H. R. 3487
One Hundred Seventh Congress
of the
United States of America
AT THE SECOND SESSION
Begun and held at the City of Washington on Wednesday,
the twenty-third day of January, two thousand and two
An Act
To amend the Public Health Service Act with respect to health professions programs
regarding the field of nursing.
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’’.
SEC. 2. TABLE OF CONTENTS.
The table of contents for this Act is as follows:
Sec. 1. Short title.
Sec. 2. Table of contents.
TITLE I—NURSE RECRUITMENT
Sec. 101. Definitions.
Sec. 102. Public service announcements regarding the nursing profession.
Sec. 103. National Nurse Service Corps.
TITLE II—NURSE RETENTION
Sec. 201. Building career ladders and retaining quality nurses.
Sec. 202. Comprehensive geriatric education.
Sec. 203. Nurse faculty loan program.
Sec. 204. Reports by General Accounting Office.
TITLE I—NURSE RECRUITMENT
SEC. 101. DEFINITIONS.
Section 801 of the Public Health Service Act (42 U.S.C. 296)
is amended by adding at the end the following:
‘‘(9) AMBULATORY SURGICAL CENTER.—The term ‘ambula-
tory surgical center’ has the meaning applicable to such term
under title XVIII of the Social Security Act.
‘‘(10) FEDERALLY
QUALIFIED
HEALTH
CENTER.—The term
‘Federally qualified health center’ has the meaning given such
term under section 1861(aa)(4) of the Social Security Act.
‘‘(11) HEALTH
CARE
FACILITY.—The term ‘health care
facility’ means an Indian Health Service health center, a Native
Hawaiian health center, a hospital, a Federally qualified health
center, a rural health clinic, a nursing home, a home health
agency, a hospice program, a public health clinic, a State or
local department of public health, a skilled nursing facility,
an ambulatory surgical center, or any other facility designated
by the Secretary.
‘‘(12) HOME
HEALTH
AGENCY.—The term ‘home health
agency’ has the meaning given such term in section 1861(o)
of the Social Security Act.
H. R. 3487—2
‘‘(13) HOSPICE PROGRAM.—The term ‘hospice program’ has
the meaning given such term in section 1861(dd)(2) of the
Social Security Act.
‘‘(14) RURAL HEALTH CLINIC.—The term ‘rural health clinic’
has the meaning given such term in section 1861(aa)(2) of
the Social Security Act.
‘‘(15) SKILLED NURSING FACILITY.—The term ‘skilled nursing
facility’ has the meaning given such term in section 1819(a)
of the Social Security Act.’’.
SEC. 102. PUBLIC SERVICE ANNOUNCEMENTS REGARDING THE
NURSING PROFESSION.
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—PUBLIC SERVICE ANNOUNCEMENTS
‘‘SEC. 851. PUBLIC SERVICE ANNOUNCEMENTS.
‘‘(a) IN GENERAL.—The Secretary shall develop and issue public
service announcements that advertise and promote the nursing
profession, highlight the advantages and rewards of nursing, and
encourage individuals to enter the nursing profession.
‘‘(b) METHOD.—The public service announcements described in
subsection (a) shall be broadcast through appropriate media outlets,
including television or radio, in a manner intended to reach as
wide and diverse an audience as possible.
‘‘(c) AUTHORIZATION OF APPROPRIATIONS.—There are authorized
to be appropriated to carry out this section such sums as may
be necessary for each of fiscal years 2003 through 2007.
‘‘SEC. 852. STATE AND LOCAL PUBLIC SERVICE ANNOUNCEMENTS.
‘‘(a) IN GENERAL.—The Secretary may award grants to eligible
entities to support State and local advertising campaigns through
appropriate media outlets to promote the nursing profession, high-
light the advantages and rewards of nursing, and encourage individ-
uals from disadvantaged backgrounds to enter the nursing profes-
sion.
‘‘(b) USE OF FUNDS.—An eligible entity that receives a grant
under subsection (a) shall use funds received through such grant
to acquire local television and radio time, place advertisements
in local newspapers, or post information on billboards or on the
Internet in a manner intended to reach as wide and diverse an
audience as possible, in order to—
‘‘(1) advertise and promote the nursing profession;
‘‘(2) promote nursing education programs;
‘‘(3) inform the public of financial assistance regarding
such education programs;
‘‘(4) highlight individuals in the community who are prac-
ticing nursing in order to recruit new nurses; or
‘‘(5) provide any other information to recruit individuals
for the nursing profession.
‘‘(c) LIMITATION.—An eligible entity that receives a grant under
subsection (a) shall not use funds received through such grant
to advertise particular employment opportunities.
‘‘(d) AUTHORIZATION OF APPROPRIATIONS.—There are authorized
to be appropriated to carry out this section such sums as may
be necessary for each of fiscal years 2003 through 2007.’’.
H. R. 3487—3
SEC. 103. NATIONAL NURSE SERVICE CORPS.
(a) LOAN REPAYMENT PROGRAM.—Section 846(a) of the Public
Health Service Act (42 U.S.C. 297n(a)) is amended—
(1) in paragraph (3), by striking ‘‘in an Indian Health
Service health center’’ and all that follows to the semicolon
and inserting ‘‘at a health care facility with a critical shortage
of nurses’’; and
(2) by adding at the end the following: ‘‘After fiscal year
2007, the Secretary may not, pursuant to any agreement
entered into under this subsection, assign a nurse to any private
entity unless that entity is nonprofit.’’.
(b) ESTABLISHMENT OF SCHOLARSHIP PROGRAM.—Section 846
of the Public Health Service Act (42 U.S.C. 297n) is amended—
(1) in the heading for the section, by striking ‘‘LOAN REPAY-
MENT PROGRAM’’ and inserting ‘‘LOAN REPAYMENT AND SCHOLAR-
SHIP PROGRAMS’’;
(2) by redesignating subsections (d), (f), (g), and (h) as
subsections (f), (h), (i), and (g), respectively;
(3) by transferring subsections (f) and (g) (as so redesig-
nated) from their current placements, by inserting subsection
(f) after subsection (e), and by inserting subsection (g) after
subsection (f) (as so inserted); and
(4) by inserting after subsection (c) the following subsection:
‘‘(d) SCHOLARSHIP PROGRAM.—
‘‘(1) IN GENERAL.—The Secretary shall (for fiscal years 2003
and 2004) and may (for fiscal years thereafter) carry out a
program of entering into contracts with eligible individuals
under which such individuals agree to serve as nurses for
a period of not less than 2 years at a health care facility
with a critical shortage of nurses, in consideration of the Fed-
eral Government agreeing to provide to the individuals scholar-
ships for attendance at schools of nursing.
‘‘(2) ELIGIBLE INDIVIDUALS.—In this subsection, the term
‘eligible individual’ means an individual who is enrolled or
accepted for enrollment as a full-time or part-time student
in a school of nursing.
‘‘(3) SERVICE REQUIREMENT.—
‘‘(A) IN GENERAL.—The Secretary may not enter into
a contract with an eligible individual under this subsection
unless the individual agrees to serve as a nurse at a
health care facility with a critical shortage of nurses for
a period of full-time service of not less than 2 years, or
for a period of part-time service in accordance with
subparagraph (B).
‘‘(B) PART-TIME SERVICE.—An individual may complete
the period of service described in subparagraph (A) on
a part-time basis if the individual has a written agreement
that—
‘‘(i) is entered into by the facility and the individual
and is approved by the Secretary; and
‘‘(ii) provides that the period of obligated service
will be extended so that the aggregate amount of
service performed will equal the amount of service
that would be performed through a period of full-time
service of not less than 2 years.
‘‘(4) APPLICABILITY OF CERTAIN PROVISIONS.—The provisions
of subpart III of part D of title III shall, except as inconsistent
H. R. 3487—4
with this section, apply to the program established in paragraph
(1) in the same manner and to the same extent as such provi-
sions apply to the National Health Service Corps Scholarship
Program established in such subpart.’’.
(c) PREFERENCE.—Section 846(e) of the Public Health Service
Act (42 U.S.C. 297n(e)) is amended by striking ‘‘under subsection
(a)’’ and all that follows through the period and inserting ‘‘under
subsection (a) or (d), the Secretary shall give preference to qualified
applicants with the greatest financial need.’’.
(d) REPORTS.—Subsection (h) of section 846 of the Public Health
Service Act (42 U.S.C. 297n) (as redesignated by subsection (b)(2))
is amended to read as follows:
‘‘(h) REPORTS.—Not later than 18 months after the date of
enactment of the Nurse Reinvestment Act, and annually thereafter,
the Secretary shall prepare and submit to the Congress a report
describing the programs carried out under this section, including
statements regarding—
‘‘(1) the number of enrollees, scholarships, loan repayments,
and grant recipients;
‘‘(2) the number of graduates;
‘‘(3) the amount of scholarship payments and loan repay-
ments made;
‘‘(4) which educational institution the recipients attended;
‘‘(5) the number and placement location of the scholarship
and loan repayment recipients at health care facilities with
a critical shortage of nurses;
‘‘(6) the default rate and actions required;
‘‘(7) the amount of outstanding default funds of both the
scholarship and loan repayment programs;
‘‘(8) to the extent that it can be determined, the reason
for the default;
‘‘(9) the demographics of the individuals participating in
the scholarship and loan repayment programs;
‘‘(10) justification for the allocation of funds between the
scholarship and loan repayment programs; and
‘‘(11) an evaluation of the overall costs and benefits of
the programs.’’.
(e) FUNDING.—Subsection (i) of section 846 of the Public Health
Service Act (42 U.S.C. 297n) (as redesignated by subsection (b)(2))
is amended to read as follows:
‘‘(i) FUNDING.—
‘‘(1) AUTHORIZATION OF APPROPRIATIONS.—For the purpose
of payments under agreements entered into under subsection
(a) or (d), there are authorized to be appropriated such sums
as may be necessary for each of fiscal years 2003 through
2007.
‘‘(2) ALLOCATIONS.—Of the amounts appropriated under
paragraph (1), the Secretary may, as determined appropriate
by the Secretary, allocate amounts between the program under
subsection (a) and the program under subsection (d).’’.
H. R. 3487—5
TITLE II—NURSE RETENTION
SEC. 201. BUILDING CAREER LADDERS AND RETAINING QUALITY
NURSES.
Section 831 of the Public Health Service Act (42 U.S.C. 296p)
is amended to read as follows:
‘‘SEC. 831. NURSE EDUCATION, PRACTICE, AND RETENTION GRANTS.
‘‘(a) EDUCATION PRIORITY AREAS.—The Secretary may award
grants to or enter into contracts with eligible entities for—
‘‘(1) expanding the enrollment in baccalaureate nursing
programs;
‘‘(2) developing and implementing internship and residency
programs to encourage mentoring and the development of
specialties; or
‘‘(3) providing education in new technologies, including dis-
tance learning methodologies.
‘‘(b) PRACTICE PRIORITY AREAS.—The Secretary may award
grants to or enter into contracts with eligible entities for—
‘‘(1) establishing or expanding nursing practice arrange-
ments in noninstitutional settings to demonstrate methods to
improve access to primary health care in medically underserved
communities;
‘‘(2) providing care for underserved populations and other
high-risk groups such as the elderly, individuals with HIV/
AIDS, substance abusers, the homeless, and victims of domestic
violence;
‘‘(3) providing managed care, quality improvement, and
other skills needed to practice in existing and emerging orga-
nized health care systems; or
‘‘(4) developing cultural competencies among nurses.
‘‘(c) RETENTION PRIORITY AREAS.—The Secretary may award
grants to and enter into contracts with eligible entities to enhance
the nursing workforce by initiating and maintaining nurse retention
programs pursuant to paragraph (1) or (2).
‘‘(1) GRANTS
FOR
CAREER
LADDER
PROGRAMS.—The Sec-
retary may award grants to and enter into contracts with
eligible entities for programs—
‘‘(A) to promote career advancement for nursing per-
sonnel in a variety of training settings, cross training or
specialty training among diverse population groups, and
the advancement of individuals including to become profes-
sional nurses, advanced education nurses, licensed practical
nurses, certified nurse assistants, and home health aides;
and
‘‘(B) to assist individuals in obtaining education and
training required to enter the nursing profession and
advance within such profession, such as by providing career
counseling and mentoring.
‘‘(2) ENHANCING PATIENT CARE DELIVERY SYSTEMS.—
‘‘(A) GRANTS.—The Secretary may award grants to
eligible entities to improve the retention of nurses and
enhance patient care that is directly related to nursing
activities by enhancing collaboration and communication
among nurses and other health care professionals, and
H. R. 3487—6
by promoting nurse involvement in the organizational and
clinical decisionmaking processes of a health care facility.
‘‘(B) PREFERENCE.—In making awards of grants under
this paragraph, the Secretary shall give a preference to
applicants that have not previously received an award
under this paragraph.
‘‘(C) CONTINUATION OF AN AWARD.—The Secretary shall
make continuation of any award under this paragraph
beyond the second year of such award contingent on the
recipient of such award having demonstrated to the Sec-
retary measurable and substantive improvement in nurse
retention or patient care.
‘‘(d) OTHER PRIORITY AREAS.—The Secretary may award grants
to or enter into contracts with eligible entities to address other
areas that are of high priority to nurse education, practice, and
retention, as determined by the Secretary.
‘‘(e) PREFERENCE.—For purposes of any amount of funds appro-
priated to carry out this section for fiscal year 2003, 2004, or
2005 that is in excess of the amount of funds appropriated to
carry out this section for fiscal year 2002, the Secretary shall
give preference to awarding grants or entering into contracts under
subsections (a)(2) and (c).
‘‘(f) REPORT.—The Secretary shall submit to the Congress before
the end of each fiscal year a report on the grants awarded and
the contracts entered into under this section. Each such report
shall identify the overall number of such grants and contracts
and provide an explanation of why each such grant or contract
will meet the priority need of the nursing workforce.
‘‘(g) ELIGIBLE ENTITY.—For purposes of this section, the term
‘eligible entity’ includes a school of nursing, a health care facility,
or a partnership of such a school and facility.
‘‘(h) AUTHORIZATION OF APPROPRIATIONS.—There are authorized
to be appropriated to carry out this section such sums as may
be necessary for each of fiscal years 2003 through 2007.’’.
SEC. 202. COMPREHENSIVE GERIATRIC EDUCATION.
(a) COMPREHENSIVE GERIATRIC EDUCATION.—Title VIII of the
Public Health Service Act (42 U.S.C. 296 et seq.) (as amended
by section 102) is amended by adding at the end the following:
‘‘PART I—COMPREHENSIVE GERIATRIC
EDUCATION
‘‘SEC. 855. COMPREHENSIVE GERIATRIC EDUCATION.
‘‘(a) PROGRAM AUTHORIZED.—The Secretary shall award grants
to eligible entities to develop and implement, in coordination with
programs under section 753, programs and initiatives to train and
educate individuals in providing geriatric care for the elderly.
‘‘(b) USE OF FUNDS.—An eligible entity that receives a grant
under subsection (a) shall use funds under such grant to—
‘‘(1) provide training to individuals who will provide geri-
atric care for the elderly;
‘‘(2) develop and disseminate curricula relating to the treat-
ment of the health problems of elderly individuals;
‘‘(3) train faculty members in geriatrics; or
‘‘(4) provide continuing education to individuals who pro-
vide geriatric care.
H. R. 3487—7
‘‘(c) APPLICATION.—An eligible entity desiring a grant under
subsection (a) shall submit an application to the Secretary at such
time, in such manner, and containing such information as the
Secretary may reasonably require.
‘‘(d) ELIGIBLE ENTITY.—For purposes of this section, the term
‘eligible entity’ includes a school of nursing, a health care facility,
a program leading to certification as a certified nurse assistant,
a partnership of such a school and facility, or a partnership of
such a program and facility.
‘‘(e) AUTHORIZATION OF APPROPRIATIONS.—There are authorized
to be appropriated to carry out this section such sums as may
be necessary for each of fiscal years 2003 through 2007.’’.
(b) TECHNICAL AMENDMENT.—Section 753(a)(1) of the Public
Health Service Act (42 U.S.C. 294c) is amended by striking ‘‘,
and section 853(2),’’ and inserting ‘‘, and section 801(2),’’.
SEC. 203. NURSE FACULTY LOAN PROGRAM.
Part E of title VIII of the Public Health Service Act (42 U.S.C.
297a et seq.) is amended by inserting after section 846 the following:
‘‘NURSE FACULTY LOAN PROGRAM
‘‘SEC. 846A. (a) ESTABLISHMENT.—The Secretary, acting
through the Administrator of the Health Resources and Services
Administration, may enter into an agreement with any school of
nursing for the establishment and operation of a student loan
fund in accordance with this section, to increase the number of
qualified nursing faculty.
‘‘(b) AGREEMENTS.—Each agreement entered into under sub-
section (a) shall—
‘‘(1) provide for the establishment of a student loan fund
by the school involved;
‘‘(2) provide for deposit in the fund of—
‘‘(A) the Federal capital contributions to the fund;
‘‘(B) an amount equal to not less than one-ninth of
such Federal capital contributions, contributed by such
school;
‘‘(C) collections of principal and interest on loans made
from the fund; and
‘‘(D) any other earnings of the fund;
‘‘(3) provide that the fund will be used only for loans
to students of the school in accordance with subsection (c)
and for costs of collection of such loans and interest thereon;
‘‘(4) provide that loans may be made from such fund only
to students pursuing a full-time course of study or, at the
discretion of the Secretary, a part-time course of study in an
advanced degree program described in section 811(b); and
‘‘(5) contain such other provisions as are necessary to pro-
tect the financial interests of the United States.
‘‘(c) LOAN PROVISIONS.—Loans from any student loan fund
established by a school pursuant to an agreement under subsection
(a) shall be made to an individual on such terms and conditions
as the school may determine, except that—
‘‘(1) such terms and conditions are subject to any conditions,
limitations, and requirements prescribed by the Secretary;
‘‘(2) in the case of any individual, the total of the loans
for any academic year made by schools of nursing from loan
funds established pursuant to agreements under subsection
H. R. 3487—8
(a) may not exceed $30,000, plus any amount determined by
the Secretary on an annual basis to reflect inflation;
‘‘(3) an amount up to 85 percent of any such loan (plus
interest thereon) shall be canceled by the school as follows:
‘‘(A) upon completion by the individual of each of the
first, second, and third year of full-time employment,
required by the loan agreement entered into under this
subsection, as a faculty member in a school of nursing,
the school shall cancel 20 percent of the principle of, and
the interest on, the amount of such loan unpaid on the
first day of such employment; and
‘‘(B) upon completion by the individual of the fourth
year of full-time employment, required by the loan agree-
ment entered into under this subsection, as a faculty
member in a school of nursing, the school shall cancel
25 percent of the principle of, and the interest on, the
amount of such loan unpaid on the first day of such employ-
ment;
‘‘(4) such a loan may be used to pay the cost of tuition,
fees, books, laboratory expenses, and other reasonable education
expenses;
‘‘(5) such a loan shall be repayable in equal or graduated
periodic installments (with the right of the borrower to accel-
erate repayment) over the 10-year period that begins 9 months
after the individual ceases to pursue a course of study at
a school of nursing; and
‘‘(6) such a loan shall—
‘‘(A) beginning on the date that is 3 months after
the individual ceases to pursue a course of study at a
school of nursing, bear interest on the unpaid balance
of the loan at the rate of 3 percent per annum; or
‘‘(B) subject to subsection (e), if the school of nursing
determines that the individual will not complete such
course of study or serve as a faculty member as required
under the loan agreement under this subsection, bear
interest on the unpaid balance of the loan at the prevailing
market rate.
‘‘(d) PAYMENT OF PROPORTIONATE SHARE.—Where all or any
part of a loan, or interest, is canceled under this section, the
Secretary shall pay to the school an amount equal to the school’s
proportionate share of the canceled portion, as determined by the
Secretary.
‘‘(e) REVIEW BY SECRETARY.—At the request of the individual
involved, the Secretary may review any determination by a school
of nursing under subsection (c)(6)(B).
‘‘(f) AUTHORIZATION OF APPROPRIATIONS.—There are authorized
to be appropriated to carry out this section such sums as may
be necessary for each of fiscal years 2003 through 2007.’’.
SEC. 204. REPORTS BY GENERAL ACCOUNTING OFFICE.
(a) NATIONAL VARIATIONS.—Not later than 4 years after the
date of the enactment of this Act, the Comptroller General of
the United States shall conduct a survey to determine national
variations in the nursing shortage at hospitals, nursing homes,
and other health care providers, and submit a report, including
recommendations, to the Congress on Federal remedies to ease
nursing shortages. The Comptroller General shall submit to the
H. R. 3487—9
Congress this report describing the findings relating to ownership
status and associated remedies.
(b) HIRING DIFFERENCES AMONG CERTAIN PRIVATE ENTITIES.—
The Comptroller General of the United States shall conduct a
study to determine differences in the hiring of nurses by nonprofit
private entities as compared to the hiring of nurses by private
entities that are not nonprofit. In carrying out the study, the
Comptroller General shall determine the effect of the inclusion
of private entities that are not nonprofit in the program under
section 846 of the Public Health Service Act. Not later than 4
years after the date of the enactment of this Act, the Comptroller
General shall submit to the Congress a report describing the
findings of the study.
(c) NURSING SCHOLARSHIPS.—The Comptroller General of the
United States shall conduct an evaluation of whether the program
carried out under section 846(d) of the Public Health Service Act
has demonstrably increased the number of applicants to schools
of nursing and, not later than 4 years after the date of the enact-
ment of this Act, submit a report to the Congress on the results
of such evaluation.
Speaker of the House of Representatives.
Vice President of the United States and
President of the Senate.