Expands eligibility for the nursing loan repayment program to include service at any health care facility with a critical shortage of nurses. Restricts service to nonprofits after FY 2007.
Directs the Secretary to provide nursing scholarships in exchange for at least two years of nursing services at facilities with a critical shortage. Makes such program discretionary after FY 2004. Permits part-time service if the aggregate service equals two full-time years. Treats such scholarships, for repayment purposes, as equivalent to those made under the National Health Service Corps Scholarship Program, except as specified.
Grants preference according to financial need. Requires detailed, annual reports to Congress on the loan and scholarship programs, including numbers, demographics, and default rates. Leaves allocation of funds between the loan and scholarship programs to the discretion of the Secretary.
Title II: Nurse Retention - Authorizes the Secretary to award grants or contracts to schools of nursing or health care facilities to expand nursing opportunities: (1) in education, through increased enrollment in four-year degree programs, internship and residency programs, or new technologies such as distance learning; and (2) in practice, through care to underserved populations, care in noninstitutional settings or organized health care systems, and through developing cultural competencies. Makes career ladder programs and activities which enhance professional collaboration, communication, and decision-making eligible for a grant award.
Directs the Secretary to award grants for geriatric care training programs.
Authorizes the Secretary, acting through the Administrator of the Health Resources and Services Administration, to establish a student loan fund to increase the number of qualified nursing faculty. Cancels up to 85 % of such loan according to a schedule of employment milestones.
Requires the Comptroller General to study and report to Congress within four years on: (1) national variations in nursing shortages; (2) any differences in nurse hiring practices between profit and nonprofit private entities because of the inclusion of for-profit private entities in the loan repayment program; and (3) whether the scholarship program increased applications to nursing schools.
Authorizes appropriations for all programs for FY 2003 through 2007.
[107th Congress Public Law 205]
[From the U.S. Government Publishing Office]
<DOC>
[DOCID: f:publ205.107]
[[Page 116 STAT. 811]]
Public Law 107-205
107th Congress
An Act
To amend the Public Health Service Act with respect to health
professions programs regarding the field of nursing.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress <<NOTE: Nurse Reinvestment
Act.>> assembled,
SECTION 1. <<NOTE: 42 USC 201 note.>> SHORT TITLE.
This Act may be cited as the ``Nurse Reinvestment Act''.
SEC. 2. TABLE OF CONTENTS.
The table of contents for this Act is as follows:
Sec. 1. Short title.
Sec. 2. Table of contents.
TITLE I--NURSE RECRUITMENT
Sec. 101. Definitions.
Sec. 102. Public service announcements regarding the nursing profession.
Sec. 103. National Nurse Service Corps.
TITLE II--NURSE RETENTION
Sec. 201. Building career ladders and retaining quality nurses.
Sec. 202. Comprehensive geriatric education.
Sec. 203. Nurse faculty loan program.
Sec. 204. Reports by General Accounting Office.
TITLE I--NURSE RECRUITMENT
SEC. 101. DEFINITIONS.
Section 801 of the Public Health Service Act (42 U.S.C. 296) is
amended by adding at the end the following:
``(9) Ambulatory surgical center.--The term `ambulatory
surgical center' has the meaning applicable to such term under
title XVIII of the Social Security Act.
``(10) Federally qualified health center.--The term
`Federally qualified health center' has the meaning given such
term under section 1861(aa)(4) of the Social Security Act.
``(11) Health care facility.--The term `health care
facility' means an Indian Health Service health center, a Native
Hawaiian health center, a hospital, a Federally qualified health
center, a rural health clinic, a nursing home, a home health
agency, a hospice program, a public health clinic, a State or
local department of public health, a skilled nursing facility,
an ambulatory surgical center, or any other facility designated
by the Secretary.
``(12) Home health agency.--The term `home health agency'
has the meaning given such term in section 1861(o) of the Social
Security Act.
[[Page 116 STAT. 812]]
``(13) Hospice program.--The term `hospice program' has the
meaning given such term in section 1861(dd)(2) of the Social
Security Act.
``(14) Rural health clinic.--The term `rural health clinic'
has the meaning given such term in section 1861(aa)(2) of the
Social Security Act.
``(15) Skilled nursing facility.--The term `skilled nursing
facility' has the meaning given such term in section 1819(a) of
the Social Security Act.''.
SEC. 102. PUBLIC SERVICE ANNOUNCEMENTS REGARDING THE NURSING PROFESSION.
Title VIII of the Public Health Service Act (42 U.S.C. 296 et seq.)
is amended by adding at the end the following:
``PART H--PUBLIC SERVICE ANNOUNCEMENTS
``SEC. 851. PUBLIC SERVICE <<NOTE: 42 USC 297w.>> ANNOUNCEMENTS.
``(a) In General.--The Secretary shall develop and issue public
service announcements that advertise and promote the nursing profession,
highlight the advantages and rewards of nursing, and encourage
individuals to enter the nursing profession.
``(b) Method.--The public service announcements described in
subsection (a) shall be broadcast through appropriate media outlets,
including television or radio, in a manner intended to reach as wide and
diverse an audience as possible.
``(c) Authorization of Appropriations.--There are authorized to be
appropriated to carry out this section such sums as may be necessary for
each of fiscal years 2003 through 2007.
``SEC. 852. STATE AND LOCAL PUBLIC SERVICE <<NOTE: 42 USC
297x.>> ANNOUNCEMENTS.
``(a) In General.--The Secretary may award grants to eligible
entities to support State and local advertising campaigns through
appropriate media outlets to promote the nursing profession, highlight
the advantages and rewards of nursing, and encourage individuals from
disadvantaged backgrounds to enter the nursing profession.
``(b) Use of Funds.--An eligible entity that receives a grant under
subsection (a) shall use funds received through such grant to acquire
local television and radio time, place advertisements in local
newspapers, or post information on billboards or on the Internet in a
manner intended to reach as wide and diverse an audience as possible, in
order to--
``(1) advertise and promote the nursing profession;
``(2) promote nursing education programs;
``(3) inform the public of financial assistance regarding
such education programs;
``(4) highlight individuals in the community who are
practicing nursing in order to recruit new nurses; or
``(5) provide any other information to recruit individuals
for the nursing profession.
``(c) Limitation.--An eligible entity that receives a grant under
subsection (a) shall not use funds received through such grant to
advertise particular employment opportunities.
``(d) Authorization of Appropriations.--There are authorized to be
appropriated to carry out this section such sums as may be necessary for
each of fiscal years 2003 through 2007.''.
[[Page 116 STAT. 813]]
SEC. 103. NATIONAL NURSE SERVICE CORPS.
(a) Loan Repayment Program.--Section 846(a) of the Public Health
Service Act (42 U.S.C. 297n(a)) is amended--
(1) in paragraph (3), by striking ``in an Indian Health
Service health center'' and all that follows to the semicolon
and inserting ``at a health care facility with a critical
shortage of nurses''; and
(2) by adding at the end the following: ``After fiscal year
2007, the Secretary may not, pursuant to any agreement entered
into under this subsection, assign a nurse to any private entity
unless that entity is nonprofit.''.
(b) Establishment of Scholarship Program.--Section 846 of the Public
Health Service Act (42 U.S.C. 297n) is amended--
(1) in the heading for the section, by striking ``loan
repayment program'' and inserting ``loan repayment and
scholarship programs'';
(2) by redesignating subsections (d), (f), (g), and (h) as
subsections (f), (h), (i), and (g), respectively;
(3) by transferring subsections (f) and (g) (as so
redesignated) from their current placements, by inserting
subsection (f) after subsection (e), and by inserting subsection
(g) after subsection (f) (as so inserted); and
(4) by inserting after subsection (c) the following
subsection:
``(d) Scholarship Program.--
``(1) <<NOTE: Contracts.>> 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
[[Page 116 STAT. 814]]
with this section, apply to the program established in paragraph
(1) in the same manner and to the same extent as such provisions
apply to the National Health Service Corps Scholarship Program
established in such subpart.''.
(c) Preference.--Section 846(e) of the Public Health Service Act (42
U.S.C. 297n(e)) is amended by striking ``under subsection (a)'' and all
that follows through the period and inserting ``under subsection (a) or
(d), the Secretary shall give preference to qualified applicants with
the greatest financial need.''.
(d) Reports.--Subsection (h) of section 846 of the Public Health
Service Act (42 U.S.C. 297n) (as redesignated by subsection (b)(2)) is
amended to read as follows:
``(h) <<NOTE: Deadline.>> Reports.--Not later than 18 months after
the date of enactment of the Nurse Reinvestment Act, and annually
thereafter, the Secretary shall prepare and submit to the Congress a
report describing the programs carried out under this section, including
statements regarding--
``(1) the number of enrollees, scholarships, loan
repayments, and grant recipients;
``(2) the number of graduates;
``(3) the amount of scholarship payments and loan repayments
made;
``(4) which educational institution the recipients attended;
``(5) the number and placement location of the scholarship
and loan repayment recipients at health care facilities with a
critical shortage of nurses;
``(6) the default rate and actions required;
``(7) the amount of outstanding default funds of both the
scholarship and loan repayment programs;
``(8) to the extent that it can be determined, the reason
for the default;
``(9) the demographics of the individuals participating in
the scholarship and loan repayment programs;
``(10) justification for the allocation of funds between the
scholarship and loan repayment programs; and
``(11) an evaluation of the overall costs and benefits of
the programs.''.
(e) Funding.--Subsection (i) of section 846 of the Public Health
Service Act (42 U.S.C. 297n) (as redesignated by subsection (b)(2)) is
amended to read as follows:
``(i) Funding.--
``(1) Authorization of appropriations.--For the purpose of
payments under agreements entered into under subsection (a) or
(d), there are authorized to be appropriated such sums as may be
necessary for each of fiscal years 2003 through 2007.
``(2) Allocations.--Of the amounts appropriated under
paragraph (1), the Secretary may, as determined appropriate by
the Secretary, allocate amounts between the program under
subsection (a) and the program under subsection (d).''.
[[Page 116 STAT. 815]]
TITLE II--NURSE RETENTION
SEC. 201. BUILDING CAREER LADDERS AND RETAINING QUALITY NURSES.
Section 831 of the Public Health Service Act (42 U.S.C. 296p) is
amended to read as follows:
``SEC. 831. NURSE EDUCATION, PRACTICE, AND RETENTION GRANTS.
``(a) Education Priority Areas.--The Secretary may award grants to
or enter into contracts with eligible entities for--
``(1) expanding the enrollment in baccalaureate nursing
programs;
``(2) developing and implementing internship and residency
programs to encourage mentoring and the development of
specialties; or
``(3) providing education in new technologies, including
distance learning methodologies.
``(b) Practice Priority Areas.--The Secretary may award grants to or
enter into contracts with eligible entities for--
``(1) establishing or expanding nursing practice
arrangements in noninstitutional settings to demonstrate methods
to improve access to primary health care in medically
underserved communities;
``(2) providing care for underserved populations and other
high-risk groups such as the elderly, individuals with HIV/AIDS,
substance abusers, the homeless, and victims of domestic
violence;
``(3) providing managed care, quality improvement, and other
skills needed to practice in existing and emerging organized
health care systems; or
``(4) developing cultural competencies among nurses.
``(c) Retention Priority Areas.--The Secretary may award grants to
and enter into contracts with eligible entities to enhance the nursing
workforce by initiating and maintaining nurse retention programs
pursuant to paragraph (1) or (2).
``(1) Grants for career ladder programs.--The Secretary may
award grants to and enter into contracts with eligible entities
for programs--
``(A) to promote career advancement for nursing
personnel in a variety of training settings, cross
training or specialty training among diverse population
groups, and the advancement of individuals including to
become professional nurses, advanced education nurses,
licensed practical nurses, certified nurse assistants,
and home health aides; and
``(B) to assist individuals in obtaining education
and training required to enter the nursing profession
and advance within such profession, such as by providing
career counseling and mentoring.
``(2) Enhancing patient care delivery systems.--
``(A) Grants.--The Secretary may award grants to
eligible entities to improve the retention of nurses and
enhance patient care that is directly related to nursing
activities by enhancing collaboration and communication
among nurses and other health care professionals, and
[[Page 116 STAT. 816]]
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) <<NOTE: Deadline.>> Report.--The Secretary shall submit to
the Congress before the end of each fiscal year a report on the grants
awarded and the contracts entered into under this section. Each such
report shall identify the overall number of such grants and contracts
and provide an explanation of why each such grant or contract will meet
the priority need of the nursing workforce.
``(g) Eligible Entity.--For purposes of this section, the term
`eligible entity' includes a school of nursing, a health care facility,
or a partnership of such a school and facility.
``(h) Authorization of Appropriations.--There are authorized to be
appropriated to carry out this section such sums as may be necessary for
each of fiscal years 2003 through 2007.''.
SEC. 202. COMPREHENSIVE GERIATRIC EDUCATION.
(a) Comprehensive Geriatric Education.--Title VIII of the Public
Health Service Act (42 U.S.C. 296 et seq.) (as amended by section 102)
is amended by adding at the end the following:
``PART I--COMPREHENSIVE GERIATRIC EDUCATION
``SEC. 855. COMPREHENSIVE <<NOTE: Grants. 42 USC 298.>> GERIATRIC
EDUCATION.
``(a) Program Authorized.--The Secretary shall award grants to
eligible entities to develop and implement, in coordination with
programs under section 753, programs and initiatives to train and
educate individuals in providing geriatric care for the elderly.
``(b) Use of Funds.--An eligible entity that receives a grant under
subsection (a) shall use funds under such grant to--
``(1) provide training to individuals who will provide
geriatric care for the elderly;
``(2) develop and disseminate curricula relating to the
treatment of the health problems of elderly individuals;
``(3) train faculty members in geriatrics; or
``(4) provide continuing education to individuals who
provide geriatric care.
[[Page 116 STAT. 817]]
``(c) Application.--An eligible entity desiring a grant under
subsection (a) shall submit an application to the Secretary at such
time, in such manner, and containing such information as the Secretary
may reasonably require.
``(d) Eligible Entity.--For purposes of this section, the term
`eligible entity' includes a school of nursing, a health care facility,
a program leading to certification as a certified nurse assistant, a
partnership of such a school and facility, or a partnership of such a
program and facility.
``(e) Authorization of Appropriations.--There are authorized to be
appropriated to carry out this section such sums as may be necessary for
each of fiscal years 2003 through 2007''.
(b) Technical Amendment.--Section 753(a)(1) of the Public Health
Service Act (42 U.S.C. 294c) is amended by striking `` and section
853(2),'' and ''inserting `` and section 801(2)''.
SEC. 203. NURSE FACULTY LOAN PROGRAM.
Part E of title VIII of the Public Health Service Act (42 U.S.C.
297a et seq.) is amended by inserting after section 846 the following:
``nurse faculty loan program
``Sec. 846A. (a) Establishment.--The Secretary, acting through the
Administrator of the Health Resources and Services Administration, may
enter into an agreement with any school of nursing for the establishment
and operation of a student loan fund in accordance with this section, to
increase the number of qualified nursing faculty.
``(b) Agreements.--Each agreement entered into under subsection (a)
shall--
``(1) provide for the establishment of a student loan fund
by the school involved;
``(2) provide for deposit in the fund of--
``(A) the Federal capital contributions to the fund;
``(B) an amount equal to not less than one-ninth of
such Federal capital contributions, contributed by such
school;
``(C) collections of principal and interest on loans
made from the fund; and
``(D) any other earnings of the fund;
``(3) provide that the fund will be used only for loans to
students of the school in accordance with subsection (c) and for
costs of collection of such loans and interest thereon;
``(4) provide that loans may be made from such fund only to
students pursuing a full-time course of study or, at the
discretion of the Secretary, a part-time course of study in an
advanced degree program described in section 811(b); and
``(5) contain such other provisions as are necessary to
protect the financial interests of the United States.
``(c) Loan Provisions.--Loans from any student loan fund established
by a school pursuant to an agreement under subsection (a) shall be made
to an individual on such terms and conditions as the school may
determine, except that--
``(1) such terms and conditions are subject to any
conditions, limitations, and requirements prescribed by the
Secretary;
``(2) in the case of any individual, the total of the loans
for any academic year made by schools of nursing from loan funds
established pursuant to agreements under subsection
[[Page 116 STAT. 818]]
(a) may not exceed $30,000, plus any amount determined by the
Secretary on an annual basis to reflect inflation;
``(3) an amount up to 85 percent of any such loan (plus
interest thereon) shall be canceled by the school as follows:
``(A) upon completion by the individual of each of
the first, second, and third year of full-time
employment, required by the loan agreement entered into
under this subsection, as a faculty member in a school
of nursing, the school shall cancel 20 percent of the
principle of, and the interest on, the amount of such
loan unpaid on the first day of such employment; and
``(B) upon completion by the individual of the
fourth year of full-time employment, required by the
loan agreement entered into under this subsection, as a
faculty member in a school of nursing, the school shall
cancel 25 percent of the principle of, and the interest
on, the amount of such loan unpaid on the first day of
such employment;
``(4) such a loan may be used to pay the cost of tuition,
fees, books, laboratory expenses, and other reasonable education
expenses;
``(5) such a loan shall be repayable in equal or graduated
periodic installments (with the right of the borrower to
accelerate repayment) over the 10-year period that begins 9
months after the individual ceases to pursue a course of study
at a school of nursing; and
``(6) such a loan shall--
``(A) beginning on the date that is 3 months after
the individual ceases to pursue a course of study at a
school of nursing, bear interest on the unpaid balance
of the loan at the rate of 3 percent per annum; or
``(B) subject to subsection (e), if the school of
nursing determines that the individual will not complete
such course of study or serve as a faculty member as
required under the loan agreement under this subsection,
bear interest on the unpaid balance of the loan at the
prevailing market rate.
``(d) Payment of Proportionate Share.--Where all or any part of a
loan, or interest, is canceled under this section, the Secretary shall
pay to the school an amount equal to the 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 a school of
nursing under subsection (c)(6)(B).
``(f) Authorization of Appropriations.--There are authorized to be
appropriated to carry out this section such sums as may be necessary for
each of fiscal years 2003 through 2007.''.
SEC. 204. REPORTS BY GENERAL ACCOUNTING OFFICE.
(a) National Variations.--Not later than 4 years after the date of
the enactment of this Act, the Comptroller General of the United States
shall conduct a survey to determine national variations in the nursing
shortage at hospitals, nursing homes, and other health care providers,
and submit a report, including recommendations, to the Congress on
Federal remedies to ease nursing shortages. The Comptroller General
shall submit to the
[[Page 116 STAT. 819]]
Congress this report describing the findings relating to ownership
status and associated remedies.
(b) Hiring Differences Among Certain Private Entities.--The
Comptroller General of the United States shall conduct a study to
determine differences in the hiring of nurses by nonprofit private
entities as compared to the hiring of nurses by private entities that
are not nonprofit. In carrying out the study, the Comptroller General
shall determine the effect of the inclusion of private entities that are
not nonprofit in the program under section 846 of the Public Health
Service Act. Not later than 4 years after the date of the enactment of
this Act, the Comptroller General shall submit to the Congress a report
describing the findings of the study.
(c) Nursing Scholarships.--The Comptroller General of the United
States shall conduct an evaluation of whether the program carried out
under section 846(d) of the Public Health Service Act has demonstrably
increased the number of applicants to schools of nursing and, not later
than 4 years after the date of the enactment of this Act, submit a
report to the Congress on the results of such evaluation.
Approved August 1, 2002.
LEGISLATIVE HISTORY--H.R. 3487:
---------------------------------------------------------------------------
CONGRESSIONAL RECORD:
Vol. 147 (2001):
Dec. 19, 20, considered and passed
House.
Vol. 148 (2002):
July 22, considered and passed
Senate, amended. House concurred
in Senate amendment.
<all>
Passed/agreed to in House: On motion to suspend the rules and pass the bill Agreed to by voice vote.(text: CR 12/19/2001 H10487-10488)
On motion to suspend the rules and pass the bill Agreed to by voice vote. (text: CR 12/19/2001 H10487-10488)
Motion to reconsider laid on the table Agreed to without objection.
Received in the Senate. Read the first time. Placed on Senate Legislative Calendar under Read the First Time.
Read the second time. Placed on Senate Legislative Calendar under General Orders. Calendar No. 306.
Measure laid before Senate by unanimous consent. (consideration: CR S7127-7132)
Passed/agreed to in Senate: Passed Senate with an amendment by Unanimous Consent.
Passed Senate with an amendment by Unanimous Consent.
Message on Senate action sent to the House.
Mr. Bilirakis moved that the House suspend the rules and agree to the Senate amendment. (consideration: CR H5053-5059)
DEBATE - The House proceeded with forty minutes of debate on the motion to suspend the rules and agree to the Senate amendment to H.R. 3487.
Enacted as Public Law 107-205
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Resolving differences -- House actions: On motion that the House suspend the rules and agree to the Senate amendment Agreed to by voice vote.(text: CR H5053-5055)
On motion that the House suspend the rules and agree to the Senate amendment Agreed to by voice vote. (text: CR H5053-5055)
Motion to reconsider laid on the table Agreed to without objection.
Presented to President.
Presented to President.
Signed by President.
Signed by President.
Became Public Law No: 107-205.
Became Public Law No: 107-205.