II 

116TH CONGRESS 

1ST SESSION S. 1399 

To amend title VIII of the Public Health Services Act to revise and extend 

nursing workforce development programs. 

IN THE SENATE OF THE UNITED STATES 

MAY 9, 2019 

Mr. MERKLEY (for himself and Mr. BURR) introduced the following bill; which 

was read twice and referred to the Committee on Health, Education, 

Labor, and Pensions 

A BILL 

To amend title VIII of the Public Health Services Act to 

revise and extend nursing workforce development programs. 

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 ‘‘Title VIII Nursing 

5 Workforce Reauthorization Act of 2019’’. 

6 SEC. 2. NURSING WORKFORCE DEVELOPMENT. 

7 (a) IN GENERAL.—Title VIII of the Public Health 

8 Service Act (42 U.S.C. 296 et seq.) is amended— 

9 (1) in section 801 (42 U.S.C. 296), by adding 

10 at the end the following: 


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1 ‘‘(18) NURSE MANAGED HEALTH CLINIC.—The 

2 term ‘nurse managed health clinic’ means a nurse3 practice arrangement, managed by advanced practice 

4 nurses, that provides primary care or wellness serv5 ices to underserved or vulnerable populations and 

6 that is associated with a school, college, university or 

7 department of nursing, federally qualified health 

8 center, or independent nonprofit health or social 

9 services agency.’’; 

10 (2) in section 802(c) (42 U.S.C. 296a(c)), by 

11 inserting ‘‘, and how such project aligns with the 

12 goals in section 806(a)’’ before the period in the sec13 ond sentence; 

14 (3) in section 803(b) (42 U.S.C. 296b(b)), by 

15 adding at the end the following: ‘‘Such Federal 

16 funds are intended to supplement, not supplant, ex17 isting non-Federal expenditures for such activities.’’; 

18 (4) in section 806 (42 U.S.C. 296e)— 

19 (A) in subsection (a), by striking ‘‘as need20 ed to’’ and all that follows and inserting the fol21 lowing: ‘‘as needed to address national nursing 

22 needs, including— 

23 ‘‘(1) addressing challenges, including through 

24 supporting training and education of nursing stu25 dents, related to the distribution of the nursing 


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1 workforce and existing or projected nursing work2 force shortages in geographic areas that have been 

3 identified as having, or that are projected to have, 

4 a nursing shortage; 

5 ‘‘(2) increasing access to and the quality of 

6 health care services, including by supporting the 

7 training of professional registered nurses, advanced 

8 practice registered nurses, and advanced education 

9 nurses within community based settings and in a va10 riety of health delivery system settings; or 

11 ‘‘(3) addressing the strategic goals and prior12 ities identified by the Secretary and that are in ac13 cordance with this title. 

14 Contracts may be entered into under this title with public 

15 or private entities as determined necessary by the Sec16 retary.’’; 

17 (B) in subsection (b)(2), by striking ‘‘a 

18 demonstration’’ and all that follows and insert19 ing the following: ‘‘the reporting of data and in20 formation demonstrating that satisfactory 

21 progress has been made by the program or 

22 project in meeting the performance outcome 

23 standards (as described in section 802) of such 

24 program or project.’’; 


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1 (C) in subsection (e)(2), by inserting ‘‘, 

2 and have relevant expertise and experience’’ be3 fore the period at the end of the first sentence; 

4 and 

5 (D) by adding at the end the following: 

6 ‘‘(i) BIENNIAL REPORT ON NURSING WORKFORCE

7 PROGRAM IMPROVEMENTS.—Not later than September 

8 30, 2020, and biennially thereafter, the Secretary shall 

9 submit to the Committee on Health, Education, Labor, 

10 and Pensions of the Senate and the Committee on Energy 

11 and Commerce of the House of Representatives, a report 

12 that contains an assessment of the programs and activities 

13 of the Department of Health and Human Services related 

14 to enhancing the nursing workforce, including the extent 

15 to which programs and activities under this title meet the 

16 identified goals and performance measures developed for 

17 the respective programs and activities, and the extent to 

18 which the Department coordinates with other Federal de19 partments with programs designed to improve the nursing 

20 workforce.’’; 

21 (5) in section 811 (42 U.S.C. 296j)— 

22 (A) in subsection (b)— 

23 (i) by striking ‘‘Master’s’’ and insert24 ing ‘‘graduate’’; and 


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1 (ii) by inserting ‘‘clinical nurse lead2 ers,’’ after ‘‘nurse administrators,’’; 

3 (B) by redesignating subsections (f) and 

4 (g) as subsections (g) and (h), respectively; and 

5 (C) by inserting after subsection (e), the 

6 following: 

7 ‘‘(f) AUTHORIZED CLINICAL NURSE SPECIALIST

8 PROGRAMS.—Clinical nurse specialist programs eligible 

9 for support under this section are education programs 

10 that— 

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

12 clinical nurse specialist education; and 

13 ‘‘(2) have as their objective the education of 

14 clinical nurse specialists who will, upon completion 

15 of such a program, be qualified to effectively provide 

16 care through the wellness and illness continuum to 

17 inpatients and outpatients experiencing acute and 

18 chronic illness.’’; 

19 (6) in section 831 (42 U.S.C. 296p)— 

20 (A) in the section heading, by striking 

21 ‘‘AND QUALITY GRANTS’’ and inserting 

22 ‘‘QUALITY, AND RETENTION GRANTS’’; 

23 (B) in subsection (b)(2), by striking ‘‘other 

24 high-risk groups such as the elderly, individuals 

25 with HIV/AIDS, substance abusers, the homeVerDate Sep 11 2014 23:27 May 21, 2019 Jkt 089200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\S1399.IS S1399

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1 less, and victims’’ and inserting ‘‘high risk 

2 groups, such as the elderly, individuals with 

3 HIV/AIDS, individuals with mental health or 

4 substance use disorders, individuals who are 

5 homeless, and survivors’’; 

6 (C) in subsection (c)(1)— 

7 (i) in subparagraph (A)— 

8 (I) by striking ‘‘advancement for 

9 nursing personnel’’ and inserting the 

10 following: ‘‘advancement for— 

11 ‘‘(i) nursing’’; 

12 (II) by striking ‘‘professional 

13 nurses, advanced education nurses, li14 censed practical nurses, certified 

15 nurse assistants, and home health 

16 aides’’ and inserting ‘‘professional 

17 registered nurses, advanced practice 

18 registered nurses, and nurses with 

19 graduate nursing education’’; and 

20 (III) by adding at the end the 

21 following: 

22 ‘‘(ii) individuals including licensed 

23 practical nurses, licensed vocational nurses, 

24 certified nurse assistants, home health 

25 aides, diploma degree or associate degree 


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1 nurses, to become registered nurses with 

2 baccalaureate degrees or nurses with grad3 uate nursing education;’’; 

4 (ii) in subparagraph (B), by striking 

5 the period and inserting ‘‘; and’’; and 

6 (iii) by adding at the end the fol7 lowing: 

8 ‘‘(C) developing and implementing intern9 ships, accredited fellowships, and accredited 

10 residency programs in collaboration with one or 

11 more accredited schools of nursing, to encour12 age the mentoring and development of special13 ties.’’; 

14 (D) by striking subsection (e); 

15 (E) by redesignating subsection (f) 

16 through (h), as subsections (e) through (g), re17 spectively; 

18 (F) in subsection (e) (as so redesignated), 

19 by striking ‘‘The Secretary shall submit to the 

20 Congress before the end of each fiscal year’’ 

21 and inserting ‘‘As part of the report on nursing 

22 workforce programs described in section 806(i), 

23 the Secretary shall include’’; 

24 (G) in subsection (f) (as so redesignated), 

25 by striking ‘‘a school of nursing, as defined in 


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1 section 801(2),,’’ and inserting ‘‘an accredited 

2 school of nursing, as defined in section 801(2), 

3 a health care facility, including federally quali4 fied health centers or nurse-managed health 

5 clinics, or a partnership of such a school and 

6 facility’’; and 

7 (H) in subsection (g) (as so redesignated), 

8 by striking ‘‘2010 through 2014’’ and inserting 

9 ‘‘2020 through 2024’’; 

10 (7) by striking section 831A (42 U.S.C. 296p– 

11 1); 

12 (8) in section 846 (42 U.S.C. 297n)— 

13 (A) by striking the last sentence of sub14 section (a); 

15 (B) in subsection (b)(1), by striking ‘‘he 

16 began such practice’’ and inserting ‘‘the indi17 vidual began such practice’’; and 

18 (C) in subsection (i)(I), by striking ‘‘2003 

19 through 2007’’ and inserting ‘‘2020 through 

20 2024’’; 

21 (9) in section 846A(f) (42 U.S.C. 247n–1(f)), 

22 by striking ‘‘2010 through 2014’’ and inserting 

23 ‘‘2020 through 2024’’; 

24 (10) in section 847(g) (42 U.S.C. 297o(g)), by 

25 striking ‘‘such sums as may be necessary for each of 


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1 fiscal years 2010 through 2014’’ and inserting 

2 ‘‘$115,635,000 for each of fiscal years 2020 through 

3 2024’’; 

4 (11) in section 851 (42 U.S.C. 297t)— 

5 (A) in subsection (b)(1)(A)(iv), by striking 

6 ‘‘and nurse anesthetists’’ and inserting ‘‘nurse 

7 anesthetists, and clinical nurse specialists’’; 

8 (B) in subsection (d)(3)— 

9 (i) by striking ‘‘3 years after the date 

10 of enactment of this section’’ and inserting 

11 ‘‘2 years after the date of enactment of the 

12 Title VIII Nursing Workforce Reauthoriza13 tion Act’’; 

14 (ii) by striking ‘‘Labor and Human 

15 Resources’’ and inserting ‘‘Health, Edu16 cation, Labor, and Pensions’’; and 

17 (iii) by inserting ‘‘Energy and’’ before 

18 ‘‘Commerce’’; and 

19 (C) in subsection (g), by striking ‘‘under 

20 this title’’ and inserting ‘‘for carrying out parts 

21 B, C, and D’’; 

22 (12) in section 865(e) (42 U.S.C. 298(e)), by 

23 striking ‘‘2014’’ and inserting ‘‘2024’’; and 

24 (13) in section 871 (42 U.S.C. 298d), by strik25 ing ‘‘$338,000,000 for fiscal year 2010, and such 


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1 sums as may be necessary for each of the fiscal 

2 years 2011 through 2016’’ and inserting 

3 ‘‘$133,837,000 for each of fiscal years 2020 through 

4 2024’’. 

5 (b) EVALUATION AND REPORT ON NURSE LOAN RE6 PAYMENT PROGRAMS.— 

7 (1) EVALUATION.—The Comptroller General 

8 shall conduct an evaluation of the nurse loan repay9 ment programs administered by the Health Re10 sources and Services Administration. Such evalua11 tion shall include— 

12 (A) the manner in which payments are 

13 made under such programs; 

14 (B) the existing oversight functions nec15 essary to ensure the proper use of such pro16 grams, including payments made as part of 

17 such programs; 

18 (C) the identification of gaps, if any, in 

19 oversight functions; and 

20 (D) information on the number of nurses 

21 assigned to facilities pursuant to such pro22 grams, including the type of facility to which 

23 nurses are assigned and the impact of modi24 fying the eligibility requirements for programs 

25 under section 846 of the Public Health Service 


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1 Act (42 U.S.C. 297n), such as the impact on 

2 entities to which nurses had previously been as3 signed prior to fiscal year 2019 (such as feder4 ally qualified health centers and facilities affili5 ated with the Indian Health Service). 

6 (2) REPORT.—Not later than 18 months after 

7 the enactment of this Act, the Comptroller General 

8 shall submit to the Committee on Health, Edu9 cation, Labor, and Pensions of the Senate and the 

10 Committee on Energy and Commerce of the House 

11 of Representatives a report on the evaluation under 

12 paragraph (1), which may include recommendations 

13 to improve relevant nursing workforce loan repay14 ment programs. 

Æ 


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