Educating Future Nurses Act

I 118TH CONGRESS 1ST SESSION H. R. 3623 To amend title XVIII of the Social Security Act to establish a national graduate nurse education program. IN THE HOUSE OF REPRESENTATIVES MAY 24, 2023 Ms. UNDERWOOD (for herself, Ms. BONAMICI, and Mr. HORSFORD) introduced the following bill; which was referred to the Committee on Ways and Means, and in addition to the Committee on Energy and Commerce, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the com- mittee concerned 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 VerDate Sep 11 2014 02:54 Jun 15, 2023 Jkt 039200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\H3623.IH H3623 pbinns on DSKJLVW7X2PROD with $$_JOB 2 •HR 3623 IH SEC. 2. NATIONAL GRADUATE NURSE EDUCATION PRO- 1 GRAM. 2 Title XVIII of the Social Security Act (42 U.S.C. 3 1395 et seq.) is amended by inserting after section 1866G 4 the following new section: 5 ‘‘SEC. 1866H. NATIONAL GRADUATE NURSE EDUCATION 6 PROGRAM. 7 ‘‘(a) IN GENERAL.— 8 ‘‘(1) ESTABLISHMENT.— 9 ‘‘(A) IN GENERAL.—The Secretary shall 10 establish a national graduate nurse education 11 program under this title under which an eligible 12 hospital may receive payment for the hospital’s 13 reasonable costs (described in paragraph (2)) 14 for the provision of qualified clinical education 15 to advanced practice registered nurses. 16 ‘‘(B) WRITTEN AGREEMENTS.—Eligible 17 hospitals participating in the program shall 18 enter into written agreements pursuant to sub- 19 section (b)(1) in order to reimburse the eligible 20 partners of the hospital the share of the costs 21 attributable to each partner. 22 ‘‘(2) COSTS DESCRIBED.— 23 ‘‘(A) IN GENERAL.—Subject to subpara- 24 graph (B), the costs described in this para- 25 graph are the reasonable costs (as described in 26 VerDate Sep 11 2014 02:54 Jun 15, 2023 Jkt 039200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\H3623.IH H3623 pbinns on DSKJLVW7X2PROD with $$_JOB 3 •HR 3623 IH section 1861(v)) of each eligible hospital for the 1 clinical education costs (as determined by the 2 Secretary) that are attributable to providing ad- 3 vanced practice registered nurses with qualified 4 clinical education. 5 ‘‘(B) LIMITATION.—With respect to a 6 year, the amount reimbursed under subpara- 7 graph (A) may not exceed the amount of costs 8 described in subparagraph (A) that are attrib- 9 utable to an increase in the number of advanced 10 practice registered nurses enrolled in an accred- 11 ited school of nursing that provides qualified 12 clinical education during the year and for which 13 the hospital is being reimbursed under the pro- 14 gram, as compared to the average number of 15 advanced practice registered nurses who grad- 16 uated in each year during the period beginning 17 on January 1, 2021, and ending on December 18 31, 2022 (as determined by the Secretary), 19 from the graduate nursing education program 20 operated by the applicable school of nursing 21 that is an eligible partner of the hospital for 22 purposes of the program. 23 ‘‘(3) ESTABLISHMENT OF REGIONS.— 24 VerDate Sep 11 2014 02:54 Jun 15, 2023 Jkt 039200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\H3623.IH H3623 pbinns on DSKJLVW7X2PROD with $$_JOB 4 •HR 3623 IH ‘‘(A) IN GENERAL.—The Secretary shall 1 establish regions for Graduate Nurse Education 2 Hubs described in subsection (b) under the pro- 3 gram based on hospital referral regions. 4 ‘‘(B) LIMITATIONS.— 5 ‘‘(i) ONE HUB PER REGION.—Only 6 one Graduate Nurse Education Hub may 7 participate in the program with respect to 8 each region established by the Secretary 9 under subparagraph (A). 10 ‘‘(ii) ELIGIBLE HOSPITALS AND ELIGI- 11 BLE PARTNERS.—An eligible hospital or el- 12 igible partner may only participate in one 13 Graduate Nurse Education Hub under the 14 program. 15 ‘‘(4) SUPPLEMENT NOT SUPPLANT.—Payments 16 under this section in any given year shall supple- 17 ment, not supplant, other Federal funds that have 18 been made available in the year for advanced prac- 19 tice registered nurse clinical education or training. 20 ‘‘(5) WAIVER AUTHORITY.—The Secretary may 21 waive such requirements of title XI and this title as 22 may be necessary to carry out the program. 23 VerDate Sep 11 2014 02:54 Jun 15, 2023 Jkt 039200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\H3623.IH H3623 pbinns on DSKJLVW7X2PROD with $$_JOB 5 •HR 3623 IH ‘‘(6) ADMINISTRATION.—Chapter 35 of title 44, 1 United States Code, shall not apply to the imple- 2 mentation of this section. 3 ‘‘(b) REQUIREMENTS.—No payment shall be made 4 under this section to an eligible hospital unless such hos- 5 pital meets the following requirements: 6 ‘‘(1) The hospital has in effect a written agree- 7 ment with the eligible partners of the hospital. Such 8 written agreement shall describe, at a minimum— 9 ‘‘(A) the obligations of the eligible partners 10 with respect to the provision of qualified clinical 11 education; and 12 ‘‘(B) the obligation of the eligible hospital 13 to reimburse such eligible partners (in a timely 14 manner) for the costs of such qualified clinical 15 education that are attributable to such partner. 16 ‘‘(2) The hospital demonstrates to the Secretary 17 that it is leading a Graduate Nurse Education 18 (GNE) Hub which has established and will maintain 19 the following in order to provide qualified clinical 20 education to advanced practice registered nurses: 21 ‘‘(A) Partnerships with one or more— 22 ‘‘(i) applicable schools of nursing; 23 ‘‘(ii) hospitals or health systems in a 24 regional area; and 25 VerDate Sep 11 2014 02:54 Jun 15, 2023 Jkt 039200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\H3623.IH H3623 pbinns on DSKJLVW7X2PROD with $$_JOB 6 •HR 3623 IH ‘‘(iii) applicable non-hospital commu- 1 nity-based care settings. 2 ‘‘(B) A governance structure that includes 3 one or more applicable schools of nursing in the 4 leadership and an oversight process that is de- 5 veloped and approved by the hospital, partici- 6 pating applicable schools of nursing, and other 7 hub partners, in accordance with requirements 8 established by the Secretary. 9 ‘‘(C) A process for timely reimbursement 10 of eligible partners for the costs of such quali- 11 fied clinical education that are attributable to 12 such partner. 13 ‘‘(D) An adequate system for coordination 14 of clinical education sites and preceptors. 15 ‘‘(E) A process for taking into consider- 16 ation local, State, and regional workforce needs 17 to facilitate innovation and value-based delivery 18 of health care. 19 ‘‘(c) PAYMENTS.— 20 ‘‘(1) PER-STUDENT RATE.—The amount of pay- 21 ment under this section to an eligible hospital shall 22 for each year of the program shall be equal to the 23 applicable per-student rate (as defined in paragraph 24 (2)) multiplied by the total number of advanced 25 VerDate Sep 11 2014 02:54 Jun 15, 2023 Jkt 039200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\H3623.IH H3623 pbinns on DSKJLVW7X2PROD with $$_JOB 7 •HR 3623 IH practice registered nurses receiving qualified clinical 1 education through the eligible hospital under the 2 program. 3 ‘‘(2) APPLICABLE PER-STUDENT RATE.—The 4 applicable per-student rate, with respect to an eligi- 5 ble hospital, is— 6 ‘‘(A) for the first year of the program, a 7 per-student rate determined by the Secretary 8 based on data from the Graduate Nurse Edu- 9 cation Demonstration established under section 10 5509 of the Patient Protection and Affordable 11 Care Act (Public Law 111–148), increased or 12 decreased by the percentage change in the con- 13 sumer price index for all urban consumers (all 14 items; United States city average) from the last 15 year of the Graduate Nurse Education Dem- 16 onstration established under section 5509 for 17 which such data is available to the June pre- 18 ceding such first year of the program under this 19 section; and 20 ‘‘(B) for a subsequent year, the amount 21 determined under this paragraph for the pre- 22 ceding year, increased or decreased by the per- 23 centage change in the consumer price index for 24 all urban consumers (all items; United States 25 VerDate Sep 11 2014 02:54 Jun 15, 2023 Jkt 039200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\H3623.IH H3623 pbinns on DSKJLVW7X2PROD with $$_JOB 8 •HR 3623 IH city average) for the 12-month period ending 1 with June of the previous year. 2 ‘‘(d) ANNUAL REPORTING REQUIRED.— 3 ‘‘(1) REDUCTION IN PAYMENT FOR FAILURE TO 4 REPORT.— 5 ‘‘(A) IN GENERAL.—The amount payable 6 under this section to an eligible hospital shall 7 be reduced by 25 percent if the Secretary deter- 8 mines that— 9 ‘‘(i) the hospital has failed to provide 10 the Secretary the report required under 11 paragraph (2) for the year; or 12 ‘‘(ii) such report fails to provide the 13 information required under any subpara- 14 graph of such paragraph. 15 ‘‘(B) NOTICE AND OPPORTUNITY TO PRO- 16 VIDE MISSING INFORMATION.—Before imposing 17 a reduction under subparagraph (A) on the 18 basis of a hospital’s failure to provide informa- 19 tion described in subparagraph (A)(ii), the Sec- 20 retary shall provide notice to the hospital of 21 such failure and the Secretary’s intention to im- 22 pose such reduction and shall provide the hos- 23 pital with the opportunity to provide the re- 24 quired information within a period of 30 days 25 VerDate Sep 11 2014 02:54 Jun 15, 2023 Jkt 039200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\H3623.IH H3623 pbinns on DSKJLVW7X2PROD with $$_JOB 9 •HR 3623 IH beginning on the date of such notice. If the hos- 1 pital provides such information within such pe- 2 riod, no reduction shall be made under subpara- 3 graph (A) on the basis of the previous failure 4 to provide such information. 5 ‘‘(C) LIMITATION.—In the case where the 6 amount payable under this section to an eligible 7 hospital is reduced pursuant to subparagraph 8 (A), the eligible hospital may not make any cor- 9 responding reductions in payment to eligible 10 partners. 11 ‘‘(2) ANNUAL REPORT.—The report required 12 under this paragraph for an eligible hospital for a 13 year is a report that includes (in a form and manner 14 specified by the Secretary) the following information 15 for the academic year completed immediately prior 16 to such year: 17 ‘‘(A) The types of qualified clinical edu- 18 cation provided to advanced practice registered 19 nurses under the program. 20 ‘‘(B) The type and number of academic or 21 practice partnerships established as a result of 22 working together in a Graduate Nurse Edu- 23 cation (GNE) Hub. 24 VerDate Sep 11 2014 02:54 Jun 15, 2023 Jkt 039200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\H3623.IH H3623 pbinns on DSKJLVW7X2PROD with $$_JOB 10 •HR 3623 IH ‘‘(C) The number of advanced practice reg- 1 istered nurse students receiving qualified clin- 2 ical education through the eligible hospital 3 under the program. 4 ‘‘(D) Any changes in qualified clinical edu- 5 cation made during such academic year (except 6 that the first report submitted by the eligible 7 hospital under this paragraph shall be for such 8 changes since the first year in which the hos- 9 pital received payment under this section), in- 10 cluding— 11 ‘‘(i) changes in curricula, clinical edu- 12 cation experiences, and types of clinical 13 education, and benefits that have resulted 14 from such changes; and 15 ‘‘(ii) changes for purposes of meas- 16 uring and improving the quality and safety 17 of patient care. 18 ‘‘(E) The numbers of advanced practice 19 registered nurses who graduated from their pro- 20 gram at the end of such academic year and care 21 for individuals within the borders of the service 22 area of the hospital or within the borders of the 23 State in which the hospital is located. 24 VerDate Sep 11 2014 02:54 Jun 15, 2023 Jkt 039200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6201 E:\BILLS\H3623.IH H3623 pbinns on DSKJLVW7X2PROD with $$_JOB 11 •HR 3623 IH ‘‘(F) The number of patients treated by 1 advanced practice registered nurses under the 2 program. 3 ‘‘(G) The number of visits by patients 4 treated by such advanced practice registered 5 nurses. 6 ‘‘(H) Of the number of advanced practice 7 registered nurses who graduated from their pro- 8 gram at the end of such academic year, the 9 number and percentage of such advanced prac- 10 tice registered nurses who entered practice at a 11 health care facility— 12 ‘‘(i) primarily serving a health profes- 13 sional shortage area with a designation in 14 effect under section 332 of the Public 15 Health Service Act or a medically under- 16 served community (as defined in section 17 799B of such Act); or 18 ‘‘(ii) located in a rural area (as de- 19 fined in section 1886(d)(2)(D)). 20 ‘‘(I) Other information as deemed appro- 21 priate by the Secretary. 22 ‘‘(3) REPORT TO CONGRESS.—Not later than 2 23 years after the date of the enactment of this section, 24 the Secretary shall submit to Congress a report— 25 VerDate Sep 11 2014 02:54 Jun 15, 2023 Jkt 039200 PO 00000 Frm 00011 Fmt 6652 Sfmt 6201 E:\BILLS\H3623.IH H3623 pbinns on DSKJLVW7X2PROD with $$_JOB 12 •HR 3623 IH ‘‘(A) summarizing the information sub- 1 mitted in reports to the Secretary under para- 2 graph (2); 3 ‘‘(B) describing the results of the program 4 carried out under this section; and 5 ‘‘(C) making recommendations for im- 6 provements to the program. 7 ‘‘(e) FUNDING.—For purposes of carrying the pro- 8 gram under this section, the Secretary shall provide for 9 the transfer, from the Federal Hospital Insurance Trust 10 Fund under section 1817 and the Federal Supplementary 11 Medical Insurance Trust Fund under section 1841, in 12 such proportion as the Secretary determines appropriate, 13 of such sums as the Secretary determines necessary, to 14 the Centers for Medicare & Medicaid Services Program 15 Management Account. 16 ‘‘(f) DEFINITIONS.—In this section: 17 ‘‘(1) ADVANCED PRACTICE REGISTERED 18 NURSE.—The term ‘advanced practice registered 19 nurse’ includes the following: 20 ‘‘(A) A clinical nurse specialist (as defined 21 in subsection (aa)(5) of section 1861). 22 ‘‘(B) A nurse practitioner (as defined in 23 such subsection). 24 VerDate Sep 11 2014 04:01 Jun 15, 2023 Jkt 039200 PO 00000 Frm 00012 Fmt 6652 Sfmt 6201 E:\BILLS\H3623.IH H3623 pbinns on DSKJLVW7X2PROD with $$_JOB 13 •HR 3623 IH ‘‘(C) A certified registered nurse anes- 1 thetist (as defined in subsection (bb)(2) of such 2 section). 3 ‘‘(D) A certif [Text truncated for display. Full text available on Congress.gov.]