I 
111TH CONGRESS 
1ST SESSION H. R. 2754 
To amend the Public Health Service Act to establish the Nurse-Managed 
Health Clinic Investment program, and for other purposes. 
IN THE HOUSE OF REPRESENTATIVES 
JUNE 8, 2009 
Mrs. CAPPS (for herself and Mr. TERRY) introduced the following bill; which 
was referred to the Committee on Energy and Commerce 
A BILL 
To amend the Public Health Service Act to establish the 
Nurse-Managed Health Clinic Investment program, and 
for other purposes. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Nurse-Managed 
Health Clinic Investment Act of 2009’’. 
SEC. 2. FINDINGS AND PURPOSE. 
(a) FINDINGS.—Congress makes the following find-
ings: 
(1) Nurse-managed health clinics (referred to in 
this section as ‘‘NMHCs’’) offer their patients pri-
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mary care and wellness services based on the nurs-
ing model, which emphasizes the protection, pro-
motion, and optimization of health along with the 
prevention of illness, and the alleviation of suffering 
in conjunction with diagnosis and treatment. Nurses 
are advocates and educators providing care for indi-
viduals, families, communities, and populations. 
(2) More than 200 NMHCs are currently in op-
eration across the United States. Such clinics record 
over 2,000,000 client encounters annually. 
(3) NMHCs offering primary care services meet 
the Institute of Medicine’s definition of safety-net 
provider by providing care regardless of their pa-
tients’ ability to pay. A substantial share of the pa-
tient mix is made up of uninsured individuals, Med-
icaid recipients, State Children’s Health Insurance 
Program recipients, and other vulnerable popu-
lations. A recent study funded by the Centers for 
Medicare & Medicaid Services reported that more 
than 45 percent of the payor mix for NMHCs is un-
insured, and 37 percent are Medicaid recipients. 
(4) NMHC patients are very diverse. According 
to recent data, 46 percent of NMHC patients are 
Caucasian, 29 percent are African-American, and 
another 20 percent are Latino. 
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(5) Approximately 133,000,000 people in the 
United States (45 percent of the population) have at 
least 1 chronic disease. These diseases account for 
81 percent of hospital admissions, 91 percent of all 
prescriptions filled, and 76 percent of all physician 
visits. About 75 percent of health care spending in 
the United States is related to chronic care. Chronic 
disease management programs have the potential to 
reduce costs and improve outcomes for chronically ill 
patients. 
NMHCs 
providing 
wellness 
services 
strengthen the health care safety-net by expanding 
access to chronic disease management services for 
geriatric and medically underserved populations. 
(6) NMHCs offering primary care provide a 
medical home for medically underserved individuals, 
and are viable partners with the Federal Govern-
ment to reduce health disparities. They provide a 
full range of health care services, including primary 
care, wellness services, and behavioral health care to 
the residents of rural and urban underserved com-
munities. Because NMHCs are often located in pub-
lic housing developments, senior living arrange-
ments, schools, and community centers, they help re-
move barriers preventing access to care and are in-
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strumental in addressing and eliminating the factors 
contributing to health disparities. 
(7) NMHCs offering wellness services reinforce 
the medical home concept by providing a critical 
first level of care for populations living in rural 
areas with limited access to physicians and other 
primary care providers. NMHC patients partici-
pating in wellness services are connected to a med-
ical home through established referral networks. 
(8) As new strategies for increasing health cov-
erage are implemented, utilization of nurse-managed 
health clinics offering both primary care and 
wellness services will help meet the increased de-
mand arising from newly covered individuals while 
alleviating current primary care physician shortages. 
(9) In spite of their numerous benefits, NMHCs 
of all types have limited access to both Federal and 
State funding. Initially, many NMHCs were estab-
lished through grants from the Division of Nursing 
of the Health Resources and Services Administration 
(referred to in this paragraph as the ‘‘Division of 
Nursing’’). Soon after their inception, NMHC direc-
tors recognized their patients had a desperate need 
for primary care and wellness services, a need that 
continues. To meet that need, NHMCs across the 
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country have expanded their mission to focus on in-
creasing access to primary care and wellness services 
the medically underserved populations, while still 
maintaining their role as clinical sites for nursing 
education. Available sources of Division of Nursing 
grant funding cannot accommodate the increased 
cost associated with caring for the uninsured and 
medically underserved populations that has accom-
panied the expanding focus of nurse-managed care. 
As a result, 50 percent of the NMHCs established 
between 1993 and 2007 have had to close. Such 
clinics frequently are the only source of health care 
for their patients, and such closures have left thou-
sands without health care. 
(10) In recognition of the growing needs of 
NMHCs, in Senate Report 109–103, Congress called 
on the Bureau of Primary Health Care (BPHC) to 
‘‘consider establishing a grant program . . . that 
would support the establishment or expansion of 
nurse practice arrangements commonly referred to 
as nurse-managed health centers . . .’’. The goal of 
this Act is to comply with the language of such Sen-
ate Report by establishing a grant program within 
BPHC that is a better fit for the changing role of 
NMHCs. The program will give NMHCs access to a 
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stable source of funding, further enabling them to 
expand primary care and wellness services in under-
served communities, while reducing the level of 
health 
disparities 
that 
vulnerable 
populations 
throughout the Nation face. 
(b) PURPOSE.—It is the purpose of this Act to fund 
the development and operation of nurse-managed health 
clinics to— 
(1) provide comprehensive and accessible pri-
mary health care and wellness services to vulnerable 
populations living in the Nation’s medically under-
served communities; and 
(2) reduce the level of health disparities experi-
enced by vulnerable populations. 
SEC. 3. NURSE-MANAGED HEALTH CLINICS. 
Title III of the Public Health Service Act (42 U.S.C. 
241 et seq.) is amended by adding at the end the fol-
lowing: 
‘‘PART S—NURSE-MANAGED HEALTH CLINIC 
PROGRAM 
‘‘SEC. 399JJ. GRANTS TO NURSE–MANAGED HEALTH CLIN-
ICS. 
‘‘(a) DEFINITION; ESTABLISHMENT OF CRITERIA.— 
In this section: 
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‘‘(1) NURSE-MANAGED
HEALTH
CLINIC
OR 
‘NMHC’.—The term ‘nurse-managed health clinic’ or 
‘NMHC’ means a nurse-practice arrangement, man-
aged by advanced practice nurses, that provides pri-
mary care or wellness services to underserved or vul-
nerable populations and is associated with a school, 
college, university, or department of nursing, feder-
ally qualified health center, or an independent non-
profit health or social services agency. 
‘‘(2) 
MEDICALLY
UNDERSERVED
POPU-
LATIONS.—The term ‘medically underserved popu-
lation’ has the meaning given such term in section 
330(b)(3). 
‘‘(3) VULNERABLE
POPULATION.—The term 
‘vulnerable population’ means a population that 
lacks access to adequate primary care or suffers 
from increased health disparities due to factors such 
as health, age, race, ethnicity, sex, insurance status, 
income level, or ability to communicate effectively. 
‘‘(4) BEHAVIORAL HEALTH CARE SERVICES.— 
The term ‘behavioral health care services’ means 
health care related to adult, family, and pediatric 
emotional health and well-being and consists of iden-
tifying, assessing, and defining mental health prob-
lems and developing a plan of care, which may in-
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clude psychopharmacological management, education 
about specific mental illnesses, or basic counseling 
services that are furnished by qualified health care 
professionals. 
‘‘(5) COMPREHENSIVE PRIMARY HEALTH CARE 
SERVICES.—The 
term 
‘comprehensive 
primary 
health care services’ means health care related to 
adult, family, and pediatric health and consisting of 
adult health, pediatrics, obstetrics, or gynecology 
services that are furnished by nurse practitioners, 
physician assistants, physicians, nurse midwives, 
clinical nurse specialists, other advanced practice 
nurses, or other qualified health care professionals. 
In addition to primary care services, specific services 
may include— 
‘‘(A) preventive health services; 
‘‘(B) prenatal and perinatal services; 
‘‘(C) appropriate cancer screening; 
‘‘(D) well-child services; 
‘‘(E) immunizations against vaccine-pre-
ventable diseases; 
‘‘(F) screenings for elevated blood lead lev-
els; 
‘‘(G) screening for communicable diseases; 
‘‘(H) cholesterol screenings; 
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‘‘(I) pediatric eye and ear screenings to de-
termine the need for vision and hearing correc-
tion; 
‘‘(J) emergency medical services; 
‘‘(K) diagnostic laboratory and radiologic 
services; 
‘‘(L) care navigation services; 
‘‘(M) pharmaceutical services, as may be 
appropriate for each clinic; and 
‘‘(N) voluntary family planning. 
‘‘(6) WELLNESS SERVICES.—The term ‘wellness 
services’ means any health-related service or inter-
vention, not including primary care, which is de-
signed to reduce identifiable health risks and in-
crease healthy behaviors intended to prevent the 
onset of disease or lessen the impact of existing 
chronic conditions by teaching more effective man-
agement techniques that focus on individual self-care 
and patient-driven decisionmaking. Specific services 
may include— 
‘‘(A) 
chronic 
disease 
self-management 
training; 
‘‘(B) health screenings relating to hyper-
tension, diabetes, cancer, HIV, lead exposure, 
and other chronic conditions; 
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‘‘(C) health and patient education; 
‘‘(D) immunizations against vaccine-pre-
ventable diseases; 
‘‘(E) outreach and home visiting services; 
‘‘(F) environmental health risk reduction 
services; 
‘‘(G) case management services; 
‘‘(H) interpretation and translation serv-
ices; 
‘‘(I) weight control programs; 
‘‘(J) smoking cessation programs; 
‘‘(K) physical activity and fitness programs 
involving geriatric, youth, and other vulnerable 
populations; 
‘‘(L) occupational safety and health; and 
‘‘(M) cognitive behavioral services. 
‘‘(b) AUTHORITY TO AWARD GRANTS.—The Sec-
retary shall award grants for the cost of the operation of 
NMHCs that meet the requirements of this section. 
‘‘(c) APPLICATIONS.—To be eligible to receive a grant 
under this section, an entity shall— 
‘‘(1) be a NMHC; and 
‘‘(2) submit to the Secretary an application at 
such time, in such manner, and containing— 
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‘‘(A) an assurance that the NMHC pro-
vides direct access to client-centered nursing 
services with access to other health care serv-
ices and that nurses are the major service pro-
viders at the NMHC; 
‘‘(B) evidence that an advanced practice 
nurse (‘APN’) holds an executive management 
position within the organizational structure of 
the NMHC and that an APN has direct respon-
sibility for overseeing the daily operations of the 
NMHC; 
‘‘(C) an assurance that the NMHC will 
continue to provide comprehensive primary care 
services or wellness services for the duration of 
the grant period; 
‘‘(D) an assurance that the nurse-managed 
health clinic will establish, not later than 90 
days after receiving a grant under this section, 
a community advisory committee composed of 
individuals, a majority of whom are being 
served by the clinic, the purpose of which is to 
provide input into the nurse-managed health 
clinic decisionmaking process; 
‘‘(E) an assurance that the NMHC will 
demonstrate the receipt of non-Federal match-
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ing funds equaling at least 20 percent of the 
Federal portion of any grant awarded under 
this section, and evidence that the necessary 
matching funds will be acquired not later than 
180 days after receiving the grant; and 
‘‘(F) an assurance that the NMHC will 
provide care regardless of the insurance status 
or income of a patient. 
‘‘(d) WAIVER OF REQUIREMENTS.—The Secretary 
may, upon a showing of good cause, waive any aspect of 
the matching funds requirement described in subsection 
(c)(2)(E). 
‘‘(e) USE OF FUNDS.— 
‘‘(1) IN
GENERAL.—Funds awarded under a 
grant under this section may be used for the provi-
sion of primary care services and wellness services, 
for the management of NMHC programs, for the 
payment of salaries for NMHC personnel, and for 
providing training for the provision of required 
health services. Funds may also be used for acquir-
ing and leasing buildings and equipment (including 
the cost of amortizing the principle of, and paying 
interest on, loans for such buildings and equipment). 
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‘‘(2) AMOUNT.—The amount of any grant made 
in any fiscal year to a NMHC shall be determined 
by the Secretary, taking into account— 
‘‘(A) the financial need of the NMHC; 
‘‘(B) State, local, and other operational 
funding provided to the NMHC; and 
‘‘(C) other factors as determined appro-
priate by the Secretary. 
‘‘(f) TECHNICAL ASSISTANCE.— 
‘‘(1) IN GENERAL.—The Secretary shall estab-
lish a program through which the Secretary shall 
provide (either through the Department of Health 
and Human Services or by grant or contract) tech-
nical and other assistance to NMHCs to assist such 
clinics in meeting the requirements of this section. 
In determining appropriate providers to assist in of-
fering technical assistance, the Secretary shall con-
sider whether the provider has demonstrated the ca-
pacity to effectively address the unique needs of 
NMHCs. 
‘‘(2) TECHNICAL SERVICES.—Services provided 
under this section may include necessary technical 
and nonfinancial assistance, including fiscal and pro-
gram management assistance, training in fiscal and 
program management, operational and administra-
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tive support, and the provision of information to 
NMHC regarding the various resources available 
under this section and how those resources can best 
be used to meet the health needs of the communities 
served by NMHCs. 
‘‘(g) EVALUATION.—The Secretary shall develop and 
implement a plan for evaluating NMHCs funded under 
this section. Such evaluations shall monitor and track the 
performance of the grantee as well as the quality of the 
services that are provided under the grant. 
‘‘(h) AUTHORIZATION OF APPROPRIATIONS.—For the 
purposes of carrying out this section, there are authorized 
to be appropriated $50,000,000 for fiscal year 2010, and 
such sums as may be necessary for each of fiscal years 
2011 through 2014.’’. 
Æ 
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