I 

111TH CONGRESS 

1ST SESSION H. R. 3185 

To amend title XVIII of the Social Security Act to provide payment to 

hospitals for costs of expanded advanced practice nurse training programs. 

IN THE HOUSE OF REPRESENTATIVES 

JULY 13, 2009 

Mrs. CAPPS introduced the following bill; which was referred to the Committee 

on Ways and Means 

A BILL 

To amend title XVIII of the Social Security Act to provide 

payment to hospitals for costs of expanded advanced 

practice nurse training 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. MEDICARE PAYMENT FOR COSTS OF EX4 PANDED ADVANCED PRACTICE NURSE 

5 TRAINING PROGRAMS. 

6 (a) IN GENERAL.—Section 1861(v) of the Social Se7 curity Act (42 U.S.C. 1395x(v)) is amended— 

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

9 following new subparagraph: 


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

2 costs described in paragraph (9) for expanded advanced 

3 nurse practice training programs.’’; and 

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

5 paragraph: 

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

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

8 paragraph are educational costs (including faculty sala9 ries, student stipends (if any), clinical instruction costs, 

10 and other direct and indirect costs) of a hospital and affili11 ated schools and settings described in clause (ii)) attrib12 utable to the training of advanced practice nurses— 

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

14 and preventive care, transitional care, chronic care 

15 management, and other nursing services appropriate 

16 for the population under this title; and 

17 ‘‘(ii) through affiliation with one or more ac18 credited schools of nursing (as defined in section 

19 801 of the Public Health Service Act) and in part20 nership with two or more non-hospital community21 based care settings where at least half of all clinical 

22 training occurs. 

23 The Secretary may waive the community-based setting re24 quirement under clause (ii) for clinical training of ad25 vanced practice registered nurses, such as certified regVerDate Nov 24 2008 02:13 Jul 14, 2009 Jkt 079200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\H3185.IH H3185

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1 istered nurse anesthetists and certified nurse-midwives, in 

2 rural and medically underserved areas. 

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

4 attributable to an increase in the enrollment and the num5 ber of advanced practice nurse graduates in each edu6 cation or training program over the comparable average 

7 number from 2006 to 2010 (as determined by the Sec8 retary) but shall not be offset or take into account tuition, 

9 fees, or State or local government appropriations. The pro10 portion of such costs paid under this paragraph shall be 

11 determined based on the proportion of the total inpatient 

12 days of the hospital attributable to this title. 

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

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

15 with the schools of nursing and settings described in sub16 paragraph (A)(ii) to pay from such payment to such a 

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

18 arranged through the school) the costs of educational ac19 tivities described in subparagraph (A) attributable to each. 

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

21 nurse’ includes a clinical nurse specialist, nurse practi22 tioner, certified registered nurse anesthetist, and certified 

23 nurse midwife.’’. 


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

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

3 January 1, 2012. 

Æ 


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