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. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. MEDICARE PAYMENT FOR COSTS OF EX-
PANDED 
ADVANCED 
PRACTICE 
NURSE 
TRAINING PROGRAMS. 
(a) IN GENERAL.—Section 1861(v) of the Social Se-
curity Act (42 U.S.C. 1395x(v)) is amended— 
(1) in paragraph (1), by adding at the end the 
following new subparagraph: 
VerDate Nov 24 2008 
02:13 Jul 14, 2009
Jkt 079200
PO 00000
Frm 00001
Fmt 6652
Sfmt 6201
E:\BILLS\H3185.IH
H3185
jbell on DSKHWCL6B1PROD with BILLS
‘‘(V) Such reasonable costs shall include hospital 
costs described in paragraph (9) for expanded advanced 
nurse practice training programs.’’; and 
(2) by adding at the end the following new 
paragraph: 
‘‘(9)(A) For purposes of paragraph (1)(V), subject to 
subparagraphs (B) and (C), the costs described in this 
paragraph are educational costs (including faculty sala-
ries, student stipends (if any), clinical instruction costs, 
and other direct and indirect costs) of a hospital and affili-
ated schools and settings described in clause (ii)) attrib-
utable to the training of advanced practice nurses— 
‘‘(i) with the skills necessary to provide primary 
and preventive care, transitional care, chronic care 
management, and other nursing services appropriate 
for the population under this title; and 
‘‘(ii) through affiliation with one or more ac-
credited schools of nursing (as defined in section 
801 of the Public Health Service Act) and in part-
nership with two or more non-hospital community- 
based care settings where at least half of all clinical 
training occurs. 
The Secretary may waive the community-based setting re-
quirement under clause (ii) for clinical training of ad-
vanced practice registered nurses, such as certified reg-
VerDate Nov 24 2008 
02:13 Jul 14, 2009
Jkt 079200
PO 00000
Frm 00002
Fmt 6652
Sfmt 6201
E:\BILLS\H3185.IH
H3185
jbell on DSKHWCL6B1PROD with BILLS
istered nurse anesthetists and certified nurse-midwives, in 
rural and medically underserved areas. 
‘‘(B) Costs under this paragraph are limited to costs 
attributable to an increase in the enrollment and the num-
ber of advanced practice nurse graduates in each edu-
cation or training program over the comparable average 
number from 2006 to 2010 (as determined by the Sec-
retary) but shall not be offset or take into account tuition, 
fees, or State or local government appropriations. The pro-
portion of such costs paid under this paragraph shall be 
determined based on the proportion of the total inpatient 
days of the hospital attributable to this title. 
‘‘(C) No payment shall be made under this paragraph 
to a hospital unless the hospital has in effect an agreement 
with the schools of nursing and settings described in sub-
paragraph (A)(ii) to pay from such payment to such a 
school or setting (through the school when the setting is 
arranged through the school) the costs of educational ac-
tivities described in subparagraph (A) attributable to each. 
‘‘(D) In this paragraph, the term ‘advanced practice 
nurse’ includes a clinical nurse specialist, nurse practi-
tioner, certified registered nurse anesthetist, and certified 
nurse midwife.’’. 
VerDate Nov 24 2008 
02:13 Jul 14, 2009
Jkt 079200
PO 00000
Frm 00003
Fmt 6652
Sfmt 6201
E:\BILLS\H3185.IH
H3185
jbell on DSKHWCL6B1PROD with BILLS
(b) EFFECTIVE DATE.—The amendments made by 
subsection (a) shall apply to costs incurred on or after 
January 1, 2012. 
Æ 
VerDate Nov 24 2008 
02:13 Jul 14, 2009
Jkt 079200
PO 00000
Frm 00004
Fmt 6652
Sfmt 6301
E:\BILLS\H3185.IH
H3185
jbell on DSKHWCL6B1PROD with BILLS