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116th Congress    }                                    {       Report
                        HOUSE OF REPRESENTATIVES
 1st Session      }                                    {      116-216

======================================================================



 
        TITLE VIII NURSING WORKFORCE REAUTHORIZATION ACT OF 2019

                                _______
                                

 September 24, 2019.--Committed to the Committee of the Whole House on 
            the State of the Union and ordered to be printed

                                _______
                                

        Mr. Pallone, from the Committee on Energy and Commerce,
                        submitted the following

                              R E P O R T

                        [To accompany H.R. 728]

    The Committee on Energy and Commerce, to whom was referred 
the bill (H.R. 728) 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, having considered the same, report favorably thereon 
with an amendment and recommend that the bill as amended do 
pass.

                                CONTENTS

                                                                   Page
  I.  Purpose and Summary.............................................4
 II.  Background and Need for the Legislation.........................4
 III. Committee Hearings..............................................6

 IV.  Committee Consideration.........................................7
  V.  Committee Votes.................................................7
 VI.  Oversight Findings..............................................7
 VII. New Budget Authority, Entitlement Authority, and Tax Expenditure7

 VIII Federal Mandates Statement......................................7
   .
 IX.  Statement of General Performance Goals and Objectives...........8
  X.  Duplication of Federal Programs.................................8
 XI.  Committee Cost Estimate.........................................8
 XII. Earmarks, Limited Tax Benefits, and Limited Tariff Benefits.....8

 XIII Advisory Committee Statement....................................8
   .
 XIV. Applicability to Legislative Branch.............................8

 XV.  Section-by-Section Analysis of the Legislation..................8
 XVI. Changes in Existing Law Made by the Bill, as Reported...........9


    The amendment is as follows:
  Strike all after the enacting clause and insert the 
following:

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 advanced 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 striking ``shall address relevant 
national nursing needs that the project will meet'' and inserting 
``shall address relevant national 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 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 establish 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 conducted 
                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
          (3) by adding at the end the following:
  ``(i) Annual Report on Nursing Workforce Programs.--Annually, the 
Secretary shall submit to 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 containing an assessment of the 
programs and activities of the Department of Health and Human Services 
related to enhancing the nursing workforce, including the extent to 
which programs and activities under this title meet identified goals 
and performance measures developed for the respective programs and 
activities.''.

SEC. 3. NURSE PRACTITIONERS, NURSE MIDWIVES, NURSE ANESTHETISTS, AND 
                    OTHER ADVANCED EDUCATION 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 inserting 
                ``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;
          (3) by inserting after subsection (e) the following new 
        subsection:
  ``(f) Authorized Clinical Nurse Specialist Programs.--Clinical nurse 
specialist programs eligible for support under this section are 
education programs that--
          ``(1) provide registered nurses with full-time clinical nurse 
        specialist education; and
          ``(2) have as their objective the education of clinical nurse 
        specialists who will upon completion of such a program be 
        qualified to effectively provide care through the wellness and 
        illness continuum to inpatients and outpatients experiencing 
        acute and chronic illness.''; and
          (4) by adding at the end the following:
  ``(i) Authorization of Appropriations.--There are authorized to be 
appropriated to carry out this section $77,585,000 for each of fiscal 
years 2020 through 2024.''.

SEC. 4. INCREASING NURSING WORKFORCE DIVERSITY.

  Section 821 of the Public Health Service Act (42 U.S.C. 296m) is 
amended by adding at the end the following:
  ``(d) Authorization of Appropriations.--There are authorized to be 
appropriated to carry out this section $18,037,000 for each of fiscal 
years 2020 through 2024.''.

SEC. 5. STRENGTHENING CAPACITY FOR BASIC NURSE EDUCATION AND PRACTICE.

  (a) Nurse Education, Practice, Quality, and Retention Grants.--
Section 831 of the Public Health Service Act (42 U.S.C. 296p) is 
amended--
          (1) in the section heading, by striking ``and quality'' and 
        inserting ``quality, and retention'';
          (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 violence;'';
          (3) in subsection (c), by amending paragraph (1) to read as 
        follows:
          ``(1) Grants for career ladder programs.--The Secretary may 
        award grants to and enter into contracts with eligible entities 
        for programs--
                  ``(A) to promote career advancement for--
                          ``(i) nursing personnel in a variety of 
                        training settings, cross training or specialty 
                        training among diverse population groups, and 
                        the advancement of individuals, including 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 degree 
                        or associate degree nurses, to become 
                        baccalaureate-prepared registered nurses or 
                        nurses with graduate nursing education;
                  ``(B) to assist individuals in obtaining education 
                and training required to enter the nursing profession 
                and advance within such profession, 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 accredited 
                schools of nursing to encourage mentoring and 
                development of specialties.'';
          (4) by striking subsection (e) (relating to preference);
          (5) by redesignating subsections (f) through (h) as 
        subsections (e) and (g), respectively;
          (6) in subsection (e), as so redesignated, by striking ``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 entity' includes 
        an accredited school of nursing, a health care facility, a 
        partnership of such a school and facility, 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 services to underserved or vulnerable populations that 
        is associated with a school, college, university or department 
        of nursing, federally qualified health center, or independent 
        nonprofit health or social services agency.''; and
          (8) in subsection (g), as redesignated by paragraph (5), by 
        striking ``such sums as may be necessary for each of fiscal 
        years 2010 through 2014'' 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 Programs.--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 thereafter)'';
          (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 programs 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''.
  (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 necessary for each of fiscal years 2010 through 2014'' and 
inserting ``$29,640,000 for each of fiscal years 2020 through 2024''.

SEC. 7. NATIONAL ADVISORY COUNCIL ON NURSE EDUCATION 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 enactment of 
        the Title VIII Nursing Workforce Reauthorization 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
          (3) in subsection (g), by striking ``under this title'' and 
        inserting ``for carrying out parts B, C, and D of this title''.

SEC. 8. OTHER PROVISIONS.

  (a) Public Service Announcements.--Part G of title VIII of the Public 
Health Service Act (42 U.S.C. 297w et seq.) is repealed.
  (b) Funding.--Part I of title VIII of the Public Health Service Act 
(42 U.S.C. 298d) is repealed.
  (c) Eliminating Limitation on Assignment.--Section 846(a) of the 
Public Health Service Act (42 U.S.C. 297n(a)) is amended, in the matter 
following paragraph (3), by striking ``After fiscal year 2007,'' and 
all that follows through the period at the end.

                         I. Purpose and Summary

    H.R. 728, the ``Title VIII Nursing Workforce 
Reauthorization Act of 2019'', was introduced on January 23, 
2019, by Reps. David Joyce (R-OH), Doris Matsui (D-CA), Rodney 
Davis (R-IL), Kathy Castor (D-FL), David McKinley (R-WV), Tulsi 
Gabbard (D-HI), Suzanne Bonamici (D-OR), and Lauren Underwood 
(D-IL) and referred to the Committee on Energy and Commerce. 
H.R. 728 would reauthorize funding at the Health Resources and 
Services Administration (HRSA) for nursing workforce, 
education, and training programs. The five-year reauthorization 
includes annual authorizations of: $77,585,000 for advanced 
education nursing grants; $18,037,000 for nursing workforce 
diversity programs; $43,590,000 for nurse education, practice, 
and quality grants; $90,620,000 for Nurse Corps loan repayment 
and scholarship programs; and $29,640,000 for the nurse faculty 
loan repayment program. The bill also recognizes the role of 
clinical nurse specialist programs and makes technical changes 
to existing nurse workforce programs to recognize diversity in 
the nursing profession and nurses practicing in a variety of 
settings.

                 II. Background and Need for Legislation

    Nurses provide frontline care in a variety of settings and 
often work to supervise and coordinate care for patients. The 
Bureau of Labor Statistics projects that an additional 203,700 
nurses will be needed every year to meet demand, filling newly 
created positions, and replacing retiring nurses.\1\ While 
there is a growth in enrollment at nursing schools, enrollment 
is not growing fast enough to meet the projected demand for 
nurses.\2\ Title VIII of the Public Health Service Act (PHSA) 
includes programs administered by HRSA to support and educate 
nursing students and professionals through targeted grant 
programs.
---------------------------------------------------------------------------
    \1\Elka Torpey, Bureau of Labor Statistics, Employment Outlook for 
Bachelor's-Level Occupations, www.bls.gov/careeroutlook/2018/article/
bachelors-degree-outlook.htm#Healthcare%20and %20science (2018).
    \2\American Assn. of Colleges of Nursing, Fact Sheet: Nursing 
Shortage, www.aacnnursing.org/Portals/42/News/Factsheets/Nursing-
Shortage-Factsheet.pdf (2019).
---------------------------------------------------------------------------
    H.R. 728 reauthorizes and updates Title VIII programs that 
will help to bolster the recruitment, training, and support for 
nursing students and professionals. In addition, H.R. 728 
includes provisions that recognize clinical nurse specialist 
programs and the need for diversity in the nursing profession, 
and improved access to nurses in rural and underserved areas.
    Advanced Nursing Education Programs include Advanced 
Nursing Workforce Education (ANEW) grants, the Advanced Nursing 
Education Nurse Practitioner Residency (ANE-NPR) program, the 
Advanced Nursing Education for Sexual Assault Nurse Examiners 
(ANE-SANE) program, and the Nurse Anesthetist Traineeships 
(NAT) Program. ANEW grants prepare primary care advanced 
practice registered nursing (APRN) students to practice in 
rural and underserved settings through academic and clinical 
training.\3\ The ANE-NPR program funds 12-month nurse 
practitioner (NP) residency programs to help primary care NPs 
transition to community-based settings.\4\ The ANE-SANE program 
funds grants to support partnerships that will recruit, train, 
and retain nurses to conduct sexual assault forensic 
examinations.\5\ Nurse Anesthetist Traineeships provide 
clinical training in medically underserved communities and/or 
primary care settings during the academic year.\6\
---------------------------------------------------------------------------
    \3\Health Resources and Services Admin., Fiscal Year 2020 
Justification of Estimates for Appropriations Committees 135 (2019).
    \4\Id. at 136.
    \5\Id.
    \6\Id.
---------------------------------------------------------------------------
    The nursing profession is predominantly white and 
female.\7\ To help alleviate health disparities, observers have 
long promoted increasing the diversity of the nursing 
workforce.\8\ In addition to reducing disparities, researchers 
have noted that achieving greater diversity among health care 
workforce will produce a more culturally competent workforce, 
improve access to high-quality care for the medically 
underserved, increase the breadth and depth of the U.S. health 
research agenda, and expand the pool of medically trained 
executives and policymakers ready to serve in leadership 
positions in the healthcare system.\9\ Despite the benefits of 
a more diverse workforce, health professional schools including 
nursing schools, have struggled to diversify the pool of health 
professional students and the future healthcare workforce.\10\ 
The Nursing Workforce Diversity Program supports the goal of 
diversifying the nursing student pool by providing stipends, 
scholarships, and a variety of pre-entry preparation, advanced 
education preparation, and retention activities for individuals 
from disadvantaged backgrounds, including racial and ethnic 
minorities who are underrepresented among registered nurses 
(RNs).\11\
---------------------------------------------------------------------------
    \7\See Nat'l Forum of State Nursing Workforce Centers, 2017 
National Nursing Workforce Study, www.ncsbn.org/workforce.htm (2018) 
(reporting that 9.1% of registered nurses (RNs) were male, and 19.2% 
were minorities).
    \8\Ernest Grant, We Can All Help Increase Diversity in Nursing, 
Modern Healthcare, May 9, 2019, www.modernhealthcare.com/opinion-
editorial/commentary-we-can-all-help-increase-diversity-nursing.
    \9\Jordan J. Cohen, Barbara A. Gabriel, and Charles Terrell, The 
Case for Diversity in the Health Care Workforce, Health Affairs, Vol. 
21, Issue 5, at 90 (2002).
    \10\Jordan J. Cohen, Barbara A. Gabriel, and Charles Terrell, The 
Case for Diversity in the Health Care Workforce, Health Affairs, Vol. 
21, Issue 5, at 90 (2002).
    \11\Supra note 3 at 139.
---------------------------------------------------------------------------
    Nurse Education, Practice, Quality, and Retention programs 
aim to increase the number of Bachelor of Science in Nursing 
students who receive clinical experience and training in 
medically underserved and rural communities, with the goal of 
increasing the number of students who choose to work in those 
settings upon graduation.\12\ These programs include the 
Behavioral Health Integration Program, the Registered Nurses in 
Primary Care Training Program, and the Veteran Registered 
Nurses in Primary Care Training Program.
---------------------------------------------------------------------------
    \12\Id. at 143.
---------------------------------------------------------------------------
    The Nurse Corps aims to support nurses and nursing students 
working in communities with inadequate access to care and 
limited access to behavioral health services by funding 
scholarships or educational loan repayment.\13\ In exchange for 
a scholarship or loan repayment, Nurse Corps members serve in 
Critical Shortage Facilities in health professional shortage 
areas and medically underserved communities.\14\
---------------------------------------------------------------------------
    \13\Id. at 150.
    \14\Id.
---------------------------------------------------------------------------
    To promote continued growth of nursing workforce, the Nurse 
Faculty Loan Program awards funds to nursing schools that 
provide student loans to graduate-level nursing students who 
are interested in serving as faculty. After graduating, loan 
recipients are eligible to have up to 85 percent of loan 
principal and interest canceled in exchange for serving as 
full-time faculty at an accredited school of nursing.\15\
---------------------------------------------------------------------------
    \15\Id. at 147.
---------------------------------------------------------------------------

                         III. Committee Hearings

    For the purposes of section 103(i) of H. Res. 6 of the 
116th Congress, the following hearing was used to develop or 
consider H.R. 728:
    The Subcommittee on Health held a legislative hearing in 
the 115th Congress entitled ``Supporting Tomorrow's Health 
Providers: Examining Workforce Programs Under the Public Health 
Service Act.'' Witnesses at the hearing included:
     Adrian Billings, M.D., Ph.D., FAAFP, Chief Medical 
Officer, Preventive Care Health Services and Associate 
Professor, Department of Family and Community Medicine, Texas 
Tech University Health Sciences Center-Permian Basin;
     Neil S. Calman, M.D., FAAFP, President, American 
Association of Teaching Health Centers, President and CEO, 
Institute for Family Health, Chair, Department of Family 
Medicine and Community Health, Icahn School of Medicine at 
Mount Sinai;
     Janice A. Knebl, D.O., M.B.A., Dallas Southwest 
Osteopathic Physicians Endowed Chair and Professor in 
Geriatrics, University of North Texas Health Science Center;
     Juliann Sebastian, Ph.D., R.N., FAAN, Chair of the 
Board of Directors, American Association of Colleges of 
Nursing, Dean and Professor, College of Nursing, University of 
Nebraska Medical Center.

                       IV. Committee Consideration

    H.R. 728, the ``Title VIII Nursing Workforce 
Reauthorization Act of 2019'', was introduced on January 23, 
2019, by Reps. David Joyce (R-OH), Doris Matsui (D-CA), Rodney 
Davis (R-IL), Kathy Castor (D-FL), David McKinley (R-WV), Tulsi 
Gabbard (D-HI), Suzanne Bonamici (D-OR), and Lauren Underwood 
(D-IL) and referred to the Committee on Energy and Commerce. 
Subsequently, the bill was referred to the Subcommittee on 
Health on January 25, 2019. The Subcommittee met in open markup 
session, pursuant to notice, on July 11, 2019, for 
consideration of H.R. 728. An amendment offered by Ms. Matsui 
was agreed to by a voice vote. Subsequently, the Subcommittee 
on Health agreed to a motion by Ms. Eshoo, Chairwoman of the 
Subcommittee, to forward favorably H.R. 728, amended, to the 
full Committee on Energy and Commerce by a voice vote.
    On July 17, 2019, the full Committee met in open markup 
session, pursuant to notice, to consider H.R. 728, as amended 
by the subcommittee. During consideration of the bill, no 
amendments were offered. Subsequently, the full Committee on 
Energy and Commerce agreed to a motion by Mr. Pallone, Chairman 
of the Committee, to order the bill H.R. 728 reported favorably 
to the House, as amended, by a voice vote, a quorum being 
present.

                           V. Committee Votes

    Clause 3(b) of rule XIII of the Rules of the House of 
Representatives requires the Committee to list each record vote 
on the motion to report legislation and amendments thereto. 
There were no recorded votes taken in connection with ordering 
H.R. 728 reported or on any amendments to the bill.

                         VI. Oversight Findings

    Pursuant to clause 3(c)(1) of rule XIII and clause 2(b)(1) 
of rule X of the Rules of the House of Representatives, the 
oversight findings and recommendations of the Committee are 
reflected in the descriptive portion of the report.

 VII. New Budget Authority, Entitlement Authority, and Tax Expenditures

    Pursuant to 3(c)(2) of rule XIII of the Rules of the House 
of Representatives, the Committee adopts as its own the 
estimate of new budget authority, entitlement authority, or tax 
expenditures or revenues contained in the cost estimate 
prepared by the Director of the Congressional Budget Office 
pursuant to section 402 of the Congressional Budget Act of 
1974.
    The Committee has requested but not received from the 
Director of the Congressional Budget Office a statement as to 
whether this bill contains any new budget authority, credit 
authority, or an increase or decrease in revenues or tax 
expenditures.

                    VIII. Federal Mandates Statement

    The Committee adopts as its own the estimate of Federal 
mandates prepared by the Director of the Congressional Budget 
Office pursuant to section 423 of the Unfunded Mandates Reform 
Act.

       IX. Statement of General Performance Goals and Objectives

    Pursuant to clause 3(c)(4) of rule XIII, the general 
performance goal or objective of this legislation is to extend 
advanced education nursing grants to support clinical nurse 
specialist programs and to support a robust and diverse nursing 
workforce.

                   X. Duplication of Federal Programs

    Pursuant to clause 3(c)(5) of rule XIII, no provision of 
H.R. 728 is known to be duplicative of another Federal program, 
including any program that was included in a report to Congress 
pursuant to section 21 of Public Law 111-139 or the most recent 
Catalog of Federal Domestic Assistance.

                      XI. Committee Cost Estimate

    Pursuant to clause 3(d)(1) of rule XIII, the Committee 
adopts as its own the cost estimate prepared by the Director of 
the Congressional Budget Office pursuant to section 402 of the 
Congressional Budget Act of 1974.

    XII. Earmarks, Limited Tax Benefits, and Limited Tariff Benefits

    Pursuant to clause 9(e), 9(f), and 9(g) of rule XXI, the 
Committee finds that H.R. 728 contains no earmarks, limited tax 
benefits, or limited tariff benefits.

                   XIII. Advisory Committee Statement

    No advisory committees within the meaning of section 5(b) 
of the Federal Advisory Committee Act were created by this 
legislation.

                XIV. Applicability to Legislative Branch

    The Committee finds that the legislation does not relate to 
the terms and conditions of employment or access to public 
services or accommodations within the meaning of section 
102(b)(3) of the Congressional Accountability Act.

           XV. Section-by-Section Analysis of the Legislation


Section 1. Short title

    Section 1 designates that the short title may be cited as 
the ``Title VIII Nursing Workforce Reauthorization Act of 
2019'' and lists a table of contents.

Section 2. General provisions

    Section 2 states general provisions. These include an 
amendment to general application language which would require 
that all applications submitted for grants under Title VIII 
programs ``shall address relevant national nursing needs that 
the project will address and how the project aligns with . . . 
national nursing service goals.'' Additionally, there is a 
requirement that funds awarded for grants under Title VIII 
should only be used to supplement, not supplant non-Federal 
funds otherwise available for projects. Furthermore, this 
section requires the Secretary to annually evaluate programs 
and projects operated by grantees and would require an annual 
report on nursing workforce programs.

Section 3. Nurse practitioners, nurse midwives, nurse anesthetists, and 
        other advanced education nurses

    Section 3 makes technical changes to Advance Nursing 
Education Programs and includes authorized clinical nurse 
specialist programs as an eligible program for support. Section 
3 provides an annual authorization of $77,585,000 for Advanced 
Nursing Education Programs each fiscal year 2020 through 2024.

Section 4. Increasing nursing workforce diversity

    Section 4 provides an annual authorization of $18,037,000 
each fiscal year 2020 through 2024 for the Nursing Workforce 
Diversity Program.

Section 5. Strengthening capacity for basic nurse education and 
        practice

    Section 5 incorporates existing nurse retention programs, 
including career ladder programs, into the same section of the 
PHSA which provides nurse education, practice, and quality 
grants.\16\ Section 5 provides an annual authorization of 
$43,590,000 each fiscal year 2020 through 2024 for nurse 
education, practice, quality, and retention grants.
---------------------------------------------------------------------------
    \16\42 U.S.C. 296p.
---------------------------------------------------------------------------

Section 6. Student loans

    Section 6 provides annual authorizations of $90,620,000 for 
the Nurse Corps student loan repayment and scholarship program 
and $29,640,000 for the nurse faculty loan repayment program. 
Authorizations would be for each fiscal year 2020 through 2024. 
This section also makes technical changes within the Nurse 
Corps program.

Section 7. National Advisory Council on Nurse Education and Practice

    Section 7 ensures clinical nurse specialists may be 
included on the National Advisory Council on Nurse Education 
and Practice and requires the National Advisory Council to 
issue a report on its activities every two years.

Section 8. Other provisions

    Section 8 repeals the requirement that the Secretary 
develop and issue public service announcements that advertise 
and promote the nursing profession and makes a technical change 
to reflect specific authorizations made for each program under 
Title VIII. This section also ensures that Nurse Corps members 
may serve in a wider variety of health care settings.

       XVI. Changes in Existing Law Made by the Bill, as Reported

  In compliance with clause 3(e) of rule XIII of the Rules of 
the House of Representatives, changes in existing law made by 
the bill, as reported, are shown as follows (existing law 
proposed to be omitted is enclosed in black brackets, new 
matter is printed in italic, and existing law in which no 
change is proposed is shown in roman):

                       PUBLIC HEALTH SERVICE ACT



           *       *       *       *       *       *       *
               TITLE VIII--NURSING WORKFORCE DEVELOPMENT

PART A--GENERAL PROVISIONS

           *       *       *       *       *       *       *


SEC. 802. APPLICATION.

  (a) In General.--To be eligible to receive a grant or 
contract under this title, an eligible entity shall prepare and 
submit to the Secretary an application that meets the 
requirements of this section, at such time, in such manner, and 
containing such information as the Secretary may require.
  (b) Plan.--An application submitted under this section shall 
contain the plan of the applicant for carrying out a project 
with amounts received under this title. Such plan shall be 
consistent with relevant Federal, State, or regional program 
plans.
  (c) Performance Outcome Standards.--An application submitted 
under this section shall contain a specification by the 
applicant entity of performance outcome standards that the 
project to be funded under the grant or contract will be 
measured against. Such standards [shall address relevant 
national nursing needs that the project will meet] shall 
address relevant national nursing needs that the project will 
address and how the project aligns with the national nursing 
service goals referred to in section 806(a). The recipient of a 
grant or contract under this section shall meet the standards 
set forth in the grant or contract application.
  (d) Linkages.--An application submitted under this section 
shall contain a description of the linkages with relevant 
educational and health care entities, including training 
programs for other health professionals as appropriate, that 
the project to be funded under the grant or contract will 
establish.

SEC. 803. USE OF FUNDS.

  (a) In General.--Amounts provided under a grant or contract 
awarded under this title may be used for training program 
development and support, faculty development, model 
demonstrations, trainee support including tuition, books, 
program fees and reasonable living expenses during the period 
of training, technical assistance, workforce analysis, and 
dissemination of information, as appropriate to meet recognized 
nursing objectives, in accordance with this title.
  (b) Maintenance of Effort.--With respect to activities for 
which a grant awarded under this title is to be expended, the 
entity shall agree to maintain expenditures of non-Federal 
amounts for such activities at a level that is not less than 
the level of such expenditures maintained by the entity for the 
fiscal year preceding the fiscal year for which the entity 
receives such a grant.
  (c) Supplement Not Supplant.--Funds awarded as a grant under 
this title for a project or activity shall be used to 
supplement, not supplant, the non-Federal funds that would 
otherwise be made available for such project or activity.

           *       *       *       *       *       *       *


SEC. 806. GENERALLY APPLICABLE PROVISIONS.

  (a) Awarding of Grants and Contracts.--The Secretary shall 
ensure that grants and contracts under this title are awarded 
on a competitive basis, as appropriate, to carry out innovative 
demonstration projects or provide for strategic workforce 
supplementation activities as needed to meet national nursing 
service goals and in accordance with this title. Contracts may 
be entered into under this title with public or private 
entities as determined necessary by the Secretary.
  (b) Information Requirements.--
          (1) In general.--Recipients of grants and contracts 
        under this title shall meet information requirements as 
        specified by the Secretary.
          [(2) Evaluations.--The Secretary shall establish 
        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 a demonstration that satisfactory 
        progress has been made by the program or project in 
        meeting the objectives of the program or project.]
          (2) Evaluations.--The Secretary shall establish 
        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 
                conducted by such program or project to meet 
                such performance outcome standards.
  (c) Training Programs.--Training programs conducted with 
amounts received under this title shall meet applicable 
accreditation and quality standards.
  (d) Duration of Assistance.--
          (1) In general.--Subject to paragraph (2), in the 
        case of an award to an entity of a grant, cooperative 
        agreement, or contract under this title, the period 
        during which payments are made to the entity under the 
        award may not exceed 5 years. The provision of payments 
        under the award shall be subject to annual approval by 
        the Secretary of the payments and subject to the 
        availability of appropriations for the fiscal year 
        involved to make the payments. This paragraph may not 
        be construed as limiting the number of awards under the 
        program involved that may be made to the entity.
          (2) Limitation.--In the case of an award to an entity 
        of a grant, cooperative agreement, or contract under 
        this title, paragraph (1) shall apply only to the 
        extent not inconsistent with any other provision of 
        this title that relates to the period during which 
        payments may be made under the award.
  (e) Peer Review Regarding Certain Programs.--
          (1) In general.--Each application for a grant under 
        this title, except advanced nurse traineeship grants 
        under section 811(a)(2), shall be submitted to a peer 
        review group for an evaluation of the merits of the 
        proposals made in the application. The Secretary may 
        not approve such an application unless a peer review 
        group has recommended the application for approval.
          (2) Composition.--Each peer review group under this 
        subsection shall be composed principally of individuals 
        who are not officers or employees of the Federal 
        Government, and have relevant expertise and experience 
        . In providing for the establishment of peer review 
        groups and procedures, the Secretary shall, except as 
        otherwise provided, ensure sex, racial, ethnic, and 
        geographic representation among the membership of such 
        groups.
          (3) Administration.--This subsection shall be carried 
        out by the Secretary acting through the Administrator 
        of the Health Resources and Services Administration.
  (f) Analytic Activities.--The Secretary shall ensure that--
          (1) cross-cutting workforce analytical activities are 
        carried out as part of the workforce information and 
        analysis activities under this title; and
          (2) discipline-specific workforce information is 
        developed and analytical activities are carried out as 
        part of--
                  (A) the advanced education nursing activities 
                under part B;
                  (B) the workforce diversity activities under 
                part C; and
                  (C) basic nursing education and practice 
                activities under part D.
  (g) State and Regional Priorities.--Activities under grants 
or contracts under this title shall, to the extent practicable, 
be consistent with related Federal, State, or regional nursing 
professions program plans and priorities.
  (h) Filing of Applications.--
          (1) In general.--Applications for grants or contracts 
        under this title may be submitted by health professions 
        schools, schools of nursing, academic health centers, 
        State or local governments, or other appropriate public 
        or private nonprofit entities as determined appropriate 
        by the Secretary in accordance with this title.
          (2) For-profit entities.--Notwithstanding paragraph 
        (1), a for-profit entity may be eligible for a grant or 
        contract under this title as determined appropriate by 
        the Secretary.
  (i) Annual Report on Nursing Workforce Programs.--Annually, 
the Secretary shall submit to 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 containing an assessment of the programs and activities 
of the Department of Health and Human Services related to 
enhancing the nursing workforce, including the extent to which 
programs and activities under this title meet identified goals 
and performance measures developed for the respective programs 
and activities.

           *       *       *       *       *       *       *


 PART B--NURSE PRACTITIONERS, NURSE MIDWIVES, NURSE ANESTHETISTS, AND 
                    OTHER ADVANCED EDUCATION NURSES

SEC. 811. ADVANCED EDUCATION NURSING GRANTS.

  (a) In General.--The Secretary may award grants to and enter 
into contracts with eligible entities to meet the costs of--
          (1) projects that support the enhancement of advanced 
        nursing education and practice; and
          (2) traineeships for individuals in advanced nursing 
        education programs.
  (b) Definition of Advanced Education Nurses.--For purposes of 
this section, the term ``advanced education nurses'' means 
individuals trained in advanced degree programs including 
individuals in combined [R.N./Master's] R.N./graduate degree 
programs, post-nursing master's certificate programs, or, in 
the case of nurse midwives, in certificate programs in 
existence on the date that is one day prior to the date of 
enactment of this section, to serve as nurse practitioners, 
clinical nurse specialists, nurse midwives, nurse anesthetists, 
nurse educators, nurse administrators, clinical nurse leaders, 
or public health nurses, or in other nurse specialties 
determined by the Secretary to require advanced education.
  (c) Authorized Nurse Practitioner.--Nurse practitioner 
programs eligible for support under this section are 
educational programs for registered nurses (irrespective of the 
type of school of nursing in which the nurses received their 
training) that--
          (1) meet guidelines prescribed by the Secretary; and
          (2) have as their objective the education of nurses 
        who will upon completion of their studies in such 
        programs, be qualified to effectively provide primary 
        health care, including primary health care in homes and 
        in ambulatory care facilities, long-term care 
        facilities, acute care, and other health care settings.
  (d) Authorized Nurse-midwifery Programs.--Midwifery programs 
that are eligible for support under this section are 
educational programs that--
          (1) have as their objective the education of 
        midwives; and
          (2) are accredited by the American College of Nurse-
        Midwives Accreditation Commission for Midwifery 
        Education.
  (e) Authorized Nurse Anesthesia Programs.--Nurse anesthesia 
programs eligible for support under this section are education 
programs that--
          (1) provide registered nurses with full-time 
        anesthetist education; and
          (2) are accredited by the Council on Accreditation of 
        Nurse Anesthesia Educational Programs.
  (f) Authorized Clinical Nurse Specialist Programs.--Clinical 
nurse specialist programs eligible for support under this 
section are education programs that--
          (1) provide registered nurses with full-time clinical 
        nurse specialist education; and
          (2) have as their objective the education of clinical 
        nurse specialists who will upon completion of such a 
        program be qualified to effectively provide care 
        through the wellness and illness continuum to 
        inpatients and outpatients experiencing acute and 
        chronic illness.
  [(f)] (g) Other Authorized Educational Programs.--The 
Secretary shall prescribe guidelines as appropriate for other 
advanced nurse education programs eligible for support under 
this section.
  [(g)] (h) Traineeships.--
          (1) In general.--The Secretary may not award a grant 
        to an applicant under subsection (a) unless the 
        applicant involved agrees that traineeships provided 
        with the grant will only pay all or part of the costs 
        of--
                  (A) the tuition, books, and fees of the 
                program of advanced nurse education with 
                respect to which the traineeship is provided; 
                and
                  (B) the reasonable living expenses of the 
                individual during the period for which the 
                traineeship is provided.
          (2) Special consideration.--In making awards of 
        grants and contracts under subsection (a)(2), the 
        Secretary shall give special consideration to an 
        eligible entity that agrees to expend the award to 
        train advanced education nurses who will practice in 
        health professional shortage areas designated under 
        section 332.
  (i) Authorization of Appropriations.--There are authorized to 
be appropriated to carry out this section $77,585,000 for each 
of fiscal years 2020 through 2024.

             PART C--INCREASING NURSING WORKFORCE DIVERSITY

SEC. 821. WORKFORCE DIVERSITY GRANTS.

  (a) In General.--
          (1) Authority.--The Secretary may award grants to and 
        enter into contracts with eligible entities to meet the 
        costs of special projects to increase nursing education 
        opportunities for individuals who are from 
        disadvantaged backgrounds (including racial and ethnic 
        minorities underrepresented among registered nurses) by 
        providing student scholarships or stipends, stipends 
        for diploma or associate degree nurses to enter a 
        bridge or degree completion program, student 
        scholarships or stipends for accelerated nursing degree 
        programs, pre-entry preparation, advanced education 
        preparation, and retention activities.
  (b) Guidance.--In carrying out subsection (a), the Secretary 
shall take into consideration the recommendations of the 
National Advisory Council on Nurse Education and Practice and 
consult with nursing associations including the National 
Coalition of Ethnic Minority Nurse Associations, American 
Nurses Association, the National League for Nursing, the 
American Association of Colleges of Nursing, the National Black 
Nurses Association, the National Association of Hispanic 
Nurses, the Association of Asian American and Pacific Islander 
Nurses, the Native American Indian and Alaskan Nurses 
Association, and the National Council of State Boards of 
Nursing, and other organizations determined appropriate by the 
Secretary.
  (c) Required Information and Conditions for Award 
Recipients.--
          (1) In general.--Recipients of awards under this 
        section may be required, where requested, to report to 
        the Secretary concerning the annual admission, 
        retention, and graduation rates for individuals from 
        disadvantaged backgrounds and ethnic and racial 
        minorities in the school or schools involved in the 
        projects.
          (2) Falling rates.--If any of the rates reported 
        under paragraph (1) fall below the average of the two 
        previous years, the grant or contract recipient shall 
        provide the Secretary with plans for immediately 
        improving such rates.
          (3) Ineligibility.--A recipient described in 
        paragraph (2) shall be ineligible for continued funding 
        under this section if the plan of the recipient fails 
        to improve the rates within the 1-year period beginning 
        on the date such plan is implemented.
  (d) Authorization of Appropriations.--There are authorized to 
be appropriated to carry out this section $18,037,000 for each 
of fiscal years 2020 through 2024.

 PART D--STRENGTHENING CAPACITY FOR BASIC NURSE EDUCATION AND PRACTICE

SEC. 831. NURSE EDUCATION, PRACTICE, [AND QUALITY]  QUALITY, AND 
                    RETENTION GRANTS.

  (a) Education Priority Areas.--The Secretary may award grants 
to or enter into contracts with eligible entities for--
          (1) expanding the enrollment in baccalaureate nursing 
        programs; or
          (2) providing education in new technologies, 
        including distance learning methodologies.
  (b) Practice Priority Areas.--The Secretary may award grants 
to or enter into contracts with eligible entities for--
          (1) establishing or expanding nursing practice 
        arrangements in noninstitutional settings to 
        demonstrate methods to improve access to primary health 
        care in medically underserved communities;
          [(2) providing care for underserved populations and 
        other high-risk groups such as the elderly, individuals 
        with HIV/AIDS, substance abusers, the homeless, and 
        victims of domestic violence;]
          (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 
        violence;
          (3) providing coordinated care, and other skills 
        needed to practice in existing and emerging organized 
        health care systems; or
          (4) developing cultural competencies among nurses.
  (c) Retention Priority Areas.--The Secretary may award grants 
to and enter into contracts with eligible entities to enhance 
the nursing workforce by initiating and maintaining nurse 
retention programs pursuant to paragraph (1) or (2).
          [(1) Grants for career ladder programs.--The 
        Secretary may award grants to and enter into contracts 
        with eligible entities for programs--
                  [(A) to promote career advancement for 
                nursing personnel in a variety of training 
                settings, cross training or specialty training 
                among diverse population groups, and the 
                advancement of individuals including to become 
                professional nurses, advanced education nurses, 
                licensed practical nurses, certified nurse 
                assistants, and home health aides; and
                  [(B) to assist individuals in obtaining 
                education and training required to enter the 
                nursing profession and advance within such 
                profession, such as by providing career 
                counseling and mentoring.]
          (1) Grants for career ladder programs.--The Secretary 
        may award grants to and enter into contracts with 
        eligible entities for programs--
                  (A) to promote career advancement for--
                          (i) nursing personnel in a variety of 
                        training settings, cross training or 
                        specialty training among diverse 
                        population groups, and the advancement 
                        of individuals, including 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 degree or associate degree 
                        nurses, to become baccalaureate-
                        prepared registered nurses or nurses 
                        with graduate nursing education;
                  (B) to assist individuals in obtaining 
                education and training required to enter the 
                nursing profession and advance within such 
                profession, 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 accredited schools of nursing to encourage 
                mentoring and development of specialties.
          (2) Enhancing patient care delivery systems.--
                  (A) Grants.--The Secretary may award grants 
                to eligible entities to improve the retention 
                of nurses and enhance patient care that is 
                directly related to nursing activities by 
                enhancing collaboration and communication among 
                nurses and other health care professionals, and 
                by promoting nurse involvement in the 
                organizational and clinical decisionmaking 
                processes of a health care facility.
                  (B) Preference.--In making awards of grants 
                under this paragraph, the Secretary shall give 
                a preference to applicants that have not 
                previously received an award under this 
                paragraph.
                  (C) Continuation of an award.--The Secretary 
                shall make continuation of any award under this 
                paragraph beyond the second year of such award 
                contingent on the recipient of such award 
                having demonstrated to the Secretary measurable 
                and substantive improvement in nurse retention 
                or patient care.
  (d) Other Priority Areas.--The Secretary may award grants to 
or enter into contracts with eligible entities to address other 
areas that are of high priority to nurse education, practice, 
and retention, as determined by the Secretary.
  [(e) Preference.--For purposes of any amount of funds 
appropriated to carry out this section for fiscal year 2003, 
2004, or 2005 that is in excess of the amount of funds 
appropriated to carry out this section for fiscal year 2002, 
the Secretary shall give preference to awarding grants or 
entering into contracts under subsections (a)(2) and (c).]
  [(f)] (e) Report.-- [The Secretary shall submit to the 
Congress before the end of each fiscal year a] As part of the 
report on nursing workforce programs described in section 
806(i), the Secretary shall report on the grants awarded and 
the contracts entered into under this section. Each such report 
shall identify the overall number of such grants and contracts 
and provide an explanation of why each such grant or contract 
will meet the priority need of the nursing workforce.
  [(g) Eligible Entity.--For purposes of this section, the term 
``eligible entity'' includes a school of nursing, as defined in 
section 801(2),, a health care facility, or a partnership of 
such a school and facility.]
  (f) Definitions.--For purposes of this section:
          (1) Eligible entity.--The term ``eligible entity'' 
        includes an accredited school of nursing, a health care 
        facility, a partnership of such a school and facility, 
        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 services to 
        underserved or vulnerable populations that is 
        associated with a school, college, university or 
        department of nursing, federally qualified health 
        center, or independent nonprofit health or social 
        services agency.
  [(h)] (g) Authorization of Appropriations.--There are 
authorized to be appropriated to carry out this section [such 
sums as may be necessary for each of fiscal years 2010 through 
2014] $43,590,000 for each of fiscal years 2020 through 2024.

[SEC. 831A. NURSE RETENTION GRANTS.

  [(a) Retention Priority Areas.--The Secretary may award 
grants to, and enter into contracts with, eligible entities to 
enhance the nursing workforce by initiating and maintaining 
nurse retention programs pursuant to subsection (b) or (c).
  [(b) Grants for Career Ladder Program.--The Secretary may 
award grants to, and enter into contracts with, eligible 
entities for programs--
          [(1) to promote career advancement for individuals 
        including licensed practical nurses, licensed 
        vocational nurses, certified nurse assistants, home 
        health aides, diploma degree or associate degree 
        nurses, to become baccalaureate prepared registered 
        nurses or advanced education nurses in order to meet 
        the needs of the registered nurse workforce;
          [(2) developing and implementing internships and 
        residency programs in collaboration with an accredited 
        school of nursing, as defined by section 801(2), to 
        encourage mentoring and the development of specialties; 
        or
          [(3) to assist individuals in obtaining education and 
        training required to enter the nursing profession and 
        advance within such profession.
  [(c) Enhancing Patient Care Delivery Systems.--
          [(1) Grants.--The Secretary may award grants to 
        eligible entities to improve the retention of nurses 
        and enhance patient care that is directly related to 
        nursing activities by enhancing collaboration and 
        communication among nurses and other health care 
        professionals, and by promoting nurse involvement in 
        the organizational and clinical decision-making 
        processes of a health care facility.
          [(2) Priority.--In making awards of grants under this 
        subsection, the Secretary shall give preference to 
        applicants that have not previously received an award 
        under this subsection (or section 831(c) as such 
        section existed on the day before the date of enactment 
        of this section).
          [(3) Continuation of an award.--The Secretary shall 
        make continuation of any award under this subsection 
        beyond the second year of such award contingent on the 
        recipient of such award having demonstrated to the 
        Secretary measurable and substantive improvement in 
        nurse retention or patient care.
  [(d) Other Priority Areas.--The Secretary may award grants 
to, or enter into contracts with, eligible entities to address 
other areas that are of high priority to nurse retention, as 
determined by the Secretary.
  [(e) Report.--The Secretary shall submit to the Congress 
before the end of each fiscal year a report on the grants 
awarded and the contracts entered into under this section. Each 
such report shall identify the overall number of such grants 
and contracts and provide an explanation of why each such grant 
or contract will meet the priority need of the nursing 
workforce.
  [(f) Eligible Entity.--For purposes of this section, the term 
``eligible entity'' includes an accredited school of nursing, 
as defined by section 801(2), a health care facility, or a 
partnership of such a school and facility.
  [(g) Authorization of Appropriations.--There are authorized 
to be appropriated to carry out this section such sums as may 
be necessary for each of fiscal years 2010 through 2012.]

PART E--STUDENT LOANS

           *       *       *       *       *       *       *


                loan repayment and scholarship programs

  Sec. 846. (a) In General.--In the case of any individual--
          (1) who has received a baccalaureate or associate 
        degree in nursing (or an equivalent degree), a diploma 
        in nursing, or a graduate degree in nursing;
          (2) who obtained (A) one or more loans from a loan 
        fund established under subpart II, or (B) any other 
        educational loan for nurse training costs; and
          (3) who enters into an agreement with the Secretary 
        to serve as nurse for a period of not less than two 
        years at a health care facility with a critical 
        shortage of nurses, or in a accredited school of 
        nursing, as defined by section 801(2), as nurse 
        faculty;
the Secretary shall make payments in accordance with subsection 
(b), for and on behalf of that individual, on the principal of 
and interest on any loan of that individual described in 
paragraph (2) of this subsection which is outstanding on the 
date the individual begins the service specified in the 
agreement described in paragraph (3) of this subsection. [After 
fiscal year 2007, the Secretary may not, pursuant to any 
agreement entered into under this subsection, assign a nurse to 
any private entity unless that entity is nonprofit.]
  (b) Manner of Payments.--The payments described in subsection 
(a) shall be made by the Secretary as follows:
          (1) Upon completion by the individual for whom the 
        payments are to be made of the first year of the 
        service specified in the agreement entered into with 
        the Secretary under subsection (a), the Secretary shall 
        pay 30 percent of the principal of, and the interest on 
        each loan of such individual described in subsection 
        (a)(2) which is outstanding on the date [he began such 
        practice] the individual began such practice.
          (2) Upon completion by that individual of the second 
        year of such service, the Secretary shall pay another 
        30 percent of the principal of, and the interest on 
        each such loan.
          (3) Upon completion by that individual of a third 
        year of such service, the Secretary shall pay another 
        25 percent of the principal of, and the interest on 
        each such loan.
  (c) Payment by Due Date.--Notwithstanding the requirement of 
completion of practice specified in subsection (b), the 
Secretary shall, on or before the due date thereof, pay any 
loan or loan installment which may fall due within the period 
of service for which the borrower may receive payments under 
this subsection, upon the declaration of such borrower, at such 
times and in such manner as the Secretary may prescribe (and 
supported by such other evidence as the Secretary may 
reasonably require), that the borrower is then serving as 
described by subsection (a)(3), and that the borrower will 
continue to so serve for the period required (in the absence of 
this subsection) to entitle the borrower to have made the 
payments provided by this subsection for such period; except 
that not more than 85 percent of the principal of any such loan 
shall be paid pursuant to this subsection.
  (d) Scholarship Program.--
          (1) In general.--The Secretary shall [(for fiscal 
        years 2003 and 2004) and may (for fiscal years 
        thereafter)] carry out a program of entering into 
        contracts with eligible individuals under which such 
        individuals agree to serve as nurses for a period of 
        not less than 2 years at a health care facility with a 
        critical shortage of nurses, in consideration of the 
        Federal Government agreeing to provide to the 
        individuals scholarships for attendance at schools of 
        nursing.
          (2) Eligible individuals.--In this subsection, the 
        term ``eligible individual'' means an individual who is 
        enrolled or accepted for enrollment as a full-time or 
        part-time student in a school of nursing.
          (3) Service requirement.--
                  (A) In general.--The Secretary may not enter 
                into a contract with an eligible individual 
                under this subsection unless the individual 
                agrees to serve as a nurse at a health care 
                facility with a critical shortage of nurses for 
                a period of full-time service of not less than 
                2 years, or for a period of part-time service 
                in accordance with subparagraph (B).
                  (B) Part-time service.--An individual may 
                complete the period of service described in 
                subparagraph (A) on a part-time basis if the 
                individual has a written agreement that--
                          (i) is entered into by the facility 
                        and the individual and is approved by 
                        the Secretary; and
                          (ii) provides that the period of 
                        obligated service will be extended so 
                        that the aggregate amount of service 
                        performed will equal the amount of 
                        service that would be performed through 
                        a period of full-time service of not 
                        less than 2 years.
          (4) Applicability of certain provisions.--The 
        provisions of subpart III of part D of title III shall, 
        except as inconsistent with this section, apply to the 
        program established in paragraph (1) in the same manner 
        and to the same extent as such provisions apply to the 
        National Health Service Corps Scholarship Program 
        established in such subpart.
  (e) Preferences Regarding Participants.--In entering into 
agreements under subsection (a) or (d), the Secretary shall 
give preference to qualified applicants with the greatest 
financial need.
  (f) Breach of Agreement.--The Secretary may make payments 
under subsection (a) on behalf of an individual only if the 
agreement under such subsection provides that section 860(c) is 
applicable to the individual.
  (g) Breach of Agreement.--
          (1) In general.--In the case of any program under 
        this section under which an individual makes an 
        agreement to provide health services for a period of 
        time in accordance with such program in consideration 
        of receiving an award of Federal funds regarding 
        education as a nurse (including an award for the 
        repayment of loans), the following applies if the 
        agreement provides that this subsection is applicable:
                  (A) In the case of a program under this 
                section that makes an award of Federal funds 
                for attending an accredited program of nursing 
                (in this section referred to as a ``nursing 
                program''), the individual is liable to the 
                Federal Government for the amount of such award 
                (including amounts provided for expenses 
                related to such attendance), and for interest 
                on such amount at the maximum legal prevailing 
                rate, if the individual--
                          (i) fails to maintain an acceptable 
                        level of academic standing in the 
                        nursing program (as indicated by the 
                        program in accordance with requirements 
                        established by the Secretary);
                          (ii) is dismissed from the nursing 
                        program for disciplinary reasons; or
                          (iii) voluntarily terminates the 
                        nursing program.
                  (B) The individual is liable to the Federal 
                Government for the amount of such award 
                (including amounts provided for expenses 
                related to such attendance), and for interest 
                on such amount at the maximum legal prevailing 
                rate, if the individual fails to provide health 
                services in accordance with the program under 
                this section for the period of time applicable 
                under the program.
          (2) Waiver or suspension of liability.--In the case 
        of an individual or health facility making an agreement 
        for purposes of paragraph (1), the Secretary shall 
        provide for the waiver or suspension of liability under 
        such subsection if compliance by the individual or the 
        health facility, as the case may be, with the 
        agreements involved is impossible, or would involve 
        extreme hardship to the individual or facility, and if 
        enforcement of the agreements with respect to the 
        individual or facility would be unconscionable.
          (3) Date certain for recovery.--Subject to paragraph 
        (2), any amount that the Federal Government is entitled 
        to recover under paragraph (1) shall be paid to the 
        United States not later than the expiration of the 3-
        year period beginning on the date the United States 
        becomes so entitled.
          (4) Availability.--Amounts recovered under paragraph 
        (1) with respect to a program under this section shall 
        be available for the purposes of such program, and 
        shall remain available for such purposes until 
        expended.
  (h) Reports.-- [Not later than 18 months after the date of 
enactment of the Nurse Reinvestment Act, and annually 
thereafter, the Secretary shall prepare and submit to the 
Congress a report describing the programs carried out under 
this section, including statements regarding] The annual report 
on nursing workforce programs, as required by section 806(i), 
shall include information regarding the programs carried out 
under this section, including--
          (1) the number of enrollees, scholarships, loan 
        repayments, and grant recipients;
          (2) the number of graduates;
          (3) the amount of scholarship payments and loan 
        repayments made;
          (4) which educational institution the recipients 
        attended;
          (5) the number and placement location of the 
        scholarship and loan repayment recipients at health 
        care facilities with a critical shortage of nurses;
          (6) the default rate and actions required;
          (7) the amount of outstanding default funds of both 
        the scholarship and loan repayment programs;
          (8) to the extent that it can be determined, the 
        reason for the default;
          (9) the demographics of the individuals participating 
        in the scholarship and loan repayment programs;
          (10) justification for the allocation of funds 
        between the scholarship and loan repayment programs; 
        and
          (11) an evaluation of the overall costs and benefits 
        of the programs.
  (i) Funding.--
          (1) Authorization of appropriations.--For the purpose 
        of payments under agreements entered into under 
        subsection (a) or (d), there are authorized to be 
        appropriated [such sums as may be necessary for each of 
        fiscal years 2003 through 2007] $90,620,000 for each of 
        fiscal years 2020 through 2024.
          (2) Allocations.--Of the amounts appropriated under 
        paragraph (1), the Secretary may, as determined 
        appropriate by the Secretary, allocate amounts between 
        the program under subsection (a) and the program under 
        subsection (d).

                       nurse faculty loan program

  Sec. 846A. (a) School of Nursing Student Loan Fund.--The 
Secretary, acting through the Administrator of the Health 
Resources and Services Administration, may enter into an 
agreement with any accredited school of nursing for the 
establishment and operation of a student loan fund in 
accordance with this section, to increase the number of 
qualified nursing faculty.
  (b) Agreements.--Each agreement entered into under subsection 
(a) shall--
          (1) provide for the establishment of a student loan 
        fund by the school involved;
          (2) provide for deposit in the fund of--
                  (A) the Federal capital contributions to the 
                fund;
                  (B) an amount equal to not less than one-
                ninth of such Federal capital contributions, 
                contributed by such school;
                  (C) collections of principal and interest on 
                loans made from the fund; and
                  (D) any other earnings of the fund;
          (3) provide that the fund will be used only for loans 
        to students of the school in accordance with subsection 
        (c) and for costs of collection of such loans and 
        interest thereon;
          (4) provide that loans may be made from such fund 
        only to students pursuing a full-time course of study 
        or, at the discretion of the Secretary, a part-time 
        course of study in an advanced degree program described 
        in section 811(b); and
          (5) contain such other provisions as are necessary to 
        protect the financial interests of the United States.
  (c) Loan Provisions.--Loans from any student loan fund 
established by a school pursuant to an agreement under 
subsection (a) shall be made to an individual on such terms and 
conditions as the school may determine, except that--
          (1) such terms and conditions are subject to any 
        conditions, limitations, and requirements prescribed by 
        the Secretary;
          (2) in the case of any individual, the total of the 
        loans for any academic year made by schools of nursing 
        from loan funds established pursuant to agreements 
        under subsection (a) may not exceed $35,500, during 
        fiscal years 2010 and 2011 fiscal years (after fiscal 
        year 2011, such amounts shall be adjusted to provide 
        for a cost-of-attendance increase for the yearly loan 
        rate and the aggregate loan;
          (3) an amount up to 85 percent of any such loan (plus 
        interest thereon) shall be canceled by the school as 
        follows:
                  (A) upon completion by the individual of each 
                of the first, second, and third year of full-
                time employment, required by the loan agreement 
                entered into under this subsection, as a 
                faculty member in an accredited a school of 
                nursing, the school shall cancel 20 percent of 
                the principle of, and the interest on, the 
                amount of such loan unpaid on the first day of 
                such employment; and
                  (B) upon completion by the individual of the 
                fourth year of full-time employment, required 
                by the loan agreement entered into under this 
                subsection, as a faculty member in a school of 
                nursing, the school shall cancel 25 percent of 
                the principle of, and the interest on, the 
                amount of such loan unpaid on the first day of 
                such employment;
          (4) such a loan may be used to pay the cost of 
        tuition, fees, books, laboratory expenses, and other 
        reasonable education expenses;
          (5) such a loan shall be repayable in equal or 
        graduated periodic installments (with the right of the 
        borrower to accelerate repayment) over the 10-year 
        period that begins 9 months after the individual ceases 
        to pursue a course of study at a school of nursing; and
          (6) such a loan shall--
                  (A) beginning on the date that is 3 months 
                after the individual ceases to pursue a course 
                of study at a school of nursing, bear interest 
                on the unpaid balance of the loan at the rate 
                of 3 percent per annum; or
                  (B) subject to subsection (e), if the school 
                of nursing determines that the individual will 
                not complete such course of study or serve as a 
                faculty member as required under the loan 
                agreement under this subsection, bear interest 
                on the unpaid balance of the loan at the 
                prevailing market rate.
  (d) Payment of Proportionate Share.--Where all or any part of 
a loan, or interest, is canceled under this section, the 
Secretary shall pay to the school an amount equal to the 
school's proportionate share of the canceled portion, as 
determined by the Secretary.
  (e) Review by Secretary.--At the request of the individual 
involved, the Secretary may review any determination by an 
accredited school of nursing under subsection (c)(6)(B).
  (f) Authorization of Appropriations.--There are authorized to 
be appropriated to carry out this section [such sums as may be 
necessary for each of fiscal years 2010 through 2014] 
$29,640,000 for each of fiscal years 2020 through 2024 .

           *       *       *       *       *       *       *


   PART F--NATIONAL ADVISORY COUNCIL ON NURSE EDUCATION AND PRACTICE

SEC. 851. NATIONAL ADVISORY COUNCIL ON NURSE EDUCATION AND PRACTICE.

  (a) Establishment.--The Secretary shall establish an advisory 
council to be known as the National Advisory Council on Nurse 
Education and Practice (in this section referred to as the 
``Advisory Council'').
  (b) Composition.--
          (1) In general.--The Advisory Council shall be 
        composed of--
                  (A) not less than 21, nor more than 23 
                individuals, who are not officers or employees 
                of the Federal Government, appointed by the 
                Secretary without regard to the Federal civil 
                service laws, of which--
                          (i) 2 shall be selected from full-
                        time students enrolled in schools of 
                        nursing;
                          (ii) 2 shall be selected from the 
                        general public;
                          (iii) 2 shall be selected from 
                        practicing professional nurses; and
                          (iv) 9 shall be selected from among 
                        the leading authorities in the various 
                        fields of nursing, higher, secondary 
                        education, and associate degree schools 
                        of nursing, and from representatives of 
                        advanced education nursing groups (such 
                        as nurse practitioners, nurse midwives, 
                        [and nurse anesthetists] nurse 
                        anesthetists, and clinical nurse 
                        specialists ), hospitals, and other 
                        institutions and organizations which 
                        provide nursing services; and
                  (B) the Secretary (or the delegate of the 
                Secretary (who shall be an ex officio member 
                and shall serve as the Chairperson)).
          (2) Appointment.--Not later than 90 days after the 
        date of enactment of this Act, the Secretary shall 
        appoint the members of the Advisory Council and each 
        such member shall serve a 4 year term. In making such 
        appointments, the Secretary shall ensure a fair balance 
        between the nursing professions, a broad geographic 
        representation of members and a balance between urban 
        and rural members. Members shall be appointed based on 
        their competence, interest, and knowledge of the 
        mission of the profession involved. A majority of the 
        members shall be nurses.
          (3) Minority representation.--In appointing the 
        members of the Advisory Council under paragraph (1), 
        the Secretary shall ensure the adequate representation 
        of minorities.
  (c) Vacancies.--
          (1) In general.--A vacancy on the Advisory Council 
        shall be filled in the manner in which the original 
        appointment was made and shall be subject to any 
        conditions which applied with respect to the original 
        appointment.
          (2) Filling unexpired term.--An individual chosen to 
        fill a vacancy shall be appointed for the unexpired 
        term of the member replaced.
  (d) Duties.--The Advisory Council shall--
          (1) provide advice and recommendations to the 
        Secretary and Congress concerning policy matters 
        arising in the administration of this title, including 
        the range of issues relating to the nurse workforce, 
        education, and practice improvement;
          (2) provide advice to the Secretary and Congress in 
        the preparation of general regulations and with respect 
        to policy matters arising in the administration of this 
        title, including the range of issues relating to nurse 
        supply, education and practice improvement; and
          [(3) not later than 3 years after the date of 
        enactment of this section, and annually thereafter, 
        prepare and submit to the Secretary, the Committee on 
        Labor and Human Resources of the Senate, and the 
        Committee on 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.]
          (3) not later than 2 years after the date of 
        enactment of the Title VIII Nursing Workforce 
        Reauthorization 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.
  (e) Meetings and Documents.--
          (1) Meetings.--The Advisory Council shall meet not 
        less than 2 times each year. Such meetings shall be 
        held jointly with other related entities established 
        under this title where appropriate.
          (2) Documents.--Not later than 14 days prior to the 
        convening of a meeting under paragraph (1), the 
        Advisory Council shall prepare and make available an 
        agenda of the matters to be considered by the Advisory 
        Council at such meeting. At any such meeting, the 
        Advisory Council shall distribute materials with 
        respect to the issues to be addressed at the meeting. 
        Not later than 30 days after the adjourning of such a 
        meeting, the Advisory Council shall prepare and make 
        available a summary of the meeting and any actions 
        taken by the Council based upon the meeting.
  (f) Compensation and Expenses.--
          (1) Compensation.--Each member of the Advisory 
        Council shall be compensated at a rate equal to the 
        daily equivalent of the annual rate of basic pay 
        prescribed for level IV of the Executive Schedule under 
        section 5315 of title 5, United States Code, for each 
        day (including travel time) during which such member is 
        engaged in the performance of the duties of the 
        Council. All members of the Council who are officers or 
        employees of the United States shall serve without 
        compensation in addition to that received for their 
        services as officers or employees of the United States.
          (2) Expenses.--The members of the Advisory Council 
        shall be allowed travel expenses, including per diem in 
        lieu of subsistence, at rates authorized for employees 
        of agencies under subchapter I of chapter 57 of title 
        5, United States Code, while away from their homes or 
        regular places of business in the performance of 
        services for the Council.
  (g) Funding.--Amounts appropriated [under this title] for 
carrying out parts B, C, and D of this title may be utilized by 
the Secretary to support the nurse education and practice 
activities of the Council.
  (h) FACA.--The Federal Advisory Committee Act shall apply to 
the Advisory Committee under this section only to the extent 
that the provisions of such Act do not conflict with the 
requirements of this section.

                 [PART G--PUBLIC SERVICE ANNOUNCEMENTS

[SEC. 861. PUBLIC SERVICE ANNOUNCEMENTS.

  [(a) In General.--The Secretary shall develop and issue 
public service announcements that advertise and promote the 
nursing profession, highlight the advantages and rewards of 
nursing, and encourage individuals to enter the nursing 
profession.
  [(b) Method.--The public service announcements described in 
subsection (a) shall be broadcast through appropriate media 
outlets, including television or radio, in a manner intended to 
reach as wide and diverse an audience as possible.
  [(c) Authorization of Appropriations.--There are authorized 
to be appropriated to carry out this section such sums as may 
be necessary for each of fiscal years 2003 through 2007.

[SEC. 862. STATE AND LOCAL PUBLIC SERVICE ANNOUNCEMENTS.

  [(a) In General.--The Secretary may award grants to eligible 
entities to support State and local advertising campaigns 
through appropriate media outlets to promote the nursing 
profession, highlight the advantages and rewards of nursing, 
and encourage individuals from disadvantaged backgrounds to 
enter the nursing profession.
  [(b) Use of Funds.--An eligible entity that receives a grant 
under subsection (a) shall use funds received through such 
grant to acquire local television and radio time, place 
advertisements in local newspapers, or post information on 
billboards or on the Internet in a manner intended to reach as 
wide and diverse an audience as possible, in order to--
          [(1) advertise and promote the nursing profession;
          [(2) promote nursing education programs;
          [(3) inform the public of financial assistance 
        regarding such education programs;
          [(4) highlight individuals in the community who are 
        practicing nursing in order to recruit new nurses; or
          [(5) provide any other information to recruit 
        individuals for the nursing profession.
  [(c) Limitation.--An eligible entity that receives a grant 
under subsection (a) shall not use funds received through such 
grant to advertise particular employment opportunities.
  [(d) Authorization of Appropriations.--There are authorized 
to be appropriated to carry out this section such sums as may 
be necessary for each of fiscal years 2003 through 2007.]

           *       *       *       *       *       *       *


                            [PART I--FUNDING

[SEC. 871. AUTHORIZATION OF APPROPRIATIONS.

  [For the purpose of carrying out parts B, C, and D (subject 
to section 851(g)), there are authorized to be appropriated 
$338,000,000 for fiscal year 2010, and such sums as may be 
necessary for each of the fiscal years 2011 through 2016.]

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