Title VIII Nursing Workforce Reauthorization Act of 2019

II Calendar No. 285 116TH CONGRESS 1ST SESSION S. 1399 To amend title VIII of the Public Health Services Act to revise and extend nursing workforce development programs. IN THE SENATE OF THE UNITED STATES MAY 9, 2019 Mr. MERKLEY (for himself, Mr. BURR, Ms. BALDWIN, Mrs. BLACKBURN, Mr. JONES, and Ms. COLLINS) introduced the following bill; which was read twice and referred to the Committee on Health, Education, Labor, and Pensions NOVEMBER 5, 2019 Reported by Mr. ALEXANDER, with an amendment [Strike out all after the enacting clause and insert the part printed in italic] A BILL To amend title VIII of the Public Health Services Act to revise and extend nursing workforce development programs. Be it enacted by the Senate and House of Representa- 1 tives of the United States of America in Congress assembled, 2 SECTION 1. SHORT TITLE. 3 This Act may be cited as the ‘‘Title VIII Nursing 4 Workforce Reauthorization Act of 2019’’. 5 VerDate Sep 11 2014 21:50 Nov 05, 2019 Jkt 099200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6401 E:\BILLS\S1399.RS S1399 kjohnson on DSK79L0C42 with BILLS 2 •S 1399 RS SEC. 2. NURSING WORKFORCE DEVELOPMENT. 1 (a) IN GENERAL.—Title VIII of the Public Health 2 Service Act (42 U.S.C. 296 et seq.) is amended— 3 (1) in section 801 (42 U.S.C. 296), by adding 4 at the end the following: 5 ‘‘(18) NURSE MANAGED HEALTH CLINIC.—The 6 term ‘nurse managed health clinic’ means a nurse- 7 practice arrangement, managed by advanced practice 8 nurses, that provides primary care or wellness serv- 9 ices to underserved or vulnerable populations and 10 that is associated with a school, college, university or 11 department of nursing, federally qualified health 12 center, or independent nonprofit health or social 13 services agency.’’; 14 (2) in section 802(c) (42 U.S.C. 296a(c)), by 15 inserting ‘‘, and how such project aligns with the 16 goals in section 806(a)’’ before the period in the sec- 17 ond sentence; 18 (3) in section 803(b) (42 U.S.C. 296b(b)), by 19 adding at the end the following: ‘‘Such Federal 20 funds are intended to supplement, not supplant, ex- 21 isting non-Federal expenditures for such activities.’’; 22 (4) in section 806 (42 U.S.C. 296e)— 23 (A) in subsection (a), by striking ‘‘as need- 24 ed to’’ and all that follows and inserting the fol- 25 VerDate Sep 11 2014 21:50 Nov 05, 2019 Jkt 099200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6401 E:\BILLS\S1399.RS S1399 kjohnson on DSK79L0C42 with BILLS 3 •S 1399 RS lowing: ‘‘as needed to address national nursing 1 needs, including— 2 ‘‘(1) addressing challenges, including through 3 supporting training and education of nursing stu- 4 dents, related to the distribution of the nursing 5 workforce and existing or projected nursing work- 6 force shortages in geographic areas that have been 7 identified as having, or that are projected to have, 8 a nursing shortage; 9 ‘‘(2) increasing access to and the quality of 10 health care services, including by supporting the 11 training of professional registered nurses, advanced 12 practice registered nurses, and advanced education 13 nurses within community based settings and in a va- 14 riety of health delivery system settings; or 15 ‘‘(3) addressing the strategic goals and prior- 16 ities identified by the Secretary and that are in ac- 17 cordance with this title. 18 Contracts may be entered into under this title with public 19 or private entities as determined necessary by the Sec- 20 retary.’’; 21 (B) in subsection (b)(2), by striking ‘‘a 22 demonstration’’ and all that follows and insert- 23 ing the following: ‘‘the reporting of data and in- 24 formation demonstrating that satisfactory 25 VerDate Sep 11 2014 21:50 Nov 05, 2019 Jkt 099200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6401 E:\BILLS\S1399.RS S1399 kjohnson on DSK79L0C42 with BILLS 4 •S 1399 RS progress has been made by the program or 1 project in meeting the performance outcome 2 standards (as described in section 802) of such 3 program or project.’’; 4 (C) in subsection (e)(2), by inserting ‘‘, 5 and have relevant expertise and experience’’ be- 6 fore the period at the end of the first sentence; 7 and 8 (D) by adding at the end the following: 9 ‘‘(i) BIENNIAL REPORT ON NURSING WORKFORCE 10 PROGRAM IMPROVEMENTS.—Not later than September 11 30, 2020, and biennially thereafter, the Secretary shall 12 submit to the Committee on Health, Education, Labor, 13 and Pensions of the Senate and the Committee on Energy 14 and Commerce of the House of Representatives, a report 15 that contains an assessment of the programs and activities 16 of the Department of Health and Human Services related 17 to enhancing the nursing workforce, including the extent 18 to which programs and activities under this title meet the 19 identified goals and performance measures developed for 20 the respective programs and activities, and the extent to 21 which the Department coordinates with other Federal de- 22 partments with programs designed to improve the nursing 23 workforce.’’; 24 (5) in section 811 (42 U.S.C. 296j)— 25 VerDate Sep 11 2014 21:50 Nov 05, 2019 Jkt 099200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6401 E:\BILLS\S1399.RS S1399 kjohnson on DSK79L0C42 with BILLS 5 •S 1399 RS (A) in subsection (b)— 1 (i) by striking ‘‘Master’s’’ and insert- 2 ing ‘‘graduate’’; and 3 (ii) by inserting ‘‘clinical nurse lead- 4 ers,’’ after ‘‘nurse administrators,’’; 5 (B) by redesignating subsections (f) and 6 (g) as subsections (g) and (h), respectively; and 7 (C) by inserting after subsection (e), the 8 following: 9 ‘‘(f) AUTHORIZED CLINICAL NURSE SPECIALIST 10 PROGRAMS.—Clinical nurse specialist programs eligible 11 for support under this section are education programs 12 that— 13 ‘‘(1) provide registered nurses with full-time 14 clinical nurse specialist education; and 15 ‘‘(2) have as their objective the education of 16 clinical nurse specialists who will, upon completion 17 of such a program, be qualified to effectively provide 18 care through the wellness and illness continuum to 19 inpatients and outpatients experiencing acute and 20 chronic illness.’’; 21 (6) in section 831 (42 U.S.C. 296p)— 22 (A) in the section heading, by striking 23 ‘‘AND QUALITY GRANTS’’ and inserting 24 ‘‘QUALITY, AND RETENTION GRANTS’’; 25 VerDate Sep 11 2014 21:50 Nov 05, 2019 Jkt 099200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6401 E:\BILLS\S1399.RS S1399 kjohnson on DSK79L0C42 with BILLS 6 •S 1399 RS (B) in subsection (b)(2), by striking ‘‘other 1 high-risk groups such as the elderly, individuals 2 with HIV/AIDS, substance abusers, the home- 3 less, and victims’’ and inserting ‘‘high risk 4 groups, such as the elderly, individuals with 5 HIV/AIDS, individuals with mental health or 6 substance use disorders, individuals who are 7 homeless, and survivors’’; 8 (C) in subsection (c)(1)— 9 (i) in subparagraph (A)— 10 (I) by striking ‘‘advancement for 11 nursing personnel’’ and inserting the 12 following: ‘‘advancement for— 13 ‘‘(i) nursing’’; 14 (II) by striking ‘‘professional 15 nurses, advanced education nurses, li- 16 censed practical nurses, certified 17 nurse assistants, and home health 18 aides’’ and inserting ‘‘professional 19 registered nurses, advanced practice 20 registered nurses, and nurses with 21 graduate nursing education’’; and 22 (III) by adding at the end the 23 following: 24 VerDate Sep 11 2014 21:50 Nov 05, 2019 Jkt 099200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6401 E:\BILLS\S1399.RS S1399 kjohnson on DSK79L0C42 with BILLS 7 •S 1399 RS ‘‘(ii) individuals including licensed 1 practical nurses, licensed vocational nurses, 2 certified nurse assistants, home health 3 aides, diploma degree or associate degree 4 nurses, to become registered nurses with 5 baccalaureate degrees or nurses with grad- 6 uate nursing education;’’; 7 (ii) in subparagraph (B), by striking 8 the period and inserting ‘‘; and’’; and 9 (iii) by adding at the end the fol- 10 lowing: 11 ‘‘(C) developing and implementing intern- 12 ships, accredited fellowships, and accredited 13 residency programs in collaboration with one or 14 more accredited schools of nursing, to encour- 15 age the mentoring and development of special- 16 ties.’’; 17 (D) by striking subsection (e); 18 (E) by redesignating subsection (f) 19 through (h), as subsections (e) through (g), re- 20 spectively; 21 (F) in subsection (e) (as so redesignated), 22 by striking ‘‘The Secretary shall submit to the 23 Congress before the end of each fiscal year’’ 24 and inserting ‘‘As part of the report on nursing 25 VerDate Sep 11 2014 21:50 Nov 05, 2019 Jkt 099200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6401 E:\BILLS\S1399.RS S1399 kjohnson on DSK79L0C42 with BILLS 8 •S 1399 RS workforce programs described in section 806(i), 1 the Secretary shall include’’; 2 (G) in subsection (f) (as so redesignated), 3 by striking ‘‘a school of nursing, as defined in 4 section 801(2),,’’ and inserting ‘‘an accredited 5 school of nursing, as defined in section 801(2), 6 a health care facility, including federally quali- 7 fied health centers or nurse-managed health 8 clinics, or a partnership of such a school and 9 facility’’; and 10 (H) in subsection (g) (as so redesignated), 11 by striking ‘‘2010 through 2014’’ and inserting 12 ‘‘2020 through 2024’’; 13 (7) by striking section 831A (42 U.S.C. 296p– 14 1); 15 (8) in section 846 (42 U.S.C. 297n)— 16 (A) by striking the last sentence of sub- 17 section (a); 18 (B) in subsection (b)(1), by striking ‘‘he 19 began such practice’’ and inserting ‘‘the indi- 20 vidual began such practice’’; and 21 (C) in subsection (i)(I), by striking ‘‘2003 22 through 2007’’ and inserting ‘‘2020 through 23 2024’’; 24 VerDate Sep 11 2014 21:50 Nov 05, 2019 Jkt 099200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6401 E:\BILLS\S1399.RS S1399 kjohnson on DSK79L0C42 with BILLS 9 •S 1399 RS (9) in section 846A(f) (42 U.S.C. 247n–1(f)), 1 by striking ‘‘2010 through 2014’’ and inserting 2 ‘‘2020 through 2024’’; 3 (10) in section 847(g) (42 U.S.C. 297o(g)), by 4 striking ‘‘such sums as may be necessary for each of 5 fiscal years 2010 through 2014’’ and inserting 6 ‘‘$115,635,000 for each of fiscal years 2020 through 7 2024’’; 8 (11) in section 851 (42 U.S.C. 297t)— 9 (A) in subsection (b)(1)(A)(iv), by striking 10 ‘‘and nurse anesthetists’’ and inserting ‘‘nurse 11 anesthetists, and clinical nurse specialists’’; 12 (B) in subsection (d)(3)— 13 (i) by striking ‘‘3 years after the date 14 of enactment of this section’’ and inserting 15 ‘‘2 years after the date of enactment of the 16 Title VIII Nursing Workforce Reauthoriza- 17 tion Act’’; 18 (ii) by striking ‘‘Labor and Human 19 Resources’’ and inserting ‘‘Health, Edu- 20 cation, Labor, and Pensions’’; and 21 (iii) by inserting ‘‘Energy and’’ before 22 ‘‘Commerce’’; and 23 VerDate Sep 11 2014 21:50 Nov 05, 2019 Jkt 099200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6401 E:\BILLS\S1399.RS S1399 kjohnson on DSK79L0C42 with BILLS 10 •S 1399 RS (C) in subsection (g), by striking ‘‘under 1 this title’’ and inserting ‘‘for carrying out parts 2 B, C, and D’’; 3 (12) in section 865(e) (42 U.S.C. 298(e)), by 4 striking ‘‘2014’’ and inserting ‘‘2024’’; and 5 (13) in section 871 (42 U.S.C. 298d), by strik- 6 ing ‘‘$338,000,000 for fiscal year 2010, and such 7 sums as may be necessary for each of the fiscal 8 years 2011 through 2016’’ and inserting 9 ‘‘$133,837,000 for each of fiscal years 2020 through 10 2024’’. 11 (b) EVALUATION AND REPORT ON NURSE LOAN RE- 12 PAYMENT PROGRAMS.— 13 (1) EVALUATION.—The Comptroller General 14 shall conduct an evaluation of the nurse loan repay- 15 ment programs administered by the Health Re- 16 sources and Services Administration. Such evalua- 17 tion shall include— 18 (A) the manner in which payments are 19 made under such programs; 20 (B) the existing oversight functions nec- 21 essary to ensure the proper use of such pro- 22 grams, including payments made as part of 23 such programs; 24 VerDate Sep 11 2014 21:50 Nov 05, 2019 Jkt 099200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6401 E:\BILLS\S1399.RS S1399 kjohnson on DSK79L0C42 with BILLS 11 •S 1399 RS (C) the identification of gaps, if any, in 1 oversight functions; and 2 (D) information on the number of nurses 3 assigned to facilities pursuant to such pro- 4 grams, including the type of facility to which 5 nurses are assigned and the impact of modi- 6 fying the eligibility requirements for programs 7 under section 846 of the Public Health Service 8 Act (42 U.S.C. 297n), such as the impact on 9 entities to which nurses had previously been as- 10 signed prior to fiscal year 2019 (such as feder- 11 ally qualified health centers and facilities affili- 12 ated with the Indian Health Service). 13 (2) REPORT.—Not later than 18 months after 14 the enactment of this Act, the Comptroller General 15 shall submit to the Committee on Health, Edu- 16 cation, Labor, and Pensions of the Senate and the 17 Committee on Energy and Commerce of the House 18 of Representatives a report on the evaluation under 19 paragraph (1), which may include recommendations 20 to improve relevant nursing workforce loan repay- 21 ment programs. 22 SECTION 1. SHORT TITLE. 23 This Act may be cited as the ‘‘Title VIII Nursing 24 Workforce Reauthorization Act of 2019’’. 25 VerDate Sep 11 2014 21:50 Nov 05, 2019 Jkt 099200 PO 00000 Frm 00011 Fmt 6652 Sfmt 6203 E:\BILLS\S1399.RS S1399 kjohnson on DSK79L0C42 with BILLS 12 •S 1399 RS SEC. 2. NURSING WORKFORCE DEVELOPMENT. 1 (a) IN GENERAL.—Title VIII of the Public Health 2 Service Act (42 U.S.C. 296 et seq.) is amended— 3 (1) in section 801 (42 U.S.C. 296), by adding at 4 the end the following: 5 ‘‘(18) NURSE MANAGED HEALTH CLINIC.—The 6 term ‘nurse managed health clinic’ means a nurse- 7 practice arrangement, managed by advanced practice 8 nurses, that provides primary care or wellness serv- 9 ices to underserved or vulnerable populations and 10 that is associated with a school, college, university or 11 department of nursing, federally qualified health cen- 12 ter, or independent nonprofit health or social services 13 agency.’’; 14 (2) in section 802(c) (42 U.S.C. 296a(c)), by in- 15 serting ‘‘, and how such project aligns with the goals 16 in section 806(a)’’ before the period in the second sen- 17 tence; 18 (3) in section 803(b) (42 U.S.C. 296b(b)), by 19 adding at the end the following: ‘‘Such Federal funds 20 are intended to supplement, not supplant, existing 21 non-Federal expenditures for such activities.’’; 22 (4) in section 806 (42 U.S.C. 296e)— 23 (A) in subsection (a), by striking ‘‘as needed 24 to’’ and all that follows and inserting the fol- 25 VerDate Sep 11 2014 21:50 Nov 05, 2019 Jkt 099200 PO 00000 Frm 00012 Fmt 6652 Sfmt 6203 E:\BILLS\S1399.RS S1399 kjohnson on DSK79L0C42 with BILLS 13 •S 1399 RS lowing: ‘‘as needed to address national [Text truncated for display. 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