,,ii  #aah? ,,congress  #a/ ,session    
,s4 #aehf  ,,9 ,,! ,,s5ate ,,( ,,!      
,,unit$ ,,/ates  ,may #aa1 #bjbc,ms4    
,/ab5[ 7= h]self1 ,mr4 ,casey1 & ,ms4   
,hassan7 introduc$ ! foll[+ bill2 :i* 0 
read twice & ref]r$ to ! ,committee on  
,f9ance  ,a ,,bill  ,to am5d title      
,,xviii ( ! ,social ,security ,act to   
e/abli% a national graduate nurse       
education program4  #a4 ,%ort title ,?is
 ,act may be cit$ z ! ,educat+ ,future  
,nurses ,act4  #b4 ,national graduate   
nurse education program ,title ,,xviii (
 ! ,social ,security ,act 7#db ,u4,s4,c4
 #acie et seq47 is am5d$ by ins]t+ aft] 
section #ahff;,g ! foll[+ new section3  
#ahff;,h4 ,national graduate nurse      
education program  7a7 ,9 g5]al  7#a7   
,e/abli%m5t  7,a7 ,9 g5]al ,! ,secret>y 
%all e/abli% a national graduate nurse  
education program "u ?is title "u :i* an
 eligible hospital may receive paym5t = 
! hospital's reasonable co/s 7describ$ 9
 p>agraph 7#b77 = ! provision ( qualifi$
 cl9ical education to advanc$ practice  

regi/]$ nurses4  7,b7 ,writt5 agreem5ts 
,eligible hospitals p>ticipat+ 9 !      
program %all ent] into writt5 agreem5ts 
pursuant to subsection 7b77#a7 9 ord] to
 reimburse ! eligible p>tn]s ( !        
hospital ! %>e ( ! co/s attributable to 
ea* p>tn]4  7#b7 ,co/s describ$  7,a7 ,9
 g5]al ,subject to subp>agraph 7,b71 !  
co/s describ$ 9 ?is p>agraph are !      
reasonable co/s 7z describ$ 9 section   
#ahfa7v77 ( ea* eligible hospital = !   
cl9ical education co/s 7z det]m9$ by !  
,secret>y7 t are attributable to provid+
 advanc$ practice regi/]$ nurses )      
qualifi$ cl9ical education4  7,b7       
,limitation ,) respect to a ye>1 ! am\nt
 reimburs$ "u subp>agraph 7,a7 may n    
exce$ ! am\nt ( co/s describ$ 9         
subp>agraph 7,a7 t are attributable to  
an increase 9 ! numb] ( advanc$ practice
 regi/]$ nurses enroll$ 9 an accr$it$   
s*ool ( nurs+ t provides qualifi$       
cl9ical education dur+ ! ye> & = :i* !  
hospital is be+ reimburs$ "u ! program1 
z comp>$ to ! av]age numb] ( advanc$    

practice regi/]$ nurses :o graduat$ 9   
ea* ye> dur+ ! p]iod beg9n+ on ,janu>y  
#a1 #bjba1 & end+ on ,decemb] #ca1 #bjbb
 7z det]m9$ by ! ,secret>y7 f ! graduate
 nurs+ education program op]at$ by !    
applicable s*ool ( nurs+ t is an        
eligible p>tn] ( ! hospital = purposes (
 ! program4  7#c7 ,e/abli%m5t ( regions 
7,a7 ,9 g5]al ,! ,secret>y %all e/abli% 
regions = ,graduate ,nurse ,education   
,hubs describ$ 9 subsection 7b7 "u !    
program bas$ on hospital ref]ral        
regions4  7,b7 ,limitations  7i7 ,"o    
,,hub p] region ,only "o ,graduate      
,nurse ,education ,hub may p>ticipate 9 
! program ) respect to ea* region       
e/abli%$ by ! ,secret>y "u subp>agraph  
7,a74  7ii7 ,eligible hospitals &       
eligible p>tn]s ,an eligible hospital or
 eligible p>tn] may only p>ticipate 9 "o
 ,graduate ,nurse ,education ,hub "u !  
program4  7#d7 ,supplem5t n supplant    
,paym5ts "u ?is section 9 any giv5 ye>  
%all supplem5t1 n supplant1 o!r ,f$]al  
funds t h be5 made available 9 ! ye> =  

advanc$ practice regi/]$ nurse cl9ical  
education or tra9+4  7#e7 ,waiv]        
au?ority ,! ,secret>y may waive su*     
requirem5ts ( title ,,xi & ?is title z  
may be necess>y to c>ry out ! program4  
7#f7 ,adm9i/ration ,*apt] #ce ( title   
#dd1 ,unit$ ,/ates ,code1 %all n apply  
to ! implem5tation ( ?is section4  7b7  
,requirem5ts ,no paym5t %all be made "u 
?is section to an eligible hospital     
unless su* hospital meets ! foll[+      
requirem5ts3 7#a7 ,! hospital has 9     
effect a writt5 agreem5t ) ! eligible   
p>tn]s ( ! hospital4 ,su* writt5        
agreem5t %all describe1 at a m9imum--   
7,a7 ! obligations ( ! eligible p>tn]s )
 respect to ! provision ( qualifi$      
cl9ical education2 &  7,b7 ! obligation 
( ! eligible hospital to reimburse su*  
eligible p>tn]s 79 a timely mann]7 = !  
co/s ( su* qualifi$ cl9ical education t 
are attributable to su* p>tn]4  7#b7 ,! 
hospital demon/rates to ! ,secret>y t x 
is lead+ a ,graduate ,nurse ,education  
7,,gne7 ,hub :i* has e/abli%$ & w ma9ta9

 ! foll[+ 9 ord] to provide qualifi$    
cl9ical education to advanc$ practice   
regi/]$ nurses3 7,a7 ,p>tn]%ips ) "o or 
m-- 7i7 applicable s*ools ( nurs+2  7ii7
 hospitals or heal? sy/ems 9 a regional 
area2 &  7iii7 applicable non-hospital  
community-bas$ c>e sett+s4  7,b7 ,a     
gov]nance /ructure t includes "o or m   
applicable s*ools ( nurs+ 9 ! lead]%ip &
 an ov]sight process t is develop$ &    
approv$ by ! hospital1 p>ticipat+       
applicable s*ools ( nurs+1 & o!r hub    
p>tn]s1 9 accordance ) requirem5ts      
e/abli%$ by ! ,secret>y4  7,c7 ,a       
process = timely reimbursem5t ( eligible
 p>tn]s = ! co/s ( su* qualifi$ cl9ical 
education t are attributable to su*     
p>tn]4  7,d7 ,an adequate sy/em =       
coord9ation ( cl9ical education sites & 
preceptors4  7,e7 ,a process = tak+ into
 consid]ation local1 ,/ate1 & regional  
work=ce ne$s to facilitate innovation & 
value-bas$ deliv]y ( heal? c>e4  7c7    
,paym5ts  7#a7 ,p]-/ud5t rate ,! am\nt (
 paym5t "u ?is section to an eligible   

hospital %all = ea* ye> ( ! program %all
 be equal to ! applicable p]-/ud5t rate 
7z def9$ 9 p>agraph 7#b77 multipli$ by !
 total numb] ( advanc$ practice regi/]$ 
nurses receiv+ qualifi$ cl9ical         
education ?r\gh ! eligible hospital "u !
 program4  7#b7 ,applicable p]-/ud5t    
rate ,! applicable p]-/ud5t rate1 )     
respect to an eligible hospital1 is--   
7,a7 = ! fir/ ye> ( ! program1 a        
p]-/ud5t rate det]m9$ by ! ,secret>y    
bas$ on data f ! ,graduate ,nurse       
,education ,demon/ration e/abli%$ "u    
section #eeji ( ! ,pati5t ,protection & 
,af=dable ,c>e ,act 7,public ,law       
#aaa-adh71 increas$ or decreas$ by !    
p]c5tage *ange 9 ! consum] price index =
 all urban consum]s 7all items2 ,unit$  
,/ates city av]age7 f ! la/ ye> ( !     
,graduate ,nurse ,education             
,demon/ration e/abli%$ "u section #eeji 
= :i* su* data is available to ! ,june  
prec$+ su* fir/ ye> ( ! program "u ?is  
section2 &  7,b7 = a subsequ5t ye>1 !   
am\nt det]m9$ "u ?is p>agraph = ! prec$+

 ye>1 increas$ or decreas$ by ! p]c5tage
 *ange 9 ! consum] price index = all    
urban consum]s 7all items2 ,unit$ ,/ates
 city av]age7 = ! #ab-mon? p]iod end+ ) 
,june ( ! previ\s ye>4  7d7 ,annual     
report+ requir$  7#a7 ,r$uction 9 paym5t
 = failure to report  7,a7 ,9 g5]al ,!  
am\nt payable "u ?is section to an      
eligible hospital %all be r$uc$ by #be  
p]c5t if ! ,secret>y det]m9es t-- 7i7 ! 
hospital has fail$ to provide !         
,secret>y ! report requir$ "u p>agraph  
7#b7 = ! ye>2 or  7ii7 su* report fails 
to provide ! in=mation requir$ "u any   
subp>agraph ( su* p>agraph4  7,b7       
,notice & opportunity to provide miss+  
in=mation ,be=e impos+ a r$uction "u    
subp>agraph 7,a7 on ! basis ( a         
hospital's failure to provide in=mation 
describ$ 9 subp>agraph 7,a77ii71 !      
,secret>y %all provide notice to !      
hospital ( su* failure & ! ,secret>y's  
int5tion to impose su* r$uction & %all  
provide ! hospital ) ! opportunity to   
provide ! requir$ in=mation )9 a p]iod (

 #cj days beg9n+ on ! date ( su* notice4
 ,if ! hospital provides su* in=mation  
)9 su* p]iod1 no r$uction %all be made  
"u subp>agraph 7,a7 on ! basis ( !      
previ\s failure to provide su*          
in=mation4  7,c7 ,limitation ,9 ! case  
:]e ! am\nt payable "u ?is section to an
 eligible hospital is r$uc$ pursuant to 
subp>agraph 7,a71 ! eligible hospital   
may n make any correspond+ r$uctions 9  
paym5t to eligible p>tn]s4  7#b7 ,annual
 report ,! report requir$ "u ?is        
p>agraph = an eligible hospital = a ye> 
is a report t includes 79 a =m & mann]  
specifi$ by ! ,secret>y7 ! foll[+       
in=mation = ! academic ye> complet$     
imm$iately prior to su* ye>3 7,a7 ,!    
types ( qualifi$ cl9ical education      
provid$ to advanc$ practice regi/]$     
nurses "u ! program4  7,b7 ,! type &    
numb] ( academic or practice p>tn]%ips  
e/abli%$ z a result ( work+ toge!r 9 a  
,graduate ,nurse ,education 7,,gne7     
,hub4  7,c7 ,! numb] ( advanc$ practice 
regi/]$ nurse /ud5ts receiv+ qualifi$   

cl9ical education ?r\gh ! eligible      
hospital "u ! program4  7,d7 ,any *anges
 9 qualifi$ cl9ical education made dur+ 
su* academic ye> 7except t ! fir/ report
 submitt$ by ! eligible hospital "u ?is 
p>agraph %all be = su* *anges s9ce !    
fir/ ye> 9 :i* ! hospital receiv$ paym5t
 "u ?is section71 includ+-- 7i7 *anges 9
 curricula1 cl9ical education exp]i5ces1
 & types ( cl9ical education1 & b5efits 
t h result$ f su* *anges2 &  7ii7 *anges
 = purposes ( measur+ & improv+ !       
quality & safety ( pati5t c>e4  7,e7 ,! 
numb]s ( advanc$ practice regi/]$ nurses
 :o graduat$ f _! program at ! end ( su*
 academic ye> & c>e = individuals )9 !  
bord]s ( ! s]vice area ( ! hospital or  
)9 ! bord]s ( ! ,/ate 9 :i* ! hospital  
is locat$4  7,f7 ,! numb] ( pati5ts     
treat$ by advanc$ practice regi/]$      
nurses "u ! program4  7,g7 ,! numb] (   
visits by pati5ts treat$ by su* advanc$ 
practice regi/]$ nurses4  7,h7 ,( !     
numb] ( advanc$ practice regi/]$ nurses 
:o graduat$ f _! program at ! end ( su* 

academic ye>1 ! numb] & p]c5tage ( su*  
advanc$ practice regi/]$ nurses :o ent]$
 practice at a heal? c>e facility-- 7i7 
prim>ily s]v+ a heal? pr(essional       
%ortage area ) a designation 9 effect "u
 section #ccb ( ! ,public ,heal? ,s]vice
 ,act or a m$ically und]s]v$ community  
7z def9$ 9 section #gii;,b ( su* ,act72 
or  7ii7 locat$ 9 a rural area 7z def9$ 
9 section #ahhf7;d77#b77;,d774  7,i7    
,o!r in=mation z deem$ appropriate by ! 
,secret>y4  7#c7 ,report to congress ,n 
lat] ?an #b ye>s aft] ! date ( !        
enactm5t ( ?is section1 ! ,secret>y %all
 submit to ,congress a report-- 7,a7    
summ>iz+ ! in=mation submitt$ 9 reports 
to ! ,secret>y "u p>agraph 7#b72  7,b7  
describ+ ! results ( ! program c>ri$ out
 "u ?is section2 &  7,c7 mak+           
recomm5dations = improvem5ts to !       
program4  7e7 ,fund+ ,= purposes ( c>ry+
 ! program "u ?is section1 ! ,secret>y  
%all provide = ! transf]1 f ! ,f$]al    
,hospital ,insurance ,tru/ ,fund "u     
section #ahag & ! ,f$]al ,supplem5t>y   

,m$ical ,insurance ,tru/ ,fund "u       
section #ahda1 9 su* proportion z !     
,secret>y det]m9es appropriate1 ( su*   
sums z ! ,secret>y det]m9es necess>y1 to
 ! ,c5t]s = ,m$ic>e  ,m$icaid ,s]vices  
,program ,managem5t ,acc\nt4  7f7       
,def9itions ,9 ?is section3 7#a7        
,advanc$ practice regi/]$ nurse ,! t]m  
advanc$ practice regi/]$ nurse includes 
! foll[+3 7,a7 ,a cl9ical nurse         
speciali/ 7z def9$ 9 subsection 7aa77#e7
 ( section #ahfa4  7,b7 ,a nurse        
practition] 7z def9$ 9 su* subsection74 
7,c7 ,a c]tifi$ regi/]$ nurse ane/heti/ 
7z def9$ 9 subsection 7bb77#b7 ( su*    
section74  7,d7 ,a c]tifi$ nurse-midwife
 7z def9$ 9 subsection 7gg77#b7 ( su*   
section74  7#b7 ,applicable non-hospital
 community-bas$ c>e sett+ ,! t]m        
applicable non-hospital community-bas$  
c>e sett+ means a non-hospital          
community-bas$ c>e sett+ :i* has ent]$  
into a writt5 agreem5t 7z describ$ 9    
subsection 7b77#a77 ) ! eligible        
hospital p>ticipat+ 9 ! program4 ,su*   

sett+s include ,f$]ally qualifi$ heal?  
c5t]s1 rural heal? cl9ics1 nurse manag$ 
cl9ics1 ambulatory practices 7includ+   
retail cl9ics71 acc\ntable c>e          
organizations1 physician or practition] 
(fices1 s*ools1 nurs+ homes1 hospice    
programs1 long-t]m c>e facilities1 home 
heal? ag5cies1 & o!r non-hospital sett+s
 z det]m9$ appropriate by ! ,secret>y4  
7#c7 ,applicable s*ool ( nurs+ ,! t]m   
applicable s*ool ( nurs+ means an       
accr$it$ s*ool ( nurs+ 7z def9$ 9       
section #hja ( ! ,public ,heal? ,s]vice 
,act7 :i* has ent]$ into a writt5       
agreem5t 7z describ$ 9 subsection       
7b77#a77 ) ! eligible hospital          
p>ticipat+ 9 ! program4  7#d7 ,program  
,! t]m program means ! graduate nurse   
education program e/abli%$ "u subsection
 7a74  7#e7 ,eligible hospital ,! t]m   
eligible hospital means a hospital 7z   
def9$ 9 subsection 7e7 ( section #ahfa7 
or a critical access hospital 7z def9$ 9
 subsection 7mm77#a7 ( su* section7 t   
has a writt5 agreem5t 9 place )-- 7,a7  

#a or m applicable s*ools ( nurs+2 &    
7,b7 #b or m applicable non-hospital    
community-bas$ c>e sett+s4  7#f7        
,eligible p>tn]s ,! t]m eligible p>tn]s 
includes ! foll[+3 7,a7 ,an applicable  
s*ool ( nurs+4  7,b7 ,a hospital or     
heal? sy/em 9 a regional area4  7,c7 ,an
 applicable non-hospital community-bas$ 
c>e sett+4  7#g7 ,qualifi$ cl9ical      
education  7,a7 ,9 g5]al ,! t]m qualifi$
 cl9ical education means education-- 7i7
 t provides an advanc$ practice regi/]$ 
nurse ) ! cl9ical skills necess>y to    
provide prim>y c>e1 prev5tive c>e1      
transitional c>e1 acute c>e1 *ronic c>e 
managem5t1 & o!r s]vices appropriate =  
individuals entitl$ to1 or enroll$ =1   
b5efits "u "p ,a1 or enroll$ "u "p ,b2 &
  7ii7 subject to subp>agraph 7,b71 at  
lea/ half ( :i* is provid$ 9 a          
non-hospital community-bas$ c>e sett+4  
7,b7 ,waiv] ( requirem5t half ( qualifi$
 education be provid$ 9 non-hospital    
community-bas$ c>e sett+ 9 c]ta9 areas  
,! ,secret>y may waive ! requirem5t "u  

subp>agraph 7,a77ii7 ) respect to       
eligible hospitals locat$ 9 rural or    
m$ically und]s]v$ areas4  4