II 

111TH CONGRESS 

1ST SESSION S. 1569 

To expand our Nation’s Advanced Practice Registered Nurse workforce. 

IN THE SENATE OF THE UNITED STATES 

AUGUST 3, 2009 

Ms. STABENOW introduced the following bill; which was read twice and 

referred to the Committee on Finance 

A BILL 

To expand our Nation’s Advanced Practice Registered Nurse 

workforce. 

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. 

4 This Act may be cited as the ‘‘Medicare Graduate 

5 Nursing Education Act’’. 

6 SEC. 2. MEDICARE PAYMENT FOR COSTS OF EXPANDED AD7 VANCED PRACTICE NURSE TRAINING PRO8 GRAMS. 

9 (a) IN GENERAL.—Section 1861(v) of the Social Se10 curity Act (42 U.S.C. 1395x(v)) is amended— 


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1 (1) in paragraph (1), by adding at the end the 

2 following new subparagraph: 

3 ‘‘(V) Such reasonable costs shall include hospital 

4 costs described in paragraph (9) for expanded advanced 

5 nurse practice training programs.’’; and 

6 (2) by adding at the end the following new 

7 paragraph: 

8 ‘‘(9)(A) For purposes of paragraph (1)(V), subject to 

9 subparagraphs (B) and (C), the costs described in this 

10 paragraph are educational costs (including faculty sala11 ries, student stipends (if any), clinical instruction costs, 

12 and other direct and indirect costs) of a hospital and affili13 ated schools and settings described in clause (ii) attrib14 utable to the training of advanced practice nurses— 

15 ‘‘(i) with the skills necessary to provide primary 

16 and preventive care, transitional care, chronic care 

17 management, and other nursing services appropriate 

18 for the population under this title; and 

19 ‘‘(ii) through affiliation with one or more ac20 credited schools of nursing (as defined in section 

21 801 of the Public Health Service Act) and in part22 nership with two or more non-hospital community23 based care settings where at least half of all clinical 

24 training occurs. 


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1 The Secretary may waive the community-based setting re2 quirement under clause (ii) for clinical training of ad3 vanced practice registered nurses, such as certified reg4 istered nurse anesthetists and certified nurse-midwives, in 

5 rural and medically underserved areas. 

6 ‘‘(B) Costs under this paragraph are limited to costs 

7 attributable to an increase in the enrollment and the num8 ber of advanced practice nurse graduates in each edu9 cation or training program over the comparable average 

10 number from 2006 to 2010 (as determined by the Sec11 retary) but shall not be offset or take into account tuition, 

12 fees, or State or local government appropriations. The pro13 portion of such costs paid under this paragraph shall be 

14 determined based on the proportion of the total inpatient 

15 days of the hospital attributable to this title. 

16 ‘‘(C) No payment shall be made under this paragraph 

17 to a hospital unless the hospital has in effect an agreement 

18 with the schools of nursing and settings described in sub19 paragraph (A)(ii) to pay from such payment to such a 

20 school or setting (through the school when the setting is 

21 arranged through the school) the costs of educational ac22 tivities described in subparagraph (A) attributable to each. 

23 ‘‘(D) In this paragraph, the term ‘advanced practice 

24 nurse’ includes a clinical nurse specialist, nurse practiVerDate Nov 24 2008 23:33 Aug 04, 2009 Jkt 079200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\S1569.IS S1569

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1 tioner, certified registered nurse anesthetist, and certified 

2 nurse midwife.’’. 

3 (b) EFFECTIVE DATE.—The amendments made by 

4 subsection (a) shall apply to costs incurred on or after 

5 January 1, 2012. 

Æ 


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