Educating Future Nurses Act
- Sponsor
- Rep. Underwood, Lauren [D-IL-14]
- Committees
- Energy and Commerce Committee (primary)
- Last action
- Sep 16, 2026
Bottom line
This bill creates a new federal program to fund clinical education for advanced practice registered nurses, aiming to boost their numbers and improve healthcare access, particularly in underserved areas, by establishing regional education hubs and specific training requirements.
What it actually does
This bill establishes a national graduate nurse education program under Title XVIII of the Social Security Act, providing federal payments to eligible hospitals to cover the reasonable costs of qualified clinical education for advanced practice registered nurses (APRNs). The program aims to increase the number of APRNs by reimbursing costs associated with an increase in student enrollment compared to a 2024-2025 baseline, with an emphasis on community-based clinical training.
Proponents argue
Supporters argue that this program will address critical shortages of advanced practice registered nurses, especially in rural and medically underserved areas, by expanding clinical education opportunities and ensuring a robust pipeline of skilled healthcare providers. They contend that increasing the number of APRNs will improve access to primary, preventive, and specialized care, leading to better patient outcomes and more efficient healthcare delivery.
Opponents contend
Critics might argue that establishing a new federal program for nurse education could lead to increased federal spending without clear evidence of long-term effectiveness or that existing programs are insufficient. Concerns could also be raised about the administrative burden on hospitals and the potential for federal intervention in nursing education to distort market forces or educational priorities.
The bill is relatively concise and clearly structured, allowing an informed reader to understand its provisions and implications within a reasonable timeframe.
Section 2, inserting new Section 1866H(a) into Title XVIII of the Social Security Act
Program Establishment and Cost Reimbursement
This provision directs the Secretary of Health and Human Services to create a national program to pay eligible hospitals for the reasonable costs of providing clinical education to advanced practice registered nurses (APRNs). Payments are limited to costs associated with increasing the number of APRNs enrolled in accredited nursing schools, compared to a 2024-2025 baseline. Hospitals must have written agreements with eligible partners (nursing schools, other hospitals, community settings) to reimburse them for their share of costs.
Supporters argue
Supporters argue this provision directly addresses the APRN shortage by incentivizing and funding the expansion of clinical education, ensuring a steady supply of highly trained nurses to meet healthcare demands. The baseline increase mechanism ensures new capacity is created.
Critics contend
Critics might contend that limiting reimbursement to an 'increase' over a baseline could be administratively complex to track and might not adequately support existing high-performing programs. They might also argue that the definition of 'reasonable costs' could be broad, leading to potential inefficiencies.
Tradeoffs
The provision balances the need to expand APRN education with fiscal accountability by tying reimbursements to an increase in student numbers, but this might create administrative challenges in tracking and verifying the increase.
Section 2, inserting new Section 1866H(a)(3) and (b) into Title XVIII of the Social Security Act
Graduate Nurse Education (GNE) Hub Structure and Requirements
The Secretary must establish regions for 'Graduate Nurse Education Hubs' based on hospital referral regions, with only one hub allowed per region. Eligible hospitals must lead a GNE Hub, which requires partnerships with nursing schools, other hospitals/health systems, and non-hospital community-based care settings. Hubs must have a governance structure including nursing schools, a timely reimbursement process for partners, and a system for coordinating clinical education sites and preceptors, considering local workforce needs.
Section 2, inserting new Section 1866H(c) and (d) into Title XVIII of the Social Security Act
Per-Student Payments and Accountability
Payments to eligible hospitals are calculated based on an 'applicable per-student rate' multiplied by the number of APRNs receiving qualified clinical education. This rate is initially based on data from a previous Graduate Nurse Education Demonstration and adjusted annually by the consumer price index. Hospitals must submit annual reports detailing education types, partnerships, student numbers, curriculum changes, graduate outcomes (including those practicing in underserved areas), and patient treatment data. Failure to report or provide complete information results in a 25% payment reduction, which cannot be passed on to eligible partners.
Section 2, inserting new Section 1866H(e) and (f) into Title XVIII of the Social Security Act
Program Funding and Key Definitions
The program is funded by transfers from the Federal Hospital Insurance Trust Fund (Medicare Part A) and the Federal Supplementary Medical Insurance Trust Fund (Medicare Part B) to the Centers for Medicare & Medicaid Services Program Management Account. The section also defines key terms such as 'advanced practice registered nurse' (including CNS, NP, CRNA, CNM), 'applicable non-hospital community-based care setting' (e.g., FQHCs, rural health clinics, nursing homes), 'applicable school of nursing,' 'eligible hospital,' 'eligible partners,' and 'qualified clinical education' (requiring at least half to be in non-hospital settings, with a waiver for rural/underserved areas).
The Secretary may waive such requirements of title XI and this title (Title XVIII) as may be necessary to carry out the program.
Section 2, inserting new Section 1866H(a)(5) into Title XVIII of the Social Security Act
Why it matters:This is a standard legislative practice to provide administrative flexibility for new programs, allowing the Secretary to adapt existing regulations to the unique needs of the program without requiring further legislation.
Case for: Proponents argue this waiver authority is essential for efficient program implementation, allowing the Secretary to quickly address unforeseen regulatory conflicts or administrative hurdles that might otherwise delay or complicate the program's rollout.
Case against: Critics might argue that broad waiver authority could lead to a lack of transparency or accountability, allowing the Secretary to bypass important safeguards or congressional intent without sufficient oversight.
Estimated impact: Potentially significant, as it grants the Secretary broad discretion to modify existing Medicare and Social Security Act requirements for this program.
Chapter 35 of title 44, United States Code (the Paperwork Reduction Act), shall not apply to the implementation of this section.
Section 2, inserting new Section 1866H(a)(6) into Title XVIII of the Social Security Act
Why it matters:This exemption is often included in legislation to expedite the implementation of new programs by reducing the administrative burden and time associated with federal information collection requirements. It can be seen as a way to fast-track program rollout.
Case for: Proponents argue this exemption allows the Secretary to quickly establish necessary data collection and reporting mechanisms without the lengthy review process mandated by the Paperwork Reduction Act, thereby accelerating the program's impact.
Case against: Critics might contend that exempting the program from the Paperwork Reduction Act removes an important layer of public and congressional oversight on federal data collection, potentially leading to inefficient or overly burdensome reporting requirements for participating entities without adequate review.
Estimated impact: Potentially significant administrative impact, allowing for faster, less scrutinized data collection and reporting requirements for the program.
At least half of the qualified clinical education must be provided in a non-hospital community-based care setting, with a waiver available for eligible hospitals in rural or medically underserved areas.
Section 2, inserting new Section 1866H(f)(7)(A)(ii) into Title XVIII of the Social Security Act, within the definition of 'qualified clinical education.'
Why it matters:This is a substantive policy choice placed within definitions for precision and to ensure the program's focus on community-based care, which is a key objective. It's not necessarily evasive but requires careful reading of definitions.
Case for: Proponents argue this requirement ensures APRNs receive diverse clinical experience in settings where many patients receive care, preparing them for practice in primary care, preventive care, and chronic care management outside of traditional hospital environments, thereby addressing community health needs.
Case against: Critics might argue that a strict 50% requirement could be challenging to meet in areas with limited non-hospital settings or for certain APRN specialties that require more intensive hospital-based training, potentially limiting program participation or flexibility.
Estimated impact: Significant impact on the structure and delivery of APRN clinical education, shifting focus towards community-based training.