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Statutory Text

SEC. 5509 42 U.S.C. 1395ww note. GRADUATE NURSE EDUCATION DEMONSTRATION.
(a) IN GENERAL.—
(1) ESTABLISHMENT.—
(A) IN GENERAL.—The Secretary shall establish a
graduate nurse education demonstration under title XVIII
of the Social Security Act (42 U.S.C. 1395 et seq.) under
which an eligible hospital may receive payment for the
hospital’s reasonable costs (described in paragraph (2)) for
the provision of qualified clinical training to advance practice
nurses.
(B) NUMBER.—The demonstration shall include up to
5 eligible hospitals.
(C) WRITTEN AGREEMENTS.—Eligible hospitals selected
to participate in the demonstration shall enter into written
agreements pursuant to subsection (b) in order to reimburse
the eligible partners of the hospital the share of the
costs attributable to each partner.
(2) COSTS DESCRIBED.—
(A) IN GENERAL.—Subject to subparagraph (B) and
subsection (d), the costs described in this paragraph are
the reasonable costs (as described in section 1861(v) of the
Social Security Act (42 U.S.C. 1395x(v))) of each eligible
hospital for the clinical training costs (as determined by
the Secretary) that are attributable to providing advanced
practice registered nurses with qualified training.
(B) LIMITATION.—With respect to a year, the amount
reimbursed under subparagraph (A) may not exceed the
amount of costs described in subparagraph (A) that are attributable
to an increase in the number of advanced practice
registered nurses enrolled in a program that provides
qualified training during the year and for which the hospital
is being reimbursed under the demonstration, as
compared to the average number of advanced practice registered
nurses who graduated in each year during the period
beginning on January 1, 2006, and ending on December
31, 2010 (as determined by the Secretary) from the
graduate nursing education program operated by the applicable
school of nursing that is an eligible partner of the
hospital for purposes of the demonstration.
(3) WAIVER AUTHORITY.—The Secretary may waive such requirements
of titles XI and XVIII of the Social Security Act as
may be necessary to carry out the demonstration.
(4) ADMINISTRATION.—Chapter 35 of title 44, United States
Code, shall not apply to the implementation of this section.
(b) WRITTEN AGREEMENTS WITH ELIGIBLE PARTNERS.—No payment
shall be made under this section to an eligible hospital unless
such hospital has in effect a written agreement with the eligible
partners of the hospital. Such written agreement shall describe, at
a minimum—
(1) the obligations of the eligible partners with respect to
the provision of qualified training; and
(2) the obligation of the eligible hospital to reimburse such
eligible partners applicable (in a timely manner) for the costs
of such qualified training attributable to partner.
(c) EVALUATION.—Not later than October 17, 2017, the Secretary
shall submit to Congress a report on the demonstration.
Such report shall include an analysis of the following:
(1) The growth in the number of advanced practice registered
nurses with respect to a specific base year as a result
of the demonstration.
(2) The growth for each of the specialties described in subparagraphs
(A) through (D) of subsection (e)(1).
(3) The costs to the Medicare program under title XVIII of
the Social Security Act as a result of the demonstration.
(4) Other items the Secretary determines appropriate and
relevant.
(d) FUNDING.—
(1) IN GENERAL.—There is hereby appropriated to the Secretary,
out of any funds in the Treasury not otherwise appropriated,
$50,000,000 for each of fiscal years 2012 through 2015
to carry out this section, including the design, implementation,
monitoring, and evaluation of the demonstration.
(2) PRORATION.—If the aggregate payments to eligible hospitals
under the demonstration exceed $50,000,000 for a fiscal
year described in paragraph (1), the Secretary shall prorate the
payment amounts to each eligible hospital in order to ensure
that the aggregate payments do not exceed such amount.
(3) WITHOUT FISCAL YEAR LIMITATION.—Amounts appropriated
under this subsection shall remain available without
fiscal year limitation.
(e) DEFINITIONS.—In this section:
(1) ADVANCED PRACTICE REGISTERED NURSE.—The term
‘‘advanced practice registered nurse’’ includes the following:
(A) A clinical nurse specialist (as defined in subsection
(aa)(5) of section 1861 of the Social Security Act (42 U.S.C.
1395x)).
(B) A nurse practitioner (as defined in such subsection).
(C) A certified registered nurse anesthetist (as defined
in subsection (bb)(2) of such section).
(D) A certified nurse-midwife (as defined in subsection
(gg)(2) of such section).
(2) APPLICABLE NON-HOSPITAL COMMUNITY-BASED CARE
SETTING.—The term ‘‘applicable non-hospital community-based
care setting’’ means a non-hospital community-based care setting
which has entered into a written agreement (as described
in subsection (b)) with the eligible hospital participating in the
demonstration. Such settings include Federally qualified health
centers, rural health clinics, and other non-hospital settings as
determined appropriate by the Secretary.
(3) APPLICABLE SCHOOL OF NURSING.—The term ‘‘applicable
school of nursing’’ means an accredited school of nursing (as
defined in section 801 of the Public Health Service Act) which
has entered into a written agreement (as described in subsection
(b)) with the eligible hospital participating in the demonstration.
(4) DEMONSTRATION.—The term ‘‘demonstration’’ means
the graduate nurse education demonstration established under
subsection (a).
(5) ELIGIBLE HOSPITAL.—The term ‘‘eligible hospital’’
means a hospital (as defined in subsection (e) of section 1861
of the Social Security Act (42 U.S.C. 1395x)) or a critical access
hospital (as defined in subsection (mm)(1) of such section) that
has a written agreement in place with—
(A) 1 or more applicable schools of nursing; and
(B) 2 or more applicable non-hospital communitybased
care settings.
(6) ELIGIBLE PARTNERS.—The term ‘‘eligible partners’’ includes
the following:
(A) An applicable non-hospital community-based care
setting.
(B) An applicable school of nursing.
(7) QUALIFIED TRAINING.—
(A) IN GENERAL.—The term ‘‘qualified training’’ means
training—
(i) that provides an advanced practice registered
nurse with the clinical skills necessary to provide primary
care, preventive care, transitional care, chronic
care management, and other services appropriate for
individuals entitled to, or enrolled for, benefits under
part A of title XVIII of the Social Security Act, or enrolled
under part B of such title; and
(ii) subject to subparagraph (B), at least half of
which is provided in a non-hospital community-based
care setting.
(B) WAIVER OF REQUIREMENT HALF OF TRAINING BE
PROVIDED IN NON-HOSPITAL COMMUNITY-BASED CARE SETTING
IN CERTAIN AREAS.—The Secretary may waive the requirement
under subparagraph (A)(ii) with respect to eligible
hospitals located in rural or medically underserved
areas.
(8) SECRETARY.—The term ‘‘Secretary’’ means the Secretary
of Health and Human Services.