shall give special consideration to an 
        eligible entity that agrees to expend the award to 
        train advanced education nurses who will practice in 
        health professional shortage areas designated under 
        section 332.

           *       *       *       *       *       *       *

 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 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)[,,], 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 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).
  (b) Grants for Career Ladder Program.--The Secretary may 
award grants to, and enter into contracts with, eligible 
entities for programs--
          (1) to promote career advancement for individuals 
        including licensed practical nurses, licensed 
        vocational nurses, certified nurse assistants, home 
        health aides, diploma degree or associate degree 
        nurses, to become baccalaureate prepared registered 
        nurses or advanced education nurses in order to meet 
        the needs of the registered nurse workforce;
          (2) developing and implementing internships and 
        residency programs in collaboration with an accredited 
        school of nursing, as defined by section 801(2), to 
        encourage mentoring and the development of specialties; 
        or
          (3) to assist individuals in obtaining education and 
        training required to enter the nursing profession and 
        advance within such profession.
  (c) Enhancing Patient Care Delivery Systems.--
          (1) Grants.--The Secretary may award grants to 
        eligible entities to improve the retention of nurses 
        and enhance patient care that is directly related to 
        nursing activities by enhancing collaboration and 
        communication among nurses and other health care 
        professionals, and by promoting nurse involvement in 
        the organizational and clinical decision-making 
        processes of a health care facility.
          (2) Priority.--In making awards of grants under this 
        subsection, the Secretary shall give preference to 
        applicants that have not previously received an award 
        under this subsection (or section 831(c) as such 
        section existed on the day before the date of enactment 
        of this section).
          (3) Continuation of an award.--The Secretary shall 
        make continuation of any award under this subsection 
        beyond the second year of such award contingent on the 
        recipient of such award having demonstrated to the 
        Secretary measurable and substantive improvement in 
        nurse retention or patient care.
  (d) Other Priority Areas.--The Secretary may award grants to, 
or enter into contracts with, eligible entities to address 
other areas that are of high priority to nurse retention, as 
determined by the Secretary.
  (e) Report.--The Secretary shall submit to the Congress 
before the end of each fiscal year a report on the grants 
awarded and the contracts entered into under this section. Each 
such report shall identify the overall number of such grants 
and contracts and provide an explanation of why each such grant 
or contract will meet the priority need of the nursing 
workforce.
  (f) Eligible Entity.--For purposes of this section, the term 
``eligible entity'' includes an accredited school of nursing, 
as defined by section 801(2), a health care facility, or a 
partnership of such a school and facility.
  [(g) Authorization of Appropriations.--There are authorized 
to be appropriated to carry out this section such sums as may 
be necessary for each of fiscal years 2010 through 2012.]

PART E--STUDENT LOANS

           *       *       *       *       *       *       *

                loan repayment and scholarship programs

  Sec. 846. (a) In General.--In the case of any individual--
          (1) who has received a baccalaureate or associate 
        degree in nursing (or an equivalent degree), a diploma 
        in nursing, or a graduate degree in nursing;
          (2) who obtained (A) one or more loans from a loan 
        fund established under subpart II, or (B) any other 
        educational loan for nurse training costs; and
          (3) who enters into an agreement with the Secretary 
        to serve as nurse for a period of not less than two 
        years at a health care facility with a critical 
        shortage of nurses, or in a accredited school of 
        nursing, as defined by section 801(2), as nurse 
        faculty;
the Secretary shall make payments in accordance with subsection 
(b), for and on behalf of that individual, on the principal of 
and interest on any loan of that individual described in 
paragraph (2) of this subsection which is outstanding on the 
date the individual begins the service specified in the 
agreement described in paragraph (3) of this subsection. After 
fiscal year 2007, the Secretary may not, pursuant to any 
agreement entered into under this subsection, assign a nurse to 
any private entity unless that entity is nonprofit.
  (b) Manner of Payments.--The payments described in subsection 
(a) shall be made by the Secretary as follows:
          (1) Upon completion by the individual for whom the 
        payments are to be made of the first year of the 
        service specified in the agreement entered into with 
        the Secretary under subsection (a), the Secretary shall 
        pay 30 percent of the principal of, and the interest on 
        each loan of such individual described in subsection 
        (a)(2) which is outstanding on the date he began such 
        practice.
          (2) Upon completion by that individual of the second 
        year of such service, the Secretary shall pay another 
        30 percent of the principal of, and the interest on 
        each such loan.
          (3) Upon completion by that individual of a third 
        year of such service, the Secretary shall pay another 
        25 percent of the principal of, and the interest on 
        each such loan.
  (c) Payment by Due Date.--Notwithstanding the requirement of 
completion of practice specified in subsection (b), the 
Secretary shall, on or before the due date thereof, pay any 
loan or loan installment which may fall due within the period 
of service for which the borrower may receive payments under 
this subsection, upon the declaration of such borrower, at such 
times and in such manner as the Secretary may prescribe (and 
supported by such other evidence as the Secretary may 
reasonably require), that the borrower is then serving as 
described by subsection (a)(3), and that the borrower will 
continue to so serve for the period required (in the absence of 
this subsection) to entitle the borrower to have made the 
payments provided by this subsection for such period; except 
that not more than 85 percent of the principal of any such loan 
shall be paid pursuant to this subsection.
  (d) Scholarship Program.--
          (1) In general.--The Secretary shall (for fiscal 
        years 2003 and 2004) and may (for fiscal years 
        thereafter) carry out a program of entering into 
        contracts with eligible individuals under which such 
        individuals agree to serve as nurses for a period of 
        not less than 2 years at a health care facility with a 
        critical shortage of nurses, in consideration of the 
        Federal Government agreeing to provide to the 
        individuals scholarships for attendance at schools of 
        nursing.
          (2) Eligible individuals.--In this subsection, the 
        term ``eligible individual'' means an individual who is 
        enrolled or accepted for enrollment as a full-time or 
        part-time student in a school of nursing.
          (3) Service requirement.--
                  (A) In general.--The Secretary may not enter 
                into a contract with an eligible individual 
                under this subsection unless the individual 
                agrees to serve as a nurse at a health care 
                facility with a critical shortage of nurses for 
                a period of full-time service of not less than 
                2 years, or for a period of part-time service 
                in accordance with subparagraph (B).
                  (B) Part-time service.--An individual may 
                complete the period of service described in 
                subparagraph (A) on a part-time basis if the 
                individual has a written agreement that--
                          (i) is entered into by the facility 
                        and the individual and is approved by 
                        the Secretary; and
                          (ii) provides that the period of 
                        obligated service will be extended so 
                        that the aggregate amount of service 
                        performed will equal the amount of 
                        service that would be performed through 
                        a period of full-time service of not 
                        less than 2 years.
          (4) Applicability of certain provisions.--The 
        provisions of subpart III of part D of title III shall, 
        except as inconsistent with this section, apply to the 
        program established in paragraph (1) in the same manner 
        and to the same extent as such provisions apply to the 
        National Health Service Corps Scholarship Program 
        established in such subpart.
  (e) Preferences Regarding Participants.--In entering into 
agreements under subsection (a) or (d), the Secretary shall 
give preference to qualified applicants with the greatest 
financial need.
  (f) Breach of Agreement.--The Secretary may make payments 
under subsection (a) on behalf of an individual only if the 
agreement under such subsection provides that section 860(c) is 
applicable to the individual.
  (g) Breach of Agreement.--
          (1) In general.--In the case of any program under 
        this section under which an individual makes an 
        agreement to provide health services for a period of 
        time in accordance with such program in consideration 
        of receiving an award of Federal funds regarding 
        education as a nurse (including an award for the 
        repayment of loans), the following applies if the 
        agreement provides that this subsection is applicable:
                  (A) In the case of a program under this 
                section that makes an award of Federal funds 
                for attending an accredited program of nursing 
                (in this section referred to as a ``nursing 
                program''), the individual is liable to the 
                Federal Government for the amount of such award 
                (including amounts provided for expenses 
                related to such attendance), and for interest 
                on such amount at the maximum legal prevailing 
                rate, if the individual--
                          (i) fails to maintain an acceptable 
                        level of academic standing in the 
                        nursing program (as indicated by the 
                        program in accordance with requirements 
                        established by the Secretary);
                          (ii) is dismissed from the nursing 
                        program for disciplinary reasons; or
                          (iii) voluntarily terminates the 
                        nursing program.
                  (B) The individual is liable to the Federal 
                Government for the amount of such award 
                (including amounts provided for expenses 
                related to such attendance), and for interest 
                on such amount at the maximum legal prevailing 
                rate, if the individual fails to provide health 
                services in accordance with the program under 
                this section for the period of time applicable 
                under the program.
          (2) Waiver or suspension of liability.--In the case 
        of an individual or health facility making an agreement 
        for purposes of paragraph (1), the Secretary shall 
        provide for the waiver or suspension of liability under 
        such subsection if compliance by the individual or the 
        health facility, as the case may be, with the 
        agreements involved is impossible, or would involve 
        extreme hardship to the individual or facility, and if 
        enforcement of the agreements with respect to the 
        individual or facility would be unconscionable.
          (3) Date certain for recovery.--Subject to paragraph 
        (2), any amount that the Federal Government is entitled 
        to recover under paragraph (1) shall be paid to the 
        United States not later than the expiration of the 3-
        year period beginning on the date the United States 
        becomes so entitled.
          (4) Availability.--Amounts recovered under paragraph 
        (1) with respect to a program under this section shall 
        be available for the purposes of such program, and 
        shall remain available for such purposes until 
        expended.
  (h) Reports.--Not later than 18 months after the date of 
enactment of the Nurse Reinvestment Act, and annually 
thereafter, the Secretary shall prepare and submit to the 
Congress a report describing the programs carried out under 
this section, including statements regarding--
          (1) the number of enrollees, scholarships, loan 
        repayments, and grant recipients;
          (2) the number of graduates;
          (3) the amount of scholarship payments and loan 
        repayments made;
          (4) which educational institution the recipients 
        attended;
          (5) the number and placement location of the 
        scholarship and loan repayment recipients at health 
        care facilities with a critical shortage of nurses;
          (6) the default rate and actions required;
          (7) the amount of outstanding default funds of both 
        the scholarship and loan repayment programs;
          (8) to the extent that it can be determined, the 
        reason for the default;
          (9) the demographics of the individuals participating 
        in the scholarship and loan repayment programs;
          (10) justification for the allocation of funds 
        between the scholarship and loan repayment programs; 
        and
          (11) an evaluation of the overall costs and benefits 
        of the programs.
  (i) Funding.--
          (1) Authorization of appropriations.--For the purpose 
        of payments under agreements entered into under 
        subsection (a) or (d), there are authorized to be 
        appropriated [such sums as may be necessary for each of 
        fiscal years 2003 through 2007] $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;
          (3) an amount up to 85 percent of any such loan (plus 
        interest thereon) shall be canceled by the school as 
        follows:
                  (A) upon completion by the individual of each 
                of the first, second, and third year of full-
                time employment, required by the loan agreement 
                entered into under this subsection, as a 
                faculty member in an accredited a school of 
                nursing, the school shall cancel 20 percent of 
                the principle of, and the interest on, the 
                amount of such loan unpaid on the first day of 
                such employment; and
                  (B) upon completion by the individual of the 
                fourth year of full-time employment, required 
                by the loan agreement entered into under this 
                subsection, as a faculty member in a school of 
                nursing, the school shall cancel 25 percent of 
                the principle of, and the interest on, the 
                amount of such loan unpaid on the first day of 
                such employment;
          (4) such a loan may be used to pay the cost of 
        tuition, fees, books, laboratory expenses, and other 
        reasonable education expenses;
          (5) such a loan shall be repayable in equal or 
        graduated periodic installments (with the right of the 
        borrower to accelerate repayment) over the 10-year 
        period that begins 9 months after the individual ceases 
        to pursue a course of study at a school of nursing; and
          (6) such a loan shall--
                  (A) beginning on the date that is 3 months 
                after the individual ceases to pursue a course 
                of study at a school of nursing, bear interest 
                on the unpaid balance of the loan at the rate 
                of 3 percent per annum; or
                  (B) subject to subsection (e), if the school 
                of nursing determines that the individual will 
                not complete such course of study or serve as a 
                faculty member as required under the loan 
                agreement under this subsection, bear interest 
                on the unpaid balance of the loan at the 
                prevailing market rate.
  (d) Payment of Proportionate Share.--Where all or any part of 
a loan, or interest, is canceled under this section, the 
Secretary shall pay to the school an amount equal to the 
school's proportionate share of the canceled portion, as 
determined by the Secretary.
  (e) Review by Secretary.--At the request of the individual 
involved, the Secretary may review any determination by an 
accredited school of nursing under subsection (c)(6)(B).
  (f) Authorization of Appropriations.--There are authorized to 
be appropriated to carry out this section [such sums as may be 
necessary for each of fiscal years 2010 through 2014] 
$26,500,000 for each of fiscal years 2017 through 2021.

           *       *       *       *       *       *       *

   PART F--NATIONAL ADVISORY COUNCIL ON NURSE EDUCATION AND PRACTICE

SEC. 851. NATIONAL ADVISORY COUNCIL ON NURSE EDUCATION AND PRACTICE.

  (a) Establishment.--The Secretary shall establish an advisory 
council to be known as the National Advisory Council on Nurse 
Education and Practice (in this section referred to as the 
``Advisory Council'').
  (b) Composition.--
          (1) In general.--The Advisory Council shall be 
        composed of--
                  (A) not less than 21, nor more than 23 
                individuals, who are not officers or employees 
                of the Federal Government, appointed by the 
                Secretary without regard to the Federal civil 
                service laws, of which--
                          (i) 2 shall be selected from full-
                        time students enrolled in schools of 
                        nursing;
                          (ii) 2 shall be selected from the 
                        general public;
                          (iii) 2 shall be selected from 
                        practicing professional nurses; and
                          (iv) 9 shall be selected from among 
                        the leading authorities in the various 
                        fields of nursing, higher, secondary 
                        education, and associate degree schools 
                        of nursing, and from representatives of 
                        advanced education nursing groups (such 
                        as nurse practitioners, nurse midwives, 
                        [and nurse anesthetists] nurse 
                        anesthetists, and clinical nurse 
                        specialists), hospitals, and other 
                        institutions and organizations which 
                        provide nursing services; and
                  (B) the Secretary (or the delegate of the 
                Secretary (who shall be an ex officio member 
                and shall serve as the Chairperson)).
          (2) Appointment.--Not later than 90 days after the 
        date of enactment of this Act, the Secretary shall 
        appoint the members of the Advisory Council and each 
        such member shall serve a 4 year term. In making such 
        appointments, the Secretary shall ensure a fair balance 
        between the nursing professions, a broad geographic 
        representation of members and a balance between urban 
        and rural members. Members shall be appointed based on 
        their competence, interest, and knowledge of the 
        mission of the profession involved. A majority of the 
        members shall be nurses.
          (3) Minority representation.--In appointing the 
        members of the Advisory Council under paragraph (1), 
        the Secretary shall ensure the adequate representation 
        of minorities.
  (c) Vacancies.--
          (1) In general.--A vacancy on the Advisory Council 
        shall be filled in the manner in which the original 
        appointment was made and shall be subject to any 
        conditions which applied with respect to the original 
        appointment.
          (2) Filling unexpired term.--An individual chosen to 
        fill a vacancy shall be appointed for the unexpired 
        term of the member replaced.
  (d) Duties.--The Advisory Council shall--
          (1) provide advice and recommendations to the 
        Secretary and Congress concerning policy matters 
        arising in the administration of this title, including 
        the range of issues relating to the nurse workforce, 
        education, and practice improvement;
          (2) provide advice to the Secretary and Congress in 
        the preparation of general regulations and with respect 
        to policy matters arising in the administration of this 
        title, including the range of issues relating to nurse 
        supply, education and practice improvement; and
          (3) not later than 3 years after the date of 
        enactment of this section, and annually thereafter, 
        prepare and submit to the Secretary, the Committee on 
        Labor and Human Resources of the Senate, and the 
        Committee on Commerce of the House of Representatives, 
        a report describing the activities of the Council, 
        including findings and recommendations made by the 
        Council concerning the activities under this title.
  (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 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 [such 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 
[$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.

           *       *       *       *       *       *       *

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