[Congressional Bills 118th Congress]
[From the U.S. Government Publishing Office]
[S. 1586 Introduced in Senate (IS)]
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118th CONGRESS
1st Session
S. 1586
To amend title XVIII of the Social Security Act to establish a national
graduate nurse education program.
_______________________________________________________________________
IN THE SENATE OF THE UNITED STATES
May 11, 2023
Ms. Stabenow (for herself, Mr. Casey, and Ms. Hassan) introduced the
following bill; which was read twice and referred to the Committee on
Finance
_______________________________________________________________________
A BILL
To amend title XVIII of the Social Security Act to establish a national
graduate nurse education program.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Educating Future Nurses Act''.
SEC. 2. NATIONAL GRADUATE NURSE EDUCATION PROGRAM.
Title XVIII of the Social Security Act (42 U.S.C. 1395 et seq.) is
amended by inserting after section 1866G the following new section:
``SEC. 1866H. NATIONAL GRADUATE NURSE EDUCATION PROGRAM.
``(a) In General.--
``(1) Establishment.--
``(A) In general.--The Secretary shall establish a
national graduate nurse education program under this
title under which an eligible hospital may receive
payment for the hospital's reasonable costs (described
in paragraph (2)) for the provision of qualified
clinical education to advanced practice registered
nurses.
``(B) Written agreements.--Eligible hospitals
participating in the program shall enter into written
agreements pursuant to subsection (b)(1) in order to
reimburse the eligible partners of the hospital the
share of the costs attributable to each partner.
``(2) Costs described.--
``(A) In general.--Subject to subparagraph (B), the
costs described in this paragraph are the reasonable
costs (as described in section 1861(v)) of each
eligible hospital for the clinical education costs (as
determined by the Secretary) that are attributable to
providing advanced practice registered nurses with
qualified clinical education.
``(B) Limitation.--With respect to a year, the
amount reimbursed under subparagraph (A) may not exceed
the amount of costs described in subparagraph (A) that
are attributable to an increase in the number of
advanced practice registered nurses enrolled in an
accredited school of nursing that provides qualified
clinical education during the year and for which the
hospital is being reimbursed under the program, as
compared to the average number of advanced practice
registered nurses who graduated in each year during the
period beginning on January 1, 2021, and ending on
December 31, 2022 (as determined by the Secretary) from
the graduate nursing education program operated by the
applicable school of nursing that is an eligible
partner of the hospital for purposes of the program.
``(3) Establishment of regions.--
``(A) In general.--The Secretary shall establish
regions for Graduate Nurse Education Hubs described in
subsection (b) under the program based on hospital
referral regions.
``(B) Limitations.--
``(i) One hub per region.--Only one
Graduate Nurse Education Hub may participate in
the program with respect to each region
established by the Secretary under subparagraph
(A).
``(ii) Eligible hospitals and eligible
partners.--An eligible hospital or eligible
partner may only participate in one Graduate
Nurse Education Hub under the program.
``(4) Supplement not supplant.--Payments under this section
in any given year shall supplement, not supplant, other Federal
funds that have been made available in the year for advanced
practice registered nurse clinical education or training.
``(5) Waiver authority.--The Secretary may waive such
requirements of title XI and this title as may be necessary to
carry out the program.
``(6) Administration.--Chapter 35 of title 44, United
States Code, shall not apply to the implementation of this
section.
``(b) Requirements.--No payment shall be made under this section to
an eligible hospital unless such hospital meets the following
requirements:
``(1) The hospital has in effect a written agreement with
the eligible partners of the hospital. Such written agreement
shall describe, at a minimum--
``(A) the obligations of the eligible partners with
respect to the provision of qualified clinical
education; and
``(B) the obligation of the eligible hospital to
reimburse such eligible partners (in a timely manner)
for the costs of such qualified clinical education that
are attributable to such partner.
``(2) The hospital demonstrates to the Secretary that it is
leading a Graduate Nurse Education (GNE) Hub which has
established and will maintain the following in order to provide
qualified clinical education to advanced practice registered
nurses:
``(A) Partnerships with one or more--
``(i) applicable schools of nursing;
``(ii) hospitals or health systems in a
regional area; and
``(iii) applicable non-hospital community-
based care settings.
``(B) A governance structure that includes one or
more applicable schools of nursing in the leadership
and an oversight process that is developed and approved
by the hospital, participating applicable schools of
nursing, and other hub partners, in accordance with
requirements established by the Secretary.
``(C) A process for timely reimbursement of
eligible partners for the costs of such qualified
clinical education that are attributable to such
partner.
``(D) An adequate system for coordination of
clinical education sites and preceptors.
``(E) A process for taking into consideration
local, State, and regional workforce needs to
facilitate innovation and value-based delivery of
health care.
``(c) Payments.--
``(1) Per-student rate.--The amount of payment under this
section to an eligible hospital shall for each year of the
program shall be equal to the applicable per-student rate (as
defined in paragraph (2)) multiplied by the total number of
advanced practice registered nurses receiving qualified
clinical education through the eligible hospital under the
program.
``(2) Applicable per-student rate.--The applicable per-
student rate, with respect to an eligible hospital, is--
``(A) for the first year of the program, a per-
student rate determined by the Secretary based on data
from the Graduate Nurse Education Demonstration
established under section 5509 of the Patient
Protection and Affordable Care Act (Public Law 111-
148), increased or decreased by the percentage change
in the consumer price index for all urban consumers
(all items; United States city average) from the last
year of the Graduate Nurse Education Demonstration
established under section 5509 for which such data is
available to the June preceding such first year of the
program under this section; and
``(B) for a subsequent year, the amount determined
under this paragraph for the preceding year, increased
or decreased by the percentage change in the consumer
price index for all urban consumers (all items; United
States city average) for the 12-month period ending
with June of the previous year.
``(d) Annual Reporting Required .--
``(1) Reduction in payment for failure to report.--
``(A) In general.--The amount payable under this
section to an eligible hospital shall be reduced by 25
percent if the Secretary determines that--
``(i) the hospital has failed to provide
the Secretary the report required under
paragraph (2) for the year; or
``(ii) such report fails to provide the
information required under any subparagraph of
such paragraph.
``(B) Notice and opportunity to provide missing
information.--Before imposing a reduction under
subparagraph (A) on the basis of a hospital's failure
to provide information described in subparagraph
(A)(ii), the Secretary shall provide notice to the
hospital of such failure and the Secretary's intention
to impose such reduction and shall provide the hospital
with the opportunity to provide the required
information within a period of 30 days beginning on the
date of such notice. If the hospital provides such
information within such period, no reduction shall be
made under subparagraph (A) on the basis of the
previous failure to provide such information.
``(C) Limitation.--In the case where the amount
payable under this section to an eligible hospital is
reduced pursuant to subparagraph (A), the eligible
hospital may not make any corresponding reductions in
payment to eligible partners.
``(2) Annual report.--The report required under this
paragraph for an eligible hospital for a year is a report that
includes (in a form and manner specified by the Secretary) the
following information for the academic year completed
immediately prior to such year:
``(A) The types of qualified clinical education
provided to advanced practice registered nurses under
the program.
``(B) The type and number of academic or practice
partnerships established as a result of working
together in a Graduate Nurse Education (GNE) Hub.
``(C) The number of advanced practice registered
nurse students receiving qualified clinical education
through the eligible hospital under the program.
``(D) Any changes in qualified clinical education
made during such academic year (except that the first
report submitted by the eligible hospital under this
paragraph shall be for such changes since the first
year in which the hospital received payment under this
section), including--
``(i) changes in curricula, clinical
education experiences, and types of clinical
education, and benefits that have resulted from
such changes; and
``(ii) changes for purposes of measuring
and improving the quality and safety of patient
care.
``(E) The numbers of advanced practice registered
nurses who graduated from their program at the end of
such academic year and care for individuals within the
borders of the service area of the hospital or within
the borders of the State in which the hospital is
located.
``(F) The number of patients treated by advanced
practice registered nurses under the program.
``(G) The number of visits by patients treated by
such advanced practice registered nurses.
``(H) Of the number of advanced practice registered
nurses who graduated from their program at the end of
such academic year, the number and percentage of such
advanced practice registered nurses who entered
practice at a health care facility--
``(i) primarily serving a health
professional shortage area with a designation
in effect under section 332 of the Public
Health Service Act or a medically underserved
community (as defined in section 799B of such
Act); or
``(ii) located in a rural area (as defined
in section 1886(d)(2)(D)).
``(I) Other information as deemed appropriate by
the Secretary.
``(3) Report to congress.--Not later than 2 years after the
date of the enactment of this section, the Secretary shall
submit to Congress a report--
``(A) summarizing the information submitted in
reports to the Secretary under paragraph (2);
``(B) describing the results of the program carried
out under this section; and
``(C) making recommendations for improvements to
the program.
``(e) Funding.--For purposes of carrying the program under this
section, the Secretary shall provide for the transfer, from the Federal
Hospital Insurance Trust Fund under section 1817 and the Federal
Supplementary Medical Insurance Trust Fund under section 1841, in such
proportion as the Secretary determines appropriate, of such sums as the
Secretary determines necessary, to the Centers for Medicare & Medicaid
Services Program Management Account.
``(f) Definitions.--In this section:
``(1) Advanced practice registered nurse.--The term
`advanced practice registered nurse' includes the following:
``(A) A clinical nurse specialist (as defined in
subsection (aa)(5) of section 1861.
``(B) A nurse practitioner (as defined in such
subsection).
``(C) A certified registered nurse anesthetist (as
defined in subsection (bb)(2) of such section).
``(D) A certified nurse-midwife (as defined in
subsection (gg)(2) of such section).
``(2) Applicable non-hospital community-based care
setting.--The term `applicable non-hospital community-based
care setting' means a non-hospital community-based care setting
which has entered into a written agreement (as described in
subsection (b)(1)) with the eligible hospital participating in
the program. Such settings include Federally qualified health
centers, rural health clinics, nurse managed clinics,
ambulatory practices (including retail clinics), accountable
care organizations, physician or practitioner offices, schools,
nursing homes, hospice programs, long-term care facilities,
home health agencies, and other non-hospital settings as
determined appropriate by the Secretary.
``(3) Applicable school of nursing.--The term `applicable
school of nursing' means an accredited school of nursing (as
defined in section 801 of the Public Health Service Act) which
has entered into a written agreement (as described in
subsection (b)(1)) with the eligible hospital participating in
the program.
``(4) Program.--The term `program' means the graduate nurse
education program established under subsection (a).
``(5) Eligible hospital.--The term `eligible hospital'
means a hospital (as defined in subsection (e) of section 1861)
or a critical access hospital (as defined in subsection (mm)(1)
of such section) that has a written agreement in place with--
``(A) 1 or more applicable schools of nursing; and
``(B) 2 or more applicable non-hospital community-
based care settings.
``(6) Eligible partners.--The term `eligible partners'
includes the following:
``(A) An applicable school of nursing.
``(B) A hospital or health system in a regional
area.
``(C) An applicable non-hospital community-based
care setting.
``(7) Qualified clinical education.--
``(A) In general.--The term `qualified clinical
education' means education--
``(i) that provides an advanced practice
registered nurse with the clinical skills
necessary to provide primary care, preventive
care, transitional care, acute care, chronic
care management, and other services appropriate
for individuals entitled to, or enrolled for,
benefits under part A, or enrolled under part
B; and
``(ii) subject to subparagraph (B), at
least half of which is provided in a non-
hospital community-based care setting.
``(B) Waiver of requirement half of qualified
education be provided in non-hospital community-based
care setting in certain areas.--The Secretary may waive
the requirement under subparagraph (A)(ii) with respect
to eligible hospitals located in rural or medically
underserved areas.''.
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