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(1) assist in—

where the Secretary determines that unusual circumstances make a larger percentage (which may in no case exceed 75 per centum) necessary in order to effectuate the purpose of this part, exceed 67 per centum of the necessary cost of construction, as so determined, of the project with respect to which the grant is made.

(b) Upon approval of any application for a grant for a construction project under this part, the Secretary shall reserve, from any appropriation available therefor, the amount of such grant as determined under subsection (a) of this section; the amount so reserved may be paid in advance or by way of reimbursement, and in such installments consistent with construction progress as the Secretary may determine. The Secretary's reservation of any amount under this section may be amended by him, either upon approval of an amendment of the application or upon revision of the estimated cost of construction of the facility.

(As amended Nov. 18, 1971, Pub. L. 92-158, §§ 2(b), 13, 85 Stat. 465, 480.)

AMENDMENTS

1971-Subsec. (a). Pub. L. 92-158, §§ 2(b), 13, substituted "Secretary" for "Surgeon General" in two places within this subsection, altered clause (A) by adding to material after "(A) in the case of a grant" the designation "(1)", substituted "(ii)” for “and in the case of a grant", added a new subclause (iii), substituted "75 per centum" for "66% per centum" and in Clause (B) substituted "75 per centum" and "67 per centum" for "663 per centum" and "50 per centum", respectively.

Subsec. (b). Pub. L. 92-158, § 13, substituted "Secretary" for "Surgeon General" in two places and substituted "Secretary's" for "Surgeon General's".

§ 296c. Recovery of payments.

If, within twenty years (or in the case of interim facilities, within such shorter period as the Secretary shall by regulation prescribe) after completion of any construction for which funds have been paid under this part

(b) the facility shall cease to be used for the training purposes for which it was constructed (unless the Secretary determines, in accordance with regulations, that there is good cause for releasing the applicant or other owner from the obligation to do so), or

(As amended Nov. 18, 1971, Pub. L. 92–158, §§ 2(d) (3), 13, 85 Stat. 468, 480.)

AMENDMENTS

1971-Pub. L. 92-158, in material preceding subsec. (a), added "(or in the case of interim facilities, within such shorter period as the Secretary shall by regulation prescribe)" following "twenty years" and in subsec. (b), substituted "Secretary" for "Surgeon General".

§ 296d. Nurse training programs.

(a) Special project grants and contracts.

From appropriations under section 296g of this title the Secretary may make grants to public and other non-profit private schools of nursing and other public or non-profit private agencies, organizations and institutions, and enter into contracts with any public or private agencies, organizations, or institutions, to meet the costs of special projects to

(A) mergers between hospital training programs or between hospital training programs and academic institutions, or

(B) other cooperative arrangements among hospitals and academic institutions, leading to the establishment of nurse training programs;

(2) develop training programs, and train, for new roles, types, or levels of nursing personnel, including programs for the training of pediatric nurse practitioners or other types of nurse practitioners;

(3) develop programs for cooperative interdisciplinary training among schools of nursing and schools of allied health, medicine, dentistry, osteopathy, optometry, podiatry, pharmacy, public health, or veterinary medicine, including training for the use of the team approach to the delivery of health services;

(4) assist in increasing the supply, or improving the distribution, of adequately trained nursing personnel or to promote the full utilization of nursing skills;

(5) effect significant improvements in the curriculums of schools of nursing;

(6) research, develop, or demonstrate advances in the various fields related to education in nursing;

(7) plan, develop, or establish new programs or modifications of existing programs of nursing education;

(8) increase educational opportunities for disadvantaged students;

(9) provide continuing education for nurses;

(10) provide appropriate retraining opportunities for nurses who (after periods of professional inactivity) desire again actively to engage in the nursing profession;

(11) otherwise strengthen, improve or expand programs to train nursing personnel, or

(12) help to increase the supply or improve the distribution by geographic area or by specialty group of adequately trained nursing personnel needed to meet the health needs of the Nation, including the need to increase the availability of personal health services and the need to promote preventive health care.

Contracts may be entered into under this subsection without regard to section 529 of Title 31 and section 5 of Title 41.

(b) Financial distress grants.

The Secretary may also make grants from appropriations under section 296g of this title to assist public or nonprofit private schools of nursing which are in serious financial straits to meet operational costs required to maintain quality educational programs or which have special need for financial assistance to meet accreditation requirements. Any such grant may be made upon such terms and conditions as the Secretary determines to be reasonable and necessary, including requirements that the school agree (1) to disclose any financial information or data deemed by the Secretary to be necessary to determine the sources or causes of that school's financial distress, (2) to conduct a compre

hensive cost analysis study in cooperation with the Secretary, and (3) to carry out appropriate operational and financial reforms on the basis of information obtained in the course of the comprehensive cost analysis study or on the basis of other relevant information.

(c) Application for financial distress grant.

An application for a grant under subsection (b) of this section must contain or be supported by assurances satisfactory to the Secretary that the applicant will expend in carrying out its functions as a school of nursing, during the fiscal year for which such grant is sought, an amount of funds (other than funds for construction as determined by the Secretary) from non-Federal sources which is at least as great as the average amount of funds expended by such applicant for such purpose (excluding expenditures of a nonrecurring nature) in the three fiscal years immediately preceding the fiscal year for which such grant is sought. The Secretary may, after consultation with the National Advisory Council on Nurse Training, waive the requirement of the preceding sentence with respect to any school if he determines that the application of such requirement to such school would be inconsistent with the purposes of subsection (b) of this section. (d) Federal medical facilities, utilization.

The Secretary may, with the advice of the National Advisory Council on Nurse Training, provide assistance (including assistance under this section which may be provided without regard to section 296f of this title) to the heads of other departments and agencies of the Government to encourage and assist in the utilization of medical facilties under their jurisdiction for nurse training programs. (As amended Nov. 18, 1971, Pub. L. 92-158, § 3(b), 85 Stat. 469.)

AMENDMENTS

1971-Subsec. (a). Pub. L. 92-158 substituted provisions authorizing special project grants and contracts for nurse training programs for provisions authorizing special project grants for improvement in nurse training.

Subsec. (b). Pub. L. 92-158 substituted provisions authorizing financial distress grants for nurse training programs for provisions determining the priority of projects for improvement in nurse training.

Subsec. (c). Pub. L. 92-158 added subsec. (c).
Subsec. (d). Pub. L. 92–158 added subsec. (d).

EFFECTIVE DATE OF 1971 AMENDMENT Section 3(b) of Pub. L. 92-158 provided in part that the amendment to this section by section 3(b) of Pub. L. 92-158 shall be effective with respect to appropriations made under section 296g of this title for the fiscal years beginning after June 30, 1971.

SECTION REFERRED TO IN OTHER SECTIONS This section is referred to in sections 296h, 298 of this title.

§ 296e. Capitation grants for institutional support. (a) Grant computation.

The Secretary shall make annual grants to schools of nursing for the support of the education programs of such schools. The amount of the annual grant to each such school with an approved application shall be computed as follows:

(1) Each such school shall receive

(A) $250 for each full-time student enrolled in such school in such year (other than a stu

dent who will graduate from such school in such year);

(B) $500 for each full-time student enrolled in such school who will graduate in such year; and

(C) $100 for each enrollment bonus student (as determined under subsection (d) of this section) enrolled in such school in such year; and

(2) Each such school which has a training program for the training of nurse midwives, family health nurses, pediatric nurse practitioners, or similar nurse practitioners shall receive

(A) $250 for each full-time student enrolled in such program in such year (other than a student who will complete the training provided under such program in such year); and

(B) $900 for each full-time student enrolled in such program who will complete the training provided under such program in such year.

(b) Apportionment of appropriations.

If the total of the grants to be made under subsection (a) of this section for any fiscal year to schools with approved applications exceeds the amounts appropriated under subsection (i) of this section for such grants, the amount of the grant for that fiscal year to each such school shall be an amount which bears the same ratio to the amount determined for the school for that fiscal year under subsection (a) of this section as the total of the amounts appropriated under subsection (i) of this section for that year bears to the amount required to make grants to each school in accordance with subsection (a) of this section.

(c) Enrollment bonus student defined.

For purposes of subsection (a) of this section, a full-time student enrolled for any school year in a school of nursing shall be considered to be an enrollment bonus student if—

(1) he enrolled in such school as a first-year student for a school year beginning after June 30, 1971; and

(2) the size of the class of first-year students which enrolled in such school for such school year met the applicable requirement of subsection (d) (1) (A) or (d) (2) (A) of this section, and the application of such school for a grant under this section for the fiscal year in which such school year began met the applicable requirement of subsection (d) (1) (B) or (d) (2) (B) of this section. Any student who is considered to be an enrollment bonus student for the school year for which he enrolled as a first-year student in a school shall be considered to be an enrollment bonus student for each school year thereafter for which he is enrolled in such school (other than as a student enrolled in a training program described in subsection (a) (2) of this section).

(d) Class size and application requirements for grants for bonus enrollment students.

(1) School year 1971-1972.

If the school year for which a class enrolled as a class of first-year students in a school was the first school year beginning after June 30, 1971

(A) the number of students who enrolled in such class for such school year must exceed the

number of first-year students who enrolled in such school for the preceding school year by 5 per centum of such number or by five students, whichever is greater; and

(B) the application of such school for a grant under this section for the fiscal year ending June 30, 1972, contains or is supported by reasonable assurances that, for the first school year beginning after June 30, 1972 and for each school year thereafter, the number of students enrolled in such school as a class of first-year students will not be less than a number equal to the sum of(i) the minimum enrollment of first-year students required under subparagraph (A); and (ii) 5 per centum of the average of the firstyear enrollment of full time students in such school for the two school years having the highest such enrollment during the five school years during the period of July 1, 1966, through June 30, 1971, or ten students, whichever is greater.

(2) School years after school year 1971-1972.

If the school year for which a class enrolled as a class of first-year students in a school was any school year beginning after June 30, 1972

(A) the number of students who enrolled in such class for such school year

(i) if such school has not previously received a grant for bonus enrollment students, must be not less than the sum of (I) the minimum number of first-year students which such school is required pursuant to subsection (e) of this section (or would be required pursuant to subsection (e) of this section except for paragraph (2) thereof) to enroll for such school year, and (II) 5 per centum of that number or 5 students, whichever is greater; or

(ii) if such school has previously qualified for a bonus enrollment grant under this section, must be not less than the sum of (I) the minimum number of students which such school was required, pursuant to paragraph (1)(B) or (2) (B) (as the case may be), to assure the Secretary would be enrolled for such school year, and (II) 5 per centum of that number or 5 students, whichever is greater; and

(B) the application of such school for a grant under this section for the fiscal year in which such school year begins contains or is supported by reasonable assurances that, for the first school beginning after the close of such fiscal year and for each fiscal year thereafter, the number of students enrolled in such school as a class of first year students will not be less than the minimum number of students such school was required under subparagraph (A) to enroll as first year students. (e) Maintenance of effort and enrollment increase requirements.

(1) The Secretary shall not make a grant under this section to any school in a fiscal year beginning after June 30, 1971, unless the application for such grant contains or is supported by reasonable assurances satisfactory to the Secretary

(A) that for the first school year beginning after the close of the fiscal year in which such grant is made and for each school year thereafter

during which such a grant is made the first-year enrollment of full-time students in such school will exceed the average of the first-year enrollment of such students in such school for the two school years having the highest such enrollment during the five school years during the period July 1, 1966, through June 30, 1971, by at least 5 per centum of such average first-year enrollment, or by ten students, whichever is greater; and

(B) that the applicant will expend in carrying out its function as a school of nursing, during the fiscal year for which such grant is sought, an amount of funds (other than funds for construction as determined by the Secretary) from nonFederal sources which is at least as great as the average amount of funds expended by such applicant for such purpose (excluding expenditures of a nonrecurring nature) in the 3 fiscal years immediately preceding the fiscal year for which such grant is sought.

The requirements of subparagraph (A) shall be in addition to the requirements of subsection (b) (2) (D) of section 296a of this title, where applicable.

(2) The Secretary is authorized to waive (in whole or in part) the provisions of paragraph (1) (A) if he determines, after consultation with the National Advisory Council on Nurse Training, that the required increase in first-year enrollment of full-time students in a school cannot, because of limitations of physical facilities available to the school for training or because of other relevant factors, be accomplished without lowering the quality of training provided therein.

(f) Plan requirement.

(1) In the case of a school which has not received a grant under subsection (a) of this section in a fiscal year beginning after June 30, 1971, an application by such school for such a grant for a fiscal year beginning after that date may not be approved by the Secretary unless the application contains or is accompanied by a plan to carry out, or establish and carry out, during the two-school year period commencing not later than the first day of the fiscal year next following the fiscal year in which the grant is made, specific projects in at least three of the following categories of projects:

(A) Projects to assist in—

(i) mergers between hospital training programs or between hospital training programs and academic institutions, or

(ii) affiliation agreements with hospitals or academic institutions;

leading to the establishment of nurse training programs.

(B) Projects to train for new roles, types, or levels of nursing personnel, including programs for the training of pediatric nurse practitioners or other types of nurse practitioners, in cooperation with appropriate academic institutions or hospitals.

(C) Projects to establish cooperative intradisciplinary training among schools of nursing with a view toward establishment of interchangeable curriculum or shared use of resources.

(D) Projects to establish cooperative interdisciplinary training between schools of nursing and

schools of allied health, medicine, dentistry, osteopathy, optometry, podiatry, pharmacy, public health, or veterinary medicine, including training for the use of the team approach to the delivery of health services.

(E) Projects to assist in increasing the supply of adequately trained nursing personnel or to promote the full utilization of nursing skills.

(F) Projects to effect significant improvements in the curricula of schools of nursing (including projects with a view toward the assumption of greater patient care responsibilities).

(G) Projects to provide in-service or other training and education to upgrade the skills of licensed vocational or licensed practical nurses, nursing assistants, and aides, and other paraprofessional nursing personnel.

(H) Projects to increase admissions to, and enrollment and retention in, such schools of qualified individuals who, due to socioeconomic factors, are financially or educationally disadvantaged.

(2) The Secretary may make on-site inspections of any school, or require the supplying of information or data from any school, receiving a grant under subsection (a) of this section to determine the extent to which such school is carrying out the specific projects required to be included in the plan submitted by such school (pursuant to paragraph (1)) in connection with its application for such grant.

(3) The Secretary shall submit to the Committee on Labor and Public Welfare of the Senate and the Committee on Interstate and Foreign Commerce of the House of Representatives two reports containing full and complete information as to the extent to which schools receiving grants under subsection (a) of this section are carrying out the specific projects included in plans submitted by them pursuant to paragraph (1). The first such report shall be submitted not later than January 1, 1973, and the second such report shall be submitted not later than September 1, 1974.

(g) Enrollment and graduation determinations.

(1) For purposes of this part and part D, regulations of the Secretary shall include provisions relating to determination of the number of students enrolled in a school, or in a particular year-class in a school, or the number of graduates, as the case may be, on the basis of estimates or on the basis of the number of students who were enrolled in a school, or in a particular year-class in a school, or were graduates, in an earlier year, as the case may be, or on such basis as he deems appropriate for making such determination, and shall include methods of making such determination when a school or a yearclass was not in existence in an earlier year at a school.

(2) For purposes of this part and part D, the term "full-time students" (whether such term is used by itself or in connection with a particular yearclass) means students pursuing a full-time course of study in an accredited program in a school of nursing.

(h) Application for new schools.

In the case of a new school of nursing which applies for a grant under this section in the fiscal year

preceding the fiscal year in which it will admit its first class, the enrollment for purposes of subsection (a) of this section shall be the number of full-time students which the Secretary determines, on the basis of assurances provided by the school, will be enrolled in the school, in the fiscal year after the fiscal year in which the grant is made.

(i) Authorization of appropriations.

(1) There are authorized to be appropriated $78,000,000 for the fiscal year ending June 30, 1972, $82,000,000 for the fiscal year ending June 30, 1973, and $88,000,000 for the fiscal year ending June 30, 1974, for grants under this section.

(2) No funds appropriated under any provision of this chapter (other than this subsection) may be used to make grants under this section. (As amended Nov. 18, 1971, Pub. L. 92-158, § 4(a), 85 Stat. 470.)

AMENDMENTS

1971-Subsec. (a). Pub. L. 92-158 substituted provisions relating to the computation of capitation grants for institional support, for provisions relating to the distribution and computations of institutional grants.

Subsec. (b). Pub. L. 92-158 substituted provisions relating to apportionment of appropriations for capitation grants for institutional support, for provisions relating to an enrollment increase requirement and the waiver of such requirement with regard to institutional grants.

Subsec. (c). Pub. L. 92-158 substituted the definition of an enrollment bonus student, for provisions relating to the determination of the number of students enrolled and defining full-time students.

Subsecs. (d)-(1). Pub. L. 92-158 added subsecs. (d)-(1). EFFECTIVE DATE OF 1971 AMENDMENT

Section 4 (a) of Pub. L. 92-158 provided in part that the amendment to this section by section 4 (a) of Pub. L. 92158 shall be effective with respect to appropriations for the fiscal years beginning after June 30, 1971.

SECTION REFERRED TO IN OTHER SECTIONS This section is referred to in section 296a of this title. § 296f. Applications for grants. (a) Filing date.

The Secretary may from time to time set dates (not earlier than in the fiscal year preceding the year for which a grant is sought) by which applications under section 296d, 296e, or 2961 of this title for any fiscal year must be filed.

(c) Eligibility; contents.

A grant under section 296d, 296e, or 2961 of this title may be made only if the application therefor

(1) is from a public or nonprofit private school of nursing, or, in the case of grants under section 296d or 2961 of this title, a public or nonprofit private agency, organization, or institution;

(2) contains such additional information as the Secretary may require to make the determinations required of him under those sections and such assurances as he may find necessary to carry out the purposes of those sections; and

(3) provides for such fiscal control and accounting procedures and reports, and access to the records of the applicant, as the Secretary may require to assure proper disbursement of and accounting for Federal funds paid to the applicant under those sections.

(As amended Nov. 18, 1971, Pub. L. 92-158, § 4(c), 85 Stat. 475.)

AMENDMENTS 1971-Subsec. (a). Pub. L. 92–158, § 4(c) (1), substituted "section 296d, 296e, or 2961 of this title" for "section 296d or 296e of this title".

Subsec. (c). Pub. L. 92–158, § 4(c) (1), substituted "section 296d, 296e, or 2961 of this title" for "section 296d or 296e of this title".

Subsec. (c)(1). Pub. L. 92-158, § 4 (c) (2), added “or 2961" following "section 296d".

Subsec. (c) (2). Pub. L. 92–158, § 4(c) (3), (4), deleted former par. (2) which permitted a grant under section 296d or 296e of this title only if the application contained assurances that the applicant would expend an amount of funds from non-Federal sources to carry out its functions as a school of nursing, during the fiscal year for which the grant was sought, which were at least as great as the average amount of funds expended by such applicant for such purpose in the three fiscal years immediately preceding the fiscal year for which such grant was sought, and redesignated former par. (3) as par. (2) and as so redesignated, substituted "those sections" for "this part" in two places.

Subsec. (c) (3). Pub. L. 92–158, § 4(c) (3), (4), redesignated former par. (4) as par. (3) and as so redesignated, substituted "those sections" for "this part". Former par. (3) redesignated par. (2).

Subsec. (c) (4). Pub. L. 92–158, § 4(c) (4), redesignated former par. (4) as par. (3).

SECTION REFERRED TO IN OTHER SECTIONS

This section is referred to in section 296d of this title.

§ 296g. Authorization of appropriations for special project grants and contracts and financial distress grants.

For payments under grants and contracts under subsection (a) of section 296d of this title there are authorized to be appropriated $20,000,000 for the fiscal year ending June 30, 1972; $28,000,000 for the fiscal year ending June 30, 1973; and $35,000,000 for the fiscal year ending June 30, 1974. There are authorized to be appropriated $15,000,000 for the fiscal year ending June 30, 1972, $10,000,000 for the fiscal year ending June 30, 1973, and $5,000,000 for the fiscal year ending June 30, 1974, to make grants under subsection (b) of section 296d of this title, and, to the extent that sums appropriated under this sentence are not used for such grants, for grants under subsection (a) of section 296d of this title. (As amended Nov. 18, 1971, Pub. L. 92-158, § 3(a), 85 Stat. 469.)

AMENDMENTS

1971-Pub. L. 92-158 substituted authorization of appropriations for special project grants and contracts and financial distress grants, for authorization of appropriations for improvement and institutional grants.

§ 296h. Loan guarantees and interest subsidies for construction of training facilities by nonprofit nursing schools.

(a) Eligible applicants; amount of loan guarantee.

In order to assist nonprofit private schools of nursing to carry out construction projects for training facilities, the Secretary may, during the period beginning July 1, 1971, and ending with the close of June 30, 1974, guarantee (in accordance with this section and subject to subsection (f) of this section) to non-Federal lenders making loans to such schools for such construction projects payment when due of the principal of and interest on any loan for construction of such facilities if the loan was made to a school which is eligible (as determined under regulations of the Secretary) for a grant under this part to assist a construction project for such facili

ties. The Secretary may make commitments, on behalf of the United States, to make such loan guarantees prior to the making of such loans. No such loan guarantee (1) may, except under such special circumstances and under such conditions as are prescribed by regulations, apply to any amount which, when added to any grant for construction under this part or any other law of the United States, exceeds 90 per centum of the cost of construction of the project, or (2) may apply to more than 90 per centum of the loss of principal of and interest on the loan. (b) Restrictions on interest subsidy payments.

In the case of any nonprofit private school of nursing which is eligible (as determined under regulations of the Secretary) for a grant under this part to assist a construction project for training facilities, and to whom a loan has been made by a non-Federal lender to assist it in carrying out such project, the Secretary, during the period beginning July 1, 1971, and ending with the close of June 30, 1974, may, subject to subsection (f) of this section, pay to the holder of such loan (and for and on behalf of the school which received such loan) amounts sufficient to reduce by not to exceed 3 per centum per annum the net effective interest rate otherwise payable on such loan.

(c) Submission and approval of applications for loan guarantees or interest subsidy payments.

A loan guarantee or interest subsidy payment may be made under this section only upon an application (submitted in such manner and containing such information as the Secretary may by regulations require) approved by the Secretary. The Secretary may not approve an application for a loan guarantee or interest subsidy payment unless he determines that the terms, conditions, security (if any), and schedule and amount of repayments with respect to the loan are sufficient to protect the financial interests of the United States and are otherwise reasonable, including a determination that the rate of interest does not exceed such per centum per annum on the principal obligation outstanding as the Secretary determines to be reasonable, taking into account the range of interest rates prevailing in the private market for similar loans and the risks assumed by the United States. The Secrtary may not approve an application for a loan guarantee, unless he determines that the loan would not be available on reasonable terms and conditions without the guarantee under this section.

(d) Recovery by United States; modification of terms and conditions by Secretary; incontestability of loan guarantee except for fraud or misrepresentations.

(1) The United States shall be entitled to recover from any school of nursing for whom a loan guarantee was made under this section the amount of any payment made pursuant to such guarantee, unless the Secretary for good cause waives such right of recovery; and, upon making any such payment, the United States shall be subrogated to all of the rights of the recipient of the payments with respect to which the guarantee was made.

(2) To the extent permitted by paragraph (3), any terms and conditions applicable to a loan guarantee

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