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Union Calendar No. 171 

116TH CONGRESS 

1ST SESSION H. R. 728 

[Report No. 116–216] 

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. 

IN THE HOUSE OF REPRESENTATIVES 

JANUARY 23, 2019 

Mr. JOYCE of Ohio (for himself, Ms. GABBARD, Mr. RODNEY DAVIS of Illinois, 

Ms. BONAMICI, Ms. MATSUI, Ms. CASTOR of Florida, Mr. MCKINLEY, 

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

to the Committee on Energy and Commerce 

SEPTEMBER 24, 2019 

Additional sponsors: Mr. FITZPATRICK, Ms. NORTON, Mr. COHEN, Ms. 

CLARKE of New York, Ms. BLUNT ROCHESTER, Mr. LIPINSKI, Ms. ROYBAL-ALLARD, Mr. DEFAZIO, Mr. POCAN, Mr. TAKANO, Mr. PAYNE, Mr. 

GALLEGO, Mr. KHANNA, Mr. PRICE of North Carolina, Mr. SABLAN, Mr. 

YOUNG, Mrs. WATSON COLEMAN, Mrs. BEATTY, Mr. RUSH, Mr. 

BRENDAN F. BOYLE of Pennsylvania, Mr. RYAN, Mr. LOEBSACK, Mr. 

AGUILAR, Mr. HECK, Ms. HERRERA BEUTLER, Mr. COURTNEY, Ms. 

JOHNSON of Texas, Mrs. DINGELL, Mr. YARMUTH, Mr. STIVERS, Mr. 

SEAN PATRICK MALONEY of New York, Mr. CARSON of Indiana, Ms. 

KUSTER of New Hampshire, Mr. TURNER, Mr. DESAULNIER, Ms. PINGREE, Mr. GONZALEZ of Ohio, Mr. CISNEROS, Ms. HILL of California, 

Mr. PAPPAS, Mr. JOHNSON of Georgia, Mr. COLE, Ms. WILD, Mr. 

O’HALLERAN, Mr. HIGGINS of New York, Mr. LAMBORN, Mr. KILMER, 

Ms. MCCOLLUM, Ms. MOORE, Ms. LOFGREN, Mr. VISCLOSKY, Mr. ROSE

of New York, Mr. TONKO, Mr. MOULTON, Mr. CASE, Mrs. NAPOLITANO, 

Mr. COOPER, Mr. LEWIS, Ms. SPEIER, Ms. JACKSON LEE, Mr. GOHMERT, Mr. RUPPERSBERGER, Mr. RUTHERFORD, Mr. THOMPSON of Mississippi, Mr. KIND, Mr. HARDER of California, Mr. KATKO, Mr. RASKIN, 

Mr. BEYER, Ms. MENG, Mr. WATKINS, Ms. FINKENAUER, Mrs. DAVIS

of California, Mr. SCHIFF, Mr. BILIRAKIS, Ms. CRAIG, Mr. GOLDEN, Ms. 

MUCARSEL-POWELL, Mr. KINZINGER, Ms. SCANLON, Mr. KENNEDY, 


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Mrs. LURIA, Ms. KAPTUR, Mr. GRIJALVA, Mr. THOMPSON of Pennsylvania, Ms. TITUS, Mr. VAN DREW, Ms. BARRAGA ́N, Mr. LUJA ́N, Ms. 

JUDY CHU of California, Ms. VELA ́ZQUEZ, Mr. STAUBER, Mr. MCGOVERN, Ms. DEGETTE, Ms. DAVIDS of Kansas, Ms. DELBENE, Mr. MICHAEL F. DOYLE of Pennsylvania, Mr. SUOZZI, Mr. KING of New York, 

Mr. MULLIN, Ms. LEE of California, Mr. DELGADO, Mr. BLUMENAUER, 

Miss RICE of New York, Mr. LAWSON of Florida, Mr. PERLMUTTER, Mr. 

ROUDA, Ms. FUDGE, Mr. CROW, Mr. ALLRED, Mr. LEVIN of California, 

Mr. CUMMINGS, Mr. TED LIEU of California, Mr. DAVID SCOTT of Georgia, Mr. CASTEN of Illinois, Mr. WALDEN, Ms. KENDRA S. HORN of 

Oklahoma, Mr. LYNCH, Mr. PETERS, Ms. SCHAKOWSKY, Mr. LARSON of 

Connecticut, Mr. MORELLE, and Ms. SPANBERGER

SEPTEMBER 24, 2019 

Reported with an amendment, committed to the Committee of the Whole 

House on the State of the Union, and ordered to be printed 

[Strike out all after the enacting clause and insert the part printed in italic] 

[For text of introduced bill, see copy of bill as introduced on January 23, 2019] 

A BILL 

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. 


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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; TABLE OF CONTENTS. 

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

5 ‘‘Title VIII Nursing Workforce Reauthorization Act of 

6 2019’’. 

7 (b) TABLE OF CONTENTS.—The table of contents of this 

8 Act is as follows: 

Sec. 1. Short title; table of contents. 

Sec. 2. General provisions. 

Sec. 3. Nurse practitioners, nurse midwives, nurse anesthetists, and other advanced education nurses. 

Sec. 4. Increasing nursing workforce diversity. 

Sec. 5. Strengthening capacity for basic nurse education and practice. 

Sec. 6. Student loans. 

Sec. 7. National Advisory Council on Nurse Education and Practice. 

Sec. 8. Other provisions. 

9 SEC. 2. GENERAL PROVISIONS. 

10 (a) APPLICATION.—Section 802(c) of the Public 

11 Health Service Act (42 U.S.C. 296a(c)) is amended by strik12 ing ‘‘shall address relevant national nursing needs that the 

13 project will meet’’ and inserting ‘‘shall address relevant na14 tional nursing needs that the project will address and how 

15 the project aligns with the national nursing service goals 

16 referred to in section 806(a)’’. 

17 (b) USE OF FUNDS.—Section 803 of the Public Health 

18 Service Act (42 U.S.C. 296b) is amended by adding at the 

19 end the following: 

20 ‘‘(c) SUPPLEMENT NOT SUPPLANT.—Funds awarded 

21 as a grant under this title for a project or activity shall 


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1 be used to supplement, not supplant, the non-Federal funds 

2 that would otherwise be made available for such project or 

3 activity.’’. 

4 (c) GENERALLY APPLICABLE PROVISIONS.—Section 

5 806 of the Public Health Service Act (42 U.S.C. 296e) is 

6 amended— 

7 (1) in subsection (b), by amending paragraph 

8 (2) to read as follows: 

9 ‘‘(2) EVALUATIONS.—The Secretary shall estab10 lish procedures to ensure the annual evaluation of 

11 programs and projects operated by recipients of 

12 grants under this title. Such procedures shall ensure 

13 that continued funding for such programs and 

14 projects will be conditioned upon the submission of— 

15 ‘‘(A) data demonstrating that satisfactory 

16 progress has been made by the program or 

17 project in meeting the performance outcome 

18 standards (as described in section 802) of such 

19 program or project; and 

20 ‘‘(B) a detailed description of activities con21 ducted by such program or project to meet such 

22 performance outcome standards.’’; 

23 (2) in subsection (e)(2), by inserting ‘‘, and have 

24 relevant expertise and experience’’ after ‘‘who are not 

25 officers or employees of the Federal Government’’; and 


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1 (3) by adding at the end the following: 

2 ‘‘(i) ANNUAL REPORT ON NURSING WORKFORCE PRO3 GRAMS.—Annually, the Secretary shall submit to the Com4 mittee on Health, Education, Labor, and Pensions of the 

5 Senate, and the Committee on Energy and Commerce of 

6 the House of Representatives, a report containing an assess7 ment of the programs and activities of the Department of 

8 Health and Human Services related to enhancing the nurs9 ing workforce, including the extent to which programs and 

10 activities under this title meet identified goals and perform11 ance measures developed for the respective programs and 

12 activities.’’. 

13 SEC. 3. NURSE PRACTITIONERS, NURSE MIDWIVES, NURSE 

14 ANESTHETISTS, AND OTHER ADVANCED EDU15 CATION NURSES. 

16 Section 811 of the Public Health Service Act (42 

17 U.S.C. 296j) is amended— 

18 (1) in subsection (b)— 

19 (A) by striking ‘‘R.N./Master’s’’ and insert20 ing ‘‘R.N./graduate’’; and 

21 (B) by inserting ‘‘clinical nurse leaders,’’ 

22 before ‘‘or public health nurses’’; 

23 (2) by redesignating subsections (f) and (g) as 

24 subsections (g) and (h), respectively; 


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1 (3) by inserting after subsection (e) the following 

2 new subsection: 

3 ‘‘(f) AUTHORIZED CLINICAL NURSE SPECIALIST PRO4 GRAMS.—Clinical nurse specialist programs eligible for 

5 support under this section are education programs that— 

6 ‘‘(1) provide registered nurses with full-time 

7 clinical nurse specialist education; and 

8 ‘‘(2) have as their objective the education of clin9 ical nurse specialists who will upon completion of 

10 such a program be qualified to effectively provide care 

11 through the wellness and illness continuum to inpa12 tients and outpatients experiencing acute and chronic 

13 illness.’’; and 

14 (4) by adding at the end the following: 

15 ‘‘(i) AUTHORIZATION OF APPROPRIATIONS.—There are 

16 authorized to be appropriated to carry out this section 

17 $77,585,000 for each of fiscal years 2020 through 2024.’’. 

18 SEC. 4. INCREASING NURSING WORKFORCE DIVERSITY. 

19 Section 821 of the Public Health Service Act (42 

20 U.S.C. 296m) is amended by adding at the end the fol21 lowing: 

22 ‘‘(d) AUTHORIZATION OF APPROPRIATIONS.—There 

23 are authorized to be appropriated to carry out this section 

24 $18,037,000 for each of fiscal years 2020 through 2024.’’. 


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1 SEC. 5. STRENGTHENING CAPACITY FOR BASIC NURSE EDU2 CATION AND PRACTICE. 

3 (a) NURSE EDUCATION, PRACTICE, QUALITY, AND RE4 TENTION GRANTS.—Section 831 of the Public Health Serv5 ice Act (42 U.S.C. 296p) is amended— 

6 (1) in the section heading, by striking ‘‘AND

7 QUALITY’’ and inserting ‘‘QUALITY, AND RETEN8 TION’’; 

9 (2) in subsection (b), by amending paragraph 

10 (2) to read as follows: 

11 ‘‘(2) providing care for underserved populations 

12 and high-risk groups, which may include the elderly, 

13 individuals with HIV/AIDS, individuals with mental 

14 health or substance use disorders, individuals who are 

15 homeless, and victims and survivors of domestic vio16 lence;’’; 

17 (3) in subsection (c), by amending paragraph 

18 (1) to read as follows: 

19 ‘‘(1) GRANTS FOR CAREER LADDER PRO20 GRAMS.—The Secretary may award grants to and 

21 enter into contracts with eligible entities for pro22 grams— 

23 ‘‘(A) to promote career advancement for— 

24 ‘‘(i) nursing personnel in a variety of 

25 training settings, cross training or specialty 

26 training among diverse population groups, 


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1 and the advancement of individuals, includ2 ing to become professional registered nurses, 

3 advanced practice registered nurses, and 

4 nurses with graduate nursing education; 

5 and 

6 ‘‘(ii) individuals, including licensed 

7 practical nurses, licensed vocational nurses, 

8 certified nurse assistants, and diploma de9 gree or associate degree nurses, to become 

10 baccalaureate-prepared registered nurses or 

11 nurses with graduate nursing education; 

12 ‘‘(B) to assist individuals in obtaining edu13 cation and training required to enter the nurs14 ing profession and advance within such profes15 sion, such as by providing career counseling and 

16 mentoring; and 

17 ‘‘(C) to develop and implement internships, 

18 accredited fellowships, and accredited residency 

19 programs in collaboration with one or more ac20 credited schools of nursing to encourage men21 toring and development of specialties.’’; 

22 (4) by striking subsection (e) (relating to pref23 erence); 

24 (5) by redesignating subsections (f) through (h) 

25 as subsections (e) and (g), respectively; 


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1 (6) in subsection (e), as so redesignated, by strik2 ing ‘‘The Secretary shall submit to the Congress before 

3 the end of each fiscal year a’’ and inserting ‘‘As part 

4 of the report on nursing workforce programs described 

5 in section 806(i), the Secretary shall’’; 

6 (7) by amending subsection (f), as redesignated 

7 by paragraph (5), to read as follows: 

8 ‘‘(f) DEFINITIONS.—For purposes of this section: 

9 ‘‘(1) ELIGIBLE ENTITY.—The term ‘eligible enti10 ty’ includes an accredited school of nursing, a health 

11 care facility, a partnership of such a school and facil12 ity, a federally qualified health center, or a nurse13 managed health clinic. 

14 ‘‘(2) NURSE-MANAGED HEALTH CLINIC.—The 

15 term ‘nurse-managed health clinic’ means a nurse16 practice arrangement, managed by advanced practice 

17 nurses, that provides primary care or wellness serv18 ices to underserved or vulnerable populations that is 

19 associated with a school, college, university or depart20 ment of nursing, federally qualified health center, or 

21 independent nonprofit health or social services agen22 cy.’’; and 

23 (8) in subsection (g), as redesignated by para24 graph (5), by striking ‘‘such sums as may be nec25 essary for each of fiscal years 2010 through 2014’’ 


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1 and inserting ‘‘$43,590,000 for each of fiscal years 

2 2020 through 2024’’. 

3 (b) NURSE RETENTION GRANTS.—Section 831A of the 

4 Public Health Service Act (42 U.S.C. 296p–1) is repealed. 

5 SEC. 6. STUDENT LOANS. 

6 (a) LOAN REPAYMENT AND SCHOLARSHIP PRO7 GRAMS.—Section 846 of the Public Health Service Act (42 

8 U.S.C. 297n) is amended— 

9 (1) in subsection (b)(1), by striking ‘‘he began 

10 such practice’’ and inserting ‘‘the individual began 

11 such practice’’; 

12 (2) in subsection (d)(1), by striking ‘‘(for fiscal 

13 years 2003 and 2004) and may (for fiscal years there14 after)’’; 

15 (3) in subsection (h), in the matter preceding 

16 paragraph (1), by striking ‘‘Not later than’’ through 

17 ‘‘regarding’’ and inserting ‘‘The annual report on 

18 nursing workforce programs, as required by section 

19 806(i), shall include information regarding the pro20 grams carried out under this section, including’’; and 

21 (4) in subsection (i)(1), by striking ‘‘such sums 

22 as may be necessary for each of fiscal years 2003 

23 through 2007’’ and inserting ‘‘$90,620,000 for each of 

24 fiscal years 2020 through 2024’’. 


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1 (b) NURSE FACULTY LOAN PROGRAM.—Section 

2 846A(f) of the Public Health Service Act (42 U.S.C. 297n– 

3 1(f)) is amended by striking ‘‘such sums as may be nec4 essary for each of fiscal years 2010 through 2014’’ and in5 serting ‘‘$29,640,000 for each of fiscal years 2020 through 

6 2024’’. 

7 SEC. 7. NATIONAL ADVISORY COUNCIL ON NURSE EDU8 CATION AND PRACTICE. 

9 Section 851 of the Public Health Service Act (42 

10 U.S.C. 297t) is amended— 

11 (1) in subsection (b)(1)(A)(iv), by striking ‘‘and 

12 nurse anesthetists’’ and inserting ‘‘nurse anesthetists, 

13 and clinical nurse specialists’’; 

14 (2) in subsection (d), by amending paragraph 

15 (3) to read as follows: 

16 ‘‘(3) not later than 2 years after the date of en17 actment of the Title VIII Nursing Workforce Reau18 thorization Act of 2019, and every 2 years thereafter, 

19 prepare and submit to the Secretary, the Committee 

20 on Health, Education, Labor, and Pensions of the 

21 Senate, and the Committee on Energy and Commerce 

22 of the House of Representatives, a report describing 

23 the activities of the Council, including findings and 

24 recommendations made by the Council concerning the 

25 activities under this title.’’; and 


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1 (3) in subsection (g), by striking ‘‘under this 

2 title’’ and inserting ‘‘for carrying out parts B, C, and 

3 D of this title’’. 

4 SEC. 8. OTHER PROVISIONS. 

5 (a) PUBLIC SERVICE ANNOUNCEMENTS.—Part G of 

6 title VIII of the Public Health Service Act (42 U.S.C. 297w 

7 et seq.) is repealed. 

8 (b) FUNDING.—Part I of title VIII of the Public Health 

9 Service Act (42 U.S.C. 298d) is repealed. 

10 (c) ELIMINATING LIMITATION ON ASSIGNMENT.—Sec11 tion 846(a) of the Public Health Service Act (42 U.S.C. 

12 297n(a)) is amended, in the matter following paragraph 

13 (3), by striking ‘‘After fiscal year 2007,’’ and all that fol14 lows through the period at the end. 


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Union Calendar No. 171 

116TH CONGRESS 

1ST SESSION H. R. 728 

[Report No. 116–216] 

A BILL 

To amend title VIII of the Public Health Service 

for other purposes. to support clinical nurse specialist programs, and Act to extend advanced education nursing grants 

SEPTEMBER 24, 2019 

Reported with an amendment, committed to the Comand ordered to be printed mittee of the Whole House on the State of the Union, 


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