PUBLIC LAW 107–205—AUG. 1, 2002 116 STAT. 811

Public Law 107–205

107th Congress

An Act

To amend the Public Health Service Act with respect to health professions programs

regarding the field of nursing.

Be it enacted by the Senate and House of Representatives of

the United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

This Act may be cited as the ‘‘Nurse Reinvestment Act’’.

SEC. 2. TABLE OF CONTENTS.

The table of contents for this Act is as follows:

Sec. 1. Short title.

Sec. 2. Table of contents.

TITLE I—NURSE RECRUITMENT

Sec. 101. Definitions.

Sec. 102. Public service announcements regarding the nursing profession.

Sec. 103. National Nurse Service Corps.

TITLE II—NURSE RETENTION

Sec. 201. Building career ladders and retaining quality nurses.

Sec. 202. Comprehensive geriatric education.

Sec. 203. Nurse faculty loan program.

Sec. 204. Reports by General Accounting Office.

TITLE I—NURSE RECRUITMENT

SEC. 101. DEFINITIONS.

Section 801 of the Public Health Service Act (42 U.S.C. 296)

is amended by adding at the end the following:

‘‘(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.

42 USC 201 note.

Nurse

Reinvestment

Act.

Aug. 1, 2002

[H.R. 3487]

116 STAT. 812 PUBLIC LAW 107–205—AUG. 1, 2002

‘‘(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.’’.

SEC. 102. PUBLIC SERVICE ANNOUNCEMENTS REGARDING THE

NURSING PROFESSION.

Title VIII of the Public Health Service Act (42 U.S.C. 296

et seq.) is amended by adding at the end the following:

‘‘PART H—PUBLIC SERVICE ANNOUNCEMENTS

‘‘SEC. 851. PUBLIC SERVICE ANNOUNCEMENTS.

‘‘(a) IN GENERAL.—The Secretary shall develop and issue public

service announcements that advertise and promote the nursing

profession, highlight the advantages and rewards of nursing, and

encourage individuals to enter the nursing profession.

‘‘(b) METHOD.—The public service announcements described in

subsection (a) shall be broadcast through appropriate media outlets,

including television or radio, in a manner intended to reach as

wide and diverse an audience as possible.

‘‘(c) 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 2003 through 2007.

‘‘SEC. 852. STATE AND LOCAL PUBLIC SERVICE ANNOUNCEMENTS.

‘‘(a) IN GENERAL.—The Secretary may award grants to eligible

entities to support State and local advertising campaigns through

appropriate media outlets to promote the nursing profession, highlight the advantages and rewards of nursing, and encourage individuals from disadvantaged backgrounds to enter the nursing profession.

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

under subsection (a) shall use funds received through such grant

to acquire local television and radio time, place advertisements

in local newspapers, or post information on billboards or on the

Internet in a manner intended to reach as wide and diverse an

audience as possible, in order to—

‘‘(1) advertise and promote the nursing profession;

‘‘(2) promote nursing education programs;

‘‘(3) inform the public of financial assistance regarding

such education programs;

‘‘(4) highlight individuals in the community who are practicing nursing in order to recruit new nurses; or

‘‘(5) provide any other information to recruit individuals

for the nursing profession.

‘‘(c) LIMITATION.—An eligible entity that receives a grant under

subsection (a) shall not use funds received through such grant

to advertise particular employment opportunities.

‘‘(d) 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 2003 through 2007.’’.

42 USC 297x.

42 USC 297w.

PUBLIC LAW 107–205—AUG. 1, 2002 116 STAT. 813

SEC. 103. NATIONAL NURSE SERVICE CORPS.

(a) LOAN REPAYMENT PROGRAM.—Section 846(a) of the Public

Health Service Act (42 U.S.C. 297n(a)) is amended— (1) in paragraph (3), by striking ‘‘in an Indian Health

Service health center’’ and all that follows to the semicolon

and inserting ‘‘at a health care facility with a critical shortage

of nurses’’; and

(2) by adding at the end the following: ‘‘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) ESTABLISHMENT OF SCHOLARSHIP PROGRAM.—Section 846

of the Public Health Service Act (42 U.S.C. 297n) is amended— (1) in the heading for the section, by striking ‘‘LOAN REPAY- MENT PROGRAM’’ and inserting ‘‘LOAN REPAYMENT AND SCHOLAR- SHIP PROGRAMS’’;

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

subsections (f), (h), (i), and (g), respectively;

(3) by transferring subsections (f) and (g) (as so redesignated) from their current placements, by inserting subsection

(f) after subsection (e), and by inserting subsection (g) after

subsection (f) (as so inserted); and

(4) by inserting after subsection (c) the following 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

Contracts.

116 STAT. 814 PUBLIC LAW 107–205—AUG. 1, 2002

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.’’.

(c) PREFERENCE.—Section 846(e) of the Public Health Service

Act (42 U.S.C. 297n(e)) is amended by striking ‘‘under subsection

(a)’’ and all that follows through the period and inserting ‘‘under

subsection (a) or (d), the Secretary shall give preference to qualified

applicants with the greatest financial need.’’.

(d) REPORTS.—Subsection (h) of section 846 of the Public Health

Service Act (42 U.S.C. 297n) (as redesignated by subsection (b)(2))

is amended to read as follows:

‘‘(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.’’.

(e) FUNDING.—Subsection (i) of section 846 of the Public Health

Service Act (42 U.S.C. 297n) (as redesignated by subsection (b)(2))

is amended to read as follows:

‘‘(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.

‘‘(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).’’.

Deadline.

PUBLIC LAW 107–205—AUG. 1, 2002 116 STAT. 815

TITLE II—NURSE RETENTION

SEC. 201. BUILDING CAREER LADDERS AND RETAINING QUALITY

NURSES.

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

is amended to read as follows:

‘‘SEC. 831. NURSE EDUCATION, PRACTICE, AND RETENTION 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;

‘‘(2) developing and implementing internship and residency

programs to encourage mentoring and the development of

specialties; or

‘‘(3) 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 managed care, quality improvement, 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

116 STAT. 816 PUBLIC LAW 107–205—AUG. 1, 2002

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, 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 2003 through 2007.’’.

SEC. 202. COMPREHENSIVE GERIATRIC EDUCATION.

(a) COMPREHENSIVE GERIATRIC EDUCATION.—Title VIII of the

Public Health Service Act (42 U.S.C. 296 et seq.) (as amended

by section 102) is amended by adding at the end the following:

‘‘PART I—COMPREHENSIVE GERIATRIC

EDUCATION

‘‘SEC. 855. 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; or

‘‘(4) provide continuing education to individuals who provide geriatric care.

Grants.

42 USC 298.

Deadline.

PUBLIC LAW 107–205—AUG. 1, 2002 116 STAT. 817

‘‘(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 2003 through 2007.’’. (b) TECHNICAL AMENDMENT.—Section 753(a)(1) of the Public

Health Service Act (42 U.S.C. 294c) is amended by striking ‘‘, and section 853(2),’’ and inserting ‘‘, and section 801(2),’’.

SEC. 203. NURSE FACULTY LOAN PROGRAM.

Part E of title VIII of the Public Health Service Act (42 U.S.C.

297a et seq.) is amended by inserting after section 846 the following:

‘‘NURSE FACULTY LOAN PROGRAM

‘‘SEC. 846A. (a) ESTABLISHMENT.—The Secretary, acting

through the Administrator of the Health Resources and Services

Administration, may enter into an agreement with any 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

42 USC 297n–1.

116 STAT. 818 PUBLIC LAW 107–205—AUG. 1, 2002

(a) may not exceed $30,000, plus any amount determined by

the Secretary on an annual basis to reflect inflation; ‘‘(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 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 a 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 2003 through 2007.’’.

SEC. 204. REPORTS BY GENERAL ACCOUNTING OFFICE.

(a) NATIONAL VARIATIONS.—Not later than 4 years after the

date of the enactment of this Act, the Comptroller General of

the United States shall conduct a survey to determine national

variations in the nursing shortage at hospitals, nursing homes,

and other health care providers, and submit a report, including

recommendations, to the Congress on Federal remedies to ease

nursing shortages. The Comptroller General shall submit to the

Deadlines.

42 USC 296 note.

PUBLIC LAW 107–205—AUG. 1, 2002 116 STAT. 819

LEGISLATIVE HISTORY—H.R. 3487:

CONGRESSIONAL RECORD:

Vol. 147 (2001): Dec. 19, 20, considered and passed House.

Vol. 148 (2002): July 22, considered and passed Senate, amended. House

concurred in Senate amendment.

Æ

Congress this report describing the findings relating to ownership

status and associated remedies.

(b) HIRING DIFFERENCES AMONG CERTAIN PRIVATE ENTITIES.—

The Comptroller General of the United States shall conduct a

study to determine differences in the hiring of nurses by nonprofit

private entities as compared to the hiring of nurses by private

entities that are not nonprofit. In carrying out the study, the

Comptroller General shall determine the effect of the inclusion

of private entities that are not nonprofit in the program under

section 846 of the Public Health Service Act. Not later than 4

years after the date of the enactment of this Act, the Comptroller

General shall submit to the Congress a report describing the

findings of the study.

(c) NURSING SCHOLARSHIPS.—The Comptroller General of the

United States shall conduct an evaluation of whether the program

carried out under section 846(d) of the Public Health Service Act

has demonstrably increased the number of applicants to schools

of nursing and, not later than 4 years after the date of the enactment of this Act, submit a report to the Congress on the results

of such evaluation.

Approved August 1, 2002.