110 HR 5924 IH: Emergency Nursing Supply Relief
U.S. House of Representatives
2008-04-29
text/xml
EN
Pursuant to Title 17 Section 105 of the United States Code, this file is not subject to copyright protection and is in the public domain.
1.This Act may be cited as the
Emergency Nursing Supply Relief
Act
.
2.
(a)Section 106 of the American Competitiveness in the
Twenty-first Century Act of 2000 (Public Law 106–313; 8 U.S.C. 1153 note) is
amended by adding at the end the following:
(e)Visa Shortage
Relief for Nurses and Physical Therapists
(1)Subject to paragraph (2), for petitions filed during the
period beginning on the date of the enactment of the Emergency Nursing Supply
Relief Act and ending on September 30, 2011, for employment-based immigrants
(and their family members accompanying or following to join under section
203(d) of the Immigration and Nationality Act (8 U.S.C. 1153(d)), which are or
have been approved based on Schedule A, Group I as defined in section 656.5 of
title 20, Code of Federal Regulations, as promulgated by the Secretary of
Labor, the numerical limitations set forth in sections 201(d) and 202(a) of
such Act (8 U.S.C. 1151(d) and 1152(a)) shall not apply.
(2)Limitation on
number of visasThe Secretary
of State may not issue more than 20,000 immigrant visa numbers in any one
fiscal year (plus any available visa numbers under this paragraph not used
during the preceding fiscal year) to principal beneficiaries of petitions
pursuant to paragraph (1).
(3)The Secretary of Homeland Security shall provide a process
for reviewing and acting upon petitions with respect to immigrants described in
paragraph (1) not later than 30 days after the date on which a completed
petition has been filed.
(f)Fee for use of
visas under subsection (a)
(1)The Secretary of Homeland Security shall impose a fee
upon each petitioning employer who uses a visa provided under subsection (e) to
provide employment for an alien as a professional nurse, except that—
(A)such fee shall be
in the amount of $1,500 for each such alien nurse (but not for dependents
accompanying or following to join who are not professional nurses); and
(B)no fee shall be
imposed for the use of such visas if the employer demonstrates to the Secretary
that—
(i)the employer is a
health care facility that is located in a county or parish that received
individual and public assistance pursuant to Major Disaster Declaration number
1603 or 1607; or
(ii)the employer is a
health care facility that has been designated as a Health Professional Shortage
Area facility by the Secretary of Health and Human Services as defined in
section 332 of the Public Health Service Act (42 U.S.C. 254e).
(2)A fee imposed by the Secretary of Homeland Security
pursuant to paragraph (1) shall be collected by the Secretary as a condition of
approval of an application for adjustment of status by the beneficiary of a
petition or by the Secretary of State as a condition of issuance of a visa to
such
beneficiary.
.
(b)Capitation
grants To increase the number of nursing faculty and students; domestic nursing
enhancement accountPart D of title VIII of the Public Health
Service Act (42 U.S.C. 296p et seq.) is amended by adding at the end the
following:
832.
(a)For the purpose described in subsection (b), the
Secretary, acting through the Health Resources and Services Administration,
shall award a grant each fiscal year in an amount determined in accordance with
subsection (c) to each eligible school of nursing that submits an application
in accordance with this section.
(b)A
funding agreement for a grant under this section is that the eligible school of
nursing involved will expend the grant to increase the number of nursing
faculty and students at the school, including by hiring new faculty, retaining
current faculty, purchasing educational equipment and audiovisual laboratories,
enhancing clinical laboratories, repairing and expanding infrastructure, or
recruiting students.
(c)
(1)Subject to paragraph (2), the amount of a grant to an
eligible school of nursing under this section for a fiscal year shall be the
total of the following:
(A)$1,800 for each
full-time or part-time student who is enrolled at the school in a graduate
program in nursing that—
(i)leads to a
master’s degree, a doctoral degree, or an equivalent degree; and
(ii)prepares
individuals to serve as faculty through additional course work in education and
ensuring competency in an advanced practice area.
(B)$1,405 for each
full-time or part-time student who—
(i)is
enrolled at the school in a program in nursing leading to a bachelor of science
degree, a bachelor of nursing degree, a graduate degree in nursing if such
program does not meet the requirements of subparagraph (A), or an equivalent
degree; and
(ii)has not more than
3 years of academic credits remaining in the program.
(C)$966 for each
full-time or part-time student who is enrolled at the school in a program in
nursing leading to an associate degree in nursing or an equivalent
degree.
(2)In
calculating the amount of a grant to a school under paragraph (1), the
Secretary may not make a payment with respect to a particular student—
(A)for more than 2
fiscal years in the case of a student described in paragraph (1)(A) who is
enrolled in a graduate program in nursing leading to a master’s degree or an
equivalent degree;
(B)for more than 4
fiscal years in the case of a student described in paragraph (1)(A) who is
enrolled in a graduate program in nursing leading to a doctoral degree or an
equivalent degree;
(C)for more than 3
fiscal years in the case of a student described in paragraph (1)(B); or
(D)for more than 2
fiscal years in the case of a student described in paragraph (1)(C).
(d)In
this section, the term eligible school of nursing
means a school
of nursing that—
(1)is accredited by a
nursing accrediting agency recognized by the Secretary of Education;
(2)has a passage rate
on the National Council Licensure Examination for Registered Nurses of not less
than 80 percent for each of the 3 academic years preceding submission of the
grant application; and
(3)has a graduation
rate (based on the number of students in a class who graduate relative to, for
a baccalaureate program, the number of students who were enrolled in the class
at the beginning of junior year or, for an associate degree program, the number
of students who were enrolled in the class at the end of the first year) of not
less than 80 percent for each of the 3 academic years preceding submission of
the grant application.
(e)The
Secretary may award a grant under this section to an eligible school of nursing
only if the school gives assurances satisfactory to the Secretary that, for
each academic year for which the grant is awarded, the school will comply with
the following:
(1)The school will
maintain a passage rate on the National Council Licensure Examination for
Registered Nurses of not less than 80 percent.
(2)The school will
maintain a graduation rate (as described in subsection (d)(3)) of not less than
80 percent.
(3)(A)Subject to subparagraphs
(B) and (C), the first-year enrollment of full-time nursing students in the
school will exceed such enrollment for the preceding academic year by 5 percent
or 5 students, whichever is greater.
(B)Subparagraph (A) shall not apply to
the first academic year for which a school receives a grant under this
section.
(C)With respect to any academic year, the
Secretary may waive application of subparagraph (A) if—
(i)the physical facilities at the
school involved limit the school from enrolling additional students; or
(ii)the school has increased
enrollment in the school (as described in subparagraph (A)) for each of the 2
preceding academic years.
(4)Not later than 1
year after receiving a grant under this section, the school will formulate and
implement a plan to accomplish at least 2 of the following:
(A)Establishing or
significantly expanding an accelerated baccalaureate degree nursing program
designed to graduate new nurses in 12 to 18 months.
(B)Establishing
cooperative intradisciplinary education among schools of nursing with a view
toward shared use of technological resources, including information
technology.
(C)Establishing
cooperative interdisciplinary training between schools of nursing and schools
of allied health, medicine, dentistry, osteopathy, optometry, podiatry,
pharmacy, public health, or veterinary medicine, including training for the use
of the interdisciplinary team approach to the delivery of health
services.
(D)Integrating core
competencies on evidence-based practice, quality improvements, and
patient-centered care.
(E)Increasing
admissions, enrollment, and retention of qualified individuals who are
financially disadvantaged.
(F)Increasing
enrollment of minority and diverse student populations.
(G)Increasing
enrollment of new graduate baccalaureate nursing students in graduate programs
that educate nurse faculty members.
(H)Developing
post-baccalaureate residency programs to prepare nurses for practice in
specialty areas where nursing shortages are most severe.
(I)Increasing
integration of geriatric content into the core curriculum.
(J)Partnering with
economically disadvantaged communities to provide nursing education.
(K)Expanding the
ability of nurse managed health centers to provide clinical education training
sites to nursing students.
(5)The school will
submit an annual report to the Secretary that includes updated information on
the school with respect to student enrollment, student retention, graduation
rates, passage rates on the National Council Licensure Examination for
Registered Nurses, the number of graduates employed as nursing faculty or
nursing care providers within 12 months of graduation, and the number of
students who are accepted into graduate programs for further nursing
education.
(6)The school will
allow the Secretary to make on-site inspections, and will comply with the
Secretary’s requests for information, to determine the extent to which the
school is complying with the requirements of this section.
(f)The Secretary shall evaluate the results of grants under
this section and submit to Congress—
(1)not later than 18
months after the date of the enactment of this section, an interim report on
such results; and
(2)not later than
September 30, 2010, a final report on such results.
(g)An
eligible school of nursing seeking a grant under this section shall submit an
application to the Secretary at such time, in such manner, and containing such
information and assurances as the Secretary may require.
(h)Authorization of
appropriationsIn addition to the amounts in the Domestic Nursing
Enhancement Account, established under section 833, there are authorized to be
appropriated such sums as may be necessary to carry out this section.
833.Domestic
nursing enhancement account
(a)There
is established in the general fund of the Treasury a separate account which
shall be known as the Domestic Nursing Enhancement Account.
Notwithstanding any other provision of law, there shall be deposited as
offsetting receipts into the account all fees collected under section 106(f) of
the American Competitiveness in the Twenty-first Century Act of 2000 (Public
Law 106–313; 8 U.S.C. 1153 note). Nothing in this subsection shall prohibit the
depositing of other moneys into the account established under this
section.
(b)Amounts collected under section 106(f) of the American
Competitiveness in the Twenty-first Century Act of 2000, and deposited into the
account established under subsection (a) shall be used by the Secretary of
Health and Human Services to carry out section 832. Such amounts shall be
available for obligation only to the extent, and in the amount, provided in
advance in appropriations Acts. Such amounts are authorized to remain available
until
expended.
.
(c)Global health
care cooperation
(1)Title III of the Immigration and Nationality Act (8
U.S.C. 1401 et seq.) is amended by inserting after section 317 the
following:
317A.Temporary
absence of aliens providing health care in developing countries
(a)Notwithstanding any other provision of this Act, the
Secretary of Homeland Security shall allow an eligible alien and the spouse or
child of such alien to reside in a candidate country during the period that the
eligible alien is working as a physician or other health care worker in a
candidate country. During such period the eligible alien and such spouse or
child shall be considered—
(1)to be physically
present and residing in the United States for purposes of naturalization under
section 316(a); and
(2)to meet the
continuous residency requirements under section 316(b).
(b)In
this section:
(1)The term candidate country
means a country
that the Secretary of State determines to be—
(A)eligible for
assistance from the International Development Association, in which the per
capita income of the country is equal to or less than the historical ceiling of
the International Development Association for the applicable fiscal year, as
defined by the International Bank for Reconstruction and Development;
(B)classified as a
lower middle income country in the then most recent edition of the World
Development Report for Reconstruction and Development published by the
International Bank for Reconstruction and Development and having an income
greater than the historical ceiling for International Development Association
eligibility for the applicable fiscal year; or
(C)qualified to be a
candidate country due to special circumstances, including natural disasters or
public health emergencies.
(2)The term eligible alien
means an alien
who—
(A)has been lawfully
admitted to the United States for permanent residence; and
(B)is a physician or
other healthcare worker.
(c)The
Secretary of Homeland Security shall consult with the Secretary of State in
carrying out this section.
(d)The
Secretary of State shall publish—
(1)not later than 180
days after the date of the enactment of this section, a list of candidate
countries;
(2)an updated version
of the list required by paragraph (1) not less often than once each year;
and
(3)an amendment to
the list required by paragraph (1) at the time any country qualifies as a
candidate country due to special circumstances under subsection
(b)(1)(C).
.
(2)
(A)Not
later than 180 days after the date of the enactment of this Act, the Secretary
of Homeland Security shall promulgate regulations to carry out the amendments
made by this subsection.
(B)The
regulations promulgated pursuant to paragraph (1) shall—
(i)permit an eligible
alien (as defined in section 317A of the Immigration and Nationality Act, as
added by paragraph (1)) and the spouse or child of the eligible alien to reside
in a foreign country to work as a physician or other healthcare worker as
described in subsection (a) of such section 317A for not less than a 12-month
period and not more than a 24-month period, and shall permit the Secretary to
extend such period for an additional period not to exceed 12 months, if the
Secretary determines that such country has a continuing need for such a
physician or other healthcare worker;
(ii)provide for the
issuance of documents by the Secretary to such eligible alien, and such spouse
or child, if appropriate, to demonstrate that such eligible alien, and such
spouse or child, if appropriate, is authorized to reside in such country under
such section 317A; and
(iii)provide for an
expedited process through which the Secretary shall review applications for
such an eligible alien to reside in a foreign country pursuant to subsection
(a) of such section 317A if the Secretary of State determines a country is a
candidate country pursuant to subsection (b)(1)(C) of such section 317A.
(3)Technical and
conforming amendments
(A)Section
101(a)(13)(C)(ii) of the Immigration and Nationality Act (8 U.S.C.
1101(a)(13)(C)(ii)) is amended by adding at the end the following:
except in the case of an eligible alien, or the spouse or child of such
alien, who is authorized to be absent from the United States under section
317A,
.
(B)Section 211(b) of such Act (8 U.S.C. 1181(b)) is
amended by inserting , including an eligible alien authorized to reside
in a foreign country under section 317A and the spouse or child of such
eligible alien, if appropriate,
after
101(a)(27)(A),
.
(C)Section 212(a)(7)(A)(i)(I) of such Act (8 U.S.C.
1182(a)(7)(A)(i)(I)) is amended by inserting other than an eligible
alien authorized to reside in a foreign country under section 317A and the
spouse or child of such eligible alien, if appropriate,
after
Act,
.
(D)The table of contents of such Act is amended by
inserting after the item relating to section 317 the following:
Sec. 317A. Temporary absence of aliens
providing health care in developing
countries.
.
(4)Authorization of
appropriationsThere are authorized to be appropriated to U.S.
Citizenship and Immigration Services such sums as may be necessary to carry out
this subsection and the amendments made by this subsection.
(d)Attestation by
health care workers
(1)Section 212(a)(5) of the Immigration and Nationality
Act (8 U.S.C. 1182(a)(5)) is amended by adding at the end the following:
(E)Health care
workers with other obligations
(i)An alien who seeks to enter the United States for the
purpose of performing labor as a physician or other health care worker is
inadmissible unless the alien submits to the Secretary of Homeland Security or
the Secretary of State, as appropriate, an attestation that the alien is not
seeking to enter the United States for such purpose during any period in which
the alien has an outstanding obligation to the government of the alien’s
country of origin or the alien’s country of residence.
(ii)In this subparagraph, the term obligation
means an obligation incurred as part of a valid, voluntary individual agreement
in which the alien received financial assistance to defray the costs of
education or training to qualify as a physician or other health care worker in
consideration for a commitment to work as a physician or other health care
worker in the alien’s country of origin or the alien’s country of
residence.
(iii)The
Secretary of Homeland Security may waive a finding of inadmissibility under
clause (i) if the Secretary determines that—
(I)the obligation was
incurred by coercion or other improper means;
(II)the alien and the
government of the country to which the alien has an outstanding obligation have
reached a valid, voluntary agreement, pursuant to which the alien’s obligation
has been deemed satisfied, or the alien has shown to the satisfaction of the
Secretary that the alien has been unable to reach such an agreement because of
coercion or other improper means; or
(III)the obligation
should not be enforced due to other extraordinary circumstances, including
undue hardship that would be suffered by the alien in the absence of a
waiver.
.
(2)Effective date;
application
(A)The amendment made by paragraph (1) shall take effect on the
date that is 180 days after the date of the enactment of this Act.
(B)Application by
the SecretaryNot later than the effective date described in
subparagraph (A), the Secretary of Homeland Security shall begin to carry out
subparagraph (E) of section 212(a)(5) of the Immigration and Nationality Act,
as added by paragraph (1), including the requirement for the attestation and
the granting of a waiver described in clause (iii) of such subparagraph (E),
regardless of whether regulations to implement such subparagraph have been
promulgated.
3.Nurse Training
and Retention Demonstration Grant Act of 2008
(a)Congress
makes the following findings:
(1)America’s
healthcare system depends on an adequate supply of trained nurses to deliver
quality patient care.
(2)Over the next 15
years, this shortage is expected to grow significantly. The Health Resources
and Services Administration has projected that by 2020, there will be a
shortage of nurses in every State and that overall only 64 percent of the
demand for nurses will be satisfied, with a shortage of 1,016,900 nurses
nationally.
(3)To avert such a
shortage, today’s network of healthcare workers should have access to education
and support from their employers to participate in educational and training
opportunities.
(4)With the
appropriate education and support, incumbent healthcare workers and incumbent
bedside nurses are untapped sources which can meet these needs and address the
nursing shortage and provide quality care as the American population
ages.
(b)Purposes of grant
programIt is the purpose of this section to authorize grants
to—
(1)address the
projected shortage of nurses by funding comprehensive programs to create a
career ladder to nursing (including Certified Nurse Assistants, Licensed
Practical Nurses, Licensed Vocational Nurses, and Registered Nurses) for
incumbent ancillary healthcare workers;
(2)increase the
capacity for educating nurses by increasing both nurse faculty and clinical
opportunities through collaborative programs between staff nurse organizations,
healthcare providers, and accredited schools of nursing; and
(3)provide training
programs through education and training organizations jointly administered by
healthcare providers and healthcare labor organizations or other organizations
representing staff nurses and frontline healthcare workers, working in
collaboration with accredited schools of nursing and academic
institutions.
(c)Not
later than 6 months after the date of enactment of this Act, the Secretary of
Labor (referred to in this section as the Secretary
) shall
establish a partnership grant program to award grants to eligible entities to
carry out comprehensive programs to provide education to nurses and create a
pipeline to nursing for incumbent ancillary healthcare workers who wish to
advance their careers, and to otherwise carry out the purposes of this
section.
(d)To be eligible to receive a grant under this section an
entity shall—
(1)be—
(A)a healthcare
entity that is jointly administered by a healthcare employer and a labor union
representing the healthcare employees of the employer and that carries out
activities using labor management training funds as provided for under section
302 of the Labor-Management Relations Act, 1947 (18 U.S.C. 186(c)(6));
(B)an entity that
operates a training program that is jointly administered by—
(i)one
or more healthcare providers or facilities, or a trade association of
healthcare providers; and
(ii)one
or more organizations which represent the interests of direct care healthcare
workers or staff nurses and in which the direct care healthcare workers or
staff nurses have direct input as to the leadership of the organization;
or
(C)a State training
partnership program that consists of non-profit organizations that include
equal participation from industry, including public or private employers, and
labor organizations including joint labor-management training programs, and
which may include representatives from local governments, worker investment
agency one-stop career centers, community based organizations, community
colleges, and accredited schools of nursing; and
(2)submit to the
Secretary an application at such time, in such manner, and containing such
information as the Secretary may require.
(e)Additional
requirements for healthcare employer desrribed in subsection
(d)To be eligible for a grant
under this section, a healthcare employer described in subsection (d) shall
demonstrate—
(1)an established
program within their facility to encourage the retention of existing
nurses;
(2)it provides wages
and benefits to its nurses that are competitive for its market or that have
been collectively bargained with a labor organization; and
(3)support for
programs funded under this section through 1 or more of the following:
(A)The provision of
paid leave time and continued health coverage to incumbent healthcare workers
to allow their participation in nursing career ladder programs, including
Certified Nurse Assistants, Licensed Practical Nurses, Licensed Vocational
Nurses, and Registered Nurses.
(B)Contributions to a
joint labor-management or other jointly administered training fund which
administers the program involved.
(C)The provision of
paid release time, incentive compensation, or continued health coverage to
staff nurses who desire to work full- or part-time in a faculty
position.
(D)The provision of
paid release time for staff nurses to enable them to obtain a bachelor of
science in nursing degree, other advanced nursing degrees, specialty training,
or certification program.
(E)The payment of
tuition assistance to incumbent healthcare workers.
(f)
(1)
(A)The Secretary may not make a grant under this section
unless the applicant involved agrees, with respect to the costs to be incurred
by the applicant in carrying out the program under the grant, to make available
non-Federal contributions (in cash or in kind under subparagraph (B)) toward
such costs in an amount equal to not less than $1 for each $1 of Federal funds
provided in the grant. Such contributions may be made directly or through
donations from public or private entities, or may be provided through the cash
equivalent of paid release time provided to incumbent worker students.
(B)Determination of
amount of non-Federal contributionNon-Federal contributions
required in subparagraph (A) may be in cash or in kind (including paid release
time), fairly evaluated, including equipment or services (and excluding
indirect or overhead costs).
(C)Funds made available under this section shall
supplement, and not supplant, resources dedicated by an entity, or other
Federal, State, or localfunds available to carry out activities described in
this section.
(2)Entities carrying out or overseeing programs
carried out with assistance provided under this section shall demonstrate
collaboration with accredited schools of nursing which may include community
colleges and other academic institutions providing associate, bachelor’s, or
advanced nursing degree programs or specialty training or certification
programs.
(g)Amounts
awarded to an entity under a grant under this section shall be used for the
following:
(1)To carry out
programs that provide education and training to establish nursing career
ladders to educate incumbent healthcare workers to become nurses (including
Certified Nurse Assistants, Licensed Practical Nurses, Licensed Vocational
Nurses, and Registered Nurses). Such programs shall include one or more of the
following:
(A)Preparing
incumbent workers to return to the classroom through English as a second
language education, GED education, precollege counseling, college preparation
classes, and support with entry level college classes that are a prerequisite
to nursing.
(B)Providing tuition
assistance with preference for dedicated cohort classes in community colleges,
universities, accredited schools of nursing with supportive services including
tutoring and counseling.
(C)Providing
assistance in preparing for and meeting all nursing licensure tests and
requirements.
(D)Carrying out
orientation and mentorship programs that assist newly graduated nurses in
adjusting to working at the bedside to ensure their retention post graduation,
and ongoing programs to support nurse retention.
(E)Providing stipends
for release time and continued healthcare coverage to enable incumbent
healthcare workers to participate in these programs.
(2)To carry out
programs that assist nurses in obtaining advanced degrees and completing
specialty training or certification programs and to establish incentives for
nurses to assume nurse faculty positions on a part-time or full-time basis.
Such programs shall include one or more of the following:
(A)Increasing the
pool of nurses with advanced degrees who are interested in teaching by funding
programs that enable incumbent nurses to return to school.
(B)Establishing
incentives for advanced degree bedside nurses who wish to teach in nursing
programs so they can obtain a leave from their bedside position to assume a
full- or part-time position as adjunct or full time faculty without the loss of
salary or benefits.
(C)Collaboration with
accredited schools of nursing which may include community colleges and other
academic institutions providing associate, bachelor’s, or advanced nursing
degree programs, or specialty training or certification programs, for nurses to
carry out innovative nursing programs which meet the needs of bedside nursing
and healthcare providers.
(h)In
awarding grants under this section the Secretary shall give preference to
programs that—
(1)provide for
improving nurse retention;
(2)provide for
improving the diversity of the new nurse graduates to reflect changes in the
demographics of the patient population;
(3)provide for
improving the quality of nursing education to improve patient care and
safety;
(4)have demonstrated
success in upgrading incumbent healthcare workers to become nurses or which
have established effective programs or pilots to increase nurse faculty;
or
(5)are modeled after
or affiliated with such programs described in paragraph (4).
(i)
(1)An entity that receives a grant under this section
shall annually evaluate, and submit to the Secretary a report on, the
activities carried out under the grant and the outcomes of such activities.
Such outcomes may include—
(A)an increased
number of incumbent workers entering an accredited school of nursing and in the
pipeline for nursing programs;
(B)an increasing
number of graduating nurses and improved nurse graduation and licensure
rates;
(C)improved nurse
retention;
(D)an increase in the
number of staff nurses at the healthcare facility involved;
(E)an increase in the
number of nurses with advanced degrees in nursing;
(F)an increase in the
number of nurse faculty;
(G)improved measures
of patient quality as determined by the Secretary; and
(H)an increase in the
diversity of new nurse graduates relative to the patient population.
(2)Not later than September 30, 2011, the Secretary of Labor
shall, using data and information from the reports received under paragraph
(1), submit to Congress a report concerning the overall effectiveness of the
grant program carried out under this section.
(j)Authorization of
appropriationsThere are authorized to be appropriated to carry
out this section for fiscal years 2010, 2011, and 2012, such sums as may be
necessary. Funds appropriated under this subsection shall remain available
until expended without fiscal year limitation.