practical nurse (as the case may be), regardless of 
whether or not the nurse is an employee. 
‘‘(4) DIRECT CARE REGISTERED NURSE.—The 
term ‘direct care registered nurse’ means an indi-
vidual who has been granted a license by at least 1 
State to practice as a registered nurse and who pro-
vides bedside care for 1 or more patients. 
‘‘(5) EMPLOYMENT.—The term ‘employment’ 
includes the provision of services under a contract or 
other arrangement. 
‘‘(6) HOSPITAL.—The term ‘hospital’ has the 
meaning given that term in section 1861(e) of the 
Social Security Act, and includes a hospital that is 
operated by the Department of Veterans Affairs, the 
Department of Defense, the Indian Health Services 
Program, or any other department or agency of the 
United States. 
‘‘(7) STAFFING PLAN.—The term ‘staffing plan’ 
means a staffing plan required under section 3101.’’. 
(b) RECOMMENDATIONS
TO CONGRESS.—No later 
than 1 year after the date of the enactment of this Act, 
the Secretary of Health and Human Services shall submit 
to Congress a report containing recommendations for en-
suring that sufficient numbers of nurses are available to 
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meet the requirements imposed by title XXXI of the Pub-
lic Health Service Act, as added by subsection (a). 
SEC. 3. ENFORCEMENT OF REQUIREMENTS THROUGH FED-
ERAL PROGRAMS. 
(a) MEDICARE PROGRAM.—Section 1866(a)(1) of the 
Social Security Act (42 U.S.C. 1395cc(a)(1)) is amend-
ed— 
(1) by striking ‘‘and’’ at the end of subpara-
graph (U); 
(2) by striking the period at the end of sub-
paragraph (V) and inserting ‘‘, and’’; and 
(3) by inserting after subparagraph (V) the fol-
lowing: 
‘‘(W) in the case of a hospital, to comply with 
the provisions of title XXXI of the Public Health 
Service Act.’’. 
(b) MEDICAID PROGRAM.—The first sentence of sec-
tion 1902(a) of the Social Security Act (42 U.S.C. 
1396(a)) is amended— 
(1) by striking ‘‘and’’ at the end of paragraph 
(71); 
(2) by striking the period at the end of para-
graph (72) and inserting ‘‘; and’’; and 
(3) by inserting after paragraph (72) the fol-
lowing new paragraph: 
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‘‘(73) provide that any hospital receiving pay-
ments under such plan must comply with the provi-
sions of title XXXI of the Public Health Service 
Act.’’. 
(c) HEALTH BENEFITS PROGRAM OF THE DEPART-
MENT OF VETERANS AFFAIRS.—Section 8110(a) of title 
38, United States Code, is amended by adding at the end 
the following new paragraph: 
‘‘(7) In the case of a Department medical facility that 
is a hospital, the hospital shall comply with the provisions 
of title XXXI of the Public Health Service Act. 
‘‘(8) Nothing either in chapter 74 of this title or in 
section 7106 of title 5 shall preclude enforcement of the 
provisions of title XXX of the Public Health Service Act 
with respect to a Department hospital through grievance 
procedures negotiated in accordance with chapter 71 of 
title 5.’’. 
(d) HEALTH BENEFITS PROGRAM OF THE DEPART-
MENT OF DEFENSE.— 
(1) IN
GENERAL.—Chapter 55 of title 10, 
United States Code, is amended by adding at the 
end the following new section: 
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‘‘§ 1110a. Staffing requirements 
‘‘In the case of a facility of the uniformed services 
that is a hospital, the hospital shall comply with the provi-
sions of title XXXI of the Public Health Service Act.’’. 
(2) CLERICAL AMENDMENT.—The table of sec-
tions at the beginning of such chapter is amended 
by inserting after the item relating to section 1110 
the following new item: 
‘‘1110a. Staffing requirements.’’. 
(e) INDIAN HEALTH SERVICES PROGRAM.—Title 
VIII of the Indian Health Care Improvement Act (25 
U.S.C. 1671 et seq.) is amended by adding at the end 
the following new section: 
‘‘SEC. 826. STAFFING REQUIREMENTS. 
‘‘A hospital of the Service shall comply with the provi-
sions of title XXXI of the Public Health Service Act.’’. 
(f) FEDERAL LABOR-MANAGEMENT RELATIONS.— 
(1) IN
GENERAL.—Section 7106 of title 5, 
United States Code, is amended by adding at the 
end the following: 
‘‘(c) Nothing in this section shall preclude enforce-
ment of the provisions of title XXXI of the Public Health 
Service Act through grievance procedures negotiated in ac-
cordance with section 7121.’’. 
(2) 
CONFORMING
AMENDMENT.—Section 
7106(a) of title 5, United States Code, is amended 
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by striking ‘‘Subject to subsection (b) of this title,’’ 
and inserting ‘‘Subject to subsections (b) and (c),’’. 
Æ 
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