‘‘(i) the ratio of available nurses to 
the number of individuals in the area or 
population group; 
‘‘(ii) the demonstrated need of a 
health care facility or other public, non-
profit, or private facility in the area; or 
‘‘(iii) the presence of innovative reten-
tion strategies utilized by eligible facilities. 
‘‘(3) RURAL HEALTH CLINIC.—The term ‘rural 
health clinic’ has the meaning given such term in 
section 1861(aa)(2) of the Social Security Act. 
‘‘(l) AUTHORIZATION OF APPROPRIATIONS.—For the 
purpose of payments under agreements entered into under 
subsection (a), there are authorized to be appropriated 
$40,000,000 for fiscal year 2003 and such sums as may 
be necessary for fiscal years 2004 through 2007. 
‘‘PART I—INITIATIVES TO RECRUIT NURSES AND 
COMBAT THE NURSING SHORTAGE 
‘‘SEC. 855. NURSE RECRUITMENT GRANT PROGRAM. 
‘‘(a) PROGRAM AUTHORIZED.—The Secretary shall 
award grants to eligible entities to increase nursing edu-
cation opportunities. 
‘‘(b) ELIGIBLE ENTITY.—In this section, the term 
‘eligible entity’ means a school of nursing, or a health care 
facility, or a partnership of such school and facility.
‘‘(c) USE OF FUNDS.—An eligible entity that receives 
a grant under subsection (a) shall use funds received from 
such grant to—
‘‘(1) support outreach programs at primary, 
junior, and secondary schools that inform guidance 
counselors and students of education opportunities 
regarding nursing; 
‘‘(2) carry out special projects to increase nurs-
ing education opportunities for individuals who are 
from disadvantaged backgrounds (including economi-
cally disadvantaged backgrounds and racial and eth-
nic minorities underrepresented among registered 
nurses) by providing student scholarships or sti-
pends, pre-entry preparation, or retention activities; 
‘‘(3) support education programs for nursing 
students who require assistance with math, science, 
English, and medical terminology; 
‘‘(4) meet the costs of dependent care and 
transportation for individuals who are taking part in 
a nursing education program at any level; or 
‘‘(5) support community-based partnerships 
seeking to recruit nurses in rural communities and 
medically underserved urban communities, and other 
communities experiencing a nursing shortage.
‘‘(d) APPLICATION.—An eligible entity desiring a 
grant under subsection (a) shall submit an application to 
the Secretary at such time, in such manner, and con-
taining such information as the Secretary may reasonably 
require. 
‘‘(e) AUTHORIZATION OF APPROPRIATIONS.—There 
is authorized to be appropriated to carry out this section 
$10,000,000 for fiscal year 2003 and such sums as may 
be necessary for fiscal years 2004 through 2007. 
‘‘PART J—INITIATIVES TO STRENGTHEN THE 
NURSE WORKFORCE 
‘‘SEC. 857. GRANTS FOR CAREER LADDER PROGRAMS. 
‘‘(a) PROGRAM AUTHORIZED.—The Secretary shall 
award grants to eligible entities to assist individuals and 
develop programs to assist individuals in obtaining edu-
cation and training required to enter the nursing profes-
sion and advance within such profession. 
‘‘(b) DEFINITION.—The term ‘eligible entity’ means 
a school of nursing or a health care facility, or a partner-
ship of such school and facility. 
‘‘(c) USE OF FUNDS.—An eligible entity that receives 
a grant under subsection (a) shall use such funds received 
through such grant to—
‘‘(1) establish student scholarships or stipends 
for nurse professionals, licensed practical nurses,
certified nurse assistants, and home health aides 
who enroll in entry level nursing programs, advanced 
practice nursing degree programs, RN/Master nurs-
ing degree programs, doctoral nursing programs, 
nurse administrator programs, and training pro-
grams focused on specific technology use or disease 
management; 
‘‘(2) provide career counseling to individuals 
seeking to advance within the nursing profession; 
‘‘(3) provide employees of the facility advanced 
training and education at the school of nursing or 
health care facility; 
‘‘(4) establish or expand nursing practice ar-
rangements in noninstitutional settings to dem-
onstrate methods to improve access to primary 
health care in medically underserved communities; 
and 
‘‘(5) develop programs, including distance 
learning programs in coordination with the Office 
for the Advancement of Telehealth, to facilitate edu-
cational advancement for individuals with existing 
degrees or health care training. 
‘‘(d) APPLICATION.—An eligible entity seeking a 
grant under subsection (a) shall submit an application to 
the Secretary at such time, in such a manner, and con-
taining such information as the Secretary may reasonably 
require. 
‘‘(e) AUTHORIZATION OF APPROPRIATIONS.—There 
is authorized to be appropriated to carry out this section 
$20,000,000 for fiscal year 2003 and such sums as may 
be necessary for fiscal years 2004 through 2007.
‘‘SEC. 858. GRANTS FOR NURSE TRAINING IN LONG-TERM 
CARE FOR THE ELDERLY. 
‘‘(a) PROGRAM AUTHORIZED.—The Secretary shall 
award grants to eligible entities to develop and incorporate 
gerontology curriculum and competencies and to encour-
age individuals to enter the nursing profession with a 
focus on providing long-term care for the elderly. 
‘‘(b) ELIGIBLE ENTITY.—The term ‘eligible entity’ 
means a—
‘‘(1) school of nursing; 
‘‘(2) health care facility; or 
‘‘(3) partnership of paragraphs (1) and (2). 
‘‘(c) 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 long-term care for the elderly;
‘‘(2) develop stand alone courses in geronto-
logical nursing to support concentrations, minors, 
and majors in the discipline; 
‘‘(3) train faculty members in gerontological 
nursing; or 
‘‘(4) provide continuing education in geronto-
logical nursing. 
‘‘(d) APPLICATION.—An eligible entity desiring a 
grant under subsection (a) shall submit an application to 
the Secretary at such time, in such manner, and con-
taining such information as the Secretary may reasonably 
require. 
‘‘(e) DEFINITIONS.—For the purposes of this section, 
the term ‘health care facility’ means a hospital, nursing 
home, home health care agency, hospice, skilled nursing 
facility, long-term care facility, or any other facility des-
ignated by the Secretary. 
‘‘(f) AUTHORIZATION OF APPROPRIATIONS.—There 
is authorized to be appropriated to carry out this section 
$12,000,000 for fiscal year 2003 and such sums as may 
be necessary for fiscal years 2004 through 2007. 
‘‘SEC. 859. GRANTS FOR INTERNSHIP AND RESIDENCY PRO-
GRAMS. 
‘‘(a) PROGRAM AUTHORIZED.—The Secretary shall 
award grants to an eligible entity to develop internship
and residency programs that encourage mentoring and the 
development of specialties. 
‘‘(b) DEFINITION.—The term ‘eligible entity’ means 
a partnership of a school of nursing and health care facil-
ity. 
‘‘(c) USE OF FUNDS.—An eligible entity that receives 
a grant under subsection (a) shall use such funds received 
through such grant to—
‘‘(1) develop internship and residency programs 
and curriculum and training programs for graduates 
of a nursing program; 
‘‘(2) provide support for faculty and mentors; 
and 
‘‘(3) provide support for nurses participating in 
internship and residency programs on both a full-
time and part-time basis. 
‘‘(d) APPLICATION.—An eligible entity seeking a 
grant under subsection (a) shall submit an application to 
the Secretary at such time, in such a manner, and con-
taining such information as the Secretary may reasonably 
require. 
‘‘(e) AUTHORIZATION OF APPROPRIATIONS.—There 
is authorized to be appropriated to carry out this section 
$10,000,000 for fiscal year 2003 and such sums as may 
be necessary for fiscal years 2004 through 2007.
‘‘SEC. 860. DEVELOPING RETENTION STRATEGIES AND 
BEST PRACTICES IN NURSING STAFF MAN-
AGEMENT. 
‘‘(a) PROGRAM AUTHORIZED.—The Secretary shall 
award grants to eligible entities to carry out and evaluate 
demonstrations of models and best practices in nursing 
care and develop innovative strategies or approaches for 
retention of professional nurses. 
‘‘(b) DEFINITIONS.—In this section: 
‘‘(1) ELIGIBLE ENTITY.—The term ‘eligible en-
tity’ means—
‘‘(A) a partnership or coalition containing 
a health care facility and a school of nursing; 
‘‘(B) a partnership or coalition containing 
a health care facility and another organization 
with expertise in outcome and cost-effectiveness 
measurement; or 
‘‘(C) containing a health care facility dem-
onstrating proficiency in outcomes and cost-ef-
fectiveness measurement, and receipt of accredi-
tation by an accepted organization shall con-
stitute evidence of such proficiency. 
‘‘(2) NURSE
LEADERSHIP.—The term ‘nurse 
leadership’ includes nurse executives, nurse adminis-
trators, and nurse managers.
‘‘(3) PROFESSIONAL NURSE.—The term ‘profes-
sional nurse’ means a registered nurse who holds a 
valid and unrestricted license to practice nursing in 
a State. 
‘‘(c) DISTRIBUTION OF GRANTS.—Grants awarded 
under this section shall be distributed among a variety of 
geographic regions and among a range of different types 
and sizes of health care facilities. 
‘‘(d) DURATION OF GRANTS.—Grants awarded under 
this section shall be awarded for a period not greater than 
2 years (and may be renewable only once). 
‘‘(e) ALLOCATION.—The Secretary shall determine 
the amount of a grant awarded under this section to the 
nursing services of the health care facility based on the 
number of staffed beds as follows, and if the Secretary 
deems appropriate these amounts may be adjusted: 
‘‘(1) A maximum of $200,000 for a facility with 
less than 100 staffed beds. 
‘‘(2) A maximum of $400,000 for a facility with 
less than 400 staffed beds. 
‘‘(3) A maximum of $600,000 for a facility with 
400 or more staffed beds. 
‘‘(f) PRIORITY CRITERIA.—The Secretary shall give 
priority in awarding grants under this section to health 
care facilities that have not previously received a grant
under this section, and in the case of a grant renewal, 
the Secretary shall give priority to grant recipients who 
have demonstrated outcome improvements or have been 
designated as a magnet hospital by the American Nurses 
Credentialing Center. 
‘‘(g) USE OF FUNDS.—An eligible entity that receives 
a grant under subsection (a) shall use such grant funds 
to do one or more of the following: 
‘‘(1) Improve the quality of the health care fa-
cility work environment, including improving com-
munication and collaboration among health care pro-
fessionals. 
‘‘(2) Initiate or maintain aggressive nurse re-
tention programs, including other initiatives as 
deemed appropriate by the nurse retention com-
mittee at the health care facility. 
‘‘(3) Reduce workplace injuries. 
‘‘(4) Reduce rates of nursing sensitive patient 
outcomes. 
‘‘(5) Provide high quality evaluations of the 
cost-effectiveness and patient-outcomes of best prac-
tices, to assist health care facility decision-makers in 
determining appropriate nurse retention strategies. 
‘‘(6) Promote continuing nursing education and 
career development.
‘‘(h) APPLICATION.—
‘‘(1) IN GENERAL.—An eligible entity desiring a 
grant under subsection (a) shall submit an applica-
tion to the Secretary at such time, and in such man-
ner, and containing such information as the Sec-
retary may reasonably require. 
‘‘(2) CONTENTS.—The application submitted 
under paragraph (1) shall include a description of—
‘‘(A) the project or projects proposed to be 
carried out with grant funds; 
‘‘(B) the means by which to evaluate the 
project with respect to its cost-effectiveness and 
outcomes as they relate to staff turnover, work-
place injuries, and patient care outcomes that 
are sensitive to nursing care; and 
‘‘(C) the system of patient outcomes meas-
urement, which shall be described by the nurse 
leadership and professional nurses of the health 
care facility and shall be sensitive to nursing 
care and shall evaluate the specific needs of the 
patients served by the health care facility and 
the educational needs of the nursing staff at 
such facility to meet the needs of the patients, 
and the health care facility must allocate suffi-
cient funds to carry out the system;
‘‘(D) the health care facility’s organiza-
tional and clinical decision-making processes 
that incorporate the input of the nursing staff, 
including the development of a nurse retention 
committee, the inclusion of nurse executive par-
ticipation in senior level management of the 
health care facility, and a nurse residency train-
ing program for new graduate nurses entering 
the workforce on a full-time basis, or nurses re-
turning to work at a health care facility on a 
full-time basis after an absence of not less than 
3 years without working in the nursing field. 
‘‘(i) AUTHORIZATION OF APPROPRIATIONS.—There is 
to be authorized to be appropriated to carry out this sec-
tion $10,000,000 for fiscal year 2003 and such sums as 
may be necessary for fiscal years 2004 through 2007. 
‘‘SEC. 861. STIPEND AND SCHOLARSHIP PROGRAM. 
‘‘(a) PROGRAM AUTHORIZED.—
‘‘(1) IN GENERAL.—The Secretary shall estab-
lish a scholarship and stipend program to encourage 
individuals to seek a masters degree or a doctoral 
degree at a school of nursing. 
‘‘(2) LIMITATION.—Assistance provided under 
paragraph (1) for a part-time masters degree pro-
gram shall be provided for not more than 6 years
and for a part-time doctoral degree program not 
more than 7 years. 
‘‘(b) ELIGIBILITY.—To be eligible to receive a schol-
arship or stipend under this section, an individual shall—
‘‘(1) submit an application to the Secretary at 
such time, in such manner, and containing such in-
formation as the Secretary may reasonably require; 
‘‘(2) be accepted for enrollment, or be enrolled, 
in an accredited school of nursing, on a full- or part-
time basis to take courses leading to a masters de-
gree or doctoral degree; 
‘‘(3) enter into an agreement with the Sec-
retary, at the time of submittal of such application, 
to—
‘‘(A) accept the conditions of the scholar-
ship and remain enrolled in a school of nursing; 
‘‘(B) maintain an acceptable level of aca-
demic standing; and 
‘‘(C) maintain enrollment in a course of 
study until the individual completes the course 
of study; and 
‘‘(4) teach at an accredited school of nursing 
for 1 year for each year of assistance with a course 
load determined by the school of nursing where the 
teaching will take place, and the individual may
complete such required period of service on a part-
time basis subject to—
‘‘(A) an agreement entered into by the fa-
cility and the individual which is approved by 
the Secretary; and 
‘‘(B) the individual agrees in writing that 
the period of obligated service will be extended 
so that the aggregate amount of less than full-
time service will equal the amount of service 
that would be performed through full-time serv-
ice. 
‘‘(c) APPLICATION.—The Secretary shall disseminate 
application forms to individuals and in such forms, in-
clude—
‘‘(1) a summary of the rights and liabilities of 
an individual whose application is approved by the 
Secretary; and 
‘‘(2) information respecting meeting the service 
obligation described in subsection (b)(4). 
‘‘(d) SCHOLARSHIP.—
‘‘(1) IN GENERAL.—A scholarship provided to a 
student for a school year under a written contract 
under the program shall consist of—
‘‘(A) payment to, or (in accordance with 
paragraph (2)) on behalf of the student of—
‘‘(i) the tuition of the student in such 
school year; and 
‘‘(ii) all other reasonable educational 
expenses and support services, including 
fees, books, and laboratory expenses in-
curred by the student in such school year; 
and 
‘‘(B) payment to the student of a stipend 
of $400 per month (adjusted in accordance with 
paragraph (3)) for each month that the student 
is enrolled. 
‘‘(2) CONTRACTS.—
‘‘(A) WITH A SCHOOL OF NURSING.—The 
Secretary may contract with a school of nurs-
ing, in which a participant in the program is 
enrolled, for the payment to the school of nurs-
ing of the amounts of tuition and other reason-
able educational expenses described in para-
graph (1)(A). 
‘‘(B) WITH
AN
INDIVIDUAL.—The Sec-
retary shall prepare a written contract for the 
program that shall be provided to any indi-
vidual who is enrolled or accepted for enroll-
ment at a school of nursing and who desires to 
participate in the program at the time that an
application is provided to such individual. The 
contract described in this paragraph shall con-
tain a provision that any financial obligation of 
the United States arising out of a contract en-
tered into under this section and any obligation 
of the individual which is conditioned thereon, 
is contingent upon funds being appropriated for 
scholarships under this section. 
‘‘(3) MONTHLY STIPEND.—The amount of the 
monthly stipend for each month that a student is 
enrolled, specified in paragraph (1)(B) and as pre-
viously adjusted (if at all) in accordance with this 
paragraph, shall be increased by the Secretary as 
the Secretary determines to be reasonable. 
‘‘(e) BREACH OF AGREEMENT.—In the case of an in-
dividual who enters into an agreement under this section 
to provide service as a nurse in consideration for receiving 
a scholarship, such individual is liable to the Federal Gov-
ernment in accordance with sections 338E and 338F as 
amended in the future. If the individual begins providing 
less than full-time service but fails to begin or complete 
the period of obligated service, the methods stated in sec-
tion 338E(c) for determining the damages for breech of 
the individual’s written contract will be used after con-
verting periods of obligated service or of service performed 
into their full-time equivalence. 
‘‘(f) AUTHORIZATION OF APPROPRIATIONS.—There 
are authorized to be appropriated to carry out this section 
$10,000,000 for fiscal year 2003 and such sums as may 
be necessary for fiscal years 2004 through 2007.’’.
TITLE 
III—MEDICAL 
MAL-
PRACTICE 
LIABILITY 
RE-
FORM 
SEC. 301. DEFINITIONS. 
In this title, the following definitions apply: 
(1) ALTERNATIVE DISPUTE RESOLUTION SYS-
TEM.—The term ‘‘alternative dispute resolution sys-
tem’’ means a system that provides for the resolu-
tion of medical malpractice claims in a manner other 
than through medical malpractice liability actions. 
(2) CLAIMANT.—The term ‘‘claimant’’ means 
any person who alleges a medical malpractice claim, 
and any person on whose behalf such a claim is al-
leged, including the decedent in the case of an action 
brought through or on behalf of an estate. 
(3) FUTURE
DAMAGES.—The term ‘‘future 
damages’’ means damages for economic or non-
economic loss incurred after the time of judgment.
(4) HEALTH CARE PROFESSIONAL.—The term 
‘‘health care professional’’ means any individual who 
provides health care services in a State and who is 
required by the laws or regulations of the State to 
be licensed or certified by the State to provide such 
services in the State. 
(5) HEALTH
CARE
PROVIDER.—The term 
‘‘health care provider’’ means any organization or 
institution that is engaged in the delivery of health 
care services in a State and that is required by the 
laws or regulations of the State to be licensed or cer-
tified by the State to engage in the delivery of such 
services in the State. 
(6) INJURY.—The term ‘‘injury’’ means any ill-
ness, disease, or other harm that is the subject of 
a medical malpractice liability action or a medical 
malpractice claim. 
(7) 
MANDATORY.—The 
term 
‘‘mandatory’’ 
means required to be used by the parties to attempt 
to resolve a medical malpractice claim notwith-
standing any other provision of an agreement, State 
law, or Federal law. 
(8) MEDIATION.—The term ‘‘mediation’’ means 
a settlement process coordinated by a neutral third
party and without the ultimate rendering of a formal 
opinion as to factual or legal findings. 
(9) MEDICAL MALPRACTICE CLAIM.—The term 
‘‘medical malpractice claim’’ means a claim against 
a health care provider, a health care professional, or 
a blood or tissue bank licensed or registered by the 
Food and Drug Administration in which a claimant 
alleges that injury was caused by the provision of (or 
the failure to provide) health care services, except 
that such term does not include—
(A) any claim based on an allegation of an 
intentional tort; or 
(B) any claim based on an allegation that 
a product is defective or unreasonably dan-
gerous. 
(10) MEDICAL
MALPRACTICE
LIABILITY
AC-
TION.—The term ‘‘medical malpractice liability ac-
tion’’ means a civil action brought in a State or Fed-
eral court against a health care provider, a health 
care professional, or a blood or tissue bank licensed 
or registered by the Food and Drug Administration 
in which the plaintiff alleges a medical malpractice 
claim.
SEC. 302. FEDERAL TORT REFORM. 
(a) IN GENERAL.—Except as provided in section 303, 
this title shall apply with respect to any medical mal-
practice liability action brought in any State or Federal 
court, except that this title shall not apply to a claim or 
action for damages arising from a vaccine-related injury 
or death to the extent that title XXI of the Public Health 
Service Act applies to the claim or action. 
(b) PREEMPTION.—The provisions of this title shall 
preempt any State law to the extent such law relates to 
a type of tort reform included under this title and is incon-
sistent with such provisions. 
(c) EFFECT ON SOVEREIGN IMMUNITY AND CHOICE 
OF LAW OR VENUE.—Nothing in this title shall be con-
strued to—
(1) waive or affect any defense of sovereign im-
munity asserted by any State under any provision of 
law; 
(2) waive or affect any defense of sovereign im-
munity asserted by the United States; 
(3) affect the applicability of any provision of 
the Foreign Sovereign Immunities Act of 1976; 
(4) preempt State choice-of-law rules with re-
spect to claims brought by a foreign nation or a cit-
izen of a foreign nation; or
(5) affect the right of any court to transfer 
venue or to apply the law of a foreign nation or to 
dismiss a claim of a foreign nation or of a citizen 
of a foreign nation on the ground of inconvenient 
forum. 
(d) FEDERAL COURT JURISDICTION NOT ESTAB-
LISHED ON FEDERAL QUESTION GROUNDS.—Nothing in 
this title shall be construed to establish any jurisdiction 
in the district courts of the United States over medical 
malpractice liability actions on the basis of section 1331 
or 1337 of title 28, United States Code. 
SEC. 303. ALTERNATIVE DISPUTE RESOLUTION METHODS. 
(a) MANDATORY MEDIATION.—In any medical mal-
practice liability action, before such action comes to trial, 
mediation shall be required. Such mediation shall be con-
ducted by one or more mediators who are selected by 
agreement of the parties or, if the parties do not agree, 
who are qualified under applicable State law and selected 
by the court. 
(b) REQUIREMENTS.—Mediation under subsection 
(a) shall be made available by a State subject to the fol-
lowing requirements: 
(1) Participation in such mediation shall be in 
lieu of any alternative dispute resolution method re-
quired by any other law or by any contractual ar-
rangement made by or on behalf of the parties be-
fore the commencement of the action. 
(2) Each State shall disclose to residents of the 
State the availability and procedures for resolution 
of consumer grievances regarding the provision of 
(or failure to provide) health care services, including 
such mediation. 
(3) Each State shall provide that such medi-
ation may begin before or after, at the option of the 
claimant, the commencement of a medical mal-
practice liability action. 
(4) The Attorney General, in consultation with 
the Secretary of Health and Human Services, shall, 
by regulation, develop requirements with respect to 
such mediation to ensure that it is carried out in a 
manner that—
(A) is affordable for the parties involved; 
(B) encourages timely resolution of claims; 
(C) encourages the consistent and fair res-
olution of claims; and 
(D) provides for reasonably convenient ac-
cess to dispute resolution. 
(c) FURTHER REDRESS AND ADMISSIBILITY.—Any 
party dissatisfied with a determination reached with re-
spect to a medical malpractice claim as a result of an al-
ternative dispute resolution method applied under this sec-
tion shall not be bound by such determination. The results 
of any alternative dispute resolution method applied under 
this section, and all statements, offers, and communica-
tions made during the application of such method, shall 
be inadmissible for purposes of adjudicating the claim.
SEC. 304. PREVENTING FRIVOLOUS MALPRACTICE SUITS. 
(a) CERTIFICATION.—The signatures of attorneys or 
parties constitute a certificate by them that they have read 
the pleading that to the best of their knowledge, informa-
tion, and belief formed after reasonable inquiry the med-
ical malpractice claim is not groundless and brought in 
bad faith or groundless and groundless and brought for 
the purpose of harassment. Attorneys or parties who shall 
bring a fictitious suit as an experiment to get an opinion 
of the court, or who shall file any fictitious pleading in 
a cause for such a purpose, or shall make statements in 
a pleading which they know to be groundless and false, 
for the purpose of securing a delay of the trial of the 
cause, shall be held guilty of contempt. If a pleading is 
signed in violation of this subsection, the court, upon mo-
tion or upon its own initiative, after notice and hearing, 
shall impose an appropriate sanction, such as striking the 
pleadings, dismissing the suit, and requiring payment of 
costs, attorneys fees, and sanctions (if appropriate) plus