,,ii ,calendar ,no4 #bhe #aafth ,,congress #ast ,session ,s4 #acii ,,in ,,the ,,senate ,,of ,,the ,,united ,,states ,may #i1 #bjai,mr4 ,merkley 7for himself1 ,mr4 ,burr1 ,ms4 ,baldwin1 ,mrs4 ,blackburn1 ,mr4 ,jones1 and ,ms4 ,collins7 introduced the following bill2 which was read twice and referred to the ,committee on ,health1 ,education1 ,labor1 and ,pensions ,november #e1 #bjai,reported by ,mr4 ,alexander1 with an amendment,strike out all after the enacting clause and insert the part printed in italic ,a ,,bill ,to amend title ,,viii of the ,public ,health ,services ,act to revise and extend nursing workforce development programs4 #a4 ,short title ,this ,act may be cited as the ,title ,,viii ,nursing ,workforce ,reauthorization ,act of #bjai4 #b4 ,nursing workforce development 7a7 ,in general ,title ,,viii of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bif et seq47 is amended-- 7#a7 in section #hja 7#db ,u4,s4,c4 #bif71 by adding at the end the following3 7#ah7 ,nurse managed health clinic ,the term nurse managed health clinic means a nurse-practice arrangement1 managed by advanced practice nurses1 that provides primary care or wellness services to underserved or vulnerable populations and that is associated with a school1 college1 university or department of nursing1 federally qualified health center1 or independent nonprofit health or social services agency4 2 7#b7 in section #hjb7;c7 7#db ,u4,s4,c4 #bif;a7c771 by inserting 1 and how such project aligns with the goals in section #hjf7;a7 before the period in the second sentence2 7#c7 in section #hjc7;b7 7#db ,u4,s4,c4 #bif;b7b771 by adding at the end the following3 ,such ,federal funds are intended to supplement1 not supplant1 existing non-,federal expenditures for such activities42 7#d7 in section #hjf 7#db ,u4,s4,c4 #bif;e7-- 7,a7 in subsection 7a71 by striking as needed to and all that follows and inserting the following3 8as needed to address national nursing needs1 including-- 7#a7 addressing challenges1 including through supporting training and education of nursing students1 related to the distribution of the nursing workforce and existing or projected nursing workforce shortages in geographic areas that have been identified as having1 or that are projected to have1 a nursing shortage2 7#b7 increasing access to and the quality of health care services1 including by supporting the training of professional registered nurses1 advanced practice registered nurses1 and advanced education nurses within community based settings and in a variety of health delivery system settings2 or 7#c7 addressing the strategic goals and priorities identified by the ,secretary and that are in accordance with this title4 ,contracts may be entered into under this title with public or private entities as determined necessary by the ,secretary4 2 7,b7 in subsection 7b77#b71 by striking a demonstration and all that follows and inserting the following3 the reporting of data and information demonstrating that satisfactory progress has been made by the program or project in meeting the performance outcome standards 7as described in section #hjb7 of such program or project42 7,c7 in subsection 7e77#b71 by inserting 1 and have relevant expertise and experience before the period at the end of the first sentence2 and 7,d7 by adding at the end the following3 7i7 ,biennial report on nursing workforce program improvements ,not later than ,september #cj1 #bjbj1 and biennially thereafter1 the ,secretary shall submit to the ,committee on ,health1 ,education1 ,labor1 and ,pensions of the ,senate and the ,committee on ,energy and ,commerce of the ,house of ,representatives1 a report that contains an assessment of the programs and activities of the ,department of ,health and ,human ,services related to enhancing the nursing workforce1 including the extent to which programs and activities under this title meet the identified goals and performance measures developed for the respective programs and activities1 and the extent to which the ,department coordinates with other ,federal departments with programs designed to improve the nursing workforce4 2 7#e7 in section #haa 7#db ,u4,s4,c4 #bif;j7-- 7,a7 in subsection 7b7-- 7i7 by striking ,master's and inserting graduate2 and 7ii7 by inserting clinical nurse leaders1 after nurse administrators12 7,b7 by redesignating subsections 7f7 and 7g7 as subsections 7g7 and 7h71 respectively2 and 7,c7 by inserting after subsection 7e71 the following3 7f7 ,authorized clinical nurse specialist programs ,clinical nurse specialist programs eligible for support under this section are education programs that-- 7#a7 provide registered nurses with full-time clinical nurse specialist education2 and 7#b7 have as their objective the education of clinical nurse specialists who will1 upon completion of such a program1 be qualified to effectively provide care through the wellness and illness continuum to inpatients and outpatients experiencing acute and chronic illness4 2 7#f7 in section #hca 7#db ,u4,s4,c4 #bifp7-- 7,a7 in the section heading1 by striking and quality grants and inserting quality1 and retention grants2 7,b7 in subsection 7b77#b71 by striking other high-risk groups such as the elderly1 individuals with ,,hiv_/,,aids1 substance abusers1 the homeless1 and victims and inserting high risk groups1 such as the elderly1 individuals with ,,hiv_/,,aids1 individuals with mental health or substance use disorders1 individuals who are homeless1 and survivors2 7,c7 in subsection 7c77#a7-- 7i7 in subparagraph 7,a7-- 7,i7 by striking advancement for nursing personnel and inserting the following3 8advancement for-- 7i7 nursing 2 7,,ii7 by striking professional nurses1 advanced education nurses1 licensed practical nurses1 certified nurse assistants1 and home health aides and inserting professional registered nurses1 advanced practice registered nurses1 and nurses with graduate nursing education2 and 7,,iii7 by adding at the end the following3 7ii7 individuals including licensed practical nurses1 licensed vocational nurses1 certified nurse assistants1 home health aides1 diploma degree or associate degree nurses1 to become registered nurses with baccalaureate degrees or nurses with graduate nursing education2 2 7ii7 in subparagraph 7,b71 by striking the period and inserting 2 and2 and 7iii7 by adding at the end the following3 7,c7 developing and implementing internships1 accredited fellowships1 and accredited residency programs in collaboration with one or more accredited schools of nursing1 to encourage the mentoring and development of specialties4 2 7,d7 by striking subsection 7e72 7,e7 by redesignating subsection 7f7 through 7h71 as subsections 7e7 through 7g71 respectively2 7,f7 in subsection 7e7 7as so redesignated71 by striking ,the ,secretary shall submit to the ,congress before the end of each fiscal year and inserting ,as part of the report on nursing workforce programs described in section #hjf7;i71 the ,secretary shall include2 7,g7 in subsection 7f7 7as so redesignated71 by striking a school of nursing1 as defined in section #hja7b711 and inserting an accredited school of nursing1 as defined in section #hja7b71 a health care facility1 including federally qualified health centers or nurse-managed health clinics1 or a partnership of such a school and facility2 and 7,h7 in subsection 7g7 7as so redesignated71 by striking #bjaj through #bjad and inserting #bjbj through #bjbd2 7#g7 by striking section #hca;,a 7#db ,u4,s4,c4 #bifp-#a72 7#h7 in section #hdf 7#db ,u4,s4,c4 #bign7-- 7,a7 by striking the last sentence of subsection 7a72 7,b7 in subsection 7b77#a71 by striking he began such practice and inserting the individual began such practice2 and 7,c7 in subsection 7i77,i71 by striking #bjjc through #bjjg and inserting #bjbj through #bjbd2 7#i7 in section #hdf;,a7f7 7#db ,u4,s4,c4 #bdgn-#a7;f771 by striking #bjaj through #bjad and inserting #bjbj through #bjbd2 7#aj7 in section #hdg7;g7 7#db ,u4,s4,c4 #bigo7g771 by striking such sums as may be necessary for each of fiscal years #bjaj through #bjad and inserting #aae1fce1jjj for each of fiscal years #bjbj through #bjbd2 7#aa7 in section #hea 7#db ,u4,s4,c4 #bigt7-- 7,a7 in subsection 7b77#a77;,a77iv71 by striking and nurse anesthetists and inserting nurse anesthetists1 and clinical nurse specialists2 7,b7 in subsection 7d77#c7-- 7i7 by striking #c years after the date of enactment of this section and inserting #b years after the date of enactment of the ,title ,,viii ,nursing ,workforce ,reauthorization ,act2 7ii7 by striking ,labor and ,human ,resources and inserting ,health1 ,education1 ,labor1 and ,pensions2 and 7iii7 by inserting ,energy and before ,commerce2 and 7,c7 in subsection 7g71 by striking under this title and inserting for carrying out parts ,b1 ,c1 and ,d2 7#ab7 in section #hfe7;e7 7#db ,u4,s4,c4 #bih7;e771 by striking #bjad and inserting #bjbd2 and 7#ac7 in section #hga 7#db ,u4,s4,c4 #bih;d71 by striking #cch1jjj1jjj for fiscal year #bjaj1 and such sums as may be necessary for each of the fiscal years #bjaa through #bjaf and inserting #acc1hcg1jjj for each of fiscal years #bjbj through #bjbd4 7b7 ,evaluation and report on nurse loan repayment programs 7#a7 ,evaluation ,the ,comptroller ,general shall conduct an evaluation of the nurse loan repayment programs administered by the ,health ,resources and ,services ,administration4 ,such evaluation shall include-- 7,a7 the manner in which payments are made under such programs2 7,b7 the existing oversight functions necessary to ensure the proper use of such programs1 including payments made as part of such programs2 7,c7 the identification of gaps1 if any1 in oversight functions2 and 7,d7 information on the number of nurses assigned to facilities pursuant to such programs1 including the type of facility to which nurses are assigned and the impact of modifying the eligibility requirements for programs under section #hdf of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bign71 such as the impact on entities to which nurses had previously been assigned prior to fiscal year #bjai 7such as federally qualified health centers and facilities affiliated with the ,indian ,health ,service74 7#b7 ,report ,not later than #ah months after the enactment of this ,act1 the ,comptroller ,general shall submit to the ,committee on ,health1 ,education1 ,labor1 and ,pensions of the ,senate and the ,committee on ,energy and ,commerce of the ,house of ,representatives a report on the evaluation under paragraph 7#a71 which may include recommendations to improve relevant nursing workforce loan repayment programs4 #a4 ,short title ,this ,act may be cited as the ,title ,,viii ,nursing ,workforce ,reauthorization ,act of #bjai4 #b4 ,nursing workforce development 7a7 ,in general ,title ,,viii of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bif et seq47 is amended-- 7#a7 in section #hja 7#db ,u4,s4,c4 #bif71 by adding at the end the following3 7#ah7 ,nurse managed health clinic ,the term nurse managed health clinic means a nurse-practice arrangement1 managed by advanced practice nurses1 that provides primary care or wellness services to underserved or vulnerable populations and that is associated with a school1 college1 university or department of nursing1 federally qualified health center1 or independent nonprofit health or social services agency4 2 7#b7 in section #hjb7;c7 7#db ,u4,s4,c4 #bif;a7c771 by inserting 1 and how such project aligns with the goals in section #hjf7;a7 before the period in the second sentence2 7#c7 in section #hjc7;b7 7#db ,u4,s4,c4 #bif;b7b771 by adding at the end the following3 ,such ,federal funds are intended to supplement1 not supplant1 existing non-,federal expenditures for such activities42 7#d7 in section #hjf 7#db ,u4,s4,c4 #bif;e7-- 7,a7 in subsection 7a71 by striking as needed to and all that follows and inserting the following3 8as needed to address national nursing needs1 including-- 7#a7 addressing challenges1 including through supporting training and education of nursing students1 related to the distribution of the nursing workforce and existing or projected nursing workforce shortages in geographic areas that have been identified as having1 or that are projected to have1 a nursing shortage2 7#b7 increasing access to and the quality of health care services1 including by supporting the training of professional registered nurses1 advanced practice registered nurses1 and advanced education nurses within community based settings and in a variety of health delivery system settings2 or 7#c7 addressing the strategic goals and priorities identified by the ,secretary and that are in accordance with this title4 ,contracts may be entered into under this title with public or private entities as determined necessary by the ,secretary4 2 7,b7 in subsection 7b77#b71 by striking a demonstration and all that follows and inserting the following3 the reporting of data and information demonstrating that satisfactory progress has been made by the program or project in meeting the performance outcome standards 7as described in section #hjb7 of such program or project42 7,c7 in subsection 7e77#b71 by inserting 1 and have relevant expertise and experience before the period at the end of the first sentence2 and 7,d7 by adding at the end the following3 7i7 ,biennial report on nursing workforce program improvements ,not later than ,september #cj1 #bjbj1 and biennially thereafter1 the ,secretary shall submit to the ,committee on ,health1 ,education1 ,labor1 and ,pensions of the ,senate and the ,committee on ,energy and ,commerce of the ,house of ,representatives1 a report that contains an assessment of the programs and activities of the ,department of ,health and ,human ,services related to enhancing the nursing workforce1 including the extent to which programs and activities under this title meet the identified goals and performance measures developed for the respective programs and activities1 and the extent to which the ,department coordinates with other ,federal departments regarding programs designed to improve the nursing workforce4 2 7#e7 in section #haa 7#db ,u4,s4,c4 #bif;j7-- 7,a7 in subsection 7b7-- 7i7 by striking ,master's and inserting graduate2 and 7ii7 by inserting clinical nurse leaders1 after nurse administrators12 7,b7 by redesignating subsections 7f7 and 7g7 as subsections 7g7 and 7h71 respectively2 and 7,c7 by inserting after subsection 7e71 the following3 7f7 ,authorized clinical nurse specialist programs ,clinical nurse specialist programs eligible for support under this section are education programs that-- 7#a7 provide registered nurses with full-time clinical nurse specialist education2 and 7#b7 have as their objective the education of clinical nurse specialists who will1 upon completion of such a program1 be qualified to effectively provide care through the wellness and illness continuum to inpatients and outpatients experiencing acute and chronic illness4 2 and 7#f7 in section #hca 7#db ,u4,s4,c4 #bifp7-- 7,a7 in the section heading1 by striking and quality grants and inserting quality1 and retention grants2 7,b7 in subsection 7b77#b71 by striking other high-risk groups such as the elderly1 individuals with ,,hiv_/,,aids1 substance abusers1 the homeless1 and victims and inserting high risk groups1 such as the elderly1 individuals with ,,hiv_/,,aids1 individuals with mental health or substance use disorders1 individuals who are homeless1 and survivors2 7,c7 in subsection 7c77#a7-- 7i7 in subparagraph 7,a7-- 7,i7 by striking advancement for nursing personnel and inserting the following3 8advancement for-- 7i7 nursing 2 7,,ii7 by striking professional nurses1 advanced education nurses1 licensed practical nurses1 certified nurse assistants1 and home health aides and inserting professional registered nurses1 advanced practice registered nurses1 and nurses with graduate nursing education2 and 7,,iii7 by adding at the end the following3 7ii7 individuals including licensed practical nurses1 licensed vocational nurses1 certified nurse assistants1 home health aides1 diploma degree or associate degree nurses1 and other health professionals1 such as health aides or community health practitioners certified under the ,community ,health ,aide ,program of the ,indian ,health ,service1 to become registered nurses with baccalaureate degrees or nurses with graduate nursing education2 2 7ii7 in subparagraph 7,b71 by striking the period and inserting 2 and2 and 7iii7 by adding at the end the following3 7,c7 developing and implementing internships1 accredited fellowships1 and accredited residency programs in collaboration with one or more accredited schools of nursing1 to encourage the mentoring and development of specialties4 2 7,d7 by striking subsection 7e72 7,e7 by redesignating subsection 7f7 through 7h71 as subsections 7e7 through 7g71 respectively2 7,f7 in subsection 7e7 7as so redesignated71 by striking ,the ,secretary shall submit to the ,congress before the end of each fiscal year and inserting ,as part of the report on nursing workforce programs described in section #hjf7;i71 the ,secretary shall include2 7,g7 in subsection 7f7 7as so redesignated71 by striking a school of nursing1 as defined in section #hja7b711 and inserting an accredited school of nursing1 as defined in section #hja7b71 a health care facility1 including federally qualified health centers or nurse-managed health clinics1 or a partnership of such a school and facility2 and 7,h7 in subsection 7g7 7as so redesignated71 by striking #bjaj through #bjad and inserting #bjbj through #bjbd2 7#g7 by striking section #hca;,a 7#db ,u4,s4,c4 #bifp-#a72 7#h7 in section #hdf 7#db ,u4,s4,c4 #bign7-- 7,a7 by striking the last sentence of subsection 7a72 7,b7 in subsection 7b77#a71 by striking he began such practice and inserting the individual began such practice2 and 7,c7 in subsection 7i77,i71 by striking #bjjc through #bjjg and inserting #bjbj through #bjbd2 7#i7 in section #hdf;,a7f7 7#db ,u4,s4,c4 #bdgn-#a7;f771 by striking #bjaj through #bjad and inserting #bjbj through #bjbd2 7#aj7 in section #hdg7;g7 7#db ,u4,s4,c4 #bigo7g771 by striking such sums as may be necessary for each of fiscal years #bjaj through #bjad and inserting #aae1fce1jjj for each of fiscal years #bjbj through #bjbd2 7#aa7 in section #hea 7#db ,u4,s4,c4 #bigt7-- 7,a7 in subsection 7b77#a77;,a77iv71 by striking and nurse anesthetists and inserting nurse anesthetists1 and clinical nurse specialists2 7,b7 in subsection 7d77#c7-- 7i7 by striking #c years after the date of enactment of this section and inserting #b years after the date of enactment of the ,title ,,viii ,nursing ,reauthorization ,act2 7ii7 by striking ,labor and ,human ,resources and inserting ,health1 ,education1 ,labor1 and ,pensions2 and 7iii7 by inserting ,energy and before ,commerce2 and 7,c7 in subsection 7g71 by striking under this title and inserting for carrying out parts ,b1 ,c1 and ,d2 7#ab7 by striking sections #hfa and #hfb 7#db ,u4,s4,c4 #bigw and #bigx72 7#ac7 in section #hfe7;e7 7#db ,u4,s4,c4 #bih7;e771 by striking #bjad and inserting #bjbd2 and 7#ad7 in section #hga 7#db ,u4,s4,c4 #bih;d71 by striking #cch1jjj1jjj for fiscal year #bjaj1 and such sums as may be necessary for each of the fiscal years #bjaa through #bjaf and inserting #acc1hcg1jjj for each of fiscal years #bjbj through #bjbd4 7b7 ,evaluation and report on nurse loan repayment programs 7#a7 ,evaluation ,the ,comptroller ,general shall conduct an evaluation of the nurse loan repayment programs administered by the ,health ,resources and ,services ,administration4 ,such evaluation shall include-- 7,a7 the manner in which payments are made under such programs2 7,b7 the existing oversight functions necessary to ensure the proper use of such programs1 including payments made as part of such programs2 7,c7 the identification of gaps1 if any1 in oversight functions2 and 7,d7 information on the number of nurses assigned to facilities pursuant to such programs1 including the type of facility to which nurses are assigned and the impact of modifying the eligibility requirements for programs under section #hdf of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bign71 such as the impact on entities to which nurses had previously been assigned prior to fiscal year #bjai 7such as federally qualified health centers and facilities affiliated with the ,indian ,health ,service74 7#b7 ,report ,not later than #ah months after the enactment of this ,act1 the ,comptroller ,general shall submit to the ,committee on ,health1 ,education1 ,labor1 and ,pensions of the ,senate and the ,committee on ,energy and ,commerce of the ,house of ,representatives1 a report on the evaluation under paragraph 7#a71 which may include recommendations to improve relevant nursing workforce loan repayment programs4 ,november #e1 #bjai,reported with an amendment