IB 
Union Calendar No. 171 
116TH CONGRESS 
1ST SESSION 
H. R. 728 
[Report No. 116–216] 
To amend title VIII of the Public Health Service Act to extend advanced 
education nursing grants to support clinical nurse specialist programs, 
and for other purposes. 
IN THE HOUSE OF REPRESENTATIVES 
JANUARY 23, 2019 
Mr. JOYCE of Ohio (for himself, Ms. GABBARD, Mr. RODNEY DAVIS of Illinois, 
Ms. BONAMICI, Ms. MATSUI, Ms. CASTOR of Florida, Mr. MCKINLEY, 
and Ms. UNDERWOOD) introduced the following bill; which was referred 
to the Committee on Energy and Commerce 
SEPTEMBER 24, 2019 
Additional sponsors: Mr. FITZPATRICK, Ms. NORTON, Mr. COHEN, Ms. 
CLARKE of New York, Ms. BLUNT ROCHESTER, Mr. LIPINSKI, Ms. ROY-
BAL-ALLARD, Mr. DEFAZIO, Mr. POCAN, Mr. TAKANO, Mr. PAYNE, Mr. 
GALLEGO, Mr. KHANNA, Mr. PRICE of North Carolina, Mr. SABLAN, Mr. 
YOUNG, Mrs. WATSON
COLEMAN, Mrs. BEATTY, Mr. RUSH, Mr. 
BRENDAN F. BOYLE of Pennsylvania, Mr. RYAN, Mr. LOEBSACK, Mr. 
AGUILAR, Mr. HECK, Ms. HERRERA BEUTLER, Mr. COURTNEY, Ms. 
JOHNSON of Texas, Mrs. DINGELL, Mr. YARMUTH, Mr. STIVERS, Mr. 
SEAN PATRICK MALONEY of New York, Mr. CARSON of Indiana, Ms. 
KUSTER of New Hampshire, Mr. TURNER, Mr. DESAULNIER, Ms. PIN-
GREE, Mr. GONZALEZ of Ohio, Mr. CISNEROS, Ms. HILL of California, 
Mr. PAPPAS, Mr. JOHNSON of Georgia, Mr. COLE, Ms. WILD, Mr. 
O’HALLERAN, Mr. HIGGINS of New York, Mr. LAMBORN, Mr. KILMER, 
Ms. MCCOLLUM, Ms. MOORE, Ms. LOFGREN, Mr. VISCLOSKY, Mr. ROSE 
of New York, Mr. TONKO, Mr. MOULTON, Mr. CASE, Mrs. NAPOLITANO, 
Mr. COOPER, Mr. LEWIS, Ms. SPEIER, Ms. JACKSON LEE, Mr. GOH-
MERT, Mr. RUPPERSBERGER, Mr. RUTHERFORD, Mr. THOMPSON of Mis-
sissippi, Mr. KIND, Mr. HARDER of California, Mr. KATKO, Mr. RASKIN, 
Mr. BEYER, Ms. MENG, Mr. WATKINS, Ms. FINKENAUER, Mrs. DAVIS 
of California, Mr. SCHIFF, Mr. BILIRAKIS, Ms. CRAIG, Mr. GOLDEN, Ms. 
MUCARSEL-POWELL, Mr. KINZINGER, Ms. SCANLON, Mr. KENNEDY, 
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Mrs. LURIA, Ms. KAPTUR, Mr. GRIJALVA, Mr. THOMPSON of Pennsyl-
vania, Ms. TITUS, Mr. VAN DREW, Ms. BARRAGA´N, Mr. LUJA´N, Ms. 
JUDY CHU of California, Ms. VELA´ZQUEZ, Mr. STAUBER, Mr. MCGOV-
ERN, Ms. DEGETTE, Ms. DAVIDS of Kansas, Ms. DELBENE, Mr. MI-
CHAEL F. DOYLE of Pennsylvania, Mr. SUOZZI, Mr. KING of New York, 
Mr. MULLIN, Ms. LEE of California, Mr. DELGADO, Mr. BLUMENAUER, 
Miss RICE of New York, Mr. LAWSON of Florida, Mr. PERLMUTTER, Mr. 
ROUDA, Ms. FUDGE, Mr. CROW, Mr. ALLRED, Mr. LEVIN of California, 
Mr. CUMMINGS, Mr. TED LIEU of California, Mr. DAVID SCOTT of Geor-
gia, Mr. CASTEN of Illinois, Mr. WALDEN, Ms. KENDRA S. HORN of 
Oklahoma, Mr. LYNCH, Mr. PETERS, Ms. SCHAKOWSKY, Mr. LARSON of 
Connecticut, Mr. MORELLE, and Ms. SPANBERGER 
SEPTEMBER 24, 2019 
Reported with an amendment, committed to the Committee of the Whole 
House on the State of the Union, and ordered to be printed 
[Strike out all after the enacting clause and insert the part printed in italic] 
[For text of introduced bill, see copy of bill as introduced on January 23, 2019] 
A BILL 
To amend title VIII of the Public Health Service Act to 
extend advanced education nursing grants to support 
clinical nurse specialist programs, and for other pur-
poses. 
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Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE; TABLE OF CONTENTS. 
(a) SHORT TITLE.—This Act may be cited as the 
‘‘Title VIII Nursing Workforce Reauthorization Act of 
2019’’. 
(b) TABLE OF CONTENTS.—The table of contents of this 
Act is as follows: 
Sec. 1. Short title; table of contents. 
Sec. 2. General provisions. 
Sec. 3. Nurse practitioners, nurse midwives, nurse anesthetists, and other ad-
vanced education nurses. 
Sec. 4. Increasing nursing workforce diversity. 
Sec. 5. Strengthening capacity for basic nurse education and practice. 
Sec. 6. Student loans. 
Sec. 7. National Advisory Council on Nurse Education and Practice. 
Sec. 8. Other provisions. 
SEC. 2. GENERAL PROVISIONS. 
(a) APPLICATION.—Section 802(c) of the Public 
Health Service Act (42 U.S.C. 296a(c)) is amended by strik-
ing ‘‘shall address relevant national nursing needs that the 
project will meet’’ and inserting ‘‘shall address relevant na-
tional nursing needs that the project will address and how 
the project aligns with the national nursing service goals 
referred to in section 806(a)’’. 
(b) USE OF FUNDS.—Section 803 of the Public Health 
Service Act (42 U.S.C. 296b) is amended by adding at the 
end the following: 
‘‘(c) SUPPLEMENT NOT SUPPLANT.—Funds awarded 
as a grant under this title for a project or activity shall 
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be used to supplement, not supplant, the non-Federal funds 
that would otherwise be made available for such project or 
activity.’’. 
(c) GENERALLY APPLICABLE PROVISIONS.—Section 
806 of the Public Health Service Act (42 U.S.C. 296e) is 
amended— 
(1) in subsection (b), by amending paragraph 
(2) to read as follows: 
‘‘(2) EVALUATIONS.—The Secretary shall estab-
lish procedures to ensure the annual evaluation of 
programs and projects operated by recipients of 
grants under this title. Such procedures shall ensure 
that continued funding for such programs and 
projects will be conditioned upon the submission of— 
‘‘(A) data demonstrating that satisfactory 
progress has been made by the program or 
project in meeting the performance outcome 
standards (as described in section 802) of such 
program or project; and 
‘‘(B) a detailed description of activities con-
ducted by such program or project to meet such 
performance outcome standards.’’; 
(2) in subsection (e)(2), by inserting ‘‘, and have 
relevant expertise and experience’’ after ‘‘who are not 
officers or employees of the Federal Government’’; and 
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(3) by adding at the end the following: 
‘‘(i) ANNUAL REPORT ON NURSING WORKFORCE PRO-
GRAMS.—Annually, the Secretary shall submit to the Com-
mittee on Health, Education, Labor, and Pensions of the 
Senate, and the Committee on Energy and Commerce of 
the House of Representatives, a report containing an assess-
ment of the programs and activities of the Department of 
Health and Human Services related to enhancing the nurs-
ing workforce, including the extent to which programs and 
activities under this title meet identified goals and perform-
ance measures developed for the respective programs and 
activities.’’. 
SEC. 3. NURSE PRACTITIONERS, NURSE MIDWIVES, NURSE 
ANESTHETISTS, AND OTHER ADVANCED EDU-
CATION NURSES. 
Section 811 of the Public Health Service Act (42 
U.S.C. 296j) is amended— 
(1) in subsection (b)— 
(A) by striking ‘‘R.N./Master’s’’ and insert-
ing ‘‘R.N./graduate’’; and 
(B) by inserting ‘‘clinical nurse leaders,’’ 
before ‘‘or public health nurses’’; 
(2) by redesignating subsections (f) and (g) as 
subsections (g) and (h), respectively; 
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SEC. 5. STRENGTHENING CAPACITY FOR BASIC NURSE EDU-
CATION AND PRACTICE. 
(a) NURSE EDUCATION, PRACTICE, QUALITY, AND RE-
TENTION GRANTS.—Section 831 of the Public Health Serv-
ice Act (42 U.S.C. 296p) is amended— 
(1) in the section heading, by striking ‘‘AND 
QUALITY’’ and inserting ‘‘QUALITY, AND RETEN-
TION’’; 
(2) in subsection (b), by amending paragraph 
(2) to read as follows: 
‘‘(2) providing care for underserved populations 
and high-risk groups, which may include the elderly, 
individuals with HIV/AIDS, individuals with mental 
health or substance use disorders, individuals who are 
homeless, and victims and survivors of domestic vio-
lence;’’; 
(3) in subsection (c), by amending paragraph 
(1) to read as follows: 
‘‘(1) 
GRANTS
FOR
CAREER
LADDER
PRO-
GRAMS.—The Secretary may award grants to and 
enter into contracts with eligible entities for pro-
grams— 
‘‘(A) to promote career advancement for— 
‘‘(i) nursing personnel in a variety of 
training settings, cross training or specialty 
training among diverse population groups, 
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and the advancement of individuals, includ-
ing to become professional registered nurses, 
advanced practice registered nurses, and 
nurses with graduate nursing education; 
and 
‘‘(ii) individuals, including licensed 
practical nurses, licensed vocational nurses, 
certified nurse assistants, and diploma de-
gree or associate degree nurses, to become 
baccalaureate-prepared registered nurses or 
nurses with graduate nursing education; 
‘‘(B) to assist individuals in obtaining edu-
cation and training required to enter the nurs-
ing profession and advance within such profes-
sion, such as by providing career counseling and 
mentoring; and 
‘‘(C) to develop and implement internships, 
accredited fellowships, and accredited residency 
programs in collaboration with one or more ac-
credited schools of nursing to encourage men-
toring and development of specialties.’’; 
(4) by striking subsection (e) (relating to pref-
erence); 
(5) by redesignating subsections (f) through (h) 
as subsections (e) and (g), respectively; 
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(6) in subsection (e), as so redesignated, by strik-
ing ‘‘The Secretary shall submit to the Congress before 
the end of each fiscal year a’’ and inserting ‘‘As part 
of the report on nursing workforce programs described 
in section 806(i), the Secretary shall’’; 
(7) by amending subsection (f), as redesignated 
by paragraph (5), to read as follows: 
‘‘(f) DEFINITIONS.—For purposes of this section: 
‘‘(1) ELIGIBLE ENTITY.—The term ‘eligible enti-
ty’ includes an accredited school of nursing, a health 
care facility, a partnership of such a school and facil-
ity, a federally qualified health center, or a nurse- 
managed health clinic. 
‘‘(2) NURSE-MANAGED
HEALTH
CLINIC.—The 
term ‘nurse-managed health clinic’ means a nurse- 
practice arrangement, managed by advanced practice 
nurses, that provides primary care or wellness serv-
ices to underserved or vulnerable populations that is 
associated with a school, college, university or depart-
ment of nursing, federally qualified health center, or 
independent nonprofit health or social services agen-
cy.’’; and 
(8) in subsection (g), as redesignated by para-
graph (5), by striking ‘‘such sums as may be nec-
essary for each of fiscal years 2010 through 2014’’ 
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and inserting ‘‘$43,590,000 for each of fiscal years 
2020 through 2024’’. 
(b) NURSE RETENTION GRANTS.—Section 831A of the 
Public Health Service Act (42 U.S.C. 296p–1) is repealed. 
SEC. 6. STUDENT LOANS. 
(a) LOAN
REPAYMENT
AND
SCHOLARSHIP
PRO-
GRAMS.—Section 846 of the Public Health Service Act (42 
U.S.C. 297n) is amended— 
(1) in subsection (b)(1), by striking ‘‘he began 
such practice’’ and inserting ‘‘the individual began 
such practice’’; 
(2) in subsection (d)(1), by striking ‘‘(for fiscal 
years 2003 and 2004) and may (for fiscal years there-
after)’’; 
(3) in subsection (h), in the matter preceding 
paragraph (1), by striking ‘‘Not later than’’ through 
‘‘regarding’’ and inserting ‘‘The annual report on 
nursing workforce programs, as required by section 
806(i), shall include information regarding the pro-
grams carried out under this section, including’’; and 
(4) in subsection (i)(1), by striking ‘‘such sums 
as may be necessary for each of fiscal years 2003 
through 2007’’ and inserting ‘‘$90,620,000 for each of 
fiscal years 2020 through 2024’’. 
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(b) NURSE
FACULTY
LOAN
PROGRAM.—Section 
846A(f) of the Public Health Service Act (42 U.S.C. 297n– 
1(f)) is amended by striking ‘‘such sums as may be nec-
essary for each of fiscal years 2010 through 2014’’ and in-
serting ‘‘$29,640,000 for each of fiscal years 2020 through 
2024’’. 
SEC. 7. NATIONAL ADVISORY COUNCIL ON NURSE EDU-
CATION AND PRACTICE. 
Section 851 of the Public Health Service Act (42 
U.S.C. 297t) is amended— 
(1) in subsection (b)(1)(A)(iv), by striking ‘‘and 
nurse anesthetists’’ and inserting ‘‘nurse anesthetists, 
and clinical nurse specialists’’; 
(2) in subsection (d), by amending paragraph 
(3) to read as follows: 
‘‘(3) not later than 2 years after the date of en-
actment of the Title VIII Nursing Workforce Reau-
thorization Act of 2019, and every 2 years thereafter, 
prepare and submit to the Secretary, the Committee 
on Health, Education, Labor, and Pensions of the 
Senate, and the Committee on Energy and Commerce 
of the House of Representatives, a report describing 
the activities of the Council, including findings and 
recommendations made by the Council concerning the 
activities under this title.’’; and 
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