,i  #aacth ,,congress  #ast ,session    
,h4 ,r4 #aheg  ,,in ,,the ,,house ,,of  
,,representatives  ,may #g1 #bjac ,mrs4 
,mc,carthy of ,new ,york introduced the 
following bill2 which was referred to   
the ,committee on ,education and the    
,workforce1 and in addition to the      
,committee on ,energy and ,commerce1 for
 a period to be subsequently determined 
by the ,speaker1 in each case for       
consideration of such provisions as fall
 within the jurisdiction of the         
committee concerned  ,a ,,bill  ,to make
 demonstration grants to eligible local 
educational agencies for the purpose of 
reducing the student-to-school nurse    
ratio in public elementary schools and  
secondary schools4  #a4 ,short title    
,this ,act may be cited as the          
,student-to-,school ,nurse ,ratio       
,improvement ,act of #bjac4  #b4        
,findings ,the ,congress finds the      
following3  7#a7 ,the ,american ,academy
 of ,pediatrics emphasizes the crucial  
role of school nurses in the seamless   

provision of comprehensive health       
services to children and youth1 as well 
as in the development of a coordinated  
school health program4  7#b7 ,the school
 nurse functions as a leader and the    
coordinator of the school health        
services team1 facilitating access to a 
medical home for each child and         
supporting academic achievement4  7#c7  
,school nurses promote wellness and     
disease prevention to improve health    
outcomes for our ,nation's children4 ,in
 addition1 school nurses perform early  
intervention services such as periodic  
assessments for vision1 hearing1 and    
dental problems1 in an effort to remove 
barriers to learning4  7#d7 ,recent     
national data indicates #de percent of  
public schools have a school nurse all  
day1 every day1 while another #cj       
percent of schools have a school nurse  
who works part time in one or more      
schools4  7#e7 ,the ,american ,nurses   
,association has reported that when     
there is no registered nurse on the     

school premises1 the responsibility to  
administer the necessary medications and
 treatments1 and appropriate monitoring 
of the children falls on the shoulders  
of administrators1 educators1 and staff 
who are ill-prepared to perform these   
tasks4  7#f7 ,statistics from the       
,national ,center for ,educational      
,statistics indicate that of the        
#eb1jjj1jjj students who currently spend
 their day in schools1 #ae to #ah       
percent of children and adolescents have
 a chronic health condition4  7#g7 ,a   
recent study indicated that from #bjjb  
to #bjjh1 the percentage of children in 
special education with health           
impairments1 due to chronic or acute    
health problems1 increased #fj percent4 
,school nurses use their specialized    
knowledge1 assessment skills1 and       
judgment to manage children's           
increasingly complex medical conditions 
and chronic health illnesses4  7#h7     
,among adolescents aged #ab to #ai years
 old1 the prevalence of pre-diabetes and

 diabetes increased from #i percent to  
#bc percent between #aiii and #bjjh4    
,more than #cj percent of children aged 
#b to #ai years old are obese or        
overweight 7#heth percentile74 ,in      
#bjjh1 more than #aj million children in
 the ,united ,states had asthma4 ,the   
prevalence of food allergies among      
children under the age of #ah increased 
#ai percent from #aiig to #bjjg4  7#i7  
,according to the ,american ,academy of 
,pediatrics1 students today face        
increased social and emotional issues1  
which enhance the need for preventive   
services and interventions for acute and
 chronic health issues4 ,school nurses  
are actively engaged members of         
school-based mental health teams and    
spend nearly #cb percent of their time  
providing mental health services1       
including universal and targeted        
interventions1 screenings to identify   
early warning signs and referrals to    
medical providers1 and crisis planning4 
7#aj7 ,in #bjaa1 the ,bureau of the     

,census reported #i4g percent of        
children under the age of #ai1 which    
equals #g4f million children under the  
age of #ai1 were without health         
insurance4 ,data shows that uninsured   
children achieve lower educational      
outcomes than those with health         
coverage4 ,children who cannot afford to
 see a medical provider miss more days  
of school1 experience increased severity
 of illness1 and suffer from disparities
 in health4  7#aa7 ,more than #a4f      
million children experience homelessness
 each year in the ,united ,states4      
,homeless children develop increased    
rates of acute and chronic health       
conditions1 and the stress of their     
living situation can negatively affect  
their development and ability to learn4 
,as a result1 schools have become the   
primary access to health care for many  
children and adolescents4 ,school nurses
 serve on the frontlines as a safety net
 for the ,nation's most vulnerable      
children4  7#ab7 ,communicable and      

infectious diseases account for millions
 of school days lost each year4 ,data   
illustrate that when students have      
access to a registered nurse in school1 
immunization rates increase4  7#ac7 ,a  
#bjaa study showed that a school nurse  
in the building saves principals1       
teachers1 and clerical staff a          
considerable amount of time that they   
would have spent addressing health      
concerns of students1 including saving  
principals almost an hour a day2 saving 
teachers almost #bj minutes a day2 and  
saving clerical staff more than #de     
minutes a day4 ,this would amount to a  
savings of about #ac hours per day in   
the aggregate for such school personnel4
  7#ad7 ,using a formula-based approach1
 taking into consideration the overall  
health acuity of the student body and   
the workload of school nurses1 for      
determining a balanced student-to-school
 nurse ratio offers a reasonable means  
for achieving better student outcomes4  
#c4 ,reducing student-to-school nurse   

ratios  7a7 ,demonstration grants  7#a7 
,in general ,the ,secretary of          
,education1 in consultation with the    
,secretary of ,health and ,human        
,services and the ,director of the      
,centers for ,disease ,control and      
,prevention1 may make demonstration     
grants to eligible local educational    
agencies for the purpose of reducing the
 student-to-school nurse ratio in public
 elementary schools and secondary       
schools4  7#b7 ,application ,to receive 
a grant under this section1 an eligible 
local educational agency shall submit to
 the ,secretary of ,education an        
application at such time1 in such       
manner1 and containing such information 
as the ,secretary may require1 which    
shall include information with respect  
to the current ratios of                
students-to-school nurses1 student      
health acuity levels1 and workloads of  
school nurses in each of the public     
elementary schools and secondary schools
 served by the agency4  7#c7 ,priority  

,in awarding grants under this section1 
the ,secretary of ,education shall give 
priority to applications submitted by   
high-need local educational agencies    
that demonstrate the greatest need for  
new or additional nursing services among
 students in the public elementary      
secondary and secondary schools served  
by the agency4  7#d7 ,matching funds    
,the ,secretary of ,education may       
require recipients of grants under this 
section to provide matching funds from  
non-,federal sources1 and shall permit  
the recipients to match funds in whole  
or in part with in-kind contributions4  
7b7 ,report ,not later than #bd months  
after the date on which a grant is first
 made to a local educational agency     
under this section1 the ,secretary of   
,education shall submit to the ,congress
 a report on the results of the         
demonstration grant program carried out 
under this section1 including an        
evaluation--  7#a7 of the effectiveness 
of the program in reducing the          

student-to-school nurse ratios described
 in subsection 7a77#a72 and  7#b7 of the
 impact of any resulting enhanced health
 of students on learning1 such as       
academic achievement1 attendance1 and   
classroom time4  7c7 ,definitions ,for  
purposes of this section3  7#a7 ,,esea  
terms ,the terms elementary school1     
local educational agency1 poverty line1 
and secondary school have the meanings  
given to those terms in section #iaja of
 the ,elementary and ,secondary         
,education ,act of #aife 7#bj ,u4,s4,c4 
#ghja74  7#b7 ,acuity ,the term acuity1 
when used with respect to a level1 means
 the level of a patient's sickness1 such
 as a chronic condition1 which          
influences the need for nursing care4   
7#c7 ,workload ,the term workload1 when 
used with respect to a nurse1 means the 
amount of time the nurse takes to       
provide care and complete the other     
tasks for which the nurse may be        
responsible4  7#d7 ,eligible local      
educational agency ,the term eligible   

local educational agency means a local  
educational agency in which the         
student-to-school nurse ratio in each   
public elementary and secondary school  
served by the agency is #gej or more    
students to #a school nurse4  7#e7      
,high-need local educational agency ,the
 term high-need local educational agency
 means a local educational agency--     
7,a7 that serves not fewer than #aj1jjj 
children from families with incomes     
below the poverty line2 or  7,b7 for    
which not less than #bj percent of the  
children served by the agency are from  
families with incomes below the poverty 
line4  7#f7 ,nurse ,the term nurse means
 a licensed nurse1 as defined under     
,state law4  7d7 ,authorization of      
appropriations ,there are authorized to 
be appropriated such sums as may be     
necessary to carry out this section for 
each of the fiscal years #bjad through  
#bjah4