Calendar No. 623

103D CONGRESS

2D SESSION S. 2433

[Report No. 103–373]

A BILL

To amend title VIII of the Public Health Service

purposes.cation programs under such title, and for otherAct to consolidate and reauthorize nursing eduSEPTEMBER 23 (legislative day, SEPTEMBER 12), 1994

Reported with an amendment
II

Calendar No. 623

103D CONGRESS

2D SESSION S. 2433

[Report No. 103–373]

To amend title VIII of the Public Health Service Act to consolidate and

reauthorize nursing education programs under such title, and for other

purposes.

IN THE SENATE OF THE UNITED STATES

SEPTEMBER 13 (legislative day, SEPTEMBER 12), 1994

Mr. KENNEDY (for himself and Mrs. KASSEBAUM) introduced the following

bill; which was read twice and referred to the Committee on Labor and

Human Resources

SEPTEMBER 23 (legislative day, SEPTEMBER 12), 1994

Reported by Mr. KENNEDY, with an amendment

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

A BILL

To amend title VIII of the Public Health Service Act to

consolidate and reauthorize nursing education programs

under such title, 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,
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1 SECTION 1. SHORT TITLE.

2 This Act may be cited as the ‘‘Nursing Education

3 Consolidation and Reauthorization Act of 1994’’.

4 SEC. 2. PURPOSE.

5 It is the purpose of this Act to restructure the nurse

6 education authorities of title VIII of the Public Health

7 Service Act to permit a comprehensive, flexible, and effec8 tive approach to Federal support for nursing workforce

9 development.

10 SEC. 3. AMENDMENTS TO PUBLIC HEALTH SERVICE ACT.

11 Title VIII of the Public Health Service Act (42

12 U.S.C. 296k et seq.) is amended—

13 (1) by striking the title heading and all that fol14 lows except for subparts II and III of part B and

15 section 855; and inserting the following:

16 ‘‘TITLE VIII—NURSING

17 WORKFORCE DEVELOPMENT’’;

18 (2) in subpart II of part B, by striking the sub19 part heading and inserting the following:

20 ‘‘PART E—STUDENT LOANS

21 ‘‘Subpart I—General Program’’;

22 (3) by redesignating subpart III as subpart II;

23 (4) by striking section 837;

24 (5) in section 846, by striking subsection (d)

25 and inserting the following new subsection:
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1 ‘‘(d) BREACH OF AGREEMENTS FOR OBLIGATED

2 SERVICE.—

3 ‘‘(1) IN GENERAL.—In the case of any program

4 under this section under which an individual makes

5 an agreement to provide health services for a period

6 of time in accordance with such program in consid7 eration of receiving an award of Federal funds re8 garding education as a nurse (including an award

9 for the repayment of loans), the following applies if

10 the agreement provides that this subsection is appli11 cable:

12 ‘‘(A) In the case of a program under this

13 section that makes an award of Federal funds

14 for attending an accredited program of nursing

15 (in this subsection referred to as a ‘nursing pro16 gram’), the individual is liable to the Federal

17 Government for the amount of such award (in18 cluding amounts provided for expenses related

19 to such attendance), and for interest on such

20 amount at the maximum legal prevailing rate,

21 if the individual—

22 ‘‘(i) fails to maintain an acceptable

23 level of academic standing in the nursing

24 program (as indicated by the program in
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1 accordance with requirements established

2 by the Secretary);

3 ‘‘(ii) is dismissed from the nursing

4 program for disciplinary reasons; or

5 ‘‘(iii) voluntarily terminates the nurs6 ing program.

7 ‘‘(B) The individual is liable to the Federal

8 Government for the amount of such award (in9 cluding amounts provided for expenses related

10 to such attendance), and for interest on such

11 amount at the maximum legal prevailing rate,

12 if the individual fails to provide health services

13 in accordance with the program under this sec14 tion for the period of time applicable under the

15 program.

16 ‘‘(2) WAIVER OR SUSPENSION OF LIABILITY.—

17 In the case of an individual or health facility making

18 an agreement for purposes of paragraph (1), the

19 Secretary shall provide for the waiver or suspension

20 of liability under such paragraph if compliance by

21 the individual or the health facility, as the case may

22 be, with the agreements involved is impossible, or

23 would involve extreme hardship to the individual or

24 facility, and if enforcement of the agreements with
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1 respect to the individual or facility would be uncon2 scionable.

3 ‘‘(3) DATE CERTAIN FOR RECOVERY.—Subject

4 to paragraph (2), any amount that the Federal Gov5 ernment is entitled to recover under paragraph (1)

6 shall be paid to the United States not later than the

7 expiration of the 3-year period beginning on the date

8 the United States becomes so entitled.

9 ‘‘(4) AVAILABILITY.—Amounts recovered under

10 paragraph (1) with respect to a program under this

11 section shall be available for the purposes of such

12 program, and shall remain available for such pur13 poses until expended.’’;

14 (6) by inserting after the title heading the fol15 lowing new parts:

16 ‘‘PART A—GENERAL PROVISIONS

17 ‘‘SEC. 801. DEFINITIONS.

18 ‘‘As used in this title:

19 ‘‘(1) ELIGIBLE ENTITIES.—The term ‘eligible

20 entities’ means schools of nursing, nursing centers,

21 State or local governments, and other public or non22 profit private entities determined appropriate by the

23 Secretary that submit to the Secretary an applica24 tion in accordance with section 802.
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1 ‘‘(2) SCHOOL OF NURSING.—The term ‘school

2 of nursing’ means a collegiate, associate degree, or

3 diploma school of nursing in a State.

4 ‘‘(3) COLLEGIATE SCHOOL OF NURSING.—The

5 term ‘collegiate school of nursing’ means a depart6 ment, division, or other administrative unit in a col7 lege or university which provides primarily or exclu8 sively a program of education in professional nursing

9 and related subjects leading to the degree of bach10 elor of arts, bachelor of science, bachelor of nursing,

11 or to an equivalent degree, or to a graduate degree

12 in nursing, and including advanced training related

13 to such program of education provided by such

14 school, but only if such program, or such unit, col15 lege or university is accredited.

16 ‘‘(4) ASSOCIATE DEGREE SCHOOL OF NURS17 ING.—The term ‘associate degree school of nursing’

18 means a department, division, or other administra19 tive unit in a junior college, community college, col20 lege, or university which provides primarily or exclu21 sively a two-year program of education in profes22 sional nursing and allied subjects leading to an asso23 ciate degree in nursing or to an equivalent degree,

24 but only if such program, or such unit, college, or

25 university is accredited.
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1 ‘‘(5) DIPLOMA SCHOOL OF NURSING.—The

2 term ‘diploma school of nursing’ means a school af3 filiated with a hospital or university, or an independ4 ent school, which provides primarily or exclusively a

5 program of education in professional nursing and al6 lied subjects leading to a diploma or to equivalent

7 indicia that such program has been satisfactorily

8 completed, but only if such program, or such affili9 ated school or such hospital or university or such

10 independent school is accredited.

11 ‘‘(6) ACCREDITED.—

12 ‘‘(A) IN GENERAL.—Except as provided in

13 subparagraph (B), the term ‘accredited’ when

14 applied to any program of nurse education

15 means a program accredited by a recognized

16 body or bodies, or by a State agency, approved

17 for such purpose by the Secretary of Education

18 and when applied to a hospital, school, college,

19 or university (or a unit thereof) means a hos20 pital, school, college, or university (or a unit

21 thereof) which is accredited by a recognized

22 body or bodies, or by a State agency, approved

23 for such purpose by the Secretary of Education.

24 For the purpose of this paragraph, the Sec25 retary of Education shall publish a list of recog-
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1 nized accrediting bodies, and of State agencies,

2 which the Secretary of Education determines to

3 be reliable authority as to the quality of edu4 cation offered.

5 ‘‘(B) NEW PROGRAMS.—A new school of

6 nursing that, by reason of an insufficient period

7 of operation, is not, at the time of the submis8 sion of an application for a grant or contract

9 under this title, eligible for accreditation by

10 such a recognized body or bodies or State agen11 cy, shall be deemed accredited for purposes of

12 this title if the Secretary of Education finds,

13 after consultation with the appropriate accredi14 tation body or bodies, that there is reasonable

15 assurance that the school will meet the accredi16 tation standards of such body or bodies prior to

17 the beginning of the academic year following

18 the normal graduation date of students of the

19 first entering class in such school.

20 ‘‘(7) NONPROFIT.—The term ‘nonprofit’ as ap21 plied to any school, agency, organization, or institu22 tion means one which is a corporation or association,

23 or is owned and operated by one or more corpora24 tions or associations, no part of the net earnings of
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1 which inures, or may lawfully inure, to the benefit

2 of any private shareholder or individual.

3 ‘‘(8) STATE.—The term ‘State’ means a State,

4 the Commonwealth of Puerto Rico, the District of

5 Columbia, the Commonwealth of the Northern Mari6 ana Islands, Guam, American Samoa, the Virgin Is7 lands, or the Trust Territory of the Pacific Islands.

8 ‘‘SEC. 802. APPLICATION.

9 ‘‘(a) IN GENERAL.—To be eligible to receive a grant

10 or contract under this title, an eligible entity shall prepare

11 and submit to the Secretary an application that meets the

12 requirements of this section, at such time, in such manner,

13 and containing such information as the Secretary may re14 quire.

15 ‘‘(b) PLAN.—An application submitted under this

16 section shall contain the plan of the applicant for carrying

17 out a project with amounts received under this title. Such

18 plan shall be consistent with relevant Federal, State, or

19 regional program plans.

20 ‘‘(c) PERFORMANCE OUTCOME STANDARDS.—An ap21 plication submitted under this section shall contain a spec22 ification by the applicant entity of performance outcome

23 standards that the project to be funded under the grant

24 or contract will be measured against. Such standards shall

25 address relevant national nursing needs that the project
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1 will meet. The recipient of a grant or contract under this

2 section shall meet the standards set forth in the grant or

3 contract application.

4 ‘‘(d) LINKAGES.—An application submitted under

5 this section shall contain a description of the linkages with

6 relevant educational and health care entities, including

7 training programs for other health professionals as appro8 priate, that the project to be funded under the grant or

9 contract will establish.

10 ‘‘SEC. 803. USE OF FUNDS.

11 ‘‘(a) IN GENERAL.—Amounts provided under a grant

12 or contract awarded under this title may be used for train13 ing program development and support, faculty develop14 ment, model demonstrations, trainee support including

15 tuition, books, program fees and reasonable living ex16 penses during the period of training, technical assistance,

17 workforce analysis, and dissemination of information, as

18 appropriate to meet recognized nursing objectives, in ac19 cordance with this title.

20 ‘‘(b) MAINTENANCE OF EFFORT.—With respect to

21 activities for which a grant awarded under this title is to

22 be expended, the entity shall agree to maintain expendi23 tures of non-Federal amounts for such activities at a level

24 that is not less than the level of such expenditures main-
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1 tained by the entity for the fiscal year preceding the fiscal

2 year for which the entity receives such a grant.

3 ‘‘SEC. 804. MATCHING REQUIREMENT.

4 ‘‘The Secretary may require that an entity that ap5 plies for a grant or contract under this title provide non6 Federal matching funds, as appropriate, to ensure the in7 stitutional commitment of the entity to the projects funded

8 under the grant. Such non-Federal matching funds may

9 be provided directly or through donations from public or

10 private entities and may be in cash or in-kind, fairly evalu11 ated, including plant, equipment, or services.

12 ‘‘SEC. 805. PREFERENCE.

13 ‘‘In awarding grants or contracts under this title, the

14 Secretary shall give preference to applicants with projects

15 that will substantially benefit rural or underserved popu16 lations.

17 ‘‘SEC. 806. GENERALLY APPLICABLE PROVISIONS.

18 ‘‘(a) AWARDING OF GRANTS AND CONTRACTS.—The

19 Secretary shall ensure that grants and contracts under

20 this title are awarded on a competitive basis to carry out

21 innovative demonstration projects or provide for strategic

22 workforce supplementation activities as needed to meet

23 national nursing service goals and in accordance with this

24 title.
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1 ‘‘(b) INFORMATION REQUIREMENTS.—Recipients of

2 grants and contracts under this title shall meet informa3 tion requirements as specified by the Secretary.

4 ‘‘(c) TRAINING PROGRAMS.—Training programs con5 ducted with amounts received under this title shall meet

6 applicable accreditation and quality standards.

7 ‘‘(d) DURATION OF ASSISTANCE.—

8 ‘‘(1) IN GENERAL.—Subject to paragraph (2),

9 in the case of an award to an entity of a grant, co10 operative agreement, or contract under this title, the

11 period during which payments are made to the en12 tity under the award may not exceed 5 years. The

13 provision of payments under the award shall be sub14 ject to annual approval by the Secretary of the pay15 ments and subject to the availability of appropria16 tions for the fiscal year involved to make the pay17 ments. This paragraph may not be construed as lim18 iting the number of awards under the program in19 volved that may be made to the entity.

20 ‘‘(2) LIMITATION.—In the case of an award to

21 an entity of a grant, cooperative agreement, or con22 tract under this title, paragraph (1) shall apply only

23 to the extent not inconsistent with any other provi24 sion of this title that relates to the period during

25 which payments may be made under the award.
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1 ‘‘(e) PEER REVIEW REGARDING CERTAIN PRO2 GRAMS.—Each application for a grant under this title, ex3 cept advanced nurse traineeship grants under section

4 811(e), shall be submitted to a peer review group for an

5 evaluation of the merits of the proposals made in the ap6 plication. The Secretary may not approve such an applica7 tion unless a peer review group has recommended the ap8 plication for approval. Each peer review group under this

9 subsection shall be composed principally of individuals who

10 are not officers or employees of the Federal Government.

11 This subsection shall be carried out by the Secretary act12 ing through the Administrator of the Health Resources

13 and Services Administration.

14 ‘‘SEC. 807. NATIONAL ADVISORY COUNCIL ON NURSE EDU15 CATION AND PRACTICE.

16 ‘‘(a) ESTABLISHMENT.—There is hereby established

17 a National Advisory Council on Nurse Education and

18 Practice (in this section referred to as the ‘Council’), con19 sisting of the Secretary or the delegate of the Secretary

20 (who shall be an ex officio member and shall serve as the

21 Chairperson), and 15 members appointed by the Secretary

22 without regard to the Federal civil service laws, of which—

23 ‘‘(1) 2 shall be selected from full-time students

24 enrolled in schools of nursing;

25 ‘‘(2) 3 shall be selected from the general public;
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1 ‘‘(3) 2 shall be selected from practicing profes2 sional nurses; and

3 ‘‘(4) 8 shall be selected from among the leading

4 authorities in the various fields of nursing, higher,

5 and secondary education, and from representatives

6 of hospitals and other institutions and organizations

7 which provide nursing services.

8 A majority of the members shall be nurses. The student9 members of the Council shall be appointed for terms of

10 one year and shall be eligible for reappointment to the

11 Council.

12 ‘‘(b) DUTIES.—The Council shall advise the Sec13 retary in the preparation of general regulations and with

14 respect to policy matters arising in the administration of

15 this title, including the range of issues relating to nurse

16 supply, education and practice improvement.

17 ‘‘(c) FUNDING.—Amounts appropriated under this

18 title may be utilized by the Secretary to support the nurse

19 education and practice activities of the Council.

20 ‘‘SEC. 808. TECHNICAL ASSISTANCE.

21 ‘‘Funds appropriated under this title may be used by

22 the Secretary to provide technical assistance in relation

23 to any of the authorities under this title.
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1 ‘‘SEC. 809. RECOVERY FOR CONSTRUCTION ASSISTANCE.

2 ‘‘(a) IN GENERAL.—If at any time within 20 years

3 (or within such shorter period as the Secretary may pre4 scribe by regulation for an interim facility) after the com5 pletion of construction of a facility with respect to which

6 funds have been paid under subpart I of part A (as such

7 subpart was in effect on September 30, 1985)—

8 ‘‘(1) the owner of the facility ceases to be a

9 public or nonprofit school,

10 ‘‘(2) the facility ceases to be used for the train11 ing purposes for which it was constructed, or

12 ‘‘(3) the facility is used for sectarian instruction

13 or as a place for religious worship,

14 the United States shall be entitled to recover from the

15 owner of the facility the base amount prescribed by sub16 section (c)(1) plus the interest (if any) prescribed by sub17 section (c)(2).

18 ‘‘(b) NOTICE OF CHANGE IN STATUS.—The owner of

19 a facility which ceases to be a public or nonprofit school

20 as described in paragraph (1) of subsection (a), or the

21 owner of a facility the use of which changes as described

22 in paragraph (2) or (3) of such subsection shall provide

23 the Secretary written notice of such cessation or change

24 of use within 10 days after the date on which such ces25 sation or change of use occurs or within 30 days after
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1 the date of enactment of the Health Professions Training

2 Assistance Act of 1985, whichever is later.

3 ‘‘(c) AMOUNT OF RECOVERY.—

4 ‘‘(1) BASE AMOUNT.—The base amount that

5 the United States is entitled to recover under sub6 section (a) is the amount bearing the same ratio to

7 the then value (as determined by the agreement of

8 the parties or in an action brought in the district

9 court of the United States for the district in which

10 the facility is situated) of the facility as the amount

11 of the Federal participation bore to the cost of the

12 construction.

13 ‘‘(2) INTEREST.—

14 ‘‘(A) IN GENERAL.—The interest that the

15 United States is entitled to recover under sub16 section (a) is the interest for the period (if any)

17 described in subparagraph (B) at a rate (deter18 mined by the Secretary) based on the average

19 of the bond equivalent rates of 91-day Treasury

20 bills auctioned during such period.

21 ‘‘(B) TIME PERIOD.—The period referred

22 to in subparagraph (A) is the period begin23 ning—

24 ‘‘(i) if notice is provided as prescribed

25 by subsection (b), 191 days after the date
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1 on which the owner of the facility ceases to

2 be a public or nonprofit school as described

3 in paragraph (1) of subsection (a), or 191

4 days after the date on which the use of the

5 facility changes as described in paragraph

6 (2) or (3) of such subsection, or

7 ‘‘(ii) if notice is not provided as pre8 scribed by subsection (b), 11 days after the

9 date on which such cessation or change of

10 use occurs,

11 and ending on the date the amount the United

12 States is entitled to recover if collected.

13 ‘‘(d) WAIVER OF RIGHTS.—The Secretary may waive

14 the recovery rights of the United States under subsection

15 (a)(2) with respect to a facility (under such conditions as

16 the Secretary may establish by regulation) if the Secretary

17 determines that there is good cause for waiving such

18 rights.

19 ‘‘(e) LIMITATION ON LIENS.—The right of recovery

20 of the United States under subsection (a) shall not, prior

21 to judgment, constitute a lien on any facility.
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1 ‘‘PART B—NURSE PRACTITIONERS, NURSE MID2 WIVES, AND OTHER ADVANCED PRACTICE

3 NURSES

4 ‘‘SEC. 811. ADVANCED PRACTICE NURSING GRANTS.

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

6 to and enter into contracts with eligible entities to meet

7 the costs of—

8 ‘‘(1) projects that support the enhancement of

9 advanced practice nursing education; and

10 ‘‘(2) traineeships for individuals in advanced

11 practice nursing programs.

12 ‘‘(b) DEFINITION OF ADVANCED PRACTICE

13 NURSES .—For purposes of this section, the term ‘ad14 vanced practice nurses’ means individuals trained in ad15 vanced degree programs, post-nursing master’s certificate

16 programs, or, in the case of nurse midwives or nurse anes17 thetists, in certificate programs that received funding

18 under this title on the date that is one day prior to the

19 date of enactment of this section, to serve as nurse practi20 tioners, nurse midwives, nurse anesthetists, nurse edu21 cators, or public health nurses, or in other nurse special22 ties determined by the secretary to require advanced edu23 cation.

24 ‘‘(c) AUTHORIZED NURSE PRACTITIONER AND

25 NURSE-MIDWIFERY PROGRAMS.—
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1 ‘‘(1) IN GENERAL.—Nurse practitioner and

2 nurse midwifery programs eligible for support under

3 this section are educational programs for registered

4 nurses (irrespective of the type of school of nursing

5 in which the nurses received their training) that—

6 ‘‘(A) meet guidelines prescribed by the

7 Secretary in accordance with paragraph (2);

8 and

9 ‘‘(B) have as their objective the education

10 of nurses who will upon completion of their

11 studies in such programs, be qualified to effec12 tively provide primary health care, including

13 primary health care in homes and in ambula14 tory care facilities, long-term care facilities and

15 other health care institutions.

16 ‘‘(2) GUIDELINES.—After consultation with ap17 propriate educational organizations and professional

18 nursing and medical organizations, the Secretary

19 shall prescribe guidelines for programs described in

20 paragraph (1). Such guidelines shall, as a minimum,

21 require that such a program—

22 ‘‘(A) extend for at least one academic year

23 and consist of—
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1 ‘‘(i) supervised clinical practice di2 rected toward preparing nurses to deliver

3 primary health care; and

4 ‘‘(ii) at least four months (in the ag5 gregate) of classroom instruction that is so

6 directed; and

7 ‘‘(B) have an enrollment of not less than

8 six full-time equivalent students.

9 ‘‘(d) OTHER AUTHORIZED EDUCATIONAL PRO10 GRAMS.—The Secretary shall prescribe guidelines as ap11 propriate for other advanced practice nurse education pro12 grams eligible for support under this section.

13 ‘‘(e) TRAINEESHIPS.—

14 ‘‘(1) IN GENERAL.—The Secretary may not

15 award a grant to an applicant under subsection (a)

16 unless the applicant involved agrees that

17 traineeships provided with the grant will pay all or

18 part of the costs of—

19 ‘‘(A) the tuition, books, and fees of the

20 program of advanced nursing practice with re21 spect to which the traineeship is provided; and

22 ‘‘(B) the reasonable living expenses of the

23 individual during the period for which the

24 traineeship is provided.
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1 ‘‘(2) DOCTORAL PROGRAMS.—The Secretary

2 may not obligate more than 10 percent of the

3 traineeships under subsection (a) for individuals in

4 doctorate degree programs.

5 ‘‘(3) SPECIAL CONSIDERATION.—In making

6 awards of grants and contracts under subsection

7 (a)(2), the Secretary shall give special consideration

8 to an eligible entity that agrees to expend the award

9 to train advanced practice nurses who will practice

10 in health professional shortage areas designated

11 under section 332.

12 ‘‘(f) AUTHORIZATION OF APPROPRIATIONS.—

13 ‘‘(1) IN GENERAL.—There are authorized to be

14 appropriated to carry out this section, $50,000,000

15 for fiscal year 1995, and such sums as may be nec16 essary for each of the fiscal years 1996 and 1997.

17 ‘‘(2) SET ASIDES.—Of the amount appropriated

18 under paragraph (1) for a fiscal year—

19 ‘‘(A) not less than 60 percent of such

20 amount shall be made available for projects to

21 enhance the training and practice of nurse

22 practitioners and nurse midwives; and

23 ‘‘(B) not less than 6 percent of such

24 amounts shall be made available for projects to
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1 enhance the training and practice of nurse an2 esthetists.

3 ‘‘PART C—INCREASING NURSING WORKFORCE

4 DIVERSITY

5 ‘‘SEC. 821. WORKFORCE DIVERSITY GRANTS.

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

7 to and enter into contracts with eligible entities to meet

8 the costs of special projects to increase nursing education

9 opportunities for individuals who are from disadvantaged

10 racial and ethnic backgrounds underrepresented among

11 registered nurses by providing student scholarships or sti12 pends, pre-entry preparation, and retention activities.

13 ‘‘(b) GUIDANCE.—In carrying out subsection (a), the

14 Secretary shall take into consideration the recommenda15 tions of the First and Second Invitational Congresses for

16 Minority Nurse Leaders on ‘Caring for the Emerging Ma17 jority,’ in 1992 and 1993, and consult with nursing asso18 ciations including the American Nurses Association, the

19 National League of Nursing, the Association of American

20 Colleges of Nursing, and the Black Nurses Association.

21 ‘‘(c) REQUIRED INFORMATION AND CONDITIONS FOR

22 AWARD RECIPIENTS.—

23 ‘‘(1) IN GENERAL.—Recipients of awards under

24 this section may be required, where requested, to re25 port to the Secretary concerning the annual admis-
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1 sion, retention, and graduation rates for ethnic and

2 racial minorities in the school or schools involved in

3 the projects.

4 ‘‘(2) FALLING RATES.—If any of the rates re5 ported under paragraph (1) fall below the average of

6 the two previous years, the grant or contract recipi7 ent shall provide the Secretary with plans for imme8 diately improving such rates.

9 ‘‘(3) INELIGIBILITY.—A recipient described in

10 paragraph (2) shall be ineligible for continued fund11 ing under this section if the plan of the recipient

12 fails to improve the rates within the 1-year period

13 beginning on the date such plan is implemented.

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

15 are authorized to be appropriated to carry out this section,

16 $5,000,000 for fiscal year 1995, and such sums as may

17 be necessary for each of the fiscal years 1996 and 1997.

18 ‘‘PART D—STRENGTHENING CAPACITY FOR

19 BASIC NURSE EDUCATION AND PRACTICE

20 ‘‘SEC. 831. BASIC NURSE EDUCATION AND PRACTICE

21 GRANTS.

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

23 to and enter into contracts with eligible entities for

24 projects to strengthen capacity for basic nurse education

25 and practice.
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1 ‘‘(b) PRIORITY AREAS.—In awarding grants or con2 tracts under this section the Secretary shall give priority

3 to entities that will use amounts provided under such a

4 grant or contract to enhance the education mix and utili5 zation of the basic nursing workforce by strengthening

6 programs that provide basic nurse education for purposes

7 of—

8 ‘‘(1) improving nursing services in schools and

9 other community settings;

10 ‘‘(2) providing care for underserved populations

11 and other high-risk groups such as the elderly, indi12 viduals with HIV-AIDS, substance abusers, home13 less, and battered women;

14 ‘‘(3) providing case management, quality im15 provement, delegation and supervision, other skills

16 needed under new health care systems;

17 ‘‘(4) developing cultural competencies among

18 nurses;

19 ‘‘(5) providing emergency health services;

20 ‘‘(6) promoting career mobility for nursing per21 sonnel in a variety of training settings cross training

22 or specialty training, and among diverse population

23 groups; or

24 ‘‘(7) other priority areas as determined by the

25 Secretary.
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1 ‘‘(c) AUTHORIZATION OF APPROPRIATIONS.—There

2 are authorized to be appropriated to carry out this section,

3 $12,000,000 for fiscal year 1995, and such sums as may

4 be necessary for each of the fiscal years 1996 and 1997.’’;

5 and

6 (7) by redesignating section 855 as section 808,

7 and transferring such section so as to appear after

8 section 807 (as added by the amendment made by

9 paragraph (7)).

10 SEC. 4. SAVINGS PROVISION AND TECHNICAL AMEND11 MENTS.

12 (a) SAVINGS PROVISION.—In the case of any author13 ity for making awards of grants or contracts that is termi14 nated by the amendment made by section 3, the Secretary

15 of Health and Human Services may, notwithstanding the

16 termination of the authority, continue in effect any grant

17 or contract made under the authority that is in effect on

18 the day before the date of the enactment of this Act, sub19 ject to the duration of any such grant or contract not ex20 ceeding the period determined by the Secretary in first

21 approving such financial assistance, or in approving the

22 most recent request made (before the date of such enact23 ment) for continuation of such assistance, as the case may

24 be.
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1 (b) CLINICAL RESEARCHERS.—Paragraph (3) of sec2 tion 487E(a) of the Public Health Service Act (42 U.S.C.

3 288–5(a)(3)) is amended to read as follows:

4 ‘‘(3) APPLICABILITY OF CERTAIN PROVISIONS

5 REGARDING OBLIGATED SERVICE.—With respect to

6 the National Health Service Corps loan repayment

7 program established in subpart III of part D of title

8 III, the provisions of such subpart shall, except as

9 inconsistent with this section, apply to the program

10 established in subsection (a) in the same manner

11 and to the same extent as such provisions apply to

12 the National Health Service Corps loan repayment

13 programs.’’.

14 (c) TECHNICAL AMENDMENTS.—Section 839 of such

15 Act (42 U.S.C. 297e) is amended—

16 (1) in subsection (a)—

17 (A) by striking the matter preceding para18 graph (1) and inserting the following:

19 ‘‘(a) If a school terminates a loan fund established

20 under an agreement pursuant to section 835(b), or if the

21 Secretary for good cause terminates the agreement with

22 the school, there shall be a capital distribution as fol23 lows:’’; and
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1 (B) in paragraph (1), by striking ‘‘at the

2 close of September 30, 1999,’’ and inserting

3 ‘‘on the date of termination of the fund’’; and

4 (2) in subsection (b), to read as follows:

5 ‘‘(b) If a capital distribution is made under sub6 section (a), the school involved shall, after such capital dis7 tribution, pay to the Secretary, not less often than quar8 terly, the same proportionate share of amounts received

9 by the school in payment of principal or interest on loans

10 made from the loan fund established under section 835(b)

11 as determined by the Secretary under subsection (a).’’.

12 SEC. 5. EFFECTIVE DATE.

13 This Act shall take effect on October 1, 1994, or the

14 date of enactment of this Act, whichever is later.

15 SECTION 1. SHORT TITLE.

16 This Act may be cited as the ‘‘Nursing Education Con17 solidation and Reauthorization Act of 1994’’.

18 SEC. 2. PURPOSE.

19 It is the purpose of this Act to restructure the nurse

20 education authorities of title VIII of the Public Health Serv21 ice Act to permit a comprehensive, flexible, and effective ap22 proach to Federal support for nursing workforce develop23 ment.
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1 SEC. 3. AMENDMENTS TO PUBLIC HEALTH SERVICE ACT.

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

3 296k et seq.) is amended—

4 (1) by striking the title heading and all that fol5 lows except for subparts II and III of part B and sec6 tion 855; and inserting the following:

7 ‘‘TITLE VIII—NURSING

8 WORKFORCE DEVELOPMENT’’;

9 (2) in subpart II of part B, by striking the sub10 part heading and inserting the following:

11 ‘‘PART E—STUDENT LOANS

12 ‘‘Subpart I—General Program’’;

13 (3) by redesignating subpart III as subpart II;

14 (4) by striking section 837;

15 (5) in section 846, by striking subsection (d) and

16 inserting the following new subsection:

17 ‘‘(d) BREACH OF AGREEMENTS FOR OBLIGATED SERV18 ICE.—

19 ‘‘(1) IN GENERAL.—In the case of any program

20 under this section under which an individual makes

21 an agreement to provide health services for a period

22 of time in accordance with such program in consider23 ation of receiving an award of Federal funds regard24 ing education as a nurse (including an award for the

25 repayment of loans), the following applies if the

26 agreement provides that this subsection is applicable:
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1 ‘‘(A) In the case of a program under this

2 section that makes an award of Federal funds for

3 attending an accredited program of nursing (in

4 this subsection referred to as a ‘nursing pro5 gram’), the individual is liable to the Federal

6 Government for the amount of such award (in7 cluding amounts provided for expenses related to

8 such attendance), and for interest on such

9 amount at the maximum legal prevailing rate, if

10 the individual—

11 ‘‘(i) fails to maintain an acceptable

12 level of academic standing in the nursing

13 program (as indicated by the program in

14 accordance with requirements established by

15 the Secretary);

16 ‘‘(ii) is dismissed from the nursing

17 program for disciplinary reasons; or

18 ‘‘(iii) voluntarily terminates the nurs19 ing program.

20 ‘‘(B) The individual is liable to the Federal

21 Government for the amount of such award (in22 cluding amounts provided for expenses related to

23 such attendance), and for interest on such

24 amount at the maximum legal prevailing rate, if

25 the individual fails to provide health services in
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1 accordance with the program under this section

2 for the period of time applicable under the pro3 gram.

4 ‘‘(2) WAIVER OR SUSPENSION OF LIABILITY.—In

5 the case of an individual or health facility making an

6 agreement for purposes of paragraph (1), the Sec7 retary shall provide for the waiver or suspension of

8 liability under such paragraph if compliance by the

9 individual or the health facility, as the case may be,

10 with the agreements involved is impossible, or would

11 involve extreme hardship to the individual or facility,

12 and if enforcement of the agreements with respect to

13 the individual or facility would be unconscionable.

14 ‘‘(3) DATE CERTAIN FOR RECOVERY.—Subject to

15 paragraph (2), any amount that the Federal Govern16 ment is entitled to recover under paragraph (1) shall

17 be paid to the United States not later than the expi18 ration of the 3-year period beginning on the date the

19 United States becomes so entitled.

20 ‘‘(4) AVAILABILITY.—Amounts recovered under

21 paragraph (1) with respect to a program under this

22 section shall be available for the purposes of such pro23 gram, and shall remain available for such purposes

24 until expended.’’;
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1 (6) by inserting after the title heading the follow2 ing new parts:

3 ‘‘PART A—GENERAL PROVISIONS

4 ‘‘SEC. 801. DEFINITIONS.

5 ‘‘As used in this title:

6 ‘‘(1) ELIGIBLE ENTITIES.—The term ‘eligible en7 tities’ means schools of nursing, nursing centers, State

8 or local governments, and other public or nonprofit

9 private entities determined appropriate by the Sec10 retary that submit to the Secretary an application in

11 accordance with section 802.

12 ‘‘(2) SCHOOL OF NURSING.—The term ‘school of

13 nursing’ means a collegiate, associate degree, or di14 ploma school of nursing in a State.

15 ‘‘(3) COLLEGIATE SCHOOL OF NURSING.—The

16 term ‘collegiate school of nursing’ means a depart17 ment, division, or other administrative unit in a col18 lege or university which provides primarily or exclu19 sively a program of education in professional nursing

20 and related subjects leading to the degree of bachelor

21 of arts, bachelor of science, bachelor of nursing, or to

22 an equivalent degree, or to a graduate degree in nurs23 ing, and including advanced training related to such

24 program of education provided by such school, but
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1 only if such program, or such unit, college or univer2 sity is accredited.

3 ‘‘(4) ASSOCIATE DEGREE SCHOOL OF NURS4 ING.—The term ‘associate degree school of nursing’

5 means a department, division, or other administra6 tive unit in a junior college, community college, col7 lege, or university which provides primarily or exclu8 sively a two-year program of education in profes9 sional nursing and allied subjects leading to an asso10 ciate degree in nursing or to an equivalent degree, but

11 only if such program, or such unit, college, or univer12 sity is accredited.

13 ‘‘(5) DIPLOMA SCHOOL OF NURSING.—The term

14 ‘diploma school of nursing’ means a school affiliated

15 with a hospital or university, or an independent

16 school, which provides primarily or exclusively a pro17 gram of education in professional nursing and allied

18 subjects leading to a diploma or to equivalent indicia

19 that such program has been satisfactorily completed,

20 but only if such program, or such affiliated school or

21 such hospital or university or such independent school

22 is accredited.

23 ‘‘(6) ACCREDITED.—

24 ‘‘(A) IN GENERAL.—Except as provided in

25 subparagraph (B), the term ‘accredited’ when
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1 applied to any program of nurse education

2 means a program accredited by a recognized

3 body or bodies, or by a State agency, approved

4 for such purpose by the Secretary of Education

5 and when applied to a hospital, school, college,

6 or university (or a unit thereof) means a hos7 pital, school, college, or university (or a unit

8 thereof) which is accredited by a recognized body

9 or bodies, or by a State agency, approved for

10 such purpose by the Secretary of Education. For

11 the purpose of this paragraph, the Secretary of

12 Education shall publish a list of recognized ac13 crediting bodies, and of State agencies, which the

14 Secretary of Education determines to be reliable

15 authority as to the quality of education offered.

16 ‘‘(B) NEW PROGRAMS.—A new school of

17 nursing that, by reason of an insufficient period

18 of operation, is not, at the time of the submission

19 of an application for a grant or contract under

20 this title, eligible for accreditation by such a rec21 ognized body or bodies or State agency, shall be

22 deemed accredited for purposes of this title if the

23 Secretary of Education finds, after consultation

24 with the appropriate accreditation body or bod25 ies, that there is reasonable assurance that the
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1 school will meet the accreditation standards of

2 such body or bodies prior to the beginning of the

3 academic year following the normal graduation

4 date of students of the first entering class in such

5 school.

6 ‘‘(7) NONPROFIT.—The term ‘nonprofit’ as ap7 plied to any school, agency, organization, or institu8 tion means one which is a corporation or association,

9 or is owned and operated by one or more corporations

10 or associations, no part of the net earnings of which

11 inures, or may lawfully inure, to the benefit of any

12 private shareholder or individual.

13 ‘‘(8) STATE.—The term ‘State’ means a State,

14 the Commonwealth of Puerto Rico, the District of Co15 lumbia, the Commonwealth of the Northern Mariana

16 Islands, Guam, American Samoa, the Virgin Islands,

17 or the Trust Territory of the Pacific Islands.

18 ‘‘SEC. 802. APPLICATION.

19 ‘‘(a) IN GENERAL.—To be eligible to receive a grant

20 or contract under this title, an eligible entity shall prepare

21 and submit to the Secretary an application that meets the

22 requirements of this section, at such time, in such manner,

23 and containing such information as the Secretary may re24 quire.
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1 ‘‘(b) PLAN.—An application submitted under this sec2 tion shall contain the plan of the applicant for carrying

3 out a project with amounts received under this title. Such

4 plan shall be consistent with relevant Federal, State, or re5 gional program plans.

6 ‘‘(c) PERFORMANCE OUTCOME STANDARDS.—An ap7 plication submitted under this section shall contain a speci8 fication by the applicant entity of performance outcome

9 standards that the project to be funded under the grant or

10 contract will be measured against. Such standards shall ad11 dress relevant national nursing needs that the project will

12 meet. The recipient of a grant or contract under this section

13 shall meet the standards set forth in the grant or contract

14 application.

15 ‘‘(d) LINKAGES.—An application submitted under this

16 section shall contain a description of the linkages with rel17 evant educational and health care entities, including train18 ing programs for other health professionals as appropriate,

19 that the project to be funded under the grant or contract

20 will establish.

21 ‘‘SEC. 803. USE OF FUNDS.

22 ‘‘(a) IN GENERAL.—Amounts provided under a grant

23 or contract awarded under this title may be used for train24 ing program development and support, faculty develop25 ment, model demonstrations, trainee support including tui-
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1 tion, books, program fees and reasonable living expenses

2 during the period of training, technical assistance,

3 workforce analysis, and dissemination of information, as

4 appropriate to meet recognized nursing objectives, in ac5 cordance with this title.

6 ‘‘(b) MAINTENANCE OF EFFORT.—With respect to ac7 tivities for which a grant awarded under this title is to

8 be expended, the entity shall agree to maintain expenditures

9 of non-Federal amounts for such activities at a level that

10 is not less than the level of such expenditures maintained

11 by the entity for the fiscal year preceding the fiscal year

12 for which the entity receives such a grant.

13 ‘‘SEC. 804. MATCHING REQUIREMENT.

14 ‘‘The Secretary may require that an entity that ap15 plies for a grant or contract under this title provide non16 Federal matching funds, as appropriate, to ensure the insti17 tutional commitment of the entity to the projects funded

18 under the grant. Such non-Federal matching funds may be

19 provided directly or through donations from public or pri20 vate entities and may be in cash or in-kind, fairly evalu21 ated, including plant, equipment, or services.

22 ‘‘SEC. 805. PREFERENCE.

23 ‘‘In awarding grants or contracts under this title, the

24 Secretary shall give preference to applicants with projects
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1 that will substantially benefit rural or underserved popu2 lations.

3 ‘‘SEC. 806. GENERALLY APPLICABLE PROVISIONS.

4 ‘‘(a) AWARDING OF GRANTS AND CONTRACTS.—The

5 Secretary shall ensure that grants and contracts under this

6 title are awarded on a competitive basis to carry out inno7 vative demonstration projects or provide for strategic

8 workforce supplementation activities as needed to meet na9 tional nursing service goals and in accordance with this

10 title.

11 ‘‘(b) INFORMATION REQUIREMENTS.—Recipients of

12 grants and contracts under this title shall meet information

13 requirements as specified by the Secretary.

14 ‘‘(c) TRAINING PROGRAMS.—Training programs con15 ducted with amounts received under this title shall meet ap16 plicable accreditation and quality standards.

17 ‘‘(d) DURATION OF ASSISTANCE.—

18 ‘‘(1) IN GENERAL.—Subject to paragraph (2), in

19 the case of an award to an entity of a grant, coopera20 tive agreement, or contract under this title, the period

21 during which payments are made to the entity under

22 the award may not exceed 5 years. The provision of

23 payments under the award shall be subject to annual

24 approval by the Secretary of the payments and sub25 ject to the availability of appropriations for the fiscal
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1 year involved to make the payments. This paragraph

2 may not be construed as limiting the number of

3 awards under the program involved that may be

4 made to the entity.

5 ‘‘(2) LIMITATION.—In the case of an award to

6 an entity of a grant, cooperative agreement, or con7 tract under this title, paragraph (1) shall apply only

8 to the extent not inconsistent with any other provi9 sion of this title that relates to the period during

10 which payments may be made under the award.

11 ‘‘(e) PEER REVIEW REGARDING CERTAIN PRO12 GRAMS.—Each application for a grant under this title, ex13 cept advanced nurse traineeship grants under section

14 811(a)(2), shall be submitted to a peer review group for an

15 evaluation of the merits of the proposals made in the appli16 cation. The Secretary may not approve such an application

17 unless a peer review group has recommended the applica18 tion for approval. Each peer review group under this sub19 section shall be composed principally of individuals who are

20 not officers or employees of the Federal Government. This

21 subsection shall be carried out by the Secretary acting

22 through the Administrator of the Health Resources and

23 Services Administration.
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1 ‘‘SEC. 807. NATIONAL ADVISORY COUNCIL ON NURSE EDU2 CATION AND PRACTICE.

3 ‘‘(a) ESTABLISHMENT.—There is hereby established a

4 National Advisory Council on Nurse Education and Prac5 tice (in this section referred to as the ‘Council’), consisting

6 of the Secretary or the delegate of the Secretary (who shall

7 be an ex officio member and shall serve as the Chairperson),

8 and 15 members appointed by the Secretary without regard

9 to the Federal civil service laws, of which—

10 ‘‘(1) 2 shall be selected from full-time students

11 enrolled in schools of nursing;

12 ‘‘(2) 3 shall be selected from the general public;

13 ‘‘(3) 2 shall be selected from practicing profes14 sional nurses; and

15 ‘‘(4) 8 shall be selected from among the leading

16 authorities in the various fields of nursing, higher,

17 and secondary education, and from representatives of

18 hospitals and other institutions and organizations

19 which provide nursing services.

20 A majority of the members shall be nurses. The student21 members of the Council shall be appointed for terms of one

22 year and shall be eligible for reappointment to the Council.

23 ‘‘(b) DUTIES.—The Council shall advise the Secretary

24 in the preparation of general regulations and with respect

25 to policy matters arising in the administration of this title,
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1 including the range of issues relating to nurse supply, edu2 cation and practice improvement.

3 ‘‘(c) FUNDING.—Amounts appropriated under this

4 title may be utilized by the Secretary to support the nurse

5 education and practice activities of the Council.

6 ‘‘SEC. 808. TECHNICAL ASSISTANCE.

7 ‘‘Funds appropriated under this title may be used by

8 the Secretary to provide technical assistance in relation to

9 any of the authorities under this title.

10 ‘‘SEC. 809. RECOVERY FOR CONSTRUCTION ASSISTANCE.

11 ‘‘(a) IN GENERAL.—If at any time within 20 years

12 (or within such shorter period as the Secretary may pre13 scribe by regulation for an interim facility) after the com14 pletion of construction of a facility with respect to which

15 funds have been paid under subpart I of part A (as such

16 subpart was in effect on September 30, 1985)—

17 ‘‘(1) the owner of the facility ceases to be a pub18 lic or nonprofit school,

19 ‘‘(2) the facility ceases to be used for the training

20 purposes for which it was constructed, or

21 ‘‘(3) the facility is used for sectarian instruction

22 or as a place for religious worship,

23 the United States shall be entitled to recover from the owner

24 of the facility the base amount prescribed by subsection
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1 (c)(1) plus the interest (if any) prescribed by subsection

2 (c)(2).

3 ‘‘(b) NOTICE OF CHANGE IN STATUS.—The owner of

4 a facility which ceases to be a public or nonprofit school

5 as described in paragraph (1) of subsection (a), or the

6 owner of a facility the use of which changes as described

7 in paragraph (2) or (3) of such subsection shall provide

8 the Secretary written notice of such cessation or change of

9 use within 10 days after the date on which such cessation

10 or change of use occurs or within 30 days after the date

11 of enactment of the Health Professions Training Assistance

12 Act of 1985, whichever is later.

13 ‘‘(c) AMOUNT OF RECOVERY.—

14 ‘‘(1) BASE AMOUNT.—The base amount that the

15 United States is entitled to recover under subsection

16 (a) is the amount bearing the same ratio to the then

17 value (as determined by the agreement of the parties

18 or in an action brought in the district court of the

19 United States for the district in which the facility is

20 situated) of the facility as the amount of the Federal

21 participation bore to the cost of the construction.

22 ‘‘(2) INTEREST.—

23 ‘‘(A) IN GENERAL.—The interest that the

24 United States is entitled to recover under sub25 section (a) is the interest for the period (if any)
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1 described in subparagraph (B) at a rate (deter2 mined by the Secretary) based on the average of

3 the bond equivalent rates of 91-day Treasury

4 bills auctioned during such period.

5 ‘‘(B) TIME PERIOD.—The period referred to

6 in subparagraph (A) is the period beginning—

7 ‘‘(i) if notice is provided as prescribed

8 by subsection (b), 191 days after the date on

9 which the owner of the facility ceases to be

10 a public or nonprofit school as described in

11 paragraph (1) of subsection (a), or 191 days

12 after the date on which the use of the facil13 ity changes as described in paragraph (2)

14 or (3) of such subsection, or

15 ‘‘(ii) if notice is not provided as pre16 scribed by subsection (b), 11 days after the

17 date on which such cessation or change of

18 use occurs,

19 and ending on the date the amount the United

20 States is entitled to recover if collected.

21 ‘‘(d) WAIVER OF RIGHTS.—The Secretary may waive

22 the recovery rights of the United States under subsection

23 (a)(2) with respect to a facility (under such conditions as

24 the Secretary may establish by regulation) if the Secretary

25 determines that there is good cause for waiving such rights.
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1 ‘‘(e) LIMITATION ON LIENS.—The right of recovery of

2 the United States under subsection (a) shall not, prior to

3 judgment, constitute a lien on any facility.

4 ‘‘PART B—NURSE PRACTITIONERS, NURSE MID5 WIVES, AND OTHER ADVANCED PRACTICE

6 NURSES

7 ‘‘SEC. 811. ADVANCED PRACTICE NURSING GRANTS.

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

9 to and enter into contracts with eligible entities to meet the

10 costs of—

11 ‘‘(1) projects that support the enhancement of ad12 vanced practice nursing education and practice; and

13 ‘‘(2) traineeships for individuals in advanced

14 practice nursing programs.

15 ‘‘(b) DEFINITION OF ADVANCED PRACTICE NURSES.—

16 For purposes of this section, the term ‘advanced practice

17 nurses’ means nurses trained in advanced degree programs

18 including individuals in combined R.N./Master’s degree

19 programs, post-nursing master’s certificate programs, or, in

20 the case of nurse midwives or nurse anesthetists, in certifi21 cate programs that received funding under this title on the

22 date that is one day prior to the date of enactment of this

23 section, to serve as nurse practitioners, nurse midwives,

24 nurse anesthetists, nurse educators, or public health nurses,
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1 or in other nurse specialties determined by the secretary to

2 require advanced education.

3 ‘‘(c) AUTHORIZED NURSE PRACTITIONER AND NURSE4 MIDWIFERY PROGRAMS.—

5 ‘‘(1) IN GENERAL.—Nurse practitioner and nurse

6 midwifery programs eligible for support under this

7 section are educational programs for registered nurses

8 (irrespective of the type of school of nursing in which

9 the nurses received their training) that—

10 ‘‘(A) meet guidelines prescribed by the Sec11 retary in accordance with paragraph (2); and

12 ‘‘(B) have as their objective the education of

13 nurses who will upon completion of their studies

14 in such programs, be qualified to effectively pro15 vide primary health care, including primary

16 health care in homes and in ambulatory care fa17 cilities, long-term care facilities and other health

18 care institutions.

19 ‘‘(2) GUIDELINES.—After consultation with ap20 propriate educational organizations and professional

21 nursing and medical organizations, the Secretary

22 shall prescribe guidelines for programs described in

23 paragraph (1). Such guidelines shall, as a minimum,

24 require that such a program—
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1 ‘‘(A) extend for at least one academic year

2 and consist of—

3 ‘‘(i) supervised clinical practice di4 rected toward preparing nurses to deliver

5 primary health care; and

6 ‘‘(ii) at least four months (in the ag7 gregate) of classroom instruction that is so

8 directed; and

9 ‘‘(B) have an enrollment of not less than six

10 full-time equivalent students.

11 ‘‘(d) OTHER AUTHORIZED EDUCATIONAL PRO12 GRAMS.—The Secretary shall prescribe guidelines as appro13 priate for other advanced practice nurse education pro14 grams eligible for support under this section.

15 ‘‘(e) TRAINEESHIPS.—

16 ‘‘(1) IN GENERAL.—The Secretary may not

17 award a grant to an applicant under subsection (a)

18 unless the applicant involved agrees that traineeships

19 provided with the grant will pay all or part of the

20 costs of—

21 ‘‘(A) the tuition, books, and fees of the pro22 gram of advanced nursing practice with respect

23 to which the traineeship is provided; and
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1 ‘‘(B) the reasonable living expenses of the

2 individual during the period for which the

3 traineeship is provided.

4 ‘‘(2) DOCTORAL PROGRAMS.—The Secretary may

5 not obligate more than 10 percent of the traineeships

6 under subsection (a) for individuals in doctorate de7 gree programs.

8 ‘‘(3) SPECIAL CONSIDERATION.—In making

9 awards of grants and contracts under subsection

10 (a)(2), the Secretary shall give special consideration

11 to an eligible entity that agrees to expend the award

12 to train advanced practice nurses who will practice

13 in health professional shortage areas designated under

14 section 332.

15 ‘‘(f) AUTHORIZATION OF APPROPRIATIONS.—

16 ‘‘(1) IN GENERAL.—There are authorized to be

17 appropriated to carry out this section, $50,000,000

18 for fiscal year 1995, and such sums as may be nec19 essary for each of the fiscal years 1996 and 1997.

20 ‘‘(2) SET ASIDES.—Of the amount appropriated

21 under paragraph (1) for a fiscal year—

22 ‘‘(A) not less than 60 percent of such

23 amount shall be made available for projects to

24 enhance the training and practice of nurse prac25 titioners and nurse midwives; and
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1 ‘‘(B) not less than 6 percent of such

2 amounts shall be made available for projects to

3 enhance the training and practice of nurse anes4 thetists.

5 ‘‘PART C—INCREASING NURSING WORKFORCE

6 DIVERSITY

7 ‘‘SEC. 821. WORKFORCE DIVERSITY GRANTS.

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

9 to and enter into contracts with eligible entities to meet the

10 costs of special projects to increase nursing education op11 portunities for individuals who are from disadvantaged ra12 cial and ethnic backgrounds underrepresented among reg13 istered nurses by providing student scholarships or stipends,

14 pre-entry preparation, and retention activities.

15 ‘‘(b) GUIDANCE.—In carrying out subsection (a), the

16 Secretary shall take into consideration the recommenda17 tions of the First and Second Invitational Congresses for

18 Minority Nurse Leaders on ‘Caring for the Emerging Ma19 jority,’ in 1992 and 1993, and consult with nursing asso20 ciations including the American Nurses Association, the

21 National League for Nursing, the American Association of

22 Colleges of Nursing, the Black Nurses Association, the Asso23 ciation of Hispanic Nurses, the Association of Asian Amer24 ican and Pacific Islander Nurses, the National Nurses Asso-
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1 ciation, the Native American Indian and Alaskan Nurses

2 Association.

3 ‘‘(c) REQUIRED INFORMATION AND CONDITIONS FOR

4 AWARD RECIPIENTS.—

5 ‘‘(1) IN GENERAL.—Recipients of awards under

6 this section may be required, where requested, to re7 port to the Secretary concerning the annual admis8 sion, retention, and graduation rates for ethnic and

9 racial minorities in the school or schools involved in

10 the projects.

11 ‘‘(2) FALLING RATES.—If any of the rates re12 ported under paragraph (1) fall below the average of

13 the two previous years, the grant or contract recipient

14 shall provide the Secretary with plans for imme15 diately improving such rates.

16 ‘‘(3) INELIGIBILITY.—A recipient described in

17 paragraph (2) shall be ineligible for continued fund18 ing under this section if the plan of the recipient fails

19 to improve the rates within the 1-year period begin20 ning on the date such plan is implemented.

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

22 are authorized to be appropriated to carry out this section,

23 $5,000,000 for fiscal year 1995, and such sums as may be

24 necessary for each of the fiscal years 1996 and 1997.
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1 ‘‘PART D—STRENGTHENING CAPACITY FOR

2 BASIC NURSE EDUCATION AND PRACTICE

3 ‘‘SEC. 831. BASIC NURSE EDUCATION AND PRACTICE

4 GRANTS.

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

6 to and enter into contracts with eligible entities for projects

7 to strengthen capacity for basic nurse education and prac8 tice.

9 ‘‘(b) PRIORITY AREAS.—In awarding grants or con10 tracts under this section the Secretary shall give priority

11 to entities that will use amounts provided under such a

12 grant or contract to enhance the education mix and utiliza13 tion of the basic nursing workforce by strengthening pro14 grams that provide basic nurse education for purposes of—

15 ‘‘(1) improving nursing services in schools and

16 other community settings;

17 ‘‘(2) providing care for underserved populations

18 and other high-risk groups such as the elderly, indi19 viduals with HIV-AIDS, substance abusers, homeless,

20 and battered women;

21 ‘‘(3) providing case management, quality im22 provement, delegation and supervision, other skills

23 needed under new health care systems;

24 ‘‘(4) developing cultural competencies among

25 nurses;
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1 ‘‘(5) providing emergency health services;

2 ‘‘(6) promoting career mobility for nursing per3 sonnel in a variety of training settings and cross

4 training or specialty training among diverse popu5 lation groups; or

6 ‘‘(7) other priority areas as determined by the

7 Secretary.

8 ‘‘(c) AUTHORIZATION OF APPROPRIATIONS.—There are

9 authorized to be appropriated to carry out this section,

10 $12,000,000 for fiscal year 1995, and such sums as may

11 be necessary for each of the fiscal years 1996 and 1997.’’;

12 and

13 (7) by redesignating section 855 as section 810,

14 and transferring such section so as to appear after

15 section 809 (as added by the amendment made by

16 paragraph (6)).

17 SEC. 4. SAVINGS PROVISION AND TECHNICAL AMEND18 MENTS.

19 (a) SAVINGS PROVISION.—In the case of any authority

20 for making awards of grants or contracts that is terminated

21 by the amendment made by section 3, the Secretary of

22 Health and Human Services may, notwithstanding the ter23 mination of the authority, continue in effect any grant or

24 contract made under the authority that is in effect on the

25 day before the date of the enactment of this Act, subject to
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1 the duration of any such grant or contract not exceeding

2 the period determined by the Secretary in first approving

3 such financial assistance, or in approving the most recent

4 request made (before the date of such enactment) for con5 tinuation of such assistance, as the case may be.

6 (b) CLINICAL RESEARCHERS.—Paragraph (3) of sec7 tion 487E(a) of the Public Health Service Act (42 U.S.C.

8 288–5(a)(3)) is amended to read as follows:

9 ‘‘(3) APPLICABILITY OF CERTAIN PROVISIONS RE10 GARDING OBLIGATED SERVICE.—With respect to the

11 National Health Service Corps loan repayment pro12 gram established in subpart III of part D of title III,

13 the provisions of such subpart shall, except as incon14 sistent with this section, apply to the program estab15 lished in subsection (a) in the same manner and to

16 the same extent as such provisions apply to the Na17 tional Health Service Corps loan repayment pro18 grams.’’.

19 (c) TECHNICAL AMENDMENTS.—Section 839 of such

20 Act (42 U.S.C. 297e) is amended—

21 (1) in subsection (a)—

22 (A) by striking the matter preceding para23 graph (1) and inserting the following:

24 ‘‘(a) If a school terminates a loan fund established

25 under an agreement pursuant to section 835(b), or if the
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1 Secretary for good cause terminates the agreement with the

2 school, there shall be a capital distribution as follows:’’; and

3 (B) in paragraph (1), by striking ‘‘at the

4 close of September 30, 1999,’’ and inserting ‘‘on

5 the date of termination of the fund’’; and

6 (2) in subsection (b), to read as follows:

7 ‘‘(b) If a capital distribution is made under subsection

8 (a), the school involved shall, after such capital distribution,

9 pay to the Secretary, not less often than quarterly, the same

10 proportionate share of amounts received by the school in

11 payment of principal or interest on loans made from the

12 loan fund established under section 835(b) as determined

13 by the Secretary under subsection (a).’’.

14 SEC. 5. EFFECTIVE DATE.

15 This Act shall take effect on October 1, 1994, or the

16 date of enactment of this Act, whichever is later.

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