II 

Calendar No. 285 

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, Mr. BURR, Ms. BALDWIN, Mrs. BLACKBURN, Mr. 

JONES, and Ms. COLLINS) introduced the following bill; which was read 

twice and referred to the Committee on Health, Education, Labor, and 

Pensions 

NOVEMBER 5, 2019 

Reported by Mr. ALEXANDER, 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 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’’. 


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1 SEC. 2. NURSING WORKFORCE DEVELOPMENT. 

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

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

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

5 at the end the following: 

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

7 term ‘nurse managed health clinic’ means a nurse8 practice arrangement, managed by advanced practice 

9 nurses, that provides primary care or wellness serv10 ices to underserved or vulnerable populations and 

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

12 department of nursing, federally qualified health 

13 center, or independent nonprofit health or social 

14 services agency.’’; 

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

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

17 goals in section 806(a)’’ before the period in the sec18 ond sentence; 

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

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

21 funds are intended to supplement, not supplant, ex22 isting non-Federal expenditures for such activities.’’; 

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

24 (A) in subsection (a), by striking ‘‘as need25 ed to’’ and all that follows and inserting the folVerDate Sep 11 2014 21:50 Nov 05, 2019 Jkt 099200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6401 E:\BILLS\S1399.RS S1399

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1 lowing: ‘‘as needed to address national nursing 

2 needs, including— 

3 ‘‘(1) addressing challenges, including through 

4 supporting training and education of nursing stu5 dents, related to the distribution of the nursing 

6 workforce and existing or projected nursing work7 force shortages in geographic areas that have been 

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

9 a nursing shortage; 

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

11 health care services, including by supporting the 

12 training of professional registered nurses, advanced 

13 practice registered nurses, and advanced education 

14 nurses within community based settings and in a va15 riety of health delivery system settings; or 

16 ‘‘(3) addressing the strategic goals and prior17 ities identified by the Secretary and that are in ac18 cordance with this title. 

19 Contracts may be entered into under this title with public 

20 or private entities as determined necessary by the Sec21 retary.’’; 

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

23 demonstration’’ and all that follows and insert24 ing the following: ‘‘the reporting of data and in25 formation demonstrating that satisfactory 


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1 progress has been made by the program or 

2 project in meeting the performance outcome 

3 standards (as described in section 802) of such 

4 program or project.’’; 

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

6 and have relevant expertise and experience’’ be7 fore the period at the end of the first sentence; 

8 and 

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

10 ‘‘(i) BIENNIAL REPORT ON NURSING WORKFORCE

11 PROGRAM IMPROVEMENTS.—Not later than September 

12 30, 2020, and biennially thereafter, the Secretary shall 

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

14 and Pensions of the Senate and the Committee on Energy 

15 and Commerce of the House of Representatives, a report 

16 that contains an assessment of the programs and activities 

17 of the Department of Health and Human Services related 

18 to enhancing the nursing workforce, including the extent 

19 to which programs and activities under this title meet the 

20 identified goals and performance measures developed for 

21 the respective programs and activities, and the extent to 

22 which the Department coordinates with other Federal de23 partments with programs designed to improve the nursing 

24 workforce.’’; 

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


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1 (A) in subsection (b)— 

2 (i) by striking ‘‘Master’s’’ and insert3 ing ‘‘graduate’’; and 

4 (ii) by inserting ‘‘clinical nurse lead5 ers,’’ after ‘‘nurse administrators,’’; 

6 (B) by redesignating subsections (f) and 

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

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

9 following: 

10 ‘‘(f) AUTHORIZED CLINICAL NURSE SPECIALIST

11 PROGRAMS.—Clinical nurse specialist programs eligible 

12 for support under this section are education programs 

13 that— 

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

15 clinical nurse specialist education; and 

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

17 clinical nurse specialists who will, upon completion 

18 of such a program, be qualified to effectively provide 

19 care through the wellness and illness continuum to 

20 inpatients and outpatients experiencing acute and 

21 chronic illness.’’; 

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

23 (A) in the section heading, by striking 

24 ‘‘AND QUALITY GRANTS’’ and inserting 

25 ‘‘QUALITY, AND RETENTION GRANTS’’; 


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

2 high-risk groups such as the elderly, individuals 

3 with HIV/AIDS, substance abusers, the home4 less, and victims’’ and inserting ‘‘high risk 

5 groups, such as the elderly, individuals with 

6 HIV/AIDS, individuals with mental health or 

7 substance use disorders, individuals who are 

8 homeless, and survivors’’; 

9 (C) in subsection (c)(1)— 

10 (i) in subparagraph (A)— 

11 (I) by striking ‘‘advancement for 

12 nursing personnel’’ and inserting the 

13 following: ‘‘advancement for— 

14 ‘‘(i) nursing’’; 

15 (II) by striking ‘‘professional 

16 nurses, advanced education nurses, li17 censed practical nurses, certified 

18 nurse assistants, and home health 

19 aides’’ and inserting ‘‘professional 

20 registered nurses, advanced practice 

21 registered nurses, and nurses with 

22 graduate nursing education’’; and 

23 (III) by adding at the end the 

24 following: 


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1 ‘‘(ii) individuals including licensed 

2 practical nurses, licensed vocational nurses, 

3 certified nurse assistants, home health 

4 aides, diploma degree or associate degree 

5 nurses, to become registered nurses with 

6 baccalaureate degrees or nurses with grad7 uate nursing education;’’; 

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

9 the period and inserting ‘‘; and’’; and 

10 (iii) by adding at the end the fol11 lowing: 

12 ‘‘(C) developing and implementing intern13 ships, accredited fellowships, and accredited 

14 residency programs in collaboration with one or 

15 more accredited schools of nursing, to encour16 age the mentoring and development of special17 ties.’’; 

18 (D) by striking subsection (e); 

19 (E) by redesignating subsection (f) 

20 through (h), as subsections (e) through (g), re21 spectively; 

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

23 by striking ‘‘The Secretary shall submit to the 

24 Congress before the end of each fiscal year’’ 

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


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1 workforce programs described in section 806(i), 

2 the Secretary shall include’’; 

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

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

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

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

7 a health care facility, including federally quali8 fied health centers or nurse-managed health 

9 clinics, or a partnership of such a school and 

10 facility’’; and 

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

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

13 ‘‘2020 through 2024’’; 

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

15 1); 

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

17 (A) by striking the last sentence of sub18 section (a); 

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

20 began such practice’’ and inserting ‘‘the indi21 vidual began such practice’’; and 

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

23 through 2007’’ and inserting ‘‘2020 through 

24 2024’’; 


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

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

3 ‘‘2020 through 2024’’; 

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

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

6 fiscal years 2010 through 2014’’ and inserting 

7 ‘‘$115,635,000 for each of fiscal years 2020 through 

8 2024’’; 

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

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

11 ‘‘and nurse anesthetists’’ and inserting ‘‘nurse 

12 anesthetists, and clinical nurse specialists’’; 

13 (B) in subsection (d)(3)— 

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

15 of enactment of this section’’ and inserting 

16 ‘‘2 years after the date of enactment of the 

17 Title VIII Nursing Workforce Reauthoriza18 tion Act’’; 

19 (ii) by striking ‘‘Labor and Human 

20 Resources’’ and inserting ‘‘Health, Edu21 cation, Labor, and Pensions’’; and 

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

23 ‘‘Commerce’’; and 


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

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

3 B, C, and D’’; 

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

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

6 (13) in section 871 (42 U.S.C. 298d), by strik7 ing ‘‘$338,000,000 for fiscal year 2010, and such 

8 sums as may be necessary for each of the fiscal 

9 years 2011 through 2016’’ and inserting 

10 ‘‘$133,837,000 for each of fiscal years 2020 through 

11 2024’’. 

12 (b) EVALUATION AND REPORT ON NURSE LOAN RE13 PAYMENT PROGRAMS.— 

14 (1) EVALUATION.—The Comptroller General 

15 shall conduct an evaluation of the nurse loan repay16 ment programs administered by the Health Re17 sources and Services Administration. Such evalua18 tion shall include— 

19 (A) the manner in which payments are 

20 made under such programs; 

21 (B) the existing oversight functions nec22 essary to ensure the proper use of such pro23 grams, including payments made as part of 

24 such programs; 


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

2 oversight functions; and 

3 (D) information on the number of nurses 

4 assigned to facilities pursuant to such pro5 grams, including the type of facility to which 

6 nurses are assigned and the impact of modi7 fying the eligibility requirements for programs 

8 under section 846 of the Public Health Service 

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

10 entities to which nurses had previously been as11 signed prior to fiscal year 2019 (such as feder12 ally qualified health centers and facilities affili13 ated with the Indian Health Service). 

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

15 the enactment of this Act, the Comptroller General 

16 shall submit to the Committee on Health, Edu17 cation, Labor, and Pensions of the Senate and the 

18 Committee on Energy and Commerce of the House 

19 of Representatives a report on the evaluation under 

20 paragraph (1), which may include recommendations 

21 to improve relevant nursing workforce loan repay22 ment programs. 

23 SECTION 1. SHORT TITLE. 

24 This Act may be cited as the ‘‘Title VIII Nursing 

25 Workforce Reauthorization Act of 2019’’. 


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1 SEC. 2. NURSING WORKFORCE DEVELOPMENT. 

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

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

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

5 the end the following: 

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

7 term ‘nurse managed health clinic’ means a nurse8 practice arrangement, managed by advanced practice 

9 nurses, that provides primary care or wellness serv10 ices to underserved or vulnerable populations and 

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

12 department of nursing, federally qualified health cen13 ter, or independent nonprofit health or social services 

14 agency.’’; 

15 (2) in section 802(c) (42 U.S.C. 296a(c)), by in16 serting ‘‘, and how such project aligns with the goals 

17 in section 806(a)’’ before the period in the second sen18 tence; 

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

20 adding at the end the following: ‘‘Such Federal funds 

21 are intended to supplement, not supplant, existing 

22 non-Federal expenditures for such activities.’’; 

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

24 (A) in subsection (a), by striking ‘‘as needed 

25 to’’ and all that follows and inserting the folVerDate Sep 11 2014 21:50 Nov 05, 2019 Jkt 099200 PO 00000 Frm 00012 Fmt 6652 Sfmt 6203 E:\BILLS\S1399.RS S1399

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1 lowing: ‘‘as needed to address national nursing 

2 needs, including— 

3 ‘‘(1) addressing challenges, including through 

4 supporting training and education of nursing stu5 dents, related to the distribution of the nursing work6 force and existing or projected nursing workforce 

7 shortages in geographic areas that have been identi8 fied as having, or that are projected to have, a nurs9 ing shortage; 

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

11 health care services, including by supporting the 

12 training of professional registered nurses, advanced 

13 practice registered nurses, and advanced education 

14 nurses within community based settings and in a va15 riety of health delivery system settings; or 

16 ‘‘(3) addressing the strategic goals and priorities 

17 identified by the Secretary and that are in accord18 ance with this title. 

19 Contracts may be entered into under this title with public 

20 or private entities as determined necessary by the Sec21 retary.’’; 

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

23 demonstration’’ and all that follows and insert24 ing the following: ‘‘the reporting of data and in25 formation demonstrating that satisfactory 


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1 progress has been made by the program or 

2 project in meeting the performance outcome 

3 standards (as described in section 802) of such 

4 program or project.’’; 

5 (C) in subsection (e)(2), by inserting ‘‘, and 

6 have relevant expertise and experience’’ before the 

7 period at the end of the first sentence; and 

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

9 ‘‘(i) BIENNIAL REPORT ON NURSING WORKFORCE

10 PROGRAM IMPROVEMENTS.—Not later than September 30, 

11 2020, and biennially thereafter, the Secretary shall submit 

12 to the Committee on Health, Education, Labor, and Pen13 sions of the Senate and the Committee on Energy and Com14 merce of the House of Representatives, a report that con15 tains an assessment of the programs and activities of the 

16 Department of Health and Human Services related to en17 hancing the nursing workforce, including the extent to 

18 which programs and activities under this title meet the 

19 identified goals and performance measures developed for the 

20 respective programs and activities, and the extent to which 

21 the Department coordinates with other Federal departments 

22 regarding programs designed to improve the nursing work23 force.’’; 

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

25 (A) in subsection (b)— 


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1 (i) by striking ‘‘Master’s’’ and insert2 ing ‘‘graduate’’; and 

3 (ii) by inserting ‘‘clinical nurse lead4 ers,’’ after ‘‘nurse administrators,’’; 

5 (B) by redesignating subsections (f) and (g) 

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

7 (C) by inserting after subsection (e), the fol8 lowing: 

9 ‘‘(f) AUTHORIZED CLINICAL NURSE SPECIALIST PRO10 GRAMS.—Clinical nurse specialist programs eligible for 

11 support under this section are education programs that— 

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

13 clinical nurse specialist education; and 

14 ‘‘(2) have as their objective the education of clin15 ical nurse specialists who will, upon completion of 

16 such a program, be qualified to effectively provide 

17 care through the wellness and illness continuum to in18 patients and outpatients experiencing acute and 

19 chronic illness.’’; and 

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

21 (A) in the section heading, by striking 

22 ‘‘AND QUALITY GRANTS’’ and inserting 

23 ‘‘QUALITY, AND RETENTION GRANTS’’; 

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

25 high-risk groups such as the elderly, individuals 


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1 with HIV/AIDS, substance abusers, the homeless, 

2 and victims’’ and inserting ‘‘high risk groups, 

3 such as the elderly, individuals with HIV/AIDS, 

4 individuals with mental health or substance use 

5 disorders, individuals who are homeless, and sur6 vivors’’; 

7 (C) in subsection (c)(1)— 

8 (i) in subparagraph (A)— 

9 (I) by striking ‘‘advancement for 

10 nursing personnel’’ and inserting the 

11 following: ‘‘advancement for— 

12 ‘‘(i) nursing’’; 

13 (II) by striking ‘‘professional 

14 nurses, advanced education nurses, li15 censed practical nurses, certified nurse 

16 assistants, and home health aides’’ and 

17 inserting ‘‘professional registered 

18 nurses, advanced practice registered 

19 nurses, and nurses with graduate nurs20 ing education’’; and 

21 (III) by adding at the end the fol22 lowing: 

23 ‘‘(ii) individuals including licensed 

24 practical nurses, licensed vocational nurses, 

25 certified nurse assistants, home health aides, 


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1 diploma degree or associate degree nurses, 

2 and other health professionals, such as 

3 health aides or community health practi4 tioners certified under the Community 

5 Health Aide Program of the Indian Health 

6 Service, to become registered nurses with 

7 baccalaureate degrees or nurses with grad8 uate nursing education;’’; 

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

10 the period and inserting ‘‘; and’’; and 

11 (iii) by adding at the end the fol12 lowing: 

13 ‘‘(C) developing and implementing intern14 ships, accredited fellowships, and accredited resi15 dency programs in collaboration with one or 

16 more accredited schools of nursing, to encourage 

17 the mentoring and development of specialties.’’; 

18 (D) by striking subsection (e); 

19 (E) by redesignating subsection (f) through 

20 (h), as subsections (e) through (g), respectively; 

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

22 by striking ‘‘The Secretary shall submit to the 

23 Congress before the end of each fiscal year’’ and 

24 inserting ‘‘As part of the report on nursing 


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1 workforce programs described in section 806(i), 

2 the Secretary shall include’’; 

3 (G) in subsection (f) (as so redesignated), by 

4 striking ‘‘a school of nursing, as defined in sec5 tion 801(2),,’’ and inserting ‘‘an accredited 

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

7 health care facility, including federally qualified 

8 health centers or nurse-managed health clinics, 

9 or a partnership of such a school and facility’’; 

10 and 

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

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

13 ‘‘2020 through 2024’’; 

14 (7) by striking section 831A (42 U.S.C. 296p-1); 

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

16 (A) by striking the last sentence of sub17 section (a); 

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

19 began such practice’’ and inserting ‘‘the indi20 vidual began such practice’’; and 

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

22 through 2007’’ and inserting ‘‘2020 through 

23 2024’’; 


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

2 striking ‘‘2010 through 2014’’ and inserting ‘‘2020 

3 through 2024’’; 

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

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

6 fiscal years 2010 through 2014’’ and inserting 

7 ‘‘$115,635,000 for each of fiscal years 2020 through 

8 2024’’; 

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

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

11 ‘‘and nurse anesthetists’’ and inserting ‘‘nurse 

12 anesthetists, and clinical nurse specialists’’; 

13 (B) in subsection (d)(3)— 

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

15 of enactment of this section’’ and inserting 

16 ‘‘2 years after the date of enactment of the 

17 Title VIII Nursing Reauthorization Act’’; 

18 (ii) by striking ‘‘Labor and Human 

19 Resources’’ and inserting ‘‘Health, Edu20 cation, Labor, and Pensions’’; and 

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

22 ‘‘Commerce’’; and 

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

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

25 B, C, and D’’; 


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1 (12) by striking sections 861 and 862 (42 U.S.C. 

2 297w and 297x); 

3 (13) in section 865(e) (42 U.S.C. 298(e)), by 

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

5 (14) in section 871 (42 U.S.C. 298d), by striking 

6 ‘‘$338,000,000 for fiscal year 2010, and such sums as 

7 may be necessary for each of the fiscal years 2011 

8 through 2016’’ and inserting ‘‘$133,837,000 for each 

9 of fiscal years 2020 through 2024’’. 

10 (b) EVALUATION AND REPORT ON NURSE LOAN RE11 PAYMENT PROGRAMS.— 

12 (1) EVALUATION.—The Comptroller General 

13 shall conduct an evaluation of the nurse loan repay14 ment programs administered by the Health Resources 

15 and Services Administration. Such evaluation shall 

16 include— 

17 (A) the manner in which payments are 

18 made under such programs; 

19 (B) the existing oversight functions nec20 essary to ensure the proper use of such programs, 

21 including payments made as part of such pro22 grams; 

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

24 oversight functions; and 


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1 (D) information on the number of nurses 

2 assigned to facilities pursuant to such programs, 

3 including the type of facility to which nurses are 

4 assigned and the impact of modifying the eligi5 bility requirements for programs under section 

6 846 of the Public Health Service Act (42 U.S.C. 

7 297n), such as the impact on entities to which 

8 nurses had previously been assigned prior to fis9 cal year 2019 (such as federally qualified health 

10 centers and facilities affiliated with the Indian 

11 Health Service). 

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

13 enactment of this Act, the Comptroller General shall 

14 submit to the Committee on Health, Education, 

15 Labor, and Pensions of the Senate and the Committee 

16 on Energy and Commerce of the House of Representa17 tives, a report on the evaluation under paragraph (1), 

18 which may include recommendations to improve rel19 evant nursing workforce loan repayment programs. 


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Calendar No. 285 

116TH CONGRESS 

1ST SESSION S. 1399 

A BILL 

To amend title VIII of the Public Health Services 

opment programs. Act to revise and extend nursing workforce develNOVEMBER 5, 2019 

Reported with an amendment 


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