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[Congressional Bills 107th Congress]
[From the U.S. Government Publishing Office]
[H.R. 1436 Introduced in House (IH)]

107th CONGRESS
  1st Session
                                H. R. 1436

  To amend the Public Health Service Act, titles XVIII and XIX of the 
Social Security Act, and the Internal Revenue Code of 1986 with respect 
to alleviating the nursing profession shortage, and for other purposes.

_______________________________________________________________________

                    IN THE HOUSE OF REPRESENTATIVES

                             April 4, 2001

  Mrs. Capps (for herself, Mrs. Kelly, Mrs. McCarthy of New York, Ms. 
Eddie Bernice Johnson of Texas, Ms. DeLauro, Mr. Gilman, Ms. Hooley of 
    Oregon, Mr. Larson of Connecticut, Mr. Towns, Mr. Langevin, Mr. 
Stenholm, Mr. Pascrell, Mr. DeFazio, Mr. Rush, Mr. Baldacci, Mr. Frost, 
   Mr. Pomeroy, Mr. Matsui, Ms. Solis, Mr. Barrett, Mr. Lantos, Mr. 
McGovern, Mr. Kind, Mr. Abercrombie, Mr. Green of Texas, Ms. Eshoo, Mr. 
    Wynn, and Mr. Dingell) introduced the following bill; which was 
 referred to the Committee on Energy and Commerce, and in addition to 
   the Committee on Ways and Means, for a period to be subsequently 
   determined by the Speaker, in each case for consideration of such 
 provisions as fall within the jurisdiction of the committee concerned

_______________________________________________________________________

                                 A BILL

 
  To amend the Public Health Service Act, titles XVIII and XIX of the 
Social Security Act, and the Internal Revenue Code of 1986 with respect 
to alleviating the nursing profession shortage, and for other purposes.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Nurse Reinvestment Act''.

            TITLE I--AMENDMENTS TO PUBLIC HEALTH SERVICE ACT

   Subtitle A--Initiatives to Combat Nursing Shortage and Strengthen 
                           Nursing Workforce

SEC. 101. ESTABLISHMENT OF INITIATIVES.

    Title VIII of the Public Health Service Act (42 U.S.C. 296 et seq.) 
is amended by adding at the end the following:

           ``PART H--INITIATIVES TO COMBAT NURSING SHORTAGES

``SEC. 851. PUBLIC SERVICE ANNOUNCEMENTS.

    ``(a) In General.--The Secretary shall develop and issue public 
service announcements that shall advertise and promote the nursing 
profession, highlight the advantages and rewards of nursing, and 
encourage individuals from diverse communities and backgrounds to enter 
the nursing profession.
    ``(b) Method.--The public service announcements described in 
subsection (a) shall be broadcast in appropriate languages through 
appropriate media outlets, including television or radio, in a manner 
intended to reach as wide and diverse an audience as possible.

``SEC. 852. STATE AND LOCAL PUBLIC SERVICE ANNOUNCEMENTS.

    ``(a) In General.--The Secretary shall award grants to designated 
eligible entities to support State and local advertising campaigns via 
appropriate media outlets to promote the nursing profession, highlight 
the advantages and rewards of nursing, and encourage individuals from 
disadvantaged communities and backgrounds to enter the nursing 
profession.
    ``(b) Definitions.--In this section:
            ``(1) Designated eligible entity.--The term `designated 
        eligible entity' means an eligible entity that is a 
        professional, national, or State nursing association, State 
        health care provider association, school of nursing, or other 
        eligible entity that provides similar services or serves a like 
        function.
            ``(2) State health care provider association.--The term 
        `State health care provider association' means a professional 
        association of hospitals, nursing homes, home health care 
        agencies, hospices, consortia of such associations, or other 
        entities determined by the Secretary to be appropriate for 
        purposes of this section.
    ``(c) Use of Funds.--A designated eligible entity that receives a 
grant under subsection (a) shall use funds received through such grant 
to buy local television and radio time, place advertisements in local 
newspapers, and post information on billboards or on the Internet, in 
order to--
            ``(1) advertise and promote the nursing profession;
            ``(2) promote nursing education programs;
            ``(3) inform the public of public assistance regarding such 
        education programs;
            ``(4) highlight individuals in the community that are 
        presently practicing nursing in order to recruit new nurses; 
        and
            ``(5) provide any other information to recruit individuals 
        for the nursing profession.
    ``(d) Method.--The campaigns described in subsection (a) shall be 
broadcast in appropriate languages on television or radio, or placed in 
newspapers as advertisements, or posted on billboards or the Internet, 
in a manner intended to reach as wide and diverse an audience as 
possible.

``SEC. 853. NURSE RECRUITMENT GRANT PROGRAM.

    ``(a) Program Authorized.--The Secretary shall award grants to 
eligible entities to increase nursing education opportunities.
    ``(b) Use of Funds.--An eligible entity that receives a grant under 
subsection (a) shall use funds received from such grant to--
            ``(1) support outreach programs at elementary and secondary 
        schools that inform guidance counselors and students of 
        education opportunities regarding nursing;
            ``(2) carry out special projects to increase nursing 
        education opportunities for individuals who are from 
        disadvantaged backgrounds (including racial and ethnic 
        minorities underrepresented among registered nurses) by 
        providing student scholarships or stipends, pre-entry 
        preparation, and retention activities;
            ``(3) provide assistance to public and nonprofit private 
        educational institutions (including junior colleges and 
        community colleges) to support remedial education programs for 
        nursing students who require assistance with math, science, 
        English, and medical terminology; and
            ``(4) meet the costs of child care and transportation for 
        individuals who are taking part in a nursing education program 
        at any level.

``SEC. 854. RULE OF CONSTRUCTION REGARDING NURSING PROFESSION.

    ``For purposes of this part, the term `nursing profession' includes 
the position of certified nursing assistant.

``SEC. 855. AUTHORIZATION OF APPROPRIATIONS.

    ``For the purpose of carrying out this part, there is authorized to 
be appropriated $20,000,000 for each of the fiscal years 2002 through 
2004.

       ``PART I--INITIATIVES TO STRENGTHEN THE NURSING WORKFORCE

``SEC. 861. CAREER LADDER GRANT PROGRAM.

    ``(a) Program Authorized.--The Secretary shall award grants to 
eligible entities to assist individuals in obtaining education required 
to enter the nursing profession and advance within such profession.
    ``(b) Use of Funds.--An eligible entity that receives a grant under 
subsection (a) shall use funds under such grant to establish student 
scholarships or stipends for nurse professionals, licensed practical 
nurses, certified nurse assistants, and home health aids who enroll in 
entry level nursing programs, advanced practice nursing degree 
programs, RN/Master's nursing degree programs, doctoral nursing 
programs, public health nursing programs, nurse educator programs, 
nurse administrator programs, long term care nursing programs, and 
training programs focused on specific technology use or disease 
management.

``SEC. 862. GRANTS FOR CURRICULUM DEVELOPMENT.

    ``(a) Program Authorized.--The Secretary shall award grants to 
designated eligible entities to develop and incorporate gerontology 
curriculum and competencies.
    ``(b) Designated Eligible Entity.--For purposes of this section, 
the term `designated eligible entity' means an eligible entity that is 
a school of nursing.
    ``(c) Use of Funds.--A designated eligible entity that receives a 
grant under subsection (a) shall use funds under such grant to develop 
stand alone courses in geriatric nursing to support concentrations, 
minors, and majors in the discipline, to hire faculty who are certified 
in geriatric nursing, to train nursing faculty members in gerontology, 
to provide continuing education in gerontology for practicing nurses at 
diploma, associate degree, and baccalaureate schools of nursing.

``SEC. 863. GRANTS FOR PARTNERSHIPS.

    ``(a) In General.--The Secretary shall award grants to designated 
eligible entities to enable such entities to form partnerships to carry 
out the activities described in subsection (d).
    ``(b) Designated Eligible Entity.--
            ``(1) In general.--For purposes of this section, the term 
        `designated eligible entity' means a school of nursing and a 
        health care facility, both of which are eligible entities, that 
        form a partnership to carry out the activities described in 
        subsection (d).
            ``(2) Health care facility.--For purposes of this section, 
        the term `health care facility' means a hospital, nursing home, 
        home health care agency, hospice, federally qualified health 
        center, rural health clinic, or public health clinic.
    ``(c) Use of Funds.--A designated eligible entity that receives a 
grant under subsection (a) shall use funds received through such grant 
to--
            ``(1) provide employees of the facility advanced training 
        and education at the school or facility;
            ``(2) establish or expand nursing practice arrangements in 
        noninstitutional settings to demonstrate methods to improve 
        access to health care in medically underserved communities;
            ``(3) purchase distance learning technology to extend 
        general education and training programs to rural areas, and to 
        extend specialty education and training programs to all areas; 
        and
            ``(4) establish or expand mentoring and internship programs 
        for training in specialty care areas.

``SEC. 864. GRANTS FOR HEALTH CAREER ACADEMIES.

    ``(a) In General.--The Secretary shall award grants to designated 
eligible entities for the purpose of assisting such entities in 
collaborating to carry out programs that form education pipelines to 
facilitate the entry of students of secondary educational institutions 
into careers in the field of nursing.
    ``(b) Designated Eligible Entities.--For purposes of subsection 
(a), the term `designated eligible entities' means eligible entities 
that are schools of nursing, health care providers, or secondary 
educational institutions.

``SEC. 865. FAST-TRACK NURSING FACULTY SCHOLARSHIP AND LOAN REPAYMENT 
              PROGRAMS.

    ``(a) In General.--The Secretary shall establish a program of 
entering into contracts with individuals described in subsection (b) 
under which the individuals agree to serve as members of the faculties 
of schools of nursing in consideration of the Federal Government 
agreeing--
            ``(1) to provide scholarships for full-time attendance at 
        doctoral programs in the field of nursing; or
            ``(2) to pay, for each year of service as such a faculty 
        member, not more than $20,000 of the principal and interest of 
        the educational loans of such individuals.
    ``(b) Eligible Individuals.--The individuals referred to in 
subsection (a) are --
            ``(1) in the case of the scholarship program under such 
        subsection, individuals who are enrolled or accepted for 
        enrollment in a doctoral program in the field of nursing; and
            ``(2) in the case of the loan repayment program under such 
        subsection--
                    ``(A) individuals who have a doctoral degree in the 
                field of nursing; or
                    ``(B) are enrolled in a doctoral program in such 
                field and are in the final academic year of the 
                program.
    ``(c) Requirements Regarding Faculty Positions.--
            ``(1) In general.--The Secretary may enter into a contract 
        under subsection (a) only if the individual involved has 
        entered into a contract with a school of nursing to serve as a 
        member of the faculty of the school for two years, or for such 
        longer period as may be specified in the contract.
            ``(2) Loan repayment program.--
                    ``(A) In general.--The Secretary may enter into a 
                contract under subsection (a)(2) only if the contract 
                referred to in paragraph (1) of this subsection 
                provides that--
                            ``(i) the school of nursing involved will, 
                        for each year for which the individual involved 
                        serves as a member of the faculty under the 
                        contract with the school, make payments of the 
                        principal and interest due on the educational 
                        loans of the individual for such year in an 
                        amount equal to the amount of such payments 
                        made by the Secretary for the year;
                            ``(ii) the payments made by the school 
                        pursuant to clause (i) on behalf of the 
                        individual will be in addition to the pay that 
                        the individual would otherwise receive for 
                        serving as a member of such faculty; and
                            ``(iii) the school, in making a 
                        determination of the amount of compensation to 
                        be provided by the school to the individual for 
                        serving as a member of the faculty, will make 
                        the determination without regard to the amount 
                        of payments made (or to be made) to the 
                        individual by the Federal Government under 
                        subsection (a)(2).
                    ``(B) Waiver regarding school contributions.--The 
                Secretary may waive the requirement established in 
                subparagraph (A) if the Secretary determines that the 
                requirement will impose an undue financial hardship on 
                the school of nursing involved.
    ``(d) Use of Scholarship.--A scholarship under subsection (a)(1) 
may be expended only for tuition expenses, other reasonable educational 
expenses, and reasonable living expenses incurred in attending the 
doctoral program involved.
    ``(e) Applicability of Certain Provisions.--With respect to the 
National Health Service Corps Schlolarship and Loan Repayment Programs 
established in subpart III of part D of title III, the provisions of 
such subpart shall, except as inconsistent with this section, apply to 
the programs established in subsections (a)(1) and (a)(2) of this 
section, respectively, in the same manner and to the same extent as 
such provisions apply to such Health Service Corps Scholarship and Loan 
Repayment Programs.

``SEC. 866. AUTHORIZATION OF APPROPRIATIONS.

    ``For the purpose of carrying out this part, there is authorized to 
be appropriated $46,000,000 for each of the fiscal years 2002 through 
2004.''.

     Subtitle B--National Nursing Service Corps Scholarship Program

SEC. 111. ESTABLISHMENT OF PROGRAM.

    Title VIII of the Public Health Service Act, as amended by section 
101 of this Act, is amended by adding at the end the following::

      ``PART J--NATIONAL NURSING SERVICE CORPS SCHOLARSHIP PROGRAM

``SEC. 871. NATIONAL NURSING SERVICE CORPS SCHOLARSHIP PROGRAM.

    ``(a) Program Authorized.--The Secretary shall establish a National 
Nurse Service Corps Scholarship program (referred to in this section as 
the `program') that provides scholarships to individuals seeking 
nursing education in exchange for service by such individuals in areas 
with nursing shortages.
    ``(b) Preference.--In awarding scholarships under this section, the 
Secretary shall give preference to applicants with the greatest 
financial need, and applicants who agree to serve in health facilities 
located in areas with nursing shortages.
    ``(c) Requirements.--To be eligible to participate in the program, 
an individual must--
            ``(1) be accepted for enrollment, or be enrolled, in a 
        school of nursing, to take courses leading to a baccalaureate 
        or associate degree in nursing (or an equivalent degree), or a 
        diploma in nursing;
            ``(2) submit an application to participate in the program; 
        and
            ``(3) enter into an agreement with the Secretary, at the 
        time of submittal of such application, to--
                    ``(A) accept payment of a scholarship and remain 
                enrolled in a nursing school;
                    ``(B) maintain an acceptable level of academic 
                standing; and
                    ``(C) serve as a nurse for a period of not less 
                than 2 years in an Indian Health Service health center, 
                a Native Hawaiian health center, tribal health center, 
                urban Indian health center, a public or nonprofit 
                private hospital, a health center under section 330, a 
                rural health clinic, a public or nonprofit private 
                nursing home, home health agency, or hospice facility 
                (including a home setting), or a public or nonprofit 
                private health facility determined by the Secretary to 
                have a critical shortage of nurses.
    ``(d) Applications.--
            ``(1) In general.--The application forms for the programs 
        shall include--
                    ``(A) a fair summary of the rights and liabilities 
                of an individual whose application is approved by the 
                Secretary; and
                    ``(B) information respecting meeting a service 
                obligation and such other information as may be 
                necessary for the individual to understand the program.
            ``(2) Accessibility.--The application form and all other 
        information furnished by the Secretary shall be written so that 
        it may be understood by the average individual applying to 
        participate in the program. The Secretary shall make such 
        application forms, and other information available to 
        individuals desiring to participate in the program, on a date 
        sufficiently early to ensure that such individuals have 
        adequate time to carefully review and evaluate such forms and 
        information.
            ``(3) Distribution.--The Secretary shall distribute to 
        nursing schools materials providing information on the program 
        and shall encourage the schools to disseminate the materials to 
        students of the schools.
    ``(e) Scholarship.--
            ``(1) In general.--A scholarship provided to a student for 
        a school year under a written contract under the program shall 
        consist of--
                    ``(A) payment to, or (in accordance with paragraph 
                (2)) on behalf of the student of--
                            ``(i) the tuition of the student in such 
                        school year; and
                            ``(ii) all other reasonable educational 
                        expenses, including fees, books, laboratory 
                        expenses, and living expenses incurred by the 
                        student in such school year; and
                    ``(B) payment to the student of a stipend of $400 
                per month for each 12 consecutive months beginning with 
                the first month of the school year.
            ``(2) Contract.--The Secretary may contract with a nursing 
        school, in which a participant in the program is enrolled, for 
        the payment to the nursing school of the amounts of tuition and 
        other reasonable educational expenses described in paragraph 
        (1)(A).
    ``(f) Breach of Agreement.--
            ``(1) In general.--In the case of an individual who enters 
        into an agreement under this section to provide service as a 
        nurse in consideration for receiving a scholarship, such 
        individual is liable to the Federal Government for the amount 
        of such scholarship, and for interest on such scholarship at 
        the maximum legal prevailing rate, if the individual--
                    ``(A) fails to maintain an acceptable level of 
                academic standing in the nursing program;
                    ``(B) is dismissed from the nursing program for 
                disciplinary reasons;
                    ``(C) voluntarily terminates the nursing program; 
                or
                    ``(D) fails to provide services in accordance with 
                the program under this section for the period of time 
                applicable under the program.
            ``(2) Waiver or suspension of liability.--The Secretary 
        shall provide for the waiver or suspension of liability under 
        this section if compliance by the individual with the agreement 
        is impossible, or would involve extreme hardship to the 
        individual, or if enforcement of the agreement with respect to 
        the individual would be unconscionable.
            ``(3) Date certain for recovery.--Subject to paragraph (2), 
        any amount that the Federal Government is entitled to recover 
        under paragraph (1) shall be paid to the United States not 
        later than the expiration of the 3-year period beginning on the 
        date the United States becomes so entitled.
            ``(4) Availability.--Amounts recovered under paragraph (1) 
        with respect to a program under this section shall be available 
        for the purposes of such program, and shall remain available 
        for such purposes until expended.
    ``(g) Definitions.--In this section:
            ``(1) Community health center.--The term ``community health 
        center'' has the meaning given such term in section 330(a).
            ``(2) Rural health clinic.--The term ``rural health 
        clinic'' has the meaning given such term in section 1861(aa)(2) 
        of the Social Security Act.
    ``(h) Authorization of Appropriations.--For the purpose of payments 
under agreements entered into under subsection (a), there is authorized 
to be appropriated $50,000,000 for each of the fiscal years 2002 
through 2004.''.

SEC. 112. INTERNAL REVENUE CODE; EXCLUSION OF CERTAIN AMOUNTS RECEIVED 
              UNDER THE NATIONAL NURSING SERVICE CORPS SCHOLARSHIP 
              PROGRAM.

    (a) In General.--Section 117(c) of the Internal Revenue Code of 
1986 (relating to the exclusion from gross income amounts received as a 
qualified scholarship) is amended--
            (1) by striking ``Subsections (a)'' and inserting the 
        following:
            ``(1) In general.--Except as provided in paragraph (2), 
        subsections (a)'', and
            (2) by adding at the end the following new paragraph:
            ``(2) Exceptions.--Paragraph (1) shall not apply to any 
        amount received by an individual under the National Nursing 
        Service Corps Scholarship program under part J of title VIII of 
        the Public Health Service Act.''.
    (b) Effective Date.--The amendments made by subsection (a) shall 
apply to amounts received in taxable years beginning after December 31, 
2001.

              TITLE II--AMENDMENTS TO SOCIAL SECURITY ACT

               Subtitle A--Amendments to Medicare Program

SEC. 201. EXPANSION OF NURSING TRAINING EDUCATION PAYMENTS TO QUALIFIED 
              NONHOSPITAL PROVIDERS.

    Section 1861(v)(1) of the Social Security Act (42 U.S.C. 
1395x(v)(1)) is amended by adding at the end the following new 
subparagraph:
    ``(V)(i) For portions of cost reporting periods beginning on or 
after October 1, 2001, the Secretary shall establish rules for making 
payments to qualified nonhospital providers for the reasonable costs of 
providing nursing training if such costs are incurred in the operation 
of a training program that is operated by a hospital.
    ``(ii) The rules established under clause (i) shall--
            ``(I) be similar to rules for payments to hospitals under 
        this subsection for such reasonable costs; and
            ``(II) specify the form and manner in which such payments 
        will be made and the portion of such payments that will be made 
        from each of the trust funds under this title.
    ``(iii) No payment shall be made to a qualified nonhospital 
provider under this subparagraph for such reasonable costs to the 
extent that such reasonable costs are otherwise reimbursed under this 
title or under any other Federal program.
    ``(iv) For purposes of this subparagraph, the term `qualified 
nonhospital provider' means--
            ``(I) a Federally qualified health center (as defined in 
        section 1861(aa)(4));
            ``(II) a rural health clinic (as defined in section 
        1861(aa)(2));
            ``(III) a skilled nursing facility (as defined in section 
        1819(a));
            ``(IV) a Medicare+Choice organization under part C; and
            ``(V) any other provider (other than a hospital) that the 
        Secretary determines to be appropriate.''.

SEC. 202. REIMBURSEMENT OF THE COSTS OF PROVIDING NURSING TRAINING 
              EDUCATION BY HOSPICE AND HOME HEALTH PROVIDERS.

    Title XVIII of the Social Security Act (42 U.S.C. 1395 et seq.) is 
amended by adding at the end the following new section:

``reimbursement of the costs of providing nursing training education by 
                   hospice and home health providers

    ``Sec. 1897. (a) Payments.--
            ``(1) In general.--The Secretary shall establish rules for 
        making payments to qualified entities for the reasonable costs 
        of providing nursing training during fiscal years 2002 through 
        2006. Subject to subsection (c), such payments shall be in 
        addition to payments otherwise made to such entities under this 
        title.
            ``(2) Rules.--The rules established under paragraph (1) 
        shall ensure that reimbursement is made for the costs of 
        training nurses to furnish items and services which are 
        specific to the qualified entity.
            ``(3) Qualified entity defined.--For purposes of this 
        section, the term `qualified entity' means--
                    ``(A) a hospice program providing hospice care; and
                    ``(B) a home health agency (as defined in section 
                1861(o)).
    ``(b) Maintenance of Effort.--The Secretary shall ensure that a 
qualified entity does not use amounts received under this section to 
reduce or eliminate staffing problems that the entity may have.
    ``(c) Prohibition on Double Payments.--No payment shall be made to 
a qualified entity under this section for the reasonable costs of 
providing nursing training to the extent that such costs are otherwise 
reimbursed under this title or under any other Federal program.
    ``(d) Funding.--For purposes of making payments under this section, 
there are appropriated, out of any money in the Treasury not otherwise 
appropriated, such sums as may be necessary for each of fiscal years 
2002 through 2006.''.

               Subtitle B--Amendment to Medicaid Program

SEC. 211. TEMPORARY INCREASE IN FEDERAL MATCHING RATE FOR MEDICAID 
              NURSE AIDE TRAINING AND COMPETENCY EVALUATION PROGRAMS.

    Section 1903(a)(2)(B) of the Social Security Act (42 U.S.C. 
1396b(a)(2)(B)) is amended by striking ``(or, for calendar quarters 
beginning on or after July 1, 1988, and before October 1, 1990, the 
lesser of 90 percent or the Federal medical assistance percentage plus 
25 percentage points)'' and inserting ``(or, for calendar quarters 
beginning on or after October 1, 2001, and before October 1, 2006, 90 
percent)''.
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