[House Report 114-803] [From the U.S. Government Publishing Office] 114th Congress } { Report HOUSE OF REPRESENTATIVES 2d Session } { 114-803 ====================================================================== TITLE VIII NURSING WORKFORCE REAUTHORIZATION ACT OF 2016 _______ November 14, 2016.--Committed to the Committee of the Whole House on the State of the Union and ordered to be printed _______ Mr. Upton, from the Committee on Energy and Commerce, submitted the following R E P O R T [To accompany H.R. 2713] The Committee on Energy and Commerce, to whom was referred the bill (H.R. 2713) to amend title VIII of the Public Health Service Act to extend advanced education nursing grants to support clinical nurse specialist programs, and for other purposes, having considered the same, report favorably thereon with an amendment and recommend that the bill as amended do pass. CONTENTS Page Purpose and Summary.............................................. 2 Background and Need for Legislation.............................. 2 Hearings......................................................... 3 Committee Consideration.......................................... 3 Committee Votes.................................................. 3 Committee Oversight Findings..................................... 3 Statement of General Performance Goals and Objectives............ 3 New Budget Authority, Entitlement Authority, and Tax Expenditures 4 Earmark, Limited Tax Benefits, and Limited Tariff Benefits....... 4 Committee Cost Estimate.......................................... 4 Congressional Budget Office Estimate............................. 4 Federal Mandates Statement....................................... 4 Duplication of Federal Programs.................................. 4 Disclosure of Directed Rule Makings.............................. 4 Advisory Committee Statement..................................... 4 Applicability to Legislative Branch.............................. 5 Section-by-Section Analysis of the Legislation................... 5 Changes in Existing Law Made by the Bill, as Reported............ 5 The amendment is as follows: Strike all after the enacting clause and insert the following: SECTION 1. SHORT TITLE. This Act may be cited as the ``Title VIII Nursing Workforce Reauthorization Act of 2016''. SEC. 2. SUPPORTING CLINICAL NURSE SPECIALISTS. (a) Advanced Education Nursing Grants.--Section 811 of the Public Health Service Act (42 U.S.C. 296j) is amended-- (1) in subsection (b), by inserting ``clinical nurse leaders,'' before ``or public health nurses''; (2) by redesignating subsections (f) and (g) as subsections (g) and (h), respectively; and (3) by inserting after subsection (e) the following new subsection: ``(f) Authorized Clinical Nurse Specialist Programs.--Clinical nurse specialist programs eligible for support under this section are education programs that-- ``(1) provide registered nurses with full-time clinical nurse specialist education; and ``(2) have as their objective the education of clinical nurse specialists who will upon completion of such a program be qualified to effectively provide care to inpatients and outpatients experiencing acute and chronic illness.''. (b) Definition of Nurse-Managed Health Clinic.--Section 801 of the Public Health Service Act (42 U.S.C. 296) is amended by adding at the end the following: ``(18) Nurse-managed health clinic.--The term `nurse-managed health clinic' has the meaning given to such term in section 330A-1.''. (c) National Advisory Council on Nurse Education and Practice.-- Section 851(b)(1)(A)(iv) of the Public Health Service Act (42 U.S.C. 297t(b)(1)(A)(iv)) is amended by striking ``and nurse anesthetists'' and inserting ``nurse anesthetists, and clinical nurse specialists''. SEC. 3. REAUTHORIZATION OF FUNDING FOR NURSING PROGRAMS. (a) In General.--Title VIII of the Public Health Service Act (42 U.S.C. 296 et seq.) is amended-- (1) in subsection (i)(1) of section 846 (42 U.S.C. 297n; loan repayment and scholarship programs), by striking ``such sums as may be necessary for each of fiscal years 2003 through 2007'' and inserting ``$83,135,000 for each of fiscal years 2017 through 2021''; (2) in subsection (f) of section 846A (42 U.S.C. 297n-1; nurse faculty loan program), by striking ``such sums as may be necessary for each of fiscal years 2010 through 2014'' and inserting ``$26,500,000 for each of fiscal years 2017 through 2021''; (3) in subsection (e) of section 865 (42 U.S.C. 298; comprehensive geriatric education), by striking ``such sums as may be necessary for each of fiscal years 2010 through 2014'' and inserting ``$38,737,000 for each of fiscal years 2017 through 2021''; and (4) in section 871 (42 U.S.C. 298d; funding for carrying out parts B, C, and D), by striking ``$338,000,000 for fiscal year 2010, and such sums as may be necessary for each of the fiscal years 2011 through 2016'' and inserting ``$119,837,000 for each of fiscal years 2017 through 2021''. (b) Conforming Changes.-- (1) Section 831 of the Public Health Service Act (42 U.S.C. 296p) is amended-- (A) in subsection (g), by striking ``,,'' and inserting ``,''; and (B) by striking subsection (h). (2) Section 831A of the Public Health Service Act (42 U.S.C. 296p-1) is amended by striking subsection (g). Purpose and Summary H.R. 2713 was introduced on June 10, 2015, by Rep. Lois Capps (D-CA) and Rep. David Joyce (R-OH). H.R. 2713 supports advanced education nursing grants and specifically reauthorizes loan repayment and scholarship programs, a nurse faculty loan program, and a comprehensive geriatric education program. Background and Need for Legislation The nursing workforce plays a critical role in ensuring that all Americans get the health care services they need. For example, they care for patients in hospitals and serve as primary care providers in health care clinics. Additionally, nursing continues to evolve to include new roles and functions. In recent years, advanced practice registered nurses have begun serving as clinical nurse specialists in addition to serving as nurse practitioners, nurse midwives, and nurse anesthetists. Despite their importance to the health care system, there are projected shortages that will leave too many patients without the nursing care services that they need. H.R. 2713 will help to increase and strengthen the nursing workforce in order to keep pace with the evolving roles that nurses play in the U.S. health care system. Hearings The Subcommittee on Health held a hearing on H.R. 2713 on December 9, 2015. The hearing was entitled ``Examining Legislation to Improve Health Care and Treatment'' and witnesses included the following:Chad Asplund, Director, Athletic Medicine and Head Team Physician, Georgia Southern University; Ovidio Bermudez, Chief Clinical Officer and Medical Director of Child and Adolescent Services, Eating Recovery Center; Ginger Breedlove, President, American College of Nurse Midwives; Anthony Gregg, Professor and Chief, Division of Maternal-Fetal Medicine, University of Florida Department of Obstetrics and Gynecology; Jonathan Reiner, Director, Cardiac Catheterization Laboratory, George Washington University Hospital; and Deborah Trautman, President and CEO, American Association of Colleges of Nursing. Committee Consideration On December 9, 2015, the Subcommittee on Health met in open markup session and forwarded H.R. 2713 to the full Committee, as amended, by a voice vote. On September 20 and 21, 2016, the full Committee on Energy and Commerce met in open markup session and ordered H.R. 2713 reported to the House, as amended, by a voice vote. Committee Votes Clause 3(b) of rule XIII of the Rules of the House of Representatives requires the Committee to list the record votes on the motion to report legislation and amendments thereto. There were no record votes taken in connection with ordering H.R. 2713 reported. Committee Oversight Findings Pursuant to clause 3(c)(1) of rule XIII of the Rules of the House of Representatives, the Committee has not held hearings on this legislation. Statement of General Performance Goals and Objectives This legislation supports advanced education nursing grants and specifically reauthorizes loan repayment and scholarship programs, a nurse faculty loan program, and a comprehensive geriatric education program. New Budget Authority, Entitlement Authority, and Tax Expenditures In compliance with clause 3(c)(2) of rule XIII of the Rules of the House of Representatives, the Committee finds that H.R. 2713, would result in no new or increased budget authority, entitlement authority, or tax expenditures or revenues. Earmark, Limited Tax Benefits, and Limited Tariff Benefits In compliance with clause 9(e), 9(f), and 9(g) of rule XXI of the Rules of the House of Representatives, the Committee finds that H.R. 2713 contains no earmarks, limited tax benefits, or limited tariff benefits. Committee Cost Estimate The Committee adopts as its own the cost estimate prepared by the Director of the Congressional Budget Office pursuant to section 402 of the Congressional Budget Act of 1974. At the time this report was filed, the estimate was not available. Congressional Budget Office Estimate At the time this report was filed, the cost estimate prepared by the Director of the Congressional Budget Office pursuant to section 402 of the Congressional Budget Act of 1974 was not available. Federal Mandates Statement The Committee adopts as its own the estimate of Federal mandates prepared by the Director of the Congressional Budget Office pursuant to section 423 of the Unfunded Mandates Reform Act. Duplication of Federal Programs No provision of H.R. 2713 establishes or reauthorizes a program of the Federal Government known to be duplicative of another Federal program, a program that was included in any report from the Government Accountability Office to Congress pursuant to section 21 of Public Law 111-139, or a program related to a program identified in the most recent Catalog of Federal Domestic Assistance. Disclosure of Directed Rule Makings The Committee estimates that enacting H.R. 2713 specifically directs to be completed no rule making within the meaning of 5 U.S.C. 551. Advisory Committee Statement No advisory committees within the meaning of section 5(b) of the Federal Advisory Committee Act were created by this legislation. Applicability to Legislative Branch The Committee finds that the legislation does not relate to the terms and conditions of employment or access to public services or accommodations within the meaning of section 102(b)(3) of the Congressional Accountability Act. Section-by-Section Analysis of the Legislation Section 1. Short title Section 1 provides that the Act may be cited as the ``Title VIII Nursing Workforce Reauthorization Act of 2016''. Section 2. Supporting clinical nurse specialists Section 2 updates various definitions in Title VIII. Section 3. Reauthorization of funding for nursing programs Section 3 reauthorizes funding for nursing programs at the fiscal year 2016 appropriated level. Changes in Existing Law Made by the Bill, as Reported In compliance with clause 3(e) of rule XIII of the Rules of the House of Representatives, changes in existing law made by the bill, as reported, are shown as follows (existing law proposed to be omitted is enclosed in black brackets, new matter is printed in italic, and existing law in which no change is proposed is shown in roman): PUBLIC HEALTH SERVICE ACT * * * * * * * TITLE VIII--NURSING WORKFORCE DEVELOPMENT 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, academic health centers, State or local governments, and other public or private nonprofit 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 an accredited (as defined in paragraph 6) collegiate, associate degree, or diploma school of nursing in a State where graduates are-- (A) authorized to sit for the National Council Licensure EXamination-Registered Nurse (NCLEX-RN); or (B) licensed registered nurses who will receive a graduate or equivalent degree or training to become an advanced education nurse as defined by section 811(b). (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, or to an equivalent degree, 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 program 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 program 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 a program. (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. (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. (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. (16) Accelerated nursing degree program.--The term ``accelerated nursing degree program'' means a program of education in professional nursing offered by an accredited school of nursing in which an individual holding a bachelors degree in another discipline receives a BSN or MSN degree in an accelerated time frame as determined by the accredited school of nursing. (17) Bridge or degree completion program.--The term ``bridge or degree completion program'' means a program of education in professional nursing offered by an accredited school of nursing, as defined in paragraph (2), that leads to a baccalaureate degree in nursing. Such programs may include, Registered Nurse (RN) to Bachelor's of Science of Nursing (BSN) programs, RN to MSN (Master of Science of Nursing) programs, or BSN to Doctoral programs. (18) Nurse-managed health clinic.--The term ``nurse- managed health clinic'' has the meaning given to such term in section 330A-1. * * * * * * * PART B--NURSE PRACTITIONERS, NURSE MIDWIVES, NURSE ANESTHETISTS, AND OTHER ADVANCED EDUCATION NURSES SEC. 811. ADVANCED EDUCATION 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 nursing education and practice; and (2) traineeships for individuals in advanced nursing education programs. (b) Definition of Advanced Education Nurses.--For purposes of this section, the term ``advanced education nurses'' means individuals 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, in certificate programs in existence on the date that is one day prior to the date of enactment of this section, to serve as nurse practitioners, clinical nurse specialists, nurse midwives, nurse anesthetists, nurse educators, nurse administrators, clinical nurse leaders, or public health nurses, or in other nurse specialties determined by the Secretary to require advanced education. (c) Authorized Nurse Practitioner.--Nurse practitioner 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-- (1) meet guidelines prescribed by the Secretary; and (2) 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, acute care, and other health care settings. (d) Authorized Nurse-midwifery Programs.--Midwifery programs that are eligible for support under this section are educational programs that-- (1) have as their objective the education of midwives; and (2) are accredited by the American College of Nurse- Midwives Accreditation Commission for Midwifery Education. (e) Authorized Nurse Anesthesia Programs.--Nurse anesthesia programs eligible for support under this section are education programs that-- (1) provide registered nurses with full-time anesthetist education; and (2) are accredited by the Council on Accreditation of Nurse Anesthesia Educational Programs. (f) Authorized Clinical Nurse Specialist Programs.--Clinical nurse specialist programs eligible for support under this section are education programs that-- (1) provide registered nurses with full-time clinical nurse specialist education; and (2) have as their objective the education of clinical nurse specialists who will upon completion of such a program be qualified to effectively provide care to inpatients and outpatients experiencing acute and chronic illness. [(f)] (g) Other Authorized Educational Programs.--The Secretary shall prescribe guidelines as appropriate for other advanced nurse education programs eligible for support under this section. [(g)] (h) 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 only pay all or part of the costs of-- (A) the tuition, books, and fees of the program of advanced nurse education 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) 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 education nurses who will practice in health professional shortage areas designated under section 332. * * * * * * * PART D--STRENGTHENING CAPACITY FOR BASIC NURSE EDUCATION AND PRACTICE SEC. 831. NURSE EDUCATION, PRACTICE, AND QUALITY 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; or (2) 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 coordinated care, 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 by promoting nurse involvement in the organizational and clinical decisionmaking 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, as defined in section 801(2)[,,], 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 2010 through 2014.] SEC. 831A. NURSE RETENTION GRANTS. (a) 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 subsection (b) or (c). (b) Grants for Career Ladder Program.--The Secretary may award grants to, and enter into contracts with, eligible entities for programs-- (1) to promote career advancement for individuals including licensed practical nurses, licensed vocational nurses, certified nurse assistants, home health aides, diploma degree or associate degree nurses, to become baccalaureate prepared registered nurses or advanced education nurses in order to meet the needs of the registered nurse workforce; (2) developing and implementing internships and residency programs in collaboration with an accredited school of nursing, as defined by section 801(2), to encourage mentoring and the development of specialties; or (3) to assist individuals in obtaining education and training required to enter the nursing profession and advance within such profession. (c) Enhancing Patient Care Delivery Systems.-- (1) 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 by promoting nurse involvement in the organizational and clinical decision-making processes of a health care facility. (2) Priority.--In making awards of grants under this subsection, the Secretary shall give preference to applicants that have not previously received an award under this subsection (or section 831(c) as such section existed on the day before the date of enactment of this section). (3) Continuation of an award.--The Secretary shall make continuation of any award under this subsection 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 retention, as determined by the Secretary. (e) 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. (f) Eligible Entity.--For purposes of this section, the term ``eligible entity'' includes an accredited school of nursing, as defined by section 801(2), a health care facility, or a partnership of such a school and facility. [(g) 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 2010 through 2012.] PART E--STUDENT LOANS * * * * * * * loan repayment and scholarship programs Sec. 846. (a) In General.--In the case of any individual-- (1) who has received a baccalaureate or associate degree in nursing (or an equivalent degree), a diploma in nursing, or a graduate degree in nursing; (2) who obtained (A) one or more loans from a loan fund established under subpart II, or (B) any other educational loan for nurse training costs; and (3) who enters into an agreement with the Secretary to serve as nurse for a period of not less than two years at a health care facility with a critical shortage of nurses, or in a accredited school of nursing, as defined by section 801(2), as nurse faculty; the Secretary shall make payments in accordance with subsection (b), for and on behalf of that individual, on the principal of and interest on any loan of that individual described in paragraph (2) of this subsection which is outstanding on the date the individual begins the service specified in the agreement described in paragraph (3) of this subsection. 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) Manner of Payments.--The payments described in subsection (a) shall be made by the Secretary as follows: (1) Upon completion by the individual for whom the payments are to be made of the first year of the service specified in the agreement entered into with the Secretary under subsection (a), the Secretary shall pay 30 percent of the principal of, and the interest on each loan of such individual described in subsection (a)(2) which is outstanding on the date he began such practice. (2) Upon completion by that individual of the second year of such service, the Secretary shall pay another 30 percent of the principal of, and the interest on each such loan. (3) Upon completion by that individual of a third year of such service, the Secretary shall pay another 25 percent of the principal of, and the interest on each such loan. (c) Payment by Due Date.--Notwithstanding the requirement of completion of practice specified in subsection (b), the Secretary shall, on or before the due date thereof, pay any loan or loan installment which may fall due within the period of service for which the borrower may receive payments under this subsection, upon the declaration of such borrower, at such times and in such manner as the Secretary may prescribe (and supported by such other evidence as the Secretary may reasonably require), that the borrower is then serving as described by subsection (a)(3), and that the borrower will continue to so serve for the period required (in the absence of this subsection) to entitle the borrower to have made the payments provided by this subsection for such period; except that not more than 85 percent of the principal of any such loan shall be paid pursuant to this 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 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. (e) Preferences Regarding Participants.--In entering into agreements under subsection (a) or (d), the Secretary shall give preference to qualified applicants with the greatest financial need. (f) Breach of Agreement.--The Secretary may make payments under subsection (a) on behalf of an individual only if the agreement under such subsection provides that section 860(c) is applicable to the individual. (g) Breach of Agreement.-- (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 section 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 subsection 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. (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. (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] $83,135,000 for each of fiscal years 2017 through 2021. (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). nurse faculty loan program Sec. 846A. (a) School of Nursing Student Loan Fund.--The Secretary, acting through the Administrator of the Health Resources and Services Administration, may enter into an agreement with any accredited 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 (a) may not exceed $35,500, during fiscal years 2010 and 2011 fiscal years (after fiscal year 2011, such amounts shall be adjusted to provide for a cost-of-attendance increase for the yearly loan rate and the aggregate loan; (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 an accredited 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 school's 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 an accredited 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 2010 through 2014] $26,500,000 for each of fiscal years 2017 through 2021. * * * * * * * PART F--NATIONAL ADVISORY COUNCIL ON NURSE EDUCATION AND PRACTICE SEC. 851. NATIONAL ADVISORY COUNCIL ON NURSE EDUCATION AND PRACTICE. (a) Establishment.--The Secretary shall establish an advisory council to be known as the National Advisory Council on Nurse Education and Practice (in this section referred to as the ``Advisory Council''). (b) Composition.-- (1) In general.--The Advisory Council shall be composed of-- (A) not less than 21, nor more than 23 individuals, who are not officers or employees of the Federal Government, appointed by the Secretary without regard to the Federal civil service laws, of which-- (i) 2 shall be selected from full- time students enrolled in schools of nursing; (ii) 2 shall be selected from the general public; (iii) 2 shall be selected from practicing professional nurses; and (iv) 9 shall be selected from among the leading authorities in the various fields of nursing, higher, secondary education, and associate degree schools of nursing, and from representatives of advanced education nursing groups (such as nurse practitioners, nurse midwives, [and nurse anesthetists] nurse anesthetists, and clinical nurse specialists), hospitals, and other institutions and organizations which provide nursing services; and (B) the Secretary (or the delegate of the Secretary (who shall be an ex officio member and shall serve as the Chairperson)). (2) Appointment.--Not later than 90 days after the date of enactment of this Act, the Secretary shall appoint the members of the Advisory Council and each such member shall serve a 4 year term. In making such appointments, the Secretary shall ensure a fair balance between the nursing professions, a broad geographic representation of members and a balance between urban and rural members. Members shall be appointed based on their competence, interest, and knowledge of the mission of the profession involved. A majority of the members shall be nurses. (3) Minority representation.--In appointing the members of the Advisory Council under paragraph (1), the Secretary shall ensure the adequate representation of minorities. (c) Vacancies.-- (1) In general.--A vacancy on the Advisory Council shall be filled in the manner in which the original appointment was made and shall be subject to any conditions which applied with respect to the original appointment. (2) Filling unexpired term.--An individual chosen to fill a vacancy shall be appointed for the unexpired term of the member replaced. (d) Duties.--The Advisory Council shall-- (1) provide advice and recommendations to the Secretary and Congress concerning policy matters arising in the administration of this title, including the range of issues relating to the nurse workforce, education, and practice improvement; (2) provide advice to the Secretary and Congress 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; and (3) not later than 3 years after the date of enactment of this section, and annually thereafter, prepare and submit to the Secretary, the Committee on Labor and Human Resources of the Senate, and the Committee on Commerce of the House of Representatives, a report describing the activities of the Council, including findings and recommendations made by the Council concerning the activities under this title. (e) Meetings and Documents.-- (1) Meetings.--The Advisory Council shall meet not less than 2 times each year. Such meetings shall be held jointly with other related entities established under this title where appropriate. (2) Documents.--Not later than 14 days prior to the convening of a meeting under paragraph (1), the Advisory Council shall prepare and make available an agenda of the matters to be considered by the Advisory Council at such meeting. At any such meeting, the Advisory Council shall distribute materials with respect to the issues to be addressed at the meeting. Not later than 30 days after the adjourning of such a meeting, the Advisory Council shall prepare and make available a summary of the meeting and any actions taken by the Council based upon the meeting. (f) Compensation and Expenses.-- (1) Compensation.--Each member of the Advisory Council shall be compensated at a rate equal to the daily equivalent of the annual rate of basic pay prescribed for level IV of the Executive Schedule under section 5315 of title 5, United States Code, for each day (including travel time) during which such member is engaged in the performance of the duties of the Council. All members of the Council who are officers or employees of the United States shall serve without compensation in addition to that received for their services as officers or employees of the United States. (2) Expenses.--The members of the Advisory Council shall be allowed travel expenses, including per diem in lieu of subsistence, at rates authorized for employees of agencies under subchapter I of chapter 57 of title 5, United States Code, while away from their homes or regular places of business in the performance of services for the Council. (g) Funding.--Amounts appropriated under this title may be utilized by the Secretary to support the nurse education and practice activities of the Council. (h) FACA.--The Federal Advisory Committee Act shall apply to the Advisory Committee under this section only to the extent that the provisions of such Act do not conflict with the requirements of this section. * * * * * * * PART H--COMPREHENSIVE GERIATRIC EDUCATION SEC. 865. 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; (4) provide continuing education to individuals who provide geriatric care; or (5) establish traineeships for individuals who are preparing for advanced education nursing degrees in geriatric nursing, long-term care, gero-psychiatric nursing or other nursing areas that specialize in the care of the elderly population. (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 2010 through 2014] $38,737,000 for each of fiscal years 2017 through 2021. PART I--FUNDING SEC. 871. AUTHORIZATION OF APPROPRIATIONS. For the purpose of carrying out parts B, C, and D (subject to section 851(g)), there are authorized to be appropriated [$338,000,000 for fiscal year 2010, and such sums as may be necessary for each of the fiscal years 2011 through 2016] $119,837,000 for each of fiscal years 2017 through 2021. * * * * * * * [all]