Sec. 5509. GRADUATE NURSE EDUCATION DEMONSTRATION
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## SEC. 5509 GRADUATE NURSE EDUCATION DEMONSTRATION **[**[42 U.S.C. 1395ww note](/us/usc/t42/s1395ww)**]** ###
(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 community-based 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. ## Subtitle G Improving Access to Health Care Services
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