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Nurse Reinvestment Act, P.L. 107-205
An Act
To amend the Public Health Service Act
with respect to health professions programs
regarding the field of nursing. Be it
enacted by the Senate and House of Representatives
of the United States of America in Congress
assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the Nurse
Reinvestment Act''.
SEC. 2. TABLE OF CONTENTS.
The table of contents for this Act is
as follows:
Sec. 1. Short title.
Sec. 2. Table of contents.
TITLE INURSE RECRUITMENT
Sec. 101. Definitions.
Sec. 102. Public service announcements
regarding the nursing profession.
Sec. 103. National Nurse Service Corps.
TITLE IINURSE RETENTION
Sec. 201. Building career ladders and
retaining quality nurses.
Sec. 202. Comprehensive geriatric education.
Sec. 203. Nurse faculty loan program.
Sec. 204. Reports by General Accounting
Office.
TITLE INURSE RECRUITMENT
SEC. 101. DEFINITIONS.
Section 801 of the Public Health Service
Act (42 U.S.C. 296) is amended by adding
at the end the following:
(9) AMBULATORY SURGICAL CENTER.The term
'ambulatory surgical center' has the meaning
applicable to such term under title XVIII
of the Social Security Act.
(10) FEDERALLY QUALIFIED HEALTH CENTER.The
term 'Federally qualified health center'
has the meaning given such term under
section 1861(aa)(4) of the Social Security
Act.
(11) HEALTH CARE FACILITY.The term 'health
care facility' means an Indian Health
Service health center, a Native Hawaiian
health center, a hospital, a Federally
qualified health center, a rural health
clinic, a nursing home, a home health
agency, a hospice program, a public health
clinic, a State or local department of
public health, a skilled nursing facility,
an ambulatory surgical center, or any
other facility designated by the Secretary.
(12) HOME HEALTH AGENCY.The term 'home
health agency' has the meaning given such
term in section 1861(o) of the Social
Security Act. H. R. 34872
(13) HOSPICE PROGRAM.The term hospice
program has the meaning given such term
in section 1861 (dd)(2) of the Social
Security Act.
(14) RURAL HEALTH CLINIC.The term rural
health clinic has the meaning given such
term in section 1861(aa)(2) of the Social
Security Act.
(15) SKILLED NURSING FACILITY.The term
skilled nursing facility has the meaning
given such term in section 1819(a) of
the Social Security Act..
SEC. 102. PUBLIC SERVICE ANNOUNCEMENTS
REGARDING THE NURSING PROFESSION.
Title VIII of the Public Health Service
Act (42 U.S.C. 296 et seq.) is amended
by adding at the end the following:
PART HPUBLIC SERVICE ANNOUNCEMENTS
SEC. 851. 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. 852. 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.
SEC. 103. NATIONAL NURSE SERVICE CORPS.
(a) LOAN REPAYMENT PROGRAM. Section
846(a) of the Public Health Service Act
(42 U.S.C. 297n(a)) is amended
(1) in paragraph (3), by striking "in
an Indian Health Service health center"
and all that follows to the semicolon
and inserting at a health care facility
with a critical shortage of nurses'';
and
(2) by adding at the end the following:
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) ESTABLISHMENT OF SCHOLARSHIP PROGRAM.Section
846 of the Public Health Service Act (42
U.S.C. 297n) is amended
(1) in the heading for the section, by
striking "LOAN REPAYMENT PROGRAM"
and inserting "LOAN REPAYMENT AND
SCHOLARSHIP PROGRAMS";
(2) by redesignating subsections (d),
(f), (g), and (h) as subsections (f),
(h), (i), and (g), respectively;
(3) by transferring subsections (f) and
(g) (as so redesignated) from their current
placements, by inserting subsection (f)
after subsection (e), and by inserting
subsection (g) after subsection (f) (as
so inserted); and
(4) by inserting after subsection (c)
the following 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
H. R. 34874 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.
(c) PREFERENCE.Section 846(e) of the
Public Health Service Act (42 U.S.C. 297n(e))
is amended by striking "under subsection
(a)" and all that follows through the
period and inserting "under subsection
(a) or (d), the Secretary shall give preference
to qualified applicants with the greatest
financial need."
(d) REPORTS.Subsection (h) of section
846 of the Public Health Service Act (42
U.S.C. 297n) (as redesignated by subsection
(b)(2)) is amended to read as follows:
(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
(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.
(e) FUNDING.Subsection (i) of section
846 of the Public Health Service Act (42
U.S.C. 297n) (as redesignated by subsection
(b)(2)) is amended to read as follows:
(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.
(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).
TITLE IINURSE RETENTION
SEC. 201. BUILDING CAREER LADDERS AND
RETAINING QUALITY NURSES.
Section 831 of the Public Health Service
Act (42 U.S.C. 296p) is amended to read
as follows:
SEC. 831. NURSE EDUCATION, PRACTICE,
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;
(2) developing and implementing internship
and residency programs to encourage mentoring
and the development of specialties; or
(3) 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;
(3) providing managed care, quality improvement,
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.
(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 H. R. 34876 by promoting nurse involvement
in the organizational and clinical decision-making
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) 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.
(g) ELIGIBLE ENTITY.For purposes of
this section, the term "eligible entity"
includes a school of nursing, a health
care facility, or a partnership of such
a school and facility.
(h) 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. 202. COMPREHENSIVE GERIATRIC EDUCATION.
(a) COMPREHENSIVE GERIATRIC EDUCATION.Title
VIII of the Public Health Service Act
(42 U.S.C. 296 et seq.) (as amended by
section 102) is amended by adding at the
end the following:
PART ICOMPREHENSIVE GERIATRIC EDUCATION
SEC. 855. COMPREHENSIVE GERIATRIC EDUCATION.
(a) PROGRAM AUTHORIZED.The Secretary
shall award grants to eligible entities
to develop and implement, in coordination
with programs under section 753, programs
and initiatives to train and educate individuals
in providing geriatric care for the elderly.
(b) USE OF FUNDS.An eligible entity
that receives a grant under subsection
(a) shall use funds under such grant to
(1) provide training to individuals who
will provide geriatric care for the elderly;
(2) develop and disseminate curricula
relating to the treatment of the health
problems of elderly individuals;
(3) train faculty members in geriatrics;
or
(4) provide continuing education to individuals
who provide geriatric care.
(c) APPLICATION.An eligible entity desiring
a grant under subsection (a) shall submit
an application to the Secretary at such
time, in such manner, and containing such
information as the Secretary may reasonably
require.
(d) ELIGIBLE ENTITY.For purposes of
this section, the term 'eligible entity'
includes a school of nursing, a health
care facility, a program leading to certification
as a certified nurse assistant, a partnership
of such a school and facility, or a partnership
of such a program and facility.
(e) 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.
(b) TECHNICAL AMENDMENT.Section 753(a)(1)
of the Public Health Service Act 42 U.S.C.
294c) is amended by striking , and section
853(2), and inserting , and section
801(2),.
SEC. 203. NURSE FACULTY LOAN PROGRAM.
Part E of title VIII of the Public Health
Service Act (42 U.S.C. 297a et seq.) is
amended by inserting after section 846
the following:
NURSE FACULTY LOAN PROGRAM
SEC. 846A. (a) ESTABLISHMENT.The Secretary,
acting through the Administrator of the
Health Resources and Services Administration,
may enter into an agreement with any 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 H. R. 34878 (a) may not exceed
$30,000, plus any amount determined by
the Secretary on an annual basis to reflect
inflation;
(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
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 school¹s 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 a 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 2003 through
2007..
SEC. 204. REPORTS BY GENERAL ACCOUNTING
OFFICE.
(a) NATIONAL VARIATIONS.Not later than
4 years after the date of the enactment
of this Act, the Comptroller General of
the United States shall conduct a survey
to determine national variations in the
nursing shortage at hospitals, nursing
homes, and other health care providers,
and submit a report, including recommendations,
to the Congress on Federal remedies to
ease nursing shortages. The Comptroller
General shall submit to the H. R. 34879
Congress this report describing the findings
relating to ownership status and associated
remedies.
(b) HIRING DIFFERENCES AMONG CERTAIN
PRIVATE ENTITIES.The Comptroller General
of the United States shall conduct a study
to determine differences in the hiring
of nurses by nonprofit private entities
as compared to the hiring of nurses by
private entities that are not nonprofit.
In carrying out the study, the Comptroller
General shall determine the effect of
the inclusion of private entities that
are not nonprofit in the program under
section 846 of the Public Health Service
Act. Not later than 4 years after the
date of the enactment of this Act, the
Comptroller General shall submit to the
Congress a report describing the findings
of the study.
(c) NURSING SCHOLARSHIPS.The Comptroller
General of the United States shall conduct
an evaluation of whether the program carried
out under section 846(d) of the Public
Health Service Act has demonstrably increased
the number of applicants to schools of
nursing and, not later than 4 years after
the date of the enactment of this Act,
submit a report to the Congress on the
results of such evaluation.
Speaker of the House of Representatives.
Vice President of the United States and
President of the Senate.
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