[Congressional Bills 103th Congress]
[From the U.S. Government Publishing Office]
[S. 2433 Referred in House (RFH)]
103d CONGRESS
2d Session
S. 2433
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
October 9, 1994
Referred to the Committee on Energy and Commerce
_______________________________________________________________________
AN ACT
To amend title VIII of the Public Health Service Act to consolidate and
reauthorize nursing education programs under such title, and for other
purposes.
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 ``Nursing Education Consolidation and
Reauthorization Act of 1994''.
SEC. 2. PURPOSE.
It is the purpose of this Act to restructure the nurse education
authorities of title VIII of the Public Health Service Act to permit a
comprehensive, flexible, and effective approach to Federal support for
nursing workforce development.
SEC. 3. AMENDMENTS TO PUBLIC HEALTH SERVICE ACT.
Title VIII of the Public Health Service Act (42 U.S.C. 296k et
seq.) is amended--
(1) by striking the title heading and all that follows
except for subparts II and III of part B and section 855; and
inserting the following:
``TITLE VIII--NURSING WORKFORCE DEVELOPMENT'';
(2) in subpart II of part B, by striking the subpart
heading and inserting the following:
``PART E--STUDENT LOANS
``Subpart I--General Program'';
(3) by redesignating subpart III as subpart II;
(4) by striking section 837;
(5) in section 846, by striking subsection (d) and
inserting the following new subsection:
``(d) Breach of Agreements for Obligated Service.--
``(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 subsection
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 paragraph 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.'';
(6) by inserting after the title heading the following new
parts:
``PART A--GENERAL PROVISIONS
``SEC. 801. DEFINITIONS.
``As used in this title:
``(1) Eligible entities.--The term `eligible entities'
means schools of nursing, nursing centers, State or local
governments, and other public or nonprofit private entities
determined appropriate by the Secretary that submit to the
Secretary an application in accordance with section 802.
``(2) School of nursing.--The term `school of nursing'
means a collegiate, associate degree, or diploma school of
nursing in a State.
``(3) Collegiate school of nursing.--The term `collegiate
school of nursing' means a department, division, or other
administrative unit in a college or university which provides
primarily or exclusively a program of education in professional
nursing and related subjects leading to the degree of bachelor
of arts, bachelor of science, bachelor of nursing, or to an
equivalent degree, or to a graduate degree in nursing, and
including advanced training related to such program of
education provided by such school, but only if such program, or
such unit, college or university is accredited.
``(4) Associate degree school of nursing.--The term
`associate degree school of nursing' means a department,
division, or other administrative unit in a junior college,
community college, college, or university which provides
primarily or exclusively a two-year program of education in
professional nursing and allied subjects leading to an
associate degree in nursing or to an equivalent degree, but
only if such program, or such unit, college, or university is
accredited.
``(5) Diploma school of nursing.--The term `diploma school
of nursing' means a school affiliated with a hospital or
university, or an independent school, which provides primarily
or exclusively a program of education in professional nursing
and allied subjects leading to a diploma or to equivalent
indicia that such program has been satisfactorily completed,
but only if such program, or such affiliated school or such
hospital or university or such independent school is
accredited.
``(6) Accredited.--
``(A) In general.--Except as provided in
subparagraph (B), the term `accredited' when applied to
any program of nurse education means a program
accredited by a recognized body or bodies, or by a
State agency, approved for such purpose by the
Secretary of Education and when applied to a hospital,
school, college, or university (or a unit thereof)
means a hospital, school, college, or university (or a
unit thereof) which is accredited by a recognized body
or bodies, or by a State agency, approved for such
purpose by the Secretary of Education. For the purpose
of this paragraph, the Secretary of Education shall
publish a list of recognized accrediting bodies, and of
State agencies, which the Secretary of Education
determines to be reliable authority as to the quality
of education offered.
``(B) New programs.--A new school of nursing that,
by reason of an insufficient period of operation, is
not, at the time of the submission of an application
for a grant or contract under this title, eligible for
accreditation by such a recognized body or bodies or
State agency, shall be deemed accredited for purposes
of this title if the Secretary of Education finds,
after consultation with the appropriate accreditation
body or bodies, that there is reasonable assurance that
the school will meet the accreditation standards of
such body or bodies prior to the beginning of the
academic year following the normal graduation date of
students of the first entering class in such school.
``(7) Nonprofit.--The term `nonprofit' as applied to any
school, agency, organization, or institution means one which is
a corporation or association, or is owned and operated by one
or more corporations or associations, no part of the net
earnings of which inures, or may lawfully inure, to the benefit
of any private shareholder or individual.
``(8) State.--The term `State' means a State, the
Commonwealth of Puerto Rico, the District of Columbia, the
Commonwealth of the Northern Mariana Islands, Guam, American
Samoa, the Virgin Islands, or the Trust Territory of the
Pacific Islands.
``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. 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.
``SEC. 804. MATCHING REQUIREMENT.
``The Secretary may require that an entity that applies for a grant
or contract under this title provide non-Federal matching funds, as
appropriate, to ensure the institutional commitment of the entity to
the projects funded under the grant. Such non-Federal matching funds
may be provided directly or through donations from public or private
entities and may be in cash or in-kind, fairly evaluated, including
plant, equipment, or services.
``SEC. 805. PREFERENCE.
``In awarding grants or contracts under this title, the Secretary
shall give preference to applicants with projects that will
substantially benefit rural or underserved populations.
``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 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.
``(b) Information Requirements.--Recipients of grants and contracts
under this title shall meet information requirements as specified by
the Secretary.
``(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.--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. Each peer review
group under this subsection shall be composed principally of
individuals who are not officers or employees of the Federal
Government. This subsection shall be carried out by the Secretary
acting through the Administrator of the Health Resources and Services
Administration.
``SEC. 807. NATIONAL ADVISORY COUNCIL ON NURSE EDUCATION AND PRACTICE.
``(a) Establishment.--There is hereby established a National
Advisory Council on Nurse Education and Practice (in this section
referred to as the `Council'), consisting of the Secretary or the
delegate of the Secretary (who shall be an ex officio member and shall
serve as the Chairperson), and 15 members appointed by the Secretary
without regard to the Federal civil service laws, of which--
``(1) 2 shall be selected from full-time students enrolled
in schools of nursing;
``(2) 3 shall be selected from the general public;
``(3) 2 shall be selected from practicing professional
nurses; and
``(4) 8 shall be selected from among the leading
authorities in the various fields of nursing, higher, and
secondary education, and from representatives of hospitals and
other institutions and organizations which provide nursing
services.
A majority of the members shall be nurses. The student-members of the
Council shall be appointed for terms of one year and shall be eligible
for reappointment to the Council.
``(b) Duties.--The Council shall advise the Secretary 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.
``(c) Funding.--Amounts appropriated under this title may be
utilized by the Secretary to support the nurse education and practice
activities of the Council.
``SEC. 808. TECHNICAL ASSISTANCE.
``Funds appropriated under this title may be used by the Secretary
to provide technical assistance in relation to any of the authorities
under this title.
``SEC. 809. RECOVERY FOR CONSTRUCTION ASSISTANCE.
``(a) In General.--If at any time within 20 years (or within such
shorter period as the Secretary may prescribe by regulation for an
interim facility) after the completion of construction of a facility
with respect to which funds have been paid under subpart I of part A
(as such subpart was in effect on September 30, 1985)--
``(1) the owner of the facility ceases to be a public or
nonprofit school,
``(2) the facility ceases to be used for the training
purposes for which it was constructed, or
``(3) the facility is used for sectarian instruction or as
a place for religious worship,
the United States shall be entitled to recover from the owner of the
facility the base amount prescribed by subsection (c)(1) plus the
interest (if any) prescribed by subsection (c)(2).
``(b) Notice of Change in Status.--The owner of a facility which
ceases to be a public or nonprofit school as described in paragraph (1)
of subsection (a), or the owner of a facility the use of which changes
as described in paragraph (2) or (3) of such subsection shall provide
the Secretary written notice of such cessation or change of use within
10 days after the date on which such cessation or change of use occurs
or within 30 days after the date of enactment of the Health Professions
Training Assistance Act of 1985, whichever is later.
``(c) Amount of Recovery.--
``(1) Base amount.--The base amount that the United States
is entitled to recover under subsection (a) is the amount
bearing the same ratio to the then value (as determined by the
agreement of the parties or in an action brought in the
district court of the United States for the district in which
the facility is situated) of the facility as the amount of the
Federal participation bore to the cost of the construction.
``(2) Interest.--
``(A) In general.--The interest that the United
States is entitled to recover under subsection (a) is
the interest for the period (if any) described in
subparagraph (B) at a rate (determined by the
Secretary) based on the average of the bond equivalent
rates of 91-day Treasury bills auctioned during such
period.
``(B) Time period.--The period referred to in
subparagraph (A) is the period beginning--
``(i) if notice is provided as prescribed
by subsection (b), 191 days after the date on
which the owner of the facility ceases to be a
public or nonprofit school as described in
paragraph (1) of subsection (a), or 191 days
after the date on which the use of the facility
changes as described in paragraph (2) or (3) of
such subsection, or
``(ii) if notice is not provided as
prescribed by subsection (b), 11 days after the
date on which such cessation or change of use
occurs,
and ending on the date the amount the United States is
entitled to recover if collected.
``(d) Waiver of Rights.--The Secretary may waive the recovery
rights of the United States under subsection (a)(2) with respect to a
facility (under such conditions as the Secretary may establish by
regulation) if the Secretary determines that there is good cause for
waiving such rights.
``(e) Limitation on Liens.--The right of recovery of the United
States under subsection (a) shall not, prior to judgment, constitute a
lien on any facility.
``PART B--NURSE PRACTITIONERS, NURSE MIDWIVES, AND OTHER ADVANCED
PRACTICE NURSES
``SEC. 811. ADVANCED PRACTICE 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
practice nursing education and practice; and
``(2) traineeships for individuals in advanced practice
nursing programs.
``(b) Definition of Advanced Practice Nurses.--For purposes of this
section, the term `advanced practice nurses' means nurses trained in
advanced degree programs including individuals in combined R.N./
Master's degree programs, post-nursing master's certificate programs,
or, in the case of nurse midwives or nurse anesthetists, in certificate
programs that received funding under this title on the date that is one
day prior to the date of enactment of this section, to serve as nurse
practitioners, nurse midwives, nurse anesthetists, nurse educators, or
public health nurses, or in other nurse specialties determined by the
secretary to require advanced education.
``(c) Authorized Nurse Practitioner and Nurse-Midwifery Programs.--
``(1) In general.--Nurse practitioner and nurse midwifery
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--
``(A) meet guidelines prescribed by the Secretary
in accordance with paragraph (2); and
``(B) 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 and other health care institutions.
``(2) Guidelines.--After consultation with appropriate
educational organizations and professional nursing and medical
organizations, the Secretary shall prescribe guidelines for
programs described in paragraph (1). Such guidelines shall, as
a minimum, require that such a program--
``(A) extend for at least one academic year and
consist of--
``(i) supervised clinical practice directed
toward preparing nurses to deliver primary
health care; and
``(ii) at least four months (in the
aggregate) of classroom instruction that is so
directed; and
``(B) have an enrollment of not less than six full-
time equivalent students.
``(d) Other Authorized Educational Programs.--The Secretary shall
prescribe guidelines as appropriate for other advanced practice nurse
education programs eligible for support under this section.
``(e) 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 pay all
or part of the costs of--
``(A) the tuition, books, and fees of the program
of advanced nursing practice 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) Doctoral programs.--The Secretary may not obligate
more than 10 percent of the traineeships under subsection (a)
for individuals in doctorate degree programs.
``(3) 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 practice nurses who will
practice in health professional shortage areas designated under
section 332.
``(f) Authorization of Appropriations.--
``(1) In general.--There are authorized to be appropriated
to carry out this section, $50,000,000 for fiscal year 1995,
and such sums as may be necessary for each of the fiscal years
1996 and 1997.
``(2) Set asides.--Of the amount appropriated under
paragraph (1) for a fiscal year--
``(A) not less than 60 percent of such amount shall
be made available for projects to enhance the training
and practice of nurse practitioners and nurse midwives;
and
``(B) not less than 6 percent of such amounts shall
be made available for projects to enhance the training
and practice of nurse anesthetists.
``PART C--INCREASING NURSING WORKFORCE DIVERSITY
``SEC. 821. WORKFORCE DIVERSITY GRANTS.
``(a) In General.--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 racial and ethnic backgrounds underrepresented among
registered nurses by providing student scholarships or stipends, pre-
entry preparation, and retention activities.
``(b) Guidance.--In carrying out subsection (a), the Secretary
shall take into consideration the recommendations of the First and
Second Invitational Congresses for Minority Nurse Leaders on `Caring
for the Emerging Majority,' in 1992 and 1993, and consult with nursing
associations including the American Nurses Association, the National
League for Nursing, the American Association of Colleges of Nursing,
the Black Nurses Association, the Association of Hispanic Nurses, the
Association of Asian American and Pacific Islander Nurses, the National
Nurses Association, the Native American Indian and Alaskan Nurses
Association.
``(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 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, $5,000,000 for fiscal year
1995, and such sums as may be necessary for each of the fiscal years
1996 and 1997.
``PART D--STRENGTHENING CAPACITY FOR BASIC NURSE EDUCATION AND PRACTICE
``SEC. 831. BASIC NURSE EDUCATION AND PRACTICE GRANTS.
``(a) In General.--The Secretary may award grants to and enter into
contracts with eligible entities for projects to strengthen capacity
for basic nurse education and practice.
``(b) Priority Areas.--In awarding grants or contracts under this
section the Secretary shall give priority to entities that will use
amounts provided under such a grant or contract to enhance the
education mix and utilization of the basic nursing workforce by
strengthening programs that provide basic nurse education for purposes
of--
``(1) improving nursing services in schools and other
community settings;
``(2) providing care for underserved populations and other
high-risk groups such as the elderly, individuals with HIV-
AIDS, substance abusers, homeless, and battered women;
``(3) providing case management, quality improvement,
delegation and supervision, other skills needed under new
health care systems;
``(4) developing cultural competencies among nurses;
``(5) providing emergency health services;
``(6) promoting career mobility for nursing personnel in a
variety of training settings and cross training or specialty
training among diverse population groups; or
``(7) other priority areas as determined by the Secretary.
``(c) Authorization of Appropriations.--There are authorized to be
appropriated to carry out this section, $12,000,000 for fiscal year
1995, and such sums as may be necessary for each of the fiscal years
1996 and 1997.''; and
(7) by redesignating section 855 as section 810, and
transferring such section so as to appear after section 809 (as
added by the amendment made by paragraph (6)).
SEC. 4. SAVINGS PROVISION AND TECHNICAL AMENDMENTS.
(a) Savings Provision.--In the case of any authority for making
awards of grants or contracts that is terminated by the amendment made
by section 3, the Secretary of Health and Human Services may,
notwithstanding the termination of the authority, continue in effect
any grant or contract made under the authority that is in effect on the
day before the date of the enactment of this Act, subject to the
duration of any such grant or contract not exceeding the period
determined by the Secretary in first approving such financial
assistance, or in approving the most recent request made (before the
date of such enactment) for continuation of such assistance, as the
case may be.
(b) Clinical Researchers.--Paragraph (3) of section 487E(a) of the
Public Health Service Act (42 U.S.C. 288-5(a)(3)) is amended to read as
follows:
``(3) Applicability of certain provisions regarding
obligated service.--With respect to the National Health Service
Corps loan repayment program established in subpart III of part
D of title III, the provisions of such subpart shall, except as
inconsistent with this section, apply to the program
established in subsection (a) in the same manner and to the
same extent as such provisions apply to the National Health
Service Corps loan repayment programs.''.
(c) Technical Amendments.--Section 839 of such Act (42 U.S.C. 297e)
is amended--
(1) in subsection (a)--
(A) by striking the matter preceding paragraph (1)
and inserting the following:
``(a) If a school terminates a loan fund established under an
agreement pursuant to section 835(b), or if the Secretary for good
cause terminates the agreement with the school, there shall be a
capital distribution as follows:''; and
(B) in paragraph (1), by striking ``at the close of
September 30, 1999,'' and inserting ``on the date of
termination of the fund''; and
(2) in subsection (b), to read as follows:
``(b) If a capital distribution is made under subsection (a), the
school involved shall, after such capital distribution, pay to the
Secretary, not less often than quarterly, the same proportionate share
of amounts received by the school in payment of principal or interest
on loans made from the loan fund established under section 835(b) as
determined by the Secretary under subsection (a).''.
SEC. 5. EFFECTIVE DATE.
This Act shall take effect on October 1, 1994, or the date of
enactment of this Act, whichever is later.
Passed the Senate October 6 (legislative day, September
12), 1994.
Attest:
MARTHA S. POPE,
Secretary.
S 2433 RFH----2