I 

111TH CONGRESS 

1ST SESSION H. R. 1928 

To increase home healthcare services, particularly for underserved and atrisk populations, by assisting visiting nurse associations and other nonprofit home health agencies to improve training and workforce development for home healthcare nurses, promoting and facilitating academicpractice collaborations, and enhancing recruitment and retention of home 

healthcare nurses. 

IN THE HOUSE OF REPRESENTATIVES 

APRIL 2, 2009 

Mr. KAGEN (for himself, Mr. TERRY, Mr. BOSWELL, Mrs. BONO MACK, Ms. 

BORDALLO, and Mr. YARMUTH) introduced the following bill; which was 

referred to the Committee on Energy and Commerce 

A BILL 

To increase home healthcare services, particularly for underserved and at-risk populations, by assisting visiting nurse 

associations and other non-profit home health agencies 

to improve training and workforce development for home 

healthcare nurses, promoting and facilitating academicpractice collaborations, and enhancing recruitment and 

retention of home healthcare nurses. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 


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1 SECTION 1. SHORT TITLE. 

2 This Act may be cited as the ‘‘Home Healthcare 

3 Nurse Promotion Act of 2009’’. 

4 SEC. 2. FINDINGS AND PURPOSE. 

5 (a) FINDINGS.—Congress makes the following find6 ings: 

7 (1) There is a significant shortage of home 

8 healthcare nurses, which is harming individuals’ ac9 cess to cost-effective home healthcare, particularly 

10 among underserved and high-risk populations. A re11 cent survey found that 59 percent of visiting nurse 

12 associations indicated they must decline patient re13 ferrals on a weekly basis. 

14 (2) The increasing aging population, prevalence 

15 of chronic disease, and strong preference by individ16 uals to live independently at home as long as pos17 sible will create an unprecedented demand for home18 based care during the next several decades. By 

19 2020, home health utilization is projected to increase 

20 by 36 percent. 

21 (3) The demand for home healthcare nurses is 

22 projected to increase by 109 percent by 2020, com23 pared to 37 percent for hospital nurses. 

24 (4) An estimated 1,000,000 new registered 

25 nurses will be needed by 2016 to fill new demand for 

26 nurses and replace retirees. 


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1 (5) Visiting nurse associations have been shown 

2 to lower costs for high-cost patient populations. Yet 

3 because they provide a substantial amount of un4 compensated care, they are increasingly unable to 

5 compete for nurses in a national nursing shortage 

6 environment. 

7 (6) A recent survey by the Visiting Nurses As8 sociation of America found that— 

9 (A) staff nursing rate shortages average 

10 around 10 percent; 

11 (B) 81 percent of visiting nurse associa12 tions indicate that salary limitations are the 

13 number one barrier to recruitment; and 

14 (C) 22 percent of visiting nurse associa15 tions indicate that their local hospital offers sal16 aries $10,000 greater than they are able to 

17 offer. 

18 (b) PURPOSE.—The purpose of this Act is to increase 

19 home health care services, particularly for underserved 

20 and at-risk populations, by— 

21 (1) assisting visiting nurse associations and 

22 other non-profit home health agencies to improve 

23 training and workforce development for home 

24 healthcare nurses; 


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1 (2) promoting and facilitating academic-practice 

2 collaborations; and 

3 (3) improving recruitment and retention of 

4 home healthcare nurses. 

5 SEC. 3. DEFINING VISITING NURSE ASSOCIATION. 

6 Section 801 of the Public Health Service Act (42 

7 U.S.C. 296) is amended by adding at the end the following 

8 new paragraph: 

9 ‘‘(16) VISITING NURSE ASSOCIATION.—The 

10 term ‘visiting nurse association’ means a home 

11 health agency that— 

12 ‘‘(A) has a participation agreement in ef13 fect under section 1866 of the Social Security 

14 Act; 

15 ‘‘(B) is a nonprofit entity exempt from tax16 ation under section 501(c)(3) of the Internal 

17 Revenue Code of 1986; 

18 ‘‘(C) is organized and participating under 

19 title XVIII of the Social Security Act as a pro20 vider of services separately from any other pro21 vider of services under such title; and 

22 ‘‘(D) is governed by a board of directors 

23 and all members of the board (excluding the 

24 head of the agency in any case in which the 


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1 head of the agency is a board member) serve on 

2 such board on an exclusively volunteer basis.’’. 

3 SEC. 4. HOME HEALTH TRAINING AND LOAN FORGIVENESS 

4 PROGRAMS. 

5 (a) HOME HEALTH NURSE TRAINING PROGRAMS.— 

6 Part D of title VIII of the Public Health Service Act (42 

7 U.S.C. 296p) is amended by adding at the end the fol8 lowing new sections: 

9 ‘‘SEC. 832. HOME HEALTH NURSE TRAINING PROGRAM 

10 GRANTS. 

11 ‘‘(a) IN GENERAL.—The Secretary may make grants 

12 under this section to visiting nurse associations for the 

13 purpose of providing training in home health care to 

14 nurses who— 

15 ‘‘(1) are hired by a visiting nurse association to 

16 provide home health care; and 

17 ‘‘(2) have no recent nursing work experience in 

18 home health care. 

19 ‘‘(b) PRIORITY FOR GRANTS.—When awarding 

20 grants under subsection (a), the Secretary shall give pri21 ority to visiting nurse associations that provide medically22 necessary home health care to individuals who request 

23 home health services (as defined in section 1861(m) of the 

24 Social Security Act) from such associations, regardless of 

25 ability to pay. 


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1 ‘‘SEC. 833. PILOT PROGRAM FOR HOME HEALTH TRAINING 

2 AT SCHOOLS OF NURSING. 

3 ‘‘(a) IN GENERAL.—Not later than the last day of 

4 the 90-day period beginning on the date of enactment of 

5 this section, the Secretary shall establish a pilot program 

6 to make grants to a number (to be determined by the Sec7 retary, but to be not less than five and not more than 

8 10) of accredited schools of nursing that have entered into 

9 partnerships with visiting nurse associations for the pur10 pose of developing and implementing a curriculum on 

11 home health care at such schools. 

12 ‘‘(b) APPLICATION.—In order to qualify for a grant 

13 under subsection (a), a school of nursing must submit an 

14 application to the Secretary— 

15 ‘‘(1) demonstrating that the school has estab16 lished a partnership with a visiting nurse association 

17 as required in subsection (a); and 

18 ‘‘(2) containing— 

19 ‘‘(A) a description of how the school and 

20 the association will work collaboratively to de21 velop and implement a curriculum on home 

22 health care for the students at the school; 

23 ‘‘(B) a description of how academic-prac24 tice collaboration will occur, such as— 

25 ‘‘(i) utilizing visiting nurse faculty 

26 from the visiting nurse association; and 


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1 ‘‘(ii) promoting student nurse intern2 ships, mentoring opportunities, or other 

3 collaborative activities to aid in the edu4 cation and practical home healthcare expe5 rience of nursing students; and 

6 ‘‘(C) any other information required by the 

7 Secretary. 

8 ‘‘(c) TERMINATION DATE.—The pilot program under 

9 subsection (a) shall terminate at the end of the 5-year pe10 riod beginning on the date of enactment of this section. 

11 ‘‘(d) REPORT.—Not later than the last day of the 

12 first calendar year following the date of enactment of this 

13 section and the end of each succeeding calendar year, the 

14 Secretary shall submit to Congress a report on the pilot 

15 program under subsection (a). 

16 ‘‘SEC. 834. AUTHORIZATION OF APPROPRIATIONS. 

17 ‘‘There is authorized to be appropriated to carry out 

18 this part (other than section 831) such sums as may be 

19 necessary in each fiscal year.’’. 

20 (b) LOAN FORGIVENESS FOR CERTAIN NURSES.— 

21 (1) AMENDMENTS REGARDING SERVICE FOR

22 VISITING NURSE ASSOCIATIONS.—Section 846 of 

23 such Act (42 U.S.C. 297n) is amended— 


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1 (A) in subsection (a)(3), by inserting ‘‘or 

2 for a visiting nurse association’’ after ‘‘critical 

3 shortage of nurses’’; 

4 (B) in subsection (g)(2)— 

5 (i) by striking ‘‘or health facility’’ and 

6 inserting ‘‘, health facility, or visiting 

7 nurse association’’; 

8 (ii) by striking ‘‘or the health facility’’ 

9 and inserting ‘‘, the health facility, or the 

10 visiting nurse association’’; and 

11 (iii) by striking ‘‘or facility’’ each 

12 place it appears and inserting ‘‘, facility, or 

13 association’’; and 

14 (C) in subsection (h)(5) by inserting ‘‘and 

15 visiting nurse associations’’ before the semi16 colon at the end. 

17 (2) TECHNICAL AMENDMENTS.—Section 846 of 

18 such Act (42 U.S.C. 297n) is further amended— 

19 (A) by striking subsection (f); and 

20 (B) by redesignating subsections (g) 

21 through (i) as subsections (f) through (h), re22 spectively. 

Æ 


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