Educating Future Nurses Act

II 118TH CONGRESS 1ST SESSION S. 1586 To amend title XVIII of the Social Security Act to establish a national graduate nurse education program. IN THE SENATE OF THE UNITED STATES MAY 11, 2023 Ms. STABENOW (for herself, Mr. CASEY, and Ms. HASSAN) introduced the following bill; which was read twice and referred to the Committee on Finance A BILL To amend title XVIII of the Social Security Act to establish a national graduate nurse education program. Be it enacted by the Senate and House of 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 ‘‘Educating Future 4 Nurses Act’’. 5 SEC. 2. NATIONAL GRADUATE NURSE EDUCATION PRO- 6 GRAM. 7 Title XVIII of the Social Security Act (42 U.S.C. 8 1395 et seq.) is amended by inserting after section 1866G 9 the following new section: 10 VerDate Sep 11 2014 23:12 May 23, 2023 Jkt 039200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\S1586.IS S1586 pbinns on DSKJLVW7X2PROD with $$_JOB 2 •S 1586 IS ‘‘SEC. 1866H. NATIONAL GRADUATE NURSE EDUCATION 1 PROGRAM. 2 ‘‘(a) IN GENERAL.— 3 ‘‘(1) ESTABLISHMENT.— 4 ‘‘(A) IN GENERAL.—The Secretary shall 5 establish a national graduate nurse education 6 program under this title under which an eligible 7 hospital may receive payment for the hospital’s 8 reasonable costs (described in paragraph (2)) 9 for the provision of qualified clinical education 10 to advanced practice registered nurses. 11 ‘‘(B) WRITTEN AGREEMENTS.—Eligible 12 hospitals participating in the program shall 13 enter into written agreements pursuant to sub- 14 section (b)(1) in order to reimburse the eligible 15 partners of the hospital the share of the costs 16 attributable to each partner. 17 ‘‘(2) COSTS DESCRIBED.— 18 ‘‘(A) IN GENERAL.—Subject to subpara- 19 graph (B), the costs described in this para- 20 graph are the reasonable costs (as described in 21 section 1861(v)) of each eligible hospital for the 22 clinical education costs (as determined by the 23 Secretary) that are attributable to providing ad- 24 vanced practice registered nurses with qualified 25 clinical education. 26 VerDate Sep 11 2014 23:12 May 23, 2023 Jkt 039200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\S1586.IS S1586 pbinns on DSKJLVW7X2PROD with $$_JOB 3 •S 1586 IS ‘‘(B) LIMITATION.—With respect to a 1 year, the amount reimbursed under subpara- 2 graph (A) may not exceed the amount of costs 3 described in subparagraph (A) that are attrib- 4 utable to an increase in the number of advanced 5 practice registered nurses enrolled in an accred- 6 ited school of nursing that provides qualified 7 clinical education during the year and for which 8 the hospital is being reimbursed under the pro- 9 gram, as compared to the average number of 10 advanced practice registered nurses who grad- 11 uated in each year during the period beginning 12 on January 1, 2021, and ending on December 13 31, 2022 (as determined by the Secretary) from 14 the graduate nursing education program oper- 15 ated by the applicable school of nursing that is 16 an eligible partner of the hospital for purposes 17 of the program. 18 ‘‘(3) ESTABLISHMENT OF REGIONS.— 19 ‘‘(A) IN GENERAL.—The Secretary shall 20 establish regions for Graduate Nurse Education 21 Hubs described in subsection (b) under the pro- 22 gram based on hospital referral regions. 23 ‘‘(B) LIMITATIONS.— 24 VerDate Sep 11 2014 23:12 May 23, 2023 Jkt 039200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\S1586.IS S1586 pbinns on DSKJLVW7X2PROD with $$_JOB 4 •S 1586 IS ‘‘(i) ONE HUB PER REGION.—Only 1 one Graduate Nurse Education Hub may 2 participate in the program with respect to 3 each region established by the Secretary 4 under subparagraph (A). 5 ‘‘(ii) ELIGIBLE HOSPITALS AND ELIGI- 6 BLE PARTNERS.—An eligible hospital or el- 7 igible partner may only participate in one 8 Graduate Nurse Education Hub under the 9 program. 10 ‘‘(4) SUPPLEMENT NOT SUPPLANT.—Payments 11 under this section in any given year shall supple- 12 ment, not supplant, other Federal funds that have 13 been made available in the year for advanced prac- 14 tice registered nurse clinical education or training. 15 ‘‘(5) WAIVER AUTHORITY.—The Secretary may 16 waive such requirements of title XI and this title as 17 may be necessary to carry out the program. 18 ‘‘(6) ADMINISTRATION.—Chapter 35 of title 44, 19 United States Code, shall not apply to the imple- 20 mentation of this section. 21 ‘‘(b) REQUIREMENTS.—No payment shall be made 22 under this section to an eligible hospital unless such hos- 23 pital meets the following requirements: 24 VerDate Sep 11 2014 23:12 May 23, 2023 Jkt 039200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\S1586.IS S1586 pbinns on DSKJLVW7X2PROD with $$_JOB 5 •S 1586 IS ‘‘(1) The hospital has in effect a written agree- 1 ment with the eligible partners of the hospital. Such 2 written agreement shall describe, at a minimum— 3 ‘‘(A) the obligations of the eligible partners 4 with respect to the provision of qualified clinical 5 education; and 6 ‘‘(B) the obligation of the eligible hospital 7 to reimburse such eligible partners (in a timely 8 manner) for the costs of such qualified clinical 9 education that are attributable to such partner. 10 ‘‘(2) The hospital demonstrates to the Secretary 11 that it is leading a Graduate Nurse Education 12 (GNE) Hub which has established and will maintain 13 the following in order to provide qualified clinical 14 education to advanced practice registered nurses: 15 ‘‘(A) Partnerships with one or more— 16 ‘‘(i) applicable schools of nursing; 17 ‘‘(ii) hospitals or health systems in a 18 regional area; and 19 ‘‘(iii) applicable non-hospital commu- 20 nity-based care settings. 21 ‘‘(B) A governance structure that includes 22 one or more applicable schools of nursing in the 23 leadership and an oversight process that is de- 24 veloped and approved by the hospital, partici- 25 VerDate Sep 11 2014 23:12 May 23, 2023 Jkt 039200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\S1586.IS S1586 pbinns on DSKJLVW7X2PROD with $$_JOB 6 •S 1586 IS pating applicable schools of nursing, and other 1 hub partners, in accordance with requirements 2 established by the Secretary. 3 ‘‘(C) A process for timely reimbursement 4 of eligible partners for the costs of such quali- 5 fied clinical education that are attributable to 6 such partner. 7 ‘‘(D) An adequate system for coordination 8 of clinical education sites and preceptors. 9 ‘‘(E) A process for taking into consider- 10 ation local, State, and regional workforce needs 11 to facilitate innovation and value-based delivery 12 of health care. 13 ‘‘(c) PAYMENTS.— 14 ‘‘(1) PER-STUDENT RATE.—The amount of pay- 15 ment under this section to an eligible hospital shall 16 for each year of the program shall be equal to the 17 applicable per-student rate (as defined in paragraph 18 (2)) multiplied by the total number of advanced 19 practice registered nurses receiving qualified clinical 20 education through the eligible hospital under the 21 program. 22 ‘‘(2) APPLICABLE PER-STUDENT RATE.—The 23 applicable per-student rate, with respect to an eligi- 24 ble hospital, is— 25 VerDate Sep 11 2014 23:12 May 23, 2023 Jkt 039200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\S1586.IS S1586 pbinns on DSKJLVW7X2PROD with $$_JOB 7 •S 1586 IS ‘‘(A) for the first year of the program, a 1 per-student rate determined by the Secretary 2 based on data from the Graduate Nurse Edu- 3 cation Demonstration established under section 4 5509 of the Patient Protection and Affordable 5 Care Act (Public Law 111–148), increased or 6 decreased by the percentage change in the con- 7 sumer price index for all urban consumers (all 8 items; United States city average) from the last 9 year of the Graduate Nurse Education Dem- 10 onstration established under section 5509 for 11 which such data is available to the June pre- 12 ceding such first year of the program under this 13 section; and 14 ‘‘(B) for a subsequent year, the amount 15 determined under this paragraph for the pre- 16 ceding year, increased or decreased by the per- 17 centage change in the consumer price index for 18 all urban consumers (all items; United States 19 city average) for the 12-month period ending 20 with June of the previous year. 21 ‘‘(d) ANNUAL REPORTING REQUIRED .— 22 ‘‘(1) REDUCTION IN PAYMENT FOR FAILURE TO 23 REPORT.— 24 VerDate Sep 11 2014 23:12 May 23, 2023 Jkt 039200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\S1586.IS S1586 pbinns on DSKJLVW7X2PROD with $$_JOB 8 •S 1586 IS ‘‘(A) IN GENERAL.—The amount payable 1 under this section to an eligible hospital shall 2 be reduced by 25 percent if the Secretary deter- 3 mines that— 4 ‘‘(i) the hospital has failed to provide 5 the Secretary the report required under 6 paragraph (2) for the year; or 7 ‘‘(ii) such report fails to provide the 8 information required under any subpara- 9 graph of such paragraph. 10 ‘‘(B) NOTICE AND OPPORTUNITY TO PRO- 11 VIDE MISSING INFORMATION.—Before imposing 12 a reduction under subparagraph (A) on the 13 basis of a hospital’s failure to provide informa- 14 tion described in subparagraph (A)(ii), the Sec- 15 retary shall provide notice to the hospital of 16 such failure and the Secretary’s intention to im- 17 pose such reduction and shall provide the hos- 18 pital with the opportunity to provide the re- 19 quired information within a period of 30 days 20 beginning on the date of such notice. If the hos- 21 pital provides such information within such pe- 22 riod, no reduction shall be made under subpara- 23 graph (A) on the basis of the previous failure 24 to provide such information. 25 VerDate Sep 11 2014 23:12 May 23, 2023 Jkt 039200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\S1586.IS S1586 pbinns on DSKJLVW7X2PROD with $$_JOB 9 •S 1586 IS ‘‘(C) LIMITATION.—In the case where the 1 amount payable under this section to an eligible 2 hospital is reduced pursuant to subparagraph 3 (A), the eligible hospital may not make any cor- 4 responding reductions in payment to eligible 5 partners. 6 ‘‘(2) ANNUAL REPORT.—The report required 7 under this paragraph for an eligible hospital for a 8 year is a report that includes (in a form and manner 9 specified by the Secretary) the following information 10 for the academic year completed immediately prior 11 to such year: 12 ‘‘(A) The types of qualified clinical edu- 13 cation provided to advanced practice registered 14 nurses under the program. 15 ‘‘(B) The type and number of academic or 16 practice partnerships established as a result of 17 working together in a Graduate Nurse Edu- 18 cation (GNE) Hub. 19 ‘‘(C) The number of advanced practice reg- 20 istered nurse students receiving qualified clin- 21 ical education through the eligible hospital 22 under the program. 23 ‘‘(D) Any changes in qualified clinical edu- 24 cation made during such academic year (except 25 VerDate Sep 11 2014 23:12 May 23, 2023 Jkt 039200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\S1586.IS S1586 pbinns on DSKJLVW7X2PROD with $$_JOB 10 •S 1586 IS that the first report submitted by the eligible 1 hospital under this paragraph shall be for such 2 changes since the first year in which the hos- 3 pital received payment under this section), in- 4 cluding— 5 ‘‘(i) changes in curricula, clinical edu- 6 cation experiences, and types of clinical 7 education, and benefits that have resulted 8 from such changes; and 9 ‘‘(ii) changes for purposes of meas- 10 uring and improving the quality and safety 11 of patient care. 12 ‘‘(E) The numbers of advanced practice 13 registered nurses who graduated from their pro- 14 gram at the end of such academic year and care 15 for individuals within the borders of the service 16 area of the hospital or within the borders of the 17 State in which the hospital is located. 18 ‘‘(F) The number of patients treated by 19 advanced practice registered nurses under the 20 program. 21 ‘‘(G) The number of visits by patients 22 treated by such advanced practice registered 23 nurses. 24 VerDate Sep 11 2014 23:12 May 23, 2023 Jkt 039200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6201 E:\BILLS\S1586.IS S1586 pbinns on DSKJLVW7X2PROD with $$_JOB 11 •S 1586 IS ‘‘(H) Of the number of advanced practice 1 registered nurses who graduated from their pro- 2 gram at the end of such academic year, the 3 number and percentage of such advanced prac- 4 tice registered nurses who entered practice at a 5 health care facility— 6 ‘‘(i) primarily serving a health profes- 7 sional shortage area with a designation in 8 effect under section 332 of the Public 9 Health Service Act or a medically under- 10 served community (as defined in section 11 799B of such Act); or 12 ‘‘(ii) located in a rural area (as de- 13 fined in section 1886(d)(2)(D)). 14 ‘‘(I) Other information as deemed appro- 15 priate by the Secretary. 16 ‘‘(3) REPORT TO CONGRESS.—Not later than 2 17 years after the date of the enactment of this section, 18 the Secretary shall submit to Congress a report— 19 ‘‘(A) summarizing the information sub- 20 mitted in reports to the Secretary under para- 21 graph (2); 22 ‘‘(B) describing the results of the program 23 carried out under this section; and 24 VerDate Sep 11 2014 23:12 May 23, 2023 Jkt 039200 PO 00000 Frm 00011 Fmt 6652 Sfmt 6201 E:\BILLS\S1586.IS S1586 pbinns on DSKJLVW7X2PROD with $$_JOB 12 •S 1586 IS ‘‘(C) making recommendations for im- 1 provements to the program. 2 ‘‘(e) FUNDING.—For purposes of carrying the pro- 3 gram under this section, the Secretary shall provide for 4 the transfer, from the Federal Hospital Insurance Trust 5 Fund under section 1817 and the Federal Supplementary 6 Medical Insurance Trust Fund under section 1841, in 7 such proportion as the Secretary determines appropriate, 8 of such sums as the Secretary determines necessary, to 9 the Centers for Medicare & Medicaid Services Program 10 Management Account. 11 ‘‘(f) DEFINITIONS.—In this section: 12 ‘‘(1) ADVANCED PRACTICE REGISTERED 13 NURSE.—The term ‘advanced practice registered 14 nurse’ includes the following: 15 ‘‘(A) A clinical nurse specialist (as defined 16 in subsection (aa)(5) of section 1861. 17 ‘‘(B) A nurse practitioner (as defined in 18 such subsection). 19 ‘‘(C) A certified registered nurse anes- 20 thetist (as defined in subsection (bb)(2) of such 21 section). 22 ‘‘(D) A certified nurse-midwife (as defined 23 in subsection (gg)(2) of such section). 24 VerDate Sep 11 2014 23:12 May 23, 2023 Jkt 039200 PO 00000 Frm 00012 Fmt 6652 Sfmt 6201 E:\BILLS\S1586.IS S1586 pbinns on DSKJLVW7X2PROD with $$_JOB 13 •S 1586 IS ‘‘(2) APPLICABLE NON-HOSPITAL COMMUNITY- 1 BASED CARE SETTING.—The term ‘applicable non- 2 hospital community-based care setting’ means a non- 3 hospital commu [Text truncated for display. 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