retaliate in any manner against any patient, em-
ployee, or contract employee of the hospital, or any 
other individual, on the basis that such individual, in 
good faith, individually or in conjunction with an-
other person or persons, has presented a grievance 
or complaint, or has initiated or cooperated in any 
investigation or proceeding of any governmental en-
tity, regulatory agency, or private accreditation 
body, made a civil claim or demand, or filed an ac-
tion relating to the care, services, or conditions of 
the hospital or of any affiliated or related facilities. 
‘‘(2) GOOD FAITH DEFINED.—For purposes of 
this subsection, an individual shall be deemed to be 
acting in good faith if the individual reasonably be-
lieves— 
‘‘(A) the information reported or disclosed 
is true; and 
‘‘(B) a violation of this title has occurred 
or may occur. 
‘‘(i) 
PROHIBITION
ON
INTERFERENCE
WITH 
RIGHTS.— 
‘‘(1) EXERCISE OF RIGHTS.—It shall be unlaw-
ful for any hospital to— 
‘‘(A) interfere with, restrain, or deny the 
exercise, or attempt to exercise, by any person 
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of any right provided or protected under this 
title; or 
‘‘(B) coerce or intimidate any person re-
garding the exercise or attempt to exercise such 
right. 
‘‘(2) OPPOSITION TO UNLAWFUL POLICIES OR 
PRACTICES.—It shall be unlawful for any hospital to 
discriminate or retaliate against any person for op-
posing any hospital policy, practice, or actions which 
are alleged to violate, breach, or fail to comply with 
any provision of this title. 
‘‘(3) PROHIBITION
ON
INTERFERENCE
WITH 
PROTECTED COMMUNICATIONS.—A hospital (or an 
individual representing a hospital) shall not make, 
adopt, or enforce any rule, regulation, policy, or 
practice which in any manner directly or indirectly 
prohibits, impedes, or discourages a direct care 
nurse from, or intimidates, coerces, or induces a di-
rect care nurse regarding, engaging in free speech 
activities or disclosing information as provided under 
this title. 
‘‘(4) PROHIBITION
ON
INTERFERENCE
WITH 
COLLECTIVE ACTION.—A hospital (or an individual 
representing a hospital) shall not in any way inter-
fere with the rights of nurses to organize, bargain 
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collectively, and engage in concerted activity under 
section 7 of the National Labor Relations Act (29 
U.S.C. 157). 
‘‘(j) NOTICE.—A hospital shall post in an appropriate 
location in each unit a conspicuous notice in a form speci-
fied by the Secretary that— 
‘‘(1) explains the rights of nurses, patients, and 
other individuals under this section; 
‘‘(2) includes a statement that a nurse, patient, 
or other individual may file a complaint with the 
Secretary against a hospital that violates the provi-
sions of this title; and 
‘‘(3) provides instructions on how to file such a 
complaint. 
‘‘(k) EFFECTIVE DATE.— 
‘‘(1) REFUSAL; RETALIATION; CAUSE
OF
AC-
TION.— 
‘‘(A) 
IN
GENERAL.—Subsections 
(c) 
through (e) shall apply to objections and refus-
als occurring on or after the effective date of 
the provision of this title to which the objection 
or refusal relates. 
‘‘(B) EXCEPTION.—Subsection (c)(2) shall 
not apply to objections or refusals in any hos-
pital before the requirements of section 3401(a) 
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or 3403(a), as applicable, apply to that hos-
pital. 
‘‘(2) PROTECTIONS
FOR
REPORTING.—Sub-
section (h)(1) shall apply to actions occurring on or 
after the effective date of the provision to which the 
violation relates, except that such subsection shall 
apply to initiation, cooperation, or participation in 
an investigation or proceeding on or after the date 
of enactment of this title. 
‘‘(3) NOTICE.—Subsection (j) shall take effect 
18 months after the date of enactment of this title. 
‘‘SEC. 3406. ENFORCEMENT. 
‘‘(a) IN GENERAL.—The Secretary shall enforce the 
requirements and prohibitions of this title in accordance 
with this section. 
‘‘(b) PROCEDURES
FOR RECEIVING
AND INVES-
TIGATING COMPLAINTS.—The Secretary shall establish 
procedures under which— 
‘‘(1) any person may file a complaint alleging 
that a hospital has violated a requirement or a pro-
hibition of this title; and 
‘‘(2) such complaints shall be investigated by 
the Secretary. 
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‘‘(c) REMEDIES.—If the Secretary determines that a 
hospital has violated a requirement of this title, the Sec-
retary— 
‘‘(1) shall require the facility to establish a cor-
rective action plan to prevent the recurrence of such 
violation; and 
‘‘(2) may impose civil money penalties, as de-
scribed in subsection (d). 
‘‘(d) CIVIL PENALTIES.— 
‘‘(1) IN GENERAL.—In addition to any other 
penalties prescribed by law, the Secretary may im-
pose civil penalties as follows: 
‘‘(A) HOSPITAL LIABILITY.—The Secretary 
may impose on a hospital found to be in viola-
tion of this title a civil money penalty of— 
‘‘(i) not more than $25,000 for the 
first knowing violation of this title by such 
hospital; and 
‘‘(ii) not more than $50,000 for any 
subsequent knowing violation of this title 
by such hospital. 
‘‘(B) INDIVIDUAL
LIABILITY.—The Sec-
retary may impose on an individual who— 
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‘‘(i) is employed by a hospital found 
by the Secretary to have violated this title; 
and 
‘‘(ii) knowingly violates this title, 
a civil money penalty of not more than $20,000 
for each such violation by the individual. 
‘‘(2) PROCEDURES.—The provisions of section 
1128A of the Social Security Act (other than sub-
sections (a) and (b)) shall apply with respect to a 
civil money penalty or proceeding under this sub-
section in the same manner as such provisions apply 
with respect to a civil money penalty or proceeding 
under such section 1128A. 
‘‘(e) PUBLIC NOTICE OF VIOLATIONS.— 
‘‘(1) INTERNET WEBSITE.—The Secretary shall 
publish on the internet website of the Department of 
Health and Human Services the names of hospitals 
on which a civil money penalty has been imposed 
under this section, the violation for which such pen-
alty was imposed, and such additional information 
as the Secretary determines appropriate. 
‘‘(2) CHANGE OF OWNERSHIP.—With respect to 
a hospital that had a change of ownership, as deter-
mined by the Secretary, penalties imposed on the 
hospital while under previous ownership shall no 
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longer be published by the Secretary pursuant to 
paragraph (1) after the 1-year period beginning on 
the date of change of ownership. 
‘‘(f) USE OF FUNDS.—Funds collected by the Sec-
retary pursuant to this section are authorized to be appro-
priated to carry out this title. 
‘‘SEC. 3407. DEFINITIONS. 
‘‘For purposes of this title: 
‘‘(1) ACUITY LEVEL.—The term ‘acuity level’ 
means the determination, using a hospital acuity 
measurement tool that has been developed and es-
tablished in coordination with direct care registered 
nurses and made transparent pursuant to section 
3401(c)(4), of nursing care requirements, based on 
the assigned direct care registered nurse’s profes-
sional judgment of— 
‘‘(A) the severity and complexity of an in-
dividual patient’s illness or injury; 
‘‘(B) the need for specialized equipment; 
and 
‘‘(C) the intensity of nursing interventions 
required. 
‘‘(2) COMPETENCE.—The term ‘competence’ or 
‘competent’ means the satisfactory application of the 
duties and responsibilities of a registered nurse in 
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providing nursing care to specific patient popu-
lations and for acuity levels for each patient care 
unit or area pursuant to the State nursing laws and 
regulations of the State in which the direct nursing 
care is being performed. 
‘‘(3) 
DIRECT
CARE
LICENSED
PRACTICAL 
NURSE.—The term ‘direct care licensed practical 
nurse’ means an individual who has been granted a 
license by at least one State to practice as a licensed 
practical nurse or a licensed vocational nurse and 
who provides bedside care for one or more patients. 
‘‘(4) DIRECT CARE REGISTERED NURSE.—The 
term ‘direct care registered nurse’ means an indi-
vidual who has been granted a license by at least 
one State to practice as a registered nurse and who 
provides bedside care for one 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 
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Program, or any other department or agency of the 
United States. 
‘‘(7) NURSE.—The term ‘nurse’ means any di-
rect care registered nurse or direct care licensed 
practice nurse (as the case may be), regardless of 
whether or not the nurse is an employee. 
‘‘(8) NURSING CARE PLAN.—The term ‘nursing 
care plan’ means a plan developed by the assigned 
direct care registered nurse (in accordance with 
nursing law in the State in which the nursing care 
is performed) that indicates the nursing care to be 
given to individual patients that— 
‘‘(A) considers the acuity level of the pa-
tient; 
‘‘(B) is developed in coordination with the 
patient, the patient’s family, or other represent-
atives when appropriate, and staff of other dis-
ciplines involved in the care of the patient; 
‘‘(C) reflects all elements of the nursing 
process; and 
‘‘(D) recommends the number and skill 
mix of additional licensed and unlicensed direct 
care staff needed to fully implement the nursing 
care plan. 
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‘‘(9) PROFESSIONAL
JUDGMENT.—The term 
‘professional judgment’ means, in accordance with 
State nursing laws and regulations of the State in 
which the direct nursing care is being performed, the 
direct care registered nurse’s application of knowl-
edge, expertise, and experience in conducting a com-
prehensive nursing assessment of each patient and 
in making independent decisions about patient care 
including the need for additional staff. 
‘‘(10) STAFFING
PLAN.—The term ‘staffing 
plan’ means a staffing plan required under section 
3401. 
‘‘(11) STATE OF EMERGENCY.—The term ‘state 
of emergency’— 
‘‘(A) means a state of emergency that is 
an unpredictable or unavoidable occurrence at 
an unscheduled or unpredictable interval, relat-
ing to health care delivery and requiring imme-
diate medical interventions and care; and 
‘‘(B) does not include a state of emergency 
that results from a labor dispute in the health 
care industry or consistent understaffing. 
‘‘SEC. 3408. RULE OF CONSTRUCTION. 
‘‘Nothing in this title shall be construed to authorize 
disclosure of private and confidential patient information, 
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if such disclosure is not authorized or required by other 
applicable law.’’. 
(b) RECOMMENDATIONS TO CONGRESS.—Not later 
than 1 year after the date of enactment of this Act, the 
Secretary of Health and Human Services shall submit to 
Congress a report containing recommendations for ensur-
ing that sufficient numbers of nurses are available to meet 
the requirements imposed by title XXXIV of the Public 
Health Service Act, as added by subsection (a). 
(c) REPORT BY HRSA.— 
(1) IN GENERAL.—Not later than 2 years after 
the date of enactment of this Act, the Administrator 
of the Health Resources and Services Administra-
tion, in consultation with the National Health Care 
Workforce Commission, shall submit to Congress a 
report regarding the relationship between nurse 
staffing levels and nurse retention in hospitals. 
(2) UPDATED REPORT.—Not later than 5 years 
after the date of enactment of this Act, the Adminis-
trator of the Health Resources and Services Admin-
istration, in consultation with the National Health 
Care Workforce Commission, shall submit to Con-
gress an update of the report submitted under para-
graph (1). 
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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) in subparagraph (X), by striking ‘‘, and’’ 
and inserting a comma; 
(2) in subparagraph (Y), by striking the period 
at the end and inserting ‘‘, and’’; and 
(3) by inserting after the subparagraph (Y) the 
following new subparagraph: 
‘‘(Z) in the case of a hospital, to comply with 
the provisions of title XXXIV of the Public Health 
Service Act.’’. 
(b) MEDICAID PROGRAM.—Section 1902(a) of the 
Social Security Act (42 U.S.C. 1396a(a)) is amended— 
(1) by striking ‘‘and’’ at the end of paragraph 
(85); 
(2) by striking the period at the end of para-
graph (86) and inserting ‘‘; and’’; and 
(3) by inserting after paragraph (86) the fol-
lowing new paragraph: 
‘‘(87) provide that any hospital that receives a 
payment under such plan comply with the provisions 
of title XXXIV of the Public Health Service Act (re-
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(2) CLERICAL AMENDMENT.—The table of sec-
tions at the beginning of such chapter is amended 
by inserting after the item relating to section 1110b 
the following new item: 
‘‘1110c. 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. 833. STAFFING REQUIREMENTS. 
‘‘All hospitals of the Service shall comply with the 
provisions of title XXXIV of the Public Health Service Act 
(relating to minimum direct care registered nurse staffing 
requirements).’’. 
(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 XXXIV 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 
by striking ‘‘Subject to subsection (b) of this sec-
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tion,’’ and inserting ‘‘Subject to subsections (b) and 
(c),’’. 
SEC. 4. NURSE WORKFORCE INITIATIVE. 
(a) SCHOLARSHIP AND STIPEND PROGRAM.—Section 
846(d) of the Public Health Service Act (42 U.S.C. 
297n(d)) is amended— 
(1) in the section heading, by inserting ‘‘AND 
STIPEND’’ after ‘‘SCHOLARSHIP’’; and 
(2) in paragraph (1), by inserting ‘‘or stipends’’ 
after ‘‘scholarships’’. 
(b) NURSE RETENTION GRANTS.—Section 831A(b) 
of the Public Health Service Act (42 U.S.C. 296p–1(b)) 
is amended— 
(1) by striking ‘‘GRANTS FOR CAREER LADDER 
PROGRAM.—’’ and inserting ‘‘GRANTS FOR NURSE 
RETENTION.—’’; 
(2) in paragraph (2), by striking ‘‘; or’’ and in-
serting a semicolon; 
(3) in paragraph (3), by striking the period and 
inserting a semicolon; and 
(4) by adding at the end the following: 
‘‘(4) to provide additional support to nurses en-
tering the workforce by implementing nursing pre-
ceptorship projects that establish a period of prac-
tical and clinical experiences and training for nurs-
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ing students, newly hired nurses, and recent grad-
uates of a direct care degree program for registered 
nurses; or 
‘‘(5) to implement mentorship projects that as-
sist new or transitional direct care registered nurses 
in adapting to the hospital setting.’’. 
Æ 
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