I 

111TH CONGRESS 

1ST SESSION H. R. 2273 

To amend the Public Health Service Act to establish direct care registered 

nurse-to-patient staffing ratio requirements in hospitals, and for other 

purposes. 

IN THE HOUSE OF REPRESENTATIVES 

MAY 6, 2009 

Ms. SCHAKOWSKY (for herself, Ms. EDDIE BERNICE JOHNSON of Texas, Mr. 

STARK, Mr. RANGEL, Mr. CONYERS, Mr. YOUNG of Alaska, Mr. ABERCROMBIE, Mr. MCGOVERN, Mr. SHERMAN, Ms. DELAURO, Mr. ELLISON, 

and Ms. BALDWIN) introduced the following bill; which was referred to 

the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, for a period to be subsequently determined 

by the Speaker, in each case for consideration of such provisions as fall 

within the jurisdiction of the committee concerned 

A BILL 

To amend the Public Health Service Act to establish direct 

care registered nurse-to-patient staffing ratio requirements in hospitals, and for other purposes. 

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

3 SECTION 1. SHORT TITLE; FINDINGS. 

4 (a) SHORT TITLE.—This Act may be cited as the 

5 ‘‘Nurse Staffing Standards for Patient Safety and Quality 

6 Care Act of 2009’’. 


wwoods2 on PRODPC68 with BILLS
2 

•HR 2273 IH

1 (b) FINDINGS.—Congress finds the following: 

2 (1) The Federal Government has a substantial 

3 interest in promoting quality care and improving the 

4 delivery of health care services to patients in health 

5 care facilities in the United States. 

6 (2) Recent changes in health care delivery sys7 tems that have resulted in higher acuity levels 

8 among patients in health care facilities increase the 

9 need for improved quality measures in order to pro10 tect patient care and reduce the incidence of medical 

11 errors. 

12 (3) Inadequate and poorly monitored registered 

13 nurse staffing practices that result in too few reg14 istered nurses providing direct care jeopardize the 

15 delivery of quality health care services. 

16 (4) Numerous studies have shown that patient 

17 outcomes are directly correlated to direct care reg18 istered nurse staffing levels, including a 2002 Joint 

19 Commission on Accreditation of Healthcare Organi20 zations report that concluded that the lack of direct 

21 care registered nurses contributed to nearly a quar22 ter of the unanticipated problems that result in in23 jury or death to hospital patients. 

24 (5) Requirements for direct care registered 

25 nurse staffing ratios will help address the registered 


wwoods2 on PRODPC68 with BILLS
3 

•HR 2273 IH

1 nurse shortage in the United States by aiding in re2 cruitment of new registered nurses and improving 

3 retention of registered nurses who are considering 

4 leaving direct patient care because of demands cre5 ated by inadequate staffing. 

6 (6) Establishing adequate minimum direct care 

7 registered nurse-to-patient ratios that take into ac8 count patient acuity measures will improve the deliv9 ery of quality health care services and guarantee pa10 tient safety. 

11 (7) Establishing safe staffing standards for di12 rect care registered nurses is a critical component of 

13 assuring that there is adequate hospital staffing at 

14 all levels to improve the delivery of quality care and 

15 protect patient safety. 

16 SEC. 2. MINIMUM DIRECT CARE REGISTERED NURSE 

17 STAFFING REQUIREMENT. 

18 (a) MINIMUM DIRECT CARE REGISTERED NURSE

19 STAFFING REQUIREMENT.—The Public Health Service 

20 Act (42 U.S.C. 201 et seq.) is amended by adding at the 

21 end the following new title: 


wwoods2 on PRODPC68 with BILLS
4 

•HR 2273 IH

1 ‘‘TITLE XXXI—MINIMUM DIRECT 

2 CARE REGISTERED NURSE 

3 STAFFING REQUIREMENT 

4 ‘‘SEC. 3101. MINIMUM NURSE STAFFING REQUIREMENT. 

5 ‘‘(a) STAFFING PLAN.— 

6 ‘‘(1) IN GENERAL.—A hospital shall implement 

7 a staffing plan that— 

8 ‘‘(A) provides adequate, appropriate, and 

9 quality delivery of health care services and pro10 tects patient safety; and 

11 ‘‘(B) is consistent with the requirements of 

12 this title. 

13 ‘‘(2) EFFECTIVE DATES.— 

14 ‘‘(A) IMPLEMENTATION OF STAFFING

15 PLAN.—Subject to subparagraph (B), the re16 quirements under paragraph (1) shall take ef17 fect not later than 1 year after the date of the 

18 enactment of this title. 

19 ‘‘(B) APPLICATION OF MINIMUM DIRECT

20 CARE REGISTERED NURSE-TO-PATIENT RA21 TIOS.—The requirements under subsection (b) 

22 shall take effect as soon as practicable, as de23 termined by the Secretary, but not later than 2 

24 years after the date of the enactment of this 

25 title, or in the case of a hospital in a rural area 


wwoods2 on PRODPC68 with BILLS
5 

•HR 2273 IH

1 (as defined in section 1886(d)(2)(D) of the So2 cial Security Act), not later than 4 years after 

3 the date of the enactment of this title. 

4 ‘‘(b) MINIMUM DIRECT CARE REGISTERED NURSE5 TO-PATIENT RATIOS.— 

6 ‘‘(1) IN GENERAL.—A hospital’s staffing plan 

7 shall provide that, during each shift within a unit of 

8 the hospital, a direct care registered nurse may be 

9 assigned to not more than the following number of 

10 patients in that unit, subject to paragraph (3): 

11 ‘‘(A) 1 patient in operating room units and 

12 trauma emergency units. 

13 ‘‘(B) 2 patients in critical care units, in14 cluding emergency critical care and intensive 

15 care units, labor and delivery units, and 

16 postanesthesia units. 

17 ‘‘(C) 3 patients in antepartum units, emer18 gency room units, pediatrics units, stepdown 

19 units, and telemetry units. 

20 ‘‘(D) 4 patients in intermediate care nurs21 ery units, medical/surgical units, and acute care 

22 psychiatric units. 

23 ‘‘(E) 5 patients in rehabilitation units. 

24 ‘‘(F) 6 patients in postpartum (3 couplets) 

25 units and well-baby nursery units. 


wwoods2 on PRODPC68 with BILLS
6 

•HR 2273 IH

1 ‘‘(2) SIMILAR UNITS WITH DIFFERENT

2 NAMES.—The Secretary may apply minimum direct 

3 care registered nurse-to-patient ratios established in 

4 paragraph (1) to a type of hospital unit not referred 

5 to in such paragraph if such other unit performs a 

6 function similar to the function performed by the 

7 unit referred to in such paragraph. 

8 ‘‘(3) ADJUSTMENT OF RATIOS.— 

9 ‘‘(A) IN GENERAL.—If necessary to protect 

10 patient safety, the Secretary may prescribe reg11 ulations that— 

12 ‘‘(i) increase minimum direct care reg13 istered nurse-to-patient ratios under this 

14 subsection to further limit the number of 

15 patients that may be assigned to each di16 rect care nurse; or 

17 ‘‘(ii) add minimum direct care reg18 istered nurse-to-patient ratios for units not 

19 referred to in paragraphs (1) and (2). 

20 ‘‘(B) CONSULTATION.—Such regulations 

21 shall be prescribed after consultation with af22 fected hospitals and registered nurses. 

23 ‘‘(4) RELATIONSHIP TO STATE-IMPOSED RA24 TIOS.— 


wwoods2 on PRODPC68 with BILLS
7 

•HR 2273 IH

1 ‘‘(A) NO PREEMPTION OF CERTAIN STATE2 IMPOSED RATIOS.—Nothing in this title shall 

3 preempt State standards that the Secretary de4 termines to be at least equivalent to Federal re5 quirements for a staffing plan established under 

6 this title. Minimum direct care registered nurse7 to-patient ratios established under this sub8 section shall not preempt State requirements 

9 that the Secretary determines are at least 

10 equivalent to Federal requirements for a staff11 ing plan established under this title. 

12 ‘‘(B) SATISFACTION OF CERTAIN FEDERAL

13 REQUIREMENTS WITH CERTAIN STATE-IMPOSED

14 NURSE-TO-PATIENT RATIOS.—States that, at 

15 least 2 years prior to the date of the enactment 

16 of this title, have enacted minimum direct care 

17 nurse-to-patient ratios that allow the use of li18 censed practical nurses to meet State-imposed 

19 minimum direct care nurse-to-patient ratios 

20 may continue to make such allowance, and such 

21 allowance shall be considered to satisfy require22 ments imposed under this subsection, so long as 

23 the particular licensed practical nurse is em24 ployed in the same or a comparable position. 

25 ‘‘(5) EXEMPTION IN EMERGENCIES.— 


wwoods2 on PRODPC68 with BILLS
8 

•HR 2273 IH

1 ‘‘(A) IN GENERAL.—The requirements es2 tablished under this subsection shall not apply 

3 during a declared state of emergency if a hos4 pital is requested or expected to provide an ex5 ceptional level of emergency or other medical 

6 services. 

7 ‘‘(B) EMERGENCY DEFINED.—For pur8 poses of subparagraph (A), the term ‘declared 

9 state of emergency’ means a state of emergency 

10 that has been declared by the Federal Govern11 ment or the head of the appropriate State or 

12 local governmental agency having authority to 

13 declare that the State, county, municipality, or 

14 locality is in a state of emergency, but such 

15 term does not include a state of emergency that 

16 results from a labor dispute in the health care 

17 industry or consistent understaffing. 

18 ‘‘(c) DEVELOPMENT AND REEVALUATION OF STAFF19 ING PLAN.— 

20 ‘‘(1) CONSIDERATIONS IN DEVELOPMENT OF

21 PLAN.—In developing the staffing plan, a hospital 

22 shall provide for direct care registered nurse-to-pa23 tient ratios above the minimum direct care reg24 istered nurse-to-patient ratios required under subVerDate Nov 24 2008 00:49 May 08, 2009 Jkt 079200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\H2273.IH H2273

wwoods2 on PRODPC68 with BILLS
9 

•HR 2273 IH

1 section (b) if appropriate based upon consideration 

2 of the following factors: 

3 ‘‘(A) The number of patients and acuity 

4 level of patients as determined by the applica5 tion of an acuity system (as defined in section 

6 3106(1)), on a shift-by-shift basis. 

7 ‘‘(B) The anticipated admissions, dis8 charges, and transfers of patients during each 

9 shift that impacts direct patient care. 

10 ‘‘(C) Specialized experience required of di11 rect care registered nurses on a particular unit. 

12 ‘‘(D) Staffing levels and services provided 

13 by other health care personnel in meeting direct 

14 patient care needs not required by a direct care 

15 registered nurse. 

16 ‘‘(E) The level of technology available that 

17 affects the delivery of direct patient care. 

18 ‘‘(F) The level of familiarity with hospital 

19 practices, policies, and procedures by temporary 

20 agency direct care registered nurses used dur21 ing a shift. 

22 ‘‘(G) Obstacles to efficiency in the delivery 

23 of patient care presented by physical layout. 


wwoods2 on PRODPC68 with BILLS
10 

•HR 2273 IH

1 ‘‘(2) DOCUMENTATION OF STAFFING.—A hos2 pital shall specify the system used to document ac3 tual staffing in each unit for each shift. 

4 ‘‘(3) ANNUAL REEVALUATION OF PLAN AND

5 ACUITY SYSTEM.— 

6 ‘‘(A) IN GENERAL.—A hospital shall annu7 ally evaluate— 

8 ‘‘(i) its staffing plan in each unit in 

9 relation to actual patient care require10 ments; and 

11 ‘‘(ii) the accuracy of its acuity system. 

12 ‘‘(B) UPDATE.—A hospital shall update its 

13 staffing plan and acuity system to the extent 

14 appropriate based on such evaluation. 

15 ‘‘(4) REGISTERED NURSE PARTICIPATION.—A 

16 staffing plan of a hospital shall be developed and 

17 subsequent reevaluations shall be conducted under 

18 this subsection on the basis of input from direct care 

19 registered nurses at the hospital or, where such 

20 nurses are represented through collective bargaining, 

21 from the applicable recognized or certified collective 

22 bargaining representative of such nurses. Nothing in 

23 this title shall be construed to permit conduct pro24 hibited under the National Labor Relations Act or 

25 under the Federal Labor Relations Act. 


wwoods2 on PRODPC68 with BILLS
11 

•HR 2273 IH

1 ‘‘(d) SUBMISSION OF PLAN TO SECRETARY.—A hos2 pital shall submit to the Secretary its staffing plan and 

3 any annual updates under subsection (c)(3)(B). A feder4 ally operated hospital may submit its staffing plan 

5 through the department or agency operating the hospital. 

6 ‘‘SEC. 3102. POSTING, RECORDS, AND AUDITS. 

7 ‘‘(a) POSTING REQUIREMENTS.—In each unit, a hos8 pital shall post a uniform notice in a form specified by 

9 the Secretary in regulation that— 

10 ‘‘(1) explains requirements imposed under sec11 tion 3101; 

12 ‘‘(2) includes actual direct care registered 

13 nurse-to-patient ratios during each shift; and 

14 ‘‘(3) is visible, conspicuous, and accessible to 

15 staff, patients, and the public. 

16 ‘‘(b) RECORDS.— 

17 ‘‘(1) MAINTENANCE OF RECORDS.—Each hos18 pital shall maintain accurate records of actual direct 

19 care registered nurse-to-patient ratios in each unit 

20 for each shift for no less than 3 years. Such records 

21 shall include— 

22 ‘‘(A) the number of patients in each unit; 

23 ‘‘(B) the identity and duty hours of each 

24 direct care registered nurse assigned to each 

25 patient in each unit in each shift; and 


wwoods2 on PRODPC68 with BILLS
12 

•HR 2273 IH

1 ‘‘(C) a copy of each notice posted under 

2 subsection (a). 

3 ‘‘(2) AVAILABILITY OF RECORDS.—Each hos4 pital shall make its records maintained under para5 graph (1) available to— 

6 ‘‘(A) the Secretary; 

7 ‘‘(B) registered nurses and their collective 

8 bargaining representatives (if any); and 

9 ‘‘(C) the public under regulations estab10 lished by the Secretary, or in the case of a fed11 erally operated hospital, under section 552 of 

12 title 5, United States Code (commonly known 

13 as the ‘Freedom of Information Act’). 

14 ‘‘(c) AUDITS.—The Secretary shall conduct periodic 

15 audits to ensure— 

16 ‘‘(1) implementation of the staffing plan in ac17 cordance with this title; and 

18 ‘‘(2) accuracy in records maintained under this 

19 section. 

20 ‘‘SEC. 3103. MINIMUM DIRECT CARE LICENSED PRACTICAL 

21 NURSE STAFFING REQUIREMENTS. 

22 ‘‘(a) ESTABLISHMENT.—A hospital’s staffing plan 

23 shall comply with minimum direct care licensed practical 

24 nurse staffing requirements that the Secretary establishes 

25 for units in hospitals. Such staffing requirements shall be 


wwoods2 on PRODPC68 with BILLS
13 

•HR 2273 IH

1 established not later than 18 months after the date of the 

2 enactment of this title, and shall be based on the study 

3 conducted under subsection (b). 

4 ‘‘(b) STUDY.—Not later than 1 year after the date 

5 of the enactment of this title, the Secretary, acting 

6 through the Director of the Agency for Healthcare Re7 search and Quality, shall complete a study of licensed 

8 practical nurse staffing and its effects on patient care in 

9 hospitals. The Director may contract with a qualified enti10 ty or organization to carry out such study under this para11 graph. The Director shall consult with licensed practical 

12 nurses and organizations representing licensed practical 

13 nurses regarding the design and conduct of the study. 

14 ‘‘(c) APPLICATION OF REGISTERED NURSE PROVI15 SIONS TO LICENSED PRACTICAL NURSE STAFFING RE16 QUIREMENTS.—Paragraphs (2), (3), (4)(A), and (5) of 

17 section 3101(b), section 3101(c), and section 3102 shall 

18 apply to the establishment and application of direct care 

19 licensed practical nurse staffing requirements under this 

20 section in the same manner that they apply to the estab21 lishment and application of direct care registered nurse22 to-patient ratios under section 3101. 

23 ‘‘(d) EFFECTIVE DATE.—The requirements of this 

24 section shall take effect as soon as practicable, as deter25 mined by the Secretary, but not later than 2 years after 


wwoods2 on PRODPC68 with BILLS
14 

•HR 2273 IH

1 the date of the enactment of this title, or in the case of 

2 a hospital in a rural area (as defined in section 

3 1886(d)(2)(D) of the Social Security Act), not later than 

4 4 years after the date of the enactment of this title. 

5 ‘‘SEC. 3104. ADJUSTMENT IN REIMBURSEMENT. 

6 ‘‘(a) MEDICARE REIMBURSEMENT.—The Secretary 

7 shall adjust payments made to hospitals (other than feder8 ally operated hospitals) under title XVIII of the Social Se9 curity Act in an amount equal to the net amount of addi10 tional costs incurred in providing services to medicare 

11 beneficiaries that are attributable to compliance with re12 quirements imposed under sections 3101 through 3103. 

13 The amount of such payment adjustments shall take into 

14 account recommendations contained in the report sub15 mitted by the Medicare Payment Advisory Commission 

16 under subsection (c). 

17 ‘‘(b) AUTHORIZATION OF APPROPRIATION FOR FED18 ERALLY OPERATED HOSPITALS.—There are authorized to 

19 be appropriated such additional sums as are required for 

20 federally operated hospitals to comply with the additional 

21 requirements established under sections 3101 through 

22 3103. 

23 ‘‘(c) MEDPAC REPORT.—Not later than 2 years after 

24 the date of the enactment of this title, the Medicare Pay25 ment Advisory Commission (established under section 


wwoods2 on PRODPC68 with BILLS
15 

•HR 2273 IH

1 1805 of the Social Security Act) shall submit to Congress 

2 and the Secretary a report estimating total costs and sav3 ings attributable to compliance with requirements imposed 

4 under sections 3101 through 3103. Such report shall in5 clude recommendations on the need, if any, to adjust reim6 bursement for Medicare payments under subsection (a). 

7 ‘‘SEC. 3105. PROTECTION OF NURSES AND OTHER INDIVID8 UALS. 

9 ‘‘(a) REFUSAL OF ASSIGNMENT.—A nurse may 

10 refuse to accept an assignment as a nurse in a hospital 

11 if— 

12 ‘‘(1) the assignment would violate section 3101 

13 or 3103; or 

14 ‘‘(2) the nurse is not prepared by education, 

15 training, or experience to fulfill the assignment with16 out compromising the safety of any patient or jeop17 ardizing the license of the nurse. 

18 ‘‘(b) RETALIATION FOR REFUSAL OF ASSIGNMENT

19 BARRED.— 

20 ‘‘(1) NO DISCHARGE, DISCRIMINATION, OR RE21 TALIATION.—No hospital shall discharge, discrimi22 nate, or retaliate in any manner with respect to any 

23 aspect of employment (as defined in section 

24 3106(5)), including discharge, promotion, compensa25 tion, or terms, conditions, or privileges of employVerDate Nov 24 2008 00:49 May 08, 2009 Jkt 079200 PO 00000 Frm 00015 Fmt 6652 Sfmt 6201 E:\BILLS\H2273.IH H2273

wwoods2 on PRODPC68 with BILLS
16 

•HR 2273 IH

1 ment against a nurse based on the nurse’s refusal of 

2 a work assignment under subsection (a). 

3 ‘‘(2) NO FILING OF COMPLAINT.—No hospital 

4 shall file a complaint or a report against a nurse 

5 with the appropriate State professional disciplinary 

6 agency because of the nurse’s refusal of a work as7 signment under subsection (a). 

8 ‘‘(c) CAUSE OF ACTION.—Any nurse who has been 

9 discharged, discriminated, or retaliated against in viola10 tion of subsection (b)(1) or against whom a complaint has 

11 been filed in violation of subsection (b)(2) may bring a 

12 cause of action in a United States district court. A nurse 

13 who prevails on the cause of action shall be entitled to 

14 one or more of the following: 

15 ‘‘(1) Reinstatement. 

16 ‘‘(2) Reimbursement of lost wages, compensa17 tion, and benefits. 

18 ‘‘(3) Attorneys’ fees. 

19 ‘‘(4) Court costs. 

20 ‘‘(5) Other damages. 

21 ‘‘(d) COMPLAINT TO SECRETARY.—A nurse or other 

22 individual may file a complaint with the Secretary against 

23 a hospital that violates the provisions of this title. For any 

24 complaint filed, the Secretary shall— 

25 ‘‘(1) receive and investigate the complaint; 


wwoods2 on PRODPC68 with BILLS
17 

•HR 2273 IH

1 ‘‘(2) determine whether a violation of this title 

2 as alleged in the complaint has occurred; and 

3 ‘‘(3) if such a violation has occurred, issue an 

4 order that the complaining nurse or individual shall 

5 not suffer any retaliation under subsection (b) or 

6 under subsection (e). 

7 ‘‘(e) PROTECTION FOR REPORTING.— 

8 ‘‘(1) RETALIATION BARRED.—A hospital shall 

9 not discriminate or retaliate in any manner with re10 spect to any aspect of employment, including hiring, 

11 discharge, promotion, compensation, or terms, condi12 tions, or privileges of employment against any indi13 vidual who in good faith, individually or in conjunc14 tion with another person or persons— 

15 ‘‘(A) reports a violation or a suspected vio16 lation of this title to the Secretary, a public reg17 ulatory agency, a private accreditation body, or 

18 the management personnel of the hospital; 

19 ‘‘(B) initiates, cooperates, or otherwise 

20 participates in an investigation or proceeding 

21 brought by the Secretary, a public regulatory 

22 agency, or a private accreditation body con23 cerning matters covered by this title; or 

24 ‘‘(C) informs or discusses with other indi25 viduals or with representatives of hospital emVerDate Nov 24 2008 00:49 May 08, 2009 Jkt 079200 PO 00000 Frm 00017 Fmt 6652 Sfmt 6201 E:\BILLS\H2273.IH H2273

wwoods2 on PRODPC68 with BILLS
18 

•HR 2273 IH

1 ployees a violation or suspected violation of this 

2 title. 

3 ‘‘(2) GOOD FAITH DEFINED.—For purposes of 

4 this subsection, an individual shall be deemed to be 

5 acting in good faith if the individual reasonably be6 lieves— 

7 ‘‘(A) the information reported or disclosed 

8 is true; and 

9 ‘‘(B) a violation of this title has occurred 

10 or may occur. 

11 ‘‘(f) NOTICE.—A hospital shall post in an appropriate 

12 location in each unit a conspicuous notice in a form speci13 fied by the Secretary that— 

14 ‘‘(1) explains the rights of nurses and other in15 dividuals under this section; 

16 ‘‘(2) includes a statement that a nurse or other 

17 individual may file a complaint with the Secretary 

18 against a hospital that violates the provisions of this 

19 title; and 

20 ‘‘(3) provides instructions on how to file a com21 plaint under paragraph (2). 

22 ‘‘(g) EFFECTIVE DATES.— 

23 ‘‘(1) REFUSAL; RETALIATION; CAUSE OF AC24 TION.— 


wwoods2 on PRODPC68 with BILLS
19 

•HR 2273 IH

1 ‘‘(A) IN GENERAL.—Subsections (a) 

2 through (c) shall apply to refusals occurring on 

3 or after the effective date of the provision to 

4 which the refusal relates. 

5 ‘‘(B) EXCEPTION.—Subsection (a)(2) shall 

6 not apply to refusals in any hospital before the 

7 requirements of section 3101(a) apply to that 

8 hospital. 

9 ‘‘(2) PROTECTIONS FOR REPORTING.—Sub10 section (e) shall apply to actions described in sub11 paragraphs (A) and (C) of subsection (e)(1) occur12 ring on or after the effective date of the provision 

13 to which the violation relates. Subsection (e) shall 

14 apply to initiation, cooperation, or participation in 

15 an investigation or proceeding on or after the date 

16 of the enactment of this title. 

17 ‘‘(3) NOTICE.—Subsection (f) shall take effect 

18 18 months after the date of the enactment of this 

19 title. 

20 ‘‘SEC. 3106. DEFINITIONS. 

21 ‘‘For purposes of this title: 

22 ‘‘(1) ACUITY SYSTEM.—The term ‘acuity sys23 tem’ means an established measurement tool that— 

24 ‘‘(A) predicts nursing care requirements 

25 for individual patients based on severity of paVerDate Nov 24 2008 00:49 May 08, 2009 Jkt 079200 PO 00000 Frm 00019 Fmt 6652 Sfmt 6201 E:\BILLS\H2273.IH H2273

wwoods2 on PRODPC68 with BILLS
20 

•HR 2273 IH

1 tient illness, need for specialized equipment and 

2 technology, intensity of nursing interventions 

3 required, and the complexity of clinical nursing 

4 judgment needed to design, implement, and 

5 evaluate the patient’s nursing care plan; 

6 ‘‘(B) details the amount of nursing care 

7 needed, both in number of nurses and in skill 

8 mix of nursing personnel required, on a daily 

9 basis, for each patient in a nursing department 

10 or unit; 

11 ‘‘(C) takes into consideration the patient 

12 care services provided not only by registered 

13 nurses but also by direct care licensed practical 

14 nurses and other health care personnel; and 

15 ‘‘(D) is stated in terms that can be readily 

16 used and understood by nurses. 

17 ‘‘(2) DIRECT CARE LICENSED PRACTICAL

18 NURSE.—The term ‘direct care licensed practical 

19 nurse’ means an individual who has been granted a 

20 license by at least 1 State to practice as a licensed 

21 practical nurse or a licensed vocational nurse and 

22 who provides bedside care for 1 or more patients. 

23 ‘‘(3) NURSE.—The term ‘nurse’ means any di24 rect care registered nurse or direct care licensed 


wwoods2 on PRODPC68 with BILLS
21 

•HR 2273 IH

1 practical nurse (as the case may be), regardless of 

2 whether or not the nurse is an employee. 

3 ‘‘(4) DIRECT CARE REGISTERED NURSE.—The 

4 term ‘direct care registered nurse’ means an indi5 vidual who has been granted a license by at least 1 

6 State to practice as a registered nurse and who pro7 vides bedside care for 1 or more patients. 

8 ‘‘(5) EMPLOYMENT.—The term ‘employment’ 

9 includes the provision of services under a contract or 

10 other arrangement. 

11 ‘‘(6) HOSPITAL.—The term ‘hospital’ has the 

12 meaning given that term in section 1861(e) of the 

13 Social Security Act, and includes a hospital that is 

14 operated by the Department of Veterans Affairs, the 

15 Department of Defense, the Indian Health Services 

16 Program, or any other department or agency of the 

17 United States. 

18 ‘‘(7) STAFFING PLAN.—The term ‘staffing plan’ 

19 means a staffing plan required under section 3101.’’. 

20 (b) RECOMMENDATIONS TO CONGRESS.—No later 

21 than 1 year after the date of the enactment of this Act, 

22 the Secretary of Health and Human Services shall submit 

23 to Congress a report containing recommendations for en24 suring that sufficient numbers of nurses are available to 


wwoods2 on PRODPC68 with BILLS
22 

•HR 2273 IH

1 meet the requirements imposed by title XXXI of the Pub2 lic Health Service Act, as added by subsection (a). 

3 SEC. 3. ENFORCEMENT OF REQUIREMENTS THROUGH FED4 ERAL PROGRAMS. 

5 (a) MEDICARE PROGRAM.—Section 1866(a)(1) of the 

6 Social Security Act (42 U.S.C. 1395cc(a)(1)) is amend7 ed— 

8 (1) by striking ‘‘and’’ at the end of subpara9 graph (U); 

10 (2) by striking the period at the end of sub11 paragraph (V) and inserting ‘‘, and’’; and 

12 (3) by inserting after subparagraph (V) the fol13 lowing: 

14 ‘‘(W) in the case of a hospital, to comply with 

15 the provisions of title XXXI of the Public Health 

16 Service Act.’’. 

17 (b) MEDICAID PROGRAM.—The first sentence of sec18 tion 1902(a) of the Social Security Act (42 U.S.C. 

19 1396(a)) is amended— 

20 (1) by striking ‘‘and’’ at the end of paragraph 

21 (71); 

22 (2) by striking the period at the end of para23 graph (72) and inserting ‘‘; and’’; and 

24 (3) by inserting after paragraph (72) the fol25 lowing new paragraph: 


wwoods2 on PRODPC68 with BILLS
23 

•HR 2273 IH

1 ‘‘(73) provide that any hospital receiving pay2 ments under such plan must comply with the provi3 sions of title XXXI of the Public Health Service 

4 Act.’’. 

5 (c) HEALTH BENEFITS PROGRAM OF THE DEPART6 MENT OF VETERANS AFFAIRS.—Section 8110(a) of title 

7 38, United States Code, is amended by adding at the end 

8 the following new paragraph: 

9 ‘‘(7) In the case of a Department medical facility that 

10 is a hospital, the hospital shall comply with the provisions 

11 of title XXXI of the Public Health Service Act. 

12 ‘‘(8) Nothing either in chapter 74 of this title or in 

13 section 7106 of title 5 shall preclude enforcement of the 

14 provisions of title XXX of the Public Health Service Act 

15 with respect to a Department hospital through grievance 

16 procedures negotiated in accordance with chapter 71 of 

17 title 5.’’. 

18 (d) HEALTH BENEFITS PROGRAM OF THE DEPART19 MENT OF DEFENSE.— 

20 (1) IN GENERAL.—Chapter 55 of title 10, 

21 United States Code, is amended by adding at the 

22 end the following new section: 


wwoods2 on PRODPC68 with BILLS
24 

•HR 2273 IH

1 ‘‘§ 1110a. Staffing requirements 

2 ‘‘In the case of a facility of the uniformed services 

3 that is a hospital, the hospital shall comply with the provi4 sions of title XXXI of the Public Health Service Act.’’. 

5 (2) CLERICAL AMENDMENT.—The table of sec6 tions at the beginning of such chapter is amended 

7 by inserting after the item relating to section 1110 

8 the following new item: 

‘‘1110a. Staffing requirements.’’. 

9 (e) INDIAN HEALTH SERVICES PROGRAM.—Title 

10 VIII of the Indian Health Care Improvement Act (25 

11 U.S.C. 1671 et seq.) is amended by adding at the end 

12 the following new section: 

13 ‘‘SEC. 826. STAFFING REQUIREMENTS. 

14 ‘‘A hospital of the Service shall comply with the provi15 sions of title XXXI of the Public Health Service Act.’’. 

16 (f) FEDERAL LABOR-MANAGEMENT RELATIONS.— 

17 (1) IN GENERAL.—Section 7106 of title 5, 

18 United States Code, is amended by adding at the 

19 end the following: 

20 ‘‘(c) Nothing in this section shall preclude enforce21 ment of the provisions of title XXXI of the Public Health 

22 Service Act through grievance procedures negotiated in ac23 cordance with section 7121.’’. 

24 (2) CONFORMING AMENDMENT.—Section 

25 7106(a) of title 5, United States Code, is amended 


wwoods2 on PRODPC68 with BILLS
25 

•HR 2273 IH

1 by striking ‘‘Subject to subsection (b) of this title,’’ 

2 and inserting ‘‘Subject to subsections (b) and (c),’’. 

Æ 


wwoods2 on PRODPC68 with BILLS